Sunday, October 27, 2013

Should Michael Jackson's Doctor Practice Medicine Again?

Before Michael Jackson, most folks didn’t know what propofol was.  Now, patients are asking me for it by name.  It’s an awesome drug.  It provides a beautiful sedation, is extremely safe and rapidly clears after the procedure.  Under its effects, colonoscopy has become a sublime experience. 

We administer it in a different manner than Conrad Murray did.  For those who may have just awakened from a 5 year coma, Conrad Murray was Michael Jackson’s personal physician who administered propofol to Jackson in his home to promote sleep.  Murray succeeded and received the modest salary of $150,000 per month for his medical services.

Sleep Aid?

Administering propofol in a patient’s home without necessary monitoring and training is an egregious breach of standard medical practice.  Those of us who use the drug properly were shocked to learn of this doctor’s reckless and indefensible care.   Here are a few hypothetical examples of similarly negligent care.
  • A surgeon removing your appendix in the back seat of your car.
  • A psychiatrist hanging up on a patient who is threatening suicide.
  • An internist invites recovering alcoholic patients to a wine tasting event.
Murray will be released this month after serving time for involuntary manslaughter.  At present, he does not have a valid license to practice medicine, but hopes to be reinstituted into the profession.
Should he be barred from medicine for life?   I believe that the depth of his negligence warrants expulsion from the profession.  If fact, if his conduct doesn’t result in permanent loss of a medical license, then what would? 

Is there a different outcome that would allow this man to use his medical skills and serve the greater good?  What if he were given a medical license with stringent restrictions and strict oversight?   If he were required, for example, to practice in an underserved community and was tightly supervised by a physician, would we support this outcome?  

I have my own view here, but I’d like to know yours.


9 comments:

Anonymous said...

He should never be allowed to practice medicine again. He wantonly disregarded safe practice and committed malpractice, and took his patient's life.

R.N.

Michael Kirsch, M.D. said...

I agree with you, but wondered if there was a valid argument that allowing him to practice under restrictions could serve the greater good.

Anonymous said...

He should not be allowed to practice medicine again, and all the oversight or restrictions in the world wouldn't change my mind. Here's why: humans are fallible, they make mistakes and in this case, he did worse than that--he was swayed by celebrity or financial gain or both. But when you start with a fallible human to begin with, you've already got one layer of possible harm (things go wrong, either unintentionally, or as in this case, intentionally). When you add a layer of restrictions or oversight, that just adds another place where the "system" can break down. There are now two weak links in the chain.

Thankfully, most of the time, docs and other professionals do not succumb to whatever swayed this doc in the MJ case. But when there is a fail, there is a spectacular fail because docs are dealing with health and lives. I don't think it is worth the risk to future Murray patients to place him in a spot with even more potentially weak links in the chain.

My answer might change in other situations and I would entertain letting a doc practice again under restrictions, depending on the nature of their infraction. And I was never a Michael Jackson fan, so that is not affecting my response here.

JPC, Ph.D.

Michael Kirsch, M.D. said...

@JPC, thanks for thoughtful and nuanced response. Do you think that his medical license will be reinstated?

Anonymous said...

Will his license be reinstated? I doubt it. For one thing, the Jackson family has too much clout and a strong interest preventing him from practicing again. And even without their clout, this whole affair has been much too public; I don't think the licensing board would want to deal with the bad press of being the ones who let him back in the fold.

From what I have seen of docs who lose their license and then petition for reinstatement, the ones who win their cases are either lower profile, or are able to make a convincing show of remorse. Some of that remorse may be real, but I tend to be a skeptic. I suppose it's possible that Murray could win his case, making a argument that is was such a unique situation that is unlikely to happen again. But I think the high-profile nature of his crime will overshadow any argument.

I was living and working in Memphis when Nicholpoulos tried, unsuccessfully, to get his license back. Too high profile.

JPC, Ph.D.

Third News said...

MD Whistleblower, your disquisition is weakened by listing hypothetical examples of similarly negligent care” in lieu of known cases of wreakless quackery from a slack-spined licensing board. BTW, Is there a physician practicing who is not privy to gossip, or witnessed a doctor who has engaged in nostrum?

Yes, Conrad Murray should be able to practice again, and for the following redargued points:

“Should Michael Jackson's Doctor…” Yes because unlike the medical profession’s usance of changing states to avoid the repercussions of sanctioning, Murray’s noriority guarentees an informed patient.


“Murray will be released this month after serving time for involuntary manslaughter... if his conduct doesn’t result in permanent loss of a medical license, then what would?”
A jeofail of voluntary manslaughter


“If he were required, for example, to practice in an underserved community and was tightly supervised by a physician, would we support this outcome?”
Your suggestion that underserved communities could benefit from a conditionally license physician is an alogism; how can a community procure a medical babysitter in ibidem that is suffering a shortage of care? Hmm, interestingly, residents in a gated community are more apt to provide the supervision you suggest

“…humans are fallible, they make mistakes and in this case, he did worse than that--he was swayed by celebrity or financial gain or both”
Yes we are capable of recadency, turpitude, and redemption; I’m not sure I’d not prefer a failed, and punished man over alcoholic, or drug addicted physicians who practices with a sufficient amount of asceticism to remain undiscovered


“… the Jackson family has too much… I don't think the licensing board would want to deal with the bad press …”
Politics isn’t a valid reason for rejecting his medical license reinstatement, but with respect to Should “he be barred from medicine for life?: No. But will he? Your anecdotalism suggest the correct political climate

Michael Kirsch, M.D. said...

Agree with Ph.D. over the logophile Third News. I think it should be over for Murray. The fact that there are tainted practitioners with valid licenses is an anemic defense to rehabilitate Murray. When you're caught speeding on the highway, try explaining to judge that other drivers were going much faster and were not molested by law enforcement.
Separate from the issue at bar, I am pleased that the Jackson family did not legally prevail against the concert promoter. Comments appreciated.

Third News said...

Murray isn’t requesting a cassation but a hearing for his iatramelia -is he not within his rights to file a ‘Petition for Reinstatement’?

MD Whistleblower, Murray's case was an "extreme departure" of care but ad rem, California’s most common physician complaint is drug related.

I believe the Jackson family did not legally prevail partially because Michael was a willing participant in his addiction, and Dr. Murray was not his first rodeo. I suspect this may also be a factor in the Medical Board’s conditional licensing -we will see

BTW, it is not epeolatry but just a glottogonic exercise for a diglot’s brain

Michael Kirsch, M.D. said...

Sure, Murray, like the rest of us, has a right to petition. I think he faces a very high bar. And, to reiterate my point, if his petition is granted, then the system shows itself to be a joke, in my view.
Regarding the concert's promoter's legal victory, I believe that this was entirely on the merits. They were clearly not culpable. They didn't need the aid of external forces. They had the facts on their side.

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