Franchell Richard Hamilton, MD
Date:
July 20, 2015
Case:
Gamaliel Mejia v. Dufek Massif Hospital
Kim Tindall and Associates, LLC
Phone: 210-697-3400
Fax: 210-697-3408
Email: [email protected]
Page 1
CAUSE NO. DC-15-01323
GAMALIEL MEJIA, ) IN THE DISTRICT COURT
INDIVIDUALLY, AND AS )
REPRESENTATIVE OF THE )
ESTATE OF FRANCES MEJIA; )
FRANK VASQUEZ AND MARY )
JANE VASQUEZ; )
Plaintiffs, )
)
VS. ) DALLAS COUNTY, TEXAS
)
DUFEK MASSIF HOSPITAL )
CORPORATION D/B/A )
UNIVERSITY GENERAL )
HOSPITAL DALLAS; JOSEPH A. )
BIANCO, D.O.; JOSEPH A. )
BIANCO, D.O., P.A., )
FRANCHELL RICHARD )
HAMILTON, M.D.; COVENANT )
SURGERY ASSOCIATES, )
P.L.L.C.; AND TONIKA )
COLLINS; )
Defendants. ) 116TH JUDICIAL DISTRICT
ORAL AND VIDEOTAPED DEPOSITION OF
FRANCHELL RICHARD HAMILTON, M.D.
JULY 20, 2015
VOLUME I
ORAL AND VIDEOTAPED DEPOSITION OF
FRANCHELL RICHARD HAMILTON, M.D., produced as a witness
at the instance of the PLAINTIFFS, and duly sworn, was
taken in the above-styled and numbered cause on
Page 2
1 Lei Sherra Torrence, CSR in and for the State of Texas,2 reported by machine shorthand, at the law offices of
3 Schell Cooley, LLP, 15455 North Dallas Parkway, Suite
4 550, Dallas, Texas, pursuant to the Texas Rules of Civil
5 Procedure and the provisions stated on the record or
6 attached hereto. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Page 3
1 A P P E A R A N C E S2 COUNSEL FOR THE PLAINTIFFS: 3 Mr. Michael Sawicki
Mr. Andrew Jones 4 SAWICKI LAW
4040 North Central Expressway 5 Suite 850 Dallas, Texas 75204 6 (214) 468-8844 (214) 468-8845 (fax) 7 [email protected] [email protected] 8
COUNSEL FOR THE DEFENDANT: (FRANCHELL RICHARD HAMILTON, 9 MD, AND COVENANT)
10 Mr. Timothy Ryan SCHELL COOLEY, LLP 11 15455 North Dallas Parkway
Suite 550
12 Addison, Texas 75001 (214) 665-2000 13 [email protected]
14 COUNSEL FOR THE DEFENDANT: (JOSEPH BIANCO, MD, BIANCO, DO, PA)
15
Mr. Russell Thornton
16 THIEBAUD REMINGTON THORNTON BAILEY, LLP 4849 Greenville Avenue 17 Suite 1150 Dallas, Texas 75206 18 (214) 954-2217 (214) 754-0999 (fax) 19 [email protected] 20 21 22 23 24 25
Page 4
1 COUNSEL FOR THE DEFENDANT: (UNIVERSITY GENERAL HOSPITALDALLAS, TONIKA COLLINS) 2
Mr. Eric Hines
3 LAW OFFICES OF BRIAN J. JUDIS Plazas of the Americas, North Tower 4 700 North Pearl Street
Suite 425 5 Dallas, Texas 75201 (214) 220-5600 6 (214) 775-4124 (fax) [email protected] 7 THE VIDEOGRAPHER: 8 Mr. Dennis Livingston 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
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1 INDEX 2 PAGE 3 Appearances...34 FRANCHELL RICHARD HAMILTON, M.D. Examination by Mr. Sawicki...6 5 Examination by Mr. Hines...214 Examination by Mr. Ryan...220 6 Reexamination by Mr. Sawicki...224 Reexamination by Mr. Ryan...231 7 Signature and Changes...233
8 Reporter's Certificate...235 9 10 EXHIBITS 11 NUMBER DESCRIPTION PAGE 12 1 Physicians Orders 21
13 2 Responses To Request For Production 87 3 E-mail From Darrin Dest 87
14 4 Agreement For Physician Services 99
5 UGH Dallas Medical Staff Rules and 15 Regulations 119
6 June 2014 General Call Calendar 131
16 7 Phone Record 133
8 Call Log for Answering Service 167
17 9 Handwritten Notes 186
10 Nurses Narrative 192
18 11 Discharge Summary 199
12 Norcal Mutual Insurance Company 19 Packet 211 20 21 22 23 24 25
Page 6
1 THE VIDEOGRAPHER: Good morning. Today's2 date is July 20th, 2015. The time is approximately
3 10:09 a.m. Here present for the video deposition of
4 Franchell Richard Hamilton, MD. Will counsel please
5 introduce themselves and whom they represent?
6 MR. SAWICKI: Michael Sawicki and Andy Jones
7 on behalf of the Mejias.
8 MR. RYAN: Tim Ryan here on behalf of
9 Dr. Richard Hamilton and Covenant.
10 MR. HINES: Eric Hines on behalf of UGH
11 Dallas and Ms. Collins.
12 MR. THORNTON: Russ Thornton on behalf of
13 Dr. Bianco and his professional association.
14 THE VIDEOGRAPHER: The witness may now be
15 sworn in.
16 FRANCHELL RICHARD HAMILTON, MD,
17 having been first duly sworn, testified as follows:
18 EXAMINATION
19 BY MR. SAWICKI:
20 Q. Good morning, Doctor. Can you tell us your full
21 name, please.
22 A. Franchell Richard Hamilton.
23 Q. And how do you prefer to be referred to?
24 A. Hamilton. Dr. Hamilton, that's fine.
25 Q. Dr. Hamilton. Dr. Hamilton, my name is Mike
Page 7
1 Sawicki. I'm here to ask you some questions. You2 understand that, correct?
3 A. Yes.
4 Q. I want to talk a little bit about some terms to
5 make sure I'm using them correctly so that you
6 understand as well, okay?
7 A. Okay.
8 Q. And first term I've seen in this case is
9 laparoscopic -- laparoscopic -- I knew I was going to
10 blow it. Laparoscopic cholecystectomy, do you know what
11 that term is?
12 A. Yes, sir.
13 Q. Have you performed that kind of procedure
14 yourself?
15 A. Yes.
16 Q. The second term of art is hepatic artery. Do you
17 know what is?
18 A. Yes.
19 Q. And with respect to laparoscopic cholecystectomy,
20 have you performed them, say, within the last two years?
21 A. No.
22 Q. When was the last time you performed one?
23 A. A hepatic artery or a laparoscopic
24 cholecystectomy?
25 Q. Laparoscopic cholecystectomy.
Page 8
1 A. Oh, yes, I have performed those within the last2 two years, yes.
3 Q. When you perform that procedure, is it something
4 you normally involve the right hepatic artery in?
5 A. No.
6 Q. And when you normally perform the laparoscopic
7 cholecystectomy, do you typically have the right hepatic
8 artery left bleeding after the procedure?
9 A. No.
10 Q. When you do the procedure, would you agree with
11 me that you do not leave the right hepatic artery
12 bleeding after doing a laparoscopic cholecystectomy?
13 A. I would agree with that.
14 Q. Is that something if you were to leave it
15 bleeding, would that represent a risk to the -- to the
16 livelihood or the health of the patient?
17 A. Yes.
18 Q. Is that something that's a new part of science or
19 medicine, or is that something that's been known for
20 some time?
21 A. That has been known.
22 Q. Would you agree with me that a surgeon performing
23 a laparoscopic cholecystectomy should stop any kind of
24 unintended bleeding after the procedure is finished?
25 A. I would agree.
Page 9
1 Q. Would you agree with me that if that's not done,2 it poses a risk of harm to the patient?
3 A. I would agree.
4 Q. And that's something that -- that you knew and
5 other doctors would know; is that true?
6 MR. RYAN: Form.
7 A. Yes.
8 Q. (BY MR. SAWICKI) Is that something that is new
9 science or new medicine or something that's been known
10 for a long time?
11 A. That's been known.
12 Q. Would you agree with me in general -- you're a
13 surgeon, correct?
14 A. Yes.
15 Q. Would you agree with me, in general, reasonable
16 and prudent surgeons should know that uncontrolled
17 bleeding after a procedure represents a serious danger
18 to the patient's safety?
19 A. I would agree.
20 Q. Is there ever a time in your understanding of
21 performing a laparoscopic cholecystectomy where it's
22 appropriate to leave the hepatic artery bleeding for
23 some reason?
24 A. No.
Page 10
1 body that it's appropriate to leave bleeding after a2 laparoscopic cholecystectomy?
3 A. No, not that I can think of.
4 Q. Okay. Now, in this case with Mrs. Mejia, you
5 understand that a laparoscopic cholecystectomy was what
6 was performed on her initially, correct?
7 A. That's what I was told.
8 Q. And that was performed by Dr. Bianco, is that
9 your understanding?
10 A. Yes.
11 Q. And that was done at University General Hospital,
12 is that your understanding?
13 A. Yes.
14 Q. Now, in this case, if I've read your answers to
15 some of the discovery and -- and the legal pleadings
16 correctly, is it your position that Mrs. Mejia -- you
17 understand who she is, correct?
18 A. Yes.
19 Q. Is it your position that you were never
20 responsible for her care?
21 A. That is my understanding.
22 Q. Okay. And was it your position that the
23 individuals at the hospital had no authority or right or
24 power to assign her to your care?
25 MR. HINES: Object to form.
Page 11
1 A. That is my understanding.2 Q. (BY MR. SAWICKI) Okay. And so let me make sure
3 I'm clear. In this case, with respect to Mrs. Mejia,
4 it's your position that you were never responsible for
5 her care so you couldn't have done anything negligent or
6 wrong or that contributed to her ultimate death, true?
7 A. It is my respons -- understanding that I have no
8 responsibility.
9 Q. Okay. Now, with respect to that understanding,
10 what is the basis for it?
11 MR. RYAN: Form.
12 A. I never formed a patient-physician relationship
13 with her.
14 Q. (BY MR. SAWICKI) And why do you believe that?
15 MR. RYAN: Form.
16 A. I never accepted her as my own patient.
17 Q. (BY MR. SAWICKI) Okay. And why is it you never
18 accepted her as your own patient?
19 A. I had no reason to accept her as my own personal
20 patient.
21 Q. Well, was there something about her that you
22 decided you would not accept or was there some other
23 reason why you didn't accept her as a patient?
24 A. It had nothing to do with the patient at all. It
25 -- I did not feel it was in her best interest that I
Page 12
1 assume the responsibility of taking care of her.2 Q. And why wasn't it in her best interest for you to
3 assume responsibility?
4 A. There were several reasons why I felt like this
5 patient -- because I felt like that. One was my
6 personal situation, and the other reason was I didn't
7 feel like the hospital had the resources to take care of
8 her condition at the time.
9 Q. All right. Let's talk about those two. First,
10 you said your personal situation?
11 A. Correct.
12 Q. And then the second was that the hospital didn't
13 have the resources?
14 A. Yeah, in my opinion.
15 Q. So let's talk first, what was it, the personal
16 situation, that you're referencing?
17 A. So at that point in time when I got asked to
18 potentially assume her care, I was actually 39 weeks
19 pregnant and about to go on maternity leave, and at that
20 point I didn't think it was in the best interest for me
21 to take on any complicated patients when I knew the next
22 week I wouldn't -- I would be gone on maternity leave at
23 that point so -- literally days after this.
24 Q. Okay. Anything else that was in this personal
25 situation category other than that?
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1 A. No.2 Q. All right. Now, the second reason you gave me
3 was that -- the second reason that you say you didn't
4 take on Mrs. Mejia's care was that the hospital, in your
5 opinion, didn't have the resources to care for her.
6 What specifically did you mean by that?
7 A. From my understanding the patient, although
8 stable, would be at risk for potential -- could be at
9 risk for a rebleed and the hospital did not have the
10 resources for multiple blood transfusions. The other
11 concern that I had was that they didn't have 24-hour
12 intensivists to manage the patient. And from what I
13 understand, the patient was on the vent and she was, I
14 believe, requiring dialysis.
15 Q. All right. Anything else with respect to the
16 second element that the hospital, in your opinion, did
17 not have the resources necessary to care for Mrs. Mejia
18 other than those two things?
19 A. Those were the -- the main -- the main concerns.
20 Q. Okay. Now, a couple of more terms I want to make
21 sure I'm using correctly. I heard the term "attending"
22 or "admitting physician" as being a way to describe the
23 physician who's got primary responsibility for a
24 patient. Have you heard those terms?
Page 14
1 Q. Is that definition, although, I may not put it as2 artfully as a medical dictionary or something else, that
3 the attending or admitting physician has primary
4 responsibility for the patient's care, is that a
5 generally true statement?
6 A. Not necessarily. The admitting physician can be
7 different from an attending physician caring for that
8 patient.
9 Q. Right. So would the -- oftentimes, am I correct
10 that, the admitting physician may also be the attending
11 physician?
12 A. That is correct.
13 Q. But there may be times when the admitting
14 physician may not have a specialty or a focus of
15 practice that the patient really requires and then a
16 doctor of that nature takes over and cares for the
17 patient as the, quote, attending physician?
18 A. In that speciality, correct, yes.
19 Q. All right. Now with respect to Mrs. Mejia, what
20 was your understanding of who was the admitting doctor
21 for this period of care where she was at the University
22 General Hospital?
23 MR. RYAN: Form.
24 MR. THORNTON: Same objection.
25 A. I don't know, honestly.
Page 15
1 Q. (BY MR. SAWICKI) Okay. What was your2 understanding of who was the attending physician for her
3 care at University General Hospital?
4 MR. RYAN: Form.
5 MR. THORNTON: Form.
6 A. It was my understanding, honestly, that she had
7 multiple physicians caring for her.
8 Q. (BY MR. SAWICKI) Was it your understanding that
9 all of them were considered to be, quote, the attending?
10 A. It was my understanding that each played a major
11 role in the care for her.
12 Q. Who were the doctors you considered to be playing
13 a major role in her care?
14 A. I honestly didn't know that information until
15 after all of this, but I was told the specialists
16 involved were critical care, pulmonary, a nephrologist,
17 Dr. Bianco and a hospitalist. That's all I knew at the
18 time.
19 Q. Okay. Do you know the name of the critical care
20 doctor?
21 A. I found that out recently and that was Dr. Kopman
22 from what I understand.
23 Q. Could you spell that for her?
24 A. I think it's K-O-P-M-A-N, but I'm not for sure.
25 Q. All right. And the pulmonologist?
Page 16
1 A. Same person. Pulmonary and critical care doctor.2 Q. And the nephrologist?
3 A. The name starts with a V. I honestly can't
4 pronounce or spell it for you.
5 Q. Is it the Indian Vin Vinkin
--6 A. I think so.
7 Q. Okay.
8 A. Yes, and I didn't find this out until after.
9 Q. And the hospitalist?
10 A. I don't recall the name of the hospitalist that
11 admitted her.
12 Q. Now, with respect to that group, were you told
13 who was the admitting physician?
14 A. At the time
--15 MR. RYAN: Form.
16 A. -- no. No.
17 Q. (BY MR. SAWICKI) Have you learned since then?
18 A. Yes.
19 Q. Who was the admitting
--20 A. And I was told the hospitalist was the admitting.
21 Q. And let me make sure I'm not invading a
22 privilege. Is this information something you got from
23 your lawyer, Mr. Ryan?
24 A. No.
25 Q. Well, who was it that you got that information
Page 17
1 from?2 A. After the fact almost during like a peer review.
3 MR. HINES: All right. I'm going to object
4 at this time. Peer-review privilege, don't answer the
5 question.
6 MR. RYAN: Anything that arises that you're
7 aware of that you know only by virtue of peer review you
8 must not speak about until you have said I only know
9 that through peer review, okay?
10 THE WITNESS: Okay. So I need to say that
11 first?
12 MR. RYAN: Yes.
13 THE WITNESS: Okay.
14 Q. (BY MR. SAWICKI) Yeah, I'll try to rephrase the
15 question so that we're -- we're not -- there are some
16 privileges that you're entitled to under the law and,
17 actually, some of the other parties. For example,
18 things that you discussed with your lawyer I don't want
19 to ask about something that is -- something your lawyer
20 has told you about where that's your only source of the
21 information. In other words, I'm not going to ask you
22 about his opinions or his staff's opinions about your
23 case, things like that, okay?
24 A. Okay.
Page 18
1 something like that, keep in mind that there's a2 privilege that you don't have to reveal that. The other
3 thing is that there are privileges that pertain to a
4 discussion held during a peer-review committee
5 investigation. So if the conversation comes from your
6 testimony or your discussion in a peer-review context, I
7 don't want to ask you about that either, okay?
8 A. Okay.
9 Q. Now, if you
--10 MR. RYAN: Hang on a second, Mike. And in
11 that regard, if you have a question as to any source of
12 information that's like, well, I think I know that, and
13 we need to talk about it, you need to let me know and
14 we'll take a break and we'll talk about it.
15 MR. SAWICKI: That's exactly what I was
16 about to say. If you have any question, I don't want to
17 cut you off
--18 THE WITNESS: Okay.
19 MR. SAWICKI: -- but I do want to let you
20 know that you have an opportunity to talk to your lawyer
21 if you're ever unclear about these things.
22 THE WITNESS: I do have one question.
23 MR. SAWICKI: Okay. What's that?
24 THE WITNESS: So if I reviewed
--25 MR. RYAN: Wait. Let's not
--Page 19
1 THE WITNESS: Okay.2 MR. RYAN: Let's not do it.
3 THE WITNESS: Okay.
4 MR. SAWICKI: Let's take a two-minute break.
5 MR. RYAN: Yeah.
6 MR. SAWICKI: Let you talk to her about that
7 and we'll get back.
8 THE WITNESS: Okay.
9 MR. RYAN: Thanks.
10 THE VIDEOGRAPHER: Off the record 10:24 a.m.
11 (Break taken from 10:24 a.m. to 10:28 a.m.)
12 THE VIDEOGRAPHER: Back on the record at
13 10:28 a.m.
14 Q. (BY MR. SAWICKI) So ma'am, you've had a moment
15 to take a break. Are you ready to proceed?
16 A. Yes.
17 Q. So again, with the same caveats about the various
18 privileges, would your knowledge of who was the
19 admitting physician have been something that came just
20 from that context of peer review?
21 A. Yes.
22 Q. All right. With respect to other individuals
23 that were involved in the care, I want to talk outside
24 of the peer-review context.
25 A. Okay.
Page 20
1 Q. You told me earlier you were under the impression2 that there were one, two, three -- four different
3 doctors involved: Critical care pulmonologist,
4 nephrologist, Dr. Bianco, and the hospitalist. With
5 respect to that group and outside of a peer-review
6 conversation, did you have an understanding of there
7 being any other surgeons involved in her care?
8 A. No.
9 Q. Now, with respect to the care of Mrs. Mejia, are
10 you aware of -- and I want to ask again outside of a
11 peer-review context where that's where you got the
12 information or something that you only know through your
13 lawyer, are you aware of any other surgeon other than
14 Dr. Bianco being involved in her care?
15 A. And this is outside of the peer review?
16 Q. Correct.
17 A. No.
18 Q. All right. Now, would you agree with me that the
19 records from UGH demonstrate that an entry was made
20 indicating you had been assigned to care for Mrs. Mejia?
21 MR. RYAN: Form.
22 A. I found that out only through peer review.
23 Q. (BY MR. SAWICKI) All right. Have you looked at
24 Mrs. Mejia's records at all?
25 A. During the peer review.
Page 21
1 Q. All right. Have you seen the entries that2 indicate you were assigned to care for Mrs. Mejia?
3 A. Yes.
4 Q. With respect to the notes, it indicates that a
5 doctor -- I'll probably say the name wrong, Dr. Chisty
6 (phonetic) Schade was the one who appointed you to care
7 for Mrs. Mejia according to the records, true?
8 MR. HINES: I'm going to object at this
9 point. She's giving information that she only learned
10 during the peer-review process. I ask that her lawyer
11 instruct her not to answer. And the hospital has
12 privilege. She's told us that's the only time she's
13 seen them. She said I've seen them outside of that and
14 that's not much I can do about that.
15 Q. (BY MR. SAWICKI) Well, you've looked at the
16 records, true?
17 A. I only looked at the records through the peer
18 review. That's the only time that I saw and looked
19 through the records.
20 MR. SAWICKI: Let me show you a record.
21 Mark this as Exhibit 1. And it's UGH 32.
22 (Exhibit Number 1 marked.)
23 MR. RYAN: Is this the same thing?
24 MR. SAWICKI: Yes.
Page 22
1 Q. (BY MR. SAWICKI) And I'm going to ask you,2 towards the bottom there's an entry that's approximately
3 -- if I read it right it's dated 16:00 on the 27th. Do
4 you see that at the bottom?
5 A. Yes.
6 Q. It says Dr. Hamilton, Franchell will cover for
7 Dr. Bianco until further notice. Do you see that?
8 A. I see that.
9 Q. And then it's RB/TO Dr. Schade, slash -- I can't
10 read that next name, but it looks like RN. Do you see
11 that?
12 A. Yes.
13 Q. Do you recognize the handwriting in this?
14 A. No.
15 Q. Do you recognize the name of the RN?
16 A. No.
17 Q. How about the initials underneath?
18 A. No.
19 Q. Do you recognize what it says off to the left
20 underneath the time and date at 16:10, a couple of
21 lines? Do you recognize what that says?
22 A. No.
23 Q. All right. Were you aware of this physician's
24 order being placed in Mrs. Mejia's records at any time
25 other than what you learned in the peer-review process?
Page 23
1 A. No.2 Q. Did Dr. Schade, then, if I'm understanding you
3 correctly, that the only source you had for this
4 information is from peer review, am I correct that no
5 one on the 27th of June told you that you would be
6 covering for Dr. Bianco?
7 A. I would agree.
8 Q. Okay. And that this note does not reflect
9 anything you recall Dr. Schade or any other doctor
10 telling you on the 27th of June?
11 A. Doctor
--12 MR. RYAN: Objection; form.
13 Q. (BY MR. SAWICKI) Did anyone ask you to cover for
14 Dr. Bianco on the 27th of June?
15 A. I received a call from Dr. Bianco.
16 MR. RYAN: You said Dr. Bianco.
17 A. Oh, I'm sorry, Dr. Schade
--18 Q. (BY MR. SAWICKI) Okay.
19 A. -- to take over a patient of Dr. Bianco on
20 June 27th.
21 Q. Do you recall when that conversation took place?
22 A. Yes. Approximately -- I had two conversations
23 with him. One was around 4 o'clock and the other one
24 was maybe 15 minutes after that.
25 Q. And 4 o'clock p.m., correct?
Page 24
1 A. Yes.2 Q. All right.
3 MR. HINES: I'm sorry. Did you say 15
4 minutes after that?
5 THE WITNESS: Yes.
6 Q. (BY MR. SAWICKI) So approximately 4 o'clock and
7 then 4:15?
8 A. Yes.
9 Q. All right. What do you remember about the
10 4 o'clock p.m. call on the 27th from Dr. Schade?
11 A. The 4 o'clock p.m. call from what I was -- what I
12 recall was Dr. Schade introducing himself as the chief
13 of staff. He stated that he apologized for having to
14 call me about a situation. He stated that Dr. Bianco
15 had been suspended and according to the hospital bylaws
16 I was the person to take over his patients and there was
17 a patient in the ICU that I needed to assume care of.
18 Q. Okay. Let me ask you a couple of things about
19 that conversation. First, where did Dr. Schade contact
20 you? Was it an office phone, a cell phone or some other
21 phone?
22 A. He contacted me both via the office and cell
23 phone.
24 Q. Okay. Was there anyone that overheard or
25 participated in this conversation other than you and
Page 25
1 Dr. Schade?2 MR. RYAN: Form.
3 A. Not that I know of.
4 Q. (BY MR. SAWICKI) Did you make any notes
5 regarding this conversation?
6 A. No.
7 Q. Was there anything else that was discussed other
8 than what you just told me about?
9 A. Not that I recall except I -- I -- I had my
10 questions such as I asked him if this was an emergency,
11 I asked him if the patient was stable and I asked him
--12 honestly, I never heard of this ever happening to a
13 physician where you're required to take over someone's
14 patient and I kind of discussed that with him also on
15 that conversation and he told me to call the ICU nurse.
16 Q. Let me ask you: Did Dr. Schade say why
17 Dr. Bianco had been suspended?
18 A. He did not.
19 Q. Was that an abnormal type of conversation to have
20 that a doctor in the course of caring for a patient had
21 his or her hospital privileges suspended?
22 MR. RYAN: Form.
23 A. That conversation -- I've never had that
24 conversation before. So for me it was a little
Page 26
1 Q. (BY MR. SAWICKI) I mean, this is the first thing2 I thought when I read it. I've never read that in my
3 limited experience that a doctor was removed from the
4 hospital in the course of care of a patient that had had
5 some complications. Had you ever run into that before?
6 MR. THORNTON: Objection; form.
7 A. I have not run into that before.
8 Q. (BY MR. SAWICKI) Have you run into it since?
9 A. No.
10 Q. What was your impression about Dr. Schade's tone
11 or emotional state to the best you can describe when you
12 were talking about these things?
13 MR. HINES: Object to form.
14 MR. RYAN: Form.
15 A. I remember him being very -- I don't know what
16 the correct term, but very almost, like, forceful and
17 aggressive, maybe, and I just remember being a little
18 offended after talking -- after that conversation with
19 him.
20 Q. (BY MR. SAWICKI) So what was it about the
21 conversation that led you to feel that Dr. Schade was
22 being forceful and offensive?
23 MR. RYAN: Objection; form.
24 A. When I had told him on that particular
25 conversation that I've never been in a situation where I
Page 27
1 was required to accept a patient, he essentially made it2 seem like, well, I had no other options.
3 Q. (BY MR. SAWICKI) Was there something about the
4 vocabulary he used or was it his tone of voice?
5 A. It was his tone.
6 Q. And what was it about his tone that led you to
7 feel it was forceful and offensive?
8 A. It was almost
--9 MR. RYAN: Objection; form.
10 A. -- degrading.
11 Q. (BY MR. SAWICKI) How so? That's what I'm trying
12 to quantify here.
13 A. I don't know if I could quantify it.
14 Q. Suffice to say, then, that Dr. Schade's
15 conversation with you led you to feel that you had
16 almost been degraded by the way he was treating you?
17 A. Bullied.
18 Q. Better term?
19 A. I would say. Bullied would be a better term,
20 yes.
21 Q. All right. Had you ever talked with Dr. Schade
22 before this?
23 A. I never knew him. Just of him.
24 Q. Had you ever been told by anyone that he had an
25 abrupt manner or something consistent with the way he
Page 28
1 treated you?2 A. Multiple physicians I was told by that.
3 Q. Tell me what it is they were -- they had reported
4 to you
--5 A. Similar
--6 Q. -- about Dr. Schade?
7 MR. RYAN: Wait. Let him get his question
8 all the way out before you start answering it and that
9 way I can object if I need to and that way the court
10 reporter can take it down clean.
11 THE WITNESS: Okay.
12 Q. (BY MR. SAWICKI) Let me rephrase. What had
13 other doctors told you about Dr. Schade's demeanor or
14 tone with respect to this bullying that you felt?
15 A. Similar situations or examples where they felt
16 they were talked either down to or bullied into doing
17 something that they didn't agree with.
18 Q. Was this a common occurrence or was this
19 something that was -- is there a particular incident
20 that stands out in your mind?
21 A. I don't know if it was common. I only know the
22 handful of physicians that I spoke to at University
23 General Hospital.
24 Q. I guess what I'm trying to quantify is: Was this
25 a -- commonly amongst your peers that you would discuss
Page 29
1 this type of information with? Was this a commonly held2 feeling regarding Dr. Schade or was this an anomalous
3 thing that just a few doctors reported to you?
4 MR. RYAN: Form.
5 A. It came up a handful of times. We wouldn't focus
6 our conversations on that.
7 Q. (BY MR. SAWICKI) Do you recall any other
8 specific doctors that had these same or related these
9 same types of experiences with him?
10 A. I do.
11 Q. Can you tell me the names?
12 A. Dr. Green was an anesthesiologist. She was one
13 of them. Dr. Payseur was a wound care doctor. She was
14 another.
15 Q. Do you recall what Dr. Green, the
16 anesthesiologist, had told you about, with respect, to
17 Dr. Schade's treatment of her that left her feeling
18 consistent with your description?
19 A. Not necessarily word for word.
20 Q. In general?
21 A. There were times when she performed anesthesia
22 and there were some complaints made by him on the way
23 she did things that she disagreed with.
24 Q. Any other descriptions that you recall in a
Page 30
1 Dr. Schade in this regard?2 A. Not outside of what I've already stated.
3 Q. All right. Same question with respect to
4 Dr. Payseur.
5 A. It was the same.
6 Q. Were
--7 A. Disagreements on the way they cared for patients
8 -- she cared for patients.
9 Q. Were there disagreements in the -- in these types
10 of conversations? Was it about the techniques that were
11 employed or the speed with which they were performed
12 or
--13 A. I don't recall the specifics.
14 MR. RYAN: Again
--15 THE WITNESS: Sorry.
16 MR. RYAN: -- please let him ask his
17 question all the way. That I way I can register an
18 objection if I need to. And I'll object to the form of
19 the question.
20 Q. (BY MR. SAWICKI) Were there concerns expressed
21 about Dr. Schade indicating that the care should've been
22 rendered in a different manner?
23 A. I don't recall
--24 MR. RYAN: Form.
25 A. -- the specifics.
Page 31
1 Q. (BY MR. SAWICKI) Okay. And what -- where I2 guess I'm trying to figure out is: Was there a
3 disagreement with the applicable standard of care, for
4 example, in the care being involved?
5 A. No.
6 Q. Was there a concern expressed about the speed or
7 the billing or any other aspect of the care involved?
8 A. No. No.
9 Q. Just that Dr. Schade had some other way of doing
10 it that he preferred versus Dr. Green or Dr. Payseur's
11 way of doing it?
12 A. Correct.
13 Q. Okay. Now, with respect to, both, Green, Payseur
14 and yourself, you're all three women; is that true?
15 A. Yes.
16 Q. Was there any sexual element of it, and I don't
17 mean in a physical act of love type way. Was there a
18 male/female type demeanor or is that part of it?
19 MR. HINES: Object to form.
20 MR. RYAN: Objection; form.
21 A. Not that I know of.
22 Q. (BY MR. SAWICKI) What I'm asking is: Was he
23 sexist or was it construed as him talking down to a
24 woman in your discussions with these other doctors?
25 MR. RYAN: Objection; form.
Page 32
1 MR. HINES: Object to form.2 A. I'm not sure because I don't know how he
3 responded to other...
4 Q. (BY MR. SAWICKI) Did -- did you have discussions
5 with any male doctors that indicated similar concerns
6 that you have described with respect to Dr. Payseur and
7 Dr. Green and yourself?
8 A. No.
9 Q. Did you talk with any of the nursing staff about
10 their interactions with Dr. Schade?
11 A. I spoke to -- at the time it was the ER director
12 who I believe was a nurse.
13 Q. Do you recall who that was?
14 A. I don't remember his name.
15 Q. And what is it that individual told you?
16 A. It was the same in the sense of he's had some
17 degrading tones or remarks made by Dr. Schade to him.
18 Q. Okay. All right. So I want to go back, with
19 respect, to this 4 o'clock conversation. Anything else
20 about Dr. Schade's tone or impressions you formed about
21 his emotional state at this conversation that you
22 haven't told me about?
23 MR. HINES: Object to the form.
24 A. No.
25 Q. (BY MR. SAWICKI) With respect to Dr. Bianco's
Page 33
1 suspension, is that something Dr. Schade told you had2 occurred?
3 A. He informed me that Dr. Bianco had been
4 suspended.
5 Q. What specifically did Dr. Schade say about
6 Dr. Bianco being suspended?
7 A. That was pretty much it.
8 Q. He just said, Dr. Bianco, the surgeon, has been
9 suspended?
10 A. He stated there was an unfortunate event and
11 Dr. Bianco is suspended.
12 Q. Did he give you any more detail about what the
13 unfortunate event was?
14 A. No.
15 Q. Had you ever heard of a doctor at UGH being
16 suspended for any kind of unfortunate event before?
17 A. No.
18 Q. Did you have any impression about what the
19 unfortunate event was?
20 A. I had heard situation from some of the OR staff
21 days before this.
22 Q. And what was the situation you had heard of?
23 A. The OR staff just said that there was a surgery
24 that was done and that something had went wrong. That
Page 34
1 details.2 Q. Who was the OR staff that you were talking with?
3 A. It was the OR director at the time and I cannot
4 recall her name.
5 Q. And what was the context that you were having
6 this discussion with the OR director at the time?
7 A. I always -- any time I went to UGH I always
8 walked through the OR. I was usually there for a
9 surgery or something and I was relatively friendly with
10 all the staff and they just mentioned there had been an
11 incident.
12 Q. So you're there to perform some kind of care on a
13 patient at UGH, you're walking through the OR department
14 and the OR director or some other members of the OR
15 staff just come up and say to you Dr. Bianco has been
16 involved in a situation?
17 MR. RYAN: Objection; form.
18 A. It started off, hey, did you hear.
19 Q. (BY MR. SAWICKI) And what is it they said
--20 A. And then
--21 Q. -- did you hear?
22 A. That there had been an incident in the OR the day
23 or so whenever it happened.
24 Q. And what was the incident they described?
25 A. Nothing more than there was a patient that was
Page 35
1 undergoing a gallbladder and what they told me is there2 was a -- they told me that there was a colonic injury is
3 what I was told by the OR staff.
4 Q. What else did they say in that regard?
5 A. That's pretty much it.
6 Q. Did the staff indicate what the outcome of that
7 case had been?
8 A. I don't know if they knew.
9 Q. Was the patient still in the hospital?
10 A. The patient was still in the hospital and they
11 indicated it was a very long surgery because it had
12 pushed back multiple surgeries for that day.
13 Q. Did they indicate anyone else that was involved
14 in that surgery?
15 A. No.
16 Q. Did they indicate what it was Dr. Bianco had done
17 or not done in that surgery?
18 MR. RYAN: I'm going to object and there has
19 not been testimony to this point that Dr. Bianco was
20 involved in the surgery. So you're mischaracterizing
21 her testimony and I think any answer she gives to it is
22 going to be misleading.
23 Q. (BY MR. SAWICKI) All right. Let me go back up.
24 The way I understood it, you said earlier -- let me go
25 back to my notes. Started talking about why Dr. Bianco
Page 36
1 was suspended. Do you remember that?2 A. Correct.
3 Q. And you told me that in talking with Dr. Schade,
4 he said that Dr. Bianco had been suspended in this
5 4 o'clock conversation; is that correct?
6 A. Yes.
7 Q. And that in your discussion with him, he said
8 something about there had been an unfortunate event; is
9 that correct?
10 A. Yes, Dr. Schade told me that.
11 Q. And that you understood that unfortunate event to
12 have been something secondary to what the OR staff had
13 said when you showed up at the hospital a few days
14 before to perform your own work at the hospital; is that
15 correct?
16 A. I didn't know what the unfortunate event was.
17 Q. Correct. But when you showed up at the hospital
18 to do your own work, the OR staff was talking about it,
19 correct?
20 A. They were talking about a situation.
21 Q. Right. And that situation was the situation
22 involving Dr. Bianco; is that correct?
23 MR. RYAN: Form.
24 A. I assume so. They mentioned Dr. Bianco.
25 Q. (BY MR. SAWICKI) Okay.
Page 37
1 A. I don't know if it was the same patient.2 Q. At least when you arrived at the OR -- or the OR
3 at UGH to perform your own work, the OR staff at the
4 time was talking about Dr. Bianco's involvement with a
5 patient involved in a gallbladder procedure; is that
6 correct?
7 A. Yes.
8 Q. And that the staff of the OR told you that that
9 patient had sustained some kind of colonic injury; is
10 that correct?
11 A. Yes.
12 Q. And that that injury was during the course of a
13 gallbladder procedure being performed by Dr. Bianco; is
14 that correct?
15 A. Yes.
16 Q. Okay. So did they tell you anything more about
17 what Dr. Bianco's involvement was?
18 A. No.
19 Q. Did they tell you what specifically had gone
20 wrong causing the colonic injury?
21 A. No.
22 Q. Did they tell you any other doctor other than
23 Dr. Bianco had been involved in the surgery?
24 A. No.
Page 38
1 colonic injury they were describing had occurred?2 A. No.
3 Q. Now, did you make a connection when you talked to
4 Dr. Schade, on that 4 o'clock conversation, did you make
5 a connection between this conversation with the OR staff
6 a few days earlier and the unfortunate event that
7 Dr. Schade was talking about with you at the 4 o'clock
8 conversation?
9 MR. THORNTON: Form.
10 A. I thought to myself, I wonder if this is the same
11 patient, but I didn't know.
12 Q. (BY MR. SAWICKI) And what was it that led you to
13 make that thought or why did you have that thought?
14 A. Because essentially the OR staff had described it
15 as an unfortunate -- almost the same, an unfortunate
16 incident during the operation.
17 Q. So let me make sure I understand. Do you believe
18 that the individual that the OR staff was talking about
19 with you when you were there was Mrs. Mejia or another
20 patient?
21 MR. THORNTON: Form.
22 A. I cannot make that decision. I don't know if it
23 was the same.
24 Q. (BY MR. SAWICKI) The conversation that you had
25 and you've been telling me about with the OR staff, did
Page 39
1 that take place on the 27th of June?2 A. No.
3 Q. Was it some days prior to that?
4 A. Yes.
5 Q. Is there any way to fix in your mind what day
--6 how many days prior it was?
7 A. I can't tell exactly. It was maybe two. Maybe
8 one or two recent.
9 Q. If the record showed Mrs. Mejia came in, I want
10 to say on the 26th -- I'll have to go back and check.
11 Yeah, if the record show Mrs. Mejia was admitted on the
12 25th of June, do you believe that was before or after
13 this conversation you described with the OR staff?
14 A. I cannot recall exactly.
15 Q. Is there any recollection you have of what
16 patient or what activity you were performing at the
17 hospital that would help us fix in time when you
18 would've been there having this conversation?
19 A. No. I was literally -- I was there rounding and
20 like I said, I always kind of go through the OR just to
21 see and plus I was on call, so I would just go through
22 the OR, go through the ER.
23 Q. Do you recall anything about the patient's
24 condition that had been involved in this colonic injury?
25 A. I didn't ask.
Page 40
1 Q. What was your impression about the condition of2 that patient?
3 MR. THORNTON: Objection; form.
4 A. I wouldn't know.
5 Q. (BY MR. SAWICKI) Did the OR staff indicate that
6 the patient was still -- you said earlier, in the
7 hospital. Do you know anything about where that patient
8 was still?
9 MR. THORNTON: Form.
10 A. No.
11 Q. (BY MR. SAWICKI) Did you have any other
12 discussions about any other patients with the OR staff
13 that were similar to this conversation that you'd had
14 about Dr. Bianco's gallbladder surgery with the colonic
15 injury?
16 MR. HINES: Object to form.
17 MR. RYAN: Form.
18 MR. THORNTON: Same objection.
19 A. No.
20 Q. (BY MR. SAWICKI) Okay. Had the OR staff ever
21 told you about other injuries like this before?
22 MR. THORNTON: Objection; form.
23 A. No.
24 Q. (BY MR. SAWICKI) Was this the first time you'd
25 ever walked into the OR and had them say, hey, have you
Page 41
1 heard we have a gallbladder surgery patient with a2 colonic injury still in the hospital?
3 A. Repeat the question.
4 Q. Sure. I guess what I'm trying to get at is: Was
5 this a topic of conversation that was a normal one that
6 you would have this kind of conversation about
7 frequently, or was this sort of an anomaly that stood
8 out in your mind?
9 MR. RYAN: Objection; form.
10 MR. HINES: Form.
11 MR. THORNTON: Form.
12 A. I would say the OR nurses always had some type of
13 story.
14 Q. (BY MR. SAWICKI) Had they told you stories
--15 the OR nurse, had they told you stories about other
16 cases where patients had sustained some kind of injury
17 like the type you're describing with respect to
18 Dr. Bianco in this colonic injury?
19 MR. THORNTON: Form.
20 A. Perhaps not exactly, no.
21 Q. (BY MR. SAWICKI) Had that happened -- when was
22 the -- prior to this, when was the last time that had
23 happened?
24 MR. HINES: Object to form.
Page 42
1 Q. (BY MR. SAWICKI) Do you remember anything else2 about who the OR staff was that had this conversation
3 with you about Dr. Bianco, the patient that sustained
4 the colonic injury?
5 MR. THORNTON: Form.
6 A. There was -- like I said, it was the OR director
7 and I know the PACU coordinator was there and then the
8 front OR nurse and I cannot recall their names right
9 now.
10 Q. (BY MR. SAWICKI) Okay. So the OR director, that
11 would be -- that was a woman, I think you told me
12 before?
13 A. They're all female.
14 Q. All female. Okay. Do you know any of these
15 individuals outside of UGH?
16 A. I did not.
17 Q. Do you know where any of them are currently?
18 A. A couple, yes.
19 Q. Who -- who do you know of where they are?
20 A. I don't recall their names.
21 Q. Well, was it, for example, the OR director?
22 A. Yes.
23 Q. Where do you believe she is?
24 A. She's at another hospital.
25 Q. Do you know which one?
Page 43
1 A. Crescent.2 Q. And where is Crescent?
3 A. It's in South Dallas, I guess you call it.
4 Q. Do you know what she's doing at South Dallas
5 Crescent?
6 A. I believe it's the same position.
7 Q. How about the PACU coordinator? Do you know
8 where she is?
9 A. She's at Methodist.
10 Q. Do you know what role she's doing at Methodist?
11 A. She's an educator of some sort.
12 Q. Do you know which Methodist location?
13 A. It's the same one in South Dallas. I don't know
14 if it has a different name.
15 Q. Okay. And the front OR nurse, do you know where
16 that individual is today?
17 A. The receptionist, I actually also saw her at
18 Crescent.
19 Q. And is she a receptionist?
20 A. She's a -- yeah, kind of like a scheduler,
21 receptionist. I don't think she's a nurse.
22 Q. Do you recall talking with any other individuals
23 other than those three about this incident with
24 Dr. Bianco a few days before Mrs. Mejia's procedure?
25 A. No.
Page 44
1 Q. Did you talk with Dr. Bianco at all?2 A. No.
3 Q. Had you ever talked to Dr. Bianco?
4 A. I think we were introduced in passing once. I
5 don't know if I would even recognize him if I saw him
6 again though.
7 Q. Did you ever discuss him with other members of
8 your surgical community?
9 A. No.
10 Q. Know of any doctors that were working with him or
11 that knew him well?
12 A. I didn't know them personally, no.
13 Q. You know them just by reputation?
14 A. There was a surgeon that knew him well.
15 Q. Who was that?
16 A. I think it was Dr. Silver, I think and that's...
17 Q. Do you ever talk to Dr. Silver about Dr. Bianco?
18 A. No.
19 Q. Do you know Dr. Silver at all?
20 A. I've met him a couple of times.
21 Q. Where is he today?
22 A. I don't know.
23 Q. Have you told me everything you remember about
24 this discussion you've had with the OR staff about the
25 other patient, the gallbladder patient, that sustained
Page 45
1 the colonic injury?2 A. Yes.
3 Q. Do you remember any other discussion with
4 Dr. Schade about that situation?
5 A. Not until the later conversation, but...
6 Q. Okay. And I'm going back to try to work through
7 everything here. So with respect to this 4 p.m.
8 conversation, we've gotten through Dr. Schade calling
9 you, telling you you're assigned to this patient using
10 the tone that you've told me about everything you
11 remember there, correct?
12 A. Correct.
13 Q. And then you've told me everything you remember
14 about him saying regarding Dr. Bianco being suspended?
15 A. Yes.
16 Q. That was due to an unfortunate situation or
17 unfortunate event?
18 A. Yes.
19 Q. Okay. And that, in your mind, was linked to the
20 earlier conversation you had with the OR staff about the
21 colonic patient -- or the colonic injury to the other
22 gallbladder patient, correct?
23 MR. THORNTON: Objection; form.
24 A. Not correct. I didn't know if it was the same
Page 46
1 Q. (BY MR. SAWICKI) All right. Were you aware of2 any other patients of Dr. Bianco that had some kind of
3 unfortunate event?
4 MR. THORNTON: Form.
5 A. No.
6 Q. (BY MR. SAWICKI) So then, as we're continuing
7 through, you told me that Dr. Schade told you that
8 according to the bylaws you were supposed to take over
9 the -- Mrs. Mejia's care. Do you remember that?
10 A. Yes.
11 Q. So I want to talk about the bylaw section and
12 what he said in that regard. What was it, if you
13 recall, that Dr. Schade told you specifically? Why were
14 the bylaws even coming up?
15 A. Because when he initially told me about the
16 patient and to assume care, I told him I didn't feel
17 comfortable. And then so the rebuttal was, well, it's
18 in the hospital bylaws. You have to take over this
19 patient. When a surgeon gets suspended, it falls to the
20 surgeon on call is what he said.
21 Q. Okay. So let me cut up those two things. You
22 were telling me when the bylaw portion came up that
23 Dr. Schade had told you something about the patient's
24 condition and you didn't feel comfortable about getting
25 involved in. What was it specifically about her
Page 47
1 condition you didn't feel comfortable getting involved2 in?
3 A. It was the fact that this patient had now been
4 operated on twice. She did require some blood products
5 and she was currently in the ICU.
6 Q. Okay. So let me -- I'm not a doctor. So help me
7 understand. What was the significance, if any, in your
8 mind about the fact that Mrs. Mejia had been operated on
9 twice that led you to feel uncomfortable about taking
10 over her care?
11 A. Essentially that means that there had been some
12 type of complication and typically I don't -- I think
13 it's in the best interest of the patient for the person
14 who knows the anatomy or who has previously operated on
15 her to continue to treat the patient, not for it to go
16 to a surgeon who knows nothing about what happened or
17 the complication.
18 Q. Is this complication something Dr. Schade told
19 you about or was that an opinion you've reached on your
20 own?
21 A. That was an opinion after him telling me, well,
22 she had to go back to the operating room.
23 Q. What was the complication you believed to be
24 present?
25 A. A bleed of some sort.
Page 48
1 Q. Sure.2 A. Sorry.
3 Q. We'll work it out. What was the complication you
4 formed in your mind an opinion about what was that
5 complication?
6 A. Just a bleed, that's all I knew.
7 Q. Now, how was it that that particular complication
8 was -- what was it about it that made you uncomfortable
9 about getting involved in her care for Mrs. Mejia?
10 A. I typically do not
--11 MR. RYAN: Form.
12 A. -- like taking over care on patients that I don't
13 know enough about and who've had complications from
14 other -- other operating surgeons, one. Two, the fact
15 that she needed blood requirements and I knew the
16 hospital did not have a large amount of blood on hand
17 was my other concern.
18 Q. Okay. Do you recall Dr. Schade telling you
19 anything more about how this bleed was caused or why it
20 was continuing?
21 MR. RYAN: Form.
22 MR. THORNTON: Same objection.
23 A. He didn't say anything about continuation but he
24 did tell me to just call the nurse.
25 Q. (BY MR. SAWICKI) Did you tell Dr. Schade at this
Page 49
1 time that you had the concern that you typically did not2 like to take over a patient that you didn't know a lot
3 about?
4 A. No. At this time, I did tell him that I don't
5 feel comfortable managing this patient and it may be in
6 her best interest to transfer.
7 Q. And when you say "transfer", transfer to another
8 facility?
9 A. A higher level of care, but I didn't say that. I
10 said another facility.
11 Q. Did you express to Dr. Schade at this point, I
12 don't words to the effect that I don't
--13 Dr. Hamilton does not like to take over patients that
14 you don't -- I'm sorry. I wrote down what you said
15 where you felt like it was in their best interest for
16 them to continue with the doctor that had been treating
17 them?
18 A. I did not tell him that.
19 Q. Okay. Did you tell Dr. Schade at this point that
20 you felt like the hospital didn't have the blood on hand
21 necessary to care for a patient like this?
22 A. No.
23 Q. Let me go back to that then for a second. Do you
24 recall -- what it is that this conversation at 4:00 in
Page 50
1 that UGH did not have the blood on hand that Mrs. Mejia2 might need to care for her condition? Why did you have
3 that opinion?
4 A. The fact that she had -- so let me -- so this is
5 what was going through my head when he was telling me
6 she had a bleed. So -- and he is not a surgeon, so he
7 doesn't know the anatomy, but I'm familiar enough with
8 the anatomy that when someone typically has -- when
9 there's a bleed, it's typically cystic, hepatic. One of
10 the hepatics. The best treatment for that is
11 interventional radiology once the patient is stable. I
12 knew for a fact UGH did not have that capability.
13 Typically what happens when you have a bleed or a leak
14 even at the gallbladder or a common bile duct injury,
15 whatever the case may be. Any injury typically during a
16 laparoscopic case, the best treatment, the safest for
17 the patient after is typically interventional radiology,
18 and I knew UGH did not have those capabilities.
19 Q. And how is it you knew they didn't have that
20 capability?
21 A. Because I've worked there, and I've needed it for
22 other purposes and we couldn't do it.
23 Q. I'm ignorant. I'm not a doctor so I don't mean
24 to ask stupid questions. I am a lawyer so that's what I
25 do. With respect to this interventional radiology, is
Page 51
1 that a department, is that an individual, is that a2 piece of equipment? Why is it that -- what is it we're
3 talking about?
4 A. A combination of those things. So you have to
5 have -- yes, the radiology department which they have.
6 Then you have to have an interventional radiologist,
7 which is a radiologist who has specialty training, and
8 then you have to have the equipment.
9 Q. So was it that UGH did not have an interventional
10 radiologist?
11 A. They did not have that and they did not have the
12 equipment.
13 Q. Now, is this something you said in -- a moment
14 ago in your response that you'd run into this before?
15 A. Correct.
16 Q. What is it -- and I'm not trying to pry into
17 other patients' specific health history, but what is it
18 about your other experiences at UGH that led you to
19 conclude that they didn't have this necessary equipment
20 and specialist to do this work?
21 MR. RYAN: Let me caution you not to
22 disclose any information that relates in any way
23 specifically to other patients in his treatment you've
24 been involved.
25 Q. (BY MR. SAWICKI) Yeah, let me rephrase the
Page 52
1 question. I'm not asking you about any other patients2 specifically. But in your earlier response you said you
3 knew when Dr. Schade called you at 4 o'clock on the 27th
4 that the hospital -- that Mrs. Mejia first was going to
5 need interventional radiology; is that correct?
6 MR. RYAN: Objection; form.
7 MR. THORNTON: Objection; form.
8 MR. HINES: Objection; form.
9 A. I believe that that would have been a good
10 treatment for her.
11 Q. (BY MR. SAWICKI) All right. And that you knew
12 at that same time frame, 4 o'clock on the 27th, that UGH
13 did not have the necessary people or equipment to
14 provide that good treatment for her; is that true?
15 A. Yes.
16 Q. Why is it you knew at 4 p.m., thereabouts, on the
17 27th that UGH lacked that kind of capability to provide
18 that good treatment?
19 A. Because I asked as soon as I started taking ER
20 call if they had interventional radiology.
21 Q. And can you fix for me in time how many weeks,
22 days or months it was before this 4 o'clock on the 27th
23 time frame where you knew that?
24 A. Three months and as a surgeon it helps decide who
25 needs to stay and who needs to be transferred. Anybody
Page 53
1 with an intraabdominal abscess, for example, that could2 benefit from interventional radiology, they cannot do at
3 UGH; therefore, as a surgeon I would make the decision
4 to transfer that patient.
5 Q. Okay. Now, this equipment -- and if I refer to
6 it as interventional radiological equipment, would that
7 be a correct way to categorize it in a general sense?
8 A. Uh-huh.
9 Q. Is that a yes for her?
10 A. Yes.
11 Q. Sorry. Okay. So this -- on the 27th of June at
12 4 p.m., you knew that UGH did not have this
13 interventional radiological capability that you would
14 have recommended as a necessary treatment for
15 Mrs. Mejia, true?
16 MR. RYAN: Objection; form.
17 A. Yes.
18 Q. (BY MR. SAWICKI) Is that something you would
19 have expected a hospital to have had at its -- as part
20 of its offerings?
21 MR. RYAN: Objection; form.
22 A. Not necessary.
23 Q. (BY MR. SAWICKI) Would you have expected the
24 staff, though, to have understood that they didn't have
Page 54
1 A. The staff, no.2 Q. How about Dr. Schade? Would you have expected
3 him to have known that the hospital didn't have that
4 kind of service available?
5 MR. RYAN: Form.
6 A. I would expect him to have known. I don't know
7 if I would have expected him to have known that that
8 would've been an appropriate treatment for this patient.
9 Q. (BY MR. SAWICKI) Is that something you would
10 have expected a surgeon familiar with laparoscopic
11 cholecystectomy and its potential complications to have
12 known?
13 MR. THORNTON: Form.
14 A. Yes.
15 Q. (BY MR. SAWICKI) Something you would have
16 expected, say, Dr. Bianco to have known?
17 A. Yes.
18 Q. Something you knew yourself, true?
19 A. Yes.
20 Q. Okay. And that's with respect to treating
21 complications of a laparoscopic cholecystectomy, a bleed
22 of the hepatic artery is something that surgeons
23 performing that procedure knows it's something that can
24 happen, true?
25 A. Yes.
Page 55
1 Q. And the standard of care requires prompt2 intervention and treatment of that condition because if
3 left untreated it can be dangerous to the patient; is
4 that true?
5 MR. RYAN: Form.
6 A. That could be true, yes.
7 Q. (BY MR. SAWICKI) And one of the treatments that
8 is accepted in the standard of care is to provide
9 interventional radiological type treatment to those
10 types of bleeds?
11 MR. RYAN: Form.
12 A. Well, there's multiple treatments. One would be
13 surgical. Hepatic artery is actually a larger artery so
14 that one may not have been able to been treated through
15 radio -- interventional radiography, but a smaller, like
16 a branch or the cystic artery, those are preferably
17 treated with interventional radiology. But the hepatic
18 artery is big enough that it requires.
19 Q. Did you do a lot of laparoscopic cholecystect
--20 cys -- starting over again.
21 Did you perform laparoscopic
22 cholecystectomies at UGH yourself?
23 A. Yes.
24 Q. Can you quantify or give me some idea of how many
25 you might have done at that particular facility?
Page 56
1 A. Between April and this time I'd say double2 digits, 13.
3 Q. When you performed them I know you didn't go in
4 intending for them to be any complications, did you have
5 a plan that if an interventional radiologist's services
6 were necessary what you would do in that situation if
7 your patient did need that?
8 A. Yes.
9 Q. What was the plan that you had for those patients
10 if they needed that kind of service?
11 A. So I would have to do it surgically.
12 Q. Okay.
13 A. And then potentially transfer.
14 Q. Did you have a particular facility in mind that
15 the transfer would -- the patient would be transferred
16 to?
17 A. I knew of this -- facilities around that had
18 interventional radiology.
19 Q. And what were those facilities that had that
20 services available that if you needed them you would
21 have sent your patient to?
22 A. Baylor and Methodist.
23 Q. Okay. Now, to go back to the conversation when
24 you told doctor -- when you were having this
25 conversation with Dr. Schade about the bylaws you told
Page 57
1 me about your -- that's where -- I'm reorienting us back2 to that and this concern that you had about the
3 interventional radiology. Is that something you
4 specifically told Dr. Schade about?
5 A. I did not.
6 MR. RYAN: Objection; form.
7 Q. (BY MR. SAWICKI) All right. Is there a reason
8 why you didn't tell him that you had that concern?
9 A. I feel like that conversation, the first, initial
10 conversation and even the second was so short, I didn't
11 really have an opportunity to explain all of my
12 concerns.
13 Q. Okay. So then the next thing you told me about
14 was that you felt like the reason you were uncomfortable
15 about taking over Mrs. Mejia's care, you said that you
16 felt she needed blood and you knew the hospital didn't
17 have sufficient blood supplies on hand?
18 MR. RYAN: Wait.
19 MR. THORNTON: Objection; form.
20 MR. RYAN: Objection; form.
21 Mischaracterizes her testimony.
22 Q. (BY MR. SAWICKI) Well, let me back up. I wrote
23 it down. So what I wrote down is you told or you felt
24 in your opinion that she needed blood and you knew the