17 October 2011

MJ: the defence crumbles

Finally the trial of Dr Conrad Murray reached the meaty stage, and the Murray defence is crumbling like a Blackberry.


Finally the trial of Dr Conrad Murray reached the meaty stage, and the Murray defence is crumbling like a Blackberry. Now led largely by Mr Flanagan, it is often dramatically ineffective.

It's rumoured that Flanagan won a case involving propofol, back in 2003. If so, he seems to have been heading way over the hill since then. Stubborn, grumpy, and rigid, he is surprisingly unconvincing. His main tactic seems to be insistently asking questions outside the expertise of the testifying expert, equivalent to asking a gynaecologist about rugby tactics, as though the repeated polite replies of "I don't know" which he elicits so relentlessly, might somehow convince a jury that the doctors are much less expert than they so obviously are.

When the judge disallows a question, he simply repeats it with slightly different wording, ignoring the basis for his error. He keeps circling back and asking the same question again, something already asked and answered. This can be highly infuriating, and I'm surprised the judge has not been far stricter in stopping this nonsense.

Oral propofol

For whatever reason, the defence has apparently somewhat sneakily abandoned their always daft claim that Jackson had swallowed an overdose of propofol, but without explaining to the jury why they had promised to prove that this happened. They already knew there would be expert evidence against this. Apart from a rare Chinese study in white mice in which it did seem to render them tired, there's no good evidence that it has significant effects when given orally to humans.

It smells and tastes horrible, and would be likely to induce vomiting if one tried to drink it, and as a prosecution expert has said, it would probably be almost entirely metabolised in the liver before entering the general circulation.

It's now not clear what if anything was delivered in Jackson's drip over that last night. Though Murray did refer to a "slow drip" in his police interview, his lawyer has tried to confuse the issue and deny any drug was given by drip infusion.

It's so noticeable in the interview Murray knew was being taped, how he took so much care to make himself look good, claiming that the children and others praised him, and asserted that he did everything he could to try to save MJ. The problem was, he did all he could (which was actually very little indeed) only after his patient was dead, but as soon as there were others watching.

Flanagan's failures

Flanagan tried clumsily to insist that other medical specialists use propofol, which is utterly irrelevant - none of them use it for insomnia or outside a hospital or clinic with all facilities available. He is so concrete, dogged and rigid, and unable to change tactics even when they're obviously failing. He shows a pattern common in neurotic patients - when their tactic isn't working, instead of trying a different approach, they do the same thing harder, louder, or more often, and seem surprised that it still fails.

He's obsessed with a few concepts he got from somewhere, like "conscious sedation" which is not the proper term - and anyhow, what use would conscious sedation be to get someone to sleep? Similarly, he sticks to the concept of "Pulseless Electrical Activity" which Murray seems fond of, and suggests Murray had miraculously identified this at the bedside. It's impossible to diagnose without an ECG - and how could there be pPulseless" anything, in the presence of a pulse? 

Flanagan keeps forgetting that he can't testify. He puts to witnesses claims that only Murray could testify to, IF Murray takes the witness-stand.

Flanagan seemed to have great difficulty in understanding exceedingly clear expert evidence. Steinberg was adamant that apart from trying to perform resuscitation by hopelessly incompetent cardiac massage (a bed board should have been in place, or the body dragged rapidly to the floor rather than doing it one-handed on a bouncy bed) but that he shouldn't have started cardiac massage at all.

It was absolutely clear that according to Murray's own words, when he returned, Michael was in respiratory arrest, and not cardiac arrest - he urgently needed oxygen, not heart compression. He had a blood pressure and pulse (according to Murray's statement) - he just wasn't breathing. By giving him what he didn't need (and uselessly, at that) and not what he did need, Murray was responsible for Jackson's death even if he hadn't given the improper propofol.

Flanagan and colleagues don't seem to see that even had Murray given Jackson no drugs whatever that night, his clumsy and chaotic failure to resuscitate was fully responsible for the death.

Flanagan was in fact hoist with his own petard. Steinberg insisted on basing his opinion about how negligent Murray was, on Murray's own words. Flanagan danced around, nearly implying that his own client had been lying, when he challenged this evidence. Weirdly, he suggested maybe Murray had been gone for a lot more than the 2 minutes Murray claimed. He didn't seem to see this made Murray more culpable, not less.  

(Professor M.A Simpson, aka CyberShrink, October 2011) 




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