John Simon: St. Louis jury sends $17.6 million message in opioid abuse verdict

By Tony Messenger St. Louis Post-Dispatch, Jun 28, 2016:  http://www.stltoday.com/news/local/columns/tony-messenger/messenger-st-louis-jury-sends-million-message-in-opioid-abuse/article_b7628f83-0e94-5bc7-a2a8-38a12ab6d7d6.html

The court documents will say that Brian and Michelle Koon won their medical malpractice lawsuit against Dr. Henry D. Walden and St. Louis University.

But the trial before Circuit Court Judge Michael Noble that ended late Tuesday afternoon was about something much bigger than one doctor making a mistake, or the health care system he works for failing to monitor the drugs he delivered to his patients.

For seven days, the nation’s opioid-abuse epidemic was on trial.

Opioids lost.

After hearing evidence that Brian Koon, a city parks employee, had been prescribed more than 37,000 pain pills between 2008 and 2012 at levels far above those recommended by the Centers for Disease Control and Prevention and other experts, a jury of eight women and four men awarded $1.4 million to Koon and an additional $1.2 million for his wife.

“Send a message from coast to coast that this is not going to happen anymore,” pleaded attorney Tim Cronin, before the jury deliberated on punitive damages. Cronin and John Simon of the Simon Law Firm represented the Koons in the lawsuit filed two years ago.

By that time, Brian Koon had already left Walden’s care. The 45-year-old mechanical maintenance worker had gone to see Walden, his primary care doctor at SLU Care, for back pain. Almost immediately, Koon found himself on an ever increasing dose of opioids, highly addictive pain medications that some experts have blamed for the rise in heroin use across the nation.

At one time, he was taking three different kinds of the narcotics prescribed by Walden: Oxycontin, Vicodin and oxycodone. He became addicted and eventually ended up in a drug rehab center. In the two years since the lawsuit was filed, Koon has tried to repair his relationship with his wife and daughter, which had been severely damaged by depression and other side effects brought on by his massive drug regimen.

The couple are in the process of a divorce. The estrangement during the time that Koon was in a “zombie-like” state, as one relative testified, was too much to take.

“Conduct like this is what destroys families,” Cronin argued.

The jury agreed.

It awarded $15 million in punitive damages against Walden and his employer.

Michelle Koon, standing next to her husband in the back row of the courtroom in the Carnahan Courthouse, wept as the verdict was read. She embraced one of the attorneys helping in the case and grasped Brian’s hand.

The couple declined to comment after the verdict.

Simon said he hopes the message has been sent.

Opioids, which have been dangerously overprescribed in the U.S. medical system for more than a decade, should be monitored more carefully by doctors, particularly primary care doctors who are prescribing the pills for simple maladies such as back pain.

“I would hope that the verdict brings attention to this problem,” Simon said.

It’s a problem that wasn’t in dispute in the trial. Everybody agrees there’s an opioid epidemic, including Walden’s attorney, Paul Venker, and all of the expert witnesses who testified in the trial.

More than one of them noted that opioid prescriptions are harder to track in Missouri, as it is the only state in the nation without a prescription drug monitoring database.

But when it comes time to assign blame for what happened to the Koons, and who caused the nation’s epidemic, the fingers pointed in multiple directions.

“Dr. Walden is nothing like the pill-pushing doctors” who define the opioid epidemic, Venker argued to the jury. “That’s somewhere else.”

The numbers, though, told a different story.

From 2008 to 2012, Koon’s average daily dose of morphine-equivalent milligrams of opioid medication rose from 49 a day to 1,555 a day. The most recently released CDC guidelines, produced as a result of an epidemic claiming more than 50 lives a day, call for no more than an average daily dose of 100 milligrams of morphine-equivalent opioid.

An expert witness for the Koons, Dr. Paul Genecin, director of Yale Health, called the doses “colossal and reckless.”

Those numbers weren’t in dispute in the trial. For the most part, neither was the fact that anything over 100 milligrams per day gets into dangerous territory.

A key piece of evidence in the case was a letter written to the Federal Drug Administration in 2012 by the Physicians for Responsible Opioid Prescribing. The letter was signed by Dr. Erik Gunderson, one of the expert witnesses for the defense.

“Unfortunately, many clinicians are under the false impression that chronic opioid therapy is an evidence-based treatment for chronic non-cancer pain and that dose-related toxicities can be avoided by slow upward titration. These misperceptions lead to over-prescribing and high dose prescribing,” the letter read.

The arguments in the letter could have come directly out of Cronin’s opening and closing arguments.

“Our country is in the middle of an opioid addiction epidemic,” the attorney said in his opening statements. He spouted off the numbers that are becoming well-known to anybody who has received a large bottle of powerful pain pills or noticed changes in a spouse after taking opioids for a period of time:

• More than 165,000 deaths since 1999.
• 19,000 deaths a year from opioid overdoses.
• 1 in 32 people prescribed more than a daily average of 200 morphine-equivalent milligrams will die.

“This is a doctor problem,” Cronin said. “The problem starts with the doctor, and we have to do something to end it.”