A medical examiner struck a major blow to the defense of Michael Jackson's doctor Tuesday, saying it is unreasonable to believe Jackson could have given himself a fatal dose of the powerful anesthetic propofol.
Dr. Christopher Rogers, who conducted the autopsy on Jackson, testified it was more likely that Dr. Conrad Murray overdosed the singer when he incorrectly estimated how much of the drug he was giving Jackson to induce sleep to fight insomnia.
Rogers said Murray had no precision dosing device available in the bedroom of Jackson's rented mansion.
"The circumstances, from my point of view, do not support self-administration of propofol," said Rogers, chief of forensic medicine in the Los Angeles County Coroner's Office.
Murray has pleaded not guilty to involuntary manslaughter.
Rogers analyzed two possible scenarios for Jackson's death. The first was the defense theory that while Murray stepped away to go to the bathroom, Jackson gave himself an extra dose of the drug he called his "milk."
"In order for Mr. Jackson to have administered the propofol to himself, you would have to assume he woke up and although he was under the influence of ... propofol and other sedatives, he was somehow able to administer propofol to himself," Rogers testified.
"Then he stops breathing and all of this takes place in a two-minute period of time," Rogers said. "To me, that scenario seems less reasonable."
"Less reasonable than what?" asked Deputy District Attorney David Walgren.
"The alternate scenario would be in order to keep Mr. Jackson asleep, the doctor would have to give him a little bit every hour, two or three tablespoons an hour," Rogers said, noting that propofol is a short-acting drug that wears off quickly.
"We did not find any precision dosing device, so the doctor would be estimating how much he was giving," the medical examiner said.
Murray told police he gave Jackson only 25 milligrams of the drug, a very small dose that usually would have kept him asleep for no more than five minutes.
Rogers said he examined evidence found in Jackson's bedroom and noted there was an empty 100 milliliter bottle of propofol.
Rogers said the cause of death was "acute propofol intoxication and the contributing condition was the benzodiazepine effect."
Two sedatives from that drug group — lorazepam and midazolam — were found in Jackson's system after he died.
Rogers said he considered a number of factors in ruling the death a homicide. Among them were Murray's statements to police and the lack of sophisticated medical equipment in Jackson's bedroom, where the superstar had been receiving the anesthetic.
He said there was no EKG monitor and no resuscitation equipment present in the room.
Rogers also testified it would be inappropriate to use propofol outside a hospital or medical clinic.
Later in the day, defense attorney Michael Flanagan spent more than two hours trying to show on cross-examination that Jackson indeed could have self-administered drugs — not just propofol but the sedative lorazepam, which could be taken in pill form.
Flanagan suggested to the witness that once Murray had started an IV drip of propofol for Jackson and left the room, "it would be easy for someone to inject into that IV?"
"Yes, " Rogers replied.
"But if they pushed it all at once, that can stop your heart, can't it?" the lawyer asked.
"Yes," said Rogers.
The implication was that if Jackson was desperate for sleep and in a hurry to administer more propofol before his doctor returned, he might have pushed it through the IV tube all at once rather in the recommended slow drip.
"We don't really know what happened when Dr. Murray went to the bathroom," Rogers said. "So we have to consider what is reasonable."
He reiterated his opinion that self-dosing by Jackson was an unreasonable theory.
Under questioning by Walgren, the coroner also said that even if Jackson had given himself propofol or lorazepam, his death would still be a homicide because Murray left him alone with the drugs within reach.
Walgren illustrated testimony about the autopsy by showing a stark photograph of the singer's body on an examining table with his genitals covered. He appeared thin but not emaciated.
"I believe he was healthier than the average person his age," Rogers said, explaining Jackson had no fatty buildup in his arteries common to people his age.
Rogers' testimony came after jurors heard the end of Murray's recorded interview with police two days after Jackson's death, in which he first disclosed he had been giving Jackson propofol to help him sleep.
The interview helped transform the investigation into Jackson's June 25, 2009, death from a simple death inquiry into a homicide case.
The interview also included Murray's description of informing Jackson's mother and children that the entertainer was dead.
"After they cried and cried and cried, then his daughter uttered a lot of words of unhappiness," Murray told detectives, saying Paris Jackson was afraid of being alone after her father's death.
"'I know you tried your best, but I'm really sad,'" he continued, recounting her words. "'I will wake up in the morning, and I won't be able to see my daddy.'"
Jackson's mother, Katherine, dabbed her eyes with a tissue as the recording played. She and other members of the family left court and did not see the autopsy picture.