Experts in Jackson doctor trial tell of surgical anesthetic’s dangers

As their case against Michael Jackson’s physician neared its end, prosecutors called to the stand medical experts who told jurors of the dangers of the potent surgical anesthetic used by Dr. Conrad Murray to get his famous patient to sleep.

Jurors on Thursday heard from the prosecution’s final witness in Murray’s involuntary manslaughter trial, Dr. Steven Shafer, a leading expert on the anesthetic propofol who devised the dosing guidelines for the drug when it was first introduced. Shafer said that although patients can wake up from the drug in minutes even after being sedated for up to 10 days, things can go wrong just as easily.

“Look how flat this curve is,” the doctor said, showing jurors a graph charting his analysis on the effects of the drug. “If you’re off a little bit and you’re giving too much drug, it can actually extend to hours” before a person awakes from the sedation, he said.

FULL COVERAGE: The trial of Conrad Murray

Another doctor, a specialist in sleep medicine, testified Thursday that Murray’s decision to administer propofol on top of other sedatives without proper monitoring was a “recipe for disaster.”

Dr. Nader Kamangar, a UCLA associate professor who reviewed the case for the California Medical Board, said Murray’s dispensing of the anesthetic in a home setting without proper monitoring or documentation, then later delaying calling 911 and making subpar attempts at resuscitation, had directly led to Jackson’s death.

“This was the perfect storm I described that culminated in his demise,” he told jurors.

In cross-examination, an attorney for Murray asked Kamangar about his review of Dr. Arnold Klein, another physician who treated Jackson and regularly provided him with large amounts of a narcotic. Flanagan asked if the expert was aware that Klein had given Jackson 6,500 milligrams of the narcotic Demerol in the three months leading up to the singer’s death, suggesting Murray had no way of knowing another doctor was giving Jackson other drugs.

Kamangar said he reviewed Klein’s records but could not determine from the documents whether Jackson had a “Demerol problem.” But the drug could have been a factor in Jackson’s insomnia, Kamangar said.

Under further questioning by a prosecutor, Kamangar said “knowing when to say no” when a patient asks for something that could be harmful is one of the fundamental elements of a physician-patient relationship.

“No matter how much the patient may complain, no matter how much the patient may beg, you as the doctor should say no?” Deputy Dist. Atty. David Walgren asked.

“That’s correct,” Kamangar replied.

The prosecution is expected to rest its case sometime early next week once Shafer, who testified for about half an hour Thursday, concludes his testimony. An attorney for Murray told the judge the defense plans on calling 22 witnesses but that the bulk of its case will come from two medical experts.

victoria.kim@latimes.com