The following blog addresses some questions and inconsistencies floating out there about Michael Jackson's death. This is a two-part series.
a) Did Michael have an pneumonia/some sort of infection when he died?
There is no evidence Michael had any sort of infection when he died. The autopsy report did not list any infection being present anywhere in his body. The best indication of infection, however, is an elevated white blood count which was not provided in the autopsy report. The report mentioned that Michael had a chronic lung condition consisting of pneumonitis and other related problems. This is different than something like pneumonia which is considered to be an acute lung condition (an acute condition is one that comes on suddenly and is most times temporary). Michael's lung ailments were not ones that would ever completely go away. Michael did have two antibiotics written for him by nurse practitioner Cherilyn Lee. The prescription for amoxicillin was filled on 02/02/2009 and the prescription for azithromycin was filed on 03/09/2009. Neither were finished nor apparently being taken when Michael died over three months later. Both of these antibiotics are used for an array of infections, usually uncomplicated infections any of us could encounter in our daily lives.
b) Was hydrocodone found at Michael's house?
No, there is no indication that hydrocodone was found at Michael's residence. The autopsy report does not list hydrocodone as a medication found at the residence. The official court transcripts do not mention hydrocodone, either. Some un-authorized reports claim that hydrocodone was found per testimony from the hearing in January. Hydrocodone is an oral medication used to treat mild to moderate pain. A medication of similar name called hydroquinone was found at the residence. Hydroquinone is a cream used to treat vitiligo. Michael did in fact suffer from vitiligo.
The lack of hydrocodone being mentioned as a combination product with another medication such as acetaminophen/paracetamol, aspirin or ibuprofen is rare as it is not available commercially in its pure form to the best of my knowledge--this further confirms a mistake in nomenclature by those present at the hearing since they did not report it as being part of a combination product. Michael's toxicology results were negative for hydrocodone (an opioid). Even if this medication had been found and was taken by Michael, if it was obtained via prescription for pain and taken as directed then there would have been no problem with it. But, thus far there is no indication he had access to or had been taking hydrocodone during the final months of his life, if not well before his death.
c) Where was the IV catheter placed that Conrad Murray used to administer propofol?
The IV catheter was placed in the inner left calf--an area that would never be used by medical personnel (other than Murray apparently) because placement in the calf increases the risk of a blood clot formation (deep vein thrombosis or DVT) which can be fatal. This is just another questionable and could-have-been lethal action apparently committed by Murray against Michael on 06/25/09 which defies common-medical-sense.
d) Was Michael capable of self-injecting propofol to himself?
I covered this in a previous blog found here:
http://gatorgirl277.blogspot.com/2010/08/michael-jackson-did-not-administer.html
Experts have deemed it almost entirely impossible that Michael could have administered propofol to himself which led to his death. Though most experts say it does not matter who delivered the final dose of propofol and conclude Murray is at-minimum guilty of Michael's death via negligence from leaving him unattended in an environment he created (assuming he did in fact leave him), I feel it is crucial to exonerate Michael from his own death while continuing to question Murray's intentions on 06/25/2009.
The coroner and his team of experts concluded Michael's death to be a "homicide--via injection by another". This conclusion was based on expert analysis and careful research. The IV set-up would have made it nearly impossible for Michael to inject himself or to have kept himself sedated/"asleep" for any extended length of time--this is not considering the fact he had a very high level of lorazepam in his system which should have sedated him before the administration of the fatal dose of propofol. Though everything being done to Michael by Murray was wrong the least Murray should have done was continuously monitor his patient--it was not too much to ask for by any means. For Murray to leave his patient and refuse to use adequate monitoring equipment under such conditions is truly inconceivable especially when one considers his anticipated salary ($150,000/month) for taking care of (and should have included keeping alive) one relatively healthy patient.
Some media reports have attempted to say Michael may have altered the propofol drip rate and thus caused his own death (assuming some sort of drip was used which will be covered later). If such a drip was actively giving him propofol he should have been sedated thus unable to adjust any administration of any medications. This scenario again disregards the high amount of lorazepam reported in the toxicology report which would also likely have render him unable to complete any sort of drip/medication administration adjustments.
e) Did Michael drink propofol?
No, Michael did not drink propofol. There has never been any indication that propofol was ingested per Murray, paramedics, the coroner or UCLA staff. The autopsy report findings state that 0.13 milligrams of propofol was found in 70 grams worth of stomach contents that were dark in color (the dark hue was likely from blood as hemorrhaging was noted in the autopsy resulting from CPR, the rest of the liquid was likely gastric juices or fluid from fluid redistribution post-mortem). Propofol is white. That amount of propofol (0.13 mg) is equal to approximately 0.013 milliliters or roughly a hundredth of a millimeter.
Propofol must be given intravenously (in the vein) to render an effect. Being ingested orally, propofol would take so long to reach the brain it would become inactivated before reaching it (propofol only renders an effect once it crosses the blood/brain barrier). Michael knew not to drink the medication as indicated by his request for a doctor or nurse to administer it IV (though he was wrong to think it a safe remedy for insomnia, based Lee's statements). If the reported number in the autopsy is wrong and any exorbitant amount ended up in his stomach then one should consider the possibility of someone forcing the medication down his throat against his own doing to make him appear desperate.
f) Is propofol addictive?
No, there is no evidence that propofol is physically addictive. Tolerance and withdrawal are components of physical addiction. Propofol does not cause withdrawals or tolerance thus is not physically addictive. It is not classified by the DEA as a drug of abuse or addiction, either.
Murray has claimed Michael was "demanding" propofol after the inability to essentially sleep at all throughout the ten hours before his death, a time frame which includes Murray drugging Michael at various times (the medication administration times reported by Murray are false given the conflicting amount of lorazepam and propofol found in the toxicology report). Murray used both oral but mainly IV benzodiazepines of which the latter should never be used for insomnia in a patient able to swallow tablets/capsules. Michael had oral diazepam, clonzepam, lorazepam, and temazepam available to him but they were not utilized other than diazepam some time well before his death.
No tablets/capsules of any kind were found in his stomach nor was any food in his stomach, either. This could be yet another indication Michael was sedated since there is no evidence Michael ate during that entire time he was awake (though had he eaten earlier in the night he may have digested this food prior to his death). His dinner prepared that evening on the 24th by chef Kai Chase remained in the refrigerator and Murray did not pick up Michael's breakfast that morning or notify Chase that Michael was sleeping in, either. Michael usually woke up at about 10 am. There is no mention of food in the bedroom to the best of my knowledge (someone please correct me if I am wrong), only bottled water and orange juice have been mentioned being found in the room which may or may not have drank that night.
Murray insists on this lack of the ability to sedate Michael despite evidence pointing to Michael being sedated ("sleeping") before he died due to the neurogenic bladder discussed in the previous blog as well as the lofty dose of lorazepam found in toxicology reports, among other issues. If Michael was not sedated Murray could have increased the dosing and frequency of the benzodiazepines so what is his excuse for not administering more of these safer drugs until sedation was achieved? There is no way Michael should have been that tolerant to benzodiazepines, especially one like midazolam. Murray is almost certainly lying about these supposed "demands" in the attempt to pin Michael as a desperate addict in order to perpetuate an erroneous defense that Michael self-injected propofol and drank it, too, thus Murray is not guilty of any wrongdoing because Michael did this all, somehow against all scientific reasoning, to himself. Then again, why would Murray give propofol to Michael if he had not been demanding it? Only Murray knows the answer to that question and he obviously is not telling. Shoddy defense attorneys will do anything to get their client off including placing unfounded blame on the victim when evidence clearly points to the contrary. They will do anything to attempt to establish "reasonable doubt" with the hopes the jury will be just as ignorant as themselves about complex situations even if it is not true.
In "Getting Over Going Under" Dr. Friedberg further establishes Murray's ignorance about propofol addiction by stating, "(p)ropofol is not physically addictive, but like any substance that is pleasurable, it is psychologically addictive. Physical addiction is defined by withdrawal or 'cold-turkey' symptoms if the agent is not supplied. The first Murray folly was the notion of propofol 'addiction'. The second fallacious notion was attempting to "wean" Jackson from a potential propofol addiction by giving him members of the benzo family. The third and lethal folly was giving Jackson two types of drugs well known to potentially stop breathing."
Murray actually ordered intravenous benzodiazepines (midazolam, lorazepam) well before there would have been an established psuedo-addiction to propofol. Murray first ordered propofol on April 6th--about a month prior to when he claims to have began giving propofol for insomnia. On April 28th ordered lorazepam and midazolam--again this is prior to any supposed administration of propofol (most claims are he began giving it on or around May 12th). Murray did not order the intravenous lidocaine (sometimes dubbed as "anti-burn") until June 10th, two weeks before Michael died. Though most reports state Murray began giving propofol six weeks prior to Michael's death, ex-manager Tohme Tohme stated to the media Murray had only been around the past two weeks.
"Weaning" an agent implies physical withdrawal and tolerance which does not develop with propofol--another proven-to-be-false statement by Murray which makes one question every single statement that has ever come out of his mouth. Even in a case where someone abused propofol up to 100 times a day, the person never found themselves needing to increase the dose or "wean" from it. If the "demanding" is part of the "weaning" equation then what does that say about the validity of these supposed demands?
Dr. Freidberg mentions not only the lack of monitoring but also the issue of giving two types of drugs that cause respiratory depression--true, Murray was not skilled as an anesthesiologist but being a cardiologist who should and does apparently possess more knowledge than the basic lay person, without a doubt, knew these drugs could be lethal given in the matter in which he gave them--without monitoring equipment, without apparently monitoring him in the room, without proper breathing measures instituted, etc. Murray also should have read up on any drug before giving it if he did not know enough information about it--that is the job of any medical professional. Murray knows benzodiazepines are depressants (and should know the ins and outs of these drugs very well given he should use them frequently in practice) and propofol is a sedative/hypnotic--just about anything that sedates or depresses can cause you to stop breathing especially when combined with other substances that cause depression or sedation. This concept should be like "1+1=2" for a physician and the likelihood of a doctor forgetting or not knowing one plus one is indeed two seems just as unlikely as one thinking a lorazepam/propofol combination, especially without monitoring and respiratory assistance, would not be lethal.
Other signs of addiction (physical or psychological) include pleasure, loss of control, compulsion and denial. There are arguments over whether or not the drug may be psychologically addictive, as Dr. Friedberg mentioned he believes it can be psychologically addictive. Other clinicians' say this drug may be psychologically addictive when given at sub-therapeutic levels only. Michael was not requesting use of the drug at sub-therapeutic levels if he requested it at all. Michael allegedly asked for propofol to treat insomnia (which he had suffered from for decades) that became troublesome while rehearsing for his upcoming tour--not for euphoric feelings or "getting high". One who lacks sleep would find receiving sleep (or what they think is sleep) pleasurable in some regard. Any substance/action could potentially create pleasure for someone thus psychological addiction--be it chocolate, lip balm, gambling or Facebook's Farmville. Apparently there was no loss of control (if one does not buy Murray's defense strategy)--he had a doctor who willfully was giving him this drug in a manner he thought was safe rather than ordering it and injecting it himself which has actually been done in the past by others. Murray's ordering and administration of propofol deemed this regimen as safe and acceptable in Michael's mind. Murray is trying to hint at compulsion by saying Michael demanded it and drank it but as discussed before this seems rather dubious. Michael did not deny the use of propofol --he had a doctor knowingly administering to him and had supposedly mentioned propofol to others, saying he was told by another doctor it was a safe way to get sleep--so long as he was monitored.
Part II will follow shortly and cover the non-rebreather mask, pulse oximeter and the technique used by Murray to administer propofol (gravity drip vs. bolus doses given via syringe).
Wednesday, March 30, 2011
Thursday, March 17, 2011
"But I Have Got to Pee..."
I have a new finding that I would like to share with everyone tonight that was meant to be a comment to my previous blog posting but became too long. I was talking with a dear friend today and it occurred to me to examine Michael's urine output. I wish I did not have to cover this topic but is important because I think this further proves that Michael was sedated when Murray did in fact give the propofol to Michael which then begs for the question--why would Murray give Michael propofol if he was already sedated?
Apparently 450 mLs of urine were found in the bottle left at the house and 550 grams (which is roughly the same amount in mL) was found in his bladder. His bladder, according to the autopsy report, was "distended and trabeculated". It was distended from the volume of urine. Trabeculated means "characterized by thick wall and hypertrophied muscle bundles; typically seen in instances of chronic obstruction". Michael had obstruction due to an enlarged prostate which is common in men around his age. When men have an enlarged prostate they tend to "go a little way too often" instead of being to empty their entire bladder at one time.
I was reading a case study on a young male nurse who died from propofol abuse. His cause of death as well as his estimated amount of propofol administration was estimated through his propofol urine content. The nurse's urine was found to have contained 5.4 ug/g--the bottle of Michael's urine found at the house had less than 0.10 ug/g and the urine from the body had 0.15 ug/g of propofol--much less than the nurse who died. This report estimated that the nurse had died after accidentally giving a 200 mg dose of propofol too himself too fast--but before he died, he'd given himself at least eleven 20mL (200 mg) doses over about six hours (roughly 2225 mg).
This report on the nurse also said that the typical person produces about 40-50 mL of urine an hour. Okay--450 mL divided by 50 mL gives you about 9 hours of urine in the bottle at the house. If you divide 550 mL by 50 mL you get about 11 hours worth of urine in Michael's bladder. Whoa. We do not know when that urine in the bottle was voided, we do not know if it was voided at one time or collected over so many hours or even days. However, it seems it may have been urine released over that night because of the similar content to the urine found in Michael's bladder--both contained propofol, lidocaine, ephedrine and midazolam (noticed the midazolam/propofol amounts "flipped" in the two samples--more propofol found in the bladder than the bottle and more midazolam found in the bottle than the bladder which seems to indicate the urine in the bottle was voided sometime that night, probably in more than one voiding).
In a normal person (as in, someone without diabetes insipidus) , someone usually makes urine in proportion the amount of fluids they take in, so, a person who drinks just a little bit of liquid should not pee as much as someone who has taken in a lot of liquids. Murray claims Michael was dehydrated--so Murray may have actually given Michael a lot of IV saline fluids, either for dehydration or some other reason (perhaps a reason like Monica hinted at, for example).
So, assuming Murray gave Michael a lot of fluids, for whatever reasons, it caused Michael to produce a lot of urine. Here is where the problem occurs--Michael had 550 mL of urine in his bladder. A normal bladder comfortably holds 300-350 mL of urine. A "full" bladder holds about 500-700 mL of urine. Michael's bladder had about 550 mL of urine in it so his bladder was at capacity. The desire to urinate begins to be felt when the bladder is at about 25% of its working value--so, if the working volume was 400 mL for Michael then at about 100 mL Michael should have felt the need to pee. Whatever the percentage, at 550 mL Michael should have felt the need to urinate and urinate ASAP. But, Murray claims Michael was awake, "demanding" propofol. Really? Michael was awake yet did not think to empty his at-capacity bladder? In fact, Michael should have felt the urge to go well before he passed away but yet died with a full bladder but Murray insists Michael was awake all this time. I seriously doubt an awake Michael consciously held this much urine and did nothing about it, hell, he did not even have to get up to pee since he had a condom catheter on--I think almost certainly Michael was sedated thus did not feel the need to urinate and that is why his bladder was full. He would have peed had he been awake during all that time when Murray claims he was awake demanding this and that and what not. With Michael creating that amount of urine and holding it all that time one has to ask if Michael EVER awoke at any point on June 25th before he died? It does not seem likely from my point of view.
Let us not forget the autopsy report also lists "benzodiazepine effect" as a indirect cause of death. This indicates that Michael was in fact being sedated by the lorazepam given to him. I mentioned before that Michael was given a large dose of lorazepam. An expert who testified at the hearing in January said his estimate of lorazepam given was 7-12 mg--a far cry from the 4 mg total Murray claims he gave that night. He also said he thought it would have been sedating him. He also estimated the amount of propofol given was somewhere between 100-200 mg--a dose that should not have caused death in Michael had he not been being sedated by lorazepam in the first place which together these medications caused Michael to not be able to breathe on his own. (I hope to soon be able to directly quote the expert on the findings above as they cannot be verified at this time since the transcripts are no longer publicly available online. I also hope to try and come up with his findings as a way of double-checking everything at some point since an expert is not always right. Estimating the doses Michael received is very difficult given possible reasons such as being over-hydrated, decomposition of propofol in plastic containers, multiple administrations of certain drugs rather than just one dosing, etc. I am not sure if the amounts quoted above are meant to indicate terminal (last) administrations or cumulative administrations of the medications, either.) However, Murray is lying about the dose and time he last gave lorazepam. Murray has lied about the dose of propofol he gave. He has almost certainly lied about Michael being awake during this time--WHY? Why do you give propofol to a man who is sedated and why do you claim he asked for it when he could not ask for it because he was already sedated?!
One thing I am still puzzled about is why were so many bottles empty at the scene. Two lidocaine bottles were empty and three others had partial amounts of drugs, two 20 mL bottles of propofol in addition to a 100 mL bottle of propofol (propofol should be discarded after 6 hours of being opened). I do not know if these were used during previous nights or if they were emptied as a part of staging a scene or something. Murray supposedly used no propofol the night before (thus should have used no IV lidocaine, either). Looking at Michael's urine levels it does not appear he had been given that much propofol before he died, certainly not any grand amount over 6 hours as was the case with the nurse died. It is difficult to make all these assumptions given Murray has done nothing but lie and evidence was not preserved properly if preserved at all. It will always be hard to state anything as 100% fact concerning Michael's death but I, and others, will try our best to piece everything together in time as more information comes out of the trial and I learn more information scientifically-related to this case.
Apparently 450 mLs of urine were found in the bottle left at the house and 550 grams (which is roughly the same amount in mL) was found in his bladder. His bladder, according to the autopsy report, was "distended and trabeculated". It was distended from the volume of urine. Trabeculated means "characterized by thick wall and hypertrophied muscle bundles; typically seen in instances of chronic obstruction". Michael had obstruction due to an enlarged prostate which is common in men around his age. When men have an enlarged prostate they tend to "go a little way too often" instead of being to empty their entire bladder at one time.
I was reading a case study on a young male nurse who died from propofol abuse. His cause of death as well as his estimated amount of propofol administration was estimated through his propofol urine content. The nurse's urine was found to have contained 5.4 ug/g--the bottle of Michael's urine found at the house had less than 0.10 ug/g and the urine from the body had 0.15 ug/g of propofol--much less than the nurse who died. This report estimated that the nurse had died after accidentally giving a 200 mg dose of propofol too himself too fast--but before he died, he'd given himself at least eleven 20mL (200 mg) doses over about six hours (roughly 2225 mg).
This report on the nurse also said that the typical person produces about 40-50 mL of urine an hour. Okay--450 mL divided by 50 mL gives you about 9 hours of urine in the bottle at the house. If you divide 550 mL by 50 mL you get about 11 hours worth of urine in Michael's bladder. Whoa. We do not know when that urine in the bottle was voided, we do not know if it was voided at one time or collected over so many hours or even days. However, it seems it may have been urine released over that night because of the similar content to the urine found in Michael's bladder--both contained propofol, lidocaine, ephedrine and midazolam (noticed the midazolam/propofol amounts "flipped" in the two samples--more propofol found in the bladder than the bottle and more midazolam found in the bottle than the bladder which seems to indicate the urine in the bottle was voided sometime that night, probably in more than one voiding).
In a normal person (as in, someone without diabetes insipidus) , someone usually makes urine in proportion the amount of fluids they take in, so, a person who drinks just a little bit of liquid should not pee as much as someone who has taken in a lot of liquids. Murray claims Michael was dehydrated--so Murray may have actually given Michael a lot of IV saline fluids, either for dehydration or some other reason (perhaps a reason like Monica hinted at, for example).
So, assuming Murray gave Michael a lot of fluids, for whatever reasons, it caused Michael to produce a lot of urine. Here is where the problem occurs--Michael had 550 mL of urine in his bladder. A normal bladder comfortably holds 300-350 mL of urine. A "full" bladder holds about 500-700 mL of urine. Michael's bladder had about 550 mL of urine in it so his bladder was at capacity. The desire to urinate begins to be felt when the bladder is at about 25% of its working value--so, if the working volume was 400 mL for Michael then at about 100 mL Michael should have felt the need to pee. Whatever the percentage, at 550 mL Michael should have felt the need to urinate and urinate ASAP. But, Murray claims Michael was awake, "demanding" propofol. Really? Michael was awake yet did not think to empty his at-capacity bladder? In fact, Michael should have felt the urge to go well before he passed away but yet died with a full bladder but Murray insists Michael was awake all this time. I seriously doubt an awake Michael consciously held this much urine and did nothing about it, hell, he did not even have to get up to pee since he had a condom catheter on--I think almost certainly Michael was sedated thus did not feel the need to urinate and that is why his bladder was full. He would have peed had he been awake during all that time when Murray claims he was awake demanding this and that and what not. With Michael creating that amount of urine and holding it all that time one has to ask if Michael EVER awoke at any point on June 25th before he died? It does not seem likely from my point of view.
Let us not forget the autopsy report also lists "benzodiazepine effect" as a indirect cause of death. This indicates that Michael was in fact being sedated by the lorazepam given to him. I mentioned before that Michael was given a large dose of lorazepam. An expert who testified at the hearing in January said his estimate of lorazepam given was 7-12 mg--a far cry from the 4 mg total Murray claims he gave that night. He also said he thought it would have been sedating him. He also estimated the amount of propofol given was somewhere between 100-200 mg--a dose that should not have caused death in Michael had he not been being sedated by lorazepam in the first place which together these medications caused Michael to not be able to breathe on his own. (I hope to soon be able to directly quote the expert on the findings above as they cannot be verified at this time since the transcripts are no longer publicly available online. I also hope to try and come up with his findings as a way of double-checking everything at some point since an expert is not always right. Estimating the doses Michael received is very difficult given possible reasons such as being over-hydrated, decomposition of propofol in plastic containers, multiple administrations of certain drugs rather than just one dosing, etc. I am not sure if the amounts quoted above are meant to indicate terminal (last) administrations or cumulative administrations of the medications, either.) However, Murray is lying about the dose and time he last gave lorazepam. Murray has lied about the dose of propofol he gave. He has almost certainly lied about Michael being awake during this time--WHY? Why do you give propofol to a man who is sedated and why do you claim he asked for it when he could not ask for it because he was already sedated?!
One thing I am still puzzled about is why were so many bottles empty at the scene. Two lidocaine bottles were empty and three others had partial amounts of drugs, two 20 mL bottles of propofol in addition to a 100 mL bottle of propofol (propofol should be discarded after 6 hours of being opened). I do not know if these were used during previous nights or if they were emptied as a part of staging a scene or something. Murray supposedly used no propofol the night before (thus should have used no IV lidocaine, either). Looking at Michael's urine levels it does not appear he had been given that much propofol before he died, certainly not any grand amount over 6 hours as was the case with the nurse died. It is difficult to make all these assumptions given Murray has done nothing but lie and evidence was not preserved properly if preserved at all. It will always be hard to state anything as 100% fact concerning Michael's death but I, and others, will try our best to piece everything together in time as more information comes out of the trial and I learn more information scientifically-related to this case.
Tuesday, March 8, 2011
Conrad Murray's Phone Records--An Analysis
The following blog is basically a stream-of-consciousness narrative concerning the best-known/developed time line of Conrad Murray's phone call records the day Michael Jackson died. Now, this time line has been composed by an array of sources. There is no intentional copying of information from anyone or any web site so if anyone sees information that is familiar please feel free to site the similar source for reference. Also, please feel free to submit corrections/conflicting information so every detail/scenario can be examined for thoroughness. No one source available is completely accurate given no one, except authorities, apparently have the actual copies of Murray's cell phone records.
Please keep in mind Murray had at least two cell phones with him that morning, possibly more though any additional phones have never been mentioned or accounted for at this time. He had an iPhone through AT&T and a phone through Sprint and was using both that morning.
I will state the time line then give commentary. My commentary may be rather biased compared with other blogs I have written and I will not have much proof, if any, to back up a few of my statements either. However, I feel my assumptions are logical and certainly possible. We must all do some rational and educated thinking to someday piece together what happened to Michael. The world deserves the truth and Michael does, too.
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Conrad Murray's Phone Records' Time line:
5:54am - (AT&T iPhone) email from Bob Taylor (London insurance broker) specifically inquiring about Michael's health and requesting confirmation Murray was the only doctor who was being consulted; had records back to 2006 and requested release of those medical records
6:31am – text to/from Texas
7:01am –(Sprint phone) call from Murray to Andrew Butler (patient/friend) in Nevada, 25 seconds long
8:36am - text to/from Texas
8:49am – (Sprint phone) call to Murray from Antoinette Gill (patient/friend) in Nevada, 53 seconds long
9:00 am – text to/from Texas
9:11 am – text to/from Texas
9:23am – (AT&T iPhone) call to Murray from Marissa Boni (friend of Murray's daughter) in Nevada, 22 minutes long
10:14am - (AT&T iPhone) call to Acres Home Heart and Vascular Institute in Houston (curious about this call since AHHVI supposedly closed sometime in 2008 due to debt; Source: http://www.chron.com/disp/story.mpl/ent/6501143.html ); 2 minutes long
10:22am - (Sprint phone) call to Murray from Dr. Joanne Prashad in Houston regarding a patient and medications 111seconds long (Prashad said Murray was able to recall information swiftly from 2 months prior)
10:34am - (Sprint phone) call from Murray to Stacey Howe-Ruggles in San Diego (or to a San Diego phone number) giving instructions for a letter regarding the upcoming tour in London, 8.5 minutes long (the letter was to the London Medical Board notifying them of his arrival and asking what facilities would be available to him--I believe the answer should have been NONE since he has no medical license in the UK; Howe-Ruggles also stated he sounded normal/not distracted during this period of time when Michael was supposedly awake and demanding propofol; according to Murray's first account of events given to police the administration of propofol was either during or immediately after this phone call)
10:36am – text to/from Texas
11:07am - (AT&T iPhone) call to Murray from Stacey Howe-Ruggles in San Diego, 1 minute long
11:17am - (AT&T iPhone) email to Bob Taylor, London insurer, answering questions from an email received earlier about Michael's health refuting the stories heard and said he was denied authorization to disclose Michael medical records back to 2006
11:18am - (AT&T iPhone) call from Murray to his Las Vegas practice in Nevada, 32 minutes long
11:26am - (Sprint phone) call to Murray from Ms. Bridgette Morgan (topless dancer) in California, 7 seconds long (call occurred during the call to his practice in Las Vegas)
11:49am - (AT&T iPhone) call from Murray to Bob Russell (patient) in Nevada; left voice mail regarding treatment update and asking him to remain his patient although he may be away overseas, 3 minutes long
11:51am - (AT&T iPhone) call from Murray to Sade Anding (cocktail waitress) in Houston, 11 minutes long
12:03pm – text to/from Texas
12:04pm - text to/from Texas
12:12pm - (AT&T iPhone) call from Murray to Michael Amir Williams (security) in California left a voicemail, 1 minute long
12:15pm - (AT&T iPhone) call from Michael Amir Williams to Murray, 1 minute long
12:53pm – text to/from California
1:08pm - (Sprint phone) call from Murray to Nicole Alvarez in California, 2 minutes long (while in the ambulance)
1:23pm – text to/from Nevada
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Thoughts on this Time Line:
Murray supposedly gave 2 milligrams of midazolam (Versed) at 7:30 am--no phone activity has been reported at 7:30 am but midazolam was not pharmacologically active (not sedating him because the concentration found in his body was too low) when Michael passed away some hours later. So, it is hard to know if Murray really did give Michael this medication at this time or not. Midazolam sedates someone for about 2 hours but sometimes can sedate up to 6 hours--dosing and metabolism are factors in how long the effects will last. Murray had no business giving this particular benzodiazepine for insomnia because of its potency and method of administration (it is given IV or intramuscular). Many of the same warnings concerning propofol apply to midazolam, too.
However, more notably, Murray claims he last gave lorazepam (Ativan), 2 milligrams, shortly before the email sent to his iPhone from Taylor (approximately 5:30 am). The last administration of lorazepam at 5:30 am is a lie as is the administration of 2 milligrams of this medication--Murray gave much more than 2 milligrams of lorazepam to Michael as toxicology reports do not lie. Michael's blood level for lorazepam was 162 ng/mL and 169 ng/mL (heart and femoral blood, the actual numbers in the autopsy report are recorded as 0.162 ug/mL and 0.169 ug/mL--I converted micrograms into nanograms for consistency). Sources state that 2 milligrams of lorazepam taken orally gives a peak blood concentration of 20 ng/mL in about 2 hours. When it is given IV the peak blood concentration is slightly higher and achieved faster--in about 10 minutes rather than 2 hours. Doing the math--if 2 milligrams gives you 20 ng/mL then 169 ng/mL gives you 16.9 milligrams of lorazepam/Ativan being administered--at minimum--because the likelihood of these numbers being "peak" blood levels are slim. These levels were likely either on the rise to a peak or on the downhill slope from a peak. Think of a mountain--you are more likely to be on one side or the other and not right on top since there is more land on the sides--same is true of medication peaks and troughs. We have yet to know if Murray gave lorazepam directly into the vein (IV) or into the muscle so we do not know what time Michael's blood level should have peaked nor do we know how many times Murray really gave this medication that night and into the morning hours.
I am not sure what the typical blood concentration is when respiratory depression is seen with lorazepam but according to this source (http://tinyurl.com/4lo9vah) it can be seen in doses as small as one milligram (this is giving the drug IV and not orally). Almost certainly Murray gave Michael lorazepam before he gave the propofol due to the high level or lorazepam in his body. The lorazepam had had time to circulate in his body before death.
If Murray's claim is this class of medication were not sedating Michael (diazepam, midazolam and lorazepam are all benzodiazepines) then why did he not try to give more of one of these medications before giving propofol? He had the antidote for benzodiazepine toxicity on-hand (flumazenil) in case he gave too much and eventually the medications should have sedated Michael--you do not become completely immune to their effects. There is no antidote for propofol other than to mechanically breathe for the patient until the drug wears off and Murray did not posses means to mechanically breathe for him. I cannot help but think Michael had slept (or moreover been heavily sedated given the condom catheter and bed pads being used) on midazolam and diazepam and very possibly lorazepam but remained sedated or was re-sedated on lorazepam shortly before the propofol was administered--without Michael's asking or knowledge. So why would someone give both lorazepam and propofol to someone given the risks of being unable to breathe and thus dying? It would not be to sleep in their bed at home--that much is certain.
The therapeutic range for lorazepam (safe blood level that gives an effect) is between 10-300 ug/L (or ng/mL). Anything over 300 ng/mL is considered to be an acute overdose so Michael's level was not an overdose--it was just extremely high especially for someone who was being given the medication for insomnia. However, the maximum dose recommended for bedtime is 4 milligrams (to be given orally in a patient who can swallow and take oral medications--Michael should have been given oral medications only)and should render a blood level of about 40 ng/mL, maybe a bit higher, but not 4 times that amount. Even though blood levels are not considered toxic until approximately 250-300 ng/mL I see no dosing for lorazepam over 8 milligrams and 8 milligrams is used either for status epilepticus (seizures) or rapid tranquilization of an agitated patient--not insomnia. There is no excuse for Murray giving Michael this enormous amount of lorazepam for insomnia--it was also very dangerous and inexcusable that Murray was using the IV formulation and administered this intravenous medication in a home with no means of respiratory assistance. Remember, one milligram of IV lorazepam can cause breathing problems and those problems would be even more likely in someone with chronic lung issues--like Michael--and Murray should have been well-aware of these lung issues as Michael was a former patient of Murray's and he should have examined his lungs before giving him any medication, especially a medication that can cause breathing problems or the complete absence of breathing. The autopsy report stated Michael had chronic (always present, not sudden like an infection) lung problems and he had probably had this problem for some time.
I am not sure if Michael became tolerant to lorazepam/benzodiazepines to some degree because of Murray's regimen but if he did there is only one person to blame for that--Conrad Murray. Michael had lorazepam tablets at his disposal since April and he refrained from taking them in excess (the same goes for other benzodiazepines found in the house)--Michael could not control what or how much Murray was administering to him at night since the medications made him unconscious. I do not think Michael had become so tolerant/dependent to benzodiazepines that over 17 milligrams of lorazepam was like water to him. Yes, you can become dependent on lorazepam for sleep and yes, you can build some tolerance to your dose over time but 17 milligrams over a span of a few weeks? No way. I am not buying it until proven otherwise. Plus, Murray claims Michael slept on midazolam and lorazepam the night before with no problems. We do not know how much was administered on the 24th or even how it was given but whatever Murray supposedly gave on June 24th was apparently enough to help him sleep throughout the night--and survive--and I do not think in a day's time that benzodiazepines would no longer have sedated Michael.
The following are gaps in time, as in time where Murray was apparently not on either phone, be it texting, emailing or on a call.
Gaps in Time:
Apparent gaps from phone usage for the 10am hour:
10:00am - 10:13am
10:17am - 10:21am
10:25am - 10:33am
10:45am - 11:06am--this is the biggest gap in time after 10:00am apparently. I do not think Michael died before 10:00am. The 10:45am to 11:06am gap directly corresponds to when Murray says he administered propofol (at approximately 10:40am), monitored Michael for 10 minutes, went to the restroom for no more than 2 minutes, then came back to find Michael in distress at approximately 10:52am. This was Murray's first story given to police--it has since changed multiple times but I find it important his first story correlates with this time frame. What is even more telling is he was apparently not on the phone until 11:17am, minus a 60-second call from Stacey Howe-Ruggles at approximately 11:07am. So, what is his excuse for not monitoring Michael during this critical time? He not only should have been monitoring him constantly by eye and equipment (most of which he did not have or chose not to use effectively if at all) but he should have been checking on Michael because propofol only lasts so long and both drugs--lorazepam and propofol--can both make someone stop breathing on their own. The effects on breathing are amplified when drugs of this nature are given together. The side effects of propofol are seen immediately after administration not as it is wearing off. Murray should have seen Michael stop breathing in those first two minutes and not 10 minutes later especially if the lorazepam was not working as Murray claims. Murray insists the benzodiazepines were not sedating Michael but if they were then there was no reason to have given propofol to him and then intent becomes highly questionable (like it is not questionable already). Both the amounts of lorazepam and propofol found in Michael's body are alarming to any health care professional especially when you consider Michael had no means for breathing assistance provided to him by Murray.
We know Murray claims he only gave 25 milligrams of propofol. This is a lie based on the levels found in Michael's body. Even if Murray gave 200 milligrams (a 20 mL vial) that would have only sedated Michael about 10-20 minutes. It has yet to be determined whether or not Murray was bolusing Michael (using the syringes found at the scene, drawing up the medications via the syringe then pushing the contents directly into the IV tubing) or if he made some sort of gravity-based IV system. I tend to lean toward Murray bolusing Michael (which I will debate in my next blog) but if Murray used some sort of gravity IV system (which he should have known would be lethal as it is NEVER given this way) then he still should have been watching Michael for imminent breathing problems.
According to his call records he was not on the phone during this time. Assuming Murray left Michael, which should constitute patient abandonment, he should have gone back to check on Michael as soon as possible to a) make sure he was breathing and b) to administer more propofol since 200 milligrams does not sedate beyond about 10-20 minutes. If Murray somehow administered 1000 milligrams (a 100 mL vial) via a drip he could not have expected Michael to survive as Michael would never have had a chance to breathe on his own because of the quantity being delivered and lack of controlled dosing from the absence of a manual IV pump. If Murray left the room and then failed to go back and check on him within seconds it would certainly appear as if he assumed he had died and thus did not need to go back and check or tend to him if that was the goal. Murray was busy the rest of the 11 am hour as if he was done dealing with Michael.
One may ask, if Michael died around 11 am why would Murray not use this time to clean up if he intended on killing Michael instead of making phone calls or what not? That makes this look accidental. Well, if you want something to look accidental, especially to look like the patient inflicted the final medication blow to himself, then you cannot "clean up" before others see the patient otherwise things would look even more suspicious. Murray was also making himself look busy on the phone while Michael supposedly killed himself. Murray's attorneys have denied he cleaned up so perhaps what appears to everyone else as a "clean-up" is being considered part of the attempt to resuscitate him (removing the old IV line, clearing the area for paramedics). Whether Michael died at 11 am or 12 pm Murray had ample time to put things away himself.
Apparent gaps from phone usage for the 11am hour:
The only breaks from phone use were from 11:00am - 11:06am (continuing on since 10:45am) and 11:08am - 11:16am. From 11:17am and until noon he was on a phone the entire time. So Murray obviously kept himself occupied--or so he wants others to assume he got tied up thus Michael, someone anesthetized without assisted breathing, fell off Murray's radar and killed himself. Yeah right. The phone did not prevent Murray from being able to be at the bedside or prevent him from administering medications, either. With Michael being given propofol he would not have been able to wake up from even the loudest of sounds--he was put in a coma, not sleeping. Murray could have stayed in the room. Murray was supposedly on the phone this entire time yet he expected Michael to stay sedated on the propofol while making calls? Especially 25 milligrams? That makes no logical sense--200 milligrams sedates about 15-20 minutes, maximum. Murray should have anticipated on Michael awaking (assuming the 17+ milligrams of lorazepam was null). Just my opinion but seeing this time line, seeing these calls, one after the other after the other during the 11 am hour it appears Murray intentionally neglected Michael, be it by leaving the room and choosing not to monitor him or witnessing him die right there in the same room while apparently being on the phone.
Notice how the concerned call to Sade Anding (which was supposedly made "out of the blue"), the call where it sounded as if something was wrong with Murray before he discovered Michael's body, took place not even less than a minute after calling patient Bob Russell and leaving a voice mail which revealed a normal Murray with no apparent stress or concern in his voice.
12:04pm - 12:12pm--If Michael had not passed away sometime during the 11:00 am hour then this time would have been the most critical time in saving Michael's life. Murray claims Michael had a weak pulse when he found him. A call to 911 should have occurred here or earlier since according to Sade Anding Murray discovered Michael at about 11:55 am yet he kept her on the line to hear "coughing and mumbling". He could have also used his other phone to dial 911. I guess help for Michael was not the first objective on his mind. At one time Murray's attorney said "Murray did not immediately call 911 because there was no house phone in the room where Jackson was and he could not leave his patient to make the call." Really? He had not one but two cell phones with him, fool. (Source: http://abcnews.go.com/GMA/TheLaw/gma-exclusive-conrad-murray-lawyer-ed-chernoff-speaks/story?id=10294040&page=1) CPR protocol states to start CPR on an adult and then call 911--there is no excuse for not calling 911. A paramedic stated in hearing testimony Michael had, in his opinion, been dead at least 20 minutes to an hour (they arrived on the scene at 12:26 pm)--if he had been dead only about 20 minutes then he would have in fact been alive when Murray found him and died sometime after talking to Anding but before placing the first call to security. Not placing a call to 911 defies all common sense. Even some toddlers know to call 911 if there is an emergency. If Michael was in fact alive at approximately noon then Murray allowed Michael to die in his presence by refusing him aid. The 911 call was not even made until 12:22 pm and it was made by Alberto Alvarez not Murray.
Why did Murray not tell chef Kai Chase that Michael was sleeping in and would not need breakfast that morning? Michael was typically up by about 10am. Murray was on the phone off and on during the 10am hour--including on a long call with one of his daughter's friends. Let's hope she is not a minor.
One cannot help but wonder if Murray was not trying to creating himself a "cellular alibi" by making himself look distracted through phone use, especially if Murray had anticipated on blaming Michael for his own death (recall Murray's insistence he gave nothing that should have killed Michael which is of course another lie). If Murray was out of the room or "distracted" he would not have witnessed Michael giving himself propofol, though a cell phone would not bar him from being in the bedroom. Maybe Murray did not know experts would clearly state in the autopsy report that Michael was virtually incapable of injecting himself with propofol. Perhaps Murray and his defense team are too ignorant to know that propofol renders no effect when ingested orally, not accounting for the lack of visible propofol in his stomach, too. Initially Murray's attorney Edward Chernoff said Murray just happened to walk in and see Michael in distress. Later on, Chernoff said Murray never left Michael. Compare "'he just came in to check on him, fortuitiously (sic),' Chernoff said." to " he denies leaving the singer alone after administering a series of sedatives to try to help him sleep". (Sources: http://www.chron.com/disp/story.mpl/ent/6501143.html and http://www.dailymail.co.uk/news/worldnews/article-1208761/Michael-Jackson-lethal-levels-anaesthetic-body-died.html). Notice the error on the "Daily Mail's" graphic titled "One Night and a Cocktail of Drugs" that states emergency services were called at 10:55 am. WRONG. So--was Murray in the bedroom or not? If he was not in the room where was he? If he was in the room then what is his explanation for being within inches of a man dying directly under his nose?
The entire night Michael was supposedly awake and "demanding propofol"--odd there was no phone activity reported before 5:54 am as he should have been awake listening to Michael's demands and likely keeping himself occupied with his phone in some manner, possibly by texting others like his numerous girlfriends. But, what if Michael was asleep and Murray went to sleep during this time, too? Was Murray reportedly sleeping during the day? He had to sleep at some point. It is also odd Murray was able to chat on the phone with others during the 9 am and 10 am hours while Michael was supposedly awake and demanding propofol during this time as well (like someone would be demanding propofol for 9 hours and be okay with having to continue asking for the entire time). The patient, especially the $150,000/month income-producing patient would seemingly come first before some casual phone calls and texts, right? Did Murray ignore a "demanding Michael" during this time or was he making calls while Michael was actually sedated? The latter appears to be the more logical scenario. Michael had told nurse Cherilyn Lee she could leave the night she stayed to watch him sleep (per the Greta Van Sustren interview). If Michael was sedated on benzodiazepines that work for so many hours then why stay awake watching someone sleep? Benzodiazepines are typically safer than propofol though IV benzodiazepines have similar risks. But, it seems logical that if Michael was sedated on benzodiazepines then Murray probably went to sleep at some point, too.
Reportedly a picture of "Murray's Room" at the Carolwood home though he did not live there with Michael--no other adults lived at the home with Michael. This was not the room paramedics went to when they arrived to try and revive Michael. The bed appears to be poorly-made.
Questions:
Could the email sent by the insurance company been a catalyst for murder? Note the reply was sent some time later, almost 6 hours later at 11:17am immediately after a 30 minutes lack of cellular activity and during the supposed initial administration of propofol.
What was Murray doing on the phone while on a call to his office in Las Vegas (11:18am - 11:49am)? Who was he talking to or was he talking to anyone? Is there any record of what transpired during this call?
The call to Bob Russell--some doctors make house calls but most do not, at least, most I know. When testing is done (be it examinations, blood work, biopsies, etc.) typically doctors have a letter mailed out to the patient within a reasonable time, typed by their staff, stating everything was normal. When something is abnormal, typically a nurse will call and tell you there are abnormal results and give some sort of explanation. Sometimes the abnormality can be taken care of over the phone (like adjusting a medication dose) or sometimes a follow-up appointment is needed. To me, and this is very opinionated, I find it odd Murray called Russell that morning, especially right after calling his office and right before calling Sade Anding "out of the blue". It may mean nothing--or it could be something.
What really possessed Murray to call Anding? Is it to provide himself with an alibi and to try and bring an element of "surprise" to finding Michael in such a manner? Anding is currently defending Murray though she has no real understanding of what he did and did not do to Michael. She calls him a "good man" though he supposedly did not bother to tell her he was married AND seeing other women besides her and his wife. Does that really sound like a "good man" to you?
Murray never placed a call or email to AEG--why not? Should he not have contacted them at some point regarding either the email from Taylor and/or Michael being in trouble?
Where or which calls/texts were to LaQuanda Price and LaQuisha Middleton (the sisters that worked for Murray) who showed up at the storage unit in Houston at 11:22 am Houston time/9:22 am Los Angeles time. Recall they had conflicting stories about going to the storage unit. Why?
Conclusion:
You have heard enough from me--now I want to hear from you, hear your opinions and what else you can add to this. What other possibilities do you see based on what we think we know? What additional information can you provide? I cannot help but see everything concerning June 25th as sinister, especially when I try to place myself in Murray's mind frame and think of how Murray refuses to admit to any form of guilt. I cannot see his actions and non-actions being anything other than intentional and with purpose. Certainly we are far from the truth when it comes to knowing not so much how but why Michael Jackson had to die.
Please keep in mind Murray had at least two cell phones with him that morning, possibly more though any additional phones have never been mentioned or accounted for at this time. He had an iPhone through AT&T and a phone through Sprint and was using both that morning.
I will state the time line then give commentary. My commentary may be rather biased compared with other blogs I have written and I will not have much proof, if any, to back up a few of my statements either. However, I feel my assumptions are logical and certainly possible. We must all do some rational and educated thinking to someday piece together what happened to Michael. The world deserves the truth and Michael does, too.
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Conrad Murray's Phone Records' Time line:
5:54am - (AT&T iPhone) email from Bob Taylor (London insurance broker) specifically inquiring about Michael's health and requesting confirmation Murray was the only doctor who was being consulted; had records back to 2006 and requested release of those medical records
6:31am – text to/from Texas
7:01am –(Sprint phone) call from Murray to Andrew Butler (patient/friend) in Nevada, 25 seconds long
8:36am - text to/from Texas
8:49am – (Sprint phone) call to Murray from Antoinette Gill (patient/friend) in Nevada, 53 seconds long
9:00 am – text to/from Texas
9:11 am – text to/from Texas
9:23am – (AT&T iPhone) call to Murray from Marissa Boni (friend of Murray's daughter) in Nevada, 22 minutes long
10:14am - (AT&T iPhone) call to Acres Home Heart and Vascular Institute in Houston (curious about this call since AHHVI supposedly closed sometime in 2008 due to debt; Source: http://www.chron.com/disp/story.mpl/ent/6501143.html ); 2 minutes long
10:22am - (Sprint phone) call to Murray from Dr. Joanne Prashad in Houston regarding a patient and medications 111seconds long (Prashad said Murray was able to recall information swiftly from 2 months prior)
10:34am - (Sprint phone) call from Murray to Stacey Howe-Ruggles in San Diego (or to a San Diego phone number) giving instructions for a letter regarding the upcoming tour in London, 8.5 minutes long (the letter was to the London Medical Board notifying them of his arrival and asking what facilities would be available to him--I believe the answer should have been NONE since he has no medical license in the UK; Howe-Ruggles also stated he sounded normal/not distracted during this period of time when Michael was supposedly awake and demanding propofol; according to Murray's first account of events given to police the administration of propofol was either during or immediately after this phone call)
10:36am – text to/from Texas
11:07am - (AT&T iPhone) call to Murray from Stacey Howe-Ruggles in San Diego, 1 minute long
11:17am - (AT&T iPhone) email to Bob Taylor, London insurer, answering questions from an email received earlier about Michael's health refuting the stories heard and said he was denied authorization to disclose Michael medical records back to 2006
11:18am - (AT&T iPhone) call from Murray to his Las Vegas practice in Nevada, 32 minutes long
11:26am - (Sprint phone) call to Murray from Ms. Bridgette Morgan (topless dancer) in California, 7 seconds long (call occurred during the call to his practice in Las Vegas)
11:49am - (AT&T iPhone) call from Murray to Bob Russell (patient) in Nevada; left voice mail regarding treatment update and asking him to remain his patient although he may be away overseas, 3 minutes long
11:51am - (AT&T iPhone) call from Murray to Sade Anding (cocktail waitress) in Houston, 11 minutes long
12:03pm – text to/from Texas
12:04pm - text to/from Texas
12:12pm - (AT&T iPhone) call from Murray to Michael Amir Williams (security) in California left a voicemail, 1 minute long
12:15pm - (AT&T iPhone) call from Michael Amir Williams to Murray, 1 minute long
12:53pm – text to/from California
1:08pm - (Sprint phone) call from Murray to Nicole Alvarez in California, 2 minutes long (while in the ambulance)
1:23pm – text to/from Nevada
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Thoughts on this Time Line:
Murray supposedly gave 2 milligrams of midazolam (Versed) at 7:30 am--no phone activity has been reported at 7:30 am but midazolam was not pharmacologically active (not sedating him because the concentration found in his body was too low) when Michael passed away some hours later. So, it is hard to know if Murray really did give Michael this medication at this time or not. Midazolam sedates someone for about 2 hours but sometimes can sedate up to 6 hours--dosing and metabolism are factors in how long the effects will last. Murray had no business giving this particular benzodiazepine for insomnia because of its potency and method of administration (it is given IV or intramuscular). Many of the same warnings concerning propofol apply to midazolam, too.
However, more notably, Murray claims he last gave lorazepam (Ativan), 2 milligrams, shortly before the email sent to his iPhone from Taylor (approximately 5:30 am). The last administration of lorazepam at 5:30 am is a lie as is the administration of 2 milligrams of this medication--Murray gave much more than 2 milligrams of lorazepam to Michael as toxicology reports do not lie. Michael's blood level for lorazepam was 162 ng/mL and 169 ng/mL (heart and femoral blood, the actual numbers in the autopsy report are recorded as 0.162 ug/mL and 0.169 ug/mL--I converted micrograms into nanograms for consistency). Sources state that 2 milligrams of lorazepam taken orally gives a peak blood concentration of 20 ng/mL in about 2 hours. When it is given IV the peak blood concentration is slightly higher and achieved faster--in about 10 minutes rather than 2 hours. Doing the math--if 2 milligrams gives you 20 ng/mL then 169 ng/mL gives you 16.9 milligrams of lorazepam/Ativan being administered--at minimum--because the likelihood of these numbers being "peak" blood levels are slim. These levels were likely either on the rise to a peak or on the downhill slope from a peak. Think of a mountain--you are more likely to be on one side or the other and not right on top since there is more land on the sides--same is true of medication peaks and troughs. We have yet to know if Murray gave lorazepam directly into the vein (IV) or into the muscle so we do not know what time Michael's blood level should have peaked nor do we know how many times Murray really gave this medication that night and into the morning hours.
I am not sure what the typical blood concentration is when respiratory depression is seen with lorazepam but according to this source (http://tinyurl.com/4lo9vah) it can be seen in doses as small as one milligram (this is giving the drug IV and not orally). Almost certainly Murray gave Michael lorazepam before he gave the propofol due to the high level or lorazepam in his body. The lorazepam had had time to circulate in his body before death.
If Murray's claim is this class of medication were not sedating Michael (diazepam, midazolam and lorazepam are all benzodiazepines) then why did he not try to give more of one of these medications before giving propofol? He had the antidote for benzodiazepine toxicity on-hand (flumazenil) in case he gave too much and eventually the medications should have sedated Michael--you do not become completely immune to their effects. There is no antidote for propofol other than to mechanically breathe for the patient until the drug wears off and Murray did not posses means to mechanically breathe for him. I cannot help but think Michael had slept (or moreover been heavily sedated given the condom catheter and bed pads being used) on midazolam and diazepam and very possibly lorazepam but remained sedated or was re-sedated on lorazepam shortly before the propofol was administered--without Michael's asking or knowledge. So why would someone give both lorazepam and propofol to someone given the risks of being unable to breathe and thus dying? It would not be to sleep in their bed at home--that much is certain.
The therapeutic range for lorazepam (safe blood level that gives an effect) is between 10-300 ug/L (or ng/mL). Anything over 300 ng/mL is considered to be an acute overdose so Michael's level was not an overdose--it was just extremely high especially for someone who was being given the medication for insomnia. However, the maximum dose recommended for bedtime is 4 milligrams (to be given orally in a patient who can swallow and take oral medications--Michael should have been given oral medications only)and should render a blood level of about 40 ng/mL, maybe a bit higher, but not 4 times that amount. Even though blood levels are not considered toxic until approximately 250-300 ng/mL I see no dosing for lorazepam over 8 milligrams and 8 milligrams is used either for status epilepticus (seizures) or rapid tranquilization of an agitated patient--not insomnia. There is no excuse for Murray giving Michael this enormous amount of lorazepam for insomnia--it was also very dangerous and inexcusable that Murray was using the IV formulation and administered this intravenous medication in a home with no means of respiratory assistance. Remember, one milligram of IV lorazepam can cause breathing problems and those problems would be even more likely in someone with chronic lung issues--like Michael--and Murray should have been well-aware of these lung issues as Michael was a former patient of Murray's and he should have examined his lungs before giving him any medication, especially a medication that can cause breathing problems or the complete absence of breathing. The autopsy report stated Michael had chronic (always present, not sudden like an infection) lung problems and he had probably had this problem for some time.
I am not sure if Michael became tolerant to lorazepam/benzodiazepines to some degree because of Murray's regimen but if he did there is only one person to blame for that--Conrad Murray. Michael had lorazepam tablets at his disposal since April and he refrained from taking them in excess (the same goes for other benzodiazepines found in the house)--Michael could not control what or how much Murray was administering to him at night since the medications made him unconscious. I do not think Michael had become so tolerant/dependent to benzodiazepines that over 17 milligrams of lorazepam was like water to him. Yes, you can become dependent on lorazepam for sleep and yes, you can build some tolerance to your dose over time but 17 milligrams over a span of a few weeks? No way. I am not buying it until proven otherwise. Plus, Murray claims Michael slept on midazolam and lorazepam the night before with no problems. We do not know how much was administered on the 24th or even how it was given but whatever Murray supposedly gave on June 24th was apparently enough to help him sleep throughout the night--and survive--and I do not think in a day's time that benzodiazepines would no longer have sedated Michael.
The following are gaps in time, as in time where Murray was apparently not on either phone, be it texting, emailing or on a call.
Gaps in Time:
Apparent gaps from phone usage for the 10am hour:
10:00am - 10:13am
10:17am - 10:21am
10:25am - 10:33am
10:45am - 11:06am--this is the biggest gap in time after 10:00am apparently. I do not think Michael died before 10:00am. The 10:45am to 11:06am gap directly corresponds to when Murray says he administered propofol (at approximately 10:40am), monitored Michael for 10 minutes, went to the restroom for no more than 2 minutes, then came back to find Michael in distress at approximately 10:52am. This was Murray's first story given to police--it has since changed multiple times but I find it important his first story correlates with this time frame. What is even more telling is he was apparently not on the phone until 11:17am, minus a 60-second call from Stacey Howe-Ruggles at approximately 11:07am. So, what is his excuse for not monitoring Michael during this critical time? He not only should have been monitoring him constantly by eye and equipment (most of which he did not have or chose not to use effectively if at all) but he should have been checking on Michael because propofol only lasts so long and both drugs--lorazepam and propofol--can both make someone stop breathing on their own. The effects on breathing are amplified when drugs of this nature are given together. The side effects of propofol are seen immediately after administration not as it is wearing off. Murray should have seen Michael stop breathing in those first two minutes and not 10 minutes later especially if the lorazepam was not working as Murray claims. Murray insists the benzodiazepines were not sedating Michael but if they were then there was no reason to have given propofol to him and then intent becomes highly questionable (like it is not questionable already). Both the amounts of lorazepam and propofol found in Michael's body are alarming to any health care professional especially when you consider Michael had no means for breathing assistance provided to him by Murray.
We know Murray claims he only gave 25 milligrams of propofol. This is a lie based on the levels found in Michael's body. Even if Murray gave 200 milligrams (a 20 mL vial) that would have only sedated Michael about 10-20 minutes. It has yet to be determined whether or not Murray was bolusing Michael (using the syringes found at the scene, drawing up the medications via the syringe then pushing the contents directly into the IV tubing) or if he made some sort of gravity-based IV system. I tend to lean toward Murray bolusing Michael (which I will debate in my next blog) but if Murray used some sort of gravity IV system (which he should have known would be lethal as it is NEVER given this way) then he still should have been watching Michael for imminent breathing problems.
According to his call records he was not on the phone during this time. Assuming Murray left Michael, which should constitute patient abandonment, he should have gone back to check on Michael as soon as possible to a) make sure he was breathing and b) to administer more propofol since 200 milligrams does not sedate beyond about 10-20 minutes. If Murray somehow administered 1000 milligrams (a 100 mL vial) via a drip he could not have expected Michael to survive as Michael would never have had a chance to breathe on his own because of the quantity being delivered and lack of controlled dosing from the absence of a manual IV pump. If Murray left the room and then failed to go back and check on him within seconds it would certainly appear as if he assumed he had died and thus did not need to go back and check or tend to him if that was the goal. Murray was busy the rest of the 11 am hour as if he was done dealing with Michael.
One may ask, if Michael died around 11 am why would Murray not use this time to clean up if he intended on killing Michael instead of making phone calls or what not? That makes this look accidental. Well, if you want something to look accidental, especially to look like the patient inflicted the final medication blow to himself, then you cannot "clean up" before others see the patient otherwise things would look even more suspicious. Murray was also making himself look busy on the phone while Michael supposedly killed himself. Murray's attorneys have denied he cleaned up so perhaps what appears to everyone else as a "clean-up" is being considered part of the attempt to resuscitate him (removing the old IV line, clearing the area for paramedics). Whether Michael died at 11 am or 12 pm Murray had ample time to put things away himself.
Apparent gaps from phone usage for the 11am hour:
The only breaks from phone use were from 11:00am - 11:06am (continuing on since 10:45am) and 11:08am - 11:16am. From 11:17am and until noon he was on a phone the entire time. So Murray obviously kept himself occupied--or so he wants others to assume he got tied up thus Michael, someone anesthetized without assisted breathing, fell off Murray's radar and killed himself. Yeah right. The phone did not prevent Murray from being able to be at the bedside or prevent him from administering medications, either. With Michael being given propofol he would not have been able to wake up from even the loudest of sounds--he was put in a coma, not sleeping. Murray could have stayed in the room. Murray was supposedly on the phone this entire time yet he expected Michael to stay sedated on the propofol while making calls? Especially 25 milligrams? That makes no logical sense--200 milligrams sedates about 15-20 minutes, maximum. Murray should have anticipated on Michael awaking (assuming the 17+ milligrams of lorazepam was null). Just my opinion but seeing this time line, seeing these calls, one after the other after the other during the 11 am hour it appears Murray intentionally neglected Michael, be it by leaving the room and choosing not to monitor him or witnessing him die right there in the same room while apparently being on the phone.
Notice how the concerned call to Sade Anding (which was supposedly made "out of the blue"), the call where it sounded as if something was wrong with Murray before he discovered Michael's body, took place not even less than a minute after calling patient Bob Russell and leaving a voice mail which revealed a normal Murray with no apparent stress or concern in his voice.
12:04pm - 12:12pm--If Michael had not passed away sometime during the 11:00 am hour then this time would have been the most critical time in saving Michael's life. Murray claims Michael had a weak pulse when he found him. A call to 911 should have occurred here or earlier since according to Sade Anding Murray discovered Michael at about 11:55 am yet he kept her on the line to hear "coughing and mumbling". He could have also used his other phone to dial 911. I guess help for Michael was not the first objective on his mind. At one time Murray's attorney said "Murray did not immediately call 911 because there was no house phone in the room where Jackson was and he could not leave his patient to make the call." Really? He had not one but two cell phones with him, fool. (Source: http://abcnews.go.com/GMA/TheLaw/gma-exclusive-conrad-murray-lawyer-ed-chernoff-speaks/story?id=10294040&page=1) CPR protocol states to start CPR on an adult and then call 911--there is no excuse for not calling 911. A paramedic stated in hearing testimony Michael had, in his opinion, been dead at least 20 minutes to an hour (they arrived on the scene at 12:26 pm)--if he had been dead only about 20 minutes then he would have in fact been alive when Murray found him and died sometime after talking to Anding but before placing the first call to security. Not placing a call to 911 defies all common sense. Even some toddlers know to call 911 if there is an emergency. If Michael was in fact alive at approximately noon then Murray allowed Michael to die in his presence by refusing him aid. The 911 call was not even made until 12:22 pm and it was made by Alberto Alvarez not Murray.
Why did Murray not tell chef Kai Chase that Michael was sleeping in and would not need breakfast that morning? Michael was typically up by about 10am. Murray was on the phone off and on during the 10am hour--including on a long call with one of his daughter's friends. Let's hope she is not a minor.
One cannot help but wonder if Murray was not trying to creating himself a "cellular alibi" by making himself look distracted through phone use, especially if Murray had anticipated on blaming Michael for his own death (recall Murray's insistence he gave nothing that should have killed Michael which is of course another lie). If Murray was out of the room or "distracted" he would not have witnessed Michael giving himself propofol, though a cell phone would not bar him from being in the bedroom. Maybe Murray did not know experts would clearly state in the autopsy report that Michael was virtually incapable of injecting himself with propofol. Perhaps Murray and his defense team are too ignorant to know that propofol renders no effect when ingested orally, not accounting for the lack of visible propofol in his stomach, too. Initially Murray's attorney Edward Chernoff said Murray just happened to walk in and see Michael in distress. Later on, Chernoff said Murray never left Michael. Compare "'he just came in to check on him, fortuitiously (sic),' Chernoff said." to " he denies leaving the singer alone after administering a series of sedatives to try to help him sleep". (Sources: http://www.chron.com/disp/story.mpl/ent/6501143.html and http://www.dailymail.co.uk/news/worldnews/article-1208761/Michael-Jackson-lethal-levels-anaesthetic-body-died.html). Notice the error on the "Daily Mail's" graphic titled "One Night and a Cocktail of Drugs" that states emergency services were called at 10:55 am. WRONG. So--was Murray in the bedroom or not? If he was not in the room where was he? If he was in the room then what is his explanation for being within inches of a man dying directly under his nose?
The entire night Michael was supposedly awake and "demanding propofol"--odd there was no phone activity reported before 5:54 am as he should have been awake listening to Michael's demands and likely keeping himself occupied with his phone in some manner, possibly by texting others like his numerous girlfriends. But, what if Michael was asleep and Murray went to sleep during this time, too? Was Murray reportedly sleeping during the day? He had to sleep at some point. It is also odd Murray was able to chat on the phone with others during the 9 am and 10 am hours while Michael was supposedly awake and demanding propofol during this time as well (like someone would be demanding propofol for 9 hours and be okay with having to continue asking for the entire time). The patient, especially the $150,000/month income-producing patient would seemingly come first before some casual phone calls and texts, right? Did Murray ignore a "demanding Michael" during this time or was he making calls while Michael was actually sedated? The latter appears to be the more logical scenario. Michael had told nurse Cherilyn Lee she could leave the night she stayed to watch him sleep (per the Greta Van Sustren interview). If Michael was sedated on benzodiazepines that work for so many hours then why stay awake watching someone sleep? Benzodiazepines are typically safer than propofol though IV benzodiazepines have similar risks. But, it seems logical that if Michael was sedated on benzodiazepines then Murray probably went to sleep at some point, too.
Reportedly a picture of "Murray's Room" at the Carolwood home though he did not live there with Michael--no other adults lived at the home with Michael. This was not the room paramedics went to when they arrived to try and revive Michael. The bed appears to be poorly-made.
Questions:
Could the email sent by the insurance company been a catalyst for murder? Note the reply was sent some time later, almost 6 hours later at 11:17am immediately after a 30 minutes lack of cellular activity and during the supposed initial administration of propofol.
What was Murray doing on the phone while on a call to his office in Las Vegas (11:18am - 11:49am)? Who was he talking to or was he talking to anyone? Is there any record of what transpired during this call?
The call to Bob Russell--some doctors make house calls but most do not, at least, most I know. When testing is done (be it examinations, blood work, biopsies, etc.) typically doctors have a letter mailed out to the patient within a reasonable time, typed by their staff, stating everything was normal. When something is abnormal, typically a nurse will call and tell you there are abnormal results and give some sort of explanation. Sometimes the abnormality can be taken care of over the phone (like adjusting a medication dose) or sometimes a follow-up appointment is needed. To me, and this is very opinionated, I find it odd Murray called Russell that morning, especially right after calling his office and right before calling Sade Anding "out of the blue". It may mean nothing--or it could be something.
What really possessed Murray to call Anding? Is it to provide himself with an alibi and to try and bring an element of "surprise" to finding Michael in such a manner? Anding is currently defending Murray though she has no real understanding of what he did and did not do to Michael. She calls him a "good man" though he supposedly did not bother to tell her he was married AND seeing other women besides her and his wife. Does that really sound like a "good man" to you?
Murray never placed a call or email to AEG--why not? Should he not have contacted them at some point regarding either the email from Taylor and/or Michael being in trouble?
Where or which calls/texts were to LaQuanda Price and LaQuisha Middleton (the sisters that worked for Murray) who showed up at the storage unit in Houston at 11:22 am Houston time/9:22 am Los Angeles time. Recall they had conflicting stories about going to the storage unit. Why?
Conclusion:
You have heard enough from me--now I want to hear from you, hear your opinions and what else you can add to this. What other possibilities do you see based on what we think we know? What additional information can you provide? I cannot help but see everything concerning June 25th as sinister, especially when I try to place myself in Murray's mind frame and think of how Murray refuses to admit to any form of guilt. I cannot see his actions and non-actions being anything other than intentional and with purpose. Certainly we are far from the truth when it comes to knowing not so much how but why Michael Jackson had to die.
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