Prosecutors in the Conrad Murray trial called their final witness, an expert on anesthesiology who is expected to tell jurors that Michael Jackson's personal physician should have never given the singer propofol.
Jackson died at 50 from an overdose of the powerful anesthetic propofol. Murray has admitted to giving the singer the anesthesia on June 25, 2009 and said that the singer begged for his "milk," the nickname he'd given for the creamy drug. The doctor could face four years in prison if convicted of involuntary manslaughter.
The trial recessed early today and the testimony of anesthesiologist Dr. Stephen Shafer will resume Monday.
Before court adjourned, Shafer described the importance of precisely administering propofol to a patient so they don't overdose and can wake up quickly after receiving the drug.
"You have to titrate carefully," he said.
Several experts have testified that Murray was grossly negligent in his care of Jackson and that he did not have a precise way of measuring the propofol he gave the singer.
"If you're using propofol...it is imperative to have a precise method of delivering the drug as a drip. It is very hard... to know exactly how much is being infused into a patient so having an automated infusion pump is very key," Doctor Nader Kamangar told jurors Wednesday.
Kamangar is an expert in critical care and sleep medicine. He continued his testimony today and reiterated that propofol is not an appropriate treatment for insomnia and that Murray didn't have several of the safeguards on hand when a patient typically receives the anesthetic.
"Mr. Jackson was receiving very inappropriate therapy in the home setting, receiving very potent sedatives including propofol, midazolam and lorazepam without appropriate monitoring by Dr. Murray and ultimately this cocktail was a recipe for disaster in a patient that had underlying dehydration," said Kamangar.
At the time of his death, Jackson was preparing for a grueling comeback tour and was receiving frequent IVs to rehydrate from Murray.
Murray's defense team claims that Jackson gave himself a lethal dose of propofol and the sedative lorazepam on the day he died. They previously claimed the singer swallowed propofol in the two minutes Murray claims he left the singer to use the bathroom. On Wednesday, they back pedaled from that argument, saying that Jackson injected the drug into himself.
Several expert witnesses have testified how difficult it would be for an already drugged Jackson to inject himself with the anesthetic in two minutes. Even if Jackson did self-administer the drug, experts testified that Murray is still responsible for the singer's death.
In a hospital setting, propofol would be locked away from a patient so they couldn't access it, something Murray didn't do.
Kamangar told jurors that Murray was also negligent in his failure to properly diagnose Jackson's sleeping problems. Kamangar said it was clear the singer did have insomnia, but the cause of it was likely another health issue.
"It certainly seemed that there were issues that …may have resulted in secondary causes of insomnia such as anxiety and perhaps a dependency to certain medications," he said.
Murray should have treated those underlying issues to solve the singer's sleep problems instead of using propofol, Kamangar said.
Defense attorneys tried to counter the damning testimony by asking Kamangar about Jackson's use of demerol. Jackson reportedly received the drug on visits to his dermatologist, Arnold Klein. Defense attorneys argue that Jackson was suffering insomnia because of his demerol addiction and that Murray wasn't fully aware of the singer's addiction.
Kamangar said that demerol can lead to insomnia.
"It can actually activate someone, make them more hyper or excitable...create more stimulation," said Kamangar of demerol. "It can have hypnotic effects."
The doctor also said that Murray failed to keep records on the singer and retrieve Jackson's medical background which would have revealed the singer's use of demerol.