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Published November 16 2012

Expert witness for Fargo surgeon says alleged sex assault 'not anatomically possible'

FARGO – A medical expert witness who testified Friday in the defense of Fargo doctor Jon Norberg said the surgeon safely injected his wife with the powerful sedative propofol in their home and called her description of how she awoke to her husband forcing oral sex on her “not anatomically possible.”

Jon Norberg is accused of injecting his wife, Alonna Norberg, with propofol without her consent and sexually assaulting her while she was sedated.

Alonna Norberg, a pediatrician with emergency room training, has testified that she agreed to let her husband inject her with Diprivan – the brand name for propofol – three times, but that she told him to stop using it when she found out it was propofol, a medication unique for its milky white appearance.

Dr. Joseph Ramos, a practicing physician and former surgical instructor at the University of Colorado who has taught conscious sedation, 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 thing was plausible.

“Not even maybe,” Ramos said.

On cross-examination, prosecutor Gary Euren asked Ramos how he knew exactly what training Alonna Norberg had to formulate his opinion.

“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.

Euren, an assistant Cass County state’s attorney, then showed Ramos an insurance company’s drug list of more than 1,200 approved medications.

“A number of which have other names, right?” Euren asked.

“Right,” Ramos said.

‘Doctor shopping’

After reviewing Alonna Norberg’s medical records, Ramos said her use of and tolerance of pain medications was “unique, to put it politely.”

He noted that at one point she was on 51 medications, and he said he found 39 different diagnoses listed in her records.

“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 said.

Ramos, who also is a licensed attorney, questioned whether Alonna Norberg actually has Sjogren’s syndrome, an immune system disorder, saying, “Many of the tests for it came back negative.”

Euren focused on an affidavit by Jon Norberg in which he stated he gave propofol to his wife 32 times over 18 months and had sex with her while she was under its influence.

Ramos said he and Jon Norberg discussed the sex in an interview. He said Jon 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.”

“Is that a benefit? I think it’s a benefit,” Ramos said, adding, “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.”

Euren asked if the sex was consistent with Jon Norberg being vigilant in observing his wife’s condition. Ramos said it was, contrasting the testimony heard last week from prosecution 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.

Sedation opinions differ

Shafer, a professor of anesthesiology at Stanford University and star witness in the trial of the doctor convicted in pop singer Michael Jackson’s death, testified earlier in the trial that Jon Norberg’s monitoring of his wife while giving her propofol and the fact that he had sex with her while she was under its influence were “all well below the standard of care.”

Shafer also said that based on statements made by Jon Norberg about how he administered propofol to his wife, it appeared she experienced short intervals of low-level awareness between periods of unconsciousness. His testimony bolstered her recollection of the alleged assault on the night of June 16-17, 2011, as a “clip in time.”

Ramos agreed with Shafer that Alonna Norberg’s level of sedation was minimal to moderate, but he said even if she had gone into moderate sedation, she “absolutely” would have been able to converse with her husband.

Regarding her description of coming in and out of consciousness, Ramos said, “the whole dreamy in-and-out thing … it’s not medically explainable” because of the quick recovery time when propofol wears off.

Ramos said Alonna Norberg’s description of the assault – with her husband on top of her, pinning her arms down with his legs and pulling her head toward him – “is not anatomically possible” given her position and his.

And, in order to return Alonna Norberg to unconsciousness, her husband would have needed to inject more propofol into her chest port, something he wasn’t in a position to do given her description of events, Ramos said.

Ramos also noted that patients receiving certain medications, including propofol, will exhibit a natural bite reflex before they completely go under. He said the level of propofol given to Alonna Norberg wasn’t enough for her to go into deep sedation, but even if she had, the act in question wouldn’t work.

Heated exchange

In a tense moment, Ramos and Euren wrangled over what Jon Norberg meant when he stated in an affidavit that his goal was to dose his wife with propofol to a level of minimal to moderate sedation – the latter falling under stricter guidelines that the state contends he didn’t follow, putting her life at risk.

Ramos said he believed Jon Norberg meant he was aiming for minimal sedation but prepared for the next step, moderate sedation – “not the 10th worst step” as he said Euren had tried to point out, which Euren denied doing.

“I would ask you not to put words in my mouth,” Euren said sternly.

“I apologize,” Ramos said.

“And I will try not to put words in my 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,” he said.

Ramos’ testimony consumed most of Friday, the seventh day of testimony in a trial that started with jury selection Nov. 5. Jurors also heard from the Norbergs’ former nanny.

Defense testimony will continue Monday.

Hoy said after court Friday that the defense hadn’t decided yet whether Jon Norberg will testify.

Jon 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.

Though The Forum does not usually identify alleged victims of sexual assaults, Alonna Norberg consented to be named to contest her husband’s claims that she gave him permission to use propofol on her and that he never sexually abused her.

Readers can reach Forum reporter Mike Nowatzki at (701) 241-5528

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