Conrad Murray's Mistakes, Part 5: Isolated from his peers, Michael Jackson's doctor had no cover

by

CHJ Fellow

March 1, 2010

Far fewer people would know Dr. Conrad Murray's name if Michael Jackson had died in a hospital.

Not only would Murray have people with similar training around to corroborate his story, but he would have entered the secretive peer review system.

Doctors have the power to conduct "peer reviews" at hospitals that could lead to a doctor losing his privileges to perform surgeries, see patients and otherwise practice medicine there. In the best case scenario, physicians police their own and take stern – albeit secretive – action.

This is what happened in the Dr. Andrew Rutland case initially when physicians at Placentia Linda Hospital voted to ban him from practicing there. None of Rutland's patients were notified about this. And, even though the hospital told the Medical Board of California, as it was required by law to do, the board dithered for nearly a decade before taking Rutland's license away.

As Public Citizen has pointed out, the Placentia Linda doctors were outliers. All physicians who are disciplined are supposed to be reported to the National Practitioner Data Bank, which was created to help hospitals stop dangerous doctors from moving from place to place without any repercussions. But since the NPDB was created about 20 years ago, nearly half of all hospitals have never reported a doctor.

This is shameful, but it is driven by an understandable "there but for the grace of God go I" impulse.

The most compelling first-person accounts written by physicians are almost always tales of them narrowly averting disaster or fighting valiantly to save a patient who just couldn't be saved. Dr. Atul Gawande, one of the best-read and best-loved medical writers in the world, wrote a book, Complications, about the difficulties of making the right decision in medicine. He opens with an anecdote about making the wrong diagnosis on a shooting victim and performing an unnecessary surgery to go after a bullet he ultimately could not find.

A couple days later we got yet another abdominal X-ray. This one revealed a bullet lodged inside the right upper quadrant of his abdomen. We had no explanation for any of this – how a half-inch-long lead bullet had gotten from his buttock to his upper belly without injuring anything, why it hadn't appeared on the previous X rays, or where the blood we had seen had come from. Having already done more harm than the bullet had, however, we finally left it and the young man alone. We kept him in the hospital for a week. Except for our gash, he turned out fine.

The club of physicians is so secure that Gawande has no qualms relating this story. He made a bad call, but don't we all?

Reporters should think about the last time they noticed an error in one of their colleagues' stories and pointed it out to an editor. (I can tell you how often I have done this: never.)

Misspelled names on the front page, though, usually don't result in suffering or death. And Gawande's example is of a patient who walked away. The trouble is that the same system that protects the innocent mistakes also protects dangerous patterns of negligence. Murray would have enjoyed this protection if he had taken Jackson's money but refused to treat him with hospital-grade drugs anywhere but a licensed health care facility.

By wandering so far outside of his specialty and by working exclusively in Jackson's home, however, Murray isolated himself from his peers and the perks that go with membership in that club.

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Conrad Murray's Mistakes, Part 5: Isolated from his peers, Michael Jackson's doctor had no cover