The North Dakota Board of Medical Examiners (BME) has reinstated the medical license of Dr. Jon Norberg as of 8/12/13. The orthopedic hand surgeon’s license has been suspended indefinitely amid allegations he injected his wife Alonna, also a physician, with the powerful anesthetic propofol, in their home. While Norberg admitted to having done so with the consent of his wife claiming it was an attempt at a desperate last option in treating her chronic pain, he denied claims by his now former wife that he used the drug to render her unconscious and have sexual relations with her against her will. Based on her allegations criminal charges were filed and Norberg was found not guilty of gross sexual imposition and reckless endangerment.
However Norberg DID admit to having CONSENSUAL sex with his wife while she was under the influence of the propofol he had administered. Law Med has opined on why Norberg, almost certainly actually innocent of the claims by his wife that he drugged and raped her (we are even more confident after the recent lie detector examination he underwent as part of his Petition), is in our view very much guilty of the crime of reckless endangerment when the facts are applied to the criminal statute’s elements as stated. Of course this can be quite different than outcomes from juries, and Jon Norberg is, officially under the law, not guilty of all charges brought. We discuss the verdict in Fargo Surgeon Not Guilty In Propofol Rape Trial, But Why?
As we previously pointed out:
North Dakota Code > Title 12.1 > Chapter 12.1-17 > § 12.1-17-03 – Reckless endangerment:
A person is guilty of an offense if he creates a substantial risk of serious bodily injury or death to another. The offense is a class C felony if the circumstances manifest his extreme indifference to the value of human life. Otherwise it is a class A misdemeanor. There is risk within the meaning of this section if the potential for harm exists, whether or not a particular person’s safety is actually jeopardized.
Administering propofol to someone in their home, especially without monitoring and airway equipment, ALWAYS “creates a substantial risk of serious bodily injury or death.” ALWAYS. Without exception. It does not matter if you are the Chief of Anesthesia at Cook County Hospital, it STILL ”creates a substantial risk of serious bodily injury or death.” There is NEVER an occasion where that scenario does not “creates a substantial risk of serious bodily injury or death.” Regardless of how we view things however, Norberg has been adjudicated not guilty and that, as they say, is that.
After this month’s action by the Board Norberg said “I think I’ve been exonerated. In basically every arena you can be exonerated in — the criminal, the civil, the professional.” Well, while he may THINK that (though he is not a stupid man so we rather doubt it) it simply is not true. The ND BME has not “exonerated” him. Much the opposite. They HAVE determined that he is not a danger to public or his patients with a reinstated medical license, and we would agree. By all accounts he is a respected and talented surgeon. His very poor judgment in administering propofol to his wife, at home, with her consent, for off-label use as a chronic pain medication does not change that. As for the BME, they charged him and found him guilty as follows:
On December 23, 2011, Administrative Law Judge Hoberg issued his Findings of Fact, Conclusions of Law and Recommended Order to the Board of Medical Examiners for its consideration and final action. AU Hoberg concluded that Dr. Norberg committed unprofessional conduct, gross negligence in the practice of medicine, and the administration of a dangerous drug to a spouse or family member, all in violation of the medical practice act. He recommended the board indefinitely suspend Dr. Norberg’s license to practice medicine. On January 5, 2012, the Board of Medical Examiners issued an order adopting the ALJ’ s findings of fact and conclusions of law, and suspended Dr. Norberg’s license indefinitely.
The BME has not changed these “findings of facts and conclusions of law” and the criminal trial’s not guilty findings have absolutely NOTHING to do with these facts. He was not on trial for whether he “committed unprofessional conduct, gross negligence in the practice of medicine, and the administration of a dangerous drug to a spouse or family member, all in violation of the medical practice act”. He IS guilty of all of these things and an Administrative Law Judge has said so and the BME agrees.
From Norberg’s Petition for Reinstatement submitted to the North Dakota Board of Medical Examiners:
In the criminal trial, two medical experts testified regarding the manner of administration of the Propofol. The prosecutions’ expert was Stephen Shafer, M.D., of notoriety for his testimony in the Conrad Murray (Michael Jackson case). Dr. Jon Norberg’s medical expert was Dr. Joseph Ramos, M.D. an Assistant Clinical Professor at the University of Colorado and an emergency room physician, where he is responsible for the clinical teaching of residents from all specialties in the Emergency Department. He is board-certified in Emergency Medicine with extensive experience in the administration of Propofol.
One cannot fault Norberg’s lawyers for presenting his “medical expert” witness, Dr. Ramos, in the most favorable light possible, while ignoring the superior qualifications of, and the damning testimony by, the state’s medical expert, Dr. Shafer. To be clear, Shafer is a Board Certified Anesthesiologist at Stanford University and is the editor-in-chief for Anesthesia & Analgesiaa highly respected Anesthesiology journal He specializes in the clinical pharmacology of intravenous anesthetic drugs and especially the pharmacokinetics and pharmacodynamics of the drug propofol. He is arguably one of the , if not THE, foremost expert(s) in the world on this drug and its use. The testimony from the two physicians at the criminal trial differed greatly, with that from Ramos (who has a questionable clinical background to begin with) being quite frankly absurd at some points. From our previous coverage:
“The monitoring, the vigilance and the ability to resuscitate were all well below the standard of care,” said Shafer. And the came the next bombshell. Norberg showed a “lack of vigilance” when, according to his own affidavit on July 19, 2011, he had sex with his wife while she was sedated with propofol. “And I do not understand how one can be vigilant as a physician looking after a patient while at the same time engaging in sexual intercourse,” he said.
Shafer went on to testify that Norberg didn’t have the proper expertise, equipment or medication available in case something went wrong, didn’t document the sedation process and didn’t have his wife sign an informed medical consent document. When asked if he could state with a reasonable degree of medical certainty that the situation of Alonna Norberg’s unconsciousness without proper personnel and safety equipment present created a substantial risk of bodily injury or death, Shafer answered, “Yes.” – Read more at: lawmedconsultant.com/4631/jackson-propofol-expert-testifies-in-norberg-rape-trial-blockbuster-details
Then there was the Ramos testimony which we reported on November 12, 2012:
Well Law Med has now heard everything and can die satisfied. Yesterday Dr. Joseph Ramos, a medical expert called by the defense in the Propofol Rape Trial of Jon Norberg, testified that when injecting his wife with the powerful sedative/anesthetic propofol, Norberg’s goal was to relieve his wife’s pain and anxiety, and that one of the benefits of someone being happy and not in pain is that they may be interested in things like sex, travel and family functions, “doing some of the things he missed.”
Referring to Norberg sedating his wife with propofol and then having sex with her, Ramos said “Is that a benefit? I think it’s a benefit. Is the goal to have a happy family and do those things. Yes, that’s probably a goal. Is the goal to knock her out and have sex with a rag? No.”
On cross examination, prosecutor Gary Euren asked Ramos if the sex was consistent with Jon Norberg being vigilant in treating his wife with propofol. Ramos claimed it was, in direct contrast with the testimony heard last week from prosecution propofol medical expert Dr. Steven Shafer. “If he gives her propofol and she feels better and he’s having sex with an awake, interactive, talking person, that’s vigilant. That’s fine,” Ramos said. Ramos said that Dr. Jon Norberg’s use of propfol, in his house, without monitors or equipment which the drug company’s insert says are required in compliance with FDA requirements, was not reckless in any way.- See more at: Medical Expert Says Propofol Safe For Home Use As Sexual Aid
After the verdict in the criminal trial the Norberg’s divorce proceedings took place, a divorce which Alonna filed for. And the not guilty verdict in Norberg’s criminal trial played no small part, as did the testimony from that trial. More from the Petition for Reinstatement quoting the judge in the divorce case:
The Court finds that Jon’s administration of Propofol to cause a light sedation in Alanna presented minimal to no risk to her. Dr. Ramos also testified credibly that minimal or light sedation entails minimal risks. Minimal sedation does not affect the airway, does not affect ventilation, and does not affect cardiovascular function. Alanna would have been conscious during light sedation. It was Dr. Ramos’ credible opinion that a minimal sedation created no substantial risk of death or bodily harm.
That judge has not the first clue about the reality of the potential effects and complications from light or minimal sedation with proprofol. After all she is a judge, not a physician familiar with propofol. She chose to rely on the absurd testimony of Ramos over that of Shafer for whatever reason, likely influenced by the acquittal in the criminal trial. The Petition goes on to overstate the findings of the jury in the criminal trial in an attempt to persuade the BME that Norberg’s actions in his administrating propofol to his wife were within accepted professional standards. They outright claimed the jury had decided just that, which they never in fact did:
After hearing all of the evidence the Jury concluded that Dr. Norberg acted responsibly and within the ASA [American Society of Anesthesiologists] Guidelines. The Jury further found that the allegations regarding the Propofol being used in a surreptitious manner, against the will of Dr. Alonna Norberg, or for other improper purposes were totally unfounded and instead, that the allegations were fabricated by Dr. Alonna Norberg to gain an advantage in the Divorce proceedings.
To be clear, the jury was to consider the guilt of Norberg regarding a singular issue specific to his administration of propofol: Reckless Endangerment. He was found not guilty, yet he can still have acted irresponsibly, outside of ASA guidelines, surreptitiously, or for other improper purposes when he administered the propofol and still not be guilty of Reckless Endangerment. And in fact he did ALL of those things and the BME knows it, has found him guilty of it, and has not and will not change their opinion.
As for being exonerated in the civil arena, Alonna Norberg still has a pending medical malpractice suit against her former husband and until that case goes away, settles, or goes to trial, there has not been civil exoneration everywhere. As for the civil divorce proceedings, Law Med does not have access to those records in total and it is not known whether the judge considered the charges from the BME or commented about them.
Norberg was however contrite in his Petition to the board:
Dr. Norberg’s current response and position with respect to his use of Propofol is stated here as a part of this verified petition and is offered under oath:
“I realize that I was wrong and arrogant to think that I could have handled the complex situation we faced without help. It was wrong of me to have attempted this myself. I never meant to do harm. I was trying to do good. Unfortunately, my arrogance led me to believe that this was something I could handle and something that I could fix.
First and foremost, as a result of my actions, I have harmed my family. I have harmed my medical career and I have harmed my ability to provide for my children. I have incurred a substantial financial burden and will likely have to file bankruptcy. I have been subjected to much harmful publicity and my reputation as a professional has been severely tarnished.
I have already been severely punished personally) professionally, and financially. From this experience, I have gained valuable insights and would never engage in anything like this again. I understand that my largest character flaw is arrogance. To say that this has been humbling, would be the a gross understatement.
I will do whatever the Board requests and will follow the conditions and recommendations that may be imposed upon me .in the lifting of the suspension of my medical license.”
As part of a multidisciplinary evaluation of Norberg presented to the BME, a polygraph examination was administered:
These findings include the results of a polygraph examination which addressed the charges made by his wife. The result of the examination supported Dr. Norberg’s repeated prior assertions that he had never utilized Propofol to impair his wife so he could engage in sexual activity, that he never had relations with her against her will and that he has never had improper sexual relations with a patient and further support the Jury’s and Divorce court findings.
We, like the jury, do not believe the claims of Alonna Norberg that she was drugged against her will and raped. Certainly her mental stability is reasonably characterized as “questionable”. Everything that has befallen Jon Norberg is due to his own, conscious, utterly irresponsible decision to introduce propofol into his home for the purpose of administering it to his wife. Norberg himself would likely be the first to now acknowledge this. He has paid a high price for a very serious lack of judgment and he can now hopefully pick up the pieces and regain some semblance of a normal life redeeming his professional reputation and climbing from financial ruin. His violation of professional medical standards has been addressed appropriately and the return of his license is not an exception.
Dr. Jon Norberg North Dakota Board of Medical Examiners 2013 License Reinstatement documents.
, Dr. Joseph Ramos
, Dr. Steven Shafer
, Dr. Norberg