After an investigation, the Los Angeles County Coroner ruled that Jackson had been in relatively good health, and that his death was a homicide involving a combination of drugs. According to the news release issued by the Coroner, “The drugs propofol [Diprivan] and lorazapam [Ativan] were found to be the primary drugs responsible for Mr. Jackson’s death.” Other drugs detected in Jackson’s body were midazolam [Versed], diazepam [Valium], lidocaine, and ephedrine. The Coroner’s statement said Jackson died from “acute propofol intoxication,” but said that other conditions relating to the death was the benzodiazepine effect (lorazapam, midazolam, and diazepam are all members of the benzodiazepine family of drugs).

Dr. Conrad Murray, Jackson’s personal physician, who was to accompany Jackson on an international tour, told investigators that he had given Jackson three anti-anxiety drugs—lorazepam, midazlolam, and diazepam—to help him sleep in the hours before he stopped breathing. Murray told detectives that he had given Jackson a dosage of the anesthetic propofol, diluted with lidocaine, to Jackson a short time before he stopped breathing. Murray also told detectives that he had been treating Jackson for insomnia for six weeks, giving him 50 milligrams of propofol diluted with lidocaine every night via an intravenous drip.

Law enforcement officers are conducting an investigation into Murray, who allegedly stated he was trying to wean Jackson off of propofol. When Murray discovered Jackson on his bed not breathing, Murray began CPR. However, proper guidelines for CPR require that it be done of a hard floor or hard board, not a soft substance such as a mattress. By the time security called 911, 30 minutes had passed.

Propofol is a powerful anesthetic administered intravenously in hospitals to prepare patients for surgery. Because of the possible effects of propofol, such as stopping breathing or causing cardiac arrest, propofol is given only where life-saving equipment is readily available, such as a ventilator and defibrillation paddles. As with any other general anesthetic, propofol should not be administered where appropriately trained staff and facilities for monitoring, airway management, supply of supplemental oxygen, artificial ventilation, and cardiovascular resuscitation are not available.

Because of its intended use and serious risks, propofol is generally not found on the shelves of your neighborhood pharmacy, or at one of the mega-pharmacies either, for that matter. Rather, it is usually found only in hospital and same-day surgery pharmacies.

It must be noted that “homicide” does not mean that the furnishing of the propofol was a criminal act. Homicide is defined in law as the death of a human being by another human being. Shooting and killing someone who is about to attack you is a homicide, but is justified on the basis of self-defense. However, I believe that in this case that Dr. Murray, a cardiologist and not an anesthesiologist, should be held legally responsible for Jackson’s death. One can easily argue that Murray is guilty of second degree murder by administering such a potent drug without life-saving equipment nearby and not monitoring his patient closely enough. Murray was in another part of the house shortly after he injected Jackson with the propofol and Jackson had stopped breathing. In my view, Murray acted with a blatant disregard for Jackson’s safety, which makes him a murderer in my book.

Another disturbing factor in this case is the number of false names that were used to obtain the prescriptions. Pharmacists have a legal obligation to know that they are giving the right medication to the right person or his or her authorized representative, such as a spouse or parent. The investigation into Jackson’s death should therefore include as many pharmacies as can be found that filled the propofol prescriptions written to aliases if they knew or had reason to know that they were going to be used by Michael Jackson.

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