13 Oct 2011
Medical peers of Michael Jackson's doctor blast him at trial
LOS ANGELES — Two medical peers of Michael Jackson's personal doctor hammered him at his involuntary manslaughter trial Wednesday, saying the defendant caused the singer's death through "extreme violations" of standards of care.
Alon Steinberg, a cardiologist like defendant Conrad Murray, and Nader Kamangar, an intensive care and sleep medicine specialist, called Murray's treatment of his only patient at the time "unconscionable" and "beyond comprehension."
Jackson died at age 50 on June 25, 2009, of an overdose of propofol, a powerful surgical anesthetic, combined with the effects of sedatives. Murray, 58, who was treating Jackson in his bedroom for insomnia, is accused of involuntary manslaughter. He has pleaded not guilty.
Prosecutors say Murray gave Jackson the lethal doses of drugs. His defense lawyers say Jackson gave himself the medications while Murray was away from the bedside.
In a surprising move before the jury entered court Wednesday, Murray's defense lawyers abandoned a key part of their theory: that Jackson might have died from swallowing propofol on his own.
They told Superior Court Judge Michael Pastor that they accepted results of recent research studies, including one they commissioned, showing that ingesting propofol would have only a slight effect.
Murray's legal team contends that Jackson surreptitiously swallowed massive amounts of the sedative lorazepam and could have injected propofol through an intravenous tube. A deputy medical examiner testifed earlier that Jackson couldn't have done that because he would have been too groggy from other drugs Murray said he had administered.
Prosecutor David Walgren asked Steinberg and Kamangar to explain critical reviews of Murray's conduct that they wrote for the California state medical board in 2009.
Both witnesses said their evaluations were based on Murray's own words —- his interview with police detectives two days after Jackson died.
Murray told the police that after administering propofol, he left a sleeping Jackson for two minutes to use the bathroom and returned to find the patient not breathing.
"When you monitor a patient, you never leave his side, especially after giving propofol," Steinberg said. "It's like leaving a baby sleeping on your kitchen countertop. You would never do it because there's a small — a very, very small — chance that the baby could fall or grab a knife or something."
Leaving the room without an assistant watching Jackson violated the "fundamental basics of the Hippocratic oath … not to abandon your patient," Kamangar said.
Murray told the police he discovered Jackson in distress at about noon. A Jackson security guard, at Murray's request, called 911 at 12:20 p.m. Paramedics arrived six minutes later.
Steinberg said the paramedics, based four minutes away, could have saved Jackson with oxygen-administering equipment and heart-reviving drugs if they had arrived by 12:06 p.m. Professional guidelines, he said, would have allowed Murray to spend no more than two minutes — from noon to 12:02 p.m. — assessing the situation.
At 12:06 p.m., "he's saveable," Steinberg said. If the medics had reached Jackson's mansion by then, he said, "Michael Jackson would still be alive."
Steinberg said he found it "bizarre" that a medical professional did not call 911 as his first action. Kamangar called the delay "an extreme and unconscionable violation of the standard of care."
The singer's parents, Katherine and Joe Jackson, his brother Randy, his sister Rebbie and a niece were in the courtroom.
Steinberg and Kamangar said Murray acted with "gross negligence" in using propofol to treat insomnia, and doing so in a home setting without proper monitoring and resuscitation equipment. Kamangar called the home use "really inconceivable."
Murray's use of propofol for insomnia was "beyond comprehension" and "frankly disturbing," Kamangar said in his report to the medical board.
Murray, who is 6-foot-5, delivered faulty, one-handed CPR on Jackson's soft bed rather than laying the 136-pound Jackson on the floor, Steinberg said. It was "inexcusable," he said, that the doctor performed chest compressions when respiratory arrest, not heart stoppage, was the problem — the heart was still beating, according to Murray's police interview.
Further "egregious" violations of medical standards, the two doctors said, were Murray's failure to get a signed consent form from Jackson for use of propofol, and to keep records of his treatments.
Taken together, Murray's errors were direct causes of Jackson's death, the doctors said.
Cross-examined by defense lawyer J. Michael Flanagan, Steinberg conceded little. He contradicted Flanagan's insistence that Murray gave Jackson a minimal 25-milligram dose of propofol after Jackson begged for it.
Steinberg said he believed from Murray's police interview that he had kept more propofol flowing through a continuous intravenous drip.
Flanagan departed from his client's version of events, asking Steinberg to assume that Murray actually had been absent for five or 10 minutes. Steinberg said Jackson's condition when Murray got back - warm body, faint pulse, heart rate of 122 beats per minute - made him saveable.
Steinberg and Kamangar said it was wrong for Murray to make unapproved use of propofol for insomnia without research justifying its use. The doctors said Murray was performing what amounted to an experiment on Jackson.
After Flanagan cited a Taiwan research study showing that propofol had a 100% success rate in curing a serious form of insomnia in 64 patients, Steinberg responded that the study was published in 2010 — after Jackson's death — and was an experiment conducted in a hospital setting with full monitoring equipment.
Kamangar said Murray erred in treating Jackson's sleeplessness with addictive sedatives without first obtaining a detailed history. A history could rule out "secondary" causes such as depression or substance abuse, underlying conditions that could have been treated with non-addictive drugs, he said.
Steinberg and Kamangar told Walgren that even if the defense was right in saying Jackson fatally took the drugs himself, Murray was responsible because he should have foreseen that risk.
In January, Pastor suspended Murray's California medical license pending completion of the trial.
Defense cross-examination of Kamangar will start Thursday's court session. Pastor said there will be no trial proceedings Friday because of witness-scheduling problems.