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Eugene D. Lee (SB#: 236812) LAW OFFICE OF EUGENE LEE 555 West Fifth Street, Suite 3100 Los Angeles, CA 90013 Phone: (213) 992-3299 Fax: (213) 596-0487 email: [email protected] Attorney for Plaintiff DAVID F. JADWIN, D.O.

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UNITED STATES DISTRICT COURT

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EASTERN DISTRICT OF CALIFORNIA

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FRESNO DIVISION

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DAVID F. JADWIN, D.O.,

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Plaintiff, v.

Civil Action No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE LEE IN OPPOSITION TO DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Fed. R. Civ. P. 56(a)]

COUNTY OF KERN, et al.,

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Defendants.

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Date: January 12, 2009 Time: 10:00 Judge: Hon. Oliver W. Wanger Courtroom: 3 Complaint Filed: January 6, 2007 Trial Date: March 24, 2009

18 19 I, Eugene D. Lee, declare as follows: 20 1.

I am an attorney at law duly licensed to practice before the Federal and State Courts of

21 California and admitted to practice before the U.S.D.C. for the Eastern District of California. I am 22 counsel of record for Plaintiff David F. Jadwin in this matter. 23 2.

I am making this declaration in opposition to Defendants’ Motion for Summary

24 Judgment. I have personal knowledge of the matters set forth below and I could and would competently 25 testify thereto if called as a witness in this matter. 26 3.

Attached hereto as Exhibits are true and correct copies of the following documents:

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Exh. 1

Date 7/10/2006

Description Memo from Mr. Bryan to JCC re Recommendation of Demotion of Dr. Jadwin

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8/14/2008 8/26/2008 1/9/2008 3/12/2008 10/21/2008

Deposition Transcript of Peter Bryan, Vol I Deposition Transcript of Peter Bryan, Vol II Deposition Transcript of David Jadwin, Vol II Deposition Transcript of David Jadwin, Vol V Deposition Transcript of David Jadwin, Vol VI

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8/18/2008

Deposition Transcript of Former Supervisor Barbara Patrick, Vol I

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4/16/2008

Deposition Transcript of Former Lab Mgr Gilbert Martinez

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8/22/2008

Deposition Transcript of Former President Scott Ragland

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8/25/2008

Deposition Transcript of Supervisor Ray Watson

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8/21/2008

Deposition Transcript of Former CEO David Culberson

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8/29/2008

Deposition Transcript of PMK Philip Dutt, Vol. I

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8/28/2008

Deposition Transcript of Former COO Sandra Chester

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9/4/2008

Deposition Transcript of PMK Eugene Kercher

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6/29/2006

Letter from Lee to Barnes re Spoliation of Evidence

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3/29/2007

Letter from Lee to Barnes re Spoliation of Evidence

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11/20/2007 Defendants’ Responses to Plaintiff’s Request for Production, Set One

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9/10/2007

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Joint Conference Committee Meeting Minutes re Demotion of OB/GYN Chair Kern County Policy & Administrative Procedures Manual, Section 139 (Disciplinary Actions)

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3/12/2002

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12/26/2003 Change of Employee Status

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CMO Marvin Kolb Memo to Jose Perez re Pathologist Elsa Ang Accusations

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5/15/2006

Expert Consulting Services Agreement, between Consultant William Colburn and Kern County

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8/30/2006

Consultant William Colburn Report to Kern County re Review of Jadwin cases

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8/13/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. I

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8/27/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. II

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5/3/2004

KMC FNA Consulting Project by UCLA Consultant David Lieu

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8/18/2008

Deposition Transcript of Former President of Medical Staff Jennifer Abraham

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Cancer Conference Presenter Guidelines

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8/15/2008

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10/19/2005 Exh. 202: Jadwin letter to Albert McBride, Cancer Conference Director re October Conference

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Deposition Transcript of Former Cancer Committee Director Albert McBride

October Conference attendee feedback

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11/9/2005

Oncology Conference attendee feedback of Savita Shertukde

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8/25/2008

Deposition Transcript of OB-GYN Physician Joseph Mansour

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Harris Memos to File re Mansour Behavior

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5/10/2006 to 4/12/2007 8/19/2008

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8/18/2008

Deposition Transcript of Chair of Surgery Maureen Martin, Vol. I

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4/16/2008

Deposition Transcript of Histotech Evangeline Gallegos

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4/19/2008

Deposition Transcript of Former CMO Marvin Kolb

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2/26/2008

Deposition Transcript of Pathology Secretary Tracy Lindsey

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2/26/2008

Deposition Transcript of Clerk Irene Lopez

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Deposition Transcript of Nurse Executive Antoinette Smith, Vol. I

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12/6/2007

Deposition Transcript of Radiology Chair Javad Naderi

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12/6/2007

Deposition Transcript of Cancer Committee Chair Ravi Patel

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8/15/2008

Deposition Transcript of Former CEO Secretary Arlene Ramos-Aninion

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12/5/2007

Deposition Transcript of Surgeon Edward Taylor

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12/6/2007

Deposition Transcript of Neurosurgeon Charles Wrobel

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8/21/2008

Deposition Transcript of Psychiatry Chair Tai Yoo

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8/20/2008

Deposition Transcript of Acting Pathology Chair Philip Dutt

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9/14/2006

Acting Pathology Chair Philip Dutt Email to Barnes re Plaintiff’s Paycut Amendment

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10/17/05

Plaintiff email to Bryan re Serious Biopsy Errors

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3/2/2006

Exh. 271: Plaintiff email to Bryan re Serious Biopsy Errors

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4/21/2006

Emails between Plaintiff and Bryan re Serious Biopsy Errors

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8/7/2008

Deposition Transcript of Pathologist Savita Shertukde

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3/11/2008

Deposition Transcript of David Jadwin, Vol. IV

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10/21/2003 Confidential Report on Lau Complaint against Jadwin

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1/8/2008

Deposition Transcript of David Jadwin, Vol. I

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9/9/2008

Deposition Transcript of PMK Acting Pathology Chair Philip Dutt, Vol. II

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12/4/2007

Deposition Transcript of HR Director Steven O’Connor

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10/10/2005 Amendment No. 1 to Employment Contract of Acting Pathology Chair Philip Dutt

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11/1/2005

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Employment Contract of Pathologist Savita Shertukde

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6/19/2007 4.

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Employment Contract of Pathologist Gian Yakoub

Attached hereto as Exhibits 2-14, 24-25, 27, 29, 33, 35-47, 52-53 and 55-57 are true and

correct certified copies of deposition transcripts which I either personally conducted or attended. 5.

Attached hereto as Exhibits 15-16 are true and correct copies of letters which I authored

and faxed to Karen Barnes, Chief Deputy County Counsel for the County of Kern on the dates indicated. 6.

I have served four sets of written discovery on Defendants which included Document

Request No. 44. asking for “Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from Chair of Kern Medical Center’s Pathology Department to staff pathologist.” To date, Defendants have not produced any of the agendas for any JCC meetings including the meeting at which the JCC voted to approve Plaintiff’s demotion from chair. Defendants have engaged in a level of discovery obstruction that is more excessive than I have ever encountered in my 13 years practicing as an attorney, of which this is but the latest example. 7.

Attached hereto as Exhibits 17 is a true and correct copy of Defendants’ responses

received by me in response to Plaintiff’s Request for Production of Documents, Set One, propounded by me on behalf of Plaintiff.

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I declare under penalty of perjury under the laws of the State of California and the United States that the foregoing is true and correct.

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Executed on: December 1, 2008

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/s/ Eugene D. Lee

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EUGENE D. LEE Declarant

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EXHIBIT 1

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",.,

KERN MEDICAL CENTER ADMINISTRATION OFFICE MEMORANDUM TO:

Joint Conference Committee

FROM:

Peter K. Bryan, CEO

SUBJECT:

Chairmanship, Department of Pathology

DATE: July 10,2006

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Under the provisions ofparagraph 9.7-4 ofthe Medical StaffBylaws (enclosure 1) I recommend that Dr. David Jadwin be removed as Chairman, Department of Pathology. This recommendation is based on Dr. Jadwin's unavailability for service because of extended medical leaves for non-work related ailments. The pertinent facts related to this recommendation are as follows: 1. Dr. Jadwin is employed through an Agreement for Professional Services, Contract Employee, dated November 12, 2002 with the term of agreement running from October 5, 2002 through October 4,2007. He has been employed at KMC as a department chairman since October 24, 2000 (see enclosure 2). 2. Dr. Jadwin's job duties are identified in Exhibit A ofthat employment agreement and in paragraph 9.7-5 of the Medical Staff Bylaws. His usual work schedule calls for him to work an average of 48 hours each week. He is subject to the terms of his contract and all policies of the County, KMC and the medical staff governing documents. 3. As chairman ofa department, Dr. Jadwin is a key member ofthe leadership team. His physical presence is necessary on a regular basis for not just the effective functioning ofhis department, but also for institutional decision making through daily interactions with members of the medical and administrative staff. 4. Dr. Jadwin accrues vacation time at the rate of 6.15 hours per pay period for a maximum accrual of 160 hours per year. He accrues sick leave at the rate of2.46 hours per pay period with a maximum accrual of 64 hours per year. By the beginning ofpay period 05-23 (after a little more than five years of service), Dr. Jadwin had used 784 Clfthe 802 hours ofvacatiori accrued leaving a balance ofl8 hours, and he had used 272 of the 320 hours of sick leave accrued leaving a balance of about 48 hours. 5. In mid November 2005 Dr. Jadwin continued using vacation and sick time at a relatively high rate such that beginning in January 2006 he began to be paid for fewer than 80 hours per pay period. In other words, his rate ofabsence exceeded his accrual rates for vacation and sick leave. 6. On March 2,2006 Dr. Jadwin submitted a request for a 90-day medical leave retroactive to December 16,2005 and running through March 15,2006 with a I' return to duty on Thursday, March 16, 2006 (enclosure 3). This requestow,As approved in accordance with County Policy (enclosure 4). . U0147\)

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7. Dr. Jadwin did not report for work until March 23, 2006, working only two days that pay period and a total of only 50 hours during the entire month of April. 8. On April 22, 2006 Dr. Jadwin submits another requestfor a six-month medical leave retroactive to March IS, 2006 and extending through September IS, 2006 (see enclosure 5). Based on this request, on April 28, 2006 I met with Dr. Jadwin, Steve O'Connor from Human Resources, and Karen Barnes to discuss Dr, Jadwin's medical leave status and expectations for return to work. Dr. Jadwin was informed that County Policy allowed him a total of 480 hours of intermittent leave over a 12-month period. Also, that at his rate of use, he had only 137 hours of medical leave left available which would take him through June 16,2006, by which time he was instructed to give me his decision about his employment status. His options were to either return full time or resign his position. Dr. Jadwin indicated that he understood the conditions and that he would not be at work from May 1,2006 until his return (see enclosure6). 9. In early June 2006 Dr. Jadwin informed me in writing that he had another medical incident, could not return to work by June 16, 2006 and that he needed to extend his medical leave. This prompted my memorandum to him dated June 14, 2006 in which I informed him of two things. First, that pursuant to County Policy I would approve a Personal Necessity Leave of up to 90 days (enclosure 7). Second, that because of his continued absences, I was going to invoke the provisions ofthe Medical StaffBylaws and rescind his appointment as Chairman, Department of Pathology. Should he decide to return to work by the end of this 90 days period his contract would be changed to reflect a regular staffpathologist duty assignment as mutually agreed (see enclosure 8). 10. Since the middle of November 2005 Dr. Jadwin has worked only 32% of the hours normally expected ofa full time pathologist (enclosure 9). Since my notice of June 14,2006 Dr. Jadwin has made no attempt to contact me concerning my decision to relieve him of his chairman duties nor has he indicated any desire to negotiate a new contract. This recommendation to rescind Dr. Jadwin's appointment as Chairman, Department ofPathology is based solely on his continued non-availability to provide the leadership necessary for a contributing member ofthe medical staffleadership group. KMC must have its key personnel available, and Dr. Jadwin has provided no indication that he is committed to return to work or resume his duties as chairman. Other than his latest written communication requesting an extension ofmedical leave, Dr. Jadwin hasmade no attempt in the last two months to contact me concerning his employment status or how the Department of Pathology should be managed during his extended absence. I therefore request that the Joint Conference Committee act pursuant to paragraph 9.7-4 of the Medical Staff Bylaws and, by majority vote, endorse my recommendation to rescind Dr. Jadwin's appointment as Chairman, Department of Pathology. Enclosures (9) cc:

Bernard Barman, County Counsel Karen Bames, Deputy County Counsel Irwin Harris, M.D., Chief Medical Officer

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the chief executive officer without hearing and appeal rights set forth in Article XII. 9.7-3

TERM OF OFFICE Each department chair shall serve until he/she resigns, is removed from office, or loses his or her medical staff membership or clinical privileges in that department.

9.7-4

REMOVAL Removal of a department chair may occur with or without cause upon the recommendation of the chief executive officer with the majority vote of the Joint Conference Committee.

9.7-5 RESPONSIBILITIES AND DUTIES OF DEPARTMENT CHAIRS Each department shall have a chair that shall be responsible for the overall supervision of clinical activity within the department. The chief executive officer shall review service by the department chair no less than biennially. The chair shall be responsible to the board, through the medical executive committee, for the following:

A.

High quality professional management and care of patients under the jurisdiction of the department.

B.

Establishing systems to monitor the quality of patient care and professional performance in the department through a planned and systematic process.

C.

Specific recornmendations and suggestions regarding improvement of patient care in his or her department.

D.

Review of professional performance of all members with respectto clinical privileges.

E.

Recommending delineated clinical privileges for each member of the department, including practitioner appointment and classification, reappointment, criteria for clinical privileges, and corrective action.

F. G.

the

Discipline of members and staff pursuant to Article XI. Evaluation of all full- and part-time medical staff and other members of the medical staff who are active clinically, or teach on an annual basis. Bylaws of the Medical Staff of Kern Medical Center Page 48

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;.1

Kern County

AGREEMENT FOR PROFESSIONAL SERVICES CONTRACT EMPLOYEE (County of Kern - David F. Jadwin, D.O.)

This Agreement is made and entered into this I ~ -eA day of M{~'t.tIt- , 2002, between the County of Kern, a political subdivision of the State of California (hereinafter "County"), which owns and operates Kern Medical Center (hereinafter "KMC"), and David F. Jadwin, D.O. (hereinafter "Core Physician"), a contract employee. RECITALS WHEREAS:

A.

County is authorized, pursuant to Government Code section 31000, to contract with specially trained persons, and further authorizes the payment of. compensation for the services rendered; and B. County requires assistance in the performance of professional medical services at KMC as such services are unavailable from County resources; and C. Core Physician has special training, knowledge and experience a"nd is licensed by the State of California to practice medicine and is qualified to render medical services. NOW, THEREFORE, it is agreed between County and Core Physician as follows:

Article I. TERM AND CONDITIONS

1.

TERM

The existing Agreement for Professional Services between County and Core Physician (Kern County Agt. #1012-2000, dated October 24, 2000) is terminated effective October 5,2002. This Agreement shalt be effective on October 5,2002, and shall remain in effect through" October 4, 2007. 2.

SERVICES

Core Physician shall render services as set forth in Exhibit "A," which is attached "and made a part of this Agreement.

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Article II. COMPENSATION 1.

SALARY (BASE) Core Physician shall be entitled to the following base compensation (as defined in Article II, Section 3): A. Core Physician will work full-time (i.e., according to AMA survey data for specialty but no less than forty [40] hours per week) and will be compensated with cash and other value as follows: Core Physician will be paid Eleven Thousand Twenty-One Dollars and Eight Cents ($11,021.08) biweekly not to exceed Two Hundred Eighty-Seven Thousand Five Hundred Twenty-Nine Dollars ($287,529) annually. The maximum payable under this Agreement shall not exceed One Million Four Hundred Thirty-Seven Thousand Six Hundred FortyFive Dollars ($1,437,645) per the five-year term of the Agreement. County will withhold, from said daily compensation of Core Physician, all applicable federal, state and local payroll taxes. County will pay the Employers portion of the hospital insurance portion of Social Security ("FICA 2"). B. Core Physician will be paid biweekly on the same schedule as regular fulltime County employees. The exact date of said biweekly payments will be at the sole discretion of County, as is reasonable and convenient for County. C. No adjustment in compensation will be effective without a written amendment to this Agreement.

2.

OVERALL COMPENSATION STRUCTURE A. The purpose of this compensation plan is to provide market-based, performance-driven compensation that recognizes a Core Physician's efforts and contributions toward promoting the mission and values of KMC. Core Physicians will be identified as such in their contracts with KMC. B. Total compensation for Core Physicians will be composed of a base salary paid by the County, professional fee payments from third-party payors, and potential other income generated due to the individual's status as a physician. These ihree sources of income shall he. referred to in this Agreement as total Core Physician compensation. The structure for determining total Core Physician compensation shall be referred to in this Agreement as the compensation plan.

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C. A Kern County clearing account and a KMC compensation budget unit will be established to account for all funds generated and received to pay total Core Physician compensation and to pay all expenses associated with this compensation plan. These will act as trust accounts and will be solely used for this purpose. D. A Plan Administrator will be retained by KMC to administer this compensation plan and will report to the Faculty Practice Board. E. A Board of Directors will be established to oversee the compensation plan and the Plan Administrator of the compensation plan. This Board of Directors shall be referred to in this Agreement as the Faculty Practice Board. The Faculty Practice Board will establish bylaws including powers, duties and responsibilities· to be approved both by a simple majority of the Faculty Practice Board and the CEOofKMC. F. An assessment for administrative expenses shall be made on total Core Physician compensation to support the administrative expenses of the compensation plan. (1) The amount or percentage of the assessment shall be determined annually by the Faculty Practice Board.. (2) Administrative expenses shall include the salary and benefits for the Plan Administrator and any staff hired by KMC to support the Plan Administrator, expenses of the Kern County Pension Plan for Physician Employees, and other business expenses as determined by the Plan Administrator and the Faculty Practice Board. (3) The amount or percentage of the assessment shall not exceed one percent of Core Physician's total compensation (as defined in Article II, Section 2, paragraph B) during the first two years of this Agreement. G. County will cover all professional services rendered by Core Physicians at KMC and at sites designated by the CEO and Plan Administrator under County's liability and malpractice coverage program. Such liability and malpractice coverage program shall not extend to any conduct, actions or activities, which do .not arise directly from the performance of this Agreement. As a matter of law, County shall defend and indemnify Core Physician to the same extent as would be afforded to a regular full-time County employee.

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BASE SALARY (ITEMS INCLUDED AND METHOD OF PAYMENT)

A.· Base salary is compensation paid to Core Physician by the County for. (1) patient care for Medically Indigent Adults (MIA), as defined by California Welfare and Institutions Code section 17000 et seq., and adults ahd juveniles incarcerated and detained in County facilities; (2) as a safety-net provider, partial compensation for under-compensated and uninsured patients; (3) teaching; (4) administrative duties; and (5) other activities approved by the CEO of KMC and the Faculty Practice Board. County shall fund the clearing account unit biweekly with an amount equal to Core Physician's biweekly base salary. The base salary, less the assessment for administrative expenses, will be reported as wages and subject to all appropriate federal and state taxes. The base salary will be considered the minimum compensation that a Core Physician shall receive under this compensation plan. B. The base salary will be based on a benchmark salary in proportion to the Core Physician's full-effort commitment. (1) The structure of benchmark salaries is based upon a national standard with four salary steps: "An, "B", "COl and "D." There are three criteria for step placement: level of clinical service, teaching, and administrative duties. This benchmark salary structure and criteria for step placement are set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual. (2) The Faculty Practice Board shall establish the criteria for measuring the full-effort commitment. The Department Chairs, with approval of the Faculty Practice Board, will establish the expected levels of the criteria to meet a full-effort commitment. The criteria for measurement of full-effort commitment is set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual. (3) Research shall not be considered as part of a Core Physician's fulleffort. commitment. Research activity will be compensated as set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual.

4.

PROFESSIONAL FEES

Professional fees include all professional fee collections or payments associated with direct patient care by Core Physician. This shall be· referred to in this Agreement as professional fees. Core Physician, or in cases where Core Physician is part of a practice group entering into an agreement for services with the County, Core Physician's practice group, is responsible for billing and 4

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collecting all professional fees for Core Physician's services. Each Core , Physician or practice group will have a separate tax identification number. Professional fees shall be collected and dispersed as follows:

A.

Professional fee billing by Core Physician or his or her practice group shall be made by a billing service company, approved in advance by the Faculty Practice Board, and based' upon minimum performance standards set by the Faculty Practice Board. All professional fees collected by the billing service for Core Physician (Le., gross professional fees, collected) shall be paid to the clearing account. The billing service will maintain individual and practice group records on professional fee billing and collections and will account for suchto the Plan Administrator. B. The assessment for administrative expenses will be deducted from gross professional fees collected. C. Overhead and expenses for a practice group or a Core Physician who is a sale practitioner, as deterr:nined by an overhead distribution formula established by the Plan Administrator and the Faculty Practice Board, will be deducted from the gross professional fees collected and returned to the practice group or Core Physician who is a sole practitioner. D. Each Department within KMC, at its option, may establish a Departmental, Pool in which a percentage of the remaining gross professional fees collected will be distributed to all Core Physicians within that Department based upon specific criteria approved by the Faculty Practice Board.

E. Gross professional fees collected, less the assessment for administrative expenses, overhead, and an optional Departmental pool (Le., net professional fees collected) will be paid monthly as wages and will be subject to all appropriate federal and state taxes; however, practice groups (consistent with their practice group agreements with the County), Core Physicians who are sole practitioners, or Core Physicians not associated with a practice group may direct the Plan Administrator as to the distribution of net professional fees collected, subject to review by the Faculty Practice Board. 5.

OTHER INCOME

A. Other income IS Income generated due to, the individual's status as a physician, which includes, but is not limited to, royalties, grants, speaker fees, professional witness fees, and other nonprofessional fees.

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B. All other income will be paid to the Cqre Physician in accordance with instructions provided the clearing account by Core Physician or Core Physician's practice group. Expenses properly incurred by the Core Physician in. generating other income will be reimbursed to the Core Physician prior to the balance being channeled through the clearing account. This remainder, less assessment for administrative expenses, will be paid monthly to Core Physician as wages. Other income shall be reported as wages and subject to all appropriate federal and state taxes. C. Income generated by a Core Physician that is deposited to the Community Medical Education and Research Foundation ("CMERF") for department educational use shall not be included as other income and shall not be subject to the assessment fot administrative expenses.

6.

PRACTICE GROUPS

A. All practice groups will contract with KMC for the provision of community . clinic services, which shall be integrated into the KMC teaching program. The contract between each pr~ctice group and KMC will define the responsibilities and funds flow, including professional fee distribution, between each organization. B. Practice group overhead and business-related expenses will be paid by the practice group in accordance with predetermined instructions. Practice groups will determine the policy for expense limits and reimbursable items. County is not responsible for the amount of group overhead and business-related expenses claimed.

7.

SOLE PRACTITIONERS

A. Sole practitioners are Core Physicians who are sole proprietors or have their own professional corporation. Core Physicians who are sole practitioners will be responsible for the cost of professional fee billing as negotiated by the Core Physician with the billing service company. Sole practitioner overhead and business-related expenses will be paid by the sole practitioner. Sole practitioners will determine the policy for expense limits and reimbursable items. County is not responsible for the amount of overhead and business-related expenses claimed. B. Any other overhead amount for use of space, supplies and personnel at KMC-owned or -contracted sites will be negotiated with the CEO of KMC.

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OTHER CORE PHYSICIANS Core Physicians who -are not part of a practice group and who are not sole practitioners and who practice exclusively at KMC-owned or -contracted sites will be responsible for the cost of professional fee billing as negotiated by the Core . Physician with the billing seiVice company.

9.

DEPARTMENTAL POOL Each Department of KMC, by simple majority of Core Physicians within that Department, may opt on a yearly basis to participate in a departmental pool. The departmental pool is a group incentive pool funded by net professional fees from a participating. Department to reward· Core Physicians within that Department for activities not recognized by other parts of this compensation plan. Each Department participating in a pool will establish criteria with the approval of the Faculty Practice Board for pool distribution. The percentage of net professional fees to be allocated to the departmental pool will be determined on a yearly basis by the Department with the approval of the Faculty Practice Board. The departmental pool will be distributed quarterly as wages· and will be subject to all appropriate federal and state taxes.

Article III. BENEFITS 1.

EFFECTIVE DATE OF BENEFITS The date of employment for the purpose of receiving and accruing benefits listed in this Article III shall not be affected by the date of this Agreement, but shall be the date the Core Physician was first continuously employed by KMC.

2.

HEALTH INSURANCE County shall provide to Core Physician and eligible dependents medical, dental and vision insurance as provided. to other regular County employees of KMC. Core Physicians first hired by the County of Kern after April 15, 1997 must pay twenty (20) percent of the cost of their health benefits. County may change the benefits proVided under this insurance as such benefits shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

3.

PAID LEAVE OF ABSENCE Core Physician will receive paid leave for holidays, vacation, sick leave and educational leave. 7

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A.

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Holidays:

Core Physician shall be entitled to such holidays as provided to full-time County employees of KMC. County may change the holidays provided under this section as such holidays change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement. B.

Vacation:

For each pay period of service, Core Physician shall be credited with a vacation entitlement of 6.15 hours, for a maximum accrual of 160 hours per year. Total unused vacation accumulated shall not exceed a maximum of 320 hours. No further vacation entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued vacation entitlement shall be credited to a maximum of 320 hours. Unused vacation benefits will be credited to Core Physician to a maximum of 320 hours if this Agreement is renewed. Core Physician will be paid for accrued and unused vacation hours upon termination of employment. C.

Sick Leave:

For each pay period of service, Core Physician shall be credited with sick leave credit for illness or accident of 2.46 hours, for a maximum accrual of 64 hours per year. After five years of employment, including full-time employment prior to the effective date of this Agreement, Core Physician shall earn and accrue sick leave credit for illness or accident at the rate of 3.07 hours for each pay period of service for an annual accrual of 80 hours per year. Total unused sick leave accumulated shall not exceed a maximum of 1152 hours. No further sick leave entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern. accrued sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will be credited to Core Physician to a maximum of 1152 hours if this Agreement is renewed. Core Physician will not be paid for accrued and unused sick leave ·upon termination of employment. County policy applicable to other regular County employees of KMC regarding use of sick leave shall apply to Core Physician. D.

Educational Leave:

Core Physician shall receive 80 hours paid education leave annually. The first 80 hours shall be credited on the effective date of the Core Physician's employment contract. On each successive anniversary date of that contract, an additional 80 hours shall accrue. Education leave must be used within the year that it is accrued and unused education leave does not accrue to the following

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contract year. Unused education leave will not be paid upon termination of employment. All education leave must be approved in advance of use by the Core Physician's Department Chair and the Medical Director.

4.

UNPAID LEAVE OF ABSENCE County shall provide Core Physician the right to unpaid leave of absence provided to other regular County employees of KMC pursuant to County policy. County may change its policy regarding leave of absence, as its policy for leave of absence shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

5.

RETIREMENT PLAN A. Core Physician shall participate in the Kern County Pension Plan and Trust Agreement for Physician Employees (the "Plan"),a qualified defined contribution pension plan, pursuant to the terms of the instrument under which the Plan has been established (the "Plan Document"), as from. time-to-time amended. County shall withhold 3.1 percent of Core Physician's biweekly gross salary (that is, before deductions including taxes) and pay such amount within a reasonable time as the Core Physician's mandatory employee contribution required under the Plan Document. County shall contribute an additional amount equal to 12.5 percent of Core Physician's biweekly gross salary (that is, before deductions including taxes) as County's required contribution under the Plan Document. Total contributions by Core Physician and County will not exceed the yearly amount allowed by law; provided, however, if any amounts are contributed in excess of such permissible amounts, the excess contribution shall be corrected as provided in the Plan Document or under law. Any changes in the Plan Document will control the terms of this Agreement. B. Subject to the receipt ofa favorable determination letter from the Internal Revenue Service, County will amend and restate the Plan Document to substitute a fixed-dollar contribution by County and Core Physician in lieu of the contributions provided in the immediately preceding paragraph A. County and. Core Physician contributions for each Plan' year (as defined In the Plan Document) under the amended and restated Plan document shall be as follows: County shall contribute as County's required contribution the sum of Seventeen Thousand Five Hundred Dollars ($17,500) for the accountof Core Physician for each complete Plan year of service (as defined in the Plan Document) by Core Physician. Core Physician's mandatory employee contributions required under the amended and restated Plan Document shall be as follows: If Core Physician's Compensation (as defined under the Plan Document) was One Hundred Fifty Thousand Dollars ($150,000) or less during the immediately preceding Plan year, Core Physician's mandatory employee contribution required 9

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under the Plan Document shall be $4,000 for a complete Plan year of service by Core Physician. If Core Physician's Compensation was more than One Hundred and Fifty Thousand Dollars ($150,000) but less than One Hundred and Seventy Thousand Dollars ($-170,000), during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Nine Thousand Dollars ($9,000). If Core Physician's Compensation was One Hundred Seventy Thousand Dollars ($170,000) or more but less than One Hundred Eighty Thousand Dollars ($180,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Twelve Thousand Five Hundred Dollars ($12,500) for a complete Plan year of services. If Core Physician's Compensation was One Hundred and Eighty Thousand ($180,000) or more but less than One Hundred Ninety Thousand Dollars ($190,000)during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Seventeen Thousand Five Hundred Dollars ($17,500) for a complete Plan year of services. If Core Physician's Compensation was at least One Hundred Ninety Thousand Dollars ($190,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be the maximum amount permitted by Internal Revenue Code section 415(c)(1 ) (which is currently $40,000) reduced by the County contribution for the account of Core Physician for the Plan year. Core Physician's mandatory employee contributions shall be withheld by County from Core Physician's biweekly salary in relatively equal amounts. Total contributions by Core Physician and County will not exceed the yearly amount allowed by law; provided, however, if any amounts are contributed in excess of such permissible amounts, the excess contribution shall be corrected as provided in the Plan Document or under law. Any changes in the Plan Document will control the terms of this Agreement. County's required contribution for the account of Core Physician and Core Physician's mandatory employee contributions are also subject to all of the transition rules contained in the Plan as it now exists or niay be hereafter amended which may reduce the amount of contribution. The transition rules include, but are not limited to, those contained in sections 3.3(b), 3.3(d), 3.5, and 3.6 of the amended and restated Plan Document. Core Physician (together with all Plan participants) shall be responsible for a pro rata share of the annual costs of administering the Plan. Due to the manner in which Plan participantaccounts are held and invested, most such costs cannot be paid directly from Plan assets. To facilitate payment of such costs, County shall advance such costs for so long as County determines such an arrangement is necessary or desirable. To offset such costs, County shall reduce its contribution to the Plan for Core Physician by Core Physician's pro rata share of such costs as determined under the Plan Document.

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C. If the fixed contribution structure described in the immediately preceding paragraph B results, or would result, in the Internal Revenue Service not issuing a favorable determination letter for the Plan under the amended and restated Plan Document, the County reserves the right to substitute another contribution structure which will be designed to maximize benefit to Core Physician on a costneutral basis to County, and such substitute contribution structure shall control the terms ofthis Agreement. County will consult with the Pension Committee, as identified in the Plan Document, with respect to such substitute contribution structure. D. County's reqUired contribution and all mandatory employee contributions will be paid to such financial services firm(s) as determined under the Plan Document. If, pursuant to the Plan Document, Plan assets are allocated to separate accounts for each Plan participant, such financial services firm(s) shall be solely responsible for allocating Core Physician's contribution amount and investment experience to his or her account. If, pursuant to the Plan Document, Plan participants control the investment of their accounts at such financial services firm(s), the investment of Core Physician's Plan account through such financial services firm shall be determined by Core Physician, County shall not be liable for the investment experience ofeore Physician's Plan account. E. Core Physician is not eligible to participate in any other retirement plan established or funded by the County for its employees, including but not limited to the Kern County Employees' Retirement Association, and this Agreement does not confer upon Core Physician any right to claim entitlement to benefits under any such retirement plan(s). 6.

SOCIAL SECURITY AND MEDICARE TAXES

Core Physician is exempt from payment of Social Security taxes as the Kern County Pension Plan for Physician Employees is a qualified alternative to the insurance system established by the federal Social Security Act. Core Physicians employed before March 31,1986, will continue to be exempt from the payment of Medicare taxes. 7.

DEFERRED COMPENSATION PLAN Core Physician shall be eligible to participate in the Kern County Deferred Compensation Plan I on the same basis and to the same extent as full-time County employees. County may change its Deferred Compensation Plan as it shall change for other County employees of .KMC. Any such change by County shall not be a breach of this Agreement.

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KERN$FLEX PLAN Core Physician shall be eligible to participate in the Kern$Flex Plan I on the same basis. and to the same extent as eligible County employees. County may change its Kern$Flex Plan, as its policy for Kern$Flex shall change for other County employees of KMC.· Any such change by County shall not be a breach of this Agreement.

9.

EXPENSE REIMBURSEMENT A. Core Physician will be reimbursed for approved and necessary expenditures related to continuing education including seminar fees, travel and study materials. Reimbursement for travel, lodging and meals shall be upon the same terms and rates as allowed for County employees of KMC. Core Physician will be reimbursed expenses and materials not to exceed $2,500 per year. B. Core Physician will be reimbursed for approved and necessary expenditures related to education and training as directed by KMC. Reimbursement for travel, lodging and meals shall be upon the same terms and rates as allowed for County employees of KMC. C. County will pay reasonable moving expenses (defined as the moving of household goods and vehicles) for Core Physician to relocate from Philadelphia, Pennsylvania, to Bakersfield, California, in an amount not to exceed Twenty Thousand Dollars ($20,000). Core Physician shall provide three written bids for moving expenses and County shall reimburse Core Physician for the lowest of the three bids. In order to be reimbursed for said moving expenses, Core Physician shall submit the three written bids along with the invoice{s} for actual services performed by the low bid contractor(s).

D. Reimbursement for expenses incurred in generating professional fees will be reimbursed as set forth in Article II, Section 4, above. E. Reimbursement for expenses incurred in generating other income will be reimbursed as set forth in Article II, Section 5, above.

Article IV. TERMINATION AND CORRECTIVE ACTION 1.

TERMINATION OF AGREEMENT A. Core Physician may terminate this Agreement, without cause, upon ninety {gO} days' prior written notice to County.

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B. County may terminate this Agreement at any time for cause. Cause is defined as a violation of administrative policy of the County of Kern or KMC, unsatisfactory clinical performance, failure to meet department accountability or performance standards, or reduction of need. County may terminate this Agreement based upon reduction of need upon ninety (90) days' prior written . notice to Core Physician. C. Termination of this Agreement by County does not per se affect medical staff membership. Actions affecting medical staff membership and clinical privileges· are governed solely by the medical staff bylaws. D. In the event of termination of this Agreernent for any reason, County shall have no further obligation to pay for any services rendered or expenses incurred by Core Physician after the effective date of the termination. Core Physician shall be entitled to receive base salary from County for services satisfactorily rendered, calculated on a prorated basis up to the effective date of termination.

E.

Professional fees earned prior to termination and collected within twelve (12) months of termination will be paid to Core Physician on a monthly basis as collected. These professional fees will continue to be subject to assessment for administrative expenses, overhead distribution formula and/or departmental pool, if applicable, and all appropriate federal and state taxes in effect at the time the professional fees are paid. If Core Physician is a member of a practice group, Core Physician will be paid in accordance with current instructions provided the clearing fund by Core Physician's practice group.

2.

CORRECTIVE ACTION A. Core Physician is subject to corrective action for violation of administrative policy of the County of Kern or KMC, unsatisfactory clinical performance, or failure to meet department accountability or performance standards. Such corrective action may include, without limitation, additional training and education, a verbal or written warning, a written reprimand, suspension with or without pay, and termination. B. Corrective action for unsatisfactory clinical performance is governed by . the medical staff bylaws. C. Corrective action is not required if the problem involves a serious ethical or clinical breach, a violation of law or a serious violation of County of Kern or KMC policy that merits immediate termination for cause.

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REVIEW AND APPEAL PROCESS Review and appeal of the decision to impose corrective action or terminate for. cause shall follow the process set forth in the KMC Faculty Practice Board policy and procedure. titled Corrective Action and Termination Review Process. or the medical staff bylaws. whichever is applicable. Article V. GENERAL PROVISIONS

1.

ASSI.GNMENT Core Physician shall not assign or transfer this Agreement or its obligations hereunder, or any part thereof. Core Physician shall not assign any money due or which becomes due to Core Physician under this Agreement without the prior written approval of County.

2.

ASSISTANCE IN LITIGATION Core Physician agrees to be available to County, at no cost to County, to testify as an expert witness or otherwise, in the event of litigation under any cause of action being brought against County or KMC, its directors, officers or employees except where the Core Physician is a named party. KMC will credit the time spent in preparation and testimony as administrative time as defined in the compensation plan.

3.

AUTHORITY TO BIND COUNTY It is understood that Core Physician. in Core Physician's performance of any and all duties under this Agreement, has no authority to bind County or KMC to any agreements or undertakings.

4.

CAPTIONS AND INTERPRETATION Paragraph headings in this Agreement are used solely for convenience. and shall be wholly disregarded in the construction of this Agreement. No provision of this Agreement shall be interpreted for or against a party because that party or its legal representative drafted such provision, and this Agreement shall be construed as if jointly prepared by the parties.

5.

CHOICE·OF LAWNENUE The parties hereto agree that the provisions of this Agreement will be construed pursuant to the laws of the State of California. This Agreement has been entered

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into and is to be performed in the County of Kern. Accordingly, the parties agree that the venue of any action relating to this Agreement shall be in the County of Kern. 6.

CONFLICT OF INTEREST

The parties to this Agreement have read and are aware of the provisions of section 1090 et seq. and section 87100 et seq. of the California Government Code relating to conflict of interest of public officers and employees. All parties hereto agree that they are unaware of any financial or economic interest of any public officer or employee of County relating to this Agreement. It is further understood and agreed that if such a financial interest does exist at the inception of this Agreement, County may immediately terminate this Agreement by giving written notice thereof. Core Physician shall comply with the requirements of California Government Code section 87100 et seq. during the term of this Agreement. 7.

COMPLIANCE WITH KMC AND COUNTY POLICIES

Core Physician will comply with all applicable KMC and County policies and procedures. Core physician will keep daily time sheets on forms supplied, and in the manner specified, by KMC. Core Physician will conform to office policy and routine as established by the Department of which Core Physician is a member, . including, but not limited to orientation, attendance at case conferences, supelVision, in service education, patients' rights functions and performance. improvement activities. Core Physician shall submit to drug testing, other laboratory testing and physical examinations as may be required by County.

8.

COMPLIANCE WITH LAW

Core Physician shall obselVe and comply with all applicable County, state and federal laws, ordinances, rules and regulations now in effect or hereafter enacted, including but not limited to JCAHO, Title 22, California Code of Regulations, EMTALA, all federal and state billing requirements including MediCallMedicaidand Medicare billing regulations, EEOC, HIPM, FEHA and CalOSHA. Core Physician will at all times meet state and federal licensure and County personnel qualifications for the practice of medicine.

9.

COUNTERPARTS

This Agreement may be executed simultaneously in any number of counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

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EMPLOYMENT STATUS

Core Physician shall be employed by the County of Kern pursuant to the terms of this Agreement and the medical staff bylaws of KMC. Core Physician acknowledges that he or she will not be deemed a classified employee, or have any rights or protections under the County's· Civil Service Ordinance, rules or regulations.

11.

ENFORCEMENT OF REMEDIES

No right or remedy herein conferred on or reserved to County is exclusive of any other right or remedy herein or by law or equity provided or permitted, but each shall be cumulative of every other right or remedy given hereunder or now or hereafter existing by law or in equity or by statute or otherwise, and may be enforced concurrently or from time to time.

12.

MEDICAL RECORDS

Any and all patient medic~1 records and charts produced as a result of either party's performance under this Agreement shall be and remain the property of County. During the term of this Agreement, Core Physician shall be permitted to inspect and/or duplicate any patient's medical record or chart to the extent necessary to meet professional responsibilities to such patient and/or to assist in . the defense of any malpractice or similar claim to which such medical record or chart may be pertinent, provided such inspection and/or duplication is permitted and conducted in accordance with applicable legal requirements and pursuant to commonly accepted standards of patient confidentiality. Core Physician shall be solely responsible for maintaining patient confidentiality with respect to any information obtained pursuant to this paragraph and will comply with all federal and state laws and regulations regarding patient confidentiality.

13.

MEDICAL STAFF MEMBERSHIP

Core Physician will at all times be a member in good standing of the medical staff of Kern Medical Center and governed as such by the medical staff bylaws. This Agreement may be immediately terminated if· Core Physician's privileges/ membership are modified or restricted pursuant to action under the medical staffbylaws such that services performed by Core Physician are limited or restricted. Prior to performing duties. Core Physician will complete the following: (a) (b) (c)

Application for medical staff membership; Provide proof of current license from Medical Board of California; Provide proof of current DEA certificate; and

16

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(d)

14.

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Meet with the medical staff office to ensure appropriate documentation is present for credentialing of medical staff privileges.

MODIFICATIONS OF AGREEMENT

This Agreement may be modified in writing only, signed by the parties in interest at the time of the modification.

15.

NON-APPROPRIATION

County reserves the right to terminate this Agreement in the event insufficient funds are appropriated or budgeted for this Agreement in any fiscal year due to closing of a clinical department or KMC. Upon such termination, County will be released from any further financial obligation to Core Physician, except for services performed prior to the date of termination or any liability due to any default existing at the time this section is exercised. Core Physician will be given thirty (30) days' written notice in the event that such an action is required by County.

16.

NON-DISCRIMINATION

The parties mutually agree to abide by all laws, federal, state and local, and by all policies of the County of Kern respecting discrimination. The parties shall not discriminate on the basis of race, color, national origin, age, religion, marital status or sexual preference.

17.

NON-WAIVER

No covenant or condition of this Agreement can be waived except by the written consent of County. Forbearance or indulgence by County in any· regard whatsoever shall not constitute a waiver of the covenant or condition to be performed by Core Physician. County shall be entitled to invoke any remedy available to County under this Agreement or by law or in equity despite said forbearance or indulgence.

18.

NOTICES

Notices to be given by one party to the other under this Agreement shall be given in writing by pe·rsonal delivery, by certified mail, return receipt requested, or express delivery service at the addresses specified below. Notices delivered personally shall be deemed received upon receipt; mailed or expressed notices shall be deemed received four (4) days after deposit. A party may change the address to which notice is to be given by giving notice as provided above.

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Core Physician

County

David F. Jadwin, D.O. 26900 Monet Lane Valencia, CA 91355

Peter K. Bryan Chief Executive Officer Kern Medical Center 1830 Flower Street Bakersfield, CA 93305-4197

PROFESSIONAL RESPONSIBILITIES Core Physician will perform the services and duties set forth in this Agreement in a diligent and conscientious manner in accordance with accepted professional and ethical standards of the medical profession and the medical staff bylaws of KMC.

20.

RELATIONSHIP County and .Core Physician recognize that Core Physician is rendering· specialized, professional services. The parties recognize that each is possessed of legal knowledge and skill, and that this Agreement is fully understood by the parties, and is the result of bargaining between the parties. Each party acknowledges their opportunity to fully and independently review and consider this Agreement and affirm complete understanding of the effect and operation of its terms prio"r to entering into the same.

21.

SEVERABILITY Should any part, term, portion or provision of this Agreement be decided finally to be in conflict with any law of the United States or the State of California, or otherwise be unenforceable or ineffectual, the validity of the remaining parts, terms, portions, or provisions shall be deemed severable and shall not be affected thereby, provided such remaining portions or provisions can be construed in substance to constitute the agreement which the parties intended to . enter into in the first instance.

22.

SOLE AGREEMENT This Agreement, including all attachments hereto, contains the entire agreement between the parties -relating to the services, rights, obligations and covenants contained herein and assumed by the parties respectively. No inducements, representations or promises have been made. other than those recited in this Agreement. No oral promise, modification. change or inducement shall be effective or given any force or effect.

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IN WITNESS TO THE FOREGOING. the parties have signed this Agreement upon the dates indicated. APPROVED AS TO CONTENT: KERN MEDICAL CE

COUNTY OF KERN

KERN COUNTY PERSONNEL

CONTRACT EMPLOYEE

BY·~>-·~

~l~!P vid F. Jadwin. D.o../

Kay F. Madden, Director ty'./I· # -

APPROVED AS TO FORM: OFFICE OF COUNTY COUNSEL

By ~A.~ Deputy . Agreemenl.Jadwin. OB1202

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EXHIBIT "A" JOB DESCRIPTION DAVID F. JADWIN, M.D. PATHOLOGY CHAIRMAN

The pathology chairman shall serve as the medical director for the anatomic pathology service and clinical laboratories at KMC. The pathology chairman will report to the KMC Medical Director. This is a full-time position requiring 48 hours of service, on average, per week. 1. Administrative responsibilities include: The pathology .chairman, together with the laboratory manager(s), will ensure that the Department: a. Is in compliance with federal and state regulations regarding clinical laboratory operation. b. Meets standards for accreditation by the College of American Pathologists (CAP) and the American Association of Blood Banks (MBB). c. Operates within the policies established by KMC and the medical staff bylaws, rules and regulations. . d. Operates effectively and smoothly, and provides timely reports, provided adequate resources are provided. 2.

Administrative duties include:

a. Oversees the development, implementation and maintenance of department policies and procedures for the clinical laboratory and pathology department, including surgical pathology, cytopathology and autopsy pathology. b. Operates and manages the pathology department quality assessment and improvement program. c. Oversees the performance of the clinical laboratory in the CAP laboratory proficiency survey program. d. Ensures that performance deficiencies are addressed in a timely manner. e. Reviews department budgets and major expenditures for appropriateness. f. Monitors performance and prepares annual evaluations for staff pathologists and the laboratory manager. g. Serves as a member of the Medical Executive Committee, the Chairmen's Council, the Faculty Practice Board, the Quality Management Committee, the Blood Usage Committee. and other committees that may be assigned by the president of the medical staff. h. Through participation in the Blood Usage Committee, ensures adequate transfusion service and utilization. i. Coordinates and monitors department faculty involvement in hospital committees.

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j. Conducts and monitors regular department meetings, in compliance with medical staff bylaws, and provides timely department reports, including an annual department report for the medical staff. k. Coordinates medical student and resident. training for students and residents on training rotation within the department. I. Meets with the KMC medical director at least monthly. m. Oversees the scheduling and effectiveness of pathology educational conferences for outside departments, including the oncology conference and the oncology clinic. n. Completes clinical pathology and anatomic pathology service work as may be required. 3.

Teaching duties include:

a. Coordinates and participates in teaching conferences to include weekly gynecology conference, oncology conference, and surgery conference. b. Prepares and presents didactic lectures. c. Actively participates in and presents departmental, interdepartmental,and interdisciplinary programs within KMC. 4.

Patient care duties include:

a. Performs anatomic pathology services as assigned. b. Documents care provided consistent with CMS professional fee billing. 5.

requirements for

Other duties as assigned by the chief executive officer or medical director.

6. A standard workweek will be 48 hours per week. Actual hours may vary week-toweek according to specific assignments; however, the objective is to achieve 2112 worked hours during a twelve-month period.

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REQUEST FOR LEAVE OF ABSENCE

3/~!at:,

DATE

>

(

NAME

o

INITIAL REQUEST DATE LEAVE OF ABSENCE STARTS

:: OF LEAVE:

I EXTENSION REQUEST

DATE LEAVE OF ABSENCE ENDS

I

RETURN TO WORK DATE

(Reference Civil Service Rule 1201.00 et. seq. and Ke.rn Co. Admin. Proc. Manual Chapter 3)

iANDATORY LEAVE FMLAoICFRANon-Job Related/Illness or Disability and re nancy Disability Leave eSR 1201.20 Intermittent-Employee eSR 1201.30 amity Care Leave-FamilyesR 1201.30 Intermittent Leave-Family eSR 1201.30 Compensable Disability eSR 1201.50

OTHER MANDATORY LEAVES Military (Reserve) eSRI201.~0 Family School Activity Leave eSR 1201.60

o

o

o o

JOB TITLE

SOCIAL SECURITY NUMBER

o

:!o

DISCREllONARYLEAVES Personal Necessity eSR 1202.20 Military (Enlistment) CSR 1202.30 Education/Personal Enrichment eSR 120VO Non-Promotional Probationer eSR 1205.00

o

o

o o

L ,

CIFIC REASON FOR LEAVE OF ABSENCE

*

,

2. PAY STATUS ~ithPay ~ick Leave Accrual ,E?vacation Accrual Compensatory Time Catastrophic Leave Without Pay 3. Physician's Note ~Yes 0 No

o

o o

I~ ",,-J~

L

·7

Jest a leave of absence for the reason stated above and understand that I will receive no wages during this absence, Ifall applicable Jals have been exhausted; further, that my rate of pay will be subject to any general increases or decreases in wage rates that become tive during my absence from work: and that my return to work will be subject to employment conditions existing at the time of such 1.

erstand that leaves taken for Non-Job Related/Illness or Disability and Pregnancy Disability, Compensable Disability, orCataslrophic e require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided nittently to cover all periods of leave taken. Also, I may be required to pass a medical. physical and lor psychological examination ,(mty expense prior to returning to duty if the illness or disability may affect job performance or the health or safety of fellow workers ~ public. understand that if my leave of absence is approved, the payment of premiums for my medical and dental benefits may become my msibility to continue coverage during the leave of absence. (Contact Health Benefits (868-3182) for information concerning your :JUon and options in this malter.)

Signature of Employee

'RTMENTHEAD RECOMMENDAT~N A.PPROVED

~TAPPROVE6) :ure

f

-
1y

I"

CIVIL SERVICE COMMISSION ACTION

''0

DATE) L OATE

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APPROVED

DATE

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NOT APPROVED

DATE

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8/".1

,

"

lily nntl-;ttedicnl Lem'e .4cr of1993 [ornin Fnmi/.I· Rights Aer

,c 8£.:0 395-5230 \10IOCl) (F,onl)

DISTRIBUTION: WHITE· P€RSONtIEl DEPARTMENT CANARY • HEAlTH BENEFITS

;:'I!:K· At=';::CUHnlG CE.F";;:':T'.~E!:r GOLOENROD·EMPlOYEE

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RULE 1200

LEAVES OF ABSENCE WITHOUT PAY

Page 32 of 93

1201.00 MANDATORY LEAVES OF ABSENCE 1201.10

Noticc of Lca,·c. An)' Counl)' cmploycc rcqucsting a leavc of abscncc without pa}' .under Sections 1201.20, 1201.30, or \'Olulltal)' Ieavc under Scclion 1201.'1.0 shall, when possible, gi,·c noticc of that requcst to UlC appointing aUlhorily, in wriLing, not less than 30 days prior to thc datc tllC Ica,'c is 10 commcncc. Such noticc shall bc forthwilh ronvardcd to tllC Dircclor by tllC appointing autllOril}'. Thc noticc shall bc submilled on a form prcscribcd by tllC Commission and shall spccify tllC Ica,'c to bc lakcn, tllC rcason or rcasons tllCrcforc, and, to tllC cxlcnt possiblc, Ihc beginning and cnding datcs of the Ica,·c. (Rc\'. 8/92)

1201.20

Non-Job-Relalcd IIIncss or DisabililY and PrC!,'11al!c\, Disabilih·. A Counl)' cmploycc shall bc grantcd a Icavc without pay for an incapacilating non-job related illncss or disabililY ofthc cmploycc, including a disability rcsulting from prq,'llancy, childbirlll, or relaled condiLion. Thc Icavc cntilJcmcnt shall bc subjccllo tllC following conditions: (I) 111e ncccssity for UIC Icavc shall bc ccrtificd by a mcdical doctor, who shall also stalc ulat UIC cmployce will bc mcdically ablc 10 return 10 work at tllC expiratioll of UIC leavc pcriod; and, (2) thc Icavc pcriod(s) authorizcd by Rulc 1201.20 shall not cumulati,·cJy cxcced six (6) months during any twelvc (I 2) montll pcriod exccpt as rcquircd by law. (Hc,·.01/97) Usc of tllis Ica,'c is subjcct to IJlC cmployce using all sick lca\'c accrucd prior tOtllC cffcClivc datc of the Ica,'c of abscllcc. Employccs shall bc cntitled to usc anyolllcr acaucd Iea,'c balances, concurrcntly with tllC Ica,'c gi"cn by this scction. Vcrilication from a 111cdical doclor of continued incapacity 10 perform tllc job duties shall bc rcqucstcd by tllC appointing aul1lOrity. Thc employec mar bc required to pass a physical, mcdical and/or psychological examination dcsignalcd by Coullly, at Counly cxpcnsc, prior 10 relurnillg to dUly if the iIIncss or disability may affcct job performancc or thc hcall1l ami safct}' of tllC cmployee, co-workcrs, onhe public. (Rc\,.

01/97)

To thc maximum cxtent pcrmillcd by law, alllea,·cs autllorizcd by tllis Hulc shall run cOllcurrcnlly \\;th Ieavcs takcn pursuant 10 Rulc 1201.30 and shall count against111c twch'c (12) wcek limit contained in Rulc 1201.30. (Re,'. 01/97)

1201.:-30

l\'landalcd Famil\' and Medical Lca\'cs - (Emplorccs and Familr) The purpose of this Rulc is to implcmcntlca\'cs ",hidl arc mandated by the Family and Mcdical Lca,'c Act of 1993 ("gILA") and tllC California Family Hi~hts Act "CFRN'). Eligible cmployces may usc Ica,'cs autllol;zcd by this Hulc on an inlcnnillcIlt basis 10 IJIC exlent that l1lC County is rcquired 10 permit inlcrmillcllt Icaves undcr FML\ all(Vor CFHA. "'hcn permilled, intermillentlca,'c may be laken in periods from onc hour to sC"cral wceks, up 10 a tOlal of '~80 hours· for full-timc employccs and prorated accordingl}' lor part-timccmployces. (Hc\,. 01/97)

0001. 5 01.

eNCL~\::;()£C

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Case 1:07-cv-00026-OWW-TAG

RULE 1200

Document 277

Filed 12/01/2008

Page 33 of 93

LEAVES OF ABSENCE WITHOUT PAY

F;unily and mcdical IC;I\"cS of abscncc arc ;l\'ailablc Oil an uupaid basis 10 eligiblc cmployccs. In ordcr 10 qualify for a Iea\"c, an cmploycc must: (a) ha\"c bccn cmploycd for atlcastlwch'e (12) moulhs rIlle tweke (12) moulhs do nol need 10 hcconsecuti\"c); ;lIld (b) workcd at Icast 1,250 hours ofsen'ice duriug UIC 12-molllh pcriod illllncclialdy hcforc the commcncemcnt of the Ica\"c. (Rcv. 01/97) An eligible cmployee may request up to Iweh'e (/2) weeks Icavc iu a twckc (12) 1I10nlh period for UIC followiug reasons: I. 'IllC carc of a newborn child; 2. Thc carc of it child who has becu placcd willi an employce lor adoption or foslcr care; 3. The care of a spousc, child or parent (including, but not limilcd to, persons who stand "in loco parcntis") who has aserious hcalth condition; or

:t The serious healLlI condition of UIC e1ihriblc cmploycc which prC\'cIIIs the employec from performing onc or morc of LlIC essential functions of his or hcr job. (HC\'. 01/97) \Vhen both parcnts arccrnplo)'ed by Ihe County, Lllcamount ofleavc for bonding (i. e" birLll, adoplion,or foslcr carc placcmcut) is limitcd to an aghrrcgale of Iwel\'c (/2) wccks, betwccn Lllc parenLe;, in a twelvc (12) month period. For any other leavc aUUlOrizccl by Lllis Rule, cach parcnt is allowed twelve (12) weeks leave, in a tweh'c (12) monLlI period, less any bonding leavc laken by lhat parcnt during thaI lwelve (12) mouLlI period. (12/05) The twelve (12) month period uscd 10 measurc the I,,"ckc (12) week limitation will be thc rolling twelve (12) month pcriod measurcd backward from Llle dale Llle Iea\'c is used, Under UIC rolling twch'e (12) monul period, each time an employce takcs lea\"e, Llle remaining Iea\'e balance consists of the portion of ule twekc (12) weeks thal was not uscd during Llle immedialel). preceding tweh'e (12) months. me\'. 01/9i) Employces shall cxhausl all accrucd sick leave 10 the miL\:imUlll cxtcnl permilled, at the commcncemcnL of LllC Icavc. Employees shall be cntitled 10 use any other accrued Ica\'c balanccs, concurrently willI UIC Ieavc givcn by this section. This Hulc is nol intcndcd to supersede tllC pro\"isions of Kcrn COUlll)' Ordinallcc Code Section 3.28.0·-1-0, which limits Llle ilmOUlll of sick Icavc which all cmployee may use lor illncss of members 01" Ihe employee's immediatc family. (HC\'.O 1/97) If an cmployce requests a Ieavc oue to a serious health coudition 01" lhe employcc or a family membcr, LllC employee must support tllC request wiLll a legally sunicicnt

0001502

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Case 1:07-cv-00026-OWW-TAG

RULE 1200

Document 277

Filed 12/01/2008

Page 34 of 93

LEAVES OF ABSENCE WITHOUT PAY

ccrLilicalioll isslIcd by Lhc heahh rarc pro\'idcr of Lhc individual willi Lhc serious healLh condition. The appointing ;lUlJlOrity may rcqucsL suhscqucnL re-ccrtilication of mcdical condilions as pcnnilled by law. (Hc\,. 01/97) For leavcs granled duc Lo a serious heahh condilion oflhe employcc, Ihe employec may be rcquired 10 pass a physical, medical and/or psychological cxamination dcsih'llaled by County, at I1lc CounlY's cxpense, prior 10 reLurning for dULy if thc scrious hcalth condilion ma}' a{fecljob perfonnance or lhe hcalLh, sately oflhc employec, co-workcrs or lhe public, (Hc\,.0l/!)7) To the maximum exlenl permilled by law, ;U1Y Icm'c laken by an cmployee undcr lhis or any olhcr Hule or aUlhority shall bc credilcd ag"
Temporal'\' Mililarv Le:l\'c Pursuanlto California f\liIilary and Velcrans Codc sections 395 a1l<1 395.0 I, any Counl)' employec ",hois a member of lhe reser\"c corps of lhe Armcd Forces of lhc Uniled Stiles or of the National Guard or lhc Nm'al Militia, is enLiLlcd 10 a Lemporal}' mililary Ica\'c ofabscnce whilc cngagcd in mililary dUly ordered for LllC purposes of active miliLal1' lraining, inacLi\'c dul)' lraining, encampmelll, lIa\'a[ cruises, special excrcises or [ike aClivil)', prO\'ided lhallhe period of ordercd dUl)' docs noL excced [90 calendar dars, includiug time in\'Oh-cd in going Lo and rClurning from Ihal dul)'; and, provided a copy of Lllc milital)' orders accompany LlIC rcquesl for mililal)' ka\"e. Any cmploree who has becn in LllC scn'icc of Lhc COllnly for al Ieasl one year, immcdiaLely prior lo Lhe dale upon which a Icmporary military Ica\'c ofabscncc bcgins, shall, Lo lhc extenL required by law, be entiLlcd lo receivc his/her salary for LllC firsl 30 calendar days of such leave and, shall accrue the same \'acalion, sick Icavc and holiday pri\"i1eges and LlIC same righls and pri\"ilcges 10 promotion, continuancc in office, cmpioymcnL, rcappoinlmenllo ollice, or rc-cmploymenllhaL lhe cmployee would h;\\,c enjoycd had hc/shc nol been abscnt Lllercfrom; howc\'cr, any lIncomplcLcd probation:uy period musl be complelcd upon reinslalcmenl. (for purposcs of Lllis scclion, in dclermining Ihc one year of sen'ice willi lhe CounLy, all scn'jce of Lllc public cmployee in Ihc rccogllized military sen,icc shall be coullied as CounLy ser\'ice). 11lc cmployce's seniorilY dales (i,e" Counly, Vacation and Incrcmcnl) ",ill nol be adjusled for Llle duration of Llle leave. Thc cmploye-c may utilize \'acation and compcnsatory Limc on' accruals beforc beginning in a non-pay slatus. Nol\\"jlhsLandill~ the abovc, an cmployee 011 lemporary mililary leavc for LllC purpose of "inacti"e dUly lraining" is nol entillcd lo ha\'c auy of his/her salary paid as dcscribcd abO\'e. (Hc\'. /0 I).

1201..1.0.10

}>ursuanllo California MililalT:lnd Veler;lllsCode scction395(c), upon cxpiration of ;lIIY lemporary military leave of abscnce, au cmployce has a righllo be reslored Lo his/hcr fOrlllCr officc or class position and stalus formcrly held by the employee in LlIC same locality and in Lhe same County dcparlmcnt. If lhe ollice or class position

0001.503

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Case 1:07-cv-00026-OWW-TAG

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RULE 1200

LEAVES OF ABSENCE WITHOUT PAY

Page 35 of 93

has becn abolished or olherwise has ceased 10 cxiSI during the employec's abscnce, hc/she shall be rcinslalcd 10 a position of likc seniority, st;ltuS, and pay if a position exists or, if no posilion exists, thc cmploycc sha/l ha\'c tllC samc rightc; and pri\'ilcgcs lhal hc/she would have had ifhc/shc had occupied lhc dass posilion whcll il ccased 10 cxisl and had nollakcn a tcmporary military lea\'cof abscncc. (Hc\', /0 I) 120 I AS

Othcr Militan' Lcaves Any Counly cmploycc who \'olunlcers for oris rcquired lo scr\'c as a mcmbcr of any branch of the armed forccs (including, bUI nol limitcd to, initial cnlistment), shall bcgrantcd a military leavc of abscncc witholll pay for a pcriod ofone cnlislmenl, nollo cxcccd fivc (5) years' duration, prm'idcd a copy of tllC military ordcrs accompany tllC request for military leavc. Thc cmploycc's scniority elatcs (i,c" County, Vacation and Incrcmcnt) will not be adjustcd for UlC duration ofthc Icavc; howc\'cr, tllC cmployce willnol accrue bcncfits, which arc bascd on mcrit or hours workcd (including, but not limitcd to mcation and sick Icave). IVlilit;Il')' leavcs of abscncc arc gm'crncd by both lhc California l\1ilital')' and Vetcrans Codc scctions 389 ct scq. and Tille 38 oflhc Unitcd Slatcs Code, sections i~30 I ct scq. (Hc\', /01)

120 I A5.1 ()

Pursmmt to titlc 38 of UIC Unitcd Slatcs Codc, section 1312, an cmploycc rcturning from an appro\'cd militaJ)' Icavc of abscncc shall be cntilled to rcturn to his/hcr formcrly held class position wilh the County, without loss of standing, as dcscribcd abovc, providcd thc rcturning cmploycc notilics tllC County of his/hcr intcnt to return to work in accordancc witll UIC noticc prm'isiolls listcd below: An cmploycc who hasbecn on milital')' Ica\'c for less than tllirly-onc (31) days mllst notify tllC County's Pcrsonnel DcpartmclIl,in writing, of his/her intcntto rcturn to work no latcr tlla)) thc beginning of thc first full pay pcriod on UIC first fuJI calendar day following tllC complction of thc pcriod of scrvice and thc cxpiration of cighl hours alicr a pcriod allowing for thc safc lransporlation of the cmployee from tllC placc of scn'icc 10 tllC cmployee's rcsidcncc; or, if ulrough no fault of his/llcr own, thc employcc cannot rcport as scl fortll abo\'c, he/shc must do so as soon as possible. An cmploycc who has becn on military lcavc for more than lhirty (30) days, b)Jlless than 181 days will be retaincd on thc County pa}ToJlin an inactivc status. ·Thc cmployec must notify thc County's Pcrsonnel Dcpartmcnt, in writiJig, of his/llcr. intcntto rcturn to work no latcr than fourlccn (1,1) days aftcr tlle complcLioll oflhc scn·icc; or, if tl Irough no fault of his/llcr own, thc employce is unablc to providc tllC ",rillcn noticc in tllC manner dcscribed, Ulell he/shc must do so by thc lirsl full calcJl(.!ar day possiblc. An employcc ",ho has bccn on mililal')' Icavc for morc than 180 days mustnoLify tllC County, in writing, or his/hcr intcntlo rcturn lo work no later tllan nincly (90) days after complction of the sen·icc. NOlwiulstanding thc foregoing, the Coullty may refuse to re-employ an cmployee rcturning from mililal')' leavc if: 1) Thc Coullty's circumstanccs havc changcd so

0001.504

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Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

RULE 1200

LEAVES OF ABSENCE WITHOUT PAY

Page 36 of 93

murh as to makc thc rc-cmploymcnt impossiblc or unrcasonablc; 2) Thc class position from which the pcrson prcviously held has bcen dclclcd atHllhcrc arc no similar or comparable positions; :~) Hc-cmploymcnt would causc undue hardship on thc COllnty; and/or Ii) Thc employmcnt from which thc pcrsoll Jell was for ahrief, non-rccurrcnt period and therc was no rcasonablc expcl"lalion the job ,,;ould continue iJl(lclinitcl}' or for an)' significant pcriod. (Rcv.II/OI) 1201.50

Lc;l\'c lor Compcnsahle Disabililv. County cmployccs shall hm'c an automatic \cave of abscnce from employment during such pcriod as the cmployec is eligiblc to rcccivc temporary disabilily compcnsation undcr thc workcrs' compcnsation laws of thc Statc. Said Ieavc shall aUlomaucally lcrminatc when lhcrightto such compcnsation tcnninalcs, thc cmploycc is dctcrmincd b)' UIC Risk l\1ilnagcmcllt Division of thc Counl)' Counsel's Ol1ice not to bc c1i/,rihlc for workcrs' compcnsation bcnclits, thc cmploycc has heen released to rcturn to work by a doctor aUUlOrizcd by thc Hisk I\'lanagemcllt or a Counl)' doclor, orUlc cmploycc rctires from Coullty sen'ice, whichcvcr occurs firs!. Employecs may usc sick lca\'c during thc Ica\'c herc prm'ic1cd for ill accordancc ",ilh Ordinancc Codc Scction 3.28.110. Employees dclermillcd 1I0t to be eligible for \Vorkcr's Compcnsation bcncfits shall havc all Icavc timc taken undcr Ulis scctioJl cOJlvcrtcd 10 allowablc lca\'es under Scctions 1201.20, or 1202.20 of the Civil Sc....·icc Hulcs, as applicablc. (Rcv.01/97) To thc maximum cxtcnt pcrmiLlcd by law, alllcavcs aUUlOrized by ulis Rulc shall run collcurrently wilh Ieavcs takcn pursuant to Rule 1201.30 and shall COUllt against the twelvc (12) wcck limit containcd in Hulc 1201.30. (Rcv. 01/97)

1201.50.10

Employccs who arc on a compensable disability Iea\'c of abscnce shall submit a slatcmcnt of their condition from ulcir doctor to their appoillting authoril)' as long as the)' rcmain on such Icavc of abscncc. (Rcv. 8/92)

1201.50.20

i\ny cmploycc who is gralltcd a scn'ire-conncctcd disability retircmcnt 'Uld who later is dctcrmincd by the Rctircmcnt Board to bc no longcr in('apacitate(\;md who dcsires to rcturn to acu\'c Count)' cmploymcnt and·is re-cmploycd shall bc decmcd to havc bccn on an approvcd lca\'c of abscnce withoul pay for thc pcriod of Limc hc/shc rccci\'cd said sen,j('c-conncclcd disability. (Rc\'. 8/92)

1201.GO

Familv School And Liccnscd Child nay Care Activitv Leavc. Any fun-time or part-time County cmploycc who is a parcnl, /",.mrdian or grandparent WiUl custody of a child in gradcs Kindcrgartcn uuough Twch'c or allcnding a liccnscd child day carc facility, shall bc cntiucd to, upon propcr wriUcn requcst to thc appointing authority, a )ca\'c froril work up 10 a maximum of forty (:to) hours pcr ycar, but no more Ulan cight (8) hours ill any calendar mOllth, to participatc ill UIC artivitics of UlC school or liccnscd child carc /:lCilily of any of his or hcr childrcn. The cmployee shall use vacation, compcnsatory time-olr or an)' othcr paid leave allowallces othcr Ul,l\l sick IC;l\'c. If the employcc has

0001505

Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

KERN COUNTY PERSONNEL DEPARTMENT REQUEST FOR LEAVE OF ABSENCE

(_<_P_C!-_·~ __·~--r~7-7r-----'------'--

:>ARTMENT _ _

DATE

SOCIAL SECURITY NUMBER

o

DATE LEAVE OF ABSENCE ENDS

o

_

RETURN TOWORK DATE

(Reference Civil Service Rule 1201.00 et. seq. and Kern Co. Admin. Proc. Manual Chapter 3)

MANDATORY LEAVE FMLA·/CFRA...· ~ Non-Job Relatedllilness or Disability and

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EXTENSION REQUEST

DATE LEAVE OF ABSENCE STARTS

,

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JOB TITLE

INITIAL REQUEST

PE OF LEAVE:

Page 37 of 93

OTHER MANDATORY LEAVES

o

o

'pregnancy Disability Leave CSR 1201.20 Intermittent-Employee CSR 1201.30 Family Care Leave-Family CSR 1201.30 Intermittent Leave-Family CSR 1201.30 Compensable Disability CSR 1201.50

o o

~ECIFIC REASON

2. PAY STATUS

Military (Reserve) CSR1201.40 Family School Activity Leave CSR 1~01.60

OWithPay Sick Leave Accrual Vacation Accrual Compensatory Time OCatastrophic Leave

o o o

DISCRETIONARY LEAVES

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Personal Necessity CSR 1202.20 Military (Enlistment) CSR 1202.30 Education/Personal Enrichment CSR 1202.40 Non-Promotional Probationer CSR 1~05.00

~ithoutPay

3. Physician's Note ·~es DNa

FOR LEAVE OF ABSENCE

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equest a leave of absence for the reason stated above and understand that I will receive no wages during this absence, If all applicable :cruals have been exhausted; further, that my rate of paywill be SUbject to any general increases or decreases in wage rates that become fective during my absence from work; and that my return 10 work will be subject to employment conditions existing at the time of such tum. Inderstand that leaves taken for Non-Job Related/Illness or Disability and Pregnancy Disability, Compensable Disability, or Catastrophic ~ave require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided termiltently to cover all periods of leave taken.. Also,l may be required to pass a medical, physical and lor psychological examination : County expense prior to returning to duty if the illness or disability may affect job performance or the health or safetyof fellow workers • the public. 31so understand that if my leave of absence is approved, the payment of premiums for my medical and dental benefits maybecome my lsponsibility to continue co~erage during the leave of absence. (Contact Health Benefits (868-3182) for information concerning your bligation and options in this matter.)

cs

APR 2 6 ~

DATE

o

DATE

NOT APPROVED

ignature , Fam;~I' mId Medical Len\'e Act of 1993 •• Californin Fami(I' R(f{ll/s Act

Signature of Employee

CIVIL SERVICE COMMISSION ACTION

,EPARTM EHT HEAD RECOMMENDATION

o APPROVED

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APPROVED

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NOT APPROVED

DATE

_

DATE

_

Signature DISTRIBUTION:

000:150' INSTRUCTIONS ON REVERSE SIDE

WHITE. PERSONNEL oeP"'RTM~NT CANARY - HEALTH BENEFITS

F:NK. ~?~Jt~T't:G OEPAF.n.~EtlT GOLOENROD· EMPlOyEE

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Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

Page 38 of 93

KERN MEDICAL CENTER ADMINISTRATION OFFICE MEMORANDUM

C-O-N-F-I-D-E-N-T -I-A-L TO:

David Jadwin, D.O. Chairman, Department of Pathology

::::~: :::~c:

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DATE: April 28, 2006 .... ~

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CEO

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brie~ng

The purpose of this memorandum is to summarize our today concerning your medical leave of absence. In attendance were you, Karen Barnes, Steve O'Conner, and I. I provided you with the summary ofyour medical leave history (see attached). This packet contain~ the calculations and policies related to how the County ofKem handles medical leaves. In essence, you have 137 hours available to be taken before you hit the 480-hour limitation. Medical Leaves also run for a maximum of six months so this criterion sets June 16, 2006 as the last day available to you under this status. You said that you did not have any questions and I referred you to Human Resources, Steve 0' Conner, should you have any questions about how to interpret the leave provisions. You also mentioned that you were scheduled to work on Monday May 1,2006 and asked if! wanted you to be present. You also indicated that from that date, you would be out until further notice. I left the option of working on Monday to you and asked that you coordinate with Dr.. Dutt about coverage. I also mentioned that after Monday it would be preferable for you not to have an intermittent work schedule and it would be easier on the department to just have you on leave until your status is resolved. Finally, I said that by June 16, 2006 you needed to give me your decision about your employment status. Your options were to either return full time or resign your position. As chairman, your department and the hospital needs you here full time. You indicated that you understood the deadline. PKB:abra O:\Pcrsonnel\042806Jadwin.doc cc: Karen Bames, Deputy County Counsel Sandra Chesler, Chief Operating Officer

0001.507

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Case 1:07-cv-00026-OWW-TAG

Document 277

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Page 39 of 93

CONFIDENTIAL

0001.508

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Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

Page 40 of 93

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Case 1:07-cv-00026-OWW-TAG Document 277 DEPARTMENT Filed 12/01/2008 KERN COUNTY PERSONNEL

Page 41 of 93

REQUEST FOR LEAVE OF ABSENCE .,vlENT

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J

JOB TITLE

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INITIAL REQUEST

DATE LEAVE OFABSENCE STARTS

EXTENSION REQUEST

DATE LEAVE OF ABSENCE ENDS

RETURN TO WORK DATE

(Reference Civil Service Rule 1201.00 et. seq. and Kern Coo Admin. Proc. Manual Chapter 3)

YPE OF LEAVE:

I. MANDATORY LEAVE FMLA*/CFRANon-Job RelatedllJlness or Disability and e. nancy Disability leave CSR 1201.20 Intermittent-Employee CSR 120UO amily Care Leave-Family CSR 1201.30 Intermittent Leave-Family CSR 1201.30 Compensable Disability CSR 1201.50

OTHER MANDATORY LEAVES Military (Reserve) CSRl20140 Family School Activity Leave CSR 1201.60

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DATE

:!

DISCRETIONARY LEAVES Personal NecessitycsR 1202.20 Military (Enlistment) CSR 120230 Education/Personal Enrichment CSR 120VO Non-Promotional Probationer CSR 1205.00

o o

o

o o

.,

2. PAY STATUS ~ithPay ~ick leave Accrual . ,E?Jacalion Accrual Compensatory Time Catastrophic Leave Without Pay 3. Physician's Note ~Yes 0 No

o

o o

L I;? /. 1-i-t.. l . 7

r

;PECIFIC REASON FOR LEAVE OF ABSENCE

·equest a leave of absence forthe reason stated above and understand that I will receiveno wages during this absence,lf all applicable ::cruals have been exhausted;further, that my rate of pay will be subject to any general increases or decreases in wage rates that become iective during m:y absence from work: and that my return to work will be subject to employment conditions existing at the time of such ·!um. ~nderstand

that leaves taken for Non-Job Related/lilness orDisabilityand Pregnancy Disability, Compensable Disability, or Catastrophic lave require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided ~ermitlenlly to cover all periods of leave taken. Also, I may be required to pass a medical, physical and lor psychological examination County expense prior to returning to duty if the illness or disability may affect job performance or the health or safety of fellow workers the pUblic. Iso understand that if my leave of absence is approved. the payment of premiums for my medical and dental benefits may become my iponsibilily to continue coverage during the leave of absence. (Contact Health Benefits (868-3182) for inforl11ation concerning your ligation and options in this mailer.)

Signature of Employee CIVIL SERVICE COMMISSION ACTION

P&ARTMENTHEADRECOMMENDATiJN APPROVED

DATE

?j

I"·'V ) L

I

N TAPPROVED} lature

I

_/.!!

DATE

C . .-'. i ' ,

·nmity nntf-:>Tedicn/ Lemoe Act 01/993 ·nlifornin Fnm;~I' Rights Act .'80 8!:-'0 39S-5230(10!OO)(Fron'l

_

o o

APPROVED

DATE

_

NOT APPROVED

DATE

_ _

Signature~

0001.51.0 INSTRUCTIONS ON REVERSESIDE

DISTRIBUTION: WHITE ·PERSOIItIEL DEPARTI.tEIIT CANARY .HEALTH BENEFITS FH:K ~;"PPCItHIUG DE.?ARiUE~H

GOLDENROD·EMPLOYEE

Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

Page 42 of 93

KERN COUNTY PERSONNEL DEPARTMENT REQUEST FOR LEAVE OF ABSENCE

_(2._~_. __ k>-r7-+'1_-_--'-------'-~

t:._=_D_,

DEPARTMENT _ _

(

DATE

SOCIAL SECURITYNUMBER

o

INITIAL REQUEST

\J.1EXTENSION REQUEST I'

DATE LEAVE OF ABSENCE eNDS

DATE LEAVE OF ABSENCE STARTS

(3J~J&t) , TYPE OF LEAVE:

JOB TITLE

i-;-s-

--

RETURN TOWORK DATE

Cf-=jt. - b~

tJl.,

(Reference Civil Service Rule 1201.00 et. seq. and Kern Co. Admin. Proc. Manual Chapter 3)

OTHER MANDATORY LEAVES Mililary (Reserve) CSR 120140 Family School Activity Leave CSR 1201.60

1. MANDATORY LEAVE FMLA*'CFRA ~On-JOb Relatedllllness or Disability and regnancy Disability Leave CSR 120120 Intermittent-Employee CSR 1201.30 0 Family Care Leave-Family CSR 1201.30 Intermittent Leave-Family CSR 1201.30 0 Compensable Disability CSR 1201.50

o o

H

o o

DISCRETIONARY LEAVES Personal Necessity CSR 1202.20 Military (Enlistment) CSR 120230 Education/Personal Enrichment CSR 1202.40 Non-Promotional PrObationer CSR 1205.00

o o o o

SPECIFIC REASON FOR LEAVE OF ABSENCE .

___=1;r J t-W-n= Y

/2

.

~

2. PAY STATUS DWithPay Sick Leave Accrual Vacation Accrual Compensatory Time Catastrophic Leave

o o o o

~ithoutPay

3. Physician's Note

~es oNo

~

~~__ . jda:J;_.. ~_/-::----:>....--_~ ~V'

.

_

G_r_Lj-f-._t<--__'

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_

I

I request a leave of absence for thereason stated above and understand that I will receive no wages during this absence, If all applicable accruals have been exhausted; further, that my rate of paywill be subject to any general increases or decreases in wage rates that become effective during my absence from work; and that my return to work will be subject to employment conditions existing at the time of such retum. Iunderstand that leaves tak~n forNon-Job Relatedllliness or Disability and Pregnancy Disability, Compensable Disability, or Catastrophic Leave require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided intermittently to cover all periods of leave taken. Also, I may be required to pass a medical, physical and lor psychological examination at County expense prior to returning to duty if the illness or disability may affect job performance or the health or safety of fellow workers or the public.

I also understand that if my leave of absence is approved, the payment of premiums for my medical and dental benefits may·become my responsibility to continue coxerage during the leave of absence. (Contact Health Benefits (868-3182) for information concerning your obligation and options in this matter.)

APA 2 6 2Xl6

c:::=:-1 II. ~ n~ ~~J~_. ~

DATE

o NOT APPROVED

DATE

Signature

or Employee

CIVIL SERVICE COMMISSION ACTION

DEPARTMENT HEAD RECOMMENDATION o APPROVED

Signature

_ _ _

o APPROVED

DATE

_

o

DATE

_

NOT APPROVED

Signaturec--

_

000151.1.

, Fami~)" and Medical Lem'e Act of /993 ,. California Fallli~I' Rig/liS Act

INSTRUCTIONS ON REVERSE SIDE

DISTRIBUTION; WHITE·PERSONNElDEPARTP.tEIIT CANARY· HEALTH BENEFITS PIIIK· A?Pon~TltjGDEPARTMEtlT GOLDENROO·EMPLOYEE

Case 1:07-cv-00026-OWW-TAG

BW

REG

05-25 05-26 06-01 06-02 06-03 06-04 06-05 06-06 06-07

'1/ /'f

1'0:

B/2

C/3

S/L

0 _ \.-;r LU k 'J.Qt aYI w.'l

40.0 57.5 60.3 41.5 16.0 12.0· 17.7' 30. O.

~

6.2 1.5 7.0

16.1 2.5

=====

=====

=====

=====

.0

.0

34.6

.0

59.7

.0

~/ it P1~ tuw M'J 4~u

=

Cv\t{~ ~

CTT

TOTAL

=====

80.0 57.7 59.7 60.3 41.5 38.3 16.0 41.8 30.0 ======

.0

;<

17 .1

=====

12./~ _ (2·/Z:) ~'?

~iL-tlfN - L ~b.pO'

~

16.0 8.0

..-3;3-r:'O

, 7J &j

~

8.0 9.7 2.2

OT

===:.=

D?/25

en

VAC

==::=

:2q J

o o o

FSL

Filed 12/01/2008

Page 43 of 93

8997

376-50-8177

JADWIN DAVID FRANK

Document 277

VACATION EARNED

S/L EARNED

VACATION BALANCE

S/L BALANCE

CT EARNED

5.23077 3.77269 3.90346 3.94269 2.71346 2.50423 1.04615 2.73307 1.96153

3.07000 2.21423 2.29098 2.31401 1.59256 1.46976 0.61400 1.60407 1.15125

9.78148 5.55417 9.45763 13.40032 16.11378 2.51801 1.06416 2.79723 4.75876

9.73040 2.24463 2.33561 4.64962 6.24218 1. 51194 0.62594 1.63001 2.78126

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

,4.2~j'

316"

q~ .~ - YCGa ~W e~ {s ,'()01',tt)

C BA O •. O. '

O. I O. ( O. (

O. (

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o. (

~~-----1 Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

Page 44 of 93

1

141009 1 1 1

contract year. Unused education leave will not be paid upon termination of employment. All education leave must be approved in advance of use by the Core Physician's Department Chair and the Medical Director.

4.

1 1

UNPAID LEAVE OF ABSENCE

county shall provide Core. Physician the right to unpaid leave of absence provided to other regular County employees of KMC pursuant to County policy. County may change its policy regarding leave of absence, as its policy for leave of absence shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

5.

1

1 1 1 1

RETIREMENT PLAN 1

A. Core Physician shall participate in the Kern County Pension Plan and Trust Agreement for Physician Employees (the "Plan"), a qualified defined contribution pension plan, pursuant to the terms of the instrument under which the Plan has been established (the "Plan Document"), as from time-to-time amended. County shall withhold 3.1 percent of Core Physician's biweekly gross salal)'(that is, before deductions inclUding taxes) and pay such amount within a reasonable time as the Core Physician's mandatory employee contribution reqUired under the Plan Document. County shall contribute an additional amount equal to 12.5 percent of Core Physician's biweekly gross salary (that is, before deductions including taxes) as County's required contribution under the Plan Document. Total contributions by Core Physician and County will not exceed the yearly amount allowed by law; provided, however, if any amounts are contributed in excess of such permissible amounts, the excess contribution shall be corrected as provided in the Plan Document or under law. Any changes in the Plan Document will control the terms of this Agreement.

1 1 1 1 1 1 1 1

B. Subject to the receipt of a favorable determination letter from the Internal Revenue Service, County will amend and restate' the Plan Document to substitute a fixed-dollar contribution by County and Core Physician in lieu of the contributions provided in the immediately preceding paragraph A. County and Core Physician contributions for each Plan yea( (as defined in the Plan Document) under the amended and restated Plan document shall be as follows: County shall contribute as County's required contribution the sum of Seventeen Thousand Five Hundred Dollars ($17,500) for the account of Core Physician for each complete Plan year of service (as defined in the Plan Document) by COfe Physician. Core Physician's mandatory employee contributions required under the 3mended and restated Plan Document shall be as follows: If Core Physician's Compensation (as defined under the Plan Document) was One Hundred Fifty Thousand Dollars ($150,000) or less during the immediately preceding Plan year, Core Physician's mandatory employee contribution required

1 1 1 1 1 1 1 1

9

0001.51.3 .

1

1

Case 1:07-cv-00026-OWW-TAG

RULE 1200

Document 277

Filed 12/01/2008

Page 45 of 93

LEAVES OF ABSENCE WITHOUT PAY

1201.00 I"'JANDATOHY LEAVES OF ABSENCE 1201.10

Noticc of Lca\'c. Any Count)'cmploycc rcqucsling a IC;I\'c of absence without pay ulllb Sl:djons 1201.20, 1201.30, on-olullta!')' leave umler Section }20 1.,'10 shall, when possiblc, gi\'c noticc of that rcqucstlO Ihe appointing authority, in writing, 1I0tiess than 30 days prior 10 the date LJIC lea\'cis 10 commcncc. Such lIoticc shall bcforLJlwith forwarded 10 UtC Director by the appointil 19 autllOrity. The notice shall be suhmillcd on a form prcscribcd by UIC Commission and shall spccify t1IC lea\'c to bc lakcn, UIC rcason or rcasons Ulcrcforc, and, to t1le cxtent possible, tIle beginning and CI lding dales of thc Ica\'c. (He\,. 8/92)

1201.20

Non-}oh-Hclatcd IIIncss or Disabilit\' and Prq,'Jlanc" Dis;,bilit\·. A Counly cmployee shall bc granted a lea\'c without pay for an incapacitating non-job relatcd illness or disability ofthc cmploycc, including a disability resulting from prcgnancy, childbirul, or relatcd condition. The Ica\'c entitlemcnt shall he subjcct to LJlcfollowing conditions: (I) thc nccessity for tllC Iea\'c shall bc ccrtificd by a mcdical doctor, \\,ho shall also stale LJlat tlIC'; clllpluycc will bc mcdically aule to returll to work at tllC expiration of tllC ka\'c period; and, (2) thc Iea\'c period(s) aut1lOrizcd by Hulc 1201.20 shall not cumulatively cxceed six (6) months during any twel\'c (12) montll period exccpt as required by law. (HC\·. 01/97) lIsc of t1lis lea\'c is subjcct to tllC cmployce using all sick Iea\'c accnlcd prior to the cffeCli\'c date of thc Iea\'c of abscllcc. Employccs shall bc cntitlcd to usc any othcr accrued lea\'c balanccs, concurrcntly with LJIC Ica\'c gi\'cn by this scction. Vcrilic;ltion from a medical doctor of continued incapacity to perform tllC job dUljcs shall!.>c rcquested by tllC appointing aUlhority. Thc employec lIlar bc requircd to pass a physical, mcdical alldlor psychological cxamination desi,!,'llaled by County, at Counly cxpensc, prior to returning to uuty if thc illness or disability may alTectjob performancc or thc hcalt11 and safcty of tllC cmployee, eo-workcrs, or t11C public (Hc\,.01/97) To the maXill1ll1l1 cxtent pcrmitlcd by law, alllca\'{~s authorizcd by t1lis Hulc shalll1.lIl concurrcntly \\;th Ica\'cs takcn pursuant to Hule 1201.30 and shall count against thc twelrc (12) wcek limit containcdin Hulc 1201.30. (He\·, 01/97)

1201.:~O

t\J;lIIdatcd Famih' and ivledicaJ LC;I\'cs - (Emplorccs and Famild 'I 'he purposc of lhis Hulc is to implemcnt lean~s which are lIland;ltcd by thc Family and Mcdical Lea\'c Act of 1993 ("F~IL.A") and LJIC C;I1ilornia Family Hights Act "CFRN'). Eli,!,~hlc cmployccs may lISC 1c;I\'cs aut1lorized by ulis Hulc 011 an intcrmiltcllt basis to thc extcnt that thc Counly is rcquircd to pcrmit intcrmiltcnt lea\'cs undcr I'M LA and/or CFI0\. \VhclI pcrmiltcd, illtcnnitlcnt learc lIlay bc lakcn in pcriods fromonc hour (0 se\'cral wceks, up (0 a lotal of ·j·80 hours for full-timc cmployees and prora(cd accordingly lor part-timc employccs. (Hc\,. 01/97)

00015j.4·

Case 1:07-cv-00026-OWW-TAG

RULE 1200

Document 277

Filed 12/01/2008

Page 46 of 93

LEAVES OF ABSENCE WITHOUT PAY

Family alld mcdical Ieavcs of abscncc arc ;I\'ailablc 011 all ullpaid basis 10 eligible cmployecs, III ordcr 10 qualify for a Iea\'c, all cmployec musl: (a) ha\'c bccn cmploycd for atleasl lwdvc (12) mOIlI1,s (rhc twelvc (12) mOlllhs do !!illllccd 10 bc COIISCCUU\'c); and (b) workcd at least 1,250 hours of scn'icc during thc I 2-muJllh pcriod immcdialely before UIC commcllccmcnt ofthc leave, (Hc\', 01/~)7) :\ n c1igi hlc cmploycc may rCCJllcslllp 10 I\\'ch'c (12) wccks 1c;I\'c in a twelvc (I2)molllh period for tJIC following reasoJlS: I, Thc carc of a ncwborn child; 2. Thc careol" a child who has bccn placcd wiul an cmploycc for adoption or fostcr carc; 3. Thc carc of a spousc, child or parcnt (including, bUI not limitcd to, pcrsons who stand "in loco parcntis") who has a scrious hcalth colldiuon; or

·L Thc scrious hcalth condition of thc eligible cmploycc which prc\"Cllts thc cmployce from performing onc or morc of UlC esscntial funclions of his or hcr job, (Hc\', 01/97) \Vhcn both parellts arc cmployed by UIC CoulIly, UIC amoullt ortca\"c for bonding (j; c., birul, adoption, or fostcr care pbcemcnt) is limitcd to all aggrcgatc of twelrc (12) \rccks, betwcen U'C parcnts, ill a twckc (12) monU1 pcriod. For allY oUlcr Icarc auulOrizcd by Lhis Hule, cach parcnt is allowed twelve (12) wccks IC;I\'c, in a twelre (12) 11101lU, pcriod, less any bonding lea\'c takcn by Ih;,t parellt during thattwcl\"c (12) 1110nth period. (I 2/05) Thc twch'c (12) month period uscd to mcasurc thc twch'c (12) wcck limitatioJl will hc Lhe rolling twch'c (12) monu, period mcasurcd backward from the datc thc !ca\'c is lIsed. UIIdcr UIC rollillg twch'c (12) monlh pcriod, cach limc an cmploycc takes leave, lhe rcmaining learc balancc consists of UIC porlionof thc lwch'c (12) wccks that was not lIscd d ming U'C immcdiately prcceding twcke (12) months. (HC\'. 01/97) . Employccs shall exhaust all accrued sick Ieavc 10 the m;L\:imum cxlcllt pcrmillccI, ;Iltlle COlllnJCllccmcnt of UIC lean:. Employccs shall be elltitled to usc ilny oth<:r accrucd !c;\\,c balances, concurrcnuy WiUI UIC Icavc gi,'clI by this section. This Hulc iSllol intcnded to supcrsedc u,c pro\'isiolls of Kcrn County Ordinancc Codc Section 3.28.010, which limits u'c amount of sick lea\'c which an cmploycc ma}' usc lor illncss of mcmbers of the cmploycc's immcdiatc family. (He\', 01/97) If an cmployec rcqucsts a Iea,'c due to a serioushcalth condition ofLhccmployec or a I;unily lllCIll bcr, UIC cm ployec IJ1 ust su pport UIC request with a lega II)' sufficicnl

0001.51. 5

Case 1:07-cv-00026-OWW-TAG

RULE 1200

Document 277

Filed 12/01/2008

Page 47 of 93

LEAVES OF ABSENCE WITHOUT PAY

n:rlificalion issued by lhe heahh carc prm'ider of lhc individual will uhc serious heallh cond ilion. Tllc appointing aUlhorily mar rcquesl subscqucnl re-ccrtilicatioll of mcdicill mlidilions ;IS pennilled b}' law. (Hc\'. () 1/97) For ka\'es granlcd duc 10 a serious heahh condition of the cmployee, lhc employee may be required 10 pass a ph)'sical, medical and/or psychological cxamination dcsignaled by Counl}', at thc COllnly's cxpcnsc, prior 10 rClurning for dULl' if lhc scrious hcallh condition may aOcctjob performancc or thc hcalth, satel)' of llic cm ployec, co-workers or lhe public. (He\,. 01/!}7) To lhc maximum cxtcnl pcrmillcd by law, ;Ulr !c;I\'c lilken by an cmploycc undcr 1I1is or any olhcr Rulc or authorilY shall bc crcdilcd ag
120lAO

TemJlorar\' Militarv Lca\'c Pursuallilo California l\Iililarr alld VClcrans Codc SCCtiOIlS 3!}S alld 395.01', any County cmployce who is a mcmbcr of lhc rCSCITC corps of thc .\nncd Forccs of lhc Unilcd Stales or of 1I1c National Guard or thc Na\'al i\lilitia, is cnlillcd to a tcm porar)' mililalJ Iea\'c of abscncc whilc cngagcd illmililarr duty ordcrcd for thc purposcs of ;ICti\·C military trailling, inactivc dutr training, Cnc;Un!Hllellt, na\'al cruises, special cxcrci'scs or likc acti\'ily, prO\'idcd t.hallhc pcriod ofordercd dUly docs nol excccd 190 calendar days, including timc in\'oh'cd in going 10 and reluruing from lhal duly; and, prO\'idcd a copr of 1IlC militalT ordcrs accompany lhc rcqucst for milil;lI)' Ieavc. Any cmploycc who has bccn ill UIC scn'ice of lhc Counl)' for at Ieasl OIlC ycar, immcdialcly prior 10 lhc dalc UpOll which a lcmpor;IIT mililiuy Ica\'c of abscncc bcgins, shall, 10 1I1c cxtcnl rcquircd by la\\', bc entiucd 10 rccci\'c Ilis/her salary for 1IlC firsl.30 calendar days of such Iea\'c and, shall accrue UIC samc \'acalion, sick Ica\'c and holiday pri\'ilegcs and 1I1e samc righls and pri\'ilcges 10 promotion, colltilluailCc in ollicc, employment, rcappoinlmclltlo oflice, or re-employmclltUlal UIC cmploycc would ha\'e cnjoyed had hc/she nol bccn abscnlUtercfrom; hO\\'c\'er, ;U1y uncompletcd probational)' period must be completcd upon rcillslatcmcnl. (fl)r purposcs of ulis seclioll, in dclcrmining UIC onc year of scrvicc wilh lhe Coullly, all sen'ice of lItC public cmploycc inlhe rccognized mililary scrvice shall bc coulltcd as COli/II)' scrvice). Thc cmployce's sellioril)' dalcs (i.c., COUllty, \'acalion ami Incrcmcnl) will nol be adjustcd lor thc duration of 1IlC Ieavc. Thc cmployec ma)' ulilize \,;\calion and compcnsatory limc oIl" accruals bcfore beginning in a non-pay slatus. N olwilllsianding thc aho\'c, an Clilplo}'ce 011 lemporal r lIIilitary lea\'c for lhc purpose of"inaclj\'c dUl}' trailling" is not. cntitled 10 ha\'e all}' or his/llcr salary paitl as describcd abo\'c. (Hc\'. /0 I).

1201..1·0.1 ()

Pursuanllo Califomia j\Iililal)' and Vctcrans Codcseclion 395(c), upon cxpiralion of an}' tcmporary mi/itarylea\'c of ahsellCc, an cmployec has a right 10 bc rcstorcd 10 his/hcr fOrlncr officc or class posilion and slat us formcrly held by t.hc cmploycc in 1I1e same localily and ill Ihc same Coullty deparullcnl. If thc orJice or class posilioll

000:151.6

·

Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

RULE 1200

LEAVES OF ABSENCE WITHOUT PAY

Page 48 of 93

'

has hccn abolishcd or othcrwisc has ccaseel to cxist e1l1rin~ thc cmplo)'ec's ;lhsencc, hc/shc shall hc rcinstatcd 10 a position of like scniority, st;ltus, and pay if a position exists or, if no position cxists, thc cmploycc shall ha\'c thc samc righL~ and pri\'ilcgcs lhat hc/shc would h;l\'C~ had if he/shc had occupied the class position when it ceaseel to cxist ;lIId had notlakcn a tClllporary milital1' Ica\'c of abscncc, (He\', /0 J)

120 I AS

Olher T\fililarv Lcavcs Any Count}' cmplo)'ee who mlllntccrs for or is required to sc.....c as a mcmbcr of an}' branch of thc armcd forces (including, 'but not limilcd to, initial enJi5IJllcI1I), shall bc granted a militall' /ca\'c of absencc \rithoLJt p;iy for a pCl'iodof OIlC cnlistmcnt, not to cxcccd firc (5) ycars' duration. prO\'idcd a copy of the miJitall' ordcrs accOlnpany thc rcqucst for military !carc, Thc cmplo)'ec's scniority dates (i,c., County, Vacatioll and Illnemcnt) will not bc adjustcd for UIC duration ofthc Ica\'c; howc\'cr, tJIC cmplo}'ce will not accruc hcncfits, which arc bascd ollmcrit or hours workcd (including, but not limitcd to \'acation amI sick leal-c), Xlilitary !carcs of abscncc arc gO\'crucd by hath tJIC California Mililall' alld Vctcrans Code scctions 389 ct scq. and Titlc 38 ofthc lJllilcd Stalcs Codc, scctions ,130 I ct scq. (Hc\', /0 J)

1201..15.10

Pursuant to tiuc 38 of thc Ullitcd Slatcs Code, scction '1312, an cmploycc relurning from an approvcd military Ica\'c of abSCllCC shall be clltitled to rcturn to his/hcr formcrly held r1ass position with the County, without loss of standing, as dcscribcd ' abo\'c, prO\'idcd tllc rClurning cmploycc notifics UIC County of his/ltcr intcnt to rcturn to \\'ork ill accordancc with UIC not icc provisions listed bclO\r: All cmploycc wlto has bccn on mililary lea\'c for less lhan ulirtY-OIIC (31) days musl 1I0tify thc Coullly's Personnel Departmcnt. in wrilillg, of his/her intcllt to return to ,,'ork no later thanthc bcginning of thc first full pay pcriod on tJIC first full calendar day following UIC completion of UIC pcriod of scrvicc and lhc expiration of cight hours alicr a pcriod allowing for thc safc lransportation of thc cmployec from lhc placc of sen'icc to thc cmploycc's residcnce; or, if through 110 fault of hi4hero\\'II, lhc cmploycc cannot rcport as scl forth abovc, he/shc musl do 50 as soon as possible. An cmployce who has bccn on mililal1' Icavc for morc than thirty (30) days. bu~ Icss Ulan 181 days will bc rctaincd OlltJlC Coullty payroll in. ,Ill inacti\'cstatus. Thc cmploYcc must notify thc County's Personnel Deparlmcllt, ill writing, of his/her intentlo rcturu to work no latcr thall fourteen (J ,1) days Clncr thc complclioll of tJlC sCITit'c; or, if tJlrough no falllt of his/hcr own,lhc cmploycc is ullablc to providc tJIC writtcn noticc in LIlc manllcr dcscribed, thcn he/shc must do so by UIC first full calcndar day possible. An cmployce who has bccn on military lea\'c fOl' morcthan 180 dars lll11slllOtify UIC COllllly, in writing, of his/he-r inlcnlto rctum to work no later tJlall nincly (90) days ancr completion of thc scn'icc, Not\\'iulstancling thc forq~oing, tllc COllnly may rcfuse to re-cmploy an clllploycc rctumillg from military Ica\'c if: I) The County's rirclllllslall{'cs ha\'c challgcd so

0001517

Case 1:07-cv-00026-OWW-TAG

RULE 1200

Document 277

Filed 12/01/2008

Page 49 of 93

LEAVES OF ABSENCE WITHOUT PAY

Illuch as to make the re-emplopl1cnt impossible or ullrca!:onablc; 2) Thc class position from which 111e pcrson pre\'iously held has bccn delctcd ;Illd 111erc arc 110 similar or comparable positions; :~) He-cmploymcllt would cause lIl1due hardship 011 the Coullty; illld/or 'I) The employmellt from \rhirh the person len was for a hrief, 1I0n-recurrcnt pcriod and thcrc was no rcasonablc cxpcctation thc job would cOlltillllC illdclinitely or for allY signilicallt pcriod. (Rc\,.II/O I)

1201.50

Lea\'e lor Compensablc DisabiJit\,. Coullty employccs shall ha\'c an automatic !carc of abscllce from employmellt during slIch period as the cmployee is eligible to rccci,'c temporal)' disability compclIsation under the workcrs' compensation laws oflhc State. Said Ica\'c shall automatically tcrmillatc whentJlc right to such compcnsationtcrminatcs, the cmployec is detcrmined by lhc Hisk l\1anagclllclIl Di"ision of the Coullty COUIIScl'S Ollicc not to bc e1igiblc for workcrs' compcnsaLion bcnefits, 111c cmployce has bcell released to rcturn to work by a doctor authorizcd by thc Hisk Managcmcllt or a County doctor, or UIC cmploycc rctires from COllnl)' sen'icc, whicllc\'cl: occurs first. Employecs may usc sick !care during the Ica\'cherc pro\'ided for in accordancc wilh Ordillance Codc Scction 3.28.110. Employecs dctcrmined not to bc c1i/:,';blc for \ Vorkcr's Compcnsalion bcncfits shall ha,'c all Ica,'c Limc lakcn undcr ulis scctioll COII\'crlcd to allowablc Ic;\\,cs under SecLiolls 1201.20, or 1202.20 of UtC Ci\'il Scr\'icc Huks, as applicable. (Rc\,. 01/97) To lhc maximum cxtcnt pcnnillcd by law, alllca\'cs authorizcd by tllis Rulc shall nlll concurrcntly with Iea\'cs takcn pursuant to Hulc 1201.30 and shall ('ounl against thc. lweh'c (12) weck limil containcd in Hulc 1201.30. (HC\', 01/97)

1201.50,10

Employccs who arc on a compcll$ablc disability Ica"c of abscncc shall submit a statcmcnt of ulcir condilion fromlhcir doctor to their appointing authority as long ilS they rcmain on such Ieaye of abscncc. (HCY. 8/92)

1201.50.20

Any cmployce who is granlcd a scrvicc-connectcd disability reLircmcnl ,U1el who latcr is dctcnnincd by thc HcLircmcnl Board to bc JlO longcr incapacitatcd and who dcsircs to rcturn to acLi\'c Counl)' cmploymcnt and is rc-cmploycd shall bc dccmedto ha\'c bccn on iln appro\'cd Ica,'c of abscncc without pay for the pcriod of limc hc/shc rccei\'cu said scnicc-conncctcd disabilit),. (Rc\'.8/92)

1'201.GO

FamilY School And Liccnscd Child Day Carc Acti\'ilY Lea\'c. Any full-Lime or part-limc COllllty cmploycc who is a parcllt, guardian or grandparcllt "'itll custod)' of a child in grades Kindcrgarlcn ulrough Twelvc or allcllding a liccnsed child day carc facility, shall hc entitled to, upon propcr wrillcn rcqllcstto thc appoinLing aUlhoril}', a Ieaye from work up to a maximum of fort)' (.to) hours per year, but no morc Ulan cight (8) hours in an)' calendar mOllth, to parLicipatc 'in UIC acli\'iLics of UIC school or liccnscd child care 1;lcility of any of his or hcr childrcn, The employcc shall usc \'acation, compcnsalol)' limc-olr or any oUlcr paid Ieayc allowanccs Olhcr tJliln sick Ica\'C. If thc cmploycc has

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RULE 1200

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paid ka\'c Limc accmcd, kll\'c without pay shall bc takcn. The cmployee shall, h~\"C Iloticc of that rcqucst in writing to thc Dcpartmcllt Hcad no less thallthrce (3) working days prior to tllC datc of tllC schcduled school or day care activity. If Loth parellL~ work for thc samc departmeul, the departme!ll head Ill:!y limillhc lea\"e to the parent initially making thc requcst. If rcquested to do so by thc dcpartmcllt head, tllC cmployce shall pro\"idc wrillcll vcri/icalion of his or her participation in the school or day care aCli\·ily. (Rcv.02/98) 110

1202.00

DISCRETIONARY LEAVES OF ABSENCE \VITHOUT PAY

1202.10

Hc(]uest for Lca\·c. Any Coullty employcc who occupics a rcgular r1assilied position may apply for the discretiollary Ieavcs providcd ror inlhis Rule. Rcqucsts fOJ- all)' such leave without pay shall bc made upon forms prcscribcd by the Commission and shall statc spccilically the rcason for the rcqucst, thc datc whcn the employee desircs thc Ieavc 10 commcncc, am) the specilic date of rcturn. The rcquest shall be dcli\'crcu to tlle appointing authority for wrillcn rccommcndation that it be granted, modi/jed, Or dcnied, and both the requcst and the rccommcndation shall bc promptly transmillcd to tllC Dircctor by tllC appoiuting autllOrity. If tllC appointing alllhority recommcnds dcnial or modilication of tlle lea\"c rcqucstcd, thcrcasons tllcrcfore shall bc commul\icatcd to tllC Dircctor in writing. No such requcst shall Le dcnicd or modi/icd witllOUt notice to the cmployec, who mar appcal tlle dcnial or modilication to thc Commissioll. (HC\·. 8/92)

1202.20

Pcrsonal Nccessitv Lca\·c.:\ny pcrmancntfull.lime or pcrmancnt part-Limc cmployec ill tllC dassilicu scrvicc may bc grantcd, upon propcr \\'rillcll rcqucst and apprO"al of thc appointing autllOrit)' and tllC Director, a Ica\"c of abscncc without pay not Lo excecd thrce (3) months for pcrsollal reasons.
l202.20.1 ()

1202.20.20

TlIc situation or condition ncccssit;Jting Ica\'e is rcmcdial \\'itllin thc pcriod rcquesled. (Hc\·.8/92) The situ;JLion or condition ncccssitating lea\'c is not remcdial by olhcr means. (Rc\,. 8/92)

I 202.20.:~0

Rcfllsalto authorizc Ica\'c will rcsult in pcrson"l hardship or su/Terillg /e)r the employec or the cmployec's immcdiate family. (Hc\,. 8/92)

1202.20.·H)

Thc cmployec's ausencc will not substantially interfcre with the business or the afleeted departmcnt. (Rc\,. 8/92)

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1202,20.50

Thc elllployec shall usc all vacation bl\'C, holiday limc, and compcnsalory limc otT to ahscncc. (Hc\". 8/!)2) his/hcr credil prior 10 thc clTeco\"e elate ofthc Ica\'c

1202.20~GO

Thc employcchas cxhauslcd thc Iea\'c prm'ided fOl iii Section 1201.20 or $cclioll 1201,:10, or both, or is othcrwisc not eligihle for cither of such lca\·cs. (Re\'. 8/92)

1202.31,20

The posilion still exists and thc cl'nplo'ycc is olherwisc qualificd for the position. (Rc\,.

or

8/92) 1202.·10

Educational/Personal Enrichmenl Lea\'c. Any pcnnancnt full-timc or permancnt parltimc employcc in thc classified scn'icc may bc !{ranted, upon propcr wrillcn request and appro\'al of thc appointing authority and the Dircctor, a le;\\'c of abscnce without pay not to excecd onc (I) ycar lor cducalional or pcrsonal cnrichment purposes. Thc cducational or pcrsonal cnrichment IC;l.\'c may bc cxtended, upon tJle proper writtcn rcquest and appro\'al, one (I) additional ycar. (Hc\,. 01/9a)

1202.·11

An employcc granted an cducational/personal enriclnllcnt!c;\\,c ofabscncc without pay shall, lor two (2) ycars, retain the right to bc appointcd to. thc lirst \"acant position availablc in thc apprO\'ing department in the class of position which he/shc had pre\'iollsly occupied prior to tJ1C lca\'c of absencc. (He\,. 01/93)

1~02.,12

During U1C pcriod of thc cducational/pcrsonal cnrichmcllt Ieavc of ahscnce, and for a pcriod or two (2) ycars following thc completion orthc Iea\'c, if tJ1C cmployee is awaiting a \'acancr in thc department which approvcd thc Ieaye in thc class of position which hc/she had prcriously occupied, tJle employec shall bc retaincd on the payroll in an illacti\'c statlls. During this period, tllc cmployec retains the same bcnefits as other employccs 011 leave of abscncc for other purposcsundcr Rule 1202. If, alter two (2) years following completion of thc educationaVor personal enrichmcnt leavc ofabsence, a vacancy has not bccome a\'ailable to which thc cmployec can be appointed, then payroll status will be terminatcd. If such occurs, the cmployec shall automatically be placed on thc re-cmploymcnt list for tJ1C class OJ' classes in which the employee previously held regular status. mC\·. 01/93)

1202A:~

Thc employec is obligated to accept tJ1C lirst appointmcnt ollcrcd rollowing completion ofthc cuucation/pcrsollal cmicllJllcnllcave. Failurc to do so will rcsult ill tJlC forfeiture of all rights undcr ulis Rule. (Re\,. 01/93)

1202,·H

Rights undcr this Rule arc conditioned

1202.H.IO

lJsin~ all

1202,·(.·1..20

If thc cmployec fails 10 acti\'c!Y, continuously, ami succcssfully pursue an euucatiolla!/pcrsollal cmiclullellt goal, tJ1C lea\'c or abscncc shall be imll1ediately

011

thc cmplovec:

vacationlc;l\'e, holiday time, alld compcnsalory time o!T to his/her credit prior to tJle cl1c(ti\'c date of the Ica\'e or abscnce. (Hc\,. 8/92)

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canceled, amI tllc employee will losc thc rigllt to return 10 a posilion wilhin tltc dassilicd sen·ice. (Hc\·.01/93)

1202..t·UlO

Upon return from such !c;weol" absence to a positioi! within the r1a~sifi('c1 scn'icc, illI employee shall bc clltillcu to, amI have reillslated to his/her credit, all sick Ica\'c acculllulated hy him/hCJ" at UIC Limcof thc granting of Ihc leave of ahscncc; The employce shall also relain the \'acation accrual ratc cnjoyed prior to thc Ieavc of abscnce. The cmployec shall also havc his/her scniority c1atc rcslorcd, minus the length of timc he/shc was on the leavc or absencc. me\'. 8/92)

120:1.0{)

DLJR..\TION/EXTENSION OF 1,E:\VE.s \VITH0 l.lT PAY Lea\"Cs ofabscncc without pay may bc approvcd for UIC maximum pcriod ofLimc as spccilicd illthcsc Rules bascd upon thc rcason for tltc rcqucst. If tllc on!,,'inallcilvc of abscnce is not for thc maximum dur.llion allowctl and thc cmployce dcsircs all cxtcnsion OfU1C oribrlnallcavc of abscntc, U1C cmployee must rcqucst said cxtcnsion 011 the Ieavc of abscncc form and rcturn UIC complclcdform 10 thc appointing authority tCIl (10) days prior to thc cxpiration of the oril,rlllal Ieavc. Thc appointing auulOrity, withappro\"al of thc Dircctor, may exlend such Ieavcs only to UIC maximum time pcriodsspccificd hcrcin. (HC\·. 8/92)

120LOO

RETURN BEFORE EXPIR:\TION \ Vhellcvcr all cmploycc who has takcn a Ica\'c wiUlOut pay desircs to rctunJ beforc cxpiralion of suclllcavc, thc cmployce shall so 1I0til)·thc appointillg authorilY ill writing at Ieavc Iivc (5) calendar days in a
1205.00

LEAVES OF ABSENCE FOR NON-PROr-,lOTIONAL PROB:\TIONAHY El'\,IPLOYEES Notwilhslanding any othcr provision of Rule 1201.20 or Hule 120210 thc contrary, Ica\'cs of abscncc for probationary cmployccs shall bc adminislcred according to the following:

1205.10

1205.20

Non-promotional probational1' cmployccs shall becnLitlcd to a lea\'c of abscnce without pay for non-job-connccted illncss or disability, including disability resulting from prcgnancy, childbirth, or relatcd condition. Such lea\'c shall not cxcecd a maximum of I'
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l205.:~0

Non-promotional probationary employces shall not hc granted a discn:Gonary lca\"C of absence without par for any rcason olllcr lllan spccified in Hulcs 1205.10 and 1205.20. (Hc\,.8/92)

1205.··10

Non-promotional flrobaGonary cmployces called to ser\'c onjury duty shall be granted lime olT without loss of pay in accordancc \\;th Onlin:lnce Codc Section 3.20.0:30. Actualtimc away for jury scrvicc will bc added to the probation pcriod on a day-for-day basis as prm-ided in Rulc 702.22. (HC\'. 8/92)

1205.50

To the maximum extcnt permilled hy law, alllca\'es authorizeu by Hull: 1205 shall rlIlI concurrcntly \\;th Iea\'cs taken pursuant to Hulc 1201.30 and shall cOlint against tlte twel\'e (12) wcek limit containcd in Hulc 1201.30. (Rc\,. 02/98)

I~O(j.OO

VACATION OH SICK LE:\VF.l\CCHU;\IS WHILE ON LE:\ VE No cmploycc who has becn granlcd a Ica\'c without flay for any reason shall accrue \:;lcation or sick lea\'e during the linlC of such leavc. Ok\'. 8/92)

1207.00

HECOHD OF LEAVE Heconls oflca\'cs without pay, military Ica\'cs, sick lc;l\'c and \'acaGon accruals, dcducLions, and balanccs shall bc maintaincd in lllC onice of !J1C Commission. The Dircctor shall furnish [jIC appointing authority any informaGon from such records as may bc requested. (Hc\,. 8/92)

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RULE 1200

LEAVES OF ABSENCE WITHOUT PAY

paid leavc timc accmcd, le:l\'c wiLhouL pay shall hc taken. The cmploycc shall, b~"C noLicc of LhaL rClluest in wriLing to thc Departmcnl Hcad no Icss than three (3) working days prior to thc datc of the scheduled school or day ("arc activity. Ifboth parents work for thc same departmcnt, the departmcnt head may limilthe Ic;l\'c to the parclIl initially making the request If requested to do so by the dcpartmcnt head, thc employec shall provide wriuen \'crilicatioll of his or her participatiollin the school or day c;u'C acth'ity. (HC\'. 02/98) .

110

1202,00

DISCRETIONARY LEAVES OF ABSENCE \VITHOUT PAY

1202.10

Requcst for Lcavc, Any County cmployec who occupies it rcgular classificd position may apply for thc discretional}' ICa\'cs providcd for in this Rule. Rcquests for any stich leavc wiUlOut par shall bc madc upon forms prcscribed by the Commission and shall state spccifically the rcason for the requcst, thc date whcn the employcc desircs the lea\'c to commence, and the specific date of return. The request shall bc dcli,'cred to thc appointing authority for wrillcn recommendation that it bc grantcd, modified, or dcnied, and both UIC rcquest and Ule rccommcndation shall bc prompuy lransmiUcd to thc Director by the appointing auulority. If Ule appointing auulority recommends denial or modification of U1C leavc rcqucstcd, the rcasons thcrefore shaH bc communicatcclto UIC Dircctor in writing. No such rcqucst shall bc dcnicd or modified WiUlOUl noticc to Ule employce, who may appcal U1C denial or modification to U1C Commission. (He\,. 8/92)

1202,20

Personal Necessity Lea\-e. Any permancnt full-timc or permancnt part-Limc employee in the classified scn-icc mar be grantcd, upon proper written request and apprO\'al of the appointing auulOrity and the Director, a Icavc of absencc wiUlOut pay not to cxceed thrcc (3) months for pcrsonal reasons. (Hcv. 8/92) ApprO\'al of ~uch le;1\'c wiUlOut pay uncleI' Ulis scction shall hc conditionccl on lindings thal:

1202.20.10

1202.20.20

Thc situation or conditjon ncccssitating Ieavc is remcdial ",iulin U1C period requcstcd. (He\·.8/92) Thc situation or condition nccessitating Ic;l\'c is not rcmcclial br othcr mcans. (Hc\,. 8/92)

1202.20.30

Hcfusalto authorizc leave will rcsult in pcrsonallmnlship orsulrcling lonhc employce or thc employce's immediate f;unily. (Hc\,. 8/92)

1202.20AO

Thc cmployec's abscncc will not substantially interfere ",iul Ule busincss of thc alleclcd dcparUllcnl. (Rc\,. 8/92)

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1202.20.5()

'nlc cmployee shall usc all vacation Icavc, holi(lay timc, a1l(1 compcllsatory timc otT to his/hcr credit prior to thc clTccti\'c datc of tJ\C Icavc of ahscncc. (Hc,·. 8/fJ2)

1202.20.()()

Thc employcc has cxhaustcd thc leavc providcd for in Scction 1201.20 or Section 1201.30, or both, or is otJ\crwisc not eligiblc for cit her of such Icavcs. (Rev. 8/92)

1202.31.20

The position still cxists and tJ\C employcc is othcmisc qualificd for tJ\C position. (Hc\'. 8/92)

1202..10

Educational/Pcrsonal Enrichment Lc;wc. Any pcrmancnt full-timc or pennancnt parttimc employec in tJ\C classified scrvicc may bc granted, upon propCI' writtcn rcqucst and appro"al of the appointing authority and tJ\e Dircctor, a Icavcof abscnce without pay not to cxcced onc (1) ycar for cducational or pcrsonal enrichmcnt purposes. Thc cducational or pcrsonal cnrichmcnt Icavc may be cxtcnded, upon tJ1C propcr written rcqucst and approval, one (I) additional ycar. (Hc,'. OI/9a)

1202.:1·1

An cmployce /,'Tanted an cducational/pcrsonal enridllncntlcm'c 01" abscnce ",itJlOut pay shall, lor two (2) ycars, retain the right to bc appointcd to thc lirst vacant position ;\\'ailablc in tJ1C approving departJ11.cntin thc class of position wllich he/shc had prc"iously occupicd prior to tJ\C Icavc of abscncc. (Rc\,. 01/93)

1202..12

During tJ\C period of the educational/pcrsonal clllichment kavc of ahsence, and for a period or two (2) ycars following thc complction orthc leave, ifthc cmployec is awaiting a vacancy in thc dcpartment which approved the Ieavc in thc class of position which hc/shc had prc\'iously occupied, thc cmployec shall bc retaincd on thc payroll in an inactive status. DUling this pcriod, the employee retains tJ\C samc benefits as other employces on lca\'c of abscncc for other purposcs undcr Rule 1202. If, aller two (2) years following complction oftJ,c cducational/or personal cnrichment lea\"c of absence, a "acancy has not becomc availablc to which tJle cmploycc can bc appointcd, tJ\cn pa)Toll status will bc terminatcd. If such occurs, thc cmployec shall automatically bc placcd on thc re-cmploymcnt list for the class or classes in which thc employee prcviously held rCb'l.Ilar status. (Hcv.Ol/93)

1202..-1.3

Thc employec is obligated to acccptthc lirst appointmcnt ol1crcd lollowing completioIl of thc education/pcrsonal enrichmcnt leave. Failurc to do so will rcsult in tJIC forfciture of all rights undcr tJlis Rule. (Rev. 01/93)

1202.·j.,t

Rights undcr this Rule are conditioned

1202A,tlO

Using all \'acationlcavc, holiday timc, and compensatory timc olT to his/her credit prior to tJ1C elTecti,'c datc of the 1ca\'c or absence.
1202.·H.20

If thc employce f;\ils to acti\·cly, continuously, and succcssfully pursuc an educational/pcrsonal enrichmcnt goal, ~IC Ieavc of abscnce shall be immediately

011

,llc elliplovee:

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• KERN MEDICAL • CENTER AFFILIATED WITH UNIVERSI1Y OF CALIFORNIA SCHOOLS OF MEDICINE AT LOS ANGELES, SAN DIEGO, AND IRVINE

. June 14, 2006 Dr. David F. Jadwin 3184 BeaudJy Terrace Glendale, CA 91208-1745 RE: Request for extension ofJune 16 deadline Dear Dr. Jadwin: I was sony to hear ofyour accident. It seems as though it has been one thing after another for you and I can imagine your growing frustration with not being healthy. My response to your request for an extension ofleave has two parts to it. First. I win grant you a Personal Necessity Leave ofup to 90 days. This is predicated on your providing a physician's note indicating the ailment. This is comnion practice with the County and I want to make sure that we are consistent in following policy. This extension of leave, however, applies only to your employment status. It does not apply to your appointment as chairman and the associated duty assignments, which brings me to the second part ofthis extension. You have essentiaUy been out either fuU- or part-time for the past eight or nine months. You have used all ofyour vacation and sick time in addition to being in a non-pay status for six months, and while I understand the circumstances, it does not diminish the fact that the Department ofPathology needs a full-time chairman. For this reason, I am going to enact the provisions ofthe Medical Staff Bylaws, Paragraph 9.6-4, REMOVAL, and rescind your appointment as chairman. I regret that I have to do this but KMC is going through some challenging times and we need a full complement of leaders. Your continued unavailability creates a void that must be filled. This decision is effective June 17,2006. The obvious question that I am sure comes to mind is, ''what does this mean for me?" This essentially means that should you decide to return to work at KMC either within this 9O-day period or at the end of it, your contract will be changed to reflect a regular staff pathologist duty assignment. The amount oftime you spend will be mutually agreeable, but your duties will not include those ofthe chairman. Ifyou have any questions concerning this please give me a call at 661-326-2106. I wish you a speedy recovery.

000152 5 cc:

Irwin Harris, M.D., CMO Eugene Kercher, M.D., President, Medical Staff Karen Barnes, Deputy County Counsel OWNED AND OPERATED BY THE COUNTY OF KERN

1830 FLOWER STREET· BAKERSFIELD. CALIFORNIA 93305·4197· TELEPHONE (661) 326-2000

(

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Peter Bryan - Extension of leave From:

Peter Bryan David Jadwin, DO Date: 6/13/2006 1:08 PM Subject: Extension of leave cc: internet:[email protected]; Irwin Harris, MD; Karen Barnes

To:

--_._-----,------

I will be sending you a hard copy of this notice. My response to your request for an extension of medicall,eave has a two part answer. First, . I will extend leave to a Personal Necessity 'Leave for your employment status only. This means that you have 90 days of extended leave which will protect your overall employment status. At the end of this 90 day period, you must either return to duty or resign from employment. Second, I will not extend your leave as it relates to your appointment as Chairman, Department of Pathology. I am implementing the provisions of paragraph 9.6-4, REMOVAL, Medical Staff Bylaws, and withdrawing your appointment as Chairman, Department of Pathology. This institution needs to have full time leadership in the department and because of your leave you have not been able to provide it. Should you return to work after the completion of your Personal Necessity Leave then your employment contract will be modified as mutually agreed to reflect that you are still an employed pathologist (should you choose this option), but you will not retain the duties and appointment of a chairman. My decision to do this, Dr. Jadwin, is based solely on your inability to prOVide consistent and stable leadership in the department for most of the past eight to nine months. You have used all of your sick and vacation time in addition to using all available time under the medical leave provisions of County policy. It is unfortunate that you had your accident which delayed your return but the hospital needs to move on. Also recognize that should. you decide to return to work that I will require your treating physicians to stipulate your ability to work. This type of stipulation is consistent with what we require of all persons who have been out on an extended medical leave. Please let me know if you have any questions. As I indicated, you will be receiving a hard copy of my decision related to extending your leave.

0001526 file://C:\Documents%20and%20Settings\bryanp\Local%20Settings\Temp\GW} 0000 I.HTM

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IOIC HR

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D. Jadwin. M.D. 12110/05 thru 06/09/06 Timeline.

I

I I I

PaE PeriodlOates

05-22 05-23

Hours worked

Houl's ne~ded to cObJplete 80 hr PDy Period

80

32

05·24 05-25 12/10/05 thru 12/23/05 05-26 12124/06 tbm 01/06/06 06-01 01/07/06 tbm 01120/06 06-02 01/21106 thru 02103/06 06-03 02/04/06 tbru 02/17/06 06-04 02/18/06 thru 03/03/06

40 hours of sick 8 hours of vac

80 56

24

40

40

57.5

22.5

60.3

19.7

41.5

38.5

40

40

Total ofbours used w/ont ~

• 02123/06, end of

14.5

leave w/pay.

•

02124/06, leave

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Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

Page 59 of 93

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b76-S0-H77

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NAME

IJADWIN, DAVID

SOC. SEC. ",

1376-50-8177

DATE

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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 64JOB of 93 TITLE KERN MEDICAL CENTER lITEM NO. 0"06

JADWIN, DAVID FRANK

I HOME DEPT. I 8719 I I #

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MEDICAL STAFF-PATHOLOGY

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I..JADWIN,DAVID FRANK

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IJADWIN, DAVID

FRANK

iOC.SEC. #

1376-50-8177

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Document 277

Filed 12/01/2008

Page 75 of 93

II KERN . II MEDICAL ...:: . CENTER AFFILIATED WITH UNIVERSITY OF CALIFORNIA SCHOOLS OF MEDICINE AT lOS ANGELES. SAN DIEGO.. AND IRVINE

RELEASE TO RETURN TO WORK ~ Following a Medical leave of Absence

o

Following a light-Duty Assignment

'"» cdho~H,

Date: 3..::13

Supervisor/Dept: .

Employee's Name:

=1)Q.\)·,d

'F.

-aCo

dcd(.~t,)~f)

The above-named employee has presented a physician's clearance to return to work following a medical leave of absence or a light-duty assignment.

3 -\ k -0\0

Return to Work Date:

~

Return to full duty with no restrictions.

o

Return with the following work restrictions:

o

_ _--,-__ Ibs.

o

_ _ _ _ _ _ _ _ with

o

minute breaks

_ _ _ _ _ _ _ _ with

minute breaks

D

o Duration of restrictions:

~~-

Please work with your employee to ensure that he/she does not exce inform us if you can no longer accommodate the restrictions.

these restrictions, and

If you have any questions, please contact the Human Resources office at 326-2640.

~"'h~~,f)e(

Phone:

3&- 2~L40

epresentative

OWNED AND OPERATED BY THE COUNTY OF KERN 1830 FLOWER STREET. BAKERSFIELD. CALIFORNIA 93305-4H17 • TELEPHONE (661)326-2000

Case 1:07-cv-00026-OWW-TAG

Filed 12/01/2008

Document 277

-

. F.

· Page 76 of 93

c0ad~i() ~o...\,)~d

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CERTIFICATION OF HEALTH CARE PROviDER ~ 2:)06 ; Medical Leave of Absence 1.

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(Note: The health care provider Ie NOT to dtscIose the underlying diagnosIs without the consent

01 the patient)

commen~· }2- I b- 0 ~

2.

Date medicat cancfdlon or need for treatment

3.

Probably duration of medical condition or need for treatment

~ - 3> ft'1o.

Approximate datB on .which you ressonably expect employee/patient will be able to retum 10 work (includIng on light duty): -:--_~~--_-

3-1C,-0& 4.

The definitions on the reverse describe what is meant by a ·Serlous Health Condition- under both the federal Family and Medical Leave Act (FMLA) and the Califomia FamUy Rights Act (CFRA). Does the patient's condition qualify under any of the categories described? I' so, plesse check the appropriate category:

"I.e.S

(1)_ (2)...! (3)_ (4).i1. (5)_ (6)_ 5.

Is employee/patlent able to perform wort< of any kind?
X

Yee .

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18 employee uneble to pertonn any on. or more of the essential functions of employee's position? Answer after reviewing statement from employer of essentlal functions of employee'S posItJon, or, if none provided. after discussing with employee. Yes _ No _

STATEMENT OF EMPLOYER:

Please answec.the following ONLY If emploYee I.s reQuestfng Intenni\ten1 Leave or a Red!JC8d Worn SChedyle:

8.

18 it medICally necessary for employee/patient to be off work on an intennlttent basis or to work less than the empk)yee'a normal work schedule in otder to be treated for the Sfri~ health condition? Yes lL No _ . Desctibe:;;;r; t I~ Mj ~e '1w r- "2-

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>,±SJ Name of Health Care Provider: ~~1fL ~ I 5-t-! cI Typo 01 Pla<:tice:£ S."c.~. Signature of ProvIder.

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Case 1:07-cv-00026-OWW-TAG

Document 277

Filed 12/01/2008

Page 78 of lof 93 1 Page

"

Christine Teutimez - Re: David Jadwin

From: To: Date: Subject:

'Arlene Ramos-Aninion Christine Teutimez 5/2/20062:23 PM Re: David Jadwin

He gets paid for 20.5 hours. The' remaining time will be in a'no pay status. Thanks for your patience.

»> Christine Teutimez 5/2/2006 9:04:39 AM »> Hi Arlene, I received a time sheet for Dr. Jadwin and he only has 20.5 hours worked but across his time sheet it states "LOA= 59.5 hours" however he doesn't have enough sick or vacation time to make the difference between the 20.5 and 59.5, or is that what he is to be paid "per contract?" '

0001.547 file:/IC:\Documents%20and%20Settings\tetimzc\Loca1%20Settings\Temp\GW}0OOl3.HTM

5/2/2006

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_ _J...__ ___-1- .

Case 1:07-cv-00026-OWW-TAG 11/ 1::/~'Ol)t; 1 (I "7 F,",j:: :::282:~ i4

From: To; Date: SUbJect:

r:.rn.- t"' ,", I HULIJI) Document 277

'j

Filed 12/01/2008

".'\'-... Page 93 of4:!J 93

David Jadwin, DO Tracy Lindsey

11/13/200610:45:19AM Sick Time

Tracy. Because the time sheets are completed before the week is done, I forgot that I had a d Friday morning (and wouldn't have known how much time I was away).

tor's appointment

Please adjust my hours to reflect the use of 4 hours sick time on Friday,' November 10 Thanks. 0.1

,

I 1'1

III

0001.562

.,.....

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6

Document 277-2

Filed 12/01/2008

Page 1 of 245

Eugene D. Lee (SB#: 236812) LAW OFFICE OF EUGENE LEE 555 West Fifth Street, Suite 3100 Los Angeles, CA 90013 Phone: (213) 992-3299 Fax: (213) 596-0487 email: [email protected] Attorney for Plaintiff DAVID F. JADWIN, D.O.

7 8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

FRESNO DIVISION

11

DAVID F. JADWIN, D.O.,

12 13 14

Plaintiff, v.

Civil Action No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE LEE IN OPPOSITION TO DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Fed. R. Civ. P. 56(a)]

COUNTY OF KERN, et al.,

15

Defendants.

16 17

Date: January 12, 2009 Time: 10:00 Judge: Hon. Oliver W. Wanger Courtroom: 3 Complaint Filed: January 6, 2007 Trial Date: March 24, 2009

18 19 I, Eugene D. Lee, declare as follows: 20 1.

I am an attorney at law duly licensed to practice before the Federal and State Courts of

21 California and admitted to practice before the U.S.D.C. for the Eastern District of California. I am 22 counsel of record for Plaintiff David F. Jadwin in this matter. 23 2.

I am making this declaration in opposition to Defendants’ Motion for Summary

24 Judgment. I have personal knowledge of the matters set forth below and I could and would competently 25 testify thereto if called as a witness in this matter. 26 3.

Attached hereto as Exhibits are true and correct copies of the following documents:

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 2 of 245

Exh. 1

Date 7/10/2006

Description Memo from Mr. Bryan to JCC re Recommendation of Demotion of Dr. Jadwin

2 3 4 5 6

8/14/2008 8/26/2008 1/9/2008 3/12/2008 10/21/2008

Deposition Transcript of Peter Bryan, Vol I Deposition Transcript of Peter Bryan, Vol II Deposition Transcript of David Jadwin, Vol II Deposition Transcript of David Jadwin, Vol V Deposition Transcript of David Jadwin, Vol VI

7

8/18/2008

Deposition Transcript of Former Supervisor Barbara Patrick, Vol I

8

4/16/2008

Deposition Transcript of Former Lab Mgr Gilbert Martinez

10

9

8/22/2008

Deposition Transcript of Former President Scott Ragland

11

10

8/25/2008

Deposition Transcript of Supervisor Ray Watson

11

8/21/2008

Deposition Transcript of Former CEO David Culberson

12

8/29/2008

Deposition Transcript of PMK Philip Dutt, Vol. I

13

8/28/2008

Deposition Transcript of Former COO Sandra Chester

17

14

9/4/2008

Deposition Transcript of PMK Eugene Kercher

18

15

6/29/2006

Letter from Lee to Barnes re Spoliation of Evidence

16

3/29/2007

Letter from Lee to Barnes re Spoliation of Evidence

17

11/20/2007 Defendants’ Responses to Plaintiff’s Request for Production, Set One

18

9/10/2007

1 2 3 4 5 6 7 8 9

12 13 14 15 16

19 20 21 22 23 24 25

19

Joint Conference Committee Meeting Minutes re Demotion of OB/GYN Chair Kern County Policy & Administrative Procedures Manual, Section 139 (Disciplinary Actions)

20

3/12/2002

21

12/26/2003 Change of Employee Status

26

CMO Marvin Kolb Memo to Jose Perez re Pathologist Elsa Ang Accusations

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

2

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 3 of 245

22

5/15/2006

Expert Consulting Services Agreement, between Consultant William Colburn and Kern County

23

8/30/2006

Consultant William Colburn Report to Kern County re Review of Jadwin cases

24

8/13/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. I

5

25

8/27/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. II

6

26

5/3/2004

KMC FNA Consulting Project by UCLA Consultant David Lieu

27

8/18/2008

Deposition Transcript of Former President of Medical Staff Jennifer Abraham

1 2 3 4

7 8 9 10

28

Cancer Conference Presenter Guidelines

29

8/15/2008

12

30

10/19/2005 Exh. 202: Jadwin letter to Albert McBride, Cancer Conference Director re October Conference

13

31

11

Deposition Transcript of Former Cancer Committee Director Albert McBride

October Conference attendee feedback

14 32

11/9/2005

Oncology Conference attendee feedback of Savita Shertukde

33

8/25/2008

Deposition Transcript of OB-GYN Physician Joseph Mansour

34

Harris Memos to File re Mansour Behavior

35

5/10/2006 to 4/12/2007 8/19/2008

36

8/18/2008

Deposition Transcript of Chair of Surgery Maureen Martin, Vol. I

37

4/16/2008

Deposition Transcript of Histotech Evangeline Gallegos

38

4/19/2008

Deposition Transcript of Former CMO Marvin Kolb

25

39

2/26/2008

Deposition Transcript of Pathology Secretary Tracy Lindsey

26

40

2/26/2008

Deposition Transcript of Clerk Irene Lopez

15 16 17 18 19 20 21 22 23

Deposition Transcript of Nurse Executive Antoinette Smith, Vol. I

24

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

3

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 4 of 245

41

12/6/2007

Deposition Transcript of Radiology Chair Javad Naderi

42

12/6/2007

Deposition Transcript of Cancer Committee Chair Ravi Patel

43

8/15/2008

Deposition Transcript of Former CEO Secretary Arlene Ramos-Aninion

5

44

12/5/2007

Deposition Transcript of Surgeon Edward Taylor

6

45

12/6/2007

Deposition Transcript of Neurosurgeon Charles Wrobel

46

8/21/2008

Deposition Transcript of Psychiatry Chair Tai Yoo

47

8/20/2008

Deposition Transcript of Acting Pathology Chair Philip Dutt

48

9/14/2006

Acting Pathology Chair Philip Dutt Email to Barnes re Plaintiff’s Paycut Amendment

12

49

10/17/05

Plaintiff email to Bryan re Serious Biopsy Errors

13

50

3/2/2006

Exh. 271: Plaintiff email to Bryan re Serious Biopsy Errors

51

4/21/2006

Emails between Plaintiff and Bryan re Serious Biopsy Errors

52

8/7/2008

Deposition Transcript of Pathologist Savita Shertukde

53

3/11/2008

Deposition Transcript of David Jadwin, Vol. IV

19

54

10/21/2003 Confidential Report on Lau Complaint against Jadwin

20

55

1/8/2008

Deposition Transcript of David Jadwin, Vol. I

56

9/9/2008

Deposition Transcript of PMK Acting Pathology Chair Philip Dutt, Vol. II

57

12/4/2007

Deposition Transcript of HR Director Steven O’Connor

58

10/10/2005 Amendment No. 1 to Employment Contract of Acting Pathology Chair Philip Dutt

59

11/1/2005

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25 26

Employment Contract of Pathologist Savita Shertukde

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

4

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

60

6/19/2007 4.

Document 277-2

Filed 12/01/2008

Page 5 of 245

Employment Contract of Pathologist Gian Yakoub

Attached hereto as Exhibits 2-14, 24-25, 27, 29, 33, 35-47, 52-53 and 55-57 are true and

correct certified copies of deposition transcripts which I either personally conducted or attended. 5.

Attached hereto as Exhibits 15-16 are true and correct copies of letters which I authored

and faxed to Karen Barnes, Chief Deputy County Counsel for the County of Kern on the dates indicated. 6.

I have served four sets of written discovery on Defendants which included Document

Request No. 44. asking for “Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from Chair of Kern Medical Center’s Pathology Department to staff pathologist.” To date, Defendants have not produced any of the agendas for any JCC meetings including the meeting at which the JCC voted to approve Plaintiff’s demotion from chair. Defendants have engaged in a level of discovery obstruction that is more excessive than I have ever encountered in my 13 years practicing as an attorney, of which this is but the latest example. 7.

Attached hereto as Exhibits 17 is a true and correct copy of Defendants’ responses

received by me in response to Plaintiff’s Request for Production of Documents, Set One, propounded by me on behalf of Plaintiff.

16 17 18

I declare under penalty of perjury under the laws of the State of California and the United States that the foregoing is true and correct.

19 20 21

Executed on: December 1, 2008

22 23

/s/ Eugene D. Lee

24

EUGENE D. LEE Declarant

25 26 27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

5

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 6 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 2

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

7

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3 4 5 6 7 8 9

DAVID F. JADWIN, D.O., ) Volume II ) Page 288 Plaintiff, ) ) vs. ) Case No. 1:07-cv-00026-OWW-TAG ) COUNTY OF KERN; et al.,) ) Defendants. ) _______________________)

10 11 12

Videotaped Deposition

13

of

14

PETER K. BRYAN

15

Tuesday, August 26, 2008

16

San Diego, California

17 18 19 20 21

Reported by:

Vivian R. Weiss, RPR, CSR No. 12380

22 23 24 25

BryanP2

Page 7 of 245 288

Case 1:07-cv-00026-OWW-TAG

1

Q.

Sure.

Document 277-2

Filed 12/01/2008

The April 28th memo, I don't know if

2

you remember it, but you did detail quite a few

3

difficulties Dr. Jadwin was having in his communication

4

style and his lack of insight into how his own behavior

5

was contributing to the problem with his peers.

6

all detailed in the April 28 memo.

7

interested in that.

8

you made that the department of pathology functions

9

well, as it has for many years, and, yes, you continue

10

That's

But I'm not

I'm interested in this statement

to make positive changes to the department.

11

What were you basing that statement on?

12

A.

13

things.

14

passed the CAP inspection, College of American Pathology

15

inspection, and the department had successfully

16

completed those.

17

In pathology, I looked at really a couple The key thing is whether or not the department

And number two, there was no documented

18

evidence to me that the department was not fulfilling

19

its clinical obligations to the staff.

20

interactive challenges with Dr. Jadwin as an individual

21

and as a chairman, but the actual functioning of the

22

department of laboratory [sic] actually was fairly good.

23

Q.

Okay.

There were

So, in other words, the issues with

24

Dr. Jadwin's extended to his responsibilities and

25

effectiveness outside the department of pathology?

BryanP2

Page 8 of 245 332

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 9 of 245 333

1

A.

Fundamentally, that's correct.

2

Q.

But you didn't have any -- you didn't see any

3

issues with Dr. Jadwin's leadership within the

4

department of pathology?

5 6

A.

Not overtly.

And, again, it did not

contribute to the decision asking him to step down.

7

Q.

8

overtly"?

9

things?

10

A.

Okay.

Well, what do you mean by "not

What do you mean?

No.

Covertly you were hearing

To me it's like our interaction here.

It

11

would be very difficult for me to be polite and

12

congenial with you and turn around in a session with

13

Mark and be a pit bull.

14

their style that dramatically.

15

my saying I did not see or hear a lot of complaints from

16

the staff within pathology, other than the pathologists

17

that left, about interactive problems.

18 19

Q.

You know, people don't change So that's the basis of

If there were complaints within the department

of pathology, who would they have gone to?

20

A.

A number of avenues.

They could have gone to

21

the chief medical officer, to me, to human resources

22

would probably be the three primary points of contact.

23 24 25

Q.

Would it eventually bubble up to you as the

A.

Yes.

CEO? If they weren't resolved and became a

BryanP2

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Filed 12/01/2008

Page 10 of 245 334

major issue, yes, they would have. Q.

Okay.

So as of April 28th, 2006, when you

3

wrote this memo to Dr. Jadwin, nothing had bubbled up to

4

you, correct?

5

A.

Nothing had bubbled up to me other than I knew

6

general uncertainty in the pathologist's staff about how

7

things were being run only because of the absence of

8

Dr. Jadwin.

9

Is he going to be on the schedule or not be on the

10 11

Is he here today, or is he not here today?

schedule? Q.

Now, was there anything communicated, to your

12

knowledge, to the department of pathology regarding

13

Dr. Jadwin's absence?

14

A.

I did not -- well, I don't recall giving any

15

specific written guidance or verbal guidance to the

16

department of pathology.

17

conversations with -- I'm going to space out his name

18

here -- with one of the pathologists who was there.

I do recall having some

19

Q.

Philip Dutt?

20

A.

Yes, with Dr. Dutt, about how to cover the

21

department and what I would expect him to do, in a very

22

general sense, in Dr. Jadwin's absence.

23 24 25

Q.

Okay.

And did Dr. Dutt express any complaints

to you at that time? A.

Well, we were most concerned about the

BryanP2

Case K. 1:07-cv-00026-OWW-TAG BRYAN, VOL. II

Document 277-2

Filed 12/01/2008

Page 11 of 245 08-26-08 Page 346

1

STATE OF CALIFORNIA

2

COUNTY OF SAN DIEGO

3 4

I, Vivian R. Weiss, RPR, a Certified Shorthand

5

Reporter for the State of California, do hereby certify

6

that the witness in the foregoing proceeding was by me

7

duly sworn; that the proceeding was then taken before me

8

at the time and place herein set forth; that the

9

testimony and proceedings were reported stenographically

10

by me and later transcribed by computer-aided

11

transcription under my direction; that the foregoing is

12

a true record of the testimony and proceedings taken at

13

that time.

14

I further certify that I am a disinterested

15

person and that I am in no way interested in the outcome

16

of said action.

17 18 19

IN WITNESS WHEREOF, I have subscribed my name this 8th day of September 2008.

20 21

22

Vivian R. Weiss, RPR, CSR No. 12380

23 24 25

vs. &

RANDALL

(800)

COUNTY 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 12 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 3

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

8

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

1

UNITED STATES DISTRICT COURT

2

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

3

---------

4

4

DAVID F. JADWIN, D.O.,

Page 13 of 245 1

) Volume I )

5

5

Plaintiff,

) ) No. 1:07-cv-00026-OWW-TAG

6

6

vs.

) )

7

7

COUNTY OF KERN; et al.

) )

8

8

Defendants.

)

___________________________) 9

9

10

10

11

11

12

12

13

13

VIDEOTAPED DESPOSITION

14

14

OF

15

15

PETER K. BRYAN

16

16

Thursday, August 14, 2008

17

17

Bakersfield, California

18

18

19

19

20

20

21

21

Reported by:

Cindee L. LeFevre, CSR No. 7974

22 23

22

24 25

23

26 27

24

28 29

25

BryanP1

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 14 of 245 110

12:17:38 him

1

recollection of what Dr. Jadwin said to Dr. Raglan about

12:17:42

2

not being qualified to be the president of the medical

12:17:44 you 12:17:48 said

3

staff.

4

have any other specific regulations of what Dr. Jadwin

12:17:51 that he 12:17:54 12:17:56 12:17:59 that

5

to the other participants or any of the participants

6 7 8

was insulting? A. My recollection was, and it's stated in, I believe, that memorandum, that he offended everyone in

12:18:02

9

meeting.

2 3 4 5

Can you think of any other specific -- well, do

6 7 8 9 10 11 Not me, but all of his colleagues and medical

12 12:18:07 10

staff officers.

13 12:18:08 11

Q.

So it was -- did Dr. Jadwin insult you at the

14 12:18:13 12

mediation meeting?

15 12:18:14 13

A.

No.

12:18:15 14 make 12:18:19 15 meeting?

Q.

Okay.

16 17 18

So what other comments did Dr. Jadwin

to Dr. Raglan, comments of insult, at the mediation

19 20 21

12:18:27 16 of 12:18:31 17 dialogue

A.

The general tenor of that meeting, the intent

that meeting was to have adults sit down and have a

22 23 24 25

12:18:38 18 understanding 12:18:42 19 12:18:47 20 meeting

with the objective of leaving there with an of how people would communicate with each other, and Dr. Kercher was very instrumental in trying to move that

12:18:53 12:18:53 to 12:18:58 12:19:02 12:19:06 at

21 22

along.

23 24 25

Dr. Jadwin, and it took awhile, and by awhile, I mean probably at least 30 minutes for Dr. Jadwin to finally acknowledge what Dr. Kercher was attempting to do, and

26 27 28 29

And Dr. Kercher repeatedly tried to apologize

BryanP1

Case 1:07-cv-00026-OWW-TAG

1 2

1 2

Document 277-2

Filed 12/01/2008

Page 15 of 245 230

Q. Okay. Do you think Dr. Jadwin was being unreasonable in any way in taking the stance as

manifested 3 3

by those two sentences?

4 5 6 7 8

16:45:59 of 16:46:03 16:46:07 16:46:08 nature

4

A.

Well, if you take -- if you put it in context

5 6 7

Toni Smith's response and what nursing did and what Dr. Jadwin's position is. And again, I get back to that collaborative

16:46:11

8

between two critical leaders in your organization where

9 10 11 12 13

16:46:15 9 there's a clear difference of opinion and an unwillingness 16:46:17 10 to communicate, and I remember private conversations Dr. 16:46:20 11 Jadwin and I had where he challenged Toni Smith's competency

14 16:46:24 12

as chief nursing officer.

15 16 17 18 19 20 21 22

16:46:26 because 16:46:29 16:46:33 16:46:36 16:46:36 16:46:39 16:46:43 put

13 14 15 16 17 18 19

Now, that was never communicated with Toni that's a private conversation that -- but Dr. Jadwin did make those comments to me. Q. Okay. A. And -- but that is not something I would share with Toni Smith, understanding where she is in things. But this, to me, says -- particularly when you

23 24 25

16:46:46 20 have 16:46:50 21 things,

it in the context of Toni Smith's memorandum -- the two

16:46:53 22 right 16:46:58 23 16:47:02 24 25 breakdown

and because it's not what Dr. Jadwin perceives as the

a distinct difference of opinion on how to handle

26 27 28 29

solution, things are amok. They are not running the way they should be running. Q. So you reviewed this issue of PCC's as a

BryanP1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 16 of 245 231

1

1

in internal communications between Dr. Jadwin and Toni

2

2

Smith, perhaps?

3

3

4

16:47:16

A.

I would categorize it as an inability of two

4

professionals to sit down and have a constructive

16:47:19

5

to come up with a satisfactory solution.

16:47:22

6

dialogue, 5

6 Q.

Okay.

Do you recall what your response was,

7

if

8

16:47:28

7

9

16:47:31

8

A.

I'm sorry.

10

16:47:32

9

Q.

Okay.

11

16:47:34 10

(Plaintiff's Exhibit Number 296

12

16:47:34 11

marked for identification.)

13

16:47:34 12

I would ask you review this a little more

14

16:47:55 13

15

16:47:56 14

16

16:47:58 15

17

16:47:59 16

A.

Okay.

18

16:50:27 17

Q.

Thank you.

19

16:50:31 18

A.

Yes, I do.

20

16:50:32 19

Q.

Tell me what it is.

21

16:50:35 20

A.

It is a memorandum from me to Dr. Jadwin

22

16:50:38 21

summarizing the meeting held among the three of us, Dr.

23

16:50:44 22

Jadwin, myself, and Karen Barnes.

any, to Exhibit 295? No, I don't.

The next one is 296.

carefully, Mr. Bryan. You have been handed a document

marked for

identification as Exhibit 296.

Do you recognize this document?

24 25

16:50:49 23

Q.

So in short, this is a memorandum from you to

26 27

16:50:52 24

David Jadwin dated April 17, 2006; correct?

28 29

25

A.

That's correct.

BryanP1

Case 1:07-cv-00026-OWW-TAG

1

1

Document 277-2

Filed 12/01/2008

Page 17 of 245 249

previous where I said I need to know by June 16th

whether or 2 2 3 4 5

not he wanted to return full-time or resign his

position. 17:15:34 give

3 4

Q. A.

Okay. And the response -- his letter to me doesn't

6 7 8 9

17:15:39 5 return. 17:15:43 6 17:15:44 7 physically

me any hint at all as to whether or not he wants to

17:15:46

8

able to return.

17:15:51

9

ingredient there, what do you want to do.

Q. A.

Okay. Regardless, secondary, to when he is

10 And to me, that was a key missing

11 12 17:15:53 10

Q.

Okay.

Did you pick up the phone and call Dr.

13 17:15:58 11

Jadwin after receiving this?

14 17:15:59 12

A.

At this point, I, as probably Dr. Jadwin, was

15 17:16:02 13

frustrated with the issues.

I do not recall having a

17:16:05 don't, 17:16:10 17:16:14 17:16:17 17:16:22 Jadwin

14

conversation with Dr. Jadwin after receiving this.

15 16 17 18

because Dr. Jadwin, in essence, had not been physically present much during the preceding six months. Q. Okay. Well, on April 28, you had -- actually, looking back at Exhibit 303, you had asked that Dr.

16 17 18 19 20 21

I

22 17:16:26 19

go on full-time leave.

17:16:30 20

there.

Isn't that correct?

Take a look

23 24 25 26 27 28

17:16:34 last 17:16:36 17:16:39 17:16:52 off

21

I am going to direct your attention to the sentence of the third paragraph on Exhibit 303. A. Right. That's what I am reading. Yes. Q. Okay. Now, this request for Dr. Jadwin to go

25

to full-time, that's what it means; right, that

29

22 23 24

sentence?

BryanP1

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Filed 12/01/2008

Page 18 of 245 250

1 2

It was saying it would be better for the Pathology Department for Dr. Jadwin to go from an intermittent

3

schedule to a full-time leave.

work 3 Is that correct?

4 17:17:14

4

A.

That's correct.

17:17:15

5

Q.

Whose idea was that?

17:17:17 6 in 17:17:21 7 Department,

A.

Essentially, it was mine, reviewing the manner

5 6 7 8

which Dr. Jadwin was present or absent from the

9 17:17:23

8

and my perception was it was creating some issues of

17:17:28

9

scheduling within the Department.

10 11 17:17:30 10

Q.

Okay.

17:17:32 11 not be 17:17:36 12 accepted

A.

I also was not aware when he would or would

12 13 14

present.

Now, in this case, it says May 1, and I

15 16 17 18

17:17:40 13 prior 17:17:44 14 17:17:47 15 Jadwin

that, but I was never certain as to when Dr. Jadwin,

17:17:51 16

should be on intermittent work schedule, instead, to

17:17:55 17

full-time leave; correct?

to that, was present in the hospital or not. Q. Okay. So you made the decision that Dr.

19 20 21 22 23 24 25 26 27 28 29

17:17:56 18 preferable, 17:17:59 19 17:18:02 20 17:18:02 21 17:18:06 22 17:18:11 23 17:18:14 24 that 25 schedule

A.

No, what I indicated was it would be

which infers a decision. Q. Okay. A. And if I am not mistaken, Dr. Jadwin made a decision not to be present. Q. Okay. A. There was no dialogue back from Dr. Jadwin said, no, I still want to continue the intermittent

BryanP1

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7

Document 277-2

Filed 12/01/2008

Page 19 of 245 261

1 2 3 4 5 6 7

to be ratified and approved by the Board of Supervisors? Would that be Karen Barnes? A. Karen Barnes or somebody in counsel's office. Q. I'm sorry. Before we get to that, 324. (Plaintiff's Exhibit Number 324 marked for identification.) Mr. Bryan, you are being handed a document

17:33:31

8

for identification as Exhibit 324.

17:33:36

9

A.

Okay.

17:33:39 10 is 17:33:46 11 you,

Q.

Well, this is a little bit confusing.

17:33:00 17:33:00 17:33:00 17:33:00 marked

8 9 10 11 12

DFJ1345

an e-mail from Renita Nunn to David Jadwin with a CC to

13 17:33:51 12

and it's dated June 26, 2006.

Is that correct?

14 17:33:55 13

A.

That is correct.

17:33:56 around 17:33:59 17:34:06 17:34:13 17:34:17 Dr.

14

Q.

And you recall receiving this e-mail at or

15 16 17 18

June 26, 2006? A. The e-mail doesn't say anything other than -excuse me -- maybe I wasn't listening well. This is an e-mail from Renita Nunn who was in the HR Department, to

17:34:23 letter 17:34:27 17:34:30 17:34:35 17:34:35 David

19

Jadwin, and in it, she is referencing the attached

20 21 22 23

that I wrote to Dr. Jadwin. Q. The attached letter is DFJ1346; correct? A. Yes. Q. And this letter attachment is from you to

15 16 17 18 19 20 21 22 23 24 25 26 27 17:34:40 24 28 29

25

Jadwin dated June 26, 2006; correct? A.

Yes.

BryanP1

Case 1:07-cv-00026-OWW-TAG

1

1

Q.

Document 277-2

Filed 12/01/2008

Page 20 of 245 262

It's not signed, but do you recall drafting

this 2 2

letter at or around June 26, 2006?

3 3

A.

Yes.

17:34:51 part 17:34:55 17:34:57 17:34:58 part of

4

Q.

Okay.

5 6 7

of performing your duties as CEO; correct? A. Yes. Q. And you did, in fact, draft this letter as

17:35:02

8

performing your duties as CEO; correct?

17:35:04

9

A.

Yes.

17:35:05 10

Q.

Okay.

4 5 6 7 8

And drafting letters such as this was

9 10 11 And when Miss Nunn forwarded that

12 13 14 15 16 17 18 19 20

17:35:07 11 your 17:35:11 12 17:35:12 13 17:35:15 14 17:35:18 15 17:35:20 16 17:35:22 17 17:35:27 18 subsequent

attachment to Dr. Jadwin, I assume she was doing it on

17:35:31 19

medical issues that need to be cleared.

authority? A. Yes, and the applicable potions in the middle paragraph, paragraph three. Q. Of DFJ1346? A. That's correct. I say out of concern for your welfare, you are not to feel obligated to work while on leave, which led me to say stay away. You have

21 22 23 24 25

17:35:33 20 Jadwin 17:35:38 21 17:35:39 22 broke

Q.

So by June 26, 2006, you are aware that Dr.

had medical issues? A. Sure. I didn't challenge the fact that he

26 17:35:42 23

his foot.

I mean, I take people at their word on that.

27 28 29

17:35:46 24 for 25 not a

Q.

Well, a broken foot would take maybe two weeks

it to heal.

So it's not major.

BryanP1

Well, actually, it's

Case 1:07-cv-00026-OWW-TAG BRYAN

Document 277-2

Filed 12/01/2008

Page 21 of 245 08-14-08

Page 287 1

STATE OF CALIFORNIA

2

COUNTY OF KERN

3 I, Cindee L. LeFevre, a Certified Shorthand

5

Reporter in the State of California, holding certification

6

No. 7974, do hereby certify that PETER K. BRYAN,

7

the witness named in the foregoing deposition,

8

was by me duly sworn; that said deposition was taken

9

Thursday, August 14, 2008, at the time and place set forth

10 11

on the first page hereof. That upon the taking of the deposition,

the

12

words of the witness were written down by me in stenotypy

13

and thereafter transcribed by computer under my supervision;

14

that the foregoing is a true and correct transcript of the

15

testimony given by the witness.

16

I further certify that I am neither counsel for

17

nor in any way related to any party to said action, nor in

18

any way interested in the result or outcome thereof.

19 20

Dated this 2nd day of September, 2008, at Bakersfield, California.

21

.

22 23

/

~L)~

Cindee L. LeFevre, CSR No. 7974

24 25

vs. NDALL

R D I

ss.

4

w o

(800)

COUNTY 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 22 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 4

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

9

Case 1:07-cv-00026-OWW-TAG

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Page 23 of 245 263

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

DAVID F. JADWIN, D.O.,

) VOLUME II ) Page 263 Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) COUNTY OF KERN; et al. ) ) ) Defendants. ) _______________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

DAVID FRANK JADWIN, D.O.

17

Wednesday, January 9, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

Reported by:

Susan R. Wood, CSR No. 6829

DFJ2

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

that she lost her position.

2

her -- or at least meant to imply that I'm sorry you

3

lost your position, but I'm not the fault of that.

4

And she continued to be sort of abrasive.

5

frankly I just said, you act like a nasty person.

6

And this was a mediation session.

7

BY MR. WASSER:

8 9 10 11

Q.

And I told -- I told

And quite

Anything more? MR. LEE:

Vague and ambiguous.

Calls for a

narrative. THE WITNESS:

Dr. Ragland was -- has also,

12

as I've mentioned in the past, not been that

13

objective.

14

reported some concerns to Mr. Bryan, and Scott

15

Ragland was nasty as a result of that, I think.

16

And in one instance I reported --

At the end of that meeting both Dr. Kercher

17

and Dr. Harris gave rather, on the face of it at

18

least, sincere apologies for the behavior that they

19

had undertaken to me.

20

saying, when Dr. Harris apologized, that -- I said

21

now that's an apology.

22

apologized he -- afterwards the meeting terminated.

23

He got up and literally slugged me so hard on the

24

shoulder that had I not been the size that I was I

25

would have been knocked over.

And I remember actually

And when Dr. Kercher then

DFJ2

Page 24 of 245 290

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

BY MR. WASSER:

2

Q.

Was that when you were working one or two

3

days a week?

4

A.

I believe so, yes.

5

Q.

Then you went on full-time leave after that?

6

A.

I had surgery, and then I had an injury to

7

my foot where I broke one of the bones in my foot,

8

ripped several ligaments in my ankle, and when I

9

recovered -- let's see.

I'm losing track of the

10

sequences here, but there was a point when Mr. Bryan

11

told me that he did not want me to take any more

12

part-time leave and that he wanted me to go on

13

full-time leave so I could use up my sick benefit.

14

Q.

15

Um-hmm. And so when you -- had you been thinking

16

about forming a corporation, a business like Columbia

17

Healthcare Analytics for some time?

18

MR. LEE:

Vague and ambiguous.

19

THE WITNESS:

I can't exactly when --

20

remember exactly when I decided to form it, but my

21

wife is in the I.T. industry, she's an executive at

22

Disney, and I think she encouraged me to think about

23

developing an I.T. company to do some of this quality

24

improvement work.

25

////

DFJ2

Page 25 of 245 384

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

515 Page 26 of 245

STATE OF CALIFORNIA ss. COUNTY OF KERN 'OB

I,

Susan R. Wood,

a Certified Shorthand

Reporter in the State of California, Certificate No.

holding

6829, do hereby certify that

DAVID FRANK JADWIN,

D.O., the witness named in the

foregoing deposition, was by me duly sworn; that said deposition was taken Wednesday,

January 9,

2008, at the

time and place set forth on the first page hereof. 1

That upon the taking of the deposition, the

2

words of the witness were written down by me in

3

stenotypy and thereafter transcribed by computer under

4

my supervision; that the foregoing is a true and correct

5

transcript of the testimony given by the witness.

6

I further certify that I am neither counsel for

.7

nor in any way related to any party to said action, nor

.8

in any way interested in the result or outcome thereof .

,9

10

Dated this 24th day of January,

2008, at

Bakersfield, California.

. 'm

23 24

rsi

Susan R. Wood,

5

CSR No.

6829

j

Ion

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 27 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 5

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

10

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) VOLUME V ) Page 838 Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

DAVID F. JADWIN, D.O.

17

Wednesday, March 12, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

DFJ5

Page 28 of 245 838

Case 1:07-cv-00026-OWW-TAG

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Page 29 of 245 854

1

09:11:26

1 home.

There was no need to particularly direct

2

09:11:30

2 onsite, directly supervise the hematology supervisor.

3

09:11:32

3 That was all done by the laboratory manager.

4

09:11:35

4 pathologists were pretty much autonomous.

5

09:11:39

5 direction they would need is in this situation what

6

09:11:42

6 should I do, which could have all been done by phone.

7

09:11:46

7 And I think the important part was to remove me away

8

09:11:51

8 from -- at least for part of the week, away from the

9

09:11:56

9 hostility of the environment in the hospital.

The

The most

10

09:12:00 10

You had mentioned Dr. Shertudke, would I be

11

09:12:03 11 surprised if she made some claim that I criticized

12

09:12:12 12 her so severely that she moved out of the room?

13

09:12:16 13 know, I don't remember any such incidents of any

14

09:12:19 14 severity whatsoever, but I haven't been provided with

15

09:12:23 15 enough facts to -- to really assess that situation to

16

09:12:26 16 provide any comment about it.

17

09:12:30 17

18

09:12:39 18 extension of my decision to decide whether or not to

19

09:12:43 19 remain on as chair occurred one day after I broke my

20

09:12:47 20 ankle.

21

09:12:53 21 was just a request to be able to defer my decision

22

09:12:59 22 past -- beyond June 16th.

23

09:13:03 23 already put in was placed earlier and -- and was

24

09:13:07 24 terminated on April 28th, when Mr. Bryan told me that

25

09:13:14 25 he wanted me to stop going on -- working on a one- to

You

Regarding my request on May 30th for an

I was in quite a bit of severe pain, and it

DFJ5

The extension that I'd

Case 1:07-cv-00026-OWW-TAG

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1

09:13:17

1 two-day schedule per week and to take my leave full

2

09:13:20

2 time so I could exhaust it as soon as possible.

3

09:13:27

3

THE REPORTER:

4

09:13:27

4

THE WITNESS:

5

So I could -Exhaust it as soon as

5 possible.

6

09:13:27

6

And I think the last thing that I want to

7

09:13:30

7 mention is that there had been some mention of my

8

09:13:37

8 activities during 2006, particularly in early 2006,

9

09:13:43

9 regarding Columbia Healthcare Analytics, and I think

10

09:13:48 10 I've mentioned several times that I did mostly setup

11

09:13:51 11 work and mostly directing other people, such as the

12

09:13:55 12 person that I hired for setting up the I.T. system

13

09:13:58 13 and my cousin and my stepdaughter to perform work,

14

09:14:02 14 and that work consisted of perhaps, at the most,

15

09:14:06 15 three or four e-mails a day.

16

09:14:10 16 were probably in the nature of one, two, or three

17

09:14:12 17 sentences long.

18

09:14:17 18 four phone calls that probably didn't last very long

19

09:14:20 19 either.

20

09:14:27 20 the Website and the design of a logo for the company

21

09:14:30 21 that was being done by other people.

22

09:14:31 22

23

09:14:35 23 developing an I.T. system; purchasing office

24

09:14:39 24 equipment, which was largely managed again through

25

09:14:42 25 that person and later on my cousin; developing a

Most of those e-mails

And I maybe made less than three or

Those activities dealt with the design of

It had to do with the direction of

DFJ5

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Page 31 of 245 983

1

13:34:31

1 Center at that time?

2

13:34:32

2

A.

Yeah.

3

13:34:39

3

Q.

And at no time did you ask anyone for an

4

13:34:42

4 accommodation?

5

13:34:43

5

6

13:34:45

6 That's vague and ambiguous as to accommodation.

7

13:34:47

7

But you can answer, if you think you know.

8

13:34:49

8

THE WITNESS:

9

13:34:52

9 with my therapist, Dr. Riskin, and mentioned at a

MR. LEE:

That calls for a legal conclusion.

Actually, we did.

I talked

10

13:34:58 10 point later on that it would be -- it was very

11

13:35:04 11 difficult to be there all the time facing all this

12

13:35:06 12 hostility but that I could potentially work one to

13

13:35:10 13 two days a week.

14

13:35:14 14 found it therapeutic that I would be away from the

15

13:35:17 15 hospital at least part of the week, and that was

16

13:35:21 16 reflected, I think, in my medical leave request.

17

13:35:25 17 BY MR. WASSER:

18

13:35:26 18

19

13:35:28 19 leave, weren't you?

20

13:35:29 20

21

13:35:31 21 That misstates -- assumes facts not in evidence.

22

13:35:33 22

But you can answer, if you think you know.

23

13:35:35 23

THE WITNESS:

24

13:35:39 24 when Mr. Bryan told me that he wanted me to go on

25

13:35:42 25 full-time leave so that I would use up my leave

Q.

He agreed with that.

He actually

And you were allowed to take intermittent

MR. LEE:

That calls for a legal conclusion.

I was allowed up until April,

DFJ5

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Page 32 of 245 984

1

13:35:45

1 faster.

2

13:35:47

2 BY MR. WASSER:

3

13:35:48

3

4

13:35:50

4 two or three days a week for some period of time,

5

13:35:54

5 weren't you?

6

13:35:55

6

A.

For some period of time, yes.

7

13:35:57

7

Q.

And did you consider that to have been in

8

13:36:00

8 response to your request to work one or two or three

9

13:36:03

9 days a week?

Q.

You were -- you were actually working one or

MR. LEE:

Um-hmm.

10

13:36:04 10

That's vague and ambiguous as to

11

13:36:06 11 request, response.

12

13:36:10 12 the administration's motives.

13

13:36:11 13

14

13:36:12 14 understand.

15

13:36:13 15

16

13:36:17 16 worked out.

17

13:36:19 17 a good working agreement.

18

13:36:22 18 department had run well.

19

13:36:26 19 in at least two different documents, plus all the

20

13:36:28 20 other evidence that I showed.

21

13:36:32 21 department was running very well with me only being

22

13:36:35 22 there one or two days a week.

23

13:36:37 23

24

13:36:41 24 April 28th, I met in his office and he instructed me

25

13:36:47 25 to use up my leave so that we could get past this

Speculative as to Mr. Bryan or

But please answer, if you think you

THE WITNESS:

It was an agreement that we

Mr. Bryan actually thought it would be He had said that the I think it's been cited now

Actually, the

And then in April, I believe it might be

DFJ5

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Page 33 of 245 985

1

13:36:51

1 period because he felt that it was -- there was a

2

13:36:55

2 need for a full-time pathologist, which I did not

3

13:37:00

3 agree with because, as he said in two different

4

13:37:03

4 places, the department was running just fine.

5

13:37:06

5

6

13:37:12

6 this was that we had made attempts much earlier to

7

13:37:15

7 get a locum tenens pathologist in place.

8

13:37:19

8 pathologists can certainly handle the work of that

9

13:37:22

9 department if they're productive and -- and

I think the one problem I had with all of

Two

10

13:37:27 10 organized.

I mean, certainly I ran the department

11

13:37:29 11 by myself with no help for weeks at times and managed

12

13:37:34 12 it.

13

13:37:36 13

14

13:37:39 14 potentially be stressed out -- I know that

15

13:37:41 15 Dr. Shertudke could handle the work, but Dr. Dutt was

16

13:37:44 16 not nearly as efficient in completing his work.

17

13:37:49 17

18

13:37:52 18 knowing that I was going to go have sinus surgery in

19

13:37:55 19 March, I believe, which was subsequently put off

20

13:37:58 20 until May because my mother had a diagnosis of

21

13:38:01 21 lymphoma and there was a prohibition against flying

22

13:38:07 22 for up to a year, I believe, as I recall, following

23

13:38:12 23 the sinus surgery.

24

13:38:15 24 surgery in March and my mother became deathly ill,

25

13:38:18 25 I wouldn't be able to fly to Michigan to -- to attend

But I -- rather than having people

I had asked some period of time before that,

And so if I'd had the sinus

DFJ5

Case 1:07-cv-00026-OWW-TAG 1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Document 277-2

Filed 12/01/2008

1001 Page 34 of 245

ss. 3 4

I,

Susan R. Wood,

a Certified Shorthand Reporter in

5

the State of California, holding Certificate No.

6829,

6

do hereby certify that DAVID FRANK JADWIN,

D.O.,

the

7

witness named in the foregoing deposition,

was by me

8

duly resworn;

9

March 12,

10 11

that said deposition was taken Wednesday,

2008,

at the time and place set forth on the

first page hereof. That upon the taking of the deposition,

the

12

words of the witness were written down by me in

13

stenotypy and thereafter transcribed by computer under

14

my supervision; that the foregoing is a true and correct

15

transcript of the testimony given by the witness.

16

I

further certify that I am neither counsel for

17

nor in any way related to any party to said action,

18

in any way interested in the result or outcome thereof.

19 20

Dated this 9th day of April,

2008,

at

Bakersfield, California.

21 22 23 Susan 24 25

WOOD & RANDALL (800) 322-4595

No.

6829

nor

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 35 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 6

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

11

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

1

2

2

3

3

4

4

5

5

6

6

7

7

8

8

9

9

10

10

11

11

12

12

13

13

14

14

15

15

16

16

DAVID FRANK JADWIN, D.O.

17

17

TUESDAY, OCTOBER 21, 2008

18

18

19

19

20

20

21

21

22

22

23

23

24

24

25

25

Page 36 of 245 1002

UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF CALIFORNIA

DAVID F. JADWIN, D.O.,

)VOLUME VI )Page 1002 Plaintiff, ) ) vs. )NO.: 1:07-cv-00026-OWW-TAG ) COUNTY OF KERN; et al. ) ) Defendants. ) ________________________)

VIDEOTAPED DEPOSITION OF

GLENDALE, CALIFORNIA

REPORTED BY: SANDRA D. ORTIZ, CSR NO. 6048

DFJ6

Case 1:07-cv-00026-OWW-TAG

Document 277-2

1

2

2

3

3

4

4

how to describe it other than that.

5

5

core physician arrangements that were set up for all

6

6

the physicians that were core physicians,

7

7

essentially permanent physicians.

8

8

9

9

10

10

contract that you believe should have been renewed?

11

11

And you mentioned that you want --

12

12

A

I want to see or would have seen?

13

13

Q

Well, that you expect to have seen.

14:27

What what was called?

Page 37 of 245 1034

1

14

Q

Filed 12/01/2008

I mean I need to pin

you down to -A

Q

The faculty practice plan.

I don't know There was the

So getting back to the question, the

question is what terms do you want to see in the

You're

14

suing -- the tenth and eleventh claims are the

15

15

contract was not renewed.

16

16

17

17

in that contract that should have been renewed.

18

18

You're in the process of --

19

19

20

20

as opposed to what I wanted at the time.

21

21

I'm a little concerned.

22

22

23

23

simply want to know what terms you want in the

24

24

contract.

25

25

A

I want to know what terms you want to see

A

Q

You're talking about it in the future tense That's why

I don't care what tense we're in, sir.

That I wanted in the contract --

DFJ6

I

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 38 of 245 1035

1

1

MR. LEE:

2

2

Objection.

3

3

sitting here today, what does he want to see in

4

4

those contracts, or do you mean as of the time his

5

5

contract expired?

6

about?

6

14:27

Hold on. Vague and ambiguous.

You mean,

What time period are you talking

7

7

MR. WASSER:

Well, I think I'm talking

8

8

about October 7, 2008, when the Second Amended

9

9

Complaint was filed.

10

10

MR. LEE:

11

11

THE WITNESS:

12

12

13

13

14

14

15

15

A

16

16

trying --

17

17

Q

I said October 7, 2008, because --

18

18

A

Okay.

19

19

Q

-- I'm trying to respond with your lawyer

20

20

who keeps trying to prevent you from answering

21

21

questions.

22

22

MR. LEE:

23

23

THE WITNESS:

24

24

about.

25

25

/ / /

Does that clarify it, Dr. Jadwin? October, 2006; right?

BY MR. WASSER: Q

Sir, I don't really care what date.

is your lawyer's issue.

It's not my issues.

I thought you said 7.

Hold on.

DFJ6

This

That's why I was

You mean 13 days ago?

That's what I'm confused

Case 1:07-cv-00026-OWW-TAG

1

1

2

2

3

14:28

3

Document 277-2

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Page 39 of 245 1036

BY MR. WASSER: Q

That's when the Second Amended Complaint

was filed.

4

4

A

Oh, okay.

5

5

Q

That's when you've alleged this.

6

6

A

Okay.

7

7

Q

That's what I'm talking about.

8

8

9

9

10

10

contract?

11

11

that you want to see renewed?

12

12

13

13

conclusion.

14

14

can't sit here and dictate what a contract would

15

15

look like.

16

16

BY MR. WASSER:

17

17

Q

What terms do you want, sir?

18

18

A

I'm still confused about "want."

19

19

20

20

What I wanted were the terms that I

21

originally had that were taken away from me.

21

14:28

What is it that you're alleging as of October 7, 2008, not renewing plaintiff's employment What terms should be in that contract

MR. LEE:

Hold on.

That calls for a legal

Dr. Jadwin is not an attorney.

He

You mean

wanted at the time?

22

22

Q

In 2000?

23

23

A

In 2006 when this amended thing came --

24

24

25

25

this amendment came up. Q

Okay.

I'm asking you what terms are those?

DFJ6

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Document 277-2

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1

1

2

2

3

3

4

4

5

5

6

6

period that you're talking about?

7

7

BY MR. WASSER:

8

14:32

8

Page 40 of 245 1041

BY MR. WASSER: Q

Please answer it, sir. MR. LEE:

answer it.

If you think you understand,

But if you don't, don't answer.

THE WITNESS:

Q

Can you clarify the time

Well, I did that.

October 7, 2008, when

9

9

10

10

11

11

was -- the chair was taken away from me, actually,

12

12

and the demotion in salary.

13

13

14

14

15

15

16

16

17

17

Q

Okay.

18

A

Yes.

19

19

Q

Okay.

20

20

21

21

A

The terms of my original contract.

22

22

Q

Well, your original contract made you

23

23

24

24

25

25

18

14:32

you filed the Second Amended Complaint. A

Q correct? A

Okay.

It had to do with the fact that I

Exhibit 581 took the chair away from you; And lowered your salary; correct? It mentioned -- I don't believe that this

took away the chair -That's correct.

The JCC did that.

Uh-huh. Well, I'm asking you.

When you say

you want your original contract back --

chair, didn't it? A

It's -MR. LEE:

Hold on.

DFJ6

Vague and ambiguous as

Case 1:07-cv-00026-OWW-TAG

Document 277-2

1

1

2

2

3

3

4

4

5

5

my objections.

6

6

too bad.

7

7

MR. WASSER:

8

THE WITNESS:

8

14:34

Filed 12/01/2008

Page 41 of 245 1044

BY MR. WASSER: Q

We've clarified that three times.

The time

reference, sir, is October 7, 2008. MR. LEE:

Mr. Wasser, I'm allowed to lodge

Okay?

If you don't like it, that's

Right. The -- without sitting here

9

9

with the contract side by side, those would be the

10

10

ones that I can think of right now, the most

11

11

important ones.

12

12

BY MR. WASSER:

13

13

14

14

contract that you're suing for, your thought is you

15

15

would -- you would what? -- you would negotiate

16

16

terms of some new arrangement with Kern Medical

17

17

Center to get a new deal?

18

18

mind?

19

19

20

20

strategy.

21

21

not to answer.

22

22

23

23

24

24

25

25

Q

So when you think about this renewed

MR. LEE:

Hold on.

Is that what you have in

First of all, that's

That's attorney work product and instruct

MR. WASSER: answer that question? MR. LEE:

You're instructing him not to On what grounds?

You're asking what he's suing

for?

DFJ6

Case 1:07-cv-00026-OWW-TAG

Document 277-2

1

2

2

finish the answer, please, before you interrupt.

3

3

BY MR. WASSER:

4

4

5

5

'08 -- that's the date we're talking about in all

6

6

these questions, sir.

7

You don't want to go work there again, do you?

14:47

Q

Hold on.

Objection.

Page 42 of 245 1060

1

7

MR. LEE:

Filed 12/01/2008

Let him

A

My question, October 7, '08, October 7,

We've made that very clear.

8

8

I don't want to work under the conditions

9

9

10

10

conditions that I had from October to December of

11

11

2006.

12

12

Q

Those two months?

13

13

A

And some other periods prior to that,

14

14

actually.

15

15

Q

16

16

MR. LEE:

17

17

THE WITNESS:

18

18

where?

19

19

BY MR. WASSER:

20

20

21

21

22

22

23

23

24

24

25

25

that I was there before at -- you know, the

Q

Going back to, actually, October, 2005. What's changed? It's vague and ambiguous. I'm sorry.

At Kern Medical Center.

What's changed

Anything changed?

You said it's gotten worse. MR. LEE:

It's vague and ambiguous.

BY MR. WASSER: Q

I believe your word was "deteriorated

further" if I --

DFJ6

Case 1:07-cv-00026-OWW-TAG

Filed 12/01/2008

Page 43 of 245 1096

1

1

2

2

3

3

4

4

MR. LEE:

5

5

MR. WASSER:

6

6

7

7

8

8

9

9

10

10

did you expect your contract, Exhibit 577 as amended

11

11

by Exhibit 581, to be renewed by the County of Kern?

12

12

A

During October of 2007?

13

Q

As of October 4 of 2007.

14

14

A

Yes.

15

15

Q

Had the contract been renewed, Exhibit 581,

16

16

as amended by Exhibit -- I'm sorry -- Exhibit 577 as

17

17

amended by Exhibit 581, had the contract been

18

18

renewed on and as of October 4 of 2007, would you

19

19

have continued with litigating this lawsuit, among

20

20

other things?

21

21

A

With -- with the 581 as well?

22

Q

Yeah.

13

22

16:01

16:01

A

Document 277-2

Yes. MR. WASSER:

got.

That's all the questions I've

Thank you very much. I'd like to ask some questions. All right.

EXAMINATION BY MR. LEE: Q

Okay.

Dr. Jadwin, as of October 4 of 2007,

And --

Exhibit 570 -- I'm sorry.

23

23

Exhibit 577 as amended by Exhibit 581, had the

24

24

County had, in fact -- had the County, in fact,

25

25

renewed that contract as amended, would you have

DFJ6

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 44 of 245 1097

1

1

continued with your lawsuit in pursuing legal

2

2

remedies against the County and other defendants?

3

3

4

4

MR. LEE:

5

5

MR. WASSER:

6

6

Thank you, Dr. Jadwin.

7

7

THE WITNESS:

8

8

THE VIDEOGRAPHER:

9

9

MR. WASSER:

10

10

11

11

12

12

13

13

14

16:02

A

Yes. Okay.

No further questions.

I have no questions.

Thank you. Off the record?

Yep.

THE VIDEOGRAPHER:

This concludes today's

deposition of David -MR. LEE: want to add.

14

I'm sorry.

Just one more thing I

I apologize.

Plaintiff would like to have the 30 days

15

15

under the statute to correct the transcript.

Under

16

16

the FRCP.

17

17

MR. WASSER:

18

18

MR. LEE:

19

19

THE VIDEOGRAPHER:

20

20

deposition of David Jadwin, D.O., Volume 5.

21

21

number of tapes used was one.

22

22

23

23

24

24

(Whereupon, the deposition proceedings

25

25

concluded at 4:02 P.M.)

That's fine.

Okay. This concludes today's

The time is 4:02 P.M.

The

We are off the

record.

DFJ6

DCase FRANK JADWIN, D.O., VOL.Document VI 1:07-cv-00026-OWW-TAG 277-2

Filed 12/01/2008

Page 45 of 245 10-21-08 Page 1099

1 2

I, SANDRA D. ORTIZ, CSR No. 6048, Certified Shorthand Reporter, do hereby certify:

3

That the foregoing proceedings were taken

4

before me at the time and place herein set forth, at

5

which time the witness declared under penalty of

6

perjury; that the testimony of the witness was

7

recorded stenographically by me and was thereafter

8

transcribed under my direction.

9

That the foregoing is a true and correct

10

transcript of my shorthand notes so taken and of the

11

testimony so given.

12

( ) That no review of the transcript was requested. ( X ) That review of the transcript was requested. ( ) That the witness has failed or refused to approve the transcript.

13 14 15 16 17 18 19

I further certify that I have no interest in the outcome of this action. In witness whereof, I have hereunto subscribed my name this 28th day of October, 2008.

20 21 Ii / I

l

()L/1L(JL~~

22

SANDRA D. ORTIZ,

23 24 25

VS. RANDALL

(800)

KERN 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 46 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 7

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

12

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) VOLUME I ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

BARBARA ELIZABETH PATRICK

17

Tuesday, August 19, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

PatrickB1

Page 47 of 245 1

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 48 of 245 22

1 BY MR. LEE:

2

13:35:49

2

Q.

I think I misheard.

Thank you.

3

13:35:53

3

4

13:35:55

4 Board of Supervisors.

5

13:35:56

5

A.

Yes, I was.

6

13:35:59

6

Q.

Can you tell us the terms of your

7

13:36:01

7 chairmanship of the board?

8

13:36:04

8

9

13:36:09

9 2006.

And were you at any point the chair of the

A.

Sure.

Three times.

It would have been in 1996, 2001, and

10

13:36:11 10

Q.

And these are, what, two-year terms?

11

13:36:13 11

A.

Just one year.

12

13:36:18 12

Q.

One-year term.

13

13:36:20 13

14

13:36:26 14 job functions of your position as County supervisor?

15

13:36:32 15

16

13:36:37 16 we did meetings; we had committees that we served on.

17

13:36:41 17 I also represented the board on the Valley Air

18

13:36:44 18 District and also represented the valley on the

19

13:36:47 19 California Air Resources Board.

20

13:36:53 20 of responsibility.

21

13:36:56 21

22

13:37:01 22 to -- bless you -- strike that.

23

13:37:01 23

24

13:37:04 24 the Board of Supervisors with respect to Kern Medical

25

13:37:06 25 Center?

What -- how would you describe your -- the

A.

Q.

How much time do you have?

We did budgets;

So I -- I had a lot

What were your job functions with respect

What were your job functions as a member of

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 49 of 245 26

1

13:41:11

1 chair of the Board of Supervisors?

2

13:41:13

2

A.

Typically, yes.

3

13:41:14

3

Q.

So in 2006 when you were the chair of the

4

13:41:19

4 Board of Supervisors, you were attending the joint

5

13:41:23

5 conference committees in your role as a chair of the

6

13:41:25

6 Board of Supervisors?

7

13:41:27

7

A.

I'm sure I attended most of them.

8

13:41:32

8

Q.

Okay.

9

13:41:37

9 recall the joint conference committee meeting

Do you recall at a joint -- do you

10

13:41:39 10 occurring on July 10, 2006, at which Dr. Jadwin's

11

13:41:43 11 removal from chairmanship of the pathology department

12

13:41:46 12 was considered and voted upon by the JCC?

13

13:41:49 13

14

13:41:52 14 but I do remember the discussion, yes.

15

13:41:54 15

16

13:41:56 16 conference committee met on July 10, 2000- -- did I

17

13:41:59 17 say '8?

18

13:42:03 18 to approve removal of Dr. Jadwin from chair of the

19

13:42:06 19 department of pathology at Kern Medical Center.

20

13:42:11 20

21

13:42:15 21 chair?

22

13:42:15 22

A.

I imagine that I did.

23

13:42:17 23

Q.

You have no reason to believe you did not.

24

13:42:19 24 Right?

25

13:42:19 25

A.

Q.

I couldn't verify that it was on that date,

Well, I'll represent to you that the joint

I meant '6 -- 2006 to vote to consider and

Did you vote on Dr. Jadwin's removal from

A.

I have no reason to believe I did not.

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Okay.

Filed 12/01/2008

Page 50 of 245 27

1

13:42:21

1

2

13:42:25

2 for? against?

3

13:42:27

3

A.

I imagine I would have voted in favor of it.

4

13:42:29

4

Q.

Favor of it.

5

13:42:30

5

6

13:42:33

6 is the basis for your decision to approve or to vote

7

13:42:36

7 in favor of removal of Dr. Jadwin.

8

13:42:39

8

What did you base that decision on?

9

13:42:41

9

MR. WASSER:

Okay.

Do you recall how you voted?

Was it

Did you --

What I'm interested in knowing today

As an elected County

10

13:42:46 10 supervisor, Supervisor Patrick has a legislative

11

13:42:49 11 immunity which extends to the rationale for votes

12

13:42:52 12 that she cast in her capacity as supervisor.

13

13:42:56 13 immunity is based upon separation of powers.

14

13:42:58 14

15

13:43:03 15 a privilege that she holds.

16

13:43:07 16 a local legislator.

17

13:43:11 17 privilege and answer the question, it is a privilege

18

13:43:13 18 she holds herself.

19

13:43:16 19 privilege, she can assert the privilege and can

20

13:43:20 20 decline to answer questions regarding the reasons she

21

13:43:26 21 had in her mind for votes that she cast in her

22

13:43:29 22 capacity as a local legislator.

23

13:43:31 23

MR. LEE:

24

13:43:33 24

MR. WASSER:

25

13:43:35 25 powers privilege.

That

So it is Ms. Patrick's -- I mention this as It's personal to her as

If she wishes to waive that

If she wishes to assert the

Okay.

I'm going to state that --

And that is the separation of

It's not based upon State statute.

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 51 of 245 30

1

13:45:48

1

(Requested portion of record read.)

2

13:46:14

2

THE WITNESS:

3

13:46:20

3 BY MR. LEE:

4

13:46:21

4

5

13:46:25

5 workplace at Kern Medical Center.

6

13:46:27

6

A.

Over an extended period of time.

7

13:46:33

7

Q.

Okay.

8

13:46:35

8 unavailability.

9

13:46:37

9

Q.

He wasn't there.

So simply physical unavailability from the Is that correct?

You've stated physical He wasn't there.

What other bases did you base your decision

10

13:46:41 10 on?

11

13:46:43 11

12

13:46:45 12 have a chair in place, and he was not there and had

13

13:46:52 13 not been there for an extended period of time.

14

13:46:54 14

15

13:46:55 15

16

13:46:57 16 period of time.

17

13:46:58 17

A.

Yes.

18

13:46:59 18

Q.

Is that the sole reason then that you based

19

13:47:00 19 your vote on, or are there others?

20

13:47:02 20

A.

Yes.

21

13:47:03 21

Q.

Yes.

22

13:47:04 22

23

13:47:06 23 unavailability of Dr. Jadwin, are you aware of the

24

13:47:11 24 reasons for Dr. Jadwin's physical unavailability at

25

13:47:14 25 Kern Medical Center?

A.

Q.

Well, it was my feeling that we needed to

I understand. So physical unavailability for an extended

Okay.

Now, regarding the physical

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Filed 12/01/2008

Page 52 of 245 70

1

14:25:47

1

2

14:25:50

2

3

14:25:53

3 would help you to recall whether or not there was

4

14:25:56

4 discussion or whether you asked any questions at that

5

14:25:58

5 removal meeting to remove Dr. Jadwin?

6

14:26:02

6

A.

No.

7

Q.

No.

A.

When I left office, I shredded all my

7

Q.

Document 277-2

Don't recall. Is there any documents you can think of that

8

14:26:12

8

9

14:26:15

9 documents.

10

14:26:16 10

Q.

When did you leave office again,

11

14:26:17 11 Ms. Patrick?

12

14:26:18 12

A.

It was on January 8th of 2007.

13

14:26:22 13

Q.

2007.

14

14:26:23 14

A.

Um-hmm.

15

14:26:24 15

Q.

Were you aware that plaintiff had sent the

16

14:26:26 16 request to defendants asking them not to destroy any

17

14:26:28 17 evidence, that we were intending to file a lawsuit?

18

14:26:33 18 Were you aware of that?

19

14:26:34 19

A.

I received nothing.

20

14:26:37 20

Q.

Did legal counsel at any point ever discuss

21

14:26:39 21 with you plaintiff's request that no documents be

22

14:26:43 22 destroyed relevant to Dr. Jadwin's litigation?

23

14:26:47 23

A.

No.

24

14:26:49 24

Q.

To this day you have not been contacted

25

14:26:51 25 regarding preservation of documents and evidence in

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 53 of 245 71

1

14:26:54

1 connection with this litigation?

2

14:26:55

2

A.

No.

3

14:27:03

3

Q.

Do you think you might have been contacted

4

14:27:04

4 before you shredded the documents?

5

14:27:07

5

A.

I would not have shredded documents --

6

14:27:10

6

Q.

Sure.

7

14:27:10

7

A.

-- had I remembered it, but I -- not that I

8

14:27:13

8 recall.

I don't remember.

9

14:27:14

9

Okay.

Q.

Not that I can recall.

Do you recall -- is there a custom to

10

14:27:29 10 take notes at any JCC meetings?

11

14:27:32 11

A.

Typically I did.

12

14:27:32 12

Q.

Typically you did.

13

14:27:35 13

14

14:27:36 14 took notes at the JCC removal meeting?

15

14:27:39 15

A.

No.

16

14:27:39 16

Q.

No reason to believe you didn't.

17

14:27:41 17

A.

Right.

18

14:27:42 18

Q.

Okay.

19

14:27:45 19 you shredded upon your -- your leaving your

20

14:27:50 20 supervisor position?

21

14:27:53 21

A.

I shredded everything when I left.

22

14:27:57 22

Q.

Everything.

23

14:27:57 23

24

14:27:59 24 the JCC meetings?

25

14:28:02 25

Do you have any recollection of whether you

Right?

Were those notes among the documents

So it would have included your notes from

A.

It might have.

I don't know that I would

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 54 of 245 72

1

14:28:04

1 have -- I don't know that I would have taken notes on

2

14:28:07

2 an executive session-type thing but....

3

14:28:10

3

4

14:28:12

4 not have taken notes for.

5

14:28:15

5 you're saying?

6

14:28:16

6

7

14:28:19

7 of doodled something on the side of -- you know, a

8

14:28:22

8 date or something like that on the side of a -- of

9

14:28:25

9 the agenda, probably.

Q.

A.

Oh, so there are some JCC meetings you would

No.

Correct?

Is that what

I'm just saying I would have just sort

10

14:28:26 10

Q.

So you consider doodles to be notes, then?

11

14:28:28 11

A.

That would -- that would be pretty much what

12

14:28:31 12 I would have done.

13

14:28:32 13

14

14:28:34 14 doodles in the margin?

15

14:28:35 15

A.

Yes.

16

14:28:36 16

Q.

Sort of like cartoon figures or --

17

14:28:38 17

A.

Oh, no, no, no.

18

14:28:41 18 maybe a date or something underlined or --

19

14:28:44 19

Q.

I see.

20

14:28:44 20

A.

-- something like that.

21

14:29:12 21

Q.

So when you say doodles, you mean notes --

22

14:29:15 22 little written notes on the sides of the agendas

23

14:29:17 23 then.

24

14:29:18 24

25

14:29:20 25 this because we would get meeting minutes.

Q.

So when you say notes, you actually mean

Not cartoon figures.

But

Correct? A.

Yes.

It wouldn't have been something like

PatrickB1

It would

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 55 of 245 73

1

14:29:23

1 be more or less reminders to myself about something.

2

14:29:26

2

3

14:29:29

3 day?

4

14:29:30

5 6

Q.

Okay.

4

A.

No.

14:29:30

5

Q.

Were they destroyed?

14:29:33

6

A.

They were probably just thrown out.

7

Q.

Thrown out.

7

And do you have those doodles to this

8

14:29:47

8

Do you recall discussing job abandonment at

9

14:29:51

9 the removal meeting?

10

14:29:56 10

A.

I remember there was discussion of that.

11

14:29:58 11

Q.

What do you remember of that discussion?

12

14:30:00 12

A.

I don't remember specifics.

13

14:30:03 13

Q.

You just remember the term job abandonment

14

14:30:06 14 and that's it?

15

14:30:07 15

16

14:30:10 16 in relationship to the item at hand, but I don't

17

14:30:16 17 remember the specifics of it.

18

14:30:18 18

19

14:30:22 19 related to the item at hand with respect to

20

14:30:25 20 Dr. Jadwin's removal?

21

14:30:40 21

A.

He had been gone a long time.

22

14:30:45 22

Q.

Okay.

23

14:30:48 23 relate to job abandonment?

24

14:30:54 24 just say you don't recall.

25

14:30:55 25

A.

Q.

A.

I remember that there was discussion of that

Well, can you recollect how job abandonment

And what's that mean?

I don't.

And if you don't recall,

I don't recall.

PatrickB1

How does that

But he had been

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 56 of 245 75

1

14:32:09

1 certain date?

2

14:32:09

2

A.

I believe so.

3

14:32:09

3

Q.

You believe so.

4

14:32:09

4

5

14:32:09

5 that, this deadline that was imposed on Dr. Jadwin?

6

14:32:14

6

A.

Not specifically.

7

14:32:16

7

Q.

Okay.

8

14:32:18

8 deadline, whether -- what the rhyme or rationale was

9

14:32:22

9 for that deadline, that particular deadline?

Okay.

A.

Do you recall that?

Do you recall how you learned of

Do you recall the basis for that

10

14:32:28 10

11

14:32:31 11 assume things.

12

14:32:32 12

13

14:32:33 13

14

14:32:34 14 BY MR. LEE:

15

14:32:35 15

Q.

If you don't recall, just say --

16

14:32:36 16

A.

I do not recall.

17

14:32:38 17

Q.

Do not recall.

18

14:32:39 18

19

14:32:40 19 deadline that -- well, I'm going to represent to you

20

14:32:43 20 that the deadline that was imposed on Dr. Jadwin was

21

14:32:46 21 that he was to render a decision to Mr. Bryan by June

22

14:32:48 22 16, 2006, as to whether he was going to return as a

23

14:32:51 23 full-time chair or resign his chairmanship.

24

14:32:55 24

25

14:32:58 25 reported having some kind of physical ailment at or

Q.

I'm assuming that -- I should probably not

You should not. MR. WASSER:

Okay.

Okay.

Do not guess.

Do you recall that at or near the

Do you recall whether Dr. Jadwin

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 57 of 245 76

1

14:33:02

1 near the deadline and asking for more time to decide?

2

14:33:07

2 Do you recall that?

3

14:33:07

3

A.

That, I do not remember.

4

14:33:09

4

Q.

Don't recall.

5

14:33:09

5

6

14:33:18

6 the removal meeting regarding Dr. Jadwin's removal?

7

14:33:20

7

A.

No, sir, I don't.

8

14:33:21

8

Q.

You don't recall whether it was more than an

9

14:33:24

9 hour, less than an hour?

Do you recall how long the discussion was at

10

14:33:26 10

A.

I do not.

11

14:33:26 11

Q.

When agenda items were discussed at the JCC,

12

14:33:31 12 can you put, like, an average time on each agenda

13

14:33:34 13 item in terms of discussion time?

14

14:33:40 14

15

14:33:42 15 were quite short.

16

14:33:46 16 executive session, and we did not typically even have

17

14:33:50 17 executive sessions at that.

18

14:33:55 18 to fit that into any kind of a continuum of time.

19

14:34:01 19

20

14:34:03 20 raised the issue of job abandonment at the removal

21

14:34:07 21 meeting?

22

14:34:07 22

A.

I do not.

23

14:34:08 23

Q.

Do you recall whether there was any

24

14:34:10 24 significant amount of discussion regarding job

25

14:34:13 25 abandonment at the removal meeting?

A.

Q.

Some of them were quite lengthy and others

Okay.

But that would have been in the

So it would be difficult

Now, do you remember the -- who

PatrickB1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 58 of 245 77

1

14:34:15

1

A.

I do not.

2

14:34:15

2

Q.

So what do you recall what was discussed at

3

14:34:22

3 the removal meeting besides a little bit of job

4

14:34:25

4 abandonment and the fact that Dr. Jadwin was

5

14:34:27

5 physically unavailable due to medical leave?

6

14:34:31

6 recall anything else being discussed?

7

14:34:35

7

8

14:34:41

8 have present chair of pathology.

9

14:34:44

9

A.

Q.

Do you

I think what was discussed was the need to

So do you recall any discussion about due

10

14:34:47 10 process rights of Dr. Jadwin?

11

14:34:50 11

A.

I don't.

12

14:34:51 12

Q.

So, in other words, you can't say one way or

13

14:34:53 13 the other.

14

14:34:54 14

A.

That's right.

15

14:34:54 15

Q.

It may have been discussed but not --

16

14:34:56 16

A.

Yes.

17

14:34:58 17

Q.

Do you recall anything about Dr. Jadwin

18

14:34:59 18 having a property right or property interest in the

19

14:35:01 19 chairmanship?

20

14:35:04 20

A.

I don't recall any such discussion.

21

14:35:06 21

Q.

Don't recall.

22

14:35:08 22

23

14:35:09 23 it happened?

24

14:35:10 24

MR. WASSER:

25

14:35:11 25

THE WITNESS:

Okay.

Again, it was a long time ago.

So, in other words, you don't believe

She didn't say that, Counsel. No.

PatrickB1

I said I don't recall any

Case 1:07-cv-00026-OWW-TAG

Document 277-2

1

14:35:13

1 such discussion.

2

14:35:14

2 BY MR. LEE:

3

14:35:15

3

4

14:35:18

4

5

14:35:20

5 the other or --

6

14:35:21

6

7

14:35:23

7 ago.

8

14:35:25

8 discussion.

9

14:35:29

9

Q.

Okay.

Filed 12/01/2008

Page 59 of 245 78

So -- I just want to clarify.

So does that mean you don't know one way or

A.

I don't know.

The meeting was a long time

I don't remember that being part of the

Q.

Okay.

So I'm just -- again, there is a fine

10

14:35:31 10 distinction for me.

11

14:35:33 11

12

14:35:34 12 way or the other or, to your recollection, it did not

13

14:35:36 13 happen?

14

14:35:38 14

15

14:35:42 15 meeting to tell you whether it occurred or not.

16

14:35:46 16

17

14:35:52 17

18

14:35:55 18 removal meeting, chief medical officer?

19

14:35:58 19

A.

I don't.

20

14:36:00 20

Q.

Do you recall if Jennifer Abraham was at

21

14:36:02 21 the -- well, she wouldn't have been there.

22

14:36:04 22 mind.

23

14:36:05 23

24

14:36:13 24 Peter Bryan sometime around early 2006 regarding

25

14:36:17 25 Dr. Jadwin?

So are you saying that you don't know one

A.

Q.

I don't remember enough specifics of the

Okay.

Thank you.

That's perfectly fine.

Do you recall if Dr. Irwin Harris was at the

Never

Do you recall receiving a memorandum from

PatrickB1

Case 1:07-cv-00026-OWW-TAG 1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Document 277-2

169 Page 60 of 245

Filed 12/01/2008

ss.

3 4

5

I,

Susan R. Wood,

a Certified Shorthand

6

Reporter in the State of California,

7

Certificate No.

8

BARBARA ELIZABETH PATRICK,

9

foregoing deposition, was by me duly sworn; that said

o

deposition was taken Tuesday, August 19,

1

time and place set forth on the first page hereof.

2

6829,

holding

do hereby certify that the witness named in the

2008,

at the

That upon the taking of the deposition,

the

3

words of the witness were written down by me in

4

stenotypy and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct

6

transcript of the testimony given by the witness. I

further certify that I am neither counsel for

nor in any way related to any party to said action,

nor

in any way interested in the result or outcome thereof. Dated this 2nd day of September, Bakersfield,

2008,

at

California.

Susan

~-N-O-'-6-8-2-9----

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 61 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 8

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

13

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

GILBERT R. MARTINEZ

17

Wednesday, April 16, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

MartinezG

Page 62 of 245 1

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

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Page 63 of 245 111

1

10:17:52

1

2

10:17:55

2 not participate in obtaining the documents.

3

10:17:58

3

4

10:17:59

4

5

10:18:01

5

6

10:18:03

6 pathology office.

7

10:18:04

7

8

10:18:07

8 work, to your knowledge, for this?

9

10:18:08

9

A.

Yes.

10

10:18:09 10

Q.

To the clerical staff?

11

10:18:11 11

A.

Yes.

12

10:18:20 12

Q.

Okay.

13

10:18:26 13 discussion with Dr. Jadwin around end of November,

14

10:18:29 14 right before Thanksgiving of 2006, regarding an audit

15

10:18:35 15 coming from CAP, JCAHO, or the Department of Health

16

10:18:39 16 Services?

17

10:18:42 17 Health Services.

18

10:18:48 18

A.

An audit regarding?

19

10:18:49 19

Q.

Well, did he ever tell you that an audit was

20

10:18:52 20 coming to the hospital?

21

10:18:54 21

A.

An audit or an inspection?

22

10:18:55 22

Q.

An inspection.

23

10:18:57 23

A.

I believe around -- it may have been around

24

10:19:04 24 that time that he came into my office and let me know

25

10:19:07 25 that there was going to probably be some type of

Q.

I just knew that that was occurring.

I did

I see. Who did?

A.

Q.

That was the clerical staff up in the

Okay.

Was this a substantial amount of

Now, do you recall ever having a

I'm sorry.

The California Department of

I'm sorry.

MartinezG

An inspection.

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 64 of 245 112

1

10:19:11

1 inspection.

2

10:19:12

2

Q.

Can you recall what exactly he told you?

3

10:19:21

3

A.

The gist of it was to make sure I had the

4

10:19:25

4 department ready, inspection ready.

5

10:19:29

5

6

10:19:32

6 said it to you or what he said?

7

10:19:34

7

A.

Not the specific words, no.

8

10:19:35

8

Q.

Basically, the message was you should get

9

10:19:39

9 ready; there's an audit coming?

Q.

Okay.

But -- so you don't recall how he

10

10

A.

Yes.

11

11

Q.

Okay.

12

10:19:41 12

A.

More an inspection.

13

10:19:43 13

Q.

An inspection.

14

10:19:44 14 inspection.

15

10:19:44 15

16

10:19:46 16 audit, actually?

17

10:19:46 17

18

10:19:49 18 purposes.

19

10:19:51 19 inspection's a survey to make sure that you're in

20

10:19:54 20 compliance with all of the regulatory requirements.

21

10:19:58 21

22

10:20:00 22

23

10:20:02 23 inspection was coming?

24

10:20:07 24

A.

I do not recall if I did or not.

25

10:20:10 25

Q.

Okay.

Yeah.

I apologize.

An

What's the difference between inspection and

A.

Q.

Well, an audit is more like for accounting When we think of an inspection,

I see. Did you ask Dr. Jadwin how he knew an

Did he mention any of the agencies

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 65 of 245 113

1

10:20:17

1 that might be doing these inspections?

2

10:20:21

2

3

10:20:23

3 specific agency.

4

10:20:24

4

5

10:20:27

5 get ready for an inspection -- well, did he say it

6

10:20:31

6 would be multiple inspections or one inspection?

7

10:20:33

7

A.

He did not say it would be multiple.

8

10:20:35

8

Q.

So when Dr. -- after Dr. Jadwin told you to

9

10:20:40

9 get ready for an inspection around November,

A.

Q.

He may have, but I don't recall if it was a

Okay.

Well, after Dr. Jadwin told you to

10

10:20:45 10 Thanksgiving of 2006, what did you do next?

11

10:20:50 11

A.

I informed my administrative supervisor.

12

10:20:55 12

Q.

Who was that?

13

10:20:57 13

A.

I believe that was Dr. Kolb at the time.

14

10:21:00 14

Q.

Marv Kolb?

15

10:21:01 15

A.

I believe so.

16

10:21:01 16

Q.

In 2006?

17

10:21:02 17

A.

Or David Hill.

18

10:21:04 18

Q.

I think Marv Kolb left --

19

10:21:07 19

A.

If he had left, it was David Hill, then.

20

10:21:09 20

Q.

David H-i-l-l?

21

10:21:10 21

A.

Yes.

22

10:21:10 22

Q.

What's David Hill's position or was it?

23

10:21:12 23

A.

He was the admin- -- he was the

24

10:21:14 24 administrator over ambulatory care.

25

10:21:16 25

Q.

Okay.

One of the two.

What did David Hill tell you?

MartinezG

What

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 66 of 245 114

1

10:21:18

1 was his response?

2

10:21:19

2

3

10:21:34

3 readiness of the laboratory for an inspection.

4

10:21:38

4

5

10:21:41

5 with David Hill?

6

10:21:42

6

A.

I do not recall.

7

10:21:43

7

Q.

Was it -- how many days or was it

8

10:21:45

8 immediately after you had the meeting with

9

10:21:47

9 Dr. Jadwin?

A.

Q.

Oh, I believe he asked me about the

Okay.

And when was the date of your meeting

10

10:21:47 10

A.

Probably within a few days.

11

10:21:49 11

Q.

Within a few days.

12

10:21:51 12

13

10:21:57 13 when Thanksgiving was.

14

10:22:08 14

15

10:22:12 15 there was an inspection coming?

16

10:22:16 16

17

10:22:18 17 me.

18

10:22:19 18

19

10:22:23 19 next or do you know what happened next?

20

10:22:26 20

21

10:22:30 21 the most part, we're pretty much ready for

22

10:22:32 22 inspections just about any time.

23

10:22:36 23 double-checked to make sure we were okay.

24

10:22:37 24

25

10:22:41 25 would be like a hospital-wide inspection or whether

Okay.

Well, let me check something.

Okay.

I want to see

Did David Hill ask you how you knew

A.

I had told him that Dr. Jadwin had talked to

Q.

Okay.

A.

Q.

No.

And then do you recall what happened

Okay.

I just made sure that we were -- for

Just -- just

Did Dr. Jadwin specify whether it

MartinezG

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 67 of 245 121

1 BY MR. LEE:

2

10:41:46

2

Q.

Mr. Martinez, did you find Dr. Jadwin to be

3

10:41:48

3 arrogant during the time working with him?

4

10:42:05

4

A.

Not arrogant.

5

10:42:07

5

Q.

Okay.

6

10:42:11

6 overbearing?

7

10:42:15

7

A.

Not with me.

8

10:42:17

8

Q.

Okay.

9

10:42:19

9 overbearing?

Did you find Dr. Jadwin to be

With other people you found him

10

10:42:25 10

A.

There was a complaint.

11

10:42:27 11

Q.

By whom?

12

10:42:29 12

A.

Jane Thornton.

13

10:42:29 13

Q.

Jane Thornton.

14

10:42:31 14

15

10:42:34 15 Did you find Dr. Jadwin to be intimidating?

16

10:42:37 16

A.

No.

17

10:42:37 17

Q.

How about uncooperative?

18

10:42:41 18 Dr. Jadwin to be uncooperative?

19

10:42:52 19

A.

There was an occasion or two, yes.

20

10:42:54 20

Q.

Can you tell me those occasions?

21

10:42:57 21

A.

One occasion was with the -- there was a --

22

10:43:00 22 another compliance issue regarding a -- the ordering

23

10:43:04 23 of a CBC versus a CBC in dif.

24

10:43:09 24

Q.

That's lab equipment?

25

10:43:10 25

A.

That's lab -- a lab test.

Okay.

I mean -- what about intimidating?

MartinezG

Did you find

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 68 of 245 122

1

10:43:13

1

Q.

Supplies?

2

10:43:14

2

A.

The test itself.

3

10:43:15

3

Q.

Oh, okay.

4

10:43:17

4

A.

CBC is a complete blood count.

5

10:43:21

5 differential is a complete blood count with a

6

10:43:25

6 differential.

7

10:43:26

7

Q.

Okay.

8

10:43:27

8

A.

What he wanted to do was delete the CBC and

9

10:43:33

9 only offer the CBC with differential, which would

CBC with

What happened?

10

10:43:36 10 have been a compliance issue, because then the CBC is

11

10:43:40 11 less expensive.

12

10:43:45 12 take up to the compliance committee.

13

10:43:47 13

Q.

Okay.

14

10:43:51 14

A.

The CBC and CBC with differential remained

15

10:43:55 15 on the test menu.

16

10:43:57 16

Q.

Okay.

17

10:43:58 17

A.

So we did not delete it.

18

10:43:59 18

Q.

Did not delete it.

19

10:44:00 19

A.

Did not.

20

10:44:02 20

Q.

Okay.

21

10:44:05 21

A.

No.

22

10:44:06 22

Q.

So he took it in stride?

23

10:44:08 23

A.

Yes.

24

10:44:08 24

Q.

Was he respectful -- was Dr. Jadwin

25

10:44:10 25 respectful toward you?

So that's another one that I had to

And what was the outcome?

Did Dr. Jadwin hold that against you?

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 69 of 245 123

1

10:44:11

1

A.

Yes.

2

10:44:12

2

Q.

Was Dr. Jadwin unfriendly at any time?

3

10:44:16

3

A.

Towards me?

4

10:44:20

4

Q.

Yes.

5

10:44:20

5

A.

Unprofessional.

6

10:44:22

6

Q.

He was unprofessional to you?

7

10:44:23

7

A.

Yes.

8

10:44:24

8

Q.

How was Dr. Jadwin unprofessional to you?

9

10:44:27

9

A.

Well, he had wanted me to step down and he

10

10:44:29 10 wanted to put the medical secretary in charge of the

11

10:44:32 11 lab.

12

10:44:32 12

13

10:44:33 13

14

10:44:35 14 knowledge?

15

10:44:36 15

16

10:44:37 16 that with me.

17

10:44:38 17

18

10:44:41 18 the head of the laboratory?

19

10:44:43 19

A.

That was before Tracy.

20

10:44:56 20

Q.

That's fine.

21

10:44:57 21

22

10:45:02 22 explained to you why he wanted to elevate the

23

10:45:04 23 secretary to the lab management position?

24

10:45:06 24

A.

No.

25

10:45:06 25

Q.

And what position was he proposing to put

Q.

I see. Why would he want to do that, to your

A.

Q.

That, I do not know.

He did not discuss

Which secretary did he want to elevate to

I forget her name.

Did he ever explain -- so Dr. Jadwin never

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 70 of 245 124

1

10:45:08

1 you in?

2

10:45:09

2

A.

He did not specify.

3

10:45:11

3

Q.

I see.

4

10:45:12

4

A.

But I told him I would not -- I would step

5

10:45:16

5 down and be in charge of the laboratory information

6

10:45:18

6 system, which was one of my previous duties --

7

10:45:20

7

Q.

Correct.

8

10:45:21

8

A.

-- and maybe some bench work, but no

9

10:45:23

9 personnel.

10

10:45:28 10

Q.

You said there was another incident as well

11

10:45:30 11 with Dr. Jadwin being unprofessional.

12

10:45:33 12

A.

No.

13

10:45:34 13

Q.

That was it.

14

10:45:35 14

15

10:45:38 15 Dr. Jadwin came to the hospital around 2000.

16

10:45:45 16

17

10:45:48 17 around there.

18

10:45:49 18

19

10:46:04 19 self-righteous?

20

10:46:04 20

A.

No.

21

10:46:06 21

Q.

No.

22

10:46:06 22

23

10:46:08 23 found Dr. Jadwin to be intimidating?

24

10:46:12 24 can't remember which one it was.

25

10:46:13 25

That was it.

Okay.

A.

Q.

When did that happen roughly?

I don't know.

Okay.

Okay.

A.

What was that?

Maybe 2004, 2005, somewhere

Did you ever find Dr. Jadwin to be

Earlier you said that other people

Overbearing.

MartinezG

Or was it -- I

Case 1:07-cv-00026-OWW-TAG

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Page 71 of 245 127

1

10:48:09

1

2

10:48:11

2 hematology department, but I don't recall which ones.

3

10:48:18

3

4

A.

Document 277-2

Q.

I believe it was some of the techs in the

These are people working beneath Jane

4 Thornton?

5

10:48:21

5

A.

Yes.

6

10:48:22

6

Q.

And there were how many techs in the

7

10:48:22

7 hematology department?

8

10:48:23

8

A.

There was only about two others.

9

10:48:25

9

Q.

Okay.

10

10:48:26 10

A.

I'm not sure specifically.

11

10:48:28 11

Q.

I see.

12

10:48:28 12

13

10:48:30 13

A.

Yeah.

14

10:48:30 14

Q.

-- they were complaining.

15

10:48:31 15

16

10:48:36 16

17

10:48:38 17 or through others.

18

10:48:41 18

19

10:48:51 19 personnel leaving the hospital because Dr. Jadwin was

20

10:48:55 20 driving them out?

21

10:49:05 21

A.

No.

22

10:49:10 22

Q.

Did you have any occasion to see Dr. Jadwin

23

10:49:13 23 lose his temper, become angry?

24

10:49:23 24

A.

Yes.

25

10:49:42 25

Q.

Can you describe the incident when he lost

So both of them would complain?

You heard through the grapevine that --

Did you hear it through Jane Thornton? A.

Q.

I don't know if it was through Jane Thornton

Okay.

Are you aware of any of the lab

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 72 of 245 128

1

10:49:43

1 his temper?

2

10:49:44

2

3

10:49:47

3 when we had an inspection and he was not present.

4

10:49:52

4 the inspection team came up, and I showed them -- the

5

10:49:57

5 inspectors around -- I gave them a general tour of

6

10:49:59

6 the laboratory.

7

10:50:01

7 already here and he -- he was extremely upset, said

8

10:50:07

8 it was totally mishandled, et cetera.

9

10:50:12

9 visibly upset.

A.

Well, it was when he became pretty angry So

And then he came in after they were

He was pretty

10

10:50:14 10

Q.

At you?

11

10:50:14 11

A.

Yes.

12

10:50:14 12

Q.

Well, when you say he was visibly upset,

13

10:50:16 13 what -- what was visible about his upset?

14

10:50:19 14 you know he was upset?

15

10:50:20 15

A.

Well, the comment that he made.

16

10:50:24 16

Q.

What was the comment?

17

10:50:25 17 just said.

18

10:50:26 18

A.

No.

19

10:50:27 19

Q.

Okay.

20

10:50:29 20

A.

If he had a gun -- a gun he would have shot

21

10:50:33 21 someone.

22

10:50:33 22

Q.

That's what he said?

23

10:50:34 23

A.

Yes.

24

10:50:34 24

Q.

So did you take that to literally mean he

25

10:50:37 25 would bring a gun to the hospital and shoot somebody?

How did

Just the comment you

Right?

What was his comment?

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 73 of 245 129

1

10:50:39

1

A.

I just dismissed it and....

2

10:50:42

2

Q.

So you didn't go to the police and file a --

3

10:50:44

3

A.

No.

4

10:50:44

4

Q.

-- report or you didn't go to administration

5

10:50:46

5 and file a workplace violence complaint or anything

6

10:50:49

6 like that?

7

10:50:49

7

8

10:50:52

8 specifically either the manager's going to go or the

9

10:50:55

9 director's going to go.

A.

No.

Because at the time Mr. Bryan had said

10

10:50:56 10

Q.

Who said that?

11

10:50:57 11

A.

Mr. Bryan, Peter, the CEO.

12

10:51:00 12

Q.

Oh, I see.

13

10:51:01 13

A.

So it would have meant that I would have

14

10:51:03 14 left.

15

10:51:04 15

16

10:51:05 16

17

10:51:10 17 with Dr. Jadwin happen where he got angry at you?

18

10:51:14 18

19

10:51:16 19 inspections -- three inspections ago.

20

10:51:20 20

Q.

So, what, three years ago?

21

10:51:23 21

A.

About three years ago, yeah.

22

10:51:25 22 Maybe longer than that.

23

10:51:27 23

Q.

So perhaps before 2005?

24

10:51:29 24

A.

Yeah.

25

10:51:30 25

Q.

Okay.

Q.

I see. Okay.

A.

I see.

Now, when -- when did this incident

I think it was an inspection about three

Well, no.

Did Dr. Jadwin ever apologize to you

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 74 of 245 130

1

10:51:36

1 about that or did you ever discuss it again with

2

10:51:37

2 Dr. Jadwin?

3

10:51:38

3

A.

No.

4

10:51:42

4

Q.

Okay.

5

10:51:50

5 he just said I'll shoot someone?

6

10:51:53

6

A.

Correct.

7

10:51:53

7

Q.

So he wasn't necessarily threatening you

8

10:51:55

8 physically, was he?

9

10:51:56

9

A.

Physically?

10

10:51:57 10

Q.

Yeah.

11

10:51:58 11

A.

No.

12

10:52:00 12

Q.

Dr. Jadwin's a tall man.

13

10:52:03 13 around six, three, six, four.

14

10:52:05 14

15

10:52:08 15 you?

16

10:52:08 16

A.

No.

17

10:52:09 17

Q.

How tall are you, roughly?

18

10:52:11 18

A.

About five, ten.

19

10:52:12 19

Q.

Okay.

20

10:52:15 20 intimidated because of his physical size?

21

10:52:16 21

A.

No.

22

10:52:22 22

Q.

Had there been a lot of defections in the

23

10:52:24 23 laboratory in the last few years?

24

10:52:27 24 defections, I mean personnel leaving the laboratory.

25

10:52:30 25

No one ever brought it up again. So he didn't say he would shoot you;

I believe he's

Was he ever physically aggressive toward

A.

Did you ever feel a little bit

When I say

It's probably normal attrition, but the --

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 75 of 245 133

1

10:54:35

1 Dr. Jadwin on, say, a weekly basis while working

2

10:54:38

2 together?

3

10:54:41

3

4

10:54:44

4 the hallway, or he might just come into my office or

5

10:54:46

5 I might go into his office.

6

10:54:51

6 two days or so.

7

10:54:53

7

Q.

Relatively frequent?

8

10:54:55

8

A.

Frequently frequent, yes.

9

10:54:57

9

Q.

And when you did interact, was it for pretty

A.

Most of them were informal, just mainly in

So at least once every

10

10:55:00 10 extended periods of time or was it just quickly?

11

10:55:04 11

A.

It was brief.

12

10:55:05 12

Q.

Brief?

13

10:55:05 13

A.

Yeah.

14

10:55:08 14 he'd want a chair or whatever.

15

10:55:13 15 come to me first, and then I'd get whatever he

16

10:55:15 16 wanted.

17

10:55:15 17

18

10:55:18 18 Dr. Jadwin?

19

10:55:18 19

A.

Yes.

20

10:55:19 20

Q.

So you feel -- did you feel like you got to

21

10:55:22 21 know him pretty well as a general?

22

10:55:27 22

A.

Yes.

23

10:55:29 23

Q.

Were you aware Dr. Jadwin was attempting to

24

10:55:32 24 start a company up called Columbia Healthcare

25

10:55:36 25 Analytics?

Q.

Maybe some issue would come up or He'd usually just

So relatively frequent interactions with

MartinezG

Case 1:07-cv-00026-OWW-TAG

Document 277-2

139 Page 76 of 245

Filed 12/01/2008

STATE OF CALIFORNIA ss. COUNTY OF KERN

I,

Susan R. Wood,

a Certified Shorthand

Reporter in the State of California, Certificate No. GILBERT R.

6829,

MARTINEZ,

deposition,

holding

do hereby certify that the witness named in the foregoing

was by me duly sworn; that said deposition

was taken Wednesday, April 16,

2008,

at the time and

place set forth on the first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action,

nor

in any way interested in the result or outcome thereof. Dated this 19th day of May, Bakersfield,

2008,

at

California.

~-

Susan R.

Wood,

WOOD & RANDALL (800) 322-4595

CSR No.

6829

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 77 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 9

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

14

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13

VIDEOTAPED DEPOSITION

14

OF

15

ALAN SCOTT RAGLAND, M.D.

16

Friday, August 22, 2008

17

Bakersfield, California

18 19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

RaglandA

Page 78 of 245 1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 79 of 245 8

1

09:20:49

1 drugs, medication or alcohol in the last 24 hours?

2

09:20:52

2

A.

No.

3

Q.

Okay.

3

Well, no -- yes. What --

4

09:20:55

4

A.

I took two aspirin this morning.

5

09:20:57

5

Q.

Okay.

6

09:21:00

6 testimony today, correct?

7

09:21:01

7

A.

I don't believe so.

8

09:21:01

8

Q.

Okay.

9

09:21:04

9 just as a reminder, but even expert deponents get

That's not going to affect your

And the last thing I just have to --

10

09:21:08 10 this wrong all the time.

Just please refrain from

11

09:21:11 11 speaking until I finish my question, and the reason

12

09:21:13 12 why is it is a courtesy to the reporter, she can only

13

09:21:17 13 record one person speaking at a time.

14

09:21:19 14

15

09:21:20 15

A.

Yes.

16

09:21:20 16

Q.

Doctor, what's your current position at the

17

09:21:23 17 hospital?

18

09:21:24 18

A.

Faculty in the internal medicine department.

19

09:21:28 19

Q.

You're not a chair of a department, correct?

20

09:21:31 20

A.

Correct.

21

09:21:31 21

Q.

You're not a vice chair either, right?

22

09:21:34 22

A.

Correct.

23

09:21:34 23

Q.

Okay.

24

09:21:37 24 of the medical staff?

25

09:21:38 25

Do you understand?

A.

Are you currently the past president

Yes.

RaglandA

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 80 of 245 9

1

09:21:38

1

2

09:21:43

2 officer position, correct?

3

09:21:44

3

A.

Yes.

4

09:21:44

4

Q.

When were you the president of the medical

5

09:21:48

5 staff?

6

09:21:52

6

7

09:21:57

7 would be two years before that.

8

09:21:58

8

Q.

Okay.

9

09:22:02

9

A.

July 1st, '06, would be the beginning; July

A.

And that is a -- that's a medical staff

My term ended in July 1st of '08.

So it

So the -- I understood that --

10

09:22:06 10 1st, '08, would be the end.

11

09:22:07 11

12

09:22:18 12 Dr. Jadwin?

13

09:22:19 13

A.

Yes.

14

09:22:19 14

Q.

Please estimate the frequency with which you

15

09:22:21 15 had interactions with Dr. Jadwin throughout his

16

09:22:25 16 tenure at Kern Medical Center.

17

09:22:27 17

A.

Twice a week.

18

09:22:29 18

Q.

Twice a week.

19

09:22:31 19

20

09:22:32 20 what was the nature of those meetings or interactions

21

09:22:36 21 with Dr. Jadwin?

22

09:22:38 22

23

09:22:40 23 on blood usage, any other functions of patient care.

24

09:22:43 24

25

09:22:48 25 Dr. Jadwin were in his capacity as the director of

Q.

Okay.

Did you have any interactions with

Why were you interacting?

A.

Q.

What were the --

Perhaps to discuss a case, perhaps to work

And so many of your interactions with

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 81 of 245 23

1

09:34:05

1 competence, right?

2

09:34:05

2

3

09:34:07

3 everybody in the room.

4

09:34:08

4

5

09:34:10

5 each individual, right?

6

09:34:11

6

A.

Sure.

7

09:34:11

7

Q.

Okay.

8

09:34:15

8 individualized insult to Mr. Bryan regarding his

9

09:34:17

9 competence?

A.

Q.

I remember he was generally insulting to

Okay.

But then you said he tailored it to

So you recall him giving a -- an

10

09:34:18 10

A.

No.

11

09:34:18 11

Q.

You don't?

12

09:34:19 12

A.

No.

13

09:34:20 13

Q.

Then what was the individualized compe- --

14

09:34:25 14 insult to Mr. Bryan about then?

15

09:34:30 15

A.

Okay.

16

09:34:31 16

Q.

I'm not asking you for the words.

17

09:34:32 17

A.

Okay.

18

09:34:32 18

Q.

I'm asking for what the content was.

19

09:34:35 19

A.

I already told you that.

20

09:34:37 20

Q.

No, you didn't.

21

09:34:38 21

A.

Insulting to everybody in the room.

22

09:34:40 22 I don't remember the details.

23

09:34:41 23

24

09:34:45 24 said to everybody that they were incompetent in the

25

09:34:47 25 room.

Q.

I don't remember the words.

Okay?

Doctor, you just said a minute ago that he

I'm asking you -- and then you said he

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 82 of 245 24

1

09:34:50

1 specialized that insult to each person.

2

09:34:52

2

3

09:34:55

3 insult to Mr. Bryan regarding his competence or not?

4

09:34:59

4

A.

I don't recall.

5

09:34:59

5

Q.

Okay.

6

09:35:03

6 specialized insult regarding competence did he direct

7

09:35:06

7 at Ms. Abraham?

8

09:35:07

8

A.

I don't remember.

9

09:35:08

9

Q.

You just recall that he insulted her

I'm asking you, did he give a specialized

Now, how about Jennifer Abraham, what

10

09:35:10 10 competence then?

11

09:35:11 11

A.

I recall that he insulted my competence.

12

09:35:13 12

Q.

What about -- I'm talking about Dr. Abraham

13

09:35:16 13 right now.

14

09:35:16 14

A.

I understand that.

15

09:35:18 15

Q.

Okay.

16

09:35:21 16 competence, then, to your recollection?

17

09:35:23 17

A.

I don't remember.

18

09:35:23 18

Q.

Okay.

19

09:35:27 19 direct a specialized insult regarding Dr. Harris'

20

09:35:30 20 competence at him?

21

09:35:31 21

A.

I don't recall.

22

09:35:32 22

Q.

Did he insult Dr. Harris' competence on an

23

09:35:35 23 individualized basis?

24

09:35:37 24

A.

I don't recall.

25

09:35:37 25

Q.

Okay.

So did he insult Dr. Abraham's

How about Dr. Harris, how did he

So as far as you can recall, the only

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 83 of 245 54

1

10:00:58

1 complete --

2

10:00:59

2

3

10:01:02

3 restore confidence in the pathology department during

4

10:01:05

4 Dr. Jadwin's tenure at the hospital?

5

10:01:07

5

A.

Because Dr. Jadwin wasn't very cooperative.

6

10:01:11

6

Q.

So -- because he wasn't cooperative with

7

10:01:14

7 whom?

8

10:01:15

8

A.

With everybody.

9

10:01:16

9

Q.

Everybody.

10

10:01:19 10

A.

Yes.

11

10:01:19 11

Q.

You -- when you say "he wasn't cooperative

12

10:01:23 12 with everybody," you mean to include every chair of

13

10:01:29 13 every department for instance, right?

14

10:01:31 14

A.

As far as I know.

15

10:01:32 15

Q.

Okay.

16

10:01:34 16 didn't get along or cooperate with any department

17

10:01:36 17 chair, right?

18

10:01:37 18

A.

Not that I'm aware of.

19

10:01:38 19

Q.

Okay.

20

10:01:40 20 any core physician at Kern Medical Center, right?

21

10:01:42 21

A.

Not that I'm aware.

22

10:01:45 22

Q.

Do you -- to your knowledge, did the

23

10:01:51 23 president take any steps to restore confidence in the

24

10:01:53 24 pathology department during --

25

10:01:54 25

Q.

A.

Yeah.

Do you know why the president did not

You mean that literally, right?

Doctor, to your knowledge, Dr. Jadwin

He didn't get along or cooperate with

Yes.

RaglandA

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 84 of 245 61

1

10:08:18

1

I wasn't complete, Doctor.

2

10:08:19

2

3

10:08:22

3 of the court reporter actually, not for my sake.

4

10:08:24

4 Okay?

5

10:08:24

5

6

10:08:26

6 this E-mail you've just referenced to your attorneys

7

10:08:29

7 in response to any request for documents in this

8

10:08:31

8 action?

9

10:08:36

9

A.

No.

10

10:08:36 10

Q.

Were you aware that in this action documents

11

10:08:42 11 were requested with regard to Dr. Jadwin to be

12

10:08:46 12 produced?

13

10:08:50 13

A.

No.

14

10:08:50 14

Q.

No one came to you and told you to not -- to

15

10:08:56 15 collect evidence and not destroy it in connection

16

10:09:02 16 with this case?

17

10:09:04 17

A.

No.

18

10:09:04 18

Q.

And you're certain about that, right?

19

10:09:11 19

A.

Yes.

20

10:09:11 20

Q.

Okay.

21

10:09:16 21 you've just referenced today?

22

10:09:23 22

A.

No.

23

10:09:23 23

Q.

Why not?

24

10:09:29 24

A.

I don't have it.

25

10:09:30 25

Q.

Why not?

And I'm asking you to do that for the sake

You don't recall handing this -- a copy of

If -- could you produce this E-mail

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 85 of 245 63

1

10:10:32

1

A.

No.

2

10:10:32

2

Q.

Okay.

3

10:10:48

3 E-mail asking who he could trust to sit on a

4

10:10:52

4 committee, but that no longer exists.

5

10:10:54

5 him -- and he responded that no one, he couldn't

6

10:10:57

6 think of anybody, that they would all rubber stamp

7

10:11:00

7 decisions, right?

8

10:11:04

8 Dr. Jadwin's E-mail that he responded to you saying

9

10:11:07

9 no one?

So you sent Dr. Jadwin this alleged

And you told

And you don't have -- do you have

10

10:11:08 10

A.

That's two questions.

11

10:11:09 11

Q.

Okay.

12

10:11:12 12 question.

13

10:11:12 13

14

10:11:14 14 told you no one?

15

10:11:15 15

A.

No.

16

10:11:15 16

Q.

Is that because you deleted it as well?

17

10:11:19 17

A.

Yes.

18

10:11:19 18

Q.

Why did you delete these E-mails?

19

10:11:23 19

A.

Because I delete my E-mails.

20

10:11:24 20

Q.

You delete -- what was -- I'm sorry, Doctor.

21

10:11:29 21 You just engaged in a facial expression.

22

10:11:31 22

23

10:11:33 23

A.

I think your question's silly.

24

10:11:34 24

Q.

Okay.

25

10:11:37 25

Well, why don't we take the second

Do you have this E-mail where Dr. Jadwin

What was the significance of that?

I will try to do better, Doctor.

Now, how do you choose which E-mails to

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 86 of 245 69

1

10:16:01

1 of your eyes, and then take the document away?

They

2

10:16:04

2 don't hand it to you?

3

10:16:05

3

A.

Sure, they hand it to me.

4

10:16:06

4

Q.

Okay.

5

10:16:08

5 possession in connection with this investigation,

6

10:16:10

6 didn't you?

7

10:16:10

7

A.

Define what you mean by "in my possession."

8

10:16:13

8

Q.

You were holding it, weren't you?

9

10:16:14

9

A.

No.

So you did have documents in your

Are you talking about holding it in my

10

10:16:16 10 hand or holding it for storage in a file?

11

10:16:18 11

12

10:16:21 12 gave you a document, what did you do with it?

13

10:16:22 13

A.

Read it.

14

10:16:23 14

Q.

Where?

15

10:16:24 15

A.

Where they handed it to me.

16

10:16:25 16

Q.

Standing in front of the person who gave it

17

10:16:27 17 to you?

18

10:16:28 18

A.

Most likely, yes.

19

10:16:29 19

Q.

And then you would hand it back to them?

20

10:16:32 20

A.

Yes.

21

10:16:32 21

Q.

Okay.

22

10:16:34 22 regarding this investigation into Dr. Jadwin to

23

10:16:37 23 anybody?

24

10:16:40 24

25

10:16:42 25 lawyers.

Q.

A.

Okay.

In this investigation when someone

Did you give any documentation

Yes, I gave that one form that I had to the

RaglandA

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 87 of 245 70

1

10:16:42

1

2

10:16:46

2 you gave this document to the lawyers?

3

10:16:48

3

A.

I handed it to them.

4

10:16:49

4

Q.

Why?

5

10:16:51

5

A.

Because it was part of this lawsuit.

6

10:16:54

6

Q.

Oh, so now you do recall the lawyers asking

7

10:16:57

7 for documents as part of this lawsuit?

8

10:16:59

8 that now?

9

10:17:06

9

A.

Oh, so now you do recall -- how was it that

You recall

A minute ago you said they didn't. I don't think they asked me for it because I

10

10:17:09 10 don't think they knew it existed.

11

10:17:10 11

Q.

So how did you end up giving it to them?

12

10:17:14 12

A.

I asked the secretary if she could go

13

10:17:16 13 through all the stuff and see if she had that

14

10:17:21 14 document from the fine needle information, and she

15

10:17:27 15 dug it out and I handed it to them.

16

10:17:29 16

17

10:17:32 17 Did they ask for it?

18

10:17:33 18

A.

No.

19

10:17:36 19

Q.

Then why would you hand it to them?

20

10:17:39 20

A.

Because I was being sued by Dr. Jadwin.

21

10:17:41 21

Q.

And so you just felt it appropriate to, on

22

10:17:44 22 your own initiative, just produce this one fine

23

10:17:47 23 needle report -- fine needle aspiration report to

24

10:17:49 24 your attorneys?

25

10:17:51 25

Q.

A.

And why would you hand it to the lawyers?

They didn't know it existed.

I felt it was more appropriate than keeping

RaglandA

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1

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1 it in my possession solely, yes.

2

10:17:56

2

3

10:17:58

3 you --

4

10:17:59

4

A.

I don't recall.

5

10:17:59

5

Q.

You don't recall the year, right?

6

10:18:01

6

A.

No.

7

10:18:01

7

Q.

You don't recall whether it was before or

8

10:18:03

8 after Dr. Jadwin had left of the hospital, right?

9

10:18:05

9

Q.

A.

Okay.

When did this happen?

When did

It was after Dr. Jadwin had left the

10

10:18:07 10 hospital.

11

10:18:07 11

12

10:18:09 12 lawyers asking you for any and all documents relating

13

10:18:12 13 to Dr. Jadwin in this action?

14

10:18:14 14

A.

I don't recall.

15

10:18:14 15

Q.

But you do recall feeling it made sense for

16

10:18:20 16 you to give this fine needle aspiration report to the

17

10:18:22 17 lawyers, right?

18

10:18:26 18

A.

Yes.

19

10:18:26 19

Q.

Nobody asked you to do that; the lawyers

20

10:18:29 20 didn't ask you, you just volunteered it, didn't you?

21

10:18:32 21

A.

Yes.

22

10:18:32 22

Q.

All right.

23

10:18:35 23 Why not anything else?

24

10:18:36 24

A.

Because that's all I had.

25

10:18:37 25

Q.

You destroyed everything else, right?

Q.

Oh, okay.

But -- and you don't recall the

Why that particular document?

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1

11:39:29

1 it.

2

11:39:30

2

Q.

You just didn't think about it, huh?

3

11:39:33

3

A.

Dr. Jadwin made no complaint to me about the

4

11:39:35

4 breach of his investigation.

5

11:39:36

5

Q.

How would he have known?

6

11:39:38

6

A.

How would he have known?

7

11:39:40

7

Q.

Yeah, that it was breached?

8

11:39:42

8

A.

He's all knowing.

9

11:39:43

9

Q.

You're being sarcastic now?

10

11:39:45 10

A.

Absolutely.

11

11:39:46 11

Q.

Okay.

12

11:39:48 12 meeting where Dr. Jadwin called you incompetent?

13

11:39:51 13

14

11:39:53 14 have here.

15

11:39:54 15

16

11:39:56 16 personal setting?

A.

Q.

Okay.

Were you sarcastic like this at the

No, I got up and left, an option I don't

You consider this a professional or a

17

17

MR. WASSER:

18

18 BY MR. LEE:

You're asking me?

19

11:40:00 19

Q.

This is a professional setting, right?

20

11:40:04 20

A.

Correct.

21

11:40:04 21

Q.

You're being -- you're being sarcastic in a

22

22 professional setting, correct?

23

23

A.

Correct.

24

11:40:09 24

Q.

That's not what you said earlier, wasn't it?

25

25 You said you're never sarcastic -- you're not

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11:50:49

1 so four to eight.

2

11:50:52

2

Q.

Yes, May of 2004.

3

11:50:55

3

A.

No.

4

11:50:56

4

Q.

You were not a -- you were not an immediate

5

11:51:01

5 past president, you weren't a president elect, you

6

11:51:04

6 weren't a president, correct?

7

11:51:06

7

8

11:51:11

8 to 2006; president, 2006 to 2008, July being the --

9

11:51:15

9 July 1st being the change date; now a past president.

A.

Q.

So May?

I believe I was president elect in July 2004

10

11:51:19 10

Is it a part of the skills of a medical

11

11:51:35 11 staff officer to be able to accurately read an FNA

12

11:51:39 12 report?

13

11:51:43 13

A.

No.

14

11:51:43 14

Q.

No.

15

11:51:49 15

16

11:51:52 16 medical staff officer to be able to interpret an

17

11:51:57 17 outside F -- outside consultant FNA report

18

11:52:00 18 accurately?

19

11:52:00 19

A.

Yes.

20

11:52:00 20

Q.

Yes.

21

11:52:04 21

22

11:52:07 22 review of Dr. Lieu's FNA consultant report, is that

23

11:52:13 23 Dr. Jadwin was the source of the problem; is that

24

11:52:15 24 correct?

25

11:52:16 25

Is it -- is it part of the skills of a

Okay.

So your conclusion, based upon your careful

A.

No.

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1

A.

No, I said I had no objective data.

2

12:11:10

2

Q.

I asked you if you had any non-objective

3

12:11:13

3 data, and you said no.

4

12:11:15

4 any objective data, and you said no.

5

12:11:19

5

6

12:11:23

6 this objective or non-objective data.

7

12:11:26

7 of FNA reports that I went through that were double

8

12:11:32

8 reads from UCLA, and they really were not able to be

9

12:11:36

9 interpreted because all of -- almost 90 percent of

A.

All right.

I've asked you if you've had

I don't know if you want to term I had a stack

10

12:11:40 10 the final dates of issue were after the final -- the

11

12:11:43 11 read came back from UCLA.

12

12:11:45 12

13

12:11:48 13 that Dr. Jadwin was going back and changing his

14

12:11:53 14 initial diagnosis to match that of UCLA's; is that

15

12:11:57 15 correct?

16

12:11:57 16

17

12:12:00 17 objective data.

18

12:12:00 18

19

12:12:03 19 came after the UCLA report had come in; is that

20

12:12:06 20 correct?

21

12:12:07 21

A.

That's correct.

22

12:12:07 22

Q.

And you couldn't be sure whether Dr. Jadwin

23

12:12:09 23 was just issuing a final report that just matched

24

12:12:12 24 UCLA's, right?

25

12:12:15 25

Q.

A.

Q.

A.

And in your mind that raised the possibility

No, I'm telling you that it doesn't make it

Because the final report from Dr. Jadwin

That's correct.

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1

2

12:12:17

2 waiting for the UCLA report to come in to then make

3

12:12:22

3 sure that he could issue his final report to have a

4

12:12:26

4 hundred percent congruence with UCLA, correct?

5

12:12:27

5

A.

That's correct.

6

12:12:28

6

Q.

Did you ever talk to Dr. Jadwin?

7

12:12:29

7

A.

Not after that point.

8

12:12:30

8

Q.

At any point regarding this issue?

9

12:12:34

9

A.

He handed me this stack of them and said

10

Q.

Document 277-2

You couldn't be sure that Dr. Jadwin was not

12:12:36 10 "Look at them," in a rather angry tone.

11

11

Q.

Yeah.

And you were --

12

12:12:40 12

A.

He gave them to me to look at.

13

12:12:42 13

Q.

You were very calm and peaceable with him,

14

12:12:45 14 weren't you?

15

12:12:45 15

A.

Tried to be.

16

12:12:46 16

Q.

Very temperate and moderate, right?

17

12:12:49 17

A.

As much as possible.

18

12:12:50 18

Q.

Right.

19

12:12:53 19 extremely calm and composed whenever you dealt with

20

12:12:55 20 him, right?

21

12:13:00 21

22

12:13:02 22

A.

The best of my ability.

23

12:13:03 23

Q.

What does that mean?

24

12:13:06 24 successful?

25

12:13:06 25

Whenever he yelled at you, you were

Is that a yes or no?

A.

You weren't

It means I don't remember any specific

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12:13:08

1 events.

2

12:13:11

2 when he called me incompetent, because I couldn't,

3

12:13:15

3 you know, be objective at that point, so I would get

4

12:13:17

4 up and leave.

5

12:13:18

5

6

12:13:21

6 weren't you?

7

12:13:21

7

A.

As patient as I could be.

8

12:13:22

8

Q.

You were very accommodating and

9

12:13:25

9 understanding to Dr. Jadwin always, right?

Q.

I would get up and leave the room like I did

You were very patient with Dr. Jadwin,

10

12:13:29 10

A.

Accommodating?

11

12:13:35 11

Q.

I'll ask you another question.

12

12:13:36 12

13

12:13:38 13 you dealt with Dr. Jadwin, right?

14

12:13:40 14

A.

Tried to be.

15

12:13:40 15

Q.

Tried to be.

16

12:13:43 16 always successful?

17

12:13:44 17

18

12:13:46 18 not.

19

12:13:47 19

20

12:13:53 20 to Dr. Jadwin as to whether or not he was issuing his

21

12:13:56 21 final FNA reports after UCLA's report had come in to

22

12:14:01 22 have an artificial hundred percent congruence?

23

12:14:05 23

A.

No.

24

12:14:06 24

Q.

Why not?

25

12:14:07 25

A.

Well, he handed me the data.

You were always very reasonable in the way

Does that mean you weren't

A.

I can't recollect any incidents where I was

Q.

So you never -- you never thought to speak

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Case 1:07-cv-00026-OWW-TAG

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1

12:14:09

1 was aware of it.

2

12:14:10

2

Q.

You make a lot of assumptions, don't you?

3

12:14:12

3

A.

Well, when there's like 11 months between

4

12:14:14

4 when the pathology sample was selected and the review

5

12:14:19

5 was done, and the final didn't come out for that 11

6

12:14:22

6 months, what conclusion would you draw?

7

12:14:26

7

8

12:14:29

8 the FNAs, he never sent initial diagnoses, did he?

9

12:14:35

9

Q.

A.

When Dr. Jadwin sent reports out to UCLA,

I don't know.

I was handed a stack of

10

12:14:36 10 papers that had his reading -- I was handed a stack

11

12:14:40 11 of papers that had his reading and UCLA's reading.

12

12:14:43 12

13

12:14:46 13 you?

14

Q.

You never thought to ask Dr. Jadwin, did

12:14:46 14

A.

No.

15

12:14:47 15

Q.

You didn't think it was important to know

16

12:14:48 16 that, right?

17

12:14:49 17

A.

To know what?

18

12:14:50 18

Q.

To know whether or not he was issuing an

19

12:14:53 19 initial diagnosis on the FNAs to UCLA, and then they

20

12:14:57 20 were then issuing their diagnosis in congruence with

21

12:15:00 21 his.

22

12:15:03 22

23

12:15:05 23 report, which should have been out long before that,

24

12:15:07 24 and the dates of the UCLA.

25

12:15:11 25

You never thought to ask that, did you? A.

Q.

All I do is look at the dates of the final

It made the data useless.

And then you made your assumptions?

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Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

Filed 12/01/2008

1

12:15:13

1

2

12:15:16

2 useless, you couldn't decide one way or the other

3

12:15:19

3 whether he could read fine needles or not.

4

12:15:21

4

5

12:15:24

5 UCLA?

6

12:15:25

6

A.

No.

7

12:15:25

7

Q.

Why not?

8

12:15:26

8

A.

Why?

9

12:15:26

9

Q.

To find out what the story was.

10

12:15:28 10

A.

I had their readings.

11

12:15:31 11 double-blinded.

12

12:15:33 12 slide and no other information, and they're supposed

13

12:15:35 13 to send it back with their reading, and then you

14

12:15:38 14 compare it to his reading.

15

12:15:41 15 data.

16

12:15:41 16

Q.

And you know this because --

17

12:15:43 17

A.

But to -- I know that because that's simple

18

12:15:46 18 scientific method.

19

12:15:47 19

20

12:15:59 20 here today, you have no knowledge that -- of whether

21

12:16:01 21 Dr. Jadwin sent his initial diagnosis of slides to

22

12:16:05 22 UCLA prior to their issuing their report, their

23

12:16:08 23 outside report on FNAs; you don't know that, right?

24

12:16:11 24

A.

That's correct.

25

12:16:11 25

Q.

Sitting here today, do you think that would

Q.

Q.

I made no assumptions.

Page 95 of 245 175

The data was

Did you ever pick up the phone and call

Uh-huh.

It was supposed to be

You're supposed to send them the

That would be objective

So you have no knowledge -- sitting

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1

12:16:13

1 be important to know that?

2

12:16:14

2

A.

No.

3

12:16:15

3

Q.

Why not?

4

12:16:16

4

A.

Well -- okay, I'm sorry.

5

12:16:18

5 no, because I thought you said -- I meant -- I

6

12:16:20

6 thought you were asking me whether it was important

7

12:16:22

7 that you send the information down to UCLA.

8

12:16:26

8

9

12:16:28

9 would have been if the final dates had been, you

I misunder- -- no,

Was it important that I would know that?

It

10

12:16:32 10 know, before they had gone to UCLA, yes.

11

12:16:35 11

12

12:16:38 12 if there's an initial --

13

12:16:39 13

14

12:16:43 14 interpret data if the final report came out after the

15

12:16:46 15 UCLA report.

16

12:16:47 16

17

12:16:50 17 Couldn't you have called UCLA and asked them was

18

12:16:54 18 Dr. Jadwin sending you his initial diagnosis along

19

12:16:55 19 with the slides, and were you coming out with a

20

12:16:57 20 report that was in 100 percent congruence with his

21

12:17:02 21 initial diagnosis?

22

12:17:03 22

A.

What would be the reason for doing that?

23

12:17:06 23

Q.

To confirm with them that they were actually

24

12:17:09 24 finding a diagnosis that matched Dr. Jadwin's.

25

12:17:12 25

Q.

A.

Q.

A.

What's your fixation with these final dates,

It makes the data useless.

You can't

Well, couldn't you have done this, Doctor:

Couldn't you have done that?

Their job was just to read the slide and

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12:17:15

1 provide the data, not provide the comparison.

2

12:17:22

2

3

12:17:24

3 don't you, Doctor?

4

12:17:26

4

A.

Absolutely.

5

12:17:26

5

Q.

It's very important to draw conclusions on

6

12:17:28

6 objective data?

7

12:17:30

7

A.

Absolutely.

8

12:17:30

8

Q.

Subjective data's not a good -- it's

9

12:17:34

9 garbage, right?

Q.

A.

You believe in the power of objective data,

10

12:17:36 10

Well, sometimes it's all you have, but

11

12:17:38 11 generally, it's not good to base some -- you know, to

12

12:17:39 12 base decisions on only subjective data, yes.

13

12:17:42 13

Q.

Certainly not?

14

12:17:43 14

A.

Certainly not.

15

12:17:44 15

Q.

So in order to come to a conclusion as to

16

12:17:46 16 whether or not Dr. Jadwin was intentionally issuing a

17

12:17:50 17 final diagnosis on the FNAs so as to create an

18

12:17:54 18 artificial 100 percent congruence with UCLA, wouldn't

19

12:17:58 19 it have behooved you to find out whether he, in fact,

20

12:18:01 20 was sending initial diagnoses out to UCLA along with

21

12:18:05 21 the slides?

22

12:18:06 22

A.

I never drew that conclusion.

23

12:18:07 23

Q.

You didn't?

24

12:18:08 24

A.

I did not.

25

12:18:08 25

Q.

You said you suspected it, right?

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1

12:18:10

1

A.

I didn't think I said that either.

2

12:18:12

2

Q.

Sitting here today, do you think that

3

12:18:15

3 Dr. Jadwin may have done that?

4

12:18:17

4

A.

I have no opinion on that.

5

12:18:18

5

Q.

You have no opinion on that?

6

12:18:20

6

A.

Not particularly.

7

12:18:20

7

Q.

Did you ever voice that suspicion to anybody

8

12:18:22

8 that he was doing that, that he was artificially

9

12:18:25

9 creating a 100 percent congruence with UCLA by

10

12:18:29 10 ensuring that the final report was only released

11

12:18:31 11 after the UCLA report had come in?

12

12:18:34 12

A.

No.

13

12:18:34 13

Q.

You never stated that to anybody, right?

14

12:18:36 14

A.

I don't believe so.

15

12:18:37 15

Q.

You never sent an E-mail or --

16

12:18:40 16

A.

I don't believe so.

17

12:18:43 17

Q.

Well, that suspicion's pretty useless, too,

18

12:18:48 18 isn't it?

19

12:18:49 19

A.

Yes.

20

12:18:49 20

Q.

It's just rumor, gossip and speculation,

21

12:18:52 21 isn't it?

22

12:18:52 22

23

12:18:55 23 issued till after the UCLA reports were issued.

A.

It's useless data.

No, it's fact that the final reports weren't

24

24

Q.

Right.

25

12:18:59 25

A.

That's fact.

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Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

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Page 99 of 245 181

1

12:20:30

1

-- wouldn't Dr. Jadwin have then reflected

2

12:20:32

2 that in the final report?

3

12:20:35

3

A.

No.

4

12:20:35

4

Q.

Why not?

5

12:20:35

5

A.

Because this was not sent out for that, it

6

12:20:37

6 was sent out for quality, okay?

7

12:20:41

7 the slides should have been sent blindly to UCLA, not

8

12:20:45

8 having Dr. Jadwin's initial pathology report, so

9

12:20:49

9 there's prejudicing of the pathologist who's reading

Isn't that reasonable?

To be done properly,

10

12:20:53 10 the second slide, and you take the reading from

11

12:20:56 11 Dr. Jadwin, which should be finalized before the UCLA

12

12:21:00 12 report is seen, and you take the UCLA report, and

13

12:21:02 13 then you compare them to see if there's a

14

12:21:05 14 discrepancy.

15

12:21:06 15 was useless.

16

12:21:08 16

Q.

And you're sure of that, right?

17

12:21:10 17

A.

Yes.

18

12:21:10 18

Q.

And you never talked to Dr. Jadwin, did you?

19

12:21:13 19

A.

No.

20

12:21:13 20

Q.

Did you ever speak to Dr. Dutt about this

21

12:21:16 21 UCLA FNA double read?

22

12:21:23 22

A.

I don't recall.

23

12:21:24 23

Q.

Did you think it was important to speak to

24

12:21:28 24 Dr. Dutt about it?

25

12:21:29 25

A.

That's not what happened, so the data

I asked -- at that point, no, because I

RaglandA

Case 1:07-cv-00026-OWW-TAG

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1

12:21:35

1 think Dr. Jadwin was already gone.

2

12:21:37

2

Q.

So the issue was moot?

3

12:21:39

3

A.

At that point, yes.

4

12:21:40

4

Q.

Yeah.

5

12:21:43

5 there?

6

12:21:44

6

A.

Correct.

7

12:21:44

7

Q.

All right.

8

12:21:46

8 Dr. Jadwin was gone -- are you talking about December

9

12:21:49

9 7th, 2006?

The person in question was no longer

So there was no need -- once

10

12:21:50 10

A.

I don't know the date he left.

11

12:21:51 11

Q.

That's the date he was placed on

12

12:21:53 12 administrative leave.

13

12:21:55 13

A.

I don't know.

14

12:21:56 14

Q.

Okay.

15

12:21:58 15 was the date he was placed on administrative leave.

16

12:22:00 16

A.

Okay.

17

12:22:01 17

Q.

So after December 7, 2006, with Dr. Jadwin

18

12:22:06 18 gone, there was no need to conduct any investigation

19

12:22:07 19 of Dr. Jadwin, was there?

20

12:22:25 20

21

12:22:27 21 was incompetent and you needed to report it to the

22

12:22:30 22 medical board.

23

12:22:34 23 so.

24

12:22:34 24

25

12:22:37 25 might have and let's talk about what was done.

A.

Q.

I'm going to represent to you that

There might have been a need if you felt he

Okay.

But other than that, I don't think

Well, let's -- let's get away from

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 101 of 245 219

1

14:25:18

1 unsatisfactory, right?

2

14:25:20

2

A.

Correct.

3

14:25:20

3

Q.

Why not?

4

14:25:21

4

A.

Why didn't it answer the question?

5

14:25:23

5

Q.

Didn't you pay the -- I mean, I assume this

6

14:25:28

6 consultant was paid a certain amount of money to do

7

14:25:30

7 this -- this report, time was spent with this

8

14:25:32

8 consultant, he -- he finalized a report, he did a

9

14:25:35

9 grand rounds lecture to which only a few people

10

14:25:38 10 showed up.

11

14:25:39 11

12

14:25:41 12 least resolve that issue?

13

14:25:42 13

14

14:25:46 14 so pathology and radiology could work together so we

15

14:25:52 15 could care for the patients.

16

14:25:52 16

17

14:25:53 17 hired a behavioral consultant to do that for you

18

What was all that exercise for if not to at

A.

Q.

To try to find a civilized, common pathway

You didn't think what -- couldn't you have

18 instead of a pathologist?

19

14:25:57 19

A.

20

14:26:00 20 could assess the needles used or the competency of

21

14:26:04 21 the radiologist in the number of passes taken.

22

14:26:07 22

23

14:26:13 23 FNA slides?

24

14:26:14 24

A.

Correct.

25

14:26:14 25

Q.

Okay.

Q.

I don't think the behavioral consultant

Or the competency of Dr. Jadwin in reading

So that's why you -- that's why this

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 102 of 245 220

1

14:26:17

1 consultant was brought in, right?

2

14:26:18

2

3

14:26:21

3 believe -- at least the overall purpose was to try to

4

14:26:25

4 find a common pathway to see if we could improve the

5

14:26:29

5 relationship between pathology and radiology so we

6

14:26:32

6 could get fine needle aspirations on our patients

7

14:26:35

7 instead of having them feud all the time.

8

14:26:39

8

9

14:26:41

9 Dr. Jadwin and/or the radiologist, wasn't that part

A.

Q.

No, the consultant was brought in, I

Right.

And determining the competency of

10

14:26:44 10 of the study, the purpose of the study too?

11

14:26:47 11

A.

I don't know.

12

14:26:47 12

Q.

You don't know?

13

14:26:49 13

14

14:26:50 14

A.

Yes.

15

14:26:51 15

Q.

Okay.

16

14:26:52 16

A.

If we're talking about the same report.

17

14:26:57 17

18

14:26:59 18 the report is that Dr. Jadwin could improve on his

19

14:27:03 19 communication, and that we should use -- the

20

14:27:06 20 radiologists should use different needles.

21

14:27:08 21 the two things I remember from reading the report.

22

14:27:10 22

Q.

Do you recall how long the report was?

23

14:27:17 23

A.

No.

24

14:27:42 24

25

14:28:12 25 Could you mark this as 110, please?

You read the report though?

As I stated, the two things I took away from

MR. LEE:

Those are

I'm going to get an exhibit.

RaglandA

Case 1:07-cv-00026-OWW-TAG

1

14:28:12

2

Document 277-2

Filed 12/01/2008

1

(Plaintiff's Exhibit No. 110

2

marked for identification.) THE WITNESS:

3

14:28:14

3

4

14:28:14

4 BY MR. LEE:

5

14:28:14

5

6

14:28:16

6 marked for identification as Exhibit 110.

7

14:28:20

7 take a moment to review it.

8

14:28:23

8

A.

Are we done with these?

9

14:28:25

9

Q.

You can leave them there.

Q.

Page 103 of 245 221

Thank you.

Doctor, you've just been handed a document Please

10

14:28:26 10

Actually, Doctor, I don't want to waste your

11

14:29:21 11 time.

12

14:29:23 12 it's about 30 or 40 pages long.

13

14:29:25 13 ask you if you can -- if you recognize it.

14

14:29:28 14

15

14:29:30 15 recognize it.

16

14:29:31 16

17

17

18

14:58:55 18

THE WITNESS:

19

14:58:56 19

MR. LEE:

20

14:58:58 20 when the last spoken statement was said, the time?

I don't think you need to read that report,

A.

Q.

I'm just going to

Oh, I'd have to read it to see if I

Okay. (Witness reviewed document.)

21

21

22

22 BY MR. LEE:

Okay.

Madame Reporter, can you state

THE COURT REPORTER:

Q.

Okay.

2:29.

23

14:59:07 23

Doctor, you've spent 31 minutes

24

14:59:15 24 reviewing that document, correct?

25

14:59:18 25 right?

RaglandA

It is what it is,

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 104 of 245 222

1

14:59:18

1

A.

Yes.

2

14:59:19

2

Q.

Okay.

3

14:59:21

3

A.

Do you want me to include the table of

4

14:59:22

4 contents?

5

14:59:23

5

Q.

No.

6

14:59:31

6

A.

There are nine pages front and back.

7

14:59:34

7

Q.

Nine pages.

8

14:59:36

8

A.

Eighteen single-faced pages.

9

14:59:39

9

Q.

Okay.

How many pages in that document?

So you've reviewed it carefully now,

10

14:59:44 10 right?

11

14:59:45 11

A.

Yes.

12

14:59:45 12

Q.

And you reviewed it this carefully when you

13

14:59:48 13 first -- do you recognize this report?

14

14:59:49 14

A.

Yes.

15

14:59:50 15

Q.

What is it?

16

14:59:51 16

A.

It's the report from the fine needle

17

14:59:53 17 consultant brought in to solve our problems.

18

14:59:55 18

19

14:59:58 19 discussing this morning, correct?

20

15:00:00 20

A.

Yes, it is.

21

15:00:00 21

Q.

Okay.

22

15:00:04 22 this report?

23

15:00:04 23

A.

No.

24

15:00:04 24

Q.

Did you ever recall reading this report?

25

15:00:07 25

A.

I read a copy of this report.

Q.

So this is the consultant report we've been

And you recall receiving a copy of

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 105 of 245 226

1

15:03:04

1 BY MR. LEE:

2

15:03:04

2

Q.

Either.

3

15:03:05

3

A.

Why don't you ask which question you want

4

15:03:06

4 answered?

5

15:03:08

5

Q.

Okay.

6

15:03:10

6

A.

It says that no dis- -- difficulties were

7

15:03:12

7 found, but it was a limited study and it was

8

15:03:12

8 retro-prospective, and a prospective study would be

9

15:03:13

9 more useful.

Either or both.

What about Dr. Jadwin's competency?

It also gave a method suggesting it

10

15:03:18 10 that, you know -- right here, "All imaging guided

11

15:03:23 11 that are determined unsatisfactory or limited should

12

15:03:26 12 be automatically referred to UCLA for a second

13

15:03:28 13 opinion; all relevant clinical, radiologic

14

15:03:31 14 information, including scan reports, should be sent

15

15:03:33 15 along with the slides."

16

15:03:35 16

Q.

Okay.

17

15:03:38 17

A.

Page 15 DFG 00267.

18

15:03:42 18

Q.

Okay.

19

15:03:45 19 determine whether or not Dr. Jadwin's diagnoses were

20

15:03:48 20 correct or not?

21

15:03:49 21

22

15:03:52 22 based on what he had.

23

15:03:54 23

Q.

I'm sorry, based on what he had?

24

15:03:57 24

A.

"No major discrepancies were discovered in

25

15:04:00 25 the slide reviews of previous unsatisfactory or

A.

What page are you reading from, sir?

So in other words, did Dr. Lieu

He determined that he had sufficient skill

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 106 of 245 230

1

15:07:19

1 non-diagnostic samples; isn't that correct?

2

15:07:23

2

A.

That's correct.

3

15:07:23

3

Q.

Okay.

4

15:07:28

4 Dr. Jadwin's competency in recognizing non-diagnostic

5

15:07:31

5 and unsatisfactory samples, that was answered by

6

15:07:33

6 Dr. Lieu, wasn't it?

7

15:07:35

7

A.

Yes.

8

15:07:35

8

Q.

Okay.

9

15:07:39

9 answer -- that's certainly an indicator of

So that -- that question as to

And that's -- that's certainly an

10

15:07:42 10 Dr. Jadwin's competence as a pathologist, isn't it?

11

15:07:46 11

A.

His ability to read slides, yes.

12

15:07:47 12

Q.

Well, isn't that important for a

13

15:07:50 13 pathologist?

14

15:07:50 14

A.

Yes.

15

15:07:51 15

Q.

Okay.

16

15:07:52 16

A.

But it doesn't mean that that was the reason

17

15:07:54 17 they were inadequate.

18

15:08:00 18

19

15:08:03 19 still the reason then?

20

15:08:08 20 non-diagnostic --

21

15:08:09 21

22

15:08:11 22 the major issues were communication.

23

15:08:13 23

24

15:08:16 24 what did you find Dr. Lieu's conclusion was there?

25

15:08:18 25

Q.

A.

Q.

A.

It was the radiologist.

Well, does it mean that the pathologist was Who's responsible for

Well, in this case I would say yes, because

What about the radiologists' competence,

That there could be some improved technique.

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 107 of 245 325

1

17:12:05

1 today, Dr. Jadwin's removal would have been justified

2

17:12:09

2 by his conduct and communication failures, correct?

3

17:12:12

3

A.

Yes.

4

17:12:12

4

Q.

Okay.

5

17:12:15

5 the vote to demote him?

6

17:12:16

6

A.

It wasn't necessary.

7

17:12:17

7

Q.

In other words, his physical absence was

8

17:12:22

8 enough, it was a sufficient reason to demote him?

9

17:12:24

9

A.

Yes.

10

17:12:24 10

Q.

There was no need for -- in your mind, there

11

17:12:27 11 was no need to discuss his misconduct or many

12

17:12:31 12 communication failures of which you witnessed so

13

17:12:34 13 many?

14

17:12:34 14

A.

No.

15

17:12:34 15

Q.

Didn't -- you didn't feel the need to

16

17:12:37 16 mention a single one?

17

17:12:38 17

18

17:12:39 18

19

17:12:41 19 Counsel.

20

17:12:41 20

21

17:12:43 21 and regs and the bylaws said he could be removed

22

17:12:44 22 without reason, there was no reason to discuss any of

23

17:12:50 23 it.

24

17:12:51 24 pathology department to maintain its ongoing

25

17:12:54 25 certification.

A.

Well, why didn't you raise them at

No. MR. WASSER:

THE WITNESS:

We've been over this a lot,

As I stated earlier, the rules

We needed leadership in the laboratory in the

You can't do that if he's not there.

RaglandA

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 108 of 245 332

1

Q.

Okay.

A.

It's basically a verbal confirmation -- or a

2

17:32:11

2

3

17:32:15

3 written confirmation of what I've been telling you.

4

17:32:17

4

5

17:32:22

5 accusing you of being an impaired physician?

6

17:32:25

6

A.

He did not accuse me.

7

17:32:26

7

Q.

I'm sorry?

8

17:32:29

8

A.

He didn't accuse me to my face.

9

17:32:30

9

Q.

Okay.

Q.

Now, you -- do you recall Dr. Jadwin ever

But -- well, did you -- you are aware

10

17:32:33 10 that he said or he thought you were an impaired

11

17:32:37 11 physician, right?

12

17:32:38 12

13

17:32:40 13 event, yes.

14

17:32:41 14

15

17:32:45 15 Dr. Jadwin something about being an impaired

16

17:32:49 16 physician during the October 17 reprimand meeting?

17

17:32:55 17

A.

I probably had some kind of remark.

18

17:32:57 18

Q.

Right.

19

17:33:00 19 Dr. Jadwin had suggested you were an impaired

20

17:33:03 20 physician?

21

17:33:04 21

A.

Oh, yes.

22

17:33:04 22

Q.

Do you recall how you learned about this --

23

17:33:07 23

A.

You know, no, I don't.

24

17:33:09 24 mentioned it to me, I think it was months -- but I

25

17:33:12 25 can't really testify to the time -- after it

A.

Q.

I was made aware of that sometime after the

All right.

Now, do you recall stating to

So you knew by then at least that

RaglandA

Somebody had

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 109 of 245 333

1

17:33:14

1 occurred, and then it was probably a year or so later

2

17:33:16

2 that somebody told me why because I didn't -- I said,

3

17:33:20

3 "Where did that come from?"

4

17:33:22

4 the process, I didn't know that he had made the

5

17:33:24

5 accusation, I didn't know at the time of that meeting

6

17:33:28

6 that he had called the licensing board, I didn't know

7

17:33:31

7 any of that.

8

17:33:32

8

Q.

Well, how --

9

17:33:34

9

A.

Then when they told me, I just didn't really

But I wasn't aware of

10

17:33:36 10 care because I just said "Whatever."

11

17:33:37 11

12

17:33:40 12 right?

13

17:33:40 13

A.

Not officially.

14

17:33:41 14

Q.

Unofficially they did tell you all --

15

17:33:43 15

A.

Somebody made mention of it or something,

16

17:33:45 16 like they thought I had already known about it, but I

17

17:33:48 17 didn't.

18

17:33:48 18

Q.

Do you recall who this was?

19

17:33:50 19

A.

No.

20

17:33:51 20

Q.

No?

21

17:33:52 21

22

17:33:55 22 learned all the details?

23

17:33:55 23

A.

Not really, no.

24

17:33:56 24

Q.

No?

25

17:33:57 25

Q.

Okay.

So they did eventually tell you,

Do you recall when this was that you finally

You didn't think it was important, right?

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 110 of 245 334

1

17:33:59

1

A.

That's, you know, out of my hands.

2

17:34:01

2

Q.

So being -- Dr. Jadwin suspecting you were

3

17:34:05

3 an impaired physician didn't bother you that much,

4

17:34:08

4 did it?

5

17:34:09

5

6

17:34:11

6 well, you know, I found it insulting.

7

17:34:14

7 bothered me.

8

17:34:18

8 bothered me.

9

17:34:19

9

A.

Q.

Well, it was so far after the fact that -So, yeah, it

Okay.

Yeah, it bothered me, of course it

Well, aside from this October 17

10

17:34:21 10 reprimand meeting, did you ever talk to Dr. Jadwin

11

17:34:24 11 about why he had suggested you were an impaired

12

17:34:28 12 physician?

13

17:34:29 13

A.

I never spoke to him even then why.

14

17:34:31 14

Q.

But you thought it was inappropriate always,

15

17:34:33 15 right?

16

17:34:34 16

A.

I -- you know, that's his decision.

17

17:34:37 17

Q.

I'm asking for your opinion.

18

17:34:40 18

19

17:34:41 19 BY MR. WASSER:

20

17:34:41 20

21

17:34:42 21 Dr. Jadwin to call you or to suggest you were an

22

17:34:45 22 impaired physician, right?

23

17:34:47 23

24

17:34:50 24 thought that was inappropriate.

25

17:34:52 25

MR. WASSER:

Q.

A.

Q.

What's your question?

You thought it was un- -- inappropriate for

Based on an E-mail, a spelling, yes, I

Did -- how did you know which E-mail

RaglandA

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

Filed 12/01/2008

Page 111 of 245 361

1

18:01:29

1

2

18:01:32

2 patient.

3

18:01:32

3

4

18:01:38

4 were being collected properly by the radiologist --

5

18:01:42

5

A.

Okay.

6

18:01:42

6

Q.

-- what's the difference?

7

18:01:43

7

8

18:01:44

8 impacted when the FNAs aren't collected properly by

9

18:01:48

9 radiologists and they have to do multiple passes

Q.

Because I needed the X-ray to evaluate the

If Dr. Jadwin needed to ensure that the FNAs

Patient -- you don't think patients are

10

18:01:50 10 unnecessarily?

11

18:01:51 11

A.

Yes, I do.

12

18:01:51 12

Q.

That is a patient care issue, isn't it?

13

18:01:54 13

A.

Yes, it is.

14

18:01:54 14

Q.

Did you recognize that before?

15

18:01:56 15

A.

Of course.

16

18:01:57 16

Q.

You understood that the FNA issue was a

17

18:01:59 17 patient care issue from the beginning, right?

18

18:02:01 18

A.

It was a patient care issue, yes.

19

18:02:03 19

Q.

It wasn't just a communication problem, was

20

18:02:05 20 it?

21

18:02:05 21

A.

The patient care issue -- well -- okay, no,

22

18:02:12 22 it was both.

23

18:02:13 23

24

18:02:17 24 was both, right?

25

18:02:18 25

Q.

A.

Just like your dispute with the radiologist

Yes.

RaglandA

Case 1:07-cv-00026-OWW-TAG

Document 277-2

382 of 245 Page 112

Filed 12/01/2008

STATE OF CALIFORNIA ss. COUNTY OF KERN

I,

Sandra L. Edmonson,

a Certified Shorthand

Reporter in the State of California, Certificate No.

holding

7704, do hereby certify that

ALAN SCOTT RAGLAND, M.D.,

the witness named in the

foregoing deposition, was by me duly sworn; that said deposition was taken Friday, August 22,

2008,

at the

time and place set forth on the first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotype and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I

further certify that I am neither counsel for

nor in any way related to any party to said action, nor in any way interested in the result or outcome thereof. Dated this 8th day of September,

2008,

at

Bakersfield, California.

Sandra L.

Edmonson,

WOOD & RANDALL (800) 322-4595

CSR No.

7704

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 113 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 10

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

15

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13

VIDEOTAPED DEPOSITION

14

OF

15

RAYMOND ALBERT WATSON

16 17

Monday, August 25, 2008

18 19

Bakersfield, California

20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

WatsonR

Page 114 of 245 1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 115 of 245 7

1

14:03:51

1 my question.

It's very unnatural to do that, but

2

14:03:55

2 it's for the sake of the reporter.

3

14:03:56

3 record one person speaking at a time.

4

14:03:58

4

5

14:04:00

5 requires -- has the same force and effect as an oath

6

14:04:03

6 administered in a court of law before a judge and/or

7

14:04:06

7 a jury.

8

14:04:09

8 truth and the whole truth.

9

14:04:11

9

A.

Yes.

10

14:04:11 10

Q.

If at any time you don't understand a

11

14:04:15 11 question that's being asked, please ask me to restate

12

14:04:17 12 or rephrase the question, and I'll be happy to do so.

13

14:04:20 13 If you answer the question, it will be presumed that

14

14:04:22 14 you understood the question; so please be sure you

15

14:04:25 15 understand before you answer.

16

14:04:27 16

A.

Yes.

17

14:04:27 17

Q.

Okay.

18

14:04:31 18 estimates.

19

14:04:35 19 speculation.

20

14:04:37 20 you could estimate it's 12 feet or so.

21

14:04:41 21 how many cats I have at home, you'd have to say I

22

14:04:43 22 don't know; it would be a guess.

23

14:04:45 23

A.

Yes.

24

14:04:45 24

Q.

Okay.

25

14:04:49 25 why today's deposition cannot proceed?

She can only

The oath you've been administered

You are under the same duty to tell the Do you understand?

Do you understand?

We are entitled to your best

If I ask -- but not your guesses or If I ask you the length of this table, If I ask you

Do you understand?

Is there any reason you're aware of

WatsonR

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Okay.

Filed 12/01/2008

Page 116 of 245 10

1

14:09:24

1

2

14:09:24

2 a vote by the JCC on July 10 of 2006 at which it was

3

14:09:24

3 considered and approved to remove Dr. Jadwin from

4

14:09:24

4 chair of pathology at KMC.

5

14:09:24

5

6

14:09:24

6

A.

Yes.

7

14:09:24

7

Q.

Okay.

8

14:09:24

8

A.

He was the chairman of the pathology

9

14:09:24

9 department.

Okay.

I'll represent to you that there was

Do you know who Dr. David Jadwin is?

Well, who was he?

10

14:09:24 10

Q.

Did you have a lot of interaction with him?

11

14:09:24 11

A.

None whatsoever.

12

14:09:24 12

Q.

You never met him personally?

13

14:09:24 13

A.

Not that I know of.

14

14:09:24 14

Q.

And do you recall why -- did you vote at

15

14:09:24 15 this JCC meeting where Dr. Jadwin was being removed

16

14:09:24 16 from chair?

17

14:09:24 17

A.

Yes.

18

14:09:24 18

Q.

Okay.

19

14:09:24 19 going to refer it to as the removal meeting.

20

14:09:24 20 okay with you?

21

14:09:24 21

A.

That's fine.

22

14:09:24 22

Q.

Okay.

23

For the sake of brevity, I'm just Is that

So at the removal meeting do you

23 recall why you voted to remove Dr. Jadwin from chair

24

14:09:24 24 of pathology?

25

14:09:24 25

MR. WASSER:

Now, as to Supervisor

WatsonR

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 117 of 245 11

1

14:09:24

1 Patrick -- let me just mention-- Supervisor Watson,

2

14:09:24

2 as a member of the board of supervisors, has a

3

14:09:24

3 privilege to not disclose the reasons for votes he's

4

14:09:24

4 cast as a member of the board of supervisors.

5

14:09:24

5 privilege is personal to Supervisor Watson, and he

6

14:09:24

6 may assert it or he may not depending upon his own

7

14:09:24

7 preference.

8

14:09:24

8

9

14:09:24

9 question.

THE WITNESS:

The

Would you restate the

10

14:09:24 10 BY MR. LEE:

11

14:09:24 11

12

14:09:24 12 voted to approve the removal of Dr. Jadwin from chair

13

14:09:24 13 at the removal meeting?

14

14:09:24 14

15

14:09:24 15 in attendance to his duties for an extended period of

16

14:09:24 16 time, and that I did not believe that a manager can

17

14:09:24 17 perform their functions unless they are present.

18

14:09:24 18

19

14:09:24 19 understood that Dr. Jadwin was not physically present

20

14:09:24 20 at the hospital for an extended period of time?

21

14:09:24 21

A.

That's correct.

22

14:09:24 22

Q.

And that was -- and your view was that a

23

14:09:24 23 manager cannot perform his duties as a manager unless

24

14:09:24 24 he is physically present at the hospital, correct?

25

14:09:24 25

Q.

A.

Q.

A.

Sure.

Do you recall the reasons why you

I was -- we were told that he had not been

Okay.

So just to be very clear, you

For at least a portion of the time to carry

WatsonR

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 118 of 245 12

1

14:09:24

1 out their duties.

2

14:09:24

2

3

14:09:24

3 was not physically present at the hospital.

4

14:09:24

4 that told to you?

5

14:09:24

5

6

14:09:24

6 Excuse me.

7

14:09:24

7

8

14:09:24

8 Bryan at this time?

9

14:09:24

9

A.

Yes.

10

14:09:24 10

Q.

Okay.

11

14:09:24 11 physical presence at the hospital as one reason.

12

14:09:25 12 there any other reasons whatsoever for your vote to

13

14:09:27 13 remove him as chair?

14

14:09:29 14

A.

No.

15

14:09:29 15

Q.

No.

16

14:09:35 16 anybody about Dr. Jadwin's conduct or misconduct at

17

14:09:39 17 the hospital aside from being physically absent from

18

14:09:42 18 the hospital?

19

14:09:44 19

20

14:09:47 20 discussed at different times over a period of months

21

14:09:52 21 before that.

22

14:09:53 22

Q.

Dr. Jadwin's misconduct?

23

14:09:55 23

A.

Yes.

24

14:09:55 24

Q.

Okay.

25

14:09:58 25 Dr. Jadwin's misconduct was discussed?

Q.

A.

Q.

A.

Okay.

And how did you know that Dr. Jadwin How was

We were told by the chairman -- by the CEO.

Okay.

Just to be clear, the CEO was Peter

You've mentioned Dr. Jadwin's lack of Are

So at this meeting were you told by

At that meeting I don't recall.

It was

Can you recall those meetings where

WatsonR

Were these

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 119 of 245 30

1

14:31:52

1 board.

2

14:31:53

2

3

14:32:07

3 final resolution of this discussion regarding

4

14:32:09

4 nonrenewal of Dr. Jadwin's contract?

5

14:32:13

5 decision, in fact, not to renew his contract then?

6

14:32:20

6

7

14:32:24

7 although I imagine it was.

8

14:32:27

8 would have supported that because I didn't feel that

9

14:32:30

9 he was doing his job.

Q.

A.

Are you aware that Dr. -- and what was the

Was there a

Q.

I don't recall a specific vote being taken,

Okay.

I can tell you that I

10

14:32:31 10

So you don't recall a specific vote,

11

14:32:39 11 but there was a decision not to renew his contract

12

14:32:42 12 then?

13

14:32:43 13

A.

Yes.

14

14:32:43 14

Q.

You can't recall who was there besides

15

14:32:45 15 yourself?

16

14:32:46 16

A.

No, I can't.

17

14:32:46 17

Q.

And you can't recall whether this was --

18

14:32:50 18 well, clearly this meeting at which his nonrenewal

19

14:32:54 19 was discussed, it must have been after he was placed

20

14:32:57 20 on paid administrative leave, right?

21

14:33:01 21

A.

I --

22

14:33:02 22

Q.

Don't know?

23

14:33:02 23

A.

I could not tell you a timeline at all.

24

14:33:04 24

Q.

Do you recall whether Dr. Jadwin was ever

25

14:33:06 25 placed -- that he was placed on paid administrative

WatsonR

Or was it not?

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 120 of 245 39

1

14:42:54

1 the economic impact of the paid administrative leave

2

14:42:58

2 on Dr. Jadwin then?

3

14:43:03

3

A.

I don't recall that.

4

14:43:03

4

Q.

Okay.

5

14:43:08

5 recollection, he wasn't present at this closed

6

14:43:11

6 session of the JCC regarding his placement on paid

7

14:43:15

7 administrative leave, correct?

8

14:43:18

8

9

14:43:21

9 Dr. Jadwin.

A.

Q.

And again, Dr. Jadwin, to your

I -- I don't believe I've ever met

10

14:43:22 10

And are you aware of whether or not

11

14:43:24 11 Dr. Jadwin was notified that this JCC closed session

12

14:43:29 12 meeting was going to occur regarding placement of him

13

14:43:32 13 on paid administrative leave?

14

14:43:33 14

15

14:43:35 15 testimony.

16

14:43:35 16

THE WITNESS:

17

14:43:35 17

MR. WASSER:

18

14:43:37 18

MR. LEE:

19

14:43:38 19

MR. WASSER:

20

14:43:39 20 statement that administrative leave was discussed at

21

14:43:42 21 the closed session, Counsel.

22

14:43:43 22

23

14:43:44 23 BY MR. LEE:

24

14:43:46 24

Q.

You want me to repeat --

25

14:43:47 25

A.

I'm not aware of that.

MR. WASSER:

MR. LEE:

That misstates the witness'

I don't know. There's no --

I'll ask -There's no foundation for your

I'm asking.

WatsonR

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 121 of 245 110

1

16:32:24

1

2

16:32:27

2 recall what the reason was for placing Dr. Jadwin on

3

16:32:29

3 paid administrative leave?

4

16:32:33

4 with his leaves, I assume, right?

5

16:32:34

5

6

16:32:37

6 that aspect of -- of it.

7

16:32:43

7 the reason was.

8

16:32:44

8

Q.

Right.

9

16:32:45

9

A.

I assume there's a memo in there somewhere,

A.

Well, then how do you explain -- do you

That had nothing to do

You know, I -- I'm really not familiar with I -- I don't recall what

10

16:32:48 10 but I can't recall what the -- what the reasons for

11

16:32:51 11 that were.

12

16:32:52 12

13

16:32:58 13 do you recall Dr. Jadwin's physical absence being a

14

16:33:02 14 reason for his nonrenewal of his contract?

15

16:33:05 15

16

16:33:06 16 fact that I think by then he was -- probably was

17

16:33:10 17 suing us.

18

16:33:12 18 contractual relationship with somebody who's suing

19

16:33:16 19 you.

20

16:33:17 20

21

16:33:19 21 time of his removal or actually at the time of his --

22

16:33:23 22 no, he wasn't.

23

16:33:26 23

24

16:33:29 24 a contractual relationship with someone who's suing

25

16:33:34 25 you, right?

Q.

A.

Okay.

Q.

What about the nonrenewal?

Well, it could be that.

I mean,

It could be the

So why would you want to establish a

Okay.

Well, he was also suing you at the

He wasn't.

Okay.

But I mean, you say why would you establish

WatsonR

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 122 of 245 111

1

16:33:34

1

A.

Right.

2

16:33:35

2

Q.

Was that -- does that mean -- are you just

3

16:33:35

3 speculating now, just guessing, or was that a

4

16:33:38

4 consideration for his nonrenewal?

5

16:33:39

5

A.

Well, I remember it being discussed.

6

16:33:41

6

Q.

Do you recall who was at that discussion?

7

16:33:45

7

A.

It would have been in one of the joint

8

16:33:47

8 conference -- one or more of the joint conference

9

16:33:50

9 committee meetings along with all the other

10

16:33:52 10 discussions about him.

11

16:33:53 11

12

16:33:56 12 of those meetings?

13

16:33:57 13

14

16:34:00 14 what meetings.

I don't know the answer to that.

15

16:34:02 15

But you recall it being discussed at

16

16:34:05 16 the JCC meetings?

17

16:34:06 17

A.

Yes.

18

16:34:06 18

Q.

Okay.

19

16:34:09 19 were discussed for the nonrenewal besides

20

16:34:14 20 Dr. Jadwin's lawsuit?

21

16:34:15 21

22

16:34:20 22 wasn't available for work.

23

16:34:26 23 available to put in the hours for a full-time

24

16:34:30 24 position.

25

16:34:30 25

Q.

A.

Do you recall if David Culberson was in any

Q.

You know, I couldn't tell you who was in

A.

Okay.

Q.

And do you recall what other reasons

The -- the -- that and the fact that he just He wasn't -- he wasn't

Well, he was working full time from October

WatsonR

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 123 of 245 113

1

16:35:30

1

2

16:35:34

2 administrative leave, quote/unquote, pending

3

16:35:36

3 personnel issues, which he was never told.

4

16:35:40

4 by the time his contract was expiring, he was not

5

16:35:43

5 renewed.

6

16:35:47

6 during the time Dr. Jadwin's been placed on paid

7

16:35:50

7 administrative leave.

8

16:35:52

8 work, it was because he was ordered to stay home.

9

16:35:57

9

A.

And then he was -- he was placed on paid

And then

So getting back to the nonrenewal, this is

So if he was not available to

Yeah, I wouldn't--

10

16:35:57 10

MR. WASSER:

11

16:35:59 11 Mr. Watson.

12

16:36:01 12

13

16:36:03 13 question actually.

14

16:36:03 14 BY MR. LEE:

15

16:36:04 15

16

16:36:05 16 for the nonrenewal one of the reasons was that

17

16:36:08 17 Dr. Jadwin wasn't available for work; is that correct

18

16:36:11 18 or --

19

16:36:12 19

20

16:36:16 20 been on medical leave, family leave, and had

21

16:36:24 21 requested even more leave, and that for that reason

22

16:36:33 22 and the fact that he was suing us, that we decided

23

16:36:40 23 not to renew his contract.

24

16:36:42 24

25

16:36:46 25 joint conference committee meeting, correct?

He's making statements.

MR. LEE:

Q.

A.

Q.

There's no question,

The question is -- no, there is a

So the question is:

You've mentioned that

My understanding was that he had -- he had

Okay.

And when you say "we," this is a

WatsonR

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

Filed 12/01/2008

Page 124 of 245 114

1

16:36:48

1

2

16:36:51

2 session of the board of supervisors.

3

16:36:53

3

Q.

As well as a closed session of the JCC?

4

16:37:00

4

A.

Yes.

5

16:37:06

5

MR. LEE:

6

16:37:13

6

(Plaintiff's counsel conferred.)

7

16:37:44

7 BY MR. LEE:

8

16:37:44

8

9

16:37:48

9 involved in the decision to put Dr. Jadwin on paid

Q.

And it -- it probably came up at a closed

Okay.

Anything else?

So you do recall Mr. Culberson being

10

16:37:50 10 administrative leave?

11

16:37:56 11

12

16:38:00 12 remember the timeline.

13

16:38:01 13

Q.

Okay.

14

16:38:06 14

A.

But if he were involved in that, he

15

16:38:09 15 apparently was experiencing the same problems that

16

16:38:12 16 Peter Bryan was, and so, you know, I don't know any

17

16:38:18 17 more than that.

18

16:38:18 18

19

16:38:21 19 meeting whether there was any discussion of the

20

16:38:24 20 medical staff bylaws and the fact that under those

21

16:38:28 21 bylaws a department chair, specifically Dr. Jadwin,

22

16:38:32 22 could be removed with or without cause upon

23

16:38:34 23 recommendation of the CEO and a majority vote of the

24

16:38:39 24 JCC?

25

16:38:41 25

A.

Q.

He was the interim CEO from --

I know who he was.

Okay.

I -- again, I don't

And do you recall at the removal

Do you recall any discussion like that? A.

Yes.

WatsonR

Case 1:07-cv-00026-OWW-TAG

Document 277-2

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

Page 125123 of 245

ss. 3 4

I,

5

Sandra L.

Edmonson, a Certified Shorthand

6

Reporter in the State of California, holding Certificate

7

No.

8

the witness named in the foregoing deposition, was by me

9

duly sworn; that said deposition was taken Monday,

7704, do hereby certify that RAYMOND ALBERT WATSON,

10

August 25,

11

first page hereof.

12

2008, at the time and place set forth on the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I further certify that I am neither counsel for

18

nor in any way related to any party to said action,

19

in any way interested in the result or outcome thereof.

20 21

Dated this 8th day of September,

2008,

at

Bakersfield, California.

22 23 Sandra L. Edmonson, CSR No. 24 25

WOOD & RANDALL (800) 322-4595

7704

nor

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 126 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 11

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

16

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

DAVID KIRKER CULBERSON

17

Thursday, August 21, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

CulbersonD

Page 127 of 245 1

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 128 of 245 10

1

09:18:05

1

2

09:18:06

2 Camden Group or since when?

3

09:18:08

3

4

09:18:11

4 November of 2007.

5

09:18:12

5

6

09:18:24

6 when you were assigned to Kern Medical Center?

7

09:18:27

7

A.

That's correct.

8

09:18:27

8

Q.

I see.

9

09:18:30

9

A.

Q.

How long have you been employed by the

I've been employed with the Camden since

You weren't employed with the Camden Group

Okay.

Well, you worked at Kern Medical

10

09:18:33 10 Center at some point in, I believe, 2006; is that

11

09:18:36 11 correct?

12

09:18:36 12

A.

Yes, it is correct.

13

09:18:37 13

Q.

Okay.

14

09:18:39 14 Kern Medical Center?

15

09:18:41 15

16

09:18:47 16 15th, 2007.

17

09:18:48 17

18

09:18:56 18 Medical Center starting January of '07?

19

09:18:59 19

A.

Not to my knowledge.

20

09:19:00 20

Q.

So to your knowledge, Paul Hensler came in

21

09:19:03 21 as the CEO around May of 2007?

22

09:19:05 22

A.

Yes, that's correct.

23

09:19:12 23

Q.

How is it that you came -- you were -- what

24

09:19:25 24 was your position at Kern Medical Center?

25

09:19:28 25 interim CEO?

A.

Q.

What were your dates of employment at

Approximately August 25th, 2006, through May

I'm sorry.

Was Paul Hensler not at Kern

CulbersonD

Was it

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 129 of 245 11

1

09:19:30

1

A.

Yes, it was, interim CEO, that's correct.

2

09:19:33

2

Q.

How was it that you became the interim CEO

3

09:19:36

3 of Kern Medical Center?

4

09:19:38

4

5

09:19:42

5 independent contractor with the Camden Group, and a

6

09:19:44

6 contract was let between the County of Kern on behalf

7

09:19:47

7 of Kern Medical Center and the Camden Group for

8

09:19:52

8 interim chief executive officer leadership as well as

9

09:19:57

9 strategic planning activities.

A.

Q.

Through the Camden Group I was a consultant,

10

09:19:59 10

11

09:20:05 11 contract then with Camden Group separately?

12

09:20:07 12

A.

Yes, that's correct.

13

09:20:08 13

Q.

Okay.

14

09:20:11 14 weren't being paid directly through -- by the County

15

09:20:14 15 of Kern, you were being paid through the Camden

16

09:20:16 16 Group; is that correct?

17

09:20:17 17

A.

Yes, that's correct.

18

09:20:17 18

Q.

Okay.

19

09:20:24 19 with Camden Group, was it exclusively and solely for

20

09:20:28 20 the purpose of your assignment to Kern Medical Center

21

09:20:31 21 or was it a broader agreement to your knowledge or

22

09:20:33 22 understanding?

23

09:20:35 23

24

09:20:37 24 there.

25

09:20:38 25 at Kern Medical Center, yes.

A.

Okay.

So in -- and I assume you had a

So when you were being paid, you

And this contract you entered into

I can't recall the full scope of the details The principal assignment would have been here

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 130 of 245 42

1

09:54:11

1

Q.

'-6 you mean, right?

2

09:54:12

2

A.

2006, thank you.

3

09:54:14

3 handwritten note sometime thereafter and then

4

09:54:17

4 shredded it or destroyed it shortly when I felt it

5

09:54:20

5 was appropriate to -- I no longer needed that piece

6

09:54:23

6 of paper for my notes or for whatever purpose I was

7

09:54:26

7 working on.

8

09:54:26

8

9

09:54:29

9 you shredded these notes regarding your investigation

Q.

Okay.

And I would have made some

I'm asking you to estimate the dates

10

09:54:31 10 of Dr. Mansour's behavior as complained about to

11

09:54:35 11 Dr. Perez.

12

09:54:37 12

A.

September 2006 through May 2007.

13

09:54:39 13

Q.

Were you aware that plaintiff had requested

14

09:54:45 14 that evidence in this case, including with respect to

15

09:54:49 15 other comparatories, not be destroyed, that not --

16

09:54:52 16 they not be dis-spoliated, were you ever advised of

17

09:54:55 17 that?

18

09:54:57 18

A.

No, I was not.

19

19

Q.

Okay.

20

09:54:58 20

A.

I'm sorry.

21

09:55:00 21 Dr. Jadwin matter versus --

22

09:55:01 22

Q.

Yes.

23

09:55:01 23

A.

Yes, I was not aware of that.

24

09:55:05 24

Q.

Okay.

25

09:55:06 25 destroy any evidence in connection with Dr. Jadwin's

Please estimate those dates.

Did there -In this case rel- -- the

No one ever instructed you not to

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 131 of 245 43

1

09:55:10

1 lawsuit?

2

09:55:14

2

A.

That's correct.

3

09:55:14

3

Q.

Okay.

4

09:55:20

4

A.

Yes, I am.

5

09:55:20

5

Q.

Had you been so instructed, you would not

6

09:55:23

6 have destroyed any notes -- well, did you -- were

7

09:55:25

7 there any notes regarding Dr. Jadwin's case that

8

09:55:28

8 you're aware of?

9

09:55:29

9

A.

You're sure about that, right?

That I took, yes, I'm sure I would have

10

09:55:31 10 taken some handwritten notes during discussions, yes.

11

09:55:34 11

Q.

Okay.

12

09:55:37 12

A.

Yes, that's correct.

13

09:55:37 13

Q.

And you don't have those notes anymore,

14

09:55:40 14 right?

15

09:55:40 15

A.

That's correct.

16

09:55:41 16

Q.

They've been destroyed, right?

17

09:55:43 17

A.

Yes.

18

09:55:43 18

Q.

Okay.

19

09:55:47 19 you recall when they were destroyed and how,

20

09:55:50 20 estimating?

21

09:55:50 21

22

09:55:53 22 sometime after September 2007, probably prior to

23

09:56:00 23 January of -- I'm sorry, September 2006 --

24

09:56:02 24

Q.

Six?

25

09:56:03 25

A.

-- prior to January of 2007.

A.

Regarding Dr. Jadwin, correct?

These notes regarding Dr. Jadwin, can

My notes with Dr. Jadwin would have been

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Okay.

Filed 12/01/2008

Page 132 of 245 44

1

09:56:05

1

Let's just -- let's talk about these

2

09:56:11

2 handwritten notes on Dr. Jadwin.

3

09:56:13

3 these notes?

4

09:56:16

4

A.

Yes, they were.

5

09:56:17

5

Q.

Okay.

6

09:56:20

6

A.

There were a number of staff core physicians

7

09:56:27

7 and staff that would have expressed concerns about

8

09:56:31

8 activities within the department, including

9

09:56:34

9 Dr. Jadwin.

When did you take

Were they -- were they at meetings?

Describe the meetings, please.

10

09:56:35 10

Q.

You mean the pathology department?

11

09:56:37 11

A.

That's correct.

12

09:56:40 12 have brought the leadership team in to talk about it,

13

09:56:46 13 and I would have taken notes just for my process.

14

09:56:51 14 would have taken notes just so I could follow the

15

09:56:53 15 discussion.

16

09:56:53 16

Q.

Okay.

17

09:56:56 17

A.

I did.

18

09:56:56 18

Q.

Okay.

19

09:56:57 19

A.

Yeah, thank you.

20

09:56:58 20

Q.

I'm not trying to give you a hard time, but

21

09:57:00 21 I need to --

22

09:57:01 22

A.

No, I understand.

23

09:57:01 23

Q.

Yeah.

24

09:57:03 24 was your custom to take notes at every such meeting?

25

09:57:07 25

A.

And at that time I would

I

Would have or did?

Okay.

So when you took these notes,

Yes.

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Page 133 of 245 45

1

09:57:08

1

2

09:57:11

2 regarding Dr. Jadwin and the pathology department to

3

09:57:16

3 your estimation?

4

09:57:21

4

A.

No more than ten.

5

09:57:23

5

Q.

So it stands to reason there should have

6

09:57:27

6 been around ten sets -- well, ten discreet items of

7

09:57:31

7 handwritten notes regarding each of these meetings,

8

09:57:34

8 correct, that you took?

9

09:57:35

9

A.

Yes.

10

09:57:35 10

Q.

Okay.

11

09:57:40 11 these notes were ever produced to anybody, given to

12

09:57:42 12 anybody by you?

13

09:57:44 13

A.

They were not given to anybody.

14

09:57:45 14

Q.

Okay.

15

09:57:48 15 these notes?

16

09:57:51 16 office?

17

09:57:53 17 briefcase?

18

09:57:56 18 in your office or anywhere?

19

09:57:58 19

20

09:58:01 20 them up or crumple them up and throw them in the

21

09:58:05 21 trash can at the end of the meeting.

22

09:58:06 22

Q.

Why would you do that?

23

09:58:08 23

A.

Because I didn't need to refer to the notes

24

09:58:10 24 at all.

25

09:58:10 25

A.

Q.

Okay.

Filed 12/01/2008

How many meetings did you attend

And do you recall whether any of

So -- I mean, where did you keep Did you keep them in a binder in your

Did you carry them around with you in your Where did you typically leave these notes

Frequently I --- I did shred -- I did rip

Uh-huh.

CulbersonD

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

Filed 12/01/2008

Page 134 of 245 46

1

09:58:11

1

I -- I used my notes to refresh my memories

2

09:58:17

2 during discussion.

3

09:58:18

3

Q.

Uh-huh.

4

09:58:18

4

A.

Found as an interim CEO it's very important

5

09:58:22

5 to get the characters and the activities down as

6

09:58:25

6 quickly as possible, and so I would take notes to

7

09:58:29

7 follow the actors and the actions during the

8

09:58:32

8 discussions we're having.

9

09:58:35

9 the processes, who the players are, what the issues

Once I think I understand

10

09:58:38 10 are, I find that I no longer need the notes, and I'd

11

09:58:42 11 crumple it up and throw it away at that time.

12

09:58:44 12

13

09:58:46 13 destroy and shred all of your notes immediately at

14

09:58:49 14 the end of each meeting in which you were taking

15

09:58:50 15 those notes?

16

09:58:51 16

A.

No, that's not correct.

17

09:58:53 17

Q.

That's correct?

18

09:58:53 18

A.

That's correct.

19

19

Q.

Okay.

20

09:58:56 20

A.

That's -- I'm sorry, that's not correct.

21

09:58:57 21

Q.

Okay.

22

09:58:59 22 sometimes did it then, right?

23

09:59:01 23

A.

Yes.

24

09:59:01 24

Q.

Okay.

25

09:59:03 25 the number of times you would shred these notes

Q.

Oh, so you -- actually your practice was to

Well, then, you said that you

So can you estimate percentage-wise

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

09:59:06

1 immediately after the meeting?

2

09:59:06

2

A.

Specific to Dr. Jadwin --

3

Q.

Yes.

3

Page 135 of 245 47

4

09:59:08

4

A.

-- or the lab department?

5

09:59:09

5

Q.

We're talking specific to Dr. Jadwin.

6

09:59:12

6

A.

No, I cannot estimate that.

7

09:59:13

7

Q.

Okay.

8

09:59:16

8 half or less than half?

9

09:59:17

9

A.

No, I could not.

10

09:59:18 10

Q.

Okay.

11

09:59:22 11 that survived the shredding at the end of a meeting

12

09:59:25 12 regarding Dr. Jadwin.

13

09:59:26 13

14

09:59:30 14 Counsel.

15

09:59:32 15

16

09:59:35 16 disposed of.

17

09:59:35 17 BY MR. LEE:

18

09:59:36 18

19

09:59:39 19 crumpled up and disposed of after the meetings.

20

09:59:41 20

21

09:59:42 21

22

09:59:44 22 pathology, Dr. Jadwin," I believe, and I would have

23

09:59:47 23 put them there.

24

09:59:48 24

25

09:59:50 25 the lab --

You can't even say if it's more than

Okay.

MR. WASSER:

He says he crumpled them up,

He didn't talk about shredding. MR. LEE:

Q.

Let's talk about the notes

I'm sorry, crumpled it up and

Let's talk about the notes that weren't

What did you do with those notes? A.

Q.

In this case I had a file for "lab

I'm sorry.

What was the name of the file,

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 136 of 245 61

1

10:15:53

1

When you spoke to Dr. Harris, what was that

2

10:15:55

2 discussion about?

3

10:15:58

3

4

10:16:01

4 medical staff and Dr. Harris' perception of what

5

10:16:07

5 occurred that would have resulted in Dr. Jadwin's

6

10:16:10

6 removal as department division chair of pathology.

7

10:16:13

7

8

10:16:15

8 the removal of Dr. Jadwin from chair of pathology

9

10:16:20

9 then informally?

A.

Q.

What did you discuss with him?

I asked for some background relative to the

Okay.

So you were investigating what led to

10

10:16:21 10

A.

Yes.

11

10:16:21 11

Q.

Okay.

12

10:16:24 12 Dr. Harris?

13

10:16:24 13

A.

No.

14

10:16:25 14

Q.

Did you take notes?

15

10:16:26 15

A.

Yes.

16

10:16:26 16

Q.

Did you -- did you crumple those notes or

17

10:16:28 17 dispose of them after a meeting with Dr. Harris?

18

10:16:30 18

A.

Yes.

19

10:16:31 19

Q.

Okay.

20

10:16:33 20

A.

I understood the nature of what I -- I

21

10:16:35 21 understood the nature of what had occurred.

22

10:16:38 22 Dr. Jadwin, new to me, write it down so I remember.

23

10:16:42 23 Matters -- I don't recall specifically what they

24

10:16:44 24 were, asked the date of the contract, date of the

25

10:16:47 25 issues, matter's over, crumple it up, throw it away,

Did you take a written statement from

Why did you do that?

CulbersonD

Case 1:07-cv-00026-OWW-TAG

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Page 137 of 245 62

1

10:16:50

1 no need to retain that.

2

10:16:52

2

3

10:16:54

3 be helpful at all to have a written documentation of

4

10:16:57

4 what you and Dr. Harris discussed?

5

10:17:00

5

A.

That's correct.

6

10:17:00

6

Q.

You didn't consider it evidence in this

7

10:17:01

7 case, right?

8

10:17:02

8

A.

That's correct.

9

10:17:02

9

Q.

Okay.

Q.

Okay.

You didn't think it would -- it would

Were you advised by anybody that that

10

10:17:05 10 was evidence in this case?

11

10:17:11 11

12

10:17:14 12 initially -- I was identified that I -- my meeting

13

10:17:19 13 with Dr. Harris?

14

10:17:20 14

15

10:17:22 15 Dr. Harris.

16

10:17:23 16

17

10:17:25 17 that that was evidence in this case.

18

10:17:27 18

19

10:17:30 19 Dr. Harris tell you?

20

10:17:32 20 perception?

21

10:17:33 21

22

10:17:35 22 removed from the department chairperson for a number

23

10:17:39 23 of issues relative to clinical, as well as behavioral

24

10:17:43 24 management activities, occurring at the hospital

25

10:17:47 25 sometime prior to me coming into Kern Medical Center.

A.

Q.

A.

Q.

A.

What was?

The piece of paper when I

The notes you took during your meeting with

No, I would not have.

That's fine.

Okay.

No one notified me

Let's -- so what did

What was his story, his

Dr. Harris told me that Dr. Jadwin had been

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 138 of 245 63

1

10:17:50

1

2

10:17:57

2 activities or conduct were?

3

10:18:06

3

A.

At that meeting, no, I cannot recall.

4

10:18:07

4

Q.

You can't recall one way or another?

5

10:18:09

5

A.

At that very initial meeting, I cannot

6

10:18:11

6 recall what the allegations were at that point.

7

10:18:14

7

8

10:18:17

8 today, correct?

9

10:18:18

9

Q.

A.

He -- he didn't specify when any of these

You mean you can't recall sitting here

I cannot recall sitting here -- sitting here

10

10:18:21 10 today, I cannot recall what the specifics would have

11

10:18:23 11 been briefed of me at that very first meeting, that's

12

10:18:27 12 correct.

13

10:18:27 13

14

10:18:29 14 the notes which you disposed of after the meeting?

15

10:18:33 15

A.

They might have, yes.

16

10:18:34 16

Q.

Yes, that's correct?

17

10:18:37 17

A.

They might -- yes.

18

10:18:37 18

Q.

Yes?

19

10:18:38 19

A.

Yes.

20

10:18:38 20

Q.

Okay.

21

10:18:42 21 did you speak about with him, same thing?

22

10:18:46 22

A.

Different matter.

23

10:18:47 23

Q.

Dif- -- okay.

24

10:18:49 24 with Dr. Dutt?

25

10:18:50 25

Q.

A.

Would the specifics have been contained in

Now, let's talk about Dr. Dutt.

What

Well, what did you talk about

Dr. Dutt relayed to me substantial concern

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-2

Filed 12/01/2008

Page 139 of 245 73

1

10:27:36

1

2

10:27:42

2 issue?

3

10:27:43

3

4

10:27:49

4 and also the way the second opinions were being

5

10:27:51

5 requested or not followed up on.

6

10:27:52

6

7

10:27:56

7 commenting on the operation of the pathology

8

10:27:58

8 department?

9

10:28:00

9

A.

Q.

A.

Dr. Jadwin's diagnoses then, was that the

Yes, that's correct.

And also the way --

How would Dr. Ragland have a basis for

He's not a pathologist?

That's correct.

Dr. Ragland is -- at the

10

10:28:04 10 time was chief of staff, and as such he represents

11

10:28:07 11 the entire medical staff and has the duty to go out

12

10:28:12 12 and receive input from everybody in the department --

13

10:28:16 13 everybody in the hospital -- all the physicians in

14

10:28:18 14 the hospital about the quality of medical care that's

15

10:28:20 15 being delivered.

16

10:28:21 16

17

10:28:24 17 was doing with respect to Dr. Jadwin?

18

10:28:27 18

A.

Yes.

19

10:28:27 19

Q.

Do you recall when Dr. Ragland was doing

20

10:28:29 20 this, speaking to various members of the medical

21

10:28:31 21 staff regarding Dr. Jadwin's diagnoses, the way

22

10:28:34 22 second opinions were not being sent out, et cetera?

23

10:28:36 23

24

10:28:41 24 of meeting with physicians.

25

10:28:42 25

Q.

A.

Q.

To your knowledge, was that what Dr. Ragland

No, I don't recall Dr. Ragland's sequencing

Okay.

You just know that they were

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 140 of 245 98

1

11:11:18

1

A.

I believe Mr. O'Connor and myself.

2

11:11:20

2

Q.

No one else?

3

11:11:21

3

A.

I don't recall anybody else, no.

4

11:11:22

4

Q.

Okay.

5

11:11:26

5

A.

The general lab operations relative to the

6

11:11:30

6 pathology staff and several of the lab employees was

7

11:11:36

7 extremely disruptive, chaotic and unstable.

8

11:11:39

8

9

11:11:46

9 specifically attributing this to Dr. Jadwin?

Q.

What did Mr. O'Connor tell you?

Due to Dr. Jadwin, right?

Was he

10

11:11:49 10

A.

No, I don't believe he did, no.

11

11:11:51 11

Q.

So he was just giving you a general report

12

11:11:54 12 on the status of the pathology department?

13

11:11:58 13

14

11:11:59 14 the employees and the pathology department and

15

11:11:59 15 several of the lab employees.

16

11:12:01 16

17

11:12:03 17 one more time?

18

11:12:06 18 department operation?

19

11:12:07 19

20

11:12:09 20 relative to the lab and pathology department.

21

11:12:12 21

Q.

And what were his findings then?

22

11:12:14 22

A.

That there -- the department was extremely

23

11:12:17 23 chaotic, disruptive, potentially resulting in

24

11:12:23 24 resignation of many of the -- or several of the staff

25

11:12:28 25 if the situation were not resolved in the immediate

A.

Q.

A.

Yes, that's correct.

Okay.

I'm sorry, sir.

The status relative to

Can you repeat that

What did he report regarding the path

He reported to the concerns expressed

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 141 of 245 99

1

11:12:33

1 future.

2

11:12:33

2

3

11:12:35

3 crisis, essentially?

4

11:12:37

4

5

11:12:41

5 expressed by non-physician staff, that's correct.

6

11:12:43

6

7

11:12:46

7 have anything to report regarding the physicians,

8

11:12:49

8 just --

9

11:12:49

9

Q.

A.

Q.

A.

So his report was that the department was in

That there was substantial concerns being

Oh, okay.

So the physicians -- he didn't

I don't recall anything specific to the

10

11:12:51 10 physicians.

11

11:12:52 11

12

11:12:56 12 to you, G-a-l-l-e-g-o-s?

13

11:12:59 13

A.

Yes.

14

11:12:59 14

Q.

Okay.

15

11:13:02 15 complaining to Mr. O'Connor?

16

11:13:06 16

17

11:13:08 17 to Mr. O'Connor.

18

11:13:12 18 employee or a pathology department employee.

19

11:13:14 19

Q.

Did you ever meet Vangie?

20

11:13:16 20

A.

I think I did, yes.

21

11:13:17 21

Q.

Okay.

22

11:13:20 22

A.

Generally I try to tour the hospital

23

11:13:23 23 regularly, and I believe I met Vangie.

24

11:13:27 24 those just kind of --

25

11:13:29 25

Q.

A.

Q.

Does the name Vangie Gallegos mean anything

Was she one of the people that was

I don't recall specifically Vangie talking I do recall Vangie as a lab

What was that in the context of?

How do you do?

CulbersonD

That's one of

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Page 142 of 245 102

1

11:15:53

1 the path department issues that Mr. O'Connor was

2

11:15:57

2 raising?

3

11:16:01

3

4

11:16:02

4 took.

5

11:16:05

5 that the lab management may have taken at that time.

6

11:16:08

6

7

11:16:13

7 action, but you just don't recall what it was or

8

11:16:16

8 whether you did?

9

11:16:17

9

A.

That's correct.

10

11:16:17 10

Q.

Okay.

11

11:16:19 11 meeting with Steve O'Connor?

12

11:16:20 12

A.

I don't recall.

13

11:16:21 13

Q.

It was your custom to take notes at your

14

11:16:25 14 meetings with people, right?

15

11:16:26 15

A.

Yes, that's correct.

16

11:16:26 16

Q.

Okay.

17

11:16:30 17 recollection, but do you have any reason to believe

18

11:16:32 18 you did not take notes at this meeting with Steve

19

11:16:34 19 O'Connor?

20

11:16:35 20

21

11:16:36 21 to believe I did not, right.

22

11:16:38 22

23

11:16:39 23

24

11:16:43 24 O'Connor to formalize his findings in writing in a

25

11:16:47 25 report or an E-mail?

A.

I don't recall any specific actions that I I don't recall -- nor do I recall any action

Q.

A.

Q.

Okay.

So in other words, you may have taken

Did you take notes during your

So you don't have a specific

That's correct, I have -- I have no reason

Okay.

That's fine.

Okay.

So -- and you did not ask Steve

CulbersonD

Case 1:07-cv-00026-OWW-TAG

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1

12:09:55

1

A.

I'm aware of that meeting, yes.

2

12:09:56

2

Q.

Okay.

3

12:09:59

3 discussion.

4

12:09:59

4

A.

That's fine, yes.

5

12:10:00

5

Q.

Okay.

6

12:10:03

6 discussion, the time it occurred, did you know

7

12:10:06

7 whether or not the allegations against Dr. Jadwin as

8

12:10:08

8 expressed by numerous people, Dr. Ragland, Harris,

9

12:10:14

9 Dutt, Ms. Barnes, Mr. O'Connor, Ms. Raison,

I'm going to call that buyout

Now, did you know as of the buyout

10

12:10:18 10 Dr. Naderi, Dr. Kercher, numerous people, did you --

11

12:10:23 11 did you know whether these allegations were actually

12

12:10:25 12 proven?

13

12:10:30 13

14

12:10:33 14 investigated upon.

15

12:10:34 15

16

12:10:36 16 there, of Dr. Jadwin prior to the buyout --

17

12:10:39 17 between -- between December 7 of 2006, and the buyout

18

12:10:45 18 discussion, there was an investigation of Dr. Jadwin,

19

12:10:48 19 wasn't there?

20

12:10:49 20

A.

Yes, that's correct.

21

12:10:49 21

Q.

Okay.

22

12:10:52 22 investigation conclude?

23

12:10:53 23

A.

I can't recall the specifics.

24

12:10:54 24

Q.

You don't recall which allegations were

25

12:10:57 25 proven and which weren't?

A.

Q.

Some were, some were not.

Some had not been

So there was an investigation, then, wasn't

And what did the -- what did the

CulbersonD

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

Filed 12/01/2008

Page 144 of 245 158

1

12:11:00

1

2

12:11:03

2 extensive letter, but I don't recall which one, that

3

12:11:06

3 had a number of matters.

4

12:11:09

4 which ones were found which way, quite honestly.

5

12:11:15

5

Q.

You said a letter from Dr. Dutt?

6

12:11:17

6

A.

Yes, that's -- I believe that's where -- the

7

12:11:19

7 letter I'm referring to, yes.

8

12:11:20

8

9

12:11:22

9 committee by any chance?

Q.

A.

I remember there was a lot -- rather

I don't recall specifically

Was this a letter to the peer-review

10

12:11:23 10

11

12:11:26 11 recipient of that letter was.

12

12:11:27 12

13

12:11:34 13 pathologic diagnoses?

14

12:11:36 14

A.

Yes, that's correct.

15

12:11:36 15

Q.

And did this letter also list disruptive

16

12:11:40 16 behavior by Dr. Jadwin?

17

12:11:42 17

18

12:11:43 18 contained in the letter.

19

12:11:44 19

20

12:11:46 20 discussing hostile work environment created by

21

12:11:50 21 Dr. Jadwin?

22

12:11:50 22

A.

I don't recall that, no.

23

12:11:51 23

Q.

Do you recall whether this letter discussed

24

12:11:53 24 retaliation by Dr. Jadwin against several core

25

12:11:57 25 physicians?

Q.

A.

Q.

I can't recall where the -- who the intended

And it listed problems in Dr. Jadwin's

I can't recall specifically what was

Did it recall -- do you recall this letter

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 145 of 245 159

1

12:11:59

1

A.

I can't recall the specifics, no.

2

12:11:59

2

Q.

Okay.

3

12:12:00

3

A.

That specifically.

4

12:12:01

4

Q.

Did -- do you recall whether Dr. Dutt's

5

12:12:09

5 letter included any mention of computer sabotage or

6

12:12:12

6 any other kind of sabotage by Dr. Jadwin?

7

12:12:15

7

8

12:12:18

8 component in the letter, that's correct.

9

12:12:20

9

A.

Q.

I cannot recall the contents of that

Okay.

Who conducted this investigation into

10

12:12:23 10 the allegations of Dr. Jadwin between December 7,

11

12:12:27 11 2006, and the buyout discussion?

12

12:12:29 12

13

12:12:31 13 investigating a large portion of the matters.

14

12:12:33 14

Q.

Who else?

15

12:12:34 15

A.

I -- I would not -- I'd just have to

16

12:12:38 16 speculate beyond that.

17

12:12:39 17

18

12:12:41 18

19

12:12:45 19 Dr. Dutt conduct this investigation into the

20

12:12:48 20 allegations?

21

12:12:50 21

22

12:12:51 22 he contacted two or three experts in the field -- and

23

12:12:57 23 I don't recall where those experts were, whether it

24

12:12:59 24 was USC, UCLA, UCSF, I don't recall the specifics.

25

12:13:04 25 But he did make some outreach to other fairly renown

A.

Q.

I believe Dr. Dutt was involved in

Okay.

Don't do that.

And how did -- to your knowledge, how did

A.

Did he speak to --

Personal investigation, and I also believe

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 146 of 245 160

1

12:13:09

1 pathologists about proper policies, procedures and

2

12:13:13

2 interpretations.

3

12:13:14

3

4

12:13:18

4 yourself?

5

12:13:19

5

A.

No, I did not.

6

12:13:19

6

Q.

Okay.

7

12:13:23

7 Did Dr. Dutt create a summary report or did he just

8

12:13:26

8 orally report?

9

12:13:27

9

Q.

A.

Did you actually see these reports then

So how did you learn of the results?

I don't recall whether it was written or

10

12:13:28 10 oral, but I certainly would have come back and

11

12:13:30 11 reported something about his findings, yes.

12

12:13:33 12

13

12:13:37 13 you meet with Dr. Dutt to hear his findings?

14

12:13:40 14

A.

Yes.

15

12:13:40 15

Q.

Did you take notes at these meetings?

16

12:13:42 16

A.

Not that I recall, no.

17

12:13:43 17

Q.

Why is it that you take notes at certain

18

12:13:45 18 meetings but not at others?

19

12:13:48 19

20

12:13:50 20 that meeting.

21

12:13:53 21 frequently to take notes.

22

12:13:55 22 specifically taking notes at that meeting.

23

12:13:57 23

24

12:13:59 24 not take notes at this meeting with Dr. Dutt where he

25

12:14:03 25 gave you the results of his investigation?

Q.

A.

Q.

Did you take notes at any of these -- did

Why not this meeting?

I don't recall specifically taking notes at It's -- my general behavior is But I do not recall

Do you have any reason to believe you did

CulbersonD

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-2

Filed 12/01/2008

1

12:14:05

1

2

12:14:07

2 notes.

3

12:14:07

3

4

12:14:13

4 these notes, is it in your own handwriting?

5

12:14:16

5

A.

Yes, it is.

6

12:14:16

6

Q.

Okay.

7

12:14:19

7

A.

Very rarely.

8

12:14:20

8

Q.

Okay.

9

12:14:24

9 your notes on?

Q.

Page 147 of 245 161

I have no reason to believe I did not take

Okay.

When you take notes -- when you take

Do you ever type these notes up?

And what kind of paper did you take Was it like college-ruled line paper?

10

12:14:28 10 You want to hold up an example of it like that?

11

12:14:31 11

A.

A yellow --

12

12:14:31 12

Q.

Pad?

13

12:14:32 13

A.

-- pad.

14

12:14:33 14

Q.

Just hold it up for the camera.

15

15

A.

Sure.

16

12:14:36 16

Q.

Show -- I mean, you can just hold it up.

17

12:14:38 17

A.

It says your location on here.

18

18

Q.

Okay.

19

12:14:42 19

A.

Similar to that, yes, correct.

20

12:14:42 20

Q.

So that's the kind of paper you took your

21

12:14:46 21 notes on, correct?

22

12:14:48 22

A.

Yes.

23

12:14:48 23

Q.

Okay.

24

12:14:49 24

25

12:14:50 25 way?

So this --

Thank you.

Is that your handwriting on there, by the

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 148 of 245 162

1

12:14:50

1

A.

No, it's not.

2

12:14:51

2

Q.

It's not?

3

12:14:53

3

4

12:14:56

4 orally the findings of his investigation of

5

12:14:59

5 Dr. Jadwin; is that correct?

6

12:15:00

6

A.

Yes, that's correct.

7

12:15:00

7

Q.

How many times did he meet with you?

8

12:15:02

8

A.

I can't recall that.

9

12:15:02

9

Q.

More than one?

10

12:15:08 10

A.

I'd have to speculate more than one, I'm

11

12:15:10 11 sorry.

12

12:15:10 12

13

12:15:12 13

14

12:15:18 14 Dr. Dutt occurred?

15

12:15:19 15

A.

No, I don't.

16

12:15:19 16

Q.

Okay.

17

12:15:22 17 administrative leave, right?

18

12:15:25 18

A.

I'd have to speculate on that.

19

12:15:27 19

Q.

You don't know which way?

20

12:15:30 20

A.

No, I don't know.

21

12:15:31 21

Q.

Okay.

22

12:15:34 22 the time of the paid administrative leave then?

23

12:15:38 23 don't know?

24

12:15:39 24

A.

It could have been, but I don't know.

25

12:15:41 25

Q.

Okay, then, that's fine.

Okay.

So Dr. Dutt, he met with you to report

Q.

Don't do that. And do you recall when this meeting with

Was it -- it was after the paid Or was it?

So it could have been right around

CulbersonD

And to your

You

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 149 of 245 163

1

12:15:43

1 knowledge Dr. Jadwin did not know that Dr. Dutt was

2

12:15:46

2 conducting an investigation into allegations against

3

12:15:48

3 him?

4

12:15:51

4

A.

I don't know one way or the other, no.

5

12:15:53

5

Q.

Okay.

6

12:15:58

6 out, right?

7

12:16:00

7

A.

Sorry?

8

12:16:00

8

Q.

You didn't -- you didn't think to find out

9

12:16:02

9 whether Dr. Jadwin was aware of the allegations

You didn't check to know -- to find

10

12:16:04 10 against him that were being made?

11

12:16:07 11

A.

I don't recall checking on that, no.

12

12:16:15 12

Q.

Did it concern you that Dr. Dutt might be

13

12:16:19 13 biased against Dr. Jadwin because Dr. Jadwin was the

14

12:16:22 14 previous chair and now Dr. Dutt was the interim

15

12:16:25 15 chair?

16

12:16:26 16

A.

Yes.

17

12:16:26 17

Q.

Okay.

18

12:16:33 18 about potential bias on Dr. Dutt's part?

19

12:16:37 19 do anything about it?

20

12:16:38 20

21

12:16:45 21 department chair and asked for his objective opinion

22

12:16:48 22 to the matter.

A.

So how did you deal with this concern Or did you

Well, I -- I certainly turned to Dr. Dutt as

23

23

Q.

Uh-huh.

24

12:16:48 24

A.

Also weighed credence to the fact that

25

12:16:52 25 outside consultants were being brought in to evaluate

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 150 of 245 164

1

12:16:55

1 practices and -- up to and including results of tests

2

12:16:59

2 as well.

3

12:16:59

3

4

12:17:01

4 consulting reports, right?

5

12:17:03

5

A.

Not to my knowledge, no.

6

12:17:04

6

Q.

They were relayed to you through Dr. Dutt,

7

12:17:06

7 correct?

8

12:17:07

8

A.

Yes.

9

12:17:07

9

Q.

You're not a pathologist?

10

12:17:09 10

A.

That's correct.

11

12:17:10 11

Q.

You have no pathologic training?

12

12:17:12 12

A.

That's correct.

13

12:17:12 13

Q.

So when you looked at -- if you -- let's say

14

12:17:15 14 you even had a chance to look at these outside expert

15

12:17:18 15 reports, you would not have been able to discern

16

12:17:21 16 their meaning or significance, would you have?

17

12:17:24 17

A.

That's correct, I would not.

18

12:17:24 18

Q.

Because they're pathologic reports, right?

19

12:17:28 19

A.

Correct.

20

12:17:28 20

Q.

So in other words, you had to depend on

21

12:17:30 21 Dr. Dutt for his interpretation or summary of the

22

12:17:34 22 outside consulting reports, correct?

23

12:17:38 23

24

12:17:41 24 might be knowledgeable of the subject matter.

25

12:17:42 25

Q.

A.

Q.

Okay.

And you never saw these outside

Yes, and perhaps any other physician that

Who else would be knowledgeable about

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 151 of 245 165

1

12:17:44

1 pathology reports?

2

12:17:46

2

A.

Generally surgeons.

3

12:17:47

3

Q.

So who else did you speak to then?

4

12:17:51

4

A.

I don't recall speaking to anybody about the

5

12:17:53

5 results of -- of any outside investigation.

6

12:17:55

6

Q.

You spoke only to Dr. Dutt then, right?

7

12:17:58

7

A.

To my recollection, only Dr. Dutt, that's

8

12:18:01

8 correct.

9

12:18:01

9

Q.

Now, at the time of this meeting with

10

12:18:03 10 Dr. Dutt, we don't recall the date, but can we at

11

12:18:10 11 least establish that Dr. -- that this meeting with

12

12:18:12 12 Dr. Dutt occurred sometime in 2006, or can you even

13

12:18:16 13 say that?

14

12:18:17 14

A.

No, I can't even say that, no.

15

12:18:18 15

Q.

Okay.

16

12:18:21 16 tenure as interim CEO, right?

17

12:18:24 17

A.

Yes.

18

12:18:24 18

Q.

Okay.

19

12:18:27 19 May of 2007, correct?

20

12:18:28 20

A.

Yes.

21

12:18:28 21

Q.

So we don't know exactly when that was,

22

22 right?

Anyway, it was somewhere during your

Which was between August of '06 to

It wasn't towards the beginning, middle, or

23

12:18:31 23 end of your tenure?

24

12:18:31 24

A.

Right, I can't -- I can't state that, right.

25

12:18:33 25

Q.

That's fine.

At the time of this meeting

CulbersonD

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 152 of 245 166

1

12:18:35

1 with Dr. Dutt where he was reporting the findings of

2

12:18:37

2 his investigation into the allegations about

3

12:18:43

3 Dr. Jadwin, did Dr. Jadwin -- do you know that

4

12:18:46

4 Dr. Dutt had reports of outside experts regarding

5

12:18:50

5 Dr. Jadwin's diagnoses?

6

12:18:55

6

7

12:18:59

7 outside opinions.

8

12:19:02

8 the specific findings were brought back, quite

9

12:19:05

9 honestly.

A.

You knew that for a fact?

Q.

I know that there were attempts made to add

10

12:19:06 10

11

12:19:09 11 did Dr. Dutt report to you about the findings of the

12

12:19:11 12 outside consultants as to Dr. Jadwin's competence, if

13

12:19:16 13 anything?

14

12:19:21 14

15

12:19:26 15 clear the outside consultant did not believe that the

16

12:19:31 16 way matters were handled was proper.

17

12:19:34 17

18

12:19:38 18 diagnoses or are we talking about policy,

19

12:19:41 19 administration, protocol within pathology?

20

12:19:45 20

A.

Actually, I believe there was both.

21

12:19:47 21

Q.

Both?

22

12:19:48 22

A.

Yes.

23

12:19:51 23 can't recall specifically what they were on, so --

24

12:19:54 24

25

12:19:57 25 Dr. Dutt hired a consultant to the pathology

A.

Q.

Q.

Okay.

I don't recall if anything else --

Do you recall whether Dr. -- so what

Did he tell you what the results were? Yes.

Okay.

There were several matters that it was

Are we talking about pathologic

But, again, I'm going to have to say I

You mean -- so you're not sure whether

CulbersonD

Case 1:07-cv-00026-OWW-TAG 1

Document 277-2

Filed 12/01/2008

177 Page 153 of 245

STATE OF CALIFORNIA ss.

2

COUNTY OF KERN

3 4

I, Sandra L. Edmonson, a Certified Shorthand

5

6

Reporter in the State of California, holding Certificate

7

No.

8

the witness named in the foregoing deposition, was by me

9

duly sworn; that said deposition was taken Thursday,

7704, do hereby certify that DAVID KIRKER CULBERSON,

August 21,

2008,

at the time and place set forth on the

first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotype and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action,

nor

in any way interested in the result or outcome thereof. Dated this 4th day of September,

2008,

at

Bakersfield, California.

Sandra L.

Edmonson,

WOOD & RANDALL (800) 322-4595

CSR No.

7704

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 154 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 12

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

17

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

1

UNITED STATES DISTRICT COURT

2

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

3

---------

4

4

DAVID F. JADWIN, D.O.,

Page 155 of 245 1

) Case No. 1:07-cv-00026-OWW-TAG )

5

5

Plaintiff,

) )

6

6

vs.

) )

7

7

COUNTY OF KERN; et al.

) )

8

8

Defendants.

)

_________________________) 9

9

10

10

11

11

12

12

13

13

OF

14

14

COUNTY OF KERN

15

15

16

16

PHILIP LEE DUTT. M.D.

17

17

Friday, August 29, 2008

18

18

Bakersfield, California

19

19

20

20

21

21

VIDEOTAPED DEPOSITION

THROUGH PERSON MOST KNOWLEDGEABLE,

Reported by:

Cindee L. LeFevre, CSR No. 7974

22 23

22

24 25

23

26 27

24

28 29

25

PMK DuttP1

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5

09:28:38 09:28:41 09:28:42 09:28:47 09:28:48 County's

1 2 3 4 5

Q. A. Q. A. Q.

Document 277-2

Filed 12/01/2008

Page 156 of 245 10

Did you speak with Dr. Harris? I have not. Okay. Did you review any documents? No. Okay. Dr. Dutt, please tell us about the

6 7 8

09:28:56 6 notice to 09:29:01 7 regulatory

response to Gilbert Martinez -- Gilbert Martinez's

09:29:06

audit.

David Hill in November of 2006 regarding upcoming

9 8

10 11 12 13

09:29:09 9 that 09:29:15 10 09:29:19 11 conversation

A.

I'm not sure I am -- I'm not sure I was aware

Gilbert had given notice to David Hill. What I know is that I know I had the

14 15 16

09:29:26 12 to 09:29:40 13 the

with Irwin Harris in which Dr. Jadwin had made a comment

09:29:48 14

hospital to JCAHO, CNPS.

Gilbert Martinez, at least, that he was going to report

17 Not necessarily in that order.

18 19 20 21

09:30:00 15 with 09:30:02 16 09:30:06 17 that

Q.

Do you recall when you had this conversation

Dr. Harris? An estimate, please. A. It was either the Friday before Thanksgiving

22 23 24 25

09:30:09 18 before 09:30:15 19 09:30:18 20 Jadwin

year or the Monday after that weekend.

So the Monday

09:30:25 09:30:28 09:30:35 that 09:30:39 about 09:30:43

21 22 23

supposedly made this comment to Mr. Martinez? A. I don't know when he made that comment to Mr. Martinez. Let me supplement what I said earlier;

24

he may have also spoken to Dr. Harris.

25

that.

Thanksgiving. One of those two days, I believe. Q. And do you know or -- do you know when Dr.

26 27 28 29

PMK DuttP1

I am not sure

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 157 of 245 13

09:33:39 Harris.

1

A.

By that time, I had already talked to Dr.

09:33:42 Dr. 09:33:50 09:33:55 had

2

Q.

I see.

3 4

Harris decide to do, if anything? A. I suggested that I could look for someone who

09:34:03

5

experience with CAP inspections to see if they would be

09:34:10

6

willing to give us a mock unannounced inspection.

09:34:15

7

Q.

Was that Stacy Garry?

09:34:18

8

A.

She agreed to do that.

09:34:20

9

Q.

G-a-r-r-y.

2 3 4 5

Okay.

And did you -- what did you and

6 7 8 9 10 11 12 13 14

09:34:23 10 Miss or 09:34:28 11 09:34:34 12 conversation

Okay.

And do you recall when you spoke to

was it Dr. Gary? A. Well, the -- I do, but when -- the

15 09:34:38 13

where she agreed to do that was on Christmas day.

16 17 18 19

09:34:48 14 CAP 09:34:52 15 09:34:55 16 she

Q.

And she agreed to do the mock, unannounced,

inspection? A. She did not want to use the word "CAP" because

20 09:34:59 17

was not acting as representative of CAP, but I wanted

09:35:03 18 inspection. 09:35:11 19 09:35:15 20 09:35:18 21 09:35:27 22 this?

someone who had experience to give us a tough

21 22 23 24 25 26

Q. Of the Pathology Department? A. And portions of the laboratory. Q. Okay. Okay. And Dr. -- I assume -- I am not going to assume anything. Did Dr. Harris then approve

27 09:35:32 23

A.

At what time?

09:35:35 24 09:35:38 25 whenever

Q. A.

At any time. Well, on the -- on either the Friday --

28 29

PMK DuttP1

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 158 of 245 14

09:35:44 before

1

we had that first conversation, on either the Friday

09:35:47 thought 09:35:51 someone

2

Thanksgiving or the Monday before Thanksgiving, he

3

it was a good idea and gave approval if I could find

09:35:59

4

to agree to do that.

09:36:03 idea? 09:36:09 09:36:12 09:36:23 to

5

Q.

So Dr. Harris agreed with you it was a good

6 7 8

A. Q.

Yes. How much cost was -- never mind. Okay. And besides the retention of Dr. Garry

09:36:29 any, 09:36:34 09:36:41 09:36:42 09:36:43 09:36:46 09:36:51 09:36:54 to

9

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

10 11 12 13 14 15 16

do a mock, unannounced inspection, what other steps, if did you or Dr. Harris decide to do? A. I believe that was it. Q. That was it? A. That was the response that I am aware of. Q. Was there any discussion -- strike that. When you heard -- when you understood that Dr. Jadwin was intending to report KMC to the authorities,

20 09:36:59 17

your understanding, did that include the tissue bank

09:37:03 18

licensing, slash, skull flap issue?

21 22 09:37:07 19

A.

That came up later.

09:37:09 20

Q.

Okay.

09:37:13 believe, 09:37:18 09:37:21 09:37:22 09:37:28 was

A.

It was one of the items in a letter, I

23 How did the skull flap issue come up?

24 25 26 27 28 29

21 22 23 24 25

addressed Q. A. Q.

to David Culbertson. By Dr. Jadwin? Correct. And this was a letter dated after Dr. Jadwin

PMK DuttP1

Case 1:07-cv-00026-OWW-TAG DUTT, M. D. P LEE

Document 277-2

Filed 12/01/2008

Page 159 of 245 08-29-08 Page 95

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

SSe

3

4

I, Cindee L. LeFevre, a Certified Shorthand

5

Reporter in the State of California, holding certification

6

No. 7974, do hereby certify that PHILIP LEE DUTT, M.D.,

7

the witness named in the foregoing deposition,

8

was by me duly sworn; that said deposition was taken

9

Friday, August 29, 2008, at the time and place set forth

10 11

on the first page hereof. That upon the taking of the deposition,

the

12

words of the witness were written down by me in stenotypy

13

and thereafter transcribed by computer under my supervision;

14

that the foregoing is a true and correct transcript of the

15

testimony given by the witness.

16

I further certify that I am neither counsel for

17

nor in any way related to any party to said action, nor in

18

any way interested in the result or outcome thereof.

19

Dated this 15th day of September, 2008, at

20

Bakersfield, California.

21 22

,

23

~~~

24

Cindee L. LeFevre, CSR No. 7974

25

vs. RANDALL

(800)

COUNTY 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 160 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 13

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

18

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) _____________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

SANDRA MARIE CHESTER

17

Thursday, August 28, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Erika Addis, CSR No. 11621

ChesterS

Page 161 of 245 1

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 162 of 245 115

1

16:01:05

1

A.

Yes.

2

16:01:05

2

Q.

All right.

3

16:01:09

3 medical leave and processed at KMC?

4

16:01:11

4

A.

Correct.

5

16:01:12

5

Q.

I see.

6

16:01:15

6

7

16:01:17

7 leave, you're saying that they have to fill out this

8

16:01:21

8 particular form that is reflected in Exhibit 819?

9

16:01:26

9

A.

Yes.

10

16:01:26 10

Q.

All right.

11

16:01:31 11 the form of a letter requesting medical leave be

12

16:01:34 12 insufficient under KMC's policies and procedures?

13

16:01:39 13

14

16:01:48 14 acceptable.

15

16:01:48 15

Q.

Okay.

16

16:01:48 16

A.

At least it would have started the process.

17

16:01:48 17 Maybe we would have been formally notified that he

18

16:01:48 18 was needing a leave.

19

16:01:48 19

20

16:01:48 20

21

16:01:50 21 would a verbal request for leave be sufficient to put

22

16:01:54 22 KMC on notice that Dr. Jadwin required leave?

23

16:01:57 23

A.

No.

24

16:01:58 24

Q.

All right.

25

16:02:01 25 verbal request for medical leave be deemed

Before it could be designated as

Right.

And when you say a written request for

A.

Q.

So would a request in writing in

I personally would have deemed it as

Right. And under KMC's policies and procedures,

Under no circumstances would a

ChesterS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 163 of 245 120

1

16:08:31

1 if I understand your testimony correctly, the fact

2

16:08:35

2 that he did provide this notice to Mr. Bryan in the

3

16:08:40

3 normal course of matters you would have expected

4

16:08:43

4 Mr. Bryan to contact you --

5

16:08:43

5

A.

Yes.

6

16:08:44

6

Q.

-- and let you know that Dr. Jadwin had made

7

16:08:47

7 a good-faith effort to try and get an extension of

8

16:08:50

8 his leave the day after it expired.

9

16:08:52

9

A.

Absolutely.

10

16:08:54 10

Q.

You know, so this e-mail, under your normal

11

16:09:05 11 program in your tenure at KMC, would constitute

12

16:09:09 12 reasonable notice of the need for an extension of his

13

16:09:12 13 medical leave that should have generated an employee

14

16:09:15 14 information packet being sent to him at that time.

15

16:09:17 15 Is that correct?

16

16:09:17 16

A.

Absolutely.

17

16:09:18 17

Q.

Did Mr. Bryan ever inform you during your

18

16:09:22 18 conversations with him that he had received this

19

16:09:24 19 e-mail from Dr. Jadwin?

20

16:09:26 20

A.

No.

21

16:09:27 21

Q.

Did Mr. Bryan represent to you he had not

22

16:09:34 22 heard -- did Mr. Bryan represent to you that

23

16:09:39 23 Dr. Jadwin had failed to notify him of his need for

24

16:09:44 24 another -- for an extension of his medical leave at

25

16:09:48 25 the time that you wrote Exhibit 297?

ChesterS

Correct?

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 164 of 245 167

1

1

STATE OF CALIFORNIA ) ) ss. COUNTY OF KERN )

2

2

3

3

4

4

5

5

6

6

in the State of California, holding Certificate

7

7

No. 11621, do hereby certify that SANDRA MARIE CHESTER,

8

8

the witness named in the foregoing deposition, was by me

9

9

duly sworn; that said deposition was taken Thursday,

10

10

August 28, 2008, at the time and place set forth on the

11

11

first page hereof.

12

12

13

13

words of the witness were written down by me in

14

14

stenotypy and thereafter transcribed by computer under

15

15

my supervision; that the foregoing is a true and correct

16

16

transcript of the testimony given by the witness.

17

17

18

18

nor in any way related to any party to said action, nor

19

19

in any way interested in the result or outcome thereof.

20

20

21

21

22

22

23

23

I, Erika Addis, a Certified Shorthand Reporter

That upon the taking of the deposition, the

I further certify that I am neither counsel for

Dated this 10th day of September, 2008, at Bakersfield, California.

_____ Erika Addis, CSR No. 11621

24 25

24 25 WOOD & RANDALL (800) 322-4595

ChesterS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 165 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 14

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

19

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

1

UNITED STATES DISTRICT COURT

2

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

3

---------

4

4

DAVID F. JADWIN, D.O.,

Page 166 of 245 1

) Case No. 1:07-cv-00026-OWW-TAG )

5

5

Plaintiff,

) )

6

6

vs.

) )

7

7

COUNTY OF KERN; et al.

) )

8

8

Defendants.

)

_________________________) 9

9

10

10

11

11

12

12

13

13

14

14

OF

15

15

COUNTY OF KERN

16

16

THROUGH PERSON MOST KNOWLEDGEABLE,

17

17

EUGENE KERCHER, M.D.

18

18

Thursday, September 4, 2008

19

19

Pasadena, California

20

20

21

21

VIDEOTAPED DEPOSITION

22 23

22

Reported by:

Cindee L. LeFevre, CSR No. 7974

24 25

23

26 27

24

28 29

25

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Filed 12/01/2008

Page 167 of 245 27

13:54:06 13:54:14 Digges'

1 2

Q. Okay. And this is Item 18 of the PMK notice. What do you understand about the nonrenewal of John

13:54:18

3

employment contract?

13:54:18

4

13:54:22

5

salary increase that was -- that was not acceptable, and

13:54:30

6

that's all I know about it.

13:54:32

7

Q.

Okay.

13:54:35 8 seem 13:54:38 9 13:54:43 10 opinion

A.

In other words, what he was asking for didn't

3 4 A.

My understanding was that he was asking for a

5 6 7 8 9 10 11

to match what he was actually doing and his job and the amount of hours he was spending. There was a strong

12 13:54:46 11

that his asking price was above and beyond what was

13:54:49 12

appropriate.

13:54:50 13 was 13:54:55 14 enough?

Q.

13 14 15 16

Okay.

So when you say it didn't match what he

doing, is that because his contribution wasn't good

17 13:55:00 15

I mean --

18 19 20 21 22

13:55:01 16 best 13:55:05 17 13:55:09 18 13:55:12 19 Department,

A.

No, I think he contributed in, you know, the

way he could. I dealt with him probably more than most physicians at Kern because we did have lots of abused children that come into the Emergency Medicine

23 13:55:17 20

and he was there, but my understanding is that the

13:55:22 -- in 13:55:28 13:55:33 13:55:36 was 13:55:39 whole

21

administration made the decision that the asking price

22 23 24

fact, I had called him a couple weeks ago to just -- on another issue -- and he related the same thing. He said can you believe they didn't think I

25

worth what I asked for.

24 25 26 27 28 29

So it sort of confirms the

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Filed 12/01/2008

Page 168 of 245 28

13:55:44 13:55:47 Digges

1 2

issue that -Q. Has he -- now, to your knowledge, is Dr.

13:55:51

3

retired?

3 4 5 6 7

13:55:52 4 capacity. 13:55:55 5 13:56:00 6 case-by-case

A.

No, I think he is still working in some

I do know that he does do forensic stuff. I don't know whether he does it on a locum tenens basis or

8 13:56:05

7

basis, but he still has expertise in that area.

13:56:09

8

Q.

Is he working then, do you know?

13:56:11 but 13:56:15 13:56:18 13:56:21 13:56:23 have to

9

A.

I -- I have never asked him that personally,

9 10 11 12 13 14 15

10 11 12 13

he is not Q. A. Q.

working for Kern Medical Center. Okay. Was he pretty close to retirement age? No. Okay. And do you recall what -- you don't

16 17 18 19 20 21

13:56:28 14 idea. 13:56:32 15 13:56:33 16 13:56:33 17 13:56:33 18 contract?

give me an exact amount, but can you give me a rough A. Q. A. Q.

I have no idea. No idea? No idea. Who made the decision not to renew his

A.

That was an administrative decision.

22 23 24 25

13:56:36 19 have 13:56:40 20 13:56:45 21 his

It may

been a Chief Medical Officer decision. I have no idea. Q. Okay. But before the decision not to renew

26 13:56:48 22

contract was made, was there a negotiation then with

13:56:52 23 13:56:54 24 I 13:56:58 25 him

Dr. Digges? A. And I can't really tell you much about that.

27 28 29

would suspect there was some attempt to negotiate with

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 169 of 245 32

14:00:45 you

1

that don't belong to you to do an evaluation on you, and

14:00:51

2

don't interrupt their work process.

14:00:53 think 14:00:55 handed

3 4

about it and have an opportunity to -- but I mean, he

14:00:58 So 14:01:03 14:01:07 They

5

it to me.

6 7

to me -- to me, that was disruptive. Okay. It was disruptive. And they -- they invaded my Department.

14:01:11

8

invaded my residents' privacy.

14:01:13

9

14:01:18 mean, 14:01:24 14:01:25 14:01:26 tell

10

remember David specifically treating me in a sassy,

11 12 13

horrible way. Q. Okay. A. I mean, he was always nice to me, but I will

2 3 4 5

You find a time when they have got time to

6 7 8 9

He came up to me afterwards and thanked me.

10 11 Okay.

And that's -- but I -- I don't ever

12 13 14 15 16 17 18 19

14:01:28 14 when 14:01:32 15 have

you something.

I have oftentimes wondered what he said

14:01:37 16 with 14:01:40 17 kind

been in situations where he has been absolutely caustic

14:01:47 Kern 14:01:51 14:01:52 I 14:01:55 David, 14:01:59 many 14:02:06 14:02:08 14:02:09 David

18

of recipient of that behavior as others have been at

19 20

Medical Center. And I was an elected officer, I was a Chair.

21

heard about all the stuff.

22

stop it.

23 24 25

times I said that. Q. How did he respond? A. Well, you know, the usual way.

I wasn't around about me, but I never -- but -- and I

20 21 22

other folks, but, fortunately, somehow, I never was the

23 24 25 26 27 28 29

And I kept reminding him,

You are building enemies.

PMK KercherE

I don't know how

You know,

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 170 of 245 33

14:02:13 the

1

was one that would listen, not necessarily respond all

14:02:17 the 14:02:23 14:02:28 ever

2

time, but he didn't yell at me or, you know, slam me in

3 4

face or anything like that. I thought he listened. Q. Well, so -- I mean, in your opinion, did you

14:02:30

5

witness Dr. Jadwin do something that would trigger the

14:02:36

6

Disruptive Physician Policy that's in place today?

14:02:39

7

A.

Oh, yeah.

14:02:40

8

Q.

Okay.

14:02:42

9

A.

That would have been one.

14:02:44 10

Q.

Okay.

14:02:45 11

A.

Then the other incident would have been his

2 3 4 5 6 7 8 9 So would it be this evaluation?

10 11 12 13 14:02:48 12

outright blasting of two elected medical officers in a

14:02:53 13

meeting.

14 15 14:02:54 14

Q.

Okay.

Tell me about that.

14:02:56 15

A.

And where he shared with the president of the

16 17 14:03:01 16

medical staff, who happened to be a woman, that --

18 14:03:05 17

Q.

Is this Dr. Abraham?

14:03:07 18 but 14:03:10 19 important,

A.

Yes.

19 20 21

And I don't know what the language was,

it was pretty demeaning in front of her, but more

22 14:03:14 20

just absolutely destroyed Dr. Ragland, who was president

14:03:21 21

elect.

23 24 25 26

14:03:22 22 happen? 14:03:25 23 president,

Actually, I was past -- no.

How did it

No, I think Jennifer was past president, I was

27 14:03:29 24

and Scott was president elect.

28 29

14:03:32 25 Ragland

But David just absolutely pulverized Scott

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Okay.

Filed 12/01/2008

Page 171 of 245 92

15:25:28 you

1

There was an e-mail exchange in which

15:25:31 stamped 15:25:37 sorry

2

were CC'd, and I am referring to Exhibit 263, Bates

3

507.

2 3 4

And it states -- this is a letter, an e-mail --

5 6 7 8

15:25:44 4 officers, 15:25:50 5 15:25:53 6 cordial

-- an e-mail from Peter Bryan to the medical staff

15:25:58

and not combative, and, goodness knows, a couple of you

stating thank you for participating in today's noontime meeting. I know it was really challenging to remain

9 7

10 11 12

15:26:01 8 restraint 15:26:05 9 And

could have really hit back.

Thank you for your

15:26:07 10

it goes on.

15:26:11 don't 15:26:14 15:26:18 15:26:22 15:26:23 15:26:26 dated

11

thank you for your efforts.

12 13 14 15 16

know if this ever got to you, but Dr. Ragland responded, that was one of the most distasteful events I have ever participated in. Do you recall what meeting this e-mail was referencing to? And I will tell you this e-mail is

and the professional manner in which you participated.

13 And Mr. Bryan concludes, anyway, thanks --

14 15 16 17 18 19 20

And then Mr. -- well, I

21 15:26:30 17

February 22.

15:26:31 18 and 15:26:32 19 15:26:35 20 Ragland

A.

22 23 24 25

I don't remember.

I don't recall that e-mail

I have no idea what that was referencing. Q. So you don't recall a meeting where Dr.

26 15:26:39 21

leaned back in his chair and said, here we are again,

15:26:42 22

Mr. Perfect?

15:26:43 23 15:26:47 24 15:26:51 25

A. I do not recall. Q. All right. Do you recall a meeting where Dr. Jadwin told Dr. Abraham that you are just a fat doctor?

27 28 29

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

A. Q.

Filed 12/01/2008

Page 172 of 245 93

15:26:58 15:27:01 meeting

1 2

I don't recall that comment any time. Okay. Do you recall -- do you recall a

15:27:03 or 15:27:08 15:27:11 some of

3

where Dr. Jadwin told Dr. Raglan you are not competent

4 5

qualified to be a president of the medical staff? A. Now, this was not in February. These were

15:27:14

6

the comments that were made back at that meeting when we

15:27:18

7

presented him the letter.

15:27:19

8

Q.

October 17?

15:27:21 9 comments 15:27:23 10 15:27:26 11 and

A.

This was not in February.

3 4 5 6 7 8 9 10 11 12 13

These are some

that were made at the meeting in October. Q. Okay. Now, do you recall a meeting where you

14 15 16 17

15:27:30 12 head 15:27:35 13 15:27:37 14 Jadwin.

Dr. Harris apologized to Dr. Jadwin, and you shook his

15:27:40 15

You know, I used to punch him in the side, I used to

15:27:43 16

choke-hold him.

15:27:48 17

him.

and kind of slugged him in the arm? A. Huh? I have done that so many times to

18 19 I mean, I did a lot of crazy stuff with

20 21 15:27:48 18

I don't remember this particular --

22 15:27:50 19

Q.

But do you remember apologizing to Dr. Jadwin?

15:27:53 20

A.

I apologize all the time, sir.

23 I apologize to

24 25 26

15:27:55 21 Jadwin? 15:28:00 22 angry

everybody.

Sorry.

Have I been an asshole today,

15:28:04 23 apologize. 15:28:07 24 15:28:08 25 am

with me because I have done something wrong?

You seem to be upset.

I really apologize.

Are you

27 28 29

I

I do it all the time. Q. Okay. Well, I am just trying to recall -- I

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 173 of 245 99

15:34:25 build

1

me, there's no better explanation for why he couldn't

15:34:31 why he 15:34:34 15:34:40 15:34:40 15:34:41 15:34:44 giving

2

friendships, why he couldn't become part of the team,

3 4 5 6 7

never felt a peace at KMC, why -- I mean, that's just my opinion. Q. Okay. A. And it could be totally wrong. I am not being dogmatic about it. I won't insist on it. I am just

15:34:48

8

you a very honest opinion.

15:34:49

9

2 3 4 5 6 7 8 9 10 Q.

I understand.

11 15:34:50 10

MR. WASSER:

As you know, this is a PMK, and I

12 13 14

15:34:52 11 hours 15:34:55 12 you

have given you enormous latitude in the last couple

15:34:58 13 know 15:35:00 14 the

need.

15:35:04 15 of 15:35:04 16 15:35:06 17 we're

PMK, don't forget this is the PMK, and we are way afield

15:35:11 18

going to wrap this up pretty soon anyway, but thanks.

15:35:13 19

BY MR. LEE:

15:35:16 20

Q.

because Dr. Kercher's testimony is, frankly, something

15 16 17

You didn't notice his deposition, and I didn't

why, and that's not my business, but if you want to do

18 19 20 21

that. MR. LEE:

I understand.

I understand.

And

22 23 24 Did you vote to remove Dr. Jadwin at the Joint

25 15:35:19 21

Conference Committee on July 10, 2006?

26 15:35:24 22

MR. WASSER:

As Chair?

27 15:35:27 23

A.

Was it 2006?

28 29

15:35:29 24 15:35:29 25 voted

BY MR. LEE: Q. July 10, 2006.

That's when Dr. Jadwin was

PMK KercherE

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7 8 9 10 11

Document 277-2

Filed 12/01/2008

Page 174 of 245 100

15:35:33 1 15:35:35 2 15:35:36 3 15:35:41 4 15:35:44 5 15:35:51 6 15:35:52 7 15:35:55 8 15:35:55 9 15:35:56 10 15:35:57 11 have

to be removed as Chair of the Department by the JCC. A. Yes, I did. Q. You did. Okay. What was your basis for doing that? A. He wasn't around anymore. Q. Physical absence? A. Yeah, he wasn't doing his job. Q. Okay. A. He was gone. Q. Okay. A. I mean, he was not there anymore. I didn't

15:36:00 12 usage or 15:36:05 13 shoulder.

any Chair of Pathology to argue with me about blood

12 13 14

I had nobody to hit in the back or punch in the

15 15:36:08 14

I didn't have anybody around.

He's not there.

16 15:36:11 15

He's gone, and extended periods of gone.

17 15:36:16 16

Q.

Well, what periods of absence did you notice?

15:36:19 17

A.

He was just not there.

15:36:21 18

Q.

Okay.

15:36:23 19 that 15:36:31 20 the

A.

And I know, having been chair at that time,

18 19 Physically?

20 21 22

if I would have taken -- and I am just going on my own,

23 15:36:35 21

way I handle my business -- if I would taken as long of

15:36:40 22

extended leave of absence as Jadwin did, for whatever

15:36:43 23 is 15:36:47 24 which

reason, and I have no reason -- I have no idea what that

15:36:55 25 were

he didn't make clear to the boss, as to what his plans

24 25 26 27

-- I would have made it a little clearer to my boss,

28 29

PMK KercherE

CaseKERCHER, 1:07-cv-00026-OWW-TAG M.D.

Document 277-2

Filed 12/01/2008

Page 175 of 245 09-04-08 Page 113

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

ss.

3 4

5

I, Cindee L. LeFevre,

a

Certified Shorthand

6

Reporter in the State of California, holding certification

7

No. 7974, do hereby certify that EUGENE KERCHER, M.D.,

8

the witness named in the foregoing deposition,

9

was by me duly sworn; that said deposition was taken

10

Thursday, September 4, 2008, at the time and place set

11

forth on the first page hereof.

12

That upon the taking of the deposition, the

13

words of the witness were written down by me in stenotypy

14

and thereafter transcribed by computer under my supervision;

15

that the foregoing is a true and correct transcript of the

16

testimony given by the witness.

17

I further certify that I am neither counsel for

18

nor in any way related to any party to said action, nor in

19

any way interested in the result or outcome thereof.

20

Dated this 22nd day of September, 2008, at

21

Bakersfield, California.

22 23 24 25

vs. RANDALL

(800)

COUNTY 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 176 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 15

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

20

From: Law OFFice of Eugene Lee From: Law Office of Eugene Lee

To: 213-596-0487 To: 213-596-0487

Case 1:07-cv-00026-OWW-TAG (213) 992-3299 TELEPHONE

FACSIMILE

Filed 12/01/2008

Page 177 of 245

OFFICE OF LEE E N E

[email protected]

555 WEST F'IFTH STREET SUITE 3100 Los ANGELES, CAL.IFORNIA 9001 3-1 01 0

WWW.LOEL.COM WEBSITE

LAW

E UG (213) 50;16-0467

Document 277-2

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EMAIL

FAX To: Fax Number: 2135960487

From: Law Office of Eugene Lee Date: 03/29/2007

Pages: 3 (including cover page) Re: Jadwin/County of Kern et al.

Comments:

Karen: Transmitted herewith is a letter regarding Dr. Jadwin's visit to his office at KMC yesterday and KMC's duty to preserve evidence.

Please contact me if you have questions.

From: Law OFFice of Eugene Lee From: Law Office of Eugene Lee

To: 213-596-0487 To: 213-596-0487

Case 1:07-cv-00026-OWW-TAG

(Z 1 3J gg 2-3 299

Document 277-2

LAW

TELEPHONE

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Filed 12/01/2008

OFFICE

EUGENE

OF

Page 178 of 245

[email protected] E-MAIL

LEE

(21:3) 596-0487

555 WEST FIFTH

STREET,

SUITE:31 00

WWW.LOEL.COM

FACSIMILE

LOS ANGELES, CALIFORNIA

9001 :::3-1010

WEBSITE

March 29, 2007 VIA fACSIMILE & US MAIL Ms. Karen S. Barnes Deputy County Counsel Kern Medical Center 1830 Flower Street Bakersfield, CA 93305-4197 Re:

100011.001

Dr. Jadwin's Access to His Personal Materials at KMC Jadwin I County of Kern (USDC EDCA No. 1:07-cv-00026-0WW/TAG)

Dear Ms. Barnes: following is brief summary of Dr. Jadwin's trip to KMC yesterday. Dr. Jadwin arrived at KMC at 2:00 p.m. on March 28,2006 and proceeded to go to the Medical Staff Office, as per your instructions. Steve, the KMC Head of Security escorted Dr. Jadwin from there to his office. The locks to Dr. Jadwin's office had apparently been changed during Dr. Jadwin's absence and Steve was therefore unable to open the door. Dr. Dutt then appeared and proceeded to unlock Dr. Jadwin's office. Upon entering his office Dr. Jadwin immediately noticed that his file cabinet and his desktop computer were both missing. Regarding the missing filing cabinet Dr. Dutt stated that he had "needed it". When Dr. Jadwin said that the cabinet had been filled with his personal items, including his personal scrubs, Dr. Dutt immediately denied it. Dr. Jadwin mentioned that a Bluetooth transmitter for his personal wireless keyboard and mouse had been attached to the back of the now-missing desktop computer. Dr. Dutt stated that it was "easy to make a mistake" when personal and county property were mixed. Regarding the missing computer, Dr. Dutt explained that the computer had been taken for use with the microscopy camera. Or. Jadwin mentioned to Or. Dutt that the computer had contained the personal and other information which Dr. Jadwin required for his Grand Rounds talk at UCLA next month. Dr. Dutt then interrogated Dr. Jadwin, asking where he was giving the talk, what the subject ofthe talk was going to be, what he needed from his computer, etc. Or. Dutt asserted that neither Dr. Jadwin nor I, his attorney, had been specific about what was needed. As such, he asserted it was "our fault" that the computer files were unavailable. Dr. Jadwin stressed that he was very short oftime and needed the materials to prepare for the lecture. When Dr. Jadwin explained that the items he sought were things that he needed to sort

To: 213-596-0487 To: 213-596-0487

From: Law OFFice of Eugene Lee From: Law Office of Eugene Lee

Case 1:07-cv-00026-OWW-TAG

Document 277-2

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through on the computer to find, Dr. Dutt replied that this was something "for the attorneys to sort out". Dr. Jadwin then collected several personal items in a box and turned over several items to Dr. Dutt that were County property. Steve escorted Dr. Jadwin off the campus. At this point, Dr. Jadwin has very little time left to prepare for his grand rounds lecture. Dr. Jadwin has irreplaceable case studies and images that he has collected through the years on his computer. He requires immediate access to these and other personal files. As I had previously explained to you in my email of March 21: It will be very time consuming, not to mention uncomfortable, for Dr. Jadwin to have to inventory the personal items he needs access to. Dr. Jadwin has a lot of personal information - including personal items predating his employment at KMC - stored on his computer in the office.

Put another way, it does not seem reasonable to expect Dr. Jadwin to recall every single personal file contained on his computer and specify which exact files he requires, not to mention their filenames and folder locations on his computer. This is why I had requested Dr. Jadwin be permitted to personally access his office and retrieve the files from his computer. Apparently, you had agreed in your reply email of March 22, when you requested I provide you with Dr. Jadwin's preferred date and time. Given the shortness of time, unless you have a different proposal in mind, I would request that ALL of Dr. Jadwin's files contained on his computer be mailed to him on CDs by overnight express mail. On a closing note, I would like to remind you that KMC is under a strict legal obligation to preserve and prevent spoliation of electronic evidence relating to Dr. Jadwin's lawsuit against the County ofKem et al. This includes the emails and files contained on Dr. Jadwin's computer. I am very disturbed to hear that Dr. Dutt has expropriated Dr. Jadwin's computer for other use and that, apparently, no measures have been taken to backup or protect any of the data contained thereon. Your prompt response is appreciated.

cc:

David F. Jadwin, DO

2

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 16

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

21

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Eugene D. Lee MaxEmail Send [[email protected]] Thursday, June 29, 2006 3:42 PM [email protected] MaxEmail Send Delivery Report Job 20183519-100011.001

From: Sent: To: Subject:

=============================================================================== Maxemail Send Job Confirmation For Job ID 20183519-100011.001 =============================================================================== Job Information Maxemail Job ID Number of Pages Recipient Count Total Charges Report Time Zone:

: 20183519-100011.001 : 0006 : 3 : $0.65 America/Los_Angeles (GMT-0700)

Recipient Delivery Summary Delivered Errorred Rec 0000 0001 0002

: 3 : 0

Fax Number 6618683809 8182499682 2135960487

Pgs* 0006 0006 0006

Duration 00:01:50 00:01:49 00:02:07

Calls 1 1 1

Status Delivered Delivered Delivered

Charge $0.20 $0.20 $0.25

================================================================================ Individual Call Detail ================================================================================ Call Detail for Item 00000 ID 3109078 Sent To 6618683809 0006 Pages Delivered Date/Time Duration Pgs* Status Charge 06/29-15:42 00:01:50 6 Transmission Successful $0.20 Call Detail for Item 00001 ID 3109079 Sent To 8182499682 0006 Pages Delivered Date/Time Duration Pgs* Status Charge 06/29-15:43 00:01:49 6 Transmission Successful $0.20 Call Detail for Item 00002 ID 3109080 Sent To 2135960487 0006 Pages Delivered Date/Time Duration Pgs* Status Charge 06/29-15:43 00:02:07 6 Transmission Successful $0.25 =============================================================================== End Of Report ===============================================================================

1

To: Eugene Lee @ 213-596-0487

From: Law OFFice o f Eugene Lee

Pg I/ 6 06/29/06

3:38 pm

L A rDocument O F277-2 F I Filed C E12/01/2008 O F

Case 1:07-cv-00026-OWW-TAG

E U G E N E

L E E

STE 2 7 0 0 4 4 5 SOUTH F I G U E R O A S T LOS ANGELES, CALIFORNIA 9 0 0 7 1 - 1 6 3 2

12 131 506-0407 FACSIMILE

[email protected]

Page 182 of 245 rm t'dA1 L W.LCIEL.ECIM WE~EITE

FAX To: Eugene Lee Fax Number: 21 35960487

Pages: 6 (including cover page) Re: Jadwin v Kern Medical Center et al. Comments: Please see the attached letters.

From: Law Office of Eugene Lee Date: 06/29/2006

To: Eugene Lee @ 213-596-0487

From: Law OFFice o f Eugene Lee

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Pg 2/ 6 06/29/06

Filed 12/01/2008

TELEPHONE

L A WOFFICE OF E U G E N E L E E

12 131 6 9 e . 0 4 0 7 FAUEIMILL

4 4 6 E O U T H FImULROA ET, E U I T L 2 7 0 0 LOU ANmLLLE. UALIFORNIA 9 0 0 7 1 . 1 - 3 2

( a 131 ~ m a - 0 4 8 a

3:38 pm

Page 183 of 245 [email protected] E-MAIL

WWW.LOLL.UOM WLEEITL

June 29,2006 VIA US MAIL. FAX & EMAIL Ms. Kasen S. Basnes Deputy County Counsel Office of the County Counsel, County of Kern Administrative Center 1115 Truxtun Avenue, Fourth Floor Bakersfield, California 93301 Re:

Preservation i no spoliation of evidence Jadwin v. County of Kern, Peter Bryan, et al.

Dear Ms. Barnes: I am writing to inform you that my office has been retained by Dr. David F. Jadwin to represent him in the above-captioned pending matter. We are currently preparing to bring suit against the County of Kern, Mr. Peter Bryan, Dr. William Roy, and other defendants whose identities are to be determined, and will soon be submitting the appropriate filings under the California Tort Claims Ad, California Fair Employment & Housing A d , etc. Dr. Jadwin is seeking to prosecute various employment-, tort- and contract-related claims arising out of, among other things: (i)

Retaliation in Violation of Cal. Familv Riehts A d : Retaliatory adions engaged in by Kern Medical Center (hereinafter referred to as " K M C ) et al. against Dr. Jadwin for taking medical leaves, in violation of the Cal. Family Rights A d ;

(ii)

Wrongful Demotion i Termination in Violation of Cal. Bus, & Prof. C. 12056 & Conspiracy Relating Thereto: Retaliatory actions engaged in by KMC et al. against Dr. Jadwin in violation of Cal. Bus, & Prof. C. 5 2056 (Protection against Retaliation for Physicians Who Advocate for Medically Appropriate Health Care), and conspiracy relating thereto by certain members of KMC's medical staff;

(iii)

Per Se Defamation & Ratification: Various communications made by certain members of KMC's medical staff which were per se defamatory of Dr. Jadwin's professional competence, and which KMC subsequently ratified and condoned;

(iv)

Disabilitv Discrimination / Failure to Accommodate in Violation of Cal. Fair Employment & Housing Act: Disability-based discriminatory harassment by KMC et al. of Dr. Jadwin, and failure to accommodate disability in violation of the Cal. Fair Employment & Housing A d ;

To: Eugene Lee @ 213-596-0487

From: Law OFFice o f Eugene Lee

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 184 of 245

(v)

Breach of Contract 1 Good Faith & Fair Dealing: Breach of Dr. Jadwin's employment contract (and implied covenant of good faith & fair dealing) by KMC et al. for failure to comply with KMC's bylaws and failure to permit Dr. Jadwin until June 16,2006 to decide whether to resign chairmanship (see Mr. Bryan's email to Dr. Jadwin of June 14,2006, where he informs Dr. Jadwin that he is abrogating the June 16 deadline and unilaterally initiating Dr. Jadwin's removal fiom chairmanship), among other things;

(vi)

Negligent Hiring I Su~ervisionI Retention

(vii)

Intentional Infliction of Emotional Distress

Please note that the foregoing list is preliminary and subject to change. Additional causes of action will likely materialize as more facts become known.

I. DEMAND FOR PRESERVATION OF EVIDENCE This letter serves as a formal demand that you take, and cause to be taken, all appropriate a r m a t i v e steps to preserve any and all evidence relating to the foregoing claims. This includes but is not limited to, all emails, oncology conference-related feedback forms and documentation, memos, letters, reports, committee and other meeting minutes, notes taken at meetings with or concerning Dr. Jadwin (including those of Dr. Marvin Kolb, Dr. Irwin Harris and Mr. Peter Bryan), administrative records (including those of Dr. Kolb and Dr. Harris), etc. Failure to do so may constitute negligent or intentional spoliation of evidence and result in, among other things, monetary, evidentiary, issue, and terminating sanctions in the pending lawsuit. In addition, intentional spoliation of evidence constitutes a criminal offense pursuant to California Penal Code 5135. That provision states: Every person who, knowing that any book, paper, record, instrument in writing, or other matter or thing, is about to be produced in evidence upon any trial, inquiry, or investigation whatever, authorized by law, willfully destroys or conceals the same, with intent thereby to prevent it fiom being produced, is guilty of a misdemeanor. Please kindly advise us of the identity, address, and telephone number of any party who may possess any evidence relating to the foregoing claims.

11. DEMAND FOR ACCESS TO CREDENTIALS FILE Turning to other matters, please note that KMC is currently in violation of both Cal. Labor C. 5 1198.5 and KMC Bylaws 5 14.9(E) regarding Dr. Jadwin's written request for access to his credentials file, dated May 19, 2006. Dr. Jadwin submitted his request in writing to Dr. Kercher more than a month ago, yet KMC continues to deny Dr. Jadwin (i) physical access to his credentials file, and (ii) a meaningful summary of the contents of the documents which KMC is refusing Dr. Jadwin access to. Please note, the mere recitation of titles of documents referenced

To: Eugene Lee @ 213-596-0487

From: Law OFFice o f Eugene Lee

Case 1:07-cv-00026-OWW-TAG

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Filed 12/01/2008

Page 185 of 245

in the foregoing subsection (ii), as KMC has provided to Dr. Jadwin, does not constitute a meaningful summary. In addition, I would like to relay Dr. Jadwin's request that I be provided access to his Kern County personnel file as soon as possible. Enclosed herewith is Dr. Jadwin's written request relating thereto.

111. DEMAND FOR ACCOUNTING OF CUMULATIVE MEDICAL LEAVE HOURS As you may know, at the meeting of April 28,2006 (and in Mr. Bryan's subsequent confirmation by fax of even date), Mr. Bryan had directed Dr. Jadwin to contact Mr. Steve O'Conner in the Human Resources department at KMC regarding all leave-related questions. Pursuant to that instruction, Dr. Jadwin spoke by phone with Mr. O'Conner on June 13,2006, and asked him to provide him with a full accounting of the actual hours of medical leave he has thus far exhausted. Dr. Jadwin has yet to receive any response. According to Kern County Civil Service Commission Rule 1201.20, Dr. Jadwin is entitled to up to 6 months' cumulative unpaid sick leave in any given 12-month period. Dr. Jadwin simply seeks to determine where he stands in terms of medical leave hours.

IV. MR. BRYAN'S EMAIL OF JUNE 26,2006 In his email to Dr. Jadwin of June 26,2006, Mr. Bryan directs Dr. Jadwin as follows: (i)

"you are to refrain from entering the facility for any reason other than seeking medical attention"

(ii)

"you are also to refrain from contacting any employee or faculty member of Kern Medical Center for any reason other than seeking medical attention"

(iii)

"In accordance with KMC policy, usage of any and all equipment as well as access to any and all systems has been suspended while you are on your approved personal necessity leave of absence"

Regarding instruction (i), please note that Dr. Jadwin had absolutely no prior notice that his leave would preclude him from access to KMC's facilities. Dr. Jadwin has a number of valuable and important personal documents and effects in his office at KMC which he requires immediate access to. For instance, Dr. Jadwin needs to retrieve CME certificates from his office so that he may submit them in response to a compliance audit, which requires submissions by early next week. Dr. Jadwin will require physical access to his office in order to retrieve these and other personal items. Please let me know what immediate arrangements can be made so that Dr. Jadwin can recover such items. Regarding instruction (ii), please provide me with the legal grounds for imposing on Dr. Jadwin (or any other KMC employee) such overbroad and blanket prohibition against association with other KMC personnel.

To: Eugene Lee @ 213-596-0487

From: Law OFFice o f Eugene Lee

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 186 of 245

Regarding instruction (iii), please provide me with the specific provisions in KMC's bylaws, KMC's rules and regulations, Kern County's Employee Manual, Kern County's Civil Service Commission Rules, or other appropriate rules and regulations, which establish that employee access to all equipment will be suspended for the duration of personal necessity (or any other) leaves. I must admit to being unable to locate any such provision. Please note, as mentioned previously, Dr. Jadwin is permitted under Kern County CSC Rules to take up to 6 months' cumulative unpaid sick leave. As we have reason to believe that such 6 month maximum has not been exhausted, we do not acknowledge nor necessarily agree that Dr. Jadwin's current leave can be characterized as personal necessity leave vis-a-vis sick leave. Finally, I would like to speak on Mr. Bryan's claims that he acts out of a "concern" for Dr. Jadwin's welfare, and that "we do not want to you to feel obligated to do work while on a leave of absence", which claims are followed by salient threats of formal termination and other penalties should Dr. Jadwin fail to comply. As Mr. Bryan is aware, the doctor's certification which Dr. Jadwin previously submitted in connection with his medical leave stated that Dr. Jadwin was capable of working 1 to 2 days per workweek. Indeed, KMC had previously reasonably accommodated Dr. Jadwin's disability by permitting Dr. Jadwin to come into work 1 to 2 days a week for several months. I fail to comprehend the sudden change in circumstance that necessitated KMC's recent decision to lock Dr. Jadwin out of the KMC campus. Mr. Bryan's expressions of concern for Dr. Jadwin's welfare strike me as particularly disingenuous. V. CONCLUSION

Litigation is always a measure of last resort and Dr. Jadwin does not undertake it lightly. It is unfortunate that events have compelled Dr. Jadwin to consider litigation at all. If you wish to discuss the foregoing with us, please feel free to contact me anytime at (213) 4531781 or at elee@,LOEL.com. We look forward to working with you toward resolution of Dr. Jadwin's claims.

enc:

Request for Kern County Personnel File

cc:

Dr. David F. Jadwin

To: Eugene Lee @ 213-596-0487

From: Law OFFice o f Eugene Lee

06/28/2006 12;41 18182499682 Case 1:07-cv-00026-OWW-TAG

Document 277-2

June 27,2006

To Whom It May Concern:

Please turn over my county personnel file to: 'Eugkne Lee 445 South Figueroa Street, Suite 2700 Los Angeles, California 90071 -1632

David F. Jndwin, DO 3 184 Beaudly Terrace

Glendale, California 91208-174.5

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EXHIBIT 17

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

22

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7 8

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Mark A. Wasser CA SB #60160 LAW OFFICES OF MARK A. WASSER 400 Capitol Mall, Suite 1100 Sacramento, CA 95814 Phone: (916) 444-6400 Fax: (916) 444-6405 E-mail: [email protected] Bernard C. Barmann, Sr. KERN COUNTY COUNSEL Mark Nations, Chief Deputy 1115 Truxton Avenue, Fourth Floor Bakersfield, CA 93301 Phone: (661) 868-3800 Fax: (661) 868-3805 E-mail: [email protected]

9 10 11

Attorneys for Defendants County of Kern, Peter Bryan, Irwin Harris, Eugene Kercher, Jennifer Abraham, Scott Ragland, Toni Smith and William Roy

12 13

UNITED STATES DISTRICT COURT

14

EASTERN DISTRICT OF CALIFORNIA

15 16

Plaintiff,

17 18 19 20

) ) ) ) ) ) ) ) ) ) ) ) ) ) )

DAVID F. JADWIN, D.O.

vs. COUNTY OF KERN, et al., Defendants.

21 22 23

Case No.: 1:07-cv-00026-OWW-TAG DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS (SET ONE) Date Action Filed: January 6, 2007 Trial Date: August 26, 2008

24

PROPOUNDING PARTY:

Plaintiff DAVID F. JADWIN, D.O., F.C.A.P.

25

RESPONDING PARTY:

Defendant COUNTY OF KERN

26

SET NUMBER:

ONE (1)

27 28 1 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

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Defendants hereby submit these responses to Plaintiff David F. Jadwin’s Request for

2

Production of Documents, Set One. Defendants have not located all the documents that are

3

responsive to this request and, for that reason, many of the production dates set forth herein are

4

estimates. Defendants will supplement or amend this response, if necessary, as additional

5

documents are located and reviewed.

6

REQUEST FOR PRODUCTION NO. 1

7

Any and all DOCUMENTS RELATING TO the First Affirmative Defense listed in

8

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

9

RESPONSE TO REQUEST NO. 1

10

Defendants object to this request on the grounds that it calls for the production of

11

documents that are protected by the attorney-work-product and attorney-client privileges.

12

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

13

any documents that are responsive to this request.

14

REQUEST FOR PRODUCTION NO. 2

15

Any and all DOCUMENTS RELATING TO the Second Affirmative Defense listed in

16

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

17

RESPONSE TO REQUEST NO. 2

18

Defendants object to this request on the grounds that it calls for the production of

19

documents that are protected by the attorney-work-product and attorney-client privileges.

20

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

21

any documents that are responsive to this request.

22

REQUEST FOR PRODUCTION NO. 3

23

Any and all DOCUMENTS RELATING TO the Third Affirmative Defense listed in

24

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

25

RESPONSE TO REQUEST NO. 3

26

Defendants object to this request on the grounds that it calls for the production of

27

documents that are protected by the attorney-work-product and attorney-client privileges.

28 2 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

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1

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

2

any documents that are responsive to this request.

3

REQUEST FOR PRODUCTION NO. 4

4

Any and all DOCUMENTS RELATING TO the Fourth Affirmative Defense listed in

5

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

6

RESPONSE TO REQUEST NO. 4

7

Defendants object to this request on the grounds that it calls for the production of

8

documents that are protected by the attorney-work-product and attorney-client privileges.

9

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

10

any documents that are responsive to this request.

11

REQUEST FOR PRODUCTION NO. 5

12

Any and all DOCUMENTS RELATING TO the Fifth Affirmative Defense listed in

13

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

14

RESPONSE TO REQUEST NO. 5

15

Defendants object to this request on the grounds that it calls for the production of

16

documents that are protected by the attorney-work-product and attorney-client privileges.

17

Without waiving those objections, Defendants will produce all non-privileged documents

18

responsive to this request on or before December 21, 2007. This request is duplicative of other

19

requests contained in Plaintiff’s request for production, set one, and the documents produced in

20

response to this request may refer to the documents produced in response to other requests.

21

REQUEST FOR PRODUCTION NO. 6

22

Any and all DOCUMENTS RELATING TO the Sixth Affirmative Defense listed in

23

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

24

RESPONSE TO REQUEST NO. 6

25

Defendants object to this request on the grounds that it calls for the production of

26

documents that are protected by the attorney-work-product and attorney-client privileges.

27

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

28

any documents that are responsive to this request. 3 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

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REQUEST FOR PRODUCTION NO. 7 Any and all DOCUMENTS RELATING TO the Seventh Affirmative Defense listed in

3

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

4

RESPONSE TO REQUEST NO. 7

5

Defendants object to this request on the grounds that it calls for the production of

6

documents that are protected by the attorney-work-product and attorney-client privileges.

7

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

8

any documents that are responsive to this request.

9

REQUEST FOR PRODUCTION NO. 8

10

Any and all DOCUMENTS RELATING TO the Eighth Affirmative Defense listed in

11

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

12

RESPONSE TO REQUEST NO. 8

13

Defendants object to this request on the grounds that it calls for the production of

14

documents that are protected by the attorney-work-product and attorney-client privileges.

15

Without waiving those objections, Defendants will produce all non-privileged documents

16

responsive to this request on or before December 21, 2007. This request is duplicative of other

17

requests contained in Plaintiff’s request for production, set one, and the documents produced in

18

response to this request may refer to the documents produced in response to other requests.

19

REQUEST FOR PRODUCTION NO. 9

20

Any and all DOCUMENTS RELATING TO the Ninth Affirmative Defense listed in

21

Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.

22

RESPONSE TO REQUEST NO. 9

23

Defendants object to this request on the grounds that it calls for the production of

24

documents that are protected by the attorney-work-product and attorney-client privileges.

25

Without waiving those objections, after diligent search, Defendants’ have not been able to locate

26

any documents that are responsive to this request.

27

REQUEST FOR PRODUCTION NO. 10

28 4 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

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1

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Any and all DOCUMENTS RELATING TO YOUR organizational structure during

2

Plaintiff’s employment with YOU, including but not limited to organizational charts, diagrams

3

and drawings.

4

RESPONSE TO REQUEST NO. 10

5

Defendants will produce all documents responsive to this request. Production may occur

6

in stages. The first stage of production will be on November 20, 2007 and may include all

7

responsive documents. If other responsive documents are discovered, they will be produced by

8

December 7, 2007.

9

REQUEST FOR PRODUCTION NO. 11

10

Any and all DOCUMENTS RELATING TO Kern Medical Center personnel directories

11

or lists, including but not limited to names, direct work phone numbers, departments, etc. which

12

were maintained by YOU during Plaintiff’s employment with YOU.

13

RESPONSE TO REQUEST NO. 11

14

Defendants will produce all non-privileged documents responsive to this request.

15

Production may occur in stages. The first stage of production will be on November 20, 2007 and

16

may include all responsive documents. If other responsive documents are discovered, they will

17

be produced by December 7, 2007. Defendants will redact personal or confidential information

18

as appropriate.

19

REQUEST FOR PRODUCTION NO. 12

20

Any and all DOCUMENTS RELATING TO YOUR personnel policies, guidelines, fact

21

sheets, posters, employee and/or employer handbooks, training materials, and employee and/or

22

employer manuals maintained by YOU that YOU contend governed Plaintiff’s terms and

23

conditions of employment at any time during the period from October 1, 2000 to October 4,

24

2007. These include but are not limited to YOUR ordinances, Kern Medical Center’s

25

Administrative Procedures Manual, Kern Medical Center’s Policy & Administrative Procedures

26

Manual, policies RELATING TO disability discrimination, reasonable accommodation,

27

interactive process, personal leave, administrative leave, medical leave, retaliation, investigations

28

into complaints of unlawful employment practices, discipline of employees, investigation of 5 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

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Page 194 of 245

1

employees, appointment of Kern Medical Center acting department chairs, hiring of Kern

2

Medical Center department chairs, demotion of Kern Medical Center department chairs, and

3

policies RELATING TO Kern Medical Center’s Pathology Department.

4

RESPONSE TO REQUEST NO. 12

5

Defendants object to this request to the extent it requests documents that contain

6

confidential personnel information, documents protected from disclosure by state or federal law,

7

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

8

Without waiving these objections, Defendants will produce documents responsive to this request

9

by December 21, 2007. Defendants will redact confidential peer review and personnel

10

information as appropriate.

11

REQUEST FOR PRODUCTION NO. 13

12

Any and all DOCUMENTS RELATING TO YOUR personnel policies, guidelines, fact

13

sheets, posters, employee and/or employer handbooks, training materials, and employee and/or

14

employer manuals maintained by YOU that YOU contend was distributed or made available to

15

YOUR employees, whether management or non-management, from October 24, 200 to the

16

present and the date of such asserted distribution. These include but are not limited to YOUR

17

ordinances, Kern Medical Center’s Administrative Procedures Manual, Kern Medical Center’s

18

Policy & Administrative Procedures Manual, policies RELATING TO disability discrimination,

19

reasonable accommodation, interactive process, personal leave, administrative leave, medical

20

leave, retaliation, investigations into complaints of unlawful employment practices, discipline of

21

employees, investigation of employees, appointment of Kern Medical Center acting department

22

chairs, hiring of Kern Medical Center department chairs, demotion of Kern Medical Center

23

department chairs, and policies RELATING TO Kern Medical Center’s Pathology Department.

24

RESPONSE TO REQUEST NO. 13

25

Defendants object to this request to the extent it requests documents that contain

26

confidential personnel information, documents protected from disclosure by state or federal law,

27

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

28

Without waiving these objections, Defendants will produce documents responsive to this request 6 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 195 of 245

1

by December 21, 2007. Defendants will redact confidential peer review and personnel

2

information as appropriate.

3

REQUEST FOR PRODUCTION NO. 14

4

Any and all DOCUMENTS RELATING TO peer review, quality management and

5

quality assurance policies and procedures at Kern Medical Center, included but not limited to

6

Kern Medical Center’s Quality Management and Performance Improvement Plan, from October

7

24, 2000 to the present, and the effective dates.

8

RESPONSE TO REQUEST NO. 14

9

Defendants object to this request to the extent it requests documents that contain

10

confidential personnel information, documents protected from disclosure by state or federal law,

11

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

12

Without waiving these objections, Defendants will produce documents responsive to this request

13

by December 7, 2007.1. Defendants will redact confidential peer review and personnel

14

information as appropriate.

15

REQUEST FOR PRODUCTION NO. 15

16 17

Any and all DOCUMENTS RELATING TO any training provided by YOU to YOUR officers, directors, agents or employees on the following subjects:

18

a) disability discrimination

19

b) accommodation of an employee’s disability

20

c) the interactive process regarding accommodation of an employee’s disability

21

d) medical leave rights

22

e) whistleblower retaliation

23

f) medical leave retaliation

24

g) due process required for demotion

25

h) due process required for pay cut

26

i) due process required for termination of employment

27

j) defamation

28

k) Fair Labor Standards Act 7 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 196 of 245

RESPONSE TO REQUEST NO. 15

2

Defendants object to this request to the extent it requests documents that contain

3

confidential personnel information, documents protected from disclosure by state or federal law,

4

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

5

Without waiving these objections, Defendants will produce documents responsive to this request

6

by December 21, 2007.

7

REQUEST FOR PRODUCTION NO. 16 Any and all DOCUMENTS RELATING To the PERSONNEL FILES of the following

8 9

people.

10

a) Plaintiff David F. Jadwin

11

b) Elsa Ang

12

c) Ellen Bunyi-Teopengco

13

d) Philip Dutt

14

e) Carol Gates

15

f) Adam Lang

16

g) Fangluo Liu

17

h) Savita Shertukde

18

i) Navin Amin

19

j) Kathy Griffith

20

k) Alice Hevle

21

l) Denise Long

22

m) Gilbert Martinez

23

n) Albert McBride

24

o) Javad Naderi

25

p) Jane Thornton

26

q) Nitin Athavale

27

r) Chester Lau

28

s) Jennifer J. Abraham 8 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

t) Bernard C. Barmann

2

u) Karen S. Barnes

3

v) Peter K. Bryan

4

w) David Culberson

5

x) Irwin E. Harris

6

y) Royce Johnson

7

z) Eugene K. Kercher

8

aa) Alan Scott Ragland

9

bb) William Roy

10

cc) Maureen Martin

11

dd) Steven O‘Connor

12

ee) Antoinette Smith

13

ff) Edward Taylor

14

gg) Marvin Kolb

15

hh) Dianne McConnehey

16

ii) Renita Nunn

17

jj) Ravi Patel

18

kk) Jose Perez

19

ll) Evangeline Gallegos

20

mm)

21

nn) Bonnie Quinonez

22

oo) James Sproul

23

pp) Rebecca Rivera

24

qq) Sheldon Freedman

25

rr) Joseph Mansour

26

ss) George Alkouri

27

tt) Nicole Sharkey

28

Document 277-2

Filed 12/01/2008

Sergio Perticucci

RESPONSE TO REQUEST NO. 16 9 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Page 197 of 245

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 198 of 245

Defendants have already produced the personnel file of David F. Jadwin. Defendants

2

will confirm that the personnel file previously produced was complete as of the time of its

3

production and, on or before December 7, 2007, will augment the documents previously

4

produced with any additional materials, if any, that have been added into Mr. Jadwin’s personnel

5

file since the file was produced. Plaintiff has narrowed the scope of this request by eliminating

6

all other documents initially requested.

7

REQUEST FOR PRODUCTION NO. 17

8 9 10

Any and all DOCUMENTS RELATING TO the search, recruitment, application, interviewing, and hiring process that resulted in Plaintiff’s employment by YOU. RESPONSE TO REQUEST NO. 17

11

Defendants object to this request to the extent it requests documents that contain

12

confidential personnel information, documents protected from disclosure by state or federal law,

13

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

14

Without waiving these objections, Defendants will produce all documents responsive to this

15

request by December 21, 2007.

16

REQUEST FOR PRODUCTION NO. 18

17

Any and all DOCUMENTS RELATING TO the terms, conditions and privileges of

18

Plaintiff’s employment with YOU.

19

RESPONSE TO REQUEST NO. 18

20 21 22

Defendants will produce all documents responsive to this request by December 21, 2007. REQUEST FOR PRODUCTION NO. 19 Any and all DOCUMENTS RELATING TO Plaintiff’s job duties and responsibilities for

23

each position held by Plaintiff during this employment with YOU.

24

RESPONSE TO REQUEST NO. 19

25 26 27 28

Defendants will produce all documents responsive to this request by December 21, 2007. REQUEST FOR PRODUCTION NO. 20 Any and all DOCUMENTS RELATING TO Plaintiff’s payroll, compensation, base salary and “professional fee payments”, as that term is defined in Plaintiff’s employment 10 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 199 of 245

1

contracts with YOU, including but not limited to any and all changes in compensation and the

2

reasons for changes, throughout Plaintiff’s employment with YOU.

3

RESPONSE TO REQUEST NO. 20

4 5 6

Defendants will produce all documents responsive to this request by December 7, 2007. REQUEST FOR PRODUCTION NO. 21 Any and all DOCUMENTS RELATING TO YOUR policies, guidelines and practices

7

regarding base salary steps, salary guidelines, deferred compensation plans, pension plans, health

8

insurance and employment benefits applicable to Plaintiff’s position s held throughout his

9

employment with YOU.

10 11 12 13

RESPONSE TO REQUEST NO. 21 Defendants will produce all documents responsive to this request by December 21, 2007. REQUEST FOR PRODUCTION NO. 22 Any and all DOCUMENTS RELATING TO Plaintiff’s work schedule and/or removal

14

there from, including but not limited to timesheets, from October 24, 200 to present.

15

RESPONSE TO REQUEST NO. 22

16 17 18

Defendants will produce all documents responsive to this request by December 21, 2007. REQUEST FOR PRODUCTION NO. 23 Any and all DOCUMENTS RELATING TO Dr. Phillip Dutt’s timesheets, from April 20

19

2005 to the present.

20

RESPONSE TO REQUEST NO. 23

21

Defendants object to this request to the extent it requests documents that contain

22

confidential personnel information, documents protected from disclosure by state or federal law,

23

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

24

Without waiving these objections, Defendants will produce all non-privileged documents

25

responsive to this request by December 21, 2007. Defendants will redact confidential

26

information, in any, as appropriate.

27

REQUEST FOR PRODUCTION NO. 24

28 11 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 200 of 245

Any and all DOCUMENTS RELATING TO Dr. Savita Shertukde’s timesheets, from

2

January 4, 2005 to present.

3

RESPONSE TO REQUEST NO. 24

4

Defendants object to this request to the extent it requests documents that contain

5

confidential personnel information, documents protected from disclosure by state or federal law,

6

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

7

Without waiving these objections, Defendants will produce all non-privileged documents

8

responsive to this request by December 21, 2007. Defendants will redact confidential

9

information, in any, as appropriate.

10 11

REQUEST FOR PRODUCTION NO. 25 Any and all DOCUMENTS RELATING TO performance reviews, comments,

12

complaints, warnings, reprimands, counseling, advisory notices or evaluations of Plaintiff’s

13

performance of his job duties throughout his employment with YOU, whether formal or

14

informal.

15

RESPONSE TO REQUEST NO. 25

16

Defendants object to this request to the extent it requests documents that contain

17

confidential personnel information, documents protected from disclosure by state or federal law,

18

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

19

Without waiving these objections, Defendants will produce all non-privileged documents

20

responsive to this request by December 7, 2007. Defendants will redact confidential

21

information, in any, as appropriate.

22

REQUEST FOR PRODUCTION NO. 26

23

Any and all DOCUMENTS maintained by Plaintiff at Kern Medical Center during his

24

employment by YOU, including any and all e-mails, Groupwise calendars, memoranda, written

25

materials, and computer files stored on Plaintiff’s computer at Kern Medical Center’s servers.

26

RESPONSE TO REQUEST NO. 26

27 28

After diligent search, Defendants believe Groupwise calendar information was deleted many months ago as part of the routine 90-day cycling of the Groupwise software. Defendants 12 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 201 of 245

1

are continuing to search for other materials that were on the computer that was assigned to

2

Plaintiff. Some material was archived before the computer was reassigned. Defendants have

3

identified about 3,000 pages of documents that appear to be responsive to this request but have

4

not yet concluded their search. Defendants will produce all documents responsive to this request

5

by December 7, 2007.

6

REQUEST FOR PRODUCTION NO. 27

7

Any and all DOCUMENTS RELATING TO any meetings RELATING TO Plaintiff or

8

Plaintiff’s employment at Kern Medical Center.

9

RESPONSE TO REQUEST NO. 27

10

Defendants object to this request to the extent it requests documents that contain

11

confidential personnel information, documents protected from disclosure by state or federal law,

12

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

13

Without waiving these objections, Defendants will produce documents responsive to this request

14

by December 7, 2007. Defendants will redact confidential peer review and personnel

15

information, if any, as appropriate.

16

REQUEST FOR PRODUCTION NO. 28

17

Any and all DOCUMENTS RELATING TO performance reviews, comments,

18

complaints, warnings, reprimands, counseling, advisory notices or evaluations of the Kern

19

Medical Center Pathology Department, whether formal or informal, from October 24, 1995 to

20

the present.

21

RESPONSE TO REQUEST NO. 28

22

Defendants object to this request to the extent it requests documents that contain

23

confidential personnel information, documents protected from disclosure by state or federal law,

24

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

25

Without waiving these objections, Defendants will produce documents responsive to this request

26

by December 7, 2007. Defendants will redact confidential peer review and personnel

27

information as appropriate.

28

REQUEST FOR PRODUCTION NO. 29 13 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

1

Any and all DOCUMENTS RELATING TO Plaintiff’s complaints of:

2

a) disability discrimination

3

b) failure to accommodate

4

c) failure to engage in an interactive process

5

d) violation of medical leave rights

6

e) whistleblower retaliation

7

f) medical leave retaliation

8

g) deprivation of property without due process

9

h) defamation

10 11

Page 202 of 245

i) Fair Labor Standards Act violations RESPONSE TO REQUEST NO. 29

12

Defendants object to this request to the extent it requests documents that contain

13

confidential personnel information, documents protected from disclosure by state or federal law,

14

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

15

Without waiving these objections, Defendants will produce documents responsive to this request

16

by December 21, 2007. Defendants will redact confidential peer review and personnel

17

information as appropriate.

18

REQUEST FOR PRODUCTION NO. 30

19

Any and all DOCUMENTS RELATING TO any investigation of Plaintiff’s complaints

20

of disability discrimination, failure to accommodate, failure to engage in an interactive process,

21

violation of medical leave rights, whistleblower retaliation, medical leave retaliation, defamation,

22

and/or deprivation of property without due process.

23

RESPONSE TO REQUEST NO. 30

24

Defendants object to this request to the extent it requests documents that contain

25

confidential personnel information, documents protected from disclosure by state or federal law,

26

including the peer-review privilege, or documents that are subject to the attorney-client privilege.

27

Without waiving these objections, Defendants will produce documents responsive to this request

28 14 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 203 of 245

1

by December 21, 2007. Defendants will redact confidential peer review and personnel

2

information as appropriate.

3

REQUEST FOR PRODUCTION NO. 31

4

Any and all DOCUMENTS RELATING TO any procedures available to YOUR

5

employees to complain of corruption, fraud and other wrongful, illegal or unethical conduct, that

6

YOU contend was distributed or made available to YOUR employees, whether management or

7

non-management, from October 24, 2000 to the present, and the date of such asserted

8

distribution(s).

9

RESPONSE TO REQUEST NO. 31

10 11

Defendants will produce all documents responsive to this request by December 21, 2007. REQUEST FOR PRODUCTION NO. 32

12

Any and all DOCUMENTS RELATING TO YOUR discipline of any employee against

13

whom a complaint or grievance of discrimination, harassment, defamation, retaliation, failure to

14

accommodate, and/or failure to engage in an interactive process in their employment was made

15

from October 24, 2000 to date.

16

RESPONSE TO REQUEST NO. 32

17

Defendants object to this request on the grounds that it requests documents that contain

18

confidential personnel information, documents protected from disclosure by state or federal law,

19

including HIPAA and the peer-review privilege, and documents that contain information that is

20

subject to the attorney-client privilege. Defendants do not believe these objections can be

21

resolved by redaction. Defendants also object on the grounds that the request is not reasonably

22

calculated to lead to the discovery of admissible evidence.

23

REQUEST FOR PRODUCTION NO. 33

24

Any and all DOCUMENTS RELATING TO complaints or grievances made by YOUR

25

past or present employees against YOU for defamation, retaliation, disability discrimination,

26

failure to accommodate, and/or failure to engage in an interactive process, including but not

27

limited to any informal or internal complaints, grievances or charges to any state or federal

28

agency, and complaints filed in any state or federal court from October 24, 2000 to date. 15 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Filed 12/01/2008

Page 204 of 245

RESPONSE TO REQUEST NO. 33 Defendants object to this request on the grounds that it calls for the production of

3

documents that contain confidential personnel information that is not relevant to any issues in

4

this case. Consequently, this request is not reasonably calculated to lead to the discovery of

5

admissible evidence. Defendants also object on the ground that the phrase, “informal or internal

6

complaints” is vague and, depending on interpretation, could include any off-hand gripe by any

7

employee, to the extent it was memorialized in writing. Defendant County of Kern employs

8

several thousand employees. In the past seven years, there could be many documents that fit the

9

description of this request yet none have anything to do with the issues in this case. This request

10

is, accordingly, overbroad and burdensome. Defendants do not believe redaction would resolve

11

these objections.

12

REQUEST FOR PRODUCTION NO. 34

13

Any and all DOCUMENTS RELATING TO any complaints or grievances made to YOU

14

by Plaintiff.

15

RESPONSE TO REQUEST NO. 34

16

Defendants believe all documents responsive to this request have been previously

17

produced to Plaintiff. Defendants will confirm this, or produce additional documents if

18

necessary, by December 7, 2007.

19

REQUEST FOR PRODUCTION NO. 35

20

Any and all DOCUMENTS RELATING TO Plaintiff which YOU sent to or received

21

from any governmental or regulatory authority, including but not limited to the California

22

Department of Fair Employment and Housing, the California Labor and Workforce Development

23

Agency, and the U.S. Department of Labor.

24

RESPONSE TO REQUEST NO. 35

25

Defendants believe all documents responsive to this request have been previously

26

produced to Plaintiff. Defendants will confirm this, or produce additional documents if

27

necessary, by December 7, 2007.

28

REQUEST FOR PRODUCTION NO. 36 16 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 205 of 245

Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and

2

evaluation of candidates for the position of staff pathologist at Kern Medical Center during the

3

period from January 1, 2006 to present.

4

RESPONSE TO REQUEST NO. 36

5

Defendants object to this request on the grounds that it calls for the production of

6

documents that contain confidential personnel information that is not relevant to any issues in

7

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

8

Defendants also object to this request to the extent it requests information protected from

9

disclosure by state or federal law, including HIPAA and the peer review privilege, and

10

documents that are subject to the attorney-client privilege. Without waving these objections,

11

Defendants will produce non-privileged documents responsive to this request, if any, by

12

December 7, 2007. Defendants will redact confidential and privileged information as

13

appropriate.

14

REQUEST FOR PRODUCTION NO. 37

15

Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and

16

evaluation of candidates for the position of Chair or Chief of Pathology at Kern Medical Center

17

during the period from January 1, 2006 to present.

18

RESPONSE TO REQUEST NO. 37

19

Defendants object to this request on the grounds that it calls for the production of

20

documents that contain confidential personnel information that is not relevant to any issues in

21

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

22

Defendants also object to this request to the extent it requests information protected from

23

disclosure by state or federal law, including HIPAA and the peer review privilege, and

24

documents that are subject to the attorney-client privilege. Without waving these objections,

25

Defendants will produce non-privileged documents responsive to this request, if any, by

26

December 7, 2007. Defendants will redact confidential and privileged information as

27

appropriate.

28

REQUEST FOR PRODUCTION NO. 38 17 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 206 of 245

Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and

2

evaluation of candidates for the position of locus tenens pathologist at Kern Medical Center

3

during the period from January 1, 2006 to present.

4

RESPONSE TO REQUEST NO. 38

5

Defendants object to this request on the grounds that it calls for the production of

6

documents that contain confidential personnel information that is not relevant to any issues in

7

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

8

Defendants also object to this request to the extent it requests information protected from

9

disclosure by state or federal law, including HIPAA and the peer review privilege, and

10

documents that are subject to the attorney-client privilege. Without waving these objections,

11

Defendants will produce non-privileged documents responsive to this request, if any, by

12

December 7, 2007. Defendants will redact confidential and privileged information as

13

appropriate.

14

REQUEST FOR PRODUCTION NO. 39

15

Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and

16

evaluation of candidates for the position of Chair or Chief of OB-GYN at Kern Medical Center

17

during the period from January 1, 2006 to present.

18

RESPONSE TO REQUEST NO. 39

19

Defendants object to this request on the grounds that it calls for the production of

20

documents that contain confidential personnel information that is not relevant to any issues in

21

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

22

Defendants also object to this request to the extent it requests information protected from

23

disclosure by state or federal law, including HIPAA and the peer review privilege, and

24

documents that are subject to the attorney-client privilege. Without waving these objections,

25

Defendants will produce non-privileged documents responsive to this request, if any, by

26

December 7, 2007. Defendants will redact confidential and privileged information as

27

appropriate.

28

REQUEST FOR PRODUCTION NO. 40 18 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 207 of 245

Any and all DOCUMENTS RELATING TOYOUR removal of Dr. Royce Johnson from

1 2

the position of Chair or Chief of Medicine at Kern Medical Center.

3

RESPONSE TO REQUEST NO. 40 Defendants object to this request on the grounds that it calls for the production of

4 5

documents that contain confidential personnel information that is not relevant to any issues in

6

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

7

Defendants also object to this request to the extent it requests information protected from

8

disclosure by state or federal law, including HIPAA and the peer review privilege, and

9

documents that are subject to the attorney-client privilege.

10

REQUEST FOR PRODUCTION NO. 41 Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and

11 12

evaluation of candidates for the position of Chair or Chief of Medicine at Kern Medical Center

13

during the period from October 24, 2000 to present.

14

RESPONSE TO REQUEST NO. 41 Defendants object to this request on the grounds that it calls for the production of

15 16

documents that contain confidential personnel information that is not relevant to any issues in

17

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

18

Defendants also object to this request to the extent it requests information protected from

19

disclosure by state or federal law, including HIPAA and the peer review privilege, and

20

documents that are subject to the attorney-client privilege. Without waving these objections,

21

Defendants will produce non-privileged documents responsive to this request, if any, by

22

December 21, 2007. Defendants will redact confidential and privileged information as

23

appropriate.

24

REQUEST FOR PRODUCTION NO. 42

25

Any and all DOCUMENTS RELATING TO presentations made at the Kern Medical

26

Center oncology conference in May 2005, including but not limited to participant evaluation

27

forms.

28

RESPONSE TO REQUEST NO. 42 19 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 208 of 245

Defendants object to this request on the grounds that it calls for the production of

1 2

documents that contain confidential personnel information that is not relevant to any issues in

3

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

4

Defendants also object to this request to the extent it requests information protected from

5

disclosure by state or federal law, including HIPAA and the peer review privilege, and

6

documents that are subject to the attorney-client privilege. Without waving these objections,

7

Defendants will produce non-privileged documents responsive to this request, if any, by

8

December 7, 2007. Defendants will redact confidential and privileged information as

9

appropriate.

10

REQUEST FOR PRODUCTION NO. 43 Any and all DOCUMENTS RELATING TO Plaintiff’s presentations made at the Kern

11 12

Medical Center oncology conference on or about October 12, 2005.

13

RESPONSE TO REQUEST NO. 43 Defendants will produce all documents responsive to this request by December 7, 2007.

14 15

REQUEST FOR PRODUCTION NO. 44 Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from

16 17

Chair of Kern Medical Center’s Pathology Department to staff pathologist.

18

RESPONSE TO REQUEST NO. 44 Defendants object to this request to the extent it requests documents that are privileged

19 20

under the attorney-client privilege. Without waiving this objection Defendants will produce all

21

non-privileged documents responsive to this request by December 7, 2007.

22

REQUEST FOR PRODUCTION NO. 45

23

Any and all DOCUMENTS RELATING To the “packets containing information about

24

Dr. Jadwin” which Peter Bryan collected at the end of Kern Medical Center’s Joint Conference

25

Committee discussion and vote on removal of Plaintiff from Chair of Pathology on July 10,

26

2006.

27

RESPONSE TO REQUEST NO. 45

28 20 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 209 of 245

Defendants are searching for documents responsive to this request. Because of

2

administrative and management changes at Kern Medical Center, it may not be possible to

3

reconstruct the “packets” requested. Defendants object to this request to the extent it requests

4

information protected by the peer-review or attorney-client privileges. Defendants also object to

5

this request to the extent it seeks documents that contain confidential personnel information.

6

Without waiving these objections, and to the extent that the “packets” can be reconstructed,

7

Defendants will produce all documents responsive to this request, if any, by December 21, 2007.

8

REQUEST FOR PRODUCTION NO. 46

9

Any and all DOCUMENTS RELATING TO YOUR decision to place Plaintiff on

10

administrative leave on or about December 7, 2006.

11

RESPONSE TO REQUEST NO. 46

12

Defendants object to this request to the extent it requests information protected by the

13

attorney-client privilege. Without waiving that objection, Defendants believe all documents

14

responsive to this request have been previously produced to Plaintiff. Defendants will confirm

15

this, or produce additional documents if necessary, by December 7, 2007.

16

REQUEST FOR PRODUCTION NO. 47

17

Any and all DOCUMENTS RELATING TO YOUR decision to restrict Plaintiff to his

18

home during working hours from on or about December 7, 2006 to on or about May 1, 2007

19

while he was on administrative leave.

20

RESPONSE TO REQUEST NO. 47

21

Defendants believe all documents responsive to this request have been previously

22

produced to Plaintiff. Defendants will confirm this, or produce additional documents if

23

necessary, by December 7, 2007.

24

REQUEST FOR PRODUCTION NO. 48

25

Any and all DOCUMENTS RELATING TO YOUR decision to lift the restriction of

26

Plaintiff to his home during working hours from on or about December 7, 2006 to on or about

27

May 1, 2007 while he was on administrative leave.

28

RESPONSE TO REQUEST NO. 48 21 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Page 210 of 245

Defendants believe all documents responsive to this request have been previously

2

produced to Plaintiff. Defendants will confirm this, or produce additional documents if

3

necessary, by December 7, 2007.

4

REQUEST FOR PRODUCTION NO. 49

5

Any and all DOCUMENTS RELATING TO YOUR decision not to renew Plaintiff’s

6

employment contract with YOU that was purportedly made on or about May 1, 2007.

7

RESPONSE TO REQUEST NO. 49

8 9

Defendants object to this request to the extent it requests information protected by the attorney-client privilege. Without waiving that objection, Defendants believe all documents

10

responsive to this request have been previously produced to Plaintiff. Defendants will confirm

11

this, or produce additional documents if necessary, by December 7, 2007.

12

REQUEST FOR PRODUCTION NO. 50

13

Any and all DOCUMENTS RELATING TO any discipline, coaching, reprimand or

14

corrective action taken against Plaintiff by YOU.

15

RESPONSE TO REQUEST NO. 50

16

Defendants believe all documents responsive to this request have been previously

17

produced to Plaintiff. Defendants will confirm this, or produce additional documents if

18

necessary, by December 21, 2007.

19

REQUEST FOR PRODUCTION NO. 51

20

Any and all DOCUMENTS RELATING TO Kern Medical Center’s Disruptive Physician

21

Policy, including but not limited to Bylaw Committee meeting minutes.

22

RESPONSE TO REQUEST NO. 51

23

Defendants object to this request to the extent it requests documents that contain

24

confidential personnel information, documents protected from disclosure by state or federal law,

25

including the HIPAA and the peer-review privilege, or documents that are subject to the

26

attorney-client privilege. Without waiving these objections, Defendants will produce documents

27

responsive to this request by December 7, 2007. Defendants will redact confidential peer review

28

and personnel information as appropriate. 22 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Filed 12/01/2008

REQUEST FOR PRODUCTION NO. 52 Any and all DOCUMENTS RELATING TO Dr. Rebecca Rivera’s lawsuit against Kern

3

Medical Center filed in Kern County California Superior Court.

4

RESPONSE TO REQUEST NO. 52

5

Page 211 of 245

Plaintiff has narrowed this request to eliminate any documents that have been filed with

6

the Kern County Superior Court. As so limited, this request seeks documents in the County

7

Counsel’s litigation file, many of which are protected by the attorney work product and attorney-

8

client privileges. To the extent this request seeks information that is protected by the attorney-

9

client privilege, Defendants object to it. Defendants also object to this request on the grounds

10

that it is not reasonably calculated to lead to the discovery of admissible evidence. Defendants

11

are in the process of reviewing documents that are may be responsive to this request and, without

12

waiving these objections, will produce non-privileged documents, if any, by December 21, 2007.

13

Defendants may redact privileged information if appropriate.

14

REQUEST FOR PRODUCTION NO. 53

15

Any and all DOCUMENTS RELATING TO services provided to YOU by the Camden

16

Group RELATING TO Kern Medical Center.

17

RESPONSE TO REQUEST NO. 53

18

Defendants believe all documents responsive to this request have been previously

19

produced to Plaintiff. Defendants will confirm this, or produce additional documents if

20

necessary, by December 7, 2007.

21

REQUEST FOR PRODUCTION NO. 54

22

Any and all DOCUMENTS RELATING TO statistics maintained by YOU RELATING

23

TO patient fatalities at Kern Medical Center from October 24, 2000 to the present.

24

RESPONSE TO REQUEST NO. 54

25

Defendants object to this request on the grounds that it calls for the production of

26

documents that contain confidential personnel information that is not relevant to any issues in

27

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

28

Defendants also object to this request to the extent it requests information protected from 23 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 212 of 245

1

disclosure by state or federal law, including HIPAA and the peer review privilege, and

2

documents that are subject to the attorney-client privilege. Without waving these objections,

3

Defendants will produce non-privileged documents responsive to this request, if any, by

4

December 21, 2007. Defendants will redact confidential and privileged information as

5

appropriate. If the redaction process renders the resulting document useless, Defendants will

6

inform Plaintiff.

7

REQUEST FOR PRODUCTION NO. 55

8 9

Any and all DOCUMENTS RELATING TO the review of Kern Medical Center’s placental evaluations and billing activity as conducted by outside consultants, including but not

10

limited to ProPay Physician Services, LLC, from October 24, 2000 to the present.

11

RESPONSE TO REQUEST NO. 55

12

Defendants object to this request on the grounds that it calls for the production of

13

documents that contain confidential personnel information that is not relevant to any issues in

14

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

15

Defendants also object to this request to the extent it requests information protected from

16

disclosure by state or federal law, including HIPAA and the peer review privilege, and

17

documents that are subject to the attorney-client privilege. Without waving these objections,

18

Defendants will produce non-privileged documents responsive to this request, if any, by

19

December 21, 2007. Defendants will redact confidential and privileged information as

20

appropriate.

21

REQUEST FOR PRODUCTION NO. 56

22

Any and all DOCUMENTS RELATING TO blood bank monthly reports, included but

23

not limited to reports generated by Michelle Burris, from January 2006 to present.

24

RESPONSE TO REQUEST NO. 56

25

Defendants object to this request on the grounds that it calls for the production of

26

documents that contain confidential personnel information that is not relevant to any issues in

27

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

28

Defendants also object to this request to the extent it requests information protected from 24 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 213 of 245

1

disclosure by state or federal law, including HIPAA and the peer review privilege, and

2

documents that are subject to the attorney-client privilege. Without waving these objections,

3

Defendants will produce non-privileged documents responsive to this request, if any, by

4

December 21, 2007. Defendants will redact confidential and privileged information as

5

appropriate.

6

REQUEST FOR PRODUCTION NO. 57

7

Any and all DOCUMENTS RELATING TO product chart copy-related quality assurance

8

reports from October 24, 2000 to the present.

9

RESPONSE TO REQUEST NO. 57

10

Defendants object to this request on the grounds that it calls for the production of

11

documents that contain confidential personnel information that is not relevant to any issues in

12

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

13

Defendants also object to this request to the extent it requests information protected from

14

disclosure by state or federal law, including HIPAA and the peer review privilege, and

15

documents that are subject to the attorney-client privilege. Without waving these objections,

16

Defendants will produce non-privileged documents responsive to this request, if any, by

17

December 21, 2007. Defendants will redact confidential and privileged information as

18

appropriate.

19

REQUEST FOR PRODUCTION NO. 58

20

Any and all DOCUMENTS RELATING TO prostate needle biopsy reports produced by

21

Dr. Elsa Ang for which Plaintiff had requested a lookback study in October 2005.

22

RESPONSE TO REQUEST NO. 58

23

Defendants object to this request on the grounds that it calls for the production of

24

documents that contain confidential personnel information that is not relevant to any issues in

25

this case and is not reasonably calculated to lead to the discovery of admissible evidence.

26

Defendants also object to this request to the extent it requests information protected from

27

disclosure by state or federal law, including HIPAA and the peer review privilege, and

28

documents that are subject to the attorney-client privilege. Without waving these objections, 25 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 214 of 245

1

Defendants will produce non-privileged documents responsive to this request, if any, by

2

December 21, 2007. Defendants will redact confidential and privileged information as

3

appropriate.

4

REQUEST FOR PRODUCTION NO. 59 Any and all DOCUMENTS RELATING TO sign-in sheets for Kern Medical Center’s

5 6

Cancer Clinic from January 1, 2003 to the present.

7

RESPONSE TO REQUEST NO. 59 Defendants will produce all documents responsive to this request by December 21, 2007.

8 9

REQUEST FOR PRODUCTION NO. 60 Any and all DOCUMENTS RELATING TO Workplace Violence or Threat Incident

10 11

Reports for all Kern Medical Center personnel from October 24, 2000 to the present.

12

RESPONSE TO REQUEST NO. 60

13

Defendants object to this request to the extent it seeks documents that contain

14

confidential personnel information or information protected by the attorney-client privilege.

15

Defendants also object to the extent the documents contain information protected by the peer-

16

review privilege and on the grounds that the request is not reasonably calculated to lead to the

17

discovery of admissible evidence. Without waiving these objections, Defendants will produce

18

all documents responsive to this request by December 21, 2007. Defendants will redact

19

confidential or privileged information as appropriate.

20

REQUEST FOR PRODUCTION NO. 61 Any and all DOCUMENTS RELATING TO Fine Needle Aspiration policies at Kern

21 22

Medical Center from October 24, 2000 to the present, including but not limited to

23

DOCUMENTS RELATING TO the outside consultant study conducted by Dr. David Lieu in

24

2004.

25

RESPONSE TO REQUEST NO. 61

26

Defendants object to this request to the extent it seeks documents that contain

27

confidential personnel information or information protected by the attorney-client privilege.

28

Defendants also object to the extent the documents contain information protected by the peer26 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 215 of 245

1

review privilege and on the grounds that the request is not reasonably calculated to lead to the

2

discovery of admissible evidence. Without waiving these objections, Defendants will produce

3

all documents responsive to this request by December 21, 2007. Defendants will redact

4

confidential or privileged information as appropriate.

5

REQUEST FOR PRODUCTION NO. 62

6

Any and all DOCUMENTS RELATING TO Peter Bryan’s appointment calendar from

7

January 1, 2004 to September 1, 2006.

8

RESPONSE TO REQUEST NO. 62

9 10 11 12

Defendants will produce all documents responsive to this request by December 7, 2007. REQUEST FOR PRODUCTION NO. 63 Any and all DOCUMENTS RELATING TO meeting minutes for the following Kern Medical Center committees or groups from October 24, 2000 to the present:

13

a) Medical Executive Committee

14

b) Joint Conference Committee

15

c) Quality Management Committee

16

d) Cancer Committee

17

e) Second Level Peer Review Committee

18

f) Transfusion Committee

19

g) Executive Staff Meetings

20 21

RESPONSE TO REQUEST NO. 63 Defendants object to this request to the extent it requests documents that contain

22

confidential personnel information or information that is protected from disclosure by state or

23

federal law, including HIPAA and the peer review privilege, or documents that are subject to the

24

attorney/client privilege. Without waiving these objections, Defendants will produce documents

25

responsive to this request by December 21, 2007. Defendants will redact confidential or

26

privileged information as appropriate.

27

REQUEST FOR PRODUCTION NO. 64

28 27 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1

Document 277-2

Filed 12/01/2008

Any and all DOCUMENTS RELATING TO policies of Kern Medical Center’s

2

Pathology Department from October 24, 2000 to the present.

3

RESPONSE TO REQUEST NO. 64

4 5

Page 216 of 245

Defendants will produce all documents responsive to this request by December 21, 2007. REQUEST FOR PRODUCTION NO. 65

6

Any and all DOCUMENTS RELATING TO case send-out logs for Kern Medical

7

Center’s Pathology Department from January 1, 1999 to the present, including but not limited to

8

corresponding Kern Medical Center pathology reports and reports from outside consultants.

9

RESPONSE TO REQUEST NO. 65

10

Defendants object to this request to the extent it requests documents that contain

11

confidential personnel information or information that is protected from disclosure by state or

12

federal law, including HIPAA and the peer review privilege, or documents that are subject to the

13

attorney/client privilege. Without waiving these objections, Defendants will produce documents

14

responsive to this request by December 7, 2007. Defendants will redact confidential or

15

privileged information as appropriate.

16

REQUEST FOR PRODUCTION NO. 66

17

Any and all DOCUMENTS RELATING TO monthly turn-around-time reports and logs

18

– by pathologist – for pathology reports processed at Kern Medical Center, including but not

19

limited to Pathology Department Semi-annual Reports to the Medical Staff, for the time period

20

from January 1, 1999 to the present.

21

RESPONSE TO REQUEST NO. 66

22

Defendants object to this request to the extent it requests documents that contain

23

privileged peer review information. Without waiving this objection Defendants will produce all

24

documents responsive to this request by December 7, 2007. Defendants will redact all privileged

25

information as appropriate.

26

REQUEST FOR PRODUCTION NO. 67

27 28

Any and all DOCUMENTS RELATING TO monthly or semi-monthly turn-around-time reports and logs – for Kern Medical Center’s Pathology Department as a whole – for pathology 28 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 217 of 245

1

reports processed at Kern Medical Center including but not limited to surgical pathology,

2

cytology and bone marrow reports, for the time period from January 1, 1999 to the present.

3

RESPONSE TO REQUEST NO. 67

4

Defendants object to this request to the extent it requests documents that contain

5

privileged peer review information. Without waiving this objection Defendants will produce all

6

documents responsive to this request by December 7, 2007. Defendants will redact all privileged

7

information as appropriate.

8

REQUEST FOR PRODUCTION NO. 68

9

Any and all DOCUMENTS RELATING TO PATHOLOGY REPORTS authored,

10

reviewed or approved by Plaintiff which YOU sent to any outside pathologists for outside review

11

from June 14, 2006 to the present.

12

RESPONSE TO REQUEST NO. 68

13

Defendants object to this request to the extent it requests documents that contain

14

privileged peer review information. Without waiving this objection Defendants will produce all

15

documents responsive to this request by December 7, 2007. Defendants will redact all privileged

16

information as appropriate.

17

REQUEST FOR PRODUCTION NO. 69

18

Any and all DOCUMENTS RELATING TO PATHOLOGY REPORTS RELATING TO

19

Case Numbers S06-4131, S06-4619, S06-5229, S06-73276.

20

RESPONSE TO REQUEST NO. 69

21

Defendants object to this request to the extent it requests documents that contain

22

information that is confidential under HIPAA. Defendants also object to the extent that it

23

requests documents that contain privileged peer-review information. Without waiving these

24

objections Defendants will produce all documents responsive to this request by December 7,

25

2007. Defendants will redact confidential and privileged information as appropriate.

26

REQUEST FOR PRODUCTION NO. 70

27 28

Any and all DOCUMENTS RELATING TO peer review RELATING TO Kern Medical Center’s Pathology Department during the time period from January 1, 1995 to the present, 29 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 218 of 245

1

including but not limited to computer-generated data, monthly peer review records completed by

2

pathologists, and peer review comment sheets that are completed by pathologists upon discovery

3

of a discrepancy.

4

RESPONSE TO REQUEST NO. 70

5

Defendants object to this request on the ground that it requests privileged peer-review

6

information. Defendants also object on the ground that it requests information that is

7

confidential under HIPAA and not reasonably calculated to lead to the discovery of admissible

8

evidence. Without waiving these objections, Defendants will produce documents responsive to

9

this request by January 7, 2008 if it is possible to redact the confidential and privileged

10

information without rendering the resulting document useless.

11

REQUEST FOR PRODUCTION NO. 71

12

Any and all DOCUMENTS RELATING TO exceptional event logs for histology and

13

pathology on Kern Medical Center’s Pathology Department from January 1, 2006 to the present.

14

RESPONSE TO REQUEST NO. 71

15

Defendants object to this request to the extent it requests documents that contain

16

information that is confidential under HIPAA. Defendants also object to the extent that it

17

requests documents that contain privileged peer review information. Without waiving these

18

objections Defendants will produce all documents responsive to this request by December 7,

19

2007. Defendants will redact confidential and privileged information as appropriate.

20

REQUEST FOR PRODUCTION NO. 72

21

Any and all DOCUMENTS RELATING TO paper accession logs at Kern Medical

22

Center’s Pathology Department from January 1, 2006 to present.

23

RESPONSE TO REQUEST NO. 72

24

Defendants object to this request to the extent it requests documents that contain

25

information that is confidential under HIPAA. Defendants also object to the extent that it

26

requests documents that contain privileged peer review information. Without waiving these

27

objections Defendants will produce all documents responsive to this request by December 7,

28

2007. Defendants will redact confidential and privileged information as appropriate. 30 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1 2

Document 277-2

Page 219 of 245

REQUEST FOR PRODUCTION NO. 73 Any and all DOCUMENTS RELATING TO tissue disposal records for skull-flaps from

3

January 1, 2006 to the present.

4

RESPONSE TO REQUEST NO. 73

5

Filed 12/01/2008

Defendants object to this request to the extent it requests documents that contain

6

information that is confidential under HIPAA. Defendants also object to the extent that it

7

requests documents that contain privileged peer review information. Without waiving these

8

objections Defendants will produce all documents responsive to this request by December 7,

9

2007. Defendants will redact confidential and privileged information as appropriate.

10

REQUEST FOR PRODUCTION NO. 74

11

Any and all DOCUMENTS RELATING TO audits of Kern Medical Center’s Pathology

12

Department by outside consultants, including but not limited to Dr. Stacey Garry, from October

13

24, 2000 to the present.

14

RESPONSE TO REQUEST NO. 74

15

Defendants object to this request to the extent it requests documents that contain

16

information that is confidential under HIPAA. Defendants also object to the extent that it

17

requests documents that contain privileged peer review information. Without waiving these

18

objections Defendants will produce all documents responsive to this request by December 7,

19

2007. Defendants will redact confidential and privileged information as appropriate.

20

REQUEST FOR PRODUCTION NO. 75

21

Any and all DOCUMENTS RELATING TO Kern Medical Center laboratory personnel

22

defections from June 14, 2006 to the present, including but not limited to exit interview notes.

23

RESPONSE TO REQUEST NO. 75

24

Defendants object to this request on the grounds that it is vague. Defendants do not know

25

what “personnel defections” means. If Plaintiff intends to request a list of employees who have

26

separated from County employment or transferred out of the laboratory, Defendants can prepare

27

such a list but Defendants believe such a list will need to be redacted to remove confidential

28

personnel information. Defendants will produce a list of employees who have separated from 31 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 220 of 245

1

County employment or transferred out of the laboratory by December 21, 2007 and will redact

2

the information as appropriate.

3

REQUEST FOR PRODUCTION NO. 76

4

Any and all DOCUMENTS RELATING TO dictation transcription logs for Plaintiff

5

from June 14, 2006 to the present.

6

RESPONSE TO REQUEST NO. 76

7 8 9

Defendants will produce all documents responsive to this request by December 7, 2007. REQUEST FOR PRODUCTION NO. 77 Any and all DOCUMENTS RELATING TO dictation transcription logs for Dr. Philip

10

Dutt from June 14, 2006 to the present.

11

RESPONSE TO REQUEST NO. 77

12 13 14

Defendants will produce all documents responsive to this request by December 7, 2007. REQUEST FOR PRODUCTION NO. 78 Any and all DOCUMENTS RELATING TO placental evaluations conducted by Plaintiff

15

from June 14, 2006 to the present.

16

RESPONSE TO REQUEST NO. 78

17

Plaintiff has attempted to narrow this request but the revised request is broader, more

18

burdensome and less calculated to lead to the discovery of admissible evidence than the original

19

request. Defendants object to it for that reason. Defendants object to this request because it is

20

not reasonably calculated to lead to the discovery of admissible evidence and is burdensome.

21

Defendants also object to this request on the grounds that it seeks information that is shielded

22

from disclosure under HIPAA. There are thousands of placental evaluations for the time period

23

specified and they are not centrally filed or maintained. Locating ones conducted by Plaintiff

24

will require writing a computer program that will sort the files. After the files are sorted, it will

25

require a manual review of each file to find the placental evaluation. It will have to be copied

26

and redacted and copied again. Defendants estimate it will take approximately 90 days to

27

comply with this request. Without waiving these objections, Defendants will attempt to locate,

28

copy and produce the documents requested 32 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

1 2 3 4

Document 277-2

Any and all DOCUMENTS RELATING TO Golden Empire Pathology Associates. RESPONSE TO REQUEST NO. 79 After diligent search, Defendants’ have not been able to locate any documents that are responsive to this request.

6

REQUEST FOR PRODUCTION NO. 80

8 9 10

Page 221 of 245

REQUEST FOR PRODUCTION NO. 79

5

7

Filed 12/01/2008

Any and all DOCUMENTS RELATING TO Golden Empire Medical Group. RESPONSE TO REQUEST NO. 80 After diligent search, Defendants’ have not been able to locate any documents that are responsive to this request.

11 12 13 14

Dated: November 20, 2007

LAW OFFICES OF MARK A. WASSER

15 16 17 18

By:

/s/ Mark A. Wasser Mark A. Wasser Attorney for Defendants, County of Kern, et al.

19 20 21 22 23 24 25 26 27 28 33 DEFENDANTS’ RESPONSES TO PLAINTIFF’S REQUEST FOR PRODUCTION OF DOCUMENTS

Case 1:07-cv-00026-OWW-TAG

Document 277-2

Filed 12/01/2008

Page 222 of 245

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 18

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

23

CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 223 245Care Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the of Health Quality Improvement Act of 1986 (P.L 99-660).

.KERN

~•

JOINT CONFERENCE COMMITTEE MEETING MINUTES September 10, 2007

MEDICAL

CENTER

Attendance Record:

Call to order: 12:10 p.m. J

M

J

J

A

P P Supervisor Don Maben* P - P Supervisor Ray Watson* P P P - P Paul J. Hensler, CEO* - P P Toni Smith, R.N.* P P - P Eugene Kercher, MD * P P P - P P P Scott Ragland, DO * P P Jennifer Abraham, MD* - Fred A. Plane, CFO P P P Ron Errea, CAO - P *Votmg Committee member. Guests: Karen Barnes, Chief Deputv County Counsel ITEM CONCLUSION

P P P P

-

P E

P P P P P P

-

-

P

P

-

1. Call to order

2. Approval of

F

-

-

M

Adjournment: 1:30 p.m.

A

-

-

-

-

-

-

-

S

4. President Elect/Past President Eugene Kercher, MD

N

D

P P P E P P P P P

Dr. Kercher announced that Jennifer Abraham, M.D. has been appointed as the President-Elect of the medical staff. Therefore, the meeting was called to order at 12:10 p.m. by Dr. Abraham as Dr. Ragland was going to be late. The minutes from July 9, 2007 were approved as written.

minutes from June

11,2007 3. Board of Supervisors

a

ACTION! FOLLOW-UP

M/S/C to

approve minutes

Supervisor Maben commented that the contract with SEIU has been ratified by the members and it will go to the BOS in the near future. The Medical Executive Committee had recent discussion on placement of patients and this is a work in progress. They are working diligently on the credentialing piece, proctoring of folks immediately without waiting, following the bylaws so they are in compliance with the law - Dr. Abraham is personally welcoming the opportunity for improvement. KMC had a local doctor who worked Friday and Saturday to work on proctoring the current anesthesia group. We brought in locum tenens because we don't have anything in place to proctor locum tenens. We will put something in place for this to not happen in the future. This was a learning experience. Both Drs' Kercher and Abraham will fix this. On the positive side, when the locum tenens came and there were issues, there was a process put in place for them to be ALS certified, etc. Paul has not been pleased how Somnia is handling this. The chair they appointed did not like the way KMC told them that they cannot proctor, it must be done outside of Somnia. They are still to this day not being friendly about this issue. They think they can choose their own proctor. They need to have six cases proctored. Once the first three doctors are proctored, then they can proctor the rest. There is a perceived conflict of interest if we are proctoring these three and they can proctor the remaining. If these 3 cannot pass the proctoring, they cannot proctor the remaining. Dr. Abraham's been told the experienced anesthesiologists are on call in the evening and the weekends. Maybe our proctorer can come in for a whole week to proctor all of them. Paul said that we're asking CMS to come back on Friday to do a re-survey. It would be great if we can show these three physicians have been proctored. Supervisor Watson said that the most important thing is for Somnia to know who's in charge and it's not

0009919 0009919

CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 224 245Care Code Section 1157. Further protections are afforded the quality management and performance improvement processes under theof Health Qualitv Improvement Act of 1986 (P.l. 99-6601.

5. Psych Issues Paul Hensler

them. The hospital can reject their Chair and two physicians without cause. The appointment of a chair requires approval of the CEO and the hospital has the opportunity to reject two doctors per year, for any reason. If things don't shape up, we'll need to talk with the MEC about it. The first thing we should do is reject the Chair. The rejection should come from the MEC, but can come from the CEO. Psychiatric issues have been longstanding. Issues revolve around 5150s that have been escaping and the fact that we're holding them because we don't have beds to move them into. The State has visited us over the year. The Mental Health department became concerned. Paul had one meeting with them, they wanted us to move them to beds, we couldn't do this without going through the right channels. Paul said patients are better off if we're closed and the MH advocate agreed. The MH advocate filed complaints with the state, they saw us in between a rock and a hard place, he made 5 complaints that were unsubstantiated, then he made 2 more, they came out and did a review, and that put us in "immediate jeopardy." The Feds came in on 8/30 and did a survey, they found credentialing errors and our plan of correction had not been carried out. The psych portion is the facility capacity, we are using a portion of ER for emergency psych (EPAC) and upstairs for in-patients. ED is over-crowded, we don't have the proper facility, making it easy for escapes. They end up spending more than 24 hours downstairs, sometimes more than a few days. A lot of their findings were surrounded around capacity issues, not protecting patient privacy, safety issue of escape and employees. We failed to organize the emergency services under a qualified medical director. By running two operations down there, communications broke down. The MH people are trying to contract for more services, including Good Sam who has 10 beds. We put ED under Dr. Kercher and Dianne McConnehey's control to do what must be done. Since then, we've had no elopements. One is controversial, we are to divert ambulance traffic once we don't have capacity. We are to the point we are doing everything we can do. We will submit a final report, they return in two days to determine if we are sufficiently in compliance to remove the fast track. They gave us until 9/30, then they can cease Medicare funding. The backup is to schedule a Belienson Hearing to terminate psych patients at the hospital. If everything we have done is not effective and they are ready to pull our funding, we are better to terminate psych services rather than having the whole ship come down. Where the patients would go is the problem. We hope not to do it, but we can't survive on 25% of what Medicare pays us. A lot of local people would have to go out of the area. We are seeing families dropping off Grandma because they can't care for her anymore. We must bring a lot of the county services together for these populations. Supervisor Watson asked what it would take to license beds upstairs. That's not feasible. We are not making headway in the MKS bldg. Dr. Kercher said the MKS bldg would be perfect. It's solid, stone, you can add stories to it and the ED is close by. He doesn't know what the obstacles are, but possibly the current occupants don't want to give it up. Dr. Kercher has been talking about this for two years. Supervisor Watson said that he, Ron Errea and Supervisor Maben need to talk with Diane Koditek. Dr. Kercher said that would be a huge unloading from our ED if patients could be done at MKS. Paul said that another immediate thing we can do it to take some of the 2C rooms and convert them to in-patient rooms, 4 per room, 2 staff members per 4 patients. Ron Errea said that Paul and Fred are working with Diane on a MH contract for provider beds with Good Sam. Good Sam seems to recognize that we are over a barrel and may take advantage of that financially. Should that fall through, we may have to move patients out of the county to address the problem. This is not a preferred option. The county will get stuck with the transportation tab if we go out of county. It might be better to pay what we have to and work hard to not utilize them more than we have to. Paul

0009920 0009920

CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 225 of 245 Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the Health Care Qualitv Improvement Act of 1986 (P.L. 99·660\.

6. OB Issues Paul Hensler

7. Adjournment

Hensler said that we are also looking at construction of a free-standing facility. General Services is looking at property and an architect to see the feasibility. It can be done in 18-24 months. A better payer mix can come out of that also. Although we are focusing on psych, capacity issues will hit us in other areas as well, Le., trauma issues. Dr. Yoo has also shared an IDT team that comes in to help facilitate discharges. Good news in OB. Dr. Wallace has done a good job getting discipline. The RRC Survey was done recently and there was a lot of concem from the residents who are being torn in the middle, but interviewing residents they are in support of the changes Wallace has imposed. Somebody had broken into the residency coordinator's office, vandalized the computer and monitor. When Dr. Wallace announced he wanted the place fingerprinted, Dr. Perez went and put his fingerprints on everything. Dr. Wallace decided to write it up as disruptive physician, it then went to MEC, they decided it was beyond them. Regarding the chainnanship issue, Karen is renegotiating a new contract. The problem is is that he can appeal. Dr. Kercher said that he and Dr. Ragland got together with Dr. Perez and Perez denied the significance of the issue. Dr. Perez said that "when Lascano leaves, I'll be next." MEC recommended the three of them meet with letters of concern. Dr. Kercher was impressed that the secretaries confinned that he did touch the computer. MEC made a decision to not get into a political fight, and for Karen to write a letter of reprimand. The DA's office is investigating the incident. Investigator met with Dr. Wallace and will come back to meet with secretarial staff this Thursday. Can this be used to get Perez out of chainnanship? This is concerning that the CEO does not have the authority to decide who is going to chair a department. The problem is we have tied a portion of the chair's compensation to that position, that is a property right. Dr. Perez is entitled to due process hearing for this reason. Karen proposes drafting a policy similar to the Faculty Practice Plan that will give him the opportunity to ask for a hearing, with the CEO having authority over the outcome. What if we give him additional clinical duties for the money we are giving him as chair? The appeals process needs to go into effect immediately. How can we legally give the CEO more authority to hire and fire chairs. We need to get out of this problem. Karen Barnes is looking into this. Contract given to recruiter for pennanent chair position and Dr. Wallace is interested. Selection committee is directed by the Bylaws. Except for the property rights issue, everything else will be governed by the Medical Staff Bylaws. The appeals process should be completed within the month, putting it on the fast track. The meeting adjourned at 1:30 p.m. The next meeting is scheduled for October 8,2007.

Submitted by:

~

Scott Ragland, D.O. Chairman abra Minutes recorded and transcribed by Arlene B. Ramos-Aninion, Office Services Coordinator

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27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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to changes in job requirements, increase the effectiveness of supervision and management, and improve employee-management relations through increased understanding of organization objectives. Continuing education programs are subject to the provisions in Chapter 3. 136. Performance Evaluations. Employee performance evaluation reports are submitted to the Personnel Department at the three and six month probationary dates, and annually on the hiring anniversary date. For those etnployees subject to a twelve month probationary period (Fire Fighters, Sheriff's Deputies, and Park Rangers), evaluation reports are filed at three, six, nine and twelve month intervals from date of hiring, and thereafter annually on the hiring anniversary. The evaluation foIm, which specifies the due date, will be sent to each department head approximately two pay periods in advance. Those performance evaluations that are completed by a department or agency head are submitted to the County Administrative Office for review. The affected employee may meet with the County Administrative Officer to discuss the evaluation

.1 Process. The mechanics of the performance evaluation are explained in the Rater's Guide for Employee Performance Reports. Department heads are to ensure the employees are counseled on their performance. The employee's signature is required on the report. An employee who disagrees with the rating may file a written statement of reasons within 30 days after the date the evaluation is prepared. This statement must be signed by the employee and department head, and attached to each copy of the rating form. .2 Record Maintenance. The Personnel Director maintains records of evaluation ratings for use in promotional examinations, determining order of layoff and reinstatement, and for recommendations relating to transfer, demotion, and removal. The department retains a copy for the employee's file. .3 Tennination. A performance evaluation report must be completed when employment is terminated, including retirement. These reports may be used if reinstatement or reemployment is considered. 137. Special Performance Evaluations. A special performance evaluation should be completed when a change ofraters occurs within an annual cycle and at any time for commendation or disciplinary action. 138. Service Awards. The Personnel Department will send a packet containing the employee's name, service length, and a catalogue from which the employee may select an award. Service awards are presented upon 10, 20, 25, 30 and 35 years of service and are recommended to be presented to the employee by the department head during a department meeting.

.1 Board of Supervisors' Resolution. Employees receiving a 25 year service award and employees retiring with 25 or more years of service will receive a Board of Supervisors Resolution. A request for Resolution should be placed on the departmental sub-agenda. Public presentation of the Resolution is at the option of the employee. .2 Retiring Reserve Deputy Sheriffs. A reserve deputy sheriff retiring after 15 or more years of service will receive a retirement badge or other suitable item in recognition of the deputy's meritorious service. The design, engraving, and type and manner of presenting of the badge is at the discretion of the Sheriff, except that the badge must clearly show that the bearer is not a County employee or a reserve deputy sheriff. 139. Disciplinary Actions. Any employee may be dismissed, suspended, reduced in rank and/or compensation, reprimanded or otherwise disciplined for any action or conduct which in the judgment of the appointing authority provides good cause for discipline under the Civil Service Rules or other laws, regulations, or policies. Civil Service Rule 1700 et. seq. specifies the procedures for dismissal, suspension or reduction in rank or compensation for employees in the classified service.

.1 County Counsel Review ofProposed Disciplinary Action. The department head must consult with County Counsel prior to any suspension without pay, demotion, compensation reduction, or termination. County Counsel will evaluate the merits of, and evidence to support, the disciplinary action and make a recommendation. County Counsel, as a rule, will not represent a department before the Civil Service Commission unless that office has been afforded an opportunity to make a thorough assessment of the discipline case before the disciplinary action is commenced by the issuance of a notice of proposed action letter (i.e., Skelly

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letter) by the department. If County Counsel determines that the proposed disciplinary action is warranted, it may represent the department in disciplinary actions before the Civil Service Commission.

.2 Reprimand. Reprimands may be verbal and/or written, and in caSes where the reprimand does not require any action of dismissal, suspension, or compensation or rank reduction for employees in the classified service, the department head is not compelled to follow the Civil Service Rule 1700 procedures. A performance evaluation report, or formal written memorandum or letter should be used in cases of reprimands to provide a permanent record of the cause of the disciplinary action, discussion with the employee, time limits for correction of the problem, suggestions for improving performance, and any other related items. The completed report, memorandum, or letter should be forwarded to the Personnel Department and a copy placed in the departmental file. The employee may file a written response within 30 calendar days of the date of reprimand.

.3 Demotion-Step Level. An employee who is demoted for disciplinary pmposes from one class position to another class position with a lower pay range shall receive the step level compensation determined by the department head unless otherwise established by the Civil Service Commission after an appeal of the disciplinary action. The anniversary date of the employee will not change. .4 Compensation Reduction. The department head may, for disciplinary purposes, reduce an employee's compensation without a demotion to a lower classified position by ordering the employee's step level changed to a lower step level.

.5 Voluntary Demotion. Any employee who takes a voluntary demotion from one class position to another class position, with a lower range of pay, shall receive a step level compensation agreeable to both the employee and the Department. The employee must have permanent status with the County prior to the demotion and will demote with permanent status. The anniversary date of any employee so demoted shall remain the same as it existed prior to his/her demotion. .6 Administrative Leave with Pay. A department head may place an employee on administrative leave with pay if the department head determines that the employee is engaged in conduct posing a danger to County property, the public or other employees, or the continued presence of the employee at the work site will hinder an investigation of the employee's alleged misconduct or will severely disrupt the business of the department. During the administrative leave, the employee shall be ordered to remain at home and available by telephone during the normally assigned work day. A department head may, if necessary, adjust the employee's work schedule to provide availability during normal business hours, Monday through Friday, 8:00 AM to 5:00 PM. A department head may not order an administrative leave with pay for a period in excess of five assigned workdays within a single pay period without the written authorization of the Employee Relations Officer in the County Administrative Office. Changes in duty status following the issuance of a notice of proposed action are as provided in Civil Service Rule 1700 et. seq., not this section. 140.

Hearings and Appeals.

.1 Suspension, Demotion, Compensation Reduction, or Termination. A permanent employee is entitled to appeal a suspension, compensation reduction, demotion, or termination as a disciplinary action to the Civil Service Commission. .2 Step Level Increment Denials. Any employee who has not received a step level advancement as provided in section 110 because of the refusal or failure of the employee's department head to recommend such advancement or because of the refusal or failure of the Personnel Director to approve such advancement, may appeal to the Civil Service Commission for a hearing on the question of the right of the employee to receive such step increase by filing a written appeal with the Personnel Director. The Commission shall set and conduct a hearing on the matter in due course in accordance with its rules, policies and practices. Within 10 days of the conclusion of the hearing the Civil Service Commission shall determine whether or not the appellant has capably and conscientiously performed the duties of his position for the period

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of one year immediately preceding the employee's anniversary date, and whether or not the failure or the refusal of the department head or the Personnel Director to approve the step level increase was arbitrary or unreasonable. The decision of the Commission shall be fmal for all purposes. .3 Salary Range Adjustment Denial. Whenever the salary range for a classification is adjusted, and the department head determines under section 109.6 that there is cause not to grant the compensation increase, the department head may deny the raise to the employee and may place the employee at a step level within the salary range for the position which most closely corresponds to but is not less than the compensation that the employee was receiving prior to the salary range adjustment for the position. The employee may appeal the department head's decision to the Civil Service Commission, which shall here the matter in accordance with the procedures and rules for reductions in compensation generally. .4 Performance Evaluation Reports. Performance evaluation reports represent the judgment and opinion of the department head with respect to an individual's performance on the job and are not subject to a formal appeal and hearing.

141. Physical Examinations. An employee may be required at any time to take a medical, physical, and/or psychological examination to determine whether the employee meets the medical and physical standards prescribed for the position. The department head or the Personnel Department may request an examination. 142. Conflict of Interest. Ordinance Code Chapter 2.02 establishes the policy and procedures relating to activities of officers and employees that are inconsistent, incompatible, or conflicting with the duties of public office or employment. Department heads are responsible for developing "regulations determining and prescribing employments, activities, and enterprises which are prohibited as being inconsistent, incompatible or in conflict with their duties as employees." Each employee must sign and date a statement that he/she has read, understood, and is in compliance with the Ordinance Code and the departmental regulation relating to conflict of interest. The department maintains an internal file of its employees' statements. 143. OvetpaymentlUndetpayment of Wages or Benefits--Correction. If an administrative error results in an employee receiving payment for wages or benefits in excess of that legally due, the employee will reimburse the County. Corrections are initiated by completion of a Request for Correction of Payroll form signed by the department head and the employee which the department shall forward to the Personnel Department for review and approval. The Personnel Department shall forward the form to the Auditor-Controller-County Clerk for approval and processing. The correction will be by one or more of the following methods as deemed appropriate for the circumstances by the Auditor-Controller-County Clerk: 1.

Repayment in cash, net of taxes, in full or by a fixed installment plan agreed to by the employee and the Auditor-Controller-County Clerk;

2.

Repayment in full, deducted from the next payroll warrant issued to the employee;

3.

Repayment by the reduction of accumulated vacation hours and/or compensatory time off hours by the number of hours calculated to produce a dollar amount, net of taxes, to repay the County;

4.

Repayment by fixed installment deductions from sequential payroll warrants, with the number and amount of installments to be determined by the Auditor-Controller-County Clerk, with due consideration of the amount of the overpayment and the amount of disposable earnings available to the employee; or

5.

Any combination of the above, as mutually agreeable to the employee and the AuditorController-County Clerk.

If, as a result of an administrative error, any employee of the County receives payment of monies or benefits less than that legally due, the County will reimburse the employee by one or more of the following methods:

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EXHIBIT 20

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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March 12, 2002

Jose Perez Jr., MD President Medial Staff 1830 Flower Street Bakersfield, CA 93305

RE: Corrective Action Investigation Special Meeting Report Dear Jose Perez Jr., MD,

~

&>rrective~tion~

Pursuant to Kern Medical Centers, Medial Staff Bylaws articl£ 7.I-3;r;vestigation5'a special meeting was convened upon receipt of a compliant from" Elsa P. Ang, MD, agaiJ:t.sl David Jadwin,DQ, Chair of the department ofPatbology._'~ meeting was held on March 11, 2002 chaired by 'myself Chief Medical Officer, Jose Perez, Jr., MD, President ofthe Medical Staff, Royce Johnson, MD, Past President of the Medical Staff, Navin Amin, MD, President Elect of the Medical Staff, J~m~.~p.f2\lI, MD, secretary treasure of the Medical Staff, and Mr. Peter Bryan, CEO;,~ allegations -were itptified in the Febr;uary 20, 2002 letter to Jose Perez, MD from Elsa P. Ang, MD. Ther~ ~ aUegatio~~fraudulent billing in the department ofPathology;'a pathology assistant engaging in the practice of medicine without a license; ~t David Jadwin, DO, failed a quarterly proficiency test on cervical pap smears', and that David Jadwin, DO, engages in frivolous spending by sending work outside of the laboratory.

;4

After thorough investigation of all documents submitted by both parties and after extensive interviews with both physicians, David Jadwin, DO, Chair of theJlepartment of Pathology and Elsa PAng, MP, <:0II:1plaj!!anj. frhe f()~lo_\\Ti!lg c()nclusions ~c:~ unanimously concluded./,Fraudulent biJlin~lJ.o eVidence of fraudulent billing could be ,.- id~ntified.J Pathology.assistant. en~g-mgjnr.-~e ~~!~c~!If Predicine withou! a license; dO,: .'.. eVIdence to support this allegatlOn,""f: the pathology asSIstant P,;:' ,: "' 1.-"'(::;"-:~; , j"" wor~ undefdefmed pr~tgcol approved by the department~~l}.!!Yff;T a;ear ago! The :r-if';~\;in;': quarterly profici:ncy tests'n"ot ~wa~~~oJ?~te)~dgment as ili'ejPi-oe:e~~~ i~ e,l~c: by the " College of Amencan Pathologlst ~Ys mdlvIdual pathology vanatIon but.ffie eIghty percent requirement is for the entire laboratory service at KM<; for which~~lias been compliant for years.'1Frivolous spending outside of the department; fib inappropriate expenditures have been identifieJ!JU1d as per the contract David J~win, Mo, has complied by no payments made'~ his personal reference lab and'n~ payment has been· verified.

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with~cle fJJ~n th~

In conclusion;the committee in compliance of Kern Medical Center bylaws 7.1-3j'nvestigation and 7.1-4 Executive~ommitteei'3ction, the recommendation is No corrective action. Complete documentation of the detailed investigation is in the Medial Staff office.

Sincerely,

Marvin o. Kolb, MD Chief Medical Officer

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Minutes from investigation

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Minutes from the Investigation of the allegations-£.Elsa P. Ang, MD against David Jadwin, DO, Chainnan of the department of Pathology. " I . . . . . , • This investigation is iiitd¢{i~' ~pMis ~~ h;fa~si~i~l~ ~'c!Orrective Action 7.13)nvestigatiom This investigation was convened within fifteen business days and included the officers of the Medical Staff, Chair of the department involved, Medical Director, and the CEO. Present at this meeting,Peter Bryan, CEO, Jose Perez Jr., MD, President ofthe Medical StatI, Royce Johnson, MD, Past President of the Medical Staff, Navin Amin, MD, President Elect of the Medical Staff, James Sproul, MD, Secretary treasure to the Medial Staff, and Marvin O. Kolb, MD, Chief Medical Officer. During the investigation both David Jadwin,~, Chair of Pathology and Elsa P. Ang, MD were ~tensively interviewed at separate times.. I (f Compliant #1 fraudulent ~?lIing. .,di.;/ ~u';.~': . Numerous documentationi!~.d the complainant identified billing code 88342 for an examination and interpretation ofa~inoperioida1e strain<;d by a pathologist which David Jadwin, MD, Chair of Pathology had'asked the Pathologist to continue to bill for even though the service was discontinue4{in~'April of2001. As identified during our i~vestigati0I)the ~eason for ~s conti?ued bill~g by KMC ~s because KM~ .is being ,f , .'./ bIlled by the outSIde PatholOgIst that IS now domg that servIce - therefore It IS past_ 'hv~{;"VP; billing. Th~=mvestigation p~s did identify that this pass through process needs to be . reevaluated to ensure that aU proper billing procedures and past due activities are " consistent and appropriate. Di' ;~(,.; .,_~'i. . ... " i . , " ,,' I c.' {' . Conclusion: No evidence of fraudulent billing was identified. The complainant also expressed':~etibe CPT cod~PYth~t'a13innanof the department. This was a process put into place by the Cha}~~~~.~~(~er~;~!,f?llRw3~~,~~ ~.; rl discussion with the individual members and;qt a;e department 'meetings~ • ~ deparim~~ with the intent being consistent and appropriate coding1Woc~intation.~~~fb[,thup codes and down codes and code changes involving all department members. The complainant did state, "She did not have any problems with the changing ofthe codes" but was more concerned with the fraudulent billing regarding compliant # 1. .. . fall-the documentsthecomnrittee telfthere--was-no ... evidenceofnaudulent·billing. CQ!l.f~fm~~at.fue.1>athologydepMtmeitt nee
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requisition cards for all placenta's first in order to identify those placenta's which Angie should or should not gross' and 'placenta's associated with f e t a l . should be completed by the pathologisf'. \ Conclusion # 2: After revieWQ,f the policy, which ha$. been discussed by the department in March of200]1fie'dis~U'~sibn ~ in variouS,fueetings it appears there was no evidence to substantiate the allegation that the pathology assistant was working beyond the scope ~fined in the policy. " ,_ ,/ Allegation #3 ./ David Jadwin, DO, failed to pass quarterly proficiency tests on cervical pap. The allegation was the other three Pathologist had maintained proficiency. The College of American Pathologist provide a service that KMC has participated in whereby quarterly cervical pap smears are forwarded to Pathologist for review. We were given by Elsa P. Ang, MD one quarters reports which showed David Jadwin, DO at sixty percent and two of the other pathologist at eighty percent and one with one hundred percent. Not included in Elsa P. Ang, MD, packets were two other quarter reports from 2001 which identified variations; one quarter all ~!hologist scored between eighty and one hundred percent and another quarter showed ':!Pathologist (not David Jadwin, DO, or Elsa P. Ang, MD) at only twenty percent. The issue is the cervical pap survey given by the College of American Pathologist is a continuing education process for the pathologist.amt1Jie eighty percent complianc~ is for the entire lab-~ KMC has been in compliance with over eight percent during thtd'it-ation , of the testing by CAP. It also ShR}~~~')b~p5}tej that since KMC has only a~proximately i}" five thousand pap smears a year ~prohciency of close to ten thousang ~s needed for continued competenc, so- therefme the service has been out sourceg{~dlh~s this CME i'~' activity with the College of American Pathologist will be discontinued. Conclusion # 3: Misinterpretation ofthe data,Ho evidence of deficiency in proficiency testing from the College of the American College of Pathologist were identified. Allegation # 4: David Jadwin, DO, Chair of Pathology engages in frivolous spending by _ spending work to outside laboratories when not necessary. This allegation-thaHhere i-:-;O:;{;-! -- .,: :.' were a few cases that were sent out to other Pathologist for evaluation, a process that has been ongoing at Kern Medical Center forever. The allegation that David Jadwin, DO , .,:.,- sent this to his private laboratory in New Jersey, Lakewood Pathology Associates for a -~:'\~. remu,nira-tion was unfounded. We documented no payments to David Jadwin, DO, Lakeview Pathology Lab, nor was if felt the referrals to outside Pathologist were ~~"\.\,\· ..lL;: '.-f i inappropriate. However there were a few de.:m•..,1 path slides!to Lakewood pathology tt/ j done without charge by~the lal>O~atory pn-DtnioWudw4h, ~fBf¥CCf8C9t: '.IJ;.:_" -';,', ,_ Conclusion # 4: Allegations regarding outsid~ ~~fe.JElI\V.o~~~~not s!l:bstantia~· \ " ',' /~ The conclusion of our investigation incompliance with,&-ticle ~ of the Kern Medical ,'- tj !,~ '" ,,' Center 'Bylaws for correctivelclctionJti~estigation7.1-3·b.ecutiveComrnittee$ivestigation 7.13-4', our.;\:;e~~iiimendation iii A. no correction actionindicated. A'

:,!:-'.

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Marvin O. Kolb, MD Chief Medical Officer

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,. , ..

ARTICLE VII CORRECTIVE ACTION

7.1

ROUTINE CORRECTNE ACTION

7.1-1

CRITERIA FOR INITIATION

Whenever a practitioner with clinical privileges shall engage in, make, or exhibit acts, statements, demeanor, or professional conduct, either within or outside of the Medical Center, and the same is, or is reasonably likely to be, detrimental to patient safety or to the delivery of quality patient care within the Medical Center, to be disruptive to Medical Center operations, or to constitute fraud or abuse; or the same results in the. imposition of sanctions by any governmental authority, and investigation or corrective action against such person may be requested by any Medical Staff member, by the Board, or by the Chief Executive Officer.

7.1-2 INITIATION Proposed corrective action, induding a request for an investigation, must be initiated by the Executive Committee on its own initiative or by a written request which is

submitted to the Executive Committee and identifies the specific activities or conduct which are alleged to constitute the grounds for proposing an investigation or specific corrective action. The President shall promptly notify the Chief Executive Officer and Board of all proposals for corrective action so initiated and shall continue to keep them fully informed of all action taken in conjunction therewith. Complaints regarding a member of the Resident Staff shalf be made to the Medical Director who may, if necessary, convene a special meeting of the Education Committee.

7.1-3 INVESTIGATION Upon receipt of a written complaint, the President of the Medical Staff in order to cause such complaint to be investigated shall thereupon convene within fifteen (15) business days a special meeting of the elected officers of the Medical Staff, the Chair of the Department involved, the Medical Director, and the Chief Executive Office, to which the member in question shall be requested to attend. No such investigative process shall be deemed to be a 'hearing" as described in Article VIII. 7.1-4

EXECUTIVE COMMlITEE ACTION As soon as is practicable after the conclusion of the investigative process, if any, but in any event within twenty (20) business days after the initiation of proposed corrective action the above Committee shall make a report of findings together with appropriate recommendations of action to the Executive Committee. The Executive Committee may forward to the Board, through the Chief Executive Officer, their own recommendations as to action to be taken, if any.

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Such action may include, without limitation, recommending: a. b. c. d. e. f. g. h.

i. j.

No corrective action. Rejection or modification of the proposed corrective action. Letter of admonition, letter of reprimand, or waming. Terms of probation or individual requirements of consultation. Reduction or revocation of dinical privileges. Suspension of clinical privileges until completion of specific conditions or requirements. Reduction of membership status or limitation of any prerogatives directly related to the practitioner's delivery of patient care. Suspension of Medical Staff membership until completion of specific conditions or requirements. . . Revocation of Medical Staff membership. Other actions appropriate to the facts which prompted the investigation.

Nothing set forth herein shall inhibit the Executive Committee from implementing summary suspension at any time, in the exercise of its discretion pursuant to Section 7.2. 7.1-5

PROCEDURAL RIGHTS

OTHER ACTION a.

b.

c.

I

I I I I I I

Any recommendation by the Executive Committee, pursuant to Section 7.1-4 which constitutes grounds for a hearing as set forth in SeCtion 8.2 shall entitle the practitioner to the procedural rights as provided in Article VIII. In such cases, the President shall give the practitionerwritten notice of the adverse recommendation within seven (7) calendar days of such an adverse recommendation and of hislher right to request a hearing in the manner specified in Section 8.3-2. 7.1-6

I

I (

I

If the Executive Committee's recommended action is to recommend no corrective action, such recommendation, together with such supporting documentation as may be required by the Board, shall be transmitted thereto. Thereafter, the procedure to be followed shall be the same as that provided for applicants in Sections 3.8-6, 3.8-7 and 3.8-8, as applicable. If the Executive Committee's recommended action is an admonition, reprimand, or waming to a practitioner, it shalt, at practitioner's request, grant him/her an interview as provided in Section 7.4. Following the interview, if one is requested, if the Executive Committee's final recommendation to the Board is an admonition, reprimand, or waming this shall condude the matter when approved by the Board without substantial modification, and notice Of the final decision shall be given to the Board, Chief Executive Officer, Executive Committee, the Chair of each Committee concemed, and the practitioner. If any proposed corrective action by the Board will ·substantially modify the Executive Committee's recommendation, the Board may submit the matter tothe Joint Conference Committee for review and recommendation before making its decision final. Any recommendation of the Board which constitutes grounds fora hearing as set forth in Section 8.2,~hall entitle the practitioner to the p'rocedural rights as provided in Article VIII. In such cases, the Board shall 38

I I

I I I

I'

"I'

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"

give the practitioner written notice of the tentative adverse recommendation and of his/her right to request a hearing in the manner specified in Section 8.3-2. d.

Should the Joint Conference Committee determine that the Executive Committee's failure to investigate or initiate disciplinary action, is contrary to the weight of the evidence, the Joint Conference Committee may direct the Executive Committee to initiate an investigation or a disciplinary action, but only after consultation with the Executive Committee. In the event the Executive Committee fails to take action in response to a directive from the Joint Conference Committee, the Joint Conference Committee, after notifying the Executive Committee in writing, may take action on its own initiative. If such action is favorable to the practitioner, or constitutes an. admonition. reprimand or warning to the practitioner, it shall becOme effective as the finaJ decision of the Joint Conference Committee. If such action is one of those set forth in Section 8.2, the Joint Conference Committee shall give the practitioner written notice of the adverse recommendation and of hislher right to request a hearing in the manner specified in Section 8.3-2 and hislher rights shall be as provided in Artide VIII.

SUMMARY SUSPENSION

Wh ever a practitioners conduct requires immediate action to be taken to re ce any a sub ntial likelihood of imminent impairment of the health or safety 0 patient, spective patient, employee or other person present in th edical Center, an person or body authorized to initiate proposed co ve action pursuant to S ·on 7.1-1 hereof shall have the authority to summ y suspend or restrict the Medi Staff membership status or all or any Po n of the dinicat privileges of such ctitioner, provided, however, that Joint Conference cutive Officer, before the susp Ion or restriction, made Committee or· Chief suspension or restriction reasonable attempts to co ct the Executive Committe by the Joint Conference C mittee or Chief Ex·ve Officer which has not been two (2) working days, exduding ratified by the Executive C mittee withi weekends and holidays, after e susQ sion or restriction shall automatically ' terminate. Such summary suspension or immediatefy upon imposition, and the person or, dy responsibl therefore shalf promptly give oral or written notice thereof to e practitioner, Join Conference Committee, Executive Committee, and Chief ecutive Officer. The notice f the suspension or restriction Committee shall constitute a re est for corrective action and given to the Exec· cept that the procedures the procedures t forth in Section 7.1 shall be followed, set forth in S ·on 7.1 shall be completed as soon as practi . In the event of any suCh sus nsion or restriction, the practitioners patients whose atment by such be assigned practi . er is terminated by the summary suspension or restriction s e wishes to ther practitioner by the Department Chair or by the Chief of Staff. the patient shall be considered, where feasible, in choosing a substitute p ·tioner.

0000682

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 21

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

26

CES Job Classfication Chang 'om Case 1:07-cv-00026-OWW-TAG

Document 277-2

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Change of Employee Status DEPARTMENT #

DEPARTMENT NAME

8997

KERN MEDICAL CENTER

I

DATE PREPARED

1211912003

SOCIAL SECURITY NBR

EMPLOYEE NAME

376-50-8 177

JADWIN DAVID F

JOB CLASSIFICATION CHANGES

I

EFFECTIVE DATE

1211312003 F

DEPARTMENT

TYPE OF CHANGE

Change of Salary

I

TYPE OF APPOINTMENT

Temporary I

CLASSIFICATION

BASIS OF

8997 KERN MEDICAL 0706 CHMNIPATHOLOGY- RANGE STEP SALARY UNIT RATE $10,679.43 $10,679.43 Biweekly CENTER C M 0

DEPARTMENT CLASSIFICATION RANGE STEP SALARY UNIT RATE BASIS OF 8997 KERN MEDICAL 0706 CHMNIPATHOLOGY0 S 1 1,021.08 $1 1,021.08 Biweekly CENTER C

I

TYPE OF WORK REQUIRED

-

A Full Time

I

EMPLOYEE'S EARNINGS WILL BE SUBJECT TO:

r

I I

SOCIAL SECURITY?

NO

I I

IF PART TIME, HOURS BIWEEKLY

SDI? RETIREMENT?

I

NO I

NO

I

TYPE OF RETIREMENT MEMBER

I

SPECIAL ALLOWANCE CHANGES ACTION PAY CODE TIMES PAID AMOUNT

DATE

SIGNATURE

ACKNOWLEDGMENT BY THE EMPLOYEE: 1 ACKNOWLEDGE AND CERTIFY THAT THE STATEMENTS ON THIS FORM ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

APPROVED

1 '

NOT APPROVED

Personnel Approval

Arrnida Smith +

Armida Smith

Barbara Lynch

I Date To ITS

12/19/2003 11:53:00 AM (Personnel ApprovedfAwaiting )

DFJ00247

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 22

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

27

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AGREEMENT FOR EXPERT CONSULTING SERVICES

THIS AGREEMENT is made and entered into by and between the County of Kern, a political subdivision of the state of California (hereinafter "County"). and William J. Colburn, M.D.• an individual (hereinafter ·Consultant"). RECITALS

WHEREAS: (a) Resolution Number 87-706 by the Kern County Board of Supervisors empowers the County Counsel to contract for needed expert consulting services; and (b) From time to time. the County Counsel needs consulting services to defend against or reduce the risk of possible lawsuits against County; and

'e

(c) County has need for consulting services with respect to the manner and quality of care given to certain patients in the department of pathology at Kem Medical Center ("KMC"). and desires recommendations for how to care for such patients in the future; and (d) Consultant is willing and able to provide said services to County for the consideration and upon the terms set forth herein; NOW. THEREFORE, in consideration of the mutual covenants contained herein, the parties hereto agree as follows: 1.

Services.

1.1 County agrees that Consultant is to render independent consulting services for the County Counsel. Consultant agrees to perform a quality assessment review of the KMC department of pathology. Said review will include review and evaluation of a selected sample of twenty-one (21) medical records including slides that relate to pathology findings of gynecologic oncology patients who were seen and treated at KMC. Consultant will provide KMC with a written report stating Consultant's findings and recommendations. 1.2 Consultant will at all times be a member in good standing of the medical staff of KMC and governed as such by the medical staff bylaws, rules and regulations. Consultant will be assigned to the advisory staff category.

2.

Fees and Expenses.

2.1 Consultant will be paid an hourly rate of Three Hundred Dollars ($300) per hour for medical records review, consultation and report preparation.

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Consultant will not be reimbursed for any costs incurred by Consultant in providing said services. 2.2 The maximum payable under this Agreement will not exceed Ten Thousand Dollars ($10,000). 3.

Payment.

3.1 Invoices for payment will be submitted in a form approved by County and list each service performed. Invoices will be sent to KMC for review and processing. Payment will be made to Consultant within thirty (30) days of receipt and approval of each invoice by KMC. 3.2 To ensure compensation is reported as paid to the proper party. Consultant will complete and execute IRS Form W-9 (Exhibit "A," attached hereto and incorporated herein by this reference), which identifies the taxpayer identification number for Consultant. 4. Representations. Consultant makes no warranty, ·either expressed or implied. as to Consultant's findings, recommendations, or professional advice except that the services or work product were performed pursuant to generally accepted standards of practice in effect at the time of performance. 5. Independent Contractor. Nothing in this Agreement shall be construed or interpreted to make Consultant anything but an independent contractor and in all Consultant's activities and operations pursuant to this Agreement, Consultant shall for no purposes be considered an employee or agent of County. 6. Authority to Bind County. It is understood that Consultant, in Consultant's performance of any and all duties under this Agreement has no authority to bind County to any agreements or undertakings with respect to any and all persons or entities with whom Consultant deals in the course of Consultant's business. 7. Non-disclosure of Information. Consultant shall not disclose, without the express written consent of County, any information relating to any patient records or any other information or documentation that has been submitted by County to Consultant pursuant to the services to be rendered pursuant to this Agreement. Upon request by County or in the event that this Agreement is terminated, Consultant shall immediately retum to County all records. documents and the like belonging to County. 8. Termination. County reserves the right \0 terminate this Agreement at any time or to discharge Consultant at any time. In the event of such discharge, County shall compensate Consultant for services actually rendered up to and inclUding the date of discharge. Consultant may terminate this Agreement at any time by giving written notice of termination to the County Counsel. 9.

Notices. The service and delivery of all notices and/or papers shall be

0026380

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deemed dUly and properly given or made five (5) days after being mailed via the U. S. Postal Service. postage prepaid and addressed as follows: To County: Counsel

B.C. Barmann, Sr.• County Counsel Attention: Karen S. Barnes, Deputy County Kern County Administrative Center 1115 Truxtun Avenue, Fourth Floor Bakersfield. California 93301

To Consultant:

William J. Colburn, M.D. Tarzana Regional Medical Center Department of Anatomic Pathology 18321 Clark Street Tarzana, California 91356

10. Assignment. Consultant shall not assign any right, title or interest Consultant rnay acquire by reason of this Agreement except upon first obtaining written consent of County. Subcontracting. Consultant may not subcontract any portion or the 11. services to be provided hereunder without the written approval of County. 12. Modifications. This Agreement may be modified or amended only by written agreement of the parties. No waiver or modification of this Agreement or of any covenant, condition or limitation herein contained shall be valid unless in writing and duly executed by the parties hereto. 13. Non-waiver. No covenant or condition of this Agreement can be waived except by the written consent of County. Forbearance or indulgence by County in any regard whatsoever shall not constitute a waiver of the covenant or condition to be performed by Consultant. County shall be entitled to invoke any remedy available to County under this Agreement or by law or in equity despite said forbearance or indulgence. 14. Venue. If any party herein initiates an action to enforce the terms hereof or declare rights hereunder, the parties agree that venue thereof shall be the County of Kern, state of California. 15. Construed Pursuant to California Law. The parties hereto agree that the provisions of this Agreement will be construed pursuant to the laws of the state of California. 16. Captions. Paragraph headings in this Agreement are used solely for convenience and shall be Wholly disregarded in the construction of this Agreement. 17.

Time of Essence. Time is hereby expressly declared to be of the

0026381

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essence in this Agreement and of each and every provision thereof, and each such provision is hereby made and declared to be a material, necessary and essential party of this Agreement. 18. Officials Not to Benefit. No member of any governing body or government. nor any employee of County shall be allowed or permitted to benefit personally from any part of or performance under this Agreement. Conflict of Interest. The parties to this Agreement have read and are 19. aware of the provisions of sections 1090 et seq. and sections 87100 et seq. of the Government Code relating to conflict of interest of pUblic officers and employees. All parties hereto agree that they are unaware of any financial or economic interest of any public officer or employee of County relating to this Agreement. It is further understood and agreed that if such a financial interest does exist at the inception of this Agreement. County may immediately terminate this Agreement by giving written notice thereof. Consultant shall comply with the requirements of Government Code sections 87100 et seq. during the term of this Agreement. [Intentionally left blank]

0026382

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IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the dates indicated below. COUNTY OF KERN Office of County Counsel

Dated:

tl5 -/5'~(j (. B.C. Barmann, Sr., County Counsel "COUNTY"

William J. Colburn, M.D.

Dated:~b IA)d

By

('{gil.&--

11\0

"CONSULTANT"

AgreemeotCvlbum.050206

0026383

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6

Document 277-3

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Page 1 of 191

Eugene D. Lee (SB#: 236812) LAW OFFICE OF EUGENE LEE 555 West Fifth Street, Suite 3100 Los Angeles, CA 90013 Phone: (213) 992-3299 Fax: (213) 596-0487 email: [email protected] Attorney for Plaintiff DAVID F. JADWIN, D.O.

7 8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

FRESNO DIVISION

11

DAVID F. JADWIN, D.O.,

12 13 14

Plaintiff, v.

Civil Action No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE LEE IN OPPOSITION TO DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Fed. R. Civ. P. 56(a)]

COUNTY OF KERN, et al.,

15

Defendants.

16 17

Date: January 12, 2009 Time: 10:00 Judge: Hon. Oliver W. Wanger Courtroom: 3 Complaint Filed: January 6, 2007 Trial Date: March 24, 2009

18 19 I, Eugene D. Lee, declare as follows: 20 1.

I am an attorney at law duly licensed to practice before the Federal and State Courts of

21 California and admitted to practice before the U.S.D.C. for the Eastern District of California. I am 22 counsel of record for Plaintiff David F. Jadwin in this matter. 23 2.

I am making this declaration in opposition to Defendants’ Motion for Summary

24 Judgment. I have personal knowledge of the matters set forth below and I could and would competently 25 testify thereto if called as a witness in this matter. 26 3.

Attached hereto as Exhibits are true and correct copies of the following documents:

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

1

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Exh. 1

Date 7/10/2006

Description Memo from Mr. Bryan to JCC re Recommendation of Demotion of Dr. Jadwin

2 3 4 5 6

8/14/2008 8/26/2008 1/9/2008 3/12/2008 10/21/2008

Deposition Transcript of Peter Bryan, Vol I Deposition Transcript of Peter Bryan, Vol II Deposition Transcript of David Jadwin, Vol II Deposition Transcript of David Jadwin, Vol V Deposition Transcript of David Jadwin, Vol VI

7

8/18/2008

Deposition Transcript of Former Supervisor Barbara Patrick, Vol I

8

4/16/2008

Deposition Transcript of Former Lab Mgr Gilbert Martinez

10

9

8/22/2008

Deposition Transcript of Former President Scott Ragland

11

10

8/25/2008

Deposition Transcript of Supervisor Ray Watson

11

8/21/2008

Deposition Transcript of Former CEO David Culberson

12

8/29/2008

Deposition Transcript of PMK Philip Dutt, Vol. I

13

8/28/2008

Deposition Transcript of Former COO Sandra Chester

17

14

9/4/2008

Deposition Transcript of PMK Eugene Kercher

18

15

6/29/2006

Letter from Lee to Barnes re Spoliation of Evidence

16

3/29/2007

Letter from Lee to Barnes re Spoliation of Evidence

17

11/20/2007 Defendants’ Responses to Plaintiff’s Request for Production, Set One

18

9/10/2007

1 2 3 4 5 6 7 8 9

12 13 14 15 16

19 20 21 22 23 24 25

19

Joint Conference Committee Meeting Minutes re Demotion of OB/GYN Chair Kern County Policy & Administrative Procedures Manual, Section 139 (Disciplinary Actions)

20

3/12/2002

21

12/26/2003 Change of Employee Status

26

CMO Marvin Kolb Memo to Jose Perez re Pathologist Elsa Ang Accusations

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

2

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22

5/15/2006

Expert Consulting Services Agreement, between Consultant William Colburn and Kern County

23

8/30/2006

Consultant William Colburn Report to Kern County re Review of Jadwin cases

24

8/13/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. I

5

25

8/27/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. II

6

26

5/3/2004

KMC FNA Consulting Project by UCLA Consultant David Lieu

27

8/18/2008

Deposition Transcript of Former President of Medical Staff Jennifer Abraham

1 2 3 4

7 8 9 10

28

Cancer Conference Presenter Guidelines

29

8/15/2008

12

30

10/19/2005 Exh. 202: Jadwin letter to Albert McBride, Cancer Conference Director re October Conference

13

31

11

Deposition Transcript of Former Cancer Committee Director Albert McBride

October Conference attendee feedback

14 32

11/9/2005

Oncology Conference attendee feedback of Savita Shertukde

33

8/25/2008

Deposition Transcript of OB-GYN Physician Joseph Mansour

34

Harris Memos to File re Mansour Behavior

35

5/10/2006 to 4/12/2007 8/19/2008

36

8/18/2008

Deposition Transcript of Chair of Surgery Maureen Martin, Vol. I

37

4/16/2008

Deposition Transcript of Histotech Evangeline Gallegos

38

4/19/2008

Deposition Transcript of Former CMO Marvin Kolb

25

39

2/26/2008

Deposition Transcript of Pathology Secretary Tracy Lindsey

26

40

2/26/2008

Deposition Transcript of Clerk Irene Lopez

15 16 17 18 19 20 21 22 23

Deposition Transcript of Nurse Executive Antoinette Smith, Vol. I

24

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

3

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41

12/6/2007

Deposition Transcript of Radiology Chair Javad Naderi

42

12/6/2007

Deposition Transcript of Cancer Committee Chair Ravi Patel

43

8/15/2008

Deposition Transcript of Former CEO Secretary Arlene Ramos-Aninion

5

44

12/5/2007

Deposition Transcript of Surgeon Edward Taylor

6

45

12/6/2007

Deposition Transcript of Neurosurgeon Charles Wrobel

46

8/21/2008

Deposition Transcript of Psychiatry Chair Tai Yoo

47

8/20/2008

Deposition Transcript of Acting Pathology Chair Philip Dutt

48

9/14/2006

Acting Pathology Chair Philip Dutt Email to Barnes re Plaintiff’s Paycut Amendment

12

49

10/17/05

Plaintiff email to Bryan re Serious Biopsy Errors

13

50

3/2/2006

Exh. 271: Plaintiff email to Bryan re Serious Biopsy Errors

51

4/21/2006

Emails between Plaintiff and Bryan re Serious Biopsy Errors

52

8/7/2008

Deposition Transcript of Pathologist Savita Shertukde

53

3/11/2008

Deposition Transcript of David Jadwin, Vol. IV

19

54

10/21/2003 Confidential Report on Lau Complaint against Jadwin

20

55

1/8/2008

Deposition Transcript of David Jadwin, Vol. I

56

9/9/2008

Deposition Transcript of PMK Acting Pathology Chair Philip Dutt, Vol. II

57

12/4/2007

Deposition Transcript of HR Director Steven O’Connor

58

10/10/2005 Amendment No. 1 to Employment Contract of Acting Pathology Chair Philip Dutt

59

11/1/2005

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25 26

Employment Contract of Pathologist Savita Shertukde

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

4

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

60

6/19/2007 4.

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Employment Contract of Pathologist Gian Yakoub

Attached hereto as Exhibits 2-14, 24-25, 27, 29, 33, 35-47, 52-53 and 55-57 are true and

correct certified copies of deposition transcripts which I either personally conducted or attended. 5.

Attached hereto as Exhibits 15-16 are true and correct copies of letters which I authored

and faxed to Karen Barnes, Chief Deputy County Counsel for the County of Kern on the dates indicated. 6.

I have served four sets of written discovery on Defendants which included Document

Request No. 44. asking for “Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from Chair of Kern Medical Center’s Pathology Department to staff pathologist.” To date, Defendants have not produced any of the agendas for any JCC meetings including the meeting at which the JCC voted to approve Plaintiff’s demotion from chair. Defendants have engaged in a level of discovery obstruction that is more excessive than I have ever encountered in my 13 years practicing as an attorney, of which this is but the latest example. 7.

Attached hereto as Exhibits 17 is a true and correct copy of Defendants’ responses

received by me in response to Plaintiff’s Request for Production of Documents, Set One, propounded by me on behalf of Plaintiff.

16 17 18

I declare under penalty of perjury under the laws of the State of California and the United States that the foregoing is true and correct.

19 20 21

Executed on: December 1, 2008

22 23

/s/ Eugene D. Lee

24

EUGENE D. LEE Declarant

25 26 27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

5

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 23

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

28

i

l'

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WILLIAM J. COLBURN, M.D. Women's Cancer Center - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

August 30, 2006 B. C. Barmann, Sr., County Counsel

By Karen S. Barnes, Deputy County Counsel OFFICE OF THE COUNTY COUNSEL - COUNTY OF KERN Administrative Center 1115 Truxtun Avenue, Fourth Floor Bakersfield, CA. 93301 RE: Expert Review - David F. Jadwin, D.O. Exhibit "A"

Dear Mr. Barmann, The 21 pathology cases forwarded to me for extramural consultation review have been completed in what I believe to be a timely manner. Dr. Judwin's pathology reports to be authoritative in all aspects rendering concise tissue diagnoses. The standardized reports issued by the Department of Anatomic Pathology Kern Medical Center, Bakersfield, California, satisfy all requirements for the pre-analytic, analytic and post-analytic phases for reporting of anatomic pathology cases. In all instances immunohistochemistry special stains were appropriately ordered and microscopically evaluated for those difficult and challenging diagnostic cases. Dr. Judwin appropriately solicited "expert" extramural consultation opinions from noted local-regional and national gynecologic pathologists and to his credit constantly up-dated the primary surgeon of record in all instances as to their progress. This reviewing pathologist concurs with Dr. Judwin's final diagnosis in 20 of21 cases. The only discordant case (S05-1347; 2-25-05) concerned the interpretation of a colposcopic biopsy of the cervix, which was initially interpreted as showing focal severe dysplasia. I find no evidence for a high grade squamous intraepitheliallesion, favoring a diagnosis of mild koilocytotic dysplasia ( CIN I / LGSIL). A subsequent LEEP conization; in view of the aforementioned, may have been averted. In regards to the 20 concordant cases, appropriate surgery was performed. In no instances was post-operative patient care in any way compromised. In view of the aforementioned, I would assess Dr. Judwin's overall performance as a

practicing anatomic and surgical pathologist to exceed the usual standard ofcare exercised by a practicing surgical pathologist in a busy tertiary community hospital. 0025924 0025924

1

----------------------

Case 1:07-cv-00026-OWW-TAG

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If I can be of any further service to you regarding this matter, please do not hesitate to contact me at your convenience. Respectfully,

Wi.U,·o~ .\
URN,M.D.

Senior Pathologt Women's Cancer Center, Tarzana Regional Medical Center, Tarzana, California

WJCIIlcIKemcountymed1eg Enclosures: 21 reports; statement of fees (microscopic slides to be returned under separate cover)

0025925

0025925

2

Case 1:07-cv-00026-OWW-TAG

Page I of2 0025926

Document 277-3

Filed 12/01/2008

Page 9 of 191

0025926

..

1

Case 1:07-cv-00026-OWW-TAG 08-22-06 19) 805-923

Document 277-3 Filed 12/01/2008 Page 10 of 191 55 minutes 1100 - 1155 hours

20) 805-2176

08-23-06 08-24-06

1345 - 1435 hours 1300 - 1345 hours

95 minutes

21) 805-2176

08-24-06

1415 - 1435 prep work 1445 - 1540

75 minutes

Review 10 Cases

08-28-06

60 minutes

Review 11 cases

08-29-06

60 minutes

Total Time 1135 min = 18.917 hours @ $3001hour = $5675.00

Billing Statement Pagc20f2 0025927

0025927

r _.

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1

~• WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

S-05-1347 CASE #: KOOOl135192 UNIT #: ACCT #: K0505600194 ATTENDING PHYSICIANS: Joseph Mansour, M.D., Nbalia Marie-Ange Soumah, M.D.

I. CLINICAL HISTORY: 33-year old GO PO female referred from Tulare, California for recurrent low grade squamous intraepitheliallesion. Status post cryotherapy, April of 2002. Cone biopsy September of 2003 revealed a low grade squamous intraepitheliallesion. II. GYNECOLOGIC PROCEDURES: A. Colposcopic biopsy of the cervix (S-05-1347; 2-25-05). - Ectocervical mucosa with focal severe dysplasia.

III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER CASE: S-05-1347; 2-25-05; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-4-06 A. COLPOSCOPIC BIOPSY UTERINE CERVIX (ANATOMIC SITE NOT OTHERWISE SPECIFIED): - mild koilocytotic dysplasia ( CIN 1/ LGSIL ). -

there is no evidence for high grade mucosal dysplasia or malignancy.

B. ENDOCERVICAL CURETTAGE: -

isolated strips of endocervical canal mucosa and portions of metaplastic squamous epithelium showing mild cytologic atypia ( ASCUS ).

-

there is no definitive microscopic evidence for HPV-induced epithelial virocytopathic effect, mucosal dysplasia or malignancy.

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I

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT:

There is no definitive microscopic evidence for a high grade squamous epithelial lesion as eluded to in the diagnosis rendered by the initial pathologist referable to cervical biopsy ( Part A). The ECC material shows squamous metaplasia exhibiting mild cytologic atypia ( ASCUS ), which is most likely secondary to inflammatory-induced changes. There is no definitive cytologic evidence for HPV-induced virocytopathic effect, or mucosal dysplasia.

W~c\fn~ URN, M.D.

WILLIAM J. C Holscherlkern/wjc/lIc/8-6-o6

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0,

I' t

-

WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-04-4674; 08-19-04/ N-04-222; 08-19-04 UNIT #: KOOO1000548 ACCT #: K0423000867 ATTENDING PHYSICIANS: William J. Roy, M.D., Nicola M. Spiros, M.D., Basem Z. Bemaba, M.D.

I. CLINICAL HISTORY: 82-year-old female with a history of a complex left adnexal mass further scheduled for an exploratory laparotomy, bilateral salpingo-oophorectomy, retroperitoneal dissection, and repair of umbilical hernia. Tentative date of surgery 08-19-04.

II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: The patient underwent an exploratory laparotomy on 08-19-04, where a dominant left adnexal mass of primary ovarian origin was found adherent to the left pelvic sidewall. The right tube and ovary were grossly unremarkable. Frozen section of the left ovary interpreted as "mucinous cystadenofibroma with focal cytologic atypia (which may lead to upgrade to mucinous borderline tumor on permanent sections)." In view of the aforementioned rendered intraoperative frozen section diagnosis findings, the surgeons in attendance decided to terminate the procedure. The patient tolerated the surgery well and left the operating room in good condition. The patient remained hospitalized for five days and was discharged to home on 08-24-04.

III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE N-04-222; 08-19-04 AND S-04-4674; 08-19-04, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-12-06 A. N-04-222 - PERITONEAL WASHINGS FOR CYTOLOGIC EVALUATION (CYTOCENTRIFUGE PREPARATIONS X 2, PAPANICOLAOU STAIN AND CELL BLOCK PREPARATION XI, H&ESTAIN): -

Amid a bloody proteinaceous background containing the usual leukocyte constituents of blood are portions of cellular debris, fibrin threads and 0025930

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particles of adipose tissue, with rare poorly preserved grouped arrays of reactive mesothelial cells encountered. No cytologically unequivocally neoplastic cells are identified.

B. S-04-4674 1. LEFT OVARY AND FALLOPIAN TUBE:

-

Clear cell adenocarcinoma exhibiting rare isolated complex glomeruloid papillae, as well as demonstrating, in some areas, an accompanying adenofibromatous stroma; left ovary. Representative cross section of histopathologically unremarkable left fallopian tube.

2. RIGHT OVARY AND FALLOPIAN TUBE: -

Cortical serous cystic inclusion rests without other significant histopathologic abnormality; right ovary Representative cross sections of histopathologically unremarkable right fallopian tube.

3. NODULE FROM HERNIA: -

Adipose tissue with saponification of fat / fat necrosis and interstitial iatrogenic induced hemorrhage; negative for metastatic tumor.

IV. EXTRAMURAL EXPERT CONSULTATION OPINION - DR. JUAN FELIX, WOMEN AND CHILDRENS HOSPITAL, KECK SCHOOL OF MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA, LOS ANGELES: A. S-04-4674; 08-25-04 Clear cell carcinoma.

B. N-04-222; 08-30-06; PERITONEAL WASHINGS

-

Peritoneal washings containing scattered mesothelial cells showing reactive changes. No cytologic evidence of tumor is identified.

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REVIEWING PATHOLOGIST'S SUMMARY COMMENT: Original pathologist intraoperative frozen section diagnosis indicates that the tumor demonstrates atypical cytomorphologic features, which may result in upgrading the left ovarian neoplasm to a carcinoma. Review of permanent sections of the frozen section material shows a dominant adenofibromatous architecture with minimal cytologic atypia. The true nature of this neoplasm was revealed by the subsequent multiple tissue sections submitted from appropriately fixed and processed. tumor tissue. Appropriate second opinion was sought in a timely manner.

S-04-4674 N-04-222 Kirsch 08-14-<J6 Page 3 00 0025932

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: UNIT #: ACCT:

S-06-1066;3-7-06 KOOO1029137 K0606600818

CASE #: S-06-1680; 4-13-06 UNIT #: KOOOI029137 ACCT: K0610300618

ATTENDING PHYSICIANS: Joseph Mansour, M.D., Kurt Finberg, M.D., Roy William, M.D.

I. CLINICAL HISTORY: 44-year old female, G3, P3,.presenting with pain and swelling of the left vulva since 106. Clinical impression: 3.5 cm mass left labia residing 1 cm from the mid-line posteriorly. Cervix and vagina - within normal limits. Uterus - normal size, shape and configuration without mass effect. Pap smear 3-21-06 - within normal limits. Vulvar mass biopsy (S-06-1066; 3-7-06): squamous cell carcinoma in situ with probable microinvasive carcinoma. II. GYNECOLOGICAL SURGERY / HOSPITAL COURSE: Modified radical hemi-vulvectomy performed 4-13-06. Patient tolerated the procedure well and without complications. Length of hospital stay - 5 days.

III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER- CASES # S-06-1066; 3-7-06 AND S-06-1680; 4-13-06, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-4-06 A. CASE S-06-1066, BIOPSY, LEFT VULVAR MASS: -

basaloid squamous cell carcinoma. superficial nature of the biopsy and tangential nature of sectioning precludes definitive microscopic diagnosis of a micro- / macro-invasive dermal tumor component.

B. CASE S-06-1680; 4-13-06, LEFT VULVECTOMY: infiltrating moderately differentiated basaloid squamous cell carcinoma.

I ,

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high-grade vulvar intraepithelial neoplasia ( VIN II-Ill ); 6:00 - 9:00 vulvar cutaneous margin of excision. angio-Iymphovascular invasion by tumor; interface of deep dennis and superficial hyperdennis..

C. LEFf VULVAR MASS, INFERIOR - LATERAL MARGIN EXCISION: multiple sections of histopathologically unremarkable hirsute skin; negative for vulvar intraepithelial neoplasia (VIN) or malignancy.

IV. REVIEWING PATHOLOGIST'S SUMMARY COMMENT: This reviewing pathologist concurs in toto with the initial pathologist's diagnoses referable to cases S-06-1066 and S-06-1680.

w· WILLIAMJ.C

Thompson/kem/wjc/1lc/8-4-2006

I

I ~

I

I \

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-05-755l UNIT #: KOOOl146283 ACCT #: K0533500457 ATTENDING PHYSICIANS: William Roy, M.D.

I. CLINICAL HISTORY: 52-year old G2, P2, referred to CSB Clinic for vaginal bleeding x 2 years. EMB,9-l4-05 reported as endometrioid adenocarcinoma. ECC, 10-28-05 - negative for neoplasm. Patient reported as menopausal since 2003. On honnone replacement therapy from 1982 to 2002.

II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: Patient was scheduled for a total abdominal hysterectomy and bilateral salpingooophorectomy and bilateral pelvic and peri-aortic lymph node dissection on 12-1-05. Patient tolerated the surgery well and had a fairly uneventful post-operative hospital course and was discharged home on post-op day 3 (12-4-05). III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE #: S-05-7551; 12-01-05; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, CALIFORNIA A. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES AND OVARIES: -

Infiltrating endometrioid adenocarcinoma; FIGO II, penetrating greater than 50% of the mural thickness of the uterine wall.

-

Isolated mural angiolymphatic channels show the presence of intraluminal free-floating tumor emboli which may represent a fictitious iatrogenicinduced phenomena.

-

Benign leiomyomata exhibiting degenerative architectural features

-

Nabothian cysts and tunnel cluster fonnation; endocervical canal mucosa. Squamous metaplasia: transition zone of cervix. 0025935

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Unremarkable well glycogenated exocervical squamous mucosa. Cortical serous cystic inclusion rests; right and left ovaries. Representative tangential sections ofhistopathologically unremarkable right and left fallopian tubes.

B. RIGHT PELVIC LYMPH NODE DISSECTION: -

benign reactive lymph nodes ( 11 ).

C. RIGHT PARA-AORTIC LYMPH NODES: -

benign reactive lymph nodes ( 1 ).

D. LEFf PELVIC LYMPH NODE DISSECTION: -

benign reactive lymph nodes ( 13 ).

E. LEFf PERI-AORTIC LYMPH NODES: -

benign reactive lymph nodes ( 2 ).

F. OMENTUM: -

unremarkable omental fat pad.

G. CLINICAL ABDOMINAL LESION EXCISION: hyperkeratotic verrucoid keratosis; not otherwise specified. there is no evidence for malignancy.

IV. REVIEWING PATHOLOGIST'S SUMMARY COMMENT: This consulting pathologist concurs with the diagnoses as rendered by the initial examining pathologist of record.

w

~

,

WILLIAMJ.C Voss/kem/wjc/l1c/S-11-o6

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

S-04-7471 CASE #: UNIT #: KOOOI138692 ACCT # K0435100474 ATTENDING PHYSICIANS: Nicola Spirtos, M.D.

I. CLINICAL HISTORY: 86-year old Caucasian female G5, P4 with a chief complaint of post-menopausal bleeding x 8 days beginning November, 2004. Scheduled for D&C.

II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: Fractional dilatation and curettage performed at Kern Medical Center, Bakersfield, California on 12-16-04 under general anesthesia. Separate and distinct EMB and ECC tissue samples forwarded to pathology for tissue analysis ( surg. path. # S-04-7471; parts A and B).

PATHOLOGY DIAGNOSIS - S-04-7471; 12-17-04: A. ENDOCERVICAL CURETTAGE: - scanty detached fragments of hypersecretory endometirum. - mucin and endocervical mucosa with no pathologic findings. B. ENDOMETRIAL BIOPSY: small fragments of endometrium, mixed with blood and endocervical mucus. - focal, limited areas suspicious for adenocarcinoma with squamous differentiation and possibly containing mixed clear cell carcinoma. - The tissue is insufficient for accurate grading or further diagnosis.

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III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER CASE: S-04-7471; 12-17-04; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA, 8-4-06 A. ENDOCERVICAL CURETTAGE: isolated rare strips of mechanically distorted endocervical canal mucosa are encountered with the overall quantitative - qualitative features of the specimen deemed inadequate in order to render a definitive tissue diagnosis. B. ENDOMETRIAL CURETTAGE: endometrioid adenocarcinoma exhibiting clear cell cytomorphologic features and accompanying squamous metaplasia. The findings of clear cell features warrant strong consideration of a high grade endometrioid adenocarcinoma; FIGO Grade 3.

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT: This reviewing pathologust concurs with the initial pathologist's final diagnosis: Part A - endocervical curettage ( not additional levels ) is deemed both quantitatively and qualitatively insufficient and therefore a definitive tissue diagnosis is not possible. Part B - endometrial curettage shows fragmented portions of endometrial gland and stromal tissue showing a moderate degree of epithelial atypia with a vague fenestrated gland architecture with isolated rare mitotic figures encountered. The nucleus to cytoplasmic ratio is moderately increased. Of note: Clear cell tumoral cytomorphologic features are noted at the surface of some frond-like structures. In the differential diagnosis is atypical complex hyperplasia with associated clear cell / squamous metaplasia vs endometrioid adenocarcinoma exhibiting clear cell features; FIGO Grade 3. This reviewer favors the latter diagnosis. This case is difficult as eluded to in the descriptive microscopic and diagnosis rendered by the original pathologist described as "hypersecretory endometrium exhibiting papillary, clear cell and eosinophilic metaplasia to focal limited areas suspicious for adenocarcinoma with squamous differentiation and possibly containing mixed clear cell carcinoma". The only criticism that can be made is the somewhat protracted delay in procuring an extramural consultation opinion (approximately 3 months). This in no way however should be considered to have negatively impacted the clinical course of this patient's disease process.

tJJ JJ.1.lo..

WILLIAM J.

~LBURN, Cc:l L&-= M.D.

assoni/kem/wjcnlcl8-4-o6

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASES #:

8-05-1514; 3-4-05 8-05-2811; 5-5-05 8-05-3286; 5-26-05 UNIT #: K0000870589 ATTENDING PHYSICIANS: Joseph Mansour, M.D., Preete Bhanot, M.D., William Roy, M.D.

I. CLINICAL HISTORY: 34 year old G2 PO female with history of status post previous vaginal biopsy reported as VAIN III and dated 2-2-05. Most recent-antecedent pap smear ( 2-15-05 ) was reported as within normal limits. The patient was scheduled for a wide radical excision of this lesion on 5-5-05. II. GYNECOLOGICAL SURGERY I HOSPITAL COURSE:

Radical wide excision of vulva was performed on 5-05-05. The pathology report reported the findings of an invasive moderately differentiated squamous cell carcinoma with submucosal microinvasion to a measured depth of 2.2 mm. A subsequent staging procedure with right groin lymph node dissection was performed on 5-26-05. Post-op convalescence uneventful. III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASES: S-05-1514, 3-4-05; S-05-2811, 5-5-05; S-05-3286, 5-26-05; WILLIAM J. COLBURN, M.D. WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-8-06

1). CASE #: S-05-1514: A. PUNCH BIOPSY, VULVA (NOS):

-

VIN III with evolution to microinvasive moderately differentiated submucosal microinvasion to a measures depth of 0.8 mm.

-

Dermal lymphatic invasion by tumor is identified. 0025939

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B. UTERINE CERVIX, 12:00 POSITION:

Superficially biopsied and tangential sections of histopathologically unremarkable well glycogenated exocervical squamous mucosa. Reserve cell change / immature squamous metaplasia; transition zone of cervix. There is no evidence ofHPV-induced epithelial virocytopathic effect, mucosal dysplasia or malignancy. 2). CASE #: S-05-2811 A. VULVA, MEDIAL MARGIN, 12:00 - 6:00 EXCISION:

Hirsute vulvar skin, negative for vulvar intraepithelial neoplasia or malignancy. B. RIGHT VULVA, RADICAL VULVECTOMY:

VIN III with evolution to infiltrating moderately differentiated keratinizing squamous carcinoma; submucosal depth of invasion greater than 2 mm ( slide section B5 ). All newly re-established circumferential cutaneous, dennal and central superficial hypodermal margins of excision are noted to be free of tumor. 3).

CASE #: S-05-3286 A. RIGHT FEMORAL LYMPH NODES:

Benign reactive lymph nodes ( 2 ). B. RIGHT FEMORAL LYMPH NODES:

Benign reactive lymph nodes ( 2 ). C. RIGHT INGUINAL / FEMORAL LYMPH NODES:

Benign reactive lymph nodes ( 7 ).

0025940 8-05-1514; 3-4-05/8-05-2811; 5-5-05/ 8-05-3286; 5·26-05

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IV. ANATOMIC PATHOLOGY SUMMARY COMMENT:

This reviewing pathologist concurs with the initial pathologist's diagnoses as rendered.

W~~Co1JJ,...LBURN, M.D.

WILiiAMJ:

Dawson/kernlwjclllc/8-9-o6

0025941 S-05-1514; 3-4-05 /5-05-2811; 5-5-05 / 5-05-3286; 5-26-05

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

S-05-812 CASE #: UNIT #: K0001142312 K0503500023 ACCT #: ATTENDING PHYSICIANS:

Joseph Mansour, M.D., William Roy, M.D.

I. CLINICAL HISTORY: 67-year old G4 P3 female with chief complaint of vulvar itching. The patient was pr~viously treated with antibiotics for infection. The lesion had been increasing in size over the course of a few months with the patient noting swelling above the clitoris without associated bleeding. II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: Biopsy performed 12-4-05 left labia minora, without complications, Kern Medical Center, Surg. Path. #: S-05-812; 2-4-05. Further review of the chart reveals a wide local excision of the vulvar lesion performed on 3-3-05. The final pathology referable to the wide local excision specimen, 3-3-05, is not available at the time of anatomic pathology consultation review. III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-05-812; 2-4-05; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA; . 8-8-06 BIOPSY LEFT LABIA MINORA, 1:00 POSITION: -

skin showing moderate parakeratosis, acanthosis and spongiosis noted in conjunction with a moderate influx of predominantly small reactive lymphocytes residing within the underlying dermis proper. there is no evidence for vulvar intraepithelial neoplasia or malignancy.

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I

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT: Although the aforementioned descriptive histomorphologic features as cited above are overall nondiagnostic, the histomorphologic features suggest a lichenoid dennatidity, i.e. early phase of lichen simplex chronicus. There is no evidence for vulvar intraepithelial neoplasia, cutaneous malignancy or underlying evolving lymphoproliferative process. The findings of this biopsy should be correlated with those of the definitive local excision of the reported mass perfonned on 3-3-05.

t . . ) l..1JJ.bM. ~CoJA,--

WILLIAM J.

BBURN, M.D.

KaurlkemlwjclllclS-S-06

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-05-3265; 5-26-05 UNIT #: K0000679293 ACCT #: K0514300893 ATTENDING PHYSICIANS: William J. Roy, M.D., Preete Bhanot, M.D. I. CLINICAL HISTORY: 66-year old gravida 2, para 2, female referred to Kern Medical Center for postmenopausal bleeding beginning in late February, 2005. The patient was seen in gynecologic consultation at Kern Medical Center on 5-19-05. Previous endometrial biopsy dated 4-28-05 was reported as poorly differentiated carcinoma with an accompanying ECC noted to reveal sheets of neoplastic undifferentiated small carcinoma cells. Cervical biopsies at the 5:00 and 12:00 positions were unremarkable. Pertinent physical examination limited to the pelvis revealed the external genitalia to be within normal limits, normal urethra and bladder. The vulva and vagina were free of abnormalities. The cervix was noted to be friable and the uterus was slightly enlarged. The right and left adnexa were "within normal limits". The patient was scheduled for an exploratory laparoscopy - total abdominal hysterectomy and bilateral salpingooophorectomy, peritoneal washings and possible lymph node dissection for staging procedure. II. GYNECOLOGIC SURGERY I HOSPITAL COURSE: The patient's TAHBSO was performed on 5-26-05 without complications and the patient left the operating room in stable condition. INTRAOPERATIVE FROZEN SECTION DIAGNOSIS (# 1): malignant neoplasm with high grade nuclear features. differential diagnosis includes chloroma, high grade sarcoma for anaplastic undifferentiated carcinoma. FROZEN SECTION DIAGNOSIS (# 2): - POSTERIOR VAGINAL MARGlN: no epithelial malignant neoplasm identified. The patient's hospital course over the next four days was relatively uneventful and she was discharged to her home on 5-30-06 in stable condition, advised to follow up in the gyne clinic in approximately one week post-discharge.

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III. EXTRAMURAL CONSULTATION OPINION REVIEW, KERN COUNTY MEDICAL CENTER, CASE #: S-05-3265; 5-26-05; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-17-06 A. UTERUS AND ADNEXAE:

- TAH-BSO: - undifferentiated small cell neoplasm exhibiting a sarcomatoid stroma and abortive attempts at gland formation; summary histomorphologic features consistent with a malignant mixed Mullerian tumor ( MMMT ); apparently eminating from the body of the uterus with local regional metastases to an ovary whose laterality is not further specified. -

angio-Iymphovascuhrr invasion by tumor is identified. adenomyosis, myometrium.

-

histopathologically unremarkable endocervical canal mucosa.

-

unremarkable well glycogenated exocervical squamous mucosa.

-

sections of atrophic ovary whose laterality is not further specified showing a lymphatic channel within the meso-ovarium containing a large intraluminal free-floating embolus of metastatic undifferentiated carcinoma. representative cross sections of histopathologically unremarkable right and left fallopian tubes.

- VAGINA, POSTERIOR MARGIN (SLIDE "B I"): squamous epithelial lined vaginal mucosa, negative for mucosal dysplasia or malignancy. B. PERITONEAL WASHINGS: - slides not available for review.

c.

RIGHT ILIAC LYMPH NODE BIOPSY: - benign reactive lymph node ( 1 ).

D. RIGHT OBTURATOR LYMPH NODE BIOPSY: - metastatic MMMT involving multiple fragmented lymph nodes. F. RIGHT PARA-AORTIC LYMPH NODE BIOPSY: benign reactive lymph nodes (5 ).

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NOTE: Slides "FI" and "F3" demonstrate the presence of multiple particles ofMMMT which do not involve lymph node structures. G. LEFT PELVIC LYMPH NODE BIOPSY: - one of twelve ( 1 /12) lymph nodes almost completely replaced byMMMT. H. LEFT PARA-AORTIC LYMPH NODE BIOPSY: - benign reactive lymph nodes ( 2 ).

IV. OUTSIDE CONSULTATION OPINION, DR. ROBERT H. YOUNG, DEPARTMENT OF PATHOLOGY, MASSACHUSETTS GENERAL HOSPITAL I HARVARD MEDICAL SCHOOL; 6-10-05 DIAGNOSIS:

- undifferentiated carcinoma exhibiting biphasic morphology; summary histomorphologic features consistent with malignant mixed Mullerian tumor. - atrophic phenomena referred to as transitional cell metaplasia; vagina.

V. ANATOMIC PATHOLOGY SUMMARY COMMENT:

This reviewing pathologist agrees with the final diagnosis as rendered by the initial pathologist of record.

w~ ~BURN, CoJW---M.D.

WILLIAM J. C

Burton-kem-wjc-llc-S-22-o6

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i'

•

WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-05-2176; 04-07-05 UNIT #: K0001146515 ACCT #: K0508000982 ATTENDING PHYSICIANS: William J. Roy, M.D., Homayoun Sadeghi, M.D., and Preete Bhanot, M.D. I. CLINICAL HISTORY: 55-year-old female admitted through Kern Medical Center ER on 03-22-05, with primary history of increasing abdominal girth / distention x two months PTA, associated with nausea and vomiting two days prior to admission. A pelvic exam revealed a large pelvic mass resulting in a gynecologic - oncologic consultation. CT and MRI studies revealed a retroperitoneal mass with associated microcalcifications. Previous abdominal surgery, ten years PTA, for a reported schwannoma; retroperitoneal. CA-125 of "666" with other tumor markers reported as negative. Paracentesis was performed with cytologic evaluation of the fluid, reported as "clear cell adenocarcinoma, origin most likely of the ovary." Further management of multiple medical conditions transpired from 03-22-05 through 04-05-05. The patient was scheduled for exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy, right pelvic lymph node dissection, and bilateral retroperitoneal lymph node dissection on 04-07-05. II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: At the time of surgery, widespread carcinomatosis was noted, with involvement of the omentum and apparent peritoneal surface involvement of the major pelvic organs. The differential diagnosis at the time of the intraoperative surgical event was primary ovarian carcinoma versus primary peritoneal carcinoma. Intraoperative Diagnosis,.. Frozen Section Diagnosis: Omentum, Hernia Sac, Tumor Excision: - Papillary serous adenocarcinoma, low grade with psammoma bodies. A complicated surgical debulking procedure continued and the patient left the operating room / recovery room in stable, but guarded condition. Subsequently, the patient developed a pulmonary embolism. Postoperative course was complicated by a pulmonary embolism and diabetes management, which resulted in a protracted hospital stay during which the patient received three cycles of chemotherapy prior to her discharge to home, with the assistance of a home healthcare nurse. 0025947 Page 1 of4 0025947

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III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-05-2176; 04-07-05, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-23-06 A. OMENTUM, HERNIA SAC, AND TUMOR EXCISION:

- Invasive desmoplastic high-grade adenocarcinoma of miillerian serous membrane origin, with adjuvant extensive immunohistochemistry tumor marker histiogenesis profile analysis supporting further classification ofthis tumor as a high-grade clear cell adenocarcinoma. B. PLAQUE OFF OF ILEUM:

- Invasive desmoplastic adenocarcinoma of miiIlerian serous surface origin. C. LEFT ANTERIOR ABDOMINAL WALL EXCISION:

- Invasive high-grade adenocarcinoma of miiIlerian serous surface origin. D. UTERUS AND ADNEXA, TOTAL ABDOMINAL HYSTERECTOMY:

- Invasive desmoplastic "implant" of high-grade serous surface adenocarcinoma; left ovary and meso-ovarian soft tissue elements. - Representative cross sections of atrophic left fallopian tube. - Atrophic right ovary and fallopian tube; negative for tumor. - Benign leiomyomata exhibiting atrophic architectural features - Inactive endometrium. - Nabothian cysts and squamous metaplasia; transition zone of the cervix. - Unremarkable proximal endocervical canal mucosa and similarly unremarkable well-glycogenated exocervical squamous mucosa. E. RIGHT PELVIC LYMPH NODES:

- Benign reactive lymph nodes (6). F. LEFT SUBCUTANEOUS TISSUE:

- Subcutaneous involvement by invasive high-grade adenocarcinoma. G. LEFT HERNIA SAC AND TUMOR:

- Invasive high-grade adenocarcinoma.

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H. PERIUMBILICAL TUMOR:

- Invasive high-grade adenocarcinoma. I. ILEAL NODULES:

- Invasive high-grade adenocarcinoma. J. SEGMENTAL RESECTION - TERMINAL ILEUM: - Mesenteric / serosal "implants" of invasive high-grade adenocarcinoma of mullerian serous surface origin. K. UMBILICAL TUMOR:

- Invasive high-grade adenocarcinoma. L. OMENTUM AND HERNIA SAC:

- Invasive desmoplastic high-grade adenocarcinoma of mullerian serous surface origin.

IV. SURGICAL PATHOLOGY CONSULTATION REPORT - UCLA MEDICAL CENTER (THEIR SURGICAL PATHOLOGY # R-05-6313; 0429-05) - PERTINENT PATHOLOGY DIAGNOSTIC FINDINGS:

A. Uterus and Adnexa: Left Ovary: - Ovarian serous surface is positive for metastatic clear cell carcinoma. Right Ovary: - Negative for carcinoma. Uterus and Cervix: - Inactive endometrium with cystic atrophy. - Leiomyomata with hyaline fibrosis. - Focal chronic cervicitis. - Negative for carcinoma. Right and Left Fallopian Tubes: - Negative for carcinoma. B. Right Pelvic Lymph Nodes: - Six lymph nodes negative for metastatic carcinoma. C. Left Subcutaneous Tissue: - Fibroadipose tissue and skeletal muscle, with clear cell carcinoma.

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i

D. Clinical Hernia Sac and Tumor, Left: - Fibroadipose tissue with clear cell carcinoma. E. Clinical Tumor, Periumbilical: - Dense fibroadipose tissue with clear cell carcinoma. F. Clinical Nodule, Ileal: - Fibroadipose tissue with clear cell carcinoma. G. Terminal Ileum: - Serosal surface of ileum with clear cell carcinoma. - Unremarkable colonic mucosa. H. Clinical Tumor, Umbilical: - Dense fibroadipose tissue with clear cell carcinoma. I. Omentum and Hernia Sac: - Fibroadipose tissue with clear cell carcinoma. Comment: The bulk of the tumor is noted in the omentum and the left ovary tumor nodules only on the serosal surface with similar histology. These findings are supportive of a peritoneum primary. The immunostains are supportive of a miillerian primary. Clinical - pathologic is suggested. V. ANATOMIC PATHOLOGY SUMMARY COMMENT:

This reviewing pathologist concurs with the final microscopic diagnosis as rendered by the initial examining pathologist. Extramural consultation review was appropriately sought by the Department of Anatomic Pathology, Kern Medical Center, Bakersfield, California. The original intraoperative pathology consultation opinion as rendered favored a low-grade miillerian serous surface carcinoma, with subsequent permanent sections upgraded to reflect a high-grade adenocarcinoma. Extensive IHC tumor histiogenesis marker profile supports clear cell differentiation of this miillerian serous surface neoplasm, which is deemed to be ofprimary peritoneal origin.

w ~ ~-.JCa..aJ.LAJ.U·===:",--_ _

WILLIAM J. C~BURN, M.D.

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WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: 8-06-757,02-16-06; 8-06-981, 03-02-06; N-06-51, 03-02-06 UNIT #: K0001155514 ACCT #: K0604600094 ATTENDING PHYSICIANS: Joseph Mansour, M.D., William J. Roy, M.D.

I. CLINICAL m8TORY: 37-year-old female G6 P5 with pertinent medical history of a cervical biopsy showing papillary serous adenocarcinoma (Kern Medical Center Case # 8-06-757; 02-16-06). The patient was scheduled for a radical abdominal hysterectomy, bilateral salpinooophorectomy, and lymph node dissection on or about 03-02-06. II. GYNECOLOGIC SURGERY I HOSPITAL COURSE: The patient was admitted to Kern Medical Center, Bakersfield, California, on 03-0206 for a radical TAH-B80 and lymph node dissection. The patient tolerated the surgicai procedure well and left the operating room.in good condition. 8he experienced an uneventful four day postop hospital course and was discharged home on 03-06-06, and scheduled for postop follow-up at prescribed intervals. III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASES 8-06-757, 02-16-06; S-06-981, 03-02-06; N-0651, 03-02-06, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-16-06 A. 8-06-757: 1. CERVICAL LESION:

.,. High-grade papillary adenocarcinoma; endocervical type, mucinous variant.

*

Extramural Expert Consultation Opinions: a) UCLA Medical Center - Cervical Lesion: - Mucinous adenocarcinoma, papillary and solid. - Poorly differentiated (high grade).

b) University o/Southern California -Juan C. Felix; Womens and Childrens Hospital- Cervical Lesion: - Adenocarcinoma of the cervix of the usual mucinous type. 0025951 Page 10f4 0025951

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B. S-06-981:

1. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES AND OVARIES: - Invasive high-grade papillary adenocarcinoma; endocervical type, mucinous variant noted in conjunction with invasive papillary endocervical adenocarcinoma, usual type, and arising at the transition zone ofthe cervix. - Lymphatic invasion by tumor is identified. - Well-glycogenated unremarkable exocervical squamous mucosa. - Secretory phase endometrium; endometrial cavity. - Representative transmural sections of histopathologically unremarkable uterine myometrium and serosa. - Physiologic cysts, right and left ovaries, and representative cross sections of unremarkable right and left fallopian tubes. 2. RIGHT PARA-AORTIC LYMPH NODES:

- Benign reactive lymph nodes ( 4 ). 3. RIGHT COMMON ILIAC LYMPH NODES:

- Subcapsular sinus involvement by micrometastatic endocervical adenocarcinoma; mucinous variant, involving one offour (1/4) lymph nodes. 4. RIGHT PELVIC LYMPH NODES:

- Macrometastatic papillary adenocarcinoma; endocervical type, mucinous variant involving one of fourteen (1/14) lymph nodes. 5. LEFT PARA-AORTIC LYMPH NODE:

- Benign reactive lymph node (1). 6. LEFT COMMON ILIAC LYMPH NODES:

- Macrometastatic high-grade papillary adenocarcinoma; endocervical type, mucinous variant involving one of three (1/3) lymph nodes. - A tumor "floater" is identified in immediately adjacent outer mantle of adipose tissue.

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7. OMENTUM:

- Histopathologically unremarkable omental fat pad. 8. OMENTAL LYMPH NODE:

- Benign reactive lymph node (l); totally embedded. 9. APPENDIX:

-

Repre~entative

sections of histopathologically unremarkable vermiform

appendix. - Periappendiceal fat pad shows the presence of a solitary (1) benign reactive lymph node. 10. LEFT PELVIC LYMPH NODES:

- Benign reactive lymph nodes (5).

*

Extramural Expert Consultation Opinion aJ UCLA Medical Center, Los Angeles, California: - Agreement in toto with the referring pathologist's interpretation; refer to UCLA Medical Center, Department of Pathology and Laboratory Medicine Surgical Pathology Consultation Report # R06-05528; 0313-06 for your further edification.

bJDr. Juan C. Felix, Keck School 0/Medicine, University o/Southern California, Los Angeles: Diagnosis - Radical Hysterectomy, Bilateral Salpingo-oophorectomy, Appendectomy, and Multiple Lymphadenoectomy Specimens: - Deeply invasive adenocarcinoma of the cervix. - Several foci of vascular space involvement are identified. - Paracervical margins negative for tumor. - Sections of uterus, fallopian tubes, ovaries, and appendix are negative for tumor. - Lymph node status: one right pelvic, one left common iliac, one right para-aortic, and one right common iliac lymph node are involved by metastatic adenocarcinoma of the cervix. C. N-06-51

1. ABDOMINAL WASHINGS FOR CYTOLOGIC EVALUATION: - Fibrin debris, red cells, and the usual leukocyte constituents of blood; with no atypical / neoplastic cells identified.

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Expert Extramural Consultation Opinion:

UCLA Medical Center, their surgicalpathology report # 806-5535; 0313-06: Final Diagnosis - Negative for malignant cells.

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT

This pathologist agrees with the original pathologist's final diagnoses.

W~~CQJ.l.w-BURN, M.D.

WILLIAM J. C

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WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-05-7114; 11-11-05 UNIT #: K001142693 ACCT #: K0519301010 ATTENDING PHYSICIANS: William J. Roy, M.D., Nbalia Soumah, D.O.

I. CLINICAL HISTORY: 35-year-old G5 P5 female presenting at the Gyn-Oncology Clinic with the chief complaint of passing flatulents and feces per vagina for several years. No remote history of vaginal laceration / vaginal trauma. Physical examination revealed a uterus of normal size, shape and configuration. Pertinent past medical history included cervical biopsies (Quest Diagnostic Laboratories) at the 7 o'clock and 11 o'clock positions, and endocervical curettings showing high-grade endocervical glandular dysplasia consistent with AIS and low-grade squamous intraepithelial dysplasia (eIN I / L8IL). The aforementioned outside diagnoses were confirmed by Kern Medical Center interdepartmental consultation slide review (case C-05-22; 07-20-05).

II. GYNECOLOGIC SURGERY I HOSPITAL COURSE: The patient was scheduled for conization biopsy of the cervix and perineal reconstruction of the vaginal laceration, the procedure carried out on 06-23-05. The patient experienced an unremarkable postoperative course and was discharged from Kern Medical Center on 06-25-05. The pathology results of the cold conization of the cervix (Kern Medical Center case No. 8-05-3830; 06-23-05) revealed focal highgrade squamous dysplasia and endocervical glandular dysplasia, high grade. A formal TAH-B80 in view of the aforementioned was performed 11-10-05, with pathology slides corresponding to the current case submitted for extramural consultation opinion (8-05-7114; 11-11-05).

III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-05-7114; 11-11-05, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-11-06 .

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A. UTERUS AND CERVIX (TOTAL LAPAROSCOPIC HYSTERECTOMY):

- Focal high-grade endocervical intraepithelial neoplasia; distal endocervical canal mucosa residing near the transition zone; totally embedded cervix. - The most distal ectocervical / vaginal margin of hysterectomy is free of HPV-induced epithelial virocytopathic change, mucosal dysplasia or malignancy. - Histopathologically unremarkable secretory phase endometrium. - Representative transmural sections of histopathologically unremarkable uterine myometrium and serosa. - Gross absence of right and left adnexal structures. IV. ANATOMIC PATHOLOGY SUMMARY COMMENT:

This reviewing pathologist agrees with the initial pathologist's final summary diagnoses.

li

l .) ; LiI.a... WILLIAM J. C

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WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-06-541; 02-02-06 UNIT #: K0000871307 ACCT #: K063300535 ATTENDING PHYSICIANS: Nbalia Soumah, D.O., William 1. Roy, M.D. I. CLINICAL HISTORY: 40-year-old female, status post Pap smear, Fall 2005, interpreted as HSIL; cannot rule out invasion (outside Pap smear, un-named laboratory). Status post colposcopic biopsies of the cervix further revealed CIS. The patient to be scheduled for a radical hysterectomy, bilateral salpingo-oophorectomy, with bilateral pelvic and possible periaortic lymph node dissection, appendectomy / or suprapubic placement of a catheter. II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: The patient was admitted to Kern Medical Center on 02-02-06 for a radical hysterectomy. TAH-BSO with pelvic lymph node dissection was performed without complication. Intraoperative pathology consultation diagnosis (frozen section diagnosis): A. Left pelvic lymph nodes - Six lymph nodes negative for malignancy. B. Right pelvic lymph nodes - Eight lymph nodes negative for malignancy. The patient had a relatively uneventful hospital stay x three days and was discharged home with a follow-up visit scheduled. III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-06-541; 02-02-06, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-14-06 A. LEFT PELVIC LYMPH NODE DISSECTION: - Benign reactive lymph nodes (11). 0025957 Page 1 of3 0025957

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B. RIGHT PELVIC LYMPH NODE DISSECTION:

- Benign reactive lymph nodes (19). C. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES, AND OVARIES:

- Infiltrating moderate - poorly differentiated squamous carcinoma, large cell type invading to a measured depth of 9 - 10 mm and arising at the transition zone of the cervix. - There is no evidence for angio -lymphovascular invasion by tumor; however fictitious inoculation of lymphatic spaces are identified due to iatrogenic sectioning at the time of pathology processing. - Basilar proliferative phase endometrium. - Representative transmural sections of histopathologically unremarkable uterine myometrium and serosa. - Immature / mature squamous metaplasia and accompanying moderate acute and chronic endocervicitis; transitional zone of the cervix. - Nabothian cysts and tunnel cluster formation; endocervical canal mucosa. - Unremarkable well-glycogenated cervical squamous mucosa. - Multiple cortical cysts of follicular derivation, right and left ovaries. - Representative cross sections of histopathologically unremarkable right and left fallopian tubes. - Appendix: Representative sections of histopathologically unremarkable vermiform appendix. IV. EXTRAMURAL EXPERT CONSULTATION OPINION - DR. JUAN FELIX, WOMEN AND CHILDRENS HOSPITAL, KECK SCHOOL OF MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA, LOS ANGELES, PATHOLOGY # S-06-541; 07-07-06:

Diagnosis: - Large cell nonkeratinizing invasive squamous carcinoma of the cervix, nuclear grade 3 / 3. V. ANATOMIC PATHOLOGY SUMMARY COMMENT

This reviewing pathologist agrees with the initial pathologist's diagnosis of a high-grade invasive squamous cell carcinoma of the cervix, but would not

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"subspeciate" the neoplasm as a true "glassy cell" carcinoma, connoting an extremely poor prognosis.

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WILLIAM J. COj:BURN, M.D.

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WILLIAM J. COLBURN, M.D. - . 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: '818-708-5528 Fax: 818-708-5546 CASE #: S-05-923; 02-10-05 UNIT #: KOOO1128182 ACCT #: K0504000959 ATTENDING PHYSICIANS: William J. Roy, M.D., Cary Freeman, M.D., Nbalia Soumah, D.O., and Margarett Ellison, M.D. I. CLINICAL HISTORY: 49-year-old gravida 4, para 4 female presenting at the Gynecology/Oncology Clinic, Kern Medical Center, on 01-20-05, with the chief complaint of vaginal bleeding for seven months, PTA. Antecedent Pap smear, 06-16-04 reported as showing endometrial adenocarcinoma. Endometrial biopsy on 01-07-05 was reported as "mildly" differentiated endometrioid adenocarcinoma with cervical biopsy reported as squamous cell carcinoma. Radical hysterectomy with bilateral salpingooophorectomy, bilateral pelvic and periaortic lymph node dissection was scheduled on or about 02-10-05. II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: The patient was admitted to Kern Medical Center on 02-10-05 for scheduled radical hysterectomy. Intraoperative Pathology Consultation Diagnosis - Frozen Section Diagnosis Uterus, Cervix, Bilateral Ovaries and Fallopian Tubes: - Uterus and Cervix, 182 grams, received. Primary endometrial adenocarcinoma (grade 2), with endocervical and lower uterine segment extension. - Neoplasm infiltrates approximately 20% of the myometrial wall thickness. The patient tolerated the surgery well and left the OR and subsequent recovery in stable condition. Postop hospital course for 8 days was eventful with respect to postop moderate normochromic, normocytic anemia requiring four units of packed RBCs and bilateral lower lobe pneumonia with pleural effusions at day 3 - 4 postop. The remainder of the patient's hospital course was fairly uneventful and she was discharged home on day 8 (02-18-05), with instructions for a scheduled postop visit at the Ob/Gyn Clinic in one week.

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III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-05-923; 02-10-05, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-22-06 A. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES, AND OVARIES:

-

Villoglandular endometrioid adenocarcinoma exhibiting composite well moderate and poorly differentiated carcinoma components analogous to a high-grade infiltrating endometrioid adenocarcinoma; FIOO III. - Lymphovascular space invasion by tumor is identified. - Tumor penetrates 35% of the mural thickness of the uterine wall. - High-grade adenocarcinoma involves the upper aspects of the endocervical canal ( proximal endocervical canal ) - Paracervical / paraendometrial margins of hysterectomy are free of tumor. - Deeply penetrating adenomyosis - Nabothian cysts; distal endocervical canal mucosa. Squamous metaplasia; transitional zone of cervix. - Well-glycogenated unremarkable exocervical squamous mucosa. - Representative sections of histopathologically unremarkable left and right ovaries and fallopian tubes. B. VAGINAL MARGIN:

-

Histopathologically unremarkable squamous epithelial-lined vaginal mu~osa; negative for malignancy.

C. RIGHT PELVIC LYMPH NODES:

-

Benign reactive lymph nodes ( 10).

D. RIGHT AORTIC LYMPH NODES:

-

Benign reactive lymph nodes ( 4 ).

E. LEFT PELVIC LYMPH NODES:

-

Benign reactive lymph nodes ( 6 ).

F. PERIAORTIC LYMPH NODES:

-

Benign reactive lymph nodes ( 3 )

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IV. EXTRAMURAL CONSULTATION OPINION - DR. LYDIA BALATIANFLORES, GENZYME IMPATH LABORATORIES, LOS ANGELES, CALIFORNIA ( THEIR CONSULTATION # LA-05-007015; 02-21-05 ):

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I

-

I

Moderately differentiated adenocarcinoma of the endometrium associated with a poorly differentiated carcinoma, with necrosis and hemorrhage. ( Refer to extensive immunohistochemistry tumor histiogenesis marker profile analysis for your further edification ).

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V. REVIEWING PATHOLOGIST'S SUMMARY COMMENT:

~

I

This pathologist concurs with the final pathology diagnosis as rendered by the initial examining pathologist.

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

I

I

I

CASE #: C-04-28 UNIT #: KOOOI097368 ACCT #: K0422600627 ATTENDING PHYSICIANS: Joseph Mansour, M.D. ,Basem Bernaba, M.D., William Roy, M.D.

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II

I. CLINICAL HISTORY: 34-year old female,GO, PO, referred to the Kern Medical Center for gynecologic followup, status post laparoscopic ovarian cystectomy 3-5-04 performed in Mexico. Referring diagnosis: serous cystadenocarcinoma of low malignant potential. Consultation diagnosis: DJ, Staff Pathologist, Kern Medical Center, Bakersfield, California. Case #: P-04-410, their consultation case #: C-04-28. A. Clinical Cyst Fluid, Left Ovary (P-04-410): Hypercellular proteinaceous substance with limited epithelial cells and mildly Atypical. B. Clinical Cyst, Left Ovary (P-04-41O, Consultation Case #: P-04-28): Proliferating borderline serous tumor of the ovary, high grade (non-invasive micropapillary serous carcinoma ).

II. EXTRAMURAL CONSULTATION OPINION, DR. JUAN FELIX, WOMEN'S AND CHILDREN'S HOSPITAL, KECK SCHOOL OF MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA, LOS ANGELES, CALIFORNIA

LEFT OVARIAN CYST: Cyto / histomorphologic findings diagnostic of a serous tumor of low malignant potential. Comment:

I find no evidence for the diagnosis of micropapillary carcinoma.

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III. EXTRAMURAL CONSULTATION REVIEW, KERN MEDICAL CENTER, CONSULTATION CASE: C-04-28; 8-17-04; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA

The reported 14 slides of this cystic left ovary, consultation case C-04-28, are not available for microscopic evaluation. I see little substantive difference in the initial reported consultation opinion rendered by Dr. Jadwin, as a proliferating borderline serous tumor of the ovary, high grade (non-invasive micropapillary serous carcinoma) and that rendered by Dr. Juan Felix at the University of Southem California, Keck School of Medicine reported as a serous tumor of low malignant potential with no evidence for the diagnosis of micropapillary carcinoma. As reported by the Borderline Ovarian Tumor Workshop, Bethesda, Maryland, August 27 - 28,2003, published as an editorial in Human Pathology, volume 35, # 8, August, 2004, some participants objected to the use of the term "micropapillary serous carcinoma" (MPSC) and nonmicropapillary serous carcinoma (NMPSC) as they believe these lesions to be akin to the routine - typical serous borderline ovarian tumors (S-BOT). Micropapillary S-BOT and typical S-BOT's show the same risk factors for recurrence and have similar prognoses. Some participants therefore objected to using terms implying potential for distant spread (carcinoma), i.e. preferring to call these lesions serous borderline tumors with micropapillary features; not otherwise specified. By definition showing at least one microscopic area, uninterrupted micropapillary growth exceeding rel="nofollow">5mm and lacking stromal micro / macro invasion constituted a serous borderline tumor with micropapillary featUres. Not having the slides for review precludes this reviewer's substantiating the presence or absence of a nonhierarchial papillary mucosal architecture and / or micropapillary structures whose length exceeds five times their width. As you can see little is to be gained by "splitting hairs" in this case. Furthermore, a micropapillary / cribriform ml,1cosal architecture may co-exist with typical S-BOT. Tumors with more focal micropapillary features, i.e. measuring less than 5 mm in one dimension, are typically classified as S-BOT. Many studies have found no difference in survival for a worse survival in patients with micropapillary serous borderline ovarian tumors vs S-BOT's.

w~ ~Co..th-BURN, M.D.

WILLIAM J. C CarpiolKem/wjclllcl8-9-Q6

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WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: S-04-6857; 11-18-04 UNIT #: K0000633431 ACCT #: K0432100805 ATTENDING PHYSICIANS: William J. Roy, M.D., Nbalia Soumah, D.O.

I. CLINICAL HISTORY: 40-year-old female with a diagnosis of cervical adenocarcinoma, status post LEEP conization procedure with pathology reviewed at an outside institution, not otherwise specified. The patient was scheduled for radical hysterectomy, bilateral salpingooophorectomy, bilateral pelvic node dissection, with suprapubic catheter placement. Tentative date of surgery 11-18-04.

II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: The patient was admitted to Kern Medical Center on 11-18-04 for a radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic node dissection, which was performed without complication. Gross Intraoperative Pathology Consultation Opinion:

A. Cervix, uterus, bilateral ovaries and tubes: - No gross residual tumor in cervix. - Frozen section diagnosis: Residual tumor seen microscopically on frozen section slide. B. Right pelvic lymph node: Frozen section diagnosis: Half of the largest lymph node and four smaller lymph nodes are negative for metastasis. The patient's postoperative course was uneventful x 4 days and the patient was discharged to home on 11-22-04 with follow-up medical visits scheduled in clinic.

III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-04-6857; 11-18-04, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-14-06

0025965 0025965

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A. UTERUS AND ADNEXA (TOTAL ABDOMINAL HYSTERECTOMY):

Invasive adenocarcinoma of the cervix; endocervical type; submucosal depth of invasion 8 nun. There is no definitive microscopic evidence for angio - lymphovascular invasion by tumor. Isolated endocervical glands are involved by squamous carcinoma in situ (CIS). . The paracervical soft tissue margins of hysterectomy are free of tumor. Well-glycogenated exocervical squamous mucosa; negative for HPVinduced epithelial virocytopathic change, mucosal atypia of malignancy. Histopathologically unremarkable early secretory phase endometrium; endometrial cavity. Solitary diminutive / microscopic cellular leiomyoma; endometrium. Histopathologically unremarkable uterine serosa. Multiple follicular cysts and involuting corpus luteum cysts; right and left ovaries. Representative cross sections of histopathologically unremarkable right and left fallopian tubes. B. RIGHT PELVIC LYMPH NODE DISSECTION:

Benign reactive lymph nodes ( 7 ). C. LEFT PELVIC LYMPH NODE DISSECTION:

Benign reactive lymph nodes ( 15 ).

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT

This reviewing pathologist agrees with the final diagnoses as rendered by the original pathologist.

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: 8-05-592 K0001141122 UNIT #: ACCT#: K0502700459 ATTENDING PHYSICIANS: William Roy, M.D., Fangluo Liu, M.D.

I. CLINICAL HISTORY: 49-year old female, status post conization of cervix with a diagnosis of adenocarcinoma ofthe endocervix. CT of pelvis (12-04) - no pelvic mass or adenopathy. II. ONCOLOGIC SURGERY: TAR, lymph node dissection (1-27-05). III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE #: S-05-592; 1-27-05; WILLIAM J. COLBURN, M.D. , WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-9-06 A. RIGHT PELVIC LYMPH NODE DISSECTION: -

benign reactive lymph nodes (9).

B. LEFT PELVIC LYMPH NODE DISSECTION: benign reactive lymph nodes ( 10 ). C. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES AND OVARIES: endocervical adenocarcinoma in situ ( AI8 ) exhibiting retrograde cancerization of endocervical glandular apparati; the bulk ofthe tumefaction concentrated at the transition zone of the cervix. an accompanying microinvasive tumor component is identified invading to a maximum depth of 4 mm. -

scattered endocervical gland necks and glands are involved by moderate dysplasia ( CIN II / HSIL ). 0025967

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i

i

there is no evidence for angio-Iymphovascular invasion by tumor. granulomatous inflammation; status post conization of the cervix. the most distal ectocervical margin of hysterectomy is free of tumor. -

inactive endometrium.

-

corpus luteum cyst; left ovary.

-

histopathologically unremarkable right ovary.

- representative tangential/cross sections of histopathologically unremarkable left and right fallopian tubes.

IV. PRIOR EXTRAMURAL CONSULTATION OPINION - DR. JUAN FELIX, WOMEN'S & CHILDREN'S HOSPITAL, DEPARTMENT OF PATHOLOGY, KECK SCHOOL OF MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA, LOS ANGELES, CALIFORNIA DIAGNOSIS: UTERINE CERVIX: - extensive "in situ~~ adenocarcinoma of the cervix and several foci of invasive adenocarcinoma of the cervix (greatest depth of invasion - 4 mm ). - no vascular space involvement is identified. - multiple lymph node specimens reveal no evidence for malignancy.

V.

ANATOMIC PATHOLOGY SUMMARY COMMENT:

This reviewing pathologist concurs with the initial pathologist~s final diagnoses.

Narinderlkem/\\jc/llc/8-10-o6

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546 CASE #: S05-2186; 4-8-05 UNIT #: KOOOl145729 ACCT #: K0509700494 ATTENDING PHYSICIANS:

William J. Roy, M.D., Chang Lee, M.D.

I. CLINICAL HISTORY: 54-year old female G3, P3, with last LMP 2001, presenting with chief complaint ofpostmenopausal bleeding ( x 6 weeks). Pertinent Past Medical History: Carcinoma, status post colectomy 2000 (Dukes' B) without adjuvant treatment. Reported low AlCC stage disease. Recent colonoscopic examination: date and time unknown, reported as an "extrinsic" left sided colonic pelvic mass. Abdominal CT (2-15-05) revealed a large mixed density predominantly cystic pelvic mass arising apparently from the left with a hypodense ovoid mass in the right adnexa suggestive of a dermoid. The patient was scheduled for a total abdominal hysterectomy, bilateral salpingo-oophorectomy with possible modified posterior exenteration, possible bilateral pelvic retro-peritoneallymph node dissection omentectomy, peritoneal biopsies and tumor debulking as indicated. II. GYNECOLOGIC SURGERY I HOSPITAL COURSE: The patient was admitted to Kern Medical Center on 4-7-05 where an exploratory laparotomy was performed resulting in a TAH-BSO and appendectomy. INTRAOPERATIVE CONSULTATION DIAGNOSIS: Right ovary and fallopian tube (gross only): ovarian cyst, likely a dermoid cyst or cystic teratoma, mature. FROZEN SECTION DIAGNOSIS: - ovarian stroma, no cyst lining or germ cell elements identified - further diagnosis pending routine tissue processing. Left ovary and fallopian tube (gross only): largely necrotic hemorrhagic mass; no malignant neoplasm identified. FROZEN SECTION DIAGNOSIS: - smaller nodule with adenocarcinoma, high grade, possible representing metastases to a lymph node - further diagnosis pending routine processing. The patient tolerated the procedure well and left the operating I recovery room in good condition. The remainder of her hospital course was relatively uneventful and the patient was discharged to her home on 4-14-05 and instructed to keep her scheduled appointment at the Women's Health Center in one week post-discharge. 0025969 0025969

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III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER CASE # S05-2186; 4-8-05; WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, CALIFORNIA; 8-23-06 A. RIGHT OVARY AND FALLOPIAN TUBE: - mature cystic teratoma ( dennoid cyst) and ofnote, residing within the ovarian corticular substance is a microscopically demonstrable 5.5 mm focus ofmetastatic adenocarcinoma; high grade, of probable colonic epithelial origin. - representative cross sections histopathologically unremarkable right fallopian tube. B. LEFT OVARY AND FALLOPIAN TUBE: - metastatic high grade colonic adenocarcinoma exhibiting extensive tumoral necrobiosis (Krukenberg's tumor); left ovary and fallopian tube.

C. RIGHT PELVIC LYMPH NODES: - benign reactive lymph nodes ( 21 ). D. LEFTPELVICLYMPHNODES: - benign reactive lymph nodes (5 ). E. LEFT PARA-AORTIC LYMPH NODES: - benign reactive lymph nodes ( 16 ). F. APPENDIX: - representative sections vennifonn appendix showing reactive serous surface / peritoneal change, well established fibromembranous adhesions without other clinically significant histopathologic abnonnality. G. LEFT URETERAL NODULE: - metastatic high grade colonic adenocarcinoma further eliciting a marked reactive stromal desmoplastic response. H. BIOPSY, URINARY BLADDER: - acute - chronically inflamed transitional epithelial lined bladder mucosa showing nests of Von Brunn / cystiticcystica; negative for significant urothelial cells, atypia, dysplasia or malignancy. - there is no evidence for metastatic tumor. I. UTERUS AND CERVIX: - metastatic high grade colonic adenocarcinoma; lower uterine segment and left parametrium. 0025970 S05-2186; 4·8-05

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inactive basilar endometrium showing subsurface mild glandular cystic transfonnation. Representative transmural sections ofhistopathologically unremarkable myometrium and overlying serosa. Nabothian cysts and squamous metaplasia; transition zone of cervix. histopathologically unremarkable proximal endocervical canal and well glycogenated exocervical squamous mucosa. gross absence of right and left adnexal structures (refer to parts A and B for your further edification ).

J. OMENTUM: - reactive serous surface change / fibromembranous adhesions; negative for metastatic tumor.

IV. SURGICAL PATHOLOGY CONSULTATION REPORT, UCLA MEDICAL CENTER, LOS ANGELES, CALIFORNIA; THEIR SURGICAL PATHOLOGY #: R05-07703; 5-12-06

A. RIGHT OVARY AND FALLOPIAN TUBE: adenocarcinoma consistent with metastatic colorectal adenocarcinoma. - mature cystic teratoma. B. LEFT OVARY AND FALLOPIAN TUBE: - metastatic adenocarcinoma involving fallopian tube and ovary. C. RIGHT PELVIC LYMPH NODES: - 21 lymph nodes negative for metastatic tumor. D. LEFT PELVIC LYMPH NODES: 5 lymph nodes, negative for metastatic tumor. E. LEFT PARA-AORTIC LYMPH NODES: - 16 lymph nodes, negative for metastatic tumor. F. APPENDIX: appendix with no pathologic diagnosis. - no tumor seen. G. LEFT URETERAL NODULE: - metastatic adenocarcinoma. H. BLADDER BIOPSY: - urothelial mucosa with mild atypia. - no definitive tumor seen.

0025971 S05-2186; 4-8-05

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I. UTERUS AND CERVIX: metastatic adenocarcinoma found in the subserosa of the lower uterine segment and involving the left parametrium. chronic endocervicitis. endometrium with cystic atrophy. J. OMENTUM: no tumor seen.

V. SUMMARY REVIEW

This pathologist concurs with the final diagnosis as rendered by the initial examining pathologist.

w

t1.t.LnMr,

WILLIAM J. C

~BURN, Co fLt=.....M.D.

Wheatlkemlwjclllcl8-24-06

0025972 S05-2186; 4-8-05

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WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546 CASE #: S-06-91 UNIT # KOOO1100262 ACCT #: K0600600245 ATTENDING PHYSICIANS: Antonio Garcia, M.D., George Alkhouri, M.D. DATE: 1-6-06

I. CLINICAL HISTORY:

47-year old female with history of breast cancer since 3-02. Tissue diagnosis: infiltrating duct carcinoma 2.5 cm. with clear margins and 5 / 20 lymph nodes positive for metastatic tumor. mc breast cancer tumor marker profile: ER- positive, PRpositive, Her2/neu - positive. Status post chemotherapy with CAP and Tamoxifen. Recurrence of breast cancer ( right breast) via ultrasound-guided biopsy ( 2-05). CT scan of the chest 8-05 revealed bony osseous metastasis at T-7 through T-11. II. GYNECOLOGIC HISTORY:

LMP 2002. Thin prep pap smear (005-3131 ) - ASCUS. HPV test utilizing 2nd generation viral captured technique reported as positive for high-risk HPV serotypes. Antecedent endocervical curettings ( 8-05-7868 ) - normal histopathology.

III. PATHOLOGY CONSULTATION REVIEW, SURGICAL PATHOLOGY CASE: 2-06-91; 1-6-06, KERN MEDICAL CENTER, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA, 8-04-06

A. CERVICAL BIOPSY, 6:00 POSITION: - atypical endocervical hyperplasia; negative for HPV-induced epithelial virocytopathic effect, mucosal dysplasia or malignancy ( x 6; sections reviewed 6). B. ENDOCERVICAL CURETTAGE: - multiple disrupted poorly preserved strips of endocervical canal mucosa showing atypical squamous cells; favor dysplasia ( CIN I / LSIL ). there is no evidence for high grade mucosal dysplasia or malignancy.

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c I

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT: This reviewing pathologist concurs with the diagnoses rendered by the initial pathologist of record.

w~

.

WILLIAMJ.

LBURN,M.D.

Villarea1/kern - wjc/llc/8-4-2006

S-06-91

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•

-It

WILLIAM J. COLBURN, M.D. - 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE: S-05-2246 K0001146465 UNIT #: ACCT #: K0510100660 ATTENDING PHYSICIANS: Miguel Lascano, M.D., Nbalia Soumah, D.O.

I. CLINICAL HISTORY: 58-year old G3, P3, female, referred to Kern Medical Center 3-21-05 with a chief complaint of abdominal pain and pelvic mass. Pertinent past medical history: uterine fibroids 1994 to the present. Pelvic ultrasound reveals an enlarged uterus, multiple myomas and the right ovary was noted to be predominantly cystic measuring up to 13.2 cm in maximum dimension, appearing complex and septate. The left ovary was not visualized. The patient was scheduled for total abdominal hysterectomy, bilateral salpingo-oophorectomy on 4-12-05. II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: Surgical procedure: TAH-BSO 12-05 without intraoperative / immediate post-operative complications. FROZEN SECTION DIAGNOSIS: Right ovary: - ovary ( 1630 grams) with papillary serous cystadenoma of uncertain malignant potential ( borderline malignant potential ).

GROSS INTRAOPERATNE DIAGNOSIS: - fallopian tube without gross pathological features. - further diagnosis pending routine processing.

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III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE #: S -05-2246; 4-12-05, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-8-06 A. CLINICAL MASS, RIGHT OVARY, EXCISION: - complex multilocular serous cystadenofibroma with evolution to serous borderline ovarian tumor (S-BOT). - a micro- / macro-invasive tumor component is not identified. - the peritoneal serosal surface is uninvolved by tumor. - representative tangential sections of histopathologically unremarkable distal fallopian tube.

B. HERNIA SAC, SITE NOT SPECIFIED; HERNIORRHAPHY: - mesothelial lined fibrovascular and adipose tissue consistent with an origin from a hernia sac; surgical repair of umbilical hernia.

C. UTERUS AND LEFT ADNEXA: - benign leiomyomata exhibiting degenerating architectural features. - inactive atrophic endometrium; lower uterine segment. - squamous metaplasia; transitional zone of cervix. - unremarkable well glycogenated exocervical squamous mucosa. - multiple cortical based serous cystic inclusion rests; left ovary. - representative cross section of histopathologically unremarkable left fallopian tube. - gross absence of right and left adnexal structures ( refer to part "A" for your further edification ).

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ANATOMIC PATHOLOGY SUMMARY COMMENT:

This reviewing pathologist agrees with the initial pathologist's diagnosis.

.

W~ WILLIAM J. C

~

~ BURN, M.D.

Martinezlkemlwjc/lIcl8-9-o6

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WILLIAM J. COLD"URN, M.D. 21114 Vanowen Street, Canoga Park, CA. 91303 Telephone: 818-708-5528 Fax: 818-708-5546

CASE #: 8-05-381; 1-14-05 UNIT #: K0001138812 ACCT #: K0501400249 ATTENDING PHYSICIANS: Preete Bhanot, M.D., Wi111iam Roy, M.D.

I. CLINICAL HISTORY: 47-year old female G5, PI with a diagnosis of well differentiated keratinizing squamous carcinoma with superficial invasion, dx, 12-16-04. Biopsies at Kern Medical Center; Gyn-oncology Clinic performed 1-14-05 consisting ofpap smear, endocervical curettage and colposcopic biopsy of the cervix and vulva. The biopsy results reveal a superficially invasive squamous carcinoma with microinvasion to 0.6 mm; 3:00 position, vulva VIN I; 7:00 position, vulva. The patient was scheduled for a wide left radical excision of the vulva, possible vulvectomy, possible left groin, possible left inguinal lymph node dissection. II. GYNECOLOGIC SURGERY I HOSPITAL COURSE: Radical unilateral vulvectomy and CUSA contralateral side, performed 4-21-05. Intraoperative frozen section margin of radical vulvectomy interpreted as negative for malignancy or lesion. Remainder of hospital course noted to be unremarkable.

III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-05-381; 1-14-05. W.J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-4-06 A. Cervical Biopsy, 1200 Position: serial sections well-glycogenated exocervical squamous mucosa without definitive microscopic evidence for HPV-induced epithelial virocytopathic effect, mucosal dysplasia or malignancy; levels (x 2; total sections 6 ). B. Endocervical Curettage: - multiple strips of histopathologically unremarkable endocervical canal mucosa exhibiting reserve cell change I immature squamous metaplasia; negative for HPV-induced epithelial virocytopathic effect, mucosal dysplasia or malignancy.

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C. Vulvar Biopsy, 3:00 Position: - YIN II - III with transition to squamous carcinoma in situ. Of note: a 0.6 mm microinvasive superficial dermal tumor component is identified. There is no evidence for dermal angio-Iymphovascular invasion by tumor. D. Vulvar Biopsy, 7:00 Position: vulvar intraepithelial neoplasia; YIN I - II. an accompanying microinvasive tumor component is not identified.

IV. ANATOMIC PATHOLOGY SUMMARY COMMENT: Anatomic pathology correlation - this reviewing pathologist agrees in toto with the initial pathologist's diagnoses; parts A - D inclusive.

W.t.J..luJ,., ~ Ct.tlL----

WILLIAM J. C

BURN, M.D.

Unkrich-wjc-l1c-8-4-2006

0025979 S-05-381; 1-14-05

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WILLIAM J. COLBURN, M.D. 21114 Vanowen Street, Canoga Park, CA 91303 Telephone: 818-708-5528 Fax: 818-708-5546 CASE #: S-06-728; 02~ 14-06 UNIT #: K0000800794 ACCT #: K0604100439 ATTENDING PHYSICIANS: William 1. Roy, M.D., Tony Hoang, M.D. I. CLINICAL HISTORY: 60-year-old Caucasian female admitted to the Gyn~Oncology Service, Kern Medical Center, with a history of bilateral adnexal masses. Tumor markers CEA and CA-125 were noted to be elevated. Colonoscopy at an outside facility showed diverticular disease with no evidence for malignancy. An upper GI endoscopic examination was not performed. The patient was scheduled for an exploratory laparotomy on 02-1006. II. GYNECOLOGIC SURGERY / HOSPITAL COURSE: Exploratory laparotomy was performed 02-10-06. Upon entering the peritoneal cavity, the surgeons encountered approximately 10.6 liters of ascitic fluid. Exploration of the abdomen and pelvis revealed peritoneal cake with diffuse peritoneal carcinomatosis. The right and left ovaries appeared massively enlarged, each measuring approximately 10.0 cm in maximum diameter. Further exploration of the upper gastrointestinal tract revealed what was presumed to represent a primary gastric neoplasm. A subsequent omentectomy and total abdominal hysterectomy, bilateral salpingo-oophorectomy was performed. Intraoperative frozen section diagnosis was interpreted as signet ring cell carcinoma; rule out primary gastric carcinoma. The patient tolerated the procedure well and left the operating room in stable condition. The patient remained hospitalized for approximately two weeks and was discharged toa skilled nursing facility on 02-23-06. III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL CENTER, CASE S-06-728; 02-14-06, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 08-12-06 A. LEFT OVARY AND FALLOPIAN TUBE: -

Metastatic signet ring cell carcinoma (mucinous adenocarcinoma) of probable primary upper gastrointestinal tract mucosal origin.

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Representative cross section left fallopian tube shows a remnant of mural mesonephric I paramesonephric cystic remnants without other significant histopathologic abnormality. B. RIGHT OVARY AND FALLOPIAN TUBE:

Metastatic signet ring cell carcinoma (mucinous / colloid adenocarcinoma) of probable upper gastrointestinal tract mucosal origin. Cross section of right fallopian tube shows extramural presence of remnant mesonephric / paramesonephric duct apparati; otherwise there is no significant histopathologic abnormality. C. OMENTUM, UTERUS AND CERVIX:

-

Metastatic mucinous I colloid adenocarcinoma exhibiting regional prominent signet ring cytomorphologic features; omentum. Atrophic endometrium; endometrial cavity, corpus uterus. Superficial adenomyosis; myometrium. Representative sections of histopathologically unremarkable uterine serosa. Nabothian cyst formation and squamous metaplasia; transition zone of cervix. Well-glycogenated histopathologically unremarkable exocervical squamous mucosa. Gross absence of right and left adnexal structures (refer to A and B for your further edification).

IV. REVIEWING PATHOLOGIST'S SUMMARY COMMENT:

This pathologist agrees with the original pathologist's microscopic and diagnosis as rendered.

W

,Ill",.",

~~

WILLIAM J. CHURN, M.D.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 24

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

IRWIN EVERETT HARRIS, M.D.

17

Wednesday, August 13, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

HarrisI1

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1

10:07:03

1 there was a quality concern.

2

10:07:06

2

3

10:07:09

3 reviewed by -- about these cases complained about by

4

10:07:11

4 Dr. Roy?

5

10:07:12

5

6

10:07:15

6 ever was told.

7

10:07:19

7

8

10:07:22

8 be told he was being peer reviewed on these cases

9

10:07:24

9 reported by Dr. Roy?

Q.

A.

Q.

A.

When was Dr. Jadwin told he was being peer

I don't remember.

I don't even know if he

Why wouldn't he -- why wouldn't Dr. Jadwin

10

10:07:25 10

11

10:07:29 11 over Dr. Jadwin's quality --

12

10:07:32 12

Q.

So when you say --

13

10:07:33 13

A.

-- from the peer review mechanism.

14

10:07:37 14

Q.

Do you think that's fair?

15

10:07:38 15 fair to peer review somebody without telling them?

16

10:07:41 16

A.

Oh, absolutely.

17

10:07:41 17

Q.

Why is that?

18

10:07:43 18

A.

Because unless there's evidence that there

19

10:07:47 19 is indeed a quality concern, it is purely private and

20

10:07:51 20 confidential among those selected few who have the

21

10:07:57 21 ability to determine whether or not there's a quality

22

10:08:01 22 issue.

23

10:08:02 23

24

10:08:04 24 conducted on the cases complained about by Dr. Roy,

25

10:08:08 25 cases -- Dr. Jadwin's cases were sent out to outside

Q.

I had no and still do not recall any concern

Do you think it's

So in Dr. Jadwin's case, peer review was

HarrisI1

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1

10:11:18

1 attention that there were competence issues with

2

10:11:21

2 Dr. Jadwin?

3

10:11:22

3

A.

Prior to his return October 4th, 2006?

4

10:11:27

4

Q.

Actually, let me -- what about after his

5

10:11:29

5 return to the hospital?

6

10:11:33

6 the hospital October 4 of 2006, were you aware of any

7

10:11:36

7 competency issues regarding Dr. Jadwin?

8

10:11:38

8

9

10:11:40

9 that time.

A.

No.

After Dr. Jadwin returned to

Q.

I believe there might have been concerns at

10

10:11:42 10

11

10:11:45 11 concerns?

12

10:11:54 12

13

10:12:05 13 I'm in a bit of an awkward position because normally

14

10:12:14 14 I ask for the evidence in order to pursue something.

15

10:12:21 15 So anything that I say is hearsay, but the hearsay

16

10:12:27 16 was is that some of the readings were probably not

17

10:12:30 17 accurate.

18

10:12:31 18

19

10:12:34 19 were not accurate?

20

10:12:35 20

A.

That's what I believe the issue was.

21

10:12:37 21

Q.

Was there a peer review conducted on that?

22

10:12:40 22

A.

No.

23

10:12:42 23

Q.

And why not?

24

10:12:43 24

A.

I don't believe there was sufficient time

25

10:12:45 25 between the date of his return and when he was no

A.

And what was -- what were some of these

Q.

The concern was that -- that -- well, again,

Some of Dr. Jadwin's pathology diagnoses

Not that I'm aware of.

HarrisI1

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 69 of 191 59

1

10:12:50

1 longer providing service to allow that to occur.

2

10:12:55

2

3

10:12:57

3 about Dr. Jadwin's diagnoses potentially being

4

10:12:59

4 incorrect after October 4 of 2006?

5

10:13:02

5

6

10:13:04

6 I said that it was hearsay is that I only operate

7

10:13:08

7 when I have evidence specifically to guide the peer

8

10:13:14

8 review process, and I don't believe that I had any.

9

10:13:16

9

Q.

A.

Q.

Who made these -- who raised these concerns

I don't recall.

Okay.

And one of the reasons why

Who told -- how did you learn about

10

10:13:18 10 these concerns about Dr. Jadwin's competence after

11

10:13:22 11 October 4, 2006?

12

10:13:23 12

A.

I don't recall.

13

10:13:25 13

Q.

You don't recall who told you?

14

10:13:27 14

A.

No.

15

10:13:27 15

Q.

Could it have been Dr. Philip Dutt?

16

10:13:31 16

A.

I -- it could have been, yes.

17

10:13:31 17

Q.

Could it have been --

18

10:13:36 18

A.

But it would not have been him exclusively.

19

10:13:39 19

Q.

Well, who does pathology interact with?

20

10:13:43 20 mean, there is a pathology department itself.

21

21

A.

Um-hmm.

22

10:13:45 22

Q.

Correct?

23

10:13:45 23

A.

The -- the -- the surgeons and other

24

10:13:49 24 physicians that rely on Dr. Jadwin's consultative

25

10:13:55 25 opinions also are knowledgeable of his work.

HarrisI1

I

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-3

Filed 12/01/2008

Page 70 of 191 60

1

10:14:01

1

2

10:14:03

2 have been raising concerns about Dr. Jadwin's

3

10:14:06

3 diagnoses being incorrect?

4

10:14:07

4

A.

I don't recall, but possibly.

5

10:14:10

5

Q.

Okay.

6

10:14:11

6 would know about these competency issues being raised

7

10:14:15

7 about Dr. Jadwin after October 4th --

8

10:14:17

8

9

10:14:18

9 colleagues and -- and the other physicians with whom

A.

And they were the ones you believe who may

Who would recall?

We just discussed that.

Do you know who

It would be his

10

10:14:24 10 he works in the institution.

11

10:14:24 11

12

10:14:26 12 were these complaints directed, these colleagues?

13

10:14:29 13

A.

You'll have to rephrase the question.

14

10:14:31 14

Q.

You said there were colleagues and various

15

10:14:33 15 people that were raising competency issues about

16

10:14:36 16 Dr. Jadwin's pathology diagnoses after October 4,

17

10:14:39 17 2006.

18

10:14:39 18

19

10:14:41 19 directed?

20

10:14:43 20

A.

Me.

21

10:14:43 21

Q.

To you?

22

10:14:44 22

A.

Yeah.

23

10:14:45 23

Q.

And you can't recall -- well, how many --

24

10:14:48 24 how many people were complaining about Dr. Jadwin?

25

10:14:50 25

Q.

Well, I guess what I'm asking is to whom

To whom would those complaints have been

A.

More than one.

HarrisI1

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-3

Filed 12/01/2008

Page 71 of 191 192

1

15:00:50

1

2

15:00:54

2 returned from his leave of absence?

3

15:00:56

3

4

15:00:57

4 tell me.

5

15:00:58

5

A.

Well, I don't think they are.

6

15:00:59

6

Q.

Right.

7

15:01:00

7

A.

If there is -- what I was trying to say was

8

15:01:02

8 if any of these cases were cases that were processed

9

15:01:06

9 and completed after he returned from his leave of

Q.

Were any of these cases done after he

I don't know.

Take a look.

You have to

10

15:01:08 10 absence I cannot speak to those, but any before his

11

15:01:12 11 leave of absence there was no quality concern.

12

15:01:16 12 said that four times now.

13

15:01:19 13 concern over the cases prior to October of 2006.

14

15:01:23 14

15

15:01:26 15 tell me if any of the cases --

16

15:01:28 16

17

15:01:31 17 to do, but I'd be happy to review the document.

18

15:01:51 18

19

15:01:54 19 help me out with some of these dates because I don't

20

15:01:57 20 fully understand them.

21

15:01:59 21

Q.

You mean you're finding them illegible or --

22

15:02:02 22

A.

No.

23

15:02:04 23 and completed 2/17/06, and I don't know whether that

24

15:02:07 24 was before or after the leave of absence or during.

25

15:02:10 25

Q.

A.

Okay.

I've

There was no quality

So can you take a look at this and

Well, that was the job that you're supposed

Can I ask the -- my counsel next to me to

Q.

There's a cervical biopsy here 1/6/06

You don't know -- you're confused about the

HarrisI1

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 72 of 191 199

1

15:22:06

1

Q.

Remember why you apologized to Dr. Jadwin?

2

15:22:09

2

A.

Yeah.

3

15:22:10

3

Q.

Okay.

4

15:22:13

4 Dr. Jadwin?

5

15:22:14

5

6

15:22:18

6 comments are sincere.

7

15:22:22

7

8

15:22:24

8 insincere or fake or meant to please anybody.

9

15:22:28

9 Correct?

A.

Q.

Yes.

A.

Was it a sincere apology to

I -- I would like to think that all my

You would never do anything that was

10

15:22:29 10

11

15:22:34 11 integrity and honesty as my major guiding light.

12

15:22:44 12

13

15:22:49 13 don't lie.

14

15:22:51 14

15

15:22:55 15 gray, and I'm not going to answer that question.

16

15:22:58 16

Q.

I'm asking if you lie, Doctor.

17

15:22:59 17

A.

There are all degrees of telling the truth.

18

15:23:03 18 Some people consider omission a lie.

19

15:23:08 19 sorry.

20

15:23:11 20 question you just asked me that I'm not going to

21

15:23:14 21 respond to.

22

15:23:14 22

23

15:23:16 23 Dr. Harris?

24

15:23:19 24

A.

I'm not going to play this game.

25

15:23:20 25

Q.

You're not going to answer?

Q.

A.

Q.

I try not to, no.

I -- I -- I try to have

So you wouldn't lie, for instance?

You

Right?

That is an absolute that has many shades of

So -- I'm

This is a hypothetical, philosophical

So do you engage in shades of lies,

HarrisI1

Case 1:07-cv-00026-OWW-TAG

Okay.

Filed 12/01/2008

Page 73 of 191 232

1

16:07:49

1

2

16:07:53

2 but it was something to the effect of what you just

3

Q.

Document 277-3

You don't recall the exact wording,

3 said.

4

16:07:54

4

A.

Paraphrased.

That's correct.

5

16:07:56

5

Q.

Do you recall what Dr. Jadwin said to

6

16:07:59

6 Dr. Kercher?

7

16:08:01

7

A.

No.

8

16:08:04

8

Q.

Did he say anything about -- what about

9

16:08:06

9 Dr. Abraham?

But I remember that it was negative.

10

16:08:06 10

A.

And Dr. Abraham even more so negative.

11

16:08:10 11

Q.

Dr. Abraham was present at that meeting of

12

16:08:12 12 February 22?

13

16:08:13 13

A.

Yes.

14

16:08:14 14

Q.

Okay.

You're sure she was present there?

15

16:08:24 15

A.

Yeah.

I'm pretty sure she was present.

16

16

Q.

Okay.

17

16:08:27 17

A.

Because I remember there was a lot of

18

16:08:29 18 negative things said about her at that meeting.

19

16:08:31 19

20

16:08:34 20 anybody at that February 22 meeting?

21

16:08:38 21

A.

Yeah.

I believe there was.

22

16:08:40 22

Q.

Okay.

Give me some examples, please.

23

16:08:41 23

A.

I think it was offered up as -- as concerns

24

16:08:45 24 and criticism.

25

16:08:53 25 in a constructive manner.

Q.

Was anything negative said to Dr. Jadwin by

It was largely tried to be delivered I suppose there was some

HarrisI1

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 74 of 191 331

1

18:41:58

1 wherein the realm of disruptive physicians, one of

2

18:42:05

2 the problems is is that they often think that they're

3

18:42:08

3 right and right about everything.

4

18:42:15

4 don't know exactly what it means from there.

5

18:42:18

5 know is that disruptive physicians often think that

6

18:42:20

6 they're right and they stick to being right so much

7

18:42:23

7 that they lose the perspectives on collaborative

8

18:42:30

8 aspect of their role.

9

18:42:31

9

And sometimes -- I All I

The second --

10

18:42:31 10

Q.

Sorry.

Can I just interrupt one question.

11

18:42:34 11

12

18:42:36 12 mean that in terms of the formal term, disruptive

13

18:42:40 13 physician as in disruptive physician policy that Kern

14

18:42:43 14 Medical Center has?

15

18:42:43 15

A.

Yes.

16

18:42:44 16

Q.

Was Dr. Jadwin a disruptive physician under

17

18:42:47 17 that policy?

18

18:42:48 18

19

18:42:51 19 that I mentioned about seven hours ago applied to

20

18:42:56 20 Dr. Jadwin, yes.

21

18:42:58 21

22

18:43:01 22 procedure under the disruptive physician policy at

23

18:43:05 23 KMC?

24

18:43:06 24

A.

In essence.

25

18:43:08 25

Q.

Well, why do you say in essence?

When you say disruptive physician, do you

A.

Q.

I considered that the progressive discipline

So you instituted the disruptive physician

HarrisI1

What's the

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 75 of 191 332

1

18:43:10

1 difference?

2

18:43:14

2 then?

3

18:43:14

3

A.

I'm not sure it was formal then.

4

18:43:17

4

Q.

Okay.

5

18:43:21

5 recall --

6

18:43:22

6

7

18:43:25

7 cannot make someone respect you or love you.

8

18:43:29

8 have to earn it by your actions.

9

18:43:32

9

A.

Q.

Are you saying that it was informally,

So at this point you can't really

And the second part of this is that you

Okay.

You

So is it correct to say that both of

10

18:43:34 10 these statements applied to Dr. Jadwin?

11

18:43:36 11

12

18:43:40 12 handwriting out of context, and I'm not sure what it

13

18:43:43 13 applied to.

14

18:43:45 14

15

18:43:46 15 about this Page 494?

16

18:43:48 16

17

18:43:58 17 written.

18

18:43:58 18

19

18:44:02 19 ask that we go off the record at this point so we can

20

18:44:04 20 calculate the time precisely.

21

18:44:10 21

Okay.

22

19:05:08 22

(Discussion off the record.)

23

19:05:08 23

MR. LEE:

24

19:05:50 24 p.m.

25

19:05:52 25

A.

Q.

A.

I'm not sure.

You gave me some of my

So really, you don't have much recollection

I would have to know in what context it was

MR. LEE:

I'm going to ask -- I'm going to

Just one second.

We are off the record at 6:43 p.m.

We're back on the record at 7:05

The deposition will be stopped for now, but

HarrisI1

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

335 Page 76 of 191

STATE OF CALIFORNIA ss. COUNTY OF KERN

I, Susan R. Wood, a Certified Shorthand Reporter in the State of California, holding Certificate No.

6829, do hereby certify that

IRWIN EVERETT HARRIS, M.D., the witness named in the foregoing deposition, was by me duly sworn; that said deposition was taken Wednesday, August 13, 2008, at the time and place set forth on the first page hereof. That upon the taking of the deposition, the words of the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action, nor in any way interested in the result or outcome thereof. Dated this 15th day of August,

2008, at

Bakersfield, California.

susa~-R

N-o.---

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 77 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 25

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

30

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) Volume II ) Page 336 Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) _____________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

IRWIN EVERETT HARRIS, M.D.

17

Wednesday, August 27, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Erika Addis, CSR No. 11621

HarrisI2

Page 78 of 191 336

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 79 of 191 409

1

10:50:42

1 there that would suggest --

2

10:50:43

2

MR. WASSER:

3

10:50:44

3

MR. LEE:

4

10:50:44

4 BY MR. LEE:

5

10:50:46

5

Q.

-- that would suggest this authority exists?

6

10:50:49

6

A.

I would have to study that particular

7

10:50:51

7 document.

8

10:50:57

8 stuff tenet that the officers of the medical staff

9

10:51:01

9 have the ability to -- in their quality roles to

708.

Sorry.

708.

But I would believe that as a medical

10

10:51:07 10 evaluate and determine whether or not a quality of

11

10:51:12 11 care concern exists or not.

12

10:51:14 12

13

10:51:20 13 of cases by Dr. Roy provided to you were sent out to

14

10:51:23 14 outside review by the medical staff officers and the

15

10:51:26 15 director of quality care -- and by the way, is this

16

10:51:32 16 -- is this -- that committee one of those committees

17

10:51:36 17 -- investigative committees you talked about, you and

18

10:51:37 18 the medical staff officers, performing here?

19

10:51:40 19

20

10:51:48 20 committee was formed.

21

10:51:49 21

22

10:51:52 22 officers informally sent out Dr. Jadwin's cases for

23

10:51:55 23 outside review, the list of cases provided by Dr. Roy

24

10:51:58 24 in 2006, you recall that the results came back that

25

10:52:04 25 Dr. Jadwin's patient care issue was not incompetence;

Q.

A.

Q.

Did anybody -- after now -- after this list

I don't recall that a formal investigative

Okay.

So when you and the medical staff

HarrisI2

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 80 of 191 410

1

10:52:08

1 that there was no incompetency about Dr. Jadwin's

2

10:52:11

2 reports.

3

10:52:12

3

A.

That is as I recall, yes.

4

10:52:14

4

Q.

Okay.

5

10:52:17

5 anybody at all?

6

10:52:18

6

7

10:52:22

7 a prior deposition.

8

10:52:24

8 here.

9

10:52:28

9 was no need to.

A.

Correct?

So did you relate those findings to

I don't -- you've asked me this question in You've asked me this question

I don't recall.

I would have felt that there

There was no quality of care concern

10

10:52:32 10 raised.

11

10:52:32 11

12

10:52:35 12 no need to explain the results to anybody.

13

10:52:37 13

A.

Exactly.

14

10:52:41 14

Q.

But you knew Dr. Jadwin was concerned?

15

10:52:48 15

16

10:52:48 16 time.

17

10:52:48 17 many times are you going to go over this?

18

10:52:48 18

19

10:52:48 19 BY MR. LEE:

20

10:52:49 20

21

10:52:52 21 David Culberson regarding Dr. Jadwin?

22

10:52:55 22

23

10:52:59 23 conversations with Mr. Culberson regarding Dr.

24

10:53:03 24 Jadwin.

25

10:53:03 25

Q.

So if no concern was raised, then there was

MR. WASSER:

Counsel, you covered this last

You covered that already this morning.

MR. LEE:

Q.

A.

Q.

How

I'll withdraw the question.

Do you recall having conversations with

I'm positive that I would have had numerous

And what would those conversations have

HarrisI2

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 81 of 191 411

1

10:53:06

1 been?

2

10:53:06

2

3

10:53:08

3 recollection of them, but I'm sure that I had them.

4

10:53:11

4

5

10:53:14

5 recall telling Dr. Culberson about Dr. Jadwin's

6

10:53:18

6 competence or incompetency as a pathologist?

7

10:53:21

7

8

10:53:25

8 have to specify in what time period you're talking

9

10:53:28

9 about, but certainly prior to the date that initiated

A.

Q.

A.

At this moment in time I don't have

And do you recall -- well, what do you

I don't recall -- and, again, I think you

10

10:53:33 10 his leave of absence, I don't believe that I would

11

10:53:37 11 have made any comment in a negative way regarding his

12

10:53:41 12 competency.

13

10:53:42 13

14

10:53:45 14 that there was an issue of his competency?

15

10:53:49 15

16

10:53:51 16 that his competency was an issue in this case.

17

10:53:53 17

18

10:53:57 18

19

10:53:58 19 either, but keep going, Counsel.

20

10:54:00 20 before.

21

10:54:00 21

MR. LEE:

22

10:54:00 22

MR. WASSER:

23

10:54:02 23 of time.

24

10:54:02 24

25

25

Q.

A.

Q.

Okay.

Because you had no evidence to show

That's correct.

Well, I wasn't even aware

Well, it certainly wasn't from our view. MR. WASSER:

It's not from the defense We covered that

Okay. That's why this is all a waste

But keep going.

HarrisI2

Case 1:07-cv-00026-OWW-TAG

Document 277-3

472 Page 82 of 191

Filed 12/01/2008

STATE OF CALIFORNIA ss. COUNTY OF KERN

I, Erika Addis, a Certified Shorthand Reporter in the State of California, Certificate No.

holding

11621, do hereby certify that

IRWIN EVERETT HARRIS,

M.D.,

foregoing deposition,

was by me duly resworn;

depo~ition

the witness named in the

was taken Wednesday, August 27,

that said

2008,

at the

time and place set forth on the first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action, nor in any way interested in the result or outcome thereof. Dated this 10th day of September,

2008,

Bakersfield, California.

at

» /J~~~_ Erik~ ~ . .£.fl621

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 83 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

EXHIBIT 26

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

31

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 84 of 191

Kern Medical Center FNA Consulting Project

David Lieu, M.D., M.B.A. Cytopathologist Assistant Clinical Professor of Pathology UCLA May 3, 2004

DFJ00251

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 85 of 191

Table of Contents Overview of the Problem External Perspectives Perceptions of the Radiology Department Perceptions of the Pathology Department Perceptions of the Clinicians Illustration of Differences in Perception: Radiology and Pathology Overview of the Solution Recommendation 1 – Existence of an FNA Service Recommendation 2 – Communication in Requesting an FNA Recommendation 3 – FNA Reporting Proportion of Unsatisfactory/Limited FNAs Causes of the High Non-Diagnostic Rate From Statistical Data Recommendation 4 – FNA Data Collection Assistance at FNA Procedures Recommendation 5 – Timing of Assistance at FNA Procedures Radiologist Aspiration Recommendation 6 – Aspiration Technique Sampling of the Mass Using CT Guidance Recommendation 7 – Sampling Caliber of Needle Recommendation 8 – Caliber of Needle for Deep and Superficial FNA Type of Biopsy Needle Recommendation 9 – Type of Biopsy Needle: A Cooperative Study Preparation of Smears for Immediate Cytologic Evaluation Recommendation 10 – Expelling Tissue from Needle onto Slide Recommendation 11 – Types of Slides Recommendation 12 – Determination of Adequacy Number of Passes if Immediate Cytologic Evaluation is not Adequate Recommendation 13 – Number of Passes Core Biopsy Recommendation 14 – Core Biopsy by Organ Recommendation 15 – Core Biopsy: When is it Optional? Laboratory Preparation of Specimen Recommendation 16 – Cell Button and Cytospin Review of Previous Unsatisfactory/Limited FNA Cases Lack of Confidence in Pathology FNA Diagnoses and Radiology Aspiration Skills Recommendation 17 – New Review System for Imaging Guided FNAs Criticism of FNA Quality Recommendation 18 – New System for Superficial FNAs Concentration of Own Goals Recommendation 19 – Reporting and Follow Up Conclusion

1 1 2 2 3 3 3 4 4 5 6 7 7 7 8 8 8 9 9 9 10 10 10 11 11 11 11 12 12 12 12 13 13 13 13 15 15 15 16 16 17 17

DFJ00252

Case 1:07-cv-00026-OWW-TAG

Document 277-3

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Overview of the Problem Since 2001 the number of fine-needle aspirations (FNAs) has decreased at Kern Medical Center (KMC) in Bakersfield, CA. The fraction that is non-diagnostic or less than diagnostic (unsatisfactory or limited) appears to have increased. As a result, the clinicians at KMC have lost confidence in the ability of the departments involved, radiology and pathology, in arriving at a correct FNA diagnosis in their patients with a mass. Most of the FNAs are imaging guided. They are performed by radiology and interpreted by pathology. Radiology and pathology in turn blame each other for the problem. The problems with the FNA service appear to coincide with the arrival of a new chief of pathology, Dr. David Jadwin, in March 2001. The interventional radiologists have not changed. Over the past 3 years, 4 other pathologists and 1 cytotechnologist have left KMC for various reasons. To determine the cause of the problem, the administration at KMC has asked a cytopathologist with expertise in FNA and affiliated with UCLA for consultation. The methods used in the consultation included a 1-day onsite visit to KMC on February 13, 2004, observation of an imagingguided FNA procedure, interviews with Dr. Jadwin, the interventional radiologists, and the clinicians, review of some slides on-site, review of 200 unsatisfactory or limited FNA smears off-site, test staining of FNA smears brought by the consultant, review of some FNA reports, and delivery of a 1 hour FNA lecture to the medical staff. Administration has asked the consultant to evaluate various technical aspects of FNA collection, preparation, staining, and interpretation to try to find the problem. Each of these aspects will be addressed in the report. However, the consultant has also identified a behavioral problem that may be the underlying cause of the FNA problem. This will also be discussed and recommendations will be made. External Perspectives The problem of excess non-diagnostic FNAs, both superficial and deep, is not unique to KMC. It exists in many small hospitals and in outpatient community practice. At Unilab in California (now Quest Diagnostics), the unsatisfactory (US) rate for superficial FNAs performed by clinicians is 50%. At Contra Costa Regional Medical Center in northern California, the non-diagnostic rate was 60% before arrival of a cytopathologist and an interventional radiologist. After the new specialists came, the US rate dropped to 10% on imaging guided FNAs and 5% on superficial FNAs. Professor Lester Layfield (formally a cytopathologist at UCLA and now at the University of Utah) found that the US rate was 35% for clinicians in west Los Angeles, 15% for clinicians on the UCLA faculty, and 5% for UCLA cytopathologists. There are several reasons for the high US rate in many practice environments. The quality of an FNA is highly correlated with the formal training and experience of the aspirator. Professor Britt Marie Ljung, director of FNA at UCSF, showed that the false-negative rate for detecting breast cancer on FNA was 10 times higher for physicians with no formal FNA training who performed a median of 2 cases per year compared to formally trained physicians who performed a median of 100 cases per year. Nearly all false-negatives were due to sampling error.

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Not all pathologists are skilled in performing and/or interpreting FNAs. Many are not experienced in performing superficial FNAs and do not like looking at FNAs. It is much more difficult to interpret the average FNA than the average core or open biopsy. An FNA consists of much less tissue and has few architectural clues. Only about 15% of pathologists in the United States are certified in the subspecialty of cytopathology. Thus, it is possible for a pathologist inexperienced in cytology to call some FNA cases unsatisfactory when they are not or negative when they are actually unsatisfactory. Although the literature is mixed in this area, pathologist assistance of clinicians for superficial FNAs or radiologists for deep FNAs appears to decrease the fraction of non-diagnostic cases. However, such assistance is not cost effective from the viewpoint of the pathologist. The reimbursement from 3rd party payers for immediate cytologic evaluation of an FNA is inadequate compared to the cost of pathologist time. Professor Lester Layfield found that the pathology department loses $40-50 per case for assistance at FNAs. Hence, many pathologists do not want to help at FNAs. However, such assistance is probably cost effective at the hospital level because some surgical procedures can be avoided. Since KMC is a county hospital, cost control at the hospital level is relevant. Pathologist assistance should continue to be provided to clinicians and radiologists performing FNAs. This will save money at the hospital level because some operations can be avoided or the wrong operation will not be performed. However, the pathology department must be adequately staffed to provide such assistance. Perceptions of the Radiology Department There are 2 interventional radiologists at KMC who perform most of the imagingguided FNAs. They state that they have extensive training and/or experience in this procedure. They perceived no problems with FNAs until Dr. Jadwin arrived in 2001. Since then, they believe that an inordinate number of their aspirations have been interpreted as US when they are not really US. They believe that Dr. Jadwin is inexperienced in interpreting FNAs. They no longer have confidence in his pathology reports. They want to continue performing FNAs rather than referring the cases out but only if the pathology reports are reliable. There is a large credibility gap. The radiologists also complain that the FNA reports are difficult to read. The history section is too long and reflects what the clinicians already know. Most cases have no microscopic description. The diagnosis is difficult to find. Perceptions of the Pathology Department Dr. Jadwin states that he is very experienced in cytopathology and FNA. He feels that the apparent paradigm shift is due to poor interpretations of FNAs in the past by the previous pathologists. He believes that many pre-2001 FNAs were called negative when they were in fact US. The old reports contained no adequacy statement. He also states that the radiologists do not care about the quality of the specimens. They do not know the clinical history. They are in an apparent rush to finish the procedure and do something else. They make additional FNA passes when Dr. Jadwin is not ready or stop the procedure before adequate tissue has been

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obtained. They refuse to go to pathology to review slides. They do not listen to his suggestions about FNA technique. In short, he believes that the high US rate is due to poor technique and failure to listen to advice. Dr. Jadwin wants to continue to assist in superficial and deep FNA procedures. Perceptions of the Clinicians The clinicians believe that the FNA problem is a new one. They do not know if the problem lies in technique, interpretation, or the system. They think that adequate clinical history is being provided to the radiology and pathology. In reality, there is no formal system to insure that clinical information is passed along the proper channels. They believe that palpable masses are not a problem because there are very few superficial FNAs. Most of these lesions are surgically excised. Some palpable masses are still aspirated using CT guidance. Illustration of Differences in Perception: Radiology and Pathology There was a recent tumor board in which radiology and pathology participated. A patient had a CT-guided FNA and core biopsy of a liver mass. The pathology department interpreted the tissue as suggestive of hepatocellular carcinoma (HCC). On review at UCLA, it was interpreted as atypical but not diagnostic of hepatocellular carcinoma. Additional biopsies were suggested. Radiology accused pathology of misdiagnosing the biopsy. Pathology charged radiology with missing the lesion. Each department blamed the other. The consultant reviewed some of the slides and photomicrographs during the onsite visit. There was adequate liver tissue on the smears and slides. Some cells showed increased N/C ratio. There were focal areas of endothelial proliferation that crossed sinusoids. These findings are frequently seen in HCC. However, a definitive diagnosis would require increased N/C ratio in many more cells and atypical naked nuclei. A well-differentiated HCC can show modest increased N/C ratio and can be very difficult to diagnose. Neither department could clearly be “blamed” for this case. There are limitations to every procedure and limitations to microscopic interpretation. The correct response would be to learn from the case and proceed to the next step in working up the patient. Yet radiology and pathology chose to blame each other and learn nothing. This incident clearly illustrated that the FNA problem at KMC far exceeds the high US rate. There is lack of communication and complete distrust between radiology and pathology with negative ramifications for the clinicians and administration. The consultant believes this is the core issue. It is not a simple technical issue. Overview of Solution In order to solve the problem, new systems must be put in place to increase the level of communications at the time of FNA request and FNA reporting. Recommendations will be given both to radiology and pathology to try to increase the technical quality of the FNA procedure. A new review system for FNAs will be

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suggested to engender trust in the FNA reports. A goal will be set for the radiologists in their imaging-guided FNAs. A goal will be set for the pathologists for superficial FNAs. A joint project will be proposed for radiology and pathology to work on together so that they will be partners instead of adversaries. Finally, a periodic review system will be suggested so that both departments will be required to report their progress towards their individual and joint goals. Recommendation 1 – Existence of an FNA Service The first question is should KMC even offer an FNA service? An institution of this size should have many more superficial and imaging-guided FNAs. The procedure is almost certainly underutilized for various reasons. The opportunity exists to gain expertise with experience and to reduce the non-diagnostic rate. Both radiology and pathology want to participate in FNA if trust and open communications can be revived. KMC should continue to offer superficial and deep FNA procedures rather than referring them out. Pathology should continue to assist at superficial and deep FNA procedures. Pathology should be adequately staffed to provide such assistance. Assistance is not cost effective at the pathology department level but is cost effective at the hospital level. Recommendation 2 – Communication in Requesting an FNA There is no formal written system of communication for FNA procedures. Representatives from clinical medicine, radiology, and pathology should meet to design a 1-page request form for FNAs. The form should be divided into thirds. The top third is for the requesting clinician to indicate the requested procedure and to provide all relevant clinical details. Essential information would include the size and location of the mass, the clinical impression based on the history and physical examination, and any history of cancer and subsequent treatment. Other relevant history should be provided on a case by case basis. For example, if the patient has a liver mass and hepatocellular carcinoma is a possibility, the results of an AFP and hepatitis markers should be given. If the patient has enlarged lymph nodes, the duration of the nodes, any growth, and the presence or absence of anemia or “B” symptoms should be noted. If there are outside films or slides to be reviewed, their existence should be noted on the form and the clinician should have the patient sign a release to get them. After the form is filled out by a clinician, it should be sent to the department doing the aspiration. The form should be in triplicate (i.e. the original plus 2 carbon copies) so that each participant in the FNA has a copy. The middle third of the form is for the radiologist. He should review the written clinical information and note the radiological findings. At minimum, the size, location, and character of the mass should be noted. Other relevant imaging findings should be noted. For example, if a retroperitoneal mass is to be aspirated and the radiologist also notes an enlarged spleen, that information should be recorded so that the pathologist can obtain RMPI at the time of aspiration to collect cells for flow cytometry to rule out lymphoma. The lower third of the form is for the pathologist. The form should be available to him at the time of the FNA. He should note the relevant clinical and radiological

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findings. He can use the form to take notes during the FNA procedure and note any special studies that are done, such as culture, flow cytometry, etc. The pathologist can attach an additional worksheet for his note if he needs more space. Recommendation 3 – FNA Reporting The FNA reports are difficult to read. Part of this problem is due to outdated software that does not allow different size fonts or bold face type. Part of the problem is also due to a long clinical history on many FNA reports and lack of a microscopic description. The microscopic description and the diagnosis are the parts that are of added value in an FNA report. The solution is 2-part: short run and long run. In the short run, the software cannot be changed. Although a detailed clinical history may help the pathologist formulate a diagnosis, it does make the report more confusing to the clinician and adds little value. In short, the pathologist is writing to himself. Therefore, the FNA report should be limited to 1 page. In complicated cases, which should not exceed 10% of cases, the report can be 2 pages. The report should contain a short microscopic description and an adequacy statement or other indicator of the quality of the specimen. The adequacy of a specimen should be categorized by 1 of 3 descriptors: 1) adequate 2) unsatisfactory or 3) undetermined - pending further work-up. Adequate describes specimens that are diagnostic of malignancy or benign and explain the patient’s findings. Unsatisfactory describes specimens that are acellular, consist mostly of blood, markedly hypocellular, poorly fixed, crushed, very thick, or otherwise impossible to make any reasonable diagnosis. Indeterminate would be reserved for specimens in which some cells possibly from the lesion are present but it is not possible to make a definitive diagnosis. Further work up may be indicated. This would be similar to BIRADS category 0 on a mammogram. Examples of cases that might be indeterminate on FNA are as follows: 1. 2. 3. 4.

Questionable liver masses on CT scan. FNA shows atypical hepatocytes. Are these regenerative nodules or well-differentiated HCC? Was a malignant nodule missed? Lung mass on CT scan. FNA shows caseous necrosis only. Is this a necrotic tumor or infection? Density in lung on CT scan. Lesion is very fibrous and FNA shows scant fibrous tissue and chronic inflammatory cells. Is this just a scar or a carcinoma with desmoplasia? Livers masses on CT scan. FNA shows many PMNs. Are these abscesses from ascending cholangitis or is there distal tumor causing biliary obstruction and abscess formation proximally?

The indeterminate category defers the question of whether the lesion was adequately sampled until the patient has more work up. It also does not count as an unsatisfactory FNA until more information is obtained. In some cases, the lesion may have been missed. The size and location of the lesion will have a great influence on the ease of sampling. If large, easily accessible masses are consistently missed, then there might be a problem with aspiration technique. If most masses that are missed are small

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and located in difficult-to-aspirate areas, then no such problem exists (see recommendation 4 regarding FNA data collection). In other cases, the nature of the lesion can cause an indeterminate FNA. A fibrous mass usually yields few cells no matter how skilled the aspirator. A biopsy, either via core needle or open, may needed to find the cause. Tumor or coccidiomycoses can cause caseous necrosis in the lung. Cultures and further biopsies may be indicated. Cases in the undetermined category can be subclassified later as to cause – sampling error or nature of the lesion. A recommendation will follow on how to minimize pathology interpretive error on these cases (see recommendation 17). In the long run, the software can be changed. With the new software, the report can be any length. If the pathologist believes a detailed clinical history is required, he can dictate one. However, a microscopic description and adequacy statement should still be done. The diagnosis should be easy to find and highlighted either in a consistent location, large font, or bold face. The radiologists and clinicians should be able to skip the long report and find the microscopic description, statement of adequacy, and diagnosis quickly. Proportion of Unsatisfactory/Limited FNAs The initial problem that grew into the present FNA problem was the increased proportion of unsatisfactory/limited FNA reports after Dr. Jadwin arrived in 2001. The radiologists and clinicians perceived no problems with the previous pathologists. To determine if the fraction of non-diagnostic FNAs had really increased, a statistical analysis was done on the FNA data provided by pathology. It is summarized below. Year

FNAs

%Unsatisfactory/Limited

1996

87

39%

1997

81

16%

1998

53

32%

1999

66

9%

2000

62

29%

2001

58

55%

2002

54

39%

2003*

21

38%

* 6 months of data

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From 1996-2000, there were 349 FNAs of which 25% were unsatisfactory or limited. From 2001-2003, there were 133 FNAs of which 46% were not diagnostic. The null hypothesis that the fraction of non-diagnostic FNAs had not increased was tested using a 1-tail z-statistic using a rejection rule of α = 0.05 (z = 1.96). The result was a z-statistic of 4.28. Therefore, the null hypothesis was rejected and the alternative hypothesis that the fraction of non-diagnostic FNAs had increased was accepted. The fraction of non-diagnostic FNAs had increased over the past few years. Causes of the High Non-Diagnostic Rate From Statistical Data The pathology department collected extensive data on past FNAs. This data included the adequacy of the aspiration, the anatomic site, and the pathologist interpreting the smears. This data was analyzed to determine what factors affected the adequacy of the specimen. A logistic regression model was devised using the statistical program EViews. The dependent variable was the adequacy of the specimen. The independent variables were the interpreting pathologist and the anatomic site. Since this data was qualitative, dummy variables were used. The model showed that the anatomic site was the most important factor in determining the adequacy of a specimen. It was statistically significant at an α = 0.05 level at most sites. In contrast, none of the pathologists individually had a statistically significant effect on the outcome. However, Dr. Jadwin did have a slightly negative effect on adequacy compared to the other pathologists but it was not statistically significant. A Wald test was performed to test the hypothesis that the pathologists jointly had no effect on outcome. The test failed at the α = 0.05 level, which meant that jointly the pathologists had an effect on outcome but not individually. The most important factor in determining adequacy was the anatomic site. Liver and abdomen were the sites most likely to be successfully aspirated. This model suffers from the flaw of omitted variables. Two important variables were missing from the data available from the pathology department: the name of the physician performing the FNA and the size of the mass. As mentioned previously in this report, the experience of the aspirator is critical in determining the adequacy of an FNA. Most false-negatives are due to sampling error. Also, the size of the mass is important. Large masses are much easier to aspirate than small ones. Dr. Anwar Padhani found that the diagnostic accuracy for masses < 1.0 cm. in the lung was 50% compared to 80% for masses > 3.0 cm. Recommendation 4 – FNA Data Collection In addition to the data currently collected, the pathology department should also record the name of the aspirator and the size of the lesion (either the largest dimension or all 3 dimensions). This data may be useful in future analyses of FNA adequacy. Assistance at FNA Procedures

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Radiology currently notifies pathology of a scheduled FNA during the morning of the aspiration. It then calls again about 5 minutes before a pathologist is actually needed. The pathology department sends a technician to radiology first. After she has labeled the slides or even made some of the smears, she calls the pathologist. The pathologist usually arrives within 1-2 minutes. He makes at determination of adequacy after examining one or more slides stained by rapid H&E. There is some disagreement about when the actual aspirations should be done – when the technician is ready or when the pathologist is present? Dr. Jadwin has complained about the radiologists performing aspirations when he is not ready or even completing the procedure and leaving the CT scan room before he arrives. On the other hand, the arrival of the pathologist at the last minute could be perceived as an elitist approach. Therefore, the following procedure is recommended to put an end to the bickering of who should do what and when. Recommendation 5 – Timing of Assistance at FNA Procedures Radiology should notify pathology of an FNA procedure requiring pathologist assistance no later than the morning of the procedure. Twenty-four hours notice should be given if possible. Rare emergency FNAs would be an exception. Approximately 510 minutes before the first pass will be done, radiology should call pathology again. At that time both the pathologist and technician will go to radiology. The technician will label slides, set up the stains, focus the microscope, and check the paperwork. The pathologist will review the clinical history and scans with the radiologist. They should discuss the differential diagnosis and the approach to the aspiration. Should the edge or center of the lesion be aspirated? Will a core biopsy be needed? Should cultures be done? If necessary, the clinician should be contacted to get additional information. After the history and scans have been reviewed and the slides, microscope, and stains are ready, the radiologist will perform the first pass when the pathologist states that he is ready. If additional passes are needed, the radiologist will perform each subsequent aspiration when the pathologist states that he is ready. Radiologist Aspiration The consultant observed one of the radiologists performing a CT-guided FNA of a non-palpable neck mass. He appeared to be skilled in performing the procedure. He was also receptive to suggestions that might improve the quality of tissue obtained. However, Dr. Jadwin and radiologists do not communicate at this level. This suggests that a breakdown in communication is the fundamental problem. This bridge was burned down long ago. Therefore, the following recommendations will be made to try to improve the technical quality of the aspirations. Recommendation 6 – Aspiration Technique The first pass on most masses should be performed using the French (or Zajdela) technique. This is essentially FNA without aspiration. After the needle is placed into the mass and the stylet is removed, the needle should be moved back and

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forth 10-15 times in the mass while no syringe is attached (i.e. no suction). The needle should then withdrawn from the patient and handed to the pathologist. This technique obtains tissue by the scraping of the mass by the beveled needle and capillary action. Less tissue is obtained than FNA with suction but there is much less blood. In many cases, FNA without suction can yield better tissue than standard technique with suction. Also, the radiologist can often tell if he is actually in the lesion by the resistance of the needle in the mass during the FNA. If the pathologist states that the tissue appears good with this technique, additional passes using the French technique can be done. After completing 1 or more passes by the French technique, the radiologist can use standard technique if more tissue is necessary. However, only slight suction (1-2 ml.) should be used. High suction only leads to a lot of blood. If no blood appears in the hub of the needle during the FNA, make 10-15 back and forth motions of the needle in the mass. Do not keep moving the needle until blood appears in the hub. If blood starts to appear in the hub during the FNA, make no more than 10 back and forth motions in the mass. If blood appears in the hub immediately upon insertion into the mass, make 5 back and forth motions in the mass. If suction is used, it must be released for 2-3 seconds before the needle is withdrawn from the patient. This allows pressure in the syringe to equalize to the atmosphere. If the needle is pulled out too quickly, the aspirate will be sucked into the syringe and the non-diagnostic rate will increase to 60%. Sampling of the Mass Using CT Guidance During the observed FNA, the radiologist placed several aspiration needles into the mass using CT-guidance before any aspirations were done. The needles stayed in place and were removed one by one as each was used do an FNA. This is not a technique that the consultant has seen done at UCLA or anywhere else. It appears to save time because several FNA needles can be placed before the pathologist arrives. However, it could result in increased bleeding since the needles are in the mass for a long time. This could compromise the quality of the specimen. Usually the interventional radiologist places a needle at edge of or in a mass and confirms its location by CT scan. He then proceeds with aspiration. The problem with this technique is that it takes a lot of time because a scan must be done with each needle pass. Recommendation 7 – Sampling The coaxial technique may be a good compromise. The radiologist places a larger guide needle (18-gauge) at or near the edge of a mass and confirms its location by CT scan. He then advances a smaller aspiration needle (22-gauge or 20-gauge) through the larger needle deeper into the mass and performs the FNA. Several FNAs can be done this way without the need for re-scanning. This latter technique was used successfully by an interventional radiologist who worked closely with the consultant for several years in the Bay Area. The diagnostic rate was over 90%. If several FNAs with the guide needle in one position do not yield good specimens, the guide needle should be

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repositioned using CT guidance and the FNA repeated. The coaxial technique should be tried. Caliber of Needle Unlike core biopsy, a large caliber FNA needle is not desirable. It results in a very bloody FNA and clotting in the needle itself. The former obscures cells and compromises fixation. The latter can cause diagnostic cells to stay in the needle or syringe and never make it to the slide. The general rule for FNA is to use the smallest possible needle that gets tissue without a lot of blood. For FNA of deep-seated lesions, too thin of a needle will not work because it will bend. A reasonable compromise between bleeding, amount of tissue, and bending of the needle on deep FNAs is as follows. Recommendation 8 – Caliber of Needle for Deep and Superficial FNAs A 22-gauge needle should be used for most CT-guided FNAs. If the lesion is too fibrous to be aspirated with a 22-gauge needle, a 20-gauge needle should be tried. The radiologist will be able to feel if a lesion is fibrous if the first 1-2 passes are done using the French technique. If a thyroid is aspirated using sonogram guidance, a 27-gauge 1¼” needle should be used. The French technique is very useful in this organ because it causes very little bleeding. This is especially significant because excess bleeding can make colloid difficult to identify. Occasionally, a 25-gauge needle may be needed to obtain tissue. This can occur in cases of Hashimoto’s disease, subacute granulomatous thyroiditis, and when draining cysts with thick contents. Almost all other FNAs of superficial masses can be done using a 25-gauge needle. Occasionally, a 23-gauge needle will be needed. In general, start with the smaller needles rather than the larger ones. Type of Biopsy Needle There are many types of FNA needles on the market. The one a radiologist might choose relates to personal preference and availability. Radiologists at KMC currently use the Turner biopsy needle. This needle appears to have a short bevel, which could decrease the area available to scrape cells in a mass. Since it is not clear which needle is best, the radiologists and pathologists at KMC should participate in a study to determine what works best at KMC. By cooperating in a study, they will be working together toward a common goal – to determine what needle works best – instead of blaming each other for problems. Recommendation 9 - Type of Biopsy Needle: A Cooperative Study Pathology and radiology should jointly cooperate in a study of FNA needles. The radiologists should order 4 types of biopsy needles for this study: Turner, Chiba, spinal, and notched aspiration biopsy. The latter is the needle used by Dr.

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Michael Price, the interventional radiologist who worked closely with the consultant for many years. It can be ordered from Boston Scientific Medi Tech at 800-2253238. The order number is 40-503-M001405030. It is 13 cm. long and is available in 22-gauge and 20-gauge. The study should be done as follows. All 4 types of these needles should be ordered in 22-gauge and 20-gauge. Each of these needles of the same gauge should be used during an imaging-guided FNA if that many passes are being done. A different type of needle should be used for each pass. The radiologist should let the pathologist know what needle is being used for each pass. The pathologist should record the needle type and technique (French or standard) on his worksheet. The pass number should be written on the slide so that the needle associated with it can be identified later. The order of the needles being used should be randomized on different patients. After collecting data from several dozen FNAs, the pathologist and radiologist should have information on the type of needle that seems to work best. The best needle can then be adopted for future cases. Preparation of Smears for Immediate Cytological Evaluation Dr. Jadwin used standard technique for expelling the aspirate from the slide, making smears, fixing them, and preparing a cell button. He then reviewed a stained smear and told the radiologist whether or not it was adequate. The previous recommendations regarding French technique, caliber of needle, and number of back and forth motions of the needle can help decrease bleeding. However, some bleeding is inevitable no matter how skilled the aspirator. If there is significant blood in the needle, it can clot and make it difficult to expel the aspirate onto a slide. Recommendation 10 – Expelling Tissue from Needle onto Slide Instead of using air in a syringe to expel the aspirate, the pathologist should use the stylet of the needle (which the radiologist has removed and is no longer using) to gently push the aspirate out of the needle onto the slide in a controlled manner. This technique will avoid the problem of a clot being forcibly expelled from the needle due to high air pressure from the syringe followed by all the unclotted aspirated tissue splashing onto one slide or all over the table. The consultant learned this technique from an interventional radiologist, not another cytopathologist, and always uses it for imaging-guided FNAs using a long needle. Recommendation 11 – Type of Slides FNA material should be placed on positively charged slides instead of regular slides. It might help the tissue stick better and minimize the loss of tissue during processing. These special slides are used by the consultant in his FNA clinic and by cytopathologists at UCLA. Recommendation 12 – Determination of Adequacy

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Since a double headed microscope is available in the CT room, both the pathologist and radiologist should look at the immediately stained smear together. This will give the radiologist a better idea of what constitutes an adequate specimen and engender a spirit of teamwork. It will also give positive feedback to the radiologist on cases in which he has obtained an adequate specimen. As previously recommended, just prior to the FNA the pathologist and radiologist should look at the scans together. By looking at each other’s work, pathology and radiology will have a better appreciation of the challenges that each faces. It will open channels of communication. Number of Passes if Immediate Cytologic Evaluation is not Adequate If immediate cytologic evaluation shows that an aspirate is not adequate, there are no hard guidelines on the number of passes that should be attempted before giving up. Studies have shown that the marginal yield markedly decreases after 4-5 passes. Patient safety is also an issue. It is more risky to do more passes in the lung than in the retroperitoneum. Recommendation 13 - Number of Passes If diagnostic tissue is not obtained after 1-2 passes on an imaging-guided FNA, up to 4-6 passes total should be attempted. Fewer passes might be done if patient safety is an issue or if complications set in. More passes should be attempted if the patient tolerates the procedure well and both pathologist and radiologist agree that it is worthwhile to continue. Core Biopsy There is a question of when a core biopsy should be done with an FNA. The answer depends on the clinical situation and site. A core biopsy is easier to interpret than an FNA. It also gives architecture, which is usually absent or more difficult to detect on an FNA. However, a core biopsy causes more bleeding and can have more complications. It also increases costs. Recommendation 14 – Core Biopsy by Organ Core needle biopsy should not be performed in the thyroid. It causes excess bleeding. FNA with a 27-gauge 1¼” or occasionally with a 25-gauge 1” or 1½” needle will usually suffice. In skilled hands, FNA of the thyroid will be satisfactory about 8590% of the time. Solid non-palpable breast masses should undergo core needle biopsy rather than be aspirated. The reason is that significant non-palpable lesions detected by imaging are often atypical hyperplasia, low-grade ductal carcinoma, lobular carcinoma, or tubular carcinoma. These lesions are diagnosed by evaluating cytology, architecture, and extent. FNA only gives cytology. That is, FNA might give a false-negative diagnosis. Non-palpable breast masses, architectural distortions, or asymmetries should have 6-8 needle cores. Indeterminate or suspicious calcifications should have 8-10

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needle cores. The tissue should be placed in formalin. Pathologist assistance at the core biopsies is usually not needed. The tissue obtained should be examined at several levels. An alternative to imaging-guided core biopsy of the breast is excisional biopsy following needle localization. A core needle biopsy is very useful when a primary hepatocellular carcinoma (HCC) is suspected. It is difficult or impossible to diagnose well-differentiated HCC by cytology alone. Architecture is very helpful. When immediate cytologic evaluation of a liver FNA raises the possibility of a primary hepatic neoplasm, further generous aspirates should be submitted for cell button and several core needle biopsies should be done. Recommendation 15 – Core Biopsy: When is it Optional? In other sites, the pathologist and radiologist should decide whether a core needle biopsy should be done along with FNA. After examining one or more smears, the pathologist should let the radiologist know if a core biopsy is needed. It might be needed if the FNA is not adequate (e.g. the mass is fibrous), the FNA is adequate but cellularity is low, architecture is required, IHC stains may be needed, lymphoma is suspected, etc. If the pathologist requests a core needle biopsy, the radiologist should obtain one or more cores if he believes it is safe to do so. If a core needle biopsy will be done, it should be done after all the FNAs have been completed since the former causes more bleeding. Laboratory Preparation of Specimen The Pap staining-technique at KMC was tested by the consultant. Three unstained alcohol-fixed slides from the consultant’s FNA practice were brought to KMC pathology for staining. The Pap stain was adequate. No cells were lost. The quality was similar to that in the consultant’s laboratory. Review of some cytospin and cell button preparations at KMC also showed that they were adequate. Cell button preparations are routinely done on imagingguided FNAs. However, cytospins were also done on a palpable thyroid mass from the previous day. A recent study by Professor Katherine Liu at Duke University showed that routine cell buttons had a marginal cost $1906 per additional diagnosis not seen on the smears. Routine cytospins had a marginal cost of $7736 per additional diagnosis not seen on the smears. A cell button is cost effective only if an immediate stain of the FNA is not diagnostic. Routine cell buttons and cytospins are not cost effective. Both alcohol-fixed and air-dried smears should be prepared on all FNAs. Usually more of the former should be made. However, extra air-dried smears should be made on FNAs of the thyroid (to help identify colloid) and in possible cases of lymphoma. Recommendation 16 – Cell Button and Cytospin Cell buttons and cytospins should not be routinely done on FNAs. If a serous fluid is aspirated, a cytospin should be done. If immediate cytologic evaluation is not diagnostic, a cell button should be made (along with a core needle biopsy in certain locations – see previous recommendation). In imaging-guided FNA (as opposed to superficial FNA), the needle and syringe should be rinsed to collect a cell button. It can be saved and processed if the smears are not diagnostic.

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Review of Previous Unsatisfactory/Limited FNA Cases The consultant on a blind basis reviewed approximately 200 slides from previous cases that were deemed unsatisfactory or limited (less than diagnostic). Minimal clinical information was provided. Overall, the consultant agreed that nearly all the cases were either non-diagnostic or limited in diagnostic value. The review diagnoses closely mirrored the original diagnoses in most cases. The consultant found no obvious problems with the pathologic interpretation of FNAs at KMC. Many cases had either excess blood or scant cellularity. Some had airdrying artifact that made interpretation difficult. Some cases had marked necrosis. Some were fibrous or inflamed. A few showed non-neoplastic tissue. In some cases, there cells in the middle of thick blood clot that made interpretation difficult or impossible. A positive diagnosis of malignancy on FNA has 4 requirements: 1) adequate cellularity 2) sufficient cytological atypia in well preserved cells 3) monomorphic cell pattern 4) cellular dyshesion. If fewer criteria are employed to diagnose malignancy, a false-positive diagnosis can result. Not every FNA of a malignant tumor will have all 4 criteria on the smears. For example, it may be impossible to obtain sufficient cellularity in a desmoplastic tumor. A low-grade cancer with minimally abnormal cells or cohesive cell pattern will not result in a positive cytologic diagnosis. There are limitations of FNA. For example, cases F00-32 and N03-91 had a few very suspicious cells. However, there was insufficient cellularity to fulfill criterion 1. Case N02-230 had sufficient cellularity and an abnormal pattern, but all the cells were necrotic and did not fulfill criterion 2. Case N02-240 had too much air-drying artifact to make any definite conclusions, which violated criterion 2. If a case is interpreted correctly but is not diagnostic, the default conclusion should not be the aspiration was done poorly or unskillfully. In many cases, the nature of the lesion is the cause of the unsatisfactory FNA. For example, many of the cases reviewed showed only caseous necrosis. This could be caused TB, coccidiomycoses, necrotic tumor, etc. The needle indeed sampled the mass. However, the exact cause of the lesion could not be determined by the smears. If it is recognized at the time of immediate cytologic evaluation, cultures should be taken and additional aspirates should be made to look for possible viable tumor cells. There should be cooperation between radiology and pathology to find the cause, not a rush to blame each other. If a mass is hypocellular at immediate cytologic evaluation due to apparent fibrosis, larger needles should be used. Core needle biopsies should be taken. No one is to blame if adequate cells cannot be obtained. It is caused by the nature of the lesion. It may not be possible to determine if an FNA is adequate even after all slides are reviewed. Clearly if the FNA reveals a malignancy or a specific benign cytologic diagnosis that explains the clinical and radiological findings, the FNA is adequate. What if only fibrosis or non-neoplastic tissue consistent with origin from the organ sampled is seen? The patient either has fibrosis only, does not really have a mass, or has a malignancy in which malignant cells were not obtained (e.g. geographic miss, desmoplasia, etc.) Cytology by itself will not answer this question. The correct procedure is to go back to the clinical and radiological findings to decide whether more

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invasive procedures should be performed (e.g. laparoscopy, open biopsy, etc.). The answer to whether an FNA with these findings was really adequate may have to wait until after an open biopsy (for a suspicious mass) or a period of clinical observation (for a nonsuspicious radiological abnormality). In other words, one may need the final answer before retrospectively deciding if an FNA was really adequate. The question of adequacy in FNA is much more difficult to answer than in gynecological Pap smears using Bethesda 2001.

Lack of Confidence in Pathology FNA Diagnoses and Radiology Aspiration Skills The problems with FNA at KMC have led to mutual distrust between radiology and pathology. They have escalated to a breakdown in communications and to mutual fault finding. Each FNA is an opportunity to blame each other if the case is not diagnostic. Pathology does not trust radiology to make good aspirations. Radiology does not trust pathology to make good interpretations. Observation of the radiologists performing the FNA, watching the pathologists making and staining the smears, and reviewing previous FNA smears have only limited value in rebuilding lost confidence. The issue of who did the review, possible bias for one party or the other, and the limitations of retrospective review (e.g. lack of opportunity to review all the clinical and radiological findings, second-guessing after the fact, etc.) will always arise. What is needed is a new prospective system to restore confidence in future FNAs. Recommendation 17 – New Review System for Imaging-Guided FNAs No major discrepancies were discovered in a slide review of previous unsatisfactory/limited FNAs from KMC. However, this is a review of the past. It will not magically engender trust in the interpretation of future FNAs. A new system is needed to reestablish trust. To restore confidence, all imaging-guided FNAs that are deemed to be unsatisfactory or limited (e.g. unsatisfactory or indeterminate) should be automatically referred to UCLA for a second opinion. All relevant clinical and radiological information, including scan reports, should be sent along with the slides. At UCLA, a cytotechnologist screens all FNAs. There are no cytotechnologist screeners at KMC. At least one cytopathologist reviews every FNA at UCLA. The study period should be 1 year. The radiologists will know that if pathology calls a case unsatisfactory or indeterminate (e.g. possible sampling error or poor technique), expert cytopathologists will review the case. This system will prompt pathology to review all cases carefully. It would be embarrassing to pathology if many cases initially called nondiagnostic are called diagnostic by experts. On the other hand, if UCLA agrees that most of the referrals of non-diagnostic cases are indeed non-diagnostic, radiology would be embarrassed because it could indicate poor sampling or aspiration technique. The bottom line is that radiology will be motivated to do careful aspirations. Pathology will be motivated to make careful interpretations. The goal of this new system is to have less than 20% unsatisfactory or indeterminate cases due to geographic misses or sampling error in the first year.

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There should a number of cases in which it was no one’s “fault” that the FNA was not diagnostic. For example, a benign fibrous scar or a desmoplastic carcinoma in the lung could both be interpreted as unsatisfactory or indeterminate on FNA. Only an open biopsy will reveal the true nature of the lesion. No one is to blame for such a nondiagnostic FNA. Criticism of FNA Quality One of the perceived problems may be that pathology is always the critic and never an active participant in FNA. It is easy to criticize aspiration technique if one does not actively perform the aspirations and know of the difficulties. It is similar to being a movie or theater critic but never being a director or actor. Pathology needs to participate more fully in the FNA service than only being a judge. By being a participant as well as a judge, it will have more credibility. Recommendation 18 – New Superficial FNA Service Since Dr. Jadwin is experienced in cytology, he should set up a superficial FNA service at KMC for patients with palpable masses. A pathologist should be available within 30 minutes to perform an FNA on a patient with a palpable mass on the hospital grounds during regular working hours. A 2-hour FNA clinic once a week should also be reserved for pathologist performed FNAs. A nurse or technician should assist the pathologist. The clinic is for scheduled FNAs for patients who were seen off the hospital grounds and are being referred for an FNA. It is also for KMC clinic patients with a palpable mass when an FNA cannot be done be done within 30 minutes due to personnel shortages, lack of space in a clinic, patient time constraints, etc. The pathology department should be adequately staffed to provide such a service since other stat procedures (e.g. frozen sections) also require immediate attention. The new pathologist FNA service for palpable masses should decrease the number of excisional biopsies at KMC. Clearly, an institution the size of KMC should have more superficial FNAs. The clinicians believe that there is no real problem with superficial FNAs. However, the consultant believes that there is a hidden problem because it is underutilized. Excisional biopsy may be overutilized. Palpable masses should not, in general, be aspirated using imaging guidance. The goal of superficial FNA is to attain a non-diagnostic rate of less than 10%. Since KMC is a teaching hospital, Dr. Jadwin can teach or supervise residents in doing FNAs on their own patients. The consultant previously taught many family practice residents to do FNAs. The first few passes should be done by Dr. Jadwin to assure adequate tissue. The resident should then perform several passes. Local anesthesia is recommended. One of the benefits of a pathologist directed and performed superficial FNA service is to increase the credibility of the department if the service is well run. For example, if most of the FNAs are adequate and ultimately shown to be correct, physicians will have confidence in FNAs done at KMC. This will extend to interpretations on imaging-guided FNAs. Concentration on Own Goals

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The new system for review of imaging guided FNAs and the pathologist performed superficial FNA service will give radiology and pathology new goals on which to concentrate instead of blaming each other for non-diagnostic FNAs. Radiology needs to achieve fewer than 20% non-diagnostic cases on imaging-guided FNAs. Expert review of non-diagnostic cases will be provided by UCLA. Pathology will start a new superficial FNA service with a goal of fewer than 10% non-diagnostic cases on palpable masses. Both departments will cooperate in the needle study to determine which type of needle works best at KMC on imaging-guided FNAs. Recommendation 19 – Reporting and Follow Up The ad hoc FNA committee should provide supervision of the implementation of these recommendations. After all interested parties have had a chance to review the report, it should meet to determine which recommendations should be implemented. A time table should be set up. Quarterly meetings for the next year should be scheduled. At these quarterly meetings, progress should be reported. How many superficial and imaging-guided FNAs were done last quarter? What was the non-diagnostic rate on each? What were the non-diagnostic cases called at UCLA? What did the follow up and subclassification on the indeterminate cases show? What is the progress on the needle study? Conclusion The FNA problem at KMC may have started with a different paradigm for interpretation of FNAs. It has escalated to a breakdown of communications between clinical medicine, radiology, and pathology. There is deep mistrust between radiology and pathology. The recommendations in this report deal both with technical issues and behavioral issues. The technical suggestions regarding number of aspirates, type of needle, aspiration technique, smear technique, etc. are aimed in trying to attain marginal improvement in technical quality. More importantly, the recommendations on new systems for FNA are aimed at correcting the miscommunication and distrust. The new FNA request form should foster better communication. The FNA report format should give added information and be more concise. The mandatory review of all non-diagnostic deep FNAs at UCLA will reestablish trust that the smears are being interpreted correctly. However, radiology now has an objective on which to concentrate – less than 20% non-diagnostic cases in the first year. It will report to the ad hoc committee. Similarly, pathology will establish a new superficial FNA service. It has the opportunity to demonstrate the expertise that it claims to have in cytology. It has a goal of less than 10% non-diagnostic cases in the first year. It will also report to the ad hoc committee. Finally, both radiology and pathology will work together to find the best needle for deep FNAs. This is a project for which both departments will be responsible.

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An effective FNA service is the product of dedication and hard work by all physicians involved. It will not happen in a few weeks or a few months. Aspirators get better with experience, even after many years. Pathologists get better with experience, even after many years. At UCSF, physicians with no experience in FNA started with an unsatisfactory rate of 60%. Two years later, after much experience and mutual support, these same physicians had an unsatisfactory rate of 5%. This is not an unreasonable time frame for KMC. If the recommendations are implemented and the physicians involved are truly dedicated to improving the service instead of bickering and passing blame, the FNA service will truly be a service to the physicians and patients of KMC.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 27

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

32

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1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

JENNIFER JANE ABRAHAM, M.D.

17

Monday, August 18, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

AbrahamJ

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1

14:09:04

1 the conclusion that he couldn't find any

2

14:09:05

2 discrepancies in Dr. Jadwin's pathology reports?

3

14:09:09

3

4

14:09:09

4 any -- yeah.

5

14:09:12

5 said anything about discrepancies in his pathology.

6

14:09:14

6 I think that's true.

7

14:09:15

7

8

14:09:16

8 finding that he was corroborating Dr. Jadwin's

9

14:09:19

9 pathology reports.

A.

Q.

A.

I don't -- no.

I don't think there was

I mean, I don't think in the report

Okay.

So Dr. Lieu -- you recall Dr. Lieu

Correct?

10

14:09:21 10

I'm sure you have this report in your

11

14:09:24 11 file --

12

14:09:24 12

Q.

We do.

13

14:09:25 13

A.

-- and so I would refer to that because the

14

14:09:29 14 black and white is better than my memory.

15

14:09:30 15

Q.

Sure.

16

14:09:31 16

A.

My memory, as I recall the evaluation by

17

14:09:34 17 Dr. Lieu, had more to do with the process of

18

14:09:37 18 obtaining the pathology reports.

19

14:09:41 19 I -- I -- my remembrance is that we still were not

20

14:09:47 20 satisfied with whether or not the -- the pathology

21

14:09:50 21 readings of the FNA was -- was -- was adequate.

22

14:09:58 22 is my remembrance.

23

14:10:00 23

Q.

Sure.

24

14:10:00 24

A.

And -- and so then I believe what happened

25

14:10:02 25 was that's when we said, let's just send these

Sure.

AbrahamJ

And when we read it

That

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14:18:00

1 was the reason for the request for -- for overreads;

2

14:18:04

2 so that -- so that we could improve our ability to

3

14:18:10

3 trust the readings of our pathologist.

4

14:18:14

4

Q.

Okay.

5

14:18:15

5

A.

So I don't think at the time we had come to

6

14:18:19

6 the conclusion that the pathologist -- that the

7

14:18:22

7 pathology readings were incorrect.

8

14:18:24

8 that we didn't know.

9

14:18:27

9

Q.

Okay.

10

14:18:27 10

A.

And I don't recall that having this report

11

14:18:36 11 did -- did an adequate -- did adequately improve that

12

14:18:42 12 trust.

13

The problem was

13 BY MR. LEE:

14

14:18:43 14

Q.

15

14:18:46 15 issued this FNA report, there still remained doubts

16

14:18:49 16 about Dr. Jadwin's competence as a pathologist?

17

14:18:52 17

18

14:18:53 18

19

14:18:55 19 know, you mentioned before peer review, but I'm

20

14:18:58 20 recalling now it wasn't for peer review.

21

14:19:01 21 improve the trust --

22

14:19:02 22

Q.

Okay.

23

14:19:02 23

A.

-- so that the physicians could then say,

24

14:19:04 24 okay, look.

25

14:19:08 25 was a new pathologist, he'd gotten rid of the ones we

A.

Okay.

So, in other words, after Dr. Lieu

Yes. Like I said, the purpose was not -- you

Our pathologist is correct.

AbrahamJ

It was to

I mean, it

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2 or second from the bottom.

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3 Aspiration.

4

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Well, take a look at that middle paragraph

4

A.

Um-hmm.

It's called Radiologist

5

14:21:55

5

Q.

Do you see that?

6

14:21:56

6

A.

Yes.

7

14:21:56

7

Q.

And here Dr. Lieu is explaining his

8

14:21:59

8 observation of the radiologists in this report.

9

14:22:07

9

A.

Breakdown in communication is a fundamental

10

14:22:11 10 problem.

11

14:22:12 11

Q.

Um-hmm.

12

14:22:13 12

A.

Yeah.

13

14:22:15 13 problem.

14

14

Q.

Right.

15

14:22:16 15

A.

This bridge was burned down long ago.

16

14:22:20 16

Q.

Right.

17

14:22:21 17

18

14:22:23 18 one radiologist performing one C.T. guided FNA on a

19

14:22:27 19 nonpalpable neck mass.

20

14:22:30 20

21

14:22:30 21

A.

Um-hmm.

22

14:22:33 22

Q.

So that was -- that was the extent of

That seemed to be the fundamental

Okay.

Right. Well, you see here Dr. Lieu observed

Do you see that? Um-hmm.

23

23 Dr. Lieu's observation of the radiologists.

24

24

A.

Right.

25

14:22:33 25

Q.

He looked at 200 samples by Dr. Jadwin.

AbrahamJ

He

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14:26:56

1 have trust in him.

2

14:26:59

2 in him?

3

14:27:01

3 of the next step was to do something to improve the

4

14:27:04

4 trust.

5

14:27:05

5

6

14:27:06

6 report then?

7

14:27:08

7

A.

To review the FNA procedure.

8

14:27:11

8

Q.

Okay.

9

14:27:11

9

A.

But we couldn't get the pathologists and the

Q.

So why didn't we still have trust

And I don't know.

Okay.

And that was the purpose

But what was the purpose of the

10

14:27:13 10 radiologists to play in the sandbox together.

11

14:27:15 11

12

14:27:18 12 reports, wasn't it to find out whether, in fact,

13

14:27:21 13 Dr. Jadwin was competent or not in interpreting FNAs?

14

14:27:25 14

15

14:27:26 15 initial reasons, yeah.

16

14:27:27 16

17

14:27:29 17 didn't disagree with Dr. Jadwin's diagnoses, that

18

14:27:32 18 didn't improve confidence?

19

14:27:36 19

20

14:27:37 20 still didn't go all the way for some reason.

21

14:27:40 21 was part of the reason for -- for -- for getting --

22

14:27:43 22 for continuing to get six -- and we were told we

23

14:27:49 23 would get six months of overreads.

24

14:27:50 24

25

14:27:51 25 shake your trust in the radiologists at all?

Q.

A.

Q.

A.

Q.

So one of the reasons for Dr. Lieu's

That was probably an initial -- one of the

Okay.

And when Dr. Lieu found that he

Unfortunately, it still didn't get -- it

Okay.

So that

Now, did this report from Dr. Lieu

AbrahamJ

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1

2

14:27:58

2 the radiologist had been there since I started, since

3

14:27:59

3 all of us had started.

4

14:28:03

4 thing.

5

14:28:05

5 they'd already earned our trust.

6

14:28:06

6

7

14:28:07

7

8

14:28:09

8 that Dr. Jadwin was sending his FNAs out to UCLA for

9

14:28:13

9 overreads from the time he started there?

Q.

See, we -- we'd been with the radiologist --

And so trust is a funny

You know, you have to sort of earn it, and

I see. Okay.

Well, would it surprise you to know

10

14:28:15 10

A.

Yes.

11

14:28:17 11

Q.

And would it surprise you that he continued

12

14:28:18 12 to do that after this --

13

14:28:19 13

14

14:28:22 14 saw a report.

15

14:28:23 15

16

14:28:24 16 Dr. Jadwin was getting a 100 percent conformity

17

14:28:28 17 with --

18

14:28:28 18

19

14:28:30 19 actually the ones that did go -- that did go out,

20

14:28:33 20 I have heard -- and this is all --

21

14:28:36 21

Q.

Hearsay.

22

14:28:36 22

A.

-- hearsay, but that the reports that were

23

14:28:41 23 dictated were dictated -- the final reports were

24

14:28:46 24 dictated after it came back from UCLA.

25

14:28:49 25

A.

Q.

A.

Q.

Yes.

It would surprise me.

Okay.

It would surprise me 'cause I never

Yes.

Would it also surprise you that

That would surprise me because

I see.

AbrahamJ

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14:28:50

2

Q.

Dr. Jadwin --

3

14:28:50

3

A.

But we still didn't feel that we had the --

4

14:28:55

4 the --

5

14:28:56

5

Q.

Evidence?

6

14:28:58

6

A.

But once again, that's hearsay.

7

14:29:00

7 see -- I don't have any specific evidence myself.

8

14:29:03

8

9

14:29:06

9 Dr. Jadwin was basically retroactively changing

Q.

I did not

So there was a rumor going around that

10

14:29:09 10 his -- his FNA --

11

14:29:09 11

A.

Right.

12

14:29:10 12

Q.

-- reports to match those of UCLA --

13

14:29:12 13

A.

Right.

14

14:29:13 14

Q.

-- to create the appearance that UCLA was

15

14:29:15 15 agreeing with his initial diagnosis?

16

14:29:17 16

A.

And that's all part of trust, isn't it?

17

14:29:19 17

Q.

Do you recall who was saying this?

18

14:29:21 18

A.

No.

19

14:29:22 19

Q.

This is -- this is part of the chatter that

20

14:29:24 20 was going around the hospital?

21

14:29:24 21

A.

Chatter.

22

14:29:26 22

Q.

Chatter?

23

14:29:26 23

A.

Chatter.

24

14:29:27 24

Q.

This is part of the chatter that was going

25

14:29:28 25 around the hospital?

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1

14:31:17

1

Q.

Okay.

2

14:31:18

2

A.

And see how that fits in with all the other

3

14:31:20

3 things I was talking about?

4

14:31:22

4

Q.

Okay.

5

14:31:23

5

A.

The whole purpose of having the overreads

6

14:31:25

6 was to build confidence and trust.

7

14:31:27

7

8

14:31:30

8 trust in Dr. Jadwin's competence as a pathologist?

9

14:31:34

9

A.

I don't have evidence one way or another.

10

14:31:37 10

Q.

Okay.

11

14:31:39 11 I mean, if you were to work with Dr. Jadwin today,

12

14:31:41 12 you wouldn't trust his competence as a pathologist.

13

14:31:44 13 Correct?

14

14:31:44 14

A.

No.

15

14:31:45 15

Q.

No.

16

14:31:45 16

A.

And that's probably not fair of me, I admit,

17

14:31:48 17 but, no.

18

14:31:53 18 or another.

19

14:31:55 19

20

14:32:10 20 competence was in question as a pathologist around

21

14:32:12 21 2004.

22

14:32:15 22 happening.

23

14:32:15 23

A.

Probably.

24

14:32:17 24

Q.

Do you recall whether his competence was in

25

14:32:20 25 question throughout his tenure?

Q.

Q.

Okay.

To this day do you have confidence or

But you don't trust Dr. Jadwin --

Because I don't have the evidence one way

Okay.

Correct?

If -- if Dr. Jadwin -- Dr. Jadwin's

This is when the FNA thing was

AbrahamJ

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Page 113 of 191 148

1

16:09:02

1 of the conference for the benefit of the residents.

2

16:09:04

2

3

16:09:05

3 referenced there?

4

16:09:06

4

5

16:09:08

5 we talked about, disagreeing with USC and how they

6

16:09:12

6 are -- you know, that he's so perfect and they're so

7

16:09:13

7 bad and -- political point probably, to my

8

16:09:19

8 understanding, wasn't -- isn't the best term --

9

16:09:21

9

Q.

Okay.

10

16:09:22 10

A.

-- because it wasn't so much politics as --

11

16:09:31 11 as -- as ego and --

12

16:09:35 12

Q.

Lack of diplomacy?

13

16:09:36 13

A.

Lack of what?

14

16:09:37 14

Q.

Diplomacy.

15

16:09:39 15

A.

Right.

16

16

Q.

Professional respect.

17

16:09:40 17

A.

Lack of diplomacy and professional respect.

18

16:09:43 18

19

16:09:46 19 other than the politics between the departments, but

20

16:09:49 20 even that wasn't so much politics as -- as

21

16:09:53 21 interpersonal problems with interpersonal

22

16:09:56 22 relationships.

23

16:10:04 23

24

16:10:06 24 the second paragraph:

25

16:10:08 25 justification for your actions of the content of your

What was the political point that's

A.

I think it had something to do with -- like

Oh, that's good.

I don't know that any politics was involved

Q.

Well, in the last sentence it says there in Regardless of the

AbrahamJ

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218 Page 114 of 191

Filed 12/01/2008

STATE OF CALIFORNIA ss. COUNTY OF KERN

I,

Susan R. Wood,

a Certified Shorthand

Reporter in the State of California, holding Certificate No.

6829,

do hereby certify that

JENNIFER JANE ABRAHAM, M.D., foregoing deposition,

the witness named in the

was by me duly sworn;

deposition was taken Monday, August 18,

that said

2008,

at the

time and place set forth on the first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action,

nor

in any way interested in the result or outcome thereof. Dated this 2nd day of September,

2008,

at

Bakersfield, California.

susan~R--N-O-.

- 6-8-2-9----

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 115 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 28

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

33

Case 1:07-cv-00026-OWW-TAG

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~ • MEDICAL CENTER .KERN

Affiliated with University o/California Schools 0/ Medicine at Los Angeles, San Diego and Irvine

Dear Cancer Conference Presenter, In order to promote an informative yet time efficient learning environment, please use this fonnat while preparing you presentation. **Please limit the number ofslides you prepare to less than 10 slides** 1) Chief Complaint-Presenting Symptoms 2) History of Present Illness 3) History of Past Medical Illness 4) Family History 5) Psychosocial History 6) Physical Exam: include performance scale (ex: Kamofsky, ECOG, APGAR, other) #1-6= 5 minutes 7) Briefoverview oftesting ordered (i.e. Diagnostic Radiology, etc...) #7= 5 minutes -f-f-f1-7 Should not take up more than 10 minutes ofyour presentation 8) lNM Stage 9) Discuss Treatment Options -f-f-f #8-9 Are essentialfor prospective case presentation, 10 minutes. 10) Discuss possible follow-up after treatment 11) Early Detection: Discuss possible screening for early detection if available for this site -f-f-f #1 0-11 For educational purposes, try to include these quickly in your presentation. A CoS-CaC requires that Oncology Conference be Prospective, which is defined as "presentation at a time when management ofthe patient could be influenced by the {!iscllssion ofmanagement options at anytime during the patient's disease".

Included in your presentation you will need to allow time for Pathology and Diagnostic Radiology and any other specialty involved in the case to present their findings. ** You will be required to meet with hoth the Pathologist and Radiologist to {Iiscuss the case to be presented at least 4 working day!. before the conference. It is also your responsibilitv to notify ALL physicians involved in the case you are presenting. Please let the Cancer Registrar know of any equipment you may need for your presentation. Any equipment other than a computer or LCD must be specified. You must provide a hard copy of your presentation to the Cancer Registrar (or Laura) by no later than the Monday preceding the date you are to present. Also, please arrive at least 15 minutes early in order to download your presentation to the computer prior to the start ofthe conference. This will cut down on delay time that occurs with multiple presenters. This guide is provided to assist us in meeting the educational objectives ofthe American College ofSurgeonsCommission on Cancer (ACoS-CoC) approved programs. Ifyou need any assistance or have any questions do not hesitate or have any question do not hesitate to call the Cancer Registry Department at ext. 62597. Sincerely,

Dr. Ravi Patel-Cancer -Committee Chair Dr. Albert Mc Bride -Cancer Committee Liaison Bonnie Quiii6nez,RHIT, eTR-Cancer Registrar

Case 1:07-cv-00026-OWW-TAG

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 29

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

34

Case 1:07-cv-00026-OWW-TAG

Document 277-3

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1

1

UNITED STATES DISTRICT COURT

2

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

3

---------

4

4

DAVID F. JADWIN, D.O.,

Page 118 of 191 1

) Case No. 1:07-cv-00026-OWW-TAG )

5

5

Plaintiff,

) )

6

6

vs.

) )

7

7

COUNTY OF KERN; et al.

) )

8

8

Defendants.

)

_________________________) 9

9

10

10

11

11

12

12

13

13

14

14

OF

15

15

ALBERT McBRIDE, M.D.

16

16

Friday, August 15, 2008

17

17

Bakersfield, California

18

18

19

19

20

20

21

21

22

22

VIDEOTAPED DEPOSITION

Reported by:

Cindee L. LeFevre, CSR No. 7974

23 24

23

25 26

24

27 28

25

McBrideA

Case 1:07-cv-00026-OWW-TAG

1

Document 277-3

MR. WASSER:

Filed 12/01/2008

Page 119 of 191 15

13:19:25 letter

1

He is responding, counsel.

13:19:27 him 13:19:32 13:19:32 have

2

speaks for itself.

3 4

a question about it, ask him a question about it. Q. I am going to remind you again, doctor.

13:19:37

5

a duty to respond to our questions.

13:19:37

6

A.

Okay.

I will respond to your question.

13:19:39 7 your 13:19:42 8 13:19:46 9 13:19:51 10 we

Q.

Okay.

Thank you, doctor.

The

2 3 4 5

He has the letter.

You want to ask

You

6 7 8 9 10 11 12

Can you state in

own words a summary of what this letter is about. A. It's asking Dr. Jadwin to present from the Department of Pathology information regarding data that

13 13:19:58 11

will need in the conference.

14 13:20:00 12

We're asking the presenters to maintain their

15 13:20:03 13

presentation to a minimum, and there's a reason for that

13:20:10 14

which you probably want to go into.

16 17 13:20:14 15

Q.

Dr. McBride, what's the reason?

13:20:17 16 As 13:20:20 17 Two

A.

I was the moderator for -- of the conferences.

18 19 20

the moderator, we had two presentations per morning.

21 22 23 24 25 26 27 28

13:20:26 18 within 13:20:28 19 presentation. 13:20:34 20 first 13:20:37 21 -13:20:41 22 13:20:45 23 all 13:20:49 24 13:20:52 25 and

presentations per morning. one hour's time.

We tried to get those in

That means half an hour per

The departments that were presenting these; the department that was presenting the case itself, the one of four departments presented each month. That presenter was a resident, generally, who had collected the data, presenting the material. Then we had the Department of Pathology present the pathologic findings,

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2 3

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13:38:15 13:38:22 13:38:22 memo

1 2 3

remind people of what the time limits were? A. Yes, sir. Q. Okay. And as far as you can recall, did this

13:38:26

4

have a purpose of reprimanding anybody in particular?

13:38:30

5

A.

No.

13:38:33

6

Q.

Okay.

13:38:36

7

13:38:38

8

A.

No.

13:38:38

9

Q.

Okay.

4 5 6 And it wasn't meant -- intended to

7 reprimand Dr. Jadwin?

8 9 Let's turn to 189, please.

10 11 12 13

13:38:41 10 through. 13:39:26 11 13:39:28 12 to

Doctor, we are already a third of the way Okay. Doctor, you have been handed a document marked for identification as 189. Please take a moment

14 13:39:31 13

review it.

15 16 17 18 19 20

13:40:28 Exhibit 13:40:32 13:40:33 13:40:34 13:40:35 write at

14 15 16 17 18

Okay.

Doctor, now that you have reviewed

189, do you recognize it? A. Yes, I do. Q. Thank you. Tell me what it is, please. A. It's a letter that Dr. Harris asked me to

21 13:40:41 19

the end of that particular conference that day.

22 13:40:45 20

Q.

Okay.

Just to backup.

When you say the

23 13:40:47 21

conference that day, you are referring to the oncology

13:40:50 October, 13:40:54 13:40:56 13:40:57 Oncology

22

conference held monthly, which was for the month of

23 24 25

2005 was held on October 12; correct? A. Yes, sir. Q. Okay. And after the end of the October

24 25 26 27 28

McBrideA

Case 1:07-cv-00026-OWW-TAG

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Page 121 of 191 29

13:41:00 13:41:04 13:41:05 you

1 2 3

Conference, is that when Dr. Harris approached you? A. Yes. Q. Okay. And can you recall exactly what he told

13:41:08

4

to do?

13:41:09 what 13:41:15 it

5 6

happened at the conference that day and present -- give

13:41:20

7

to him.

13:41:22

8

Q.

13:41:26

9

4 5 6 7

A.

Yes, he asked me to write a letter regarding

8 9 Okay.

And did he give you any other guidance

10 beyond just that?

11 13:41:26 10

A.

No.

13:41:27 11 draft 13:41:31 12 Harris?

Q.

Okay.

12 13 14

Now prior to Dr. Harris asking you to

this letter, Exhibit 189, had you complained to Dr.

15 13:41:37 13

A.

No.

13:41:39 14

Q.

No.

16 Okay.

Now, writing letters such as this

17 13:41:46 15

Exhibit 189, was that part of your function as -- one of

13:41:50 16

your job functions as the cancer committee liaison?

18 19 13:41:56 17

A.

I don't think so.

13:41:58 18

Q.

Okay.

13:41:59 19

A.

I was asked to do it because I am Medical

20 21 22 13:42:03 20

Director.

It's the only letter I have ever written like

13:42:06 21

that --

13:42:07 22

Q.

Okay.

13:42:07 23 that 13:42:08 24 13:42:09 25

A.

-- in the eight years that I have been there

23 24 25 26 27 28

I recall. Q. Okay.

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2 3

A. Q. A.

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Filed 12/01/2008

Page 122 of 191 30

13:42:10 13:42:13 13:42:16 Harris

1 2 3

I was reluctant to write this letter. Okay. And why is that? Well, I just was. I didn't want to -- Dr.

13:42:20 people. 13:42:26 see,

4

was at the conference, Dr.

5

The conference was -- by the nature of that letter, you

13:42:30

6

it went over and we never got the presentations in.

13:42:36 but I 13:42:41 Harris.

7

4 5 6

Johnson was -- all these

7 8 9 10

8

But no, I did not want to write this letter, wrote it at the request, direction really, of Dr.

11 12 13

13:42:49 9 -13:42:54 10 case,

Q.

Okay.

And is following the direction of the

well, the directives of the medical director, in this

14 13:42:58 11

Dr. Harris, is that a part of your job function?

15 13:43:00 12

A.

I thought so.

13:43:01 13 up 13:43:04 14 directives

Q.

Okay.

16 17 18

So, therefore, that's why you did end

drafting this letter, because complying with the

19 13:43:07 15

of the medical director was part of your job; correct?

20 13:43:11 16

A.

Yes, sir.

13:43:13 17

Q.

Okay.

21 Now, were you at all uncomfortable in

22 13:43:16 18

writing Exhibit 189?

23 13:43:18 19

A.

Yes.

13:43:19 20 13:43:23 21 position 13:43:28 22 13:43:32 23 directly. 13:43:35 24 to 13:43:39 25

Q. A.

And how so? I just don't like to put myself down in a

24 25 26 27 28

like that. If I am going to have a discussion with somebody, I would just as soon discuss it with him It's not my position to -- I don't feel it's my position be put in a position like this, but I was directed to do

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6

13:44:41 13:44:43 13:44:45 13:44:48 13:44:49 13:44:51 you

1 2 3 4 5 6

Document 277-3

A. Q. mentioned wall? A. Q.

Filed 12/01/2008

Page 123 of 191 32

Yes, I look at the clock. So in order to derive these times which are in 189, you had looked up at the clock on the I was keeping an eye on the clock. Now, during the conference, you didn't know

7 8 9 10 11

13:44:54 7 189, 13:45:00 8 13:45:00 9 13:45:01 10 such

were going to be asked by Dr. Harris to write Exhibit

13:45:03 11

exact times recorded here?

13:45:04 12

record times?

did you? A. Q.

No. So why is it is you still, nevertheless, had

12 Is it just your practice to

13 14 15 16 17 18

13:45:05 things. 13:45:09 13:45:09 13:45:11 clear

13

A.

My practice is to try to be on time to do

14 15 16

Q. A. Q.

Okay. I look at the clock a lot. Okay. So you just happened to have a very

19 20 21 22

13:45:13 17 this 13:45:16 18 13:45:16 19 only

recollection of all the times involved when you wrote

13:45:19 idea of 13:45:25 13:45:27 13:45:29 time 13:45:32 13:45:33

20

have half an hour for each one, you have a very good

21 22 23

how much time pretty much has gone by. Q. There's a lot of time pressure on you. A. Well, I thought so. Can I tell you why these

24 25

pressures are? Q. Sure.

letter? A.

When you have two cases to present and you

23 24 25 26 27 28

McBrideA

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1

A.

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Page 124 of 191 33

13:45:33 to

1

Because the other doctors are leaving at 8:30

13:45:37 Surgery 13:45:43 13:45:46 13:45:46 get

2

go to their various rounds and surgical procedures.

3 4 5

starts at 8:30 on those Monday -- Wednesdays. Q. Uh-huh. A. We lose those people. My intent was to try to

2 3 4 5 6 7 8 9 10 11 12 13

13:45:51 6 people 13:45:55 7 13:45:59 8 13:46:00 9 13:46:01 10 13:46:02 11 are

as much information to as many people and get as many

13:46:05 12

you confident these times are accurate in Exhibit 189?

involved in these discussions, et cetera. It's never perfect. Q. Okay. A. Never perfect. Q. So getting back to the times, here, doctor,

14 15 13:46:10 13

A.

They're roughly accurate.

13:46:12 14 situated 13:46:14 15 that

Q.

Okay.

16 17 18

Can you think of a person better

than yourself to know what the times were involved in

19 13:46:18 16

conference?

13:46:19 17

A.

20 Can I think of a better person for those

21 13:46:22 18

particular conferences?

22 13:46:23 19

Q.

At that -- no, I am talking about this October

23 24 25 26 27 28

13:46:26 to 13:46:30 13:46:31 13:46:38 13:46:41 13:46:45

20

12th conference.

Was there a person better positioned

21 22 23 24 25

know the time? A. No, this was all me. Q. Okay. Thank you. Now, were you upset by Dr. Jadwin's going over time at this October 12th, 2005 conference?

McBrideA

Case 1:07-cv-00026-OWW-TAG

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13:46:45 1 13:46:48 2 13:46:54 3 pathologist.

A. No, I was not upset with Dr. Jadwin. I have always had a lot of professional respect for Dr. Jadwin. Frankly, I think he is a very good

13:46:57 him 13:46:59 he

4

He gives a lot of good information.

5

that I would like to listen to him the entire hour, and

13:47:03 that. 13:47:08 I

6

can tell you that that's a true statement.

13:47:10

8

am trying to get a case presented and these other people

13:47:12

9

have prepared to present it too.

4 5 6

And I've even told

7 8 9

7

I told him

But I am not the only one in that conference.

10 11 12 13 14 15

13:47:15 10 was 13:47:20 11 13:47:21 12 you're

So, you know, I come off as the bad guy, but I necessarily the moderator. Q. There's no implication, Dr. McBride, that

16 13:47:25 13

the bad guy here, at least not from us.

13:47:29 14

clear.

Just to be very

17 18 13:47:30 15

Dr. McBride, I just want to walk through the

19 13:47:32 16

times, because the times have become a very big issue in

13:47:36 17

this litigation for some odd reason.

20 Now --

21 13:47:39 18

A.

Okay.

13:47:40 19

Q.

Okay.

22 And I will tell you right now, this is

23 13:47:42 20

probably one of the most important exhibits of today's

13:47:46 21

deposition.

24 25 26 27 28

13:47:46 22 conference, 13:47:49 23 assume; 13:47:54 24 13:47:56 25

Okay.

Now, this conference, the first

Presentation A of the morning, it started at 7:30, I correct? A.

Again, I usually try to start at 7:30.

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2

Q. A.

Document 277-3

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Page 126 of 191 36

13:48:57 13:48:59 in

1 2

Okay. And then when the presenter gets to that point

13:49:03 present 13:49:07 that.

3

his presentation, then he asks the pathologist to

4

the findings, and then the pathologist comes and does

13:49:10 want 13:49:13 the

5

That's depending on the presenter.

6

the radiologist to present a little first, but, usually,

13:49:19

7

pathologist presents first.

13:49:20 to 13:49:23 13:49:27 13:49:27 13:49:31 13:49:34 time.

8

3 4 5 6 7 8

He may

9 10 11 12 13 14 15 16

9 10 11 12 13

So it was up to Dr.

Alkhouri to determine --

ask Dr. Jadwin in this case to present. Q. I understand. So the moderator -A. The presenter is essentially in control of his presentation. I am just the moderator, just hoping they just kind of get it all in sequence and get it in in

17 13:49:38 14

Q.

Understood.

And the moderator tends to be a

18 13:49:40 15

resident; correct?

19 13:49:41 16

A.

Generally, yes.

13:49:42 17

Q.

And this is part of the resident's training?

13:49:44 18

A.

Yes, it is.

13:49:44 19

Q.

Learning how to stand up and talk?

13:49:47 20

A.

Absolutely.

13:49:48 21

Q.

Okay.

20 21 22 23 24 So the first -- according to your line

25 26 27 28

13:49:50 13:49:53 sorry, 13:49:57 five 13:50:00 at

22 23

here, the first sentence of your second paragraph, Presentation B started at about five minutes -- I am

24

Presentation A ended a little bit late, went over about

25

minutes.

Does that suggest that presentation A started

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7

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1 2 3 4 5 6 7

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8:05 a.m. A. Yes. Q. Okay. Just following your letter, then Dr. Alkhouri presented. Now, you must have moderated over, well, scores of those cancer committee conferences? A. Many, many. Q. Many. Typically how long -- well, do you

8 9 10 11 12

13:50:21 8 salient 13:50:25 9 13:50:28 10 13:50:29 11 would

specifically how long Dr.

Alkhouri took to present

13:50:31 12

that initial introduction be by the resident?

features of the second case? A. No, I don't know. Q. Well, based upon your experience, how long

13 14 13:50:34 13

A.

Some do a very fine presentation and do it

13:50:39 14 corral 13:50:44 15 the

succinctly.

13:50:48 16

radiologist.

13:50:51 17

along a little bit.

15 16 17

Some ramble a little more, and I have to

them in a little bit so we can get it into -- let's get

18 So I kind of say, you know, let's move it

19 20 21 22

13:50:54 18 it 13:50:55 19 maybe

Q.

Keep it going.

So would it be -- I mean, does

sound -- is it typical that the presenter would take

23 13:50:57 20

about five minutes to introduce the case?

24 13:51:00 21

A.

It's a rough estimate.

13:51:01 22

Q.

Okay.

13:51:02 23

A.

Just a rough estimate.

13:51:03 24

Q.

Okay.

13:51:04 25

A.

Yes, it does.

25 26 27 It ranges all over the place?

28

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13:52:09 perhaps,

1

And finally, I think when we keep going,

13:52:13 there 13:52:16 Jadwin

2

to the last paragraph, second sentence, and finally,

3

was less than five minutes past, and then at 8:25 Dr.

13:52:21

4

sat down; correct?

13:52:25

5

A.

Yes, I believe that's how it happened.

13:52:27

6

Q.

Okay.

13:52:29

7

Presentation B started at 8:05.

13:52:34

8

Jadwin sat down at 8:25?

13:52:37

9

A.

Apparently.

13:52:37 10 both 13:52:41 11 8:05

Q.

Okay.

2 3 4 5 Do you see the third paragraph?

6 7 So I just want to be very clear.

8 It ended -- well, Dr.

9 10 11 12 13

Dr.

So during that 20-minute time span,

Alkhouri and Dr. Jadwin spoke.

Dr.

Alkhouri at

14 15 16

13:52:47 12 then 13:52:48 13 that

stood up to present the case or introduce the case, and

13:52:52 14

correct?

he sat down, and then Dr. Jadwin spoke 'til 8:25.

Is

17 18 13:52:52 15

A.

Yes, that's probably correct.

13:52:54 16 that 13:52:58 17 13:53:00 18 13:53:00 19 13:53:00 20 13:53:03 21 breaking 13:53:09 22 Dr. 13:53:14 23 13:53:20 24 going 13:53:26 25 precisely

Q.

Okay.

19 20 21 22 23 24 25 26 27 28

Well, is there any reason to believe

anything else happened differently? A. No. Q. No. A. That's how I recall it pretty much. Q. Thank you. Now, do you recall a dispute out between Dr. Jadwin and Dr. Roy during the course of Jadwin's presentation of October 12, 2005? A. Well, I -- I think that there were disputes on between them, but I can't tell you the nature

McBrideA

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14:01:16 and

1

write letters is to be abbreviated and not to write War

14:01:19

2

Peace; right?

14:01:20

3

A.

True.

14:01:21

4

Q.

So I guess what I am trying to ask is if Dr.

14:01:26 the 14:01:31 detail

5

Jadwin had engaged in some kind of aberrant behavior at

6

October conference, do you think that's an important

14:01:34 what 14:01:36 14:01:37 That's

7

you would have included in your abbreviated account of

8 9

happened that day in Exhibit 189? MR. WASSER: He's answered the question.

2 3 4 5 6 7 8 9 10 11 12 14:01:39 10

the third variation of it.

13 14 15

14:01:41 11 aberrant 14:01:45 12 was

A.

I don't know that he did engage in any

behavior.

All I know is just the time went by.

And I

16 14:01:48 13

not unhappy with his presentation.

He had a lot of good

14:01:52 14 hour 14:01:55 15 what

material to present.

14:01:58 16 in 14:02:02 17 14:02:06 18 Let's

we were trying to get.

14:02:11 14:02:17 a 14:02:21 14:02:21 14:02:22 14:02:23 silly, 14:02:26

19 20

say Dr. Jadwin strips naked, runs around the conference room, and starts assaulting people, do you think that is

21 22 23 24

detail you would have included in Exhibit 189? MR. WASSER: That is a ridiculous question, counsel. MR. LEE: I mean, I know it's a little bit

25

but I do --

17 18 19

As I told you before, the whole

could have been with his presentation, but that wasn't

20 21 22 23

We're trying to get everything

here, and I know that we were running out of time. Q. Okay. Let me pose another hypothetical.

24 25 26 27 28

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1 2 3 4

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14:04:54 14:04:58 14:05:00 14:05:00 do,

1 2 3 4

Lau actually had presentations to give that day? MR. WASSER: Dr. Lau? Q. Dr. Chester Lau? A. I just assume he did. Radiologists generally

14:05:05

5

but --

14:05:06

6

Q.

You don't know one way for --

14:05:07

7

A.

I don't know one way or another.

14:05:09

8

Q.

Okay.

5 6 7 8 And who is Dr.

Desai, D-e-s-a-i.

9 10 11 12

14:05:12 9 A. A medical oncologist who works for Comprehensive 14:05:18 10 Blood and Cancer Center. He's a radiation oncologist. 14:05:25 11 Q. And he was scheduled to give some comments at this

13 14:05:29 12

presentation?

14 15 16

14:05:30 13 A. Yes. I always expected the medical oncologists to 14:05:35 14 give some comments. That was very cogent to our review and

17 18 19 20

14:05:42 15 of a 14:05:45 16 14:05:47 17 the

discussion and what we're to do in terms of management

14:05:50 18 five-minute 14:05:53 19 14:05:55 20 that,

morning ran over by about five minutes.

14:05:58 21

but that happened.

14:06:01 14:06:03 was 14:06:06 14:06:07

22 23

Q. Sure. So, I mean, it wasn't uncommon to see a presentation run over, say, about five minutes. That

24 25

not uncommon? A. No, it was not uncommon.

case.

They're very important. Q. Now, you mentioned the first presentation of

21 22 23 24

overruns common? A. Yeah. Yeah, they were.

Were

And I didn't like

25 26 27 28

McBrideA

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1

Q.

Document 277-3

Okay.

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14:06:12 of

1

And to your recollection, do you know

14:06:15

2

any other physician receiving a letter of reprimand for

14:06:19

3

running over time at this cancer committee conference?

14:06:23

4

14:06:24

5

BY MR. LEE:

14:06:25

6

Q.

I am sorry.

14:06:27

7

A.

No.

14:06:29 the 14:06:32 14:06:35 14:06:36 14:06:37 14:06:48 14:06:51 14:06:54 14:06:54 14:06:56 am

8

Q.

It's a really --

2 3 4 MR. WASSER:

At that particular conference?

5 6 At any oncology conference.

7 8 9 10 11 12 13 14 15 16 17 18

9 10 11 12 13 14 15 16 17

you haven't -- have you seen

letter of reprimand that was issued to Dr. Jadwin? A. No. Q. Okay. So we can't even discuss it. Okay. You said you don't have a lot of familiarity with pathology; correct? A. I don't have a lot of familiarity with pathology. Q. Maybe I misheard you. A. I have a lot of familiarity with Pathology.

19 14:07:01 18

a urologist.

14:07:01 19

Q.

14:07:04 20

better.

20 Okay.

I am an attorney, so I don't know any

Okay.

Well, if there is a case where the

21 22 14:07:05 21 23 14:07:11 22

pathology, pathologic findings, for the patient are

14:07:16 23 orientation 14:07:23 24 that's

incorrect, based upon poor histology, incorrect

14:07:26 25 they

important information for the clinician to know before

24 25 26

of the slide, in that particular case, do you think

27 28

McBrideA

I

Case 1:07-cv-00026-OWW-TAG

1 2

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14:07:30 14:07:32 of

1 2

operate on the patient? A. I don't know where -- I don't know what kind

14:07:35 rely 14:07:39 or

3

answer you want from me.

4

on the final report from the pathologist as to what is

14:07:44 and 14:07:49 14:07:52 14:07:56 me in

5

isn't the pathologic finding, but if I am going to go

6 7 8

tell a pathologist, oh, you're wrong, no, that's not my position, and I am not that good. I cannot compete with them in that realm any more than they can compete with

14:08:00

9

cutting out a kidney.

3 4 5

I am not a pathologist.

We

6 7 8 9 10 11 12 13 14

14:08:02 10 Conference 14:08:06 11 that.

Q.

All right.

Well, the October Oncology

was about a hysterectomy.

I don't know if you recall

15 14:08:09 12

I will represent to you that it was about a hysterectomy

14:08:12 13

procedure.

16 17 14:08:13 14

A.

All right.

14:08:14 15

Q.

Okay.

18 And Dr. Jadwin's presentation, which is

19 20 21

14:08:18 16 181 -14:08:21 17 histology

actually that exhibit in front of you -- it's Exhibit

14:08:26 18 14:08:30 19 14:08:35 20 corroborated, 14:08:39 21 14:08:43 22 was 14:08:47 23 have 14:08:53 24 based 14:08:59 25 on

in the pathology for this hysterectomy patient, that the pathology -- the slides were incorrectly oriented and leading to results that he thought should be

that presentation pointing out that there was poor

22 23 24 25 26 27 28

and therefore, that's what the presentation - was about. Now that I have laid out what the presentation about, would you agree that it's an important thing to the pathology corrected, the pathologic findings be upon a good histology prior to conducting a hysterectomy

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7 8 9

14:09:03 14:09:04 14:09:06 14:09:10 14:09:14 14:09:17 14:09:20 14:09:21 14:09:24 operation

1 2 3 4 5 6 7 8 9

Document 277-3

Filed 12/01/2008

Page 133 of 191 52

a patient? A. I couldn't agree with you more. Q. Okay. Okay. Would you say it would almost be medically irresponsible to conduct a hysterectomy on a patient based upon poor histology? A. Well, that certainly is a -Q. It's a tough question. A. It's a tough question, but the answer is, obviously, yes. I mean, you want to do the right

10 14:09:30 10

for the right pathology --

11 14:09:32 11

Q.

Right.

14:09:32 12

A.

-- on anything

14:09:34 13

Q.

Right.

12 13 I mean, you can't think of a situation

14 15 16 17

14:09:36 14 patient 14:09:40 15 14:09:45 16 don't

where it would be advisable to perform surgery on a

14:09:49 17 have a 14:09:52 18 doing.

think you should operate on something that you don't

based on poor histology; right? A. You're asking me personally, yeah, right, I

18 19 20

good diagnosis on unless you're sure of what you're

21 14:09:55 19

Q.

Okay.

And in your opinion -- well, in your

22 14:09:56 20

opinion, can an appropriate treatment plan be based on

14:10:00 21

inaccurate pathologic findings based on poor histology?

23 24 14:10:05 22

A.

No.

14:10:05 23 was 14:10:12 24 14:10:17 25 assume

Q.

No.

25 26 27 28

Okay.

Now, actually, this patient which

the topic of this Exhibit 181 had a tubal ligation. So, in other words, we could that safely

McBrideA

Case 1:07-cv-00026-OWW-TAG

1

A.

Document 277-3

Filed 12/01/2008

Oh, I have never seen this.

Page 134 of 191 54

14:12:47 first

1

Not one -- the

14:12:51

2

14:12:51

3

Q.

Okay. So --

14:12:52

4

A.

It was a CC, it never got to my hands.

14:12:55

5

Q.

Okay.

14:12:57

6

14:13:02 that 14:13:05 14:13:11 14:13:14 14:13:17 14:13:20 14:13:22 14:13:22 seen

7

2 time.

3 4 5 So then, is that your e-mail address,

6 [email protected]?

7 8 9 10 11 12 13 14 15

8 9 10 11 12 13 14

A.

No, it's not.

Oh, wait.

That's a -- yeah,

is.

That's a -- but that doesn't mean that I saw this. Q. Okay. So to the best of my recollection, you haven't seen this e-mail before? A. To the best of my recollection, this was never sent to me. Q. Okay. A. Despite that that's in there, I have never

16 14:13:23 15

this, on a stack of bibles.

17 14:13:23 16

Q.

I am sorry.

14:13:26 17 this. 14:13:29 18 the

A.

I am -- on a bible, I have never ever seen

Q.

Not even necessary.

14:13:30 19

way, just --

14:13:31 20

A.

What you get from me today is total honesty.

14:13:34 21

Q.

I can see that, and I appreciate it very much,

14:13:37 22

doctor.

And I can tell you it's going to speed things a

14:13:41 23

long very much.

18 19 20

I understand, doctor.

By

21 22 23 24 25 26 27 28

14:13:43 24

Why don't we move on then to 202, please.

14:14:19 25

Okay.

Doctor, you have been handed a document

McBrideA

Case 1:07-cv-00026-OWW-TAG

1

14:14:23 going to

1

Document 277-3

Filed 12/01/2008

Page 135 of 191 55

marked for identification as Exhibit 202.

And I am

2 3 4 5

14:14:28 2 if 14:14:32 3 14:15:36 4 recognize

ask you to familiarize yourself with this briefly to see

14:15:38

5

this letter?

14:15:38

6

A.

Yes, I do.

14:15:41

7

Q.

Can you tell me what it is.

14:15:42

8

A.

Well, briefly, it's describing Dr. Jadwin's

you recognize it. All right, doctor.

Is this -- do you

6 7 I remember this letter.

8 9 10 11 12 13

14:15:46 9 Canada, 14:15:49 10 14:15:52 11 important

difficulty with time constraints, getting back from

14:15:55 12 support 14:15:59 13 conferences

ones that he felt that he had to make, and he had

14:16:08 14

requiring pathologic presentation, that the pathologic

14:16:12 and 14:16:16 14:16:19 14:16:19 14:16:22 with

15

presentation was by far the most important part of that,

16 17 18 19

I -- I didn't disagree with him then. Q. Okay. A. In fact, Dr. Jadwin and I discussed this afterwards. As I said before, I never had disagreement

14:16:25 that 14:16:32 14:16:32 these 14:16:37 not. 14:16:41 14:16:45

20

his ability and even his comments that pathology was

21 22

important.

23

conferences should be an hour on each case, but they're

24 25

They haven't been over there, and -- but his points are well-taken. I never disagreed with that.

whatever, and finally, realizing that he had a very important presentation to make, one of the most

14 15 16

from this Fox or wherever the center was, that

17 18 19 20 21 22 23 24 25 26 27 28

Quite frankly, I think they are.

McBrideA

I think

Case 1:07-cv-00026-OWW-TAG

1 2

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Page 136 of 191 57

14:17:39 14:17:42 no

1 2

And I am going to ask you, do you think that's referring to Dr. Jadwin's assertion that radiology had

14:17:48

3

pertinent or significant radiologic findings that day?

3 4 5 6 7 8 9 10 11 12

14:17:51 4 until 14:17:55 5 14:17:56 6 14:17:57 7 14:17:59 8 14:18:01 9 14:18:04 10 14:18:05 11 is

A.

In retrospect, I did not realize all this

the conference was already all over. Q. Okay. A. Okay. The bottom line is his points well-taken regarding the pathology, this whole Q. Okay. So when you look at this -- I A. No, I am sorry. Q. Okay. When you look at Exhibit 202,

were thing. am sorry. doctor,

13 14 15 16

14:18:09 12 in 14:18:12 13 14:18:13 14 have

there anything that you disagree with that's contained

14:18:17 15

talked about most of my disagreements and concerns.

this letter? A. I can't really disagree with -- I think we

17 18 14:18:21 16

Q.

Okay.

14:18:22 17

A.

And I think addressed to this letter.

14:18:25 aspect 14:18:27 14:18:32 14:18:32 14:18:36 you

Q.

Okay.

19 20 21 22 23 24 25

18 19 20 21 22

So I mean -- actually, is there any

of this letter that you disagree with or find to be untrue? A. With what little time I have had to peruse it again, I am not in disagreement with anything, but if

26 14:18:39 23

want to point out something.

27 28

14:18:42 24 end, 14:18:45 25

Q.

Actually, doctor, we are getting close to the

so if you wouldn't mind, could you just read the letter

McBrideA

Case 1:07-cv-00026-OWW-TAG

Document 277-3

bit, I think.

Filed 12/01/2008

Page 137 of 191 91

1

15:14:17

1

More so than most, I guess.

2

15:14:24

2

Q.

Okay.

3

15:14:25

3

A.

Actually, I would see him in the cafeteria and

I 4 15:14:30

4

used to go over there and sit down with him and vice

5

versa.

6

15:14:33

5

I actually -- you know, I used to talk to him.

7

15:14:36

6

friendly, communicated.

8

15:14:38

7

Q.

Okay.

9

15:14:38

8

A.

We had a pretty good professional

Q.

Okay.

We were

relationship. 10 15:14:40

9

So did you find Dr. Jadwin to ever be

11 15:14:46 10

unprofessional with you?

12 15:14:47 11

A.

Never.

15:14:48 12

Q.

Okay.

13 Are you aware of any instances where

14

Dr.

15

15:14:51 13

16

15:14:54 14

A.

Not to me.

17

15:14:55 15

Q.

Okay.

18

15:14:56 16

A.

I have no idea.

19

15:14:57 17

Q.

Okay.

20

15:14:57 18

A.

I have no idea what he did with others.

21

15:15:00 19

Q.

None that you're aware of?

22

15:15:01 20

A.

Not that I am aware of.

23

15:15:03 21

Q.

Okay.

Jadwin acted inappropriately in your opinion? Or towards anybody?

Are you aware of any instances where

Dr. 24 15:15:07 22

Jadwin just lost his temper with anybody?

25 15:15:09 23

A.

No.

15:15:10 24

Q.

Okay.

26 27

Dr.

28

15:15:14 25

Are you aware of any instances where

Jadwin threatened anybody?

McBrideA

Case 1:07-cv-00026-OWW-TAG

1 2

A. Q.

Document 277-3

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15:15:14 15:15:15 Jadwin

1 2

No. Are you aware of any instances where Dr.

15:15:18

3

15:15:20

4

A.

No.

15:15:22 Dr. 15:15:26 15:15:28 15:15:29 Dr.

5

Q.

Okay.

6 7 8

Jadwin was insulting people? A. No. Q. Okay. Are you aware of any instances where

15:15:34

9

Jadwin was making false allegations against people?

3 raised his voice at anybody?

4 5 6 7 8 9

Are you aware of any instances where

10 11 15:15:37 10

A.

No.

15:15:39 11

Q.

Okay.

12 So would you say -- did you -- can you

13 14 15 16 17

15:15:42 Dr. 15:15:46 15:15:47 15:15:50 I

12

recall any instances where any interactions you had with

13 14 15

Jadwin were unpleasant? A. They were all very pleasant, and I can comment that he helped me a lot up in the operating room. When

18 19 20 21

15:15:53 16 always 15:15:58 17 15:15:58 18 getting

would call pathology, come up and see a case, he was

15:16:02 how 15:16:06 15:16:10 15:16:14 15:16:19 with 15:16:23 15:16:25

19

more appropriate biopsies on prostates, helped us with

20 21 22 23

to do that a little better, and how to manage testicular tumor pathology reports, you know, specimens. No, I can honestly say that the relationship professionally was good with me and him. What he did

24 25

any other people, I have no idea. Q. Uh-huh. Of course. Okay.

right there. And I can honestly say he helped me with

22 23 24 25 26 27 28

McBrideA

What's the -- I am

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5

Document 277-3

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15:21:15 15:21:17 15:21:20 15:21:23 15:21:24 lodged

1 2 3 4 5

Q. Okay. Are you aware of any instances of other core physicians filing green papers, complaints? A. Not that I know of. I have no knowledge of anything like that. Q. Are you aware of any complaints ever being

15:21:26

6

against you at Kern Medical Center?

15:21:29

7

A.

No.

15:21:33 Royce 15:21:36 Center?

8

Q.

No.

6 7 8 9 10

9

Okay.

Can you recall a time when Dr.

Johnson took a medical leave from The Kern Medical

11 15:21:40 10

A.

Dr. Johnson took a medical leave?

15:21:41 11

Q.

Yes.

15:21:42 12

A.

Really.

15:21:43 13

Q.

No?

15:21:44 14

A.

No.

15:21:44 his 15:21:48 15:21:53 15:21:55 I

Q.

Okay.

12 13 14 15 16 17 18 19 20

15 16 17 18

Can you recall a time when Dr.

Naderi,

son got into a car accident, and he was on some kind of leave for about a month or so? A. I don't know that -- I didn't know he'd left.

21 22 23 24 25 26

15:21:58 19 That 15:22:01 20 15:22:06 21 15:22:09 22 15:22:12 23 questions

knew I had read about his son getting in an accident.

15:22:14 24 15:22:15 25 what

you asked him today. A. I have no idea.

was pretty common knowledge around the hospital. Q. Are you familiar with the circumstances of Dr. Sheldon Friedman's departure from KMC? MR. WASSER: That was one of the first

27 28

McBrideA

I don't know why he left or

McBRIDE, M.D. Case 1:07-cv-00026-OWW-TAG

Document 277-3

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Page 140 of 191 08-15-08 Page 109

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

ss.

3

4

I, Cindee L. LeFevre, a Certified Shorthand

5

Reporter in the State of California, holding certification

6

No. 7974, do hereby certify that ALBERT McBRIDE, M.D.,

7

the witness named in the foregoing deposition,

8

was by me duly sworn; that said deposition was taken

9

Friday, August 15, 2008, at the time and place set forth

10 11

on the first page hereof. That upon the taking of the deposition, the

12

words of the witness were written down by me in stenotypy

13

and thereafter transcribed by computer under my supervision;

14

that the foregoing is a true and correct transcript of the

15

testimony given by the witness.

16

I further certify that I am neither counsel for

17

nor in any way related to any party to said action, nor in

18

any way interested in the result or outcome thereof.

19

20

Dated this 9th day of September, 2008, at Bakersfield, California.

21 22 23 24

~L:)~ LeF~O. Cindee L.

7974

25

VS. &

RANDALL

COUNTY (800)

322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 141 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 30

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

35

Case 1:07-cv-00026-OWW-TAG

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Page 142 of 191

Albert MfeBride, MD; Department of Surgery Kern Medical Center Bakersfield, California 93305 19 October 2005

Dear Dr. McBride: I wish to express my apology for the confusion that occurred at the October Oncology Conference. I had traveled to Canada on the preceding Saturday to attend a family Canadian Thanksgiving Holiday on Monday and the return trip on Tuesday night was long and complicated. I worked on the presentation most of the trip and returned to Bakersfield after midnight on the day of the conference. With barely four hours of sleep I was intensely focused on the presentation to be given and because of my absence from the country and fatigue I did not have an opportunity to discuss this case with you before hand. Since the pathology department has presented concise, well organized presentations for years, I felt that I would be respectfully given the latitude to make the presentation without discourteous interruption. I worked many hours to put together a pathology presentation that would detail the problems encountered with this patient's care and hopefully improve general awareness about important KMC patient care issues I feel that this presentation was perhaps the most important that I have delivered at a KMC Oncology Conference. It was a standard pathology case presentation that would be found in any oncology conference around the country; a detailing of the specimens received, gross & microscopic findings, diagnosis and conclusions. The director of the Fox Chase Cancer Center, one of the very top cancer centers in the world, has stated to me that it is not reasonable to limit the time of the pathology presentation, but rather that the time spent should relate to the complexity of the case that is presented. The guiding operational principle for me was and is that content is more important than the time the conference is concluded. Certainly other oncology conferences have run over without incident and most other conferences throughout the institution run over all of the time. It was certainly difficult for me to focus on continuity issues with the inappropriate distractions that Dr. Harris made during my presentation. If there had been questions asked in a standard manner, I would have been glad to respond to any issues at the time in the form of a question, but I was not given that opportunity. Unfortunately, there were misperceptions that 1 was stealing other people's time, when such was not the case. As you hopefully now know, there were no management issues or diagnosis issues other than pathology to be discussed. Again, I am sorry for the confusion about the issues surrounding my presentation.

1/ "—

David F. Jadwin, DO Chair, Department of Pathology

CC: Eugene Kercher MD, Scott Ragland DO, Jennifer Abraham MD, Irwin Harris MD, Royce Johnson MD, Maureen Martin MD, Leonard Perez MD, George Alkouri MD Exhibit 202 Susan R. Wood, CSR # 6829

08/13/08 Irwin Everett Harris, M.D.

DFJ00591

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 143 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 31

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

36

Case 1:07-cv-00026-OWW-TAG

C

.. Dept

~ Status

· .-

-

Document 277-3

Filed 12/01/2008

Page 144 of 191

..... ..,.

Organization

Visual

Oral

R R R

Clin Disc

2 2

Impact

2 2

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2

2

1

1

R S

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 146 of 191

• KERN

MEDICAL • CENTER

ONCOLOGY CQNFERNCE DATE: October 12,2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P.

IOB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Perfonnance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

Case Presenter Organization of Presentation Quality of Visual Presentation Quality of Oral Case Presentation Quality of Subsequent Clinical Management Discussion Impact of Management Discussion on KMC Patient Care Overall Presentation Rating I learned new information while attending this conference:

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Signature: (Optional)

000051.5

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 147 of 191

• KERN • MEDICAL . CENTER

ONCOLOGY CQNFERNCE DATE: October 12; 2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P.

IOB/OYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. O. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 148 of 191

• KERN . MEDICAL • CENTER

ONCOLOGY CONFERNCE 1)ATE: October 12,2005

Sponsoring Department: D Dept. of Med. D F.P. IOB/GYN

D Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

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3- Needs Improvement

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

• KERN • MED.ICAL CENTER

Filed 12/01/2008

Page 149 of 191

ONCOLOGYCONFERNCE DATE: October 12, 2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P. IOB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement B

A

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

· KERN II,MEDICAL CENTER

Filed 12/01/2008

Page 150 of 191

ONCOLQOYCQNFERNCE 1)ATE: October 12,2005 ------~-­ ~------

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3- Needs Improvement

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 151 of 191

• M.EDICAL KERN

.• CENTER

ONCOLOGYCONFERNCE DATE: October 12, 2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P.

IOB/GYN

0 Surgery

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2- Satisfactory

3- Needs Improvement

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 152 of 191

· ... KERN •• •. MEDICAL

"'II.

CENTER

QNCOLOC;YCQNFERNCE DATE: October 12,2005

Sponsoring Department: 0 Dept. of Med. D F.p.1 OB/GYN

0 Surgery

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2- Satisfactory

3- Needs Improvement

Case Presenter Organization ofPresentation Quality of Visual Presentation Quality of Oral Case Presentation Quality of Subsequent Clinical Management Discussion Impact of Management Discussion on KMC Patient Care Overall Presentation Rating I learned new information while attending this conference: The information I learned will improve my clinical practice: How would you rate the overall presentation from Pathology? How would you rate the overall presentation froin Radiology?

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 153 of 191

• KERN • MEDICAL . CENTER

ONCOLQGYCONFERNCE DATE: October 12, 2005

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 154 of 191

• KERN

,MEDICAL • CENTER

ONCOLO(rY CONFERNCE DATE: October 12, 2005

SponsoringDepartment: 0 Dept. ofMed. 0 F.P. ;, OB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

• KERN MEDICAL • CENTER

Filed 12/01/2008

Page 155 of 191

ONCOLOGY CQNFERNCE DATE: October 12,2005

Sponsoring Department: 0 Dept. of Med. 0 F.P. IOB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3.- Needs Improvement

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 156 of 191

ONCOLOGY CONFERNCE lJATE: October 12,2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P.

IOB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

Case Presenter Organization of Presentation Quality of Visual Presentation Quality of Oral Case Presentation Quality of Subsequent Clinical Management Discussion Impact of Management Discussion on KMC Patient Care Overall Presentation Rating I learned new information while attending this conference: The information I learned win improve my clinical practice:

,

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Comments:

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-----~-------

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Signature: (Optional)

0000525

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 157 of 191

. KERN I MEDICAL

I. CENTER

ONCOLOGYCONFERNCE DATE: October 12, 2005

SponsoringDepartment: D Dept. ofMed. 0 F.P.

IOB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

Case Presenter Organization ofPresentation Quality of Visual Presentation Quality of Oral Case Presentation Quality of Subsequent Clinical Management Discussion Impact of Management Discussion on KMC Patient Care Overall Presentation Rating I learned new information while attending this conference: The information I learned will improve my clinical practice: How would you rate the overall presentation from Pathology?

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Signature: (Optional)

0000526

Case 1:07-cv-00026-OWW-TAG

Document 277-3

• KERN MEDICAL • CENTER

Filed 12/01/2008

Page 158 of 191

ONCOLOGY CONFERNCE

l)ATE: October 12,2005

Sponsoring Department: 0 Dept. ofMed. 0

F.p.1 OB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri ~erformance

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2- Satisfactory

3- Needs Improvement A

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0 Pathology

0 Radiology

------------

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 159 of 191

··KERN • MEDICAL • CENTER

ONCOLOGY CONFERNCE

l)ATE: October 12, 2005

Sponsoring Department: 0 Dept ofMed. 0 F.P.

IOB/GYN

0 Surgery

Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

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Signature: (Optional)

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Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 160 of 191

w.o., • KERN

MEDICAL ~ • CENTER o

ONCOLOGY CONFERNCE DATE: October 12, 2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P.

lIoB/GYN

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Presenter A: Dr. N. Sharkey Presenter B: Dr. G. Alkhouri Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

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Signature: (Optional)

0000529

Case 1:07-cv-00026-OWW-TAG

Document 277-3

KERN • CENTER

Filed 12/01/2008

Page 161 of 191

. MEDICAL ONCOLOGY CONFERNCE DATE: October 12, 2005

Sponsoring Department: 0 Dept. ofMed. 0 F.P.

IOB/GYN

0 Surgery

Presenter A: Dr. N.Sharkey Presenter B: Dr. G. Alkhouri Perfonnance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement

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ONCOLOGY CONFERNCE DATE: October 12, 2005

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Filed 12/01/2008

Page 170 of 191

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Document 277-3

Filed 12/01/2008

Page 171 of 191

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. CENTER

ONCOLOGY CONFERNCE DATE: October 12, 2005

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3- Needs Improvement

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Filed 12/01/2008

Page 172 of 191

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ONCOLOGY CONFERNCE l)ATE: October 12,2005

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Filed 12/01/2008

Page 175 of 191

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Page 176 of 191

ONCOLOGY CONFERNCE DAtE: October 12, 2005

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2- Satisfactory

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Document 277-3

• KERN MEDICAL • CENTER

Filed 12/01/2008

Page 177 of 191

ONCOLQGY CONFERNCE DATE: October 12,2005

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Document 277-3

Filed 12/01/2008

Page 178 of 191

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ONCOLOGY CONFERNCE DATE: October 12, 2005

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Document 277-3

·. KERN :MBJCAL . CENTER

Filed 12/01/2008

Page 179 of 191

ONCOLOGY CONFERNCE DATE: October 12, 2005

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From: To: Date: Subject:

Document 277-3

Filed 12/01/2008

Page 180 of 191

Serena Sepulveda-Rini David Jadwin. DO 10/14120052:43:20 PM Fwd: Re: Oncology Conference

Serena Sepulveda-Rioi Office Services Assistant Lab - Pathology Kern Medical Center [email protected] 661-326-2259 *********. CONFIDENTIALITY STATEMENT

.*******.*

This message is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged. confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination. distribution or copying of the communication is strictly prohibited. If you received this communication in error. please notify us immediately by telephone and return the original message to us at the e-mail address above. Thank you. OWNED AND OPERATED BY THE COUNTY OF KERN 1830 Flower Street, Bakersfield California 93305-4197 (661) 326-2416

»> Laura Quinonez 10/14/20052:42:51 PM >>> 35 Residents; 25 Medical Students; 25 Staff Members Note: Staff Members Include the following: Cancer registristry staff; outside physicians Regards. Laura Heredia-Quinonez Oncology Clinic Coordinator Cancer Registry/Kern Medical Center (661) 326-5692 (661) 862-7623 (fax) [email protected]

>>> Serena Sepulveda-Rini 10/14/20052:10:08 PM »> Hi Laura. Dr. Jadwin would like to know how many people attended the conference. How many were staff and how many were residents? Thank you, Serena

Serena Sepulveda-Rini Office Services Assistant Lab - Pathology

0000549

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 181 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 32

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

37

1

Case 1:07-cv-00026-OWW-TAG

I!'E"%AL CENTER

Sponsoring Department: Presenter A:

Document 277-3

Filed 12/01/2008

Page 182 of 191

ONCOLOGY CONFERNCE DATE: November 9,2005

I.M.

F.P.

OBIGYN

Surgery

Dr. Ryan Hudson

Presenter B: Dr. Steven Chen Performance Rating: 1- Very Good

2- Satisfactory

3- Needs Improvement B

A

Case Presenter Organization of Presentation Quality of Visual Presentation Quality of Oral Case Presentation Quality of Subsequent Clinical Management Discussion Impact of Management Discussion on KMC Patient Care Overall Presentation Rating I learned new information while attending this conference:

d:s

NO

d e s

NO

The information I learned will improve my clinical practice:

d e s CI NO

d e s

NO

I ,

f.-

1

5

-

?a

How would you rate the overall presentation from Pathology?

5

How would you rate the overall presentation from Radiology?

Comments:

// ( ,(

~ h ,~ , U U L AWL

Department: E.R. F.P. I.M. ONursing Pharmacy

k

OBIGYN Other:

Pos' on: d f Physician Medical Resident R.N. El Other Healthcare Associate

8138 A M .

&ology

• Radiology

Other Healthcare Provider

CI

Surgery

Medical Student

Signature: (optional)

DFJ00686

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 183 of 191

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 33

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

38

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13

VIDEOTAPED DEPOSITION

14

OF

15

JOSEPH MANSOUR, M.D.

16

Monday, August 25, 2008

17

Bakersfield, California

18 19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

MansourJ

Page 184 of 191 1

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 185 of 191 10

1

09:04:18

1

A.

Correct.

2

09:04:18

2

Q.

Did you ever have any unpleasant

3

09:04:20

3 interactions with Dr. Jadwin?

4

09:04:22

4

A.

Personally, no.

5

09:04:23

5

Q.

Okay.

6

09:04:26

6

A.

I've heard he had interaction with other

7

09:04:31

7 people.

8

09:04:31

8

Q.

Okay.

9

09:04:34

9

A.

Correct.

10

09:04:34 10

Q.

Have you ever witnessed Dr. Jadwin acting

11

09:04:37 11 inappropriately?

12

09:04:38 12

A.

No.

13

09:04:39 13

Q.

Okay.

14

09:04:57 14 Dr. Jadwin's inappropriate interactions from others?

15

09:05:08 15

16

09:05:11 16 other physicians regarding some cases on some medical

17

09:05:16 17 issues, and that's basically all that I heard.

18

09:05:18 18

Q.

That's all you've heard?

19

09:05:20 19

A.

Uh-huh.

20

09:05:21 20

Q.

Okay.

21

09:05:23 21 inappropriate of Dr. Jadwin?

22

09:05:25 22

A.

Did I say inappropriate?

23

09:05:26 23

Q.

Yes.

24

09:05:28 24 inappropriate interactions.

25

09:05:30 25

A.

Well, what about not personally?

But you personally no, correct?

So what did you hear about

I've heard that he had some interaction with

But how -- why did you think it was

I was asking if you were aware of any

MR. WASSER:

I think you used the word

MansourJ

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 186 of 191 98

1

11:05:43

1

A.

Yes.

2

11:05:44

2

Q.

Okay.

3

11:05:48

3 your conversation with Dr. Harris?

4

11:05:51

4

5

11:06:02

5 "Dr. Mansour became inappropriately angry and raised

6

11:06:07

6 his voice."

7

11:06:09

7

8

11:06:11

8 say that, that's in the middle of the first page

9

11:06:14

9 where it says, "Dr. Mansour became apparently angry

A.

Q.

Is this an accurate account of -- of

Somewhat.

The first paragraph it's stated,

I don't agree with that.

I just want to be very clear.

So when you

10

11:06:18 10 and raised his voice to me implying that it is

11

11:06:20 11 outrageous to suggest that he should not go to the

12

11:06:23 12 board with complaints"?

13

11:06:24 13

A.

Correct.

14

11:06:25 14

Q.

You don't agree with that?

15

11:06:26 15

A.

Right.

16

11:06:26 16

Q.

You don't agree with that?

17

11:06:28 17

A.

I don't agree with that.

18

11:06:29 18

Q.

Okay.

19

11:06:30 19 it says, "Dr. Mansour asked me if I was aware that

20

11:06:33 20 the county was paying malpractice coverage for

21

11:06:36 21 doctors to do cases at Memorial and at Mercy"?

22

11:06:39 22

A.

Correct, I did ask that.

23

11:06:40 23

Q.

Okay.

24

11:06:43 24 the county using taxpayer dollars to provide

25

11:06:46 25 malpractice coverage to OB-GYN doctors even though --

What about the next paragraph where

So this was -- this is a practice of

MansourJ

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 187 of 191 99

1

11:06:51

1 even though they were doing work at other hospitals?

2

11:06:54

2

3

11:06:58

3 practice plan that I was complaining about, that the

4

11:07:00

4 county would provide malpractice coverage for

5

11:07:04

5 everything that's done outside Kern Medical Center

6

11:07:06

6 with the approval and blessing of Peter Bryan.

7

11:07:10

7

8

11:07:12

8 issue to Mr. Bryan?

9

11:07:13

9

A.

Yes.

10

11:07:17 10

Q.

Okay.

11

11:07:20 11 disagreed with your concern?

12

11:07:22 12

A.

Correct.

13

11:07:22 13

Q.

Okay.

14

11:07:25 14 Bryan about this?

15

11:07:27 15

A.

No more than once.

16

11:07:28 16

Q.

No more than once.

17

11:07:30 17 went to Mr. Bryan about this issue?

18

11:07:32 18

A.

No.

19

11:07:33 19

Q.

Okay.

20

11:07:42 20 Mr. Bryan and expressed this concern about the

21

11:07:44 21 malpractice insurance on or --

22

11:07:47 22

A.

I --

23

11:07:48 23

Q.

-- on or around the date of this letter?

24

11:07:50 24

A.

I do not recall specifically going to

25

11:07:53 25 Mr. Bryan regarding this issue only.

A.

Q.

Correct.

Okay.

And that was part of the faculty

And you -- you -- you explained this

And he said this is business plan. So he -- he basically discounted or

How many times did you go to Peter

Do you recall when you

Do you recall whether you met with

MansourJ

Case 1:07-cv-00026-OWW-TAG

Document 277-3

Filed 12/01/2008

Page 188 of 191 100

1

11:07:55

1

Q.

Okay.

2

11:07:56

2

A.

It's regarding the whole faculty practice

3

11:08:01

3 plan, and that's probably one of the items on the

4

11:08:03

4 faculty plan.

5

11:08:05

5 issue.

6

11:08:06

6

7

11:08:11

7 raised this issue about malpractice insurance?

8

11:08:17

8

9

11:08:20

9 the business plan that made sense.

Q.

A.

Okay.

I don't recall going only for that

And was Mr. Bryan hostile when you

Q.

I can't remember.

10

11:08:22 10

11

11:08:25 11 Mr. Bryan, did you ever discuss this issue with

12

11:08:28 12 anybody else?

13

11:08:30 13 Dr. Harris, right?

14

11:08:31 14

15

11:08:35 15 was aware of this or not.

16

11:08:36 16

Q.

What did he say?

17

11:08:38 17

A.

He said he was.

18

11:08:42 18 aware and he agrees with it.

19

11:08:45 19

Q.

He agrees with you?

20

11:08:46 20

A.

He agrees with the plan.

21

11:08:47 21

Q.

Oh, he thinks the plan is fine?

22

11:08:49 22

A.

That's fine.

23

11:08:51 23 doesn't see, like he stated, why I don't take

24

11:08:56 24 advantage of that and do private practice at

25

11:08:59 25 Memorial.

A.

Okay.

All I remember is part of

And did you -- after you talked with

Obviously you discussed it with

I asked Mr. -- Dr. Harris, yeah, whether he

I remember he said he was

It's a business plan, and he

MansourJ

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-3

Filed 12/01/2008

Page 189 of 191 101

1

11:08:59

1

So is this memo -- that discussion regarding

2

11:09:12

2 the malpractice coverage, is that -- do you see that

3

11:09:15

3 last paragraph on 27083, that last paragraph?

4

11:09:20

4

A.

Yeah.

5

11:09:20

5

Q.

Is that an accurate account of your

6

11:09:22

6 discussion with Dr. Harris?

7

11:09:28

7

A.

Correct.

8

11:09:28

8

Q.

It says -- you see there on 27084, the

9

11:09:38

9 second page, it's going to be about almost near the

10

11:09:41 10 end of that first big paragraph, it says, "I asked

11

11:09:44 11 Dr. Mansour why he would not also take advantage of

12

11:09:46 12 this and work in the community too"?

13

11:09:48 13

A.

Correct.

14

11:09:49 14

Q.

So he was suggesting why don't you go use

15

11:09:51 15 this malpractice coverage and work at other hospitals

16

11:09:54 16 and get free coverage, correct?

17

11:09:56 17

A.

Correct.

18

11:09:56 18

Q.

What did you -- how did you respond to that?

19

11:09:58 19

A.

I thought it was -- I don't know if I

20

11:10:01 20 responded or not, but I thought it was outrageous to

21

11:10:04 21 do that.

22

11:10:05 22

23

11:10:08 23

24

11:10:15 24 in the same paragraph, "Dr. Mansour said that it is a

25

11:10:18 25 business decision that the board wants to appeal."

Q.

So -I think so too. Okay.

Do you see that last sentence there

MansourJ

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-3

Page 190 of 191 104

1

11:13:05

1

2

11:13:07

2 aware?

3

11:13:09

3

4

11:13:12

4 meetings, one of those open session with Peter Bryan,

5

11:13:16

5 that issue was raised.

6

11:13:17

6

7

11:13:20

7 with Peter Bryan?

8

11:13:21

8

9

11:13:23

9 supervisors.

A.

Okay.

Filed 12/01/2008

So how do you know that the board was

Q.

Because it was raised in one of their

A.

I'm sorry, what do you mean open session

I mean the regular session of the board of It was -- that issue was raised one

10

11:13:28 10 time with Peter Bryan.

11

11:13:29 11

12

11:13:33 12 knowledge, did the board actually approve the plan

13

11:13:36 13 still?

14

11:13:38 14

15

11:13:40 15 was can- -- the malpractice coverage, that's all

16

11:13:43 16 canceled.

17

11:13:44 17

Q.

Oh, it was canceled?

18

11:13:46 18

A.

Yeah.

19

11:13:46 19

Q.

So they fixed the problem?

20

11:13:48 20

A.

Yeah, it was canceled.

21

11:13:49 21

Q.

The board fixed the problem?

22

11:13:51 22

A.

Well, yeah, they canceled it before those

23

11:13:54 23 guys resigned, like in maybe to late -- early 2007 or

24

11:14:02 24 late 2006.

25

11:14:06 25 away.

Q.

A.

Oh, I see.

That's gone.

And did the board -- to your

That's disappear.

The plan

So that malpractice coverage was taken

MansourJ

Case 1:07-cv-00026-OWW-TAG

Document 277-3

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

Page 191189 of 191

ss. 3 4

I, Sandra L. Edmonson, a Certified Shorthand

5

6

Reporter in the State of California,

7

No.

8

the witness named in the foregoing deposition, was by me

9

duly sworn;

7704,

do hereby certify that JOSEPH MANSOUR, M.D.,

that said deposition was taken Monday,

10

August 25,

11

first page hereof.

12

holding Certificate

2008,

at the time and place set forth on the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision;

16

transcript of the testimony given by the witness.

17

I

that the foregoing is a true and correct

further certify that I am neither counsel for

18

nor in any way related to any party to said action,

19

in any way interested in the result or outcome thereof.

20 21

Dated this 8th day of September,

2008,

at

Bakersfield, California.

22 23 Sandra L.

Edmonson,

24 25

WOOD & RANDALL (800) 322-4595

CSR No.

7704

nor

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6

Document 277-4

Filed 12/01/2008

Page 1 of 209

Eugene D. Lee (SB#: 236812) LAW OFFICE OF EUGENE LEE 555 West Fifth Street, Suite 3100 Los Angeles, CA 90013 Phone: (213) 992-3299 Fax: (213) 596-0487 email: [email protected] Attorney for Plaintiff DAVID F. JADWIN, D.O.

7 8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

FRESNO DIVISION

11

DAVID F. JADWIN, D.O.,

12 13 14

Plaintiff, v.

Civil Action No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE LEE IN OPPOSITION TO DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Fed. R. Civ. P. 56(a)]

COUNTY OF KERN, et al.,

15

Defendants.

16 17

Date: January 12, 2009 Time: 10:00 Judge: Hon. Oliver W. Wanger Courtroom: 3 Complaint Filed: January 6, 2007 Trial Date: March 24, 2009

18 19 I, Eugene D. Lee, declare as follows: 20 1.

I am an attorney at law duly licensed to practice before the Federal and State Courts of

21 California and admitted to practice before the U.S.D.C. for the Eastern District of California. I am 22 counsel of record for Plaintiff David F. Jadwin in this matter. 23 2.

I am making this declaration in opposition to Defendants’ Motion for Summary

24 Judgment. I have personal knowledge of the matters set forth below and I could and would competently 25 testify thereto if called as a witness in this matter. 26 3.

Attached hereto as Exhibits are true and correct copies of the following documents:

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 2 of 209

Exh. 1

Date 7/10/2006

Description Memo from Mr. Bryan to JCC re Recommendation of Demotion of Dr. Jadwin

2 3 4 5 6

8/14/2008 8/26/2008 1/9/2008 3/12/2008 10/21/2008

Deposition Transcript of Peter Bryan, Vol I Deposition Transcript of Peter Bryan, Vol II Deposition Transcript of David Jadwin, Vol II Deposition Transcript of David Jadwin, Vol V Deposition Transcript of David Jadwin, Vol VI

7

8/18/2008

Deposition Transcript of Former Supervisor Barbara Patrick, Vol I

8

4/16/2008

Deposition Transcript of Former Lab Mgr Gilbert Martinez

10

9

8/22/2008

Deposition Transcript of Former President Scott Ragland

11

10

8/25/2008

Deposition Transcript of Supervisor Ray Watson

11

8/21/2008

Deposition Transcript of Former CEO David Culberson

12

8/29/2008

Deposition Transcript of PMK Philip Dutt, Vol. I

13

8/28/2008

Deposition Transcript of Former COO Sandra Chester

17

14

9/4/2008

Deposition Transcript of PMK Eugene Kercher

18

15

6/29/2006

Letter from Lee to Barnes re Spoliation of Evidence

16

3/29/2007

Letter from Lee to Barnes re Spoliation of Evidence

17

11/20/2007 Defendants’ Responses to Plaintiff’s Request for Production, Set One

18

9/10/2007

1 2 3 4 5 6 7 8 9

12 13 14 15 16

19 20 21 22 23 24 25

19

Joint Conference Committee Meeting Minutes re Demotion of OB/GYN Chair Kern County Policy & Administrative Procedures Manual, Section 139 (Disciplinary Actions)

20

3/12/2002

21

12/26/2003 Change of Employee Status

26

CMO Marvin Kolb Memo to Jose Perez re Pathologist Elsa Ang Accusations

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

2

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 3 of 209

22

5/15/2006

Expert Consulting Services Agreement, between Consultant William Colburn and Kern County

23

8/30/2006

Consultant William Colburn Report to Kern County re Review of Jadwin cases

24

8/13/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. I

5

25

8/27/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. II

6

26

5/3/2004

KMC FNA Consulting Project by UCLA Consultant David Lieu

27

8/18/2008

Deposition Transcript of Former President of Medical Staff Jennifer Abraham

1 2 3 4

7 8 9 10

28

Cancer Conference Presenter Guidelines

29

8/15/2008

12

30

10/19/2005 Exh. 202: Jadwin letter to Albert McBride, Cancer Conference Director re October Conference

13

31

11

Deposition Transcript of Former Cancer Committee Director Albert McBride

October Conference attendee feedback

14 32

11/9/2005

Oncology Conference attendee feedback of Savita Shertukde

33

8/25/2008

Deposition Transcript of OB-GYN Physician Joseph Mansour

34

Harris Memos to File re Mansour Behavior

35

5/10/2006 to 4/12/2007 8/19/2008

36

8/18/2008

Deposition Transcript of Chair of Surgery Maureen Martin, Vol. I

37

4/16/2008

Deposition Transcript of Histotech Evangeline Gallegos

38

4/19/2008

Deposition Transcript of Former CMO Marvin Kolb

25

39

2/26/2008

Deposition Transcript of Pathology Secretary Tracy Lindsey

26

40

2/26/2008

Deposition Transcript of Clerk Irene Lopez

15 16 17 18 19 20 21 22 23

Deposition Transcript of Nurse Executive Antoinette Smith, Vol. I

24

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

3

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 4 of 209

41

12/6/2007

Deposition Transcript of Radiology Chair Javad Naderi

42

12/6/2007

Deposition Transcript of Cancer Committee Chair Ravi Patel

43

8/15/2008

Deposition Transcript of Former CEO Secretary Arlene Ramos-Aninion

5

44

12/5/2007

Deposition Transcript of Surgeon Edward Taylor

6

45

12/6/2007

Deposition Transcript of Neurosurgeon Charles Wrobel

46

8/21/2008

Deposition Transcript of Psychiatry Chair Tai Yoo

47

8/20/2008

Deposition Transcript of Acting Pathology Chair Philip Dutt

48

9/14/2006

Acting Pathology Chair Philip Dutt Email to Barnes re Plaintiff’s Paycut Amendment

12

49

10/17/05

Plaintiff email to Bryan re Serious Biopsy Errors

13

50

3/2/2006

Exh. 271: Plaintiff email to Bryan re Serious Biopsy Errors

51

4/21/2006

Emails between Plaintiff and Bryan re Serious Biopsy Errors

52

8/7/2008

Deposition Transcript of Pathologist Savita Shertukde

53

3/11/2008

Deposition Transcript of David Jadwin, Vol. IV

19

54

10/21/2003 Confidential Report on Lau Complaint against Jadwin

20

55

1/8/2008

Deposition Transcript of David Jadwin, Vol. I

56

9/9/2008

Deposition Transcript of PMK Acting Pathology Chair Philip Dutt, Vol. II

57

12/4/2007

Deposition Transcript of HR Director Steven O’Connor

58

10/10/2005 Amendment No. 1 to Employment Contract of Acting Pathology Chair Philip Dutt

59

11/1/2005

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25 26

Employment Contract of Pathologist Savita Shertukde

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

4

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

60

6/19/2007 4.

Document 277-4

Filed 12/01/2008

Page 5 of 209

Employment Contract of Pathologist Gian Yakoub

Attached hereto as Exhibits 2-14, 24-25, 27, 29, 33, 35-47, 52-53 and 55-57 are true and

correct certified copies of deposition transcripts which I either personally conducted or attended. 5.

Attached hereto as Exhibits 15-16 are true and correct copies of letters which I authored

and faxed to Karen Barnes, Chief Deputy County Counsel for the County of Kern on the dates indicated. 6.

I have served four sets of written discovery on Defendants which included Document

Request No. 44. asking for “Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from Chair of Kern Medical Center’s Pathology Department to staff pathologist.” To date, Defendants have not produced any of the agendas for any JCC meetings including the meeting at which the JCC voted to approve Plaintiff’s demotion from chair. Defendants have engaged in a level of discovery obstruction that is more excessive than I have ever encountered in my 13 years practicing as an attorney, of which this is but the latest example. 7.

Attached hereto as Exhibits 17 is a true and correct copy of Defendants’ responses

received by me in response to Plaintiff’s Request for Production of Documents, Set One, propounded by me on behalf of Plaintiff.

16 17 18

I declare under penalty of perjury under the laws of the State of California and the United States that the foregoing is true and correct.

19 20 21

Executed on: December 1, 2008

22 23

/s/ Eugene D. Lee

24

EUGENE D. LEE Declarant

25 26 27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

5

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 6 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 34

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

39

Case 1:07-cv-00026-OWW-TAG

Document 277-4

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CONFIDENTIAL: Trfe document was prepared in furtherance of the qualiy management and performance Improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible In a court of taw pursuant to California Evidence Code Section 1157. Further protections are afforded the quaKy management and performance improvement processes under the Health Care Quality Improvement Act of 1988 (P.L. 99660).

May 10,2006 Re: Joseph Mansour, MJ>. Err. Mansour came to talk to me today at 3:30 p.m. and we spoke for about 30 minutes. In retrospect, what he was really asking was why the department of OB-GYN was not being run by a committee of four with him being one and I being the fifth member as tie breaker. Feeling that he has little input into the running of the department, he plans to go to the Board and state that this structure had not been implemented. I told Dr. Mansour that he had mentioned this management structure to me about 3 months or so ago. I tried to validate such a proposed structure, but was unable to verify it with Peter Bryan or others. I told Dr. Mansour that his statement that he would go to the Board with such a complaint surprised me. I told him that it would be considered inappropriate for a member of the medical staff to go to a governing board for a hospital for such a matter, that governing boards set policy and strategic direction for an institution, and that such a matter of management is dealt with at an administrative level. Furthermore, when a medical staff member or employee has a concern, there are mechanisms for dealing with those concerns without having to go to the board. He said that he is a taxpayer. He said that if he has exhausted all other means of addressing his concerns, he should go to the board. I told him that maybe so, but that he has not come to me prior to this, so certainly he had not exhausted all other means. I still have not heard his specific complaint that he would present at such a management committee. Dr. Mansour became apparently angry and raised his voice to me, implying that h is outrageous to suggest that he should not go to the Board with complaints. He wanted me to put in writing that I said that it is inappropriate for a medical staff member to go to the board. I did not respond. If every time a medical staff member had an issue on his or her personal agenda and went to the Board, nothing would ever get accomplished. I asked him if he had complaints of improprieties that needed to be addressed at such a high level? I asked if there were noncompliant issues or issues of ethics? He looked at me strangely and said there were no issues of ethics. I said that if he needed to bring any improprieties to light, that we have a compliance officer who would deal with the issue, and that he would have no need to go to the Board. He said that he did have examples but that they were not of ethical issue. I asked him to please give me an example.

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Dr. Mansour asked me if I was aware that the County was paying the malpractice coverage for doctors to do cases at Memorial and at Mercy? I at first said no, as we have asked doctors to purchase private malpractice coverage for any private practice activity. I told Dr. Mansour, however, we want in the future to encourage doctors to work in the community, build relationships, enhance the image and services of our practice groups,

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and bring a more favorable payer mix to KMC. Then I remembered that we had already begun that transition plan starting with OB-GYN and that the Board had approved and sanctioned the malpractice coverage for those OB-GYN doctors for work in the community. Dr. Mansour implied that was a misuse of taxpayer dollars. I explained that it costs us no more money or no less money regardless of whether the doctor works outside of KMC. I do recognize that if a payout is made, then indeed it would cost the County some money, but we had decided that the potential benefits of such a practice design far outweigh the added risks. Dr. Mansour thought that it was wrong for the doctors to do this (obviously not unethical though, based on his previous discussion). I asked Dr. Mansour why he would not also take advantage of this and work in the community too? He said that he does do work at Memorial. I did not ask him if he felt it was so wrong that he purchases his own private malpractice. I told Dr. Mansour, that regardless of how he feels about it, the Board approved the plan. It was and still is nothing more than a business decision. Dr. Mansour said that h is a business decision that the Board wants to repeal. From the comments that Dr. Mansour was making it was obvious that he had an audience at the Board level. I asked Dr. Mansour if he had any further examples. None were forthcoming. Dr. Mansour did mention that he felt that the department secretary kept few minutes and was of little help to him. He felt that the department secretary was part of the "family affair" goings on in the department, clouded by secrecy and underhanded dealings. Dr. Mansour wanted to know why Dr. Perez's resignation was being kept so quiet. I told Dr. Mansour that with the recruitment and replacement of the Chairmanship of the Department of OB-GYN that his complaints will likely vanish under new leadership. He agreed but said that could take months. He said that when tried in the past, no one could be found that was willing to become the Chair of OB-GYN. We ended the meeting with me reiterating that I will set up a meeting with him to clarify whether the managing structure that Dr. Mansour had assumed was going to put into place was actually what was agreed upon. I thanked him for his input. Respectfully submitted,

Irwin Harris, M.D. Chief Medical Officer

0027084

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CONFIDENTIAL: This document was prepared In furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the Health Care Quality Improvement Act of 1986 (P.L. 99660).

Re. Dr. Joseph Mansour as report by Dr. William Roy September 12,2006 Dr. Roy came to see me today, Tuesday, September 12, 2006 at 12:30 p.m. with Dr. Leonard Perez as witness to complain about abuses by Dr. Mansour. Dr. Mansour accused Dr. Roy of canceling a patient's surgery under the alleged pretense that Dr. Roy had a case at Memorial. In actuality, the patient required a bowel preparation which had not been done prior to the planned operation. Dr. Mansour was said to have been heard stating that Dr. Roy gave renal failure, when in actuality, the patient had had congenital kidney disorder and a stent had been replaced. The comment was made by Dr. Mansour in front of students and residents. It is said that Dr. Mansour often slaps the desk in front of him making for extreme emphasis of such criticisms. Dr. Roy said that if the event had been true, the case would have been in peer review. Rather, the comments made by Dr. Mansour were unprofessional, inappropriate, and of malicious intent.

Dr. Roy feels that he delivers care in prolonged hours and service to KMC and despite the additional effort and service, he is subjected to Dr. Mansour's ridicule and criticism. Unless the environment was to change, Dr. Roy states that he will leave. Respectfully submitted,

Irwm E. Harris, M.D. Chief Medical Officer

Plaintiffs Exhibit 740 Susan R. Wood, CSR # 6829 08/13/08 Irwin Everett Harris, M.D. /

0027094

£X.?4O

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CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Code Section 1157. Further protections are afforded the quality management and performance Improvement processes under the Health Care Quality Improvement Act of 1986 (P.L. 99660).

October 16,2006 Re: Dr. Joseph Mansour Dr. Mansour, in my opinion, was inappropriate at both the OB department meeting and the resident meeting that followed on Monday, October 16, 2006. Leonard Perez agreed. Dr. Mansour consumed a large part of the faculty meeting arguing that having the OB Chair candidates give a lecture on their return visit might alienate them and chase them away. He made an issue of lack of coordination for medical students rotating through OB, despite the fact that last week Hansa Patel volunteered to organize this matter. (Dr. Mansour did have a good suggestion however, that students be assigned clinic, OR, or L&D in alternating fashion rather than assigning them to teams. Rounding teams for the morning could still be assigned.) Dr. Mansour said that there are sufficient nursing issues in L&D that he could do a writeup every 5 minutes. Unfortunately, he made this statement in front of all of the residents. I did do an on the spot counseling of Dr. Mansour, by giving him a note of advice: Do not criticize the nursing staff in front of the residents. Respectfully submitted,

jU—« 7Lu^ Irwin Harris, M.D. Chief Medical Officer

Plaintiffs Exhibit 742 Susan R. Wood, CSR # 6829 08/13/08 Irwin Everett Harris, M.D. / 0027097

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CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the Health Care Quality Improvement Act of 1986 (P.L. 9 9 660).

Re: Phil Dutt, M.D. February 6, 2007

Plaintiffs Exhibit 745 (2 pgs.) Susan R. Wood, CSR # 6829 08/13/08 Irwin Everett Harris, M.D.

Counseling and Considerations Concerning his Role as Acting Chair On February 6, 2007,1 phoned Dr. Dutt after a meeting with Karen Barnes (on the phone), David Culberson, and Steve O'Connor, where Dr. Dutt lost his temper on a couple of occasions while trying to advance a suggestion that recent events could possibly be leveraged for dealing with a problem supervisor and the potential litigation by Dr. Jadwin. Dr. Dutt remarked that he has lost his temper on rare occasion. I mentioned to Dr. Dutt that over the past several months, many have noticed periods when he has manifested signs of stress. I expressed my concerns for his well being and suggested several approaches that he consider: Environmentally, he 1. Needs more staff to do the daily load of cutting in specimens and reading slides through hiring or locums. 2. Be relieved of exclusive burden to oversee the work of Dr. Sherdetuke. 3. Hire the PA to help with cutting in of specimens

Personally, he 1. May need to find means to mitigate stress. 2. Needs a vacation (has not taken one since May) 3. Find a way to compensate Dr. Dutt for Chair duties. 4. Further counseling to decrease the compulsiveness and unbalanced approach with which he is consumed and subsumed with the Dr. Jadwin issues and internal politics within the pathology department and lab. From his perception it is him, Tracy, and one other? Gilbert against all the others. In essence, Dr. Dutt is doing at least three jobs: full time clinical pathologist, overseer and assumption of responsibility for all of the quality of the product being produced, and legal consultant to deal with the previous chair. He cannot do all three jobs and have a manageable life. I did not discuss with him, but I feel that for now, I would keep Dr. Dutt in the acting Chair position and try to pay him for the administrative services that he provides. He appears to not have embraced the broad support of the pathology department and lab and has on previous occasion prompted complaints from other medical staff members within

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his department. For these two reasons, I believe he should remain acting Chair until he can demonstrate those administrative demeanors desired of a Chair under conditions of lower environmental stress. Respectfully submitted,

Irwin Harris, M.D. Chief Medical Officer

0027101

2-

t

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CONFIDENTIAL: This document was prepared In furtherance of the quality management and performance Improvement activities of Kem Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Code Section 1157. Further protections are afforded the quality management and performance Improvement processes under the Health Care Quality Improvement Act of 1966 (P.L. 9 9 660).

March 12,2007 Re: Dr. Joseph Mansour

On Monday late afternoon, Joseph Mansour asked to meet with me as he had some additional information to share with me regarding ACOG recommendations about the role of the obstetrician in neonatal resuscitatioa I told him that I would go upstairs to his office and meet him there. Earlier in the morning, I had presented what is considered the national standard regarding a Neonatal Resuscitation Team and to have the OB department endorse the current policy and use of such a team. Dr. Mansour could hardly keep quiet when I tried to ask the other members of the department for their opinion first. Dr. Mansour then demanded to explain the circumstances that he believed prompted this inquiry. I advised him not to share that information in a common forum as the case is scheduled to be peer reviewed. Upon entering his office, Dr. Mansour asked if Dr. Lopez could join us and I agreed. Dr. Mansour initially showed me the three entries in the ACOG guidelines that referred to the topic of neonatal resuscitation and I listened intently. Things deteriorated from there. Dr. Mansour obviously was out to get my goat and he certainly did. First he began to rant and rave about something. In all honesty, I do not recall what he said. He made me very uncomfortable, as he had raised his voice and was excited. He said that he did this just to make a point. I asked him if he wanted some feedback from me as a listener, and how he made me feel. He nodded yes. I told him that he made me feel uncomfortable, somewhat uneasy, threatened, and that the anxiety I was feeling made me not be able to listen to him very well. He proceeded to ask me how his case got into peer review so quickly. I told him the speed was not important. What I did not tell him was that his actions were perceived to be so egregious to the NRP Team and the medical staff officers, that Dr.'s Ragland and Jose Perez were at one point considering suspension, if for no other reason than for "possible assault" on the respiratory therapist. I told him that when the medical staff officers feel that a case deserves peer review it goes to peer review. Dr. Mansour said that he has not had a chance to give his side of the story. I told him, of course not, that peer review will allow for his side of the story to be told as part of the process. He thought that if he could tell his side of the story the case would not need to be sent to peer review at all. I told him that peer review is done regardless and that many peer reviews find current acceptable practice fulfilled.

Plaintiffs Exhibit 746 (3 pgs.) Susan R. Wood, CSR # 6829 08/13/08 Irwin Everett Harris, M.D. 0027102

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Dr. Mansour proceeded then to ask me what side I was on. I looked at him puzzled as if picking a side was the only position someone could take. I told him that I do not pick sides, but if a line were drawn, I would fall on that side of the line that would have skepticism as to his behavior. He became more agitated with me and said see, you are on the side of those who conspire to get me. He went into a long over-reactive tirade that all along he had been suspicious that I was not on his side and I now admitted that to be true. I told him that I was giving him an honest answer but that I do not pick sides. I told him that I wished that I had not been so honest with him as obviously he has exaggerated my answer and immediately concluded that I am out to get him and in support of Leonard Perez. All I had said was that if a line had to be drawn, I would fall on the opposite side of unquestionable support for him as I remain skeptical of his ability to communicate constructively and to engender the support of others with whom he works. Dr. Mansour went on to say in his office, how proud he was that he had brought down the CEO, that for 10 years the other group has taken advantage of the county, that he was in the right, that he has been awarded the best teacher award for good reason, that I should speak with the residents to learn what a great obstetrician he is, how Leonard and his group are manipulative, that I have been duped into believing the Peter Bryan philosophy, that I confirmed his suspicion that I am against him, and that he plans to contact his attorney because as a CMOI am not neutral. I had grown somewhat annoyed with Dr. Mansour; he refused to shake my outstretched hand, and I went out into the hall disgusted. Sensing that neither of us wanted to part in such unpleasant state, I asked him if he wanted to go back into his office and talk. He said yes. When we returned to his office, he tried to make me commit, in front of Dr. Lopez, that I was against him, on the opposite side of the fence, that I had raised my voice, that I was frustrated with the conversation because of my guilt in not being impartial, and other psychological analysis of me. I asked Dr. Mansour what he had hoped would be a desirable result of our further conversation. He never really answered that question. From this point forward, I was largely quiet, except to point out to Dr. Mansour that it is he who has a problem that only he can solve. He asked me what I meant. I asked him to try to identify for me what that problem might be so that I could see how much insight he has. He said that his problem was Leonard and his group. I said that from my point of view it is a different problem. Dr. Mansour seemed unaware. I explained to him that he has a problem with the institution, his nursing staff, and many of his patients who have complained. He seemed surprised to learn of this. He said it is not true, Ifthereisany such instance, it is precipitated by Leonard and his group. He asked me to produce the evidence. I told him that I had intended to bring some examples up to his office as it is my responsibility to counsel him on such matters. In retrospect, it was fortunate for me that I had not confronted Dr. Mansour with these complaints considering how upset he became with me even without such provocation.

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I reiterated that because of his communication style, he has not contributed to a communicative, helpful, collegial, and effective environment at the hospital. We apparently departed company in peace. He said that our conversation will remain only between us, but within 10 minutes he phoned David Culberson to discuss his concerns. I remain frustrated by his provocative demeanor, his apparent need to be the boss, his apparent need to be in control, his apparent need to feel superior to me as Chief Medical Officer, to intimidate me by his threat of contacting his attorney, and his apparent need to reassure me that he would not use his power to retaliate against me. He further patronized me by stating that he feels sorry for me since I have been swayed by being under the influence of Peter Bryan and was biased by Leonard Perez, and that he recognizes that this negative bias toward him is not my fault. I am left with feelings of having been manipulated, not respected for my position or knowledge as Chief Medical Officer, and that he would only be appeased by my submission. He is insistent that he is right. I felt pressured to offer him my allegiance. I have only gotten my blood pressure up once or twice since I began at KMC and I teach residents and medical staff to never get angry. Frankly, Dr. Mansour twisted the issues and statements in such a convoluted manner to his liking and at such a fast paced pressured manner, that it became truly exasperating. I wonder if consciously or subconsciously, Dr. Mansour classifies each person as with him or against him as a pre-emptive defensive maneuver to neuter those who may potentially criticize him or discipline him in the future, so that all he has to do is claim unfair treatment if he is called on his actions. As a result, he can never be legitimately criticized, because anyone who would criticize him would have to be out to get him. Respectfully submitted,

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Irwin Harris, M.D. Chief Medical Officer

0027104

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CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kem Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the Health Care Quality Improvement Act of 1986 ( P . L 99660).

April 12,2007 Re: J. Mansour, M.D. The purpose of this report is to document discussion with Joseph Mansour, M.D. held with Mr. Culberson at 9:20 am for about 45 minutes on Thursday, morning, April 12, 2007. Two days prior, Mr. Culberson and I decided that we would present the 5 occurrence reports of quality concerns and one patient complaint to Dr. Mansour and allow him to have time to think about his response before we met with him to discuss our expectations for improved working relationships between him, patients, and the nursing staff. We typed an accompanying letter and made copies of the six complaints which we had intended to deliver to Dr. Mansour on Wednesday late afternoon before meeting with him to discuss the matters on Thursday at 5 p.m. The delivery was postponed until Thursday morning, when Mr. Culberson had time to present them to him in person. Dr. Mansour could not wait and insisted on receiving the letter first thing Thursday morning. Dr. Mansour then insisted on meeting with Mr. Culberson immediately thereafter and by so doing demanded immediate audience. I was asked to join in the discussion at about 9:20 am. I made notes of the comments made by Dr. Mansour. He said, "that others are out to get him. Why else would there be a flurry of complaints recently against him? All of the complaints are of malignant intent. No doctor is more caring than he. In 30 years he has never been sued. Roughness in case 1 is only in the eye of the beholder. It was the nurse who refused my order to set up for delivery. The nurse medicated the patient before delivery against my advice. It is not whether I am a compassionate or a noncompassionate doctor, rather is a lazy nurse who does not wish to do her job. In case 2, it was Michelle, the nurse, who stopped pitocin on her own for mild deceleration without my order. Mansour ordered her to restart the pitocin and she refused to follow Mansour orders. If a woman is 9 cm as was case 3, of course she should have VBAC instead of Csection. It is not true in case 4 that I threw instruments. In case 5 the patient had to push for a while, so what is the big deal? The patient never complained to me. Obviously this occurrence report is of malicious intent." I tried to change the tone of the meeting away from a defense of cases, to a more constructive outcome. I asked Dr. Mansour what he could do differently to improve the working relationships as a team and to improve quality of patient care. He stated that he could respond to each allegation more in writing. I reiterated the question, what can you do to help the situation. He replied, "nothing. I do not need to change. My behavior has not changed from before, so why now should I have to change. Why is there a flurry of activity now? I resent the fact that Dr. Harris believes the other side." Mr. Culberson

Plaintiffs Exhibit 747 (2 pgs.) Susan R. Wood, CSR # 6829 08/13/08 Irwin Everett Harris, M.D. 0027105

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stepped up and said that is not true, that both he and Dr. Harris are neutral. Dr. Mansour then said, " let me meet with the nurses and let us clear this up." Dr. Mansour went on to complain about Elaine. He stated, "you need to think about this: why is only Mansour targeted? I have been here for 30 years? Perez is well connected to the nurses. Cindy Delgado and the other nurses are well connected. Sandy Rebeski is on top of all this. There is evil spirit at play. All of this is a remnant of Peter Bryan. It was Mansour who got rid of Peter Bryan. The County has a different opinion about these matters. I will apply for the Chairmanship. I am the only person who can run this department. Now, because of these complaints against me, I will be turned down for the position of chair. My attorney will be able to use this information. Compassionate -1 am. Caring - 1 am. Why are there no complaints from the clinic nurses? It is because Perez is not there manipulating them. All of this is retaliation." I suggested that perhaps Dr. Mansour could present a few ideas of how he can be part of the solution instead of just identifying the problems. He said that he does not feel he has to do this. So, I asked what have we concluded from this meeting? Dr. Mansour said that he concludes that he must now respond in writing and in detail to each of the issues. I told him that I would get him the medical record of the patient complaint and we adjourned. Respectfully submitted,

Invin E. Harris, M.D. Chief Medical Officer

0027106

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CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to CaEfornia Evidence Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the Hearth Care Quality Improvement Act of 1986 (P.L. 99660).

April 12, 2007 Re: J. Mansour, M.D. I was asked by David Culberson, who was unfortunately unable to be in attendance, to investigate from those present in the room with Dr. Mansour regarding the alleged "throwing of instruments" during the Cesarean-Hysterectomy. On Thursday afternoon, April 12, 20071 met with Dr. Fahmy first who explained that the pressures were large, the patient had lost much blood and was continuing to bleed, 9 units of blood had been transiused, Dr. Mansour had tried to clamp to stop the bleeding with the wrong instrument and caused more tissue damage without accomplishing hemostasis, the nurses were unable to find the appropriate instruments, and Dr. Fahmy was surprised that Dr. Mansour was being scrutinized, when in reality it was the nursing staff that should be called to task for not having the appropriate instruments available. When I asked Dr. Fahmy how Dr. Mansour reacted, especially with regard to how he passed the instruments in his frustration, she stated that he put the wrong instrument down on the table forcibly like pounding the table, but did not 'throw' the instrument. I then interviewed Ms. Ramirez, who was the circulator in the room. Her response was that she and the scrub tech were trying as best they could, and that "no one deserved to be treated in such a verbally rude manner and to have the instruments be 'flung' at the scrub tech, no matter how gently or forcibly, as the person can be injured." Although Dr. Mansour did not throw, toss, or propel the instrument with force, he did release the instrument such that it passed through the air a short distance before landing on the instrument table stand. I later interviewed Dr. Kalifa with Mr. Culberson, and although the resident was trying to be helpful, he either did not recall the event or came into the room after the event had occurred. The resident stated that he has seen others toss instruments and I used the opportunity to emphasize to him, to never, ever, toss instruments. They are either to be placed into a tray by the surgeon or handed, non sharp end first and outward, toward the scrub until the scrub takes hold of the instrument from the surgeon's hand. On rare and unusual circumstances, a surgeon may gently place an instrument down, him or herself, on the stand. Respectfully submitted,

Irwin E. Harris, M.D. Chief Medical Officer

Plaintiff s Exhibit 749

Susan R. Wood, CSR # 6829 08/13/08 Irwin Everett Harris, M.D. 0027109

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 35

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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UNITED STATES DISTRICT COURT

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FOR THE EASTERN DISTRICT OF CALIFORNIA

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______________

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F. JADWIN, D.O.,

) VOLUME I ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

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OF

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ANTOINETTE CATHERINE SMITH

17

Tuesday, August 19, 2008

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Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

SmithT1

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MR. LEE:

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1

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2 I'll look into that later.

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3 BY MR. LEE:

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4

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5 this removal of Dr. Jadwin at the removal meeting?

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7 removal.

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9 couple of abstentions.

Q.

A.

Q.

Okay.

That's a good point.

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You know,

And do you recall how you voted on

To my best recollection, I voted for his

And do you recall -- I believe there was a

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09:18:29 10

Do you recall who abstained on the vote?

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09:18:34 11

A.

I believe Dr. Ragland abstained.

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09:18:39 12

Q.

Okay.

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09:18:40 13

A.

But I do not remember anyone else.

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Q.

Do you believe David Hill might have

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09:18:46 15 abstained?

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09:18:49 16

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09:18:55 17 member -- was not.

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09:18:58 18

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09:19:00 19 abstained from the vote?

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09:19:02 20

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09:19:04 21 before or after.

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09:19:11 23 Dr. Jadwin from chair?

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09:19:14 24

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09:19:18 25 because of his absence from the premises.

A.

Q.

A.

Q.

A.

He was the director of ambulatory care.

David Hill didn't -- is not a voting

Any idea why Dr. Ragland might have

I have -- I had no conversation with him

Okay.

And why did you vote to remove

My rationale for removing him from chair was

SmithT1

He had not

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1

09:19:25

1 been present for quite some time, as I recall.

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09:19:28

2 can't tell you the amount of time.

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09:19:32

3 know, those positions are extremely important, and we

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09:19:36

4 need to have a chair who is present to do the work of

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09:19:42

5 the department.

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09:19:42

6

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09:19:46

7 physical absence and physical presence.

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09:19:47

8

A.

Correct.

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09:19:49

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Q.

Okay.

Q.

I

And as you might

When you say absence and presence, you mean Correct?

And were you aware of why Dr. Jadwin

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09:19:52 10 was physically absent from Kern Medical Center for a

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09:19:54 11 large part of 2006?

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09:19:59 12

13

09:20:04 13 that it was -- actually, I have no idea.

14

09:20:12 14

Q.

No idea?

15

09:20:14 15

A.

No idea.

16

09:20:16 16 unavailability.

17

09:20:19 17

18

09:20:21 18

19

09:20:29 19 who brought this -- this agenda item to the JCC of

20

09:20:32 20 Dr. Jadwin's removal?

21

09:20:36 21

22

09:20:38 22 Mr. Bryan.

23

09:20:39 23

24

09:20:40 24

25

09:20:47 25 explanation given as to why physical presence of a

A.

Q.

I have no idea.

It was basically due to his

Due to his unavailability. And -- okay.

A.

Q.

I believe there was mention

Did Dr. -- well, who was --

Do you recall?

To the best of my recollection, it was

Mr. Bryan. And do you recall why -- was there any

SmithT1

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-4

Filed 12/01/2008

Page 23 of 209 82

1

10:50:32

1

2

10:50:36

2 authorities ever reviewed the PCC issue?

3

10:50:40

3

4

10:50:43

4 review our entire blood administration process.

5

10:50:47

5

Q.

Okay.

6

10:50:50

6

A.

Joint commission, CAP, and CMS.

7

10:50:59

7

Q.

I'm sorry.

8

10:51:06

8

A.

Shoot.

9

10:51:08

9

Q.

California Medical Society or --

A.

Do you recall whether any regulatory

We've had multiple regulatory agencies

Can you name those agencies?

What's CMS?

What the heck does it stand for?

10

10:51:10 10

MR. WASSER:

11

10:51:12 11

THE WITNESS:

12

10:51:14 12 government --

13

10:51:15 13

MR. WASSER:

Social Security.

14

10:51:16 14

MS. BARNES:

It's the Centers for Medicare

15

10:51:18 15 and Medicaid Services, formerly HCFA, Healthcare

16

11:23:53 16 Financing Administration.

17

10:51:25 17

THE WITNESS:

18

10:51:25 18

MR. LEE:

19

10:51:26 19 answer.

20

10:51:26 20

21

10:51:28 21 BY MR. LEE:

22

10:51:28 22

23

No.

It's a welfare -It's a federal

Thank you.

Thank you.

THE WITNESS:

Q.

No.

That's a very good

It's the federal government.

Do you recall if Dr. Jadwin -- let me back

23 up.

24

10:51:34 24

Do you recall if the Department of Health

25

10:51:36 25 Services ever looked at the PCC or blood issue --

SmithT1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 24 of 209 83

1

10:51:39

1 blood administration issue?

2

10:51:40

2

3

10:51:42

3

MR. WASSER:

4

10:51:44

4

THE WITNESS:

5

10:51:47

5 BY MR. LEE:

6

10:51:49

6

7

10:51:56

7 you happen to learn what the findings were or the

8

10:51:58

8 reports were of these multiple regulatory agencies

9

10:52:02

9 looking at the blood administration?

A.

Q.

That would be Title 22. DHS. DHS.

I don't recall.

A.

And what do you recall -- were you -- did

10

10:52:05 10

Well, the way -- the way we usually have

11

10:52:07 11 reports from these agencies are if there are -- if

12

10:52:10 12 they review something and there's a deficiency, then

13

10:52:13 13 they write it as a deficiency.

14

10:52:15 14

Q.

Okay.

15

10:52:17 15

A.

And, I mean, I -- our latest survey of

16

10:52:24 16 CMS -- I know for a fact because I remember very

17

10:52:28 17 clearly that we had no deficiencies in nursing,

18

10:52:32 18 period.

19

10:52:35 19 blood.

20

10:52:39 20

Q.

What about -- I'm sorry.

21

10:52:41 21

A.

I was going to say, I don't believe joint

22

10:52:43 22 commission found any.

23

10:52:46 23 reports.

24

10:52:52 24

Q.

The same thing with CAP?

25

10:52:56 25

A.

The same thing with CAP.

So they did not find any fault with the Joint -Go ahead.

I would have to refer to those

SmithT1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 25 of 209 85

1

10:54:03

1 jeopardy --

2

10:54:04

2

Q.

Okay.

3

10:54:04

3

A.

-- which in their mind places the safety of

4

10:54:09

4 patients or staff in immediate harm.

5

10:54:14

5

6

10:54:18

6 agencies determined that there was jeopardy?

7

10:54:21

7

A.

Correct.

8

10:54:25

8

Q.

Nevertheless, a deficiency is never a good

9

10:54:28

9 thing to hear about -- right? -- from a regulatory --

Q.

A.

So, in other words, none of the regulatory

10

10:54:32 10

11

10:54:33 11 patients to have perfect care.

12

10:54:40 12

13

10:54:40 13

14

10:54:47 14 PCCs that were incomplete or incorrectly filled out.

15

10:54:51 15

16

10:54:54 16 audits were picking up the same types of errors in

17

10:54:59 17 the original PCCs?

18

10:55:01 18

19

10:55:05 19 less than 100 percent compliance.

20

10:55:12 20 looking at the same things, I have no idea.

21

10:55:20 21

22

10:55:25 22 of Dr. Jadwin's concerns about incomplete or

23

10:55:27 23 inaccurately -- inaccurately filled original PCCs, to

24

10:55:34 24 your knowledge?

25

10:55:34 25

Q.

Oh, we want to be perfect and we want our That's a goal.

Right. Now, Dr. Jadwin was finding some original

Were you aware of whether Ms. Hevle in her

A.

Q.

A.

Well, Ms. Hevle's audits certainly reflected

Okay.

Whether they were

But there was some corroboration then

Well, I wouldn't call it corroboration

SmithT1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 26 of 209 87

1

10:56:33

1 you familiar with statistical sampling error?

2

10:56:35

2

A.

Yes.

3

10:56:36

3

Q.

The size of the sample will determine the

4

10:56:38

4 accuracy or trustworthiness of the average you

5

10:56:42

5 derive?

6

10:56:43

6

7

10:56:45

7 applies here.

8

10:56:46

8

9

10:56:48

9 other?

A.

Q.

A.

I'm familiar with that.

Okay.

I'm not sure it

But you don't know one way or the

10

10:56:48 10

11

10:56:50 11 that Ms. Hevle's samples were statistically -- that

12

10:56:57 12 she abided by joint commission regulations on how

13

10:57:00 13 many samples.

14

10:57:02 14

15

10:57:05 15 to yield a pretty accurate finding?

16

10:57:09 16

A.

We believe so.

17

10:57:10 17

Q.

Okay.

18

10:57:17 18 let's say you find one percent or two percent

19

10:57:21 19 incomplete or inaccurate PCCs being filled out.

20

10:57:25 20 That's still a problem regardless, isn't it?

21

10:57:27 21 wouldn't want to sit there and say oh, that's fine.

22

10:57:29 22 There's no problem here.

23

10:57:29 23

24

10:57:36 24

25

10:57:37 25 the record just briefly for a rest room break?

Q.

A.

I don't know one way or the other.

I know

So probably her sample size was large enough

Okay.

But regardless, finding --

You

I would never say that was okay. MR. LEE:

Okay.

Would you mind going off

SmithT1

Case 1:07-cv-00026-OWW-TAG 1

Document 277-4

Filed 12/01/2008

101 Page 27 of 209

STATE OF CALIFORNIA ss.

2

COUNTY OF KERN

3 4 5

I,

Susan R. Wood,

a Certified Shorthand

6

Reporter in the State of California, holding

7

Certificate No.

8

ANTOINETTE CATHERINE SMITH, the witness named in the

9

foregoing deposition, was by me duly sworn; that said

10

deposition was taken Tuesday, August 19, 2008, at the

11

time and place set forth on the first page hereof.

12

6829,

do hereby certify that

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotypy and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I

further certify that I

am neither counsel for

18

nor in any way related to any party to said action, nor

19

in any way interested in the result or outcome thereof.

20 21

Dated this 2nd day of September,

24

at

Bakersfield, California.

22 23

2008,

S us a n

~-N-O-'--=6-=8-=2'--9=-----

25

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 28 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 36

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

41

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) VOLUME I ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

MAUREEN FRANCES MARTIN, M.D.

17

Monday, August 18, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

MartinM1

Page 29 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 30 of 209 34

1

09:40:23

1 lot of his presence was either fabricated or not --

2

09:40:33

2 I mean, what he presented himself as and what he, in

3

09:40:36

3 fact, was were very different.

4

09:40:40

4 big disappointment to me over time to realize that,

5

09:40:46

5 you know, aside from the inappropriateness that there

6

09:40:50

6 wasn't a lot of substance and value to his role as

7

09:40:55

7 a pathologist.

8

09:41:02

8

9

09:41:04

9 the street, how would you greet him?

Q.

And it was quite a

Would you -- if you saw Dr. Jadwin today on

10

09:41:06 10

A.

I would say hello.

11

09:41:07 11

Q.

Okay.

12

09:41:09 12

A.

I would.

13

09:41:10 13

Q.

Okay.

14

09:41:14 14 feelings of resentment or anger or disappointment

15

09:41:17 15 with Dr. Jadwin?

16

09:41:18 16

17

09:41:20 17 disappointment.

18

09:41:21 18

19

09:41:24 19

20

09:41:26 20 turn the other way and just pretend like you didn't

21

09:41:29 21 see him?

22

09:41:30 22

A.

No.

23

09:41:30 23

Q.

You wouldn't do that.

24

09:41:31 24

25

09:41:34 25

A.

Q.

Would you be friendly with him?

So do you have any kind of lingering

If any, of all those words I would say

Um-hmm.

Um-hmm.

But if you did see Dr. Jadwin, would you

Do you like Dr. Jadwin? A.

I do.

MartinM1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 31 of 209 35

1

09:41:35

1

Q.

Okay.

Even today you like Dr. Jadwin?

2

09:41:37

2

A.

I do.

3

09:41:38

3

Q.

Okay.

4

09:41:44

4 just speculative, but I'm going to ask it.

5

09:41:47

5 Dr. Jadwin called you up and said, hey, can we meet

6

09:41:49

6 for a meal, I'm in Bakersfield, would you do it?

7

09:41:51

7

A.

Probably not.

8

09:41:52

8

Q.

And why is that?

9

09:41:52

9

A.

I really don't feel that I have a lot in

If Dr. Jadwin wanted to -- you know, If

10

09:41:58 10 common with him.

11

09:42:04 11 the department of surgery in a difficult situation

12

09:42:09 12 vis-a-vis pathology.

13

09:42:13 13 very important to me, and I would not go out of my

14

09:42:18 14 way to spend additional time with David Jadwin.

15

09:42:21 15

16

09:42:32 16 clarify a few statements.

17

09:42:34 17

18

09:42:35 18 left the department of surgery in a difficult

19

09:42:38 19 position vis-a-vis pathology.

20

09:42:40 20

21

09:42:41 21

22

09:42:43 22 department -- the department was without a leader for

23

09:42:46 23 a long time.

24

09:42:47 24

Q.

You are talking about pathology.

25

09:42:49 25

A.

Yes.

Q.

Okay.

I think his presence at KMC left

Okay.

So, quite frankly, my time is

Besides -- first of all, let's

Now, you said the department -- Dr. Jadwin

What does that mean? A.

Well, he was absent for a long time.

MartinM1

The

Right?

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-4

Filed 12/01/2008

Page 32 of 209 91

1

12:08:11

1

2

12:08:16

2 was a professional interaction regarding a pathology

3

12:08:20

3 report --

4

12:08:20

4

Q.

I see.

5

12:08:21

5

A.

-- that I would ask to either be reviewed,

6

12:08:24

6 sent out, or revisited.

7

12:08:29

7

8

12:08:31

8

9

12:08:33

9 respect to sending pathology reports out at your

Q.

In that setting it was not counseling; it

Oh, I see. So Dr. Jadwin's conduct did improve with

10

12:08:36 10 request?

11

12:08:36 11

12

12:08:39 12 appropriate interaction with him regarding the case

13

12:08:41 13 at hand.

14

12:08:42 14

15

12:08:42 15

16

12:08:45 16 did he show any kind of improvement, other than that,

17

12:08:47 17 in your interactions with him?

18

12:08:52 18

19

12:08:54 19 with him.

20

12:08:54 20

21

12:08:54 21

22

12:09:02 22 the need -- because Dr. Jadwin was responding to your

23

12:09:05 23 meetings with him, you didn't feel the need to report

24

12:09:07 24 him to administration as a patient care issue?

25

12:09:11 25

A.

Q.

Well, at my request.

I usually had a very

I see. Did Dr. Jadwin's conduct or interactions --

A.

Q.

Quite frankly, I never had a bad interaction

I see. Okay.

A.

So these -- so you didn't feel ever

That's correct.

MartinM1

Case 1:07-cv-00026-OWW-TAG 1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Document 277-4

Page 102 33 of 209

Filed 12/01/2008

ss. 3 4

5

I,

Susan R. Wood,

a Certified Shorthand

6

Reporter in the State of California,

7

Certificate No.

8

MAUREEN FRANCES MARTIN, M.D.,

9

foregoing deposition, was by me duly sworn; that said

6829,

holding

do hereby certify that the witness named in the

10

deposition was taken Monday, August 18,

11

time and place set forth on the first page hereof.

12

2008,

at the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotypy and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I

further certify that I am neither counsel for

18

nor in any way related to any party to said action, nor

19

in any way interested in the result or outcome thereof.

20 21

Dated this 2nd day of September,

24

at

Bakersfield, California.

22 23

2008,

Su s

a~g-R-N-O-.--=-6-=-8-=-2-=9----

25

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 34 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 37

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

42

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

EVANGELINE F. GALLEGOS

17

Wednesday, April 16, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

GallegosE

Page 35 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 36 of 209 23

1

13:30:34

1

A.

Or manage their time more effectively.

2

13:30:38

2

Q.

Okay.

3

13:30:41

3 directed at you somehow?

4

13:30:45

4

5

13:30:47

5 to me.

6

13:30:49

6

Q.

It was everybody?

7

13:30:50

7

A.

Yeah.

8

13:30:56

8

Q.

Okay.

9

13:30:59

9 add to this issue about him putting more work on your

A.

No.

And you felt that comment was

I think he -- it wasn't just directed

It was everybody.

Is there anything else you want to

10

13:31:03 10 shoulders when you were already busy?

11

13:31:06 11

A.

No.

12

13:31:07 12

Q.

That's it.

13

13:31:08 13

14

13:31:10 14 personality or his style of management.

15

13:31:14 15 him to be -- did you find Dr. Jadwin to be arrogant?

16

13:31:19 16

A.

Yes.

17

13:31:20 17

Q.

Okay.

18

13:31:23 18 detail?

How was he arrogant?

19

13:31:30 19

He's approachable, but I guess maybe -- I

20

13:31:39 20 don't mean to be judgmental, but sometimes he would

21

13:31:43 21 say things that were kind of arrogant.

22

13:31:46 22 recall.

23

13:31:55 23 very kind and generous man, but in the workplace he's

24

13:31:58 24 just different.

25

13:32:01 25 work with people.

That's it.

Okay.

A.

Well, let's talk about his Did you find

Can you describe that in any more

I can't

But, I mean, he's -- outside of work he's a

You know, it's different when you

GallegosE

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 37 of 209 24

1

13:32:05

1

Q.

Perhaps a little demanding, then?

2

13:32:07

2

A.

Yes.

3

13:32:11

3 wants them his way.

4

13:32:16

4

5

13:32:19

5 then, Dr. Jadwin was arrogant?

6

13:32:25

6

A.

Yes.

7

13:32:26

7

Q.

Okay.

8

13:32:33

8 opinion?

9

13:32:34

9

A.

What do you mean by disagreeable?

10

13:32:37 10

Q.

That's a good question.

11

13:32:47 11 your attorney, but that's a little hard.

12

13:32:49 12 know.

13

13:32:55 13 give you my understanding of the dictionary meaning

14

13:32:59 14 of that word, but perhaps unpleasant.

15

13:33:02 15

16

13:33:05 16 in the sense of being unpleasant?

17

13:33:10 17

A.

No.

18

13:33:16 18

Q.

Okay.

19

13:33:17 19 uncooperative?

20

13:33:29 20

21

13:33:34 21 issues, if something was told had to be done this

22

13:33:40 22 way.

23

13:33:43 23

24

13:33:45 24 maybe not easy to work with.

25

13:33:49 25

Q.

Okay.

He wants certain things done and he

So in that sense he was arrogant,

I feel, yes. Was Dr. Jadwin disagreeable, in your

I'll take a stab at it.

I wish we could ask I don't

I'm going to try to

Disagreeable -- was Dr. Jadwin disagreeable

A.

He's pleasant. Did you find Dr. Jadwin to be

Uncooperative as far as with staff or with

Is that what you mean? Q.

A.

I guess uncooperative in the sense that

Yeah.

He -- it was not easy working with

GallegosE

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 38 of 209 25

1

13:33:55

1 him.

2

13:33:57

2

Q.

All the time or --

3

13:33:58

3

A.

Not all the time, no.

4

13:34:01

4 moments.

5

13:34:04

5

6

13:34:07

6 easy to work with?

7

13:34:09

7

A.

Moments of not being easy to work with.

8

13:34:13

8

Q.

I see.

9

13:34:13

9

Q.

He would have his

We all have our moments. Moments of being easy to work with or not

So in other words, it wasn't all the time

10

13:34:15 10 that he was uncooperative, but there were times when

11

13:34:18 11 he was uncooperative?

12

13:34:20 12

13

13:34:21 13 uncooperative.

14

13:34:22 14

15

13:34:24 15 intimidating?

16

13:34:31 16

A.

No.

17

13:34:33 17

Q.

Okay.

18

13:34:35 18 six three or six four.

19

13:34:37 19

20

13:34:38 20

A.

Five two.

21

13:34:39 21

Q.

Five two.

22

13:34:42 22

23

13:34:45 23 aggressive or intimidating?

24

13:34:47 24

A.

No.

25

13:34:49 25

Q.

Okay.

A.

Q.

Yes.

Okay.

There were times when he was

Did you find Dr. Jadwin to be

Well, he's a tall man.

He's about

How tall are you?

So a lot smaller than he is.

Did you ever feel he was physically

Did you find Dr. Jadwin to be

GallegosE

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 39 of 209 26

1

13:34:53

1 overbearing?

2

13:35:02

2

A.

Sometimes.

3

13:35:03

3

Q.

Sometimes.

4

13:35:04

4

There's only a couple more.

5

13:35:07

5

Did you find Dr. Jadwin to be

6

13:35:09

6 self-righteous?

7

13:35:16

7

A.

Yes.

8

13:35:18

8

Q.

Can you go into that or is it -- I mean, you

9

13:35:20

9 don't have to repeat the examples, if that's what

10

13:35:22 10 you're going to refer to.

How was he self-righteous?

11

13:35:26 11 What instances come to mind?

12

13:35:28 12

A.

He always thought he was right.

13

13:35:30 13

Q.

Okay.

14

13:35:31 14

A.

If that's the definition of self-righteous,

15

13:35:34 15 yes.

16

13:35:39 16 thought.

17

13:35:41 17

18

13:35:43 18 to other viewpoints?

19

13:35:46 19

A.

No.

20

13:35:48 20

Q.

Okay.

21

13:35:49 21 only in reference to you or is that something you

22

13:35:52 22 felt he was doing with everybody?

23

13:35:55 23

24

13:35:57 24 It's just my point of view.

25

13:35:59 25

Everything he said was right.

Q.

A.

Q.

Or so he

So you found Dr. Jadwin wasn't exactly open

And when you say that, do you mean

I don't know how he does with everybody.

Your personal interactions.

GallegosE

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Filed 12/01/2008

Page 40 of 209 27

1

13:36:01

1

2

13:36:03

2 to be unfriendly?

3

13:36:05

3

A.

No.

4

13:36:06

4

Q.

Okay.

5

13:36:11

5 you mean he was -- so he could be pleasant, then?

6

13:36:14

6

A.

He could be pleasant.

7

13:36:15

7

Q.

Okay.

8

13:36:18

8 pretty generous and kind person?

9

13:36:20

9

A.

Yes.

10

13:36:20 10

Q.

Why do you say that?

11

13:36:24 11

A.

Because we -- we as the lab or the

12

13:36:30 12 department, he's had barbecues or little outings that

13

13:36:34 13 we would go to his home.

14

13:36:37 14

15

13:36:41 15 easygoing and sociable at these outings?

16

13:36:45 16

A.

Totally different from work.

17

13:36:48 17

Q.

Okay.

18

13:36:54 18 you?

19

13:36:54 19

A.

Not necessarily me.

20

13:36:56 20

Q.

Okay.

21

13:36:57 21

A.

I just really felt kind of odd because since

22

13:37:05 22 I work with him and then how he is at work and then

23

13:37:10 23 how he is outside of work, he's just different.

24

13:37:14 24

Q.

Um-hmm.

25

13:37:15 25

A.

I'm the same at work and outside of work.

Q.

And last one, did you find Dr. Jadwin

So when you say he's not unfriendly,

Okay.

And you said outside of work he was a

Based on what?

And then you thought he was very

So more relaxed, cracking jokes with

GallegosE

I

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Page 41 of 209 28

1

13:37:21

1 don't know how else to phrase that.

2

13:37:23

2

3

13:37:25

3

4

13:37:32

4 got along generally -- generally, did you feel like

5

13:37:33

5 you got along well with Dr. Jadwin?

6

13:37:37

6

A.

I could get along with anybody.

7

13:37:45

7

Q.

Okay.

8

13:37:48

8 you got along with Dr. Jadwin?

9

13:37:52

9

A.

Yes.

10

13:37:54 10

Q.

Okay.

11

13:37:57 11 angry?

12

13:37:58 12

A.

Yes.

13

13:37:59 13

Q.

Okay.

14

13:38:02 14 many instances did you see him get angry on?

15

13:38:08 15

A.

Twice.

16

13:38:09 16

Q.

Twice.

17

13:38:11 17 instance.

18

13:38:12 18

19

13:38:15 19 how he got angry in the first instance.

20

13:38:20 20

A.

Give me a minute because I have to think.

21

13:38:22 21

Q.

Sure.

22

13:38:23 22

A.

It was way far back.

23

13:38:30 23

Q.

Take your time.

24

13:38:46 24

A.

When you mean angry, what -- you mean angry

25

13:39:02 25 such as shouting or me perceiving him to be angry or

Q.

No.

It's very clear.

Okay.

So now, do you think that you

So the answer is yes, you felt like

Have you ever seen Dr. Jadwin get

Can you tell me about -- well, how

Okay.

Let's focus on the first

Can you tell -- please go into detail about

GallegosE

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98 Page 42 of 209

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R

STATE OF CALIFORNIA

D

ss. 2

I N

COUNTY OF KERN

D E

3

X

4

5

I,

Susan R.

Wood,

a Certified Shorthand

6

Reporter in the State of California,

7

Certificate No.

8

EVANGELINE F. GALLEGOS,

9

foregoing deposition, was by me duly sworn; that said

o

deposition was taken Wednesday, April 16,

1

time and place set forth on the first page hereof.

2

6829,

holding

do hereby certify that the witness named in the

2008,

at the

That upon the taking of the deposition,

the

3

words of the witness were written down by me in

4

stenotypy and thereafter transcribed by computer under

5

my supervision;

6

transcript of the testimony given by the witness.

7

that the foregoing is a true and correct

I further certify that I am neither counsel for

8

nor in any way related to any party to said action,

9

in any way interested in the result or outcome thereof.

o 1

Dated this 19th day of May,

2008,

at

Bakersfield, California.

2 3

Susan R.

Wood,

4

5

WOOD & RANDALL (800) 322-4595

CSR No.

6829

nor

Case 1:07-cv-00026-OWW-TAG

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 38

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

43

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1

UNITED STATES DISTRICT COURT

2

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

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3

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8

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9

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12

13

13

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14

MARVIN OTTO KOLB, M.D.

15

15

Saturday, April 19, 2008

16

16

Los Angeles, California

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20

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21

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24

25

25

DAVID F. JADWIN, D.O.,

) ) ) ) ) ) ) ) ) )

Plaintiff, vs. COUNTY OF KERN; et al. Defendants.

Case No. 1:07-cv-00026-OWW-TAG

VIDEOTAPED DEPOSITION OF

Reported by:

Lynda L. Fenn, CSR No. 12566

KolbM

Page 44 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

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MR. PEAKE:

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MR. LEE:

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THE WITNESS:

5

Page 45 of 209 17

professional? That's probably compound. You can answer, Dr. Kolb. As I would know people who were

5

working there in a similar capacity, I would say

6

6

relatively well, yes.

7

7

BY MR. LEE:

8

8

Q

9

9

Dr. Jadwin?

10

10:23

Filed 12/01/2008

10

A

11

11

everybody.

12

12

Q

13

13

14

14

A

I would say yes.

15

Q

Did you like Dr. Jadwin?

16

16

A

I liked everybody.

17

17

Q

Okay.

18

18

19

19

15

20

10:23

Would you say you were friendly with

10:23

10:24

20

I would like to think I was friendly with

Uh-huh.

So the answer is yes, you were

friendly with Dr. Jadwin?

And you didn't find Dr. Jadwin to be

arrogant to you? A

Oh, you're back to that question again.

21

MR. PEAKE:

22

22

THE WITNESS:

23

23

MR. PEAKE:

24

24

MR. LEE:

25

THE WITNESS:

10:24

I

don't know what you are asking.

21

25

I liked Dr. Jadwin.

Yeah, it really is vague. Huh? It really is vague. You can answer, Dr. Kolb.

KolbM

Describe for me an arrogant

Case 1:07-cv-00026-OWW-TAG

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Page 46 of 209 19

1

1

terms not -- you know, not being arrogant, just let me

2

2

know.

3

3

So, conceited, yes or no?

4

4

MR. WASSER:

5

10:26

5

These are supposed to be

characteristics of arrogance?

6

6

MR. LEE:

7

7

MR. PEAKE:

8

8

MR. LEE:

9

9

THE WITNESS:

10

Aspects of arrogance, actually. Fine. So then, are you asking me if I

10

agree with that word as arrogance or if I agree that

11

11

that characterizes David -- Dr. Jadwin?

12

12

MR. LEE:

13

13

THE WITNESS:

14

14

want to make sure.

15

MR. LEE:

15

10:26

Yeah, or synonyms of arrogance.

10:26

That's a good point. Well, what are you asking?

I

Sorry, Madam Reporter.

16

16

BY MR. LEE:

17

17

Q

18

18

19

19

conceited?

20

A

No.

21

21

Q

Would you characterize Dr. Jadwin as pompous?

22

22

A

From my perspective?

23

23

Q

Yes.

24

24

A

No.

25

Q

Would you characterize Dr. Jadwin as being

20

25

10:26

10:26

That's a very good point. Would you characterize Dr. Jadwin as

KolbM

Case 1:07-cv-00026-OWW-TAG

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Filed 12/01/2008

Page 47 of 209 20

patronizing? MR. PEAKE:

You are talking about his

interactions? MR. LEE:

Based on your interactions.

All of

5

these questions are based on your interactions with

6

6

Dr. Jadwin.

7

7

THE WITNESS:

8

8

MR. LEE:

9

9

10

10:26

Document 277-4

Yeah.

BY MR. LEE:

10

Q

Or in general?

11

11

A

Well, my only interaction -- you know, I

12

12

13

13

14

14

15

10:26

That he was patronizing of me?

I can answer my interaction with him if I thought he was patronizing of me.

15

Q

Uh-huh.

16

16

A

No.

17

17

Q

Okay.

18

18

19

19

MR. WASSER:

20

MR. LEE:

21

21

THE WITNESS:

22

22

MR. LEE:

23

23

BY MR. LEE:

24

24

Q

20

25

10:27

wasn't around him all the time, so I can't answer that.

10:27

10:27

25

Would you characterize Dr. Jadwin as

viewing himself as being better than you? Better than Dr. Kolb?

Yes, I said "you." I didn't feel that.

Okay.

So, after hearing all this, would you agree

Dr. Jadwin was not arrogant to you?

KolbM

Case 1:07-cv-00026-OWW-TAG

1

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10:27

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A

Document 277-4

Filed 12/01/2008

Page 48 of 209 21

If you are describing what you just referenced

as words that would describe arrogance. Q

Uh-huh. MR. PEAKE:

And the question really is vague,

but go ahead.

6

6

7

7

the question as no in my interaction with David -- Dr.

8

8

Jadwin on those issues.

9

9

10

10

BY MR. LEE:

11

11

Q

12

12

13

13

14

14

15

10:27

THE WITNESS:

MR. LEE:

So then I would say I answered

Okay.

So the question is:

Would you agree that

Dr. Jadwin is not arrogant or arrogant? MR. PEAKE:

Well, that's overbroad again and

vague.

15

THE WITNESS:

I'll go back to the -- the

16

16

questions that you asked before about the definition of

17

17

arrogance, did I see those characterizes in my

18

18

relationship with David, and I said no to them.

19

19

20

Okay.

Dr. Kolb, it's really a

20

simple question.

21

21

BY MR. LEE:

22

22

Q

23

23

24

24

The witness is not prepared to answer the question yes

25

or no.

25

10:28

MR. LEE:

10:28

Yes or no will do.

Do you think Dr. Jadwin was arrogant to you? MR. PEAKE:

That's actually argumentative.

The witness can answer the question any way they

KolbM

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

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2

2

3

3

BY MR. LEE:

4

4

Q

5

10:28

5

MR. LEE:

Okay.

Okay.

Mr. Peake, thank you.

Did you believe that Dr. Jadwin was

arrogant to you?

6

7

7

8

8

MR. LEE:

9

9

THE WITNESS:

MR. PEAKE:

Well, that's, again,

argumentative. You can answer, Dr. Kolb. I do not feel that in my

10

interaction with Dr. Jadwin in our professional roles

11

11

that the characteristics that you just asked me about

12

12

referencing those describing arrogance, did I see those

13

13

in Dr. Jadwin.

14

14

15

15

that.

16

16

is -- I'm not asking about the characteristics that we

17

17

just discussed.

18

18

BY MR. LEE:

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19

Q

20

10:28

Page 49 of 209 22

feel to reflect their state of mind.

6

10

Filed 12/01/2008

10:29

20

MR. LEE:

Dr. Kolb, we already established

The question again, and I just want an answer,

I'm asking whether you think Dr. Jadwin was

arrogant to you?

21

21

MR. PEAKE:

22

22

MR. LEE:

23

23

MR. WASSER:

24

24

25

10:29

25

It's vague. Okay.

It's ambiguous.

You can answer, Dr. Kolb.

This is going to take until 6:00

at this point. THE WITNESS:

KolbM

I don't believe so.

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

1

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BY MR. LEE:

3

3

Q

4

4

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10:29

MR. LEE:

Filed 12/01/2008

Page 50 of 209 23

Thank you.

Did you have any interactions with Bill Taylor

or otherwise known as Edward Taylor, T-a-y-l-o-r?

5

A

He was a member of the medical staff, so I

6

6

7

7

8

8

Dr. Taylor, say, on a weekly basis, during your tenure

9

9

at Kern Medical Center?

10

10:29

would have interactions with him, correct. Q

10

A

How often did you have interactions with

I couldn't say that.

Sometimes it was weekly;

11

11

sometimes it would go weeks without interactions with

12

12

him.

13

13

Q

14

14

Dr. Taylor?

15

A

I would define it that way.

16

16

Q

Okay.

17

17

18

18

A

We had a very professional relationship.

19

19

Q

Okay.

20

Dr. Taylor?

21

21

A

Personally?

22

22

Q

Uh-huh.

23

23

A

No.

24

24

Q

How about professional?

25

A

There's a difference between liking a person

15

20

25

10:30

10:30

10:30

So you had sporadic interactions with

And how did you get along with

Dr. Taylor, in your opinion?

Did you ever have reason to dislike

KolbM

Case 1:07-cv-00026-OWW-TAG

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Page 51 of 209 36

1

1

Q

Of pathology?

2

2

A

-- the pathology department, all of the chairs

3

3

4

4

5

10:55

5

reported to me, correct. Q

Did you meet with Dr. Jadwin one-on-one as a

chair pathologist?

6

6

A

Correct.

7

7

Q

Would you say it was on a bi-weekly basis or

8

8

9

9

10

10:56

10

how frequently were these one-on-one meetings? A

I know there was some periodicity to it, but I

don't remember exactly what it was.

11

11

12

12

department chairs at Kern Medical Center while you were

13

13

the CMO or chief medical officer?

14

14

15

A

How often, in general, did you meet with

My recollection is that I tried to meet with

15

each one of them at least monthly, if not -- and it

16

16

depended on kind of their scope of activities.

17

17

18

18

frequently than other department chairs at Kern Medical

19

19

Center?

20

10:56

Q

Did you meet with Dr. Jadwin more or less

20

A

I don't think there was any difference.

21

21

Q

Did the department of pathology run well under

22

22

23

23

MR. PEAKE:

24

24

MR. LEE:

25

THE WITNESS:

25

10:56

Q

10:57

Dr. Jadwin's chairmanship, in your opinion? May be vague.

Overbroad.

You can answer.

KolbM

By "well," do you mean that it

Case 1:07-cv-00026-OWW-TAG

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Filed 12/01/2008

Page 52 of 209 37

1

1

met the expectations that we, as the medical staff,

2

2

needed?

3

3

BY MR. LEE:

4

4

Q

5

10:57

5

Yes.

Did you note any problems with the department

of pathology operating under Dr. Jadwin?

6

6

MR. PEAKE:

7

7

MR. LEE:

8

8

THE WITNESS:

9

9

10

Okay.

Overbroad.

You can answer.

I guess I'd have to ask you what

you mean by "problems."

10

Just the normal operations, there are

11

11

problems, you know, that you have to deal with.

12

12

I think it was a large department and there's a large

13

13

clinical laboratory that's part of it.

14

14

15

10:57

Again, it's vague.

10:57

15

And so

So there's problems that exist as part of the normal operation and implementation of that.

16

16

17

17

that were part of the laboratory to make things run

18

18

fairly effective and the laboratory services at Kern

19

19

Medical Center?

20

10:58

So, did I think that he worked with his people

20

MR. LEE:

21

21

BY MR. LEE:

22

22

Q

23

23

24

24

25

10:58

25

Yes. Okay.

Let's get into the circumstances of the hiring

of Dr. Jadwin. Why was Dr. Jadwin recruited to the chair of the department of pathology at Kern Medical Center?

KolbM

Case 1:07-cv-00026-OWW-TAG

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Page 53 of 209 62

1

1

2

2

A

I don't know.

3

3

Q

Would you agree that Dr. Jadwin made quality

4

4

changes and improvements to the pathology department at

5

Kern Medical Center?

6

6

MR. PEAKE:

7

7

THE WITNESS:

8

8

again?

9

9

BY MR. LEE:

5

10

11:21

11:21

10

County would have destroyed those notes?

Q

Compound.

Vague.

Would you repeat the question

Would you agree that Dr. Jadwin made quality

11

11

improvements in the department of pathology at Kern

12

12

Medical Center?

13

13

MR. PEAKE:

14

14

THE WITNESS:

15

As a general statement, I would

15

say yes.

16

16

BY MR. LEE:

17

17

Q

18

18

19

19

A

I would say yes.

20

Q

Did you ever oppose any of those changes that

20

11:21

Again, vague and ambiguous.

11:22

Were you supportive of those quality changes

that Dr. Jadwin instituted in the pathology department?

21

21

Dr. Jadwin was making in the pathology department to

22

22

improve quality?

23

23

24

24

25

11:22

25

MR. PEAKE:

I think it's vague.

ambiguous. THE WITNESS:

KolbM

I can't remember.

May be

Case 1:07-cv-00026-OWW-TAG

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Page 54 of 209 75

1

1

Mr. Wasser.

2

2

BY MR. LEE:

3

3

Q

4

4

MR. PEAKE:

5

THE WITNESS:

6

6

MR. LEE:

7

7

THE WITNESS:

8

8

There's a piece -- I just can't be a hundred percent

9

9

sure, no.

5

10

11:33

Okay.

Dr. Kolb, can you answer the question? Your personal knowledge. I can't remember that for sure.

So you think -I'm afraid to answer it yes.

So my answer is I don't remember.

10

BY MR. LEE:

11

11

Q

12

12

to anger management therapy during your tenure as CMO at

13

13

Kern Medical Center?

14

14

A

I did.

15

Q

How many physicians did you send to anger

15

11:34

You don't have to go on the record.

11:34

Do you recall ever sending any core physicians

16

16

17

17

A

Less than five.

18

18

Q

Did you ever send Dr. Jadwin to anger

19

19

management therapy during your tenure as CMO at Kern

20

20

Medical Center?

21

21

22

22

allowing him to answer that question, since you are

23

23

posing it as Dr. Jadwin's counsel.

24

24

25

11:34

25

management during your tenure as CMO?

MR. PEAKE:

MR. LEE:

Well, I'm assuming that you are

Your objection -- just answer the

question, Dr. Kolb.

KolbM

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privilege is being waived with respect to any actions

3

3

that involve Dr. Jadwin.

4

4

MR. LEE:

5

MR. PEAKE:

5

11:34

6

6

7

7

8

8

9

9

10

Well, I just want to make sure any

Mr. Peake -Because I don't know the scope of

the issues. MR. LEE:

Mr. Peake, you are not objecting and

you are not instructing him not to answer yet again. Dr. Kolb, you can answer.

10

THE WITNESS:

11

11

MR. LEE:

12

12

BY MR. LEE:

13

13

Q

14

14

other whether you sent Dr. Jadwin to anger management

15

therapy during your tenure --

15

11:35

MR. PEAKE:

Filed 12/01/2008

11:35

I don't remember.

Okay.

So you don't know for sure one way or the

16

16

A

That's correct.

17

17

Q

-- as CMO?

18

18

A

That's correct.

19

19

Q

Do you ever recall an incident where a

20

20

physician became angry and drove through the parking

21

21

gate at Kern Medical Center -- the parking gate blocker,

22

22

I suppose you call it?

23

23

A

No.

24

24

Q

Do you recall an incident or a situation where

25

11:35

11:35

25

Dr. James -- well, first of all, let's back up.

KolbM

KOLB, M.D. Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

04-19-08 Page 56 of 209 Page 134

C E R T I F I CAT E

I,

the undersigned, a Certified Shorthand

Reporter for the State of California, do hereby certify: That the foregoing proceedings were taken before me at the time and place herein set forth; that any witnesses in the foregoing proceedings, prior to testifying, were placed under oath; that a verbatim record of the proceedings was made by me using machine shorthand, which was thereafter transcribed under my direction; further,

that the foregoing is an accurate

transcription thereof. I further certify that I am neither financially interested in the action nor a relative or employee of any attorney of any of the parties. IN WITNESS THEREOF, I have this date subscribed my name this 1st day of May, 2008.

Lynda L. Fenn, CSR No. 12566

vs.

COUNTY OF KERN (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 57 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 39

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

44

Case 1:07-cv-00026-OWW-TAG

1

09:49:49

1

2

09:35:04

2

3

09:35:04

3

4

4

Document 277-4

Filed 12/01/2008

Page 58 of 209 1

UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF CALIFORNIA --------DAVID F. JADWIN, D.O.,

) No. 1:07-cv-00026-OWW-TAG )

5

5

Plaintiff,

) )

6

6

vs.

) )

7

7

COUNTY OF KERN, et al.

) )

8

8

Defendants.

)

___________________________) 9

09:35:04

9

10

09:35:04 10

11

09:35:04 11

12

09:35:04 12

13

09:35:04 13

14

09:35:04 14

15

09:35:04 15

16

09:35:04 16

17

09:35:04 17

VIDEOTAPED DESPOSITION

18

09:35:04 18

OF

19

09:35:04 19

20

09:35:04 20

21

09:35:04 21

22

09:35:04 22

TRACY LINDSEY Tuesday, February 26, 2008 Bakersfield, California

23 24

09:35:04 23

25 26

09:35:04 24

27 28

09:35:04 25

Reported by:

Cindee L. LeFevre, CSR No. 7974

LindseyT

Case 1:07-cv-00026-OWW-TAG

1

Q.

Document 277-4

Great.

Filed 12/01/2008

Page 59 of 209 8

08:09:18 today's

1

Are you aware of any reason why

08:09:24

2

08:09:25

3

A.

No.

08:09:27 4 restricts 08:09:29 5 08:09:33 6 08:09:34 7 08:09:36 8 08:09:38 9 08:09:40 10 08:09:45 11 08:09:49 12 08:09:51 13 were

Q.

Is there anything that prevents you or

2 deposition cannot proceed?

3 4 5 6 7 8 9 10 11 12 13 14

you from giving your best most truthful answers today? A. No. Q. Have you taken any medication in the last 24 hours, drugs or alcohol? A. No. Q. Great. So you stated earlier that you started working at KMC in March of '05; correct? A. Yes. Q. Can you state the people that -- you said you

15 08:09:54 14

a secretary to the chair.

16 08:09:56 15

A.

Uh-huh.

08:09:56 16

Q.

Which chairs have you worked for during your

17 18 08:09:59 17

tenure at KMC?

19 08:10:00 18

A.

Dr. Jadwin and Dr. Dutt.

08:10:04 19

Q.

Dr. Philip Dutt?

08:10:05 20

A.

Yes.

08:10:05 21

Q.

Is that spelled with two "L's" or one?

08:10:08 22

A.

I think it's one.

08:10:12 23

Q.

Did you find Dr. Jadwin to be arrogant?

08:10:16 24

A.

No.

08:10:18 25

Q.

Did you find him to be overbearing?

20 21 22 23 24 25 26 27 28

LindseyT

Case 1:07-cv-00026-OWW-TAG

1 2

A. Q.

Document 277-4

Filed 12/01/2008

Page 60 of 209 9

08:10:21 08:10:23 other

1 2

No. Did you find Dr. Jadwin to be dismissive of

08:10:27

3

08:10:30

4

A.

No.

08:10:32

5

Q.

Did you ever have reason to believe that Dr.

08:10:37

6

08:10:42

7

A.

No.

08:10:44 8 Dr. 08:10:48 9 08:10:50 10 08:10:50 11 to?

Q.

How did you find Dr. Jadwin as -- he was --

3 people's input or opinions?

4 5 6 Jadwin was engaging in any kind of fraud or dishonesty?

7 8 9 10 11 12

Jadwin was your boss; correct? A. Yes. Q. He was the person that you directly reported

13 08:10:53 12

A.

Yes.

08:10:53 13

Q.

How did you find Dr. Jadwin as a boss?

08:11:02 14

A.

He was good, approachable.

08:11:06 as 08:11:09 08:11:09 08:11:17 Jadwin

Q.

Did you have any complaints about Dr. Jadwin

14 15 16 17 18 19 20

15 16 17 18

your boss? A. No. Q. How much interaction did you have with Dr.

21 08:11:20 19

on a daily basis, if you could estimate.

22 08:11:26 20

A.

Probably about 80 percent.

08:11:31 21

Q.

You mean 80 percent of your interactions with

23 24 08:11:34 22

people in the day would be with Dr. Jadwin?

25 08:11:37 23

A.

Yeah, I guess.

08:11:38 24 then? 08:11:43 25

Q.

So you worked pretty closely with Dr. Jadwin

A.

Yes.

26 27 28

LindseyT

Case 1:07-cv-00026-OWW-TAG

1

Q.

Document 277-4

Filed 12/01/2008

Page 61 of 209 10

08:11:44 you

1

And would you say he is the person at KMC that

08:11:48

2

08:11:51

3

A.

Yes.

08:11:55 '05 to 08:12:02 08:12:05 08:12:06 you

4

Q.

So you worked with Dr. Jadwin from March of

5 6 7

October of '06. A. Yes. Q. Okay.

08:12:11

8

hear about Dr. Jadwin's departure from KMC?

08:12:14

9

A.

It was just a personal leave.

08:12:19 personal 08:12:22 08:12:23 08:12:26 08:12:30 08:12:32 he

10

Q.

So you were consistently told it was a

2 worked the most closely with?

3 4 5 6 7 8

Is that correct? What did you hear was the -- what did

9 10 11 12 13 14 15 16 17

11 12 13 14 15

leave? A. Yeah, there wasn't much said about it. Q. And what you did hear about Dr. Jadwin's departure, who told it to you? A. I don't think anyone ever really did say that

18 08:12:35 16

was gone.

19 08:12:38 17

Q.

So what is your understanding of Dr. Jadwin's

20 08:12:41 18

employment status as of today as you sit here?

21 08:12:45 19

A.

Leave of absence.

08:12:47 Dr. 08:12:51 08:12:55 08:12:58 08:12:58 08:13:11 the

Q.

Absence.

22 23 24 25 26 27 28

20 21 22 23 24 25

And what is your understanding of

Philip Dutt's position at KMC as of today? A. He is interim chair. Q. Interim chair? A. Yes. Q. Did you notice any difficulties or problems in

LindseyT

INDSEY Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page02-26-08 62 of 209

Page 92 1

STATE OF CALIFORNIA

2 3

ss. COUNTY OF KERN

4

5

I, Cindee L. LeFevre, a Certified Shorthand

6

Reporter in the State of California, holding certification

7

No. 7974, do hereby certify that TRACY LINDSEY,

8

the witness named in the foregoing deposition,

9

was by me duly sworn; that said deposition was taken

10

Tuesday, February 26, 2008, at the time and place set forth

l I o n the first page hereof.

12

That upon the taking of the deposition,

the

13

words of the witness were written down by me in stenotypy

14

and thereafter transcribed by computer under my supervision;

15

that the foregoing is a true and correct transcript of the

16

testimony given by the witness.

17

I further certify that I am neither counsel for

18

nor in any way related to any party to said action, nor in

19

any way interested in the result or outcome thereof.

20 21

Dated this 18th of March, 2008, at Bakersfield, California.

22 23 24 25

vs. RANDALL

COUNTY OF KERN (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 63 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 40

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

45

Case 1:07-cv-00026-OWW-TAG

1

Document 277-4

Filed 12/01/2008

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

---------

4 5 6 7 8

DAVID F. JADWIN, D.O.,

) No. 1:07-cv-00026-OWW-TAG ) Plaintiff, ) ) vs. ) ) COUNTY OF KERN, et al. ) ) Defendants. ) ___________________________)

9 10 11 12 13 14

DESPOSITION OF IRENE LOPEZ

15

Tuesday, February 26, 2008

16

Bakersfield, California

17 18 19 20

Reported by:

Cindee L. LeFevre, CSR No. 7974

21 22 23 24 25

LopezI

Page 64 of 209 1

Case 1:07-cv-00026-OWW-TAG

1

Filed 12/01/2008

Page 65 of 209 8

blood products that were ordered.

2 3

Document 277-4

Q.

Okay.

Who was your direct supervisor while you

were working at KMC?

4

A.

It would be Gilbert Martinez, lab manager.

5

Q.

Did you have many interactions with Dr. Jadwin,

6

David F. Jadwin?

7

A.

Yeah, I worked with him, I would say, pretty much

8

on a daily basis, whether it be looking for slides or him

9

asking me to pull a prior pathology report, sending out

10

specimens to UCLA, Cedar Sinai.

11

labs.

12

I don't remember the other

It's been three and a half years. Q.

13

That's pretty good. Well, if you could just estimate --

14

A.

Uh-huh.

15

Q.

-- how many interactions in a week you would have

16 17 18

had with Dr. Jadwin. A.

Pretty much I would say on a daily basis and quite

often throughout the day.

19

Q.

Okay.

20

A.

No, I personally did not.

21

Did you find Dr. Jadwin to be arrogant? I would say I would

find him intimidating.

22

Q.

What was intimidating about Mr. Jadwin?

23

A.

I would say his presence.

You come into the

24

office and you just see a tall person.

25

clerical, extra help.

So --

LopezI

I was entry level

Case 1:07-cv-00026-OWW-TAG

1

A.

Document 277-4

Filed 12/01/2008

Page 66 of 209 10

No, but honestly speaking, I would say, you know,

2

we did interact, you know, him being a pathologist and me

3

being clerical, and him needing something.

4

Sometimes he would come through the office, and I

5

would say he would have a dry sense of humor.

6

would say things, and I am, like, okay.so that was funny or

7

something like that.

8

overall a pleasant experience.

9 10

Q.

Sometimes he

I didn't quite catch it, but it was

So he was trying to be funny, and it didn't quite

work out then?

11

A.

Yeah.

12

Q.

Okay.

13

A.

Or I didn't understand it or I missed something.

14

Q.

Right.

15

A.

I would be, like --

16

Q.

I get that reaction with my jokes all the time.

17 18 19

Did you ever see Dr. Jadwin emotional, upset, during your tenure at KMC? A.

That I recall an incident, no.

No, I would hear

20

co-workers within the lab say, oh, you know, just

21

complaining of X, Y, or Z reason, he did this, this

22

happened, but that was it.

Nothing that I saw personally --

23

Q.

Uh-huh.

24

A.

-- finding offensive or harassing, in that nature.

25

I mean, I believe it happens everywhere you go.

LopezI

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 67 of 209 11

1

Q.

Right.

2

A.

So --

3

Q.

So I mean, the complaints about Dr. Jadwin that

4

you were hearing --

5

A.

Uh-huh.

6

Q.

-- there was nothing remarkable about them.

7

Just

the kind of complaints you would hear in most workplaces?

8

A.

Yes, I would be safe to say, yes.

9

Q.

Would you agree that Dr. Jadwin then was generally

10 11

well liked in the Department of pathology? A.

I wouldn't necessarily say that he was well liked.

12

I know there was some people who did like him.

13

others that verbally voiced their dislikes.

14 15 16 17

Q.

There was

Would you mind stating the names of the people who

disliked Dr. Jadwin or stated they disliked him? A.

There was certain people that I knew that I

just -- I worked with on a everyday basis.

18

Q.

Uh-huh.

19

A.

I know Vangie Tolentino --

20

Q.

Uh-huh.

21

A.

-- was one, and she had a lot more one-on-one

22

interaction with him.

23

Rachelle Dirui.

She was a histology tech.

24

Q.

Could you spell that.

25

A.

Rachelle D-i-r-u-i.

I know

I believe she is retired now.

LopezI

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 68 of 209 12

1

You know, she often complained of this or that, you know.

2

They had different duties than I did, so oftentimes I would

3

just kind of listen and so forth.

4 5

Q.

Miss -- Vangie, does she complain a lot

generally?

6

A.

She was just, I think -- I mean, I don't really

7

know the nature.

8

pick them up from ER, assess them.

9

I know she assessed specimens, would go

He would cut them, whatever they did back there.

10

Oftentimes, I think it was maybe the procedures that were in

11

place.

12

None of that.

13

She had one way of doing them, and he wanted them done one

14

way.

15 16

Q.

It wasn't anything about personality or harassment. I think it was more the procedures in place.

So it was more in the nature of disagreements

about the way things should be done.

17

A.

Yes.

18

Q.

So was it Vangie's then --

19

A.

Yes.

20

Q.

-- voicing these concerns?

21

A.

Yes, there was other people.

Yes?

I mean, those were

22

the ones that I directly, you know -- I would say friends

23

that I could probably sit down, have a everyday conversation

24

with.

25

most.

So those are probably the ones that I would hear the

LopezI

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 69 of 209 15

1

would go and ask him something, and I would see that, you

2

know, she would be -- I would say a little bit uneasy, a

3

little bit uncomfortable.

4

Q.

Okay.

So would you agree that -- well, so you

5

don't think -- do you think Dr. Jadwin was disagreeable

6

then?

7 8

MR. WASSER: BY MR. LEE:

9 10

To Dr. Shertukde?

Q.

Just generally speaking, did you ever find Dr.

Jadwin acted in a manner that was disagreeable?

11

A.

Such as what or --

12

Q.

In your interactions with Dr. Jadwin, did you ever

13

find him to be disagreeable?

14

A.

In other words, he had his own mind, his own way

15

of doing things, and are you saying not coming to an

16

agreement or a give and take relationship?

17 18

Q.

Maybe I should switch the word.

Did you ever find

Dr. Jadwin to be overbearing?

19

A.

I don't think I understand.

20

Q.

Now, these are kind of SAT words.

Let me say --

21

overbearing would be, I guess, intimidating or, you know,

22

speaking in a loud voice in a dominating manner.

23

So with that definition of overbearing, would you

24

say that Dr. Jadwin was overbearing in his behavior towards

25

you?

LopezI

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

A.

Towards me, no.

2

Q.

Okay.

3

Page 70 of 209 16

Well, did you ever witness Dr. Jadwin being

overbearing towards other people?

4

A.

I am not sure.

5

Q.

Okay.

6

Filed 12/01/2008

Did you ever see Dr. Jadwin act in a manner

that was unfriendly towards you?

7

A.

Towards me, no.

8

Q.

Did you see Dr. Jadwin acting in a manner that was

9

unfriendly toward other people at KMC?

10

A.

I don't recall.

11

Q.

Did you ever witness Dr. Jadwin acting in an

12

unprofessional manner during your time at KMC?

13

A.

Unprofessional, no.

14

Q.

Did you ever notice Dr. Jadwin or did you ever

15

witness Dr. Jadwin acting in a manner that was dismissive

16

towards other people's views and ideas at KMC?

17

A.

I am not sure.

18

Q.

Okay.

19 20

Did you ever have any interactions with Dr.

Jadwin outside of KMC? Q.

After I left KMC, he did have a gathering for all

21

the personnel.

This was probably -- it was County Fair

22

time, so I am thinking September of '05.

23

He had a gathering for lab personnel, and he requested, I

24

think it was through Vangie -- the invitation was -- he

25

extended invitations to me and I believe Vangie and I did

LopezI

The lab personnel.

Case 1:07-cv-00026-OWW-TAG LOPEZ

Document 277-4

Filed 12/01/2008

Page 71 of 209 02-26-08

Page 26 STATE OF CALIFORNIA ss. COUNTY OF KERN

I, Cindee L. LeFevre, a Certified Shorthand in the State of California, holding certification 7974, do hereby certify that IRENE LOPEZ, witness named in the foregoing deposition, by me duly sworn; that said deposition was taken Tuesday, February 26, 2008, at the time and place set forth the first page hereof. That upon the taking of the deposition, the the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision; is a true and correct transcript of the given by the witness. I further certify that I am neither counsel for in any way related to any party to said action, nor in way interested in the result or outcome thereof. Dated this 18th day of March, 2008, at akersfield, California.

Cindee L. LeFevre, CSR No. 7974

VS.

NDALL

COUNTY OF KERN (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 72 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 41

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

46

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

JAVAD NADERI, M.D.

17

Thursday, December 6, 2007

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

NaderiJ

Page 73 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 74 of 209 38

1

10:55:54

1 either of yourself or an immediate family member

2

10:55:57

2 during your employment at KMC?

3

10:55:58

3

A.

No.

4

10:55:59

4

Q.

Dr. Naderi, do you have any children?

5

10:56:08

5

A.

Three.

6

10:56:08

6

Q.

Have any of your children experienced an

7

10:56:16

7 accident or been seriously hurt --

8

10:56:18

8

A.

Yes.

9

10:56:18

9

Q.

-- or injured during your time of employment

10

10:56:21 10 at KMC?

11

10:56:22 11

A.

Yes.

12

10:56:22 12

Q.

Can you tell me roughly when that occurred?

13

10:56:26 13

A.

That was 1998.

14

10:56:33 14 school education -- I mean graduation -- he -- my son

15

10:56:38 15 got involved in accident and he got paralyzed.

16

10:56:42 16 was in coma for -- excuse me.

17

10:57:15 17 involved with that, but I was on and off, back and

18

10:57:18 18 forth to work taking care of him, the hospital, come

19

10:57:25 19 back and forth.

20

10:57:28 20 continuous.

21

10:57:28 21

Q.

So Dr. Naderi --

22

10:57:30 22

A.

Does that answer your question?

23

10:57:32 23

Q.

Yes, it does, Dr. Naderi.

24

10:57:35 24 intermittent leave of absence, then, that you took in

25

10:57:37 25 relation to your son's accident?

Three days after his high

He

And so I was -- I was

It was intermittent, it was not

NaderiJ

So that was an

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-4

Filed 12/01/2008

Page 75 of 209 39

1

10:57:39

1

2

10:57:42

2 think I had enough vacation to take care of that.

3

10:57:47

3

4

10:57:52

4 continue for?

5

10:57:57

5

6

10:58:02

6 not going to answer.

7

10:58:04

7

8

10:58:07

8 estimate of the amount of time that you were on

9

10:58:09

9 intermittent leave at the hospital.

Q.

It was sick leave, vacation or what.

I

A.

How long did your intermittent work schedule

Q.

The subject for me is very difficult.

I'm

A.

Well, Dr. Naderi, we do need to know just an

10

10:58:11 10

11

10:58:16 11 more than two months was no -- at no time was any

12

10:58:20 12 continuation of leave of absence more than two months

13

10:58:25 13 as you wanted to.

14

10:58:27 14

15

10:58:30 15 My question is, for how long did the intermittent

16

10:58:33 16 leave of absence -- or I'm sorry -- the intermittent

17

10:58:36 17 work schedule that you were on in connection with

18

10:58:38 18 your son's accident, how long did that continue?

19

10:58:40 19 What was the duration of that intermittent work

20

10:58:45 20 schedule?

21

10:58:47 21

22

10:58:48 22 mischaracterizing his testimony.

23

10:58:50 23 he was on an intermittent work schedule, he said he

24

10:58:54 24 came and went.

25

10:58:56 25 intermittent work schedule, coming and going.

Q.

Was no continuation, as your question is

Dr. Naderi, that doesn't answer my question.

MR. WASSER:

I think you're He's not testified

That may be different from an

NaderiJ

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 76 of 209 43

1

11:02:01

1 that?

2

11:02:02

2

A.

Yes.

3

11:02:04

3

Q.

Okay.

4

11:02:10

4 working a few days and taking off a few days in

5

11:02:14

5 connection with your son's accident, were you

6

11:02:18

6 notified of your rights and obligations under the

7

11:02:23

7 Fair -- I'm sorry, the Family Medical Leave Act or

8

11:02:27

8 the California Family Rights Act?

9

11:02:32

9

10

A.

Thank you. When you were on this schedule of

I didn't ask anybody.

I just used my sick

11:02:36 10 leave and my vacation.

11

11

Q.

Are you fam- --

12

11:02:39 12

A.

I didn't ask anybody because I didn't want

13

11:02:41 13 to have any leave of absence.

14

11:02:44 14 anything special for me to be gone because my family

15

11:02:49 15 was involved in accident, I just use my sick leave

16

11:02:51 16 and my vacation.

17

11:02:58 17 vacation, we don't have to ask for favor, we just

18

11:03:04 18 take vacation.

19

11:03:08 19 to explain anything to me.

20

11:03:09 20

21

11:03:15 21 your direct supervisor at KMC?

22

11:03:20 22

23

Q.

I did not want to have

When you or me or anybody takes

So I didn't ask anybody, nobody had

Dr. Naderi, was it -- who was your -- who is

MR. WASSER:

Now?

23 BY MR. LEE:

24

11:03:22 24

Q.

Now.

25

11:03:22 25

A.

As a chairman, then the next step above you

NaderiJ

Case 1:07-cv-00026-OWW-TAG

Document 277-4

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Page 77 of 209 51

1

11:11:44

1 answer.

2

11:11:44

2

3

11:11:47

3 Mark.

4

11:11:48

4 necessary.

5

11:11:49

5

6

11:11:51

6 and no?

7

11:11:51

7

8

11:11:53

8 hospital -- I mean the function of the department

9

11:11:58

9 is -- does not need any -- anything from anybody else

MR. LEE: Thank you.

Q.

Your objection's on the record, No further discussion is

A.

Can you please clarify what you mean by yes

Whenever I thought the function of the

10

11:12:07 10 and was a short term, and I was here, so I didn't

11

11:12:13 11 inform.

12

11:12:19 12 matter what, those days were marked as vacation or

13

11:12:24 13 sick leave, no matter whether they knew or they

14

11:12:29 14 didn't.

15

11:12:29 15

16

11:12:34 16 had been in an accident?

17

11:12:43 17 KMC?

18

11:12:44 18

19

11:12:47 19 "anyone"?

20

11:12:50 20 what does it mean anyone?

21

11:12:52 21

22

11:12:55 22 at KMC that your son had been in an accident?

23

11:13:02 23

24

11:13:05 24 that because that was very bad accident, and they

25

11:13:11 25 knew that he is in ICU and he's comatose.

Q.

Whenever needed, I informed them.

Well, did you notify anyone that your son

A.

Q.

A.

But no

Did you notify anyone at

You mean anyone -- what do you mean That means employee of the department, or

Okay.

Yes.

Did you notify any employee or staff

Even before I informed them, they knew

NaderiJ

They knew,

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 78 of 209 63

1

11:39:22

1

Q.

Okay.

2

11:39:23

2

A.

Not -- no personal relationship, but

3

11:39:26

3 reasonable professional relationship.

4

11:39:29

4

5

11:39:31

5 relationship with Dr. Jadwin?

6

11:39:34

6

A.

Okay.

7

11:39:35

7

Q.

Did you find Dr. Jadwin to be arrogant?

8

11:39:47

8

A.

I don't -- I don't like to characterize

9

11:39:51

9 anybody by, you know, terminology.

Q.

Okay.

Well, how would you characterize your

Good.

We all have

10

11:39:55 10 different personalities.

11

11:39:58 11 yes or no answer, but I don't think it's nice -- I

12

11:40:02 12 don't think it's nice to talk about somebody.

13

11:40:05 13 have all different personalities.

14

11:40:10 14 know, each of us we are different, so arrogant to you

15

11:40:17 15 may not be arrogant to me.

16

11:40:23 16 has different personality than somebody else, which

17

11:40:26 17 is fine.

18

11:40:27 18

19

11:40:31 19 your interactions with Dr. Jadwin?

20

11:40:34 20

21

11:40:41 21 relationship, like I have with other departments.

22

11:40:46 22 Surgery, we might have discussions about cases, I

23

11:40:51 23 give him discussion, but not more than that.

24

11:40:53 24

25

11:40:56 25 instances where Dr. Jadwin was emotional or

Q.

A.

Q.

I'm sorry I cannot give you

But we

Sometimes, you

I think he's okay as he

Did you ever experience any difficulty in

Not -- not much, as we have case

Was -- did you ever -- can you recall any

NaderiJ

Case 1:07-cv-00026-OWW-TAG

Document 277-4

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Page 79 of 209 64

1

11:41:00

1 confrontational with you or with anyone else?

2

11:41:05

2

3

11:41:08

3 getting emotional with somebody else, you know, in

4

11:41:12

4 the meeting, conference or what.

5

11:41:17

5 with me is -- that's --

6

11:41:22

6

7

11:41:25

7 was no particular instance that stands out to you?

8

11:41:29

8

A.

Nothing with me, no.

9

11:41:30

9

Q.

Okay.

A.

Q.

Well, each of us may have seen somebody

Okay.

Nothing special

So as far as you can recollect, there

Did you find interacting with

10

11:41:37 10 Dr. Jadwin unpleasant in any way?

11

11:41:45 11

12

11:41:48 12 characterize it the same as others that, again, you

13

11:41:52 13 deal with attorneys who maybe not like the discussion

14

11:41:56 14 you have with other attorney, but next time you get

15

11:41:59 15 to see each other, then it's okay, is -- like that.

16

11:42:02 16 But those are just the usual routine things, nothing

17

11:42:07 17 specific that, you know, we go head to head or fist

18

11:42:12 18 to fist or something like that, just more

19

11:42:15 19 professional.

20

11:42:16 20

21

11:42:19 21 certain physicians at KMC who are arrogant?

22

11:42:24 22

23

11:42:26 23 as arrogant, as that's -- so I -- different

24

11:42:33 24 personality, but I don't characterize, you know,

25

11:42:38 25 whatever personality.

A.

Q.

A.

I don't recall any instance, but I

Okay.

Well, would you say that there are

Again, I don't like to characterize anybody

Because if -- if I want to say

NaderiJ

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 80 of 209 75

1

11:58:20

1 know, what you're doing and what you're -- well,

2

11:58:22

2 nobody is perfect.

3

11:58:27

3 are, you have your strengths in certain part and

4

11:58:31

4 weakness in certain part, and as honest you are, I

5

11:58:35

5 know this, but I don't know this.

6

11:58:37

6 do, I'm willing to work on it, and then I learn it

7

11:58:39

7 and so on.

8

11:58:42

8 what we do.

9

11:58:46

9 may do better because of personality, some may do

No matter how good lawyer you

But this is what I

This is all we need to do, and this is And I think we all try to do that.

Some

10

11:58:49 10 better and go along, and some may not because of

11

11:58:51 11 personality.

12

11:58:54 12 individual, and this is why we are characterizing,

13

11:58:58 13 characterizing in this society, is what they know us.

14

11:59:00 14

15

11:59:03 15 Dr. Jadwin's ability to get along with people?

16

11:59:07 16

A.

He know --

17

11:59:09 17

Q.

Let me finish.

18

11:59:10 18 Dr. Jadwin's ability to get along with people was any

19

11:59:14 19 worse than any other people?

20

11:59:15 20

21

11:59:18 21 problem with Dr. Jadwin, but I don't know about

22

11:59:21 22 others.

23

11:59:24 23 report; the referring physician will get the result

24

11:59:27 24 of his report.

25

11:59:31 25 how much they believe him or didn't believe him or

Q.

A.

And this is perfectly normal for each

So in the case of Dr. Jadwin, did you see

Did you notice that

Between us, because I didn't have any

And also I don't get the end result of his

And I don't know how good, bad, or

NaderiJ

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

159 Page 81 of 209

ss. 3 4

5

I,

Sandra L.

Edmonson,

a Certified Shorthand

6

Reporter in the State of California, holding Certificate

7

No.

8

witness named in the foregoing deposition,

9

duly sworn;

that said deposition was taken Thursday,

10

December 6,

2007,

11

first page hereof.

12

7704,

do hereby certify that JAVAD NADERI,

M.D.,

the

was by me

at the time and place set forth on the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision;

16

transcript of the testimony given by the witness.

17

that the foregoing is a true and correct

I further certify that I am neither counsel for

18

nor in any way related to any party to said action,

19

in any way interested in the result or outcome thereof.

20 21 22 23

Dated this 20th day of December, Bakersfield,

2007,

nor

at

California.

~ ~ * 7704 CQy"(

S r a ~ons

;o~

24 25 II

WOOD & RANDALL (800) 322-4595 i

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 82 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 42

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

47

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

RAVI PATEL, M.D.

17

Thursday, December 6, 2007

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

PatelR

Page 83 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 84 of 209 16

1

17:10:03

1 on other things in the cancer committee.

2

17:10:04

2

3

17:10:09

3 Dr. Jadwin fairly well, then, on a personal level?

4

17:10:17

4

5

17:10:20

5 in the cancer committee, and that was my extent of

6

17:10:22

6 knowing him.

7

17:10:23

7

Q.

Okay.

8

17:10:27

8

A.

Now, if by "personal" meaning, you know, I

9

17:10:30

9 never had any -- we never socialized or went out or

Q.

A.

Okay.

So would you say that you knew

I can -- I knew him enough to be, you know,

Did you --

10

17:10:34 10 met after the cancer committee to discuss a variety

11

17:10:36 11 of things.

12

17:10:39 12 cancer committee or any issues related to that, I

13

17:10:42 13 would make a phone call to him sometimes to discuss,

14

17:10:44 14 you know, what we need to discuss on this particular

15

17:10:47 15 item or whether he had any, you know, comments on a

16

17:10:51 16 particular issue.

17

17:10:51 17

18

17:10:54 18 with Dr. Jadwin to be unpleasant in any way?

19

17:10:57 19

A.

No.

20

17:11:00 20

Q.

During the time you were the chair of the

21

17:11:04 21 cancer committee, can you estimate how many times

22

17:11:06 22 Dr. Jadwin gave a presentation at the tumor board?

23

17:11:11 23

24

17:11:13 24 committee was the meeting where the cancer committee

25

17:11:16 25 members met to oversee the cancer program, and the

Q.

A.

If there was an issue related to the

Did you ever find any of your interactions

My personal interactions were not.

There's two separate things:

PatelR

The cancer

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 85 of 209 24

1

17:20:05

1 fact that it was brought to me -- to my attention

2

17:20:08

2 particularly because I was the cancer committee

3

17:20:10

3 chairman, that, you know, look, can we speak to

4

17:20:14

4 Dr. Jadwin because, you know, time runs out.

5

17:20:17

5 think that, you know, it was not something that, you

6

17:20:20

6 know, Dr. Jadwin is doing this bad thing and let's

7

17:20:23

7 shake him up, and, you know, we need to talk to him.

8

17:20:25

8 It was just a comment that, you know, look, the time

9

17:20:28

9 is running out, other people don't get enough time to

And I

10

17:20:31 10 discuss it; can we speak to Dr. Jadwin to cut it down

11

17:20:34 11 or whatever.

12

17:20:36 12 really runs the cancer conference was Dr. McBride,

13

17:20:40 13 and so I felt that, you know, the purpose, this issue

14

17:20:44 14 needs to be brought up by Dr. McBride, who is the

15

17:20:48 15 person normally running the conference, in charge of

16

17:20:51 16 the conference.

17

17:20:51 17

18

17:20:57 18 recall the sequence of events that happened at the

19

17:21:05 19 conference in question?

20

17:21:08 20 recall whether the resident presenter spoke first or

21

17:21:12 21 second?

22

17:21:12 22

23

17:21:16 23 the sequence would be always the same.

24

17:21:19 24 would present first; then the imaging would be

25

17:21:24 25 presented, that means the X-ray data would be

Q.

A.

Okay.

And I said, Okay, well, the person who

At Dr. Jadwin's presentation, do you

Oh, yes.

I mean, for example, do you

The resident would have spoken --

PatelR

The resident

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 86 of 209 38

1

17:50:06

1 Is that acceptable to you?

2

17:50:07

2

A.

Can you repeat that, please.

3

17:50:08

3

Q.

When I refer to IPR, I'm referring to

4

17:50:11

4 suggested policy by Dr. Jadwin of having outside

5

17:50:15

5 pathology reports by outside experts reviewed by the

6

17:50:15

6 KMC pathology department.

7

17:50:18

7

A.

I got it.

8

17:50:21

8

Q.

Okay.

9

17:50:22

9

A.

I got it.

10

17:50:22 10

Q.

So I'll refer to that as IPR.

11

17:50:25 11

A.

Yes.

12

17:50:26 12

Q.

Okay.

13

17:50:27 13 discussed IPR with Dr. Jadwin?

14

17:50:30 14

15

17:50:32 15 very well because of the fact that it was presented

16

17:50:35 16 as a possibly, as far as I can recall, an agenda item

17

17:50:40 17 in the cancer committee, that outside would be

18

17:50:46 18 reviewed by other pathologists or any experts outside

19

17:50:50 19 of the hospital needs to be reviewed within the

20

17:50:52 20 hospital.

21

17:50:57 21 appropriate and useful, and I supported Dr. Jadwin

22

17:51:01 22 for that.

23

17:51:01 23

24

17:51:06 24 would improve patient quality care to have IPR at

25

17:51:10 25 KMC?

A.

Q.

Do you recall when you first

No, I don't, but I do remember that issue

And I do feel that that policy was

Okay.

Do you feel that there's a -- that it

PatelR

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 87 of 209 41

1

17:54:04

1 pathology diagnosis, could that cause to a patient

2

17:54:10

2 fatality at KMC?

3

17:54:11

3

4

17:54:15

4 correct, it can potentially produce a problem.

5

17:54:17

5

6

17:54:24

6 a -- of a mistaken pathology diagnosis causing a

7

17:54:29

7 patient mortality?

8

17:54:34

8

9

17:54:36

9 but it would be very small.

A.

Q.

A.

It can.

If the pathology diagnosis is not

How would you rate the probability of -- of

From a probability standpoint, I'm not sure, But it could be -- you

10

17:54:39 10 know, it could affect the outcome of the patient.

11

17:54:41 11

12

17:54:47 12 a mistaken pathology diagnosis caused a patient

13

17:54:51 13 death?

14

17:54:58 14 experience?

15

17:54:58 15

16

17:55:10 16 numbers, the numbers could be very different, but it

17

17:55:14 17 can happen.

18

17:55:14 18

19

17:55:21 19 increase the chance of having an appropriate

20

17:55:23 20 treatment plan?

21

17:55:24 21

A.

Yes.

22

17:55:24 22

Q.

Okay.

23

17:55:29 23 that outside experts, such as USC and Stanford, could

24

17:55:34 24 issue mistaken pathology diagnoses on tissue samples

25

17:55:41 25 that have been referred to them by KMC?

Q.

A.

Q.

Okay.

Are you aware of any instances where

Not just at KMC, but anywhere in your

Yes.

Okay.

Now, you know, if you look at the

Do you believe that having IPR can

Do you have any reason to believe

PatelR

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

86 Page 88 of 209

ss. 3

4

I,

5

Sandra L. Edmonson,

a Certified Shorthand

6

Reporter in the State of California, holding Certificate

7

No.

8

witness named in the foregoing deposition,

9

duly sworn; that said deposition was taken Thursday,

7704, do hereby certify that RAVI PATEL, M.D.,

10

December 6,

11

first page hereof.

12

the

was by me

2007, at the time and place set forth on the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I further certify that I am neither counsel for

18

nor in any way related to any party to said action, nor

19

in any way interested in the result or outcome thereof.

20 21

Dated this 20th day of December, Bakersfield, California.

22 23 24 25

WOOD & RANDALL (800) 322-4595

2007, at

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 89 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 43

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

48

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

1

UNITED STATES DISTRICT COURT

2

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

3

---------

4

4

DAVID F. JADWIN, D.O.,

Page 90 of 209 1

) Case No. 1:07-cv-00026-OWW-TAG )

5

5

Plaintiff,

) )

6

6

vs.

) )

7

7

COUNTY OF KERN; et al.

) )

8

8

Defendants.

)

_________________________) 9

9

10

10

11

11

12

12

13

13

14

14

OF

15

15

ARLENE BARBARA RAMOS-ANINION

16

16

Friday, August 15, 2008

17

17

Bakersfield, California

18

18

19

19

20

20

21

21

22

22

VIDEOTAPED DEPOSITION

Reported by:

Cindee L. LeFevre, CSR No. 7974

23 24

23

25 26

24

27 28

25

RamosA1

Case 1:07-cv-00026-OWW-TAG

1 2 3 4

09:54:02 09:54:05 09:54:08 not so

Document 277-4

Filed 12/01/2008

Page 91 of 209 47

1 2 3 4

these one-on-one meetings with Mr. Bryan less frequently than other chairs were with Mr. Bryan? A. I do not believe so. Q. Your -- are you certain of that, or you are

5

certain?

5 09:54:11 6 7 8

09:54:12 6 basis, so 09:54:14 7 other

A.

They would all be scheduled on a regular

I don't believe this happened any less often than any

9 09:54:20

8

chairs.

09:54:21 9 during 09:54:24 10 09:54:27 11 hallway,

Q.

10 11 12 13

How often did you interact with Dr. Jadwin

your tenure at KMC? A. Well, you know, if I would see him in the

14 15 16

09:54:30 12 call 09:54:33 13 wouldn't

I would interact with him.

09:54:36 14 do 09:54:41 15 09:54:43 16 Jadwin

say a daily basis, maybe a weekly basis, with him as I

09:54:46 17

unpleasant?

09:54:47 18

A.

No.

09:54:48 19

Q.

Did you like Dr. Jadwin?

20 21 22

A. Q. A.

I did. Why did you like Dr. Jadwin? He was very -- always cordial to me.

him.

He would call or I would

We didn't interact all the time.

You know, I

17 18 19 20

all the chairs. Q. Okay.

And were your interactions with Dr.

21 22 23 24 25 26

never

27

well.

28

was

I -- I

23

had any problems with him.

We always got along really

24

I believe it was because he was From New Jersey and I

25

from New Jersey.

So I think we had a little -- a little

RamosA1

Case 1:07-cv-00026-OWW-TAG

1 2 3 4

Document 277-4

Filed 12/01/2008

Page 92 of 209 48

1 2 3 4

bond over Q. A. Q.

09:55:16

5

temper?

09:55:17

6

A.

I never did witness anything like that.

09:55:19

7

Q.

Did you ever witness Dr. Jadwin threatening

09:55:23

8

09:55:25

9

A.

No, I did not.

09:55:28 10

Q.

Okay.

09:55:07 09:55:10 09:55:12 his

there. I am New York. Almost counts. Exactly. Did -- did you ever witness Dr. Jadwin losing

5 6 7 8 physical violence to anybody?

9 10 Well, I should -- let me rephrase those

11 09:55:31 11

questions.

12 09:55:31 12

Were you ever aware of any instances where Dr.

13 09:55:34 13

Jadwin became angry with people?

14 09:55:36 14

A.

I had heard of a situation, physician and

15 16 17 18 19 20 21 22 23

09:55:38 not a 09:55:41 09:55:43 09:55:43 09:55:44

15

physician, but that's hearsay, and I -- I don't -- I'm

16 17 18 19 20 21 22

hearsay kind of person. Q. Okay. A. I like -Q. So you heard it through the grapevine, and you don't know whether it is to be believed or not? A. That is correct. Q. Okay. And are you aware whether Dr. Jadwin

23

ever made physical threats against anybody else?

had 24 25 26 27 28

24

A.

No.

25

Q.

Are you aware of whether Dr. Jadwin ever acted

RamosA1

Case 1:07-cv-00026-OWW-TAG

1 2 3

09:56:03 09:56:07 Jadwin's

Document 277-4

Filed 12/01/2008

Page 93 of 209 49

1 2 3

inappropriately with anybody? A. No. Q. Do you -- are you familiar with what Dr.

4

reputation was at the hospital?

4 09:56:11 5 6 7 8 9 10 11

09:56:12 5 they 09:56:16 6 09:56:19 7 09:56:21 8 09:56:24 9 09:56:25 10 any

A.

Not really, other than -- I don't know how

felt about him. I have no idea. Q. Do you know what his reputation was with the support staff at Kern Medical Center? A. No. Q. You didn't hear anything -- you didn't hear

12 09:56:30 11

negative things about Dr. Jadwin in general, did you?

13 09:56:33 12

A.

No.

09:56:33 13

Q.

Have you ever witnessed any kind of angry

14 15 09:56:36 14

interaction -- well, let me strike that.

16 09:56:38 15

Are you aware of any angry confrontations

17 09:56:41 16

occurring between any core physicians at Kern Medical

09:56:44 17

Center?

18 19 20 21 22

09:56:46 18 A. anything 09:56:49 19 factual. 20 Q. confrontations

Again, I've heard things, but don't know So nothing I can honestly say that I know. Okay. Have you witnessed any angry

23 21 24 25 26

between any other core physicians at Kern Medical

Center? 22 23

A. Q.

No. Have you witnessed any -- any confrontations

at 27 24

all at Kern Medical Center?

28 25

A.

No.

RamosA1

Case 1:07-cv-00026-OWW-TAG

1 2 3 4

Document 277-4

Filed 12/01/2008

Page 94 of 209 55

1 2 3 4

Q. And were you aware of anyone else feeling threatened by Dr. Jadwin's physical size? A. No. Q. So Dr. Jadwin didn't walk around using his

10:03:20

5

a way to kind of intimidate people in any way?

10:03:23

6

A.

Never -- never in front of me.

10:03:25 Jadwin's 10:03:28 10:03:32 you

7

Q.

What was -- how would you describe Dr.

10:03:12 10:03:16 10:03:16 size as

5 6 7 8 9 10

8 9

demeanor? Was he, you know -- was he walking around strutting with his chest out all the time or -- would

11 12 13 14

10:03:35 10 describe 10:03:36 11 10:03:37 12 professional

just try to put it in your own words how you would

10:03:39 13 never 10:03:43 14 I

walking down the hallway.

10:03:46 that 10:03:49 10:03:50 10:03:53 10:03:53

15

didn't see him being anything other than the physician

16 17 18 19 20 21 22

he was. Q. Jadwin? A. Q. A. Q.

his demeanor. A. I always thought Dr. Jadwin was very

15 16 17

Whenever I would see him, I

thought him different than any other person.

You know,

18 19 20 21 22 23 24 25 26

Did you ever feel physically threatened by Dr. No. Did you ever feel scared of Dr. Jadwin? No. Did you ever hear of anyone else being

terrified 27

23 24 25

28

of Dr. Jadwin? A. No. Q. Can you imagine any reason why anybody would

be

RamosA1

Case 1:07-cv-00026-OWW-TAG BARBARA RAMOS-ANINION

Document 277-4

Filed 12/01/2008

Page 95 of 209 08-15-08

Page 119 1

STATE OF CALIFORNIA

2

COUNTY OF KERN

ss.

3

4

I, Cindee L. LeFevre, a Certified Shorthand

5

Reporter in the State of California, holding

6

certification No. 7974, do hereby certify that

7

ARLENE BARBARA RAMOS-ANINION, the witness named in the

8

foregoing deposition, was by me duly sworn; that said

9

deposition was taken Friday, August 15, 2008, at the

10 11

time and place set forth on the first page hereof. That upon the taking of the deposition, the

12

words of the witness were written down by me in stenotypy

13

and thereafter transcribed by computer under my supervision;

14

that the foregoing is a true and correct transcript of the

15

testimony given by the witness.

16

I further certify that I am neither counsel for

17

nor in any way related to any party to said action, nor in

18

any way interested in the result or outcome thereof.

19 20

Dated this 9th day of September, 2008, at Bakersfield, California.

21 22 23 24

.

~L)~

Cindee L. LeFevr , CSR No. 7974

25

VS.

RANDALL

(800)

COUNTY 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 96 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 44

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

49

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

EDWARD WILLIAM TAYLOR, M.D.

17

Wednesday, December 5, 2007

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

TaylorE1

Page 97 of 209 1

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-4

Filed 12/01/2008

Page 98 of 209 88

1

18:07:32

1

Okay?

2

18:07:33

2

3

18:07:34

3 time like that is confabulating.

4

18:07:38

4 confabulate, then you can say anything in the world

5

18:07:42

5 is possible.

6

18:07:43

6

7

18:07:46

7 partner would have to take care of us because I'm

8

18:07:48

8 here, but that's kind of not realistic, is it?

9

18:07:52

9

Somebody that makes up a word like that -- a So if you want to

Okay?

A plane could land in here right now, and my

Q.

Okay.

Well, how long do you estimate it

10

18:07:54 10 took for Dr. Jadwin to present his portion of

11

18:07:59 11 Presentation B of the October oncology conference?

12

18:08:02 12

13

18:08:04 13 This is now the sixth time.

14

18:08:05 14

15

18:08:06 15 BY MR. LEE:

16

18:08:06 16

Q.

Don't know.

17

18:08:07 17

A.

Do you want me to speculate?

18

18:08:09 18 said no.

19

18:08:12 19

Q.

No.

20

18:08:13 20

A.

Estimate?

21

18:08:14 21

22

18:08:16 22 20 minutes.

23

18:08:16 23

24

18:08:23 24 paragraph you say, "In general I get along fine with

25

18:08:25 25 Dr. Jadwin."

MR. WASSER:

THE WITNESS:

I don't know.

You've already

We're going in a circle. I want you to estimate.

Okay.

Q.

You've asked and answered that.

Okay.

I would estimate that his talk took

Now, at the very end of the last

TaylorE1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 99 of 209 89

1

18:08:26

1

How would you -- would you say that that's a

2

18:08:28

2 pretty accurate assessment of your --

3

18:08:31

3

4

18:08:33

4 way.

5

18:08:38

5 peripherally knew about, like I said before, some of

6

18:08:41

6 the FNA arguments, and afterwards I realized there's

7

18:08:45

7 something going on between him and Roy.

8

18:08:48

8 after that, I really didn't have any problem with

9

18:08:50

9 him.

A.

Yeah.

And I really -- I still feel that

I really didn't -- you know, I -- I very

But even

We were cordial in the halls, and he called me

10

18:08:54 10 with the path reports and told me.

11

18:08:58 11 I completely believe that.

12

18:09:00 12

13

18:09:03 13 many problems in your interactions with Dr. Jadwin

14

18:09:06 14 before October 12, 2005?

15

18:09:07 15

A.

No.

16

18:09:09 16

Q.

How many --

17

18:09:10 17

A.

And I had no problem with my interaction

18

18:09:12 18 with him then because I didn't.

19

18:09:16 19 something that I thought was inappropriate, and I

20

18:09:18 20 commented on it to try to help make things better.

21

18:09:25 21 Nothing personal.

22

18:09:25 22

23

18:09:30 23 Dr. Jadwin prior to -- well, let's just say for the

24

18:09:33 24 one-year period before October 12 of 2005?

25

18:09:38 25

Q.

Q.

A.

Okay.

I really -- yes,

And so basically do you recall having

I just observed

How many interactions did you have with

Probably dozens.

TaylorE1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 100 of 209 90

1

18:09:39

1

Q.

So --

2

18:09:40

2

A.

Some are shorter than others.

3

18:09:48

3

4

18:09:50

4 is covering me.

5

18:09:55

5 people to tell them not to page me.

6

18:09:57

6

7

18:10:02

7 understood your answer, you're saying that there was

8

18:10:05

8 a pretty significant -- you almost saw him on a,

9

18:10:07

9 what, weekly basis then?

There's people that don't know somebody else

Q.

A.

Okay.

Excuse me.

I would have to call 100

10

18:10:09 10

11

18:10:11 11 the hall, saying hi.

12

18:10:14 12 faculty practice plan committee; so I would see him

13

18:10:18 13 every -- once a month, and then quite a few times

14

18:10:21 14 over the phone with frozen sections or -- or -- or

15

18:10:24 15 path reports that he would call me quite a few times.

16

18:10:27 16

17

18:10:30 17 raising his voice with you?

18

18:10:31 18

A.

No.

19

18:10:31 19

Q.

Do you recall him ever being

20

18:10:33 20 confrontation -- confrontational with you?

21

18:10:35 21

A.

No.

22

18:10:35 22

Q.

Okay.

23

18:10:42 23

A.

The only arrogance I felt from him was at

24

18:10:45 24 this conference.

25

18:10:48 25 from him.

Q.

Yeah.

The question was so -- as I

Okay.

A lot of it would be just passing in We were on, I think, the

So do you recall Dr. Jadwin ever

Would you say Dr. Jadwin is arrogant?

Other than that, I never got that

TaylorE1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 101 of 209 93

1

18:12:27

1 doctor that you consider to be arrogant at KMC?

2

18:12:31

2

3

18:12:33

3 Dr. Jadwin was arrogant and so I'm not even part of

4

18:12:37

4 that group that thinks he's arrogant nor part of that

5

18:12:40

5 lawsuit.

6

18:12:43

6 has nothing to do with this because I don't think

7

18:12:46

7 Dr. Jadwin's arrogant.

8

18:12:48

8

9

18:12:56

9 you -- I don't know if you are aware of this, but you

A.

Q.

It's not relevant because I never thought

So me thinking somebody else is arrogant

Okay.

Dr. Taylor, I'm just going to remind

10

18:12:58 10 are here in regard to a lawsuit, and we have a right

11

18:13:02 11 to answers to our questions.

12

18:13:06 12 answer a question, you will be -- well, we can, at

13

18:13:10 13 our option, bring a motion to the judge and request

14

18:13:12 14 that you be sanctioned for not answering a question

15

18:13:15 15 to which we're entitled to an answer.

16

18:13:19 16 you to understand that.

17

18:13:20 17

A.

Okay.

18

18:13:26 18

Q.

And I just want to add that it's not --

19

18:13:28 19 you're actually not in a position to say what's

20

18:13:31 20 relevant or not relevant in this deposition.

21

18:13:32 21

22

18:13:36 22 with attorneys and depositions, I've never been asked

23

18:13:40 23 something very personal like that that -- and I --

24

18:13:43 24 and I really think that -- that that is just an

25

18:13:49 25 absolutely unfair question to ask.

A.

I know I'm not.

And if you refuse to

I just want

I'm also -- in all my time

TaylorE1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

128 Page 102 of 209

Filed 12/01/2008

ss. 3 4

5

I,

Sandra L. Edmonson, a Certified Shorthand

6

Reporter in the State of California,

holding

7

Certificate No.

8

EDWARD WILLIAM TAYLOR, M.D.,

9

foregoing deposition, was by me duly sworn; that said

7704, do hereby certify that the witness named in the

10

deposition was taken Wednesday,

11

time and place set forth on the first page hereof.

12

December 5,

2007,

That upon the taking of the deposition,

at the

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I further certify that I am neither counsel for

18

nor in any way related to any party to said action, nor

19

in any way interested in the result or outcome thereof.

20 21

Dated this 20th day of December, Bakersfield, California.

22 23

2007, at

S

~J3 GJ ~J~--cA. ~ ra L. Edmonson, CSR No. 7704

24 25

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 103 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 45

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

50

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

CHARLES JOSEPH WROBEL, M.D.

17

Thursday, December 6, 2007

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

WrobelJ

Page 104 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

08:12:09

1

A.

-- is that correct?

2

08:12:10

2

Q.

Well, actually, let's see.

3

08:12:12

3

A.

Calendar years.

4

08:12:13

4

Q.

Let's say five years.

5

08:12:16

5

A.

Probably ten times.

6

08:12:18

6

Q.

Ten times.

7

08:12:26

7 significant with Dr. Jadwin or --

8

08:12:28

8

A.

No.

9

08:12:28

9

Q.

No.

Page 105 of 209 12

Yeah, that's correct.

And were those interactions very

So were they really more in the nature

10

08:12:31 10 of just saying hello in the hallway?

11

08:12:33 11

12

08:12:36 12 specimen which happened, I believe, probably twice a

13

08:12:39 13 year.

14

08:12:39 14

Q.

I'm sorry?

15

08:12:40 15

A.

It was to ask about a pathology specimen,

16

08:12:44 16 maybe twice a year, my recollection.

17

08:12:45 17

18

08:12:48 18 work-related then, correct?

19

08:12:49 19

A.

That is correct.

20

08:12:49 20

Q.

Okay.

21

08:12:52 21 arrogant?

22

08:12:54 22

A.

I don't remember.

23

08:12:54 23

Q.

Well, we're entitled to your best

24

08:12:58 24 recollection.

25

08:13:01 25 arrogant at any time with you?

A.

Q.

No, they were to ask about a pathology

Okay.

So the conversations were strictly

Did Dr. Jadwin ever strike you as

Is your best recollection that he was

WrobelJ

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-4

Filed 12/01/2008

Page 106 of 209 13

1

08:13:02

1

2

08:13:05

2 would say no.

3

08:13:06

3

4

08:13:10

4 be emotional or confrontational?

5

08:13:12

5

6

08:13:14

6 that we had, I don't think so.

7

08:13:16

7

Q.

So your best recollection is no, correct?

8

08:13:19

8

A.

That is correct.

9

08:13:19

9

Q.

Okay.

Q.

On the basis of my limited interactions, I

A.

Okay.

Did Dr. Jadwin ever appear to you to

On the basis of the ten short interactions

Did you have -- do you have any

10

08:13:24 10 reason to believe that Dr. Jadwin is arrogant or was

11

08:13:28 11 arrogant?

12

08:13:29 12

MR. WASSER:

13

08:13:30 13

THE WITNESS:

14

08:13:32 14

MR. LEE:

15

08:13:34 15 believe.

16

08:13:35 16

17

08:13:36 17 Dr. Jadwin's emotional and confrontational?

18

08:13:39 18

A.

No.

19

08:13:39 19

Q.

Okay.

20

08:13:47 20 during your time at KMC?

21

08:13:48 21

A.

No.

22

08:13:48 22

Q.

So since -- I'm sorry.

23

08:13:53 23 at KMC, 19 --

24

08:13:54 24

A.

'91.

25

08:13:54 25

Q.

-- 91?

Q.

You just asked him that. No.

I'm asking if he has any reason to

Do you have any reason to believe that

Have you taken any leaves of absence

WrobelJ

When did you begin

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

46 Page 107 of 209

Filed 12/01/2008

ss. 3 4

5

Sandra L.

I,

Edmonson,

a Certified Shorthand

6

Reporter in the State of California,

7

Certificate No.

8

CHARLES JOSEPH WROBEL, M.D.,

9

foregoing deposition,

7704,

holding

do hereby certify that the witness named in the

was by me duly sworn; that said

10

deposition was taken Thursday,

11

time and place set forth on the first page hereof.

12

December 6,

2007,

at the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision;

16

transcript of the testimony given by the witness.

17

I

that the foregoing is a true and correct

further certify that I am neither counsel for

18

nor in any way related to any party to said action,

19

in any way interested in the result or outcome thereof.

20 21

Dated this 20th day of December, Bakersfield,

California.

22 23 24 25

WOOD & RANDALL (800) 322-4595

2007,

at

nor

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 108 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 46

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

51

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

TAI YOO, M.D.

17

Thursday, August 21, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

YooT

Page 109 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 110 of 209 9

1

13:13:45

1

Q.

Okay.

2

13:13:50

2

A.

Other than my vitamins this morning.

3

13:13:52

3

Q.

Okay.

4

13:13:53

4

A.

Yes.

5

13:13:53

5

Q.

That will not affect your testimony today,

6

13:13:55

6 right?

7

13:13:56

7

A.

Right.

8

13:13:56

8

Q.

Okay.

9

13:13:59

9

Thank you.

What is your current title at Kern Medical

10

13:14:03 10 Center?

11

13:14:03 11

12

13:14:07 12 Kern Medical Center and the Kern County Mental

13

13:14:12 13 Health, and also residency program director for the

14

13:14:15 14 UCLA Kern psychiatry residency program, and the

15

13:14:22 15 professor and the vice chairman at UCLA psychiatry

16

13:14:25 16 department.

17

13:14:25 17

18

13:14:27 18

19

13:14:29 19 witness put on the microphone.

20

13:14:32 20

21

13:14:34 21 microphone on.

22

13:14:35 22

THE WITNESS:

23

13:14:36 23

THE VIDEOGRAPHER:

24

13:14:37 24 BY MR. LEE:

25

13:14:46 25

A.

Q.

I am the joint chairman of psychiatry at

Okay. THE VIDEOGRAPHER:

MR. LEE:

Q.

Okay.

Counsel, can we have the

I'm sorry.

I forgot to instruct. Can you put this

Oh. Thank you.

Doctor, when did you begin your

YooT

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 111 of 209 10

1

13:14:48

1 employment with the County of Kern?

2

13:14:49

2

A.

August the 1st, 2001.

3

13:14:52

3

Q.

So you've been employed by the county for

4

13:14:56

4 almost seven years now?

5

13:14:58

5

A.

Seven years, yeah.

6

13:14:59

6

Q.

Okay.

7

13:15:01

7 with the County of Kern you were -- you were hired as

8

13:15:04

8 a chair of psychiatry?

9

13:15:06

9

A.

Yeah.

10

13:15:06 10

Q.

Okay.

11

13:15:07 11

A.

First joint chairman for both Kern Medical

12

13:15:13 12 Center and the county mental health.

13

13:15:15 13

14

13:15:22 14 of the Kern Medical Center --

15

13:15:24 15

A.

Yes.

16

13:15:24 16

Q.

-- and -- yes?

17

13:15:27 17

A.

Uh-huh.

18

13:15:27 18

Q.

Okay.

19

13:15:30 19

A.

Yes.

20

13:15:30 20

Q.

Okay.

21

13:15:33 21 you have with Dr. Jadwin during your tenure or during

22

13:15:37 22 his tenure at Kern Medical Center?

23

13:15:40 23

24

13:15:42 24 started soon after I started, and we -- as chair of

25

13:15:53 25 different departments, we had chairs' council

Q.

A.

And when you first began employment

Oh, okay.

And are you still a joint chair

Do you know Dr. Jadwin?

Did you -- how many interactions did

I don't know the exact date.

YooT

I think he

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1

13:15:58

1 once-a-month --

2

13:15:59

2

Q.

I see.

3

13:15:59

3

A.

-- meeting.

4

13:16:04

4 And since he is -- he was the chairman of the

5

13:16:08

5 pathology department, I had a few discussions about

6

13:16:11

6 some lab testing component for our psychiatry faculty

7

13:16:18

7 members.

8

13:16:18

8

9

13:16:21

9 council meetings?

Q.

Okay.

So we had that interaction.

So you saw him once a month at chair

10

13:16:22 10

A.

Right.

11

13:16:22 11

Q.

And then outside of the chair council you

12

13:16:24 12 saw him sporadically?

13

13:16:26 13

14

13:16:31 14 gathering once in a while when the previous chief

15

13:16:36 15 medical officer left.

16

13:16:39 16

Q.

Dr. Kolb?

17

13:16:40 17

A.

Yeah, Dr. Kolb.

18

13:16:45 18 Bryan's house, and I think another time we were

19

13:16:49 19 together at Dr. Martin's house.

20

13:16:52 20

21

13:16:58 21 your interactions with Dr. Jadwin?

22

13:17:01 22

23

13:17:07 23 don't think we had any close social interactions.

24

13:17:14 24 And he doesn't have any residency program, and none

25

13:17:19 25 of our residents, they have to go through his

A.

Q.

A.

Sporadically for -- we had some social

We gathered at Peter

How were your -- how would you characterize

Mostly professional interactions, and I

YooT

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1

13:17:22

1 service, other than some care coordination issues in

2

13:17:27

2 the lab testing.

3

13:17:31

3 testing for our patients in emergency room.

4

13:17:39

4

5

13:17:43

5 interaction with Dr. Jadwin at any time?

6

13:17:46

6

A.

No.

7

13:17:46

7

Q.

Okay.

8

13:17:51

8

A.

Well, I learned he was at the same hospital

9

13:17:56

9 working in Michigan, I was chairman of Henry Ford

Q.

Okay.

I wanted him to have some drug

Did you ever have an unpleasant

Did you like Dr. Jadwin?

10

13:18:02 10 Hospital for quite some time, and overall I was with

11

13:18:08 11 Henry Ford about 23 or -4 years, and the last eight

12

13:18:18 12 to ten years I was doing outside joint venture work

13

13:18:23 13 between Henry Ford Health System and Emergency Health

14

13:18:29 14 Services as vice president of behavior services.

15

13:18:33 15 while I was out doing those work handling several

16

13:18:40 16 hospitals, he was at Henry Ford Hospital.

17

13:18:44 17 didn't know him, and I knew he was there only when we

18

13:18:50 18 worked together here.

19

13:18:51 19

20

13:18:54 20 Dr. Jadwin at Henry Ford Hospital?

21

13:18:57 21

A.

No.

22

13:18:57 22

Q.

Okay.

23

13:19:04 23 right?

24

13:19:05 24

A.

No reason to dislike.

25

13:19:06 25

Q.

Okay.

Q.

Oh.

So

So I

So did you hear anything about

You don't dislike Dr. Jadwin then,

So as far as you're concerned when

YooT

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1

13:21:13

1 less-than-professional conduct by some residents?

2

13:21:17

2

A.

Uh-huh.

3

13:21:19

3

Q.

Okay.

4

13:21:22

4 question, that was a yes?

5

13:21:24

5

A.

Repeat the question again.

6

13:21:25

6

Q.

Sure.

7

13:21:27

7

8

13:21:30

8 less-than-professional conduct by nurses against

9

13:21:33

9 certain residents, correct?

So that's a yes, correct?

To my last

So what you heard was some complaints of

10

13:21:35 10

A.

Right.

But none necessarily directly what

11

13:21:40 11 you described, F words, like that.

12

13:21:42 12

Q.

Right.

13

13:21:46 13

A.

No.

14

13:21:47 14

Q.

Not even similar?

15

13:21:48 15

A.

Uh-huh.

16

13:21:49 16

Q.

Okay.

17

13:21:57 17 meetings did you witness -- you saw Dr. Jadwin, you

18

13:22:00 18 said, once a month at the chair council meetings?

19

13:22:03 19

A.

Right.

20

13:22:03 20

Q.

Did you ever witness Dr. Jadwin doing

21

13:22:05 21 anything unprofessional or inappropriate in a chair

22

13:22:08 22 council meeting?

23

13:22:11 23

A.

I do not recall.

24

13:22:20 24

Q.

You saw him 12 times a year at the chair

25

13:22:23 25 council meetings, right?

But similar?

But similar?

Now, at any of the chair council

YooT

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1

13:27:58

1

Q.

Okay.

2

13:27:59

2

A.

And I'm responsible for all the medical

3

13:28:03

3 services in psychiatry at both system.

4

13:28:10

4

5

13:28:14

5 spend during working hours at Kern Medical Center?

6

13:28:25

6

7

13:28:32

7 responsibilities.

8

13:28:40

8 any physicians -- full-time physicians to spend

9

13:28:44

9 minimum 40 hours, and we usually spend roughly about

Q.

A.

Okay.

So how much time do you physically

It's fluctuating depending on overall Our county contract stipulates for

10

13:28:52 10 50 or 60 hours plus altogether per week, and I split

11

13:29:00 11 the time between.

12

13:29:02 12

13

13:29:06 13 Medical Center?

14

13:29:07 14

A.

Sometimes more.

15

13:29:07 15

Q.

Sometimes more.

16

13:29:10 16

A.

Yeah, uh-huh.

17

13:29:13 17 full-time job --

18

13:29:14 18

Q.

Right.

19

13:29:14 19

A.

-- when you are responsible for two

20

13:29:16 20 agencies.

21

13:29:16 21

22

13:29:32 22 became ill and just couldn't work because you're sick

23

13:29:36 23 and you need to recover, what would you do?

24

13:29:40 24

25

13:29:49 25 leave and our -- Kern Medical Center or Kern County

Q.

Q.

A.

So you spend 25 to 30 hours a week at Kern

Okay. And it's more than one

So if you had to be absent from -- if you

Then I would take medical leave or sick

YooT

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Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

94 Page 116 of 209

ss.

3 4

Sandra L.

I,

5

Edmonson,

a Certified Shorthand

6

Reporter in the State of California, holding Certificate

7

No.

8

witness named in the foregoing deposition,

9

duly sworn; that said deposition was taken Thursday,

7704,

do hereby certify that TAl YOO, M.D.,

10

August 21,

11

first page hereof.

12

2008,

the

was by me

at the time and place set forth on the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I

further certify that I am neither counsel for

18

nor in any way related to any party to said action,

19

in any way interested in the result or outcome thereof.

20 21

Dated this 4th day of September, Bakersfield,

2008,

at

California.

22 23

Sandra L.

Edmonson,

24 25

WOOD & RANDALL (800) 322-4595

CSR No.

7704

nor

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 47

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

52

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1

1

2

2

METROPOLITAN DIVISION

3

3

---------

4

4

Page 118 of 209 1

SUPERIOR COURT OF CALIFORNIA, COUNTY OF KERN

DAVID F. JADWIN, D. O.

) Volume 1 )

5

5

Plaintiff,

) ) Case No. 1:07-CV-00026-OWW-TAG

6

6

) vs.

7

)

7

) COUNTY OF KERN, et. al., )

8

8

) Defendants.

9

9

10

10

11

11

12

12

13

13

14

14

15

15

16

16

17

17

18

18

19

19

20

20

21

21

22

22

)

_________________________)

VIDEOTAPED DEPOSITION OF PHILIP DUTT, M.D. Wednesday, August 20, 2008 Bakersfield, California

Reported by:

Cindee L. LeFevre, CSR No. 7974

23 24

23

25 26

24

27 28

25

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09:28:32 1 director,

A.

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I'm a pathologist, I'm the laboratory

2 09:28:36

2

and the interim Chair of pathology.

09:28:40

3

Q.

You have been interim chair since when?

09:28:46

4

A.

Friday, I believe it was July 14 of 2006.

09:28:52

5

Q.

July 14, 2006?

09:28:54

6

A.

Yes.

09:28:56 7 you 09:28:59 8 09:29:03 9 09:29:04 10 needed

Q.

How did you -- how were you made aware that

3 4 5 6 7 8 9 10 11

were the interim chair of the Department of Pathology at Kern Medical Center? A. There was a meeting in which they said they

12 09:29:08 11

a laboratory director, and they asked me to become a

09:29:13 12

laboratory director.

13 14 09:29:14 13

Q.

Who is they?

09:29:15 14

A.

Irwin Harris, Sandy Chester, and David Hill.

09:29:22 15

Q.

What was this meeting?

09:29:24 16

A.

Pardon me.

09:29:25 17 special 09:29:28 18 09:29:31 19 09:29:32 20 09:29:34 21 09:29:37 22 09:29:40 23 discussed

Q.

You say there was a meeting.

15 16 17 18 19 20 21 22 23 24 25

Was this a

meeting just for you or was this a regularly scheduled meeting? A. It was not a regularly scheduled meeting. Q. So this was a meeting just for the purpose of appointing you director, interim chair? A. That was not the only purpose. We also

26 09:29:43 24 27 28

09:29:48 25

bringing back Dr. Liu as another pathologist. Q.

Dr. Fang Luo Liu?

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09:45:16 Dr.

1

it would cause unnecessary anxiety.

Why did you tell

09:45:20

2

Jadwin that his case was being investigated?

2 3 4 5

09:45:23 3 the 09:45:26 4 pathologist.

A. situation.

I said that -- I think I said it depends on So you might not want to tell the

6 7 8 9

09:45:32 decide 09:45:36 09:45:37 said

5 6 7

Q.

What about Dr. Jadwin's case.

Why did you

to tell him? A. Because he asked to look at the slides, and I

10 11 12 13 14

09:45:41 8 slides to 09:45:46 9 09:45:49 10 09:45:52 11 Dr.

it's going to go for peer review, and I wanted the

09:45:58 12

Shertukde was right, but it could have involved her, it

09:46:02 wanted 09:46:05 09:46:07 09:46:11 09:46:13 09:46:14 09:46:16 review

13

could have involved him.

14 15 16 17 18 19

the slides to be secure. Q. Okay. But Dr. Jadwin was asking for access to those slides. Isn't that what you just said? A. He wanted to see the slides. Q. Did you give him access? A. No. I told him the case was going for peer

be locked up until they were sent for peer review. Q. Locked up from Dr. Jadwin too? A. Not necessarily from him. I mean, I thought

15 16 17 18 19 20 21 22 23

I just wanted the case -- I

24 25 26 27 28

09:46:20 20 09:46:22 21 one of 09:46:24 22 09:46:27 23 originating 09:46:31 24 09:46:34 25 protect

and that was the reason he couldn't have the slides. Q. I don't understand. I thought peer review, the missions was to educate the originating pathologist. Why wouldn't you want to show the slides to the pathologist? That's not part of peer review? A. The purpose of peer review primarily is to

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09:46:37 1 09:46:37 2 09:46:41 3 protecting

patients. Q. I see. So how was locking up the slides preventing or denying Dr. Jadwin access to them

09:46:42

patients?

4 4

5 6 7 8 9 10 11 12

09:46:43 5 purpose 09:46:46 6 09:46:50 7 09:46:52 8 09:46:53 9 09:46:54 10 09:46:57 11 that

A.

I wasn't denying Dr. Jadwin access.

The

was not to -Q. Well, did you give him access to the slides? A. No. Q. Why not? A. Because I wanted the slides to be secure and locked up. Pathologists frequently will lock up slides

13 14 15 16

09:47:02 12 doing. 09:47:07 13 09:47:07 14 legal

might have a legal implication.

09:47:11 15

implication.

09:47:11 16

Q.

What's that legal implication?

09:47:14 17 lawsuit 09:47:17 18 or

A.

Well, if you know there is going to be a

Q. A.

That's what I was

Uh-huh. I was doing it because there was a potential

17 18 19 20 21

about a case or an autopsy, there are certain evidence

22 23 24

09:47:22 19 so 09:47:27 20 trained to

potential evidence that you don't want to get lost, and

09:47:33 21

do in terms of locking up potential evidence.

it's -- I just sort of did it as what I have been

25 26 09:47:36 22

Q.

So you were acting as an attorney not as

27 28

09:47:40 23 09:47:40 24 09:47:42 25

pathologist? A. I did not say that. Q. You said you were looking up evidence with

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09:48:51 09:48:51 said.

1 2

sufficient. MR. WASSER:

09:48:53

3

BY MR. LEE:

09:48:54 was 09:48:57 evidence

4

Q.

5

a possibility of legal liability and you wanted the

09:48:59 have 09:49:03 09:49:16 09:49:18 about

6

locked up.

7 8 9

interfered with that process? A. I'm not sure. Q. Now, what legal liability are you talking

09:49:21 a 09:49:26 09:49:28 09:49:29 lawsuit

10

with regard to case SO6-4131?

11 12 13

letter threatening suit? A. No. Q. So what legal liability was there?

I need to remind you of what he

3 4 5 6

Doctor, the question is how -- you said there

7 8 9 10 11

How would Dr. Jadwin's viewing the slides

12 13 14 15 16

Did the patient send you

What

17 09:49:33 14

was being pending or threatened?

18 19 20 21 22 23 24 25

09:49:35 15 Dr. 09:49:42 16 09:49:48 17 09:49:54 18 09:50:02 19 09:50:05 20 09:50:07 21 liability in

A. Shertukde either he needed an Q. answer? A.

Well, Dr. Jadwin had told me and others that had made a mistake. So it seemed to me that or she was wrong, and, therefore, I thought we outside opinion to see who was right. Okay. So where's the legal liability in that Well, because there's potential legal

26 27 28

09:50:09 09:50:12 there 09:50:16 09:50:18

22 23

terms of an incorrect diagnosis. Q. So whenever a pathologist makes a mistake,

24 25

is legal liability? A. I'm not sure.

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10:07:10 10:07:11 got

1 2

to be too much. Q. It got to be too much.

10:07:15

3

too disappointed in Dr. Jadwin?

10:07:18

4

A.

That was part of it.

10:07:19

5

Q.

What were you disappointed in?

10:07:32 his 10:07:38 10:07:43 pressure

6

A.

Well, he just quit working, and he dumped all

In other words, you

3 4 5 6 7 8 9

7 8

work on Dr. Shertukde and me. Initially, he was pressure -- trying to

10 11 12

10:07:45 9 an 10:07:53 10 take

the medical staff and the administration into giving him

10:07:58 11

a leave of absence.

apology by taking a leave of absence or threatening to

13 14 10:07:59 12

Q.

How do you know that?

10:08:00 13

A.

Because he told me.

10:08:01 absence 10:08:04 10:08:12 10:08:17 upset

Q.

He told you, I'm going to take a leave of

15 16 17 18 19 20

14 15 16 17

to pressure the administration to apologize? A. What he said was I'm going to take a leave of absence. That occurred in the context where he was

21 22 23 24

10:08:20 18 tumor 10:08:25 19 10:08:30 20 take

about a letter he had received regarding the October

10:08:34 give 10:08:37 10:08:39 10:08:41 10:08:43 in

21

a leave absence in order to force the administration to

22 23 24 25

me an apologyIs that what he said? A. He didn't use those exact words. Q. But did he say something to that effect? A. He said I'm going to take a leave of absence

conference, and he kept saying all I want is an apology. Q. So he didn't say the exact words I'm going to

25 26 27 28

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I just needed to inform them.

Page 124 of 209 290

16:31:06 started

1

going.

It initially

16:31:09 and 16:31:14 16:31:17 16:31:20 make

2

out as a hostile work environment, harassment concern,

3 4 5

then, quality concerns came up. Q. Did you submit -- how did you initiate this meeting? Did you send an e-mail to somebody or did you

16:31:24

6

phone calls?

16:31:24

7

A.

No, I talked to Dr. Harris.

16:31:26 8 if 16:31:30 9 16:31:36 10 16:31:40 11 16:31:42 12 16:31:45 13 16:31:46 14 environment

Q.

Okay.

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

And what was decided at that meeting,

anything? A. I just informed Dr. Harris that there were problems and -Q. You mean problems with Dr. Jadwin; right? A. Yes. Q. Dr. Jadwin was creating a hostile work

17 16:31:50 15

and was harassing people?

18 16:31:53 16

A.

That was my concern at the time.

16:31:54 17 harassment 16:31:58 18 16:32:01 19 I

Q.

And at this meeting you discussed his

19 20 21 22

of Vangie Gallegos? A. At the meeting itself?

I discussed complaints

23 16:32:06 20

had received from both Dr. Shertukde and from Vangie.

24 16:32:10 21

Q.

Any other complaints?

16:32:14 some 16:32:17 16:32:19 issue? 16:32:24

A.

And then I was -- at that meeting, I raised

25 26 27 28

22 23 24 25

concerns about the diagnoses. Q. So his competence as a pathologist was at A.

Or that he was issuing certain diagnoses to

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16:40:41

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1

would say, I have to go to Los Angeles or he would have

16:40:44

2

go to the gym.

16:40:49

3

to 2 He made it difficult to talk to him.

3 Q.

So you thought it easier to assign it to the

4

Peer

5

16:40:53

4

6

16:40:53

5

A.

I didn't say that.

7

16:40:55

6

Q.

Then why didn't you keep it in the department?

8

16:40:55

7

A.

Because Dr. Jadwin would avoid conversations.

9

16:40:58

8

Q.

So, therefore, you thought it would be better

Review Committee?

to 10 16:41:01

9

send it to Peer Review Committee?

11 16:41:03 10

A.

I didn't think better.

It was the only option

12

I

13

16:41:05 11

14

16:41:06 12

Q.

You had no other choice?

15

16:41:07 13

A.

Right.

16

16:41:08 14

Q.

Did you discuss your decision to send cases to

17

16:41:13 15

18

16:41:15 16

19

16:41:16 17

20

16:41:21 18

21

16:41:22 19

22

16:41:23 20

23

16:41:27 21

24

16:41:28 22

25

16:41:30 23

had.

peer review with Dr. Jadwin at any point? A.

Well, I mentioned to him the original prostate

case was going to be peer reviewed. Q.

By the Peer Review Committee.

You told him

that? A.

No, by -- at that time, it was going to be

reviewed by an expert. Q.

Within the -- I'm talking about the procedure.

Within the department, according to the Department's

peer 26 16:41:34 24

review proceedings or did you tell him that.

27 28

16:41:36 25

A.

No.

I mean, two of us thought one thing, the

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16:41:40 it

1

other person thought another thing.

So it was obvious

16:41:44

2

was going to go to an outside expert.

16:41:47 Peer 16:41:50 16:41:54 16:41:54 out

3 4 5 6

Review Committees or was this still department peer review? A. It was neither. I mean, I just wanted to find

16:41:59

7

Dr. Epstein's opinion.

16:42:00

8

16:42:02

9

2 3 4 5 6 7

Q.

Okay.

And this is under the auspices of the

8 9 Q.

Okay.

And this is the case where you denied

10 Jadwin, Dr. Jadwin access to the slides?

11 16:42:06 10

A.

We went over this this morning.

16:42:09 11 right? 16:42:10 12 locked

Q.

I'm just making sure.

A.

I didn't deny him access.

16:42:14 14

Q.

When he asked to see the slides, you said no?

16:42:17 15 not 16:42:20 16 16:42:21 17 him

A.

I told him the slides were locked up and I did

12 13 14

That's this case; I had the slides

15 16:42:14 13

up.

16 17 18 19 20

give him the slides. Q. What's the difference when I said you denied

21 16:42:24 18

access.

16:42:26 19

A.

What's the difference?

22 I was denying everybody access.

I wanted the

23 16:42:29 20

slides locked up.

24 16:42:30 21

Q.

Including Dr. Jadwin; right?

16:42:32 22

A.

And including Dr. Shertukde.

16:42:34 23

Q.

What was Dr. Shertukde's complaint that you

25 26 27 28

16:42:38 24 16:42:41 25 to

presented at the first meeting in November, 2006? A. She had been asking me in late October to go

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w Page 351 1

I

COUNTY OF KERN

N

o

3 4

E

I, Cindee L. LeFevre, a Certified Shorthand

5

Reporter in the State of California, holding certification

6

No. 7974, do hereby certify that PHILIP LEE DUTT, M.D.,

7

the witness named in the foregoing deposition,

8

was by me duly sworn; that said deposition was taken

9

Wednesday, August 20, 2008, at the time and place set forth

10 11

on the first page hereof. That upon the taking of the deposition, the

12

words of the witness were written down by me in stenotypy

13

and thereafter transcribed by computer under my supervision;

14

that the foregoing is a true and correct transcript of the

15

testimony given by the witness.

16

I further certify that I'm neither counsel for

17

nor in any way related to any party to said action, nor in

18

any way interested in the result or outcome thereof.

19

Dated this 10th day of September, 2008, at

20

R

o

STATE OF CALIFORNIA ss.

2

o

Bakersfield, California.

21 22 23 Cindee L. LeFevre,

24 25

vs.

COUNTY (800) 322-4595

X

Case 1:07-cv-00026-OWW-TAG

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EXHIBIT 48

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

53

Case 1:07-cv-00026-OWW-TAG

From: To: O",te: S"-bjeet:

Document 277-4

Filed 12/01/2008

Page 129 of 209

Karen Barnes Philip Dutt, MD 9114/2006 1:14:54 PM Re: Dr. Jadwin's contract (cont'd)

I have made the requested changes to his job description, both your's and Irwin's, and attached the revised amendment. let me know if further changes are necessary. I need to talk with you and Irwin about a strategic matter related to the amendment. Are you available this aftemoon before 4 p.m.? Jadwin can do whatever his contract says he can do, subject to the policies of the county and the needs of the department. I know that's not the answer you want to hear; however, I do not believe(~-------" ----_.------'

His use of educational leave is subject to approval in advance. His first obligation is to staff the department. rm not sure how Rae books the CME days. You may want to ask her before pursuing this further. .

»> Philip Dutt, MD 911412006 8:06:21 AM »> I think we should add to the job description that when he is on call on weeknights or weekends that he is able to come to the hospital within 30 minutes if needed. This is a fairly standard expectation of pathologists nation wide. Also, KMC is a trauma center, and one of the trauma surgeons called me recently to confirm that the pathologist on call can come to the hospital within 30 minutes; this apparently is one of their requirements to be a trauma center. Article 1II.3.B., page 8: Will Dr. Jadwin be allowed to take off days without pay, as he did in 2005, orwill he be restricted to 20 days of vacation per year like everyone else? Article III.3.D.,page 8-9: Should his CMEleducationalleave be prorated over an entire year, or will he be allowed to take 10 days off for CME between now and December 31? Thank You, Philip Dutt Pathologist Lab Kern Medical center [email protected]

* * * *** * * * * CONFIDENTIALITY STATEMENT ** ** ** ** ** This message is intended only for the use of the individual or entity to which it is addressed and may contain infonnation that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of the communication is strictly prohibited. If you received this communication in error, please notify us immediately by telephone and return the original message to us at the E-mail address above. Thank you

CC:

Irwin Harris, MD; Rae McDonald

0000830

Case 1:07-cv-00026-OWW-TAG

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54

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Document 277-4

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Page 1 of 1 Page 131 of 209

-

David Jadwin, DO Pathology Look Back Study From: To: Subject: CC:

David Jadwin, DO Peter Bryan Pathology Look Back Study Gene Kercher; Susie Price

Peter: We have discovered a series of serious diagnostic errors committed by a former pathologist working at KMC over a period of years. These errors involve the failure to identify frankly invasive adenocarcinoma in several prostate needle biopsies. A multi-year look back study will need to be undertaken. I have identified 95 prostate specimens in the HBO system of which only 10% are malignant. Of prostate needle biopsies, only 8.6% are malignant.

The expected rate of malignant biopsies is O h . I am pulling all of these slides, the path history and all subsequent PSAs to determin followup status. David

DFJ00589

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55

Untitled

04/19/2006 12:30 PM

Case 1:07-cv-00026-OWW-TAG

Document 277-4

j Reminder: AOL will never ask you to send us your password or credit card number in an email. I !(

Filed 12/01/2008

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This message has been scanned for known viruses.

Prom: •

David Jadwin, DO

i

_o:

Peter Bryan

\

i

Cc:

[email protected], Karen Barnes

I

;

1

Subject:

Cytology Screening at KMC

i

Date:

Thu, 2 Mar 2006 11:36:58-0800

]

Peter: A couple years after I arrived at KMC, Gilbert and I elected to not offer a full time position to the cytotech that had worked at KMC for a couple of years as a temporary employee. There were some ethical issues involved and I discovered on retrospective review that the cytotech was missing several high grade lesions and calling them negative. I received a lot of harsh criticism from the gynecologists and the radiologists. There was a lot of hard feelings in other areas as well. Some time later, Dr. Schmalhorst from Physicians Automated Laboratory harshly said that cytotech was one of the best, he had seen. Leonard Perez told me last week that PAL sent a notice out to all of their clients stating that they had to let their cytotech go because of several missed high grade lesions; and they mentioned that they were going to have to rescreen several past months (years?) of pap smears. On another issue, I have not received a response from you regarding the need to rescreen 50 prior prostate needle biopsies from a. former KMC pathologist. What do you want me to do? David

Exhibit 271 Cindee L LeFevre, CSR # 7974

08/14/08 Peter Bryan, CEO

Pa^lj DFJ00750

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56

Case 1:07-cv-00026-OWW-TAG

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Page 135 of 209

From: Peter Bryan To: [email protected] Cc: Irwin Harris, MD Sent: Fri, 21 Apr 2006 12:46:16 -0700 Subject: Re: Fwd: Cytology Screening at KMC Work through Irwin Harris on the need for a review of the cases. I have alerted him to the issue so he will help with what ever the appropriate process should be. It could be that he will suggest that you also take the issue to the Quality Management Committee for their information, but I will leave that to the two of you to decide. »> 4/19/2006 12:30:17 PM »> -----Original Message----From: David Jadwin, DO <[email protected]> To: Peter Bryan Cc: [email protected]; Karen Barnes Sent: Thu, 2 Mar 2006 11:36:58 -0800 Subject: Cytology Screening at KMC Peter: A couple years after I arrived at KMC, Gilbert and I elected to not offer a full time position to the cytotech that had worked at KMC for a couple of years as a temporary employee. There were some ethical issues involved and I discovered on retrospective review that the cytotech was high grade lesions and calling them negative. I received a lot of harsh criticism from the gynecologists and the was a lot of hard feelings in other areas as well.

missing several

radiologists. There

Some time later, Dr. Schmalhorst from Physicians Automated Laboratory that cytotech was one of the best he had seen.

harshly said

Leonard Perez told me last week that PAL sent a notice out to all of their clients s~ating that they had to let their cytotech go because of several missed high grade lesions; and they mentioned that they were going to have to rescreen several past months (years?) of pap smears. On another issue, I have not received a response from you regarding the need to rescreen 50 prior prostate needle biopsies from a former KMC pathologist. What do you want me to do? David 12

DFJ00799

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57

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

SAVITA PRASAD SHERTUKDE, M.D.

17

Thursday, August 7, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

ShertukdeS

Page 137 of 209 1

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-4

Filed 12/01/2008

1

13:29:03

1

2

13:29:05

2 Dr. Jadwin at Kern Medical Center?

3

13:29:06

3

A.

No, I did not.

4

13:29:08

4

Q.

Why is that?

5

13:29:09

5

A.

I don't understand.

6

13:29:16

6

Q.

Okay.

7

13:29:18

7 about Dr. Jadwin to Kern Medical Center?

8

13:29:21

8

9

13:29:22

9 submit any complaint.

A.

Page 138 of 209 25

Did you ever submit any complaints about

I didn't --

Why did you not submit any complaints

Because there wasn't any reason for me to

10

13:29:25 10

Q.

You weren't terrified of him?

11

13:29:28 11

A.

Not -- not before this incident.

12

13:29:31 12

Q.

Okay.

13

13:29:34 13 you submit -- you didn't submit any complaints about

14

13:29:36 14 Dr. Jadwin at or around the incident in October 2005?

15

13:29:39 15

16

13:29:42 16 scared, but I -- I didn't submit a formal complaint,

17

13:29:48 17 like, you know.

18

13:29:51 18 you know, and --

19

13:29:52 19

20

13:29:55 20 about Dr. Jadwin scaring you at around the incident

21

13:29:58 21 in October 2005 --

22

13:29:59 22

A.

It just didn't seem like, you know --

23

13:30:00 23

Q.

Sorry.

24

13:30:02 24

25

13:30:04 25 2005?

A.

Q.

What about after the incident?

I told Dr. Dutt.

Did

I told Dr. Dutt that I'm

I told Dr. Dutt I'm scared, like,

Why didn't you submit a formal complaint

Just let me finish.

At or around the incident of October of

ShertukdeS

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 139 of 209 42

1

13:49:07

1 know.

2

13:49:07

2

Q.

What did he do to you?

3

13:49:10

3

A.

This is what he did.

4

13:49:13

4 a clinician.

5

13:49:15

5 clinician.

A surgeon, like, you know, he's

6

13:49:18

6 important.

Dr. McBride used to run the oncology

7

13:49:21

7 conference.

8

13:49:23

8 clinician.

9

13:49:26

9 you know, we are -- like, you know, all of us, like,

He basically called up

Like, you know, it's important

Like, you know, it's an important And we want to be on good terms, like,

10

13:49:27 10 work here, like, you know.

11

13:49:30 11 like, you know, say something like that about us,

12

13:49:32 12 like....

13

13:49:34 13

14

13:49:36 14 with regard to the radical prostatectomy case, that

15

13:49:39 15 was completely wrong.

16

13:49:44 16

A.

Yeah.

17

13:49:48 17

Q.

Do you recall whether that patient

18

13:49:50 18 eventually had a prostatectomy or not?

19

13:49:53 19

20

13:49:55 20 refused after that for a prostatectomy.

21

13:49:59 21 I heard during oncology conference.

22

13:50:03 22 presented.

23

13:50:03 23

Q.

Again?

24

13:50:03 24

A.

Not -- that prostatectomy -- not the

25

13:50:06 25 prostatectomy.

Q.

A.

You know, trying to,

So in your opinion, Dr. Jadwin's behavior

Right?

No.

Dr. Jadwin was wrong, yeah.

The patient did not.

The patient That's what

This case got

The needle biopsies got presented.

ShertukdeS

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-4

Contract.

Filed 12/01/2008

Page 140 of 209 203

1

17:13:50

1

I think my contract will get

2

17:13:52

2 renewed if I get an evaluation from my peers, like,

3

17:13:58

3 you know, one of the two peers or somebody else in

4

17:14:00

4 the hospital or somebody who is aware of my work,

5

17:14:05

5 like, you know, a permanent physician at present.

6

17:14:09

6 Like, I have a permanent contract, you know.

7

17:14:13

7 within the -- within the -- I'm not on a one-year

8

17:14:17

8 contract.

9

17:14:27

9

Q.

What do you mean by permanent contract?

10

17:14:29 10

A.

It's valid.

11

17:14:31 11 few years.

12

17:14:34 12 have to validate it.

13

17:14:37 13 valid up to a certain date.

14

17:14:39 14

Q.

Okay.

15

17:14:44 15

A.

And then you have to validate it.

16

17:14:46 16 what I know, like, you know.

17

17:14:51 17

18

17:14:52 18 we been on the record?

19

17:14:57 19

MR. LEE:

20

17:15:01 20

THE REPORTER:

21

17:15:04 21

MS. BARNES:

22

22

23

23 off --

I am

I have a permanent contract.

You have to validate it every

I don't -- two years or three years you

MS. BARNES:

It's valid.

MR. LEE:

My contract is

That's

Madam Reporter, how long have

Do you want to go off the record? I can check for sure. Are you just about finished?

Getting very close.

24

17:15:10 24

MS. BARNES:

25

17:15:11 25 That's why I'm asking.

But we can go

We're approaching four hours.

ShertukdeS

Case 1:07-cv-00026-OWW-TAG

Document 277-4

MR. LEE:

Okay.

Filed 12/01/2008

Page 141 of 209 204

1

17:15:12

1

2

17:15:15

2 finished.

3

17:15:21

3

4

17:15:22

4 and see.

5

17:15:22

5

6

17:15:27

6 BY MR. LEE:

7

17:15:33

7

8

17:15:36

8 every few years, as you say?

9

17:15:38

9

A.

Yeah.

10

17:15:39 10

Q.

So why would -- can you think of any reasons

11

17:15:42 11 why your contract would not become -- would not be

12

17:15:46 12 validated at any particular time?

13

17:15:47 13

14

17:15:49 14 shouldn't be validated.

15

17:15:51 15

16

17:15:53 16 mistakes like Dr. Jadwin and engaging in all sorts of

17

17:15:56 17 incompetence?

18

17:15:59 18 then not be validated or --

19

17:16:01 19

20

17:16:03 20 colleagues or from Dr. Dutt or from, you know, like

21

17:16:07 21 the CMO or the CEO, like, you know.

22

17:16:11 22 about it.

23

17:16:12 23

24

17:16:20 24 non-core physician?

25

17:16:20 25

MS. BARNES:

MR. LEE:

Q.

A.

Okay.

Q.

A.

Okay.

We'll go on.

I don't think of any reason why it

Okay.

A.

We'll go another five minutes

So your contract is self-validating

No.

Q.

We're very close to

Well, what if you were really making

No.

Would you then -- would your contract

Okay.

I would know about it from my

I would know

What's a core physician versus a

A core physician is what -- a non-core

ShertukdeS

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-4

Filed 12/01/2008

Page 142 of 209 206

1

17:17:17

1

2

17:17:21

2 a self-validating contract like yours?

3

17:17:24

3

A.

Non-core physicians?

4

17:17:25

4

Q.

They don't get permanent contracts.

5

17:17:28

5

A.

They become permanent.

6

17:17:30

6 physicians after a year.

7

17:17:31

7

8

17:17:34

8 you're becoming a permanent physician.

9

17:17:36

9

A.

That's right.

10

17:17:37 10

Q.

And you get a permanent contract.

11

17:17:39 11

A.

Yeah.

12

17:17:40 12

Q.

Permanent contract just like yours.

13

17:17:43 13

A.

Yeah.

14

17:17:44 14

Q.

Okay.

15

17:17:46 15 physician -- core physicians expect to continue

16

17:17:49 16 working at Kern Medical Center for the rest of their

17

17:17:52 17 careers.

18

17:17:53 18

19

17:17:56 19 contract.

20

17:17:58 20 departments probably have a five-year contract.

21

17:18:00 21

Q.

Okay.

22

17:18:01 22

A.

Or some people have a four-year contract,

23

17:18:05 23 some people have a three-year contract, things like

24

17:18:07 24 that.

25

17:18:08 25

Q.

Now, do -- non-core physicians, do they get

Okay.

Right?

They become core

So when you become a core physician, Correct?

Correct?

Right?

And then you expect that as a core

Correct?

A.

Q.

No, they don't.

No.

I think many of them have certain years

Like some people, like, you know, heads of

Okay.

So you think there's a difference

ShertukdeS

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

220 Page 143 of 209

STATE OF CALIFORNIA ss. COUNTY OF KERN

I,

Susan R. Wood, a Certified Shorthand

Reporter in the State of California, holding Certificate No.

6829, do hereby certify that

SAVITA PRASAD SHERTUKDE, M.D., the witness named in the foregoing deposition, was by me duly sworn; that said deposition was taken Thursday, August 7,

2008,

at the

time and place set forth on the first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action, nor in any way interested in the result or outcome thereof. Dated this 15th day of August,

2008,

at

Bakersfield, California.

WOOD & RANDALL (800) 322-4595

----------------_41

Case 1:07-cv-00026-OWW-TAG

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EXHIBIT 53

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

58

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 145 of 209 549

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

DAVID F. JADWIN, D.O.,

) VOLUME IV ) Page 549 Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) COUNTY OF KERN; et al. ) ) ) Defendants. ) _______________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

DAVID FRANK JADWIN, D.O.

17

Tuesday, March 11, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

Reported by:

Susan R. Wood, CSR No. 6829

DFJ4

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

Q.

What is Exhibit 592?

2

A.

It's an e-mail that I sent expressing a

3

rather serious concern to the president of the

4

medical staff and to the CEO of medical -- of Kern

5

Medical Center.

6 7 8 9 10

Q.

And what was your serious concern that you

expressed in this memo? A.

I was very concerned that Dr. Ragland was

somehow impaired. Q.

11

Impaired.

12 13

What is -- what did you mean when you say impaired? A.

I think the -- the term relative to a

14

physician is that they may not be able to carry out

15

their duties appropriately.

16 17

Q.

And your reasons for believing that way are

set forth in this memo?

18

A.

This and the e-mail that was attached, yes.

19

Q.

There was an e-mail attached to this?

20

A.

I believe so, yes.

21

Q.

What was the e-mail that was attached?

22

A.

We've actually reviewed that in a past

23 24 25

session. Q.

Fine. Tell me what it is, sir.

DFJ4

Page 146 of 209 618

Case 1:07-cv-00026-OWW-TAG

1

Q.

2 A.

4

I showed him the e-mail.

Do you want to spell his name,

MR. WASSER:

Yeah.

Let's spell his name,

please. THE WITNESS:

T-a-i Y-o-o.

BY MR. WASSER:

10 11

Yes, I did.

please.

8 9

Tai Yoo.

MR. LEE:

6 7

Filed 12/01/2008

You talked to Dr. Tai Yoo?

3

5

Document 277-4

Q.

Is he -- and what was his position at that

time?

12

A.

He was the chair of psychiatry.

13

Q.

All right.

14

A.

So I didn't do this on a lark.

I actually

15

went to the chair of psychiatry and expressed my

16

concern with him, and he agreed that there was

17

some -- some worrisome features here.

18

Q.

Some worrisome?

19

A.

Worrisome features.

20

Q.

And that's why you wrote this memo that

21 22 23

we've marked as Exhibit 592? A.

I think physicians have an obligation to

report possible impaired physicians, yes.

24

Q.

They do?

25

A.

Yes, they do.

DFJ4

Page 147 of 209 621

Case 1:07-cv-00026-OWW-TAG

1 2

Q.

Document 277-4

Filed 12/01/2008

Do physicians have an obligation to report

anything else?

3

MR. LEE:

That's overbroad.

4

THE WITNESS:

5

I -- I don't know what you mean by that, but

Yeah.

6

I do know that physicians -- there have actually

7

been, I believe, cases that I've heard about where

8

physicians were sued because someone was practicing

9

in an aberrant way and the medical staff didn't do

10

anything about it when they should have.

11

BY MR. WASSER:

12 13

Q.

Things like -- like making mistakes, things

of that nature?

14

A.

Yes.

15

Q.

Physicians have a duty to report that kind

16

Um-hmm.

of thing, don't they?

17

MR. LEE:

And it's overbroad, vague and

18

ambiguous, and it calls for a conclusion.

19

BY MR. WASSER:

20

Q.

You can answer, sir.

21

A.

During a joint commission inspection of the

22

hospital several years ago, the inspector actually

23

asked the question, what do you do if you see someone

24

who may be impaired down the hall?

25

because you do have an obligation to report -- that's

And it was a test

DFJ4

Page 148 of 209 622

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

a serious quality issue.

2

intoxicated, they're going to go into the operating

3

room or deliver a baby, that's a -- that's a serious

4

problem.

5 6

Q.

And you drew all those conclusions about

Dr. Ragland from the memo he wrote you?

7

MR. LEE:

8

THE WITNESS:

9

I mean, if someone's

all.

Misstates his testimony. I don't think I said that at

I said I had some concerns based upon the

10

pattern of his behavior, as expressed in words; plus

11

the lack of capability of expressing it, anything

12

above an eighth grade English level; that there may

13

have been -- you know, if someone was on drugs or

14

alcohol, they could well have typed or written

15

something like this.

16

I -- I don't know.

It was also, in my opinion, an inappropriate

17

tone in response.

It was a punishment or punitive

18

type of response, actually, to some very valid,

19

properly construed questions that I had written in my

20

e-mail.

21

Q.

To him?

22

A.

Yes.

23

Q.

So -- so part of your concern about

24

Dr. Ragland's e-mail was that you thought it was

25

retaliatory to you?

DFJ4

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1

you know, it's this, this, this, this.

2

make sense.

Filed 12/01/2008

It doesn't

3

Q.

Did you ever go just talk to Dr. Perticucci?

4

A.

I actually did talk to Dr. Perticucci after

5

the fact, after this letter.

6

Q.

After the letter?

7

A.

Actually -- well, I don't remember exactly,

8

but I did talk to Dr. Perticucci, and I explained the

9

situation to him.

And his response was, oh, I'm

10

sorry.

11

had just come directly to me I could have corrected

12

the problem within seconds.

13

Q.

14

letter?

15

A.

He was high strung.

I don't know.

But if he

You talked to him after you wrote your

I don't remember if it was before or after.

16

Probably afterwards.

17

the telephone, and it was apparently obvious to him

18

once I explained to him what had happened and why it

19

all made sense.

20

sorry.

MR. LEE:

25

I think we're going to want 30

days to correct the transcript.

23 24

And all he could say was, oh, I'm

And that was the end of it, so....

21 22

But I explained it to him on

MR. WASSER:

Whatever the rules call for,

Counsel. Let's mark this as our next one, please.

DFJ4

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w

o

STATE OF CALIFORNIA

R

ss.

D

COUNTY OF KERN

I

N D E

X I,

Susan R. Wood,

a Certified Shorthand

Reporter in the State of California, 'holding Certificate No.

6829,

DAVID FRANK JADWIN,

do hereby certify that

D.O.,

foregoing deposition,

the witness named in the

was by me duly resworn;

deposition was taken Tuesday,

March 11,

2008,

that said at the

time and place set forth on the first page hereof. That upon the taking of the deposition,

the

the witness were written down by me in stenotypy and thereafter transcribed by computer under my supervision;

that the foregoing is a true and correct

transcript of the testimony given by the witness. I

further certify that I am neither counsel for

in any way related to any party to said action,

nor

way interested in the result or outcome thereof. Dated this 31st day of March,

2008,

at

California.

Susan

~-N-o-.-6-8-2-9----

WOOD & RANDALL (800) 322-4595

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 54

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

59

;

/

I

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.KERN

~ • MEDICAL CENTER

HUMAN RESOURCES DEPARTMENT

Memorandum To:

Dr. Marvin Kolb, Chief Medical Officer

From:

Michael Ewald, Hospital Human Resources Director

Date:

October 21,2003

Re:

Confidential Report of Investigative Findings - Complaint of Dr. Chester Lau Against Dr. David Jadwin

Please find attached a confidential report of the Human Resources Department's investigation into a formal complaint by Dr. Chester Lau against Dr. David Jadwin.

I am available to discuss with you or anyone else you designate the findings and conclusions of this investigative report. Please do not hesitate to contact me at Extension 62339.

~/ Michael Ewald, SPHR Hospital Human Resources Director

Attachment xc:

Peter Bryan, Chief Executive Officer Linda Nipper, PHR, Hospital Employment Specialist

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• KERN MEDICAL • CENTER

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October 20,2003

--CONFIDENTIALREPORT OF INVESTIGATIVE FINDINGS

INVESTIGATION OF COMPLAINT BY DR. CHESTER LAU, DEPARTMENT OF RADIOLOGY AGAINST DR. DAVID JADWIN, DEPARTMENT OF PATHOLOGY At the request of Dr. Marvin Kolb, Chief Medical Officer, on October 8, 2003, the Human Resources Department began investigating Dr. Chester Lau's allegation that he was physically assaulted and intimidated by Dr. David Jadwin on August 9, 2003 in the Kern Medical Center Radiology Department. A fonnal complaint by Dr. Lau was made in a memorandum, dated August 12,2003, addressed to Dr. Javad Naderi, Chainnan of Department of Radiology, with a copy to Dr. Marvin Kolb, Chief Medical Officer. Dr. Lau's complaint concerns an August 9, 2003 incident where he alleges "unprofessional behavior" by Dr. Jadwin when Dr. Jadwin "grabbed" his tie with his hand and "dragged" him "several feet." Dr. Lau stated in his letter, "I felt that 1 lost my breath for a few seconds and 1 felt the sudden ripping force around my neck." He said that he "managed to regain (his) posture by pulling (his) tie out of his (Dr. Jadwin's) hand." Dr. Lau wrote, "During this incident, I felt physically threatened. Dr. Jadwin's behavior is not just inappropriate. His behavior is downright unprofessional and dangerous. I am formally filing a complaint regarding his unprofessional behavior." Complaint Investigated

Our investigation focused on the August 9, 2003 incident in an effort to determine whether there was sufficient credible evidence substantiating Dr. Lau's allegation that Dr. Jadwin, without provocation or warning, forcibly pulled on Dr. Lau's necktie, causing Dr. Lau to take several involuntary steps across the Radiology reading room into the Radiology hallway before Dr. Lau pulled his necktie out of Dr. Jadwin's hand. The investigation included an assessment as to whether the incident constituted a minor physical assault that could reasonably have created in Dr. Lau excessive, disruptive anxiety and short-termed neck pain during the incident. Specifically, the investigation sought to determine if there had been a Physical Assault (Minor) Level 3 violent act inflicted on Dr. Lau in Kern Medical Center in violation of Section 1211 of the Kern County Policy and Administrative Procedures Manual (Workplace Violence Policy). The investigation addressed three examples in the Workplace Violence Policy of threats, or acts of violence for which criminal prosecution and disciplinary action may be taken. I. 2.

Committing an assault or battery. Engaging in any behavior that unreasonably risks the safety of another.

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Accosting or harassing another, either face to face, or by telephone, fax, mail, computer, or other form of communication.

Method of Investigation The investigation consisted of a review of the August 12, 2003 written complaint and interviews with those connected with the case. Both the accuser and the accused were separately interviewed. Two eyewitnesses were also interviewed. Additionally, Drs. Kolb and Naderi were interviewed about what Dr. Jadwin and/or Dr. Lau told them about the incident. Investigative Findings I.

There were two eyewitnesses to the incident: Dr. Nitin Athavale of the Department of Radiology, and Erin Baldwin, a medical student assigned at that time to the Department of Pathology rotation. Both were interviewed and provided substantially similar accounts of the incident.

2.

The parties to the incident and the eyewitnesses all agree that a verbal argument immediately preceded the tie-pulling incident. The argument was over the validity of statistical information gathered and presented by Dr. Jadwin showing, in Dr. Jadwin's opinion, the inadequacy of biopsy samples submitted by the Department of Radiology to the Department of Pathology. First Dr. Athavale and then Dr. Lau vehemently disagreed with the assertions made by Dr. Jadwin that the biopsy samples were shown by his research to be inadequate. There is some divergence of recollection and opinion as to who was more angry and vocal, but the witnesses agree that Dr. Lau and Dr. Jadwin were both involved in an escalating and heated disagreement that culminated in Dr. Jadwin inviting Dr. Lau to accompany him to the Department of Pathology to review more research. When Dr. Lau adamantly refused to accompany Dr. Jadwin, stating that he had a procedure to perform, an evidently exasperated and angry Dr. Jadwin reached over to take hold of Dr. Lau's necktie with his hand and pulled Dr. Lau by his necktie about four or five steps from the reading room to the doorway of the hall before Dr. Lau told him to stop doing that and pulled his necktie back.

3.

According to those prt;:sent, the tie-pulling incident was completely unexpected. No threats were made before or during the incident, and Dr. Jadwin ceased any contact with Dr. Lau at the end of the incident. Dr. Jadwin left the Department of Radiology immediately and reported the incident to the Chief Medical Officer within minutes of it ending. Neither Dr. Lau nor the two witnesses report that Dr. Jadwin had any physical contact with Dr. Lau other than to pull his necktie. The action did not appear premeditated nor did it appear intended to injure or frighten Dr. Lau. Both parties have avoided each other since the incident.

4.

Dr. Lau is seeking assurances that there will not be a repeat incidence from Dr. Jadwin. Dr. Jadwin has expressed regret over the incident. This appears to be an isolated incident, and there have been no related complaints against Dr. Jadwin either before or after this incident.

2

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Conclusions The preponderance of evidence shows: 1.

During an argument between Dr. Chester Lau and Dr. David Jadwin in the Department of Radiology on August 9, 2003, Dr. Jadwin reinforced his demand that Dr. Lau accompany him to the Department of Pathology by unexpectedly taking Dr. Lau's necktie in his hand and pulling Dr. Lau by his necktie several feet into the Radiology hallway before Dr. Lau stopped him. It is reasonable to conclude that this constituted a minor physical battery that at a minimum caused physical discomfort for Dr. Lau and created excessive, disruptive anxiety for him.

2.

Dr. Jadwin's action created a hostile work environment and violates the Workplace Violence Policy of the County of Kern; specifically, by engaging in a Level 3 act of violence that unreasonably risked the safety of another physician working at the hospital. Since Dr. Lau had stated he had to perform a medical procedure on a patient moments before he was accosted by Dr. Jadwin, it not unreasonable to conclude that Dr. Jadwin's action could have potentially endangered the quality or efficiency of care provided to patients, although there is no evidence to suggest that patient care was compromised or affected.

3.

[n accordance with the Workplace Violence Policy of the County of Kern and my responsibilities as Hospital Human Resources Director, I will attach this report to the Workplace Violence or Threat Mitigation Report, and forward these documents to the County Risk Management Division.

~C2~ Director of Human Resources Kern Medical Center County of Kern

.<

~ 74r;"" ~,PHR Hospital Employment Specialist Kern Medical Center County of Kern Attachments: Memo from Dr. Chester Lau to Dr. Javad Naderi, dated August 12, 2003 Transcript of Interview with Dr. Chester Lau Memo to File - Interview with Dr. Nitin Athavale Transcript of Interview with Dr. Marvin Kolb Transcript of Interview with Erin Baldwin Transcript of Interview with Dr. Javad Naderi Transcript of Interview with Dr. David Jadwin

3

0000034

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TO:

JAVAD NADERI, \I.D, Cf-L\IR.M.AN OF DEPARTMENT OF RADIOLOGY

FROM:

CHESTER LAU, i\!.D

SUBJECT:

DR.Jl\DWIN'S UNPROFESSIONAL BEHAVIOR

DATE:

8/ 12!2003

cc:

MAR\rlN KOLB, M.D., MEDlC'\L DIRECTOR

Page 157 of 209

[ ,un bringing to your attention to an incident regarding of Dr. Jadwin's unprofessional behavIOr. On August 9 at approximately 10:30 am, Dr. Jadwin and I were debating over some pathology data he brought over to the department of radiology. Towards the end of the debate, Dr. Jadwin insisted that I have to go over to his office in Pathology to look over more data. I told him that I could not leave the department because I was attending to a patient to whom I was going to perform an angIOgram. He further insisted that I had to go with him He grabbed my tie with his hand and dragged me for several feet I felt that I lost my breath for a few seconds and I felt the sudden ripping force arOlmd my neck. I managed to regain my posture by pulling my tie out of his hand. I warned him not to do that mymore. During the incident, Dr. Athavale and one of the female medical students who was on the pathology rotation witnessed the entire transaction. Durmg this incident, I felt physically threatened. Dr. Jadwin's behavior is not just inappropriate. His behavior is downright unprofessional md dangerous. I am formally fuing a complaint regarding his lmprofessional behavior

?'4~4-.~

Chester Lau, MD.

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INTERVIEW WITH DR. LAD October 8, 2003

MICHAEL EWALD:

Linda Nipper and I, Mike Ewald, are meeting with Dr. Lau. It is October 8,2003, at approximately 3:00 p.m. and we are recording this with Dr. Lau's permission and this has to do with this incident with Dr. Jadwin where there was apparently some - he pulled an article of your clothing. Maybe if you could just kind of recap what exactly happened and maybe what led up to it, and then what happened and what happened afterwards.

DR. LAU:

So, I am Dr. Lau, by the way. The incident happened I would say about a month ago. I couldn't recall the date now.

MICHAEL EWALD:

Okay.

DR. LAU:

It was in the morning - late morning. I was waiting to do a procedure, an angiogram of a patient. Patient was down in the department and we were getting ready to go, and Dr. Jadwin came into the department and showing data to Dr. Athavale. I wasn't paying attention at the time.

MICHAEL EWALD:

Was this in the little room where you read the film?

DR.LAU:

Yes. Correct. It was in the room right at the end of the Radiology Department where all the radiologists read their films. He was showing Dr. Athavale some data regarding how accurate in his diagnosis of pathological specimens. I wasn't paying attention at the time and he called to my attention. He said I should look at his data. And I said, ''I'm busy." But he insisted that I look at his data. So, I stand by him and start looking at his data and he pointed out to me that since he got 20% or 30% - wasn't sure the percentage -less than 50% of his specimens are malignant - core malignant - then his data should be good to say that his core or (inaudible) data is minimal. And I couldn't understand that and argued with him. It was in a way a kind of heated argument. I told him that you can't say that because it's malignant and the rest or more than 50% - you don't know - it's not adequate - how can you say that because you have something that's malignant, you can imply the rest is okay. You can't say that. And he said, "Okay, fine. Come to my office." He told me to go to his office to look at the rest of the data and I wasn't in a mood to see any more data - to argue any more at that time and I said, "No, I got to stay here because I have an angiogram coming up and I got to attend to the patient." It was an unstable patient - a patient from the ICU. Apparently, he didn't take that for - as a no to go to his office. He

-I -

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grabbed my tie - grabbed my tie - and yanked me out from that small room into the hallway.

MICHAEL EWALD:

So, he actually pulled you -

DR. LAD:

Oh, he pulled me out of the room.

MICHAEL EWALD:

So, how many steps is that? Three or four?

DR.LAU:

Five steps - I would say five steps altogether.

MICHAEL EWALD:

Okay.

DR. LAD:

Until I regained my posture and then ripped my tie back out of his hand. And I told him, "Don't you do that." I didn't appreciate that movement at all. I personally don't like to wear ties. I don't wear ties when I don't need to. I go to formal receptions - I go to work and wear a tie. When I go home or everywhere I go, I don't like to wear a tie. The tie is a method of representing of what I do and maybe my reputation in a way. But, I don't like somebody to pull on something that could intend danger to my physical being. When he pulled my tie - and I do feel my neck bend backward because of the force - you know - he's a big guy. He's a pretty good size guy. Maybe he didn't realize what he was doing, but that movement - that does cause me a little bit of pain - a little bit of pain at the time and when I was doing the angiogram, I could feel it. After the angiogram, which was about an hour and a half afterward, I went to lunch and I start thinking of it - I still had a little bit of pain in my neck and I decided that maybe I should do something about it. Not that I want to punish the guy. I want to make sure that he would not do that to me or to anybody else in this hospital. It is not correct to yank on somebody's tie with that kind of force to the point that the other person would feel pain in the neck. I do not have any persistent pain after lunch - afterwards - but I think that ifhe had just given a little bit stronger yank on my tie, I might have sustained injury in my neck.

MICHAEL EWALD:

After he did that and you grabbed your tie back from him - back out of his hands, did he do this with his right hand or left hand?

DR. LAD:

Oh,jeez. I can't tell. I don't remember. It happened so fast.

MICHAEL EWALD:

Okay. But, anyway he had your tie - you took it back from him then what did he sayar do?

DR. LAD:

He - I told him don't do that any more. He didn't say anything else. He turned around and walked away.

-2-

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MICHAEL EWALD:

He just walked away. He didn't say a thing?

DR. LAU:

He didn't say he's sorry. He didn't say anything else. But, he walked away. I don't remember he say anything. No. Not that I wanted him to say sorry about it. At that time, I was kind of too infuriated because of the fact that somebody would do that to me and something not asking for. No doubt about it, I may have put him down a little bit by saying his data wasn't correct - the way he interpreted his data was incorrect. I'm sorry that I belittled him that way, but I just do it professionally to point out that the way he interpreted his data is not the way that any other people would see it. Only he could see that way.

MICHAEL EWALD:

So, you had - could I characterize this properly as a heated professional argument about the data and did you call - did he call you names or did you call him names - or did he get personal in anyway?

DR. LAU:

No name was called - nothing was personal. Everything was on the data. I just said the data - the data. You cannot- if anything, I just said that you cannot say - you cannot conclude from this data that - that you have enough adequate specimens. I just tried to tell him that you just have less than 50% of what is going on and how can you confer 100% of what's going. You have half - I did mention that you have half of the empty glass. How can you say that the full glass will be the same. And I did mention those words to him.

MICHAEL EWALD:

And he - and what he was saying to you was he was still insisting that it was valid data and that he then wanted you to come down to his office to see more?

DR. LAU:

To see more.

MICHAEL EW ALD:

Who witnessed this?

DR. LAU:

Dr. Athavale was there. He has a female - not sure if she's a medical student or a technician - along with him. She was there, too. Two persons there.

MICHAEL EWALD:

Do you know her name or could you get us her name?

DR. LAU:

I don't know her name.

MICHAEL EWALD:

Okay. Have you seen her since then?

DR.LAU:

No. I haven't seen her since then.

-3-

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MICHAEL EWALD:

Okay.

DR. LAU:

No, because he brought her along.

MICHAEL EWALD:

Alright. Did he say anything to you afterwards?

DR. LAU:

Regarding that incident?

MICHAEL EWALD:

Yes.

DR. LAD:

No. Nothing yet. Nothing.

MICHAEL EWALD:

Okay.

DR.LAU:

I try to avoid him as much as possible, except at the professional level.

MICHAEL EWALD:

Oh, I'm sorry. Dr. Athavale?

DR. LAU:

No, I'm - oh, you mean Dr. Athavale?

MICHAEL EWALD:

Yes. I'm sorry. I was unclear. Did Dr. Athavale say anything to you? Did he make any comments.

DR. LAU:

Yes. He mentioned to me that - yes, he saw the incident. He saw exactly what was going on and he can recount what was going on. He did mention it to me.

MICHAEL EWALD:

Okay. Did he express anything to you about being surprised or upset about that?

DR. LAU:

No.

MICHAEL EWALD:

But he just basically said that he could be a witness for you, is that it?

DR. LAU:

Yes. He said he saw the incident. Basically, that's what he said.

MICHAEL EWALD:

Okay. Now when you were pulled out into the hall, there was nobody else out in the hall who saw that?

DR. LAU:

Vh - okay - oh I remember that. There was - Greg Prince was there afterwards. Not sure he saw exactly what's going on. He was in the hallway further down, near by the main hallway.

MICHAEL EWALD:

And who was this?

-4-

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DR. LAU:

Greg Prince. He's the supervisor.

MICHAEL EWALD:

Oh, Greg Prince. Okay.

DR.LAU:

He's at the end of the hallway where the reading room is - the entrance is right here - I flew out into the hallway. Greg Prince was walking out of his office at the other end of the hallway. I'm not sure he saw what's going on.

MICHAEL EWALD:

Okay. He may have heard though.

DR.LAU:

Might have heard.

MICHAEL EWALD:

And you say that you said, "Don't pull my tie" or words to that effect.

DR. LAU:

Might have, yes. You may want to call- corroborate it with him. I'm not sure he saw what was going on, but he was there at the end.

MICHAEL EWALD:

Okay. Have you had any other unsatisfactory interactions with Dr. Jadwin before?

DR. LAU:

I just don't like the way that he called the results of the biopsies, that's the only thing I don't like.

MICHAEL EWALD:

But you haven't had any shouting matches or angry words or anything else with him before that time?

DR. LAU:

No.

MICHAEL EWALD:

So, were you surprised when he pulled your tie? Was that one of the feelings that you had when he did that?

DR. LAU:

Surprised - infuriated - both.

MICHAEL EWALD:

Because he took a part of your clothes and pulled them without any cause or justification for that?

DR. LAU:

Yeah. The other feeling i got in my mind was I was coerced to do something. I feel that Dr. - to a certain place. Now, I didn't want to go somewhere. He insist that I got to be there by physical force and he did it with physical force, even for five steps or so.

MICHAEL EWALD:

Uh-huh. And do you think that he knew what he was doing or was he just so caught up in the moment that he just lost it?

DR. LAD:

I don't know. I really don't know. You'd have to ask him on that

-5-

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point. I don't know. I got the feeling that maybe he just didn't know what he's doing and I - when I report this, I didn't think that he - I did not think that he know what he's doing and I'm afraid that he will cause damage to other people or to me or maybe - who knows - you know. One thing can lead to another and I hate to see that and I see that in my life - (inaudible) my life and other people's lives and (inaudible) - and it wasn't a good outcome and nothing is pretty and I don't want to see that at all. I want to stop before - at the first step and nothing is going to be (inaudible) towards the end. MICHAEL EWALD:

Have you heard of any other incidents involving Dr. Jadwin where he's pulled a tie or touched somebody or been very angry at somebody?

DR.LAU:

No. No. This is the first time I've deal with him in this way.

MICHAEL EWALD:

Okay. What happened afterwards? Did he come back and talk to you or have you heard from him at all? Has he written to you or telephoned you or talked to you? When you see him, what does he say or do to you?

DR. LAU:

Uh. I try to avoid him as much as I can. I don't even want to have any eye contact with him in the hallway when I see him walking the other way. I try to do something - I don't want to get close to him. The only time that I need to be close to him is when I take a biopsy of the patient and hand the specimen over to him. That's the only time that I will be with him and that's on professional level and there's a lot of people there. And I feel comfortable with it. If I'm one-an-one with him or even in (inaudible) area, I try to avoid as much as I can with him. Not that I'm scared or what, it's just that I don't want to escalate the situation further. That's how I think of it.

MICHAEL EWALD:

Has he tried to talk to you at all about this incident?

DR. LAU:

No.

MICHAEL EWALD:

Then it's safe to say that he hasn't apologized?

DR.LAU:

Not that I want one - no, he didn't. No, I didn't - it doesn't matter if he apologized or not. All I need to know is - make sure that this would not happen again. Unless he would say to me that it would not happen again, so we would not have any future incidents like that happen. He never talked to me - I'm sorry - to answer the question.

-6-

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MICHAEL EWALD:

Has he - have you been feeling any other pain or any other affects after this other than the immediate time when that was happening and right afterwards where you felt neck pain and - but, you don't have any stress or any incidents where you're afraid? You're not afraid of him, or anything like that?

DR. LAU:

No. I'm not afraid of him and I don't have any pain now. I have full function. I wouldn't hold him for anything physically or emotionally - no, no. It was - I believe it was a spontaneoussomething spontaneous - something that he maybe get used to doing. I'm not saying he did this before. Maybe he thinks it's so spontaneous doing it. He didn't know what he's doing. Ijust want make it plain - to warn him that that's not the right way to do things and to not do it again. Because if this is a spontaneous thing that he does and he may do it again - and with his strength he can do damage.

MICHAEL EWALD:

So, if you could just tell me - we usually ask this of anybody in this situation - what would you like to see the hospital do in this case?

DR. LAU:

I think the hospital has done everything and I don't think the hospital is liable for anything. There's no damage - no foul- no harm. I wouldn't hold anybody for it. I just want Dr. Jadwin not to do that to me again and or to anybody-

MICHAEL EWALD:

So, you would like assurances from Dr. Jadwin that he will not do that again and that he recognizes that that was to you, certainly, serious breach of decorum by grabbing your tie and pulling you.

DR. LAU:

That's all I want. That's all I want.

MICHAEL EWALD:

Okay. Linda, do you have any questions?

LINDA NIPPER:

No, I don't.

MICHAEL EWALD:

Okay. Alright. We will be investigating this and preparing a report for the Medical Director with our conclusions and recommendations. If anything else comes to mind - if you think of anything else - please contact either myself or Linda so that we can get any other thoughts that you have down. I would ask, as we do with anybody in an investigation, that from this point on not to discuss it with anybody until we've completed our investigation.

DR. LAU:

Okay.

MICHAEL EWALD:

And if Dr. Jadwin attempts to talk to you about it, I would ask that

-7-

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you refer him to us so that we can discuss it with him and not - I don't think it would be good ifhe attempted to discuss it with you or anyone else either. We'll be asking him not to talk about it with other people, too. DR. LAU:

I'm sorry if I caused any alarm or whatsoever by writing this letter. I didn't mean to cause so much trouble and cause County to spend so much resources on this matter. I really don't-

MICHAEL EWALD:

I think it's an important issue to you. 1- certainly, it was an unusual - maybe even a frightening incident - that - and I'm glad that you brought...i t to our attention and we will do everything we can to investigate it and make sure it doesn't happen again. So, I think that it's - I don't think that you should be apologetic at all. I think that it was good that you did that. Well, thank you very much, Dr. Lau. I appreciate it. And, again, if anything comes to mind, please let me know. Okay?

DR. LAU:

Okay. Thank you very much.

MICHAEL EWALD:

Thank you.

MICHAEL EWALD:

The time is 3: 16 p.m. and this is the conclusion of the interview.

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.KERN

~ • MEDICAL CENTER

Human Resources Department

Memorandum To:

File

From:

linda F. Nipper, Hospital Employment Specialist

Date:

October 9,2003

Re:

Investigative Notes Lau - Jadwin Complaint Interview with Dr. Nitin Athavale

I met with Dr. Nitin Athavale at 1:50 pm on October 9, 2003 in the Radiology Department. Dr. Athavale was named as a witness to the alleged workplace violence incident between Drs. Lau and Jadwin on August 9, 2003. Dr. Athavale stated he was involved in a discussion with Dr. Lau and Dr. Jadwin regarding pathology issues with the lab. Drs. Lau and Jadwin continued the discussion, which became a heated professional disagreement. Dr. Athavale, while no longer involved in the discussion at that time, remained within a few feet of both doctors. Dr. Athavale heard the doctors arguing, though not in a loud tone. Dr. Athavale saw Dr. Jadwin pull Dr. Lau by his necktie into the hall. Dr. Athavale stated that he didn't know why. Dr. Athavale does recall there was a medical student who entered the reading room with Dr. Jadwin, who may have also been present during the altercation. He did not know who she was. Dr. Athavale recalls that after Dr. Jadwin pulled Dr. Lau into the hall by his necktie, the two spoke briefly and went their separate ways. Dr. Athavale has not spoken to either doctor about the incident and has heard nothing about it again. He did not hear what was said between the doctors in the hallway after Dr. Jadwin pulled Dr. Lau there.

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INTERVIEW WITH DR. KOLB October 10,2003

MICHAEL EWALD:

This is an interview - a taped interview with Dr. Marvin Kolb on October 10,2003, at approximately 9:30 a.m. in Dr. Kolb's office. Present also is Linda Nipper, Hospital Employment Specialist and we are here to discuss an alleged incident between Dr. Jadwin and Dr. Lau and I'd like to ask Dr. Kolb if you could tell us when you first learned of the incident, who you learned it from, and what you learned.

DR. KOLB:

Okay, this is Marv Kolb and I'm here on October lOth responding to questions posed. I have to refer to some notes of the date because, Mike, I don't remember the date or the time, but I do know that to my recollection it was not too long after this event, which I see here was on August 9th at 10:30 in the morning, David came by - David Jadwin came by myoffice to tell me about the event. I think it was the same day- I'm almost positive - well, pretty certain it was the same day, but it was - that he came in. He was pretty excited about it and he said that he'd just had an interaction with Chester Lau about an issue that I'm very familiar with, which is the bi-needle aspirations. And that Chester - this was down in Radiology and David had gone down there to talk about some of the specimens that they receive from Radiology which do not have adequate samples on them. The radiologists do the procedures. Pathologists are there at the time and determine whether there's enough tissue to make a diagnosis. So, anywayand this is a growing issue for us because David has stated that this was before the event - that we have a growing problem with adequacy oftissue by our clinicians who give biopsies. So there's a debate going on in the institution whether this is a competency issue of the ''biopsier,'' i.e. radiology, surgery, some of the surgical sub-specialties, Auggie Munoz or is it a pathology competency with those guys down in Pathology not knowing what they're doing. The long and short, David went down there and was talking to them about a biopsy. Chester got upset immediately - this was David's version - Chester got upset immediately about it. Very upset. Angry with him. Called David incompetent and David said "With that I grabbed his tie and said, Come on down to the lab and 1 will show you what's going on."

MICHAEL EWALD:

He specifically said, "I grabbed his tie?"

DR. KOLB:

Yup.

MICHAEL EWALD:

And what did he say about that incident as far as what did Dr. Lau do and did he talk about that in any kind of detail?

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DR. KOLB:

Urn - David felt that it was - that he was just kind ofjoking with Chester and pulling his tie a little bit and "Come on down to the lab and I will show you." I asked him if he touched him. He said, "No. I just grabbed his tie and pulled on it." So, I said, "Well, how did you pull on it?" "Well, a little bit like this, so it wasn't a very hard pulL" A little different story from what Chester told me. So, anyway - and then with that event, then Chester just backed away from him and I think they both walked away from it. I'm not really sure, but I think that kind of shook everybody up and they just walked away from it. So, right after it happened, he came down here. David talked about it and I told David at that time, "David, you're wrong. Don't ever touch anybody. I don't care how mad you get. Don't ever touch anybody. You were wrong." I told him right from the start and I told him then that I would talk to Chester - urn - about the event.

MICHAEL EWALD:

Did Dr. Jadwin express remorse or concern or anything? Or was this just sort of a factual report of what he had done?

DR. KOLB:

Urn - he was concerned about the event, no doubt about it.

MICHAEL EWALD:

He was concerned about the repercussions of the event?

DR. KOLB:

Well, the fact that he got angry enough and I made him aware of the fact that you don't ever touch anybody and he knew that. He knew he was wrong, but he didn't say, Marvin - he called me incompetent - I was so angry with him - urn - but he said, "He provoked me." But, I said, "David, I don't care how mad you get. I don't care how incompetent. You can't touch anybody." Umso, I had to reinforce that. He - the fact that he came in here right after it happened, he knew that there was something inappropriate in his actions.

MICHAEL EWALD:

Okay. And, you say that you later had a discussion with Dr. Lau. What did Dr. Lau tell you?

DR. KOLB:

It wasn't the same day. It was probably a day or two after thisurn - because I did - I'm not sure ofthe timing of all this, Mike, but I did have a conversation with Peter about this - I talked to Peter about this. So, I told Peter that I was - he and I talked about it and we decided that we - at this point in time - I can't remember whether - where you fit into this loop - if I called you about this or if I talked to Chester first and talked about it - but, anyway, the long and short of it all is that in conversations - I know with Peter and I can't remember how much we had involved you as advice and counsel on it - but, we detennined that I would have a conversation with Chester. I would see if- where he was with this - what he wanted to do about this - to validate the event and also to get David to apologize for this. And I can't remember the

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sequence. I then - within a short period of time - within a few days - had a conversation with Chester. MICHAEL EWALD:

And what did Dr. Lau tell you?

DR. KOLB:

When I talked to Chester about it, he said that yes it happened. He said, "He really pulled me tight. It almost took my breath away he pulled me so tight." Same event. Urn - and I said, "Well, you .know that was wrong." He said, "Yeah, I know it's wrong." And I said, "Well, I will get David to apologize to you because - Do you want it in writing or do you want him to come talk to you?" And Chester said, "I don't want either. David doesn't have to do anything." He said, "It's fine. As long as he leaves me alone, I don't care about him doing anything more about it. I don't want him to do anything. I just want to leave it alone." So, I told him, "No, I'll get David to apologize." "No, no. I don't feel that's necessary. I'd just as soon leave it alone." So, that's where it was left. And then I've had several conversations with David - urn about this issue - urn - because he remains very upset that Chester continued to challenge his integrity as a physician. And that's he's not alone in that issue. That's surfacing as a part of a bigger picture that I'm dealing with in a separate way. But - um - I then - somewhere along this line I did go talk to Athavale.

MICHAEL EWALD:

Oh, okay. Thank you. And what did Dr. Athavale say?

DR. KOLB:

Dr. Athavale confirmed the event. He said David did pull on his tie - did pull on his tie firm - it was hard. He said he really jerked on him. And - urn - so that's all I really needed from Athavaleconfirmation that this event really occurred. Urn - and I did not ask Athavale if Chester was verbally abusing or saying things. I did not get into that. All I did was ask Athavale what happened and for him to tell me if this event occurred. I just wanted a confirmation that a third party had seen this as it had been described to me.

MICHAEL EWALD:

One of the descriptions of the incident is that when Dr. Jadwin reached and took hold of Dr. Lau's tie, he then stepped back out of a room into the hallway, approximately three to five steps. Did you hear anything like that? Did that come out of anybody's report to you of the incident?

DR. KOLB:

Urn - maybe yes and no, because I know this did occur in a room, hallway kind of situation. Did someone tell me that Jadwin pulled Lau out of a-

MICHAEL EWALD:

We have - you know - it could be one where you grabbed the tie to get somebody's attention. Another is to step backwards and pull somebody with the tie.

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DR. KOLB:

Well, I think: David did say that he grabbed his tie and tried to pull him to come down to the Pathology department with him. He said - you know - his action was to grab his tie and say, "Come on down and I'll show you - I'll show you the stuff." So, did I ask David, "Did you drag him down the hallway?" No, but in essence, I think: the event was that David said what he was trying to do was grab his tie and say, "Come on down to the - " yeah - "Come on with me." He was trying to bring him down to the Pathology Department to show him the slides to prove to him that there was nothing there. So, there's probably some truth to that. But, I did not ask specifically, "Did you drag him?" But he did pull his tie and was attempting to say, "Come on down to the Pathology Department with me." So, I would assume he could have very well stepped back.

MICHAEL EWALD:

And just to make very sure in your discussion with Dr. Jadwin, Dr. Jadwin did admit to you that he pulled Dr. Lau's tie?

DR. KOLB:

Correct.

MICHAEL EWALD:

Not a badge? Not any other article of clothing? His tie.

DR. KOLB:

It was his tie.

MICHAEL EWALD:

Okay.

DR. KOLB:

It was his tie. And he - I said, "Did you touch him?" "No. Ijust grabbed his tie."

MICHAEL EWALD:

Well, I want to thank: you very much. The time is 9:42 and the interview is concluded. Thank: you.

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INTERVIEW WITH ERIN BALDWIN October 10, 2003

MICHAEL EWALD:

It's October 10,2003, and approximately 12:07 p.m. I am here with Erin Baldwin, a medical student. With me also is Linda Nipper, Hospital Employment Specialist. And I guess I'll just ask you on August 9, 2003, there was an incident involving Dr. David Jadwin and Dr. Lau and can you tell me what you saw?

ERIN BALDWIN:

What I witnessed is that I went with Dr. Jadwin to the Department of Radiology. He wanted to - Dr. Jadwin wanted to discuss with Dr. Lau some issues about a study that was being done by the Department of Pathology concerning bi-needle aspirations in the hospital. Dr. Lau subsequently became upset with the information being presented to him and was expressing himself in a very loud voice. Dr. Jadwin attempted to get him to lower his voice - to keep the conversation between those two. That was my impression of what had happened. And, because Dr. Lau continued to express himself in a loud voice, Dr. Jadwin then led Dr. Lau out of the Department of Radiology by assisting him with his tie out the door.

MICHAEL EWALD:

So, he pulled his tie and pulled Dr. Lau out of the Radiology room into the hallway.

ERIN BALDWIN:

Yes. I wouldn't say that it was a forceful pull. It was more leading him out. It didn't appear to me that Dr. Lau was resisting or there was a forceful pull on the neck. But, just a leading out of the area that we were in.

MICHAEL EWALD:

Did you have the impression that Dr. Lau anticipated that that would happen and was not surprised that he was being led out?

ERIN BALDWIN:

I'm not sure-

MICHAEL EWALD:

Okay.

ERIN BALDWIN:

- if he anticipated it.

MICHAEL EWALD:

Alright. What did Dr. Lau do as he was being led out into the hallway?

ERIN BALDWIN:

He just seemed to allow himself to be led out. He wasn't resisting and at that point he had quieted down.

MICHAEL EWALD:

Okay. Was he talking as he was being led out?

ERIN BALDWIN:

I cannot recall like whether he was saying anything particular, but I do recall the tone in the voice had decreased. And, so, he was - 1-

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being led out and he didn't seem to be resisting or protesting. MICHAEL EWALD:

Did Dr. Jadwin let go of the tie when he got out to the hallway?

ERIN BALDWIN:

I did not witness anything after being led out of the room. I actually remained in the initial area and there was another radiologist there - I believe it was Dr. Athavale - but, I'm not certain - and I remained in the radiology reading area with -

MICHAEL EWALD:

So, you didn't see - you saw him going out to the hallway, but you didn't see what happened after that.

ERIN BALDWIN:

No, I didn't see what happened after that.

MICHAEL EWALD:

Would you say - what I'm hearing you say is that Dr. Lau was his voice was raised - he was very excited and upset with Dr. Jadwin and Dr. Jadwin was being - was trying to calm things down?

ERIN BALDWIN:

Hush - you know - hush the loudness of the conversation because the tone in Dr. Lau's voice was such that it was-

MICHAEL EWALD:

Carrying everywhere.

ERIN BALDWIN:

- carrying out into the hall. I think people were walking by. think people were wondering what was going on.

MICHAEL EWALD:

How long.was this dialogue between them? How long did that go - about?

ERIN BALDWIN:

Urn - not very long. Probably a few minutes. But, I'm not certain. It wasn't a very long period. It was a short interaction.

MICHAEL EWALD:

Did either physician call each other names or use foul language or say anything inappropriate? Or was it just a heated professional exchange?

ERIN BALDWIN:

I don't recall any profanity being used. I would say it was morein my limited experience, I don't know what you call heated professional exchange. I guess that would be what I would categorize it - heated professional exchange. I didn't hear any profanity. There wasn't any profanity.

MICHAEL EWALD:

Did you hear either physician call the other incompetent?

ERIN BALDWIN:

I don't remember. I don't remember specifically what was said.

MICHAEL EWALD:

Okay. Urn -let's see. And did you talk to Dr. Athavale about this?

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ERIN BALDWIN:

I think when he had them led out the door, we both were surprised. That's - I remember looking at him with a surprised - you knowsort of surprised at what had just happened. I think I stated to him that I was just a medical student. And I think he thought that maybe I was waiting to ask him a question about a film, but I told him I was just a medical student in Pathology. And then, he may have said like one other word and I think I just then walked back to the Pathology Department.

MICHAEL EWALD:

Did you walk back with Dr. Jadwin?

ERIN BALDWIN:

No.

MICHAEL EWALD:

Had Dr. Jadwin already left?

ERIN BALDWIN:

Yes.

MICHAEL EWALD:

Okay. Urn - did Dr. Jadwin when he took the tie - what did he say? Did he say anything?

ERIN BALDWIN:

I think he said, "Come here." I'm not sure. I can't say for certain what was said. I don't know whether he said, "Come here" or - I don't know.

MICHAEL EWALD:

Okay.

ERIN BALDWIN:

I can't remember.

MICHAEL EWALD:

Alright. That's fine. That was a couple of months ago.

ERIN BALDWIN:

Yes.

MICHAEL EWALD:

So, you were surprised to see this happen and everyone - were there other people who saw and heard this?

ERIN BALDWIN:

I believe there was other people that heard this and Dr. AthavaleifI'm recalling this - was the radiologist. He was sitting right there with us. So, it was Dr. Athavale sitting at the radiation reading table, myself, Dr. Jadwin, and Dr. Lau. But, I believe other people heard.

MICHAEL EWALD:

And from where Dr. Athavale was, was he in a position to see what went on out in the hall? Or was he sitting with you or right next to you?

ERIN BALDWIN:

It's possible he may have seen. I can't comment on - I guess - the geometry of it, it is possible that he may have seen, but I don't know. And I don't remember him -like - particularly commenting on that -looking directly outside. I remember him -3-

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asking me, "Can I help you?" MICHAEL EWALD:

Afterwards?

ERIN BALDWIN:

Yes, because I was standing there.

MICHAEL EWALD:

Probably with your mouth open, right? .

ERIN BALDWIN:

So-

MICHAEL EWALD:

Urn - what did you think of the whole incident?

ERIN BALDWfN:

Urn - I was surprised at the incident. happened.

MICHAEL EWALD:

Did you think it was a natural type of thing that would occur in a business setting?

ERIN BALDWIN:

I'm sure it does occur in a business setting, but I had never witnessed this type of exchange before.

MICHAEL EWALD:

Did Dr. Jadwin talk to you about it afterwards?

ERIN BALDWIN:

Not that day, but I believe one or two days later he did talk to me about that.

MICHAEL EWALD:

Okay. What did he say?

ERIN BALDWfN:

He just made some comments about the study and he said something - I can't remember - and this is why I led him out of the room - this is why I led him out by the tie. But - he didn't-

MICHAEL EWALD:

So, he admitted that he had pulled his tie? There's no question -

ERIN BALDWfN:

Yes, he did.

MICHAEL EWALD:

Urn - did you go down there with Dr. Jadwin?

ERIN BALDWfN:

Yes.

MICHAEL EWALD:

So, you saw how it started?

ERIN BALDWIN:

Yes.

MICHAEL EWALD:

And Dr. Jadwin was pointing out some kind of problem with specimens or whatever to Dr. Lau and it's then that Dr. Lau became increasingly excited?

ERIN BALDWIN:

Yes.

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MICHAEL EWALD:

And then started speaking loudly and forcefully to Dr. Jadwin?

ERIN BALDWIN:

Yes, that's what happened.

MICHAEL EWALD:

Okay. Do you have any questions?

LINDA NIPPER:

I think the only question I would have is when you witnessed Dr. Jadwin and Dr. Lau talking, was Dr. Jadwin also loud? I mean did he raise his voice as they were talking?

ERIN BALDWIN:

It's - not to the same level. I believe it did get - I wouldn't say equally loud, but it seemed to me that Dr. Jadwin was trying to quiet the situation down. He may have - his voice may have escalated a little bit when Dr. Lau was yelling, but I can't say whether it was exactly the same level that -

LINDA NIPPER:

Do you know why Dr. Jadwin was leading him out of the room?

ERIN BALDWIN:

I think to quiet him down - to say "come over here and discuss this away." I thought he was leading him into another room where they were going to talk privately. That's what I thought. That's what I thought he was doing.

MICHAEL EWALD:

When -let me - when he was doing that -let me just - don't worry, I won't hurt you. Was his neck - was Dr. Lau's neck kirid of like following there? Or was it just kind of like a "come oncome on with me" - you know - type of thing?

ERIN BALDWIN:

It wasn't-

MICHAEL EWALD:

I mean was he trying to stop - or was he trying to pull back - Dr. Lau was trying to pull back? And he was being really led against his will?

ERIN BALDWIN:

That - I did not witness - I witnessed Dr. Lau just going along with him and he - actually it didn't seem to be pulled - it was more the tie just hanging down and it was the lower part that was -

MICHAEL EWALD:

So, he grabbed the very lowest part of it?

ERIN BALDWIN:

Not the very lowest, but towards the end.

MICHAEL EWALD:

Uh-huh.

ERIN BALDWIN:

And it wasn't a forceful, jerking-

MICHAEL EWALD:

It wasn't forceful-

ERIN BALDWIN:

It wasn't - "Oh, come on." -5-

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MICHAEL EWALD:

Okay.

ERIN BALDWIN:

It wasn't like this. It was - the tie was down and - just leading him . out and Dr. Lau then followed.

MICHAEL EWALD:

So, it's fair to say because we're seeing this that it was not a forceful thing where Dr. Lau was struggling and following-

ERIN BALDWIN:

No.

MICHAEL EWALD:

- but struggling. He didn't appear to be struggling, he just kind of docilely followed the tie -

ERIN BALDWIN:

Yes.

MICHAEL EWALD:

- where the tie was going.

ERIN BALDWIN:

Yes. He did not seem to be physically resisting or resisting at all. He just seemed to go along and then he quieted down and -

MICHAEL EWALD:

Okay. Is there anything else you remember from this?

ERIN BALDWIN:

That's about all that I remember.

MICHAEL EWALD:

Okay. Well, have you ever seen anything like thisbefore?

ERIN BALDWIN:

No.

MICHAEL EWALD:

Okay. Have you seen physicians fight before?

ERIN BALDWIN:

No.

MICHAEL EWALD:

Okay.

ERIN BALDWIN:

Just - you know - discussing things - you know - but -

MICHAEL EWALD:

Sharing opinions -

ERIN BALDWIN:

Yes.

MICHAEL EWALD:

- maybe forcefully.

ERIN BALDWIN:

Yeah, stating their opinions. Stating it strongly. Never like that before.

MICHAEL EWALD:

Okay. Well, thank you very much and the interview is over at 12:22 p.m. And I want to thank you very much for your cooperation.

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INTERVIEW WITH DR. NADER! October 10, 2003

MICHAEL EWALD:

This is-

DR. NADERI:

Have you tape recorded Dr. Lau?

MICHAEL EWALD:

Yes.

DR. NADER£:

And also Dr. Athavale?

LINDA NIPPER:

Not Dr. Athavale.

DR. NADERI:

He said no?

MICHAEL EWALD:

No, he didn't say no. We couldn't get the recorder to go. And we recorded Dr. Kolb, too. Dr. Lau was very forthcoming about the incident and -let me just start by saying this is October 10,2003. This is an interview with Dr. Naderi. He has given permission to record this interview and I'll just start by asking you, when the incident between Dr. Jadwin and Dr. Lau occurred, when was the first time you heard about it and who told you and what did you learn about it?

DR. NADERI:

Well Dr. Lau mentioned it to me and I don't know exactly ifit was the same day or the next day, or whenever it was - that this had happened and he was embarrassed because Dr. Jadwin did it in front of - in the department and it was in front of others - and he was very embarrassed by that. I said, "Okay, as the chairman you notified me. I'll talk to Pete and I asked him ifhe has talked to anybody else or not and he said well, he had gone to Dr. Kolb immediately and Dr. Kolb was not in his office. He went back again and - a second time - so I don't recall that he finally could connect with him or not and maybe he has told you ifhe-

MICHAEL EWALD:

They did have a discussion.

DR. NADERI:

And, well I said, "Fine, then I'm sure they will take care of it." But, I think it was the following day or whenever it was - the next day - he gave me that letter. And he said he really doesn't want this to continue. He thought that Dr. Jadwin might (inaudible) habit or personality or something. He might do it to almost anybody and he thought he had to talk to somebody, so he realizes that it's not a good habit and that's (inaudible). I mentioned it toduring my meeting with Pete - you know - I mentioned it to him. I think he was aware of it and -

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MICHAEL EWALD:

What did Dr. Lau specifically tell you happened?

DR. NADERI:

Well, as I recall, it was about a couple months ago, right?

MICHAEL EWALD:

It was August 9th •

DR. NADERI:

August 9 th ? September, October - yeah - about two months - and he said he grabbed him in the middle of the room here in the reading room and apparently he grabbed him by his tie and he pulled him across the room here while some others were also here and says he tried to talk to - Dr. Jadwin's a tall man and a strong man - so he just stopped him - just dragged him out of the room, through the door, to the hallway and then he said also - anyway, he felt that he had difficulty - almost had difficulty to breathe because the tie was around his neck - was fastened to his neck and so on. And he wanted to pull himself back, but Jadwin was - Dr. Jadwin was strong and was still pulling him. So, as I recall, that's the way he told me - (inaudible) - from the room into the hallway - and then whatever happened after that -

MICHAEL EWALD:

Has Dr. Lau complained of any pain or anything else after that?

DR. NADERI:

He just had a pressure around his neck - (inaudible) - he felt that he was going to have some breathing problem and that he couldn't get himself (inaudible) -

MICHAEL EWALD:

As department chair, what do you feel would be an appropriate response or action by the hospital to this incident?

DR. NADER!:

Well, I don't know. I thought Mike, I was concerned about my duty. My duty was to inform the responsible people in the hospital, the medical staff. And I tried to be fair - give a chance to the hospital officers - so they were both notified. I thought maybe that Lau should have a fair response within a timely basis, so that he knows we are taking this seriously and so on, but based on - he's told me he's not received anything in writing from anybody up to now. I thought maybe the medical staff office also should know that if anything they should do - I really don't know when two physicians are like this, I am sure one part of it as County, Personnel should take action like they are doing now. But I don't know if (inaudible) or medical staff should or should not do anything on top of that or - so, I didn't know. So, after no action and no response in writing - so, I notified medical office - medical staff - which was late - you know - it was one and a half months or something -like that - and that's why I thought there should be something - some response - somehow that he's assured that this not going to happen to him or anybody else.

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MICHAEL EWALD:

Well, we've been asked recently to investigate this and we are going to be preparing an investigative report that will go to Dr. Kolb, at his request. One final question I have is - there's some question as to what led up to this incident. Did Dr. Lau - or have you heard that there was any sort of professional disagreement that was going on? Not that that would absolve anybody of pulling somebody's tie, but was there some sort of words being exchanged or some other problem?

DR. NADERI:

Since I wasn't here at that time, I don't really know what Dr. Jadwin was doing first of all in this department. Suppose it was something that he was here, but I don't know what was that. I don't know was a discussion between him and others and or he just came to talk to Dr. Lau for whatever reason or to talk to somebody else. He not being clinician and usually we don't have that much personal patient relationship between Radiology and Lab. As you just saw, the other physicians they come and review their x-rays here - we have a lot of relationship with clinicians, but not really much between us - for example, (inaudible) very seldom do we go to the Lab for anything that we need and very seldom if he needs anything in X-ray - recognizing this is a hospital, of course, we have a relationship and so on, but we don't have that much direct relationship to go and visit with others - but again I don't know what the reason for his visit or he came just to talk to Dr. Lau or Dr. - somebody else. I don't kriow. I don't know what - What do you feel now in this situation - that's for my education - what happened between two physicians. Is that part of Human Resources - should it have been medical staff- maybe it also should have something to do with this - or not. We're talking how should we take care of this or what's my role in this - so, what do you think?

MICHAEL EWALD:

Well, we have been asked to investigate it because of the allegation of workplace violence - of an inappropriate contact - the allegation of inappropriate contact between two people working here who are actually County employees. And so we are investigating that as per the County's policy and a report will be prepared for the County. We have to submit a report and we also will be submitting a report to the Medical Director. What he wants to do with it at that time, or what Peter wants to do with it, as far as sharing it with anyone, that's up to them. Our report will only contain findings and conclusions. We do not make recommendations. Based on our findings and conclusions, then they can determine what they want to do from there.

DR.NADERI:

I see. So, (inaudible) according to bylaws of the hospital and the staff.

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MICHAEL EWALD:

I'm not aware of any bylaws, but after the report is done, how that's handled is fine. We attempt to give as unbiased and neutral investigation as we can, and let the facts speak for themselves.

DR. NADER!:

Right. I know you have done it before. I know that Steve has done it before. I know that you do an excellent job - you're unbiased and I really appreciate it. So, that was the thing - because now it's between two physicians, even though they're both employees - as compared to two non-physicians - [didn't know how we-

MICHAEL EWALD:

Well, we recently investigated one between two physicians down in Emergency Department. There was allegations which were proven to be fa~al of inappropriate contact between two physicians.

DR. NADERI:

Was it staff or was it staff and residents?

MICHAEL EWALD:

It was two residents.

DR. NADER!:

Right. So, there's a little bit of difference, but it's still not the same as two physicians.

MICHAEL EWALD:

So, we do have - it's my understanding that that had already been agreed to that if there were any types of complaints lodged that a neutral third party would investigate it and provide the facts. How it's handled from that point, it's not my- it's not my job to specify that.

DR. NADERI:

No. I didn't know - I know - or at least Isee it as my role - I have to explore the policies - both sides - medical staff and - I did at the time.

MICHAEL EWALD:

I think you acted appropriately.

DR. NADERI:

But, Ijust want to make sure that I don't fail in myresponsibilities~ That's my concern is to take it on or how he didn't receive anything back - but still I played it low key. I didn't - you know I just waited long enough to see what - and I'm glad you are doing this, so at least somebody will be informed at least that it's not the proper way-

MICHAEL EWALD:

Well, there will be a report and it will be delivered to Peter and Dr. Kolb and - but not shared with anyone else until they've had a chance to read it and determine what to do.

DR.NADERI:

(Inaudible) - as I recall what I think was in his letter was also another person with Dr. Jadwin who was rotating in his department.

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MICHAEL EWALD:

We've located that individual and she will be interviewed.

DR. NADERI:

Oh, good. Then I think that's the best we can do.

MICHAEL EWALD:

Thank you very much for your time.

DR. NADERI:

r appreciate it.

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INTERVIEW WITH DR. JADWIN October 17,2003

MICHAEL EWALD:

Okay. It is October 17,2003. This is an interview with Dr. David Jadwin. Linda Nipper is also present. And we'll just start. Actually, I think you know what the allegation and the complaint was from Dr. Lau. Perhaps you could tell us from your perspective what occurred and we'll have some questions maybe afteIWards, but why don't you just tell us what happened, what immediately led up to that, and what actually happened, and what happened afteIWards.

DR. JADWIN:

I was - I went to the Radiology Department with a medical student to look at some sort of case - uh - I can't remember what it was. And the day before we had had a quality management committee meeting and one of the problems that's been at this hospital probably for years is the collection ofbi-needle aspirations specimens by CT guide-ins and part of my coming here - they're sort of cavalier and a lot of times they would just sort of look at it and say well, maybe it's adequate and go back to the laboratory and they generate a report that maybe says something to the fact that the specimen was limited - did not - unsatisfactory for evaluation. I came on board and started scrutinizing these more thoroughly and we were having a lot of problems with getting adequate samples to the point that when I would go down to the CT Scan, the radiologists would leave before I even got there to tell them it's adequate. And so -

MICHAEL EWALD:

So you went down there for the purpose of discussing that issue?

DR. JADWIN:

No. Actually I was just trying to lead up to the circumstances. So, the quality management committee had been looking at this as a problem and of course the radiologists were quite defensive about all of this and we started looking at some data on a spreadsheet, looking at adequacies and malignancies and I had done a preliminary study which I was going to share with Dr. Wells. So, I went down to look at the - I believe, as I recall - I went down to look at some sort of radiology study with a student and I was also going to share this data with Dr. Wells. So, I went into the Radiology Department and asked for Dr. Wells. And they said he was in another part of the Radiology Department and I was going to go over there, but Dr. Athavale was there and I know he was concerned with this data So, I should have just gone to see Dr. Wells, but I showed the data to Dr. Athavale and basically it showed that from 1996, which was well before I came here, the adequacy and malignancy things had changed like this so there was

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no recent trend. And I thought Dr. Athavale was a pretty reasonable person who would at least look at this in a way and immediately they started getting defensive and Dr. Lau came from another part and literally started screaming at me. He said, "I'm getting tired of you changing all the data and making" - I'd never talked to him before in my life, and he's accusing meMICHAEL EWALD:

You'd never talked to him at all before?

DR. JADWIN:

About this-

MICHAEL EWALD:

About that.

DR. JADWIN:

About this - any type of data thing - and he started accusing me of always changing the data, and screaming. Literally being very hyper. I'm sure maybe you've seen how he behaves, but in his characteristic manner, and to the point where he was just irrational. And so finally I said - I was just trying to say this was preliminary data. We're looking at all the data, etc. And he just went on and on and on, and finally I said, "Calm down. Calm down. Calm down" - like this and I got him to calm down to the point where he literally sat in a chair and was almost whispering, but he was still agitated. And I tried to explain to him that this was just preliminary data that - you know - we're collecting all the data available - radiologists, needle, citing all this type of stuff - and we're putting it into a spreadsheet to be looking at it, and he started becoming agitated and various other types of things. He says - and Dr. Athavale was a little defensive, too. I was trying to mention to him that - you know - negative cytology means absolutely nothing which is what the textbooks will tell you, but they're under the impression that if you get a negative cytology then you don't have any disease. And, so -

MICHAEL EWALD:

Did your voice -

DR. JADWIN:

No. I was very calm the whole time.

MICHAEL EWALD:

You were calm the whole time?

DR. JADWIN:

Calm the whole time. I never raised my voice - at any rate -

MICHAEL EWALD:

So, then what happened? He was seated-

DR. JADWIN:

Yeah, he was seated and he was going on and he was just - I don't know if you've had any conversations with the man, but he just doesn't listen - you know. He just goes off on tangent and gets very excitable. I probably should have just walked away and

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realized that communication with this man is virtually impossible. And he started up again by saying, "Why don't you do this? Why don't you do that?" He wasn't hearing a single word that I had said - a preliminary looking at complete information - all that sort of stuff. So, literally- I don't remember ifit was his name tag or his tie - but I said - at that point Ijust got so frustrated with trying to verbally communicate with him, I said, "Let's go down to my office" - I literally went something like this - "Let's go to my office and I'll show you the data sheet." And Dr. Athavale couldn't possibly have seen what happened. He was sitting back here and Dr. Lau was here and I was in the middle of this. And we literally took one or two steps and Dr. Lau (sound of movement) went straight across the hall like this and he's like this MICHAEL EWALD:

And he appeared - he got up against the wall?

DR. JADWIN:

In the door - he was terrified - he was terrified. And he wasn't terrified of me. He was terrified - I think - of the data that I was going to present to him. And, so, he said - well, I said, "Come on down to my office and look at the data" - just like that. "Come on down." "No, I can't." Now, I have to give you a little bit of background on this. This is not the first time that he's done something like this to me. Urn - in one of these instances where we went down to the Radiology Department and they collected the sample, left the room, and the patient was coming off of the CT Scan. And I get down there and the sample is unsatisfactory for evaluation. So, I walk down to Dr. Lau and I said, "Well, Dr. Lau, I'm sorry, but maybe we'll get something on the permanence, but on the preliminary it was just necrotic" - you know - or whatever it was - and - you know - "I'm not sure if we're going to have an adequate specimen." I said, "Would you like to come down and look at the slides with me?" Because for a year and a half I've been trying to get these guys to meet with me to discuss this. I've met the surgeons and various other people. These people - I'm not sure they have regular meetings. It's been very frustrating for me because I go down there and try to get them as a group to talk to them about how best to collect a sample. And he said, "What needle was in the ." And, "I know I got a good sample." And I said, "Come on down to the laboratory and look at it." "No. I'm too busy. Too busy." So, I left and immediately, he goes down to Kolb's office and complains about the pathologyyou know - and so Marv brings him down finally to my office where we look at the slides. And there's nothing on the slides. All of our stuff is double reviewed. Recently, we've been sending everything to UCLA and they agree with me. So, he's sitting there with Kolb and the microscope and we've got two sets over here, _ and he says "What's that down there? What's that? It's

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cells." And I said, "Well those are red blood cells, doctor." And Dr. Lau said, "What's that I notice over here?" And he doesn't even know what he's looking at. And, so this happened at least once and possibly two times where I've asked him to come down and review things and they just won't have any part of it. To me, it's, quite frankly, because they don't know what they're doing. Yes, they know how to put a needle into the lesion, but putting a needle into the lesion is not the same thing as getting the sample into the needle, pulling it out and putting it on the slide and getting a good sample. And that's what they don't understand. ',!:,,,

MICHAEL EWALD:

Let's go back to the tie pulling incident, okay? You are testifying that you did pull his tie - you did take his tie -

DR. JADWIN:

Tie and/or name tag - I don't remember what it was -like this.

MICHAEL EWALD:

Okay. The witnesses are saying and he's says that it was his tie. So, you pulled his tie and did you pull him from one room to the other or out into the hall?

DR. JADWIN:

No. I don't think it was more than one or two steps.

MICHAEL EWALD:

Okay.

DR. JADWIN:

It was like this. It was a like a light - like a tug on - "Come down to my office and look at this stuff."

MICHAEL EWALD:

Okay.

DR. JADWIN:

And I did it because in the past he's not done it and I was hoping he would-

MICHAEL EWALD:

What did you expect when you took his tie and started to pull him behind you? Were you pulling and backing up?

DR. JADWIN:

No. No. No. No. He was like - he's sitting here-

MICHAEL EWALD:

Okay. He's seated.

DR. JADWIN:

And I said, "Come on down to my office" - like this

MICHAEL EWALD:

Okay.

DR. JADWIN:

Basically, I have two to three fingers -

MICHAEL EWALD:

Okay. And then he followed with that -

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DR. JADWIN:

He stood up one or two steps and then charged away.

MICHAEL EWALD:

Charged away. Okay. And - urn - did he pull the tie back or did you-

DR. JADWIN:

No. There was nothing - if I grabbed his tie hard - you've seen him and me - there's no way he would have gotten away. It was like this - "Come up tD my office."

MICHAEL EWALD:

So, what you're showing - since I'm not videotaping this - you're showing that you took three fingers - four fingers - three fingers and a thumb and put it on his tie and gave a tug. And then you're testifYing that he overreacted to that - maybe took a couple of steps - got out of his chair - took a couple of steps and ran into the hallway-

DR. JADWIN:

Ran out of the room, out into the hallway, into the other doorway. And Dr. Athavale was behind me, so he had no view of what was transpiring. The medical student was standing over here, so she would be the person who would -

MICHAEL EWALD:

Right. She's been interviewed.

DR. JADWIN:

Okay.

MICHAEL EWALD:

As well as Dr. Athavale, too. And the - what did you expect - this was not a - you're saying this was not an aggressive gesture to hurt him or anything, but that it was to - why did you take his tie?

DR. JADWIN:

I wanted to lead him into my office to see the data. Talking to him was -

MICHAEL EWALD:

You mean you would have led him all the way down the hall ifhe

DR. JADWIN:

Not necessarily. I wanted to get him up and out and get him movmg. It was sort of an encouragement type of thing.

MICHAEL EWALD:

Okay.

DR. JADWIN:

You know - um-

MICHAEL EWALD:

Okay. Do - is this something you have done before to him or to anyone else?

DR. JADWIN:

Never. Never in my life.

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MICHAEL EWALD:

Is this something you would do again?

DR JADWIN:

No.

MICHAEL EWALD:

Okay. Do you regret doing it?

DR JADWIN:

Urn - I'm sort of surprised that it has gotten to this level. Urn - I regret having even gone past one sentence of conversation with him because I firmly believe it's impossible to communicate with this man on a professional basis.

MICHAEL EWALD:

Okay. Do you regret pulling his tie?

DR. JADWIN:

Yeah, at this point I do.

MICHAEL EWALD:

Urn - have you had any discussions about this with him or have you written to him or has there been any communication between you about this subject?

DR. JADWIN:

There was one time when he was walking out of the hospital and I was walking out at the same time. And I quite frankly looked at him very close and I said, "I don't think you're an honest man." And I walked out ofthe hospital. Because I read that letter he wrote and I orange highlighted some things on there that were just outrageously stretched or even factually untrue, I think.

MICHAEL EWALD:

In the letter, what do you feel is not factually true?

DR. JADWIN:

Well, you know I don't have that letter any more. It was some sort of something or other -

LINDA NIPPER:

I have the letter here.

DR. JADWIN:

If you have a yellow highlighter and can make a copy 0 fit -

MICHAEL EWALD:

Well, if you'll just point out the parts that you feel are factually untrue.

DR. JADWIN:

"Dr. Jadwin and I were debating over some pathology data." There was no debate about it. The man was yelling and screaming at me, and was hysterical.

MICHAEL EWALD:

Okay.

DR. JADWIN:

Urn - "Dr. Jadwin insisted that I go over to his office to look over more data." I wanted him to come to the office, and -

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MICHAEL EWALD:

Did you invite him to come to your office?

DR. JADWIN:

I said, "Come" - when I did this, I said, "Come and see the data."

MICHAEL EWALD:

Okay.

DR. JADWIN:

Because verbal discussion at this point was useless. I was hoping and then actually when I left - when he refused to come, I went down to my office. I brought the spreadsheet and I showed it to the people. And then I went - the funny thing about all this is that I then went to Dr. Wells - after all of this - and showed him the stuff and he was perfectly fine with it. He saw it and saw it as a reasonable thing and made no comments. He even commented that maybe part of the problems were the needles that they were using, because one of the things is a cutting needle and aspiration needle, and they've been using cutting needle and I've been trying to get them to use an aspiration needle and etc. So - "I told him I could not leave the department because I was attending to a patient whom I was going to perform an angiogram." Well, I think this would have only taken a couple of minutes. But, this is characteristic of his behavior when he is confronted with trying to deal with something objectively, he runs and hides.

MICHAEL EWALD:

Do you recall him saying that to you?

DR. JADWIN:

Yes, he did. But, I'm not sure that two minutes would have made much difference one way or other. I mean, he wasn't even invited into this conversation. I was showing the data to Dr. Athavale, who was defensive because, quite frankly, he's one of the people that hasn't been doing the job of collecting the stuff. And Dr. Lau came from out of nowhere and started screaming at me about manipulating the data and he was an expert in statistics - that's something I didn't mention before - and I didn't know what I was doing. He knew everything about statistics and I was manipulating the data to show them in a bad light. "He further insisted." I said, "Come on down to my office and look at the data." If that's "insisting" then that's "insisting," but I don't think that's what"He grabbed me by the tie." Some of this seems a little bit out of place. "He grabbed me by the tie with his hand and dragged me for several feet." I didn't drag him for several feet. I got him up to a standing position - one or two steps and he took off. "I warned him not to do that any more." I'm not sure ifhe said anything to that effect.

MICHAEL EWALD:

You're not sure ifhe warned you not to do it.

DR. JADWIN:

Yeah, I don't-

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MICHAEL EWALD:

You don't have any recollection of that?

DR. JADWrN:

No. I tell you, I was quite peeved with the man because I walked over there in a way to show him data. He's been out there saying different things to medical staff about the problem's actually my problem and not his problem, when I think we're actually in the process of collecting all stuff and sending it to UCLA. I think that they're going to substantiate the fact that we haven't been getting good material. And, so I've taken this as a personal assault on my integrity and my character and then he started accusing me of manipulating the data and - urn - you know -

MICHAEL EWALD:

So, would it be fair to say that when you took hold of his tie, you were upset?

DR.JADWrN:

I was upset, but I was in control. I mean, I hadn't raised my voice to any extent and I think he made a comment during this "debate" which was not even closely a debate that this data did not mean anything. And I said, "Well, I think it does mean something." And I said it with that sort of emphasis - "Well, I think it does mean something," but that was the most of anything that I ever said in a way. I was trying to do this in a professional educational manneryou know - talking with them. And it sort of reflects my frustration for a year and a half of even trying to meet with these people, or having even some type of professional interaction to help them do a better job.

MICHAEL EWALD:

Okay. Urn - alright - so it is - what I've heard from you is that there was a discussion between you and Dr. Lau and Dr. Lau, according to you, became - his voice raised up, he became pretty loud and then he sat down - quieted down - and at that point you reached over, took his tie, started to pull his tie so that he began to come up out of his seat, taking one or two steps and then he reacted by - with you dropping the tie, or somehow getting the tie back -

DR. JADWIN:

Well, he just pulled way. There was no tension to it.

MICHAEL EWALD:

So, he just pulled - did he pull the tie out of your grasp, do you . think?

DR. JADWIN:

Well, he wouldn't have had to try hard. I was holding it with-

MICHAEL EWALD:

So, he pulled it back and then went out on his own -

DR. JADWIN:

Ran out into the hallway, ran across the hallway and into the other room.

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MICHAEL EWALD:

He was running?

DR. JADWIN:

Running. He was running.

MICHAEL EWALD:

Running out to the hallway where he appeared - he went against the wall and acted as though you were going to -

DR. JADWIN:

In the doorway.

MICHAEL EWALD:

Oh, in the doorway.

DR. JADWIN:

He was in the doorway like this.

MICHAEL EWALD:

Okay. Alright. (Inaudible)

DR. JADWIN:

He had literal terror on his face.

MICHAEL EWALD:

Terror. Okay. And - it was then-

DR. JADWIN:

Which caused me - I was sort of dumbfounded when I saw this reaction. So-

MICHAEL EWALD:

So then he got out of your way and you just left without any further incident.

DR. JADWIN:

No. At that point, he went over there and I said, "Come on down to my office and look at the data." And he said, "No. I'm too busy." Now, he may have even said that twice. He said, "I've got to do an angiogram. I can't." At that point, I just walked down to my office. I got the spreadsheet printouts that we have and I went over it with Dr. Athavale. He was gone somewhere else. Dr. Athavale nodded and - I mean - I'm a very compulsive person. We collected everything. There's nothing left to question on this.

MICHAEL EWALD:

So, actually, you pulled the tie, he got up a little bit and then he went over and he went back in, sat down and then you asked him again ifhe wanted to come down?

DR. JADWIN:

Oh no, no, no. Okay. I tugged him up out of the chair -like "come down to my office" - I said, "Come down to my office and see this data." He immediately ran - tugged away - ran out of the room, across the hall in the crouching position. I walked out into the hall and said, "Come down to my - why don't you come down to my office and look at the" - and he said, "I can't." And he might have even said this twice. "I've got to do a procedure."

MICHAEL EWALD:

Okay.

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DR. JADWIN:

Now, he had to do a procedure before all this started and it didn't stop him from taking time away from the procedure to do this, but when I asked him to do the data, he wouldn't. Then I left and went to get the spreadsheet data to show them the information we were collecting.

MICHAEL EWALD:

He wasn't there when you came back?

DR. JADWIN:

I don't remember ifhe was there, but I did show it to Dr. Athavale and I don't remember seeing him. Even ifhe was there, I wouldn't have discussed it with him. But I showed Dr. Athavale, who sort of nodded his head a little bit. And I went to show the information to Dr. Wells, who was perfectly happy with it.

MICHAEL EWALD:

Okay.

DR. JADWIN:

The type of response that I would have hoped that the other two· would have been able to display.

MICHAEL EWALD:

Okay. Vh - is there any other thing that you'd like to tell us about this?

DR. JADWIN:

Well, again, his behavior was almost hysterical and I had to spend quite a bit of time to just get him to calm down and I said, "Dr. Lau, calm down. Calm down. Calm down." Literally, to the point where I sort of backed him into his chair and over a period ofmany seconds, he finally calmed down to the point where you could have a conversation with him, because you couldn't even have a conversation with him.

MICHAEL EWALD:

Do you feel- yet you don't really see your actions as all that professional either?

DR. JADWIN:

I don't - well, I'm not sure - you know - Dr. Kolb's first response would have been my first response when Dr. Lau went there and he says, "So, come on Chester. He was just kidding with you" - you know. And that is the nature of the thing as I saw it. I was trying to get him to come to my office and review the material. But, I had zero ability to discuss it with him because of his behavior.

MICHAEL EWALD:

Okay.

DR. JADWIN:

There was nothing physically aggressive or hostile. I was a little peeved. I will say I was a little peeved, but I've never had this type of incident before. I never had to work with someone like this before and-

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MICHAEL EWALD:

Do you have any questions?

LINDA NIPPER:

No.

MICHAEL EWALD:

Okay. Good. Thank you very much. The conclusion of the interview is 10:24 a.m., October 17, 2003.

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 55

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) Volume I ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

DAVID FRANK JADWIN, D.O.

17

Tuesday, January 8, 2008

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

DFJ1

Page 194 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 195 of 209 222

1

16:02:47

1 relationships with Dr. Abraham?

2

16:02:50

2

MR. LEE:

3

16:02:51

3

THE WITNESS:

4

16:02:54

4 professional.

5

16:02:59

5 her in a professional manner on -- on clinical

6

16:03:03

6 matters and in medical executive committee meetings.

7

16:03:07

7 Even when she said we have no confidence in the

8

16:03:11

8 pathology department, I did not respond but chose to

9

16:03:15

9 discuss that with her after the fact in confidence --

It's vague and ambiguous. On clinical matters, they were

From my perspective, I always treated

10

16:03:18 10 in -- in a quiet venue, rather than making a big

11

16:03:23 11 battle out of it in front of the department.

12

16:03:25 12 that's typically my style.

13

16:03:27 13 BY MR. WASSER:

14

16:03:27 14

15

16:03:30 15 others that she was not competent?

16

16:03:32 16

A.

In what way?

17

16:03:34 17

Q.

Using words.

18

16:03:36 18

19

16:03:37 19 argumentative.

20

16:03:39 20

21

16:03:41 21 she was clinically incompetent.

22

16:03:43 22 BY MR. WASSER:

23

16:03:44 23

24

16:03:45 24

25

16:03:48 25 Dr. Abraham to her face in a meeting with other

Q.

And did you ever tell her in the presence of

MR. LEE:

I'm sorry.

It's vague and ambiguous and

THE WITNESS:

Q.

And

I absolutely never said that

I don't know that you added the adverb. I'm just asking did you ever tell

DFJ1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 196 of 209 223

1

16:03:52

1 doctors present what she was not competent?

2

16:03:54

2

3

16:03:56

3 something competent to assess fine needle

4

16:03:59

4 aspirations, but I never would have crit- -- first of

5

16:04:00

5 all, I don't know what her competency level is, and

6

16:04:03

6 it's not my nature to make those types of criticisms,

7

16:04:09

7 especially in a professional venue.

8

16:04:12

8

9

16:04:15

9 where you're -- where you're trying to work through

A.

Oh, absolutely not.

I may have said

Now, in a mediation session where you're --

10

16:04:18 10 problems, that's a different issue.

11

16:04:21 11 impugned her clinical skills.

12

16:04:23 12 have thought that she was -- I would not have thought

13

16:04:27 13 that she had clinical problems with a couple of

14

16:04:31 14 sections -- exceptions that I know about.

15

16:04:34 15

16

16:04:37 16 unfit to be -- be head of the medical staff?

17

16:04:40 17

A.

Absolutely not.

18

16:04:42 18

Q.

Was your motive and interest in composing

19

16:05:00 19 the E-mail we see in Exhibit 573 primarily to salvage

20

16:05:06 20 the reputation of the pathology department and

21

16:05:09 21 yourself?

22

16:05:09 22

A.

No.

23

16:05:09 23

Q.

I think in one of the earlier E-mails we

24

16:05:18 24 have read today you -- you expressed the concern to

25

16:05:20 25 Mr. Bryan that other members of the medical staff had

Q.

But I -- I never

And in fact, I would

Did you ever tell Dr. Kercher that he was

DFJ1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 197 262 of 209

STATE OF CALIFORNIA ss. COUNTY OF KERN

I,

Sandra L. Edmonson,

a Certified Shorthand

Reporter in the State of California, Certificate No.

holding

7704, do hereby certify that

DAVID FRANK JADWIN,

D.O.,

the witness named in the

foregoing deposition, Volume I, was by me duly sworn; that said deposition was taken Tuesday,

January 8,

2008,

at the time and place set forth on the first page hereof. That upon the taking of the deposition,

the

words of the witness were written down by me in stenotype and thereafter transcribed by computer under my supervision; that the foregoing is a true and correct

t ~

transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action,

nor

1

f b

i .~

in any way interested in the result or outcome thereof. Dated this 21st day of January,

2008,

at

Bakersfield, California .

1

I

s~~~?at~~:.- 7~ WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 198 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 56

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

61

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9 10

F. JADWIN, D.O.,

) VOLUME II ) Page 96 Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) ) Defendants. ) __________________________)

11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

COUNTY OF KERN THROUGH PERSON MOST KNOWLEDGEABLE,

17

PHILIP LEE DUTT, M.D.

18

Tuesday, September 9, 2008

19

Bakersfield, California

20 21 22 23 24 25

ted by:

Susan R. Wood, CSR No. 6829

PMK DuttP2

Page 199 of 209 96

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 200 of 209 232

1

12:13:46

1

due to a pathologist shortage and backlogs with

2

12:13:49

2

transcription.

3

12:13:49

3

4

12:13:52

4

5

12:13:55

5

A.

I think so.

6

12:14:16

6

Q.

You took a medical leave in 2007.

7

12:14:29

7

8

12:14:31

8

A.

No.

9

12:14:32

9

Q.

No?

Is that an accurate representation of what Dr. Gerry said at this meeting?

correct?

Is that

Because your mother was sick.

10

12:14:33 10

What happened?

11

12:14:35 11

12

12:14:37 12

13

12:14:45 13

14

12:14:47 14

15

12:14:49 15

16

12:14:51 16

17

12:14:52 17

18

12:14:54 18

19

12:14:55 19

20

12:14:57 20

21

12:14:57 21

22

22

23

12:14:59 23

THE WITNESS:

24

12:15:00 24

MS. BARNES:

25

12:15:01 25

You took a leave because one

of your parents got ill, passed away? A.

They both were ill.

I took family sick

leave, as I understand it. Q.

How did you -- I'm sorry. Okay.

How did you go about applying for

this family sick leave? MS. BARNES:

What does this have to do with

the PMK designation? MR. LEE:

I don't need to answer that

question. MS. BARNES:

Well, it's outside the scope of

the -It does. Please let me make the

objection.

PMK DuttP2

Case 1:07-cv-00026-OWW-TAG

Q.

Document 277-4

Okay.

Filed 12/01/2008

Page 201 of 209 237

1

12:20:18

1

Did you tell the CEO at the time or

2

12:20:21

2

3

12:20:24

3

4

12:20:32

4

5

12:20:38

5

6

12:20:41

6

did you -- how did you become aware that he found

7

12:20:43

7

out?

8

12:20:45

8

9

12:20:50

9

any of your superiors? A.

Well, I did not tell the CEO.

I'm not sure

how Dr. Harris found out. Q.

Okay.

Well, when Harris did find out, how

Did he have a conversation with you? A.

At some point he said take some time to --

to work with my parents.

10

12:20:56 10

Q.

Okay.

Do you recall when he told you that?

11

12:20:59 11

A.

I don't remember the exact day.

12

12:21:01 12

Q.

Give me an estimate.

13

12:21:03 13

14

12:21:06 14

A.

Well, it was either late 2006 or early 2007.

15

12:21:12 15

Q.

Okay.

16

12:21:17 16

and get medical leave form and fill it out, go to

17

12:21:20 17

H.R., do a doctor certification, anything of that

18

12:21:24 18

nature?

19

12:21:24 19

A.

I didn't even consider it.

20

12:21:27 20

Q.

Why not?

21

12:21:27 21

A.

Well, for one thing, I didn't want to be

22

12:21:30 22

23

12:21:33 23

Q.

What does that mean?

24

12:21:34 24

A.

Well, I didn't want to take off or quit

25

12:21:37 25

What month?

Okay.

like Dr. Jadwin.

What year?

And you never decided to go

For another thing -Hold on.

working or -- or decrease my workload from anywhere

PMK DuttP2

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 202 of 209 243

1

12:27:51

1

needed me to be there rather than being away for a

2

12:27:54

2

three- or a one-month period solid.

3

12:28:09

3

4

12:28:11

4

5

12:28:16

5

6

12:28:18

6

7

12:28:21

7

8

12:28:22

8

wrong for an employer to punish an employee for

9

12:28:25

9

taking medical leave for a legitimate reason?

Q.

What do you think of the notion of taking

medical leave off when you're sick? A.

Oh, I think -- I think if it's a legitimate

reason then people have a right to do it. Q.

A.

Do you think people -- do you think it's

10

12:28:28 10

Maybe.

It would depend on the

11

12:28:29 11

12

12:28:30 12

Q.

So sometimes it would be okay?

13

12:28:31 13

A.

I don't know the law in that area.

14

12:28:35 14

15

12:28:36 15

16

12:28:39 16

17

12:28:41 17

18

12:28:49 18

to the medical leave; whether there were, as I said

19

12:28:56 19

in this case, previous statements; and it would

20

12:29:00 20

depend on the nature and legitimacy of the medical

21

12:29:04 21

condition and the seriousness, for example.

22

12:29:14 22

THE WITNESS:

23

12:29:16 23

MR. LEE:

24

12:29:19 24

Let's go off the record at 12:29 p.m.

25

12:42:55 25

(Recess taken.)

circumstances.

That's a

legal question. Q.

I'm not asking for the law.

I'm asking for

your opinion on this. A.

It would depend on, for example, what led up

Can we take a break?

Sure.

PMK DuttP2

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

263 Page 203 of 209

ss. 3 4 5

I,

Susan R. Wood,

a Certified Shorthand

6

Reporter in the State of California,

7

Certificate No.

8

PHILIP LEE DUTT, M.D.,

9

foregoing deposition,

6829,

holding

do hereby certify that the witness named in the was by me duly sworn; that said

10

deposition was taken Tuesday,

11

time and place set forth on the first page hereof.

12

September 9,

2008,

That upon the taking of the deposition,

at the

the

13

words of the witness were written down by me in

14

stenotypy and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness. I further certify that I am neither counsel for nor in any way related to any party to said action,

nor

in any way interested in the result or outcome thereof. Dated this 30th day of September,

2008,

at

Bakersfield, California.

--s-u-s-a-n-~~-N-O-.

- 6::-:8:-2::-:-9----

WOOD & RANDALL (800) 322-4595

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 204 of 209

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 57

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

62

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

1

UNITED STATES DISTRICT COURT

2

FOR THE EASTERN DISTRICT OF CALIFORNIA

3

______________

4 5 6 7 8 9

F. JADWIN, D.O.,

) ) Plaintiff, ) ) vs. ) No. 1:07-cv-00026-OWW-TAG ) Y OF KERN; et al. ) ) Defendants. ) __________________________)

10 11 12 13 14

VIDEOTAPED DEPOSITION

15

OF

16

STEVEN GEORGE O'CONNOR

17

Tuesday, December 4, 2007

18

Bakersfield, California

19 20 21 22 23 24 25

ted by:

Sandra L. Edmonson, CSR No. 7704, RPR, CRR

OConnorS

Page 205 of 209 1

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 206 of 209 68

1

09:53:02

1 any preparation for the meeting with the CEO and with

2

09:53:07

2 Dr. Jadwin and with Karen Barnes?

3

09:53:11

3

A.

I did not.

4

09:53:11

4

Q.

Okay.

5

09:53:13

5 be at the meeting?

6

09:53:14

6

7

09:53:18

7 representative from human resources.

8

09:53:20

8

9

09:53:23

9 questions or that you would give any input at the

A.

What did you understand your role to

Q.

I thought my role probably was as a

Did you expect that you would be asking any

10

09:53:26 10 meeting?

11

09:53:26 11

A.

No.

12

09:53:26 12

Q.

Okay.

13

09:53:29 13 would be expected to be familiar with this packet,

14

09:53:31 14 Exhibit No. 3, before going into the meeting?

15

09:53:37 15

16

09:53:39 16 meeting.

17

09:53:39 17

18

09:53:44 18 confused.

19

09:53:47 19 just to be there?

20

09:53:48 20

21

09:53:50 21 was in Peter Bryan's mind or what?

22

09:53:53 22 BY MR. LEE:

23

09:53:53 23

24

09:53:55 24 Peter Bryan, why did --

25

09:53:56 25

A.

Did you understand that maybe you

Q.

I don't believe I said a word or two in the

Uh-huh.

So my -- I guess my -- I'm a little

Why would Peter Bryan ask you to be there,

MR. WASSER:

Q.

You're asking him to know what

Well, based upon your communications with

MR. WASSER:

He said he didn't recall.

OConnorS

Case 1:07-cv-00026-OWW-TAG

Document 277-4

Filed 12/01/2008

Page 207 of 209 73

1

09:58:02

1

A.

I didn't ask, no.

2

09:58:03

2

Q.

Do you think it could have been because you

3

09:58:05

3 were more familiar with Dr. Jadwin's case than

4

09:58:09

4 Ms. Chester?

5

09:58:11

5

A.

I'm sorry, I don't know.

6

09:58:12

6

Q.

You don't know.

7

09:58:17

7 why it was you and --

8

09:58:18

8

9

09:58:20

9 years and, you know, known as a contact person in the

A.

So you just have no idea

Well, I've worked at the department for 14

10

09:58:28 10 department.

11

09:58:30 11

12

09:58:37 12 called into a meeting with the CEO then?

13

09:58:43 13

MR. WASSER:

14

09:58:44 14

THE WITNESS:

15

09:58:45 15

MR. WASSER:

16

09:58:46 16 BY MR. LEE:

17

09:58:46 17

18

09:58:51 18 would you expect to -- for an HR rep to be called

19

09:58:55 19 into a meeting with Peter Bryan?

20

09:58:58 20

A.

What -- I'm sorry.

21

09:59:00 21

Q.

You said --

22

09:59:00 22

A.

Any meeting he asked for.

23

09:59:03 23

Q.

Okay.

24

09:59:06 24 with Peter Bryan.

25

09:59:08 25 meetings were about where you were called in?

Q.

Q.

So . . .

So is it customary for an HR rep to be

Is it customary? Is it customary? What do you mean?

Is it like a -- I mean, what type of meeting

But you said there were some meetings Can you tell us what those

OConnorS

Case 1:07-cv-00026-OWW-TAG

A.

Document 277-4

Filed 12/01/2008

Page 208 of 209 74

1

09:59:12

1

Well, I mean, I attended a variety of

2

09:59:15

2 meetings with him.

3

09:59:19

3 will, would be a meeting where the HR department

4

09:59:23

4 prepared for a regular hospital county employee a

5

09:59:28

5 proposal for discipline, for possibly a clerical

6

09:59:31

6 support staff or a nurse or anybody in a regular

7

09:59:35

7 position, and Pete -- Peter Bryan, the CEO, acts as

8

09:59:42

8 the hearing officer.

9

09:59:44

9 with him; we would prepare for the meeting.

Probably the most typical, if you

So we would attend the meeting We would

10

09:59:48 10 be present in the meetings.

11

09:59:50 11 the most typical.

12

09:59:51 12

13

09:59:54 13 case, then, his -- who was most familiar with

14

09:59:57 14 Dr. Jadwin's request for LOA as captured in Exhibit

15

10:00:02 15 No. 2?

16

10:00:13 16

A.

I'm not sure who's most familiar with it.

17

10:00:15 17

Q.

Okay.

18

10:00:17 18 handled that process?

19

10:00:19 19

20

10:00:22 20 was Pat Perez, and then Renita Nunn signed off on it

21

10:00:26 21 as recommending it.

22

10:00:27 22

23

10:00:30 23 the handling of Exhibit No. 2?

24

10:00:32 24

A.

That's correct.

25

10:00:32 25

Q.

Okay.

Q.

A.

Q.

That would probably be

Who was most familiar with Dr. Jadwin's

Who in your department would know who

Well, it was -- from the ground floor up it

So really you had almost no involvement in

Did you think -- did you suggest to

OConnorS

Case 1:07-cv-00026-OWW-TAG

Document 277-4

1

STATE OF CALIFORNIA

2

COUNTY OF KERN

Filed 12/01/2008

228 Page 209 of 209

ss.

3 4

5

I,

Sandra L.

Edmonson,

a Certified Shorthand

6

Reporter in the State of California, holding Certificate

7

No.

8

the witness named in the foregoing deposition,

9

dUly sworn;

that said deposition was taken Tuesday,

10

December 4,

2007,

11

first page hereof.

12

7704,

do hereby certify that STEVEN GEORGE O'CONNOR, was by me

at the time and place set forth on the

That upon the taking of the deposition,

the

13

words of the witness were written down by me in

14

stenotype and thereafter transcribed by computer under

15

my supervision; that the foregoing is a true and correct

16

transcript of the testimony given by the witness.

17

I

further certify that I am neither counsel for

18

nor in any way related to any party to said action, nor

19

in any way interested in the result or outcome thereof.

20 21

Dated this 17th day of December,

2007,

at

Bakersfield, California.

22 23

~dJOe (3 arLm.ct!C-cA. nQra L. Edmonson, CSR No.

24 25

WOOD & RANDALL (800) 322-4595

CQV\.

7704

Case 1:07-cv-00026-OWW-TAG

1 2 3 4 5 6

Document 277-5

Filed 12/01/2008

Page 1 of 56

Eugene D. Lee (SB#: 236812) LAW OFFICE OF EUGENE LEE 555 West Fifth Street, Suite 3100 Los Angeles, CA 90013 Phone: (213) 992-3299 Fax: (213) 596-0487 email: [email protected] Attorney for Plaintiff DAVID F. JADWIN, D.O.

7 8

UNITED STATES DISTRICT COURT

9

EASTERN DISTRICT OF CALIFORNIA

10

FRESNO DIVISION

11

DAVID F. JADWIN, D.O.,

12 13 14

Plaintiff, v.

Civil Action No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE LEE IN OPPOSITION TO DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT [Fed. R. Civ. P. 56(a)]

COUNTY OF KERN, et al.,

15

Defendants.

16 17

Date: January 12, 2009 Time: 10:00 Judge: Hon. Oliver W. Wanger Courtroom: 3 Complaint Filed: January 6, 2007 Trial Date: March 24, 2009

18 19 I, Eugene D. Lee, declare as follows: 20 1.

I am an attorney at law duly licensed to practice before the Federal and State Courts of

21 California and admitted to practice before the U.S.D.C. for the Eastern District of California. I am 22 counsel of record for Plaintiff David F. Jadwin in this matter. 23 2.

I am making this declaration in opposition to Defendants’ Motion for Summary

24 Judgment. I have personal knowledge of the matters set forth below and I could and would competently 25 testify thereto if called as a witness in this matter. 26 3.

Attached hereto as Exhibits are true and correct copies of the following documents:

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

1

Case 1:07-cv-00026-OWW-TAG

Document 277-5

Filed 12/01/2008

Page 2 of 56

Exh. 1

Date 7/10/2006

Description Memo from Mr. Bryan to JCC re Recommendation of Demotion of Dr. Jadwin

2 3 4 5 6

8/14/2008 8/26/2008 1/9/2008 3/12/2008 10/21/2008

Deposition Transcript of Peter Bryan, Vol I Deposition Transcript of Peter Bryan, Vol II Deposition Transcript of David Jadwin, Vol II Deposition Transcript of David Jadwin, Vol V Deposition Transcript of David Jadwin, Vol VI

7

8/18/2008

Deposition Transcript of Former Supervisor Barbara Patrick, Vol I

8

4/16/2008

Deposition Transcript of Former Lab Mgr Gilbert Martinez

10

9

8/22/2008

Deposition Transcript of Former President Scott Ragland

11

10

8/25/2008

Deposition Transcript of Supervisor Ray Watson

11

8/21/2008

Deposition Transcript of Former CEO David Culberson

12

8/29/2008

Deposition Transcript of PMK Philip Dutt, Vol. I

13

8/28/2008

Deposition Transcript of Former COO Sandra Chester

17

14

9/4/2008

Deposition Transcript of PMK Eugene Kercher

18

15

6/29/2006

Letter from Lee to Barnes re Spoliation of Evidence

16

3/29/2007

Letter from Lee to Barnes re Spoliation of Evidence

17

11/20/2007 Defendants’ Responses to Plaintiff’s Request for Production, Set One

18

9/10/2007

1 2 3 4 5 6 7 8 9

12 13 14 15 16

19 20 21 22 23 24 25

19

Joint Conference Committee Meeting Minutes re Demotion of OB/GYN Chair Kern County Policy & Administrative Procedures Manual, Section 139 (Disciplinary Actions)

20

3/12/2002

21

12/26/2003 Change of Employee Status

26

CMO Marvin Kolb Memo to Jose Perez re Pathologist Elsa Ang Accusations

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

2

Case 1:07-cv-00026-OWW-TAG

Document 277-5

Filed 12/01/2008

Page 3 of 56

22

5/15/2006

Expert Consulting Services Agreement, between Consultant William Colburn and Kern County

23

8/30/2006

Consultant William Colburn Report to Kern County re Review of Jadwin cases

24

8/13/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. I

5

25

8/27/2008

Deposition Transcript of Former Chief Medical Officer Irwin Harris, Vol. II

6

26

5/3/2004

KMC FNA Consulting Project by UCLA Consultant David Lieu

27

8/18/2008

Deposition Transcript of Former President of Medical Staff Jennifer Abraham

1 2 3 4

7 8 9 10

28

Cancer Conference Presenter Guidelines

29

8/15/2008

12

30

10/19/2005 Exh. 202: Jadwin letter to Albert McBride, Cancer Conference Director re October Conference

13

31

11

Deposition Transcript of Former Cancer Committee Director Albert McBride

October Conference attendee feedback

14 32

11/9/2005

Oncology Conference attendee feedback of Savita Shertukde

33

8/25/2008

Deposition Transcript of OB-GYN Physician Joseph Mansour

34

Harris Memos to File re Mansour Behavior

35

5/10/2006 to 4/12/2007 8/19/2008

36

8/18/2008

Deposition Transcript of Chair of Surgery Maureen Martin, Vol. I

37

4/16/2008

Deposition Transcript of Histotech Evangeline Gallegos

38

4/19/2008

Deposition Transcript of Former CMO Marvin Kolb

25

39

2/26/2008

Deposition Transcript of Pathology Secretary Tracy Lindsey

26

40

2/26/2008

Deposition Transcript of Clerk Irene Lopez

15 16 17 18 19 20 21 22 23

Deposition Transcript of Nurse Executive Antoinette Smith, Vol. I

24

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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41

12/6/2007

Deposition Transcript of Radiology Chair Javad Naderi

42

12/6/2007

Deposition Transcript of Cancer Committee Chair Ravi Patel

43

8/15/2008

Deposition Transcript of Former CEO Secretary Arlene Ramos-Aninion

5

44

12/5/2007

Deposition Transcript of Surgeon Edward Taylor

6

45

12/6/2007

Deposition Transcript of Neurosurgeon Charles Wrobel

46

8/21/2008

Deposition Transcript of Psychiatry Chair Tai Yoo

47

8/20/2008

Deposition Transcript of Acting Pathology Chair Philip Dutt

48

9/14/2006

Acting Pathology Chair Philip Dutt Email to Barnes re Plaintiff’s Paycut Amendment

12

49

10/17/05

Plaintiff email to Bryan re Serious Biopsy Errors

13

50

3/2/2006

Exh. 271: Plaintiff email to Bryan re Serious Biopsy Errors

51

4/21/2006

Emails between Plaintiff and Bryan re Serious Biopsy Errors

52

8/7/2008

Deposition Transcript of Pathologist Savita Shertukde

53

3/11/2008

Deposition Transcript of David Jadwin, Vol. IV

19

54

10/21/2003 Confidential Report on Lau Complaint against Jadwin

20

55

1/8/2008

Deposition Transcript of David Jadwin, Vol. I

56

9/9/2008

Deposition Transcript of PMK Acting Pathology Chair Philip Dutt, Vol. II

57

12/4/2007

Deposition Transcript of HR Director Steven O’Connor

58

10/10/2005 Amendment No. 1 to Employment Contract of Acting Pathology Chair Philip Dutt

59

11/1/2005

1 2 3 4

7 8 9 10 11

14 15 16 17 18

21 22 23 24 25 26

Employment Contract of Pathologist Savita Shertukde

27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

60

6/19/2007 4.

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Employment Contract of Pathologist Gian Yakoub

Attached hereto as Exhibits 2-14, 24-25, 27, 29, 33, 35-47, 52-53 and 55-57 are true and

correct certified copies of deposition transcripts which I either personally conducted or attended. 5.

Attached hereto as Exhibits 15-16 are true and correct copies of letters which I authored

and faxed to Karen Barnes, Chief Deputy County Counsel for the County of Kern on the dates indicated. 6.

I have served four sets of written discovery on Defendants which included Document

Request No. 44. asking for “Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from Chair of Kern Medical Center’s Pathology Department to staff pathologist.” To date, Defendants have not produced any of the agendas for any JCC meetings including the meeting at which the JCC voted to approve Plaintiff’s demotion from chair. Defendants have engaged in a level of discovery obstruction that is more excessive than I have ever encountered in my 13 years practicing as an attorney, of which this is but the latest example. 7.

Attached hereto as Exhibits 17 is a true and correct copy of Defendants’ responses

received by me in response to Plaintiff’s Request for Production of Documents, Set One, propounded by me on behalf of Plaintiff.

16 17 18

I declare under penalty of perjury under the laws of the State of California and the United States that the foregoing is true and correct.

19 20 21

Executed on: December 1, 2008

22 23

/s/ Eugene D. Lee

24

EUGENE D. LEE Declarant

25 26 27 28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 58

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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AMENDMENT NO. 1 TO· AGREEMENT FQRPROFESSIONALSERVICES· CONTRACT EMPLOYEE

{County .... Philip Lbutt, M.b.} This Amendment No.1 to the Agreement for Professional Services is made and entered into this tott..... day of Oe.Jpber:, 2005. by and between the County of Kern (hereinafter "Gounty"},a political subdivision of the state of California, which. owns and operates Kern Medical Center (hereinafter "KMC"), and Philip L DOO, M.D. (hereinafter "Core Physician"), a contrad employee,

RECITALS WHEREAS: (a.) County and Core Physician have heretofore entered into an Agreement for Professional Services (Kern County Agt.#513~2005, dated June 21, 2005) (hereinafter "Agreement"), to provide professional medical services in the Department of pathology at KMC; and (b) County· and Core Physician desire to amend the Agreement to (i) reflect· the full time status of Core Physician effective October 15, 2005. (ii) increase the annual compensation paid to Core Physician, from $155;137 to $186,687, effective October 15, 2005, (iii) clarify the methodology used to pay the professional fee guarantee set forth in Article II, Section 4 of the Agreement, and (iii) revise Exhibit "N' to refJectcurrent assignments and incorporate medical record documentation requiremehts; NOW, THEREFORE, in consideration of the mutual covenants and conditions hereinafter set forth and incorporating by this reference the foregoing recitals, the parties hereto agree to amend the Agreement as follows: 1. Effective October 15; 2005, Article II, Compensation, section 1. Salary (Base), paragraph A, shall be amended as follows:
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2. Effective October 15, 2005, Article II, Compensation, section 1, Salary (Base), paragraph E, shall be amended as follows: "E. The maximum payable under this Agreement, including base salary and professional fees paid by County to Core Physician pursuant to Article II, section 4, paragraph G, will not exceed Nine Hundred Eighty-One Tho~sand Six Hundred Sixty-Two Dollars ($981,662) per the fIVe-year term of this Agreement."

3. Effective June 25, 2005, Article II, Compensation, section 4, Professional Fees, paragraph F, shall be amended as follows: "F. Based on the assumption that the patient activity of Core Physician will be in accordance with the attached job description and medical records documentation by Core Physician regarding supervision of resident physicians a~d care provided will be consistent with CMS requirements for professional billing, Co.unty agrees that the amount of professional fees to be paid by County to Core phYsician will not be less than Fifty-Seven Thousand Nine Hundred One Dollars ($57,901), prorated monthly in twelve (12) equal installments, for a period not to exceedtwel}Je (12) months from the effective date of this Agreement. The professional fees collected between June 25, 2005, the effective date of this Agreement, and June 24, 2006, will be paid by County to Core Phy~ician as follows: July 19, 2005, for the period June 25, 2005 through July 31, 2005; August 16, 2005, for August 2005; September 27,2005, for September 2005; October 25, 2005, for October 2005; Nov~mber 22, 2005, for November 2005; December 20, 2005, for December 2005; January 17, 2006, for January 2006; February 28, 2006, for February 2006; March 28, 2006, for March 2006; April 25, 2006, for April 2006; May 23, 2006, for May 2006; and June 20, 2006, for the period June 1, 2006 through June 30, 2006. The gross professional fees collected between June 25, 2005 and June 24, 2006, and subsequently paid by County to Core Physician are subject to the assessment for administrative expenses and all appropriate federal and state taxes."

4.

Effective June 25, 2005, Article II, Compensation, section 4, Professional Fees, paragraph G, shall be amended as follows: "G. Core Physiciarn hereby assigns toKMC and agrees that :KMC shall have the exclusive right to bill and collect for services prOVided by Core Physician under this Agreement for the twelve (12) month period beginning June 25; 2005 through June 24, 2006, or until such time as the gross professional fees coll~cted by County for services provided by Core Physician under this Agreement ~ceeds $57,901, in addition to the cost: of overhead and assessment for admi(:1istrative expenses. During the period June 25, 2005 through June 24, 2006, or until such time as the professional fees collected and paid by County to Core Physician for services provided by Core Physician under this Agreement exceeds $57,901, Core Physician represents and warrants that Core Physician shall not bill or submit a statement of charges to, or enter into any agreement or undertaking with, any patient, third person or entity for the provision of services (With or without consideration), nor

2

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shall Core Physician initiate any surcharge for care without the prior written authorization and approval of County and KMC." 5. Effective October 15, 2005, Article III, Benefits, section 3, Paid Leave of Absence, paragraph 8, shall be amended as follows: "B. Vacation: Effective October 15, 2005, for each pay period of service, Core Physician shall be credited with a vacation entitlement of 6.15 hours, for a maximum accrual of 160 hours per year. Total unused vacation accumulated shall not exceed a maximum of 320 hours. No further vacation entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued vacation entitlement shall be credited to a maximum of 320 hours. Unused vacation benefits will be credited to Core Physician to a maximum of 320 hours if this Agreement is renewed. Core Physician will be paid for accrued and unused vacation hours upon termination of employment." 6. Effective October 15, 2005, Article III. Benefits. section 3, Paid Leave of Absence, paragraph C, shall be amended as follows: "C. Sick Leave: Effective October 15. 2005. for each pay period of service, Core Physician shall be credited with sick leave credit for illness or accident of 2.46 hours, for a maximum accrual of 64 hours per year. After fIVe years of employment. including full-time employment prior to the effective date of this Agreement. Core Physician shall earn and accrue sick leave credit for illness or accident at the rate of 3.07 hours for each pay period of service for an annual accrual of 80 hours per year. Total unused sick leave accumulated shall not exceed a maximum of 1152 hours. No further sick leave entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will be credited to Core Physician to a maximum of 1152 hours if this Agreement is renewed. Core Physician will not be paid for accrued and unused sick leave upon termination of employment. County policy applicable to other regular County employees of KMC regarding use of sick leave shall apply to Core Physician. n 7. Effective October 15. 2005, Article III. Benefits, section 4. Paid Leave of Absence, paragraph 0, shall be amended as follows: "D. Educational Leave: Effective October 15, 2005. Core Physician shall receive 80 hours paid education leave annually. The first 80 hours shall be credited on the effective date of the Core Physician's employment contract. On each successive anniversary date of that contract, an additional 80 hours shall accrue. Education leave must be used within the year that it is accrued and unused education leave does not accrue to the following contract year. Unused education leave will not be paid upon termination of employment. All education leave must be approved in

3

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advance of use by the Core Physician's Department Chair and the Medical Director." 8. Effective October 15. 2005. Article III. Benefits, section 9. Expense Reimbursement. paragraph A, shall be amended as follows: "A. Effective October 15. 2005, Core Physician will be reimbursed for approved and necessary expenditures related to continuing education including seminar fees, travel and study mat~rials. Reimbursement for travel, lodging and meals shall be upon the same terms and rates as allowed for County employees of KMC. Core Physician will be reimbursed expenses and materials not to exceed· $2,500 per year." 9. Effective October 15, 2005, Exhibit "A," Job Description, sh~1I be replaced with Exhibit "A" to Amendment No.1. Job Description, attached hereto and incorporated herein by this reference. 10. Except as provided herein, all other terms, conditions, and covenants of the Agreement shall remain in filill force and effect. [Intentionally left blank]

4

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IN WITNESS WHEREOF, the: PC3rtie~ have executed this Amendnwnt No.1 to the Agreement as oftheday and year fir~;{written·.above. . APPROVED AS TO CONTENT: KERN MEDICALCENTER

n~.···(~~·

\. By "

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COUNTY OF KERN

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Pete~72~~ Chief8xecUtl~tCer //~-.)

By

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./~/fat.rA;(.. 4;./--r:;.• ~"

.

A

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Chairman' Board of Supervisors

KERN COUNn/ PERSONNEL

.

By

CORE PHYSICIAN

l> .. _,. ~ ,:.,...)

j ; ' ; " . L-.-...;~./

! 1

Kay F. Madden

7~' F~,f

c{;

Director APPROVED AS TO FORM: OFFICE OF COUNTY COUNSEL

By

rft/lbv'\/ A. lY~VVLt:t:-­ Deputy

Amend1.Dutt081105

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Exhibit "An To Amendment No.1 Job' Description Philip L. Dull, M.D. The Department of Pathology provides professional anatomic and clinical pathology services to Kern Medical Center and oversees the administration ahd operation of the clinical laboratory, blood bank and histology and department administriative services. Key duties center upon providing high quality. timely and cost effective patient care. Position Summary: Reports to Chairman, Department of Pathology. Clinical Responsibilities: Provides professional pathology services required to process, interpret and report of pathology specimens, including but not limited tp surgical pathology specimens, bone marrow specimens, non-gynecologic and gynecologic cytology specimens and fine needle aspirates. 1. Performs collection procedures, such as bone marrow aspiration and biopsy. fine needle aspiration and skin punch biopsies. 2. Performs medical autopsies and prepares complete autopsy reports. 3. Performs professional surgical pathology, cytopathology anp hematopathology services on a rotational basis with one or more pathologist. 4. Performs call coverage on a proportional basis with two other p~thologists. 5. Serves as a clinical pathologist and co-laboratory directqr covering clinical laboratory and blood bank services. , 6. Responsibly examines and interprets clinical microscopy speci~ens, such as body fluid, urine, sputum. peripheral blood and other clinical specimeps. 7. Completes all seJVice work in a timely, accurate and professional manner. Administrative Responsibilities: 1. Follows department rules as specified in the pathology department policies and procedures. i . 2. Attends histology and pathology department meetings as scheduled. 3. Attends other laboratory meetings as appropriate or assigned I by the department chairman. , 4. Attends inter-departmental meetings and committees as I assigned by the department chairman. and president of the medical staff. i 5. Attends general medical staff meetings on a semi-annual basis. i 6. Participates in the training of hospital physician residents an
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8. Participates in proficiency testing and performance improvement programs as required.

Assignments: Work assignments will be based upon a work schedule of 44 weeks per year on a flexible basis that fulfills the needs of the deparbTlent. Medical Record Documentation: Documentation by Core Physician will conform to the requirements for evaluation 'and management (ElM) services billed by:teaching physicians set forth in the Medicare earners Manual, Part 3, sections 15016 -15018, inclusive.

7

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AMENDMENT NO.. ·2 T0 AGgEEMENT FORPROFESSIONAL SERVICES CONTRACT"EMPLOYEE (County~ Philip L Outt, M.D,)

This Amendment No.2, to the Agreement for Professional Services is made and entered into this ,,;Cff:bday, oflJu.e-rnhe-r--; '2006, by and between the County of Kern (hereinafter·"County"),a political subdivision ,of the state of California, which owns and 'operates Kern Medical Center (hereinafler "KMC") , and Philip L Dutt, M.D. (hereinafter "Gore Pbysician"), a· contraCt employee. RECITALS

WHEREAS: (a) County and Gore Physician have heretofore entered into an Agreement for Professional Services (Kern County Agt. #513~2005, dated June 21, 2005) (hereinafter "Agreement"JandAmendment No.1 (Kern County Agt #857-200.5" dated October 10, 2005); for the period Jun$ 25, 2005 through June 24, 2010, to provide professional medical services in tbe 'Oepf;lftment of Pathology at KMC; and (b) County and Gore Physician desire to amend the Agreement to reflect the handling of professional fees paid to the clearing account effective January 1,2007; and (c)

The Agreement is amended effective January 1, 2007;

NOW, THEREFORE, in consideration of the mutual covenants and conditions hereinafter set forth and incorporating by this reference the foregoing recitals, the parties hereto agree to amend the Agreement as follows: i

1, Notwithstandingany\provision oUhe Agreement to the contrary, effective January 1, 2007, all professiQnalfees bollected by Core Physidan'sbilling service will continue to be paid to the clearingaccounl. County wilJcontinue, to deduct, from gross professional fees collected and subsequentty deposited into the clearing account, 'the assessment for administrative expenses arid the overhead expenses for Core Physioian's practice group. co,'unty,will no I,onger pay Rrofessional fees as we,ges ,to Core Physician. Net professional fees will be paid monthly d~rectly from the clearing account, as directed by Core Physician or Core P,h,ysician's practic$, group, as a distribution to Core PbysiCl,'arl. Core Physician will be responsible for all appropriate federal and state taxes and withholding requirements. 2, Except. as prbvide~ herein, all other terms,conditions, and covenants of the Agreement and any andall!amendments thereto shall remain in full force and effect.

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fNWITNESS WHEREOF, the parties have ente~d into this Amendment No; 2 the Ag.reemeritasof the day and yearfirstwlittenabove.

COUNTY OFKER.N

to

CORE PHYSICIAN

By<8Ar~~ a~~

By,~M-V PhilipL. >utt,M.D.

Ohairman Board ofSupervisors

APPRO\JEDAS TO CONTENT: KERN MEDICAL CENTER

By

ill ·2[U2~-----~··

David KGulberson Interim Chief Executive Officer

KERN COUNTY PERSONNEL .,~

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''';''.-''',.'-".,Z410:~''''-'''''_!.7:, By i( //} . KayF. Madden /;.~<{~ :'

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.(l;(,

Director

APPROVED AS TO FORM: OFFICE OF OOUNTY COUNSEL

BY&~VZ.~ Deputy , Amend2.Dutt,111506

2

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 59

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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AGREEM.e~:r_FQR.~RQ.~s.SSiONAL·SERV'CES CONTRA.CT ISMPLOYEE (CQuntyof Kern-Savit~tP.Shertukde, M,D,) This Agreement is. made. and entered into this {at d$Y of~&~, 2005, between the County of Kern, a political subdivision of the state of California (hereinafter "County"), which owns and operates Kern Medical Center (hereinafter "KMC and Savita P. Shertukde, M.D. (herein$fter "CorePhysician a contract employee. H

),

H

),

RECITALS. WHEREAS:

A. County is authorized, pursuant to Government Code section 31000, to contract with specially trained persons, and further authorizes the payment of compensation for the sef\Jices rendered; and

8.

County requires assistance in the performance of professional medical services at KMCas such services are unavailable from County resoDrces; and C. Core Physician has special training, knOWledge and experience and is licensed by the state of California to practice medicine and Is qualified to render medical services. NOW, THEREFORE, His agreed between County and Core Physician as follows:

Article I. rERM AND CONDITIONS 1.

TERM This Agreement shall be effective on November 1, 2005, and shall remain in effect through October 31, 2010.

2.

SERVICES Core Physician shall render services as set forth in Exhibit "A," which is attached and made a part of this Agreement. Article It COMPENSATION

1.

SALARY (BASE) Core Physician shall be entitled to the following compensation (as defined in Article II, Section 3):

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A. Core Physician will work full-time (according to AMA survey data for specialty but no less than forty [40] hours per week) and will be compensated with cash and other value as follows: Core Physician will be paid Five Thousand Four Hundred Eighty-Four Dollars and Sixty-One Cents ($5,484.61) biweekly not to exceed One Hundred Forty-Three Thousand Eighty-Eight Dollars ($143,088) annually. County will withhold, from said daily compensation of Core Physician, all applicable federal, state and local payroll taxes. County will pay the employer's portion of the hospital insurance portion of Social Security (FICA 2). B. Core Physician will be paid biweekly on the same schedule as regular fulltime County employees. The exact date of said biweekly payments will be at the sale discretion of County, as is reasonable and convenient for County. C. No adjustment in compensation will be effective without a written amendment to this Agreement. D. The maximum payable under this Agreement, including base salary and professional fees paid by County to Core Physician pursuant to Article II, section 4, paragraph G, will not exceed Seven Hundred Seventy-Three Thousand Three Hundred Forty-One Dollars ($773,341) per the five-year term of this Agreement.

2.

OVERALL COMPENSATION STRUCTURE A. The purpose of this Compensation Plan is to provide market-based, performance-driven compensation that recognizes a Core Physician's efforts and contributions toward promoting the mission and values of KMC. Core Physicians will be identified as such in their contracts with KMC. B. Total compensatiQn for Core Physician will be composed of a base salary paid by the County, professional fee payments from third-party payors, and potential other income generated due to the individual's status as a physician. These three sources of income shall be referred to in this Agreement as Total Core Physician Compensation. The structure for determining Total Core Physician Compensation shall be referred to in this Agreement as the Compensation Plan. C. A Kem County clearing account and a KMC compensation budget unit will be established to account for all funds generated and received to pay Total Core Physician Compensation and to pay all expenses associated with this Compensation Plan. These will act as trust accounts and will be solely used for this purpose. D. A Plan Administrator will be retained by KMC to administer this Compensation Plan and will report to the Faculty Practice Board. 2

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E. A Board of Directors will be established to oversee the Compensation Plan and the Plan Administrator of the Compensation Plan. This Board of Directors shall be referred to in this Agreement as the Faculty Practice Board. The Faculty Practice Board will establish bylaws inclUding powers, duties and responsibilities to be approved both by a simple majority of the Faculty Practice Board and the CEO of KMC. F. An assessment for administrative expenses shall be made on Total Core Physician Compensation to support the administrative expenses of the Compensation Plan. (1) The amount or percentage of the assessment shall be determined annually by the Faculty Practice Board. The amount or percentage of the assessment shall not exceed two percent (2%) of Total Core Physician Compensation (as defined in Article II, Section 2, paragraph B) annually. (2) Administrative expenses shall include the salary and benefits for the Plan Administrator and any staff hired by KMC to support the Plan Administrator, expenses of the Kem County Pension Plan for Physician Employees. and other business expenses as determined by the Plan Administrator and the Faculty Practice Board. G. County agrees to assume liability for and indemnify and hold harmless Core Physician against all claims, losses. expenses, costs, actions, settlements, attorneys' fees and judgments incurred by Core Physician or for which Core Physician becomes liable to pay, arising out of or in connection with or related to the services rendered or which a third party alleges should have been rendered by Core Physician pursuant to this Agreement. The obligation of County under this paragraph shall arise as to all incidents occurring on and after November 1, 2005, and prior to termination or expiration of this Agreement. This paragraph shan survive the termination or expiration of this Agreement and shall apply to all claims made during or after the termination or expiration of this Agreement, which allegedly arise out of services rendered or which should have been rendered by Core Physician during the term of this Agreement. The liability coverage of this paragraph shall not apply to services at sites other than KMC unless approved by the Kern County Board of Supervisors. H. County shall indemnify and defend Core Physician to the same extent as would be afforded to a regular full-time County employee. Said duty of defense and indemnity shall not apply to intentional or willful misconduct, gross negligence, dereliction or criminal misconduct on the part of Core Physician, and further shall not extend to any conduct, actions or activities that do not arise directly from the performance of this Agreement. 3

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BASE SALARY (ITEMS INCLUDED AND METHOD OF PAYMENT)

A. Base salary is compensation paid to Core Physician by the County for: (1) patient care for Medically Indigent Adults (MIA), as defined by Califomia Welfare and Institutions Code sections 17000 et seq., and adults and juveniles incarcerated and detained in County facilities; (2) as a safety-net provider, partial compensation for under-compensated and uninsured patients; (3) teaching; (4) administrative duties; and (5) other activities approved by the CEO of KMC and the Faculty Practice Board. County shall fund the clearing account unit biweekly with an amount equal to Core Physician's biweekly base salary. The base salary, less the assessment for administrative expenses, will be reported as wages and subject to all appropriate federal and state taxes. The base salary will be considered the minimum compensation that a Core Physician shall receive under this Compensation Plan. B. The base salary will be negotiated between the parties and set out for each Core Physician at the end of twelve (12) months by means of an amendment to this Agreement. The base salary will be based on a benchmark salary in proportion to the Core Physician's full-effort commitment. (1) The structure of benchmark salaries is based upon a national standard with four salary steps: "A", "B", "C" and "D." There are three criteria for step placement: level of clinical service, teaching, and administrative duties. This benchmark salary structure and criteria for step placement are set forth in the KMC Faculty Practice Administrat.ive Policies and Procedures Manual. (2) The Faculty Practice Board shall establish the criteria for measuring the full-effort commitment. The Department Chairs, with approval of the Faculty Practice Board, will establish the expected levels of the criteria to meet a full-effort commitment. The criteria for measurement of full-effort commitment is set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual. (3) Research shall not be considered as part of a Core Physician's full-effort commitment. Research activity will be compensated as set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual. 4.

PROFESSIONAL FEES

A. Professional fees include all professional fee collections or payments associated with direct patient care by Core Physician. This shall be referred to in this Agreement as professional fees. Core Physician's practice group is responsible for billing and collecting all professional fees for Core Physician's services. Core Physician's will have a separate tax identifICation number. 4

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B. Professional fee billing by Core Physician's practice group shall be made by a billing service company, approved in advance by the Faculty Practice Board, and based upon minimum performance standards set by the Faculty Practice Board. All professional fees collected by the billing service for Core Physician (i.e., gross professional fees collected) shall be paid to the clearing account. The billing service will maintain individual and practice group records on professional fee billing and collections and will account for such to the Plan Administrator. C. The assessment for administrative expenses will be deducted from gross professional fees collected. D. Overhead and expenses for a practice group, as determined by an overhead distribution formula established by the Plan Administrator and the Faculty Practice Board, will be deducted from the gross professional fees collected and returned to the practice group. E. Gross professional fees collected, less the assessment for administrative expenses and overhead, will be paid monthly as wages and will be subject to all appropriate federal and state taxes; however, practice groups (consistent with their practice group agreements with the County) may direct the Plan Administrator as to the distribution of net professional fees collected, subject to review by the Faculty Practice Board. F. Based on the assumption that the patient activity of Core Physician will be in accordance with the attached job description and medical records documentation by Core Physician regarding supervision of resident physicians and care provided will be consistent with CMS requirements for professional billing, County agrees that the amount of professional fees to be paid by County to Core Physician will not be less than Fifty-Seven Thousand Nine Hundred One Dollars ($57,901), prorated monthly in twelve (12) equal installments, for a period not to exceed twelve (12) months from the effective date of this Agreement. The professional fees collected between November 1, 2005, the effective date of this Agreement, and October 31, 2006, will be paid by County to Core Physician as follows: November 22, 2005, for November 2005; December 20, 2005, for December 2005; January 17, 2006, for January 2006; February 28, 2006, for February 2006; March 28, 2006, for March 2006; April 25, 2006, for April 2006; May 23, 2006, for May 2006; June 20, 2006, for June 2006; July 18, 2005, for July 2006; August 29,2006, August 2006; September 27, 2006, for September 2006; and October 24, 2006, for October 2006. The gross professional fees collected between November 1, 2005 and October 31, 2006, and subsequently paid by County to Core Physician are subject to the assessment for administrative expenses and all appropriate federal and state taxes. G. Core Physician hereby assigns to KMC and agrees that KMC shall have the exclusive right to bill and collect for services provided by Core Physician under this Agreement for the twelve (12) month period beginning November 1, 2005 through 5

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October 31, 2006, or until such time as the gross professional fees collected by County for services provided by Core Physician under this Agreement exceeds $57,901, in addition to the cost of overhead and assessment for administrative expenses. During the period November 1, 2005 through October 31, 2006, or until such time as the professional fees collected and paid by County to Core Physician for services provided by Core Physician under this Agreement exceeds $57,901, Core Physician represents and warrants that Core Physician shall not bill or submit a statement of charges to, or enter into any agreement or undertaking with, any patient, third person or entity for the provision of services (with or without consideration), nor shall Core Physician initiate any surcharge for care without the prior written authorization and approval of County and KMC. 5.

OTHER INCOME

A. Other income IS Income generated due to the individual's status as a physician, which includes, but is not limited to, royalties, grants, speaker fees, professional witness fees, and other nonprofessional fees. B. All other income will be paid to the Core Physician in accordance with instructions provided the clearing account by Core Physician or Core Physician's practice group. Expenses properly incurred by the Core Physician in generating other income will be reimbursed to the Core Physician prior to the balance being channeled through the clearing account. This remainder, less assessment for administrative expenses, will be paid monthly to Core Physician as wages. Other income shall be reported as wages and subject to all appropriate federal and state taxes. C. Income generated by a Core Physician that is deposited to the Community Medical Education and Research Foundation ("CMERF") for department educational use shall not be included as other income and shall not be subject to the assessment for administrative expenses. 6.

PRACTICE GROUPS

A. Core Physicians will be members of a practice group. All practice groups will contract with KMC for the provision of community clinic services, which shall be integrated into the KMC teaching program. The contract between each practice group and KMC will define the responsibilities and funds flow, including professional fee distribution, between each organization. B. Practice group overhead and business-related expenses will be paid by the practice group in accordance with predetermined instructions. Practice groups will determine the policy for expense limits and reimbursable items. County is not responsible for the amount of group overhead and business-related expenses claimed. 6

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OTHER CORE PHYSICIANS

Core Physicians who are not part of a practice group and who practice exclusively at KMC-owned or -contracted sites will be responsible for the cost of professional fee billing as negotiated by the Core Physician with the billing service company. Article III. BENEFITS 1.

EFFECTIVE DATE OF BENEFITS

The date of employment for the purpose of receiving and accruing benefits listed in this Article III shall not be affected by the date of this Agreement, but shall be the date the Core Physician was first continuously employed by KMC. 2.

HEALTH INSURANCE

County shall provide to Core Physician and eligible dependents medical, dental and vision insurance as provided to other regular County employees of KMC. Core Physicians first hired by the County of Kern after April 15, 1997, must pay twenty (20) percent of the cost of their health benefits. County may change the benefits provided under this insurance as such benefits shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement. 3.

PAID LEAVE OF ABSENCE

Core Physician will receive paid leave for holidays, vacation, sick leave and educational leave.

A.

Holidays: Core Physician shall be entitled to such holidays as provided to full-time County employees of KMC. County may change the holidays provided under this section as such holidays change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement. B. Vacation: For each pay period of service, Core Physician shall be credited with a vacation entitlement of 6.15 hours, for a maximum accrual of 160 hours per year. Total unused vacation accumulated shall not exceed a maximum of 320 hours. No further vacation entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued vacation entitlement shall be credited to a maximum of 320 hours. Unused vacation benefits will be credited to Core Physician to a maximum of 320 hours if this Agreement is renewed. Core Physician will be paid for accrued and unused vacation hours upon termination of employment.

C. Sick Leave: For each pay period of service, Core Physician shall be credited with sick leave credit for illness or accident of 2.46 hours, for a maximum accrual of 7

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64 hours per year. After five years of employment, including full-time employment prior to the effective date of this Agreement, Core Physician shall earn and accrue sick leave credit for illness or accident at the rate of 3.07 hours for each pay period of service for an annual accrual of 80 hours per year. Total unused sick leave accumulated shall not exceed a maximum of 1152 hours. No further sick leave entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will be credited to Core Physician to a maximum of 1152 hours if this Agreement is renewed. Core Physician will not be paid for accrued and unused sick leave upon termination of employment. County policy applicable to other regular County employees of KMC regarding use of sick leave shall apply to Core Physician. D. Educational Leave: Core Physician shall receive 80 hours paid education leave annually. The first 80 hours shall be credited on the effective date of the Core Physician's employment contract. On each successive anniversary date of that contract, an additional 80 hours shall accrue. Education leave must be used within the year that it is accrued and unused education leave does not accrue to the following contract year. Unused education leave will not be paid upon termination of employment. All education leave must be approved in advance of use by the Core Physician's Department Chair and the Medical Director.

4.

UNPAID LEAVE OF ABSENCE County shall provide Core Physician the right to unpaid leave of absence provided to other regular County employees of KMC pursuant to County policy. County may change its policy regarding leave of absence, as its policy for leave of absence shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

5.

RETIREMENT PLAN A. Core Physician shall participate in the Kern County Pension Plan and Trust Agreement for Physician Employees (the "Plan"), a qualified defined contribution pension plan, pursuant to the terms of the instrument under which the Plan has been established (the "Plan Document"), as from time-to-time amended. County and Core Physician contributions for each Plan year (as defined in the Plan Document) under the amended and restated Plan document shall be as follows: County shall contribute as County's required contribution the sum of Seventeen Thousand Five Hundred Dollars ($17,500) for the account of Core Physician for each complete Plan year of service (as defined in the Plan Document) by Core Physician. Core Physician's mandatory employee contributions required under the amended and restated Plan Document shall be as follows: If Core Physician's Compensation (as defined under the Plan Document) was One Hundred Fifty Thousand Dollars ($150,000) or less during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan 8

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Document shall be Four Thousand Dollars ($4,000) for a complete Plan year of service by Core Physician. If Core Physician's Compensation was more than One Hundred and Fifty Thousand Dollars ($150,000) but less than One Hundred and Seventy Thousand Dollars ($170,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Nine Thousand Dollars ($9,000) for a complete Plan year of service by Core Physician. If Core Physician's Compensation was One Hundred Seventy Thousand Dollars ($170,000) or more but less than One Hundred Eighty Thousand Dollars ($180,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Twelve Thousand Five Hundred Dollars ($12,500) for a complete Plan year of service by Core Physician. If Core Physician's Compensation was One Hundred and Eighty Thousand ($180,000) or more but less than One Hundred Ninety Thousand Dollars ($190,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Seventeen Thousand Five Hundred Dollars ($17,500) for a complete Plan year of service by Core Physician. If Core Physician's Compensation was at least One Hundred Ninety Thousand Dollars ($190,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be the maximum amount permitted by Internal Revenue Code section 415(c)(1) reduced by the County contribution for the account of Core Physician for the Plan year. Core Physician's mandatory employee contributions shall be withheld by County from Core Physician's biweekly salary in relatively equal amounts. Total contributions by Core Physician and County will not exceed the yearly amount allowed by law; provided, however, if any amounts are contributed in excess of such permissible amounts, the excess contribution shall be corrected as provided in the Plan Document or under law. Any changes in the Plan Document will control the terms of this Agreement. County's required contribution for the account of Core Physician and Core Physician's mandatory employee contributions are also subject to all of the transition rules contained in the Plan as it now exists or may be hereafter amended which may reduce the amount of contribution. The transition rules include, but are not limited to, those contained in sections 3.3(b), 3.3(d), 3.5, and 3.6 of the amended and restated Plan Document. Core Physician (together with all Plan participants) shall be responsible for a pro rata share of the annual costs of administering the Plan. Due to the manner in which Plan participant accounts are held and invested, most such costs cannot be paid directly from Plan assets. To facilitate payment of such costs, County shall advance such costs for so long as County determines such an arrangement is necessary or desirable. To offset such costs, County shall reduce its contribution to the Plan for Core Physician by Core Physician's pro rata share of such costs as determined under the Plan Document.

8.

If the fixed contribution structure described in the immediately preceding paragraph A results, or would result, in the Internal Revenue Service not issuing a favorable determination Jetter for the Plan under the amended and restated Plan 9

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Document, the County reserves the right to substitute another contribution structure which will be designed to maximize benefit to Core Physician on a cost-neutral basis to County, and such substitute contribution structure shall control the terms of this Agreement. County will consult with the Pension Committee, as identified in the Plan Document, with respect to such substitute contribution structure. • C. County's required contribution and all mandatory employee contributions will be paid to such financial services firm(s) as determined under the Plan Document. If, pursuant to the Plan Document, Plan assets are allocated to separate accounts for each Plan participant, such financial services firm(s) shall be solely responsible for allocating Core Physician's contribution amount and investment experience to his or her account. If, pursuant to the Plan Document, Plan participants control the investment of their accounts at such financial services firm(s), the investment of Core Physician's Plan account through such financial services firm shall be determined by Core Physician. County shall not be liable for the investment experience of Core Physician's Plan account. D. Core Physician is not eligible to participate in any other retirement plan established or funded by the County for its employees, inclUding but not limited to the Kem County Employees' Retirement Association, and this Agreement does not confer upon Core Physician any right to claim entitlement to benefits under any such retirement plan(s). 6.

SOCIAL SECURITY AND MEDICARE TAXES

Core Physician is exempt from payment of Social Security taxes as the Kern County Pension Plan for Physician Employees is a qualified alternative to the insurance system established by the federal Social Security Act. Core Physicians employed before March 31, 1986, will continue to be exempt from the payment of Medicare taxes. 7.

DEFERRED COMPENSATION PLAN

Core Physician shall be eligible to participate in the Kem County Deferred Compensation Plan I on the same basis and to the same extent as full-time County employees. County may change its Deferred Compensation Plan as it shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement. 8.

KERN$FLEX PLAN

Core Physician shall be eligible to participate in the Kem$Flex Plan I on the same basis and to the same extent as eligible County employees. County may change its Kern$Flex Plan, as its policy for Kem$Flex shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement. 10

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EXPENSE REIMBURSEMENT Core Physician will be reimbursed for approved and necessary expenditures related to continuing education including seminar fees, travel and study materials. Reimbursement for travel, lodging and meals shall be upon the same temis and rates as allowed for County employees of KMC. Core Physician will be reimbursed expenses and materials not to exceed $2,500 per year.

A.

B. Core Physician will be reimbursed for approved and necessary expenditures related to education and training as directed by KMC. Reimbursement for travel, lodging and meals shall be upon the same terms and rates as allowed for County employees of KMC. C. Reimbursement for expenses incurred in generating professional fees will be reimbursed as set forth in Article II, Section 4, above. D. Reimbursement for expenses incurred in generating other income will be reimbursed as set forth in Article II, Section 5, above. Article IV. TERMINATION AND CORRECTIVE ACTION

1.

TERMINATION OF AGREEMENT

A. Core Physician may terminate this Agreement, without cause, upon ninety (90) days' prior written notice to County. B. County may terminate this Agreement at any time for cause. Cause is defined as a violation of administrative policy of the County of Kern or KMC, unsatisfactory clinical performance, failure to meet department accountability or County may terminate this performance standards, or reduction of need. Agreement based upon reduction of need upon ninety (90) days' prior written notice to Core Physician. C. Termination of this Agreement by County does not per se affect medical staff membership. Actions affecting medical staff membership and clinical privileges are governed solely by the medical staff bylaws. D. In the event of termination of this Agreement for any reason, County shall have no further obligation to pay for any services rendered or expenses incurred by Core Physician after the effective date of the termination. Core Physician shall be entitled to receive base salary from County for services satisfactorily rendered, calculated on a prorated basis up to the effective date of termination. E. Professional fees earned prior to termination and collected within twelve (12) months of termination will be paid to Core Physician in accordance with current 11

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instructions provided the clearing fund by Core Physician's practice group. These professional fees will continue to be subject to assessment for administrative expenses, overhead distribution formula, and all appropriate federal and state taxes in effect at the time the professional fees are paid. 2.

CORRECTIVE ACTION

A. Core Physician is subject to corrective action for violation of administrative policy of the County of Kern or KMC, unsatisfactory clinical performance, or failure to meet department accountability, or performance standards. Such corrective action may include, without limitation, additional training and education, a verbal or written warning, a written reprimand, suspension with or without pay, and termination. B. Corrective action for unsatisfactory clinical performance is governed by the medical staff bylaws. C. Corrective action is not reqUired if the problem involves a serious ethical or clinical breach, a violation of law or a serious violation of County of Kern or KMC policy that merits immediate termination for cause. 3.

REVIEW AND APPEAL PROCESS

Review and appeal of the decision to impose corrective action or terminate for cause shall follow the process set forth in the KMC Faculty Practice Board policy and procedure, titled Corrective Action and Termination Review Process, or the medical staff bylaws, whichever is applicable. Article V. GENERAL PROVISIONS 1.

ASSIGNMENT

Core Physician shall not assign or transfer this Agreement or Core Physician's obligations hereunder, or any part thereof. Core Physician shall not assign any money due or which becomes due to Core Physician under this Agreement without the prior written approval of County. 2.

ASSISTANCE IN LITIGATION

Core Physician agrees to be available to County, at no cost to County, to testify as an expert witness or otherwise, in the event of litigation under any cause of action being brought against County or KMC, its directors, officers or employees except where Core Physician is a named party. KMC will credit the time spent in preparation and testimony as administrative time as defined in the Compensation Plan. 12

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AUTHORITY TO BIND COUNTY It is understood that Core Physician, in Core Physician's performance of any and all duties under this Agreement, has no authority to bind County or KMC to any agreements or undertakings.

4.

CAPTIONS AND INTERPRETATION Paragraph headings in this Agreement are used solely for convenience, and shall be wholly disregarded in the construction of this Agreement. No provision of this Agreement shall be interpreted for or against a party because that party or its legal representative drafted such provision, and this Agreement shall be construed as if jointly prepared by the parties.

5.

CHOICE OF LAWNENUE The parties hereto agree that the provisions of this Agreement will be construed pursuant to the laws of the state of California. This Agreement has been entered into and is to be performed in the County of Kern. Accordingly, the parties agree that the venue of any action relating to this Agreement shall be in the County of Kem.

6.

CONFLICT OF INTEREST The parties to this Agreement have read and are aware of the provisions of sections 1090 et seq. and sections 87100 et seq. of the California Government Code relating to conflict of interest of public officers and employees. All parties hereto agree that they are unaware of any financial or economic interest of any public officer or employee of County relating to this Agreement. It is further understood and agreed that if such a financial interest does exist at the inception of this Agreement, County may immediately terminate this Agreement by giving written notice thereof. Core Physician shall comply with the requirements of California Government Code sections 87100 et seq. dUring the term of this Agreement.

7.

COMPLIANCE WITH KMC AND COUNTY POLICIES Core Physician will comply with all applicable KMC and County policies and procedures. Core Physician will keep daily time sheets on forms supplied, and in the manner specified, by KMC. Core Physician will conform to office policy and routine as established by the Department of which Core Physician is a member, including but not limited to orientation, attendance at case conferences, supervision, in service education, patients' rights functions and performance improvement activities. Core Physician shall submit to drug testing, other laboratory testing and physical examinations as may be required by County. 13

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COMPLIANCE WITH LAW Core Physician shall observe and comply with all applicable County, state and federal laws, ordinances, rules and regulations now in effect or hereafter enacted, including but not limited to JCAHO, Title 22, California Code of Regulations, EMTALA, all federal and state billing requirements including Medi-CaVMedicaid and Medicare billing regUlations, EEOC, HIPAA, FEHA and Cal-OSHA. Core Physician will at all times meet state and federal licensure and County personnel qualifications for the practice of medicine.

9.

COUNTERPARTS

This Agreement may be executed simultaneously in any number of counterparts, each of which shall be deemed an original but all of which together shall constitute one and the same instrument. 10.

EMPLOYMENT STATUS

Core Physician shall be employed by the County of Kern pursuant to the terms of this Agreement and the medical staff bylaws of KMC. Core Physician acknowledges that Core Physician will not be deemed a classified employee, or have any rights or protections under the County's Civil Service Ordinance, rules or regulations. 11.

ENFORCEMENT OF REMEDIES

No right or remedy herein conferred on or reserved to County is exclusive of any other right or remedy herein or by law or equity provided or permitted, but each shall be cumulative of every other right or remedy given hereunder or now or hereafter existing by law or in equity or by statute or otherwise, and may be enforced concurrently or from·time to time. 12.

MEDICAL RECORDS

Any and all patient medical records and charts produced as a result of either party's performance under this Agreement shall be and remain the property of County. During the term of this Agreement, Core Physician shall be permitted to inspect or duplicate any patient's medical record or chart to the extent necessary to meet professional responsibilities to such patient or to assist in the defense of any malpractice or similar claim to which such medical record or chart may be pertinent, provided such inspection or duplication is permitted and conducted in accordance with applicable legal requirements and pursuant to commonly accepted standards of patient confidentiality. Core Physician shall be solely responsible for maintaining patient confidentiality with respect to any information obtained pursuant to this paragraph and will comply with all federal and state laws and regulations regarding patient confidentiality. 14

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MEDICAL STAFF MEMBERSHIP Core Physician will at all times be a member in good standing of the medical staff of Kem Medical Center and govemed as such by the medical staff bylaws. This Agreement may be terminated immediately if Core Physician's membership or privileges are modified or restricted pursuant to action under the medical staff bylaws such that services performed by Core Physician are limited or restricted. Prior to performing duties, Core Physician will: (a) complete an application for medical staff membership; (b) provide proof of current license from the Medical Board of California; (c) provide proof of current DEA certificate; and (d) meet with the medical staff office to ensure appropriate documentation is present for credentialing of medical staff privileges.

14.

MODIFICATIONS OF AGREEMENT This Agreement may be modified in writing only, signed by the parties in interest at the time of the modification.

15.

NON-APPROPRIATION County reserves the right to terminate this Agreement in the event insufficient funds are appropriated or budgeted for this Agreement in any fiscal year due to closing of a clinical department or KMC. Upon such termination, County will be released from any further financial obligation to Core Physician, except for services performed prior to the date of termination or any liability due to any default existing at the time this section is exercised. Core Physician will be given thirty (30) days' written notice in the event that such an action is required by County.

16.

NON-DISCRIMINATION The parties mutually agree to abide by all laws, federal, state and local, and by all policies of the County of Kern respecting discrimination. The parties shall not discriminate on the basis of race, color, national origin, age, religion, marital status or sexual preference.

17.

NON-WAIVER No covenant or condition of this Agreement can be waived except by the written consent of County. Forbearance or indulgence by County in any regard whatsoever shall not constitute a waiver of the covenant or condition to be performed by Core Physician. County shall be entitled to invoke any remedy available to County under this Agreement or by law or in equity despite said forbearance or indulgence.

15

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NOTICES Notices to be given by one party to the other under this Agreement shall be given in writing by personal delivery, by certified mail, return receipt requested, or express delivery service at the addresses specified below. Notices delivered personally shall be deemed received upon receipt; mailed or expressed notices shall be deemed received four (4) days after deposit. A party may change the address to which notice is to be given by giving notice as provided above.

19.

Notice to Core Physician:

Savita P. Shertukde, M.D. 5401 Lennox Avenue, Apt. 20-G Bakersfield, California 93309

Notice to County:

Peter K. Bryan Chief Executive Officer Kern Medical Center 1830 Flower Street Bakersfield, California 93305

PROFESSIONAL RESPONSIBILITIES Core Physician will perform the services and duties set forth in this Agreement in a diligent and conscientious manner in accordance with accepted professional and ethical standards of the medical profession and the medical staff bylaws of KMC.

20.

RELATIONSHIP County and Core Physician recognize that Core Physician is rendering specialized, professional services. The parties recognize that each is possessed of legal knOWledge and skill, and that this Agreement is fully understood by the parties, and is the result of bargaining between the parties. Each party acknowledges their opportunity to fUlly and independently review and consider this Agreement and affirm complete understanding of the effect and operation of its terms prior to entering into the same.

21.

SEVERABILITY Should any part, term, portion or provision of this Agreement be decided finally to be in conflict with any law of the United States or the state of Califomia, or otherwise be unenforceable or ineffectual, the validity of the remaining parts, terms, portions, or provisions shall be deemed severable and shall not be affected thereby, provided such remaining portions or provisions can be construed in substance to constitute the agreement which the parties intended to enter into in the first instance. 16

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SOLE AGREEMENT This Agreement, including all attachments hereto, contains the entire agreement between the parties relating to the services, rights, obligations and covenants contained herein and assumed by the parties respectively. No inducements, representations or promises have been made, other than those recited in this Agreement. No oral promise, modification, change or inducement shall be effective or given any force or effect. [Intentionally left blank]

17

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IN WITNESS TO THE FOREGOING, the parties have executed this Agreement as of the day and year first written above. COUNTY OF KERN

APPROVED AS TO CONTENT: KERN MEDICAL CENTER

By

(1;;,~- Q, !~

C~ilJ.-.....peter K. Bryan IJ Chief Executive Officer

CONTRACT EMPLOYEE

KERN COUNTY PERSONNEL

.

/")

By

.>;::7di{ £:

{"j". (

\

V- / Kay F. Madden, Director

/,:'

APPROVED AS TO FORM: OFFICE OF COUNTY COUNSEL I

I-

\, S y NIl£· ~C/Vj// "'\ Deputy

AgrcerncntShertuKcc.1G0305

IS

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Exhibit II A" Job Description Savita P. Shertukde. M.D. The Department of Pathology provides professional anatomic and clinical pathology services to Kem Medical Center and oversees the administration and operation of the clinical laboratory, blood bank and histology and department administrative services. Key duties center upon providing high quality, timely and cost effective patient care. Position Summary: Reports to Chairman, Department of Pathology. Clinical Responsibilities: Provides professional pathology services required to process, interpret and report of pathology specimens, inclUding but not limited to surgical pathology specimens, bone marrow specimens. non-gynecologic and gynecologic cytology specimens and fine needle aspirates. 1. Performs collection procedures, such as bone marrow aspiration and biopsy, fine needle aspiration and skin punch biopsies. 2. Performs medical autopsies and prepares complete autopsy reports. 3. Performs professional surgical pathology, cytopathology and hematopathology services on a rotational basis with one or more pathologist. 4. Performs call coverage on a proportional basis with two other pathologists. 5. Serves as a clinical pathologist and co-laboratory director covering clinical laboratory and blood bank services. 6. Responsibly examines and interprets clinical microscopy specimens, such as body fluid. urine. sputum. peripheral blood and other clinical specimens. 7. Completes all service work in a timely. accurate and professional manner. Administrative Responsibilities: 1. Follows department rules as specified in the pathology department policies and procedures. 2. Attends histology and pathology department meetings as scheduled. 3. Attends other laboratory meetings as appropriate or assigned by the department chairman. 4. Attends inter-departmental meetings and committees as assigned by the department chairman and president of the medical staff. 5. Attends general medical staff meetings on a semi-annual basis. 6. Participates in the training of hospital physician residents and medical students, including the review of active and past case material as required for patient care. 7. Participates in quality assurance, quality management and quality improvement activities, including peer review and quality control functions of the pathology service. 8. Participates in proficiency testing and performance improvement programs as required. 19

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Assignments: Work assignments will be based upon a work schedule of 44 weeks per year on a flexible basis that fulfills the needs of the department. Medical Record Documentation: Documentation by Core Physician will conform to the requirements for evaluation and management (ElM) services billed by teaching physicians set forth in the Medicare Carriers Manual, Part 3, sections 15016 -15018, inclusive.

20

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

EXHIBIT 60

28 USDC, ED Case No. 1:07-cv-00026 OWW TAG DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT

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AGREEMENT FOR PROFESSIONAL SERVICES CONTRACT EMPLOYEE (County of Kern - Gian A. Yakoub, D.O.)

This Agreement is made and entered into this 19-1-!? day of ,fun e ,2007, between the County of Kern, a political subdivision of the state of California (hereinafter "County"), which owns and operates Kern Medical Center (hereinafter "KMC"), and Gien A. Yakoub, 0.0. (hereinafter "Core Physician"), a contract employee. RECITALS

WHEREAS: A. County is authorized, pursuant to Government Code sections 31000 and 53060, to contract for the furnishing of special services with individuals specially trained and experienced and competent to perform those services; and B. County requires assistance in the performance of professional medical services at f<MC as such services are unavailable from County resources: and

C. Core Physician has special training, knowledge and experience and is licensed by the state of California to practice medicine and is qualified to render medical services; NOW, THEREFORE, it is agreed between County and Core Physician as follows: Article I. TERM AND CONDITIONS '1.

TERM

This Agreement shall be effective on July 1, 2007 (tile "Effective Date"), and shall remain in effect through June 30, 2012, unless earlier terminated pursuant to oUler provisions of this Agreement. 2.

SERVICES Core Physician shall render services as set forth in Exhibit "A," which is attached and made a part of this Agreement. Article II. COMPENSATION

1.

SALARY (BASE)

Core Physician shall be entitled to the following compensation (as defined in Article II, section 3): 1

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A.

Core Physician will work full-time (i.e., according to AMA survey data for specialty but no less than an annual average of forty [40] hours per week) and will be compensated with cash and other value as follows: Core Physician will be paid Four Thousand Twenty-Four Dollars and Eighteen Cents ($4,024.18) biweekly not to exceed One Hundred Four Thousand Nine Hundred Eighty-Seven Dollars ($104,987) annually. County will withhold from said daily compensation of Core Physician all applicable federal, state and local payroll taxes. County will pay the employer's portion of the hospital insurance portion of Social Security (FICA 2). B. Core Physician will be paid biweekly on the same schedule as regular fulltime County employees. The exact date of said biweekly payments will be at the sole discretion of County, as is reasonable and convenient for County. C. No adjustment in compensation will be effective without a written amendment to this Agreement. D. The maximum payable under this Agreement, including base salary and professional fees paid by County to Core Physician pursuant to Article II, section 5, paragraph A, will not exceed Five Hundred Ninety-Nine Thousand Nine Hundred Thirty-Five Dollars ($599,935) over the five-year term of this Agreement. E. County will reimburse Core Physician for moving expenses (defined as the moving of household goods and vehicles) associated in moving from Glendora, California, to Bakersfield, California, in an amount not to exceed Six Thousand Dollars ($6,000), payable in arrears. in accordance with County policy.

. 2.

OVERALL COMPENSATION STRUCTURE A. The purpose of this Compensation Plan is to provide market-based compensation that recognizes a Core Physician's efforts and contributions toward promoting the mission and values of KMC. Core Physician will be identified as such in this Agreement. B. Total compensation for Core Physician will be composed of a base salary paid by County and potential other income generated due to the individual's status as a physician. These two sources of income shall be referred to in this Agreement as Total Core Physician Compensation. The structure for determining Total Core Physician Compensation shall be referred to in this Agreement as the Compensation Plan. C. A Kern County clearing account and a KMC compensation budget unit will be established to account for all funds generated and received to pay Total Core Physician Compensation and to pay all expenses associated with this Compensation Plan. These will act as trust accounts and will be solely used for this purpose.

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D. A Plan Administrator will be retained by KMC to administer this Compensation Plan and will report to the Faculty Practice Board. E. A Board of Directors will be established to oversee the Compensation Plan and the Plan Administrator of the Compensation Plan. This Board of Directors shall be referred to in this Agreement as the Faculty Practice Board. The Faculty Practice Board will establish bylaws including powers, duties and responsibilities to be approved both by a simple majority of the Faculty Practice Board and the CEO of KMC. F. An assessment for administrative expenses shall be made on Total Core Physician Compensation to support the administrative expenses of the Compensation Plan. (1) The amount or percentage of the assessment shall be determined annually by the Faculty Practice Board. (2) Administrative expenses shall include the salary and benefits for the Plan Administrator and any staff hired by KMC to support the Plan Administrator, expenses of the Kern County Pension Plan for Physician Employees, and other business expenses as determined by the Plan Administrator and the Faculty Practice Board. G. County agrees to assume liability for and indemnify and hold harmless Core Physician against all claims, losses, expenses, costs, actions, settlements, attorneys' fees and judgments incurred by Core Physician or for which Core Physician becomes liable to pay, arising out of or in connection with or related to the services rendered or which a third party alleges should have been rendered by Core Physician pursuant to this Agreement. The obligation of County under this paragraph shall arise as to all incidents occurring on and after July 1, 2007, and prior to termination or expiration of this Agreement This paragraph shall survive the termination or expiration of this Agreement and shall apply to all claims made during or after the tennination or expiration of this Agreement, which allegedly arise out of services rendered or which should have been rendered by Core Physician during the term of this Agreement. The liability coverage of this paragraph shall not apply to services at sites other than KMC unless approved by the Kern County Board of Supervisors. H. County shall indemnify and defend Core Physician to the same extent as would be afforded to a regular full-time County employee. Said duty of defense and indemnity shall not apply to intentional or willful misconduct, gross negligence, dereliction or criminal misconduct on the part of Core Physician. and further shall not extend to any conduct, actions or activities that do not arise directly from the performance of this Agreement.

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BASE SALARY (ITEMS INCLUDED AND METHOD OF PAYMENT)

A. Base salary is compensation paid to Core Physician by County for. (1) patient care for Medically Indigent Adults (MIA), as defined by California Welfare and Institutions Code sections 17000 et seq., and adults and juveniles incarcerated and detained in County facilities; (2) as a safety-net provider, partial compensation for under-compensated and uninsured patients; (3) teaching; (4) administrative duties; and (5) other activities approved by the CEO of KMC and the Faculty Practice Board. County shall fund the clearing account unit biweekly with an amount equal to Core Physician's biweekly base salary. The base salary, less the assessment for administrative expenses, will be reported as wages and subject to all appropriate federal and state taxes. The base salary will be considered the minimum compensation that Core Physician shall receive under this Compensation Plan. B. The base salary will be negotiated between the parties and set out for each Core Physician at the end of twelve (12) months by means of an amendment to this Agreement. The base salary will be based on a benchmark salary in proportion to Core Physician's full-effort commitment. (1) The structure of benchmark salaries is based upon a national standard with four salary steps: "A", "B", "C" and "D." There are three criteria for step placement: level of clinical service, teaching, and administrative duties. This benchmark salary structure and criteria for step placement are set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual. (2) The Faculty Practice Board shall establish the criteria for measuring the full-effort commitment. The Department Chairs, with approval of the Faculty Practice Board, will establish the expected levels of the criteria to meet a full-effort commitment. The criteria for measurement of full-effort commitment are set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual. (3) Research shall not be considered as part of Core Physician's full-effort commitment. Research activity will be compensated as set forth in the KMC Faculty Practice Administrative Policies and Procedures Manual.

4.

PROFESSIONAL FEES

Professional fees include all professional fee collections or payments associated with direct patient care by Core Physician. This shall be referred to in this Agreement as professional fees. Core Physician's practice group is responsible for billing and collecting all professional fees for Core Physician's services. Core Physician will have a separate tax identification number. A.

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B. Professional fee billing by Core Physician's practice group shall be made by a billing service company, approved in advance by the Faculty Practice Board, and based upon minimum performance standards set by the Faculty Practice Board. All professional fees collected by the billing service for Core Physician shall be paid to the clearing account. The billing service will maintain individual and practice group records on professional fee billing and collections and will account for such to the Plan Administrator. C. From gross professional fees collected, County shall deduct (i) the assessment for administrative expenses and (ii) overhead expenses for Core Physician's practice group. D. Net professional fees will be paid monthly directly from the clearing account, as directed by Core Physician or Core Physician's practice group, as a distribution to Core Physician. Core Physician will be responsible for all appropriate federal and state taxes and withholding requirements. 5.

PROFESSIONAL FEE GUARANTEE

A.

Notwithstanding any other provision of this Agreement to the contrary, County agrees that the amount of net professional fees to be paid by County to Core Physician will not be less than Seventy-Five Thousand Dollars ($75,OOO), prorated monthly in twelve (12) equal installments, for a period not to exceed twelve (12) months from July 1, 2007, the effective date of this Agreement rMonthly Guarantee"). Such Monthly Guarantee is based on the assumption that the patient activity of Core Physician will be in accordance with the attached job description and medical records documentation by Core Physician regarding supervision of resident physicians and care prOVided will conform to the requirements for evaluation and management (ElM) services billed by teaching physicians set forth in the Medicare Carriers Manual, Part 3, sections 15016 -15018, inclusive. B. Core Physician hereby assigns to KMC and agrees that KMC shall have the exclusive right to collect gross professional fees with a date of service between the period July 1, 2007 and June 30, 2008, inclusive, for services provided by Core Physician under this Agreement for the twelve (12) month period beginning July 1, 2007 through June 30, 2008, or until such time during the twelve (12) month period as the gross professional fees collected by County for services provided by Core Physician under this Agreement, net of the cost of the assessment for administrative expenses and overhead, exceeds Seventy-Five Thousand Dollars ($75,000) ("Guarantee Period"). The gross professional fees collected (i) in any given month during the twelve (12) month period and (ii) with a date of service between the period July 1, 2007 and June 30, 2008, inclusive, which exceeds the Monthly Guarantee and any balance owing from prior months and after allocation of the assessment for administrative expenses and overhead will be paid monthly directly from the clearing account, as directed by .Core Physician or Core Physician's practice group, as a distribution to Core Physician. Core Physician will

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be responsible for all appropriate federal and state taxes and withholding requirements. C. County will undertake a reconciliation of the professional fees collected, for services provided by Core.Physician through June 30, 2008, no later than the end of one hundred twenty (120) days from the conclusion of the Guarantee Period. Any professional fees collected after completion of the reconciliation, regardless of when the services were provided, will be paid monthly directly from the clearing account, as directed by Core Physician or Core Physician's practice group, as a distribution to Core Physician. Core Physician will be responsible for all appropriate federal and state taxes·and withholding requirements.

6.

OTHER INCOME A. Other income IS Income generated due to the individual's status as a physician, which includes, but is not limited to, royalties, grants, speaker fees, professional witness fees, and other nonprofessional fees. All other income will be paid to Core Physician in accordance with instructions provided by Core Physician. B. Income generated by Core Physician that is deposited to the Community Medical Education and Research Foundation (UCMERF") for department educational use shall not be included as other income and shall not be subject to the assessment for administrative expenses. Article III.

BENEFITS 1.

EFFECTIVE DATE OF BENEFITS . The date of employment for the purpose of receiving and accruing benefits listed in this Article III shall not be affected by the date of this Agreement, but shall be the date Core Physician was first continuously employed by KMC.

2.

HEALTH INSURANCE County shall provide to Core Physician and eligible dependents medical, dental and vision insurance as provided to other regular County employees of KMC. Core Physicians first hired by the County of Kern after April .15, 1997, must pay twenty percent (20%) of the cost of their health benefits. County may change the benefits provided under this insurance as such benefits shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

3.

PAID LEAVE OF ABSENCE Core Physician will receive paid leave for holidays, vacation, sick leave and educational leave.

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A. Holidavs: Core Physician shall be entitled to such holidays as provided to full-time County employees of KMC. County may change the holidays provided under this section as such holidays change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement. B. Vacation: For each pay period of service, Core Physician shall be credited with a vacation entitlement of 6.15 hours, for a maximum accrual of 160 hours per year. Total unused vacation accumulated shall not exceed a maximum of 320 hours. No further vacation entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued vacation entitlement shall be credited to a maximum of 320 hours. Unused vacation benefits will be credited to Core Physician to a maximum of 320 hours if this Agreement is renewed. Core Physician will be paid for accrued and unused vacation hours upon termination of employment. C. Sick Leave: For each pay period of service, Core Physician shall be credited with sick leave credit for illness or accident of 2.46 hours, for a maximum accrual of 64 hours per year. After five years of employment, Including full-time employment prior to the effective date of this Agreement, Core Physician shall earn and accrue sick leave credit for illness or accident at the rate of 3.07 hours for each pay period of service for an annual accrual of 80 hours per year. Total unused sick leave accumulated shall not exceed a maximum of 1152 hours. No further sick leave entitlement shall be credited so long as Core Physician has the maximum hours credited. If Core Physician is presently employed by the County of Kern, accrued sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will be credited to Core Physician to a maximum of 1152 hours if this Agreement is renewed. Core Physician will not be paid for accrued and unused sick leave upon termination of employment. County polley applicable to other regular County employees of KMC regarding use of sick leave shall apply to Core Physician. D. Educational Leave: Core Physician shall receive 80 hours paid education leave annually. The first 80 hours shall be credited on the effective date of the Core Physician's employment contract. On each successive anniversary date of that contract, an additional 80 hours shall accrue. Education leave must be used within the year that it is accrued and unused education leave does not accrue to the following contract year. Unused education leave will not be paid upon termination of employment. All education leave must be approved in advance of use by Core Physician's Department Chair and the Medical Director. .

4.

UNPAID LEAVE OF ABSENCE

County shall provide Core Physician the right to unpaid leave of absence provided to other regular County employees of KMC pursuant to County policy. County may change its policy regarding leave of absence, as its policy for leave of absence shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement

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RETIREMENT PLAN A. Core Physician shall participate in the Kern County Pension Plan and Trust Agreement for Physician Employees (the "Plan"), a qualified defined contribution pension plan, pursuant to the terms of the instrument under which the Plan has been established (the "Plan Document"), as from time-ta-time amended. County and Core Physician contributions for each Plan year (as defined in the Plan Document) under the amended and restated Plan document shall be as follows: County shall contribute as County's required contribution the sum of SeventeeFl Thousand Five Hundred Dollars ($17,500) for the account of Core Physician for each complete Plan year of service (as defined in the Plan Document) by Core Physician. Core Physician's mandatory employee contributions required under the amended and restated Plan Document shall be as follows:

If Core Physician's Compensation (as defined under the Plan (1) Document) was One Hundred Fifty Thousand Dollars ($150,000) or less during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Four Thousand Dollars ($4,000) for a complete Plan year of service by Core Physician; If Core Physician's Compensation was more than One Hundred (2) and Fifty Thousand Dollars ($150,OOO) but less than One Hundred and Seventy Thousand Dollars ($170,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Nine Thousand Dollars ($9,000) for a complete Plan year of service by Core Physician; If Core Physician's Compensation was One Hundred Seventy (3) Thousand Dollars ($170,000) or more but less than One Hundred Eighty Thousand Dollars ($180,000) dUring the immediately preceding Plan year, Core Physician's mandatory employee contribution reqUired under the Plan Document shall be Twelve Thousand Five Hundred Dollars ($12,500) for a complete Plan year of service by Core Physician; (4) If Core Physician's Compensation was One Hundred and Eighty Thousand ($180,000) or more but less than One Hundred Ninety Thousand Dollars ($190,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be Seventeen Thousand Five Hundred Dollars ($17,500) for a complete Plan year of service by Core Physician; and

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(5) If Core Physician's Compensation was at least One Hundred Ninety Thousand Dollars ($190,000) during the immediately preceding Plan year, Core Physician's mandatory employee contribution required under the Plan Document shall be the maximum amount permitted by Internal Revenue Code section 415(c)(1) reduced by the County contribution for the account of Core Physician for the Plan year.

B.

Core Physician's mandatory employee contributions shall be withheld by County from Core Physician's biweekly salary in relatively equal amounts. Total contributions by Core Physician and County will not exceed the yearly amount allowed by law; provided, however, if any amounts are contributed in excess of such permissible amounts, the excess contribution shall be corrected as provided in the Plan Document or under law. Any changes in the Plan Document will control the terms of this Agreement. County's required contribution for the account of Core Physician and Core Physician's mandatory employee contributions are also subject to all of the transition rules contained in the Plan as it now exists or may be hereafter amended which may reduce the amount of contribution. The transition rules include, but are not limited to, those contained in sections 3.3(b), 3.3(d), 3.5, and 3.6 of the amended and restated Plan Document. Core Physician (together with all Plan participants) shall be responsible for a pro rata share of the annual costs of administering the Plan. Due to the manner in which Plan participant accounts are held and invested, most such costs cannot be paid directly from Plan assets. To facilitate payment of such costs, County shall advance such costs for so long as County determines such an arrangement is necessary or desirable. To offset such costs, County shall reduce its contribution to the Plan for Core Physician by Core Physician's pro rata share of such costs as determined under the Plan Document. C. If the fixed contribution structure described in the immediately preceding paragraph A results, or would result, in the Internal Revenue Service not issuing a favorable determination letter for the Plan under the amended and restated Plan Document, the County reserves the right to substitute another contribution structure which will be designed to maximize benefit to Core Physician on a cost-neutral basis to County, and such substitute contribution structure shall control the terms of this Agreement. County will consult with the Pension Committee, as identified in the Plan Document, with respect to such substitute contribution structure. D. County's required contribution and all mandatory employee contributions will be paid to such financial services firm(s) as determined under the Plan Document. If, pursuant to the Plan Document, Plan assets are allocated to separate accounts for each Plan participant, such financial services firm(s) shall be solely responsible for allocating Core Physician's contribution amount and Investment experience to his or her account. If, pursuant to the Plan Document, Plan participants control the investment of their accounts at such financial services firm(s), the investment of Core Physician's Plan account through such financial services firm shall be

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determined by Core Physician. County shall not be liable for the Investment experience of Core Physician's Plan account. E. Core Physician is not eligible to participate in any other retirement plan established or funded by County for Its employees, including but not limited to the Kern County Employees' Retirement Association, and this Agreement does not confer upon Core Physician any right to claim entitlement to benefits under any such retirement plan(s). 6.-

SOCIAL ~ECURITY AND MEDICARE TAXES

Core Physician is exempt from payment of Social Security taxes as the Kern County Pension Plan for Physician Employees is a qualified alternative to the insurance system established by the federal Social Security Act. Core Physicians employed before March 31, 1986, will continue to be exempt from the payment of Medicare taxes.

7.

DEFERRED COMPENSATION PLAN

Core Physician shall be eligible to participate in the Kern County Deferred Compensation Plan I on the same basis and to the same extent as full-time County employees. County may change its Deferred Compensation Plan as it shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

8.

KERN$FLEX PLAN

Core Physician shall be eligible to participate In the Kern$Flex Plan I on the same basis and to the same extent as eligible County employees. County may change Its Kern$Flex Plan, as its policy for Kern$Flex shall change for other County employees of KMC. Any such change by County shall not be a breach of this Agreement.

9.

EXPENSE REIMBURSEMENT A. Core Physician will be reimbursed for approved and necessary expenditures related to continuing education Including seminar fees, travel and study materials. Reimbursement for travel, lodging and meals shall be upon the same terms and rates as allowed for County employees of KMC. Core Physician will be reimbursed expenses and materials not to exceed two thousand five hundred dollars ($2,500) per year.

B. Core Physician will be reimbursed for approved and necessary expenditures related to education and training as directed by KMC. Reimbursement for travel, lodging and meals shall be upon the same terms and rates as allowed for County employees of KMC.

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C. Reimbursement for expenses incurred in generating other income will be reimbursed as set forth in Article II, section 5, above. Article IV. TERMINATION AND CORRECTIVE ACTION

1.

TERMINATION OF AGREEMENT

A. Termination without Cause by Core Physician. Core Physician shall have the right to terminate this Agreement without penalty or cause, by giving not less than one hundred twenty (120) days' prior written notice to County.

8. Termination without Cause by County.. It is understood and agreed that County shall have the right to terminate this Agreement as of the first anniversary date from the Effective Date without penalty or cause, by giving no less than one hundred twenty (120) days' prior written notice to Core Physician. C. Termination for Cause. County may terminate this Agreement at any time for cause. Cause is defined as a violation of administrative policy of the County of Kern or KMC, unsatisfactory clinical performance, failure to meet department accountability or performance standards, or reduction of need. County may terminate this Agreement based upon reduction of need upon ninety (90) days' prior written notice to Core Physician. D. Effect of Termination on Medical Staff Membership. Termination of this Agreement by County does not per se affect medical staff membership. Actions affecting medical staff membership and clinical privileges are governed solely by the medical staff bylaws. E. Effect of Termination Generally. In the event of termination of this Agreement for any reason, County shall have no further obligation to pay for any services rendered or expenses incurred by Core Physician after the effective date of the termination. Core Physician shall be entitled to receive base salary from County for services satisfactorily rendered, calculated on a prorated basis up to the effective date of termination.

2.

CORRECTIVE ACTION

A. Core Physician is subject to corrective action for violation of administrative policy of the County of Kern or KMC, unsatisfactory clinical performance, or failure to meet department accountability or performance standards. Such corrective action may include, without limitation, additional training and education, a verbal or written warning, a written reprimand, suspension with or without pay, and termination.

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B. Corrective action for unsatisfactory clinical performance is governed by the medical staff bylaws. C. Corrective action is not required if the problem involves a serious ethical or clinical breach, a violation of law or a serious violation of County of Kern or KMG policy that merits immediate termination for cause.

3.

REVIEW AND APPEAL PROCESS Review and appeal of the decision to impose corrective action or terminate for cause shall follow the process set forth In the KMC Faculty Practice· Board policy and procedure, titled Corrective Action and Termination Review Process, or the medical staff bylaws, whichever is applicable.

Article V. GENERAL PROVISIONS 1.

ASSIGNMENT Core Physician shall not assign or transfer this Agreement or Core Physician's obligations hereunder, or any part thereof. Core Physician shall not assign any money due or which becomes due to Core Physician under this Agreement without the prior written approval of County.

2.

ASSISTANCE IN LITIGATION Core Physician agrees to be available to County, at no cost to County, to testify as an expert witness or otherwise, in the event of litigation under any cause of action being brought against County or KMC, its directors, officers or employees except where Core Physician is a named party. KMC will credit the time spent in preparation and testimony as administrative time as defined in the Compensation Plan.

3.

AUTHORITY TO BIND COUNTY It is .understood that Core Physician, in Core Physician's performance of any and all duties under this Agreement, has no authority to bind County or KMC to any agreements or undertakings.

4.

CAPTIONS AND INTERPRETATION Paragraph headings in this Agreement are used solely for convenience, and shall be wholly disregarded in the construction of this Agreement. No provision of this Agreement shall be interpreted for or against a party because that party or its legal representative drafted such provision, and this Agreement shall be construed as if jointly prepared by the parties.

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CHOICE OF LAWNENUE The parties hereto agree that the provisions of this Agreement will be construed pursuant to the laws of the state of California. This Agreement has been entered into and is to be performed in the County of Kern. Accordingly, the parties agree that the venue of any action relating to this Agreement shall be in the County of Kern.

6.

CONFLICT OF INTEREST The parties to this Agreement have read and are aware of the provisions of sections 1090 et seq. and sections 87100 et seq. of the California Government Code relating to conflict of interest of public officers and employees. All parties hereto agree that they are unaware of any financial or economic interest of any public officer or employee of County relating to this Agreement. It is further understood and agreed that if such a financial interest does exist at the inception of this Agreement, County may immediately terminate this Agreement by giving written notice thereof. Core Physician shall comply with the requirements of California Government Code sections 87100 et seq. during the term of this Agreement.

7.

'

COMPLIANCE WITH KMC AND COUNTY POLICIES Core Physician will comply with all applicable KMC and County policies and procedures. Core Physician will keep daily time sheets on forms supplied, and in the manner specified, by KMC. Core Physician will conform to office policy and routine as established by the Department of which Core Physician is a member, including but not limited to orientation, attendance at case conferences, supervision, in service education. patients' rights functions and performance improvement activities. Core Physician shall submit to drug testing, other laboratory testing and physical examinations as may be required by County.

8.

COMPLIANCE WITH LAW Core Physician shall observe and comply with all applicable County. state and federal laws. ordinances, rules and regulations now in effect or hereafter enacted, including but not limited to JCAHO, Title 22, California Code of Regulations. EMTALA, all federal and state billing requirements including Medi-CallMedicaid and Medicare billing regulations, EEOC, HIPAA. FEHA and Cal-OSHA. Core Physician will at all time meet state and federal licensure and County personnel qualifications for the practice of medicine.

9.

COUNTERPARTS This Agreement may be executed simultaneously in any number of counterparts. each of which shall be deemed an original but all of which together shall constitute one and the same instrument.

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EMPLOYMENT STATUS Core Physician shall be employed by the County of Kern pursuant to the terms of Core Physician this Agreement and the medical staff bylaws of KMC. acknowledges that Core Physician will not be deemed a classified employee, or have any rights or protections under the County's Civil Service Ordinance, rules or regulations.

11.

ENFORCEMENT OF REMEDIES No right or remedy herein conferred on or reserved to County is exclusive of any other right or remedy herein or by law or equity provided or permitted, but each shall be cumulative of every other right or remedy given hereunder or now or hereafter existing by law or in equity or by statute or othelWise, and may be enforced concurrently or from time to time.

12.

MEDICAL RECORDS Any and all patient medical records and charts produced as a result of either party's performance under this Agreement shall be and remain the property of County. During the term of this Agreement, Core Physician shall be permitted to inspect or duplicate any patient's medical record or chart to the extent necessary to meet professional responsibilities to such patient or to assist in the defense of any malpractice or similar claim to which such medical record or chart may be pertinent, provided such inspection or duplication is permitted and conducted in accordance with applicable legal requirements and pursuant to commonly accepted standards of patient confidentiality. Core Physician shall be solely responsible for maintaining patient confidentiality with respect to any information obtained pursuant to this paragraph and will comply with all federal and state laws and regulations regarding patient confidentiality.

13.

MEDICAL STAFF MEMBERSHIP Core Physician will at all times be a member in good standing of the medical staff of KMC and governed as such by the medical staff bylaws. This Agreement may be terminated immediately if Core Physician's membership or privileges are modified or restricted pursuant to action under the medical staff bylaws such that services performed by Core Physician are limited or restricted. Prior to performing duties, Core Physician will: (a) complete an application for medical staff membership; (b) provide proof of current license from the Medical Board of California; (c) prOVide proof of current DEA certificate; and (d) meet with the medical staff office to ensure appropriate documentation is present for credentialing of medical staff privileges.

14.

MODIFICATIONS OF AGREEMENT This Agreement may be modified in writing only, signed by the parties in interest at the time of the modification.

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NON-APPROPRIATION County reserves the right to terminate this Agreement in the event insufficient funds are appropriated or budgeted for this Agreement in any fiscal year due to closing of a clinical department or KMC. Upon such termination, County will be released ffOro any further financial obligation to Core Physician, except for services performed prior to the date of termination or any liabnity due to any default existing at the time this paragraph is exercised. Core Physician will be given thirty (30) days' prior written notice in the event that County requires such an action.

16.

NON-DISCRIMINATION The parties mutually agree to abide by all laws, federal, state and local, and by all policies of the County of Kern respecting discrimination. The parties shall not discriminate on the basis of race, color. national origin, age, religion, marital status or sexual preference.

17.

NON-WAIVER No covenant or condition of this Agreement can be waived except by the written consent of County. Forbearance or indulgence by County in any regard whatsoever shall not constitute a waiver of the covenant or condition to be performed by Core Physician. County shall be entitled to invoke any remedy available to County under this Agreement or by law or in equity despite said forbearance or indulgence.

18.

NOTICES Notices to be given by one party to the other under this Agreement shall be given in writing by personal delivery, by certified mail, return receipt requested. or express delivery service at the addresses specified below. Notices delivered personally shall be deemed received upon receipt; mailed or expressed notices shall be deemed received four (4) days after deposit. A party may change the address to which notice is to be given by giving notice as prOVided above.

19.

Notice to Core Physician:

Notice to County:

Gian A. Yakoub, D.O. 529 N. Wildwood Avenue Glendora. California 91741

Kern Medical Center 1830 Flower Street Bakersfield, California 93305 Attn.: Chief Executive Officer

PROFESSIONAL RESPONSIBILITIES Core Physician will perform the services and duties set forth in this Agreement in a diligent and conscientious manner in accordance with accepted professional and ethical standards of the medical profession and the medical staff bylaws of KMC.

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RELATIONSHIP County and Core Physician recognize that Core Physician is rendering specialized, professional services. The parties recognize that each is possessed of legal knowledge and skill, and that this Agreement is fully understood by the parties, and is the result of bargaining between the parties. Each party acknowledges their opportunity to tully and independently review and consider this Agreement and affirm complete understanding of the effect and operation of its terms prior to entering into the same.

21.

SEVERABILITY Should any part, term, portion or provision of this Agreement be decided finally to be in conflict with any law of the United States or the state of California, or otherwise be unenforceable or ineffectual, the validity of the remaining parts, terms, portions, or provisions shall be deemed severable and shall not be affected thereby, provided such remaining portions or provisions can be construed in substance to constitute the agreement which the parties intended to enter into in the first instance.

22.

SOLE AGREEMENT This Agreement, including all attachments hereto, contains the entire agreement between the parties relating to the services, rights, obligations and covenants contained herein and assumed by the parties respectively. No inducements, representations or promises have been made, other than those recited in this Agreement. No oral promise, modification, change or inducement shall be effective or given any force or effect. [Intentionally left blank]

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IN WITNESS TO THE FOREGOING, the parties have executed this Agreement as of the day and year first written above. COUNTY OF KERN

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CONTRACT EMPLOYEE

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Gran A. Yakoub, 0.0/

Chalrnlan Board of Supervisors

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APPROVED AS TO CONTENT: KERN MEDICAL CENTER ! -, '

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KERN COUNTY PERSONNEL By

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Lawrence D. Espinosa Interim Director

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APPROVED AS TO FORM: OFFICE OF COUNTY COUNSEL

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Case 1:07-cv-00026-OWW-TAG

Document 277-5

Filed 12/01/2008

Page 55 of 56

Exhibit "A" Job Description Gian A. Yakoub, D.O. The Department of Pathology provides professional anatomic and clinical pathology services to Kern Medical Center and oversees the administration and operation of the clinical laboratory, blood bank and histology and department administrative services. Key duties center upon providing high quality, timely and cost effective patient care. Position Summary: Reports to Chairman, Department of Pathology. Clinical Responsibilities: Provides professional pathology services required to process, interpret and report of pathology specimens, including but not limited to surgical pathology specimens, bone marrow specimens, non-gynecologic and gynecologic cytology specimens and fine needle aspirates. 1. Performs collection procedures, such as bone marrow aspiration and biopsy, fine needle aspiration and skin punch biopsies. 2. Performs medical autopsies and prepares complete autopsy reports. 3. Performs professional surgical pathology, cytopathology and hematopathology services on a rotational basis with one or more pathologist. 4. Performs call coverage on a proportional basis with two other pathologists. 5. Serves as a clinical pathologist and co-laboratory director covering clinical laboratory and blood bank services. 6. Responsibly examines and interprets clinical microscopy specimens, such as body fluid, urine, sputum, peripheral blood and other clinical specimens. 7. Completes all service work in a timely, accurate and professional manner. Administrative Responsibilities: 1. Follows department rules as specified in the pathology department policies and procedures. 2. Attends histology and pathology department meetings as scheduled. 3. Attends other laboratory meetings as appropriate or assigned by the department chairman. 4. Attends inter-departmental meetings and committees as assigned by the department chairman and president of the medical staff. 5. Attends general medical staff meetings on a semi-annual basis. 6. Participates in the training of hospital physician residents and medical students, including the review of active and past case material as required for patient care. 1. Participates in quality assurance, quality management and quality improvement activities, including peer review and quality control functions of the pathology service. 8. Participates in proficiency testing and performance improvement programs as required.

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Document 277-5

Filed 12/01/2008

Page 56 of 56

Assignments: Work assignments will be based upon a work schedule of 44 weeks per year on a flexible basis that fulfills the needs of the department. Medical Record Documentation: Documentation by Core Physician witl conform to the requirements for evaluation and management (ElM) services billed by teaching physicians set forth in the Medicare Carriers Manual, Part 3, sections 15016 -15018, Inclusive. [Intentionally left blank]

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