Transcript of the Testimony of Franchell Richard Hamilton, MD

Transcription

1 Transcript of the Testimony of Franchell Richard Hamilton, MD Date: July 20, 2015 Case: Gamaliel Mejia v. Dufek Massif Hospital Kim Tindall and Associates, LLC Phone: Fax: Internet:

2 lectronically signed by Lei Sherra Torrence ( ) Franchell Richard Hamilton, MD July 20, 2015 CAUSE NO. DC GAMALIEL MEJIA, ) IN THE DISTRICT COURT INDIVIDUALLY, AND AS ) REPRESENTATIVE OF THE ) ESTATE OF FRANCES MEJIA; ) FRANK VASQUEZ AND MARY ) JANE VASQUEZ; ) Plaintiffs, ) ) VS. ) DALLAS COUNTY, TEXAS ) DUFEK MASSIF HOSPITAL ) CORPORATION D/B/A ) UNIVERSITY GENERAL ) HOSPITAL DALLAS; JOSEPH A. ) BIANCO, D.O.; JOSEPH A. ) BIANCO, D.O., P.A., ) FRANCHELL RICHARD ) HAMILTON, M.D.; COVENANT ) SURGERY ASSOCIATES, ) P.L.L.C.; AND TONIKA ) Page 1 COLLINS; ) Defendants. ) 116TH JUDICIAL DISTRICT ORAL AND VIDEOTAPED DEPOSITION OF FRANCHELL RICHARD HAMILTON, M.D. JULY 20, 2015 VOLUME I ORAL AND VIDEOTAPED DEPOSITION OF FRANCHELL RICHARD HAMILTON, M.D., produced as a witness at the instance of the PLAINTIFFS, and duly sworn, was taken in the above-styled and numbered cause on July 20, 2015, from 10:09 a.m. to 4:31 p.m., before

3 lectronically signed by Lei Sherra Torrence ( ) Franchell Richard Hamilton, MD July 20, 2015 Page 2 1 Lei Sherra Torrence, CSR in and for the State of Texas, 2 reported by machine shorthand, at the law offices of 3 Schell Cooley, LLP, North Dallas Parkway, Suite 4 550, Dallas, Texas, pursuant to the Texas Rules of Civil 5 Procedure and the provisions stated on the record or 6 attached hereto Page 3 1 A P P E A R A N C E S 2 COUNSEL FOR THE PLAINTIFFS: 3 Mr. Michael Sawicki Mr. Andrew Jones 4 SAWICKI LAW 4040 North Central Expressway 5 Suite 850 Dallas, Texas (214) (214) (fax) 7 Msawicki@sawickilawfirm.com Ajones@sawickilawfirm.com 8 COUNSEL FOR THE DEFENDANT: (FRANCHELL RICHARD HAMILTON, 9 MD, AND COVENANT) 10 Mr. Timothy Ryan SCHELL COOLEY, LLP North Dallas Parkway Suite Addison, Texas (214) Tryan@schellcooley.com 14 COUNSEL FOR THE DEFENDANT: (JOSEPH BIANCO, MD, BIANCO, DO, PA) 15 Mr. Russell Thornton 16 THIEBAUD REMINGTON THORNTON BAILEY, LLP 4849 Greenville Avenue 17 Suite 1150 Dallas, Texas (214) (214) (fax) 19 Rthornton@trtblaw.com Page 4 1 COUNSEL FOR THE DEFENDANT: (UNIVERSITY GENERAL HOSPITAL DALLAS, TONIKA COLLINS) 2 Mr. Eric Hines 3 LAW OFFICES OF BRIAN J. JUDIS Plazas of the Americas, North Tower North Pearl Street Suite Dallas, Texas (214) (214) (fax) Eric.hines@cna.com 7 THE VIDEOGRAPHER: 8 Mr. Dennis Livingston INDEX 2 PAGE 3 Appearances FRANCHELL RICHARD HAMILTON, M.D. Examination by Mr. Sawicki Examination by Mr. Hines Examination by Mr. Ryan Reexamination by Mr. Sawicki Reexamination by Mr. Ryan Signature and Changes Reporter's Certificate EXHIBITS 11 NUMBER DESCRIPTION PAGE 12 1 Physicians Orders Responses To Request For Production From Darrin Dest Agreement For Physician Services 99 5 UGH Dallas Medical Staff Rules and 15 Regulations June 2014 General Call Calendar Phone Record Call Log for Answering Service Handwritten Notes Nurses Narrative Discharge Summary Norcal Mutual Insurance Company 19 Packet Page 5 2 (Pages 2 to 5)

4 Page 6 1 THE VIDEOGRAPHER: Good morning. Today's 2 date is July 20th, The time is approximately 3 10:09 a.m. Here present for the video deposition of 4 Franchell Richard Hamilton, MD. Will counsel please 5 introduce themselves and whom they represent? 6 MR. SAWICKI: Michael Sawicki and Andy Jones 7 on behalf of the Mejias. 8 MR. RYAN: Tim Ryan here on behalf of 9 Dr. Richard Hamilton and Covenant. 10 MR. HINES: Eric Hines on behalf of UGH 11 Dallas and Ms. Collins. 12 MR. THORNTON: Russ Thornton on behalf of 13 Dr. Bianco and his professional association. 14 THE VIDEOGRAPHER: The witness may now be 15 sworn in. 16 FRANCHELL RICHARD HAMILTON, MD, 17 having been first duly sworn, testified as follows: 18 EXAMINATION 19 BY MR. SAWICKI: 20 Q. Good morning, Doctor. Can you tell us your full 21 name, please. 22 A. Franchell Richard Hamilton. 23 Q. And how do you prefer to be referred to? 24 A. Hamilton. Dr. Hamilton, that's fine. 25 Q. Dr. Hamilton. Dr. Hamilton, my name is Mike Page 8 1 A. Oh, yes, I have performed those within the last 2 two years, yes. 3 Q. When you perform that procedure, is it something 4 you normally involve the right hepatic artery in? 5 A. No. 6 Q. And when you normally perform the laparoscopic 7 cholecystectomy, do you typically have the right hepatic 8 artery left bleeding after the procedure? 9 A. No. 10 Q. When you do the procedure, would you agree with 11 me that you do not leave the right hepatic artery 12 bleeding after doing a laparoscopic cholecystectomy? 13 A. I would agree with that. 14 Q. Is that something if you were to leave it 15 bleeding, would that represent a risk to the -- to the 16 livelihood or the health of the patient? 17 A. Yes. 18 Q. Is that something that's a new part of science or 19 medicine, or is that something that's been known for 20 some time? 21 A. That has been known. 22 Q. Would you agree with me that a surgeon performing 23 a laparoscopic cholecystectomy should stop any kind of 24 unintended bleeding after the procedure is finished? 25 A. I would agree. Page 7 1 Sawicki. I'm here to ask you some questions. You 2 understand that, correct? 3 A. Yes. 4 Q. I want to talk a little bit about some terms to 5 make sure I'm using them correctly so that you 6 understand as well, okay? 7 A. Okay. 8 Q. And first term I've seen in this case is 9 laparoscopic -- laparoscopic -- I knew I was going to 10 blow it. Laparoscopic cholecystectomy, do you know what 11 that term is? 12 A. Yes, sir. 13 Q. Have you performed that kind of procedure 14 yourself? 15 A. Yes. 16 Q. The second term of art is hepatic artery. Do you 17 know what is? 18 A. Yes. 19 Q. And with respect to laparoscopic cholecystectomy, 20 have you performed them, say, within the last two years? 21 A. No. 22 Q. When was the last time you performed one? 23 A. A hepatic artery or a laparoscopic 24 cholecystectomy? 25 Q. Laparoscopic cholecystectomy. Page 9 1 Q. Would you agree with me that if that's not done, 2 it poses a risk of harm to the patient? 3 A. I would agree. 4 Q. And that's something that -- that you knew and 5 other doctors would know; is that true? 6 MR. RYAN: Form. 7 A. Yes. 8 Q. (BY MR. SAWICKI) Is that something that is new 9 science or new medicine or something that's been known 10 for a long time? 11 A. That's been known. 12 Q. Would you agree with me in general -- you're a 13 surgeon, correct? 14 A. Yes. 15 Q. Would you agree with me, in general, reasonable 16 and prudent surgeons should know that uncontrolled 17 bleeding after a procedure represents a serious danger 18 to the patient's safety? 19 A. I would agree. 20 Q. Is there ever a time in your understanding of 21 performing a laparoscopic cholecystectomy where it's 22 appropriate to leave the hepatic artery bleeding for 23 some reason? 24 A. No. 25 Q. Is there any other artery or structure within the 3 (Pages 6 to 9) lectronically signed by Lei Sherra Torrence ( )

5 Page 10 1 body that it's appropriate to leave bleeding after a 2 laparoscopic cholecystectomy? 3 A. No, not that I can think of. 4 Q. Okay. Now, in this case with Mrs. Mejia, you 5 understand that a laparoscopic cholecystectomy was what 6 was performed on her initially, correct? 7 A. That's what I was told. 8 Q. And that was performed by Dr. Bianco, is that 9 your understanding? 10 A. Yes. 11 Q. And that was done at University General Hospital, 12 is that your understanding? 13 A. Yes. 14 Q. Now, in this case, if I've read your answers to 15 some of the discovery and -- and the legal pleadings 16 correctly, is it your position that Mrs. Mejia -- you 17 understand who she is, correct? 18 A. Yes. 19 Q. Is it your position that you were never 20 responsible for her care? 21 A. That is my understanding. 22 Q. Okay. And was it your position that the 23 individuals at the hospital had no authority or right or 24 power to assign her to your care? 25 MR. HINES: Object to form. Page 12 1 assume the responsibility of taking care of her. 2 Q. And why wasn't it in her best interest for you to 3 assume responsibility? 4 A. There were several reasons why I felt like this 5 patient -- because I felt like that. One was my 6 personal situation, and the other reason was I didn't 7 feel like the hospital had the resources to take care of 8 her condition at the time. 9 Q. All right. Let's talk about those two. First, 10 you said your personal situation? 11 A. Correct. 12 Q. And then the second was that the hospital didn't 13 have the resources? 14 A. Yeah, in my opinion. 15 Q. So let's talk first, what was it, the personal 16 situation, that you're referencing? 17 A. So at that point in time when I got asked to 18 potentially assume her care, I was actually 39 weeks 19 pregnant and about to go on maternity leave, and at that 20 point I didn't think it was in the best interest for me 21 to take on any complicated patients when I knew the next 22 week I wouldn't -- I would be gone on maternity leave at 23 that point so -- literally days after this. 24 Q. Okay. Anything else that was in this personal 25 situation category other than that? Page 11 1 A. That is my understanding. 2 Q. (BY MR. SAWICKI) Okay. And so let me make sure 3 I'm clear. In this case, with respect to Mrs. Mejia, 4 it's your position that you were never responsible for 5 her care so you couldn't have done anything negligent or 6 wrong or that contributed to her ultimate death, true? 7 A. It is my respons -- understanding that I have no 8 responsibility. 9 Q. Okay. Now, with respect to that understanding, 10 what is the basis for it? 11 MR. RYAN: Form. 12 A. I never formed a patient-physician relationship 13 with her. 14 Q. (BY MR. SAWICKI) And why do you believe that? 15 MR. RYAN: Form. 16 A. I never accepted her as my own patient. 17 Q. (BY MR. SAWICKI) Okay. And why is it you never 18 accepted her as your own patient? 19 A. I had no reason to accept her as my own personal 20 patient. 21 Q. Well, was there something about her that you 22 decided you would not accept or was there some other 23 reason why you didn't accept her as a patient? 24 A. It had nothing to do with the patient at all. It I did not feel it was in her best interest that I Page 13 1 A. No. 2 Q. All right. Now, the second reason you gave me 3 was that -- the second reason that you say you didn't 4 take on Mrs. Mejia's care was that the hospital, in your 5 opinion, didn't have the resources to care for her. 6 What specifically did you mean by that? 7 A. From my understanding the patient, although 8 stable, would be at risk for potential -- could be at 9 risk for a rebleed and the hospital did not have the 10 resources for multiple blood transfusions. The other 11 concern that I had was that they didn't have 24-hour 12 intensivists to manage the patient. And from what I 13 understand, the patient was on the vent and she was, I 14 believe, requiring dialysis. 15 Q. All right. Anything else with respect to the 16 second element that the hospital, in your opinion, did 17 not have the resources necessary to care for Mrs. Mejia 18 other than those two things? 19 A. Those were the -- the main -- the main concerns. 20 Q. Okay. Now, a couple of more terms I want to make 21 sure I'm using correctly. I heard the term "attending" 22 or "admitting physician" as being a way to describe the 23 physician who's got primary responsibility for a 24 patient. Have you heard those terms? 25 A. I have. 4 (Pages 10 to 13) lectronically signed by Lei Sherra Torrence ( )

6 Page 14 1 Q. Is that definition, although, I may not put it as 2 artfully as a medical dictionary or something else, that 3 the attending or admitting physician has primary 4 responsibility for the patient's care, is that a 5 generally true statement? 6 A. Not necessarily. The admitting physician can be 7 different from an attending physician caring for that 8 patient. 9 Q. Right. So would the -- oftentimes, am I correct 10 that, the admitting physician may also be the attending 11 physician? 12 A. That is correct. 13 Q. But there may be times when the admitting 14 physician may not have a specialty or a focus of 15 practice that the patient really requires and then a 16 doctor of that nature takes over and cares for the 17 patient as the, quote, attending physician? 18 A. In that speciality, correct, yes. 19 Q. All right. Now with respect to Mrs. Mejia, what 20 was your understanding of who was the admitting doctor 21 for this period of care where she was at the University 22 General Hospital? 23 MR. RYAN: Form. 24 MR. THORNTON: Same objection. 25 A. I don't know, honestly. Page 16 1 A. Same person. Pulmonary and critical care doctor. 2 Q. And the nephrologist? 3 A. The name starts with a V. I honestly can't 4 pronounce or spell it for you. 5 Q. Is it the Indian Vin -- Vinkin -- 6 A. I think so. 7 Q. Okay. 8 A. Yes, and I didn't find this out until after. 9 Q. And the hospitalist? 10 A. I don't recall the name of the hospitalist that 11 admitted her. 12 Q. Now, with respect to that group, were you told 13 who was the admitting physician? 14 A. At the time MR. RYAN: Form. 16 A. -- no. No. 17 Q. (BY MR. SAWICKI) Have you learned since then? 18 A. Yes. 19 Q. Who was the admitting A. And I was told the hospitalist was the admitting. 21 Q. And let me make sure I'm not invading a 22 privilege. Is this information something you got from 23 your lawyer, Mr. Ryan? 24 A. No. 25 Q. Well, who was it that you got that information Page 15 1 Q. (BY MR. SAWICKI) Okay. What was your 2 understanding of who was the attending physician for her 3 care at University General Hospital? 4 MR. RYAN: Form. 5 MR. THORNTON: Form. 6 A. It was my understanding, honestly, that she had 7 multiple physicians caring for her. 8 Q. (BY MR. SAWICKI) Was it your understanding that 9 all of them were considered to be, quote, the attending? 10 A. It was my understanding that each played a major 11 role in the care for her. 12 Q. Who were the doctors you considered to be playing 13 a major role in her care? 14 A. I honestly didn't know that information until 15 after all of this, but I was told the specialists 16 involved were critical care, pulmonary, a nephrologist, 17 Dr. Bianco and a hospitalist. That's all I knew at the 18 time. 19 Q. Okay. Do you know the name of the critical care 20 doctor? 21 A. I found that out recently and that was Dr. Kopman 22 from what I understand. 23 Q. Could you spell that for her? 24 A. I think it's K-O-P-M-A-N, but I'm not for sure. 25 Q. All right. And the pulmonologist? Page 17 1 from? 2 A. After the fact almost during like a peer review. 3 MR. HINES: All right. I'm going to object 4 at this time. Peer-review privilege, don't answer the 5 question. 6 MR. RYAN: Anything that arises that you're 7 aware of that you know only by virtue of peer review you 8 must not speak about until you have said I only know 9 that through peer review, okay? 10 THE WITNESS: Okay. So I need to say that 11 first? 12 MR. RYAN: Yes. 13 THE WITNESS: Okay. 14 Q. (BY MR. SAWICKI) Yeah, I'll try to rephrase the 15 question so that we're -- we're not -- there are some 16 privileges that you're entitled to under the law and, 17 actually, some of the other parties. For example, 18 things that you discussed with your lawyer I don't want 19 to ask about something that is -- something your lawyer 20 has told you about where that's your only source of the 21 information. In other words, I'm not going to ask you 22 about his opinions or his staff's opinions about your 23 case, things like that, okay? 24 A. Okay. 25 Q. So if you ever find yourself about to tell me 5 (Pages 14 to 17) lectronically signed by Lei Sherra Torrence ( )

7 Page 18 1 something like that, keep in mind that there's a 2 privilege that you don't have to reveal that. The other 3 thing is that there are privileges that pertain to a 4 discussion held during a peer-review committee 5 investigation. So if the conversation comes from your 6 testimony or your discussion in a peer-review context, I 7 don't want to ask you about that either, okay? 8 A. Okay. 9 Q. Now, if you MR. RYAN: Hang on a second, Mike. And in 11 that regard, if you have a question as to any source of 12 information that's like, well, I think I know that, and 13 we need to talk about it, you need to let me know and 14 we'll take a break and we'll talk about it. 15 MR. SAWICKI: That's exactly what I was 16 about to say. If you have any question, I don't want to 17 cut you off THE WITNESS: Okay. 19 MR. SAWICKI: -- but I do want to let you 20 know that you have an opportunity to talk to your lawyer 21 if you're ever unclear about these things. 22 THE WITNESS: I do have one question. 23 MR. SAWICKI: Okay. What's that? 24 THE WITNESS: So if I reviewed MR. RYAN: Wait. Let's not -- Page 20 1 Q. You told me earlier you were under the impression 2 that there were one, two, three -- four different 3 doctors involved: Critical care pulmonologist, 4 nephrologist, Dr. Bianco, and the hospitalist. With 5 respect to that group and outside of a peer-review 6 conversation, did you have an understanding of there 7 being any other surgeons involved in her care? 8 A. No. 9 Q. Now, with respect to the care of Mrs. Mejia, are 10 you aware of -- and I want to ask again outside of a 11 peer-review context where that's where you got the 12 information or something that you only know through your 13 lawyer, are you aware of any other surgeon other than 14 Dr. Bianco being involved in her care? 15 A. And this is outside of the peer review? 16 Q. Correct. 17 A. No. 18 Q. All right. Now, would you agree with me that the 19 records from UGH demonstrate that an entry was made 20 indicating you had been assigned to care for Mrs. Mejia? 21 MR. RYAN: Form. 22 A. I found that out only through peer review. 23 Q. (BY MR. SAWICKI) All right. Have you looked at 24 Mrs. Mejia's records at all? 25 A. During the peer review. Page 19 1 THE WITNESS: Okay. 2 MR. RYAN: Let's not do it. 3 THE WITNESS: Okay. 4 MR. SAWICKI: Let's take a two-minute break. 5 MR. RYAN: Yeah. 6 MR. SAWICKI: Let you talk to her about that 7 and we'll get back. 8 THE WITNESS: Okay. 9 MR. RYAN: Thanks. 10 THE VIDEOGRAPHER: Off the record 10:24 a.m. 11 (Break taken from 10:24 a.m. to 10:28 a.m.) 12 THE VIDEOGRAPHER: Back on the record at 13 10:28 a.m. 14 Q. (BY MR. SAWICKI) So ma'am, you've had a moment 15 to take a break. Are you ready to proceed? 16 A. Yes. 17 Q. So again, with the same caveats about the various 18 privileges, would your knowledge of who was the 19 admitting physician have been something that came just 20 from that context of peer review? 21 A. Yes. 22 Q. All right. With respect to other individuals 23 that were involved in the care, I want to talk outside 24 of the peer-review context. 25 A. Okay. Page 21 1 Q. All right. Have you seen the entries that 2 indicate you were assigned to care for Mrs. Mejia? 3 A. Yes. 4 Q. With respect to the notes, it indicates that a 5 doctor -- I'll probably say the name wrong, Dr. Chisty 6 (phonetic) Schade was the one who appointed you to care 7 for Mrs. Mejia according to the records, true? 8 MR. HINES: I'm going to object at this 9 point. She's giving information that she only learned 10 during the peer-review process. I ask that her lawyer 11 instruct her not to answer. And the hospital has 12 privilege. She's told us that's the only time she's 13 seen them. She said I've seen them outside of that and 14 that's not much I can do about that. 15 Q. (BY MR. SAWICKI) Well, you've looked at the 16 records, true? 17 A. I only looked at the records through the peer 18 review. That's the only time that I saw and looked 19 through the records. 20 MR. SAWICKI: Let me show you a record. 21 Mark this as Exhibit 1. And it's UGH (Exhibit Number 1 marked.) 23 MR. RYAN: Is this the same thing? 24 MR. SAWICKI: Yes. 25 MR. RYAN: Thank you. 6 (Pages 18 to 21) lectronically signed by Lei Sherra Torrence ( )

8 Page 22 1 Q. (BY MR. SAWICKI) And I'm going to ask you, 2 towards the bottom there's an entry that's approximately 3 -- if I read it right it's dated 16:00 on the 27th. Do 4 you see that at the bottom? 5 A. Yes. 6 Q. It says Dr. Hamilton, Franchell will cover for 7 Dr. Bianco until further notice. Do you see that? 8 A. I see that. 9 Q. And then it's RB/TO Dr. Schade, slash -- I can't 10 read that next name, but it looks like RN. Do you see 11 that? 12 A. Yes. 13 Q. Do you recognize the handwriting in this? 14 A. No. 15 Q. Do you recognize the name of the RN? 16 A. No. 17 Q. How about the initials underneath? 18 A. No. 19 Q. Do you recognize what it says off to the left 20 underneath the time and date at 16:10, a couple of 21 lines? Do you recognize what that says? 22 A. No. 23 Q. All right. Were you aware of this physician's 24 order being placed in Mrs. Mejia's records at any time 25 other than what you learned in the peer-review process? Page 24 1 A. Yes. 2 Q. All right. 3 MR. HINES: I'm sorry. Did you say 15 4 minutes after that? 5 THE WITNESS: Yes. 6 Q. (BY MR. SAWICKI) So approximately 4 o'clock and 7 then 4:15? 8 A. Yes. 9 Q. All right. What do you remember about the 10 4 o'clock p.m. call on the 27th from Dr. Schade? 11 A. The 4 o'clock p.m. call from what I was -- what I 12 recall was Dr. Schade introducing himself as the chief 13 of staff. He stated that he apologized for having to 14 call me about a situation. He stated that Dr. Bianco 15 had been suspended and according to the hospital bylaws 16 I was the person to take over his patients and there was 17 a patient in the ICU that I needed to assume care of. 18 Q. Okay. Let me ask you a couple of things about 19 that conversation. First, where did Dr. Schade contact 20 you? Was it an office phone, a cell phone or some other 21 phone? 22 A. He contacted me both via the office and cell 23 phone. 24 Q. Okay. Was there anyone that overheard or 25 participated in this conversation other than you and Page 23 1 A. No. 2 Q. Did Dr. Schade, then, if I'm understanding you 3 correctly, that the only source you had for this 4 information is from peer review, am I correct that no 5 one on the 27th of June told you that you would be 6 covering for Dr. Bianco? 7 A. I would agree. 8 Q. Okay. And that this note does not reflect 9 anything you recall Dr. Schade or any other doctor 10 telling you on the 27th of June? 11 A. Doctor MR. RYAN: Objection; form. 13 Q. (BY MR. SAWICKI) Did anyone ask you to cover for 14 Dr. Bianco on the 27th of June? 15 A. I received a call from Dr. Bianco. 16 MR. RYAN: You said Dr. Bianco. 17 A. Oh, I'm sorry, Dr. Schade Q. (BY MR. SAWICKI) Okay. 19 A. -- to take over a patient of Dr. Bianco on 20 June 27th. 21 Q. Do you recall when that conversation took place? 22 A. Yes. Approximately -- I had two conversations 23 with him. One was around 4 o'clock and the other one 24 was maybe 15 minutes after that. 25 Q. And 4 o'clock p.m., correct? Page 25 1 Dr. Schade? 2 MR. RYAN: Form. 3 A. Not that I know of. 4 Q. (BY MR. SAWICKI) Did you make any notes 5 regarding this conversation? 6 A. No. 7 Q. Was there anything else that was discussed other 8 than what you just told me about? 9 A. Not that I recall except I -- I -- I had my 10 questions such as I asked him if this was an emergency, 11 I asked him if the patient was stable and I asked him honestly, I never heard of this ever happening to a 13 physician where you're required to take over someone's 14 patient and I kind of discussed that with him also on 15 that conversation and he told me to call the ICU nurse. 16 Q. Let me ask you: Did Dr. Schade say why 17 Dr. Bianco had been suspended? 18 A. He did not. 19 Q. Was that an abnormal type of conversation to have 20 that a doctor in the course of caring for a patient had 21 his or her hospital privileges suspended? 22 MR. RYAN: Form. 23 A. That conversation -- I've never had that 24 conversation before. So for me it was a little 25 abnormal. 7 (Pages 22 to 25) lectronically signed by Lei Sherra Torrence ( )

9 Page 26 1 Q. (BY MR. SAWICKI) I mean, this is the first thing 2 I thought when I read it. I've never read that in my 3 limited experience that a doctor was removed from the 4 hospital in the course of care of a patient that had had 5 some complications. Had you ever run into that before? 6 MR. THORNTON: Objection; form. 7 A. I have not run into that before. 8 Q. (BY MR. SAWICKI) Have you run into it since? 9 A. No. 10 Q. What was your impression about Dr. Schade's tone 11 or emotional state to the best you can describe when you 12 were talking about these things? 13 MR. HINES: Object to form. 14 MR. RYAN: Form. 15 A. I remember him being very -- I don't know what 16 the correct term, but very almost, like, forceful and 17 aggressive, maybe, and I just remember being a little 18 offended after talking -- after that conversation with 19 him. 20 Q. (BY MR. SAWICKI) So what was it about the 21 conversation that led you to feel that Dr. Schade was 22 being forceful and offensive? 23 MR. RYAN: Objection; form. 24 A. When I had told him on that particular 25 conversation that I've never been in a situation where I Page 28 1 treated you? 2 A. Multiple physicians I was told by that. 3 Q. Tell me what it is they were -- they had reported 4 to you -- 5 A. Similar -- 6 Q. -- about Dr. Schade? 7 MR. RYAN: Wait. Let him get his question 8 all the way out before you start answering it and that 9 way I can object if I need to and that way the court 10 reporter can take it down clean. 11 THE WITNESS: Okay. 12 Q. (BY MR. SAWICKI) Let me rephrase. What had 13 other doctors told you about Dr. Schade's demeanor or 14 tone with respect to this bullying that you felt? 15 A. Similar situations or examples where they felt 16 they were talked either down to or bullied into doing 17 something that they didn't agree with. 18 Q. Was this a common occurrence or was this 19 something that was -- is there a particular incident 20 that stands out in your mind? 21 A. I don't know if it was common. I only know the 22 handful of physicians that I spoke to at University 23 General Hospital. 24 Q. I guess what I'm trying to quantify is: Was this 25 a -- commonly amongst your peers that you would discuss Page 27 1 was required to accept a patient, he essentially made it 2 seem like, well, I had no other options. 3 Q. (BY MR. SAWICKI) Was there something about the 4 vocabulary he used or was it his tone of voice? 5 A. It was his tone. 6 Q. And what was it about his tone that led you to 7 feel it was forceful and offensive? 8 A. It was almost -- 9 MR. RYAN: Objection; form. 10 A. -- degrading. 11 Q. (BY MR. SAWICKI) How so? That's what I'm trying 12 to quantify here. 13 A. I don't know if I could quantify it. 14 Q. Suffice to say, then, that Dr. Schade's 15 conversation with you led you to feel that you had 16 almost been degraded by the way he was treating you? 17 A. Bullied. 18 Q. Better term? 19 A. I would say. Bullied would be a better term, 20 yes. 21 Q. All right. Had you ever talked with Dr. Schade 22 before this? 23 A. I never knew him. Just of him. 24 Q. Had you ever been told by anyone that he had an 25 abrupt manner or something consistent with the way he Page 29 1 this type of information with? Was this a commonly held 2 feeling regarding Dr. Schade or was this an anomalous 3 thing that just a few doctors reported to you? 4 MR. RYAN: Form. 5 A. It came up a handful of times. We wouldn't focus 6 our conversations on that. 7 Q. (BY MR. SAWICKI) Do you recall any other 8 specific doctors that had these same or related these 9 same types of experiences with him? 10 A. I do. 11 Q. Can you tell me the names? 12 A. Dr. Green was an anesthesiologist. She was one 13 of them. Dr. Payseur was a wound care doctor. She was 14 another. 15 Q. Do you recall what Dr. Green, the 16 anesthesiologist, had told you about, with respect, to 17 Dr. Schade's treatment of her that left her feeling 18 consistent with your description? 19 A. Not necessarily word for word. 20 Q. In general? 21 A. There were times when she performed anesthesia 22 and there were some complaints made by him on the way 23 she did things that she disagreed with. 24 Q. Any other descriptions that you recall in a 25 general fashion about what Dr. Green said about 8 (Pages 26 to 29) lectronically signed by Lei Sherra Torrence ( )

10 Page 30 1 Dr. Schade in this regard? 2 A. Not outside of what I've already stated. 3 Q. All right. Same question with respect to 4 Dr. Payseur. 5 A. It was the same. 6 Q. Were -- 7 A. Disagreements on the way they cared for patients 8 -- she cared for patients. 9 Q. Were there disagreements in the -- in these types 10 of conversations? Was it about the techniques that were 11 employed or the speed with which they were performed 12 or A. I don't recall the specifics. 14 MR. RYAN: Again THE WITNESS: Sorry. 16 MR. RYAN: -- please let him ask his 17 question all the way. That I way I can register an 18 objection if I need to. And I'll object to the form of 19 the question. 20 Q. (BY MR. SAWICKI) Were there concerns expressed 21 about Dr. Schade indicating that the care should've been 22 rendered in a different manner? 23 A. I don't recall MR. RYAN: Form. 25 A. -- the specifics. Page 32 1 MR. HINES: Object to form. 2 A. I'm not sure because I don't know how he 3 responded to other... 4 Q. (BY MR. SAWICKI) Did -- did you have discussions 5 with any male doctors that indicated similar concerns 6 that you have described with respect to Dr. Payseur and 7 Dr. Green and yourself? 8 A. No. 9 Q. Did you talk with any of the nursing staff about 10 their interactions with Dr. Schade? 11 A. I spoke to -- at the time it was the ER director 12 who I believe was a nurse. 13 Q. Do you recall who that was? 14 A. I don't remember his name. 15 Q. And what is it that individual told you? 16 A. It was the same in the sense of he's had some 17 degrading tones or remarks made by Dr. Schade to him. 18 Q. Okay. All right. So I want to go back, with 19 respect, to this 4 o'clock conversation. Anything else 20 about Dr. Schade's tone or impressions you formed about 21 his emotional state at this conversation that you 22 haven't told me about? 23 MR. HINES: Object to the form. 24 A. No. 25 Q. (BY MR. SAWICKI) With respect to Dr. Bianco's Page 31 1 Q. (BY MR. SAWICKI) Okay. And what -- where I 2 guess I'm trying to figure out is: Was there a 3 disagreement with the applicable standard of care, for 4 example, in the care being involved? 5 A. No. 6 Q. Was there a concern expressed about the speed or 7 the billing or any other aspect of the care involved? 8 A. No. No. 9 Q. Just that Dr. Schade had some other way of doing 10 it that he preferred versus Dr. Green or Dr. Payseur's 11 way of doing it? 12 A. Correct. 13 Q. Okay. Now, with respect to, both, Green, Payseur 14 and yourself, you're all three women; is that true? 15 A. Yes. 16 Q. Was there any sexual element of it, and I don't 17 mean in a physical act of love type way. Was there a 18 male/female type demeanor or is that part of it? 19 MR. HINES: Object to form. 20 MR. RYAN: Objection; form. 21 A. Not that I know of. 22 Q. (BY MR. SAWICKI) What I'm asking is: Was he 23 sexist or was it construed as him talking down to a 24 woman in your discussions with these other doctors? 25 MR. RYAN: Objection; form. Page 33 1 suspension, is that something Dr. Schade told you had 2 occurred? 3 A. He informed me that Dr. Bianco had been 4 suspended. 5 Q. What specifically did Dr. Schade say about 6 Dr. Bianco being suspended? 7 A. That was pretty much it. 8 Q. He just said, Dr. Bianco, the surgeon, has been 9 suspended? 10 A. He stated there was an unfortunate event and 11 Dr. Bianco is suspended. 12 Q. Did he give you any more detail about what the 13 unfortunate event was? 14 A. No. 15 Q. Had you ever heard of a doctor at UGH being 16 suspended for any kind of unfortunate event before? 17 A. No. 18 Q. Did you have any impression about what the 19 unfortunate event was? 20 A. I had heard situation from some of the OR staff 21 days before this. 22 Q. And what was the situation you had heard of? 23 A. The OR staff just said that there was a surgery 24 that was done and that something had went wrong. That 25 was pretty much it. I don't know if they knew all the 9 (Pages 30 to 33) lectronically signed by Lei Sherra Torrence ( )

11 Page 34 1 details. 2 Q. Who was the OR staff that you were talking with? 3 A. It was the OR director at the time and I cannot 4 recall her name. 5 Q. And what was the context that you were having 6 this discussion with the OR director at the time? 7 A. I always -- any time I went to UGH I always 8 walked through the OR. I was usually there for a 9 surgery or something and I was relatively friendly with 10 all the staff and they just mentioned there had been an 11 incident. 12 Q. So you're there to perform some kind of care on a 13 patient at UGH, you're walking through the OR department 14 and the OR director or some other members of the OR 15 staff just come up and say to you Dr. Bianco has been 16 involved in a situation? 17 MR. RYAN: Objection; form. 18 A. It started off, hey, did you hear. 19 Q. (BY MR. SAWICKI) And what is it they said A. And then Q. -- did you hear? 22 A. That there had been an incident in the OR the day 23 or so whenever it happened. 24 Q. And what was the incident they described? 25 A. Nothing more than there was a patient that was Page 36 1 was suspended. Do you remember that? 2 A. Correct. 3 Q. And you told me that in talking with Dr. Schade, 4 he said that Dr. Bianco had been suspended in this 5 4 o'clock conversation; is that correct? 6 A. Yes. 7 Q. And that in your discussion with him, he said 8 something about there had been an unfortunate event; is 9 that correct? 10 A. Yes, Dr. Schade told me that. 11 Q. And that you understood that unfortunate event to 12 have been something secondary to what the OR staff had 13 said when you showed up at the hospital a few days 14 before to perform your own work at the hospital; is that 15 correct? 16 A. I didn't know what the unfortunate event was. 17 Q. Correct. But when you showed up at the hospital 18 to do your own work, the OR staff was talking about it, 19 correct? 20 A. They were talking about a situation. 21 Q. Right. And that situation was the situation 22 involving Dr. Bianco; is that correct? 23 MR. RYAN: Form. 24 A. I assume so. They mentioned Dr. Bianco. 25 Q. (BY MR. SAWICKI) Okay. Page 35 1 undergoing a gallbladder and what they told me is there 2 was a -- they told me that there was a colonic injury is 3 what I was told by the OR staff. 4 Q. What else did they say in that regard? 5 A. That's pretty much it. 6 Q. Did the staff indicate what the outcome of that 7 case had been? 8 A. I don't know if they knew. 9 Q. Was the patient still in the hospital? 10 A. The patient was still in the hospital and they 11 indicated it was a very long surgery because it had 12 pushed back multiple surgeries for that day. 13 Q. Did they indicate anyone else that was involved 14 in that surgery? 15 A. No. 16 Q. Did they indicate what it was Dr. Bianco had done 17 or not done in that surgery? 18 MR. RYAN: I'm going to object and there has 19 not been testimony to this point that Dr. Bianco was 20 involved in the surgery. So you're mischaracterizing 21 her testimony and I think any answer she gives to it is 22 going to be misleading. 23 Q. (BY MR. SAWICKI) All right. Let me go back up. 24 The way I understood it, you said earlier -- let me go 25 back to my notes. Started talking about why Dr. Bianco Page 37 1 A. I don't know if it was the same patient. 2 Q. At least when you arrived at the OR -- or the OR 3 at UGH to perform your own work, the OR staff at the 4 time was talking about Dr. Bianco's involvement with a 5 patient involved in a gallbladder procedure; is that 6 correct? 7 A. Yes. 8 Q. And that the staff of the OR told you that that 9 patient had sustained some kind of colonic injury; is 10 that correct? 11 A. Yes. 12 Q. And that that injury was during the course of a 13 gallbladder procedure being performed by Dr. Bianco; is 14 that correct? 15 A. Yes. 16 Q. Okay. So did they tell you anything more about 17 what Dr. Bianco's involvement was? 18 A. No. 19 Q. Did they tell you what specifically had gone 20 wrong causing the colonic injury? 21 A. No. 22 Q. Did they tell you any other doctor other than 23 Dr. Bianco had been involved in the surgery? 24 A. No. 25 Q. Did you form any impressions as to how the 10 (Pages 34 to 37) lectronically signed by Lei Sherra Torrence ( )

12 Page 38 1 colonic injury they were describing had occurred? 2 A. No. 3 Q. Now, did you make a connection when you talked to 4 Dr. Schade, on that 4 o'clock conversation, did you make 5 a connection between this conversation with the OR staff 6 a few days earlier and the unfortunate event that 7 Dr. Schade was talking about with you at the 4 o'clock 8 conversation? 9 MR. THORNTON: Form. 10 A. I thought to myself, I wonder if this is the same 11 patient, but I didn't know. 12 Q. (BY MR. SAWICKI) And what was it that led you to 13 make that thought or why did you have that thought? 14 A. Because essentially the OR staff had described it 15 as an unfortunate -- almost the same, an unfortunate 16 incident during the operation. 17 Q. So let me make sure I understand. Do you believe 18 that the individual that the OR staff was talking about 19 with you when you were there was Mrs. Mejia or another 20 patient? 21 MR. THORNTON: Form. 22 A. I cannot make that decision. I don't know if it 23 was the same. 24 Q. (BY MR. SAWICKI) The conversation that you had 25 and you've been telling me about with the OR staff, did Page 40 1 Q. What was your impression about the condition of 2 that patient? 3 MR. THORNTON: Objection; form. 4 A. I wouldn't know. 5 Q. (BY MR. SAWICKI) Did the OR staff indicate that 6 the patient was still -- you said earlier, in the 7 hospital. Do you know anything about where that patient 8 was still? 9 MR. THORNTON: Form. 10 A. No. 11 Q. (BY MR. SAWICKI) Did you have any other 12 discussions about any other patients with the OR staff 13 that were similar to this conversation that you'd had 14 about Dr. Bianco's gallbladder surgery with the colonic 15 injury? 16 MR. HINES: Object to form. 17 MR. RYAN: Form. 18 MR. THORNTON: Same objection. 19 A. No. 20 Q. (BY MR. SAWICKI) Okay. Had the OR staff ever 21 told you about other injuries like this before? 22 MR. THORNTON: Objection; form. 23 A. No. 24 Q. (BY MR. SAWICKI) Was this the first time you'd 25 ever walked into the OR and had them say, hey, have you Page 39 1 that take place on the 27th of June? 2 A. No. 3 Q. Was it some days prior to that? 4 A. Yes. 5 Q. Is there any way to fix in your mind what day -- 6 how many days prior it was? 7 A. I can't tell exactly. It was maybe two. Maybe 8 one or two recent. 9 Q. If the record showed Mrs. Mejia came in, I want 10 to say on the 26th -- I'll have to go back and check. 11 Yeah, if the record show Mrs. Mejia was admitted on the 12 25th of June, do you believe that was before or after 13 this conversation you described with the OR staff? 14 A. I cannot recall exactly. 15 Q. Is there any recollection you have of what 16 patient or what activity you were performing at the 17 hospital that would help us fix in time when you 18 would've been there having this conversation? 19 A. No. I was literally -- I was there rounding and 20 like I said, I always kind of go through the OR just to 21 see and plus I was on call, so I would just go through 22 the OR, go through the ER. 23 Q. Do you recall anything about the patient's 24 condition that had been involved in this colonic injury? 25 A. I didn't ask. Page 41 1 heard we have a gallbladder surgery patient with a 2 colonic injury still in the hospital? 3 A. Repeat the question. 4 Q. Sure. I guess what I'm trying to get at is: Was 5 this a topic of conversation that was a normal one that 6 you would have this kind of conversation about 7 frequently, or was this sort of an anomaly that stood 8 out in your mind? 9 MR. RYAN: Objection; form. 10 MR. HINES: Form. 11 MR. THORNTON: Form. 12 A. I would say the OR nurses always had some type of 13 story. 14 Q. (BY MR. SAWICKI) Had they told you stories the OR nurse, had they told you stories about other 16 cases where patients had sustained some kind of injury 17 like the type you're describing with respect to 18 Dr. Bianco in this colonic injury? 19 MR. THORNTON: Form. 20 A. Perhaps not exactly, no. 21 Q. (BY MR. SAWICKI) Had that happened -- when was 22 the -- prior to this, when was the last time that had 23 happened? 24 MR. HINES: Object to form. 25 A. They didn't mention a situation like that. 11 (Pages 38 to 41) lectronically signed by Lei Sherra Torrence ( )

13 Page 42 1 Q. (BY MR. SAWICKI) Do you remember anything else 2 about who the OR staff was that had this conversation 3 with you about Dr. Bianco, the patient that sustained 4 the colonic injury? 5 MR. THORNTON: Form. 6 A. There was -- like I said, it was the OR director 7 and I know the PACU coordinator was there and then the 8 front OR nurse and I cannot recall their names right 9 now. 10 Q. (BY MR. SAWICKI) Okay. So the OR director, that 11 would be -- that was a woman, I think you told me 12 before? 13 A. They're all female. 14 Q. All female. Okay. Do you know any of these 15 individuals outside of UGH? 16 A. I did not. 17 Q. Do you know where any of them are currently? 18 A. A couple, yes. 19 Q. Who -- who do you know of where they are? 20 A. I don't recall their names. 21 Q. Well, was it, for example, the OR director? 22 A. Yes. 23 Q. Where do you believe she is? 24 A. She's at another hospital. 25 Q. Do you know which one? Page 44 1 Q. Did you talk with Dr. Bianco at all? 2 A. No. 3 Q. Had you ever talked to Dr. Bianco? 4 A. I think we were introduced in passing once. I 5 don't know if I would even recognize him if I saw him 6 again though. 7 Q. Did you ever discuss him with other members of 8 your surgical community? 9 A. No. 10 Q. Know of any doctors that were working with him or 11 that knew him well? 12 A. I didn't know them personally, no. 13 Q. You know them just by reputation? 14 A. There was a surgeon that knew him well. 15 Q. Who was that? 16 A. I think it was Dr. Silver, I think and that's Q. Do you ever talk to Dr. Silver about Dr. Bianco? 18 A. No. 19 Q. Do you know Dr. Silver at all? 20 A. I've met him a couple of times. 21 Q. Where is he today? 22 A. I don't know. 23 Q. Have you told me everything you remember about 24 this discussion you've had with the OR staff about the 25 other patient, the gallbladder patient, that sustained Page 43 1 A. Crescent. 2 Q. And where is Crescent? 3 A. It's in South Dallas, I guess you call it. 4 Q. Do you know what she's doing at South Dallas 5 Crescent? 6 A. I believe it's the same position. 7 Q. How about the PACU coordinator? Do you know 8 where she is? 9 A. She's at Methodist. 10 Q. Do you know what role she's doing at Methodist? 11 A. She's an educator of some sort. 12 Q. Do you know which Methodist location? 13 A. It's the same one in South Dallas. I don't know 14 if it has a different name. 15 Q. Okay. And the front OR nurse, do you know where 16 that individual is today? 17 A. The receptionist, I actually also saw her at 18 Crescent. 19 Q. And is she a receptionist? 20 A. She's a -- yeah, kind of like a scheduler, 21 receptionist. I don't think she's a nurse. 22 Q. Do you recall talking with any other individuals 23 other than those three about this incident with 24 Dr. Bianco a few days before Mrs. Mejia's procedure? 25 A. No. Page 45 1 the colonic injury? 2 A. Yes. 3 Q. Do you remember any other discussion with 4 Dr. Schade about that situation? 5 A. Not until the later conversation, but... 6 Q. Okay. And I'm going back to try to work through 7 everything here. So with respect to this 4 p.m. 8 conversation, we've gotten through Dr. Schade calling 9 you, telling you you're assigned to this patient using 10 the tone that you've told me about everything you 11 remember there, correct? 12 A. Correct. 13 Q. And then you've told me everything you remember 14 about him saying regarding Dr. Bianco being suspended? 15 A. Yes. 16 Q. That was due to an unfortunate situation or 17 unfortunate event? 18 A. Yes. 19 Q. Okay. And that, in your mind, was linked to the 20 earlier conversation you had with the OR staff about the 21 colonic patient -- or the colonic injury to the other 22 gallbladder patient, correct? 23 MR. THORNTON: Objection; form. 24 A. Not correct. I didn't know if it was the same 25 person. 12 (Pages 42 to 45) lectronically signed by Lei Sherra Torrence ( )

14 Page 46 1 Q. (BY MR. SAWICKI) All right. Were you aware of 2 any other patients of Dr. Bianco that had some kind of 3 unfortunate event? 4 MR. THORNTON: Form. 5 A. No. 6 Q. (BY MR. SAWICKI) So then, as we're continuing 7 through, you told me that Dr. Schade told you that 8 according to the bylaws you were supposed to take over 9 the -- Mrs. Mejia's care. Do you remember that? 10 A. Yes. 11 Q. So I want to talk about the bylaw section and 12 what he said in that regard. What was it, if you 13 recall, that Dr. Schade told you specifically? Why were 14 the bylaws even coming up? 15 A. Because when he initially told me about the 16 patient and to assume care, I told him I didn't feel 17 comfortable. And then so the rebuttal was, well, it's 18 in the hospital bylaws. You have to take over this 19 patient. When a surgeon gets suspended, it falls to the 20 surgeon on call is what he said. 21 Q. Okay. So let me cut up those two things. You 22 were telling me when the bylaw portion came up that 23 Dr. Schade had told you something about the patient's 24 condition and you didn't feel comfortable about getting 25 involved in. What was it specifically about her Page 48 1 Q. Sure. 2 A. Sorry. 3 Q. We'll work it out. What was the complication you 4 formed in your mind an opinion about what was that 5 complication? 6 A. Just a bleed, that's all I knew. 7 Q. Now, how was it that that particular complication 8 was -- what was it about it that made you uncomfortable 9 about getting involved in her care for Mrs. Mejia? 10 A. I typically do not MR. RYAN: Form. 12 A. -- like taking over care on patients that I don't 13 know enough about and who've had complications from 14 other -- other operating surgeons, one. Two, the fact 15 that she needed blood requirements and I knew the 16 hospital did not have a large amount of blood on hand 17 was my other concern. 18 Q. Okay. Do you recall Dr. Schade telling you 19 anything more about how this bleed was caused or why it 20 was continuing? 21 MR. RYAN: Form. 22 MR. THORNTON: Same objection. 23 A. He didn't say anything about continuation but he 24 did tell me to just call the nurse. 25 Q. (BY MR. SAWICKI) Did you tell Dr. Schade at this Page 47 1 condition you didn't feel comfortable getting involved 2 in? 3 A. It was the fact that this patient had now been 4 operated on twice. She did require some blood products 5 and she was currently in the ICU. 6 Q. Okay. So let me -- I'm not a doctor. So help me 7 understand. What was the significance, if any, in your 8 mind about the fact that Mrs. Mejia had been operated on 9 twice that led you to feel uncomfortable about taking 10 over her care? 11 A. Essentially that means that there had been some 12 type of complication and typically I don't -- I think 13 it's in the best interest of the patient for the person 14 who knows the anatomy or who has previously operated on 15 her to continue to treat the patient, not for it to go 16 to a surgeon who knows nothing about what happened or 17 the complication. 18 Q. Is this complication something Dr. Schade told 19 you about or was that an opinion you've reached on your 20 own? 21 A. That was an opinion after him telling me, well, 22 she had to go back to the operating room. 23 Q. What was the complication you believed to be 24 present? 25 A. A bleed of some sort. Page 49 1 time that you had the concern that you typically did not 2 like to take over a patient that you didn't know a lot 3 about? 4 A. No. At this time, I did tell him that I don't 5 feel comfortable managing this patient and it may be in 6 her best interest to transfer. 7 Q. And when you say "transfer", transfer to another 8 facility? 9 A. A higher level of care, but I didn't say that. I 10 said another facility. 11 Q. Did you express to Dr. Schade at this point, I 12 don't -- words to the effect that I don't Dr. Hamilton does not like to take over patients that 14 you don't -- I'm sorry. I wrote down what you said 15 where you felt like it was in their best interest for 16 them to continue with the doctor that had been treating 17 them? 18 A. I did not tell him that. 19 Q. Okay. Did you tell Dr. Schade at this point that 20 you felt like the hospital didn't have the blood on hand 21 necessary to care for a patient like this? 22 A. No. 23 Q. Let me go back to that then for a second. Do you 24 recall -- what it is that this conversation at 4:00 in 25 the afternoon, what is it that led you to the conclusion 13 (Pages 46 to 49) lectronically signed by Lei Sherra Torrence ( )

15 lectronically signed by Lei Sherra Torrence ( ) Franchell Richard Hamilton, MD July 20, 2015 Page 50 1 that UGH did not have the blood on hand that Mrs. Mejia 2 might need to care for her condition? Why did you have 3 that opinion? 4 A. The fact that she had -- so let me -- so this is 5 what was going through my head when he was telling me 6 she had a bleed. So -- and he is not a surgeon, so he 7 doesn't know the anatomy, but I'm familiar enough with 8 the anatomy that when someone typically has -- when 9 there's a bleed, it's typically cystic, hepatic. One of 10 the hepatics. The best treatment for that is 11 interventional radiology once the patient is stable. I 12 knew for a fact UGH did not have that capability. 13 Typically what happens when you have a bleed or a leak 14 even at the gallbladder or a common bile duct injury, 15 whatever the case may be. Any injury typically during a 16 laparoscopic case, the best treatment, the safest for 17 the patient after is typically interventional radiology, 18 and I knew UGH did not have those capabilities. 19 Q. And how is it you knew they didn't have that 20 capability? 21 A. Because I've worked there, and I've needed it for 22 other purposes and we couldn't do it. 23 Q. I'm ignorant. I'm not a doctor so I don't mean 24 to ask stupid questions. I am a lawyer so that's what I 25 do. With respect to this interventional radiology, is Page 51 1 that a department, is that an individual, is that a 2 piece of equipment? Why is it that -- what is it we're 3 talking about? 4 A. A combination of those things. So you have to 5 have -- yes, the radiology department which they have. 6 Then you have to have an interventional radiologist, 7 which is a radiologist who has specialty training, and 8 then you have to have the equipment. 9 Q. So was it that UGH did not have an interventional 10 radiologist? 11 A. They did not have that and they did not have the 12 equipment. 13 Q. Now, is this something you said in -- a moment 14 ago in your response that you'd run into this before? 15 A. Correct. 16 Q. What is it -- and I'm not trying to pry into 17 other patients' specific health history, but what is it 18 about your other experiences at UGH that led you to 19 conclude that they didn't have this necessary equipment 20 and specialist to do this work? 21 MR. RYAN: Let me caution you not to 22 disclose any information that relates in any way 23 specifically to other patients in his treatment you've 24 been involved. 25 Q. (BY MR. SAWICKI) Yeah, let me rephrase the Page 52 1 question. I'm not asking you about any other patients 2 specifically. But in your earlier response you said you 3 knew when Dr. Schade called you at 4 o'clock on the 27th 4 that the hospital -- that Mrs. Mejia first was going to 5 need interventional radiology; is that correct? 6 MR. RYAN: Objection; form. 7 MR. THORNTON: Objection; form. 8 MR. HINES: Objection; form. 9 A. I believe that that would have been a good 10 treatment for her. 11 Q. (BY MR. SAWICKI) All right. And that you knew 12 at that same time frame, 4 o'clock on the 27th, that UGH 13 did not have the necessary people or equipment to 14 provide that good treatment for her; is that true? 15 A. Yes. 16 Q. Why is it you knew at 4 p.m., thereabouts, on the 17 27th that UGH lacked that kind of capability to provide 18 that good treatment? 19 A. Because I asked as soon as I started taking ER 20 call if they had interventional radiology. 21 Q. And can you fix for me in time how many weeks, 22 days or months it was before this 4 o'clock on the 27th 23 time frame where you knew that? 24 A. Three months and as a surgeon it helps decide who 25 needs to stay and who needs to be transferred. Anybody Page 53 1 with an intraabdominal abscess, for example, that could 2 benefit from interventional radiology, they cannot do at 3 UGH; therefore, as a surgeon I would make the decision 4 to transfer that patient. 5 Q. Okay. Now, this equipment -- and if I refer to 6 it as interventional radiological equipment, would that 7 be a correct way to categorize it in a general sense? 8 A. Uh-huh. 9 Q. Is that a yes for her? 10 A. Yes. 11 Q. Sorry. Okay. So this -- on the 27th of June at 12 4 p.m., you knew that UGH did not have this 13 interventional radiological capability that you would 14 have recommended as a necessary treatment for 15 Mrs. Mejia, true? 16 MR. RYAN: Objection; form. 17 A. Yes. 18 Q. (BY MR. SAWICKI) Is that something you would 19 have expected a hospital to have had at its -- as part 20 of its offerings? 21 MR. RYAN: Objection; form. 22 A. Not necessary. 23 Q. (BY MR. SAWICKI) Would you have expected the 24 staff, though, to have understood that they didn't have 25 that capability at the hospital back in June of 2014? 14 (Pages 50 to 53)

16 lectronically signed by Lei Sherra Torrence ( ) Franchell Richard Hamilton, MD July 20, 2015 Page 54 1 A. The staff, no. 2 Q. How about Dr. Schade? Would you have expected 3 him to have known that the hospital didn't have that 4 kind of service available? 5 MR. RYAN: Form. 6 A. I would expect him to have known. I don't know 7 if I would have expected him to have known that that 8 would've been an appropriate treatment for this patient. 9 Q. (BY MR. SAWICKI) Is that something you would 10 have expected a surgeon familiar with laparoscopic 11 cholecystectomy and its potential complications to have 12 known? 13 MR. THORNTON: Form. 14 A. Yes. 15 Q. (BY MR. SAWICKI) Something you would have 16 expected, say, Dr. Bianco to have known? 17 A. Yes. 18 Q. Something you knew yourself, true? 19 A. Yes. 20 Q. Okay. And that's with respect to treating 21 complications of a laparoscopic cholecystectomy, a bleed 22 of the hepatic artery is something that surgeons 23 performing that procedure knows it's something that can 24 happen, true? 25 A. Yes. Page 55 1 Q. And the standard of care requires prompt 2 intervention and treatment of that condition because if 3 left untreated it can be dangerous to the patient; is 4 that true? 5 MR. RYAN: Form. 6 A. That could be true, yes. 7 Q. (BY MR. SAWICKI) And one of the treatments that 8 is accepted in the standard of care is to provide 9 interventional radiological type treatment to those 10 types of bleeds? 11 MR. RYAN: Form. 12 A. Well, there's multiple treatments. One would be 13 surgical. Hepatic artery is actually a larger artery so 14 that one may not have been able to been treated through 15 radio -- interventional radiography, but a smaller, like 16 a branch or the cystic artery, those are preferably 17 treated with interventional radiology. But the hepatic 18 artery is big enough that it requires. 19 Q. Did you do a lot of laparoscopic cholecystect cys -- starting over again. 21 Did you perform laparoscopic 22 cholecystectomies at UGH yourself? 23 A. Yes. 24 Q. Can you quantify or give me some idea of how many 25 you might have done at that particular facility? Page 56 1 A. Between April and this time I'd say double 2 digits, Q. When you performed them I know you didn't go in 4 intending for them to be any complications, did you have 5 a plan that if an interventional radiologist's services 6 were necessary what you would do in that situation if 7 your patient did need that? 8 A. Yes. 9 Q. What was the plan that you had for those patients 10 if they needed that kind of service? 11 A. So I would have to do it surgically. 12 Q. Okay. 13 A. And then potentially transfer. 14 Q. Did you have a particular facility in mind that 15 the transfer would -- the patient would be transferred 16 to? 17 A. I knew of this -- facilities around that had 18 interventional radiology. 19 Q. And what were those facilities that had that 20 services available that if you needed them you would 21 have sent your patient to? 22 A. Baylor and Methodist. 23 Q. Okay. Now, to go back to the conversation when 24 you told doctor -- when you were having this 25 conversation with Dr. Schade about the bylaws you told Page 57 1 me about your -- that's where -- I'm reorienting us back 2 to that and this concern that you had about the 3 interventional radiology. Is that something you 4 specifically told Dr. Schade about? 5 A. I did not. 6 MR. RYAN: Objection; form. 7 Q. (BY MR. SAWICKI) All right. Is there a reason 8 why you didn't tell him that you had that concern? 9 A. I feel like that conversation, the first, initial 10 conversation and even the second was so short, I didn't 11 really have an opportunity to explain all of my 12 concerns. 13 Q. Okay. So then the next thing you told me about 14 was that you felt like the reason you were uncomfortable 15 about taking over Mrs. Mejia's care, you said that you 16 felt she needed blood and you knew the hospital didn't 17 have sufficient blood supplies on hand? 18 MR. RYAN: Wait. 19 MR. THORNTON: Objection; form. 20 MR. RYAN: Objection; form. 21 Mischaracterizes her testimony. 22 Q. (BY MR. SAWICKI) Well, let me back up. I wrote 23 it down. So what I wrote down is you told or you felt 24 in your opinion that she needed blood and you knew the 25 hospital did not have blood on hand. Do you remember 15 (Pages 54 to 57)

17 Page 58 1 that? 2 MR. RYAN: Objection; form. 3 A. If she needed blood. 4 Q. (BY MR. SAWICKI) Right. So what was it that you 5 were telling me about earlier about Mrs. Mejia needing, 6 potentially, blood and the hospital not having it on 7 hand? 8 A. If somebody needs blood, I was told they only 9 carried O negative blood, like, two units. 10 Q. So let me -- let me reorient us. When we were 11 talking earlier, we were talking about the bylaws 12 discussion and you told me why you felt uncomfortable. 13 And we've already talked about some of that. But 14 another element of it was this concern about whether the 15 hospital had sufficient blood supplies. Is it this O 16 negative that you were referencing earlier? 17 A. Yes. 18 Q. All right. Was Mrs. Mejia -- I guess it'd been 19 related to you, am I correct, when Dr. Schade first 20 called you was that she had had a bleed, postoperative 21 bleeding; is that correct? 22 A. It was relayed that she had a bleed and required 23 return to the OR. 24 Q. Did you form the impression that she continued to 25 bleed or that that condition had been resolved? Page 60 1 A. Even when I spoke to Dr. Schade and I was asking 2 him give me more information about the patient, he could 3 not respond. He just kept saying call the nurse. And 4 then when I called the nurse, she couldn't tell me which 5 vessel had been injured. Really pretty much what she 6 did relay is that there was a bleed, it was repaired, 7 the patient got blood and the patient had been stable 8 for several hours. 9 Q. Did she relay anything to you that led you to 10 conclude that the bleed was completely resolved? 11 A. She just relayed the vitals and the patient had 12 been instable for several hours. 13 Q. If the patient had been stable and the nurse 14 reported that the second procedure had been completed to 15 address the bleed, could you tell me why you would have 16 a concern that the patient might need more blood in the 17 future? 18 A. Well, and that's the thing, I didn't do the 19 surgery and so that's my -- one of my concerns with 20 taking over someone's patient. I don't -- did they put 21 a clip on it, did they oversew it. I have no idea how 22 they -- how different people or different surgeons 23 repair vessels, and so being a surgeon, you know, and 24 this is a complication, ties can fall off, clips can 25 fall off so. Page 59 1 A. I was under the impression after speaking to the 2 nurse that it had resolved. 3 Q. Okay. What was it that led you to feel 4 uncomfortable about if Mrs. Mejia needed additional 5 blood, the hospital's ability to provide that blood? 6 Why was that a concern for you? 7 A. Knowing kind of -- and this is later -- well, 8 kind of during this, could tell me -- honestly, no one 9 really could tell me what happened or what was going on 10 and so I don't -- no one knew what artery, what it was 11 that was bleeding and so it's hard to know for sure 12 there's not going to be any issues later on down the 13 line when I don't -- I didn't really get a good idea of 14 what happened or what was repaired or what was injured. 15 Q. Okay. So let me fix up the time frame here in 16 your last response. When you initially received the 17 call from Dr. Schade, I think you told me you then also 18 talked to the OR nurse or someone in the ICU, right? 19 A. ICU nurse. 20 Q. And is it a result of that conversation that you 21 had this concern that you didn't really know what was 22 bleeding or whether it was fixed because no one could 23 accurately relay that to you? 24 MR. RYAN: Objection; form. 25 MR. HINES: Object to form. Page 61 1 Q. So at this point in time when you're talking to 2 the ICU nurse, did you have a concern that Mrs. Mejia 3 might still need additional blood products? 4 A. Not necessarily. 5 Q. Did you have a concern that if she did, the 6 hospital didn't have the supplies on hand? 7 A. I did. 8 Q. And is that because of this two units of O 9 negative? 10 A. Yes. 11 Q. So let me speak more about that. What is it 12 we're talking about when you're referencing two units of 13 O negative? Why is that insufficient to address the 14 concern you had? 15 THE WITNESS: Can I take a bathroom break 16 after I answer this? 17 MR. SAWICKI: Sure. 18 THE WITNESS: Okay. 19 A. So MR. RYAN: Thank you. 21 A. Two units of O negative blood is untyped 22 essentially and it is not uncommon for community 23 hospitals to keep this kind of on hand in case, but when 24 someone has extensive bleeding or a risk of extensive 25 bleeding, that amount of blood is not going to be 16 (Pages 58 to 61) lectronically signed by Lei Sherra Torrence ( )

18 Page 62 1 enough. For example, in trauma centers or there's 2 what's called, like, a massive transfusion protocol 3 where you do platelets, FFP and blood and they didn't 4 have this -- these products at the hospital. 5 Q. And I'll let you go after this one question. 6 A. Okay. 7 Q. So was that a concern you had at this 4 p.m. time 8 frame? 9 A. That was a concern that if something were to come 10 up, this hospital did not have the resources. 11 Q. And was that part of the reason why you felt she 12 needed to be transferred? 13 A. Yes. 14 Q. Okay. 15 A. And the interventional radiology. 16 MR. SAWICKI: Okay. Let's take that break. 17 THE WITNESS: Okay. Thank you. 18 THE VIDEOGRAPHER: Off the record 11:25 a.m. 19 (Break taken from 11:25 a.m. to 11:36 a.m.) 20 THE VIDEOGRAPHER: This begins media number 21 two. We're back on the record at 11:36 a.m. 22 Q. (BY MR. SAWICKI) Ma'am, are you ready to 23 continue? 24 A. Yes. 25 Q. I wanted to ask you, you used the term in our Page 64 1 place for them to be at. 2 Q. And why is that? 3 A. I feel, in particular, some of the nursing staff 4 are not used to dealing with certain types of 5 complicated patients. 6 Q. Did you believe that was implicated in 7 Mrs. Mejia's case? 8 MR. RYAN: Form. 9 MR. HINES: Object to form. 10 A. I have had conversations with certain ICU nurses 11 and felt that they did not -- they would not be able to 12 take care of a complicated patient and I have discussed 13 that with the CNO. 14 MR. HINES: Objection, nonresponsive. 15 Q. (BY MR. SAWICKI) Okay. So let me make sure I 16 understand. Did you have the opinion back when 17 Dr. Schade called you on the 27th of June 2014 that the 18 nurses in the University General Hospital's ICU might 19 not be able to care for Mrs. Mejia? 20 A. Yes. 21 Q. Why did you feel that the nurses at the 22 University General Hospital intensive care unit might 23 not be able to care for Mrs. Mejia? 24 A. Because of previous experiences that I've had 25 with less complicated patients. Page 63 1 prior discussions I wanted to make sure I wasn't 2 confusing things. Is a bleed to the hepatic artery 3 something you would describe as a colonic injury? 4 A. No. 5 Q. Okay. And then with respect to Mrs. Mejia, do 6 you know if she continued to bleed at any time after 7 this 4 p.m. conversation? 8 MR. RYAN: Form. 9 A. No. 10 Q. (BY MR. SAWICKI) You don't know one way or the 11 other? 12 A. I didn't -- I was unaware. 13 Q. Okay. Now, we were talking about the bylaws. 14 You've told me about when Dr. Schade first brought that 15 up, the concerns you had about her operations, the the complications, the blood issue. Were there any 17 other reasons why you didn't feel comfortable even 18 though Dr. Schade was saying the bylaws required you to 19 take over the patient that you haven't told me about 20 now? 21 A. My only other concerns that I had was there was 22 not an in-house intensivist. 23 Q. And what was your concern there? 24 A. I feel if patients who are complicated or require 25 more care, sometimes community hospitals aren't the best Page 65 1 Q. Okay. Can you describe generally what it is 2 those previous experiences were? Let me strike that and 3 start over. 4 Were these previous experiences with nurses 5 at University General Hospital? 6 A. Yes. 7 Q. Were they experiences regarding patients of your 8 own that you were caring for in the ICU setting? 9 A. They were in the ICU but they weren't like sick 10 like ICU patients. There were times where they were 11 just there because they didn't -- weren't moved or 12 whatever the case may be. 13 Q. Were the experiences that you're referencing with 14 the ICU nurses at the University General Hospital's Hospital prior to Mrs. Mejia, did those experiences lead 16 you to have a concern about their ability to handle a 17 case like Mrs. Mejia's? 18 A. Yes. 19 Q. Why? Why did you feel that way? 20 A. Because I've had much less complicated patients 21 where there was issues with orders getting done 22 properly. 23 Q. Did -- did those experiences lead you to feel 24 that the nurses working in the intensive care unit at 25 University General Hospital were not capable of doing 17 (Pages 62 to 65) lectronically signed by Lei Sherra Torrence ( )

19 lectronically signed by Lei Sherra Torrence ( ) Franchell Richard Hamilton, MD July 20, 2015 Page 66 1 the types of things you would have expected them to be 2 able to do? 3 A. Not all the nurses. 4 Q. Were there some that you felt were not qualified 5 or capable of handling the type of patients you expected 6 to be in the intensive care unit at a hospital? 7 A. There was some, yes. 8 Q. And what is it about them? I'm trying to get 9 more information. 10 A. There was some that didn't even know what some 11 basic orders were used for. For example, you start 12 somebody on medication to treat diabetes, and they 13 didn't -- weren't familiar with that medication; or 14 someone has a feeding tube, and they didn't know how to 15 manage that feeding tube. 16 Q. So did you have a concern back in 2014 that 17 nurses working in the University General Hospital's 18 intensive care unit didn't know -- some of the nurses 19 didn't know basic things about medications and how they 20 were to be used for patients in the intensive care unit? 21 MR. RYAN: Form. 22 MR. HINES: Object to the form. 23 A. There were one or two that I experienced that 24 didn't know what certain medications were used for. 25 Q. (BY MR. SAWICKI) Okay. Did you have concerns Page 67 1 that the nurses working at the University General 2 Hospital's intensive care unit had other issues other 3 than the knowledge of basic medications? 4 A. I had some issues with the knowledge of, as an 5 example, how to use a feeding tube. Some of them did 6 not know. 7 Q. As a surgeon, did you have confidence in the 8 nurses working at University General Hospital's 9 intensive care unit, that they would be capable of 10 handling a complex patient? 11 MR. THORNTON: Object to form. 12 MR. RYAN: Form. 13 MR. HINES: Object to the form. 14 A. No. 15 Q. (BY MR. SAWICKI) Why -- why did you have that 16 concern? 17 A. Just based on my interactions with the handful of 18 nurses that I ran into. 19 Q. Was this a -- something that built over the time 20 you worked at University General Hospital, or was it 21 something that was immediately apparent to you? 22 A. It was almost immediate. 23 Q. And why was it almost immediate? 24 A. Again, most of the cases I did there were through 25 the emergency room. I did not bring elective cases, and Page 68 1 the cases that I've done there I had some concerns about 2 my patient care from the nursing staff on the floor and 3 in the ICU. 4 Q. If you had the choice -- if you had a loved one 5 you were about to have to admit into an intensive care 6 unit in the hospital, would you have put that person in 7 University General Hospital? 8 MR. RYAN: Objection; form. 9 MR. HINES: Object to the form. 10 MR. THORNTON: Objection; form. 11 A. No. 12 Q. (BY MR. SAWICKI) Why not? 13 A. I didn't feel that -- I didn't feel like they 14 would be able to get the type of care, per se, they 15 needed. I felt like some of the nurses needed more 16 education. 17 Q. Did you express that concern to anyone at 18 University General? 19 A. I MR. HINES: To the extent she's going to get 21 into anything she did in the peer review MR. SAWICKI: Let me rephrase. 23 MR. HINES: -- proceeding of any sort. 24 MR. SAWICKI: Right. Yeah, totally. 25 MR. HINES: I instruct her not to answer. Page 69 1 Q. (BY MR. SAWICKI) Outside of the peer-review- 2 type discussion we had earlier, outside of that, did you 3 ever express these concerns you're telling me about the 4 nursing staff being -- some of the nurses staff being 5 incapable of handling for patients in the intensive care 6 unit to anyone at University General? 7 MR. RYAN: Wait. Wait. Wait. I'm going to 8 instruct you not to answer as to any peer review, any 9 quality assurance, any physician committee or hospital 10 committee interactions relating to quality assurance, 11 peer review, morbidity, mortality and similar types of 12 confidential interactions. With that caution, you can 13 answer his question. 14 A. Yes. 15 Q. (BY MR. SAWICKI) Again, outside of the 16 instructions, who did you relay that information to? 17 A. The CNO. 18 Q. And do you recall who that was? 19 A. I think her first name was Emily. 20 Q. And what led you to talk to the CNO, Emily, about 21 your concerns about the capability of the intensive care 22 unit nurses at University General Hospital? 23 A. From the care that I had from my own patients. 24 Q. Was there a particular incident that triggered 25 this conversation? 18 (Pages 66 to 69)

20 Page 70 1 A. I'm sure, but I do not recall the exact. 2 Q. Do you remember the time frame when this 3 conversation came? 4 A. I remember speaking to her once probably in April 5 and May. 6 Q. Of 2014, correct? 7 A. Yes. 8 Q. Do you recall the -- the response, the CNO, 9 Emily, made to your concerns? 10 A. She said that she would take care of it and excuse me -- educate the nurses. 12 Q. Did you see any action consistent with that? 13 A. No. 14 Q. Did you continue to have this concern about the 15 capabilities of the nursing staff through the course of 16 your relationship with University General? 17 A. Yes. 18 Q. Did it ever go away? 19 A. No. 20 Q. Did it get better or worse or stayed the same? 21 A. Stayed the same. 22 Q. All right. So we've talked -- have we talked 23 about all the concerns you had about the nurses or some 24 of the nurses in the intensive care unit at University 25 General Hospital in your mind not being qualified to Page 72 1 making or raising this concern? 2 A. I wasn't the only one. 3 Q. Can you give me your recollection of was this a 4 widespread concern or was this a small concern? 5 A. Well, the concerns were different for different 6 specialties, but in general, some of the physicians that 7 I spoke to also had similar concerns. 8 Q. Would this have been -- can you describe for me 9 the population of doctors that were expressing this 10 concern? By that, I mean, were they all surgeons or 11 were they spread over a range of specialties and 12 performances? 13 A. They were spread. 14 Q. Among this group when you discussed your concerns 15 about the capabilities of the nursing staff, was it a 16 systemic concern or were there specific departments 17 where there was a problem? 18 MR. HINES: Object to the form. 19 MR. RYAN: Form. 20 A. Based on my discussions it sound like a systemic. 21 Q. (BY MR. SAWICKI) Why was it your impression in 22 your discussions with other doctors that they had a 23 concern about a systemic problem with nurses at 24 University General Hospital? 25 MR. HINES: Object to form. Page 71 1 handle patients like Mrs. Mejia? Were there any other 2 conversations about that that we haven't talked about? 3 MR. HINES: Form. 4 Q. (BY MR. SAWICKI) Again, outside of the peer 5 review instruction that your attorney gave you. 6 A. That's it. 7 Q. I guess bad way of asking. Other than Emily, 8 were there any other individuals that you had that 9 conversation with? 10 MR. RYAN: Outside the context? 11 MR. SAWICKI: Again -- right. 12 A. Yes. Yes. 13 Q. (BY MR. SAWICKI) For all of my question outside 14 the context of peer review, were there others, other 15 than Emily, that you've told me about where you've had 16 that same kind of conversation? 17 A. Yes. 18 Q. Tell me about those. 19 A. It was with other physicians. We Q. What did you talk about with other physicians in 21 that regard? 22 A. The concerns with some of the nursing staff. Not 23 necessarily in the ICU but in general. 24 Q. Was this concern something that other doctors 25 related that they had also, or were you the only one Page 73 1 A. Because it wasn't in just one area. 2 Q. (BY MR. SAWICKI) What do you mean by that? 3 A. For example, it wasn't just ICU nurses. 4 Q. What was it? 5 A. OR nurses, floor nurses, you know. There was -- 6 I mean, every -- like I said, it was kind of a wide 7 range. We all worked in different areas and everybody 8 had some type of complaint. 9 Q. Were these complaints from other doctors 10 something that happened -- or were they something you 11 heard, rather, when you first started working there or 12 at some other point in time? 13 A. When I first started working. 14 Q. Was it something you heard right away or was it 15 after being there a period of time? 16 A. Right away. 17 Q. Was it something that changed over the course of 18 your relationship with University General or did it stay 19 the same? 20 A. Honestly, I -- it's hard to answer that question 21 because I started going to University General less and 22 less as the longer -- so I don't -- I don't know if it 23 got better. 24 Q. Did doctors ever relate to you that conditions 25 had improved at some point in time? 19 (Pages 70 to 73) lectronically signed by Lei Sherra Torrence ( )