Michael Jackson's Medical Homicide: What The Coroner's Announcement Really Means

Michael Jackson's death took a bizarre turn this afternoon when the Los Angeles County Coroner's office announced it'd found the anesthetic propofol, usually used in general surgery, and two other sedatives to have caused the singer's death in June. The drugs were no surprise—court testimony earlier this week established early on that Jackson was on myriad medications the day he died. The big shock came when the coroner announced that the death was being labeled a homicide.

It's important to note that homicide indicates that Jackson was killed; it does not, necessarily, mean he was murdered (homicide with intent to kill); many previous medical homicide cases have involved euthanasia. The Los Angeles County DA has not yet announced murder or manslaughter charges against Jackson's physician, Conrad Murray, who admits to giving Jackson the drugs.

Besides the fact that it made Jackson family whisperings of a conspiracy sound slightly less crazy, the homicide announcement left us wondering: what does medical homicide even mean? How do you draw the line between medical homicide and malpractice? And is as bad as it sounds?

Yes, actually. NEWSWEEK's Sarah Kliff spoke with Dr. Vincent DiMaio, editor of the American Journal of Forensic Medicine and Pathology and former chief medical examiner in Baxter County, Texas about what constitutes medical homicide, what doesn't and why it's actually not too difficult to tell the difference. Excerpts:

By classifying this death as a homicide, what is the Los Angeles County Coroner's Office saying about the actions of Jackson's doctor?
What they're alleging is that [Michael Jackson's doctor] gave [Jackson] a medication for a non-medical reason and that caused the death…The reason they can classify this as a homicide is that there is simply no medical reason for this drug to have been administered. Suppose he was in surgery, and the doctor had given him too much medication. That's a different situation which would probably be signed off on as an accident. But in this situation, it's clearly a homicide.

In general, how do you define a medical homicide? What makes it different from medical malpractice?
There are five ways that forensic pathologists categorize deaths: natural, accidental, homicide, suicide or undetermined. Essentially, homicide means that somebody has caused the death of another person…In terms of medical homicide specifically, I think the simplest way to say it is that it's a medical decision that's outrageous, that you could not justify your actions medically. Or you just go to extremes, like deciding to do an operative procedure for which you don't have the support, doing an operation on your kitchen table. That's essentially the way to say it: if you have a medical situation, where you're using things inappropriately and have no medical justification, that's homicide.

Is it difficult, in medical situations, to draw a line between accident and homicide? Are there cases that fall in between?
Usually, it's actually really simple. If the doctor makes a mistake, you have records and other people who were in the room, and it would mostly be classified as malpractice. If it's reasonable, and you screw up, it's not going to be homicide. When you do something that's really out there, that makes absolutely no medical sense at all, something like this, that's when it's no longer malpractice.

What about the Jackson case clearly indicates it was a homicide?
Even though there was no intention to kill, what he did was so beyond what normal people would consider reasonable medicine that it gets classified as a homicide. There was no medical justification and, besides that, he was using an anesthetic without an anesthesiologist. So not only do you have no medical justification, you also don't have the right support system in place.

Will it be possible for the doctor to argue his case as a medical mistake, a case of negligence, not homicide?
You just can't argue this one. Here's the problem question for him: what is the medical justification for giving him this drug? And that's where they've got him, because there is no medical reason for the situation he was in. He wasn't even doing an operative procedure and there was no anesthesiologist. Moreover, he's an internist. Even if the drug were warranted, the conditions would be inappropriate. It's not his specialty, its not internal medicine and there were no support personnel.

How often do medical homicide cases come up in forensic pathology?
Very rarely. You do get some situations where doctors do medical procedures that are not recognized, causing the death of a patient, but most of these are medical malpractice. Most of the homicide cases that I know of are euthanasia, which is a bit different. It just gets to the point that, for something to be categorized as homicide, it would have to be something really gross, where there's no real justification for what they are doing.

How does the Jackson case fit into the history of forensic pathology?
It's completely unusual, not something that anyone, myself included, would ever expect to encounter. The only cases called homicide, that I know of, were where it was intended [the euthanasia cases]. But there's nothing to this level.

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