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Malpractice or Manslaughter: Comments on People v. Conrad Murray

By Kevin M. Miller

The recent guilty verdict in the criminal prosecution of Dr. Conrad Murray for the death of pop star Michael Jackson has left many wondering, what is the distinction between a death that results from medical malpractice and a death as a result of a crime? Under what circumstances will a healthcare provider face criminal prosecution for a patient’s unfortunate outcome?

The criminal prosecution of a healthcare provider for the death of a patient is a rare thing, compared to being sued for civil medical malpractice. Just look at the numbers. It is generally believed that one third of all physicians in the low risk specialities will face at least one medical malpractice claim before they reach age 45. Contrast that with the research published recently in a law review article which found only 30 cases of criminal prosecution against physicians between 1981 and 2005 nationwide. D. Hoffmann, Physicians Who Break the Law, 53 St. Louis U.L.J. 1049, 1082 (2009).

So what distinguishes that rare criminal case, making certain facts criminally wrong as opposed to civilly wrong, and when should the healthcare practitioner anticipate criminal prosecution for misdeeds? To answer this question, keep two principles in mind: a criminal state of mind (degrees of which can be described as recklessness or intentional conduct), and a gross deviation from the standard of care.

Criminal law has no interest in prosecuting anyone for an honest accident or a mistake in judgment. To readily identify conduct that is criminal, the law requires the accused to be found to have acted with a criminal state of mind. If a healthcare provider would ever intentionally cause the death of a patient, few would criticize the law for the provider’s subsequent prosecution for murder, as an intent to cause death is criminal. Similarly, when a healthcare provider recklessly causes the death of a patient, he opens himself up to prosecution for manslaughter.

A simple example can distinguish between the most serious criminal state of mind of intentional conduct, and the less serious criminal state of mind of recklessness. Imagine a street party with crowd of people tightly packed into a confined area. If an onlooker throws a beer bottle into that crowd to strike a certain, identified individual in that crowd, he has acted intentionally. But if the onlooker throws his bottle into the crowd without meaning harm to any particular person, but with that knowledge that his action carries a high likelihood that someone will get hurt, he has acted recklessly. Generally speaking, either intentional conduct to cause harm to a specific person, or reckless conduct that carries a high likelihood to cause harm, is necessary to establish criminal liability, with the former carrying stiffer penalties.

Once there has been a finding of criminal intent made, typically a finding of a gross deviation from the standard of care is also required to turn malpractice into criminal activity. A mere breach of the standard of care is not enough: flagrant acts departing from normal standards are typically seen in criminal prosecutions.

Dr. Conrad Murray was charged with the involuntary manslaughter death of Michael Jackson in that he administered Propofol to the singer at Jackson’s home, rather than at a hospital or out-patient care center where proper safeguards and monitoring of the patient’s condition could be undertaken. He was not charged with murder, as he had no specific intention of causing Jackson’s death. Instead he was charged with manslaughter: displaying a recklessness about the way he administered medical treatment to his patient. The judge in the case, the Hon. Michael Pastor of Los Angeles Superior Court, instructed the jury as follows:

“Criminal negligence” involves more than ordinary carelessness, inattention, or mistake in judgment. A person acts with criminal negligence when:

  1. He or she acts in a reckless way that creates a high risk of death or great bodily injury; AND
  2. A reasonable person would have known that acting in that way would create such a risk.

The jury hearing Dr. Murray’s case found him guilty of manslaughter. He was sentenced on November 29 to four years in prison, and recently filed an appeal.

The lesson learned from Dr. Conrad Murray’s trial is simple: so long as the healthcare provider does not intentionally cause harm, he/she is safe from prosecution for the most serious of crimes. And to the extent that any patient’s wrongful death is a result of an accident or error in judgment, and not the result of criminally reckless conduct, the law has no interest in pressing criminal charges.

Originally published in the Winter 2011 edition of Quinn Quarterly.

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