Rape Trial Medical Expert: Home Propofol Safe Sex Aid

Dr Ramos

Fargo, ND – Well Law Med has now heard everything and can die satisfied. Yesterday Dr. Joseph Ramos, a medical expert called by the defense in the Propofol Rape Trial of Jon Norberg, testified that when injecting his wife with the powerful sedative/anesthetic propofol, Norberg’s goal was to relieve his wife’s pain and anxiety, and that one of the benefits of someone being happy and not in pain is that they may be interested in things like sex, travel and family functions, “doing some of the things he missed.”

Referring to Norberg sedating his wife with propofol and then having sex with her, Ramos said “Is that a benefit? I think it’s a benefit. Is the goal to have a happy family and do those things. Yes, that’s probably a goal. Is the goal to knock her out and have sex with a rag? No.”

On cross examination, prosecutor Gary Euren asked Ramos if the sex was consistent with Jon Norberg being vigilant in treating his wife with propofol. Ramos claimed  it was, in direct contrast with the testimony heard last week from prosecution propofol medical expert Dr. Steven Shafer. “If he gives her propofol and she feels better and he’s having sex with an awake, interactive, talking person, that’s vigilant. That’s fine,” Ramos said.  Ramos said that Dr. Jon Norberg’s use of propifol, in his house, without monitors or equipment which the drug company’s insert says are required in compliance with FDA requirements, was not reckless in any way. One of the charges Norberg faces is felony reckless endangerment for this very reason.

How Ramos, as a trained emergency medicine physician, could with a straight face spin home propofol injections followed by sex with the patient as in any way beneficial, appropriate or “vigilant” is utterly mind-boggling. It smacks of a case of “pay my fee and I will say anything you want”.

Law Med cannot recall hearing anything more preposterous come from a medical experts mouth on a witness stand. This beats the previous record held by a surgeon who once testified that a patient may have had blood in their stool because they ate some “raw or poorly cooked meat”. This is AMAZING news that should be distributed to anesthesia professionals everywhere! When sedating patients with propofol you may have sex with them (consent given first of course) and it is NOT considered to be something which distracts you from monitoring your patient! Hopefully Dr. Ramos will write a paper on the subject as I am sure he will have NO shortage of anesthesiology journals clamoring to publish his breakthrough findings. After all it is not every day that a practicing physician “expert” and former surgical instructor at the University of Colorado who has “taught conscious sedation” and is NOT an expert on propofol or anesthesia, comes up with something that flies in the face of the most basic principles of the practice of anesthesia.

I trust I have not been too subtle in my sarcasm.

Ramos did manage to make SOME sense and expressed an opinion which Law Med has previously voiced. He was asked by defense attorney Robert Hoy if he thought Alonna Norberg’s claim that she didn’t know Diprivan and propofol were the same drug was plausible. “Not even maybe,” Ramos said.

On cross Euren asked Ramos how he knew exactly what training Alonna Norberg had regarding Diprivan. “You do not make it through medical school residency and emergency medicine residency and be a specialist in pediatric emergency medicine and try to pull some line that you don’t know the difference between Diprivan and propofol. That is a joke,” Ramos said.

When Alonna Norberg first testified that she did not know that Dirpivan was the same drug as propofol we said:

There are major problems with Alonna Norberg’s story. First of all, she is an emergency room physician. EVERY emergency room physician knows what Diprivan is, unless they went through residency in the very recent past as the drug came off patent and is now referred to mostly by its generic name propofol. Regardless, what sort of physician consents to the off label use of an IV medication on their person without looking the drug up for themselves? It is absurd. Furthermore, propofol is an utterly unique drug as it is the only drug in the world which is milky white. In fact its nickname is “the milk of amnesia”. Surely she would have noticed this when her husband came at her with a syringe filled with white liquid. And EVERY emergency room physician, even those who graduated yesterday, knows what propofol is.

In review of Alonna Norberg’s medical records, Ramos said her use of and tolerance of pain medications was “unique, to put it politely.” At one point she was on 51 medications, and he found 39 different diagnoses listed. “There were so many doctor’s notes, sometimes from similar fields, it was almost what we call ‘doctor shopping’ in medicine, where you go to one pain doctor and they don’t give you what you want so you go to another and they don’t give you what you want and you go to another state because the two don’t give you what you want,” he said.

“Could it have been just simply the fact that she had extreme pain that nothing was taking care of?” Euren asked. “Yes,” Ramos replied. Ramos also questioned whether Alonna Norberg actually has Sjogren’s syndrome, an immune system disorder which can be accompanied by arthritis. “Many of the tests for it came back negative,” he noted.

Ramos then made some more ridiculous claims. He agreed with the prosecution’s expert Dr. Shafer, that the level of sedation (based on Alonna Norberg’s description of events) was “minimal to moderate”. But then he said even if she had gotten moderate sedation, she “absolutely” would have been able to converse with her husband.
Regarding Norberg’s description of coming in and out of consciousness, Ramos said, “the whole dreamy in-and-out thing … it’s not medically explainable” pointing to the quick recovery time patient’s experience as the drug wears off. Ramos went on to claim that the oral sex event was “anatomically impossible” and that it would require additional propofol to be injected into the chest port, which Jon Norberg could not have reached while in that position. In addition he claimed that Mrs. Norberg would have exhibited a natural “bite reflex” due to the amount of propofol and sedation making the act impossible.

Nonsense. When sedated with propofol a patient does not converse with anyone. Does not matter if it is light or moderate. If administered in a dose which sedates the patient, propofol results in unconsciousness…period. Whether the patient wakes up when physical stimuli is applied is one thing, but the ability to carry on a conversation is one of the first things lost under propofol sedation. The danger of having anything stuck in such a patient’s mouth being bitten off is quite real, but the “natural bite reflex” Ramos describes is not a medical fact. Law Med can see no reason why additional propofol could not be injected into a chest port while straddling the victims chest. And Law Med IS an expert on propofol, its administration and effects.

Euren at one point had a heated exchange with Ramos. Ramos said he believed Jon Norberg meant he was aiming for minimal sedation but prepared for the next step when in his affidavit he had said his goal was to dose his wife with propofol to a level of minimal to moderate sedation, “not the 10th worst step” as he said Euren had claimed. Euren, who had not made such a comment, was not happy.

“I would ask you not to put words in my mouth,” Euren shot back angrily.

“I apologize,” Ramos said.

“And I will try not to put words in your mouth,” Euren said.

“I apologize. I’m just trying to teach you how doctors think on these things,” Ramos said.

“I don’t need to be taught by you. I’m asking the questions, you answer them,” Euren said tersely.

The defense will continue with their witness testimony on Monday. Defense attorney Hoy said he has not decided whether Jon Norberg will take the stand in his own defense. Norberg is charged with gross sexual imposition, a Class AA felony punishable by up to life in prison upon conviction. He also faces a Class C felony reckless endangerment charge carrying a maximum penalty of five years.

Dr. Joseph Ramos Has A Clouded Past

Dr. Joseph Ramos is an emergency medicine physician in Denver and a member of the clinical faculty at the University of Colorado Health Sciences Center. However he is also an owner of a string of clinics that treat personal injury patients who are referred by attorneys representing them in related lawsuits or insurance claims, exclusively. Ramos and chiropractor Robert Walford co-owned and operated Spine and Injury Centers, a company which operated a number of such clinics. They had struck an agreement with local personal injury attorney David Mintz where they would pay $10,000 per month to Lawyer Connection, a company owned by Mintz’s wife, Julia, for “marketing”.  The Lawyer Connection ran print and TV ads promoting the Mintz Law Firm. Accident victims who called the ad’s toll-free number in search of legal advice would be referred to the firm for a consultation. If those callers also needed medical care, they were urged to see one of several providers. Those providers had either paid for their own ads through the Lawyer Connection or were contributing to the operation’s overhead, including paying for the phone dispatchers who screened the calls. At $10,000 per month, Spine and Injury Centers got their fair share of referrals.

Accepting a fee to refer patients to a medical provider is not allowed and can result in disbarment for an attorney. Having your wife accept the fee via a company she owns is pushing the envelope. In addition to the ten grand a month for marketing costs, Spine and Injury Centers was paying the Lawyer Connection up to 20 percent of the fees it collected from patients who’d been referred to them by Mintz’s firm. According to Ramos this was a continuation of an arrangement that Walford had with the Lawyer Connection before Ramos entered the picture.

Ramos and Walford dissolved their partnership in 2004. Walford left Colorado for a time, while Ramos went on to launch another series of injury-treatment clinics, Mile High Medical Group, with orthopedic surgeon Steven Nadler, who also worked at Spine and Injury Centers. Ramos also went to law school. Mintz and Ramos had a falling out and a legal dispute over client funds and monies owed ensued and resulted in the court taking control of some funds. Mintz and Ramos traded accusations and Mintz claims Ramos was running an enterprise aimed at defrauding insurance companies.

For an in-depth investigative report into these shenanigans see the 2007 Denver Westword News piece called High Trauma. What does all this have to do with anything? A medical expert witness who is an emergency medicine physician, yet spends a great deal of time and effort in alternative money making schemes involving personal injury attorneys, who also went to law school, is, in Law Med’s view, more likely to shape their opinions according to the needs of their attorney client rather than acceptable medical standard of care. Considering the bizarre testimony given by Ramos AND his history of business activities, questions and red flags are raised.

 

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