Some of the witnesses who are now testifying in the Trial already testified in PREtrial and their Trial testimonies are the same in substance as their PREtrial testimonies. Jamie Lintemoot testified on January 7, 2011 in regads to the LA Coroner’s toxicology findings. The following is my notes of her PREtrial testimony based on the official court transcripts.
In Conrad Murray Trial, Dan Anderson, Jamie Lintemoot’s supervisor testified pertaining to the Coroner’s Toxicology findings. Under my notes for Mr Anderson’s testimony, you will find info NOT included in Jamie Lintemoot’s testimony.
JAMIE LINTEMOOT: PREtrial Testimony (Jan 7, 2011)
Direct by David Walgren:
She is senior criminalist at LA county Dept of LA Coroner
She analyzes blood and other biological specimens in the presence of drugs
She analyzes medical evidence
Prior to 2005, their office didn’t have a way to detect Propofol. She established a method, suitable for Propofol testing. Since then, she has been the primary consultant at LA Coroner’s office in Propofol testing
After she received a service request for Propofol testing, she pulls the samples from the toxicological cooler. She notes the information from the sample bottle so chain of custody is maintained. Then she perform an “extraction” = “chemical steps to isolate the drug into a medium that is suitable for analysis” Then she places it on drug detective instrument and she will leave it there overnight. The next day, she will evaluate the levels contained on that particular sample.
She tested the blood samples, obtained from UCLA, labeled “Gershwin”
June 29, 2009- preliminary testing of MJ blood samples showed presence of Propofol
June 30, 2009- she conducted a “full tissue distribution analysis”
Full tissue distribution analysis = In this case, it is testing of hospital, femoral and heart bloods, liver, gastric contents, urine and vitreous
She determined the levels of propofol found in above samples
An 8-page “Laboratory Summary report” included her findings and the findings of her colleagues
She particularly did the Propofol testing, her colleagues tested for other agents
Nordiazepam =Metabolite=something body forms as it metabolizes the drug
All drugs listed in autopsy, except Nordiazepam, are drugs found in Michael’s blood
Propofol level in heart blood=3.2ug/ml
Propofol level in hospital blood= 4.1ug/ml
Propofol level in femoral blood =2.6ug/ml
Propofol level in vitreous = less than 0.40ug/ml
Propofol level in liver = 6.2ug/gram
Propofol in gastric contents = 0.13mg
Propofol in gastric contents = 1.6mg
Propofol level in urine = 0.15ug/ml
Propofol level in scene urine = less than 0.10ug/ml
Lidocaine in heart blood= 0.68ug/ml
Lidocaine in hospital blood= 0.51ug/ml
Lidocaine in femoral blood = 0.84ug/ml
Lidocaine in liver = 0.45ug/gr
Lidocaine in gastric content = 1.6mg
Diazepam in heart blood= less than 0.10ug/ml
Nordiazepam was found in heart blood, less than 0.05ug/ml
Lorazepam in heart blood= 0.162ug/ml
Lorazepam in femoral blood= 0.169ug/ml
Midazolam in heart blood=0.0046ug/ml
Midazolam in urine = 0.0068ug/ml
Midazolam in scene urine= 0.025ug/ml
Ephedrine is present in urine & scene urine but negative in heart blood
Scene urine=urine recovered from the jug at the scene
Urine = urine recovered from bladder during autopsy
She tested the syringe barrel (from the nightstand), positive for Propofol and lidocaine
IV stand was broken into pieces & labeled (see pic in Dan Anderson testimony below)
A=IV bag
B= Syringe
C= Y site connector (syringe goes into one end, one end goes to long tubing, another end goes to short tubing)
D= Short tubing
E= “Clear tip” that the short tubing proceeds to. It had a little bit of red fluid or red stain on the end of it
F=Long tubing
G=White clamp (was attached to the tubing)
H=White Thumb Clamp
I= IV bag plug (cylindrical piece that the long tubing was attached to, with a spike on the end. It goes into the IV bag)
For analysis purposes, she broke down the IV components into 4 parts:
IV bag (A)
Long tubing (F)
Syringe (B)
Short tubing (D)
There were no drugs in long tubing
There were no drugs in the IV bag
Syringe tested positive for Propofol, Lidocaine and Flumanezil
Short tubing tested positive for Propofol, Lidocaine and Flumanezil
Cross by Michael Flanagan:
Lidocaine in femoral blood = 0.84ug/ml
Propofol in femoral blood= 2.6ug/ml
The ratio is 1 part lidocaine to 3 parts Propofol
She used nanogram to quantify Lorazepam
1000nanogram (ng) =1microgram (ug)
Why did she use different units to test Propofol and Lorazepam? Testing is done in therapeutic range. The range for most benzodiazepines (Lorazepam is a benzodiazepine) is ng/ml
Propofol in heart blood=3.2
The different levels from femoral and heart is normal
Toxicologists mainly rely on the femoral blood, it is less contaminated
Propofol to lidocaine ratio in femoral blood is 3 to 1
Propofol to lidocaine ratio in heart blood is 4.5-5 to 1
Why are the ratios in femoral and heart different? Different drugs, different specimen sources and post-mortem redistribution. After someone dies, the drugs can leak out into other tissues, thus, change the levels.
Propofol level in hospital blood = 4.1
Lidocaine in hospital blood = 0.51
(blogger- To get below ratios, you divide Propofol level for that particular specimen (heart, femoral, hospital) by Lidocaine level for corresponding specimen. For example, to calculate the Propofol-Lidocaine ratio in hospital blood, we divide 4.1 / 0.51= 8.03 We round that number to 8 so we conclude that the ratio is 8 to 1. What does this ratio mean? It means, in hospital blood, in every 1ml blood sample, we have 8 times Propofol than Lidocaine)
Propofol-Lidocaine ratio in hospital blood is 8 to 1
Propofol-Lidocaine ratio in femoral blood is 3 to 1
Propofol-Lidocaine ratio in heart blood is 4.5 to 1
These levels are measured by ug/ml
To get Liver measurement = weight the liver, transfer liver into a liquid and “homogenize it” (put it in a blender and grind it so everything is in liquid format)
Liver Propofol =6.2ug/gram
Liver Lidocaine=0.45ug/gram
The ratio is 12 to 1
She typically needs a 2ml sample from vitreous (clear fluid behind eyeballs) but she had less than typical amount of sample available to her. She examined only 0.5ml sample, which was four times less than the amount she needed. The Propofol was present in vitreous but she couldn’t accurately detect the amount due to lack of the amount of sample available to her. Her detection level was between 0.02 to 0.1 so she multiplied the maximum amount (0.1) by 4 and came up with less than 0.4ug/ml on autopsy
She can’t exactly be sure of the actual amount but it would be between 0.08-0.4
Gastric contents had 0.13mg of Propofol = total amount of Propofol in stomach
Gastric contents has 1.6mg of Lidocaine = total amount of Lidocaine in stomach
The ratio to Lidocaine to Propofol is 12 to 1. For the first time, lidocaine levels are higher than Propofol levels in stomach than in any other samples.
She analyzed the syringe barrel (recovered from the nightstand next to bed) but she didn’t analyze the needle (recovered from the floor). She didn’t try to put together the 2 detached pieces.
Coroner’s office doesn’t have a method to detect Flumanezil in the body
The fully intact syringe from the IV stand had 0.16gram of fluid in it
She wasn’t asked to analyze any empty fruit juice bottles for Propofol
IV bag was broken into components & labeled (pic in Dan Anderson testimony)
A= IV Bag
B= Syringe
C= Y site connector (syringe goes into one end, one end goes to long tubing, another end goes to short tubing)
D= Short tubing
E= “Clear tip” that the short tubing proceeds to. It had a little bit of red fluid or red stain on the end of it
F=Long tubing
G=White clamp (was attached to the tubing)
H=White Thumb Clamp
I= IV bag plug (cylindrical piece that the long tubing was attached to, with a spike on the end. It goes into the IV bag)
DAN ANDERSON TESTIMONY: Conrad Murray Trial
(October 6 and 7, 2011)
(October 6 and 7, 2011)
Mr. Anderson where r u employed?
I employed with the LA county dept of coroner as a supervising criminalist or as a toxicologist
What is a toxicologist?
Toxicologist is a person who works on biological specimens, analyzes for drugs and poisons as well as makes interpretations of those drugs and their levels in regards to an investigative process such as a death investigation
You indicatedur
You indicated
I am ultimately responsible for the toxicology laboratory. All the analytical results that come out of that facility, I am ultimately responsible for as well as the people
(blogger- So Dan Anderson is Jamie Lintemoot’s supervisor. If you look at the toxicology results in the autopsy, you will notice that drug testings were done by various people in the coroner’s office. Dan Anderson explains the reason)
“In our laboratory, I think at the time of this particular case in 2009, we had 8 or 9 analysts at the time. We typically go thru about 6000 cases each and every year in this office. We have all 7 or 8 people working on one case at one time; everyone has a hand in the pot at one time. It is an assembly-line type of process. That allows us to be a lot more efficient with case work”
Didur
“In our laboratory, I think at the time of this particular case in 2009, we had 8 or 9 analysts at the time. We typically go thru about 6000 cases each and every year in this office. We have all 7 or 8 people working on one case at one time; everyone has a hand in the pot at one time. It is an assembly-line type of process. That allows us to be a lot more efficient with case work”
The biological specimens, can u generally describe what that process entails
Toxicology analysis generally starts out with screens, some type of screening process where it is a yes or no answer. It is a simple test that says yes or no, is it there or isn’t there. If it isn’t there, then we are done but if it is there, it goes on for a secondary test to definitively say what drug is in there. There are variety of tests that you have to begin with to get a basic understanding of what’s going on with a particular case
And does part of that testing process involve performing what’s known as an extraction?
An extraction is nothing more than taking a blood sample and adding a chemical in order for the blood sample to release the drug into my chemical. I’m trying to get the drug out of the dirty matrix, blood matrix, and into a clean medium where I can actually introduce onto an instrument. You can not inject blood directly onto an instrument. So u actually clean up the blood specimen by doing a chemical extraction on it and put it on an instrument
It sounds like isolating what will actually be used with the instrument to test?
Yes, it is isolating the drugs of the interest that you want to target and introduce it onto the instrument, yes
These instruments are scientific drug detection instruments?
They are called GC/MSs – Gas chromatography mass spectroscopy. We use GC/NPDs -Gas chromatography Nitrojen Phoshorus Detector. We use electron capture detectors, we use liquid chromatography with mass spectrometry (LC/MS), we use variety of instruments These instruments are scientific drug detection instruments?
Did
Yes
In the process of conducting biological testing in this case, did u take blood vials that had been recovered from coroner’s investigator Elissa Fleak from UCLA and include those as part of your testing?
Yes I did. Elissa Fleak hand-delivered the 4 hospital specimens to me
The biological testing of the specimens would include both what was recovered from UCLA and hand-delivered to you by Elissa Fleak as well as what was obtained as a result of the autopsy in this case?
Yes
“The autopsy occurred on Friday the 26th of June 2009. I actually attended the autopsy, at least the beginning portions of it to advise the docs these are the type of the specimens we would need and they collected them and submitted them to the laboratory that afternoon. That afternoon we immediately began the process of screening.”
Femoral blood = taken from the leg vein (at autopsy)
Heart blood = blood from heart (at autopsy)
Hospital blood = 4 vials of blood from UCLA
Vitreous Humor = clear fluid behind the eyeballs
Gastric contents = stomach contents (at autopsy)
Urine = Taken from bladder (at autopsy)
Urine scene = urine from the jug in MJ bedroom
MEPERIDINE = DEMEROL = Not detected in MJ blood
NORMEPEREDINE = Metabolite of Demerol = NOT detected in MJ blood
“Urine analysis represents a history. It not only represents what someone used recently but also represents days ago use too. It doesn’t mean whole a lot interpretively with a urine result, other than yes the person used it one time.”
As far as analytical tool, analyzing the urine is more valuable than the blood?
For interpretation purposes, yes. It gives a toxicologist an idea of what is in the system but you need to evaluate what’s going on in the blood because the blood is what is affecting somebody immediately
Urine reflects what has gone thru the body and is now expelled from the body?
Yes
To given an idea as to the amounts of Propofol and Lidocaine found in Michael Jackson stomach, Mr. Davidson used a 1gram sugar pack that we see in restaurant tables. 0.13ml (of Propofol) is equivalent to specks of sugar crystal in 1/MILLIONTH of that sugar pack.
0.16ml (of Lidocaine) is slightly more than 1/1000th of the sugar pack
Cross by Michael Flanagan:
(blogger- Concentration of Lorazepam in stomach as per the defense lab result is 634ng/ml=0.634ug/ml. If you divide this amount by the concentration amounts of Lorazepam in heart blood (0.0162) or femoral blood (0.0169), we find that concentration of Lorazepam in stomach is 4 times highter than the other two blood samples)
Do u think that is an important number?
(blogger- I am going to expand on ion trapping in a seperate blog entry. But basically, Lorazepam is a basic (alkaline) drug-as opposed to acidic drugs. Basic drugs gets into stomach due to the acidic nature of stomach. The presence of a basic drug- in our case Lorazepam- in stomach does NOT necessarily mean that it was orally digested)
ReDirect by David Walgren:
From the toxicology point of view when you are determining the numbers that you reference, could you please explain the difference between a blood sample and the urine sample as to the value it has in your analysis?
Counsel represented this is a gastric contents result although it indicates urine. For the sake of my questioning, let’s just assume that it is gastric contents as indicated here. Let’s assume that this is 634ng/ml in the gastric contents for Lorazepam, you had a chance to review that?
Cross by Michael Flanagan:
Starting from the Propofol. Why did you analyze it on 3 separate blood samples?
Typically on positive drug analysis, we will actually perform on 2 separate blood samples. One being the central blood, the other being the peripheral blood. Central being the heart blood, the peripheral being away from the central cavity in the leg.
You typically have to analyze them together because of what they call postmortem redistribution. Drugs are stored in tissues and fats. When u die, it has a tendency to release the drug back into sort-of circulation. You are not really circulating any blood when u die but it is available to move around artificially. So as the body gets moved, transported, taken from the cooler, it potentially can re-move high concentrations of drug into different areas that you wouldn’t have expected. That’s why you take two blood samples, both centrally and peripherally so that you can actually measure the difference in drug concentrations. In this case, we got a third blood sample. It was a hospital admission blood. It was like an icing on the cake, it was an extra specimen for us to look at.
Hospital blood (for Propofol) is higher than the heart blood. Do you know why?
No
The femoral blood is the lowest them all. Do you know why?
What I just got done explaining about postmortem redistribution
I wanna know why the femoral blood is the lowest in concentration of any of the drugs up there
That’s typical in most drug analysis that we perform
I noticed that you have done Lidocaine in heart, hospital and femoral bloods, why didn’t you do it in the vitreous?
Probably because we didn’t have enough of it o do it
Propofol in urine-scene =0.026ug/ml
So that’s negligible?
It’s negligible, yes
Ephedrine is present in urine and urine scene but not detected in heart blood. Is it because bladder store things for days?
Yes
Let’s assume hypothetically that the scene urine was deposited somewhere between 7:00 - 7:30am, time of death is somewhere between 12:00 2:26 and the autopsy urine was collected after time of death, that much urine would be collected after the initial time of death, wouldn’t it?
To correct you, actually there was quite a bit of autopsy urine was collected. Two jars worth which is quite a bit of urine for a decedent that I’m typically seeing
That’s a lot of Lorazepam, isn’t it?
162ng/ml is upper therapeutic range, it is high therapeutic range
Would u be able to relate that 0.162 or 0.169 in the femoral blood, would u be able to relate that to the milligrams of Lorazepam used?
The calculations actually back-extrapolate from concentration to the actual milligram dose given. It is actually a dangerous area when having to deal with post mortem blood samples. Yes it can be done, people will do it, you can give an estimate but there are assumptions that have to be made but it isn’t an exact science. Yes you will have people that will do that for you but it is dangerous and there are a lot of assumptions to be made
What assumptions do you have to have made?
Prosecution: Objection, beyond his area of expertise, you Honor
Judge: Have you engaged in this type of research or analysis or aware of the findings?
Anderson: I am. I am familiar with why you shouldn’t be doing it
Judge: I will over rule the objection, you can explain
You have to assume that the drug is fully distributed. You have to assume that post mortem redistributed has not occurred, that that level in the heart blood is not falsely elevated which elevates your calculation
Lorazepam is not subject to post mortem redistribution, is it?
How do I know that?
Do you have a PDR?
You cannot find it in a PDR (Physician’s Desk Reference)
Are u familiar with a book written by Baselt?
Yes ‘Disposition of Toxic Drugs & Chemicals in Man’
Is he an authority on drugs?
Dr Baselt is a retired toxicologist who is practiced in the field very long time. This book is a bunch of monographs or drug information
From the measurement of Lorazepam, could you tell whether or not that Lorazepam was IV Lorazepam or a pill form?
You cannot tell route of administration thru a blood level
I noticed that there is no testing for a metabolite of Lorazepam, is that correct?
That is correct. I am not aware of a metabolite of Lorazepam
By virtue of your testing, are you able to determine how long prior to time of death Lorazepam was consumed?
No
Are you familiar with the half life of Lorazepam?
Yes
What figure do you use for half life of Lorazepam?
Half life of Lorazepam is approximately 9 to 16 hours
So that would mean that if a person has 0.162 in his system, it would take them about 9 to 16 hours to metabolize down to 0.08?
Yes that is true
Is half life the time it takes a drug to dissipate half of what is in your system?
Yes
If Lorazepam was taken by way of injection, 2mg at 2 and 2mg at 5, how long would it take to get that out of your system?
Same half life
Do u know what level of Lorazepam you would start with before you star deducting for the half life?
No I don’t know
You tested for metabolite of Diazepam, is it your testimony today that there is not a metabolite for Lorazepam?
There is not a metabolite for Lorazepam that is commonly tested in the toxicology community
So it is very difficult to test for, is it called Gluconride?
Glucuronide. What happens is when you take Lorazepam, injected or tablet, your body will attack the Lorazepam and attach a large protein onto it, that is the Glucuronide. So analytically, what we intend to analyze for is the free portion of the Lorazepam, not the Lorazepam Glucuronide. It is not really a metabolite. It is a process.
(blogger- The Lorazepam levels reported by the coroner’s lab belongs to ONLY pharmacologically active Lorazepam, it does NOT include Lorazepam Glucuronide)
0.162 and 0.169 pretty consistent, aren’t they?
Very consistent, yes
That has a tendency to indicate that Lorazepam is at equilibrium in the body?
Potentially, yes
It takes time for the body to reach equilibrium, doesn’t it?
Yes
Would that be consistent with Lorazepam being in the body for couple of hours?
I’d like to agree with you but I just don’t know
I’d like for you to agree with me too
Heart, hospital, femoral, vitreous, those are not at equilibrium, is it?
In regards to Propofol?
Yes
I agree with you, the numbers are not in equal
They are not equal but looking at those numbers, you cannot determine that the body is at equilibrium, can you?
If comparing numbers and equating that to equilibrium, I agree with you
If the person has been on a drip, say for an hour, you would expect the body to be at equilibrium, wouldn’t you?
If the person was on a drip, I would expect to have found the Propofol in a drip bag so I am not understanding the question
I was talking about the body, we’ll get to the drip bag in a while. If a person was on a drip for an hour or so, that the blood levels, the vitreous, maybe in urine, everything would kind of reach equilibrium, wouldn’t it?
I don’t know how Propofol will redistribute via elimination thru the urine nor do I know how it distributes into the vitreous, we don’t know if this is a common to find a low amount in the vitreous
The concentration of Lorazepam in stomach is 4 times higher than that of concentrations of femoral and heart blood, isn’t it?
Yes, if u r comparing the 600 number to the 169 number, yes
Do u think that is an important number?
NOT REALLY, NO
Isn’t that consistent with oral consumption of Lorazepam?
NO
Why do you say that?
JUST BECAUSE YOU ANALYZE THE STOMACH CONTENTS AND FIND A DRUG IN THE STOMACH CONETMTS DOESNT NECESSARILY MEAN IT IS ORAL ADMINSITATION. WE FIND PLENTY OF DRUGS IN PEOPLE’S SYSTEM, THEY SMOKE IT, THEY IV IT, what have you, AND YOU WILL FIND THE DRUG IN THE STOMACH AT SMALL LEVELS. IT IS A COMMON OCCURANCE KNOWN AS ION TRAPPING WHERE A DRUG CAN GET TRAPPED IN THE ACIDIC ENVIRONMENT OF YOUR STOMACH.
Is lorazepam subject to ion tapping?
Lorazepam is a basic drug and yes it can
What was ur calculation of gross contents of Lorazepam in the stomach?
The calculation that I performed?
Yes
In comparison to the milligram amounts, 0.046mg of Lorazepam
What is the equivalent of that in pills?
In this particular case, there was 2mg size tablets, so 1/43rd of A PILL
(blogger- Dan Anderson said that if we were to assume oral administration, Lopazepam amount in Michael's stomach is equal to 1/43rd of following ONE pill)
Now Midazolam. You haven’t made the calculations as to the amount of IV Midazolam it would take to g4et to those levels, is that correct?
That’s correct. The levels are negligible, they are actually very small.
Would that indicate that if Midazolam was used earlier in the day, it is largely metabolized, would that be correct?
Would that indicate that if Midazolam was used earlier in the day, it is largely metabolized, would that be correct?
I’m not sure when the Midazolam was used. I don’t know whether a large amount was given or provided and he is metabolizing it out slowly and that is the residual amount or that is a recent amount, I don’t know
Well if the evidence came out and it was established that that Midazolam was taken 2mg at 3 o’clock and 2mg at 7:30, would it be consistent with those figures?
I don’t know I am not set down to actually do calculations for Midazolam being given multiple times and what kind of levels you would get or see
Fluid in the syringe = 0.17gram
What does it mean?
How available the drug is to your system depending on the route of administration
If we look at the urine test. The urine at the scene, of that plastic bottle that was captured from the scene, that is 0.025, is that correct?
Correct
Fluid in the syringe = 0.17gram
Fluid in the short tubing = 0.47grams
The syringe and the short tubing held a mixture of Flumanezil, Propofol and Lidocaine
No drugs in saline bag
No drugs in long tubing
Tubing was hanging from the IV stand; it was NOT attached to the IV bag
The IV bag from medical evidence #2, was it found to contain any drugs?
NO
Do u know whether or not the IV tubing was attached to that IV bag?
When the medical laboratory received medical evidence #2, entire apparatus, the IV bag was disconnected from the long tubing or the spike, they were not connected
Yesterday we were talking about equilibrium. I forgot to have you to define equilibrium as it relates to body fluids. Could you define that?
Equilibrium is when the concentrations of a drug are equal in all compartments
Prescription of Lorazepam usually involves one 2mg pill, doesn’t it?
It is prescribed in several different milligram size pills and it really depends on the patient that is being prescribed to
I am gonna show you People’s Exhibit 107 which is a Lorazepam bottle. That is a prescription for Michael Jackson. What does it indicate that the prescribed amount is?
It is a prescription for Michael Jackson. It is labeled Lorazepam. 2mg. Take 1 tablet by mouth, at bedtime, as needed for insomnia
You indicated yesterday that 0.16 level would indicate approximately 11mg?
According to the quick calculations that I made, yes
So that would be, maybe, 5 ½ of these pills or were your calculations related of IV?
The calculations were regardless of the route of administration. It was the totality of drug that would have made that blood value
What’s the bioavailability of Lorazepam?
That I don’t know
You know what the term bioavailability means?
Yes I do
What does it mean?
How available the drug is to your system depending on the route of administration
So bioavailability of IV injection would be %100, wouldn’t it?
Correct, it can be
And oral has got lower bioavailability, doesn’t it?
Yes it does
You don’t know what that percentage factor is for Lorazepam?
No I do not
So it would take more pills to get to the same level than it would take, in terms of milligrams, it would take more milligrams by way of pill to get to the same level as IV, is that correct?
I would agree with that
To get 11mg in Michael Jackson’s body, how many pills would he have to….the level he had indicate that he had 11mg of Lorazepam in him, correct?
It is an approximate number, yes
If he were getting it IV, 11mg IV would achieve that number, isn’t that correct?
The number is the totality, regardless of route of administration, IV, milligram amounts, it can represent several days of accumulation. I can’t testify at all or I don’t feel comfortable testifying at all in regards to how he achieved this level in the blood based on your dosing schemes
So you’d have to take into consideration the time of dosing?
You are going to have to take a lot into consideration
What else other than time of dose and amount of dose, would you have to take into consideration?
As I said yesterday, assumptions being made. You are starting to get very deep into pharmacology which I don’t have a thorough background in and I would rather leave it for the many experts that is gonna march up here after me to talk about pharmacology
So u r not qualified to answer that question?
I prefer not to, no
R u comfortable with discussing ion tapping?
Other than explaining what I typically see in my coroner’s case work, to that degree, I have a sense of it, I know about it and I have experienced it
Do you have a sense of it with respect to Lidocaine?
Yes I do
Because u read Dr Shaffer’s report, is that correct?
Oh it goes beyond that
What do u know about with respect to Lorazepam
Lorazepam is a basic drug and it would behave very similar to all the other basic drugs such as Propofol and other drugs that I am familiar with
Wouldn’t it have a little bit difference from Propofol and Lidocaine in that Lorazepam is not subject to redistribution?
Objection, beyond the scope of his expertise
If u understand and are able to answer fine, if not, tell us
It is starting to go beyond
So u wouldn’t know anything about Lorazepam and post mortem redistribution?
I am not prepared today to talk about Lorazepam and post mortem redistribution
But u would agree that a drug that is not subjected to postmortem redistribution is not going to be subject to ion trapping in the stomach?
THAT IS NOT TRUE AT ALL
If a drug was subject to ion trapping in the stomach, and not subject to postmortem redistribution, you could take it orally, could you?
Those two terms, ion trapping and post mortem redistribution, have NOTHING to do with each other.
Well for ion trapping in the stomach, you have to have a way of getting the drug in the stomach, don’t you?
You have to have it available
And postmortem redistribution is one way of making it available, is that right?
Post mortem redistribution is the movement of the drug from high to low so you are stretching it a little bit
In order to get Lorazepam in the stomach, do you know of another way, other than postmortem redistribution or oral ingestion?
The only way that u can get it (Lorazepam) the stomach is thru oral administration or ion trapping. It is NOT postmortem redistribution
“I can testify that I have personal experience that drugs levels can be detected in the stomach of many different types of decedents of many different types of drugs and they were NOT given orally”
And those were drugs that were subjected to postmortem redistribution, isn’t it?
Again, they are basic drugs that we commonly find in gastric analysis. That does NOT necessarily mean they were orally administrated. How they got there, I would rather leave that for the pharmacologist to testify to
Do you have experience with a decedent having Lorazepam in the stomach that was not orally ingested?
I do not have personal experience with that particular drug Lorazepam
That’s all I am talking about, Lorazepam
I do not have personal experience with Lorazepam
But you do have personal experience with other drugs being in the stomach that were not orally ingested?
Yes I do
Such as Lidocaine?
Such as Lidocaine, such as Fentanyl
The other drugs that you measured, ephedrine being present in the urine would not be at a therapeutic level, would it?
You can not relate urine values to blood values
The diazepam, that is not at a therapeutic level, is it?
Diazepam is very therapeutic
It is therapeutic but it is not at a therapeutic quantity in the blood stream here, is it?
I don’t know
The Midazolam, in the heart blood, 0.0046, that is not a therapeutic level, is it?
I do not what the therapeutic range for Midazolam so I can’t answer your question
I am beyond your expertise again?
Yes
You came to a quick judgment that Propofol was the most important drug in this case, didn’t you?
Yes I did
You didn’t do the calculations that u talked about today with regards to the 11mg (of Lorazepam) in stomach) until last weekend?
Actually it is two weekends ago, I mis-spoke but that is true
Why did you do them then?
B/c I was presented the info about the analysis that the defense did for Lorazepam in the gastric sample
Were u also presented with the analysis that the defense did with Lorazepam in the urine samples?
Yes I was, the two urine samples
Did u do any special calculation for the purposes for determining what they meant?
As stated before, the urine values don’t mean anything. It is an historical perspective. It is an accumulation of drug in that reservoir
The why did you analyze the urine for Propofol and for Lidocaine?
When we do our analysis, we are trying to do as through of the job as we can with the info than we have today. We try to answer a lot of the question that we THINK are going to be there. We can’t anticipate all the questions all the way thru. We thought we would do every specimen just to try to answer anybody’s potential question
Why did u analyze the urine for Midazolam?
Remembering that most of the analysis is performed by many different analysts, each of the analyst will tackle the cases a little bit differently, trying to achieve the same goal. And this particular case, criminalist Budd happen to do both the bloods knowing that there is gonna be a small amount of Midazolam in those blood, he wanted to substantiate the finding with a urine value knowing that the urines are typically are much more elevated as it is more concentrated
So why did u do the urine for Midazolam?
b/c the values in the blood stream are extremely low and we know that the urine values are higher, typically. In order to substantiate the identification of the drug in the system
How does the urine values usually relate to Lorazepam?
I expect them to be much more elevated
And they were in the results of the analysis that u seen done?
That the sample that the defense had done, yes I did
Has your lab confirmed the analysis done by my lab?
No there is no reason to b/c that is what I expected, to begin with
And the Lorazepam levels in the urine are much higher than the Midazolam levels, aren’t they?
Yes Lorazepam is much more elevated
Lorazepam levels would be 13 point something in the scene urine and 15 point something in autopsy urine?
I exactly haven’t seen a document presented to me. I got it in my book somewhere but I haven’t seen you present it in court specifically, unless you want me to find it…
Why don’t you find it?
Okay
13ug/ml = Lorazepam in scene urine
0.025ug/ml = Midazolam in scene urine
A lot more Lorazepam, isn’t it?
In the urine, yes
Lorazepam in autopsy urine = 15ug/ml
So with respect to the urine at the scene, the Lorazepam level goes up in the urine sample at the autopsy, correct?
The autopsy urine is greater than the scene concentration
And with respect to Midazolam, the autopsy urine concentration is much less, isn’t it?
Much less than those two urine samples of Lorazepam
No, no, the urine sample Midazolam at autopsy is much less than the urine sample Midazolam at the scene?
It is 3 times less, 4 times less at max
It is 1/4th as much
To me it is NOT that significant but okay it is less
In the jug that was sitting on the chair, it is 4 times as much as it was at the time of autopsy?
Fine, yes
Whereas Lorazepam in the jug that was on the chair, it actually goes UP at the time of the autopsy?
Prosecutor: Objection, vague as to ‘go up’
Court: Overruled
It is greater than
The half life of Midazolam, do u know that?
I do not know
But Lorazepam, you looked at the half life and that is 9 to 16 hours?
That’s correct
Would you be familiar with the fact that Midazolam has a shorter half life?
I would agree with you b/c it is a short acting drug
When a person consumes Lorazepam orally, do u have any knowledge as to the time that it takes to get to the peak level?
No, I don’t know
Where did you learn that the half life is 9 to 16 hours?
I looked it up in the Dr. Basalt’s book
Doesn’t Dr. Baselt’s book also indicate the time to reach peak level also?
Prosecutor: Objection, relevance
Judge: Sustained
ReDirect by David Walgren:
From the toxicology point of view when you are determining the numbers that you reference, could you please explain the difference between a blood sample and the urine sample as to the value it has in your analysis?
Typically we are analyzing the blood samples for drugs. Drugs in the blood generally represent what’s happening in your system, what actually can affect your system as a whole. The urine is just a simple reservoir of collecting everything that your body is metabolizing out. It is collecting everything that you possibly have taken 5 minutes ago, all the way out to days ago. Hence, that’s why we saw ephedrine in the urine but nothing in the blood. The value for us interpreting-wise, is we expect the urine to be a lot more concentrated. That is the expectation. If you find it in the blood, you expect to see a lot more of it in the urine. Usually, when we find trace amounts of things in your blood stream, we will look to the urine for an excretion product to substantiate what we think we are finding in the blood steam. It just helps us in our interpretation later down the road
So the urine is more historical in nature, it is what has been expelled from the body possibly over a period of time?
That’s correct
(blogger- David Walgren put, on the overhead, defense exhibit GG which is the lab result for gastric contents for Lorazepam. But the report has “URINE” on it)
Yes I have
Did u work thru some calculations to break that number down into a meaning as it relates to tablets?
I have
Walgren introduces a 2-page document titled “Lorazepam in Stomach”= People 172
Recross by Michael Flanagan:
Walgren introduces a 2-page document titled “Lorazepam in Stomach”= People 172
(blogger- Dan Anderson calculated THE TOTAL amount of Lorazepam is stomach based on the defense lab result which listed the CONCENTRATION of Lorazepam in stomach as 64ng/ml
What is the difference between concentration and total amount?
Concentration is the amount per unit, in our case the Lorazepam in defense lab result measured Lorazepam from a sample unit of 1 MILLILITER. To find the TOTAL AMOUNT of Lorazapen in stomach contents, we need to multiply that amount with the amount of stomach content.
Stomach content was 70gram but for uniformity of units, we need to convert this into MILLILITER which Dan Anderson measured as 73.5ml
So to find the total amount of Lorazepam in stomach, we then multiply 64ng/ml times 73.5ml =46599ng/ml )
Propofol you just don’t have the expertise to correlate its excretion into the urine with respect to how much was in blood?
That is true, yes
You wouldn’t be able to give us a timing estimate either?
No I would not
Would you with Lorazepam?
Prosecution: Objection, beyond the area of expertise
Judge: Is it beyond your area of expertise?
It is, it is certainly, you guys are touching on beyond my expertise
Judge: Sustained
By looking at the urine results and comparing it with the blood results, you can predict whether the substance was taken at a point in time close enough that the body hasn’t had a chance to come into equilibrium, can’t you?
Objection, vague, speculation, beyond his area of expertise
Beyond the scope, sustained
So but if there is nothing in the blood, there is some in the urine, it means it is taken a long time ago but if it is high in the blood and nothing in the urine, it means it is taken very recently, the drug, doesn’t it?
In a general scheme yes but you have to have knowledge that it does excrete into the urine. There are some drugs that just don’t excrete into the urine
When u did the gross calculations of milligrams of Lorazepam contained in the stomach, is it something Mr. Walgren asked you to do?
Objection, relevance
Sustained
In the event that a person were to take, say 7 or 8 tablets of Lorazepam and you were to analyze the stomach contents and you found 16mg of Lorazepam in the stomach, you would know that it was just taken, wouldn’t you?
Yes if I am analyzing the stomach for Lorazepam in that scenario, it would be a lot of Lorazepam in the stomach and the interpretation would be very recently ingested, possible abuse of the drug
(blogger- Michael Flanagan asked series of questions in an attempt to imply oral administration of Lorazepam close to the time of death. Prosecution objected consecutively. Judge sustained consecutively. The witness stated that it was not his area of expertise and that he would rather have a pharmacologist testify to these questions. Finally the judge said “we are gonna have to move another subject, Mr. Flanagan”.
“I have no further question, your Honor” stated Michael Flanagan.)
“I have no further question, your Honor” stated Michael Flanagan.)
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Michael Jackson Autopsy Report
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