Tuesday, August 2, 2011

Critical Analysis of Joseph Jackson's Lawsuit Against Conrad Murray Part I

This blog covers pages 1-9 (1-16 via Adobe Reader) of the following document:


Section 11

"In 2008, in Las Vegas, Nevada, Michael Jackson consulted with defendant Murray concerning the medical care of Jackson's children who were suffering from colds and the flu. Defendants Murray, et al. solicited Michael Jackson to take care of his individual health needs. Defendants Murray, et al. began a course of medication treatments for Michael Jackson which was below the standard of care and ultimately resulted in Jackson's over-medication and death on June 25th, 2009."

There is uncertainty when Michael first met Murray. What is known is Michael was introduced to Murray by a security team member whose father was a patient of Murray's. When this occurred is unknown. Some claims are they initially met in 2006. However, Michael was out of the country until the last week of that year. Now there is this claim of 2008--Murray should have been keeping records as to when he saw Michael and/or his children which should definitively give an answer as to when Murray first treated Michael. If Murray did not keep records that is a violation of care and basic medical standards.

What is meant by Murray "soliciting" Michael? Does Oxman have any records of what Murray did and did not treat, what medications he did and did not prescribe to Michael for the entire duration of care? If not then what Murray may or may not have done before June 25th may or may not be "below the standard of care" nor a result "in Jackson's over-medication and death". Looking at the medications legally prescribed to Michael from Murray from Table 3A of the autopsy report includes tamsulosin (Flomax) from 6/2009, temazepam from 12/2008, lorazepam from 4/2009 and diazepam from 6/2009. None of these medications in their corresponding formulations (oral) were implicated in Michael's death nor is any addiction/abuse implicated by the number of prescriptions or the amounts left over as of 6/25/2009.

Conrad Murray ordered and directly administered the inappropriate medications to Michael at night. The autopsy report says Michael could not have self-injected any of the IV medications, including propofol. There is no indication that Murray was enabling Michael to harm himself with any prescribed or un-prescribed medications. All harm presented to Michael was presented directly through Murray's actions taken forth for an unknown time shortly before his death.

Michael died from propofol in combination with intravenous lorazepam. Murray, not Michael, was also administering midazolam in a manner that would be deemed below the standard of care. However, there is no indication that Murray initiated such inhumane and illogical practices until shortly before Michael's death. Furthermore, this is not a logical case of "over-medication". "Over-medication" would be prescribing a 75 mcg fentanyl patch to someone who is not tolerant to the respiratory effects of the medication who then consequently suffers from respiratory depression. There is no real comparison or label to what Murray did to Michael. Murray administered anesthetics to someone who suffered from insomnia most of his life. The medical boards have labeled Murray's treatment as "non-therapeutic". I call it euthanasia against one's will. There should be no indication or emphasis that Murray enabled Michael to over-medicate and/or harm himself which could be easily drawn from the last statement in Section 11.

Section 12

"Defendants utilized their facilities, drug registrations, prescription medication rights, equipment and operations in Texas, Nevada and California to treat Michael Jackson from 2008 through 2009."

What equipment? There was no equipment used by Murray, certainly none conducive to maintaining life that were required to be present when administering propofol and/or midazolam. Murray did not utilize his DEA number or medical license (according to the Nevada search warrant) to acquire the adulterated purchases made through Applied Pharmacy Services. Murray had no legitimate reason to be ordering IV benzodiazepines or propofol from any pharmacy whether he used his registrations or not. If he was to ever use such medications, which was possible, such should only have been used in a hospital where equipment is in place and ACLS-certified staff are tending to the patient. Doctors should acquire such medications from the hospital's pharmacy.

Section 14

"On May 12th, 2009, defendants purchased the drug propofol, along with other medications, from various unknown pharmacies, including Applied Pharmacy in Nevada, for Michael Jackson's treatment, and defendant transported the drugs to Santa Monica, California, utilizing their Texas and Nevada drug registrations with the Drug Enforcement Administration. Defendants procured equipment and facilities to treat Michael Jackson based on t heir practices of medication in Texas and Nevada. Defendants utilized their personnel in Texas and Nevada to conduct and carry out Michael Jackson's diagnosis, care and treatment."

Unknown pharmacies? There is no evidence other pharmacies contributed to Murray's fraudulent "care". A physician has a medical license on a state-by-state basis. Their DEA registration (which is what entitles an MD to write for various narcotics) is a federal registration.

Actual ordering of propofol began much earlier than May 12th.

Timeline of Orders from Applied Pharmacy by Murray:

6th April

10-100 mL bottles of propofol
25-20 mL bottles of propofol
9-1 L bags normal saline
10-30g tubes of benoquin

Out of this order he removed several bottles of propofol in his Las Vegas office and requested the rest be shipped to Santa Monica.

28th April

4 boxes of 10-100 mL of propofol (40 bottles in total)
1 box of 25-20 mL of propofol
1 tray of 10-10 mL vials of lorazepam
2 trays of 10-2 mL vials of midazolam

In early May Murray spoke to Lopez (owner of Applied Pharmacy) about getting an energy formulation for his (Murray's) personal use. He wanted it to include caffeine and be as natural as possible, over the counter, not prescription. He also inquired about a topical anesthetic cream containing only lidocaine.

12th May

4 boxes of 10-100 mL of propofol
1 box of 25-20 mL of propofol
2 trays of 10-2 mL vials of midazolam
1 tray of 10-5mL vials of flumazenil
60g of 2% lidocaine cream

14th May

Murray discussed with Lopez the base formulation of the benoquin cream and Llopez agreed to provide 3 different samples. He said he needed stronger lidocaine cream, requested 4% and again discussed an energy formulation. He placed an order. Lopez offered to deliver to him in Santa Monica, Murray said ship it.

60g of 4% lidocaine cream
1 tube of benoquin 20% in HRT base
1 tube of benoquin 20% in Lipoderm base
1 tube of benoquin 20% in APLO base

1st June

He called and spoke again about the energy formulation but no order was placed.

10th June

1 tray of 25-30 mL lidocaine 1% vials (this is the first time lidocaine for injection was ordered--lidocaine cream would not have helped with the burning sensation from the propofol)
4 boxes of 10-100 mL of propofol
2 box of 25-20ml vials of propofol
20 tubes of 60g hydroquinone 8% cream
20 tubes of 60g benoquin 20% cream
30 capsules of the ephedrine/caffeine capsules requested by Murray for Murray

15th June

1 tray of 10-10 mL vials of lorazepam
2 trays of 10-2 mL vials of midazolam
12-1 L bags of normal saline

23rd or 24th June

At about 5 pm Murray called Lopez, Lopez could not hear Murray, sounded like Murray was in his car with the windows down, he agreed to call back next day but never spoke to him again.

Section 25

"Defendant demonstrated a disregard for Michael Jackson's life by not disclosing the propofol and the 'polypharmacy' Michael Jackson had received for months."

A doctor does not have to perform below a certain standard of care for any length of time before it becomes a genuine concern. Falling below the standard of care is like premeditation--it can occur within a fraction of a second. There is no indication Murray's standard of care was below par for "months". However, there is reason to believe that over the last few weeks Murray's care was detrimental, possibly deliberately detrimental, given he should have known his conduct, in all matters and train of actions, would be deemed not only inappropriate but not contributing to life, either. There were noticeable differences in Michael's demeanor and behavior in the last few weeks if not days of his life--not months.

This not a case of "polypharmacy", either. Polypharmacy can be accidental or deliberate but in either form is considered to be when a patient combines multiple medications together which causes harm from interactions. Polypharmacy does not directly correlate to abuse or addiction. Polypharmacy is common in the elderly and ill because of the increased need of multiple medications.

The administration of lorazepam and propofol by Conrad Murray resulted in synergism that Murray should, by all means, have known would occur. Polypharmacy is almost exclusively reserved when one is discussing medications taken by or administered by the patient themselves--not medications directly administered by a physician in a household, no less.

Section 28, 29 and 30

"Defendant Murray told police on June 27th, 2009, two days later, he was afraid Michael Jackson was addicted to propofol. He had a history of addiction, and defendant was trying to wean him off the drugs. Yet, he told Dr. Cooper two days earlier that Michael Jackson had no drug use history."

"Defendants' history of prescriptions to Michael Jackson dated back to at least December 2008, and earlier. When police searched Michael Jackson's (home) on June 26th, 2009 they seized dozen of drug vials showing Michael Jackson's drug use. Some of the vials showed that on December 22nd, 2008, defendants prescribed temazepam to Michael Jackson. On May 14th, 2009 defendants prescribed lidocaine to Michael Jackson. Yet, defendant Murray told Dr. Cooper, Michael Jackson had no history of drug use.

"Defendant Murray told Dr. Cooper that Michael Jackson had not been ill. However, aside from Michael Jackson's polypharmacy addiction illness, as discussed below regarding the Coroner's Autopsy, Michael Jackson was suffering at his death from co-morbidities including anemia, chronic pneumonia, chronic bronchitis and brain swelling."

There is no reason to correlate a possible dependence to pain medications in 1993 (with use of the pain medications stemming from reconstructive surgery to the scalp) to Michael's death of anesthetics administered by Conrad Murray in 2009. There is no correlation between the two events and any notion promoting such is ludicrous and reprehensible.

Is there any indication Murray wrote any prescriptions for Michael before 2008? If so they should be listed.

It is inherently wrong to say "dozens of drug vials" were seized. There were medication bottles found that had been written from up to 6 months prior to June 25th and remained with unused quantities--that is not something typically seen with someone who is abusing medications--including someone who was supposedly abusing or tolerant to benzodiazepines. Furthermore, such indicates that Michael himself was not abusing these medications on his own terms--any tolerance of medications was a direct result of Murray's so-called "care". There were 11 bottles of medications recovered if you do not include what was contained in Murray's bags.

Murray wrote the lidocaine (cream) for himself, not Michael, as he requested the "energy formula" for himself, not Michael. The injectable lidocaine was not prescribed to anyone.

There is no mention of anemia in the autopsy report. The brain swelling is a result of hypoxia just prior to death. Michael did not have not chronic pneumonia (a bacterial infection) but rather he had pneumonitis (inflammation). He had a chronic, on-going lung condition likely from lupus.

There is was no evidence of chronic IV drug abuse seen on Michael's skin. Almost all punctures were the result of paramedics trying to place a line to administer life-saving medications. They were unsuccessful with most punctures not because of chronic drug abuse but because Michael was deceased. The following blog discusses the condition of his skin in more detail:


Drug use and drug abuse are not the same thing. They are not interchangeable terms.

Weaning is not required with propofol, especially not a small dose of propofol given infrequently (i.e., not through a continuous drip for days or weeks). Weaning would only be necessary if withdrawal or tolerance were occurring but there is no conclusive evidence that propofol causes withdrawal or tolerance which are key components to dependence and addiction.

Underlined claim #4, above Section 31

"Despite heroic resuscitation efforts Michael Jackson died."

Though UCLA and paramedics' actions were heroic, Murray's actions were not heroic but rather injurious. One-handed CPR (which Murray claims was necessary since his other hand was needed for the phone) in a bed is not heroic. Adults require two-handed CPR. Refusing to move a patient to the floor until paramedics arrived, even after the 911 operator requests such movement, is not heroic. Refusing to call 911 or have someone else call 911 is not heroic. Telling paramedics that Michael was "alright" and simply "dehydrated" when in fact he was deceased is NOT heroic or remotely normal (http://michaeljacksonfansite.webnode.com/news/emt-richard-senneff-transcription-testimony/). Please do not forget this is licensed cardiologist who has done all this--not someone who knows absolutely knowing about the practice of medicine or even basic life support (CPR). If Murray found him with a pulse at approximately 12:05 pm, had he called 911 immediately upon finding him, Michael would likely still be alive even without resuscitative equipment present in the house--Michael was merely minutes from one of the best medical facilities in the United States and within minutes of paramedic assistance. Murray withheld information because he knew what he had done, not what Michael had done to himself, was wrong.

Section 31 and 32

"At 1:21 pm, the nurses and physicians at UCLA detected a week femoral pulse and cardiac activity for Michael Jackson. At 1:22 pm he showed cardiac activity. At 1:33 pm he showed a weak ventricular rhythm (contracting of the lower heart chambers). Dr. Cooper reported that when Michael Jackson was intubated with an endotrachial tube he had good breath sounds and 'the initial cardiac rhythm appeared to be wide and slow in the 40s'. At 1:52 pm he had a pulse of 53 beats per minute, with a MAE complex (major arrhythmic event)."

"At 2:05 pm the physicians inserted an intra-aortic balloon pump to attempt resuscitation and obtain circulation with a spontaneous heartbeat. The pump was placed in the aorta just above the heart."

Please read the following blog for a better understanding of what really occurred at UCLA:


The "heartbeat" detected at UCLA was not indicative of life or the possibility of saving Michael's life. As "LadyMedic" stated in her blog above--the cardiac activity was likely due to the medications and/or CPR. It could also have been an agonal rhythm (the rhythm of a dying heart). The fact Michael had good "breath sounds" also does not imply he was breathing--it simply means the endotrachial tube in the airway and there was no blockage.

A balloon pump is not above the heart in the aorta. This photo shows the general placement of a balloon pump:


Section 33

"On June 26th, 2009 the police searched the Carolwood house and seized 8 used bottles of propofol and later another three." They seized medications at Michael's bedside, including clonazepam, benoquin, tamsulosin, hydroquinone, lidocaine, temazepam, tizanidine, trazodone, flumazenil, ephedrine, prednisone, amoxicillin, azithromycin, BQ/KA/RA, lorazepam, midazolam and diazepam. Police also found in his house baggies of marijuana, lantaprost and nystatin/triamcinolone."

Notice what was not found--a stockroom of propofol and other IV medication. Murray initially told police he did not order the propofol but that was proven false--he is the only source of propofol and he was the direct source of propofol. Had Michael wished to use this medication or any IV medication without Murray's presence, abused these medications without supervision, he'd had his own supply and not bothered with having an physician around, would he not?

The following is listed as being found in the house:

Black Square Bag w/ a Zipper Contents

*Blood pressure cuff
*3 vials of lidocaine--all 3 were used, 2 were empty and 1 had remaining medication

Large Blue Costco Bag Contents

*Normal saline IV bag cut open from top to the bottom--inside the bag was a 100ml propofol vial, it was opened with medication in it (notice no mention of connected tubing to the bag or bottle)
*20 mL propofol bottle used w/ remaining medication
*10 mL vial of lorazepam used with remaining medication
*2-10 mL vials of midazolam both used w/ medication remaining
*1 bloody piece of gauze
*Miscellaneous packaging
*Pulse-ox monitor

Light Brown/Blue Baby Essentials Bag Contents

*2-100 mL propofol bottles unused
*4-20 mL propofol bottles unused
*3-20 mL vials of propofol used w/ remaining medication
*2-30 mL vials of lidocaine used w/ medication remaining
*1-30 mL vial of lidocaine unused
*1-10 mL vial of midazolam used w/ medication remaining
*2-10 mL vials of midazolam unused
*3-5 mL vials of flumazenil unused
*1-5 mL vial of flumazenil used w/ remaining medication.
*1 vial of lorazepam used w/ remaining medication.
*1 vial of lorazepam unused
*Red pill bottle without labeling containing 14 capsules of ephedrine/caffeine
*1 tube Benoquin
*1 tube lotion
*Eye drops
*5 business cards (Murray's own cards)
*1 IV clamp
*1 blue rubber strip (tourniquet)

According to this report there were a total of:

11 vials of propofol--3-100 mL vials and 8-20 mL vials; of the 3-100 mL bottles only one was apparently used (the one in the cut saline bag) and of the 8-20 mL vials 4 were apparently used; only one 100 mL bottle and one 20 mL bottle were in the Costco bag (what appears to have been a trash bag as all the medications in this bag were apparently used), the rest were in the Baby bag that appeared to be the "mobile stockroom" which contained both used and unused medications. Murray was packing more anesthetics than a roving anesthesiologist who treats multiple patients a day--he also lacked KEY medications and equipment that an anesthesiologist would have present to keep his patients alive.

The bigger question is why are so many bottles of propofol empty when Murray claims he only gave 25 mg (2.5 mL) that morning on the 25th? He also claimed to give no more than 50 mg (5 mL) before--though he gave no frequency. Used propofol vials are to be discarded after 6 hours of use. If he was only giving 25-50 mg then why did he order the 100 mL vials? Michael, according to Murray, did not receive any propofol on the night of the 24th. According to Michael's urine levels it does not seem he was given that much propofol before he died however a better indication as to how much he was given would be to know how much was in the central nervous system when he died. His urine levels may be low because his body did not have time to metabolize the propofol before he died, especially if the lorazepam had been depressing his respirations before he was ever administered propofol. Did the coroner quantify the amount actively in the brain when he passed? That is a critical piece of information that thus far is missing from this case.

3 vials of lorazepam--2 were apparently used and 1 was unused

5 vials of midazolam--3 were apparently used and 2 were unused

Section 36 and 37

"Defendant Murray told police he gave 50 mg of propofol diluted with an unspecified amount of lidocaine by IV drip to Michael Jackson each night for six weeks. He said he had been treating Michael Jackson for insomnia. The propofol helped Michael Jackson sleep."

"Defendant claimed he felt Michael Jackson may have been forming an addiction and therefore attempted to "wean" Michael off the drugs. His "weaning" process involved giving Michael Jackson on June 22nd, 2009, three days before his death, 25 mg of propofol along with an unknown amount of lorazepam and midazolam. Defendant claimed Michael Jackson was able to sleep with these mixtures. One June 23rd, 2009, defendant claimed he gave Michael Jackson lorazepam and midazolam without any propofol (and he was able to sleep per his interview with police). His conduct was below the standard of care."

Given the super-fast duration of action for propofol (maximum ~15 minutes with a 100-200 mg bolus), the respiratory depression and hemodynamic changes (hypotension), there is no way this medication could have been used to help Michael "sleep". Certainly 50 mg would not help someone sleep during the night or for even 10 minutes. Again, we do not know how often Murray supposedly gave this medication--he offered no frequency as to when he repeated the propofol. If Murray gave this medication and Michael remained "asleep" then he was either sleeping on his own terms or he was sedated on another medication with a longer duration of action like lorazepam. Given Michael had a condom catheter on--he would not simply have been sleeping but rather been being heavily sedated as if he was having surgery performed on him nightly. When someone is sleeping you can wake them--if someone is heavily sedated you cannot wake them. Can you imagine someone trying to dance or even think straight after having this done to them, possibly every night for days or weeks?

Murray's recount of his own conduct is a lie. Sadly, there are no witnesses to counteract his claims when Michael was still living. If Murray was using a saline "drip" to help administer medications as he explained--how did he do this with only 21 saline bags ordered over 80 days? Plus, if he was treating dehydration why was he not replacing electrolytes? Were all the medications Murray was ordering for Michael or was it for other patients as well?

Propofol is not diluted with lidocaine--a small amount of lidocaine can be added to propofol to minimize burning. Propofol is given undiluted.

Section 39 and 40

"Defendant told police Michael Jackson complained of not feeling well, dehydration and not being able to sleep. He said that at 1:30 am he attempted to induce sleep by giving Michael Jackson a 10 mg tablet of diazepam. Thirty minutes later at 2:00 am when Michael Jackson had not gone to sleep, defendant injected Michael Jackson with 2 mg of lorazepam after dilution with an unknown substance and administered the drugs by IV. At 3:00 am defendant Murray administered 2 mg of midazolam IV after dilution with an unknown substance. At 5:00 am Michael Jackson remained awake and defendant Murray administered 2 mg of lorazepam after dilution with an unknown substance."

"Defendant claimed Michael Jackson remained awake for the next two and a half hours. At 7:30 am defendant Murray administered another 2 mg of midazolam IV after dilution with an unknown substance. Defendant claimed he was continuously at Michael Jackson's bedside and was monitoring him with a pulse oximeter. However, when police searched the house they found the pulse oximeter in the closet in the next room.

Murray's so-called timeline of drug administration and drug addiction is impossible based on the information above. There is no logic in his statements, no substance. He says Michael was "addicted" to propofol yet says just the night before Michael died he slept throughout the night without any propofol. He says that same night he had no propofol (the 24th) he slept fine on two benzodiazepines. Yet the very next day Michael was supposedly unable to even be made woozy by the very same medications he slept fine on 24 hours before. This is simply not how tolerance or addiction work.

If Michael did not fall asleep taking one Valium, why did he not take two of them? If Murray anticipated on giving Michael IV benzodiazepine formulations, why did he even bother asking Michael to take an oral tablet of anything when IV is much more potent? Why did he even write him a prescription for the Valium? How could Murray allow Michael to lie in bed for over 9 hours begging for sleep? Phone records indicate Murray was not tending to his patient during the latter morning hours but rather was on the phone almost non-stop. That likely indicates Michael was in fact sedated or how else would Murray be able to talk on the phone while dealing with a "demanding patient" at the same time? Also, if Michael was unable to sleep--why was only lorazepam active in his blood? Why did Murray not give both lorazepam and midazolam in active concentrations to try and achieve sedation (assuming Michael was not sedated)?

What is meant by "dilution with an unknown substance"? This sort of information should be known by now. These medications do not have to be diluted nor did Murray apparently have anything to dilute with--the saline bags were not for dilution though they could be used to help medication flow into the vein through the tubing. But again--if he only ordered 21 bags over 80 days--how could he have been doing this nightly for 6-8 weeks?

One of the most blatant lies told by Murray is the supposed amount and time of administration of lorazepam. Michael had a lorazepam level of 169 ng/mL when he passed. There is no possible way that Murray gave a total of 2-2 mg of lorazpam that night (estimate of given amount was 7-12 mg or more) nor could it have last been given a 5:00 a.m. The therapeutic window for lorazepam is 50 ng/mL-250 ng/mL (some state 10 ng/mL-300 ng/mL). This tells us that Michael should have bee, without a doubt, sedated on this medication alone before Murray gave him propofol. Recall also that Michael's bladder contained a significant amount of urine--had he been awake before propofol was given it seems logical he would have relieved himself before being asked to be sedated.

Section 41

"At 10:40 am defendant claimed he administered 25 mg of propofol diluted with lidocaine through an IV drip. Defendant said Michael Jackson finally went to sleep. After approximately 10 minutes, defendant Murray stated he left Michael Jackson's bedside to go to the restroom to relieve himself. He claimed he was out of the room for approximately 2 minutes until 10:52 am."

Hearing testimony from the paramedics who tended to Michael do not add up to Murray finding Michael within minutes of his respiratory or cardiovascular collapse. He had been deceased for at least 20 minutes if not longer. Murray continued on--lying to everyone he came across about what happened to Michael and continues to do so. Sadly, the victim in the case cannot speak to tell what really happened to him that tragic morning.

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