By JEN McCAFFERY
THE ROANOKE TIMES

Archives Reprint

   Cecil Byron Knox was the doctor who ditched his white coat because he didn't want patients to see him as inaccessible.

    That's what the former Roanoke pain specialist said when he testified in federal court Wednesday for the first time in his own defense.

    During his testimony, Knox described his early enthusiasm for the painkiller OxyContin for patients who suffer from chronic pain. He also addressed some of the allegations prosecution witnesses have leveled at him during the trial.

    But Knox, 54, has yet to testify about the overdose deaths of eight people and other medical issues in the case. That testimony will likely come this morning , as will his cross-examination by federal prosecutor Rusty Fitzgerald.

    The following information emerged from Knox's testimony in response to questions from Knox's attorney, Tony Anderson of Roanoke.

    Knox came to Roanoke in 1988 when he was hired as medical director of the rehabilitation ward at Lewis Gale Hospital. But the doctor who wore jeans, cowboy boots and his hair in a ponytail eventually had a disagreement with the hospital director and left after he finished his contract.

    Knox opened his own outpatient practice, Southwest Physical Medicine and Rehabilitation, in 1992. He specialized in pain management and physical rehabilitation.

    Pain management as a field was in the very early stages. When the painkiller OxyContin was introduced in 1996, Knox considered its active ingredient, oxycodone, "an exciting new medication." The narcotic did not damage the liver or the kidneys like some other painkillers did. There's no limit to how much a patient can take if the dosage is increased gradually and it is taken according to doctor's orders. And OxyContin's manufacturer, Purdue Pharma, initially marketed the drug as having low abuse potential.

    "It was a real godsend for chronic pain management and also for cancer pain management," Knox testified.

    Within four or five years, the company changed its warnings to reflect the abuse potential of the drug.

    Knox also testified that as a doctor, he did a lot more than just write pain prescriptions for patients. With his undergraduate background in engineering, he helped design braces and foot orthotics for some of his patients. He also examined them and showed them how to do exercises.

    During his testimony, Knox also addressed some of the allegations of prosecution witnesses.

    He admitted that he smoked marijuana with a former employee in the basement of his practice after he saw patients . He also testified that he had smoked marijuana with two patients down by the Roanoke River and that he had once accepted and took some stimulant pills that he had prescribed for another patient.

    Knox also admitted that once when he went on vacation, he left several signed prescriptions with his office manager, Beverly Gale Boone, in case of emergency. But he said that practice employees worked for months before he would go on vacation to make sure they would have patient refills arranged.

    He added that Boone had to check with him before filling out the top of a prescription. He also asked her to make sure that the patient's request was timely and that there was nothing abnormal about the patient's behavior.

    But Knox denied that he had ever traded prescriptions for marijuana or for an antique radio or wine rack, as some former patients had alleged.

    He also testified that a squirrel did get into his office, which is located in a converted old house at 1130 Second Ave. The squirrel did die in his office, but Knox said no one ever filed any complaints with the Board of Health about the incident.

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