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Coroner Attributes Michael Jackson's Death to Propofol

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By Ashley Surdin
Washington Post Staff Writer
Tuesday, August 25, 2009

LOS ANGELES, Aug. 24 -- 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.

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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.

Staff researcher Julie Tate contributed to this report.


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