When Doctors Kill: Who, Why, and How
Page 34
So he kept giving her more of it.
The London coroner, Gavin Thursdon, ruled that the cause of death was “an incautious self-overdosage” of barbiturates. Thursdon stressed that the overdose had been unintentional and that there was no evidence to suggest she had committed suicide. Further, Thursdon said the autopsy showed that Miss Garland had been addicted to sleeping pills for years (although, from a forensic pathologist’s standpoint, it is unclear to us what findings these might be). “She took more Seconal than her body could tolerate,” Thursdon told a courtroom packed with newsmen and fans of the dead singer in describing the cause of death. He continued, “Whether she did this in a daze from previous doses is unclear. But one thing is certain – there is absolutely no evidence this was intentional.” The Coroner opined that most likely she had taken several capsules, woken up, and forgetting how many pills she had taken gulped down a few more, a behavior referred to as “automatism.” Interestingly, a number of studies have shown automatism in this type of setting to be fallacious, though it is handy to be able to make this argument for personal, professional or legal reasons to rule a probable suicide as an accident.
The death certificate issued by Coroner Thursdon listed the cause of death as
“Barbiturate poisoning (quinalbarbitone), incautious self overdosage, accidental.”
He may be right. Then again, given Judy’s history of chronic depression with occasional flare-ups and recurrent suicide attempts, her financial troubles, her waning career, and her string of failed relationships, a strong argument can be made for suicide or, at the least, an undetermined manner of death.
An estimated 20,000 people lined up for hours at the Frank E. Campbell Funeral Chapel waiting to view the open casket. Judy wore the silver gown that she wore at her most recent wedding and her casket was white metal lined with blue velvet. Her mourners included her daughter Liza Minnelli and many entertainment stars including Ray Bolger (the scarecrow from Oz), June Allyson, Lauren Bacall, Jack Benny, Sammy Davis Jr., Cary Grant, Katharine Hepburn, Burt Lancaster, Dean Martin, Mickey Rooney, Frank Sinatra and Lana Turner. Garland was interred in Ferncliff Cemetery, in Hartsdale, New York. Budd Schulbert, a well-known screen writer, novelist and producer, accurately summarized Judy’s life in stating: “Judy Garland somehow survived as a star of the first magnitude – a Lady Lazarus who kept rising from the dead, from countless suicide attempts, and broken marriages and nervous breakdowns and neurotic battles with weight and sleep, to somehow pull her jangled nerves together, take command of the Palladium, Palace or Carnegie Hall and bring down that audience one more time.”
Both studio employees and doctors willing to ignore her well publicized addiction provided Judy with drugs to control her weight, increase her productivity, get her up, bring her down, and help her sleep. As a teenage star, Garland had been effectively sentenced to a life marred by depression, insomnia and addiction to both uppers and downers. The singer allegedly spent at least $1 million per year on drugs and doctors’ fees or inducements. She could not have been a prescription pill addict without the assistance of many medical professionals. That being said, many physicians also made valiant efforts to rehabilitate her.
Long Live the King – Or Not
209
When Judy Garland died, none of the suppliers of her prescription drugs or any of the studio executives who pushed Judy into addiction were ever condemned or accused of child abuse or criminal wrongdoing. Only decades later, her daughter, Lorna Loft, angrily commented in a 2009 interview:
What has saddened, disturbed, angered and frustrated me in the last 40 years is still the unethical and irresponsible way that many doctors in the medical field continue to overprescribe drugs to celebrities and the rich and famous. It seems that we haven’t learned anything over the past four decades. My belief is that the responsibility of the addict is absolutely number one, but we can’t forget the enablers who have helped them all on their journey into the abyss – the ones who have “lied” to protect, “deceived” to protect, “loved them” to protect, and most importantly, benefitted from their addiction…
We are facing a moral and ethical dilemma: shameful doctors who took an oath to save lives have now helped destroy them. These people must be severely prosecuted and given long and healthy prison sentences.
As we shall see in a bit, unfortunately for Anna Nicole Smith’s doctors, the District Attorney in Los Angeles must have been listening.
Long Live the King – Or Not
There aren’t all that many people who have been on a first name basis with the entire world – Elvis’ was one of them. Elvis’ Aaron Presley, The King, was born on January 8, 1935 in Tupelo, Mississippi. When he was 13, Elvis’ and his parents moved to Memphis, Tennessee, one of the hubs of the Blues. After graduating from Humes High School, Elvis’ worked a series of odd jobs while singing locally as “The Hillbilly Cat.” He earned a local recording contract and, when he was 20, signed a deal with RCA. His popularity and fame started to blossom at a vertiginous pace.
By his mid-20’s, Elvis’ had become a walking trademark. His sneer, his gyra-tions, and his hair were adored and emulated everywhere. Truly, he was one of those guys who “women wanted to be with, and men wanted to be like.” Despite being arguably the most popular man in the world, he had his critics, particularly when it came to his acting. Nonetheless, his 33 movies did very well at the box-office earning upwards of $150 million dollars. His mother, to whom Elvis’ was very close, enjoyed her son’s fame and success but was frightened by the frantic and hysterical reaction of his audiences. Her stress contributed to her alcoholism, which likely contributed to her premature death due to heart failure at the age of 46.
Elvis’ was heartbroken, “grieving almost constantly” for days. This emotional crisis may or may not have further opened his mind to drug abuse.
Several months after his mother’s death he began re-experimenting with amphetamines, a drug introduced to him while he was on active duty in the U.S. Army serving in Germany. This was the beginning of Elvis’ long, persistent and ill-fated voyage into the drug world. When his tour of duty in the Army was over, Elvis’
settled in Hollywood, starring in movies throughout the 1960s. In 1968, he returned 210
21 Doctors to the Stars
to live performances with a television special, which led to a string of successful tours across America. The famous composer and conductor Leonard Bernstein remarked: Elvis’ is the greatest cultural force in the twentieth century. He introduced the beat to everything – music, language, clothes, it’s a whole new social revolution… the 60’s comes from it.” In 1973, Presley staged the first global live concert via satellite ( Aloha from Hawaii), reaching at least one billion viewers live and an additional 500 million on delay. That was ¼ of the world’s population.
Despite having it all, Elvis’ life was spinning out of control. He was taking stimulants with increasing frequency and in increasing amounts, partly to control his weight (which occasionally pushed 300 pounds) and partly because he liked them. He needed antidepressants to elevate his mood and downers (barbiturates) to combat insomnia. Eventually his drug addiction caused him to act bizarrely and his artistic performances declined dramatically in quality and consistency. His walk was at times unstable, his speech slurred, and he had to cut short or cancel some of his shows. By 1974, Elvis’ was a very sick man due to a combination of lifestyle and a number of medical conditions (a dilated colon, glaucoma, mild hypertension and possible arthritis). It is possible that his bowel problems were related to his drug abuse; people taking excessive painkillers often become consti-pated. His entourage, known as the Memphis Mafia, and his personal doctors indulged the King’s every whim.
On January 28, 1975, 20 days after his fortieth birthday, Elvis’ was hospitalized for close to a month. The press was told that the hospitalization was because of an enlarged colon, however the primary reason was drug detoxification. A biopsy taken during that admission showed severe liver damage. By
December of that year, Elvis’ was in financial straits and had to work through the holidays despite a clause in his contract relieving him of all duties during that time of year. On New Year’s Eve, Elvis’ performed before 80,000 in the huge Silver Dome in Pontiac, Michigan. Artistically the show was a disaster and midway through it the star’s pants embarrassingly split at the seams because of his extra weight. This notwith-standing, the show was a financial success and grossed $800,000, a world record for a single show, with half of the take going to Elvis’. A subsequent tour through the South had mixed reviews. Some shows were good, some were fair and some were miserable. He dropped lyrics, mumbled introductions and very nearly stum-bled around the stage. On March 31, a Baton Rouge concert had to be cancelled because of singer’s “illness” and he was subsequently hospitalized in a two-room suite on the 16th floor of Baptist Hospital. The press was informed that Elvis’ was being treated for “exhaustion.” The truth is Elvis’ apparently nearly overdosed on a number of occasions during this tour and was found at times unconscious or unable to catch his breath.
This may come as a shock, but Elvis’ was described by some close acquaintances as a drug experimenter. Just as he wanted the latest car model, he wanted the latest drug du jour whether it was a painkiller, a stimulant, or an anti-depressant. Some of his favorite cocktails included a mix of Valium, ethinamate, Dilaudid, Demerol™, Percodan, Placidyl, Dexedrine, amphetamine, biphetamine, Amytal, Quaalude, Carbrital, cocaine and Ritalin. Elvis’ argued with his friends Long Live the King – Or Not
211
that the many drugs he took were legitimate prescription medications for pain, insomnia, and dieting – except that no one was really fooled. Everyone knew that Elvis’ was really yearning for their euphoric effect – the “high.” Dilaudid, a very powerful pain medication that causes a dreamy somnolence, was Elvis’ favorite drug. He reportedly told one of his friends “I’ve tried them all, honey, and believe me, Dilaudid is the best.” Initially, the drug prescriptions were supplied by a number of doctors, but in Elvis’ last couple of years Dr. George Nichopoulos, known as “Dr. Nick,” was his primary caregiver.
On August 16, 1977, the 42 year-old Presley had stayed up all night at his 18
room, limestone mansion, Graceland, in Memphis, Tennessee. He had entertained friends, played the piano, sang, and even played racquetball in the early morning.
His 21 year-old fiancée, Ginger Alden, a fledgling actress and model, was staying with him in separate quarters adjacent to his master bedroom. Ginger was the last person to see Elvis’ alive. At 9:00 AM, Ginger awoke to find Elvis’ reading. He told her he couldn’t sleep and was going into the bathroom to “read” some more. Ginger knew that meant he was going to take some of his medications. Elvis’ syringes were in the bathroom and so was a good part of his personal pharmacy. “Okay,” Ginger said, “just don’t fall asleep.” With that, she rolled over on the big bed and went back to sleep.
At about 2:00 PM she reawakened and went into the bathroom only to find Elvis’ lying on the floor unconscious. Most sources indicate that Elvis’ was likely sitting in the toilet area, partially nude, and reading when he collapsed. “I thought at first he might have hit his head because he had fallen out of his black lounging chair and his face was buried in the carpet” said Alden. Ginger called Elvis’ to him and when she got no response slapped him a few times in an attempt to wake him.
She raised the eyelid of one eye and the eye was “just blood red.” She quickly summoned road manager Joe Esposito, bodyguard Al Strada, and Dr. Nick. The doctor unsuccessfully attempted mouth to mouth resuscitation and the medics were called.
Presley, with his doctor in attendance, was rushed to Baptist Hospital where he was declared dead after additional resuscitation was attempted (including opening his chest to pump his heart by hand). Dr. Nichopoulos had the onerous task of informing Elvis’ father of the death. Police on the scene said that there was no indication of foul play.
Under Tennessee statutes Elvis’ death was clearly under the jurisdiction of the Shelby County Medical Examiner, Dr. Jerry Francisco. In the case of the sudden, unexpected death of a celebrity the public has a fervent interest in finding out what exactly happened. This is accompanied by intense media publicity and scrutiny –
believe us, we know (Anna Nicole Smith came to our Office). Many of the supporters or fans of the deceased celebrity feel a sense of personal loss and are grieved that the world has lost a very valuable individual. Some simply cannot accept that the star was responsible for their own demise and wonder whether someone else was responsible, at least in part, for the death. Conspiracy theories soon emerge and cover-ups are often alleged. This constellation of factors places even a greater than usual burden on the Medical Examiner and law enforcement officials to conduct an extremely thorough and multifaceted investigation when faced with the death of a celebrity.
212
21 Doctors to the Stars
The investigation of the Medical Examiner must include a thorough review of the medical history; smoking, drinking, and drug habits; the circumstances leading up to death; a thorough and well documented external and internal examination of the body; and extensive toxicological analysis for drugs and medications. All of the physical, chemical, and investigative findings are then integrated to determine the cause and manner of death to within a reasonable degree of medical certainty.
The Medical Examiner of Shelby County seems to have abdicated portions of his responsibility in this case. To begin with, the autopsy was done at the request of the family rather than under Medical Examiner jurisdiction. Dr. Eric Muirhead, a hospital pathologist, performed the autopsy with the assistance of two pathology residents with Dr. Francisco as a witness. Francisco announced that the cause of death was a cardiac arrhythmia even prior to the completion of the autopsy and before any toxicological studies were performed. This proclamation is meaningless –
everyone dies of “cardiac arrhythmia” which only means the heart stops. The actual cause of death is the disease or injury which causes the heart to stop. He also said that, “there was no indication of any drug abuse of any kind.” This cannot be determined before the lab has completed their analysis of the blood samples taken at autopsy.
Elvis’ autopsy did show evidence of severe heart disease, certainly enough to kill him, but also a host of prescription drugs were detected in his system.
Toxicological studies were performed on his blood at no less than three independent laboratories. In a press conference on October 21, 1977, Dr. Francisco stated that four drugs were found in significant quantities in the entertainer’s bloodstream: ethinamate, methaqualone (Quaalude), codeine and barbiturates. The first two are sedatives, codeine is a narcotic cough suppressant and painkiller, and barbiturates are “downers.” Four other drugs including chlorpheniramine (an antihistamine), meperidine (a painkiller), morphine (likely a byproduct of codeine) and Valium were also found in what were said to be “insignificant amounts.” The Associated Press quoted Dr. Francisco as saying that the amount of drugs found in Presley’s body, collectively, would not have constituted a drug overdose and that it was unlikely that the drugs’ chemical reactions within the body could have contributed to his death. He confidently stated that Presley died of heart disease adding, “had these drugs not been there, he still would have died.” There is an interesting corol-lary to consider: in the absence of heart disease, would combined drug toxicity have been considered sufficient to have caused death in this case? If so, one can make a strong argument that they at least contributed to death and the manner of death should be considered accidental rather than natural.
The Medical Examiner’s final report listed the probable cause of death as:
“HCVD (hypertensive cardiovascular disease)” with “associated ASHD (arterio-sclerotic heart disease)” and the manner of death as “natural.” Dr. Francisco’s ruling was met with skepticism by the press and with criticism by experienced fellow physicians. In 1991 D
r. Muirhead, the retired pathology chief of Baptist Memorial Hospital who had headed the autopsy team, took the first official shot at Francisco.
Muirhead, who had remained quiet for 14 years, stated unequivocally that Elvis’
“was a drug addict. We knew he was a drug addict because he had been at Baptist Long Live the King – Or Not
213
to be treated for that.” Further, the autopsy team was shocked that death was attributed to heart disease. “We were appalled that he made that announcement,” said Muirhead, “there were eight other doctors there who disagreed with him.”
Nationally known forensic pathologists Dr. Thomas Noguchi and Dr. Cyril Wecht also disagreed strongly with Francisco, asserting that prescription drugs were a major contributory cause to Elvis’ Presley’s demise. Other forensic experts such as Dr. Michael Baden were more lenient stating; Elvis’ had had an enlarged heart for a long time. That, together with his drug habit, caused his death. But he was difficult to diagnose; it was a judgment call.” Dr. Joseph Davis, an esteemed forensic pathologist, also reviewed the case and supported Francisco’s opinion.
Among forensic pathologists, the controversy is ongoing.
In 1980, 3 years after Elvis’ death, Dr. Nick was indicted on 14 counts of overprescribing drugs to Elvis’, Jerry Lee Lewis, and a dozen other patients. The jury acquitted Dr. Nick on all counts concluding that he was acting in the best interests of his patients. Later that same year, the Tennessee Board of Medical Examiners suspended his medical license for 3 months for overprescribing medications. Dr. Nick’s troubles were not over, however. In 1995, the Tennessee Board of Medical Examiners permanently suspended Dr. Nick’s medical license after it was revealed that he had been overprescribing drugs to many patients, including Elvis’, for many years. It was reported that the doctor had prescribed more than 19,000 doses of medication to Elvis’ over the last 2 years of the King’s life. Dr. Nick’s appeals in 1995 and 1998 to reinstate his medical license were rejected.