Los Angeles - Michael Jackson's personal physician acted like the pop star's obedient "employee" and not his doctor, granting his every request before his June 2009 death, a medical expert told the court on Wednesday.
Anaesthesiologist Steven Shafer took the stand for the prosecution after a nearly week-long break in the trial of Conrad Murray, who has been charged with involuntary manslaughter over the King of Pop's death at age 50.
Murray is accused of giving Jackson an overdose of the anaesthetic propofol while trying to help him sleep. If convicted, he faces up to four years in prison.
"The facts, in this case, in my view, suggest that virtually none of the safeguards for sedation were in place when propofol was administered to Michael Jackson," said Shafer, an expert on the drug.
The forensic toxicology report two years ago found the cause of death to be acute intoxication of propofol, but also noted the anti-anxiety drug lorazepam was in the singer's system.
'Extraordinary amount of drugs'
"Egregious", "unconscionable", "inconceivable", "inexcusable" - Shafer did not pull punches as he described what he called Murray's professional errors on the day of Jackson's death and in the months leading up to it.
One of those mistakes, according to Shafer, was to cede to every request made by Jackson, who was paying Murray $150 000 a month.
"Michael Jackson wanted propofol every night to go to sleep and Conrad Murray said 'yes'. That is what an employee does... he's not exercising his medical judgment," Shafer said.
"A doctor would have said, 'I'm not giving anything to you, you have a sleeping disorder.'"
"The relationship between a doctor and his patient is hallowed," he said, adding that Murray "was not putting Michael Jackson first".
When asked by prosecutors about the amount of propofol Murray had bought in the 80 days before Jackson's death - 15.5 litres - Shafer said it was an "extraordinary amount of drug to purchase for a single individual".
The court was shown a video about how to properly administer propofol - a move the defence opposed as a "terrifying dramatisation" but which was allowed by Judge Michael Pastor, who called it "highly relevant".
Shafer said rules had to be followed to the letter to avoid any mishaps.
"The worst disasters that I have seen in practice have been during sedation. It's not in a big cardiac surgery, brain surgery, when everything is set up. The worst disasters occur in sedation," he said.
The trial had been suspended for two days on Monday to allow Murray's defence team to assess a new report on what was in the singer's stomach when he died.
Pastor agreed to give Murray's lawyers the time to discuss the medical examiner's report with their own experts.
The anaesthesiologist enumerated what he said was an "enormous" list of mistakes made by Murray, citing the lack of respiratory monitors, a device to control the propofol drip and blood pressure monitors.
Shafer said it was "inexcusable" that Murray failed to tell first responders what medications he had given Jackson.
He also told the court that there should not be a fear when the drug is properly used.
"Propofol is an outstanding drug," he said.
"I would like, hopefully from my testimony in part, the people to understand that when they are given these drugs by people who know what they are doing, they are good drugs and that what's happened in this case has nothing to do with their experience when they see a doctor for a procedure."
Defence lawyers have portrayed Jackson as a desperate addict and at first suggested he could have given himself an extra dose of propofol while the doctor was out of the room.
But in a surprise move they later dropped that claim and focused instead on the theory that a fatal cocktail was produced when the late singer administered himself some extra lorazepam.
The trial in Los Angeles Superior Court is expected to last until the end of October.