Homicides Using Anesthesia Medications Increase - Examined in Medical Journal

A study published in March’s issue of Anesthesiology examines several homicides involving anesthetic drugs and calls on anesthesiologists to assist in the investigation and prosecution of criminals who divert and kill with these drugs.

The 2009 death of singer Michael Jackson from propofol, a widely used anesthetic, along with the ruling that the death was a homicide, heightened the profile of this issue. The article outlines the experiences of anesthesiologists in several investigations and prosecutions.

“The role of anesthesiologist is that of a healer and defender of life” said Robert E. Johnstone, M.D., lead study investigator. “Seeing the harm done to victims in these cases, several anesthesiologists have offered their expertise to help solve these crimes and bring the perpetrators to justice. This paper outlines the cases and these anesthesiologists’ experiences.”

Dr. Johnstone also calls on anesthesiologists to continue to work with health care providers and administrators to stop drug diversion.

Anesthesiologists can support criminal investigations by:

1. Recommending to prosecutors specific anesthetic drugs, muscle relaxants and metabolites for tissue and blood analysis. 
2. Explaining the meaning and limitations of drug tests. 
3. Explaining how muscle relaxants and anesthetic drugs can cause death. 
4. Describing probable routes for drug administration. 
5. Explaining drug dosages and effect timing. 
6. Explaining anesthetic drug storage and access issues in institutions. 
7. Explaining the probability of various natural causes of death.
8. Describing the anesthesiologist’s expert qualifications.

About the Study
The article reports on four homicides and one attempted homicide involving medications typically used during anesthesia such as rocuronium, succinylcholine, fentanyl, and pancuronium. These are cases where anesthesiologists provided insight into the investigation and prosecutions.

“The person on trial in cases involving murder by muscle relaxants or anesthetic drugs is often a health care worker, occasionally a physician,” said Dr. Johnstone. “The drugs used in four of the cases reported in this article came from hospitals. Drug diversion from operating rooms is a recognized problem, especially with the storage of such medications throughout hospitals, possibly making their diversion easier.”

The Drug Enforcement Agency has not classified muscle relaxants or propofol as controlled substances, so they are not individually tracked in most hospitals.

To learn more about the specific cases, please visit the journal's website to access the complete article.