Michael Jackson’s Physician Gave Propofol to Singer As a Sleep Aid

In this March 17, 2005 file photo, pop star Michael Jackson arrives at the Santa Barbara County Courthouse in Santa Maria, Calif. (AP Photo/Michael A. Mariant, file) (Michael A. Mariant - AP)

Michael Jackson died in his rented mansion June 25 from a deadly dose of the powerful anesthetic drug propofol, according to an affidavit unsealed Monday.

The Los Angeles coroner made that assessment after reviewing preliminary toxicology results from Jackson’s autopsy, according to the search warrant affidavit given by police Detective Orlando Martinez.

Conrad Murray, the Las Vegas cardiologist whom Jackson called his personal physician, told detectives that he had been treating Jackson for insomnia for about six weeks, and had been giving Jackson 50 milligrams of propofol every night using an intravenous drip, the report notes. The affidavit was unsealed in Houston, where Murray has an office that was raided by U.S. agents on July 22.

Murray said he feared that Jackson was forming an addiction to the drug, which the singer allegedly referred to as “milk,” and that he was trying to wean him off of it. So he lowered Jackson’s propofol dosage to 25 milligrams, mixing it with two other sedatives, lorazepam and midazolam, according to the report. On June 23, two days before the singer’s death, he reportedly gave Jackson lorazepam and midazolam, withholding the propofol.

On the day Jackson died, Murray tried to induce sleep at 1:30 a.m. with Valium; at 2 a.m. with lorazepam; and at 3 a.m. with midazolam, according to the affidavit. After Murray failed to put Jackson to sleep with additional doses over the next few hours, Jackson then demanded propofol. At 10:40 a.m., the report notes, Murray administered 25 milligrams of the drug and continued to monitor Jackson for 10 minutes, until Murray left for the restroom. Murray told investigators that he returned after no more than two minutes and noticed Jackson had stopped breathing.

But the story might be more complicated than that. Investigators have indicated through a series of search warrants that they are probing manslaughter, excessive use of prescribing medication and prescribing to an addict.

In the months since Jackson’s death, police officers and the Drug Enforcement Administration have raided Murray’s Las Vegas home and office, his second office and storage unit in Houston, and Applied Pharmacy Services, a pharmacy in western Las Vegas. They have searched for propofol information and copied computer data. And they have combed through cellphone records, storage receipts and evidence of names like Bianca Nicholas and Prince Jackson, just two of Jackson’s nearly 20 alleged aliases.

Medical records have also been subpoenaed from Jackson’s other doctors, including dermatologist Arnold Klein, general practitioner Allan Metzger and anesthesiologists David Adams and Randy Rosen.

The latest details surrounding the singer’s death come two months after Jackson, 50, was rushed from his Westwood, Calif., mansion and pronounced dead at UCLA Medical Center. Occurring just before Jackson’s planned comeback, with a series of 50 sold-out concerts in London, his death drew hordes of mourners from around the world to his star on the Hollywood Walk of Fame and his Neverland home, spiked sales of his music and inspired a televised memorial service watched around the world.

The cause of death, as yet unofficially released by the coroner’s office, hardly comes as a surprise. For weeks, propofol has dominated reports of Jackson’s death, as have stories about Jackson’s heavy dependency on drugs and his revolving entourage of enablers. If anything, the results further focus attention on Murray, 51, who, according to his attorney Ed Chernoff, “just happened to find [Jackson] in his bed” not breathing.

Propofol, also known as Diprivan, is an IV anesthetic agent typically used in operating rooms to put patients to sleep in about a minute. In drip form, it keeps them asleep. It’s reserved for procedures where a patient would otherwise be uncomfortable — say, plastic surgery, a colonoscopy or hip replacement — but must be meticulously monitored because the drug can stop a person’s breathing.

Propofol is fairly easy for a doctor to acquire, but is never intended for home use, where proper equipment to resuscitate a patient is typically absent, says John F. Dombrowski, director of the American Society of Anesthesiologists. Nor is the drug ever intended to help someone with sleep troubles. “That’d be like me taking chemotherapy because I’m tired of shaving my head,” Dombrowski says.

Authorities said they could find no evidence that Murray had purchased, ordered or obtained the medication under his medical license or Drug Enforcement Administration tracking number, according to the affidavit. But detectives found several unlabeled bottles of propofol in the house along with other vials and pills on Jackson’s nightstand prescribed by Murray, Klein and Metzger, according to the affidavit.

The report noted that between March and April 2009, Jackson requested that Murray arrange to have Adams administer propofol, which he did. Murray also said he unsuccessfully asked Jackson to tell him about his other doctors and prescriptions when he noticed injection marks on the pop star’s hands and feet — marks Jackson told him were the result of a “cocktail.”

The scrutiny has been tough on Murray, his attorney says. “He has to walk around 24/7 with a bodyguard. He can’t operate his practice. He can’t go to work because he is harassed no matter where he goes,” Chernoff, a Houston-based criminal defense attorney, wrote on a blog he keeps to update the press. “Dr. Murray didn’t prescribe or administer anything that should have killed Michael Jackson.”

Despite the release of the report, it remains unclear whether Murray and others will be charged in connection with Jackson’s death.

“I think it’s far too early to say he’ll be charged with any crime,” said Laurie Levenson, a professor at Loyola Law School in Los Angeles. “We know that the coroner believes that this is a death at the hands of another. Now the question is whether that involved criminal conduct,” she said, citing intent to harm and gross negligence as examples.

“Nobody should jump to the conclusion from the release of this report that Dr. Murray will be charged immediately or in the future,” she added. “He is clearly the target of this investigation, and they are going through this with a fine-tooth comb.”

If Murray or others were charged, it would mark yet another matter heading to the courtroom after Jackson’s death. He left behind three children, a pile of debts and a complicated financial empire that are likely to be the subjects of legal proceedings and courtroom battles for years, legal experts say.

Earlier this month, a Los Angeles Superior Court judge awarded permanent custody of Jackson’s three children — Prince Michael, 12; Paris, 11; and Prince Michael II, 7 — to the late singer’s mother, Katherine Jackson. The same judge has also approved a $60 million deal for a feature film with Columbia Motion Pictures, a traveling memorabilia show and a slew of new Jackson-related merchandise.

By Ashley Surdin
Washington Post Staff Writer
Tuesday, August 25, 2009
Staff researcher Julie Tate contributed to this report.

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Jackson’s Family Looks Forward to Justice

Hours after Michael Jackson’s death was ruled a homicide by the Los Angeles County coroner, the late singer’s family “looks forward” to justice.

“The Jackson family has full confidence in the legal process, and commends the ongoing efforts of the L.A. County Coroner, the L.A. District Attorney and the L.A. Police Department,” the family told Usmagazine.com in a statement on Monday.

See 32 photos from inside Michael Jackson’s Staples Center memorial.

The homicide ruling makes it likely criminal charges will be brought against Conrad Murray, the physician who admitted he administered a powerful anesthetic propofol the morning he died. Detectives have been investigating whether Murray’s decision to administer Jackson propofol outside a hospital and as a sleep aid would be classified as negligence for an involuntary manslaughter charge.

“The family looks forward to the day that justice can be served,” the statement continued.

Relive Jackson’s most unforgettable moments.

The Los Angeles coroner’s office found lethal levels of propofol in Jackson’s body after he died, according to a search warrant affidavit unsealed in a Houston court Monday.

The official coroner’s report is sealed at the request of the Los Angeles Police Department due to the ongoing investigation.

See photos of Jackson and his kids through the years.

In July, one week after Los Angeles police confirmed that investigators had not ruled out homicide, the King of Pop’s older sister, La Toya Jackson, first revealed her suspicions.

“I believe Michael was murdered,” she had said. “I felt that from the start. Not just one person was involved, rather it was a conspiracy of people. He was surrounded by a bad circle. Michael was a very meek, quiet, loving person. People took advantage of that. People fought to be close to him, people who weren’t always on his side.”

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Coroner Rules Jackson’s Death Homicide, Murray Lied To Police

LOS ANGELES — The Los Angeles County coroner’s finding that the death of Michael Jackson was a homicide could mean criminal charges for his doctor, who told investigators that he administered a mix of powerful drugs to treat the pop star’s insomnia hours before his death.

The homicide ruling was based on forensic tests that found the anesthetic propofol combined with at least two sedatives to kill Jackson, a law enforcement official told The Associated Press on Monday, speaking on condition of anonymity because the findings have not been publicly released.

While the finding does not necessarily mean a crime was committed, it means more likely that criminal charges will be filed against Dr. Conrad Murray, the Las Vegas cardiologist who was caring for Jackson when he died June 25 in a rented Los Angeles mansion.

Through his lawyer, Murray has said he administered nothing that “should have” killed Jackson.

Murray told investigators that at the time of the King of Pop’s death, he had been trying to wean Jackson off propofol. The doctor said he’d been treating Jackson for insomnia for about six weeks with 50 milligrams of the drug every night via an intravenous drip, a search warrant affidavit said.

Murray said he feared Jackson was becoming addicted to the anesthetic, which is supposed to be used only in hospitals and other advanced medical settings.

The affidavit unsealed in Houston, where Los Angeles police took materials from one of Murray’s clinics last month as part of their manslaughter investigation, includes a detailed account of what detectives say Murray told them. Manslaughter is homicide without malice or premeditation.

Murray told detectives that he had lowered the propofol dose to 25 milligrams and added the sedatives lorazepam and midazolam two days prior to Jackson’s death, a combination that succeeded in helping the pop star sleep. The next day, Murray said, he cut off the propofol – and Jackson fell asleep with just the two sedatives.

But on June 25, Murray said he tried unsuccessfully to make Jackson sleep with a series of drugs that included a 10-milligram tablet of Valium and repeated injections of two milligrams of lorazepam and two milligrams of midazolam.

When they didn’t work, he gave in to Jackson’s “repeated demands/requests” for propofol, which the singer called his “milk,” according to the affidavit. Murray administered 25 milligrams of the white-colored liquid – a relatively small dose – and finally, Jackson fell asleep.

Murray remained with the sedated Jackson for about 10 minutes, then left for the bathroom, the affidavit said. Less than two minutes later, Murray returned – and found Jackson had stopped breathing.

Cell phone records show three separate calls from Murray’s phone for between 11:18 a.m. and 12:05 p.m., the affidavit said. It’s not clear who received the calls. Murray had told authorities he was administering CPR during that time.

In a statement posted late Monday on his firm’s Web site, Murray’s attorney Edward Chernoff questioned the timeline as depicted in the affidavit, calling it “police theory.”

“Dr. Murray simply never told investigators that he found Michael Jackson at 11:00 a.m. not breathing,” Chernoff said. He declined to comment on the homicide ruling, saying, “We will be happy to address the coroner’s report when it is officially released.”

The coroner’s office has withheld its autopsy findings, citing a request from police to wait until their investigation is complete.

It is no surprise that such a combination of medications could kill someone, said Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill.

“All those drugs act in synergy with each other,” Zvara said. Adding propofol on top of the other sedatives could have “tipped the balance” by depressing Jackson’s breathing and ultimately stopping his heart.

The 25 milligrams of propofol “is not a whopping amount,” said Lee Cantrell, director of the San Diego division of the California Poison Control System. It was the cocktail of the other sedatives, known as benzodiazepines, that “may have been the trigger that pushed him over the edge,” Cantrell said.

“This is horrible polypharmacy,” he said, referring to the interaction among the various drugs. “No one will treat an insomniac like this.”

The affidavit, signed by a judge July 20, said that the coroner’s office chief medical examiner told police his review of preliminary toxicology results showed “lethal levels of propofol.”

Besides the propofol and two sedatives, the coroner’s toxicology report found other substances in Jackson’s system but they were not believed to have been a factor in the singer’s death, the official told the AP.

Murray didn’t tell paramedics or doctors at the UCLA hospital where Jackson was rushed about any drugs he administered other than lorazepam and flumazenil, a “rescue drug” to counteract problems from too much lorazepam, according to the affidavit.

It was only during a subsequent interview with Los Angeles Police detectives that Murray gave a more full accounting of the events leading up to the 911 call, the document said.

A call to the coroner’s office was not returned Monday. A spokeswoman for the Los Angeles District Attorney’s said no case had been presented so the office had nothing to comment on.

The line between safe and dangerous doses of propofol is thin, and according to the drug’s guidelines a trained professional must always stay bedside. Home use of propofol is virtually unheard of – safe administration requires both a specially trained anesthesiologist and an array of lifesaving equipment. Murray was trained as a heart doctor, not a pain and sedation specialist.

Murray told investigators he didn’t order or buy any propofol, but investigators served a search warrant Aug. 11 at a Las Vegas pharmacy and uncovered evidence showing Murray legally purchased from the store the propofol he gave Jackson on the day he died.

Jackson’s family released a statement Monday, saying it has “full confidence” in the legal process and the efforts of investigators. It concludes: “The family looks forward to the day that justice can be served.”
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Contributing to this report were AP Medical Writer Marilynn Marchione in Milwaukee and Associated Press Writers Alicia Chang in Los Angeles and Michael Gracyzk in Houston.

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