Michael Jackson--In Perspective (2nd Saturday Update)

There is no doubt that Michael Jackson's death at age fifty was an event that the world could hardly fail to notice. There will be considerable press coverage over the next few weeks, and possibly months, regarding his career, his talent, and his title as The King of Pop. This post will be dealing with some nuts-and-bolts issues surrounding his sudden and unexpected death, including some legal issues that will arise over the course of the next few days.

Why was the Medical Examiner called in? The most pressing issue that is absorbing the news sites is the actual medical cause of his death. A heart attack is the known immediate cause, but there are many facets to that. The Medical Examiner's (Coroner's) report took longer than expected, but the preliminary results are inconclusive at the time of this writing. Was there a crime? Not necessarily. There are many reasons why such an examination would be required, many of which have little to do with a suspected crime. The most common reason would explain this one initially. A fifty year old man, with easy access to medical treatment and personal care is not expected to die of a sudden coronary arrest. That alone is sufficient to warrant an official medical examiner's report.

Once the determination to perform an autopsy has been made, the results may go nearly anywhere. Most often, an underlying medical condition that was either unsuspected or undetected is the cause. In the case of a public figure, known medical conditions are often hidden from the public to avoid potential damage to the person's career or privacy. In most of those cases, the examination will reveal that condition, but no further action will be taken on it so long as there was no indication of medical malpractice or foul play.

Given the mystery surrounding Jackson's life, the official medical examination was inevitable, but like so many things in Jackson's life, the results will intrigue people. Many are already speculating that there was either a crime, or a course of medical treatment for pain and other undisclosed diseases that went outside the ordinary bounds of good medicine. The allegations are that Jackson had a personal physician who lived at the residence, and may have been repeating the type of overmedication discovered in the death of Elvis Presley.

In addition, as of this writing, the doctor's car was found near the residence, but the doctor was nowhere to be found. On top of that, there have been allegations that the doctor was not licensed in California, which could then make the course of treatment and medication illegal even if it was otherwise appropriate. One of the drugs alleged to have been prescribed is demerol. This is a powerful opium derivative, used to treat acute pain. Rarely, it is used to treat chronic pain, but is contra-indicated for anyone who has either suffered previous addiction to opiates or who has any history of cardio-vascular disease. Like most pain medications, dependency is always a possibility, and the drug requires larger and larger doses to produce the minimum result.

In any event, this medical issue will not be resolved today or in the next few days. If there is a hint in the Medical Examiner's report that drugs of any kind were involved, no final conclusions can be drawn because the complete toxicology report cannot be finished in less than five or six weeks. If demerol is detected, that proves little or nothing in and of itself, unless an inordinately large amount is found in his system. But drug interactions are often the ultimate cause, and many of those drugs, if there are any, won't be identified for some time to come. The most the Medical Examiner can announce today is that the death was not from natural causes, or that it was from natural causes under suspicious circumstances. A pure finding of death from natural causes is highly unlikely, but possible. More likely the finding will be indeterminate, with some preliminary information about the actual sudden coronary arrest and any medication in Jackson's system. It is highly unlikely that the initial report will actually determine that the death was the result of any criminal act, or even medical malpractice.

California is very loosy-goosy about personal drug use, but when it comes to doctors who prescribe, overprescribe, or illegally prescribe a course of medication which may have resulted in a death, the state can be very tough and unforgiving. In the case of a beloved public figure, the political ramifications of ignoring the doctor's medical procedures would be disastrous for the police and the prosecutors. Although the news reports continually report that the doctor is not a "suspect," the simple fact is the police are looking hard for this phantom doctor, and for very good reason. For one thing, the doctor was allegedly performing the CPR while another person made the 911 call, and then described at least an hour of CPR before the call. That immediately raises the question of why an in-house doctor would not have immediate access to a defribillator, particularly if he knew of a potential coronary problem. One result which could occur from such a scenario are charges of criminal negligence or even homicide against the doctor.

UPDATE: The Medical Examiner's preliminary report has been released. In a brief and terse statement, the announcement stated that the autopsy had been completed, that there was no "immediate" indication of a criminal act, and that no final determination of the cause of death other than sudden coronary arrest was found.

UPDATE: Police are reporting that the residence contained a "treasure trove" of prescription medications, including multiple painkillers and anti-depressants. A full syringe of demerol was found near the body when paramedics arrived. They do not have the doctor in custody, but their information so far indicates that the doctor is a coronary specialist, and that he was employed by AEG, the company which was promoting Jackson's comeback tour. Beyond that, the police say they either have information they are not free to release, or information that has yet to be organized. As of this writing, the spokesman for the LAPD has said that the Department is in contact with the doctor, and will be scheduling an interview with him at the earliest possible time. The announcement also indicated that the detectives believe that the doctor is a California practitioner.

The next question being asked is "what will happen to the children?" California law leans very heavily toward awarding physical custody to the natural mother (assuming both the children and the mother are presently in California where the death occurred). If she chooses, she will get that custody almost immediately, despite the fact that she has not seen the children at all since she signed an agreement with Jackson that he would have sole and exclusive custody. That does not mean she will be allowed to keep the children permanently, or that she even wants them. The marriage was clearly a sham, and many of her actions subsequent to the divorce could be used to prove that she is not a fit parent. Yet under California law, a natural mother must be highly unfit, not merely negligent, eccentric or inattentive, for the court to award custody to anyone except her. And then the question becomes, "if not her, then who is next in line?" That would be family blood relatives. The Jackson family has had many problems, including charges of child abuse, so that's a questionable avenue, yet they have at least been in constant contact with Jackson and the children.

But there is more at stake than mere custody. Unless Jackson left a will (undetermined at this point), the children are entitled to his entire estate. Since they are minors, the court must appoint a guardian ad litem to determine who will be in charge of the fortune (or mound of debts, whichever it turns out to be). If the mother decides she wants the children, but there is serious doubt that she could handle the finances, the court could award her physical custody (guardian of the person) while giving legal and financial custody to a neutral professional third party (guardian of the estate). Even if she is a competent person with money, the court might still choose to appoint a guardian of the estate since Jackson's financial affairs were chaotic at best, and involve millions of dollars and control of certain assets which may be worth millions more. But there is also the matter of settling the debts (he is said to owe the local pharmacy over $100,000). This would be troubling for a team of highly-qualified certified public accountants, let alone a single mother of ordinary talents.

In the long run, this death will result in investigations, lawsuits, possible criminal charges, and estate challenges which will make the Anna Nicole Smith fiasco look like child's play.

If there are any new legal or factual developments in the reports of Michael Jackson's death, we will attempt to update you tonight or tomorrow. At this point, you know everything we know, and perhaps you may even know a little more.

UPDATE: Saturday, June 27--11:45 AM PDT: The Jackson family has ordered a separate autopsy. This was not entirely unexpected, but does firm up the talk that the family was not happy with the Medical Examiner's office so far. The name of the person designated to perform the autopsy has not yet been revealed, but the office of the Medical Examiner issued a brief statement in which it stated that "the family had every right to do this, and given the current status of personnel cutbacks and reductions in funding, it is not unreasonable to think that a private party might be able to act quicker and more efficiently." It's not clear from my point of view whether this is a sneaky plea for restoration of staffs and funding, an admission of incompetence, or a genuine statement of the intelligent concept of getting a second opinion. Much of the validity of the second autopsy will be in question, depending on which expert the family chooses. And there is always the underlying assumption that an independently-paid expert will attempt to find results that the family wants to be found.

UPDATE: Saturday, June 27--3:12 PM PDT: The name of the doctor has been confirmed by official sources. His name is Conrad Murray. Official sources have not yet confirmed news that he is a cardio-vascular specialist or whether he is properly licensed in California. Police repeated that he has been cooperative, and will hold a formal interview as early as Monday. As I suggested in yesterday's post, he is represented by counsel, which could explain the short "disappearance." He has been quoted as denying that he is in any way responsible for the death, but that is unconfirmed, and fully expected.