Experts: Drugs May Have Caused 8 Deaths

FORENSIC EXPERTS TESTIFY IN KNOX CASE

Defense Attorneys Have Argued That Knox Cannot Be Held Responsible for
Patients Who Did Not Take Medications As Directed.

Forensic experts testified Thursday in federal court that eight former
patients of Roanoke pain specialist Cecil Byron Knox died because of
large concentrations of drugs in their systems.

Roanoke Assistant Chief Medical Examiner William Massello said at the
trial of Knox and three of his associates that former community
activist Lin Edlich, former welder Edgar O'Brien, and former Wythe
County resident Eben Earhart died as a result of the drugs they had
taken.

Federal prosecutors Rusty Fitzgerald and Pat Hogeboom have argued that
Knox and his office manager, Beverly Gale Boone, are responsible for
the death of eight of Knox's patients. Meanwhile, defense attorneys
have argued that Knox cannot be held responsible for patients who did
not take medications as prescribed.

Massello addressed only three of the cases in court Thursday. Forensic
pathologist James Kuhlman addressed some of the other cases.

Massello testified that Edlich, who had been severely wounded in an
attack about six months before her death, died from the mixture of
drugs in her system. Edlich, 54, died July 15, 2001, at her Smith
Mountain Lake home in Bedford County. Edlich was co-founder of VA
CARES, a program to help people adjust to life after prison.

"Several drugs, all of which in combination, brought about this
woman's death," Massello said. He also testified that Edlich had a
history of drug abuse.

Edlich's autopsy showed she had the painkillers hydrocodone and
OxyContin as well as the antidepressant medication Zoloft in her
system. But in the case of Earhart, who was 48 when he died Jan. 10,
2002, a high dosage of OxyContin was the cause of death, Massello said.

"He died from the respiratory paralysis that this drug can cause,"
Massello said.

Former Roanoke resident Edgar O'Brien was 40 when he died May 25,
2002. Massello said O'Brien was a long-term abuser of intravenous
drugs. His autopsy showed that O'Brien had morphine, the painkillers
OxyContin, hydrocodone and methadone, along with the tranquilizer
Valium in his system.

O'Brien also had cocaine in his system, Massello said. He also had
injection marks on his arms that were fresh enough to suggest that the
morphine in O'Brien's system could have resulted from the
decomposition of heroin he injected.

The drug amounts were such that each one alone could have caused
O'Brien's death, Massello testified. Altogether, they overwhelmed him,
Massello said.

But on cross-examination by Roanoke attorney John Lichtenstein, who is
representing Knox's practice, Southwest Virginia Physical Medicine and
Rehabilitation, Massello agreed that people develop tolerances to
medications.

In some cases, a concentration of methadone that might cause the
overdose of a person who ingested the opiate for the first time, would
not prove fatal to a longtime user , Massello agreed.

And Massello also did not dispute that any level of cocaine can kill a
person, and that it could have been that factor alone that led to
O'Brien's death.

Earlier in the day, Kuhlman testified that five other Knox patients -
Michael Debusk, Monte Kidd, Michael March, John Tisdale and Donald
Boyer - each also died with an amount of drugs in their systems that
could be considered fatal.

Debusk, Boyer and Tisdale had large concentrations of methadone in
their systems, while March and Kidd had large concentrations of
morphine in their systems.

The trial continues today and is expected to last about four more
weeks.