Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 22 of 43 IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OE TEXAS HOUSTON DIVISION UNITED STATES OF AMERICA ex rel. JOYCE RILEY, Plaintiffs vs. CASE NO. Hm94m3996 . ST. ERISCORAL DR ERANISLAV O. ERAEIER, M.D SURGICAL ASSOCIATES OE TEXAS, OF TEXAS HEALTH) SCIENCE CENTER AT SAILOR COLLEGE OE TEXAS HEART AND EDNARD K. MASSIN, N.D., ??Defendants ORAL VIDEOTAPED DEPOSITION 0.51. FRAZIER, M.D. OCTOBER 24 2007 cg: CARIISLE REPORTING 523?. "??ane Street . Texas: 7700'? a ?1'1 1384.44.42. 4 Pm:- 71136444? - Amway 3FAAZIER, MD. Case 49401203996 Document 307-2 Filed in TXSD on 05/05/08 Page 23 of 43 10/24/2007 USA V. ST. Page 1 Page 3 IN THE UNITED DISTRICT COURT 3. APPEARANCES FOR THE SOUTHERN DISTRICF OF TEXAS 2 HOUSTON DIVISION 3 FOR THE PLAINTIFF-RELATOR, JOYCE RILEY: 4 MR. 31M PEROUE, JR. UNITED ewes OF AMERICA ex rei. The Perdue Law Firm 1OYCE RILEY, 3 5 2727 Alien Parkway, Suite 800 Plaintiffs Houston, Texas ?27019 5 Telephone: 713.520.2500 Fax: 713.528.2525 vs. CASE NCL E-mail: jperduejr@perdoelaw.com 3 7 . 's ISCOPAL 3 g: BRANISLAV) 3 9 FOR DEFENDANT ST. EPISCOPAL HOSPITAL: O. HOWARD 10 ?13 Sf?; FREZER SURGICAL 11 3323??: ASSOCIATES OF TEXAS, la? 5 JAIVEASOY OF Texas 77092 SCIENCE CENTER AT HOUSTON) 12 Telephone: 713.529.5622 Fax 713.529.3735 3; Enmaii: sfrazker?ba?rmcom BAYLOR COLLEGE OF 13 "rams 14 JUDGE ANDREW JEFFERSON ?3 ENWTEF AND EDWARD K- 1314 Texas, Suite son l3 ?-03 15 Houston, Texas 77002 Defendants . 15 . FOR uwzveasmr OF TEXAS HEALTH SCIENCE 17 CENTER AT HOUSTON: 18 19 MS. LAURA TRENAMAN ORAL VIDEOTAPEO oeeosmoo OF Andrews Km}, up OH. FRAZER, MD. 20 600 Travis, Suite 4209 OCTOBER 24 2007 Houston, Texas 77002 21 Telephone: 713.220.4783 - Fax: 713.238.7429 Emaii: lauratrenaman?andrewskorth.com 22 23 24 25 Page 2 Page 4 1 APPEARANCES (Cont) 2 3 FOR THE DEFENDANT BAYLOR COLLEGE OF MEDICINE: 4 MS. NANCY LOCKE MS. ANISSA FERRAR 3 5 Fulbright 81 Jaworski, LLP 1301 McKinney ORAL VIDEOTAPED DEPOSITION OF 5 ?0335301139an 77310 FRAZER Telephone: 713.651.5151 - Fax 713.551.5246 .5: -H- 3 - - 7 Email: October 24, 2007 8 9 FOR DEFENDANT DR. BRANISLAV RADOVANCEVIC AND TEXAS HEART mm: zo 11 MA, ERIC WADE Porter 81 Had es LLP ORAL VIDEOTAPED DEPOSITION OF O.H. FRAZIER, 12 moo Main 5,3863, 36th F300, M.D., produced as a witness at the instance of the ?rst? Texas 7:20:68 71 6284 i5 - - - 13 op. one: 713.2 . 4 Faxr" 3.226. Plaintiff and duly sworn, was taken to the am?: Moonewpommedgesmm above?styled and numbered cause on the 24th day Of 14 October, 2007?, from 11:46 am. to 8:48 before ?13: FORMgEiimi?Tm?k?gg$Am K- Laurie Carlisle, Certified Shorthand Reporter 3n and JoAnson. 593]de for the State of Texas, reported by computerized 17 919 Milan. Sutte 1700 machine shorthand at the Offices of The Texas Heart 18 Fax 7112222225 Institute, Malay Room, Houston, Texas, pursuant to the Federal Rules of Civil Procedure and the :3 A LS 0 - provisions stated on the record, or attached hereto. 21 Mr, Nathan l-iewitt, Videographer 22 Ms. 3oyce Riley 23 Mr. Marc Mattsson 24 Mr. Bil! Taylor 25 3 CARLISLE REPORTING 713*8644443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 24 of 43 O.H. FRAZIER, MB. 10/24/2007 USA v, ST. Page 53 Page 55 1 or the ones for the Heart Institute, you 1 Q. Who is Peggy 'Odegaarcl? - 2 know, Marc Mattsson or Mike McGee or these people. I 2 A. Same Peggy must have come I don?t 3 think they're Heart Institute employees. 3 know if she came after Penny, but pretty much -- 4 And some of them were like some of 4 would say she was here by ?85, so and she's been 5 my secretaries, I'm not sure if they were I think 5 with us. 6 during that period of time they were partially 6 Q. Is she also 7 employees of SAT and partially of the Heart 7 A. consistently. 8 Institute. I?m actually not sure. 8 Q. Also a transplant coordinator? 9 Q. Is there anybody that you could identify 9 A. Yes. 10 from SAT, Surgical Associates of Texas, who would 10 Q. Likewise, Ms. Odegaard is an 11 know? 11 A. Yes. 12 A. Well, Bill Taylor or I guess would know. 12 Q. Has she been, regardless of who her 13 Mike McGee would know at the Heart Institute. 13 employer is, working with you in transolant for over 553 14 Q. Do you know a Penny Powers? 14 20 years? 15 A. Yes. 15 A. Yes. 16 Q. Who is Penny Powers? 16 Q. When you talk about transplant coordinators 17 A. That's our'm? she's now our chief 17 keeping some record that then was turned in to the 18 coordinator. We started, as I told you, with just 18 secretary for purposes of billing immunosuppresslve . 19 one nurse and, you know, transplant started in the '19 rounds, would those be people like Penny Powers and j. 20 late '605 and then it stopped from '67 to ?71. First 20 Peggy Odegaard? 21 one was done here in '68 to '71. And then it was 23. A. Yes. - 22 only done at just because of the research of it at 22 . Q. Now, you just mentioned something, and the 23 Stanford and at the Medical College of Virginia under 23 history is somewhat interesting and relevant. Was 24 NIH protocol. But when we started doing it and we 24 the restarting of a dedicated transplant program here 25 did transplants during that period but only as 25 at St. Luke's sometime around 1984? Page 54 Page 56' 1 bridges in patients that we put a pump in. 1 A. No, '82. July the lst'82, when cyciosporine came out 2 ?rst I'm sorry, July the 4th, ?82, because Cooley 3 Barry Kahan and, of course, I was a professor at 3 had to come in from a July 4th party, and he was not 4 the medical school, and I felt like the evidence was 4 happy about it. But you ..- and that was of 5 good enough to start the transplantation again 5 course, we'd put together sort of the essentials of 6 because the immunotherapy was so improved. So that's 6 how the program would be managed, you know, the 7 when we started this program here, and it was the 7 structure. There wasn't any guideposts. 8 only program in the central part of the United States 8 Dr. Kahan and Dr. Van Buren were the 9 from early ?80, until '84, ?85 I think Methodist 9 closest to experts in the United States on the use of 10 started here. 10 Cyclosporine, which was the new immunosuppression 11 But and Penny, I believe, was the 11 which prompted this venture. r" 12 second one employed when we started getting more 12 Q. And we're talking July 1982? 13 patients. I'm not sure when she came. Probably '83 13 A. July 1982. I know we started, perhaps, 14 or ?84. And she's been here the whole time, so she's 14 putting it together probably "the and of '81 or 15 now over all the coordinators. She?s in charge of 15 January, just to put it together. As I said, the 16 the coordinators. 16 only other person involved at that time was Linda 17 Q. To your knowledge 17 Chandler, a nurse. 18 A. I don't know what her title is. 18 Q. You mentioned that at some point in time 19 Q. To your knowledge, is Penny Powers an 19 the distinction between Texas Heart Institute and 20 A. Yes. 20 St. Luke?s, I guess at least in your perception, 21 Q. Sounds like, given that history, that she 21 became more defined? 22 has been and I don't know who her employer has 22 A. Yes. They became there was some 23 been, but she has in some form or fashion worked with 23 agreement initially the Heart Institute, 24 you for over 20 years. 24 Dr. Cooley started in 1962 as a research educational - 25 A. Yes. 25 entity, but it was always melded into St. Luke's. 14 (Pages 53 to 56) CARLISLE 713~864~4443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 25 of 43 O.H. FRAZIER, MD. 10/24/2007 USA v. ST. Page 57 Page 59 1 That is to say, there were no employees of the Heart 1 A. It was the late ?805 I think whenever these 2 Institute, I guess. 2 people were sort of transferred. I actually couldn't 3 And I for exampie, all these 3 tell you, except in reviewing Brano's fiie trying to 4 administrators and the people that I dealt with on 4 sort of look into these things, I .. Jeff showed 5 the transplant fund we alluded to were St. Luke's 5 me -- Mr. McClure showed me that I think in ?89 there 6 administrators and they were we had administrators 6 was communication between the St. Luke's 7 for our lab and that sort of thing. And that changed 7 - administrators and the then Texas Heart Institute 8 with the -- some agreement, some sort of contractual 8 administrators that he would be under the Texas Heart 9 agreement between the Heart Institute and St. Luke's. 9 Institute auspices. So that's 10 I think it was '88. 10 (Exhibit 7 marked) 11 Q. Let me ask you. I have been, during the 11 Q. Let me go through some of those documents ii. 12 course of this case, produced what is amended and 12 with you so that we can understand this. I've marked 13 restated bylaws of the professional staff of the 13 in front of you, Dr. Frazier, Exhibit 7, which is a 14 Texas Heart Institute, which are dated December 5, 14 memo from you to the coordinator of medical education 15 1991. 15 regarding a house staff appointment, correct? 16 First, are you at all familiar with 16 A. Yes. 17 bylaws for theprofessional staff of the Texas Heart 17 MR. Can you give me the big 18 Institute? 18 long the last few digits of the big long number? 19 A. Yes, I'm familiar with that. 19 MR. PERDUE: VESLEH00818. 20 Q. Is December 1991, the time period of this 20 Q. (By Mr. Perdue) This is .. is this your 21 separation and distinction, or is that just a 21 signature on there?_ - 22 coincidence on the document? 22 A. Yeah, I think so. I?m not sure. Either 23 A. It's .. the separation occurred before 23 I signed it or someone I authorized. 24 then. 24 Q. It says head of department or chief of 25 Q. Okay. 25 service. In 1984 when that comes to you, what would Page 58 Page 60 1 A. And I think there was some discussion as to 1 that be referring to? 2 how to define the professional staff of the Heart 2 A. I suppose the transplant service, but we 3 Institute, as far as I can recall generated by 3 had I?m not sure exactly when that was set up as a 4 philanthropic inquiries that Mr. Maley made to 4 separate service at St. Luke's. I don't believe it 5 various foundations, and the foundations wanted to 5 was at that time. But we had circulatory support 6 define who was on the professional staff, and I think 6 service, which we dealt with the balloons and various 7 that's what generated that. So there was a certain 7 forms of circulatory support. So that was probably fi 8 time lag between then and the actual '87 to '88 for a 8 what that referred to. 9 three to four?year period. 9 But mainly this was as things got 10 Q. As I understand it, Texas Heart Institute, 10 busier, we needed, you know, obviously more help 11 when it was set up, perhaps in this split time 11 other than myself and the nurse. And we actually 12 period, is set up as a 501(23 entity? 12 had -- the first one of these persons like this 13 A. I'm not sure. I don't know what that 13 was a French fellow and must have started in July of 14 means. 14 ?83. And then he left and Brand came over from 15 Q. A tax exempt entity? 15 Yugosiavia to work strictly in transplant and devices 16 A. Yes, an educational research entity. 16 because we?ve had a long?standing relationship with 17 That?s its 17 the Heart Institute and in Houston between ourselves Q. Do you have any recollection or 18 and Yugoslavia because their chief was came here understanding of why, to be a tax exempt entity for 19 in the '505 as the chief of all the surgical purposes of philanthropic purposes, you had to de?ne 20 activities, as I recall, in Yugoslavia and trained who professional staff is? 21 with Dr. Debaltey and Dr. Cooley. A. No. 22 So and this came from the chief at Q. When did Texas Heart Institute begin 23 that time who had been here for years and went back offering a fellowship program under its auspices? 24 to Beigrade, and he wanted to start his own MR. WADE: Objection, form. 25 transplant service in Beigrade. And Brano Brano ll ii 15(Page557t060) CARLISLE REPORTING 713-864-4443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 26of48 I O.H. FRAZIER, MD. 10/24/2007 USA v. ST. Page 173 Page 175 1? A. No, I don?t recaii. What do you i mean, 1 If there was something we decided on mutuailyknow he may be asked to look at things or 2 would give the order or the cardiologist would or the i. 3 be asked questions by the feliows and consulted just 3 nephrologist. 4 like, as far as I was concerned, he could do. 4 Q. Wait a second. You?re not you?re not 5 Q. Did you ever see Dr. Radovancevic perform 5 suggesting that if Dr. Radovancevic was on the floor, 6 physical examination on a patient on the transplant 6 either in the ICU or in the post?transplant floor, 7 floor? 7 that you were with him every time? 8 A. I'm sure It did. I don?t recoil during that 8 A. No, I wasn?t with him every time, butI 9 period. He certainly did during the time -- you 9 think usually he was with somebody. He was -. 10 know, we would make rounds. He wouldn't be 10 because he was once we asked him to not do that, I 11 performing physical examinations. We might listen to 11 think he was, you know, very he you know, he 12 the heart or we might ask opinions according to 12 was 32 years old. tie came from a communist country. 13 anyone, heart or whatever. The nurse might 13 He seemed to be very used to authoritarian I never 14 give us opinions, that sort of thing, obviously. 14 saw him write an order. I never once he was told 15 Q. Did you ever see Dr. Radovancevic use a 15 that was to be his role, I think he conformed to 16 stethoscope on a patient? 16 that, as far as I know. 17 A. We sure I did. I don't recall right now 3.7 Q. Was that the instruction as of 1989, that 18 after '88 after we told him he couldn't be 18 Dr. Radovancevic was not supposed to be writing 19 involved in patient care, I don't recall ever seeing 19 orders personally in the chart? 20 him. 20 A. Yes. And he wasn?t -- that was what we 21 Q. Did you ever see Mr. Radovancevic review 21 were told, that he could provide obviously advice 22 the medicai chart on a patient in this time period? 22 from his expertise. People asked him all over the 23 A. Well, he obviously we would review the 23 country. They called from California or Maine or 24 charts and use that as a source of making decisions 24 Boston. We would ask him, too. But he couldn't 25 regarding patient care. And as I said, he was an 25 write or give orders. Page 174 Page 128? 1 expert in the field. I?m sure he looked at the 1 Q. Did you have any further instruction from 2 chart. I don't recall specifics, no. 2 whoever gave it to you regarding what he could or 3 Q. Did you ever see Dr. Radovancevic issue 3 could not do as far as interacting with house staff? . 4 verbal orders on a patient in the ICU 4 A. Other than acting as a resource, 5 A. No. 5 knowiedge a resource of knowledge, it was my 6 Q. after 1989? 6 understanding he could certainly do that. 7 A. No, I don't -- I never saw that. 7 Q. Did you have any further instruction or 8 Q. Did you ever see Dr. Radovancevic issue 8 understanding of what he could or could not do as far 9 verbal orders to a nurse on the post?transplant 9 as interacting with nurses fioor? to floor? 11 A. No. 11 A. Within the confines of what I've just 12 Q. Did you ever see Dr. Radovancevic prescribe 12 stated, it was my understanding he could act as a 13 medications for a transplant patient on the ?oor? 13 resource. .. 14 A. No, not after the period involved. 14 Q. Did you have any understanding of what he 15 I mean .. 15 could or could not do as far as interacting with 16 Q. Did you ever see Dr. Radovancevic prescribe 16 patients? 17 medications on a patient in the ICU after 1989? 17 A. Well, no, I you know, he was always very 18 A. No. 18 cordial and friendly and helpful, I think, to the 19 Q. Did you ever review a chart for which you 19 patients and their families. There was no 20 were supposed to be providing a countersignature 20 stipulation I understood prior to until '96 when 21 which suggested that a verbal order had been given by 21 I -- was that he couldn't write or give orders. 22 Dr. Brano or Dr. Radovancevic? 22 Q. In '96 what happenedknowledge. I mean, we've 23 A. Well, '96 it is my recollection that we 24 looked at charts that when we wetter? the only time i 24 became aware of this iawsuit, and from that time he 25 would be involved is, of course, we were together. didn?t he was instructed not to see patients and 44 "(pages . .. 1N ,m CARLISLE REPORTING 7131-8644443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 27 of 43 O.H. FRAZIER, MB. 10/24/2007 USA v. ST. Page 177 Page 179 1 he didn?t. 1 think? every third night there Would be one of thern on 2 Q. So there was some change as far as what he 2 call. We didn't always have three. Sometimes we had 3 could and could not do or was instructed that he 3 two and they were on every other night. And I was 4 could or could not do in 1996 after becoming aware of 4 always here during that time period. 6 this claim? 5 Q. As of 1991. Dr. Radovancevic?s title was 6 A. Yes. 6 assistant director for cardiovascular research, 7 Q. And what changed? 7 correct? 8 A. Well, he didn't make rounds on the floors. 8 A. Yes. 9 He just .. he would be involved in the transplant 9 Q. Who, other than Dr. Radovancevic, would 10 research and these sort of things, that he was 10 have been a cardiovascular research physician from 11 involved in anyway. Coordinating the research -- you 11 ?91 to '95? 12 know, the protocols, interacting with research 12 MS. FRAZIER: Objection, form. 13 projects. He became more active in the laboratory, 13 MR. Object to the form. 00 14 you know, the animal lab. And more or less confined 14 ahead. 15 to pure research, writing papers and advising on 15 MR. PERDUE: What?s the objection? . 16 scienti?c research related to transplantation. 16 MR. I think you're assuming 17 Q. Do you have an understanding as to why that 17 facts not in evidence. I'll tell youwhat facts if 18 change was made? 18 you want to know. 19 A. The administration said that they thought 19 MR. PERDUE: I'd be curious. 20 it was wise at that point to do that. 20 MR. I think the way you 21 Q. Let me hand you 21 asked that, you're making the statement that Brand 22 A. I don't know whether they did that. 22 qualifies as one of the cardiovascular research 23 (Exhibit 41 marked) 23 physicians in the certainly the way the term is 24 Q. Let me hand you what?s been marked as 24 used in Exhibit 41 when I'm not sure that's 25 Exhibit 41. This is something that?s been produced 25 A. No, he wasn't he wasn?t involved with l- Page178 Page 180 1 to me out of the critical care clinical practice 1 that. That was just a nomenclature, I suppose. This 2 standards manual from St. Luke's Episcopal Hospital. 2 is April '95. We would have we had the records. 3 Page 730. And if you would look over at 7 South 6, 3 i could name whoever was on at that time. 4 the very bottom there. "All cells regarding 4 Q. (By Mr. Perdue) Do you know, Doctor, if the prentransplant patients will be directed to the CCU circumstance ever came up between ?91 to ?95 where a 6 fellow first and then the attending physician." Who 6 nurse in the ICU had a patient for 7 is the CCU fellow. 7 whom she had to go to the call schedule and the call 8 A. Be the cardiology fellow on the cardiology 8 schedule would lead to a call to Dr. Brand? 9 service. 9 A. No, I don?t know of that circumstance. 10 . Q. And then the attending physician, as we 10 Q. Do you think that?s impossible? 11 knew for ore-transplant patients, would generally be 11 A. I don?t know. Anything is possible, but it 12 the cardiologist, correct? 12 shouldn't it wasn't in the -- in our program. 13 A. Yes. 13 i; mean, it wasn't in the way we were directed to 14 Q. "All calls regarding post?transplant 14 or the process. The process was they may as we've 15 patients or patients on IABP or assist devices will 15 discussed, if -- obviously if there was a the 16 be directed to the cardiovascular research physician 16 nurses have the same obligation and oath that we have 17 with the CCU fellow as backup." Did I read that 17 to the patient. If there was something that 18 correctly? 18 I suppose in some sort of dire circumstance that they 19 A. Yes. 19 needed advice, he certainly was experienced and could 20 Q. Who was the cardiovascular research 20 render advice 21 physician as of the ?90 through '95 time period? 21 Q. Let me ask you this 22 A. Well, we would have. we had three 22 A. but he usually wasn?t here I don?t 3 23 physicians through St. Luke?s that were physicians 23 know. tyne assigned to our service, and they would betakingthe assistant director for .25 calls and appeared every day or making rounds, and I 25 cardiovascular research, did Dr. RadovanCevlc ever ., l? CARLISLE REPORTING 713*8644443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 28 of 43 O.H. FRAZIER, MD. 10x24/200?? USA v. ST. Page 233 . . ?Page 235 1 A. No. 1 do. He couldn't do surgery. He couidn?t he? 2 Q. You don?t know one way -- you wouidn't 2 wasn?t involved with any of the surgicai procedures, 3 remember one way or the other? 3 that sort of thing. But I think againresource in the best interest of the patient, he 5 (Exhibit 61 marked) 5 was as that. There's no reason to think 6 Q. Let me show you Exhibit 61, and this is a 6 otherwise. 7 note from October 3, 1993 and timed. If you look at 7 Q. (By Mr. Perdue) Could he he used as a 8 the second time entry from noon, "Dr. Brand was in 8 resource to provide evaiuation and management 9 and toid patient he wooid be getting heart TX, 9 services regarding immunosuppressive therapy in the 10 transpiant, soon. Patient very excited. Went 10 post~transplant period? 11 downstairs." Did I read that correctly? 11 MS. Objection, form. 12 A. Yes. 12 A. Under what context? 13 Q. Was Dr. Brano invoived in patients 13 Q. (By Mr. Perdue) If you 14 under your service the or time iine for 14 A. I mean, these are routine as I said, 15 receiving heart transpiants? 15 routine orders. I don?t know what he could he 16 A. Again, as far as i know, certainly he 16 utilized as a resource for people to ask his thoughts 17 couid I don't know the circumstances of this, but 17 on matters regarding this if there were questions, 18 if somebody asked him and he knew something about it, 18 it's my understanding. 19 I suppose he could answer. 19 Q. So it was your understanding that for a 20 Q. He?d been giving advice for years. In your 20 service to which Medicare was bilied, it was 2-1 opinion, he was qualified and there was no 21 appropriate and acceptabie for residents under your 22 restriction on such? 22 supervision to take the advice and, indeed, institute 23 A. Weii, i -- there's no restriction as far as 23 orders based on Dr. Radovancevic's recommendation? 24 I can say. He was involved as we discussed. 24 MR. Objection to form. 25 (Exhibit 62 marked) 25 MS. FRAZIER: Objection,~form. Page 234 Page 236 1 Q. Exhibit 62 is a page from January 1, 1994 1 A. The orders were not, in my mind, for 2 from the attending cardioiogist. In this case, that 2 biliing. I had nothing to do with that. That was a 3 is Dr. 3ames T. Wilierson, correct? 3 process. It was mereiy knowledge and concerning 4 A. Yes. 4 the patient. It?s the oniy thing I would have been 5 Q. have discussed the situation with concerned about or I'm sure the doctors. Don't know 6 Dr. Frazier and with Dr. Brand.? Do you have some 6 the biliing thing. 7 understanding of whether other physicians such as 7 (Exhibit 63 marked) 8 Dr. Hogan Dr. or Dr. Massin had any 8 Q. (By Mr. Perdue) I?li show you Exhibit 63 9 understanding of whether Dr. Brano had restrictions 9 from June 37, 1994. If you'll look at the bottom 10 on what he could and couid not do? 10 there, can you teli what those orders were for? 11 MS. MADDEN: Objection, form. 11 A. Those are just orders for lab, a daiiy lab 12 A. I have no have no reason to think they 12 of an SMA6, which is, you know, a routine iaboratory. 13 wouidn?t fee! free to ask him for ali the reasons 13 Q. The iast one there purports to be a verbal 14 we've discussed. Just like people ail over the 14 order from Dr. Frazier? 15 country would ask him. 15 A. Yes. 16 Q. (By Mr. Perdue) Do you have -- 16 Q. Is that your signature on that order? 17 A. So I I know in ?89 we went through this 17 A. Looks like as I said, I can?t teli the 18 order thing, and I don?t know that everybody was 18 signature from a stamp, but in general these 1 19 informed of that. I don?t know. 19 Q. In general these are stamps or somebody 20 Q. As of 1994, it would still be your position 20 else signing for you, right? . 21 that the oniy thing Dr. Brano couidn't do would be to 21 A. Yes. 22 write orders on the chart? 22 Q. Somebody had your authority to affix your MS. FRAZIER: Objection, form. 23 signature in June 1994 on orders in Mr. Kinnard?s MR. Objection, form. 24 chart? A. Weil, there?s a iot of things he couidn't 25 A. Something like this, SMA6. 59(Page5233t0236) CARLISLE REPORTING 7136644443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 29 of 43 O.H. FRAZIER, MD. 10/24/2007 USA v. ST. Page 237 Page 239 1 Q. If your personai calendar and conference 1 A. I don't see anything. 2 caiendar shows that you were in Moscow, Russia from 2 Dr. Zeiuff, Dr. Patei. 3 June 6th to June 12th, wouid you have any reason to 3 Q. Did someone have authority to affix your i 4 dispute that? 4 signature to the cardiac transplant immunosuppressive 5 A. I have no reason to dispute it. If such is 5 therapy staff note from that we have here on this 2 6 the case, this was a mistake. 6 first page? 7 Q. Doctor, let me ask you this: If you were 7 A. Again, these were routine and the 8 out of the country and some other doctor was covering 8 coordinators would have signed these. 9 for you, why would it read as a verbai order from 9 (Exhibit 65 marked) 10 you? 10 Q. Let me hand you Exhibit 65, which I beiieve 11 A. I don?t know. I just don't know. I -- if 11 is from the next day, July 11th, 1994. Again, is 12 I were in Moscow .. I?ve been to Moscow. I'm not 12 that your signature on the immunosuppressive therapy 13 sure when the dates were, and I don?t have those 13 note? 14 records anymore. But it?s uniikeiy I would give a 14 A. Yes. 15 verbai order for SMA6, and I don?t even know how that 15 Q. If your personal calendar and conference 16 would be generated. If I were gone, usualiy, as I 16 caiendar shows that you were in Lyon, France on 17 said Macris would cover and he was very assiduous 17 July 11, 1994, do you have any reason to diSpute 18 about covering and dealing with things. 18 that? 19 Q. Can we agree, Doctor, that if you were out 19 A. Same answer. was, then this was 20 of the country or somebody for whom you had coverage 20 obviously a mistake. The wrong .. as I said, there 21 agreements, that it they were making orders on your 21 was a process for the billing which 1w 2.2 behalf or doing things on your behalf, their name 22 Q. Do you recail a feiiow or resident by the 23 would appear in the chart? 23 name of Dr. Pathan, 24 A. Yeswouidn?t read 25 Q. Do you recaii a feilow or resident by the Page 238 Page 240 1 A. So I think this wouid just have to be a 1 name of Dr. Springer? 2 mistake. I don?t know what would generate it or 2 A. Springer was a staff doctor. 3 where they wouid have gotten my name. Or, you know, 3 Q. What circumstance would it be that 4 again, the dates on the -- on my travel do not 4 A. i think there was also a Springer that was 5 necessariiy re?ect the dates I was gone. They may 5 a resident. 6 have been re?ecting just the time of whatever 6 Q. They don?t put their first names on these 7 meeting it was. 7 things. 8 Q. Let me show you 8 A. Yeah. 9 A. So there?s no correlation for sure between 9 Q. What circumstance would it be where a staff 10 that. 10 physician would enter an order and then it would be 11 (Exhibit 64 marked) 11 expected that you would counterSign? 12 Q. Lei: me show you Exhibit 64. Can you teil 12 A. I don?t -- I can?t imagine in all the 13 us if this is your signature on the ?rst page of the 13 orders where that would occur. Again, he a mistake. 14 exhibit? 14 (Exhibit 66 markedShow you Exhibit 66, which are 16 Q. If you'd took at the second page of the 16 physician order forms for Juiy 11th continuing on. ii: 17 exhibit, can you teli us it that's your handwriting .17 A. Wax buiidup in the ears. Springer, yes. 18 or signature on the second page? 18 Q. Debrox used as directed for wax buiidup in 19 MR. Handwriting or 19 ears, verbal order Dr. Springer? 20 signature? 20 A. Yes. 21 A. I don't see signature. 21 Q. And then is that your signature stamp? 22 Q. (By Mr. Perdue) You?ve got a different page 22 A. Yes. As I said, there was 53 Springer that 23 than I'm deaiing with, and I don?t think your 23 was also a resident, but I don't I mean, he couid 24 handwriting or signature appears on that page. On 24 write that aiso, so certainly an order like that 25 the third page of the exhibit do you hav 25 I wouldn?t have to, I don't think, cosign. m? {ur?wlld .1. .-.- of.? 10 CARLISLE REPORTING 713864?4443 FRAZIER, MD. Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 30 of 43 Q. (By Mr. Perdue) I?ll show you Exhibit 67 on 43 10f24/2007 USA v. ST. Page 241 Page 243 1 Q. July -- if you look at the third page, 1 Q. "Can we agree that an order for 10 mill 2 July 11th, there's a verbal order by Dr. Patel for 2 equivalents of potassium chloride would require 3 Dulcolax? 3 somebody to pull it from the pharmacy, administer to 4 A. Yeah. 4 the patient, and that would presumptively result in a 5 Q. Then if you continue on there's a verbal 5 bill for that service on the hospital bill? 6 order for the patient?s discharge on July 13th, a 6 A. Potassium, I don?t know, I guess it would. 7 verbal order from Dr. Patel.. And Dr. Patel was a 7 Q. It's not free? 8 fellow, correct? 8 A. It's pretty minuscule part of the billresident, yeah. 9 would think, but I?m sure it's true. 10 Q. A resident. And then that is your 10 (Exhibit 68 marked) 11 signature stamp on that discharge order? 11 Q. Exhibit 68 is a note at the bottom by the 12 A. Yes. 12 cardiology attending, and that in this case is 13 Q. if your personal calendar shows that you 13 Dr. Willerson, correct? 14 were in Lyon, France on those days, would you have 14 A. Yes. 15 any reason to dispute that? 15 Q. will be away from am." this is dated 16 A. Same response. 16 April 28th "through May 4th. I would like 17 Q. You had given someone the authority to 17 Dr. Brano in transplant service to follow him closely 18 af?x your signature stamp on these orders by 18 in my absence." Did I read that correctly? 19 residents even though you were out of the country? 19 A. Yes. 20 MR. MCCLURE: Object to form. 20 Q. Do you have any understanding how it would 21 A. They had an authority to affix my stamp but 21 be that Dr. Willerson would chart that his the country, it was a mistake. 22 expectation would be for Dr. Brano, along with the (Exhibit 67 marked) 23 transplant service in general, to follow this patient? A. It looks like his signature. Doesn?t look like a stamp. patient Kinnard here. This is a physician order form 25 A. Well, as I said, I'm sure that - Page 242 Page 244 1 from April 24, 1994, plus which would be potassium 1 Dr. Willerson is one of the most respected I 2 now, correct? 2 cardiologists in the world, he would think that 3 A. Potassium, yeah. 3 Dr. Brano, who is one of the most knowledgeable 4 Q. Give 10, is that 4 people in transplant, could do it. He probably 5 A. Mill equivalents of KCL times two. 5 didn?t know anything about or if he knew 6 Q. Okay. Does that read as verbal order 6 anything -- this is '94. The situation changed in 7 Dr. Brano to S. Rutledge, 7 '89. Again, I think he was probably thinking about 8 A. Yes. 8 the care of the patient and not realizing that 9 Q. Do you know how it would be that Dr. Brano 9 Dr. Brano couldn't give orders. 10 would be giving a verbal order for potassium chloride 10 Q. i?m not sure Dr. Massin would agree with 11 on April 24, 1994 on patient Kinnard? 11 that assessment, but regardless of that 12 A. No. 12 MS. MADDEN: Objection, form. 13 Q. Is that your signatur 13 (Exhibit 69 marked) a; 14 A. I can?t recall the cardiologist on Kinnard. 14 Q. Let me show you Exhibit -- 15 Q. Does that look 15 MR. Strike that comment. 16 A. There?s a signature stamp on the next one. 16 Q. (By Mr. Perdue) This is a note from patient 17 Q. That?s your signature stamp on the second 17 Kinnard from May 25, 1994. It starts at 7:00 pm, 18 one? 18 correct, according to the top there? May 25th at the 19 A. Yeah. 19 very top. Time is not relevant. May 25th, correct, 20 Q. Do you know it that' 3 actually 20 Doctor? 21 Dr. Willerson 3 personal signature on the first one, 21 A. Yes, it seems. 22 the verbal order Dr. Brano? Idon't expect you to 22 Q. Now, according to the billing records that know Dr. Willerson's signature. 23 we looked at earlier, patient Kinnard was transplanted on May 24, 1994. Do you recall that? Accept that(Pages 241t0244) CARLISLE REPORTING 713?864-4443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 31 of 43 O.H. FRAZIER, MB. 10/24/2007 USA v. ST. - Page 245 Page 247 1 A. I'li accept it. 7 1 the transplant charge has within it a a 2 Q. This is post?transpiant day one. Fair? 2 presumption that the charge is for a bundie of 3 A. Yes. 3 postoperative services as well, correct? 4 Q. If you'll look at there's an entry - 4 A. Yes, I know that now. i?m not sure I knew 5 starting on the ?rst page here beginning at 19:00 or 5 it then. 6 7:00 pm. and continuing on to the second page. At 6 (Exhibit 70 marked) 7 the end of the entry from time 7:00 pm, it says, 7 (2. Let me show you Exhibit 70 on patient 8 "Dr. Brand at bedside, hemoglobin 12.1, Albumin 8 Kinnard, which is a nurse flow sheet from May 31, 9 28 percent, 200 cc?s IV ordered, and to transfuse two 9 1994. Again, this patient was transplanted on 10 units of packed red biood ceils. Dopamine aiso 10 May 24, so we?re postoperative day seven, correct? 11 restarted at 2 micrograms per kilogram per minute." 11 If you?ii turn with me, Doctor, to the 12 Did I read that correctly? 12 second page of the exhibit, at 6:45 the note says, 13 A. Yeah, I assume 13 "Dr. Radovancevic at bedside check PM 3P, no 14 Q. Do you know how it wouid be that 14 underiying noted. Also checked PM. Not 15 A. I can?t say. 15 capturing 100 percent. Order obtained to have PM on 16 Q. Do you know how it would be that Dr. Brano, 16 standby at bedside." There's a monitor that is used 17 or Mr. Radovanceyic would be at the bedside of 17 on patients such as this to capture their cardiac 18 patient Kinnard on day one entering 18 correct? 19 orders for Albumin, packed red biood cells and 19 A. Yes. 20 Dopamine? 20 Q. That?s a piece of equipment for which 21 A. Weil, I -- same response. I know it was 21 presumptively a patient is Fair? 22 he could have been there with a resident, I don't 22 A. Well, yeah. We had it on these 23 know, or a feiiow and that's the way they recorded it 23 patients post?transplant. They would have patient 24 inappropriately, or they may have just not known. 24 wires and a pacemaker at bedside. I don't see 25 This was ?ve years after the again, I never saw 25 anything unusual about that. They frequently wouid Page 246 Page 248? 1 Brand write an order. These are just things the 1 have no -- i" 2 nurses interpreted. 2 Q. Would it be 3 Q. This note does not reference anybody other 3 A. in the postoperative, post?transplant 4 than Dr. Brano at bedside, correct? 4 period, so . 5 A. Weii, it appears Dr. there's severai 5 Q. Wouid it be your expectation that 6 doctors mentioned at the bedside. Dr. Wilkerson at 6 Dr. Radovanceyic would go to the bedside of a patient 7 bedside and 7 such as Mr. Kinnard and check that? 8 Q. Other services, correct? 8 A. Certainty. I mean, if he were around or 9 A. So there's plenty of other doctors around. 9 whoever was around at the time, the residents, 10 In the ICU, there were always doctors around. 10 certainly he could -- my understanding, that would be 11 Q. At 10:10 there is a note, "Dr. Brano at 11 something you would check routinely and you?d want to 12 bedside, cardiac output seen with adequate numbers. 12 make sure they had a pacemaker. Idon't know, again, 13 Vent change settings were noted and arteriai biood 13 the particular circumstances. 14 gases in 30 minutes noted." Did I read that 14 Q. Under what authority would it be that 15 correctiy? 15 Dr. Brano would be at the bedside checking the 16 A. Yes. 16 monitoring of the cardiac on a post-transplant 17 Q. Did you know that your service, Surgical 17 patient? . 18 Associates of Texas, billed on May 25, 1994 a CPT 18 A. The same authority that they said he was 19 code of 99232 with a modifier of 24 for 19 he could be sought advice on. He?s one of the most 20 immunosuppressive therapy rounds? 20 experienced physicians in the ?eld. 21 A. No. As I said, that was a process. But 21 Q. Experienced in cardiac 22 1 don't know who was making rounds then or who was 22 A. Certainly after transplants. 23 doing the transplant. 1 mean, I did the transplant 23 (Exhibit 71 marked) 24 in most of these cases. 24 Q. Let me show you Exhibit 71. And this is 25 Q. I understand that. And you understand that 25 from June 1, 1994 for which your service 62 (Pages 245 to 248) CARLISLE REPORTING 71343644443 FRAZIER, M.D. Case Document 307-2 Filed in TXSD on 05/05/08 Page 32 of 43 10/24/2007 USA v. ST. Page 249 Page 251 1 9923124 on that day for immunosuppressive rounds. Do 1 A. Yes. .. i 2 you recall that from the bill? 2 Q. Have you ever seen this record before? 3 MR. Object to form on that 3 A. I don?t recall. We reviewed some of these 4 one. 4 with Jeff, but I don't recall it. 5 Q. (By Mr. Perdue) You want me to show you the 5 Q. How would it be that a verbal order would 6 bill, Doctor? Let me show you the exhibit. It's the 6 be written verbal order Or. Radovancevic and then 7 very iast charge down there at the bottom, it you see 7 your name above it? 8 June 1, 1995iL and 9923124. Do you see that? 8 A. We were both there, I suppose. 9 A. Yeah. 9 Q. If you were both there, how would a nurse 10 Q. That?s the evaluation and management charge 10 write down an order where you?re the attending 11 for immunosuppressive therapy that we talked about 11 physician as if it?s coming from Dr. Radovancevic? 12 before, correct? 12 A. What's 5 13 A. Yes. 13 Q. Well, we just 14 Q. Now, we just iooked at this ICU nursing 14 A. I I mean, I don't know why. You have to 15 record regarding having the pacemaker on standby at 15 ask the nurse why she would do that. I don't know. 16 the bedside, right? 16 Q. Let's go back to Exhibit 70. In the time 17 A. When. 17 entries of this nurse in the 10.), there's no mention 18 Q. If you look at the exhibit that we?ve just 18 of you being at the bedside, correct? If you look at 19 marked, 71, at the ?rst order form here, it?s 19 Page 2. 20 3une ist, '94, 6:45 a.rn., and the first order is have 20 A. Yeah. PM, pacemaker, on standby at bedside, correct? 21 Q. We read that entry before, 6:45 A. Yes. 22 Dr. Radovancevic at bedside? Q. The second order is Solurnedroi 15 23 A. Yeah. milligramsf20 15 on an Show 24 Q. It does not say Dr. Radovancevic and Q, correct? 25 Dr. frazier at bedside? Page 250 Page 252 A. Yes. 1 A. It doesn't. You know, I have no idea. Q. And Solumedrol is a steroid therapy used in 2 Q. And we now have this order from June 1, postoperative period? 3 1994 at 6:45 am. conforming exactly to this idea of A. Yes. 4 the pacemaker on standby, correct? Q. The second order, on June 2nd, the next 5 A. Yeah. clay, Solumedroi 15 milligrams, 12 milligrams, 6 And I?m sorry. I don?t feel weli. 15 milligrams on an 8-hour Q, correct? 7 Q. I understand, Doctor. Step out. A. Uh-huh. 8 A. I'm going to have to leave you. I?m sorry. Q. Solumedroi would be a medication which 9 Best of luck. I'll be happy to come back at some requires a physician order, correct? 10 . other time, but right now I don't feei well. A. Yes. It is part of our protocols. 11 Q. I can teil you that Fit be done in five Q. Part of the immunosuppressive protocol, 12 minutes, if you want to stay. But if you want to go, correct? 13 that?s fine. A. Yeah. 14 A. Weil, I need to lie down a few minutes. Q. It would require that somebody would pull 15 Maybe give me 15 10 or 15 minutes and come such medication from the pharmacy at St. Luke's 16 back. Episcopai Hospital, correct, to be administered? 17 THE VIDEOGRAPHER: The time is 7:46. A. Yes. 18 We?re off the record. Q. And presumptively that wouid iead to a 19 (Recess taken) charge on the hospital bili? 20 THE VIDEOGRAPHER: The time is 8:11. A. Yes. 21 We're now on the record. Q. Now, this says verbal order 22 Q. (By Mr. Perdue) Dr. Frazier, did you ever Dr. Radovancevic, and then it?s written in above his 23 hear any of your colieagues refer to Dr. Radovancevic name Dr. Frazier, signed off on by an M. Falkenberry 24 as Dr. Brano or Dr. Radovancevic? I and then your signature stamp, correct? 25 A. Well, yeah, he would be cailed that. There 63 (Page5249t0252) CARLISLE REPORTING 713?864'4443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 33 of 43 O.H. FRAZIER, MD. 10/24/2007 USA v. ST. . Page 257 Page 259 1 administrationwooid have to give you the process 1 being in the ICU, which was increased cost for the 2 there. There's certain heart transplant centers have 2 hospital. 3 Medicare approval and the bulk of them do not. Ours 3 Q. Were you personally involved in changing 4 does. 4 the UNOS criteria which deleted the patient being in Q. Is the function one of the aspects 5 the ICU on a Dopamine drip as leading to a status one 6 looked at as far as Medicare approval for heart 6 designation? i 7 transplantation the volume of the service? 7 MS. FRAZIER: Objection, form. 8 A. Yes. 8 A. Patients being in the ICU, and that in 9 Q. Do you know of any heart transplant service 9 itself was reasonable why they were in ICU didn't 10 that has the volume that this service has? 10 have to he Dopamine or anything else. It had to 11 MS. FRAZIER: Objection, form. 11 he the it was the judgment of the physician taking 12 A. Well, yes, some of the academic services. 12 care, which we assumed would be -- his primary 13 UCLA does now and Columbia and Cleveland Clinic. But 13 commitment would be to the patient and that would .. 14 as I said, this hospital, other than myself I was 14 that was the original. 15 never in private practice per se, but it's a private 15 Now, sometime in the mid ?905, as with 16 hospital in general. So I think it has the largest 16 the proliferation of the programs, they began a i? of a private hospital. And about the fourth we 17 more we've tried to establish a a more 18 usually are the fourth or ?fth in the country, 18 specific and that's when the drugs themselves 19 something like that. 19 became involved. The drugs themselves weren't 20 Q. (By Mr. Perdue) Do you know when the UNOS 20 involved at this time. It was just whether they were 21 criteria for a status one patient as it regards the 21 in the ICU or not. 22 use of Dopamine in the ICU was changed? 22 And it's my recollection that 23 A. Well, I set up the original criteria with 23 because I was chairman of the committee again I 24 the group in with affiliated with Stanford and 24 don't have my CV with the years, but in the '903 also some of the other. And I think that was ?85 to '87 25 we were still working on the criteria, the various Page 258 Page 260 we set up the status one, status two and status 1 status. And it's been changed several times over the three. And then that was changed. Just iterations 2 last decade, It would think, having to do with ., of it were introduced sometime in the mid ?905 and 3 particularly with the wider use of pumps. The LVADs, the -- and they changed it now so that it's actually 4 we've changed that a few times. I was always very convoluted. But I believe that process at the 5 consulted on that. And so there have been a number start ?w I would have to refer to the records, but I 6 of iterations. And I didn't anticipate this think sometime in the mid ?905. And at this time 7 I couldn?t find that when it actually started, but my it's just status one, status two, status three, as I 8 recollection it was sometime in the mid '905. recall. 9 Q. (By Mr. Perdue) And I have a CV from '03. Q. To your understanding, can a patient reach 10 And let me ask you, Doctor, it you have any status one as of the mid ?905 time period simply by 11 recollection of giving presentations to cardiologists being in the ICU on Dopamine? 12 with privileges at St. Luke's Episcopal Hospital A. Being in the ICU, that was something we 13 regarding achieving status one designation for worked on for nearly a year and we decided that that 14 patients for heart transplantation? was the best way to regulate it, because we assumed 15 A. No. that the hospital itself, since they had -- would 16 Q. Do you ever have any recollection of giving they always lost money on heart transplants, or at 17 presentations to cardiologists regarding the UNOS least in that period, but they had a set DRG. And 18 criteria for heart transplantation? the longer they were in the ICU, the hospital itself 19 A. Well, no. It may have come up in some would regulate it. 20 presentations. I've given a number of presentations And we, of course, recognized that the 21 on this. I don't recall. As I said, took us a year f; individual physician had to do the best thing he 22 meeting in Chicago to decide on what we thought was thought for his patient and what we had no 23 the simplest classification, which was the status regulatory system within UNOS other than the local 24 one, just the three classifications. hospital." "entire? course-the- status? one ?involved -- - yearrecaii,? -. V. . 65 (Pages 257 to 260) CARUSLE REPORTING 713*864?4443 Case 4:94-cv-03996 Document 307-2 Filed in TXSD on 05/05/08 Page 34 of 43 O.H. FRAZIER, MD. 10/24/2007 USA v. ST. . Page 261 Page 263 1 as best as you recall, regarding what administration 1 that would be untoward. (. 2 told you in 1996 about how Mr. Radovancevic?s work or 2 Q. (By Mr. Perdue) if someone, some nursing - I 3 authority had to change? 3 person at St. Luke?s says that they were told during 4 A. Well, I .. my recollection was just as I 4 this time period from '88 to '95 that if Brano gives 5 said, that prior from '89, it?s my understanding he 5 you an order, to write it down as a verbal order from 6 could continue to make rounds, continue to be asked 6 the fellow or Dr. Frazier, you have no reason to say 2 advice and utilized as a resource for patient care 7 that did not occur? 8 and but couldn't write orders and couldn't .. 8 MS. FRAZIER: Objection, form. 9 wasn't to write or give orders and that .. I think my 9 A. I have no reason to think it did occur, one 10 recollection came from whoever it was with Medicare 10 way or the other. I have no knowledge of that. 11 that started it up in the first place. 11 Q. (By Mr. Perdue) Do you have any knowledge 12 But after '96, this suit was fiied 12 one way or the other about nurses being counseled on ii 13 which, of course, I didn't we none of us knew 13 how to interact with Mr. Radovancevic? :3 14 anything about that. And then the hospital I 14 A. No. 15 can't I don?t recall who I think my 15 Q. Personally, you don't have that knowledge? 16 recollection it was Carol Edwards who was our CV 16 A. No. 17 administrator said he shouldn't make rounds, couldn't 17 Q. If someone says -- 18 be making rounds on the floor. inst until this thing 18 A. You might 19 was resolved I think. Idon?t think anybody 19 Q. I?m sorry? 20 anticipated this going on this length of time but 20 A. It?s my recollection, although I've never 21 Q. I can agree with that. 21 seen a memo or anything to that effect, that there 22 A. We at that time so, you know, we just 22 was some information sent out in '89 when this came 23 had other set up other systems. And, you know, 23 out that he couldn?t give orders, but that's all. 24 Brano was still active certainly, as I mentioned, in 24 Q. Do you have any recollection of why, if it 25 the research iab and dealing with the research 25 was an issue in '89, somebody would handle it in some Page 262 Page 264' protocois and that sort of thing. 1 way other than in writing? i" 2 Q. Okay. 2 A. Pardon me? 3 A. But he didn?t make rounds. 3 MS. FRAZIER: Objection, formthat I tie that back up. 4 Q. (By Mr. Perdue) Do you have any 5 Prior to that change in 1996, we can agree that 5 appreciation why, if this came to everybody's 6 Dr. Radovancevic was making rounds on patients on the 6 knowledge in 1989, it was handled in some way other 7 transplant floor? 7 than in writing? 8 A. Yes. 8 MS. FRAZIER: Objection, form. 9 Q. He was consulting with feiiows, residents 9 A. Well, I nobody ever wrote me. They told 10 and other physicians regarding drug therapies? 10 me to tell Brano not to write orders. I told him not 11 A. Well, he would be available for advice on 11 to write orders, and as far as I know he never wrote 12 the rounds and that sort of thing. 12 another order. 13 Q. And he was interacting in different aspects 13 Q. (By Mr. Perdue) If someone says that they 14 with the patients themselves, correct? 14 were ordered by Dr. Brano to give OKT3 in 1993 or 15 A. Yes. 15 1994, would you have any way to say that such a thing 16 Q. We have seen 16 did or did not occur? 17 A. Just as a again, for the best interests. 17 MS. FRAZIER: Objection, form. 18 Q. We?ve seen a host of records to that 18 A. Iwouid have no way of knowing one way or 19 effect. ?there?s no reason that you?re going to 19 the other. I think that would be unlikely because 20 suggest that these records regarding nurses 20 I used the OKTB. I had a lot of experience with 21 interacting with Dr. Brand or Dr. Brano at bedside 21 it, so I was generally involved in that particular 22 are all incorrect or mistakes? 22 drug. 23 MS. FRAZIER: Objection, form. 23 Q. (By Mr. Perdue) If transplant fellows were 24 MR. Form. 24 interacting with post~transplant patients for whom ?26w A .3. dome-think-anyone would have thought making patient-care. 66 (Pages 261 to 264) rx .1'4'lu Tr "t r? ugu 3.1 we. CARLISLE REPORTING 713?864-4443