|Thursday, September 11, 2003
|'Making the pain go away at all costs'
Testimony begins in pain doctor's trial
By JEN McCAFFERY
THE ROANOKE TIMES
Two very different portraits of Dr. Cecil Byron Knox and the medical practice he ran emerged Wednesday during opening statements and testimony at the federal trial of the Roanoke pain specialist and three of his associates.
Assistant U.S. Attorney Rusty Fitzgerald portrayed Knox's practices as a violation of the age-old Hippocratic wisdom, "first, do no harm."
"Making the pain go away at all costs ... is not within the scope of legitimate medical practice," Fitzgerald said in his opening statement.
According to court testimony, when the staff would arrive at Southwest Virginia Physical Medicine and Rehabilitation, patients would already be lined up in the alley behind the old house on Second Street, waiting for their painkiller prescriptions.
In eight cases, Knox's free-flow prescribing of painkillers led to the death of his patients, Fitzgerald said.
Knox's attorney, Tony Anderson, countered that Knox's ponytail, bolo tie and cowboy boots may not have squared with the typical perception of a doctor. But, he argued, Knox is a caring doctor who has helped more than 2,000 patients from about 1995 when he opened his practice until 2002, when federal authorities shut it down.
Also Wednesday, testimony surfaced about the big business of OxyContin, about Knox ranking 11th on OxyContin's prescribers list throughout the nation, and whether Knox traded OxyContin pills for marijuana.
Attorney John Lichtenstein, who is representing the practice, called it a "house of healing" and the knot at the end of the rope for many of Knox's patients.
"Dr. Knox became one of the strongest patient advocates that any patient could have," Lichtenstein said.
Knox had a special allegiance to patients who were veterans, and it was his rule to place them at the front of the line for appointments, Anderson said.
Lichtenstein acknowledged that patients of Knox's had died, but said that was not unusual with the grave medical histories and debilitating pain many of his patients suffered. He added that state and federal authorities have approved the prescription of narcotics such as OxyContin for long-term medical care.
He also raised the question of personal responsibility.
"Is the man responsible for the actions of patients who do the wrongdoing?" Lichtenstein asked.
William Cleaveland, who is representing Knox's office manager, Beverly Gale Boone, 44, argued that the federal prosecution targeted the practice because of Knox's prescription of OxyContin.
"Make no mistake about it," Cleaveland said. "We are here because the government has decided that OxyContin is a bad thing."
However during the day, two former employees of the practice, Robin Rose and Virginia Wyatt, testified that they had concerns about Knox's prescribing practices.
But the question of how the prosecution can prove at least one charge against the doctor rose when Fitzgerald called his first witness to testify, Edwin Shomaker.
Knox is charged with trading OxyContin pills for marijuana on at least 10 occasions. But on the stand, Shomaker, who is serving time in connection with robbing a pharmacy and assaulting a police officer, could not identify Knox either in the courtroom or from an earlier photo of him with long hair. He did testify that he exchanged drugs with a man he knew as "Doc" or "Knox" outside Southwest Virginia Physical Medicine and Rehabilitation.
Knox, Boone and the two other defendants in the case, Willard Newbill James, 58, of Roanoke and Kathleen O'Gee, 54, of Pulaski, also face charges that they were involved in a criminal operation. Prosecutors have argued that Knox, Boone, James, and O'Gee also conspired and committed health care and mail fraud, and that they developed a kickback arrangement for patient referrals.
O'Gee is facing charges in connection with an alternative therapy federal prosecutors say is medically unproven.
David Damico, who is representing licensed counselor James, said that James entered into a contract with Knox for rent and a flat payment. Both he and O'Gee would see patients Knox referred, then submit paperwork about it to the office downstairs.
Mistakes were made in the billing, Damico said, but his client did not intend to commit a criminal act.
Lisa Bryant, a sales representative for Purdue Pharma, the company that makes OxyContin, also testified that the company published the risks of OxyContin abuse and illegal sales in package inserts for the narcotic. Another Purdue Pharma employee, Alicia Graziano, testified that Knox ranked 11th on a list she developed of the top 500 OxyContin prescribers in the United States. Many anesthesiologists were left off that list, however.