"The Smith case is rich with many forensic toxicology, forensic pathology and forensic psychiatry and legal issues, woven together in a very complex fashion that will untangle very slowly. The case and its evolution is a terriric way to introduce people to the process of forensic investigation, apart from CSI," said Welner in an interview with washingtonpost.com.
Welner has consulted on a broad range of high profile cases involving questionable death and has served as a key witness in many highly sensitive criminal trials. He is an associate professor of psychiatry at the New York University School of Medicine and a special consultant to ABC News.
A transcript follows.
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Dr. Michael Welner: Good afternoon. Sorry to meet you under these macabre circumstances, but I hope I can help you understand some of the issues relating to death investigation and help you sort out the complexities of this case. While many people have focused on the sensational aspects of Anna Nicole Smith's life and death, I can tell you that keeping a cool and patient head and taking your time and being determined and creative about getting the answers helps in the long run.
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Alexandria, Va.: Don't you find it interesting that whenever a celebrity is involved with a drug overdose of prescription drugs, there is little said about the larger than usual amounts of prescriptions given to these people. It seems as if the MDs involved seldom face scrutiny for overprescribing. Clearly, giving someone a large bottle of Methadone for self-administration sounds like a very bad idea.
Dr. Michael Welner: Very true. Unfortunately, doctors are people too and may bend their rules of prescribing for their more famous patients. Or, they may rely on famous patients as more responsible or more "managed" by the foks around them. You have touched on an important aspect of this case. Even if drugs are not involved in her death, how did ANS get the drugs she had been taking to the degree that they worsened her function and general well-being? And why was a woman so supervised so unsupervised when all was said and done?
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Janesville, Wisc.: Dr. Welner: Do we know what medications Ms. Smith was prescribed? Is it likely that she was addicted to heroin in the past, placed on methadone when pregnant (due to heroin withdrawal dangers during pregnancy), weaned off the methadone after giving birth to her daughter, and then used methadone the day of her death? Methadone seems to be a culprit in so many unintentional deaths when the person ingesting the drug does not realize the sustained-release effect of the drug or its ability to build up in the system due to its long half-life. In addition, a lot of these victims have also consumed sedatives, increasing the risk of overdose. I know this is a complicated scenario with a lot of "ifs" involved, but it would also provide clues into the death of Ms. Smith's son. By the way, photographs of the son in the hour prior to his death clearly show very enlarged pupils leading one to suspect he was in opiate withdrawal prior to ingesting the methadone. Your comments please.
Dr. Michael Welner: Methadone, implicated in her son's death, makes me wonder whether she would go near such a drug when she passed. Best to be very cautious and wait for conformation of mathadone presence in her system, given its history in her family tragedy.
On the methadone question - yes, methadone intoxication would shrink the pupils. Methadone was found in his system, and his death was determined to be from a drug interaction involving methadone. Because he was so unresponsive when he died, the evidence reflects that Danny Smith was not withdrawing from methadone.
But you are raising important points. Why would she be taking painkillers at all. And if so, why be placed on methadone? Methadone is not a drug for painkiller users - it has no kick. If anything, it decreases anxiety and sedates, but is hard to obtain. The presence of methadone without explanation for where a young man obtained it is one of the medical and forensic mysteries of this case -- even before ANS died. No less an authority than Dr. Wecht -- who performed the autopsy on Danny, said that he does not know to this day where the methadone originated from.
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Alexandria, Va.: So Valiumn was found in her room, and no doubt alcohol was available as well. She has a history of substance abuse. I don't see where the mystery lies here.
Dr. Michael Welner: Valium and alcohol alone will not kill a person. Keep in mind that ANS is a large woman with a tolerance to alcohol. For that reason, a Valium-alcohol death would only be likely to happen, in the middle of the afternoon, were a person to have intentionally overdosed herself with a tremendous quantity of Valium or especially alcohol. That would have presented more obvious findings to the medical investigators of acute intoxication. From medical statememnts given to date, there is no obvious indication of acute overdose. If Valium/alcohol were involved, likely something else was as well.
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Fairfax, Va.: How do you think the medical examiner did at his press conference? Do you agree with his conclusions so far?
Dr. Michael Welner: Dr. Perper is a very experienced medical examiner who recognizes that the pressure from the public will only increase if he is silent, and if he does not inform the public of his following up on areas that are unclear (the condition of her heart, blood toxicology). The pressures on him go beyond the public pressures of the community interested in this case; vested parties in the legal dispute will almost definitely hire their own medical examiners to review and redo as much of his work as they can, because his findings are going to have a detrimental impact on at least someone's financial interests. So he has to cover all bases in the way that a judge might who knows his ruling will be appealed to another court regardless of his determination.
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Fort Smith, Ark.: Dr. Welner, Is there any "forensic" significance to the men Anna Nicole had in her life?
Dr. Michael Welner: Absolutely. Great question. Marshall was a tremendously wealthy man. But beyond that, he was an anchor, a mature, stable man who gave her some foundation. She has since been associated with an attorney in the Bahamas and the attorney Stern who took her case to the US Supreme Court and then, who assumed a more directive role in her public relations and other private/professional concerns. Now there is tabloid talk of her linkage with a "prince" and even with the Bahamanian Immigration Minister. In my professional opinion, this reflects her attachments to people who give her anchor and security, more than merely symbols of power or wealth. This is significant because those individuals had great caoacity to control her, even as free - spirited as she projects to the rest of the universe.
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Woodstock, Ga.: Given that very little has been confirmed about the death of ANS, I have just a couple of questions. First, how long really will the tests of her tissue, etc., take to determine what, if anything, she injested prior to death? Second, is it unlawful for the investigators involved to be doing so much speculation in the media?
Dr. Michael Welner: Toxicology analysis, at least preliminary, should be available in 1-2 weeks. I must say that I find there to be little speculation by the folks closest to this case. That is quite appropriate. I have heard no suspiciousness expressed by the investigating authorities. Publicly, in my experience, that is how suspicious people should carry themselves as well.
In my professional experience, watching the reactions to her death and tracing the papertrail of interested parties shortly before and in the wake of ANS' death will be important evidence in the death investigation or related legal maneuvering. Financial and legal transactions, telephone and email correspondence, chats, other dialogue and travel and connections are best preserved when the involved parties do not feel they are attracting scrutiny.
In my professional experience, it is wise to keep public attention on ANS and private attention on everyone around her.
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Arlington, Va.: For DNA testing, is it necessary to have samples from the baby and its mother, Anna Nicole Smith? If so, why?
Dr. Michael Welner: Mr. Birkhead is claiming that the baby could be switched for testing in order to demonstrate that Mr. Birkhead was not the father. Remember that DNA testing is all about the match. No match does not rule out the possibility of a switched subject.
It is simple enough to do such testing. The court's ruling about preserving ANS' body has as much to do with the suspicions of others regarding her death, notso much the paternity testing and the DNA.
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Fort Smith, Ark.: Dr. Welner, thank you for providing this information via this online chat -- it is very informative. I know that the Forensic Panel is known for it wide range of expertise in psychiatric and medical matters relating to the law -- but can you answer a question that may affect many women: where does postpartum depression fit in here? Is this something that could cause Anna Nicole to harm herself or that would make her vulnerable to others harming her?
Dr. Michael Welner: High functioning individuals are harder to track, in terms of how substantial their depression is. In a way, low functioning individuals (from drug impairment and general erratic behavior) may prove difficult to track a decline in as well. What is so challenging about the Smith matter, from afar, is that we are dealing with a woman who had to maintain her appearances for interviews and showbiz, and so would be skilled in doing so notwithstanding emotional burdens. At the same time, ANS was so familiar to many for intoxicated or peculiar behavior that for her to be in an unusual emotional or mental place would not be such a departure from how many others encountered her.
This is not to say that these questions cannot be answered. But a textbook appreciation of post partum depression, or even major depression apart from the pos partum stage, is more difficult in a person like ANS for the reasons above. It's all about understanding and learning about the context of her life when she passed away.
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Falls Church, Va.: Are you tempted to speculate as to why she died? Is maintaining your "professional distance" from conjecture tempting?
Dr. Michael Welner: I avoid the temptation for many reasons. First of all, because I have to answer, in cross examination of future cases unrelated to this, for what I have said publicly if I am unfair or rash in my judgment. Second of all, as a method of practice my modus operandi is to push to get evidence, not to push to conclusion; an ounce of evidence is worth a pound of expertise.
It is helpful for a physician to leave all possibilities open and to rule them out, one by one. Forensics is so interesting because if you keep asking questions, especially if you leave them open ended, you never know what you will learn. It keeps things interesting, moreso than even the best book. If you skip from chapter one to try to guess the end, you eviscerate the intellectual challenge and the treasure hunt that is forensics.
On the other hand, in my professional opinion, I find it important to illuminate and emphasize all potential sources of information and the questions that should be posed of them. if there is enough of a public groundswell for diligent explanation, in any case, it is harder to conceal facts and evidence.
For example I can recall, from my experience as as a witness in Andrea Yates, how much I wanted to interview Michael Woroniecki, her former priest. If there were public clamor for him to have contributed to helping understand her, from his and his wife's experience, he would not have evaded my efforts for months to find him and the court would not have accepted his silence.
Public discussion makes it harder to conceal evidence without fingerprints.
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Washington, D.C.: Are the forensics used on the CSI TV shows realistic? Do you watch them?
Dr. Michael Welner: The biggest problem with shows like CSI is that the answers are always under someone's nose or conveniently accessed. The best forensics involves interviewing, interviewing, interviewing, and burning holes in the bottom of your shoes chasing folks down. And, poring through records that seem to contain little but bear clues within. Lab tests guide the inquiry, as they will here, but they do not flesh out the story in a way that minimizes speculation.
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Washington, D.C.: Re: post-partum depression: I've seen reported some of her acquaintances say she hasn't been herself since her son died. Can grief exercebate other physical issues?
Dr. Michael Welner: Absolutely. And physical issues can exacerbate grief. If you are too lethargic to participate in things that help to pull you together, you will sink further or at the very least, stall.
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London, England: Dr. Welner, what can you tell us about the sources that investigators need to pursue, based upon the information available?
Dr. Michael Welner: I've mentioned the importance of interviewing. That does not merely reflect my responsibilities as a forensic psychiatrist. Consider, for a moment, the importance of whatever may be found in ANS' system.
How did it get there?
What do pharmacy records show?
Who called in the prescription?
Did that parallel what the doctor remembers calling in (yes, I have worked on cases where people called pharmacies posing as physicians, even knowing their controlled substance ID)?
What was the progression of her prescriptions? Meds changed? Why? Lowered, raised?
What symptoms was she being treated for?
Who interacted with doctors?
Who informed them?
The list goes on and on, and of very necessary questions that tease out the more likely scenarios from a multitude of possibilities...
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New York, N.Y.: Dr. Welner,
As a Washington Post reader, I'd like to thank you for joining this discussion forum. With all of the buzz on the Anna Nicole Smith case, it's tremendously helpful to hear what an expert has to say.
My question to you: Why is forensic psychiatry so important to this case, and to the investigation?
Dr. Michael Welner: Thank you for your interest. This is a unique opportunity to communicate directly with readers of The Post and to appreciate how hard it is to provide answers but how necessary it is to ask many questions.
Forensic psychiatry is particularly important for a number of reasons.
First of all, the possibility of suicide and the assessment of depression is complex in ANS and that much harder with no obvious signs of ovrdose, a history of treated depression, and a history of impulsive behavior.
Second, and I hope this is not overlooked, is that even if ANS' death appears to be an accident, either because there is no evidence of large quantities of drugs in her system or a particular poison, there is still the possibility that whomever was heavily influencing her or had access to her could have endangered her to the end that her death would appear to be an accident but could still happen. Interpersonal dynamics, actions and decisions and how they were made, along with actual chemical analysis of the pills left behind, reflect the role of forensic psychiatry in reviewing and interviewing and exploring the range of scenarios as they relate to ANS, her decision making, and the contacts in her life and the nature of their supervision over her.
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Lake Mary, Fla.: Don't you find it suspicious that Anna Nicole and her son died of an overdose involving Methadone and antidepressants?
Dr. Michael Welner: The investigation of Danny Smith's death would benefit from input from his psychiatrist and psychologist. I cannot speculate more.
However, I would say that none of the three medicines involved in his death are considered drugs of particular abuse. At the same time, doctors would prescribe even one of those antidepressants cautiously if they knew he was taking methadone. More importantly, to take Lexapro and Zoloft is an unusual combination, unless one is in the process of going off one medicine and onto another. Even then, the two are just not prescribed together - because they act in the same manner as antidepressants. The very combination of the specific medicines involved demands a close probe into the origin of each.
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Washington, D.C.: Dr. Welner,
Another celebrity, Gerald Levert, was recently determined to have died from Acute Intoxication after originally telling the public he died from a heart attack at age 40. He had many painkillers in his system in addition to taking Xanax and over the counter antihistamine. Do you think something like that could have happened in the ANS case? And why aren't they talking about Gerald Levert, that makes two celebrities who possibly died from prescription drug abuse.
washingtonpost.com: Accidental Drug Mix Said to Kill Levert ( AP, Feb. 11)
Dr. Michael Welner: I need to study the Levert case more. But let me note the following:
Many causes of death are listed as heart attack when death is sudden. When heart stoppage occurs, particularly someone who is only 40 years old, the heart may have stopped because of drug interactions -- not even necessarily involving large amounts of drugs -- because of how those drugs produce cardiac rhythym abnormalities.
For this reason, I would encourage you to be patient about the findings and to use them, as they are released in the ANS case, to think about the questions they resolve and the questions they introduce. Following that path, eventually the right stones get unturned, especially if the public demands it.
Thanks to all for attending. If you are interested in more about forensic science, allow me to invite you to participate in depravityscale.org, surveying the general public about what we feel, as citizens, should be seen as the worst of crimes. I hope to be in touch with you again; best wishes and good health in the meantime.
