Today a big news story is that Conrad Murray, MD, an internist and cardiologist, attending to Michael Jackson at home at the time of his death, has been accused of involuntary manslaughter, a very serious charge. While this is a matter of medical treatment gone awry, it is considered so serious that the matter now falls not only in the hands of the state medical boards but the criminal justice system.
Good Drug. Wrong Place.
The medical issue here is whether Dr. Murray had erred in dispensing an operating room medication to Michael Jackson at home. Disregarding the manufacturer’s warnings against doing so, Dr. Murray administered a potent drug that is by nature appropriate only in a facility where there is proper monitoring, resuscitative and supportive drugs, supplies and equipment. Apparently some sort of home sleeping quarters/medical treatment room was constructed for Michael Jackson to be treated by an in-house doctor for his chronic insomnia.
The Los Angeles Times has reported that Dr. Murray is accused of having “violated accepted medical standards.” That he ignored the medical “Rules of the Road”.
While there was said to be oxygen, intravenous fluids and some other medical equipment in the room, they were insufficient. Apparently there was not the proper electronic monitoring nor was there the resuscitative equipment standard in an operating room or recovery room. The drug propofol (brand name Diprivan) is a common drug used by all anesthesiologists and nurse anesthetists in the operating room environment. It is a reliable drug and has contributed greatly to the safety of modern anesthesia. But it is not intended for home use, and the doctor who administers it should be familiar with all the caveats attached to it – including the need to have monitoring equipment and resuscitative equipment and medications at hand when the drug is being administered.
Dr. Murray, not an Anesthesia Specialist, Injected a Powerful Anesthetic
A cardiologist (heart specialist) is not an anesthesiologist. Propofol is routinely used by only practitioners within the operating room world. No other specialty’s members would have a use for a drug designed for use in anesthesia. Thus, Dr. Murray was not qualified to administer propofol in his patient’s home.
There is another issue here. Michael may have been taking a variety of other medications which would only further confuse the picture when a potent drug such as propofol is given to the patient. Only an anesthesia specialist has the knowledge of drug and anesthetic interactions to manage such complex situation.
It is said that Dr. Murray, after administering the propofol, left Michael’s bedside for two minutes, during which time Michael apparently stopped breathing. Cardiac arrest soon followed. One of the core rules of sound medical practice is that when administering any potent drug that can influence breathing and heart function, the doctor or appointed registered nurse must monitor and remain with the patient to observe for problems and immediately intervene as needed. Leaving the patient after having given the medication is difficult to justify, in my opinion.
The Celebrity Trap
There often is an ethical and moral dilemma when MDs deal with high-profile people. I have written about this in my book, Secrets of a Beverly Hills Cosmetic Surgeon. I would like to quote from my discussion of how otherwise good physicians can get off track.
Why does an ordinarily objective and wise doctor temporarily discard the sound advice his teachers gave him? Because, he too, has a chance to be a celebrity, however vicarious. An opportunity to bask in that special glow we Americans are so good at fostering is often too hard to pass up.
Media personalities are attractive, smart and charming; that is how they reach their level of success and fame. They can be very manipulative, very convincing in their arguments. Isn’t that their craft? That is why, it is hard to say “no” to the lady or gentleman sitting in front of you whose face may be recognized by billions of people. And, perhaps subconsciously, the doctor wants to say “yes”, wants to satisfy this important person, to ingratiate himself, to join the club, to be part of that special world. It can be heavy stuff.
In summary, an otherwise well-intending physician strayed off path and entered an inappropriate medical arena for which he was neither trained nor experienced. Dr. Murray was out of his league. In fact, had a fully-qualified anesthesiologist instead been selected to be Michael’s “sleep doctor”, as bizarre as that might be, there probably would not have been that early and tragic end to Michael’s unique and productive life.
—Robert Kotler, MD, FACS