Michael Jackson's doctor is...guilty!

[Riff]

Have a few days off, so I might as well do what I do best, vent. Not talking about this case but the news of it today jogged my memory, reminding me of the old philosophical debate about causation--proximate and ultimate.

You could have a real mess of a patient, I mean history of sexual abuse, neglect, the whole deal, couple of personality disorders, and God help you if you administer some med off label which harms the patient seriously.

Suddenly everything you did is under the microscope. Your whole life. And suddenly family and friends and "concerned" others appear out of nowhere. And you become like the perfectly placed garbage sponge, to absorb all the negativity in the family, past and present, and a good punching bag. As if you did what you did out of malice as opposed to functional concerns of reducing patient's suffering.

Look, there is absolutely no excuse to treat someone who is severely ill with any less care or concern. If anything, they need more of it. But there is a reason why neurosurgeons get sued more often than any other specialist. There are just many more ways that things can go wrong when you're dealing with complex problems or brittle systems that are barely held together. That someone dies, that someone is harmed because of something one does, does not negate the various other causes, proximate and ultimate, that contributed to the situation that the person is in presently. But death is final and we need to blame someone, better the neurosurgeon than the nameless cancer.

What I do love to see is patient's family come and voice their concerns if the patient gets worse. It truly makes me happy, to feel that there are people who care about a very ill person. But what infuriates me is a family that has been nothing but abusive, suddenly appear out of nowhere, to project their own incompetence onto you.

I don't know much about Michael Jackson but as far as I know, he was abused as a child and exposed to fame rather early on. A disaster of a life, comes to a disastrous end, and a doctor there, to blame.

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[F0nzie]

Found this exerpt on Wikipedia:

"Murray tape:
Amir phoned to say Jackson was finished rehearsals at 12:10 am and to meet him at the house. Amir got there at 12.:0 am, Jackson arrived between 1:05–1:10 am.
Jackson showered, Murray put cream on his body because of dermatological issues.
Murray put an IV saline drip in his leg to treat for dehydration from dancing at rehearsals and gave the sedative Valium (10 mg, 1 tablet, orally taken) to help him sleep. He did not sleep.
At 2:00 am, Murray gave Jackson 2 mg of Lorazepam diluted in saline and pushed slowly over 2–3 mins into the IV line. He observed Jackson stay wide awake for an hour. Jackson complained he could not sleep.
At 3:00 am, Murray gave Jackson 2 mg Midazolam. Jackson was still awake. Murray tried to get Jackson to meditate and turned down the lights and music. His eyes closed and he fell asleep between 3:20–3:30 am. 10-12 minutes later he was awake again.
At 4:30 am, Jackson was still awake and complaining, "need to sleep, must be ready for the concerts, would have to cancel the trip because I cannot function if I don't get sleep". "The medicine doesn't work".
At 5:00 am, Murray gave Jackson 2 mg Lorazepam. Still awake and complaining about canceling rehearsals, not satisfying fans and there being lots of pressure.
At 6:00–6:30 am, Jackson was still awake and still talking.
At 7:30 am, Murray gave Jackson 2 mg Midazolam. It had no effect, and he wondered why Jackson was not responding.
At 10:00 am, Jackson was still awake. He said he wanted "milk" (Propofol) so he could sleep, saying. "I know it works".
At 10:40 am, Jackson said "Just make me sleep, no matter what", "can't function without sleep", "have to cancel concerts". Murray said he felt under a lot of pressure, so he switched to Propofol.
At 10:50 am, Murray gave Jackson 25 mg Propofol diluted with Lidocaine slowly infused over 3–5 minutes. Lidocaine was used because the Propofol could burn the vessels. It had a very quick effect.
Because of the other drugs in his system, Murray gave 25 mg (the usual dose was 50 mg) before starting the drip to keep him asleep. Murray was asked how often had he gave Jackson the "milk", and he answered "2 months, every day". He was also asked "before you became his doctor did you know he was taking it?" Murray said he was surprised about how much Jackson knew about the drug. He knew it worked, he knew how much to put in, knew how to inject it, he said it was the only thing that worked, the Lidocaine was needed with it to stop it burning (Jackson called it anti-burn, "anti-burn makes it comfortable"). Other doctors allowed Jackson to push it himself, and Murray "wouldn't allow it" because it made him sleep instantly. Murray kept telling Jackson that it was artificial sleep. Murray said that Jackson's veins were coarse, dried up and filled with clots caused by too much IV over time. He could not get an IV in his hands.
At 11.00 am, Jackson was asleep but not snoring. Usually he would be in a deep sleep and snoring, so Murray thought Jackson would wake up again. Murray watched Jackson. Oxygen saturation was 90, heart rate was 70. Murray felt comfortable, so he got up to go to the bathroom and took some of Jackson's urine with him. Murray said he was gone for two minutes. When Murray returned, Jackson was not breathing and his heart rate was 122. He felt a pulse in Jackson's femoral artery; his body was warm and had not changed color. Murray started CPR and mouth-to-mouth resuscitation. Jackson's chest was rising and falling upon ventilation. Murray looked at the telephone then remembered none of them worked. He could not move Jackson off the bed to do CPR, so he placed his left hand under Jackson's body to continue chest compression. Murray said he did not call 911 because he did not know Jackson's zip code. He called Amir to tell security to come up. There was no pulse now, so he lifted his legs to try and get the blood flowing to his heart. He then infused 0.2 mg Flumazonil into the IV to try and counteract the Lorazepam. He went to the landing to meet Alvarez. Alvarez came in, and Murray told him to call 911 and to help move Jackson onto the floor, which he did. Murray was still giving CPR and mouth-to-mouth when the paramedics arrived and intubated him. They saw PEA (pulseless electrical activity, they could see a beat but there was no contraction) and administered Atropine, Epinephrine and sodium bicarbonate. After 20 minutes, the paramedics (while in contact with UCLA) wanted to call time of death. However, Murray got them to transfer care to him. Murray said "I didn't want to give up, I love Michael, he was my friend, I wanted to help, he was a single parent, thinking about the children, thinking about my own children". CPR continued down to the ambulance; once in the trauma bay, medical personnel tried for at least an hour, they "would have given up without me" said Murray. They pronounced him dead, but Murray would not sign the death certificate because he did not know the cause of death."


Stacking benzo's and using Propofol "off-label" for sleep...

 

[whopper]

A frustrating part of this case is that we doctors aren't supposed to discuss cases unless we've done a professional level examination.

But there's so many things in this case that are definite no-nos that no doctor should've done. It's obvious to medical doctors what those no-nos are. From there I do think there is some room for discussion.

We could discuss aspects of the case in general terms.

 

[Apollyon]

A frustrating part of this case is that we doctors aren't supposed to discuss cases unless we've done a professional level examination.

But there's so many things in this case that are definite no-nos that no doctor should've done. It's obvious to medical doctors what those no-nos are. From there I do think there is some room for discussion.

We could discuss aspects of the case in general terms.

Actually, the ethics are about discussing patients whom we've (well, you folks that are psychiatrists) have not examined - but, as is with most homicide cases, it's mostly about the offender, not the victim. The only topics about the patient/victim, ostensibly, were insomnia and whether he gave himself the propofol.

Otherwise, it's about Dr. Murray, and unethical behavior by other physicians is not a forbidden topic; especially in this case, it involves a criminal level of action, and that is certainly open to discussion without ethical concern, as the testimony is a matter of public record, and, by law, factual.

 

[OldPsychDoc]

Ah yes--in general terms--about the wisdom of letting your patients drive their own treatment regimens, about "I love [my patient], he was my friend", about the general wisdom of concierge practice to entitled persons....

 

[Doctor Bagel]

Ah yes--in general terms--about the wisdom of letting your patients drive their own treatment regimens, about "I love [my patient], he was my friend", about the general wisdom of concierge practice to entitled persons....

This. I guess I'm more interested in how he got himself into this position as this type of provider (which is inherently troublesome).

 

[Ibid]

This. I guess I'm more interested in how he got himself into this position as this type of provider (which is inherently troublesome).

Looks like he was a smooth criminal....

 

[Riff]

Hmmm, I started this thread feeling sorry for the doctor (despite his "aggressive" treatment of Michael's anxiety and chronic insomnia and his oversight), and blaming Michael's uncaring family who allowed things to get this bad; but come to think of it, the doctor is to blame for the mess he's gotten himself into now.

Based on some of the replies, I started to wonder what it might be like to be a very famous and troubled celebrity's personal physician. What sort of boundary violations take place in this kind of relationship? What about other aspects of this kind of unique and unusual relationship, in terms of confidentiality and trust, honesty, integrity, balance of power, etc.

 

[erg923]

Looks like he was a smooth criminal....

He didnt stop till he got enough...

Ok, maybe that was crossing a line.

 

[OldPsychDoc]

He didnt stop till he got enough...

Ok, maybe that was crossing a line.

You Thriller, you.

[sorry--my knowledge of the victim's discography is, happily, limited...]

 

[sunlioness]

I don't have a ton of sympathy for the doc and think the verdict was likely the correct one. And he really lost me when he tried to blame Jackson for taking the propofol when he wasn't there and also when he said that Jackson was his "friend." Patient's aren't friends. And last I checked, you can't wander into your corner pharmacy and buy propofol over the the counter. The fact that it was there in the first place is problematic, never mind who administered it.

 

[nancysinatra]

A frustrating part of this case is that we doctors aren't supposed to discuss cases unless we've done a professional level examination.

But this case was in the news. Why would it be ok for ordinary citizens to discuss what they hear in the news, but doctors should have to keep their mouths shut? We are covered by the same first amendment as everyone else. If you went on TV and in an official medical capacity claimed to diagnose a celebrity or public figure, that would be different, but that's not what this is.

Plus as someone said, it's the doctor that is the subject of discussion. There is no "confidentiality" applied to doctors. In this case the patient's family and lawyers have revealed to the world what happened, which they have every right to do. Plus the case was in court and anyone could request those documents. Why on earth should "doctors" not be allowed to comment on matters of public knowledge?

 

[nitemagi]

The goldwater rule pre-dates the use of online forums, and so becomes a gray area. The original rule was in relation to a survey in a magazine to thousands of psychiatrists about Barry Goldwater, and psychiatrists sent in everything from short answers to psychodynamic formulations, many of which were scathing. Are posts on a forum like SDN actually a public opinion, since they're readable by the public? Is it different than giving an interview and professional opinion to a news organization? I can see arguments on both sides.

I'd err on the side of discussing topics in medicine in general, rather than the case. Propofol for sleep no matter what seems a little ridiculous.

 

[nancysinatra]

The goldwater rule pre-dates the use of online forums, and so become a gray area. Are posts on a forum like SDN actually a public opinion, since they're readable by the public? Is it different than giving an interview and professional opinion to a news organization? I can see arguments on both sides.

Yes it's different--because no one cares what is posted on SDN, whereas people pay to watch and read the news and the public is influenced by it.

If you have a conversation in a coffee shop, anyone sitting nearby can listen in to that. Would you say that is "public opinion" as well?

We who post on here are far less important than we ourselves seem to think. I realize there are SDN moderators who take their jobs as seriously as if they were planning an international summit with dozens of news crews from around the world, but in fact, all this is is a rather sedate message board. SDN is not a news organization!!! If you give an interview on the TV news it's actually edited by someone else and the news organization is the one that publishes it. It's not the same as just randomly posting your thoughts and musings.

Granted if you publicly claim that you are using your medical knowledge to "diagnose" someone OR if you blatantly give out advice then that's different. But just conversing? And discussing facts that are public knowledge?

Just because I say on this forum that "Michael Jackson was reported to have bad insomnia" or even "Michael Jackson had insomnia" does not mean I am "diagnosing" him or using my medical knowledge. His insomnia was already written about in the paper. I am discussing something I heard in the news. Medical things come up in the news a lot, and so do celebrities.

Ok now I will probably get banned...

 

[Shufflin]

Long-term disruptions to propofol production in 2010 makes this all just a bit more interesting. Veterinarians and anesthesiologists were scrambling to get some, and here a doctor uses it in a completely off-label manner. Adds a little intrigue to the picture.

 

[Ibid]

Yes it's different--because no one cares what is posted on SDN, whereas people pay to watch and read the news and the public is influenced by it.


We who post on here are far less important than we ourselves seem to think. I realize there are SDN moderators who take their jobs as seriously as if they were planning an international summit with dozens of news crews from around the world, but in fact, all this is is a rather sedate message board. SDN is not a news organization!!! If you give an interview on the TV news it's actually edited by someone else and the news organization is the one that publishes it. It's not the same as just randomly posting your thoughts and musings.

I wouldn't be so sure about all of that. It is the opinion of the readership that matters. Take a look at the Vbulletin licence agreement. Specifically section 10, LIMITATION OF LIABILITY. Vbull have taken the trouble to write it in CAP LOCKS as opposed to the rest of the doc.

https://www.vbulletin.com/order/license_agreement.php

The significance of that is that they have gone to a lot of trouble to distance themselves from what is published using the software.

Depending on the jurisdiction, where the rules differ as to who is considered to be the publisher of any postings and where the server is located and so on......the bottom line is that if you libel someone on here and they can show loss of earnings, future earnings and so on.....you could end up on the wrong end of a suit that could make your student loan look like a library fine. Random musing could end up being very expensive.

Unlikely but possible.

 

[whopper]

And he really lost me when he tried to blame Jackson for taking the propofol when he wasn't there and also when he said that Jackson was his "friend." Patient's aren't friends

Jackson shouldn't have been given Propofol to begin with. To merely call this off-label is misleading. There were specific guidelines in place to prevent it from being given for this off-label purpose.

I will say that this case is a shining example of doctors willing to say anything on the stand for the right amount of money. I don't know what the expert witnesses were paid, but I've heard some of the testimony and it's laughable.

This is a reason why I get especially upset when doctors do this. We already make a six figure salary. Do we really need to ***** ourselves to make an extra $1000 an hour?

 

[digitlnoize]

I'm not technically a doctor yet. Does this mean I can say whatever I want about this case? lol.

If you haven't seen it, this little section from Kevin Smith's Q&A Session (An Evening with Kevin Smith), I think gives us some important insight into what it's like to work with these type of celebrities...in this case, Prince.

It's on YouTube in 4 parts, and the whole thing is a little long, but pretty funny, and I think is very insightful.

If you're short on time, just watch the beginning of Part 2, with the background story that Prince called Kevin Smith (Clerks, Dogma, Jay&Silent Bob, etc) to make a "documentary" for him...but I think it's worth it to watch the whole thing. Honestly, this entire Q&A DVD is one of the funniest things I've ever seen.

Warning: This is Kevin Smith, and there are, of course, curse words.

Part 1: http://www.youtube.com/watch?v=Gy_cLJ19HMg&feature=watch_response_rev
Part 2: http://www.youtube.com/watch?v=a9O130NYr_4&feature=related
Part 3: http://www.youtube.com/watch?v=rCm4Jxo3ltE&feature=watch_response
Part 4: http://www.youtube.com/watch?v=Vo0LbQzdz1A&feature=related

 

[sunlioness]

This is a reason why I get especially upset when doctors do this. We already make a six figure salary. Do we really need to ***** ourselves to make an extra $1000 an hour?

Yeah, it really cheeses me off. I feel so fortunate in this economy to have a well paying job and in demand job that when I see things like this, it just really sticks in my craw.

 

[whopper]

Yeah well the good Dr. Murray is going to be on the Today Show for an undisclosed amount of money where he can further violate professional ethics and tell personal details of Mr. Jackson, his so-called "friend," unless of course Mr. Jackson allowed for the doctor to disclose this information prior to his death, and I highly doubt that.

 

[archiearchie]

Weird. Is Kevin Smith allowed to talk behind his back like that or is the whole thing just an act? Like don't they sign something that says you can't talk about what goes on behind the scenes to anybody or they'll sue your pants off? I'm not sure Prince would approve.

It sounded plausible though. Celebrities like that, and I think Michael really tops them, really do live in a world of their own, a narcissistic and almost childish world where people around you make things happen regardless of how unrealistic the demands are. So it's that much more important that you got a principled and tough minded doctor to work with them. Because so many people are making money off of ya, they have little interest in telling the person the truth. Keep the fragile genius happy enough so he does what he does best, which is to keep all upsetting things or thing that may lead to maturity and growth far away from him and just let him remain in that world where he makes great music and lots of money for people all around. If you are a doc going into that, you better have a will of steel, non-negotiable principles, and also no greed whatsoever.

 

[digitlnoize]

Weird. Is Kevin Smith allowed to talk behind his back like that or is the whole thing just an act? Like don't they sign something that says you can't talk about what goes on behind the scenes to anybody or they'll sue your pants off? I'm not sure Prince would approve.

It sounded plausible though. Celebrities like that, and I think Michael really tops them, really do live in a world of their own, a narcissistic and almost childish world where people around you make things happen regardless of how unrealistic the demands are. So it's that much more important that you got a principled and tough minded doctor to work with them. Because so many people are making money off of ya, they have little interest in telling the person the truth. Keep the fragile genius happy enough so he does what he does best, which is to keep all upsetting things or thing that may lead to maturity and growth far away from him and just let him remain in that world where he makes great music and lots of money for people all around. If you are a doc going into that, you better have a will of steel, non-negotiable principles, and also no greed whatsoever.

I don't think it's an act...at least not all of it. He's very candid with the stories he tells in the video, and he never got in trouble for it. I think the Prince one in particular is more likely because it didn't seem like there was an actual contract. Kevin didn't get paid for it...and he never got in trouble for saying anything, I don't think....

Although, if you watch the rest of the DVD (and I highly recommend it, this was one of the least amusing stories in there)...he DID get in trouble for saying things publicly about Tim Burton, with hilarious results. Not real trouble, but yelled at by Mr. Burton. My wife and I are actually not huge Kevin Smith fans, but just happened to catch this on TV one night, and found ourselves literally rolling on the floor laughing. Far more fun than his movies (which have grown on me after seeing this), IMO.

 

[whopper]

I find Kevin Smith's commentary more entertaining than his movies. Maybe it's because I'm from NJ, I'm a sci-fi and comic book geek and the places he hung out at in his 20s were the same places I did too.

 

[Ibid]

If you're short on time, just watch the beginning of Part 2, with the background story that Prince called Kevin Smith (Clerks, Dogma, Jay&Silent Bob, etc) to make a "documentary" for him...but I think it's worth it to watch the whole thing. Honestly, this entire Q&A DVD is one of the funniest things I've ever seen.

Warning: This is Kevin Smith, and there are, of course, curse words.

Part 1: http://www.youtube.com/watch?v=Gy_cLJ19HMg&feature=watch_response_rev
Part 2: http://www.youtube.com/watch?v=a9O130NYr_4&feature=related
Part 3: http://www.youtube.com/watch?v=rCm4Jxo3ltE&feature=watch_response
Part 4: http://www.youtube.com/watch?v=Vo0LbQzdz1A&feature=related

Just got around to watching, brilliant....reminded me of the best rock documentary ever....you must have seen it but anyway two of the best for nostalgia from "This is Spinal Tap".

Eleven
[YOUTUBE]http://www.youtube.com/watch?v=XuzpsO4ErOQ&feature=related[/YOUTUBE]

A Mach Piece in D minor by Nigel Tufnel of Spinal Tap - Lick My Love Pump.
[YOUTUBE]http://www.youtube.com/watch?v=NgViOqGJEvM[/YOUTUBE]

 

[whopper]

I remember when the "Artist formerly known as Prince" changed his name back to Prince, he held a press conference as if it were a big deal. Howard Stern brought in his news team and a heckler (part of the show) to basically ask Prince out loud...

"Why the heck do you think anyone would ever care?"

 

[peiyueng]

On a personal level, I feel that if a patient doctor shops and finds a doc that will do those questionable things that eventually leads to harm, then it is the doctor who is guilty. It was disgustingly revolting to watch the Murray defense team try to blame mike.

 

[whopper]

As was said by several, even if Jackson injected himself, then it begs the argument, is that even a defense when he shouldn't have been given it in the first place?