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

Johnson & Johnson appealed in 2020 after Superior Court Judge Eddie Sturgeon assessed a $344 million fine by its subsidiary Ethicon.

Sturgeon found after a non-jury trial that the company made misleading and potentially harmful statements in hundreds of thousands of advertisements and instructional manuals over nearly two decades.

California’s Fourth District Court of Appeals issued a ruling Monday that found the company’s $42 million fine for pitching to doctors was unreasonable because there was no evidence of what the sales reps actually said.

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

Johnson & Johnson spokesman Ryan Carbain told the Chronicle that the company will appeal the appeals court decision to the state Supreme Court.

Instructions for use on all of the company’s pelvic mesh implant packaging “falsify or omit the full scope, severity, duration, and cause of complications associated with Ethicon pelvic mesh products, as well as their potential irreversible and catastrophic consequences,” the chief said. Justice Judith McConnell of the Court of Appeals said in a 3-0 ruling that the $302 million fine was upheld.

She dismissed the company’s claims that the fine was excessive, saying the fine was less than 1 percent of Johnson & Johnson’s $70.4 billion net worth.

These products, also known as transvaginal meshes, are synthetic and surgically inserted into the vagina of women who have sagging pelvic organs or who experience stress incontinence when coughing, sneezing or lifting heavy objects.

Many women have sued the New Jersey-based company, claiming the mesh can cause severe pain, bleeding, infection, discomfort during intercourse and the need for surgery to remove it.

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 wellness products, is pursuing other lawsuits over drug side effects, its role in the U.S. opioid epidemic and allegations that its baby powder caused cancer in some users.