Autopsy Reveals Anna Nicole Smith Died of Accidental Drug Overdose

Mar 27, 06:54 AM

Current Headlines: By Marlene Naanes, South Florida Sun-Sentinel

Mar. 27--Anna Nicole Smith died of an accidental overdose of prescription drugs, and an infection and possibly the flu contributed to her demise, Broward Medical Examiner Dr. Joshua Perper said Monday.

The announcement came six weeks after the former Playboy playmate and reality TV star was found unresponsive in her hotel room at the Seminole Hard Rock Hotel & Casino in Hollywood and later pronounced dead at Hollywood Memorial Regional Hospital.

Perper said Smith mixed a lethal combination of anti-depressants and anti-anxiety medications, antibiotics, Valium and chloral hydrate, a rarely prescribed sedative. Chloral hydrate, which has been around since the mid-1800s and sometimes used as a sleep aid, was found in high levels in her body, Perper said.

An infection in her buttocks caused after injections of health serums, including vitamin B-12, caused a high fever days before her death, and Smith may have also suffered from the flu, Perper said. Those conditions weakened the former Guess? model and contributed to her death, he said.

Perper ruled out homicide, saying there was no evidence anyone forced Smith to take the drugs. He also ruled out suicide because she did not take extreme quantities of the medicines she had on hand, as is typical in a suicide case. Also, she had been planning for the future, and generally had been in good spirits since the birth of her daughter, Dannielynn, Perper said.Perper also considered but disregarded Smith once saying she wanted to die the same way Marilyn Monroe died -- suicide by chloral hydrate and another drug, he said.

The medical examiner conducted an autopsy and also interviewed Smith's friends, employees and companions, including Smith's live-in boyfriend, Howard K. Stern. He also employed several experts outside his office.

During the investigation and the media firestorm that entranced South Florida and the world, Perper was ready to release his findings two weeks ago. He put off making an announcement when Seminole Police asked him to look at two laptop computers found in Stern and Smith's Bahamian home. The doctor scoured the computer for e-mails indicating Smith was suicidal or in fear for her life, but found none.

Experts said chloral hydrate in combination with other drugs most likely interacted to depress Smith's system.

"It depresses all brain activity from thinking to breathing, and as the level goes up, it can lead to cardiac arrest and death," said H. Chip Walls, technical director of the forensics lab at the University of Miami Miller School of Medicine.

Chloral hydrate is more problematic than newer medications and toxicologists don't often see it in deceased patients, Walls said.

Smith's psychiatrist friend, Kristina Eroshevich, prescribed chloral hydrate because Smith was having trouble sleeping while grieving the passing of her son, Daniel, who died in September, Lilly Ann Sanchez, an attorney for Stern said Monday.

Daniel died in the Bahamas, Smith's adopted home, and an independent medical examiner declared his death was caused by methadone and anti-depressants.

Smith was taking chloral hydrate throughout her trip to South Florida that began on Feb. 5, Perper said. That day, Smith suffered from the chills and a temperature of 105 degrees. Friends urged her to go to an emergency room, but she refused. On Feb. 8, Smith was found about 1 p.m., unresponsive, in Room 607 at the Seminole Hard Rock Hotel. She was taken to Memorial Regional Hospital, where she was pronounced dead about 2:49 p.m.Almost immediately, a legal maelstrom ensued. An ongoing paternity battle over Smith's daughter, Dannielynn, between Smith's ex-boyfriend, Larry Birkhead, and Stern, heated up. After the death, Zsa Zsa Gabor's husband also claimed he was the father.

A battle also ensued between Stern and Smith's mother, Virgie Arthur, over Smith's remains.

On Feb. 22, Broward Circuit Court Judge Larry Seidlin ruled that Dannielynn's court-appointed guardian would decide where Smith would be buried. The guardian, Miami-based attorney Richard C. Milstein, chose the Bahamas. Smith was buried there March 2. Legal battles still rage in California and the Bahamas over paternity of Dannielynn and ownership of the Bahamas house where Smith lived.

Nancy Haas, an attorney for Birkhead who attended Perper's news conference, said afterward that she was not surprised at the cause of death. And the lawyer for Stern, Sanchez, said the way Smith died was "painful" and "tragic."

She said Stern wishes he had insisted Smith go to the hospital to seek treatment for her symptoms. Responding to Haas' and others' questions as to why no one forced Smith to go to an emergency room when she first became sick, Sanchez said, "Anna called the shots for Anna. Anyone who knew her knows that."

Staff Writers Brian Haas, Madeline Barâ€" Diaz, Nancy McVicar and Macollvie Jean-Franâ€"ois contributed to this report.

Marlene Naanes can be reached at mnaanes@sun-sentinel.com or 954-385-7922.

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