A medical expert looked jurors in the eyes Wednesday and told them that Michael Jackson's doctor committed 17 flagrant violations of the standard of care for his famous patient and was directly responsible for the death of the King of Pop.
Dr. Steven Shafer at one point called the defendant, Dr. Conrad Murray, "clueless" when it came to using the powerful anesthetic propofol and said he didn't know what to do when Jackson stopped breathing.
Prosecutor David Walgren concluded the day's questioning by asking Shafer: "Would it be your opinion that Conrad Murray is directly responsible for the death of Michael Jackson for his egregious violations and abandonment of Michael Jackson?"
Shafer replied, "Absolutely."
Just giving Jackson the anesthetic as a sleep aid was unconscionable, Shafer testified earlier.
"We are in pharmacological never-never land here, something that was done to Michael Jackson and no one else in history to my knowledge," he told jurors.
When Murray found Jackson not breathing, there was nothing more important than calling 911, Shafer said.
Asked about Murray's failure to do so, the witness caught his breath and said, "I almost don't know what to say. That is so completely and utterly inexcusable."
In addition, Murray was acting more like Jackson's employee than a physician who should have rejected the singer's requests for propofol as a sleep aid, Shafer said.
"Saying yes is not what doctors do," he testified. "A competent doctor would know you do not do this."
He added, "If a patient requests something frivolous or dangerous, it is the doctor's responsibility to say no."
The Columbia University professor and researcher gave jurors a crash course on propofol, an anesthetic used in hospital settings.
A video shown to jurors detailed numerous safety measures that were not employed by Murray when he administered the drug to Jackson as a sleep aid at the singer's home, according to testimony.
"The worst disasters occur in sedation and they occur when people cut corners," Shafer said. In Jackson's case, "virtually none of the safeguards were in place," he added.
Shafer is expected to be the last prosecution witness in the involuntary manslaughter case against Murray. His testimony will resume Thursday.
He said the fact that Murray was on his cell phone in the hours before Jackson's death was a setup for disaster.
"A patient who is about to die does not look all that different from a patient who is OK," Shafer said, adding that doctors cannot multitask and properly monitor a patient who is sedated.
Shafer, who wrote the package insert that guides doctors in the use of the anesthetic, lectured the jury as if they were in a classroom. He narrated while the silent video took jurors into an operating room to see the specialized equipment and procedures.
The researcher told jurors that it appeared Murray intended to give Jackson large doses of propofol on a nightly basis. He said records showed Murray purchased 130 100ml vials of propofol in the nearly three months before Jackson's death.
Shafer said that is "an extraordinary amount to purchase to administer to a single individual."
He also told jurors that keeping records is essential. While narrating the video, Shafer noted the doctor in the footage was taking copious notes.
"Moment by moment, the anesthesiologist writes down everything that happens, as diligently as you are doing here," he said as jurors scribbled in notebooks.
He said the lack of record-keeping was a violation of Jackson's rights, especially if something went wrong.
"He has a right to know what was done to him," Shafer said. "With no medical record, the family has been denied that right."
Testimony has shown that Murray took no notes on his treatment of Jackson and didn't record his vital signs on June 25, 2009, the day Jackson died.
Shafer said he was testifying for the prosecution without a fee because he wants to restore public confidence in doctors who use propofol, which he called a wonderful drug when properly administered.
"I am asked every day in the operating room, 'Are you going to give me the drug that killed Michael Jackson,'" Shafer said. "This is a fear that patients do not need to have."
Shafer, who edits journals on anesthesia and is widely published on the subject, also gave jurors a demonstration from the witness stand of how propofol is drawn into an IV bag with a large syringe. He produced a bottle of the white substance that Jackson referred to as his "milk" and showed the steps involved, which took several minutes.