So the final toxicology reports indicate that MJ was found with lethal levels of propofol, an anesthetic used to induce sleep. I am not a toxicologist, BUT I have to say that specific doses of any medication in an appropriate clinical situation are meaningless.
It's very difficult to state, with 100% clinical certainty that a patient had a lethal level of any medication in their system because every patient responds differently to different medications. Criminalizing lethal levels sets a dangerous precedent for doctors everywhere who's patients are walking around with lethal levels of medication in their system.
What killed MJ was not likely a lethal dose of any medication, but rather a combination of clinically therapeutic drugs that resulted in a bad outcome. A bad outcome killed MJ. A bad outcome that was the result of his own drug addiction, using drugs, at clinically therapeutic levels for him.
Take for example Oxycontin, a powerful long acting narcotic pain medicine blamed on thousands of deaths a year due to overdose. A normal starting dose is 10mg twice a day. I have a patient that presents to Happy's hospital every so often on 640mg (that's six hundred and forty) of Oxycontin twice a day PLUS high doses of immediate release narcs PLUS a PCA IV pain pump while hospitalized.
These doses are enough to kill 99.99999% of the population of humans, horses, elephants and rhinos. But these doses are clinically safe for the patient. And these doses are required to treat the underlying condition. Is the patient physiologically addicted? Of course. Are these doses lethal? Of course not, at least not yet. But they would be if my patient died. A walking talking and breathing patient taking lethal doses of Oxycontin contradicts the notion that you can have lethal levels of propofol in your system. You only know the dose is lethal until after the fact. MJ may have had the same dose, or likely even larger 999 times before. Does that mean the dose was lethal if the patient lived? Of course not. It just happened to be lethal this one time because the patient died.
Regarding my Oxycontin patient, what happens next year if this patient comes in, takes the same clinically therapeutic dose they have taken for years and suddenly gets respiratory arrest and dies? Heck, what if they took these same doses they have taken for years at home and dies in their sleep from respiratory arrest?
They would show lethal doses of narcs in their system, while living with these doses for years. Are you going to arrest the doctor for manslaughter because the patient had lethal levels of Oxycontin in their system?
If MJ was taking propofol for a long time (which sounds like he was) what may be lethal to the average Joe is not lethal to a prescription drug addict like MJ. He must also be addicted to benzodiazepines. Hell, he got benzo doses high enough to kill 99.9999% of humans, horses, elephants and rhinos. What's to say he isn't also phsyiologically addicted to the propofol too? I have alcoholics who require huge doses of propofol just to get them to close their eyes. Would their levels be lethal? Surely as defined by what ever standards to coroner is using. But then again, any level is lethal if the patient dies. You only know that after the fact. My patient taking 640 mg of Oxycontin twice a day is not taking a lethal dose until they die, and then the coroner could say they were taking a lethal dose and accuse the doctor of criminal homicide or manslaughter.
Ridiculous.
Now there is word that the DA is going after other doctors as well:
So my question is who are you blaming? Are you going to criminalize every doctor who, in retrospect (it's always retrospect) gave benzo's or narcs to a prescription junkie? Are you trying to criminalize medical treatment, that in retrospect was not the right medical treatment. The last time I checked not practicing standard of care (which itself is often irrational and legal based) got you sued in civil court not criminal court. If the DA is now going to criminalize bad standard of care practices, then every doctor and patient should be on the look out for the future of medicine.
If a patient has a bad outcome from off label uses of medications for which the FDA has not clinically approved, doctors everywhere risk going to jail for practicing medicine that isn't approved by your government. And patients risk losing access to life saving medicines that doctors are too afraid to prescribe.
I'll tell you right now, if Dr Conrad is convicted of manslaughter for administering "lethal levels" of a medication, I'm going to refuse to prescribe my patient who requires 640mg of Oxycontin twice a day and instead refer them to detox while they are writhing in pain. I'm not going to take the fall and go to jail for prescribing "lethal levels" of Oxycontin to a patient that requires lethal levels to function on a daily basis.
Heck, I may even decide that my alcoholics going through DTs who require lethal levels of propofol represent too great a risk for me and not induce a medical coma, but rather let them lay in agony while their DTs subside. I'm not going to risk being convicted of criminal homicide for giving lethal levels of medications to patients who's physiology requires it and who may die with lethal levels of propofol in their system.
The same could be said for IV insulin. I've had patients on 20 units an hour of insulin drip. Is this a lethal level to most people. Of course. But to the diabetic who needs 20 units an hour, it's therapeutic. If that patients gets a hypoglycemic coma, arrests and dies, will I get convicted of criminal homicide for giving lethal levels of insulin?
What the DA is trying to do here is criminalize doctors for providing care that is not FDA approved, that is outside normal physiology and that is outside standard of care. Every doctor and patient should fear for the future of medicine if the DA succeeds in criminalizing a bad outcome.
Take away his license. Sue him for all his debt. Throw him in jail for a bad outcome? Hardly. You as a patient should fear for your future health if doctors are thrown in jail for bad outcomes.
