Jackson’s health data subpoenaed

Investigators trying to determine how Michael Jackson died are faced with the daunting task of creating an accurate medical biography for a superstar whose ailments, surgeries and doctors have been tabloid fodder for three decades.

Jackson has seen more than a dozen doctors since 1993, according to various public records and accounts, and investigators are now collecting as much medical data about him as possible.

Sources told The Times on Thursday that the Los Angeles County coroner’s office has requested and subpoenaed medical files and records from a number of doctors who treated the singer. That is in addition to at least three search warrants issued last week as part of a Los Angeles Police Department probe into whether prescription drugs played a role in his death.

A source who has seen one of the coroner’s office subpoenas said it asked for “any and all” of Jackson’s medical records “including radiology and psychiatric records.”

An attorney for Dr. Arnold Klein, a Beverly Hills dermatologist who treated Jackson for nearly 25 years, said his client was among those receiving a formal request from the coroner’s office.

“It was a standard form subpoena and we turned over medical records to the medical examiner in response,” said lawyer Richard Charnley.

Authorities have identified some of Jackson’s doctors from the medications and other medical evidence they recovered from the Holmby Hills mansion where Jackson was stricken two weeks ago, according to sources familiar with the investigation. But those sources said that some of the medications lacked prescription labels and that officials are trying to determine how Jackson got them.

A longtime Jackson associate, who spoke on the condition that he not be named because of the investigation, said the pop star had little trouble finding doctors eager to treat him -- and prescribe him drugs.

“They rotate in and out,” said the source. “There were a lot of doctors over the years. . . . They liked to be known as Michael Jackson’s doctor.”

Experts said the task before detectives and coroner’s investigators amounts to a medical jigsaw puzzle. They must get a strong handle on his medical status at the time of his death, including pre-existing conditions, previous medical procedures and his drug-use history -- things that can be gleaned through many of the records requested and subpoenaed.

After gathering information about what was prescribed and in what quantity, investigators with medical training look at the patient’s history, the possible reasons each drug was prescribed, the side effects and the interactions with other medications. Investigators must also cross-reference files to try to recreate what a physician knew at the time he or she wrote a prescription.

Ed Winter, assistant chief of the coroner’s office, said the office does send subpoenas out in death investigations. “In many cases doctors will hand over the records,” he said. “In some cases they will ask us for a subpoena to get those records.”

Winter would not comment on whether subpoenas were issued in Jackson’s death. Authorities have stressed that it’s too early to know whether any crimes have been committed and that much depends on the official cause of death.

While officials are awaiting the results of toxicology tests conducted by the coroner’s office the day after Jackson’s death, they warn that those tests may not answer all the questions. For example, sources have told The Times that detectives found large amounts of the powerful anesthetic Diprivan at Jackson’s home. But experts said that the drug moves through the body quickly and might not show up in some tests.

It’s an extremely potent drug that is supposed to be dispensed by a person trained to administer anesthesia.

Paul Wischmeyer, an anesthesiologist at the University of Colorado who co-wrote a 2007 study of Diprivan abuse for the journal Anesthesia & Analgesia, said that Diprivan would be “probably undetectable” in the bloodstream in 20 minutes after a single dose.

But he said that there are other ways that pathologists have used to identify the presence of the drug in autopsies, if they know what to look for.

In an interview with Larry King on Wednesday, Klein said that Jackson was using Diprivan “when he was on tour in Germany.” It’s unclear exactly when that was, but the last time Jackson was on tour in Germany was 1997.

Klein said that Jackson “was using it, with an anesthesiologist, to go to sleep at night. And I told him he was absolutely insane. I said you have to understand that this drug, you can’t repeatedly take. Because what happens with narcotics, no matter what you do, you build a tolerance to them.”

Wischmeyer disputed that, saying that he had never observed a person building up tolerance to the drug, nor had he seen any such reports in the descriptions from abusers.

One of the few death investigations with a similar level of complexity and public scrutiny was the one conducted after the death of model Anna Nicole Smith, who died of a drug overdose in 2007.

Dr. Stephen J. Cina, deputy chief medical examiner in Broward County, Florida, where Smith died, said that it took the medical examiner’s office six weeks to investigate the cause of her death.

In addition, investigators from the Drug Enforcement Administration, three state agencies and the L.A. County district attorney’s office pored over evidence related to her death for two years before prosecutors charged her boyfriend and two physicians with conspiracy to illegally furnish the late model with sleeping pills, painkillers and other drugs.

The three have pleaded not guilty, and a preliminary hearing is set for later this summer.

Adam Braun, a former federal prosecutor who is representing one of the defendants, Khristine Eroshevich, said such investigations take much longer than other probes because of the medical expertise required to review cases.

“The patient might be seeing three or four different doctors who are prescribing medications that the other doctors are unaware of,” he said. “Just because there is a deadly cocktail doesn’t mean the actions of one physician were inappropriate.”

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Times staff writers Andrew Blankstein, Joel Rubin, Kimi Yoshino, Jeff Gottlieb and Rong-Gong Lin II contributed to this report.