Knox was not at fault
Former Roanoke pain doctor Dr. Cecil Knox on Thursday won the first of several wrongful death cases against him when a federal jury found his actions were not a direct cause of a patient's overdose.
Despite the favorable verdict, the jury also decided the doctor was negligent in his care of John "Rock" Tisdale, but that the negligence didn't contribute to Tisdale's death.
"We don't feel that Dr. Knox was responsible for the overdose," said juror Paul Purcell, who also said, "My personal belief is there was some lack of normal care and follow-up that should have happened."
After Rock Tisdale died in September 2000 at age 46, an autopsy concluded the cause was methadone poisoning. The lawsuit, filed in February 2002 by Tisdale's widow, Deloris Tisdale, claimed that Knox should never have prescribed the methadone, saying it was that action that was a direct cause of the man's death.
"However it occurred, whether a voluntary overdose or whatever, he [Tisdale] would have not had methadone if it were not prescribed," said Tisdale's attorney, Tony Russell.
But Knox's lawyers, John Jessee and Powell Leitch, countered that their client could not be blamed for Rock Tisdale's death when Tisdale himself took too many pills and understood the risk inherent in his actions.
"I am not saying it was an intentional act," Jessee told the jury. "I'm saying that he contributed to his own death."
Russell contended that after a relatively minor car crash in January 1999, Rock Tisdale visited several physicians. At most, those doctors put him on Percocet and Celebrex and told him to come back if he still had pain in four to six weeks.
But Deloris Tisdale, herself a patient of Knox's at the time, suggested her husband also see Knox. Knox first prescribed morphine for Rock Tisdale's pain, but later switched to OxyContin when the morphine made him sick. The methadone was added several months later.
This week, Russell called two pain management experts, Richard Wilson and Richard Rauck, to the stand, who both testified that Knox should not have prescribed methadone to a patient already taking OxyContin after a relatively minor car crash.
They added that Knox should have "worked up" Tisdale, or had more X-rays and blood tests done, before prescribing the methadone.
But Knox testified that he saw many of Rock Tisdale's medical records and recent X-rays when he first took him on as a patient. He also conducted a head-to-toe examination of Tisdale, he said.
When he requested that Tisdale get additional tests later, the patient did not follow through time and again, Knox's lawyers said.
Russell accused Knox of never diagnosing the cause of Rock Tisdale's pain, pointing out that late in the doctor's treatment of Tisdale, he ordered tests to rule out diabetes and "other causes" of the pain.
Instead of getting at the root of the pain by running tests or referring Tisdale to other physicians, Knox simply continued to "prescribe and prescribe," Russell said.
Even after Tisdale reported that his pain was lessening, Knox did not lower the dosages, the plaintiff argued.
But Knox said he was confident that Tisdale suffered from "sacroiliac joint dysfunction," or an alteration in normal joint function in the area of the lower back and hip.
Jessee and Leitch argued that Knox's treatment of Rock Tisdale, including the medication, allowed the man to function again and return to work.
Knox said he prescribed the methadone because he wanted to wean Tisdale off the OxyContin, adding that he had in fact lowered the dosage on the OxyContin at the office visit two days before Tisdale's death.
Ultimately, the jury may have given much weight to the toxicology report in the case and the testimony of Kenneth Latta, a Duke University pharmacist specializing in the human body's metabolism of drugs.
Latta said when a person takes a steady dose of methadone, the blood levels plateau after about 10 days and level out from then on unless the dosage is increased.
Because Tisdale was on the same dosage of methadone for more than a year, Latta said, he should not have suddenly died of methadone poisoning without an unauthorized increase in the drug.
Russell said Deloris Tisdale contended that her husband worked the day before his death, then came home and had a couple of beers before going to bed.
But a family friend, Christopher Pappas, testified that Deloris Tisdale told him her husband had stayed home that day, drinking and taking many pills.
"The contributing factor was he overdosed and was taking alcohol at the same time," said Purcell, the juror.
He later added, "You must follow your instructions. You must live within the confines of what you are supposed to do."
Deloris Tisdale took the stand briefly to say just one thing: That Pappas' testimony was a lie.
According to Purcell, her lack of testimony was troubling.
Deloris Tisdale's daughter, Gesele Craig, said the family was disappointed in the verdict and would appeal.
"Because he [Tisdale] drank a couple of beers, that's why we just lost this case," Craig said.
Knox pleaded guilty to three felonies in October after a 2003 criminal jury acquitted him on most charges and was hung on the rest. He was sentenced last month to five years probation and voluntarily surrendered his medical license.
He still faces at least four more wrongful death cases, which were put on hold for the criminal case.
Knox called the victory "bittersweet," saying he hoped it would at least alleviate the fears of fellow pain doctors.
Asked whether Thursday's verdict would have any impact on the other cases, Leitch said, "We can only wait and see."
There is something funny going on here. Time after time, physicians win these cases in the civil arena, where it should be much easier for plaintiffs to win than is should be for the government to win in the criminal venue, where they almost invariably prevail with the same evidence.
This is compelling evidence that it is not possible for physicians to get a fair trial in the criminal courts. This might also be the most compelling evidence we have that these criminal cases should not be perpetrated against physicians at all.
Pain doctor's wrongful death trial begins
February 22, 2006 -
John Tisdale died in 2000 of methadone poisoning, a fact unopposed Tuesday at the outset of a wrongful-death jury trial in federal court.
But the disagreement over whether Roanoke pain doctor Cecil Knox should ever have prescribed the drug to Tisdale is at the heart of the case, which is expected to run through Thursday.
Deloris Tisdale, John Tisdale's widow, is seeking $1.55 million in damages for claims that Knox's negligence led to her husband's death at age 46.
Tisdale's attorney, Tony Russell, told jurors in his opening arguments that John Tisdale had suffered only minor back problems before a car crash Jan. 27, 1999.
After that, John Tisdale visited several doctors for knee pain and lower back pain that radiated into his right leg and upper body. He was first prescribed Percocet, then Celebrex, before an orthopedic specialist told him to return to work and follow up with him in four to six weeks, Russell said.
But Deloris Tisdale, already a Knox patient, recommended Knox to her husband, Russell said. He argued that Knox put John Tisdale on the opium-based drug OxyContin, then the narcotic methadone, without giving the patient a full work-up.
Russell asserted that Knox also increased the dosages "without ever trying to find out what the problems were."
Russell said that when Tisdale died, no illegal drugs were detected in his system, only methadone and alcohol. He said Knox never told Tisdale that he should not drink with the medications.
"Had it been worked up, this was a condition that more than likely could have been treated without these medications," Russell said.
But in his opening argument, Knox's attorney, Powell Leitch, said John Tisdale had serious pain problems before and after his crash, and that Knox spent a lot of time talking to Tisdale and examining him.
Leitch said jurors would hear that John Tisdale was not on a large dose of OxyContin or methadone, and that Knox was tapering the patient off OxyContin. Under Knox's care, John Tisdale was back at work and had achieved functionality, Leitch said.
He added that Deloris Tisdale would likely testify that her husband worked until about 6 p.m. the evening before his death, then had a couple of beers and went to bed. But a family friend will testify that Deloris Tisdale told him her husband spent the entire day before his death drinking beer and taking pills, Leitch said.
"Dr. Knox didn't cause Mr. Tisdale's death by something he did. Mr. Tisdale caused his own death by something he did," Leitch concluded.
The past few years have been long ones of legal turmoil for Knox, who was at one time facing more than 300 criminal charges in connection with his medical practice.
After a jury acquitted him on half and was hung on the rest in 2003, Knox pleaded guilty last year to three charges. He was sentenced to five years' probation and voluntarily surrendered his license to practice medicine.
Self-absorbed prosecutor goes too far
January 26, 2006 -
They slung terms like "house of death," "drug kingpin" and "fraud central." Cecil Knox waited for them to realize their mistake, but he finally grasped that U.S. Attorney John Brownlee was not vested in truth. Brownlee wanted a high-profile case to make him a hero and had chosen "Dr. Knox" to play the villain.
For four years, Cecil's life has been scorched by Brownlee's devotion to ego, his propensity for making poor decisions and his disturbing lack of integrity. It is time to publicly examine this prosecutor who has the gall to pretend he is serving the public good when he trumps up charges, brandishes enormous prison sentences and visits financial ruin upon his targets. It is time to hold Brownlee accountable.
Having launched an offensive against Cecil where none was justified, Brownlee set about concocting a case. He accused Cecil of intentionally addicting patients to narcotics to make them return for more; of being responsible for the death of a patient he hadn't seen in 18 months; of trading narcotics for drugs many times with a convict who, at trial, couldn't even identify him.
Cecil is an incredibly dedicated physician. He accepted patients other doctors couldn't help. He worked all hours, made house calls, and went well beyond the call to help suffering people. Many of them credit him with saving their lives.
But Cecil was different, with his long hair and his cowboy boots. Brownlee tried hard to confuse eccentricity with criminality. His accusations were preposterous. A genuine investigation would have revealed that.
Brownlee acted utterly without conscience. His team blatantly manipulated people and information as they scoured the region for anything they could twist into evidence. They exemplified the deplorable mentality that it is better to destroy an innocent man than to lose a case.
Brownlee stooped to disingenuous press conferences and distortion of the Medicare billing process to set up fraud, conspiracy and racketeering charges. He indicted Cecil's staff, terrorizing them with inexcusable threats. He disregarded the Medical Board's earlier findings that Cecil's treatments were appropriate. It was a telling display of over-reaching by a prosecutor without a case.
Few of us stop to consider the imbalance of power in criminal prosecutions, and how prosecutors can abuse the system to bully defendants. Using all-too-common tactics, Brownlee froze our assets, had Cecil's practice closed and deluged him with an attack involving 23 government entities.
But Cecil was determined to fight: for patients' rights to pain relief and for doctors' rights to answer to medical boards, not to rogue prosecutors seeking notoriety.
After a brutal eight-week trial, Brownlee was soundly defeated. He slipped from the courtroom, deprived of the victory speech he had, undoubtedly, envisioned as a stepping stone to greater professional heights.
Needing to save face, Brownlee reindicted Cecil, then pushed for a deal just before the second trial.
Cecil had borrowed more than $1 million and would need another half-million to proceed. His cancer was in remission, and the trauma of another trial might've provoked a relapse. He wanted to end the case for his office manager, whom Brownlee had tormented for refusing to capitulate.
Reluctantly, Cecil accepted a plea agreement, admitting to relatively minor misconduct, unrelated to pain medicine, giving Brownlee nothing he had charged, and foreclosing the threat of prison. The plea was a legal fiction -- a ransom federal prosecutors often extract, even from innocent people. It is government coercion that society should not tolerate.
Brownlee's boastings about Cecil's plea bore little relationship to reality. He acted as if he had proven his case and brought down a terrible criminal. After wasting untold millions in taxpayer dollars, it is Brownlee who should be brought down.
We all lose when a prosecutor, enamored with himself and uninterested in his obligation to justice, rides roughshod over criminal defendants in search of personal glory. We can measure Brownlee by his conduct in the two largest cases of his tenure in Roanoke: Cecil's and that of Richard Burrow.
In both, Brownlee tried to create flashy crimes where none had been committed; he painted good, honest men as big-time criminals, setting in motion the limelight he coveted for himself.
Thankfully, people in our community are not as ignorant as Brownlee supposed. But, the fact that the ultimate travesty was not occasioned in these cases should not distract us from the threat to our core beliefs that Brownlee poses.
Brownlee's attitude of entitlement allows him to subvert the truth, destroy the lives of innocent people and place his personal ambition above the public good. This is a man who abuses power; a man who should not hold public office.
Knox is married to Cecil Knox. A former journalist, Ms. Knox currently advocates on behalf of missing American servicemen and practices family law in the Roanoke Valley.
Dr. Knox gets five years probation
January 20, 2006 -
A federal judge today sentenced Cecil Knox to five years probation. The former pain doctor from Roanoke pled guilty last fall to racketeering. He had been under indictment for three and a half years.
"They haven't stopped me from caring about people and trying to help people," Dr. Knox told News-7's Keith Humphry after today's sentencing. "I can live with this plea agreement easier than my patients can continue to live with intractable pain," Knox said.
In September he agreed to surrender his medical license, make a restitution payment of $5,000 and plead guilty to three felonies and a misdemeanor. Today's sentencing took place in U.S. District court in Abingdon.
Dr. Knox employee wants attorney fees paid by government
January 07, 2006 - Beverly Gale Boone is seeking more than $250,000 for the expense of defending herself in what she calls "wrongful prosecution."
A co-defendant in the federal case against Roanoke pain specialist Dr. Cecil Knox is seeking to have the government reimburse her for legal expenses she incurred in her defense of charges that were later dropped.
Beverly Gale Boone, who was an office manager for Knox, filed a complaint this week under the Hyde Amendment, saying the United States should pay her more than $250,000 for attorney fees and other costs.
The Hyde Amendment allows a prevailing party to recover litigation expenses if the court finds the United States' position in the case was "vexatious, frivolous, or in bad faith."
"By filing this petition against the government, I am not only seeking financial compensation for the expense of defending this wrongful prosecution, I am seeking justice and accountability as well," Boone said Friday.
But John Brownlee, U.S. Attorney for the Western District of Virginia, said Boone signed a statement agreeing not to take the kind of step she has taken.
Boone and Knox were arrested along with co-workers in 2002. They were charged with conspiring to illegally distribute prescription drugs, distributing narcotics for no legitimate purpose, racketeering and health care fraud, among other things.
After an October 2003 jury trial, Knox and Boone were acquitted on some charges. The jury was hung on others.
Knox and Boone were later indicted again, but after Knox pleaded guilty to three charges in September 2005, charges were dropped against Boone.
In the complaint filed Wednesday against the U.S. Attorney's Office, Department of Justice and Drug Enforcement Administration, Boone says federal authorities tried to bully her into cooperating with their investigation and threatened to prosecute her if she did not.
The complaint states that after Boone refused to assist, Brownlee said, "In the quest to bring Dr. Knox to justice, you are just collateral damage and that is going to happen."
Boone also cites the number of charges filed against her as a bad faith move by the government. At one point, she was facing more than 300 charges.
Boone added in her complaint that she was not even working at the practice when many of the offenses were alleged to have occurred.
She claims to qualify as a "prevailing party" under the Hyde Amendment because all drug charges brought against her in the third indictment resulted in not guilty verdicts.
The government had filed no response to Boone's complaint as of Friday afternoon, but Brownlee provided a written statement.
He pointed out that Boone entered into and signed a pretrial diversion agreement Sept. 14, 2005, when charges against her were dropped.
That agreement includes the statement, "I stipulate that the United States had probable cause to bring all counts in said indictment which are being dismissed under the agreement, that these charges were not frivolous, vexatious or in bad faith, and that I am not a 'prevailing party' with regard to these charges."
A pretrial diversion agreement usually means 18 months' probation for a defendant, but the government accepted the period of supervised release that Boone had already served.
But Boone refuses to interpret the agreement as an admission of guilt. "I did not violate the law," she has said, "and I stood by that."
The U.S. Attorney's Office is standing by its claims as well.
"Beverly Boone and Dr. Cecil Knox caused great pain and suffering to a great many people in the Roanoke Valley," Brownlee said, "and we are pleased this medical practice is no longer in business."
End of case is 'almost bittersweet'
September 20, 2005 -
All charges have been dropped against Beverly Gale Boone, former office manager of Roanoke pain doctor Cecil Knox.
At the government's request, a federal judge has dropped all charges against Beverly Gale Boone, former office manager of Roanoke pain doctor Cecil Knox, and ordered that the charges cannot be brought again.
After more than four years of prosecution, a two-month trial and six amended indictments, Boone was the last of five defendants to reach some resolution in a case that at one point included 313 charges each against Knox and Boone and threatened life in prison for both of them.
"I am innocent, and I would have and was prepared to go to the next trial and defend myself," Boone, 46, said Monday. "So this is almost bittersweet for me because I've done a lot of work for myself for four years."
In exchange for dismissing the charges, Boone entered into pretrial diversion, which usually means 18 months' probation for a defendant. But the government accepted the period of supervised release that Boone has already served.
According to federal prosecutor Tom Bondurant, the pretrial diversion agreement signed by Boone includes the statement "Upon your accepting responsibility for your wrongful behavior ..." and states that she committed misdemeanor health care fraud.
But Boone refuses to interpret that as an admission of guilt on her part.
"I did not violate a law, and I stood by that," she said.
Bondurant said Monday that the government had met its objective in the case when Knox pleaded guilty earlier this month and gave up his medical license and his right to prescribe medication. Knox pleaded guilty Sept. 2 to felony racketeering, two counts of marijuana distribution and misdemeanor health care fraud.
"Cecil Knox is no longer a doctor, he can no longer write scrips and he's a convicted racketeer, and I think with those objectives being met, I don't think there's any reason to go further," Bondurant said.
Boone was arrested in February 2002 along with Knox and Tiffany Durham, who also worked at Knox's Roanoke practice, Southwest Virginia Physical Medicine and Rehabilitation. They were charged with conspiring to illegally distribute drugs, including methadone and OxyContin; distributing narcotics for no legitimate medical purpose; racketeering and health care fraud, among other things. Their actions were alleged to have resulted in death or serious injury to patients.
Counselor William Newbill James Jr. and alternative medicine specialist Kathleen O'Gee, who both practiced with Knox, were also arrested and charged with health care fraud.
Just before the October 2003 trial, Durham pleaded guilty to knowledge of a felony. Midtrial, a judge dropped all charges against O'Gee. The other three defendants were acquitted on some charges, and the jury was hung on the remaining charges.
About three months later, Knox, Boone and James were indicted again on the charges that were not acquittals and on some additional charges. Charges against James were dismissed in March 2004, leaving only Knox and Boone as defendants.
In light of the outcome of Boone's case, Durham's attorney, Jeff Dorsey, said he plans to take another look at his client's case. She has not been sentenced.
"I will be exploring all possibilities for Tiffany Durham, including the possibility of her case being dismissed as well," he said.
Boone said Monday that the case has devoured her life for the past four years. She has not been able to find a job, instead spending her days working on her own defense.
After she was arrested at Knox's office, her then-13-year-old daughter slept on a cot beside her bed for months, she said, and her entire family has suffered emotional strain. She said it has been her family, friends and spirituality that pulled her through.
"Don't back down," she said she told herself, "even in the face of the power, the intimidation and the unlimited finances that the government could put behind their prosecution."
John Brownlee, U.S. Attorney for the Western District of Virginia, made a statement Monday through his office's spokeswoman, Heidi Coy.
"We understand this has been difficult for Mrs. Boone, and we are pleased that she has accepted responsibility for her fraudulent conduct and has agreed to serve 18 months' probation," Coy said.
Boone's attorney, Bill Cleaveland, said he does not believe that his client needed to be involved in the investigation at all because Knox was clearly the government's focus.
"I think that the fact that the government spent as much time, money and energy as they did to prosecute her to end up at this point speaks volumes," he said.
FEDS DROP CHARGES AGAINST KNOX OFFICE MANAGER
September 19, 2005 -
All charges have been dismissed against the last of the five original
defendants in the case involving Doctor Cecil Knox. Beverly Boone served as
the doctor's office manager.
Boone was under indictment for almost four years, but the government asked
the court last week to drop the case. The judge dismissed the charges in a
way that prevents the government from bringing them against Boone again.
How 313 Crimes Became Four
September 06, 2005 - Cecil Knox, the Roanoke, Virginia, physician whose case was discussed in Maia Szalavitz's Reason article about pain doctor prosecutions, has entered a plea agreement that may allow him to avoid prison time. This is a remarkable turn of events for a man portrayed as a menace to society, an alleged pill mill operator who at one point faced 313 federal charges connected to his medical practice. That indictment eventually was whittled down to 69 counts, of which a federal jury rejected about half while failing to reach verdicts on the rest. Three months later federal prosecutors indicted Knox again, this time on 95 charges. Now, with his second trial scheduled to begin next month, the ailing physician, who is suffering from lymphoma, has pleaded guilty to "racketeering," two counts of marijuana distribution, and misdemeanor health care fraud. He also has agreed to surrender his medical license and his DEA registration (which makes it legal to prescribe controlled substances).
The racketeering charge is based not on the promiscuous, deadly narcotic prescribing of which he was originally accused but on two occasions when he prescribed diet pills for a patient who agreed to share them with him. Those infractions and his marijuana offenses both came to light in Knox's own testimony during the first trial. In other words, the Justice Department has almost entirely given up on its original case. U.S. Attorney John Brownlee, who declared Knox's plea agreement "the most significant conviction in this district...in the past 30 years," tried to obscure the government's humiliation by claiming his main goal was to prevent a bad doctor from practicing medicine. But if that was the case, he could have left matters to the state medical board instead of bringing criminal charges in federal court.
It's clear that Knox was not in all respects a by-the-book doctor. But it is equally clear that the Justice Department's indictments were ridiculously inflated (by a factor of 78, considering just the number of counts) and based on allegations it could not prove. As Szalavitz explained in her piece, the strategy of intimidating defendants into guilty pleas by turning every alleged act into multiple offenses is a conspicuous feature of the DEA's war on pain doctors.
[Thanks to Siobhan Reynolds of the Pain Relief Network for the tip.]
Please take a look at this coverage (below) of Dr. Cecil Knox's deal. Note the fact that none of the charges were the ones originally charged. Note also the prosecutor's gratuitous injection of Oxycontin into the agreement.
One wonders how many millions of taxpayer dollars were squandered on procuring a conviction on "racketeering" that involved a couple of diet pills.
What this reflects is a US Government that has no compunction about using its astonishing power to coerce "confessions" that serve its political ends.
A society that has US prosecutors behaving in this way toward medical practitioners who are responsible for the welfare of hundreds, sometimes thousands of people in a community, is a society
whose social fabric is badly torn.
Family Member of a Chronic Pain Patient
Pain Relief Network
Dr. Knox pleads guilty, surrenders license
Saturday, September 03, 2005 -
The Roanoke pain doctor who once faced more than 300 federal charges pleaded guilty Friday to four crimes and agreed to surrender his license to practice medicine.
Cecil Byron Knox's plea in an Abingdon courtroom marks the homestretch in more than four years of legal wrangling. While defense attorneys say the case was settled on Knox's terms in the end, U.S. Attorney John Brownlee said it is a victory for the many people the government alleged were hurt by Knox.
"In my opinion, it's the most significant conviction in this district in the United States in the past 30 years," Brownlee said, later adding: "Our goal was to stop him and this plea allows us to do that."
A month and a half before he was scheduled to go to trial for the second time, Knox, 56, opted instead to plead guilty to felony racketeering, two counts of felony marijuana distribution and misdemeanor health care fraud. He also surrendered his medical license and Drug Enforcement Agency registration number, which allowed him to prescribe controlled substances.
The racketeering charge relates to two incidents in 1998 when Knox distributed the controlled substance Fastin to a patient with the understanding that she would share the drug with him. Those acts constitute racketeering because they represent a pattern of illegal activity committed within the operation of an enterprise, the medical practice.
For reasons that included Knox's ongoing battle with non-Hodgkin's lymphoma, the government has agreed to a sentencing range that maxes out at one year in prison but also includes alternatives to jail time. Knox is scheduled to be sentenced in November.
Knox was first indicted in February 2002, along with his practice, his former office manager, Beverly Boone, and employees Willard Newbill James and Kathleen O'Gee.
Knox's charges included prescribing controlled substances such as the painkiller OxyContin outside the scope of legitimate medical practice, and the government alleged that in multiple cases the doctor's irresponsible drug dispensing resulted in injury or death to patients.
As more charges were added and subtracted before the first trial, the total number at one point reached 313. Knox went to trial on 81 counts, which were whittled down to 69 over the course of the eight-week trial.
The October 2003 trial ended with not guilty verdicts on about half of the charges. The jury could not reach a verdict on the rest of the charges. Boone also was acquitted.
Charges against O'Gee and James were dismissed at different times, but three months after the first trial ended, Knox and Boone were indicted again. The second time, Knox faced 95 charges, including racketeering, conspiracy to commit racketeering, criminal conspiracy, mail fraud and perjury.
Boone was indicted a second time and is scheduled to go to trial on her charges later this year. Her attorney, William Cleaveland, could not be reached for comment Friday.
Defense attorneys John Lichtenstein and Tony Anderson said Friday that the Fastin incidents and the two marijuana incidents were never alleged against Knox until he admitted them under oath during his 2003 trial. It was those admissions that led to the felony charges he pleaded to, not the government's original evidence in the case, they said.
They also said that none of the charges in the original indictments, including allegations that Knox overprescribed painkillers and caused harm to patients, were part of the agreement on Friday. All of those remaining charges have now been dropped.
"He is not entering any plea to any charge that he was originally indicted on," said Lichtenstein, who later added: "The reason Dr. Knox said, 'I want to close it on this basis' is because, if you look where he started and where he came from, the government basically walked away from the case."
But Brownlee said the racketeering charge encompassed many acts, including repeated distribution of drugs such as OxyContin, methadone and Fastin. Knox and his attorneys chose to plead to the Fastin-related acts rather than others, but the effect was the same, he said: Knox was convicted of racketeering.
"I don't think if there were just two incidents of illegal Fastin distribution that we would be talking about a racketeering conviction today," Brownlee said. "It's much broader in scope."
He added that the most important objective in the case was putting an end to Knox's career as a doctor. Although Knox could conceivably reapply for his medical license in the future, he can never prescribe medicine without a DEA registration number.
"Lawyers may debate about what he pled guilty to and OxyContin's role in that guilty plea, but I can guarantee you this: He will never write another prescription for OxyContin," Brownlee said.
Knox, who continues to receive treatment for his illness, said he was ready to take his daughter to college for her first year and get on with his life.
Forfeiture of Knox's home and other property was not part of the plea agreement. Immediately after Knox's plea, his attorneys said they were able to unfreeze much-needed assets, including proceeds from the sale of his office that have been held in escrow.
"It's been a long trail," Knox said. "I'm glad to finally have put it to rest on my terms and to go home with my family."
In regard to Brownlee's reference to Knox as a "rogue doctor" who needed to be removed from the medical community, Knox would only say quietly: "I think we would say differently."
(C)2005 The Roanoke Times
Dr. Knox pleads guilty to four charges
September 2005 -
Roanoke pain doctor Cecil Knox this morning pleaded guilty to four
felony counts and one misdemeanor count against him. Dr. Knox
admitted to racketeering, distribution of marijuana and health care
fraud. Federal Judge James Jones accepted the plea in Abingdon this
morning, avoiding the necessity of a second trial for Knox.
Dr. Knox will be sentenced in November. The counts he pleaded guilty
to normally carry a prison sentence of more than 30 years in prison,
but the federal prosecutors say they will ask for a sentence of no
more than 12 months, which might be served as home confinement. Dr.
Knox has been battling cancer. He told the judge today that he is
schedule for a bone marrow biopsy and other medical tests.
A judge ruled last April that Dr. Knox had recovered enough from his
lymphoma to stand trial for a second time on charges that he over-
prescribed painkillers, including OxyContin.
In October of 2003, a federal jury in Roanoke declined to convict
Knox of any of 69 charges against him. That jury cleared Knox on more
than 30 of the charges and deadlocked on the rest, prompting the
judge to declare a mistrial. He was to have been re-tried beginning
October 17th in Abingdon, along with his office manager, Bev Boone.
Prosecutors say there has been no plea agreement in the case against
Dr. Knox' Daughter Offers
Valedictorian Speech of
June 9, 2005 -
Kirstyn Knox heads for Harvard University
Kirstyn's father, Dr. Cecil Knox, awaits a second trial on federal drug charges
Dr. Knox watches daughter deliver PH Valedictorian address
Patrick Henry High School students heard a message of perseverance in the face of adversity. It came from a fellow student, a young woman whose family knows a bit about trying circumstances.
Valedictorian Kirstyn Knox is headed to Harvard. Her father is Dr. Cecil Knox, who has been under criminal investigation since she started high school.
Trial of pain doctor
Manager off docket
October 2004 -
The second federal trial of Roanoke pain specialist Dr. Cecil Byron Knox
and his office manager has been taken off the court docket and no new date has been set.
The trial was scheduled to begin Monday in federal court in Roanoke. Lawyers in the case would not comment on why the case was taken off the docket.
Knox and Beverly Gale Boone, both Roanoke County residents, are charged with racketeering, conspiracy to commit racketeering, criminal conspiracy, mail fraud, health care fraud and illegal kickback charges.
Knox is also charged with 14 counts that his prescriptions of opioid medications such as OxyContin and Oxy IR were outside the scope of legitimate medical practice and led to death or serious bodily injury.
Knox, 55, also faces charges that in 64 other instances, he prescribed medication outside the scope of legitimate medical practice and with perjury.
When Knox and Boone, 45, and a third defendant, licensed professional counselor Willard Newbill "Bill" James, faced trial in the fall of 2003, the jury acquitted defendants in the case of about half the charges they faced. The jury could not reach a consensus on the other charges. The charges against James, 59, were later dropped.
Pain specialist indicted again
Prosecutors to seek a new indictment in the
24 Aug 2004
By Jen McCaffery
A federal grand jury in Charlottesville has come down with a new indictment
against a former Roanoke pain specialist and his former office manager.
Dr. Cecil Byron Knox and Beverly Gale Boone are still charged with the same
number of alleged criminal acts they faced in the last indictment. But
federal prosecutors Tom Bondurant and Patrick Hogeboom included new language
in the indictment pertaining to sentencing issues should Knox or Boone be
convicted of any of the charges.
The indictment came down in Charlottesville last week and was entered in the
federal court's electronic system Monday.
Federal prosecutors throughout the United States have been seeking new
indictments that contain the sentencing language in the wake of a recent
U.S. Supreme Court decision that called into question whether issues that
could enhance a defendant's sentence should be determined by a judge or by a
The decision raised the issue of whether a jury should determine those
sentencing issues, but the U.S. Supreme Court has yet to decide whether or
not that issue will pertain to the federal system.
Knox and Boone, Roanoke County residents, are charged with racketeering,
conspiracy to commit racketeering, criminal conspiracy, mail fraud, health
care fraud, and illegal kickback charges.
Knox, 55, is also charged with 14 counts that his prescriptions of opioid
medications such as OxyContin and Oxy IR were outside the scope of
legitimate medical practice and led to death or serious bodily injury.
Knox is also charged in 64 instances in which he is accused of prescribing
medication outside the scope of legitimate medical practice. He also faces
At their first trial last fall, a jury failed to convict Knox and Boone, 46,
of any of the charges and acquitted them on about half of the charges they
faced. They are scheduled for trial again Nov. 1.
Is Dr. Cecil Knox the Godfather?
Feds Indict Southwest Virginia Pain Specialist Cecil Knox for Third
Time, Aim to Win Racketeering Conviction 6/25/04
Roanoke, Virginia, Pain management specialist Dr. Cecil Knox has been
re-re-indicted by a federal grand jury in Charlottesville in a vivid
example of prosecutorial manipulation of the grand jury system. Knox,
who operated the Southwest Virginia Physical Medicine and
Rehabilitation Clinic, was originally charged and tried on a 69-count
indictment alleging he and his office staff caused the death of
patients by improperly prescribing opioid pain relievers and that
they defrauded Medicaid by writing the improper prescriptions. But a
federal jury last fall found Knox innocent on 30 counts and could not
reach a verdict on the remaining counts, prompting the trial judge to
declare a mistrial.
Having been defeated initially in their effort to send Dr. Knox away
for decades, the federal prosecutors went back to the federal grand
jury and sought a new indictment in January. Even though the judge in
the initial trial had not yet decided whether to dismiss the
remaining counts, the prosecutors couldn't wait. As is always the
case with prosecutors and grand juries, the prosecutors got what they
wanted. This time Knox was to be charged with 95 counts, including 14
counts of illegally prescribing medication that caused death or
bodily harm, and running a continuing criminal enterprise, or
racketeering. The federal crime of racketeering was originally
designed to target organized crime, but has since been used by
innovative prosecutors to charge people who don't have anything to do
with what is commonly considered organized crime. Like a doctor's
Last week, the feds were back before the grand jury to massage a
slightly different indictment from it, one that makes it easier for
them to prove their racketeering case. Under federal law, a jury must
convict a defendant of at least two of the acts listed in the
racketeering charge. To un-level the playing field, prosecutors got
the grand jury to indict as three crimes what it had indicted as one
crime in January.
In January, the grand jury charged that Knox improperly prescribed
the stimulant Fastin to a patient as one of the seven acts listed in
the racketeering indictment. Now, again at the prompting of federal
prosecutors, the grand jury as split the Fastin-prescribing incident
into three separate acts, making it that much easier for the feds to
achieve the magic number of two acts needed to get the racketeering
US Assistant Attorneys Tom Bondurant and Patrick Hogeboom were not
returning media calls with questions about the re-re-indictment. Knox
and his office manager, Beverly Gale Boone, are set for re-trial on
Grand jury hands down charges against Dr. Knox
The new allegations are slightly different from those in the previous
By Jen McCaffery
The Roanoke Times
[email protected] 981-3336
Roanoke pain specialist Cecil Byron Knox faces additional allegations of actions federal prosecutors say were part of an organized criminal
enterprise, according to a new indictment a grand jury in Charlottesville handed down Wednesday.
The new allegations are slightly different from those in the previous
indictment against Knox.
In the previous indictment, the allegation that Knox prescribed the
stimulant Fastin to a patient in February, March and April 1998 with the intention of sharing it with her was named as one of seven acts to support the charge that Knox had committed racketeering.
The new indictment has split the allegation that Knox prescribed Fastin to the patient into three separate acts that prosecutors Tom Bondurant and Patrick Hogeboom say show that Knox was running a criminal enterprise with his medical practice, Southwest Virginia Physical Medicine and Rehabilitation on Second Street Southwest.
To convict a defendant of racketeering, a jury must determine that the
person committed at least two of the acts named under the racketeering
charge in the indictment.
The other racketeering allegations are that Knox and his office manager, Beverly Gale Boone, committed health care fraud in five instances. Prosecutors also say Knox was trafficking drugs as part of the alleged criminal enterprise.
"We'll plan to defend it," Roanoke attorney Tony Anderson, one of Knox's lawyers, said of the new allegations.
In addition to the racketeering charge, Knox also faces 14 charges that his prescriptions of opioid medications such as OxyContin and Oxy IR were outside the scope of legitimate medical practice and led to someone's death or serious bodily injury.
Knox is also charged in 64 instances in which he is accused of prescribing medication outside the scope of legitimate medical practice, and he faces perjury charges.
Knox, 55, and Boone, 45, both of Roanoke County, face additional charges of conspiracy, mail fraud, health care fraud and illegal kickbacks. A jury failed to convict the two defendants of any charges last fall, the first time they stood trial.
They are scheduled for trial again Nov. 1.
Bondurant did not return a call for comment, and Hogeboom declined to
comment on the allegations.
Date set for 2nd Knox trial
The Roanoke pain specialist and his office manager are scheduled to be tried in November.
Thursday, April 15, 2004
The second federal trial of a Roanoke pain specialist and his office manager was set Wednesday for November, according to the federal court schedule.
Cecil Byron Knox, 54, and Beverly Gale Boone, 45, are set to be tried in Roanoke from Nov. 1 through 24, according to the court docket.
Knox faces charges that he prescribed medication such as OxyContin outside the scope of legitimate medical practice, and that in some cases those prescriptions led to death or serious bodily injury. He could face a life sentence if convicted of those counts.
Knox and Boone, who both live in Roanoke County, are also charged with racketeering, conspiracy, fraud and taking illegal kickbacks. Knox also faces a perjury charge.
In October, at their first trial, a jury acquitted Knox and Boone on many of the federal charges but could not reach a decision on the other counts. Those counts still remain unresolved, and federal prosecutors have since sought new charges in the case.
Chief U.S. District Judge Samuel Wilson has dismissed federal charges against two other defendants in the case: licensed professional counselor Willard Newbill "Bill" James Jr. of Roanoke and Kathleen O'Gee of Pulaski.
A fifth defendant in the case, former receptionist Tiffany Durham, pleaded guilty on the eve of the first trial to knowing that criminal activity was going on at the practice and not reporting it.
Tuesday, March 09, 2004
Judge drops all charges against defendant in Knox case
Chief U.S. District Judge Samuel Wilson dismissed all charges Monday against Willard Newbill "Bill" James.
By Laurence Hammack
A counselor accused of fraud at Dr. Cecil Byron Knox's pain management office will not be among the defendants when the case is tried a second time.
Chief U.S. District Judge Samuel Wilson dismissed all charges Monday against Willard Newbill "Bill" James, a licensed professional counselor who was accused of cheating insurance companies through improper billing practices at Knox's Southwest Roanoke practice.
Prosecutors had asked Wilson to dismiss the charges against James without prejudice, meaning the case could be brought against him sometime in the future.
The judge refused to do that, noting that James has been the subject of a lengthy investigation and a trial last year in which the jury was unable to reach a verdict on his charges of conspiracy, mail fraud and health care fraud.
In dismissing the charges with prejudice, Wilson wrote: "It appears that the likelihood of further criminal proceedings against James is small, but he, having come this far, is entitled to certainty - a resolution that has finality."
Defense attorney David Damico said James has always maintained his innocence.
Damico said his client suffered the misfortune of sharing an office with Knox, the key target in a federal investigation into charges of overprescribing OxyContin and other drugs prone to abuse and fatal overdoses.
"I think the case against Bill James had more to do with the government's dislike of Dr. Knox than it had to do with anything that Bill James did," Damico said.
Assistant U.S. Attorney Tom Bondurant said last week that James was dropped from the prosecution to streamline the remaining case against Knox and his office manager, Beverly Gale Boone.
At a trial last year for Knox, Boone and James, a jury found the defendants not guilty of about half the charges and deadlocked on the rest. Charges against a fourth defendant were dismissed.
Bondurant said last week he planned to refer the case against James to the civil side of the U.S. Attorney's Office for possible collection of the money he allegedly obtained through fraud. Wilson's order Monday would apparently have no bearing on that process.
Knox faces trial next month on charges the first jury was unable to decide - that his prescription of painkillers led to the death or serious injury of some of his patients. He and Boone face additional charges that include drug distribution, health fraud and perjury.
As for James, he hopes to get his practice back in order.
"He's very skilled in treating people with brain injuries," Damico said. "He continues to be interested in that and is very interested in going back to that kind of work."
Defendant may be cut in Knox trial
Prosecutor Tom Bondurant asked for charges against Willard Newbill "Bill"
James to be dismissed without prejudice. Cecil Byron Knox and Beverly Gale
Boone face an April 13 trial.
By Jen McCaffery [email protected] 981-3336
Friday, March 05, 2004
Federal prosecutors asked a judge this week to drop charges against a
licensed professional counselor who worked with Roanoke pain specialist
Cecil Byron Knox.
In a very brief motion filed in federal court, prosecutor Tom Bondurant
asked for charges against Willard Newbill "Bill" James to be dismissed
without prejudice, which means that James could be tried again in connection
with the alleged offenses. As of the most recent indictment in the case,
James is charged with criminal conspiracy, mail fraud and health care fraud.
The request comes less than a month and a half before the defendants that
remain in the case are scheduled to stand trial for the second time. Knox
still faces charges that his prescription of painkillers such as OxyContin
led to death or serious bodily injury, which carry a potential life
sentence. He also faces other drug distribution and perjury charges.
Bondurant made clear in the motion that he only sought the dismissal of
charges against James, not the other two defendants who remain in the case:
Knox, 54, and office manager Beverly Gale Boone, 45.
"We wanted to streamline the case," Bondurant later said in a phone
interview. "The main focus of the case has always been Knox and Boone, so we
might as well pare it down, since it's already been tried before."
Bondurant also said he planned to refer the case against James to
prosecutors on the civil side of the U.S. Attorney's Office, because "there
are civil sanctions for violating health care laws."
Roanoke attorney David Damico, who represents James, said in another phone
interview that he planned to ask Chief U.S. District Judge Samuel Wilson to
dismiss the charges against his client with prejudice, so that James could
not be tried again in connection with the alleged offenses. But Damico said
he had not heard before that his client could also face civil sanctions.
At the first trial last fall, the jury found defendants in the case not
guilty on about half the charges, and could not reach the consensus required
for conviction or acquittal on the remaining charges. Wilson declared a
mistrial on the those charges, but they have yet to be resolved.
One juror interviewed on the condition of anonymity after the first trial
said that the vote to acquit James, 58, on all five charges he faced was 11
to 1 for acquittal. Other jurors could not be reached or declined to comment
to corroborate the first juror's recollection.
Should Wilson decide to drop charges against James, he would be the second
defendant in the case to have all charges dropped. During the first trial,
Wilson dismissed all charges against the fourth defendant in the case,
Kathleen O'Gee, 55, of Pulaski, based largely on his finding that the
prosecution did not present enough evidence of guilt.
Another defendant in the case, Tiffany Durham of Blue Ridge, pleaded guilty
before the first trial to charges that she knew a felony was going on and
did not report it.
Damico also pointed out that Wilson has not yet made a decision on the
charges that remain from the first trial. Since then, federal prosecutors
sought another indictment against Knox, Boone and James, which came down in
"We've already got pending motions from the old indictment, and we're
entitled to some resolution on the issues," Damico said. A hearing in the
case is scheduled for this afternoon.
During the first trial, federal prosecutors argued that James cheated health
insurance programs through how his services were billed and participated in
a kickback arrangement with Knox for patient referrals. But Damico argued
that James was not responsible for the billing.
Knox and Boone, both of Roanoke County, are also still charged with charges
of racketeering, conspiracy to commit racketeering, criminal conspiracy,
mail fraud and health care fraud, as well as charges that they were part of
an illegal kickback scheme. The trial is scheduled to begin April 13 in
Pain doctor, associates' new trial to be in RoanokeSaturday, January 31, 2004
A federal judge ruled Friday that the second trial of Roanoke pain specialist Cecil Byron Knox and two of his associates will take place in Roanoke.
In a meeting in his chambers with attorneys in the case, Chief U.S. District Judge Samuel Wilson said he planned to seek jurors from outside the Roanoke area because of the media attention to the first trial. That trial, which ended in October, resulted in a hung jury for Cecil Byron Knox, his office manager, Beverly Gale Boone, and licensed professional counselor Willard Newbill "Bill" James.
Knox, 54, faces multiple counts of prescribing medication outside the scope of legitimate medical practice, which federal prosecutors Rusty Fitzgerald and Patrick Hogeboom argue led to death or serious injury in some cases. He also faces perjury charges.
Knox and Boone, 44, also face charges of racketeering, conspiracy to commit racketeering, criminal conspiracy, mail fraud and health care fraud, as well as charges that they were part of an illegal kickback scheme. James, 58, also faces criminal conspiracy, mail fraud and health care fraud charges.
Prosecutors Response to the Jury in the Knox Case
Dr. Knox re-indicted
By John Adams / WSLS NewsChannel 10
January 21, 2004
Newschannel 10 has gotten a copy of a new 95 count indictment against Dr. Cecil Knox and his office manager, Beverly Boone.
Last fall, Dr. Knox faced more than 80 charges ranging from wrongful death, to dealing drugs, and even mail fraud.
Last Halloween, a federal jury acquitted Knox on More than 30 charges, and deadlocked on several others.
A grand jury in Charlottesville brought the 95 new charges against Knox and his office manager.
Many of these charges, including racketeering charges, are being "re-alleged." That means that Knox will be facing many of the same charges again.
The new charges including 14 counts of illegally prescribing drugs that led to serious injury or death, and more than 60 counts of illegal distribution.
Also included are three counts of racketeering, 5 counts of mail fraud, and 5 counts of medical insurance fraud.
The final count, number 95 is a perjury charge.
The grand jury has accused Knox of lying to the court during his previous trial last fall.
Knox's attorney, Tony Anderson, says he didn't know anything about the government's new charges.
He says he's surprised by the timing, because the court is still considering a motion to dismiss the charges against Knox from his last trial.
Knox is scheduled to go on trial in Lynchburg federal court on April 13th.
Family Member of a Chronic Pain Patient
Founding Executive Director
"Standing up for patients in pain and the doctors who treat them"
It's not unusual for prosecutors to do this. They don't like to lose and they are on salary. We pay the taxes that pays their salary. They have no respect for the conclusions of the jury, so they 'll just go get another one. Anyone out there have a legislative repreentative who need to know what is going on? How about all those patients who now have o pain relief? You get what you'll allow.
Pubdate: 1 Nov 2003
Source: Times-Dispatch (VA)
Author: REX BOWMAN
No convictions against physician
Accusations against pain doctor end in not guilty verdicts and indecision
BY REX BOWMAN TIMES-DISPATCH STAFF WRITER
Nov 1, 2003
Federal prosecutors failed to win a single conviction yesterday against a Roanoke doctor they had accused of illegally prescribing medicine that contributed to the deaths of seven patients.
After a seven-week trial and more than a week of deliberating in U.S. District Court, a jury found Dr. Cecil Knox not guilty of about 30 of the 69 charges against him. Jurors were unable to reach a verdict on the remaining counts, prompting Chief U.S. District Judge Samuel Wilson to declare a mistrial.
Though Knox could face retrial on those remaining counts - three of which charge him with contributing to patients' death or serious bodily injury - he left the courtroom at 6:15 p.m. yesterday crying tears of joy.
"Right now, there is no anxiety," said a tearful Knox, 54. "I feel very good and very positive about the future. I think I'm going to be back, my practice will be back."
"I just want to savor the moment," said Knox's wife, Donna, as she dabbed tears from her eyes. "I'm just thankful. It's been a long time filled with fear and anxiety, and now it's over."
In seven weeks of testimony, prosecutors alleged that Knox ran a "pill mill" from his office on Roanoke's Second Street, handing prescriptions for powerful drugs like OxyContin and methadone to known addicts and others who came to see him with stories of severe pain. Knox's eagerness to prescribe potent drugs contributed to the deaths of seven patients, prosecutors alleged.
In one year alone, Knox wrote prescriptions for $1.6 million worth of OxyContin, according to testimony, becoming the 19th leading prescriber of the drug in the nation.
Yesterday, prosecutors hurriedly left the courthouse after the verdict was announced, mostly avoiding the swarm of reporters who had gathered in the lobby. Assistant U.S. Attorney C. Patrick Hogeboom III, who helped prosecute the case, declined to comment.
While the two dozen Knox supporters in the courtroom greeted the verdicts with cries of elation, others were surprised and disappointed. They left the courtroom in tears.
"I'm stunned, just stunned," said a weeping Tammy Akers, clutching a photo of her brother Tracy's grave. Tracy Akers, paralyzed from the neck down from gunshot wounds, was one of the patients who died after being heavily medicated by Knox.
Defense attorneys Tony Anderson and John Lichtenstein left the courthouse asserting that the not-guilty verdicts were a vindication of Knox and his treatment methods. During the trial, they portrayed him as a compassionate and caring doctor who, though unorthodox in his sandals and long hair, dealt with patients in such severe pain that other doctors wouldn't treat them.
Anderson said he couldn't say much about the verdicts until he examines more closely which of the many charges against Knox could be retried. He said he's still not sure of which charges Knox has been exonerated.
"I was trying to write them down" as the court clerk read off the verdicts, he said, "but I was emotional."
Knox had been charged with 50 drug-related charges, as well as 19 fraud, racketeering and conspiracy charges related to his billing practices. His office manager, Beverly Gale Boone, faced the same charges. The jury found her not guilty of more than 60 charges and was unable to reach a verdict on the remaining charges.
A third defendant, Willard Newbill James Jr., a professional counselor accused of paying kickbacks to Knox in exchange for patient referrals, had faced five fraud-related charges. Jurors were unable to reach a verdict on any of those charges.
A federal grand jury indicted Knox in October 2002. Judge Wilson temporarily postponed the trial in December, as Knox underwent treatment for non-Hodgkin's lymphoma.
Yesterday, surrounded by his wife and children, Knox said he hopes to reopen his medical practice, but has other business to attend to first. "The first thing is to get my health back," he said, "and spend more time with my family."
Contact Rex Bowman at (540) 344-3612 or [email protected]
Pubdate: 1 Nov 2003
Source: Roanoke Times (VA)
Author: Tad Dickens and Shawna Morrison
Supporters celebrate verdict
"We'll be the very first" to go back if Knox is able to re-establish a practice, said the wife of a former patient.
Some who sat through weeks of trial and days of deliberation over the legal fate of Dr. Cecil Knox and two employees were ecstatic at the verdicts.
Others were angry.
But few would disagree with Tammy Akers' assessment of the result.
"I don't think anyone was really expecting this," Akers said.
Akers lost her brother, Tracy Akers, and blames Knox. But many in the courtroom came to support Knox, who with office manager Beverly Boone, was acquitted Friday night of many of the charges against him, and convicted of none.
Knox, Boone and and licensed professional counselor Willard Newbill still face a variety of charges, on which the federal jury could not agree.
Still, supporters celebrated for Knox, a man they said cared about them as if they were family.
Rick Dudding of New Castle said that when he was at one of his lowest points, Knox gave him a tiny card to show his support.
The card depicted a weakened man who held a nail in one hand and a hammer in the other. Jesus held the man up.
Dudding became Knox's patient in 1995, after a drunken driver struck the tractor-trailer he was driving.
"That's when I was down in the dumps. That's when I was falling apart," Dudding said after the trial ended. "The pain was so bad ... you wanted to shoot yourself."
At the trial he wore the card pinned to his shirt, along with a prescription sheet on which Knox had drawn a heart for Dudding.
Friday evening, Dudding gave the card back to Knox "to let him know that I was there for his uplift," Dudding said.
"He started crying, just like me," Dudding said. "Cecil means a lot to me."
After group hugs, laughter and pats on backs, participants and supporters filed outdoors.
Standing beside a courthouse door, Doug Douglas stood smiling with his wife, Beverly.
While Beverly Douglas was mostly excluded as a viewer because of her status as a witness, Doug Douglas said he watched most of the past two weeks - after he returned from a hospital stay which included 11 days in a coma.
His time viewing the trial could be "pretty frustrating," he said, "because of some of the things they talked about. I wished I could respond."
Knox has treated Doug Douglas for years because of a variety of physical problems. Knox even built his patient a support for his boot, to improve a limp caused by shortness in one leg.
Doug Douglas, like other Knox patients, has had to seek new options since federal authorities shuttered the practice. That has been hard, Beverly Douglas said, because she always knew Knox would be there for her husband, through suicide attempts and nightmares caused by pain and war-related post - traumatic stress syndrome.
"We'll be the very first" to go back if Knox is able to re-establish a practice, Beverly Douglas said.
As the Douglases walked away, only one person - Tammy Akers - remained in the courtyard. She sat on a concrete bench, sobbing over her 37-year-old brother, whose February 2002 overdose death haunts her still.
She had testified for the prosecution and said outside court that Knox turned her brother, a quadriplegic, into a man who could barely hold up his head.
"We thought Dr. Knox was a miracle worker for us," Akers said outside the courtroom. "And in the end, he didn't care."
Saturday, November 01, 2003
Jury finds pain specialist not guilty on many charges
Cecil Byron Knox still faces a potential life sentence in connection with a
By Jen McCaffery
A federal jury Friday found Roanoke pain specialist Cecil Byron Knox not
guilty on most of the drug charges he faced in connection with the
allegation that he prescribed narcotics outside the scope of legitimate
medical practice. The jury also exonerated Knox's office manager, Beverly
Gale Boone, of the drug distribution charges she faced.
The jury did not convict any of the defendents in the case.
The prosecution was one of an increasing number across the United States
that has pitted law enforcement officials against some members of the
medical community over the question of what constitutes the legitimate
prescription of narcotics such as OxyContin and who should be making that
At almost eight weeks - the longest trial in Western Virginia in decades
- it was also a case that raised questions about the validity of some of the
For example, Chief U.S. District Judge Samuel Wilson dismissed all
charges against one of the defendants, Kathleen O'Gee, before the defense
even started its case.
But federal prosecutors have already vowed to try Knox, Boone and
licensed professional counselor Willard Newbill James on the remaining
charges for which the jury could not reach a unanimous decision, they said
Friday. Most of those charges are racketeering, conspiracy and fraud
Knox also still faces a potential life sentence in connection with two
allegations that he prescribed painkillers outside the scope of legitimate
medical practice, which led to the death or serious injury of two people.
Those people include Monte Kidd, a Salem resident and Knox patient who
died in October 2001. Federal prosecutors argued that he died of an overdose
of painkillers that Knox prescribed.
Knox is also still accused of causing severe withdrawal symptoms
suffered by a baby born to a patient, Chris Ann Brown, who took medications
Knox had prescribed. Knox also still faces other drug distribution charges.
After the verdict, Knox, flanked by his wife, Donna, and son and
daughter, said he was grateful for the support he received.
But he added, "we still have a ways to go." He said he felt very
positive about the future, and that the first thing he planned to
concentrate on was getting his health back in order. Knox is in remission
from non-Hodgkin's lymphoma.
He also vowed, "I'm going to be back in practice."
But federal prosecutors, in telephone interviews after the verdict came
down, made a promise of their own Friday.
"We greatly appreciate the hard work of this jury and are disappointed
that they were not able to finish their work," said U.S. Attorney John
Brownlee. "But we will prosecute Cecil Knox for the racketeering, fraud and
remaining drug counts, as well as Ms. Boone and Mr. James."
Federal prosecutor Rusty Fitzgerald said in a separate interview that
"the jury's inability to resolve some of the counts is no indication of the
strength of the case or the brilliance of the defense attorneys. It's an
indication that this jury, with these instructions, just couldn't decide."
A juror in the case, who spoke on condition of anonymity in a telephone
interview, said the deliberations - which took about 5 1/2 days - were "long
and intense" because there was so much to consider. But, the juror said,
"overall, there just wasn't a whole lot of strong evidence either way. This
was a case with a lot of opinion."
They worked hard, the juror said, and even though they had differences
of opinion, they respected one another's views.
"Every single person really tried hard to come up with what they felt
was right," the juror said.
The juror said the decisions the 12-member jury made hinged mostly on
whether the defendants had the knowledge and the intent to commit crimes.
"I think the evidence acknowledged mistakes were made and there was some
carelessness," the juror said. "But to make the jump from that to that they
were criminal acts, there just was not strong evidence there."
With respect to office manager Boone, the juror said the jury members
agreed that she was not guilty of the drug charges she faced because "she
didn't write the prescriptions and she didn't personally give them drugs or
anything like that."
The juror also said the jury tried hard to look at the evidence
pertaining to each of the charges, and not what Knox might have done outside
of the charges that they might have considered inappropriate.
"If something didn't really apply to the charges specifically, we didn't
really consider it," the juror said.
Wednesday, October 22, 2003
Closing arguments in Knox case
What a long, strange trip it's been,' said one federal prosecutor in summarizing the trial
Defense attorney Tom Anderson said the trial has been a "complete character assassination" of the Roanoke doctor.
By JEN McCAFFERY
THE ROANOKE TIMES
Roanoke pain specialist Cecil Byron Knox showed "no remorse, no tears" for his dead patients.
Federal prosecutor Rusty Fitzgerald argued that point to a federal jury Tuesday in his closing argument. He likened the practice of medicine to a road bordered by a guardrail, one which Knox's medical treatment went outside, he said.
"He's driving past the guardrail into the deep weeds ... as a result of which, patients die," Fitzgerald argued.
But defense attorney Tony Anderson of Roanoke argued that some evidence presented against Knox at trial had nothing to do with the charges he faces.
"What you heard over the course of the last seven weeks has been complete character assassination of Dr. Knox," Anderson argued.
Knox and his office manager, Beverly Gale Boone, each face a mandatory minimum sentence of 20 years in connection with the 10 charges that the prescription of medication outside the scope of legitimate medical practice led to the death or serious injury of 10 people.
Roanoke attorney John Lichtenstein, who is representing Knox's practice, Southwest Virginia Physical Medicine and Rehabilitation, is expected to argue about alleged overdoses today. Defense attorneys for Knox's associates, Boone and counselor Willard Newbill James, are also expected to make their closing arguments today, and the case should go to the jury this afternoon.
As the trial wound down Tuesday, Fitzgerald invoked the Grateful Dead in the beginning of his closing argument, telling the jury, "what a long, strange trip it's been."
Though Fitzgerald presented much evidence to the contrary during the trial, he also argued that it wasn't Knox's ponytail and cowboy boots that meant he prescribed medicine outside the scope of legitimate medical practice. Rather, Fitzgerald argued, Knox had no scientific basis for the medical decisions he made.
"These patients were not fixing to die," Fitzgerald argued.
In a separate closing argument, federal prosecutor Pat Hogeboom argued that Knox's practice was a criminal operation.
"Beverly Boone was the person driving this ship financially," Hogeboom argued. He said the practice was struggling financially, and that the defendants in the case committed fraud to generate more money.
Hogeboom pointed out a performance review Boone submitted to Knox. In it, Boone wrote that she deserved a bonus for "quietly building the practice a small fortune" and managing it through several investigations and audits.
Hogeboom also showed e-mails between Boone and Knox's wife, Roanoke lawyer Donna Knox, that concerned the decision to tape record patients without their knowledge. He argued that the defendants tried to conceal their fraud.
Hogeboom also rejected the anticipated argument that practice members didn't know how to navigate the complex and ever-changing rules of health care billing.
"They knew the rules well enough to get payment," Hogeboom argued.
But Anderson argued that in May 2002, three months after Knox and his associates were arrested and his practice was shut down, the practice received a letter from the Center for Medicaid and Medicare Services.
The letter notified the practice that after a review of Knox's medical files, the federal health care program intended to place Knox in a pre-payment review plan. No mention was made of prosecuting anyone in the practice in connection with how the billing was done.
"It would appear from this exhibit that the right hand did not know what the left hand was doing," Anderson said.
He also argued that he had added up the total for the amount of alleged fraudulent billings the practice had submitted to health care programs and insurance companies. That total came to $5,032.85.
Anderson argued that federal prosecutors were using Knox's medical records both as evidence against him in his prescribing practices, and as evidence that he kept incriminating information out of the patient files.
After two raids on Knox's practice in 2001 and 2002 and one on his Roanoke County home, the defendants in the case knew they were under federal investigation, Anderson argued.
Pubdate: 17 Oct 2003
Source: Roanoke Times (VA)
Author: JEN McCAFFERY
Knox defends care of patients
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
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
"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 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
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
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
"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
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
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.
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
TRACY LYNN AKERS, 37, VINTON
Became a quadriplegic after a gunshot wound in 1982. Died Feb. 22,
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
SOURCES: court testimony, court documents, medical opinion of defense
expert witness Dr. Richard Bonfiglio of Pittsburgh.
Source: Roanoke Times (VA)
Author: JEN McCAFFERY
Thursday, October 16, 2003
OxyContin 'was a real godsend for chronic pain management,' Knox testifies
Knox takes stand and testifies in his own defense
It is likely that Cecil Byron Knox will testify about the overdose deaths of eight people and other medical issues in the case today.
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.
May be only place with talk of voodoo, dead rodent and pot Knox trial may be long,but it's been quite a ride An example of the trial's lighter moments is this tidbit: Beverly Douglas implied that she certainly would know the smell of pot because she's "from the '60s."
By JEN McCAFFERY THE ROANOKE TIMES
Six weeks is a long time. Particularly for the handful of former patients of Roanoke pain specialist Cecil Byron Knox, family members, federal agents and other spectators in the gallery at his federal court trial who don't get the cushy seats that the lawyers, jurors and judge do.
Nonetheless, the trial of Knox and his associates has contained elements that have made the time on the benches go a bit faster.
Was it voodoo?
The stuffed brown bear bearing a flag with the first name of federal prosecutor Rusty Fitzgerald made its appearance during the early weeks of the trial. It was seized during a raid at Knox's practice, Southwest Virginia Physical Medicine and Rehabilitation, in February 2002. Fitzgerald introduced the bear as evidence in the early weeks.
Fitzgerald questioned former practice employee Tiffany Durham about the stuffed animal, which also had pins sticking in it and a target drawn on its head. Durham testified that the daughter of another former employee of the practice wrote his name on the flag. (The daughter was not charged in the case.)
Chief U.S. District Judge Samuel Wilson interjected.
"You didn't think you were doing Mr. Fitzgerald any harm by sticking pins in the stuffed animal?"
Durham replied that she didn't think she was doing any harm. Fitzgerald was sick one day, but no link to the stuffed bear was ever established.
The squirrel carcass
Former practice employee Donna Stone first raised the specter of the dead squirrel in Knox's office. Durham later confirmed the report of the dead squirrel in Knox's office and elaborated on its demise.
She said she followed the smell to Knox's office, where the squirrel must have crawled up into one of the arms of a sweater that was lying on the couch.
Durham thought that at some point, someone must have mistakenly sat on the squirrel and squashed it. The squirrel remained in the sweater arm until Durham discovered it.
During a break in proceedings days later, lawyers from both sides of the case acknowledged that squatting squirrels are an underreported menace.
Several witnesses for the prosecution have testified that Knox smoked marijuana at the office with his patients.
When the defense began its case this week, Roanoke attorney Melissa Friedman asked Beverly Douglas, the wife of a former Knox patient, whether she ever smelled marijuana at Knox's office. Douglas said she didn't.
But before she could give that answer, prosecutor Fitzgerald objected, arguing that Friedman had not established that Beverly Douglas would know what marijuana smelled like. Beverly Douglas's reply?
"I'm from the '60s."
Judging from the laughter that followed, her credential seemed to satisfy the court.
Charges dismissed against Knox co-defendant
The Associated Press
A federal judge Thursday dismissed 10 more charges against Roanoke pain
specialist Cecil Byron Knox and two of his associates, a day after all the
charges were thrown out against a Pulaski contractor caught up in the
federal sting on Knox's Roanoke practice.
Chief U.S. District Judge Samuel Wilson's rulings Thursday were another
setback for prosecutors. But Wilson did not get rid of the most severe
charges in the indictment. Knox and his office manager, Beverly Gale Boone,
still face potential life sentences.
Prosecutors say Knox distributed OxyContin, Oxy IR, MS Contin, oxycodone,
methadone, morphine, Dexidrine and Ritalin for no legitimate medical
purpose, contributing to the death or serious injury of 10 patients. Knox
and the other defendants also face other charges, including conspiracy and
Attorneys for Knox have argued that the overdose deaths occurred more than a
year and a half after he stopped prescribing medicine to the patients.
Attorneys also argue that he and the other defendants did not intend to
perform criminal acts with reference to the racketeering, fraud and
Several of Knox's former patients testified for the defense Thursday. They
said he helped them with their medical problems.
Beverly Douglas, whose husband, Douglas, was a patient, testified that the
Knox "gave me back my husband instead of a person who lies in bed in pain
Wilson dismissed charges that Knox, 55, traded OxyContin pills to Edwin
Shomaker for marijuana on at least 10 occasions. Shomaker, who testified for
federal prosecutors, could not identify Knox either in the courtroom or from
Wilson also threw out racketeering and conspiracy charges against the third
defendant in the case, licensed professional counselor Willard Newbill
James, and judge dismissed eight counts related to allegations of kickback
arrangements with regard to reimbursement for services.
On Wednesday, Chief U.S. District Judge Samuel Wilson ruled Wednesday that
the prosecution did not present enough evidence against Kathleen O'Gee to
send the case to the jury. Defense attorneys argued the charges should be
dropped after the prosecution finished presenting its case Wednesday.
O'Gee, 55, said she believed she had been the target of two years of
intimidation by federal authorities. She had been charged with racketeering,
six health care fraud charges, conspiracy to commit racketeering, conspiracy
to violate general criminal statutes, three counts of mail fraud and three
counts of mail fraud using a kickback scheme.
"I'm happy that truth and justice came out of it," she said. "I think that
it's important to people when they're standing in the truth not to back
O'Gee provided a form of therapy, called craniosacral therapy, at Southwest
Virginia Physical Medicine and Rehabilitation that prosecutors argued had no
recognized medical value. They claimed federal health care and insurance
programs did not allow reimbursement for the treatment.
Information from: The Roanoke Times
Friday, Oct. 10, 2003
Judge clears Kathleen O'Gee
Woman in Knox trial cleared of all charges
In a major blow to the prosecution's case, a federal judge found that
there was insufficient evidence to prosecute Kathleen O'Gee.
By JEN McCAFFERY
THE ROANOKE TIMES
A federal judge dismissed all charges Wednesday against a Pulaski
woman who was indicted along with Roanoke pain specialist Cecil Byron
Knox and had been pressured by the U.S. attorney to plead guilty in
In a rare move of dismissing all counts against a defendant, Chief
U.S. District Judge Samuel Wilson ruled that federal prosecutors Rusty
Fitzgerald and Pat Hogeboom did not present sufficient evidence
Kathleen O'Gee to warrant sending the case to the jury. The
finished presenting its case Wednesday, and defense attorneys argued
that charges against their clients should be dropped.
Wilson also said he would rule this morning on other arguments in
the case - including that Knox and his office manager Beverly Gale
should not be held responsible for the overdose deaths of people for
whom Knox had not prescribed medication in more than a year and a
O'Gee said after the charges against her were dismissed that she
happy to see what she said were two years of intimidation by federal
authorities come to an end. She added that she planned to attend the
rest of the trial to support the remaining defendants in the case.
"I'm happy that truth and justice came out of it," O'Gee said. "I
think that it's important to people when they're standing in the truth
not to back down."
Fitzgerald and Hogeboom declined to comment after the charges were
O'Gee was implicated in connection with a form of therapy, called
craniosacral therapy, that she provided at Southwest Virginia Physical
Medicine and Rehabilitation. Federal prosecutors argued that the
therapy, gentle massage that targets the central nervous system, had
recognized medical utility and that federal health care and insurance
programs did not allow reimbursement for the treatment.
O'Gee, 55, a former flight attendant, was charged with
six health care fraud charges, conspiracy to commit racketeering,
conspiracy to violate general criminal statutes, three counts of mail
fraud and three counts of mail fraud using a kickback scheme.
O'Gee also described the case against Knox, Boone, counselor
Newbill James and herself as a political steppingstone for U.S.
"The government and some of these people who are in these
can't destroy innocent people's lives for their careers," O'Gee said.
O'Gee also said she understood why Tiffany Durham, her former
associate at Southwest Virginia Physical Medicine and Rehabilitation,
pleaded guilty in the case. She said she thought Durham decided to
cooperate with federal authorities because she has three children and
faced a serious prison sentence.
O'Gee, who said she lives alone, added that she never planned to
plead guilty. She said she had met with the federal prosecutors and
agents Gregg Wood and Robert Wardlow, and they tried to persuade her
plead guilty. She said she was told that they planned to convince the
jury that she had conspired with Knox and that she would go to prison
for the rest of her life.
Still, O'Gee said she never agreed to cooperate with federal
prosecutors and plead guilty. Nonetheless, in August, Brownlee
for the scheduling of her guilty plea on the federal court docket
with Durham's. O'Gee's attorney, Randy Cargill of Roanoke, had to
arrange for his client's guilty plea to be taken off the docket.
Wilson said he would rule this morning on motions by other defense
attorneys in the case to dismiss charges against their clients.
Defense attorneys have argued that their clients did not intend to
perform criminal acts with reference to the racketeering, fraud and
Roanoke attorney Melissa Friedman, who is representing Knox along
with Tony Anderson, also argued that in several of the cases in which
federal prosecutors say Knox and Boone were responsible for the
deaths, the patients had not received medication from Knox in more
And Roanoke attorney Greg Lyons, who is representing the practice
along with John Lichtenstein, said that several of the overdoses in
indictment are attributed to Knox's prescription of certain
But Lyons argued that in some cases, the allegations did not
with what toxicology reports found in their systems after their
The case continues at 8:30 a.m. today.
Thursday, October 02, 2003
Incongruity in documents puts witness' testimony in question during Knox
One expert's testimony may have less impact after the defense called into
question inconsistencies between his resume and school transcripts.
By JEN McCAFFERY
THE ROANOKE TIMES
You just don't know when those academic transcripts are going to come
back to haunt you.
An expert witness for the prosecution in the trial against Roanoke pain
specialist Cecil Byron Knox and three of his associates was forced Wednesday
to confront what one defense attorney argued were discrepancies concerning
his educational background, previous employment and military record.
George Alex's testimony was not the first time defense attorneys were
able to raise significant questions about a witness' credibility in the
Alex testified for federal prosecutors Rusty Fitzgerald and Pat Hogeboom
about coding for medical billing in the case against Knox and his
associates, Beverly Gale Boone, Willard Newbill James and Kathleen O'Gee.
Alex, 39, is managing partner of a Baltimore medical coding company called
Iatro . Three people work for the company, Alex said in an interview after
But on cross-examination, defense attorney David Damico raised questions
about inconsistencies between Alex's academic transcripts and one version of
Damico, who represents James, said after the court proceedings Wednesday
that the defense team had subpoenaed documents to verify that the
information on Alex's resumes was correct. He said they noticed some
discrepancies between the documents they had obtained and two versions of
"We felt that the jury should be aware of these discrepancies and his
explanation of them when judging his credibility as an expert witness,"
But Alex said in an interview after the court testimony that he attended
college roughly 20 years ago and that despite his poor academic record, he
became an expert in medical coding through on-the-job training. He added
that he is now an instructor at Johns Hopkins University School of Medicine.
He has also written about 20 books on medical coding, according to the
resume he submitted to the court.
The defense team got access to an earlier version of Alex's resume after
private investigator David Williams subpoenaed records from when Alex worked
as assistant director of faculty practice at Sinai Hospital in Baltimore.
That resume says Alex attended the University of Utah from 1984 to 1989
and that he was in the pre-medicine program.
But Alex's transcripts from the University of Utah showed that he took
classes in 1981, 1984 and 1985. He received no credit for the courses he
took, according to the transcript. Alex failed or withdrew from beginning
painting, basic drawing, health medical terminology, intermediate algebra
and human anatomy, according to the transcript.
That resume also says Alex attended the University of California at Los
Angeles. When Damico showed Alex a letter from UCLA that said the school had
no record that he had ever attended there, Alex said he took a
correspondence course there when he was in the Navy Reserves. The letter
does say that verification for correspondence courses should come from
another office at the university.
The question of Alex's military duty also arose. Damico questioned why
the resume Alex submitted as part of the court files in the Knox case said
that he served in the Navy as a Seabee , while military records showed he
had served in the Navy Reserves.
Damico also questioned Alex about the circumstances surrounding his
departure from Sinai Hospital in Baltimore in 1994. Alex testified that he
left on good terms.
Damico showed Alex documents that said Alex had been issued an oral
warning for falsifying timecards and that when he left, it was recommended
that he not be rehired.
But Alex testified that he continued to work as a consultant for the
Alex also testified that he was paid $175 for his work for federal
prosecutors, though he said he had not yet calculated the total hours he had
worked or submitted an invoice. He said the prosecution sent him 19 charts
to review in connection with what the prosecution has argued were unlawful
Alex testified that based on his review of the medical files, "the
practice was calling a zebra a horse."
The trial continues today.
24 Sep 2003
Source: Roanoke Times (VA)
Cross-examination sheds new light on charges against O'Gee
Testimony undermines 12 charges in Knox trial
Special agent Robert Wardlow acknowledged that in 12 fraud charges
against Kathleen O'Gee, patient files tell another story.
By JEN McCAFFERY
THE ROANOKE TIMES
The lead health care fraud agent admitted on the stand Tuesday that
12 of the allegations against one of the defendants in the federal case
against a Roanoke pain specialist and three of his associates did not
square with records in patient charts.
The testimony of special agent Robert Wardlow of the U.S. Department
of Health and Human Services marks another time in the trial that the
testimony of a witness for the prosecution has undermined charges
Under cross-examination by Roanoke attorney Randy Cargill, Wardlow
acknowledged that the charts of several patients contained notes about
their treatment that did not agree with some of the allegations federal
prosecutors Rusty Fitzgerald and Pat Hogeboom have leveled at Kathleen
O'Gee of Pulaski.
O'Gee, 55, has been charged in connection with the billing of an
alternative treatment she practiced from 1997 to 2002 at the Roanoke
practice of Dr. Cecil Byron Knox. Federal prosecutors have argued that
craniosacral therapy, a treatment of gentle massage that targets the
central nervous system, has no recognized medical utility and that
federal health care and insurance programs will not provide
reimbursement for the treatment.
Federal prosecutors have also used patients' medical files
extensively in the case as evidence that Knox, 54, routinely prescribed
painkillers such as OxyContin and methadone outside the scope of
legitimate medical practice.
O'Gee, along with Knox, and his practice's office manager, Beverly
Gale Boone, 44, and the practice itself - Southwest Virginia Physical
Medicine and Rehabilitation - face charges of defrauding Medicaid,
Medicare, and Trigon Blue Cross/Blue Shield. Federal prosecutors argue
they illegally billed the programs for craniosacral therapy.
The charges include specific occasions on which federal prosecutors
argue that the group defrauded the health care and insurance programs.
Federal prosecutors have alleged that the group defrauded the programs
But Wardlow acknowledged that on 12 of the instances O'Gee has been
charged with fraud, patient files say another practitioner performed the
The revelation also shows that at least four other people - Kimball
Egge, Greg Shaller, Diane Caldwell and Tim Rowe - also practiced
craniosacral therapy at Southwest Physical Medicine and Rehabilitation,
but they have not been charged in the case.
In addition to six health care fraud charges, O'Gee faces counts of
racketeering, conspiracy to commit racketeering, conspiracy to violate
general criminal statutes, three counts of mail fraud, and three counts
of mail fraud involving a kickback scheme.
Wardlow also acknowledged that Southwest Virginia Physical Medicine
and Rehabilitation was audited by Medicaid in 1997 and that the auditor
approved payment for craniosacral therapy, based on the information the
auditor was supplied by the practice. Hogeboom later pointed out that
Trigon has said it will not reimburse for craniosacral therapy.
Wardlow also acknowledged on cross-examination by David Damico, who
is representing counselor Willard Newbill "Bill" James in the case, that
some health care publications say it is appropriate to bill for all
physical therapies provided under one code.
The prosecution hit its first roadblock in the first week of the
case, when the first witness Fitzgerald called, Edwin Shomaker, could
not identify Knox either in the courtroom or in a photograph. One of the
charges against Knox is that he traded Shomaker OxyContin for marijuana.
The trial continues today and is expected to last another four and a
25 Sep 2003
Source: Roanoke Times (VA)
All 3 have been convicted of crimes that stem from abuse of prescription
Ex-patients of Dr. Knox testify they lied to him
One man testified that Dr. Cecil Byron Knox traded prescriptions of
OxyContin for an antique radio and for a wine rack.
By JEN McCAFFERY
THE ROANOKE TIMES
Todd Richardson didn't tell the truth to Roanoke pain specialist Dr.
Cecil Byron Knox when he said he was in pain and always seemed to run
out of his OxyContin weeks early.
Bobby Lee Dalton injected OxyContin in the sole of his foot so no
track marks would be visible in a typical medical exam.
And Tony Chrisley lied when he told Knox that he was a U.S. Marine
when the embassy fell in Saigon during the Vietnam War.
"It was a good way to get in good with him," testified Chrisley.
The three men testified this week at the federal trial of Knox and
three of his associates at Southwest Physical Medicine and
Rehabilitation in Roanoke.
What they have in common is that they were all at one time Knox's
patients , and they are all from Pulaski County, where a significant
proportion of Knox's patients came from.
Richardson, Dalton and Chrisley were part of a loosely knit network
of patients - which in some cases involved several family members - who
sometimes even carpooled together to appointments at Knox's office.
But all three men have also been convicted in connection with crimes
that stemmed from their admitted abuse of prescription drugs. Some
testified that Knox 's patients traded pills and crushed, snorted and
injected them together.
A Pulaski restaurant, Tom's Drive-In , was known for being a place
to get OxyContin, Dalton testified. Law enforcement authorities searched
the drive-in in connection with that allegation in January 2002.
And two of the men whose names came up often in discussions about
Knox 's patients in Pulaski County, Donald Boyer and Junior Boyd, are
dead. Federal prosecutors have attributed their deaths to Knox's
prescribing OxyContin outside the scope of legitimate medical practice.
Two pharmacists in Pulaski County have also testified that they were
concerned about Knox's prescription of powerful painkillers such as
OxyContin and methadone. One testified that he mailed a newspaper
account of a large prescription drug bust to Knox's office.
Another pharmacist testified that he stopped filling prescriptions
for Knox 's patients based on their disheveled appearance and because
they would sometimes pay for prescriptions with up to $1,400 in cash.
But even though some of Knox's former patients testified that the
painkillers Knox prescribed harmed their faculties - Chrisley testified
OxyContin left him "in a stupor" - they also showed a certain
resourcefulness when it came to getting the drug.
Chrisley testified that he was caught in both Maryland and North
Carolina trying to get OxyContin at pharmacies he had heard filled
prescriptions without asking questions. Paul Cole, another former Knox
patient from Pulaski County, testified that he would drive down to North
Carolina to buy $10,000 to $15,000 worth of OxyContin at a time.
Some of the former Knox patients also testified that they did not
become Knox 's patients through traditional referrals.
Dalton, whose brother-in-law Boyer died in May 2000, also said that
he was not referred to Knox by another doctor.
"I had heard about him through my brother-in-law," Dalton said. "He
talked to Knox and got me in."
Dalton also testified that on two occasions, Knox traded
prescriptions of OxyContin for an antique radio and for a wine rack.
Dalton said Knox asked him how much he wanted, then said of the wine
rack, "If you bring it down, I'll make it right with you."
When Dalton gave Knox the wine rack, Knox gave him a prescription
for 90 80-milligram pills of OxyContin, Dalton testified.
"He asked me would that be suitable enough" referring to the
prescription, Dalton testified. "And I said yes."
Dalton also testified that Knox exchanged marijuana for OxyContin
But Chrisley, Dalton and Richardson each testified that Knox tried
to either change their medicine or cut them off completely when he
learned they were abusing their painkillers.
And defense attorneys questioned their testimony, detailing their
convictions and the lies they admitted they told Knox.
21 Sep 2003
Source: Roanoke Times (VA)
Case shows atypical practice run by atypical pain doctor
According to testimony at his trial, Cecil Byron Knox did not run your
usual doctor's office.
By JEN McCAFFERY
THE ROANOKE TIMES
Maybe it was the wooden throne, the whispers about the dead squirrel
under the couch, or the story that those noises in the basement were
courtesy of beings known only as Beetle and Spider.
There's no argument that Roanoke pain specialist Cecil Byron Knox's
practice, Southwest Virginia Physical Medicine and Rehabilitation, was
not the typical doctor's office.
The one thing federal prosecutors and defense attorneys in the case
against Knox and three of his associates at the practice do seem to
agree about is that Cecil Byron Knox was not a typical doctor.
The trial, which continues Monday, is focused in part on what went
on in the converted home, teal with purple trim, at 1130 Second Street
Donna Stone, a former employee of the practice, testified for the
prosecution last week that the office was a cluttered place where
patients' files were sometimes stacked in piles around, on top of, or
under Knox's stately throne. Or they were impossible to find because
Knox had taken them out to his truck or home. She also testified that
Knox smoked marijuana with his patients.
Stone said other things also concerned her about the practice.
Patients used to whisper that there was a dead squirrel under the
couch in Knox's office, Stone testified. Stone also asked questions
about noises she heard in the basement of the practice. Other employees
told her that people named Beetle and Spider were living there.
But Stone said office manager Beverly Boone, who is also facing
federal charges, did not appreciate her questions.
"Bev would tell me I need to learn to ignore things," Stone
Defense attorneys pointed out that Stone worked at the practice for
only about two months in 1999 and that she was fired, according to court
John Lichtenstein, who is representing the practice, described
Southwest Physical Medicine and Rehabilitation as a "house of healing"
in his opening statement. Knox's office was the "knot at the end of the
rope " for chronic pain sufferers who had already been through the
medical wringer, Lichtenstein argued.
"All of the sudden, many of the people who had no hope began to feel
like a human being," Lichtenstein said. Defense attorneys have estimated
Knox has treated more than 2,000 patients since he opened his practice.
The office seems to have been a reflection of Knox's personality.
Knox's defense attorney, Tony Anderson, has described as him as
"contrarian" who became a "thorn in the side" of benefit programs to get
what he thought was right for his patients.
"Dr. Knox became one of the strongest patient advocates that any
patient could have," Anderson argued.
Knox was born in west Texas, Anderson said. His father was the only
doctor in an 80-mile radius, and Knox would travel with his father to
Knox eventually graduated from the University of Texas with a degree
in engineering. He brought that mechanical point of view to his medical
practice later, designing braces for patients, Anderson said.
During his medical training in Boston, Knox met the woman who would
become his wife, Donna Knox. They discovered that they each had
relatives who had been prisoners of war.
Concern for veterans was important to Knox. After he opened his
practice, veterans were treated with special respect at Southwest
Virginia Physical Medicine and Rehabilitation, Anderson said. Former
employees have testified that even if there was a roomful of patients
who had waited for hours to see Knox, the rule was that veterans always
got to see him first.
When Knox first came to Roanoke, he worked for Lewis-Gale Medical
Center. His unconventional long ponytail and cowboy boots stood out in
the medical community, Anderson said. Then in the mid-1990s, Knox opened
Southwest Physical Medicine and Rehabilitation.
Another former employee of the practice, Cindy Conner , also
testified last week that she was concerned with some of the
responsibilities that were expected of her at the practice.
Conner was asked to fill out prescriptions for patients based on
previous dosages found in the medical files. Knox would then check over
the prescriptions and sign them, Conner said.
But Conner said she was never trained on how to write prescriptions.
Sometimes she made mistakes and ordered prescriptions filled early or in
the wrong amounts, Conner testified. When she made mistakes, Tiffany
Durham, Knox's medical assistant, would sometimes yell at her, Conner
Conner said she could recall only one time when Knox handed her a
prescription that was blank, except for his signature. She testified
that she did not feel comfortable filling out the dosage with Knox's
signature already on the prescription.
She said she ripped the prescription up.