When Doctors Kill: Who, Why, and How

by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.

  The autopsy report and the detailed toxicology reports were temporarily sealed at the request of the LAPD and Los Angeles County District Attorney on grounds that the death is still under investigation and charges may be filed. As of today, criminal charges of manslaughter had not yet been pressed against Dr. Murray though they appeared to be imminent several months ago. But it seems to be just a matter of time and timing (there will be a Governor’s race coming up in California and the Attorney General is a candidate) before such criminal charges will be prof-fered. In theory, Jackson’s doctor could go on trial around the same time as Anna Nicole Smith’s physicians.

  If manslaughter charges are leveled at Dr. Murray they most likely will be based on his administration of drugs to a known addict, the inappropriate Moonwalk

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  administration of a drug (propofol) not recommended for use as a sleeping aid, failure to take appropriate measures to combat possible serious drug side effects, inappropriate resuscitation measures, and a delay in seeking emergency assistance. While such charges may be more than sufficient for a determination of gross medical negligence and malpractice in a civil trial and there may be enough evidence to revoke Dr. Murray’s medical license, it is much less clear that the District Attorney could secure a conviction on a criminal charge such as involuntary manslaughter, much less murder. The defense in a criminal trial is likely to argue that:

  – There was a clear lack of “mens rea” (“evil intent”) to kill Michael Jackson

  – Dr. Murray tried his utmost to keep this patient alive and wean him of his addictions

  – Michael Jackson was apparently addicted to propofol while in Germany, well before Dr. Murray treated him

  – Dr. Murray advised Jackson of the propofol risks and side effect, so adequate informed consent was obtained

  – Michael Jackson was addicted to a number of prescription drugs, some obtained from other physicians, as the postmortem toxicology revealed the presence of several drugs which had not been prescribed or given to Jackson by Dr. Murray, and of which Dr. Murray had no knowledge

  – Propofol is not an illegal drug

  – While it is true that the manufacturer recommends propofol as an anesthetic drug and not as a sleeping aid, physicians use many drugs for conditions not recommended by official sources and in some cases they are quite effective

  – Some medical publications have indicated that propofol significantly improves the recovery from insomnia-related symptoms and it may have been an effective therapy in Jackson’s case

  – In the entire United States there have been very few (only 48) deaths due to propofol toxicity, and

  – If a combination of drugs killed Jackson, rather than propofol alone, and Jackson was taking several of these drugs without Murray’s knowledge, it will be difficult to determine beyond a reasonable doubt that Murray’s actions alone resulted in death. Michael’s own actions may have pushed him over the edge

  To sum up this defense strategy, “drugs kill addicts, not the doctors who administer or prescribe them.”

  On the other hand, a conviction of involuntary manslaughter might be sustained against Dr. Murray if the jury can be convinced that Dr. Murray was recklessly negligent and caused the death of Michael Jackson on the grounds that Dr. Murray:

  – Knowingly prescribed improper and excessive medications to an obvious addict

  – As a cardiologist, was neither qualified nor sufficiently knowledgeable to safely administer and monitor propofol, an anesthetic

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  – Lacked the skilled or the training for attempting to cure Jackson of his drug addiction

  – Administered excessive amounts of propofol via injections to Michael Jackson and that the singer did not inject himself

  – Did not have the necessary resuscitation skills, equipment and personnel required to treat Jackson should he stop breathing (a common complication of propofol toxicity)

  – Made no efforts to consult with drug treatment experts as to the diagnosis and treatment of Jackson’s drug addiction, and

  – Inappropriately monitored and treated the Jackson’s terminal collapse by performing inadequate CPR on a bed rather than on a firm surface and delayed notifying emergency medical personnel for mysterious reasons

  In other words, “drugs don’t kill people, bad doctors who give addicts drugs do.”

  As juries are well known to be unpredictable, one can only guess as to what their decision would be should this case go to trial. It is worth remembering that the burden of proof for any criminal trial will rest with the District Attorney – they have the hard job. In a civil trial, such as a malpractice suit, the burden will be on Dr.

  Murray to successfully defend himself.

  We have not yet discussed one other facet of this case. Whether Dr. Murray’s acts were criminal or not, whether he should be allowed to practice medicine or not, or whether he should or should not have been providing Jackson this dangerous drug, we cannot deny that Michael Jackson had free will. Michael Jackson was addicted to sedatives and pain pills and he repeatedly asked for the drugs that eventually killed him. One of the people who knew him stated emphatically: “Michael knew what he was doing.” “He knew that the drugs he was taking – that the amount that he was taking – could kill him at any moment. And many people tried to stop him and discourage him, and it’s very, very sad and tragic that he lived with so much pain that he couldn’t stop.” Jackson was in physical pain from years of physical abuse related to dancing and the rigors of performing and in mental and emotional agony from the loss of his childhood and his yearning to one day find it. But in the end, his choices killed him. The courts will only be deciding if Dr. Murray helped and, if so, how much.

  Jackson never gave a farewell concert. Nonetheless, a movie (“This Is It”) depicting the rehearsals for a final tour that never materialized earned $150 million within weeks of its release. His memorial service on July 7, 2009 was broadcast live around the world, attracting a global audience of up to one billion people. Now Little Michael finally has a chance to play and be whoever he wants to be.

  Shooting Stars

  The actions of physicians in combination with the personal choices made by the celebrities resulted in the deaths of the stars described above. Many other celebrities have died of overdoses related to prescription drug abuse and others have Can It Be Stopped?

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  struggled with addictions to sedatives and painkillers. In some cases, there is little doubt that doctors provided these addicts with medications and turned a blind eye to overt substance abuse. In others, practitioners may have been duped into providing drugs to famous patients with fictitious illnesses or prescribing medications to groupies hoping to ingratiate themselves with a celebrity by providing them with a few pills. This is nothing new-groupies have been helping their idols to die for years. Other celebrities, however, have proven to be quite capable of helping themselves into the grave by abusing prescription medications with little assistance from fans or physicians.

  Nearly 50 years ago, Marilyn Monroe died of an apparent suicidal overdose of barbiturates. Her drugs were prescribed by physicians, yet by all accounts at least one doctor was trying to wean her of her drug dependence. In 1965 Dorothy Dandridge, the first African American to be nominated for an Academy Award for Best Actress, was found dead by her manager. Her death was ruled to be due to an accidental overdose of imipramine, an antidepressant, that she took for a bipolar disorder. Jimi Hendrix, the famous American guitarist, was found dead in his girl-friend’s London hotel room (although some have claimed that he died in the ambulance on the way to the hospital). The cause of death noted on the coroner’s report was “inhalation of vomit” after “barbiturate intoxication (quinalbarbitone)”, the same prescription medication that had killed Monroe. In 1996

  Margaux Hemmingway, a 42-year-old model and actress and granddaughter of Ernest Hemingway, was found dead in her apartment
in Santa Monica, California.

  She died of a suicidal overdose of phenobarbital. Heath Ledger won a posthumous Oscar for his role as the Joker following his accidental drug overdose in early 2008.

  Although two doctors were investigated by the DEA following his death, no charges were filed and the U.S. Attorney in New York decided there were no

  “viable targets” for criminal prosecution. None of the above were following

  “doctor’s orders” when they died.

  Can It Be Stopped?

  The short answer is “no.” It is simply impossible (and probably unconstitutional) to make people stop acting in their own worst interests. That being said, steps can be taken to make it more difficult to obtain, abuse, and overdose on prescription medications. The first step is to recognize that there is a national prescription drug abuse epidemic that affects both the rich and famous as well as the masses. Doctors overprescribe pain medications and sedatives to Grammy Winners, Academy Award nominees, truck drivers, plumbers, and housewives. In many states, especially Florida, there has been an unfortunate blooming of “pill mills” where cash is exchanged for pills to treat ubiquitous lower back pain, migraines, and fibromyalgia.

  In fact, the authors have recently been informed that there are more pain clinics in their county than McDonald’s restaurants. Just down the street from the Medical Examiner’s Office, one can glance in the parking lot of the local pain clinic and 228

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  study our newest South Florida tourists, the so-called “pillbillies,” who obtain oxycodone and alprazolam for their “illnesses” and transport them back to Kentucky and West Virginia for distribution.

  A few states have passed legislation requiring the creation of mandatory and confidential pharmacy databases. In theory, these information warehouses will facilitate the tracking of doctors who are giving out pills upon request. Unfortunately, though this sounds good, such measures have met with only limited success. Until stiffer penalties for both the prescribing physicians and abusing patients are enacted and enforced, people will continue to kill themselves, their friends, and their idols with prescription medications. And there will be physicians willing to inadvertently assist them.

  Doctors have killed people, no doubt about it. But the death toll from medical murder, malfeasance, experimentation, terrorism, euthanasia, and tyranny is dwarfed by the carnage that patients have inflicted on themselves and those around them, including the ones they profess to love, by drug abuse. But who wants to read about that.

  Suggested Reading

  Chapters 1 and 2: In the Beginning; Perfect Intentions,

  Imperfect People

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  J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 229

  DOI 10.1007/978-1-4419-1369-2_22, © Springer Science+Business Media, LLC 2010

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  Suggested Reading

  Chapter 3: The Alpha Killers: Three Prolific

  Murderous Doctors

  A Esmail. Physician as serial killer – the Shipman case. The New England Journal of Medicine 2005; 352:1843–1844.

  Harold Shipman’s clinical practice 1974–1997. A clinical audit commissioned by the Chief Medical Officer of Britain Health Ministry. London, UK: Department of Health, 2001.

  R Kaplan. The clinicide phenomenon: an exploration of medical murder. Australasian Psychiatry 2007; 15(4):299–304.

  H Kinnell. Serial homicide by doctors: Shipman in perspective. British Medical Journal 2000; 321:1594–1597.

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  B Whittle, J Ritchie. Prescription for murder. The true story of mass murderer Dr. Harold Frederick Shipman. Time Warner Paperbacks, 2004.

  C Wilson. The mammoth book of history of murder – the history of how and why mankind is driven to kill. Carrol and Graaf, 2000.

  C Wilson, D Wilson. Written in blood: a history of forensic detection. Carroll and Graf, 2003.

  Chapter 4: America’s Contribution to Medical Mayhem

  W Clarkson. The Good Doctor. St. Martin’s Paperbacks, 2007.

  C Evans. Killer Doctors: The Shocking True Crimes of Medical Deviates Who Practiced in Murder. Penguin Group, 2007.

  K Iserson. Demon Doctors: Physicians as Serial Killers. Galen Press, 2002.

  H Kinnell. Serial homicide by doctors: Shipman in perspective. British Medical Journal 2000; 23(321): 1594–1597.

  G Olsen. Starvation Heights: A True Story of Murder and Malice in the Woods of the Pacific Northwest. Warner Books, 1997.

  A Rule. Bitter Harvest. Pocket Books, 1999.

  A Rule. Last Dance Last Chance – Ann Rule’s Files. Pocket Books, 2003.

  H Schechter. The Serial Killer Files. Ballantine Books, 2003.

  G Scott. Homicide by the Rich and Famous – A Century of Prominent Killers. Westport Publishers, 2005.

  J Stewart. Blind Eye: The Terrifying Story of a Doctor That Got Away with Murder. Simon and Schuster, 2000.

  Chapter 5: International Men of Mystery:

  Other Serial Killers

  E Carrere. L’adversaire; ed Gallimard – Collection, La Bibliotheque Gallimard, 2003.

  Internet People’s Daily January 16, 2001 at http://english.peopledaily.com.cn.

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  Killer’s beliefs in omens, spirits led to attack on toddler. South Africa’s Herald on-line (Port Elizabeth), October 28, 2008.

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  Maxim Petrov. Wikipedia at http://en.wikipedia.org/wiki/Maxim_Petrov.

  S Okie. Dr. Pou and the Hurricane – Implications for Patient Care During Disasters. The New England Journal of Med
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  A Pou. Hurricane Katrina and Disaster Responsiveness. The New England Journal of Medicine 2008; 358:1524.

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  Chapter 6: To Catch a Killer: Investing Serial Murder

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  K Iserson. Demon Doctors: Physicians as Serial Killers. Galen Press, 2002.

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  H Kinnell. Serial homicide by doctors: Shipman in perspective. British Medical Journal 2000; 23(321): 1594–1597.

  A McLaren. A Prescription for Murder: The Victorian Serial Killing of Dr. Thomas Neill Cream.

  University of Chicago Press, 1995.

  L Miller. Practical Police Psychology – Stress Management and Crisis Intervention for Law Enforcement. Charles C. Thomas, 2006.