Anna Nicole Smith Died of Accidental Overdose, Authorities Say

Mar 26, 10:00 PM

Current Headlines: MIAMI _ Anna Nicole Smith's autopsy results, released Monday, reveal as much about the star's reckless life as they do about her sudden death of an accidental overdose at age 39.

The autopsy report paints a complex, yet human picture of Smith: a mother battling depression after losing her son; a woman struggling to quell chronic pain from several plastic surgeries; and a star so obsessed with preserving her beauty that she gobbled diet pills, drank SlimFast and injected her buttocks with anti-aging drugs.

Yet Smith was a woman in control, even in the final days of her life, days that she spent in a suite at the Seminole Hard Rock Hotel & Casino fighting a 105-degree fever, flu symptoms, sweating and a painful infection caused by a ruptured abscess in her buttocks.

Three days before her Feb. 8 death, her temperature soaring, Smith took an ice bath and Tamiflu, but firmly refused to go to the emergency room.

Smith improved the next day, but Broward Medical Examiner Dr. Joshua Perper said Monday that a trip to the ER could have prevented her fatal overdose, caused by at least nine prescription drugs. The combination of drugs slowed down her brain and caused respiratory arrest.

Instead, Perper said, Smith holed up in her hotel room, surrounded by cold and flu medications, soda cans, nicotine gum and room service. There, she took a lethal dose of chloral hydrate, a rarely-prescribed sleeping medication that she often gulped straight from the bottle.

Ironically, the same drug contributed to the death of her idol, Marilyn Monroe. Smith told friends she wanted to die like Monroe _ whose visage she had tattooed on her right calf.

Lawyers for Smith's estranged mother, Virgie Arthur, have not yet seen the investigation documents, but say they may consider filing a civil suit against Smith's longtime partner, Howard K. Stern, or her doctors.

At a press conference Monday afternoon, attorneys for Stern said the autopsy findings brought him "no relief or peace," but lawyers have no plans to pursue other legal action.

Arthur and others have cast Stern as a schemer who engineered Smith's death and the death of her son Daniel, but Seminole police said there is no evidence of criminal wrongdoing.

"The case is closed," said Lilly Ann Sanchez, one of Stern's Miami attorneys.

Daniel's death is the subject of an inquest set to begin Tuesday in the Bahamas; authorities say his cause of death remains unresolved. A forensic pathologist hired by Smith determined that Daniel died from a heart condition caused by an overdose of methadone, Zoloft and Lexapro.

Forensic experts say doctors who prescribed medications for Smith under her own name and under various aliases are unlikely to face criminal charges because there is no evidence to suggest she took medications against her will.

Smith's relatives could file negligence suits against her doctors only if records show the physicians insufficiently monitored her or knowingly over-prescribed her drugs.

Smith's doctors could also face professional sanctions. One of her doctors, Sandeep Kapoor, is under investigation by the Medical Board of California, though officials won't say whether the probe is related to Smith.

Smith's psychiatrist and personal physician, Khristine Eroshevich, prescribed her chloral hydrate as a sleeping aid about five days after Smith's son died in the Bahamas, said Sanchez.

Doctors rarely prescribe chloral hydrate nowadays because of overdose risks, but Smith's friends and doctors told Perper that modern drugs such as Ambien and Lunesta did not work for her.

Perper's initial autopsy on Feb. 9 isolated no clear cause; bacterial and microbial tests also came back inconclusive. Crime scene investigators who surveyed Smith's hotel room found no illegal drugs, and none were found in her system.

Autopsy results show Smith consumed enough chloral hydrate to harm herself. The dose proved fatal in combination with other drugs she took regularly, such as anti-anxiety and weight loss medications.

Perper's report says the reality TV star and diet pill pitchwoman frequently self-medicated and had developed a high tolerance to the drugs she took.

But this particular combination of drugs may have overwhelmed Smith's system, said H. Chip Walls, a forensic toxicologist at the University of Miami's Miller School of Medicine.

"Does Elvis Presley ring a bell? This is the exact scenario," Walls said. "He had 10 to 12 drugs on board, but when all of them mix together, you ask `how did he not die of all of these drugs?'"

Perper consulted Smith's friends and reviewed information stored on her personal computers to determine the manner of her death _ suicide, homicide, or accident.

After the death of her son last fall, friends and loved ones said Smith was suicidal, once nearly drowning after another accidental overdose.

But her outlook brightened as 2006 came to a close, said Perper.

Smith reportedly wanted to marry Stern on Feb. 28, was planning a trip to Dubai this month and talked about having another child _ all signs that point away from suicide, Perper said.

Documents also show that investigators found no physical evidence that anyone force-fed Smith drugs.

"The evidence for accident is more convincing than all other options (including suicide or homicide)," wrote Perper in his findings.

___

(McClatchy Newspapers correspondents Evan S. Benn and Roberto Santiago contributed to this report.)

___

(c) 2007, The Miami Herald.

Visit The Miami Herald Web edition on the World Wide Web at http://www.herald.com/

Distributed by McClatchy-Tribune Information Services.

_____

ARCHIVE PHOTOS on MCT Direct (from MCT Photo Service, 202-383-6099): Anna Nicole Smith

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.