The Defense called Dr Robert Waldman to the stand. He is a specialist in addiction. A discussion followed on addictions in general which then moved onto Demerol addiction and the symptoms of withdrawal. Some symptoms mentioned during the testimony, were stated as the same as side effects of Propofol.
Dr Waldman explained that the first action a doctor should take when addiction is discovered is to withdraw the offending drug. The addict, in many cases, wants to be helped to give it up and the treatments are discussed and agreed. The treatments are often long and painful, but other drugs can be prescribed to help the addict recover. An addict who does not want to be helped, hides the addiction, uses the offending drug secretly and fights against intervention. They can even go to other doctors or illegal sources for his supply. Dr Waldman said he would also refuse treatment if the person refuses to comply with the suggested treatment and prefers to continue their illegal use.
Dr Waldman was asked how long the symptoms of addiction would take to disappear and stated that it would depend on the patient’s overall health, the drug, and the dosage. When the doctor evaluates that the addict improves and agrees that he does not need any more help and when his withdrawal is almost complete, he can attend group or individual therapy. He was then asked about rapid detox. He replied that it was not a recommended treatment. It needed treatment in a hospital setting, general anesthesia and high doses of drugs to tolerate the ensuing discomfort. Dr Waldman said that the physical dangers of detox are an over-activity of the nervous system when the body goes into overdrive. The heart is in danger also. Rapid detox is also stressful as it is necessary to give a general anesthesia, as the pain could not be tolerated if the patient was not asleep.
He told the court that as with any other medical problem there are degrees of variability which are not predictable and strict care must be taken not to over or under medicate.
Mr Chernoff then asked the witness to look at thirty-six pages of Dr Arnold Klein’s medical records. The records were of Michael’s treatment in his office during the months from March to June 2009. Mr Chernoff discussed with the witness charts which he had produced to simplify the drugs Arnold Klein had given to Michael. Dr Waldman’s secretary had actually produced the charts by computer.
While Michael had been receiving Botox treatments during that period of time, he had also received multiple injections of Demerol and Midazolam. Each individual treatment was itemised and Dr Waldman agreed that the amount of Demerol Michael had received during that period was very large and could indicate a dependence on the drug.
Mr Walgren began his cross-examination by asking if Dr Waldman had reviewed the report of Michael’s autopsy and the evidence from three prior witnesses about his health. The doctor agreed that the autopsy had found no traces of Demerol in any part of Michael’s body.
When asked if he had reviewed Murray’s statement to the police, he answered that he had not. Asked if he was aware of the Lorazepam and Midazolam which had been shipped to Murray’s girlfriend’s home, he said he was not. Was he aware of the volume of those drugs Murray had given to Michael? Mr Walgren then asked. He answered that he was not and he had not written a report on his findings when reviewing the evidence.
Mr Walgren asked if, in his opinion and based on the records he had reviewed, was Michael an addict? The doctor said that he could not say, as he did not know if the records were complete, or if any other doctor had given Michael anything else. He said that the facts he had would “raise the spectre of opioide abuse.” Mr Walgren asked was he dependent, based on THOSE records? He answered; “probably not.” The witness explained that he would give a new patient – A full medication history, a very comprehensive physical examination and complete chemical and laboratory testing, for example; blood and urine. He would get the patient’s permission to approach family and friends for information on the addiction. He would recommend a competent addiction specialist.
Mr Walgren continued his cross examination of Dr Waldman, who had become very defensive at this time. The doctor said he had not used Demerol in two decades, as there are better medications. Michael’s last dose of Demerol was given on June 22nd and had none after that. He was asked, in those circumstances, when would the withdrawal symptoms appear? Dr Waldman said that Demerol has a three to four to six hours half-life, so eight to ten hours later he would not feel well, at most within the day. Mr Walgren asked about the charts he had given to the defense, which the witness said were correct. They were produced and Mr Walgren began to dissect the information in them. He was unhappy that the data was incorrect, while the witness attempted to explain the anomalies within them.
After a long and somewhat bad-tempered exchange, Mr Walgren moved on to the storage of controlled substances. Dr Waldman agreed that The California Medical Board and the Federal Drug Authority have specific rules for the use of controlled substances. These must be stored securely at all times, with records maintained and each dose used must be inventoried. The purpose of this rule is to prevent theft and diversion.
The Doctor/Patient relationship was then discussed. Options for treatment would be given to the patient and if he decided not to agree to those options Dr Waldman would refuse treatment. If a harmful drug was involved, he would absolutely refuse.
Mr Walgren discussed with the witness the charts which he had produced to simplify the drugs Arnold Klein had given to Michael. He pointed out multiple mistakes in those charts. One telling mistake was the entry on the charts of doses of 200mls of Midazolan instead of 2mls. The doctor became even more defensive, trying to explain what was actually meant by some entries on those charts and the tone became rather testy. Mr Walgren asked if he had known that Conrad Murray was Michael’s personal doctor and would it have been important for him to have that information? Mr Walgren inferred that he had used what he had heard “in the public arena” to make his decision that Michael could have been an addict.
The doctor’s testimony ended soon after that bad-tempered exchange.
Dr Paul White was sworn in after the lunch break for the Defence. He gave a history of his education and his work in the development of anesthesia, in particular Propofol. His work has made him one of the pre-eminent experts in the field. He has had his work published in many journals, written fifteen books on the subject and chapters in many more and he is known throughout the world for his achievements.
Dr White’s involvement in Murray’s case began when Mr Flanagan contacted him in January, asking him to consider appearing for Murray. He asked for more information and was sent a package of details which he duly considered. He decided then that it was not obvious to him that Murray had done what he was accused of, so asked to meet Murray face to face. (It was not made clear if this had, in fact, happened). Having learned of additional information he formed conclusions, which he now no longer believes to be correct.
He went on to discuss the merits of the various experiments to gauge the use of Propofol for sleeplessness and the experiments done on animals. Having heard some of the testimony in this case he had even discussed with Dr Shafer the possibilities the experiments had opened up.
Much of his testimony was extremely complex. Discussing Propofol, which has now replaced less successful anesthesia, he explained for the jury the roles different drugs play and the combinations of different drugs for different levels of sedation.
Flanagan began to question Dr White about the facts in Murray’s case. There was some confusion over some of the evidence available and the judge decided to adjourn for the day.