Q, 1 SUPERIOR COURT OF THE STATE OF CALIFORNIA 2 COUNTY OF SAN BERNARDINO 3 VICTORVILLE DIVISION 4 DEPT. V--10 HON. STANFORD E. REICHERT, JUDGE 5 6 DESERT VALLEY HOSPITAL, INC., CASE NO. 7 PLAINTIFF, 8 vs. 9 TINA BUCHANAN AND LISA CROUCH, 10 DEFENDANTS. 11 TINA BUCHANAN AND LISA CROUCH, 12 CROSS--COMPLAINANTS, 13 VS. 14 DESERT VALLEY HOSPITAL, INC., I ET AL, 15 CROSS--DEFENDANTS. 16 17 TRANSCRIPT OF ORAL PROCEEDINGS 18 TESTIMONY OF PANCH JEYAKUMAR 19 MONDAY, AUGUST 29, 2005 TUESDAY, AUGUST 30, 2005 20 21 APPEARANCES: 22 23 FOR THE PLAINTIFES DEBORAH S. TROPP AND CROSS--DEFENDANTS: ATTORNEY AT LAW 24 611 ANTON BOULEVARD SUITE 1050 25 COSTA MESA, CA 92626 --AND-- 26 MICHAEL J. SARRAO ATTORNEY AT LAW 27 26632 TOWNE CENTRE DRIVE . SUITE 300 28 FOOTHILL RANCH, CA 92610 1 2 3 FOR THE DEFENDANTS VINCENT P. NOLAN AND CROSS--COMPLAINANTS: ATTORNEY AT LAW 4 3877 TWELFTH STREET RIVERSIDE, CA 92501 REPORTED BY: FRED BERZAK, C.S.R. 28 OFFICIAL REPORTER, NO. 5815 INQEX 2 WITNESS LIST 3 4 WITNESS PAGE 5 6 PANCH JEYAKUMAR 7 CROSS--EXAMINATION BY MS. TROPP 8 DIRECT EXAMINATION BY MR. NOLAN T64 RECROSS--EXAMINATION BY MS. TROPP 252 9 REDIRECT EXAMINATION BY MR. NOLANA 126 THAT MEETING WAS IN MAY OF 2 A THAT WAS A TELEPHONE CALL IN MAYCOURSE. . 5 YOU KNOW WHY HE WAS ANGRY, DO A 6 A I KNOW. 7 NOT ANYTHING WE CAN TALK ABOUT A A 8 A UNFORTUNATELY NOT. 9 ON FEBRUARY T3, ZOO3, DURING THIS MEETING, DOCTOR TO REDDY NEVER CALLED TINA BUCHANAN OR LISA CROUCH A NAME IN TW YOUR W2 A I CANNOT RECALL MYSELF. T3 IN THIS MEETING, MISS BUCHANAN AND MISS CROUCH 14 STATED THEIR CONCERNS TO DOCTOR T5 A YES. T6 THAT THEY HAD HEARD HE WAS IN THE EMERGENCY ROOM T7 SMELLING OF T8 A YES. T9 THAT THEY HAD HEARD HE WAS WRITING ON PATIENT CHARTS 20 IN THE 2T A YES. 22 THAT THEY HAD HEARD HE WAS TREATING PATIENTS 23 DIFFERENTLY BASED ON 24 A YES. 25 AND THAT WAS I 26 A THOSE WERE THE MAIN ISSUES TO BE DISCUSSED. MR. LEX 127 I I REDDY WANTED THOSE CLARIFIED. 2 THEY NEVER MENTIONED ANY ALLEGATIONS OF UP--CODING IN 3 THIS MEETING, 4 A I RECALL PERSONALLY. 5 THEY NEVER RAISED THAT ISSUE WITH YOU BY FEBRUARY 6 A 7 A NOT SPECIEICALLY. I RECALL. 8 DURING THIS MEETING THERE WAS SOME DISCUSSION ABOUT 9 PATIENT B, THE KAISER PATIENT, IO A YES. II DID MISS CROUCH AND MISS BUCHANAN STATE THEIR I2 CONCERNS TO DOCTOR REDDY ABOUT PATIENT T3 A YES. I4 THEY THINK THIS PATIENT SHOULD HAVE BEEN I5 ADMITTED TO THE I I6 A THE DISCUSSIONS OF THAT PATIENT THAT OCCURRED T7 ACTUALLY STEMMED FROM AN EARLIER ISSUE WHICH WAS DOCTOR T8 REDDY HAD BEEN INTEREERING AND WRITING ON CHARTS AS WELL AS T9 KAISER PATIENTS WERE ADMITTED INAPPROPRIATELY WHO WERE 2O DISCHARGED BY THE EMERGENCY ROOM PHYSICIAN. BASED ON THAT 21 DISCUSSION, HE WANTED A SPECIFIC INSTANCE OF THIS HAPPENING, 22 AND WHEN THIS DISCUSSION OCCURRED ABOUT THIS PATIENT. 23 WHEN MISS CROUCH AND MISS BUCHANAN COMPLAINED THAT . 24 DOCTOR REDDY WAS WRITING ON PATIENT CHARTS THAT HIS 25 PATIENT AND THAT HE WAS ADMITTING PATIENTS THAT HAD ALREADY 26 BEEN DISCHARGED BY THE ER DOCTOR, THIS IS THE EXAMPLE THEY W28 CAME UP 2 A YES, WHERE HE USED A DIAGNOSIS WHICH WAS 3 INAPPROPRIATE AND EXCESSIVE FOR THE CONDITION TO 4 JUSTIEY THE ADMISSION. 5 THIS IS THE ONE INCIDENT THEY COULD COME UP 6 A THIS IS ONE INCIDENT WE DISCUSSED. 7 THIS INCIDENT INVOLVED A 55 YEAR OLD MAN WITH A 8 FAINTING 9 A YES. IO DURING THIS PERIOD OF TIME, THE PATIENT HAD NO BLOOD TT T2 A FOR A MINUTE OR SO. T3 THE PARAMEDICS GET A BLOOD I4 A FOR A MINUTE THEY GET A BLOOD PRESSURE. T5 AND HE HAD A VERY LOW HEART I6 A TWENTY. W7 A NORMAL HEART T8 A SEVENTY TO NINETY. T9 VERY 20 A YES. 2I AND DOCTOR REDDY, AS A CARDIOLOGIST, DECIDED THIS 22 PATIENT SHOULD BE ADMITTED, 23 A CORRECT. 24 AND THE ER PHYSICIAN WHO WAS THE ER 25 A I THINK IT WAS DOCTOR WASSEF. 26 IT TRUE THAT DOCTOR WASSEF HAD NOT ACTUALLY I29 I DISCHARGED THE PATIENT BUT WAS CONSIDERING DISCHARGING THE 2 3 A POSSIBLE. 4 AND IT TRUE THAT THIS PATIENT WAS IN THE A 5 EMERGENCY ROOM AT OR ABOUT THE LUNCH HOUR, AND DOCTOR REDDY 6 HAPPENED TO BE DOWN THERE AND SAW THIS 7 A POSSIBLE. I KNOW. THE DIAGNOSIS THAT DOCTOR REDDY PLACED ON THIS 9 CHART WAS SUDDEN CARDIAC DEATH TO A AN INCORRECT DIAGNOSIS. Ti IS THAT THE DIAGNOSIS HE PLACED ON THE . T2 A YES. T3 WHAT HE T4 A YES. T5 AND YOU DID NOT AGREE WITH I6 A YES, I DID NOT. T7 AND YOU THINK THIS PATIENT SHOULD BE 78 T9 A NO. THIS PATIENT SHOULD HAVE BEEN ADMITTED. 20 SO JUST UPSET ABOUT THE ZW A YES. 22 YOU THINK THAT WAS AN ACCURATE Z3 YOU WOULD HAVE PUT SOMETHING 24 A THE APPROPRIATE DIAGNOSIS WOULD HAVE BEEN SYNCOPE, Z5 FAINTING SPELL. 26 IF YOU PUT SYNCOPE AS A DIAGNOSIS, HOW WOULD YOUR T30 II I DIAGNOSIS TELL THE NEXT PHYSICIAN THAT THIS GENTLEMAN ACTUALLY HAD NO BLOOD PRESSURE FOR A PERIOD OF 3 A THAT IS PART OF THE SYNCOPE. WHY HE PASSED 4 OUT. I 5 DID YOU EVER SPEAK TO THE WIFE IN THE 6 A NO. 7 DID YOU EVER KNOW THE FAMILY 8 A NO. 9 HOW OLD WAS THIS WO A FIFTY PLUS. IT DID YOU KNOW THAT THIS PARENT, IF NOT T2 PARENTS, HAD DIED IN THEIR SIXTIES FROM CARDIAC I3 A I KNOW THAT. I4 OF A THORACIC I I5 A I READ THE SO I KNOW THAT INFORMATION. T6 WHEN YOU TALKED TO DOCTOR REDDY ABOUT THIS PATIENT T7 ON FEBRUARY THIRTEENTH, YOU WERE DISCUSSING WITH HIM YOUR T8 DISPUTE REGARDING THIS T9 A CORRECT. 20 AND HE STOOD HIS ZW A TILL THAT EVENING, YES. 22 HE STOOD HIS GROUND AND SAID WHAT HE THOUGHT 23 THE PATIENT A 24 A YES. 25 IRRESPECTIVE OF WHAT HE WAS WRITING ON THE CHART, 26 YOU THOUGHT THIS PATIENT SHOULD HAVE BEEN TBI A YES. A 2 AND THIS PATIENT WAS ONLY ADMITTED 3 A EVENTUALLY, YES. 4 HE WAS ADMITTED OVERNIGHT AT DESERT VALLEY HOSPITAL, 5 6 A YES. 7 AND THEN HE WAS TRANSPORTED BY THE TRANSPORT TEAM TO A 8 9 A YES. TO EVEN KAISER FELT THAT HE NEEDED TO BE TT A YES. T2 IN THIS FEBRUARY THIRTEENTH MEETING IN THE T3 BOARDROOM, WAS IT EVER AGREED THAT THE CHAIRMAN OF THE BOARD T4 COULD CONTINUE TO COME TO THE HOSPITAL AND SEE PATIENTS T5 AFTER CONSUMING ALCOHOL AND THE STAFF MUST TELL HIM IF THEY T6 SMELL IT ON HIS BREATH SO HE KNOWS TO COVER THE T7 A YES. T8 THAT WAS AGREED TO AT THE T9 A NOT AGREED TO. THE ISSUES WE DISCUSSED WERE THE 20 FOLLOWING: NUMBER T, HE WAS GOING TO THE EMERGENCY ROOM 2W WITH ALCOHOL ON HIS BREATH, WHICH I HAD TALKED TO HIM 22 SEVERAL TIMES, AND HE LISTEN. IN THIS MEETING WHEN 23 HE TALKED, HE KIND OF NONCHALANTLY DISMISSED THAT SAYING, 24 I SMELL OF ALCOHOL, ASK TO GIVE ME A BREATH i 25 IT TRUE IT WAS NEVER AGREED AT THIS MEETING BY 26 ANYBODY THAT DOCTOR REDDY COULD COME TO THE HOSPITAL UNDER W32 I THE INFLUENCE OF 2 A HE VERY DEFINITELY SHOULD NOT COME TO THE HOSPITAL 3 UNDER THE INFLUENCE OF ALCOHOL. 4 IT WAS NOT AGREED UPON, WAS 5 A NO. 6 YOU WOULD NEVER AGREE TO IT, WOULD 7 A NO. 8 LEX REDDY WOULD NEVER AGREE TO 9 A NO. IO DOCTOR REDDY ASKED MISS CROUCH AND MISS BUCHANAN FOR TT SPECIFIC INSTANCES REGARDING ALCOHOL, AND THEY GIVE I2 HIM ANY, . T3 A HE HAD ADMITTED TO ME SEVERAL TIMES THAT HE DID GO T4 TO THE EMERGENCY ROOM WITH ALCOHOL ON HIS BREATH. T5 THAT THE QUESTION. THE QUESTION WAS: DURING I6 THIS FEBRUARY THIRTEENTH MEETING, MISS CROUCH AND MISS I T7 BUCHANAN NEVER RAISED SPECIFICS TO DOCTOR REDDY OF ANY T8 ALCOHOL USE AND THEN TREATING PATIENTS, T9 A NOT SPECIFICALLY. 2O YOU NEVER SAW DOCTOR REDDY UNDER THE INFLUENCE ZT 22 A NO, EXCEPT THE FACT THAT HE TOLD ME HE HAD TAKEN 23 DRINKS BEFORE HE WENT TO THE EMERGENCY ROOM. 24 HE TOLD YOU ABOUT A PARTICULAR NIGHT, I 25 A SEVERAL TIMES. I HAD TALKED TO HIM SEVERAL TIMES. 26 HIS EXPLANATION WAS THAT HE DRINKS EXPENSIVE WINE AND IT T33 1 SMELLS. 2 IT TRUE THAT THE ONLY TIME DOCTOR REDDY TOLD 3 YOU HE HAD HAD ALCOHOL WAS THE NIGHT THAT HE HAD BEEN OUT TO 4 DINNER WITH HIS FAMILY AND HE WAS CALLED INTO THE GLASS OF 6 A NO. MORE THAN THAT. 7 DURING ZOOT AND 2003, DID MISS BUCHANAN OR MISS 8 CROUCH EVER TELL YOU THAT THEY WERE OFFENDED OR TOOK ISSUE 9 WITH ANY OF THE NAMES THEY WERE SUPPOSEDLY CALLED BY DOCTOR T0 TW A THEY DID NOT SPECIFICALLY TELL ME THEY WERE T2 OFFENDED, BUT THEY HAD MENTIONED TO ME THEY HAD BEEN CALLED T3 NAMES. THEY COME TO ME AND SPECIFICALLY SAY T4 OFFENDED BY T5 THEY TELL YOU THEY WERE UPSET ABOUT IT AT T6 T7 A THEY TELL ME WHETHER THEY WERE UPSET OR NOT. A T8 EITHER WAY, THEY DID NOT TELL T9 A THEY TELL ME. A 20 THEY NEVER TOLD YOU THAT THESE COMMENTS AFFECTED ZT THEM IN ANY WAY, 22 A THEY MAKE ANY SPECIFIC ALLEGATIONS AS SUCH. 23 THEY COME AND TELL ME IT DID AFFECT THEM OR THE OTHER 24 WAY. THEY EASICALLY DID NOT COMPLAIN TO ME ABOUT BEING 25 AFFECTED BY THEM. 26 THE COURT: COUNSEL, TAKE OUR AFTERNOON BREAK T34 AT THIS POINT. 2 FIVE TO, MEMBERS OF THE JURY 3 (A RECESS WAS TAKEN.) 4 THE COURT: BACK ON THE RECORD IN THE DESERT 5 VALLEY HOSPITAL MATTER. 6 MISS TROPP. 7 BY MS. TROPP: - 8 GOOD AFTERNOON AGAIN. 9 A GOOD AFTERNOON. TO I KNOW BEEN A LONG DAY. I WANT TO CLARIFY A TT FEW THINGS WITH YOU, IE I MAY, AND I HOPE NOT TO GO OVER 12 THINGS I ALREADY ASKED. I JUST WANT TO BE CLEAR. T3 DOCTOR JEYAKUMAR, YOU PERSONALLY NEVER SAW DOCTOR T4 REDDY TREAT A PATIENT UNDER THE INFLUENCE, T5 A YES. W6 YOU PERSONALLY NEVER SMELLED ALCOHOL ON HIS BREATH T7 ON THE PREMISES, T8 A CORRECT. A T9 YOU NEVER HEARD SPECIFIC INSTANCES OF HIM TREATING A Z0 PATIENT UNDER THE INFLUENCE, ZT A CORRECT. 4 22 YOU NEVER HEARD SPECIFIC INSTANCES OE HIM BEING IN 23 THE ER SMELLING OF ALCOHOL, A 24 A SPECIFIC INSTANCES, NO. GENERALIZED COMPLAINTS, 25 YES. 26 YOU HEARD GENERALIZED TALK ABOUT DOCTOR REDDY BEING 135 1 IN THE ER SMELLING OF 2 A YES, CONFIRMED EY HIM. . 3 DO YOU THINK THAT BEING UNDER THE INFLUENCE OF 4 ALCOHOL AND SMELLING OF ALCOHOL ARE TWO DIFFERENT 5 A I KNOW HOW TO ANSWER THAT QUESTION. 6 WHEN IT COMES TO OPERATING A MOTOR VEHICLE, THERE 7 ARE CERTAIN STANDARDS FOR DRINKING AND DRIVING UNDER THE 8 INFLUENCE. WHEN IT COMES TO PATIENT CARE AREAS, I 9 THINK THERE ARE ANY STANDARDS. TO PERSONALLY, I WANT MY DOCTOR, IF TW TREATING ME, SMELLING OF ALCOHOL. 12 I AGREE WITH YOU. T3 IN YOUR DEPOSITION, YOU SAID YOU THOUGHT THERE WAS A T4 DIFFERENCE, T5 A YES, A DIFFERENCE. T6 IN FACT, YOU SAID IN YOUR DEPOSITION THAT BEING I 17 UNDER THE INFLUENCE OF ALCOHOL MEANS CONSUMING A SUBSTANCE T8 WHICH IMPAIRS YOUR ABILITY TO W9 A CORRECT. 20 YOU HAVE NO KNOWLEDGE OF DOCTOR REDDY EVER BEING IN 21 THE EMERGENCY ROOM UNABLE TO 22 A I HAVE NO WAY OF DETERMINING THAT. 23 HE NEVER ADMITTED THAT TO 24 A NO. 25 YOU ARE AWARE OF GENERAL COMMENTS REGARDING DOCTOR 26 REDDY BEING IN THE EMERGENCY ROOM AND HAVING SMELLED OF T36 I ALCOHOL, 2 A CORRECT. 3 YOU KNOW WHAT HE WAS DOING IN THE EMERGENCY 4 ROOM ON THOSE OCCASIONS, 4 5 A NOTHING SPECIFICALLY, YES. 6 YOU KNOW IF HE WAS TREATING A 7 A I KNOW THAT. 8 YOU KNOW IF HE WAS LOOKING AT A 9 A I KNOW HE LOOKS AT CHARTS. WHETHER THEY WERE IO HAPPENING AT THE SAME TIME, I KNOW. I KNOW THE TI SPECIFICS. 4 I2 WHEN YOU WERE TOLD THAT DOCTOR REDDY WAS IN THE ER T3 SMELLING OF ALCOHOL, NOBODY EVER TOLD YOU WHAT HE WAS DOING T4 IN THE ER AT THAT I5 A NO. I6 NOBODY EVER TOLD YOU HE WAS TALKING OR SEEING T7 PATIENTS AT THAT T8 A NOT SPECIFICALLY. T9 RIGHT BEFORE WE TOOK THE BREAK, I ASKED THIS 20 QUESTION: IT TRUE THAT NEITHER MISS BUCHANAN NOR MISS ZT CROUCH EVER TOLD YOU THAT DOCTOR REDDY CALLING THEM SUPPOSED 22 NAMES AFFECTED THEM IN ANY 23 MR. NOLAN: YOUR HONOR, ASKED AND ANSWERED. 24 THE COURT: OVERRULED. I 25 THE WITNESS: UNCLEAR WHAT THE QUESTION IS. IE 26 YOU ARE ASKING ME IF THEY EVER CAME AND TOLD ME THEY WERE T37 OEFENDED BY THE STATEMENTS, THE ANSWER IS NO. 2 MS. TROPP: 3 ACTUALLY, THE QUESTION WAS: THEY NEVER TOLD YOU 4 THEY WERE AFFECTED BY IT IN ANY 5 A THEY NEVER CAME AND TOLD ME EXACTLY THAT IN THOSE -- 6 TERMS. 7 THEY NEVER TOLD YOU THEY WERE 8 A NOT IN THOSE TERMS. 9 THEY NEVER TOLD YOU THEY WERE DISTRESSED BY TO A NOT IN THOSE TERMS. TT YOU WERE CLOSE FRIENDS WITH MISS T2 A YES. T3 A AND YOU WOULD SPEAK TO HER OFTEN AT T4 A YES. T5 AND OCCASIONALLY ON THE T6 A OCCASIONALLY ON THE PHONE. T7 IN ALL THE TIMES THAT YOU SPOKE TO MISS BUCHANAN, T8 SHE NEVER SAID TO YOU THAT SHE WAS UPSET ABOUT THIS SUPPOSED T9 NAME CALLINGPERSONALLY, NO. ZT IN ALL THE TIMES THAT YOU SPOKE TO MISS CROUCH, THE 22 HUNDREDS OF TIMES THAT YOU SPOKE ON THE PHONE, SHE NEVER Z3 ONCE TOLD YOU THAT SHE WAS UPSET ABOUT THIS SUPPOSED NAME 24 CALLING, 25 A CORRECT. 26 LET ME DIRECT YOUR ATTENTION BACK TO FEBRUARY T38 THIRTEENTH. YOU AND DOCTOR REDDY DISAGREED ON THE DIAGNOSIS 2 THAT HE GAVE PATIENT B, 3 A CORRECT. 4 NOT THE FIRST TIME YOU HAVE HEARD OF TWO 5 DOCTORS DISAGREEING HAPPENS ALL THE 8 A CORRECT. 9 WHY WE GET SECOND TO A YES. TT WHEN DOCTOR REDDY AND YOU DISCUSSED PATIENT B, HE I2 WAS UPSET, I3 A HE WAS. T4 HE TELL YOU THAT HE FELT YOU WERE ATTACKING T5 HIS T6 A HOW HE FELT. I FELT IT WAS AN ECONOMIC T7 DECISION AT THIS TIME. HE FELT VERY OFFENDED. TS HE WAS OFFENDED THAT YOU WERE CRITIQUING HIS ETHICS, T9 20 A NO. HE WAS OFFENDED THAT I QUESTIONED HIS DIAGNOSIS 21 IN FRONT OF THEM. 22 IT TRUE THAT YOU QUESTIONED HIS DIAGNOSIS AND 23 HIS REASONS FOR ADMITTING THE 24 A YES. A 25 DOCTOR REDDY WAS UPSET WITH YOU BECAUSE YOU TOLD HIM 26 THAT YOU BELIEVED HE ADMITTED THIS PATIENT PURELY FOR T39 I FINANCIAL A I DID BELIEVE THAT HE EXAGGERATED THE DIAGNOSIS EOR 3 ADMISSION AND TO MAKE THE PATIENT NONTRANSFERRABLE. I WAS 4 UPSET THAT HE GAVE A DIAGNOSIS WHICH WAS UNNECESSARY AND HAS 5 CONSEQUENCES THAT MADE THE PATIENT NONTRANSFERABLE AT THAT 6 TIME. 7 IT TRUE THAT DOCTOR REDDY WANT THIS 8 PATIENT TRANSFERRED AT THAT TIME BECAUSE HE THINK 9 THIS PATIENT WAS IO A THE STABILITY IS ARGUABLE. IE THE TRUE DIAGNOSIS IS TT SYNCOPE, AS IT TURNED OUT TO BE BECAUSE THE INTERNIST AND . 12 THE CARDIOLOGIST CONFIRMED IT, THE PATIENT WAS 13 TRANSFERRABLE. T4 THE SECOND THING, IF DOCTOR DIAGNOSIS WAS T5 CORRECT, THE PATIENT WOULD HAVE BEEN BETTER OFF IN A T6 HOSPITAL WHERE THERE IS CARDIAC INTERVENTION CAPABILITIES T7 BECAUSE IT IS A VERY MAJOR DIAGNOSIS TO GIVE. THE PATIENT T8 WAS TRANSFERRABLE. T9 I WORK IN ORANGE COUNTY. I WORK IN SEVERAL 20 HOSPITALS. WE TRANSFER THESE PATIENTS TO THE UPPER GRADE ZT HOSPITAL AS WE SEE FIT. 22 WHETHER OR NOT THIS PATIENT WAS STABLE FOR TRANSFER, A 23 IS IT FAIR TO SAY, WAS A JUDGMENT 24 A IT WAS A JUDGMENT CALL AT THE TIME. 25 IT WAS 26 A CORRECT. T4O I AND DOCTOR REDDY USED HIS JUDGMENT IN DETERMINING 2 THAT THIS PATIENT WAS NOT STABLE FOR 3 A YES. 4 UNTIL THE NEXT 5 A HE MADE THE DIAGNOSIS THAT MADE THE PATIENT 6 NONTRANSFERAELE BY MOST STANDARDS. I 7 AFTER THE FEBRUARY THIRTEENTH MEETING, THE NIGHT OF 8 FEBRUARY THIRTEENTH YOUR TESTIMONY THAT YOU RECEIVED A 9 PHONE CALL FROM DOCTOR TO A CORRECT. TT AND IT TRUE THAT IN THIS PHONE CALL WITH IZ DOCTOR REDDY HE WAS STILL UPSET ABOUT YOUR CONVERSATION AT I T3 THE T4 A YES. I5 HE WAS STILL UPSET THAT YOU HAD DISAGREED WITH HIM I6 AND, IN HIS OPINION, ATTACKED HIS INTEGRITY, T7 A YES. T8 HE TOLD YOU T9 A HE TOLD ME HE WAS THERE WERE A COUPLE OF ISSUES 20 WE DISCUSSED BEFORE THAT. 2I DID HE TELL YOU HE WAS UPSET, 22 A YES. 23 MR. NOLAN: CAN THE WITNESS FINISH HIS 24 THE COURT: YES. HE GETS TO FINISH THE ANSWER. 25 THE WITNESS: THERE WERE A COUPLE OF OTHER ISSUES 26 WHICH WERE DISCUSSED WITH REGARD TO MISS LISA CROUCH, AND HE 741 I SAID, QUESTIONED MY AND HE SAID, WAS 2 WRONG FOR THE FIRST TIME IN MY LIFE, AND YOU HAD TO TELL IT 3 IN FRONT OF THE 4 BY MS. TROPP: 5 DOCTOR REDDY HAD BEEN DRINKING THAT 6 A PROBABLY. A 7 IT TRUE THAT HE HAD TOLD YOU HE 8 A YES. 9 HE WAS HONEST ABOUT WO A QUITE OBVIOUSLY, YES. T1 AND IT TRUE THAT AT THE BEGINNING OF THIS I2 PHONE CALL DOCTOR REDDY ASKED YOU ABOUT YOUR RELATIONSHIP I3 WITH MISS T4 A CORRECT. T5 HE INQUIRED ABOUT T6 A CORRECT. W7 DID HE APPEAR TO BE WORRIED ABOUT T8 A NO. W9 JUST 20 A HE WAS ACCUSATORY. ZW SOMETIME IN THIS CONVERSATION YOUR TESTIMONY I 22 THAT DOCTOR REDDY TOLD YOU LISA CROUCH HAD TO 23 A THE VERY NEXT SENTENCE WAS HAS TO Z4 AND YOU TOLD HIM, GOT TO DO WHAT YOU GOT TO 25 26 A I TOLD HIM, WHAT YOU WANT, YOU NEED T42 I MY 2 WHY YOU TELL HIM DO 3 A MY BOSS. 4 WHY YOU TELL HIM THAT YOU RECOM END 5 6 A I HAD ALREADY TALKED TO HIM ABOUT THAT BEFORE. THIS 7 CONVERSATION WAS NOT THE FIRST CONVERSATION ABOUT LETTING I 8 THEM GO. HE SAID HE WANTED HER TO GO. AND IF WHAT 9 HE WANTED, HE CAN HAVE IT. IO DID YOU TELL HIM THAT YOU THOUGHT HIS DECISION WAS 4 II T2 A NOT AT THAT MOMENT. T3 DID YOU TELL HIM THAT YOU SUPPORT HIS T4 T5 A HE KNEW THAT. T6 DID YOU TELL HIM THAT HE SHOULD SPEAK TO LEX REDDY T7 ABOUT T8 A NO. T9 DID YOU SPEAK TO LEX REDDY ABOUT 20 A I DID NOT PERSONALLY SPEAK TO MR. LEX REDDY, BUT HE 2T WAS AVAILABLE THE NEXT MORNING. 22 BUT NOT THAT 23 A NO. 24 YOU CALL HIM AND TALK TO HIM ABOUT 25 A IS MY PERSONAL PRIVATE TIME. I 26 APPRECIATE GETTING A CALL FROM MY BOSS WHEN I WAS WITH MY T43 I FAMILY. NOT MY TIME TO CALL MR. LEX REDDY AND START 2 ARGUING OR DEFENDING. HE COULD HAVE GIVEN ME THE COURTESY 3 TILL NEXT MORNING. HE COULD HAVE WAITED WHEN I CAME TO WORK 4 AND TALKED TO ME WHY HE WANTS TO LET ANYBODY GO. HE 5 OFFER ME THE COURTESY THAT NIGHT. HE DECIDED TO ENCROACH ON I 6 MY PERSONAL TIME THAT NIGHT. I WAS WITH MY FAMILY, AND I 7 APPRECIATE THAT. 8 WITH ALL RESPECT, DOCTOR JEYAKUMAR, YOU CERTAINLY 9 HAD NUMEROUS PHONE CALLS WITH MISS CROUCH AFTER AT TO NIGHT. IT MR. NOLAN: OBJECTION, ARGUMENTATIVE. T2 THE COURT: OVERRULED. T3 THE WITNESS: MY PERSONAL CHOICE. W4 BY MS. TROPP: T5 SO FOR PERSONAL REASONS, YOU CHOSE NOT TO SPEAK TO T6 LEX REDDY THAT NIGHT, T7 A YES. I WAS VERY UPSET. T8 INCIDENTLY, SIR, DID YOU SPEAK TO LISA CROUCH THE W9 NIGHT OF FEBRUARY 2O A NO. ZW SIR, TURN TO EXHIBIT 2OI--36. ARE YOU ON THAT PAGE, 22 23 A YES. 24 TAKE A LOOK AT ABOUT THREE QUARTERS OF THE PAGE 25 DOWN. ACTUALLY, YOU DID SPEAK TO MISS CROUCH THAT NIGHT, 26 1 SOMETHING CALLED PREM NEW A YES. 3 DID DOCTOR REDDY EVER TALK ABOUT HIS NEW 4 A HE DID. 5 WHAT DID HE SAY ABOUT 6 A HE SAID THERE WAS A FINANCIAL CRUNCH, AND, 7 THEREFORE, FINANCES WERE GOING TO BE THE PRIMARY DRIVING 8 FORCE. THAT MAY NOT BE THE EXACT WORDS. THEY WOULD BE THE 9 PRIMARY GOAL OF THE ORGANIZATION. IO DID HE TALK ABOUT WHAT WOULD BE SECOND AFTER 11 FINANCES AS FAR AS THE GOAL OF THE T2 A FINANCES. I3 THAT WAS SECOND AS T4 A I THINK SO. T5 DID HE TALK ABOUT WANTING TO INCREASE THE REVENUES T6 AT THE T7 A YES. T8 DID HE GIVE YOU ANY INDICATION IN LATE ZOOT AND T9 EARLY ZOOZ WHAT HE WANTED TO DO TO INCREASE Z0 A IN ZOOT TO INCREASE THE REVENUES HE -- IN LATE ZOOT ZW HE GOT INVOLVED IN THE BUSINESS OFFICE WHERE HE WENT AND ZZ MADE SURE THE BILLINGS WERE APPROPRIATE, THE COLLECTIONS Z3 WERE APPROPRIATE, AND THERE WAS NO LOST MONEY OVER THERE. Z4 THAT WAS WHERE HE STARTED. THAT WAS ONE. Z5 THEN LATER AS THE MONTHS WENT BY, HE WANTED TO 26 INCREASE THE FEE--FOR--SERVICE ADMISSIONS TO THE HOSPITAL. I82 THIRDLY, HE ALSO WAS WORKING WITH MR. LEX REDDY IN 2 IMPROVING THE MANAGED CARE CONTRACTS THAT WE HAD, WHICH WERE 3 REIMBURSING THE GROUP RATHER POORLY. 4 WHICH BRINGS ME TO A DOCUMENT THAT YOU SPOKE ABOUT 5 THIS MORNING. DO YOU HAVE EXHIBIT 207 NEARBY, DOCTOR 6 YOUR E--MAIL TO LEX REDDY DATED MARCH I6, 7 2002. 8 A YES, I DO. 9 IF YOU LOOK AT THE SECOND TO THE LAST PARAGRAPH I0 WHY I PUT THIS UP SO THE JURY CAN SEE IT AS WELL. TW YOU JUST TOLD US THAT DOCTOR REDDY TOLD YOU THAT THE T2 THIRD ITEM ON HIS LIST WAS TO IMPROVE THE MANAGED CARE T3 CONTRACTS. IN THE SECOND TO THE LAST PARAGRAPH, YOU SAID: I4 IS DOING A GREAT JOB WITH 15 MANAGED I6 WHAT WERE YOU REFERRING TO THERE, T7 A THE MANAGED CARE IS A GENERAL TERM SOMETIMES SOME OF T8 US USE FOR THE BUILDING, WHICH IS SEPARATE FROM THE HOSPITAL T9 A COUPLE MILES AWAY, WHICH HOUSES THE MANAGED CARE, THE 20 BILLING OFFICE, AND THE BUSINESS OFFICE. 2W SOMETIME IN 200W HE STARTED GETTING INVOLVED IN THE 22 ORGANIZATION. WHERE HE STARTED. AND THE EFFICIENCY 23 HE WAS BRINGING OVER THERE WAS QUITE WELCOME. SO I WAS VERY 24 HAPPY BY THAT. AND THEN THE IDEAS WE DISCUSSED IN THE MEMOS 25 WITH REGARD TO TRYING TO AVOID OR MINIMIZE UNNECESSARY 26 TESTING AND OTHER POLICIES WE WERE TRYING TO IMPLEMENT. 183 I WANT TO DIRECT YOUR ATTENTION TO THE THIRD TO THE 2 LAST PARAGRAPH. YOU SAID: 3 DO GET CONCERNED OFF AND ON WHEN 4 PREM ACTS UP FRUSTRATING THE 5 WHAT WERE YOU REFERRING TO THERE, DOCTOR 6 A THE MEETINGS WITH THE MANAGERS WERE OFTEN VERY 7 TUMULTUOUS. THERE WAS A LOT OF NAME CALLING AND INSULTS 8 WHEN HE GET WHAT HE WANTED. 9 WHO WAS DOING THE NAME CALLING AND THE IO A DOCTOR REDDY. TI DID THE WORD COME UP AT I2 A YES. HE WOULD REFER TO THE MANAGERS AND SOMETIMES I3 THE PHYSICIANS AS MORONS AND STUPID. I4 HOW ABOUT DID THAT EVER COME I5 A YES. I6 DID HE EVER USE PROFANITY WHEN HE WAS CALLING NAMES T7 TO THE NURSES AND THE I T8 A NOT THAT I HEARD OF. T9 IF I UNDERSTOOD YOU CORRECTLY THIS MORNING, IS IT 2O FAIR TO SAY THAT YOU DISAGREE WITH REASONABLE COST 21 CONTAINMENT MEASURES THAT WOULD NOT COMPROMISE PATIENT 22 A ABSOLUTELY. Z3 AND THAT WAS IN LATE ZOOT AND INTO THE EARLY PART OF 24 25 A CORRECT. 26 AT ANY TIME DID THE CHANGES THAT WERE GOING ON MOVE I84 I OUT OF THAT 2 A LATER IN 2002, HE SEEMED TO GET MORE FRUSTRATED AND 3 MORE AGITATED ABOUT THE LACK OF PROGRESS PERHAPS IN THE 4 FINANCIAL ARENA. SO I HAD A FEELING THAT THAT WOULD BECOME 5 THE ONLY CONCERN AND THE PATIENT CARE WAS BECOMING A 6 QUALITY OF CARE WAS BECOMING OF A SECONDARY NATURE AT THIS 7 POINT. 8 ONE OF THE FRUSTRATING STATEMENTS WHICH I NEVER 9 HEARD HIM SAY BEFORE WAS ARE WHAT I CARE ABOUT. I T0 CARE ABOUT THE I WAS TAKEN BACK BY THAT. IT HE SAID, CARE ABOUT THE I2 A YES. I3 WHAT KIND OF I4 A A STATEMENT HE MADE PROBABLY ABOUT THE I5 QUALITY OF CARE. HE WAS NOT SPECIFIC ABOUT ANYTHING. IT T6 WAS A GENERALIZED STATEMENT. T7 HE SAID, CARE ABOUT THE QUALITY OF CARE. 18 FINANCES IS WHAT I CARE T9 A YES. 20 WE LOOKED AT A LOT OF MEMOS THIS MORNING. MANY OF ZT THEM WERE DRAFTED BY YOU OR AT LEAST THAT YOU SIGNED OFF 22 ON. I NOTICED THAT MOST OF THOSE MEMOS HAD TO DO WITH 23 DESERT VALLEY MEDICAL GROUP. NOT INVOLVED IN THIS 24 CASE. MOST OF THEM DID NOT HAVE TO DO WITH THE HOSPITAL. 25 IS THERE A DIFFERENCE BETWEEN COST CONTAINMENT 26 MEASURES ON THE GROUP SIDE AS OPPOSED TO THE HOSPITAL 185 A SURE THE BOOKS ARE SEPARATE FOR LEGAL AND 2 ACCOUNTING PURPOSES. BUT FOR OUR PURPOSE, IT EUNCTIONED AS 3 A SINGLE ORGANIZATION, AND WE ALWAYS TOUTED THE FACT A 4 SEAMLESS ORGANIZATION. 5 SO THE GROUP AND THE HOSPITAL KIND OF FUNCTIONED AS 6 . 7 A YES. 8 IN YOUR EXPERIENCE WORKING AT DESERT VALLEY 9 HOSPITAL, DID YOU BECOME KNOWLEDGEABLE ABOUT DIFFERENT TYPES TO OF TT A YES. I2 YOU MENTIONED INSURANCE. WHAT IS T3 T4 A EVERY TIME YOU GET CARE, YOU PAY. IF YOU GIVE T5 CARE, YOU RECEIVE PAYMENT. T6 HOW DOES MEDICARE T7 A ALMOST EVERY TIME YOU PROVIDE A SERVICE TO THE T8 PATIENT, A BILL IS GENERATED. AND THE PATIENT MAY HAVE A T9 COMPONENT TO PAY. OTHERWISE THE REMAINDER IS REIMBURSED BY 20 THE GOVERNMENT. 27 IS MEDICARE MORE LIKE FEE--FOR--SERVICE OR MORE LIKE 22 23 A THAT IS TYPICAL FEE--FOR--SERVICE. 24 I HEARD YOU TALK TODAY ABOUT HMO INSURANCE. WITHOUT 25 GOING INTO GREAT DETAIL, CAN YOU JUST QUICKLY TELL US HOW 26 HMO INSURANCE DIFFERS FROM OR MEDICARE. 786 I A IN THE HMO INSURANCE, THE GROUP IS PREPAID FOR EACH 2 MEMBER OF THE GROUP. IE YOU HAVE MEMBERS, THEN THE HMO 3 PLAN, SUCH AS AETNA OR BLUE CROSS, WOULD GIVE A CERTAIN 4 AMOUNT OF MONEY EVERY MONTH TO MANAGE THEIR HEALTH ISSUES. 5 SOMETIMES IT WOULD INCLUDE HOSPITAL. 6 CALLED 7 A YES. AND SOMETIMES IT WAS NOT INCLUDED. IT WOULD 8 BE CALLED PARTIAL-RISK. 9 WITH AN HMO ASSUME A FULL-RISK IS A IO THE GROUP AND HOSPITAL RESPONSIBLE TO TAKE CARE OF THAT . 11 PATIENT COME WHAT I2 A YES. - I3 UNINSURED PATIENTS HAVE ANY INSURANCE AT T4 A ALSO CALLED SELF--PAY. THEY HAVE A W5 THIRD PARTY WHICH PAYS FOR THEM. T6 DOES INSURANCE, AS A GENERAL RULE, T7 PROVIDE BETTER REIMBURSEMENT TO DESERT VALLEY MEDICAL GROUP 18 AND HOSPITAL THAN HMO T9 A CORRECT. 20 AND CERTAINLY WOULD PROVIDE BETTER 2W REIMBURSEMENT THAN UNINSURED 22 A YES. 23 MR. NOLAN: I THINK THE HEARD ENOUGH ABOUT 24 CAPITATED RATE. LATE IN THE SO I TALK ABOUT 25 THAT NOW. 26 THE COURT: IN FACT, IT IS SO LATE IN THE DAY 187 I TAKE OUR AFTERNOON BREAK AT THIS TIME. 2 MR. NOLAN: PERFECT. 3 THE COURT: MEMBERS OF JURY, SEE YOU TOMORROW 4 AT 9:45. PLEASE DISCUSS THE CASE AMONG YOURSELVES OR 5 WITH ANYONE ELSE UNTIL THE CASE IS SUBMITTED TO YOU FOR YOUR 6 CONSIDERATION. THANK YOU VERY MUCH. SEE YOU TOMORROW AT 7 9:45. 8 (WHEREUPON, THE FOREGOING PROCEEDINGS WERE 9 HEREBY CONTINUED TO TUESDAY, AUGUST 30, 2005, TO FOR FURTHER PROCEEDINGS HEREIN188 1 VICTORVILLE, CALIFORNIA TUESDAY, AUGUST 30, 2005 2 DEPARTMENT HON. STANFORD E. REICHERT, JUDGE 3 APPEARANCES: 4 A.M. SESSION 5 DESERT VALLEY HOSPITAL WAS REPRESENTED 6 BY ITS COUNSEL, DEBORAH S. TROPP AND 7 MICHAEL J. SARRAO, ATTORNEYS AT 8 TINA BUCHANAN AND LISA CROUCH WERE 9 REPRESENTED BY THEIR COUNSEL, T0 VINCENT P. NOLAN, ATTORNEY AT LAW. TT (FRED BERZAK, C.S.R., OFFICIAL REPORTER, NO. 5875) 12 T3 THE COURT: ON THE RECORD IN THE DESERT VALLEY T4 HOSPITAL MATTER. ALL THE JURORS, COUNSEL, AND THE PARTIES T5 ARE PRESENT. T6 MR. NOLAN. T7 MR. NOLAN: THANK YOU, YOUR HONOR. A T8 BY MR. NOLAN: T9 GOOD MORNING, DOCTOR JEYAKUMAR. 20 A GOOD MORNING. 21 WHEN WE LEFT OFF YESTERDAY, I WAS ASKING YOU ABOUT 22 DIFFERENT INSURANCES, AND I WANTED TO TOUCH VERY QUICKLY ON 23 ONE POINT. 24 IF AN HMO PATIENT FROM ANOTHER GROUP, KAISER, BLUE 25 CROSS, SAINT CHOICE, SHOWS UP AT DESERT VALLEY 26 HOSPITAL, IS DESERT VALLEY HOSPITAL COMPENSATED UNDER THE I89 . HMO REGIME, OR IS DESERT VALLEY HOSPITAL COMPENSATED AS A 2 FEE--EOR--SERVICE 3 A FEE--FOR--SERVICE. I 4 IS THAT CALLED AN 5 A CORRECT. 6 DOCTOR JEYAKUMAR, YESTERDAY YOU TESTIEIED THAT IN 7 LATE 2002 THERE WERE SOME CHANGES AT DESERT VALLEY HOSPITAL 8 THAT YOU BECAME AWARE OF. DO YOU RECALL THAT 9 A YES. T0 WHEN DID THOSE CHANGES . IT A PROBABLY IN THE LATTER PART OF 2002 AROUND T2 SEPTEMBER, OCTOBER OF 2002. I3 WHAT WERE THESE CHANGES THAT YOU BECAME AWARE OF AT W4 THAT T5 A MAINLY WITH REGARD TO THE UTILIZATION PROCESS AND T6 THE PHILOSOPHY. THE GROUP WAS CHANGING. THAT WAS DOCTOR T7 MAIN AND ONLY FOCUSES. EVERYTHING ELSE BECAME OF T8 SECONDARY IMPORTANCE. T9 YOU MENTIONED YESTERDAY THAT YOU HEARD FROM OTHERS 20 ABOUT DOCTOR REDDY SMELLING OF ALCOHOL AND THAT YOU SPOKE TO 2I HIM ABOUT THAT SUBJECT. DO YOU RECALL A 22 A YES. 23 HOW MANY TIMES DID YOU AND DOCTOR REDDY SPEAK ABOUT 24 HIS DRINKING AT DESERT VALLEY 25 A SEVERAL TIMES I TALKED TO HIM PRIVATELY, AND I ALSO 26 TALKED TO MR. LEX REDDY. 4 190 I WHEN YOU SPOKE TO DOCTOR REDDY ABOUT HIS DRINKING, 2 DID HE DENY 3 A NO, HE DID NOT. 4 WERE YOU EVER TOLD BY MISS CROUCH THAT SHE WAS ASKED 5 TO COME TO THE EMERGENCY ROOM TO GET DOCTOR REDDY OUT 6 BECAUSE OF HIS 7 A THERE WAS ONE INSTANCE WHERE SHE NOTIFIED ME THAT 8 MR. LEX REDDY ASKED HER TO INTERVENE WHEN DOCTOR REDDY WENT 9 DOWN TO THE EMERGENCY ROOM WITH ALCOHOL. I0 DID YOU SPEAK TO LEX REDDY ABOUT PREM IT DRINKING AT THE T2 A YES, SEVERAL TIMES. T3 WHAT DID MR. LEX REDDY SAY ON THAT A T4 A HE COULD NOT DO ANYTHING ABOUT IT. HE SAID, T5 DOCTOR AND HE SUGGESTED THAT I TALK TO HIM. T6 DID LEX REDDY DO ANYTHING TO TRY TO STOP PREM T7 T8 A NOT THAT I KNOW OF. W9 YOU TOLD US YESTERDAY THAT AS MEDICAL DIRECTOR YOU 20 WERE RESPONSIBLE FOR HEARING COMPLAINTS FROM PHYSICIANS IF ZT THEY HAD DO YOU RECALL 22 A CORRECT. 23 IN LATE 2002 AND EARLY 2003, DID YOU RECEIVE ANY - 24 COMPLAINTS FROM PHYSICIANS PERTAINING TO DOCTOR 25 A CAN YOU BE MORE SPECIFIC. 26 I WAS GOING TO ASK YOU TO TELL ME WHAT THEY WERE IF T9I I THERE WERE ANY. 2 A THERE WERE SOME. 3 CAN YOU TELL US THE NAMES OF THE PHYSICIANS WHO 4 COMPLAINED TO YOU. 5 A I GOT REGULAR COMPLAINTS FROM SEVERAL PHYSICIANS IN 6 THE GROUP, SAY, DOCTOR NESTER, DOCTOR SIA, DOCTOR 7 SUBERWAHL. THERE WERE OTHERS TOO. BASICALLY THEIR 4 8 COMPLAINT WAS ABOUT THEY ABLE TO OBTAIN 9 AUTHORIZATION FOR REFERRALS AND FOR PROCEDURES. THAT WAS TO ONE. II THE SECOND AREA OF COMPLAINT THESE ARE VERBAL I2 WAS IN THE EMERGENCY ROOM ABOUT WRITING ON I3 CHARTS. I4 DOCTOR BOLIVAR MENTIONED TO ME ONCE ABOUT WRITING ON I5 HIS CHARTS. I6 ABOUT DOCTOR REDDY WRITING ON PATIENT CHARTS IN THE T7 T8 A CORRECT. T9 DOCTOR BOLIVAR WAS WHAT WAS HIS JOB 20 A HE WAS THE MEDICAL DIRECTOR OF THE EMERGENCY ROOM. 2I YOU SAID THAT DOCTOR SUBERWAHL, DOCTOR SIA, AND 22 DOCTOR NESTER COMPLAINED ABOUT DIFFICULTY GETTING Z3 AUTHORIZATION FOR 24 A AND REFERRALS. 25 WERE THEY COMPLAINING ABOUT DIFFICULTY GETTING THOSE 26 THINGS FROM DOCTOR 792 I A YES. 2 DID DOCTOR SURDYKA EVER COMPLAIN TO 3 A YES. DOCTOR SURDYKA COMPLAINED ABOUT THE INABILITY 4 TO GET AUTHORIZATION FOR ORTHOPEDIC SURGERIES. 5 DID ANY CARDIOLOGIST EVER COMPLAIN TO YOU IN LATE 6 2002 AND EARLY 2003 ABOUT DOCTOR 7 A YES. BOTH DOCTOR AHMED AND DOCTOR RAZA COMPLAINED 8 ABOUT DOCTOR INTERFERENCE WITH THEIR DECISIONS OE 9 DOING PACEMAKERS AND ANGIOGRAMS. I0 WAS THERE ANY DISCUSSION ABOUT TT A THEY COMPLAINED ABOUT BEING CALLED FOR CONSULTATIONS T2 WHICH WERE NOT APPROPRIATE FOR FEE--EOR--SERVICE PATIENTS, T3 WHICH THEY BELIEVED DID NOT REQUIRE CONSULTATIONS BUT SEEMED T4 TO BE FINANCIALLY MOTIVATED. T5 YOU HAVE KNOWN DOCTOR REDDY FOR A LONG TIME, HAVE T6 YOU T7 A YES. T8 DO YOU KNOW HIS MEDICAL TRAINING INTERNIST AND THEN BECAME A CARDIOLOGIST. 20 DID DOCTOR REDDY HAVE ANY TRAINING IN EMERGENCY ROOM 21 22 A NO. 23 DO PHYSICIANS WHO WORK IN EMERGENCY ROOM MEDICINE 24 HAVE SPECIALIZED 25 A YES. 26 AS MEDICAL DIRECTOR, DID YOU BELIEVE IT WAS T93 I APPROPRIATE FOR DOCTOR REDDY TO BE WRITING ON PATIENT CHARTS 2 AND SEEING PATIENTS IN THE 3 A THE ONLY WAY I WOULD JUSTIFY IT IS IF HE HAD BEEN 4 ASKED TO CONSULT IN HIS SPECIALTY. 5 IF DOCTOR REDDY WAS JUST WALKING INTO THE ER AND 6 MAKING NOTES ON PATIENT CHARTS AND GOING OVER AND CONSULTING 4 7 WITH PATIENTS ON HIS OWN, THAT WOULD NOT BE 8 A NOT APPROPRIATE. 9 IN YOUR ROLE AS MEDICAL DIRECTOR, WHEN YOU WERE TOLD IO BY DOCTORS AHMED AND RAZA THAT THEY WERE BEING ASKED TO DO Ti WHAT THEY BELIEVED TO BE UNNECESSARY CONSULTATIONS, DID YOU I2 KNOW ONE WAY OR THE OTHER WHETHER DOCTOR REDDY HAD BEEN T3 ASKED BY ANY OTHER PHYSICIAN TO DO THESE I4 A NOT IN THOSE SPECIFIC ONES THAT THOSE DOCTORS T5 COMPLAINED TO ME ABOUT. T6 AS FAR AS YOU KNEW, THERE HAD BEEN NO SUCH REQUEST T7 FOR DOCTOR REDDY TO DO T8 MS. TROPP: OBJECTION, LEADING. T9 THE WITNESS: NO. 2O THE COURT: OVERRULED. 4 ZT BY MR. NOLAN: 22 IN THE TIME THAT YOU WORKED AS MEDICAL DIRECTOR AT 23 DESERT VALLEY HOSPITAL, WERE YOU AWARE OF ANY OTHER 24 PHYSICIANS AT THE HOSPITAL WHO WOULD WANDER INTO THE ER AND 25 START MAKING NOTES ON CHARTS OTHER THAN DOCTOR 26 A NO. W94 I WERE YOU AWARE OF ANY OTHER PHYSICIAN AT DESERT 2 VALLEY HOSPITAL WHO WOULD GO TO THE ER AND REORGANIZE THE 3 TRIAGE 4 A NO. 5 WERE YOU AWARE OF ANY OTHER PHYSICIAN AT DESERT 6 VALLEY HOSPITAL WHO WOULD GO INTO THE ER AND BEGIN HAVING 7 DISCUSSIONS WITH EMERGENCY ROOM 8 A NOT UNLESS WE HAD BEEN ASKED TO CONSULT, SEE, OR 9 ADMIT PATIENTS BY THE EMERGENCY ROOM PHYSICIANS, BUT NOT ON TO OUR OWN. WT IN ADDITION TO COMPLAINTS YOU RECEIVED FROM T2 PHYSICIANS, DID YOU RECEIVE, IN LATE 2002 OR EARLY 2003, ANY T3 COMPLAINTS OR CONCERNS EXPRESSED TO YOU BY THE NURSING STAFF T4 AT DESERT VALLEY HOSPITAL ABOUT DOCTOR . T5 A WITH REGARD TO THE EMERGENCY ROOM NURSES, A COUPLE T6 OF THEM COMPLAINED TO ME REGARDING HIM COMING IN WITH T7 ALCOHOL ON HIS BREATH, WRITING ON CHARTS, BEING LOUD AND T8 INAPPROPRIATE IN THE EMERGENCY ROOM. THERE WAS ONE INSTANCE T9 OF HIM BEING LOUD AND INAPPROPRIATE AND ARGUING WITH THE 20 PATIENT OR YELLING AT THE PATIENT OR FAMILY. THERE WAS ONE 2T INSTANCE REPORTED. 22 WHAT DID YOU HEAR ABOUT THAT INSTANCE WHERE DOCTOR 23 REDDY WAS PURPORTEDLY YELLING AT THE PATIENT AND THE 24 25 A THERE WAS A PATIENT WHO USED TO GET ADMITTED FAIRLY 26 FREQUENTLY BECAUSE HE WAS AN ILL MAN. HE WAS IN THE 195 EMERGENCY ROOM, AND DOCTOR REDDY HAD CONERONTED THE FAMILY -- 2 MEMBER AND HAD A HEATED EXCHANGE. . 3 WHO TOLD YOU ABOUT 4 A IT WAS REPORTED TO ME BY MISS LISA CROUCH AS 5 REPORTED TO HER BY A NURSE THERE. 6 DID MISS CROUCH TELL YOU THAT THIS WAS TOLD TO HER 7 BY SHERI 8 A I REMEMBER WHO EXACTLY TOLD HER. 9 YOU TALKED YESTERDAY ABOUT THE ISSUE OF TRIAGE. SO WO THAT CLEAR, DID YOU RECEIVE COMPLAINTS ABOUT DOCTOR TT REDDY INVOLVING HIMSELE IN TRIAGE ISSUES IN THE EMERGENCY T2 T3 A THAT WAS ONE OF THE COMPLAINTS WHICH LED TO THE A T4 MEETING ON FEBRUARY TWELFTH. T5 I THINK YOU SAID YESTERDAY THAT SATURATION WAS T6 ANOTHER OF THOSE T7 A CORRECT. T8 DO YOU KNOW THERESA T9 A YES. SHE WAS DIRECTOR OE THE RESPIRATORY SERVICES 20 AND CARDIO DIAGNOSTICS. 21 I THINK YOU TOLD US YESTERDAY A PERSONAL 22 FRIEND OF 23 A SHE BECAME A PERSONAL FRIEND WITH TIME. 24 YOU TOLD US YESTERDAY THAT YOU WENT ON A VACATION 25 AND A MEMO WAS SHOWN WHERE YOU SAID TO THE PHYSICIANS, LOOK, 26 NOT BE HERE. IF YOU NEED A CONSULTATION, SPEAK TO T96 DOCTOR REDDY. DO YOU RECALL THAT 2 A CORRECT. 3 AND YOU SAID THAT YOU INTEND FOR DOCTOR REDDY 4 TO DO THE CONSULTATIONS, MERELY TO MAKE THE REFERRAL TO THE 5 APPROPRIATE IS THAT 6 A CORRECT. 7 THE AGREEMENT WAS WHEN I GO ON VACATION AND NOT 8 AVAILABLE DURING THE WEEKENDS, A LOCAL PULMONARY PHYSICIAN 9 WAS COVERING THE EMERGENCIES AND MY PRACTICE. AND HE WAS TO BEING PAID FOR THESE SERVICES. AT SOME POINT DOCTOR REDDY TT DECIDED HAVE TO PAY ANYBODY. JUST ASK HIM TO T2 CONTACT ME AND MAKE THE NECESSARY ARRANGEMENTS AS T3 T4 WAS YOUR VACATION IN OCTOBER OR NOVEMBER OE T5 A MY LONGEST VACATION WAS IN DECEMBER OF 2002. T6 WHILE YOU WERE GONE, DID YOU LEARN LATER THAT DOCTOR T7 REDDY HAD BEEN ACTUALLY DOING CONSULTATIONS ON SOME OE YOUR T8 T9 A I WAS TOLD THAT. 20 THESE WOULD BE PULMONARY 2T A WHAT I WAS TOLD. 22 YOU TOLD US YESTERDAY THAT BOARD CERTIFIED IN 4 23 PULMONARY 24 A YES. 25 DOES DOCTOR REDDY HAVE ANY TRAINING IN PULMONARY 26 I97 I A NO. 2 YOU TESTIFIED YESTERDAY MORNING ABOUT LUIS LEON, A 3 4 A CORRECT. 5 WHAT IS A IS THAT DIFFERENT 6 THAN A 7 A YES. THEY GO TO A SEPARATE SCHOOL. THEIR TRAINING 8 IS TWO YEARS. WHEN THEY GRADUATE, ALLOWED TO SEE 9 PATIENTS UNDER THEY HAVE AN INDEPENDENT LICENSE TO I0 PRACTICE, BUT THEY PRACTICE UNDER THE SUPERVISION OR THE TT LICENSURE OF A PHYSICIAN IN CERTAIN AREAS. 12 KIND OF LIKE A PARALEGAL IN THE LEGAL T3 A NOT CERTAIN WHAT A PARALEGAL DOES. I4 YOU TOLD US YESTERDAY THAT LUIS LEON TOLD YOU THAT I5 DOCTOR REDDY HAD BEEN IN THE EMERGENCY ROOM SMELLING OF I6 T7 A ONCE. T8 IS LUIS LEON A FRIEND PERSONAL 2T A A PERSONAL FRIEND AND A FAMILY FRIEND. 22 DO YOU KNOW A WOMAN BY THE NAME OF PATTY 23 A SHE WAS ONE OF THE SECRETARIES IN ADMINISTRATION. 24 IN LATE 2002 OR EARLY 2003, DID YOU RECEIVE A 25 TELEPHONE CALL FROM PATTY HERNANDEZ ABOUT DOCTOR 26 A YES. 798 I CAN YOU GIVE US YOUR BEST RECOLLECTION AS TO WHEN 2 THAT TELEPHONE CALL WAS MADE TO YOU. 3 A IT WAS IN THE EVENING. 4 MS. TROPP: YOUR HONOR, OBJECT ON HEARSAY. 5 MR. NOLAN: YOUR HONOR, BEEN ALL KINDS OF 6 QUESTIONS 7 THE COURT: OVERRULED. - 8 THE WITNESS: I RECEIVED A CALL LATE ONE EVENING 9 FROM HER NOT EXACTLY SURE WHERE I WAS AT THE TIME. I IO COULD HAVE BEEN IN A MEETING OR ON SOME RETREAT SOMEWHERE TT THAT DOCTOR REDDY WAS UNDER THE INFLUENCE OF ALCOHOL IN THE I2 ADMINISTRATION IN THE AREA WHERE SHE WAS WORKING. SHE WAS T3 UNCOMFORTABLE. I ASKED HER TO GO HOME, AND THEN I PLACED A I4 CALL TO DOCTOR REDDY. I5 BY MR. NOLAN: I6 WHAT DID YOU SAY TO DOCTOR REDDY WHEN YOU PLACED THE T7 CALL TO T8 A WHEN I CALLED HIM, I ASKED HIM HOW DOING. HE W9 SAID, YOU ARE CALLING TO CHECK UP ON ME IF I HAVE BEEN 20 DRINKING, YES, I HAVE BEEN ZW I SAID, NEED TO GO HOME. DO YOU NEED SOMEBODY 22 TO DRIVE 23 AND HE SAID, I WILL TAKE CARE OF 24 DO YOU KNOW A WOMAN BY THE NAME OE TINA 25 A SHE WAS THE TELEPHONE KEYBOARD OPERATOR. 26 DID YOU RECEIVE A TELEPHONE CALL FROM MISS HOWARD IN T99 I LATE 2002 OR EARLY 2003 ABOUT DOCTOR 2 A ONE CALL. 3 WHAT DID SHE SAY TO 4 A BASICALLY THAT DOCTOR REDDY WAS UNDER THE INFLUENCE 5 AND HE WAS SAYING THINGS ABOUT EVENTS WHICH HAD HAPPENED IN 6 THE PAST YEARS WITH A PREVIOUS PHYSICIAN. I TALKED TO HER 7 ABOUT IT THE NEXT DAY, AND SHE SAID THAT THE EVENT WAS OVER 8 AND SHE JUST WANTED TO GET PAST IT AND MOVE ON. 9 WHEN SHE CALLED YOU, DID SHE TELL YOU WHERE SHE I0 A SHE WAS IN THE HOSPITAL LOBBY. THE PLACE T1 WHERE SHE WORKS. T2 DID SHE TELL YOU THAT DOCTOR REDDY WAS ALSO IN THE T3 T4 A SHE SPECIFICALLY MENTION THE LOCATION WHERE I5 HE WAS, BUT HE WAS ON THE PREMISES. WHETHER HE WAS ON THE . T6 HOSPITAL SIDE OR GROUP SIDE, I DO NOT KNOW. T7 DO YOU KNOW WHAT KIND OF CLOTHING DOCTOR REDDY WEARS T8 WHEN HE MAKES . T9 A BLUE SCRUBS, WHITE COAT, AND A STETHOSCOPE. 20 DOES HE EVER MAKE ROUNDS IN A BUSINESS SUIT AS YOU ZT ARE WEARING 22 A I HAVE ALMOST NEVER SEEN HIM WHERE A SUIT AND DO 23 ROUNDS. MAYBE ON A RARE OCCASION. 24 YOU TESTIFIED YESTERDAY THAT YOU KNOW A WOMAN BY THE 25 NAME OF 26 A YES. ZOO I DID YOU CONSIDER HER A 2 A NO, NOT A CLOSE FRIEND. A COWORKERVERY WELL. 5 WERE YOU INVOLVED IN HELPING HER SECURE THE POSITION 6 OF MANAGER OR DIRECTOR OF MANAGED CARE AT DESERT VALLEY 7 8 A YES. WHEN THE PREVIOUS MANAGED CARE DIRECTOR 9 BARBARA CAUDELL LEFT, I WANTED HER TO BECOME THE DIRECTOR OF TO THE MANAGED CARE. I LIKED TO WORK WITH HER. ALTHOUGH THE TT ADMINISTRATION, WHICH INCLUDED THE SENIOR ADMINISTRATION 72 WITH MR. LEX REDDY, WAS SOMEWHAT RELUCTANT TO PROMOTE HER TO T3 THAT POSITION, I WAS INSISTENT THAT SHE WAS THE RIGHT T4 CANDIDATE AND SHE DESERVED TO BE THERE. T5 DID DOCTOR PREM REDDY EXPRESS HIS VIEWS ON HER T6 PROMOTION TO T7 A THEIR MAIN CONCERN ABOUT HER WAS SHE COULD BE ROUGH T8 SOMETIMES WITH PEOPLE IN DEALINGS. THEIR MAIN CONCERN WAS, T9 ESPECIALLY IN DEALING WITH HEALTH PLANS AND OTHER AREAS, SHE 20 MIGHT COME OUT ROUGH AROUND THE EDGES. AND IN DEALING WITH ZT OTHER STAFF MEMBERS, SHE MAY NOT BE TOO CORDIAL. BUT I 22 ASSURED THEM SHE WOULD WORK, SHE WOULD CHANGE. 23 AFTER MISS BECAME THE DIRECTOR OF MANAGED 24 CARE, DID YOU HAVE RESPONSIBILITIES FOR MAKING ROUNDS WITH 25 26 A YES. 207 HOW FREQUENTLY DID YOU DO 2 A ALMOST ON A DAILY BASIS. WHEN I SAY THESE 3 ARE MEETING WITH HER DAILY WITH REGARD TO MANAGED CARE 4 REFERRALS. 5 WHEN YOU WOULD MEET WITH HER ON A DAILY BASIS ABOUT 6 MANAGED CARE REFERRALS, WHAT WOULD THE TWO OF YOU WHAT 7 WOULD YOU TALK 8 A WE WOULD TALK ABOUT UTILIZATION REVIEW. VERY 9 STRAIGHTFORWARD, LOGICAL PROCESS. BASICALLY, A TO REFERRAL THAT COMES FROM THE OFFICE TO MANAGED WT CARE REQUESTING A CONSULT OR A PROCEDURE OR A PATIENT T2 REQUEST. NUMBER I, THEY CHECK WHO THE PATIENT BELONGS TO. T3 A STANDARD CHECK. CONFIRMATION IS BROUGHT TO ME FOR T4 REVIEW. BOTH OF US REVIEW AND SAY, OKAY, THIS PATIENT WANTS T5 THIS OR THE DOCTOR WANTS THIS FOR THIS PATIENT. IS IT I6 MEDICALLY AND IF DETERMINED THAT T7 MEDICAL NECESSARY, THE NEXT QUESTION WE ASK IS: WHERE CAN T8 WE GIVE THIS CAN WE GIVE THIS SERVICE IN OUR T9 IF THE ANSWER IS YES, THEN WE AGREE TO DIRECT 20 THEM THERE. AND MANY TIMES MISS HERSELF HAD THE ZW AUTHORITY TO DO THAT. 22 IF THE SERVICE CANNOT BE PROVIDED IN THE 23 ORGANIZATION, THEN MY DECISION, ALONG WITH MISS 24 WAS: WHERE CAN WE SEND HAVE A CONSULT AND 25 THEN MAKE ARRANGEMENTS FOR IT. 26 IF SOMETHING TOTALLY OUT OF THE NORM LIKE A 202 I TRANSPLANT REQUEST OR SOME COMPLEX NEUROSURGICAL PROBLEM, 2 THEN WE GO BACK AND REFER IT TO THE HEALTH PLANS TO HELP US 3 SEEK A PLACE UNDER THEIR CONTRACT TO SEND THE PATIENT. 4 A VERY SIMPLE, LOGICAL PROCESS. 5 WHEN DID YOU AND MISS BEGIN PERFORMING 6 THIS FUNCTION 7 A I HAD BEEN DOING IT SINCE MY ARRIVAL IN MAY OF 20OI 8 WITH THE FORMER MANAGED CARE DIRECTOR BARBARA CAUDELL. WHEN 9 SHE LEFT AND MISS TOOK OVER, WE CONTINUED T0 TO DO IT. IT WAS PROBABLY SOMETIME THE END OF 200W. TI AND AS THE YEAR WENT BY IN 2002, THAT JOB WAS T2 ELIMINATED FROM MY DAILY SCHEDULE. W3 WHEN YOU AND MISS WERE DOING THIS MANAGED T4 CARE FUNCTION THAT YOU HAVE JUST DESCRIBED, WERE THERE I T5 DENIALS OF T6 A THERE WERE SOME DENIALS OF CARE WHICH I MADE BASED T7 ON MEDICAL NECESSITY. WHAT WE DO WHEN WE MAKE A DENIAL 18 GIVE YOU AN EXAMPLE WHERE I DENIED. T9 OFTEN WE WOULD GET REFERRALS FROM PATIENTS OR 20 MEMBERS FOR GASTRIC BYPASS SURGERY. FOR WEIGHT LOSS 2W SURGERY. THERE WERE CERTAINLY INDICATIONS FOR THIS 22 SURGERY. IT USED TO BE A VERY COMPLEX SURGERY IN THE PAST. 23 TODAY THEY DO IT RATHER EASILY WITH LAPAROSCOPY. IT USED TO 24 BE AN OPEN SURGERY. THERE WERE REASONS TO DO THIS SURGERY. 25 IT WAS NEVER MEANT TO BE A SURGERY TO LOOK BEAUTIFUL OR LOOK 26 THIN. THE PURPOSE OF THE GASTRIC BYPASS SURGERY IS IF YOU 203 HAVE ANY ASSOCIATED MEDICAL CONDITIONS, SOME OF THEM CAN BE 2 CORRECTED WITH TIME LIKE DIABETES, HIGH BLOOD PRESSURE, 3 SLEEP APNEA. THEY DO RESPOND VERY WELL TO GASTRIC BYPASS 4 SURGERIES. 5 OFTEN WE WOULD GET WITHOUT THOSE PROBLEMS, 6 SIMPLY SAYING WANT IT BECAUSE UNCOMFORTABLE TO BE 7 LARGE. I GET BACK SOMETHING NOT DIRECTLY 8 ATTRIBUTABLE TO AN OVERWEIGHT PROBLEM. . 9 I PERSONALLY HAD MAJOR CONCERNS ABOUT THE SURGERY WO AND THE SURGEON IN THE INLAND EMPIRE AT THE TIME WHO WAS TT DOING THIS. AND IN DIRE STRAITS WITH THE MEDICAL W2 LICENSING BOARD AT THIS TIME FOR THIS. I W3 MS. TROPP: YOUR HONOR, MOVE TO STRIKE. T4 THE COURT: STRICKEN. THE EVIDENCE ABOUT THE OTHER T5 DOCTOR IS STRICKEN, AND THE TO DISREGARD IT. T6 THE WITNESS: I HAVE DECLINED THOSE. WHAT WE DO IS T7 ALL DENIALS ARE BROUGHT TO A UTILIZATION REVIEW T8 MEETING. THE FINAL SAY DOES NOT REMAIN WITH ME. A T9 REVIEW. I EXPLAIN TO THE OTHER PHYSICIANS WHY THIS HAD BEEN A 20 TURNED DOWN, AND THEY CAN AGREE OR THEY CAN CONVINCE ME OR 2} ARGUE IF THEY BELIEVE THAT THE DECISION WAS INCORRECT. THEN 22 SENT BACK TO THE HEALTH PLANS, AND THE HEALTH PLANS CAN 23 FURTHER OVERRULE THE DECISION. 24 BY MR. NOLAN: 25 YOU TALKED ABOUT SOME PROCEDURES THAT MAYBE CAN BE 26 DONE AT DESERT VALLEY HOSPITAL BUT MAYBE HAVE TO BE DONE 204 I IS THAT 2 A SOME PROCEDURES CANNOT BE DONE AT DESERT VALLEY 3 HOSPITAL. 4 CERTAIN HEART PROCEDURES IN 2002 AND EARLY 2003 5 COULD NOT BE DONE AT DESERT VALLEY 6 A CORONARY ANGIOGRAMS COULD NOT BE DONE AT DESERT 7 VALLEY HOSPITAL. 8 THAT IS BECAUSE THEY DID NOT HAVE CALLED A 9 CATH T0 A CORRECT. TT IF A CARDIOLOGIST WAS SEEKING A CORONARY ANGIOGRAM T2 FOR ONE OE THEIR HEART PATIENTS, WOULD THAT PATIENT HAVE TO T3 BE TRANSFERRED OUT OE DESERT VALLEY HOSPITAL TO HAVE THE T4 PROCEDURE T5 A IF THEY WERE ADMITTED PATIENTS, THEY NEEDED TO BE I6 TRANSFERRED. IE WE ENCOUNTERED THEM IN THE OFFICE, THEN T7 THEY CAN DIRECTLY GO TO ANOTHER FACILITY AND GET IT DONE. T8 YOU SAID THAT YOU WERE DOING UTILIZATION REVIEW AND T9 MANAGED CARE REVIEW FROM THE TIME YOU CAME BACK IN MAY OF 20 21 A CORRECT. 22 AT SOME POINT IN TIME, YOU WERE RELIEVED OF THAT 23 24 A SOMETIME IN 2002. 25 WHEN IN 2002? 26 A MID 2002. 205 I HOW WERE YOU RELIEVED OF 2 A HE SAID HE WAS GOING TO DO THAT IN THE FUTURE. 3 4 A DOCTOR REDDY. 5 DOCTOR REDDY ASSUMED RESPONSIBILITY FOR UTILIZATION 6 REVIEW FROM THERE ON 7 A YES. 8 WHEN DOCTOR REDDY BEGAN DOING UTILIZATION REVIEW, 9 WAS HE DOING IT FOR DESERT VALLEY HOSPITAL IO A HE WAS DOING UTILIZATION REVIEW FOR DESERT VALLEY I1 MEDICAL GROUP PATIENTS. I2 WERE ANY OF THEM HOSPITALIZED AT DESERT VALLEY T3 HOSPITAL WHEN HE DID UTILIZATION T4 A PERIODICALLY SOME OF THE PATIENTS DO GET T5 HOSPITALIZED. I6 YOU TALKED ABOUT A UTILIZATION REVIEW COMMITTEE. T7 DID DOCTOR REDDY SERVE ON SUCH A TELL US HOW HE T8 DID HIS UTILIZATION REVIEW WHEN YOU WERE RELIEVED. T9 A ONCE HE TOOK OVER THE UTILIZATION REVIEW, I 20 KNOW WHAT HAPPENED BEYOND HIS REVIEW. I ZT WERE YOU TOLD BY ANY PHYSICIANS THAT THEY WERE 22 INVOLVED IN UTILIZATION REVIEW WITH DOCTOR A 23 A NO. WE DID CONTINUE TO HAVE THE MEETINGS OF 24 UTILIZATION REVIEW, BUT HE NEVER PRESENTED ANY CASES FOR OUR 25 REVIEW OVER THERE. 26 DOCTOR REDDY DID NOT PRESENT ANY 206 A NO. 2 HE SIMPLY MADE THE 3 A IT LOOKED LIKE IT. 4 ARE YOU AWARE THAT A PHYSICIAN WITH AN OWNERSHIP 5 INTEREST IN A HOSPITAL IS PROHIBITED BY LAW FROM MAKING 6 UTILIZATION REVIEW I 7 A NOT CERTAIN ABOUT THE LAW, BUT CERTAINLY A 8 CONFLICT. 9 YOU THINK IT IS A CONFLICT OF TO A CORRECT. I TT T2 A BECAUSE IF YOU ARE A HOSPITAL OWNER AND YOU ARE T3 DOING UTILIZATION, IT INVOLVES YOUR MONEY BEING SPENT. I4 NOT HARD TO FATHOM THAT. T5 WHEN I WAS DOING THE UTILIZATION REVIEW, I COULD T6 MAKE THE DECISION INDEPENDENTLY OF THE EVENTUAL PERSONAL T7 SO THAT MAKES IT MORE OBJECTIVE IN MY REVIEWS. T8 DID YOU EVER HAVE A DISCUSSION WITH DOCTOR REDDY T9 ABOUT HIS UTILIZATION REVIEW DECISIONS AT DESERT VALLEY 2O ZT A THERE WERE A COUPLE OF INSTANCES OF PATIENTS WHERE 22 THE DOCTORS HAD COME TO ME BECAUSE DOCTOR REDDY WOULD NOT 23 AUTHORIZE CERTAIN REFERRALS, AND I RAISED THOSE CONCERNS I 24 WITH HIM. 25 DID DOCTOR REDDY SAY ANYTHING TO YOU ABOUT THE 26 SUBJECT OF CONFLICT OF 207 I A INITIALLY HE SEEMED TO BE A LITTLE CONCERNED ABOUT 2 IT, AND HE SAID HE WILL DO THE UTILIZATION REVIEW, BUT HE 3 WAS SENDING THE DENIAL LETTERS BACK UNDER MY NAME BECAUSE HE 4 SAID IT DID NOT LOOK RIGHT TO SEND THE LETTERS UNDER HIS 5 NAME BEING AN OWNER. 6 HE TOLD YOU HE WAS USING YOUR NAME BECAUSE IT 7 APPROPRIATE FOR HIM WOULD STILL CONTINUE TO USE MY NAME AS THE 9 MEDICAL DIRECTOR. TO DID HE TELL YOU WHY HE WAS GOING TO USE YOUR NAME AS 11 OPPOSED TO USING HIS 4 T2 A HE BELIEVED THERE WAS A CONFLICT. I3 HE SAID T4 A YES. T5 AFTER DOCTOR REDDY BEGAN DOING UTILIZATION REVIEW, T6 WAS THERE A CHANGE IN THE NUMBER OF WERE THERE T7 MORE OR LESS DENIALS OF TB A I KNOW THE EXACT NUMBER BECAUSE I WAS NOT T9 PRIVY TO THE EXACT NUMBERS. 20 MS. TROPP: OBJECTION, YOUR HONOR. LACK OF 21 FOUNDATION. 22 THE COURT: SO FAR HE HAS NOT ANSWERED THE 23 QUESTION. OVERRULED AT THIS TIME. 24 THE WITNESS: MISS THE MANAGED 25 CARE DIRECTOR, DID SAY ON MORE THAN ONE OCCASION THAT THE 26 DENIALS WENT UP SIGNIFICANTLY, AND CALLS WERE COMING FROM 208 I HEALTH PLANS, ESPECIALLY TO ME FROM VARIOUS HEALTH PLAN 2 MEDICAL DIRECTORS, AS TO WHY THESE DENIALS WERE MADE. 3 TYPICALLY WHEN A MEDICAL DIRECTOR CALLS YOU, THEN A 4 SIGNIFICANT DENTAL. 5 BY MR. NOLAN: 6 DOCTOR JEYAKUMAR, WHAT IS SUPPOSED TO BE THE BASIS 7 FOR UTILIZATION REVIEW 8 A IS IT MEDICALLY 9 FROM WHAT YOU OBSERVED AND WHAT YOU HEARD, WAS TO DOCTOR REDDY MAKING UTILIZATION REVIEW DECISIONS BASED UPON Ti MEDICAL T2 A WHAT WAS EXPECTED. T3 IS THAT WHAT HE WAS T4 A THERE WERE SOME AREAS WHERE I BELIEVED IT WAS NOT 75 HAPPENING. T6 WHAT DO YOU BELIEVE WAS THE BASIS FOR DOCTOR A T7 DECISION IN THOSE T8 A FINANCIAL. W9 YOU TOLD US ABOUT A LUNCH THAT YOU HAD WITH MISS 20 MISS BUCHANAN, AND MISS CROUCH, AND MISS 2W EXPRESSED SOME CONCERNS TO YOU ABOUT DOCTOR I 22 UTILIZATION REVIEW 23 A CORRECT. 24 YOU TOLD US YESTERDAY THAT SHE TALKED TO YOU ABOUT A 25 CLEFT PALATE 26 A YES. 209 A 1 IS THERE ANY DOUBT IN YOUR MIND SHE WAS TALKING 2 ABOUT A 3 A I HAVE ABSOLUTELY NO DOUBT IN MY MIND. 4 YOU TOLD US YESTERDAY THAT SHE SAID THAT THIS BABY 5 WAS NOT TAKING 6 A THAT WAS WHAT SHE TOLD ME FROM THE 7 COMPLAINT. A 8 WHAT IS A CLEFT PALATE, AND HOW DOES IT AFFECT 9 TO A A CLEFT PALATE IS A CONDITION WHERE WHEN BORN I T1 EITHER THE LIP OR THE UPPER ROOF OF THE MOUTH CLOSE T2 AND FUSE. A COMMON CHAMBER BETWEEN THE MOUTH AND THE T3 NOSE, AND WHEN THAT CLOSE WE CANNOT SWALLOW. THE T4 MECHANISM FOR SWALLOWING IS THE MOUTH HAS TO CLOSE AND ALL T5 OPENINGS HAVE TO CLOSE EXCEPT THE ESOPHAGUS, THE SWALLOWING T6 TUBE. T7 WHEN A BABY HAS A CLEFT PALATE, WHEN THE BABY CLOSES T8 THE MOUTH, INSTEAD OF THE FOOD OR MILK GOING BACKWARDS, IT T9 GOES UP THROUGH THE NASAL PASSAGES AND REGURGITATES--THROUGH 20 THE NOSE. DEPENDING ON HOW BAD THE CLEFT PALATE IS, THEY ZT GET ADEQUATE NUTRITION, AND ALSO A RISK FOR 22 ASPIRATION INTO THE LUNGS AND SO ON. 23 WHAT IS ASPIRATION INTO THE 24 A ASPIRATION OF FOREIGN MATTER, FOOD, GOING INTO THE 25 LUNGS. 26 WHAT ARE THE POTENTIAL CONSEQUENCES OF THIS ZTO . 2 A COMMONLY PNEUMONIA. AND IT CAN BE LIFE THREATENING 3 PNEUMONIA. 4 DO YOU RECALL MISS TALKING ABOUT A PATIENT 5 WITH FACIAL 6 A CORRECT. THIS WAS A FACIAL CANCER PATIENT WHO HAD 7 BEEN WITH THE ORGANIZATION FOR SEVERAL YEARS AND WAS 8 SPECIFICALLY BEING TREATED IN THE PALM SPRINGS AREA BECAUSE 9 THEY HAD SOMETHING CALLED HYPERBARIC OXYGEN, WHICH IS HIGH TO PRESSURE PURE OXYGEN. IT WAS TOO COMPLEX FOR HER TO BE TT TREATED IN OUR FACILITY OR OTHER SO SHE WAS GOING T2 TO PALM SPRINGS REGULARLY AND GETTING THIS TREATMENT. MISS I T3 BROUGHT TO MY ATTENTION THAT THAT REFERRAL T4 WAS BEING DENIED. T5 WHO DID MISS TELL YOU WAS DENYING THIS T6 T7 A DOCTOR REDDY. T8 DID MISS TALK TO YOU AT ANY TIME ABOUT A T9 HEART TRANSPLANT 2O A ACTUALLY, THAT HEART TRANSPLANT PATIENT WAS BROUGHT ZT TO MY ATTENTION BY DOCTOR NESTER AND ALSO BY DOCTOR REDDY 22 HIMSELF. . 23 THIS WAS A PATIENT WHO HAD A HEART TRANSPLANT 24 SOMETIME IN THE RECENT PAST BEFORE MY RETURN THERE AND WAS 25 TO RECEIVE FOLLOW-UP CARE AT UCLA, DOCTOR NESTER APPROACHED 26 ME SEVERAL TIMES FOR A REFERRAL TO UCLA. ZTW BY THIS TIME IT WAS DOCTOR REDDY WHO WAS DOING 2 UTILIZATION, AND SHE COULD NOT GET THE REFERRAL FROM HIM. 3 AND ONCE SHE CAME TO THE EMERGENCY ROOM BECAUSE OF SOME 4 MEDICAL EMERGENCY AND WANTED TO BE TRANSFERRED TO UCLA, AND 5 DOCTOR REDDY HAD MET HER IN THE EMERGENCY ROOM AND TOLD HER 6 THIS IS IN HIS OWN WORDS. HE SAID, ALREADY SPENT A 7 MILLION DOLLARS ON 8 DOCTOR REDDY WAS IN THE ER AND SPOKE TO THE HEART 9 TRANSPLANT TO A WHAT HE SAID. AND HE SAID, NEED TO TT FOLLOW UP WITH OUR CARDIOLOGISTS A T2 WAS THAT IN FACT TRUE THAT DOCTOR REDDY HAD SPENT A 13 MILLION DOLLARS ON THIS T4 A NO. IT WAS PHYCOR THAT SPENT THE MONEY. THE I5 PREVIOUS OWNERS. W6 IT DOCTOR MONEY AT W7 A NO. T8 DID MISS TALK TO YOU AT ALL ABOUT DENIALS T9 OF CARE FOR SKILLED NURSING ZG A YES. 2T WHAT DID SHE SAY ABOUT 22 A WHEN PATIENTS HAD SUCH THINGS AS HIP SURGERY, HIP 23 REPLACEMENT, AND KNEE REPLACEMENT THESE ARE ELDERLY 24 PATIENTS, AND TYPICALLY THEY WOULD REQUIRE TWO TO FOUR WEEKS 25 OE SKILLED NURSING CARE AND PHYSICAL THERAPY AND 26 REHABILITATION IN A SKILLED NURSING FACILITY. KIND 2T2 I OF STANDARD OF CARE. AND HE WOULD DENY THEM. SHE WAS TOLD 2 NOT TO APPROVE THOSE OR TO MINIMIZE THE PHYSICAL THERAPY. 3 SHE WAS QUITE UPSET ABOUT IT. SHE WOULD COME AND TALK TO 4 ME, AND SOMETIMES I WOULD, ON MY OWN, ASK HER TO GO AHEAD 5 AND AUTHORIZE IT. I WOULD TAKE RESPONSIBILITY FOR THIS. 6 SHE WAS TRULY DISTRESSED BY THOSE. 7 YESTERDAY MISS TROPP SHOWED YOU A MEMO THAT YOU HAD 8 IN FACT WRITTEN SAYING TO THE PHYSICIANS, LOOK, IE YOU ARE 9 GOING TO SEND A PATIENT FOR PHYSICAL THERAPY, SEND THEM, BUT TO LET THE PHYSICAL THERAPIST DECIDE HOW MUCH PHYSICAL THERAPY TI AND HOW OFTEN. DO YOU RECALL THAT I2 A YES. THAT WAS FOR GROUP PHYSICAL NAMELY, T3 OUTPATIENT PHYSICAL THERAPY PATIENTS WHO ARE LEAVING THE HOSPITAL WHO NEEDED TO BE INSTITUTIONALIZED IN A SKILLED T5 NURSING FACILITY. T6 THOSE MEMORANDUMS, WHICH WE WENT THROUGH YESTERDAYTHINGS. THEY ACTUALLY ARE THE WAY T8 UTILIZATION REVIEW SHOULD FUNCTION. T9 I WAS IN AGREEMENT WITH THE CONCEPT. THERE WAS 20 ALWAYS, UNFORTUNATELY, A DIFFERENCE BETWEEN WHAT WAS WRITTEN 21 AND WHAT WAS SPOKEN AND WHAT WAS DONE. A 22 ALLOWING THE PHYSICAL THERAPIST TO DETERMINE THE 23 AMOUNT OF PHYSICAL THERAPY, WOULD YOU DIFFERENTIATE THAT 24 FROM DOCTOR DENTAL OF PHYSICAL THERAPY FOR THESE 25 ELDERLY 26 A THESE ARE HOSPITAL DISCHARGED PATIENTS. ZTB 1 WAS IT INAPPROPRIATE TO DENY THOSE 2 A YES. 3 DID MISS TALK TO YOU ABOUT DENIALS OF 4 DIABETIC IS THAT THE RIGHT 5 A DIABETIC STRIPS ARE PATIENT BENEFITS. WE WANTED TO 6 REORGANIZE AS TO HOW MANY DIABETIC STRIPS A PATIENT WOULD I 7 NEED TO ADEQUATELY MANAGE THEIR DIABETES. SAY SOMEBODY 8 ON INSULIN WOULD NEED FOUR STRIPS A DAY, AND SOMEBODY 9 ON TABLETS WOULD REQUIRE ABOUT ONE TO TWO PER DAY. TO THOSE CHANGES WERE MET, AND I BELIEVE I HAD A MEMO TO THAT TT EFFECT STATING THAT. THEY WERE NEVER DENIED. THEY WERE T2 JUST REARRANGED TO MEET THEIR NEEDS. T3 DID MISS TALR TO YOU AT ALL ABOUT THIS I4 ISSUE OF DIABETIC STRIPS THAT YOU CAN T5 A NOTHING AS A COMPLAINT. WE TALKED ABOUT IT. THESE I6 ARE EFFICIENCIES, IF YOU WILL, THAT WE WERE TRYING TO BRING . T7 INTO THE ORGANIZATION. T8 WHEN YOU HAD YOUR CONVERSATION I THINK YOU SAID T9 YESTERDAY YOU HAD MORE THAN ONE CONVERSATION WITH MISS 20 DID SHE EVER SAY THAT SHE WAS CONCERNED THAT 21 DOCTOR REDDY WAS COMPROMISING PATIENT 22 A YES, SHE IMPLIED THAT. ONCE SHE STATED THAT THE 23 ONLY REASON THERE IN THE ORGANIZATION IS BECAUSE 24 STILL THERE TO SUPPORT HER. 25 YOU SAID SHE IMPLIED IT. WHAT DID SHE SAY TO IMPLY 26 THAT PATIENT CARE WAS BEING 2I4 I A BECAUSE OF THE DENIALS, DELAYS ESPECIALLY WITH 2 REGARD TO A TYPICAL EXAMPLE IS THE CLEET PALATE BABY. 3 BASED UPON WHAT YOU HEARD FROM THE PHYSICIANS AND 4 BASED UPON WHAT YOU HEARD FROM MISS DID YOU AGREE 4 5 WITH HER THAT DOCTOR REDDY WAS ARGUABLY COMPROMISING PATIENT 6 7 A I BELIEVE SO. 8 WHAT IS THE ORTHOPEDIC REVIEW 9 A A COM ITTEE FORMED BY DOCTOR REDDY. HE BELIEVED T0 THERE WERE LOTS OE UNNECESSARY ORTHOPEDIC SURGERIES SUCH AS Ii HIP REPLACEMENTS AND KNEE SO HE WANTED TO HAVE I2 A SEPARATE COMMITTEE TO REVIEW THE NEED FOR THESE T3 PROCEDURES. I4 I AGREED INITIALLY BECAUSE THE CONCEPT WAS GOOD T5 BECAUSE ALWAYS SOME THINGS IN MEDICINE THAT ARE I6 DONE, PERHAPS, UNNECESSARILY, AND THAT WOULD GIVE US THE T7 OPPORTUNITY TO LOOK AT IT. T8 THE COMMITTEE WAS COMPRISED OF HIM LEADING THE A T9 COMMITTEE, MYSELF, THE TWO ORTHOPEDIC SURGEONS, A 20 RHEUMATOLOGIST. IT WAS A GOOD COMBINATION OE PEOPLE. 21 WHEN DID THIS COM ITTEE 22 A SOMETIME IN LATE 2002. 23 WE WOULD GO THROUGH THE CASES. THESE WERE CASES 24 BEING BROUGHT FROM ORTHOPEDIC SURGEONS THAT HAVE SEEN THE 25 PATIENTS, AND THEY HAVE AGREED TO DO THE SURGERY. THEN WE I 26 WOULD GO THROUGH THE CASES TO MAKE SURE, JUST LIKE THE MEMO ZT5 I IMPLIED, THEIR MEDICAL CONDITIONS WERE APPROPRIATE AND 2 CONSULTATIONS WERE DONE. THAT WAS THE INTENT OF THE 3 COMMITTEE IN MY MIND. . 4 AS TIME WENT BY, IT WAS QUITE APPARENT TO ME THAT 5 THE PURPOSE OF THE COM ITTEE WAS TO SIMPLY FIND A REASON NOT 6 TO DO SURGERIES SUCH AS THINK THIS PATIENT SHOULD 7 HAVE SURGERY. THIS PATIENT IS TOO RISKY FOR A 8 IT WAS QUITE APPARENT TO ME THAT THE PURPOSE OF THE 9 COM ITTEE CHANGED FROM BASED ON MEDICAL NECESSITY TO TO FINANCIALLY MOTIVATED. AND AFTER A FEW MEETINGS, I STOPPED TI ATTENDING THEM. AND THEN IT CAME TO A POINT THAT THE T2 ORTHOPEDIC SURGEONS THERE WERE HARDLY ANY SURGERIES BEING T3 PERFORMED. T4 YOU SAY THAT IT WAS APPARENT THAT THE COMMITTEE WAS I T5 BEING USED SIMPLY TO DENY SURGERIES USED BY WHOM TO DO I6 A DOCTOR REDDY WAS SPEARHEADING THE COMMITTEE. T7 YOU HAVE TESTIFIED PREVIOUSLY THAT THE ORTHOPEDIC T8 SURGEONS WERE PLEADING WITH DOCTOR T9 A YES. INITIALLY THEY MAKE THE ASSESSMENT AND THEY Z0 MAKE THE DECISION THAT THIS PATIENT REQUIRES SURGERY. THE ZT DECISION FOR ORTHOPEDIC SURGERIES SUCH AS KNEE AND HIP 22 REPLACEMENT ARE FAIRLY SIMPLE. YOU DO THE SURGERIES WHEN 23 THE DISEASE COMES TO A POINT OF UNMANAGEABLE PAIN OR 24 UNMANAGEABLE DISABILITY. . 25 THE ORTHOPEDIC SURGEONS REPLACE FUNCTIONAL 26 HIPS AND KNEESL SO WHEN THEY REQUESTED THE SURGERY, MANY ZW6 I TIMES THEY WOULD PLEAD BECAUSE THIS PATIENT ACTUALLY NEEDED 2 THE SURGERY. 3 THERE ARE ISSUES ABOUT ORTHOPEDIC SURGEONS WHO 4 LOOK AT THE REST OF THE MEDICAL PROBLEMS. THE 5 PURPOSE OF THE CONSULTATION, EXCEPT ON A RARE OCCASION, IS 6 TO FINE TUNE THEM, GET THEM PREPARED FOR THE SURGERY. 7 EVENTUALLY THEY GAVE UP AND THREW UP THEIR HANDS AND 8 SAID, YOU WANT SURGERY, SEND THESE PATIENTS 9 FOR CONSULTATIONS. WE WANT TO SEE TO WHO SAID A DOCTOR SURDYKA AND DOCTOR STANTON. I BELIEVE THOSE T2 ARE THE TWO ORTHOPEDIC SURGEONS. I3 WHEN THESE ORTHOPEDIC SURGEONS WERE SAYING YOU I4 WANT THE PATIENTS TO HAVE SURGERY, SEND THEM EOR I5 THE WHO WERE THEY SAYING THAT T6 A BASICALLY THEY TOLD DOCTOR REDDY TO TELL THE PRIMARY T7 CARE PHYSICIANS NOT TO SEND THEM. T8 WERE THERE INSTANCES WHERE IT WAS APPROPRIATE TO T9 DENY A SURGICAL 20 A YES. WHEN THE MEDICAL CONDITION IS TOO 21 RISKY FOR THE PROCEDURE, THEN IT SHOULD NOT BE DONE. Z2 FROM WHAT YOU HEARD AT THESE MEETINGS OF THE A 23 ORTHOPEDIC REVIEW COMMITTEE, WAS DOCTOR REDDY DENYING 24 SURGERIES ONLY WHEN IT WAS TOO RISKY TO BE 25 A NO. IT WAS BEING DENIED TOO PREMATURELY BEFORE 26 PROPER EVALUATIONS WERE BEING DONE. 2T7 I DID YOU EVER HEAR OF DOCTOR REDDY DENYING A SURGERY 2 FOR A FEE--FOR--SERVICE 3 A NO, BECAUSE HE GET INVOLVED IN THEM. 4 ALL OF THESE DENIALS WERE FOR HMO 5 A YES, BECAUSE THE ONES WHO COME FOR REVIEW. 6 WAS THERE ALSO A COM ITTEE KNOWN AS THE CARDIOLOGY 7 REVIEW 8 A AGAIN, A COMMITTEE HE APPOINTED WITH HIMSELE AND THE 9 TWO CARDIOLOGISTS AT THE TIME TO REVIEW THE PACEMAKERS IO BECAUSE HE BELIEVED THAT THERE WERE TOO MANY PACEMAKERS TI BEING PLACED. T2 WERE PACEMAKERS BEING DONE AT DESERT VALLEY T3 I4 A YES. T5 WHEN DID DOCTOR REDDY START THIS CARDIOLOGY REVIEW T6 17 A AROUND THE SAME TIME, LATE 2002. T8 YOU SAID THERE WERE TWO CARDIOLOGISTS INVOLVED. WHO T9 WERE 2O A DOCTOR AHMED AND DOCTOR RAZA. 2T DID YOU ATTEND ANY OF THOSE 22 A I DID NOT. 23 DID DOCTOR RAZA DOCTOR AHMED COMPLAIN TO YOU 24 ABOUT DOCTOR CARDIOLOGY REVIEW COM 25 A THEY DID. 26 WHAT DID THEY TELL 2TS . I I A THE BIGGEST COMPLAINT WAS THAT THE PACEMAKERS AND 2 SOME OF THE CORONARY ANGIOGRAMS WERE BEING DENIED, WHICH 3 THEY BELIEVED WERE NECESSARY. 4 4 DID THEY TELL YOU THAT THESE PROCEDURES WERE BEING 5 DENIED BY DOCTOR 6 A YES. 7 THE COURT: TAKE OUR MORNING BREAK AT THIS 8 TIME. SEE YOU BACK AT 9 (A RECESS WAS TAKEN.) IO THE COURT: BACK ON THE RECORD. THE JURY, THE IT PARTIES, AND ATTORNEYS ARE PRESENT. I2 GO AHEAD, MR. NOLAN. T3 MR. NOLAN: THANK YOU, YOUR HONOR. I4 BY MR. NOLAN: 4 T5 DOCTOR JEYAKUMAR, WHAT IS THE HOSPITAL CENSUS T6 A THE HOSPITAL CENSUS LIST IS A LIST OF PATIENTS THAT T7 IS PRINTED USUALLY AFTER MIDNIGHT FOR USE THE NEXT DAY. IT T8 HAS INFORMATION OE THE NAMES, ROOM NUMBERS, T9 INSURANCE, AND HOW MANY DAYS THEY HAVE BEEN IN THE HOSPITAL. 20 AFTER YOU RETURNED IN MAY OF 2001, DID YOU 21 PERIODICALLY, REGULARLY, WHATEVER, REVIEW THE CENSUS LIST A 22 WITH DOCTOR 23 A AT THE BEGINNING I WAS GOING THROUGH THE CENSUS NOT . 24 WITH HIM BUT ON MY OWN AND SEEING THE PATIENTS. I WOULD DO 25 THE HOSPITAL UTILIZATION. I WAS KIND OF IN CHARGE OF THE 26 OVERALL CARE AND UTILIZATION OF THE HOSPITAL. I DID GO 2T9 THROUGH THEM. WE HAD DISCUSSIONS WITH REGARD TO PATIENTS, 2 BUT NOTHING SIGNIFICANT. EVENTUALLY DOCTOR REDDY TOOK OVER 3 THAT FUNCTION TOO. 4 WAS THIS IN LATE - 5 A YES. 6 AFTER DOCTOR REDDY TOOK OVER UTILIZATION REVIEW, DID 7 HE BEGIN TO REVIEW WITH YOU THE CENSUS 8 A NOT IN THE FORMAL SENSE. HE WOULD POINT OUT CERTAIN 9 PATIENTS, TYPICALLY NO INSURANCE PATIENTS, AND SAY TO GET TO THEM OUT OF THERE. TI HOW WOULD HE POINT THEM OUT TO T2 A HE WOULD MAKE A CIRCLE ON THE INSURANCE INFORMATION T3 ON THE SHEET. T4 WOULD HE IDENTIFY OR CIRCLE ALL OF THE NO INSURANCE I5 PATIENTS ON THE CENSUS T6 A TYPICALLY, YES. T7 HOW MANY WOULD THERE BE ON A TYPICAL DAYMAYBE ONE OR TWO. IT WAS KIND OF SPORADIC. 20 SOMETIMES NONE. 2T AFTER HE WOULD CIRCLE THEIR NAMES, WHAT DID HE TELL 22 YOU HE WANTED 23 A THE IMPLICATION WAS TO GET THEM OUT. I 24 HE WANTED THEM OUT OF THE 25 MS. TROPP: OBJECTION, YOUR HONOR. THE QUESTION WAS . 26 WHAT HE SAID, AND THE ANSWER WAS THE IMPLICATION. 220 I THE COURT: I THINK GETTING TO IT. 2 REPHRASE THE QUESTION, PLEASE. 3 BY MR. NOLAN: 4 YOU SAID THERE WAS AN IMPLICATION THAT HE WANTED 5 THEM OUT. WHAT DID HE TELL 6 A SPECIFICALLY ON ONE PATIENT WHO WE DISCUSSED 7 YESTERDAY, THAT PATIENT IN THE ICU 8 THE VENTILATOR 9 A YES. HE SAID TO GET HIM OFF THE VENTILATOR AND GET A T0 HIM OUT OF HERE. USUALLY HE WOULD SAY, THIS PATIENT TO TI THE COUNTY T2 YOU HAVE TESTIFIED, DOCTOR JEYAKUMAR, THAT YOU WERE T3 TOLD ABOUT DOCTOR REDDY BEING IN THE EMERGENCY ROOM AND W4 BEING I5 A YES. T6 WERE YOU EVER TOLD ABOUT SOME OF THE THINGS DOCTOR T7 REDDY WAS SAYING IN THE EMERGENCY ROOM IN LATE 2002 AND T8 EARLY 2003? T9 A IN FACT, I HAVE SPOKEN TO HIM ABOUT THESE AND ASKED 20 HIM TO TONE DOWN. ONE OF THE EMBARRASSING STATEMENTS HE 2] MADE IS HE WOULD STAND THERE AND SAY, IS A GOLD MINE. 22 THIS IS A GOLD 23 WHERE WAS HE WHEN HE WOULD SAY 24 A IN THE EMERGENCY ROOM. 25 WERE YOU EVER PRESENT WHEN THAT STATEMENT WAS 26 A YES. THERE WAS ONE EVENING WHEN I WAS MEETING A 221 PATIENT THERE THAT THIS INCIDENT HAPPENED. 2 TELL ME ABOUT WHAT YOU WERE DOING WITH THIS I 3 PATIENT. 4 A THERE WAS THIS PATIENT WHO CAME IN WITH A DRUG 5 OVERDOSE. HE WAS UNCONSCIOUS. WE HAD TO PUT A TUBE DOWN 6 THE MOUTH, PLACED HIM ON LIFE SUPPORT, STABILIZED HIM, AND 7 WE WERE MOVING THIS PATIENT TO THE INTENSIVE CARE UNIT. OUR 8 EMERGENCY ROOM HAS TWO AREAS, FRONT AND BACK. THIS HAPPENED 9 IN THE BACK. WE STABILIZED HIM, AND WE WERE MOVING HIM WO WHILE THE RESPIRATORY THERAPIST WAS BAGGING THE PATIENT, TI VENTILATING THE PATIENT MANUALLY. I WAS ACCOMPANYING THE T2 PATIENT, THE NURSING STAFF, THE RESPIRATORY THERAPIST, AND I3 SOMEBODY PUSHING THE GURNEY. WE WERE GOING THROUGH THE I4 FRONT PORTION OF THE EMERGENCY ROOM, AND DOCTOR REDDY WAS T5 WORKING IN THE FRONT PORTION ON THE OTHER SIDE. T6 WHAT WAS HE T7 A HE HAD SOME CHARTS IN HIS HANDJUST YELLED ACROSS THE ROOM, THIS IS A GOLD T9 AND HE WAIVED THE CHARTS. 20 DID HE OFFER TO HELP YOU WITH THE PATIENT WHOSE LIFE 2W YOU WERE TRYING TO 22 A NO. 23 THERE WERE SOME QUESTIONS OE YOU YESTERDAY FROM MISS I 24 TROPP ABOUT A PATIENT ON A VENTILATOR. WAS THAT THE SAME 25 PATIENT YOU JUST TOLD US 26 A YES. 222 I DO YOU RECALL WHEN THAT PATIENT WAS HOSPITALIZED AT 2 DESERT VALLEY 3 A THAT EVENING. 4 WHEN WAS 5 A IT WAS SOMETIME IN MID TO LATE 2002. 6 YOU SAID YOU PUT THE PATIENT ON LIFE SUPPORT. HOW 7 SERIOUS WAS THE CONDITION OF THIS 8 A CRITICAL. 9 YOU JUST MENTIONED A MOMENT AGO THAT DOCTOR REDDY IO SPOKE TO YOU ABOUT THAT PATIENT AND CIRCLED THAT PATIENT ON II THE CENSUS I2 A YES. I W3 WHAT DID DOCTOR REDDY SAY TO YOU ABOUT THAT PATIENT I4 AFTER HE CIRCLED THAT PATIENT ON THE CENSUS I5 A THAT WAS THE NEXT MORNING. WE MET OUTSIDE THE I6 INTENSIVE CARE UNIT, AND HE SHOWED ME THE NAME AND CIRCLED W7 IT AND TOLD ME TO GET THIS PERSON OFF THE VENTILATOR AND GET T8 HIM OUT OF HERE. T9 YESTERDAY YOU WERE ASKED ABOUT WHAT YOU DID TO TRY - 20 TO INTERVENE PERTAINING TO THESE COMPLAINTS ABOUT DOCTOR 21 REDDY, AND YOU TESTIFIED THEN, AS WELL AS THIS MORNING, THAT 22 YOU HAD A NUMBER OF CONVERSATIONS WITH DOCTOR REDDY. CAN 23 YOU ESTIMATE FOR US HOW MANY CONVERSATIONS YOU HAD WITH 24 HIM. 25 A AT LEAST FOUR, FIVE, SIX CONVERSATIONS. 26 I REPEATEDLY PLEADED WITH HIM THE PERCEPTION OF A 223 I CHAIRMAN AND OWNER OF AN INSTITUTION GOING DOWN TO THE 2 EMERGENCY ROOM AND BEING PERCEIVED THIS WAY IS NOT GOOD. HE 3 HAS TO BE ABOVE IT ALL. NOT ONLY SHOULD HE NOT BE DOING 4 THIS, BUT HE SHOULD NOT EVEN GIVE THE PERCEPTION OF THIS. 5 IN THE LATTER STAGES, HE STARTED SAYING I PLEADED 6 WITH HIM NOT TO GO TO THE EMERGENCY ROOM. I SAID, DO 7 THIS FOR YOU. WE KNOW WHAT YOU WANT, AND WORK WITH 8 9 HE SAID, GOING TO GO T0 HE WAS GOING ONCE A DAY IN THE EVENINGS. HE SAID, II GO TWICE A DAY AND DO T2 YOU SAID YOU TOLD DOCTOR REDDY THAT THE PERCEPTION T3 OE HIM, AS THE CHAIRMAN, DOING THESE THINGS WAS NOT A T4 A THAT WAS MY EXPLANATION TO HIM. THE CHAIRMAN, T5 YOU SHOULD NOT BE DOING I6 WAS THERE REALITY TO THAT T7 A SOMEHOW HE NEVER FELT THAT THAT WAS THE WRONG THING T8 TO DO. HE WAS SO FOCUSED ON GETTING WHAT HE WANTED IN THE T9 EMERGENCY ROOM. HE LISTEN. THE BOTTOM LINE. 20 IN THE FALL OF 2002 AS YOU WERE HAVING CONVERSATIONS I 2I WITH DOCTOR REDDY, DID YOU BELIEVE OR AT LEAST HOPE THAT YOU 22 WERE GOING TO BE ABLE TO BRING THESE ISSUES UNDER 23 A TILL EARLY 2003, THAT WAS MY HOPE. I WAS HOPING HE 24 WOULD CHANGE. 25 WHAT HAPPENED IN EARLY 2003 TO CHANGE YOUR 26 A THE MEETING ON FEBRUARY TWELFTH. 224 CORRECT. 3 IN EARLY ZOO3, WERE ANY MORE OF YOUR JOB DUTIES 4 TAKEN AWAY FROM 5 A BY THAT TIME I WAS BASICALLY DOING ONLY MY CLINICAL 6 WORK AS LUNG PHYSICIAN AND HOSPITAL CONSULTATIONS FOR 7 PULMONARY PATIENTS, WHICH I VERY MUCH ENJOY. 8 THE TITLES WERE CERTAINLY NOT TAKEN AWAY, BUT THEY 9 WERE MORE OF A TITLE THAN ANY FUNCTION. AS CHIEF OPERATING TO OFFICER, THE ONLY JOB I WAS DOING WAS SIGNING RETIREMENT TT FORMS FOR PEOPLE. T2 OTHER THAN SIGNING A FORM FOR RETIREMENT, IS IT FAIR W3 TO SAY THAT YOU WERE NO LONGER FUNCTIONING AS CHIEF T4 OPERATING T5 A NOT IN THE TRUE SENSE. I WOULD SIGN A MEMO HERE AND T6 THERE AND WOULD ATTEND MEETINGS. IT WAS MORE OF A TITLE W7 THAN A FUNCTION. I T8 YOU HAVE TOLD US THAT YOU HAVE HAD CONVERSATIONS T9 WITH MISS BUCHANAN AND MISS CROUCH ABOUT THESE VARIOUS 20 ISSUES THAT YOU DESCRIBED YESTERDAY. HOW MANY SUCH 21 CONVERSATIONS DID YOU HAVE WITH MISS 22 A SEVERAL DISCUSSIONS. MOST OF THEM WERE INFORMAL. 23 MEET AT NOONTIME, LUNCHTIME, HALLWAYS, ON THE PHONE. 24 WE NEVER REALLY HAD TOO MANY FORMAL MEETINGS TO DISCUSS 25 THESE. 26 DID YOU HAVE ABOUT THE SAME NUMBER OF CONVERSATIONS 7 225 I WITH MISS CROUCH ABOUT THESE 2 A MAYBE EVEN MORE BECAUSE SHE WAS DIRECTLY INVOLVED IN 3 THE CLINICAL AREAS. BECAUSE SHE WAS IN THE ICU AND 4 EMERGENCY ROOM MY AREA OF SPECIALTY 5 TALK A LOT ABOUT THE EVENTS AND ISSUES, ESPECIALLY AT THE 6 END OF THE DAY WHEN WE WERE DONE WITH THE WORK. A A 7 GOOD TIME TO HASH OUT THE EVENTS OF THE DAY. SOMETIMES 8 SERIOUS, SOMETIMES FUNNY, SOMETIMES JUST WONDERING WHAT TO 9 DO. TO I WANT TO BREAK AWAY FOR A MOMENT AND ASK YOU ABOUT II SOMETHING THAT CAME UP YESTERDAY. I2 THERE WAS AN ELABORATE SET OF QUESTIONS ASKED OF YOU I3 YESTERDAY BY MISS TROPP ABOUT YOUR FRIENDSHIP WITH MISS I4 CROUCH. DO YOU RECALL I5 A YES. I6 A GENTLEMAN HERE IN A TAN SHIRT SITTING ON T7 THE AISLE. DO YOU KNOW THAT T8 A BOB. W9 HIS LAST 2O A CROUCH. 2I IS THAT 22 A YES. 23 DO YOU KNOW 24 A I KNOW HIM VERY WELLFRIEND. 226 SITTING NEXT TO HIM IS ANOTHER GENTLEMAN AND A 2 WOMAN. WHO ARE 3 A THE PARENTS OF LISA. 4 HER MOTHER AND 5 A YES. 6 DO YOU KNOW 7 A I KNOW THEM VERY WELL. 8 ARE THEY 9 A FRIENDS. AND I USED TO TAKE CARE OF SOME OF I TO HER MEDICAL ISSUES. TT DOCTOR JEYAKUMAR, DID HMO INSURANCE DIFFERENTIATE IN I T2 TERMS OF REIMBURSEMENT FOR PROCEDURES DONE IN THE MEDICAL T3 OFFICES OVER AT THE GROUP SIDE AND FOR THE SAME PROCEDURE IF T4 DONE IN THE 15 A SOMEWHAT COMPLEX. EVERY INSURANCE IS A LITTLE 16 DIFFERENT. TYPICALLY ANY PROCEDURES DONE AS AN OUTPATIENT T7 ON THE MEDICAL GROUP SIDE THE COST IS BORNE BY THE MEDICAL T8 GROUP. NO EXTRA REIMBURSEMENT. ON THE HOSPITAL T9 SIDE, DEPENDING UPON THE INSURANCE, SOME OF THE PROCEDURES, 2O AT LEAST AT THAT TIME, WERE BEING REIMBURSED BY CERTAIN ZT HEALTH PLANS. I . 22 DO YOU RECALL DOCTOR REDDY GIVING INSTRUCTIONS TO 23 PHYSICIANS REGARDING WHERE CERTAIN PROCEDURES SHOULD BE DONE 24 IN EARLY 25 A YES. IN ONE OF THE MEETINGS, HE 26 ANNOUNCED TO THE PHYSICIANS THAT HE WANTED CERTAIN 227 I PROCEDURES LIKE CT SCANS FOR CERTAIN INSURANCE PATIENTS TO 2 BE DONE THROUGH THE EMERGENCY ROOM, TO ASK THE PATIENT TO GO 3 TO THE EMERGENCY ROOM TO GET IT DONE BECAUSE THEY GET ACTUAL 4 REIMBURSEMENT FOR THAT BECAUSE THE CONTRACT ALLOWS THAT. HE 5 ALSO STATED, YOU WOULD SEND THEM TO THE EMERGENCY ROOM 6 TO GET THE PROCEDURE DONE, THEN YOU NEED NOT GET MY 7 AUTHORIZATION FOR THIS 8 WERE THESE PROCEDURES THAT DOCTOR REDDY WAS 9 DISCUSSING AT THIS MEETING WERE THESE REAL TO EMERGENCIES THAT HE WANTED DONE IN THE EMERGENCY TT A NO. THESE WERE ROUTINE PROCEDURES. T2 IN YOUR ESTIMATION, WAS IT APPROPRIATE FOR DOCTOR T3 REDDY TO BE DIRECTING PATIENTS TO THE EMERGENCY ROOM FOR 14 NONEMERGENCY PROCEDURES SO HE CAN GET MORE I T5 A NO. IT ACTUALLY CROWDS UP THE EMERGENCY ROOM. I6 IS THE EMERGENCY ROOM SUPPOSED TO BE FOR REAL T7 T8 A SUPPOSED TO BE. T9 IN EARLY 2003, DID YOU CONTINUE TO GET COMPLAINTS 20 FROM PHYSICIANS AND STAFF ABOUT DOCTOR ACTIVITES AT 2T THE 22 A IT BECAME SPORADIC BECAUSE PHYSICIANS WERE AWARE BY 23 THEN THAT THERE WAS NOTHING I CAN DO ABOUT THIS. I 24 YOU HAD A FAIRLY DISCUSSION WITH MISS TROPP 25 YESTERDAY ABOUT WHAT WE HAVE NAMED PATIENT B, THE GENTLEMAN 26 WHO FAINTED AND TURNED UP AT THE ER AND WAS DIAGNOSED BY THE 228 ER PHYSICIAN WITH SYNCOPE, WHICH IS FAINTING YOU TOLD US, 2 AND THAT DOCTOR REDDY CHANGED THAT DIAGNOSIS TO SUDDEN 3 CARDIAC DEATH YOU SAID YESTERDAY YOU HAD A 4 DISAGREEMENT WITH THE 5 A YES. 6 WHAT ARE THE POTENTIAL CONSEQUENCES OF PUTTING ON 7 PAPER A DIAGNOSIS OF SUDDEN CARDIAC DEATH FOR 8 9 A IT IS A MAJOR, POTENTIALLY FATAL DIAGNOSIS. IT T0 PROBABLY WILL IMPACT OBTAINING FUTURE HEALTH INSURANCE, LIFE WI INSURANCE, AND MAY HAVE SOME IMPLICATIONS WITH YOUR 72 LICENSE. W3 IT IS NOT A DIAGNOSIS THAT SHOULD BE MADE T4 A NOT A DIAGNOSIS TO BE MADE A T5 DIAGNOSIS OR CONCLUSION TO BE MADE AFTER DOING TESTING. W6 IN EARLY 2003, CAN YOU JUST GIVE US YOUR BEST T7 ESTIMATE AS TO HOW LONG YOU HAD KNOWN LISA CROUCH AND TINA T8 BUCHANAN. T9 A MISS CROUCH I HAD KNOWN SINCE, I THINK, 1992. 20 ABOUT TT 2W A YES. . 22 AND MISS TINA BUCHANAN SINCE T995 WHEN SHE JOINED AS 23 THE DIRECTOR OF THE EMERGENCY ROOM WHEN IT OPENED. 24 ABOUT EIGHT YEARS FOR MISS 25 A CORRECT. 26 AT ANY TIME BEFORE FEBRUARY T4, 2003, DID LISA 229 I CROUCH TELL YOU THAT SHE WOULD BE LEAVING DESERT VALLEY 2 HOSPITAL TO TAKE ANOTHER POSITION 3 A NO. 4 DID DOCTOR REDDY TELL YOU AT ANY TIME BEFORE 5 FEBRUARY T4, 2003, THAT HE KNEW THAT LISA CROUCH WAS LEAVING DID DOCTOR REDDY TELL YOU AFTER FEBRUARY FOURTEENTH 9 AT ANY TIME THAT HE HAD BEEN AWARE BEFORE FEBRUARY T0 FOURTEENTH THAT LISA CROUCH WAS LEAVING TO GO WT A NO. T2 DID LEX REDDY EVER TELL YOU AT ANY TIME BEFORE OR T3 AFTER FEBRUARY FOURTEENTH THAT HE KNEW BEFORE THE FOURTEENTH T4 THAT LISA CROUCH WAS T5 A NO. T6 IN JANUARY OF 2003, DID DOCTOR REDDY SPEAK TO YOU T7 ABOUT LISA AND TINA CONTINUED EMPLOYMENT T8 AT DESERT VALLEY T9 A IN ONE OF THE INFORMAL MEETINGS WHICH WE HAD IN HIS 20 OFFICE, HE MENTIONED THAT MISS TINA BUCHANAN AND MISS LISA 21 CROUCH HAD TO GO. 22 DID HE SAY WHY THEY HAD TO 23 A HE SAID NOT HELPFUL WITH HIS POLICIES. THEY 24 CARE TOO MUCH FOR PATIENTS. HE CALLED THEM MISS MORALS. 25 HE CALLED THEM MISS 26 A YES. 230 I WAS THIS ABOUT A MONTH BEFORE THEY WERE 2 A YES. 3 I GO THROUGH THIS MEETING AGAIN WITH YOU IN 4 DETAIL. I WANT TO ASK A FEW QUESTIONS ABOUT THE MEETING IN 5 THE BOARDROOM ON FEBRUARY T3, 2003. 6 DO YOU RECALL THE GOLD MINE COMMENT BEING DISCUSSED 7 AT THAT 8 A YES. A 9 HOW DID IT COME UP AND WHO SAID T0 A IT WAS A MEETING WHICH I ARRANGED TO DISCUSS A FEW IT ISSUES INCLUDING, AGAIN, PLEADING WITH HIM NOT TO SAY THOSE T2 THINGS IN THE EMERGENCY ROOM, BUT HE BECAME AGITATED AND T3 SAID GOING TO DO WHAT GOING TO DO. THIS IS HIS W4 HOSPITAL, HIS MONEY, AND HE WOULD DO IT THE WAY HE PLEASES. T5 HE SAID, YOU AGREE WITH WHAT I DO EVEN I0 PERCENT T6 OF THE THIS WAS SPECIFICALLY DIRECTED TOWARDS ME 17 BE WORKING FOR T8 DID YOU DISAGREE WITH T0 PERCENT OR MORE OF WHAT T9 DOCTOR REDDY WAS 20 A DEFINITELY. 2T DID MISS BUCHANAN AND MISS CROUCH, TO THE BEST OF 22 YOUR KNOWLEDGE BASED ON YOUR CONVERSATIONS WITH THEM BEFORE 23 AND DURING THE FEBRUARY THIRTEENTH MEETING, ALSO DISAGREE 24 WITH DOCTOR REDDY T0 PERCENT OR 25 A MANY TIMES. 26 YOU TOLD US YESTERDAY THAT MISS CROUCH AND MISS 231 I BUCHANAN BROUGHT UP A NUMBER OF THINGS THAT THEY WERE 2 CONCERNED ABOUT AND TOLD DOCTOR REDDY HE HAD TO 3 A CORRECT. 4 HOW DID DOCTOR REDDY REACT WHEN THEY TOLD HIM THESE 5 6V A HE LOOKED VERY UPSET AND ANGRY. HE WAS STOMPING ON 7 THE DESK. I COULD SEE SPIT FLYING OUT OF HIS MOUTH. HE WAS 8 VERY AGITATED. 9 IN LATE 2002 AND EARLY 2003, DID DOCTOR REDDY HAVE WO ANY CONFLICTS WITH ANY HEALTH PLANS THAT YOU CAN TT A HE HAD HIS MAIN CONFLICTS ACTUALLY HIS UPSET WAS T2 WITH BLUE CROSS AND KAISER. WITH REGARD TO BLUE CROSS, HE T3 WAS ANGRY BECAUSE THEY CANCELLED HIS CONTRACT. WITH KAISER T4 HIS ANGER WAS THAT HE WAS UNDER THE IMPRESSION THAT THE T5 KAISER REIMBURSEMENT WAS BASED ON A FEE--FOR-SERVICE BASIS T6 WHEREAS LATER THEY FOUND OUT THAT KAISER ACTUALLY PAID T7 THROUGH A THIRD PARTY ON A CONTRACTUAL BASIS WHICH HAD BEEN T8 ESTABLISHED THROUGH PHYCOR BEFORE. SO HE FELT KIND OF T9 CHEATED, BUT THAT WAS AN ESTABLISHED CONTRACT BEFORE. 20 DID HE TELL YOU THAT HE FELT ZW A YES. 22 HE WAS ANGRY WITH KAISER OVER REIMBURSEMENT 23 A YES. - 24 WHAT DID HE TELL YOU THAT HE WANTED DONE ABOUT 25 A HE SAID, GOING TO ADMIT THE KAISER PATIENTS 26 AND BILL THEM. AND ALSO BLUE 232 I THIS PATIENT THAT WE HAD A LONG DISCUSSION ABOUT 2 YESTERDAY WAS A KAISER PATIENT, 2 A YES. 4 DOCTOR JEYAKUMAR, FROM WHERE YOU WERE SITTING IN 5 THAT MEETING ON FEBRUARY T3, 2003, DID YOU BELIEVE THAT LISA 6 CROUCH AND TINA BUCHANAN WERE QUESTIONING DOCTOR 7 ETHICS BY TELLING HIM HAVE GOT TO STOP DOING THIS QUESTION OF THAT. WE WERE ADVISING HIM TO NOT TO DO THOSE THINGS. THEY WERE BEING PERCEIVED AS WRONG, TT AND IT WAS EMBARRASSING AS THE CHAIRMAN AND FOR THE T2 ORGANIZATION WE WERE WORKING FOR. . T3 YOU TOLD US ABOUT YOUR CONVERSATION WITH DOCTOR T4 REDDY LATER THAT EVENING WHERE YOU SAID HE REMAINED T5 A HE DID. T6 DID HE TELL YOU THAT HE FELT THEY WERE QUESTIONING 17 HIS T8 A HE TOLD ME I QUESTIONED HIS ETHICS. T9 WHAT ABOUT MISS CROUCH AND MISS 20 A HE SAID I QUESTIONED HIS ETHICS. 21 YOU TESTIFIED YESTERDAY THAT IN THIS CONVERSATION 22 THAT EVENING THAT DOCTOR REDDY HAD BEEN 23 A 24 DID HE TELL YOU 25 A I THINK HE TOLD ME THAT DURING THAT 26 CONVERSATION IN FEBRUARY. 233 1 DID YOU KNOW HIM LONG ENOUGH TO KNOW WHEN HE HAD 2 BEEN 3 A YES. 4 WAS THERE ANY DOUBT IN YOUR MIND THAT HE HAD BEEN 5 . 6 A THERE WAS NO DOUBT, BUT HE WAS MORE ANGRY THAN, SAY, 7 SOUNDING DRUNK. 8 YOU SAID IN RESPONSE TO MISS QUESTION THAT 9 PREM REDDY SAID CROUCH HAS TO I IO A YES. T1 IS THERE ANY DOUBT IN YOUR MIND THAT THAT IS WHAT HE T2 T3 A ABSOLUTELY NOT. 14 ON THE FOURTEENTH, THE NEXT DAY, YOU CAME IN AND YOU I5 TOLD TINA BUCHANAN WHAT DOCTOR REDDY HAD SAID ABOUT LISA I6 CROUCH HAVING TO GO, A T7 A I CONTACTED HER BY PHONE AND TOLD HER THAT. T8 YOU TOLD HER THAT SHE, AS THE HUMAN RESOURCES T9 DIRECTOR, WOULD HAVE TO BE THE ONE TO CARRY OUT THAT I 20 A THE HUMAN RESOURCES DIRECTOR AND HER IMMEDIATE ZW SO I NOTIEIED HER. 22 AT ANY TIME ON THE FOURTEENTH OF FEBRUARY, DID 23 DOCTOR REDDY TELL YOU CHANGED MY MIND. I WANT HER ANY TIME AFTER THE FOURTEENTH, DID DOCTOR REDDY 234 I TELL YOU WANT HER 2 A NO. 3 ON FEBRUARY T4, 2003, DID LEX REDDY TELL YOU AT ANY 4 TIME THAT HE HAD SPOKEN TO DOCTOR REDDY AND DOCTOR REDDY 5 SAID, NOT FIRE LISA 6 A NO. 7 AT ANY TIME AFTER FEBRUARY T4, 2003, DID LEX REDDY -- 8 TELL YOU THAT DOCTOR REDDY CHANGED HIS MIND AND DID NOT WANT 9 TO FIRE LISA TO A NOT IN THOSE TERMS. II IN AN E--MAIL SOMETIME THEREAFTER, I THINK HE T2 MENTIONED THAT TO ME, BUT NOT DURING THOSE DAYS. T3 YOU TOLD US YESTERDAY THAT YOU SHOWED UP AT LISA 4 T4 OFFICE AFTER THE TERMINATION HAD BEEN T5 A CORRECT. I6 WHO WAS THERE WHEN YOU GOT T7 A MISS WILLIAMS. T8 WHO T9 A KIND OF A BLUR. MISS TINA BUCHANAN WAS THERE. 20 LISA 2W A YES. 22 I THINK YOU SAID YESTERDAY THAT LISA CROUCH--WAS 23 24 A EVERYBODY WAS CRYING. A 25 DOCTOR JEYAKUMAR, YOU WERE ASKED YESTERDAY ABOUT 26 YOUR DECISION TO LEAVE DESERT VALLEY HOSPITAL. WHEN DID YOU 235 1 MAKE THE DECISION TO 2 A I MADE THAT DECISION IN MY MIND WHEN I WAS TOLD IF I 3 AGREE WITH HIM EVEN I0 PERCENT, YOU HAVE TO WORK 4 WITH ME IN THAT MEETING. I MADE UP MY DECISION AT THAT 5 TIME. THEN OTHER EVENTS SO MY LETTER WAS WRITTEN 6 A FEW DAYS LATER. -- I 7 WHAT WERE ALL THE REASONS WHY YOU LEFT DESERT VALLEY . 8 9 MS. TROPP: OBJECTION, YOUR HONOR, RELEVANCE. T0 MR. NOLAN: THIS WAS BROUGHT UP BY COUNSEL IT YESTERDAY, YOUR HONOR. T2 THE COURT: IT WAS, BUT BEFORE WE GO INTO IT, T3 HAVE TO TAKE OUR AFTERNOON BREAK. I4 MEMBERS OF THE JURY, SEE YOU BACK AT DO T5 NOT DISCUSS THE CASE AMONG YOURSELVES OR WITH ANYBODY ELSE I6 UNTIL THE CASE IS SUBMITTED TO YOU FOR YOUR CONSIDERATION. T7 SEE YOU BACK THIS AFTERNOON AT T8 (A RECESS WAS TAKEN. 246 I WANTED TO DO EVERYTHING AND MAXIMIZE REVENUEI 2 THE NEXT LINE SAYS: 3 WERE ASKED TO DO 4 CONSULTS ON PRIVATE 5 ARE THOSE THE FEE--FOR--SERVICE 6 A CORRECT. A 7 WHO WAS ASKING THE SPECIALISTS TO DO CONSULTS ON 8 9 A DOCTOR REDDY. . IO UNDERNEATH THAT IT SAYS: TI IO PM WAS ASKED TO COME IN FOR I2 ROUTINE CONSULT FOR AN ADDITIONAL DAY I3 OF I4 WHAT DOES THAT T5 A A COMPLAINT FROM DOCTOR RAZA AND DOCTOR AHMED I6 THAT ONE NIGHT AROUND 70:00 THEY WERE ASKED TO COME TO THE T7 EMERGENCY ROOM FOR A PATIENT WITH CHEST PAIN THAT HE HAD T8 SEEN. PATIENT WAS STABLE, GOING TO BE ADMITTED, AND HE T9 CALLED DOCTOR RAZA AND SAID, AND SEE THIS PATIENT 2O I BELIEVE DOCTOR RAZA CAN ANSWER THIS BETTEREMERGENCY, BUT HE SAID, IN TO CONSULT SO WE 22 CAN GET AN ADDITIONAL DAY OF 23 UNDERNEATH THAT IT SAYS: 24 NOT HIS 25 THE REFERRING 26 A DOCTOR REDDY. 247 I DOWN TOWARD THE BOTTOM, IT SAYS: 2 CROSS. ORDERED EXCESS WORKUP. 3 KAISER PATIENTS WERE FORCED TO 4 4 5 A YES. 6 WHAT IS THAT REFERENCING, 7 A BECAUSE THE BLUE CROSS CONTRACT WAS CANCELED, HE 8 SAID THAT WHENEVER BLUE CROSS PATIENTS WERE ADMITTED HE 9 WANTED A LOT OF TESTING DONE. AND ON KAISER PATIENTS WHO TO COME TO THE EMERGENCY ROOM HE SAID HE WOULD ADMIT AS MANY AS A TT POSSIBLE. T2 ON THE NEXT PAGE IT SAYS: T3 TO EMBARRASS T4 IS THAT WHAT THAT I5 A YES. I6 THE NEXT LINE SAYS: 17 DRUNK IN HIS T8 A THIS WAS THE CALL I RECEIVED FROM MISS PATTY T9 HERNANDEZ THAT I SPOKE OF EARLIER. 20 THIS IS REFERENCING, I BELIEVE, A TELEPHONE CALL 21 BETWEEN YOURSELF AND DOCTOR REDDY MAY 5, 2003; IS THAT 22 . 23 A CORRECT. 24 IN THE MIDDLE, IT SAYS: 4 25 THAT I SUPPORTIVE IN 26 THE 248 I A BY NOW A LAWSUIT AGAINST MISS TINA BUCHANAN AND MISS 2 LISA CROUCH HAD BEEN FILED. HE CALLED ME THAT NIGHT AFTER 3 DRINKING. HE WAS SCREAMING AT ME. HE TALKED ABOUT HIS 4 EIGHT MILLION DOLLAR LOSS AND HOW I DID NOT HELP HIM TO TURN 5 IT AROUNDHIMSELF. WE TALKED ABOUT 6 THIS LAWSUIT. 7 WHEN I TRIED TO TALK ABOUT SOME OF THE GOOD THINGS 8 THAT TINA AND LISA HAD DONE, HE REFUSED TO ACKNOWLEDGE IT, 9 AND HE SUDDENLY CLAIMED THEY WERE ONLY BROUGHT BACK FOR SIX TO MONTHS. TT HE SAID THEY WERE ONLY BROUGHT BACK FOR SIX T2 A YES. . T3 THEN HE ASKED ME HOW SUPPORTING THEM AND NOT HIM T4 IN THIS LAWSUIT. FINALLY HE CALLED THEM NAMES, AND I TOLD T5 HIM NEVER TO CALL ME AGAIN. W6 IT SAYS RIGHT HERE IN THE MIDDLE OF THE PAGE: W7 HER A BITCH SEVERAL T8 YOU SEE T9 A THAT WAS WITH REGARD TO MISS LISA CROUCH. 20 WHO WAS CALLING HER A 21 A DOCTOR REDDY. I 22 UNDERNEATH THAT, IT SAYS: 23 BITCH VERSUS 24 HOW DID COME INTO WHAT DID DOCTOR 25 REDDY SAY ABOUT 26 A THAT WAS IN REFERENCE TO MISS TINA BUCHANAN. 249 I DOCTOR JEYAKUMAR, DO YOU RECALL YOUR DEPOSITION 2 BEING TAKEN AT DOCTOR OFFICES IN IRVINE ON 3 MAY T7, 4 A YES. ACTUALLY FOOTHILL RANCH IN ORANGE COUNTY. 5 FOOTHILL RANCH. 6 WAS DOCTOR REDDY PRESENT FOR YOUR DEPOSITION 7 TESTIMONY ON THAT 8 A YES. 9 YOU HAVE HAD THREE DEPOSITION DAYS IN THIS CASE, T0 HAVE YOU TI A CORRECT. I2 AFTER THAT DEPOSITION ON MAY T7, 2004 ENDED, DID T3 DOCTOR REDDY APPROACH YOU AND SPEAK TO T4 A YES, HE DID. T5 BEFORE YOU TELL US WHAT HE SAID, WHAT WAS HIS I6 DEMEANOR AND ATTITUDE TOWARD T7 A THE DEPOSITION WAS OVER, AND WE STEPPED OUT OF THE T8 CONFERENCE ROOM. HE FIRST CAME AND SAID HE WANTED TO HAVE I T9 DINNER WITH ME TO TALK ISSUES. I SAID NO. THEN RIGHT IN 20 THE HALLWAY HE BASICALLY STATED THAT MY DEPOSITION WAS VERY 2T DAMAGING TO HIM AND GOING TO TAKE ACTION AGAINST ME. 22 SO I TOLD HIM, YOU ALSO GOING TO SUE YOUR 23 LAWYER FOR ASKING ME QUESTIONS AND ME SPEAKING THE 4 24 AND HE SAID, I HAVE TO TAKE ACTION AGAINST 25 26 HE SAID, THINGS THAT I DID WERE TO SAVE THE 250 I INSTITUTION, AND DESPERATE TIMES REQUIRE DESPERATE 2 3 DOCTOR REDDY TOLD YOU THAT DESPERATE TIMES REQUIRE 4 DESPERATE 5 A YES. 6 SINCE DOCTOR REDDY HAD THAT CONVERSATION WITH YOU, 7 HAVE YOU BEEN SUED EITHER BY HIM OR BY HIS HOSPITAL DESERT 8 VALLEY 9 A I HAVE TWO LAWSUITS FILED AGAINST ME. ONE IS FROM TO THE HOSPITAL ALONG WITH TWO OTHER EMPLOYEES OF THE 0 TT ORGANIZATION. AND HE ALSO FILED A PERSONAL LAWSUIT AGAINST T2 ME. T3 THESE OTHER TWO EMPLOYEES OF THE ORGANIZATION, DID W4 THEY ALSO TESTIFY UNDER OATH IN A DEPOSITION IN THIS T5 A CORRECT. T6 DOCTOR JEYAKUMAR, YOU TESTIFIED YESTERDAY THAT YOU T7 HAD LISA CROUCH ASSIST YOU ON A FEW OCCASIONS WITH THE T8 INSERTION OE A CHEST T9 A CORRECT. 20 WAS MISS CROUCH COMPETENT TO DO THAT ZT A VERY MUCH. 22 YOU WERE ASKED BY MISS TROPP WHETHER YOU TOLD DOCTOR 23 REDDY ABOUT THE PHONE CALLS YOU MADE ON YOUR CELL PHONE. DO 24 YOU RECALL THOSE 25 A YES. 26 DID DOCTOR REDDY EVER TELL YOU WHO HE CALLED ON HIS