David Fournier


David Fournier (CRNA: Nurse Anesthetist)

Jackson V AEG Live July 25th 2013 Transcripts David J. Fournier, CRNA

The following are updates from media, Please bookmark this page as transcripts will be posted here in few days.

Michael Jackson had a high tolerance for certain drugs and wasn’t always forthcoming with his medical history, a nurse anesthetist who treated the singer testified Thursday.

Witness David Fournier told jurors he had worked with Jackson for a decade until the relationship ended in 2003, when Fournier refused to participate in a medical procedure.

Jackson was acting “goofy” and was slow to respond to standard questions before a scheduled cosmetic surgery that was canceled after Fournier refused to administer an anesthetic, he said.

The incident came a few months after Fournier said he had to help Jackson breath while undergoing another procedure and later determined that Jackson had not disclosed a new medical condition.

“He wasn’t honest with me,” Fournier said.

At the time, Jackson had an implant in his abdomen to block the effects of Demerol and other opiate drugs.

Fournier testified that he had given the singer a relatively large dose of a powerful anesthetic and needed to know how Jackson was going to react.

AEG denies it is liable for Jackson’s death. Its lawyers have said Jackson hid his prescription drug use from nearly everyone.

Fournier said his incomplete medical records show he administered propofol to Jackson at least 14 times between 2000 and 2003. He estimated he gave the singer the drug numerous other times over the years for a variety of cosmetic and dental procedures.

He noted in his records that Jackson had a high tolerance for certain drugs, which Fournier said could be attributed to a variety of factors, including genetics.

During cross-examination, Fournier said Jackson never requested any specific drugs, including propofol, during procedures or asked to be sedated for longer than was necessary. He said the singer didn’t exhibit any drug-seeking behavior or signs that he was doctor-shopping.

Fournier said he knew that Jackson had received an above-average number of anesthetic treatments over his lifetime, and many were related to procedures needed after Jackson was badly burned in a shoot for a Pepsi commercial in 1984.

Fournier said it was not common to administer an anesthetic during cosmetic procedures, but the ones done on Jackson were complex and involved dozens of injections. Some of the procedures were near Jackson’s eye and sedation was necessary to keep him still, Fournier said.

Fournier also said he never had any indication that the singer was using propofol as a treatment for insomnia.

Jackson’s physician Conrad Murray had been giving the singer nightly doses of propofol as Jackson prepared for his ill-fated “This Is It” shows.

Mrs Jackson was i court today,
Outside the presence of the jury, Jacksons’ attorney Brian Panish expressed concern about next witness.
Nurse and anesthetist David Fournie had conversation with Dr. Klein and defendants want to introduce that conversation in the testimony.

Fournier is performing anesthesia in MJ, there’s a situation that arises, Kathryn Cahan said.

‘Oh, he has a Narcan implant,’ Dr. Klein allegedly told Fournier, who then directs Fournier how to treat MJ.

Panish said this was in 2003. He claims it’s character evidence, that MJ never disclosed it to the nurse. He also claims to be hearsay.

Judge asked sides to research if the conversation would be considered exception to the hearsay rule.
Bina said Fournier didn’t know what to do, he asked the doctor and changed the treatment. She said MJ admitted he had an implant after.

Cahan: He’s administered anesthesia, MJ stopped breathing for 5 minutes, Fournier had to breath for him
Cahan: That continues until he realizes there’s a reaction to Narcan implant.

Panish asked what the relevance is, said defendants are trying to introduce character evidence, which has nothing to do with this case.

Cahan said the relevance is that Fournier asked MJ about changes from prior treatment.

Cahan: MJ knew he had a Narcan implant and chose not to disclose it. He stopped breathing for 5 minutes in the middle of the procedure.

Cahan said it goes to the issues of life expectancy, addiction issue, concealment of drug use.
Judge is overruling the objection since she thinks it’s been offered for the truth and it’s hearsay. Defendants not allowed to use it.

Kathryn Cahan did direct examination of David Fournier. Fournier said he’s terrified of testifying today. He’s testified twice before. He is a Certified registered nurse anesthetist, trained in the specialty of anesthesia. He did Bachelor Degree in Nursing and Master’s Degree in Anesthesia. There’s a board exam that need to be taken, Fournier did very well. There’s a number of hours of continuing education needed to maintain license. Anesthesiologist gets bachelor degree in science, then medical school. Nurse anesthetist goes 2 nursing school, then same training as doctor

Fournier graduated in 1984 from UCLA, has been practicing continuously since that time.  He’s self-employed, works at outpatient surgery in Beverly Hills; works with plastic, reconstructive, orthopedics, gynecological surgeries  Fournier said he got a call in 1992 from a dermatologist’s office, asked him to come by, stand by, didn’t tell him who the client was. Doctor had a concern there might be anaphylactic reaction to inoculations. Fournier: I initially refused, I don’t do that, doctor was very insistent, offered me cash upfront. “He said it was really important for me to go, since it was Michael Jackson,” Fournier recalled. Fournier said the doctor was very concerned, didn’t want anything to go wrong. Airway management is one of his skills, Fournier said.

Three to six months later, Fournier recalled he was called back to treat MJ. This was in Jan 1993. Most of the records were destroyed due to time limit, Fournier said. Last time he treated Michael was in 2003, about 6 yrs before his death.  He treated MJ for about 10 years. Fournier said he does not have all the records of his treatment to Michael Jackson, but has some. Fournier gave a deposition in this case. He provided the medical records he had pursuant to a subpoena.

Fournier said he believes the standard is 7 years before a physician destroys a patient’s record. Some of the times I did not give him medication, just observed him, Fournier said.  Fournier estimates he treated MJ 30-35 times, anesthesia perhaps 25 times. Cahan showed a medical history form and anesthetic consent. Weight: 130 lbs — Date: 1/19/2000 Fournier said he always asks height and weight of patients and if he thinks the weight is off, he puts patient on scale. Michael had a number of aliases, Omar Arnold was one of them, Fournier said. MJ said he weighed 130 lbs in January of 2000. Fournier said he probably accepted MJ’s representation. Weight is a factor in anesthesia, Fournier said. It gives a very rough estimate where to start the dosage.

Fournier: I think he weighed between 130 and 140 pounds during the 10 years I treated him. Cahan: Did he have a good appetite? Fournier: Not really. I would ask him what he had to eat last and he would say lunch the day before One time Fournier said he asked why MJ was down to 130 lbs. He said the singer told him he had been on tour, dancing. Cahan asked if it concerned him that MJ was 130 lbs. Fournier: No, he’s lean, muscular, in good shape, so no Fournier explained all the questions he asks the patient before giving anesthesia: medical history, medications, etc. The nurse said that if it’s a regular patient, he would still take medical history, but it would be abbreviated.

Fournier said he always took MJ’s medical history prior to procedures. The nurse worked on MJ at the following procedures: scalp reduction for burn he suffered, abscessed tooth, root canal More procedures: extensive tattooing on his lips, eyes, brown area, Botox, collagen and filler injections Cahan: Do you frequently anesthetize patients receiving Botox or fillers? Fournier: No Fournier: Michael was special in that. Instead of 5 or 6 injections that people normally get, MJ would get 50-100 MJ got 100s of injections around the eye, various parts of his face. It’s more than average patients, needed to be sedated to tolerate pain. Fournier has been using Propofol since 1990. It’s appropriate to use the drug mostly in operating room and/or controlled setting, he said.

Equipment needed for Safe Administration of Propofol: Ambu bag and mask, Assorted airway equipment, Laryngoscope blade, Laryngeal mask More equipments: Endotracheal tube ready to go, Available source of oxygen, EKG, Capnograph, Ability to measure blood pressure More equipment: Pulse oximeter, IV access and IV fluids, Resuscitation Drugs, Continuos monitoring Fournier said to keep patient sedated you also need computerizing infusion. It’s a more controlled way to administer drugs rather than drip.  Depending on the dose, the patient can breath on his own, Fournier said.

Fournier read the label of Diprivan (brand name for Propofol). He said monitoring the patient is a full time job. All the equipments needed are very expensive, Fournier said. He had about $70,000 invested in his operating room.  “Every time we give anesthetic there’s a potential for reaction,” Fournier said. Propofol is not available in pill form and is not given as prescription to patients because it’s an anesthetic, dangerous, Fournier said. If the drug is not in proper hands, administered with proper monitoring, it’s dangerous, Fournier explained Fournier said Propofol half life is 2-8 minutes. It metabolizes relatively quickly, patients wake up feeling well, there’s anti-nausea in it

The nurse said Propofol burns if not given correctly, can cause hypertension. Medical record from 4/11/02: Omar Arnold Weight: 132 lbs Dr. Koplin Multiple collagen injections Additional drugs given — Propofol 140 mg Cahan said she counted 14 different occasions where Fournier administered Propofol to MJ. He has record for 2000, 2002 and 2003 only. From 1993 to 2000, there are no medical records. He said he believes he gave MJ Propofol in 2001, but does not have records. He said he did not administer anesthetics after September 2003. Fournier: The street name (of Propofol) is “milk of amnesia.” One time I remember he (MJ) referred to it as “milk.”

Fournier said MJ was very warm, likable guy and they became friends. He visited Neverland twice. MJ never told him he was using Propofol to help sleep. Fournier said he never used Propofol to treat a patient for insomnia. The nurse said he had trouble some times placing IV on Michael Jackson. He said at times he would have to change places. Fournier said it required multiple attempts some times to get an IV line in MJ. “I think the most I had to stick him was 3 times,” he said. Fournier explained that some times he would have to start IV on small veins on MJ on the top of his finger or surface of the arm.

Medical record from 5/13/2003 — weight 135 lbs difficult IV place, difficult monitoring anesthesia, high tolerance of medication Fournier said sometimes he would go 6 months without seeing MJ, so he explained the risks of anesthesia every time.  Medical record of 11/14/2000 Weight: 130 lbs Mentions Versed, 5 mg Very high tolerance noted Vitals stable Versed is a benzodiazepine, same as Valium, Fournier explained. “He was taking a little bit more than I’d anticipate to keep him comfortable,” Fournier said. Fournier’s normal starting dose is 1 mg of Versed. This was a dental procedure. The nurse cannot perform any procedure without a doctor present. Doctors MJ saw: – Dr. Arnold Klein (dermatologist) Doctors MJ saw: – Dr. Stephen Hoefflin (plastic surgery)- Dr. Allan Metzger (internist) – Dr. Lawrence Koplin (plastic surgery)

Doctors MJ saw: – Dr. Edward “Lee” Baxley (dentist) – Dr. Leslie Levine (dentist) Doctors MJ saw: – Dr. Lee Bosley (hair restoration) – Dr. Gary Tearston (plastic reconstructive surgery) Fournier said it is not appropriate to give Propofol in a home setting. He would never allow a patient to dictate how to give anesthesia. MJ was very concerned about his privacy, Fournier said. He could not even go shopping without being disguised. “He loved people, but people could be overbearing sometimes,” Fournier explained. Fournier said MJ would have procedures done in the evening, came in the back door, bodyguards used umbrella to shield the camera.

MJ used aliases, before he left they looked outside to see if paparazzi were not there. Other aliases MJ used: Michael James, Jack James. “Procedures were done at night to protect his privacy and for his safety,” Fournier said. Cahan: Was there a time you didn’t think MJ was being truthful with you? Fournier: Towards the end of our working relationship, yes

Medical records from 6/02/2003 Problems: Denies any medical or medication changes Three days ago slurred speech, heard on the phone
Fournier said 3 days before the procedure it was his birthday and MJ called to wish happy birthday. “His speech was slurred,” the nurse said

Fournier testified Michael told him he was tired, or might’ve take something to sleep.
“He was more than tired, he was slurring the words,” Fournier said. “I assumed something was going on.”
Fournier said he quizzed MJ about the slurred speech, if he was using recreational drugs. He denied it, said he was not using anything.

Medical record from 6/02/03: Dr. Klein Multiple derm procedures Weight: 140 lbs

At some point MJ had an unusual reaction, Fournier said

Fournier: I controlled his ventilation 4 couple of minutes, it happened again, I lightened him up, assisted one more time w/ his breathing.

Fournier said Dr. Klein told him something during the procedure and that they spoke after about it.

MJ did not tell Fournier about any recent changes in his medication, according to Fournier’s chart.

Cahan: Did you form an impression after this procedure whether MJ was being honest with you denying any change of medication?

Fournier: My impression is that he had not been truthful

Fournier: The last time I treated MJ, a few months after, he came to surgery center. He was a little goofy, a little slow to respond.

Fournier: I asked if there were any changes in medication, he denied it, I didn’t believe it, we canceled the procedure

“He was acting inappropriate,” Fournier recalled. He said he believes the procedure was with Dr. Klein and another doctor to do facial work.

Fournier said he felt uncomfortable. This was about 3 months after the last procedure.

Judge: Was Dr. Klein there? Fournier: Yes Judge: And he didn’t stop the procedure? Fournier: Michael came in and I made the decision

After that, Fournier explained what happened to their relationship.

Fournier: Despite 10 years of quality of care, and taking good care of him, he (MJ) never called me back

Fournier: I felt this period here, in June (of 2003), he wasn’t honest with me

Fournier said that post-operatively they want patients to go home with an adult to keep an eye on them for 24 hours.

“I told him to go home and instead of going home he went to rehearse,” Fournier said. MJ sprained his ankle at rehearsal for Grammy Awards.

Fournier said he tells patients after anesthesia to resume diet slowly, told MJ to go home, have crackers, soup.

But he said he happened to drive by Kentucky Fried Chicken, saw MJ’s limo parked. Fournier tapped at the window and saw MJ eating a bucket of chicken and some biscuits. “He was embarrassed,” Fournier said.

Fournier said MJ became a patient in 1992-93. He said in 1993 MJ announced he was addicted to prescription medication. Every time they met, Fournier said they talked about the medications he was taking. Cahan: Did you ever administer an opioid/painkiller in connection with a procedure? Fournier: Yes. Fentanyl, Demerol, Dilaudid

They are controlled substances to relieve pain, Fournier said. MJ said he did not like Demerol one time, according to the nurse.

Cahan: In the last times you treated MJ, did he ask you not to use Demerol? Fournier: Yes, he said he didn’t like it, didn’t want it

Cahan: Did you ever have a conversation with Mr. Jackson where he said he had a procedure to block the effects of opioids? Fournier: No

“My understanding is that the last time he had a problem (with Demerol) was in 1993, when he announced to the world,” Fournier said.

MJ never discussed Naltrexone with Fournier. Cahan: Do you know what Narcan implant is? Fournier: I do now, it was not FDA approved then

Cahan: Did you have conversation with Mr. Jackson about Narcan implant? Fournier: Yes

Fournier: Subsequent to the procedure, he said he have had one but it was out, that he was clean and didn’t need one.

This was late August/September in 2003, after the procedure MJ stopped breathing.

Fournier said the discussion was probably pre-op call before a procedure. Fournier: I had become aware of Narcan implant had been used for his care so I asked him about that. The procedure moved forward next day, Fournier said. MJ did great. Fournier said he was sometimes paid for his work, but sometimes it took up to a year to receive payment for care to Michael Jackson.

Fournier said he ran into MJ in 2005 at the waiting room of a doctor’s office.

Michael Koskoff did cross examination. He wanted to talk about the thing that really got you angry at MJ. “I wasn’t angry,” Fournier said.

Koskoff recalled the day MJ called Fournier to wish him happy birthday. Fournier said he knew MJ had a problem sleeping.

Koskoff asked if Fournier inquired ‘Michael, has there been any change in medication since last time I saw you?’ Fournier: Correct Koskoff: And MJ said there was no changes Fournier: Right Koskoff: Something happened at that point to make you believe Michael had misrepresented that he didn’t change his medications?

Fournier: I believe he denied all medications

Koskoff asked if MJ did well in the procedure on 5/13/03. “Other than difficult IV placement and high tolerance to medication, he did fine”

Koskoff asked in April 24, 2003 — how did that procedure go? Fournier: No problem

Koskoff: Did you believe he was lying to you? Fournier: The problem happened after that discussion

June 2, 2003 is the date MJ had an apnea episode. “Yes, I was upset about that,” Fournier said.

Koskoff: Would you be willing to apologize to Mrs. Jackson for saying her son was lying to you? Objection, sustained, irrelevant

Koskoff: You have no knowledge whether the Narcan implant had anything to do with the reaction in June? Fournier: No

Fournier said he never heard Narcan as an implant, had never seen one
“I was told by two of his physicians there was one,” Fournier said. He spoke with doctors Klein and Metzger about it.

Koskoff: If Dr. Farshchian said it was Naltrexone implant and he thought it was the same as Narcan, it would be a mistake, correct?

Fournier: Correct. They are two different drugs.

Dr. Klein told Fournier MJ had a Narcan implant, he went home, research it and could not find anything on it.
“I know the effects of Narcan,” Fournier said. It can cause cardiac arrest, tachycardia, defibrillation.

Naloxene, which is Narcan — Fournier has familiarity with it Fournier is not used to Naltrexone, but said it’s also an opioid inhibitor.
Koskoff: Do you know the effects of Naltroxene in anesthesia?

Fournier: It would have the same effect of this kinds of drugs, antagonist opioid effect and it’s dose-dependent.

Koskoff: In approximately 10 year he never reported to you allergy to Demerol? Fournier: In the last year he did (after he started implant)

Fournier: He never told me he was allergic to it (Demerol), he said he didn’t like it.

In the medical record, Fournier wrote allergy to Demerol. He said it was a code to himself to not give MJ that drug.

Koskoff: Did you use any opiates in June 2? Fournier: Yes, Remifentanil

Koskoff: May, 2003 — did you give him an opioid? Fournier: Remifentanil, high dose, developed tolerance Propofol — 240 mg

Koskoff: If you assume he was implanted in April 2003, at this time (May) he had it on, right? Fournier: Correct

Medical record from May 13, 2003: Height: 72 inches (6 feet) Weight: 140 lbs Allergy: Demerol Medications: Denied

Koskoff asked if Fournier knows what caused the reaction on June 2, 2003.

“I have a suspicion of what causes it,” Fournier said. “Very strong suspicion.”
Fournier has no prescription authority in California.

Koskoff said about holding Michael’s hand, if that was literal. Fournier: Yes, it’s literal

Fournier: the doctors appreciated someone monitoring MJ, he was very important, at the peak of his career, and Michael was paying me

“They were very happy to have me there to make sure Michael was safe,” Fournier testified.

Koskoff: You said you literally held his hand? Fournier: Yes, for painful injections, squeeze my hand if you feel pain

Fournier agreed that Michael never chose the drugs he administered, never asked for more.

Koskoff: You gave MJ Propofol and he never asked you for Propofol, correct? Fournier: Correct

Koskoff: You called the shots? Fournier: Correct

Koskoff: If someone say MJ had drug-seeking behavior, you didn’t see it? Fournier: Correct

All the doctors treating MJ were top notch physicians, Fournier said.

Fournier about Dr. Klein and Botox: He was quick to tell me he was a pioneer and no one could do better than him

Fournier said he never felt MJ had anesthesia inappropriately and didn’t feel like MJ was doctor shopping.

Koskoff: Did he ever ask you to remain under anesthesia for longer than you thought was necessary? Fournier: No

“He told me he didn’t like it,” Fournier said MJ told him about Demerol.

Koskoff: Physically, during the time you treated him, did he look well? Fournier: Yes

Fournier said MJ was very thin and frail in pictures he saw of the singer in 2009.
Koskoff asked if MJ was the same as when Fournier treated him. “He was thinner,” Fournier responded.
Koskoff: Isn’t it true a fit and competent doctor would not give Propofol at home? Fournier: Correct

Fournier said he uses Demerol in a limited basis. It was popular in the ’70s. It’s a drug used for pain, analgesic, opioid.

“12.5 mg of Demerol is giving intravenously for shivering,” Fournier said. The dose if from 12.5-25 mg.

Koskoff: You treated MJ over period of more than 10 years Fournier: Correct

Fournier said they had a good relationship and MJ was a good patient. But MJ did not followed post-operative recommendations.

Koskoff asked if Fournier was more concerned that Dr. Klein didn’t tell him. He said yes. Michael told Dr. Klein about it, Koskoff said.

“You expect your clients and your doctors to be honest with you,” Fournier explained.
Fournier: I was angry at Dr. Klein, I was angry at Michael, I was angry at anyone who knew about it and didn’t tell me.

Koskoff: Are you still mad? Fournier: No, got over it
Fournier said it’s a small community (of anesthesiologists) and everyone talks to everybody about who they are treating.

“Sometimes when it involved patient care, we talk to each other,” Fournier said.

Koskoff: If MJ was concerned that an anesthetist was talking about him having Narcan for drug addiction, would that be a valid concern?

Fournier said he didn’t understand the question, that he talked to other people treating MJ.

Koskoff said there are 200-300 people in the anesthesia community.

Fournier: If you’re taking care of somebody and if someone else asks you, that’s taking care of patient. It’s not chattering.

Fournier said it’s usual for physicians to look at charts to see what kind of treatment was done before and the response he had.

Cahan, in re-direct, asked if 300 mg of Demerol in single intramuscular is a lot. “That’s a tremendous amount,” Fournier responded.

“If you gave it to me I would probably stop breathing,” Fournier said.

“If you gave it to me I would probably stop breathing,” Fournier said.

Fournier: Hiding information from person who’s going to take care of you can lead to untoward event.

Cahan asked Fournier to assume MJ, beginning in Nov 2002 to July 2003 placed 5 Naltrexone implants.

Cahan: Did MJ ever say he was on any medication whatsoever in April, May and June 2003?

Fournier: All of those times Michael denied taking any medication

Cahan: So 3 times in 2003 he did not disclose he had a Naltroxene implant? Fournier: Correct

“He was not telling me the truth,” Fournier said.

Fournier said that after he canceled the surgery, MJ never called him again on his birthday and never used his service anymore.

Koskoff asked Fournier if he knows whether Dr. Farshchian told MJ the implant had medication in it. He said he doesn’t know.

So if MJ didn’t say anything about the implant, it could be because he didn’t know it was a medication, Koskoff asked.

Fournier: I’m going to assume if he’s having a surgical procedure to implant something he would know what that is for.

Dr. Klein apologized afterwards for not telling Fournier about the implant.

“Some burn patients get hundreds of anesthesia,” Fournier said, and Michael was a burn patient.
“I knew he was in the hospital in 1994 after the burn, yes,” Fournier said.

Witness is excused. Trial adjourned until tomorrow morning at 9:30 am. Next witness is Dr. Scott Saunders – via video deposition.
Then next witness will be Eric Briggs – Retained expert projections and evaluation in the entertainment business (to counter what Erk said)

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