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Tanya M. Acker

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The Conrad Murray Trial: Medicine, Money and Patient Care

Posted: 09/26/11 05:48 PM ET

It is never easy to predict the twists and turns that the latest high-profile trial will take and Dr. Conrad Murray's involuntary manslaughter case is no different. But while the trial is sure to feature all the usual bells and whistles that attend these excursions into celebrity justice, when it comes to one staple of these affairs -- the revelation of salacious new details about the troubles of a fallen icon -- its offerings may be limited. The judge in the case already has ruled that discussion of the Michael Jackson molestation trial is off limits (thereby ensuring that we won't have to relive the trip through that particular rabbit hole) and also has excluded a variety of other evidence about Jackson's allegedly fragile state. The garden from which the digging up of dirt may be done now has a fence around it; how securely that fence may guard against trespassers, of course, is an entirely different story.

What the trial certainly will contain, however, is a high-profile exploration of what we -- celebrities and "normals" alike -- expect from the people who care for us; and as the 32-page questionnaire issued to jurors suggests, the lawyers in this case seem to be particularly interested in whether those expectations shift depending upon which category (celebrity or regular folk) the patient falls.

Among other topics, the questionnaire asked jurors whether they thought celebrities received special treatment and whether a doctor ever had refused to prescribe medication that they specifically had requested. While most of us with access to medical care never will face the dilemma of whether we are asking "too much" of our $150,000 per month doctors, the issue of whether money buys new rules is as pertinent to medical treatment as it is to other areas of American life where its ability to change the game is firmly established. Indeed, in an era of Internet-fueled self-diagnoses, where well-heeled patients (sometimes armed with information of questionable legitimacy) may stubbornly insist upon particular therapies, doctors have a greater responsibility than ever to serve as a bulwark between the curative and the dangerous.

The issue of Murray's guilt or innocence will turn on a few discrete questions: Did the doctor fail to perform a legal duty that he owed to Jackson? If so, was his failure so reckless as to create a high risk of death or great bodily injury? Would a reasonable person have known that acting in such a way would have created the risk it did? Did that risky conduct cause Jackson's death?

Already the defense has raised questions surrounding Jackson's use of other drugs, arguing that it was Jackson's alleged self-medicating and addiction to other drugs, rather than Murray's conduct, that resulted in the music legend's demise. (One of the pretrial battles involved the defense's access to medical records held by longtime Jackson dermatologist, Dr. Arnold Klein, who allegedly injected Jackson with Demerol 51 times over 3 months. The Murray team won that round, gaining access to a certain number of the records.) This narrative, however, proves only so much: Dr. Murray was just that -- a doctor, so pointing the finger at a patient's other alleged bad habits will not suffice as an excuse for allegedly mismanaged care. Indeed, it is precisely because of a patient's vulnerabilities, physical and otherwise, that we expect physicians to adhere to objectively reasonable standards in treating them: jurors in the court of public opinion may have an even shorter fuse for the alleged practice of "celebrity medicine," in which one might purchase his way around those standards, than they do for the "celebrity justice" that seems regularly to cut big breaks to stars in distress.

But proving that this case involves such "celebrity doctoring" is the state's burden to carry. Expect Murray's team to tell the story of a physician dedicated to a patient in such distress that only the most extraordinary therapies could serve to treat him. They will urge jurors not to play the "20/20-hindsight" game -- arguing that Dr. Murray did the best he could for a demanding patient whose self-destructiveness ultimately would overwhelm the efforts of even the most attentive physician. At the end of the day it will be for the jury -- the one that sits in the actual courtroom -- to decide whether Murray's conduct was that of a solicitous personal physician or a fiscally driven reckless profiteer. The rest of us will simply be left to consider whether that slope really is as slippery as some say.

 

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03:49 PM on 10/14/2011
three days after MJ's death I had some outpatient surgery in which Diprovan was used i was monitored very carefully,,I dont think i was able to count to ten before i was OUT and i am a proffessional drug abuser.there is no way MJ could have done anything let alone swallow more drugs(the drug does NOT work orally) when the dr left the room. The key issue is that the dr left the room did not know CPR nor was there a crash cart, This case is over,,,,
10:52 PM on 09/28/2011
Everyone knows you can only help an addict once they realize they have a problem and want help..Dr. Murray is guilty of negligence and malpractice in my opinion and nothing else..(MJ would have gotten those drugs from somewhere else had Murray not provided them) even some of the other meds he had was prescribed by other Drs and even had some of his security staffs name on them.Its been said either you were on the MJ train or he would cut all ties..MJ created this environment that ultimately led to his death. MJ himself lied to his own family and would refuse them access to him when they were trying to help him..he surrounded himself with only ppl who could supply his drug need, and actively sought them out.The reason he didnt have any real friends in his inner circle is because he didnt want any. Im sure he felt they would have tried to intervene in his addiction..and that to him was a hinderance..He chose his inner circle and he alone is responsible for his death..He has been on the road to self destruction for years and years..he didnt just get on that road in 2009...It just caught up with him then...His family wants to blame someone..Maybe MJ should have had a talk with "THE MAN IN THE MIRROR." or did he...and just didnt know how to change his ways..
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06:16 PM on 09/28/2011
No one seems to be asking an awful lot of questions ... they do seem to be taking it for granted. Such as, "how exactly did a dermatologist come up with 51 doses of Demerol, almost one every other day, and ... gosh ... nobody asked questions?"

Uh huh. Nobody asks questions in Hollywood, or Nashville, or Memphis, or Chicago, or New York, nor anywhere else that drugs and money and fame and power "inevitably" (sic...) meet.

"M.D." in those places means that you're the pusher with the DEA license number.

Let's not kid ourselves about that, okay? Let's just not do it.

If you're truly a physician and you encounter a drug-addicted patient with (supposedly) self-destructive tendencies in spite of the hours he's already spent creating a truly-brilliant comeback tour, what's the one thing you DON'T do? Right: you don't give him drugs. That is, if you're truly a physician.

If you're truly a physician, then, yeah, "with power (a DEA number) comes responsibility," and also with that power comes a certain amount of leeway. But ... what if you really aren't? What if long ago, like so many others, you were "turned?"
02:58 PM on 09/28/2011
He was using LONG............Before the good doctor came along....
02:53 PM on 09/28/2011
PLEASE correct me if I am wrong, but this is Michael's own fault, not the doctor...Anna Nicole's death was also BLAMED on a doctor...These ADDICTS just enjoy using like all addicts...All the people in jail could also BLAME someone else for their drug problems...I say BLAME the user !
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maybesomeday
War is not about who is right its about who's left
07:49 AM on 09/28/2011
I read this article and came here to post my view on what the writer said, but instead I found myself commenting upon other's opinions and views. The real truth will hopefully come out in this trial.

Yes Dr. Murray had a responsibility to give the best care to his patient and he failed to do so. He knew that what he was doing was wrong, and I don't know if it was greed that drove him, I think it was more the celebrity of it.

MJ had no right to be telling any physician what he wanted. But at the end of the day, he bought his own demise because he demanded that propofol and Dr. Murray in his misguided attempts to please the "King of Pop" created very dangerous circumstances. But did he know that this patient was going to be in immenent danger, yes I believe he did.

He was not experienced in adminstering these kinds of sedatives, he was not in control, he was being told by the patient what he needed to do. It's tragic that it resulted in MJ's death, but I hope the finger pointing will stop once a verdict is read.

The truth and justice will prevail.
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Gizmo9
hmmmm...very interesting
01:46 PM on 09/27/2011
Any decent doctor would refuse to become an enabler to a drug addicted individual. So yes we can now point the finger at Dr. Murray but if it was not him it would have been another doctor of his caliber who would have been responsible for Michael 's demise. There is no win situation in drug addiction. It is more matter of time. The blame goes to both parties involved unfortunately one of them is not with us anymore.
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maybesomeday
War is not about who is right its about who's left
07:00 AM on 09/28/2011
I agree Gizmo9. No doctor should ever carry that kind of burden of giving a known drug addict medications that will ultimately cause the death of that drug addict. That's more the job of the street corner dealer who doesn't carry the burden of the hippocratic oath, to do no harm.

And as you have already stated here, if it wasn't Murray, MJ would of course have found another doctor with the same vunerabilities as Dr. Murray had. But at the same time I do not believe it was ever Dr. Murray's intentions to harm MJ, that I will never believe.

He had no reason to actually harm MJ. If one were to keep score of who is more to blame I would think the patient was, merely by the fact that he would even request or demand sedative's as a way to get some sleep. The doctor on the other hand hold's the responsbility of monitoring the patient under his care, so I would give it a 60/40% ratio, 60% being the patient and 40% being the doctor.

At the end of the day who win's? No one. MJ has died and Dr. Murray is on trial that has worldwide attention. Sadly the attention is about MJ and his legacy more than it's about MJ the drug addict who demanded drugs and skipped over any regular care that a medical professional would give him.
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huffposter07
12:06 AM on 09/27/2011
Good post, Ms. Acker. IF Michael Jackson really WAS the physical wreck that ConMan Murray claims, that would just mean that ConMan should have been much more careful with Diprivan than he was. If the "patient" was really THAT frail, then the "doctor" should have been more cautious. I wonder---for the $150,000 ConMan expected to get, did he order blood tests to screen for sedating meds MJ could have been on (Xanax, pain meds, etc)? After all, when you have only ONE patient in the world, don't you have time to be ultra-thorough and make sure he's taking things he's not telling you? This "doctor" and his team of lawyers are a bunch to make you vomit.
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brokenangel143
Sometimes you have to think outside the box...
11:08 AM on 09/27/2011
Huffposter... try adding is own family to the mix and you have the complete picture of Michaels life at the end.
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brokenangel143
Sometimes you have to think outside the box...
10:49 PM on 09/26/2011
Dr. Murray is guilty of obtaining Propofol and other drugs but the real cause of death of Michael Jackson was a broken man suffering from abuse ( both metal and physical at the hands of his own father ), never having a childhood, being responsible for the financial needs of all the Jackson's.
It was only when Michael made the split from the Jackson 5 that he became know as the "King of Pop".
The other brother were jealous of what he was accomplishing and always had their hand out, even to the end of his life.
Michael's three children gave him the most joy and happiness of his life. He always protected them from the public and his own family. Now look were they have been living for the last several years and what stories they have been subjected too. If you read Michael's own feeling about his family, he wanted Catherine to be the guardian in the case of death. Had he known that that things worked out the way they did, he would have made other provisions for his children.

I hope and pray that the time spent with their father gave Michael, Paris and Blanket the knowledge that he wanted them to learn from in the future.
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brokenangel143
Sometimes you have to think outside the box...
11:31 PM on 09/26/2011
The Jackson's will use this trial for just another way of promoting books or concerts. Jermaine is already touting his book... Through the eyes of his brother... the problem. Jermaine never saw the life Michael lead or what he really felt. All Jermaine is ....... anyway to make a BUCK...
Catherine just received 30 million, that should keep a roof over all the Jackson's for awhile...
I sure hope Michael protected the interest of his children or they will be the one's hounded for the rest of their lives... How sad. Michael would have never wanted this to happen...

Dr. Murray is Guilty of Involuntary Manslaughter because of NEGLECT for using Propofol not in a hospital setting. It was never Dr. Murray's intent to Murder Michael Jackson or accidentally take his life. He had nothing to benefit from his death.... who knows what happen when he left the room. Could Michael have taken extra Propofol or could their be another answer to how he died?
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maybesomeday
War is not about who is right its about who's left
07:28 AM on 09/28/2011
How about MJ protecting his children, did he do that? No he really didn't because he himself knew that he had a drug problem. A drug problem that ultimately cost him his own life, so now his children are left with no father.

What MJ really needed to do was clean up his act, get off the drugs but he didn't. He chose every single thing that went into his body, he was never tied down and administered any medications.

You know nothing about drug addicts because like any good enabler would do you are pointing fingers at everyone else, which is kind of funny to me. You probably don't even know MJ the private MJ, all you know is that you liked his music, grew up with it, just like I did.

The real Michael Jackson was a very troubled soul who lost his way and used drugs to ease that pain. MJ had money so he wasn't on the street corner purchasing his drugs. But he's no different than a junkie looking for the next fix.

They are the best manipulators, convincing to the end. Michael Jackson led people to believe he was always the victim. Well the real victims are his own children who are now fatherless because of his bad choices, the victims of molestation, not guilty does not mean innocent. His own children are left alone to pick up the pieces, how sad is that??
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maybesomeday
War is not about who is right its about who's left
07:16 AM on 09/28/2011
brokenangel --- You sound like a typical MJ fan who is living a fantasy of who the real Michael Jackson was. There are millions of children that unfortunately grow up in abusive homes.

The family dynamic's aside, one is always, always, always the keeper of their own health and circumstance as adults. But one either grows out of that family dynamic and move's on with their own life, or they get all wrapped up in this rich fantasy life of being the victim, and it would seem that MJ took the victim role in his life.

As far as loving his children so much and making provision's in a will about their care should he died, don't you think that taking the drug's that he was taking would be a form of abuse on his own children? Drug addict's can barely take care of their own needs, never mind a child's, and in this case it would seem that MJ was extremely selfish in his own needs. Not saying he didn't love them, but his abuse of his children was no different than that of his father, it was just done in a different way.

But with someone like you do deeply entrenched into the fantasy that MJ was suppose to be, it would never occur to you of what the real man was, questionable behaviors with children, drug abuse, neglect.
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brokenangel143
Sometimes you have to think outside the box...
10:00 PM on 09/26/2011
Michael's own family wasn't even overseeing his care and they all knew he had several drug problems. They were only allowed into his rented home after he died. After Jermaine announced the passing of Michael, Catherine returned to his home and retrieved items and checkbooks and his family proceeded to remove items before the police could lock down the area for investigation.
I hear that Michael's children will be testifying at the trial and this should really be interesting to hear what happen in Michael's room when he was taken by ambulance to the hospital. I'd really like to know what the children saw after the Jackson family returned and went through the house. Their were tapes of songs and personal information in Michael's safe, that were unaccountable after the Jackson family left the home that day.
As far as Michael's health, he never completed the physical examination for the coverage of the insurance that was to cover the concert commitments. Now they say, Michael was in good health. He only attended the last two days of rehearsal during the whole time. He never showed up for rehearsal before that time...

This will be a very interesting trial.... Who would benifit from the Death of Michael?
Theire is an answer to this question..... IMO
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maybesomeday
War is not about who is right its about who's left
07:34 AM on 09/28/2011
Who benefit's from Michael Jackson's death? Enquiring minds want to know. I sort of feel sorry for you brokenangel, you've fallen victim to the Michael Jackson fantasy. You are speaking on behalf of whom exactly?
This isn't a game, a real person died, not some mythical fantasy person, and there is a real person on trial for his death. What does anything you've just said have to do with this trial?
I'm actually getting a little creeped out by your words, your obession, does it in anyway benefit you?
Do you realize that 3 children have no father because their father chose drugs over them? This is reality, not some made up fantasy. Are you the girl that was on the news this week telling viewers that Michael Jackson is still alive and being forced to write music under heavy sedation?
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No death panels
There's no man with a trumpet. Only me.
09:22 PM on 09/26/2011
Murray isn't board-certified in internal medicine, let alone cardiology. Even if he'd been in the room when MJ stopped breathing I wonder if he would have known what to do. Being blinded by money and celebrity just magnified his laziness and incompetence.He should be toast.
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KellyRyan
A micro-bio for one who has none.
06:11 PM on 09/26/2011
If one was to set aside the issue of doctor and patient or set aside celebrity, the argument is then reduced to, "duty of care." Did Murray have a responsibility to provide reasonable care to MJ?

Yes ...

(But, I'm nor a juror and not attached to the outcome of the trial.)
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maybesomeday
War is not about who is right its about who's left
07:36 AM on 09/28/2011
Thank you KellyRyan for an actual real comment, not emeshed with fantasy.

Yes Dr. Murray did indeed have a responsibility to provide not only reasonable care, but excellent care, which of course he didn't. He crumbled up that sheet of paper with the oath to do no harm and tossed it in the trash.
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gloriaswanson43
Ask and you will get more info.
05:52 PM on 09/26/2011
This sounds very similar to the life of Howard Hughes. His handlers didn't take good care of him, either.
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maybesomeday
War is not about who is right its about who's left
07:43 AM on 09/28/2011
But didn't he become a recluse? And the list is very large of those who died too young, Elvis didn't have the right people around him either.

But at the end of the day, everyone is responsible for what they put into their bodies. Once you are prescribed a strong narcotic it's very easy to be lulled into thinking it's a magic pill, the one thing that has all the answers.

But at the end it's your worse enemy, you can't seem to take enough of the drugs to get that wonderful feeling you had when you took the first pill. Michael Jackson became a drug addict, he admitted it and was doing something about it.

But he fell short and turned to drugs once again to ease the emotional, physical, and spiritual pain he was in. He absolutely knew that he wasn't doing the right thing. It was all hush, hush until the moment he died. Then the gates of hell opened and everyone couldn't wait to point fingers at everybody else.

But at the end of it all, whether Murray is convicted or not, it was Michael Jackson's drug addiction that did him in.
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gloriaswanson43
Ask and you will get more info.
09:52 AM on 09/28/2011
If I remember correctly, Howard's OCD took over. He paid his people to do exactly what he said. If they didn't, they were fired. They shut their eyes, did what they were told and got their paychecks. Honestly, though, how is this any different than what happened to Michael? He constructed a fantasy world around himself instead of living in one room. His family probably did try to reach him over the years. There were probably many people who tried, outsiders who genuinely cared about him. He either couldn't or wouldn't live in the real world. And there were plenty of others more than willing to tell him what he wanted to hear, maybe to exploit his talent or just to be in the light of a great star. I'm not condoing the behavior of these folks by any stretch. But how long would a normal, caring human being be able to watch Michael slowly kill himself?