Propofol Expert Testifies Against Murray

by John M. Curtis
(310) 204-8700

Copyright October 14, 2011
All Rights Reserved.                                         

          Getting to the heart of the prosecution’s case, propofol expert Columbia University anesthesiology professor Dr. Steven Shafer testified Oct. 13 that Murray lacked the proper monitoring equipment to use propofol safely.  After conducting propofol research in the early ‘90s, Shafer indicated that if physicians are off in the dosing by small amounts it could have catastrophic consequences on patients.  Going  “off by just a little,” patients could take hours, not minutes, to recover from a drug-induced anesthesia.  When Los Angeles County Coroner announced Aug. 24, 2009 that Michael Jackson died from acute propofol intoxication, Murray’s defense got a lot more complicated.  Murray’s defense team led by Ed Chernoff wanted to argue that Jackson self-administered his own lethal propofol dose.  They’re now considering alternative scenarios and explanations.

            Pressed by co-defense counsel Michael Flanagan about responsibility, if, hypothetically, Jackson self-administered his own lethal dose, sleep specialist Dr. Nader Kamangar emphatically told the jury the fault was still with Murray.  Because it’s difficult to self-administer a lethal dose of propofol, Murray’s defense team now wants to attribute Jackson’s death to the so-called “synergistic effect.”  When drugs are used in combination it’s difficult to attribute which drug caused Jackson’s respiratory or cardiac arrest.  “Is it your position that even if Michael Jackson self-medicated with excessive amounts of lorazapam . . . pushed 25 milligrams of propofol, Dr. Murray is still responsible for his death,?” asked Flanagan.  “Absolutely,” responded Kamangar. Flanagan then asked Kamangar about a hypothetical situation involving a normal month’s supply of sleep meds.

            If the patient takes all the pills at once against doctor’s orders, overdoses and dies, is the doctor still responsible for the patient’s death?  Before Kamangar could answer, a prosecutor objected to the question and the Judge Michael Pastor sustained the objection, preventing Kamangar from answering.  If Flanagan’s hypothetical could have been the prosecution’s last nail in the defense’s coffin.  Flanagan’s question of who’s responsible for suicidal drug overdoses goes to the heart of how the Murray trials crosses the line from medical malpractice to criminal behavior.  Had Kamangar simply said “no” to Flanagan’s question with respect to whether or not the doctor’s responsible for patients’ overdoses, it could have settled the case.  Kamangar’s “no” answer would have opened a discussion over usual and customary treatments for insomnia.  There’s nothing conventional about Murray’s propofol drip.

            Whether Jackson was using lorazapam or any other prescribed medication doesn’t get Murray off the hook.  Murray’s defense team aren’t experts and can’t repudiate the coroner’s Aug. 24, 2009 report that identified propofol as the culprit causing Jackson’s respiratory arrest.  Suggesting to jurors that other drugs in Jackson’s system could have precipitated Jackson’s death is a clever tactic but can’t reverse the best medical evidence.  Prosecutors should have jumped at the chance to hear Kamangar say, even with a self-administered overdose, Murray was still responsible.  Kamangar should have pointed out that there’s not known treatment for insomnia using propofol, precisely  because it’s a dangerous anesthetic that could cause a patient’s death.  Kamangar made the point that doctors can never acquiesce to patients’ demands, no matter how well-intentioned, desperate or demanding.

            Kamangar made the point that doctors must draw the line when patients make demands.  Even if Jackson begged for propofol, Kamangar believes a doctor must resist the temptation to accommodate patients’ demands.  “No matter how much the patient may complain, no matter how much the patient may beg, you as the doctor should say no,” asked Deputy DA David Walgren.  “That’s correct,” replied Kamangar, telling the jury that Murray’s decision to provide Jackson was a propofol drip was inappropriate.  Jurors need to hear directly from experts that using propofol to treat Jackson’s insomnia by Murray or anyone else was “reckless negligence,” crossing the criminal line.  All the talk about hypothetical drug overdoses could have clarified the line crossed by Murray from medical malpractice to criminal behavior.  Whether Murray gave Jackson too much or too little propofol is not relevant.

            Prosecutors need to get clear that “gross negligence” isn’t enough to convict Murray of involuntary manslaughter.  Most malpractice cases involve gross negligence, a kind of professional incompetence and bungling.  What makes Murray’s case criminal is not “gross negligence” but instead “reckless negligence.”  Murray, in effect, hit Jackson in the crosswalk while legally drunk.  Using propofol to treat Jackson’s insomnia was a reckless act that caused Jackosn’s death.  It doesn’t really matter whether the dose was too high to low, whether Murray had proper monitoring equipment or whether he took appropriate life-saving steps after he found Jackson not breathing.  “In this case, Conrad Murray was grossly negligent in multiple instances and that gross negligence directly caused the death of Michael Jackson, is that correct,” Flanagan asked Kamangar.  “That’s correct,” said the expert.

John M. Curtis writes politically neutral commentary analyzing spin in national and global news.  He's editor of OnlineColumnist.com.and author of Dodging the Bullet and Operation Charisma.

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