Death of Michael Jackson

On June 25, 2009, American singer Michael Jackson died of acute propofol intoxication after he suffered cardiac arrest at his home in the Holmby Hills neighborhood in Los Angeles, California. His personal physician, Conrad Murray, said he found Jackson in his room, not breathing, but with a faint pulse, and that he administered CPR to no avail. After placing a call to 9-1-1 at 12:20 p.m., Jackson was treated by paramedics at his home, and later pronounced dead at the Ronald Reagan UCLA Medical Center. On August 28, 2009, the Los Angeles County Coroner declared Jackson's death a homicide. Before his death, Jackson reportedly had been administered propofol, along with two anti-anxiety benzodiazepines: lorazepam and midazolam. Law enforcement officials investigated Jackson's personal physician. On February 8, 2010, Murray pleaded not guilty to charges of involuntary manslaughter, and was released after posting a US$75,000 bail. His trial is scheduled to start September 8, 2011.

Jackson's death triggered an outpouring of grief around the world, creating unprecedented surges of Internet traffic and causing sales of his music and that of the Jackson 5 to increase dramatically. Jackson had been scheduled to perform his This Is It concert series to over one million people at London's O2 Arena, from July 13, 2009 to March 6, 2010. His public memorial service was held on July 7, 2009, at the Staples Center in Los Angeles, where he had rehearsed for the London concerts the night before his death. His memorial service was broadcast live around the world, attracting a global audience of up to one billion people. In March 2010, Sony Music Entertainment signed a US$250 million deal with Jackson's estate to retain distribution rights to his recordings until 2017, and to release seven posthumous albums over the decade following his death. His death ranked #1 on VH1/VH1 Classic's list of 100 Most Shocking Moments in Music.

Circumstances

Jackson's body arrived at Ronald Reagan UCLA Medical Center 6/25/09 at 1:14 p.m. local time.

Jackson arrived for rehearsal at Staples Center around 6:30 p.m. on Wednesday, June 24, according to a magician who was there. The singer complained of laryngitis and did not rehearse until 9 p.m. "He looked great and had great energy, the magician added. The rehearsal went past midnight.The next morning Jackson did not come out of his bedroom. According to the attorney of Conrad Murray, Jackson's personal physician, Murray entered the room in the afternoon and found Jackson in bed and not breathing. Jackson had a weak pulse, and his body was still warm. Murray tried to revive Jackson for five to ten minutes, at which point he realized he needed to call for help. Murray stated that he was hindered because there was no landline in the house. Murray also stated that he could not use his cell phone to call 911 because he did not know the exact address. Murray stated that he also phoned security, but did not get an answer. Finally Murray ran downstairs, yelled for help, and told a chef to bring security up to the room. By the time security called 911, Murray stated that only 30 minutes had passed.

Statements described Murray as using a non-standard CPR technique on Jackson. During the tape of the emergency call, released on June 26, the doctor was described as administering CPR on a bed, not on a hard surface such as a floor, which would be standard practice. The doctor's attorney said that Murray placed one hand underneath Jackson and used the other hand for chest compression, where the standard practice is to use both hands for compression. A Los Angeles Fire Department (LAFD) spokesperson said the 911 call came in at 12:21:04 p.m. PST (19:21:04 UTC). Paramedics reached Jackson at 12:26 p.m. and found that he was not breathing.

Paramedics performed CPR for 42 minutes at the house. Murray's attorney stated that Jackson had a pulse when he was taken out of the house and put in the ambulance. An LAFD official gave a different account, stating that paramedics found Jackson in "full cardiac arrest", and that they did not observe a change in Jackson's status en route to the hospital. LAFD transported Jackson to Ronald Reagan UCLA Medical Center.[ The ambulance arrived at the hospital at approximately 1:14 p.m. A team of medical personnel attempted to resuscitate Jackson for more than one hour. They were unsuccessful and he was pronounced dead at 2:26 p.m.

Investigation

Autopsies

Jackson's body was flown by helicopter to the Los Angeles Coroner's offices in Lincoln Heights, where on June 26 a three-hour autopsy was performed on behalf of the Los Angeles County Coroner by the chief medical examiner, Lakshmanan Sathyavagiswaran. Jackson's family arranged for a second autopsy, a practice that could yield expedited—albeit limited—results. After the preliminary autopsy was completed, Craig Harvey, chief investigator for the coroner's office, said there was no evidence of trauma or foul play. On August 28, the LA County Coroner made an official statement classifying Jackson's death as a homicide. The county coroner stated that Jackson died from the combination of drugs in his body, with the most significant drugs being the anesthetic propofol and the anxiolytic lorazepam. Less significant drugs found in Jackson's body were midazolam, diazepam, lidocaine and ephedrine. The coroner is keeping the complete toxicology report private, as requested by the police and district attorney. On October 1, the BBC reported that the autopsy report revealed that Jackson was "fairly healthy" for his age and that his heart was strong. The document stated that Jackson's most significant health problem was his chronically inflamed lungs, but this did not contribute to his death. The autopsy stated that he weighed 136 pounds (62 kg) with a height of 5'9" (175 cm). Fox News said that this confirmed rumors that Jackson was emaciated, while the Associated Press stated that his weight was in the acceptable range.The autopsy also revealed that Jackson's arms were covered with punctures and his face and neck were scarred.

Law enforcement agencies

Although they did not immediately announce that they suspected foul play, by the day after Jackson's death the Los Angeles Police Department (LAPD) began to investigate the unusual and high-profile case. By August 28, the LAPD had announced that the case would be referred to prosecutors who might file criminal charges. Because the LAPD did not secure Jackson's home, and allowed the Jackson family access to it, before returning to remove certain items, the department raised concerns by some observers that the chain of custody had been broken. The police maintained that they had followed protocol. On July 1, the Drug Enforcement Administration (DEA) joined the LAPD in the investigation. Having the authority to investigate issues otherwise protected by doctor-patient confidentiality, the DEA could legally follow the entirety of what appeared to be the complex trail of prescription drugs supplied to Jackson. California Attorney General Jerry Brown announced that his office was helping the LAPD and DEA to create a statewide database of all medical doctors and prescriptions filled.

The LAPD subpoenaed medical records from doctors who had treated Jackson. On July 9, William Bratton, the Los Angeles Chief of Police, indicated that investigators were focusing on the possibility of homicide or accidental overdose, but had to wait for the full toxicology reports from the coroner. The Los Angeles Times quoted a senior law enforcement source as saying authorities may not pursue charges even if the coroner declares the case a homicide, because Jackson's well-documented drug abuse would make any prosecution difficult. Nonetheless, the source said prosecutors had not ruled out more serious charges "all the way up to involuntary manslaughter" if it were determined that Jackson's death was indeed caused by the drug propofol.

Drug-use allegations

The website TMZ, which broke the news of Jackson's death, wrote that Jackson used a number of aliases to secure prescription drugs, including Omar Arnold and Jack London, and the names of one of his bodyguards and an office manager. One doctor would allegedly call the pharmacy to say that Jackson was coming to get Pethidine, and the pharmacy would fill the prescription with the patient's name blank.Jackson was said to have used propofol, as well as alprazolam (an antianxiety agent), and sertraline (an antidepressant). Other drugs named in connection with him included omeprazole, hydrocodone, paroxetine, carisoprodol, and hydromorphone. Police found several drugs in his home, including propofol. Some of these drugs had labels made out to Jackson's pseudonyms, while others were unlabeled. A 2004 police document prepared for the 2005 People v. Jackson child abuse trial alleged that Jackson was taking up to 40 alprazolam pills a night.

Deepak Chopra, an internist, endocrinologist, and mind–body theorist who was a friend of Jackson's for 20 years, expressed concern that, although Jackson presumably had access to a large arsenal of drugs, Jackson appears to have been given no naloxone, a drug used to counteract the effects of an opioid overdose. Chopra also criticized what he saw as "enabling" by some Hollywood doctors. "We put drug pushers in jail but give licenses to doctors to do the same thing", he said. "I know personally that they write multiple prescriptions and they even use false names ... This cult of drug-pushing doctors, with their co-dependent relationships with addicted celebrities, must be stopped. Let's hope that Michael's unnecessary death is the call for action.

Eugene Aksenoff, a Tokyo-based physician who had treated Michael Jackson or his children on a few occasions, expressed concern about Jackson's use of and interest in various drugs. Aksenoff told The Japan Times that Jackson asked for stimulants so that he could get through some demanding performances. Aksenoff said he refused to prescribe them. He recalled that the singer suffered chronic fatigue, fever, insomnia and other symptoms and took a large amount of drugs. He suspected one of the major factors causing Jackson these symptoms was excessive use of steroids or other skin-whitening medications. People magazine reported that the Jackson family tried to stage an intervention in early 2007, when Michael was living in Las Vegas; a fact Janet Jackson later confirmed. Janet Jackson and some of her brothers allegedly traveled to his home, but were turned away by security guards who were ordered not to let them in. He was also rumored to have refused calls from his mother. "If you tried to deal with him," one source told CNN, "he would shut you out. You just wouldn't hear from him for long periods." The family denied that they had tried to intervene.

Propofol

An ampoule of propofol

Of all the drugs found in Jackson's home, the one that most concerned investigators was propofol (Diprivan), a powerful anesthetic administered intravenously in hospitals to induce anesthesia in preparation for surgery. Nicknamed "milk of amnesia" because of its opaque, milky-like appearance (and a play on words of "milk of magnesia"), the drug has been associated with cardiac arrest, but it still may be increasingly used off-label for anxiolytic and other medically unsubstantiated purposes. Several propofol bottles—some empty, some full—were found in Jackson's home.

On June 30, Cherilyn Lee, a nurse who had worked as Jackson's nutritionist, said that he had asked her in May to provide propofol to help him sleep, but she refused. He told her he had been given the drug before for persistent insomnia, and that a doctor had said it was safe. Lee said she received a telephone call from an aide to Jackson on June 21 to say that Jackson was ill, although she no longer worked for him. She reported overhearing Jackson complain that one side of his body was hot, the other side cold. She advised the aide to send Jackson to a hospital.

Arnold Klein told CNN that Jackson used an anesthesiologist to administer propofol to help him sleep while he was on tour in Germany. CNN said the anesthesiologist would "take him down" at night and "bring him back up" in the morning during the HIStory tour of 1996 to 1997. On August 24, a search warrant affidavit sworn by a Los Angeles detective was made public. The affidavit indicated that authorities were considering a potential manslaughter charge. According to the affidavit, Jackson "was very familiar with" propofol "and referred to it as his 'milk. On August 28, the Los Angeles County Coroner made an official statement that Jackson died from the combination of drugs in his body, with propofol and lorazepam, a benzodiazepine, playing the largest role.

Medical professionals

The Los Angeles Times wrote that the DEA was focusing on at least five doctors who prescribed drugs to Jackson, trying to determine whether they had had a "face to face" relationship with him, and whether they had made legally-required diagnoses. Fox News Channel published a list of nine doctors whom they said were under investigation. The UK Sunday Times wrote that the police wanted to question 30 doctors, nurses, and pharmacists, including Arnold Klein. Klein said that he occasionally had given Jackson Pethidine to sedate him, but had administered nothing stronger, and that he had turned his records over to the medical examiner