How did Michael Jackson really die?

It's hard to say, I'll just give you the Chinese translation of Jackson's time, you define it yourself Sources: 1. Detective W. Porche, LAPD - West Los Angeles Division 2. Detective S. Smith, LAPD - Robbery-Homicide Unit 3. UCLA Medical Center, Medical Records #397-5944 Investigation: June 25, 2009 At 3:38 p.m. Detective W. Porche from the LAPD listed this case as an accidental death or natural death case for presentation to the Los Angeles Department of Coroner. At 4:15 p.m. Police Lieutenant F. Corral assigned the death investigation to me. I arrived at UCLA Medical Center at 5:20 p.m. with Assistant Chief E. Winter and Court Forensics Investigator A. Perez. After my thorough examination of the body at the hospital, the decedent was transferred to the Coroner's Court Forensic Science Center (FSC) by the LAPD Air Division. Court Forensics Science Section Investigator Perez was responsible for escorting the decedent's body during the transfer. Assistant Chief Superintendent E. Winter and I left the hospital for the decedent's residence. We arrived at the decedent's residence at 7:10 p.m. I then investigated the scene. We left the scene to return to FSC at 8:20 p.m. Location: Place of Death: 757 Westwood Plaza Boulevard, UCLA Medical Center, Los Angeles, California 90095 Informant's/Witness's Testimony: The following information is preliminary and is subject to further investigation by the appropriate jurisdictions, and the record may vary. I spoke with Detective S. Smith of the Los Angeles Police Department, who reported that at approximately 1:00 a.m. on June 25, 2009, Decedent called his primary care physician, Dr. Corad Murray, a cardiologist. Dr. Murray went to the decedent's residence and rendered medical assistance. The exact details of the medical assistance are not known at this time; however, decedent slept for several hours with Dr. Murray at his bedside. At approximately 12:00 p.m., Dr. Murray discovered that decedent had stopped breathing. He dragged decedent to the bedroom floor and began performing cardiac resuscitation.The 911 call for help was answered and emergency personnel arrived on the scene. According to medical records (listed above), EMTs arrived at Decedent's home at 12:26 p.m. and found that Decedent's heart had stopped beating. EMTs proceeded with cardiac resuscitation and a series of deep cardiac resuscitation procedures including two rounds of epinephrine and atropine. Decedent was intubated at that time and continued with cardioversion. Decedent remained unresponsive; his pupils were unresponsive and dilated. At Dr. Murray's recommendation, decedent was placed in an ambulance and transferred to UCLA Medical Center. Dr. Murray gave all medical orders throughout the transfer. Decedent's heart had stopped beating when he entered the hospital. Despite being hooked up to a built-in aortic pump, decedent's primary physiological parameters did not return.Dr. Cooper pronounced decedent dead on June 25, 2009 at 2:26 p.m. According to Detective Sergeant S. Smith, decedent was engaged in daily physical training in preparation for an upcoming music tour, which must have put decedent in good physical condition. Decedent had no previous heart problems. He was on several prescription medications, including clonazepam, trazodone, valium, lorazepam and flomax. It is not known if they were used voluntarily. Page 3 - 4 SCENE DESCRIPTION: The residence of the deceased was located in a large two-story house in a quiet neighborhood of Bel-Air. The house was clean and well decorated. I noted that the bedroom was located on the second floor of the house to the right of the stairs. This bedroom is alleged to be where the deceased was resting and where his heart stopped beating. His everyday bedroom was located at the other end of the hallway. The bedroom to the right of the stairs contained a double bed, numerous tables and chairs, a cupboard and a television. There was also a closet the size of a person could walk into that connected to the bedroom. Bedding was strewn about and it looked like someone had slept on the left side of the bed at one point. There was a blue cotton lined plastic cushion in the center of the bed to the left of the sheets. There was a string of wooden beads and a tube of toothpaste next to the left foot of the bed. There are also various items on the right side of the bed including a book, a laptop and a pair of glasses. Next to the foot of the bed, an airtight bottle containing urine sits on a chair. On the left side of the bed, there were two tables and a brown sofa chair. This is where the deceased's doctor allegedly sat. Green oxygen tubing was also on this side of the bed. Decedent's prescription medication bottles were on the table with an assortment of medications and equipment, including a bottle of catheters, disposable needles and alcohol pads. There were also several empty orange juice bottles on the table, a telephone and a desk lamp. Oxygen resuscitation bags and latex gloves were scattered around the bed. EVIDENCE: I collected medical evidence at the decedent's residence on June 25, 2009; see Form 3A for details. EXAMINATION OF THE BODY: On June 25, 2009, I did a preliminary body surface examination of the body at the hospital. Decedent was wearing a hospital gown. The decedent was an adult black male who appeared to be approximately 50 years old. Brown eyes, natural teeth, brown hair. Decedent had thinning hair with wig extensions attached to the hair. Decedent had white patches and black areas throughout his skin. The ambient temperature in the hospital at 6:15 p.m. was 68 F. At 6:11 p.m., the entire body had not yet exhibited total rigor mortis. The necrotic spots presented under light pressure. The postmortem spots were consistent with a supine position. There was dark black discoloration on the decedent's forehead near the hairline. The eyebrows, eyelashes and lips of the deceased appeared black. The deceased had a small piece of gauze over his nose and his mouth contained a first aid ventilation tube, which was held in place with medical tape. The middle of his chest showed a distinct red discoloration. The right side of his neck was taped with gauze covering a puncture wound. There were IV catheters on the left side of his neck and on both sides of his groin, and an external urinary catheter. He has more puncture wounds on his right shoulder, both arms and both ankles. There were bruises on the inside of his left leg, just below the knee. Four discolored indentations were found on the lower back. On June 25, 2009, the body was identified as the body of Michael Joseph B. Bowman, a former California driver's license holder, who was found to be in the custody of the police. Joseph. Page four. Page 4: NOTICE TO RELATIVES: The deceased was not married and all of his children were under the age of 18. His mother was the legal relative notified of the death on 6/25/09. Organ Donation: Hospital records do not indicate whether or not the decedent's family negotiated an organ donation. Autopsy Notification: An autopsy was requested by LAPD Robbery-Homicide Division Investigator S. Smith. Please see related documents for contact information. Investigator Elissa Fleak Supervisor 6/26/09 Page 5-6 County of Los Angeles Medical Evidence Autopsy Section Drug Name Prescription Number Prescription Date Prescription Quantity Prescribed Quantity Remaining Quantity of Medication Form of Medication Dosage Prescription Directions for Use Physician's Name Pharmacy Phone Number or Comments BENOQUIN (a type of Monophenazone) LIQUID 20% LIQUID MEDICATIONS REQUIRED TO BE STORED IN TUBES APPLIED PHARMACOLOGICAL SERVICES; WITHOUT A PRESCRIPTION ORIGINAL INFORMATION Clonazepam (CLONAZEPAM) 1793217 4/18/2009 30 8 Tablets 1 mg/tablet 1 tablet at bedtime METZGER RITE AID 310-273-3561 Diazepam Tablets (DIAZEPAM) C0222066 6/20/2009 60 57 Tablets 10 mg/tablet 1/two or one tablet every six hours MURRY 2 or 1 tablet MURRY CVS 310-273-5252 TAMLOSINE (FLOMAX) 567153 6/3/2009 30 24 Capsules 0.4 mg/capsule 1 tablet daily MURRY CVS 310-474-2152 Hydroquinone Liquid 8% Liquid medications need to be stored in tubes Applied Pharmacy Services; No original prescription information Lidocaine (LIDOCANE) 6636823 5/14/2009 60 Liquid 4% PLO Liquid medication to be stored in test tubes MURRY Applied Pharmacy Services; 702-304-0770; Prescribed to Dr. Murray Lorazepam (LORAZEPAM) C567154 4/28/2009 30 9 Tablets 2 mg/tablet 1 tablet at bedtime MURRY CVS 310-474-2152 TEMAZEPAM C541756 12/22/2008 30 3 Capsules 30 mg/capsule 1 capsule at bedtime ASN MURRY CVS 310-474-2152 TEST TIZANIDINE 1812056 6 6/7/2009 10 8 Tablets 4 mg/tablet 1/2 tablet at bedtime KLEIN RITE AID 310-273-3561; prescribed OMAR ARNOLD TRAZADONE 1793218 4/18/2009 60 38 Tablets 50 mg/tablet 2 tablets at bedtime if needed METZGER RITE AID 310-273-3561 Miscellaneous 310-273-3561 OTHER ITEMS: One green oxygen cylinder; one broken syringe; one unsealed box of disposable injection needles; one unsealed box of IV catheters; one bottle of UVA SkinSprings XL Sunscreen; one opened bottle of Bayer Aspirin; one empty vial of Isopropylphenol 1% (PROPOFOL) for Injection; and one empty vial of FLUMAZENIL 0.5 mg/mL for Injection. FLUMAZENIL) in an empty vial. Tizanidine (ZANAFLEX) 7018879 11/6/08 4 0 Tablets 4 mg/tablet 1/2 tablet at bedtime KEILN,ARNOLD MICKEY FINE PHARMACY; 310-271-6128 Prednisone (PREDNISONE) 1795927 4/25/09 10 0 Tablets 10 mg/tablet 6 tablets taken today. TAKE 4 TABLES TOMORROW KEILN,ARNOLD RITE AID 310-273-3561 AMOXICILLIN (AMOXICILLIN) 53380 2/2/09 28 21 PILLS 500 mg/each 4 times daily DWIGHT JAMES/CHERILYN LEE Patient's name blacked out on label Azithromycin ( Azithromycin (AZITHROMYCIN) 54729 3/9/09 6 2 Tablets 250 mg/tablet 2 tablets on the first day, then 1 tablet per day for 4 days DWIGHT JAMES/CHERILYN LEE Patient's name: KATHLYN HURSEY Other Items: On the bedside table were BAUSH&LOMB eye drops and small tubes of "AZITHROMYCIN" eye drops, as well as a small tube of "AZITHROMYCIN" eye drops, and a small bottle of "AZITHROMYCIN" eye drops. BAUSH&LOMB eye drops are on the bedside table, as well as small tubes of "UV protection" ointment. Investigator: ELISSA J. FLEAK (497061) Date: 7/9/2009 Page 11 C) Intra-aortic balloon pump inserted into left femoral artery D) Pinholes and contusions on right neck, arms, left calf and right ankle E) Urinary condom F) Abrasions in center of chest due to resuscitation G) Resuscitation-induced fracture of the sternum with the fourth and fifth ribs on the right and the third to fifth ribs on the left. to fifth ribs. H) alveolar hemorrhage due to first aid I) transmural hemorrhage of the stomach due to first aid 6. The following diagnostic reports were made by different specialists: A) Neuropathology 1. mild cerebral vascular congestion 2. mild diffuse cerebral swelling without signs of anterior lumbar disc herniation 3. mild calcification of the basal ganglia B) Pulmonary Pathology 1. marked diffuse congestion and lamellar hemorrhage of both the right and left lungs 2. marked respiratory bronchiectasis with Chronic interstitial pneumonitis with histiocyte desquamation and multiple foci 3. Fibro-collagenous scarring from multiple foci 4. Organized and recanalized thrombosis of two small arteries 5. Intravascular eosinophilia due to intermittent interstitial eosinophil infiltration and permeation 6. Focal desquamation of respiratory cells with squamous epithelial hyperplasia C) X-ray Radiology 1. Very mild degenerative vertebral joint stiffness of the inferior thoracic vertebrae. Degenerative vertebral joint stiffness 2. seventh cervical vertebrae on the right 3. Degenerative inflammation of the lower lumbar vertebral joints, distal interphalangeal joints of the index and middle fingers on the right hand and the interphalangeal joint of the little finger on the left hand. Page 12: Autopsy Report I performed an autopsy on the body of Michael Jackson in the autopsy office Los Angeles, California June 26, 2009 10:00 AM From the autopsy findings and the patient's medical history I attribute the cause of death to: 1. Acute isoproterenol intoxication Other factors contributing to, but not leading to, immediate death: Benzodiazepine diazepam effects Anatomical summary: 1. Toxicologic Findings (see separate reports) A) Isoproterenol, lorazepam, midazolam, lidocaine, diazepam, and desipramine were found in blood samples (see toxicology report for further details) B) Isoproterenol, midazolam, lidocaine, and ephedrine were found in urine. C) Isoproterenol, lidocaine were found in liver sections. D) Isoproterenol was found in the vitreous humor. E) lidocaine and isoproterenol were found in stomach tissue. 2. tuberculous prostatic hyperplasia A) enlarged flap in bladder hyperplasia B) urinary retention 3. vitiligo 4. tuberculous adenoma of the colon 5. Evidence of treatment A) tracheal intubation B) endovascular catheterization of the left neck as well as the femoral sites on both sides p. xiii 4. slight calcification atherosclerosis of the legs D) Dentistry 1. Tooth #13 was treated with a root canal procedure 2. Teeth #18 & #19 have intraosseous implants 3. Lower right tooth has a metal porcelain restoration 4. Maxillary teeth are restored with multiple porcelain restorations E) Anesthesiology The detailed plot is as follows: The deceased, a fifty year old man, became unconscious on June 25, 2009 in his apartment. He was taken to the UCLA Medical Center where he was eventually pronounced dead. EXTERNAL EXAMINATION: His body, identified by tags on his toes and frozen directly without embalming, was that of this adult black man who had been on stage for nearly 50 years. He weighed 136 pounds, stood 69 inches tall, and was very thin. There were signs of abrasions at the time of death about 1/4 to 1/2 inch down the lower back. (Note: The photographs of the scene show some signs of water droplets on the bed). EVIDENCE OF RECENT TREATMENT: There was an endotracheal tube located just inside his trachea. An endovascular catheter was in the left jugular vein and both femoral arteries. An intra-aortic balloon pump is in the left femoral artery just inside the aorta. A urinary condom is present. There are numerous pinholes in both arms. There are also pinholes on the inside of the left knee and the inside of the right ankle. There were gauze pads on the right neck and left elbow socket, left forearm and right elbow socket. There is an irregular abrasion mark measuring 1-1/2 x 1-1/4 inches in area in the middle of the chest surrounded by a bruise measuring roughly 3 x 3 inches. There was a bruise on the soft tissue of the left anterior chest measuring 3-1/2 x 2 inches and a bruise on the soft tissue of the right anterior chest measuring 5 x 3-1/2 inches. The sternum was fractured at the third rib. Autopsy Report No. 2009-04415 JACKSON, MICHAEL There were findings on examination that the iris of the eye was brown and the sclera was not jaundiced. There was no ecchymosis on the conjunctiva or sclera of the eyelids, and the oral and nasal passages were not blocked. The bandages are still in place and intact. (See consultation of the teeth for details). The neck is intact. There is no deformity of the chest. There is also no increase in the diameter of the anterior and posterior chest. The abdomen is flat. The genitalia show the characteristics of an adult male. The penis was not circumcised. The extremities showed no signs of edema or joint deformities or abnormal mobility. Clothing: The body was unclothed Unclothed for diagnostic purposes. ORIGINAL INCISIONS: The head and body cavities were incised through standard input coronal and standard Y shapes, respectively. No heterogeneous material was utilized in the oral cavity, upper respiratory tract area, or throat. Neck: The neck organ, the tongue was incised in one piece. Small wounds accompanied the inner lips and the middle area of the tongue. In the mucosa of the left pyriform crypt there were three nodules measuring slightly elevated, 0.2 for centimeters in diameter. There was no laryngeal edema. The hyoid bone and larynx were not fractured and were intact. There was no hemorrhage in the organs adjacent to the larynx. Deep bandages in the deep fascia of the neck, muscles, thyroid gland, viscera. Thoracoabdominal cavity: The pleural cavity contains very little fluid and there are no adhesions. There is no movement of the pneumothorax. The pleura of this apex is intact. The thoracic cavity of the lungs is slightly dilated, and the soft tissues of the chest and abdominal walls are well preserved. The organs in the abdomen were functioning normally in the abdominal cavity, but there was no accumulation of fluid in the abdomen. There was no evidence of inflammation of the peritoneum in the abdominal cavity, and there were no adhesions. Page 16 SYSTEMS AND ORGANS DISCUSSION CARDIOVASCULAR SYSTEM: The aorta is quite elastic and spread out in a network. Even from it usually throughout the vessels. Lipid streaks are also visible. There is no curvature and no dilatation or aneurysm of the aorta. The major branches of the aorta show no abnormalities. There is a small amount of plasma fluid in the internal capsule of the heart. The weight of the heart is two hundred and ninety grams. This is a very normal configuration. The right ventricle is 0.2 cm thick and the left ventricle is 1.4 cm thick. The atria are usually molded. There are no blood clots in the walls of the heart. The heart is strong , lush and robust. Peripheral valves: tricuspid valve 12.8 cm, pulmonary valve 7.0 cm, 8.8 cm meter valve and aortic valve 7.2 cm. There was no discoloration. There was no focal damage. There were no abnormalities where the tubules entered or exited. The root canal of this artery has been ablated. The coronary arteries are extensively proprietary, with only the right coronary artery remaining as the dominant vessel. There is no coronary atherosclerosis. There are no focal points, changes in valves or myocardial injury. Blood from the heart and great vessels is fluid-like. RESPIRATORY SYSTEM: Very little secretion is affixed to the upper respiratory tract. Mainly hemorrhages from the mucous membrane of its larynx. With independent squeezing of the plugs. The left lung was 1060 g. (see Special Procedures below for details) and the right lung 940 g. The left lung was 1060 g. (see Special Procedures below for details). The visceral pleura is smooth and intact. The thin walls are congested. The pulmonary vessels were not thrombosed. Page 17 Gastrointestinal System: The entire esophagus was intact. There was no dilatation of the stomach, which contained 70 grams of dark liquid material. There was a small amount of bleeding from the gastric mucosa, but no ulceration. No remnants of pills or capsules were found in the stomach. No abnormalities were noted in the external and primitive state of the small intestine and colon. The small intestine and colon were incised along the para-membranous margin and a 2-mm stemmed polyp was found in the sigmoid colon. The mucosa of the colon was lavender in color. The appendix was not removed. The body of the pancreas was normal and no necrosis was found. The glandular cellular tissue was in the form of firm blades. No dilatation of the pancreatic duct was noted and there was no calcification of the glandular cell tissue. Hepatobiliary system: The liver weighed 1480 grams. It was reddish brown in color on the outside with a very thin podocarp. The liver was soft and smooth in section. The lobular tissue was normal. The gallbladder was intact with a very thin and soft outer wall. Ten grams of bile were memorized and no stones were found. No obstruction or dilatation of the extrahepatic bile ducts was noted. No dilatation of the lymph nodes in the confluent area was also noted. Urinary system: The left kidney weighed 120 grams and the right kidney weighed 140 grams. Both kidneys had normal body position and presented a smooth outer wall of dark purple color after stripping the epididymis. There was a medullary division of the renal cortex preserved. The right kidney had a 0.2 cm piece of white medulla. Vertebralization was not evident. No increase in parapelvic fat was seen. There is no dilatation or obstruction of the ureter and the urinary tract is normal. The bladder was dilated with trabecular formation. The bladder contained 550 grams of clear orange-yellow urine. REPRODUCTIVE SYSTEM: The prostate is slightly hyperplastic with a prominent bladder flap growing centrally. The soft tissue of the prostate was knotted. Both testes were in the scrotum and were not found to be abnormal and undamaged. Page 18 LYMPHATIC SYSTEM: The spleen weighed 110 grams. The epididymis was thin and overall dark red in color. No hyperplasia was noted in the follicles of the lymph. Overall, the lymph nodes throughout the body were small and no abnormalities were noted. However, there was a 1.5 cm piece of white medulla in the left part of the adrenal gland in the area of the para-aortic lymph node. The bone was not prominent. The marrow in the spine is red and wet. Endocrine system: The thyroid gland weighs 24 grams and is not found to be abnormal. The parathyroid region requires microscopic examination. Each adrenal gland weighed 5 grams and was well preserved and undamaged with no necrosis or hemorrhage noted. The thymus was unrecognizable. The pituitary gland was normal in size. HEAD AND CNS: No hemorrhage was found in the subcutaneous and sub-tendinous membranes of the scalp. The skull was not found to be fragmented at the top or bottom of the skull after the exostoses and dura mater were peeled off. There were no signs of lacerations in the dura mater. No hemorrhage was found in the epidural, subdural, or subarachnoid. The brain weighed 1380 grams. Spinal Cord: The spinal cord was not dissected. NEUROPATHOLOGY: The brain was placed in formalin solution pending further fixation and subsequent neuropathologic examination. NOTE: The remaining brain tissue should be returned to the morgue on July 8, 2009, following neuropathologic examination. Page 19 Tissue Sections: Samples from the different organs were preserved in two vials of formalin solution at a concentration of 10%. The other containing selected brain tissue was kept until July 8, 2009 by the neuropathologist. The organs were sectioned in the autopsy section. The major sections are shown below: A. Adrenal glands B. Left pyriform fossa C. Parathyroid region D. Thyroid gland E. Medulla of the left para-aortic lymph node F. Bone marrow G. Aorta, right ventricle H. Pituitary gland I. Ventricular septum J. Left ventricle K. Right lung L. Right testis M. Left testis N. Stomach, gallbladder O. Pancreas P. Spleen Q. Liver R. Right kidney S. Left kidney T. Intestines U. Scars, e.g., neck Right posterior V. Prostate Toxicology: Blood, bile, liver tissue, stomach, urine, and vitreous fluid from the eyes are sent to the laboratory for examination. More comprehensive testing is needed. SPECIAL PROCEDURES: The left lung was sent for pulmonary pathology (see separate report on lungs for details). NOTE: Following pulmonary pathology, the remaining left lung tissue should be released back to the morgue on July 8, 2009, and the selected portion of the perfused and distended lung should be preserved in the initial two bottles.