According to the "Peter Principle" espoused by Laurence Peter and Raymond Hull,"in a hierarchy every employee tends to rise to his level of incompetence." We see this every time a good underling is promoted into becoming a disastrous leader. The principle applies in other settings beside organizations, and may be reframed in systems (and cautionary) terms to read: "people are tempted to aspire to roles for which they are unsuited or unready, but it is in their own interest to honestly weigh the risks and rewards before they take an upward leap." As in anything, the risk in taking on an unsuitable role can range from minor (unhappiness, failure) to major (catastrophe). The story of Dr. Conrad Murray, the physician whose behavior resulted in the death of pop icon Michael Jackson as well as his own career is an illustration of the latter.
Jackson met Murray when the entertainer was in Las Vegas and he was called in to treat one of Jackson's children. Murray is an internist and (non Board-certified) cardiologist, with offices in Nevada and Texas. Jackson apparently liked Murray and asked him to be his personal physician for the duration of a six month show in London and in the several months of rehearsal leading up to that show. Murray, a man with seven children, a complicated love life and major debts, was teetering on the brink of (a second) bankruptcy. When approached by Jackson, he initially asked for a yearly salary of $5 million, but eventually settled for $1.8 million. Murray's major job was to help Jackson, a man with severe primary insomnia, to get to sleep at night. Jackson made clear to Murray that he wanted him to administer propofol, a powerful drug used by anesthesiologists to induce sedation in surgical settings. Jackson, who had previously been given propofol for cosmetic procedures (always by an anesthesiologist), had reportedly asked other medical personnel to administer it to help him sleep, but had been tuned down. Murray, a man with no training in either anesthesiology or sleep disorders, apparently had no such reservations, and agreed to the request.
According to his recorded statement to police, Murray had been administering propofol to Jackson for over a month, using an injection followed by an IV-drip. On the night when Jackson died, Murray claims he initially resisted giving propofol, feeling the singer was becoming addicted, but he eventually relented. Leaving the singer's side to go in another room (he claimed it was a two-minute bathroom break, but cell phone records suggest it was much longer) he returned to find Jackson had stopped breathing. Instead of calling 911 immediately (he delayed that critical step by 30 minutes), he called in a security guard and ordered him to dispose of evidence, then made an inept (and counter-productive) attempt at chest compression, when the correct protocol called for pumping in oxygen (as the problem was not cardiac arrest but lack of oxygen getting to the heart). When paramedics arrived, Murray did not tell them he had administered propofol (suggesting consciousness of wrongdoing), and he also kept this critical information from the doctor treating Jackson in the emergency room.
After the coroner found that Jackson had died from acute propofol intoxication, and in light of Murray's admission to having administered the drug, the physician was charged with and tried for involuntary manslaughter: essentially gross negligence reflecting disregard for life. Murray faces four years in prison (the trial is still ongoing), significant financial liability and the loss of his license, career and reputation. Although Murray's disposing of evidence makes some speculation necessary, the most likely explanation for what happened is that the propofol was being administered through an IV-drip without the use of a dose-regulating pump, and there was a malfunction or miscalculation resulting in way too much of the sedative getting into Jackson's bloodstream. This caused the patient to cross over the thin line between unconsciousness with, to unconsciousness without, breathing. The lack of monitoring or emergency equipment, coupled with the doctor's lack of knowledge or preparation in coping with the emergency situation, combined with his fear-driven delay in calling 911, all contributed to an easily preventable death.
In terms of the Peter Principle, an attractive upward status move (a sizeable salary and the prestige of attending to the world's most famous person) resulted in the worst kind of failure imaginable for Murray. According to my theory of foolish behavior, such an act results from the intersection of four factors, one of them (situation) being external to the actor, and three of them (cognition, personality and affect/ state) being internal. There were two action points in this story that involved foolishness: (a) the first was when Murray agreed to Jackson's request to administer propofol, (b) the second was his failure to use appropriate emergency procedures, including immediately calling 911. I will not consider Murray's incriminating statements about propofol administration to police as foolish (after first trying to cover it up in the hospital), as I believe full honesty in such a situation is an ethical requirement. However, as a general rule, it is usually a mistake for a criminal suspect or offender to agree to a police interview, as nothing good generally comes out of it.
