CHRISTOPHER ROGERS
(LA Co. Deputy Coroner performed autopsy on Michael Jackson)
CALLED ON BEHALF OF THE PEOPLE, HAVING BEEN FIRST DULY SWORN, WAS EXAMINED AND TESTIFIED AS FOLLOWS:
DIRECT EXAMINATION BY MR. WALGREN:
Q GOOD MORNING, DOCTOR.
A GOOD MORNING.
Q SIR, WHERE ARE YOU EMPLOYED?
A AT THE LOS ANGELES COUNTY CORONER.
Q WHAT IS YOUR POSITION THERE?
A I’M THE CHIEF OF FORENSIC MEDICINE.
Q WHAT ARE THE RESPONSIBILITIES OF THE CHIEF OF FORENSIC MEDICINE?
A I SUPERVISE THE DOCTORS WHO WORK AT THE CORONER’S OFFICE. ALSO, AT TIMES, I DO AUTOPSIES MYSELF.
Q HOW LONG HAVE YOU BEEN EMPLOYED WITH THE L.A. COUNTY CORONER’S OFFICE?
A SINCE 1988.
Q AS A FORENSIC PATHOLOGIST?
A YES.
Q WHAT IS A FORENSIC PATHOLOGIST?
A THAT IS A PATHOLOGIST WHO SPECIALIZES IN MEDICO-LEGAL WORK OR CORONER TYPE WORK.
Q COULD YOU ELABORATE ON THAT. WHEN YOU SAY SPECIALIZE IN, WHAT DOES A FORENSIC PATHOLOGIST DO?
A A FORENSIC PATHOLOGIST DETERMINES THE CAUSE AND MANNER OF DEATH IN CORONER’S CASES, AND THEN WRITE REPORTS WHICH DESCRIBE THE AUTOPSY FINDINGS AND ALSO THE OPINION.
Q WHAT, SIR, IS YOUR EDUCATIONAL BACKGROUND THAT PREPARED YOU TO START THAT CAREER IN 1988?
A I ATTENDED MEDICAL SCHOOL AT THE UNIVERSITY OF CALIFORNIA SAN DIEGO. I DID PATHOLOGY RESIDENCY AT LOS ANGELES COUNTY USC MEDICAL CENTER, AND TRAINED IN FORENSIC PATHOLOGY AT LOS ANGELES COUNTY CORONER. AND I’M BOARD CERTIFIED IN FORENSIC PATHOLOGY.
Q OF COURSE, YOU ARE A MEDICAL DOCTOR?
A YES.
Q APPROXIMATELY FROM 1988 TO THE CURRENT TIME, APPROXIMATELY HOW MANY AUTOPSIES HAVE YOU EITHER PERSONALLY PERFORMED OR BEEN INVOLVED IN?
A I WOULD ESTIMATE THOUSANDS.
Q WHAT IS AN AUTOPSY?
A AN AUTOPSY IS AN EXAMINATION OF THE OUTSIDE OF THE DECEASED PERSON AS WELL AS EACH OF THE INTERNAL ORGANS.
Q THE PURPOSE OF AN AUTOPSY THEN IS TO DETERMINE CAUSE AND MANNER OF DEATH?
A YES.
Q DID YOU PERFORM THE AUTOPSY IN THIS PARTICULAR CASE INVOLVING DECEDENT, MICHAEL JACKSON?
A YES.
Q THAT BEARS AN AUTOPSY CASE NUMBER OF 2009-04415?
A THAT’S CORRECT.
Q ON WHAT DATE DID YOU PERFORM THAT AUTOPSY?
A JUNE 26, 2009.
Q INITIALLY, LET ME ASK YOU, WERE YOU ABLE TO DRAW ANY CONCLUSIONS OR MAKE OBSERVATIONS REGARDING THE GENERAL HEALTH OF MICHAEL JACKSON AT THE TIME OF HIS DEATH?
A YES.
Q CAN YOU EXPLAIN YOUR OBSERVATIONS AND/OR CONCLUSIONS IN REGARD TO HIS GENERAL HEALTH?
A THE AUTOPSY DID SHOW SOME INCIDENTAL FINDINGS. HOWEVER, HIS GENERAL HEALTH WAS EXCELLENT.
Q THE INCIDENTAL FINDINGS WERE WHAT?
A HE HAD PROSTATIC HYPERPLASIA, ENLARGEMENT OF THE PROSTATE GLAND. HE ALSO HAD VITILIGO, WHICH IS A CONDITION THAT CAUSES DEPIGMENTATION OF THE SKIN. HE HAD A POLYP OF THE COLON. AND THEN HE HAD SOME INFLAMMATION AND SCARRING OF HIS LUNGS, AND HE ALSO HAD SOME ARTHRITIS NOTABLY IN HIS SPINE.
Q HOW TALL WAS MICHAEL JACKSON?
A HE WAS FIVE FOOT NINE.
Q HOW MUCH DID HE WEIGH AT THE TIME OF AUTOPSY?
A 136 POUNDS.
Q WHAT IS B.M.I.?
A THAT STANDS FOR BODY MASS INDEX. THAT IS A NUMBER THAT IS OFTEN USED TO ESTIMATE WHETHER A PERSON IS IN THE NORMAL WEIGHT RANGE.
Q FROM YOUR OBSERVATIONS OF MICHAEL JACKSON, WAS HE A THIN INDIVIDUAL?
A YES.
Q DID YOU DRAW ANY CONCLUSIONS REGARDING HIS B.M.I., HIS BODY MASS INDEX?
A I CALCULATE HIS BODY MASS INDEX AS 20.1.
Q WHERE DOES THAT FALL IN THE RANGE OF THE BODY MASS INDEX AS TO WHETHER IT IS NORMAL OR NOT?
A THAT IS A NORMAL WEIGHT.
Q NOW, YOU TESTIFIED THAT HIS GENERAL HEALTH WAS EXCELLENT. LET ME ASK YOU SPECIFICALLY ABOUT HIS HEART. DID YOU MAKE OBSERVATIONS ABOUT THE STRENGTH OR VITALITY OF HIS HEART?
THE COURT: IF YOU NEED TO REFRESH YOUR RECOLLECTION BY LOOKING AT YOUR REPORT —
THE WITNESS: YES. I HAVE BEFORE ME A COPY OF THE CORONER’S REPORT WHICH I’M USING. I DID MAKE OBSERVATIONS OF THE HEART.
Q BY MR. WALGREN: WHAT WERE THOSE OBSERVATIONS, DR. ROGERS?
A THAT HE DID NOT HAVE ANY ABNORMALITIES OF THE HEART AND, IN PARTICULAR, HE DID NOT HAVE CORONARY ARTERY ATHEROSCLEROSIS WHICH IS A SURPRISING FINDING.
Q WHY WAS THAT SURPRISING?
A BECAUSE VIRTUALLY EVERYBODY, PARTICULARLY PEOPLE AT HIS AGE OF 50, HAS SOME ATHEROSCLEROSIS.
Q SO HOW WOULD YOU CHARACTERIZE THE STRENGTH AND/OR VITALITY OF HIS HEART?
A HE DID NOT HAVE ANY CARDIAC DISEASE.
Q DID YOU OBSERVE IN YOUR AUTOPSY OF MICHAEL JACKSON THEN ANY TRAUMA OR ANY NATURAL DISEASE THAT WOULD HAVE CAUSED HIS DEATH?
A NO.
Q NOW, AS PART OF YOUR INVESTIGATION AS A MEDICAL DOCTOR IN DETERMINING THE CAUSE OF DEATH, DID YOU CONSIDER SOURCES IN ADDITION TO YOUR PHYSICAL OBSERVATIONS OF THE DECEDENT’S BODY
A YES.
Q — AND ORGANS?
A YES.
Q WERE YOU PROVIDED A TRANSCRIPT OF DR. MURRAY’S INTERVIEW WITH THE POLICE?
A YES.
Q DID YOU CONSULT WITH OUTSIDE EXPERTS IN VARIOUS FIELDS OF MEDICINE?
A YES.
Q DID YOU ALSO CONSULT AND CONSIDER THE TOXICOLOGY FINDINGS AS TO WHAT WAS FOUND IN THE BLOOD OF MICHAEL JACKSON AT THE TIME OF HIS DEATH?
A YES, I DID.
Q AND BASED ON YOUR CONSULTATIONS AND YOUR REVIEW OF MATERIALS, DID YOU ALSO SEEK OUT MEDICAL RECORDS PERTAINING TO DR. MURRAY’S CARE OF MICHAEL JACKSON DURING THIS TIME PERIOD OF JUNE 2009 AND THE MONTHS PRECEDING THAT?
A YES.
Q DID YOU OR WERE YOU PROVIDED BY ANY SOURCE ANY MEDICAL RECORDS DOCUMENTING THE CARE GIVEN BY DR. MURRAY TO MICHAEL JACKSON DURING THIS TIME PERIOD OF APRIL, MAY AND JUNE OF 2009?
A NO.
Q BASED ON YOUR PHYSICAL AUTOPSY, YOUR OBSERVATIONS, AS WELL AS THE OTHER RESOURCES AND SOURCES THAT YOU RELIED UPON, DID YOU DRAW A CONCLUSION AND DETERMINE THE MANNER OF DEATH?
A YES.
Q WHAT WAS THAT?
A THAT IT WAS HOMICIDE.
Q YOUR FINDING THIS WAS A HOMICIDE WAS BASED ON WHAT?
A IT WAS BASED PRIMARILY ON THE INFORMATION THAT WE HAD ABOUT THE MEDICAL CARE THAT MR. JACKSON RECEIVED. SPECIFICALLY, THAT THE CARE WAS SUBSTANDARD AND THERE WERE —
Q WHEN YOU SAY THE CARE WAS SUBSTANDARD, YOU MEAN THE CARE PROVIDED BY DR. MURRAY, THE DEFENDANT IN THIS CASE?
A YES.
Q YOU BEGAN WITH, “THE CARE WAS SUBSTANDARD AND –“
A AND THERE WERE SEVERAL ACTIONS THAT SHOULD HAVE BEEN TAKEN, BUT WE DON’T HAVE ANY EVIDENCE THAT THEY WERE TAKEN IN THIS CASE.
Q SUCH AS?
A WELL, THE FIRST WOULD BE THAT A PHYSICIAN SHOULD NOT USE PROPOFOL UNLESS IT IS INDICATED. SO IN THIS CASE, THE USE OF PROPOFOL WAS FOR INSOMNIA, WHICH IS NOT AN INDICATION. THE SECOND ISSUE IS THAT WHEN YOU GIVE A DRUG SUCH AS PROPOFOL, YOU HAVE TO BE PREPARED TO TREAT THE COMPLICATIONS. SO COMMON COMPLICATIONS, FOR EXAMPLE, ARE LOWERING OF BLOOD PRESSURE, AND YOU NEED TO BE PREPARED TO TREAT THAT WITH APPROPRIATE MEDICATIONS. ALSO THERE CAN BE DIFFICULTY IN BREATHING OR OBSTRUCTION OF THE AIRWAY. YOU NEED TO BE ABLE TO TREAT THAT, IF NECESSARY, BY INTUBATING THE PATIENT. IN ADDITION, THE INFORMATION THAT WE RECEIVED INDICATES THAT THE DOCTOR LEFT MR. JACKSON WHILE HE WAS ANESTHETIZED. THIS IS SOMETHING THAT YOU WOULD NOT DO.
Q WHY WOULD YOU NOT LEAVE YOUR PATIENT WHEN HE IS UNDER ANESTHESIA?
A WELL, BECAUSE IN A PATIENT UNDER ANESTHESIA, BAD THINGS CAN HAPPEN VERY QUICKLY. YOU NEED TO HAVE SOMEONE WHO IS STANDING THERE MONITORING THE PATIENT SO THAT IF THERE IS SOME BAD SIDE EFFECT, THEN YOU COULD RESPOND TO IT.
Q NOW, IN ADDITION TO DETERMINING THIS WAS A HOMICIDE, DID YOU MAKE SPECIFIC FINDINGS AS TO THE CAUSE OF DEATH?
A YES.
Q DR. ROGERS, WHAT WAS THE CAUSE OF MICHAEL JACKSON’S DEATH?
A HE DIED OF AN ACUTE PROPOFOL INTOXICATION AND THE CONTRIBUTING CONDITION WAS BENZODIAZEPINE EFFECT.
Q WHAT DO YOU MEAN BY BENZODIAZEPINE EFFECT?
A TOXICOLOGY SHOWED SEVERAL BENZODIAZEPINES IN HIS SYSTEM, AND SPECIFICALLY THERE WAS A MINOR AMOUNT OF DIAZEPAM OR VALIUM. THERE WAS SOME LORAZEPAM, AND ALSO THERE WAS SOME MIDAZOLAM.
Q AND IN CONSIDERING THAT THE BENZODIAZEPINES WERE IN MICHAEL JACKSON’S SYSTEM IN ADDITION TO THE PROPOFOL, WHAT IS THE CONTRIBUTORY EFFECT THAT YOU ARE COMMENTING UPON?
A BOTH THE BENZODIAZEPINES AND THE PROPOFOL ARE SEDATIVE MEDICATIONS. SO EVERYTHING IS KIND OF GOING IN THE DIRECTION OF ADDITIONAL SEDATION.
Q IS IT FAIR TO SAY THEN THIS COMBINED EFFECT OF THE BENZODIAZEPINES IN ADDITION TO THE PROPOFOL, THEY COMBINE AND WORK TOGETHER TO PRODUCE HEIGHTENED SEDATION ALL WORKING IN UNISON?
A YES. I WOULD EXPECT THE COMBINATION TO PRODUCE MORE SEDATION THAN EITHER OF THOSE BY ITSELF.
MR. WALGREN: THANK YOU, DR. ROGERS. NOTHING FURTHER, YOUR HONOR.
CROSS-EXAMINATION
BY MR. FLANAGAN:
Q DOCTOR, YOUR CONCLUSION AS TO THIS BEING A HOMICIDE ASSUMES THE ADMINISTRATION OF PROPOFOL BY ANOTHER, DOESN’T IT?
A YES.
Q NOW, YOU HAVE MADE SEVERAL FINDINGS IN YOUR CONCLUSION. IS IT A FACT YOU ASSUME THAT CIRCUMSTANCES INDICATED THAT PROPOFOL AND BENZODIAZEPINES WERE ADMINISTERED BY ANOTHER?
A YES.
Q YOU ALSO CONCLUDED THAT PROPOFOL WAS 5 ADMINISTERED IN A NON-HOSPITAL SETTING WITHOUT ANY APPROPRIATE MEDICAL INDICATION?
A YES.
Q DID YOU ALSO CONCLUDE THE STANDARD OF CARE FOR ADMINISTERING PROPOFOL WAS NOT MET, IN THAT THE RECOMMENDED EQUIPMENT FOR PATIENT MONITORING AND RESUSCITATION WAS NOT PRESENT?
A YES.
Q AND LASTLY, YOU ALSO IN YOUR CONCLUSION STATED CIRCUMSTANCES DO NOT SUPPORT SELF-ADMINISTRATION OF PROPOFOL?
A YES.
Q DOCTOR, IN YOUR REVIEW OF THE SYSTEMS OF MICHAEL JACKSON AND YOUR REVIEW OF THE TOXICOLOGY, DID YOU COME ACROSS ANY FACTORS THAT YOU FELT WERE INCONSISTENT WITH YOUR CONCLUSIONS?
A NO, I DON’T BELIEVE SO.
Q DOCTOR, I WANT TO REFER YOU TO — I BELIEVE YOU HAVE IT IN YOUR AUTOPSY REPORT IN FRONT OF YOU. IT MIGHT BE ABOUT THE SECOND TO THE LAST PAGE. I’LL PUT IT UP THERE FOR THE COURT TO BE ABLE TO SEE. DO YOU HAVE THAT PAGE IN MIND, DOCTOR?
A YES.
Q DO YOU HAVE IT IN FRONT OF YOU IN YOUR REPORT?
A YES.
Q DID YOU CONSIDER THIS PAGE IN FORMING YOUR OPINION?
A YES.
Q NOW, DOCTOR, WE HAVE GOT A MEASUREMENT OF THE HEART BLOOD WHICH SAYS 3.2 PROPOFOL AND 0.68 LIDOCAINE. DO YOU SEE THAT?
A YES.
THE COURT: FOR THE RECORD, WHICH EXHIBIT?
MR. FLANAGAN: THIS IS EXHIBIT 68.
THE COURT: THANK YOU.
Q BY MR. FLANAGAN: TELL ME, HOW DO DRUGS GET INTO THE HEART BLOOD?
A WELL, IN THIS SETTING, PROPOFOL HAS TO BE ADMINISTERED INTRAVENOUSLY. SO FOLLOWING INTRAVENOUS ADMINISTRATION, IT WOULD CIRCULATE THROUGH THE BODY.
Q I WAS KIND OF ASKING YOU A GENERAL QUESTION ABOUT DRUGS. HOW DO THEY GET IN THE BLOODSTREAM?
A WELL, THEY HAVE TO COME IN BY SOME MEANS. EITHER HAVE TO BE TAKEN ORALLY, OR INTRAVENOUSLY, INTRAMUSCULARLY THROUGH THE SKIN. THERE HAS TO BE SOME WAY THEY GET IN THERE.
Q SO THE DRUGS CAN COME IN THROUGH AN I.V.?
A YES.
Q THEY CAN ALSO COME IN THROUGH AN INJECTION?
A YES.
Q THE MOST COMMON METHOD OF GIVING DRUGS INTO A BLOODSTREAM, THOUGH, WOULD PROBABLY BE ORALLY, WOULDN’T IT?
A IF WE SPEAK IN GENERAL, YES.
Q AND NOW WE HAVE GOT, IF YOU GO ON DOWN A LITTLE BIT FURTHER, AND IT SAYS LORAZEPAM 0.162?
A YES.
Q IN THE HEART BLOOD?
THE COURT: IS THAT RIGHT, IN THE HEART BLOOD?
THE WITNESS: YES, THAT’S CORRECT.
Q BY MR. FLANAGAN: FIRST OF ALL, THE 0.162 LEVEL OF LORAZEPAM, I BELIEVE THAT IS NANOGRAMS PER MILLILITER. THAT IS A SIGNIFICANT AMOUNT OF LORAZEPAM, ISN’T IT?
A YES. I WOULD EXPECT IT TO HAVE A PHARMACOLOGIC EFFECT.
Q THAT IS WHAT WE WOULD CALL A THERAPEUTIC DOSE?
A YES.
Q AND A NORMAL PERSON WHO HAS NOT BUILT UP A GREAT TOLERANCE WOULD BE SLEEPING WITH THAT AMOUNT OF LORAZEPAM, WOULDN’T THEY?
A THAT IS LIKELY, YES.
Q AND THAT IS ENOUGH TO PUT A PERSON TO SLEEP IF THEY WANT A SLEEPING AID?
A YES.
Q IT IS NOT ENOUGH TO KILL A PERSON, THOUGH, IS IT?
A NOT BY ITSELF, NO.
Q DO YOU NOTICE THAT THE RELATIONSHIP BETWEEN PROPOFOL AND LIDOCAINE IN THAT HEART BLOOD IS APPROXIMATELY A FOUR-AND-A-HALF TO ONE RELATIONSHIP. PROPOFOL MORE THAN LIDOCAINE?
A YES.
Q IF WE MOVE OVER TO THE NEXT COLUMN, WE HAVE THE HOSPITAL BLOOD. THAT IS 4.1 PROPOFOL?
A YES.
Q AND 0.51 LIDOCAINE. THAT IS THE RELATIONSHIP OF ABOUT EIGHT TO ONE, ISN’T IT?
A YES.
Q HOW WOULD YOU EXPLAIN THE DIFFERENCES IN THE FOUR-AND-A-HALF TO ONE VERSUS EIGHT TO ONE. WHY WOULD THERE BE A DIFFERENCE?
A ONE OF THE THINGS THAT PROPOFOL DOES WHEN IT ENTERS THE BODY IS IT GOES FROM THE CIRCULATION INTO THE TISSUES. AND SO THIS HOSPITAL BLOOD IS TAKEN PRESUMABLY DURING RESUSCITATION, AND I BELIEVE THERE WAS SOME RESUSCITATION AFTER THAT ALSO. AND SO DURING THE RESUSCITATION AND ALSO DURING THE POSTMORTEM PERIOD, THERE MAY BE TIME FOR THE PROPOFOL TO MOVE FROM THE CIRCULATION INTO THE TISSUES.
Q WHERE IS THE HOSPITAL BLOOD TAKEN FROM?
A I DON’T RECALL WHERE THE HOSPITAL GOT IT. WE GOT IT FROM THE HOSPITAL.
Q YOU GOT IT FROM THE HOSPITAL, BUT THE HOSPITAL — I MEAN, WOULD IT MOST LIKELY BE OUT OF THE VENOUS SYSTEM, ANA-CUBITAL VEIN?
MR. WALGREN: CALLS FOR SPECULATION.
THE COURT: I WILL SUSTAIN THE OBJECTION. CALLS FOR SPECULATION.
Q BY MR. FLANAGAN: YOU HAVE NO IDEA WHERE THE HOSPITAL WOULD TAKE A BLOOD SAMPLE?
A THAT IS CORRECT.
Q IS THERE A MORE COMMON THAN NOT LIKELIHOOD OF WHERE THEY WOULD TAKE IT?
A WELL, POSSIBILITY IN THIS CASE WOULD BE THE VENOUS SYSTEM OR ALSO THE ARTERIAL SYSTEM, BECAUSE THEY HAD SOME CATHETERS IN THE ARTERIES.
Q NOW, I NOTICE WHEN IT COMES TO HOSPITAL BLOOD, THAT WHEN IT COMES TO NORDIAZEPAM, LORAZEPAM, MIDAZOLAM, EPHEDRINE, THERE IS JUST A DASH THERE. DOES IT MEAN THOSE SUBSTANCES WEREN’T TESTED FOR IN THE HOSPITAL BLOOD?
MR. WALGREN: OBJECTION. THIS IS BEYOND HIS AREA OF EXPERTISE AND SCOPE.
THE COURT: I’LL OVERRULE THE OBJECTION. BASED UPON YOUR EXPERIENCE, CAN YOU OFFER AN ANSWER OR NOT?
THE WITNESS: I CAN ANSWER THE QUESTION, YES. THIS WOULD INDICATE THAT THE BOTTOM FOUR SUBSTANCES WERE NOT TESTED IN THE HOSPITAL BLOOD.
Q BY MR. FLANAGAN: NOW, MOVING ON TO THE FEMORAL BLOOD, THAT IS 2.6 PROPOFOL MICROGRAMS PER MILLILITER?
A YES.
Q AND THE LIDOCAINE IS 0.84 MICROGRAMS; IS THAT CORRECT?
A YES.
Q THE LORAZEPAM WAS 0.169?
A THAT’S CORRECT.
Q THE OTHER SUBSTANCES WERE NOT TESTED?
A THAT’S CORRECT.
Q NOW, THE FEMORAL BLOOD IS IN RELATIONSHIP OF THREE TO ONE WITH THE LIDOCAINE IN THE FEMORAL BLOOD; IS THAT CORRECT?
A YES.
Q DO YOU KNOW WHERE THE FEMORAL BLOOD WOULD BE TAKEN FROM?
A THE FEMORAL BLOOD WAS TAKEN AT AUTOPSY FROM THE FEMORAL VEIN.
Q WAS THAT TAKEN BY YOU?
A YES.
Q WHY DO YOU NEED MORE THAN ONE SOURCE OF BLOOD?
A AT TIMES, THERE CAN BE POSTMORTEM REDISTRIBUTION EFFECTS WHICH MAKE THE AMOUNT OF DRUG IN THE HEART BLOOD DIFFERENT FROM THE AMOUNT OF DRUG IN THE PERIPHERAL OR FEMORAL BLOOD. SO WE GET BOTH OF THOSE.
Q BUT THE LORAZEPAM READING IN THE HEART AT 0.162 AND THE FEMORAL BLOOD AT 0.169, THOSE ARE FAIRLY CONSISTENT RESULTS?
A YES.
Q FROM THAT, WOULD YOU KIND OF CONCLUDE THE LORAZEPAM WAS FAIRLY EVENLY DISTRIBUTED THROUGHOUT THE BLOOD SYSTEM?
A AT THESE TWO SITES, YES.
Q THE VITREOUS THAT WAS ANALYZED, WHY DO YOU ANALYZE THE VITREOUS FOR PROPOFOL?
A WE DRAW VITREOUS BECAUSE THE VITREOUS FLUID IS A RELATIVELY PROTECTED SITE. IT IS NOT AS SUBJECT TO DEGRADATION AS OTHER SITES. NOW, I’M NOT CERTAIN WHY IN THIS CASE THE TOXICOLOGIST TESTED IT.
Q SO THAT ONE DID PLAY A PART IN YOUR OPINION?
A THAT’S CORRECT.
Q THE LIVER. YOU ANALYZED THE LIVER, AND YOU FOUND THAT IT WAS A 6.2 PROPOFOL TO 0.45 LIDOCAINE. THAT IS ABOUT A 12 TO ONE RATIO, CORRECT?
A YES.
Q IS THAT BECAUSE THE LIVER CAPTURES MORE PROPOFOL BECAUSE THAT IS WHERE A LOT OF IT IS METABOLIZED?
A YES. THE LIVER IS ONE OF THE TISSUES THAT CAN RECEIVE PROPOFOL FROM THE CIRCULATION.
Q SO THE PROPOFOL THAT IS CIRCULATING THROUGH THE BLOOD, AS THE HEART BLOOD AND HOSPITAL BLOOD AND FEMORAL BLOOD, THE LIVER MIGHT CAPTURE A LITTLE BIT OF IT AND KEEP IT?
A YES.
Q GOING ON TO THE NEXT COLUMN, WE HAVE GASTRIC CONTENTS. NOW, THE GASTRIC CONTENTS WERE DISCOVERED BY YOU DURING THE AUTOPSY; IS THAT CORRECT?
A YES.
Q THOSE GASTRIC CONTENTS, ARE THOSE THE CONTENTS THAT ARE REFERRED TO IN YOUR AUTOPSY REPORT AS THE 70 GRAMS OF DARK FLUID?
A YES.
Q THE DARK FLUID, HOW DID YOU GET THAT OUT OF THE STOMACH?
A DURING THE EARLY PART OF THE AUTOPSY, I OPENED THE STOMACH AND THEN USED A LADLE TO REMOVE THE STOMACH CONTENTS AND PUT IT IN A TOXICOLOGY CONTAINER.
Q YOU HAVE DESCRIBED IT HERE AS A DARK FLUID. BASED UPON YOUR TRAINING AND EXPERTISE, MAYBE PRIOR OCCASIONS, DID YOU HAVE AN OPINION AS TO WHAT THAT DARK FLUID WAS?
A NO.
Q YOU WOULD HAVE RECOGNIZED IT IF IT WAS BLOOD, WOULDN’T YOU?
A IF IT WERE GROSS BLOOD. NOW, DIGESTED BLOOD IS A BIT MORE DIFFICULT BECAUSE IT MAY BE DIFFICULT TO TELL THE DIFFERENCE BETWEEN DIGESTED BLOOD, FOR EXAMPLE, AND COCA COLA IF IT IS VERY THIN.
Q SO DO YOU KNOW WHETHER OR NOT THIS DARK FLUID THAT WAS IN THE STOMACH WAS — COULD IT HAVE BEEN FRUIT JUICE?
A AS FAR AS I KNOW, IT COULD HAVE BEEN.
Q IT COULD HAVE BEEN BEET JUICE, OR GRAPE JUICE, OR SOMETHING?
A SOME KIND OF DARK JUICE, YES.
Q NOW, YOU ASKED THE CORONER OR THE TOXICOLOGIST, MS. LINTEMOOT, AND MR. FU TO ANALYZE THE CONTENTS OF THAT, TOO, DIDN’T YOU?
A I DID NOT SPECIFICALLY ASK THEM TO ANALYZE THE STOMACH CONTENTS, BUT THEY DID.
Q THEY DID?
A YES.
Q THEY FOUND IN THE STOMACH THERE WAS 0.13 MILLIGRAMS OF PROPOFOL AND 1.6 MILLIGRAMS OF LIDOCAINE; IS THAT CORRECT?
A YES.
Q HOW DO THINGS GET INTO THE STOMACH?
A IN THIS CASE, THERE ARE TWO MECHANISMS. ONE IS THAT IF THERE IS BLEEDING INTO THE STOMACH OR IF SOME BLOOD GETS MIXED WITH THE STOMACH CONTENTS DURING AUTOPSY, WHATEVER IS IN THE BLOOD WOULD APPEAR IN THE STOMACH CONTENTS. ANOTHER POSSIBILITY IS THAT THINGS, DRUGS, CAN COME INTO THE STOMACH FROM ADJACENT ORGANS.
Q IS THERE ALSO ANOTHER METHOD THAT THINGS COULD GET INTO THE STOMACH?
A WELL, SPEAKING OF THESE PARTICULAR SUBSTANCES, I BELIEVE THAT IT IS POSSIBLE TO TAKE LIDOCAINE ORALLY. I DON’T THINK YOU WOULD TAKE PROPOFOL ORALLY.
Q WHY WOULDN’T YOU TAKE PROPOFOL ORALLY?
A MY UNDERSTANDING IS THAT IT HAS TO BE GIVEN INTRAVENOUSLY. I’M NOT SURE WHY THAT IS. I SUPPOSE IT HAS TO DO WITH THE PHARMACOLOGY OF PROPOFOL.
Q FOR IT TO HAVE THE SAME EFFECT, IT WOULD BE CERTAINLY MORE EFFECTIVE TO INJECT IT BY WAY OF I.V. THAN ORALLY, WOULDN’T IT?
A I BELIEVE SO, YES.
Q BUT IN THE EVENT THE PROPOFOL WERE TAKEN ORALLY, THAT IS ONE WAY IT COULD APPEAR IN THE STOMACH, ISN’T IT?
A YES. IN THAT CASE, IT WOULD APPEAR IN THE STOMACH.
Q AND PROPOFOL, WHEN IT IS TAKEN, INJECTED IN THE VEIN, IT CAUSES A BURNING SENSATION, DOESN’T IT?
A YES.
Q IT IS VERY UNCOMFORTABLE, CORRECT?
A YES, I HAVE HEARD THAT.
Q SO AS A NORMAL METHOD OF GIVING PROPOFOL IN A VEIN, IT IS EITHER MIXED WITH SOME LIDOCAINE OR SOME LIDOCAINE IS PUT IN AHEAD OF THE PROPOFOL, ISN’T IT?
A YES.
Q NOW, IF PROPOFOL WERE TAKEN ORALLY, THAT WOULD CAUSE PAIN IN THE ESOPHAGUS AND THE STOMACH, WOULDN’T IT?
A I DON’T KNOW.
Q NOW, IF THE PROPOFOL CAME INTO THE STOMACH FROM THE BLOOD SYSTEM, YOU WOULD EXPECT A SIMILAR RELATIONSHIP IN THE STOMACH CONTENTS WITH THE OTHER, WITH THE DRUGS THAT ARE IN THE BLOOD SYSTEM, WOULDN’T YOU?
A YOU WOULD EXPECT THAT WHEN IT INITIALLY CAME IN, YES.
Q SO IF PROPOFOL IS FOUR-AND-A-HALF TO ONE, EIGHT TO ONE, THREE TO ONE, AND 12 TO ONE IN THE REST OF THE BODY, FAVORING PROPOFOL OVER LIDOCAINE, YOU WOULD EXPECT THAT IF THE GASTRIC CONTENT CAME FROM THE BLOOD SYSTEM, THAT IT WOULD MOST LIKELY FAVOR PROPOFOL OVER LIDOCAINE THERE, TOO, WOULDN’T YOU?
A I WOULD NOT NECESSARILY EXPECT THAT FOR A COUPLE OF REASONS. NUMBER ONE, BECAUSE THERE CAN BE POSTMORTEM REDISTRIBUTION OF VARIOUS MEDICATIONS AND PROPOFOL MAY NOT REDISTRIBUTE IN THE SAME WAY AS LIDOCAINE DOES. NUMBER TWO, I’M NOT CERTAIN WHETHER LIDOCAINE WAS USED IN RESUSCITATION HERE. IT IS A COMMON DRUG IN THAT CONTEXT.
Q LET’S ASSUME IT WAS NOT USED IN RESUSCITATION. YOU HAVE READ ALL THE REPORTS ON RESUSCITATION, CORRECT?
A I HAVE READ THE MEDICAL RECORDS.
Q UCLA MEDICAL CENTER, WHEN THEY ARE RESUSCITATING, WHEN THE FIRE DEPARTMENT IS RESUSCITATING, THEY WRITE DOWN ALL OF THE CHEMICALS THEY USE, DON’T THEY?
A YES.
Q THERE WAS NEVER ANY LIDOCAINE USED, WAS THERE?
A NO, I DIDN’T FIND ANY MENTION OF THAT.
Q IS IT YOUR POSITION THAT PROPOFOL IN ITS REDISTRIBUTION PROCESS POSTMORTEM WOULD GO INTO WHATEVER THAT 70 GRAMS OF LIQUID WAS, DARK LIQUID WAS, IN THE STOMACH?
A I BELIEVE THAT IS QUITE POSSIBLE, YES.
Q IT IS A POSSIBILITY?
A YES.
Q IT IS ALSO POSSIBLE THE PROPOFOL WAS TAKEN ORALLY AND LIDOCAINE PUT IN ON TOP OF IT. IS THAT ALSO A POSSIBILITY?
MR. WALGREN: OBJECTION. VAGUE.
THE COURT: DO YOU UNDERSTAND IT?
THE WITNESS: YES.
THE COURT: OVERRULED. YOU MAY ANSWER.
THE WITNESS: IT IS A POSSIBILITY, ALTHOUGH IN THIS CASE BECAUSE THE AMOUNT OF PROPOFOL IN THE STOMACH IS SO SMALL, IT WOULD INDICATE IT WAS AN EXTREMELY SMALL AMOUNT.
Q BY MR. FLANAGAN: PROPOFOL IS A VASODILATOR, ISN’T IT?
A YES.
Q SO IF IT WERE PUT INTO THE STOMACH, IT WOULD BE ABSORBED VERY RAPIDLY, WOULDN’T IT?
A WELL, I’M NOT SURE HOW RAPIDLY IT WOULD BE ABSORBED.
Q BUT IT WOULD BE ABSORBED?
A THAT’S LIKELY, YES.
Q NOW, IF PROPOFOL, SAY, 15 MILLILITERS OR 150 MILLIGRAMS OF PROPOFOL WERE TAKEN ORALLY AND IT CAUSED A BURNING SENSATION, IT CAUSED THE NEED FOR SOME LIDOCAINE TO ANESTHETIZE THE GASTROINTESTINAL TRACT, THE ESOPHAGUS, THE STOMACH, YOU WOULD EXPECT TO FIND THE GASTRIC CONTENTS IN ABOUT THAT PROPORTION, WOULDN’T YOU?
A WHEN THE MEDICATIONS ARE FIRST ADMINISTERED, YES.
Q AND NOW IF — WELL, THESE BLOOD LEVELS THAT WE HAVE UP HERE, DO YOU HAVE AN OPINION AS TO HOW MUCH PROPOFOL WOULD HAVE TO BE IN THE BLOODSTREAM TO ARRIVE AT THOSE BLOOD LEVELS?
A NO. I WOULD NEED TO RELY ON THE TOXICOLOGIST TO FIGURE THAT OUT.
Q SO PART OF YOUR OPINION WAS THAT THE CAUSE OF DEATH WAS ACUTE PROPOFOL INTOXICATION. THOSE ARE VERY HIGH LEVELS, AREN’T THEY?
A YES.
Q THOSE ARE THE LEVELS THAT ONE WOULD SEE POSSIBLY IN FULL ANESTHESIA?
A THAT’S CORRECT.
Q AND FULL ANESTHESIA FOR PROPOFOL, THE RECOMMENDED DOSAGE WOULD BE ANYWHERE FROM TWO MILLIGRAMS TO TWO-AND-A-HALF MILLIGRAMS PER KILOGRAM BODY WEIGHT; IS THAT CORRECT?
A WELL, I CAN’T SPEAK TO DOSAGE. I’M NOT SURE HOW MUCH YOU WOULD GIVE.
Q YOU DON’T HAVE ANY IDEA HOW YOU GET TO THE ANESTHESIA LEVEL WITH PROPOFOL?
A NO.
Q IN THE REPORTS THAT YOU HAVE READ, THE CONSULTATION REPORTS, HAVE YOU SEEN IT REPORTED THAT ANESTHETIC DOSES OF PROPOFOL ARE BASED UPON A TWO TO TWO-AND-A-HALF MILLIGRAMS PER KILOGRAM WEIGHT?
A WELL, THE RECOMMENDED DOSE FOR INDUCTION OF ANESTHESIA WOULD BE TWO MILLIGRAMS PER KILOGRAM, APPROXIMATELY.
Q THAT SHOULD GET YOU CLOSE TO THE 3.2, OR THE 4.1, THE 2.6, THOSE ANESTHESIA DOSES UP THERE?
A WELL, THAT I DON’T KNOW. I MEAN, IT WOULD DEPEND TO SOME EXTENT ON HOW RAPIDLY THE PROPOFOL IS GIVEN AND THINGS LIKE THAT. AND ALSO IF IT IS GIVEN OVER A PERIOD OF TIME, THE RATE OF INFUSION MAY BE DIFFERENT AT DIFFERENT TIMES.
Q 25 MILLIGRAMS OF PROPOFOL WOULD NOT GET YOU ANYWHERE NEAR THOSE LEVELS, WOULD IT?
A NO.
Q 25 MILLIGRAMS OF PROPOFOL WOULD INDUCE SLEEP FOR APPROXIMATELY FIVE MINUTES, WOULDN’T IT?
A THAT I DON’T KNOW.
Q 25 MILLIGRAMS OF PROPOFOL WOULD BE ENTIRELY CLEANED OUT OF THE SYSTEM WITHIN THE BLOODSTREAM WITHIN TEN TO 20 MINUTES?
A THAT IS LIKELY, YES.
Q SO NOW IF THE DOCTOR GAVE AN INJECTION OF PROPOFOL OF 25 MILLIGRAMS, PROPOFOL ACTS REALLY QUICKLY, DOESN’T IT?
A YES. I WOULD EXPECT IT TO TAKE EFFECT WITHIN A MINUTE AFTER INJECTION.
Q SO WITHIN A MINUTE AFTER INJECTION, IT WOULD TAKE EFFECT. THE PERSON WOULD BE ASLEEP. IF THERE WAS NO FURTHER PROPOFOL GIVEN, YOU WOULD EXPECT THAT PERSON TO WAKE UP VERY RAPIDLY, WOULDN’T YOU, WITHIN FIVE MINUTES?
A YES.
Q YOU WOULD EXPECT THAT PROPOFOL TO BE GONE FROM THE ENTIRE SYSTEM WITHIN TEN TO 20 MINUTES?
A SOMETHING LIKE THAT, YES.
Q NOW, YOU READ DR. MURRAY’S STATEMENT —
A YES.
Q — AS PART OF YOUR OPINION. AND HE SAID THAT HE GAVE 25 MILLIGRAMS OF PROPOFOL SOMETIME BETWEEN 10:40 AND 10:50; IS THAT CORRECT?
A YES.
Q HE NEVER SAID HE GAVE A DRIP, DID HE?
A WELL, MY RECOLLECTION OF THE STATEMENT IS THAT THE DOCTOR SAID HE GAVE IT OVER 25 MINUTES. NOW, I DON’T KNOW IF THIS WAS 25 MINUTES AFTER THE INITIAL BOLUS OR, YOU KNOW, EXACTLY WHAT THE DOSE WAS THERE.
Q BUT HE NEVER SAID HE GAVE A DRIP, DID HE, ON THAT DAY?
A NO, HE DID NOT.
Q AND FOR THE 25 MINUTES, YOU ARE RELYING UPON THE TRANSCRIPTION OF THAT STATEMENT, AREN’T YOU?
A YES.
Q IF IT WAS THREE TO FIVE MINUTES AND THE 25 MINUTES WAS A TRANSCRIPTION ERROR, YOU WOULD EXPECT THE PATIENT TO GO TO SLEEP FOR A PERIOD OF MAYBE FIVE MINUTES AND WAKE UP, WOULDN’T YOU?
MR. WALGREN: I OBJECT TO RELEVANCE. SPECULATION, YOUR HONOR.
THE COURT: SUSTAINED.
MR. WALGREN: YOUR HONOR, DEFENSE COUNSEL HAS AUDIO IF THEY WANT TO PLAY IT.
MR. FLANAGAN: WE ARE GOING TO NEED TO PLAY IT. WE WILL HAVE TO BRING THE DOCTOR BACK.
THE COURT: WHAT IS THAT?
MR. FLANAGAN: WE WILL NEED TO BRING HIM BACK AFTER WE PLAY IT. IF YOU WANT US TO PUT THAT INTO EVIDENCE NOW OR OF IT IS A COURT HEARING, MAYBE WE COULD TAKE IT SUBJECT TO STRIKE.
MR. WALGREN: I’M CONFUSED, YOUR HONOR.
THE COURT: I DON’T KNOW. DO YOU HAVE SOME AUDIO?
MR. CHERNOFF: CAN I ASK A QUESTION OF MR. WALGREN?
THE COURT: YOU MAY.
(COUNSEL CONFER.)
MR. CHERNOFF: WE HAVE A TRANSCRIPT.
MR. FLANAGAN: MAYBE I COULD JUST ASK IT AS A HYPOTHETICAL. IF IT IS NOT PERTINENT AND WE CAN’T PROVE UP THE FACTS IN THE HYPOTHETICAL, THE COURT WOULD DISREGARD IT.
THE COURT: BUT THAT IS THE POINT. IN ORDER TO ASK THE HYPOTHETICAL, THERE HAVE TO BE FACTS IN EVIDENCE OR ABOUT TO BE IN EVIDENCE. DO WE HAVE THE AUDIO?
MR. WALGREN: COUNSEL HAS HAD THE AUDIO FOR MONTHS, YOUR HONOR. I HAVE PROOF. I HAVE DISCOVERY RECEIPTS. YES, WE HAVE THE AUDIO. DEFENSE COUNSEL HAS THE AUDIO.
THE COURT: I WASN’T ASKING THE PEOPLE. I WAS ASKING DEFENSE. IF THIS IS AN ISSUE YOU ARE RAISING, WHERE IS THE AUDIO? IS IT AROUND?
MR. CHERNOFF: IF WE HAVE IT. IT IS GOING TO BE IN DIGITAL FORM. WE CAN CERTAINLY PLAY IT. THE QUESTION IS IF WE CAN’T ASK A HYPOTHETICAL OF AN EXPERT WITH HYPOTHETICAL FACTS — I’M SORRY. I DIDN’T MEAN TO SIT DOWN.
THE COURT: YOU CAN SIT.
MR. CHERNOFF: THEN I SUPPOSE, OKAY, WE CAN PLAY THAT AUDIO, THE ENTIRE AUDIO, IF NECESSARY. BUT THIS IS JUST A HYPOTHETICAL BASED ON FACTS THAT ARE MADE KNOWN TO THE EXPERT WHICH, AS I UNDERSTAND, UNDER 800 IS ALLOWABLE.
THE COURT: BUT THERE HAS TO BE A BASIS FOR THE HYPOTHETICAL, NOT JUST COMING OUT WITH A FIGURE. IF YOUR POSITION IS THAT IS WHAT THE AUDIO SAYS —
MR. CHERNOFF: THAT IS OUR POSITION.
THE COURT: — AND IT DIFFERS FROM THE TRANSCRIPT?
MR. CHERNOFF: THAT IS OUR POSITION.
THE COURT: WHERE IS THE AUDIO?
MR. FLANAGAN: WELL, IT WOULD HAVE TO BE PLAYED AFTER THE PEOPLE REST. WE CAN’T PUT ON OUR EVIDENCE UNTIL THE PEOPLE PUT ON THEIR EVIDENCE. THEY HAVE BROUGHT IN A DOCTOR, AND I’D LIKE TO ASK HIM A HYPOTHETICAL BASED UPON FACTS THAT I THINK THAT WE CANPROVE UP.
MR. CHERNOFF: KNOWN TO THE EXPERT.
THE COURT: MR. WALGREN?
MR. WALGREN: I DON’T QUITE KNOW HOW TO RESPOND, BUT OBVIOUSLY THEY CAN ASK AN APPROPRIATE HYPOTHETICAL.OBVIOUSLY, FOR THEM TO PUT ON A WITNESS OR SOMETHING IN THEIR CASE, OBVIOUSLY THERE ARE RULES OF PRELIMINARY HEARING REGARDING AN OFFER OF PROOF AND AFFIRMATIVE DEFENSE AND THINGS OF THAT NATURE. I’M A LITTLE CONFUSED BY THE REASONING BEING OFFERED BY THE DEFENSE, SO I DON’T QUITE KNOW HOW TO RESPOND, QUITE HONESTLY.
THE COURT: I’LL RESPOND. I’LL ALLOW THE QUESTION TO BE ASKED BASED UPON THE GOOD FAITH. IT IS SUBJECT TO A MOTION TO STRIKE.
MR. FLANAGAN: THANK YOU.
THE COURT: I DON’T WANT TO DRAG BACK WITNESSES UNNECESSARILY. GO AHEAD.
Q BY MR. FLANAGAN: DOCTOR, IF DR. MURRAY GAVE A 25-MILLIGRAM INJECTION OF PROPOFOL OVER A PERIOD OF THREE TO FIVE MINUTES, YOU WOULD EXPECT IT TO PRODUCE SLEEP, WOULDN’T YOU?
A IT IS LIKELY IT WOULD PRODUCE SLEEP.
Q AND THE SLEEP, IF IT WAS BASED UPON PROPOFOL, WOULD BE VERY SHORT-LIVED, WOULDN’T IT?
A YES.
Q A PERSON WOULD BE TOTALLY REASONABLE IN ASSUMING THAT AFTER FIVE OR TEN MINUTES OF SLEEP, THAT THE SLEEP IS NO LONGER BEING PRODUCED BY PROPOFOL?
A YES, THAT WOULD BE CORRECT.
Q NOW, IN THE EVENT THAT A PERSON WERE TO WAKE UP AFTER FIVE OR TEN MINUTES AND INGEST ENOUGH PROPOFOL TO GET — FIRST OF ALL, STOMACH INGESTION IS ONLY ABOUT THREE-QUARTERS AS EFFECTIVE AS I.V., ISN’T IT?
THE COURT: WELL, THESE VARY ON A PARTICULAR DRUG.
Q BY MR. FLANAGAN: ORAL MEDICATION IS THE SAME MILLIGRAM DOSE, OR MILLIGRAM DOSE IS ONLY ABOUT THREE-QUARTERS EFFECTIVE IN THE STOMACH AS IT IS IN THE I.V., ISN’T IT?
A WELL, BASED UPON THE REQUIREMENT TO GIVE PROPOFOL INTRAVENOUSLY, I’M NOT SURE IT WOULD BE EFFECTIVE AT ALL IN THE STOMACH.
Q YOU DON’T THINK IT WOULD BE ABSORBED IN THE BLOODSTREAM?
A WELL, I’M NOT SURE WHAT WOULD HAPPEN.
Q IT IS NOT A WHOLE LOT OF STUDIES ON THAT, ARE THERE?
A NO.
Q THE REQUIREMENT OF GIVING PROPOFOL IS FOR A DOCTOR ADMINISTERING IT, RIGHT?
A EITHER A DOCTOR OR TRAINED PERSON UNDER A DOCTOR’S SUPERVISION.
Q IF YOU HAD A TOTALLY UNTRAINED PERSON, SUCH AS MICHAEL JACKSON SELF-ADMINISTERING PROPOFOL ORALLY, YOU WOULD EXPECT IT TO BE ABSORBED IN THE BLOODSTREAM, WOULDN’T YOU?
A I DON’T KNOW. I’M NOT SURE WHETHER IT MIGHT BE DIGESTED IN STOMACH BEFORE IT COULD BE ABSORBED.
Q IF, AFTER ORALLY TAKING PROPOFOL, WHAT IS YOUR EXPECTATION? WOULD IT CAUSE DISCOMFORT TO THE ESOPHAGUS AND STOMACH?
A I DON’T KNOW.
Q IF IT DID AND THE PERSON TOOK LIDOCAINE, WOULD YOU EXPECT THAT TO APPEAR IN THE STOMACH?
A YES.
Q AND NOW WE HAVE STOMACH CONTENTS HERE. THERE IS 12 TIMES AS MUCH LIDOCAINE AS THERE IS PROPOFOL, RIGHT?
A YES.
Q THAT RATIO YOU WOULDN’T EXPECT TO COME OUT OF THE BLOODSTREAM, WOULD YOU?
A WELL, I’M NOT SURE WHAT WOULD HAVE COME OUT OF THE BLOODSTREAM.
Q IF THIS IS THE HYPOTHETICAL, THAT THE INGESTION BY THE DECEDENT OF PROPOFOL FOLLOWED BY THE INGESTION OF LIDOCAINE, IF THAT IS WHAT LED TO THOSE BLOOD LEVELS, THIS WOULD NOT BE A HOMICIDE, WOULD IT?
A I BELIEVE IT WOULD STILL BE A HOMICIDE.
Q IF THE DOCTOR DIDN’T PUT THE PROPOFOL IN MR. JACKSON, IT IS NOT A HOMICIDE, IS IT?
A BASED ON THE QUALITY OF THE MEDICAL CARE, I WOULD STILL CALL THIS A HOMICIDE EVEN IF THE DOCTOR DID NOT ADMINISTER THE PROPOFOL TO MR. JACKSON.
Q YOU ARE TALKING ABOUT THE QUALITY OF MEDICAL CARE IN WHAT RESPECT? THE RESUSCITATIVE CARE?
A WELL, THE FACT THAT THERE WAS PROPOFOL THERE IN THE FIRST PLACE. IN OTHER WORDS, THIS IS NOT A USUAL SETTING TO ADMINISTER PROPOFOL. AND AS THERE WAS PROPOFOL THERE, IT PRESUMABLY IS THERE TO BE ADMINISTERED TO MR. JACKSON. SO THE DOCTOR WOULD NEED TO BE PREPARED FOR ADVERSE EFFECTS.
Q DO YOU THINK THE DOCTOR SHOULD BE PREPARED FOR MR. JACKSON SELF-ADMINISTERING PROPOFOL?
A WELL, IF THAT IS A POSSIBILITY, THEN YES.
Q THAT IS A COMMON OCCURRENCE?
MR. WALGREN: OBJECTION. RELEVANCE.
THE COURT: SUSTAINED. IT IS VAGUE.
Q BY MR. FLANAGAN: HAVE YOU EVER SEEN THAT BEFORE, DOCTOR?
MR. WALGREN: OBJECTION. VAGUE.
THE COURT: SUSTAINED.
Q BY MR. FLANAGAN: HAVE YOU EVER SEEN WHERE A PATIENT SELF-ADMINISTERED PROPOFOL?
A I HAVE SEEN ONE CASE.
Q ONE CASE?
A YES.
Q WAS THAT A DOCTOR?
A YES.
Q HAVE YOU EVER SEEN A NON-DOCTOR SELF-ADMINISTER PROPOFOL?
A I PERSONALLY HAVE NOT.
Q ARE YOU AWARE OF ONE IN L.A. COUNTY?
A I BELIEVE THERE IS AT LEAST ONE. I’M NOT SURE WHETHER IT WAS IN L.A. COUNTY OR NOT, BUT I DO RECALL HEARING OF A CASE OF A NURSE SELF-ADMINISTERING IT.
Q WHEN THAT NURSE SELF-ADMINISTERED PROPOFOL, DID YOU CALL IT A HOMICIDE?
MR. WALGREN: OBJECTION. RELEVANCE.
THE COURT: SUSTAINED.
Q BY MR. FLANAGAN: NOW, IN REACHING YOUR OPINION, YOU ALSO RELIED UPON AN ANESTHESIOLOGY CONSULTATION, DIDN’T YOU?
A YES.
Q PART OF THE ANESTHESIOLOGY CONSULTATION WAS IN THE REPORT HE ANSWERED A QUESTION, “COULD THE DECEDENT HAVE GIVEN PROPOFOL TO HIMSELF.” CORRECT?
A YES.
Q AND IT IS THAT OPINION WHICH YOU PLACED IN YOUR REPORT IN TERMS OF FINDINGS NO. 1 AND FINDINGS NO. 4 THAT ASSISTED YOU IN DETERMINING THIS TO BE A HOMICIDE, CORRECT?
A YES.
Q AND THE BASIS FOR THE ANESTHESIOLOGIST, THAT WAS A DR. CALMES?
A THAT’S CORRECT.
Q SHE CONCLUDED THAT THE PROPOFOL COULD NOT HAVE BEEN SELF-ADMINISTERED, GIVEN THE CONFIGURATION OF THE I.V. SETUP; IS THAT CORRECT?
A SHE CONCLUDED THAT IT WOULD BE DIFFICULT FOR HIM TO ADMINISTER IT TO HIMSELF.
Q AND THE FIRST REASON WAS DUE TO THE — DO YOU HAVE THAT REPORT IN FRONT OF YOU?
A YES.
Q WHAT SHE STATED IS: “IT WOULD HAVE BEEN DIFFICULT FOR PATIENT TO ADMINISTER THE DRUGS TO HIMSELF GIVEN THE CONFIGURATION OF THE I.V. SETUP.” CORRECT?
A YES.
Q THE I.V. CATHETER WAS IN THE LEFT LEG; IS THAT CORRECT?
A THAT’S CORRECT.
Q DO YOU KNOW WHERE IN THE LEG IT WAS?
A YES. IT WAS IN THE, I BELIEVE, A LITTLE BIT BELOW THE KNEE.
Q SO IT WAS IN THE UPPER PART OF THE LOWER LEG, CORRECT?
A YES.
Q NOW, THE INJECTION PORT OF THE I.V. TUBING WAS 13.5 CENTIMETERS FROM THE TIP OF THE CATHETER?
A YES.
Q THAT IS BETWEEN FIVE AND SIX INCHES?
A YES.
Q SO THAT INJECTION PORT WOULD BE RIGHT NEXT TO THE KNEE, WOULDN’T IT?
A WELL, IT DEPENDS ON HOW THE TUBING IS CONFIGURED. IT COULD BE NEAR THE KNEE OR FURTHER DOWN NEAR THE FOOT.
Q THE I.V. PROBABLY WOULDN’T BE LAYING ON THE BED. IT WOULD BE GOING UP, WOULDN’T IT?
A THE INTRAVENOUS FLUID WOULD HAVE TO BE ABOVE THE PATIENT.
Q YOU EXPECT IT TO BE FIVE OR SIX INCHES ABOVE THE UPPER PART OF THAT LEG; IS THAT CORRECT?
A WELL, NO. WHAT I’M SAYING IS THAT THERE IS A PIECE OF TUBING ATTACHED TO THE LEG. THIS PIECE OF TUBING IS 13 AND A HALF CENTIMETERS LONG. AND AT THE END OF THE TUBING THERE IS A “Y” CONNECTOR. SO ONE PIECE OF THE “Y” GOES UP TO THE I.V. BAG, AND THE OTHER PIECE OF THE “Y” IS AN INJECTION PORT.
THE COURT: LET THE PHYSICIAN FINISH, PLEASE.
THE WITNESS: JUST EXPLAINING THAT THE 13.5 CENTIMETERS COULD BE IN ONE OF SEVERAL POSITIONS. IT JUST HAS TO BE WITHIN 13.5 CENTIMETERS OF THE I.V. SITE.
Q BY MR. FLANAGAN: IT COULD BE RIGHT THERE NEXT TO THE TOP OF THE KNEE, COULDN’T IT?
A THAT IS POSSIBLE, YES.
Q NOW, IN HER EXPLAINING THE DIFFICULTY OF THE CONFIGURATION, THE I.V. SETUP, SHE SAID: “HE WOULD HAVE HAD TO HAVE BENT HIS KNEE SHARPLY, OR SIT UP TO REACH THE INJECTION PORT AND PUSH THE SYRINGE BARREL, AN AWKWARD SITUATION ESPECIALLY IF SLEEP WAS THE GOAL.”IS THAT WHAT SHE SAID?
A YES.
Q NOW, IF MR. JACKSON WAS LAYING DOWN, HOW HARD WOULD IT BE FOR HIM TO TOUCH HIS KNEE AREA?
MR. WALGREN: OBJECTION. CALLS FOR SPECULATION.
THE COURT: I’M GOING TO SUSTAIN THE OBJECTION. THERE ARE A WHOLE HOST OF VARIABLES THERE.
Q BY MR. FLANAGAN: DO YOU AGREE THAT LOCATION NEAR THE KNEE MAKES IT VERY DIFFICULT FOR THE PATIENT TO USE THE “Y” PORT?
A I WOULDN’T SAY IT IS IMPOSSIBLE. SO, FOR INSTANCE, IN THE SITUATION WHERE THE 13.5 CENTIMETERS STRETCHED UP THE THIGH, IT MIGHT BE POSSIBLE FOR HIM TO REACH THE PORT.
Q IT IS NOT TOO DIFFICULT TO TOUCH YOUR ANKLE WHEN YOU ARE IN BED, IS IT?
A FOR MOST PEOPLE, YES, THAT IS TRUE.
Q YOU JUST HAVE TO BEND YOUR LEG?
A YES.
Q WERE THERE ANY LEG PROBLEMS WHERE MR. JACKSON COULDN’T BEND HIS LEG?
A NO.
Q NOW, SHE ALSO SAYS IF IT WERE ONLY A BOLUS INJECTION, SLEEP WOULD NOT HAVE BEEN MAINTAINED DUE TO THE SHORT ACTION OF PROPOFOL. DO YOU AGREE WITH THAT, TOO? DON’T YOU?
A YES.
Q THEN SHE SAYS SOMEONE WITH MEDICAL KNOWLEDGE OR EXPERIENCE WOULD HAVE STARTED THE I.V. IT TAKES MEDICAL EXPERIENCE TO START AN I.V., DOESN’T IT?
A YES.
Q THEN SHE SAID ANYONE COULD HAVE DRAWN UP AND ADMINISTERED MEDICATIONS AFTER THE I.V. WAS STARTED. YOU WOULD AGREE WITH THAT?
A IN GENERAL, YES. HOWEVER, I THINK IT IS IMPROBABLE IN THIS SPECIFIC SITUATION.
Q IMPROBABLE?
A YES.
Q ON WHAT DO YOU BASE THE IMPROBABILITY?
A WELL, IN ORDER FOR MR. JACKSON TO ADMINISTER THE PROPOFOL TO HIMSELF, A SERIES OF THINGS HAVE TO HAPPEN. FIRST, THE DOCTOR HAS TO START THE PROPOFOL. THE DOCTOR HAS TO LEAVE. AND THEN AT SOME POINT, MR. JACKSON WOULD NEED TO WAKE UP. AND ALTHOUGH HE HAS SOME PROPOFOL AND SOME BENZODIAZEPINES IN THE SYSTEM, HE WOULD HAVE TO BE SUFFICIENTLY AWARE TO REACH OVER IN SOME WAY AND DEPRESS THE PLUNGER OF THE SYRINGE OR HOWEVER IT WAS BEING DELIVERED. NOW, THE DOCTOR TELLS US IN HIS STATEMENT THAT HE WAS IN THE BATHROOM FOR A VERY SHORT TIME. AND SO THE QUESTION FOR ME WOULD BE WHETHER ALL OF THOSE
THINGS CAN HAPPEN DURING THE SHORT TIME THAT THE DOCTOR WAS IN THE BATHROOM.
Q NOW, YOU HAVE COME ACROSS SUBSEQUENT INFORMATION. THE DOCTOR WAS ON THE PHONE FOR 40 SOME MINUTES.
MR. WALGREN: OBJECTION. ASSUMES FACTS NOT IN EVIDENCE THAT HE IS AWARE OF THAT.
THE COURT: I’LL SUSTAIN THE OBJECTION TO THE FORM OF THE QUESTION.
Q BY MR. FLANAGAN: WERE YOU GIVEN A TIME LINE IN THIS CASE?
A APPROXIMATELY, YES.
Q WERE YOU GIVEN A LIST OF ALL THE PHONE CALLS MADE THAT MORNING?
A NO.
Q SO YOU DON’T — YOU NEVER HEARD THAT THE DOCTOR WAS ON THE PHONE TO HIS OFFICE FOR 32 MINUTES?
A NO.
Q YOU NEVER CONSIDERED THAT?
A NO.
Q AND YOU NEVER CONSIDERED THE FACT THAT THE DOCTOR LEFT A VOICEMAIL FOR THREE MINUTES TO A PATIENT?
A NO.
Q NOR THE 11-MINUTE PHONE CALL TO THE LADY IN TEXAS?
A NO.
Q BUT YOU WOULD AGREE THAT IF THE PATIENT WAS BEING KEPT ASLEEP BY PROPOFOL AND THE ONLY INJECTION THE DOCTOR GAVE WAS BETWEEN 10:40 AND 10:50, YOU WOULD EXPECT THE PATIENT TO BE AWAKE WITHIN FIVE MINUTES.
A YES.
Q AND AFTER THAT FIVE MINUTES, CERTAINLY WITHIN 20 MINUTES, HE WOULDN’T BE UNDER THE INFLUENCE OF PROPOFOL, WOULD HE?
A THAT IS LIKELY.
Q SO BASICALLY, WHAT WE HAVE DISCUSSED IS THERE ARE TWO POSSIBILITIES OF SELF-ADMINISTRATION. ONE THROUGH THE I.V., AND ONE ORALLY; IS THAT CORRECT?
A YES, WE HAVE DISCUSSED THOSE.
Q THE GASTRIC CONTENTS TEND TO SUPPORT THE ORAL CONSUMPTION, DOESN’T IT?
A NO. I DON’T BELIEVE THE FINDINGS IN THE GASTRIC CONTENTS SUPPORT THE ORAL CONSUMPTION. THE REASON I SAY THAT IS THAT THE AMOUNT THAT IS MEASURED IN THE ENTIRE GASTRIC CONTENTS IS 0.13 MILLIGRAMS. SO A MILLIGRAM IS JUST A TINY PINCH, AND 0.13 IS A TENTH OF THAT. THIS IS AN EXTREMELY SMALL AMOUNT.
Q WELL, WHAT WE HAVE IN THE BLOOD, THEY ARE NOT MEASURED IN MILLIGRAMS, ARE THEY?
A NO, THEY ARE MEASURED IN MICROGRAMS PER MILLILITER.
Q HOW BIG IS A MICROGRAM COMPARED TO A MILLILITER?
A A MICROGRAM IS 1/1000 OF A MILLIGRAM.
Q THE 0.16 MILLIGRAMS OF LIDOCAINE, THAT WOULD BE 1600 MICROGRAMS, WOULDN’T IT?
A THAT IS CORRECT.
Q AND 1600 MICROGRAMS IN THOSE STOMACH CONTENTS IS WAY MORE THAN THERE IS IN ANY OTHER ORGAN THAT WAS TESTED, ISN’T IT?
A WELL, I COULDN’T SAY THAT BECAUSE THE 1.6 REFERS TO THE ENTIRE STOMACH CONTENTS; WHEREAS, THE OTHER MEASUREMENTS ARE EITHER IN MICROGRAMS PER MILLILITER OF FLUID OR MICROGRAMS PER GRAM OF TISSUE.
Q WE HAVE GOT 70 GRAMS IN THE STOMACH. THAT WOULD BE 1600 MICROGRAMS AND 70 GRAMS, WHICH IS WAY HIGHER THAN THE 0.45 MICROGRAMS PER GRAM IN THE LIVER, ISN’T IT?
A OKAY. WE ARE SPEAKING OF LIDOCAINE. YES, IT WOULD BE HIGHER.
Q AND WOULD IT BE YOUR OPINION, LOOKING AT THE DRUG DISTRIBUTION, THAT AT LEAST THE LIDOCAINE MAY HAVE BEEN TAKEN ORALLY?
A IT IS POSSIBLE THAT THE LIDOCAINE COULD HAVE BEEN TAKEN ORALLY, ALTHOUGH AGAIN IT WOULD BE A VERY SMALL AMOUNT.
Q BUT YOU DON’T HAVE ANOTHER EXPLANATION FOR THE LIDOCAINE BEING IN THE STOMACH, DO YOU?
A WELL, THE ALTERNATIVE EXPLANATION WOULD BE THAT EITHER IT ARRIVED THERE BY POSTMORTEM DISTRIBUTION, OR THERE WAS SOME BLOOD THAT GOT INTO THE STOMACH EITHER AT AUTOPSY, OR BECAUSE THERE MAY HAVE BEEN SOME BLEEDING BEFORE AUTOPSY.
Q ARE YOU SAYING THAT IS MORE THAN LIKELY?
A WELL, THE IDEA OF SOMEONE TAKING 1.6 MILLIGRAMS OF LIDOCAINE, TO ME, SEEMS — I MEAN, THAT IS SUCH A SMALL AMOUNT.
Q THE PERSON COULD HAVE TAKEN MORE OF THAT AND PART OF IT WAS ABSORBED IN THE BLOOD SYSTEM. THE PROPOFOL WAS BEING ABSORBED IN THE BLOOD SYSTEM, WASN’T IT?
A IT IS A POSSIBILITY. I MEAN, IF YOU CONSIDER THAT THERE IS PERHAPS AN INTERVAL OF MAYBE AN HOUR, HOUR AND A HALF, SOMETHING LIKE THAT BETWEEN THE TIME MR. JACKSON GETS IN TROUBLE AND THE TIME HE IS PRONOUNCED DEAD, WOULD IT GO THAT FAST? I DON’T KNOW.
Q WHERE ARE YOU COMING UP WITH THIS HOUR, HOUR AND A HALF?
A WELL, THE DOCTOR SAYS IN HIS STATEMENT THAT HE GAVE PROPOFOL AT ABOUT 10:40 TO 10:50. AND LET’S SEE IF I CAN FIND IT. NOW, WE ARE NOT EXACTLY SURE WHEN THE PROBLEM OCCURRED. IT PRESUMABLY WAS BEFORE THE PARAMEDICS GOT THERE. THEN AFTER ALL OF THE RESUSCITATION, HE IS PRONOUNCED DEAD AT 2:26 P.M. SO THAT ACTUALLY WOULD BE — IT WOULD BE ABOUT TWO-AND-A-HALF HOURS.
Q IF I WERE TO GIVE YOU THIS SCENARIO, THE PARAMEDICS GOT THERE ABOUT 2:26.
THE COURT: NOT 2:26.
Q BY MR. FLANAGAN: 12:26. EXCUSE ME. ABOUT 12:26, THEY LOOKED AT HIM AND THEY VENTURE THE OPINION THAT MR. JACKSON HAD BEEN DEAD FOR AT LEAST 20 TO 30 MINUTES. WE ALSO HAVE A PHONE CALL THAT APPEARS TO HAVE BEEN INTERRUPTED BETWEEN 11:51 AND 12:02, DURING WHICH TIME I THINK THE THEORY IS THERE MIGHT HAVE BEEN THE DISCOVERY OF MR. JACKSON NOT BREATHING. WE ALSO HAVE THE EVIDENCE THAT BETWEEN 10:40 AND 10:50, DR. MURRAY INJECTED 25 MILLIGRAMS OF PROPOFOL WHICH MAY HAVE BEEN SUCCESSFUL KEEPING THE PATIENT AWAKE FOR A SHORT DURATION OF TIME.
THE COURT: I’M SORRY. AWAKE OR ASLEEP?
MR. FLANAGAN: ASLEEP.
THE COURT: THANK YOU.
MR. FLANAGAN: I KNOW YOU ARE PAYING ATTENTION. MAYBE I’M NOT. I DON’T ALWAYS SAY WHAT I’M TRYING TO SAY, YOUR HONOR.
THE COURT: YOU DO.
Q BY MR. FLANAGAN: AND BASED UPON THE INJECTION AT 10:40, 10:50, THE DOCTOR WOULD BE TOTALLY CONFIDENT THE PROPOFOL IS GONE BY 11:00, 11:05 FOR SURE, CORRECT?
A YES, ASSUMING THAT IT WAS JUST THE ONE INJECTION.
Q AND IN THE EVENT THAT THE DOCTOR STEPPED OUT OF THE ROOM TO MAKE A PHONE CALL ABOUT 10:18 AND DOESN’T MAKE THE DISCOVERY OF MR. JACKSON NOT BREATHING, THAT 40 MINUTES WOULD BE ENOUGH TIME TO SELF-MEDICATE ORALLY OR BY I.V., WOULDN’T IT?
A I’M JUST LOOKING BACK AT MY NOTES THAT I MADE REGARDING THE DOCTOR’S STATEMENT. OKAY. SO THE DOCTOR GIVES PROPOFOL AT ABOUT 10:40, AND THEN MR. JACKSON IS ASLEEP AT 11:00. THE PARAMEDICS, YOU SAID, ARRIVED AT 12:26.
Q YES, AND IN THEIR OPINION MICHAEL JACKSON HAD BEEN DEAD AT LEAST 20 TO 30 MINUTES.
A WELL, IF THE PARAMEDICS ARE CORRECT IN THAT, THEN THAT WOULD PUT THE TIME OF DEATH A LITTLE BIT BEFORE NOON.
Q RIGHT.
A SO HE IS ASLEEP AT 11:00. THERE IS NO MORE PROPOFOL GIVEN. HE SHOULD WAKE UP WELL BEFORE NOON.
Q YES, UNLESS IN BETWEEN THAT TIME HE EITHER SELF-INJECTED OR ORALLY MEDICATED, CORRECT?
MR. WALGREN: OBJECTION. CALLS FOR SPECULATION. IT IS ALSO NOT THE FULL RANGE OF POSSIBILITIES.
THE COURT: THE OBJECTION IS SUSTAINED.
Q BY MR. FLANAGAN: NOW, IN THE EVENT THAT YOU GET THE PROPOFOL LEVEL TO THE BLOOD LEVELS WE SEE HERE, YOU WOULD ANTICIPATE A RAPID ONSET OF, I DON’T KNOW WHAT YOU CALL IT, SLEEP OR DEEP SLEEP OR ANESTHETIC STATE. YOU WOULD EXPECT A RAPID ONSET, WOULDN’T YOU?
A YES.
Q IN THE EVENT, WELL, WHEN WE SAY RAPID ONSET, HOW LONG WOULD YOU EXPECT?
A WELL, IF IT WERE GIVEN AS A BOLUS INTRAVENOUSLY, THEN THE TIME FOR HIM TO GO TO SLEEP WOULD BE LESS THAN A MINUTE.
Q NOW, IF THE DOCTOR GAVE HIM THE BOLUS TO GET TO THE ANESTHETIC STATE WE ARE TALKING ABOUT HERE, THAT WOULD REQUIRE AT LEAST TWO MILLIGRAMS PER KILOGRAM OF WEIGHT, WOULDN’T IT?
A THAT WOULD BE THE USUAL DOSE.
Q NOW, IF HE GAVE THAT BOLUS AND NOTHING MORE, HOW LONG WOULD IT BE BEFORE THE PATIENT WOKE UP WITH THAT KIND OF A BOLUS?
A WELL, I WOULD ANTICIPATE WITHIN MINUTES. PROBABLY WITHIN FIVE MINUTES.
Q SO EVEN WITH THOSE LEVELS, THAT WOULD QUICKLY METABOLIZE, WOULDN’T IT?
A YES. I WOULD EXPECT HIM TO WAKE UP WITH THOSE LEVELS IN A MATTER OF SOME MINUTES.
Q AND WHEN IT METABOLIZES, YOU EXPECT THOSE LEVELS TO GO WAY DOWN REAL QUICK, WOULDN’T YOU?
A YES.
Q AND SO IN THE EVENT THAT THE DOCTOR GAVE THAT KIND OF BOLUS TO GET TO THAT NUMBER, YOU EXPECT HIM TO GO TO SLEEP IN A MINUTE. YOU EXPECT IT TO METABOLIZE WITHIN FIVE MINUTES. THE FACT IS AT THOSE LEVELS, YOU WOULD EXPECT THE PERSON TO QUIT BREATHING WITHIN A MINUTE OR TWO, WOULDN’T YOU?
A YES, ASSUMING THAT HIS BREATHING WAS NOT SUPPORTED.
Q SO IF THE DOCTOR GAVE THAT KIND OF INJECTION, HE WOULD HAVE HAD TO SEE MR. JACKSON STOP BREATHING WITHIN A MINUTE OR TWO?
A ASSUMING THAT AMOUNT WAS GIVEN BY BOLUS, YES.
Q AND SO, AFTER THE GIVING OF THE BOLUS TO GET TO THOSE LEVELS, UNLESS THE DOCTOR LEFT WITHIN TWO MINUTES, HE WOULD SEE THE PATIENT STOP BREATHING?
A THAT IS LIKELY, YES.
Q BUT IF MICHAEL JACKSON GAVE THAT INJECTION OR CONSUMED IT ORALLY WHILE THE DOCTOR IS OUT OF THE ROOM, YOU STILL GET THE SAME RESULT, THE CESSATION OF BREATHING WITHIN A COUPLE MINUTES?
A YES.
MR. FLANAGAN: I HAVE NOTHING FURTHER, YOUR HONOR.
REDIRECT EXAMINATION
BY MR. WALGREN:
Q DR. ROGERS, JUST A COUPLE QUESTIONS. A LARGE PORTION OF MR. FLANAGAN’S QUESTIONING WAS ASSUMING THAT THE DOSAGE ADMINISTERED BY DR. MURRAY WAS 25 MILLIGRAMS. WERE YOU MAKING THAT ASSUMPTION IN YOUR ANSWERS?
A WELL, IN TERMS OF WHEN HE GOES TO SLEEP AND HE WAKES UP, A SINGLE DOSE OF 25 MILLIGRAMS WOULD HAVE THAT EFFECT. HE WOULD GO TO SLEEP WITHIN A MINUTE, WAKE UP WITHIN PROBABLY FIVE OR TEN MINUTES.
Q WHAT I’M ASKING ABOUT IS THE AMOUNT OF THE DOSAGE, THE 25 MILLIGRAMS. YOU WERE ASSUMING THAT WAS THE DOSAGE GIVEN BY DR. MURRAY BASED ON DR. MURRAY’S STATEMENTS IN THE TRANSCRIPT, CORRECT?
A YES.
Q ONE POSSIBILITY CERTAINLY IS THAT IS NOT AN ACTUAL ACCOUNTING OF HOW MUCH DR. MURRAY GAVE THE PATIENT; ISN’T THAT TRUE?
A THAT IS POSSIBLE.
Q NOW, FOR THE SAKE OF ARGUMENT, I WANT TO PRESENT YOU WITH A HYPOTHETICAL. I WANT YOU TO ASSUME THAT DR. MURRAY HAD BEEN GIVING MICHAEL JACKSON PROPOFOL NEARLY EVERY NIGHT FOR TWO MONTHS. THAT HE HAD BEEN ADMINISTERING THIS PROPOFOL FOR INSOMNIA OR DIFFICULTY IN SLEEPING FOR WHICH IT WAS NOT INDICATED. THIS WAS DONE IN A HOME SETTING WITHOUT ANY OTHER EMERGENCY MEDICAL PERSONNEL PRESENT. THAT THE NECESSARY RESUSCITATIVE DRUGS AND MONITORING EQUIPMENT WAS NOT PRESENT. THERE WAS INEFFECTUAL AND IMPROPER RESUSCITATION AFTER IT WAS MADE.
LET’S ALSO HAVE YOU ASSUME THAT THE DOCTOR HIMSELF, AS REFLECTED IN THE TRANSCRIPT, HAD EXPRESSED CONCERNS THAT THE PATIENT, MICHAEL JACKSON, MAY HAVE A DEPENDENCY ISSUE AS IT RELATES TO PROPOFOL. WITH ALL THOSE FACTORS IN PLAY, LET’S ASSUME FOR THE SAKE OF ARGUMENT THAT THE DOCTOR LEFT HIS PATIENT ALONE, UNMONITORED, WHERE HE HAD ACCESS TO PROPOFOL.
IS IT YOUR TESTIMONY THAT YOU WOULD CONCLUDE BASED ON THOSE FACTS, EVEN IF THE PATIENT SELF-ADMINISTERED AFTER THE INITIAL DOSAGE BY DR. MURRAY, THAT UNDER THOSE FACTS IT WOULD BE A HOMICIDE?
A YES.
Q THAT IS BASED ON THE DOCTOR’S FAILURE TO PROVIDE THE REQUISITE STANDARD OF CARE AND TO MONITOR, CARE FOR, AND TEND TO HIS PATIENT, CORRECT?
A YES.
MR. WALGREN: THANK YOU. NOTHING FURTHER.
RECROSS-EXAMINATION
BY MR. FLANAGAN:
Q NOW, THE EVIDENCE THAT DR. MURRAY GAVE OF 25 MILLIGRAMS IS DR. MURRAY’S STATEMENT, SO YOU HAVE TO DEPEND UPON THE ACCURACY OF WHAT HE SAID. HE SAYS TO CONCLUDE THAT. DON’T YOU?
A YES.
Q ON THE OTHER HAND, IN THE EVENT THAT MR. JACKSON WAS GIVEN 150 MILLIGRAMS, THAT WOULD PRODUCE SLEEP WITHIN A MINUTE, CORRECT?
A YES.
Q HE WOULD ALSO WAKE UP FROM THAT WITHIN FIVE TO TEN MINUTES UNLESS HE DIED, WOULDN’T HE?
A YES.
Q AND IF HE DIED WITHIN FIVE OR TEN MINUTES AND DR. MURRAY WAS THERE, HE WOULD SEE IT, WOULDN’T HE?
A YES.
Q SO EVEN IF DR. MURRAY GAVE MORE THAN 25 MILLIGRAMS BETWEEN 10:40 AND 10:50, WE STILL HAVE THE SAME RESULT. MR. JACKSON WOULD BE AWAKE AT ELEVEN O’CLOCK IF HE WAS BEING KEPT ASLEEP BY PROPOFOL, CORRECT?
A YES, ASSUMING THERE WAS A SINGLE DOSE.
Q IF THERE WAS PROPOFOL IN THAT FATAL DOSE, HE WOULD ALSO BE DEAD BY ELEVEN O’CLOCK, WOULDN’T HE?
A THAT IS LIKELY, YES.
Q BUT IF THE PROPOFOL IS WORN OFF, WHEN IT WEARS OFF YOU PRETTY MUCH ARE FULLY RECOVERED, AREN’T YOU?
A FROM THE PROPOFOL, YES.
Q SOMEHOW, IF IT IS ACCORDING TO THE PARAMEDICS THAT MR. JACKSON DIES AROUND NOON OR JUST BEFORE, THESE ARE THE LEVELS THAT WOULD PROBABLY BE IN HIS SYSTEM AT THE TIME OF AUTOPSY; IS THAT CORRECT?
A YES.
Q AND THOSE LEVELS COULD NOT POSSIBLY COME FROM A 10:40 OR 10:50 INJECTION, COULD THEY?
A ASSUMING A SINGLE INJECTION, NO, THEY WOULD NOT.
MR. FLANAGAN: THANK YOU.
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