On November 7, 2011, Dr. Conrad Murray, Michael Jackson’s former private physician, was found guilty of Manslaughter in a Los Angeles courtroom. Since I strongly support the US justice system’s principle of innocent until proven guilty, although I followed this trial very closely and heard all the expert witness testimony, I have refrained from blogging about it until now. Suffice it to say that I am 100% in agreement with the jury’s verdict. Although, perhaps the charges could have been at a higher level than manslaughter, I understand the State’s reluctance to overcharge and risk a complete acquittal. The prosecution did an excellent job proving its case beyond any reasonable doubt, which included testimony from three of the best expert witnesses I have ever seen: Drs. Alon Steinberg, Nadar Kamangar and Steven Shafer. Clearly Conrad Murray committed extreme deviations from the standard of care by administering the surgical anesthetic propofol to Michael Jackson in his bedroom, not having the proper monitoring equipment, failing to immediately call 911 and a number of other violations clearly listed by the expert witnesses, point by point. While a number of other physicians declined Michael Jackson’s pleas for propofol, Conrad Murray gave in, not just once, but for many weeks prior to the fatal incident.
Of course, there are always malpractice lawsuits, but what made this one different, aside from the fact it involved a celebrity, is that criminal charges were brought and it involved the private practice of a physician rather than a hospital. As I watched this trial, I couldn’t help but wonder what would happen if, heaven forbid, a child died as a result of prone restraints being administered at home by parents, on the recommendation of a private mental health professional who trained the parents while assuring them that the procedure was perfectly safe and used in hospitals when, in fact, it is banned in hospitals and schools in a number of states. We already have cases in hospitals, such as Angelica Arndt, where prone restraint deaths resulted in criminal charges against the professionals involved, but who would be held responsible if a death occurred in a private home. The parents? The professional(s) involved? Both? This sort of situation would have similarities to propofol being administered at home. A key difference, however, is that propofol is universally accepted as a safe and acceptable drug, provided it is used in hospitals or other medical facilities with the proper monitoring equipment. This is not the case with prone restraints, as they are completely banned in hospitals, schools and other public facilities in a number of states, under any conditions. In the states where they are still legal, however, there are stringent requirements for monitoring, should the child stop breathing. What would happen at home if this were to happen and nobody knew CPR or that failing, if there was no equipment to resuscitate the child? Are the parents even trained in CPR? Do they have access to equipment to immediately revive a child who stopped breathing? Would the recommendation that parents use prone restraints on children at home constitute an extreme deviation from a standard of care? Given that prone restraints have been completely banned in so many facilities and have definitive safety requirements in public facilities in states where there are still legal, it seems to be a reasonable conclusion. The bottom line is, if a procedure is considered so dangerous and risky in a highly monitored hospital environment, so much so that it is banned completely in some states, how much more dangerous would it be when used at home?
The Conrad Murray trial also brought up the ethical dilemma of what a professional should do if a patient/client is asking for a procedure that the professional knows to be dangerous? Although client empowerment and self-determination is highly valued, the death of Michael Jackson provides us with a powerful lesson that professionals have to learn when to say no. The argument that Michael Jackson would have found a way to get the propofol anyway is no excuse for a professional to administer it in such a reckless way. Moreover, there is no evidence that propofol is safe and effective for insomnia. Professionals ultimately do not have any control over whether the client will engage in the self-destructive behavior anyway, but they can choose not to aid and abet it.
Like some of the mental health professionals I have expressed concerns about, Conrad Murray has a number of patients and former patients who strongly supported him and testified on his behalf. It appears that those patients did, in fact, receive excellent care from Dr. Murray who saved many of their lives with his excellent care as a Cardiologist. That does not mean however, as the verdict illustrates, that he ought not to be held accountable for his violations. Such testimonials did not let him off the hook.
What this case clearly illustrated is when a physician deviates from the accepted standard of care for his profession, he can and will be held criminally liable for any deaths that may occur under his care. The closest the mental health profession has come to this is the conviction of Connell Watkins and Julie Ponder for the death of Candace Newmaker, but in that case, the mental health professionals were not licensed.
During the 1990s, Judith Peterson, a psychologist was charged with insurance fraud for allegedly inducing false memories of her hospitalized patients in a DID unit at Spring Shadows Glen Hospital, a number of whom also sued her in civil court. The criminal case against Peterson and others, unfortunately, had to be dropped because the number of jurors had been reduced to 11, the defense would not agree to continue under those conditions. The State could have had a second trial, but declined because the patients/alleged victims would have been placed under too much stress. However, people can read the therapy session transcripts which became public record as a part of this case and decide for themselves what would have been a just outcome and whether such treatment would warrant criminal charges.
What would happen if a death occurred involving restraint under the care of a licensed mental health professional in a private setting? I hope we never have to find out and that no child has to die for this lesson to be learned, but my fear and opinion is that it is a matter of when, not if, if prone restraints continue to be used, rather than following the well-tested preventive measures and interventions recommended by agencies such as SAMHSA for behavior problems that have greatly reduced and in many cases, eliminated the need to use such forceful interventions that often are traumatic, not only for the patients but also for the providers.
Given Michael Jackson’s great love for children, I cannot think of a better way to honor his memory than to use this as a wake up call for all mental health professionals who deal with children, to make sure that the practices they use and/or recommend are safe and effective.
