The word "circus" would be a severe understatement to describe the medical world surrounding Michael Jackson. It features live-in cardiologists, traveling anesthesiologists, home IV poles and stockpiles of drugs that most doctors would never dream of prescribing. It all seems to be moving toward a criminal investigation of some kind. Just now, though, none of the doctors are speaking publicly about his professional relationship with Jackson. Save one.
Last week, Dr. Arnold Klein, Michael Jackson's Beverly Hills dermatologist, showed up on "Larry King Live." Klein is usually described as "the father of cosmetic dermatology" (he pioneered the use of botox for wrinkles) and "the dermatologist to the stars." Klein's bio on his Web site shows him to be a well respected, philanthropic and frequently published medical expert. But Google him and you'll notice few serious publications between the numerous results that land you at TMZ and other Hollywood gossip sites. Klein seems to bask in this world like a lizard under a hot sun. And so it was in the spirit of infotainment that Arnie (as his friends call him) made the decision to dish about Jackson. At best, Klein and King behaved in bad taste. At worst, I was left wondering if Klein and his loose lips crossed a medical law.
Klein began by revealing personal details about his friendship with the singer. To my surprise, he then divulged facts about Jackson that only a physician knows about a patient. In describing his first meeting with Jackson, Klein noted how the singer had "a butterfly rash and he also had severe crusting you could see on the anterior portion of his scalp." He subsequently "did a biopsy" on Jackson and diagnosed him with Lupus, an autoimmune disorder that causes those and other symptoms.
Klein went on to reveal many other details, like how he was "rebuilding" Jackson's face before his comeback concert. On the subject of drug use, Klein continued to chat up the audience. He admitted to providing Jackson with Demerol to sedate him and stated that, contrary to reports, Jackson was not "riddled with needle marks" (though Klein told King he never examined his entire body). Perhaps most revealingly, Klein, as if he had Jackson's chart in front of him, dished about the singer's past medical history. "Michael, at one time, had an addiction," he said. "And he went to England and he withdrew that addiction at a secure setting, where he went off of drugs altogether. And what I told Michael when I met him in this present situation when I was seeing him, that I had to keep reducing the dosage of what he was on, because he came to me with a huge tolerance level."
Klein's comments struck me as incredibly disrespectful. More than that, if I or any other doctor revealed those kinds of intimate medical details publicly, we might be vulnerable to a charge of violating federal health privacy laws, a punishable offense.
These laws stem from 1990s legislation known as the Health Insurance Portability and Accountability Act or HIPAA. Basically, the law forbids medical professionals from disclosing health information unless a patient provides consent to do so. Among other things, HIPAA is the reason that your doctor can't fax a letter to you or transfer your records to another doctor without your filling out permission forms. It's the reason the mother of a teenage patient of mine, a nurse, was disciplined when she looked at the medical records of her own son. It's also the reason you'll never see me, or any other physician, reveal the identities of our patients -- without their consent -- when we discuss or write about them.
What's made HIPAA particularly visible -- and health professionals especially paranoid about it -- are recent stories of violations of celebrity health cases. In 2007, 27 New York Hospital employees were suspended for peeking at George Clooney's medical records after he had a motorcycle accident, as CNN reported. More recently, according to the Los Angeles Times, a UCLA Medical Center employee was disciplined for leaking Farrah Fawcett's (remember her?) records to the National Enquirer.
In the shadow of the Fawcett story, it struck me as bizarre that Klein (who is himself on staff at UCLA) went public about Jackson. What made it even more unusual was that on June 30, Klein's attorney, Richard Charnley, released a statement requesting privacy that directly referenced HIPAA:
"Dr. Klein is aware of media reports connecting him to Michael Jackson. Because of patient confidentiality, Dr. Klein will make no statement on any reports or allegations. Out of respect for his patients and adherence to federal HIPAA regulations, Dr. Klein asks that the media not contact him or his patients, nor interfere with their medical treatments. Like millions of Michael's fans around the world, Dr. Klein is saddened by Michael's death and extends his condolences to the family."
Klein seemed to have had it right -- before he went on "Larry King Live." And HIPAA does apply to deceased individuals. "It doesn't matter whether a patient is dead or alive -- the HIPAA and state privacy law protections still apply," Stephen K. Phillips, a healthcare attorney in San Francisco, told me. "A deceased patient's rights accrue to his/her legal representative for enforcement and redress purposes."
At the same time, said Phillips, it's possible that Jackson may have given Klein permission to discuss his PHI, or private health information, in public. In that case, Phillips said, "you haven't violated the law by doing so, unless and until that authorization is withdrawn." I tried to contact Klein to clarify these important points several times, but never received a response. His attorney didn't get back to me either.
Whatever the case, Klein most certainly violated something fundamental -- common decency. A dead man's supposedly close friend, a doctor, goes on prime-time TV to eulogize him. "For about five hours, I couldn't move, because I was very close to him," Klein told King. His tribute then turns into his very own "Michael and Me" medical memoir, biopsy results included. It's the kind of jabbering that gives Hollywood and cable news a bad name, although most of us don't flinch at that anymore. But this time I had to flinch. By epitomizing the limousine-chasing, wannabe-celebrity doctor, Klein bruised the reputation of his colleagues everywhere.