CHARLESTON – The program director for Huntington's Quick Response Team and Cabell EMS employee testified during the first federal trial against the “Big Three” opioid distributors over their role in the drug crisis that Cabell County does have data tying prescription drug use to illegal drug use, and to an "overwhelming" impact of the drug crisis on the community and first responders.
Meanwhile, the drug distributors – McKesson, AmerisourceBergen and Cardinal Health – sought to put the focus on the role of prescribers, as well as health officials' decision not to go after distributors earlier.
The City of Huntington and Cabell County sued the distributors in 2017 over their role in the overdose crisis, after more than 80 million doses of the drugs were sent to the area in an eight-year period.
Quezon
Thursday, the fourth day in the bench trial in Senior Judge David Faber’s courtroom in Charleston, plaintiffs called Connie Priddy, the program director for Huntington's Quick Response Team and director of quality compliance for Cabell EMS, to testify. The QRT visits people up to three days after they've overdosed and encourages treatment, or directs them to harm reduction services if they decline.
Amy Quezon, plaintiffs' lawyer, asked what Priddy observed, as the director of quality compliance, about the effect of the number of overdose calls in the county on first responders.
Priddy said first responders, her field crew, made statements like “I feel angry and I don’t know why.”
She recounted a particularly devastating incident in 2017, when Sierra Burgess drove while intoxicated by opioids and wrecked, resulting in the deaths of two of her three children in the vehicle.
After her daughter asked first responders for “sissy,” responders searched the area for hours until they saw a tuft of blonde hair in the wreckage.
The responders “broke down. “They were all in tears,” Priddy said.
Cabell County began a “critical incident stress management team” and began promoting more mental health treatment.
Healthcare providers, political leaders and others met to form solutions.
“As we talked, we realized this is overwhelming our community,” Priddy said. “It's overwhelming our resources. We have got to look for answers."
Under cross-examination from Laura Wu, representing McKesson, Priddy recounted a previous statement she made, that she was no longer hearing of a lack of treatment beds, in a deposition last summer. Wu also had Priddy confirm she had given patients opioids in her capacity as a nurse, that paramedic protocols direct opioids to be used in certain situations, and that illegal drugs are also problems in Cabell County.
"And you're not aware of any data on the percentage of people using illegal drugs in Cabell County, who started with illegal prescription medication for an opioid, correct?" Wu said.
"Am I aware of any data that is out there?" Priddy said.
"That's correct, in Cabell County."
"Yes," Priddy responded.
"You are aware of data specific to Cabell County, which identifies the prescription drug history for individuals currently using illicit heroin or fentanyl?"
"Yes," Priddy said.
Wu asked for the source.
"The Cabell-Huntington Health Department, through their harm reduction program, they actually interview the individuals that come in there for their harm reduction program," Priddy said.
Defendants have argued that plaintiffs can't prove a linkage or transition between prescription painkiller authorized use and illegal drug use.
Priddy said along with an effort “to help the helpers" by referring them to mental health treatment, they also started the QRT in December of 2017, which she said led to a decline in overdoses due to the personal connections established with survivors.
Survivors were grateful someone cared, she said, although the cost of treatment precluded some from seeking it. About 30 percent of people they reach go into treatment, she said.
“What makes it work is it’s going to people where they are," she said.
Quezon also asked Priddy if there is a "typical" patient. Priddy said while the average person is 37 and more likely to be male than female, there is no "typical" patient.
“Our teams will tell you they sit on a dirt floor with a mattress and they sit in mansions," she said.
Priddy said that program's grant funding had ended, but in-kind contributions have paid for salaries. Plaintiffs are seeking $2.6 billion from defendants for a $2.6 billion abatement plan, which would include funding for the team.
"We need reliable, sustainable funding," she said.
She said they'd like to create a follow-up team and help people with substance use disorder with other aspects of their health care needs.
Dr. Rahul Gupta, who testified Wednesday, was under cross-examination Thursday. Gupta was the West Virginia health officer and commissioner of the Bureau for Public Health from 2015-2018.
Previously, plaintiffs had asked him about his work with DHHR analyzing overdose deaths in 2018, when he found people who overdosed had previous interactions with the healthcare system. Defendants have pointed to other entities contributing to the epidemic.
On Thursday, Timothy Hester, representing McKesson, focused on the role of doctors, who prescribed the painkillers, and also sought to bring attention to the role of illegal drugs and misuse in the crisis by pointing to DHHR's own statistics.
Gupta added that there are "good doctors and bad doctors" as well as "pill mills." At one point, he mentioned pill mills out of state.
"So it needs to be a multi-state process to deal with the issues of the opioid crisis?" Hester asked.
"It is certainly a national crisis, as we've discussed, West Virginia's at ground zero," Gupta said.
The case technically is part of multi-district litigation.
Hester pointed Gupta to statements from the federal Centers for Disease Control and Prevention and West Virginia Board of Medicine saying the choice to begin clinical opioid therapy is a shared decision between clinician and patient. Gupta had signed the 2017 Board of Medicine statement.
The Board of Medicine statement also described a shift to heroin in 2012 and again in 2014 to fentanyl. Defendants noted that the fentanyl was illegally sourced.
“And the fentanyl is, typically the illicit fentanyl in the country now is typically sourced out of China and illegally smuggled to the US. Is that your understanding?” Hester asked.
“My understanding is there are four nations that are responsible for fentanyl in this country,” Gupta responded.
Defendants pointed out that the statements didn't say opioid therapy should be reserved for acute care, meaning short-term. Gupta added that other factors should be considered and clinicians should rule out other treatments first.
Defendants have argued that West Virginia had pre-existing conditions predisposing it to opioid misuse. Gupta added Thursday that characteristics like age or conditions like diabetes or obesity don’t automatically equal a need for pain treatment.
“It’s not just obesity,” he said. “It’s the consequences of obesity.”
Hester also pointed Gupta to a line in a West Virginia Department of Health and Human Resources report that said the common risk factor for new Hepatitis B and C cases was injection use. In seeking to make the case that painkillers caused a public nuisance for the area, plaintiffs have included high Hepatitis B and C rates as part of that nuisance.
Gretchen Callas, representing AmerisourceBergen, asked Gupta about the Board of Pharmacy's controlled substance monitoring system, pointing out that only certain groups of people could access information like the distributors who were shipping the most painkillers.
Faber, though, asks who could make complaints about something like suspicious activity at a pharmacy down the street. Anyone can do so anonymously, Gupta said.
The defense also referenced previous arguments over whether Gupta could speak about the gateway theory,” or the transition from painkillers to illegal drugs, saying he is a hybrid opinion witness limited to speaking to his involvement in events giving rise to the litigation. Faber said the plaintiffs could not pursue that line of questioning.
Priddy is expected to return Friday, along with Jan Rader, Huntington’s fire chief.
Huntington is represented by Anne Kearse, Joseph Rice, Linda Singer and David Ackerman of Motley Rice and Rusty Webb of Webb Law Centre. Cabell County is represented by Paul Farrell Jr. of Farrell Law, Anthony Majestro of Powell & Majestro and Michael Woelfel of Woelfel & Woelfel.
AmerisourceBergen is represented by Gretchen Callas of Jackson Kelly and Robert Nicholas and Shannon McClure of Reed Smith. Cardinal Health is represented by Enu Mainigi, F. Lane Heard III and Ashley Hardin of Williams & Connolly. McKesson is represented by Mark Lynch, Christian Pistilli, Laura Wu and Megan Crowley of Covington & Burling.
U.S. District Court for the Southern District of West Virginia case numbers 3:17-cv-01362 (Huntington) and 3:17-cv-01665 (Cabell)
