Michael Jackson's personal physician was giving the pop superstar a modern drug to help him sleep, but a prosecution expert told jurors Wednesday that in doing so he violated ancient principles for conduct between doctors and patients.
Dr. Steven Shafer, an expert in the anesthetic propofol that Jackson's doctor had been using as a sleep aid, said there were 17 violations by Dr. Conrad Murray that each put Jackson's life at risk.
Murray has pleaded not guilty to involuntary manslaughter. He was Jackson's personal physician for roughly two months before the singer's unexpected death in June 2009. The cardiologist's attorneys will cross-examine Shafer on Thursday.
Many of the violations concerned modern life-saving equipment that Murray lacked when he gave Jackson propofol in the bedroom of his rented mansion, but Shafer said among the cardiologist's worst transgressions was he put his own interests ahead of Jackson's.
Since Ancient Greece -- and probably before -- Shafer said societies had held doctors to high standards. He quoted the Hippocratic oath, "'In every house where I come, I will enter only for the good of my patients."'
Instead of honoring the ancient creed, Murray came to Jackson's rented mansion nightly and gave the singer propofol, a drug as a sleep aid, a use it was never intended for, Shafer said. He likened the Houston-based cardiologist to an employee, akin to a housekeeper, who wouldn't tell his boss no.
"Saying yes is not what doctors do," he testified. "A competent doctor would know you do not do this."
Shafer, a Columbia University professor and researcher who helped write the guidelines and warnings included with every vial of propofol, repeatedly said Murray's actions were unconscionable, unethical and illegal. He frequently travels to lecture on propofol's effects, and his testimony took a global view Wednesday as he described attending anesthesia conferences in China, research from Canada, and how hieroglyphs in ancient Egypt showed doctors interacting with patient.
But he said Murray's case is unlike any he's seen before.
"We are in pharmacological never-never land here, something that was done to Michael Jackson and no one else in history to my knowledge," he told jurors.
Shafer's testimony tied together pieces of prosecution's case against Murray laid out over four weeks. The professor reminded jurors that Murray had bought more than four gallons of propofol to use on the singer during his employment, was on the phone in the hours before Jackson's death and delayed calling 911 when he found the singer unresponsive.
"A patient who is about to die does not look all that different from a patient who is OK," Shafer said, adding that doctors cannot multitask and properly monitor a patient who is sedated.
"The worst disasters occur in sedation and they occur when people cut corners," Shafer said. In Jackson's case, "virtually none of the safeguards were in place," he added.
Shafer, who wrote the package insert that guides doctors in the use of the anesthetic, leaned forward and spoke to jurors directly at times, as if he were in a classroom. Indeed, the early portion of his testimony was a crash course in propofol, explaining its effects on the body and why despite being a remarkable drug, it needed to be used by skilled people in the proper medical setting.
The researcher told jurors that it appeared Murray intended to give Jackson large doses of propofol on a nightly basis. He said records showed Murray purchased 130 100ml vials of propofol in the nearly three months before Jackson's death.
Shafer said that is "an extraordinary amount to purchase to administer to a single individual."
Like other expert witnesses, Shafer based much of his opinions on the case on Murray's own words during a lengthy interview with police two days after Jackson's death.
He said the lack of record-keeping was a violation of Jackson's rights, especially since something went wrong.
"He has a right to know what was done to him," Shafer said. "With no medical record, the family has been denied that right."
When Shafer spoke of Jackson's family, a couple jurors looked out into the audience, where the singer's mother, father, sister Rebbie and brother Randy were seated.
Testimony has shown that Murray took no notes on his treatment of Jackson and didn't record his vital signs in the hours before the singer's death.
Shafer said he was testifying for the prosecution without a fee because he wants to restore public confidence in doctors who use propofol, which he called a wonderful drug when properly administered.
"I am asked every day in the operating room, `Are you going to give me the drug that killed Michael Jackson,"' Shafer said. "This is a fear that patients do not need to have."
Defense attorneys will begin calling their own witnesses. One of them will be a colleague of Shafer's at Columbia, Dr. Paul White, who was sitting in the courtroom during Wednesday's testimony.
Murray was mainly stoic as he listened to his medical skills and judgment were repeatedly called into question. White, seated behind him, took notes.