Pharmacist balked at drug order

The request for drugs for Anna Nicole Smith slid off the fax of a Valley Village pharmacy five days after the model’s son had died in the Bahamas. A psychiatrist wanted 300 tablets of methadone, two types of sedatives, a muscle relaxer, an anti-inflammatory drug and four bottles of a painkiller nicknamed “hospital heroin,” unsealed court records show.

The amount and combination alarmed the pharmacist, who later recalled thinking, “They are going to kill her with this.” He phoned Smith’s internist and said he had no intention of filling a prescription that amounted to “pharmaceutical suicide,” according to court documents.

Less than five months later, on Feb. 8, 2007, the 39-year-old overdosed on prescription medication in a Florida hotel room.

The account of the pharmacist’s warning is contained in recently unsealed affidavits written by state officials investigating the role her physicians and a companion played in her drug use. The affidavits document similar admonitions from two other pharmacists and allege that Smith’s psychiatrist, Dr. Khristine Eroshevich, and internist, Sandeep Kapoor, ignored obvious dangers in providing an array of powerful and addictive drugs to a woman with a history of substance abuse.

The documents also cite evidence that both doctors separately transgressed professional boundaries by having sexual contact with their famous patient.

Los Angeles prosecutors charged the doctors and Smith’s boyfriend and lawyer, Howard K. Stern, in March with conspiring to provide her with controlled substances. All three have pleaded not guilty. A preliminary hearing is set for next month and, in court papers filed last week, prosecutors indicated they plan to call as witnesses those close to the former Playboy playmate, including her bodyguard and Larry Birkhead, the father of her daughter Dannielynn.

Smith had prescriptions for 44 medications under at least nine aliases at the time of her death, according to the unsealed affidavits accompanying warrants for searches of physicians’ offices and other areas. A Florida medical examiner found nine medications in her system and labeled her death the result of “acute combined drug intoxication.”

Investigators determined that four doctors had prescribed her medication but zeroed in on Kapoor, who has a Studio City practice, and Eroshevich, who lived next door to Smith in Studio City and has several L.A. offices, according to the affidavits.

State prescription records showed Kapoor prescribed Smith sedatives and painkillers, often in quantities far beyond medical standards, wrote Jon Genens, a senior investigator with the Medical Board of California. During a 27-day period in 2005, Kapoor prescribed an amount of methadone that averaged more than twice the usual daily dose, Genens wrote. His prescriptions for half a dozen drugs, including Xanax, Dilaudid, Lorazepam and methadone, continued and in some cases increased during Smith’s 2006 pregnancy, despite potential hazards to the fetus, the investigator wrote.

Records of other patients found what Genens called “a pattern of overprescribing drugs which could pose a potential danger to his patients.”

Kapoor’s attorney said authorities miscalculated the amounts prescribed. “There’s been a misreading of the medical records,” lawyer Ellyn Garofalo said. “When all the facts are disclosed, they will show that Dr. Kapoor’s treatment of Anna Nicole Smith was in good faith and consistent with good medical practice.”

Eroshevich’s relationship with Smith appears to have initially been a friendship, but records referenced in the affidavit suggest she began prescribing large quantities of medication for the model after the birth of her daughter and death of her son. A day after Daniel Smith died from a drug overdose, the physician went to a Burbank pharmacy for chloral hydrate, which she told a pharmacist she planned to use as a sleep aid for Smith, according to an affidavit to search Eroshevich’s properties.

“I wouldn’t give her chloral hydrate unless you want your picture on the front page of the National Enquirer,” the pharmacist reported telling her of the drug, which is considered an out-of-date insomnia treatment, the affidavit states.

The psychiatrist got the prescription as well as one for a sedative but was warned again about her prescriptions a week later when she consulted a retired toxicologist, according to the affidavit.

That expert, Special Agent Jennifer Doss of the state Justice Department, told Eroshevich the drug combination “might work for a drug addict under supervised care or with a dying cancer patient in a hospital or ‘if you were going to kill someone,’ ” according to the affidavit.

The investigation also turned up images that authorities contend are evidence of a lack of professionalism by the doctors. Three photos on the hard drive of Smith’s laptop show the model and Eroshevich naked and embracing in a bathtub, according to an affidavit. The photos are dated two months before Smith’s death. Another affidavit cites video, previously aired on Inside Edition, showing Smith in a “nightclub setting” with a shirtless Kapoor who “was kissing and nuzzling” her.

Kapoor’s attorney said the video was taken after a fundraiser for a charity and was the only time the two ever socialized. An attorney for Eroshevich declined to comment on the nude photos but said the doctor’s commitment to helping Smith in her time of need was at the heart of her actions.

She “was in a position of either doing nothing and leaving a psychologically unstable person to fend for herself or attempt to help Anna even if the circumstances surrounding the treatment were less than ideal,” said lawyer Adam Braun.

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harriet.ryan@latimes.com