The Diprivan Mystery
I have talked to several nurses over the past few weeks about the strange situation involving the drug Diprivan and Michael Jackson. As something of an expert on Diprivan (I have been involved in professional discipline cases involving the drug), I have to confess that I do not understand why it was given (if it was in fact given to Jackson). While the possibilities are certainly varied regarding a prosecution, the Michael Jackson case stands as an example to people who would use their access to drugs (even drugs like Diprivan, that are not controlled substances) to aid their friends and family.
Most nurses are aware of a co-worker who, during their employment, has taken a couple of Tylenol 3, Valium, or similar drug that should have been destroyed home for use by someone who they thought might need it. I once knew a nurse who brought home diuretics so that her mother could lose weight prior to a wedding. There are, of course, two good reasons not to do this. The first is that its unlawful, it's stealing, and it can get your license taken away. The second is that if the person you give a dangerous drug to has a reaction to it, and suffers some catastrophic result like Michael Jackson, you can go to jail for homicide.
There are several classes of homicide. Voluntary manslaughter is the killing, without premeditation, of another human being. Usually this is thought of as "heat of the moment" or similar situations where a person takes an action that takes a life. Involuntary manslaughter is a situation where a person acts in a negligent or reckless manner (like driving drunk) that results in the death of another. Vehicular homicide is a type of involuntary manslaughter.
Murder charges are usually leveled when someone acts intentionally to kill another, and there are various classes of murder, with the most serious being first degree murder where a person acts with premeditation, or lies in wait for their victim.
Where a health care provider acts so far outside the standard of care that it equates to acting with criminal negligence or recklessness, manslaughter charges are often brought. Several years ago Colorado authorities went after an anesthesiologist who fell asleep during a surgical procedure. The child on the table died as a result, and the doctor was prosecuted. However, where a person acts with intent, as in the case of respiratory therapist Efren Saldivar, and kills a person intentionally, it is murder that is charged, not negligence.
The issue for the police in Los Angeles is whether anyone may have administered Diprivan to Mr. Jackson for a purpose other than the induction of anesthesia. Although Diprivan is a procedural sedative and is used frequently to induce complete loss of consciousness, normally it is not given unless the airway is protected and the patient is being ventilated. It is frequently given to help patients with post-surgical wounds sleep in the open-heart unit. However, when it is given, it is always to an intubated and mechanically-ventilated patient.
Media reports, if they are to be believed, suggest that Jackson routinely got Diprivan to sleep, and that it was administered by IV drip. When the singer wanted to waken, the doctor would stop the drip at the pre-determined time. Doing this for a patient who is not intubated would be reckless and criminally negligent because Diprivan is well-known to cause an interruption in ventilatory drive.
Although the media has not made any mention of it, administering Diprivan without a monitor (pulse oximeter, capnograph, cardiac monitor, etc.) would also suggest gross clinical negligence. This because while a patient may seem to be ventilating well, without a patent airway the patient may simply obstruct and ventilatory efforts may continue without effect. The only way to know that a patient is being properly monitored is to monitor pulse oximetry and cardiac rate and rhythm. Certainly changes in these parameters would permit early detection of a catastrophic event.
If, as the media suggests, the physician in this case routinely administered Diprivan without having any protocol to monitor Mr. Jackson, he should not only face professional discipline, he should probably face criminal charges as well.
And this also serves as a lesson to those who would use their access to drugs to benefit their family or friends. It only takes one untoward reaction, or one accidental overdose, to ruin a life, and with it, to ruin a career and your right to freedom. If you know people who routinely abuse the trust of their employers and take medications meant for destruction, in almost every state you have an ethical obligation to report that behavior. You may never know the lives you save with such an action.