Jacksons vs AEG - Day 43 – July 3 2013 – Summary
Katherine Jackson is in court.
Dr. Sidney Schnoll Testimony
Koskoff asked if you take someone off Demorol suddenly what happens. Dr. Schnoll: “like falling off a cliff, you don’t want that to happen.” Methodone is an opioid drug used for pain and treatment of opioid addiction. Dr. Schnoll explained how the drug works. Dr. Schnoll said the most important factor in determining if the person should go off the drug is to find out what the underlying problem is. Koskoff: What if a person has chronic osteoarthritis? Dr. Schnoll: May have remain on medication all his life. If a person has underlying condition and take opioid they could function better, Dr Schnoll explained. There's no harm in doing it medically. Koskoff: Any famous people who have been opioid dependent? Dr. Schnoll: President John F. Kennedy (Judge asks why?) Back pain. (ABC7)
Dr. Schnoll said addiction can also be treated by competent and fit physicians. (ABC7)
Koskoff: If a person is being treated, as part of good medical practice, can someone become drug dependent? Dr. Schnoll: if they're on long term opioid treatment, they'll become dependent. Opioids are the most commonly prescribed drugs in the US. Some patients become addicted, Dr. Schnoll said. But it's not s large percentage. Dr. Schnoll: The figures indicate 10 to 12% become addicted, the same percentage of people who become addicted to alcohol. Dr. Schnoll explained pain threshold is the level at which someone feels discomfort. They are quite variable, he said. “Opioids are most popular because they work," Dr. Schnoll said. "Pain is the most common complaint that comes to a doctor's office.” (ABC7)
Koskoff: Any evidence from any witness that MJ used Demerol outside the medical setting? Dr. Schnoll: No
Koskoff: Was there a period of time when MJ used Demerol for scalp treatments? Dr. Schnoll: Yes (ABC7)
Dr. Schnoll said he reviewed medical records that Dr. Farshian implanted a patch into MJ's abdomen. The patch was done for treatment of Demerol dependency in early 2000s. The drug would block the effect of the opioid, Dr. Schnoll said. (ABC7)
Koskoff said based on the medical records in the last 16 years of MJ’s life, he was Demerol free for 13 1/2 years. Koskoff asked if that was consistent with a drug addict. Dr. Schnoll answered no. (ABC7)
Koskoff asked if Dr. Schnoll read testimony from Dr. Earley saying MJ was a drug addict and that he was going to die early. Koskoff: Do you agree with that opinion? Dr. Schnoll: No (ABC7)
Dr. Schnoll said he saw no evidence that MJ ever used recreational drug or self-injected in the absence of a doctor. The expert said he saw evidence MJ was afraid of needles; didn't take medications in excess of what was prescribed by doctors. (ABC7)
Dr. Schnoll talked about the surgery MJ to repair damage to his scalp.(ABC7)
Koskoff: On Dangerous tour, was MJ getting opioid drugs according to Dr. Finkelstein? Dr. Schnoll: Yes
Dr. Schnoll: I don’t know if MJ was an addict. I haven’t seen the information that would allow me to make a diagnosis of addiction
Koskoff: Was there a time MJ did take benzodiazepines? Dr. Schnoll: Yes
Dr. Schnoll said MJ was prescribed Midazolam and Versed which is commonly for short term surgical procedures, dental procedures.
Koskoff: Did he use it for sleep? Dr. Schnoll: Yes K: Is that appropriate? Dr: Yes K: Did MJ have a sleep problem? Dr: Yes (ABC7)
Dr. Schnoll treated patients addicted to Propofol. They were health technicians and none had it administered by another person. "Typically, they steal it from operating room or critical care unit or inject it in a home, or a bathroom," Dr. Schnoll explained. Dr. Schnoll said after the Propofol infusion stops, the effect wears off quickly. Propofol is the most popular anesthetic in the world, Dr. Schnoll said. Propofol is the generic term. (ABC7)
Koskoff showed a timeline and asked if there was any record MJ received Propofol during the Dangerous tour in 1994. Dr. Schnoll testified Debbie Rowe said yes, but she wasn't sure if it was Propofol or Fentanyl. He didn't think Rowe was a licensed nurse. Koskoff: What kind of specialist was on that tour for Michael? Dr. Schnoll: He was anesthesiologist. Between 1994 and 1996, Dr. Schnoll saw no evidence of any use of Propofol by MJ under any circumstance. The drug was used for dental procedures and cosmetic treatment, Dr. Schnoll said, adding it was appropriate for that. Dr. Murray used Propofol for sleep, which Dr. Schnoll said was inappropriate. "Plus, he was not an anesthetic or an anesthesiologist." Koskoff asked if there was any evidence MJ was addicted or dependent of Propofol up until Dr. Murray. Dr. Schnoll said no. Dr. Schnoll said Propofol is not appropriate to treat insomnia, even if MJ suggested it. (ABC7)
Dr. Schnoll talked about Dr. Klein giving MJ 100mg doses of Demerol in 2008. He said from mid-year to December it was the same amount. Dose went up in January 2009. Dr Schnoll said if a person was previously dependent on Demerol, stops and then resumes, tolerance is built up. Koskoff: Is there a record MJ was getting Demerol from any other doctor? Dr. Schnoll: No. The very last Demerol injection MJ received from Dr. Klein was on June 22, 100 mg dose, according to the records, Dr. Schnoll testified. Dr. School said there was no trace of the drug in MJ's body at the time of his death. He also said this drug would not have had effect on MJ on June 25. (ABC7)
Koskoff: What does Demerol do to sleep? Dr. Schnoll: When you are taking it, it could make you sleepy. "If you are dependent, you could have some insomnia if you go off of it," Dr. Schnoll testified. (ABC7)
Sometimes prescription is given under other people's names, Dr. Schnoll said, since celebrities often don't want people prying their records. Dr. Schnoll said once Frank Sinatra went to the hospital he worked after collapsing on the stage. The hospital computer overloaded with people trying to get information on what happened with Sinatra, Dr. Schnoll said. (ABC7)
Koskoff: Was Dr. Murray competent to handle MJ's pain? Dr. Schnoll: He was not competent. Koskoff: Was Dr. Murray competent to handle MJ's drug dependency issues? Dr. Schnoll: He was not competent
Koskoff: Was Dr. Murray competent to handle MJ's sleep problems? Dr. Schnoll: He was not competent
Koskoff: Assuming AEG hired Dr. Murray, was he fit and competent to treat Michael's pain problems? Dr. Schnoll: No, he was not
Koskoff: Assuming AEG hired Dr. Murray, was he fit and competent to treat Michael's sleep problems? Dr. Schnoll: No, he was not (ABC7)
Dr. Schnoll: Dr. Murray was an interventionist cardiologist and that is a highly specialized field. He had no background in treating pain. "They pass catheters and look at hearts, which is totally unrelated to pain," Dr. Schnoll said about cardiologists. (ABC7)
Koskoff asked if MJ were under the care of a competent doctor, would he have been able to get off the drugs, Demerol and benzodiazepines. Dr. Schnoll: If his underlying medical condition, pain, insomnia, had been appropriately treated, he may have been able to get off the drugs. "He would've been able to continue to perform if he was appropriately treated for the underlying medical conditions," Dr. Schnoll said. Dr. Schnoll testified MJ had two major problems: pain and insomnia. Dr. Schnoll: Should MJ have someone knowledgeable for treatment of pain, he could've been treated appropriately. Dr. Schnoll said if MJ were treated appropriately for pain and sleeping problems, it would not have an effect in shortening his life. (ABC7)
Koskoff: Assuming MJ was dependent, do you think proper treatment would be able to eliminate his dependency? Dr. Schnoll: Yes. Koskoff: Let's assume MJ really was addicted to Demerol in 2009, do you have an opinion as to his prognosis for successful treatment? Dr. Schnoll: He could've been treated, he could've been treated if he had the proper people. Having a supportive family and environment is critical in overcoming addiction, Dr. Schnoll explained. "The autopsy said he was in really, very good condition," Dr. Schnoll told the jury about MJ. Dr. Schnoll: Some of the best outcomes in treatment are with people who have a lot to lose if they continue their addiction.(ABC7)
Koskoff: Based on Mr. Jackson's family, do you know if any members of his family were addicted? Dr. Schnoll: I have no indication of that (ABC7)
Dr. Schnoll agreed MJ had the means to get proper drug dependency treatment.
Koskoff: Assuming he was not addicted, but had periods of drug dependency, would that have an impact on his life expectancy?
Dr. Schnoll: If appropriately treated, it would have no affect (ABC7)
Drug addicts can die early due to overdose; infections are very common, like HIV, Dr. Schnoll said. If MJ got proper treatment, he would have like normal life expectancy, Dr. Schnoll said. Keith Richards and The Rolling Stones have been performing for 50 years. Richards writes in his autobiography about his drug addiction. Dr. Schnoll said he's reading Richards' book, but hasn't finished yet. Defendant's objected to the doctor talking about it based on hearsay. (ABC7)
Schnoll said based on his review of medical records, he saw no evidence that Jackson was addicted to prescription meds. Schnoll reviewed medical records dating back until at least 1997. They included dental records, and files of Arnold Klein. The records showed that Jackson received propofol for dental procedures dating back to 1997, Schnoll said. Schnoll said it wasn’t clear if Jackson received propofol during the 1993 “Dangerous” tour because Debbie Rowe wasn’t clear. He said Rowe used two different names for medications she saw Jackson receive in 1993, so it wasn’t clear if propofol was used. Schnoll’s point about the documented use of propofol by Jackson was that it was in medical settings with proper supervision. Until Murray. The doctor also addressed Demerol use, saying there was no sign Jackson received the drug between 2003 and 2008. Schnoll said even if Jackson were addicted to medications, with proper treatment he could have lived a long, healthy life. (AP)
Koskoff finished direct examination.
AEG attorney Kathryn Cahan did cross examination of Dr. Schnoll.
Dr. Schnoll created the term "Rock Doc", referring to doctors who work on rock n roll concerts. Cahan: Do you think it's ethical for doctors to go on tour? Dr. Schnoll: It depends on what they do when they go on tour with them
I know some people who worked at concerts, Dr. Schnoll said. He has been one.
Dr. Schnoll said at times he was asked to treat performers, was hired to provide medical treatment at the facility to fans or artists.
Dr. Schnoll said his primary duty was to treat concert goers. He was paid by the promoters.
Cahan: Did you think that created a conflict of interest? Dr. Schnoll: As long as I acted ethically, I did not
Dr. Schnoll said he acted ethically at that job. He worked at rock concerts in the '70s. (ABC7)
Cahan asked if Dr Schnoll brought medical students to help him out. He said yes. She asked if he did background or credit checks on them. "I knew most of them and I knew them well," Dr. Schnoll said. (ABC7)
Cahan: You were never hired as a doctor to accompany a band on tour? Dr. Schnoll: That's correct (ABC7)
Dr. Schnoll works for Pinney Associates, he's a salaried employee and receives bonus at the end of the year, should there be one. Cahan said Pinney Associates is charging $790/hour for Dr. Schnoll's time. Dr. Schnoll said he has no idea how many hours he has worked in this case. He was retained back in January. There were weeks he put in 7-8 hours, some didn't do anything. He said it would be hard to estimate, spoke with plaintiff attorney 10-15 times (ABC7)
Dr. Schnoll said doctor shopping is going from doctor to doctor to receive medication. Pseudoaddiction is when a patient is undertreated for pain, Dr. Schnoll said. A professional doctor knows the difference between addiction and pseudoaddiction. (nurse juror nodding in agreement). (ABC7)
Dr. Schnoll: If they have a severe pain problem that can only be treated by opioids, it is appropriate to give it. Just the fact that Dr. Klein injected MJ with Demerol doesn't raise concern of a relapse of Demerol dependency, Dr. Schnoll. Cahan asked if it's common practice to use Demerol for Botox injections and facial fillers treatment. Dr. Schnoll responded he didn't know, since he doesn't do these procedures. Dr Schnoll said Demerol is not commonly used anymore because it has other effects than just opioids, considered a dirty drug the doctor said. Dr. Schnoll said use of Demerol for pain went into question in the '90s. Cahan: How common is for pain specialists to have Demerol handy? Dr. Schnoll: Probably not at all at this point, pain specialist would not keep Demerol handy. Dr. Schnoll said he last prescribed Demerol in the late 1970s. He stopped treating patients in 2001. (ABC7)
"There was no evidence of addiction at that time," Dr. Schnoll said about MJ in 2009. Dr. Schnoll did not offer opinion whether the amount or type of drug MJ was taking for cosmetic and dental work was appropriate. (ABC7)
Cahan: When you are evaluating a patient you rely on the patient being honest with you, correct? Dr. Schnoll: Yes
Cahan: Did some patients did not want to get treatment?
Dr. Schnoll: Well, of they came to me to treat addiction, they usually would come because they wanted to treat their addiction
Cahan: There has got to be some amount of trust between doctor and patient? Dr. Schnoll: Right (ABC7)
Dr. Schnoll said people get confused as to whether the patient is addicted or dependent of drugs. The expert said people would recognize there was something wrong with MJ, but may not be able to recognize it as withdrawal from opioids. Some of opioids withdrawal include chills, running nose, tearing of the eyes, dilated pupil, goose bumps. Dr. Schnoll said most doctors would be able to put all the symptoms together and conclude it is opioid withdrawal. The doctor agreed that some lay people could identify the symptoms as flu.(ABC7)
Dr. Schnoll said he has treated tens of thousands of patients and only 5-6 were addicted to Propofol. These people were in the medical field. Dr. Schnoll said some of the patients might have been addicted to Propofol, but others were just abusing it. (ABC7)
Outside the presence of the jury, judge discussed with the attorneys about Jean Seawright's testifying yesterday that AEG hired Dr. Murray. Judge said that violated the motion in limine regarding this issue. Experts are NOT to give their opinion on whether AEG hired Dr. Murray. Judge: This is your crucial, central issue in the case Mr. Panish. I'm surprised you had no discussion with her about it.Panish: I know you're upset, I can tell that Judge: I'm not upset, I think it's entirely appropriate Panish: I told her not to do it. Judge: there's a ruling prohibiting any testimony, by any expert, on the issue! An upset judge said: This is my concern, we are 9 weeks in this trial and it's getting into mistrial territory. I don't want to go there! Judge: I don't want this kind of problem that can lead to mistrial. I'm asking you to speak with all your experts. Judge: Every expert is only to make assumptions about hiring. I specifically did that (ruling) for a reason. Advise them about my order! Judge: I don't want a mistrial, it's a waste of resources Panish: I don't want a mistrial either. Judge: There are bright lines Mr. Panish and you don't even go near it because you may cross it accidentally. Panish: She said it, I wish she hadn't, I don't want a mistrial. Putnam said he agreed with the judge and agrees the instruction should be given as written. Judge: I don't know why you are pointing your fingers that way, Mr. Panish (to AEG's side). I really don't. Judge admonished Panish to tell all experts to abide by her motions in limine. (ABC7)
After the afternoon break, Judge Yvette Palazuelos returned to the testimony of HR expert Jean Seawright. She was upset about yesterday. The judge noted that expert witnesses had been instructed not to state opinions on whether AEG Live hired Conrad Murray. Seawright told the jury she thought AEG did hire Murray, based on a question from plaintiff’s attorney Brian Panish. Panish had asked whether Seawright she had an opinion on whether AEG Live hired Murray. He said today he thought it was a yes-no question. The judge said the answer veered into mistrial territory, and that Panish should have warned Seawright to not state her opinion. Panish protested, saying “All I was trying to show was that she was trying to show was that she has an opinion.” Palazuelos: “This is my concern. Nine weeks into this trial and this is getting in a mistrial situation.” (We’re in 10th wk of testimony.) Panish also said that he was trying to counter questions from AEG’s attorneys that suggested Seawright didn’t have an opinion. Palazuelos: “I don’t know why you’re pointing the finger that way.” She told Panish to make sure he warns his experts from now on. (AP)
Judge read them the following instruction: Yesterday, plaintiiff's expert Jean Seawright said she believed they, AEG, hired Dr Murray. That violated a court order, the statement is stricken, shouldn't be considered (ABC7) The jury was brought in, and Palazuelos read an instruction stating that Seawright violated a court order. The judge said the jury should disregard her testimony about whether AEG Live hired Conrad Murray. (AP)
Cahan asked if MJ was seeing other doctors at the same time he saw Dr. Murray, like Dr. Klein. Dr. Schnoll said yes. Cahan: Are you aware of Dr. Klein being investigated... Panish stopped and objected as improper. He asked for a sidebar.(ABC7)
Cahan: Did Dr. Klein write prescriptions to Mr. Jackson under other names? Dr. Schnoll: Yes. Cahan: Could MJ have opiates in pill forms in 2009 from doctors while having Demerol injections from Dr. Klein? Dr. Schnoll: I don't like to work under possibilities, since everything under the sun is possible. I like working with probabilities. Dr. Schnoll said you try to look at the whole picture of what was going on and not look at the possibilities, but probabilities. Cahan: Is it legal to write prescription to someone under another name? Dr. Schnoll: Yes, it's illegal C: Have you ever done it? Dr: No (ABC7)
Cahan asked if Dr. Schnoll testified in his deposition that MJ was dependent on Demerol? He answered yes, the time around the Dangerous tour. However, Dr. Schnoll says today he's not sure MJ was dependent on Demerol in 2009. He said he continued to investigate the case, looked at more records, and is now uncertain. He's also not absolutely sure, but says MJ was probably dependent on Demerol in 1993. Dr. Schnoll said he could not opine whether the treatment after the burn on MJ's scalp was . Schnoll said he doesn't think MJ was dependent on Demerol in January of 2009. (ABC7)
In April 2009, MJ received 375 mg of Demerol, the highest amount given by Dr. Klein. Cahan asked what would happen if doctor gave her 375 mg of Demerol. "For you? You'd probably sleep for a while, about several hours" he said. Dr. Schnoll said he would probably give her initial dose of 50 mg. (ABC7)
The expert said that if the withdrawal symptoms were present, someone might have asked why MJ had the flu. (ABC7)
Dr. Schnoll said he asked for a chart to be made to be able to see how much Demerol MJ was getting and how frequent. "Was he really dependent?" Dr. Schnoll asked himself. He said the appearance of withdrawal from Demerol usually shows within 24-36 hours. "It didn't coincide with when I expected that withdrawal to occur," Dr. Schnoll said about MJ. Dr. Schnoll: It was very hard for me to say he was dependent that time. He doesn't think the symptoms MJ was having on June 19, 2009 were related to Demerol withdrawal. (ABC7)
Cahan asked about patients who think they have their addiction under control and don't want to quit the drug. "That's why your job is to motivate them and help them see the problems with the dependency," Dr. Schnoll responded. Dr. Schnoll said he didn't have 100% success rate in his practice and that no one does. Dr. Schnoll: MJ could've been off the drugs or taking the drugs in appropriate dosages if properly treated (ABC7)
Cahan asked about MJ's family failed interventions. He said he doesn't know if they were appropriately done; practice not used as much.(ABC7)
Cahan asked if Dr. Schnoll reviewed testimony that MJ had boxes of Propofol at Neverland and asked a doctor to inject him. He said yes. Dr. Schnoll said he saw a concern one time of MJ going to Santa Ynez Cottage Hospital for excessive use of Demerol.(ABC7)
Dr. Schnoll said he looked at the totality of the picture, like a puzzle, trying to put everything together to understand what was going on. "They were not symptoms of Demerol withdrawal, but probably of Propofol," Dr. Schnoll testified about MJ's symptoms in June 2009. (ABC7)
On cross-examination, she tried to make the point that it’s hard for a lay person to tell difference between addiction and dependency. AEG defense attorney Kathryn Cahan also asked Schnoll about Demerol. He called it a “dirty opioid.” The doctor said he probably hadn’t prescribed Demerol since the 1970s. (He hasn’t been practicing with patients for several years.) (AP)
Koskoff asked in re-direct if Propofol was given for the drug or underlying condition. Dr. Schnoll said MJ asked Propofol to help him sleep. (ABC7)
Cahan in re-cross: What did nurse Cherilyn Lee said to MJ when he was looking for a doctor to give him Propofol? Dr. Schnoll said Lee responded that MJ was taking chances. (ABC7)
Koskoff noted that MJ replied it would be safe if done under the supervision of a doctor. Koskoff: And Dr. Murray gave it to him? Dr. Schnoll: Yes (ABC7)
Dr. Schnoll was then excused and session adjourned.
Jury ordered to return on Monday at 10 am PT. Plaintiffs will play Dr Finkelstein's deposition. Kenny Ortega set to testify in the afternoon