Opinion ID: 2978563
Heading Depth: 6
Heading Rank: 2

Heading: Blair Knight

Text: As with Lancaster, there is no evidence that a prescription written by Martinez directly caused Knight’s death, but there is sufficient circumstantial evidence to allow a rational jury to conclude that Martinez proximately caused his death. Before his death, Knight was Martinez’s patient for sixteen months, and evidence supports a conclusion that Martinez fraudulently treated Knight in a manner similar to that of other patients. Evidence at trial demonstrated that, over the course of Knight’s treatment by Martinez, Knight’s health deteriorated such that he was bloated, unresponsive, and immobile. As with Lancaster, there were “red flags” that Martinez’s treatment was enabling and exacerbating Knight’s addiction to controlled substances. There were notes in Knight’s charts indicating that Martinez’s staff was aware of Knight’s addiction and that Knight’s treatment was harming him, including notes that his speech was “slurred and slow,” that Knight had trouble walking due to the lack of feeling in his leg, and that he was failing to follow the doctor’s prescribing orders. A January 3, 2001, letter in Knight’s patient file indicated that Knight was being treated at a drug rehabilitation facility. Moreover, an August 29, 2000, note in Knight’s patient chart stated that Knight was taking “double the number” of OxyContin pills that Martinez prescribed, and that his speech was “slurred and slow”––indicating overuse of the drug. (JA 1446-47, 3625.) And, as with Lancaster and Martinez’s other patients, there is no indication that Martinez provided individualized treatment or appropriately responded to these red flags but, instead, continued to provide Knight with prescriptions and injections. During the two weeks preceding Knight’s death, he twice visited Martinez in extreme pain. Knight was so bloated that he could not wear socks or shoes and was covered in a red rash. Nonetheless, Martinez’s office notes show that Knight received the “standard treatment,” and the notes contain the same generic statements indicating that all was going well. There is no evidence that Martinez altered his treatment of Knight even though these were indications of drug misuse. Knight died of a drug Nos. 06-3882/4206 United States v. Martinez Page 26 overdose on the same day as his last visit with Martinez. Toxicology reports indicate that Knight overdosed on OxyContin pills from an unknown source, as well as hydrocodone and Valium. The jury heard evidence that when Knight was transported to the hospital, he had green-colored medicine in his mouth and nose, and that OxyContin tablets are green or bluish green. During that last office visit, Martinez prescribed OxyContin and Endodan, and pharmacy records show that Martinez was the only doctor who prescribed OxyContin to Knight shortly before his death. There is no definitive evidence that Martinez prescribed the drugs in Knight’s system at the time of his death. Nonetheless, there is sufficient evidence that Martinez’s overall course of treatment proximately caused Knight’s death. Dr. Kennedy testified that Martinez’s entire course of treatment of Knight “contributed largely” to Knight’s death. The jury heard evidence that Knight became addicted to narcotics as a result of Martinez’s fraudulent prescriptions and injections. Dr. Kennedy suggested that Martinez should have monitored Knight’s addiction and provided him with medication only under the supervision of an addiction specialist. He also testified that Martinez continued to feed Knight’s addiction in order to get Knight to “come in and get [billable] procedures.” (JA 1457.) Similarly, Dr. Parran testified that “any reasonable physician should [have known] that this patient has an addiction problem” and should have known that continued prescriptions would create a risk of overdose. (JA 2118-19.) Based on this evidence, a reasonable jury could have inferred that Martinez furthered Knight’s addiction to advance his fraudulent billing scheme and that Knight’s subsequent misuse of prescribed substances was a foreseeable result of that addiction. Viewing the evidence in the light most favorable to the Government, a rational jury could have concluded that Knight’s overdose was the reasonably foreseeable result of Martinez’s conduct.