Michael Jackson, Dr. Conrad Murray and the Need For Regulatory Reform

Convicting Dr. Conrad Murray may appease the public's anger and sadness over his role in a beloved icon's death. But unless there is true and effective medical oversight, history will be apt to repeat itself.
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Nineteen years ago, I was in my twelfth year of practice in plastic surgery where I shared a surgical suite with Michael Jackson's plastic surgeon. Though I never personally treated Jackson, I observed his possessiveness over his patient. At this point of his career, Jackson had reached the height of his popularity with international fame and recognition for his incredible talent. Though Jackson had undergone numerous plastic surgeries in the mid eighties, he still retained the facial characteristics and likeness of who he was -- which is far from what can be said about his condition at the time of his death.

With the many surgeries that followed, Jackson was left as the shell of who he used to be. The excessive and overly frequent plastic surgical procedures and the use of skin bleaching agents destroyed his physical appearance. You didn't need a medical license to see that.

In my opinion, the accompanying prescription of narcotics destroyed his stamina, spirit and health. After every plastic surgery, there is a recovery and with every recovery there are pain relieving drugs. In Michael's case, these drugs became an escape from the disappearing man in the mirror.

Eighteen years ago when I suspected that this was the beginning of Michael Jackson's path to destruction, my colleagues, as well as many on the California Medical Board, and even the media shied away from accepting this as a reality. Instead, my relationship ended on less than cordial terms with my colleague and I received a menacing letter from a high profile attorney who warned me about discussing any aspects of Michael's care. It was not until 2002, when I was asked to do an analysis of Michael's facial photographs for "Dateline, NBC" that I was able to bring some of these issues to light. Even then, I was brought before a committee of the American Society of Plastic Surgeons (where I had been a member for approximately 25 years) because of a complaint filed by an anonymous member alleging that I had violated my privacy oath. This charge was dismissed on a number of grounds.

The most pressing dilemma for doctors, medical regulatory agencies and politicians is how to distinguish between those who serve the needs of patients truly benefiting from medication and those who engage in overprescription and the enabling of individuals on the path to addiction. There must be a middle ground between overzealous prosecutors and regulatory agencies and the "blind eye" approach that was taken in Michael Jackson's case. Accommodating Michael's desire for relief from his emotional pain with drugs and surgery did him no service. The failure to investigate the physicians who contributed to Michael's demise along the way is a disservice to society and to my profession. Attorney General Jerry Brown's decision to investigate the trail of prescription narcotics in the Anna Nicole Smith case is a step in the right direction.

I am now in my 32nd year of practice. Watching the medical profession suffer from years of losing our autonomy (and perhaps our dignity) to insurance carriers and government regulators has given me perspective. In many ways, Dr. Conrad Murray's plight symbolizes the decline of our profession. On one hand, he represents the physician today who is strangled by debt resulting from diminishing reimbursement, large malpractice premiums, and high overhead costs. Many doctors today can empathize with him on these grounds. It's understandable why a doctor would want to seek out a niche in concierge medicine, with less oversight and more profit. On the other hand, that very doctor can contribute to the decline of the profession when unethical treatment leads to, say, the death of an individual who has been addicted to drugs for many years stemming from surgeries -- some warranted and some reckless. We read about these stories only when an international celebrity is involved. But it is a far more prevalent problem. Convicting Dr. Conrad Murray may appease the public's anger and sadness over his role in a beloved icon's death. But unless there is true and effective regulation and oversight, not from government officials, but amongst doctors themselves, such a conviction will not help prevent history from repeating this all too common tragedy.

Regulatory reform is needed in several areas. State government regulation of physicians is currently wasteful and ineffective. Investigations should be carried out by individuals with medical knowledge and training. The solution lies in early and impartial investigation. It also calls for overhauling the regulatory system which bankrupts physicians for poor record keeping and ignores real abuses. It calls for medical malpractice reform. The current system drives up medical costs for patients and causes physicians to practice defensive medicine spending more time with their charts than with their patients. Finally, regulation of the insurance industry itself is required in order to end its immunity from competition and its ability to write its own rules its own rules. Recent events in Haiti and Chile have reinforced the idea that doctors' most important function is care giving and not compiling time consuming and excessive documentation for insurance companies and the attorneys.

Most importantly, we must conquer the selfish aspect of human nature that distances us from concern for the common good. If we do not, statistics from drug related deaths will continue to mount, hospitals will continue to shut down en masse, and the quality of medical care in this country -- once the best in the world -- will continue to decline.

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