Expert Disputes Conrad Murray Defense Claims

Los Angeles - Michael Jackson's personal physician was a "direct cause" of the singer's June 2009 death from a powerful anesthetic that was used to help him go to sleep at his rented Holmby Hills estate, a key prosecution witness testified today.

"... You concluded that Conrad Murray was not only a substantial factor but a direct cause of Michael Jackson's death?" Deputy District Attorney David Walgren asked Dr. Steven Shafer, the prosecution's final witness in Murray's involuntary manslaughter trial.

"Yes," responded Shafer, an anesthesiologist who agreed to consult for free on the case.

When the prosecutor asked if Murray would still be a direct cause of Jackson's death if the singer had given himself propofol or the sedative lorazepam, Shafer responded, "Absolutely."

He noted that Murray was a "physician who has brought propofol into the room" to a patient who may have been developing a dependency to sedatives.

Murray told police two days after Jackson's death that he had been trying to wean Jackson off the anesthetic over a three-day period, and finally consented to give the singer a 25-milligram dose -- infused over three to five minutes -- after Jackson complained for hours that he could not sleep without the drug he called "milk."

"He is responsible for every drop of propofol in that room. He is responsible for every drop of lorazepam in that room," Shafer told the seven-man, five-woman jury hearing the case against Murray.

Murray, a 58-year-old cardiologist, is charged with a felony count of involuntary manslaughter stemming from Jackson's death on June 25, 2009, from what was ruled as propofol intoxication. The 50-year-old entertainer was in Los Angeles to prepare for 50 concerts in England.

Shafer, a prominent anesthesiologist and Columbia University professor, said the only scenario he came up with that could generate the amount of propofol found in Jackson's femoral blood during the autopsy would be if the singer had received "an infusion, a drip of propofol."

"I'm postulating here that at 9 a.m. an infusion was started," he said, adding that he believed the infusion ran until noon after all 1000 milligrams in the bottle had been infused into Jackson.

The anesthesiologist said he believed Jackson's breathing would have begun to slow down between 9 a.m. and 10 a.m. as his carbon dioxide levels began to rise. He added that an examination that didn't include careful analysis of his breathing and carbon dioxide monitoring might have indicated that Jackson was comfortably asleep as the propofol level continued to rise.

"Had Conrad Murray been with the patient, with Michael Jackson, during this period of time, he would have seen the slowed breathing ...," Shafer testified, noting that the infusion pump could have easily be turned off then.

Shafer testified he believed it was "completely consistent with Michael Jackson dying on an infusion, a drip of propofol," resulting in the high levels of propofol in his femoral blood.

"Is this what you think happened?" Walgren asked.

"Yes," the prosecution witness responded.

Shafer -- who showed the jury how a propofol drip is begun by using an IV pole -- said he ruled out other scenarios such as single doses of 50 milligrams and 100 milligrams and self-administration by Jackson of six 50-milligram injections of propofol over 90 minutes or six 100-milligram injections over three hours. He noted that the 100-milligram dose is at an anesthetic level in which it would require time for Jackson to repeatedly wake up, calling it a "crazy scenario."

The anesthesiologist testified that to self-inject propofol one would have to draw up the anesthetic into a syringe and either inject it directly into a vein or find an injection port and attach the needle, saying it takes a bit of time and coordination.

He noted that Murray had told police in his interview two days after Jackson's June 25, 2009, death that Jackson did not have good veins and that he had to start an IV below the singer's left knee.

The prosecution witness also disputed a report from a defense expert, Dr. Paul White, suggesting that Jackson may have orally consumed the propofol that caused his death.

"I was disappointed because it's not possible," Shafer told jurors.

He said the drug is quickly broken down in the liver when taken orally, noting a recent study in Chile in which three people drank 200 milligrams of propofol and three others drank 400 milligrams.

"There was no sedation at any time following oral consumption," Shafer said of the study.

One of Murray's attorneys, J. Michael Flanagan, announced last week that the defense would no longer assert that Jackson had swallowed the fatal dose of propofol, noting that the defense had commissioned a report determining that orally ingesting it would not prove deadly.

Shafer also disputed the defense's contention that Jackson took eight tablets of the sedative lorazepam in the hours leading up to his death while the doctor was out of the room. He said the findings from a defense-commissioned study of Jackson's stomach contents disproves the suggestion that the entertainer orally ingested lorazepam tablets between 8 a.m. and noon.

In his opening statement, lead defense attorney Edward Chernoff told jurors that the evidence would show that Jackson swallowed eight two-milligram tablets of lorazepam "when Dr. Murray was not around" and "self-administered a dose of propofol" after Murray left the room that "created a perfect storm" and "killed him instantly."

But Shafer said the defense's study did not separate lorazepam and a metabolite that is created in the liver, adding that he believed the "true amount of lorazepam is much, much smaller." He called it a "rather trivial amount of lorazepam," saying it amounts to one-forty-third of a two-milligram tablet.

On the stand Wednesday, Shafer said Murray committed 17 "egregious" violations in his treatment of Jackson, including his failure to notify paramedics and emergency room doctors that he had given propofol to Jackson.

Murray's failure to write down information about Jackson's vital signs and the medication he had been given "violated the rights of both Michael Jackson and the Jackson family," and, along with his failure to call 911 for help, was one of four violations that were considered egregious and "unconscionable," Shafer testified.

Murray told police that he left Jackson's side only for about two minutes to use the bathroom and insisted that he was trying to wean the singer off propofol, which Jackson used to combat insomnia.

Prosecutors claim Murray gave Jackson a fatal, intravenous dose of the anesthetic, then spent about 45 minutes on the phone or sending emails, without properly monitoring the singer.

The defense is expected to begin presenting its portion of the case Friday after Shafer finishes his testimony. Defense attorneys have indicated they expect to call 15 witnesses.