Updated May 8, 2013
The King of Pop could not fall asleep and then he could not wake up. For his role in Michael Jackson's death, Dr. Conrad Murray was found guilty of involuntary manslaughter on November 7, 2011. On November 29, 2011 he was sentenced to four years in prison.
by Don Fulsom
Two days before Michael Jackson’s death on June 25, 2009, the American Association of Nurse Anesthetists warned hospitals to restrict access to Propofol because some doctors and nurses were addicted to the substance. Mainlining Propofol for recreational reasons is known as “dancing with the white rabbit.”
That phrase derives from the potent liquid’s milky color and its comparison to the hallucinogenic drugs of the 1960s, according to the Wall Street Journal—which says Propofol brings on “a brief but captivating high as the sedation wears off.” In 1967, Jefferson Airplane recorded a psychedelic Grace Slick song called "White Rabbit,” with references to a character in Lewis Carroll’s Alice’s Adventures in Wonderland as metaphors for drug-induced experiences.
Propofol, also known as Diprivan, is a heavy-duty general anesthetic. It can reportedly make a 10-minute nap feel like you’ve slept a full night. It is readily available in hospitals, which makes it appealing to certain medical professionals who want to catch 40 winks quickly and effectively during a long shift. That’s called “pronapping.”
But some doctors, nurses and other hospital employees have been known to shoot up Propofol as many as 50 times a day. The Journal quoted an unnamed anesthesiologist from the Midwest, who recently completed a stint in rehab to kick the Propofol habit as saying, “I was injecting it [Propofol] 50 times a day when I was in my worst period.” He said he began “pronapping” a couple of years ago while under stress from his job, family and finances. He hid the signs of shooting up by putting a port for a syringe on his leg, where it was not visible.
When the King of Pop returned to his sprawling $100,000-a-month mansion in the exclusive Holmby Hills section of Los Angeles, he was wired from a long night of singing, dancing and directing. He badly needed sleep but was unable to nod off. He tossed and turned.
At the time, the legendary 50-year-old pop singer was 27 years removed from the release of his “Thriller” CD, the best-selling album of all time. Now he was in final rehearsals for the kickoff of a slated "This Is It" tour at London's O2 Arena. He hoped the tour, only weeks away, would reignite his sagging career and halt his mounting financial woes.
Earlier in 2009, Jackson had hired 51-year-old Conrad Murray, a cardiologist, as his live-in physician. At the time, Murray was in dire financial shape when he signed on as the astronomical rate of $150,000 per month, according to the New York Daily News.
At 1:30 a.m., Dr. Murray gave the pop icon a light blue 10 mg Valium tablet—a dose of the venerable tranquilizer some aficionados call a “Blue Bomber” because of its quick calming effects –a feeling first experienced by a frazzled U.S. public in 1963. But the pill did nothing for Jackson.
So at 2 a.m., Murray hooked up the singer to an IV and inserted 2 mg of the anti-anxiety agent Ativan.
Jackson was still awake at 3 a.m.—so the doc put 2 mg of Versed, a potent sedative, in Michael’s IV.
But sleep still wouldn’t come. At 5 a.m., Murray added another 2 mg of Ativan to Jackson’s drip.
When, by 7:30 a.m., the singer was still awake, the physician gave him another 2 mg of Versed.
Despite this prescription cocktail concocted by Murray, sleep kept eluding Jackson—even though the clock now registered 10:40 a.m. At that point, the doctor finally gave in to the entertainer’s constant demands for his “milk.”
In an affidavit released September 14, 2009 by the L.A. County Coroner’s Office, Murray swore that Jackson pleaded with him to give him more sedatives to combat his insomnia prior to his death. In the affidavit, Murray said Jackson made “repeated demands/requests” for Propofol, which he said the singer called his “milk.” Murray said he complied by shooting 25 mg of Propofol, a relatively small dose, into his patient’s bloodstream.
For insurance, the doctor added a little Xylocaine, a local anesthetic. Jackson quickly fell asleep. He would never wake up.
When Murray returned to Jackson’s bedside after a quick bathroom break, he says he found a non-breathing Jackson with a weak pulse. The doctor, calling upon his experience at a cardiologist, immediately started applying CPR in an attempt to revive the world famous singer.
When that didn’t work, Murray administered yet another drug—Flumazenil—in an apparent effort to offset the sedatives already circulating through Jackson's body. “Some experts have said Murray's use of this additional medicine may have actually exasperated the problems caused by Propofol,” according to Biography.com.
Individuals who are physically dependent on sedatives, hypnotics and anti-anxiety medications may suffer withdrawal symptoms, including seizure, upon administration of Flumazenil, according to Principles of Critical Care by Jesse Hall, Gregory Schmidt and Lawrence Wood. These experts do not recommend Flumazenil for routine use in those with a decreased level of consciousness.
The Los Angeles County Corner ruled Jackson’s death a homicide due to “acute propofol intoxication.” An autopsy report released Feb. 8, 2010 found that Jackson was administered the potent anesthetic at a level equivalent to what would be used in a “major surgery.” The report added that the “standard of care for administering propofol was not met,” according to the Los Angles Times.
As the Coroner’s findings were made public, Dr. Murray was arraigned at the Los Angeles Superior Court on charges of involuntary manslaughter. He pleaded not guilty.
Judge Keith Schwartz set bail at $75,000 and forbade Murray from prescribing heavy sedatives—including propofol—to his patients. The judge set April 5 for the next hearing in the case.
If convicted, Dr. Murray faces up to four years in prison.
A noted criminal defense attorney, Ellyn Garofalo, tells The Christian Science Monitor it is not illegal to administer propofol at home. “The prosecution will have to show that Murray gave him too much propofol and knew it, or that the propofol interacted with other drugs already in Jackson’s system,” Garofalo said. “That will depend on what the Coroner found in the autopsy and won’t come out until the trial.”
How dangerous is Propofol? Dubbed by anesthesiologists as "milk of amnesia," the drug is usually used to render patients unconscious for surgery. It's only supposed to be administered in medical settings by specially trained medical personnel and, “because of its potency, requires the patient be closely monitored at all times. Using Propofol strictly as a sleep agent violates medical guidelines,” the Associated Press reported, quoting medical authorities.
Fairly or not, Murray is now known to some as “Dr. Death.” Curiously, even before Murray was charged with Jackson’s homicide, another “Dr. Death” from another era weighed in on the controversy over Jackson’s death … and took Murray’s side.
Dr. Jack Kevorkian placed the blame for Jackson’s death squarely on Jackson himself—likening his death to a suicide: “The patient got what he wanted. He is the one who said yes or no to take a drug,” Kevorkian told Fox News. (Kevorkian was paroled in 2007 after serving eight years in prison for helping terminally ill patients die.)
Among those on the other side of this debate is Propofol authority Dr. Barry Friedberg, who told the tabloid Globe, “Shooting up Michael all night with a variety of medications, then giving him a Propofol chaser is the height of irresponsibility.”
A leading anesthesiologist, Friedberg added: “The jury (that could eventually try Murray) may believe Michael bullied the doctor into giving him the drugs, but Murray took the Hippocratic oath to ‘do no harm.’”
Another top doctor in that field, John Dombrowski—who, like Friedberg, never treated Jackson—told MTV.com the drug is so powerful that it is critical to have someone in attendance who has the ability to rescue you should you stop breathing: “It is never used outside a medical setting during a procedure. And it is never used as a sleeping aid. I've never heard of that in my 16 years of practice."
Other than the affidavit released by the Coroner’s Office on September 14, the Caribbean-accented Murray has had no public comment on the controversy—except for a one-minute video posted on YouTube. He thanked his supporters and patients, explaining that he had been unable to check his e-mail or return phone calls due to death threats.
The doctor then tearily declared: "Please don't worry, as long as I keep God in my heart and you in my life I will be fine. I have done all I could do. I told the truth and I have faith the truth will prevail.”
Murray’s lawyer, Ed Chernoff, said his client "didn't prescribe or administer anything that should have killed Michael Jackson."
But In January 2011, after a six-day preliminary hearing, Los Angeles County Superior Court Judge Michael Pastor ordered Murray to stand trial on a charge of involuntary manslaughter. Pastor also suspended Murray's California medical license.
At the hearings, Dr. Christopher Rogers of the county coroner's office testified that it was "substandard" to administer Propofol in a home setting without the proper monitoring equipment, according to the Los Angeles Times. Rogers said even if the pop star self-administered the drug that killed him, the physician caring for the singer would have committed homicide. The coroner’s testimony could damage a possible defense plan, at trial, to claim the singer caused his own death—not Murray, according to Reuters.
Conrad Murray is not the first M.D. to dole out a multiplicity of controlled substances to a major celebrity. Dr. George Nichopoulos filled that role and those prescriptions for the undisputed King of Rock and Roll, Elvis Presley.
In the final seven months of the King’s life alone, Nichopoulos prescribed Presley at least 5,300 uppers, downers, and painkillers, according to Rolling Stone. Elvis' favorite drugs included Valium, Dexedrine, Ethinamate, Dilaudid, Demerol, Quaaludes, and Ritalin.
A bloated, 250-pound drug-dependent Elvis died at 42 in 1977. Nichopoulos was indicted in 1980 for "willingly and feloniously" over-prescribing drugs to Presley and two members of his entourage, Jerry Lee Lewis, and five other patients. Nichopoulos was acquitted and is still alive.
Some two months after he died, Michael Jackson was entombed at a highly guarded mausoleum in the Los Angeles suburb of Glendale. About 200 people—including Elizabeth Taylor, Lisa Marie Presley, Macaulay Culkin and Quincy Jones—attended burial ceremonies at Forest Lawn Memorial Park.
Before the ceremonies, Jackson’s three children: Prince Michael I, 12; Paris Michael, 11; and seven-year-old Prince Michael II, a.k.a. “Blanket”) had a private moment with their father’s casket. They placed a crown on the golden coffin to signify the final resting place of the King of Pop.
Michael Jackson has plenty of celebrity company at Forest Lawn, where the bodies of Walt Disney, Clark Gable, Carole Lombard and W. C. Fields are interred. Unlike his neighbors, however, MJ is permanently dancing with the white rabbit.
Of course, he’s appropriately attired for the big affair. He’s wearing full stage makeup, sunglasses, a gigantic gold belt, and a costume of glimmering white pearl beads. And—most fitting of all—he’s wearing one of his famous white gloves.
In Los Angeles, in November 2011, as Dr. Conrad Murray’s trial ended, the prosecutor, Deputy District Attorney David Walgren, invoked the entertainer’s children in a spellbinding closing argument: "For Michael's children, this case will go on forever because they do not have a father. They do not have a father because of the actions of Conrad Murray."
On November 29th, Superior Court Judge Michael Pastor sentenced Murray to four years in jail. Pastor labeled the doctor a “reckless” liar and “a danger to the community” with “no sense of remorse.”
Though he was given the maximum sentence for involuntary manslaughter, Murray could be released much earlier because of prison overcrowding.
Murray, who is appealing his conviction, remains in a Los Angeles jail. But he is expected to be called to testify in the wrongful death case in L.A. brought by Jackson’s mother Katherine against entertainment giant AEG.
An early witness in the trial—which began May 1, 2013—police detective OrlandoMartinez said Murray’s huge mountain of debts may have caused him to act inappropriately in his treatment of Jackson.
Martinez testified that Murray’s debts convinced him that “for this easy money, the $150,000-a-month (Murray’s income from his lone star patient), he may break the rules, bend the rules to do whatever he needed to get paid. It might solve his money problems,” according to the Associated Press.
Martinez said Murray faced hundreds of thousands of dollars in tax liens, student loans, home loans, child support and credit card payments that were in arrears in 2009.
Another witness, paramedic Richard Senneff, described Jackson on his deathbed as looking pale and skeletal “like someone who was at the end stage of a long disease,” according to the Los Angeles Times.
The trial is expected to last for many months. Also expected to appear: Jackson’s mother and his two oldest children, Prince and Paris; Diana Ross; Quincy Jones; and Spike Lee.