Dr. Hallberg: Michael Jackson's doctor and the scope of practice

Jurors at the trial of Michael Jackson's doctor Conrad Murray heard today from investigators and detectives who looked into the singer's death.

Prosecutors will also play recordings of Jackson and his doctor. Murray has pleaded not guilty to involuntary manslaughter.

There's an aspect to the very public trial of Dr. Murray that has MPR medical analyst Dr. Jon Hallberg thinking about the role of specialists and the scope of what doctors are licensed to practice.

Hallberg discussed these issues today with MPR's Tom Crann.

Hallberg is a physician in family medicine at the University of Minnesota and director of the Mill City Clinic.

Tom Crann: A lot of sensational aspects to this trial, Jon, but tell us what aspect of it has struck you.

Dr. Jon Hallberg: Well, there are really two aspects, and it's not just me. I think it's all of my colleagues that I've talked to about this case. On the one hand, none of us have any idea how a cardiologist would get a hold of a powerful anesthetic like propofol. I mean the only place this is used is in operating suites. And so on the one hand, that just is utterly baffling how that could happen.

On the other hand, the thing that I think is more a philosophical piece and that gets us really thinking is this is a guy who was a board-certified cardiologist basically practicing anesthesia. And that is such an odd thing to our ears. We just can't really wrap our heads around that.

Crann: You mentioned he's a cardiologist. When you're granted a license to practice medicine, are you actually licensed in a certain specialty?

Hallberg: We get our licenses after just one year of internship. So we graduate from medical school. We have an M.D. degree or a D.O. degree behind our names. And then you do an internship, and at that point you take this national qualifying exam that basically says you are able to practice medicine and surgery, but that doesn't really grant you much more than that.

You have to go through specialization, and even me as a family physician, I went through a three-year residency in that specialty. So you have to do that and then you've got to go through credentialing at hospitals and then you even have to prove that you've done a certain number of cases if you want to do certain procedures.

Crann: How often do you find doctors who in the course of their work move into other specialties occasionally or even more permanently?

Hallberg: Well, if it happens, it happens in a very formal, very thought out way I've known family physicians who became psychiatrists, but it wasn't an overnight thing. They had to go back to residency. They've got to do years of additional training to get certified in that, so it doesn't happen that often. We all know people who have done it, but it's a tedious, cumbersome long-term process. It's not something you suddenly do.

Crann: You've mentioned you have a license to practice medicine, then certified in a specialty. How does that work?

Hallberg: Once you finish your residency, you take yet another set of board exams, and in fact many of us take those exams every seven years or so to keep proving that sort of certification. You have to really, really show both your specialty board, but also your hospitals, I mean you just can't do this kind of thing in a hospital setting without proving that you've trained to do it.

Crann: In a case here like Dr. Murray, this seems extraordinary to most people to have a personal doctor not affiliated with a hospital to do one's bidding, even administer anesthesia, unusual if not unethical, it would seem.

Hallberg: Yes, I think to our Midwestern ears this is just highly unusual. I think that places on the coast in California and certainly in New York people have more access to concierge physicians who are sort of available to them 24-7.

And this is something that's always bothered me about that whole concept is that people are sort of waiting to be called to do someone's bidding. And it's very tricky when you've got someone of Michael Jackson's stature. How do you say no to that? I mean when money's being held in front of you, I think that there's a very steep slippery slope that anyone of us would be capable of falling into.

Crann: Theoretically, can a doctor lose a license for working in a specialty beyond their training and certification?

Hallberg: Oh, certainly. I mean that's I think one of the reasons the boards exist is to make sure that we practice within our scope of medicine, our scope of practice, that we have certain skills and we should practice within them, and when you push the boundaries and do things you shouldn't be doing, I mean that is exactly when people can have their licenses restricted or revoked.

(Interview edited and transcribed by MPR reporter Madeleine Baran)

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