Anesthesia represents: The Conrad Murray case

[Gern Blansten]

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It's very different. MJ had an actual medical problem.

so, MJ's medical problem (or one of them) was insomnia. Does the person who undergoes 30 unnecessary cosmetic surgeries also have a problem? A psychiatric problem? It is not normal. Does a trained plastic surgeon have a duty to refuse these patients because they are putting themselves at unnecessary risk? Murray had a duty. Why don't they? To add to it, the surgeon (and anesthesiologist for that matter) is instead lining their pockets with the profits from this person's mental illness and poor self perception.
You say it is different. But why? Just because putting scalpel to skin to change the perfectly healthy body is socially acceptable?
Different things are socially acceptable in different cultures. Imagine 200 years in the future trying to explain some of the things we do today that are commonplace. I think people will look back on some of our normal practices and consider them barbaric, just like we consider therapeutic bleedings from hundreds of years ago.
It is funny how things evolve over time. Some practices are accepted, and some are considered egregious.

"You know, let's put it this way, if all the people in Hollywood who have had plastic surgery, if they went on vacation, there wouldn't be a person left in town." — Michael Jackson

 

[KungPOWChicken]

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.[/QUOTE]

Or you could give the wrong drug resulting in a patient's death as this nurse did with an epidural...oops!

http://www.ismp.org/pressroom/viewpoints/julie.asp

 

[pgg]

so, MJ's medical problem (or one of them) was insomnia.

His problem was drug abuse. Probably depression and some other issues, but the one thing we can say with absolute certainty is that he was an addict.

Does the person who undergoes 30 unnecessary cosmetic surgeries also have a problem? A psychiatric problem?

Such a person is probably certifiably nuts. And I do think the plastic surgeon has an ethical duty to at least assess why the patient wants plastic surgery, what their desired endpoint is, what realistic expectations are, and turn away obviously mentally ill patients seeking treatment way outside the norm.

In more general terms, I think it's important to note that elective plastic surgery has

• an anticipated endpoint with the expectation that it will treat the underlying problem (even if the "problem" is near-pathological distorted self perception)
• an enormous body of data supporting its general safety
• a recognized subspecialty board that certifies its practitioners

To paraphrase Jules, an elective boob job, and giving drug addicts anesthetic induction agents to help them sleep, ain't the same ballpark, it ain't the same league, it ain't even the same sport. 🙂

It is funny how things evolve over time. Some practices are accepted, and some are considered egregious.

I'm willing to bet that nightly induction of general anesthesia in depressed drug addicts will never be accepted. 🙂

 

[CambieMD]

The issue in the Conrad Murray/MJ case is one of reasonableness of actions. It is not reasonable for a physician with no airway training or available backup to administer a medication that can induce apnea. Dr. Murray was unreasonable in his treatment of MJ. It is unreasonable to bolus a patient with propofol and then step out of the room for several minutes. It is unreasonable to administer anesthetics with not resuscitative equipment available. It is unreasonable to delay calling EMS while you remove incriminating articles from the home. In doing that Dr. Murray was acting like a criminal and not a physician.

This is not an issue of low mcat scores or going to the, "wrong" med school.Dr. Murray has poor judgement. That is reflected in his personal life as well. He has fathered a child with a former stripper, he was arrested for domestic abuse but the charges were dropped.I am not saying that having a child with a stripper makes one a bad person but that is not something that physicians usually aspire to.

Our conscience/character guides our actions. A flawed character will get you every time. Actually , a flawed character negates an extremely high IQ.

Those with character flaws will do things that seem unreasonable to everyone but themselves. Look at Wall Street. Those who brought this country to its' knees financially went to some of the best colleges and universities in the world.

I find the area of human performance to be fascinating. The way certain goals and objectives make us blind to the obvious has been written about by countless authors. The ER doc trying to perform plastic surgery is a prime example of someone blinded by greed. I would bet you that he had problems in other areas of his life.

Things must make sense and be reasonable. If we are always resonable in the care of our patients we still may be sued because sometimes poor outcomes can't be prevented. It is unlikely however,that the plantiff will win.

Cambie

p.s
Did you know that Conrad Murray was never paid for his servicesto MJ.

 

[hoyden]

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.

In the United States the violation of standard of care which resulted in a bad outcome will be punished - in some cases it will be criminal case.
In the medical models which are not based on evidence based medicine and standards of care, doctors sometimes are being killed as a punishment for the bad outcome( even if they are not guilty of violating any standards).

In MJ case the violations of standards of care were so big that it does make this case criminal. It is difficult for me to see that much negligence and cavalier approach for anybody who knows what he is dealing with... Dr. Murray is simply ignorant in the area he was venturing to. He was simply putting him "to sleep" with a knowledge of a lay person ( almost) what is he actually doing.

 

[cincincyreds]

Hey guys, who is this Dr. White. Listening to him for the defense, he sounds like a real clown defending Dr. Murray. I don't think it is his responsibility for coming up with a theory that MJ injected himself. How about the fact Murray provided the white stuff? Isn't that criminal behavior? I would be a little concerned about that. I also found out he is being paid about 10k for his testimony. For his time, it seems similar to about a week's worth of work for me if I do some overtime. Is that normal pay for testimony?

 

[PMPMD]

Hey guys, who is this Dr. White. Listening to him for the defense, he sounds like a real clown defending Dr. Murray. I don't think it is his responsibility for coming up with a theory that MJ injected himself. How about the fact Murray provided the white stuff? Isn't that criminal behavior? I would be a little concerned about that. I also found out he is being paid about 10k for his testimony. For his time, it seems similar to about a week's worth of work for me if I do some overtime. Is that normal pay for testimony?

That figure sounds low given the profile and length of this trial. I wonder if that was just for testimony, and he got a separate fee for consulting.

 

[UTSouthwestern]

Hey guys, who is this Dr. White. Listening to him for the defense, he sounds like a real clown defending Dr. Murray. I don't think it is his responsibility for coming up with a theory that MJ injected himself. How about the fact Murray provided the white stuff? Isn't that criminal behavior? I would be a little concerned about that. I also found out he is being paid about 10k for his testimony. For his time, it seems similar to about a week's worth of work for me if I do some overtime. Is that normal pay for testimony?

Paul was former chairman here at Southwestern and a former professor of mine before leaving for the northeast a couple of years ago. MD,PhD with his own handbook of anesthesia drugs. Lectures on PONV ad nauseum. I am disappointed that he chose to take this case and create a magical scenario for the defense. I assure you he is getting paid more than $10K. That and having face time = future press interviews = much more $$$ for him, but at what cost to his reputation?

 

[Per4mer8]

Paul was former chairman here at Southwestern and a former professor of mine before leaving for the northeast a couple of years ago. MD,PhD with his own handbook of anesthesia drugs. Lectures on PONV ad nauseum. I am disappointed that he chose to take this case and create a magical scenario for the defense. I assure you he is getting paid more than $10K. That and having face time = future press interviews = much more $$$ for him, but at what cost to his reputation?

Maybe it's golden parachute time?

 

[Socrates25]

Paul was former chairman here at Southwestern and a former professor of mine before leaving for the northeast a couple of years ago. MD,PhD with his own handbook of anesthesia drugs. Lectures on PONV ad nauseum. I am disappointed that he chose to take this case and create a magical scenario for the defense. I assure you he is getting paid more than $10K. That and having face time = future press interviews = much more $$$ for him, but at what cost to his reputation?

Like I said, the anesthesiology boards should strip him of his certification and the medical boards should pull his license. He's a for-hire clown, not a professional.

 

[jwk]

Paul was former chairman here at Southwestern and a former professor of mine before leaving for the northeast a couple of years ago. MD,PhD with his own handbook of anesthesia drugs. Lectures on PONV ad nauseum. I am disappointed that he chose to take this case and create a magical scenario for the defense. I assure you he is getting paid more than $10K. That and having face time = future press interviews = much more $$$ for him, but at what cost to his reputation?

Maybe it's $10k per day. Figure they gotta have a big gun and they don't come cheap. But I agree - what's the cost to his reputation? He will forever be tied to this trial, regardless of the verdict. Why would anyone with the academic credentials that he has ***** himself out for this?

And I thought this was particularly interesting...

GUIDELINES FOR EXPERT WITNESS QUALIFICATIONS AND TESTIMONY
Committee of Origin: Professional Liability
(Approved by the ASA House of Delegates on October 15, 2003, and last amended on
October 22, 2008)

B. EXPERT WITNESS ETHICAL GUIDELINES
1. The physician's review of the medical facts should be truthful, thorough and impartial and should not exclude any relevant information to create a view favoring either the plaintiff or the defendant. The ultimate test for accuracy and impartiality is a willingness to prepare testimony that could be presented unchanged for use by either the plaintiff or defendant.

 

[cincincyreds]

Thanks guys for the info on this guy. I guess if he was actually impartial and doing this without pay, I would have some respect for him. For the few years I've been doing this, I'm so disgusted by how the specialty has been sold out.

This guy probably has a bigger house than mine and probably a nicer car, but I at least get some respect from the people I work with.

 

[Planktonmd]

Thanks guys for the info on this guy. I guess if he was actually impartial and doing this without pay, I would have some respect for him. For the few years I've been doing this, I'm so disgusted by how the specialty has been sold out.

This guy probably has a bigger house than mine and probably a nicer car, but I at least get some respect from the people I work with.

You would be surprised how many of the big names of anesthesia are involved in the lucrative business of expert testimony.
Actually many of them make a decent income testifying against other anesthesiologists.
It's all about the money my friend.

 

[cincincyreds]

Its good to know there are people on my side. If I had Dr. White testifying against me, I would give him the Quadafi treatment.

 

[CambieMD]

Conrad Murray should try for a plea agreement. He could do six months in a medium security facility maybe with the option to reapply for his license to kill in a few years.

How can he beat this. His patient is dead and he was with him at the time.
The argument that MJ injected himself points to the fact that Murray left his patient unattended with zero monitors in use.

Cambie

 

[epidural man]

Like I said, the anesthesiology boards should strip him of his certification and the medical boards should pull his license. He's a for-hire clown, not a professional.

I disagree and I think you need to re-listen to his testimony.

He agreed that Dr. Murray was way out of the standard of care. He agreed that he himself would have acted different than Dr. Murray once seeing that MJ was in cardiac arrest.

I think Dr White's main point was that after administering 25mg of propofol and observing someone for 30 minutes, and that if the patient was doing fine, he was fine to be left alone.

I'm not sure Dr White would agree that leaving the propofol in the room was a good idea. That's like leaving a loaded gun with bullets and instructions in a room with someone who wants to commit suicide.

I have enjoyed Dr. White's lectures and his writings. I was sad to see him on the defense side - but after watching his testimony, I thought he looked a little like a baffoon and I was a little disappointed he allowed the lawyer to use such railroading and fallacy arguments against him. The prosecuting lawyer kept using a forced either/or argument. I wish Paul would have stuck up for himself more and not allowed such juvenile tactics. (Don't think I am arguing for Dr. Conrad by the way....)

Finally, why the crap would Dr Conrad use propofol anyway? It doesn't produce an EEG near normal sleep.

But residents...what drug do we commonly use that produces a sleep pattern (EEG) very close to a drug-free sleep? And what is great about this drug is it isn't a respiratory depressant. This drug is the closest thing we have to making someone sleep with a normal EEG pattern. Why Dr. C didn't use this drug is beyond me.

 

[RT2MD]

Not a resident, but taking a stab at it... Precedex?

 

[Planktonmd]

Conrad used Propofol because MJ who pays him $150,000 a month wanted him to.
And Conrad thought that it is so easy anyone can do it because that's what it looks like to outsiders when we give anesthesia to patients, we make it look too easy which encourages people like Conrad to think they can do it too.

I disagree and I think you need to re-listen to his testimony.

He agreed that Dr. Murray was way out of the standard of care. He agreed that he himself would have acted different than Dr. Murray once seeing that MJ was in cardiac arrest.

I think Dr White's main point was that after administering 25mg of propofol and observing someone for 30 minutes, and that if the patient was doing fine, he was fine to be left alone.

I'm not sure Dr White would agree that leaving the propofol in the room was a good idea. That's like leaving a loaded gun with bullets and instructions in a room with someone who wants to commit suicide.

I have enjoyed Dr. White's lectures and his writings. I was sad to see him on the defense side - but after watching his testimony, I thought he looked a little like a baffoon and I was a little disappointed he allowed the lawyer to use such railroading and fallacy arguments against him. The prosecuting lawyer kept using a forced either/or argument. I wish Paul would have stuck up for himself more and not allowed such juvenile tactics. (Don't think I am arguing for Dr. Conrad by the way....)

Finally, why the crap would Dr Conrad use propofol anyway? It doesn't produce an EEG near normal sleep.

But residents...what drug do we commonly use that produces a sleep pattern (EEG) very close to a drug-free sleep? And what is great about this drug is it isn't a respiratory depressant. This drug is the closest thing we have to making someone sleep with a normal EEG pattern. Why Dr. C didn't use this drug is beyond me.

 

[pgg]

But residents...what drug do we commonly use that produces a sleep pattern (EEG) very close to a drug-free sleep? And what is great about this drug is it isn't a respiratory depressant. This drug is the closest thing we have to making someone sleep with a normal EEG pattern. Why Dr. C didn't use this drug is beyond me.

I've thought for years that this drug has big potential for abuse.

Murray probably didn't use it because he's probably not even aware of its existence. (Also, like planktonmd says, because rich addicts want what rich addicts want.)

 

[CambieMD]

I disagree and I think you need to re-listen to his testimony.

He agreed that Dr. Murray was way out of the standard of care. He agreed that he himself would have acted different than Dr. Murray once seeing that MJ was in cardiac arrest.

I think Dr White's main point was that after administering 25mg of propofol and observing someone for 30 minutes, and that if the patient was doing fine, he was fine to be left alone.

I'm not sure Dr White would agree that leaving the propofol in the room was a good idea. That's like leaving a loaded gun with bullets and instructions in a room with someone who wants to commit suicide.

I have enjoyed Dr. White's lectures and his writings. I was sad to see him on the defense side - but after watching his testimony, I thought he looked a little like a baffoon and I was a little disappointed he allowed the lawyer to use such railroading and fallacy arguments against him. The prosecuting lawyer kept using a forced either/or argument. I wish Paul would have stuck up for himself more and not allowed such juvenile tactics. (Don't think I am arguing for Dr. Conrad by the way....)

.

This is what the DA thinks of Dr. White


the prosecutor in the trial of Michael Jackson's personal physician told jurors on Thursday that the testimony a renowned anesthesiologist gave in Dr. Conrad Murray's defense was "junk science."The harsh rebuke of the testimony of Dr. Paul White, a leading expert on the surgical anesthetic propofol, came near the conclusion of the prosecution's closing argument. A defense attorney for Dr. Conrad Murray was expected to begin arguing before the jury in the afternoon.

White, who was among the first scientists in the U.S. to study the drug, testified over four days in Murray's defense and said Jackson probably injected himself with the drug and caused his own death.

This tells me that you can find someone to say anything if you pay them enough.

Cambie

 

[cincincyreds]

Money talks, and something I just forgot walks. Hopefully that something in this case will be walking straight into jail and hopefully that key will be lost.

 

[jwk]

Money talks, and something I just forgot walks. Hopefully that something in this case will be walking straight into jail and hopefully that key will be lost.

Even if he walks, the civil trial is still coming.

 

[Socrates25]

Both Murray and "Dr" Paul White are ******; they just sell out for different amounts of cash.

 

[WholeLottaGame7]

Both Murray and "Dr" Paul White are ******; they just sell out for different amounts of cash.

We all have a price, some people's are just lower than others.

 

[michigangirl]

4 p.m. today for the verdict-- seems like a pretty speedy deliberation, so guilty sounds likely...

 

[cincincyreds]

Involuntary manslaughter. Is there gonna be a civil trial next? Dr. Murray should have digged up Cocharen and Kardashian for his defense.

 

[michigangirl]

thank goodness the jury saw the true colors of this case.

 

[doctor712]

And he was just remanded to court custody, no bail, and will be sentenced Nov 29 or 30.

D712

 

[kazuma]

If he was really as smart as the defense claimed him to be, he would have entered a plea bargain. I can't believe he dared to say he was not guilty with the huge amount of evidence the prosecuters had against him. What a nut case. I'm glad the jury didn't by the whole "swallowing propofol" theory or any of the other wild defense claims.

 

[Dwindlin]

Isn't anyone concerned with the precedent this sets? Granted what he did was definitely malpractice and he should lose his license, but criminal charges is concerning to me.

 

[pgg]

Isn't anyone concerned with the precedent this sets?

😕 Did you read this thread? It's full of concern about the precedent it sets.

Mostly unfounded concern, IMHO, but it's there.

 

[epidural man]

Isn't anyone concerned with the precedent this sets? Granted what he did was definitely malpractice and he should lose his license, but criminal charges is concerning to me.

NO. Not at all. He was SO FAR outside the standard of care - the guy brought propofol and gave it someone in their personal bedroom (with no monitors).

Then, when MJ arrests, he doesn't even call 911 first. Holy CRAP!

And I again have to defend Dr. White a little - I don't agree with his decision to work for the defense, and I think he looked completely flustered on the stand. But I think his arguement is sound - and that is...it isn't unreasonable to think that 25mg of propofol is not enough to kill someone - and 25min post injection time of 25mg of propofol is enough time to watch someone after the injection before leaving the bedroom.

Now, I am sure that Dr. Conrad is probably lying about how much he gave, or how much he monitored after the injection - but if you take him for his word, what Dr. White says is pretty right, isn't it?

 

[pgg]

If he was really as smart as the defense claimed him to be, he would have entered a plea bargain. I can't believe he dared to say he was not guilty with the huge amount of evidence the prosecuters had against him. What a nut case. I'm glad the jury didn't by the whole "swallowing propofol" theory or any of the other wild defense claims.

Well, as stupid as juries and prosecutors can be in high profile circus cases, I'm inclined to think that his BEST chance at getting off scott free was to count on a dumb jury and/or incompetent prosecutor. He took his chances and lost.

(It worked for OJ.)

 

[Chi77]

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

Because there was a breach of the standard of care expected. If entry requirements are intended to ensure people meet a certain standard, then relaxing them for affirmative action purposes may increase the risk of having people who breach the expected standard of care. Murray may have been eligibile for affirmative action therefore some people may naturally wonder whether he would have been practising without the benefit of affirmative action.

From what I can gather he didn't benefit from affirmative action.

 

[Socrates25]

And I again have to defend Dr. White a little - I don't agree with his decision to work for the defense, and I think he looked completely flustered on the stand. But I think his arguement is sound - and that is...it isn't unreasonable to think that 25mg of propofol is not enough to kill someone - and 25min post injection time of 25mg of propofol is enough time to watch someone after the injection before leaving the bedroom.

Now, I am sure that Dr. Conrad is probably lying about how much he gave, or how much he monitored after the injection - but if you take him for his word, what Dr. White says is pretty right, isn't it?

You dont get paid $100k by a defense attorney only to put out theoretical implausible scenarios. You get paid to claim that the plaintiff's expert is WRONG and that MJ more likely died from an auto-injection rather than Conrad Murray giving it to him. THAT is what Dr Paul White testified to.

Thank god the jury saw thru his bull**** scenario.

Dr Paul White sold out his field and his honor for $$$. He's a scumbag who needs to have his license pulled.

 

[homeobox_genes]

His problem was drug abuse. Probably depression and some other issues, but the one thing we can say with absolute certainty is that he was an addict.



OK, this is an interesting comment. He was probably dependent on benzodiazapines and / or propofol for sleep, but your comment makes it sound like he was craving and seeking these substances for the euphoria or to get high. Is this established? As far as we know, these were medications he took at bedtime only to deal with his issues with insomnia. I didn't hear testimony that Jackson was popping benzos recreationally, or asking for Propofol other than for sleep. "the one thing we can say with absolute certainly is that he was an addict," I think is a bit of a leap perhaps, with regard to these two medications.

 

[michigangirl]

Because there was a breach of the standard of care expected. If entry requirements are intended to ensure people meet a certain standard, then relaxing them for affirmative action purposes may increase the risk of having people who breach the expected standard of care. Murray may have been eligibile for affirmative action therefore some people may naturally wonder whether he would have been practising without the benefit of affirmative action.

From what I can gather he didn't benefit from affirmative action.

This again? Affirmative action is not relaxing expected standards when it comes to standard of care and ethical conduct-- i.e. benefiting from affirmative action doesn't mean you're more likely to do stupid things. Like I've said before, just because you have amazing "stats" and accomplishments doesn't mean you won't be bitten in the a#s by the pull to do stupid things in the name of money. Conrad Murray could be the most brilliant man with the most amazing grades to get into med school. Doesn't mean he's not a greedy bastard who thought he could get away with "innocently" gving a general anesthetic in someone's home.

 

[El Dooderino]

His problem was drug abuse. Probably depression and some other issues, but the one thing we can say with absolute certainty is that he was an addict.



OK, this is an interesting comment. He was probably dependent on benzodiazapines and / or propofol for sleep, but your comment makes it sound like he was craving substances for some kind of high. I don't know that there's evidence for that--you're making a leap here, and an unsubstantiated one at that. As far as we know, these were medications he took at bedtime only to deal with his issues with insomnia. I didn't hear testimony that Jackson was popping benzos recreationally, or asking for Propofol other than for sleep. "the one thing we can say with absolute certainly is that he was an addict," couldn't be more incorrect.

uhhhh, he was addicted to those medications to help him sleep...does that make you feel any better? he was also getting demerol and other opiods from his doctor Arnie Klein. Why comment on the case if you don't know much about it?

 

[pgg]

His problem was drug abuse. Probably depression and some other issues, but the one thing we can say with absolute certainty is that he was an addict.

OK, this is an interesting comment. He was probably dependent on benzodiazapines and / or propofol for sleep, but your comment makes it sound like he was craving substances for some kind of high. I don't know that there's evidence for that--you're making a leap here, and an unsubstantiated one at that. As far as we know, these were medications he took at bedtime only to deal with his issues with insomnia. I didn't hear testimony that Jackson was popping benzos recreationally, or asking for Propofol other than for sleep. "the one thing we can say with absolute certainly is that he was an addict," couldn't be more incorrect.

The definition of addiction has nothing to do with "recreational" use, and everything to do with loss of control and continued compulsive use despite adverse physical or social consequences.

Most recreational drug users aren't addicts.

 

[Hamhock]

Most recreational drug users aren't addicts.

Does this include users of "propofol"?

I honestly don't know the academic answer...only asking.

HH

 

[pgg]

Does this include users of "propofol"?

I'd guess almost certainly not ...

I honestly don't know the academic answer...only asking.

I can't for the life of me find the reference I was thinking of there, which I think actually predated the last decade's rise in meth and rx drug abuse, so my statement may not even be accurate any more. I recall thinking the data there was skewed because most US illicit drug users are pot smokers, and a huge % of them are casual recreational users that certainly don't exhibit the behavior of addicts.

I guess I ought to retract my "Most recreational drug users aren't addicts" statement, since I can't cite any actual evidence. I believe it to be true though.

 

[matt30]

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.

I'm not a medical student but I thought I'd address this since I have a particular interest in this field (research bioethics and medical ethics). I'm a law student (I know, heresy right? ) at Cornell.

In civil cases a plaintiff can recover if he/she demonstrates that a medical professional is negligent. The traditional negligence standard is given by the Hand formula (named after Judge Learned Hand). The formula states that a person is negligent when the probability of a harmful outcome multiplied by seriousness of the injury is greater than the burden of providing safeguards. This calculus is not quantitative but qualitative. In less formal terms the question posed is whether the professional acted as a prudent and educated member of the profession he/she represents.

If your anesthesiologist in scenario one did not obtain a medical history and did not have the proper antidote on-hand because of some pressing medical emergency, he/she is unlikely to be held civilly liable. Extrinsic factors are very important to a proper application of the test.

In scenario two, there is a causation issue (another, different legal standard) that would need to be addressed first. What was the disposition of the patient's health before the change in procedure? But for the doctors actions, would the patient have died just as soon? Was the death a foreseeable consequence of the change?

In criminal law the crime of manslaughter usually requires more than just mere negligence. There must be so-called gross negligence. Gross negligence sits somewhere between regular negligence (explained above) and deliberate evil. Traditionally, culpability rests on whether the offender has the opportunity to consider his actions and make a deliberate choice to be indifferent to the consequences. The standard varies by state.

 

[Pooh & Annie]

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.

You're a physician I assume. An anesthesiologist. So you know what the risks/benefits of administering propofol are. I'd be interested to hear how administering propofol in this situation would benefit your patient.

 

[Gern Blansten]

You're a physician I assume. An anesthesiologist. So you know what the risks/benefits of administering propofol are. I'd be interested to hear how administering propofol in this situation would benefit your patient.

Just schtick...I hope.

 

[Pooh & Annie]

Just schtick...I hope.

His recurrent threads about income potential suggest otherwise.

 

[jetproppilot]

You're a physician I assume. An anesthesiologist. So you know what the risks/benefits of administering propofol are. I'd be interested to hear how administering propofol in this situation would benefit your patient.

The spirit of the post was that had Michael Jackson selected an appropriate physician to perform what he desired, he'd still be alive today.

Your finger-wagging-style question is noted. I'll still answer.

I'm not convinced that a propofol induced sleep would be of no benefit to a raging insomniac. Even justa cuppla hours. It's impossible to say yes or no to this speculation at this point but I'd be willing to give it a try, albeit in a safe environment commensurate to our operating rooms of current day.

We've put people to sleep for drug addiction withdrawal. We put females to sleep for completely elective plastic surgery. Do you wag your judgement finger at these scenerios as well?

Cottage industries are born by saying "what if?"

Get off your high horse.

Oh, and since when is it illegal to seek financial incentive for expertise? You speak as tho it's a sin to seek financial gain.

 

[cincincyreds]

Contrary to Dr. White's testimony, 25mg of propfol is enough to kill someone. I had someone in my group give a 90 year old 25mg of propfol for a TEE. About 10 minutes later I was called when the patient was arresting. Now, I don't know the stae Michael Jackson's heart was in. I remember seeing him in a wheel chair, so he was not the healthiest person on this planet.

Here's my question. Lets say Dr. Murray managed to bring Michael back. Someone comes by and reports Dr. Murray for this. Would there be criminal activity for using propofol outside of an approved medical setting or use? Kind of like how we use botox for wrinckles.

 

[jwk]

I'm not a medical student but I thought I'd address this since I have a particular interest in this field (research bioethics and medical ethics). I'm a law student (I know, heresy right? ) at Cornell.

In civil cases a plaintiff can recover if he/she demonstrates that a medical professional is negligent. The traditional negligence standard is given by the Hand formula (named after Judge Learned Hand). The formula states that a person is negligent when the probability of a harmful outcome multiplied by seriousness of the injury is greater than the burden of providing safeguards. This calculus is not quantitative but qualitative. In less formal terms the question posed is whether the professional acted as a prudent and educated member of the profession he/she represents.

If your anesthesiologist in scenario one did not obtain a medical history and did not have the proper antidote on-hand because of some pressing medical emergency, he/she is unlikely to be held civilly liable. Extrinsic factors are very important to a proper application of the test.

In scenario two, there is a causation issue (another, different legal standard) that would need to be addressed first. What was the disposition of the patient's health before the change in procedure? But for the doctors actions, would the patient have died just as soon? Was the death a foreseeable consequence of the change?

In criminal law the crime of manslaughter usually requires more than just mere negligence. There must be so-called gross negligence. Gross negligence sits somewhere between regular negligence (explained above) and deliberate evil. Traditionally, culpability rests on whether the offender has the opportunity to consider his actions and make a deliberate choice to be indifferent to the consequences. The standard varies by state.

An attorney actually interested in facts and applying "the law"? Those are few and far between. You haven't learned this yet?

 

[Pooh & Annie]

The spirit of the post was that had Michael Jackson selected an appropriate physician to perform what he desired, he'd still be alive today.

Your finger-wagging-style question is noted. I'll still answer.

I'm not convinced that a propofol induced sleep would be of no benefit to a raging insomniac. Even justa cuppla hours. It's impossible to say yes or no to this speculation at this point but I'd be willing to give it a try, albeit in a safe environment commensurate to our operating rooms of current day.

We've put people to sleep for drug addiction withdrawal. We put females to sleep for completely elective plastic surgery. Do you wag your judgement finger at these scenerios as well?

Cottage industries are born by saying "what if?"

Get off your high horse.

Oh, and since when is it illegal to seek financial incentive for expertise? You speak as tho it's a sin to seek financial gain.

I hadn't thought about it, but maybe I am finger wagging.
Your expertise is in providing a safe anesthetic and providing pain relief in the peri-operative period.
NOT sleep medicine, addiction medicine, and maybe psychiatry, all of which Michael Jackson apparently needed.
I'm agnostic so I don't think it would be "a sin" to seek financial gain in this situation. I do believe in greed (and potentially negligence), which offering your "expertise" would, in my opinion, equate to here. "Cottage industry"? Give me a break bro.
Your examples of providing an anesthetic for elective surgery or withdrawal symptoms (which we know isn't completely supported by the evidence) do fall under your area of expertise, so the comparison is false.

 

[doctor712]