A MEDICAL expert has testified that Dr Conrad Murray’s repeated and flagrant violations of the standard of care involving a powerful anaesthetic, led to the death of Michael Jackson.

Dr Steven Shafer told jurors the lack of proper medical equipment and the absence of notes and medical records by Murray, along with a breakdown of the patient-doctor relationship were factors in the death.

Murray was acting more like Jackson’s employee than a doctor who should have rejected the singer’s requests for the anesthetic 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.”

The Columbia University professor and researcher gave jurors a crash course on propofol, the powerful anaesthetic used in hospital settings that has been cited as Jackson’s cause of death.

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.

He said the fact that Murray was on his mobile 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 anaesthetic, lectured the panel as if they were in a classroom. He narrated while the silent video took jurors into an operating room to see the specialised 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 an unconscionable 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.

“The record is not just some static document,” Shafer said. “It’s fundamental to the care that is given.”

He also said Jackson should have signed a written informed consent form to show he knew the danger of his treatment.

“Verbal informed consent is not recognised,” he said. “It does not exist.”

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