Patterico's Pontifications

8/24/2009

Michael Jackson’s Death Ruled a Homicide

Filed under: General — DRJ @ 3:33 pm

[Guest post by DRJ]

Michael Jackson’s death has been ruled a homicide by the LA County Coroner due to lethal levels of the anesthetic propofol.

— DRJ

Comments (44)

44 Responses to “Michael Jackson’s Death Ruled a Homicide”

Quick – play the race card!
JayC (5122d1) — 8/24/2009 @ 3:42 pm
So does this mean that they’re going after his live – in doctor? That guy was shady beyond belief.
Dmac (e6d1c2) — 8/24/2009 @ 3:52 pm
This will probably sound stupid, but in CA, would they ever classify a suicide a homicide? Just making sure. From the article, it sure sounded like the Dr. was culpable.
carlitos (3b87c2) — 8/24/2009 @ 3:56 pm
My wife, who is an OR nurse, could not believe that the drug was being used in a private home.
Mike K (2cf494) — 8/24/2009 @ 4:05 pm
i believe in homicide…

although i’m thinking it was more negligent than felonious…. but then again, i’m no lawyer.
redc1c4 (fb8750) — 8/24/2009 @ 4:08 pm
It might not be homicide, but sure smacks of “reckless disregard”!
There was no excuse for this drug being present in a home environment.
AD - RtR/OS! (cbe8a1) — 8/24/2009 @ 4:32 pm
#6: it *can* be used in a home environment, it’s just not used there very often, because you have to be on all sort of monitors and have various equipment on standby in case someone screws up…. but i have seen it used there.
redc1c4 (fb8750) — 8/24/2009 @ 5:10 pm
Assisted suicide.
nk (8214ee) — 8/24/2009 @ 5:17 pm
It’s a sad situation but it should be an interesting case. Based solely on the linked article, it seems the physician with Jackson at his death was trying to wean Jackson off propofol that had been prescribed for him by other physicians. If that’s true, who do you charge? The prescribing physician(s), the physician who was present at Jackson’s death who administered propofol in a (reportedly) small amount, or all of the above?
DRJ (3f5471) — 8/24/2009 @ 5:37 pm
I think Jackson spent 25 years committing time-lapse suicide.
ELC (7bf716) — 8/24/2009 @ 6:06 pm
I don’t think anyone should be charged with any degree of homicide. There was horrendous medical malpractice and violations of the drug laws, though, and a few years in prison plus loss of licenses would benefit the entire druggie Hollywood community. We saw this exact same thing with Anna Nicole Smith, if you’ll remember.
nk (b17d90) — 8/24/2009 @ 6:19 pm
nk,

What about negligent homicide or manslaughter in addition to malpractice?
Stashiu3 (ed6467) — 8/24/2009 @ 6:24 pm
What I mean is, I thought malpractice was a civil proceeding and wouldn’t produce jail time. Don’t you need a criminal charge for that?
Stashiu3 (ed6467) — 8/24/2009 @ 6:29 pm
You’re right, Stashiu. The drug law violations would be the criminal offenses. But coupled with the malpractice it would be loss of the DEA (prescription) license and license to practice medicine generally. I know doctors who have triple pads but never have Schedule II drugs on hand, and others who refuse to even have triple pads, because they don’t need the grief.
nk (b17d90) — 8/24/2009 @ 6:35 pm
The cynic would say about this entire embroglio…
It’s just Hollywood, being Hollywood!
AD - RtR/OS! (cbe8a1) — 8/24/2009 @ 6:41 pm
To be clearer, criminal state of mind is a much stricter standard than civil. The minimal is that you knew that there was a strong possibility that someone could die and you did not give a shit.
nk (b17d90) — 8/24/2009 @ 6:41 pm
You’d be surprised how many times (or how much) a doc can game the system and avoid consequences for loose prescription practices, even ones that result in harm. A 1-year suspension would not be that surprising for a single incident.

A negligent homicide or manslaughter conviction would be another story and a much greater warning to others. If the story is accurate, that’s not really a med that should be administered at home and leave the patient to go do something else. The key to me is that the doc actively participated by administering the drug and then left the patient unattended. Kind of like leaving an infant in a bathtub and returning to find them drowned, it’s a failure to exercise due care. Just my layman opinion though, I’m interested in your take.
Stashiu3 (ed6467) — 8/24/2009 @ 6:45 pm
A (very) minor point but the LA Times spells it ‘anesthetic.’ When did everyone stop using the second “a” in anaesthetic?
DRJ (3f5471) — 8/24/2009 @ 6:47 pm
I’ve never used a second “a” in any variation. You spell funny. 😉
Stashiu3 (ed6467) — 8/24/2009 @ 6:50 pm
I don’t know the details about propofol — maybe it’s such an intense drug that you never leave a patient unattended — but I’d also want to know if the physician with Jackson had the proper monitoring equipment, if it was correctly hooked up and functioning, and whether he stayed close enough to hear it if it signaled a problem. The issue is whether he exercised due care and, to me, this would be evidence bearing on whether he met that standard.
DRJ (3f5471) — 8/24/2009 @ 6:51 pm
Wiktionary says the US spelling is without the second “a”.
Stashiu3 (ed6467) — 8/24/2009 @ 6:54 pm
Apparently I spell very British but I never realized it.
DRJ (3f5471) — 8/24/2009 @ 6:55 pm
Once again, if you have enough money, you can always find a doctor to give you what you want.
Dmac (e6d1c2) — 8/24/2009 @ 6:55 pm
It’s extremely unusual, if not unheard of, to have that administered at home. It’s not a sleeping aid, it’s a knockout drug typically used to put someone to sleep for surgery. At a minimum, vital signs should be monitored continuously with a reversal agent immediately at hand.

Also, there are significant drug interactions with some of the other meds described in the article which makes it even more bizarre that the doc would leave the patient unattended. Like I said, failure to exercise due care seems pretty easy to prove.
Stashiu3 (ed6467) — 8/24/2009 @ 7:04 pm
I assume that will be an evidentiary issue. For instance (and I’m offering this as a hypothetical and not as fact), it would obviously be a problem for the physician if he left Jackson unattended for 45 minutes than if he left him for 5 minutes while he was in an adjoining bathroom.
DRJ (3f5471) — 8/24/2009 @ 7:19 pm
There better not be nurses on the jury. You get someone to relieve you if you have to leave, even for a moment. The patient is completely helpless and dependent. Like the infant in a tub, even 5 minutes would be unacceptable because an infant has no way to protect itself from drowning.

Maybe one of the docs here can weigh in, I might be too harsh, but I don’t think so.
Stashiu3 (ed6467) — 8/24/2009 @ 7:26 pm
Stashiu,

I believe you know this but I’m going to say it anyway because not everyone is aware of it. And hopefully nk or someone will correct me if I misstate it since this isn’t my field.

Evidentiary issues are different than final decisions. Defendants generally have a right to offer evidence that supports their version of events, (e.g., “I only left the patient for 5 minutes” and here’s my evidence that supports that claim). The jury will hear that evidence and decide whether it’s true (e.g., “We believe you only left the patient for 5 minutes”) and how much weight to give the evidence. A jury could believe the evidence is true and still find a physician guilty if it also heard and believed evidence that leaving a patient unattended for any length of time when they take this medication is outside the standard of care. But there has to be evidence showing that. A jury with one or more nurses or health care providers can’t decide he’s wrong if that information isn’t in evidence.
DRJ (3f5471) — 8/24/2009 @ 7:37 pm
Plus, as nk noted earlier, there must also be evidence of intent to harm or recklessness that meets the criminal law standards.
DRJ (3f5471) — 8/24/2009 @ 7:39 pm
At this point, I am looking at the prosecution’s burden. Were I to prosecute it I would have to prove that the defendants consciously disregarded a strong possibility that their actions would lead to death or great bodily harm to an innocent human being. I don’t think that’s the case here. The were pandering to a drug (and surgery) addict, for a fact. But with the prospect of killing him clearly before them? A better case is that they were trying to keep him alive short of involuntarily committing him.
nk (b17d90) — 8/24/2009 @ 7:44 pm
They’re not supposed to, and I would try to follow the rules, I really would. I would also probably asked to be excused if the prosecutor hadn’t brought the standard of care into evidence. Not that I’d ever make that jury anyway. I’m sure nk’s first thought would be, “Are you kidding me?”, then thank me for coming.

Note for defense attorneys: If you ever have a doctor for a client, do NOT let nurses into your jury. Ever. 😉
Stashiu3 (ed6467) — 8/24/2009 @ 7:49 pm
Thanks nk and DRJ,

I understand better now, but it would be difficult to separate professional standards from legal standards. As an intellectual discussion, I see what you’re saying. As a nurse, I say, “Lock him up.”
Stashiu3 (ed6467) — 8/24/2009 @ 7:54 pm
Note for defense attorneys: If you ever have a doctor for a client, do NOT let nurses into your jury. Ever.

When my brother, the ophthalmologist, was doing his transitional, he had nurses complaining to him and about him constantly. And it bothered him a lot. He was just out of medical school. So I arranged for him to have a talk with a doctor I knew. The experienced doctor told him, “Nurses are always complaining”. That was the end of the matter.
nk (b17d90) — 8/24/2009 @ 7:58 pm
Jackson didn’t need a murderer. He was his own assassin, if you will, his own worse enemy. In that regard, he’s not too different from quite a few people of a certain political persuasion, one in which common sense often is in short supply.

Huffington Post:

Two of Michael Jackson’s former confidantes, medium Uri Geller and ex-bodyguard Matt Fiddes, say they tried in vain to keep the pop superstar from abusing painkillers and other prescription drugs suspected of leading to his death, but others in the singer’s circle kept the supplies flowing.

“When Michael asked for something, he got it. This was the great tragedy,” Geller said Thursday.

Geller, who said he suffered a terrible falling-out with Jackson several years ago over the issue, said he often had “to shout at Michael, to scream at Michael” as he sought to confiscate the singer’s stocks of medication during his travels in England.

“I tried to drum sense into his brain,” Geller said. “I told him, ‘Michael you’re going to die, Michael you’re going to kill yourself.’ But he just stared at me. Many a time he was in his bed and I stood and shouted at him. He just stared at me.”

“Most of the people around Michael could not say `No!’ to him. He desperately needed someone there all the time who could say `No!’ and mean it, who could warn him of the dangers … and tell him the truth,” Geller said. “The big problem was that many people wanted to help Michael, to save his life, but we could not be there all the time.”

Fiddes, an English karate instructor who worked as a senior bodyguard during Jackson’s travels in Britain for a decade, said the pop idol abused prescription medications, not recreational drugs, and took so much that it could be difficult to wake him for engagements.

“I confiscated packages and Uri did too. I mean, Uri confiscated injection equipment from his room,” Fiddes said in an interview broadcast Thursday by Sky News. “And Uri would scream at Michael, you know, intensely, to stop doing this. But we just were getting pushed out.”

Mark (411533) — 8/24/2009 @ 8:07 pm
“Nurses are always complaining”.
Comment by nk — 8/24/2009 @ 7:58 pm

I would have trouble arguing against that statement and won’t even try. I don’t know that it’s worse than many other professions, but being in charge of a group of nurses is always a ~~pain in the ass~~ challenge.
Stashiu3 (ed6467) — 8/24/2009 @ 8:11 pm
If what I’ve read is true (that he also had benzodiazepines and possibly narcotics aboard) it’s hard to not think there’s some criminal liability for the doc. Mixing those drugs is a pretty potent cocktail. (Or maybe the MD didn’t know what else MJ took that day) In any event convincing someone to use propofol to treat insomnia is beyond my reality. I’ve never had the experience of caring for a VIP, I’m sure it’s very hard to say NO, I won’t do it. But that sure seems to have been what was needed here.

Perhaps propofol was just used to give him a few cc’s to get him to sleep (admittedly stupid and inappropriate use of the drug), the MD observed him for the initial few minutes to let the bolus wear off and then retired to another room. Still stupid, but I see that in a somewhat different light than if he was being given a continuous infusion through the night.

With repeat dosing, if the patient’s airway is secure (intubated and ventilated) and vitals are otherwise stable (monitoring oxygen saturation, HR and BP) perhaps running to an adjoining bathroom – briefly – where you can still hear the monitors MAY be understandable. But that’s about the ‘loosest’ that I can imagine monitoring under a repeated dosing scenario. Additionally, if you’re going to obtund someones protective airway reflexes with these drugs, then you have to consider the last time they ate or drank to avoid aspiration.

I don’t know of any instances where it’s been used in a private home, but under the appropriate monitoring conditions, and with appropriate resuscitation equipment I suppose it could be. Most mere mortals don’t have the financial resources to accomplish the necessary monitoring.

Of course, there may be a whole as of yet unexplained set of circumstances that makes me eat these words. And this scenario just came to me– Maybe the doc gave him a small amount, watched him for an appropriate amount of time, then left. Later MJ awakened during the night and decided to self administer a bigger dose that was fatal. We may never know the whole story.
some anonymous anesthesiologist (ee680a) — 8/24/2009 @ 9:33 pm
Could you please never mention Michael Jackson again? If you do it one more time I will never read your blog again. I really mean this.
William Wilson (40bc94) — 8/24/2009 @ 9:41 pm
I’m fine with yanking this guy’s license. But, the state would have a terrible time proving to me criminal intent.

Nailing him in civil court, a la OJ would be fine, too. But I am sick to death with overcharging/over-reaching. Unrelated, but the whole Special Prosecutor for the CIA being the latest example. Let it be enough that he is stripped of his licene(s) and all of his assets.
Ed from SFV (c4544e) — 8/24/2009 @ 9:56 pm
Wilson – News is news. This blog often tracks events in legal news and issues, in the LA area especially. Try covering your ears and shouting LA LA LA LA LA at the top of your lungs. The rest of us live in the real world.
Chuck Roast (12f134) — 8/24/2009 @ 11:02 pm
Who REALLY cares?

I mean that sincerely. He was a performer, and he is now dead. None of theis handwringing will bring him back, and who would want to?

Too bad for him and his family. This is just a distraction.
Dr. K (f704f3) — 8/25/2009 @ 3:26 am
[…] reading: Patterico’s Pontifications: Michael Jackson’s Death Ruled a Homicide Debbie Schlussel: LIVE BLOG: Funniest Thing About the Michael Jackson Memorial Circus; UPDATED: […]
Michael Jackson: King of Pop’s Death Ruled a Homicide « Frugal Café Blog Zone (a66042) — 8/25/2009 @ 8:09 am
We have to give the man his due: Michael Jackson was – beyond a shadow of a doubt – a great artist whose recorded legacy will endure for decades, maybe even a century or more. But an examination of his life is riddled with questions of all that might have been; all that should have been. It is more than likely that this was a severely mentally ill human being who never sought the treatment he so desperately needed; surrounded by fawning sycophants who enabled his sickness by constantly reassuring him that he could do no wrong. As John Lennon once said in the same context about Elvis Presley, another victim of the excesses of fame: “It’s always the courtiers that kill the king”.

The sad, inescapable truth is that for reasons we will probably never be able to fully understand, his talent and his career were ultimately wasted. Like Charlie Parker, Montgomery Clift, Judy Garland and Lenny Bruce before him, his brilliance as an artist would be overshadowed by severe, psychological torment and an unexplainable desire for self-destruction. Therein lies the real, unspeakable tragedy of Michael Jackson.

http://www.tomdegan.blogspot.com

Tom Degan
Goshen, NY
Tom Degan (42a1c2) — 8/25/2009 @ 8:29 am
From an anaesthesiologist (for DRJ’s Comfort)of my acquaintance.

doubtful that it was the the propofol itself in the dose that was reportedly given. I suspect it was either the plethora of benzodiazepines given earlier (if given orally) finally starting to work. OR it was the combination of the benzodiazepines and the propofol if all were given IV. All of these meds are respiratory depressants when given in high enough doses or with synergistic medications.
GM Roper (85dcd7) — 8/25/2009 @ 11:19 am
[…] Ted Kennedy’s Ghost Will Be Spotted Asking For ObamaCare Patterico’s Pontifications: Michael Jackson’s Death Ruled a Homicide Debbie Schlussel: LIVE BLOG: Funniest Thing About the Michael Jackson Memorial Circus; UPDATED: […]
Death Coverage Snit: Michael Jackson vs. Ted Kennedy, from Fried Green al-Qaedas « Frugal Café Blog Zone (a66042) — 8/29/2009 @ 10:12 am
All of these conspiracy theorists that state the Mossad and the Jews killed Michael Jackson are totally anti-semitic and a lynch squad. These idiots are still parroting on and on about how they think that now that Michael Jackson’s death has officially been called a homicide, that they freaked out and arranged to pay off Dr. Conrad Murray an obscene amount of money to take the fall, like some “patsy” like Lee Harvey Oswald, with the promise that they would line up the best lawyers/corrupt judges to preside over his case in Los Angeles, thus ensuring that he would ultimately walk away from the whole thing with no real jail time. These racists and anti-semites go on an on about how it was actually Dr. Neil Ratner, a member of the Mossad’s “sayanim” network who actually did the killing because Michael Jackson dared to perform and practice the very anti-semitic song “They Don’t Care About Us” tons of times days before he was killed, against the wishes and threats by the Anti-Defamation League ten years ago, and against the Jewish communities’ warnings to him to never sing that song again, every few years. What a bunch of racist myopic losers.
Victor Ostrovsky (d8aefa) — 9/5/2009 @ 11:41 pm

8/24/2009

Michael Jackson’s Death Ruled a Homicide

44 Responses to “Michael Jackson’s Death Ruled a Homicide”

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