Los Angeles, Oct 14 : Dr. Conrad Murray's use of a cocktail of drugs on Michael Jackson as he struggled to fall asleep on the day he died was a "recipe for disaster" and ultimately caused his death, a sleep therapy expert testified Thursday.
Dr. Nader Kamanger described Murray's treatment as "unethical, disturbing and beyond comprehension."
Kamanger, one of the experts who evaluated Murray's actions for the California Medical Board, expressed dismay about the drugs Murray gave the pop star, his failure to immediately call for help and his lack of monitoring and record-keeping.
Authorities say Murray gave Jackson a fatal dose of propofol, a powerful anesthetic used in surgeries. Murray has pleaded not guilty to involuntary manslaughter in the 2009 death.
Kamanger was the third expert for the prosecution to criticize Murray's conduct. He said his first mistake was using propofol to treat insomnia, calling it an unacceptable application of the drug.
"To summarize, Mr. Jackson was receiving very inappropriate therapy in a home setting, receiving very potent therapies without monitoring," Kamanger said.
He said diazepam (Valium), lorazepam (Ativan) and midazolam (Versed) were given to the sleepless star during a 10-hour period throughout the night and morning.
"This cocktail was a recipe for disaster," Kamanger said.
Noting the addition of propofol (Dipravan), Murray's attorney, J. Michael Flanagan, asked: "Could this have caused death?'
"Absolutely," Kamanger said. "Absolutely."
Murray was unable to produce any written records on his treatment of Jackson, Kamanger noted.
"There were no records whatsoever," he said. "It's very easy to forget details. We do not rely on memory."
"So it's your opinion that there's no way he could have remembered what he did if he didn't write it down?" Flanagan asked.
"It is an egregious violation of the standard of care when you are using sedatives like propofol and you are not writing it down," Kamanger answered.
He said Jackson's demand for the drug was not a sufficient reason to give it. He also suggested Murray should have done a physical examination, taken a history from his patient about his insomnia, and called in other medical experts if necessary to evaluate the problem.
"The most important thing he should have done is call for help," Kamanger said.
He said Murray's interview with police made it clear that he waited too long to call for help when he found Jackson not breathing.
On Wednesday, Murray's defense team announced they were dropping a claim that was the centerpiece of their case -- that Jackson swallowed additional propofol when Murray was out of the room. Flanagan did not bring up self-dosing on Thursday.
Murray could face up to four years behind bars and the loss of his medical license if convicted.