|Thursday, October 23, 2003
Jury begins deliberations in Knox prescription drug case
|A prosecutor described Cecil Byron Knox's practice as "eccentric." A defense attorney said Knox was the "knot in the rope" for patients.
By JEN McCAFFERY
THE ROANOKE TIMES
Years from now, will Roanoke pain specialist Cecil Byron Knox be considered a pioneer in the practice of pain management, or will the Roanoke County man be serving time for the overdoses of his patients?
Those are two of the scenarios lawyers presented to a federal jury Wednesday as closing arguments in the seven-week trial wound down. The jury is expected to begin deliberations in the case today.
Knox is one of an increasing number of doctors around the nation who have been charged in connection with their prescription of painkillers such as OxyContin. The debate over what constitutes effective pain management is playing out both locally in federal court and nationally.
Last month, an advisory panel for the Food and Drug Administration voted against imposing restrictions on the prescription of OxyContin, according to the American Medical Association. Some lawmakers and the Drug Enforcement Administration had supported the restrictions, the AMA reported.
Knox's prescriptions were "good medicine," argued Roanoke attorney John Lichtenstein. The 31 patients federal prosecutors Rusty Fitzgerald and Pat Hogeboom focused on in the indictment were the "hardest patients" in the more than 1,700 patients Knox treated, Lichtenstein argued.
"If you don't treat that patient's pain, it fuels their drug-seeking," Lichtenstein said. He argued that if Knox were a doctor who just wrote prescriptions indiscriminately, some of his former patients would not have testified that they knew they had to lie about their pain to get prescriptions from Knox.
Lichtenstein pointed out that one of the prosecution's witnesses, Dr. Richard Wilson, testified that a medium dosage of OxyContin is 360 milligrams a day. By comparison, the criminal allegations against Knox include many dosages of 120 milligrams and 240 milligrams, Lichtenstein argued.
The prosecution did not prove that Knox's prescription resulted in the death or serious injury of 10 of his patients, Lichtenstein argued. Both Knox, 54, and his office manager, Beverly Gale Boone, 44, face a potential life sentence on each of the 10 overdose charges.
Lichtenstein argued that Knox was the "knot in the rope" for many of his patients.
But on his rebuttal, prosecutor Fitzgerald placed blame for the overdose deaths squarely on Knox and Boone.
"There's no reason why the knot at the end of that rope had to be a noose," Fitzgerald argued.
Fitzgerald described Knox's practice as "eccentric," a place of "drug experimentation on unwitting human subjects who did not consent to it."
Roanoke attorney William Cleaveland, who is representing Boone, also reiterated his earlier argument that the case "was about OxyContin from day one." He argued that the prosecution could point to no intentional criminal activity on Boone's part.
"No patient, not one, said she did any nursing," Cleaveland argued.
Cleaveland argued that practice employees did their best to keep up with changing health care regulations.
"Every mistake that's made does not constitute a crime," he argued. He added that the practice had even repeatedly returned money to Medicare after the health care program had sent too much money to the practice.
But Fitzgerald countered that the case was not just about OxyContin; it also involved other painkillers and fraud allegations. He added that former practice employees Tiffany Durham and Heather Basham had testified that Boone knew everything about what went on at the practice.
"She was trusted with the most delicate decisions and actions this corporation made," Fitzgerald argued. "She was absolutely the tip of the pyramid. Even Cecil Knox said that."
Roanoke attorney David Damico, who is representing licensed professional counselor Willard Newbill James, pointed out that federal judge Samuel Wilson already dropped racketeering and conspiracy counts against his client.
He argued that James may have made mistakes but did not intend to cheat health care and insurance programs.
"These people had no reason to think they were doing anything wrong," Damico argued. James did not try to hide his clinic notes when they were submitted for reimbursement, and he did not take care of billing.
But Fitzgerald countered that James "got tired of not being paid," when he had his own practice before going to work as an independent contractor for Knox. "He wanted the money."
As in the case of Knox and Boone, Fitzgerald argued that James was "willfully blind" to evidence that the practice might be doing something wrong in the way they billed his services.
Several defense attorneys advised the jury to consider what they argued was the background to former practice employee Durham's testimony. They said that Durham only agreed to plead guilty after her lawyer told her criminal activity was going on at the practice. She has three small children and was facing a mandatory minimum sentence of 20 years.