Jacksons vs AEG - Day 36 – June 24 2013 – Summary
Katherine Jackson was in court.
Dr. Paul Earley video deposition (continued)
Early is an addiction medicine expert. He is an AEG -retained expert, but Katherine Jackson’s lawyers are playing his deposition. AEG’s attorneys say they expect to call Dr. Early to the stand later in the case. (AP)
Kevin Boyle: Do you think Demerol addiction caused MJ's death? Dr. Earley: I do not (ABC7)
Dr. Earley opined that benzodiazepines alone were not the cause of MJ's death, but the synergy with propofol was fatal. After reviewing MJ's medical record, Dr. Earley opined: "There's evidence of addiction to opioids dating back to early 1990s." However, Dr. Earley said he didn't think there was sufficient data to reach a conclusive opinion about MJ being addicted to Propofol. Opioids dependency start when they're used, Dr. Earley explained. He said the single largest contributor is genetic. It matters whether your parents had substance abuse or dependency disorder, but not true in 100 percent of the cases, Dr. Earley said. Other contributing factors for opioid dependency: psychological issues, early life trauma, access to drug, alcohol abuse. (ABC7)
Dr. Earley said Michael was a man whose reputation, skills, wonder exceeded 99% of the people in the planet, so it was hard to say no to him. "I'd like to say I wouldn't have done what other doctors did" Dr. Earley testified. "Prescribing MJ's Propofol ultimately caused his death". (ABC7)
Dr. Earley conducted a case study with 22 Propofol dependent individuals. The study was funded by AEG Live. Dr. Earley said the withdrawal of Propofol can cause depression, insomnia and irritability. Dr. Earley: MJ most likely had some baseline insomnia, which was worsen by the use of benzodiazepine and Propofol use. "When you take away the Propofol, you have insomnia," Dr. Earley explained. People can be irritable, don't have chills, some had seizures. (ABC7)
Dr. Earley: Chills is very generic symptom and could mean anything: flu, cold, low blood sugar, lots of different reasons people have chills. (ABC7)
Dr. Earley: Discontinuing opioids cold turkey is not life threatening, it can be done. Before we had detox drug, that's what I would do. Dr. Earley explained the current practice to treat opioid dependency is to use a drug called buprenorphine (suboxone). "I saw evidence MJ was treated with buprenorphine, I think by doctor Saunders," Dr. Earley said, but couldn't remember the dates. Dr. Earley said he did not see any record that Dr. Murray treated MJ with suboxone. (ABC7)
"When people are addicted to Propofol, you just stop it," Dr. Earley said. "Discontinuing it is not life threatening." Occasionally, Dr. Earley had to give sedative drugs because patients are agitated and irritable. (ABC7)
"Benzodiazepine requires cautious, careful taper," Dr. Earley said. Some individuals are very sensitive, it's very difficult to get off." Detox is difficult, slow but safe and preferred. "I don't make my medical decisions based on corporate decision," Dr. Earley testified.( ABC7)
"MJ was taking opioids for a prolonged period of time," Dr. Earley said, which decreased his prognosis. (ABC7)
Dr. Earley: His legendary status caused people to, unfortunately, set aside boundaries. Also, the fact MJ was providing financial resources to family made it harder for an intervention, Dr. Earley opined. MJ was extremely secretive regarding his style, would not talk about drug use to all physicians treating him, Dr. Earley testified. Dr. Earley said if he were to treat MJ, he would have tried to understand if family could stand behind him not obtaining drugs. He would also explain the need for prolonged period of rehab, more than 3 months and less than year treatment. Dr Earley would prescribe naltrexone, alternative ways to manage pain. He would close down access to opioid, contact every doctor, pharmacy. Dr. Earley said he would've given MJ skills called drug refusal, unearth tragic secrecy surrounding his life, which contributed to his death. Dr. Earley testified he saw no evidence the family gave MJ drugs."I'm completely clear his family wanted nothing but to help him." One intervention failed because Michael Jackson appeared quite healthy, Dr. Earley said. "The problem comes from the issue of power," the expert testified. "It's much more difficult to treat a patriarch than the patriarch's son." Dr Earley: I'm not inferring the family was getting/giving him drugs. There's zero evidence of that, they wanted nothing but the best 4 him. (ABC7)
"Addiction is a biological disease, once it gets going overrides a lot of decision making," Dr. Earley explained. (ABC7)
Boyle: Was MJ's death all his own fault? Dr. Earley: I dedicated my career to take care of addicted people in this planet.
Dr. Earley: I will stand strongly against someone saying it was the addict's fault.
Dr. Earley: I will stand strongly against someone saying it was the addict's fault.
Dr. Earley: However, it doesn't mean addict doesn't have to take charge of recovery at some point
"No, I don't believe it's proper to blame the addict," Dr. Earley expressed. (ABC7)
"There was secrecy, hiding, one doctor not talking to another, that's the kind of stuff we saw," Dr. Earley said. (ABC7)
Dr. Earley testified some people can overcome addiction with very little initial motivation. Dr Earley: Everyone gets motivation from different source. Some by professional reasons, other by family, getting their pride/name back. Dr Earley: Universally was stated in the record MJ's dedication/compassion to his children, wanting the best for them, desire to be good dad. Dr. Earley said he remembered some statements in the record that MJ wanted his children to see him perform, wanted to be a good parent. (ABC7)
"Addiction memory is a expression I coined," Dr. Earley said. "The brain learns automatically how to maintain the addiction." "Unfortunately, doctors became a source of drugs for him," Dr. Earley opined. "Having doctor with him, prescription pad, was dangerous." (ABC7)
Dr. Earley: I saw nothing on the record showing that in the last two months of his life any doctor, but Dr. Murray, gave him PropofolDr Earley: Being around physicians triggered drug craving inadvertently and power was inverted. MJ was in the power seat cause of his status. (ABC7)
That concluded Dr. Earley's video deposition
Dr. Gordon Matheson, a conflict of interest specialist, Jacksons expert.
Jackson direct
Matheson is an expert in sports doctors and conflicts of interest. He teaches at Stanford University and is a team physician. Matheson is a Canadian and was educated there. He started out as a doctor in Inuit communities and has been at Stanford for 19 years. Part of Dr. Matheson’s work is to work with Stanford athletes, keeping them healthy. He’s also been team physician for NHL’s Canucks. He also served as the team physician for the Canadian hockey team for 8 years. Fun fact from Dr. Matheson: Stanford as won 2 ½ times as many Olympic gold medals as the country of Canada, he said. (AP)
Dr. Matheson is a physician, works at Stanford University, Professor in the School of Medicine, sports medicine. Dr. Matheson work splits between teaching, research and medical care. He has written about 150 articles for professional publications. Sports medicine is the care of athlete involved in competitive endeavors and physical activity, nutrition and health, Dr. Matheson explained. Dr. Matheson was recruited to Stanford to take care of their sports medicine program and their athletes. He has worked with Canadian hockey team, Olympic games as medical officer and looked after university teams prior to Stanford. (ABC7)
He explained what a conflict of interest is in the sports medicine world. He said it’s when there are 3 interested parties in medical care. He said in sports medicine, there may be conflicts between the patient, the doctor and the coach or team administrator, agents, etc. Matheson said financial gain is one potential conflict of interest, but so are reputation, status, recognition. (AP)
"In clinical practice it's you and patient," Dr. Matheson said. "But in team practice you have 3 way parties: patients, coach, agent, etc". "The minute you have a three way party there may be conflict of interest," Dr. Matheson opined. (ABC7)
Dr. Matheson said conflict of interest is circumstances that create risks that decisions may be unduly influenced for secondary interest. "When someone stands to gain, it stands to affect their decision-making," Dr. Matheson explained. (ABC7)
Dr. Matheson worked with former Secretary of State Condoleezza Rice at Stanford in the conflict of interest area. Dr. Matheson said Dr. Rice loved football, and her quote was that if she were a man, she would play football. (ABC7)
Dr. Matheson never testified as a witness before. He's been paid $500/hour, got information with colleagues on what to charge. (ABC7) Matheson, who has never been an expert witness, said he is being paid $500 an hour. (AP)
Dr Matheson never worked in music industry but said one of the most obvious relations between sports/musicians is the 3 way party scenario. "I think Mr. Jackson's performance was highly physical, similar to what an athlete does," Dr. Matheson expressed. (ABC7)
He said assuming that Dr. Murray was hired by AEG Live, it appears there was a conflict of interest in his care of Michael Jackson. Part of that conflict was created by Murray's debts and his expected $150k/mo. payday. Another conflict source was his contract w/ AEG. Matheson said since the contract allowed for Murray's services to be terminated if the tour was postponed or canceled, that was a conflict. Dr. Matheson: "When Mr. Jackson’s health deteriorated, I think that conflict of interest played out." (AP)
Bloss: Do you believe there was conflict of interest between MJ and AEG? Dr Matheson: Yes, I do. I believe they created conflict of interest. Dr. Matheson said he believes Dr. Murray was in a conflicting position, promised payment he was to receive to get MJ ready. "Contract made him answerable to AEG," Dr. Matheson said. "It could be canceled if the tour were canceled or terminated. "When MJ was deteriorating, I think that conflict of interest played out," Dr. Matheson said. Dr. Matheson: "I think in this case the conflict of interest led to poor medical decisions." "The contract was negotiated," Dr. Matheson opined. "I think Dr. Murray was operating under the assumption the contract was enforced." (ABC7)
The Stanford doctor, who worked as the team physician for the Vancouver Canucks professional hockey team and the Canadian Olympic hockey team, said it didn’t make a difference that AEG didn’t sign the contract because the terms had been negotiated, and that Murray was “fully engaged” and had passed on his bank information to the company so he could get paid. “Whether it was signed or not didn’t change my feeling as to whether there was conflict of interest,” he testified. Matheson pointed to a line in the contract that said Murray was to “Perform the services reasonably requested by Producer.” The language he said, tied Dr. Murray to AEG even though his was supposed to be looking after Jackson’s health, creating a conflict “as to which of the interests is primary.” AEG has argued that the contract Murray signed was one of the three or four drafts and that “Producer” was one of several mistakes that would have been corrected in the final version of the contract. Matheson wondered why Murray would close his practice when he faced losing his job caring for Jackson if the show were canceled, especially since he was in such bad financial straits. “It can produce a bias in the thinking where Dr. Murray wants to preserve that income at all costs and keep the people paying that income happy,” he said. (LAtimes)
"It's a lot of money to be paid to a physician, particularly a physician who was deeply indebted," Dr. Matheson testified. "I think Dr. Murray needed to be paid certain amount of money, because he owed a lot of money," Dr. Matheson said. (ABC7)
The director of Stanford University’s sports medicine program testified Monday that Michael Jackson’s doctor for his “This Is It” concert series, who administered a fatal dose of the anesthetic propofol to the singer, had conflicts of interest with the tour promoter that “were likely to lead to poor medical decisions.” Testifying in the wrongful death case brought by Jackson’s mother and children against promoter and producer AEG Live and two of its executives, Dr. Gordon Matheson said Dr. Conrad Murray’s debts meant he badly needed the $150,000 a month he was supposed to receive. Matheson testified that the contract made him answerable to AEG rather than his patient, and that because he would have been out of a job if the 50 concerts had been postponed, Murray was more likely to want to please the company. Matheson, who has an M.D. and a doctorate, said that when Jackson’s health deteriorated, “that conflict played out.” (LATimes)
Dr. Gordon Matheson, the director of the sports medicine department at Stanford University, testified as an expert in medical conflicts of interestMonday.After reviewing testimony and evidence in the case, Matheson concluded that AEG Live created a conflict of interest because the contract it negotiated with Murray to serve as Jackson's personal doctor for $150,000 a month "was likely to lead to poor medical decisions." Matheson, the team doctor for Stanford's athletic department, compared it to a football coach telling a team doctor on the sidelines in the fourth quarter of a big game that a star quarterback has to go back in the game despite a suspected concussion. Murray, who had closed his clinics to take the job and was $1 million in debt, would be inclined not to resist the AEG Live executives' pressure to get Jackson to rehearsals despite evidence of his failing health, Matheson testified. Murray himself was conflicted because the negotiated contract was structured so that he answered to AEG, but it also could be canceled if the tour was canceled, he said. "I think that conflict played out as Michael Jackson's health began to deteriorate." (CNN)
"When doctors take on roles, you want them to make independent medical decisions not tied to secondary interests," Dr. Matheson explained. Dr. Matheson said the contract was subject to immediate termination if show was canceled or postponed. Dr. Matheson: It can produce bias in thinking, the doctor wants to retain that payment and please the producer paying him. "That conflicts which priority is primary: MJ or producer of shows," Dr. Matheson explained. (ABC7)
Matheson spent much of his later testimony going through emails he said supported his conflict of interest determination. The doctor focused on emails sent by Kenny Ortega on June 14th, and also the 'trouble at the Front' emails from June 20, 2009. (AP)
Bloss talked about emails exchanged. On 6/14/09 Ortega asked who was responsible for MJ's nourishment, advised doctor didn't allow rehearsal. Dr. Matheson said the email pointed some health concerns that needed attention, questioned if physician was making independent decisions. As to Phillips' email saying AEG was paying doc salary email: "That very directly relates to the intent to control the doctors' decision." "The email shows lack of independent decision," Dr. Matheson said about Phillips' email. "The result of a conflict of interest could be a bad medical decision," Dr. Matheson explained. (ABC7)
The pressure increases as you get close to the end of the game, for example, Dr. Matheson said. "If MJ was unable to rehearse or perform, the show would stop completely," Dr. Matheson said. Bloss: What impact would that have on Dr. Murray? Dr. Matheson: He wouldn't have a job and he wouldn't have an income."Doctors should be able to make independent medical decision on what the best care is for the patient," Dr. Matheson expressed. (ABC7)
Regarding chain email "Trouble at the Front": Dr Matheson said he was intrigued Hougdahl needed to qualify he wasn't being 'a drama queen'."Basket case is a strong word, doubt is pervasive is fairly strong statement," Dr. Matheson said. Phillips responded "we have a real problem here," which Dr. Matheson said showed Phillips recognized there was a problem with MJ. Ortega's reference that 'we brought Dr. Murray into the fold' shows Dr. Matheson that there's a full alignment with the way they thought. But it also showed it wasn't working, MJ was still weak and showing psychological problems, Dr. Matheson explained. Phillips' response 'I will call you when I figure this out' showed that Phillips was in charge, Dr. Matheson said. "We wouldn't normally put an athlete back in the game while their health was declining," Dr. Matheson explained. As to Phillips writing Dr. Murray is extremely successful and doesn't need this gig, Dr. Matheson reacted: "The fact that Mr. Phillips realizes that's important, to me he realizes there's a potential for conflict in this scenario." (ABC7)
Matheson said he got sense of Conrad Murray's debt from Detective Orlando Martinez's testimony, investigation. He said Murray's expected payday was problematic because he was in such deep debt (about $1 million), and it might bias his care of Jackson. He drew a distinction between the June 14 email in which Murray held Jackson back from practice, possibly for good medical reasons versus the June 20, 2009 conversations in which Murray apparently told AEG that practice would keep MJ from deteriorating more. Matheson also pointed to the language in one of Gongaware's emails about reminding Murray who was paying him as a possible conflict. The doctor likened that to a coach telling a team doctor to put an injured player back in a ballgame because it was an important time. Matheson said a later email about bringing Murray "into the fold" showed a conflict. Matheson said it signaled "the removal of independence" (AP)
Matheson discussed several emails written by AEG executives, the tour manager and tour director that have become central pieces evidence in the trial. In one email, AEG Live executive Paul Gongaware wrote of Murray, “We want to remind him that it is AEG, not MJ who is paying his salary. We want him to understand what is expected of him.” Matheson said the email “relates directly to attempts to control the doctor’s decision-making or professional judgment.” He likened it to a quarterback being pulled from a game in the fourth quarter because of an injury and the team owner pressuring the doctor to put him back into the game by reminding the physician that he was paying his salary. “We wouldn’t normally put an athlete back into the game when they had worsening symptoms related to their health,” he said. The sports medicine expert said that in order to avoid conflicts, the doctors for Stanford athletic teams are in charge of an athlete’s healthcare. He said they also teach or perform research at the university so their decisions about athletes don’t affect their income. He said there is a separate facility away from the coaches where players and doctors can have confidential discussions. Matheson said that an email from AEG Live Chief Executive Randy Phillips showed he was aware of the potential conflict with Murray but did not believe one existed. In the email he wrote that Murray “does not need this gig he [is] totally unbiased and ethical.” (LATimes)