Dr. Steven Shafer demonstrates how the anesthetic propofol is extracted… (Reed Saxon / AFP/Getty Images )
If Michael Jackson's doctor had acted more like a medical professional and less like a domestic, the singer would be alive today, a prosecution expert testified Wednesday at the physician's trial.
The witness, an anesthesiologist who specializes in the drug that killed Jackson, told jurors that an improper "employer-employee" relationship between the singer and Dr. Conrad Murray, who was paid $150,000 a month, directly led to the singer's fatal overdose.
"Dr. Murray should have said, 'Michael Jackson, I am not giving you propofol. I am not giving you anything. You have a sleep disorder and you need to be evaluated," said Dr. Steven Shafer, a Columbia University professor.
FULL COVERAGE: The Conrad Murray trial
Instead, Shafer said, Murray let the singer order him around as he would a house cleaner.
"What I saw was a patient who stated what he wanted. 'I want this. I want this. I want this.' And I saw Conrad Murray said, 'Yes. Tell me what you want and I'll do it.' That is what an employee is," Shafer said.
Jackson's role in his own death is the central point of contention in the trial, with the defense arguing that the singer alone was responsible. Prosecutors have touched on the issue in their questioning of previous witnesses, but they waited until the testimony of Shafer, their star expert and final witness, to address the issue head-on.
Under questioning by Deputy Dist. Atty. David Walgren, Shafer blasted Murray's treatment of Jackson as "pharmacological never, never land" and said that the singer's demands for drugs were irrelevant to his ethical obligations as a doctor.
"If the patient should request something that is foolish or dangerous, it is the doctor's obligation to use his medical judgment and say no," he said.
In his daylong appearance on the stand, Shafer was emphatic in his condemnation of Murray's conduct and at times seemed personally offended by it. While discussing Murray's delay in phoning 911, Shafer shook his head and told jurors, "I almost don't know what to say. That is so completely and utterly inexcusable."
He said he had offered his expertise to prosecutors without charge because he was concerned that Jackson's high-profile death had hurt the reputation of physicians in general and of propofol, "an outstanding drug" for which Shafer had helped develop national guidelines.
Patients asked him daily, he said: "Are you going to give me the drug that killed Michael Jackson?"
"This is a fear that patients do not need to have," Shafer said.
Shafer called the amount of propofol Murray had ordered in the months leading up to Jackson's death "an extraordinary amount to purchase to administer to a single individual."
His calculations showed that more than four gallons of the drug were shipped to Murray, averaging out to nearly 2,000 milligrams per day over the more than two months he treated Jackson. In a police interview, Murray said he had given Jackson a single 25-milligram dose on the day of his death.
Shafer said Murray committed 17 "egregious" violations of the standard of care, which he defined as acts that posed a foreseeable danger to his patient's life. These acts included a lack of monitoring equipment for his heart, breathing and blood pressure and the failure to keep medical records.
"Each one individually could be expected to lead to a catastrophic outcome, including death?" Walgren asked.
"Absolutely," Shafer answered.
He said four of the violations rose to the level of "unconscionable."
Shafer also narrated a video showing the proper procedures for using propofol. The video, prepared for prosecutors by a Canadian anesthesiologist, walked jurors through the many precautions doctors take — from checking each piece of equipment before administering anesthesia to using a mechanized pump to dispense exact amounts of propofol.
"The facts in this case, in my view, suggest that virtually none of the safeguards for sedation were in place when propofol was administered to Michael Jackson," Shafer told jurors.
The defense, which is to begin presenting its case Friday, contends Jackson swallowed a handful of sedatives and then injected himself with propofol. They have said he died immediately, and that no efforts could have saved him.
FULL COVERAGE: The Conrad Murray trial