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:

http://reg.tmb.state.tx.us/TMBPublicWebSite/BOARD%20ORDERS/e00/00/89/00008904.pdf

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:

http://reg.tmb.state.tx.us/TMBPublicWebSite/BOARD%20ORDERS/e00/00/8b/00008b5f.pdf

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:

http://reg.tmb.state.tx.us/TMBPublicWebSite/BOARD%20ORDERS/e00/00/90/00009000.pdf

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:

http://reg.tmb.state.tx.us/TMBPublicWebSite/BOARD%20ORDERS/e00/00/92/0000921e.pdf

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:

http://reg.tmb.state.tx.us/TMBPublicWebSite/BOARD%20ORDERS/e00/00/91/000091bf.pdf

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 (http://febone1960.net/febone_blog/?tag=dr-conrad-murray )--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.

Michael and Insomnia--a Deeper Look

I was thinking last night about Michael and his severe insomnia. I do not know all the causes of sleep disorders, and most doctors do not know either, as they just toss prescriptions for sleep aids to their patients and do not follow up to see if they have or have not worked. It does seem, however, most people's problems are either from lifestyle issues (being on the computer late at night, drinking too much coffee, exercising before bedtime, taking certain medications etc.) or sleep apnea. Sleep apnea is a huge contributor to insomnia. Sleep apnea is usually something that affects middle-aged, overweight males. Just looking at Michael you would not think he suffered from sleep apnea. However, anyone can suffer from sleep apnea. Michael had a chronic lung condition as well that was disclosed when he passed. His lungs were found to be "chronically inflammed" which means they had been inflammed for a long period of time. This was not from a cold or something recent. I would like to know what it was from as he was not a smoker. Perhaps it was from lupus? I then began to wonder if Michael was having breathing problems while sleeping and did in some way have some form of sleep apnea. Most people who have sleep apnea do not know they have it. Their spouses are the ones to tell them they have it because they get no sleep from their partner's snoring. Michael told nurse Cherilyn Lee he would sometimes fall asleep only to awake in a couple hours and not be able to fall asleep again. He said he just wanted "eight hours of sleep". Could breathing problems be what woke him up? I know some people sometimes wake up as if they are choking and it jolts them so badly they cannot fall back asleep, yet they sometimes have a problem explaining why they woke up so suddenly. I know this is all speculation but it sounds highly possible to me and all things should be examined as Michael was taken from this world well before his time. I know he had a lot stress in his life, was working on the concerts until late at night sometimes and had a racing, active mind, but still, to be so sleep-deprived as to ask for propofol (which, while adminstered you cannot wake up), makes me think it was more than what meets the eye. Instead of doctors breaking down what was causing his sleep deprivation and working to try and correct or diagnose all the possible health issues contributing to his insomnia, in turn helping him get the sleep he needed naturally, they gave him propofol--an anesthetic, not a sleep aid. What about the strenous physical exams he supposedly passed with "flying colors" for AEG? Flying colors? He was not a marathon runner. If he had a chronic lung condition then that would have shown up and been a problem, maybe not enough to keep him from being able to perform on some level, but he was expected to sing live for a certain amount of time and then dance as well for I believe at least 2 hours. Have any of you tried dancing or jogging while singing at the same time? You have to FORCE the air out to even really be audible and to hit the right notes--at least I do and I have mild asthma. He really had no business doing this kind of concert with a lung condition and severe insomnia that obviously was not being treated properly. Maybe he needed a CPAP machine. Maybe he needed a new schedule that promoted better sleeping habits. He did NOT need to be doing the type of show he was preparing for and did NOT need propofol! Then, the question becomes, did someone take advantage of his desire for propofol and see it as a way commit murder? Doctors having a client like Michael should want to do anything to keep him alive (as is their duty as a doctor) and to keep him as a patient (if they want the profit). I am not a conspiracy theorist and I try to be as rational as possible and am by nature skeptical of all things, but if you look at ALL the facts, dating back to YEARS ago, looking at all aspects of Michael's life, his business transactions, his financial woes, his problems with Sony, AEG's motives for having him do 50 shows (when he agreed to 10 only) things are looking more and more suspicous. He needed to be treated and helped by people who cared about him, whether it personally or just professionally, not used, lied to and killed by people only seeking a profit which is looking more and more like the case each passing day.