Murray case puts showbiz doctors in the dock

Michael Jackson's killer may have been part of a wider culture of malpractice

The placards waved outside Los Angeles Superior Court might have told Dr Conrad Murray to "Burn in Hell!" but to a small and discrete group of his fellow professionals, the man convicted of Michael Jackson's involuntary manslaughter was simply unlucky to have been caught.

Monday's guilty verdict has sent ripples of concern through the ranks of so-called "concierge doctors", the highly-paid and lightly-regulated breed of private physicians who have for years been catering to the exotic medical demands of America's most famous.

Long suspected of placing the demands of high-profile clients ahead of medical ethics they have until now operated largely without sanction. But the fate of Dr Murray suggests their days of criminal impunity are over.

The US is suffering from a prescription drug epidemic. Figures released last month revealed that deaths linked to over-the-counter medications are now approaching 40,000. With this in mind, prosecutors are less prepared to react leniently to allegations of abuse.

That Michael Jackson's $150,000-a-month private quack agreed, in 2009, to purchase a four gallon domestic supply of propofol, a hospital-grade anaesthetic the late singer was in the habit of taking to ward off insomnia, is mind-boggling. That he failed to properly monitor his patient, botched an attempted resuscitation, and lied to paramedics only adds to his air of sublime recklessness.

But in normal circumstances Dr Murray would have been highly unlikely to face criminal proceedings, still less to be convicted. Traditionally, the very worse sanction facing professionals of his standing might be a compensation lawsuit, which would most likely be settled by insurers, out of court.

Although prescription drug abuse has been part of Hollywood for as long as wealthy celebrities have been customers of the world's most capitalistic healthcare system, it has historically been notoriously difficult to make homicide charges stick against the physicians who "enable" the addictions of their starry clients.

No one was ever held accountable for supplying Marilyn Monroe with the barbiturates which killed her in 1962. And when Elvis Presley, who was addicted to Dexedrine and codeine died in 1977, his full-time doctor George Nichopoulos was later stripped of his medical licence, but acquitted of all criminal charges.

More recently, no charges were levelled in the case of Heath Ledger, who died in 2008 from what coroners called "the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam, and doxylamine." Neither was anyone held responsible for the death of Brittany Murphy, who passed away in 2009 with 24 empty pill bottles in her bedroom. Cases which did end up in court have mostly failed. When Anna Nicole Smith's former lawyer and doctors were prosecuted last year for "dispensing controlled substances to an adult" one of them, Sandeep Kapoor, was totally acquitted, one, Howard K Stern, acquitted on appeal, and one, Khristine Eroshevich, given 12 months probation for a minor count of fraud.

Part of the problem facing prosecutors is that it's often impossible to hold a single doctor responsible for a famous client's woes. A recent paper in the Expert Review of Clinical Pharmacology suggested that the itinerant celebrity lifestyle helps them source drugs such as Vicodin – a highly-addictive painkiller – from a diverse assortment of physicians. "The involvement of multiple doctors working without a unified medical record may be an important point of vulnerability leading to potentially dangerous drug interactions," noted the paper. "Indeed, 'doctor shopping' might have been the case in the death of Brittany Murphy."

Another problem has been a lack of will. Previously prosecutors have preferred to pursue professional misconduct cases, rather than full criminal complaints, since they are easier to nail. Jackson's high-profile death has raised the stakes, though. The prosecution of Conrad Murray serves notice that a patient's fame can never place doctors outside the law. "The enabling doctors are in denial of their own co-dependence. Frequently they are very narcissistic. And they want to be important in the life of the patient," said Deepak Chopra, the television doctor and former friend of Michael Jackson. "It's a very lucrative profession. It's unethical, and [now] it's criminal."

Dead famous: Prescriptions that killed

Heath Ledger

The Oscar-nominated actor died in 2008 after accidentally overdosing on a cocktail of prescription painkillers, anti-anxiety drugs and sleeping pills, according to New York authorities. Ledger was 28 years-old when he died, and was best-known for his critically acclaimed roles in 'Brokeback Mountain' and the Batman film 'The Dark Knight'.

Marilyn Monroe

An empty bottle of sleeping pills was reportedly found by the screen icon's side when she was found dead in her hotel room in August, 1962, but speculation over the true cause of her death continues. Some believe she committed suicide, some think she accidentally overdosed on prescription pills, and others suggest a third party may have been involved.

Brittany Murphy

A lethal combination of pneumonia, anaemia and prescription drugs caused the 'Clueless' star's death in December 2009, according to the Los Angeles coroner. Investigators reportedly found more than 10 different types of pills on the 32 year-old's bedside table, including treatments for migraines and depression.

Anna Nicole Smith

A six-week investigation came to the conclusion that the former 'Playboy' model had not committed suicide in her Florida hotel room in 2007, but had died after taking nine prescription drugs. Authorities said each drug was present in her bloodstream in small amounts, but it was their combined effect which had proven deadly.

Elvis Presley

Plenty of conspiracy theories abound over the death of the King, one of which includes the suggestion that a titanic appetite for prescription drugs may have killed him. George Nichopoulos (who spent a decade as Elvis's personal physician before his medical licence was revoked) has admitted prescribing around 10,000 doses of drugs (including laxatives and hormones) for Elvis in 1977 alone – the year that the singer died in August in his Memphis mansion at the age of 42.

Enjoli Liston