By JEN McCAFFERY
THE ROANOKE TIMES

   An expert witness for the defense team of Roanoke pain specialist Cecil Byron Knox testified Tuesday that Knox's prescription of painkillers such as OxyContin and methadone fell within the scope of legitimate medical practice.

    Dr. Richard Bonfiglio testified that Knox "ended up at the bottom of the funnel" of doctors for the "difficult" patients who comprised much of his practice. Many had medical histories that included workplace accidents, multiple surgeries and histories of substance abuse or psychiatric problems, Bonfiglio testified.

    Based on the 31 patient charts he reviewed, Bonfiglio said Knox did not stray outside the scope of legitimate medical practice with the dosages of painkillers he prescribed and that it was appropriate for Knox to prescribe more than one painkiller at a time.

    On cross-examination by Assistant U.S. Attorney Rusty Fitzgerald, Bonfiglio, who practices pain management in Pittsburgh, admitted that he had testified in about 80 cases over the past 20 years. He also testified that he was being paid $450 per hour for his review of the medical charts in the case, $750 for his first hour at trial and $600 per hour for the rest of the time he testified.

    Bonfiglio also agreed with Fitzgerald that it would be outside the scope of medical practice for a doctor to let a nurse write prescriptions with his signature already on them when he was out of the country. He also testified that it would be inappropriate for a doctor to smoke marijuana with his patients outside the office.

    After objections by defense attorneys, Chief U.S. District Judge Samuel Wilson reminded Fitzgerald that the charges against Knox concerned the prescription of medication outside the scope of legitimate medical practice, not necessarily inappropriate activities.

    Fitzgerald also asked Bonfiglio if he prescribed as high a dosage for his patients as Knox did.

    Bonfiglio replied that he doesn't, not because there isn't a medical justification for it, but because he did not want to find himself the subject of a federal prosecution.

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