For Michael Jackson, a trip to the doctor's office sometimes wasn't just paying a visit to a health care provider. It was paying a visit to a trusted friend.
A jury has been hearing for weeks about the pop superstar's close relationship with many of his medical providers — spending Christmas with some doctors, inviting others to spend time at Neverland Ranch. His primary care doctor served as the best man at the singer's second wedding, to a woman who worked in his dermatologist's office and became a frequent companion on his medical visits.
Jackson's relationship with his final doctor, Conrad Murray, is important to the negligent hiring case, but in the process jurors are getting an inside look at celebrity health care — after-hours visits, house calls and false names on records and prescriptions — that are meant to preserve confidentiality but can present ethical challenges for doctors. They have also heard a detailed portrait of medical history, including painful burns and the skin conditions vitiligo and discoid lupus that led Jackson to feel he was disfigured.
Other practitioners have recounted stories of telling Jackson they wouldn't comply with his requests for painkillers or the powerful anesthetic that would kill him in his bedroom in 2009.
The parade of testimony from Jackson's doctors is central to the defense case being mounted by AEG Live LLC, the company promoting Jackson's ill-fated comeback concerts, which is being sued by the singer's mother. Katherine Jackson says the company hired Murray to help her son prepare for his "This Is It" shows. In the process, her attorneys say, AEG Live created a conflict of interest that compelled Murray to provide her son with the anesthetic propofol as a sleep aid in order to preserve his anticipated $150,000 a month payday.
AEG contends it is not liable for the superstar's death but that it was his own personal choices that led to his demise.
Stories the jurors have heard throughout the 18-week trial about Jackson and his doctors:
— Two of Jackson's doctors, Scott Saunders and William Van Valin II, went to Jackson's Neverland Ranch near Santa Barbara, according to testimony from Saunders. Saunders recounted how Jackson occasionally showed up at his home unannounced and sent him and his family Christmas presents one year. Saunders said Jackson would sometimes invite him out to Neverland and would ask him to stay longer so they could just talk.
— Jackson occasionally lived in the garage, converted into a guest room, of Dr. Alimorad Farshcian when the Miami physician was treating the singer from 2001 until 2003. Farshchian placed an implant in Jackson's abdomen to block the euphoric effects of opioid drugs so he would stop taking them. Farshcian said he traveled with Jackson and spent Christmas with him in 2002.
— Several witnesses who described Jackson's medical treatments said the singer required after-hours visits to avoid paparazzi scrutiny. His records were sometimes filed under the names Omar Arnold, Michael Jefferson or other aliases and prescriptions were also sometimes placed in false names to try to protect his privacy.
— Jackson's second wife, Debbie Rowe, worked for the singer's longtime dermatologist Dr. Arnold Klein and would accompany the singer to many of his medical appointments throughout the 1980s and 1990s. Rowe said Jackson was intensely afraid of pain and required numerous procedures to treat his vitiligo and try to repair damage to his scalp after it was burned while filming a Pepsi commercial in 1984. When Rowe and Jackson married in Australia in 1996, another of the singer's physicians, Dr. Allan Metzger, served as their best man.
— Rowe said Klein and a now-retired plastic surgeon, Dr. Steven Hoefflin, competed with each other for who could give Jackson the best painkillers. Rowe said Jackson trusted his doctors. "Michael had a very low pain tolerance and his fear of pain was incredible," she said. "I think the doctors took advantage of him that way."
— Dental anesthesiologist Dr. Christine Quinn said in 1998 or 1999 Jackson summoned her to a Beverly Hills hotel and asked her to give him propofol to help him sleep. She said she refused.
— Dr. Gordon Sasaki, who tried to repair damage to Jackson's scalp in 2003, said he accepted the singer's invitation to go to Neverland Ranch after they met. Sasaki however refused to prescribe any more painkillers to Jackson after the singer requested Percocet three times in a short time span. Sasaki said he turned over Jackson's pain management to Klein.
— Dr. Stephen Gordon, a Las Vegas plastic surgeon, said Jackson requested that he give him a shot of the painkiller Demerol "for the road" after a procedure in 2003. Gordon refused and didn't see Jackson again for another four years, when he returned with Murray. Jackson acted as if he didn't know Gordon, the doctor said, and Murray took charge of the visit, driving Jackson to the office and paying for it when it was over. "There was nothing usual or customary about what he was doing," Gordon said of Murray.
Attorneys for Jackson's mother have acknowledged that Jackson struggled with painkillers throughout his life, but have said most of his prescriptions were tied to medical procedures. AEG Live's lawyers contend Jackson showed signs that he was doctor shopping, hid his addiction to painkillers and lied about his medical history.
A close relationship between a doctor and patients is not inherently wrong, said Arthur Caplan, the director of the Division of Medical Ethics at NYU Langone Medical Center. He said it often occurs in small towns, and wealthy patients can sometimes afford to hire their own doctors. The problem occurs when the doctor's judgment is clouded and their treatment is affected.
"If you can't say no or stop, you probably are too far down the friendship highway," Caplan said.
Anthony McCartney can be reached at http://twitter.com/mccartneyAP