Roanoke pain specialist's trial likely to focus on scope of legitimate
medical practices Depending on one's perspective, Dr. Cecil Knox's
practice was either a haven for patients no one else would treat or an
efficient drug-distribution operation.

A Vietnam veteran who overdosed on methadone. A longtime community
leader who died with OxyContin in her system. A baby girl born
suffering from drug withdrawal.

These are just a handful of the people federal prosecutors will claim
were victims of Roanoke pain specialist Dr. Cecil Byron Knox and his
office manager, Beverly Gale Boone. Knox and Boone are scheduled to be
tried, along with two of their colleagues and the medical practice
itself, starting Monday in federal court in Roanoke.

Depending on one's perspective, Knox's practice, Southwest Virginia
Physical Medicine and Rehabilitation, was either a haven for patients
no one else would treat or an efficient drug-distribution operation.

Selected jurors will spend much of at least the next six weeks hearing
evidence from both sides on that question. It could mean the
difference between life in prison or freedom for Knox and Boone.

Since federal authorities went public with their investigation of
Knox's office in June 2001, the path to trial has been marked by
questions of whether federal prosecutors were controlling the case and
whether Knox would be able to stand trial at all. After Knox was
diagnosed with lymphoma, Chief U.S. District Judge Samuel Wilson
postponed the first trial date.

But Knox, 54, is now in remission and able to help with his own
defense. Much of the trial will likely center on the question of pain
management and whether Knox went outside the scope of legitimate
medical practices with his prescriptions of powerful painkillers such
as OxyContin and methadone.

Federal prosecutors Rusty Fitzgerald and Pat Hogeboom have
characterized Knox's practice as a criminal enterprise, a place where
fraud was prevalent and prescriptions were doled out freely, even
through a side door. They argue that, in at least 10 cases, those
prescriptions led to death or serious injury of Knox's patients.

Defense attorneys in the case are expected to present evidence from
experts who will testify that Knox's prescriptions did not violate
medical standards. Most of his patients suffered from "serious,
life-altering, often debilitating pain," according to the opinion of
one of the defense expert witnesses, Dr. Richard Bonfiglio of
Pittsburgh. He also found that Knox had established procedures to
monitor his patients' prescriptions.

Bonfiglio also expressed the opinion that there was a limit to Knox's
responsibility for his patients' actions.

"Despite any doctor's best efforts, there is nothing that will
absolutely prevent or detect a patient's lying, attempting forgery, or
misdirecting medications," Bonfiglio said, according to court documents.

Michael Troyer, president of the National Chronic Pain Outreach
Association, an advocacy group in Millboro, Va., for people who suffer
chronic pain, said he had been watching developments in the Knox case
closely.

"The last thing we need to be doing is persecuting physicians who are
willing to take these risks for those that the entire rest of the
medical community has shunned," Troyer said. He estimated that about
four to five million Americans suffer from "intractable pain," and
added that the medical community has only in recent years tried to
start addressing chronic pain management.

According to court documents, the medical histories of Knox's patients
that are likely to be examined at trial show that collectively their
lives have been a painful litany of car accidents, workplace injuries,
multiple surgeries and addictions.

Those patients will likely include Michael Lee March of Moneta,
according to court documents. An Army veteran who won a Silver Star in
Vietnam, March was 53 and had a wife and eight children when he died
on Jan. 8, 2001, according to his obituary. His widow, Kristi March,
filed a lawsuit against Knox in 2002, alleging that her husband
overdosed on methadone prescribed by Knox.

The story of Lin Edlich will also likely be part of the trial,
according to court documents. Edlich, who in 1976 co-founded VA CARES
, a program to help prisoners adjust to life after incarceration, was
also a patient of Knox's, according to court documents.

Edlich, 54, was found dead in her Smith Mountain Lake home in July
2001. Her ex-husband, TAP president Ted Edlich, told The Roanoke Times
later that year that a toxicology report said her death was caused by
an overdose of OxyContin.

The effects of Knox's prescriptions may have also reached a generation
beyond his immediate patients, according to court documents. A baby
girl born to one of Knox's patients tested positive for opiate drugs
and suffered life-threatening withdrawal symptoms, according to a
summary of testimony from Roanoke neonatologist Robert Wilson Allen
Jr. that was part of court documents.

The newborn had to stay in the hospital for three weeks and needed
morphine to control her withdrawal symptoms, according to the summary.

Knox's former medical assistant, Tiffany Durham, 29, did not dispute
that she told Knox she was concerned that some of his patients were
abusing or reselling some of the narcotics he prescribed for them.
Durham was also charged in the case and is the only defendant so far
to have pleaded guilty to federal charges . Her attorney, Jeff Dorsey,
has said he expected Durham would be called to testify against her
former boss.

The case has also been characterized by intermittent concern about the
number of charges against the defendants. After federal prosecutors
returned to a grand jury in October 2002 and came back with 250 more
charges in the case, Judge Wilson questioned whether the adversaries
in the case were "on a level playing field" or whether the prosecution
was "driving the ship."

Under a plea agreement with the prosecution, Durham pleaded guilty
Aug. 21 to two felony counts of knowledge that a felony was going on
and not letting law enforcement authorities know about it.

Before her plea, Durham, who operated the prescription refill hotline
at the practice, also faced dozens of charges that she assisted in the
distribution of narcotics outside the scope of medical practice that
in at least 10 cases resulted in death or serious injury. If Durham
had been convicted of any of those counts, she would have faced a
mandatory sentence of 20 years in prison.

Federal prosecutors have also leveled racketeering and a variety of
fraud charges against Knox, Boone and the three other defendants in
the case - Willard Newbill James, Kathleen O'Gee and the practice,
Southwest Virginia Physical Medicine and Rehabilitation. James and
O'Gee were not employees at Knox's clinic, but they worked out of the
same building.

James, 58, is a licensed counselor and O'Gee, 54, practiced a
treatment called craniosacral therapy. Prosecutors argue that the
method is not recognized by the medical establishment and thus not
eligible for health care reimbursement claims.

Essentially, federal prosecutors say Knox, Boone, James and O'Gee
cheated the health care programs Medicaid, Medicare, Trigon and
TRICARE, a program for veterans. They argue that the office submitted
claims for reimbursement for services that were more expensive than
the ones that were actually performed, which is known as "upcoding."

The defendants hid that they were billing for O'Gee's alternative
therapy, craniosacral therapy, federal prosecutors say, because the
claims were submitted under Knox's name. And they also charge that
James and O'Gee paid Knox and Boone kickbacks for patient referrals.

David Damico, who is representing James, said Knox's office handled
the billing for his client.

"I think the evidence is going to show that there were some technical
errors in a very complicated area," Damico said. "But the evidence is
going to be clear that he [James] didn't do anything wrong and made no
effort to misrepresent what he was doing."

Randy Cargill, who is representing O'Gee, also said that his client
was not involved with the billing to the health care programs. Cargill
did say that when O'Gee testified before the grand jury, federal
prosecutors told her that what the practice was doing in terms of
health care billing was wrong.

But O'Gee went back to Southwest Physical Medicine and Rehabilitation
and continued to work. Soon after, she was indicted on federal charges.

"She suffered a grave consequence for not following their advice,"
Cargill said. "Advice, by the way, that I'm not even sure is correct."