When Doctors Kill: Who, Why, and How
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Fatal overdoses from prescription painkillers alone have more than doubled from 3,994 in 2000 to 8,541 in 2005 (the last year for which complete data is available) –
this doesn’t even address the problems associated with sedatives such as Valium and Xanax™. The Centers for Disease Control and Prevention (CDC) has predicted that prescription drug abuse related deaths will continue to increase at an alarming rate.
We have certainly witnessed this trend in our forensic practice. While we still encounter deaths due to heroin or cocaine use, we see several cases a week involving prescription drug toxicity. The abuser routinely obtains these drugs through one of four main routes: stealing them, buying them illegally, accepting them as offerings from their friends (or disciples in the case of celebrities), or obtaining excessive prescriptions and medications from licensed physicians. As this book is focused on doctors who kill, we will focus on the latter means. In some situations, an honest doctor is duped by a deceptive patient who feigns an illness or symptom to obtain drugs. In fact, the Internet has created a cohort of very savvy patients who know just the right things to say to get what they want. With malpractice litigation running rampant, physicians are essentially forced to do something for most everyone Celebrities and Abuse of Prescription Drugs
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who comes through their door for fear of being sued for “failure to treat.” In other cases, however, physicians running “pill mills”, shady pain clinics, and other high-profit, cash-only practices are eager to build a clientele who knows they can rely on the good doctor to cure what ails them. These unethical practitioners have cast a shadow on the many physicians who correctly and judiciously prescribe medications for pain, mental illness, or emotional stress. In fact, it is likely that some patients who truly need painkillers are being underprescribed badly needed medications because some doctors are afraid of being accused of creating and enabling addicts.
The Rich and Famous have the financial means to rent a “personal physician” to address their urgent or ongoing care needs. Many celebrities would justify the need for round-the-clock medical attention by reminding us just how stressful their lives can be. To be fair, some world-class athletes and performing artists do have to put up with stressors that most of us do not have to endure including:
– Long and strenuous performance hours interfering with the normal “biological clock”
– Weeks to months of grueling rehearsals
– Months of cross country and international travel
– An ongoing battle against aging resulting in dependency on plastic surgery, toxins, hormones, or other remedies
– Unrelenting scrutiny from the media and fans
– A constant fear of tumbling down from stardom into obscurity
– Probing interviews
– Blackmail attempts or civil suits by employees, acquaintances, or strangers threatening disclosure of some real or imaginary scandal
– Innate sensuality leading to sexual excesses and a propensity toward short-lived marriages often followed by acrimonious divorces and litigation
– A sense of loneliness and isolation while in the midst of tumultuous gatherings of fans and “friends”
– A nagging insecurity that anyone who claims to care for them actually loves their persona and not “the real me,” and
– A total loss of privacy due to relentless pursuit by the paparazzi Couple these stressors with a tendency to party all night, eat very little, and embrace the philosophy of “it’s better to burn out than to fade away” and you have a recipe for a celebrity fatality waiting to happen.
Whereas, remarkably, some celebrities are able to create a “normal life” for themselves and their families, others cannot cope with the unbearable stress that comes with success. The triad of insomnia, depression and resulting drug abuse/
addiction has been afflicting our brightest stars for decades if not centuries. We may call this psychopathological state the “SIDDA” syndrome (Stress, Insomnia, Depression, Drug Abuse). Obviously members of the general population may suffer from this condition, but members of the entertainment elite seem to be particularly prone to developing this condition. Wolfgang Amadeus Mozart, a former child prodigy turned pop star, may have been an early sufferer of this condition.
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SIDDA fatalities are likely closely related to another condition afflicting both celebrities and countless others who party themselves to death, DUMASS (Death Using Multiple Addictive Substance Syndrome).
Doctors who choose to treat celebrities are seeking out an inherently high-risk patient population. It is no wonder that they are handsomely compensated for their efforts. Nonetheless, physicians are responsible for treating their patients in a manner consistent with the accepted standard of care regardless of who they are. It is the sworn duty of these concierge doctors to be providers of relief and appropriate therapy, not enablers of drug addiction or, worse still, creators of addicts. By virtue of their training doctors are more aware of the addictive potential of prescription medications than are their patients (rich or poor, famous or not). “Physicians to the stars” may create addicts by flippantly or indiscriminately prescribing and providing medications to their luminous clients just as doctors staffing “pill mills” may create addicts out of patients just like us who have legitimate medical conditions requiring potent prescription drugs. Once a patient has become hooked on a medication, a phenomenon called “tolerance” may ensue. Over time, in order to get the same beneficial effect from a given medication, higher and higher dosages of the drug are required. A doctor who fails to recognize this complication of therapy and, instead, blindly dishes out bottle upon bottle of drugs is not helping the patient. There are often (though not always) viable alternatives that can be explored.
Why would a reputable physician take on the risks associated with treating a prima donna? Well, for one thing it is likely extremely cool to go to a cocktail party and be able whisper, “I am ______ _______’s personal physician.” Undoubtedly, this is much more successful than most pickup lines (particularly those used by forensic pathologists such as “No, it’s not rigor mortis-I’m just happy to see you”). Second, doctors are fans too and it may well be like living a dream to treat a person that you idolize.
Third, the money is good. Rumor has it that Michael Jackson’s physician was offered $150,000 per month to take care of the pop icon. Fourth, a physician working on a “for cash” basis doesn’t have to worry about haggling with insurance companies or the implications of any national health care overhaul. Last, celebrities talk to their friends just like other patients do. If you do a good job (whatever that may be) for one celebrity, chances are you may earn some other high profile clients. These perks are enough to lure some physicians to wander beyond the fringes of ethical medical care.
There is a lot of pressure on the physician treating a celebrity to trade in the Hippocratic Oath for the business adage “the customer is always right.” Some “doctors to the stars” are simply unable to say NO and instead surrender to their patient’s demands for excessive amounts of painkillers, antidepressants, sedatives, and sleeping medications. Not unexpectedly, in some instances these patients die as a result of drug overdoses either under accidental or suicidal circumstances. Although the treating physician obviously did not have the intent of killing the patient (it would be rather unwise to kill the “golden goose”) they are, nevertheless, clear facilitators of an otherwise preventable death. In many of these cases, the doctor has committed malpractice and risks civil penalties and loss of medical licensure.
In some cases, criminal charges may also be in order. In some states, particularly California, there is an apparent prosecutorial trend to view such improper medical Somewhere Under the Rainbow
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conduct in fatal celebrity overdoses as manslaughter, although the chances of conviction appear to be slim. One would like to hope that such aggressive prosecution
is based on the merits of the cases and not motivated by political expediency on the part of the prosecutor. That “tough on crime” slogan, though, does look really good on campaign posters if you are running for Governor.
Somewhere Under the Rainbow
Judy Garland (born Frances Ethel Gumm on June 10, 1922) was a dynamic and versatile actress of the stage and screen as well as an enthralling contralto singer. On June 22, 1969 she was found dead in her London apartment, apparently from a drug overdose. Her tumultuous and turbulent life experiences more than explain her tragic and untimely demise at the age of 47 years. Some of her doctors helped Dorothy do to herself what the Wicked Witch of the West was unable to accomplish.
Little Frances Gumm never knew the taste of a normal childhood. While still a toddler she made appearance on the stage of the New Grand Theater in Grand Rapids, Minnesota singing Jingle Bells, as part of a trio with her two sisters. She was featured in Vaudeville acts with her parents and The Gumm Sisters throughout her childhood. Her mother, Ethel, was the stereotypical domineering and controlling type of stage mother, largely oblivious to the intense physical and mental stress on young Frances. Her father Frank was the only person during Frances’s early years that showered her with love and tried to protect her from the exhausting demands of the stage. Unfortunately, he died when Frances was only 12.
By the time she was 13, Frances had adopted the stage name of Judy Garland and was put under contract to Metro Goldwyn Mayer. Her career blossomed and she made more than two dozen films, including nine with Mickey Rooney. In order to keep up with the frantic pace of making one movie after another, Garland, Rooney, and other young performers were given amphetamines to boost their energy followed by barbiturates to take before bedtime to allow them to fall sleep.
For Garland, this constant regimen of drugs established a pattern of addiction by age 15 and heralded a lifelong struggle to break free from this disease, a fight which she unfortunately lost. In her later life, she would resent the hectic schedule of her youth and felt that MGM studios had stolen her childhood.
In 1939, at the age of 17, she portrayed Dorothy in The Wizard of Oz. Her rendition of “Over the Rainbow” has captivated audiences for 70 years and the film vaulted her to superstardom. Judy found herself caught in a cyclone of publicity and pressure following the film and she was seeing a psychiatrist within a year. It was during this period that she also began to ramp up her use of stimulants and depressants. She wrote about the experience years later: “No wonder I was strange.
Imagine whipping out of bed, dashing over to the doctor’s office, lying down on a torn leather couch, telling my troubles to an old man who couldn’t hear, who answered with an accent I couldn’t understand, and then dashing to Metro to make movie love to Mickey Rooney.” That could mess someone up.
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The studio’s abuse of their young stars was astonishing. “They’d give us pep pills,” she wrote. “Then they’d take us to the studio hospital and knock us cold with sleeping pills… after four hours they’d wake us up and give us the pep pills again…”
This regimen of expert medical care resulted in the production of 21 Garland films between 1939 and 1948, including the musicals Meet me in St Louis (1944) and the Easter Parade. That’s a lot of pills. And a lot of very bad medicine.
In 1947 during filming of The Pirate, the 25-year-old Garland suffered a nervous breakdown and was placed in a private sanitarium. She was able to complete filming, but later that year made her first suicide attempt. Her mother taped up the cuts she had slashed in her wrists with a piece of broken glass. The next year Judy was cast by MGM in the musical The Barkleys of Broadway alongside Fred Astaire but could not finish it because of her disabling drug addiction. She was taking prescription sleeping medication along with illicitly obtained pills containing morphine. When Garland’s doctor advised the studio that she could work only in 4- to 5-day incre-ments with extended rest periods between, MGM executives suspended Garland and replaced her with Ginger Rogers. This was a nice break for Ginger.
By the time she was 27 years-old, Judy was being treated with electroshock therapy for depression. Her relationship with MGM further deteriorated in the 1950s resulting in another suspension after she decompensated during filming of
“Annie Get Your Gun. ” The suspension triggered a suicide attempt in 1950 in which she cut her throat with a shard of a broken glass and was sent to a “dry out” clinic where she was given additional electroshock therapy. When studio head Louis B.
Mayer was told that Garland would need months to recuperate, he reportedly stated:
“I’ve got millions tied up in this girl, I need her to work.”
After release from the facility Judy was immediately cast in the film Summer Stock. After completion of this movie, Garland was called to replace a pregnant June Allyson in the leading role of Royal Wedding alongside Fred Astaire. Judy failed to report to the set on multiple occasions and on June 17, 1950 MGM studios terminated her contract, branding her as being “irresponsible, unreliable and unem-ployable.” This did not help her deep seated self esteem issues.
In 1957 and several times thereafter, Judy again tried to commit suicide. Her preferred method was incising her wrists. Each time an attempt was reported in the tabloids, her fans would wear band-aids on their wrists in solidarity. She was especially idolized by the gay community, which saw in her tortured existence a reflection of their own difficulties and lifestyle problems. As the drugs took progressively greater hold of her life, Judy’s behavior became increasingly unruly, disruptive and demoralizing. By the late Sixties, she was on an expanding list of psychiatric medications, now including Valium and Ritalin™. Ignoring the potential long-term consequences of prescription psychoactive drug use, her doctors continued to meet all of her medicinal needs and requests. They either were unaware of the dangers of the prolonged use of these medications (in which case they were incompetent) or they were too scared or lazy to confront the actress (in which case they passively facilitated her death). Either way, someone should have pulled their medical licenses.
In November 1959 alcoholism and drug addiction prompted another hospitalization. Upon admission, she was 50 pounds overweight (150% of her normal weight) Somewhere Under the Rainbow
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and her liver was tremendously enlarged and affected by hepatitis. Seven weeks later she was discharged after she had lost 30 pounds. She was apparently drug free but was so weak that she had to use a wheelchair. The therapists told her that she would remain a semi-invalid for life and would never sing again, but they were proven wrong by Judy’s resiliency. She successfully returned to both films and television and a concert appearance at Carnegie Hall on April 23, 1961, was called by many the “greatest single night in show business.”
After hugely successful television specials and guest appearances in the early 1960s, CBS made a $24 million offer to Garland for a weekly television series of her own, The Judy Garland Show, which was deemed by the press to be “the big-gest talent deal in TV history.” The critics praised her television series but, for a variety of technical reasons, it was cancelled in 1964 after only 26 episodes. The demise of the series was personally and financially devastating for Garland, and she never fully recovered from its failure.
A dejected Garland returned to the stage and made various television appearances over the next few years. Most notably, she performed at the London Palladium with her then 17-year-old daughter, Liza Minnelli, in 1964. The concert, which was also filmed for television, was one of Garland’s final appearances at the venue. In 1967 Garland was cast as Helen Lawson in Valley of the Dolls, the film version of Jacqueline Susann’s bestseller featuring the character Neely O’Hara (played by Patty Duke), who was largely based upon Garland herself. As with previous projects, Garland missed days of work, blew repeated takes, and delayed production by refusing to leave her dressing room. She was finally replaced by Susan Hayward.
Depression and an acute sense of loneliness were omnipresent. Judy is reported to have sadly observed: “If I am a legend, then why am I so lonely?” Her five marriages and several affairs were symptomatic of her intense and constant search for meaningful and loving companionship. She performed in London at the “Talk of the Town” nightclub for a 5-week run and made her last concert appearance in Copenhagen in March 1969. Garland was plagued by financial instability, often owing hundreds of thousands of dollars in back taxes and, at times, going totally broke. She was even incapable of paying for her detoxification episodes.
On late Sunday morning, June 22, 1969, Mickey Deans, her fifth husband, found the 47 year-old Garland lying lifeless on the bathroom floor of their rented Chelsea, London house. There were no injuries and Scotland Yard ruled out foul play. Judy, Deans, and a friend had spent the previous night at home eating and watching television. According to friends the singer was said to be in good spirits prior to her death. At the Coroner’s Inquest R. E. K. Pocock, the pathologist who performed the autopsy, testified that he found extremely high levels of secobarbital (Seconal, a fast acting barbiturate sleeping pill) in her blood, the equivalent of taking ten 100 mg capsules. But Pocock emphasized that he found no inflammation of the stomach lining and no trace of barbiturates in the stomach suggesting that the Seconal had been absorbed over a considerable period rather than taken in a single, massive dose. At the Inquest, both Deans and her London doctor, Dr. John Traherne, testified that Judy had habitually used Seconal “for many years.” Dr. Traherne 208
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stated: “I don’t think Miss Garland would have been able to sleep without Seconal.”