By JEN McCAFFERY
THE ROANOKE TIMES

Archives Reprint

   Roanoke pain specialist Cecil Byron Knox testified Friday that he doesn't feel responsible for the deaths of people he treated, but that "in hindsight, there are things that could have been done."

    During cross-examination by federal prosecutor Rusty Fitzgerald, Knox testified that in the case of his former patient Edgar O'Brien, he should have been more aggressive about getting O'Brien to return to see him. O'Brien died of a drug overdose 19 months after he stopped seeing Knox.

    More than two years after the investigation of Knox and his practice began, Fitzgerald hammered Knox with questions about the medical treatment federal prosecutors say led to the overdose deaths of eight people and to a baby born suffering from withdrawal from painkillers.

    Two potential impressions of Knox came from his testimony.

    Knox appeared to be a distracted but caring doctor who didn't know much about his office's billing practices and trusted that his patients told him the truth.

    "Unless I had proof positive" that a patient was not using medication as prescribed, "I would give the patient the benefit of the doubt," Knox testified. He answered "I don't remember" or "I don't recall" to many questions.

    But there was also evidence that he was courted by the manufacturer of the narcotic OxyContin, chose to ignore reports that some patients were abusing or selling their medications, and removed incriminating information from medical charts.

    Fitzgerald brought out several instances in which previous testimony contradicted Knox's version of events.

    Knox testified that he didn't know that some patients from Pulaski were selling or abusing their painkillers, such as OxyContin and methadone. But Knox admitted he had read notes from phone messages that had come into the practice detailing allegations of abuse.

    Knox said he believed his patients rather than the anonymous reports. He said he sometimes did not include notes about alleged criminal activity in patient charts. In the case of William Barbour, Knox admitted that he kept out of his medical chart a report about Barbour allegedly getting cocaine smuggled into jail in a cane.

    Knox cited patient confidentiality laws as his justification and that Barbour denied the allegation. He said it was his practice to talk to the patient about the allegations but not necessarily include the information in the patient's chart.

    Knox also said he knew nothing about a phone message from a husband who was concerned that Knox continued to prescribe painkillers to the man's pregnant wife.

    Fitzgerald also questioned Knox about the number of patients he actually treated. Knox had testified earlier in the trial that he had about 2,000. But a list that was supposed to name all of his patients not only contained fewer than 1,800 names but also included names other than his patients'.

    Knox also denied that the notes on his medical examinations of patients sounded similar - "consistent with all previous exams" popped up often in the charts - and that he gave the patients cookie-cutter treatment. But he acknowledged that though he said he checked and signed the prescriptions other staff members filled out before they were given to patients, some mistakes slipped out.

    Fitzgerald also pointed out that Knox was one the the nation's leading prescribers of OxyContin, generating $1.6 million in revenue for the company in one year.

    Knox acknowledged that the drug's maker, Purdue Pharma, did fly him to a seminar where he spoke about pain management. He denied, however, that the company encouraged him to hawk the painkiller.

    Knox also said he was not aware of any medical studies done on humans that showed it was effective to prescribe several painkillers at the same time, as he often did with his patients. He said the combination did produce good results in his patients, however.

    During his testimony Friday, Knox also refused to name people who had supplied him with marijuana or moonshine.

    Although Chief U.S. District Judge Samuel Wilson said he understood why Knox would not want to name his marijuana supplier, he ordered him to answer the question.

    Knox replied that a college friend from Texas had supplied him with a small amount of marijuana. A former patient brought him moonshine, Knox said.

    But Knox denied that he ever traded prescriptions for marijuana or accepted it from patients.

    The trial continues Monday.

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