Murray Trial Day 5 October 3, 2011
Dr. Richelle Cooper Resumption of Direct by David Walgren
Cooper states that CM indicated he had given MJ 4 miligrams of lorazepam, with no mention of propofol. Cooper states that there were over 14 people in the room where MJ was at UCLA, but that she had the final say over everything that happened in the room. Cooper states that she was aware that paramedics have given "starter drugs" at the Carolwood home and also during transport to UCLA. Cooper states that at UCLA,
epinephrine, sodium bicarbonate, vasopressin were all given to try to restart MJ's heart. Dopamine was given in a drip. Cooper states that chest compressions were given from time of arrival.
Cooper states MJ arrived at 1:13 pm and was death was called 2:26, chest compressions were given continuously throughout. Cooper states MJ had an endotracheal tube, and a respiratory therapist was squeezing an ambu- bag to pump oxygen into MJ's lungs throughout. Cooper also states that MJ was hooked to monitors throughout. Cooper states that during this hour and thirteen minutes, from the time MJ arrived at UCLA, until the time of death was called, she never felt a pulse. Cooper states that when compressions were going on, they could feel a pulse. But, that a spontaneous pulse (when there are no chest compressions going on) was not found by her. Cooper states at 13:21 (military time for 1:21) one of the staff reported a pulse, but when Cooper consulted the monitor it was not consistent with a pulse.
Cooper states that she made the decision at 2:26 pm to call the time of death, even though she called time of death at the Carolwood home at 12:57 pm. Cooper states that from 12:57 pm to 2:26 pm there had been no notable change in MJ's condition. Cooper states that she noticed a condom catheter on MJ's body. Cooper states that condom catheters are used to collect urine when unconscious. Cooper states that the condom catheter was unusual for a 50 year old male who was reportedly healthy.
Cooper states that she did not request Murray to sign a death certificate, because MJ was her patient.
Cooper states she did not have a reason for MJ's death and therefore MJ's case would be a coroner's case. Cooper states that there was a social work team to help with the family even before the time of MJ's death was called. Cooper states that the social work team is standard care for UCLA, not initiated by Conrad Murray. Cooper states that she was notified that MJ's children were aware that their father was dead. Cooper states that she saw the children, that they were scared and that they were fairly hysterical, and taken care of by someone referred to as their nurse.
Cooper states she does not know exactly time of death for MJ, she bases it on what the paramedics told her, and called time of death at 12:57 pm. Cooper states based on the information she had, she believed MJ to be dead at 12:57 pm. Cooper states that she could override Murray's request to continue to try to revive Murray, but she allowed Murray to make that call. Cooper states that her assessment when MJ arrived, he was clinically dead and that any revival would be futile. Cooper stated that Murray claimed there was a pulse, so she continued efforts to save MJ.
Cooper states she was never an anesthesiologist, but she has used propofol, at UCLA you need to have privileges. Cooper states she always practices medicine in a hospital emergency room setting. Cooper states that in her use of propofol, she uses amounts that are based by case. Cooper states that she chooses a dose that will make a patient comfortable, so that the patient does not feel pain. Cooper states she never used propofol as a pre-med student. Cooper states that if 25 mg of propofol was slowly infused in 3-5 minutes, on a patient at 135 pounds, and he received no other medications, she believes if she achieved sedation, he would wake up in seven to ten minutes. Cooper does not believe that the propofol would be completely metabolized in seven minutes. Cooper states that 25 mg is very small, and would not be sufficient to sedate a patient.
Cooper states that Murray stated he witnessed MJ's cardiac arrest. Cooper states that she never asked what time the lorazepam was given to MJ. Cooper states that she previously testified that Murray stated he witnessed MJ's cardiac arrest. Cooper states that the half life of benzodiazepines varies greatly.
Cooper has been to courses in procedural sedation, she has administered procedural sedation, and reviews articles on procedural sedation. Cooper states that on a healthy patient, she would start sedation at a mg per kg dose, and in MJ's case that would be 60 mg, it would keep them asleep for about 10 minutes.
Cooper states that if Murray had told her that he had given 25 mg of propofol at 10:40, it would have not changed how she treated MJ as a patient. Cooper states that MJ died long before he became her patient.
Cooper states that Murray stated that he thought MJ was dehydrated, had given him lorazepam, and had witnessed MJ's cardiac arrest. Cooper states that Murray told her MJ took Flomax which is typically taken for a urinary problem.
Cooper states that while it is normal to take a rectal temperature, but Cooper cannot recall if it was done. Cooper states that rectal temperature would not tell her time of death. Cooper states that there is a protocol for LA county paramedics, with 20 minutes of revival procedures, after 20 minutes with no change, it's time to call time of death. Cooper states that this is the first time that paramedics have ever asked her to continue revival procedure after she tells them to call the time of death.
Cooper states that she does not recall Murray being frantic, but to be honest, she does not pay that much attention to someone other than the patient. Cooper does not recall much about Murray's demeanor, except that Murray was respectful in that he was not allowed to do procedures in the emergency room. Cooper states that Murray and a Dr. Cruz had a conversation, which she did not hear, but then the aortic pump was inserted. Cooper states that there was no urine present in the condom catheter or the collection bag. Cooper states that had there been urine, Cooper would have sent it to the lab to be analyzed.
Cooper states that she assumed that Conrad Murray was not lying to her. Cooper states that Murray told her that MJ was working hard, was dehydrated and he had given him lorazepam. Cooper states that all physicians do not have propofol privileges. Cooper states that they have equipment set up within a room and outside a room for issues arising in a patient who has received propofol. Cooper states that there is always an attending physician present, plus other physicians when administering propofol or another anesthetic agent.
Cooper states that when administering propofol, it should go in as a slow infusion through a bolus. Cooper states that a direct injection of propofol would cause apnea, although she has never seen a direct injection done. Cooper states that continual propofol usage is rare.
Cooper states that she is prepared as a an emergency physician to intubate patients or attend to patient's airway during procedural sedation.
Cooper states she has never had a patient stop breathing during a procedural sedation. Cooper states that if there is a problem, the first thing to do is to stimulate the patient, meaning wake the patient up and that that is almost always sufficient. Cooper states that if a doctor was to administer 60 mgs to 60 kg patient, the doctor would be able to see insufficient breathing right away, that it could be determined by seeing, but that capnography would be able to detect a breathing problem first.
mid morning break
Edward Dixon Testimony
Dixon states he works for AT & T as a senior support engineer since 1997. Dixon states that he is familiar with preparations of cell phone records and has testified previously in cases regarding cell phone records. Dixon states he has reviewed Murray's cell phone records. Dixon states that Murray's cell phone account status was active in June, 2009.
Dixon states that on June 25, 2009, calls were made:
- 9:23 am Call placed to Murray's phone lasting 22 minutes
-10:14 am Call placed to Murray's phone lasting 2 minutes
-11:07 am Call placed to Murray's phone lasting 1 minute
-11:18 am Call placed from Murray's phone lasting 32 minutes
-11:49 am Call placed to Murray's phone lasting 3 minutes
- 11:51 am Call placed from Murray's phone lasting 11 minutes
- 12:12 pm Call placed from Murray's phone lasting 1 minute
-12:15 pm Call placed to Murray's phone lasting 1 minute
- 3:38 pm Call placed from Murray's phone lasting 2 minutes
- 4:31 pm Call placed from Murray's phone lasting 1 minute
-4:32 pm Same as above
-5:02 pm Same as above
Dixon states that cell phone contains data as well as calls. Dixon states that data activity occurred on Murray's cell phone on June 25, 2009:
- 1:04 am, 2:04 am, 3:04 am, 4:04 am, 5:04 am and 6:04 am, Dixon states that this is pull notification, and that information is pulled to the phone.
-8:54 am - 5:02 pm Data activity
Gourjian Defense cross
Dixon states the records do not identify who is using the phone. Dixon states that there is no way to identify what is said in a text message sent from any AT&T phone (referring to data activity). Dixon states that he does not know, as of today, who own the cell phones that Murray called on June 25, 2009. Essentially, Dixon states that he can tell if calls went to voicemail or they were answered only if they made from or to AT&T phones.
Dixon states that regarding data usage, the data is set automatically, in this case, it was set at 1:04 am, 2:04 am, 3:04 am, 4:04 am, 5:04 am and 6:04 am.
11:07 am, phone call to Murray's call, Dixon states that he cannot tell whether the call was answered or it went to voicemail. Dixon then looks to his records, looking specifically at the duration of the call, and states it is identified as an incoming call, length is 1 minute, but he still cannot tell if it went to voicemail or answered.
Brazil corrects that 3:38 pm call is wrong, it is 3:58 pm.
Jeff Strohom Testimony
Strohm states that he is a custodian of records for Sprint/Nextel, and is responsible testifying for courts who require it. Strohm states that the subscriber for the number that Brazil asks, is Conrad Murray. Strohm states that calls were made from or to Murray's phone on 6/25/09:
- 7:01 am Call made to Murray lasting 25 seconds
- 8:25 am Call made from Murray lasting 0 seconds (text message)
- 8:39 am Call made from Murray lasting 53 seconds
- 10:20 am Call made to Murray lasting 111 seconds
- 10:34 am Call made from Murray lasting 8 1/2 minutes
- 11:26 am Call made to Murray lasting 7 seconds
- 1:08 pm Call made from Murray lasting 2 minutes
Gourjian Defense Cross
Strohm states that the 11:26 am call cannot tell whether the phone was answered or not, but that the call is not a voicemail.
Dr. Thao Nyguen Testimony
Dr. Nguyen states she works at UCLA as a cardiologist/scientist. Nguyen 20% of her time spent as a cardiologist, 80% of her time she researches. Nguyen states that in June, 2009, she was a cardiology fellow. Cooper states her responsibilities included taking care of patients that were critically ill in CCU at UCLA, managing patients and supervising her was Dr. Daniel Cruz.
Cooper states she was called into the emergency room at UCLA to help with the patient MJ. Cooper states she received a page that the ER needed help with a VIP patient, named Michael Jackson. Nguyen states that Dr. Cooper was treating MJ when she arrived at the emergency room. Nguyen states that Murray introduced himself to her as MJ's private physician. Nguyen asked Murray what happened, and Murray replied that MJ was very tired, he was preparing for a concert tour. Nguyen states that she asked Murray if there were any drugs given, Murray stated 4 mg of Ativan(another name for lorazepam). Nguyen asked if any other medications were given, Murray stated no other medications given.
Nguyen states that she asked what time the Ativan was given, Murray stated he did not know. Nguyen states that Murray told him he found MJ not breathing, Nguyen asked what time was that, Murray stated he did not know. Nguyen states that she then asked Murray what time was 911 called, Murray stated he did not know, he had no concept of time because he did not have a watch. Nguyen states she asked for an estimate from Murray from the time he found him not breathing to the time he called 911, Murray was not able.
Nguyen states that Murray never mentioned propofol to her. Nguyen states that after receiving from Murray, she consulted Dr. Cruz. Murray told them that he found a pulse, but Dr. Nguyen nor Dr. Cruz found a pulse. Murray asked both Nguyen and Cruz to continue to try to revive MJ, to not give up easily. Nguyen states that the next thing to do to try to revive MJ is to use a balloon pump for MJ's heart. Nguyen states that she feared they were running too late, that time was not on MJ's side.
Murray Trial Day 5 October 3 2011
Thao Nguyen (TN)Testimony
Walgren Direct continued
What is a balloon pump? It is inserted into aorta to help heart. She was doubtful that it would help. It looked like time wasn't on MJ's side and he looked lifeless. She went forward with the balloon pump to show good faith. TN and Dr. Cruz (attenting cardiologist) could not felt a pulse but CM told them he felt a pulse and asked them not to give up easily on MJ and try to save his life. TN and Dr. Cruz moved forward with balloon pump even though they thought it was futile. Dr. Cruz decided and authorizated the ballon pump. It was quite smoothly placed but the attempt was futile.
Before they did the balloon pump placement, they made an agreement with CM that this would be the last attempt to save MJ and if it didn't work they would stop the efforts.
Dr. Nguyen: "We wanted Mr. Jackson to depart with dignity and respect, so we decided to end our efforts. "
Shortly after the balloon pump MJ was pronounced dead.
CM did not mention propofol during all these balloon pump efforts.
Defense Flanagan cross
TN was called a minute before 1:35. TN remembers the time because she looked to her pager. TN was on the 7th floor in the rounding room of cardiac care. She talked to Dr. Cooper when she came into the trauma bay and Dr. Cooper pointed and introduced her to CM saying that CM is the physican for MJ.
TN knew the patient was MJ because page she received was a code for "VIP named Michael Jackson".
TN talked and asked CM first because he was the primary source . She always goes to the source and then talks to ucla attending doctor (Dr. cooper).
CM said to TN that MJ was having hard time sleeping, MJ was tired because of preparation/ rehearsal for the concert tour and MJ asked for sleeping aid. CM told TN that he gave MJ "Ativan 4 mg IV" .
CM didn't tell her that he gave it in 2 seperate doses. CM didn't mention Valium or Flomax and said no when she asked if there was any other sedatives and narcotics involved. CM did not recall the time when gave Ativan to MJ. CM didnot remember the time of the arrest. CM did not recall when he called EMS.
TN had some concerns: 1)time was not on their side 2) IV for insomnia for outpatient setting is quite uncommon. The dosage wasn't too high but there was a lifeless patient.
4mg of Ativan by IV would put a person to sleep. TN would start with 1 mg by a mouth. IV would be stronger than by mouth usage. She wouldn't use Ativan in outpatient setting and even inpatient setting because they are better drugs that are non-sedatives and non-narcotics.
Recommended dosage for Ativan is 2 -4 mg by mouth for an adult. 2 mg Ativan by IV would put a patient to sleep pretty quick in 5-7 minutes depending on the patient. If a person is used the drug before it can take them longer to sleep. Ativan half time is 12 +- 5 hours. TN says the amount of sleep would depend on the patient and the conditions. She says that normally people would be able to sleep through the night with that dose.
Defense asks about the second dose of 2mg Ativan and if it would put the person to sleep. TN says yes if the person has not developed higher tolerance , if they had a high tolerance they would need higher dosage. TN also mentions that the even though a person's tolerance to drug could increase, their body's tolereance level to toxicty wouldn't increase.
Defense asks 20 mg Ativan IV, TN says that it's a really high dose. Defense asks if it would kill a person. TN says that Ativan affects the brain and will make the brain sleepy (depress the consciousness) and it would not tell the diaphragm to breath.
Defense talks about half life of Ativan. Defense asks if Ativan would be expected in to be present in blood at 12:00PM if 2mg is given at 2 AM and 5 AM.
Defense asks if they would watch the patient if they gave them Ativan. TN says that multiple people watch them until they would gain total consciousness.
Slurry speech is mentioned and TN says that it would be an affect of Ativan. TN has used Propofol. She says that they don't hear slurred speech in Propofol.
CM sounded desperate and looked devastated. CM said "Do not give up easily, please save his life".
There was no pulse but TN didn't know how long he didn't have pulse. TN believed when she was called to come down, CPR was partially successful. All TN knows when she came down MJ appeared lifeless and TN and Dr. Cruz could not find a pulse. There was typically no reason to use a balloon pump.
TN says as CM was there and he was trained and knew how to take pulse so TN gave CM the benefit of the doubt and believed when he said he felt a pulse.
Defense asks when they did the balloon pump. She says that they got the equipment in 5-7 minutes and did the balloon pump immediately after they got the equipment.
Defense again goes over the agreement they did with CM to do balloon pump and stop if it doesn't work. TN repeats multiple times of her previous explanations.
TN says she asked CM if he gave anthing to reverse the effect of atrivan. Later TN explains the drug Flumazenil. 0.2 mg to prevent the further depression of the brain. To reverse the effect of Ativan it should be given immediately like in seconds. Defense questions about window of opportunity. TN says seconds to minutes (2-3 minutes). TN says you can 100% reverse Ativan but if you wait too long then you would zero chance to reverse it. It must be given as soon as you find the patient. TN says that antidote should be to be at hand when giving Ativan to a patient. TN says the next step will be to incubate the patient and to be put on a ventilator to breathe.
Defense asks is she would expect 4 mg Ativan need Flumazenil. TN says she would not typically expect any complications in a person that is accustomed to the drug and tolerant to it. TN adds that anything can happen and they always use it at a monitored environment with oxygen on board.
TN use propofol at the hospital but uses an anesthesiologist in procedures. TN says at least 3 people will be in the room - cardiologist,anesthesiologist and a nurse. TN says Propofol will be administered in a hospital setting and furthermore only in an ICU or procedure room. TN also mentions that it would be administered in a designated place, with designated personnel and necessary equipment. TN says thatcrash cart should be available. TN says she wouldn't administer Propofol without the necessary equipment.
TN mentions Propofol can cause negative effects and that it doesn't have an antidote so that they should be prepared for the worst when giving Propofol before they even start administering it. TN mentions it's a must.
Defense asks if Propofol can be used for other reasons than procedures. Defense asks if TN knows conscious sedation. Defense mentions that TN only used Propofol during a procedure so divided the responsibility with anesthesiologist and asks if there's no procedure could she give it alone (be in charge of giving Propofol). TN replies " I don't use Propofol when there's no procedure being done". Flanagan says that's because she never practiced outside a hospital. TN says she does work outside a hospital setting and she would never use Propofol in an outpatient setting.
Defense asks how much Propofol she would give to someone MJ's size. TN says that it would depend the conditions and if other sedatives were used.
Flanagan states Propofol being commonly used outside hospital setting. TN disagrees , Flanagan asks if TN knows Propofol being given at a dentist offices and gastroenterologist, TN says she was not aware of it and never asked what they gave and wasn't interested. TN says that she was only concerned with what is given to her.
Walgren asks TN if she has ever heard Propofol being used in someone's home in a private residence, she says that's a first.
Dr. Joanne Prashad (JP) Testimony
JP Internal medicine physician for 9 years at a Houston Hospital.
JP was called to evaluate a patient for a surgery to see if the patient can undergo surgery. JP generally sees the patient, takes their medical history, does a physical exam and she would review medical charts. The patient had a recent surgery done by CM, CM had placed a stent to an artery on his leg to keep a blood vessel open. Patient was taking medications (Plavix) which was a concern for the surgeon and the anesthologist.
Patient had an open wound on the leg that went to the bone. If they do the surgery the wound would additional bleed. The concern was that if the patient could continue to take Plavix or not.
The stent was put into 4.5 months ago. JP saw that he was taking plavix medicine , generally it's taken for 6 months. She needed to learn if the medicine could be stopped. JP wanted to ask CM what was his opinion about this patient and if she can tell the patient to stop the plavix and have the surgery.
Brazil questions about medical chart and asks if they are important. JP says they are important because they can get the accurate medical information from them. Patient generally don't know the details of the medications and previous procedures.
Shee called CM's office and was given a phone number it was a answering service. She called the office again and was given a second phone number. JP called the second number and explains her reason for calling and she asked if this patient needs to continue to take Plavix or if they can stop it and the patient can have the surgery. CM was clear, he said the patient need to continue the medicine for 6 months and postpone the surgery until that the time period was over. CM properly told the medicine dosage and his treatment plan.
She was surpised that she called out of the blue and he was able to give an answer. Generally doctors would say they need to review the chart and call back. CM was clear about the treatment and about the need for the medication.
10:20 AM . It was a brief call. CM provided the information she needed. She decided to postpone the procedure based on the information she got from CM.
Defense Chernoff cross
Defense mentions that a lot of the times doctors doens't remember the patient but CM did, he knew the treatment, he knew the medication. Chernoff asks if she was impressed with CM, she says she was impressed.
Mid Afternoon Break
Antoinette Gill Testimony
She's from Las Vegas, Nevada. She has known Murray for over 10 years. She was referred to him by a client of hers. She is a patient of CM.
Mid June she received a letter from CM's office. It said that CM was going on to a sabbatical. She called CM's cell phone on June 25th at 8:45AM . She had a short normal conversation. She was seeking referral for another physician she didn't receive it.
No Defense Cross
Consuelo Ng (CN) testimony
CN met CM 2003 -2004 when CM was treating her grandmother. CN says CM helped to cure her grandmother. She volunteered to work at CM's Las Vegas office and she was working as a caregiver at a group home. She's not a nurse.
She consistently volunteered in CM's Las Vegas office 5 days a week. She worked at the front and back of the office. She did filing, answered phones and took vitals of the patients.
She knows Robert Russell who used the ECP room. 3 other girls Carol, Sarah, Leah worked at CM's office. Carol mostly handles the front office - checking in patient, scheduling appointments , answering the phones, authorizations from insurance and verification and filing of insurances. Leah works at back of the office also answer calls and help the front if needed. Sarah does the same. None of them are registered nurse. They are not licensed vocational nurses. All of them did whatever needd in the office. CM also has an assistant administrator Stacy who worked from San Diego. Stacy order supplies, process payroll.
CM will be in Houston for a week and next week he will be in Las Vegas. Las Vegas office will be open when CM was in Houston . When CM is in Houston they would provide ECP threaphy and an Echo tech would come and do echocardiogram (echo).
ECP threaphy : They would wrap lower extremities, they put the patient on a Blood Pressure cuff, check oxygen level, hook up the patient on machine. They would check the oxygen level with a machine that they put it on the finger.
When CM was not in office he would call the office daily to check. When CM was in Houston they would see patients in a partial day basis. CM did not perform procedures in his office. His procedures will be on Friday at the hospital.
June 2009 - she did not know CM was in California. CM would call in to say to rechedule some patients.
Brazil mentions the June 15 letter sent to CM's patients telling that the CM would leave his practice for a period of time. CM told his staff that he was the personal physician of MJ before the June 15 letter. They would continue working for CM, another physician would come and would take over but it wasn't set up.
June 25, she was working in the office with Carol, Leah and Sarah. CM called the office, she did not speak to him. 11:18 AM 32 minute call. She did not speak to him, someone else from the office could have talked to CM. It was his normal habit to call the office when he was away.
They went to lunch, they weren't seeing patients that day. When they got back from lunch, they got a call from their biller. That how they found up something happened to MJ.
Defence cross Chernoff
Defense asks if she was supbeonad to testify. She says yes.
Defense goes over CM's schedule. Mondays and wednesdays he sees patients in the afternoon, mornings makes rounds in the hospital. Tuesdays see patients mornings, make rounds in the afternoons. Fridays he does procedures at the hospital.
Defense again goes over if CM would call the office and what they would do in the office when CM was away. She repeats the previous answers.
Defense asked why she volunteered to work in CM's office. She says because she wanted to learn and experience how it is working as a medical assistant was. she saw how CM treated her grandmother.
Chernoff question : Did CM had a tendency to become friends with his patients? Yes. Patients had an attachment to CM? Yes they did.
She stopped working CM because of what happened , CM shut down his practice due to what happened with MJ Objection. Sustained.
CM talked everyone at the same time and told that he was going on sabbatical to go on tour with MJ. They were excited "because it was MJ and everyone knows MJ". CM told them he would be back by the end of year.
Bridgette Morgan testimony
She met CM in 2003 in a social setting. She maintained a relationship / friendship with CM. CM told her that he was MJ's personal physician.
She called CM on June 25th. 11:26 AM. CM didn't answer the phone.
She lives in LA since 1998.
She met CM in Las Vegas.