The court re-convened today with Mr Flanagan for the Defense continuing his re-direst cross examination of Dr White.
The discussions of the models provided by Dr Onelis for Dr White continued at length with various possibilities arising. The variables were explained by the fact that the models were not based on exact sciences. The slightest deviation from the actual facts would produce different results.
The two men discussed the variables at length, but no firm decisions on the value of the models were made because of that variability.
The number of tablets that the Defense think Michael took was varied from eight taken all at once, to a series of two tablets every hour. As there is no actual evidence that Michael swallowed those tablets at all, these discussions were just conjecture. Dr White even said at one point that any variation would apply in any scenario. No one knows how many tablets, if any, were swallowed by Michael.
Other inconsistencies regarding the Lidocaine were discussed, whether or not it was mixed with the Propofol, whether or not it was given prior to the 25mls of Propofol, which causes a burning sensation on application, or with it. Flanagan and Dr White discussed the possibility of Murray loading a syringe with 25mls of Propofol and 25 mls of Lidocaine and just giving half to Michael who fell asleep and later when Murray was out of the room, this time for forty minutes, Michael woke up and injected himself with the remaining drugs in the syringe, causing his own death.
Flanagan had no more questions and neither did Mr Walgren so the court adjourned for the mid-morning break.
After the break, Mr Walgren recalled Dr Shafer to the stand for rebuttal. He agreed that all intravenous drugs are absorbed into all the tissues in the body and that process has nothing to do with post mortem redistribution. He also said that there was no way that they could distinguish whether Michael took the Lorazepam tablets, or if Murray had given them to him.
Dr Shafer spoke about the simulation he had prepared to show that when Michael’s breathing stopped and the infusion continued, the high levels of the drugs would remain in his blood and that there was no precise way of calculating the time of his death.
Speaking about an infusion pump on the IV line, Dr Shafer said it would not have been absolutely necessary as the line itself had roller clamps to control the IV flow, but it was typically common practice to use an infusion pump.
He was asked by Mr Walgren if in his simulations, were the Lidocaine levels he had taken into account any different from the autopsy results. He replied that they were not different. Next Mr Walgren asked what the dangers of Propofol were. He answered that the most important danger was the failure to breathe. He explained that when the breathing stops, all the organs run out of oxygen and the heart stops beating without oxygen. In Dr Shafer’s words, lack of oxygen in the heart kills the heart.
Dr Shafer went on to discuss the impact of Dr White’s simulations referencing an article by Simons in 1988. He said that article had measure the Propofol in the urine, but it could have been Propofol and the Propofol metabolite, He continued by saying that he had researched another article written in 2002 which said that Simons was correct, but with improved technology small amounts of unchanged Propofol could be measured more successfully. He also mentioned that, in a table of surgical operations on five patients performed using Propofol, it was shown that the infusions ran for longer than the actual operations.
Next he explained that the amount of unchanged Propofol in the urine would reveal how much of that drug Michael had received, adding that he was sure that Michael had received more than he had suggested in his examples.
Speaking again about standards of care, he confirmed that those standards should be even greater in a home setting, as in an eye clinic, for example, or a radiology suite. He said it is even more important to be particularly careful, as a doctor has no back-up and there shouldn’t be any short cuts. Standard guidelines are a minimum, not a maximum, as one error could mean a death.
Flanagan then re-crossed and accused Dr Shafer of rejecting the Simons, but the doctor said that was not true, it just needed to be understood correctly. The two men went on to discuss dosages in contrasting and conflicting cases using those articles.
The Defense rested their case, as did the Prosecution.
The judge adjourned the case until Thursday morning to allow the attorneys to prepare their closing statements and excused the jury.