Ephedrine 25mg

1972- The Jackson 5 perform "Ain't Nothing Like The Real Thing" on the Flip Wilson Show
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1974- Michael performs "Whatever You Got I Want" , "What You Don’t Know" & "If I Don’t Love You This Way" on Soul Train
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1979- On their Destiny Tour, The Jacksons perform at Market Square Arena (closed-1999) in Indianapolis, Indiana
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1983- "Beat It" is chosen as 'Best Overall Clip' and cleans up at the 1st Billboard Magazine Video Music Awards, winning 5 honors
1983 - Arena magazine [Yugoslavia (Serbia and Montenegro)] featured Michael on their cover
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1984- On their Victory Tour, The Jacksons perform the first of two nights at the Municipal Stadium in Cleveland, Ohio
1985- Michael visits Princess Margaret’s Children Hospital in Perth.
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Later he is presented with the City’s Keys by Mayor Michael Agapitos.
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The crowd stirs and begins to invade the stage and Michael was quickly evacuated via the Entertainment Center, prompting Michael to meet and pose for photos with members of the Western Australia Police in charge of security.
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In the afternoon, Michael visits the home of Robert Holmes a Court and his wife, Janet. Michael provides for an auction, two fedoras and a pair of rhinestone socks he wore on stage during the Victory Tour, accompanied by a certificate of authenticity signed by himself. Janet serves as a guide to Michael during his stay and he asks her to go shopping.
In the afternoon, a toy store closes for him. A three year old girl, Bree Rosenthal will have the chance to pose with Michael inside the store. While shopping, Michael also takes time to leave his footprints for Betts & Betts (Australian shoe company) Walk Of Fame.
At night Michael appears live on Australian TV Telethon with Peter Waltham & Molly Meldrum. The telethon is a program that aims to raise funds for hospitals and charities focused on the health and protection of children.
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1988- On his Bad world tour, Michael performs the last of four nights at the Capitol Centre (closed-2002) in Landover, Maryland
1989- Michael gives a deposition in the copyright infringement lawsuit regarding The Girl Is Mine, Thriller and We Are The World
1993- On his Dangerous tour, Michael's show at Maracanã Stadium in Maracanã, Rio de Janeiro, Brazil is cancelled due to health problems
2001- "What More Can I Give" is completed & will premiere in two days
2009 - Two legal documents, signed by Michael, handing to USA for Africa the profits from the 1985 hit "We Are the World" that Jackson and Lionel Richie wrote, and which brought in "tens of millions", will go to auction, benefiting VH1's Save the Music Foundation.
"(Michael Jackson) was a bigger philanthropist than most people gave him credit for," USA for Africa Executive Director, Marcia Thomas, says. "He didn't do it for the credit. He did it because he felt it was the right thing to do."
Nancy Birdsall, president of the Washington-based Center for Global Development, adds that "We Are the World marked what at that time was a high point in rich-world concern about poor people in the developing world. That sort of awareness helps to open the way not only for more effective foreign assistance but for other changes in policy, such as trade and migration, that can have a big impact on poor people's lives."
The 2 legal documents, transferring his rights and profits to the group USA for Africa, are estimated to gross in 50,000 dollars at the Alexander Autographs auction at the Mohegan Sun Casino in Connecticut.
2009- Kenny Ortega, director of This Is It, appears on Oprah to discuss Michael & the documentary
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2011 - People v. Murray Trial Day 13. Week 3
Dr. Shafer Testimony continued/Walgren Direct continued
Walgren goes over again the credentials of Dr. Shafer by showing the journal he's editor in chief and multiple research articles he's written. Research articles examine the differences in regards to gender and age. Dr. Shafer also has done research on Lorazepam, Midazolam and Lidocaine. DA Walgren says that he will ask about these topics during testimony.
Walgren mentions difference between intensive care sedation and procedure related sedation (MAC). Dr. Shafer tells that intensive care sedation would be for longer time, MAC would be shorter.
Dr. shafer says that all the work he has done on this case was for free. He says he never charged money for testimony because he feels it's inappropriate and unethical to benefit from medical misadventures. Shafer says he doesn't want his integrity to be questionned as well Shafer also says he wanted to get involved in this case to restore general public's confidence in anesthesia and doctors. Dr. Shafer says that he's asked daily by his patients "Are you going to give me that drug that killed Michael Jackson?" He says that he hopes to alleviate this unneeded fear with his testimony.
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Mid morning break
Dr. Shafer has brought several medical items for demonstration. First he starts with explaining Saline bag and it's ports. Later Shafer tells what an IV is. Infusion (Drip) when the drug drips in slowly. Shafer explains that Propofol comes in a glass vial, there's an aluminium seal and a rubber stopper on top. To get the drug out you need to go through with a slow needle or a large spike to get the drug out.
Walgren asks Shafer to demonstrate to get Propofol out of the bottle.
Shafer demonstrates how to get out Propofol with a syringe / needle. Shafer tells to get Propofol out you need to replace Propofol with air so that Propofol will go into the needle.
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Walgren asks Dr. Shafer to examine 100 ml Propofol bottle from the scene. Shaffer says that it has a spike hole and not a needle hole.
Dr Shafer has made a video for his case, to demonstrate what is necessary for sedation, even for 25mg propofol. They play the video : "An over view of safe administration of sedation"
The doctor first prepares the room, checks the equipment. Video shows multiple equipment for airway management such as a tube for the throat, a tube for the nose, equipment for intubation, a throat mask for air. Organizes these items.
Then the doctor checks the oxygen equipment. Doctor checks if the oxygen supply work, checks nasal cannula, checks to see if nasal cannula is measuring carbon dioxide by capnometer. Doctor tests anesthesia breathing circuit. This is the equipment used if the patient stops breathing and the doctor needs to push oxygen into the lungs. Doctor then checks the back up oxygen. This is used if for some reason the breathing circuit fails.
Doctor then checks suction apparatus. This is important because if the contents of the stomach gets into the lungs or if the vomit (bile) gets into the lung, it would destroy the lungs. This is why patients are told to not to eat or drink prior to anesthesia. if the patient vomits or the contents of the stomach come to the mouth, the doctor has to be very quick to clean them with the suction equipment before it goes into the lungs and destroys the lungs.
Next step is to set up the infusion pump. It takes a few minutes to set it up. In the video they use a syringe pump. Doctor first draws Propofol into the syringe. As Dr. Shafer demonstrated this is not easy. You need to draw air into the syringe and do multiple draws to fill the syringe. Dr. Shafer tells a narrow tubing has to be used in the infusion pump as the wide tubing could be problematic. Then the doctor programs the pump, putting the patients weight, correct drug name, infusion rate. Doctor verifies the information for a second time.
Next step is to assess the patient. Anesthesiologist is repsonsible for knowing his patient. Makes a physical examination, first thing is airway, listens to the lungs, checks the heart. Always done for each procedure, for every patient. No exception.
Doctor also gets the informed consent of the patient. Doctor informs the patient of risks and explains what the procedure entails, asks the patient if he has any questions, then patient signs the informed consent form. Dr. Shafer says oral consent is not binding, and is not recognized.
Some steps are not shown on the video. These are: patient put on table, monitoring equipment such as blood pressure cuff, pulse oximeter, ECG are put on patient. Oxygen in place, intravenous catheter is put into the patient. After these,the doctor pauses to verify again. Doctor does one last check before injecting the propofol.
Propofol infusion pump is started. Anesthesiologist is close to the patient, monitors the patient. Doctor keeps records of the vitals. Chart is a necessity to track the patient and the patterns. It's a responsibility to the patient.
In this part of the video, we are shown examples of what can go wrong.

1. Blood pressure drops . Dr. Shafer says this is very common and he sees it everyday. Propofol lowers blood pressure especially if the patient is dehydrated. Doctor gives ephedrine through the IV line. Generally blood pressure comes to normal levels.
2. Carbon dioxide. The monitor shows that carbon dioxide stopped. It means the patient is not exhaling and the airway is obstructed. Doctor immediately does chin lift and jaw thrust. Dr. Shafer says this is also done very routinely. Shafer says the most common reason is because the tongue is blocking the airway and by doing a chin lift and jaw thrust you can move the tongue.
3. Apnea. This is when the patient doesn't even try to breath. In this instance you need to take over for the patient and force air into the lungs. Doctor removes the nasal cannula, places the mask on the patient's mouth and nose and squeezes the bag to push oxygen into the lungs.
4. Aspiration (not shown on video). This is when the patient vomits and/or stomach contents come to the mouth. Patient is turned sideways and before the next breath you need to suction everything.
5. Cardiac arrest. Heart stops beathing and the patient stops breathing. Doctor does a 2-3 second assesment to make sure that the monitor has not failed. Then the doctor calls for help. First thing is always to call for help. One person begins CPR, one person is ventilating the patient and other person gives resuscitation drugs. All of this is done to keep the patient alive for enough time to fix the problem that caused the arrest. These efforts are continued until the patient is revived or is pronouced dead.

Lunch break
Afternoon session
Dr. Shafer Testimony continued/Walgren Direct continued
Dr. Shafer says that the safeguards and requirements apply to all doctors who perform sedation, for any type of IV sedatives. Some nurses are also trained about sedation. These guidelines apply to them as well.
Walgren asks if Murray's intent were to give 25mg would these standards still apply. Shafer says yes and continues to say the patient (MJ) had other IV sedatives, profound inability to sleep, he was exhausted, dehydrated and he had been given sedatives for some time and he could have same elements of dependency or withdrawal.
Walgren asks if it's possible to go in saying "I'll only give a small amount so I don't need these guidelines". Dr. Shafer says it's a trap. Even for a little sedation , it's a slippery slope, you may have to give more. You never know how the patient will react. Shafer says there's no such thing as a little sedation and the worst disasters happen when people cut corners.
Facts in this case suggest that virtually none of the safeguards for sedation were in place when propofol was administered to Michael
Walgren asks Shafer to explain how patients react differently to the same dose of sedatives. Shafer says that some patients will need half the usual dose and some patients will need double the dose. Shafer says 25 mg is the limit when a patient might stop breathing. Shafer says you can't assume that this will be an average patient. Shafer says you always assume your patient is at the edge of sensitivity and prepare for the worst case scenario.
Shafer did a report about this case dated 4/15/11. In his report he used some terms.

• Minor violation : not consistent with standard of care, but would not expect to cause harm for the patient unless there are several other violations
• Serious violation : expected to cause harm to the patient, in combination of other violations
• Egregious violation : These should never happen in the hands of competent doctors. An egregious violation can alone be catastrophic for the patient. Competent doctors know that a bad outcome is a high possibility
• Unconscionable violation : It goes beyond the standard of care. It's an ethical and moral violation as well as a medical violation.

Walgren goes over Dr. Shafer's report and 17 egregious violations he identified.

• Lack of basic airway equipment. Michael died because he stopped breathing which is expected when you give IV sedatives. It must be there without question.

Walgren asks Dr. Shafer to assume that Murray had left only for 2 minutes and if he had the equipment could Michael have been saved? Dr. Shafer says yes and Michael probably had an obstructed airway and even a simple chin lift might have been required to save him. Shafer says that Murray says he didn't use the ambu bag. Shafer says mouth to mouth is less effective and gives used air.

• Lack of advanced airway equipment. Those are equipment such as laryngeal masks, or laryngoscope and endotracheal tube. Shafer had described it as a serious deviation originally but changed his mind to an egregious because of the setting. Murray had no help.

Shafer says that it's his view that Murray had anticipated to give 100 ml vials. He had purchased at least 130 100 ml vials, Shafer believes that's at least one per night. Shafer says it's an extraordinary amount for one patient; between April – to June 25th, that's 80 nights, 1937 mg/night. Walgren asks how he came to this determination. Shafer says Propofol is an environment for bacteria development. Once a bottle is opened with a needle, it has to be used within 6 hours. Shafer says this suggests Murray planned to use 100ml, if he didn't he would purchase smaller vials.
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• Lack of suction apparatus. Shafer reminds the jury that any stomach content and/or vomit has to be suctioned so that it won't go into the lungs. Shafer says there's no evidence that Michael was asked to fast for 8 hours prior being given Propofol. Due to this he was at greatly higher risk. Therefore suction equipment was needed.
• Lack of infusion pump. There was no infusion pump. Without it the rate cannot be precisely controlled and the risk of overdose is very high. Shafer says in his opinion this likely contributed to Michael's death.

Walgren asks without an infusion pump how can one person control the drip. Shafer answers by roller clamp. It's a plastic wheel that pinches the tubing to decrease the amount . Shafer says it's extremely imprecise and that was the only thing available to CM when he gave propofol.

• Lack of pulse oximetry. The pulse oximeter that Murray used was completely inappropriate. It's not intended to be used for continuous care as it had no alarm. Shafer says that on monitors in hospital they can see it on the screen and there is a tone. Doctors will hear the tone changes which alerts them that there's a problem. In Michael's case the only way to monitor was to take his hand and continuously look at it. If there was proper equipment, there would be a monitor showing the vital signs from a distance and there would be an alarm that could have saved Michael's life.

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• Lack of blood pressure cuff. Propofol lowers everyone's blood pressure. Doctors would treat it with additional saline solution or with less propofol. Michael was dehydrated, the risks are higher for exaggerated response. If blood pressure falls the body shuts down the flow to the arms and legs and concentrates on providing blood to heart and the brain. The drug becomes more potent. Dr. Shafer says the manual blood pressure cuff that Murray had in his bag in the cabinet is useless.
• Lack of ECG. ECG allows you to see the heart rate & rhythm. This is routine monitoring. In this case Murray couldn't know what kind of therapy to use when Michael went into arrest.
• Lack of capnography. Dr. Shafer initially thought that it was not a violation as other specialists don't use it. However in Michael's environment, it was a disaster. If Murray had it he would have known immediately that Michael had stopped breathing.
• Lack of emergency drugs. Dr. Shafer doesn't think lack of emergency drugs contributed to Michael's death. Shafer says if Michael had low blood pressure as he wasn't going through surgery, he could have been woken up and hydrated; stopping propofol would have been enough.
• Lack of charts (egregious violation as well as unethical). Shafer says a doctor needs charts to assess what's going on and the changes. Shafer says the patient or if the patient doesn't survive the family has a right to know what happened and what the doctor did.

Dr. Shafer gives an example and Dr. Shafer looks clearly upset. Dr. Shafer says he knows how he would feel if his father , brother or son went to a medical facility for 80 days and died and the doctors told him they don't know what happened because they have no reports. Dr.Shafer says it's unbelieveable that after 80 days of treatment there's not a single record of treatment. Dr.Shafer says that not keeping records is also illegal in California. Dr. Shafer says that doctors have to keep records even if the patient doesn't want them and confidentiality cannot be an excuse.
Shafer says that in Murrays interview he mentioned Michael could have been dependent on Propofol and that would require a referral but he can't do that referral as he had no records.

• Obligation to get information about the patient. Shafer says it's doctors responsibility to know everything about their patient to provide care. Shafer says Murray mentions IV sites but didn't follow through and ask what was happening. Walgren asks what if the patient says it's none of your business, Shafer says that then he would say "Then I can not be your doctor".

Dr. Shafer the only physical evidence of Michael was done months ago. Shafer says Murray mentioned Michael being dehydrated but yet he didn't do a simple blood pressure check. Shafer says there's no history, not even a simple recording of the vital signs. Shafer calls this a serious violation and that no doctor does that.

• Failure to maintain a doctor patient relationship. In this relationship the doctor would put the patient first. It doesn't mean to do what the patient asks, it's to do what's best for the patient. If patient asks for something foolish or dangerous, doctor should have said no. Dr. Shafer describes the relation between Murray and Michael as employeemployee relationship. Patient stated what he wanted, Murray says yes. Shafer compares Murray to a housekeeper that does what they're told. That's what an employee does. Shafer says Murray was not exercising his medical judgement and he was not acting in Michael's best interest. Murraycompletely abandoned medical judgement.Shafer says the very first time Michael asked for propofol, Murray should have sent him to a sleep specialist.
• Lack of Inormed consent (egregious and unconscinable). An informed consent would have involved that propofol is not a treatment for insomnia, It woud have explained risk of death and alternative treatments. Dr. Shafer says there's no proof that Michael knew that he was putting his life at risk. Shafer again mentions that the consent has to be written. Michael was denied his right to make an informed decision.
• Need to continuously observe the mental status (egregious and unconscinable). Dr. Shafer says that doctors need to stay with the patient and Murray abandoned his patient. Shafer compares giving sedation to driving a motor home. Shafer says you cannot leave the steering wheel on a highway to relieve yourself. If you do it would be an disaster. Dr. Shafer says in 25 years he has been a physician he have never walked out of the room.
• Continious monitoring / observation. Murray left Michael alone and he was on the phone. Shafer says you can't multi-task especially if you have no monitoring equipment. Dr. Shafer: "A patient who is about to die, doesn't look that different from a patient that is okay". Dr. Shafer says from a distance you can't tell if a person is breathing. Shafer says he believes Murray may have been in the room and not realized Michael had stopped breathing.

Shafer says resuscitation would have been easy as all that is needed is to stop propofol and make Michael beathe. Shafer once again reminds that it's common that patients would stop breathing during anesthesia and it's expected. Shafer says as Murray was monitoring all he needed to do was to lift the chin and ventilate.
Mid afternoon break

• Lack of continuous documentation (egregius and unconscionable violation). Dr. Shafer says documentation is part of giving care. Shafer says if Murray had the reports he would have seen that the oxygen saturation lowered or the heart rhythm changed.
• Failure to call 911 timely. Shafer says in that setting Michael could not have been revived without assistance. Shafer says calling 911 was the highest priority given the lack of help and equipment. Shafer says if calling 911 was not possible, Propofol should not been given at all.

Shafer says assuming Murray realized there was a problem at 12:00, he doesn't understand that Murray left a voice message to Michael Amir Williams and how it took 20 minutes to call 911. Shafer calls it inconceivable and completely and utterly inexcusable.
Shafer says if Murray left only for 2 minutes and called paramedics immediately Michael would be alive with some brain damage. If Murray realized Michael was in trouble within 2 minutes and had the airway equipment, he would be alive and uninjured.
Walgren asks how effective is one handed CPR on a bed. Shafer says the patient sinks into the bed and it's ineffective. Even if Murray had his hand behind Michael's back it's ineffective because you need your body weight to do effective CPR. Shafer says you need 2 hands, one hand is not enough. Shafer says Murray should have called 911 first and then moved Michael to the floor. Shafer also says based on Murray's interview the issue here was not that the heart stopped; Michael stopped breathing. Murray said there was a pulse. If there was a pulse what he needed to do was to have oxygen into his lungs. There was no need for CPR if there was a pulse. Shafer says a lay person would use mouth to mouth as they have no other means. For a doctor it shows that the doctor doesn't have the equipment needed.
Shafer says that he doesn't understand why Murray raised Michael's legs. Shafer calls it a waste of time. Shafer says raising the legs is done when you think there's not enough blood in the heart but that wasn't Michael's problem. His breathing had stopped. Shafer says that it shows Murray was clueless about what to do.
Walgren asks what is flumazenil. Shafer explains it's a drug that reverses the effects of lorazepam and midazolam. Dr. Shafer says he's curious why Murray gave it. Shafer says it doesn't fit with only giving 2 doses of 2 mg several hours before. Dr. Shafer says he believes that Murray knew that there was a lot more lorazepam.

• Deception of paramedics and UCLA doctors and not mentioning propofol (egregious and unconscionable violation). Dr. Shafer says a person's life was in the balance, it's inexcusable. Shafer says he also mischaracterized this event as a witnessed arrest. Shafer says a witnessed arrest is not an arrest for lack of breathing, it is usually something like a heart attack. So the therapy of the paramedics and ER doctors was not appropriate. In an arrest you have only seconds to choose a treatment, paramedics and ER doctors were not given the corect information. Shafer says witholding information is a violation of patient's trust.

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Walgren asks what is polypharmacy. Shafer explains it's administering many drugs at once and it's a serious violation. Shafer says what Murray gave to Michael didn't make any sense. Shafer says Midazolam and lorazepam are very similar drugs and the only difference is how long they stay in the system. Shafer says he doesn't understand why Murray switched from midazolam to lorazepam and back. Shafer says that he thinks that Murray did not understand the drugs he was giving.
Walgren asks if 25mg of Propofol is a safe dose. Shafer says in this setting there was no safe dose. Midazolam and lorazepam were given. Michael had received benzos for 80 nights, he could have been dependent or in withdrawal from the benzos or propofol. Dr. Shafer says he never heard of a person being given propofol for 80 nights and doesn't know what would happen.
Walgren asks about the Taiwan study. Shafer says there are over 13,000 medical articles about propofol, 2,500 articles about propofol and sedation and there's only one article on Propofol and insomnia. It's this study done in 2010. Dr. Shafer says that he wouldn't publish the Taiwan study because the dose of Propofol that was given is not mentioned. Dr. Shafer also says that the conditions of the study don't apply here. That study was done in a hospital, by anesthesiologists, patients had fasted for 8 hours, they were monitored, an infusion pump was used, propofol was used for 2 hours for 5 days during two weeks. There was no other medication. The patients were treated within the standard of care. Shafer says the article actually highlights Murray's deviations from standard of care.
Walgren asks even if Michael had taken Lorazepam and/or Propofol would these 17 deviations would still be relevant and if Shafer would consider Murray responsible for Michael's death. Dr. Shafer answers "Yes".
Walgren asks about the doctopatient relationship. Dr. Shafer says it's dated back centuries ago. Dr. Shafer says that doctors have power to give drugs and cut open a patient,etc and this is because they are entrusted to do that because they are supposed to put the patient first. Dr. Shafer reads hippocratic oath. Shafer says when Murray agreed to give propofol to Michael, he put himself first. When Murray was showing up every night with propofol and saline bags, he was putting himself first. When Murray withheld info from paramedics and ER doctors, he put himself first
Video
2012- Bad25 premiered on the big screen in both Los Angeles and New York theaters for an exclusive one-week engagement

1972 - "Ben" is the #1 song in the US
1979- On their Destiny tour, The Jacksons perform at Spectrum Arena (closed-2009) in Philadelphia, Pennsylvania
1979- "Don't Stop 'Til You Get Enough" hit #1 on Billboard's Hot 100, giving Michael his first #1 hit since "Ben" in 1972
The song also gave Michael his first solo #1 for five weeks on the R&B singles chart.
1984 - On their Victory Tour, The Jacksons perform at Comiskey Park(closed-1990) in Chicago, Illinois
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1985- Diana Ross' single "Eaten Alive" hit the charts in the US. The song was co-written, co-produced and co-vocalized with Michael Jackson and Barry Gibb
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1987- Michael plays the last of three nights at Osaka Stadium (closed-1998) in Naniwa-ku, Osaka, Japan
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1987- Michael is on the cover of People magazine with the headline "MESSAGE FROM MICHAEL", featuring a handwritten letter from Michael
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He sat down at the desk in his room at the Capitol Tokyo Hotel in Tokyo and, on the back of a piece of hotel stationery, wrote what he said would be his only discussion of his private life.
"As an old Indian proverb says... 'Don't judge a man until you've walked two moons in his loafers.' Most people don't know me, that's why they write things that most of them aren't true. I cry a lot because it hurts and I care about the kids, all my kids all over the world, I live for them If a man can't say anything he can't prove, against a character, the story can't be written. Animals don't attack out of malice, but because they want to live, it's the same with those who criticize me, they want our blood, not our pain. But I still have to reach my goals, I have to seek the truth in all things. I have to bear for the power that I was sent, into the world for the children. But have mercy, because I'm bleeding already long time now." - MJ
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1993- On his Dangerous tour, Michael performs the 3rd & final night at the Estadio Monumental in Buenos Aires, Argentina
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1995- "You Are Not Alone" was certified Gold and Platinum.
1997- Michael plays the second of two nights at Johannesburg Stadium in Johannesburg, South Africa to an audience of 58,000. His parents, Lisa Marie & her children attend
1999- History: Past, Present & Future Book 1 was certified 7X Platinum
2001 –Tele Poche magazine (France) featured Michael on the cover with the headline: "Michael Jackson – Verites ou mensonges?" ["Michael Jackson – Truth or lies?"]
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2002- As a personal acknowledgement of the gallantry and sacrificial services made by the military in his community, Michael invites over 200 US Air Force members from "Team Vandenberg" (recently returned from overseas deployments) and their families to spend the day at Neverland.
2004- Michael calls the Steve Harvey Morning Radio Show to ask TV networks not to air Eminem's video for the song "Just Lose It", the new video which makes fun of him.

"I would like to thank you, Steve, Radio One, the African-American community, my fans from around the world, and some of the members of the media, for the support that you have given to me. I would also like to thank Mr. Robert Johnson, Chairman and Founder of BET for pulling the Eminem video from BET's airplay. I appreciate very much the love and support that you all have shown me. I am very angry at Eminem's depiction of me in his video. I feel that it is outrageous and disrespectful. It is one thing to spoof, but it is another to be demeaning and insensitive. I've admired Eminem as a artist, and was shocked by this. The video was inappropriate and disrespectful to me, my children, my family, and the community at large. It is my hope that the other networks will take BET's lead and pull it"

BET accepts but not MTV which creates a new controversy
2004 – CBS Early Show airs an interview of Genevieve, Randy Jr, Dante, Jaffar, & Jermajesty Jackson at Hayvenhurst defending their uncle Michael.
2005- Michael takes Prince, Paris & Blanket to Harrods where they are greeted by owner Mohamed Al Fayed.
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Michael raced around the posh London store and reserved two watches worth £55,000 and £30,000
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His children Prince Michael, eight, Paris, seven and Prince Michael II, three, then descended upon the toy department.
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An insider said:

"He was only in the store for about 30 minutes. His kids had a fantastic time in the toy department. They fell in love with this gigantic toy Hummer".
"After spending thousands of pounds on gifts for them, including life-size teddy bears, Michael signed autographs for fans."

Michael’s spokesman said:

"Last time he came to London he went to Hamleys - but he loves the cuddly toys at Harrods."

2009- A never-before released song from Michael, "This Is It", was unveiled on his website
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2011 - People v. Murray Trial Day 11
Dr. Alon Steinberg (Cardiologist) Testimony
Walgren Direct
Steinberg is a board certified cardiologist for 13 years. He is not an expert in anesthesia, sleep medicine, pharmacology or addiction medicine.
Steinberg has reviewed Conrad Murray's resume. Murray was not board certified on 6/25/09. Steinberg tells board certification is an extensive 2 day test and 90% of the cardiologists that take it pass it.
Steinberg is an expert reviewer for the California Medical Board, he reviews other doctors' actions to ensure the standard of care has been respected. 3 levels are possible:

• no deviation
• simple deviation
• extreme deviation

Extreme deviation is also defined as gross negligence.
Steinberg has conducted a review for this case. He had conducted 8 prior reviews. In 4 cases he found no deviation; in 4 cases he found simple deviation of care. This is the first time he's seen an extreme deviation from standard of care.
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Cardiologists use sedation for many procedures and sometimes they use Propofol. Cardiologists are experts in mild or moderate sedation. In conscious sedation the patient is able to talk and respond to touching. Deep sedation is when patients are only responsive to pain or repeated stimuli. General anesthesia is when patients feel no pain. Cardiologists are not trained in deep sedation. When deep sedation is needed, they call an anesthesiologist and that’s the only time they use Propofol.
When they are giving mild or moderate sedation they use benzodiazepines. For deep sedation they are required to give Propofol with an anesthesiologist.
Steinberg has reviewed this case. He has focused his review based on Murray's interview with police. Steinberg wanted to judge Murray on his own words.
Steinberg found 6 separate extreme deviations from standard of care.

• Propofol was not medically indicated. Steinberg mentions Propofol is an anesthetic. Steinberg tells there was no written informed consent. The patient must be informed of the risks and benefits of treatment. Steinberg never heard of Propofol being used for insomnia. Steinberg says that using propofol for insomnia is gross negligence and extreme deviation.
• Propofol was given in a home setting, without proper equipment and without proper staff.

Walgren asks what equipment is needed. Steinberg says that first a pulse oximeter with an alarm is needed but Murray's oximeter didn't have an alarm. Steinberg says he'd have to stare at Michael nonstop every second. Steinberg says he should have an automated blood pressure cuff, to check blood pressure at least every 5 minutes. Murray had a manual cuff and did not use it. Next thing is needed is an EKG monitor to track the heart rhythm. Another thing that is needed is oxygen with a nasal cannula or mask. You need suction in case the patient regurgitates and you need to get it before it goes into patient’s lungs. Another equipment needed is an Ambu bag. Murray had an Ambu bag but did not use it, he did mouth to mouth. You also need to have a way to call for help. Backboard is needed in case CPR is needed. You also need a back up battery for the equipment in case of a black out. Other equipment needed is equipment needed for airway such as endotracheal tube. Endotracheal tube requires trained staff to place it. Also you need a defibrillator.
A lot of special drugs are also needed. Those are fluamzenil, narcan, lidocaine, betablockers, atropine, dopamine, epinephrine, prednisone, dextrose.
Steinberg says when giving sedation you also need BLS (basic life support) and ACLS (advanced cardiac life support) trained assistant.

• Inadequate preparation for an emergency. You need to have the drugs ready, equipment ready, have a person ready to help you. You need to be prepared to use those medicines and equipment in the case of emergency.
• Improper care during the arrest. Michael’s breathing had stopped and Murray didn't follow proper protocol.

Steinberg explains cardiac arrest which is when the heart stops beating. There’s no blood pressure and the patient collapses. In that case you call 911, use a defibrillator, and do CPR on a hard surface.
In Michael's case, it was a respiratory arrest. Michael stopped breathing and the oxygen went down. Then the heart started to beat harder while trying to distribute little oxygen in the body. According to Murray's statement this is when Murray found Michael. If you do nothing, the heart weakens because of lack of oxygen, and stops contracting but there is still an electrical activity. That’s PEA (Pulseless Electrical Activity). After PEA, there's asystole.
Steinberg says Murray should have called 911 immediately then try to arouse Michael, should have used the Ambu bag and give him Flumanezil. Steinberg says it’s inexcusable that Murray did chest compressions. This was a respiratory arrest not a cardiac arrest and there was blood pressure and pulse. Murray should NOT have done CPR.
Conrad Murray’s CPR was poor quality because Michael was on a bed. It has to be done on a hard surface such as on the floor and should have done CPR with 2 hands. Steinberg says it would have been very easy to put Michael on the floor.

• Failing to call for help. Murray should have called 911 immediately. He should have known that he didn’t have any of the medications and the equipment and he had to call for help. But Murray instead called Michael Amir Williams which caused a significant delay. EMS was only 4 minutes away. If Murray had called them he could have gotten help sooner.

For every minute delay in calling EMS, there are less and less chances the patient will survive and there is a risk of permanent brain damage. Walgren: “Every minute counts”.
Steinberg also thought it was bizarre to call an assistant instead of calling 911. Murray as a medical doctor should have realized he needed help and called 911.

• Failure to maintain proper medical records. Medical records are important for several reasons. Insurance companies want them. Second reason is litigation. The most important reason is for better health care for the patient. Murray did not document a single thing. He didn’t ask when the last time Michael ate was, he had no vital sign records, he had no physical exam. There was no informed consent. He didn’t write what medication he gave and what was the reaction. Murray was confused and was not able to explain Michael's history or what he gave him to the ER doctor or EMTs. Walgren asks if he could be dishonest rather than confused.

Steinberg concluded that these extreme deviations directly contributed to Michael's death. Without these deviations, he would still be alive.
Walgren asks based on Murray’s statement if he gave benzodiazepines and only 25mg Propofol if the risk of respiratory depression is foreseeable. Steinberg answers yes.
Walgren assumes everything happened as Murray described and as Murray left Michael alone, Michael was able to take Lorazepam pills or Propofol. Steinberg says all the things he said still apply. Steinberg says you never leave the patient and always monitor patient. If Michael self administered, it means that Murray was away, and that should not have happened. Steinberg compares leaving a patient under the effect of Propofol to leaving a baby sleeping alone on the kitchen counter. Steinberg says the baby might have woken up and fallen down.
Steinberg also mentions that medication should not have been within Michael's reach. Steimberg explains how in hospitals every medication will be under lock and says that having medications out in the open is a foreseeable risk that the patient can self administer and take the wrong medication.
Mid morning break
Flanagan Cross
Steinberg is not currently trained in using Propofol. When Steinberg was NY he had privileges to use Propofol. In his current work he does not have the privileges and he hasn’t used it in 7 years. When he was in NY he felt confident in using Propofol because he was trained in protecting airways.
Flanagan asks if there is a difference in the equipment needed for moderate and deep sedation. Steinberg answers no, they will be the same.
Flanagan asks if Steinberg thought Murray's declaration to the cops was thorough and complete. Steinberg says he assumed it was complete.
Flanagan asks how Steinberg knows Murray didn’t have informed consent. Steinberg says because there was none. Flanagan asks if the informed consent can be oral. Steinberg says it has to be written. “If it's not written it's not done.” Steinberg says he has never heard an oral consent. Flanagan asks if any written document had anything to do with Michael's death. Steinberg says if Michael had been informed about risk and benefits, he might not have agreed to this.
Steinberg says he cannot know if Michael had been informed, but assumes he was not informed that a powerful dangerous drug would be used on him without proper monitoring. Steinberg assumes he would not have agreed to it.
Flanagan asks if Steinberg knows anything about Michael's propensity towards drugs and mentions Demerol and Klein. Flanagan asks what if Michael was an addict; would he have agreed to it? Steinberg says if he was an addict, he wouldn't give it to him in the first place.
Other doctors that use Propofol could be dentists, gastroenterologist, pulmonary doctors, ER doctors. But their societies have advice on how to use it and they are trained. Their societies outline the same monitoring equipment that Steinberg mentioned. Steinberg says there’s no difference in equipment needed for conscious sedation.
Flanagan asks what killed Michael? Steinberg says a respiratory arrest because he still had a pulse that means there was a heart rate and blood pressure. Murray said there was blood pressure and a pulse, it was later PEA.
Steinberg says that according to Murray he found Michael around noon and EMS arrived at 12:26. There was a delay in calling 911 for at least 12 minutes. Flanagan mentions Murray made a lot of time estimations and it might be all precise.
Flanagan asks what 2mg of Lorazepam would do to a patient. Steinberg says he’s not an expert, he gave it as a sedative orally before but he never used IV. Steinberg says he gives it an hour before the procedure orally. Flanagan asks further questions about Lorazepam, Midazolam. Objections. Sustained. It’s beyond his area of expertise.
Flanagan turns the subject to Propofol and say that Michael and Murray had been discussing Propofol for the past 3 nights and Murray told him it was not good for him and he was trying to wean him off.
Steinberg states that Murray said that he gave 25mg initially and started Michael on IV. Flanagan denies that there was an IV. Steinberg understood that after that initial 25mg dose, there was a drip based on his police interview. Steinberg cites a lot of examples in Murray interview referencing IV and says it makes sense because 25mg would not keep Michael asleep.
Flanagan insists there was no drip on the 25th, Steinberg insists there was a drip, they both give examples in Murray's LAPD interview. They agree it's not clear, but Steinberg says it makes no sense. It's logical Murray gave a drip. Michael logically would have woken up, and there was no reason that Murray changed his methods.
Flanagan says that 25mg is not a heavy dose and it would make Michael sleep 4 to 7 minutes. Steinberg agrees. So Flanagan asks if Michael was still asleep he was sleeping for other reasons such as being tired. Steinberg says that he would have worried that Michael was still asleep if he was not on a drip. Protocol says that after Propofol you should watch the patient. Steinberg says just looking at Michael doesn't tell if he's in mild sedation or in deep sedation. Steinberg says they need to be continuously checked for their reaction to stimuli. Steinberg says Murray should have woken him up. Steinberg says the fact that he was still asleep after 10 minutes, if there was no drip, is very alarming. Steinberg it might mean that something was going wrong.
Flanagan mentions a study that Propofol was successfully used on refractory chronic primary insomnia in Taiwan. Steinberg says that the article dates back to 2010, in 2009 when Murray gave propofol there was no medical knowledge that Propofol could be given for sleep. Murray was unethical in giving Propofol with no medical knowledge. Article mentions Propofol given for 2 hrs per night 5 nights, not 8 hours per night for 2 straight months. The article says that this test was successful, but it's still not used as a sleep medication because it's still experimental, there is not enough data about this. It needs to be extensively researched and tested. Murray is the first doctor he's heard who used propofol for insomnia.
Flanagan asks how Steinberg knows Murray didn't use Ambu bag, Steinberg says because Murray said he did mouth to mouth. Flanagan asks how Steinberg knows Murray didn’t use the blood pressure cuff, Steinberg says because it was not on Michael. Steinberg says pulse oximeter was not on Michael
Steinberg says he doesn’t know what happened between 11 and 12 or how long Murray watched Michael or when Murray went to bathroom. Flanagan asks if he has an idea about the actual time of death. Steinberg says Michael was pronounced dead at 2:26PM but he was probably clinically dead for some time.
Steinberg says Michael was savable when Murray found him based on his interview. Steinberg says Murray said he left Michael for 2 minutes. By using Ambu bag, by arousal and changing the effects of the medicines and if 911 was called Michael was savable.
Flanagan tries to get Steinberg to assume that Murray was gone longer than 2 minutes. Steinberg is not comfortable making those assumptions as he based his report on Murray’s statements. Flanagan mentions the phone calls; Steinberg does not want to comment on them. Steinberg says saying Murray was on the phone tells him that he shouldn’t have been on the phone and if Michael was only given 25mg it would wake him up. Steinberg says that it tells Michael was on a drip.
Flanagan wants him to assume that if Murray was gone longer than 2 minutes if Michael was savable. Steinberg says he was savable because according to Murray’s statement Michael had a pulse, blood pressure and heart was still beating and with proper equipment he could have been saved. He could have given Michael oxygen. Steinberg says Michael wasn’t PEA when Murray came back because he had a pulse. Flanagan asks how he knows know Michael had a pulse, Steinberg says because Murray said so. Flanagan asks if it could PEA. Steinberg says in PEA there’s no pulse.
Flanagan asks what Murray should have done. Steinberg says he should have called 911 and it would have taken 2 seconds. Steinberg says protocol says doctors are allowed 2 minutes to determine the situation. Flanagan asks if Murray went down to ask for help in 12:05 – 5 minutes after – if it would be a violation of standard of care. Steinberg says he didn’t have the right equipment so he should have called 911 immediately.
Flanagan tries to talk about Kai Chase. Steinberg says Murray didn’t ask Kai to call 911. Flanagan asks what if Murray called for help in 5 minutes but not in 2 minutes. Steinberg says it’s still a deviation from standard of care.
Flanagan asks if he talked to Murray to review the case. Steinberg says no and he didn’t ask. Steinberg used Murray’s 2 hour interview.
Flanagan asks what Murray should have done in 2 minutes. Steinberg says call 911, tilt the head to open airway, make him breathe with Ambu bag and give Flumazenil. Steinberg says he would have called 911 first. Steinberg says Murray had to increase Michael’s breathing.
Flanagan asks if Murray made a mistake in asking someone to call 911 Steinberg says he had no one around and he had to call 911. Steinberg says for the time it takes to call for security Murray could have called 911. He had a cell phone. Steinberg says it would have taken him 2 seconds to say “I’m a doctor, there’s an arrest, come to 100 Carolwood now” and then Murray could have put 911 on loudspeaker and continue to do what he was doing.
Flanagan asks if he’s aware that EMS said Michael was cool to the touch. Yes but Murray said he was warm. Steinberg says you get cold in 26 minutes when you have no blood pressure.
Flanagan asks if Steinberg has no doubts that if 911 had been called immediately Michael would still be alive. Steinberg says he has no doubt about that, they could have saved him. Murray said that he lost the pulse after calling Williams at 12:12. So if the paramedics had been there at 12:05 or 12:10, they could have saved him.
Flanagan says that Murray was in an emergency situation and he could be mistaken in his estimations. Steinberg says there is clear evidence that there was a delay in calling 911 as Murray went downstairs and called Williams rather than calling 911.
Flanagan asks based upon these facts if Steinberg thinks Murray is responsible for Michael's death. Steinberg says yes.
Flanagan asks if Murray should have dropped Michael on the floor, in spite of the IV line. Steinberg says he should stop the Propofol drip first and then he should be careful with the line when he’s putting Michael down the floor.
Flanagan asks rather than suction would it be okay to turn the patient on his side and clean the mouth with a finger will be okay. Steinberg says suction is needed.
Flanagan asks if a doctor has only 1 patient, he would still need to document everything he does. Steinberg says he does because obviously Murray didn't recall what he had given when he talked to UCLA or with the paramedics.
Flanagan says that not having records did not kill Michael. Steinberg says it wouldn’t cause his death but it’s still a deviation.
Lunch break
Afternoon Session
Dr.Steinberg Testimony/Walgren Redirect
Steinberg states that Murray did not act like he was ACLS certified.
Steinberg states that he used propfol in New York, but it was in hospital settings.
Steinberg states that gastroenterologists, dentists and ER doctors who use propofol receive appropriate training, with a trained staff and appropriate monitoring equipment are necessary.
Steinberg states that an article about the propofol study in Taiwan, published in 2010, was an experimental study. The patients were given propofol in a hospital , with the appropriate equipment, the experiment was approved by their ethics committee. Steinberg states that written, informed consents were obtained from the patients. Steinberg states that 8 hours of fasting occurred prior to being given propofol, and that the propofol was given by an anesthesiologist. Steinberg states that the patients were constantly monitored and pulse oximeters were attached to the patients. Steinberg states that the propofol was administered by an infusion pump, a drip was not used. Steinberg states that no other benzos were used. Steinberg states that the authors of the article specifically state that the study was an experiment, and that is does not dictate a standard of care. Steinberg states that what Murray was doing was essentially an experiment.
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Steinberg states that if he had to assume that Murray gave only 25mg, that there was no drip, would he draw the same conclusions? Steinberg states yes, that standard of care was deviated from in an unmonitored setting, without appropriate equipment, response was inappropriate, medical records were inappropriate and that it was be a foreseeable prediction that there would be respiratory depression (stop breathing).
Steinberg states that Murray played a direct, causal role in Michael's death.
Recross Flanagan
Steinberg states that the sleep study showed that propofol helped insomnia.
Steinberg states that in his analysis for the CA medical Board, that Murray deviated from the standard of care for Michael
Steinberg states that the lack of a backup battery did not lead to the cause of Michael's death, however, 5 out of 6 deviations did lead to his death.
Steinberg states that he did read Murray's interview with LAPD that he gave Michael propofol for 40-50 days without incident. Flanagan asks if Steinberg has made certain assumption, Steinberg states no. Steinberg states that he didn't assume that Murray gave propofol, that Murray didn't have the proper equipment, the delay in calling 911, improper care during the arrest, that all of these things are facts.
Walgren Re-redirect
Steinberg states that even if the defense theory that Michael self-injected propofol and therefore accidentally killed himself, according to Conrad Murray's own words, Murray would still be the causal factor in his death.
Dr. Nader Kamangar (Sleep Medicine Expert) Testimony
Walgren Direct
Kamangar states he is a pulmonary care/sleep medicine/critical care physician at UCLA. He states he is board certified in four areas: internal medicine, pulmonary medicine, critical care, and sleep medicine.
Kamangar states he is a medical reviewer for the CA Medical Board , and that he assessed Murray's care to Michael for the medical board. Kamangar states that propofol is used in critical care unit on a daily basis. He states he is trained in using propofol. Kamangar states propofol is used for placement of endotracheal tubes, and for people on breathing machines. Kamangar states that propofol is the most commonly used drug for this.
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Kamangar states that he found multiple deviations of standard of care with regard to Conrad Murray's care of Michael :

• Propofol was given in an unacceptable setting : using this deep sedation agent in a home setting is inconceivable and an egregious violation of standard of care.
• ACLS certified : the person who gives propofol must be trained in ACLS and airways management. There was a risk of hypoventilation (diminishment in rate of breathing), apnea and obstruction of the airway.
• Need of assistance : Murray needed a second person (a nurse) to monitor, to pay complete and utter attention to Michael, especially if Murray was going to leave the room; this goes without saying. This violations Hippocratic oath, to abandon his patient.
• Pre-procedure setup : imperative to be prepared for unforeseen circumstances. Things can change very quickly. A patient may look good, and the next minute there's a problem. Murray needed a suction catheter, because patients can regurgitate into their airway, and block the airway, this can cause death. A crash cart (medication on hand : adrenaline, ephedrine, medication to correct the heart beat, etc...) , pulse oximeter, defibrillator, automated infusion pump (precise dosing for propofol) even with people who are intubated;

Kamangar states that all of these factors are extreme deviations of standard of care and are the equivalent of gross negligence.
Kamangar states that he has never seen someone giving propofol at home in such settings, and would not have expected to see that.

• Charts / medical documentation : or medical history, reactions to a medication. For example a blood pressure can look normal, but not be normal for a particular patient, and that change in blood pressure could be the indication of a problem.
• Michael was left alone, which is not acceptable, especially since Murray didn't have the right equipment.
• Use of benzodiazapines: using lorazepam and midazolam on top of propofol can have higher effects : more significant respiratory depression, decrease cardiac output (often a consequence of respiratory depression), decreased blood pressure and cardiac arrest can occur directly, or because of low levels of oxygen.
• Dehydration : blood circulation is not good when you are dehydrated , causes low blood pressure. Benzos and propofol would also lower blood pressure . Murray should not have used benzos or propofol if the patient is dehydrated.
• Failure to call 911 : 911 should have been called immediately.
• Improper CPR : Murray stated there was a pulse, therefore the heart was beating, so the problem was respiratory not cardiac. Murray should have dealt with airway management by placing an ambu-bag over Michael's mouth. Murray's administration of CPR was ineffective; it was not on a hard surface, and it was done with one hand . Correct CPR correctly allows about 20% of the normal blood circulation, so if you do it incorrectly

Kamangar states that assuming Murray found Michael at noon, and calls Williams at 12:12 pm, the significance of the 12 minutes is the lack of blood flow to vital organs, especially to the brain. He states that some individuals are more susceptible than others to a lack of oxygen. Kamangar states that generally it takes 3 to 4 minutes before brain cells start to die. He states that time is really important. Kamangar states that because 911 was called at 12:20 pm, with the passage of 20 minutes, it reaches a point where it becomes irreversible.
Kamangar states that Murray Deceived paramedics and ER staff because he did not provide the accurate information, which is a deviation of standard of care.
Kamangar states that Murray did not properly evaluate insomnia. He states that insomnia can have many causes, so it's important to have a detailed history. Kamangar states that Murray needed to exclude secondary problems (psychological problems, substance abuse, underlying conditions, chronic anxiety, depression , etc...) He states that insomnia is defined by no restful sleep for 4 weeks or more. Kamangar states that once all the secondary problems are ruled out, primary insomnia is considered.
Kamangar states that in order to diagnose/treat insomnia. a detailed sleep history is needed : when do they go to bed, when do they fall asleep, when do you wake up, etc.. check sleep apnea. In some cases you need a sleep study.
Kamangar states that a detailed pharmaceutical history was needed; both prescribed or over the counter (example migraine pills contain caffeine, that can cause insomnia), illicit drugs.
Kamangar states that a detailed physical examination was needed; some underlying conditions can cause insomnia, for example asthma, congestive heart failure, diabetes, bladder problems, enlargement of prostate, thyroid conditions, etc..
Kamangar stated blood testing was needed to rule out certain conditions; examples: diabetes, kidney problems, restless legs , etc..
Kamangar states that a good blood workup would reveal the use of narcotics, if the doctor asks the patient for one. He states that if the patient is not giving the information, a doctor can simply refuse to treat the patient.
Kamangar states that when all the above mentioned are done, then the doctor can treat the underlying condition that causes the insomnia.
Kamangar states that in this case , Murray didn't have a detailed history. In addition, Murray didn't check what the root problem for Michael's insomnia was before treating him.
Kamangar states that Murray did say that he saw that other doctors were treating Michael, he said he saw IV sites. Kamangar states that if Murray could not get that info from Michael, Murray should have refused care and refused to give further medication. Murray didn't do that, and that was unethical.
Kamangar states that Murray bypassed the evaluation of insomnia, bypassed the detailed history which was a deviation of care.
Kamangar states it was obvious there was probably secondary causes in Michael's insomnia (substance abuse or anxiety or depression ) and that these underlying causes should have been treated.
Kamangar explains about sleep hygiene techniques that can help in case of insomnia (using a bedroom to sleep only, among other things)
Kamangar explains about sleep restriction, that the doctor should tell the patient to go to bed later , and limit their time in bed.
He states that relaxation techniques can be used to treat insomnia.
Kamangar states that all these can usually work better to treat insomnia than pharmacological approach, but that the pharmacological approach can also be used.
He states that Murray did not use any of the above approaches on Michael, that Murray went direct to the pharmacological approach.
Kamangar states that the pharmaceutical approach : 3 medications that are not benzos should be used first, because they are not addictive . He states that a newer drug is melatonin something less addictive.
Kamangar cites 4 different benzodiazepines that deal with insomnia. He states that others are used also, but their main goal is to treat underlying conditions (anxiety). They are used in tablet form.

1. Midazolam : not appropriate for long term use for primary insomnia
2. Valium : not appropriate for long term use for primary insomnia
3. Lorazepam : can be used on short term basis, tablet form. Really addictive after 3 to 4 weeks. Used to treat underlying conditions, not primary innsomnia.

Kamangar states that the use of midazolam and lorazepam to treat insomnia was an extreme deviation of care, especially in IV form.
He states that it is inconceivable to use propofol for the management of insomnia, regardless of the setting. Kamangar states that it is "beyond comprehension, inconceivable and disturbing." He states that it is beyond a departure of standard of care, especially when underlying causes for insomnia were not treated.
Kamangar states that even if Michael took lorazepam and propofol himself, Murray was the causal factor in his death, especially if Michael had substance abuse problems. He states that the lorazepam and the propofol should not have been readily available
Kamangar states that there is a risk of respiratory complications, especially if Michael was dehydrated, and that any competent doctor would have been aware of the risk.
Video

Been running an ECA cycle since this past Monday, so I'm staying off the high stim stuff for the next few weeks. I absolutely love Apollon Nutrition Bare Knuckle. Easily one of the best stim-free pre workouts I have ever used!
Combining 25mg of ephedrine sulfate (one Bronkaid tablet) and 100mg of caffeine.
Honestly better energy than most pre-workouts. People sleep on this amazing combo 🔥🔥

Hey guys is this just for fun or does this preworkout really exist?! 😅