This is a GUEST ENTRY by KZ. KZ, a CRNA, is giving T&T readers her analysis of the events that apparently caused Michael Jackson's death, based on the evidence presented at the preliminary hearing. Sprocket
Conrad Murray's Death Drip: Explained
Part 1 - IV Technique: Tutorial on the Basics
Part 2- The Evidence: What we think we know
Part 3 - The Lies: Conrad Murray's words and actions
Part 4 - Putting it all together: What I think really happened
Introduction
This is the third part of a 4-part series examining Conrad Murray's (CM) administration of propofol to Michael Jackson (MJ) in MJ's private home.
My report of the evidence in this article, and my conclusions are the result of my own critical thinking and speculation. I did not sit in the courtroom listening to testimony, nor have I seen any actual evidence or photographs of evidence in this case, and I don't know a single person connected to this case. So, as a disclaimer, think of this article as a couple of us private citizens gathering at Sprocket's home for some great conversation, coffee, and dessert. (And I hear Sprocket is a generous and gracious host!)
Part 3 will discuss the myriad lies CM has told and promulgated as they pertain to his administration of propofol to MJ. To clarify, my personal opinion is that CM is an accomplished liar-- beginning with a string of mistresses and out-of-wedlock children that he had difficulty "remembering" to support financially. To be sure, $150,000 a month is a potent incentive, IMO, to do a lot of things that one might not do for other, less wealthy or less prominent people. Trouble is, once I started looking, I found so many lies that I really don't have time to discuss ALL of them. So I had to make a command decision to just focus on a few (ok, 10) of the really BIG whoppers that lead directly to the Propofol Death Drip that CM absolutely denies he ever had hanging the morning of June 25, 2009. So, that leads us to lie #1.
Part 3 - The Lies: Conrad Murray's words and actions
Lie #1:
Conrad Murray was providing LEGITIMATE medical care for MJ's intractable insomnia by dosing him with injectable propofol and injectable benzodiazepines EVERY NIGHT for at least 8 weeks. (The lie is that it was legitimate medical care. I absolutely believe MJ had insomnia.)
Testimony of Orlando Martinez, Law Enforcement Officer who conducted an official recorded interview with CM and his attorneys.
"In describing these evenings, last couple days, did he tell you he’d been giving MJ propofol every single night for over 2 months?
Yes."
This is a cut and paste of my comment January 21, 2011 9:22 AM, from the thread discussion from Part 1- IV Technique: Tutorial on the Basics.
I'd like to address the issue of "standard of care." This really amused me when I read that line of questioning from the prelim, because to even begin a conversation about what IS or IS NOT standard of care, one has to agree that what Murray was providing met a definition of some kind of LEGITIMATE medical care.
To begin at the very beginning, propofol has absolutely no indication, on-label or OFF label, or in published or anecdotal literature, for use in the outpatient or home setting, for the reasons Murray said he was using it-- treatment of insomnia. So, to suggest or imply that there is some kind of standard of care for a cardiologist, anesthesiologist, CRNA, doctor, lawyer, nurse, or layperson to administer propofol to someone in a private home would be to give in to the urge to analyze Murray's actions AS IF they were legitimate medical care. NOTHING about what Murray did constituted legitimate medical care. The use of injectable propofol and injectable benzodiazepines in a HOME setting for relief of insomnia in a presumably healthy 50 year old man IS NOT MEDICAL CARE.
So NO, there is NO standard of care for what Murray was doing. That is the whole point. Just because Murray sports "M.D." after his name does NOT mean that anything he wants to do outside of a hospital is legitimate medical care. We do not treat ANY patients IN hospitals for insomnia with injectable propofol, so how can there possibly be a "standard of care" for Murray to do this in a private home? Even if Murray had carted in truckloads of monitors and equipment, and converted the "treatment bedroom" to a fully functional operating suite, he would STILL not have met any standard of care, or have been in compliance with any legitimate use of that drug! EVEN if he was an anesthesiologist!And if the defense thinks they can find a Board Certified Cardiologist expert witness who will come in and say that what Murray was doing met the standard of care for a Board Certified Cardiologist who was treating a patient at home for insomnia by using IV propofol, well, GOOD LUCK with that search, defense team! How many Cardiologists are going to stick their neck out for Conrad Murray on this one? That would be professional suicide.
And I will say this again, also: Conrad Murray would NEVER have received clinical privileges in ANY hospital to do what he was doing in that bedroom. The letters M.D. after his name are NOT sufficient to receive clinical privileges to administer sedation and/ or anesthesia in a hospital-- he would have had to document a bunch of training and education to receive those privileges, and document a legitimate need to have the privileges, as a cardiologist. Even then, the insurance carriers, hospital medical staff committee, and hospital attorneys would have a LOT of heartburn about giving him privileges to personally perform sedation and anesthesia in a hospital.
Let me say it again: there is NO legitimate medical indication for the use of propofol and boatloads of injectable benzodiazepines in a home care setting for the treatment of insomnia in a healthy 50 year old person! Therefore, there is NO standard of care to be met. That is precisely why Murray's actions were criminal, and not "mere" civil negligence.
Lies #2 & #3:
Conrad Murray was trying to wean MJ off of propofol. (Stop laughing, I can hear you.) CM was giving propofol to MJ as a treatment for insomnia. (Lie #3)
To save some space, please refer back to Part 2- The Evidence: What We Know from the preliminary hearing testimony. 4 gallons of propofol ordered in about 8 weeks time for only one intended recipient (not patient; see Lie #1 above) is not a pattern of weaning anybody off of propofol.
Or if it IS, someone please explain this to me. Because I'm just a lowly CRNA. I can't possibly be expected to understand the complex logic and verbal gymnastics that spin this situation into legitimate medical care. Defense team-- go for it! We all have our listening ears on and are sitting quietly with our hands folded.
And I am personally outraged that he was so meticulous in his ordering of propofol and benzodiazepines, but this CARDIOLGIST did not order any CARDIAC LIFE SUPPORT medications from that pharmacy. Why? Because he simply never anticipated that he would need them. We'll talk about hubris in a minute.
Questions for Conrad Murray:
Who did you consult about your concerns about MJ's propofol use? Who advised you to continue to give him propofol? Did you consult any specialists with specialized knowledge about propofol addiction, or daily propofol abuse? Or did you make the decision to give MJ propofol on your own? What sources or references can you show us that support the use of IV propofol for the treatment of insomnia in the home setting? Who are other peers, doctors, or Cardiologists, who are using IV propofol in a home setting for the treatment of insomnia? Who have you talked to about using propofol in this manner? Have you published any anecdotal reports in peer reviewed journals about the emerging indications for IV propofol as a home care treatment for severe insomnia? Are you conducting investigational studies about using IV propofol as a home care treatment for insomnia? Please show us any notes or records you have about using IV propofol at home as a treatment for insomnia.
As to Lie #3, that propofol was somehow a legitimate treatment for insomnia, I will offer that Murray's goals for his treatment (benzodiazepines and propofol) was to induce a level of unconsciousness equivalent to a general anesthetic. Heavy use of benzodiazepines and propofol, and other poly-pharmacy, tend to upset the body's natural ability to sleep. Anesthesia is NOT the same thing as sleep.
General Anesthesia More Like Coma Than SleepLie #4:
According to a review of general anesthesia, sleep, and coma in the Dec. 30 online issue of the New England Journal of Medicine, coma and general anesthesia appear to share key similarities. The researchers found that when patients are under general anesthesia, their brain is not "asleep" but instead enters a state comparable to a reversible coma. In the review, the three doctors—each specializing in one area of the study—discuss how a fully anesthetized brain more closely resembles the deeply unconscious brain that is seen in coma patients and is less like that of a sleeping brain. They go on to conclude that being under general anesthesia is tantamount to being in a drug-induced coma, in which states of consciousness and unconsciousness operate on different time scales. The researchers hope the findings will help to create new approaches to general anesthesia and improve the diagnosis and treatment of sleep abnormalities and emergence from coma.
From "General Anesthesia More Like Coma Than Sleep"
Medical News Today (12/30/10) Paddock, Catharine
Conrad Murray was guilted, manipulated, finagled, finessed, maneuvered, persuaded, railroaded, arm twisted, tricked, fooled, or otherwise "FORCED" into giving propofol to MJ. Lots and lots of IV propofol. Over and over. Every night for AT LEAST 8 weeks straight, by his own report. And four enormous pharmacy orders, just for MJ. (And I'm havin' a really hard time mustering up sympathy for CM here.)
CM's 4-Part plan of care related to propofol should have been:
1. Say "no."
2. You are a big, strong, tall DOCTOR. Walk away, DOCTOR, walk away.
3. Just say NO!
4. Get this man, MJ, your PATIENT the care that he so DESPERATELY needed.
If CM had done any of the above four things, MJ might still be alive.
Conrad Murray has seven children. Wouldn't you think at one point, during a parenting moment, he would have had to say "NO"? So, he should be very practiced at saying "NO", right? What am I missing here.....hmmmmm.....oh yes. A little incentive in the amount of $150,000 A MONTH. That might be just a wee bit persuasive, if one is inclined to be unethical.
Lie #5:
(Paraphrased) I'm just giving him a little bit of propofol....really...... I gave him 25mg at 10:40 or 10:50. That shouldn't have killed him.
Testimony of Orlando Martinez; L.A. Robbery/ Homicide
Being questioned about the interview 6-27-09 with Mr. Pena, Ed Chernoff, CM, and Detective Smith.
(KZ note: it is a bit uncertain to me which person Martinez is describing as answering questions here, but it appears CM is present during the interview at the hotel.)
How did he say he was assisting?
He would assist Mr. Jackson with 50 milligrams of propofol. An injection to get him to sleep and with an IV drip to keep him under.
"Initial infusion followed by a drip? Objection. Sustained.
You mentioned 50 milligrams, did he say that was 50 milligrams every night?
That was the maximum.
Did he say that was the total or the amount of one dose? ???
I don’t think he specifically noted.
He told me it was a dosage, to put him under and then a specific drip."
(Testimony snipped.)
"In describing these evenings, last couple days, did he tell you he’d been giving MJ propofol every single night for over 2 months?
Yes."
(Testimony snipped.)
"10 am June 25th 2009, according to Dr. Murray, what is happening?
MJ was still awake, and was asking for “milk” which was his name for propofol.
Around 10:40 or 10:50, did he give propofol (according to Dr. Murray)?
Yes.
Did he look at his watch?
Yes. According to Dr. Murray he had to look at his watch, to calculate (miss last)
He said he halved his normal dose, gave him only 25 milligrams over 25 minutes.
It was simply an injection to put Mr. Jackson asleep, and then a slow drip to keep him asleep."
Okay, time for another math lesson.
Please refer back to Part 2: The Evidence for the initial math explaining the amount of drug found in MJ's blood at autopsy.
We know that an induction bolus dose of approximately 150mg for a 62 kg person (which is 2.5 mg/ kg) will produce blood levels of (averaged) approximately 4.0 micrograms per ml of blood volume.
Range is 1.3 to 6.8 ug/ ml......1.3 + 6.8 =8.1......8.1 divided by 2 = 4.05
So, rounding off, 4 ug/ml as the average of what we know should be produced by an induction bolus of 2.5mg/ kg of propofol.
www.anesthesia-analgesia.org
Therefore, we can construct an equation using that ratio to determine what the micrograms per ml should be using a different, smaller dose. Let's use a 25mg dose, since that is what CM claims to have given at 10:40 or so.
We can construct a proportional ratio equation using algebra and cross multiplying:
150mg..=..4.0 ug/ml
25mg..............x..........150x = 100.....100 divided by 150 = 0.67 ug/ ml
Now, let's assume CM is actually telling the truth. (No snickering-- I can hear you.) So let's take him at his word that he did not give MJ any propofol the morning of June 25, 2009, UNTIL the dose at 10:40 or 10:50. He reports he gave MJ 25mg.
MJ's results at post mortem, from the autopsy report. Summary of Toxicological Findings
Heart: 3.2 ug/ ml
Hospital: 4.1 ug/ ml (possibly from a venous draw during or right after attempted resuscitation)
Femoral: 2.6 ug/ ml
To recap, 0.67 is a whole heckuva lot less than 3.2, 4.1, 0r 2.6.
Without question, MJ received a whole lot more propofol than CM's 25mg dose, that he embellished with pushing over "2 to 5 minutes". (Yeah, right-- using a 10cc syringe??) Even with that detail embellished, that he gave the 25mg over 2 to 5 minutes, well, the person would still have been talking to him at that rate. Pushing 25mg over 2 to 5 minutes would NOT put even an average person who has not been exposed to daily propofol to sleep.
Hmmmm........I'm beginning to get VERY suspicious about the "IV bag with bottle" that CM directed Antonio Alvarez to take down and placed (hid) in the blue costco bag that was found by Elissa Fleak. How about you?
And lest we all get too wrapped up in the math about whether or not the amount of propofol in MJ's body at autopsy was too much, too little, or just right, let me emphasize AGAIN that there was NO legitimate medical reason for ANY propofol to be administered to him in his home. Even by a doctor.
Lies #6, #7, and #8:
Dr. Murray, a Cardiologist, believed successful resuscitation from asystole was possible at UCLA Medical Center. He was frantic to reach the hospital quickly so that advanced measures could be utilized to successfully resuscitate MJ. (Lie #6.)
Well, he was certainly frantic, but not because he didn't have an intra-aortic balloon pump (IAPB) available in the "treatment" bedroom of the rented mansion.
He was frantic to start cleaning up all of the evidence of the propofol, as we have heard from Antonio Alvarez. So frantic, that calling 911 must have slipped his mind for 20 minutes or so. So frantic that he forgot that 20 minutes of pulseless arrest means the victim has virtually no chance of being successfully resuscitated, and if his heart is miraculously restarted, his brain is very likely mush. So frantic that he, a Cardiologist, panicked and forgot how to do proper CPR. So frantic he forgot that there was an ambu bag present in the room.
Cardiologists are extensively educated in all manner of the anatomy and physiology, health and disease processes, of the human heart. It's their primary business.
When paramedics hooked up the cardiac monitor to MJ in the bedroom of the mansion, and he saw aysytole with occasional agonal spasms of PEA (pulseless electrical activity), he knew his patient was dead. Unless Conrad Murray was asleep in every single class he ever took related to Advanced Cardiac Life Support, and also slept through his entire internship, fellowship, and board certification process, HE of all people at the scene KNEW the likelihood of resuscitation for MJ was essentially zero. He knew, when he saw asystole, and a few errants bits of electrical activity, that the game was over. And he KNEW at that moment that he had been out of the room yakking on his cell phone for FAR too long.
Make no mistake-- Conrad Murray KNOWS that asystole with bits of agonal PEA in a 50 year old man with a healthy heart is a very LATE stage of cardiac arrest. There was NO doubt in Murray's mind about what he was seeing. There was NO doubt that the asystole was from any other cause than a long respiratory arrest that deteriorated into a long cardiac arrest. Murray KNEW the window for successful resuscitation was past. But he didn't want to be the one to both CAUSE the cardiac arrest AND call the code and pronounce the victim dead.
Asystole at Wikipedia
So he LIED (Lie #7) again to the paramedics and didn't tell them all the meds MJ had received, most especially, propofol. So they loaded up the ambulance and headed to UCLA Medical Center.
Where CM LIED (Lie #8) again, to multiple members of the ER resuscitation staff, who asked him for a history of the arrest, and what meds the victim had received. Again, that propofol seems to have slipped his mind. Ask yourself, WHY would a DOCTOR who is certain he provided appropriate care, LIE about the meds he gave the victim?
Lies #9 & #10:
Dr. Conrad Murray could not possibly have foreseen that any of his actions surrounding the administration of propofol to MJ could have caused the death of MJ. (Lie #9)
(To be accurate, Lie #9 has been told and promulgated by CM's defense attorney on CM's behalf, but I'm including it here anyway.)
If that is true, then Conrad Murray is the dumbest doctor on planet earth, IMO. A layperson or elementary school student could have foreseen that death was a possibility in that bedroom, using an IV surgical anesthetic to help a man in his home, battle "insomnia". How is it remotely possible that CM did not anticipate death could be a possible outcome?
Hubris. And $150,000 a month.
Hubris whispered to CM that he was a big, strong, smart, important, infallible DOCTOR. Hubris told CM he could do whatever he wanted to do in the name of medical care in that private home. And the laws allowed CM to do just that. Until we change the laws about what doctors are allowed to do in private homes and offices, these situations will continue to happen, and people who trust these "doctors" will be hurt, or die as a result of their incompetence. We have extensive safeguards in place that regulate the practice and credentialing of doctors in hospitals and clinics; we minimally regulate procedures provided by doctors in private homes, or in their offices.
For the safety of the public, I strongly support more regulation of doctors in the activities they perform in private homes and offices. Doctors should not be able to do procedures and give drugs in their offices or private homes that they would not be able to receive hospital privileges to perform. Whether we like it or not, there was nothing illegal about CM ordering 4 gallons of propofol from a compounding pharmacy. The pharmacy did not have to notify ANY agency that this activity was occurring. No agency had oversight responsibility to make sure there was a legitimate need for that much propofol in the "clinic" of a Cardiologist. Apparently, there is nothing illegal about shipping that propofol through the mail or using a cargo carrier like FedEx to ship that dangerous drug to a private apartment. And yes, he lied (Lie #10) to the pharmacist Tim Lopez about THAT, too, and said the address was a "clinic" in L.A. Why did he lie if it was legal? Hmm. "Wherever I am at the moment, or wherever I'm going, is a clinic." Hubris.
We should all be enraged that what he did was LEGAL. Right up until he killed the person he was giving it to. The district attorney has called that involuntary manslaughter. A lot of us think it should have been charged as second degree murder. I really wish someone could explain to me why it is that a person who is driving under the influence and kills another person, is charged and punished more harshly than a DOCTOR who invents a new "off-label experimental" use for a dangerous anesthetic in a private home, and KILLS his victim?? Yeah...maybe that will be the defense strategy-- Conrad Murray was investigating a new off label use for propofol. I'm looking forward to reading that in a peer reviewed Cardiology journal. CM should have a couple of years to write it up while he rests in prison, hopefully.
The biggest gift Conrad Murray has ever received in his life was the charge of Involuntary Manslaughter, in my opinion. That gift says he was simply too stupid and oblivious to realize that the totality of what he was doing could have caused another person's death. So in that respect, I guess the charges are correct.
As a post script, I would like to take a moment and say that despite my ire, it is not doctors I am upset with. It is this particular doctor's conduct that invokes my indignation. Incompetence and recklessness from any health care provider invokes my outrage and indignation, on behalf of the vulnerable patients who are harmed. Competence or incompetence has little to do with the letters after the name of a health care professional. A doctor is not automatically competent simply because he has M.D. after his name.
There are competent and incompetent practitioners in every profession. My profession, Nurse Anesthesia, is forever proving that our outcomes are excellent, and that we provide competent care, and yet there are still "attacks" on my profession from those who opine that we could not possibly be knowledgeable and competent, because our basic education did not occur in a medical school. Fortunately, the tide is turning, and laws are slowly changing to recognize that the overlap between some professions is simply a turf war over money that has nothing to do with safety, outcomes, or competence.
And yes, this Nurse Anesthetist dares to say that Conrad Murray, M.D. IS an incompetent, arrogant fool, who recklessly killed his victim. (Victim, not patient.) The victim just happened to be a famous musician named Michael Jackson, or none of us would ever have heard of Conrad Murray. Hubris.
Thanks for reading! Part 4: Putting it all Together: What I think Really Happened, will be out soon!
~KZ
Posts
117 comments:
KZ, thank you once again for making such a valuable and informative contribution to this blog. Your wealth of knowledge and ability to convey it in easily understood terms is a boon to those us struggling to understand what happened on 6/25.
Thank you.
@ KZ I think you deserve at least a "bravo" or a "hear, hear." At most I think you should be called to testify at CM's trial!
One of the things you wrote above that stood out to me as being highly relevant was that "CM is an accomplished liar." His personal life does attest to that. In fact, I've wondered now and again whether he is a Walter Mitty type and thought it might be worthwhile that someone, anyone, from his alumni at Meharry came forward to attest to his actual presence there - so great was the departure from patient care.
Very much looking forward to Pt 4. Please don't keep us in suspense for too long.
There is something I've come across which I would like to send to you and get your opinion on. Is it possible that could be arranged through Sprocket?
Anna, and Anonymous at 5:48-- thank you so much for your kind words! Anonymous, I have no desire to testify! We are just private citizens discussing this over coffee, and I have no urge or intention to go any further with this! My drive was simply to figure out exactly what was happening in that bedroom as it related to propofol and the many other drugs.
I'd be happy to look at whatever you want-- send to Sprocket and she will forward to me. Of note, I'm out of town beginning this evening, until Feb 6, so will be limited a bit. And part 4 is nearly done. Not sure if I will be able to coordinate having it posted before I return, but will try!
Bravo! This piece is great. I know Sprocket doesn't approve of using material from the blog, but this entry should be quickly snapped up by the prosecution and used in court!
This makes a lot of sense to a layperson. I am sure it would assist a jury.
Meg,
I deleted your comment out of concern that you posted your full name at the end. I did not know if you meant to do that or not.
I did forward your comment onto KZ, and hopefully she will share her thoughts.
For my thoughts on whether or not Murray was hired to "take out" Jackson, I do not think Dr. Murray is smart enough to be hired out as a hit man for anybody.
He was clearly having financial problems. That's documented, public record. There are news reports that he tried to get his insurance carrier to pay for his defense (meaning, he doesn't have to cash to do so). He did not pay back child support for one child, but brokered a deal so he would not lose his license in another state.
$150,000 is quite a bit of incentive to a Dr. who has to support several children out of wedlock, not to mention the legal ones.
If he was hired, (and I don't think there is a shred of evidence to support he was) why did it take so long?
Sprocket - sorry for using my full name.
Thank you for sharing your thoughts and for sending my comment on to KZ
Sprocket wrote: " $150,000 is quite a bit of incentive to a Dr. who has to support several children out of wedlock, not to mention the legal ones."
I must have written my point in a confusing manner.
I was trying to say that it seems odd that Murray would not have done everything in his power to ensure his job with Jackson had longevity. I agree that $150,000 is quit a carrot and I am totally aware of the data surrounding his financial problems. What seems odd is that he did not take the steps to be sure the job continued (i.e., be sure the patient lived). Very hard to believe that a cardiologist was unaware that the roulette of not having correct equipment to monitor and resuscitate endangered his continued employment. He had to know he was risking killing his cash cow. Why didn't he fill that upstairs with the equipment and support staff to keep MJ alive - and his 150,000 coming in....?
Ironically, I have read that Murray never received one payment of the $150,000 he was supposed to receive each month. If I'm not mistaken, AEG never signed the contract.
I think KZ is right that there was no intent to kill MJ. Murray was incompetent and arrogant and desperate for the money. A volatile combination where any patient's life is concerned.
Meg:
Quote:
Why didn't he fill that upstairs with the equipment and support staff to keep MJ alive - and his 150,000 coming in....?
Hubris. And the fact that it worked (from what we know so far) for two months.
We don't know at this point if he DID request other equipment but if so, AEG was slow to deliver, or it just took a long time.
Doesn't make AEG a party to Jackson's death in any way shape or form.
Even if he did request all that equipment and there was a delay in obtaining it, what he did is not accepted standard of care in a hospital or clinic, and that is treat insomnia with propofol.
I have another thought on this. Let's even take the $$$ out of it.
For some people, just being in the presence of someone famous (and Jackson was not just US famous, he was WORLD famous) and attached to them in some fashion or needed by that famous person, makes them do things that they would not do in a normal situation.
It's very possible that being around Jackson inflated Murray's ego and made him feel more important than he really was.
You have to ask yourself, why did he take this job? Were his clinics not bringing in enough cash? I suspect most definitely.
Thank you again KZ and Sprocket for this informatative work. It is much appreciated.
Anne
I think whatever propelled Murray to live beyond his means, stiff creditors, and chase the ladies (to put it mildly) completely overwhelmed whatever common sense and good intention he had left when he hooked up with Jackson. Whatever good there was in his character was swallowed whole by his full-time affiliation with MJ. Egos and compulsions are dangerous things.
Sprocket,
I think, in fact, that Murray may have made requests for equipment to AEG but they weren't forthcoming. My recollection is that Murray was MJ's choice, which AEG wasn't too keen on, not understanding why Jackson couldn't get a doctor once he was in London. Of course, this is how AEG is telling the tale, so who knows. All that matters is that the care was substandard.
KZ, I am so glad we reached out to you for this thoughtful commentary! Sorry I have dropped off the face of the earth… such is life when one is self-employed—feast or famine when work is available!
A couple of rhetorical questions—probably no answers available as of yet, but certainly questions I’d like to see come out at “Dr.” Conrad Murray’s trial.
1. What are the exact drugs, or classes of drugs, tested for as part of Los Angeles County Toxicology Screen C? Recall that immediately after Jackson’s death, former family attorney Brian Oxman was quoted as saying MJ’s use of drugs was “extensive,” and that his family “enabled him.” Shortly after Jackson’s death, an unnamed family friend stated MJ received “daily” injections of Demerol. Is the presence of narcotics part of tox screen C, or did the coroner go looking for what were known to be present, namely benzos and the propofol?
(I am not suggesting that any other drug caused Jackson’s death. It’s pretty clear what killed him, I’m just curious about rumors of long-term prescription drug abuse and how it appears that this was not the case based on the results of tox screen C—in other words, Jackson was using only what Murray prescribed/gave to him. I am very curious what drug screens were used for the hair sample, collected ~6 weeks after MJ’s death.)
2. In anticipation of the “MJ drank the propofol” defense tactic, what is the possible rate of absorption/action had the propofol been taken orally? I know that some medications that are available for injection and for oral use are not dosed the same, for example, meperidine (Demerol) is prescribed in a higher does when used orally because it is poorly absorbed by the gut (it is twice as effective given by injection). Of course the propofol obtained and used by Murray was specifically for injection/infusion only… the only preparation available at the time. In other words, how much needed to be taken orally and how quickly would it have worked?
I honestly believe Jackson’s legacy, along with that of Anna Nicole Smith, will be more scrutiny upon prescribing physicians regarding the specific drugs they prescribe and that doctor’s area of specialty and the patient’s diagnosis. It’s mind-boggling that a death due to irresponsible, inappropriate drug use and administration by order of and in the presence of a licensed physician is punishable by only four years in prison, even if that patient wanted, asked and paid for it. I cannot imagine my orthopedic surgeon prescribing meds for high cholesterol, asthma and hypertension; even though his license allows him to do so, his ethics tell him to refer that kind of care to an internist. Neither my orthopedic spine surgeon nor my internal medicine doctor perform my annual facet rhizotomies—an anesthesiologist who specializes in pain control and nerve blocks does. Why didn’t Murray refer MJ to a sleep specialist, or pain specialist if it was actually pain keeping him from sleeping? (Guessing the answer here is MJ wouldn’t consent to this; he had his mind made up he wanted his “milk” and went doctor-shopping for a broke-ass baby-daddy behind in child support looking to make an easy buck who would give him exactly what he wanted.)
As far as AEG being responsible for Murray’s hiring, wasn’t that Jackson’s decision to hire that particular physician based on care Murray had given to Jackson and his children (WTF? A cardiologist giving care to pediatric patients???) when living in Las Vegas? AEG was just giving Jackson what he demanded. If AEG was guilty of anything it was failure to ask “Why a cardiologist, Mr. Jackson? And why this one?”
I don't understand this. The family has often said the following
"...the autopsy shows he had brain swelling, he had pneumonia, bronchitis; he was anemic. Everyone around him should have known." Brian Oxman, family lawyer.
Do they have access to another autopsy report perhaps? The one I've read doesn't say any of this but I've heard this repeated 'officially' by the family often.
What gives?
There may be detail pages of the autopsy report that are not made public (even though they are part of the public record). I don't know.
I was not in the courtroom, just the media overflow room, so I did not see if Dr. Rogers brought the original autopsy file to court for his testimony and if he did, how thick was the file.
Back up. The information is there in the report about the brain swelling and the lungs.
PAGE 6 of the autopsy report AT
THE SMOKING GUN. Link to the autopsy report is on T&T's QUICK LINKS.
QUOTE AUTOPSY REPORT:
PAGE 6 of the autopsy report
#6
A) Neuropathology
1. Mild cerebral vascular congestion. [cerebral = brain]
2. Mild diffuse brain swelling without herniation syndrome
3. Mild basal ganglia calcification
B) Pulmonary pathology [pulmonary = lungs]
(there's more under B but I did not take the time to type it all out.)
Understand that all of this detail, could be the normal course of the respiratory arrest and then the cardiac arrest.
Hopefully, CaliGirl9 or KZ will elaborate on that.
Ah, I see. Thanks, Sprocket. I don't know how to 'read' these types of reports in detail. The way the family described it, it all sounds much more extreme than the 'mild' nomer - but in autopsy terms, what does 'mild' mean? As you said, it could be part of the course of MJ's last hours/minutes.
Remember, the autopsy report is a snapshot of what the coroner sees at death.
My interpretation of this is, if the coroner saw these conditions as "mild," (I'm sure the coroner was experienced enough to determine if what he saw was serious or not) then they were not significant findings that would relate to his death.
In my humble, layperson's opinion, if they were significantly related to Jackson's death, then that would have been noted in the actual cause of death.
KZ thank you for your explanation
and a little question to you and Sprocket
you said "I really wish someone could explain to me why it is that a person who is driving under the influence and kills another person, is charged and punished more harshly than a DOCTOR who invents a new "off-label experimental" use for a dangerous anesthetic in a private home, and KILLS his victim?? "
but I think "drunk driving & killing another person" is also involuntary manslaughter.
@Anon Brian Oxman is a not very good lawyer that likes to exaggerate stuff and spreads his BS around.
for example the "pneumonia and bronchitis" he mentions is "Respiratory bronchiolitis" - a condition seen in smokers. For a nonsmoker such as MJ it's associated with Lupus. If you read MJ's own autobiography written in the 1980s you'll see him mention a lung condition. There's an (not so positive) interview with Quincy Jones in which he says Michael told him he had "blister on his lungs". Michael's lung condition is known since 1980s. So in short it's more likely a longtime existing non life threatening condition (chronic inflamed lungs due to Lupus) and not a recent sickness (pneumonia, bronchitis)as wrongly repeated by Oxman.
Killing someone under the influence while driving. It can be gross vehicular manslaughter. In California Remember, we are dealing with California law here, and not the current law of some other state or country.
If you look at the California Penal Code section 191.5, (link can be found on the QUICK LINKS PAGE) gross vehicular manslaughter can have prison charges higher than 4 years. It just depends on what (if any) other vehicle codes were broken and/or if the death occurred in conjunction with the "commission of an unlawful act."
Here is another thing to consider, and how I understand "implied malice" to reach 2nd degree murder. It was brought up by Truc Do in closing arguments of the Phil Spector 2 (retrial).
Here is how I remember it. Say you are convicted of drunk driving. Just drunk driving, nothing else. You get sentenced or get probation or a treatment facility, whatever; doesn't matter what the sentence is really. But in the eyes of the court, you were convicted of this crime.
But lets say, you drink and drive again. But this time, you kill someone. You can be charged with (and in LA Co., you will) 2nd degree murder.
That's because when you got behind the wheel a second time drunk, that now becomes "implied malice."
See?
@sprocket
You (and KZ) are right I just checked laws in my state - it's called "DUI involuntary manslaughter" but have a sentence of up to 11 years.
So I guess the same name of "involuntary manslaughter" confused me to think the same sentence time but actually the maximum sentence was higher.
This is comparing apples to oranges. One big difference between the two situations is that whereas one perpetrator is "impaired" when the actual crime occurs, repeat or not, the other is very consciously aware of everything he is doing -- having absolute responsibility for and control over another life -- before, during and after the crime is committed, which many believe to be death by lethal injection, given the "unusual" circumstances.
This also raises the issue of the current law in CA that needs to be challenged and changed via case law.
But how committed is the DA office to really serving justice in this case?
How deep is the DA office willing to dig to find critical info and evidence to prove at least 2nd degree murder?
If it turns out to be anything less, this case will be the travesty of the century. The public needs to pressure the DA office to refile the charges to 2nd degree murder during the trial as the law allows.
We we "know" the situations are different. It was a comparison on the AMOUNT OF TIME you could be sentenced with. The reality that in Caifornia, more time for killing someone with your vehicle while impaired than what Dr. Murray will get.
I will address this one last time.
The DA's office is NOT influenced by what Michael Jackson fans "wants" or "emotional needs" are.
I don't believe that a criminal case of involuntary manslaughter ~ and trying to create "case law" by charging 2nd degree ~ will change how DOCTOR'S are regulated inside a patient's home in the single state of California, much less Los Angeles County. I'm betting there are more cases like this than people realize. The only difference is, the patient was world famous. That's it.
Leaving a comment asking if the DA's office is not committed to justice in this case tells me people have not read or understood California law, and know little to nothing about the dedication of the LA County District Attorney's office.
Leaving a comment asking the general public, "demand" the DA's office increase the charges, TO ME, is an INSULT to the many, many hours of hard work the LA Co. DA's office put into investigating and analyzing this case, and determining what charge they could or could not successfully convict Dr. Murray of.
I firmly believe they spent a long time trying to find a way to charge him with more, but came to the conclusion they could not.
I do believe, like Tom Mesereau said on the 1/26/11 TODAY SHOW interview with Matt Lauer, that there were many, lengthy discussions about what to charge Dr. Murray with. I do NOT believe the DA's office is taking this case lightly. I firmly believe under the current laws, they are charging him with the only charge they can.
That's my opinion.
If, as a Jackson fan, you want to write the DA's office, knock yourself out. But I will no longer be publishing any comments that "demand" the DA's office increase the charges against Dr. Murray, or comments that imply the DA's office is not dedicated to justice.
I think KZ and I have gone to great lengths to explain to our readers what the laws are in California as well as explain that everything Dr. Murray did up until the moment Jackson died was technically LEGAL under the current laws.
Sprocket, no need to take any poster's comments personal. You're doing an admirable work here that is much appreciated by all, even those who are NOT MJ fans but are concerned about due process and seeing justice properly pursued in this case.
The issue raised regarding the DA office seems to be speaking to the highly suspected corruption involving AEG's strong political influence in LA. Suffice it to say here, much has been circulating on the Internet about that.
Hello,
Thank you everyone for your comments and thoughts. CaliGirl9, thank you! I't been a great opportunity to guest write here, and the main reason I agreed is that I respect the in-depth commitment to discussion made by Sprocket, you, Ritanita, and donchais. I also really appreciate the respectful tone of this site, and that we can have opposing viewpoints on some things without the conversation deteriorating to adolescent sniping (or worse!)
I have received several messages forwarded by Sprocket. As she mentioned, I'm out of state until Feb 6, so am limited to comments on a mobile device. So I will answer briefly this morning, and hope to add some relevant links later.
As to the autopsy report near comments, hypoxia (critically low oxygen levels) produces brain swelling, among other physiological derrangements. Herniation of the brain is bulging of brain tissue into the base of the skull. It is, of course, an ominous sign. Herniation can be caused from severe swelling, as well as some things like space occupying lesions (tumors), and collections of blood from trauma or ruptured vessels. The skull is a mostly closed container, so herniation is when brain tissue is forced out of the only outlet available at the base of the brain where the brainstem and spinal cord exit. This impairs the brainstem, where things like control of respiration reside. Please understand that this is greatly simplified explanation. I am not a coroner or ME, but it seems very likely that the hypoxic (low O2) event led to anoxia (no oxygen) over a relatively long time (greater than 20 minutes before 911 was called is relatively long in terms of low to no O2.) Plus the attempted resuscitative process at the scene and hospital. So some brain swelling is, in my opinion, very expected in the autopsy report. It simply adds more evidence, imo, for a repiratory arrest coming first, as opposed to something causing sudden asystole, like a heart block condition, or a gunshot wound with exsanguination, etc.
The mild basal ganglia calcification is possibly just a result of MJ being 50 years old-- a bit of hardening of the arteries setting in. Though he appeared so vigorous and youthful on stage, he was, in fact, 50 years old.
I haven't read the 58 autopsy page report yet. As to the bronchitis/ bronchiolitis, that may be why he was on 2 oral antibiotics. Dunno. You all have followed this much more closely than I have.
A question for you, Sprocket. Why was this objection 'sustained'? It sounds to my unschooled ears as if the prosecution was simply repeating/affirming what the investigator Martinez had already said?
How did he say he was assisting?
He would assist Mr. Jackson with 50 milligrams of propofol. An injection to get him to sleep and with an IV drip to keep him under.
"Initial infusion followed by a drip? Objection. Sustained.
Thanks!
Good Morning, Sprocket~
You stated:
I don't believe that a criminal case of involuntary manslaughter ~ and trying to create "case law" by charging 2nd degree ~ will change how DOCTOR'S are regulated inside a patient's home in the single state of California, much less Los Angeles County. I'm betting there are more cases like this than people realize. The only difference is, the patient was world famous. That's it.
I, for one, do wish the DA would have decided to use this case to make case law. IMO, for them to have done so, and fought to win it (and, succeeded, of course) would have gone far towards making change happen concerning the regulation of physician's patient in-home care.
Specifically, because of the high profile stature of this case, would have propelled it that much farther, and further towards that change becoming a reality in legislation. I can't imagine why it would not. I was leaning more towards the possibility of maybe it would be to cost prohibitive in light of the financial crisis of CA's government, to pursue establishing case law with this trial?? It just SO seems the MOST opportune case to "run with it"...
It is in only this aspect, of the DA's not seeking to attempt to make this into case law, I find it so disconcerting. We are ALL patients... this case is about the death of Micheal Jackson, yes... and, yes, it is tried IN CA, and MUST be tried following CA's definitons of it's laws - but, we are ALL patients, and this case could have had such HUGE necessary beneficial impact, throughout ALL of the states. The huge potential.
It begins somewhere, and I just so feel that if they had, and fought to win it, for the sake of ALL patients - iow, this reaches FAR further than 'hang Murray', for even if Murray were to only receive a slap on the wrist, to have won CASE law, it would have been a far larger win for not only Michael, but BECAUSE of Micheal... a win for ALL. At the very least in the state of CA, if not nationally.
I thank all who's efforts, and contributions together make T&T, what it is = unbiased reporting of facts to the best of their ability within their constraints, with integrity. Thank you. :o)
Rose
I am so glad I found this blog, and I apologize for asking questions you might have previously covered, but I have wondered: why would the Vegas pharmacy ship four gallons of propofol to a residence in Los Angeles? I've heard it opined that Murray lied to them and said he had an active clinic in LA, but that still does not explain why the pharmacy would ship to a residential address, does it? And who paid for all this propofol and whatever else he shipped from the Vegas pharmacy? I hope the DA has subpoenaed all these records.
And, per the prelim, I believe Alvarez said he saw a vial with a milky substance INSIDE the hanging IV bag; very suspicious if that is the truth. Would Murray have inserted the open propofol vial inside the IV bag, let it go and left the room?
Final analysis, no matter what happened, Murray is guilty, as the physician in charge, he abandoned his patient, Michael.
Morning everyone! A little over a week until the next hearing in the Dr. Murray case.
tiya:
I believe it has to do with the accuracy of the statement the detective testified Dr. Murray said in the taped interview.
The exact statements Dr. Murray said (by playing the 2 hour audio tape) were not introduced into evidence by the prosecution. I don't believe so. They were not PLAYED in court, nor were excerpts played.
The only thing I do remember about the recording is that both sides conceded that the transcript of the recording had an error. It was regarding the supposed bolus propfol injection over "25 minutes." It should read: over "2 to 5 minutes." Big difference.
So, I'm betting that Murray's attorney's know word for word exactly what was on the audio recording regarding the sustained question.
I'm sorry that I did not write down the "reason" the objection was sustained. Remember, my typing skills suck and I'm trying to do what a court reporter does with years of training and skill.
FWIW, the initial SEARCH WARRANTS (available at the QUICK LINKS on T&T) have a short transcript of the taped interview with Dr. Murray.
Anon @ 7:03am
Oh to have been a fly on the wall of the DA's office, to know "exactly" what the arguments back and forth were for 2nd Degree & involuntary manslaughter.
Is the purpose of the Los Angeles County DA's office, to set case law? (I'm sure that's a question that could create hours of discussion.) Or is the purpose of the DA's office to prosecute arrested individuals under the current penal code of the state?
Anon @11:19am:
How (and why) was the Las Vegas Pharmacy required to verify the address the drugs were shipped to was in fact a real clinic? From my understanding, the Pharmacy is not required by law to verify that.
From my understanding, the pharmacist was only required to verify that the individual ordering the drugs was currently licensed to order them. He testified that he did that; he did his due diligence.
And last but not least,
Anon @5:54am:
You said:
The issue raised regarding the DA office seems to be speaking to the highly suspected corruption involving AEG's strong political influence in LA. Suffice it to say here, much has been circulating on the Internet about that.
There may be speculation on the Internet about AEG's political influence...but unless someone can show me clear evidence that Steve Cooley's office is corrupt...the speculation is just that, speculation and is not relevant to the discussion.
But since the speculation is out there, I will say this:
The specific unit in the District Attorney's office that is handling the Dr. Murray Case is the "Major Crimes" unit.
From my understanding, this is the most senior, most experienced unit in the DA's office.
I've personally met Pat Dixon, Department Head of Major Crimes. I've had several conversations with his Deputy of the department, Alan Jackson (during the Spector case) who is currently running for Los Angeles County District Attorney in 2012.
From my personal experience, I have to say that I believe Alan Jackson is a very honest, dedicated prosecutor. A very dedicated and honest, public servant. I do know from talking to him that all he has ever wanted as an attorney is to be a prosecutor. During the Spector 2 trial, I asked him if he would ever consider entering private practice, you know, become a defense attorney. His reply was quick and forceful. "Never!"
Who knows what may happen if he loses the election...., he may enter private practice....or more possibly public office...but at this point in time, I don't believe Pat Dixon or Alan Jackson are corrupted/influenced by AEG.
The following is from a recent interview from Murray's lawyers. It includes some stuff we discussed before as well as "drinking propofol"
Chernoff says he wants Murray's trial to start quickly before additional authorities have a chance to strip the doctor of his Texas and Nevada medical licenses.
A loss of his Texas license would diminish Murray's income and his ability to pay for his defense, not to mention affect the well-being of the doctor's patients and Murray's sense of purpose.
Flanagan says another reason for a speedy trial has to do with the testimony presented by the 24 witnesses prosecutors called at the preliminary hearing — testimony he says "went in opposite directions," which will help the defense raise reasonable doubt at trial. A speedy trial gives the prosecution less time to fix the problems with their case, Flanagan says.
During the hearing, Flanagan says the prosecution changed its theories about what took place in Jackson's home — specifically regarding the Propofol. According to a transcript of the hearing, in his opening statement Walgren talked about Murray "slowly infusing Michael with an injection of Propofol."
But Flanagan elicited testimony showing Jackson could have ingested the Propofol himself. During Flanagan's cross-examination of prosecution witness Dr. Richard Ruffalo, Ruffalo conceded he had mistaken "micrograms" for "milligrams" when measuring concentrations of Jackson's stomach contents from the coroner's toxicologist's report. "I didn't have my glasses on well," Ruffalo testified. Ruffalo also said that properly re-calculated numbers may lead to the conclusion that Jackson "self-ingested" or "drank" some of the Propofol as opposed to Murray administering all of the drug to Jackson.
I've seen the article.
Here is a DIRECT LINK to the story at LAW.com so everyone can read it.
The defense strategy was clear to see in their cross examination of the witnesses. To me, there is nothing new in this article, except information about Chernoff's firm and how they handle cases.
Implying that Jackson drank propofol and convincing a jury that actually happened (or was possible) are two different things.
Flanagan (IMHO) spun the story that the prosecution changed it's theory during the presentation of their evidence.
I totally disagree with that. I think they will still go forward with their theory that the propofol bottle found inside the bag was the "slow drip."
The defense is challenging what they "believe" happened, but I don't think the prosecution changed their theory of the case in the midst of their presentation.
Dear Sprocket, I've been really sick the last two days or I'd have posted this sooner. KZ mentioned that your were a very warm hostess when she visited. It is very clear that that would be true because you bring that great spirit into your blog. I so much appreciated how available and caring you are when people e-mail you or post comments. It's such a pleasure to deal with someone who consistently goes that extra mile. Thank you again for being a window into the court room for many of us.
The thing that has me stumped is how Mr Jackson's vital organs ( particularly his liver ) could be as health as the autopsy suggests if he was an active drug addict and had been active for years. The liver bears a huge part of the onus to detoxify the body {along with the kidneys}. Long time drug addiction lives its signature on the vital organs just the same as a chain smoker for 20 years would not have unscathed lungs.
Meg:
Although Jackson's body was free of narcotics at the time of autopsy,
please understand, that does not mean that Jackson did not have an addiction to propofol.
I've said several times that I think it's possible Jackson was psychologically addicted to propofol.
Please understand that I don't see this as a "slam" on Jackson. I see it as him having a problem that many people in the world have dealt with. It makes him human.
Remember, propofol clears from the body pretty quickly via the liver, which is why it has to be continuously administered to keep someone sedated.
I'm hoping KZ will expand more on this (possible propofol addiction) in PART 4 of Dr. Conrad Murray's Death Drip: Explained.
First I want to say that this is probably the best discussion I have read about the different aspects of this case. KZ, thank you for your highly detailed look at Murray's actions. I work in medicine but not as an anesthesiologist and appreciate the information concerning that drug.
Couple of thoughts: As far as Michael ingesting propofol, Mark Fuhrman once explained that a defense will look for one area where the prosecution may have not fully examined the evidence
and focus their case there; in this situation, the contents of that 'juice box' was not tested. So, now they can postulate that Michael ingested propofol.
It is obvious and documented that Murray attempted to conceal his actions. To me, that means he most likely was moving and hiding things before security arrived. Therefore, the scene was compromised...yet placement of items in that room are taken as gospel and will be used at trial.
I personally think this was a terrible accident due to Murray's Third World medicine and clear negligence. To me, what Michael may have taken before June 25 has no bearing on this case at all. It doesn't change one iota the fact that Murray was reckless in his treatment of his one patient, resulting in death.
Lauren
I personally think this was NO accident.
It was NO accident that Murray did not perform CPR in a manner to SAVE his patient's life.
It was NO accident that Murray did NOT call 911 until AFTER he did some "cleaning up" of the crime scene.
There are many more reasons why this was NO accident!
About the lack of evidence of narcotic use in Michael Jackson's body, I too have wondered about this. But I also recall that shortly after Jackson's death, LaToya Jackson said that he had gone through a 'detox' before starting the rehearsals for This Is It.
I don't know what that means exactly, if anything, or if it can be believed, but wanted to put it out there.
From all the stories about his long history of drug use, and his gaunt appearance during the rehearsals, I too was surprised that the autopsy report revealed a relatively healthy 50 year old man.
Anon @2:37 pm:
It would help if someone could find a video or accredited news report where LaToya was quoted saying Jackson went through detox and detox for.....what, exactly.
Sprocket,
What are your thoughts about the emails between AEG and Murray discussing the "medical" care? How do those emails play into this case?
Is it true that AEG's insurance will only pay if death resulted from accidental overdose, and NOT from murder or even from natural causes?
Is it true that Murray's malpractice insurance will only pay if he's found not guilty and that they have refused to pay for his legal expenses for the trial?
Can you explain how a guilty or not guilty verdict would impact each of these insurance companies?
Anon@ 7:06pm:
The specifics of AEG's insurance policy was not presented at the preliminary hearing.
The specifics of Murray's malpractice insurance was not presented at the prelim.
I cannot say how a verdict will impact these issues.
I'm sure there will be litigation out the wazoo regarding who has to pay who...but all of that will not be part of the criminal trial.
You would need to consult a knowledgeable individual in insurance law who can review the actual policies and give their opinion.
The E-mails themselves. From my memory of testimony, (without having to go back and look) the E-mails were to an Insurance Agent, they were not to a CEO or president of AEG specifically.
From what I'm remembering, the Insurance Agent was requesting the medical files of Jackson (to continue the policy????). Murray was assuring the agent that Jackson was healthy, not to believe anything he read in the press about Jackson's health and that Jackson will be able to meet his obligations (concerts). Murray was not willing to turn over any medical files on Jackson.
Murray could not turn over any medical files on Jackson, because he didn't keep any. From my understanding, no medical files were ever found that Murray might have created on his care of Jackson.
This tells us that Murray was being deceptive, lying to the agent about the existence of medical files he was not willing to turn over.
It doesn't tell me anything about who will have to pay who (if anyone) once the criminal case is settled.
Regarding the propofol in the stomach at autopsy, I think it is absurd to suggest MJ awoke while CM was out of the room and drank propofol, IMO. Remember also that we think the biggest syringes CM had were 10cc. And to get the rim and stopper off the bottles takes know how, time, dexterity, and tools like scissors.
First, propofol is suspended in a carrier lipid emulsion. Lipids are fats. If MJ had ingested propofol, suspended in it's carrier emulsion, close to the time of his cardiac arrest and death, I would have expected a different report of the Ostomach contents. I would have expected WHITE tinged liquid in the stomach, not dark liquid. Lipids (fats) are broken down by bile in the small intestine. Fats do not rapidly leave the stomach, nor are they digested in the stomach. And, as I recall, the amount in the stomach was VERY small.
Recall that propofol was also found in the fluid of MJs eyes. Now, how did THAT get there? The eye viterous humor is a nonvascular fluid. How did propofol get out of the blood and into his eye fluid? Diffusion. He was saturated with propofol. His body still had propofol in tissues during the day from his nightly "therapy." Propofol, like many drugs, has multiple metabolic pathways. Just because the depressant effects have dissipated, that doesn't mean the drug is completely metabolized.
Weren't there "text messages" between the insurange agent and Murray regarding medical records, and as well as "emails" between AEG and Murray regarding medical care equipment, etc?
Although the specifics of the insurance policies were not presented at the prelim, do you think they are important in the criminal case? Isn't "insurance" usually an area covered in criminal investigations to help with discovering motive?
Lauren at 9:56
I also agree that CM was delivering substandard care, even lower quality than third world, IMO. And I say this as one who has seen and participated in hospitals in third world countries. The techniques I believe CM was using I will outline in part 4 when I return next week. No place in the world I've been would have done what I'm pretty sure he was doing.
But we have to remember that what CM was doing was NOT legitimate medical care. And as such, there was no standard of care. However, this is where it gets interesting, legally. CM was also NOT participating in a wild drug party. He was doing what he did AS a doctor, employed by MJ/ AEG. To my knowledge, this is the first propofol death under those circumstances. CM was being paid as a doctor, licensed and with malpractice insurance at the time. So, if CM wasn't giving legitimate medical care ( as to the propofol), and he also wasn't participating in a wild drug party, what exactly WAS he doing?? I think this is partly why the DA struggled with the charges.
Anon @8:12pm:
Regarding the "text messages"
Witness #17, Stephen J. Marx, computer forensic examiner
They were specifically E-mails.
Below is ALL the information that was presented about any attachment E-mails from anyone representing AEG.
This is from DAY 5, PART I
Defense attorney Chernoff Cross.
Q: In additon to the emails we have seen today, were there were forwarded emails attached from the insurance broker?
Marx: Yes there were.
Q: Did they seem to be sent back and forth regarding company officials rep MJ and AEG?
Question about if the communication was with someone (I miss the name) from AEG.
END
I don't have the answer in my notes. I'm guessing the answer would have been YES.
But understand, that's it. There were other E-mails attached, forwarded with the ones described.
The prosecution did NOT introduce these other E-mails into evidence. Consequently, on cross, the defense could not introduce the content of those E-mails unless they were willing to introduce the documents themselves into evidence.
From what I have seen so far of the evidence at the preliminary hearing, (and the boatload of evidence that KZ has been patiently explaining to everyone about Murray's actions) I do not think any insurance policy, no matter who was the beneficiary, has any bearing on the criminal case.
KZ,
Could it be that Murray was doing his modified version of "CPR" designed to try and dissipate the propofol in the body, while he still had the IV hooked up and the room sweltering hot, and that he was buying some time for this to happen by delaying the call to 911?
Based on prelim testimonies, looks like he was doing everything he possibly could to hide that propofol.
Another comment. Remember that hair samples were taken from MJ about 2 months after he died. As I recall, the natural hair length was 2 inches or a little more. If the entire shaft tests positive for benzos and propofol, we will know MJ was using/ being given propofol for greater than the 8 weeks CM said he gave it to him. Hair grows about 1/2 inch a month. A 2 inch hair is about 4-5 months old.
Sprocket, can you insert the link I sent you to the pubmed Article on benzo/ propofol hair testing? Thanks if you can. Comment is also ok without it.
KZ
Anonymous at 8:31
No. CPR doesn't speed up the metabolism of a drug. Room temperature would be irrelevant to drug metabolism during CPR.
However, taking down a bag with a bottle inside and tossing vials into another bag are 2 methods of reducing the amount of propofol evident in the room. Could even be construed as tampering with evidence, as these actions came subsequent to the identification of the cardiac arrest by CM's own admission. Not exactly CPR priorities, being that 911 wasn't even called yet.
Determination of the chronic abuse of the anaesthetic...PubMed
Short text below from link:
QUOTE:
Cirimele V, Kintz P, Doray S, Ludes B.
Institut de Médecine Légale, Strasbourg, France. vincent.cirimele@medecine.u-strasbg.fr
Abstract
A 44-year-old female nurse in a department of anesthesiology was found dead at home. An empty bottle of Hypnovel (midazolam 5 mg/5 ml) and a hypodermic syringe were found near the corpse. The nurse was a known abuser of anaesthetic agents for many years. A complete screening for general unknown substances by FPIA, GC/MS, head space GC/MS and HPLC/DAD revealed the simultaneous presence of midazolam, propofol and ethanol in femoral blood. Segmental analysis of a 6-cm-long hair strand revealed the presence of midazolam and propofol in each 2-cm-long segment. Repetitive consumption of the two anaesthetic agents during the last 6 months before the death was therefore demonstrated. These compounds were also detected in pubic and axillary hairs. Self-administration of midazolam and propofol without respiratory assistance and medical control certainly contributed to the death.
PMID: 11924712 [PubMed - indexed for MEDLINE]
KZ,
If propofol does not replace a person's need for normal sleep, how can the doctor reasonably expect the patient to survive without normal sleep, night after night, week after week, with such a body-taxing rehearsal schedule? Isn't that slow torture leading up to certain death?
About the hair testing for propofol - what if the person is balding? Might a two inch hair length not be consistent with growth over time but simply the length it was at time of death and 2 months after?
this doesn't really say much in in the details...
http://www.people.com/people/package/article/0,,20287787_20289401,00.html
In the months leading up to his London performances, Jackson told his sister that he was on a six-month detox to prepare for his comeback, but LaToya says she had other suspicions.
Anonymous at 9:24.
The answer to that question would take more than the 4096 characters I have in this window! The short answer is that sleep deprivation would not be the manner of death or the cause of death on the death certificate. Sleep deprivation would be part of a constellation of factors creating physical stress and debilitation over months and years of substance abuse. Chronic alcohol abuse, for example, generally takes decades to "kill" someone, unless they die from accident, violence, or simple or poly pharmacy overdose. So, sleep deprivation, in and of itself, would not create something seen at autopsy that a coroner would list as COD. Contributing factors could be listed, such as chronic substance abuse, etc.
MJ had a lot of health risk factors in what we know of his lifestyle. Frankly, I'm surprised that he escaped serious health consequences for as long as he did. A personal chef, body guards, and a personal Cardiologist could only mitigate those risk factors for so long. IMO, serious health consequences were inevitable.
KZ, I can't wait for your part 4!
It's looking like MJ was getting his nightly IV for hydration purposes understandably, as he was historically prone to dehydration, but it looks like the doc set things up so that he could inject propofol (or other substances) into his patient without the patient's knowledge, and he didn't even keep any medical treatment records to boot!
Also, in the prelim testimonies, a lot of the references to propofol seem to come from the doctor himself as he frames it to sound like MJ was asking for this med.
I personally don't think all this happened in a vacuum, there's much more involved as far other people or entities who stood to gain. I think this is where the insurance policies should come into the picture.
Anon @6:22am:
It doesn't matter if the individual is balding. The coroner's office took hair from Jackson's head. Since they were able to obtain hair samples, hair was tested. Drugs are recorded in the hair. The hair will tell....
Anon @6:36am:
I've made your URL a working link.
People.com Article Jackson Detox
But what did "Jackson" himself really mean by "detox?" That's the question. Did he mean, just detox himself from the normal day to day junk food he might have been eating?
Child stars in particular are prone to drug and alcohol use in later life, in part because they tend to be given drugs as children in order to perform in the evening, to endure long hours on a set, to endure the rigors of touring, etc. Is it any wonder that they have sleep disturbances as adults, especially if they continue to perform, or resort to drugs to keep them energized, then to relax them and help them sleep, then to wake them up - on and on.
I believe that their experience with enabling physicians starts at a very early age, and follows them through their lives. This experience can also include not only young performers but children who's parents consent to letting a physician medicate the children for unsupportable reasons.
I'm of the belief that MJ's introduction to drugs happened much much earlier than is admitted. The guy was playing clubs and then touring the country from the age of 9, on a nightly basis sometimes. How does a child manage that, to perform at odd hours, to have no regular schedule for sleeping, eating, going to school, playing?
There are many ethical physicians, of course, but this MJ case just reveals how it can play out to tragic consequences.
It's been said that the effect of sleep deprivation is similar to being under the influence of meds, etc., which greatly impacts a person's reaction time and alertness.
Putting both of these together (sleep deprivation plus the doctor administering various meds), this would explain why MJ would not have been in a position, mentally or physically, to self-inject as the defense is incredibly claiming.
Anon @9:18am:
You said:
but it looks like the doc set things up so that he could inject propofol (or other substances) into his patient without the patient's knowledge, and he didn't even keep any medical treatment records to boot!
How do you know that the propofol was administered without Jackson's knowledge? Dr. Murray stated Jackson was addicted to propofol.
How did Jackson, an admitted insomniac, let the doctor give him drugs without him knowing what the drugs were? I don't believe there is any evidence of that at all.
I don't believe Jackson was oblivious to the drugs he was receiving. I don't believe the insurance policies play any part in Dr. Murray's actions.
I don't believe there is a conspiracy here, although I understand why some would like to believe that to be so. People are fascinated by conspiracy theories.
Sprocket, not sure if you would know the answer to this:
If Murray was operating (licensed) in more than one state and using the US (federal) telecommunications systems by making/receiving phone calls, exchanging text messages, emails, etc., across state lines and country borders (including to ins agent in UK), why is the FBI not involved in investigating this very high profile case?
Sprocket, the doctor's story seems to change so much that it's hard to believe anything he says, and his actions reek of coverup. So I think the broader picture needs to be looked at. There's much more to this than meets the eye.
Anon @10:40am:
I don't see how the FBI has to be involved just because Dr. Murray was using a cell phone to send and receive E-mail.
I think you are confusing law that covers transmitting radio stations (that have to comply with federal guidelines/laws) verses regulations covering cell phone towers that transfer private telephone calls from one individual to the next.
The forensic examiner who testified as to the content of the E-mails found on Dr. Murray's cell phone was employed by the DEA (Drug Enforcement Agency), which is not a part of the FBI.
I don't know how or why the LAPD of the DA's office called this individual to testify about the records retrieved.
My best guess is, it's very possible the DEA conducted their OWN investigation regarding Dr. Murray's drug use. As part of that investigation, they used their own forensic examiner for the cell phones.
OR, it could just be, the LAPD did not have a forensic examiner who was experienced in retrieving data from a cell phone memory (card/chip/whatever) that had initially been erased.
The reason I say that's scenario is also possible is because it wasn't until the very end of Phil Spector's first trial, that all the E-mails from Lana Clarkson's computer were obtained off the hard drive. Those E-mails were not discovered by their own, in-house LAPD examination of the old computer. It was an independent computer expert who was able to retrieve the data.
So, in that sense, I could see why the DA's office or LAPD (whomever asked) could have gone outside their own in-house examiners and asked another government agency to take a look at the cell phone memory.
Anon @10:48am:
That is your opinion anon, and you are welcome to voice it. <3
It's my opinion that the DA's office has looked at every possible angle of involvement of the case. It's my opinion that we will not see anything regarding the insurance policies in regards to the charge of involuntary manslaughter during the trial.
If there was something involving the insurance policies the DA's office would have added a conspiracy charge. The fact that they did not do so leads me to my opinion.
Again, let me repeat, I believe the DA's office looked at every possible angle of this case. That is supported by the time it took from Jackson's death in June, 2009 to charge Dr. Murray (early 2010) with Involuntary Manslaughter, to the time it took to bring the initial preliminary hearing in front a judge (January, 2011).
I don't believe the DA's office sat on their hands that entire time.
I just wanted to address one thing.
Anon said:
Sprocket, the doctor's story seems to change so much that it's hard to believe anything he says, and his actions reek of coverup.
I agree that much of his post-incident actions reek of a coverup. A coverup of what HE was actually doing.
I don't see Dr. Murray's story actually "changing" all that much. He did not give full disclosure to paramedics and doctors at UCLA. It was lie by omission as to what/when he was doing and what/when Jackson respiratory and cardiac arrested.
He told one story to LAPD Robbery/Homicide, in the presence of his attorney.
The collected evidence, autopsy, toxicology results and testimony of other individuals are what contradict Dr. Murray's taped interview of what he said he did and what happened in that "treatment room."
Thanks for that explanation, Sprocket. The thing is that a lie is a lie, whether by ommission or not, so how can anyone really believe anything Murray says?
Anon @3:28pm:
"So how can anyone really believe anything Murray says?"
Because the physical evidence found in the home, the invoices from the pharmacy, the autopsy (massive amounts of propofol in the body and KZ's explanation that the body isn't "completely rid of it) as well as other witness statements (Mr. Alvarez) supports the theory that Murray was dosing Jackson with propofol for eight weeks.
Like I mentioned earlier, ...the hair will tell....
Thank you so much for your analysis, once again! It has really helped me understand this case in a way I would never been able to.
What do you make of the alleged healed "bedsores" that Michael had on his backside on his autopsy? He had indentations on his bottom. They were healed, but left scars none the less. I know I'm getting a little off topic here, but if they really are bedsores, could he have had a long history of using propofol and being bedbound for those to have developed? If true, that is so sad. Just tragic. Here is a link that I found that also talks about the bedsores. http://today.msnbc.msn.com/id/32542682/ns/today-entertainment/
I know that my question is not specifically related to his death, but it could show signs of long term use of propofol maybe? I just cannot understand how a 50 year old man, who is not paralyzed nor in a nursing home... could develop something like that. Unless he was sedated for hours and hours every day, and left in one position.
Made the URL in the above comment a working link
TODAY MSNBC Story on Jackson bedsores
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TODAY MSNBC Story on Jackson bedsores
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{a href="http://today.msnbc.msn.com/id/32542682/ns/today-entertainment/"}TODAY MSNBC Story on Jackson bedsores{/a}
Sprocket, I know you are looking at everything that can be legally proven, but I for one concur with another anon poster: how do we know what Murray gave Jackson? How do we know he wasn't treating Jackson for dehydration via saline drip, or that's what he was "hired for". I agree with you that the DA's office is looking into everything. I hope they include Nurse Lee who said, right after Jackson died, on national TV many times, that he had asked her for prop months before he died, before she even went to the police. Do you have any info on Nurse Cherilyn Lee aside from what the media has fed us? Any connections to Murray?
Thanks for your great work.
QUOTE:
how do we know what Murray gave Jackson?
THE AUTOPSY.
Jackson's body was saturated with propofol. Did you read what KZ added above about propofol being in the vitreous?
The hair analysis to come at trial. It will prove beyond a shadow of a doubt that Jackson was on propofol for the two months that Murray was ORDERING it from the Las Vegas Pharmacy.
From all that KZ has explained in detail, I do not believe it was possible for Murray to be giving Jackson propofol without his knowledge. I believe that is an impossible scenario.
I personally know very little beyond what was presented at the preliminary hearing. On Monday, January 3rd, that was the day I found out that I would be allowed in the media overflow room. Before that, I had not followed this case very much. CaliGirl9 did research and wrote articles after Jackson died.
Most of my knowledge about the case has been obtained after the prelim.
Anonymous at 9:19 am
The IV hydration is one of the many OTHER lies I chose to leave out of Part 3, but I will briefly address it now.
First, there was not a single thing wrong with MJ's ability to drink fluids. He absolutely, 100% DID NOT need IV hydration. He was not vomiting or otherwise ill or unable to drink fluids in the usual manner. His DOCTOR should have ensured that MJ's handlers on the set of his rehearsals placed a glass of water or Gatorade type fluid in his hand at every break, and held up rehearsal until he drank it! Tough love! There is NO excuse for an experienced dancer like him to become seriously dehydrated after an athletic rehearsal. So, in that respect, CM both LIED again, as well as demonstrated his incompetence. The risks of routine IV hydration far exceeded the benefit of one bag or so of fluids.
Oh, and by the way, a liter of IV fluids bolused wide open only remains in the intravascular compartment for about 45 minutes. Fluid shifting occurs rapidly, and the fluid redistributes to nonvascular tissues, or is filtered out by the kidneys rapidly.
CM never once, that we know of, EVER gave MJ enough IV fluids to meet any criteria for IV hydration! For pete's sake, he only ordered 9 bags of NS with his first pharmacy order! Who does that? IV bags come 12 per case! Plain and simple, CM started an IV every night with a bag of fluids so he had a mainline to piggyback his drip into, as well as a running line for boluses.
Hydration was nothing more than a bogus excuse for starting an IV for the propofol.
Let's talk about Michael's drug history as we know
Propofol
This wasn't the first time anesthesia is mentioned with Michael's name and it's safe to say he probably knew the drug.
First mention of anesthesia and Michael goes back to 1996-1997 History tour. During an unrelated fraud case in 2000 Neil Ratner was asked about his mini clinic and giving anesthesia to MJ during the tour. (judge didn't allow most of the questions and Ratner didn't give any confirming answers to remaining questions)
Although Michael had used propofol before I don't think he had a physical or psychological dependency or used propofol continuously because many other people confirmed him not sleeping on many occasions - such as Tom Meserrau said MJ used to call him at 4AM during the 2005 trial, the owner of the Irish estate he stayed during 2007 said he used to walk outside at 3-4AM in the morning, Las Vegas bodyguards 2008 also said that MJ would be up and dancing at 3AM. Plus at least the time period he was outside US 05-07 he was travelling only with his kids, nanny and a tutor - no doctor. all of these shows a man that has insomnia, not a man using any sleep aids including propofol.
Murray's hiring and giving propofol starts with the rehearsals for the TII concerts and he was hired to accompany MJ for the concerts.
My opinion is that MJ had sleep problems but he didn't use any remedies (including propofol) unless he needed to follow a schedule such as the concerts. In tours he had doctors to give him anesthesia.
Pain medications and anxiety drugs
MJ's history with these type of medications go back to the 1993 allegations.
He entered and completed rehab for it.
His next obvious problem with drugs was in 1999 when performing a bridge fall down and he was seriously hurt.
Reportedly he was given pain medications for his pain and he relapsed.
There's a reported 1999 detox done by Ratner as well. As I mentioned before Ratner was the anesthesiologist that accompanied MJ during 96-97 tour. So we don't know if this was a detox related to anesthesia or pain medication/anxiety drugs. (however with my medical knowledge I think detox for anesthesia is not needed)
2000-2005 period is relatively unknown. Some periods he looked like he was under the influence (in 2001 he had a nerve damage on his face , don't mix the two) sometimes he was okay.
2005 mid trial it was again obvious that he was dependent on pain medications/anti anxiety drugs.
There's another reported rehab right after the end of the trial.
and he looked lucid between 06 and till the time of his death.
in 2009 Arnie Klein was doing extensive cosmetic work on MJ such as fillers, rebuilding his nose and botox and all those treatments included shots of pain medication (that's why he looked hazed and out of it coming out of doctor offices etc). By autopsy it doesn't look like he was forming an addiction to them.
So in regards of pain / anti anxiety drugs my take is that he had some periods that he was addicted and some periods that he was clean - therefore no signs long term abuse at his internal organs.
@KZ
I don't know if you watched This is it movie. there's actually a scene in it where Kenny Ortega (director of the tour) after a song is finished tells Michael to drink some water. And Michael goes to the water singing "water, water".
Anonymous at 10:00
Thanks for that look at MJ's use of benzodiazepines and narcotics over years.
I'm on a mobile device for a few days, and am less skilled at in depth research and cutting and pasting. However, I'll just make a brief comment here that it matters not whether the insomnia came before the heavy, chronic med use, or as a result of the chronic, heavy use of these meds.
A brief search using insomnia and benzodiazepines yielded 863,000 results this morning. Even the most basic references, such as wikipedia, have a good discussion of the risks of development of tolerance, rebound insomnia, and light sleep vs deep sleep with use. Benzodiazepines are definitely among the most difficult meds to get off of, and tolerance and dependence can develop in a matter of weeks.
I think in this conversation about med use, it's important that we lay any blame at the feet of those who recklessly provided MJ with these drugs on an ongoing basis. Both IV, and pills. Imo, all of these doctors were simply enabling a man who needed close, ongoing REAL treatment for dependency. The doctor AEG and MJ should have had on staff 24 hours a day was one skilled in treatment of chronic dependency. A doc like Drew Pinsky. If AEG was smart, they should have insisted a doc like that was on board, to protect their investment. IMO.
I agree with the assessment about
Michael's purported medication use.
Propofol for touring so he could
maintain a schedule and for medical
procedures; prescription pain medication for physical, emotional,
psychological pain with probably long stretches of non-use. Of course, we
can't know and it feels intrusive in a way to speculate about it. But again, what Michael did or didn't do in the past really has no bearing on the issues in this case. It is Murray's behavior on trial and I think the defense is depending on long discussion and focus on MJ's history as a means to deflect attention from their client.
Lauren
I have a question for KZ. We know that propofol is fast acting with effects that quickly resolve. Is it
possible that the high levels of propofol found at autopsy had accumulated over time...the 6-8 weeks of nightly administration? Or, did
the high level represent only what was given on June 25?
Lauren
Let's not forget that the case is The People vs. Conrad Murray.
Thus, rather than focusing on MJ, it is important to remain focused on what Murray did or did not do that resulted in the death of his one and only patient.
If the defense has to build their case on MJ's past and then proceed to present that as the core of their case, it simply means and sends the clear message that they have NO case.
Is the doc claiming that his patient dictated the treatment?
After the doc shot the patient up into the twilight zone, the doc claims that the patient demanded a specific powerful med on top of all of that?
IMO, any jury who believes this needs to be drug-tested!
Anonymous/ Lauren at 7:23
The blood levels at autopsy represent what was given within a very short time before cardiac arrest. Those are the femoral, hospital, and heart levels of propofol, among the other drugs tested. Things like vitreous humor represent chronic use.
The testing of MJs natural hair that was obtained 2 months after his death will definitively demonstrate if there was chronic use of propofol, as well as benzodiazepines, and whatever else they test for. As I noted above, the natural hair was about 2" in length, iirc. Hair grows 1/2" a month, so 2" would represent about 8 weeks. Whatever is positive along the whole shaft will represent use in the 8 weeks preceding death.
However, in an official interview that was recorded, CM admitted to giving MJ propofol on a nightly basis for 8 weeks. So if the natural hair only represents 8 weeks, testing will only confirm or refute CMs words here. Along with any other meds the hair tests positive for.
Anonymous at 8:46
I disagree with your assessment that ONLY Murray's actions are relevant. I think it is HIGHLY relevant that the circumstances that brought CM and MJ AND propofol together in that bedroom be examined in great detail. After all, CM did not break into the mansion and force propofol and benzodiazepines on MJ. A collection of circumstances laid the foundation that ultimately produced the death of a beloved pop star from an IV anesthetic in his home.
We cannot, and should not, remove MJs lifestyle and chemical dependency illness from the circumstances which produced his death. We do not diminish the great talent that he was, by acknowledging the human condition he lived. We can, and should celebrate the genius and hard working talent that he was, and also accept the truth of his demons. In facing the demons, we can all "start with the man in the mirror", and look out for each other.
I do not believe Conrad Murray is a scapegoat or sacrificial lamb. He was a more-than-willing participant in all of this. He definitely bears the burden of responsible decision making here, IMO, and he failed miserably.
As I've read through the questions and comments, I realize that I agree with Sprocket and KZ about facts, evidence, and the general narrative about the relationship between CM and MJ and propofol that led to the MJ's death.
I don't believe in the conspiracy theories that are being tossed around, nor to the 'innocence' of MJ in his knowledge and desire for propofol.
I do find myself wondering, though, how the transaction that led to MJ's death started, because the story we're given is that MJ asked for propofol and CM consented. That's CM's story. So I wonder who suggested it be given at home? Was that something that had been done before, with a whole 'home hospital' setup? Did MJ receive assurance from Murray that it could be done safely? Clearly he trusted his doctor and he always seemed to have licensed doctors involved in his care. And just as clearly, MJ needed drugs and may have been willing to suspend judgement to get them.
I'm just musing out loud, but as this case unfolds, as it becomes clear that the ONLY story we have is CM's version, I do wonder how that transaction began or if we'll ever know. Perhaps it doesn't matter, and it's only that MJ, who vacillated between naivety and the absolute power/willfulness that fame brings, could find a doctor who'd do it.
Its unsettling in its way to think of the forces that may have been in play. What a waste.
IMO, it needs to be made crystal clear that MJ was just like any other human being in that he used prescription meds periodically NOT for recreational use, but for easing the pains he suffered from work-related injuries and other physical illnesses/conditions.
However, it's doctors who prescribe these meds, and it's the types of meds that are prescribed that are questionable in that they are known to cause any human being to become dependent on them. This is in NO way the fault of the patient. The drug industry also shares in this responsibility.
Having said this, with the knowledge of MJ's human limitations and conditions and as clear signs of his physical/mental distress were being ignored by the powers that be, all those involved in creating the need for and subsequent production of the "comeback" concerts -- including the promoters and their background counterparts as well as this specialist doctor -- need to be thoroughly investigated.
What can be seen is that outside pressure was brought to bear on a human being to perform beyond human capacity, and that TOGETHER WITH the insurance policies CANNOT be ignored. IMO, therein lie the motives and answers, and scream for further investigation...WHO GAINED FROM MJ'S DEATH?
"WHO GAINED FROM MJ'S DEATH?"
No one. AEG had way more to lose $$$$ by Jackson's death.
Conspiracy theories are just that, theories, with nothing to back them up.
This is exactly why the DA office needs to do more investigations.
At this time, they can only bring charges according to the amount of investigation they have conducted. They put the limits on themselves.
If they are WILLING to dig deeper, they will find MORE evidence to bring charges against MORE people.
That's all there is to it.
Anon at 10:51am:
You are implying the DA's office did not do their due diligence, and that somehow, somewhere, this late in the game there is evidence to prove a "conspiracy."
I don't believe the DA's office is that inept. Maybe you've experienced that where you live, but in my years covering the LA Co criminal courts, I've not seen that type of incompetence here.
I don't believe there is a conspiracy, anywhere. No one, anywhere, has provided evidence of a conspiracy. If you are so certain of a conspiracy, ~I mean, you must have something to support that allegation because you keep saying it in all caps~ what evidence have you passed onto the DA's office? I don't mean accusations. I mean, solid evidence that can be presented in a court of law.
You haven't answered your own question as to who would benefit. Again, the answer is:
NO ONE.
The truth is, there are people whose thinking process is to choose to believe in conspiracy theories, rather than accept the logical explanation of a doctor who provided sub-standard care to a patient.
We should focus on what we know.
The cause of Michael Jackson's death, according to the Coroner, is homicide at the hands of another. That was the Coroner's finding after all the evidence was examined.
It appears from what we know of the prelim testimonies that Conrad Murray, rather than caring for his patient, was reckless and grossly negligent. Further to this, there is no doubt, according to the testimonies, that Murray has been trying to cover up the facts of his recklessness and negligence from the moment he "discovered" his patient had died. However, Murray has denied doing anything wrong at all.
From the reports of the testimonies given, including those firsthand testimonies of paramedics and doctors, it appears Murray did nothing right.
Murray and his attorneys will attempt to lessen the responsibility Murray had as a doctor in order to obtain the lightest possible sentence. Murray and his attorneys cannot and should not lie - that would be subverting the course of justice. The most they can do is to try create a suspicion in people's minds so that Murray does not feel the full weight of the law for the crime he is accused of committing.
Murray was the doctor. His duty was to take care of his patient. He did not do that. His patient died and it seems he died while Murray was chatting on the phone.
The Coroner's Office, the police, the DA's office have all carried out their investigations. Murray has been accused of a crime and following the prelim hearing Judge Pastor, after finding sufficient evidence, ordered Murray to stand trial. There are reasons why Murray is the one on trial.
Anon at 6:50
I am quite willing to believe MJ had a lot of aches, pains, and arthritis. I'm even willing to entertain the idea that he may have had a chronic pain condition, exacerbated by generous prescriptions designed to mask his pain and keep him performing. However, if the ultimate goal is to keep him performing to make lots of $$$ for lots of people, generous provision of meds for years at a time, known to cause dependency and health problems, isn't the way to do it. Professional athletes may have a shot of local anesthetic to get thru the game, but then the pro sports machine ensures the athlete gets top notch orthopedic care, and, if necessary, comprehensive rx from pain specialists. I've never heard one story talk about MJ seeking or receiving ongoing specialist care for orthopedic conditions. Or pain specialists. These are not one time, or a few appointments. They are life long, for effective treatment.
But I have heard a lot of speculation from fans about how desperately sick and in pain MJ was, as a justification for the meds he was on. It is difficult for some fans to admit that there could be a component of MJs extensive med use and seeking behaviors that was driven by psychology.
To be sure, MJ was a victim of a poly pharmacy overdose. It is disingenuous to imply that MJ was an innocent, naive victim of poly pharmacy at the hands of a trusted doctor. MJ knew full well how hard it was to find a doc willing to give him propofol at home, IMO.
Every person close to MJ was part of the deadly "care plan" that placed a doctor in his home with a deadly anesthetic, no education in giving it, and reckless hubris in using it. Including MJ.
MJ WAS quite ill, IMO, and needed and deserved the best care he could buy to help him. The best care was not a cardiologist to give him propofol every night at home (along with a boatload of benzodiazepines). He needed comprehensive, multidisciplinary care that was centered around qualified pain specialists and chemical dependency specialists. That would have kept him alive, performing, and there for his kids.
As a side note, I realize that outside of California (in the US and other countries) it seems like California is just one big country...well maybe two...Northern California and Southern California, lol, but the truth is, we are no different than any other state.
Let me explain to those who don't know how things work as far as bringing charges against individuals in the state of California.
After state level government, there is COUNTY government. At the county level, there is the DISTRICT ATTORNEY for each county. California has many counties. These county offices are independent of each other.
If a crime is committed In Los Angeles County, that's where the accused defendant will stand trial.
Sometimes, district attorney's will combine cases, to reduce costs to the taxpayer. (For example, the recent Alcala murder case where there were murders in Orange County & LA County and the prosecution for all cases was in Orange County. That made sense. The counties are close together and this saved the various counties, and taxpayers $$$.)
Steve Cooley, the DA in Los Angeles county has been in office for three, 4-year terms. His third term will end in 2012. Everyone is waiting to see if he will run for a 4th term.
The district attorney in Orange County, or the district attorney Santa Barbara County, or district attorney Riverside County have nothing to do with how the LA County district attorney's office is run. And vice versa. The LA County DA's office doesn't have any jurisdiction as to who is prosecuted in those other counties.
I don't believe in conspiracies, and feel that most of those who do just cannot comprehend what happened to Michael Jackson! He has been touted as a loving father who was always with his children. Then why would he allow himself to be put out at night, night after night, with no access for them to get to him in an emergency situation. In that house were only Michael, a nanny, bodyguards in a trailer outside, and Murray upstairs some nights, other nights not. Would Michael Jackson leave himself unaccessible to his dearly loved children, the reason for whatever joy he obtained in this life? Most of us would say no. But, then, was he so tormented that this first priority in his life, his children, took second place? Did he lose himself due to the angst caused by this "comeback"? Respectfully speaking, this suspension of belief has fueled the conspiracy theories as, to some, it could not have occurred, nor should it have occurred, in this most obvious manner, of a wilful arrogant doctor abandoning his morals and principles and his patient for money.
A question For KZ and SPROCKET.
Sorry for my bad english. After many nights full of propofol can someone be able to sing and dance in the way MJ did in the TII movie ? Assuming that the movie plays reality, and that anesthesia was there every night, we should see a person dizzy , tired ...
How long after the anesthesia with propofol, a person is perfectly lucid and capable of sustained effort,in the way MJ was in TII?Assuming that the movie was not tricked.
Thanks in advance for answer.
Alina
Your English is just fine Alina.
I'm sure KZ will help answer this later tonight, but I will try to give you a quick answer, now.
FILM: This Is It
I have not seen the movie. I cannot make an evaluation on it as to how representative it is of the days and weeks preceding his death. Were any of the pieces of the video documented as to the date they were filmed? Was video also included of Michael at home, with his children? Was video also included of other things Jackson did? How much of the video is of the actual date, June 24th, 2009, the last day Michael rehearsed?
Do you see where my questions are going regarding the film, This Is It?
Propofil & the body:
From my understanding of what KZ has posted in the comments above, propofol clears from the body pretty quickly via the liver; enough for you to "wake up" completely from the anaesthetic and get out of bed and become functional. This is why it has to be continuously administered to keep you under.
However, just because you can wake up and function, doesn't mean that the propofol is completely cleared from all the body's other tissues. This is why the propofol in the viterous (of the eye) is indicative of long-term, night after night use.
Sprocket: about your answer to Alina, I've seen This Is It several times always looking for clues as to Michael's condition. Your questions to Alina are very important to have answered, however, it's not possible to do so, i.e., no dates of filming (put out by producers it was last couple days of Michael's life, I don't buy it), no shots of children with Michael; the only portion that has a telltale sign of "when" that portion might have been filmed, is when Ortega asks the pyrotechnic guy to "do that times 10", (i.e., when there were ten concerts, had to be March, right?) in spite of all the rhetoric about the film having been mostly shot June 23-24, to make it appear Michael was in "wonderful health". Absolutely no way to say for sure how it was pieced together, as I'm sure was the intent of AEG and Sony.
I do not believe in conspiracies in this case either. However, I do not agree that Michael's history has anything to do with what this case is about. Nor does Murray's. It is about
what happened in that bedroom on June 25 that led to Michael's death. Based on testimony so far it appears that in that time and place, Murray's
negligence and incompetence resulted in the death of his one patient. What led both those people to that situation is noise as far as I'm concerned and it will be dealt with in the civil cases. A physician does not admiinister propofol in a bedroom, for insomnia, without monitoring, let distractions lead him to abandon his patient, lie repeatedly, conceal his actions and then agree to blame his patient for his own death. A physician is obligated to say 'No'; seek appropriate care for his patient and if refused, walk away. Michael had his demons, for sure, but that in no way diminishes Murray's lapse in judgement and horrendous behavior.
Anon @7:14pm:
But, how did Murray and Jackson get to the place of how things ended on June 25th, 2009?
Murray's history (and financial needs) and Jackson's history (improperly treated health/addiction issues) has something to do with that, no?
Sprocket, what would happen if a defense attorney believed, in the course of a trial, that their client had been untruthful and wasn't innocent?
Is this a plausible scenario, or does a defense attorney sense this at the first interview and decline the case?
Are there any cases you know of where this this happened? Would the attorney just exit the case with no needed explanation?
Just curious about this whole process because there must be clients who are smooth liars and could convince anyone of their 'innocence.'
Thanks for all your good work!
Anon @7:19pm:
Understand that defense attorney's defend clients all the time that they "know" are guilty. Often times these same attorneys will make statements to the press defending their clients and their client's wanting to tell their 'side of the story' in a court of law.
No attorney can legally put a witness on the stand if they know the witness will lie (commit perjury). This goes for prosecutors and defense attorney's alike. I believe it is a crime to put a witness on the stand that you "know" will lie. It is a crime to lie under oath.
I've watched a lot of crime shows over years, and it frustrates me to no end when the writers get it wrong. I know they've got it wrong because I've watched real trials and how the process works.
Legally, an attorney cannot lie to anyone in the course of their work or their work on an investigation. That's different from police and detectives who can lie to a suspect or non-suspect in the course of their investigations.
A defense attorney does not have to "believe" in their client's innocence to represent them. Their job, is to defend their client to the best of their ability. It's not necessarily to "find the truth" about what happened (that's the prosecutor's job) but to protect their client within the bounds of what is legal.
Hypothetical situation here.
So, lets say a highly principled defense attorney finds out during the course of a trial that their client is 100% guilty. What that attorney decides to do is up to that particular attorney...but it may also not be in their power to abandon their client. Even if the attorney found himself ethically unable to adequately represent his client anymore, it would be up to a judge whether or not a defense attorney could "recluse himself" from representing a client mid-trial. IMHO, it's not likely to happen, unless of course, the client wishes to represent himself and the judge agrees.
There are some former prosecutors who go onto private practice as defense attorneys who pick and choose who they decide to represent. Some don't care who they take on as clients; some do. Some defense attorneys may choose NOT to represent someone they suspect is guilty, especially if it is a crime such as murder. They can easily say, "no thanks, find someone else."
Famous prosecutor Vincent Bugliosi, who convicted Charles Manson is one. Bugliosi wrote in one of his books that he turned down a request by Jeffrey MacDonald to represent him in the murder trial of MacDonald's wife and two children. (Those who don't know, the Jeffrey MacDonald case is a very famous case. He is a former army physician who was convicted of the brutal deaths of his wife and two daughters. He claimed that hippies broke into his duplex home, attacked him and killed his family.)
Bugliosi wrote that he required Macdonald to take a polygraph before he would consider representing him. MacDonald declined.
I hope that answers your question.
Alina at 2:41- I echo Sprocket that your English is clear!
What I think you're asking, is does propofol leave a person with a drug hangover that would be obvious? How does an athletic dancer and singer function if they are receiving, in essence, a general anesthetic every night?
This is not a short answer, but I'll try to keep it brief.
We know MJ was not receiving ONLY propofol. He was also receiving several benzodiazepines at the same time. There is a phenomenon called tachyphylaxis that explains the process of physical dependence. In essence, the body becomes very efficient at removing the drugs. The cytochrome P450 enzyme system in the liver is partly responsible.
There is a great study out of Japan from 2008 that tested driving (simulator) abilities of patients after receiving propofol, versus midazolam + propofol, versus no meds. These were non-tolerant patients, who had received sedation for colonoscopy or EGD. The take home message is that the propofol only group was back to baseline (actually BETTER) at about 2 hours. The propofol + midazolam group took about 3+ hours to get back to baseline on their driving responses. (Cant link the article tonight.)
Anyway, propofol is a superb anesthetic precisely for the properties that make patients so functional after receiving it. Propofol inhibits nausea, induces a feeling of well being, and renders patients much more alert and functional than any other anesthetic. It's the Cadillac of anesthetics, so to speak. Often patients awaken and are immediately able to move to a stretcher, follow instructions, interact fairly clear headed, converse with the surgeon, pay attention to discharge instructions, etc. We absolutely love propofol for these properties. The drug has revolutionized same-day surgeries.
We also must remember that CM was actively seeking ephedrine and other "wakeful" meds as part of his "care" of MJ. The compounding pharmacy was assisting in providing meds to help provide energy (stimulants). Poly pharmacy didn't stop with propofol and benzodiazepines. I'm personally on the fence as to whether the ephedrine was to help MJ wake up, or keep his BP from crashing on the propofol. Pretreatment with ephedrine is an "old" anesthetic technique. CM could have learned about it by phoning a friend.
Hope this helps!
~KZ
Y'all seem to forget that during all these long WEEKS, the patient is living without normal or natural sleep. Don't you think that needs to be computed in the equation? IMO, this is the biggest and most important part of the equation. Propofol does NOT replace the patient's NEED for natural or normal sleep.
I agree that this is slow TORTURE carried out by the doctor, leading to certain death of his one and only patient.
Unfortunately, some lawyers do whatever they have to make a name for themselves, whether their client is guilty or not. Ethics means nothing to them. That's the dark side of the profession!
Thanks for these valuable explanations and discussions. I hope Part 4 will be posted soon - I know KZ is away, but I'm chomping at the bit.
Anne
Anon @ 7:32am
I've never heard of anyone dying because they lacked "natural, normal sleep" while being in an induced coma. Jackson did not die because he did not get natural sleep. He died from a combination of drugs given to him by his doctor that depressed his breathing. Respiratory arrest led to cardiac arrest. Not lack of sleep.
If every attorney refused to defend someone because they were guilty, well, then, what would happen is, 80 to 90 % of the people so charged would go into court without an attorney.
The truth is, most people charged are guilty. But in the eyes of the court, your are innocent until evidence and a jury proves you are not.
I personally don't see anything wrong with an attorney representing a guilty individual to the best of their ability. I would hope every defendant has an attorney that is dedicated and passionate. Defense attorneys go to bat for their clients.
They ensure that the evidence presented against their clients is obtained legally and entered into evidence at a trial legally. They ensure that laws are followed in the prosecution of their client.
And, not all grandstanding media hound attorneys are defense attorneys.
In addition to Nifong, Bonnie Dumanis comes to mind.
Thank you for the link to the LA Superior Court high profile case document list. I faxed a request that they update the Murray document list, but they haven't. I have seen on another case (Johannes Mesherle) that the list of documents is extensive and complete. I wish they would post the motion documents and the minute orders.
Also, I have wondered if you ever watched the judge during the prelim, and if he made any facial expressions worth mentioning?
Thanks, and looking forward to your guest's part 4.
I am not familiar with the Johannes Mersherle case. Is that LA County?
I was trying to watch the witness and look at my computer screen to see how bad I was typing at the same time.
Understand, I am familiar with Judge Pastor. I reported on most of a trial in his courtroom over a year ago, the Cameron Brown Case.
Judge Pastor is not one to make a "lot" of facial expressions, but he does occasionally. He is a very fair judge and usually runs his courtroom like a tight ship....right on time. He will go right to 4:15pm, using as much of the time without going into overtime. He's very conscious about overtime. He does call parties on the carpet for being late to court or unprepared....he expects solid explanations and not BS excuses.
During that case, big exhibit boards with huge enlarged photographs were shown to the jury by the prosecution. They were set up on an easel right in front of the jury box.
Each and every time, Pastor left the bench, and situated himself in the gallery, right next to the jury box so that he could see exactly where the witnesses were pointing and describing. He's sharp. He stays right on top of things inside his courtroom.
Sprocket, it's understood that it was not lack of sleep that actually killed the patient.
But the lack of sleep has a similar effect on the body as being under the influence of meds. So that together with everything else the doctor was shooting into his patient's body would render his patient very weak.
So, the patient, continually deprived of natural sleep, would grow progressively weaker over the weeks, at the same time the various meds being administered to the patient would have a more powerful, controlling and disabling effect on the patient...all of this resulted in the patient's death.
Thank you Sprocket. Prosecutorial misconduct is not investigated enough. Even when it is investigated, research has shown there is a gross imbalance in the number of convictions/penalties applied v the number of dismissals. This is a whole other issue though.
@ Anne: I'm chomping at the bit too.
What is mind boggling is how is it possible for those who worked closely with Jackson on a daily basis NOT see that something was clearly NOT right with him and that he needed attention, being that he IS the show?
Apparently the "powers that be" were salivating at completing the rehearsals, and the resulting blockbuster movie, at all costs?
Is this any different from unethical lawyers salivating at winning a case at all costs?
With the end justifying the means for many (more than the public is aware of), there needs to be more aggressive enforcement of the laws in this country to preserve the integrity of the system of justice.
Lack of sleep issue:
Read back through the comments. I'm not sure where it is. It's either on this thread or others. From my understanding, people who wake up from this anesthesia say they feel like they have had "the best sleep ever."
Prosecutorial misconduct:
I'd like to see an actual independent study over many years before I'd believe that.
This Is It Show:
Kenny Ortega testified and cleared up this issue of "The Show."
There never was a plan for a film by the financiers of THIS IS IT. Ever.
Here is the CROSS EXAMINATION of ORTEGA by ED CHERNOFF, taken from my own notes. I've bolded the most important part of the answer.
________
EC: When did filming begin for the THIS IS IT documentary?
KO: We never filmed FOR that documentary.
KO: (Michael) He asked to film the rehearsals. The interviews were done for shows that were to be done in London. We never started filming the documentary. The documentary was never a plan. The filming of rehearsals were for our personal use. And to review rehearsals. Sometimes he had a private camera rolling. It was always through via Michael’ s request.
EC: Did you yourself do any film?
KO: No.
____________
So, the "only thing" that was for the public were the interviews. Filming the rehearsals was for their own private use.
AEG was lucky that Jackson requested rehearsals be filmed. Very lucky indeed.
Johannes Mesherle is the BART police officer who shot a man who was being disruptive on a train early New Year's Day 2008 (?). The police officer meant to grab a taser but he took his service pistol out instead and shot the perp in the back. The whole thing was videoed from multiple cell phones.
The trial was moved to LA County, heard last fall and already put to bed, and it's been the cause of much racial tension here in the Bay Area. Mesherle is white, the dead guy black. I think I wrote about it when it first happened. There's also a big fat lawsuit and BART did settle with the dead guy's baby mama.
When I watched "This is It," I frequently saw a man who was in pain based on the way he moved at times. I have got to give MJ credit—I cannot imagine pushing through back pain like he did.
I've also read that people don't think he's "giving his all" during some of the sequences, and I agree. But why did he have to for rehearsals? He didn't. He had the moves down, and the mental ability to push through his pain and perform. And half of an MJ performance would have been more entertaining than a whole show of many artists out there today.
He was worth more to AEG alive than dead. Anyone who thinks AEG was part of a conspiracy needs to really think about this. Even if MJ had been able to do only half the booked shows (and as I understand, he really cared about his fans, so I'd like to think he'd have gotten in all 40 dates one way or another), he was going to earn a boatload of money for everyone involved. "This is It" shows us what a fantastic show it would have been (not my cup of tea, but many people enjoy the spectacle), it was a first-class production that would have changed the way many performers deliver their craft. Bigger is better may well have become the industry norm.
To suggest a conspiracy of any kind shows a lack of faith in MJ's abilities. There is no way AEG came out on top in all of this. No insurance policy could possibly make up for the loss of revenue MJ would have provided.
Although people do in fact awaken with a sense of alert well being after sedation with Propofol, in that case we are looking at a normal use of the drug (i.e., sedation for a surgical procedure).
We are looking at an isolated event where a person wakens refreshed and more clear headed than for other forms of anesthesia.
We can not transfer that scenario seamlessly into a situation where a general anesthesia state is maintained nightly for 6-8 weeks. In that situation the deprivation of REM sleep that is not available to a person who is fully sedated does have an impact. Must research exists on the mental and physical degradation that REM sleep deprivation can cause.
Johannes Mesherle
Thanks CaliGirl9. If someone had said "taser vs gun; Bart shooting" I would have remembered. I do think you blogged about this a while back.
Where is part 4?
I am so looking forward to Part IV.
This series is excellent.
Thank you again.
Lauren
KZ has written most of PART 4. Still a bit more work to do.
Hopefully, it will be up on the blog late tonight or sometime tomorrow.
KZ:
Can you explain (maybe again) how
the minute amount of propofol may have been found in stomach contents? Of course the defense will jump on this. My thought is
that the level were so high that
it seeped into the stomach or that aggressive CPR and rescue maneuvers caused it. I don't for a
minute believe MJ ingested it.
Thanks for your thoughts.
Lauren
I believe KZ already left a comment (somewhere) that it would not have been pushed into the stomach by the CPR.
Testimony from the prelim by either the coroner or Dr. Ruffalo indicated that the saturation levels can get there through the natural progression of saturation of fluids leaking from other organs/tissues near/beside where it was found.
I hope KZ will expand more on this or clarify where I am wrong.
I wanted to let everyone know that have Part 4 in hand, ready to edit. However, I've come down with a nasty bug/flu and I will start reviewing her article tomorrow and hopefully have it up on the web by early evening.
Thank you everyone, for reading T&T.
Hope you feel better soon, Sprocket.
One thing everyone should keep in mind: The "doctor" will be judged by a jury of his "peers." It certainly will be interesting to see how many and who among his peers would do what he did or did not do that led to the death of his one and only patient.
Anon at 5:33,
I'm not sure from your comment if you reside outdside of the U.S. In the U.S. a "jury of one's peers" does not refer to professional peers. I have long considered the ramifications of how our judicial system would function in the area of malpractice if juries were composed of professional peers of the accused. It might be better, it might be worse. It would certainly be different than what we have now. Currently, both plaintiff and defense utilize "expert witnesses" to interpret specialized information for jury members, who are NOT specialists in the field of the accused. Both sides want "blank slates" on the jury to present their information to, so that pre-conceived ideas or interpretation using specialized knowledge is limited to what has been presented.
A jury of one's peers is a cross section of the general population and demographics in the area in which an accused person is tried. Almost never will a jury include medical or health care professionals in a case trying a health professional or doctor. (They are usually excluded during voir dire.)
Conrad Murray's peers are citizens of L.A. who will be called for jury duty during his trial. They will decide if he is guilty or not guilty of the charges. However, CMs professional peers will demonstrate their approval or disapproval by defending his actions, or distancing themselves from his actions, or soundly criticizing his actions. Silence is also a method of demonstrating disapproval, and I sure don't hear a lot of physicians speaking out to defend CM's actions.
Of note, I recently served as an expert on a civil case involving an advanced practice nurse where a doctor's expert testimony about the nurse's actions was ruled as inadmissible by the judge. The judge ruled that the doctor (who is prominent) could not give an opinion about the scope of practice and standards of care of the advanced practice nurse. He was permitted to render an opinion on the radiological evidence only.
As I was the nurse testifying as an expert, I interpreted that as a very big victory for my profession! (Albeit one that very few people will ever know about!)
KZ,
Are you saying that a doctor is not permitted to give an opinion or assessment on the care provided by a peer?
If not, can you further clarify?
But if so, how is this case supposed to proceed?
Anon @ 6:31 am:
No, that is not what she means. She was explaining a hypothetical.
IF, by chance a random doctor received a jury summons for this trial to show up on March 24th, most likely he would not be approved by either the prosecution or the defense.
Selecting a jury is a drawn-out process where each side, through questioning, is trying to determine if that person is able to weigh the evidence and come to a conclusion favorable to their side. They want to make sure the individual doesn't have any pre-conceived beliefs about drug dependent individuals, doctor/ patient care and/or responsibilities.
At a trial, both parties would want the jury to only consider the testimony from approved experts who testified, and not the personal opinions of a licensed doctor who is part of the jury.
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