STORM'S EYE Anesthesiologist John Culclasure, MD, was the medical director and chief physician at the Saint Thomas Outpatient Neurosurgical Center in Nashville, Tenn.

BOSTON, Mass. — A pain management physician who suddenly found himself in the midst of a growing public health crisis broke down in tears yesterday as he told a jury about his first encounter with patients who had been sickened from contaminated steroid injections he administered.

Testifying in U.S. District Court, anesthesiologist John Culclasure, MD, said he and his colleagues had expected the patients to be angry and blame them for the fungal meningitis from which they were suffering.

"Instead they were concerned about us. I was shocked," said Dr. Culclasure.

U.S. District Judge Richard G. Stearns called a short recess as Dr. Culclasure wiped tears from his eyes.

Dr. Culclasure was the medical director and chief physician at the Saint Thomas Outpatient Neurosurgical Center in Nashville, Tenn., the pain clinic where 115 patients were sickened after being injected with fungus-laden spinal steroids shipped from a now-defunct Massachusetts drug compounder.

The testimony came at the beginning of the second week in the criminal trial of pharmacist Barry J. Cadden, the president and part-owner of the New England Compounding Center, the company blamed for the 2012 outbreak that sickened some 778 patients, killing 76 of them. Mr. Cadden is facing charges of racketeering and 25 counts of second-degree murder.

Dr. Culclasure said that 13 patients from the Nashville clinic eventually died. He described the first hints of the outbreak, including the news that a patient was under treatment for a fungal infection at the nearby Vanderbilt University Medical Center.

"I was trying to see what was common among the victims," said Dr. Culclasure. He said in addition to the methylprednisolone acetate from NECC, patients were treated with a numbing agent and a dye before the spinal injection.

Dr. Culclasure said they closed the pain center and then started calling all the patients recently injected to see if they were showing symptoms of meningitis.

"The patients kept coming," he said. "It didn't make sense to me. I've never seen anything like that in all my years of training."

Though at first there was concern that something at the clinic was to blame, he said he cleared the clinic when outbreak cases began popping up across the country. That left the NECC steroid as the common denominator.

Once Dr. Culclasure identified victims, he said he put them on powerful anti-fungal medications that were extremely toxic. "The cure was almost as bad as the disease itself."

Dr. Culclasure said that as the enormity of the outbreak became more apparent, Tennessee Department of Health officials stepped in and began directing the efforts. He said those state officials directed his staff not to use the word meningitis in talking with patients.

Under cross examination, Bruce Singal, Mr. Cadden's attorney, questioned Dr. Culclasure about the clinic's decision to purchase drugs from NECC.

Asked if NECC filled an important need, Dr. Culclasure said yes. He said the clinic began sending NECC lists of patients after the company told them they were needed due to a Massachusetts law. But he acknowledged they couldn't really identify which patients would be injected ahead of time.

Court records show the Nashville clinic reached a settlement in a civil suit brought by outbreak patients, but the terms of that settlement have not been made public.

Walter F. Roche, Jr.

Mr. Roche, a former reporter for the Baltimore Sun and Nashville Tennessean, is covering the NECC trial in Boston for Outpatient Surgery.