Los Angeles prosecutors filed a long-anticipated involuntary manslaughter charge against Michael Jackson's personal physician Monday as the coroner's office made public a report concluding that the care the singer received in the final hours of his life violated accepted medical standards.
Dr. Conrad Murray, a cardiologist hired to care for Jackson during the pop star's ambitious comeback attempt last year, pleaded not guilty in a courtroom near Los Angeles International Airport packed with international media and members of the entertainer's family. Outside, a handful of fans held signs and wore T-shirts reading "Justice for Michael."
The 51-page coroner's office report of Jackson's June 25 death suggests that to prove manslaughter, prosecutors, who worked closely with the office's medical investigators and experts in building a criminal case, will focus on Murray's use of the operating-room anesthetic propofol as a sleep aid.
The coroner's office previously said Jackson died from "acute propofol intoxication" in combination with the use of sedatives. The report released Monday went further, describing the level of anesthetic as enough to render a patient unconscious for "major surgery."
Murray told investigators that Jackson, 50, was a chronic insomniac who had depended for years on propofol -- a white liquid the singer called "milk" -- to sleep, according to police affidavits filed in court. But an anesthesiologist consulted by the coroner's office wrote in the report that she knew of "NO reports of its use for insomnia relief."
"The only reports of its use in homes are cases of fatal abuse . . . suicide, murder and accident," Dr. Selma Calmes wrote.
She added that because of the risk of respiratory or cardiac side effects, propofol should be administered only by anesthesiologists or others trained to recognize those complications. "Full patient monitoring is required any time propofol is given," she wrote.
The setup in Jackson's bedroom did not include proper monitoring or precise dosing equipment, and an oxygen tank at his bedside was empty, according to the report.
In addition, Murray acknowledged leaving Jackson alone and under the influence of the drug for what he said was a two-minute visit to the restroom, according to police affidavits.
Whether Murray was negligent in administering propofol to Jackson will probably be the central dispute in his involuntary manslaughter prosecution, experts say.
