A heated fist-fight discussion has been going on on three mediblogs – White Coat’s, Happy Hospitalist’s, and Nurse K’s. It started when White Coat bemoaned the fact that Michael Jackson’s doctor is possibly being charged with manslaughter in connection with the singer’s death, allegedly from the drug, propofol. He (and then Happy echoed it) is very concerned that if the doc is successfully prosecuted for this crime, it will set a precedent to charge doctors with all sorts of criminal acts if patients have bad outcomes from the off-label use of drugs. Doctors have been doing this since the dawn of medicine – usually appropriately and safely (after all, pharmaceutical companies cannot petition the FDA for every new indication of every drug that is discovered – it costs jillions of dollars to do so, and for what? We will prescribe them regardless if with think something will work and is safe). Here is my two cents.
I agree with them IF such a horrific precedent were to be set in this case, the practise of medicine would be egregiously harmed. As Happy (paraphrased) says, doctors will have to stop giving neurontin for diabetic neuropathy, and lasix for ascites (both are common off label uses for them). However, I agree with Nurse K that such an outcome is extraordinarily unlikely – mostly because what Dr Murray did (or allegedly did) was very different from what Happy describes. Propofol is a HEAVY duty anaesthetic induction agent. It induces deep levels of anaesthesia in higher doses, allowing us to safely put people “to sleep” for operations (and then maintain them on inhaled agents like Sevoflurane until the operation is done). It does not take a rocket scientist to realise that such a drug could kill you – it makes you completely lose the ability to protect your airway at higher doses. Thus, even when given at LOW doses for “conscious or moderate sedation”, one must strictly monitor the patient. It should not be given to anyone (except in the most emergent of life-threatening reasons) who has eaten or drunk anything within the last 6 hours (to avoid aspiration). The patient must be on a cardiac and oxygen saturation monitor. Airway equipment must be present (intubation supplies, a ventilator, oxygen, etc), and well as access to ACLS drugs (epinephrine, atropine, etc) in case the patients crashes. This occasionally happens and as a result, the person giving the propofol must be able to resuscitate the patient – and this does not mean just to do CPR. He or she needs to comfortable intubating and be ACLS certified. At my hospital these are the BASIC prerequisites to perform conscious sedation. We have an additional level of certification as well. You have to be either an idiot, a cavalier cowboy, or beyond uncaring to just bolus someone with propofol in at home (unless MJ’s house was basically set up like an ER and Dr Murray was properly certified with an attendant RN as well). Giving someone lasix for ascites or neurontin for diabetic neuropathy is not much different than giving it for it’s original use. Both drugs are pretty damn safe and dosed similarly for these off label conditions. I find it hard to believe that doctors will be prosecuted if someone so happens to die from lasix – induced hypkalaemia JUST because they gave it for an off label use. I just don’t see how that would be manslaughter just like they are proposing MJ’s death is a case of. It’s like apples and oranges. That said, I am very interested to see what happens – and I wonder if the government will make propofol a controlled substance finally.
agree that this case is too extreme to pose any real threat to doctors.
one question that i don’t hear asked though- why does the addict have no blame in all this??
interesting debate, however I don’t think it is progress to affecting the liability of credible doctors and of medications prescribed within medical necessity. I can’t believe that the drug wasn’t classified as a controlled substance to begin with, and obviously money can buy both doctors and drug of choice.
I guess instead of typing “is” it should have read “will”. I agree it will be interesting to see what develops from it.
Hello ERP! and others, while I totally agree with you and bella too, the answer to all these baffling details of this case and what it contains all boil down to that one 5 letter word……. ,$ MONEY $!!! by how much you have(MJ)and how much is worth loosing not only your career but your freedom as well,(Dr.Murray) and Yes!! the addict’s actions should be the main topic and focus of this case. Stacy(:
[...] See additional discussion about the criminalization of medicine from Happy Hospitalist, Nurse K and ERP. It’s official. Michael Jackson had lethal levels of propofol in his system. The [...]
Reminds me of the old joke…. “we’ve already established what you are. Now we’re just negotiating price.”
Seems with all the complaining by Happy Hospitalist about the stuff he does without being compensated, he would have gladly taken Dr. Murray’s place — $150K a month is nothing to sneeze at!
Classof65
I don’t know if you’ve heard, but news sources are saying the good doc Murray also administered other sedative/narcotics, including lorazepam, diazepam, and mirtazapine, prior and up to the administration of prophonol (sp?).
Just an outsider’s perception, but it seems unlikely the scenarios of loosing the ability to prescribe Prophonol off-label is unlikely. Dr. Murray failed to follow prescribing protocols in addition to bein grossly negligent in a lack of monitering equipment (Murray claims to have only monitered Jackson’s pulse and oxygen levels),
adequit airway established, and a lack of rescussitation equipment. Dr. Murray is an embarrassment to the medical community and I hope harsh penalties fall upon him.
LOL, did I say “unlikely” twice up there? My apologies for that and my spelling, I’m trying to type too quickly on my mobile device. What I ment to say was, “the scenario of loosing the ability to prescribe Prophonol off-label (or have penalties incurred for adverse outcomes following this case) seems unlikely as Dr. Murray was negligent and failed to follow even basic protocols.
[...] Click here for other health care professionals opinions on this matter, Whitecoat, Nurse K, Happy Hospitalist, ERP [...]
Have you started using MJ’s name when telling people about the medicine you’re going to give them before you pull their hip back in?
Has anyone said, “hey isn’t that the medicine that killed MJ?”
I am not in favor of prosecuting doctors for medical errors.
I don’t see this as a medical error.
The AMA, ASA, ACEP, and other organizations of physicians who use propofol need to make coordinated statements that this was not medical care. This was so irresponsible that it does not even come close to representing competent medical care.
The death of Michael Jackson, under these circumstances was not an unforeseeable accident, but the inevitable outcome of reckless behavior. This is no more medicine than if someone overdoses on heroin.
I saw that happened to Michael. when Dr. Murray give him the dose of propofol, he fell asleep, but it suffered him a cardiac arrest and he died when he’s not breathing.