Day One of the Conrad Murray Trial

I will go over some key elements that I was able to hear myself though I am sure there will be missing. This will not be a complete analysis of today's testimony but the rest of it will have to come another day when transcripts are made available at some point.

Lorazepam:

I thought many times before that maybe, just maybe, Conrad Murray had hoped to blame Michael's death on lorazepam initially though it is rare that someone dies from lorazepam without some other contributing factor (Michael did have a chronic lung disease which could have possibly been a factor). Without some inkling of propofol being used, it would have never been tested for by toxicologists as it is not something commonly used in a household (or as a death weapon). Initially, Murray admitted giving Michael lorazepam only to paramedics and UCLA staff. I always wondered had he been able to go back and remove those bags, the ones he claimed contained "creams Michael would not want the world to know about", AKA creams to treat vitiligo, would he have never mentioned propofol? Remember, these bags were the same ones that had all the intravenous medications in them, the ones Murray were shocked to learn during his interview with police that they had not actually been found when Carolwood was searched. (More information on this will be included in the January hearing testimony from Michael's security and personal assistant.)

Then, I thought, well, maybe not, because nurse Cherilyn Lee knew about the propofol (Michael had asked her about the drug but there is no clear connection that Murray knew Lee had been asked about it by Michael though later on he accused her of administering propofol to him which is a bold-faced lie). There is also some indication that Murray asked anesthesiologist David Adams about giving Michael propofol--however, it is unclear yet if Adams knew that Murray was using propofol for "sleep" and wanted him to do the same (which if that were the case, why would Murray be basically handing over his job to someone else?). There are the receipts from Applied Pharmacy Services, too, though perhaps Murray did not think those would be traced if propofol was never brought to the forefront.

However, with the defense's opening statements, the notion of "death by lorazepam" came like a thief in the night, and in such a horribly illogical way. I guess withdrawing of Demerol, drinking and self-injecting propofol were not enough excuses. Anyway, Ed Chernoff stated that while Murray was out of the room, no more than 2 minutes to use the restroom (strike one, he admits he abandoned his patient) he not only gave himself propofol (take your pick as to if it were drank or injected, perhaps he thinks it was somehow both) but he also chugged down 8 tablets of lorazepam and then...drum roll please...died instantly.

First, you do not die instantly from oral forms of medication. It would have taken at around 30 minutes for the lorazepam tablets to take an effect. Secondly, the autopsy report states the following on page 7:

GASTROINTESTINAL SYSTEM:

The esophagus is intact throughout. The stomach is not distended. It contains 70 grams of dark fluid. There are a few mucosal hemorrhages, but no ulceration. Portions of tablets and capsules cannot be discerned in the stomach.

If he died...instantly...after taking tablets then there would have to have some traces of those tablets, if not complete, whole tablets still available. I was seriously stunned that the defense would make such a claim because it is, well, impossible. There is more evidence for life on Mars than for Michael taking 8 lorazepam tablets and them being absorbed in literally seconds.

On April 28th, Michael had a prescription from Murray filled at CVS for 30 - 2 mg lorazepam tablets. There were 9 tablets remaining so 21 were missing. First, why did Murray write for this script if Michael was being drugged by him nightly? Second, how would the defense know it was 8 tablets taken when a) Murray did not see this happen, b) no one else was in the room besides Michael who is now dead and c) there were no tablets to count in the stomach?

I then recalled something important--Christopher Rogers and Richard Ruffalo's testimony about the lorazepam found in Michael's system. This is what they stated about the lorazepam found in the blood:

Flanagan: FIRST OF ALL, THE 0.162 LEVEL OF LORAZEPAM, I BELIEVE THAT IS NANOGRAMS PER MILLILITER. THAT IS A SIGNIFICANT AMOUNT OF LORAZEPAM, ISN'T IT?

Rogers: YES. I WOULD EXPECT IT TO HAVE A PHARMACOLOGIC EFFECT.
-----------------------------------------------------
Walgren: WELL, LET ME JUST ASK YOU. CAN YOU TELL US GENERALLY ON PEOPLE'S 68 WHAT OBSERVATIONS, CONCLUSIONS, YOU MADE BASED ON THE VALUES LISTED THERE AS IT RELATES TO THE VARIOUS BENZODIAZEPINES?

Ruffalo: WELL, THE MOST IMPORTANT ONE IS LORAZEPAM, ALSO KNOWN AS ATIVAN IS ITS MAJOR TRADE NAME. UNFORTUNATELY, WE DON'T HAVE A HOSPITAL VALUE THAT WOULD HAVE BEEN MORE HELPFUL, BUT WE DO HAVE THE HEART AND FEMORAL LEVELS. AND CLEARLY, THOSE LEVELS ARE SUBJECT TO A VERY SMALL DEGREE OF REDISTRIBUTION BECAUSE IT IS A MORE WATER-LUGGING DRUG. IT DOESN'T HAVE AS MUCH REDISTRIBUTION PHENOMENA AS SOMETHING LIKE PROPOFOL OR EVEN ITS FIRST COUSIN, WHICH IS DIAZEPAM OR VALIUM. SO IT IS A LITTLE LESS SUSCEPTIBLE TO THAT. IF YOU WERE TO COMPARE ANTEMORTEM BLOOD LEVELS AND ASSUME THEY ARE EQUIVALENT, FOR EXAMPLE, THOSE WOULD BE EXCEEDINGLY HIGH BLOOD LEVELS, THE EQUIVALENT OF TAKING ANYWHERE FROM SEVEN TO 12 MILLIGRAMS OF LORAZEPAM EITHER ORALLY OR I.V. OR I.M. SO IT TELLS US THAT THERE IS A SIGNIFICANT AMOUNT OF LORAZEPAM IN THE BLOOD. IT IS WHAT WE CALL A VERY, VERY HIGH LEVEL. NOT LETHAL, BUT VERY, VERY HIGH. (That) WOULD INDUCE, DEPENDING UPON THE PATIENT'S TOLERANCE TO THE DRUG, YOU KNOW, SIGNIFICANT DEGREE OF SEDATION.

So, from this we see a couple things. First, the lorazepam level, which was very high, was also evenly distributed in the body it seems based on the two blood levels taken. This could not happen instantly as Chernoff would like for it to occur.

I also now can see how the defense came up with the "8 tablets" claim. For every 2 mg or oral lorazepam taken, the resulting blood level is approximately 20 ng/mL. Michael's blood level was 169 ng/mL and 162 ng/mL, depending on the source. To achieve that level, it would take approximately 16 mg (or eight 2 mg tablets) to get there. But again, what Chernoff forgot was oral lorazepam blood levels peak about 90-120 minutes after the dose is taken. Thus, Chernoff's claim that Michael killed himself with lorazepam is not only false but completely and totally false based on proven science. The only lorazepam in his body was placed there by Murray, via the intravenous route, and it was certainly more than 4 mg and given well after 5:30 a.m.--as Murray claims. Chernoff may not be the brightest attorney but certainly it does not help when your client is a pathological liar.

Demerol and Dr. Arnold Klein:

We saw the defense attack Dr. Arnold Klein who will not be testifying during the trial. People following this case knew this was in the works so it is nothing new.

First, here is a breakdown of all the visits Michael had with either Dr. Klein or one of his two partners:

March: 23rd

April: 6th, 9th, 13th, 15th, 17th, 21st, 22nd, 23rd, 25th, 27th, 28th, 30th

May: 4th, 5th, 6th, 15th (15th w/ Dr. Reyter), 19th, 20th, 21st ( 19th-21st w/ Dr. Rish)

June: 1st, 3rd, 4th, 10th, 16th, 22nd

The appointments above did NOT always include Demerol injections (some injections were of Botox, some of Restylane, etc.). In a TMZ interview Klein stated he would sometimes give Demerol for sedation/pain control for minimally invasive procedures to the face but he would also switch it up and give 2 Percocets sometimes as well, rather than the Demerol. This information above does not support an "addiction" to Demerol. It does not support Klein having a role in Michael's death. It does not support there being an ability for Michael to be "withdrawing" from Demerol, either. Klein saw Michael at the times above. Murray supposedly saw Michael every day, or at least 6 nights a week, for hours at a time. Who is facing the homicide charge? Certainly the right doctor is...

As a constant reminder-- there was no Demerol in the house, no Demerol in the body, no Demerol in the toxicology exams and none involved in his death--this is the TRUTH. Check the autopsy report--it pretty much sums everything up in a nice, clear manner--and does not lie.

Demerol and Insomnia:

Chernoff would like for people to believe Michael was suffering from insomnia due to Demerol withdrawal. That is incorrect. For starters, Michael suffered from insomnia his entire life, at least his entire adult life . He was a night person by nature and his mind just would not "turn off". I am still trying to locate the interview in which he says this--it was done sometime in the early 1980s, I believe at Hayvenhurst. I will post it when I find it. Here is also an interview where he states the same thing in 1996:

http://www.allmichaeljackson.com/interviews/mollymeldrum.html

Michael also describes how touring is "hell" for him because of the exhaustion and insomnia he suffers from the adrenaline rush of performing:

http://www.youtube.com/watch?v=eD_LE6HJqZw

I am not sure when a Demerol withdrawal would begin to occur but I am assuming it would be so many hours after the last use, as the drug is very short-acting:

http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm

You will see in the link above that insomnia is an early symptom of withdrawal--as in, it would occur hours or maybe a couple days after the last exposure. Withdrawals to a drug would NOT, ever, begin to be experienced MONTHS after exposure. Withdrawals typically last days or possibly a week, again, depending on the drug. Withdrawal do not last for months, either, and it would not have a additive or synergistic effect with sedatives as Chernoff would like to hope. Also, with Demerol specifically, there is a grave risk of seizures because of the stimulant effect of the metabolite normepiridine. This is why Demerol is rarely used anymore for patients, especially in the elderly. If someone is abusing this drug, it seems highly likely they would at some point suffer from seizures. I have never heard of Michael having any issues with seizures to date.

Because the opioid panel in the toxicology screening was negative, that tells us that Michael likely had not had any Demerol for approximately a week or longer (this is derived off the half-lives of Demerol and its metabolite normepiridine). He also was not experiencing many of the symptoms above (though in the January hearing the defense tried to force Ortega to say Michael was sweating--Ortega flatly denied this). Michael's problems with being cold, sluggish and not completely coherent is a direct result of Murray's administration of sedatives, namely midazolam and lorazepam, at night, likely every night for some time.

This link provides a good explanation of dependence vs. addiction:

http://www.novusdetox.com/opiate-opioid-withdrawal.php

Calling 911 Would Constitute Neglect?

Murray said he would have been neglecting Michael had he called 911. What does Murray consider all of his previous actions before? They were by no means beneficial.

The Pulse-Oximeter

Another important element that came to light today was the pulse-oximeter Murray had, which he may or may not have used, was a basic model that did NOT feature an alarm. Apparently the oxygen tank was also empty--on that very day--but I will have to get that information confirmed. The nasal cannula was already useless but to not even have any oxygen? I am literally shaking my head right now...

Murray and his "Groupies":

Chernoff mentioned that many of Murray's patients can attest to him taking great care of them. If he could take care of them so well, some possibly for little or no fee, then what happened when it came to taking care of Michael? Michael was, sadly, a cash-cow for Murray. Chernoff stated that Murray is a smart man--well, if he is smart, like I assume he is, how did he disregard what was common-physician-sense when it came to treating insomnia with anesthetics? I kept hearing the mention of the money, the $150,000 a month, that Murray was to be paid. This is being mentioned as a motive for Murray to give into Michael's requests--but no one has mentioned yet that a) Murray never received a penny from AEG (at least, not while Michael was alive) and b) if you are wanting such a income, would you not do everything to make sure your patient survived even if your treatment is off-kilter? Even through his botched treatment for insomnia--there is still no excuse for Murray not having the means to preserve life, like a way to ventilate Michael or maintain his blood pressure--or even monitor his heart-rate. Those were simple measures that Murray, for whatever reasons, failed to obtain when, as a doctor, he knew what he was risking, as in, risking another human's life all in the name of "sleep".

"Weaning"--it is a term some of us have heard many times. Simply put, you do not wean someone off something that does not create tolerance or withdrawal. To date, there is no conclusive evidence that propofol causes withdrawal or tolerance--key components to physical addiction. Murray was not weaning anything.

The iTalk Recording:

Lastly, I wanted to touch on that audio recording of Michael from May 10th, 2009 recorded at 9:00 a.m. First, this was NOT a phone call. Murray used an application on his phone called "iTalk"--it transforms your phone into a personal voice recording device, like an old cassette tape recorder.

Now, why Murray recorded Michael--I can only speculate, but whatever the reason, I can only see it being for malicious reasons.

I keep hearing the media state the recording must have been from him being under or having been under the influence of propofol. This is incorrect. When someone is placed under propofol, and propofol alone, they are quickly out and quickly back--as if nothing happened. There is no "hangover" or lingering sedative properties. That is part of the reason propofol is not only abused but so hard to detect when abused--the after-effects are essentially non-existent.

When I heard the tape, my first thought was "Versed"--Versed is the trade name for midazolam. Midazolam is one of the many drugs Murray gave to Michael, along with its cousin, lorazepam or Ativan. Murray first ordered lorazepam and midazolam on April 28th (that might ring a bell as that is also the date Michael also had his oral lorazepam filled at CVS). Benzodiazepines are similar to alcohol in their effects, either when used in excess or used for procedural sedation. Speech can be slurred and rambling, for example. With propofol, midazolam and lorazepam there can be amnesia that occurs for some time, even while conscious, especially with Versed. Versed is used especially for this reason because the person can remain awake but not remember the trauma that comes along with a procedure. In fact, when people go to same-day surgery clinics, they are typically told not to sign any legal documents are make any important decisions for at least 24 hours because of the effects of Versed.

It is very likely that Micahel did not know that he was being recorded that morning. He likely would not have been able to recall what he was saying--though his statements would have been genuine statements, including those about wanting a "Michael Jackson Children's Hospital". In this situation, Versed basically served as a truth serum of sorts...

So far, people like Raymone Bain and Kathy Hilton have expressed never seeing or hearing Michael in such a state. Bain even thought it may not be Michael and she had spoken to him over a 7 year period in the 2000s. She told Jane Velez Mitchell others she has spoke to who had known Michael for 20 and 30 years had never heard Michael sound like that before, either.

I will say that is unequivocally Michael Jackson--in his most pure and honest form. Even while in such a vulnerable state, his genuine concern for children was still first on his mind--as always. It is hard to listen to the tape because it creates a picture of a man, a man in need, a man in some sort of distress and even to some point, agony. Michael was in a sort of agony because he wanted to be able to sleep, he wanted to be able to rest, so he could literally heal the world and make his children and fans happy and proud. He was finally bouncing back from 2005--though maybe not quite in the way he wanted to as touring was not easy for him to do from the exhaustion. Murray took it upon himself to drug him, regardless of what Michael may or may not have said to him. Michael was in no state to be making any decisions when given anything anyway and did not have any sort of medical training. It is so difficult to think, here Michael lay on what very likely became his death bed, talking about his shows, talking about wanting to help children, while the man who put him in that state for money, for greed and for power taped him. To me, that tape was in some ways like another strip search, per 1993. This time, instead of having to bare his genitals, he bared his soul in a manner in which it should never been. How people could still think this man ever hurt a child, I will never understand. I can see the innocence in his eyes but now we hear it in his voice in a manner in which apparently no one had ever heard it before. To me, that tells me with Murray's arrival--things changed. That state he was put in by Murray on that morning was not normal for him. And again, sadly, it is almost certain Michael would have never known he was in such a state because of the retro-amnesic effects of benzodiazepines.

I cannot say anything "good" came from that tape, but at least some type of truth did. Michael was a man with his heart in the right place. Sadly, his trust was in the wrong place--placed into Conrad Murray's uncaring hands.