Conrad Murray: Michael Jackson's struggles on display at doctor's trial

Jurors on Tuesday are set to hear opening arguments in the trial of Michael Jackson’s personal physician, accused of administering a fatal dose of a surgical anesthetic meant to help the pop star fall asleep.

Mr. Jackson fell asleep, but he never woke up.

Prosecutors charged Dr. Conrad Murray, a Houston cardiologist, with involuntary manslaughter. They say he recklessly failed to fulfill his duty to closely monitor his patient to ensure Jackson did not stop breathing while under the anesthetic.

Defense lawyers argue that Dr. Murray fulfilled his professional responsibilities, but was faced with a patient addicted to the anesthetic that killed him, propofol. They have suggested in court filings that Jackson might have acted without Murray’s knowledge and boosted his propofol dosage beyond safe levels.

The month-long trial at the Los Angeles County Courthouse is set for televised gavel-to-gavel coverage. Many analysts expect it to reach mega-trial status, rivaling the national attention paid to the Casey Anthony and O.J. Simpson trials.

If Jackson’s funeral is any measure, the TV audience could be huge. Thirty-one million tuned in to Jackson’s memorial service in July 2009. In comparison, 33 million watched Princess Diana’s funeral in 1997.

The trial promises gritty insight into the real-life struggles of the man universally hailed as the King of Pop. The enigmatic 50-year-old performer had been acquitted in 2005 of child molestation charges, but was still struggling to resurrect his image in the wake of the devastating ordeal.

In mid-2009, he was hard at work preparing for what he advertised as his final performances – a series of concerts entitled “This Is It.”

His rehearsals were inconsistent. Sometimes he failed to even show up. Behind the scenes, according to defense lawyers, Jackson was fighting a running battle with various medical conditions, countering the pain and discomfort with an increasingly complex cocktail of pharmaceutical wizardry.

After his death, detectives found seven different prescription drugs at or near Jackson’s bedside. The prescriptions had been authorized by three different physicians, court documents say. Some were prescribed to pseudonyms used by Jackson apparently to mask his significant drug consumption.

It all came to a head on June 25, 2009. Murray had been treating Jackson for insomnia for the previous six weeks. Most nights he would give Jackson 50 mg of propofol diluted with another drug, Lidocaine.

Propofol is an anesthetic that is usually administered by a specialist in a hospital in preparation for surgery. Jackson had persuaded several doctors to help him use it as a sleep aid. Eventually an intravenous delivery system was set up in the bedroom of his rented mansion in Los Angeles to help him sleep.

In a hospital setting, a technician is required to monitor the patient constantly in the event that the propofol stops a patient’s breathing. In that case, the technician must quickly insert a device into the patient’s throat to reopen the airway and restore breathing.

No similar devices were found at Jackson’s home.

Murray told the police after Jackson’s death that he had been worried that Jackson might be developing an addiction to propofol. He said when Jackson was unable to get to sleep through the early morning hours of June 25, he tried several different drugs first. They didn’t work. Jackson remained awake from 1:30 a.m. to about 10:40 a.m. By that time, he said, Jackson demanded propofol – which he called his “milk,” because of its white color.

That’s when Murray told police he administered 25 mg of propofol diluted with Lidocaine. Jackson fell asleep. As he slept, Murray monitored his heart rate and checked his breathing.

According to a police account: “After approximately 10 minutes, Murray stated he left Jackson’s side to go to the restroom to relieve himself. Murray stated he was out of the room for about 2 minutes maximum.”

The account continues: “Upon his return, Murray noticed that Jackson was no longer breathing.”

At this point the account gets murky. According to Murray, he first noticed Jackson not breathing at about 11 a.m., but Murray’s cellphone records show that he was on his cellphone talking to three different callers from 11:18 a.m. to 12:05 p.m.

The 911 call was not placed until 12:22 p.m. Jackson was pronounced dead at the hospital at 2:26 p.m.

The county coroner’s office determined the cause of death to be “acute propofol intoxication.” The manner of death was ruled a homicide.

Prosecutors allege that Murray failed to give his full attention to Jackson while he was sedated and vulnerable. They say the doctor made personal phone calls while he should have been monitoring his patient.

Murray’s lawyers counter that Jackson was weak, addicted, and desperate in the final hours of his life.

Murray has pleaded not guilty. If convicted, he faces up to four years in prison and loss of his medical license.