Anna Nicole Smith died of accidental overdose

updated 1:26 p.m. ET March 27, 2007

DANIA BEACH, Fla. - Anna Nicole Smith accidentally overdosed on at least nine prescription drugs — including a powerful sleep syrup she was known to swig out of the bottle — after a miserable last few days in which she endured stomach flu, a 105-degree fever, pungent sweating and an infection on her buttocks from repeated injections.

In a detailed autopsy report released Monday, a medical examiner noted the former Playboy playmate refused to go to a hospital three days before her Feb. 8 death. She chose to ride out her illness in a hotel suite littered with pill bottles, soda cans, SlimFast, nicotine gum and an open box of Tamiflu tablets.

Broward County Medical Examiner Dr. Joshua Perper found that in the days leading up to her death, Smith, 39, had been taking large amounts of the seldom prescribed sedative chloral hydrate, which also contributed to the 1962 overdose death of Smith’s idol, Marilyn Monroe.

Police found no apparent signs of foul play, and the medical examiner also ruled Smith’s death probably was not a suicide because people who take their own lives typically use much more lethal drugs than chloral hydrate.

Smith perhaps unaware of lethal drug combos
Rather, he said, Smith might have been simply unaware that the sedative could be fatal in combination with multiple other prescriptions she was taking in normal doses for anxiety, depression and insomnia.

Contributing factors included her weakened condition from a stomach flu and fever brought on by a pus-filled infection on her buttocks from repeated injection of other drugs.

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“She may have taken the dosages she was accustomed to but succumbed because she was already weakened,” Perper said in his report. “Miss Smith has a long history of prescription drug abuse and self-medicated in the past.”

The recommended dose of chloral hydrate is one to two teaspoons before bed. Smith often took two tablespoons, and she sometimes drank directly from the bottle, the report said.

A statement issued by lawyers for Howard K. Stern, Smith’s companion, who was with her before her death, said Smith’s physician and Stern urged her to get emergency treatment but that she refused because “she did not want the media frenzy that follows her.”

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“Anna called the shots in Anna’s life, and everyone close to her knows that,” said attorney Lilly Ann Sanchez in a statement.

The autopsy report left some unanswered questions, such as why it took so long for emergency personnel to be summoned when Smith was discovered unresponsive on Feb. 8 in her room at the Seminole Hard Rock Hotel and Casino.

The report found that a private nurse had asked a bodyguard to call 911 about 1 p.m. and had started CPR. The Seminole EMS was called about 1:40 p.m. by a bodyguard and arrived six minutes later. The ambulance reached the hospital at 2:43 p.m., and Smith was pronounced dead shortly thereafter.

Perper said Smith could have been saved had she been hospitalized earlier in the week, simply because her drug intake could have been controlled.

“If she would have gone to the hospital she wouldn’t have died, because she wouldn’t have had the opportunity to take the excessive amount of chloral hydrate,” he told The Associated Press.