By JEN McCAFFERY
THE ROANOKE TIMES

Archives Reprint

   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.

    JEN McCAFFERY can be reached at 981-3336 or jen.mccaffery@roanoke.com.

   yancey read

   jen 580 1857

   this is the list to go w/the knox story

   THE OVERDOSE CASES

   Here is a list of the eight patients of Dr. Cecil Byron Knox who federal prosecutors say died as a result of Knox and his office manager, Beverly Gale Boone, prescribing painkillers such as OxyContin and methadone outside the scope of legitimate medical practice. Knox's lawyers contend that the overdoses had nothing to do with his medical care.

    TRACY LYNN AKERS, 37, VINTON

   Became a quadriplegic after a gunshot wound in 1982. Died Feb. 22, 2000.

    DONALD BRIAN BOYER, 38, PULASKI

   Suffered chronic back pain after car and motorcycle accidents. Died May 12, 2002.

    EBEN EARHART, 50, SPEEDWELL

   Suffered a pelvic fracture after a fall from a horse in 1998. Died Jan. 10, 2002.

    LIN EDLICH, 54, BEDFORD COUNTY

   A community activist who founded VA CARES, a program to help people adjust to life after prison. The victim of a violent attack at her Smith Mountain Lake home about six months before she died, Edlich suffered from chronic pain and panic attacks. Died July 15, 2001.

    MONTE KIDD, 39, SALEM

   Treated for neck and back pain after a work injury, car wreck and surgery. His widow, Jenny Frei, has filed a wrongful death lawsuit against Knox. Died Oct. 17, 2001.

    MICHAEL MARCH, 53, MONETA

   Suffered from chronic pain because of kickboxing and a motorcycle accident. His widow, Kristi March, has filed a wrongful death lawsuit against Knox. Died Jan. 8, 2001.

    EDGAR O'BRIEN, 40, ROANOKE

   A welder, he suffered from knee and back pain. Also had history of heroin addiction. Died May 25, 2002.

    JOHN ROCK TISDALE, 46, BEDFORD COUNTY

   Suffered chronic neck and back pain after two car wrecks. Died Sept. 25, 2000. His widow, Deloris Tisdale, has filed a wrongful death lawsuit.

   SOURCES: court testimony, court documents, medical opinion of defense expert witness Dr. Richard Bonfiglio of Pittsburgh.

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