Patterico's Pontifications

3/29/2007

Getting Information The Hard Way (Or, Why I Should Be Working For TMZ.com)

Filed under: Miscellaneous,Snarkage — Justin Levine @ 2:39 am

[posted by Justin Levine] 

Roger Friedman from Fox News gives us this breathless tidbit concerning the Anna Nicole Smith story –

How close was Anna Nicole Smith to the psychiatrist who prescribed all those drugs for her? Very close, it seems. Maybe too close. In fact, they were next-door neighbors.

Real estate records for both Anna Nicole and Dr. Khristine Eroshevich reveal that the patient and her doctor actually lived next door to each other in million-dollar homes in Studio City, Calif.

Umm…Note to Roger: Why did you feel the need to spend the time and effort combing through real estate records to discover this? Wouldn’t it have been easier simply to watch the Anna Nicole Smith Show? After all, Episode 18 features Khristine Eroshevich throughout the narrative and clearly announces her as being a neighbor. But then again, the second season is hard to find on DVD, so I guess only true fans of the Anna Nicole Smith Show would consider this to be common knowledge.

Note to TMZ.com:  My starting salary for such superior investigative tabloid skills starts at six-figures….

20 Responses to “Getting Information The Hard Way (Or, Why I Should Be Working For TMZ.com)”

  1. Since we have a thread referring to the Smith autopsy, etc., I’m going to throw in my two cents worth, my comments preceded by ***.

    From news articles, review of autopsy report (http://www.thesmokinggun.com/archive/years/2007/0326074report1.html):

    Smith had a cocktail of prescription drugs in her body … including Valium, Ativan, Methadone, Klonopin, Topramax, Cipro, caffeine, acetaminophen, …, and chloral hydrate … [Chloral hydrate is a sedative used to treat insomnia and alcohol withdrawal … (infrequently used since the benzodiazepines were introduced years ago-MD in P)]
    She died of “combined drug intoxication” with the sleeping medication chloral hydrate as the major factor, the medical examiner said.

    *** It is not uncommon for people to keep bottles of medications around from previous prescriptions and use them inappropriately, which would be one explanation for the relatively strange combination of overlapping medications which have little reason to be used together. THAT SAID, with as many people in her entourage, including supposedly responsible professional people, either she was successful in hiding things and/or demanding things, or some folks weren’t being as helpful to her as they might have been.

    A bacterial infection from injecting medication in her buttocks and a viral infection contributed to her death, the autopsy report said.
    Smith felt ill shortly after arriving in Fort Lauderdale from the Bahamas on Feb. 5 and eventually developed a fever of 40.5 C (105 F). The medical examiner said Smith had a blood infection likely caused by a contaminated needle but “it was quickly brought under control by antibiotics and an ice bath”. (Quotations MD in P) “Her temperature never went again above 100 (37.8 C) and, except for an episode of vomiting, she felt relatively well expect for feeling very weak,” he said.

    *** Temperatures of 105 in an adult usually mean a severe infection or other life-threatening process. The facts that she had a temp go down with an ice bath and was on antibiotics do not prove an infection was not a major contributor to her death. In fact, when a person is “losing the fight” against an infection the fever can decrease- not a sign of improvement necessarily.
    *** While the ME states she “felt relatively well expect(sic) for feeling very weak” and “an episode of vomiting”, the narrative in the autopsy report states she was found “in an empty bathtub and confused” the day prior to her death. Such behavior on it’s own would warrant medical evaluation.

    “A news release issued by lawyers for Stern said that both he and Smith’s physician urged her to get emergency treatment for her fever but she refused because ‘she did not want the media frenzy that follows her.’

    *** Famous people go into hospitals all of the time. If info is released or access to the patient is given contrary to the patients wishes you can lose your job, even if you are the chief of medicine. There are ways she could have sought care with minimal fuss, at least to her. (More on this later).

    Another story:
    Did Too Much Caffeine Kill Anna Nicole Smith?
    Here’s a theory about Anna Nicole Smith’s various drug interactions. Apparently, the antibiotic she was taking has a deleterious effect when mixed with caffeine. Around Smith’s bed, according to her autopsy report, were cans of soda.
    The theory offered to me by an expert source is that the combination of Cipro and soda was keeping Smith awake and unable to sleep. The result was her accidentally overdosing on chloral hydrate, which she took in liquid form to sleep.
    In other words: Dealing with severe insomnia, Smith was swigging the chloral hydrate and overdosed.
    I asked Broward County toxicologist Howard Schueler about this Wednesday. He said caffeine was present in Smith’s blood, but they don’t how much. Her Cipro level was not that high, as it turns out, but it’s there. The main thing was the chloral hydrate. That level was over the top.
    Schueler says the caffeine-Cipro theory could be contributory to Smith lapping up the sleep medication. On top of that, he adds, the other drugs in her system were just too much.
    “It’s the Ativan, the Valium, the Klonopin and the chloral hydrate together,” he said.

    ***Cipro amounts were low, caffeine in toxic amounts causes significant GI upset (which she did have), and I don’t think caffeine is a match for the sedatives she was taking. (Distance cyclists, for instance, sometimes use caffeine suppositories that give high levels, so high one couldn’t tolerate taking that much by mouth).

    ***Obviously I am far removed, and it could be a sad confluence of events in the life of someone “out of control” that fought those who wanted to help her. On the other hand, I would not want to be a doctor who gave any kind of approval to not seeking hospital evaluation with the fever to 105 or when she exhibited “mental status changes”, especially someone with lots of money where people may want to get more from the doc from a wrongful death or malpractice suit, or people would be fighting over stuff, at least without clearly informing the patient and family that they were going against my preferred medical advice. (I have at times been in such situations. Sometimes a pt refuses to do what you think is critically important, but you don’t tell them to get another doctor. Sometimes you do. I imagine that lawyers sometimes have the same issues.)

    MD in Philly (3d3f72)

  2. Oh Patterico! Don’t tell me YOU’VE become enthralled by the postmortem charms of Anna Nicole.

    David Ehrenstein (2289f8)

  3. She was an opiate addict. My opinion is that she was self-treating withdrawal due to cessation, for whatever reasons, of her methadone. (The medical examiner stated that he had found methadone only in the bile not in the blood.) It’s idiotic to allow a druggie to self-administer drugs like valium, klonopin, ativan and chloral hydrate. If the addict is looking to replicate the effect of the methadone, she will abuse them. I expect that one or more doctors will lose their prescription pads if not worse.

    May she rest in peace but she died the way most drug addicts die — infection, overdose, malnutrition.

    nk (829232)

  4. At least her psychiatrist will not be among the parents of her baby.

    Raul Alessandri (97b150)

  5. nk-

    My concern is she was a very rich drug addict (whose son and lone heir per her will previously died of a “drug overdose”), who supposedly was surrounded by professionals like lawyers and doctors and such. None of those drugs were a very good substitute to ease narcotic withdrawal, and lots of drugs that could have been used (like clonidine, propoxyphene, etc.) weren’t present.

    MD in Philly (3d3f72)

  6. I don’t disagree with you, MD in Philly. I believe she had enablers rather than caregivers, for her addiction, which included physicians. Although drug addicts who do not want to quit can be very cunning and “conning” in getting their fix one way or another. I seriously question whether the cessation of her methadone was part of a treatment plan. More likely, her source dried out. She then turned to the drugs available (listed above) and killed herself. That’s what I meant by “self-treating” and that it was “idiotic” to allow her to control the dosages.

    nk (829232)

  7. Thanks for the clarification. I agree that there is a lot that is “idiotic”, as you say, about the story. Knowing that “the love of money is the root of evil”, I just see it as too convenient for her to die and leave all of that money that needs to be taken care of, when she was literally surrounded with people who don’t appear to have been very wise handling some things.

    Perhaps the very wealthy and “vulnerable” should pay someone (very well) to tell them the truth and act in their best interest, and who will get zero out of the estate when they die.

    MD in Philly (3d3f72)

  8. David:

    I’m trying to convert Patterico unto the social magic that is Anna Nicole. But alas, the post was authored by me – Justin Levine.

    Justin Levine (20f2b5)

  9. Perhaps the very wealthy and “vulnerable” should pay someone (very well) to tell them the truth and act in their best interest, and who will get zero out of the estate when they die.

    Like a doctor?

    DRJ (ec59b5)

  10. Broken link, nk.

    Christoph (92b8f7)

  11. Yes, but they grind.

    DRJ (74c23b)

  12. Are you discussing the law or a lap dancer?

    Christoph (92b8f7)

  13. DRJ #13,

    Yup. I predicted that doctors were going to, at a minimum, lose their prescription pads. When search warrants are issued, the stakes are much higher. If the licensing authority is concerned merely with bad prescriptions or bad administration of controlled substances, it can make its case with administrative subpoenas or simple tracing of the controlled substances. With search warrants, we have moved into the realm of doctors as pushers. One got thirty years in prison for it a little while back according to a NYT article.

    nk (6e4f93)

  14. nk and DRJ, my buds… I surely agree with you the wheels should grind in this case and do some crushing.

    Christoph (92b8f7)

  15. I am still not talking to somebody until he apologizes to DRJ. And I advise somebody to make his apology sufficiently sincere for DRJ to accept it.

    nk (6e4f93)

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