Everyone knows who Dr Conrad Murray is. He's the cardiologist that was present the night Michael Jackson died from a cocktail of sedatives including benzodiazepines and propofol (Diprovan). Dr Murray has been charged with involuntary homicide in the death of Michael Jackson. Where is he now? I have found Dr Conrad Murray moonlighting in small town emergency rooms in Happy's state working in small town emergency departments caring for agitated bipolar patients. Yes folks, twice in the last month Happy's hospitalist service has been asked to accept, on transfer from hundreds of miles away, patients being treated for acute agitation in the emergency department using propofol without intubation.
In one patient, Happy's partner took the call from a family medicine resident moonlighting in an ER 200 miles away. His name might as well have been Dr Conrad Murray. The resident wanted to send the patient by ambulance, on a propofol drip, without intubation. Happy's partner gave the resident two options:
- Intubate the patient and then send him on a propofol drip
- or discontinue the propofol drip and send him with something else.
And Happy took the other call from a family medicine attending who was manning the ED with anesthesiology present administering propofol boluses in an unintubated patient.
Happy: Doc. Please don't pull a Conrad Murray on me.Family Medicine Doc: Laughing out loud. Happy, I have anesthesia here helping outHappy: Yes, but once that patient gets into the ambulance, Conrad Murray will be gone. Who's going to control his airway if the Diprovan knocks him out? I'm sure the EMTs aren't going to stand for it. Besides, it's probably against their allowed protocols. Why don't you have anesthesia intubate him before he leaves so we can use all the propofol necessary to keep him sedated before he freaks out and attacks the ambulance driver.Family Medicine Doc: Sounds like a plan.
Twice in two months I've experienced emergency room doctors contemplating sending patients on Diprovan drips by ambulance to my hospital without intubation. There you have it folks. I've got Dr. Conrad Murray living in my state. If something bad happened on the way and the EMTs couldn't get an airway secured, would an over zealous district attorney feel compelled to charge either doctor with involuntary manslaughter for taking on such a risk?
You bet they could. Would I ever try and send a patient by ambulance to another facility using medications that could potentially lead to a lost airway, without securing the airway prior to transfer? Not in a million years. But does failure to do so rise to the charge of involuntary manslaughter? In this case, I have two situations where highly competent doctors felt compelled to do so. What Dr Conrad Murray did is not as out of this world as you may think. I have two Conrad Murrays right in my back yard. I'm sure hundreds, perhaps thousands of Conrad Murrays are peppered all across this great land of ours. Should they all be charged with involuntary manslaughter every time a bad outcome happens?