LOS ANGELES — A hospital psychiatrist testified Friday that medication given to Anna Nicole Smith by a doctor now on trial was "overkill" for the kind of pain she was describing.
Dr. Nathalie Maullin said she believed Smith had "a borderline personality disorder" and was addicted to prescription medications.
Maullin said she was on staff at Cedars-Sinai Medical Center in April 2006 when Smith was brought in pregnant and in withdrawal from anti-anxiety drug Xanax and the pain killer Methadone. The celebrity model told her she had gone "cold turkey," discontinuing her medications all at once because she was concerned for the welfare of her expected baby.
By doing that, Maullin said, she had actually endangered the baby and herself. The doctor said she quickly resumed her medication with Methadone and began weaning her off Xanax, both of which had been prescribed by Dr. Sandeep Kapoor, a defendant in the drug conspiracy case.
"My thoughts were these were very hard core medications to be giving for the kind of pain she was demonstrating," said Maullin. "She was on medication that seemed like overkill for the type of pain she was in."
She said it was difficult to get a medical history from Smith because she was "putting on a show" and was deferring questions to her lawyer-boyfriend, Howard K. Stern, who was with her at all times.
Kapoor, Stern and Dr. Khristine Eroshevich have pleaded not guilty to conspiring to provide excessive opiates and sedatives to Smith. They are also charged with prescribing drugs to an addict, but are not charged with causing her 2007 overdose death.
Maullin said Stern told her Smith had been suffering from back pain for five years. She said the former Playboy model also complained of pain in her upper back and arm.
Another doctor who testified earlier this week said Smith suffered from chronic pain syndrome all over her body.
Maullin said she conferred with Kapoor by phone, gave him her plan for weaning Smith off Xanax and any drugs known as benzodiazopines which can be addictive. She said he agreed and told her he would leave the prescribing of Methadone to her.
"Did you see any pain that needed treatment with opiates?" asked the prosecutor.
"No," Maullin said.
The problem was that Smith showed no enthusiasm for the plan, the doctor said.
"It was like pulling teeth to get some response from her," she said. "She was compliant but not really interested. She was not wholehearted."
Five days after Smith checked in to the hospital, Maullin said she received a page at midnight from a nurse that said Smith's eyes had rolled back in her head.
That sounded like a drug reaction and a one-time dose of Benadryl was prescribed, Maullin said. However, the next day, she received another call saying Smith was having hallucinations.
"The nurse said that she was flossing her teeth with no floss and was out of it," Maullin said. "This was a radical change."
Under questioning by Deputy District Attorney David Barkhurst, Maullin said she did not consider this an emergency and she tended to other patients before going to see Smith five hours later.
"In psychiatry, we are used to seeing patients do strange things," she said.
Upon her arrival, Stern told Maullin that Smith "was generally acting goofy." Smith was angry and made no eye contact but seemed lucid, Maullin said.
The psychiatrist said she suggested that Smith go into an inpatient facility that deals with addicts. But Smith wasn't interested and told Stern she wanted to leave the hospital.
Maullin said she informed Kapoor and he said he would go to her house.
"I thought that was unusual," she said. "Physicians generally see patients in the office or the hospital. There was no reason she could not leave her home to come to see him. Just in terms of proper boundaries with patients, you see them in your office.
"She needed to participate in her care," Maullin said. "It's not a home delivery service."
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