Forensics Talk

Michael Jackson's Hired Physician Says MJ had a Pulse . . . Oh, Really?

  Point of View                                                                         

     According to Fox News today, "Michael Jackson still had a faint pulse and his body was warm when his doctor found him in bed and not breathing, a lawyer for the doctor told The Associated Press on Sunday. . . Chernoff told the AP that Murray was at the pop icon's rented mansion on Thursday afternoon when he discovered Jackson in bed and not breathing. The doctor immediately began administering CPR, Chernoff said."

      OK, I have a slight problem with this info . . . and more than a few questions. First off, if the physician was the one who found Michael Jackson, why wasn't he the one who called 911? Was someone else in the room when the physician found him and was that person asked to call 911? 

   If so, how many minutes passed between the time the physician found him, "warm and with a slight pulse," and the unidentified person called 911 saying that he had no pulse, wasn't breathing, and that the physician was performing CPR? 

  What did his pupils look like? The classic sign of an overdose with narcotics is pin point pupils. After checking a patient's breathing and heart rate, the next thing would be checking the pupils. It can all be done in a matter of seconds.

  And why in the world would a cardiologist not know what any first time CPR trainee is taught - that you have to have a hard surface beneath the patient or CPR won't work? A bed is way too soft.

  I once arrived to visit a home health care patient, only to find him in complete arrest (after a "night of partying"). The first thing I did, after assessing his respiratory, cardiac and pupil status, and asking the family to call 911, was pull him to the floor and begin CPR. Geezz, how long has it been since this guy renewed his CPR certification? We're required to renew every year. 

  According to Fox news, "Dr. Murray has never prescribed nor administered Demerol to Michael Jackson," Chernoff said. "Not ever. Not that day. ... Not Oxycontin (either) for that matter."

  Well, that's all fine and good. But did the good doctor know about the drugs? It's one thing to practice in an office, and the patient not tell you they are taking drugs, quite another to be living in residence with that patient and not know what was going on.

   Whether he actually wrote any prescriptions, or actually gave any narcotics, or any other drugs, to Michael Jackson or not, it was still that physician's responsibility to know what was going on with his patient and what drugs that patient was taking.

Did he give any to Michael Jackson at any time? Sometimes drugs can react negatively with each other and increase the effects of other drugs, especially if there are other conditions, like kidney or liver disease, whereby the drugs couldn't be cleared properly from the body. This could possibly cause a build up of drugs in his system.

   In other words, Demerol, being a respiratory depressant, could increase the effects of any other meds, built up in his system, which would also have a respiratory depressive effect. Together, they could severely depress the respiratory system by acting on the respiratory center of the brain which controls breathing. The combined effect could also decrease the patient's heart rate, blood pressure, and circulation, potentially causing a cardiac arrest.

   Whether Dr. Murray prescribed Demerol or not, if he was aware that Michael Jackson was taking it, long term, he should also have been aware that Demerol, or any other narcotic, is not an appropriate treatment for chronic back pain and, most definitely, not appropriate treatment for a fractured leg that reportedly had occurred years before. It was his job to know these things. I did check his name and license out on the CA Medical Board website. It stated, "No records returned." Although it's possible to obtain a temporary licensure, according to the research, it's usually reserved for visiting professors or to complete continuing educational requirements in a different state from which the original license was obtained.

   Narcotics are Schedule II drugs used for pain relief of acute injury only and its use is severely restricted by law under the Control Substances Act. NSAIDS (Non-steroid anti-inflammatory drugs) are usually the appropriate choice for chronic back pain, not narcotics.

   If Michael Jackson was actually being given Demerol, or any other narcotic, long term, as reported, then the investigation should determine who prescribed the narcotic, who obtained it, and who gave it. Someone had to have done so. IMO, the facts, as they are coming out, just don't pass the smell test at the moment.

 

 

 

 

Autoerotic Asphyxia A Dangerous Game

     Much has been made by the media over the tragic death of David Carradine who was found hanging in his Bangkok hotel room. The initial report, indicating a suicide, was later replaced with the news that he died of possible autoerotic asphyxia; meaning, possibly an accidental death, rather than intentional suicide.

     Either way, it's still a tragedy for Mr. Carradine's family, made much worse by the intense scrutiny of the news media. My heart goes out to them. While David Carradine was a well known celebrity, he was still a human being, with a family who loved him, and they should be afforded a certain amount privacy.

    Having said that, because of that intense scrutiny, I feel it's important to post some facts about this unusual manner of death in order to get the word out to the public and, hopefully, prevent copy cat deaths from occurring.

    Although, according to Dr. Park Dietz, co-author of Autoerotic Fatalities ( Dietz, et al., 1983), the media is "not a suitable medium to discuss this syndrome", due to copy cat behavior. It's for that very reason that I feel it's appropriate to discuss it in this blog. In fact, according to the above cited article, two fatal incidents occurred following the viewing, against Dr. Dietz' advice, of a show on autoerotic asphyxia, by persons who had viewed the show.

     Autoerotic asphyxia is an unusual, though not unheard of, manner of death. It has been documented since the 1600's, for treatment of erectile dysfunction and impotence, and is described as being among the most bizarre of the "paraphilias," or abnormal sexual behaviors. It occurs primarily among adolescents and young adult males.  

     In the book, Autoerotic Fatalities by Hazelwood et al. (1983), the authors suggest that the most common psychological processes underlying autoerotic asphyxia ". . . are the desire for the subjective experience of hypoxia, the acting out of a masochistic fantasy that includes being abused, tortured, or executed, and the desire to be sexually aroused through risk-taking."

Autoerotic asphyxia typically begins in adolescence and most fatalities occur in this age group. According to the paper, The Autoerotic Asphyxiation Syndrome in Adolescents and Young Adult Males, "A study of five teen survivors showed "a history of choking, physical abuse, sexual abuse, other risk-taking behaviors, and pairing of sexual arousal with the choking experience.

   Their behavior was found to be ritualistic and compulsive . . .  physical and sexual abuse can be precursors to the abnormal sexual behavior." This behavior is often seen in introverted male teens engaging in increased sexual fantasies. The adult practice has been named "terminal sex" or "scarving". Most victims are heterosexual and there's usually no known history of deviant sexual behavior. Unfortunately, since there are few survivors, there is still too little information to determine the exact causes.

    Of course, from a death investigation stand point, the first question is whether it was an intentional suicide or an accidental death? Two elements are required to conclude suicide:

(1) The intent of the victim to commit suicide

(2) A specific act which carries out the suicide. The scene of death, if left undisturbed, will usually reveal the clues.

     The obvious question is what was the intent of the victim? Was it an intentional suicide or the acting out of sexual fantasies? And how do we tell? According to Dr. Mary H Dudley, Chief Medical Examiner for Sedgwick County, Wichita, KA, from whom I took my death investigator training, those investigating the death scene, "should not jump to conclusions . . . examine the scene very closely, listen to the family, and check that nothing has been moved."

   This last part is very important, as family members often conceal or destroy evidence at the scene, or alter the body. "The visual memory of the death scene becomes imprinted in the family member's mind forever." It can be done for any number of reasons, including embarrassment, financial gain, religious beliefs, or the social stigma involved with suicides. In a hanging death, the knot of the ligature is the most valuable piece of evidence. It should never be altered. If the ligature has to be cut off the body, it should be cut away from the knot.

   According to the media reports, David Carradine was found hanging with his hands tied behind his back. However, photographic evidence from the scene, published by Thai Rath newspaper, showed "hands apparently bound together above the head" [Carradine family upset by Thailand By: Bangkokpost.com and Agencies], which would indicate an accidental autoerotic asphyxiation death, rather than an intentional suicide.

Suicide

A death investigation of suicide begins with interviewing family and friends in order to create a "psychological autopsy," followed by reviewing the victim's past medical and mental history. The medical examiner will search the body for signs of previous attempts, such as "hesitation marks". These are marks and scars along the wrists, arms, or neck, made by someone who starts to cut, then changes their minds.  Multiple old scars, from such attempts, are often seen. In my work I've seen this on several females, from a few old, healed, superficial cuts along the wrist areas, to multiple scars all over their bodies.

   Past history of depression is also a strong indicator. Prior attempts are seen in as much as 20-60 percent of successful suicides. While the CDC states that teen suicide was the 3rd leading cause of death among young adults and adolescents, 15 to 24 years of age, peak age for suicide by males is 55-65 and females is 60-70.

Suicide Risk Signs

 Sudden, unexpected mood changes - especially going from an extremely agitated state to one of "calm deliberation"

 Increased depression or exalted mood

 Increased fatigue and sleeping

 Suddenly giving away personal belongings

 Making peace with others

Suicide Death Scene Signs

A suicide note

A tape/video recording

The body is found in a locked room

Firearm residue on the hands

Evidence of prior rehearsal

Presence of the book, Final Exit or a recent membership in the Hemlock Society

Recent grief over loss or threat of losses

Recent purchase of weapons

Prior suicide attempt

Autoerotic Death Scene

The victim:

 Usually male, between the ages of 12-25

Is found dead of asphyxia by hanging, a plastic bag over his head, or by gas.

He is either naked or is wearing female clothing

 There is usually pornographic material and a mirror found close by

He's usually found by a family member in his bedroom or other private area of the home

Appearance of solo sexual activity in conjunction with the Asphyxia

 Suicide Intent

Victims often found alone or in a secluded location

Signs of suicide (see above)

Ligature will have no release mechanism

No pornographic material or mirror

Usually a note or video left behind

Accidental Autoerotic Suicide

Victims often found alone or in secluded location

No apparent suicide attempt

No obvious intent

Evidence of a physical mechanism for enhancing sexual gratification

Evidence of a safeguard mechanism

Evidence of sexual fantasy aides

May have bondage items

Evidence of prior dangerous autoerotic practice

Caution

  Parents, it's important that you monitor your teen's activities both online and off. Studies have shown that many learned of this behavior through word of mouth, detective magazines, sex manuals, and pornographic literature and media - easily available on line.

    Counseling, education, law enforcement, and clergy should all be used to help family and friends cope with such an extremely traumatic event. In addition, in my opinion, while they should be offered strong emotional support, they should also be allowed their privacy in which to grieve for their loved one.

 

Infant Suffocation Deaths Are Rising

WEB MD

But Study Shows Sudden Infant Death Syndrome Is Declining

By Bill Hendrick
WebMD Health News

Reviewed by Louise Chang, MD

Jan. 26, 2009 -- Rates of infant mortality due to accidental suffocation and strangulation in bed have quadrupled since 1984, a new study shows.

In the same period, rates of sudden infant death syndrome (SIDS) declined, while sudden unexpected infant deaths remained stagnant, shows the study, published in the February edition of Pediatrics.

The seeming contradictions in increases and declines in deaths of infants are likely due to changes in the way such tragedies are investigated and classified, researcher Carrie K. Shapiro-Mendoza, PhD, of the CDC, tells WebMD.

She credits an "impressive" decline in SIDS cases to a national "back to sleep" campaign that, among other things, urges parents to put babies to sleep on their backs.

The reason for the sharp increase in accidental suffocation and strangulation in bed, or ASSB, isn't known for sure.

"It's probably due to poor bedding, blankets in cribs, sleeping with parents or siblings, or bad habits," she tells WebMD. "Or infants getting wedged between the mattress and the wall."

Also, despite urgings from the American Academy of Pediatrics and the CDC, many parents still put babies to bed on their stomachs, which can lead to suffocation.

The decline in SIDS rates has been offset by an increase in other sudden unexplained infant deaths, a new category called SUIDs. ASSB death, a subgroup of SUIDs, is a leading cause of infant mortality, says Shapiro-Mendoza... Read More

The Body Farm: Unique Forensic Research Facility

  NEWS VOA COM

Mike Osborne                                                                            
Knoxville, Tenn
13 May 2008

        TV dramas that follow detectives as they investigate a crime have long been a staple of American television. But in recent years, these shows have taken a decidedly graphic turn, focusing on the forensic teams that examine the victim's body and look for evidence that can help investigators bring the killers to justice.

     While autopsies, blood spatter analysis and DNA research apparently make for entertaining television, Mike Osborne discovered that real forensic science is far less glamorous.

     It's a beautiful spring day in East Tennessee. The trees are just putting on leaves and every shrub and wildflower is in full bloom. But as you enter one of the most unusual research facilities in the world, even the sweetest smelling blossoms can't mask the stench of rotting flesh.                                                 

This is the Anthropological Research Facility at the University of Tennessee in Knoxville, a facility more commonly referred to as The Body Farm.... Read More

Ligature Strangulation: Not Very Common But Contested Too Often.

Crime & Clues

The Art and Science of Criminal Investigation

The following article is presented in both the Posts & Pages sections:

One finding. Many conclusions

Abstract:

This paper discusses the difficulties in differentiating ligature strangulation from hanging during life and also after death.

   The cases shown are those cases of hanging, which appeared and were considered to be that of ligature strangulation or that of Post Mortem hanging till few weeks after the autopsy.

   These controversial homicides turned out to have been suicidal deaths due to hanging. The cases highlight the difficulty in differentiating hanging during life or immediately after death.

   The controversies in hanging are relevant because hanging being presented, as ligature strangulation and ligature strangulation being contested as hanging are not rare.

   The paper also discusses the possibility of mistaking ligature strangulation for hanging during life...

Read Full Abstract

Girls' Suicide Rates Rise Dramatically

CBS News
ATLANTA, Sept. 6, 2007

                CDC Advises Prevention Programs To Focus On Gender And Age Groups Most At Risk

    (AP) The suicide rate among preteen and young teen girls spiked 76 percent, a disturbing sign that federal health officials say they can't fully explain.

For all young people between ages 10 to 24, the suicide rate rose 8 percent from 2003 to 2004 - the biggest single-year bump in 15 years - in what one official called "a dramatic and huge increase."

The report, based on the latest numbers available, was released Thursday by the Centers for Disease Control and Prevention and suggests a troubling reversal in recent trends. Suicide rates had fallen by 28.5 percent since 1990 among young people... Read More

Dialysis Deaths Prompt Warning

24 patients in Md. died from bleeding; precautions urged

By Jonathan Bor

sun reporter

Originally published January 25, 2007

     The Maryland medical examiner's office has called attention to the cases of 24 kidney dialysis patients who bled to death, usually at home alone, prompting health agencies to alert dialysis centers and patients to take precautions.

Dr. David Fowler, the state's chief medical examiner, said the cases of 22 people who died at home and two others who died at dialysis centers since 2000 came to light after he noticed a cluster and asked his staff to review records. A regional coalition of kidney programs said it is aware of 38 deaths over the six-year period.
Full Article

Missing Toddler’s Body Found in Septic Tank

From MSNBC

Updated: 7:36 p.m. ET Jan 27, 2007

   Remains of 3-year-old missing since Wednesday discovered near his home

    

KALISPELL, Mont. - The body of a 3-year-old boy was found in a septic tank less than 10 feet from the house where he was reported missing, Flathead County Sheriff Mike Meehan said Saturday.

The body of Loic J.M. Rogers was found late Friday, and an autopsy showed that he drowned, Meehan said.

It was unclear how the boy got into the septic tank, and the manhole-sized lid was closed. Meehan said investigators do not believe he could have climbed into the tank and put the lid back on himself, but declined to speculate how Loic may have gotten inside. An investigation is continuing.

Full Article

Hospital Liable For Covering Up Child's Injury

By Dick Dahl Staff writer

© 2007, Lawyers USA

       An Oklahoma jury ordered a university hospital to pay $18 million to parents who were investigated for abusing their 9-month-old son after a CAT-scan showed the boy had a fractured skull.

The injuries had actually occurred when a nurse at the hospital accidentally bumped the infant's head on a nightstand, but she failed to report the incident and the parents became the prime suspects.

Although this suit was filed as a straight medical negligence case, the last-minute evidence of the hospital's alleged cover-up prompted a $9 million punitive damage award, according to the plaintiffs' attorney, Gerald Durbin.

  The Accident:
Full Article

 

Family of 3rd Preemie To Die of Overdose Speaks

Indiana infants were accidentally given adult-sized doses of blood thinner
From MSNBC (AP)

INDIANAPOLIS - The grandmother of a third premature infant who died after being accidentally given an adult-sized dose of blood thinner medication at a hospital said Wednesday that she prayed other families wouldn’t go through what she had, because it was hard “to sit there and watch my granddaughter die.”

The baby girl, Thursday Dawn Jeffers, died late Tuesday at Riley Hospital for Children five days after she was born at Methodist Hospital. She had been transferred to Riley once her condition worsened from receiving an adult dose of heparin, a drug routinely given to premature babies.

Full Article

Point of View 

As a former neonatal intensive care unit nurse, I find the actions of the hospital personnel completely unacceptable. It goes without saying that the behavior, which lead to the deaths of these three preemies, was way below the accepted standard of care. This is so sad. These deaths could have been prevented so easily.

   First of all, I really don't care that the pharmacy technician accidental left adult doses of heparin on the preemie unit by mistake. Yes, he/she was wrong and should be held accountable. No question. Mistakes happen. However he/she is not the primary person who should be held accountable.

      The person who should be held the most accountable is the nurse who gave the patient the heparin dose.  The nurse is always the person directly responsible for giving the medications.

     This is basic nursing 101. Double check. Always double check! Certain safeguards are supposed to be in place to prevent just this type of tragedy. The very first one is to always double check the medicine and the dose to see that it's what the physician ordered!

   This is basic standard of care that's used in every medical facility, on every single unit. This procedure has been in place for decades. It was among the very first things we were all taught way back when in nursing school.

     Even when I worked in the preemie unit 20 years, we had certain other safeguards in place. Primarily, to always have two nurses check every single medicine before it's given to a preemie, to make sure it's the right patient, the right medicine, the right time, the right route of administration, the right dose. These are known among all medical personnel as the five R's.

     I read in the article that the hospitals will now put the safeguard of having two nurses check the medicines into practice. They're just now getting around to this? That's inexcusable! There's no way their policies and procedures could be that far behind!

     Many hospitals these days are using what's called the Pixis system. A wonderful system. It's an automated medicine cart that's computerized and filled by pharmacy. After selecting the medicine, a drawer pops open to allow the nurse to get the medicine out. It's supposed to help prevent medication errors from happening - and it does if it's used correctly. But we nurses have to do more.

   We can't just rely on automated machines to dispense medications properly. We have to use our brains and our eyes too. Modern technology is great and has been a wonderful boon to the medical field. Computers are everywhere. Patients are diagnosed faster and more accurately, and the work load is much more streamlined - which helps everyone.

     However, computers can't do everything. We shouldn't become too complacent, relying too heavily on computerized machines, to replace people who should be using their brains and practicing the skills they've been taught.

   I feel bad for those nurses. I really do. We are only human and we all make mistakes. I can't begin to imagine what they'll have to live with for the rest of their lives. But I feel worse for the parents of those babies, and I feel more pain for them because it's their babies they will have to learn to live without.

 

Police: 3 college students died by violence

Deaths occurred after drinking, party in home near Wyo. university campus

Updated: 5:17 p.m. ET July 17, 2006

LARAMIE, Wyo. - Three college students found dead in a home near the University of Wyoming campus had been drinking that night and died violent deaths, police said Monday.

The three victims and another student who was injured in the attack knew one another and apparently had been having a small party that night, Laramie Police Commander Dale Stalder said.

Investigators were still trying to piece together what happened in the home early Sunday, but Stalder said they believe everyone involved had been accounted for and were considering the possibility it was a murder-suicide.

Full Article

Ligature Strangulation: Not Very Common But Contested Too Often.

(One finding: many conclusions)

Abstract:

This paper discusses the difficulties in differentiating ligature strangulation from hanging during life and also after death. The cases shown are those cases of hanging, which appeared and were considered to be that of ligature strangulation or that of Post Mortem hanging till few weeks after the autopsy. These controversial homicides turned out to have been suicidal deaths due to hanging. The cases highlight the difficulty in differentiating hanging during life or immediately after death. The controversies in hanging are relevant because hanging being presented, as ligature strangulation and ligature strangulation being contested as hanging are not rare. The paper also discusses the possibility of mistaking ligature strangulation for hanging during life...

Read Full Abstract