Jury Holds St. Louis Doctor and University Liable for Opioid Overprescribing, Judgment Stands at $16.74 Million

In June 2016, a St. Louis City jury found that a primary care physician and his employer, Saint Louis University, negligently escalated opioid prescriptions to a patient with chronic back pain, and awarded the patient and his wife compensatory damages plus $15 million in punitive damages. After the jury's fault finding against the patient was applied, the judgment stood at about $16.74 million.

Brian Koon worked for the City of St. Louis as a parks employee and mechanical maintenance worker. He went to Dr. Henry Walden at SLU Care for back pain. According to the Missouri Court of Appeals, Walden started him on hydrocodone in February 2008. By March 2008 Koon was telling the doctor he was taking twice the amount prescribed. Oxycontin was added by February 2009, while the hydrocodone continued, even though Walden knew that combining oxycontin with other opioids raises the risk of respiratory depression.

Over about four years, Koon was prescribed more than 37,000 pills, including Oxycontin, Vicodin and oxycodone. His daily dose, measured in morphine equivalents, climbed from 49 milligrams to 1,555 milligrams, many times the 100 milligram ceiling the Centers for Disease Control and Prevention advises. He became severely addicted. The addiction brought depression and strained his relationships with his wife and daughter, and by the time of trial the couple was divorcing.

Koon and his wife, Michelle, sued Walden and Saint Louis University. John Simon and Timothy Cronin of The Simon Law Firm tried the case before Judge Michael Noble. The plaintiffs argued that Walden skipped proper risk assessments, documented his discussions poorly, raised doses without reassessing benefits and risks, and brushed past warning signs: early refill requests, rising doses, and Koon's own statement that he needed help.

The jury returned its verdict on June 28, 2016. It awarded $1.4 million to Brian Koon and $1.2 million to Michelle Koon, and $15 million in punitive damages against Walden and the university. The jury also assigned 33 percent of the fault to Koon, which reduced the compensatory awards to $938,000 for him and $804,000 for her. Cronin told the Post-Dispatch that 'conduct like this is what destroys families.'

The defendants appealed, challenging the denial of a mistrial during jury selection, evidentiary rulings, the punitive damages instruction, and whether the claim had been properly submitted to the jury. On October 24, 2017, the Eastern District of the Missouri Court of Appeals affirmed on every point. Rehearing and transfer to the Missouri Supreme Court were denied on December 19, 2017.