Sleep Medicine Care Extreme Deviations witness stated in board review report:
1. At no time did Dr. Murray provide or have a diagnostic evaluation of MJ's insomnia performed (now saying why that is so important to determine the reason for the insomnia - a lot is involved in that from the sounds of it). There are different types of insomnia and prosecution has asked him to briefly explain the different types. If underlying condition is found, that is treated first and then the insomnia is looked at to see if it improved. witness: this is an extreme deviation to treating insomnia (witness noted in his report that Dr. Murray states MJ was seeing other drs and he noticed IV marks on him but got no further information on this. Witness says Murray should have gotten the information on that and if he didn't, then treatment should have been refused. Unethical to treat him otherwise when ignoring the patient's past and instead just moving to these extreme sedation methods. Talked a lot about primary and secondary causes of insomnia.
2. no detailed pharmaceutical history (over the counter, RX, illicit, etc. - everything)
3. no detailed physical exam/history
4. no lab testing to rule out basic conditions as the cause of sleep problems
Pharmacological approach to treating insomnia.
Witness: 8 agents approved by FDA. Some are in the benzodazopiens and some are not. (okay he is confusing me with the benzo... non benzo...lingo but there's a difference and one is addictive others are not)
P: as far as benzodiaz... what are those treatments approved by the FDA for insomnia
w: (lots of pams...many i didn't recognize from prior testimony)
p: benzodiaz that are approved by FDA they are all in oral, not IV
w: yes
p: you are aware of the drugs Dr. M was giving MJ (lists them)
w: yes
p: IV lirizapam long term management care for insomnia
w: no, that is not appropriate long term management
p: asking about oral forms for long term care
w: not really, highly addictive drug no longer than 3 to 4 weeks
p: using the combination or singly using any of the drugs Dr. M was treating MJ was classified as you as extreme deviation of care for insomnia
w: yes
p: and the use of propofol
w: utterly has no management for insomnia, regardless of setting has no use for insomnia.
p: why did you make the statement that use of propofol for insomnia like in this case, inconceivable and unethical, why is that
w: never even fathom doing, no reason to use this drug for insomnia
p: (oh wow) you state that Dr. M caused MJ's death
w: that is correct
p read long statement included in report that was terribly damning to Dr.M. and ended with that Dr. M caused MJ's death.
Now talking about how these drugs were left in MJs reach and that is gross negligence and a very foreseeable complication.
