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EXHIBIT C

UTH~i~lth

Med1cl!ll School

The University of Texas

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Ho.dlth Scittnc.1< Center dt Houston

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Tomas G. Rios, M.D.
4000 Essex Ln, Apt 6312
Houston, Texas 77027

Notice of Non-Reappointment and Rescission of Appointment

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Dear Dr. Rios:

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After careful consideration of your performance history, I have determined that you lack the minimum
competencies that are essential for continuation in the program. On December 6, 2013, we met to discuss
concerns that had been expressed to me about your performance. Specifically, we discussed issues ·
regarding your patient care in the continuity clinic and professionalism in the patient setting with Dr. Bela
Patel and Dr. JB Durand. At that time we discussed that I would monitor your performance and obtain
feedback from your attending physicians and ancillary staff regarding your performance.

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Since that time, I have received further expressions of concern regarding your progress. These instances
stemmed from your March 2014 CCU rotation. The first concern was a letter that I received on March 26,
2014 from Dr. Richard Smalling. In that letter, he indicated that your performance was "substandard and
antagonistic." Based on his interactions with you while on the CCU, he had very serious concerns and
reservations about your ability to handle patient care responsibilities. In addition, he indicated that he was
not comfortable with you in the catheterization lab given your poor judgment. The second concerning
communication I received came from a faculty member in a different division within Internal medicine and
consulting in the CCU. The concerns expressed related to poor patient care on multiple patients. This
particular physician considered your clinical decision making to be deficient and demonstrating a lack of
understanding of critical care medicine. The third set of concerns that I received were from the 360 degree
evaluation from nursing staff in the CCU. The majority of the statements characterize you as confrontational.
disrespectful to the staff and physicians, as well as having difficulty communicating with the nursing staff
and other members of the healthcare team. Finally, and most recently, I received a letter from your March
2014 CCU attending concerning your ability to care for patients during the CCU rotation. He notes serious
concerns regarding your performance. including the failure to understand your limitations and notify your
attending of escalating patient issues.
Based on your performance, the faculty and I believe you do not possess the clinical competencies necessary
to function effectively in the Cardiovascular Diseases Fellowship Training Program; specifically, the
application of your knowledge as well as professional standards are below the level required for a PGY-4
fellow.
Consequently. this letter serves as notice to you of your non reappointment to the UT Medical School at
Houston Cardiovascular Diseases Training Program. effective July 1. 2014

UTHSCH-000002

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Medical School

The University of Texas

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Additionally. this letter also serves as notice to you that your appointment for the July 1. 2014 - June 30.
2015 appointment term is hereby rescinded.
Your last day of duty with the Program and employment by The University of Texas System Medical
Foundation is June 30, 2014 During your remaining months in the program, you will be required to report
daily, both at the beginning and end of your rotation(s), to your attending for the month as follows:

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May 2014 - MD Anderson: Report to Dr. Nada Memon
June 2014 - LBJ Consults: Report to Dr. John Higgins

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Margaret 0. Uthman, M.D.
Associate Dean for Educational Programs
6431 Fannin Street, JJL 310
Houston, Texas 77030

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The Graduate Medical Education Resident Handbook found online at
http://med. uth. tmc .edu/administration/edu programs/Assets/documents/gme/GM E-2013 ·2014Handbook.pdf outlines the terms of your agreement with your employer, The University of Texas System
Medical Foundation, including your right to request a review by a subcommittee of the Graduate Medical
Education Committee of the Program Director's decision to not reappoint you and rescind your future
appointment. Such review would be limited to the sole question of whether you were given the requisite
notice and guidance by the Program Director and faculty prior to this decision. Should you desire such a
review, a request to that effect must be delivered, within seven days of this letter to:

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We regret that this serious but appropriate action has become necessary, and wish you the best in your
future endeavors.

cc:

Margaret 0. Uthman, M.D.
David McPherson, M.D.

My signature below acknowledges that I received a copy of this letter.

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Signature

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