Michael Jackson was so heavily drugged in the hours before his death that he would have been incapable of self-administering the massive dose of propofol that killed him, a medical expert testified Thursday at the trial of Jackson's doctor.
Dr. Steven Shafer, who presented a number of possible scenarios for Jackson's overdose, said one posed by Dr. Conrad Murray's defense — that the star gave himself the powerful anesthetic — is "crazy."
"He can't give himself an injection if he's asleep," Shafer told jurors.
The more likely scenario was that Murray placed Jackson on an IV propofol drip on the morning of his death then left the room as the singer slept, Shafer said.
Jackson probably stopped breathing before Murray returned, and the singer's lungs emptied while the propofol kept flowing into his body, even after he was dead, the witness said.
"This fits all of the data in this case and I am not aware of a single piece of data that is inconsistent with this explanation," Shafer said.
He suggested Murray infused Jackson with the full contents of a 100 milliliter bottle of the drug with a flow that was regulated only by gravity because the doctor lacked dose regulating equipment. Murray claimed he gave Jackson only 25 milligrams over a period of three to five minutes.
Jurors stood up to get a better view as Shafer used an IV pole and apparatus for a courtroom demonstration. He dribbled the drug into a trash can so they could see how it moved through the tubing.
Earlier, Shafer took the jury through a virtual chemistry class with diagrams and formulas projected on a large screen. He indicated the residue of drugs found during Jackson's autopsy suggested Murray gave his patient much larger doses of sedatives than he told police.
He also said Jackson would have been extremely groggy from the drugs administered by IV throughout the night.
Murray told police he was away from Jackson for just two minutes — a period during which the defense says the singer could have grabbed a syringe and given himself additional propofol.
"People don't just wake up from anesthesia hell bent to pick up a syringe and pump it into the IV," Shafer said, reminding the jury that the procedure was complicated. "It's a crazy scenario."
He also said it was unlikely that Jackson injected himself with a needle because the pop star's veins were too deteriorated and the procedure would have been extremely painful.
Witnesses have said Jackson knew the drug had to be diluted with lidocaine in an IV to prevent burning when it entered the veins.
Shafer, a leading expert on anesthesiology who teaches at Columbia University Medical School, also rejected the claim that Jackson may have swallowed eight pills of the sedative lorazepam, also known as Ativan, causing his death.
Shafer said the amount of lorazepam found in Jackson's stomach was "trivial" and not linked to oral ingestion. He suggested Murray gave Jackson much more lorazepam by IV infusion than the four milligrams he said he did.
After receiving lorazepam, another sedative known as midazolam (Versed) and propofol, Jackson would have been too groggy to handle the infusion of more anesthetic through an IV pump, Shafer said.
His opinions set up an expected clash with the views of his colleague, Dr. Paul White, who was waiting to testify for the defense. The men have been friends and associates for 30 years.
White, who sat in the courtroom taking notes, has suggested to the defense in a written report that Jackson might have swallowed a vial of propofol, accounting for the high level of the drug in his autopsy.
But the defense announced last week it had abandoned the theory in May after running its own tests that disproved the theory.
Coroner's officials determined Jackson died on June 25, 2009, from acute propofol intoxication, and Murray has acknowledged giving the singer the drug as a sleep aid. The officials cited other sedatives as a contributing factor.
Murray has pleaded not guilty to involuntary manslaughter.
Prosecutor David Walgren concluded his nearly three-day examination of Shafer, with the witness saying Murray was "a direct cause of Michael Jackson's death'" even if Jackson administered a drug to himself.
"He is responsible for every drop of propofol in that room, every drop of lorazepam in that room," Shafer said.
The trial was recessed until Friday afternoon.