The star medical expert for Michael Jackson's physician began his testimony Thursday with the acknowledgment that not even he could explain the doctor's treatment of the pop star.
"Let's deal with the elephant in the room here," a defense attorney said to Dr. Paul White, the most important and probably final witness for the physician. "Conrad Murray has been accused of infusing a dose of propofol and leaving his patient. Can you justify that?"
"Absolutely not," White replied.
The exchange was a strong indication the defense planned to concede that Murray provided substandard care to Jackson but argue that his conduct did not rise to the level of involuntary manslaughter.
Exactly how White would advance the defense case was unclear in his initial two hours of testimony, a period he spent mostly laying out his academic credentials and familiarity with propofol. Some of his responses suggested he would provide a counter-theory to the damaging conclusions of the prosecution's central expert witness, White's longtime friend and fellow anesthesiology researcher Steven Shafer.
In five days of testimony ending this week, Shafer told jurors the singer died from a massive intravenous dose of propofol that an inattentive Murray allowed to continue even after Jackson stopped breathing.
In his testimony, White said there were problems with the math models Shafer presented to bolster his claims. Those graphs, White said, might show how the general population would respond to a drug, but "the challenge is using models to predict levels in a specific or particular individual."
White also seemed to offer some support for Murray's use of propofol for Jackson's insomnia, something three prosecution experts have condemned. He said off-label drug use by physicians is common and legal and described a recent Chinese study of propofol as an insomnia treatment as flawed but "very interesting." Shafer had rejected the same study.
The stakes of the two experts' testimony became apparent last week when White was accused of calling Shafer, who had criticized his analysis, a "scumbag." White denied the allegation, but the judge set a November hearing for possible contempt-of-court charges.
Shafer was not present for his colleague's testimony, but he was mentioned so frequently that the judge and a defense attorney repeatedly referred to White by Shafer's name.
"I should get a name tag," White joked.
White was one of the first American researchers to test propofol, and his clinical trials in the 1980s paved the way for the drug's FDA approval. He told jurors that when the defense approached him earlier this year, he was hesitant.
"I really wasn't sure I wanted to get involved in a high-profile celebrity case involving the death of an icon," White said.
Before White took the stand, an addiction specialist testified that Jackson was "probably" addicted to Demerol provided by his dermatologist.
Dr. Robert Waldman, who works at a Malibu rehabilitation center, said medical records indicated that the dermatologist, Arnold Klein, injected the singer with increasingly large doses of the painkiller during office visits for Botox and another wrinkle remover.
"I believe there's evidence he was dependent on Demerol," Waldman said.
He said that factoring in "what's known about his public behavior" -- a reference, he said later, to media reports about the singer's past drug problems -- Jackson "was probably addicted to opioids."
The defense has sought to blame Klein for Jackson's insomnia. Withdrawal from the painkiller left him unable to sleep at a time when he needed rest for critical rehearsals and drove him to self-administer propofol, Murray's lawyers have said.
Waldman said he believed the cosmetic procedures Klein provided Jackson would not cause severe pain that necessitated Demerol. Jackson received as much as 375 milligrams of Demerol in a 90-minute period, Klein's records show. A typical dose is 50 milligrams, Waldman said.
On cross-examination, a prosecutor implied that Waldman's testimony was irrelevant to the manslaughter case before the jury."You understand there is no Demerol in the toxicology findings" from Jackson's autopsy, said Deputy Dist. Atty. David Walgren.
"Correct," Waldman replied.
The case is expected to go to the jury next week. If convicted, Murray, 58, faces a maximum of four years in prison.
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