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Dr. Johnny Benjamin
Orthopedic Spine Surgeon, Medical Journalist
Posted: April 13, 2010 07:36 AM
Conrad Murray was charged with involuntary manslaughter in relation to the death of Michael Jackson. I am not an attorney but I can read, comprehend and I can certainly comment professionally on the matter of 'reasonable care'.
The legal definition of involuntary manslaughter is as follows: an unintentional killing that occurs as the result of improper use of reasonable care or skill while performing a legal act, or while committing an act that is unlawful but not felonious.
There seems to be two fundamental requirements for involuntary manslaughter.
• Was there a death/killing while under the care of another?
• Did the caregiver utilize proper and reasonable care/skill?
Michael died while under the direct care of Conrad Murray; little controversy there.
The second question of 'did the caregiver utilize proper and reasonable care/skill' requires a bit more investigation.
What is proper and reasonable care/skill for a physician to administer the medication Propofol?
Propofol can be a tricky medication because it may behave differently in every patient. What by dosing guidelines for weight may be considered to be a small dose may induce profound sedation in some people with little to no warning. Proper monitoring and rescue equipment must be readily available and the caregiver must be proficient in their use.
Unlike other medication, there is no anti-dote or antagonist medication for Propofol to reverse its actions. As with many medications, if the physician desires to reverse the effects of the medication another drug can be administered to accomplish this task; thus providing a back up and an additional measure of safety. No such drug currently exists to reverse Propofol.
Below you will find a short blurb included to give this discussion a bit more perspective:
STATEMENT ON SAFE USE OF PROPOFOL
Committee of Origin: Ambulatory Surgical Care
(Approved by the ASA House of Delegates on October 27, 2004, and amended on
October 21, 2009)
• The practitioner administering propofol for sedation/anesthesia should, at a minimum, have the education and training to identify and manage the airway and cardiovascular changes which occur in a patient who enters a state of general anesthesia, as well as the ability to assist in the management of complications.
The practitioner monitoring the patient should be present throughout the procedure and be completely dedicated to that task. • During the administration of propofol, patients should be monitored without interruption to assess level of consciousness, and to identify early signs of hypotension, bradycardia, apnea, airway obstruction and/or oxygen desaturation. Ventilation, oxygen saturation, heart rate and blood pressure should be monitored at regular and frequent intervals.
There are literally hundreds of medical articles written on safety issues related to the proper use of Propofol. As the literature an experience emphasizes, Propofol is not a drug to be taken or administered casually.
I have also reviewed the package insert provided by the maker of Propofol/Diprivan,
AstraZenca. This information that accompanies every package of Propofol does not
list the treatment of insomnia as an approved indication for use of the drug; nor
does is state that Propofol is appropriate for use outside of a highly monitored
hospital or surgical facility.
Propofol is not a drug that can be left unsecured where it may be used inadvertently
or improperly. If a patient comes in possession of Propofol it was either not properly
secured or the patient broke into a locked medication box or pharmacy to steal it.
Did Conrad Murray:
• Receive proper training for the induction on general anesthesia?
• Have proper rescue equipment available and maintain proficiency in its' proper use?
• Utilize proper monitoring equipment?
• Maintain constant supervision of the patient at all times and stay dedicated to the
• task (Did not leave to speak on the phone or take rest room breaks)?
• Properly secure the drug Propofol?
• Administer Propofol for an approved condition/indication?
Conrad Murray will be granted the opportunity to have his day in court and have his guilt or innocence determined by a jury of his peers. If only the facts are to be considered this trial shouldn't take very long.
http://www.huffingtonpost.com/johnny-benjamin/did-michael-jackson-fall_b_535236.html
Orthopedic Spine Surgeon, Medical Journalist
Posted: April 13, 2010 07:36 AM
Conrad Murray was charged with involuntary manslaughter in relation to the death of Michael Jackson. I am not an attorney but I can read, comprehend and I can certainly comment professionally on the matter of 'reasonable care'.
The legal definition of involuntary manslaughter is as follows: an unintentional killing that occurs as the result of improper use of reasonable care or skill while performing a legal act, or while committing an act that is unlawful but not felonious.
There seems to be two fundamental requirements for involuntary manslaughter.
• Was there a death/killing while under the care of another?
• Did the caregiver utilize proper and reasonable care/skill?
Michael died while under the direct care of Conrad Murray; little controversy there.
The second question of 'did the caregiver utilize proper and reasonable care/skill' requires a bit more investigation.
What is proper and reasonable care/skill for a physician to administer the medication Propofol?
Propofol can be a tricky medication because it may behave differently in every patient. What by dosing guidelines for weight may be considered to be a small dose may induce profound sedation in some people with little to no warning. Proper monitoring and rescue equipment must be readily available and the caregiver must be proficient in their use.
Unlike other medication, there is no anti-dote or antagonist medication for Propofol to reverse its actions. As with many medications, if the physician desires to reverse the effects of the medication another drug can be administered to accomplish this task; thus providing a back up and an additional measure of safety. No such drug currently exists to reverse Propofol.
Below you will find a short blurb included to give this discussion a bit more perspective:
STATEMENT ON SAFE USE OF PROPOFOL
Committee of Origin: Ambulatory Surgical Care
(Approved by the ASA House of Delegates on October 27, 2004, and amended on
October 21, 2009)
• The practitioner administering propofol for sedation/anesthesia should, at a minimum, have the education and training to identify and manage the airway and cardiovascular changes which occur in a patient who enters a state of general anesthesia, as well as the ability to assist in the management of complications.
The practitioner monitoring the patient should be present throughout the procedure and be completely dedicated to that task. • During the administration of propofol, patients should be monitored without interruption to assess level of consciousness, and to identify early signs of hypotension, bradycardia, apnea, airway obstruction and/or oxygen desaturation. Ventilation, oxygen saturation, heart rate and blood pressure should be monitored at regular and frequent intervals.
There are literally hundreds of medical articles written on safety issues related to the proper use of Propofol. As the literature an experience emphasizes, Propofol is not a drug to be taken or administered casually.
I have also reviewed the package insert provided by the maker of Propofol/Diprivan,
AstraZenca. This information that accompanies every package of Propofol does not
list the treatment of insomnia as an approved indication for use of the drug; nor
does is state that Propofol is appropriate for use outside of a highly monitored
hospital or surgical facility.
Propofol is not a drug that can be left unsecured where it may be used inadvertently
or improperly. If a patient comes in possession of Propofol it was either not properly
secured or the patient broke into a locked medication box or pharmacy to steal it.
Did Conrad Murray:
• Receive proper training for the induction on general anesthesia?
• Have proper rescue equipment available and maintain proficiency in its' proper use?
• Utilize proper monitoring equipment?
• Maintain constant supervision of the patient at all times and stay dedicated to the
• task (Did not leave to speak on the phone or take rest room breaks)?
• Properly secure the drug Propofol?
• Administer Propofol for an approved condition/indication?
Conrad Murray will be granted the opportunity to have his day in court and have his guilt or innocence determined by a jury of his peers. If only the facts are to be considered this trial shouldn't take very long.
http://www.huffingtonpost.com/johnny-benjamin/did-michael-jackson-fall_b_535236.html