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Jackson death homicide, sleep aids caused death

LOS ANGELES (AP) - Michael Jackson's death was a homicide caused primarily by the powerful anesthetic propofol and another sedative, the coroner announced Friday in a highly anticipated ruling
increasing the likelihood of criminal charges against the pop
star's doctor.
The Los Angeles County coroner's office determined the cause of
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.
The coroner did not release Jackson's full autopsy report,
citing a security hold requested by Los Angeles authorities
investigating the case, and declined to comment beyond a short
statement announcing the manner and cause of death.
The coroner's determination of a homicide confirmed what The
Associated Press first reported Monday, citing an anonymous law
enforcement official.
The 50-year-old Jackson died June 25 at his rented Los Angeles
mansion. Dr. Conrad Murray, the Las Vegas cardiologist who was the
pop star's personal physician, told police he gave Jackson propofol
that morning after a series of sedatives failed to help Jackson
sleep.
Murray has not been charged with any crime but is the target of
what police term a manslaughter investigation. Multiple search
warrants served at his 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.
Except for a brief video posted to YouTube earlier this month,
Murray has not spoken publicly since Jackson's death. In the video,
he said: "I told the truth and I have faith the truth will
prevail."
Murray's attorney, Edward Chernoff, 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."
Chernoff repeated his assertion that nothing Murray gave Jackson
"should have" killed him.
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.
A statement by the LAPD said the investigation into the death is
ongoing and "will result in the case being presented to the Los
Angeles County District Attorney for filing consideration."
The coroner's determination of homicide makes it more likely
criminal charges will be filed but does not guarantee it. 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.
Murray was hired by Jackson's promoter AEG Live to help keep the
aging star fit during the grueling preparation for a series of
comeback "This Is It" concerts in London. 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.
It was a break - and a $150,000-a-month salary - that Murray
desperately needed. 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.
Murray has been interviewed twice by police. According to court
records, he 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, dubbed "milk of amnesia" among anesthesia
professionals, 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.
---
Associated Press reporter Alicia Chang in Los Angeles, AP
Medical Writer Marilynn Marchione in Milwaukee and AP Researcher
Rhonda Shafner in New York contributed to this report.

(Copyright 2009 by The Associated Press. All Rights Reserved.)


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