Anna Nicole Smith Investigation Reports(Invetigation Report document, pages 14-15).
There are two areas Perper discusses in the report to come to that conclusion.
A. The Exclusion of Homicide, and
B.Accident vs. Suicide
XI. Manner of Death
Since drugs were the major cause of death in this case, the manner of death cannot be considered natural. The remaining choices are homicide, suicide, accident, or undetermined (the latter if two or more possibilities are equally possible according to the Manner of Death Classification Guide distributed by the National Association of Medical Examiners-NAME).Based on the available evidence, it is our opinion that the manner of death is deemed ACCIDENT.
A. The Exclusion of Homicide
The following factors were noted but homicide was excluded:
1. Given the high level of the chloral hydrate in Miss Smith’s blood someone would have to either force-feed or coerce her into ingesting a large amount of chloral hydrate solution; (note: Why had to force-feed her or coerce her? Liquid Chloral Hydrate recommended DOSAGE AND ADMINISTRATION: The syrup may be administered in a half glass of water, fruit juice, or ginger ale.)
2. There was no oral trauma to suggest force-feeding; (note: Is oral the only way it could have been administered; and why would it have to be force-feed if done orally?
3. Chloral hydrate has an unpleasant, harsh taste which would be easily detectable if it was “slipped” into a drink;(note: On the many sites I have searched looking for this fact I have inactuality found that CH, because of its lack of taste, is used in “A Mickey Finn” which is any drug laced drink given to an unsuspecting victim in order to incapacitate them (also called knockout drops). A mixture of chloral hydrate and alcohol is thought to have been the original Mickey Finn. Chloral hydrate is now illegal in the United States without a prescription. Chloral hydrate is a schedule IV controlled substance in the United States. Its properties sometimes lead to its use as a date rape drug.)
4. There were no other significant injuries.
*One could speculate that Miss Smith was cognitively impaired due to her infections and use of benzodiazepines and that this rendered her susceptible to homicidal poisoning. However, given the evidence produced by the parallel police and medical examiner investigations this would represent mere speculation and does not hold up under scientific scrutiny.
(*Check out that statement!)
B. Accident vs. Suicide
The chloral hydrate levels in the blood, liver and brain are certainly in the high toxic/lethal range. As noted above, the levels of multiple other medications found in the blood were in the therapeutic range. A cogent argument for the two remaining manners of death is now in order.
1. Is it a suicide?
Suicide was considered in this case for the following reasons but it was ultimately dismissed:
a. Miss Smith suffered acute and chronic, waxing and waning, depression following the loss of her son Daniel, to whom she was extremely attached.
b. Her depression over the loss of her son three days after the delivery of her infant daughter by Caesarean section occurred at a very critical time in which many women are predisposed to endogenous depression (so-called postpartum depression). Furthermore, Miss Smith’s depression may have been further magnified by the physiologic response to a painful Caesarean section incision.
c. Miss Smith stated that “she wanted to die” after Daniel’s death but she did not develop a specific plan of action.
d. There was a near-drowning episode several months ago which could be construed as a suicide attempt, however she thanked the person who revived her (see below).
e. At one point, Miss Smith declared that she wished to die in the same fashion as her idol, Marilyn Monroe, who died by suicide. It should be noted that Miss Monroe employed chloral hydrate (in combination with a barbiturate) in her own highly publicized demise.
f. While still chronically depressed, Miss Smith experienced additional significant physical stressors: the abscess-related infection, viral enteritis, and “the flu.” The chemical mediators produced by the body in response to severe illnesses are also chemical mediators commonly elevated in major depression.
g. Several months prior to her death, Miss Smith bought several plots in a Bahamian cemetery and had possibly commissioned a dress for her funeral.
h. By report, Miss Smith did not appear to be intoxicated when she was last seen alive. This suggests that she took a significant dose of chloral hydrate in the hours preceding her death.
i. Miss Smith suffered from chronic pain and Hashimoto’s thyroiditis, both of which are associated with depression.
j. Chloral hydrate may result in jaundice or icterus in cases of chronic toxicity. The absence of these findings suggests an overdose resulting in acute toxicity in this case.
2. Is it an accidental overdose?
Accident is favored for the following reasons:
a. The chloral hydrate level, definitively toxic and potentially lethal, would not be considered lethal in all cases, particularly in an individual who has developed some resistance to this drug through chronic use. It was lethal in this case, however, in combination with other prescription drugs.(note-It was lethal in this case, and was stated in interview with Greta, lethal dose of 2 ounces taken prior to her death. Who was the only one with her during this time frame? HKS stayed in suite of rooms, so wouldn't he have seen her getting bottle of CH out of duffle bag where he said it was being kept?)
b. If most cases of suicide, the victim ingests a large amount of a drug to insure death. The bottle found of chloral hydrate found near Miss Smith was only half empty.(note: Now the CH was found near Miss Smith, which is not mention and the scene report and was actually mentioned being in guestroom 609 and then later we are told per interview with Perper and Schueler, in a duffle bag.)
c. In many case of prescription drug overdose, multiple drug levels are elevated. In this case, all drugs except chloral hydrate are at therapeutic levels.(note: But what about the Benzodiazepines in combination: Parent/Drug - Clonazepam (Klonopin)0.04mg/L, Diazepam (Valium)0.21mg/L, Lorazepam (Ativan)22ng/mL, and Metabolites - Nordiazepam0.38mg/L, Temazepam0.09mg/L, and Oxazepam130ng/mL.)
d. Reports of suicidal ideation are vague and unsubstantiated. By many accounts, her mood had been improving over the past few months and she did not seem depressed in the days leading up to death.(note: Were ten different reasons listed, a.-j., under the question "1. Is it Suicide?")
e. A near drowning episode in a pool several months prior to death appears to have followed an accidental drug overdose rather than a suicidal act. Indeed, she thanked the individual who had resuscitated her rather than expressing consternation.(note: Now, here it is talked about in that this pool/ drowning incident was another accidental overdose, but under the question, "1. Is it Suicide?" item d, "There was a near-drowning episode several months ago which could be construed as a suicide attempt, however she thanked the person who revived her(see below).")
f. Miss Smith was likely not aware of the risks of using multiple drugs while in a physically vulnerable state consequent to her infections. In this instance, she may have over medicated herself with chloral hydrate to alleviate the symptoms of her infections.(note: She took the chloral hydrate, this time, out of the duffle bag and out of eyesight range of HKS who was supposedly monitoring her in-take of drugs from the duffle bag and was in the suite with her from 10:00-12:00?)
g. Miss Smith has a long history of prescription drug use and had undergone treatment in an in-patient rehabilitation center in the past. She was used to taking as much medicine as she wanted to and she had “over self-medicated” in the past.(note: Was she used to taking this much CH in one dose?)
h. Miss Smith had recently had a baby and, by some accounts, was planning another pregnancy and marriage in the near future. Further, she was about to make a music video and take a vacation to Dubai. This type of advance planning makes suicide less likely.(note: Now she is not having all the incidents of depression listed under "1. Is it Suicide?" items a-g and i? What evidence was given for this vacation to Dubai?)
i. There was no suicide note (though these are absent in many suicides) or recent statements to suggest suicidal ideation.(note: See items c,d and e under "1. Is it Suicide?")
j. There was no physical evidence or documented history in the medical records to support prior suicide attempts.(note:??-What was given above and taken as medical history for "1. Is it Suicide?"?)
k. Miss Smith’s obsession with Marilyn Monroe had waned somewhat over time.(note: Now ANS' obsession with MM had waned?)
l. Miss Smith sometimes drank her chloral hydrate out of the bottle making it difficult to determine the exact dosage ingested. On this trip, she had taken multiple doses of chloral hydrate in combination with her “usual” assortment of pills.(note:Interesting "fact" of Perper's based on witness interviews with whom, one of which was the one person that was in the suite when she took the lethal dose, but saw her ingest no drugs that morning?
Please note: This subject has been brought up for a matter of discussion with the group. It is posted as just some personal observations as related to this report. Just looking at these things that go to the determination of manner of death, A. The Exclusion of Homicide and B. Accident vs. Suicide and the final determination being accidental seems to based more heavily on what appears to be witness testimony, one of whom was in the suite with ANS during the ingestion of the lethal dose, and seems to be based less in scientific fact. Perhaps with further police investigation more scientific facts could be determined and the report would not have to be based as much on witness interviews. It seems, from this layperson's opinion, from this report that the scientific facts more readily support manner of death as being either suicide or homicide. It would also seem to this layperson that Cause of Death: Overdose with a determined Manner of Death: Accidental, might be a much more beneficial conclusion in the future than a determination of Manner of Death: suicide or homicide.
Wow - excellent work...thanks.