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Sunday, August 30, 2009

Michael Jackson and the Coroner's Report

Finally, a partial coroner's report on Michael Jackson has been released. Amid speculation that the entertainer's death was the result of a drug overdose, the question, of course, turned to "How did this happen?" The following information is now public. Many stones are left unturned. "The office of the Los Angeles County coroner confirmed Friday that it had ruled Michael Jackson’s death a homicide. It said the cause was a mixture of the powerful anesthetic propofol and the anti-anxiety drug lorazepam, both of which, previously disclosed court documents say, Mr. Jackson’s doctor has acknowledged administering to him the day he died." (Solomon Moore, "Jackson's Death Ruled a Homicide," The New York Times, August 28 2009) Who may have killed Michael Jackson? The last physician to treat Mr. Jackson, Dr. Conrad Murray, a cardiologist who was acting as the entertainer’s personal physician at the time. Dr. Murray has denied any responsibility for Mr. Jackson’s death. Los Angeles Times Staff Writers Dr. Murray administered the sedatives Valium, lorazepam and midazolam -- five times over six hours because Jackson pleaded for the powerful anesthetic before his death. But none of the sedatives put Jackson to sleep and he continued to demand his "milk," the word the doctor said the pop star used for propofol. (August 28 2009) Murray said he finally relented and at 10:40 a.m. added the drug to Jackson's intravenous drip, according to the records. On June 25, the day of the homicide, he briefly left the bedroom of the star’s home (10 minutes to use the restroom) and returned to find him unconscious. Dr. Murray, however, has not been named by authorities as a suspect. Dr. Murray's lawyer is demanding that the coroner's office release the full autopsy report. Edward Chernoff said he needs to know the exact levels of the various drugs in Jackson's system and said the refusal to release the report suggests "gamesmanship." Dr Murray told investigators he was not the first doctor to administer propofol to the star. According to Murray, he was concerned that the singer was becoming addicted to the drug and had been trying to wean him off, using alternative drugs. (BBC News, August 29 2009) The L.A. Times report also states Jackson had specifically asked concert promoter AEG Live to hire Murray as his $150,000-a-month physician to travel with him to London, where he was scheduled to perform 50 concerts. The heat is also being turned up on Jackson's longtime friend and dermatologist Arnold Klein, who investigators believe facilitated the singers' years-long drug abuse. Law enforcement sources told that a recent search of the Beverly Hills pharmacy yielded records of Klein prescribing controlled substances to himself. The Washington Post reports that the coroner has subpoenaed medical records from general practitioner Allan Metzger, anesthesiologists David Adams and Randy Rosen, and holistic nurse practitioner Cherilyn Lee, who has said that Jackson unsuccessfully requested propofol from her, telling her he would "pay a doctor anything" for the drug. (Ashley Surdin, "Coroner Confirms Death of Jackson Was Homicide," August 29 2009) California Attorney General Jerry Brown announced that at the request of the LAPD, his office would launch an independent investigation into several doctors who may have treated Jackson in recent months. What killed Michael Jackson? A surgical anesthetic combined with other medication created a cocktail that killed him. According to the L.A. Times, officials listed the cause of Jackson's June 25 death as "acute propofol intoxication" with the additional factor of "benzodiazepine effect." ( Propofol, normally used with instruments that measure oxygen levels, blood pressure and heart rate, to anesthetize patients for surgery is believed to be one of the drugs responsible although Jackson had several other drugs in his system, including midazolam, an anti-anxiety medication; diazepam, or Valium; lidocaine, a local anesthetic; and ephedrine, a stimulant and decongestant. CNN reports, "The drugs said to have contributed to Jackson's death are routinely used in hospital settings, but should never be combined at home, medical professionals say." (Elizabeth Landau, August 28 2009) The effects of Propofol can be compounded when there are other drugs in the system, especially those like lorazepam, a member of a class of medications called benzodiazepines. Benzodiazepines also slow breathing, and Mr. Jackson was given three different benzodiazepines in the six hours before receiving propofol, according to court documents. What is the background of the killer drugs? CNN further reports, Propofol has generated controversy in the anesthesiology community because of reports of its abuse by health care workers. A 2007 study by the International Anesthesia Research Society found that "about 18 percent of the 126 academic anesthesia programs in the United States had at least one reported instance of propofol abuse within the previous 10 years." There is not adequate accounting of propofol in hospitals, said Dr. Paul Wischmeyer, professor of anesthesiology at the University of Colorado, lead author of the study. The drug is often abused by risk-taking people who may have had trauma earlier in life. Because propofol is not a controlled substance, doctors other than Anesthesiologists can get it, even if they are not trained in using it, and that's where they can get in trouble. Propofol can cause patients to stop breathing, but in the operating room, anesthesiologists are equipped to resuscitate them. Why was Michael Jackson killed? In the six weeks before Jackson died (including June 25, the day of Jackson's death) Dr. Murray administered propofol intravenously to Jackson nightly to help him sleep. Some sources say the toxicology reports have led investigators to suspect that Murray gave Jackson more propofol than he told police. Dr. Eugene Viscusi, anesthesiologist and director of pain management at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania states, "The use of propofol in a nonmonitored setting is 'ludicrous,' The Food and Drug Administration has not approved propofol for use as a sleep aid." (Elizabeth Landau, CNN, August 28 2009) Where Was Michael Jackson killed? The L.A. coroner's office confirms that Jackson died in his rented Westwood mansion on June 25. What does the charge of homicide mean? The coroner's classification of homicide -- the killing of one person by another -- does not always translate into criminal charges, and those close to the investigation have said Jackson's history of drug use and health problems could complicate any prosecution. The coroner's report did not cite the nature of the homicide finding or whether the coroner's office concluded that a crime took place. The Washington Post reports, "The ruling means Jackson died at the hands of another, but whether criminal activity is involved -- such as gross negligence or intent to harm -- remains undetermined." (Ashley Surdin, "Coroner Confirms Death of Jackson Was Homicide," August 29 2009) MTV News legal expert Peter T. Haven says unless Murray is proved to have had full knowledge that the dosage he gave Jackson would be fatal but continued anyway, a criminal charge will be hard to pursue. However, it's worth noting that a medical malpractice charge may be pursued if it's determined Murray acted below the standard care expected of a physician. (Jayson Rodriguez,, August 28 2009) Murray could face involuntary manslaughter charges as a result of the coroner's report. But, reports say the U.S. Drug Enforcement Administration states it has no record of Dr. Murray ordering, purchasing or obtaining propofol. (Voice of America News, AP and Reuters, August 28 2009) A Final Word At the request of the Los Angeles County District Attorney and the Los Angeles Police Department, "the final Coroner's report, including the complete toxicology report will remain on Security Hold" until their investigations are complete, the coroner's statement said.
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