Witness: Drug cocktail killed Michael Jackson

LOS ANGELES -- Dr. Conrad Murray's use of a cocktail of drugs on Michael Jackson as he struggled to fall asleep on the day he died was a "recipe for disaster" and caused his death, a UCLA sleep therapy expert testified Thursday.

Dr. Nader Karmanger described Murray's treatment as "unethical, disturbing and beyond comprehension."

Under questioning by Murray's attorney, J. Michael Flanagan, the witness was asked to tell jurors what he knew about the events of June 25, 2009, the day of Jackson's death.

"To summarize, Mr. Jackson was receiving very inappropriate therapy in a home setting, receiving very potent therapies without monitoring," Karmanger said.

He said diazepam (Valium), lorazepam (Ativan) and midazolam (Versed) were given to the sleepless star during a 10-hour period throughout the night and morning.

"This cocktail was a recipe for disaster," Karmanger said.

Noting the addition of propofol (Dipravan), a powerful anesthetic used in surgeries, Flanagan asked: "Could this have caused death?'

"Absolutely," Karmanger said. "Absolutely."

Authorities say Murray gave Jackson a fatal dose of propofol. Murray has pleaded not guilty to involuntary manslaughter.

The witness, one of the experts who evaluated Murray's actions for the California Medical Board, expressed dismay about the drugs Murray gave the pop star, his failure to immediately call 911 for help and his lack of monitoring and record keeping.

Murray was unable to produce any written records on his treatment of Jackson, Karmanger said.

"There were no records whatsoever," he said. "It's very easy to forget details. We do not rely on memory."

"So it's your opinion that there's no way he could have remembered what he did if he didn't write it down?" Flanagan asked.

"It is an egregious violation of the standard of care when you are using sedatives like propofol and you are not writing it down," Karmanger answered.

The defense lawyer pressed on, asking, "Because he didn't write down the pulse rate, oxygen saturation, heart rate ... that didn't kill Michael Jackson, did it?'

"It's a combination of factors," Karmanger said.

"But not the cause of death?" Flanagan asked.

"It's a contributing factor," the witness said.

Karmanger was the third prosecution expert to criticize the conduct of Murray.

He said his first mistake was using propofol to treat insomnia, calling it an unacceptable application of the drug.

He said Jackson's demand for the drug -- the subject of previous testimony -- was not a sufficient reason to give it. He also suggested Murray should have done a physical examination, taken a history from his patient about his insomnia and called in other medical experts if necessary to evaluate the problem.

"The most important thing he should have done is call for help," Karmanger said.

He said Murray's interview with police made it clear that he waited too long to call 911 when he found Jackson not breathing.

Flanagan suggested at one point that doctors sometimes practice "bad medicine," but their patients are unharmed. Kamanger agreed.

On redirect questioning, Deputy District Attorney David Walgren queried: "Mr. Flanagan asked if a doctor could be grossly negligent and the patient could survive?"

"Yes," Karmanger said.

"Conrad Murray was grossly negligent in many areas, and he caused Michael Jackson's death, is that correct?"

"Yes," the witness said.

On Wednesday, Murray's defense team announced it was dropping a contention that was the centerpiece of its case -- that Jackson swallowed additional propofol when Murray was out of the room. Flanagan did not bring up self-dosing Thursday.

Before court recessed, the prosecution called to the stand Dr. Steven Shafer, one of the nation's leading experts on propofol. But he did not get into his substantive testimony before trial recessed until Monday because he had a schedule conflict.

Shafer was expected to be the final prosecution witness in the case. The defense has a colleague of Shafer's waiting to take the stand.