UPDATE 4:15 p.m.: Court ended for the day with the defense planning to begin its cross-examination of Shafer tomorrow at 8:45 a.m.
UPDATE 3:10 p.m.: If Michael Jackson had a sleep disorder, Murray should have sent him to another specialist, Shafer said.
"An anesthesiologist is responsible for driving, just like driving a motor home," he explained. "You are the driver, you are responsible. Dr. Murray left the steering wheel. In 25 years of giving anesthesia, I have never walked out of the room while a patient was under. Doctors don't do that...Mr. Jackson's death is an expected outcome from not continuously monitoring the patient."
UPDATE 2:50 p.m.: "There is no such thing as a little anesthetic, and the worst disasters have been during sedation, and they occur when people cut corners," Shafer testified after lunch. "The facts in this case, in my view...virtually none of the safeguards were in place when propofol was administered to Mr. Jackson." Even if Murray "only" gave Jackson 25 ml of the stuff, all of the guidelines in the video still applied. Doctors must always prepare for the worst-case scenario, he added. "Some patients will stop breathing at that dose," Shafer said. "You have to prepare for that patient. You have to assume that your patient will be at the edge of sensitivity."
Simply put, Shafer said, Murray should have had life-saving equipment at the ready. Nor did have an infusion pump to properly measure Jackson's intake of propofol, which was amounting to a bottle a night, Shafer calculated. "The possibility of an overdose is very high in this setting," he said. "The complication from overdose is death. This is an egregious violation. The lack of an infusion pump contributed to the death of Michael Jackson." A pulse oximeter, which would have alerted Murray to the singer's weakening heartbeat also could have been a lifesaver.
And Murray's admission that Jackson begged him for propofol means nothing, Shafer asserted. "We put patients first," he said. "That does not mean doing what the patient asks. That is doing the care that is in the best interest. If the patient requests something foolish or dangerous, it is the doctor's obligation to say no. They will not engage in reckless activity at the patient's expense."
UPDATE 11:55 a.m.: First thing a doctor learns on day one, Shafer says, is to call for help when a patient goes into cardiac arrest. A video shown in court, without audio, called An Overview of Safe Administration of Sedation includes a checklist of live-saving measures that should be taken, he pointed out. Pastor then called a recess for lunch until 1:30 p.m.
UPDATE 11: 46 a.m.: Shafer testifies that it's imperative a physican "document, document, document" everything having to do with a patient's treatment, noting how even more important that can be if the patient ever comes into the care of another doctor—such as an emergency room physician, in Michael Jackson's case. Propofol can lower a person's blood pressure, so it's important that an ER doc know exactly what he or she is dealing with. (Paramedics previously testified that Murray did not mention propofol when they arrived at Jackson's home.)
UPDATE: 11:05 a.m.: Walgren presents Shafer with a syringe and has the doctor demonstrate how to remove propofol from the vial.
UPDATE 10:55 a.m.: Shafer is talking propofol, describing what an "infusion" is (a drip, in layman's terms) and the functions of usage of the anesthetic. Walgren hands him a propofol vial and asks him to how to open it. Shafer jokes that you don't need medical training for such a thing.
UPDATE 9:48 a.m.: Pastor calls for a midmorning break. Hearing all of Shafer's credentials was tiring.
UPDATE 9:21 a.m.: Shafer retakes the stand, with Pastor apologizing for the delay. Deputy District Attorney David Walgren resumes establishing Shafer's expertise on the subject ot propofol, lorazepam and other sedatives.
Conrad Murray is still on trial for involuntary manslaughter in the death of Michael Jackson. It's just been a few days.
But the proceedings resume today and here we are.
Propofol expert Dr. Steven Shafer, who devised the original dosing guidelines for the drug, returned to the stand for the prosecution, which is expected to rest its case this week.
There is a possibility that court will not be in session tomorrow, however, while the defense awaits new toxicology results regarding the level of lorazepam Jackson had in his system when he died. Since abandoning their supposition that Jackson self-administered a fatal dose of propofol, they have been zeroing in on the effects of the other sedative.
Murray's lawyers informed Judge Michael Pastor that they intend to call 15 witnesses and, if they get started on Friday, should be done by next Wednesday.
(Originally published Oct. 19, 2011, at 8:45 a.m. PT)