BOSTON, Mass. — "He knew right away it was us."
That was the testimony Friday by the one-time national sales director for the now-defunct New England Compounding Center.
Referring to his boss, Barry J. Cadden, Ron Ronzio told jurors that as soon as they got word on Sept. 21, 2012, that a patient at the Saint Thomas Outpatient Neurosurgical Center in Nashville, Tenn., was ill after being injected with an NECC steroid, Mr. Cadden knew his company was to blame.
Mr. Ronzio, who was testifying under the terms of a plea agreement, delivered the most damaging testimony yet in a trial that is nearing its 40th day. Mr. Cadden has been charged with racketeering and 25 counts of second-degree murder. Mr. Ronzio pleaded guilty late last year to a single count of conspiring to defraud the federal government.
The charges against Mr. Cadden and 13 others stem from a lengthy grand jury investigation of the 2012 fungal meningitis outbreak that sickened 778 patients, killing 76 of them. State and federal regulators have concluded the outbreak was caused by fungus-riddled spinal steroids shipped from NECC's Framingham, Mass., facility.
Under questioning for more than 3 hours by Assistant U.S. Attorney George Varghese, Mr. Ronzio also detailed, through a series of emails, how NECC, under Mr. Cadden's direction, dodged and darted to get around state laws and regulations requiring patient-specific prescriptions for all the drugs they were selling.
In states like Colorado and Oregon where regulators were closing in, Mr. Cadden instructed his sales staffers to "just walk away. We have nothing to gain and we have a lot to lose."
In testimony about the outbreak itself, Mr. Ronzio recalled Mr. Cadden was in Boston for a hearing on an unrelated matter when he got word that NECC was being forced to surrender its pharmacy license.
"It's over," Mr. Ronzio quoted Mr. Cadden as saying.
Mr. Ronzio said the statement shocked him because he had been led to believe that NECC did extensive product testing and held drugs for 2 weeks to ensure that they were not contaminated.
"It can't be us," Mr. Ronzio said was his first reaction at the time.
Mr. Ronzio also recalled that Mr. Cadden said, "Oh no," when he got word on Sept. 25, 2012, from a sales representative that an Indiana clinic was complaining about seeing a foreign object in a vial of NECC's methylprednisolone acetate.
Mr. Ronzio said until the pharmacy license was actually surrendered, NECC continued shipping other drugs even as they were voluntarily recalling the preservative-free methylprednisolone acetate. A recall of all of NECC's products was later issued.
Much of Ronzio's testimony related to skirmishes with state regulators over a requirement that individual prescriptions had to be written for each patient receiving NECC products.
He described a process called "backfilling" in which clinics and other customers would provide the names of previous patients for subsequent orders to make it appear that the requirement was being met. He said some customers, especially hospitals, resisted providing names and Mr. Cadden authorized exemptions for customers with substantial orders, like Partners, the Boston health conglomerate, which he called "our stable."
Mr. Roche, a former reporter for the Baltimore Sun and Nashville Tennessean, is covering the NECC trial in Boston for Outpatient Surgery.