Doctors Who Do Harm: Beware the Ghost of Anna Nicole

by Diane Dimond

You may not give a darn about the late buxom sex-pot Anna Nicole Smith, but the recent verdict in a Los Angeles criminal case stemming from her drug-overdose death has certainly captured the attention of doctors nationwide. I’ll bet insurance companies specializing in malpractice medical coverage have snapped to attention as well.

After Anna Nicole Smith died in February 2007, three of the people closest to her--her attorney and lover Howard K. Stern, her psychiatrist, Dr. Khristine Eroshevich, and her personal physician, Dr. Sandeep Kapoor were criminally charged. Among the most serious of the original 23 charges was “providing controlled substances to a known addict.”

Interestingly, the trio was never accused of actually causing Smith’s death, and along the way some of the other charges were dismissed. It came down to a trial about whether they’d engaged in a conspiracy to help the 39-year-old former Playboy cover girl and TV personality obtain prescription drugs through the use of false names and misrepresentation.

During nine weeks, the jury testimony boiled down to this:

Stern, Eroshevich and Kapoor finagled prescriptions using both real and fictitious names to get mountains of drugs for Smith. She had recently given birth to a baby girl and a few days later she suffered through the overdose death at her hospital bedside of her 20-year-old son, Daniel. So, as the defense team presented it at trial, no wonder the poor woman needed drugs to get her through the ordeal! The prosecution argued this threesome of so-called professionals--an attorney and two doctors--acted not only unethically but that they each also crossed the line sexually with Anna Nicole Smith.

The 11 drugs found in Smith’s systems ranged from methadone (10 pills a day as prescribed by Dr. Kapoor and taken even while Smith was pregnant), to powerful sleep aids like chloral hydrate, and a long list of narcotic painkillers like Vicodin (prescribed by Dr. Eroshevich). The name found most often on her prescription bottles was Howard K. Stern but the doctors also used Jane Brown, Susie Wong and Vickie Lynn Marshall, which just happens to be Anna Nicole’s real name. Dr. Eroshevich was warned by two different pharmacists that the type and amount of prescriptions she was writing for her patient amounted to “pharmaceutical suicide.” Still, the state said, Eroshevich personally transported massive amounts of prescription drugs to Smith in both Florida and the Bahamas.

The jury ultimately acquitted Dr. Kapoor but found Stern and Dr. Eroshevich guilty of the false name conspiracy. While the dead starlet’s supporters moaned that it wasn’t enough of a conviction, the verdict still sent an earthquake sized shock through Hollywood’s celebrity, medical and legal communities.

California defense lawyer Harlan Braun told the Associated Press that writing bogus prescriptions in today’s paparazzi inspired media atmosphere is routine. “It’s absolutely necessary for survival in Hollywood. If … keeping these people anonymous is a criminal act, a lot of doctors will have to refuse to take celebrity patients.”

Do famous people deserve privacy about their medical conditions? You bet. Do their doctors get to break the law while attempting to facilitate their privacy? No way. I, for one, hope we’re witnessing the beginning of a trend where over-prescribing doctors are charged with serious crimes and lose their medical licenses permanently if convicted.

Prescription drug abuse is at epidemic levels. We spend millions on campaigns against street drugs like cocaine, methamphetamine and heroin but we say little about the scourge of desperation and crime left behind by those drugs that come via a prescription pad or an illicit internet “pharmacy.” I quoted studies in this space last year saying a total of 34 million Americans are currently taking painkillers or anti-depressants. Our kids watch us do it and many mimic the behavior.

L.A.-based attorney and addiction intervention specialist Darren Kavinoky agrees: “The fact is that we, as a nation, love our drugs. Pharmaceuticals appeal to a broader (and sadly, younger) audience, because they don’t have the stigma associated with street drugs, and are readily available … pills are now number two behind marijuana for young people, and we are seeing more addiction and more overdose deaths because of it.”

On the verdict in the Anna Nicole case Kavinoky says there’s one upcoming defendant who should be shaking in his boots. He is Dr. Conrad Murray who was tending to Michael Jackson when the entertainer died last June and who is set to go on trial soon on charges of involuntary manslaughter. Kavinoky explains that to reach their guilty finding the Smith jury had to have dismissed the expert medical testimony, “We’re all taught to believe doctors, to trust their judgment as being superior to our own. Those jurors had to disregard this notion in order to get to a conviction. This willingness to disregard the judgment, wisdom and experience of a medical professional should make Dr. Murray righteously nervous.”

Frankly, I hope it makes over-prescribing doctors everywhere mighty nervous.

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The Media - America's Next Courtroom?

by Anne Bremner

Having been a trial lawyer for well over two decades, I'm keenly interested in the public's perception of the judicial process, the practice of law, and what really transpires in an actual courtroom. With the ever-increasing ranks of pseudo-courtroom shows; the burgeoning blogosphere; reporters with unused bar cards spouting legalese; and lawyers heavy on chutzpah but light on credentials out-shouting each other on the TV screen, it seems that the media portrayal of jurisprudence is increasingly diverging from actuality--the real American courtroom.

The tabloidization of high-profile cases has created a distorted, hybrid version of our legal system--much like a locomotive engine, cut loose from the rest of the train. The rest of the train includes the rules of evidence, admissibility, procedure, burden of proof and the presumption of innocence. The engine steams ahead, fascinating to watch as it veers off the tracks. Train wrecks are compelling. In the blogosphere, over the airwaves, in sensational tabloids, mini-trials are conducted, concluded, verdicts pronounced. Those with mouths open, ears closed, cultivate a certain ipsi dixit mentality devoid of civility. Personal attacks substitute for educated, thoughtful or persuasive argument.

In our instant-everything culture, there is a tendency to want everything wrapped up in a sound bite. We see, as in the Anna Nicole Smith case and the Michael Jackson case, an impatience to wait for toxicology results, the conclusion of a thorough investigation. There is an eagerness to turn "what if's" into presumed fact, the presumption that a bit of google searching turns laypersons into forensic experts, detectives, and armchair lawyers.

Sometimes the rampant speculation ultimately proves to be correct, but many times it does not. For several days Richard Jewell was the Atlanta City Bomber, John Mark Karr had killed JonBenet Ramsey, Kobe Bryant had raped a hotel clerk, the Duke Lacrosse players had raped a stripper. 

In the media, there is no ramification for getting it wrong. In the real courtroom, there is. No one knows that more than Michael Nifong, disbarred for his bungling of the Duke Lacrosse prosecution. No one feels it more than any trial lawyer who has lived and breathed a case for several years leading up to a trial-- the burden of standing in the shoes of a client whose future hangs in the balance.

Then there is the phenomena I call "blogulgation" -- when a group of bloggers feed off each other's posts, citing each other as reliable sources to bolster the validity of their position. A diatribe by another blogger is tagged as "news" in a cyber game of telegraph, where a surreal "reality" is crafted from amalgamated speculation corroborated not by actual facts or independent investigation but by endorsement of other speculators. 

Often regurgitating outdated news, disproven facts, they share such a fanatic devotion to their cultivated theories that they become disturbingly hostile, on a personal level, towards anyone with divergent views. Rather than a quest for enlightenment or intellectual debate, these groups often evolve into a support group for those with identical, albeit misinformed opinions.

Although I appear on a variety of networks discussing numerous topics, I am most frequently asked about my appearances on Nancy Grace. The show is a lightening rod for controversy--viewers divided into two categories: those that love the show and those that love to hate it. Many attorneys who appear on the show receive a mixed bag of effusive fan emails and the smattering of vitriolic admonitions from viewers who suggest the show is not highbrow legal analysis. The show doesn't purport to be highbrow. It is is a forum for the prosecution/victim point of view, those who feel the justice system doesn't effectively deter and punish perpetrators who harm and exploit vulnerable victims. 

A case can't be dissected in a few sound bites. The best I hope to do is act as a counterweight, maybe interject a brief point that will serve to plant a seed in the minds of viewers, a reminder that every case, no matter how open and shut it appears to be, will be defended and must be proven. That Nancy Grace interjects her laserlike acerbic wit makes the show entertaining. I know many lawyers and judges who consider it their "little secret" that they are fascinated by the show.

I know Nancy Grace as a dear friend, champion of the underdog, promoter of others in her profession, generous to a fault, wickedly witty, endlessly kind. I have seen her at home with her ever-amused husband, the breathtakingly adorable twins that are the center of their universe--Nancy in sweats, no makeup, the kind of friend you hang out with on the back porch, drinking sweet tea and talking about normal, everyday things that friends share. On the TV screen, we're just two lawyers on opposite sides of an issue. If I get cut off, don't get to wax loquacious, no harm done. TV is fleeting, soon forgotten. 

I try to remind people that TV is no substitute for reality, that bloggers are no substitute for quality journalism. As long as we all understand the line between entertainment and reality, the only harm that comes is taking the TV version too seriously.

My advice to anyone interested in the trial process? Pick any courthouse in any town, find a jury trial on the court docket and sit in the courtroom from start to finish. From the motions in limine. voir dire of jurors, opening statements, closings, jury instructions. Listen as the jury's verdict is read. That is our justice system. Accept no substitute.

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Three Arrested in Death of Anna Nicole Smith

by Donna Weaver

With little fanfare, an important development in the Anna Nicole Smith saga occurred last month.

Anna Nicole Smith's lawyer and former lover Howard K. Stern, 40, and doctors Sandeep Kapoor, 40, and Khristine Eroshevich, 61, are free on bail after being arrested and charged with giving her the prescription drugs that led to her death. Smith, 39, was found dead in her hotel room at the Hard Rock Cafe in Seminole, Fl on February 8, 2007.

Under Florida law, Stern, Kapoor, and Eroshevich can be charged at least with manslaughter by culpable negligence, and at most, first-degree homicide for illegally providing Smith with the drugs that ultimately killed her.

Two years ago, the psychiatrist who treated Anna Nicole Smith, Dr Khristine Eroshevich, was under investigation by California authorities. At that time, California medical board spokesperson, Candis Cohen, confirmed that Dr Eroshevich was being investigated in connection with Smith’s death, but declined to provide further details.

As I read through the medical examiner's reports and timeline of events, I noticed some disturbing findings regarding the actions of Dr Eroshevich, and others, contained in documents released by the Broward County Medical Examiner’s Office. These findings raise questions that require answers.

The investigative report by Broward County Chief Medical Examiner, Dr. Joshua Perper contains a timeline of events beginning with the arrival of Smith and her companions, which included Dr Khristine Eroshevich, in Florida.

"…At 8:30 pm the party checked in at the Hard Rock Hotel in Hollywood. Maurice Brighthaupt, a friendand former body guard met them at the hotel. Anna’s temperature was taken by Dr. Khristine Eroshevich and was 105 degrees. Anna was told to have 911 call for transport to the hospital, but she categorically refused. She was given an ice bath and her temperature dropped to 97 degrees. She was given Tamiflu as well as 1000 mg of Ciprofloxacin with water. Chloral Hydrate was added for sleep. She fell asleep around 10 pm”

After Dr Eroshevich discovered Anna Nicole had a fever of 105, she told her “to have 911 call for transport to the hospital, but she categorically refused” Why did she ask an extremely ill patient with a dangerously high body temperature if she wanted to call 911? Then Dr Eroshevich proceeds to treat her for the fever and infection and give her a drug for sleep that is “a DEA Schedule IV controlled substance that is infrequently prescribed as a hypnotic agent which may cause respiratory and central nervous system depression, coma, convulsions, cardiac arrhythmias and death.

“3. Tuesday, February 6, 2007Anna Nicole Smith did not urinate and had a “pungent” odor and temperature of 100 degrees. She was at time depressed but she was able to watch television and appeared overall okay. She was given a bath and various fluids including pedialyte, chamomile tea and Fiji water. She felt well in the afternoon after a bath and was given chloral hydrate for sleep. She slept about two hours, then she watched television until 11 pm. She took another dose of chloral hydrate and asked for Soma, Klonopin, Valium, Topamax (unknown if she took these medicines).”

Anna Nicole still has a fever and is now presumably severely dehydrated evidenced by a lack of urination. Dr Eroshevich gives Anna Nicole fluids, a bath, and more chloral hydrate. Furthermore, autopsy test results show that Soma, Klonopin, Valium, and Topamax, were 4 of the 7 prescription drugs (plus 2 over-the-counter drugs for a total of 9), which included chloral hydrate, found in Anna Nicole’s system. It may be “unknown” if she took those medications at that time on February 6th, but she did take them in the days prior to her death.

“4. Wednesday, February 7, 2007Anna stayed awake in bed, watching television around 11 am. She was feeling better and ate breakfast/lunch (omelet of egg white and spinach). In the afternoon she was observed naked and sitting confused in a dry bathtub. She subsequently took a bath. In the evening she ordered 2 crab cakes and shrimp for dinner. Dr. Eroshevich left in the evening for California. Anna was upset and depressed over her friend’s departure. Maurice (“Big Mo”) Brighthaupt returned after Dr. Eroshevich left. Anna was still complaining of not feeling well. She was in the bathtub when Maurice Brighthaupt left for several hours returning between 8-10 pm. Anna was seen on the couch and Howard K. Stern was present but in the bedroom. Maurice went to sleep in the guest room and awakened around 4 am. When he checked the couch, Anna was no longer there and he assumed she had gone to sleep in her room.”

Soon after the still ill Anna is “observed naked and sitting confused in a dry bathtub”, no doubt due to a drug induced stupor, Dr Eroshevich leaves her with the 7 drugs that she has prescribed for Anna Nicole under false names and no medical supervision, then proceeds on her merry way back to California.

If this is how Dr Eroshevich “treats” her friends, who needs enemies.

The rest of Anna Nicole’s companions aren’t much better.

"5. Thursday, February 8, 2007Maurice woke up around 9 am. Around 9:30 am he went to Anna’s room and thought he saw her moving but was not certain. He told Howard he was going to have breakfast with his wife, Tasma. Mr. Stern awoke between 9-10 am and helped Anna to the bathroom. He then watched television in another room until King Eric called to inform him of his arrival at the airport. Mr. Stern then called Maurice to instruct him to pick up the guests (King Eric, his common-law wife, and another man). Upon the arrival of King Eric and his party at the hotel at around 12 pm, Mr. Stern called out to Anna who was still in bed to arouse her. One of the guests then urged him not to wake her so he did not call her again.”

Stern “called out to Anna who was still in bed to arouse her.” The least he could have done was actually enter the bedroom to check on her.

“Shortly after 12 pm, Maurice, Mr. Stern, King Eric, and the other male visitor left the room at the Hard Rock Hotel. Maurice left to take care of personal business and Mr. Stern, King Eric, and the other male guest left at the same time to pick up the boat. Maurice asked Tasma, his wife who is a registered nurse, to stay with Anna. She worked on the computer in Anna’s room while Anna remained in bed under the covers. King Eric’s common-law wife remained in an adjoining room. At about 1 pm Tasma Brighthaupt was on the phone with her husband, Maurice Brighthaupt. The boat captain’s wife, who had been in the guest room, came into Anna Nicole’s room because she thought Tasma was talking to Anna Nicole. When the captain’s wife realized Tasma was not talking to Anna Nicole, she went around Miss Smith’s bed and took a look at her. She then told Tasma to come take a look at Anna because she didn’t like the way Anna Nicole looks. Tasma hang up with Maurice and came around the bed. She saw Anna’s face slumped downward on her chest, her mouth open and without breathing sounds. Tasma Brighthaupt initiated CPR after calling her husband Maurice. She alternated mouth to mouth breathing with chest compressions, checking for a pulse until Maurice arrived.

1:38 pm Maurice returns to the Hard Rock Hotel and he took over resuscitation.

1:40 pm Seminole Emergency Medical Service was called.1:43 pm First patrol unit arrived to room 607.

1:46 pm Seminole paramedics arrived. CPR was continued.

2:43 pm Anna Nicole Smith arrived at Hollywood Memorial Hospital.

2:49 pm Anna Nicole Smith is pronounced dead and the Medical Examiner’s Office is notified.

4:15 pm Associate Medical Examiner, Dr. Gertrude Juste responds to scene of death pronouncement at the Hollywood Memorial Hospital.

4:59 pm Anna Nicole Smith’s body arrived at the Medical Examiner’s Office and is logged in.”

At about 1 pm, Mrs. Brighthaupt, who is a registered nurse, calls her husband before starting CPR, and does not call 911. The “Scene Report - Seminole Hard Rock Café” by Associate Medical Examiner Gertrude M. Juste, M.D. states information was initially provided by Seminole Detective Marian Bryant that Tasma Brighthaupt noticed something wrong with Smith at around 12:30 p.m. Maurice Brighthaupt arrives approximately 38 minutes later, and then 911 is called.

Dr. Perper’s final summary conclusions:

“D. HOW THE INCIDENT OCCURRED:

INGESTED EXCESSIVE AMOUNTS OF CHLORAL HYDRATE IN COMBINATION WITH THERAPEUTIC LEVELS OF OTHER MEDICATIONS.

E. PROBABLE TERMINAL MECHANISM:

RESPIRATORY DEPRESSION”

The report also states, “Chloral Hydrate was the most significant drug implicated in this fatality, however several other prescription medications also played a role in this death.7-10 Although the remaining pharmacologic agents were at therapeutic levels, each of these drugs is known to interact with chloral hydrate resulting in an increased risk of overdose.”

No matter what you think of Anna Nicole Smith and her behavior, in the eyes of the law, Anna Nicole’s life is no less valuable than anyone else’s is. Yes, Anna Nicole was an admitted abuser of prescription drugs, and this contributed to her death. However, this does not relieve Drs. Eroshevich and Kapoor of their responsibility for prescribing the potentially lethal combination of medications, or Howard K. Stern from giving them to the severely ill woman. Would Smith still be alive if 911 were called sooner so that she could receive proper emergency medical care? We will most likely never know, but the fact remains it was at the very least irresponsible, and at most, criminal, that help was not summoned sooner.

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The World's Fascination with Gore

by Stacy Dittrich

Human beings continue to be fascinated by gore. The latest drama in the Caylee Anthony case confirms this statement as gospel. Allegedly, someone is attempting to sell photographs of the innocent, murdered, and forgotten victim of this entire debacle—or should I say photographs of her remains. Perhaps we should remember the ordeal surrounding the death of model/actress Anna Nicole Smith. The need to obtain photographs of her lying on a slab in the morgue was so overwhelming security had to be placed around the building. We hear of outrageous amounts of money being paid for photographs of celebrities and politicians—a photograph of Britney Spears doing something outrageous allegedly commands up to a couple hundred thousand dollars from the tabloids.

But, what about the dead?

It’s unknown what sites like CelebrityMorgue.com or Rotten.com pay for the famous and recently deceased. Regardless, one might think they were perusing the Hollywood Walk of Fame and Criminal Hall of Fame when looking at several sites. At celebrity morgue, Marilyn Monroe, John F. Kennedy (fresh on the slab, bullet hole and all), Ted Bundy (with his head burns from the electric chair), and Sharon Tate smack in the crime scene were enough to make my stomach turn knowing anyone can view these. Regardless, posting the actual remains of the Lindbergh baby went entirely too far. In fact, all of the photographs go too far and a website like this has no business being allowed to run. Bored? Feel the need to see someone freshly ground up in a meat grinder? Well, skip on over to…

It’s appalling. I can’t imagine losing a loved one and having their remains, morgue photos, or crime scene photos—with them included, posted on a web site for those thrill seekers to enjoy. I simply can’t put my finger on the fascination.

Several years ago, when I naively thought I had seen it all as a police officer, I found myself blocking off a street where my agency was having a stand-off that began with a man murdering an innocent women, robbing another, and then engaging us on a high-speed police chase where he ultimately stopped his car and put a gun to his head. If this weren’t horrific enough, the crowds of people that began forming behind the barricades included those with coolers, blankets, tripods, telescopes, and video cameras. As if going out for a picnic, they absolutely didn’t want to miss a murderer blowing his own head off or being shot by police. Getting it all on film would simply be the cherry on top. It was simply mind boggling.

Some of the people listed in the celebrity morgue still have immediate relatives living. I’m sure Sharon Tate’s sister (Sharon Tate, right), or Carolyn Kennedy truly appreciate the respect their loved ones are being shown by the sites. I’m somewhat confused by the lack of laws preventing web sites like these from existing or tabloids from printing photographs of dead bodies for profit. Even though a photograph of my own corpse wouldn’t likely fetch a nickel, I believe that all of the dead, even the famous, should be respected equally.

Shut these sites down.

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