This column was the first to report on Dr. Khristine Eroshevich’s shady behavior regarding Anna Nicole Smith and the drugs she prescribed her. On Friday, search warrants were issued and searches of the doctor’s offices began by the California Medical Board and the California Department of Justice.
I told you first on March 2 and then all through that month about the psychiatrist's questionable practices regarding Smith — long before the California Medical Board started investigating Dr. Eroshevich’s actions. In fact, we asked the board to start the investigation.
And I told you exclusively on March 16 about a fax Dr Eroshevich, Smith’s personal psychiatrist, sent to a Los Angeles pharmacy asking that a laundry list of drugs be couriered to the Bahamas for Anna Nicole. The doctor used the pseudonym “M. Chase” for Smith.
The list of drugs requested included four bottles of 2 mg Dilaudid; 2 milliliter bottles of Lorazepam (Ativan); two bottles of 350 mg Soma, a total of 180 tablets; one bottle each of 30 mg Dalmane and 400 mg Prexige, the latter a British drug; and one bottle of methadone, 300 5mg tablets. All of them are classified as different types of painkillers.
Eroshevich sent the fax on Sept. 15, 2006, a week after baby Dannielynn was born, five days after the death of Smith's 20-year-old son, Daniel Smith, and about five months before the former Playboy pinup died.
At first she sent it from the Bahamas to Sandeep Kapoor, the Los Angeles physician who treated Smith under the pseudonym “Michelle Chase” — and who is also a focus of the state investigation.
When Kapoor refused to fill the prescriptions, sources say, Eroshevich sent the request directly to Key Pharmacy in North Hollywood, Calif. It was also refused there.
The doctor wrote the fax in her own hand and added a note at the bottom: “You have my local number here. Please call if half of the amounts can be prepared, I’ll have someone take them to a courier to bring to me and he can [illegible] Fedex the rest, except for the Intensol, which has to be on ice.”
She signed it “Kris,” even though it seemed from the fax that she didn’t actually know Kapoor.
Raw Data: Click here to see the fax (pdf)
One pharmacist, to whom I read this list, noted that all the dosages requested were much higher than usual.
“That’s 12 times the amount of Dalmane. All together, these drugs potentially will kill you. I would have refused to fill the order.”
All of the drugs carry warnings for pregnant women and especially for those who are breastfeeding not to take them.
The directions for Prexige read: “Tell your doctor if you are breastfeeding a baby. Ask your doctor about the risks and benefits of taking Prexige in this case. It is not known if lumiracoxib, the active ingredient of Prexige, passes into the breast milk and could affect your baby.”
In a brief conversation I had with Eroshevich in March, the psychiatrist acknowledged the existence of the fax, but declined to comment on it, citing "patient confidentiality."
But there's more: Around that same day, Sept. 15 of last year, the good doctor was told of the dangers of the mix of pills and the dosages requested — but she didn't heed the warnings.
After Dr. Kapoor refused to fill prescriptions that Eroshevich wanted, she was put in touch by phone with an addiction and pharmacology expert at a prestigious local university. Smith's local pharmacist, who also refused to fill the prescriptions, made the connection. The expert told Eroshevich that the medicines and doses she was asking for were inappropriate and dangerous.
"He told her she was in way over her head and that Anna Nicole should be hospitalized," a source who knew about the conversation told me.
Eroshevich was referred to treatment centers where Smith's problems — chronic pain and grief over her son's death — could be addressed professionally.
But Eroshevich would have none of it. Even though the expert warned her that the drugs she was ordering were "horrible combinations" and that one dose was enough to kill someone, Eroshevich ignored him.
Luckily, sources say, Kapoor was reassured when he first heard from Eroshevich, Smith and Smith's companion and lawyer Howard K. Stern that she was not breastfeeding her newborn baby girl.
Nevertheless, Kapoor was apparently horrified when Eroshevich told him, "I need something to knock her out." And the notion that the baby might be a priority didn't seem to matter.
"She told Kapoor that she hadn't bonded with the baby, and that she had people there to look after her," a source said.
That’s not all. I also told you, on March 7th, that Dr. Eroshevich was stripped of her duties at the Los Angeles County Employees Retirement Association (LACERA) back in July 2006 for failing to perform her duties properly.
From the Board of Retirement minutes:
"Recommendation to terminate the services of Board Panel Psychiatrist Khristine Eroshevich, M.D., Ph.D. (Memo dated July 7, 2006):
"Mr. [James] Castranova [the board's legal counsel] gave a brief explanation of the recommendation to terminate Dr. Eroshevich's services. It was noted that on two occasions, Dr. Eroshevich arranged for psychologists to conduct fact-to-face examination of LACERA members, which is a violation of the agreement between LACERA and Dr. Eroshevich, when only Board Certified Physicians are allowed to conduct these examinations.
"A motion was made by Mr. Russin, seconded by Mr. Chery, to approve the recommendation. The Legal Office, at the request of Mr. Russin, will review Dr. Eroshevich's invoices to ensure that charges are proper. The Legal Office will report its findings and any recommendations to the Insurance, Benefits and Legislative Committee. The motion passed with Mr. Macias abstaining."
James Castranova, whom I spoke with last March, confirmed that Dr. Eroshevich farmed out her duties to other shrinks in violation of her agreement.
In other words, she was sending unqualified doctors to interview members of LACERA when she was supposed to be doing the work herself.
LACERA spokesman Gregg Rademacher told me it's the first time he can remember that his organization had a physician who farmed out his or her job to other professionals, only to be caught later.
Calls to Eroshevich at two California offices with answering machines were not returned. But I wrote in this column last March that Smith had become so close to and dependent on Eroshevich that she and Stern bought the house right next to that of the doctor and her husband in Studio City, Calif.
As for Dr. Kapoor, don’t be surprised if nothing comes of the current investigation into his dealings with Anna Nicole Smith.
As I reported last winter, he inherited her as a patient in 2004 from the retiring physician from whom he bought his practice. He once prescribed Methadone for her, but ceased giving her treatment after a short time. He also didn’t know Dr. Eroshevich, who took over Anna Nicole’s treatment.
Kapoor had continued the treatment prescribed by the prior doctor: a low dose of methadone for chronic pain.
"Hundreds of thousands of pregnant women are on methadone. It doesn't affect the placenta," a source said.
Many respected medical journals describe the safety of taking methadone during pregnancy. But the other drugs Eroshevich ordered surprised Kapoor, friends say, especially since he had never heard her name until that day in September.
"Stern told him Eroshevich was a longtime friend," a source said. "He said that they hadn't given Anna anything for pain after her C-section. And Eroshevich said she would be with Anna Nicole 24/7 and that she would administer the drugs herself."
Kapoor responded that he would not send them, and that he was particularly concerned about the dose of Dalmane, since it was 12 times the limit.
"Eroshevich told him Anna Nicole was really tolerant of Dalmane," a source said.
But after the phone call and fax from Eroshevich, Kapoor heard from Smith only one or two more times. The last time was in November. Smith died three months later.
Also interesting, from a media perspective, is how CBS Paramount Television, which produces “The Insider” and “Entertainment Tonight” paid Dr. Eroshevich either directly or through Stern to be their exclusive correspondent all during that period last winter from Smith’s death through to her funeral and afterward.
The CBS Paramount shows treated Dr. Eroshevich with incredible deference, turned her into an authority, and at a high price. I wonder how they’ll feel about that once reports are filed from Friday’s raids.