Pubdate: Fri, 17 Oct 2003
Source: Roanoke Times (VA)
Copyright: 2003 Roanoke Times
Contact:  http://www.roanoke.com/roatimes/
Details: http://www.mapinc.org/media/368
Author: Jen McCaffery
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

KNOX DEFENDS CARE OF PATIENTS

Cross-examination expected today Dr. Cecil Byron Knox testified that he
regularly had to make decisions about the consequences of treating people,
instead of turning them away.

Roanoke pain specialist Cecil Byron Knox accepted Edgar O'Brien as a patient
because he thought he could help the Roanoke man.

Knox testified in his own defense for the second day Thursday about
his care for eight patients who fatally overdosed. He testified he
knew that O'Brien, a recovering heroin addict, would need close
monitoring when he took him on as a patient.

Under questioning by John Lichtenstein - who represents Knox's
practice, Southwest Virginia Physical Medicine and Rehabilitation -
Knox defended his care of the people who federal prosecutors Rusty
Fitzgerald and Pat Hogeboom have argued died as a result of
prescriptions Knox wrote.

His office manager, Beverly Gale Boone, is also charged in connection
with the deaths.

Fitzgerald is expected to begin his cross-examination of Knox
today.

But Knox, 54, also testified that O'Brien was one of a fraction of the
2,000 patients Knox cared for who presented him with difficult
choices. Knox testified that he regularly had to make decisions about
the consequences of treating people, instead of turning them away. He
said he tried to find a balance in caring for patients with chronic
pain from debilitating injuries, who also had histories of psychiatric
problems or substance abuse.

Knox testified that he prescribed no medication to a third of
patients. He prescribed only one medication to another third of his
patients. Most of his practice involved physical rehabilitation, he
testified.

"Medications were just a way to pick up those pieces that all the
king's horses and all the king's men couldn't put back together
again," Knox testified.

Knox thought that if he didn't treat O'Brien, the man would return to
street drugs for relief from his knee and back pain. He likened
treating an IV heroin user to treating a cancer patient, adding that
the most he hopes for is longer and longer remissions.

After O'Brien abused painkillers prescribed by both Knox and another
doctor, Knox testified, he told O'Brien he would no longer prescribe
medication for him. But Knox said he told O'Brien he would continue to
treat him with physical therapies.

Knox never saw O'Brien again.

O'Brien overdosed about 19 months after Knox last prescribed
medication for him. Knox and Boone each face a life sentence in
connection with the deaths of O'Brien and seven others. He faces the
same sentence in connection with a patient's baby who was born
suffering from withdrawal.

Knox also addressed the case of Monte Kidd. Knox prescribed Kidd a
morphine sulfate drip because Kidd was in great pain after back
surgery. He testified that he prescribed the same amount of morphine
that Kidd's doctor in Richmond had prescribed after Kidd's back
surgery. In that case, Kidd's morphine drip was patient-controlled.
But when Knox prescribed the morphine, the pump was pre programmed and
the patient could not alter it.

Knox also testified that he made a house call to see Kidd the day he
prescribed the morphine. He told Kidd not to take any oral medications
and had one of Kidd's sons even remove Kidd's medications from his
room.

When Kidd was found dead, the remnants of four oral painkillers were
found in a wastebasket next to his bed, according to earlier court
testimony.

Former patient Chris Ann Brown also presented Knox with difficult
decisions, he testified. She was four months pregnant and suffering
from severe back pain when she came to see him.

Knox decided that it was better to treat her pain and risk having her
baby born suffering from withdrawal, than to take her off
painkillers.

"She was afraid that she would end up seeking an abortion for the
pregnancy," because of her pain, Knox testified.

Brown has previously testified that she became addicted to OxyContin
during her pregnancy and that her baby girl was born suffering from
withdrawal.

But Knox testified that Brown's obstetrician, Dr. Christopher Keeley,
knew that Knox continued to prescribe the painkiller to Brown. But
doctors have testified that they planned to taper Brown off the
medications.

Asked by Lichtenstein about the medical soundness of the decision to
keep Brown on painkillers, Knox replied, "I would say it's a clear
choice, not an easy choice," Knox testified.

In the cases of the other former patients who died, Knox testified
that he made the choices to treat them with the narcotics he did
because, in his medical judgment, he was trying to control their pain.
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