Dr. James Gagne, a specialist in addiction and pain management medicine, said Dr. Sandeep Kapoor was acting "outside the standard of practice" when he prescribed large amounts of medications to the former Playboy model to treat her for pain.
Gagne suggested Kapoor should have concluded from the records of the doctor who preceded him on her case that Smith was addicted to opiates and sedatives known as benzodiazopenes. He said Kapoor should have tried to wean Smith from the drugs rather than continuing to prescribe them.
Asked how the sedatives would have affected her behavior, he said, "The closest lay term I think of is space cadet."
Gagne said those who take such large quantities of drugs are "out of it. Emotionally, they're up and down, not functioning cognitively."
Evaluating one of Kapoor's prescriptions, he said, "Three sedatives were prescribed at the same time, and one would expect she would abuse them based on her medical history."
He said Kapoor gave Smith large amounts of the pain killer Dilaudid, known colloquially as "hospital heroin" and Xanax, both drugs coveted by addicts. She was also being maintained on the pain killer Methadone, with Kapoor issuing prescriptions for that as well as the sleeping medication Ambien. Hesaid she was also taking a number of anti-anxiety medications.
Gagne said his review of Kapoor's records showed that he refilled prescriptions early when Smith asked for them, an indication she was taking more than the prescribed amount.
Asked by Deputy District Attorney David Barkhurst why Kapoor would have obliged her requests, Gagne said, "One cannot imagine a purpose other than to supply drugs to an addict."
Superior Court Judge Robert Perry reminded jurors that they would be given a legal definition of an addict which might be different from the one Gagne was using.
Kapoor, Howard K. Stern and Dr. Khristine Eroshevich have pleaded not guilty to prescribing excessive opiates and sedatives to an addict. They are not charged with causing Smith's death in 2007 from a drug overdose.
Gagne said he was aware that Smith suffered fractured ribs and a dislocated shoulder in two separate incidents while under Kapoor's care. But he said he thought the doctor continued prescribing opiates for too long to ease her pain.
In an example of what he said were actions outside the standard of practice, Gagne noted that on Aug. 17, 2006 Kapoor prescribed 460 tablets of Methadone for Smith. Eight days later, Gagne said, Kapoor's records showed he wrote another prescription after Smith called from the Bahamas and said she was out of the drug and starting to experience withdrawal.
The trial entered its second month with a question remaining about whether two nannies who took care of Smith's baby would testify.
Prosecutors told the judge they expect the nannies to appear on Sept. 7. But they have not yet been able to locate a Creole translator and may have to seek one from Louisiana.