By JEN McCAFFERY
THE ROANOKE TIMES

Archives Reprint

   Amy Wade's memories of her children are little more than "bits and pieces" because of the 10 years she spent as a patient of Roanoke pain specialist Cecil Byron Knox.

    She testified Monday at the federal trial of Knox and four of his associates at Southwest Physical Medicine and Rehabilitation that Knox prescribed her so many powerful narcotics that she sometimes fell asleep in his office, waiting for her next prescription. At times, she took 51 pills a day, including four doses each of the painkillers OxyContin and methadone.

    A member of the office staff would wheel Wade out to her car and let her drive home, her children in tow, she testified. She often nodded off as she drove, her son, Garland Mullins, testified. Sometimes he pretended he was sick so he could stay home and take care of his mother, who on bad days couldn't get out of bed or stopped breathing.

    Court testimony Monday provided more of a snapshot of the prosecution's case against Knox and the devastation and even death that federal prosecutors argue he caused. Knox is alleged to have prescribed narcotics outside the scope of legitimate medical practice, though defense attorneys challenged those charges.

    Federal prosecutors allege that eight people died as a result of Knox's prescription of powerful painkillers. Defense attorneys have argued that several of the patients who died were no longer being treated by Knox and that Knox and his office manager Beverly Gale Boone, who is also charged, cannot be blamed for patients' abuse of drugs.

    When Knox was arrested on federal charges in February 2002 and a federal judge shut his practice down, Wade, like many other of Knox's estimated 800 patients, was lost without her medication, she testified.

    "I thought I was going to die," Wade testified.

    Wade was turned away for treatment at area emergency rooms when doctors learned she had been a patient of Knox's, she testified.

    When her withdrawal got really bad, Wade admitted under cross-examination by defense attorney Tony Anderson that she tried crack cocaine.

    Finally, she landed in detox. Since then, Wade testified, she's been drug-free and manages her pain with exercise and vitamins.

    Former Knox patient Monte Kidd wasn't so lucky.

    Richard Wilson, a physiatrist from Iowa and an expert witness for the prosecution, examined Kidd's medical chart along with about 39 others during the trial Monday.

    According to notes on Kidd's chart, Kidd had back surgery in 2001. Afterward, he was in such pain that Knox made a house call and brought along morphine sulfate, to be taken intravenously, Wilson testified. Knox left Kidd in the care of one of his children, who was a minor, Wilson testified. The next morning, a detective called the practice to let Knox know Kidd was dead, according to notes on the chart.

    Wilson, who once practiced at Montgomery Regional Hospital in Blacksburg and had a clinic in Pulaski, testified that after examining 39 medical charts of Knox's patients, he saw 12 "red flags":

    Knox relied heavily and almost exclusively on the prescription of narcotics, with little consideration of the use of drugs with less potential for abuse.

    Knox prescribed more than one powerful opiate at a time to the same patient.

    There was little evidence that Knox took into consideration the complexity - and perhaps alternative course of treatment - for each patient.

    There was not a lot of evidence that Knox tried to account for prescriptions of patients who had history of addiction or who had been convicted of drug offenses.

    Knox consistently failed to follow through on instructions to patients on complex medicine schedules.

    Knox's prescriptions were routinely filled out to maximum levels.

    Knox heavily prescribed Marinol, a drug that contains the active ingredient in marijuana.

    Knox often discounted input from patients or from family members about their care.

    Knox did not follow his own monitoring system for patients who had legal problems from selling OxyContin or who lost pills.

    Knox kept prescribing heavy doses, even after people had problems with losing or selling pills.

    Knox did not routinely test his patients for drug abuse, and when he did, he did not follow up on the results.

    Knox did not maintain a professional distance from his patients, which included smoking marijuana with them at the office.

    But under cross examination by John Lichtenstein, who is representing the practice, Wilson conceded that some medical research in the field of pain management says that it is effective to use more than one opioid - drugs such as OxyContin and methadone - in conjunction with each other. He also admitted that 39 patients do not make a completely fair snapshot of Knox's practice.

    Lichtenstein also pointed out that Virginia law and the Virginia Board of Medicine each say that a doctor can prescribe more than the recommended dosage of a medication if the doctor feels it is medically necessary.

    The trial continues today and is expected to last five more weeks.

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