Jackson's death a homicide, Murray is burnt toast

Got toast? Yes we do!

No surprises here, though the type and amount of drugs Dr. Toast gave Michael prior to the dose of propofol is shocking. Irresponsible would be an understatement, if you ask me.

(CNN) - The Los Angeles coroner has concluded preliminarily that singer Michael Jackson died of an overdose of propofol, a powerful sedative he was given to help him sleep, according to court documents released Monday.

Los Angeles coroner Dr. Lakshmanan Sathyavagiswaran reached that preliminary conclusion after reviewing toxicology results carried out on Jackson's blood, according to a search warrant and affidavit unsealed in Houston, Texas.

The affidavit, used to outline probable cause for search warrants of the offices of doctors who are believed to have treated Jackson, disclosed many details of drugs given to Jackson in the weeks before his death.

Jackson family lawyer Londell McMillan said the report "reaffirms the very sad reality that there was a tragic and gross violation of duty and care for Michael Jackson."

The publicist for Jackson's family said the "family looks forward to the day that justice can be served."

"The Jackson family has full confidence in the legal process, and commends the ongoing efforts of the L.A. County Coroner, the L.A. District Attorney and the L.A. Police Department," the statement said.

While Murray fucked up and he will likely pay for it, I think many people--the family in particular--are forgetting that Michael should be held accountable for his actions. He was an adult. He was addicted. He had choices--difficult, limited, but choices nonetheless. He chose poorly.

The Associated Press is quoting a single law enforcement official, who said the L.A. County Coroner ruled Michael Jackson's death a homicide. The Los Angeles County Coroner's office told CNN they had "no comment" on the report. An LAPD spokesman said the story did not come from their department.

"We will not comment on the "anonymous" law enforcement source that claims that Michael Jackson's death will be ruled a homicide," Murray's lawyer Ed Chernoff said in a statement on his firm's Web site. "Most of the reports by "anonymous" sources have been proven wrong. We will be happy to address the Coroner's report when it is officially released."

The 32-page warrant said Dr. Conrad Murray, Jackson's personal physician, told a detective that he had been treating Jackson for insomnia for six weeks. Murray said each night he gave Jackson 50 mg of propofol, also known as Diprivan, diluted with the anesthetic lidocaine via an intravenous drip.

Worried that Jackson may have been becoming addicted to the drug, the Houston cardiologist said he attempted to wean him from it, putting together combinations of other drugs that succeeded in helping Jackson sleep during the two nights prior to his death.

On June 22 Murray said he gave Jackson a cocktail of drugs similar to what he gave him on the day he died, June 25 -- propofol, Ativan and Versed, which helped the star fall asleep, according to the documents. On June 23 he gave Jackson only the Ativan and Versed, which helped him sleep.

But on June 25, other drugs failed to do the job, as Murray recounted to detectives in an hour-by-hour account detailed by detective Orlando Martinez of the Los Angeles Police Department:

-- At about 1:30 a.m., Dr. Toast gave Jackson 10 mg of Valium.

-- At about 2 a.m., he injected Jackson with 2 mg of the anti-anxiety drug Ativan.

-- At about 3 a.m., Murray then administered 2 mg of the sedative Versed.

-- At about 5 a.m., he administered another 2 mg of Ativan.

-- At about 7:30 a.m., Murray gave Jackson yet another 2 mg of Versed while monitoring him with a device that measured the oxygen saturation of his blood.

-- At about 10:40 a.m., "after repeated demands/requests from Jackson," Murray administered 25 mg of propofol, the document said.

Holy crap!!!

"Jackson finally went to sleep and Murray stated that he remained monitoring him. After approximately 10 minutes, Murray stated he left Jackson's side to go to the restroom and relieve himself. Murray stated he was out of the room for about two minutes maximum. Upon his return, Murray noticed that Jackson was no longer breathing," the affidavit said.

Efforts at CPR proved fruitless, according to Murray.

Shortly after Murray said he found Jackson not breathing, Murray was on the phone with three separate callers starting at 11:18 a.m. and ending at 12:05 p.m., according to the court documents which cite the doctor's phone records.

"Murray didn't tell this to anyone when he was interviewed," the court documents said.

Chernoff denied the timeline referenced in the affidavit.

"Much of what was in the search warrant affidavit is factual. However, unfortunately, much is police theory. Most egregiously, the timeline reported by law enforcement was not obtained through interviews with Dr. Murray, as was implied by the affidavit," the statement said. "Dr. Murray simply never told investigators that he found Michael Jackson at 11:00 a.m. not breathing. He also never said that he waited a mere 10 minutes before leaving to make several phone calls. In fact, Dr. Murray never said that he left Michael Jackson's room to make phone calls at all."

The document also cited reports from staff at the University of California at Los Angeles Medical Center, where Jackson's body was taken, who said Murray "admitted" to having given Jackson flumazenil to counteract the Ativan.

The document lists another five doctors and a nurse practitioner who reportedly treated Jackson.

"Detectives ... believe that the miscellaneous prescriptions, from multiple doctors ... could have contributed to his death," the document said.

"It cannot be determined whether the cause of death is due to the actions of a single night and/or a single doctor, or the grossly negligent treatment of several doctors over an extended period of time."

According to the warrant and affidavit, Murray said he was not the first doctor to give Jackson the powerful anesthetic, which the singer called his "milk." The drug has a milky appearance.

Jackson also told Murray about two unknown doctors in Germany who gave him propofol, according to documents.

Documents show police found eight bottles of propofol inside Jackson's home.

A search of Murray's doctor bag, which he left at the house the day Jackson died, contained multiple bottles/vials of Lidocaine and several bottles/vials of propofol, Ativan, Versed and Anexate, according to the documents.

The affidavit said a search of Jackson's home revealed "numerous bottles of medications" at Jackson's bedside that were prescribed by Murray and two other physicians -- Dr. Allan Metzger and Dr. Arnold Klein.

Many of the drugs "have an indicated or off label use in the treatment of insomnia," the affidavit said.

Metzger's lawyer told CNN last month that Metzger -- who treated Jackson in 2003 -- refused Jackson's request in April for a propofol prescription.

Klein -- a dermatologist who also was Jackson's longtime friend -- has insisted he never gave Jackson dangerous drugs.

Jackson visited Klein's Beverly Hills, California, medical office just days before his June 25 death.

Murray took the job as Jackson's personal physician in May, as the pop star was preparing for a series of comeback concerts set to begin in July at London's O2 arena.

Murray told investigators that Jackson would not tell him what drugs other doctors had given him, but he did tell Murray the medicine given to him by Klein and Metzger was not working, the affidavit said.

The DEA has been unable to find a record of Dr. Murray purchasing, ordering or obtaining any propofol under his medical license or DEA number, according to the documents.

Source: CNN, McHumor, CartoonStock

Why primary care doctors are fed up

Interesting commentary on healthcare reform from the primary care doctor's point of view posted on CNN. I find myself agreeing with some of his points and disagreeing with others--typical of the reform debate.

(CNN) -- Health policy experts agree that any reform in our health care system must include a well-educated, caring primary care doctor who is able to manage the health of his or her patients with an eye to using resources optimally to keep costs down.

That's a tall order and it seems that few policy makers realize the value of primary care physicians.

People are making a huge assumption in this reform effort that as we extend coverage to millions who don't have health insurance, there will be doctors there to actually provide the health care. Fewer and fewer medical students are choosing primary care and many primary care doctors are leaving the field.

Let me share with you why we are losing so many primary care doctors. What follows are a few examples I experience each week.

How many dozens of chest pain patients have I seen in the last month for whom I didn't order an EKG, get a consult, set up nuclear imaging or send for a catheterization?

Only I have the advantage of knowing how anxious some are and that they have had similar symptoms over the last 20 years. After a history and exam, I am willing to make the call that this is not heart disease. In doing so, I save the system tens of thousands of dollars.

Most of these patients are worked into a busy day, pushing me even deeper into that mire of tardiness for which I will be chastised by at least six patients before the end of the day. My reward for working these people in and making the call is at most $75.

How many times has an anxious patient come in demanding an endoscopy who I examined and then decided to treat less invasively for three to four weeks first? Few of these patients are happy no matter how many times I explain that it is reasonable to treat their reflux symptoms for several weeks before endoscopy.

Dr. Vance Harris (right) says primary care doctors get minuscule payment for saving the system huge sums of money.

This delay in referral has led to many tense moments in the last 20 years. The cost savings to the system is thousands of dollars each and every time I am willing to make the call and go with the treatment. My reward is about $55 from Medicare and private health insurers.

How many low back pain patients have come to the office in agony knowing that there has to be something serious to cause this kind of pain? A good history and exam allows me to reassure the patient that there is nothing we need to operate on and that the risk of missing anything is low.

This takes a lot of time to explain as I teach them why they don't need an MRI. If someone else ordered the MRI, guess who gets to explain the significance of bulging disks to an alarmed patient? Setting realistic expectations on recovery and avoiding needless imaging helps saves the system thousands of dollars. My reward is another $55.

How many diabetics do I struggle with, trying to get them to take better care of themselves? How many hours have I spent with teenage diabetics who will not check their blood sugar and forget half of their insulin doses?

Hundreds of hours seem wasted until one day they open their eyes and want to take care of themselves. My reward for years of struggle is a few hundred dollars at best. The savings to society for my hard work and never-give-up attitude is in the tens of thousands of dollars.

I am in my 22nd year in practice, now caring for 3,600 patients. Having me in the system has resulted in savings in the hundreds of thousands of dollars each and every year. My financial incentive to hang in there and work harder is that I now make less than half what I did 20 years ago. This year I will make even less.

These are the reasons so many physicians have left medicine entirely and most of us who are left wonder how long can we continue to work like this? I have always served my fellow man out of a sense of love and compassion. That's why I went into medicine.

I have been richly rewarded by my patients over the decades as they have appreciated my judgment and skills. Isn't it a shame that after all this time and with skills honed by decades of experience, many of us can no longer afford to work as a physician?

No one is talking about this on the national level. If they don't address these issues, then good luck having physician assistants provide the safety net with two years of training. Good luck getting newly trained physicians once they see our salaries. Good luck finding internists in your community with only 1% of medical students going into internal medicine.

Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020, according to the American Academy of Family Physicians. And nearly half of all doctors surveyed by the Physicians' Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

I know this is true because I am struggling to find a primary care doctor to take care of my wife and myself. Now that is ironic. Anyone know who is taking new patients in California?

Editor's note: Dr. Vance Harris is a primary care physician in Redding, California.

Source: CNN

Heidi Montag wrecks at Miss Universe pageant

All I can say is, OMFG! OMFG! OMFG!!!

How could they put her on air, and during a live broadcast? Didn't anyone--from her manager (is that her dumb fuck husband Spencer?), agent, the pageant people, NBC, Trump...someone for Xst sake!--notice that she can't dance at all? Not to mention the efforts at lipsynching an already shitty song sang with a shitty voice. Oh, dear...

It was painful to watch. She looked...watchamacallit...retarded. And the pants...WTF was that?!

That was no Ricky Martin. That was a monumental train wreck, if you ask me.



Source: YouTube