Coroner Rules Jackson's Death a Homicide

Death Caused Primarily by Powerful Anesthetic Propofol and Another Sedative, Medical Examiner Says

(CBS/AP)  Michael Jackson's death was a homicide caused primarily by the powerful anesthetic propofol and another sedative, the coroner announced Friday in a highly anticipated ruling increasing the likelihood of criminal charges against the pop star's doctor.

The Los Angeles County coroner's office determined the cause of death was "acute propofol intoxication." Lorazepam, another sedative sold under the brand name Ativan, contributed to the death.

Additional drugs detected in Jackson's system were the sedatives midazolam and diazepam, the painkiller lidocaine and the stimulant ephedrine.

The coroner did not release Jackson's full autopsy report, citing a security hold requested by Los Angeles authorities investigating the case, and declined to comment beyond a short statement announcing the manner and cause of death.

"The findings are not a surprise but they do confirm that the singer had an awful lot of very strong medicine in his body when he died, a fact that clearly will help determine whether prosecutors now believe they have enough physical evidence to charge someone, including Jackson's treating physician Conrad Murray, with some sort of involuntary manslaughter charge," says CBS News legal analyst Andrew Cohen.

"The key here is not to get caught up in the use of the word 'homicide.' It does not mean we are going to see an intentional murder case here," Cohen notes. "It's just a generic word the medical examiner uses. When the prosecutor's office starts talking about terms like that we'll need to pay attention and I still think the most likely scenario here is an involuntary manslaughter charge against someone."

The coroner's determination of a homicide confirmed what The Associated Press first reported Monday, citing an anonymous law enforcement official.

The 50-year-old Jackson died June 25 at his rented Los Angeles mansion. Dr. Conrad Murray, the Las Vegas cardiologist who was the pop star's personal physician, told police he gave Jackson propofol that morning after a series of sedatives failed to help Jackson sleep.

Read CBSNews.com's complete coverage of Michael Jackson's life and death

Murray has not been charged with any crime but is the target of what police term a manslaughter investigation. Multiple search warrants served at his home and businesses in Las Vegas and Houston sought evidence detailing how he procured the propofol that killed Jackson. Jackson's interactions with at least six other doctors also are being scrutinized.

Except for a brief video posted to YouTube earlier this month, Murray has not spoken publicly since Jackson's death. In the video, he said: "I told the truth and I have faith the truth will prevail."

Murray's attorney, Edward Chernoff, said he was disappointed the full autopsy report wasn't released. Without that, it was impossible to seek independent expert opinion on the significance of the various drugs detected.

"Release the toxicology report, the whole thing. Sunlight is the best disinfectant," Chernoff said. "This smells like gamesmanship."

Chernoff repeated his assertion that nothing Murray gave Jackson "should have" killed him.

It's not clear when the full report may be released. The coroner said the security hold would remain until the investigation is wrapped up. The Los Angeles Police Department and the district attorney's office said they did not know when that would be.

A statement by the LAPD said the investigation into the death is ongoing and "will result in the case being presented to the Los Angeles County District Attorney for filing consideration."

The coroner's determination of homicide makes it more likely criminal charges will be filed but does not guarantee it. In the past seven years just a handful of doctors have been convicted of manslaughter, mostly involving their patients' use of painkillers. To win a conviction, prosecutors would have to show that Murray acted recklessly and with negligence.

Murray was hired by Jackson's promoter AEG Live to help keep the aging star fit during the grueling preparation for a series of comeback "This Is It" concerts in London. Jackson got to know Murray in Las Vegas, where he moved after a stint overseas following his 2005 exoneration on child molestation charges and where the Caribbean native ran a clinic.

It was a break — and a $150,000-a-month salary — that Murray desperately needed. The doctor hadn't paid the mortgage on his country club mansion in 2009, and according to court records he owed a total of at least $680,000 in judgments against him and his medical practice, delinquent student loans, child support and credit cards.

Murray has been interviewed twice by police. According to court records, he told investigators that over about six hours he injected Jackson with two doses each of lorazepam and midazolam. Finally, around 10:40 a.m., Murray said he succumbed to Jackson's demands and administered propofol, a drug Murray said he had given Jackson every night for six weeks. He said he had diluted the propofol with lidocaine.

Propofol, dubbed "milk of amnesia" among anesthesia professionals, commonly is used to render patients unconscious for surgery. It's only supposed to be administered by anesthesia professionals in medical settings and, because of its potency, requires the patient be closely monitored at all times. Using propofol strictly as a sleep agent violates medical guidelines.

Medical experts said the drugs found in Jackson's system magnify each other's effects.

"Instead of one plus one equals two, one plus one equals three," said Lee Cantrell, a toxicologist and director of the San Francisco division of the California Poison Control System.

A search warrant affidavit unsealed this week in Houston includes a detailed account of what detectives say Murray told them. The doctor said he'd been treating Jackson for insomnia for about six weeks with 50 milligrams of propofol every night via an intravenous drip, the affidavit said. Murray said he feared Jackson was becoming addicted to the anesthetic, which is supposed to be used only in hospitals and other advanced medical settings, so he had lowered the dose to 25 milligrams and added the sedatives lorazepam and midazolam.

That dosage is very small and by itself it's very unlikely it would have killed him. But with the other drugs there was a "benzodiazepine effect," according to the coroner, and it was deadly.

Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill, said it's difficult to determine what constitutes a fatal dose of propofol in someone receiving other sedatives.

"It's hard to set any level because of the way those act in synergy," he said. Given after the sedative lorazepam, "Even a small dose of propofol might have a very large effect."

Jackson had many medical procedures over the year and a long history with various drugs. Following his death, three medical professionals said Jackson asked them for propofol this spring. All refused. One, a registered nurse named Cherilyn Lee, recounted that Jackson told her he liked how the drug knocked him out fast and allowed him to sleep for hours longer than he could naturally.

Doctors were surprised by the coroner's mention of ephedrine, once sold as the controversial diet drug Ephedra and now banned by the federal Food and Drug Administration, though the drug can be used for resuscitation. Zvara said it's unlikely emergency personnel who responded to Jackson's home would have used that drug since epinephrine, otherwise known as adrenaline, is favored.

[pickaguitar1]

RIp Michael

[pickaguitar1]

RIP Michael

[trapbreaking]

Jackson was a doper and dopers with gobs of money can always find a doctor to get it for them, or they can go offshore, or they can use their hang on groupies get the drugs.

.

[thomasxstewa]

thomasxstewart wrote:

Murray commited homicide by obtaining control drugs in Las Vegas, Nv by writing false script with murray as patient. then traveling interstate to resell control narcotics at profit to Michael J. Jackson, in such low doseages as to insure Emotional dependance. with Lidocaine, which can cause extremely great cravings for more. Lidocaine is over counter drug used in Crack Cocaine manufacturer,
Lidocine is stimulant.

Big block to Homicide trial is DA itself. DA come up thru petty drug incursions & street level open air markets. Making conveants to avoid loss of own team extreme in calous nature. even though control Drug are Non tranferable, MD not To Profit from dispensation, Writing narcotics script in ones own name for onesself, & dispensing narcotic to drug addict ARE ALL FELONIES, Most DA don't have courage to enforce those laws. IUn Fact Da Orchestrate & Have commited More Deaths with Drug Weapons than many others.

DA Sells Priviledge & thats part of back room lawyer/Account dealing to manage highly paid "professionals", Da hopes to cull. More Boy Scout troupe than Legal Justice.

however, family Demands Prosecution & Coroner is willing to testify its' Homicide. Only FOOL wouldn't Start with greater charge & let jury decide if lesser charge is in order.

Signed:PHYSICIAN THOMAS STEWART von DRASHEK M.D.


Posted by: thomasxstewart | August 24, 2009 at 09:09 PM

8/25/2009 12:24 AM EDT
Recommend


http://www.geocities.com/tsvondrashekmd/THOMASSTEWART.html

[MySay2]

yoyoinla, That is not a rebuttal it is simply incorrect information.

1. Dr. Murray is a DOCTOR/PROFESSIONAL, he attended a school of medicine to obtain licensing in medicine.

2. As a Doctor Murray swore by the Hippocratic oath which partly states ethically taking care of a patient nursing him/her back to good health.

3. Dr. Murray did not do an assessment on his patient to find out what his problem was he allowed the patient to dictate the problem to him

4. Dr. Murray allowed the patient to tell him what type of medication to give him, There is no such thing as a patient telling the Doctor what he should give him.

5. Dr. Murray DID NOT have a license in CA to dispense medication nor to write prescription for medication.

6. Dr. Murray obtained medication used for sedation ONLY in an operating room of a hospital or outpatient of a clinic

7. Dr. Murray used a medication which is ONLY to be used by an anesthesiologist or nurse anesthetist only these professionals are authorized to use this medication.

8. Dr. Murray not authorized to dispense medicine, not authorized to use propofol used propofol in a home environment.
Dr. Murray used propofol which is a sedative of operation as a means of treating insomnia

9. Dr. Murray had NO life saving equipment or monitoring equipment REQUIRED for administering this medication, notice, this equipment is REQUIRED.

10. Dr. Murray gave his patient various drugs 2 to 3 times in a very narrow time frame without regard to their interaction.

11. Dr. Murray left his patient unattended which should never be done under any circumstance while under the influence of this medication.

12. Dr. Murray found his patient DEAD and did not call 911 for more than an hour yet he managed to call other places first.

13. Dr. Murray refused to sign the death certificate as though is he didn't sign it than Michael Jackson didn't die at home but he died at the hospital under the care of the paramedics.

Now allow me to further educate you. No matter who a patient is, how much money a patient has, or how demanding a patient is. THE PATIENT ACTIONS DOES NOT NEGATE THE RESPONSIBILITY OF THE DOCTOR WHO IS THE PROFESSIONAL. There is no cause an effect when it comes to the demands of a patient and the action of the Doctor.

Michael Jackson was not Dr. Murray's client, HE WAS DOCTORS MURRAY'S PATIENT. Therefore Dr. Murray had the responsibility to nurse his patient back to good health and if his patient was requesting medicine which was off limits, the Doctor's responsibility was to deny the patient.

[yoyoinla]

Uh, excuse me. Please direct your comments to the place they belong. I'M ON YOUR SIDE. I don't need to be "educated". I believe you are directing your ire at the intelligent Pensacola, who is equally educated, I would suspect, but looks at this from a different perspective. (I say that seriously, by the way).

[ccrn1234]

Ok. So this "Doctor" is totally unethical for administering these drugs at Jackson's home. Any idiot should know nit is not enough to monitor his O2 Saturation. That is often the last thing to decrease. Your sat can be fine till you actually stop breathing meanwhile the CO2 level is climbing till eventually you stop breathing. Was it worth it to the doctor to sel his sole and life for 100,000 a month. He should have know better. If Jackson needed those kinds of meds he needed hospitalization. Probably needed electroshock therapy too.

[Nitcroler]

Although it may be right that Michael Jackson is dead. But recently I was browsing through the web and I came accross a web site which I cannot remember, it shows someone wearing a white shirt, long black hair leaving the back of the coronary van and taken inside the building. If Jackson died wearing a white shirt, which I wouldn't know, then maybe there is some truth in it. And I am still puzzeled about the called that was made to 911, the person calling didn't mentioned it was Michael Jackson. There are rumors that did spread after Elvis Presley died, only rumors.

[knowdalaw]

I agree with Dr. Murray's attorney. Release the whole toxicology report. Release the Full autopsy report. What are they afraid of? What are they holding back?

[scabbard2]

Jesse and Al are probably the biggest loosers here...no one to rail against, well maybe the doctor, but he's black.

[ivehadit9]

See, when I become a medical doctor I wouldn't associate myself whatsoever with some celebrity, because you never really know what's gonna happen to you. When that celebrity finally says "au revoir" for all eternity, you never know what's gonna happen to you. Now, Conrad Murray is facing prosecution and, perhaps, jail time, although I doubt he'll serve a day in prison. But even then, his notoriety of causing MJ's death will be there forever. It's highly doubtful if he'll practice medicine again. Why was he dumb enough to associate himself with MJ in the first place, I don't know, except for the glory.

[jovanar]

If this do not result in conviction then there is something seriously wrong with the legal system. The evidence is just too obvious. No matter what is said but Michael would never do anything to jeopardise his life or lives of his children. he loved them too much.

[tugar04]

I LOVED MICHAEL TOO, BUT....

All of this is so very sad and did not have to happen. But Michael had a responsibility in all of this insomnia-drug-taking business as well. Its being reported that he employed people (doctors especially) who gave him anything he wanted in drugs in order to sleep. But all of this cannot be laid at the foot of one doctor when Michael himself, as well other doctors attributed to his ultimate death.

[whatsup49]

who cares anymore. his family needs to bury him. let him rest in peace. it is a shame he has not been buried. for anyone who cares, this is a disgrace to the dead.

[jcdugger1234]

LMBO @ IndepTex10! That's some funny stuff right there!! :)

[pensacola8-2009]

When it is all finished, the doctor will be free to practice medicine again, but whether he can find a patient that wants to use his services for traditional medical practice is another story.

Dr. Murray has a good defense that his client was faithless. It will be difficult to prove that Jackson had no part in his own death.

Drug rehabilitation programs do exist, but only work if the patient's self discpline can be built up to be stronger than their addictive behavior patterns. Jackson certainly had the means to detox himself, but he also had poor self-discipline and exhibited a refusal to grow up. His ranch was dedicated to Peter Pan and his character flaw of refusing to grow up.

Some will argue that Dr. Murray simply facilitated Jackson's behavior and really exhibited no control over Jackson. Proving that homicide was the real cause requires proof that Jackson was never in control, but only Dr. Murray soley was.

Some will argue that people who refuse to grow up never die from it, but Jackson's use of alias names to acquire medications exhibits clear proof that his character flaws were severe enough to do harm to himself and reinforce his will feed his addiction through non-compliant and non-conformant behavior to both civil laws and reasonable personal values of a mature adult. At best, it will be considered an accident of negligence, just like frequently seen when a gun owner and a friend mishandle a loaded weapon and discharge it causing a fatal injury.

[yoyoinla]

A few points....
1. Dr. Murray can't possibly have a good defense for illegally dispensing Propofol for incorrect purposes. Whether or not his client was faithless is irrelevant. A Doctor is not under obligation to dispense drugs just because he is demanded to do so..nor should he if it isn't appropriate...period.
2. Dr. Murray most certainly DID facilitate MJ's behavior. Granted MJ was a 50-year old man...with money...doesn't mean Dr. Murray had to help him with his addiction.
3. Homicide isn't the issue. It is clear that MJ died because "something" caused it. Manslaughter is the issue. Manslaughter, a crime. Homicide, not a crime.
4. Dr. Murray was in "control". No administering of the Propofol...no Propofol in the body.
5. Whether or not MJ never "grew up"...isn't this just a bit beside the point. The man had discipline. Who on earth could accomplish the things that he did without discipline?

[pensacola8-2009]

by yoyoinla August 28, 2009 5:14 PM EDT

Excellent post!! Here is my rebuttal:

The dispensing of propofol is definitely controversial, but we are talking about an addict who already had this and other medications that were playing games with the patient's liver. Once a person's liver becomes acclimated to one drug and stops working, it is common for a doctor to prescribe another of a different derivative compound to be effective.

Dr. Murray did not facilitate Jackson's behavior. Jackson already had the problem, and it is doubtful that his choice to hire Dr. Murray was for rehabilitation purposes.

The difference about homicide or manslaughter is more about intent, than about result, because we can see the results are the same.

Dr. Murray may have been in 'control' of the act of administering the Propofol, but Jackson was in control of Murray by requesting and paying for his service. If he had not hired him, Dr. Murray wouldn't have done anything and walked away.

Jackson's refusal to acquire self-discipline and grow up in a way that is sufficient to survive addictions and the behavior patterns was factor. Becoming a star performer was a remarkable achievement, but required discipline of a different type.

I will express this compassion for Jackson's death and call it tragic. Bringing a doctor to Jackson's residence to treat him instead of bringing Jackson to a treatment facility compares to bringing a loaded gun into a room of angry people. It is easier to control what will happen in a gun store if several angry people showed up to buy a gun, then if someone took a loaded weapon into a room full of angry people.

The only thing I will call Dr. Murray foolish over was his choice to attend to Jackson's needs at his residence, because Dr. Murray did compromise the arena of control and surrender it to Jackson by treating him at his residence, but even that is legal, just not wise.

[j1p9m5d2]

There is no legal basis for your first 2 points to have any merit - pure speculation ..... point 3: looks like you need a crash course in Law 101... point 4: Michael certainly had the ability to administer the drug
himself... point 5: -?- what the heck does this have to do with anything !

[yoyoinla]

Pensacola, I agree with you to some degree. However, having come from a family wrought with addictions, I know how "convincing", whether by offer of money, or just pitiful actions, addicts can be when they want something. Enabling from another Family member is bad, being enabled from a medical "professional" should be thought of as a crime. If anyone in his life ever said "NO" to him, he might still be alive.

From a logical standpoint, I agree with you in most of your points. From a cynical standpoint, Dr. Murray should be prosecuted. I have one uncle who would likely be alive had anyone told him "NO".

j1p9m5d2 - Points 1 & 2 - No part of this is speculation. "Dr. Murray has been very open about these points. Point 3 - THrowing the "Law 101" back at ya. Homicide: The killing of a person, by another person, whether intended or not. Not all homicide is unlawful.
Point 4 - Thinking you haven't been paying attention to the stories. Point 5 - I was answering Pensacola's post. Wasn't talking to you.

[Markie33tx]

All true fans knew all along that this was a Homicide. It was not manslaughter because while he may have wanted them, he didnt give them to himself. All of you with negative comments; if you are glad he is gone dont bother with your silly comments. Move on to another story about redneck hillbilly killers or something just as tragic.

[obomba1]

Jackson killed himself. It was a 20 year suicide plan.
O.D. on plastic surgery (check)
Have nose removed (check)
Get plastered on Jesus juice (check & hic)
Be one with the children (priceless)

[yoyoinla]

Depend on some idiot blogger calling himself something that resembles the US President's name, showing Jackson the error of his ways (USELESS)

[taxchurches]

Another junkie dead. Who the hell cares? Give doc a vote of thanks for ridding the world of another useless pop idiot.

[bjo1109]

Although I may be wrong in terms of the law, I do not believe his death should be classified a homicide. At the most, manslaughter---maybe. After all, MJ wanted the drug(s), he was a user if not an addict, and he was a grown man capable of making his own decisions. Nobody forced MJ to take the drug(s), nobody meant to murder him, and MJ is the only one responsible for his decisions. I believe it was an accidental overdose. Calling it a homicide is like saying anyone who died from smoking cigarettes was murdered. How many people agree with that?

[rwsmith29456]

Just take the guy's license to practice. 'Some sort of manslaughter charge' doesn't sound like it will stick very well and will just be a burden to the courts.