The following blog addresses some questions and inconsistencies floating out there about Michael Jackson's death. This is a two-part series.
a) Did Michael have an pneumonia/some sort of infection when he died?
There is no evidence Michael had any sort of infection when he died. The autopsy report did not list any infection being present anywhere in his body. The best indication of infection, however, is an elevated white blood count which was not provided in the autopsy report. The report mentioned that Michael had a chronic lung condition consisting of pneumonitis and other related problems. This is different than something like pneumonia which is considered to be an acute lung condition (an acute condition is one that comes on suddenly and is most times temporary). Michael's lung ailments were not ones that would ever completely go away. Michael did have two antibiotics written for him by nurse practitioner Cherilyn Lee. The prescription for amoxicillin was filled on 02/02/2009 and the prescription for azithromycin was filed on 03/09/2009. Neither were finished nor apparently being taken when Michael died over three months later. Both of these antibiotics are used for an array of infections, usually uncomplicated infections any of us could encounter in our daily lives.
b) Was hydrocodone found at Michael's house?
No, there is no indication that hydrocodone was found at Michael's residence. The autopsy report does not list hydrocodone as a medication found at the residence. The official court transcripts do not mention hydrocodone, either. Some un-authorized reports claim that hydrocodone was found per testimony from the hearing in January. Hydrocodone is an oral medication used to treat mild to moderate pain. A medication of similar name called hydroquinone was found at the residence. Hydroquinone is a cream used to treat vitiligo. Michael did in fact suffer from vitiligo.
The lack of hydrocodone being mentioned as a combination product with another medication such as acetaminophen/paracetamol, aspirin or ibuprofen is rare as it is not available commercially in its pure form to the best of my knowledge--this further confirms a mistake in nomenclature by those present at the hearing since they did not report it as being part of a combination product. Michael's toxicology results were negative for hydrocodone (an opioid). Even if this medication had been found and was taken by Michael, if it was obtained via prescription for pain and taken as directed then there would have been no problem with it. But, thus far there is no indication he had access to or had been taking hydrocodone during the final months of his life, if not well before his death.
c) Where was the IV catheter placed that Conrad Murray used to administer propofol?
The IV catheter was placed in the inner left calf--an area that would never be used by medical personnel (other than Murray apparently) because placement in the calf increases the risk of a blood clot formation (deep vein thrombosis or DVT) which can be fatal. This is just another questionable and could-have-been lethal action apparently committed by Murray against Michael on 06/25/09 which defies common-medical-sense.
d) Was Michael capable of self-injecting propofol to himself?
I covered this in a previous blog found here:
Experts have deemed it almost entirely impossible that Michael could have administered propofol to himself which led to his death. Though most experts say it does not matter who delivered the final dose of propofol and conclude Murray is at-minimum guilty of Michael's death via negligence from leaving him unattended in an environment he created (assuming he did in fact leave him), I feel it is crucial to exonerate Michael from his own death while continuing to question Murray's intentions on 06/25/2009.
The coroner and his team of experts concluded Michael's death to be a "homicide--via injection by another". This conclusion was based on expert analysis and careful research. The IV set-up would have made it nearly impossible for Michael to inject himself or to have kept himself sedated/"asleep" for any extended length of time--this is not considering the fact he had a very high level of lorazepam in his system which should have sedated him before the administration of the fatal dose of propofol. Though everything being done to Michael by Murray was wrong the least Murray should have done was continuously monitor his patient--it was not too much to ask for by any means. For Murray to leave his patient and refuse to use adequate monitoring equipment under such conditions is truly inconceivable especially when one considers his anticipated salary ($150,000/month) for taking care of (and should have included keeping alive) one relatively healthy patient.
Some media reports have attempted to say Michael may have altered the propofol drip rate and thus caused his own death (assuming some sort of drip was used which will be covered later). If such a drip was actively giving him propofol he should have been sedated thus unable to adjust any administration of any medications. This scenario again disregards the high amount of lorazepam reported in the toxicology report which would also likely have render him unable to complete any sort of drip/medication administration adjustments.
e) Did Michael drink propofol?
No, Michael did not drink propofol. There has never been any indication that propofol was ingested per Murray, paramedics, the coroner or UCLA staff. The autopsy report findings state that 0.13 milligrams of propofol was found in 70 grams worth of stomach contents that were dark in color (the dark hue was likely from blood as hemorrhaging was noted in the autopsy resulting from CPR, the rest of the liquid was likely gastric juices or fluid from fluid redistribution post-mortem). Propofol is white. That amount of propofol (0.13 mg) is equal to approximately 0.013 milliliters or roughly a hundredth of a millimeter.
Propofol must be given intravenously (in the vein) to render an effect. Being ingested orally, propofol would take so long to reach the brain it would become inactivated before reaching it (propofol only renders an effect once it crosses the blood/brain barrier). Michael knew not to drink the medication as indicated by his request for a doctor or nurse to administer it IV (though he was wrong to think it a safe remedy for insomnia, based Lee's statements). If the reported number in the autopsy is wrong and any exorbitant amount ended up in his stomach then one should consider the possibility of someone forcing the medication down his throat against his own doing to make him appear desperate.
f) Is propofol addictive?
No, there is no evidence that propofol is physically addictive. Tolerance and withdrawal are components of physical addiction. Propofol does not cause withdrawals or tolerance thus is not physically addictive. It is not classified by the DEA as a drug of abuse or addiction, either.
Murray has claimed Michael was "demanding" propofol after the inability to essentially sleep at all throughout the ten hours before his death, a time frame which includes Murray drugging Michael at various times (the medication administration times reported by Murray are false given the conflicting amount of lorazepam and propofol found in the toxicology report). Murray used both oral but mainly IV benzodiazepines of which the latter should never be used for insomnia in a patient able to swallow tablets/capsules. Michael had oral diazepam, clonzepam, lorazepam, and temazepam available to him but they were not utilized other than diazepam some time well before his death.
No tablets/capsules of any kind were found in his stomach nor was any food in his stomach, either. This could be yet another indication Michael was sedated since there is no evidence Michael ate during that entire time he was awake (though had he eaten earlier in the night he may have digested this food prior to his death). His dinner prepared that evening on the 24th by chef Kai Chase remained in the refrigerator and Murray did not pick up Michael's breakfast that morning or notify Chase that Michael was sleeping in, either. Michael usually woke up at about 10 am. There is no mention of food in the bedroom to the best of my knowledge (someone please correct me if I am wrong), only bottled water and orange juice have been mentioned being found in the room which may or may not have drank that night.
Murray insists on this lack of the ability to sedate Michael despite evidence pointing to Michael being sedated ("sleeping") before he died due to the neurogenic bladder discussed in the previous blog as well as the lofty dose of lorazepam found in toxicology reports, among other issues. If Michael was not sedated Murray could have increased the dosing and frequency of the benzodiazepines so what is his excuse for not administering more of these safer drugs until sedation was achieved? There is no way Michael should have been that tolerant to benzodiazepines, especially one like midazolam. Murray is almost certainly lying about these supposed "demands" in the attempt to pin Michael as a desperate addict in order to perpetuate an erroneous defense that Michael self-injected propofol and drank it, too, thus Murray is not guilty of any wrongdoing because Michael did this all, somehow against all scientific reasoning, to himself. Then again, why would Murray give propofol to Michael if he had not been demanding it? Only Murray knows the answer to that question and he obviously is not telling. Shoddy defense attorneys will do anything to get their client off including placing unfounded blame on the victim when evidence clearly points to the contrary. They will do anything to attempt to establish "reasonable doubt" with the hopes the jury will be just as ignorant as themselves about complex situations even if it is not true.
In "Getting Over Going Under" Dr. Friedberg further establishes Murray's ignorance about propofol addiction by stating, "(p)ropofol is not physically addictive, but like any substance that is pleasurable, it is psychologically addictive. Physical addiction is defined by withdrawal or 'cold-turkey' symptoms if the agent is not supplied. The first Murray folly was the notion of propofol 'addiction'. The second fallacious notion was attempting to "wean" Jackson from a potential propofol addiction by giving him members of the benzo family. The third and lethal folly was giving Jackson two types of drugs well known to potentially stop breathing."
Murray actually ordered intravenous benzodiazepines (midazolam, lorazepam) well before there would have been an established psuedo-addiction to propofol. Murray first ordered propofol on April 6th--about a month prior to when he claims to have began giving propofol for insomnia. On April 28th ordered lorazepam and midazolam--again this is prior to any supposed administration of propofol (most claims are he began giving it on or around May 12th). Murray did not order the intravenous lidocaine (sometimes dubbed as "anti-burn") until June 10th, two weeks before Michael died. Though most reports state Murray began giving propofol six weeks prior to Michael's death, ex-manager Tohme Tohme stated to the media Murray had only been around the past two weeks.
"Weaning" an agent implies physical withdrawal and tolerance which does not develop with propofol--another proven-to-be-false statement by Murray which makes one question every single statement that has ever come out of his mouth. Even in a case where someone abused propofol up to 100 times a day, the person never found themselves needing to increase the dose or "wean" from it. If the "demanding" is part of the "weaning" equation then what does that say about the validity of these supposed demands?
Dr. Freidberg mentions not only the lack of monitoring but also the issue of giving two types of drugs that cause respiratory depression--true, Murray was not skilled as an anesthesiologist but being a cardiologist who should and does apparently possess more knowledge than the basic lay person, without a doubt, knew these drugs could be lethal given in the matter in which he gave them--without monitoring equipment, without apparently monitoring him in the room, without proper breathing measures instituted, etc. Murray also should have read up on any drug before giving it if he did not know enough information about it--that is the job of any medical professional. Murray knows benzodiazepines are depressants (and should know the ins and outs of these drugs very well given he should use them frequently in practice) and propofol is a sedative/hypnotic--just about anything that sedates or depresses can cause you to stop breathing especially when combined with other substances that cause depression or sedation. This concept should be like "1+1=2" for a physician and the likelihood of a doctor forgetting or not knowing one plus one is indeed two seems just as unlikely as one thinking a lorazepam/propofol combination, especially without monitoring and respiratory assistance, would not be lethal.
Other signs of addiction (physical or psychological) include pleasure, loss of control, compulsion and denial. There are arguments over whether or not the drug may be psychologically addictive, as Dr. Friedberg mentioned he believes it can be psychologically addictive. Other clinicians' say this drug may be psychologically addictive when given at sub-therapeutic levels only. Michael was not requesting use of the drug at sub-therapeutic levels if he requested it at all. Michael allegedly asked for propofol to treat insomnia (which he had suffered from for decades) that became troublesome while rehearsing for his upcoming tour--not for euphoric feelings or "getting high". One who lacks sleep would find receiving sleep (or what they think is sleep) pleasurable in some regard. Any substance/action could potentially create pleasure for someone thus psychological addiction--be it chocolate, lip balm, gambling or Facebook's Farmville. Apparently there was no loss of control (if one does not buy Murray's defense strategy)--he had a doctor who willfully was giving him this drug in a manner he thought was safe rather than ordering it and injecting it himself which has actually been done in the past by others. Murray's ordering and administration of propofol deemed this regimen as safe and acceptable in Michael's mind. Murray is trying to hint at compulsion by saying Michael demanded it and drank it but as discussed before this seems rather dubious. Michael did not deny the use of propofol --he had a doctor knowingly administering to him and had supposedly mentioned propofol to others, saying he was told by another doctor it was a safe way to get sleep--so long as he was monitored.
Part II will follow shortly and cover the non-rebreather mask, pulse oximeter and the technique used by Murray to administer propofol (gravity drip vs. bolus doses given via syringe).