Michael Jackson.  Brittany Murphy.  Heath Ledger.

Three celebrities whose recent deaths were the result of, or incidental to, their use of prescription drugs.  But the problem that their deaths signal is widespread.  Just last week, my local news outlet reported on a high school principal who contacted his students’ parents to warn them of the risks from prescription drug intoxication following incidents of students sent to the ER after overdosing on prescription meds.

And, now, came the news that Michael Jackson’s personal physician, cardiologist Conrad Murray, has been charged in the King of Pop’s death.

The district attorney for Los Angeles released the following statement in a press release:

Dr. Conrad Robert Murray, 56 was charged in case No. SA 073164, filed at the Airport Branch of Los Angeles Superior Court. The count alleged that Murray “ did unlawfully, and without malice, kill Michael Joseph Jackson…in the commission of an unlawful act, not amounting to a felony; and in the commission of a lawful act which might have produced death, in an unlawful manner, and without due caution and circumspection.

What makes Dr. Murray complicit in the death of Jackson when the physicians supplying Brittany Murphy and Heath Ledger avoided such censure?  Let’s take a look at a portion of Jackson’s autopsy report (released by TMZ).  Yes, I know that is ghoulish.  But, it’s necessary, and you can’t say you aren’t curious yourself, right?

1.      Circumstances indicate the Propofol and the benzodiazepines were administered by another.
2.      Propofol was administered in a non-hospital setting without any appropriate medical indication.
3.      The standard of care for administering Propofol was not met. Recommended equipment for patient monitoring, precision dosing and resuscitation was not present.
4.      The circumstances do not support self-administration of Propofol.

But, let’s get down to the nitty gritty:  analyzing the content of the press release.

Criminal law is a type of statutory law, codified at the state level.  The state statute outlines the elements of a crime.  But, it always comes down to actus reus and mens rea.  Ugh.  Yes, that’s right, I am throwing Latin phrases around.  I had to suffer through law school professors throwing them out regularly, so I might as well pass that knowledge on to you.  Who knows, it might win you a trivia competition some day.

Actus reus means “guilty act,” or the physical element of committing a crime.  But, to be charged with a crime, one must possess the requisite mens rea, as well.  Mens rea means “guilty mind,” and stands for the intent to commit some wrongful act.  In order for someone to be held culpable for a criminal act, the person committing the criminal act must possess the requisite mental state at the time that the act is done.  The Model Penal Code, on which most state criminal laws are based, adopts a four-tiered hierarchy of culpable mental states, arranged from highest to lowest below:

1.         purpose,
2.         knowledge,
3.         recklessness, or
4.         negligence

The actus reus element can consist of an action, the threat of an action, or much more rarely, the failure to act by a person with a duty to act.  Here, the press release describes that the good doctor has been charged with murder, which is defined as the unlawful killing of a person.

The seriousness of the crime – murder – is based on the intent of the person committing the criminal act.  Here, the press release mentions two important phrases: “without malice” and “without due caution and circumspection.”  These phrases indicate that Dr. Murray was, in essence, reckless in administering MJ’s milk (Jackson referred to Propofol in this way because of the powerful anesthetic’s milky white appearance).  If only the effects of MJ’s milk were as benign as the actual dairy product’s, no?

Here, the press release describes that the good doctor has been charged with murder.  However, if murder had a scale on which someone’s intent to commit the crime was logged, Dr. Murray’s would be in the less serious category, “without due caution and circumspection” which really equates with recklessness.  Dr. Murray, as a medical professional, must ascribe to certain, acceptable medical standards.  The coroner’s report makes clear that Dr. Murray’s conduct fell below such standards.  It will be up to Dr. Murray’s defense team to present an expert at trial to dispute the expert testimony of the coroner.  In other words, get ready for dueling experts to attempt to define what medical standards surround the use of Propofol and to opine if the cardiologist breached his duty of care.

Brittany Murphy and Heath Ledger also died as a result of prescription drug usage.  Neither was injected with an anesthetic.  Both actors, however, were provided with numerous prescriptions for drugs which – if mixed – had the potential for deadly consequences.  How, then, did either prescribing physician avoid criminal charges?  Weren’t these physicians just as reckless as Dr. Murray?  I would argue that they were not.

As a nation, we look to pills first and foremost to cure our ills.  Medical professionals have become used to writing out scripts, passing the buck for possibly harmful interactions to pharmacists filling prescriptions.  Were Brittany and Heath’s doctors too generous in handing out meds?  Possibly.  Probably.  However, their conduct was not as grievous as Murray’s, who prescribed a surgery-strength anesthetic as a sleeping potion for a drug addict with multiple health issues.

Commentators have speculated for weeks that the physician treating Jackson would be charged for administering Propofol.  Now that he has, is anyone really surprised by the charges?  The Jackson family is outraged and believes that the charges are not serious enough.  What do the rest of you think?  And do you think that the circumstances surrounding MJ’s death differ sufficiently from the circumstances of Murphy’s and Ledger’s deaths to result in a manslaughter charge against Conrad Murray but not the prescribing physicians of the other two celebrities?

Posted by Krystyna on February 16, 2010 at 11:23am.