Jan 11 2011

Murray Pretrial Hearings -01/11/2011 (AFTERNOON)

Seven @ 10:54 pm

Day 5: 01/11/2011 (AFTERNOON)

SOURCE: http://sprocket-trials.blogspot.com/2011/01/dr-conrad-murray-prelim-day-6-part-ii.html

NOTE from Sprocket at T & T:

This is an unedited, draft entry. Please refer to the MSM (mainstream media) for 100% accuracy. If you are copying and pasting to other web sites before the edit, please be sure to include a link-back to this specific entry and this disclaimer with your copy. Thank you, Sprocket.

• • •

1:23 p.m.
Judge Pastor

Resumption of direct, but Walgren asks to approach.

We’ve been conferring about a stipulation.

Stipulation regarding the Dr. Murray transcript. Reflected on page 37 line 18 typo error, slowly infused over 25 minutes. Should read slowly infused over 3-5 minutes.

Requisite equipment for these type of benzo and prop treatment.

Had you mentioned an entitle CO2 monitor. Means entitle, the end of a resting breath. Tech term, capnograph.

Is an entitle cO2 monitor something thatwould be required? Exactly.

Is it something that would be able to detect an airway obstruction? that woud be correct.

Now, I want to direct attention back to exhibit 68, want to aks specif. about some of these foundings as they may or may not relate to one another.

Gastric contents. 1.3 lido 1.6 and were you able ot determine through review medical evidence.

Coronor reported there were aditional contents of fluid, what you would do total content, 1.3 of propofol inside the 70. Same with the lidocaine.

The numbers reflect in 68, do those reflect the concentraiton.

Those reflect the amout not concentration, taht was found within the 70 mil. And with your expertiese and math, convert to a concentration.

propofol = consults notes. 0.00186 mg per milliliter.

What does that mean as far as level of concetration. It’s a very (low?) concentration compared to the liver.

Now, the lidocaine, that’ waht I would expect.

The liver for example. the propofol, the concentration is higher than what is in the stomach. Even though the liver is a very high, there is no blood flow to give that concentration back and forth. Drugs go from a high concentration to low, but they are inhibited to a degree by the organs…

You could also say the same of the heart.
going fro a high to a low concentration.

Did same for lidocaine. When converted get concentration.
.0228 milligrams per milliliter. It’s same issue as the propofol difference is difference in concentrations difference in high to low and different drugs are more or less readily diffused. Depends on their type of charge, the molecules…..

Once you ahve the concentrations taht you’ve computed, they’re very low… yes.
Are they consistent with concentrations taken orally?
No.
With lidocaine it would have to be much higher.

And how about propofol. Same.

In the report you created, did you identify particular issues that deviated from the standard of care in this case. I did.

Did you go through those items to document the level of departure? I did.

Series of issues as simple of departure.

Failure to recognize the ? pulse. thready pulse.

Lengthy description. and that there is at least a solic blood pressure. I mis it all.

That woul d tell you, don’t start CPR. chest compression. Start air way.

Air way is first
Breathing is second
Compression is third.

So, thready pulse is the first departure.

How about the failure to appreciate the drug on drug on acton. Same thing. The issue of not recognizing you can forgive, but still you need to know what to do to correct it.

Propofol.
In statement, that he was likely but not sure that MJ was addicted but he was not sure. the fact is, that he was propperly informed of that. (That there are some cases of addiction that he did not research up.)

Insomnia.
And propofol indicated for the treatment as a sleep aid or insomnia. Absolutely not.

Dr. Murray to recognize that as a departure. correct.

As far s MJ not breathing, as a departure. I did.

When you have a patient with respitory depression involving benzodiazp… so the treatment to reverse…. (sheesh. I mis it.

Focusing on just those that ou mentioned, who now become an extreme departure of care. Yes.

So each individual, when you put them together, it becomes so agregous, that it becomes extreme. That any phoysician should know, should be trained in the basics of life support.

Standing alone, extreme.
Failure to use appropriate monitoring equip.
blood pressure equip, that is electronic. People have them in their home and they set the time.
Next EKG. Even have an o

A defribrilator.

Then have pulsoximitery. which should have a sound alarm for a change in oxygen. preprogrammed for an automatic alarm that you can set high or low.

CO2/ chap alarm, so that you get a qualatative depth of breathing. (more explaination)

And the absence of equip would be an extreme departure.
Yes.

Failure to inform the paramedics and doctor’s the nature of the drugs given. Yes. You should let those (trying to ressitate to know all drugs given.)

Failure to monitor and document all drugs given. Yes. Explains the details of what you monitor and what can change (the breathing, the blood pressure, depth of sedation) all those things can be factored in and recorded.

Failure to remain and be present. What did you mean by that.
1. if you have a patient that is being given drugs like this, with a patient in like anethesisa. you have ot be vigilant you have ot bet there all the time. Someone hwo is qualified ot handle the issue and monitor the equipment.

If you walk out and leave the patient, things can happen. If you do’t know what the patient did, if you didnt nitice it or record it or note it, no matter what, you are responsible 100 percent for the patient.

Failure to provide ACLS care. And you described that as an extreme departure.

Overall, identified several points of extreme deviation of care.

Failure to immediately call 911. If you are a single person by yourslef, the first thing you do is to call to get (other’s to help).

Failure to use ambu bag, with oxygen. Dr. Explains the use and how it’s used. Long explanation as to how the ambu bag can give you information back, (to see the chest move(

Airway and breathing, are the first steps.

Failure to apply the ABC’s of ACLS.

And addressed the one handed CPR on the bed. “Totally useless.”

One handed behind the back? It’s totally useless. You can’t get enough pressure to push down on the chest. We use that in neonatal. Describes what you should do with an adult in the bed. Describes how you get them out of the bed easily. Even if you claim you can’t move the person from the bed, the proper training would be to protect the head, slide the individual off the bed, and then bea ble to start chest compression.

Even if they are morbidly obese, you can generally do that. (ans)

Failure to use the nasal trumpets. (Yes. long explanation)

Long explanation about airway trumpets.

Included in this category you also identify the failure to have the appropriate ACLS medications o nhand.

Yes.
Fairlure to use the correct clomazinal dose. absolutely.
Fail to rappidly assess the situation and failure to give the appropriate ACLS care, and that all is an extreme departure. That’s correct.

during the noo hour, that there was an ifusion time error,
do those opinions all stand, even if he infused over 5 minutes.
Doesn’t make any difference. (ans)

Just asume that’s true, and either through being on the phone or where ever he was, and the patient self administered, even the, still stand,

That would be then another extreme departure, because the patient is a known addict, and the docotr then allowed that much like a known heroin addict, and leaving a syringe of drugs available. It’s an extreme departure.

And making sure the patient can’t have self access to drugs. That’s an extreme departure.

Cross – Flanagan:

Did you work our your map on the gastric over the noon hour? yes.

Certainly wasn’t in your report was it? No.

who did caliculations? I did.

Trying to back track for what he came up with the contents .0xx for prop. in stomach. No. Content would be numbers there. Concentration is per unit of volume.

Would you come up with those numbers, would you just ivide those numbers by 70? Yes.
In dividing by 70, piece of paper here… now wants to put that on the ELMO…

Flanagan, does this on the ELMO… converting it to concentation. the math. too funny.

Questions, about the fluid in the stomach. I stop typing. I don’t see how they are important.

Now askng about micrograms vs milligrams of the stomach content…

45x what it is in the hospital blood.
That doesn’t go with your theory.

Yes, I made a mistake.

Now if we have 45x whats in the stomach than what’s in the blood. then we have evidence of oral ingestion.

We may have to check with the coroner, to check with what the numbers mean. Now, it doesn’t make sense unless he ingested it orally.

SO he had to have ingested it orally?

obj misstates evidence.

So, I may have made an assumption, depending on how the coroner reported this.
(So, his calculation over lunch may not be correct.) (me)

So as it stands, you made a mistake. I made an interpretation mistake. I thought it was micrograms and it’s really milligrams.
So, we’re back to it being orally? Well, we’ll have to talk to the coroner.

It’s a big difference isnt’ it? I totally agree.

Now, in your report, you went thorugh all the statements, (blah blah blah), and Dr. Murray statement, he said he gave 25 mil prop between 10 40 and 10 50. didn’t he.?
and the statement you said was over 25 minutes.
that’s what I reviewed in the report.

Oh, if he gave it over 3-5 minutes…?
Still, it’s a very small dose.

Now asking about the other drugs in the heart the coroner found….

JP asks about something.

This is getting down into the minucia.

Now, assuming the 25 ml between 10 40 10 50. That could keep him asleep short period of time. Well, six five minutes.

We are coming back tomorrow. PIO confirmed.

As of 11 oclock, propofol is no longer keeping him asleep. That’s always possible.

From Dr. M statement and phone records, Dr. Murray probably was out of the room for 40 minutes.

Let’s assume that’s right. ad made the assumption that he discovered that Dr. M discovered MJ not breathing around 11:50 something.

That would put him in a little bit of a panic state? I would assume (think?) so.

Did you know that at that time, he yells for security at 12:05.

So the delay from discovery, So what should he do…

He should have monitored the situation, the pulseoxsimeter…. (more explain) so, it’s airway and breathing.

Now how long should he spend diagnosing airway and breathing before he ran for health.
If he had done the airway and breathing, he probalby wouldn’t hae needed to run for help.

Just get the patient through that step.

So you just need to fix the airway and breathing.? Tha’ts correct.

The propofol in the blood from the hospital was 4.5 how could he have brought him back? (question not completely right)

doctor responds that sure. He could bring breathing back.

The doctor give a good explanation as to why if the intervention was immediate, and the right intervention, he could have brought the breathing back.

How would he know, that propofol was in the blood at that concentration? You don’t. But you know you have a known addict patient, who may do anything.

But you should anticipate that your patient… ?

Same situation as a heroin addict.

First, do no harm.

You would know the patient would drink it? Well, maybe not know drink it but certainly inject it. You know the patient. He’s a known addict. (Should have anticipated.)

But based on the toxicology, it looks as if he drank it? Not necesarily. He abandoned his patient.

If he had a cell phone, he could dial 911..

Is it beyond the care not to do that himself? Absolutely.

Now goes back to the numbers… with the stomach, and ingestion. Witness doesn’t know concerning ingestion.

Would you also agree that ingestion of propofol would be less efficient than IV. Yes, it’s going to take time (to absorb).

Propofol: another sort of hypothetical. of injecting 150 vs ingesting…? He doesn’t know about ingestion. No studies. It is a high fat solulable drug. The higher the fat solulability, the greater the absorption through biological tissues. (That may not be exactly what he said.)

have you heard the term conscious sedation. Yes. very much so. Write about it in the books. Yes. Different from general anethesia? yes, but long explanation about continuing that long sedation level. And that’s all part of that “misnomer” conscious sedation.

Conscious sedation diff from general anethesia? Depends on the drugs involved.

We don’t know in this case, how the mixture of drugs (worked on the body).

REDIRECT

Assuming self admistration as Mr. F included, would any of your opinions change in your standard of care? No. You don’t walk away from a patient. (explains in detail. Addicts, that is the first tip off, you dont walk away, just like a heroin addict.)

Your opinion doesn’t change whether or not there was a self administer…. No. the standard of care doesn’t change. You don’t walk away from a patient.

No recross.

2:26 p.m.

Ask that peoples exhibits (all 70) are moved into evidence for reference only.

Defense exhibits? Up to Paper G.

Couple minutes to review things.

Can we take this time to review defense exhibits? (DW)

JP: Yes.

Judge steps off the bench.

DW. I don’t have a defense C.

We don’t either. I don’t know where it is.

Received in evidence for REFERENCE only. The people rest their case.

Chernoff:
Defense exhibits, missing C for some reason. Dan Myers may have walked out with it. Going to try to locate it.

Never submitted to the clerk, because it doesn’t have a tag on it.

They were all used to refress recollection, other than to refresh recolection…various obj to foundation and evidence….But there was no foundation made for the records.

Chernoff. Absolutely right.

All except D, E, F, nobody actually took ownership of those. Withdrawing those.

What about A-C & G? (JP)

B withdrawn withdraw A as well.

G for the defense received in evidence.

Any addition evidence the defense wish to

We’d like to make a statement? in c

Defense rests it’s case?

any defense motion? vis a vi charge defense o f dismiss of this case/

Wish to be heard?

Depeding on how I may rule on defense mtion, there is pending there is a request of the medical board.

Is the Attorney General present? (did JP ask that? I think they said they were!)

JP said he was ready to rule on that request (from the medical board.)

So lets take the 15 break. now.

Holy moley! It appears the defense wants to make some kind of closing argument. Does NOT appear that they are going to present any witnesses or other evidence other than the calculation paper put up on the ELMO!

If I have this correct, it appears Judge Pastor is ready to rule on the request of the medical board via the attorney general’s office.

I’m back inside the courtroom.

There is speculation among the MSM that this the last day. I overheard one reporter tell another that Mr. Walgren went up to members of the Jackson family and asked if Katherine Jackson was going to be coming. Janet left during lunch.

The PIO officer tells us we only have the empty courtroom for one more day.

Some new reporters show up in the overflow room. I overhear that the out of town CNN/In Session staff may be stuck in Los Angeles until the weekend due to storms on the east coast. (Poor guys! What a “cold” place to have to stay lol!)

I see the witness take the stand. Judge is not on the bench yet.

Sound!
1:23 p.m.
Judge Pastor

Resumption of direct, but Walgren asks to approach.

We’ve been confiring about a stipulation.

Stipulation regarding the Dr. Murray transcript. Reflected on page 37 line 18 typo error, slowly infused over 25 minutes. Should read slowly infused over 3-5 minutes.

Requisite equipment for these type of benzo and prop treatment.

Had you mentioned an entitle CO2 monitor. Means entitle, the end of a resting breath. Tech term, capnograph.

Is an entitle cO2 monitor something thatwould be required? Exactly.

Is it something that would be able to detect an airway obstruction? that woud be correct.

Now, I want to direct attention back to exhibit 68, want to aks specif. about some of these foundings as they may or may not relate to one another.

Gastric contents. 1.3 lido 1.6 and were you able ot determine through review medical evidence.

Coronor reported there were aditional contents of fluid, what you would do total content, 1.3 of propofol inside the 70. Same with the lidocaine.

The numbers reflect in 68, do those reflect the concentraiton.

Those reflect the amout not concentration, taht was found within the 70 mil. And with your expertiese and math, convert to a concentration.

propofol = consults notes. 0.00186 mg per milliliter.

What does that mean as far as level of concetration. It’s a very (low?) concentration compared to the liver.

Now, the lidocaine, that’ waht I would expect.

The liver for example. the propofol, the concentration is higher than what is in the stomach. Even though the liver is a very high, there is no blood flow to give that concentration back and forth. Drugs go from a high concentration to low, but they are inhibited to a degree by the organs…

You could also say the same of the heart.
going fro a high to a low concentration.

Did same for lidocaine. When converted get concentration.
.0228 milligrams per milliliter. It’s same issue as the propofol difference is difference in concentrations difference in high to low and different drugs are more or less readily diffused. Depends on their type of charge, the molecules…..

Once you ahve the concentrations taht you’ve computed, they’re very low… yes.
Are they consistent with concentrations taken orally?
No.
With lidocaine it would have to be much higher.

And how about propofol. Same.

In the report you created, did you identify particular issues that deviated from the standard of care in this case. I did.

Did you go through those items to document the level of departure? I did.

Series of issues as simple of departure.

Failure to recognize the ? pulse. thready pulse.

Lengthy description. and that there is at least a solic blood pressure. I mis it all.

That woul d tell you, don’t start CPR. chest compression. Start air way.

Air way is first
Breathing is second
Compression is third.

So, thready pulse is the first departure.

How about the failure to appreciate the drug on drug on acton. Same thing. The issue of not recognizing you can forgive, but still you need to know what to do to correct it.

Propofol.
In statement, that he was likely but not sure that MJ was addicted but he was not sure. the fact is, that he was propperly informed of that. (That there are some cases of addiction that he did not research up.)

Insomnia.
And propofol indicated for the treatment as a sleep aid or insomnia. Absolutely not.

Dr. Murray to recognize that as a departure. correct.

As far s MJ not breathing, as a departure. I did.

When you have a patient with respitory depression involving benzodiazp… so the treatment to reverse…. (sheesh. I mis it.

Focusing on just those that ou mentioned, who now become an extreme departure of care. Yes.

So each individual, when you put them together, it becomes so agregous, that it becomes extreme. That any phoysician should know, should be trained in the basics of life support.

Standing alone, extreme.
Failure to use appropriate monitoring equip.
blood pressure equip, that is electronic. People have them in their home and they set the time.
Next EKG. Even have an o

A defribrilator.

Then have pulsoximitery. which should have a sound alarm for a change in oxygen. preprogrammed for an automatic alarm that you can set high or low.

CO2/ chap alarm, so that you get a qualatative depth of breathing. (more explaination)

And the absence of equip would be an extreme departure.
Yes.

Failure to inform the paramedics and doctor’s the nature of the drugs given. Yes. You should let those (trying to ressitate to know all drugs given.)

Failure to monitor and document all drugs given. Yes. Explains the details of what you monitor and what can change (the breathing, the blood pressure, depth of sedation) all those things can be factored in and recorded.

Failure to remain and be present. What did you mean by that.
1. if you have a patient that is being given drugs like this, with a patient in like anethesisa. you have ot be vigilant you have ot bet there all the time. Someone hwo is qualified ot handle the issue and monitor the equipment.

If you walk out and leave the patient, things can happen. If you do’t know what the patient did, if you didnt nitice it or record it or note it, no matter what, you are responsible 100 percent for the patient.

Failure to provide ACLS care. And you described that as an extreme departure.

Overall, identified several points of extreme deviation of care.

Failure to immediately call 911. If you are a single person by yourslef, the first thing you do is to call to get (other’s to help).

Failure to use ambu bag, with oxygen. Dr. Explains the use and how it’s used. Long explanation as to how the ambu bag can give you information back, (to see the chest move(

Airway and breathing, are the first steps.

Failure to apply the ABC’s of ACLS.

And addressed the one handed CPR on the bed. “Totally useless.”

One handed behind the back? It’s totally useless. You can’t get enough pressure to push down on the chest. We use that in neonatal. Describes what you should do with an adult in the bed. Describes how you get them out of the bed easily. Even if you claim you can’t move the person from the bed, the proper training would be to protect the head, slide the individual off the bed, and then bea ble to start chest compression.

Even if they are morbidly obese, you can generally do that. (ans)

Failure to use the nasal trumpets. (Yes. long explaination)

Long explanation about airway trumpets.

Included in this category you also identify the failure to have the appropriate ACLS medications o nhand.

Yes.
Fairlure to use the correct clomazinal dose. absolutely.
Fail to rappidly assess the situation and failure to give the appropriate ACLS care, and that all is an extreme departure. That’s correct.

during the noo hour, that there was an ifusion time error,
do those opinions all stand, even if he infused over 5 minutes.
Doesn’t make any difference. (ans)

Just asume that’s true, and either through being on the phone or where ever he was, and the patient self administered, even the, still stand,

That would be then another extreme departure, because the patient is a known addict, and the docotr then allowed that much like a known heroin addict, and leaving a syringe of drugs available. It’s an extreme departure.

And making sure the patient can’t have self access to drugs. That’s an extreme departure.

Cross.

Flanagan.
Did you work our your map on the gastric over the noon hour? yes.

Certainly wasn’t in your report was it? No.

who did caliculations? I did.

Trying to back track for what he came up with the contents .0xx for prop. in stomach. No. Content would be numbers there. Concentration is per unit of volume.

Would you come up with those numbers, would you just ivide those numbers by 70? Yes.
In dividing by 70, piece of paper here… now wants to put that on the ELMO…

Flanagan, does this on the ELMO… converting it to concentation. the math. too funny.

Questions, about the fluid in the stomach. I stop typing. I don’t see how they are important.

Now askng about micrograms vs milligrams of the stomach content…

45x what it is in the hospital blood.
That doesn’t go with your theory.

Yes, I made a mistake.

Now if we have 45x whats in the stomach than what’s in the blood. then we have evidence of oral ingestion.

We may have to check with the coroner, to check with what the numbers mean. Now, it doesn’t make sense unless he ingested it orally.

SO he had to have ingested it orally?

obj misstates evidence.

So, I may have made an assumption, depending on how the coroner reported this.
(So, his calculation over lunch may not be correct.) (me)

So as it stands, you made a mistake. I made an interpretation mistake. I thought it was micrograms and it’s really milligrams.
So, we’re back to it being orally? Well, we’ll have to talk to the coroner.

It’s a big difference isnt’ it? I totally agree.

Now, in your report, you went thorugh all the statements, (blah blah blah), and Dr. Murray statement, he said he gave 25 mil prop between 10 40 and 10 50. didn’t he.?
and the statement you said was over 25 minutes.
that’s what I reviewed in the report.

Oh, if he gave it over 3-5 minutes…?
Still, it’s a very small dose.

Now asking about the other drugs in the heart the coroner found….

JP asks about something.

This is getting down into the minucia.

Now, assuming the 25 ml between 10 40 10 50. That could keep him asleep short period of time. Well, six five minutes.

We are coming back tomorrow. PIO confirmed.

As of 11 oclock, propofol is no longer keeping him asleep. That’s always possible.

From Dr. M statement and phone records, Dr. Murray probably was out of the room for 40 minutes.

Let’s assume that’s right. ad made the assumption that he discovered that Dr. M discovered MJ not breathing around 11:50 something.

That would put him in a little bit of a panic state? I would assume (think?) so.

Did you know that at that time, he yells for security at 12:05.

So the delay from discovery, So what should he do…

He should have monitored the situation, the pulseoxsimeter…. (more explain) so, it’s airway and breathing.

Now how long should he spend diagnosing airway and breathing before he ran for health.
If he had done the airway and breathing, he probalby wouldn’t hae needed to run for help.

Just get the patient through that step.

So you just need to fix the airway and breathing.? Tha’ts correct.

The propofol in the blood from the hospital was 4.5 how could he have brought him back? (question not completely right)

doctor responds that sure. He could bring breathing back.

The doctor give a good explanation as to why if the intervention was immediate, and the right intervention, he could have brought the breathing back.

How would he know, that propofol was in the blood at that concentration? You don’t. But you know you have a known addict patient, who may do anything.

But you should anticipate that your patient… ?

Same situation as a heroin addict.

First, do no harm.

You would know the patient would drink it? Well, maybe not know drink it but certainly inject it. You know the patient. He’s a known addict. (Should have anticipated.)

But based on the toxicology, it looks as if he drank it? Not necesarily. He abandoned his patient.

If he had a cell phone, he could dial 911..

Is it beyond the care not to do that himself? Absolutely.

Now goes back to the numbers… with the stomach, and ingestion. Witness doesn’t know concerning ingestion.

Would you also agree that ingestion of propofol would be less efficient than IV. Yes, it’s going to take time (to absorb).

Propofol: another sort of hypothetical. of injecting 150 vs ingesting…? He doesn’t know about ingestion. No studies. It is a high fat solulable drug. The higher the fat solulability, the greater the absorption through biological tissues. (That may not be exactly what he said.)

have you heard the term conscious sedation. Yes. very much so. Write about it in the books. Yes. Different from general anethesia? yes, but long explanation about continuing that long sedation level. And that’s all part of that “misnomer” conscious sedation.

Conscious sedation diff from general anethesia? Depends on the drugs involved.

We don’t know in this case, how the mixture of drugs (worked on the body).

REDIRECT

Assuming self admistration as Mr. F included, would any of your opinions change in your standard of care? No. You don’t walk away from a patient. (explains in detail. Addicts, that is the first tip off, you dont walk away, just like a heroin addict.)

Your opinion doesn’t change whether or not there was a self administer…. No. the standard of care doesn’t change. You don’t walk away from a patient.

No recross.

2:26 p.m.

Ask that peoples exhibits (all 70) are moved into evidence for reference only.

Defense exhibits? Up to Paper G.

Couple minutes to review things.

Can we take this time to review defense exhibits? (DW)

JP: Yes.

Judge steps off the bench.

DW. I don’t have a defense C.

We don’t either. I don’t know where it is.

Received in evidence for REFERENCE only. The people rest their case.

Chernoff:
Defense exhibits, missing C for some reason. Dan Myers may have walked out with it. Going to try to locate it.

Never submitted to the clerk, because it doesn’t have a tag on it.

They were all used to refress recollection, other than to refresh recolection…various obj to foundation and evidence….But there was no foundation made for the records.

Chernoff. Absolutely right.

All except D, E, F, nobody actually took ownership of those. Withdrawing those.

What about A-C & G? (JP)

B withdrawn withdraw A as well.

G for the defense received in evidence.

Any addition evidence the defense wish to

We’d like to make a statement? in c

Defense rests it’s case?

any defense motion? vis a vi charge defense o f dismiss of this case/

Wish to be heard?

Depeding on how I may rule on defense mtion, there is pending there is a request of the medical board.

Is the Att G present?

So lets take the 15 break. now.

xxxx

Any motion instruciton.?

Not a motion instruciton, comments on the

If ther any affirmative defense, Is there any defense motion not additonal dcuments or

Is there argument.

Is there a defense motion to dismiss/

Yes there is.

JP has to explain to atty’s the procedure here in ct.

It’s in your court.

Defense is a little befuddled (Low?)

Your honor I’m trying to see ow we started out in this court, and probaly started out in a detail anticiption, as to why his office has accused Dr. Murray of this ugly thing.

When looking back at some of the things written down.

well, propofol, is for general surger only, so I guess we wnat to keep this specific to the facts.

Rambling statement if you ask me.

So you have to determine, if Mr. Walgren put on evidence to support each and every one of the (elements)?

Was Dr. Murray, ?? killed Michael Jackson?

When did we hear where the time of death, once we can figure out the time of death we can know who was involved.

They didn’t ask the Coroner the time of death.
Dr. cooper was asked what time she announced, but no time for arrest( cardiac).

I’m sorry. This is unforkin’ believeable.

Now about what the paramedic’s thought MJ died.

We don’t have a time of death, we have an approximation.

We didn’t hear anyone say who killed MJ. we have a lot of ????

I don’t understand that. All that testimony comes after the fact. Who’s going to tell me, what Conrad Murray did before his death, that caused that death.

There is only person, through Detective Martinez, was Dr. Conrad Murray.

I’m sorry. This is comical if you ask me.

Every expert that Mr. Walgren called agreed, that 25 mg propofol of what Dr. Murray pushed, was not enough to kill a man.

Witnesses called, said that the amount of propofol in the stomach, (was enough to???)

More talk about levels found in the body after the fact got in there that we dont know how.

Came from ? only or came from Michael Jackson only or came from a combination.

The amt of propofol found in the stomach of MJ, and the fact that you have the juice on the counter, and no history ever of Dr. M would give him oral prpopfol drugs.

Again, strong possibility based on the prior…. when it comes down to Dr. M, did you kill MJ, it just didn’t make any sense.

If you look at the conduct of Dr. Murray over 3 months time, Dr. M would have the best understanding day after day after day, exactly how MJ would have reacted to the propofol drugs.

All those machines in the hospital tell doctors who have never seen a patient before….but Dr. Murray, who had seen MJ day after day would have seen how this drug (interacted with him).

The course of conduct and the experience, and the day that Dr. Murray trying to wean him off the drug, he suddenly doses him out the roof? He’s a ? docotr. He cares about MJ.

We have a serious causation here.. What we did not hear was from I’m going to talk about a witness was not here, can I talk about that?

JP No,

Only we did not hear from a like minded similar cardiac doctor say on the stand in a similar situation to present on the standard of care. We heard from a professor and a clinicitian, says HE would require for standard of care. But that’s from an anethesiologist what he would use as a standard of care. We didn’t hear from a cardiologist in a similar situation and training.

And lastly sir, I know you heard that some of the experts were asked their opinion whether or not enough time it took to administer propofol 3-5 vs 15 minutes would not change their mind,
I would submit to you sir, that putting someone out for a few minutes. (longer argument here)

That it would be resonable to believe that it would put the patient out for more than about a few minutes.

And that propofol would have burned off… ( did he say that? !!!)

Now taking about Dr. Murray injecting about 10:40… they used that even so if Dr. Murray was away from MJ, so even if he was, how could he have given another dose of propofol?

so what was going on between 11 am and 12 am?

That goes to show ou right there that Dr. Murry could not have given that dose, he was on the phone.

We can talk about the proper way to do CPr, I don’t know that Dr. Murray should be held accountable for killing MJ for not “breathing the life” back into MJ…. (not sure that’s correct).

Something about “the guys in the field” who do this for aliving… sometimes (you just can’t save them????)

Based on your argument. how reasonable is it to accept, the proposition that a very demanding patient, was being tended to by his phys from 1 am to approx 10:40 and admistered a miryad of sedatives. different quantities, how that had no effect, how reasonalbe is it that administering a 5 minute does of propofol.?

I think it is reasonable, because you know it’s not going to last more than 5 minutes.

Dr. cooper presented, talked about using propofol to use on brain injury patients. But the other beautiful thing is it doesn’t last long and when you come out you’re not drugged out?

Isn’t the person stil lsleep devprived?

What purpose does it serve, if it’s only going to keep the person asleep for five minutes? JP

Low. talks about shot of adreneline. In front of hundreds of fans, and when you come off the stage, it just doesn’t shut off…. is that it’s difficult to come down off our own chemestry to say you will. Gives this other explanation of not being able to go to sleep….Then your natural body takes over so that our natural body sleep can take over.

Atleast it allows you to get ther.

People heard?

DW:

your honor, in contrst Mr. Low’s comment, it was not MJ time to go. It was not for the recklessnes of Dr. M. It was not his time to go.
MJ children are without a father.

And for him to opine, that it was just frankly time to go, is offensive.

The reason MJ is not here today, is because of the carless, neglegence careless incompetence of Dr. M.

MJ is dead at the hands of Dr M.

Walgren is very angry and passionately in a loud voice, arguing his case.

Every single drug on that report, was provided, by Dr. Murray.

He’s very forceful in his statements.

Goes over the testimony of various witnesses.

But at 12:12 receives first phone call MAW receives.

Mr. Alvarez, from when he enters the room.

He’s busy with hiding evidence.
He’s telling him to take these bags.
Take down an IV bag that appeared to have a bottle in it so that it could be placed elsewhere.

We also know Dr. M tells members of the detail, Dr. M is trying to get back to the home to get some cream, I submit it was to get back to the home to dispose of evidence.

paramedics testimony.
What we do know from paramedics, at no time did Dr. M mention propofol. when the information was needed, he never mentioned it. That goes to consciousness of guilt. But never once mentions propofol, but never mentions the benzodiaz he administered.

He doesn’t mention to UCLA medical doctors. He doensnt mention becuase he knows what he’s done, he knows that he’s trying to cover up.

Fleak testimony, and what she found at the house.

Also know, cooberating testimony of Alvarez, recovered an IV bag with a bottle of propofol upsidedown in the bag.

Toxicology findings by Jaime Lintemoot.

Testimony of how much propofol was shipped. 90 bottles shipped on June 10 just two weeks before his death.

Coroner testimony.
It’s still a homicide, even if MJ self administered.
Ruffalo testimony. The detail of the gross neglegence and standard of care. That it was an extreme departure from standard of care. ANY doctor, any doctor should know.

we heard from DEA as to the email. we know from the screen shots, that Dr. Murray is reding from the email.

We know that he’s responding with another lengthly email.
we heard in detail about thephone records, and the phone calls to girlfriends and from patients.

Heard from Sade Anding at 11:51, and that Dr. Murray stopped responding and after 5 mnutes , Dr. M stopped responding and she heard a comotion.

Now look at Dr. M ‘s own words.

Goes over what he has said that he did to treated MJ in the interview . Goes over his detail time line.

Goes to the bathroom and he’s shocked. Shocked to find MJ not breathing, and that he’s never breathing again.

Why is that significant.

MJ was called at 12:17.. That means Dr. Murray waited almost an hour before he calls 911. (over an hour)

Points out the specific contradiction. Given not the day of the incident, given 2 days after the incident in a hotel, with his attorneys.

Dr. Murray has time to think about the events thnk about what he’s going to say.

According to Dr. Murray’s own timeline, that he let MJ lie there for over an hour not breathing.

Or he could be lying about his timeline, and Dr. M is not being truthful about his timeline.

Third option, is that Dr. Murray is so utterly so incompetent and reckless, that he has no idea what he gave him or when.

Tragically, it led to the death of MJ, based on the theory of involuntary manslaughter.

took time to call Michale Amir. Took time to call security guard.

To call 911 would give a quicker response, but would not give him time enough to cover up what he had done.

Okay. Walgren is talking so fast I can’t get it all. My fingers are TIRED!

Goes over the explanations he gave for not calling 911 when he did and why he din’t get MJ off the bed so he culd do proper CPR.

You are trained ot grab them by the shoulder protect the head and drag them to the floor.

Goes over the cream he wanted ot get.

Propofol is not indicated for sleep. It’s used for an anethetic.

Heard about the failure tokeep medical records or to monitor.
failure to monitor and be present.

Failfure to provid the proper cardica care.

Standard was breached over and over and over again.

Because of Dr. M. actions is why MJ is not longer here, and Not becuse it was his time to go.

He was motivated by other things. Because of his complete failure and his acton. that MJ is no longer with us.

submitted.

Low further comments.

When I was in the service of the marine core…

Oh blather!

Saying does’t make it so. Although Mr. Walgren appears to be angry, saying doesn’t make it so.

That if Dr. Murray would have been… saying doesn’t make it so.

Although there appears to be emotion and angry.. need to…. sheesh. I can’t keep up.

Did Mr. Walgren ever prove to you that if they had done something sooner, no that was just benefit without the fact.

I’m sorry. I just can’t write anymore of this weak, ineffectual argument.

Instead of getting upset, at least prove. Saying doesn’t make it so.

These points he’s bringing up….Oh. My. Lord. Now the discrepancy as to the LENGTH of the interview of Dr. Murray by the detectives.

Sorry. No more of this argument from me.

This court has reviewed all the evidence the def motion to dismiss is denied.

Appears 2 me of the evidence the offense has bene committed, I order Dr murray be held therefore.

Any issues of bail filed by medical board. do the state want to be heard?

As it relates to any bail, or thereof

DW:

We confronted back then, Judge Schwartz, we asked for bail back then at 300, at that time Judge ordered bail to be set at 75,000 we now ask for bail for 300,000 for flight risk and safety of the public.

We understand that the judge was not as informed as your honor. Now that your honor has heard more of what has transpired, we ask that that bail.

Ms. Saunders Medical board:

We’re appearing on behalf of director of the medical board, to provide justice and that as a conditon of bail, that the defendant have restrictions on him as a conditon of his bail not to be able to practice,

After trial, that this order to this defendant not practice and to show that an order of the saftely to the public has bene met.

Sicne the defendant held over, that there are restrictions on his license are in effect, we further request that he be prevented from practicing here in California.

delay in calling 911.

did not monitor patient while under heavy sedation.
(goes through her list of reasons to restrict his license.)

I’m not going to list all that she says. Sorry. It’s like a total repeat.

If he’s still allowed to practice, the public is at risk (more).

Waiting for action, (trial outcome) continues the public’s risk.

The judge can pose limitations on bail.

allowing the defendant to continue to practice is too much of a risk to the public.

At a minimum, the court impose the same restrictions.

Chernoff.
First respond to def request to raise bail.
Flight risk and danger to the public.

Murray has always appeared. He has never failed to appear. Don’t know that he’s a flight risk. He’s already under 3 times the amount scheduled.

He did help a woman who has fainted in the air (flight).

No reason what so ever, and certainly not for reasons Mr. W stated. So I would disagree with that.

Medical license.

Now asking, you’ve found probable cause that something going on, but they have not provided any other infor, no complaints, no malpractice, he’s spent 21 years as a Dr… the thing you found probably cause for, was an issue in isolation.

The At G. full well knows, Dr. M hasn’t practiced in Cal since 2009. Dr. Murray prac have been limited to two other states. there’s no meaningful distinction from practicing, from that. His patinets, they do not have a doctor, the efffect it wil lhave on his personal life, his defense, is immediate.

You familiar with Gray vs medical board. the standard is immenent, public danger. It’s not immenent. If it was immenent, we would have heard this already.

All they’ve done, is waited for you to act. They could have gone in before. (feb, earlier)

If you’re trying to determine if it’s immenent public harm, then you need ot look at what they did to make that determination.

The effect on the citizens. they’ve asked you to take away his ability to practice in California. The real effect of that is nothing, since he doens’t practice here.

The real effect is punishment, because of where he does practice in TX.

Anything more Ms. Saunders. Yes your honor.

Defense states that Mr. Murray doesn’t have any complaints against him. Well, that was the same situation at the time of MJ death.

If he really doesn’t have any patients here, then not practicing here in California, won’t be a problem.

Prior, we didn’t have all the facts that we have now heard in the last six days.

More…. All of this makes him a danger, but to any patient he sees.

One more comment from Chernoff.

It’s not that Dr. M says he wants to practice in California, it’s the effect.

Talks about what he does currently, sees patients in his office and prescribes heart medication.

There are things you can do, verse the ? action.

Increase the bail, court denies the request. Satisfied that the bail presently set, which is three tiems the presumptive bail (is sufficinet(. Certainly recognize posture. ct does have the ability to reconsider, I have done so and I am satisfied and shall remain.

In regard of the requesto of the motion of the medical bouard, ct understands that any such order must comport with due process…

Cites a case I don’t get, before the court can undertake any restrictions of a defendant phys, the defense has a right to be provided with notice and a right to be heard.

Certianly the defense has been provided with notice, when the medical board presneted back in 2009 (error? ) and the ct took into cnsideration of that notice at that time.

At that time I made it very clear, my denial of the motion was based on the clear dictates of the appellate couts of the state.

This court did not have the authority of bail at the juncture. or of the license.

if at the prelim the things change. in a predepravation hearing the court must balance due process. First the private interest that will be effected by the act.

The continued livelihood
the risk of eroneous depravation based on the depravaton used.
and the dignity interest.

(more)

This hearing has been a sginficant hearing as far as presentaton and evidence and the rights of the defense to explore evidence presented and to underline the sufficiency of any case. The corss has been extensive probing and vigerous. There is no eroneous issue of a deprivacy issue.

The prceduralsafeguards are to this proceeding as to this magistrate for fact finding.

The govts nterest and invovle the burdens… shoot. I can NOT keep up with Pastor’s ruling that he’s going through!

So as I balance all of these factors under Eldridge and Ppl vs Ramarez, due process has been afforded Dr. Murray .

Another case called, the def dr. murrya had been provided with a phonacaphy of legal proteection.

Ct is relying on all the facts presented, as well as allthe facts at this hearing

gillmar vs harmar

gray vs superior ct

In evaluation bail conditions, penal 1273, 1273 12 77,
explains about bail decision.

Circumstances have changed have changed dramatically,
court finds extraordinary manates to approving the request by the medical board.

So, he’s restricting the license or banning it all together.

cites a case.

the overall consideration of the protection of the public, and I’m satisfied that non intervention at this time, does impose a danger to public safety.

citing another case.
“There is no other profession where one passes so completely when one passes control of one person to another.”

In this case there is a direct nexus and connection between the actions of Dr. Murray, and a homicide.
(more) and the fitness and competence to practice medicine.

In undertaking an issue of restrictions ct recognizes the standard of proof is not simple probable cause, the standard of proof the ct must utilize, there is clear and convincing prooof that there is a certaintly that sanctions are appropriate.

another case.

This ct is satisfied by clear and convicing proof to a medical certainty.

Conditions of bail is appropriate. Orders all of existing conditons of bail amt. and also orders the conditonal

Immediatley cease and disist frompracticing in the state of californila is now suspended by this court as a conditon of bail.

They are to notifiy the approprite authorities in other states within the next 24 hours.

Provide represite proof to this court, in the next 24 hours.
to any and all licensing agencies where Dr. M holds a license.

Find there is good cause. (lists examples of the changed circumstances)

cites a case for finding. for good cause.

Dr. Murray is not to practice in any other jursdiction, in less he is so license.

Arraignment will be set two weeks from today.
January 25th, at 8L30 am.

Nothing else?

Defense?
Stay this order pending apellate review?

No.

That’s it. concluded.

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