Sunday, April 1, 2012

Shades Of Grey

By now we are all too familiar with the sordid details of Dr.(?) Conrad Murray and his unscrupulous treatment of Michael Jackson. We all know how he gave the anesthetic propofol for treatment of insomnia in a private bedroom with no monitoring equipment, no supplementary oxygen, and no presence of the doctor himself when the late singer needed him most when he went into respiratory and cardiac arrest. We anesthesiologists loudly and sanctimoniously proclaimed that propofol should never, NEVER, EVER be given in a private home.

Now comes the story of Dr. Robert Markman. Dr. Markman is a retired anesthesiologist who just had his medical license suspended by the California Medical Board for giving his daughter propofol in a converted bedroom in her house. The Northridge, CA physician was charged by the Board with giving his daughter propofol 500 times over the last five years. She had been suffering from debilitating pelvic pain for seventeen years that had not been able to be controlled by other doctors. As a last resort, he started giving her propofol every three days which he claimed gave her the best pain relief she ever had.

Unlike Dr. Murray, Dr. Markman kept detailed records of his daughter's medical treatments. In fact he gave the Medical Board over 1200 pages of records to prove he was legitimately treating his daughter/patient. Presumably as an anesthesiologist he also had all the usual ASA mandated monitoring equipment in her bedroom while giving her the anesthetic.

So now we have a dilemma. Is the use of propofol ever appropriate outside a hospital or surgery center setting? If somebody's bedroom is equipped with oxygen, monitoring equipment, and personnel trained in giving an anesthetic, can it be legitimately used for giving sedation? Can a room be used for sedation or surgery only if it is inspected and certified by a government agency or can anyone set up a cubicle somewhere with all the necessary equipment and personnel and start giving propofol? With Dr. Murray, the answer was crystal clear. In Dr. Markman's case, the answer is a lot murkier.

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