Anesthesia represents: The Conrad Murray case

[michigangirl]

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Anyone been listening to the trial on HLN? On my way home from work yesterday on Sirius, I caught the middle of Dr. Shafer's comments. I gotta say he did a beautiful job representing the wrong that occurred and the anesthesia profession-- the way he explained everything in a way the lay public could understand and got across how wrong it was for MJ to be getting propofol in a non-monitored setting was outstanding. How simple knowledge of bag mask ventilation (if you actually have a bag) and resuscitation could have easily saved his life. How simple documentation of vital signs every five minutes would have actually forced him to notice that he had stopped breathing-- all standard of care. My favorite part was when he firmly stated that the first thing any anesthesia resident learns on their first day of training is that if something goes wrong to "CALL FOR HELP" Finally someone states the horrendous big picture the way it needs to be painted, in a way the people making the decisions can understand. And elevates the anesthesia profession in the process.

 

[foxtrot]

I agree. It is nice to someone representing our field in a very professional and dignified manner. I read that he is doing all of this testimony without accepting any financial compensation, which is also pretty cool. Conrad Murray is such a scum bag.

 

[sevoflurane]

👍

I enjoyed his testimony.

 

[DreamLover]

I certainly think that the prosecution went all out, as Dr. Shafer is a top representative of our profession in the world. Professor at Columbia/Stanford/UCSF and Editor in Chief of Anesthesia and Analgesia....just to name a few of the things he does...

I thoroughly enjoyed/appreciated listening to his testimony

 

[jwk]

I certainly think that the prosecution went all out, as Dr. Shafer is a top representative of our profession in the world. Professor at Columbia/Stanford/UCSF and Editor in Chief of Anesthesia and Analgesia....just to name a few of the things he does...

I thoroughly enjoyed/appreciated listening to his testimony

Don't worry - the defense will be putting on their "expert" soon - and if early reports hold true, it sounds like he won't represent the specialty nearly as well.

 

[PMPMD]

Don't worry - the defense will be putting on their "expert" soon - and if early reports hold true, it sounds like he won't represent the specialty nearly as well.

Is this the guy who will say MJ drank the propofol?

 

[jwk]

Is this the guy who will say MJ drank the propofol?

I think he's the one that proposed the idea, but not sure. He's already caused a little problem in the courtroom. Somehow he got a waiver to remain in the courtroom and listen to other testimony, which witnesses don't usually get do. And then he talked to the media when there was a gag order for the witnesses and lawyers in the case, so he may get cited for contempt of court. Duh.

 

[UTSouthwestern]

I think he's the one that proposed the idea, but not sure. He's already caused a little problem in the courtroom. Somehow he got a waiver to remain in the courtroom and listen to other testimony, which witnesses don't usually get do. And then he talked to the media when there was a gag order for the witnesses and lawyers in the case, so he may get cited for contempt of court. Duh.

That's Paul White. One of my professors when he was at UT Southwestern. Going to make everything a circus more than he already has.

 

[cincincyreds]

It would have been my pleasure to testify against Dr. Murray. I wonder if he got into medical school thru affirmative action.

 

[foxtrot]

It would have been my pleasure to testify against Dr. Murray. I wonder if he got into medical school thru affirmative action.

I don't know if affirmative action had anything to do with it or if he is just a greedy, unethical jerkoff. I am sure MJ could have found any number of doctors who would be willing to do this. It is amazing how ethics go out the door when large sums of cash are involved.

 

[pgg]

I wonder if he got into medical school thru affirmative action.

Is this really necessary?

 

[cincincyreds]

In 1980, two years after first visiting Houston and getting a chance to introduce himself to his father, Conrad Murray returned to Texas to enroll at Texas Southern University, where in just three years he graduated magna cum laude with a degree in pre-medicine and biological sciences. From there, Murray followed in his father's footsteps and attended the primarily African-American Meharry Medical College in Nashville, Tennessee.

So just looked it up out of curiousity. Sounds like he was a smart guy to graduate magna cum laude. Meharry Medical College for med school, funded by my tax payer dollars. So yes, this discussion is necessary. I wonder at what point he became greedy for every penny.

I just raise all of this up because I am sick and tired of dealing with greed. I'm not saying Michael Jackson was a good person, but I think he deserved better as a human being from all who surrounded him.

 

[Bertelman]

In 1980, two years after first visiting Houston and getting a chance to introduce himself to his father, Conrad Murray returned to Texas to enroll at Texas Southern University, where in just three years he graduated magna cum laude with a degree in pre-medicine and biological sciences. From there, Murray followed in his father's footsteps and attended the primarily African-American Meharry Medical College in Nashville, Tennessee.

So just looked it up out of curiousity. Sounds like he was a smart guy to graduate magna cum laude. Meharry Medical College for med school, funded by my tax payer dollars. So yes, this discussion is necessary. I wonder at what point he became greedy for every penny.

I just raise all of this up because I am sick and tired of dealing with greed. I'm not saying Michael Jackson was a good person, but I think he deserved better as a human being from all who surrounded him.

I still fail to understand what race or affirmative action has to do with this case.

 

[ghost dog]

I still fail to understand what race or affirmative action has to do with this case.

Meharry Medical College
School of Medicine
Director, Admissions and Records
1005 D. B. Todd Boulevard
Nashville, TN 37208
(615) 327-6223
AMCAS -- Private
Deadline: Dec.1

Average GPA: 3.1
Average MCAT: 7.5

source: http://www.mcattestscores.com/usmedicalschoolsmcatscoresGPA.html

Wow. Now that's craptacular.

Why didn't MJ pick a better MD ? Say, someone who didn't graduate from Hollywood upstairs medical school?

 

[cincincyreds]

Thanks ghost dog. Wow, the stats are even worse than I thought. GPA 3.1, MCAT 7.5. I think a monkey throwing darts at a dart board can get a 7.5 on the MCAT.

I love to investigate stupidity. The more I dig, the more unbelievable things I find in life.

I wonder if these statistics will show up in court also.

"You want the truth. You can't handle the truth."

Hopefully, Dr. Murray will rot in jail where he belongs making license plates for a very long time.

 

[WholeLottaGame7]

Meharry Medical College
School of Medicine
Director, Admissions and Records
1005 D. B. Todd Boulevard
Nashville, TN 37208
(615) 327-6223
AMCAS -- Private
Deadline: Dec.1

Average GPA: 3.1
Average MCAT: 7.5

source: http://www.mcattestscores.com/usmedicalschoolsmcatscoresGPA.html

Wow. Now that's craptacular.

Why didn't MJ pick a better MD ? Say, someone who didn't graduate from Hollywood upstairs medical school?

Still don't see what race or affirmative action has to do with it. Unless you're suggesting that medical licensing boards have different passing scores for different ethnicities, I'm pretty sure he had to take the same tests to get licensed everyone else did.

Minus the anesthesiology boards; which in this case are the most pertinent.

 

[Bertelman]

Meharry Medical College
School of Medicine
Director, Admissions and Records
1005 D. B. Todd Boulevard
Nashville, TN 37208
(615) 327-6223
AMCAS -- Private
Deadline: Dec.1

Average GPA: 3.1
Average MCAT: 7.5

source: http://www.mcattestscores.com/usmedicalschoolsmcatscoresGPA.html

Wow. Now that's craptacular.

Why didn't MJ pick a better MD ? Say, someone who didn't graduate from Hollywood upstairs medical school?

Walk down the halls of your average medical school and look at the graduating classes of 1980-1985. I'll venture to guess that there will be at most 1-2 black students in each class. And 1-2 women. Maybe one black woman per decade. I don't expect you to know Dr. Murray's achievements that led to his matriculation at that time, but you should understand that the current class statistics are unlikely to represent his class in 1980-whatever. Meharry may have been the best chance for a black man to become a physician in the 80's.

Before some myopic fool accuses me of defending this man for his behavior in this case, understand that there are many reasons to condemn his behavior, none of which are his race. If race/affirmative action is your ace in the hole, you're probably racist. So find some other line of attack, please.

 

[climbingak]

Unfortunately he was destined to die. Paying $150K per month, MJ would have found someone with ethics low enough to administer home propofol. If not Murray, then someone else. Too bad for him he didnt find a greedy anesthesiologist who would have at least been able to support him through the episode and maybe had proper equipment there before giving him the prop.

 

[hoyden]

I guess it is a particular all-American goal to get to race relations in ANY plain stupidity situation 🙄

You could have been the smartest kid in your school, but it has nothing to do with your stupid choices later in life. Even if your skin color is purple with green polka dots.

 

[michigangirl]

Count me annoyed that this thread has turned into race/affirmative action issue. So silly. Murray is just a crappy doctor with crappy ethics who did something crappy. There are PLENTY of crappy doctors with crappy ethics who got awesome grades and MCATs.

And Bertelman is right on-- standards for grades and MCATs have majorly changed since back in the day. So all of these comparisons are just moot.

 

[pgg]

Why didn't MJ pick a better MD ?

What makes you think he didn't try?

We'll never know how many "better" doctors he asked first, before he found Murray, because all of those hypothetical "better" doctors would've told him it was unsafe and unethical to provide nightly multi-drug IV sleeping cocktails in a person's home.

 

[ArMed]

I was listening to some of the testimony and at one point during Dr. Shafer's explanation of drug pharmacokinetics he said something that made me crack up. Paraphrasing:
I can't figure what the polypharmacy pharmacokinetics are. There is no one documented in the history of propofol who has ever taken the drug daily for insomnia. This is "pharmacological never-never land"

Given MJ's obsession, I wonder if this remark was deliberate...

 

[Gern Blansten]

I was listening to some of the testimony and at one point during Dr. Shafer's explanation of drug pharmacokinetics he said something that made me crack up. Paraphrasing:
I can't figure what the polypharmacy pharmacokinetics are. There is no one documented in the history of propofol who has ever taken the drug daily for insomnia. This is "pharmacological never-never land"

Given MJ's obsession, I wonder if this remark was deliberate...

Ha ha. Good pick up. Hadn't heard that referenced before.

 

[Gern Blansten]

I have a question about the trial. Admittedly, I have not followed it very closely and don't know all of the details. My question: Is Dr Murray a "criminal" or just a really bad doctor? What is the difference? Are all unethical and dangerously dumb doctors criminal?
At what point does being a really bad doctor who makes really poor decisions become a crime? Is his level of medical decision making so poor that he deserves prison for manslaughter? I don't think anyone here thinks that, if he had foreseen this, he would not have chosen a different path.
So, to extrapolate to a hospital setting. If a doctor was known to take risks and do things that were a bit outside of accepted protocols and he had a tragic patient outcome resulting in death, should he/she be held accountable criminally or just to the state medical board?
Hypothetical Examples:
-An anesthesiologist fails to get an adequate history on a patient with a history of MH and provides a triggering anesthetic in an ambulatory setting. To complicate matters, the ASC does not have dantrolene immediately available and the result is a patient death.
-A surgeon changes the course of surgery in a cardiac procedure to try an unproven technique (without consent) because they "think it might work." The result is catastrophic and the patient dies.

I guess my question has to do with how doctors are held accountable. If medical mistakes or poor judgement are criminally prosecuted, will this blur the lines in the future? Will there come a day when a bad outcome will lead to jail time for physicians. It seems far fetched, but I have heard of this type of behavior in the middle east.

Given, Dr Murray's situation is about as bad as it gets, but does he need to go to prison or just have his license revoked never to be returned? I guess this may be similar to impaired physicians who divert narcotics and (rarely) end up in prison.

I just wanted to throw that out there to see if anyone else has considered this.

 

[DreamLover]

At what point does being a really bad doctor who makes really poor decisions become a crime? Is his level of medical decision making so poor that he deserves prison for manslaughter? I don't think anyone here thinks that, if he had foreseen this, he would not have chosen a different path.

At the point that MJ stopped breathing and was not able to be resuscitated and he died.

Not only was his medical decision making that poor that it was criminal...he failed to keep a single record of anything he did or gave to MJ over the several months he was "under his care" citing that MJ requested he not keep records for privacy sake (unethical, not in pt's best interest, That was not MJ's decision to make)

Not only was the decision to give propofol in MJ's bedroom at home with no standard monitoring and no vital signs etc etc etc a criminal move that blatantly went against the lawful standard of care...he didn't know how to properly perform BLS/ACLS directly leading to his death AND he is essentially lying by claiming he was only out of the room a minute or two and he lied about what he was doing and who he was talking to and he is blaming MJ for swallowing/injecting/adjusting the gtt/whatever else he can think of to save his butt....when nothing he did from day one was not only unethical but illegal. The pharmacist testified how he tried to have tons of propofol shipped to a residential address (which she did not allow) and the EMTs were certain MJ had been dead for MUCH longer than Murray has claimed....his body was cold when they arrived.

This is just my opinion and everyone is entitled to theirs...but I feel that this is different than having a bad outcome in the OR....Murray was never, from day one attempting to provide standard of care....just not defensible to me

 

[hoyden]

I have a question about the trial. Admittedly, I have not followed it very closely and don't know all of the details. My question: Is Dr Murray a "criminal" or just a really bad doctor? What is the difference? Are all unethical and dangerously dumb doctors criminal?
At what point does being a really bad doctor who makes really poor decisions become a crime? Is his level of medical decision making so poor that he deserves prison for manslaughter? I don't think anyone here thinks that, if he had foreseen this, he would not have chosen a different path.
So, to extrapolate to a hospital setting. If a doctor was known to take risks and do things that were a bit outside of accepted protocols and he had a tragic patient outcome resulting in death, should he/she be held accountable criminally or just to the state medical board?
Hypothetical Examples:
-An anesthesiologist fails to get an adequate history on a patient with a history of MH and provides a triggering anesthetic in an ambulatory setting. To complicate matters, the ASC does not have dantrolene immediately available and the result is a patient death.
-A surgeon changes the course of surgery in a cardiac procedure to try an unproven technique (without consent) because they "think it might work." The result is catastrophic and the patient dies.

I guess my question has to do with how doctors are held accountable. If medical mistakes or poor judgement are criminally prosecuted, will this blur the lines in the future? Will there come a day when a bad outcome will lead to jail time for physicians. It seems far fetched, but I have heard of this type of behavior in the middle east.

Given, Dr Murray's situation is about as bad as it gets, but does he need to go to prison or just have his license revoked never to be returned? I guess this may be similar to impaired physicians who divert narcotics and (rarely) end up in prison.

I just wanted to throw that out there to see if anyone else has considered this.

Very interesting questions. The answer depends on what kind of medicine you are practicing - not which specialty, but what kind in a wide variety of models.
By American standards - he definitely committed a crime. By Tanzanian ones - probably not...

 

[Gern Blansten]

Very interesting questions. The answer depends on what kind of medicine you are practicing - not which specialty, but what kind in a wide variety of models.
By American standards - he definitely committed a crime. By Tanzanian ones - probably not...

I agree that his case is pretty blatant. But, my point is, how far back do you extrapolate this to other scenarios? Will doctors be sued for criminal negligence more in the future when patients have bad outcomes where the doctor was practicing outside of acceptable norms? Who determines the acceptable norms? If I fail to exercise within ASA guidelines, is it negligence, or criminal when there is a bad outcome. I am thinking of precedence in the long term outlook. It seems far fetched to be criminally prosecuted for medical malpractice. But really, when does medical malpractice become criminal. Is there a definite line that you cross? If so, what is it?
I am in no way defending Dr Murray. His case just got me thinking about other possible scenarios. What if he was providing that service for MJ in a doctor's office or clinic? What if it was an anesthesiologist that was doing it in the PACU of a hospital? If the outcome was the same, does that change anything? Is it still criminal? Not advocating any of this, just wondering what particular portion of his negligence and malpractice tipped it over to be manslaughter.
Just bored and wanting to generate a philosophical discussion.

 

[Gern Blansten]

At the point that MJ stopped breathing and was not able to be resuscitated and he died.

Not only was his medical decision making that poor that it was criminal...he failed to keep a single record of anything he did or gave to MJ over the several months he was "under his care" citing that MJ requested he not keep records for privacy sake (unethical, not in pt's best interest, That was not MJ's decision to make)

Not only was the decision to give propofol in MJ's bedroom at home with no standard monitoring and no vital signs etc etc etc a criminal move that blatantly went against the lawful standard of care...he didn't know how to properly perform BLS/ACLS directly leading to his death AND he is essentially lying by claiming he was only out of the room a minute or two and he lied about what he was doing and who he was talking to and he is blaming MJ for swallowing/injecting/adjusting the gtt/whatever else he can think of to save his butt....when nothing he did from day one was not only unethical but illegal. The pharmacist testified how he tried to have tons of propofol shipped to a residential address (which she did not allow) and the EMTs were certain MJ had been dead for MUCH longer than Murray has claimed....his body was cold when they arrived.

This is just my opinion and everyone is entitled to theirs...but I feel that this is different than having a bad outcome in the OR....Murray was never, from day one attempting to provide standard of care....just not defensible to me

I don't disagree with anything you stated. I want to make sure you know that so you don't think that I am advocating anything Murray did. I am thinking of a less blatant case as I described in my other response. Poor record keeping? I agree. The medical board frequently fines physicians for that. Lying to cover your butt? I've seen it happen. Standard of care is different for different specialties, as we have discussed on this board before. EMed is held to a much lower standard than ASA guidelines when they do sedations in the ED. Shipping controlled substances illegally? Probably a huge issue, but propofol does not currently have the controlled substance tag, not yet anyway. Anyway, he did a lot of stuff that was very bad, I think we can all agree. Just trying to get philosophical. I hope it does not appear I am in disagreement about his situation. Just curious about how it might have been handled if a few factors were different.

 

[ArMed]

Grabbed this from a legal website:

1. The Legal Definition of Involuntary
Manslaughter in California

Involuntary manslaughter differs from Penal Code 187 PC murder in that it involves an unintentional death.2
California Penal Code 192(b) PC defines "involuntary manslaughter" as an unlawful killing that takes place

1. during the commission of an unlawful act (not amounting to a felony), or
2. during the commission of a lawful act which involves a high risk of death or great bodily harm that is committed without due caution or circumspection.

Without due caution and circumspection

The phrase "without due caution and circumspection" is basically synonymous with California's legal definition of "criminal negligence." It is an act which is "aggravated, reckless and flagrant and which is such a departure from what would be the conduct of an ordinary prudent, careful person under the same circumstances as to be in disregard for human life, or an indifference to the consequences of such an act."7
Criminal negligence means that the death was not the result of inattention, mistaken judgment or misadventure. But rather it was a reasonably foreseeable consequence of the aggravated, reckless or negligent conduct.

Example: In People v. Conrad Murray…the pending case against Michael Jackson's doctor…the Los Angeles District Attorney's Office charged Dr. Murray with violating Penal Code 192(b) PC California's involuntary manslaughter law for allegedly administering lethal doses of an anesthetic (propofol) to Jackson while treating him for insomnia. And although this case is still ongoing, it serves as a good example, since it is currently one of the most famous cases dealing with California's involuntary manslaughter laws.

In their complaint, the D.A. stated that "Dr. Murray did unlawfully kill Michael Joseph Jackson by acting without due caution and circumspection". Prosecutors will attempt to prove that Dr. Murray acted with criminal negligence when he administered such a large dose of the anesthetic…an anesthetic that they contend is used in preparation for surgery, not as a sleep aid (which is why it was being used). The D.A. will argue that a reasonable doctor in the same situation would not have authorized the same quantity of the drug.

(http://www.shouselaw.com/involuntary_manslaughter.html)
​

 

[jetproppilot]

Unfortunately he was destined to die. Paying $150K per month, MJ would have found someone with ethics low enough to administer home propofol. If not Murray, then someone else. Too bad for him he didnt find a greedy anesthesiologist who would have at least been able to support him through the episode and maybe had proper equipment there before giving him the prop.

I would've gladly administered MJ propofol at his home. My price for 24-7 care would've been higher.

He'd still be alive today though.

 

[ssmallz]

I would've gladly administered MJ propofol at his home. My price for 24-7 care would've been higher.

He'd still be alive today though.

+1. For 150k/month I would have spent some of that on an ETCO2 montior, pulse ox, and intubation equipement. All tax deductable of course b/c they are business expensese

 

[Surfer]

At the point that MJ stopped breathing and was not able to be resuscitated and he died.

Not only was his medical decision making that poor that it was criminal...he failed to keep a single record of anything he did or gave to MJ over the several months he was "under his care" citing that MJ requested he not keep records for privacy sake (unethical, not in pt's best interest, That was not MJ's decision to make)

Not only was the decision to give propofol in MJ's bedroom at home with no standard monitoring and no vital signs etc etc etc a criminal move that blatantly went against the lawful standard of care...he didn't know how to properly perform BLS/ACLS directly leading to his death AND he is essentially lying by claiming he was only out of the room a minute or two and he lied about what he was doing and who he was talking to and he is blaming MJ for swallowing/injecting/adjusting the gtt/whatever else he can think of to save his butt....when nothing he did from day one was not only unethical but illegal. The pharmacist testified how he tried to have tons of propofol shipped to a residential address (which she did not allow) and the EMTs were certain MJ had been dead for MUCH longer than Murray has claimed....his body was cold when they arrived.

This is just my opinion and everyone is entitled to theirs...but I feel that this is different than having a bad outcome in the OR....Murray was never, from day one attempting to provide standard of care....just not defensible to me

I'm kind of with bertelman here. As docs you all sure seem really quick to throw him in the clink and throw the key away. What he did was medical malpractice for sure. Did it deserve jail time?? I dunno, but its a real slippery slope folks. Easy for you to say this case is different... but in 10 years will medicare find some vitals you "extrapolated" while in a difficult case (in which the patient died) and say you "falsified record keeping" and had a poor outcome (on a risky patient) and send YOU to jail? Hey, you falsified medical records! Or hey, you're an anesthesiologist, you should have anticipated that difficult airway and done an awake fiberoptic intubation. If you had done that, little timmy would still be alive. therefore, you are guilty of manslaughter for not doing due diligence. OFF TO JAIL FOR YOU!!

I think they should take his medical license away. Should he go to jail? wow, i dunno, that is such a slippery slope....

 

[PMPMD]

I'm kind of with bertelman here. As docs you all sure seem really quick to throw him in the clink and throw the key away. What he did was medical malpractice for sure. Did it deserve jail time?? I dunno, but its a real slippery slope folks. Easy for you to say this case is different... but in 10 years will medicare find some vitals you "extrapolated" while in a difficult case (in which the patient died) and say you "falsified record keeping" and had a poor outcome (on a risky patient) and send YOU to jail? Hey, you falsified medical records! Or hey, you're an anesthesiologist, you should have anticipated that difficult airway and done an awake fiberoptic intubation. If you had done that, little timmy would still be alive. therefore, you are guilty of manslaughter for not doing due diligence. OFF TO JAIL FOR YOU!!

I think they should take his medical license away. Should he go to jail? wow, i dunno, that is such a slippery slope....

I'm sorry but what Murray did was beyond a slippery slope. He dove straight off the cliff. Failing to predict a difficult airway is bad, but it's understood that physical exam findings don't have 100% predictive value, even when taken as an aggregate. But giving propofol in an unmonitored setting, without proper resuscitation equipment or training, is beyond one bad judgement. It reflects a cascade of bad ideas, each worse than the other.

 

[Bertelman]

I'm kind of with bertelman here.

Just for the record, I was only redirecting our attacks towards his competence and judgment, and away from his race.

I've got no problems sending him to jail.

 

[PMPMD]

Just for the record, I was only redirecting our attacks towards his competence and judgment, and away from his race.

I've got no problems sending him to jail.

Of course you don't Bert, you're from TEXAS!!

 

[Bertelman]

of course you don't bert, you're from texas!!

 

[pgg]

Of course you don't Bert, you're from TEXAS!!

They stand outside the prison and cheer when the lights go dim!



I guess "aggravated, reckless and flagrant" is like porn, we're supposed to know it when we see it.

I would've gladly administered MJ propofol at his home. My price for 24-7 care would've been higher.

He'd still be alive today though.

Really?

You'd treat a patient's actual medical problem - in this case depression and substance abuse - with nightly propofol to help him sleep? Really?

Even if Murray hadn't bumped Jackson off via his inattention or incompetence, he was still harming him by giving wildly inappropriate "treatment" for his mental illness.


You may as well open a clinic for crack addicts and administer topical cocaine hydrochloride. Of course, there won't be $150K/month in it for you.

 

[Gern Blansten]

Really?

You'd treat a patient's actual medical problem - in this case depression and substance abuse - with nightly propofol to help him sleep? Really?

Even if Murray hadn't bumped Jackson off via his inattention or incompetence, he was still harming him by giving wildly inappropriate "treatment" for his mental illness.


You may as well open a clinic for crack addicts and administer topical cocaine hydrochloride. Of course, there won't be $150K/month in it for you.

Think of the wildly inappropriate things done electively for vain plastic surgery patients. They pay large amounts to a medical team to perform things that are dangerous and completely unnecessary and possibly harmful or, at their worst, fatal. Should we throw them in jail when a patient dies from full body lipo done in an office based setting with a bad outcome? If we only did surgeries that were absolutely needed, we might not have much work. How much different is MJ from the patient who just had their 40th plastic surgery procedure/surgery done. The patient wants it done and the surgeon agrees to do it, even though most in medicine would agree that the patient would be far better off without it being done. So, it is acceptable in plastic surgery, but not in other areas. Not saying I agree with it, but is it really that much different than the other things people with ridiculous amounts of money want?

So, approaching 24 hours and not a single person has addressed my question. If this was an anesthesiologist performing this service in a clinic or PACU and the outcome was the same, would it still be criminal? What if it was a celebrity who was undergoing a rapid detox and they died? Manslaughter? Plastic surgeon doing full body lipo in an office setting under MAC without an anesthesia provider and the patient develops CHF and dies? Criminal?

BTW, I think surfer mistakenly attributed my comments to Bertelman. I would never want Bertelman to be wrongly accused of having an association with me. Nobody deserves that punishment.🙂

 

[Bertelman]

...How much different is MJ from the patient who just had their 40th plastic surgery procedure/surgery done. The patient wants it done and the surgeon agrees to do it, even though most in medicine would agree that the patient would be far better off without it being done.

...

BTW, I think surfer mistakenly attributed my comments to Bertelman. I would never want Bertelman to be wrongly accused of having an association with me. Nobody deserves that punishment.🙂

Actually, MJ was that guy. There may not be a person in the US with the plastic surgery bona fides that guy had.

And I think we all kind of deserve each other on this forum. 😉

 

[Gern Blansten]

Actually, MJ was that guy. There may not be a person in the US with the plastic surgery bona fides that guy had.

And I think we all kind of deserve each other on this forum. 😉

You're right. MJ is that guy, but also just wanted to get some sleep, dangit. I wonder if N2O piped through the ventilation would have done better for him.🙂

 

[pgg]

How much different is MJ from the patient who just had their 40th plastic surgery procedure/surgery done.

It's very different. MJ had an actual medical problem. Instead of helping his patient, to whom he had a duty, he signed up to be his drug dealer. This isn't even as defensible as a medical marijuana prescription-mill clinic. It doesn't get much more "aggravated, reckless and flagrant" than "treating" a drug addict's insomnia with IV induction agents in his bedroom.

So, approaching 24 hours and not a single person has addressed my question. If this was an anesthesiologist performing this service in a clinic or PACU and the outcome was the same, would it still be criminal?

Maybe not criminal. The lack of monitors, resuscitation equipment, and knowledge/training are a large part of what make the Murray case reckless in my view.

What if it was a celebrity who was undergoing a rapid detox and they died?

No. Rapid detox is a treatment for addiction. Maybe not the best treatment, certainly not risk free, but reasonable people can assess those risks and potential benefits to a recovering addict, and make that informed decision. Perhaps malpractice if it was done poorly and a standard of care was violated. But not criminal ... unless perhaps it was done by a dermatologist in someone's garage.

Plastic surgeon doing full body lipo in an office setting under MAC without an anesthesia provider and the patient develops CHF and dies? Criminal?

I don't know. Possibly. Worth discussing. I don't like the thought of prosecutors and the criminal justice system getting involved in malpractice suits in which a clear crime hasn't been committed.


I'm not arguing that there's a distinct, definable line between egregious malpractice and criminal behavior. We have juries to determine that. If ArMed's post about criminal negligence requiring "aggravated, reckless and flagrant" actions is accurate, I think the Murray case meets and exceeds that threshold.

 

[RT2MD]

I have a question about the trial. Admittedly, I have not followed it very closely and don't know all of the details. My question: Is Dr Murray a "criminal" or just a really bad doctor? What is the difference? Are all unethical and dangerously dumb doctors criminal?
At what point does being a really bad doctor who makes really poor decisions become a crime? Is his level of medical decision making so poor that he deserves prison for manslaughter? I don't think anyone here thinks that, if he had foreseen this, he would not have chosen a different path.
So, to extrapolate to a hospital setting. If a doctor was known to take risks and do things that were a bit outside of accepted protocols and he had a tragic patient outcome resulting in death, should he/she be held accountable criminally or just to the state medical board?
Hypothetical Examples:
-An anesthesiologist fails to get an adequate history on a patient with a history of MH and provides a triggering anesthetic in an ambulatory setting. To complicate matters, the ASC does not have dantrolene immediately available and the result is a patient death.
-A surgeon changes the course of surgery in a cardiac procedure to try an unproven technique (without consent) because they "think it might work." The result is catastrophic and the patient dies.

I guess my question has to do with how doctors are held accountable. If medical mistakes or poor judgement are criminally prosecuted, will this blur the lines in the future? Will there come a day when a bad outcome will lead to jail time for physicians. It seems far fetched, but I have heard of this type of behavior in the middle east.

Given, Dr Murray's situation is about as bad as it gets, but does he need to go to prison or just have his license revoked never to be returned? I guess this may be similar to impaired physicians who divert narcotics and (rarely) end up in prison.

I just wanted to throw that out there to see if anyone else has considered this.

Very interesting thought. It's one that I hadn't really considered before, but I see where you are coming from. I don't know the answer, but I agree that it warrants some thought. I agree that what Dr. Murray did wasn't on a slippery slope, but the precedence that could be set by this case might lead down a path that physicians wouldn't want it to go down... see my point below:

I'm not arguing that there's a distinct, definable line between egregious malpractice and criminal behavior. We have juries to determine that. If ArMed's post about criminal negligence requiring "aggravated, reckless and flagrant" actions is accurate, I think the Murray case meets and exceeds that threshold.

I believe that there is some problem with your logic here. I'd be willing to bet that there are many lawyers who could, in those scenarios Gern posted, twist facts around to make it look like "aggravated, reckless and flagrant" actions were committed. Never underestimate the stupidity (maybe too harsh of a word?) of the general population.

It'd be interesting to see if there were any other similar cases that had already been tried, and found in favor of the plaintiff... surely this can't be the first time that a physician has been involved in a criminal trial for "malpractice". I would love to do some research, but I have a big test coming up and don't think I have the time! 😀

 

[cincincyreds]

I would argue the reckless part here was adminstering propfol without the appropriate monitors or backup equipment such as oxygen, LMA, ambu bag, ...

I wonder if over time Michael would develop propfol infusion syndrome if he were still alive today? I have read about this in pediatric ICUs with patients on propofol infusions.

 

[Arch Guillotti]

I'm not arguing that there's a distinct, definable line between egregious malpractice and criminal behavior. We have juries to determine that. If ArMed's post about criminal negligence requiring "aggravated, reckless and flagrant" actions is accurate, I think the Murray case meets and exceeds that threshold.

This is not the first time this has happened (blurring the line between egregious malpractice and criminal behavior).

There was a case in Arizona that I read about on sermo a while ago.

The pdf file from the Arizona medical board is some interesting reading.

 

[PMPMD]

This is not the first time this has happened.

There was a case in Arizona that I read about on sermo a while ago.

The pdf file from the Arizona medical board is some interesting reading.

 

[foxtrot]

This is not the first time this has happened (blurring the line between egregious malpractice and criminal behavior).

There was a case in Arizona that I read about on sermo a while ago.

The pdf file from the Arizona medical board is some interesting reading.

Wow. How in the heck do people like this make it through their training? This is scary stuff.

 

[ArMed]

Still don't see what race or affirmative action has to do with it. Unless you're suggesting that medical licensing boards have different passing scores for different ethnicities, I'm pretty sure he had to take the same tests to get licensed everyone else did.

Minus the anesthesiology boards; which in this case are the most pertinent.

Note: I am NOT bringing up the racial thing. I am just using this as an opportunity to point out that Conrad Murray was not board certified at the time of the MJ incident (or possibly ever).

 

[PMPMD]

Wow. How in the heck do people like this make it through their training? This is scary stuff.

Technically, he didn't (wasn't trained in plastics or anesthesia). He did IM residency then practiced in ERs. It takes a LOT to get fired from some programs.

 

[Bertelman]

This is not the first time this has happened (blurring the line between egregious malpractice and criminal behavior).

There was a case in Arizona that I read about on sermo a while ago.

The pdf file from the Arizona medical board is some interesting reading.

That's actually worse than Conrad Murray.

 

[Socrates25]

Dr Paul White (UT Southwestern anesthesiologist) needs to have his license revoked and his board certification nullified.

He's a scumbag hired expert ***** who publicly claims that its OK to give propofol at home.