Saturday, October 23, 2010

Conrad Murray vs. Doctor #1

Dr. Davill Armstrong has been an internal medicine doctor in the state of Texas since 1979. He was previously board-certified in internal medicine before his license was subjected to disciplinary action. He has his own clinic, dubbed Armstrong Medical Clinic, that is located in Houston, Texas. Another physician by the name of Conrad Murray, whom we have all come to know, has been known to see patients at Armstrong Medical Clinic. He resumed his practice at this clinic after the death of his patient Michael Jackson. Armstrong Medical Clinic is not Murray's clinic. Murray's clinic in Houston is Acres Homes Heart and Vascular Institute. I am not sure why Murray has a practice or visiting role at Armstrong Medical Clinic along with another practice in Las Vegas by the name of Global Cardiologist Associates. "Global" seems to be a fitting term since Murray seems to go wherever the wind blows him.

It was brought to my attention that Dr. Armstrong has ran into some problems with his license in the past so I decided to look into the matter for kicks. I have tried to summarize the findings below as swiftly as possible:

Medical Board Order #1:

On August 13th, 2004 Armstrong's license was place under disciplinary action by the Texas State Board of Medical Examiners. Disciplinary action was sought because in late 2002 he saw a patient referred to as "C.H.". The chief complaint (problem) for C.H. was listed by Armstrong as "? seizures". He noted on the physical exam that all basic vital signs were normal. He diagnosed the patient as having seizures and asthma. He wrote prescriptions for albuterol for the asthma and Dilantin (phenytoin) for the questionable seizures. Armstrong did not follow-up with the patient, determine what the cause of the seizures were and failed to check serum blood levels for the Dilantin. Those aforementioned actions violated the standard of care in his treatment of C.H. thus disciplinary action was taken forth on his practice of medicine.

Due to his violation of the standard of care mentioned above, his practice of medicine was to be monitored for three years by the Compliance Division of the Board. Also, Armstrong was forced to allow the Compliance Division to review his patient records, up to 30 records every 90-day period for the duration of his monitoring. After 3 years, he was to enroll and successfully complete 30 hours worth of courses related to record-keeping and/or risk management.

Medical Board Order #2:

On June 2nd, 2006 another court order took place against Armstrong. Recall Armstrong was to be monitored for 3 years. The Board found he again violated the standard of care for 15 patients by "treating only specific patient complaints at each office appointment without completing a history and physical on the patient and without monitoring chronic medical conditions, such as diabetes." He is also said to have violated the standard of care by not documenting enough, failing to provide "preventative medicine and disease management, and failure to evaluate patients for acute medical conditions in each of the 15 patients". He also hospitalized many patients for extended durations without justification.

Armstrong was reviewed by the Center for Personalized Education for Physicians and was found to have judgment and reasoning below acceptable standards as well as gaps in his medical knowledge. A neuropsychological exam was recommended.

Armstrong's license was then suspended.

Medical Board Order #3:

On May 29th, 2009 Armstrong asked that his license be reinstated so he could be allowed to practice medicine in order to complete the obligations in which he had to undertake to get his license and practice back. His request was granted under very limited limitations, under the scope of the Center for Personalized Education for Physicians.

Medical Board Order #4:

This order details information from a document of complaints dated on November 23rd, 2009 which discusses multiple alleged violations of the Medical Practice Act along with a rundown of alleged violations of the orders placed against his license. His license is currently valid but only in order for him to meet the necessary requirements to have his license fully reinstated so that he may practice medicine again.

I am not by any means trying to vilify Armstrong for his actions or alleged actions but I feel his plight serves as good comparison against his fellow physician Conrad Murray.

The single Board Order for Murray:

The order states that Murray is facing charged related to possible "non-therapeutic prescribing" that resulted in the death of a patient (Michael Jackson). It mentions that he is part of a "criminal investigation". Could non-therapeutic prescribing qualify as misbranding which is a strict liability action? If so, then why is Murray not facing such liability which should strip him of a defense in his trial? (I will highlight on strict liability in another blog.) I am not sure we could call what he did "prescribing" as he did not prescribe propofol--he administered it against all logic and reason--to a man rendered unconscious and powerless as soon as it hit his vein. He did not give the bottles of propofol to Jackson and say, "here you go, use it as you please."

All that is required of Murray in this order is a) he not administer sedatives normally given by an anesthesiologist and b ) that he not personally administer or prescribe general sedation BUT he may be part of a team that provides such services. THE END. These requirements are valid until further notice, basically.

Though not clearly established it appears C.H., Armstrong's questionable seizure patient that initiated his downfall from the practice of medicine, did not die from his failure to meet the standard of care. Apparently none of Armstrong's patients died from his deviation from the standard of care. Murray "allegedly" did not meet the standard of care either, according to experts in the autopsy report, yet it appears his competency, reasoning, knowledge of medicine and the law are all intact with respect to the Texas State Board of Medical Examiners. At least, that is the message I am receiving from them by their lack of what I deem as appropriate action. Murray provided the means to use propofol for insomnia by his own admission though he lied saying that he did not obtain the propofol himself initially ( )--a receipt from Applied Pharmacy in Las Vegas shows he did in fact order propofol at least once. He administered propofol for insomnia by his own admission. This enough is a blaring statement to the medical community that something is wrong with this man and his judgment, be it medical judgment and/or conscionable judgment.

As far as the public can tell Murray failed to keep records of Michael's "care" while he tended to him during the last few weeks of his life. What doctor would want to keep records of his treatment in this case anyway? It would have been a "Diary of Death" in my opinion.

Now to my main point--why is it Murray has not been subjected to the same types of disciplinary actions as Armstrong, or at least anything close?

First, let me say I am by no means going to imply the Texas State Board of Medical Examiners is being paid to let Murray off. I do not think that is the case by any means. I do realize that I do not know all the information here, but I do know a lot more about Murray's "pickle" than Armstrong's predicaments. I cannot help but say that it seems like the actions taken forth upon Armstrong is the Board's way of trying to protect the public from him accidentally hurting a patient. That is a good thing. With what we know based on Murray's own words--should we not worry about what Murray will do to a patient, especially if monetary gain may be involved? In Murray's case it is evident that he has lied, he admits to giving four respiratory depressants to one individual in one night for "sleep" including one heavy anesthetic agent that induces a coma, NOT sleep. His patient died likely due to his actions though he does claim he gave "nothing that should have killed Jackson". I beg to differ.

I cannot help but say--is Murray facing such leniency because of WHO his patient was and what has been said about Michael Jackson regarding both the molestation allegations AND his purported drug addictions, both of which are unfounded? If this were the president who was killed, would Murray still have his license and furthermore would it have been renewed as Murray's was this past August? What if it were Joe Blow? Though highly unlikely, what if it were a homeless man? All of these people should be seen as equal in the eyes of the medical world, especially concerning disciplinary action. None of them are more important than the other. I know it is common to be indifferent when a serial killer is dies but that is just it--Michael Jackson was a kind, caring, compassionate man who had his life and image destroyed by others. I cannot help but say that I feel because of the lies out there about him many are indifferent to his death. There is no evidence that he ever did any criminal wrongdoing to anyone. I have said before that all the events that occurred to Michael were chain events. Everything really started in 1993 when Evan Chandler accused Michael of molesting his son Jordan. Almost, if not every event in Michael's life after that was in some way tied to those baseless allegations. His financial situation was controlled by it, his career was controlled by it, maybe even his medical treatment was controlled by it because of the stress and pain it brought to his life, his image was controlled by it, his joy in life was diminished by it. Michael was a man who most could not relate to on a personal level before the allegations but after the allegations he was turned into a mirage of a man. He so desperately wanted people to relate to him and his way of living. Now people look to his tattered and torn image to judge him inappropriately and one cannot help but think that that automatically gives Murray the upper hand. Not only do the allegations hurt him but what about the drug abuse claims that are swirling?

Michael died from acute propofol intoxication--a drug. When people discuss his past drug use they are adding salt to the wound though some think they are just being "honest" or that "facts are facts". Regardless of facts, those sort of "facts", if that is what one thinks they are, do not help rebuild a reputation which should be the goal of anyone who loves him. We have very few "facts" about how Michael died as it stands and it will likely always be that way. Drug use, especially addiction, is a very complex subject that many do not understand and it is easy to mislead yourself on what you think you "know". I can equate the topic of drug use to the allegations of molestation. Would stating Michael shared his bedroom with children help defend him against the allegations of molestation? No. People do not understand the reasoning and facts behind such a statement. It is likely this statement alone, which was revealed in the Bashir documentary, led to the further destruction of his life in 2005. His statement, like many, were taken out of context and not allowed an explanation. The same principle applies to his drug use or implied addiction. No one currently understands the full reasoning and facts behind his use of medications, either.

People should not be so naive. If they do not think there is a relation between the actions taken forth upon Murray's license and the implied notion that Murray was duped by a spoiled celebrity addict who "demanded" propofol you are sorely mistaken. This is blatantly obvious as it is not Murray's apparent competency, reasoning or medical knowledge that has been questioned, as Armstrong's was, but instead Michael's reasoning is being judged and insulted when he did not have a medical license. He was "crazy", he was "warned"--so what? He was a lay person and a person desperate to sleep who likely been misled before by doctors regarding the use of propofol. The moment Murray bought the propofol and administered it he was approving Michael's mistaken theoretical treatment for insomnia--Murray justified it, he approved it, and he is the one with years of hands-on medical practice under his belt, not Michael. If Michael had bought propofol off eBay and gave it to himself (as one individual did and subsequently died) then we would have a different problem to discuss and blame shifted upon someone else. Murray KNEW what he was doing. We just cannot prove, yet, what his desired outcome for Michael was that morning on June 25th.

This is just the first blog of many where I will be comparing Murray to other physicians who have not been so lucky. Maybe then people will see just how much injustice Michael and his family are being dealt with regarding not only his life, but very much so his death as well, and there is only a slight glimmer of hope that anything will be done about it as it currently stands.


  1. You should send this to the Family, LMP, Oprah....

  2. Excellent read Nikki! I'm looking forward to your future posts on this issue!! This is so important! Having a reasoned, measured, objective comparison between Murray and what other doctors have experienced when they have exhibited poor, lazy, profit driven decision making that affected someone's life will be very valuable. The example you give above of Dr. Armstrong is a perfect example, and like you said, his patient didn't have to die for there to be disciplinary action taken. Apparently, Murray lives in a different universe now that abides by a different ethical standard simply because of who is patient was.

    The idea of shifting the blame to the patient in this case is incomprehensible. But many in the "public" are doing just that. Many in the public will dismiss this case as just another "Heath Ledger" or "Anna Nicole Smith." The ignorance and arrogance of such a statement is staggering! As you stated, Michael had a health care "professional," I use the term lightly, administering medication to him on a nightly basis. One may wish to fault Michael for insisting on this type of treatment but at the end of the day the burden of responsibility lies with the doctor and the doctor alone. He was expected to have the academic and clinic background to make healthcare decisions on behalf of his patient along with consulting his patient on those decisions. He entered Michael's home for the sole purpose of acting as his doctor, a trained professional, who had the responsibility to keep his patient OUT of harm’s way. Dr. Murray fails miserably by this standard!

    Dr. Armstrong showed flawed decision making with his negligence and laziness and was disciplined for it. Dr. Murray's flawed decision making eclipse Dr. Armstrong's by light years with essentially a slap on the wrist!!!! What am I missing here! Hopefully the trial will bring Dr. Murray back to THIS universe where he can receive the appropriate scrutiny and punishment that is just for his criminal negligence.

    Thank you.

  3. Excellent exposure, well argumentated.
    Thank you "gato". I would like to share it with others, if you don´t mind.
    All those interviews (Janet talking about drug abuse, now LMP, then...who´s the next?...stand up please!!!)...everyone has something to say about MJ´s drug adiction, maybe they are all fools that think this is a great way to picture MJ in front of the world, trying to give another point of view which will glorify him as a:" poor mickey , conceiling his physical and emotional pain under the use of painkillers...blahblahblah"...this is not going to help!!! this is not the way to talk about someone you love in front of the public,and less when there´s a suite and an investigation!!
    Like always, desinformation around covering true facts..sad

  4. I too wander why they did not suspended Murray license on till the out come of the trail, it brake my heart to see how people judge Michael even people who claim to love him.
    I was very disappointed over LMP coming on Oprah to say drug brake up she and MJ relationship, with out explaining what drug MJ was taking and how it effected them, and I have to ask the question when there is a court case going on are people allowed to make such comment?
    No one seam to care about him in life and in death.
    I often wonder why is that?

  5. Nikki,

    I wanted to share this story that I just recently read about a doctor who treated Michael after he collapsed after a rehearsal for an HBO special in the mid 90's. He was rushed to a nearby Hospital. The doctor who treated him was Dr. William Alleyne II. This man exemplifies what a health care professional should be. He treated Michael like he did all his patients, with dignity and respect.

    Dr. C. Murray, and other profit driven doctors, please read and LEARN.

    Published: Wednesday, Jul. 08, 2009
    "Rock Hill doctor helped saved Michael Jackson's life after 1995 rehearsal collapse."

    Here are some excerpts from that article:

    "In December 1995, Alleyne was the critical care director at Beth Israel North Hospital, on the Upper East Side in New York City."

    "Alleyne and his wife had seen Jackson before in concert, on television, and now, in 1995, Jackson was waiting, unconscious, for Bill Alleyne to save his life."

    "Mr. Jackson was in critical condition, Alleyne said. He was dehydrated. He had low blood pressure. He had a rapid heart rate. He was near death."

    "Alleyne went from doctor to a star, to doctor of a man who could die."

    "And inside the hospital, Alleyne said, it was absolute pandemonium.

    Jackson's entourage had muscled into intensive care. Alleyne had a brief showdown with one bodyguard who did not want to let Alleyne in the room again after Alleyne had left briefly. Alleyne recalled he said to the bodyguard, Your boss is dying in there, and I am going in there to save his life. You can be the one who has to say you wouldn't let me in.

    Bill Alleyne walked in and saved Michael Jackson."

    "He told his wife Michael Jackson was his patient, and she said to her husband, verbatim, in words Alleyne will never forget: Well, you take care of Mr. Jackson and hurry home, because I have two kids here and you need to take out the garbage." (LOVE THIS!)

    "Michael Jackson was the most soft-spoken, least demanding guy you would ever want to meet, Alleyne said. Everything he said was a whisper. His biggest concern was could he perform.

    Alleyne told Jackson no way could he perform anytime soon."

    "In one moment of weakness, Alleyne said he almost asked Jackson to teach him how to moonwalk Jackson's famous trademark dance.

    But Alleyne kept it professional with Michael Jackson, as the entourages and the world watched Alleyne's every move.

    Finally, about two weeks into this whirlwind relationship, Alleyne told Jackson, Mr. Jackson, you are stable. I can stop being your doctor and return to being your fan.

    All humble Alleyne asked for was an autographed picture for his kids to have years down the road.

    Before Alleyne left the hotel that day, Alleyne recalled Jackson telling him: Thank you for saving my life.

    Then Jackson told Alleyne he understood how difficult it had been for a black man to get to such a distinguished position within the medical world, that Alleyne's accomplishments were inspiring to Jackson.

    “It was very touching, Alleyne said. I will never forget that.

    Alleyne never gave an interview since then, never signed any book deals or made a nickel off being Michael Jackson's doctor of almost two weeks. He never spoke to Michael Jackson again."


  6. Thank you everyone for your comments! They are all great and add well to the blog above. I am hoping to get up my next comparison here soon. It will blow this one out of the water.

    Thanks Sandy! I am actually going to use that article for my blog about Lisa's recent appearance on Oprah. That blog will be coming up soon, too!

  7. Hi Nikki,

    Yes, the article mentions Lisa's visit, but doesn't go into details of how she was banned from the hospital after arguing with Michael while he was still recovering there.

    Looking forward to the next post!!!

    Great job by the way!!!!!!!