Coroner: Jackson death homicide, sleep aids caused

[August 29, 2009]  LOS ANGELES (AP) -- The morning Michael Jackson died, his personal physician says, he was given a series of sedatives to help him sleep, and when those didn't work, he was given the powerful anesthetic propofol.

Dr. Conrad Murray, a Las Vegas cardiologist who has been interviewed twice by police, has not been charged with any crime but he is the target of what police term a manslaughter investigation.

The Los Angeles County coroner's office announced Friday in a highly anticipated ruling that Jackson's death was a homicide caused primarily by propofol and another sedative increasing the likelihood of criminal charges against Murray.

In a brief video posted on YouTube earlier this month, Murray said: "I told the truth and I have faith the truth will prevail." Except for the video, Murray has not spoken publicly since Jackson, 50, died June 25.

Murray's attorney, Edward Chernoff, has repeated his assertion that nothing Murray gave Jackson "should have" killed him.

The coroner's office determined the cause of Jackson's death was "acute propofol intoxication." Lorazepam, another sedative sold under the brand name Ativan, contributed to the death.

Additional drugs detected in Jackson's system were the sedatives midazolam and diazepam, the painkiller lidocaine and the stimulant ephedrine.

Multiple search warrants served at Murray's home and businesses in Las Vegas and Houston sought evidence detailing how he procured the propofol that killed Jackson. Jackson's interactions with at least six other doctors also are being scrutinized. In addition, California Attorney General Jerry Brown has opened an independent probe of several physicians.

In the past seven years just a handful of doctors have been convicted of manslaughter, mostly involving their patients' use of painkillers. To win a conviction, prosecutors would have to show that Murray acted recklessly and with negligence.

The coroner's determination of homicide makes it more likely criminal charges will be filed but does not guarantee it.

"That decision is not binding on the district attorney," said Steve Cron, a criminal defense attorney and adjunct professor at Pepperdine University's law school. "But it is one more piece of the puzzle that leads toward the conclusion that someone will be prosecuted for his death."

The coroner's determination of a homicide confirmed what The Associated Press first reported Monday, citing an anonymous law enforcement official.

The coroner did not release Jackson's full autopsy report Friday, citing a security hold requested by Los Angeles authorities investigating the case. The coroner also declined to comment beyond a short statement announcing the manner and cause of death.

Murray's attorney said he was disappointed the full autopsy report wasn't released. Without that, it was impossible to seek independent expert opinion on the significance of the various drugs detected.

"Release the toxicology report, the whole thing. Sunlight is the best disinfectant," Chernoff said. "This smells like gamesmanship."

It's not clear when the full report may be released. The coroner said the security hold would remain until the investigation is wrapped up. The Los Angeles Police Department and the district attorney's office said they did not know when that would be.

When Michael Jackson's promoter AEG Live hired Murray to help keep the aging pop star fit for a series of comeback concerts in London, the doctor hadn't paid the mortgage on his country club mansion in 2009, and according to court records, he owed a total of at least $680,000 in judgments against him and his medical practice, delinquent student loans, child support and credit cards.

For Murray, the $150,000-a-month job was a break he desperately needed.

Jackson got to know Murray in Las Vegas, where he moved after a stint overseas following his 2005 exoneration on child molestation charges and where the Caribbean native ran a clinic.

According to court records, Murray told investigators that over about six hours he injected Jackson with two doses each of lorazepam and midazolam. Finally, around 10:40 a.m., Murray said he succumbed to Jackson's demands and administered propofol, a drug Murray said he had given Jackson every night for six weeks. He said he had diluted the propofol with lidocaine.

Propofol commonly is used to render patients unconscious for surgery. It's only supposed to be administered by anesthesia professionals in medical settings and, because of its potency, requires the patient be closely monitored at all times. Using propofol strictly as a sleep agent violates medical guidelines.

Medical experts said the drugs found in Jackson's system magnify each other's effects.

"Instead of one plus one equals two, one plus one equals three," said Lee Cantrell, a toxicologist and director of the San Francisco division of the California Poison Control System.

A search warrant affidavit unsealed this week in Houston includes a detailed account of what detectives say Murray told them. The doctor said he'd been treating Jackson for insomnia for about six weeks with 50 milligrams of propofol every night via an intravenous drip, the 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, so he had lowered the dose to 25 milligrams and added the sedatives lorazepam and midazolam.

That dosage is very small and by itself it's very unlikely it would have killed him. But with the other drugs there was a "benzodiazepine effect," according to the coroner, and it was deadly.

Dr. David Zvara, anesthesia chairman at the University of North Carolina at Chapel Hill, said it's difficult to determine what constitutes a fatal dose of propofol in someone receiving other sedatives.

"It's hard to set any level because of the way those act in synergy," he said. Given after the sedative lorazepam, "Even a small dose of propofol might have a very large effect."

Jackson had many medical procedures over the year and a long history with various drugs. Following his death, three medical professionals said Jackson asked them for propofol this spring. All refused. One, a registered nurse named Cherilyn Lee, recounted that Jackson told her he liked how the drug knocked him out fast and allowed him to sleep for hours longer than he could naturally.

Doctors were surprised by the coroner's mention of ephedrine, once sold as the controversial diet drug Ephedra and now banned by the federal Food and Drug Administration, though the drug can be used for resuscitation. Zvara said it's unlikely emergency personnel who responded to Jackson's home would have used that drug since epinephrine, otherwise known as adrenaline, is favored.

Meanwhile, a lawyer for Dr. David Adams, an anesthesiologist mentioned in a search warrant affidavit, said Murray's account of their meeting with Jackson was inaccurate.

Documents state Murray told detectives he was present when Adams sedated Jackson with propofol at a cosmetologist's office in March or April.

Adams' lawyer, Liborius Agwara, said his client spoke to Murray on the phone and met him in person only once, at a meeting with Jackson at Murray's Las Vegas office in March. Adams didn't perform or witness any medical procedures at that meeting, the lawyer said.

Agwara said Adams administered propofol to Jackson four times in 2008 to assist a dental surgeon.

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Associated Press reporters Alicia Chang in Los Angeles and Oskar Garcia in Las Vegas, AP Medical Writer Marilynn Marchione in Milwaukee and AP Researcher Rhonda Shafner in New York contributed to this report.

[Associated Press; By THOMAS WATKINS and JUSTIN PRITCHARD]

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