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Commonwealth v. Paolino12/2/2003
prescribed OxyContin on the first visit in the dose of 240 milligrams per day. And it is my opinion within a reasonable medical certainty, because of the dose, because of the significant history of the recurrent severe alcohol abuse, that the combination of alcohol and OxyContin is an important and significant finding and that leads me to state that the combination can cause from both of those drugs, alcohol and OxyContin, respiratory depression which would jeopardize the health, welfare and safety and even life of this patient.
And it is my opinion that that is a deviation from the standards of medical practice that would be seen by the responsible segment of physicians, and the deviation from that standard is a gross deviation and in my opinion it is reckless negligence.
N.T., 4/9/02, at 65-68.
As to Jennifer Smith:
Q. Doctor, again given your examination of this file, given your expertise, did you make a determination concerning the prescribing that was being done here to a reasonable medial certainty, did you make a determination as to whether the defendant, Richard Paolino, deviated from medically accepted treatment principles that would be expected from a responsible segment of physicians in the community?
MR. GRAHAM: Objection.
THE COURT: Overruled.
THE WITNESS: Yes, I have.
BY MR. GAMBARDELLA:
Q. What is that opinion, sir?
A. In my opinion within a reasonable medical certainty, Dr. Paolino prescribed a Schedule II narcotic, OxyContin, to a patient who was an opioid-naïve patient, had not taken these drugs before, to a female where we would expect a 25 percent higher drug level of the drug compared to males, in addition to another central nervous system depressant, Valium, for the diagnosis that she had damaged her low-back and without any prior medical records in the chart, without any x-rays of the back, either old or new. The doctor prescribed these medications on one occasion a week earlier when the patient came back requesting a re-fill.
And in my opinion there's nothing on this chart that justifies the prescribing of this potent but good analgesic but without justification. We don't even know what damage was done. That was the patient's report. She had damage. I don't know whether - there's nothing on the report that says what the damage was from what I could read. It said damage to the low-back. And without justification, these are strong - this OxyContin is a very strong drug to start off with when a lesser potency drug could be given and then on examination of the patient could be titrated up to higher doses or higher types of drugs, such as OxyContin.
But the doctor started out with a blast of the OxyContin as the first drug he prescribed.
He did this knowingly and willingly.
MR. GRAHAM: Objection.
Objection, your Honor.
THE COURT: Sustained. That you can't possibly know, Doctor, and the jury will disregard any characterizations about the state of mind of the defendant in connection with the treatment of this individual.
BY MR. GAMBARDELLA:
Q. Let me ask you this, Doctor. If you find it to be a deviation, to what extent do you find it to be a deviation?
MR. GRAHAM: Objection.
THE COURT: Overruled.
THE WITNESS: In my opinion I feel this is a deviation from the standard of medical care practiced by the responsible segment of physicians, and by the types of medication and examination or lack of examination that this is not only a deviation but it's a gross deviation from the accepted standards of medical pra
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