Thursday, October 20, 2011

The Jury's Still Out on Dr. Murray

Today marks the last day of testimony for the prosecution against Dr. Conrad Murray, cardiologist and former physician of Michael Jackson.

It has also been nearly two years since my initial post 'Why no hurry to nab Dr. Murray?'. The defense is set to begin arguments tomorrow.

I am struggling to understand how the defense plans on winning this case. The prosecution has done a terrific job showing the reckless abandon that was Dr. Murray's "care" of Jackson. That the defense planned on arguing that Jackson injected himself (or drank additional Propofol) is laughable in and of itself and numerous witnesses, including today's testimony from anesthesiologist Dr. Steven Schafer, have been quick to explain the improbability of this scenario. A defense team building a strategy blaming the victim for their death has their work cut out for them. How many scenarios can you think of where a patient dies under a doctor's care and it's the patient's fault? The defense has finally decided to toss out the theory that Jackson may have ingested Propofol, though that it was even suggested at all is preposterous, and that a segment of the population actually believed Jackson self-injected or drank Propofol is even worse. If the patient had any other name, I don't believe anyone would entertain that suggestion.

I believe name recognition has a great deal to do with the public's opinions on such matters. I have never seen a celebrity (or any dead man) be subjected to the claims and scenarios I have witnessed over the past two years in relation to this case.

Let's review the facts. Dr. Conrad Murray administered Propofol repeatedly to patient Michael Jackson. Propofol is a dangerous anesthetic, one that slows heart rate and depresses breathing, as such it is not supposed to be administered outside of a hospital setting, nonetheless for "insomnia". Even as a Cardiologist, Murray did not anesthetize his other patients - he had an anesthesiologist do this and he did not have the training or knowledge to properly administer doses. He did not have the equipment on hand to correctly monitor the patient or prepare for an emergency situation. He broke the cardinal rule for administering anesthesia - leaving the room to talk on the telephone (he claimed he went to the bathroom for two minutes, which contradicted his phone records and witness testimony). The patient was left unsupervised (which, given that the patient is unconscious and on a dangerous drug, heart rate and breathing must be constantly monitored). When Dr. Murray discovered Jackson wasn't breathing, he did not call 911 immediately, which is standard protocol, and the 911 call was not placed until 20 minutes after the discovery, which the paramedic on scene claimed would have saved Jackson's life. Despite his years as cardiologist, Dr. Murray did not know how to properly administer CPR and did so one handed (as opposed to using both hands) and on a bed (as opposed to the floor, a hard surface). The patient was already dead yet Dr. Murray continued to give CPR and staged a show, having Michael's eldest son Prince brought up to the bedroom so he could see Dr. Murray trying to 'save' Jackson and when paramedics came, Dr. Murray insisted they continue CPR, despite their belief that he had passed. Dr. Murray lied to paramedics about the IV bags, claiming they were filled with harmless saline solution, lied to EMTs, firefighters, doctors, and police, failed to mention Propofol as a drug he had administered when inquired, ordered hundreds of vials of the dangerous substance, lied to law enforcement saying he had comforted Michael's children at the hospital (a claim they refute), hid evidence, and fled the scene. Do these events sound like the actions of an innocent man? Dr. Murray can choose to blame the patient or other doctors, but he is clearly at fault - this was his patient, who died under his care, due to his negligent decisions. Dr. Conrad Murray took a Hippocratic Oath - and on all levels, failed to care for his patient, resulting in Jackson's death from "acute Propofol intoxication".

Despite all the testimonials and evidence from those who were actually there and who saw the events unfold, a significant percentage of the population continues to assert that Jackson killed himself and is responsible for his own death. Again, the name "Michael Jackson" appears to be the source of bias in opinions as these people negate fact. Some have apathy for the situation, suggesting no one should care, or insinuate that the trial is a loss of tax payer's money (they certainly weren't saying this when Jackson was on the stand). This is a human life we are discussing and the implications are significant for all patients who have faith in their doctors to provide adequate healthcare. If this happened to your loved one or certainly if it had happened to you (though you wouldn't witness the outcome), you would have wanted the truth to emerge, the facts brought to light, and would want to see justice served. Not to mention, Jackson gave a great deal of himself as an artist to the public and as a humanitarian to the world, to suggest the matter is 'irrelevant' or not worth taking the time to examine is a sad statement. How many public figures have to die at the hands of these 'celebrity doctors' who compromise health standards for blood money? Elvis Presley, Anna Nicole Smith, and Heath Ledger, to name a few, might still be with us if the were not enabled by their doctors, the very people paid (handsomely) to care for them.

Along with this trial come accusations that Jackson was an unhealthy drug addict. What is known about Jackson's past is that he began to take painkillers in 1984 due to pain from burns he suffered on the set of a Pepsi commercial. As he had numerous surgeries, he was not a stranger to undergoing anesthetics for procedures. In the early 90s, spurred by the initial allegations, he had a painkiller addiction for which he went to rehab and overcame in 1995 (he references his addiction to Demerol in the song "Morphine"). While no other mention was made, Jackson was known for his insomnia and chronic back pain. While it isn't known what his exact habits were in his last years, Jackson was said to take painkillers regularly given physical (and presumably some emotional) pain and his family did claim to have had interventions with him, so he must have relapsed at some point. He was taking painkillers prior to his death as Dr. Murray recorded audio of Jackson's slurred speech (a sad recording was played in the courtroom). Why the doctor secretly recorded him, nonetheless kept the recording, is highly questionable and disturbing, a clear breach of patient/doctor confidentiality clause and ethics).

Was Jackson addicted to anesthetics and/or painkillers in the midst of his last months? This Is It" director Kenny Ortega did notice some health problems at one point upon which he confronted Dr. Murray who denied there were any problems, while Michael's manager Frank DiLeo mentioned that Michael had "an episode". Dancers and crew working on "This Is It" didn't notice anything wrong and if you watch the concert film footage, Jackson appears hyper-focused, able to intensely concentrate and multi-task, and seems like an artist not only at the top of his game, but clear-headed and able to carry out his vision of a great show. As such, perhaps he had a bad reaction to medication, if he was using drugs at this very busy time that required so much physical and mental focus and stamina, it was most likely sporadic and not a constant. This was certainly not a man who was drugged beyond rationality every day he was preparing for his final concerts, he had too much to do.

If Jackson was an addict, does this still make his death his fault? It is a doctor's responsibility to know their patient's history. If Dr. Conrad Murray's sole patient at the time was Michael Jackson and they had a working relationship, he knew better than anyone what Michael's habits may have been and bore the ultimate responsibility of ensuring his patient's healthcare needs were met. Jackson didn't inject himself - Dr. Murray injected him and had hundreds of vials ready. For what?! Let's entertain the hypothetical fantasy that Jackson did inject himself (which, anesthesiologists and the coroner have already explained didn't happen). Jackson was left alone in a room, something you don't do when a patient is under anesthesia nonetheless if a patient has a drug problem, therefore it would have been Dr. Murray's responsibility regardless of scenario as his physician. The doctor broke countless rules and procedures, leading to this tragic passing.

To assert that Jackson was physically unhealthy is problematic. Despite Jackson's frail figure, he was always known for his poor appetite and struggled with anorexia throughout his life (if you observe footage of him during the Thriller era, he is just as painfully thin). Perhaps with the appearance of age, this was even more superficially noticeable. However, all reports peg Jackson as healthy, despite his low weight. The autopsy report confirmed how healthy he was (aside from his cause of death) and the coroner noted in court that he was healthier than a 5o-year old would normally be. Personal Trainer Lou Ferrigno trained Jackson several times a week for his tour, insisting that Michael was very strong, and AEG, the company involved in Jackson's last would-be concerts ensured that he passed a battery of tests and rigorous physicals to ensure he was in good physical condition to perform. Addict or not, Jackson's physical health was in good form.

I am also most disturbed by images of Jackson's corpse that continue to surface both through the trial and in other avenues (such as autopsy photos shown by VH1). I have grappled with this, trying to determine a reason we are subjected to this constant inappropriate viewing - often without warning. I can think of no other entertainers where such graphic photos were openly displayed for all to see - sure, there is the supposed photo of Elvis in his coffin, which is a far cry from a corpse lying nude on a sheet. Like Elvis, Jackson was the largest star of his time and the most famous man on the planet, though I doubt the King of Rock N' Roll would have ever been publicly displayed in such a manner (regardless of era). I also shudder to think of Jackson's children coming across such images, that corpse doesn't simply belong to a megastar - but also a father, brother, and son. Initially, I suspected this came out of Jackson's level of unprecedented fame and global recognition, but I recognize it as an extension of the blatant disregard and disrespect consistently bestowed upon him by the media and further attempts to exploit his name and image unethically for continued ratings and profit, a recurring theme. Even in death, Jackson is not allowed to peacefully rest or avoid scrutiny on the most invasive levels.

In summary, this is not a trial about the name "Michael Jackson". It is irrelevant whether or not you liked the man, whether or not he was a "junkie", or what you think he did or didn't do in the past. This trial is simply about a human being that died as a result of a doctor who was engaging in unethical behavior and treatment (or lack thereof) of his patient. Dr. Murray has had two years to carry on with his life, while Jackson has been deprived of breath altogether. (Consequently, on zero evidence and based on an accusation alone, Jackson was dragged out of bed, handcuffed, and thrown into a police station for allegations while upon his death, the man responsible has walked free without being subjected to any such indignities. I'll leave you to speculate what's wrong with that picture). Among reasons for the lengthy delay, the LAPD did not treat the scene as a crime scene, perhaps due to the patient's name and their assumptions, they assumed a crime wasn't committed, so the evidence was not correctly collected and processed and sloppy mistakes were made, as evidenced in the courtroom upon several interrogations. Who knows what facts may have been brought to light if these procedures were properly handled?

It is my understanding that Dr. Murray can face up to 4 years in jail if found guilty and that he may be allowed to undergo house arrest at some point during that sentence. The outcome of the trial remains to be seen. In any event, he will most certainly lose his licenses to practice medicine and will forever be known as the man who killed Michael Jackson. Given that Jackson has millions of adoring fans spread around the globe, it's a safe bet that Conrad Murray will never have a smooth ride through life, regardless of the jury's decision.

I am not sure what the definition of "justice" is within the context of such a situation. Three children must grow up without the only parent they knew and adored, a family continues to grieve, and the world was deprived of a singular talent that can no longer grace the stage. I can only hope that this trial sets an example for other "celebrity doctors", too often it is their patients who pay the ultimate price. Patient care is the number #1 responsibility of a physician, perhaps this case will remind all doctors how important it is to remain vigilant and prioritize ethics in treatment, to not anesthetize if you don't have the training or equipment to do so, and to learn CPR, which seems obvious but clearly can't be emphasized enough. I can only take comfort that this man will most likely be rendered unable to provide medical services or anesthesia to patients again and hope something is learned in the wake of this tragic event, so we don't continue to see history repeat itself in Hollywood.

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