by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.
Years after Elvis’ died, Dr. Nick claimed he was guilty only of caring too much for his patients. He showed this care in an unusual manner. In the final 7
months of Elvis’ life, Dr. Nick prescribed 5,300 uppers, downers and painkillers for Elvis’, resulting in an average of 25 pills or injectable vials a day. When questioned about the unusual number of prescriptions he had written for the King, he argued that he issued them in order to monitor the singer’s drug use and eventually wean him of his addictions. In fact, during his legal proceedings he even claimed to have manufactured 1,000 doses of placebo for his most famous client. Still, it seems that somehow providing Elvis’ with multiple prescriptions for Demerol, Nembutal, Dilaudid, Halcion, Didrex, Valium, Placidyl, Haldol, Nubain, Percodan, Nembutal, Stadol, and oxycodone was not effectively treating his addiction.
Dr. Nichopoulos, then 82 years-old, resurfaced in 2009. In interviews given to ABC, CBS, and CNN he complained of having been subjected to an unjustified
“witch hunting” and being the “whipping boy” of the media and medical authorities. Conveniently, in the wake of Michael Jackson’s death, Dr. Nick announced the upcoming publication of “The King and Dr. Nick: What Really Happened to Elvis’ and Me.” Dr. Nick has acknowledged that Elvis’ was a challenging patient.
“Unfortunately there’s not a drug you can give somebody to take care of everything.
You need a different drug for every situation.” He also clarified that he was not only Elvis’ physician but also treated up to 150 people on the road with the star.
Nichopoulos relayed to the interviewers that Elvis’ insisted that all of the prescrip-214
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tions to his entire entourage be written in his name in order to keep his father, Vernon Presley, from getting upset by the cost of prescription drugs for so many people. “So it looked like he (Elvis’) was taking all these drugs because the prescriptions were in his name.” Ahhhhh, now it all makes sense!
Anna Nicole Smith
It was difficult to think of a catchy subtitle for this section. Everyone knows that Judy Garland was Dorothy, that Elvis’ was the King, and that Michael Jackson was a uniquely talented dancer, singer, and songwriter. But, despite being intimately familiar with the life and death of Anna Nicole Smith (she happened to die in our jurisdiction and came to reside in our Office), we still are not quite sure what she was famous for. This is what we do know.
Anna Nicole Smith was born Vickie Lynn Hogan on November 28, 1967 near Houston, Texas. She was raised by her mother Virgie, a law enforcement officer, after her father had left the family. She did not excel in academics, failing her fresh-man year of high school and dropping out entirely as a sophomore. She obtained gainful employment at Jim’s Krispy Fried Chicken and soon thereafter met her future first husband, Billy Ray Smith, a cook at the restaurant. When Anna was 17
and Billy was 16 they married and the next year they had a son, Daniel Wayne Smith. The couple separated in 1987 and eventually divorced in 1993. Vickie Lynn moved to Houston and worked sequentially at Wal-Mart and Red Lobster. She then turned to exotic dancing for additional income. So far, the same story could be told of thousands of women.
Vickie’s big break came in 1992 when she appeared as the cover girl for the March issue of Playboy magazine. Vickie Lynn was a throwback to the days of the “blond bombshell” – she had curves and she was proud of them. In fact, she aspired to be the next Marilyn Monroe and she bore an uncanny resemblance to the dead sex goddess in several of her photo shoots. In 1993 she was chosen the Playmate of the Year, a great honor of the soft pornography industry, and had adopted the stage name of Anna Nicole Smith. She was a highly sought after model and her hourglass figure (36DD-26-38) was seen in ad campaigns in the United States and abroad. These were the salad days for Anna Nicole.
Love had also reentered the young stripper’s life. In 1991, she met billionaire J. Howard Marshall while performing at Gigi’s in Houston. After her divorce from Billy Smith had been finalized, the 26 year-old model married the 89 year-old oil magnate in 1994, officially becoming Vickie Lynn Marshall. Though the couple never lived together, Anna professed to love him deeply. Calloused cynics, however, began to spread rumors that she had married the elderly gentleman for his $1.6
billion, not accepting the possibility that they were soulmates. Some even believed her grief was feigned when Marshall died 13 months after their marriage. The dis-believers included the billionaire’s two sons who fought Anna Nicole bitterly over her claim to half of the dead man’s estate. Whether she loved him or not, it is clear Anna Nicole Smith
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that Anna Nicole was not doing well after her husband’s death for one reason or another – in 1996 she was admitted to the Betty Ford Clinic.
Anna Nicole Smith’s legal battle with the Marshalls went on for more than a decade. While the courts sided with Anna Nicole some of the time, they ruled against her on several occasions and in 1996 she filed for bankruptcy. By 2005 the U.S.
Supreme Court even weighed in on her case, asserting that she had the right to pursue a share of the estate in federal court. The next year one of Marshall’s two sons died, but the case continued on with his widow representing the estate. The estate issue was not resolved at the time of Anna Nicole’s death in 2007 raising the possibility that her daughter would inherit millions. A federal appeals court, however, recently decided that Anna and her estate would see none of the $300 million she was seeking.
Anna Nicole Smith was a full figured girl but, unlike most models, did not appear to be all that bothered by it. Nonetheless, in 2003 she signed a deal with TrimSpa, a diet program that helped her to lose almost 70 pounds. Her weight rapidly moved up and down over the next few years, cycling almost as rapidly as her sobriety. In 2004, Anna Nicole was widely ridiculed after slurring her speech and acting erratically at the American Music Awards. Videos of the model taken over the next few years depict Anna as highly intoxicated and childlike; in a few home movies she was wearing smeared clown makeup. In the years leading up to her death, she had developed a full blown addiction to prescription medications, most notably chloral hydrate (a sleeping aid which had been a favorite of Marilyn Monroe’s) and sedatives (specifically a class of drug called benzodiazepines).
Anna Nicole was under severe emotional stress the last year of her life. Her estate lawsuit with the Marshalls had not been resolved. Her tenuous relationship with TrimSpa was closely related to her unstable weight. Her acting and producing career was nonexistent. And she was having issues with her family. On September 7, 2006 she gave birth to a daughter , Dannielynn; 3 days later her 20 year-old son Daniel died of a drug overdose while visiting her in the maternity ward. Smith hired well-known forensic pathologist Dr. Cyril Wecht to perform a second autopsy on his body. Dr. Wecht concluded that Daniel had died of an overdose of Zoloft, Lexapro, and methadone. The presence of the latter drug is significant. This medication is used to wean people off of heroin addiction and as a treatment for chronic pain – Daniel suffered from neither condition. It was never determined where he had obtained this drug or from whom. It is quite possible that Daniel got his drugs the same way thousands of teens get them across the country – from his mom’s medicine cabinet. But where was Mom getting them?
Anna Nicole obtained her drugs via several means. Some of her medications were obtained through good, old fashioned prescriptions made out in her name.
Other drugs were scored by filling prescriptions made out to pseudonyms and close friends, including her lawyer and lover (what a strange combination!) Howard K. Stern and her close friend and physician, Dr. Khristine Eroshevich. There was never a shortage of pills, alcohol, and elixirs around Anna Nicole Smith. Friends were amazed at how many pills she was taking. When she traveled, a tote bag filled with painkillers, sedatives, and chloral hydrate accompanied her. Although allegations have been made that Stern kept Anna Nicole stuporous in order to control her 216
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(she apparently could be very domineering when she was sober), Smith also clearly exercised her own free will by voluntarily swallowing excessive medications.
Anna’s entourage enabled her addiction, but the drugs would not have been around if she wasn’t asking for them constantly.
Anna Nicole Smith’s fatal road trip from the Bahamas to Florida began on February 5, 2007. Leading up to the trip, she had been in relatively good spirits, having apparently pulled herself out of the depression that followed the death of her son. She was still abusing prescription medications, including methadone, but was apparently relatively functional. In addition to an assortment of pills, she was taking injections into her buttocks of vitamin B-12, Human Growth Hormone, and immu-noglobulins to “rejuvenate” her and assist with weight loss. While flying to Florida from the Bahamas she began to complain of pain at her latest injection site; shortly after landing she complained of chills and spiked a fever to 105°F. She was treated with Tamiflu and antibiotics followed by a cold bath and she began to feel a bit better. She attempted to take some cough medicine prior to bed but could not hold it down. Eventually, Anna took two tablespoons of chloral hydrate and was able to fall asleep.
The next day Miss Smith felt tired but her temperature remained below 100°F.
She drank plenty of fluids, watched a lot of TV, and napped. That evening, she asked for more chloral hydrate then slept for 1–2 hours. When she awoke, she watched a little television then asked for and was given Klonopin (a seizure medicine also used to treat panic disorder), Soma (a muscle relaxant), Valium (a sedative used for antianxiety disorder), and Topamax (a drug used to treat seizures and migraines) followed by a chaser of chloral hydrate. She was attended to by Howard K. Stern and Dr. Eroshevich.
By February 7, her third day in Fort Lauderdale, Anna Nicole Smith was still on the mend. Early that afternoon, she was found sitting naked in a dry bathtub, a situation that raises questions about her mental state. That evening Anna was very upset when Dr. Eroshevich left Florida for California. She took another dose of chloral hydrate and went to bed but did not sleep well. It is worth noting that chloral hydrate is a liquid medication. We simply don’t know if she actually used a tablespoon to take this drug, poured it into a glass, or swigged it from a bottle. We do know she was taking too much of it.
On the morning of February 8, 2007, Howard K. Stern has stated that he woke up around 10:00 in the morning. Anna was already awake and feeling fairly well except for fatigue. He helped her to the bathroom then put her back in bed prior to leaving the hotel to purchase a boat at her request. According to him, he did not see Anna Nicole take any medications that morning nor did he give her any. Anna was then babysat for several hours; it was assumed she was asleep in bed. When her bodyguard’s wife, a registered nurse, checked on her at 1:00 PM she was unresponsive and not breathing. Resuscitative efforts by the nurse, the bodyguard, and paramedics ensued but were unsuccessful. She was pronounced dead at 2:49 PM at Hollywood’s Memorial Regional Hospital.
The death scene was secured by the local police who initiated an investigation.
Staff from the Medical Examiner’s Office also responded, confirming the presence Anna Nicole Smith
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of numerous prescription medications in the room. The body was initially examined at the Broward County Medical Examiner’s Office that afternoon and samples were taken for toxicological analysis and for microbiological studies to rule out infection.
A complete autopsy was completed the next day. Following the procedure, a press conference was held and it was announced that there were no signs of foul play but that additional studies were required to determine the cause and manner of death.
Given the circumstances surrounding this fatality and the fact that most young people who die suddenly and unexpectedly in South Florida have taken drugs, an overdose was suspected.
When the first battery of toxicological studies was completed, there was no obvious cause of death. Though several drugs were identified, including acetaminophen, Topomax, diphenhydramine, Klonopin, Valium, Ativan, Robaxin, and Soma, none were at toxic levels. At that time, although a drug overdose could not be excluded since these drugs can act together to kill you even at “safe” levels, the Medical Examiner team’s attention was turned to possible infectious causes of death. An interview with Dr. Eroshevich lead the pathologists to dissect the tissue beneath the injection sites. Large abscesses, scars and needle tracks were identified in her buttocks. Infectious disease specialists were consulted and death due to sepsis from infected injection sites was beginning to appear likely. Molecular analysis for inter-leukins and cytokines was ordered and several markers were elevated, supporting an acute systemic infection. But additional studies were still pending so the cause of death was not finalized.
Real life is not like CSI – sometimes it takes weeks to months to get the results of complex toxicological tests. One goal of the Medical Examiner is to provide answers to the police, the family, and the public in a timely manner but the primary mission is to get the cause and manner of death correct. Despite significant pressure to rule on this fatality prematurely, the Medical Examiner waited until all of the results were in. Doing so in this case prevented a great deal of egg on the face. On the third week following the autopsy, a referral lab informed the Medical Examiner that there was a toxic level of chloral hydrate in the blood. Despite Anna Nicole’s probable tolerance to this medication, this drug taken in combination with the cocktail of prescription medications described above, caused her to fall asleep, stop breathing, and die in her bed in the Hard Rock Hotel.
The cause of death in this case was combined drug toxicity and the manner was ruled as accidental. A probable infection was considered a contributory factor in this fatality in that it likely weakened her and may have predisposed her to take excessive medications to try to feel better or get some rest. With the final press conference, the satellite television trucks finally pulled away from the Medical Examiner’s Office.
The drug concentrations in Anna Nicole’s blood were clearly sufficient to kill, but they were not in the massive range commonly seen in suicides. Homicide was also considered but ruled out. Although the sheer number of prescription drugs present suggested bad medicine, none of the interviews conducted by either the Medical Examiner or the police suggested that anyone other than Anna Nicole Smith was responsible for taking the medications that killed her. Yes, her medications 218
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were prescribed and amassed in excess. Yes, she was likely taking medications prescribed in her name as well as drugs prescribed to fake names and friends. And yes, she was being prescribed medications that could easily be abused and, by all accounts, her physicians knew or should have known that she was an addict and that they were providing her with substances that had the potential to kill her. But, unless someone poured the chloral hydrate down her throat or shoved a handful of pills into her mouth the morning of her death, nobody committed homicide in our estimation. The Attorney General of California, however, plans on holding someone accountable.
On November 1, 2009 the Associated Press reported that Stern and two of Anna’s physicians, Drs. Khristine Eroshevich and Sandeep Kapoor, have been ordered to stand trial for conspiring to provide controlled substances to the dead celebrity. During the hearing, Gina Shelley, a friend of Anna Nicole, said that she had seen Stern placing pills in Anna’s mouth on occasion – “He poured them in her mouth like you would a bird” – though this was not witnessed on the day of her death. The physicians have been accused of providing excessive medications to a known pill addict. During the preliminary hearing in Los Angeles, a pharmacist swore under oath that he had told Eroshevich that “Unless you want your picture on the cover of the National Enquirer, I wouldn’t give her (chloral hydrate) because it is a powerful respiratory depressant.” Good advice! It will also keep you out of nonfiction bestsellers such as When Doctors Kill.
While the behavior of the physicians in this case is certainly questionable from an ethical standpoint and it is likely that their medical licenses are endangered, it will be interesting to see if a jury finds them guilty of any crime other than poor judgment (which is not necessarily illegal). Stern has no medical training, so it will be more problematic establishing criminal fault in his case. Consider that if every friend or family member who gave an addict a pill or an alcoholic a drink was forced to stand trial, the courts would be overwhelmed. More likely than not, in the absence of a smoking gun, Stern will not be found guilty of playing a part in Anna Nicole Smith’s death. But you never know. If additional evidence or a shocking eyewitness account of her death surfaces over the course of the trial, we would be happy to consider reclassifying the manner of death in this case. For example, if someone injected her with a powerful anesthetic (such as propofol) to help her sleep we may consider ruling the death as a homicide; of course, if there was no intent to kill we may still deem the death accidental. Barring the unforeseen, the death of Anna Nicole Smith will remain an accidental overdose and the case will remain closed. And her doctors will stand trial in a precedent setting case.
Moonwalk
Michael Jackson sold more than 750 million records and CDs before his untimely death on June 25, 2009 at age 50. By the time you read this, he may have sold over a billion. He was the undisputed “King of Pop” and there will never be another artist like him. He was quite a character.
Moonwalk
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Michael Joseph Jackson was born the seventh of nine children on August 29, 1958 in Gary, Indiana, an industrial suburb of Chicago. His mother, Katherine, a devout Jehovah Witness, brought music into the home. His father, Joe, also was involved in the upbringing of the kids; allegations of his physical and emotional abuse followed the Jacksons for decades. Joe never lived out his dream of being a professional musician but he did have talented children. He organized his older sons (Tito, Jermaine and Jackie) into a singing group, to which later a fourth son, Marlon, was added. When little Michael joined them in 1964, the Jackson 5 was born.