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Doctor continued prescribing addictive drugs even after Anna-Nicole Smith refused rehab, witness says [Updated]

October 27, 2009 |  2:15 pm

Anna Nicole Smith’s internist prescribed dangerous amounts of addictive opiates and sedatives even after the model refused his recommendation of substance abuse counseling and stopped coming to his office for appointments, an expert told a judge today

The expert, a physician specializing in the treatment of chronic pain patients, testified that Dr. Sandeep Kapoor provided excessive amounts of the medications without obtaining a complete medical history, sending out for lab tests or even trying to determine whether anything was actually wrong with Smith.

“I saw no meaningful work-up,” expert witness Dr. James Gagne told a judge, who will determine whether there was sufficient evidence to try Kapoor; Smith’s psychiatrist and her boyfriend on charges of illegally furnishing her with prescription medication.

Gagne’s testimony came a day after another physician expert criticized the prescribing practices of Kapoor’s co-defendant, psychiatrist Khristine Eroshevich, as excessive and without a legitimate medical purpose. Both doctors as well as Howard K. Stern, Smith’s confidant and lover, have pleaded not guilty.

Gagne, who reviewed Kapoor’s conduct for the state medical board, said there were repeated instances of excessive prescribing in the three years leading up to the Playboy playmate’s 2007 fatal overdose at the age of 39.

When she fractured two ribs in 2004, he wrote a prescription for Dilaudid, a powerful and highly addictive opiate nicknamed “hospital heroin.” Her injuries, Gagne said, necessitated only “a low level opiate for a week or two.”

Instead, Smith remained on Dilaudid for six months, coming off only after Kapoor saw her on a televised awards show looking stoned and slurring her words, Gagne said.

He said Kapoor’s medical records indicate he met with Smith and Stern and she agreed to stop taking Dilaudid, but refused drug counseling.

Sixteen months later, a pregnant Smith was hospitalized for acute drug withdrawal. The treating psychiatrist at the hospital previously testified that she called Kapoor and told him that Smith was being weaned off methadone and sedatives, which posed grave dangers for her baby.

But on the day she was released, Kapoor prescribed her additional sedatives and over the next two months, wrote prescriptions for at least 540 sedative tablets as well as methadone.

He said he was also troubled by what he described as a fall-off in the doctor-patient relationship that made the prescriptions seem to “appear out of thin air,” he said. After her hospitalization, Kapoor saw her only one time – a meeting at a hair salon – and she subsequently decamped to the Bahamas.

The prescriptions for methadone and other drugs continued, Gagne said.

An attorney for Kapoor is to cross-examine the expert this afternoon.

[Updated at 6:32 P.M.

On cross-examination, a defense attorney implied that Kapoor deserved credit for raising the issue of drug use after the awards show and suggested the doctor was reassured Smith’s behavior was the result of a seizure, not too much medication.

"He took some action to address the possibility drugs were being abused," Ellyn Garofalo asked. The witness agreed.]

-- Harriet Ryan

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