More on the MJ Trial: What to Watch For

As I stated in a prior blog about the trial of Dr. Conrad Murray, I wasn’t even planning on reading about it. But in the end, I couldn’t resist – it involves a subject I know too well – anesthesia safety and propofol – and my good friend Dr. Paul White, an anesthesiologist who is as solid on the science of propofol as anyone is, is scheduled to testify as an expert witness for the defense.

Posted on | Mike Roizen, MD | Comments ()

As I stated in a prior blog about the trial of Dr. Conrad Murray, I wasn’t even planning on reading about it. But in the end, I couldn’t resist – it involves a subject I know too well – anesthesia safety and propofol – and my good friend Dr. Paul White, an anesthesiologist who is as solid on the science of propofol as anyone is, is scheduled to testify as an expert witness for the defense.

Now I’ve learned that another friend, equally wise, Dr. Steven Shafer is going to testify for the prosecution – wow. Both are powerful speakers and scientists. Dr. Steve Shafer is Editor in Chief of the academic journal Anesthesia and Analgesia, and Dr Paul White is a section editor of his, I believe, or was. Not only might this strain friendships, but it will be interesting if they have opposing points of view on the same issue. These are the issues that are likely to be discussed that we should watch for this week:

Issue A: If MJ drank propofol, is that likely the cause of death that Dr. Murray couldn’t have predicted? My take (without enough data): Yes for two reasons (well maybe three).

1. Propofol from the stomach goes 100% to the liver and is totally inactivated before it leaves the liver, meaning there is no chance it affected MJ’s heart or brain. That is why docs need to inject it in a vein where most avoids the liver before it hits the target organ for anesthesia, the brain.

2. If the vials of propofol were left near MJ, then that is a break in the standard of care – negligence – as all brain-active drugs should be under lock and key and not available to inject or ingest, except for the doctor.

3. From early animal studies, as I remember them – my  memory may be failing me here – propofol is found in the stomach after IV injection due to equilibration between blood and stomach fluid – thus propofol in the stomach is not there necessarily from drinking it.

Issue B: If Dr. Murray gave MJ only 25 mg of propofol, was he negligent in not monitoring MJ as if he were at any other site where a doctor would administer propofol – an ICU, hospital operating room, surgicenter, or colonoscopy suite? My take (again without enough data): Yes for two reasons.

1. Propofol should only, even if in small doses, be administered with direct and direct observation continuously of heart rate and respiratory monitoring, as it can cause respiratory arrest, especially in a dehydrated person.

2. If an IV was left in MJ for resuscitation precaution, there was no evident resuscitation equipment like a defibrillator. Again, if the vials of propofol were left near MJ, then that is a break in the standard of care – once, again, negligence – as all brain-active drugs should be under lock and key and not available to inject or ingest by anyone but the doctor providing care.

Now as I stated, I really am just guessing here, but these are the key points to watch for in Dr. White and Dr. Shafer’s testimonies. Did Dr. Murray’s breach of the standard of care cause or contribute to MJ’s demise? We’ll have to wait for the evidence but you can see what points I’ll be looking for the prosecution and defense to make.

Blog written by Mike Roizen, MD
Dr. Roizen is a past chair of a Food and Drug Administration advisory committee and a former editor for 6 medical journals with...