A California appeals court upheld a lower court ruling that Johnson & Johnson should pay state fines for deceptively marketing pelvic mesh implants to women, but reduced the amount by $42 million to $302 million.

Johnson & Johnson had appealed in 2020 after Superior Court Judge Eddie Sturgeon imposed the $344 million in penalties against Ethicon, a subsidiary of Johnson & Johnson.

Sturgeon discovered after a trial without a jury that the company had made misleading and potentially damaging statements in hundreds of thousands of advertisements and educational brochures over nearly two decades.

California’s Fourth District Court of Appeals on Monday ruled that $42 million in penalties imposed for the company’s sales pitches to doctors were unjustified because there was no evidence that sales reps had actually said.

But the appeals court said Sturgeon received ample evidence that Ethicon knowingly misled doctors and patients about the risks posed by its products, the San Francisco Chronicle reported.

Ryan Carbain, a spokesman for Johnson & Johnson, told the Chronicle the company will appeal the appeals court ruling to the state Supreme Court.

The instructions for use of all of the company’s pelvic mesh implant packaging “false or omit the full range, severity, duration and cause of complications associated with Ethicon’s pelvic mesh products, as well as the ‘potential irreversibility and catastrophic consequences,’ said presiding judge Judith. McConnell of the appeals court said in a 3-0 decision upholding the $302 million penalty.

She rejected the company’s claim that the fine was excessive, saying it represented less than 1% of Johnson & Johnson’s net worth of $70.4 billion.

The products, also called transvaginal mesh, are synthetic and surgically implanted into the vagina of women whose pelvic organs have collapsed or who have suffered from stress urinary incontinence when coughing, sneezing or lifting heavy objects.

Many women have sued the New Jersey-based company, alleging the mesh caused severe pain, bleeding, infection, discomfort during sex, and the need for removal surgery.

The condition is estimated to affect 3% to 17% of women and sometimes becomes severe after age 70.

Johnson & Johnson, the world’s largest maker of health care products, is challenging other lawsuits over drug side effects, its role in the US opioid epidemic and claims that its baby powder reportedly caused cancer in some users.

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