In early 2020, a pharmacist at the Biddeford Walmart refused to fill a man’s oxycodone prescription for dental pain.

She was concerned by his history with substance use disorder after he mentioned he was in recovery. And the prescription appeared outside the usual scope of the woman who had written it – Dr. Merideth Norris, an osteopath in Kennebunk.

The pharmacist, Lori McKeown, was one of the first people to testify in Norris’ two-week trial Monday in U.S. District Court in Portland. The doctor is now facing 16 counts of illegal distribution of controlled substances for writing prescriptions that go beyond what prosecutors say is medically necessary.

The federal government’s case against Norris focuses on five patients, whose names are being withheld in court and who will not testify. They include the man McKeown described, whom lawyers referred to as “Patient Two.”

“I was concerned for his safety,” McKeown testified. She said she refused to fill the man’s prescription again a year and a half later.

Prosecutors have alleged Norris was writing life-threatening combinations of opioids, sedatives and stimulants to vulnerable patients in the throes of addictions.

They said in opening arguments Monday that Norris “was drug dealing with a prescription pad” and ignored several warning signs over the years, including when McKeown had filled out a form for a blanket refusal against all of Norris’ prescriptions at the Biddeford Walmart. And later, the entire company issued a central block, barring any of its stores from filling her prescriptions. Norris had also received several letters of concern from an insurance company that reviews claims from pharmacists.

Norris has pleaded not guilty to the charges. Her lawyers have argued the government’s case ignores the complexities of Norris’ large patient base – including patients whom she inherited from other doctors and were already on incredibly high opioid doses before coming to her practice. Norris also treated many patients with substance use disorder and was the medical director of a methadone clinic.

Her lawyers also said that the prosecution has failed to offer any alleged motive.

“Why would Dr. Merideth Norris commit these crimes?” asked her attorney Timothy Zerillo. “If I go out and rob a bank, maybe I need some money. If I shoot my sworn enemy dead, maybe my motive is revenge. What does Dr. Norris get out of this?”

Prosecutors say they plan to call on federal agents who built the case. They’ll also call on others who raised concerns about Norris’ prescriptions, as well as an expert whom prosecutors hired to review Norris’ patient records.

According to court records, the defense plans to question may of the agents who were involved in Norris’ cases. They’ll also call witnesses of their own, including other doctors and medical professionals who know Norris.

Some medical professionals, who aren’t involved in Norris’ case, have raised concerns that her prosecution could deter other doctors from taking on patients with complicated health histories.

BUILDING THE CASE

Much of Monday’s testimony focused on Walmart’s block – Russell Baer from Walmart Global Investigations testified that the company has blocked 47 prescribers in Maine, or 0.3% of all the people who have written prescriptions for Walmart stores in the state – and how the company’s decision led to the federal government’s involvement.

Norris’ attorneys disagreed that Walmart’s decision to block her prescriptions showed any criminal doing. They said Walmart’s review was based exclusively on data and didn’t take into account patients’ substance use histories, social histories or their “barriers to treatment.”

“Your evaluation of that data is done without the medical training and (experience) that my client has,” Zerillo said.

He also suggested Walmart’s practice goes beyond what’s legally and medically required, and instead focuses on keeping the company safe from any liability. Zerillo pointed to a multistate, billion-dollar settlement Walmart reached in 2022 for over-dispensing pain medication. The company’s “opioid stewardship initiative” was formed around the same time.

OVERSIGHT 

The sides were most at odds Monday when it came to the entity charged with overseeing Norris’ work.

To prescribe controlled substances, Norris had to register with the U.S. Drug Enforcement Administration.

Assistant U.S. Attorney Thomas Campbell said opioids and other controlled substances can have legitimate medical purposes, even though they’re “among the most addictive and dangerous drugs that can be prescribed.”

Norris violated the law, Campbell argued, because her prescriptions fall “outside the usual course of professional practice” and “without a legitimate medical purpose.”

“She was not practicing medicine,” he said. “She was illegally distributing narcotics.”

But the state body tasked with Norris’ oversight actually dismissed a complaint against her prescribing habits before the federal government announced its charges.

The Maine Osteopathic Board of Licensure, made up of physicians and physicians’ assistants, reviewed files from six of Norris’ patients after learning that Walmart was blocking her.

In a public meeting before agreeing to dismiss the complaint, the board thanked Norris for her work and found she hadn’t done anything wrong.

Norris’ attorneys raised concerns before the trial that the federal government ignored the state board’s findings. They asked U.S. District Judge Nancy Torresen this year to throw out all of the state’s evidence, saying it was seized using a search warrant that mischaracterized the board’s work.

Torresen agreed federal investigators acted with “reckless disregard for the truth,” but she declined to throw anything out because she believed the government had sufficient evidence to establish probable cause.

The board’s decision appears to mean little to federal investigators, who have pointed out the board has fewer resources and only reviewed a smaller portion of records.

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