The trial of Dr. Conrad Murray, the physician involved in the death of pop sensation Michael Jackson, is well underway in a Los Angeles area courtroom.  Dr. Murray stands accused of involuntary manslaughter in Jackson’s death.  The accusation is that Dr. Murray used lethal doses of the anesthetic propofol and insufficient monitoring equipment to sedate Mr. Jackson (at his request), and that these actions caused the death of Mr. Jackson.

The real issue in this trial is not about doses of a medication or types of cardiac and respiratory monitors, however.  The over-riding and precedent setting issue of this trial is the charge against Dr. Murray and the type of trial being conducted.  Dr. Murray is accused of involuntary manslaughter, and is thus facing a criminal trial brought by the state.

When boiled down to its essence, however, Dr. Murray was hired for his medical services by Mr. Jackson.  In the performance of those medical services, Dr. Murray displayed incompetence in the dosing and usage of the medication propofol, and gross negligence in the monitoring of his patient.  This incompetence and gross negligence led to the death of his patient, Michael Jackson.  This is clearly an egregious case of medical malpractice, a civil charge brought by the family or other survivors.

The difference between these charges is extremely important.  Involuntary manslaughter, in this case, refers to “death during the commission of a lawful act which involves a high risk of death or great bodily harm is committed without due caution or circumspection”.  Medical malpractice, on the other hand, requires four components to be proven:

1) A duty of care was owed by the physician

2) The physician violated the standard of care

3) The person suffered a compensable injury

4) The injury was caused in fact and proximately caused by the substandard conduct.

Physicians deal daily with life and death decisions, and their actions, negligent or otherwise, can and do result in the death of those in their care.  This particular fact, combined with the fact that no other field is charged with such obligations, is the entire purpose behind the development of medical malpractice laws to begin with.  In a very real sense, medical malpractice laws exist to provide a rational exemption to physicians from charges such as assault, battery, and manslaughter.

I cannot and will not excuse or defend the actions of Dr. Murray, as they were by any standard incompetent and grossly negligent.  However, to try him for manslaughter when this is a clear example of malpractice is a distortion of the legal system which sets dangerous precedents.  Doctors are not immune to the law by any means, but during the act of practicing medicine, as the very practrice of medicine carries a high risk of death or great bodily harm, doctors are and should continue to be held to the standard of malpractice rather than criminal manslaughter.

The proper sanction against Dr. Murry would be revocation of his license to practice and malpractice proceedings along the most severe lines.  And in the case of almost any other plaintiff, this would have been the case.  This case, however, is different and to deny its differences would be false.  In my own medical community, a patient recently died when having an outpatient surgical procedure by a doctor who was not qualified to perform said procedure and gave the anesthesia himself (which he was also not qualified to do).  This incident made the local news, and may result in license revocation (probably with a stay if he takes certain useless “medical care” courses) and a fine.  But the fact is, this doctor has been busted for the same thing previously and no action had been taken to date.

But Michael Jackson? That’s a different story.  As a public figure and a relatively beloved one at that (we can go into the psychological scrubbing of ones images and selective memories of one’s actions after their death another time), the public outcry was likely irresistable.  A very public spectacle with very severe punishments (what, you mean he’s not even going to jail?) would be necessary for the appearance of justice to be done.

In the state of California, malpractice awards are capped.  One million dollar awards per occurrence, for a total of three million dollars a year.  Such awards would (rightfully) be viewed as a veritable joke to the Jackson family, and would in no way sate the hunger of the public for justice.  In contrast, the ensuing wrongful death suit after a manslaughter conviction will be uncapped, and substantial.

The fact is then, that just as different standards of care exist for the rich and the poor, so then do different standards of justice apparently exist for their doctors.  If we are to argue that health care standards should be equalized across the socioeconomic spectrum, which is no doubt a noble goal, we should also strive to equalize justice across the socioeconomic spectrum.  And the trial of Dr. Conrad Murray is in clear violation of that principle.

Allowing Dr. Murray to be convicted of manslaughter will set a precedent which will have far reaching ripple effects.  It will open up potential litigation against many doctors whose patients die during the deliverance of medical care, either careful or negligent (negligence need not be proven for charges to be brought, after all).  This will serve to render malpractice tort reform and capitation utterly useless.  Insurance premiums will rise and consequently availability of health care will drop.  Costs of health care will increase as defensive medicine is redoubled out of fear of criminal litigation.  In the end doctors and their patients will be harmed.

Dr. Murray should have known what he was getting into when he signed on as Mr. Jackson’s personal physician.  And if Michael Jackson had been any other Joe Somebody, he never would have allowed the deviances in care which he did with Mr. Jackson.  So perhaps it is poetic justice, if not real justice, that by treating his patient differently because he was rich Dr. Murray will now be exposed to a different standard of justice because of his patient’s wealth.