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Michael Jackson's doctor made 17 flagrant violations when administering propofol to the star, an expert on the potent anaesthetic has told the court.
Dr Steven Shafer said the drug should never be used to treat insomnia and Dr Conrad Murray's negligence was directly responsible for Jackson's death.
The expert called Dr Murray "clueless" about the drug that contributed to the 50-year-old singer's June 2009 death.
Dr Murray denies involuntary manslaughter of the star.
Dr Shafer, who helped write the guidance on every bottle of propofol, told the Los Angeles court that Dr Murray did not know how to respond when the star stopped breathing.
He said of Dr Murray's delay in calling 911: "I almost don't know what to say. That is so completely and utterly inexcusable."
The Columbia University professor said propofol should never be taken as a sleeping aid.
"We are in pharmacological never-never land here, something that was done to Michael Jackson and no one else in history to my knowledge," he told the jury.
The expert in anaesthesiology also said Dr Murray had acted like the pop star's obedient "employee" and not his doctor, who should have refused the star's requests for propofol.
"Saying 'yes' is not what doctors do," said Dr Shafer. "A competent doctor would know you do not do this."
Dr Shafer testified that Dr Murray should have taken minute-by-minute notes of Jackson's condition while he was under the influence of propofol.
He said Dr Murray's lack of record keeping had been a denial of Jackson's rights.
Dr Shafer also criticised Dr Murray for talking on the phone in the hours before Jackson's death.
The anaesthesiology expert said doctors should never multi-task while monitoring a sedated patient.
"A patient who is about to die does not look all that different from a patient who is OK," he said.
Dr Shafer is expected to be the prosecution's final witness, and his testimony will continue on Thursday.
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