JURY TO BEGIN DELIBERATIONS TODAY

Lawyers present closing arguments in Knox prescription drug case. A prosecutor
described Cecil Byron Knox's practice as "eccentric." A defense attorney said
Knox was the "knot in the rope" for patients.

Years from now, will Roanoke pain specialist Cecil Byron Knox be considered a
pioneer in the practice of pain management, or will the Roanoke County man be
serving time for the overdoses of his patients?

Those are two of the scenarios lawyers presented to a federal jury
Wednesday as closing arguments in the seven-week trial wound down. The
jury is expected to begin deliberations in the case today.

Knox is one of an increasing number of doctors around the nation who
have been charged in connection with their prescription of painkillers
such as OxyContin. The debate over what constitutes effective pain
management is playing out both locally in federal court and nationally.

Last month, an advisory panel for the Food and Drug Administration
voted against imposing restrictions on the prescription of OxyContin,
according to the American Medical Association. Some lawmakers and the
Drug Enforcement Administration had supported the restrictions, the
AMA reported.

Knox's prescriptions were "good medicine," argued Roanoke attorney
John Lichtenstein. The 31 patients federal prosecutors Rusty
Fitzgerald and Pat Hogeboom focused on in the indictment were the
"hardest patients" in the more than 1,700 patients Knox treated,
Lichtenstein argued.

"If you don't treat that patient's pain, it fuels their drug-seeking,"
Lichtenstein said. He argued that if Knox were a doctor who just wrote
prescriptions indiscriminately, some of his former patients would not
have testified that they knew they had to lie about their pain to get
prescriptions from Knox.

Lichtenstein pointed out that one of the prosecution's witnesses, Dr.
Richard Wilson, testified that a medium dosage of OxyContin is 360
milligrams a day. By comparison, the criminal allegations against Knox
include many dosages of 120 milligrams and 240 milligrams,
Lichtenstein argued.

The prosecution did not prove that Knox's prescription resulted in the
death or serious injury of 10 of his patients, Lichtenstein argued.
Both Knox, 54, and his office manager, Beverly Gale Boone, 44, face a
potential life sentence on each of the 10 overdose charges.

Lichtenstein argued that Knox was the "knot in the rope" for many of
his patients.

But on his rebuttal, prosecutor Fitzgerald placed blame for the
overdose deaths squarely on Knox and Boone.

"There's no reason why the knot at the end of that rope had to be a
noose," Fitzgerald argued.

Fitzgerald described Knox's practice as "eccentric," a place of "drug
experimentation on unwitting human subjects who did not consent to
it."

Roanoke attorney William Cleaveland, who is representing Boone, also
reiterated his earlier argument that the case "was about OxyContin
from day one." He argued that the prosecution could point to no
intentional criminal activity on Boone's part.

"No patient, not one, said she did any nursing," Cleaveland
argued.

Cleaveland argued that practice employees did their best to keep up
with changing health care regulations.

"Every mistake that's made does not constitute a crime," he argued. He
added that the practice had even repeatedly returned money to Medicare
after the health care program had sent too much money to the practice.

But Fitzgerald countered that the case was not just about OxyContin;
it also involved other painkillers and fraud allegations. He added
that former practice employees Tiffany Durham and Heather Basham had
testified that Boone knew everything about what went on at the practice.

"She was trusted with the most delicate decisions and actions this
corporation made," Fitzgerald argued. "She was absolutely the tip of
the pyramid. Even Cecil Knox said that."

Roanoke attorney David Damico, who is representing licensed
professional counselor Willard Newbill James, pointed out that federal
judge Samuel Wilson already dropped racketeering and conspiracy counts
against his client.

He argued that James may have made mistakes but did not intend to
cheat health care and insurance programs.

"These people had no reason to think they were doing anything wrong,"
Damico argued. James did not try to hide his clinic notes when they
were submitted for reimbursement, and he did not take care of billing.

But Fitzgerald countered that James "got tired of not being paid,"
when he had his own practice before going to work as an independent
contractor for Knox. "He wanted the money."

As in the case of Knox and Boone, Fitzgerald argued that James was
"willfully blind" to evidence that the practice might be doing
something wrong in the way they billed his services.

Several defense attorneys advised the jury to consider what they
argued was the background to former practice employee Durham's
testimony. They said that Durham only agreed to plead guilty after her
lawyer told her criminal activity was going on at the practice. She
has three small children and was facing a mandatory minimum sentence
of 20 years.