Thursday, October 1, 2009

Michael Jackson's Autopsy



LOS ANGELES - Michael Jackson's arms were covered with punctures, his face and neck were scarred and he had tattooed eyebrows and lips, but he wasn't the sickly skeleton of a man portrayed by tabloids, according to his autopsy report obtained by The Associated Press.

In fact, the Los Angeles County coroner's report shows Jackson was a fairly healthy 50-year-old before he died of an overdose. His 136 pounds were in the acceptable range for a 5-foot-9 man. His heart was strong with no sign of plaque buildup. And his kidneys and most other major organs were normal.

Still, Jackson had health issues: arthritis in the lower spine and some fingers, and mild plaque buildup in his leg arteries. Most serious was his lungs, which the autopsy report said were chronically inflamed and had reduced capacity that might have left him short of breath.

However, according to the document, the lung condition was not serious enough to be a direct or contributing cause of death.

"His overall health was fine," said Dr. Zeev Kain, chairman of the anesthesiology department at the University of California, Irvine, who reviewed a copy of the autopsy report for the AP. "The results are within normal limits."

Kain was not involved in the autopsy. The full autopsy report has not been released publicly, but the AP obtained a copy.

Jackson died at his rented Los Angeles mansion June 25 after his personal physician, Dr. Conrad Murray, administered the anesthetic propofol and two other sedatives to get the chronic insomniac to sleep, court documents state. Propofol, normally a surgical anesthetic used in operating rooms, acts as a respiratory depressant and requires constant monitoring,

Murray told police he left the room to use the bathroom and phone records show he also made calls for 47 minutes around the time Jackson encountered problems. When Murray realized Jackson was unresponsive, he began frantic efforts to revive him, but Jackson never regained consciousness and was declared dead at the University of California, Los Angeles Medical Center.

The coroner's office announced last month that Jackson's death was a homicide caused by "acute propofol intoxication," with the other sedatives listed as a contributing factor. They said the standard of care for administering propofol was not met and the recommended equipment for patient monitoring, precision dosing and resuscitation was missing.

Murray is the target of what Los Angeles police term a manslaughter investigation. The decision on criminal charges will come from the Los Angeles County district attorney's office. Murray has been interviewed twice by police.

Except for a brief video posted to YouTube, Murray has not spoken publicly since Jackson's death, and his lawyer Edward Chernoff did not immediately respond to requests for comment Thursday. In the video, Murray said: "I told the truth and I have faith the truth will prevail." Chernoff previously has said nothing Murray gave Jackson "should have" killed him.

Jackson was declared dead a little more than two hours after paramedics were called. Evidence of the desperate struggle to save the star was evident on his body. He had chest bruising and cracked ribs from CPR, and a mechanical device known as a balloon pump was inserted into his heart to try to restart it, according to the autopsy report.

Jackson's body was taken by helicopter to the coroner's office where the following morning Chief Medical Examiner Lakshmanan Sathyavagiswaran and Dr. Christopher Rogers carried out an extensive review and ordered a toxicology screening to look for drugs in his system.

Aside from propofol and the sedatives, the only substances found in his system were the local anesthetic, Lidocaine, sometimes used to numb injection sites and ephedrine, a commonly used resuscitation stimulant.

No other drugs — legal or otherwise — were detected, nor was any alcohol.

Kain said he was surprised that three other sedatives, known as benzodiazepines, were present with propofol. Anesthesiologists sometimes mix one "benzo" with propofol to help put a patient under, but using three increases the danger for the patient.

"People don't mix the benzodiazepines together because they interact with each other and increase the risk of respiratory arrest," Kain said, adding it was likely Jackson first stopped breathing and then suffered cardiac arrest.

The autopsy findings cut off a potential defense for Murray — that Jackson hid serious pre-existing conditions that increased the risk of death from the drugs he willingly took. Even if he did hide a condition such as his weakened lungs, a prosecutor could argue Murray should have detected the condition before administering drugs, said Michael Brennan, a clinical law professor at the University of Southern California who specializes in criminal defense.

"A doctor has some obligation to know what his patient's physical condition is," Brennan said. "The doctor is going to try to substantiate whatever the patient told him ... and not simply rely on a patient's descriptions of his physical condition."

At the time of his death Jackson was preparing for a series of comeback concerts in London. Rehearsals were rigorous and there were questions about whether Jackson would be physically able to hold up.

But aside from his lungs, the autopsy report did not identify any serious physical problems that might have limited Jackson's ability to perform. It also provided details about his physical state from head to toes.

He had a 3/4-inch scar behind his left ear and another apparent scar behind his right ear. He had a scar beside each of his nostrils and another, 4-inch scar on his right shoulder. He had a pair of additional scars about 3-inches long at the base of his neck and smaller scars on his arms and wrist. He also had a small scar near his navel and a 2-inch scar on the right-hand side of his abdomen.

Kain said most of the scars appeared to be from plastic surgery though others, like a scar on the knee, could have been from a medical procedure.

The medical examiner found numerous punctures on both arms and on a knee and ankle. The leg punctures could have been from intravenous therapies not described in the autopsy report, Kain said.

Jackson had several tattoos, all them cosmetic, including dark tattoos in the areas of both eyebrows and under his eyes, and a pink tattoo around his lips.

He was going bald at the front of his head, with his remaining hair described as short and tightly curled. The bald part of his scalp was darkened with what appeared to be a tattoo stretching across the top of his head from ear to ear.

The coroner found depigmentation of his skin around his chest, abdomen, face and arms.

The coroner also found Jackson was actively producing sperm.

Los Angeles Police Department spokeswoman April Harding said the investigation was ongoing and she couldn't comment further.

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'Pepeng could be super-typhoon'



Major dams to release water for buffer storage

MANILA - Weather bureau PAGASA on Thursday said typhoon Pepeng (international codename Parma) is forecast to bring more rains and very strong winds in Northern Luzon including Metro Manila once it makes landfall Saturday afternoon.

"There is a big possibility that it will become a supertyphoon. This is a very strong storm, packing winds of 175 kilometers per hour and gusts of up to 210 kph. Most likely it will make landfall in the afternoon of Saturday. That is when it is most critical," Nathaniel Cruz, PAGASA director for operations, said in a press briefing.

Cruz said Pepeng is much stronger than last Saturday's tropical storm Ondoy (international codename Ketsana), which brought record amounts of rainfall and triggered the worst flooding in Metro Manila in 40 years.

"In terms of wind intensity, Ondoy was only half of the strength of Pepeng. When it made landfall, Ondoy only had winds of 85 kph while Pepeng is 175 kph. However, we cannot really compare the two because it was the rain that was really destructive about Ondoy," he said.

He added: "Our major concern with Pepeng is the disastrous winds - 175 kph to 210 kph. We expect typhoon Pepeng to intensify further as it moves towards northern Luzon."

He said the weather bureau will give a forecast on the typhoon's estimated rainfall intensity before it makes landfall.

As of 10 a.m., the new typhoon was sighted 520 km east of Borongan, Eastern Samar and is moving 24 kilometers per hour in the general direction of Northern Luzon and the Taiwan area.

Cruz said the typhoon is forecast to make landfall over Aurora-Isabela by Saturday morning. It said the typhoon will bring occasional rains over the eastern section of Luzon and Visayas and more frequent rains in Samar and Bicol Thursday afternoon.

Storm Signal no.1 remains hoisted in Camarines Norte, Camarines Sur and Catanduanes, he added.

Similar to 'Reming'

Cruz also likened typhoon Pepeng to super-typhoon Reming (international codename Durian), which killed at least 734 people in the country in 2006.

"This could be like Reming. We are not just talking here about Metro Manila. We are talking of the entire Luzon area where there is probability of devastation in terms of flooding...and wind," he said.

Dr. Susan Espinueva, assistant weather services chief of the Hydro Metrological Division of PAGASA, said major dams in Northern Luzon will be releasing water today until Friday before Pepeng hits.

"All major dams in Northen Luzon wll be releasing water to lower the water level so that when the storm hits, there will be a buffer of storage capacity in our dams and the spillover will not be as severe,' she said.

The government has started preparing more evacuation centers as it anticipates more people to be displaced by the new storm.

Disaster officials fear more rains spawned by the typhoon could trigger another massive flood as streets and drainage systems remain clogged from the tons of debris left by the previous deluge caused by tropical storm Ondoy (international codename Ketsana).

As of 6 a.m., the National Disaster Coordinating Council said more than half a million families of 2.50 million individuals have been affected by Ondoy in 11 regions, including Metro Manila and the Calabarzon area in southern Luzon.

It said that a total of 686,699 people are now staying in 726 evacuation centers. It said Ondoy’s death toll has reached 277 and 42 were still missing.

The storm, which also devastated Vietnam and Cambodia, damaged crops and infrastructure worth at least P4.80 billion.



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'Ondoy' death toll hits 246 as 'Pepeng' nears Philippines


Photo released by the Philippine Air Force shows flood victims scampering for relief supplies being dropped by PAF crewmen in San Mateo, Rizal yesterday.

MANILA, Philippines - Swollen rivers and debris-strewn streets yielded more bodies yesterday, bringing the death toll from massive flooding brought by tropical storm “Ondoy” to 246.

As disaster teams sifted through tons of debris in search of bodies – and hopefully survivors – two new storms brewing in the Pacific threatened to complicate relief efforts.

Heavy rain brought by Ondoy (international name Ketsana) inundated the homes of nearly 1.9 million people in Metro Manila and surrounding areas over the weekend, the National Disaster Coordinating Council (NDCC) said yesterday. Nearly 380,000 people have sought shelter in schools, churches and other evacuation centers.

In a press briefing after a Cabinet meeting at the NDCC headquarters in Camp Aguinaldo, Defense Secretary Gilbert Teodoro said 101 of the casualties were from Metro Manila.

The biggest number of fatalities in Metro Manila was in Quezon City at 44, followed by Marikina with 26, and Pasig, 17. Five people were reported killed in Valenzuela and three each in Mandaluyong, San Juan, and Muntinlupa.

There were 105 reported deaths in Rizal, Cavite, Laguna and Batangas, 25 in Bulacan and 12 in Pampanga. Three casualties were reported in Kabugao, Apayao and Buguias, Benguet. Thirty-seven people remained missing as of press time yesterday.

The Defense chief said damage to infrastructure was P1.5 billion and to agriculture P888.5 million.

He said the figures are expected to go up. “We’ll get a clearer picture (today),” he said.

“It is a partial damage assessment, definitely. Even opportunity loss to revenues of establishments alone would amount to hundreds of millions at the least per day,” he said.

With the number of affected persons estimated at close to 1.9 million, more evacuation centers have been set up from more than 200 on Sunday to 607 yesterday.

Overwhelmed officials have called for international aid, warning they may not have sufficient resources to withstand two new storms forecasters have spotted east of the country in the Pacific Ocean. One could hit parts of Luzon later this week and the other early next week, although meteorologists say that could change.

Forced evacuation

As two new tropical storms threaten Luzon, President Arroyo ordered “preemptive evacuation” of residents in high-risk areas at the first sign of massive flooding.

Mrs. Arroyo issued the order during the NDCC-Cabinet meeting at Camp Aguinaldo.

“What we have to do here as soon as we know where it (tropical depression) will go, we have to do forced evacuation, preemptive evacuation like what they did in Albay,” Mrs. Arroyo told the Cabinet.

“Many residents said they were warned but it (calamity) did not happen so they ignored it this time,” the President said.

She said local disaster teams as well as the Philippine National Police would supervise the evacuation.

“The other thing is those living along the rivers, and along the hillsides, who should have not been there anyway, should not return to those places anymore,” Mrs. Arroyo said.

She directed Interior Undersecretary Mel Robles to mobilize concerned barangay officials to prevent the return of residents living near high-risk areas such as riverbanks and hillsides.

The Civil Service Commission, for its part, directed heads of government offices and personnel to make their facilities available “for those who need temporary shelter, without compromising security and public service.”

Crackdown on looters

Mrs. Arroyo also ordered the PNP to set up detachments in affected residential areas to prevent looting.

PNP chief Jesus Verzosa said there are enough police patrols for all affected areas, particularly in Metro Manila.

“We assure all our affected residents in the different areas in Metro Manila that the PNP will be there. They will be pre-positioned with mobile cars for easy ID and they will be moving around to provide security to all affected residents,” PNP spokesperson Nicanor Bartolome said. He said even cadets of the Philippine National Police Academy might be asked to assist in securing the affected towns and villages.

Bartolome said the PNP has around 3,500 new recruits and an estimated 800 to 1,000 cadets from the PNPA.

Desperation

Angry flood survivors queued for tinned fish and noodles while another line built for a single toilet at a gymnasium that was turned into an evacuation center in Cainta, Rizal.

On the concrete floor of the covered basketball court, bedraggled children wearing dirty clothes or barely anything at all lay on flattened cardboard cartons, sleeping side-by-side with dogs.

Their parents attempted to build fires with charcoal to cook their meager food rations.

“Get in line!” local official Candy Regavillo barked at the hungry hordes. “Show us some discipline and we will assure everyone gets his or her share.”

Some in the crowd angrily yelled back: “When will we get ours?!”

About 3,000 residents of the depressed neighborhood of San Andres, situated beside a creek in Cainta on the outskirts of Metro Manila, fled to the government gym after floodwaters swamped their homes on Saturday.

“I lined up at 4 a.m. and all I got was a bottle of water,” grumbled 67-year-old grandfather Primo Orcillo at breakfast time, who was barefoot and had the trouser-less child of a missing neighbor with him.

Like many others, Orcillo had missed out on a blue plastic bag of two canned sardines and a pack of noodles designed to sustain each family for an entire day.

“We are very hungry. I haven’t even had coffee,” Orcillo complained.

He said his own daughter was in a different shelter in another part of town, while her husband had gone back to their home to try to salvage what he could.

Even though the food was gone, the lines continued to stretch 250 meters as people hoped more supplies would be delivered.

Some nursing mothers were also asking for infant formula milk, while a top concern was stopping any disease outbreaks that could arise from having so many people crammed together in dirty conditions, officials said.

“We are trying to educate them on proper handling of water and sanitation,” said Cristina Bernaldo, a district social welfare worker. “That’s the most difficult thing to teach.”

Even harder was when 3,000 people had access to just one toilet.

Bernaldo’s boss, Joe Ferrer, summed up the exasperation felt by so many in Cainta and the hundreds of other shelters set up over the past few days.

“We need clothing, food supplies, food rations and medicines,” said Ferrer.

“We don’t know how long we will be able to sustain this,” he said.


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