William The Coroner’s Forensic Files

Monday, 24, August, 2009

Homicide–Manner of Death

Filed under: Forensics — williamthecoroner @ 21:11

Michael Jackson’s death has been ruled a homicide by the Los Angeles Coroner’s office. His personal physician used propofol, a sedative agent used for surgical procedures and procedures like colonoscopies to help Mr. Jackson sleep. This is an off-label use of the drug, it was not designed as a sleep aid. It was also not designed to be taken anywhere else but a monitored room with crash carts and help close at hand.

Propofol is abused, usually by CRNAs or AAs or anesthesiologists. All of these gas passers are at risk due to the nature of their job. I have had a patient who hung his bottle on a floor lamp, and infused it in himself. Propofol deaths also seem to decompose very quickly, as my patient did. (I snarkily wonder how much Mr Jackson will decompose, considering he was mostly plastic, but that is by the bye).

Mr. Jackson was deliberately injected by his physician with a pharmacologic agent that caused his death. This is what makes the death a homicide, a death due to the deliberate actions of another human being. Now, there was no intent to cause death. If anything, the doc had a vested interest in keeping his cash cow patient alive. One can make a case for accident, as the doctor wasn’t trying to kill his patient.

The accidental manner, though, does imply a lack of intent, or at least an element of bad luck. Falling off a ladder is an accident. Getting hit by a bus is an accident. Taking an overdose of heroin is an accident. But the doctor is supposed to know what he is doing. Many medications are used in an off-label way, that is other than what they were designed for. Tri-cyclic antidepressants, for example, treat nerve pain quite well.

But in the Jackson case there is more than an element of bad luck. His doctor should have known better, and took tremendous risks that were not justified by the situation. If you need your gall bladder out, I could remove it. If we were stuck on a desert island, I’d be your only hope. In any normal situation, you’d be wise to get a real surgeon, I don’t sew my patients up again afterwards. Propofol is not a sleep aid. This went beyond off-label use, and I believe crossed the line into criminal negligence. Other docs have written about the dangers of giving bad outcomes criminal penalties (hey, WhiteCoat), but I (and most of my forensic colleagues) would rule the same way.

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4 Comments »

  1. Homicide is not the same as murder. That is a good point that you make. One that is not always clear in reporting – and definitely not well observed in movies and TV dramas.

    To pick a nit, however, getting hit by a bus may not always be an accident. It could be suicide by bus – or even homicide (murder?!) by a deranged, psychotic robo-bus.

    Comment by Anne Bonney — Tuesday, 25, August, 2009 @ 08:38 | Reply

  2. Dr. WZBG;

    The way I see it is that physicians are generally “clever” people. They know the system in which they find their employ. Thus, they find ways to circumvent such systems. Having said that, EVERY physician knows right from wrong. “Milk of Amnesia” has no place anywhere other than an OR or PACU. Correct me if I’m wrong, but it has no therapeutic value other than complete inactivation of one’s reticular formation.

    But doctors are people too. They accumulate debts great enough that they can’t pay off by salary alone. It seems that Mr. Jackson’s cardiologist was in the pill mill business… and such ventures usually end badly. Reference the cases of Dr. Peter Franklin and Dr. Bruce Feldman.

    Personally, I think there’s something to be said for living humbly, not buying into the McMansion culture and just being happy with what you have, for better or for worse.

    Comment by Andrew Neil — Wednesday, 26, August, 2009 @ 18:55 | Reply

    • I think you’ve got a point there. Not saying I don’t like material things, I do. I’m not going to go sell my soul for them. I pay the academic tax, and have quite a nice life, thank you very much. There are ways I could use my training to game the system for money, but it’s not worth it.

      Comment by williamthecoroner — Wednesday, 26, August, 2009 @ 20:02

  3. As my uncle used to say: “The gains earned by cheating are vastly outweighed by the penalties suffered by being caught.” (Cough cough, Pete Rose, Barry Bonds, ahem)

    Comment by Andrew Neil — Wednesday, 26, August, 2009 @ 20:30 | Reply


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