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Accidental Drug Overdose Declared Cause of Anna Nicole`s Death

Aired March 26, 2007 - 20:00:00   ET


NANCY GRACE, HOST: Tonight, breaking news. The tightly guarded cause of death in the sudden collapse of covergirl Anna Nicole Smith secret no more. Cause of death a deadly mixture of drugs coursing through her body and a toxic level of old-school sleeping med, chloral hydrate, plus complications using hypodermic injections. But questions still remain. What was in the mystery needle? And who injected her?
And tonight, 12 hours to formal inquest there in the Bahamas in the death of Anna Nicole`s young son, Daniel Smith, his death eerily similar to his own mother`s.

And tonight, the clock is ticking down on DNA of 6-month-old Dannielynn, Nicole Smith`s only descendent. Who is the baby`s biological father, set to control the baby estate`s, that estate topping $475 million? Today`s announcement on cause of death just in time for a battle royale -- paternity.


CHARLIE TIGER, SEMINOLE POLICE CHIEF: It`s a little more than six weeks since the death of Anna Nicole Smith. The Broward sheriff`s crime scene unit completed a thorough investigation of the case of the death of this -- of the scene of the death and found no evidence of illegal drugs.

DR. JOSHUA PERPER, BROWARD COUNTY MEDICAL EXAMINER: Based on the totality of our finding at the time, we concluded that the cause of death was combined drug intoxication.

What we found, however, were about nine prescription medications in the blood, including three drugs medications which are (INAUDIBLE) benzodiazepine (INAUDIBLE) included Klonopin, Valium and Ativan, and also (INAUDIBLE) but they were all in therapeutic levels. Therefore, the cause of death is combined drug intoxication, with chloral hydrate being the major component and the other drugs which I mentioned (INAUDIBLE) contributed.

The manner of death is not homicide.

We knew that Miss Smith suffered with back and abdominal pain, and she was on a variety of pain medications, including methadone. In addition to that, she was taking a number of anti-anxiety, anti-depression drugs and a number of drugs which could be qualified as longevity drugs or drugs which are sometimes used for weight-reducing purposes, such as human growth hormone, vitamin B-12 and immunoglobulin (INAUDIBLE) by injection.

She was very depressed after the death of her son, Daniel, and made all kinds of statements that she wanted to die.

UNIDENTIFIED FEMALE: In only a couple of e-mails that were sent to friends shortly after Daniel`s death in September did Anna express the understandable lament of a grieving mother who wrote that she wished that she were dead. First and foremost, let me start by saying that at no time was there any indication of wrongdoing whatsoever. The truth is finally known to all.

PERPER: We believe, and the infectious diseases experts agree with us, that the episode of very high fever, 105, was most likely due to the fact that at the time of the perforation of the abscess by the needle, infectious material and (INAUDIBLE) reached the blood and caused the high fever.

UNIDENTIFIED FEMALE: No one more than Howard and Dr. Eroshevich wish they could have convinced Anna to go to the hospital on that Monday night.

PERPER: She had a long history of prescription (INAUDIBLE) drug use and (INAUDIBLE) And apparently, she was most likely not aware of the risks of using multiple drugs, particularly when she was sick.

QUESTION: Does this mean Howard Stern will not be charged with murder or any crime at all?

TIGER: At this point, yes.


GRACE: Good evening. I`m Nancy Grace. I want to thank you for being with us tonight. Finally, an official cause of death on covergirl Anna Nicole Smith, while a phalanx of lawyers prepare for legal battle. If you were listening to Dr. Joshua Perper today live, you would learn that a deadly mixture of drugs were coursing through the covergirl`s body, along with old-school sleeping tonic chloral hydrate, then complications from hypodermic use in the buttocks. What does it all mean? For right now, it means accident, a deadly mixture of drugs in the covergirl`s system.

Out to you, Jean Casarez. What exactly are the drugs?

JEAN CASAREZ, COURT TV: Well, first of all, the contributing factor, the primary, is chloral hydrate. That`s the one drug. But then we have eight others, and these were therapeutic drugs that were in her system -- you`re seeing them on the screen right now -- including benadryl. That obviously was found in Daniel`s system, too. I think there is no significance, though. But all of these drugs, the doctor said, were contributory factors to her death.

GRACE: I want to go right now to Dr. Joshua Perper. He`s the chief medical examiner there in Broward County. He along with a team of others performed an autopsy on the covergirl that lasted over six hours. Dr. Perper, thank you for being with us.


GRACE: Dr. Perper, I`ve been reading your autopsy report very, very carefully, and I see that it says an acute combination of drugs intoxication with contributory cause of death being abscesses to the buttocks and viral enteritis. The abscesses in the buttocks clearly come from hypodermic use, but you say not indicative of a dirty needle, correct?

PERPER: Well, I would say that there are two possibilities. One was that the skin was not cleaned enough. And I cannot exclude the possibility of a dirty needle, but it`s unlikely because, you know, it`s very easy and cheap to buy new needle every time.

GRACE: Dr. Perper, you said what may not have been cleaned well enough?

PERPER: The skin in the area of the injection.

GRACE: Oh, so when the needle injects, it could actually take germs into the body. I noticed on page eight of your autopsy, done under the name Vickie Lynn Marshall, you say there is a "deep-seated abscess within the musculature of the left buttock, with a creamy yellow-green pus on sectioning." Does that mean that you could not see the pus until you dissected it?

PERPER: Correct. This was a deep-seated abscess, yes.

GRACE: "A recent needle track extends into the abscess wall directly from the skin surface." What does that mean?

PERPER: It means that this was a perforation of the skin by the needle which caused a bleeding track inside the skin to the abscess.

GRACE: So Dr. Perper, the abscesses on the buttocks -- I saw something else very interesting. I saw in your autopsy report that there were also -- there was also bruising on the interior (ph), the front thigh. Were there injections on the front thigh, as well, Doctor?

PERPER: Correct. And both the injection on the buttock and on the right thigh were associated with scarring and damage to the fat tissue because repeated injections do that. They damage the fat inside the tissue and they cause destruction and scarring, but no abscesses. The abscesses were only in the left buttock.

GRACE: So Dr. Perper, all of this scarring, every time you get a shot with a hypodermic needle, do you get a scar?

PERPER: Well, people don`t realize that if you do injection repeatedly inside the skin, in the tissue below, there are changes and there`s damage and there`s scar because there`s always a little bit of bleeding.

GRACE: Dr. Perper, you also said that human growth hormone may have been used. What is that?

PERPER: Well, human growth hormone is a hormone that its name (ph) which is secreted by a gland inside the brain or just below the brain which is called the (INAUDIBLE) or pituitary. And this is the hormone which causes normal people to grow from children to adults. It`s also used today as a rejuvenating drug and in some weight loss reduction programs.

GRACE: Dr. Perper, is it legal?

PERPER: No, it`s legal.

GRACE: Wait, it is or is not legal?

PERPER: It is absolutely legal. It has to be prescribed by a doctor, but it is legal. And it`s not dangerous in itself.

GRACE: OK. So it in itself is not dangerous, but possibly the use of the hypodermic is what you believe may have caused the abscesses?

PERPER: That`s correct.

GRACE: And so at this juncture, Dr. Perper, we still don`t know what was in that needle or who injected her.

PERPER: Well, we know that there are three alternative. There was either growth hormone or a medication which is called Topomax or vitamin B- 12 or an immunoglobulin. We don`t know which one of those. But neither of those caused any particular damage, and definitely, they did not contribute to the death.

GRACE: And Doctor, I also see that you say depression in Roman numeral V, page one. Why were you convinced that she was depressed? And is there a possibility she had post-mortem depression? Excuse me -- postpartum depression.

PERPER: Well, definitely, she had a good what we call exogenous, outside reason for depression. She lost her son, and this is a terrible blow to a mother. But this is a period after delivery when the woman is very prone to depression, and some women develop what is called postpartum depression. So there was a combination of a circumstance which predisposes to depression, plus a real event which certainly causes and would cause depression in most people, in most parents.

GRACE: Dr. Perper, I also see on page two, Roman numeral XIV, you mention bruises on her shoulders. Why?

PERPER: We have information that about several days before, she fell on her back, and that`s the explanation on the bruises on the shoulder.

GRACE: And doctor, can I ask you about Roman numeral number VII? What is fibrous pleural adhesions?

PERPER: That`s really a finding which is related to her prior pneumonia and the scarring which results from a prior infection of the covering of the lung.

GRACE: Dr. Perper, when you heard essentially portions of your report leaked on Friday, what was your reaction?

PERPER: Well, first of all, it`s not clear that -- that it`s really leaked from my report because there were allegations before that they leaked from my report diagnosis which we never made, such as alcoholism, diagnosis of pneumonia due to drugs -- pneumonia. We never made those diagnosis, so it`s very possible that they came from other source.

But if this is the source, if somebody succeeded in bribing some employee who basically violated his loyalty to the workplace, that`s not surprising. Unfortunately, weak people sell their soul to Satan and sometimes betray their country and their countrymen and countrywomen. This doesn`t make betrayal and bribery less despicable.

GRACE: You`re absolutely right, Dr. Perper.

Let`s go out to the lines. Chris in Canada. Hi, Chris.

UNIDENTIFIED FEMALE: Hi, Nancy. My question is, would the psychiatrist/friend not be able to intervene legally if she was concerned about Anna Nicole`s well-being? And the amount of medicines in her body, are they all FDA-approved?

GRACE: OK. Your first question is about whom?

UNIDENTIFIED FEMALE: Yes, about Anna Nicole, wondering if the psychiatrist/friend could have intervened by legally, you know, asking her to go to the hospital when she was in such difficulty.

GRACE: Good question. Out to you, Jean Casarez with Court TV, who`s been on the case from the very, very beginning. We`ve heard a lot about that figure. What do you know?

CASAREZ: Well, this was a doctor -- this is Dr. Khristine Eroshevich. She came from the Bahamas with Anna Nicole Smith to Florida. She does have a duty as a doctor. Now, also Anna Nicole Smith has a right to say she doesn`t want to go, but if a doctor believes that her life is in jeopardy and there`s something serious, then her medical duty would be to intervene.

GRACE: And I want to go out to James Neavitt. This is Howard K. Stern`s attorney. Today, as you all know, all you legal eagles, there was an extended press conference this afternoon out of Florida with several of his lawyers, at least one of them a criminal lawyer, Lilly Ann Sanchez (ph).

Joining us, Jim Neavitt. Welcome, Jim. Thank you for being with us.


GRACE: Mr. Neavitt, question. What`s your response to Perper`s findings today?

NEAVITT: I think that they`re comprehensive. I`ve reviewed them. I think it pretty much says that, you know, Anna Nicole died of this combination of prescription medicines. And that`s pretty much what it says.

GRACE: Why the press conference?

NEAVITT: You know, I`ve been in court all day, so I really wasn`t involved in any of that today.

GRACE: You know what, Jim? You`re one of the very few TV lawyers that actually makes a living trying cases, so I totally understand that. With us is Howard Stern`s lawyer, Jim Neavitt. Mr. Neavitt, don`t move a hair.

Take a listen to this.


PERPER: What we found, however, were about nine prescription medications in her blood, including three medications which are against anxiety and depression (INAUDIBLE) benzodiazepine, that included Klonopin, Valium and Ativan -- Klonopin, Valium and Ativan -- and also an antihistaminic, benadryl. But they were all in therapeutic levels.


GRACE: That was Dr. Joshua Perper giving the cause of death today, now determined to be a deadly mixture of nine different drugs coursing through the covergirl`s body, along with abscesses due to use of hypodermic needles, as well as viral enteritis.

Dr. Perper, viral enteritis -- is that a stomach flu?

PERPER: That`s correct. That`s true.

GRACE: Doctor, when I was reading the investigative description of the hotel room, I notice that it mentioned emesis, which is basically vomit, to my understanding, in the bathroom sink. Now, if she were found dead or almost dead -- I believe the words were blue in the bed -- where would she have had time to go to the bathroom and throw up?

PERPER: Well, we know that she was able to move because she moved to the bathroom with the assistance of Mr. Stern. She moved by herself in the hallway. So she had this capability. Unfortunately, she had also this minor, which was not a very severe but still bothering, intestinal flu.

GRACE: Dr. Perper, take a listen to this.


LARRY BIRKHEAD, ANNA NICOLE`S FORMER BOYFRIEND: We had a couple clashes in the hospital room because she and Mr. Stern brought in a duffle bag, and when there wasn`t enough administered through the drips that she was on, they were taken out of the bag and taken on top of the drugs that they were giving at the hospital and thwarting the efforts by the hospital to get her off the medications.


GRACE: Joining us right now, John O`Quinn. He is a veteran trial lawyer, as well. He`s also Virgie Arthur`s attorney. Virgie, as you know, is Anna Nicole Smith`s mother. Mr. O`Quinn, thank you for being with us tonight. First of all, what is your reaction to the cause of death that Dr. Perper gave us today?

JOHN O`QUINN, ATTORNEY FOR VIRGIE ARTHUR: Well, Dr. Perper gave us one golden piece of evidence, Anna Nicole died because of a deadly mixture of drugs. The only question is how did those drugs get in her body. And I`ve heard this allegation that somehow she injected her left hip with her right hand. I can`t dig my wallet out of my left rear pocket with my right hand. This thing is bizarre and crazy.



PERPER: We take a great deal of care in treating the individual who unfortunately die (INAUDIBLE) and are under our jurisdiction as patients. And they receive all the respect which every patient everywhere fully deserves.

UNIDENTIFIED MALE: Looks like Dr. Perper did a very thorough investigation. You know, the antibiotic seemed to have taken care of whatever infectious agent was in that abscess, and you know, really, we`re just dealing with a drug overdose death.


GRACE: A deadly mixture of nine separate drugs coursing through the covergirl`s veins, along with an infection caused from hypodermic abscess in the buttocks, as well as gastroenteritis. It all joined together. And according to this crime report that I`ve read, she was found lying blue in the hotel bed -- blue -- by the time it was noticed. She was unresponsive.

Out to the lines. Brenda in Virginia. Hi, Brenda.

UNIDENTIFIED FEMALE: Good afternoon. Excuse me, good evening.

GRACE: Yes, dear?

UNIDENTIFIED FEMALE: I was calling to find out how today`s results will impact the paternity case in the Bahamas.

GRACE: How will it affect the paternity case? Out to you Jean Casarez. It`s definitely going to affect paternity.

CASAREZ: Well, I think the paternity case will be interesting because that is who is the birth father. But I think the guardianship issue could be definitely impacted by this because Howard K. Stern, I think, will fight to be the guardian of this case. And now that the investigators are saying that he has no culpability, I think that will be much better for him in a Bahamian court.

GRACE: And that could explain the impromptu press conference conducted by Howard K. Stern`s criminal lawyers today.

And it`s very confusing. Paternity and custody in the Bahamas, two different things. Birkhead could be the dad and Stern could get custody of the little girl.

To you, Dr. Perper. I was taking a look at the crime scene investigation report, and I notice a discrepancy as to what time she was noticed ill. I noticed that on one crime scene, it states at 12:30 PM she was observed to be blue. In the other crime scene investigation, it states she arrived at 12:23 PM at Memorial Regional. Which one is correct?

PERPER: The second one is correct. The second one is correct.

GRACE: Because the first one, you were acting -- the investigator was acting off eyewitness accounts, right?

PERPER: That`s correct.



PERPER: Only when we had the chloral hydrate that we were able to put all the picture together and to realize that the chloral hydrate, in combination with the other therapeutic level, resulted, unfortunately, in her death.


GRACE: Chief medical examiner Dr. Joshua Perper giving cause of death on covergirl Anna Nicole Smith. Dr. Perper is with us tonight.

But first, very quickly to you, David Caplan. If you look at this crime scene investigation, we see that Stern leaves around 12:00 noon. And then at 12:30, the bodyguard`s wife finds her blue -- blue in the bed. An hour later, EMS comes.

DAVID CAPLAN, "START" MAGAZINE: Yes, it`s very suspect. I`m still not convinced the timeline that we`re even hearing today is completely solid because it leaves so many discrepancies. And you know, regardless, it seems like there was a huge amount of time that passed. Why didn`t anyone get the paramedics there quicker? It still remains a mystery.

GRACE: And Dr. Perper, the times in these crime scene investigations from your office is based on interviews with the various witnesses, right?

PERPER: This is correct. However, our toxicology reveals the presence of a medication which was done during resuscitation.



UNIDENTIFIED MALE: We are convinced, based on the extensive review of the evidence, that this case is an accidental overdose with no other criminal element present.

DR. JOSHUA PERPER, BROWARD COUNTY MEDICAL EXAMINER: The cause of death is combined drug intoxication, with chloral hydrate being the major component. The mechanism of death was because the centers of expiration and circulation (INAUDIBLE) in the brain were shut off by the excessive levels of the combined drugs. She didn`t stop it. She went to sleep and into death.


GRACE: This girl clearly on drugs, we know now dying of a mixture of nine drugs coursing through her system. That video was from FOX News Channel. It was played in evidence in the courtroom last month by attorneys who were trying to show Anna Nicole Smith`s state of mind. And if you don`t believe that, take a listen to this.


UNIDENTIFIED MALE: We had a couple clashes in the hospital room because she and Mr. Stern brought in a duffle bag. And when there wasn`t enough administered through the drips that she was on, they were taken out of the bag and taken on top of the drugs that they were given at the hospital and thwarting the efforts by the hospital to get her off the medications.


GRACE: Sneaking meds into the hospital, incredible, in a duffle bag, so many meds required. What does it mean for somebody to stand by and keep feeding you narcotics, shooting you up with hypodermic needles that leave scars on the fronts of your legs, on your buttocks?

Joining me now, a panel of lawyers. Out of San Francisco, veteran trial lawyer Dan Horowitz. In New York, Ed Sapone. In Atlanta, Eleanor Dixon. Also with us by phone, Howard Stern`s attorney, Jim Neavitt. And with us, Virgie Arthur`s lawyer, John O`Quinn.

Back to you, Mr. O`Quinn. The thought of bringing in a duffle bag full of drugs while Smith was pregnant.

JOHN O`QUINN, ATTORNEY FOR VIRGIE ARTHUR: Oh, but we`re supposed to believe this was all accidental. Remember, all accidental? So Stern can walk away from a murder.

This is not accidental. That duffle bag is not an accident. It was brought in there on purpose. Extra drugs beyond what the hospital was giving was not an accident. It was done on purpose. And let somebody lay blue in a bed and not try to get any medical attention for them is not an accident.

GRACE: Mr. Neavitt, Jim Neavitt with us, this is Howard Stern`s attorney, response?

JIM NEAVITT, ATTORNEY FOR HOWARD STERN: Well, you know, the main thing here is that the coroner gave a comprehensive report. The police department said that there was no criminal activity. He did a thorough investigation.

Counsel is just, you know, doing what he`s done consistently through this case: tried to speculate and cast aspersions where there`s no basis for it. And, you know, that will be dealt with at the appropriate time.

But right now, we know what Dr. Perper said. We know what the police chief said. And this was an accidental combination of medications she was taking for -- and you`ve read it -- for her stress disorder and her depression, which to some extent is understandable, considering what she had been through, including the death of her son, the legal attacks, the unprecedented media attention, and just a number of lawsuits she was dealing with.

I mean, she was a very depressed person at that time, and it was very obvious from what the report said, and she was being treated. And she took a combination of drugs which she obviously wasn`t aware of. There was no indication of suicide, that there was a plan for suicide.

GRACE: Well, let`s go to Dr. Joshua Perper. This is the chief medical examiner who performed the autopsy, who guarded this body for Anna Nicole Smith`s own sake since the very beginning. Dr. Perper is with us tonight, not only medical examiner, but also author.

Dr. Perper, you made it very clear that homicide is not a factor in your cause of death. Why?

PERPER: Well, because we have to make a determination of the manner of death based on facts and not based on speculation. And there was absolutely no verifiable or credible fact which pointed to homicide. There was no evidence of any kind of injury to the body. There was no evidence of injury to the mouth that indicated that somebody forced the liquid inside her mouth.

You cannot basically put this kind of chloral hydrate undetected in a beverage because it has a very distinctive, unpleasant taste. And there was no other evidence to point to homicide.


GRACE: Is chloral hydrate a sleep potion?

PERPER: Chloral hydrate is a sedative and a sleeping medication. And according to the information which she had, she preferred this kind of medication because other sleeping medication did not work well enough for her.

GRACE: Back to the lawyers joining us, Ed Sapone, Dan Horowitz, Eleanor Dixon, James Neavitt, John O`Quinn, to you, Daniel Horowitz, I noticed in the wording that the police stated no criminal charges right now. What do you make of it?

DANIEL HOROWITZ, DEFENSE ATTORNEY: Nancy, there can be no criminal charges. This report makes it absolutely clear, even if you add up all of the valium-type drugs, there was not anything close to an overdose. There was a reasonable dose of chloral hydrate.

If she weren`t sick, if she weren`t despondent over the death of her son, she would have survived this. And Howard Stern did nothing wrong. And let me tell Mr. O`Quinn that, in my opinion, you`re irresponsible in your allegations against Howard Stern. And I can answer each and every one of your attacks if I had the time.

GRACE: Mr. O`Quinn, is your client, Virgie Arthur -- that`s Anna Nicole`s mother -- considering a civil suit?

O`QUINN: You know, Carroll O`Connor, who played Archie on the television, he`d lost his sons to an overdose, the initial Perper-type report was it was all accidental, but the man who furnished the drugs ultimately went to prison for manslaughter. This is not over, folks.

GRACE: Wasn`t that an illegal drug, though?

O`QUINN: Well, to give drugs -- to get four prescriptions for the same drug is illegal, and that`s what they did.

GRACE: You know, it is very interesting -- back to the lawyers, to you, Eleanor Dixon. Apparently -- let me ask David Caplan -- weren`t some of these drugs in the name much Howard stern?

DAVID CAPLAN, "STAR" MAGAZINE: Yes, absolutely. The prescriptions were also in Howard`s name. We`ve known this from the early days of the case, so really our perception of him shouldn`t have changed much, even given today`s autopsy results.

O`QUINN: That`s illegal.

GRACE: And to you, Eleanor, is there any responsibility when the drugs are prescribed in somebody else`s name?

ELEANOR DIXON, PROSECUTOR: Well, I think there is. You have a duty not to just hand over the drugs to anybody, especially if the person has a known problem to drugs, as Anna Nicole Smith clearly did. You saw that from the video. So there is some duty there, especially as a lawyer.

GRACE: And to you, Mike Brooks, former D.C. cop and former fed with the FBI, who`s joining us live from the Bahamas tonight, it`s highly coincidental that the son, a 20-year-old boy, dies of similar problems.

MIKE BROOKS, FORMER D.C. POLICE: It is, Nancy. And I`ll tell you, the Royal Bahamas police and the Seminole police were looking at that, you know, but they decided -- I think the Seminole police basically say case closed in this particular case, but, you know, I think it`s going to take some overriding evidence here in the coroner`s inquest that, you know, something bad happened in Florida.

But, you know, they`re probably going to be looking at that. They`re going to take a look, starting tomorrow at 10:00 a.m. with the coroner`s inquest here. Forty-five witnesses, Nancy, that are going to be coming through here in the next couple of weeks.

And Judge Gomez, who I spoke to today, you know, he says that he wants to see Howard K. Stern, because he is the only living person who was in that hospital room when Daniel died. It was Daniel, Anna Nicole, and Howard K. Stern. So he`s going to be one of the key witnesses that`s going to be coming through here.

Tomorrow, they`re going to start off probably just talking about the autopsy and then kind of lay the groundwork, if you will. And then the witnesses are going to be coming through here at a quick pace.

GRACE: And to you, Ed Sapone, veteran trial lawyer, Ed, they`ve been referred to as enablers, people that stand around, allow the drug use, even provide the drugs. We hear about in a duffle bag in the hospital. Any criminal or civil liability?

ED SAPONE, DEFENSE ATTORNEY: Absolutely not. You know, there`s no good Samaritan rule, first of all. Let`s keep that in mind. No one has a duty legally to help anyone else. And what we have here is an overdose of chloral hydrate, where she was drinking it out of the bottle, Nancy. The fact that these drugs were brought it is in no way criminal negligence or responsibility.



UNIDENTIFIED FEMALE: At no time was there any indication of wrongdoing whatsoever. That is why, in this case, has Seminole Police Chief Charlie Tiger made it very clear there was never a criminal investigation.

UNIDENTIFIED MALE: We analyzed the contents of the laptop computer belonging to Mr. Stern with the approval of his attorney, and we found nothing to indicate any foul play.

UNIDENTIFIED MALE: Does this mean Howard Stern will not be charged with murder or any crime at all?

UNIDENTIFIED MALE: At this point, yes.

PERPER: The last person who said that he saw her alive -- alive -- was Mr. Stern, Howard K. Stern. He denies that he gave her any medication. There`s no any other testimony indicating that his statement is not true.

After that she was still apparently sleeping by a number of people. And everybody agrees that she was sleeping. At one time, I think it was about 11:30 or so, a group of people entered the room, and Mr. Stern offered to wake up Anna Nicole Smith, and the other person said, "Don`t wake her up. Let her sleep."


GRACE: That is Dr. Joshua Perper, the medical examiner, that performed the six-hour autopsy on cover girl Anna Nicole Smith, and he is with us tonight.

Dr. Perper, again, thank you for being with us. This chloral hydrate, it was just mentioned that she drank it straight out of the bottle. That`s not the way I understood it. This is not really an overdose of chloral hydrate, is it?

PERPER: Well, she drank approximately one quarter of a glass, about two ounces, and what she was supposed to do is to drink only two tablespoons at the most.

GRACE: Oh, I see. I see. So would this constitute as an O.D. on chloral hydrate alone?

PERPER: It was theoretically sufficient alone, but in a person who has already experience with a drug, it might not be sufficient. And, therefore, the addition of the other therapeutic anti-depressant, anti- anxiety drugs caused definitely the death, due to combined intoxication.

GRACE: Dr. Perper, is it your understanding she was drinking that much of it straight out of the bottle?

PERPER: Well, not all the time, but at least on two occasions, this was reported to us that she did that.

GRACE: Out to Art Harris, investigative reporter with "E.T." and "The Insider." He`s been reporting on both press conferences today. Art, why the human growth hormone? And why wouldn`t she go to the hospital with a 105-degree fever?

ART HARRIS, INVESTIGATIVE JOURNALIST: Human growth hormone is a factor in the land of Hollywood and vanity. It`s supposed to be rejuvenating, create muscle mass, make you younger. And, by God, this was a woman who wanted to stay beautiful.

As far as not going to the hospital, this was a very stubborn woman who had her own way. And despite the insistence, the urging of her doctor, Rosavich (ph), and Howard Stern and others to go to the emergency room, she didn`t want to go because, whenever she did go to the hospital, Nancy, it escalated into a media circus of people probing into her private life. And she did not want to have that revelation. So she, frankly, did not go because she was afraid of the media coverage.

GRACE: Out to Jennifer in Canada. Hi, Jennifer.

CALLER: Hi, Nancy. I love your show.

GRACE: Thank you.

CALLER: I just wanted to ask, I think you may have already touched on it, but I saw on an earlier news program that of the medication taken out of the hotel room, that some of the medication found in there did have Howard Stern`s name on them. And I was wondering if there was any truth to that?

GRACE: To you, David Caplan. I believe you broke that with "Star." Was it in his name? And let`s go through the time line leading up to Anna Nicole`s death.

CAPLAN: Yes, there were bottles that were both in Anna`s name, as well as in Howard K. Stern`s name.

GRACE: Well, the timeline, I`m very interested -- I didn`t realize until I actually read the crime scene investigative reports that, when they looked at her, she was already blue, lying there in the bed. Was she already dead in the hotel room?

CAPLAN: Yes, she was.

GRACE: The time line, take us through the time line that Dr. Perper announced today. What happened during those three days leading up to her death, David?

CAPLAN: All right, so earlier, when Anna Nicole was boarding a plane from the Bahamas to Miami, and while she was on the plane, she began to feel uncomfortable. She felt the abscess in her left buttocks. It was getting more painful, it was growing. And that was caused, as we already ascertained, by the needle perforating the abscess.

By the time she got to the hotel in Hollywood, Florida, she had a 105- degree fever. Then, as we went through sort of Monday, you know, the temperature goes up. She refused to go to the hospital, and then she`s given antibiotic and an over-the-counter flu medication.

We go to Tuesday. She continues not to feel well. She`s sweating. And then, that evening, she takes chloral hydrate, but she makes it through the night to wake up on Wednesday. And she was also given a slew of other anti-anxiety pills, like soma, and valium, and Topamax.

So then we go to Wednesday. She wakes up after a good night`s sleep with chloral hydrate, and then she was able to eat, and she took chloral hydrate again and didn`t sleep well.

Then, the following day, this is when we have that her bodyguard and the wife, who was essentially a nurse to Anna Nicole, found her unresponsive, and this is in the morning, and that she was blue. And she was eventually pronounced dead at about ten to 3:00, 2:49.

GRACE: David Caplan, I asked Dr. Perper his reaction when -- it`s very obvious that portions of his analysis were leaked. "The Star" and "The Enquirer" broke that. He said it`s very common for people to sell their soul to Satan, and I agree with him, and I think that makes you, at least, Beelzebub.

CAPLAN: I`m not Satan, and no one sold their soul to me.

GRACE: Well, you know what? That remains to be seen, David Caplan.

Back to you, Dr. Perper. Question, when they saw her there in the hotel room, she was already tinted blue. Was she dead at that time?

PERPER: Well, a lot of people become blue as a result of lack of sufficient oxygen to the tissue, because the heart stops, and most likely she was dead, but not for a long time, because we found in her blood a medication which is (INAUDIBLE) and if she had been dead for longer periods of time, no resuscitation effort could have moved blood in her body.

GRACE: Right. Joining us, also, clinical psychologist Dr. Andrea Macari. Andrea, how can it be accidental when somebody has nine different drugs in their system?

ANDREA MACARI, INSTRUCTOR OF PSYCHOLOGY: Well, because doctors prescribe them, Nancy. I think the real question here is, if she was that anxious, if she was that depressed, why wasn`t she in therapy? We all know that cognitive behavioral therapy in many cases is way more effective in treating anxiety than polyfarmiphate (ph). I don`t get it.



JEAN CASAREZ, COURT TV: The medical examiner says that she was taking a liquid sleeping medication called chloral hydrate in combination with anti-depressants and anti-anxiety drugs that she was taking. And the combination of all of these wound up, in effect, turning off a switch in her brain that regulated her breathing and, in the end, it was too much for her.


GRACE: Nine different drugs coursing through her body, along with abscesses due to hypodermic injections. It all added up to cause of death.

Back to you, Andrea Macari. I just don`t understand how, with nine different drugs in your system, it can be accidental, duffle bags full of drugs at the hospital.

MACARI: Well, don`t forget people who use and abuse drugs create a network of family, friends, and doctors that enable these unhealthy behaviors. So don`t forget that. She had a lot of people who were in on the scheme.

GRACE: True. True. And to you, Jean Casarez, it`s not all over, because technically there is an inquiry tomorrow as to cause of death on Daniel.

CASAREZ: That`s right. It starts tomorrow in Nassau, Bahamas. It is an inquest with a jury. There will be seven jurors to determine if charges should be filed against someone, anyone, in regard to Daniel`s death.

GRACE: Daniel`s death at age 20 eerily similar to that of his mother. Thank you to all of you, especially to you, Dr. Perper.

Let`s stop to remember Army Sergeant Brandon Allen Parr, 25, Utah, killed, Iraq. On second deployment, he enlisted after September 11 attacks on our country. He was laid back, funny, loved travel, football, and baseball. Leaves behind his mother, a grieving little son, Nicholas. Brandon Allen Parr, American hero.

Thank you to our guests and to you for being with us. NANCY GRACE signing off until tomorrow night. Until then, good night, friend.


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