Perspective: Why Did Conrad Murray Get Just Four Years In Jackson’s Death?

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Mario Anzuoni / Reuters

Dr. Conrad Murray, convicted of involuntary manslaughter in the death of Michael Jackson, was sentenced on Tuesday to four years in prison, the maximum sentence for the crime. On the day the Jackson died and on many occasions before that, Murray gave the singer propofol, an anesthetic drug that has no legitimate medical use outside of surgery, supposedly to help him sleep. During sentencing, the judge angrily slammed Murray for caring more about “money, fame and prestige” than about his patient and for killing Jackson by treating him like “an experiment.”

Still, Murray got just four years in prison. It’s a stark contrast to past cases in which doctors have received decades-long sentences for drug-related charges, even when their link to their patients’ deaths or injuries was much less clear.

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Let’s look at the case of Dr. William Hurwitz, a Virginia internist who was first convicted in 2004 of 50 counts of drug trafficking, receiving a 25 year sentence. That sentence was overturned and led a 2007 retrial, where he was convicted of 16 counts of drug trafficking, each of which carried a mandatory minimum sentence of 20 years.

The jurors convicted Hurwitz of “knowingly and intentionally” distributing drugs “outside the bounds of medical practice” and engaging in drug trafficking “as conventionally understood,” reported the New York Times’ John Tierney at the time. And yet, when Tierney spoke with some of the jurors after the trial, they said they didn’t think Hurwitz was selling drugs to patients for the money, as the prosecution claimed, and that it was he who was being conned by his patients.

Tierney characterized the jurors’ beliefs this way:

[T]hey told pretty much the same story. They said that the jury considered Dr. William Hurwitz to be a doctor dedicated to treating pain who didn’t intentionally prescribe drugs to be resold or abused. They said he didn’t appear to benefit financially from his patients’ drug dealing and that he wasn’t what they considered a conventional drug trafficker.

Here are a few direct quotes from those jurors, who had heard testimony during the trial about how addicted patients had lied to the doctor and tricked him into prescribing them drugs that would later lead to overdose in some cases:

“Those patients used the doctor shamelessly. … They exploited him. I didn’t see him getting anything financial out of it. Many of his patients weren’t even paying him. He had to believe that he was just treating them for pain.”

“There was no financial benefit to him that was very evident to us. … I think that Dr. Hurwitz really did care about his patients.”

How, then, did Hurwitz wind up facing decades of mandatory prison time while Murray — who was actually present at his patient’s death and who knew his prescriptions were not medically appropriate — got four years?

The jurors’ reasoning, wrote Tierney:

“There were just some times he fell down on the job.”

“There were red flags he should have seen.”

In other words, Tierney found, the jurors got confused between malpractice (a civil offense, which would include falling down on the job) and prescribing drugs “outside the bounds of medical practice” (a criminal offense, which includes drug trafficking and requires deliberate criminal intent). But since Hurwitz was being tried for the criminal charge, not malpractice, he ended up getting 25 years for what should have amounted to a civil conviction and financial penalties.

Although Hurwitz’ sentence was ultimately reduced to just under six years, he is not alone in having served more time for being an accidental drug dealer than he would have if a patient had died on his watch due to his clear negligence.

Dr. Ronald McIver was sentenced to 30 years in prison in 2005, on charges of drug trafficking resulting in death and other trafficking-related charges. In this case also, the drug-dealing charges resulted from the doctor providing legitimate medications to patients who lied about their pain and concealed their addictions.

The death in this case occurred in a patient, Larry Shealy, who was taking large doses of Oxycontin and other medications. On appeal, however, McIver’s lawyers successfully argued that Shealy’s death was likely due to congestive heart failure rather than overdose. McIver was released in 2010, after serving five years.

Also in 2010, Kansas pain physician Stephen Schneider and his wife, Linda, who was his office manager, were convicted on similar charges related to drug trafficking and patient overdose deaths. She received 33 years and he was sentenced to 30 in a case the judge said was “motivated by greed.” This case is currently being appealed.

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America’s drug laws are unique in their harshness toward those they blame for drug problems — both the traffickers and the users. Curiously, our overwhelming loathing of drug addiction often ends up producing cases in which killers, rapists and people like Murray, whose negligence was directly involved in a patient’s death, are punished less severely than are doctors who have been conned into prescribing drugs for addicts.

As a former addict myself, I think this situation sends a truly bizarre message to people with addictions. On one hand, it suggests that addicted people have no free will and are unable to make any deliberate choices about drugs; we are mere pawns in the larger drug problem, which can be blamed on dealers (or doctors). Yet, when you look at the laws prohibiting drug possession or prescription forgery, drug addicts are suddenly assigned criminal responsibility for their actions and punished accordingly.

This means that people with addictions suffer the worst of both worlds: we are treated as mindless zombies when society wants to blame others for our problems (often, say, when the addicted person is a relative or celebrity or someone else for whom there is sympathy), or as deliberate actors when the hatred is turned against us (typically, when the addicted party is a member of a minority group).

The reality of addiction is much more complicated. Addicted people do make choices about drug-taking, but at many points, these choices are affected by their illness. Given that it is impossible to determine when addicted people (or anyone else, for that matter) are acting freely, blaming pain-management doctors for not being able to see through patients’ lies seems absurd.

A more just system would give Murray — not Hurwitz — the longer sentence. It would try cases of ambiguous “overprescribing” to deceptive patients as civil malpractice suits, not in criminal court. If we want compassionate doctors to treat pain effectively, we shouldn’t incarcerate them for not being lie detectors — but we should lock them up when they cross the line into criminal negligence, as Murray clearly did.

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Maia Szalavitz is a health writer at Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.