275-283 D MSJ Opp

Case 1:07-cv-00026-OWW-TAG Document 275 Filed 12/01/2008 Page 1 of 29
1 Eugene D. Lee (SB#: 236812)

LAW OFFICE OF EUGENE LEE
2 555 West Fifth Street, Suite 3100
Los Angeles, CA 90013
3 Phone: (213) 992-3299
Fax: (213) 596-0487
4 email: elee@LOEL.com
5 Attorney for Plaintiff
DAVID F. JADWIN, D.O.
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8 UNITED STATES DISTRICT COURT
9 EASTERN DISTRICT OF CALIFORNIA
10 FRESNO DIVISION
11 DAVID F. JADWIN, D.O., Civil Action No. 1:07-cv-00026 OWW TAG
12 Plaintiff, PLAINTIFF’S OPPOSITION TO
DEFENDANTS’ MOTION FOR SUMMARY
13 v. JUDGMENT
[Fed. R. Civ. P. 56(e)]
14 COUNTY OF KERN, et al.,
Date: January 12, 2009
15 Defendants. Time: 10:00
Courtroom: U.S. Dist. Ct., Crtrm. 3
16 2500 Tulare St., Fresno, CA
17 Complaint Filed: January 6, 2007
Trial Date: March 24, 2009
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
Π’S OPPOSITION TO ∆s MOTION FOR SUMMARY JUDGMENT 1
1 Table of Contents
I. EXECUTIVE SUMMARY ................................................................................................................ 1
2 A. Credential Threat .......................................................................................................................... 1
B. Forced Full-Time Leave ............................................................................................................... 1
3 C. Demotion and Paycut ................................................................................................................... 2
D. Administrative Leave ................................................................................................................... 2
4 E. Nonrenewal .................................................................................................................................. 3
II. ARGUMENT ...................................................................................................................................... 4
5 A. THRESHOLD ISSUES ................................................................................................................ 4
1. Defendants’ Spoliation of Evidence Creates an Adverse Inference Avoiding Summary
6 Judgment ............................................................................................................................................. 4
2. Defendants Failed to Plead Affirmative Defenses ................................................................... 7
7 B. Adverse Employment Actions Common to Counts ..................................................................... 7
C. COUNTS 1 & 2: Whistleblower Retaliation................................................................................ 8
8 1. October Conference .................................................................................................................. 8
2. PCCs ......................................................................................................................................... 9
9 3. Radical Prostatectomy .............................................................................................................. 9
4. Martinez Tipoff......................................................................................................................... 9
10 5. Skull Flaps .............................................................................................................................. 10
6. Smear Campaign..................................................................................................................... 10
11 D. COUNTS 3 & 4: Medical Leave Retaliation ............................................................................. 10
E. COUNTS 4 & 5: Medical Leave Denial/Interference ................................................................ 13
12 F. COUNT 9: Deprivation without Due Process ............................................................................... 14
1. Demotion ................................................................................................................................ 14
13 2. Admin Leave .......................................................................................................................... 15
3. Nonrenewal ............................................................................................................................. 16
14 4. Qualified Immunity ................................................................................................................ 17
5. Stigma ..................................................................................................................................... 18
15 G. COUNTS 3, 10 AND 11: Oppositional/Participatory Retaliation ............................................. 18
H. COUNT 6: Disability Discrimination ........................................................................................ 20
16 I. COUNT 7: Failure to Accommodate ............................................................................................. 23
J. COUNT 8: Interactive Process ...................................................................................................... 24
17 III. CONCLUSION .............................................................................................................................. 25
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Π’S OPPOSITION TO ∆s MOTION FOR SUMMARY JUDGMENT i
1 Table of Authorities
2 Cases
Aerel, S.R.L. v. PCC Airfoils, LLC (6th Cir. 2006) 448 F3d 899, 907–908 ............................................. 19
3 Ayoob v. Ayoob (1946) 74 Cal.App.2d 236, 250-251 ............................................................................... 15
Bachelder v. America West Airlines, Inc., 259 F.3d 1112, 1124 (9th Cir. 2001) ............................... 11, 12
4 Bank of Ill. v. Allied Signal Safety Restraint Systems (7th Cir. 1996) 75 F3d 1162, 1169 ....................... 19
Block v. City of Los Angeles (9th Cir. 2001) 253 F3d 410, 419, fn. 2 ...................................................... 19
5 Blumer v. Madden (1932) 128 Cal.App. 22, 24 ........................................................................................ 15
Board of Regents v. Roth 408 U.S. 564, 578 n.16 (1972) ........................................................................... 8
6 Bowen v. Missouri Department of Social Services, 311 F.3d 878, 884 (2002) ........................................ 23
Brewster v. Bd. of Educ. 149 F.3d 971, 987, fn.9. (9th Cir. 1998) ........................................................... 17
7 Brown v. Sierra Nevada Memorial Hospital 849 F.2d 1186 (9th Cir. 1988) ........................................... 22
Byrnie v. Town of Cromwell, Board of Ed. (2nd Cir. 2001) 243 F3d 93, 107 ............................................ 4
8 California Fair Employment and Housing Commission v. Gemini Aluminum Corp. 122 Cal.App.4th
1004 (2004) ............................................................................................................................................. 1
9 City of Moorpark v. Superior Court, 18 Cal.th 4th 1143 (1998) ................................................................. 21
Colarossi v. Coty USA, Inc. 97 Cal. App. 4 1142 ................................................................................... 10
10 Dee v. Vintage Petroleum, Inc. (2003) 106 Cal.App.4th 30 ..................................................................... 23
Deschene v. Pinole Point Steel Co. (1999) 76 Cal.App.4th 33 .................................................................. 3
11 EEOC v. Board of Governors (7th Cir. 1992) 957 F.2d 424 ...................................................................... 3
EEOC v. Sears Roebuck Co. (4th Cir. 2001) 243 F.3d 846, 853 .............................................................. 22
12 Humphrey v. Memorial Hosps. Assn. (9 Cir. 2001) 239 F. 3d 1128, 1139-1140 ..................................... 21
Kimbro v. Atlantic Richfield Co. 889 F.2d 869 (9th Cir., 1989) ................................................................. 1
13 Logan v. Zimmerman Brush Co. (1982) 455 U.S. 422, 430 ..................................................................... 16
Lujan v. Minagar 124 Cal.App.4th 1040, 1045-46 (2005) ......................................................................... 9
14 McDonnell Douglas v. Green, 411 U.S. 792 (1973) ................................................................................ 22
Mendiondo v. Centinela Hosp. Medical Center 521 F.3d 1097, 1105 (9th Cir. 2008) .............................. 8
15 Mora v. Chem-Tronics Inc., 16 F.Supp. 2d 1192, 1202, 1217 (S.D. Cal. 1998) ...................................... 13
Morgan v. U.S. Xpress, Inc., 2006 U.S. Dist. LEXIS 36195 (M.D. Ga. June 2, 2006) .............................. 4
16 O’Mary v. Mitsubishi Electronics of America, Inc., 59 Cal. App. 4th 563, 574-75 (1997) ..................... 22
Payne v. Norwest Corp. (9th Cir. 1997) 113 F.3d 1079, 1080 .................................................................. 22
17 Perry v Sindermann 408 U.S. 593, 602 (1972)..................................................................................... 8, 17
Richards v. CH2M Hill, Inc. 26 Cal. 4th 798, 803 .................................................................................... 10
18 Roberts v. College of Desert 870 F.2d 1411, 1416 (9th Cir. 1988) .................................................... 14, 17
Roth v. Veteran’s Admin. of United States 856 F.2d 1401, 1409 ....................................................... 16, 17
19 Schneider v. TRW, Inc. (9th Cir. 1991) 938 F.2d 986, 990–991................................................................. 7
Shoemaker v County of Los Angeles (1995 2d. Dist.) 37 Cal.App.4th 618, 630 ...................................... 16
20 Transworld Airlines v. Thurston, 469 U.S. 111, 105 (1985) .................................................................... 22
Williams v. Shenango, Inc. 986 F. Supp. 309, 320-21 (W.D. Pa. 1997)................................................... 13
21 Zubulake v. UBS Warburg LLC (SD NY 2004) 229 FRD 422, 432........................................................... 4
Statutes
22 29 U.S.C. § 2615(b) .................................................................................................................................. 18
Cal. Gov’t C. § 12945.2 ............................................................................................................................ 13
23 Cal. Gov’t Code §§ 12926.1(c) ................................................................................................................. 21
Cal. Gov’t. C. § 12940(h) ......................................................................................................................... 18
24 Cal. Gov’t. C. §§ 12900 to 12996 ............................................................................................................. 18
Cal. Gov't. Code 12926(i)(1)(B) ............................................................................................................... 21
25 Cal. Health & Safety Code § 1278.5........................................................................................................... 8
Cal. Health & Safety Code § 1278.5(b)(1)(A) ............................................................................................ 8
26 Cal. Health & Safety Code § 1602.5........................................................................................................... 9
Cal. Health & Safety Code § 1635.1......................................................................................................... 10
27 Cal. Health & Safety Code 1278.5(d) ......................................................................................................... 8
Cal. Labor Code § 1102.5(e)....................................................................................................................... 8
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Π’S OPPOSITION TO ∆s MOTION FOR SUMMARY JUDGMENT ii
Cal. Labor Code § 1102.6 ........................................................................................................................... 8

1 U.S.C. § 2615(b)(1) .................................................................................................................................. 18
2 Other Authorities
Adv. Comm. Note to 2006 Amendment to FRCP 26(b)(2) ........................................................................ 4
3 Judicial Council of California Civil Jury Instructions No. 2600 .............................................................. 13
Regulations
4 2 Cal. Code of Regs. § 7297.1(2).............................................................................................................. 13
2 Cal. Code of.Regs. § 7297.7 .................................................................................................................. 11
5 2 Cal.Code.of Regs. § 7287.8(b)..................................................................................................... 7, 11, 18
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Π’S OPPOSITION TO ∆s MOTION FOR SUMMARY JUDGMENT iii
1 I. EXECUTIVE SUMMARY
2 Plaintiff David F. Jadwin (“Plaintiff” or “Jadwin”) is a disabled doctor who was formerly chair
3 of the Pathology department at Kern Medical Center (“KMC” or “hospital”), a large 60-doctor acute
4 care teaching hospital that is owned and operated by Defendant County of Kern (“Defendant County” or
5 “County”). [Plaintiff Material Fact (“PMF”) 5, 30]. Plaintiff’s major depression disability was known to
6 his employer as early as 2003. [Separate Statement in Support of Defendants’ Motion for Summary
7 Judgment (Doc. 259), Defense Material Fact (“DMF”) 62, 63, 64].1
8 A. CREDENTIAL THREAT
9 After Plaintiff began blowing the whistle to his employer and, later, outside agencies, regarding
10 serious patient care issues and regulatory noncompliance, Plaintiff was subjected to retaliation. In
11 October 2005, Defendant County informed Plaintiff of its decision to place letters of reprimand into his
12 physician credentialing file (“Credential Threat”). [PMF 40-42, DMF 106]. The unwarranted Credential
13 Threat led to a recurrence of his chronic depression disability which necessitated medical leave. [PMF
14 75]. Plaintiff notified his employer in January 2006 of his need for medical leave and was thereafter
15 granted reduced work schedule medical leave whereby Plaintiff was permitted to work 2 to 3 days per
16 week. [PMF 13, 121]. Beginning January 2006, Defendant County did not pay Plaintiff for the days he
17 did not work. [PMF 226].
18 B. FORCED FULL-TIME LEAVE
19 In April 2006, several months into Plaintiff’s reduced work schedule leave, Defendant Peter
20 Bryan, then-Chief Executive Officer of KMC (“Bryan”) observed that “Yes, the Department of
21 Pathology continues to function well, as it has for many years, and, yes, you have made many positive
22 changes to the department” [PMF 123]. He later testified that “actual functioning of the department of
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1
It is undisputed that, in 2003, Plaintiff told Marv Kolb, M.D., then-Chief Medical Officer and
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Plaintiff’s direct supervisor, that he was depressed. There is no legal requirement that Plaintiff notify
25 each and every officer at KMC of his disability, or that he use the word “disability”. In Kimbro v.
Atlantic Richfield Co. 889 F.2d 869 (9th Cir., 1989), the court held that notice to Plaintiff’s supervisor
26 was imputed to the person(s) who made the final decisions regarding the adverse action. See also
California Fair Employment and Housing Commission v. Gemini Aluminum Corp., 122 Cal.App.4th
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1004 (2004) (notice to ANY supervisor of plaintiff’s limitations is sufficient to trigger the
28 accommodation duty.)

1 [pathology] actually was fairly good” [PMF 227] and that no complaints about Plaintiff were “bubbling”
2 up to him at the time [DMF160]; nevertheless, Bryan then proceeded to interfere with Plaintiff’s medical
3 leave by ordering him onto full-time medical leave in April 2006 (“Forced FT Leave”) so as to burn up
4 Plaintiff’s medical leave entitlement. [PMF 228]. This violated the California Family Rights Act
5 (“CFRA”) and the Family & Medical Leave Act (“FMLA”).
6 C. DEMOTION AND PAYCUT
7 In July 2006, after Plaintiff had been on Forced FT Leave as ordered by Bryan for almost 3
8 months, Bryan caused Plaintiff to be demoted by making a recommendation for removal of Plaintiff to
9 KMC’s highest decisionmaking body, the Joint Conference Committee (“JCC”) [PMF 16-17], which the
10 JCC then approved (“Demotion”). [PMF 18]. The Demotion was accompanied by a more than $100,000
11 reduction (“Paycut”) in Plaintiff’s base compensation (“Base Pay”). [PMF 48]. Bryan’s written
12 recommendation to the JCC stated that Plaintiff should be demoted based on “Dr. Jadwin’s
13 unavailability for service because of extended medical leaves for non-work related ailments” and “solely
14 based on his continued non-availability.” (emphasis added). [PMF 17, 122]. Defendant County was
15 interfering with and retaliating against Plaintiff’s protected medical leave.
16 Moreover, Defendant Bryan and the County failed to give Plaintiff impartial adjudicators, notice
17 of the JCC vote, nor any opportunity to face his accusers or defend himself when depriving him of his
18 clearly-established contractual right to over $100,000 of Base Pay. [PMF 182-187]. Defendant Bryan
19 willfully and maliciously violated Plaintiff’s due process rights. [PMF 123, 162, 15-16].
20 D. ADMINISTRATIVE LEAVE
21 Prior to the Demotion in July 2006, Bryan had ordered Plaintiff onto 90-day personal necessity
22 leave. Defendants claim Bryan was simply “granting” Plaintiff’s request, but Plaintiff never made any
23 such request. [PMF 264, 265].
24 After that personal necessity leave ended, Defendant County permitted Plaintiff to return to work
25 in October 2006 as a demoted staff pathologist and placed him beneath a former subordinate whom
26 Plaintiff had hired and trained the year before and whom the County had elevated to Acting Chair of
27 Pathology. [PMF 21]. Plaintiff was subjected to further retaliation and harassment. [PMF 23, DMF 176-
28 190]. When Plaintiff complained in December 2006 about additional patient care issues and the
1 harassment he was being subjected to [PMF 22-23, DMF 190], Defendant Irwin Harris, then-Chief
2 Medical Officer of KMC (“Harris”) and the County placed Plaintiff on administrative leave (“Admin
3 Leave”) “pending resolution of a personnel matter”. [PMF 24, 58, 229]. In so doing, Defendants Harris
4 and County violated County policy by keeping Plaintiff on administrative leave for more than 5 days
5 without obtaining written authorization from the County Administrative Office. [PMF 258].2 During the
6 Admin Leave, Plaintiff was physically restricted to his home during work hours [PMF 28, 59, 81] and
7 given no explanation or indication as to whether or when the Admin Leave would end. [PMF 24, 26,
8 60]. Plaintiff remained on Admin Leave for almost a year until his contract ended on October 4, 2007.
9 [PMF 64]. Defendant Harris was acting willfully and maliciously.
10 The Admin Leave denied Plaintiff his clearly-established, contractually-provided for right to
11 earn professional fees (“Professional Fees”), which had historically amounted to over $100,000 per year.
12 [PMF 25]. Plaintiff was given no notice of the charges against him, nor any opportunity to defend
13 himself, nor any other due process. [PMF 193-197]. To date, Plaintiff has yet to personally receive an
14 explanation from Defendants why he was placed on Admin Leave despite his several requests to
15 Defendant County. [PMF 196, 204].
16 E. NONRENEWAL
17 Defendant County decided not to renew Plaintiff’s contract (“Nonrenewal”) [PMF 29, 68], which
18 expired on October 4, 2007 [PMF 29], in further retaliation for Plaintiff’s medical leaves and
19 prosecution of this lawsuit in defense of his legal rights under the Fair Employment & Housing Act
20 (“FEHA”) and FMLA. [PMF 68]. As Ray Watson, then-Chair of the Board of Supervisors for the
21 County of Kern, testified: “My understanding was that [Plaintiff] had – he had been on medical leave,
22 family leave, and had requested even more leave, and that for that reason and the fact that the was suing
23 us, that we decided not to renew his contract.” [PMF 68]. As a member of the JCC, Watson had voted to
24 demote Plaintiff [PMF 67] and also participated in the JCC’s decision not to renew Plaintiff’s contract.
25 [PMF 67, 68].
26
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An employer’s’ failure to follow its own policies and procedures gives rise to an inference of unlawful
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motive because it establishes that the ‘work rules apply to everyone but Plaintiff’. Deschene v. Pinole
28 Point Steel Co. (1999) 76 Cal.App.4th 33; EEOC v. Board of Governors (7th Cir. 1992) 957 F.2d 424.

1 Plaintiff had a constitutional property right to continued employment by Defendant County.

2 [PMF 69, 70, 200, 201]. Yet, when Defendant County decided to not to renew his contract, they gave
3 him no due process. They never put him on notice as to what the charges against him were nor gave him
4 any opportunity to defend himself. [PMF 202-204]. This is despite the fact that, in May 2007, Plaintiff
5 had written to Defendant County requesting an explanation for its decision not to renew his contract.
6 [PMF 204]. To date, Plaintiff has not received any response from Defendant County, let alone an
7 explanation or opportunity to respond. [PMF 204].
8 II. ARGUMENT
9 A. THRESHOLD ISSUES
10 1. Defendants’ Spoliation of Evidence Creates an Adverse Inference Avoiding
Summary Judgment
11
Spoliation of relevant evidence creates an inference adverse to the party responsible for the
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spoliation. That inference, in combination with “some (not insubstantial) evidence for plaintiff’s cause
13
of action” may allow plaintiff to survive summary judgment. Byrnie v. Town of Cromwell, Board of Ed.
14
(2nd Cir. 2001) 243 F3d 93, 107 (parentheses in original); see, e.g., Morgan v. U.S. Xpress, Inc., 2006
15
U.S. Dist. LEXIS 36195 (M.D. Ga. June 2, 2006).
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Once a party reasonably anticipates litigation, it must suspend its routine document
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retention/destruction policy and put in place a “litigation hold” to ensure preservation of relevant
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documents. Once the “litigation hold” is in place, a party and its counsel must communicate with key
19
employees to make certain all sources of potentially relevant information are identified and placed “on
20
hold,” and that all backup media are identified and stored in a safe place. See Zubulake v. UBS Warburg
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LLC (SD NY 2004) 229 FRD 422, 432; see also Adv. Comm. Note to 2006 Amendment to FRCP
22
26(b)(2).
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Plaintiff twice requested Defendant County to preserve evidence. On June 29, 2006, Plaintiff’s
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counsel sent a letter to Kern County counsel Karen Barnes (“Barnes”) which was captioned “Re:
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Preservation / no spoliation of evidence Jadwin v. County of Kern, Peter Bryan, et al.”. This letter pre-
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dated the Demotion of July 10, 2006 by almost a month. [PMF 230]. It outlined in detail Plaintiff’s
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pending claims for whistleblower and medical leave retaliation and disability discrimination and
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1 formally demanded Defendant County take all appropriate affirmative steps to preserve evidence
2 relating to those claims, including “notes taken at meetings with or concerning Dr. Jadwin”. [PMF 231].
3 On March 29, 2007, Plaintiff’s counsel again sent a letter to Barnes stating, “I would like to remind you
4 that KMC is under a strict legal obligation to preserve and prevent spoliation . . . .”. [PMF 232].
5 Nevertheless, at Plaintiff’s 8/19/08 deposition of Barbara Patrick, former Chair of the Kern
6 County Board of Supervisors and member of the JCC who voted to demote Plaintiff (“Patrick”) [PMF
7 233], Patrick testified that: 1) she had taken notes at every JCC meeting [PMF 234], 2) she had shredded
8 all of her documents upon leaving office on January 8, 2007 [PMF 235], 3) she had thrown out
9 documents which included JCC meeting agendas on the margins of which she had taken notes [PMF
10 236], and 4) Kern County counsel had never contacted her regarding preservation of documents and
11 evidence in connection with Plaintiff’s lawsuit. [PMF 237]. It should be noted that Defendants failed to
12 produce a single JCC meeting agenda in response to Plaintiff’s numerous discovery demands. [PMF
13 238]. Moreover, in the absence of the spoliated agendas, Patrick was able to recall very little about the
14 JCC meeting at which the Demotion was approved. [PMF 239].
15 Patrick’s spoliated notes were material evidence relating to the circumstances surrounding the
16 Demotion and Paycut and therefore relevant to Plaintiff’s allegations that whistleblower retaliation,
17 medical leave interference/retaliation and disability discrimination were motivating factors in the
18 Demotion, that Defendant County acted willfully in engaging in FMLA interference with respect to the
19 Demotion, that Defendant Bryan acted with malice in causing violation of Plaintiff’s constitutional due
20 process rights with respect to the Demotion, and that Defendants’ alternative explanations therefor are
21 pretext, among other things.
22 Likewise, at Plaintiff’s 8/21/08 deposition of David Culberson, former CEO of KMC who
23 decided to place Plaintiff on Admin Leave (“Culberson”) [PMF 240], Culberson testified that: 1) he had
24 taken notes at each of up to 10 meetings of the KMC “leadership team” regarding Plaintiff and the
25 Pathology department [PMF 241], 2) Culberson destroyed those notes prior to January 2007, by
26 shredding them, ripping them up, crumpling them up and throwing them in the trash [PMF 242], and 3)
27 no one ever contacted him regarding preservation of documents and evidence in connection with
28 Plaintiff’s lawsuit. [PMF 243]. In the absence of those notes, Culberson was unable to recall important
1 details, such as the allegations against Plaintiff that led to the Demotion as related to him by Harris
2 [PMF 244], the HR director’s investigative findings as to disruption and chaos in the Pathology
3 department at the end of 2006 just prior to the Admin Leave [PMF 245], Dr. Dutt’s investigative
4 findings regarding Plaintiff’s alleged misconduct at the end of 2006 [PMF 246], etc.
5 Culberson’s spoliated notes were material evidence relating to the circumstances surrounding the
6 Demotion, Admin Leave and Nonrenewal and therefore relevant to Plaintiff’s allegations that
7 whistleblower retaliation, medical leave interference/retaliation and disability discrimination were
8 motivating factors in the Demotion, Admin Leave and Nonrenewal, that Defendant County acted
9 willfully in engaging in FMLA interference with respect to the Demotion, Admin Leave and
10 Nonrenewal, that Defendant Harris acted with malice in causing violation of Plaintiff’s constitutional
11 due process rights with respect to the Admin Leave, and that Defendants’ alternative explanations
12 therefor are pretext, among other things.
13 Finally, Scott Ragland, former President of the Medical Staff and member of the JCC
14 (“Ragland”) [PMF 247], testified at his 8/22/08 deposition that no one ever contacted him regarding
15 preservation of documents and evidence in connection with Plaintiff’s lawsuit. [PMF 248]. He also
16 testified that he deleted all of his emails, including emails relating to Plaintiff [PMF 249], and sneered at
17 Plaintiff’s consternation over the spoliation.
18 Q. Okay. Well, why don’t we take the second question. Do you have this E-mail where
Dr. Jadwin told you no one?
19 A. No.
Q. Is that because you deleted it as well?
20 A. Yes.
Q. Why did you delete these E-mails?
21 A. Because I delete my E-mails.
Q. You delete -- what was -- I’m sorry, Doctor. You just engaged in a facial expression.
22 What was the significance of that?
A. I think your question’s silly.
23 [PMF 250].
24 Despite the fact that Culberson recalled that Ragland had investigated Plaintiff just prior to the
25 Admin Leave [PMF 251], that Ragland was one of Plaintiff’s most vocal critics and that Ragland is cited
26 numerous times by Defendants in support of the many smears against Plaintiff contained in their motion,
27 Ragland testified that he produced only a single document in all of discovery in this action, and even
28 that was not in response to any discovery-related request from an attorney (as he never received one) but
1 on his own initiative. [PMF 252]. In the absence of the spoliated documents, Ragland was able to recall
2 little. [PMF 253].
3 The foregoing spoliation not only gives rise to an adverse inference defeating Defendants’
4 Motion for Summary Judgment, it demands sanction.
5 2. Defendants Failed to Plead Affirmative Defenses
6 Defendant County asserts a statutory affirmative defense to oppositional retaliation liability
7 under FEHA (but not FMLA): that it engaged in the Demotion, Admin Leave and Nonrenewal for a
8 legitimate business reason, excusing it from liability pursuant to 2 C.C.R. § 7287.8(b). (Doc. 262, 7:20-
9 8:25). Defendants also assert the affirmative defense that the amendment by which the Paycut was
10 instituted on July 10, 2006 (“Paycut Amendment”) represented a new employment contract which
11 completely supplanted, and extinguished all claims under, the old one. (Doc. 262, 30:17-31:5.5; 31:21-
12 22).
13 Defendants failed to assert either of these defenses in their pleadings; nor do they have any
14 excuse for this dilatory behavior. As recently as last month, Plaintiff had filed the Second Amended
15 Complaint (Doc. 241). After unsuccessfully opposing Plaintiff’s motion for leave to amend, Defendants
16 filed their Answer to the Amended Complaint (Doc. 246) on October 27, 2008 – a month ago. Plaintiff
17 has been prejudiced. These unpleaded defenses should be barred.
18 B. ADVERSE EMPLOYMENT ACTIONS COMMON TO COUNTS
19 Defendants’ argument that Plaintiff did not suffer “an adverse employment actions” is baseless.
20 (Doc. 262, 8:1-2). Without citing any specific facts to support this conclusory statement, Defendants are
21 making a bald assertion of an “ultimate fact” and that is insufficient. See Schneider v. TRW, Inc. (9th
22 Cir. 1991) 938 F2d 986, 990–991. For sake of economy, Plaintiff hereby incorporates Section II.C of his
23 Motion for Summary Judgment (Doc. 272, 4:24.5-8:14) in rebuttal of Defendants’ assertion.
24 Defendants elsewhere state that the Nonrenewal was not an adverse action because “Plaintiff had
25 no right to a renewed employment agreement” and Plaintiff testified at his deposition that he did not
26 want to have his contract renewed anyway. (Doc. 262, 6:5-9).
27 First, Defendants misstate the law. Board of Regents v. Roth stands for the opposite proposition.
28 There, the court looked for something “approaching a common law of re-employment” a la Perry v
1 Sindermann and failed to find it. 408 U.S. 564, 578 n.16 (1972)(citing to Perry v Sindermann 408 U.S.
2 593, 602 (1972)). Here, it is incontrovertible that Plaintiff had the equivalent of tenure. His position at
3 KMC was “core physician”, a permanent position [PMF 69-70]. In fact, since October 2000, the contract
4 of only one member of KMC’s sizable medical staff has not been renewed [PMF 71], and that was due
5 to a breakdown in negotiations over compensation. [PMF 254].
6 Second, Defendants misstate Plaintiff’s deposition testimony by suggesting he did not want
7 renewal of his contract anyway. [DMF 46]. Plaintiff testified he had expected his contract to be renewed
8 as of October 4, 2007, and that he would have accepted such renewal, albeit under protest over his
9 demoted status and reduced Base Pay. [PMF 254].
10 C. COUNTS 1 & 2: WHISTLEBLOWER RETALIATION
11 Defendant County contends that Plaintiff engaged in only one instance of whistleblowing – on
12 November 28, 2006, when Plaintiff submitted complaints (“Outside WB Reports”) to the California
13 Department of Health (“DHS”), the College of American Pathologists (“CAP”) and the Joint
14 Commission for the Accreditation of Hospital Organizations (“JCAHO”). (Doc. 262, 4:12-15). But
15 California Health & Safety Code § 1278.5 also prohibits retaliation against any employee of a health
16 facility who complains to his employer about unsafe patient care or conditions. H&S § 1278.5(b)(1)(A);
17 see also Mendiondo v. Centinela Hosp. Medical Center 521 F.3d 1097, 1105 (9th Cir. 2008). Likewise,
18 California Labor Code § 1102.5(e) expressly protects employees of a government agency who make a
19 report to their employer.
20 Plaintiff submitted several complaints to KMC leadership, all of them within 120 days prior to
21 adverse employment actions, giving rise to a rebuttable presumption of retaliation which shifts the
22 burden of production to Defendants under H&S 1278.5(d). Under California Labor Code § 1102.6, the
23 proximity in time also shifts the burden of proof at trial to Defendants to demonstrate by clear and
24 convincing evidence that such adverse actions would have occurred for legitimate, independent reasons.
25 1. October Conference
26 At a monthly KMC oncology conference held on October 12, 2005 (“October Conference”),
27 Plaintiff made a protected report to medical staff leadership on the medical appropriateness of a radical
28 hysterectomy for a KMC patient that had relied on inaccurate outside pathology reports, as well as
1 unsafe conditions created for other patients by the lack of a KMC policy requiring internal confirmatory
2 review of all outside pathology reports prior to treatment (“IPR”) [PMF 89]. Defendants Harris and the
3 County made the Credential Threat just days later, on October 17, 2005, retaliating specifically against
4 his October Conference presentation. [DMF 106-116].
5 2. PCCs
6 Starting January 9, 2006, Plaintiff made protected reports to Bryan regarding noncompliance
7 with H&S § 1602.5, specifically failure to maintain accurate and complete records of patient blood
8 transfusions (so-called product chart copies or “PCCs”) in accordance with accreditation standards.
9 These reports culminated in Plaintiff’s demand to Bryan on April 17, 2006, to set up a meeting with
10 County Counsel to resolve the PCC issue. [PMF 96, 97]. That same day, Bryan sent a memo to Plaintiff
11 threatening to demote him. [PMF 99]. Then, on April 28, 2006, Bryan forced Plaintiff onto Forced FT
12 Leave [PMF 123] and on July 10, 2006, the County demoted him. The California Department of Health
13 Services later determined during the course of an inspection that KMC was failing to comply with PCC-
14 related regulations [PMF 98].
15 3. Radical Prostatectomy
16 On December 6, 2006, Plaintiff made a protected report to Culberson regarding a KMC patient
17 who was scheduled for imminent radical prostatectomy despite pathologic findings of cancer which
18 were inconclusive. [PMF 114]. The next day, Plaintiff was placed on Admin Leave. Subsequent biopsies
19 which were conducted ultimately came back negative for cancer, leading to conflicting diagnoses by
20 outside experts. [PMF 114]. The patient ultimately elected not to proceed with the prostatectomy. [PMF
21 266].
22 4. Martinez Tipoff
23 Defendants contend that Plaintiff’s tipoff of coming outside inspections to Gilbert Martinez
24 (“Martinez”), then-Manager of Laboratory Services, prior to Thanksgiving 2006 did not constitute
25 whistleblowing. But adverse actions against employees whom employers suspect or believe intend to
26 file workplace safety complaints constitutes whistleblower retaliation. Lujan v. Minagar 124
27 Cal.App.4th 1040, 1045-46 (2005). Martinez testified that Plaintiff warned him of coming outside
28 inspections around Thanksgiving and that he informed his supervisor, David Hill, Director of
1 Ambulatory Services (“Hill”), a few days later. [PMF 55]. Dr. Philip Dutt, Acting Chair of Pathology,
2 testified as PMK for the County that by the Monday following Thanksgiving 2006, he had had a
3 conversation with Harris regarding Plaintiff’s statement to Martinez that “he was going to report the
4 hospital to JCAHO, CNPS [sic] . . . either the Friday before Thanksgiving that year or the Monday after
5 that weekend.” [PMF 255]. Dutt then suggested to Harris that KMC retain someone who had experience
6 with CAP inspections to conduct a mock unannounced inspection. Harris quickly approved Dutt’s
7 proposal on either the Friday or the Monday before Thanksgiving. [PMF 256]. Two weeks later, on
8 December 7, 2006, Defendants Harris and the County placed Plaintiff on Admin Leave. [PMF 58, 229].
9 5. Skull Flaps
10 Included in the Outside WB Reports was Plaintiff’s protected report that patient skull flaps
11 (“Skull Flaps”) were being stored in an unlicensed KMC freezer in violation of H&S § 1635.1. [PMF
12 102, 110]. On January 4, 2007, Dutt received confirmation that Plaintiff had complained to CAP about
13 unlicensed tissue storage and informed Culberson. [PMF 111].
14 On May 1, 2007, 6 months after Defendants learned of Plaintiff’s tipoff to Martinez and 4
15 months after they learned of Plaintiff’s report to CAP about Skull Flaps, Defendant County informed
16 Plaintiff that it would not be renewing Plaintiff’s contract. [PMF 63]. During that time, Plaintiff was
17 continuously on Admin Leave, was restricted to his home during work hours, and was given no notice of
18 the charges against him, whether he would be permitted to respond or return to work, or even when the
19 leave would end. [PMF 59, 62].
20 6. Smear Campaign
21 In response to his whistleblowing, Defendants targeted Plaintiff with a smear campaign of
22 disparate treatment, heightened scrutiny, retaliatory peer review and baseless accusations to label him
23 “arrogant, disagreeable, uncooperative, intimidating, overbearing, self-righteous, unfriendly, non-
24 collaborative, and uncooperative”. [Answer (Doc. 246), 12:14-22; Colarossi v. Coty USA, Inc. 97 Cal.
25 App. 4th 1142 (heightened scrutiny was retaliatory); Richards v. CH2M Hill, Inc. 26 Cal. 4th 798, 803
26 (baseless accusations that Plaintiff not disabled and “milking the system” were harassing.)] [DMF 69-
27 190].
28 D. COUNTS 3 & 4: MEDICAL LEAVE RETALIATION
1 Defendants’ legal analysis regarding medical leave retaliation is woefully deficient.

2 First, Defendants suggest that the affirmative defense set forth in 2 C.C.R. § 7287.8(b) applies to
3 medical leave retaliation and then proceeds to launch into a discussion of Defendants’ allegedly
4 legitimate business reasons for their actions independent of medical leave retaliation. However, Section
5 7287.8(a) makes it clear that that regulation is related only to oppositional/participatory retaliation under
6 CFRA. The discussion in Defendants’ motion regarding Count 3 is irrelevant and insufficient.3 (Doc.
7 262, 7:7-9:7).
8 Second, Defendants’ motion suggests that FMLA interference analysis devolves to an analysis of
9 whether Plaintiff’s medical leave rights were “chilled”, which in Defendants’ view is satisfied by
10 exhaustively cataloging all of the many ways Defendant County allegedly complied – and Plaintiff
11 allegedly didn’t comply – with CFRA and FMLA. (Doc. 262, 10:8-12:13). This entire analysis has no
12 support in caselaw and is irrelevant to a leave retaliation analysis.
13 To establish medical leave retaliation, a plaintiff need only show: (1) his employer was covered
14 by CFRA/FMLA; (2) he was an employee eligible to take medical leave; (3) he exercised his right to
15 medical leave; and (4) thereafter, his employer subjected him to an adverse employment action because
16 of his exercise of his right to medical leave. See 2.C.C.R. § 7297.7; see also Bachelder v. America West
17 Airlines, Inc., 259 F.3d 1112, 1124 (9th Cir. 2001).
18 Elements 1-3 are undisputed that [PMF 4, 36, 120, 121]. As for element 4, the 9th Circuit in
19 Bachelder v. Am. W. Airlines, Inc. established that Plaintiff need only prove by a preponderance of the
20 evidence that her taking of FMLA-protected leave constituted a “negative factor” in the decision to
21 terminate her. 259 F.3d 1112, 1124 (9th Cir. Ariz. 2001). Under this analysis, the McDonnell Douglas
22 burden shifting framework does not apply. Id. at 1131. While Defendants’ brief did not contend that
23 Defendant County would have taken the actions it did anyway for legitimate, independent reasons,
24 consideration of Plaintiff’s medical leaves notwithstanding, such argument would have been to no avail
25
26 3
Section 7287.8(a) states: “It is unlawful for an employer or other covered entity to demote [. . .] or
otherwise deny any employment benefit to an individual because that individual has opposed practices
27
prohibited by the Act or has filed a complaint, testified, assisted or participated in any manner in an
28 investigation, proceeding, or hearing conducted by the Commission or Department or their staffs.”

1 anyway. Id. at 1131 (9th Cir. Ariz. 2001). In short, once Plaintiff establishes that his medical leaves
2 were a negative factor in the Demotion and the Nonrenewal, the analysis ends there. Liability is
3 established.
4 The 9th Circuit further stated in a footnote that the defendant’s consideration of the plaintiff’s
5 “continued unavailability” further established that the plaintiff’s medical leave had been a negative
6 factor in her termination:
7 We note that it appears fairly clear in any event that Bachelder would not have been
fired had she not taken the protected leave. The supervisor who recommended that
8 Bachelder be fired admitted in his deposition that “the basis for her termination, for the
most part, was availability,” and characterized her on-time performance and Employee
9 of the Month deficiencies as “minor performance issues.” Moreover, America West’s
witnesses testified at the trial that Bachelder’s attendance was the primary reason for
10 firing her, and the district court ultimately found that Bachelder failed to contradict their
testimony that “the likely reason for her termination …was because of her continued
11 unavailability in 1996.”
Bachelder v. Am. W. Airlines, Inc., 259 F.3d 1112, 1131 (9th Cir. Ariz. 2001) n22
12 (emphasis added).
13 Here, it is incontrovertible that Defendant County considered Plaintiff’s medical leave as a
14 negative factor in the Demotion and Nonrenewal. In the case of the Demotion, Plaintiff’s “continued
15 unavailability” due to medical leave wasn’t just a negative factor, it was the only factor. Defendants’
16 own motion asserts: “The evidence is undisputed that Defendants removed Plaintiff from the
17 chairmanship only because of his physical absence from the hospital.” (Doc. 262, 31:9-10) (emphasis
18 added). When Bryan initiated the KMC procedure to demote Plaintiff, his memo to the JCC stated that
19 his recommendation was based on Plaintiff’s “unavailability for service because of extended medical
20 leaves” and “solely based on his continued non-availability”. [PMF 17] (emphasis added). The JCC
21 then “took Bryan’s advice and they did it for the reason that he gave in his memorandum”. [DMF 33].
22 As in the case of Bachelder, it is incontrovertible that Plaintiff was demoted for “continued non-
23 availability” due to protected leave.
24 Regarding the Nonrenewal, Watson testified: “My understanding was that [Plaintiff] had -- he
25 had been on medical leave, family leave, and had requested even more leave, and that for that reason
26 and the fact that he was suing us, that we decided not to renew his contract.” [PMF 68]. It is
27 incontrovertible that Plaintiff’s medical leave was also a negative factor in the Nonrenewal.
28 In fact, Defendant County, through its PMK, testified that punishing employees for taking
1 medical leave was “sometimes” appropriate. [PMF 150].

2 E. COUNTS 4 & 5: MEDICAL LEAVE DENIAL/INTERFERENCE
3 Defendants contend that “Every request for leave that Plaintiff made was granted.” (Doc.
4 262:10:10) and exhaustively catalog all of the many ways Defendants allegedly complied with medical
5 leave laws (Doc. 262, 11:7-12:13). However, even if true, 99 instances of compliance won’t blot out 1
6 instance of egregious non-compliance. And the evidence establishes that such egregious non-compliance
7 did occur. Defendants’ discussion is therefore insufficient.
8 An employer’s suggestion that an employee take different dates of leave in order to
9 accommodate the employer can constitute impermissible FMLA interference. See Williams v. Shenango,
10 Inc. 986 F. Supp. 309, 320-21 (W.D. Pa. 1997) (employer’s motion for summary judgment denied where
11 suggestion of rescheduling leave may constitute interference with FMLA rights). The evidence
12 establishes that, after Plaintiff requested an extension of his medically-required part-time medical leave
13 on April 26, 2006 [PMF 13, 14], Defendant Bryan refused and forced him onto full-time medical leave
14 on April 28, 2006, so as to exhaust his medical leave as soon as possible. [PMF 228].
15 Defendants take special pains in their brief to smear Plaintiff with many alleged violations of
16 Defendant County’s internal procedures. (Doc. 262, 10:11-13; 11:2-112). Plaintiffs disputes them [DMF
17 11-22]; moreover, they have no relevance to Counts 4 and 5 and are insufficient. Plaintiff was required
18 only to provide reasonable notice to Defendant County of his need for medical leave, including its
19 expected timing and length, and that was all he was legally required to do. Gov’t C. § 12945.2; CACI
20 No. 2600; Mora v. Chem-Tronics Inc., 16 F.Supp. 2d 1192, 1202, 1217 (S.D. Cal. 1998); see also 2
21 C.C.R. § 7297.1(2). Sandra Chester, Defendant County’s then-HR Director, testified in deposition that
22 Plaintiff’s email request to Bryan for extension of part-time medical leave on March 16, 2006, the day
23 after his initial medical leave expired, was timely:
24 Q: You know, so this e-mail, under your normal program in your tenure at KMC, would
constitute reasonable notice of the need for an extension of his medical leave that should
25 have generated an employee information packet being sent to him at that time. Is that
correct?
26 A. Absolutely.
[PMF 128].
27
It is incontrovertible that Plaintiff gave reasonable notice of his need for an extension of medical
28
1 leave. Defendants’ allegations of Plaintiff’s noncompliance with FMLA/CFRA are insufficient.

2 F. COUNT 9: DEPRIVATION WITHOUT DUE PROCESS
3 Defendants allege Plaintiff cannot show he had a constitutional property right to chairmanship
4 and Base Pay, Professional Fees, or continued employment. Plaintiff can show by incontrovertible
5 evidence that he did.
6 1. Demotion
7 Plaintiff had a constitutional property right to his Base Pay. The Demotion and Paycut resulted in
8 a reduction and deprivation of over $100,000 of his Base Pay.
9 Under California law, a contract-based entitlement constitutes a constitutionally protectable
10 interest. Roberts v. College of Desert 870 F.2d 1411, 1416 (9th Cir. 1988). Plaintiff’s employment
11 contract expressly set forth a mutually explicit understanding with Defendant County that Plaintiff
12 would receive Base Pay of $287,529, and that Plaintiff would be chair of KMC’s pathology department
13 [PMF 176]. Moreover, the employment contract barred Defendant County from reducing Plaintiff’s
14 Base Pay, removing Plaintiff from chair or terminating or otherwise modifying the Contract at will,
15 without cause, or without Plaintiff’s consent [PMF 177].
16 To date, Defendant County has not removed a department chair without cause. [PMF 178]. In
17 fact, Defendant County has expressly recognized the constitutional right of chairs not to be demoted
18 without due process. JCC minutes regarding the contemplated demotion of the chair of the OB-GYN
19 department stated: “The problem is we have tied a portion of the chair’s compensation to that position,
20 that is a property right. Dr. Perez is entitled to due process hearing for this reason.” [PMF 257]. It is
21 undisputed that a portion of Plaintiff’s chair compensation was likewise tied to his chair position. [PMF
22 47]. Plaintiff was likewise entitled to due process.
23 Moreover, Defendants’ contention that a Base Pay reduction without cause was already
24 encompassed and provided for in Plaintiff’s contract is contradicted by Defendants’ own repeated
25 insistence that the Paycut Amendment was in fact necessary after the Demotion. [PMF 47, 48]. If
26 Defendants’ contention were correct, no contract modification should have been necessary. However,
27 Defendants were acutely aware that the opposite was true, that the Demotion and Paycut in fact
28 necessitated an amendment. Defendants therefore preconditioned Plaintiff’s continued employment on
1 his execution of just such an amendment. [PMF 47, 48, 179]. In short, it is incontrovertible that Plaintiff
2 had a constitutional property right to the over $100,000 reduction in his Base Pay.
3 Defendants state an affirmative defense that the Paycut Amendment was a new contract that
4 completely supplanted and extinguished all rights under the old one. However, an amendment of a
5 contract cannot be presumed to be a novation; that requires evidence that the parties intended the rights
6 and obligations of a new contract be substituted for those of the old one. Ayoob v. Ayoob (1946) 74
7 Cal.App.2d 236, 250-251; Blumer v. Madden (1932) 128 Cal.App. 22, 24. Defendants present no such
8 evidence. In fact, Plaintiff placed Defendants on notice by letter dated June 29, 2006, that he intended to
9 file suit challenging the Demotion. [PMF 184].
10 Defendants further argue frivolously that Defendant Bryan had no part in the Demotion and is
11 therefore relieved of liability. However, it is undisputed that Bryan initiated the demotion process in the
12 first place by submitting a recommendation to the JCC that Plaintiff be removed from chairmanship, and
13 that the JCC “took Bryan’s advice and they did it for the reason that he gave in his memorandum”.
14 [DMF 33].
15 2. Admin Leave
16 Plaintiff had a constitutional property right to Professional Fees. His employment contract
17 expressly set forth a mutually explicit understanding with Defendant County that Plaintiff would be paid
18 Professional Fees [PMF 190]. Plaintiff’s Professional Fees historically amounted to over $100,000 per
19 year. [PMF 25]. When Defendants County and Harris decided to place Plaintiff on Admin Leave [PMF
20 229], they barred him from earning Professional Fees, depriving him of his constitutional property right
21 to them. [PMF 25, 56].
22 In fact, Defendant County was acutely aware of Plaintiff’s contractual interest in Professional
23 Fees. In his letter to Plaintiff regarding the Paycut, Culberson explained that, as a demoted staff
24 pathologist with a drastically reduced base salary, Plaintiff would nevertheless be able to take advantage
25 of his reduced administrative duties in order to increase his Professional Fees-based income [PMF 191].
26 Ironically, it was Culberson who then denied Plaintiff the opportunity to earn those same Professional
27 Fees when he decided to place Plaintiff on Admin Leave [PMF 192].
28 More importantly, Defendant County’s own policy explicitly states that Defendants were not
1 permitted to place Plaintiff on Admin Leave, and thereby deprive Plaintiff of Professional Fees, in the
2 absence of “good cause”. “The hallmark of property ... is an individual entitlement grounded in state
3 law, which cannot be removed except ‘for cause.’” Shoemaker v County of Los Angeles (1995 2d. Dist.)
4 37 Cal.App.4th 618, 630 (citing Logan v. Zimmerman Brush Co. (1982) 455 U.S. 422, 430).
5 Defendants’ motion admits: “Plaintiff was placed on paid administrative leave on December 7, 2006
6 pursuant to the Kern County Policy and Procedures Manual” (“Manual”). (Doc. 262, 33:11-12).
7 Paragraph 139 (“Disciplinary Actions”) of the Manual states in relevant part:
8 Any employee may be dismissed, suspended, reduced in rank and/or compensation,
reprimanded or otherwise disciplined for any action or conduct which in the judgment of
9 the appointing authority provides good cause for discipline under the Civil Service
Rules or other laws, regulations, or policies [. . . .] .6 Administrative Leave with Pay. A
10 department head may place an employee on administrative leave with pay if the
department head determines that the employee is engaged in conduct posing a danger to
11 County property, the public or other employees, or the continued presence of the
employee at the work site will hinder an investigation of the employee’s alleged
12 misconduct or will severely disrupt the business of the department [. . . .]
[PMF 258] (emphasis added).
13
It is incontrovertible that Plaintiff had a contractual right to earn Professional Fees and that
14
Defendants Harris and County were not permitted to place Plaintiff on Admin Leave, and deprive
15
Plaintiff of Professional Fees, without cause. Plaintiff thus had a constitutional property right to those
16
Professional Fees and was entitled to due process relating to their deprivation.
17
Defendants make a frivolous argument that Defendant Harris had no part in placing Plaintiff on
18
Admin Leave and is therefore relieved of liability. (Doc. 262, 32:19-21). However, in its verified
19
response to Plaintiff’s Interrogatory No. 42, Defendant County identified Harris as one of 4 participants
20
in the decision to place Plaintiff on administrative leave [PMF 229], depriving him of Professional Fees
21
without any due process whatsoever. [PMF 24, 26, 60].
22
3. Nonrenewal
23
A party’s expectation of continued employment may be based on rules or understandings,
24
entitling him to constitutional due process. Roth v. Veteran’s Admin. of United States 856 F.2d 1401,
25
1409 (“If Roth was a permanent, non-probationary VA employee, he was clearly entitled to procedural
26
protections before being deprived of his job”.) (emphasis added). In Board of Regents v. Roth, a case
27
which Defendants incorrectly cite in support of their motion, the court considered the question of
28
1 whether a plaintiff had a constitutional right to due process with respect to continued employment by
2 looking for something “approaching a common law of re-employment” a la Perry v Sindermann. 408
3 U.S. 564, 578 n.16 (1972). Perry v Sindermann established:
4 A teacher, like the respondent, who has held his position for a number of years, might be
able to show from the circumstances of this service -- and from other relevant facts --
5 that he has a legitimate claim of entitlement to job tenure. Just as this Court has found
there to be a “common law of a particular industry or of a particular plant” that may
6 supplement a collective-bargaining agreement, Steelworkers v. Warrior & Gulf Co., 363
U.S. 574, 579, so there may be an unwritten “common law” in a particular university
7 that certain employees shall have the equivalent of tenure.
408 U.S. 593, 602 (1972).
8
Here, it is incontrovertible that Plaintiff had the equivalent of “tenure” and was a “permanent”,
9
non-probationary employee of Defendant County. His position at KMC was “core physician”, a
10
permanent position as acknowledged by Bryan in deposition testimony. [PMF 69]. There was a mutually
11
explicit understanding that his contract would be continuously renewed [PMF 70]. Defendant County
12
had a policy of renewing the contracts of all of its non-probationary physicians [PMF 70] – since
13
October 2000, the contract of only one member of KMC’s sizable medical staff has not been renewed
14
[PMF 71] , and that was due to a breakdown in negotiations over compensation. [PMF 254].
15
It is incontrovertible that there was a “common law of re-employment” at KMC, that Plaintiff
16
was a “permanent”, non-probationary employee, and that Plaintiff therefore had a constitutional property
17
right to continued employment by Defendant County.
18
4. Qualified Immunity
19
Defendants argue Bryan and Harris enjoy qualified immunity because they did not violate a
20
clearly established right. (Doc. 262, 32:1-23). However, the 9th Circuit has established that when a
21
property interest is determined to be constitutionally protected under the Perry v Sindermann “mutually
22
explicit understandings” standard, it is clearly established and the defendant is not entitled to qualified
23
immunity. Roberts v. College of Desert 870 F.2d 1411, 1416-17 (9th Cir. 1988) (“Because we have
24
found that the understanding between Roberts and Dr. Stout satisfies the Perry standard, the defendants
25
are not entitled to immunity from liability for the College’s failure to provide Roberts the rudiments of
26
due process.”). Moreover, where pre- and post-deprivation procedures are absent, the offending officials
27
are not entitled to qualified immunity. Brewster v. Bd. of Educ. 149 F.3d 971, 987, fn.9. (9th Cir. 1998)
28
1 (“Presumably, when an individual is given neither a predeprivation hearing nor a postdeprivation

2 hearing at which to contest the taking of his property, his clearly established due process rights have
3 been violated, because under no reading of Mathews could such a taking be constitutional. In that case,
4 the offending officials would not be entitled to qualified immunity.”).
5 Plaintiff has already established supra that Plaintiff and Defendants had a mutually explicit
6 understanding that (i) Plaintiff would not be subjected to demotion and Base Pay reduction absent cause,
7 and (ii) Plaintiff would not be placed on administrative leave and deprived of his contractual right to
8 Professional Fees absent cause. It is also undisputed that Defendants gave Plaintiff neither a
9 predeprivation nor a postdeprivation hearing in the case of either the Demotion or the Admin Leave (In
10 the interests of economy, Plaintiff hereby incorporates the discussions contained in Sections II.L.4 and 5
11 of his motion for summary judgment (Doc. 272, 28:2-29:3; 29:20-27)). Hence, Plaintiff has
12 incontrovertibly established that neither Bryan nor Harris is entitled to qualified immunity with respect
13 to the Demotion and Admin Leave, respectively.
14 5. Stigma
15 Defendants’ discussion regarding stigma is inapposite. Stigma is relevant to establishing a
16 deprivation of liberty, not property. Smith v Siegelman (2003, 11th Cir. Ala) 322 F.3d 1290, 1296.
17 Plaintiff does not allege deprivation of liberty.
18 G. COUNTS 3, 10 AND 11: OPPOSITIONAL/PARTICIPATORY RETALIATION
19 Both FEHA and FMLA provide protection for an employee who opposes any discriminatory
20 practices or participates in any proceeding under Gov’t C. §§ 12900 to 12996. [Gov’t. C. § 12940(h); 29
21 U.S.C. § 2615(b)]. The protected activity of “participation” is expressly defined within the code as “filed
22 a complaint, testified, or assisted in any proceeding under [Gov’t C. §§ 12900 through 12996].” Id.;
23 U.S.C. § 2615(b)(1).
24 Defendant County asserts a statutory affirmative defense to oppositional retaliation liability
25 under FEHA (but not FMLA) pursuant to 2 C.C.R. § 7287.8(b). As for Defendants’ allegedly
26 “legitimate business reasons” for the Demotion and the Admin Leave, Defendants cannot satisfy their
27 burden of proof with incontrovertible evidence. Regarding the Demotion, it is undisputed that
28 Defendants demoted Plaintiff solely due to unavailability for medical leave. [DMF 33, PMF 17].
1 Plaintiff’s unavailability due to medical leave cannot be a legitimate business reason for employment
2 action, as established in Section II.D supra and by Bachelder v. America West Airlines, Inc., 259 F.3d
3 1112 (9th Cir. 2001).
4 Regarding the Admin Leave, Plaintiff disproves Defendants’ alleged reasons as non-credible
5 pretext supra at •.
6 Regarding the Nonrenewal, Defendants’ brief does not even bother to allege a “legitimate
7 business reason” (Doc. 262, at 8:24-9:7). Instead, Defendants focus their efforts on contradicting the
8 sworn deposition testimony of Ray Watson, former Chair of the Board of Supervisors (“Watson”),
9 through use of “sham” declarations. However, a party cannot create an issue of fact by a declaration
10 contradicting his or her own deposition or other sworn testimony. See Block v. City of Los Angeles (9th
11 Cir. 2001) 253 F3d 410, 419, fn. 2. The same rule applies to postdeposition affidavits that contradict the
12 affiant’s deposition testimony. Aerel, S.R.L. v. PCC Airfoils, LLC (6th Cir. 2006) 448 F3d 899, 907–908;
13 Bank of Ill. v. Allied Signal Safety Restraint Systems (7th Cir. 1996) 75 F3d 1162, 1169.
14 Here, Watson testified at his deposition that Defendant County decided not to renew Plaintiff’s
15 contract in retaliation for his filing the instant lawsuit. Watson was asked twice if he recalled clearly that
16 this was the case and each time he answered yes:
17 Q. Okay. What about the nonrenewal? I mean, do you recall Dr. Jadwin’s physical
absence being a reason for his nonrenewal of his contract?
18 A. Well, it could be that. It could be the fact that I think by then he was -- probably was
suing us. So why would you want to establish a contractual relationship with somebody
19 who’s suing you.
Q. Okay. Well, he was also suing you at the time of his removal or actually at the time
20 of his --no, he wasn’t. He wasn’t. Okay. But I mean, you say why would you establish a
contractual relationship with someone who’s suing you, right?
21 A. Right.
Q. Was that -- does that mean -- are you just speculating now, just guessing, or was that
22 a consideration for his nonrenewal?
A. Well, I remember it being discussed.
23
[…]
24
Q. Okay. But you recall it being discussed at the JCC meetings?
25 A. Yes.
[PMF 259].
26
Watson then re-affirmed a third time – volunteering it on his own initiative – that oppositional
27
retaliation was an additional motivating factor for the Nonrenewal:
28
Q. So the question is: You’ve mentioned that for the nonrenewal one of the reasons was
1 that Dr. Jadwin wasn’t available for work; is that correct or --
A. My understanding was that he had -- he had been on medical leave, family leave, and
2 had requested even more leave, and that for that reason and the fact that he was suing us,
that we decided not to renew his contract.
3 [PMF 260].
4 Defendants resort to frivolous arguments in their bid to contradict Watson’s testimony, setting up
5 fallacious strawman arguments and knocking them down one-by-one.
6 • Defendants point out Watson testified that he didn’t recall discussion of Plaintiff’s termination or
7 denial of his medical privileges. This proves nothing about the Nonrenewal and whether a
8 discussion about it occurred. Defendant County could have contemplated nonrenewal without
9 considering immediate termination or medical privileges denial. A discussion of one doesn’t
10 necessitate or preclude a discussion of the others. Moreover, the testimony Defendants cite to
11 appeared over 100 pages and 2 hours earlier in the deposition transcript than the Nonrenewal
12 discussion and arose in response to a completely unrelated line of questioning. [PMF 261].
13 • Defendants then point out Watson couldn’t recall a formal JCC vote to not renew Plaintiff’s
14 contract. This proves nothing about whether or not the JCC decided to not renew Plaintiff’s
15 contract A JCC decision is not preconditioned on a JCC vote occurring. In any event, Watson
16 confirmed several times that he clearly recalled the JCC deciding on the Nonrenewal.
17 • Defendants then reference declarations submitted by members of the Kern County Board of
18 Supervisors asserting that the Board never discussed or made any decision regarding nonrenewal
19 or expiration of Plaintiff’s contract. This proves nothing about whether such a decision or
20 discussion occurred at the JCC level. The absence of a decision by the Board of Supervisors in
21 no way precludes a decision being made by the JCC. Again, Watson confirmed several times that
22 he clearly recalled the JCC deciding on the Nonrenewal.
23 Watson’s testimony is more than clear. Defendants’ sham declarations should be disregarded.
24 There is no question that Defendant County engaged in oppositional/participatory retaliation against
25 Plaintiff when it decided not to renew his contract. Defendants’ motion should be denied.
26 H. COUNT 6: DISABILITY DISCRIMINATION
27 Plaintiff incorporates by reference the points and authorities set forth in Sections II (I) & III (I)
28 of Plaintiff’s Corrected Motion for Full or Partial Summary Judgment regarding his Sixth Claim for
1 Disability Discrimination and Defendant’s Eleventh Affirmative Defense re Workers Compensation

2 Preemption.
3 Contrary to Defendant’s assertion, Plaintiff has expressly stated that his Sixth Claim for
4 Disability Discrimination if brought against Defendant County. [Defendants’ Motion (Doc. 262) at
5 22:14-23; SAC (Doc. 241) at ¶188, 35:16-18].
6 Also contrary to Defendants’ assertion, the FEHA covers both industrial and non-industrial
7 injuries. [Defendants’ Motion (Doc. 262) at 13:7-9; City of Moorpark v. Superior Court, 18 Cal. 4th
8 1143 (1998). Further, Defendants’analysis of Plaintiff’s disability claim under the ADA is inapposite
9 because Plaintiff is bringing his claim under the FEHA. [SAC (Doc. 241) at ¶ 188, 35:16-18]. The
10 California Legislature has rejected both the ADA “substantially limits” test and the work limitation test
11 relied on by Defendants. [Gov’t C. §§ 12926.1(c), 12926(i)(1)(B); Defendants’ Motion (Doc. 262) at
12 14:10-13].
13 It is undisputed that Plaintiff suffered from known chronic depression that limited his ability to
14 work full-time as Chair of Pathology at KMC from December 16, 2005 to September 6, 2006, requiring
15 accommodation in the form of reduced work schedule medical/recuperative leave. [DMF 10, 14, 65 &
16 67; PMF (1/9/06 memo) 144-148 & 154]. It is undisputed that Defendant County accommodated
17 Plaintiff’s chronic depression from December 16, 2005 to April 28, 2006, when Defendant Bryan forced
18 Plaintiff to take full-time leave until October 4, 2006. [DMF 20-21; PMF 155, 159]. The evidence shows
19 that Plaintiff was “otherwise qualified” because Defendant Bryan admitted that Plaintiff was
20 successfully performing his duties as Chair of Pathology with accommodation just prior to revoking
21 Plaintiff’s accommodation. [PMF 141, 227 ].
22 Defendants’ own admissions establish that Defendant Bryan’s revoking of Jadwin’s
23 accommodation was the sole reason for the Demotion and Paycut, and a motivating reason for the
24 Nonrenewal, and are direct evidence of disability discrimination. [Humphrey v. Memorial Hosps. Assn.
25 (9 Cir. 2001) 239 F. 3d 1128, 1139-1140 (“…the conduct resulting from a disability is considered part of
26 the disability, rather than a separate basis for termination. The link between the disability and the
27 termination is particularly strong where it is the employer’s failure to reasonably accommodate a known
28 disability that leads to discharge for performance inadequacies resulting from that disability”); PMF
1 150].
2 A prima facie case of age discrimination may be established by either (a) direct evidence of
3 discriminatory intent, Transworld Airlines v. Thurston, 469 U.S. 111, 105 (1985), or (b) by proof of
4 disparate treatment based upon circumstantial evidence using the standards set forth in McDonnell
5 Douglas v. Green, 411 U.S. 792 (1973). Direct evidence of discriminatory intent cannot be rebutted by
6 articulating or producing evidence of legitimate, non-discriminatory reasons. [Brown v. Sierra Nevada
7 Memorial Hospital, 849 F.2d 1186 (9th Cir. 1988)]. Because Plaintiff relies on direct evidence to
8 establish Defendant County’s discriminatory motive, the McDonnell-Douglas burden-shifting
9 framework does not apply, and Defendant County is precluded from arguing that it had a “legitimate”
10 reason for the Demotion, Paycut, and Nonrenewal.
11 If the court does not strike Defendants’ improper Section E, then it must consider Defendants’
12 post-hoc attempt to attribute the Demotion, Paycut, and Non-renewal to any reasons than those already
13 admitted as evidence of pretext. [EEOC v. Sears Roebuck Co. (4th Cir. 2001) 243 F.3d 846, 853 ("[A]
14 factfinder could infer from the late appearance of [the employer's] current justification that it is a post-
15 hoc rationale, not a legitimate explanation for [its] decision not to hire [the employee]."); Payne v.
16 Norwest Corp. (9th Cir. 1997) 113 F.3d 1079, 1080 ("A rational trier of fact could find that [the
17 employer's] varying reasons shows that the stated reason was pretextual, for one who tells the truth need
18 not recite different versions of the supposedly same event.").
19 To the extent that Defendants offer evidence of Plaintiff’s conduct to justify his placement on the
20 Admin Leave [DMF 69-190, PMF 150, 267], the Court view the totality of the circumstances in the light
21 of the fact that both Defendant County and Dr. Dutt have admitted harboring unlawful animus towards
22 individuals with disabilities who may need to take medical/recuperative leave. [O’Mary v. Mitsubishi
23 Electronics of America, Inc., 59 Cal. App. 4th 563, 574-75 (1997) (“On occasions where there is
24 evidence of clear discriminatory intent, it is like a gold nugget which happens to be lying on the ground.
25 You do not throw it away as if it were so much dross. To put the idea in typical evidentiary terms,
26 evidence of clear discriminatory intent is overwhelmingly probative in a discrimination case because it
27 shines the spotlight on the very thing which is the focus of the litigation.”); [DMF 69-190, PMF 150]
28 Defendant County and Dr. Dutt acted on this unlawful animus as soon as Plaintiff indicated his intent to
1 return to work from medical/recuperative leave. Dr. Dutt asked County Counsel if he could prevent Dr.
2 Jadwin from taking any further leave as a condition of his return to work. [PMF 267]. The disparate
3 terms and conditions regarding Plaintiff's hours of work and productivity contained in Amendment 1 to
4 Dr. Jadwin’s employment contract of 11/12/02 achieve this goal. [PMF 267].
5 Defendant County's and Dr. Dutt's admitted unlawful animus also taints all of their dealings with
6 Plaintiff subsequent to his taking medical/recuperative leave. [Dee v. Vintage Petroleum, Inc. (2003)
7 106 Cal.App.4th 30 (supervisor's pattern of mistreatment is illuminated by a single racial remark);
8 Bowen v. Missouri Department of Social Services, 311 F.3d 878, 884 (2002) (Where supervisors and
9 other harassers used epithets with clear racial content, it can be inferred “that racial animus motivated
10 not only [their] overtly discriminatory conduct but all of [their] offensive behavior toward [plaintiffs]".
11 Dr. Dutt participated in the smear campaign targeting Dr. Jadwin in retaliation for his whistleblowing,
12 subjecting him to heightened scrutiny and unwarranted criticism until Plaintiff was placed on Admin
13 Leave. [DMF 69-190, PMF 267].
14 The evidence is so strongly in Plaintiff’s favor that the court must deny Defendants’ motion for
15 summary judgment, and should grant summary adjudication on all elements of Plaintiff’s disability
16 discrimination claim except the amount of damages.
17 I. COUNT 7: FAILURE TO ACCOMMODATE
18 Plaintiff incorporates by reference the points and authorities set forth in Section II(K) of
19 Plaintiff’s Corrected Motion for Full or Partial Summary Judgment, and Sections D, E, & H, infra.
20 An employer is required to modify it's policies and procedures to provide reasonable
21 accommodation. [Gov't Code § 12926(n) Jensen v. Wells Fargo Bank (2000) 85 Cal.App.4th 245, 263
22 (holding job open while employee takes recuperative leave was reasonable accommodation).
23 Defendants’reliance on Swonke v. Sprint, Inc. 327 F.Supp.2d 1128(N.D. Cal. 2004) for support of its
24 contention that an employer may force an employee to take full-time leave is also misplaced. Swonke’s
25 doctor’s notes precluded him from performing any work, thus requiring his employer to place him on
26 full-time leave until he obtained a release to work. Plaintiff’s psychiatrist never precluded him from
27 performing any work. [PMF 146]. It was illegal for Defendant County to require Dr. Jadwin to take
28 more recuperative leave than medically necessary. DFEH v. California State University, FEHC Dec. No.
1 87-28 at page 9 (forcing complainant to take involuntary leave is not a reasonable accommodation);
2 DFEH v. Ford of Simi Valley, Inc. (2005) FEHC Dec. No. 06-02 at page 12 (employer failed to
3 accommodate complainant by failing to return him to work on his release to part-time work).
4 Raine v. City of Burbank 135 Cal.App. 4th 1215 (2006) is also distinguishable. In Raine, the City
5 was not required under FEHA to convert an injured police officer’s temporary, light-duty
6 accommodation in a front-desk position into a permanent position once the officer’s temporary disability
7 became permanent because the officer sought reclassification of front-desk position from a civilian
8 position to a sworn-officer position, and city was not required to reclassify the front-desk job to
9 accommodate the officer. Id. at 901, 1223-1124. Unlike Raine, Dr. Jadwin’s disability was “chronic” not
10 “permanent”; Dr. Jadwin did not request permanent light work as an accommodation, and no
11 reclassification of Dr. Jadwin’s position was required to allow him to work part-time as an
12 accommodation.
13 As an accommodation, an employer must provide an employee with disabilities with similar
14 assistance and benefits that it offers others. Prilliman v. United Air Lines, Inc. 53 Cal.App.4th 935, 950-
15 51 (1997). Defendant Bryan’s explanation” of why he conditioned Dr. Jadwin’s continuance as Chair of
16 Pathology on his full-time attendance at KMC is pretextual. Defendant County allowed Dr. Tai Yoo
17 attend KMC part-time as Chair of Psychiatry, so must also allow Dr. Jadwin to attend KMC part-time as
18 Chair of Pathology as an accommodation of his disabilities. [DMF 25]. Moreover, if Defendant County
19 believed that Plaintiff’s accommodation wasn’t working, then it had a duty to engage in an interactive
20 process regarding other possible accommodations. Humphries v. Memorial Hospitals
21 Association (9 Cir. 2001) 239 F.3d 1128, 1138 (“...the employer’s obligation to engage in the
22 interactive process extends beyond the first attempt at accommodation and continues when the employee
23 asks for a different accommodation or where the employer is aware that the initial accommodation is
24 failing and further accommodation is needed.”).
25 J. COUNT 8: INTERACTIVE PROCESS
26 Plaintiff incorporates by reference the points and authorities set forth in Section II(L) of
27 Plaintiff’s Corrected Motion for Full or Partial Summary Judgment. Plaintiff incorporates by reference
28 the points and authorities set forth in Sections D-F, infra.
1 The ten minute meeting on April 26, 2006 was to inform Plaintiff of his leave balance, not to
2 engage in an interactive process. [DMF 20, 22,]. Nor was Steven O'Connor sufficiently knowledgeable
3 or prepared to answer any questions that Plaintiff might have regarding his leave.
4 Defendant County failed to engage in good faith in an interactive consultation with Plaintiff.
5 III. CONCLUSION
6 For the foregoing reasons, the Court should deny Defendants’ Motion for Summary Judgment in
7 its entirety and grant Plaintiff’s Motion for Summary Judgment.
8
9 RESPECTFULLY SUBMITTED on December 1, 2008.
10
/s/ Eugene D. Lee
11 LAW OFFICE OF EUGENE LEE
555 West Fifth Street, Suite 3100
12 Los Angeles, CA 90013
Phone: (213) 992-3299
13 Fax: (213) 596-0487
email: elee@LOEL.com
14 Attorney for Plaintiff DAVID F. JADWIN, D.O.
15
16
17
18
19
20
21
22
23
24
25
26
27
28

3 Phone: (213) 992-3299
Fax: (213) 596-0487

6
7
10 FRESNO DIVISION
12 Plaintiff, PLAINTIFF’S RESPONSIVE STATEMENT

OF MATERIAL FACTS IN OPPOSITION TO
13 v. DEFENDANTS’ MOTION FOR SUMMARY
JUDGMENT
14 COUNTY OF KERN, et al., [Fed. R. Civ. P. 56(a)]
15 Defendants. Date: January 12, 2009

Time: 10:00
16 Judge: Hon. Oliver W. Wanger
Courtroom: 3
17
Complaint Filed: January 6, 2007
18 Trial Date: March 24, 2009
19
20
21
22
23
24
25
26
Plaintiff DAVID F. JADWIN, D.O., hereby submits the following statement of disputed and
27
undisputed material facts in support of his Opposition to Defendants’ Motion for Summary Judgment
28
Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

∆’S MOTION FOR SUMMARY JUDGMENT 1
1
Δ’s MATERIAL FACTS Δ’S Π’S RESPONSE
2 (“DMF”) SOURCE
3 LEGAL RELATIONSHIP
4 BETWEEN KERN
MEDICAL CENTER AND
5 DAVID F. JADWIN, D.O.
6 1. First Employment DFJ00025 Undisputed.
Contract between Kern -00046
7 Medical Center (hereinafter
referred to as KMC) and
8 David F. Jadwin, D.O.
(hereinafter referred to as
9 Jadwin) was entered into on
October 24, 2000.
10
a) Article 1, ¶2 incorporates DFJ00043 Undisputed.
11 attached Exhibit A as a part -46
of the agreement
12
b) Article 5, ¶20 states, in Undisputed that the document says what it says.
13 part, “The parties recognize
that each is possessed of
14 legal knowledge and skill,
and that this Agreement is
15 fully understood by the
parties, and is the result of
16 bargaining between the
parties.”
17
c) Article 5, ¶22 states, in Disputed only as to the word “Agreement”. Article 5 ¶ 22
18 part, “This Agreement, actually uses the word “document”, “This document,
including all attachments including all [….]”.Undisputed that the document says
19 hereto, contains the entire what it says.
agreement between the
20 parties relating to the
services, rights, obligations
21 and covenants contained
herein and assumed by the
22 parties respectively.”
23 2. Employment Verification DFJ00358 Undisputed.
letter gives original date of
24 hire as December 3, 2000.
25 3. Jadwin received the 0000202- See evidentiary objections.
Medical Staff Bylaws. 203
26
4. Medical Staff Bylaws. 0000272- Undisputed.
27 358
28

1 5. Responsibilities and duties DFJ00046 See evidentiary objections.

of the pathology dept. chair
2 are set out in the KMC Disputed: Sections 6. through 6.4-3 of the Bylaws do
Medical Staff Bylaws, NOT contain any such provisions.
3 sections 6. through 6.4-3.
4 6. Second Employment 0001479- Undisputed.

Contract between KMC and 1499
5 Jadwin was effective October
5, 2002.
6
a) Exhibit A to the Second Undisputed.
7 Employment Contract: Job
Description, David F.
8 Jadwin, M.D., Pathology
Chairman.
9
i) First paragraph, 3rd line Disputed in that Article II.1.A. of the Second
10 reads “This is a full-time Employment Contract provides that Plaintiff was required
position requiring 48 hours to work “no less than forty [40] hours per week”. (Bates
11 of service, on average, per 0001480). Otherwise, undisputed that the document says
week.” what it says.
12
ii) Second page, paragraph 6 Disputed in that Article II.1.A. of the Second
13 states “A standard workweek Employment Contract provides that Plaintiff was required
will be 48 hours per week. to work “no less than forty [40] hours per week”. (Bates
14 Actual hours may vary week- 0001480). Otherwise, undisputed that the document says
to-week according to specific what it says.
15 assignments; however, the
objective is to achieve 2112
16 worked hours during a
twelve-month period.”
17
b) Section V, ¶10 states Undisputed that the document says what it says.
18 “Core physician shall be
employed by the County of
19 Kern pursuant to the terms of
this Agreement and the
20 medical staff bylaws of
KMC. Core physician
21 acknowledges that he or she
will not be deemed a
22 classified employee, or have
any rights or protections
23 under the County’s Civil
Service Ordinance, rules or
24 regulations.”
25
FMLA/CFRA
26 RETALIATION
27
28

1 7. Letter to Peter Bryan DFJ00723 See evidentiary objections.

2 Bryan) from Jadwin, dated Disputed: Plaintiff states on DFJ000723 that “This
1/9/06, requesting harassment had led me develop depression, anxiety and
3 administrative leave with pay insomnia.
until hostile environment is Although I enjoy much of my work at KMC, it is not
4 corrected. He demanded possible for me to continue to
action on 1) sending work under this form of harassment.” Under FEHA, this
5 transfusion Product Chart letter placed Defendants on notice that Plaintiff was
Copies (hereinafter referred suffering a recurrence of his chronic depression and that
6 to as PCCs) to the blood the leave he was requesting was a reasonable
bank; 2) KMC’s alleged lack accommodation of his disability. See evidentiary
7 of compliance with their objections. Otherwise, undisputed that the document says
weekly oncology conferences what it says.
8 by reporting themselves
(KMC) to the American
9 College of Surgeons
10 ACS); 3) reviewing time
limits on pathology
11 presentations; and 4)
implementing protocol of
12 collection of Fine Needle
Aspiration (hereinafter
13 referred to as FNA)
specimens.
14
7A. Dutt recalled Jadwin’s Dutt See evidentiary objections.
15 threat of taking a leave of Depo.,
absence until the medical 8/20/08, Disputed: Jadwin never made such a threat. [Decl. of
16 staff and the administration pgs. 52:5- David Jadwin in Opposition to Defendants’ Motion for
apologized to him. 53: 18 Summary Judgment (“Jadwin Opp. Decl.”), para. 3].
17
8. Jadwin conducted a DFJ02422 See evidentiary objections: Irrelevant to proving disability
18 vigorous job search in the -2459 under FEHA vis-à-vis ADA.
first six months of 2006. He
19 was actively looking for
another job as there are
20 inquiries into at least six
other full-time positions.
21
a) “You know, I wish I could Jadwin See evidentiary objections: Irrelevant to proving disability
22 go back because I enjoyed Depo., under FEHA vis-à-vis ADA.
that job. I mentioned 10/21/08,
23 multiple times during my pg.
recruitment and elsewhere 1087:9-17
24 that that was the last position
that I wanted to take, that I
25 saw myself retiring out of
that position and not moving.
26 And I was very disappointed
when-when things-when
27 people that were in a position
to do the right thing didn’t do
28 the right thing.”

1 9. Sandi Chester effectively Chester See evidentiary objections: Irrelevant to excusing

refutes any argument that Depo., Defendants’ liability under any of Plaintiff’s counts, as
2 Jadwin’s letter to Peter 8/28/08, evidenced by Defendants’ failure to cite this DMF
Bryan of January 9, 2006 pgs. anywhere in their motion brief (Doc. 262).
3 was notice to KMC that 135:12-
Jadwin needed medical 137: 6 See evidentiary objections: Irrelevant to prove Plaintiff
4 leave or that, by failed to give reasonable notice on 3/16/06 of his need for
implication, Jadwin was Pg. extension of medical leave prior to being placed on
5 absolved of the 136:17-18 Forced FT Leave by Bryan on 4/28/06. Chester later
responsibility to notify HR admitted that Plaintiff’s email to Bryan of 3/16/06
6 that he was taking a leave constituted reasonable notice of his need for extension of
of absence. As Sandi medical leave.
7 Chester said “I mean, [Smith Depo., 8/19/08, pg. 65:2-13 and 74: 12-22]
anybody can write a
8 letter.”
9 10. Certification of Health DFJ00726 Undisputed that the document says what it says.
Care Provider dated 1/13/06
10 for Jadwin. Includes the
duration of the medical
11 condition (2-3 months) and
the expected date to return to
12 work (3/16/06). It gives the
date the medical condition
13 commenced as 12/16/05.
14 11. Jadwin did not Chester See evidentiary objections: Irrelevant to excusing
communicate with Human Depo., Defendants’ liability under any of Plaintiff’s counts.
15 Resources (hereinafter 8/28/08,
referred to as HR) at all, HR pgs. Disputed: Plaintiff obtained permission in January 2006
16 discovered that Jadwin ------ 75:19- from Bryan before commencing his medical leave. Bryan
had unilaterally assigned 76:10 promised to contact HR and send Plaintiff the necessary
17 himself to 1 to 2 workdays leave forms but was late in doing so. Plaintiff submitted
per week but, per policy, an the form and medical certification promptly after being
18 employee must use vacation, provided the forms and appropriate instructions from HR.
sick time, or leave of absence [Jadwin Opp. Decl., para. 4].
19 when not working full-time.
It was HR that brought Defendant County waived any such policy by allowing
20 Jadwin into compliance with Dr. Naderi and Dr. Dutt to take leave for known
County policy by putting him FMLA/CFRA qualifying purposes without requiring them
21 on leave of absence. to contact HR, submit a request for family leave
supported by a doctor's certificate; HR did not designate
22 either of their leaves as family leave. [Lee Opp. Decl.,
Exh. 56 (PMK Dutt Depo at 232:6-13, 237:1-9); Exh. 41
23 (Naderi Depo. at 38:6-39:25, 43:2-10, 51:21-25); Exh. 29
(McBride Depo. at 98:15-22) (Naderi's son's accident was
24 common knowledge at KMC)]. The fact that Defendants
apply it strictly against Plaintiff is further evidence of
25 retaliatory animus.
26
27
28

1 12. KMC had to designate Bryan See evidentiary objections: Irrelevant to excusing
Jadwin’s medical leave Depo., Defendants’ liability under any of Plaintiff’s counts.
2 retroactively because Jadwin 8/14/08,
was late in giving appropriate pgs. Disputed: Plaintiff’s timecards show that he took vacation
3 requests. 195:9- from 12/16/05 to 1/2/06. Plaintiff obtained permission in
196: 14 January 2006 from Bryan before commencing his medical
4 leave. Bryan promised to contact HR and send Plaintiff
the necessary leave forms but was late in doing so.
5 Plaintiff submitted the form and medical certification
promptly after being provided the forms and appropriate
6 instructions from HR. On 1/13/06, Plaintiff’s therapist,
Dr. Riskin, certified that Plaintiff's need for reduced work
7 schedule began on 12/16/05. Accordingly, KMC
retroactively deducted Jadwin's vacation days from his
8 FMLA/CFRA balance even though he worked full time
for approximately three weeks after returning from
9 vacation. [Lee Decl., Exh. 14 (Bryan Memo to Jadwin of
4/28/06 at DFJ01155); [Declaration of Paul Riskin
10 (“Riskin Decl.”), Exh. 1 (Certification of 1/13/06 at
DFJ1810)].
11 [Jadwin Opp. Decl., para. 4].
13. Jadwin’s submission of Chester See evidentiary objections: Irrelevant to excusing
12 his healthcare provider’s Depo., Defendants’ liability under any of Plaintiff’s counts.
certification was not timely 8/28/08,
13 and was only provided upon pgs. Disputed: Plaintiff obtained permission in January 2006
prompting from HR. 113:23- from Bryan before commencing his medical leave. Bryan
14 114: 12 promised to contact HR and send Plaintiff the necessary
leave forms but was late in doing so. Plaintiff submitted
15 the form and medical certification promptly after being
provided the forms and appropriate instructions from HR.
16 [Jadwin Opp. Decl., para.4].
14. Certification of Health DFJ0l150 Disputed in that the form also states that Plaintiff can
17 Care Provider, dated 4/26/06, work “part-time, now”, and is able to “work for 1-2 days
stating that Jadwin’s medical per week”; and Defendant did not engage in interactive
18 condition goes back to consultation to clarify any confusion over the Riskin’s
10/30/03. The Certification certification.
19 states that Jadwin requires
“part-time or less to avoid
20 worsening of his serious
medical condition.”
21
15. Jadwin’s Request for DFJ00746 See evidentiary objections: Irrelevant to excusing
22 Leave of Absence Defendants’ liability under any of Plaintiff’s counts.
23 LOA), dated 3/2/06, notes Otherwise undisputed that the document says what it says.
that the LOA started on
24 12/16/05.
25
26
27
28

1 16. KMC’s responsive DFJ00747 See evidentiary objections: Irrelevant to excusing

document to the LOA -748 Defendants’ liability under any of Plaintiff’s counts.
2 request, dated 3/2/06,
indicating that the leave ends
3 on 3/15/06 and stating “ ..
have the right to be reinstated
4 to the same or an equivalent
job with the same pay,
5 benefits and terms and
conditions of employment.”
6
17. E-mails dated 3/16/06. DFJ00752 Undisputed.
7 One to Peter Bryan from -753
Jadwin telling him that he
8 (Jadwin) will take Bryan’s
suggestion to take 2-3
9 months additional leave;
the other to Dr. Kercher
10 from Jadwin telling him
that he (Jadwin) is having
11 surgery and will need 2-3
months of additional leave
12 for the surgery and
requesting apologies from
13 Dr. Ragland (President-
elect), Dr. Abraham and
14 Dr. Taylor and an
investigation into Dr. Roy.
15
18. Notice from Human DFJ00796 See evidentiary objections: Irrelevant to prove Plaintiff
16 Resources to Jadwin, dated failed to give reasonable notice on 3/16/06 of his need for
4/20/06, that his leave of extension of medical leave prior to being placed on
17 absence expired on 3/15/06. Forced FT Leave by Bryan on 4/28/06. This is also See
evidentiary objections: Irrelevant to excusing Defendants’
18 liability under any other of Plaintiff’s counts.
19 Chester admitted in Depo. that Plaintiff’s email to Bryan

of 3/16/06 constituted reasonable notice of his need for
20 extension of medical leave.
[Smith Depo., 8/19/08, pg. 65:2-13 and 74: 12-22]
21
Otherwise, undisputed that the document says what it
22 says.
23 19. Jadwin’s request for DFJ01158 See evidentiary objections: Irrelevant to prove Plaintiff
Leave of Absence Extension, failed to give reasonable notice on 3/16/06 of his need for
24 dated 4/26/06, has a starting extension of medical leave prior to being placed on
date of 3/15/06 and an Forced FT Leave by Bryan on 4/28/06.
25 ending date of 9/16/06.
Chester admitted in Depo. that Plaintiff’s email to Bryan
26 of 3/16/06 constituted reasonable notice of his need for
extension of medical leave.
27 [Smith Depo., 8/19/08, pg. 65:2-13 and 74: 12-22]
28 Otherwise, undisputed that the document says what it
says.

1 20. Memo from Bryan to DFJ0l121 Undisputed that the document says what it says.
Jadwin, dated 4/28/06,
2 notifying him that his leave
would be up on 6/16/06 and
3 he either returns fulltime or
resigns. Also, it notes that
4 Jadwin was provided a
medical leave history, along
5 with the calculations and
policies about his medical
6 leave.
7 21. Bryan noted that he gave Bryan See evidentiary objections.

the option to Jadwin whether Depo.,
8 to go on full-time leave, 8/14/08, Disputed: Plaintiff has testified multiple times that, after
although full-time leave was pgs. 250: he requested an extension of his medically-required part-
9 preferable to Bryan. Bryan 15- 251:6, time medical leave in April 2006 [Jadwin Decl. (Doc.
asserts that it was Jadwin’s Exhibit 265), Exh. 6 (Jadwin’s Request for Leave Extension of
10 decision to go on fulltime 303 4/26/06 at DFJ00157), Exh. 4 (Jadwin’s Email to Bryan,
leave and that Jadwin never Chester, & Dutt of 3/16/06 at DFJ00752)], Defendant
11 communicated with Bryan Bryan refused and forced him onto full-time medical
any contrary intent. leave on April 28, 2006, so as to exhaust his medical
12 leave as soon as possible. [Lee Opp. Decl., Exh. 2 (Bryan
Depo at 249:24-250:19; Exh. 4 (Jadwin Depo. at 384:9-
13 13); Exh. 5(Jadwin Depo. at 983:23-984:1, 94:23-
985:4).]. Plaintiff’s testimony is unrefuted: Defendant
14 Bryan admitted in Depo. that it was his idea that day to
have Plaintiff convert his part-time leave to full-time,
15 based upon a perception that Plaintiff’s part-time leave
was creating “issues” within the Pathology department
16 (not a concern that part-time work might worsen
Plaintiff’s condition). [Lee Opp. Decl., Exh. 2 (Bryan
17 Depo at 249:24-250:19; Exh. 4 (Jadwin Depo. at 384:9-
13); Exh. 5(Jadwin Depo. at 983:23-984:1, 94:23-
18 985:4).].
19 It should be noted that the “issues” within the Pathology

department to which Bryan referred are clearly pretext.
20 Less than 2 weeks before Bryan interfered with Plaintiff’s
leave, he wrote to him saying: “Yes, the Department of
21 Pathology continues to function well, as it has for many
years, and, yes, you have made many positive changes to
22 the department” [Lee Decl. (Doc. 266), Exh. 12 (Bryan
memo to Jadwin of 4/17/06 at DFJ795); Bryan Depo at
23 332:12-22; Lee Decl. (Doc. 266), Exh. 14 (Bryan’s Memo
to Jadwin of 4/28/06 at DFJ1152)]. Later, Bryan testified
24 that, as of April 28, 2006, “actual functioning of the
department of [pathology] actually was fairly good”. [Lee
25 Opp. Decl., Exh. 3 (Bryan Depo at 332:12-22).].
26
27
28

1 22. Memo from Bryan to Bryan See evidentiary Objections

Jadwin dated 4/28/06, Depo.,
2 summarizing a meeting held 8114/08, Disputed: Plaintiff has testified multiple times that, after
with Bryan, Karen Barnes, pgs. he requested an extension of his medically-required part-
3 Steve O’Connor, and Jadwin. 240:9- time medical leave in April 2006 [Jadwin Decl. (Doc.
The meeting was held to 244: 2, 265), Exh. 6 (Jadwin’s Request for Leave Extension of
4 “insure that [Jadwin] had all Exhibit 4/26/06 at DFJ00157), Exh. 4 (Jadwin’s Email to Bryan,
information available 303 pg Chester, & Dutt of 3/16/06 at DFJ00752)], Defendant
5 concerning his status and 243:22-25 Bryan refused and forced him onto full-time medical
what was possible and not pg.244:1- leave on April 28, 2006, so as to exhaust his medical
6 possible according to County 2 leave as soon as possible. [Lee Opp. Decl., Exh. 2 (Bryan
policies for leaves of Depo at 249:24-250:19; Exh. 4 (Jadwin Depo. at 384:9-
7 absence.” It was not a 13); Exh. 5(Jadwin Depo. at 983:23-984:1, 94:23-
disciplinary meeting. 985:4).]. Plaintiff’s testimony is unrefuted: Defendant
8 Bryan admitted in Depo. that it was his idea that day to
have Plaintiff convert his part-time leave to full-time,
9 based upon a perception that Plaintiff’s part-time leave
was creating “issues” within the Pathology department
10 (not a concern that part-time work might worsen
Plaintiff’s condition). [Lee Opp. Decl., Exh. 2 (Bryan
11 Depo at 249:24-250:19; Exh. 4 (Jadwin Depo. at 384:9-
13); Exh. 5(Jadwin Depo. at 983:23-984:1, 94:23-
12 985:4).].
13 Disputed that it was not a disciplinary meeting. [Lee Opp.

Decl., Exh. 57 (O’Connor Depo. at 68:4-11). Meetings
14 that Defendant Bryan ordered him to attend were typically
those involving employee discipline. [Id. at 73:23-74:11].
15 O’Connor also testified that his role at the meeting did not
include offering any input, and that he did not do so.
16
17
18
19
20
21
22
23
24
25
26
27
28

1 23. A letter to Bryan from Bryan See evidentiary objections.

Jadwin, dated May 31, 2006, Depo.,
2 where Jadwin requests more 8/14/08, Undisputed that Plaintiff was requesting more time to
time to make the decision by pgs. make decision by June 16th whether to return full-time or
3 June 16th of whether to 248:16249 resign.
return full-time or resign. : 9 Exhibit
4 Bryan did not have the 311 Disputed that Plaintiff “did not do that”. It is true Bryan
authority to make an had told Plaintiff to make a decision to return full-time by
5 exception to County policy 6/16/06. Plaintiff’s request for more time to decide was
by extending leave beyond sent on 5/31/06. All Bryan had to do was say yes or no.
6 the maximum period granted He did neither. Instead, on 6/14/06, 2 days before the
for leave. Jadwin wasn’t deadline, Bryan pre-empted Plaintiff by informing him he
7 being asked to return full- was going to “enact the provisions [of REMOVAL], and
time on June 16th, he just rescind your appointment as chairman…This decision is
8 had to give his decision to effective 6/17/07. [Lee Decl. (Bryan memo to Jadwin of
return full-time by June 16th. 6/14/06 at DFJ01181].
9 He did not do that.
Disputed: Bryan did not lack authority to extend leave
10 beyond June 16, 2006. Kern County Civil Service
Commission rule 1201.20 provided that Plaintiff was
11 permitted to have medical or recuperative leave of up to 6
months CUMULATIVELY. [Lee Decl., Exh. 18 (CSC
12 Rules, Rule 1201.20 on Bates 0001501)]. June 16 is
exactly 6 calendar months after Plaintiff’s leave allegedly
13 began (December 16, 2005). Since Plaintiff had been on
part-time leave from 12/16/05 to 4/28/06, he had not used
14 up 6 months of cumulative leave by 6/16/06. On June 29,
2006, Plaintiff’s counsel informed County Counsel
15 Barnes of this error. [Lee Opp. Decl., Exh. 16 (Lee Letter
to Barnes of 6/29/06 at sec. III)]. Defendant County
16 responded by demoting Plaintiff on July 10, 2006
anyway.
17
24. Letter from Peter Bryan DFJ01141 Disputed that Plaintiff ever asked for 90-days Personal
18 to Jadwin, dated 6/14/06, Necessity Leave. He never did; Bryan forced him onto
granting him Personal personal leave. Plaintiff’s leave extension request of
19 Necessity Leave of 90 days, March 16, 2006 asked for extension of Plaintiff’s
pursuant to Rule 1202.2, but protected medical leave, not personal leave. [Jadwin Decl.
20 only for his employment with (Doc. 265), Exh. 6 (Jadwin’s Request for Leave
KMC, not for his position as Extension of 4/26/06 at DFJ00157); Exh. 4 (Jadwin’s
21 pathology department chair. Email to Bryan, Chester, & Dutt of 3/16/06 at DFJ00752);
Lee Supp. Decl. (Doc. 267), Exh. 15 (Chester Depo at
22 120:1-16)]. Meanwhile, Defendants’ own Separate
Statement (Doc. 259) admits that Plaintiff’s letter to
23 Bryan of May 31, 2006 was requesting more time to
decide whether he would be returning full-time or
24 resigning. It was not requesting more leave past
September 16, 2006. [Defendants’ Separate Statement
25 (Doc. 259), DMF 23]. The notion that Bryan “granted”
Plaintiff personal leave is pretext.
26
27
28

1 25. Bryan artfully explained Bryan See evidentiary objections.

why the Chair of the Depo.,
2 Department of Pathology 8/14/08, Disputed: This is pretext. On 4/17/06, just prior to placing
needs to be present full-time. pg. Plaintiff on Forced FT Leave, Bryan admitted to Plaintiff:
3 “It’s not just the task 216:3·22. “Yes, the Department of Pathology continues to function
orientation of handling a well, as it has for many years, and, yes, you have made
4 duty. It’s being present many positive changes to the department.” [Lee Decl.
within the organization to (Doc. 266), Exh. 12 (Bryan memo to Jadwin of 4/17/06 at
5 influence the organization’s DFJ795); Bryan Depo at 332:12-22; Lee Decl. (Doc.
policies and practices. 266), Exh. 14 (Bryan’s Memo to Jadwin of 4/28/06 at
6 Organizations tend to drift DFJ1152)]. Later, Bryan testified that, as of April 28,
without the constancy of 2006, “actual functioning of the department of
7 leadership, because that is [pathology] actually was fairly good”. [Lee Opp. Decl.,
part of what a leader does is Exh. 3 (Bryan Depo at 332:12-22).].
8 monitor the performance to
ensure things stay on track, But in Bryan’s letter to the DHS of 7/25/06, he contradicts
9 and without that constant himself when explaining to the DHS that Plaintiff had
dialogue present, you can been demoted as follows: “Quality of care issues
10 find yourself getting off was not the basis for making this decision. To the
track. In the medical arena contrary, Dr. Jadwin has been on an extended leave of
11 when patient care is absence from the hospital and there was a need to provide
involved, you don’t allow it consistent administrative leadership within the
12 to get to the point where you department. In compliance with section 1265 and CLIA,
don’t have the leadership Philip Lee Dutt, M.D., has been selected as the interim
13 necessary. So that’s inferred director of the laboratory and will serve in that capacity
in it being a full-time until a permanent replacement is appointed.”
14 position.” [Lee Decl., Exh. 19 (Bryan letter to DHS of 7/25/06 at
Bates 0001619)(emphasis added)]. Bryan made no
15 mention in his letter of a failure to “influence” policies
and practices outside of the pathology department or
16 across KMC as an organization.
17 Moreover, this responsibility to “influence” policies and

procedures outside of the Pathology department, across
18 KMC as an organization, is conspicuously absent from
Plaintiff’s job description. In fact, the job description’s
19 only reference to “policies and procedures” is as follows:
“Oversees the development, implementation and
20 maintenance of department policies and procedures for
the clinical laboratory and pathology department,
21 including surgical pathology, cytopathology and autopsy
pathology.” [Lee Decl., Exh. 2 (Second Employment
22 Contract of 11/12/2002 at Section 2.a. of Exhibit A on
Bates DFJ00171)].
23
Bryan's "explanation" is a pretext for discrimination in
24 that Dr. Tai Yoo, Chair of Psychiatry, is a chair even
though he is not present full-time. Yoo testified that he
25 typically spent 25 to 30 hours per week at KMC [Lee
Opp. Decl., Exh. 46 (Yoo Depo. at 20:4-15)], dividing his
26 time 50/50 between KMC and Kern Mental Health [Id. at
9:11-16; 20:4-11]. He has been employed by Defendant
27 County as a part-time chair since 8/1/01. [Id. at 9:25-
10:9]. He remains a chair and has not been removed.
28

1 a) Responsibilities and duties DFJ00046 See evidentiary objections.

of the pathology dept. chair
2 are set out in the KMC Disputed: Sections 6. through 6.4-3 of the Bylaws do
Medical Staff Bylaws, NOT contain any such provisions.
3 sections 6. through 6.4-3.
4 26. Mortgage verification of DFJ01343 See evidentiary objections: Irrelevant and immaterial to
employment for Jadwin, excusing Defendants' liability under any of Plaintiff's
5 dated 6/22/06, noting that the counts.
probability of continued
6 employment for Jadwin was Bryan had solicited Plaintiff’s resignation earlier on
good and he was okay to 4/28/06. [Lee Decl., Exh. 14 (Bryan Memo to Jadwin of
7 return to work when well. 4/28/06 at DFJ001152)].
8 27. Letter from Dr. Harris 0001424 See evidentiary objections: Irrelevant to excusing
(writing on behalf of Defendants’ liability under any of Plaintiff’s counts, as
9 Bryan) to Jadwin, dated evidenced by Defendants’ failure to cite this DMF
6/26/06, stating that he anywhere in their motion brief (Doc. 262).
10 (Jadwin) has been seen in
and around KMC and that Disputed: Bryan testified in deposition that this letter was
11 while he (Jadwin) is on drafted by him (not Harris). [Lee Opp. Decl., Exh. 2
leave, he is not to enter the (Bryan Depo., 261:7-262:19)].
12 hospital except for seeking
medical attention. He is
13 also not to contact any
employee or faculty
14 member of KMC while on
leave.
15
28. In his letter of June 14, Bryan See evidentiary objections: Irrelevant to excusing
16 2006, Bryan notifies Jadwin Depo., Defendants’ liability under any of Plaintiff’s counts, as
that Jadwin will be 8/14/08, evidenced by Defendants’ failure to cite this DMF
17 removed as chair and tells pg. 257:9- anywhere in their motion brief (Doc. 262).
Jadwin to call him if he has 15
18 questions. Bryan states that Disputed: Bryan is not an impartial adjudicator. Offering
put the burden of Plaintiff to contact him was not adequate due process.
19 challenging the action or [Lee Decl. (Doc. 266), Exh. 15 (Bryan Letter to Jadwin of
asking for reconsideration 6/14/06 at DFJ1181); Lee Decl. (Doc. 266), Exh. 16
20 on Jadwin who never called (Bryan Letter to Jadwin of 6/26/06 at DFJ1346); Lee
him about the letter. Decl. (Doc. 266), Exh. 17 (JCC Minutes of 7/1/06 at
21 0009821); Jadwin Decl. (Doc. 265), Exh. 1 (Jadwin email
to Bryan of 2/28/05 at DFJ355); Lee Supp. Decl. (Doc.
22 267), Exh. 13 (Ragland Depo at 332:14-21); Lee Decl.
(Doc. 266), Exh. 8 (Bryan email to Harris of 11/8/05 at
23 0000503); Lee Decl. (Doc. 266), Exh. 11 (Ragland email
to Bryan of 2/23/06 at 0000507)].
24
25
26
27
28

1 29. According to Exhibit Bryan See evidentiary objections: Irrelevant to excusing

303, Jadwin’s leave and all Depo., Defendants’ liability under any of Plaintiff’s counts, as
2 allowances by the County 8/14/08, evidenced by Defendants’ failure to cite this DMF
expired by June 16th. After pg. 244:6- anywhere in their motion brief (Doc. 262).
3 that date, Bryan had no 16
authority to extend Undisputed that the document says what it says.
4 Jadwin’s employment
relationship. Disputed: Bryan did not lack authority to extend leave or
5 employment beyond June 16, 2006. Kern County Civil
Service Commission rule 1201.20 provided that Plaintiff
6 was permitted to have medical or recuperative leave of up
to 6 months CUMULATIVELY. [Lee Decl., Exh. 18
7 (CSC Rules, Rule 1201.20 on Bates 0001501)]. June 16 is
anyway.
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

1 30. By June 2006, Jadwin Bryan See evidentiary objections.

had fully exhausted his rights Depo.,
2 and the institutional 8/14/08, Undisputed that the document says what it says.
obligation to grant him pgs.
3 medical leave. 280:21- Disputed: Bryan testified that, towards the end of his
281:4 leave, Plaintiff was requesting extension of his leave even
4 though he had fully his medical leave right under law and
County policy. This is pretext.
5
First, Bryan did not lack authority to extend leave or
6 employment beyond June 16, 2006. Kern County Civil
Service Commission rule 1201.20 provided that Plaintiff
7 was permitted to have medical or recuperative leave of up
to 6 months CUMULATIVELY. [Lee Decl., Exh. 18
8 (CSC Rules, Rule 1201.20 on Bates 0001501)]. June 16 is
anyway.
13
Second, Plaintiff was not asking for an extension of his
14 leave. As Defendants’ own Separate Statement (Doc. 259)
admits Plaintiff’s letter to Bryan of May 31, 2006 was
15 requesting more time to decide whether he would be
returning full-time or resigning, not more leave past
16 September 16, 2006. [Defendants’ Separate Statement
(Doc. 259), DMF 23]. Bryan’s testimony is pretext
17 manufactured after the fact to justify the Demotion.
18 31. Adherence to the Bryan See evidentiary objections: Irrelevant to excusing

Medical Staff Bylaws Depo., Defendants’ liability under any of Plaintiff’s counts, as
19 afforded Jadwin the due 8/14/08, evidenced by Defendants’ failure to cite this DMF
process that he was entitled pg. 258:7- anywhere in their motion brief (Doc. 262).
20 to. 16
Disputed: The Bylaws’ failure to provide for due process
21 in connection with the Demotion is a violation of due
process. Because the Bylaws were ratified by the Kern
22 Board of Superviors, it establishes the 42 USC § 1983
liability of Defendant County under Monell.
23
Disputed: JCC minutes regarding the contemplated
24 demotion of the chair of the OB-GYN department stated:
“The problem is we have tied a portion of the chair’s
25 compensation to that position, that is a property right. Dr.
Perez is entitled to due process hearing for this reason.”
26 [Lee Opp. Decl., Exh. 18 (JCC Meeting Minutes of
9/10/07 at Agenda Item 6 on Bates 0009221)].
27
See evidentiary objections.
28

1 32. Tort Claims Act Exhibit 2 See evidentiary objections: Irrelevant to excusing
Complaint, dated 7/3/06, to Second Defendants’ liability under any of Plaintiff’s counts.
2 Jadwin admits that he had Amended
used up his CFRA leave by Complaint
3 June 14th, 2006. Page 1 of
the Attachment (page 3 of
4 the entire complaint), Section
A, paragraph 1, last sentence
5 reads “As of June 14, 2006,
Complainant had taken 12
6 weeks of CFRA sick leave
and approximately 3-4 weeks
7 of County sick leave based
on doctor’s certifications
8 which he submitted.”
9 33. Memorandum to the Joint 0001476- See evidentiary objections.

Conference Committee 1565
10 (JCC) from Bryan, dated 0000073- Undisputed that the JCC “took [Bryan’s] advice”.
7/10106, recommending that 75
11 the Committee approve the Disputed: Evidence establishes that the JCC voted to
demotion of Jadwin from demote Plaintiff not only for the reasons that he gave in
12 chair of the pathology his memorandum, but also for whistleblower retaliation
department to staff and disability discrimination, as well as
13 pathologist. “This oppositional/participatory retaliation for threatening to file
recommendation to rescind lawsuit.
14 Dr. Jadwin’s appointment as
Chairman, Department of
15 Pathology, is based solely on
his continued non-
16 availability to provide the
leadership necessary for a
17 contributing member of the
medical staff leadership
18 group. KMC must have its
key personnel available, and
19 Dr. Jadwin has provided no
indication that he is
20 committed to return to work
or resume his duties as
21 chairman.” Also, “Dr. Jadwin
has made no attempt to
22 contact me concerning my
decision to relieve him of his
23 chairman duties nor has he
indicated any desire to
24 negotiate a new contract.”
JCC meeting minutes
25 confirm that the committee
took Bryan’s advice and they
26 did it for the reason that he
gave in his memorandum.
27
28

1 34. Ray Watson (hereinafter Watson See evidentiary objections.

referred to as Watson) Depo.,
2 testified that he only 8125/08, Disputed: Watson testified at his deposition that he clearly
remembers a discussion on pgs. recalled Defendant County had decided not to renew
3 removing Jadwin from the 13:17- Plaintiff’s contract. [Lee Opp. Decl., Exh. 10 (Watson
department chair position; he 14:14 Depo. at 30:10-13).].Watson was asked twice if he
4 was quite clear (and he was recalled clearly whether it was to punish Plaintiff for
asked three times) that he did bring suit and each time he answered yes:
5 not remember any discussion
about Jadwin’s Q. Okay. What about the nonrenewal? I mean, do you
6 “termination.” He recall Dr. Jadwin’s physical absence being a reason for
affirmatively stated that he his nonrenewal of his contract?
7 knew of no discussions about A. Well, it could be that. It could be the fact that I think
Jadwin resigning or being by then he was -- probably was suing us. So why would
8 denied privileges. you want to establish a contractual relationship with
somebody who’s suing you.
9 Q. Okay. Well, he was also suing you at the time of his
removal or actually at the time of his --no, he wasn’t. He
10 wasn’t. Okay. But I mean, you say why would you
establish a contractual relationship with someone who’s
11 suing you, right?
A. Right.
12 Q. Was that -- does that mean -- are you just speculating
now, just guessing, or was that a consideration for his
13 nonrenewal?
14 […]
Q. Okay. But you recall it being discussed at the JCC
15 meetings?
A. Yes.
16 [Id. at 110:12-111:5; 111:15-24].
17 Watson then re-affirmed a third time – volunteering it on

his own initiative – that oppositional retaliation was an
18 additional motivating factor for the Nonrenewal:
19 Q. So the question is: You’ve mentioned that for the

nonrenewal one of the reasons was that Dr. Jadwin wasn’t
20 available for work; is that correct or --
A. My understanding was that he had -- he had been on
21 medical leave, family leave, and had requested even more
leave, and that for that reason and the fact that he was
22 suing us, that we decided not to renew his contract.
[Id. at 113:15-114:4).].
23
Watson failure to recall discussion of Plaintiff’s
24 termination or denial of his medical privileges proves
nothing about the Nonrenewal and whether a discussion
25 about it occurred. A discussion of one doesn’t necessitate
or preclude a discussion of the others. Moreover, the
26 testimony Defendants cite to appeared over 100 pages
and 2 hours earlier in the deposition transcript than the
27 Nonrenewal discussion and arose in response to a
completely unrelated line of questioning. [Id. at 12:10-14;
28 13:17-14:2)].

1 35. Watson testified that he Watson See evidentiary objections.

became aware that Jadwin’s Depo.,
2 contract was not renewed 8/25/08, Disputed: For sake of economy, see Item 34 supra, which
although he could not give a pgs. 28:6- is incorporated in its entirety herein.
3 timeline as to when things 30:23
happened. He also testified Disputed: The fact that Watson couldn’t recall a formal
4 strongly that he does not JCC vote to not renew Plaintiff’s contract proves nothing
recall a vote taken on the about whether or not the JCC decided to not renew
5 nonrenewal “although [he] Plaintiff’s contract. JCC decision do not all require a
imagine[s] it was,” formal JCC vote. In any event, Watson confirmed several
6 times that he clearly recalled the JCC deciding on the
Nonrenewal.
7 36. Watson testified that the Watson See evidentiary objections.
fact that Jadwin was suing Depo.,
8 KMC was brought up in 8/25/08, Disputed: For sake of economy, see Item 34 supra, which
discussions of whether to pgs. is incorporated in its entirety herein.
9 renew Jadwin’s contract 110:12112
although he would not say it : 13 Disputed: On the one hand, Defendants argue that
10 was a consideration, only Watson’s testimony is “confused” and unreliable. Yet, In
that it was discussed. In their own motion, Defendants cite liberally to Watson’s
11 addition, it became obvious supposedly “unreliable” testimony when it suits them.
after a few questions that [Defendants’ Separate Statement (Doc. 259) at DMF 34
12 Watson was confused about on 9:16-22; at DMF 35 on 9:23-27; at DMF 145 on 34:4-
the sequence of events which 5; DFM 36 on 34:6-9]. Defendants’ argument is a bad
13 can lead to the inference that faith attempt to controvert Watson’s testimony when it is
he does not recall anything damaging, but to otherwise rely on it when it suits them.
14 specifically or correctly.
Watson was scrupulous about stating in his deposition
15 when he did or did not have clear or certain recall. [Lee
Opp. Decl., Exh. 10 (Watson depo. at 13:17-14:19, at
16 38:9-40:5)]. Watson confirmed several times that he
clearly recalled the JCC deciding on the Nonrenewal for
17 the reasons he stated.
[Lee Opp. Decl., Exh. 10 (Watson Depo. at 110:12-111:5;
18 111:15-24; at 113:15-114:4)].
19
20
21
22
23
24
25
26
27
28

1 a) Kern County Board of Decl. of See evidentiary objections.

Supervisors did not discuss Michael
2 the non-renewal of Jadwin’s Rubio, Disputed: Defendants’ declarations submitted by
employment agreement or 11/10/08, members of the Kern County Board of Supervisors
3 made any decisions ¶2; Decl. asserting that the Board never discussed or made any
regarding the non-renewal of of decision regarding nonrenewal or expiration of Plaintiff’s
4 the employment agreement. Raymond contract proves nothing about whether such a decision or
The subject never came Watson, discussion occurred at the JCC level. The absence of a
5 before the Board of 11/10/08, decision by the Board of Supervisors in no way precludes
Supervisors. ¶¶3, 4 and a decision being made by the JCC. Again, Watson
6 5; Decl. of confirmed several times that he clearly recalled the JCC
Mike deciding on the Nonrenewal.
7 Maggard, [Lee Opp. Decl., Exh. 10 (Watson Depo. at 30:10-13;
11/10/08, 110:12-111:5; 111:15-24; 113:15-114:4)].
8 ¶2; Decl.
of Jon Disputed: a party cannot create an issue of fact by a
9 McQuisto declaration contradicting his or her own deposition or
n, other sworn testimony. See Block v. City of Los Angeles
10 11/10/08, (9th Cir. 2001) 253 F3d 410, 419, fn. 2. The same rule
¶2; Decl. applies to postdeposition affidavits that contradict the
11 of Don affiant’s deposition testimony. Aerel, S.R.L. v. PCC
Maben, Airfoils, LLC (6th Cir. 2006) 448 F3d 899, 907–908; Bank
12 11/10/08, of Ill. v. Allied Signal Safety Restraint Systems (7th Cir.
¶2 1996) 75 F3d 1162, 1169.
13
37. Letter from Karen Barnes DFJ01359 See evidentiary objections.
14 (hereinafter referred to as -1361
Barnes) to Plaintiffs attorney Disputed: The Bylaws’ failure to provide for due process
15 Eugene Lee, dated 7118/06, in connection with the Demotion is a violation of due
in which she mentions (pg. 2) process. Because the Bylaws were ratified by the Kern
16 that Jadwin was removed as Board of Superviors, it establishes the 42 USC § 1983
pathology department chair liability of Defendant County under Monell.
17 on 7/10/06 at a regularly
scheduled meeting of the
18 Joint Conference Committee,
pursuant to Bylaws article
19 IX, section 9.7-4 “removal of
a department chair may occur
20 with or without cause .. “
21 38. Plaintiffs’ attorney Bryan See evidentiary objections: Irrelevant to excusing

Eugene Lee agrees that Depo., Defendants’ liability under any of Plaintiff’s counts.
22 Jadwin was not removed as 8/14/08,
chair during his medical pg. 222:8-
23 leave. 13
24 39. Letter to Dr. Harris from DFJ01388 Undisputed that the document says what it says.
Jadwin, dated 9111/06, -1389
25 stating that he (Jadwin) will
be returning to work on
26 9/18/06 and enclosed was a
doctor’s certification that he
27 was able to return to work
full-time.
28

1 40. Letter from David DFJ01398 Undisputed.

Culberson to Jadwin, dated
2 9/20/06, explaining the
reasons for reduction in
3 pay.
4 41. Letter from David DFJ01482 Undisputed that the document says what it says.
Culberson to Jadwin, dated
5 12/7/06, putting Jadwin on
administrative leave with pay
6 and confining him to his
home during business hours,
7 pursuant to Kern County
Policy and Administrative
8 Procedures Manual section
124.3.
9
a) Kern County Policy and 0016941 See evidentiary objections.
10 Administrative Procedures
Manual, pg. 1:22, Section Undisputed that the document says what it says.
11 titled “Administrative Leave
with Pay.” “During the
12 administrative leave, the
employee shall be ordered to
13 remain at home and available
by telephone .. “.
14
42. Letter from Mark DFJ01701 See evidentiary objections: Irrelevant to excusing
15 Wasser to Eugene Lee, Defendants’ liability under any of Plaintiff’s counts, as
dated 4/30/07, allowing evidenced by Defendants’ failure to cite this DMF
16 Jadwin to pursue his own anywhere in their motion brief (Doc. 262).
activities during the work
17 week and retaining him, at Undisputed that the document says what it says.
his usual salary, for
18 consulting. Disputed: Defendant County was not “retaining” Plaintiff
for consulting. Rather, the intent was to “run out’ the term
19 of his existing contract, which was due to expire on
October 4, 2007.
20 [Lee Supp. Decl. (Doc. 267), Exh. 21 (Rog No. 43 at
53:3-9); Lee Supp. Decl. (Doc. 267), Exh. 22 (Rog. No.
21 44, 28:17-22); Lee Supp. Decl. (Doc. 267), Exh. 6
(Wasser Email to Lee of 5/1/07 at DFJ01705)].
22
23
43. Letter to Mark Wasser DFJ01703 Undisputed that the document says what it says.
24 from Eugene Lee, dated -1704
5/1/07, noting that on
25 4/28/07 and in several
following e-mails he was
26 notified that KMC wanted to
terminate Jadwin’s contract
27 and would not renew it on
10/4/07.
28

1 44. Exhibit 644 is an e-mail Jadwin See evidentiary objections.

with an amendment attached Depo.,
2 to it. The amendment is a 3/12/08, Undisputed that the amendment is a contract amendment
contract amendment which pgs. which Jadwin had to sign before returning to work.
3 Jadwin had to sign before 969:1-
returning to work. Exhibit 974:2 Disputed: Plaintiff’s confirmation of discussions with his
4 581 is also the same contract (Exhibits attorney about the amendment proves nothing, much less
amendment although Exhibit 644 and that Plaintiff negotiated the amendment with Defendants.
5 581 is signed. There are 581) In fact, later, Plaintiff confirmed he did not know whether
differences between Exhibit his attorney had engaged in negotiations or made
6 644 and 581, in proposals regarding the amendment.
subparagraphs “h” and “i”.
7 Jadwin confirmed that he had Disputed: Defendants cite DMF 44 in support of an
discussions with his attorney affirmative defense that the Paycut Amendment was a
8 about the amendment; novation of Plaintiff’s employment contract, thus
Jadwin does not know if his extinguishing all prior claims. This is an unpleaded
9 attorney negotiated any of affirmative defense which Defendants failed to plead as
the terms in it. Jadwin does recently as October 27, 2008, when they filed their
10 not know if his attorney Answer to the Second Amended Complaint. It should be
made proposals to KMC with stricken.
11 suggested changes in the
language of the amendment.
12 Jadwin was aware of the
changes at the time they
13 occurred but he does not
recall how the changes came
14 about. One change that
Jadwin recalls talking about
15 is the cut in his salary which
he didn’t agree with.
16
17
18
19
20
21
22
23
24
25
26
27
28

1 45. The last two pages of Jadwin See evidentiary objections: Irrelevant to excusing
Exhibit 581 is Exhibit A Depo., Defendants’ liability under any of Plaintiff’s counts.
2 which is a job description. 3/12/08,
Jadwin confirms that he read 974:3~97 Disputed: Plaintiff had requested reasonable
3 it at the time of signing the 6:l2 accommodation of his disability by asking to extend his
amendment. Jadwin looked part-time medical leave. Bryan refused on 4/28/06,
4 at the tasks listed and does forcing Plaintiff onto Forced FT Leave.
not believe that any of those [Jadwin Decl. (Doc. 265), Exh. 6 (Jadwin’s Request for
5 tasks require Leave Extension of 4/26/06 at DFJ00157), Exh. 4
accommodation. Jadwin does (Jadwin’s Email to Bryan, Chester, & Dutt of 3/16/06 at
6 not recall asking anyone with DFJ00752)]
the County for an
7 accommodation of any of the [Lee Opp. Decl., Exh. 2 (Bryan Depo at 249:24-250:19;
tasks listed in Exhibit A. Exh. 4 (Jadwin Depo. at 384:9-13); Exh. 5(Jadwin Depo.
8 at 983:23-984:1, 94:23-985:4).]
9 Plaintiff’s testimony is unrefuted: Defendant Bryan

admitted in Depo. that it was his idea that day to have
10 Plaintiff convert his part-time leave to full-time, based
upon a perception that Plaintiff’s part-time leave was
11 creating “issues” within the Pathology department (not a
concern that part-time work might worsen Plaintiff’s
12 condition).
[Lee Opp. Decl., Exh. 2 (Bryan Depo at 249:24-250:19;
13 Exh. 4 (Jadwin Depo. at 384:9-13); Exh. 5(Jadwin Depo.
at 983:23-984:1, 94:23-985:4).].
14
15
16
17 46. Jadwin testified that he Jadwin See evidentiary objections. Completely misstates
wanted his employment Depo., Plaintiff’s testimony.
18 contract renewed, but when 10/21/08,
presented with the fact that pg. 1011:
19 his employment contract in 161016:
place at the time of 19
20 nonrenewal contained his
reduced salary, he denied
21 wanting to renew that
contract.
22
47. Jadwin said that the Jadwin See evidentiary objections. Completely misstates
23 contract he wanted renewed Depo., testimony.
was his Department Chair 10/21/08,
24 contract. pgs. Disputed: What Plaintiff wanted is irrelevant
1032:1610 to establishing what he was willing to agree to in terms of
25 33: 3; pg. contract renewal. Plaintiff testified on the record that he
1043:12- expected his contract to be renewed on 10/4/07 and that
26 20 he would have continued prosecuting his lawsuit, had it
been renewed. [Lee Opp. Decl., Exh. 6 (Jadwin Depo. at
27 1096:9-14; 1096:22-1097:3)].
28

1 JADWIN’S
ALLEGATIONS OF
2 REGULATORY
3 VIOLATIONS
4 48. Approved Cancer 0000623- See evidentiary objections: Irrelevant to excusing

Program Performance 630 Defendants’ liability under any of Plaintiff’s counts, as
5 Report for KMC, dated evidenced by Defendants’ failure to cite this DMF
7/14/04, with a rating of “I anywhere in their motion brief (Doc. 262).
6 “meaning KMC’s Cancer
program-including number See evidentiary objections.
7 of meetings-is approved for
three years with Disputed: See evidentiary objections: Irrelevantas this is
8 commendation. allegedly a report issued as of 7/14/04, more than a year
before the October Conference of 10/12/05 and the
9 Credential Threat and before Plaintiff reported concerns
that the monthly oncology conference was not compliant
10 with accreditation requirements.
49. Exchange of e-mails 0000421- See evidentiary objections: Irrelevant to excusing
11 between Toni Smith and 424 Defendants’ liability under any of Plaintiff’s counts, as
Jadwin, dated 6/15/05, evidenced by Defendants’ failure to cite this DMF
12 about the PCC issues. In anywhere in their motion brief (Doc. 262).
0000423, Jadwin states that
13 a PCC must not be signed Undisputed that the document says what it says.
until the time of the
14 infusion, or KMC is not
meeting American
15 Association of Blood
Banks’ (hereinafter
16 referred to as AABB)
accreditation standards.
17
50. Typed notes, dated 0000575 See evidentiary objections:
18 1/10/06, of interviews done
to rebut Jadwin’s claim Irrelevant to excusing Defendants’ liability under any of
19 that the meeting frequency Plaintiff’s counts, as evidenced by Defendants’ failure to
standard set by the cite this DMF anywhere in their motion brief (Doc. 262).
20 American College of
Surgeons (hereinafter
21 referred to as ACS) was not
being met at KMC.
22
51. In meeting on 2/22/06, 0000578 See evidentiary objections:
23 Jadwin alleges that KMC is
not meeting the ACS Irrelevant to excusing Defendants’ liability under any of
24 standard for frequency of Plaintiff’s counts, as evidenced by Defendants’ failure to
staff meetings; was cite this DMF anywhere in their motion brief (Doc. 262).
25 rebutted during the
meeting that KMC is
26 meeting standard based on
2 surveys and paperwork.
27
28

1 52. In an e-mail to Peter DFJ00784 Undisputed.

Bryan dated 4/10/06,
2 Jadwin brings up non-
compliance with state
3 regulations, Joint
Commission for the
4 Accreditation of Hospital
Organizations (hereinafter
5 referred to as JCAHO),
and AABB on the issues of
6 the PCCs.
7 53. Notes of meeting with DFJ00788 See evidentiary objections:

Peter Bryan, Karen Barnes
8 and Jadwin on 4/13/06. Irrelevant to excusing Defendants’ liability under any of
There is no problem with Plaintiff’s counts, as evidenced by Defendants’ failure to
9 the PCCs because 5 charts cite this DMF anywhere in their motion brief (Doc. 262).
were reviewed (and
10 approved) by JCAHO.
11 54. E-mail to Peter Bryan DFJ00793 Undisputed.

from Jadwin, dated
12 4/17/06, claiming that the
JCAHO review was too
13 small of a sample so KMC
was not in compliance on
14 their handling of the PCCs
and there was a need for
15 action.
16 55. Gilbert Martinez, the Martinez See evidentiary objections.

Laboratory manager, recalls Depo.,
17 Jadwin telling him before 4/16/08, Disputed: Dr. Philip Dutt, Acting Chair of Pathology,
Thanksgiving in 2006 to pgs. 111: testified as PMK for the County on 8/29/08 that by the
18 prepare the laboratory for 12-118: Monday following Thanksgiving 2006, he had had a
possible inspections (so 22 conversation with Harris regarding Plaintiff’s statement to
19 sometime before 11/22/06). Martinez that “he was going to report the hospital to
He does not recall if Jadwin JCAHO, CNPS [sic] . . . either the Friday before
20 told him how Jadwin might Thanksgiving that year or the Monday after that
know about it. He remembers weekend.” [Lee Opp. Decl., Exh. 12 (Dutt Depo. at 10:5-
21 inspectors coming in from 24)].
the California Dept. of
22 Health Services (hereinafter
referred to as DHS) and
23 receiving written inquiries
from the CAP. These
24 inspections occurred several
months after Jadwin had
25 mentioned it. Jadwin did not
“confide” in him or tell him
26 that the inspections were
happening because of
27 whistleblowing by Jadwin.
28

1 a) CAP conducts routine Martinez See evidentiary objections.

inspections, unannounced, on Depo.,
2 a known periodic basis. 4/16/08,
pgs.
3 118:23-
120:19
4
5 56. Jadwin first reported Disputed only as to the statement “more than five years
concerns to JCAHO, CAP, after noticing alleged violations”. There is no support for
6 and DHS in November 28, this statement.
2006 (more than five years
7 after noticing alleged
violations).
8
a) Actual complaint filed DFJ02540 Undisputed.
9 with JCAHO by Jadwin. -2541
10 b) E-mail from JCAHO to DFJ01454 Undisputed.

11 acknowledging receipt of
complaint about KMC.
12
c) Letter from DHS to DFJ01459 Undisputed.
13 Jadwin, dated 12/1/06,
acknowledging receipt of
14 complaint.
15 57. E-mail to JCAHO from DFJ02538 See evidentiary objections: Irrelevant to excusing
Jadwin, dated 12/8/06, -2539 Defendants’ liability under any of Plaintiff’s counts, as
16 wanting to talk with the evidenced by Defendants’ failure to cite this DMF
JCAHO investigator and anywhere in their motion brief (Doc. 262).
17 requesting quickness on the
investigation because KMC Misstates the evidence.
18 might be covering up
noncompliance evidence.
19 He brings up the issue of
skull flaps being stored on-
20 site.
21 58. Letter to KMC from 0001455- Undisputed.
Jadwin dated 12/13/06 1458
22 notifying hospital
administration that he has
23 notified governmental and
enforcement agencies of
24 alleged violations.
25
26
27
28

1 59. Letter from Dr. Dutt to 0020278 See evidentiary objections:

Gerald Hoeltge of the CAP,
2 dated 1/11/07, telling him Irrelevant to excusing Defendants’ liability under any of
that Jadwin had never Plaintiff’s counts, as evidenced by Defendants’ failure to
3 informed him (Dutt) that cite this DMF anywhere in their motion brief (Doc. 262).
some tissue handling and
4 storage was occurring but Undisputed that unlicensed tissue handling and storage
the situation has been taken was occurring.
5 care of.
6 60. Letter to Dr. Dutt from 0020279 See evidentiary objections:

CAP, dated 3/22/07,
7 informing him that the Irrelevant to excusing Defendants’ liability under any of
KMC laboratory continues Plaintiff’s counts, as evidenced by Defendants’ failure to
8 to be in compliance with cite this DMF anywhere in their motion brief (Doc. 262).
the CAP Standards for
9 Laboratory Accreditation.
10 61. Dr. Dutt believed that Dutt See evidentiary objections:

Jadwin, after returning Depo.,
11 from leave, might be 8/20/08, Irrelevant to excusing Defendants’ liability under any of
intentionally issuing wrong pg. 296: Plaintiff’s counts, as evidenced by Defendants’ failure to
12 opinions to prove he was a 10- 19 cite this DMF anywhere in their motion brief (Doc. 262).
whistleblower.
13
14
DEPRESSION
15 DISABILITY,
16 REASONABLE
ACCOMMODATION,
17 INTERACTIVE
PROCESS
18 62. Jadwin described his Jadwin See evidentiary objections.
disability as severe Depo.,
19 depression, manifested by a 1/9/08, Undisputed.
lack of ability to concentrate; pgs.
20 loss of joy in his work; 414:24-
extreme anxiety and 418:12
21 difficulty sleeping. Jadwin
testified that he told Dr.
22 Kolb, during a meeting he
had with him in 2003, that he
23 was depressed. Jadwin
thought this meeting was a
24 one-on-one weekly meeting
that each department chair
25 had with Dr. Kolb. Jadwin
said that Dr. Kolb must have
26 noticed that he was depressed
because he would often ask
27 him if he was alright.
28

1 63. Jadwin told Dr. Kolb that Jadwin See evidentiary objections.
he suffered from depression Depo.,
2 when he notified him of the 1/9108, Undisputed.
weekly half-day medical pgs.
3 leave day off to see his 491:1-
therapist. 493:17
4
64. Jadwin asked Dr. Kolb Jadwin See evidentiary objections.
5 for accommodations for his Depo.,
disability by requesting time 1/9108, Undisputed.
6 off for his therapist visits. Dr. pgs. 506:
Kolb granted that 16-507: 1
7 accommodation.
8 65. Jadwin had an episode of Jadwin See evidentiary objections.

depression in the 1990s Depo.,
9 before coming to work at 1/9/08,
KMC. Jadwin affirmed his pgs.
10 earlier testimony that his 452:4-
recent depression started in 455:19
11 2002 or 2003. Jadwin said Pg. 455:8-
that he was taking weekly 13
12 half-day leaves starting in or
about 2003 and he told Dr.
13 Kolb it was because of his
problems with radiology and
14 others.
15 66. Bryan does not recall Bryan See evidentiary objections:

Jadwin mentioning to him Depo.,
16 about depression, 8/14/08, Irrelevant to excusing Defendants’ liability under any of
sleeplessness, etc. nor did pgs. 1ll: Plaintiff’s counts, as evidenced by Defendants’ failure to
17 Bryan notice behavior that 12113: 2 cite this DMF anywhere in their motion brief (Doc. 262).
he would call mental and
18 illness. 128:16- Disputed: This is pretext. Bryan testified that he recalled
129:3 receiving a letter from Plaintiff on 1/9/06 in which
19 Plaintiff stated he was “depressed” and requested leave
due to his depression. [Lee Supp. Decl., Exh. 10 (Bryan
20 Depo at 105:7-106:2); Lee Decl., Exh. 9 (Jadwin letter to
Bryan of 1/9/05 on Bates 0001140)]. Defendants also
21 admit that Plaintiff had told Kolb he was depressed in
2003 and was accommodated in the form of part-time
22 leave so he could obtain treatment. [Defendants’ Motion
(Doc. 262) at 27:12-14 (“Plaintiff first complained of
23 depression in 2003. He told Dr. Marvin Kolb, Chief
Medical Officer at the time, that he suffered from an
24 inability to concentrate, anxiety, and sleeplessness”);
Defendants’ Separate Statement (Doc. 259) at DMF 62-
25 64]. On 1/17/06, Bryan also sent a letter to the Kern
Board of Supervisors in which he stated he had become
26 concerned about Plaintiff’s “emotional health”. [Lee
Decl., Exh. 10 (Bryan memo to BOS of 1/17/06 at item 8
27 on Bates 0001567)].
28

1 67. Jadwin only discussed his Jadwin See evidentiary objections.

disability with Dr. Kolb. Depo.,
2 When asked whether he had 3/12/08, Disputed: Bryan testified that he recalled receiving a letter
ever told Peter Bryan, Jadwin pgs. 976: from Plaintiff on 1/9/06 in which Plaintiff stated he was
3 said that subsequently during 13983: 2 “depressed” and requested leave due to his depression.
one-on-one meetings with lines [Lee Supp. Decl., Exh. 10 (Bryan Depo at 105:7-106:2);
4 Bryan he had mentioned 977:5-8 Lee Decl., Exh. 9 (Jadwin letter to Bryan of 1/9/05 on
being depressed by lack of and lines Bates 0001140)].
5 action on the concerns 977:24-
Jadwin was raising. When 978:8 and On 1/17/06, Bryan also sent a letter to the Kern Board of
6 pressed on whether he had lines 981: Supervisors in which he stated he had become concerned
ever actually told Peter 17-982: 1 about Plaintiff’s “emotional health”. [Lee Decl., Exh. 10
7 Bryan he was disabled, and lines (Bryan memo to BOS of 1/17/06 at item 8 on Bates
Jadwin said that in late 2005 982: 18- 0001567)].
8 or early 2006, he told Bryan 24 lines
that sometimes he was so 978: 15- Defendants also admit that Plaintiff had told Kolb he was
9 depressed he couldn’t work 979:1 depressed in 2003 and was accommodated in the form of
at KMC anymore until it lines part-time leave so he could obtain treatment. [Defendants’
10 fixed some of his concerns. 979:24- Motion (Doc. 262) at 27:12-14 (“Plaintiff first
Jadwin said that he also told 980:8 complained of depression in 2003. He told Dr. Marvin
11 Dr. Yoo, head of psychiatry, lines Kolb, Chief Medical Officer at the time, that he suffered
that he was depressed from 982:9-24 from an inability to concentrate, anxiety, and
12 working at the hospital. sleeplessness”); Defendants’ Separate Statement (Doc.
Jadwin does not recall 259) at DMF 62-64]. Once Plaintiff informed Kolb, the
13 talking to Dr. Dutt about this CMO, of his disability, Defendant County was legally on
issue. Jadwin could not recall notice of his disability.
14 any other people at KMC
that he talked to about his
15 disability. In fact, Jadwin
would not use the term
16 “disabled” just that he could
not work there.
17
68. When asked what Jadwin See evidentiary objections:
18 considerations there were Depo.,
in renewing a contract with 10/21/08, Irrelevant to excusing Defendants’ liability under any of
19 KMC, Jadwin replied “All pgs. Plaintiff’s counts, as evidenced by Defendants’ failure to
of the working 1055:13- cite this DMF anywhere in their motion brief (Doc. 262).
20 environment situations. 1056: 15
The patient quality issues,
21 the administration, what-
what type of administrative
22 operation is there. The
emphasis on quality,
23 interest in quality. Interest
in patient safety. The
24 collaborative working
environment. Are the other
25 physicians going to be
responsible in working for
26 the betterment of patient
care, or are they just going
27 to be working for their own
self-interest.”
28

1 JADWIN’S ERRORS
Failure to Produce Timely
2 or Correct Diagnoses
3
69. Dr. Ragland brings up the Ragland See evidentiary objections.
4 issue that a stack of FNA Depo.,
reports that Jadwin had given 8/22/08, Disputed: Ragland testified that he never even bothered to
5 him had issue dates after the pgs. investigate his serious fraud concern by speaking with
date of a double read, in each 171:5- Plaintiff or UCLA or even Dutt directly. Had he done so,
6 case, was done by UCLA. 172:5 and Plaintiff would have explained that the he issued
This raises the possibility 328:7- diagnoses to clinicians PRIOR to sending reports out to
7 that Jadwin waited to enter a 329: 14 UCLA for confirmatory review and that when he later
diagnosis until the double received UCLA’s confirmatory reports, he entered them
8 read had come back from into the KMC computer system, which automatically
UCLA so that he could be in updates the “Completed” report date to the date of the last
9 100% agreement with modification. The “Completed” date does not equate to
UCLA. the date when Plaintiff issued his own diagnosis that was
10 later confirmed by UCLA. This quickness to conclude
Plaintiff had engaged in wrongdoing -- by fraudulently
11 withholding diagnoses until UCLA issued their reports so
that he could issue parallel diagnoses -- without informing
12 Plaintiff of the suspicions or allowing him to explain
himself was typical of how Ragland and KMC officers
13 dealt with Plaintiff. [Lee Opp. Decl., Exh. 9 (Ragland
Depo. at 171:22-172:7; 173:19-23; 174:7-175:24; 177:15-
14 176:12; 181:20-182:3); [Jadwin Opp. Decl., para. 5].
Even worse, Ragland spread rumors of Plaintiff’s
15 suspected FNA fraud so that he was tried and convicted in
the court of opinion. [(Lee Opp. Decl., Exh. 27 (Abraham
16 Depo. at 73:15-74:16)]. Abraham admitted she still
doesn’t trust Jadwin's competence. [Id. at 77:10-18].
17 70. Letter from Dr. Ang to 0000690- See evidentiary objections: Irrelevant to excusing
Dr. Perez, Peter Bryan, Dr. 691, Defendants’ liability under any of Plaintiff’s counts. It
18 Kolb, and Dr. Munoz, dated 0000736 predates the October Conference of 12/16/05 by several
2/20/02, containing formal years. Also, it is pretext. On 12/26/03, Defendant County
19 complaints of misconduct increased Plaintiff’s biweekly base salary from
against Jadwin. Complaint #3 $10,679.43 to $11,021.08 establishing that Defendant
20 states that Jadwin failed to County was satisfied with Plaintiff’s performance as of
pass the quarterly proficiency that date. [Lee Opp. Decl., Exh. 21 (Change of Employee
21 tests on cervical pap smears Status of 12/26/03 at Bates DFJ00247).
so those tests are sent out. It
22 states that this was an Disputed: Plaintiff’s proficiency with cervical pap smears
unnecessary cost and delay is irrelevant. KMC had outsourced Pap smear analysis and
23 because the other three was no longer conducting them by 2002. Moreover,
pathologists in the Kolb’s investigative report concluded that there was no
24 department could examine basis for any of Ang’s accusations. [Lee Opp. Decl., Exh.
the pap smears because they 20 (Kolb memo to Perez of 3/12/02 at Bates 0000676-
25 have maintained their 677)].
proficiency.
26
27
28

1 a) Document asserting 0000737 See evidentiary objections.

Jadwin’s failing test scores
2 and the fact that the See evidentiary objections: Irrelevant to excusing
Department of Pathology has Defendants’ liability under any of Plaintiff’s counts. It
3 not been sued for medical predates the October Conference of 12/16/05 by several
malpractice in 23 years. years. Also, it is pretext. On 12/26/03, Defendant County
4 increased Plaintiff’s biweekly base salary from
$10,679.43 to $11,021.08 establishing that Defendant
5 County was satisfied with Plaintiff’s performance as of
that date. [Lee Opp. Decl., Exh. 21 (Change of Employee
6 Status of 12/26/03 at Bates DFJ00247).
7 Disputed: Plaintiff’s proficiency with cervical pap smears

is irrelevant. KMC had outsourced Pap smear analysis and
8 was no longer conducting them by 2002. Moreover,
Kolb’s investigative report concluded that there was no
9 basis for any of Ang’s accusations. [Lee Opp. Decl., Exh.
20 (Kolb memo to Perez of 3/12/02 at Bates 0000676-
10 677)].
11 Whether or not the Department of Pathology has not been

sued for malpractice is irrelevant to prove that such
12 malpractice did or did not occur.
13
b) Jadwin’s actual (failing) See evidentiary objections:
14 test for cervical pap smears.
This test is conducted by the Irrelevant to excusing Defendants’ liability under any of
15 College of American Plaintiff’s counts. It predates the October Conference of
Pathologists (CAP). Of 12/16/05 by several years. Also, it is pretext. On 12/26/03,
16 interest, on Case #3 Jadwin Defendant County increased Plaintiff’s biweekly base
marked “unsatisfactory for salary from $10,679.43 to $11,021.08 establishing that
17 evaluation” when the Defendant County was satisfied with Plaintiff’s
accurate diagnosis was performance as of that date. [Lee Opp. Decl., Exh. 21
18 “squamous cell carcinoma.” (Change of Employee Status of 12/26/03 at Bates
DFJ00247).
19
Disputed: Plaintiff’s proficiency with cervical pap smears
20 is irrelevant. KMC had outsourced Pap smear analysis and
was no longer conducting them by 2002. Moreover,
21 Kolb’s investigative report concluded that there was no
basis for any of Ang’s accusations. [Lee Opp. Decl., Exh.
22 20 (Kolb memo to Perez of 3/12/02 at Bates 0000676-
677)].
23
24
25
26
27
28

1 71. Report to Maureen 0001059- See evidentiary objections.

Martin from Jadwin, dated 1072
2 11/20/02, on the results of Irrelevant to excusing Defendants’ liability under any of
the evaluations of the Plaintiff’s counts. It predates the October Conference of
3 pathologists (Jadwin and 12/16/05 by several years. Also, it is pretext. On 12/26/03,
Lang) by resident physicians Defendant County increased Plaintiff’s biweekly base
4 and staff physicians in salary from $10,679.43 to $11,021.08 establishing that
surgery. On a three-point Defendant County was satisfied with Plaintiff’s
5 scale, where 2 means performance as of that date. [Lee Opp. Decl., Exh. 21
satisfactory and 3 means (Change of Employee Status of 12/26/03 at Bates
6 needs improvement, Jadwin DFJ00247).
scored low on timeliness
7 (lower than Lang), IOC Disputed: Defendants neglect to mention that Plaintiff
quality, completeness, and scored higher than Lang on 14 out of 16 of the criteria and
8 clarity of diagnosis. Jadwin also overall.
blamed unhappiness of a Dr.
9 Prunes for his low scores.
10 72. Twenty-nine (29) 0001163- See evidentiary objections.

medical reports from 2004 1310
11 and 2005 with all of the Disputed: Ragland testified that he never even bothered to
following in common: 1) all investigate his serious fraud concern by speaking with
12 are FNA reports; 2) all were Plaintiff or UCLA or even Dutt directly. Had he done so,
processed in-house and then Plaintiff would have explained that the he issued
13 sent to outside labs for diagnoses to clinicians PRIOR to sending reports out to
independent diagnosis; and UCLA for confirmatory review and that when he later
14 3) the turn-around time for received UCLA’s confirmatory reports, he entered them
the final diagnosis ranged into the KMC computer system, which automatically
15 from three weeks to five or updates the “Completed” report date to the date of the last
six months. modification. The “Completed” date does not equate to
16 the date when Plaintiff issued his own diagnosis that was
later confirmed by UCLA. This quickness to conclude
17 Plaintiff had engaged in wrongdoing -- by fraudulently
withholding diagnoses until UCLA issued their reports so
18 that he could issue parallel diagnoses -- without informing
him of the suspicions or allowing him to explain himself
19 was typical of how Ragland and KMC officers dealt with
Plaintiff. [Lee Opp. Decl., Exh. 9: 171:22-172:7; 173:19-
20 23; 174:7-175:24; 177:15-176:12; 181:20-182:3].
21
22
23
24
25
26
27
28

1 73. Letter from Dr. Roy to DFJ00363 See evidentiary objections.

2 complaining that samples Defendant County retained outside pathology experts and
from 2 cases still had not sent out the pathology cases of which Roy complained
3 been analyzed and diagnosed and several others to such experts for evaluation of
and were over one week late. Plaintiff’s performance. The experts determined that
4 Plaintiff’s performance had been exemplary. Dr. William
Colburn was retained by Kern County to evaluate 21 of
5 Plaintiff’s pathology reports. [Lee Opp. Decl., Exh. 22
(Colburn Agreement with Kern County of 5/15/06)]. Dr.
6 Colburn issued an extensive report 3 months later that
concluded that Plaintiff’s overall performance was found
7 to “exceed the usual standard of care exercised by a
practicing surgical pathologist in a busy tertiary
8 community hospital”, that Plaintiff’s reports were
“completed in what I believe to be a timely manner”, that
9 his reports were “authoritative in all aspects rendering
concise tissue diagnoses”, that he “appropriately solicited
10 ‘expert’ extramural consultation opinions from noted”
pathologists, and “to his credit constantly up-dated the
11 primary surgeon of record in all instances as to their
progress”. He also concurred with Plaintiff’s final
12 diagnoses in 20 of 21 cases. [Lee Opp. Decl., Exh. 23
(Colburn Report to Barnes of 8/30/06 at Bates 0025924)].
13
Moreover, Harris, then-CMO, testified that “before
14 [Plaintiff’s] leave of absence there was no quality
concern. I’ve said that four times now. There was no
15 quality concern over the cases prior to October of 2006.”
[Lee Opp. Decl., Exh. 24 (Harris Depo at 192:7-13); see
16 also Lee Opp. Decl., Exh. 24 (Harris Depo at 409:21-
410:3)]. Harris further testified: “I wasn’t even aware that
17 his competency was an issue in this case.” When
Plaintiff’s counsel responded: “Well, it certainly wasn’t
18 from our view”, Mr. Wasser, defense counsel of record,
volunteered: “It’s not from the defense either, but keep
19 going, Counsel. We covered that before.” [Lee Opp.
Decl., Exh. 25 (Harris Depo at 411:4-20)].
20
Regarding the period after Plaintiff’s return to work as a
21 staff pathologist on 10/4/06, Harris testified that all
complaints about Plaintiff’s competency were directed to
22 him [Lee Opp. Decl., Exh. 24 (Harris Depo. at 60:14-22)];
and that Defendant County never conducted any peer
23 review in response to any of those complaints. [Lee Opp.
Decl., Exh. 24 (Harris Depo. at 58:4-59:1)].
24
25
26
27
28

1 74. Letter to Dr. Roy from DFJ00364 See evidentiary objections.

Jadwin, dated 4/20/05, in -366
2 response to his complaint Irrelevant to excusing Defendants’ liability under any of
about late diagnoses. On Plaintiff’s counts.
3 page 3 Jadwin writes
“Pathology diagnoses are Disputed: For sake of economy, Plaintiff’s Response to
4 consensus based, with few DMF 73 supra is incorporated herein in its entirety.
gold standards to affirm
5 accuracy. Consultants offer
opinions, not accurate
6 diagnoses. There is no
universally agreed upon
7 definition for what
constitutes an ‘accurate’
8 diagnosis.”
9 75. Notes by Dr. Harris, 0027066- See evidentiary objections.

dated 6/8/05, of a meeting 27068
10 between himself and Dr. Roy Irrelevant to excusing Defendants’ liability under any of
in which Dr. Roy again raises Plaintiff’s counts.
11 his concerns with the
pathology department. Disputed: For sake of economy, Plaintiff’s Response to
12 DMF 73 supra is incorporated herein in its entirety.
13 76. Notes by Dr. Harris, 0027069- See evidentiary objections.

dated 7/1/05, of a meeting 27070
14 between himself and Dr. Irrelevant to excusing Defendants’ liability under any of
Roy. Dr. Roy had specific Plaintiff’s counts.
15 examples of his complaints
about the pathology Disputed: For sake of economy, Plaintiff’s Response to
16 department including three DMF 73 supra is incorporated herein in its entirety.
missed diagnoses and an
17 example-by name and report
number--()f a pathology
18 report changed after the fact
by Jadwin.
19
77. Letter from Dr. Roy to DFJ00439 See evidentiary objections.
20 Jadwin, dated 7/15/05, ,
responding to Jadwin’s letter DFJ00437 Irrelevant to excusing Defendants’ liability under any of
21 to him dated 6/5/05 and Plaintiff’s counts.
stating that he (Dr. Roy) has
22 raised pathology department Disputed: For sake of economy, Plaintiff’s Response to
mistakes, delays and DMF 73 supra is incorporated herein in its entirety.
23 discrepancies with Jadwin
many times before.
24
78. Phone message from Dr. 0000506 See evidentiary objections.
25 Roy, dated 11/18/05,
identifying a patient error by Irrelevant to excusing Defendants’ liability under any of
26 Jadwin. Plaintiff’s counts.
27 Disputed: For sake of economy, Plaintiff’s Response to
DMF 73 supra is incorporated herein in its entirety.
28

1 79. Letter from Dr. Roy to 0000434- See evidentiary objections.

Dr. Harris, dated 2/22/06, 476
2 identifying 19 cases (with Irrelevant to excusing Defendants’ liability under any of
medical records backup) Plaintiff’s counts.
3 where KMC pathology
department was wrong in Disputed: For sake of economy, Plaintiff’s Response to
4 their diagnosis, or very late DMF 73 supra is incorporated herein in its entirety.
in getting a diagnosis, or
5 changing an initial wrong
diagnosis.
6
a) Pathology Quality 0018516 See evidentiary objections.
7 Management Policy,
September 2005, “Correction Irrelevant to excusing Defendants’ liability under any of
8 of significant error must be Plaintiff’s counts.
made through a corrected
9 report.” Disputed: For sake of economy, Plaintiff’s Response to
10
c) Two letters from Dr. Felix 0000432- See evidentiary objections.
11 at USC to Dr. Roy, dated 433
3115/06 and 3/16/06, with to excusing Defendants’ liability under any of Plaintiff’s
12 diagnoses of samples that Dr. counts.
Roy sent to him. Handwritten
13 notes on bottom of letters Disputed: For sake of economy, Plaintiff’s Response to
describe discrepancy with DMF 73 supra is incorporated herein in its entirety.
14 KMC pathology diagnosis
and that pathology changed
15 its diagnosis in one instance.
16 80. After returning from Dutt See evidentiary objections.

leave, Jadwin had to be told Depo.,
17 to slow down on regular case 8/20/08, Irrelevant to excusing Defendants’ liability under any of
work because he was going pg. 285:6- Plaintiff’s counts.
18 too fast and making errors. 23
Disputed: For sake of economy, Plaintiff’s Response to
20
Other Mistakes
21
81. E-mail from Reyes to Dr. 0000398 See evidentiary objections.
22 Harris and Tony Smith, dated
4/17/06, reporting that Irrelevant to excusing Defendants’ liability under any of
23 Jadwin was making copies of Plaintiff’s counts.
patient files which is a Title
24 22 violation. Disputed: For sake of economy, Plaintiff’s Response to
25
26
27
28

1 82. Minutes of the meeting of 0000899 See evidentiary objections.

the pathology/histology
2 department on 10/17/06. It Irrelevant to excusing Defendants’ liability under any of
was noted that Dr. Shertukde Plaintiff’s counts.
3 was concerned that blades
were not being removed once Disputed: For sake of economy, Plaintiff’s Response to
4 grossing was done. She and DMF 73 supra is incorporated herein in its entirety.
Dr. Dutt remove and discard
5 the blades immediately.
6 83. E-mail from Dr. Dutt to DFJ01449 See evidentiary objections.

Jadwin, dated 11/22/06, DFJ01446
7 reminding him of a rush case -1447 Irrelevant to excusing Defendants’ liability under any of
that Jadwin failed to process Plaintiff’s counts.
8 promptly and counseling
Jadwin to remember it when Disputed: For sake of economy, Plaintiff’s Response to
9 criticizing others. DMF 73 supra is incorporated herein in its entirety.
10 84. E-mail from Tracy 0000823 See evidentiary objections.

Lindsey to Ramona Case,
11 dated 11/27/06, stating that Irrelevant to excusing Defendants’ liability under any of
Jadwin had labeled some (9) Plaintiff’s counts.
12 placentas wrong and she
gave the incorrect labels Disputed: For sake of economy, Plaintiff’s Response to
13 alongside the correct labels. DMF 73 supra is incorporated herein in its entirety.
14 85. E-mail from Dr. Dutt to 0000862 See evidentiary objections.

Yolanda Figueroa, dated
15 12/7/06, acknowledging her Irrelevant to excusing Defendants’ liability under any of
report that Jadwin had left Plaintiff’s counts.
16 two long blades and a scalpel
out after he was finished. Disputed: For sake of economy, Plaintiff’s Response to
18 Figueroa vigorously denies that this claim is true.
(“Jadwin Opp. Decl.”) para. 6].
19
86. Report from Dr. Dutt to 0000882- See evidentiary objections.
20 Peer Review Committee, 895
dated 12/14/06, describing Irrelevant to excusing Defendants’ liability under any of
21 with documentation five Plaintiff’s counts.
mistakes by Jadwin: 1)
22 missed diagnosis and failure Disputed: For sake of economy, Plaintiff’s Response to
or refusal to seek outside DMF 73 supra is incorporated herein in its entirety.
23 consultation (with backup
letter from Dr. McBride); 2)
24 misdiagnosis of prostate
carcinoma and of prostatic
25 biopsies; 3) missed diagnosis
of thyroid microcarcinoma;
26 4) performance of sternal
bone marrow examination;
27 and 5) assignment of
procedures to physician
28 without privileges.

1
JADWIN’S INABILITY
2 TO GET ALONG WITH
OR COMMUNICATE
3
WELL WITH OTHERS
4 Policy
5 87. Policy Statement of the 0010685- Undisputed that the document says what it says.
Disruptive Behavior, 10688
6 Discrimination & Disputed: This is pretext. This policy is irrelevant as it
Harassment Policy “It is the was ratified in May 2007 during Plaintiff’s Admin Leave.
7 policy of Kern Medical It could not have served as the basis for any of
Center that all associates are Defendants’ actions prior to 2007.
8 expected to conduct
themselves at all times while
9 on hospital premises in a
courteous, professional,
10 respectful, collegial, and
cooperative manner. This
11 applies to interactions and
communications with or
12 relating to physicians,
nursing and technical
13 personnel, other caregivers,
other hospital personnel, .. “
14 [emphasis added]
15 88. Section V Item A of the 0010686- Undisputed that the document says what it says.
Kern Medical Center 10687
16 Procedure on Disruptive Disputed: This is pretext. This policy is irrelevant as it
Behavior, Discrimination and was ratified in May 2007 during Plaintiff’s Admin Leave.
17 Harassment Policy It could not have served as the basis for any of
“Examples of prohibited Defendants’ actions prior to 2007.
18 conduct include but are not
limited to the following ..
19
a) 6. Use of racial, ethnic, 0010686 Undisputed that the document says what it says.
20 epithetic or derogatory
comments.. Disputed: This is pretext. This policy is irrelevant as it
21 was ratified in May 2007 during Plaintiff’s Admin Leave.
It could not have served as the basis for any of
22 Defendants’ actions prior to 2007.
23 b) 8. Use of medical record 0010686 Undisputed that the document says what it says.
entries to criticize KMC
24 associates, policies or Disputed: This is pretext. This policy is irrelevant as it
equipment, other was ratified in May 2007 during Plaintiff’s Admin Leave.
25 practitioners, or others; It could not have served as the basis for any of
Defendants’ actions prior to 2007.
26
27
28

1 c) 14. Persisting to criticize, 0010687 Undisputed that the document says what it says.
or to discuss performance or
2 quality concerns with, Disputed: This is pretext. This policy is irrelevant as it
particular KMC associates or was ratified in May 2007 during Plaintiff’s Admin Leave.
3 others after being asked to It could not have served as the basis for any of
direct such comments Defendants’ actions prior to 2007.
4 exclusively through other
channels; .. “
5
89. Jadwin was dealt with Harris Undisputed that the document says what it says.
6 pursuant to the Disruptive Depo.,
Physician Policy. 8/13/08, Disputed: This is pretext. This policy is irrelevant as it
7 pgs. was ratified in May 2007 during Plaintiff’s Admin Leave.
330:21- It could not have served as the basis for any of
8 332: 3 Defendants’ actions prior to 2007.
9 Harris himself testified that he wasn’t sure if the policy

was in place when he allegedly disciplined Plaintiff. In
10 fact, the policy was ratified in May 2007. By that time,
Plaintiff had been on Admin Leave and restricted to his
11 home for 6 months.
[Lee Opp. Decl., Exh. 24 (Harris Depo at 331:21-332:3)].
12
13 Pulling Dr. Lau’s Tie
14 90. E-mail to Michael Ewald 0000260 See evidentiary objections.
from Jadwin, dated 10/9/03, (Exhibit
15 telling Ewald how to conduct 560) Irrelevant to excusing Defendants’ liability under any of
the investigation into the Plaintiff’s counts. It predates the October Conference of
16 “tiepulling” incident, who to 12/16/05 by several years. Also, it is pretext. On 12/26/03,
talk to, and what questions to Defendant County increased Plaintiff’s biweekly base
17 ask. salary from $10,679.43 to $11,021.08 establishing that
Defendant County was satisfied with Plaintiff’s
18 performance as of that date. [Lee Opp. Decl., Exh. 21
(Change of Employee Status of 12/26/03 at Bates
19 DFJ00247).
20 Disputed: The investigator concluded: “Dr. Jadwin has
expressed regret over the incident. This appears to be an
21 isolated incident, and there have been no related
complaints against Dr. Jadwin either before or after this
22 incident.” [Lee Opp. Decl., Exh. 54 (Investigation Report
of 10/21/03 at “Investigative Findings” item 4 on Bates
23 0000033)].
24
91. Confidential file of 0000031- For sake of economy, see Plaintiff’s Response to DMF 90
25 investigation of Jadwin 70 supra.
pulling Dr. Lau by his tie,
26 dated 10/21/03.
27
28

1 a) Portion of Jadwin’s 0000061- For sake of economy, see Plaintiff’s Response to DMF 90
interview blaming Dr. Lau 63 supra.
2 for the incident, alleging a
prior history of Dr. Lau being
3 afraid of him because Jadwin
(allegedly) points out Dr.
4 Lau’s many mistakes.
5 b) During Jadwin’s 0000063 For sake of economy, see Plaintiff’s Response to DMF 90
interview, conducted on supra.
6 10/17/03, Jadwin accepts that
he pulled the tie, says he
7 cannot really remember.
8 c) The investigator finds, by 0000034 For sake of economy, see Plaintiff’s Response to DMF 90
a preponderance of the supra.
9 evidence, that (Item #2)
Jadwin violated the
10 Workplace Violence Policy
of the County of Kern and
11 potentially endangered the
quality or efficiency of
12 patient care (because both
Jadwin and Lau testified that
13 Lau told Jadwin that he could
not accompany him because
14 he had patient work to do).
15 92. Letter from Dr. Kolb to DFJ00246 For sake of economy, see Plaintiff’s Response to DMF 90
Jadwin, dated 11/26/03, supra.
16 reprimanding him for pulling
Dr. Lau by his tie.
17
93. Letter to Dr. Lau from DFJ00590 For sake of economy, see Plaintiff’s Response to DMF 90
18 Jadwin, dated 10/19/05, supra.
apologizing for past wrongs.
19
20 Dispute with Radiology
21
22
23
24
25
26
27
28

1 94. Dr. Ragland implied that Ragland See evidentiary objections.

Jadwin was wrong in the Depo.,
2 dispute with the radiology 8/22/08, Defendant County retained an outside consultant to
department because the pgs. review FNA procedures at KMC in 2004. The consultant,
3 procedurist (the radiologist) 155:2- David Lieu observed the radiologists engaging in just one
should chose the equipment 156:13 FNA procedure on a single day. [Lee Opp. Decl., Exh. 26
4 he uses (gauge of needle is (Lieu Report of 5/3/04 at DFJ00260)]. By contrast, he
an example) because that is reviewed 200 of Plaintiff’s FNA reports. [Id. at
5 who is performing the task. DFJ00266]. Despite this bias, he nevertheless concluded:
1) the radiologist still managed to err in the one procedure
6 Lieu witnessed [Id. at DFJ00261], 2) Plaintiff made no
errors in any of his 200 reports [Id. at DFJ00266]; 3)
7 Radiologists needed to improve [Id. at DFJ00269]; and 4)
Plaintiff should set up a weekly FNA clinic whereby
8 pathologists would take FNAs on superficial masses,
replacing the radiologists. [Id. at DFJ00268].
9
Ragland himself admitted that Lieu had found the
10 radiologists’ FNA technique could be “improved”. [Lee
Opp. Decl., Exh. 9 (Ragland Depo. at 230:23-25)]. By
11 contrast, he admitted that Lieu had “determined that
[Plaintiff] had sufficient [FNA] skill”. [Lee Opp. Decl.,
12 Exh. 9 (Ragland Depo. at 226:18-22)].
13 Later, Ragland admitted that the FNA concerns Plaintiff

had raised were not just a communication issue but a valid
14 “patient care issue” and that he had always known that
even from the beginning. [Lee Opp. Decl., Exh. 9
15 (Ragland Depo. at 361:3-18)]. Yet, he had earlier
characterized the FNA issue as merely a “feud” between
16 pathology radiology and that the issue was the need for
Plaintiff to improve his “communication”. [Lee Opp.
17 Decl., Exh. 9 (Ragland Depo. at 219:25-220:7; 220:16-
21)]. This establishes Ragland’s retaliatory animus.
18
Abraham shows her retaliatory animus when she likewise
19 minimizes the FNA issue as merely a “communication”
problem and unlike Ragland refuses to admit it was a
20 patient care issue. [Lee Opp. Decl., Exh. 27 (Abraham
Depo. at 67:7-15)]. Abraham later testified that, despite
21 Lieu’s report, “we still were not satisfied with whether or
not the – the pathology readings of the FNA was – was –
22 was adequate.” [Id. at 56:16-22)]. She also testified that,
even after the Lieu report came out, there remained
23 doubts about Plaintiff’s competence as a pathologist.
[Id. at 63:14-17] and that she remained loyal to her long-
24 time friends, the radiologists. [Id. at 73:1-5].
25 When Plaintiff’s FNA reports were later confirmed as

100% accurate by ongoing outside reviews by UCLA,
26 Ragland concocted far-fetched suspicions of fraud by
Plaintiff which he unsuccessfully investigated, but
27 directly confronted Plaintiff with. See Plaintiff’s
Response to DMF 69 supra, which is incorporated in its
28 entirety herein.

1 95. Dr. Abraham, while Abraham See Plaintiff’s Response to DMF 94 supra, which is
discussing the FNA Depo., incorporated in its entirety herein.
2 Consulting Report, 8/18/08,
mentioned that the pgs. 59:6- See evidentiary objections.
3 radiologists were upset with 60:2
Jadwin because he was
4 accusing them of too many
inadequate specimens
5 (“unsatisfactory for
evaluation”) when there were
6 relatively few complaints of
that before Jadwin arrived.
7
a) Jadwin’s actual (failing) 0000737 See evidentiary objections.
8 test for cervical pap smears.
This test is conducted by the Irrelevant to excusing Defendants’ liability under any of
9 College of American Plaintiff’s counts. It predates the October Conference of
Pathologists (CAP). Of 12/16/05 by several years. Also, it is pretext. On 12/26/03,
10 interest, on Case #3 Jadwin Defendant County increased Plaintiff’s biweekly base
marked “unsatisfactory for salary from $10,679.43 to $11,021.08 establishing that
11 evaluation” when the Defendant County was satisfied with Plaintiff’s
accurate diagnosis was performance as of that date. [Lee Opp. Decl., Exh. 21
12 “squamous cell carcinoma.” (Change of Employee Status of 12/26/03 at Bates
DFJ00247).
13
Disputed: Plaintiff’s proficiency with cervical pap smears
14 is irrelevant. KMC had outsourced Pap smear analysis and
was no longer conducting them by 2002. Moreover,
15 Kolb’s investigative report concluded that there was no
basis for any of Ang’s accusations. [Lee Opp. Decl., Exh.
16 20 (Kolb memo to Perez of 3/12/02 at Bates 0000676-
677)].
17
18 96. Dr. Abraham talked Abraham See Plaintiff’s Response to DMF 94 supra, which is
about the lack of trust Depo., incorporated in its entirety herein.
19 between the other doctors 8/18/08,
and Jadwin, which the FNA pgs. 62: See evidentiary objections.
20 Consulting Project report 16-64:3
addresses as communication
21 problems.
22 97. Kern Medical Center DFJ00251 Undisputed.

FNA Consulting Project -270
23 report by Dr. David Lieu, But see Plaintiff’s Response to DMF 94 supra, which is
M.D., M.B.A., dated 5/3/04. incorporated in its entirety herein.
24
a) Consultant’s core issue is DFJ00255 Disputed: for sake of economy, see Plaintiff’s Response
25 the lack of communication to DMF 94 supra, which is incorporated in its entirety
and complete distrust herein.
26 between radiology and
pathology with negative See evidentiary objections.
27 ramifications for the
clinicians and administration.
28

1 b) Consultant agreed with DFJ00257 Disputed: for sake of economy, see Plaintiff’s Response
radiologists that long clinical to DMF 94 supra, which is incorporated in its entirety
2 history on the FNA reports herein.
was unnecessary.
3 See evidentiary objections.
4 c) “ .. Dr. Jadwin and DF100260 Disputed: for sake of economy, see Plaintiff’s Response
radiologists do not to DMF 94 supra, which is incorporated in its entirety
5 communicate at this level. herein.
This suggests that a
6 breakdown in
communication is the
7 fundamental problem. This
bridge was burned down long
8 ago.”
9 d) “Finally, both radiology DFJ00269 Disputed: for sake of economy, see Plaintiff’s Response
and pathology will work to DMF 94 supra, which is incorporated in its entirety
10 together to find the best herein.
needle for deep FNAs.”
11
98. E-mail to Drs. Kercher DFJ00289 Disputed: for sake of economy, see Plaintiff’s Response
12 and Kolb from Jadwin, dated -290 to DMF 94 supra, which is incorporated in its entirety
9/3/04, stating “You cannot herein.
13 dictate the size of the needle
by policy” and calling Dr.
14 Lieu “unjustifiably
pompous,”
15
99. E-mail to Peter Bryan DFJ00319 Disputed: for sake of economy, see Plaintiff’s Response
16 from Jadwin, dated 2/2/05, -320 to DMF 94 supra, which is incorporated in its entirety
listing his suggestions for herein.
17 improvement on the FNA
issue. Jadwin also states that
18 the radiology department was
“substantially at fault” for the
19 conflict between the
departments. He requested a
20 formal apology from the
radiology department to
21 himself and the pathology
department. He also
22 requested (in bold lettering) a
public announcement at the
23 next Medical Executive
Committee (hereinafter
24 referred to as MEC) meeting
that there are no quality
25 issues involving the
pathology department and
26 Drs. Amin, Abraham, Munoz
and Naderi should be
27 standing at the podium
during the announcement.
28

1 100. Exchange of e-mails DFJ00353 Disputed: for sake of economy, see Plaintiff’s Response
between Dr. Ragland and -354 to DMF 94 supra, which is incorporated in its entirety
2 Jadwin, dated 2/25/05, in herein.
which Jadwin complains
3 about some comments made Despite the fact that Ragland was chair of the quality
by the radiologists at the committee and the fact that, as he himself testified, he
4 February QM meeting and knew from the beginning that the FNA issue was a patient
informing Dr. Ragland to be care issue, he refused to let Plaintiff address it at the
5 prepared for Jadwin to Quality Management meeting. He retaliated against
request him to call for Plaintiff by dismissing the issue as “battling doctors” and
6 supporting documentation attacking Plaintiff for his “poor” communication skills.
from radiology or announce
7 that the previous comments
were unsupported. Dr.
8 Ragland shot back his
displeasure at the continuing
9 conflict between radiology
and pathology, and stated
10 that his committee will not
become a battleground for
11 this conflict.
12
Length of
13 Presentations/October 2005
Oncology Conference
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

1 101. Exchange of e-mails DFJ00241 See evidentiary objections: Irrelevant to excusing

between Dr. Ragland and -242 Defendants’ liability under any of Plaintiff’s counts. It
2 Jadwin, dated 11/19 & predates the October Conference of 12/16/05 by several
11/20/03, about the last years. Also, it is pretext. On 12/26/03, Defendant County
3 Quality Management increased Plaintiff’s biweekly base salary from
meeting. Dr. Ragland $10,679.43 to $11,021.08 establishing that Defendant
4 contradicted Jadwin’s County was satisfied with Plaintiff’s performance as of
statement that the pathology that date. [Lee Opp. Decl., Exh. 21 (Change of Employee
5 presentation during the Status of 12/26/03 at Bates DFJ00247).
meeting was 20 minutes; Dr.
6 Ragland said it went on Disputed: for sake of economy, see Plaintiff’s Response
much longer than 20 minutes to DMF 94 supra, which is incorporated in its entirety
7 and proceeded to give Jadwin herein.
advice on which information
8 was most important to Despite the fact that Ragland was chair of the quality
present and how it could be committee and the fact that, as he himself testified, he
9 presented succinctly. knew from the beginning that the FNA issue was a patient
care issue, he refused to let Plaintiff address it at the
10 Quality Management meeting. He retaliated against
Plaintiff by dismissing the issue as “battling doctors” and
11 attacking Plaintiff for his “poor” communication skills.
12 In one email exchange with Bryan, he expressed his

disdain for Plaintiff’s whistleblowing efforts: “that was
13 one of the most distasteful event I have ever participated
in [Plaintiff] has fixed his department so now he is going
14 to fix us?” [Lee Decl., Exh. 11 (Ragland email to Bryan
of 2/23/06 at 0000507)]. Bryan made no bones about
15 indicating that his allegiance lay with Ragland, Harris,
Abraham and Kercher: “I know it was really challenging
16 to remain cordial and not combative [with Plaintiff], and
goodness a couple of you could have really hit back”,
17 even as he portrayed himself as an impartial adjudicator to
Plaintiff. [Ibid.].
18
In his depo testimony, Ragland was so extreme in his
19 retaliatory animus against Plaintiff, he became almost a
caricature. [Lee Opp. Decl., Exh. 9: 54:2-21; 138:3-10)].
20
102. Memo from Dr. DFJ00248 Disputed: for sake of economy, see Plaintiff’s Response
21 Ragland to Jadwin, dated to DMF 94 supra, which is incorporated in its entirety
1/21/04, that presentations herein.
22 must be concise and that the
last Blood Usage Report-52 Despite the fact that Ragland was chair of the quality
23 slides-will not fit in the committee and the fact that, as he himself testified, he
allotted time. knew from the beginning that the FNA issue was a patient
24 care issue, he refused to let Plaintiff address it at the
Quality Management meeting. He retaliated against
25 Plaintiff by dismissing the issue as “battling doctors” and
attacking Plaintiff for his “poor” communication skills.
26
27
28

1 103. Memo from Dr. DFJ00381 Disputed: For sake of economy, see Plaintiff’s Response
McBride to Jadwin, dated to DMF 104 and DMF 106 infra.
2 5/9/05, requesting that the
time required for the Disputed: McBride stated that the purpose of the memos
3 pathology presentation at the from the Cancer Committee to Plaintiff was NOT to
oncology conference be kept reprimand Plaintiff or anybody in particular. [Lee Opp.
4 to a minimum. Decl., Exh. 29 (McBride Depo. at 28:3-8)].
5 104. Instructions for the Patel Disputed: The document specifies NO time limits for the
Cancer Conference Depo., pathology portion of the presentation, contrary to
6 presenters 1) the presentation 12/6/07, Defendants’ claims and consistent with what Plaintiff
is to contain less than 10 Exhibit 25 claims. Defendants fundamentally misconstrue this
7 slides, 2) length not to document. The guidelines are directed to the RESIDENT
exceed 20 minutes for who will be introducing the case, giving the background
8 comprehensive background and going through preliminary slides at the beginning, as
and overview of testing, and evidenced by the instruction “You will be required to
9 3) all physicians involved in meet with both the Pathologist and Radiologist to discuss
the case being presented the case to be presented at least 4 working days before the
10 must be notified beforehand. conference. It is also your responsibility to notify ALL
physicians involved in the case you are presenting.” It is
11 NOT directed at the pathologists.
[Lee Opp. Decl., Exh. 28 (Conference Guidelines at Bates
12 0000804); Lee Opp. Decl., Exh. 29 (McBride Depo. at
362-16)].
13
105. Pathology Dept.’s DFJ00508 Disputed: See Plaintiff’s Response to DMF 104 supra and
14 oncology conference -574 DMF 106 infra, which are incorporated in their entirety
presentation--67 slides-by herein.
15 Jadwin, reviewing
gynecology cases and alleged
16 errors in diagnosis by
University of Southern
17 California (hereinafter
referred to as USC).
18
19
20
21
22
23
24
25
26
27
28

1 106. Memo from the Cancer DFJ00578 Disputed: For sake of economy, see Plaintiff’s Response
Committee (Drs. Patel, to DMF 104 supra, which is incorporated in its entirety
2 Johnson, and McBride) to herein.
3 insisting that his presentation McBride testified that: 1) McBride was the timekeeper
take no more than 5 minutes and there was no one better positioned to keep track of the
4 per patient case. timing of events at the October Conference [Id. at 32:2-5;
33:19-22]; 2) Plaintiff and the resident presenter together
5 spoke at the October Conference for a total of 20 minutes,
during which the resident typically spoke for “roughly” 5
6 minutes [Id. at 37:18-21; 39:10-20]; hence, Plaintiff’s
presentation only took 15 minutes max; 3) the total
7 conference time was typically 1 hour [Id. at 15:16-19]; 4)
he did not disagree with Plaintiff when Plaintiff informed
8 him that the director of a preeminent cancer center had
stated that it is not reasonable to limit the time of the
9 pathology presentation, that the “pathology department
has presented concise, well organized presentations for
10 years”, that Plaintiff’s October Conference presentation
detailed “problems encountered with this patient’s care
11 and hopefully improve general awareness about important
KMC patient care issues”, that “other oncology
12 conferences have run over without incident and most
other conferences throughout [KMC] run over all of the
13 time”, etc. [Lee Opp. Decl., Exh. 29 (McBride Depo. at
54:24-55:16; 57:7-8); Lee Opp. Decl., Exh. 30 (Jadwin
14 letter to McBride of 10/19/05 re October Conference at
DFJ00591)]; 5) “I was not unhappy with [Plaintiff’s
15 October Conference] presentation. He had a lot of good
material to present.” [Id. at 46:11-14)]; 6) He had
16 moderated “many, many” Cancer Conferences [Id. at
37:2-6)], 7) the first presentation on the morning of the
17 October Conference ran over by about 5 minutes without
incident and that “it was not uncommon” for time
18 overruns to occur at Cancer Conferences. [Id. at 49:17-
25)]; 8) he could not recall any other physician receiving
19 a letter of reprimand for running over time at a Cancer
Conference; 9) he had moderated “many, many” Cancer
20 Conferences [Id. at 50:1-7)]; 10) Harris had forced him to
write a letter of dissatisfaction against Plaintiff at the end
21 of the October Conference [Id. at 29:11-13]; 11) he didn’t
want to do write the letter [Id. at 30:1-8]; 12) that he was
22 not upset with Plaintiff for going over time [Id. 33:19-
34:6].
23
Plaintiff’s expert, Lawrence Weiss, Chair of Pathology at
24 City of Hope in Duarte, CA, stated re Plaintiff’s time
overrun: “Customarily, if an Oncology Conference runs
25 over the time scheduled, those attendees who need to
leave to perform other duties simply do so…. In all my
26 years of experience, I have never seen a physician’s
privileges threatened for such an insignificant and
27 patently unwarranted reason.” [Decl. of Lawrence Weiss
(“Weiss Decl.”) at pp. 4-5.
28

1 107. Anonymous (redacted) DFJ00580 See evidentiary objections.

memo (author-Dr. Taylor) of
2 complaint about Jadwin’s Disputed: See Plaintiff’s Response to DMF 104 supra and
oncology presentation, dated DMF 106 infra, which are incorporated in their entirety
3 10/12/05. Some quotes: “ .. herein.
inappropriate to bring
4 political/personal battles to
an educational forum filled
5 with residents and students,”
and “ .. inappropriate to
6 ‘bash’ reputable institutions
like USC and Stanford,” and
7 “ ..made [Jadwin] look like a
conceited, pompous
8 buffoon.”
9 108. Dr. Royce Johnson also Harris See evidentiary objections.

voiced a complaint. Depo.,
10 8/13/08, Disputed: See Plaintiff’s Response to DMF 104 supra and
pgs. DMF 106 infra, which are incorporated in their entirety
11 126:8- herein.
127: 19
12
109. Oncology Conference Exhibit Disputed: in those same evaluations, Plaintiff’s
13 Performance Evaluations of 190 presentation received high praise from the majority of
10/12/05 where criticisms of attendees. [Lee Opp. Decl., Exh. 31 (October Conference
14 Jadwin’s presentation are Feedback at 0000517, 520, 521 (“V. good speaker,
written in the comments confident & clear”; “V. important topic for women’s
15 section on the following health”), 523, 524, 527, 528, 531 (“Great”), 534, 537,
Bates-stamped pages: 538, 539, 542, 544, 545.
16 0000516,522,526,536, and
548.
17
110. Dr. Ragland was not Ragland Disputed: Plaintiff never said that “the only important
18 present at the October Depo., information on that [October Conference] case was his.”.
Oncology Conference so his 8/22/08, [Jadwin Opp. Decl., para. 7].
19 testimony was limited to the pgs. 106:
comments he heard Jadwin 18-109: See evidentiary objections.
20 make regarding the 14 and
conference (which is an 156:14-25
21 admission against interest).
Dr. Ragland said that
22 Jadwin’s excuse for
monopolizing the oncology
23 conference was that “the only
important information on that
24 case was his.”
25
26
27
28

1 111. Dr. Abraham testified Abraham See evidentiary objections.

that Jadwin went on much Depo.,
2 longer than a normal 8/18/08, Disputed: For sake of economy, see Plaintiff’s Responses
pathology presentation and pgs. 14: to DMF 94, 104, 106, 113.
3 she was embarrassed for him 10-21: 17
and by some of the things and
4 that he said. Her overall 131:5-
feeling was one of 133:23
5 discomfort. She definitely and
felt that his criticisms of 135:24-
6 outside consultants were 138:22
inappropriate and further
7 evidence of his arrogance
because the issue was not
8 one of who was- right-and-
who-was-wrong but of the
9 actual sample and how it
could be read. Jadwin’s
10 position that it is a patient
care issue presumes that
11 Jadwin is right and Dr. Roy
and the outside pathologist
12 are wrong.
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

1 112. Dr. Dutt believed that Dutt See evidentiary objections.

Jadwin retaliated against Dr. Depo.,
2 Roy by verbally attacking 8/20/08, Disputed: Dutt insisted that the Paycut Amendment to
him, angrily, at the October pgs.292:2 Plaintiff’s contract limit his medical leave allowance upon
3 oncology conference. 5-293:20 his return to work in retaliation for his prior medical
leaves. [Lee Opp. Decl., Exh. 48 (Dutt email to Barnest
4 of 9/14/06 at 0000830)].
5 Then-CEO Culberson testified that Dutt, Plaintiff’s

former subordinate who had been elevated to replace him
6 as Acting Chair of Pathology, could be biased against
Plaintiff. [Lee Opp. Decl., Exh. 11 (Culberson Depo. at
7 163:12-16)].
8 Plaintiff’s expert, Dr. Lawrence Weiss, stated in his

report: “Dr. Dutt’s so-called peer review of Dr. Jadwin
9 was not only unwarranted, but was also non-compliant
with customary and KMC’s procedures (that would
10 require that reviewer comments be returned to the original
pathologist and the original pathologist be given an
11 opportunity to review the slides, make an assessment and
acknowledge the receipt of the comments by the original
12 pathologists), and not designed to achieve any legitimate
peer review purpose that I can discern.” [Weiss Decl.,
13 Exh. 1 at p. 8-9].
14 According to Culberson, sometime between August 2006

and May 2007, Dutt investigated Plaintiff for competency
15 errors and reported to him that “There were several
matters that it was clear the outside consultant did not
16 believe that the way matters were handled [by Plaintiff]
was proper.” [Lee Opp. Decl., Exh. 11 (Culberson Depo.
17 at 165:9-20; 166:6-20)]. Dutt confirmed submitting such
complaints to then-CMO Harris about Plaintiff’s
18 competence in the middle of November 2006. [Lee Opp.
Decl., Exh. 47 (Dutt Depo. at 289:5-21; 289:25-290:7)].
19 Dutt also confirmed that he told Plaintiff he was
subjecting his report to outside peer review, then locked
20 up the slides at issue and denied Plaintiff access to them.
[Id. at 35:5-36:15; 38:4-25; 297:14-21; 298:3-13].
21
Harris testified at his depo. that “There was no quality
22 concern over [Plaintiff’s] cases prior to October of 2006.”
[Lee Opp. Decl., Exh. 24 (Harris Depo at 192:7-13); see
23 also Lee Opp. Decl., Exh. 24 (Harris Depo at 409:21-
410:3)]. Harris further testified: “I wasn’t even aware
24 that [Plaintiff’] competency was an issue in this case.”
[Lee Opp. Decl., Exh. 25 (Harris Depo at 411:4-20)].
25
Regarding the period after Plaintiff’s return to work as a
26 staff pathologist on 10/4/06, Harris testified that all
complaints about Plaintiff’s competency were directed to
27 him [Lee Opp. Decl., Exh. 24 (Harris Depo. at 60:14-22)];
and that Defendant County never conducted any peer
28 review in response to any of those complaints. [Lee
Opp. Decl., Exh. 24 (Harris Depo. at 58:4-59:1)].

1 113. Letter from Drs. DFJ00588 See evidentiary objections.

Kercher, Ragland, Abraham
2 and Harris to Jadwin, dated Disputed: For sake of economy, see Plaintiff’s Responses
10/17/05, about Jadwin’s to DMF 94, 101, 104, 106, 126, which are incorporated in
3 October oncology their entirety herein.
presentation. The criticisms
4 of the presentation were 1) it Disputed: The fact that the letter references “personal
exceeded the time allotted to agenda” and “political statement” is, if anything, direct
5 it, 2) Jadwin failed to follow evidence that Defendants were retaliating against Plaintiff
the leader of the conference for blowing the whistle on the fact that the patient whose
6 on brevity, and 3) Jadwin case was being discussed at the October Conference had
used a public forum for a received a hysterectomy based upon outside pathology
7 personal agenda and/or for reports from USC that had been wrongly based upon
making a political statement. incorrectly oriented slides. As Abraham testified, the
8 political point referenced was the errors made by USC in
their pathology report which Plaintiff was highlighting in
9 his October Conference presentation – the very patient
care issue which Plaintiff was raising. [Lee Opp. Decl.,
10 Exh. 27 (Abraham Depo. at 148:2-9)].
114. E-mail from Dr. 0000094 See evidentiary objections.
11 Ragland to Dr. Harris, dated
10/18/05, describing Disputed: For sake of economy, see Plaintiff’s Responses
12 Jadwin’s attitude during the to DMF 104, 106 and 113 supra, which is incorporated in
meeting on 10/17/05. When its entirety herein.
13 handed the evaluations of his
presentation, he would not Disputed: Plaintiff’s recollection of this meeting is
14 look at them. The e-mail entirely opposite to what is described in this email.
states that Jadwin has a “lack Plaintiff recalls: “Dr. Ragland began by saying “So Dr.
15 of communication skills” and Jadwin, Mr. Perfect, here we are again, having problems
fails to “extend basic with your behavior.” He said that he had been selected to
16 courtesy to his colleagues.” deal with this issue. I said I wanted Mr. Bryan present.
Kercher said this has nothing to do with Peter, this is a
17 medical staff issue. Dr. Kercher started yelling at me:
“David if you needed more time, why didn’t you tell Dr.
18 McBride beforehand?” Dr. Ragland read the letter of
reprimand aloud to me, which stated that letters were
19 placed in my file. When I asked to see them, Dr. Harris
said that I could not see them. When I turned to address
20 Dr. Kercher, as the senior person in the room, Dr.
Ragland on two occasions said “Don’t look at him, look at
21 me; I am the person you need to talk to!” and “Noo, don’t
look at [Kercher] look at me. That’s riiight, you don’t
22 need to look at him, you need to look at me.” It was
humiliating. Drs. Kercher and Ragland who were not at
23 the conference, obviously listened to Dr. Harris’s account
only. I was not given an opportunity to speak or
24 otherwise defend myself.”
[Jadwin Opp. Decl., para. 8].
25
26
27
28

1 115. Jadwin’s evaluation of DFJ00689 See evidentiary objections.

the 11/9/05 oncology
2 conference (what he filled
out). He complained that it Disputed: Defendants omit Dr. Shertukde’s feedback form
3 ran to 8:38 a.m. and he noted which confirms that “The conference ran to 8:38 am”
he would discuss the overrun [Lee Opp. Decl., Exh. 32 (Oncology Conference feedback
4 with Dr. McBride. form of Shertukde of 11/9/05 at DFJ00686). The
conference is supposed to end at 8:30 am [Lee Opp. Decl.,
5 Exh. 29 (McBride Depo. at 32:26-33:3)], so this
represents an 8 minute overrun for which no one was
6 reprimanded. In contrast, the October Conference ended
at 8:25 a.m., 5 minutes early. [Lee Opp. Decl., Exh. 29
7 (McBride Depo. at 39:6-9)]. Nevertheless, Plaintiff was
severely reprimanded for an alleged time overrun.
8
116. Memorandum to 0001566- Undisputed that the document says what it says.
9 Supervisor Michael Rubio, 1567
District V, from Peter Bryan, Disputed: This memorandum’s reference to “emotional
10 dated 1/17/06, giving him health” is direct evidence that Bryan knew of Plaintiff’s
background on the problems depression disability and that he was discriminating
11 arising from the October against him on that basis.
oncology conference. Bryan
12 tells of a meeting he had with
Jadwin about a week after
13 the conference in which
Jadwin was extremely angry
14 and making loud, derogatory
comments about various
15 members of the medical
staff. He said he became
16 concerned about Jadwin’s
emotional health. He also
17 said that Jadwin has never
been able to state a resolution
18 to the impasse. Bryan also
says that he will meet again
19 with Jadwin and inform him
of some expectations for
20 future conduct, or he will
consider removing him as the
21 chairman of the pathology
department.
22
23 PCCs
24
25
26
27
28

1 117. PCC issue was a Bryan See evidentiary objections.

difference in professional Depo.,
2 judgment, the process by the 8/14/08, Disputed: PCC issue was NOT a difference in
nursing staff was working for pgs. professional judgment. It was an issue of illegal
3 them, and Jadwin failed to 205:6- noncompliance with H&S § 1602.5 and AABB standards.
work within the institution 206: 25 The DHS later concluded that KMC was not complying
4 and committee structure. (Exhibit with blood transfusion documentation and reporting
Also, Bryan inferred that 291) procedures. [Jadwin Decl. (Doc. 265), Exh. 13 (DHS’s
5 Jadwin had accused Toni Fax to Jadwin of 8/11/08 at E264 on pages 2-4 (finding
Smith of ethical lapses which almost 50% noncompliance at KMC)]. The fact that
6 is an example of “a pattern of Bryan ignored and belittled Plaintiff’s many reports of
inability to establish an PCC noncompliance as a “difference in professional
7 effective means of dialogue.” judgment” and indication of Plaintiff’s deficient
leadership style and later caused Plaintiff to be demoted is
8 further evidence of Bryan’s hostility to whistleblowers.
For Bryan, “dysfunction” is nothing more than a code
9 word for whistleblowing. Legal noncompliance becomes
an issue of ethics when people choose to disregard it
10 instead of fixing the problem. Bryan and Smith are guilty
of ethical lapses in their betrayal of the public trust.
11
Even as late as 8/14/08, Bryan still didn’t get it. He
12 continued to minimize the PCC issue as an “inability of
two professionals to sit down and have a constructive
13 dialogue, to come up with a satisfactory solution.” [Lee
Opp. Decl., Exh. 3 (Bryan Depo at 230:25-231:5)]. He
14 took no responsibility whatsoever as then-CEO for failing
to step in and break the deadlock between Nurse
15 Executive Smith and Plaintiff, nor for failing to discipline
Smith for her incompetence or willful resistance to
16 bringing KMC into compliance with H&S 1602.5. He is
under the delusion that all responsibility for enforcing
17 compliance with regulations at KMC rested with Plaintiff
alone, and not anyone else, including him and Smith.
18
Bryan was far from impartial and demonstrated a clear
19 bias against Plaintiff over time. [Lee Decl. (Doc. 266),
Exh. 15 (Bryan Letter to Jadwin of 6/14/06 at DFJ1181);
20 Lee Decl. (Doc. 266), Exh. 16 (Bryan Letter to Jadwin of
6/26/06 at DFJ1346); Lee Decl. (Doc. 266), Exh. 17 (JCC
21 Minutes of 7/1/06 at 0009821); Jadwin Decl. (Doc. 265),
Exh. 1 (Jadwin email to Bryan of 2/28/05 at DFJ355); Lee
22 Supp. Decl. (Doc. 267), Exh. 13 (Ragland Depo at
332:14-21); Lee Decl. (Doc. 266), Exh. 8 (Bryan email to
23 Harris of 11/8/05 at 0000503); Lee Decl. (Doc. 266), Exh.
11 (Ragland email to Bryan of 2/23/06 at 0000507)].
24
Joseph Mansour, a doctor in OB-GYN, similarly testified
25 that when he blew the whistle to Bryan on improper
publicly-funded malpractice coverage of KMC doctors’
26 activities outside of KMC, Bryan discounted / disagreed
with the concern. Mansour testified that the Kern County
27 Board of Supervisors became aware of the problem and
later canceled all such improper policies. [Lee Opp. Decl.,
28 Exh. 33 (Mansour Depo. at 98:18-99:12; 104:11-25)].

1 118. E-mail to Toni Smith, DFJ00408 Undisputed.

R.N. from Jadwin, dated -409
2 5/20/05, inquiring after
audits of the nursing
3 department of which only
one was received and arguing
4 that PCCs should be sent to
the blood bank when
5 complete.
6 119. E-mail to Toni Smith DFJ02499 Undisputed.

from Jadwin, dated 5/20/05,
7 recounting Jadwin’s
telephone conversation with
8 Holly Rapp, AABB
Accreditation Director.
9
120. Exchange of e-mails 0000421- Undisputed.
10 between Toni Smith and 424
Jadwin, dated between
11 6/15/05 and 6/28/05, about
the PCC issues. In 0000423,
12 Jadwin states that a PCC
must not be signed until the
13 time of the infusion, or KMC
is not meeting AABB
14 accreditation standards.
15
16
17
18
19
20
21
22
23
24
25
26
27
28

1 121. Typed notes, dated 0000572 See evidentiary objections.

1/10/06, of interviews with
2 various people and Disputed: For sake of economy, see Plaintiff’s Response
institutions re: sending the to DMF 117.
3 Product Chart Copies (PCCs)
back to the blood bank
4 (pathology). The author
unknown- interviewed
5 Michelle Burris who said
there is no reason to return
6 PCCs to pathology. The
author interviewed Ann
7 Schadler, UCLA Blood Bank
Director, who said their
8 PCCs are in the patient’s
record only, not the blood
9 bank. The author interviewed
Julia, UCSD Blood Bank,
10 who said there was no reason
to return the form to the
11 blood bank. The author also
interviewed Dr. Wu and Jay,
12 supervisor of Mercy Lab and
Blood Bank, who said that
13 the PCC goes in the patient’s
record and there is no reason
14 to return the PCC to the
blood bank.
15
122. E-mail to Peter Bryan DFJ00784 Undisputed.
16 from Jadwin, dated 4/10/06,
about several issues but he Seven days later, on 4/17/06, Bryan threatened Plaintiff
17 brings up non-compliance with termination. This is compelling evidence of
with state regulations, whistleblower retaliation. “Dysfunction” for Bryan is
18 JCAHO, and AABB on the nothing more than a code word for whistleblowing.
issues of the PCCs. [Lee Decl., Exh. 12 (Bryan Memo to Jadwin of 4/17/06 re
19 Termination Threat at DFJ000795)].
20 123. Notes of meeting dated DFJ00788 See evidentiary objections.

4/14/06 with Peter Bryan,
21 Karen Barnes and Jadwin on Disputed: For sake of economy, see Plaintiff’s Response
4/13/06. There is no problem to DMF 117.
22 with the PCCs because 5
charts were reviewed (and
23 approved) by JCAHO.
24 124. E-mail to Peter Bryan DFJ00793 Undisputed.

from Jadwin, dated 4/17/06,
25 claiming that the JCAHO
review was too small of a
26 sample and KMC was in
noncompliance on their
27 handling of the PCCs and
there was a need for action.
28

1 a) Bryan criticizes Jadwin’s Bryan Disputed: For sake of economy, see Plaintiff’s Response
57 memos to Toni Smith, Depo., to DMF 117.
2 R.N. as a “way of flooding 8/14/08,
the system and seeing what pg. 226: See evidentiary objections.
3 sticks and what doesn’t.” 10-16
4 125. Memo to Peter Bryan 0000401- Disputed: For sake of economy, see Plaintiff’s Response
from Toni Smith, dated 403 to DMF 117.
5 4/17/06, responding to
Jadwin’s e-mail to Peter See evidentiary objections.
6 Bryan of 4/17/06,
disagreeing with Jadwin’s
7 characterization of the PCC
situation and stating that
8 Jadwin’s proposals on this
issue were strategies that
9 have previously been
rejected by KMC.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

1 126. Harris had complaints Harris See evidentiary objections.

about Jadwin’s handling of Depo.,
2 the PCC issue-Jadwin was 8/13/08, Disputed: For sake of economy, see Plaintiff’s Response
demanding, inflexible, pgs. to DMF 112 and 117.
3 unreasonable in wanting the 268:8-23
originals, impatient. Harris’s view of Plaintiff’s reports of non-compliant
4 PCCs is further evidence of Harris’s hostility to
whistleblowers like Plaintiff.
5
Harris later testified: “I Harris’s retaliatory animus is well-documented. Harris
6 wasn’t even aware that had coordinated with a gynecologist, William Roy, in
[Plaintiff’] competency was 2005 to 2006 to conduct retaliatory peer review of
7 an issue in this case.” [Lee Plaintiff’s work. As Plaintiff’s expert Dr. Lawrence Weiss
Opp. Decl., Exh. 25 (Harris noted in his report: “However, contrary to customary
8 Depo at 411:4-20)]. practice, the peer review was not opened in a timely
fashion, occurring more than six months after Dr. Roy
9 provided a list of [Plaintiff’s] cases to Dr. Harris (Bates
No. 434-438), and more than a year after Dr. Jadwin
10 challenged Dr. Roy to provide the cases for which he
questioned Dr. Jadwin’s abilities in a letter copied to the
11 hospital administration and the medical staff leadership
(Bates No. 1614). If the interests of patient care were to
12 be served, the cases would have been provided and the
review performed promptly.”[Weiss Decl., Exh. 1 at p. 7].
13 Weiss further noted: “It is very clear that these peer
review activities were not conducted as an educational
14 tool or as a method of risk reduction, as is customary.
Peer review needs to be conducted confidentially--opaque
15 to the world outside of the Medical Staff; but it is not
conducted like the inquisition, in which one does not
16 know who the accuser is or what the allegations are. In
my entire career, I have never encountered so much peer
17 review directed at one individual and with so little
return.” [Weiss Decl., Exh. 1 at p. 6-7].
18
Plaintiff is not the only whistleblower to whom Harris
19 was hostile. Joseph Mansour, a doctor in the OB-GYN
department, testified that when he blew the whistle to
20 Harris on improper publicly-funded malpractice coverage
of KMC doctors’ activities outside of KMC, Harris said
21 he was aware of the problem and thought it was fine, then
suggested to Mansour “why don’t you go use this
22 malpractice coverage and work at hospitals and get free
coverage [yourself]”. Mansour view of Harris’s unethical
23 suggestion was that “I thought it was outrageous to do
that”. Mansour then testified that the Kern County Board
24 of Supervisors became aware of the problem and later
canceled all such improper policies. [Lee Opp. Decl., Exh.
25 33 (Mansour Depo. at 100:14-25; 101:8-21; 104:11-25)].
The conversation between Harris and Mansour is
26 memorialized in one of Harris’s memos to file. [Lee Opp.
Decl., Exh. 34 (Harris memo to file of 5/10/06 at
27 0027083-27084)].
28

1 127. Toni Smith, R.N. Smith D Disputed: For sake of economy, see Plaintiff’s
explained that the reason that Depo., Response to DMF 117.
2 some PCCs looked like they 8/19/08,
were not complete is that the pgs. 59:4- Disputed: Even as of 8/19/08, Smith took no
3 PCC form was actually in 60: 13 responsibility for her role in failing to get KMC into
duplicate and the nurses were compliance with H&S 1602.5. Instead, she focuses on
4 not consistent about writing Plaintiff’s alleged dysfunction and unsubstantiated
on only one copy and speculation that one of Plaintiff’s proposed solutions
5 throwing the blank copy might run afoul of a regulation.
away.
128. Toni Smith said that Smith D Disputed: For sake of economy, see Plaintiff’s
7 Jadwin was never interested Depo., Response to DMF 117.
or willing to listen to her 8/19/08,
8 ideas. When asked what pg. 65:2- Disputed: Even as of 8/19/08, Smith took no
Jadwin’s physical demeanor 13 and 74: responsibility for her role in failing to get KMC into
9 was like in these 12-22 compliance with H&S 1602.5. Instead, she focuses on
conversations in which he Plaintiff’s alleged dysfunction and unsubstantiated
10 was allegedly uncooperative, speculation that one of Plaintiff’s proposed solutions
she said “He was obviously might run afoul of a regulation.
11 frustrated, obviously not
going to change his mind, See evidentiary objections.
12 obviously not willing to
listen to anything. I presented
13 cases from other hospitals,
some of the lab directors that
14 I hold in high esteem. [He]
had no interest in any of
15 that.”
16 129. Jadwin’s idea to have Smith D Disputed: For sake of economy, see Plaintiff’s
the PCCs stored in his Depo., Response to DMF 117.
17 department may violate 8/19/08,
California law, Title 22, by pg. 71:2- Disputed: Even as of 8/19/08, Smith took no
18 fragmenting the medical 21 responsibility for her role in failing to get KMC into
record. Jadwin’s idea was compliance with H&S 1602.5. Instead, she focuses on
19 opposed by Toni Smith, Plaintiff’s alleged dysfunction and unsubstantiated
R.N., the medical records speculation that one of Plaintiff’s proposed solutions
20 department, and the medical might run afoul of a regulation.
records committee which
21 ultimately determines what See evidentiary objections.
the contents of a medical
22 record will be.
23
24
25
26
27
28

1 130. Toni Smith, R.N. Smith D Disputed: For sake of economy, see Plaintiff’s
offered a succinct description Depo., Response to DMF 117.
2 of her conversations with 8/19/08,p
Jadwin on the issue of PCCs. gs.72:19- Disputed: Even as of 8/19/08, Smith took no
3 The conversations were not 73:17 responsibility for her role in failing to get KMC into
professional conversations- compliance with H&S 1602.5. Instead, she focuses on
4 ”It just was a dead-end Plaintiff’s alleged dysfunction and unsubstantiated
conversation. I mean, he had speculation that one of Plaintiff’s proposed solutions
5 his mind made up that those might run afoul of a regulation.
things-he had never seen an
6 organization where they See evidentiary objections.
hadn’t been stored in the lab.
7 I had indicated-I indicated to
him that I had never seen an
8 organization where they were
stored in the lab. And I
9 questioned him as to how he
was going to be able to locate
10 that if we needed it for
patient care purposes. I think
11 he said he was going to store
them in binders or in
12 notebooks or boxes or
something. You know, it was
13 See evidentiary objections:
Irrelevantas far as I was
14 concerned. I felt that it was
very important to have that
15 information-one, we needed
to know that the patient had-
16 had received the blood. We
needed the vital sign
17 information during the blood
transfusion part, which
18 would leave a huge gaping
hole in patient information if
19 that was stored somewhere in
the lab.”
20
131. Toni Smith considered Smith D Disputed: For sake of economy, see Plaintiff’s
21 Jadwin’s conduct at the MEC Depo., Response to DMF 117.
meeting as uncooperative, 8/19/08,
22 refusal to consider other pg. 77:9- Disputed: Even as of 8/19/08, Smith took no
points of view or 20 responsibility for her role in failing to get KMC into
23 suggestions, etc. compliance with H&S 1602.5. Instead, she focuses on
Plaintiff’s alleged dysfunction and unsubstantiated
24 speculation that one of Plaintiff’s proposed solutions
might run afoul of a regulation.
25
26
27
28

1 132. Jadwin’s charges of Smith D Disputed: For sake of economy, see Plaintiff’s
being out of compliance with Depo., Response to DMF 117.
2 regulatory agencies were 8/19/08,
unfounded, and regulatory pgs. 84: Disputed: Even as of 8/19/08, Smith took no
3 agencies found no jeopardy 11-85:7 responsibility for her role in failing to get KMC into
of KMC’s level of compliance with H&S 1602.5. Instead, she focuses on
4 compliance. Plaintiff’s alleged dysfunction and unsubstantiated
speculation that one of Plaintiff’s proposed solutions
5 might run afoul of a regulation.
6 Disputed: At her deposition, Smith claimed not to recall

whether DHS found KMC blood transfusion
7 documentation procedures to be noncompliant, even
though she is Nurse Executive, in charge of nurses who
8 fill out PCCs at time of transfusion. [Lee Opp. Decl., Exh.
35 at 82:24-83:4)]. One month earlier, DHS had issued
9 their report finding PCC deficiencies to KMC. [Jadwin
Decl., Exh. 13 (DHS Report of 7/22/08)]. Smith is either
10 incompetent or lying.
11 Disputed: Smith later testified that another KMC audit of

PCCs confirmed Plaintiff’s finding of “less than 100
12 percent compliance” and that even regarding one percent
or two percent incomplete or inaccurate PCCs, “I would
13 never say that was okay”. [Lee Opp. Decl., Exh. 35 at
85:18-20; 87:17-23;
14
15
In General Treatment of
16 Other Staff
17
18
19
20
21
22
23
24
25
26
27
28

1 133. Dr. Abraham gradually Abraham Disputed: Mr. Bryan (Former CEO), Dr. Abraham
had fewer and fewer Depo., (Former President of Medical Staff), Dr. Ragland (Former
2 interactions with Jadwin 8/18/08, President of Medical Staff), Dr. Kercher (Former
because his attitude was pgs. 49: President of Medical Staff), Ms. Smith (Nurse Executive),
3 pompous and arrogant. Since 16-52:9 and Dr. Dutt (Acting Chair of Pathology and Plaintiff’s
the conversations with and former subordinate) were in the minority of people who
4 Jadwin were not cordial, it 75:22-76: were detractors of Plaintiff.
negatively affected patient 19
5 care. She didn’t discuss The vast majority of people – Dr. Martin (Surgery Chair),
Jadwin’s attitude with other Ms. Gallegos (Histotech), Dr. Kolb (Former CMO), Ms.
6 doctors because she thought Lindsey (Secretary), Ms. Lopez (Clerk), Dr. Mansour
his attitude was evident to (OB-GYN physician), Mr. Martinez (Former Lab
7 everyone. Manager), Dr. McBride (Former Cancer Conference
Director), Dr. Naderi (Radiology Chair), Dr. Patel
8 (Cancer Committee Chair), Ms. Ramos (Secretary), Dr.
Taylor (Surgeon), Dr. Wrobel (Neurosurgeon), and Dr.
9 Yoo (Psychiatry Chair) – liked Plaintiff, reported having
no or few bad interactions with him and found he
10 generally conducted himself professionally.
[Lee Opp. Decl., Exh. 36 (Martin Depo. at 34:24-35:2;
11 91:14-19); Exh. 37 (Gallegos Depo. at 23:19-25; 24:17;
28:7-9); Exh. 38 (Kolb Depo. at 17:12-16; 19:17-21:18;
12 22:19-23:1; 75:11-76:10; 62:10-19; 36:21-19); Exh. 39
(Lindsey Depo. at 8:23-10:3); Exh. 40 (Lopez Depo. at
13 8:19-20; 10:4-8; 11:3-8; 12:4-19; 15:20-16:13); Exh. 33
(Mansour Depo. at 10:2-4); Exh. 8 (Martinez Depo. at
14 121:2-7; 122:8-123:1; 124:18-21; 127:18-21; 130:12-16;
133:17-22); Exh. 29 (McBride Depo. at 91:3-92:24);
15 Exh. 41 (Naderi Depo. at 63:18-64:19; 75:17-22); Exh. 42
(Patel Depo. at 16:2-6; 16:17-19); Exh. 43 (Ramos Depo.
16 at 47:9-48:9; 48:22-49:2; 49:10-12); Exh. 44 (Taylor
Depo. at 88:23-89:25; 90:16-90); Exh. 45 (Wrobel Depo.
17 at 12:15-13:18); Exh. 46 (Yoo Depo. at 10:20-11:23;
12:4-6; 12:22-24).
18
Even Dr. Kercher testified “I don’t ever remember
19 [Plaintiff] specifically treating me in a sassy, mean,
horrible way” and “he was always nice to me”. [Lee Opp.
20 Decl., Exh. 14 (Kercher PMK Depo at 32:9-13; 32:25-
33:3)].
21
Disputed: For sake of economy, see Plaintiff’s Response
22 to DMF 94.

134. Dr. Abraham testified Abraham Disputed: For sake of economy, see Plaintiff’s Response
24 that many or most physicians Depo., to DMF DMF 94, 101, 117, 126, 127, 133, 176. The
reported difficulties in 8/18/08, group of people alleging difficulties with Plaintiff were in
25 getting along with Jadwin. pgs. the minority of people retaliating against Plaintiff - Bryan,
185:7- Harris, Kercher, Ragland, Abraham, Smith and Dutt.
26 187:9
27
28

1 135. Jadwin’s Bryan Disputed: For sake of economy, see Plaintiff’s Response
communication style was, to Depo., to DMF DMF 94, 101, 117, 126, 127, 133, 176. Bryan,
2 some people, offensive and 8/14/08, Harris, Kercher, Ragland, Abraham, Smith and Dutt were
abrasive, and he had a hard pgs. 90:4- intolerant in accepting the patient care and noncompliance
3 time accepting differing 92:2 issues Plaintiff was blowing the whistle on.
opinions from others.
4 Disputed: This is pretext. On 12/26/03, Defendant County
increased Plaintiff’s biweekly base salary from
5 $10,679.43 to $11,021.08 establishing that Defendant
County was satisfied with Plaintiff’s performance 3 years
6 into his tenure. [Lee Opp. Decl., Exh. 21 (Change of
Employee Status of 12/26/03 at Bates DFJ00247).
7
8 136. “Compromise” was not Bryan Disputed: For sake of economy, see Plaintiff’s Response
in Jadwin’s vocabulary. It is Depo., to DMF DMF 94, 101, 117, 126, 127, 133, 176. Bryan,
9 not enough to be right; a 8114/08, Harris, Kercher, Ragland, Abraham, Smith and Dutt were
department chair must pgs. 100: just as intolerant in accepting the patient care and
10 exercise judgment on how to 12102: 1 noncompliance issues Plaintiff was blowing the whistle
deal with others. on.
11
Disputed: This is pretext. On 12/26/03, Defendant County
13 County was satisfied with Plaintiff’s performance 3 years
into his tenure. [Lee Opp. Decl., Exh. 21 (Change of
14 Employee Status of 12/26/03 at Bates DFJ00247).

137. Jadwin said Dr. Ragland Bryan See evidentiary objections.
16 was not qualified to be a staff Depo.,
officer, and he called Dr. 8/14/08, Disputed: For sake of economy, see Plaintiff’s Response
17 Harris an idiot on several pgs. to DMF DMF 94, 101, 117, 126, 127, 133, 176. Bryan,
occasions. 107:16- Harris, Kercher, Ragland, Abraham, Smith and Dutt
18 109:11 engaged in retaliatory attacks against Plaintiff which were
far more severe and coordinated.
19 138. E-mail to Bryan from Bryan See evidentiary objections.
Jadwin asking Bryan what he Depo.,
20 (Bryan) has done on the 8/14/08, Disputed: Plaintiff had discovered Elsa Ang, a former
cytotech issue. Bryan said pgs. 171: pathologist, had made failed to diagnose florid cancer in
21 that he was not the 17-173:11 numerous prostate slides, raising a serious patient care
appropriate person to resolve (Exhibit issue. Plaintiff reported the issue to Bryan and Bryan’s
22 this. Jadwin should be 271) response was, true to form, to disregard it. Only later did
directing this to the Bryan finally decide to ask Harris to look into the issue.
23 chairman; Bryan only gets This is further evidence of Bryan’s hostility to
involved if approval is whistleblowers. [Lee Opp. Decl., Exh. 49 (Jadwin email
24 necessary. to Bryan of 10/17/05 at DFJ00589); Exh. 50 (Jadwin
email to Bryan of 3/2/06 at DFJ00750); Exh. 51 (Emails
25 between Bryan and Plaintiff of 4/21/06 at DFJ00799)].
26
27
28

1 139. Bryan recalls private Bryan Disputed: For sake of economy, see Plaintiff’s Response
conversations with Jadwin Depo., to DMF 94, 101, 117, 126, 127, 133, 176. Bryan did not
2 where Jadwin challenged 8/14/08, display similar concern when Plaintiff’s FNA competency
Toni Smith’s competency as pg. 230: was being attacked in retaliatory fashion by Ragland,
3 chief nursing officer. 10-15 Abraham, Kercher, Harris, Smith, and others.
4 Disputed: Even as of 8/19/08, Smith took no

responsibility for her role in failing to get KMC into
5 compliance with H&S 1602.5. Instead, she focuses on
Plaintiff’s alleged dysfunction and unsubstantiated
6 speculation that one of Plaintiff’s proposed solutions
might run afoul of a regulation. Smith is either
7 incompetent or retaliating.
8 140. Jadwin was so obsessed Harris Disputed: For sake of economy, see Plaintiff’s Response
with personnel actions or Depo., to DMF 94, 101, 117, 126, 127, 133, 176. Harris leveled
9 inactions that he was 8/13/08, far more severe charges of assault, intimidation and
distracted in his duties. “ .. pgs. 171: violence at Mansour, yet Mansour was not subjected to
10 his behavior threatened a 16174: 8 administrative leave or nonrenewal as Plaintiff was.
healthy, productive work pg. 173:9-
11 environment at the hospital.” 10 Disputed: This is pretext. On 12/26/03, Defendant County
increased Plaintiff’s biweekly base salary from
12 $10,679.43 to $11,021.08 establishing that Defendant
14
15 141. In most cases, doctors Harris Disputed: For sake of economy, see Plaintiff’s Response
know how to calm each other Depo., to DMF 94, 101, 117, 126, 127, 133, 176. Harris leveled
16 down and act professionally 8/13/08,p far more severe charges of assault, intimidation and
and collegially. Jadwin was gs.212:16 violence at Mansour, yet Mansour was not subjected to
17 “unusual.” Jadwin was 218: 11 administrative leave or nonrenewal as Plaintiff was.
unable to interact collegially pg.215:18
18 and professionally to create a -21 Disputed: This is pretext. On 12/26/03, Defendant County
healthy, collaborative increased Plaintiff’s biweekly base salary from
19 working environment. $10,679.43 to $11,021.08 establishing that Defendant
21
22 142. Jadwin denied referring Jadwin See evidentiary objections.
to Dr. Epstein as cavalier. Depo.,
23 Jadwin said that on another 3/12/08,9 Disputed: Pathologists disagree with outside experts all
matter, at another time, he 01:12- the time. That was the basis for the policy of internal
24 said that Dr. Epstein’s 903: 1 pathology review of outside expert reports which Plaintiff
diagnoses were a little was espousing at the October Conference. Dr. Patel, Chair
25 cavalier. of the Cancer Committee, enthusiastically supported
Plaintiff’s advocacy. [Lee Opp. Decl., Exh. 42 (Patel
26 Depo. at 38:3-7; 38:20-22; 41:11-21)].
27
28

1 143. Dr. Ragland testified Ragland Disputed: For sake of economy, see Plaintiff’s Response
that Jadwin acted Depo., to DMF 94, 101, 117, 126, 127, 133, 176. Ragland’s
2 inappropriately in several 8/22/08, retaliatory animus against Plaintiff is so extreme, it
instances. pg. 12:8- approaches hatred.
3 23
Disputed: This is pretext. On 12/26/03, Defendant County
5 County was satisfied with Plaintiff’s performance 3 years
into his tenure. [Lee Opp. Decl., Exh. 21 (Change of
6 Employee Status of 12/26/03 at Bates DFJ00247).
a) The first incident was pg.16:15- See evidentiary objections.
7 when Jadwin, in a meeting, 16.
said Dr. Ragland was Disputed: For sake of economy, see Plaintiff’s Response
8 incompetent and shouldn’t be to DMF 94, 101, 117, 126, 127, 133, 176. Ragland had no
the medical staff president. hesitation launching more severe retaliatory attacks
9 against Plaintiff. Ragland’s retaliatory animus against
Plaintiff is so extreme, it approaches hatred.
10 b) The second incident was pgs. See evidentiary objections.
Jadwin taking over the blood 59:21-60:
11 usage committee and not 17 and Disputed: For sake of economy, see Plaintiff’s Response
letting any other physicians 86:5-25 to DMF 94, 101, 117, 126, 127, 133, 176. Ragland
12 on it. Jadwin sent Dr. spoliated the emails referenced here and testified he was
Ragland an e-mail stating never contacted by anybody with instructions not to
13 that he thought having other spoliate or to produce documents responsive to Plaintiff’s
physicians on the committee discovery requests.
14 was a waste of time because
“they will all rubber stamp
15 it.” Dr. Ragland interpreted
this to mean that Jadwin did
16 not think that anyone else at
KMC had the competence or
17 experience to sit on the
committee.
18
c) The third incident was pg. 94:16 Disputed: For sake of economy, see Plaintiff’s Response
19 Jadwin’s fighting with the 95:15 and to DMF 94, 101, 117, 126, 127, 133, 176. The
radiologists and calling them 155:2- radiologists, Ragland and Abraham numerous times aired
20 incompetent. According to 156:13 their suspicions that the Pathology department was
Dr. Ragland, Jadwin was incompetent. According to Abraham, that is what led up
21 wrong because the to the retention of David Lieu to conduct an outside
procedurist (the radiologist) review.
22 should chose the equipment
he uses (gauge of needle is See evidentiary objections.
23 an example) as that is who is
performing the task.
24
d) The fourth incident was pgs. 106: See evidentiary objections.
25 Jadwin hijacking the 18-109:
presentation at the October 14 and Disputed: For sake of economy, see Plaintiff’s Response
26 2005 oncology conference. 156:14-25 to DMF 94, 101, 117, 126, 127, 133, 176. Ragland was
not even in attendance.
27
28

1 144. Dr. Ragland observed Ragland See evidentiary objections.

an incident involving Dr. Depo.,
2 Shertukde wherein Jadwin 8/22/08, Disputed: For sake of economy, see Plaintiff’s Response
intimidated her into giving pg. 110:7- to DMF 94, 101, 117, 126, 127, 133, 176.
3 the answer he wanted and 17
then he dismissed her from Disputed: Shertukde never submitted a single complaint
4 the room. against Plaintiff because “there wasn’t any reason for me
to submit any complaint”. [Lee Opp. Decl., Exh. 52
5 (Shertukde depo. at 25:1-9)].
145. Watson describes how Watson See evidentiary objections.
6 Jadwin’s disruptive Depo.,
misconduct was discussed at 8/25/08, Disputed: For sake of economy, see Plaintiff’s Response
7 several JCC meetings. pg. 13:3- to DMF 94, 101, 117, 126, 127, 133, 176. These accounts
16 were being provided by Bryan who had retaliatory animus
8 against Plaintiff. [Lee Opp. Decl., Exh. 10 (Watson Depo.
at 13:8-16)].
9
Watson testified he has never even met Plaintiff, much
10 less heard Plaintiff’s side of the story.[Id. at 10:5-13].
146. Watson testified to his Watson See evidentiary objections.
11 impression of Jadwin’s Depo.,
involvement with KMC 8/25/08, Disputed: For sake of economy, see Plaintiff’s Response
12 management regarding pg. 32:6-1 to DMF 94, 101, 117, 126, 127, 133, 176.
whether to remove him as 0
13 chair, etc. He felt that Peter Watson testified he has never even met Plaintiff, much
Bryan had made a lot of less heard Plaintiff’s side of the story. [Lee Opp. Decl.,
14 effort to engage Jadwin but Exh. 10 (Watson Depo. at 10:5-13)].
that Jadwin was
15 unresponsive.
16
17
18
19
20
21
22
23
24
25
26
27
28

1 147. Letter to Dr. Ko1b from DFJ00243 See evidentiary objections.

Jadwin, dated 11/22/03, -245
2 complaining about the See evidentiary objections: Irrelevant to excusing
situation at KMC. Jadwin Defendants’ liability under any of Plaintiff’s counts. It
3 asserted the following: 1) predates the October Conference of 12/16/05 by several
offense at Dr. Kolb’s years. Also, it is pretext. On 12/26/03, Defendant County
4 counseling of Jadwin that his increased Plaintiff’s biweekly base salary from
leadership style needs to be $10,679.43 to $11,021.08 establishing that Defendant
5 kinder and gentler; 2) distress County was satisfied with Plaintiff’s performance just one
at the criticisms he received month after this letter and 3 years into Plaintiff’s tenure.
6 from Drs. Ragland and [Lee Opp. Decl., Exh. 21 (Change of Employee Status of
Abraham at a Wednesday 12/26/03 at Bates DFJ00247).
7 meeting; 3) blame for the
schism between pathology Disputed: For sake of economy, see Plaintiff’s Response
8 and radiology over FNA was to DMF 133.
on the radiologists; 4)
9 personally unaware of any
inappropriate interpersonal
10 relations involving himself;
5) hoped to be recognized by
11 others at KMC as one of the
best physicians and directors
12 there; and 6) any complaints
about him were
13 “irresponsible attempts by a
few inadequate individuals.”
14
148. E-mail to Dr. Kercher DFJ00316 Disputed: For sake of economy, see Plaintiff’s Response
15 from Jadwin, dated 2/1/05, to DMF 94, 101, 117, 126, 127, 133, 176. Plaintiff had
requesting Dr. Abraham be grounds for this concern. Even after Dr. Lieu reviewed
16 removed from the FNA 200 of Plaintiff’s cases and issued a report exonerating
Committee because she Plaintiff, Abraham testified at her deposition that she still
17 wasn’t (by implication) harbored suspicions about Plaintiff’s competence
honest, objective or afterwards. [Lee Opp. Decl., Exh. 27 (Abraham Depo. at
18 impartial. 56:16-22)].
19 149. E-mail from Dr. DFJ00317 See evidentiary objections.

Kercher to Jadwin, dated
20 2/1/05, telling Jadwin that he Disputed: For sake of economy, see Plaintiff’s Response
was not acting like a team to DMF 94, 101, 117, 126, 127, 133, 176. Kercher did not
21 member. lift a finger to address the numerous patient care and
noncompliance concerns Plaintiff was reporting to him,
22 showing his hostility to whistleblowers.
23
24
25
26
27
28

1 150. E-mail to Peter Bryan DFJ00319 Disputed: For sake of economy, see Plaintiff’s Response
from Jadwin, dated 2/2/05, -320 to DMF 94, 101, 117, 126, 127, 133, 176. Plaintiff
2 listing his suggestions for requested his name be cleared of the radiologists’
improvement on the FNA accusations of incompetence after Dr. Lieu’s outside
3 issue. Jadwin also states that report exonerated him. That never happened. As
the radiology department was Abraham’s testimony showed, even to this day, Plaintiff’s
4 “substantially at fault” for the competence remains in question. [Lee Opp. Decl., Exh. 27
conflict between the (Abraham Depo. at 56:16-22)].
5 departments. He requested a
formal apology from the
6 radiology department to
himself and the pathology
7 department. He also
requested (in bold lettering) a
8 public announcement at the
next MEC meeting that there
9 are no quality issues
involving the pathology
10 department and Drs. Amin,
Abraham, Munoz and Naderi
11 should be forced to stand at
the podium during the
12 announcement.
13 151. Exchange of e-mails DFJ00353 Disputed: For sake of economy, see Plaintiff’s Response
between Dr. Ragland and -354 to DMF 94, 101, 117, 126, 127, 133, 176.
14 Jadwin, dated 2/25/05, in
which Jadwin complains Ragland admitted in depo that the FNA concerns Plaintiff
15 about some comments made had raised were not just a communication issue but a valid
by the radiologists at the “patient care issue” and that he had always known that
16 February QM meeting and even from the beginning. [Lee Opp. Decl., Exh. 9
informing Dr. Ragland to be (Ragland Depo. at 361:3-18)]. Yet here he is minimizing
17 prepared for Jadwin to the issue as “battling doctors” in retaliatory fashion.
request him to call for
18 supporting documentation
from radiology or announce
19 that the previous comments
were unsupported. Dr.
20 Ragland shot back his
displeasure at the continuing
21 conflict between radiology
and pathology, and stated
22 that his committee will not
become a battleground for
23 this conflict.
24
25
26
27
28

1 152. E-mail to Peter Bryan DFJ00355 Disputed: Plaintiff was making a confidential report of
and Dr. Kercher from genuine concern regarding Ragland to Bryan and Kercher.
2 Jadwin, dated 2/28/05, He expected it to be kept confidential. [Lee Opp. Decl.,
forwarding Dr. Ragland’s e- Exh. 53 (Jadwin Depo. at 618:8-9; 622:21-623:4; 621: 14-
3 mail of 2/25/05 and asserting 17)]. They had a duty to keep the report confidential.
that because of spelling, Instead, the report was leaked to Ragland, leading to
4 grammar, and syntax errors predictable escalation of animosity just prior to the
in it that Dr. Ragland may be October Conference. [Lee Opp. Decl., Exh. 9 (Ragland
5 an “impaired physician” with Depo. at 332:9-21; 333:11-17; 334:2-8)]. Amazingly,
a “level of intellectual Bryan and Kercher then turned around and chided
6 functioning well below the Plaintiff for not getting along better with Ragland.
high school graduate level”
7 and thought processes that
are “chaotic and almost
8 incoherent.” Jadwin alleges
that Dr. Ragland may have a
9 substance abuse, emotional
and/or cognitive function
10 disorder, and suggests
monitored drug testing and
11 that Dr. Ragland’s patient
care duties be monitored as
12 well.
13 a) Dr. Ragland heard about Ragland See evidentiary objections.

the e-mail although he never Depo.,
14 saw it. He heard that the e- 8/22/08, Disputed:
mail was turned over to Dr. pgs.
15 Yoo, head of psychiatry. He 332:4-
also heard that Jadwin had 337:2
16 contacted the licensing board
about him with this same
17 accusation.
18 b) Letter to Dr. Ragland from [Compare See evidentiary objections.

Jadwin, dated 10/19/05, to
19 apologizing for past wrongs, DFJ00355 Disputed: For sake of economy, see Plaintiff’s Response
although he asserts that he above] to DMF 152. Plaintiff testified that he acted out of
20 does not know how Dr. DFJ00592 genuine concern, and he submitted it confidentially. This
Ragland came to dislike him. letter proves nothing.
21 The irony is that Jadwin’s
letter contains many spelling
22 and grammatical mistakes
and a Freudian slip” .. and I
23 have never treated you and
your patients exceptionally
24 well ..”
25
26
27
28

1 153. Letter to Dr. Sergio DFJ00356 See evidentiary objections.

Perticucci from Jadwin, ~357
2 dated 3/3/05, complaining Disputed: As Plaintiff testified, when he approached
about Dr. Perticucci’s Perticucci after sending him the letter, he explained why
3 complaints about the he was upset and Perticucci apologized to him. [Lee Opp.
pathology department. In Decl., Exh. 53 (Jadwin Depo. at 650:13-20)].
4 particular, Jadwin attempted
to assert that an original
5 diagnosis of “atypical
metaplasia” was merely a
6 transcription error because
the diagnosis should have
7 been “atypical hyperplasia.”
Jadwin also called the
8 diagnosis rendered on the
same case by Dr. Felix of use
9 “nebulous.” Jadwin called
Dr. Perticucci dishonest and
10 demanded an apology.
11 154. E-mail to Dr. Kercher DFJ00427 Disputed: For sake of economy, see Plaintiff’s Response
from Jadwin, dated 6/7/05, to DMF 94, 101, 117, 126, 127, 133, 176. Kercher was
12 complaining about Dr. quick to criticize Plaintiff, but looked the other way when
Abraham’s conduct at an Abraham attacked Plaintiff in public.
13 MEC meeting and accusing
her of an “inappropriate
14 personality defect.”
15 155. E-mail to Dr. Kercher DFJ00436 Disputed: For sake of economy, see Plaintiff’s Response
from Jadwin, dated 6/27/05, to DMF 94, 101, 117, 126, 127, 133, 176. Abraham
16 demanding that Dr. Abraham harbored retaliatory animus against Plaintiff for pointing
publicly apologize to Jadwin out that the radiologists were not receptive to addressing
17 at the next MEC meeting. the FNA problem. She testified that she still questions
Plaintiff’s competence to this day, despite all the contrary
18 evidence.
19 156. Letter to Dr. Roy from DFJ00738 See evidentiary objections.

20 demanding apology “meeting Disputed: For sake of economy, see Plaintiff’s Response
my specifications” if alleged to DMF 94, 101, 117, 126, 127, 133, 176.
21 (pathology department)
deficiencies are not received Roy’s letter of dissatisfaction of 10/13/05 issued to Harris
22 in 14 days. at the October Conference went beyond the scope of the
October Conference and devolved into baseless personal
23 attacks on Plaintiff. [Weiss Decl., Exh. 1 at pp. 7-8]. Dr.
Weiss, Plaintiff’s expert, noted how KMC was quick to
24 upbraid Plaintiff for being slightly critical of anyone, but
refused to discipline anyone who launched attacks against
25 Plaintiff like Roy’s letters, and in fact upbraided Plaintiff
further when he tried to defend himself. [Id. at p. 6].
26
27
28

1 157. Memorandum from DFJ00740 See evidentiary objections.

Peter Bryan to Jadwin, dated -741;
2 2/21/06, chastising Jadwin Bryan Disputed: For sake of economy, see Plaintiff’s Response
for the tone of voice he used Depo., to DMF 156.
3 in his letter to Dr. Roy of 8/14/08,
2/10/06 and stating that “this pgs.
4 method.. exemplifies why it 137:1-
is becoming increasingly 144:9
5 difficult for you to work with
key members of the medical
6 staff.”
7 158. Email to Peter Bryan DFJ00744 Undisputed that the document says what it says.
from Jadwin, dated 2/23/06, -745
8 following the meeting of
2/22/06 urging Bryan to take
9 the moral high ground and
called Drs. Ragland and
10 Abraham “disgruntled,
vindictive individuals.”
11
159. Exchange of e-mails DFJ00783 Disputed: As is apparent from the email of 3/24/06,
12 with Peter Bryan from Plaintiff was protesting the delay in getting temporary
Jadwin, dated 3/24/06, help hired to assist his department during his medical
13 3/27/06, 4/5/06, criticizing leave. Plaintiff’s expert, Regina Levison, stated in her
Karen Barnes for insisting on report: “According to the documents I read and my
14 vicarious liability of staffing conversations with Dr. Jadwin, it is my opinion that Kern
agency before placing a County could have arranged for locum tenens coverage
15 temporary pathologist. Also, for the Pathology Department at Kern Medical Center
Jadwin postponed his own much more quickly than they did. Kern County could
16 surgery indefinitely because have contacted several other locum tenens firms if they
his mother was ill. were not able to reach contractual agreement with
17 CompHealth or any other companies in a reasonable
amount of time…Over the past 10-15 years, I have seen it
18 become more common for organizations needing locum
tenens coverage to place the request with several locum
19 tenens search firms simultaneously. If Kern County had
followed this practice, there would have been several
20 firms working to fill the Pathology Department's need for
locum tenens coverage. Kern County would not have been
21 liable to pay every firm for recruiting for a Pathologist
locum tenens, only the firm that found the Pathologist that
22 took the assignment”. [Declaration of Regina Levison
(Doc. 268) (“Levison Decl.”), Exh. 1 at Section 5 on p.8].
23
24
25
26
27
28

1 160. Memo from Peter Bryan DFJ00794 See evidentiary objections.

to Jadwin, dated 4/17/06, -795;
2 telling him that he must Bryan Disputed: For sake of economy, see Plaintiff’s Response
either work on improving his Depo., to DMF 94, 101, 117, 126, 127, 133, 156, 176.
3 relationships with staff or 8/14/08,
step down as chairman of pgs. In that same letter, Bryan stated: “Yes, the Department of
4 pathology department. Bryan 231:9- Pathology continues to function well, as it has for many
states “You have made many 237:25; years, and, yes, you have made many positive changes to
5 derogatory comments about pgs. the department” [Lee Decl. (Doc. 266), Exh. 12 (Bryan
some of the staff members” 233:2-17 memo to Jadwin of 4/17/06 at DFJ795); Bryan Depo at
6 and “this apparent lack of and 332:12-22; Lee Decl. (Doc. 266), Exh. 14 (Bryan’s Memo
insight on your part is at the 237:2-11 to Jadwin of 4/28/06 at DFJ1152)]. Later, Bryan testified
7 heart of your inability to that, as of April 28, 2006, “actual functioning of the
meaningfully contribute as a department of [pathology] actually was fairly good”. [Lee
8 member of the medical staff Opp. Decl., Exh. 3 (Bryan Depo at 332:12-22).]. Bryan
leadership group.” In Bryan’s also testified that if there were any complaints about
9 Depo., he distinguished Plaintiff they would have “bubbled” up to him as CEO,
between the department but that was not the case as of 4/17/06. [Lee Opp. Decl.,
10 running well on a technical Exh. 2 (Bryan Depo. at 333:18-334:9)]. At the same time,
level (which he notes in this Bryan wrote to the DHS re: Plaintiff’s demotion: “Quality
11 memo) and Jadwin’s of care issues was not the basis for making this decision.
deficiencies as department To the contrary, Dr. Jadwin has been on an extended
12 chair leave of absence from the hospital and there was a need to
provide consistent administrative leadership within the
13 department.” [Lee Decl., Exh. 19 at 0001619)].
14 161. E-mail from Peter 0001581 See evidentiary objections:

Bryan to Jadwin, dated
15 4/17/06, responding to an e- Irrelevant to excusing Defendants’ liability under any of
mail from Jadwin in which Plaintiff’s counts.
16 Jadwin pushes an issue of
“pathology informatics.”
17 Bryan’s response was stem,
“I clearly indicated to you
18 that your proposed solution
of a free standing system for
19 pathology was not going to
happen. I have repeated this
20 to you many times .. “
21
22
23
24
25
26
27
28

1 162. Jadwin wanted to delete Martinez See evidentiary objections:

the “Complete Blood Count” Depo.,
2 from the laboratory’s test 4/16/08,
menu and only offer the pgs.
3 “Complete Blood Count with 121:17122 Irrelevant to excusing Defendants’ liability under any of
Differential.” Gilbert : 19 Plaintiff’s counts. It predates the October Conference of
4 Martinez believed Jadwin’s 12/16/05 by several years. Also, it is pretext. On 12/26/03,
idea would pose a Defendant County increased Plaintiff’s biweekly base
5 compliance issue so Martinez salary from $10,679.43 to $11,021.08 establishing that
took the matter to the Defendant County was satisfied with Plaintiff’s
6 Compliance Committee. performance as of that date. [Lee Opp. Decl., Exh. 21
Both options stayed on the (Change of Employee Status of 12/26/03 at Bates
7 test menu. Martinez felt that DFJ00247).
Jadwin was being
8 uncooperative in this
incident.
9
163. Gilbert Martinez Martinez See evidentiary objections:
10 described an incident an Depo.,
unannounced inspection 4/16/08, Irrelevant to excusing Defendants’ liability under any of
11 occurred and Jadwin was not pgs. Plaintiff’s counts. It predates the October Conference of
present. Martinez proceeded 127:22- 12/16/05 by several years. Also, it is pretext. On 12/26/03,
12 to show the inspectors 130:3 Defendant County increased Plaintiff’s biweekly base
around the laboratory. salary from $10,679.43 to $11,021.08 establishing that
13 Jadwin returned, became Defendant County was satisfied with Plaintiff’s
upset when he discovered the performance as of that date. [Lee Opp. Decl., Exh. 21
14 inspectors were there, stated (Change of Employee Status of 12/26/03 at Bates
that the inspection had been DFJ00247).
15 mishandled, and then said
that if Jadwin had a gun, he Disputed: Martinez also testified that he did not interpret
16 would shoot someone. the comment to mean that Plaintiff was physically
Jadwin never apologized to threatening him or anyone else. [Lee Decl., Exh. 8
17 him for making the remark. (Martinez Depo. at 128:19-129:7; 130:4-11)]. Martinez
The incident happened testified that he didn’t file a police complaint or a
18 sometime before 2005. workplace violent or any other complaint – instead he
dismissed it as a stray remark. [Ibid.].
19
164. Dr. Dutt believed that Dutt See evidentiary objections.
20 Jadwin tried to retaliate Depo.,
against Dr. Taylor who is 8/20/08
21 married to Dr. Abraham. pgs.
Jadwin’s dislike of Dr. 291:7-
22 Abraham is well-known. For 292: 11
instance, Jadwin refused to
23 make the obvious diagnosis
on one of Dr. Taylor’s cases.
24
25
26
27
28

1 165. Dr. Dutt reported to Dr. Dutt See evidentiary objections.

Harris complaints by Dr. Depo.,
2 Shertukde that Jadwin was 8/20/08,
angry and hostile toward her. pgs.
3 Dutt did so because he was 298:23-
afraid that Dr. Shertukde or 300:24
4 Vangie Gallegos would file a
case against the County for
5 harassment or hostile work
environment based on
6 Jadwin’s behavior.
7
Meeting on February 22,
8 2006
9 166. Dr. Abraham recalled Abraham See evidentiary objections.
how Jadwin insulted her and Depo.,
10 how he had insulted Dr. 8/18/08, Disputed: For sake of economy, see Plaintiff’s Response
Ragland and, in general, that pgs. to DMF 94, 101, 117, 126, 127, 133, 156, 176.
11 he managed to insult 198:24-
everyone who was there but 207: 17 Harris testified that he sincerely apologized to Plaintiff
12 she did not remember after the meeting. [Lee Opp. Decl., Exh. 24 (Harris Depo.
specific statements beyond at 199:1-6)]. He also testified that negative things were
13 those directed at her and Dr. said to Plaintiff at the meeting as well. [Id. at 232:19-21].
Ragland. Kercher was asked if he apologized to Plaintiff at the
14 meeting, and he responded “I apologize all the time,
sir…I do it all the time.” [Lee Opp. Decl., Exh. 14
15 (Kercher PMK Depo. at 93:19-24)].
16 Kercher also testified, “I don’t ever remember David
specifically treating me in a sassy, mean, horrible way…I
17 mean, he was always nice to me.” [Lee Opp. Decl., Exh.
14 (Kercher PMK Depo at 32:9-13)]. Bryan testified that
18 Plaintiff did not insult him at the meeting. [Lee Opp.
Decl., Exh. 3 (Bryan Depo at 110:11-13)]. Abraham
19 testified that Plaintiff called her a “fat doctor” but Kercher
testified “I don’t recall that comment any time”. [Lee
20 Opp. Decl., Exh. 14 (Kercher PMK Depo at 92:24-93:1)].
21 Plaintiff denied insulting anyone at the meeting. [Lee
Opp. Decl., Exh. 55 (Jadwin Depo. at 222:14-223:7;
22 223:15-17). He also confirmed that Harris and Kercher
had both apologized to him after the meeting. [Lee Opp.
23 Decl., Exh. 4 (Jadwin Depo. at 290:16-19)].
24 167. Jadwin insulted, Bryan For sake of economy, see Plaintiff’s Responses to DMF
literally, everyone at the Depo., 166 supra.
25 meeting face-to-face. 8/14/08,
pgs. 109:
26 12-111:10
27
28

1 168. Bryan thanked Dr. Bryan See evidentiary objections.

Ragland for showing Depo.,
2 restraint in the face of 8/14/08, For sake of economy, see Plaintiff’s Responses to DMF
Jadwin’s insults. pgs. 166 supra.
3 156:22-
157:12
4
169. Jadwin made attacking Harris See evidentiary objections.
5 statements and charges at Depo.,
attendees of 2/22/06 meeting. 8/13/08, For sake of economy, see Plaintiff’s Responses to DMF
6 pg. 159:2- 166 supra.
13
7
170. Jadwin insulted Dr. Harris See evidentiary objections.
8 Ragland severely at the Depo.,
2/22/06 meeting. 8113/08, For sake of economy, see Plaintiff’s Responses to DMF
9 pg. 196:7- 166 supra.
20
10
171. Jadwin insulted all of Harris See evidentiary objections.
11 the doctors at the meeting, Depo.,
including Dr. Harris. 8/13/08 For sake of economy, see Plaintiff’s Responses to DMF
12 pgs. 166 supra.
230:4-
13 232: 13
14 172. Harris refused to Harris See evidentiary objections.
characterize Jadwin’s Depo.,
15 behavior as crazy but he did 8113/08, For sake of economy, see Plaintiff’s Responses to DMF
offer “excessive” as a pgs. 166 supra.
16 description and agreed with 234:24-
Eugene Lee’s adjectives of 235: 23 For sake of economy, see Plaintiff’s Responses to DMF
17 “unprofessional” and and 176 supra. Harris’s pretext is belied by his memos to file
“unreasonable.” Harris said it 305:20- regarding Mansour and the many formal and informal
18 was the most unprofessional, 308: 22 complaints submitted against him. To date, Mansour was
unreasonable, excessive not subjected to administrative leave or nonrenewal as
19 behavior he has ever seen in Plaintiff was.
a physician.
20
173. The first incident of Ragland See evidentiary objections.
21 Jadwin’s inappropriate Depo.,
conduct was when Jadwin, 8/22/08, For sake of economy, see Plaintiff’s Responses to DMF
22 during this meeting, said Dr. pg. 16:12- 166 supra.
Ragland was incompetent 16
23 and shouldn’t be the medical
staff president.
24
25
26
27
28

1 174. E-mail from Dr. 0000507 Disputed: Defendants are quoting out of context. In that
Ragland to Peter Bryan, email exchange, Ragland specifically expressed his
2 dated 2/23/06, stating that the disdain for Plaintiff’s whistleblowing efforts: “that was
meeting with Jadwin on one of the most distasteful event I have ever participated
3 2/22/06 was “one of the most in [Plaintiff] has fixed his department so now he is going
distasteful events I have ever to fix us?” [Lee Decl., Exh. 11 (Ragland email to Bryan
4 participated in.” of 2/23/06 at 0000507)].
5 Bryan made no bones about indicating that his allegiance

lay with Ragland, Harris, Abraham and Kercher: “I know
6 it was really challenging to remain cordial and not
combative [with Plaintiff], and goodness a couple of you
7 could have really hit back”, even as he portrayed himself
as an impartial adjudicator to Plaintiff. [Ibid.].
8
9
10 Demotion to Staff
Pathologist
11
175. Pathology Dept. 0000903 - See evidentiary objections.
12 Proctoring Report on Dr. 913
Dutt, dated 1/l8/06, and Disputed: Plaintiff issued this proctoring report just a few
13 completed by Jadwin who months after Dutt’s hire. Plaintiff was able to form a
said that Dr. Dutt’s fuller, and very different, opinion of Dutt’s performance
14 performance is “responsible as a pathologist after further opportunity to work closely
and excellent.” with him. Plaintiff formed the opinion over time that Dutt
15 was a weak pathologist.
[Jadwin Opp. Decl., para. 9].
16
17
18
19
20
21
22
23
24
25
26
27
28

1 176. Exchange of e-mails DFJ01430 Disputed: For sake of economy, Plaintiff’s Response to
between Dr. Dutt and DMF 112 is incorporated in its entirety herein.
2 Jadwin, dated 11/6/06,
regarding a container of Disputed: This is pretext for retaliatory motive and
3 specimen left sitting out. To disparate treatment of Plaintiff. Dr. Mansour, an OB-
remedy the situation, Dr. GYN core physician, is a direct comparator to Plaintiff
4 Dutt instructed that only after his demotion – both reported to respective
Evangeline “Vangie” department chairs at KMC. Mansour was the subject of a
5 Gallegos was to process the staggering number of serious complaints of disruptive
placentas. behavior from 5/10/2006 to 4/12/2007. Yet, he was not
6 put on administrative leave or subjected to nonrenewal.
Harris reported in numerous memos to file that: 1)
7 Mansour had used an “angry and raised voice” at him.
[Lee Opp. Decl., Exh. 34 (Harris memos to file, Exh. 736
8 at Bates 0027083)]; 2) Roy went to Harris to “complain
about abuses by Dr. Mansour” including “ridicule and
9 criticism” and threatened to leave KMC [Id. at Exh. 740
at Bates 0027094]; 3) Harris concluded “the comments
10 made by Dr. Mansour [about Roy] were unprofessional,
inappropriate, and of malicious intent.” [Id. at Exh. 740 at
11 Bates 0027094]; 4) Harris counseled Mansour “on the
spot” regarding his inappropriate criticism of nursing staff
12 in front of residents - [Id. at Exh. 742 at Bates 0027097];
5) Harris noted that Mansour’s actions were so egregious
13 to the “NRP Team” and medical staff officers that
Ragland and Jose Perez contemplated suspending him, “if
14 for no other reason than for ‘possible assault’ on the
respiratory therapist.” [Id. at Exh. 746 at Bates 0027102];
15 6) Harris noted that he remained skeptical of Mansour’s
ability to “communicate constructively and to engender
16 the support of others with whom he works”. [Id. at Exh.
746 at Bates 0027103]; 7) Harris faulted Mansour’s
17 “communication style” as not contributing to a
“communicative, helpful, collegial, and effective
18 environment at the hospital”. [Id. at Exh. 746 at Bates
0027104]; 8) Harris noted that only once or twice had his
19 blood pressure “gotten up” at KMC but that Mansour had
become “truly exasperating” and that Mansour “can never
20 be legitimately criticized, because anyone who would
criticize him would have to be out to get him”. [Id. at Exh.
21 746 at Bates 0027104]; 9) Harris noted that he and
Culberson presented to Mansour five complaints of
22 quality concerns and one patient complaint. [Id. at Exh.
747 at Bates 0027105]; 10) Mansour responded that “all
23 of this is a remnant of Peter Bryan. It was Mansour who
got rid of Peter Bryan”. [Id. at Exh. 747 at Bates
24 0027106]; 11) Harris noted a complaint that Mansour had
improperly thrown surgical instruments. [Id. at Exh. 749
25 at Bates 0027109].
26 Disputed: Plaintiff disputes this hearsay account reported

by Dutt. [Jadwin Opp. Decl., para. 10].
27
28

1 177. E-mail from Evangeline 0000824 Disputed: Dutt himself was the target of complaints
“Vangie” Gallegos to Dr. within the Pathology department. Yet he was not
2 Dutt, dated 11/6/06, thanking subjected to disciplinary action. As late as 2/6/07, Harris
him for his support and noted in his memos to file that Dutt himself had not
3 complaining about Jadwin “embraced the broad support of the pathology department
interfering in her work area and lab” and has been the target of complaints from other
4 and “creating more work for medical staff members in the pathology department.
everybody.” She asked if she Harris decided Dutt should not be promoted from Acting
5 could go home early as she to full Chair of Pathology until he could demonstrate
was feeling sick. “those administrative demeanors desired of a Chair under
6 conditions of lower environmental stress.” [Lee Opp.
Decl., Exh. 34 (Harris memos to file, Exh. 745 at Bates
7 0027100-27101].
9 Disputed: Plaintiff disputes this account by Dutt. [Jadwin

Opp. Decl., para. 11].
10
178. Exchange of e-mails DFJ01439 For sake of economy, see Plaintiff’s Responses to DMF
11 between Dr. Dutt and (0000840 176 and 177 supra, which are incorporated in their
Jadwin, dated 11/13/06 and 841) entirety herein.
12 11/14/06, wherein Jadwin
requested that he have an See evidentiary objections.
13 assigned assistant and that
the assigned assistant be Disputed: Plaintiff disputes it would be demeaning and
14 required to notify him when time consuming to have an employee clock in and out. It
leaving the lab for more than occurs in workplaces all across the country every day.
15 5 minutes. Dr. Dutt’s [Jadwin Opp. Decl., para. 12].
response was to deny the
16 need for an assistant as the
department had three
17 pathologists and to remark
how “demeaning and time
18 consuming” it would be to
constantly clock in and out.
19
179. E-mail from Dr. Dutt to DFJ01446 For sake of economy, see Plaintiff’s Responses to DMF
20 Jadwin, dated 11/17/06, -01447 176 and 177 supra, which are incorporated in their
expressing frustration with (0000843) entirety herein.
21 Jadwin’s reaction to
counseling which is to See evidentiary objections.
22 escalate the situation, blame
others, or attack others. Dr. Disputed: Plaintiff disputes this account by Dutt. [Jadwin
23 Dutt also promised to find Opp. Decl., para. 13].
the records where Jadwin did
24 not submit a “rush” case or
most of his other cases that
25 day. He also asserted that
Jadwin had done this before.
26
27
28

1 180. E-mail from Dr. Dutt to DFJ01448 For sake of economy, see Plaintiff’s Responses to DMF
Jadwin, dated 11/22/06, (0000850) 176 and 177 supra, which are incorporated in their
2 discussing their disagreement entirety herein.
on the necessity for
3 privileges for FNA and the See evidentiary objections.
necessity for proctoring.
5
181. E-mail from Dr. Dutt to DFJ01449 For sake of economy, see Plaintiff’s Responses to DMF
6 Jadwin, dated 11/22/06, (000085]) 176 and 177 supra, which are incorporated in their
reminding him of a rush case entirety herein.
7 that Jadwin failed to process
promptly and counseling See evidentiary objections.
8 Jadwin to remember it when
criticizing others. Disputed: Plaintiff disputes this account by Dutt. [Jadwin
9 Opp. Decl., para. 15].
10 182. E-mail from Dr. Dutt to 0000827 For sake of economy, see Plaintiff’s Responses to DMF
Jadwin, dated 12/4/06, 176 and 177 supra, which are incorporated in their
11 chastising Jadwin for entirety herein.
criticizing Dr. Shertukde’s
12 diagnosis without consulting See evidentiary objections.
others first; chastising him
13 for refusing to get outside Disputed: Plaintiff disputes this account by Dutt. [Jadwin
consult on a hard case; and Opp. Decl., para. 16].
14 chastising him for failing to
remove the sharps from the
15 cutting area when he was
done.
16
a) Minutes of the meeting of 0000899 For sake of economy, see Plaintiff’s Responses to DMF
17 the pathology/histology 176 and 177 supra, which are incorporated in their
department on 10/17/06. It entirety herein.
18 was noted that Dr. Shertukde
was concerned that blades See evidentiary objections.
19 were not being removed once
grossing was done. She and Disputed: Plaintiff disputes this account by Dutt. [Jadwin
20 Dr. Dutt remove and discard Opp. Decl., para. 16].
the blades immediately.
21
b) E-mail from Dr. Dutt to 0000862 For sake of economy, see Plaintiff’s Responses to DMF
22 Yolanda Figueroa, dated 176 and 177 supra, which are incorporated in their
12/7/06, acknowledging her entirety herein.
23 report that Jadwin had left
two long blades and a scalpel Disputed: Figueroa disputes this hearsay account reported
24 out after he was finished. by Dutt. [Jadwin Opp. Decl., para. 6].
26
27
28

1 183. E-mail from Dr. Dutt to DFJ01465 For sake of economy, see Plaintiff’s Responses to DMF
Jadwin, dated 12/5/06, (0000856) 176 and 177 supra, which are incorporated in their
2 regarding Jadwin’s entirety herein.
uncooperativeness with him
3 and general failure to adhere See evidentiary objections.
to a chain of command.
5
184. E-mails between Dr. DFJ01476 For sake of economy, see Plaintiff’s Responses to DMF
6 Dutt and Jadwin, dated -1478 176 and 177 supra, which are incorporated in their
12/6/06, arguing over a (0000857- entirety herein.
7 criticism Jadwin made of a 858)
diagnosis that Dr. Shertukde See evidentiary objections.
8 did and involving alleged
defamatory and retaliatory Disputed: Plaintiff disputes this account by Dutt. [Jadwin
9 statements made by Jadwin. Opp. Decl., para. 18].
Dr. Dutt tells Jadwin that
10 people are afraid of him
because of his hostility and
11 that it is Jadwin’s fault for
how he treats others.
12
185. E-mail from Dr. Dutt to 0001466 For sake of economy, see Plaintiff’s Responses to DMF
13 David Culberson, dated 176 and 177 supra, which are incorporated in their
12/6/06, stating that he had entirety herein.
14 counseled Jadwin for not
sending out a case for See evidentiary objections.
15 consultation that, in fact,
turned out to be a missed Disputed: Plaintiff disputes this account by Dutt. [Jadwin
16 endometrial cancer and now Opp. Decl., para. 19].
Jadwin was pushing a lot of
17 cases out for consultation,
burdening the staffs time and
18 budget.
19 186. E-mail from Dr. Dutt to 0000863 For sake of economy, see Plaintiff’s Responses to DMF
Jadwin, dated 12/7/06, 176 and 177 supra, which are incorporated in their
20 chastising him for entirety herein.
commanding Yolanda to
21 treat the placentas when in Disputed: Figueroa disputes this hearsay account reported
his e-mail of 11/6/06 by Dutt. [Jadwin Opp. Decl., para. 20].
22 (0000825 above) specifically
said that only Vangie was to See evidentiary objections.
23 work with placentas.
24 187. Jadwin was Dutt For sake of economy, see Plaintiff’s Responses to DMF
uncooperative after returning Depo., 176 and 177 supra, which are incorporated in their
25 from leave. He was asked 8/20/08, entirety herein.
specifically to resume doing pg.
26 the blood bank reviews and 284:25- See evidentiary objections.
he did not do them. 285:5
28

1 188. Dr. Dutt, acting Chair of Dutt For sake of economy, see Plaintiff’s Responses to DMF
the Pathology Department Depo., 176 and 177 supra, which are incorporated in their
2 had concerns that Jadwin was 8/20/08, entirety herein.
creating a hostile work pgs.
3 environment. This prompted 286:6- See evidentiary objections.
meetings with Dr. Perez, 289: 1;
4 David Culberson, and Dr. 290:14-20 Disputed: Plaintiff disputes this account by Dutt. [Jadwin
Harris. Opp. Decl., para. 22].
5
189. Dr. Dutt would try to Dutt For sake of economy, see Plaintiff’s Responses to DMF
6 counsel Jadwin one-on-one Depo., 176 and 177 supra, which are incorporated in their
but Jadwin would avoid the 8/20/08, entirety herein.
7 conversation. He would pgs.296:2
make an excuse to leave the 0-297:13 See evidentiary objections.
8 room or leave the hospital.
Because Jadwin made it Disputed: Plaintiff disputes this account by Dutt. [Jadwin
9 difficult for Dr. Dutt to talk Opp. Decl., para. 23].
to him, Dr. Dutt had no
10 alternative but to send his
concerns about Jadwin’s
11 work to the Peer Review
Committee.
12
190. E-mail to Dr. Dutt from DFJ01479 Undisputed.
13 Jadwin, dated 12/6/06, with -1480
copies to David Culberson,
14 Dr. Harris and Karen Barnes,
alleging that he has been
15 “singled out for non-
transparent ‘PCC r review’”
16 as well as personal attacks,
and he requests the KMC
17 administration to initiate a
formal review.
18
19
20
21
22
23
24
25
26
27
28

1
Π’S MATERIAL FACTS (“PMF”) Π’S SOURCE
2 2
3 3 A. INTRODUCTION
4 4
5 5 Plaintiff is the former Chief of Pathology at Kern Medical Supplemental Decl. of Eugene
Center (“KMC” or “the hospital”), an acute care teaching Lee in Support of Plaintiff’s
6 hospital and health care facility that is owned and operated Motion for Summary Judgment
by Defendant County of Kern (“Defendant County” or “the (“Lee Supp. Decl.”, Doc. 267),
7 County”). Exh. 19 (Scheduling Order
(“SCO”) at 8:2-4); Exh. 20 (RFA
8 No. 18 at 5:7-10, RFA No. 19 at
13-15; RFA No. 24 at 6:7-10).
9
10
11
12
13 6
14 7 B. STATEMENT OF FACTS
15 8 In October 2000, Dr. Jadwin began full-time employment at Lee Supp. Decl. (Doc. 267), Exh.
KMC as chair of the pathology department. Plaintiff was an 19 (Scheduling Order (“SCO”) at
16 employee of Defendant County from October 24, 2000 to 8:2-4), Decl. of Eugene Lee in
October 4, 2007. Support of Plaintiff’s Motion
17 for Summary Judgment (“Lee
Decl.”, Doc. 266) Exh. 22
18 (Amendment 1 to Jadwin
Employment Contract of
19 11/12/02 at (a) on DFJ1416)
20 9 Throughout the course of his employment at KMC, Dr. Lee Supp. Decl. (Doc. 267), Exh.
Jadwin tried to ensure that patient care was based on 10 (Bryan’s Letter to Supervisors
21 adequate and accurate pathology. of 1/17/06 at No. 10 on 0001567)
22
10 In May 2005, Dr. Jadwin began formally expressing his Decl. of David F. Jadwin in
23 concerns that KMC was not complying with state Support of Plaintiff’s Motion
regulations regarding blood transfusion documentation. for Summary Judgment
24 (“Jadwin Decl.” Doc. 265), Exh.
2 (Jadwin Email to Ramos-
25 Aninion of 5/19/05 at DFJ00407)
26
27
28

1 11 In October 2005, Dr. Jadwin presented at an intra-hospital Jadwin Decl. (Doc. 265), Exh. 2
conference where he reported on uncaught pathology report (Presentation at DFJ481-484,
2 errors that potentially jeopardized the care of a 494-495)
hysterectomy patient and the need for a policy to address
3 the problem.
4
5 12 Defendants responded by calling him into a meeting, Lee Decl. (Doc. 266), Exh. 4
severely reprimanding him, and informing him that letters (Taylor Letter to Harris of
6 of reprimand would be placed in his physician credentials 10/12/05 at DFJ00580); Exh. 5
file. (McBride Letter to Harris of
7 10/12/055 at DFJ00581); Exh. 6
(Roy Letter to Harris of 10/12/05
8 at DFJ00583); Exh. 7 (Kercher et
al Letter to Jadwin of 10/17/05 at
9 DFJ00588))
10
11
13 Defendants’ retaliatory conduct exacerbated Dr. Jadwin’s Lee Decl. (Doc. 266) Exh. 9
12 chronic depression and proved so disabling that, at the end (Jadwin’s Letter to Bryan of
of 2005, he was forced to take a reduced work schedule 1/9/06 at 0001140); Decl. of Paul
13 medical leave as an accommodation and seek psychiatric Riskin, M.D. Authenticating
therapy. Documents (“Riskin Decl.”, Doc.
14 270) (Certification of 1/13/06 at
DFJ1810); Lee Supp. Decl. (Doc.
15 267), Exh. 8 (Jadwin Depo. at
495:2-496:20)
16
17 14 In April 2006, Dr. Jadwin requested an extension of his Jadwin Decl. (Doc. 265), Exh. 6
reduced work schedule leave. (Jadwin’s Request for Leave
18 Extension of 4/26/06 at
DFJ00157), Exh. 4 (Jadwin’s
19 Email to Bryan, Chester, & Dutt
of 3/16/06 at DFJ00752)
20
21
15 On April 28, 2006, Defendant Bryan responded by placing Lee Supp. Decl. (Doc. 267), Exh.
22 him on full-time “personal necessity leave” under the 22 (Rog. No. 36, 27:1-4); Lee
County’s leave policy and, a few months later, ordered him Decl. (Doc. 266), Exh. 14
23 not to contact anybody at KMC or he would be fired (Bryan’s Memo to Jadwin of
(“Forced FT Leave”). 4/28/06 at DFJ01152, DFJ01155-
24 1159, DFJ01164); Lee Decl.
(Doc. 266), Exh. 16 (Nunn’s
25 Cover Email to Jadwin of 6/26/06
at DFJ01346)
26
27
28

1 16 On June 14, 2006, Defendant Bryan told Dr. Jadwin that he Lee Decl. (Doc. 266), Exh. 15
had decided to “rescind your appointment as chairman” and (Bryan’s Letter to Jadwin of
2 that “This decision is effective June 17, 2006”. 6/14/06 at DFJ01181)
3
17 On July 10, 2006, Defendant Bryan recommended to Lee Decl. (Doc. 266), Exh. 18
4 KMC’s Joint Conference Committee (“JCC”) that Plaintiff (Bryan’s Memo to JCC of
be removed from his position as Chair of the pathology 7/10/06 at 0001476-77); Lee
5 department “based on Dr. Jadwin’s unavailability for Supp. Decl. (Doc. 267), Exh. 21
service because of extended medical leaves for non-work (Rog No. 37 at 51:20-23); Lee
6 related ailments” and “solely based on his continued non- Supp. Decl. (Doc. 267), Exh. 22
availability to provide the leadership necessary for a (Rog. No. 37, 27:9-11)
7 contributing member of the medical staff leadership
group..Dr. Jadwin has provided no indication that he is
8 committed to return to work or resume his duties as chair.
Other than his latest written communication requesting an
9 extension of his medical leave, Dr. Jadwin has made no
attempt in the last two months to contact me concerning his
10 employment status or how the Department of Pathology
should be managed during his absence”.
11
12
13
14
15
16
17
18 18 At a meeting of the JCC on July 10, 2006, Defendant Lee Supp. Decl. (Doc. 267), Exh.
County approved the demotion of Plaintiff from chair of the 14 (Watson Depo. at 113:15-
19 pathology department for “unavailability”. Members of the 114:4); Lee Decl. (Doc. 266),
JCC based their vote on his unavailability due in part to his Exh. 17 (JCC Minutes of 7/10/06
20 medical leave. at 0009819-21); Lee Decl. (Doc.
266), Exh. 18 (Bryan’s Memo to
21 JCC of 7/10/06 at 0001476-77)
22
23 19 Defendant County then conditioned Dr. Jadwin’s return to Lee Supp. Decl. (Doc. 267), Exh.
work as a regular pathologist on his medical release to full 21 (Rog1 No. 33 at 50:16-26;
24 time work and entry into an amendment to his contract that Rog1 Nos. 38-41 at 51:26-52:23);
contained restrictive terms and conditions and reduced Dr. Lee Decl. (Doc. 266), Exh. 22
25 Jadwin’s base pay from roughly $300,000 to $200,000. (Amendment 1 to Jadwin
26 11/12/02 at (a) & (f) on DFJ1416,
(i) on DFJ1417, & DFJ1420 at
27 “Assignments”)
28

1 20 When demoting Dr. Jadwin, Defendants Bryan and the Jadwin Decl. (Doc. 265), para 9)
County did not notify Dr. Jadwin of the hospital committee
2 vote to demote him or give him a chance to defend himself
prior to, at or after the vote.
3
4
21 On his return to work as a demoted pathologist in late 2006, Lee Supp. Decl. (Doc. 267), Exh.
5 Dr. Jadwin was placed beneath a former subordinate whom 19 (SCO at 9:10-11); Lee Supp.
he had hired and trained the year before. Decl. (Doc. 267), Exh. 22 (Rog.
6 No. 10, 4:10-11)
7
8
22 After about two months, Dr. Jadwin decided to go outside Jadwin Decl. (Doc. 265), Exh. 8
9 the hospital and report his ongoing suspicions of legal (JCAHO’s Email to Jadwin of
noncompliance and illegal and/or unsafe care and 11/29/06 at DFJ01454); Exh. 9
10 conditions of patients at KMC to regulatory and (DHS Letter to Jadwin of
accreditation agencies, as well as KMC senior management. 12/1/06); Exh. 12 (Jadwin Decl.
11 (Doc. 265), Exh. 12 (Jadwin’s
Email to CAP of 1/15/07 at
12 DFJ02463-DFJ02499)
13
14 23 Plaintiff also complained to KMC’s senior management Jadwin Decl. (Doc. 265), Exh. 11
about the harsh treatment he was receiving. (Jadwin Email to Culberson of
15 12/13/06 at DFJ01488-DFJ1491)
16
17 24 The following day, on December 7, 2006, Defendant Lee Supp. Decl. (Doc. 267), Exh.
County placed Dr. Jadwin on administrative leave “pending 21 (Rog1 No. 42 at 52:24-53:1);
18 resolution of a personnel matter.” Lee Decl. (Doc. 266), Exh. 24
(Culberson Letter to Jadwin of
19 12/7/06 at DFJ01482)
20 25 The leave denied Plaintiff the opportunity to earn patient- Decl. of Stephanie Rizzardi in
based professional fees, which had amounted to roughly Support of Plaintiff’s Motion for
21 $100,000 per year (“Professional Fees”) prior to his taking Summary Judgment (“Rizzardi
of reduced work schedule leave. Decl.”, Doc. 271), Exh. 1, Table
22 7; Jadwin Decl. para 14
23
26 Dr. Jadwin formally notified KMC of his whistle-blowing Jadwin Decl. (Doc. 265), Exh. 10
24 reports to the outside regulatory and accreditation agencies. (Jadwin Letter to Culberson of
12/6/06 at DFJ01488-91)
25
26
27
28

1 27 Dr. Jadwin remained on administrative leave for another ten Lee Decl. (Doc. 266), Exh. 22
months until his contract expired on October 4, 2007. (Amendment 1 to Jadwin
2 Employment Contract of
11/12/02 at (a) on DFJ1416);
3 Jadwin Decl. para 12
4 28 During six of those months, Dr. Jadwin was physically Lee Supp. Decl. (Doc. 267), Exh.
restricted to his home during work hours. 5 (Wasser Letter to Lee of
5 4/30/07 at DFJ01701)
6 29 The county decided not to renew Dr. Jadwin’s contract, Lee Supp. Decl. (Doc. 267), Exh.
which expired on October 4, 2007. 14 (Watson Depo. at 113:15-
7 114:4);Lee Decl. (Doc. 266),
Exh. 22 (Amendment 1 to Jadwin
11/12/02 at Recital (a))
9
10 30 From October 2000 to the present, KMC – a hospital with Lee Supp. Decl. (Doc. 267), Exh.
roughly 60 full-time faculty physicians – had failed to 22 (Rog. No. 28, 20:8-21)
11 renew the contract of only 1 other KMC physician.
12
13 31 Plaintiff’s position had been that of a permanent, core Lee Supp. Decl. (Doc. 267), Exh.
physician, whose contracts are customarily renewed. 10 (Bryan Depo, 39:6-8); Lee
Decl. (Doc. 266), Exh. 2 (Jadwin
14 Employment Contract, p.1);
Jadwin Decl. para 7
15
16 32 Defendant County based its nonrenewal decision on Dr. Lee Decl. (Doc. 266), Exh. 18
Jadwin’s medical and recuperative leave, and the fact he (Bryan’s Memo to JCC of
had brought a lawsuit opposing employment practices 7/10/06 at 0001476-77)
17 prohibited by the Family & Medical Leave Act (“FMLA”),
the California Family Rights Act (“CFRA”), and the Fair
18 Employment & Housing Act (“FEHA”).
19
20
21
22 33 To this day, Dr. Jadwin has not personally received an Jadwin Decl. (Doc. 265), para 13
explanation from Defendants as to why he was placed on
23 administrative leave or why his contract was not renewed,
despite repeated requests for an explanation. Defendants
24 never notified Dr. Jadwin of the charges against him or
permitted him to defend himself.
25
26
27
34
28

1 35 B. THRESHOLD ISSUES
2 36 During the entire tenure of Plaintiff’s employment, Lee Supp. Decl. (Doc. 267), Exh.
Defendant County was continuously an employer within the 19 (SCO at 6:25-7:3)
3 meaning of FMLA [29 C.F.R. § 825.105(C)], CFRA [Gov’t
C. § 12945.2 (b)(2)], and FEHA [Gov’t C. § 12926(d)]
4 engaged in interstate commerce, and regularly employing
more than fifty employees within seventy-five miles of
5 Plaintiff’s regular workplace at KMC.
6
7
8
9 37 Defendant County is a government agency. Lee Supp. Decl. (Doc. 267), Exh.
20 (RFA No. 20, 5:16-19)
10
11
38
12
39 1. Threats to Plaintiff’s Credentials
13
40 On October 12, 2005, Defendant Harris solicited and Lee Decl. (Doc. 266), Exh. 4
14 received letters of dissatisfaction from three KMC core (Taylor Letter to Harris of
physicians, criticizing Dr. Jadwin’s presentation at a KMC 10/12/05 at DFJ00580); Exh. 5
15 monthly Oncology Conference. (McBride Letter to Harris of
10/12/055 at DFJ00581); Exh. 6
16 (Roy Letter to Harris of 10/12/05
at DFJ00583); Exh. 7 (Kercher et
17 al Letter to Jadwin of 10/17/05 at
DFJ00588))
18
19
20 41 On October 17, 2005, KMC’s senior medical staff wrote to Lee Decl. (Doc. 266), Exh. 7
Dr. Jadwin notifying him that these letters of dissatisfaction (Kercher et al Letter to Jadwin of
21 would be placed in his credentialing file (“Credential 10/17/05 at DFJ00588)
Threat”).
22
23
42 Some of the medical staff involved later apologized to Dr. Lee Decl. (Doc. 266), Exh. 12
24 Jadwin. (Bryan Letter to Jadwin of
4/17/06 at DFJ00794
25
43
26
44 2. Demotion & Pay Cut
27
28

1 45 Dr. Jadwin’s employment contract expressly provided that Lee Supp. Decl. (Doc. 267), Exh.
Dr. Jadwin would be chair of the KMC pathology 20 (RFA No. 243 at 49:22-27)
2 department and paid base compensation of $287,529 (“Base
Pay”).
3
4
46 On July 10, 2006, Bryan recommended and the JCC Lee Supp. Decl. (Doc. 267), Exh.
5 approved Jadwin’s demotion from department chair to staff 20 (RFA No. 229 at 47:4-9); Lee
pathologist (“Demotion”). Supp. Decl. (Doc. 267), Exh. 20
6 (RFA No. 228 at 46:27-47:1)
7
8
9
10
47 It is uncontested that Defendants considered a portion of Lee Supp. Decl. (Doc. 267), Exh.
Dr. Jadwin’s pay to be tied to his chair position, and that 20 (RFA No. 228 at 58:6-10);
11 the demotion therefore made the paycut a foregone Lee Supp. Decl. (Doc. 267), Exh.
conclusion. The JCC vote to demote Plaintiff was 21 (Rog No. 11 at 13:10-21); Lee
12 effectively a vote to reduce his Base Pay as well. Supp. Decl. (Doc. 267), Exh. 3
(Barnes Letter to Lee of 9/15/06
13 at DFJ1390); Lee Decl. (Doc.
266), Exh. 22 (Amendment No. 1
14 to Employment Contract dated
10/3/06 at (a) & (f) on DFJ01416,
15 (i) on DFJ01417)
16
48 Defendants County and Harris informed Dr. Jadwin that his Lee Supp. Decl. (Doc. 267), Exh.
17 return to work at KMC was conditioned on his entry into an 20 (RFA No. 246 at 50:12-16)
amendment to his employment contract, instituting a
18 reduction in Base Pay from $287,529 to $186,687
(“Paycut”).
19
20
49 On October 3, 2006, Plaintiff executed the amendment to Lee Decl. (Doc. 266), Exh. 22
21 his employment contract. (Amendment No. 1 to
Employment Contract dated
22 10/3/06 at DFJ01418)
23 50
24 51 3. Administrative Leave
25 52 A pathologist is valued according to the efficacy of his Decl. of Regina Levison in
“eye”, i.e., the training and experience that allows him to Support of Plaintiff’s Motion
26 spot minute patterns and telltale abnormalities in for Summary Judgment
microscopic and gross tissue samples. (“Levison Decl.”, Doc. 268) Exh.
27 1 At p 6
28

1 53 Developing and maintaining the pathologist “eye” requires Levison Decl. (Doc. 268), Exh. 1
years of daily pathology work; however, it takes only a few At p 6
2 months of being away from work to lose enough efficacy to
threaten a pathologist’s career.
3
4
54 Moreover, Dr. Jadwin’s contract expressly provided that he Lee Decl. (Doc. 266), Exh. 2
5 was to earn patient billing-based professional fees, separate (Jadwin Employment Contract of
and apart from his fixed Base Pay. 11/12/02 at No. 4 on DFJ00156-
6 157)
7 55 In order to earn Professional Fees, Dr. Jadwin needed to Lee Decl. (Doc. 266), Exh. 2
process and bill patient cases. (Jadwin Employment Contract of
8 11/12/02 at No. 4 on DFJ00156-
157 (“direct patient
9 care”…through “an agreement
for services with the County”);
11
12 56 Restriction to his workplace at KMC by placement on leave Lee Decl. (Doc. 266), Exh. 2
denied him the opportunity to earn such fees. (Jadwin Employment Contract of
11/12/02 at No. 4 on DFJ00156-
13 157 (“direct patient
care”…through “an agreement
14 for services with the County”)
15
16
57 Dr. Jadwin’s professional fee income amounted to Rizzardi Decl. (Doc. 271), Exh.
17 approximately $100,000 per year. 1, Table 7; Jadwin Decl. para 14
18
58 On December 7, 2006, Defendant County placed Plaintiff Lee Supp. Decl. (Doc. 267), Exh.
19 on paid administrative leave “pending resolution of a 20 (RFA No. 252 at 51:16-20);
personnel matter” (“Admin Leave”). Lee Supp. Decl. (Doc. 267), Exh.
20 22 (Rog. No. 42, 28:3-9); Lee
Decl. (Doc. 266), Exh. 24
21 (Culberson Letter to Jadwin of
12/7/06 at DFJ01482)
22
59 Defendant County further ordered Plaintiff to “remain at Lee Decl. (Doc. 266), Exh. 24
23 home and available by telephone during normal business (Culberson Letter to Jadwin of
hours” and not to contact anyone at KMC, else he could be 12/7/06 at DFJ01482)
24 terminated. There was no further indication of what
Plaintiff was being charged with, whether he would be
25 permitted to respond to charges, or when the leave would
end.
26
27
28

1 60 No investigation, explanation or resolution ensued. Jadwin Decl. (Doc. 265), para 6
2
61 On April 4, 2007, Plaintiff notified Defendant County that Lee Supp. Decl. (Doc. 267), Exh.
3 the long leave was exacerbating his depression, eroding his 4 (Lee Letter to Barnes of 4/4/07
pathology skills and employability, and denying him the at DFJ01619)
4 opportunity to earn professional fees.
5
6
62 On April 30, 2007, Defendant County informed Dr. Jadwin Lee Supp. Decl. (Doc. 267), Exh.
7 that he remained on administrative leave but removed the 22 (Rog. No. 43, 28:10-16); Lee
home restriction. Supp. Decl. (Doc. 267), Exh. 5
8 (Wasser Letter to Lee of 4/30/07
at DFJ01701)
9
63 On May 1, 2007, Defendant County informed Dr. Jadwin Lee Supp. Decl. (Doc. 267), Exh.
10 that they intended to keep Dr. Jadwin on leave and “let his 21 (Rog No. 43 at 53:3-9); Lee
contract run out”. Supp. Decl. (Doc. 267), Exh. 22
11 (Rog. No. 44, 28:17-22); Lee
Supp. Decl. (Doc. 267), Exh. 6
12 (Wasser Email to Lee of 5/1/07 at
DFJ01705)
13
14
15
16
17
18
19
64 Dr. Jadwin remained on administrative leave until his Lee Decl. (Doc. 266), Exh. 22
employment contract expired on October, 4, 2007. (Amendment 1 to Jadwin
11/12/02 at (a) on DFJ01416, (i)
21 on DFJ01417; Jadwin Decl. (Doc.
265), para. 12
22
23 65
24 66 4. Nonrenewal
25 67 Supervisor Ray Watson, then-Chair of the Board of Lee Supp. Decl. (Doc. 267), Exh.
Supervisors, voted as a member of the JCC to demote Dr. 14 (Watson Depo. at 113:15-
26 Jadwin and effectively cut his pay, and also participated in 114:4)
the decision not to renew Plaintiff’s employment contract
27
28

1 68 Ray Watson, Chair of the Board Supervisors at the time of Lee Supp. Decl. (Doc. 267), Exh.
the Nonrenewal, testified in Depo.: “My understanding was 14 (Watson Depo. at 113:15-
2 that [Plaintiff] had -- he had been on medical leave, family 114:4)
leave, and had requested even more leave, and that for that
3 reason and the fact that he was suing us, that we decided
not to renew his contract.” (“Nonrenewal”).
4
5
6
7 69 Moreover, Dr. Jadwin was a “core physician” at KMC, a Lee Supp. Decl. (Doc. 267), Exh.
permanent position. 10 (Bryan Depo, 39:6-8); Lee
8 Decl. (Doc. 266), Exh. 2 (Jadwin
Employment Contract, p.1);
10
70 There was a mutually explicit understanding that, as a core Lee Supp. Decl. (Doc. 267), Exh.
11 physician, Plaintiff’s contract would be continuously 10 (Bryan Depo, 39:6-8); Jadwin
renewed. Decl. para 7; Lee Supp. Decl.
12 (Doc. 267), Exh. 22 (Rog. No. 28,
20:8-21)
13
71 In fact, from October 2000 to present, only one other Lee Supp. Decl. (Doc. 267), Exh.
14 physician besides Dr. Jadwin has not had his contract 20 (RFA No. 275 at 55:22-26)
renewed.
15
16
17 72
18 73 D. CAUSATION
19 74 Credential Threat was a substantial cause of Dr. Jadwin’s Decl. of Anthony Reading,
emotional distress leading to recurrence of his chronic Ph.D. (“Reading Decl.”, Doc.
20 major depressive disorder. 269) Exh. 1, p. 58 - 59 at Overall
Conclusions
21
22
75 Credential Threat was a substantial cause of Dr. Jadwin’s Reading Decl. (Doc. 269), Exh. 1,
23 reduced work schedule medical/recuperative leave and loss p. 58 - 59 at Overall Conclusions;
of opportunity to earn Professional Fees from December 16, Supplemental Decl. of David F.
24 2005 to on or around April 28, 2006. Jadwin in Support of Plaintiff’s
Motion for Summary Judgment
25 (“Jadwin Supp. Decl.” Doc. 272)
5, 6
26
27
28

1 76 Forced FT Leave was a substantial cause of Dr. Jadwin’s Reading Decl. (Doc. 269), Exh. 1,
emotional distress, leading to worsening of Dr. Jadwin’s p. 59-60 at Overall Conclusions;
2 major depression. Jadwin Supp. Decl. 6
3
4 77 Forced FT Leave was a substantial cause of Plaintiff’s loss Lee Decl. (Doc. 266), Exh. 2
of opportunity to earn Professional Fees as provided for in (Jadwin Employment Contract, at
5 his employment contract from on or around April 28, 2006 DFJ00154, 156); Jadwin Supp.
to June 17, 2006. Decl. 6
6
7
78 Demotion and Paycut were substantial causes of Dr. Reading Decl. (Doc. 269), Exh. 1,
8 Jadwin’s emotional distress, leading to worsening of Dr. p. 58 - 59 at Overall Conclusions
Jadwin’s major depression.
9
10
11 79 Demotion and Paycut were substantial causes of Base Pay Lee Decl. (Doc. 266), Exh. 22
reduction from $287,529 to $186,687 from October 3, 2006 (Amendment 1 to Lee Decl.
12 onward. (Doc. 266)); Exh. 2 (Jadwin
13 11/12/02 at (i) on DFJ1417)
14 80 Demotion and Paycut were substantial causes of Levison Decl. (Doc. 268), Exh. 1
termination of Plaintiff’s career as a pathology department At p 6
15 chair due to unemployability.
16
17 81 Admin Leave, during 5 months of which Plaintiff was Reading Decl. (Doc. 269), Exh. 1,
restricted full-time to his home, was a substantial cause of p. 59-60 at Overall Conclusions
Dr. Jadwin’s emotional distress, leading to worsening of
18 Dr. Jadwin’s major depression.
19
20 82 Admin Leave was a substantial cause of Plaintiff’s loss of Lee Decl. (Doc. 266), Exh. 22
opportunity to earn Professional Fees as provided for in his (Amendment 1 to Jadwin
21 employment contract from on or around December 7, 2006 Employment Contract of
to October 4, 2007 11/12/02 at (i) on DFJ1417);
22 Jadwin Decl. (Doc. 265), para 14
23
83 Admin Leave was a substantial cause of loss of Plaintiff’s Levison Decl. (Doc. 268), Exh. 1
24 pathologist “eye”, causing him to become unemployable as At p 6
a pathologist.
25
84 Nonrenewal was a substantial cause of Dr. Jadwin’s Reading Decl. (Doc. 269), Exh. 1,
26 emotional distress, leading to worsening of Dr. Jadwin’s p. 59-60 at Overall Conclusions
major depression.
27
28

1 85 Nonrenewal was a substantial cause of Plaintiff’s lost Base Lee Decl. (Doc. 266), Exh. 2
Pay of $186,687 and Professional Fees of roughly $100,000 (Jadwin Employment Contract of
2 per year, as provided for in his employment contract, from 11/12/02 at No. 4 on DFJ00156-
on or around October 4, 2007 onward. 157); Lee Decl. (Doc. 266), Exh.
3 22 (Amendment 1 to Jadwin
4 11/12/02 at (i) on DFJ1417)
5
6 86
7 87 E. COUNTS 2&3: DEFENDANT COUNTY’S
8 WHISTLEBLOWER RETALIATION
9
88 1. Oncology Conference
10
89 Dr. Jadwin made a protected report to KMC’s medical staff Jadwin Decl. (Doc. 265), Exh. 2
11 leadership about (a) the medical appropriateness of a (Presentation at DFJ481-484,
radical hysterectomy for a KMC patient (Patient No. 494-495)
12 1142693) based on inaccurate outside pathology reports –
which case was the subject of Plaintiff’s presentation at the
13 monthly KMC oncology conference held on October 12,
2005 (“October Conference”) – and (b) the unsafe
14 conditions created for other patients by the lack of a KMC
policy requiring internal pathology review of all outside
15 pathology reports prior to treatment (“IPR”).
16
17
18
19
20 90 Defendant County knew of Dr. Jadwin’s whistleblowing Lee Decl. (Doc. 266), Exh. 7
report at the October Conference since Defendant Harris, (Kercher et al Letter to Jadwin of
21 then-CMO of KMC, and Jennifer Abraham, then- 10/17/05 at DFJ00588)
Immediate Past President, were in attendance.
22
23
24
25
26
27
28

1 91 Each of the letters of reprimand which Defendant County Lee Decl. (Doc. 266), Exh. 4
decided to place into Plaintiff’s medical credential file (Taylor Letter to Harris of
2 specifically reference Dr. Jadwin’s presentation at the 10/12/05 at DFJ00580); Exh. 5
October Conference. (McBride Letter to Harris of
3 10/12/055 at DFJ00581); Exh. 6
(Roy Letter to Harris of 10/12/05
4 at DFJ00583); Exh. 7 (Kercher et
al Letter to Jadwin of 10/17/05 at
5 DFJ00588)
6
7
92
8
93 2. PCCs
9
94 On January 9, 2006, Dr. Jadwin made a protected report to Lee Decl. (Doc. 266), Exh. 9
10 Bryan regarding KMC’s noncompliance with state (Jadwin’s Letter to Bryan of
regulations regarding blood transfusion related 1/9/06 at 0001141)
11 documentation called product chart copies (“PCCs”),
jeopardizing patient safety.
12
13
95 Improper documentation of blood transfusions creates Jadwin Supp. Decl. (Doc. 272),
14 patient risk of morbidity and mortality. para 3
15
16 96 Dr. Jadwin reasonably suspected that KMC’s ongoing Jadwin Decl. (Doc. 265), Exh. 12
failure to maintain accurate and complete records of patient (Jadwin’s Email to CAP of
blood transfusions did not comply with H&S § 1602.5, 1/15/07 at DFJ02499); Jadwin
17 which requires PCC documentation to conform to AABB Decl. (Doc. 265), Exh. 13
accreditation standards. (DHS’s Fax to Jadwin of 8/11/08
18 at E264 on pages 2-4 (finding
almost 50% noncompliance at
19 KMC)); Jadwin Supp. Decl.
(Doc. 272), Exh. 1 at DFJ793
20
21 97 During his reduced work schedule medical leave, Dr. Jadwin Decl. (Doc. 265), Exh. 12
Jadwin audited PCCs, and continued to report (Jadwin’s Email to CAP of
noncompliant incomplete or missing PCCs to Defendant 1/15/07 at both DFJ02463-
22 Bryan, Toni Smith, KMC Nurse Executive, and Risk DFJ02499); pages in between
Management and Quality Assurance through at least April show Dr. Jadwin’s audits of
23 17, 2006, when Plaintiff asked Defendant Bryan to set up a PCCs & his efforts to correct
meeting with Bernard Barmann, County Counsel, to discuss noncompliance internally);
24 his concerns regarding PCC noncompliance. Jadwin Supp. Decl. (Doc. 272),
Exh. 1 at DFJ793 (subject line
25 states “Compliance with
Regulations”)
26
27
28

1 98 The California Department of Health Services later Jadwin Decl. (Doc. 265), Exh. 13
determined during the course of an inspection that KMC (DHS’s Fax to Jadwin of 8/11/08
2 was indeed failing to comply with PCC-related regulations. at E264 on pages 2-4 (finding
almost 50% noncompliance))
3
4
99 On April 17, 2006, Defendant Bryan threatened to demote Lee Decl. (Doc. 266), Exh. 12
5 Plaintiff. (Bryan Letter to Jadwin of
4/17/06 at DFJ00795)
6
100
7
101 3. Skull Flaps
8
102 Dr. Jadwin reasonably believed that storage of patient skull Lee Supp. Decl. (Doc. 267), Exh.
9 caps occurring in an unlicensed laboratory freezer at KMC 9 (Martinez Depo at 14:2-22);
violated H&S § 1635.1. Lee Supp. Decl. (Doc. 267), Exh.
10 12 (Dutt Depo at 244:6-9)
11
12 103 Unlicensed skull flap storage could give rise to a risk of Jadwin Decl. (Doc. 265), at para
patient morbidity or mortality. 15
13
104 Gilbert Martinez, the Manager of Laboratory Services at Lee Supp. Decl. (Doc. 267), Exh.
KMC (“Martinez”) confirmed that there were typically 9 (Martinez Depo At 10:2-7,
14 seven to nine skull flaps being stored in the lunlicensed 16:6-21)
aboratory freezer.
15
16
105 At times, upwards of 15 to 20 skull flaps were being stored Lee Supp. Decl. (Doc. 267), Exh.
17 in KMC’s unlicensed freezer. 12 (Dutt Depo at 244:6-9)
18
19
20 106 Martinez shared Plaintiff’s concerns about unlicensed skull Lee Supp. Decl. (Doc. 267), Exh.
flap storage in the laboratory freezer. 9 (Martinez Depo 14:2-12)
21
22
23
107 When Dr. Jadwin discovered skull flaps being illegally Lee Supp. Decl. (Doc. 267), Exh.
stored in the laboratory freezer, he discussed the problem 9 (Martinez Depo 14:2-22)
24 with Gilbert Martinez, the Manager of Laboratory Services
at KMC (“Martinez”).
25
26
27
28

1 108 Around Thanksgiving 2006, Dr. Jadwin tipped Martinez off Lee Supp. Decl. (Doc. 267), Exh.
that he intended to blow the whistle about his unresolved 9 (Martinez Depo at 111:12-
2 complaints about unsafe patient care and conditions, 112:4)
including unlicensed skull flap storage, and that inspections
3 of KMC by regulatory and accreditation agencies was
likely.
4
5
6 109 Within a few days, Martinez relayed this information to his Lee Supp. Decl. (Doc. 267), Exh.
supervisor, David Hill, the Director of Ambulatory Care; 9 (Martinez Depo at 113:8-
who in turn relayed it to a pathologist, Philip Dutt, and/or 114:23)
7 Defendant Harris.
8
9
110 Beginning November 28, 2006, Dr. Jadwin formally Lee Supp. Decl. (Doc. 267), Exh.
10 reported his suspicions of illegal and/or unsafe care and 20 (RFA No. 35 at 8:10-14); Lee
conditions of patients at KMC – including unlicensed skull Supp. Decl. (Doc. 267), Exh. 20
11 flap storage, noncompliant PCCs, and an inappropriate (RFA No. 21 at 5:22-24 (DHS));
radical prostatectomy (see below) – to the Joint Lee Supp. Decl. (Doc. 267), Exh.
12 Commission on Accreditation of Hospital Organizations 20 (RFA No. 22 at 5:25-6:2
(“JCAHO”), the College of American Pathologists (JCAHO); Lee Supp. Decl. (Doc.
13 (“CAP”), and the California Department of Health Services 267), Exh. 20 (RFA No. 23 at
(“DHS”). (“Outside WB Reports”). 6:3-6 (CAP))
14
15
16
17
18
19
20
21 111 On January 4, 2007, Dr. Dutt received confirmation that Dr. Jadwin Supp. Decl. (Doc. 272),
Jadwin had in fact complained to CAP about the unlicensed Exh. 2 (Dutt’s Email to
22 tissue storage and noncompliant PCCs, and shared this with Culberson of 1/4/07 at 0001330)
then-CEO Mr. Culberson.
23
24
112
25
113 4. Radical Prostatectomy
26
27
28

1 114 At 12:54 p.m. on December 6, 2006, Dr. Jadwin formally Jadwin Decl. (Doc. 265), Exh. 10
reported to KMC leadership his concerns regarding a KMC (Jadwin’s email to Dutt,
2 patient who was scheduled for immediate radical Culberson et al. of 12/6/06 at
prostatectomy to treat possible cancer. Plaintiff had DFJ1479); Lee Supp. Decl. (Doc.
3 recommended the attending physician delay the 267), Exh. 20 (RFA No. 61 at
prostatectomy because he believed the pathologic findings 13:19-25); Lee Supp. Decl. (Doc.
4 of cancer were inconclusive. Instead, Plaintiff had 267), Exh. 24 (Rog 67 at 14:22-
recommended the findings be validated by outside experts. 23 (noting difficulties outside
5 reviewers had reaching
conclusions about the diagnosis)
6
7
8
9 115 Radical prostatectomies pose numerous risks to patient Jadwin Decl. (Doc. 265), Exh. 10
care, including incontinence, impotence and other morbid (Jadwin’s email to Dutt,
factors. Culberson et al. of 12/6/06 at
10 DFJ1479)
11
116 In his report to KMC leadership, Dr. Jadwin also Jadwin Decl. (Doc. 265), Exh. 10
12 complained of a pattern of non-transparent “peer review” (Jadwin’s email to Dutt,
being conducted against him and asked that the Board of Culberson et al. of 12/6/06 at
13 Supervisors be apprised of his concerns and initiate a DFJ1479-1480)
formal review.
14
15
117 Four minutes later, at 12:58 p.m., Dr. Dutt emailed Mr. (Lee Decl. (Doc. 266), Exh. 23
16 Culberson complaining about Dr. Jadwin’s competency, (Dutt Email to Culberson dated
and insistence on outside review of numerous cases after 12/6/07 at 0001466)
17 Dr. Dutt had counseled him on failing to send a case out for
consultation. Dr. Dutt also complained about alleged “other
18 problems” involving Dr. Jadwin which he worried might
lead to loss of staff and the pathology department’s ability
19 to serve patients and doctors in a timely manner.
20
21
22
23 118 The patient ultimately decided not to proceed with the
prostatectomy.
24
119 G. COUNTS 3 & 4: DEFENDANT COUNTY’S
25 MEDICAL LEAVE RETALIATION
26
27
28

1 120 Plaintiff was eligible to take medical leave as of December Lee Supp. Decl. (Doc. 267), Exh.
16, 2006 20 (RFA NO. Nos. 134-138 at
2 28:15-29:10)
3
4
5 121 Plaintiff requested and took reduced work schedule CFRA Lee Decl. (Doc. 266), Exh. 14
medical leave from December 16, 2005 to at least March (Bryan’s Memo to Jadwin of
6 15, 2006. 4/28/06 at DFJ1152, 1154); Exh.
18 (Bryan memo to JCC at 1476-
7 1477, paras 6,7); Riskin Dec,
Exh. 1 & 2
8
9 122 Members of the JCC subsequently voted to demote Lee Supp. Decl. (Doc. 267), Exh.
Plaintiff, basing their decision on his unavailability due in 19 (SCO at 8:28-9:5); Lee Decl.
10 part to his medical leave. Mr. Bryan told the JCC at the (Doc. 266), Exh. 17 (JCC
removal vote: “This recommendation [for removal] is based Meeting Minutes of 7/10/06 at
11 on Dr. Jadwin’s unavailability for service because of item 10 on 0009820 to 0009821);
extended medical leaves..” Exh. 18 (Bryan’s Memo to JCC
12 of 7/10/06 at 0001476).
13
14
123 Previously on April 17, 2006, 4 months into Plaintiff’s Lee Decl. (Doc. 266), Exh. 12
15 reduced work schedule medical leave, Bryan admitted to (Bryan memo to Jadwin of
Dr. Jadwin, “Yes the Department of Pathology continues to 4/17/06 at DFJ795); Bryan Depo
16 function well as it has for many years, and yes, you have at 332:12-22; Lee Decl. (Doc.
made many positive changes in the department.” Yet on 266), Exh. 14 (Bryan’s Memo to
17 April 28, 2006, Bryan ordered Dr. Jadwin onto full-time Jadwin of 4/28/06 at DFJ1152)
leave unti lJune 16, 2006.
18
19
20
21 124 Plaintiff also has direct evidence that Plaintiff’s medical Lee Supp. Decl. (Doc. 267), Exh.
leave was a negative factor in the Nonrenewal 14 (Watson Depo. at 113:19-
22 114:4)
23
24
25 125
26 126 H. COUNTS 4 & 5: DEFENDANT COUNTY’S

MEDICAL LEAVE DENIAL/INTERFERENCE
27
28

1 127 On April 28, 2006, Defendant Bryan represented to Dr. Lee Decl. (Doc. 266), Exh. 14
Jadwin that he was still entitled to 137 hours of medical (Bryan Memo to Jadwin of
2 leave. 4/28/06 at DFJ1152, 1154)
3 128 Sandra Chester, Defendant County’s then-HR Director, Lee Supp. Decl. (Doc. 267), Exh.
testified in Depo. that Plaintiff’s request for medical leave 15 (Chester Depo at 120:1-16)
4 in his email to Bryan and herself on March 16, 2006; and
provision by Dr. Jadwin’s treating therapist, Dr. Riskin, of
5 leave certification on April 29, 2006 was timely under
Defendant County’s customary practice.
6
7
8
9 129 Dr. Riskin’s certifications notified it that Plaintiff’s Riskin Decl. (Doc. 270), Exh. 1
depression was serious enough to require a reduced work &2
10 schedule leave and regular treatment from December 16,
2005 to September 16, 2006
11
12
130 Nonetheless, Defendant Bryan denied Plaintiff reduced Lee Decl. (Doc. 266), Exh. 14
13 work schedule medical leave, and forced him to take full- (Bryan Memo to Jadwin of
time “personal necessity leave” under the County’s leave 4/28/06 at DFJ1152); Lee Decl.
14 policy. (Doc. 266), Exh. 18 (Bryan
Memo to JCC of 7/10/06 at No. 9
15 on 001476); No. 1201.20 on
0001501; No 1201.30 on
16 0001501-1502; No. 1202.20 at
0001523-1524
17
131
18
132 I. COUNT 6: DEFENDANT COUNTY’S DISABILITY
19
DISCRIMINATION
20
21 133 1. Jadwin Was An Individual With Disabilities
22 134 Dr. Jadwin was an individual with a mental disability Reading Decl. (Doc. 269), Exh. 1
because of his chronic major depressive disorder. Dr. at “Diagnostic Impressions” on p.
23 Reading, Plaintiff’s forensic psychologist, diagnosed Dr. 58; Reading Decl. (Doc. 269),
Jadwin as having Major Depressive Disorder. Dr. Reading Exh. 1 at “Structured Clinical
24 also noted Dr. Jadwin reported developing depressed mood, Interview” at p. 57-58
pervasive anhedonia, suicidal ideation, sleep disturbance,
25 and other symptoms while working at KMC.
26
27
28

1 135 Dr. Jadwin’s depression limited his ability to take pleasure Reading Decl. (Doc. 269), Exh. 1
from life, and to engage full-time in, and take pleasure at “Structured Clinical Interview”
2 from, the medical work to which he had devoted his life. at p. 57-58
3
136 Likewise, Defendant County has admitted, by and through Lee Supp. Decl. (Doc. 267), Exh.
4 the PMK Depo. testimony of its representative, Eugene 17 (Kercher Depo at 95:13-22,
Kercher, a psychiatrist, that it was familiar with the 96:3-8)
5 symptoms of depression and believed that Dr. Jadwin was
depressed over several years during the tenure of his
6 employment at KMC.
7
8
9 137 Plaintiff also required sinus surgery and required a few Jadwin Decl. (Doc. 265), Exh. 7
weeks to recover from it during May of 2005. (Jadwin’s Letter to Bryan of
10 5/31/06 at DFJ1175)
11
138 Further, Plaintiff suffered an avulsed ankle at the end of Jadwin Decl. (Doc. 265), Exh. 7
May of 2005 that limited his ability to walk. (Jadwin’s Letter to Bryan of
12 5/31/06 at DFJ1175)
13
139 The limitations from these physical conditions contributed Riskin Decl. (Doc. 270), Exh. 3 at
14 to Plaintiff’s limitations from his chronic depression during DFJ1814
May through the first part of June of 2005.
15
16
17 140
18 141 2. Plaintiff Was “Otherwise Qualified” Lee Decl. (Doc. 266), Exh. 19
(Bryan’s Letter to DHS of
19 7/25/06 at 0001619); Exh. 18
(Bryan’s Letter to JCC of 7/10/06
20 at top of 001476 and end of
001457); Exh. 14 (Bryan’s Memo
21 to Jadwin of 4/28/06 at
DFJ01152, DFJ01155-1159,
22 DFJ01164); Exh. 16 (Nunn’s
Cover Email to Jadwin of 6/26/06
23 at DFJ01346); Exh. 10 (Bryan’s
Letter to Supervisors of 1/17/06
24 at No. 10 on 0001567)
25
26
142
27
143 3. Defendant County Knew Dr. Jadwin Was An
28 Individual with Disabilities

1 144 Plaintiff’s physician, Dr. Lempel, disclosed Plaintiff’s Lee Decl. (Doc. 266), Exh. 1
depression when he faxed his medical report to KMC’s HR (Lempel Medical Report of
2 Department on November 30, 2000, around the time of 11/30/00 at DFJ00102-103 and
Plaintiff’s hire. handwritten Zoloft prescription at
3 bottom of page)
4
145 Defendant Bryan admitted knowing that Dr. Jadwin needed Lee Decl. (Doc. 266), Exh. 9
5 leave because of his depression. (Jadwin’s Letter to Bryan of
1/9/06 at 0001140); Exh. 18
6 (Bryan Memo to JCC of 7/10/06
at 0001500 & 0001506)
7
146 Dr. Riskin’s certifications stated that Plaintiff needed Riskin Decl. (Doc. 270), Exh. 1
8 medical/recuperative leave for depression from December &2
16, 2005 to September 16, 2006
9
10
147 Supervisor Watson testified in Depo. that he knew Dr. Lee Supp. Decl. (Doc. 267), Exh.
11 Jadwin was in continuous need of extensions of his medical 14 (Watson Depo. at 80:22-81:2)
leave.
12
13
14 148 On April 4, 2007, during Plaintiff’s Admin Leave, Plaintiff Lee Supp. Decl. (Doc. 267), Exh.
expressly notified Defendant County in writing that 4 (Lee Letter to Barnes of 4/4/07
Plaintiff was depressed and that the Admin Leave was at DFJ01619)
15 exacerbating his chronic depression.
16
17 149
18
19
20
21
22
23
24
25
26
27
28

1 150 4. Disability Was A Motivating Factor in Demotion, Pay Lee Supp. Decl. (Doc. 267), Exh.
Cut & Nonrenewal 14 (Watson Depo. at 113:15-
2 114:4); Lee Decl. (Doc. 266),
Exh. 18 (Bryan’s Memo to JCC
3 of 7/10/06 at top of 001476; No.
9 on 001477; and end of 001457)
4
[Lee Decl., Exh. 17 (JCC Minutes
5 of 7/10/06 meeting at ¶ 10 on
0009830-9831); Lee Opp. Decl.,
6 Exh. 7 (Patrick Depo. at 27:5-8 &
30:2-20); Lee Opp. Decl., Exh.
7 14 (Kercher Depo. at 99:20-
100:17); Lee Opp. Decl., Exh. 35
8 (Smith Depo. at 14:22-15:8); Lee
Opp. Decl., Exh. 48 (emails
9 between Dutt & Barnes of
9/14/06 at 0000830)].
10
.
11
Lee Opp. Decl., Exh. 56 (PMK
12 Dutt Depo. at 243:7-11)
(sometimes appropriate to punish
13 an employee for taking medical
leave)].
14
151
15
152 J. COUNT 7: DEFENDANT COUNTY’S FAILURE TO
16 REASONABLY ACCOMMODATE
17
153 On January 9, 2006, Dr. Jadwin asked Defendant Bryan to Lee Decl. (Doc. 266), Exh. 9
18 allow him to work part-time and at home while he was (Jadwin’s Letter to Bryan of
recovering from his disabling depression. 1/9/06 at 0001140)
19
20
154 Dr. Riskin, Plaintiff’s psychiatrist, certified that part-time Riskin Decl. (Doc. 270), Exh. 1
21 work was medically necessary. &2
22
155 KMC accommodated Jadwin’s disability from December Lee Decl. (Doc. 266), Exh. 18
23 16, 2005 to April 28, 2006 by providing him with the (Bryan memo to JCC at 1476-
reduced work schedule medical/recuperative leave and 1477, paras 6,7); Riskin Dec,
24 ability to perform work at home that he requested during Exh. 1 & 2
his meeting with Defendant Bryan on January 9, 2006.
25
26
27
28

1 156 As customary, a Locum Tenens pathologist covered

Plaintiff’s clinical pathologist duties, while Plaintiff
2 performed the remaining10-20% of his administrative
duties as Chair of Pathology.
3
4
157 As usual, if Dr. Jadwin was unable to attend to an
5 administrative duty at a particular time, then Dr. Dutt filled
in for him.
6
158 On March 16, 2006, Dr. Jadwin requested an extension of Jadwin Decl. (Doc. 265), Exh. 6
7 his reduced work schedule leave. Dr. Jadwin submitted (Jadwin’s Request for Leave
Dr. Riskin’s certification of his continuing need for a Extension of 4/26/06 at
8 reduced work schedule within three days of learning that DFJ00157); Exh. 4 (Jadwin’s
Defendant County required it. Email to Bryan, Chester, & Dutt
9 of 3/16/06 at DFJ00752)
10
159 On April 28, 2006, Bryan refused to accommodate
11 Jadwin’s disability. Instead he forced him to take full-time
leave, and refused to hold his job open for him any longer
12 while he was on recuperative leave, and refused to allow
Dr. Jadwin to return to work until he could work full-time.
13 As a result, Dr. Jadwin was prevented continuing to carry
out his duties as Chair of Pathology.
14
15
16
17 160
18 161 K. COUNT 8: DEFENDANT COUNTY’S FAILURE

TO ENGAGE IN INTERACTIVE PROCESS
19
20 162 Defendant Bryan acted in bad faith when he unilaterally Lee Decl. (Doc. 266), Exh. 18
denied Dr. Jadwin’s request for continuing accommodation (Bryan’s Memo to JCC of
21 in the form of part-time work, and refused to allow him to 7/10/06 at 0001500 & 0001506);
return to work until he could work full time. Lee Decl. (Doc. 266), Exh. 14
22 (Bryan’s Memo to Jadwin of
4/28/06 at DFJ01152, DFJ01155-
23 1159, DFJ01164)
24 163 Defendant Bryan also acted in bad faith when he Lee Decl. (Doc. 266), Exh. 18
represented to the JCC that Dr. Jadwin’s lack of (Bryan’s Memo to JCC of
25 communication with him led him to believe that Dr. Jadwin 7/10/06 at 0001500 & 0001506);
had essentially abandoned his job. Lee Decl. (Doc. 266), Exh. 14
26 (Bryan’s Memo to Jadwin of
4/28/06 at DFJ01152, DFJ01155-
27 1159, DFJ01164)
28 164

1 165 L. COUNT 9: ALL DEFENDANTS’ PROCEDURAL

DUE PROCESS VIOLATIONS
2
3 166 1. Direct Liability of Defendant County under Monell
4
167 The Bylaws of Kern Medical Center as in effect between Lee Decl. (Doc. 266), Exh. 3
5 June 13, 2006 and October 4, 2007 (“Bylaws”) provided for (Bylaws at 11599 - 11601 etc.)
due process for core physicians in numerous scenarios like
6 loss of hospital privileges, but not for (i) removal of
physicians from department chairmanship, (ii) placement of
7 physicians on administrative leave, or (iii) nonrenewal of
physician employment contracts with Defendant County.
8
According to Bylaws Section 12.2 GROUNDS FOR
9 HEARING, due process is provided in the following
situations:
10 “A. Denial of medical staff membership.
B. Denial of requested advancement in staff membership
11 status, or
category.
12 C. Denial of medical staff reappointment.
D. Suspension of staff membership or clinical privileges for
13 more than
thirty (30) days in any twelve (12) month period.
14 E. Demotion to lower staff category or membership status.
F. Summary suspension of staff membership or clinical
15 privileges for
more than fourteen (14) days.
16 G. Revocation of medical staff membership.
H. Denial of requested clinical privileges.
17 I. Involuntary reduction of current clinical privileges.
J. Termination of all clinical privileges.
18 K. Involuntary imposition of significant consultation or
monitoring
19 requirements (excluding monitoring incidental to
provisional status
20 and Section 7.3).”
21 The due process afforded by the Bylaws in the above cases

is robust, e.g., Bylaws Section 12.3-1 NOTICE OF
22 ACTION OR PROPOSED ACTION.
23 168 The Board of Supervisors of Defendant County ratified the Lee Supp. Decl. (Doc. 267),
Bylaws on December 13, 2004. Patrick depo, 40:1-4); Lee Supp.
24 Decl. (Doc. 267), Exh. 1 (Board
of Supervisor Minutes of
25 12/13/04 at p. 4, item 20); Lee
Decl. (Doc. 266), Exh. 3 (Bylaws
26 at 0011529)
27
28

1 169 When the Defendants failed to provide Plaintiff with Lee Supp. Decl. (Doc. 267), Exh.
adequate due process in connection with the Demotion, 20 (RFA Nos. 219-221 at 45:3-
2 Admin Leave and Nonrenewal, they were acting pursuant 21); Lee Supp. Decl. (Doc. 267),
to the Bylaws. Exh. 10 (Bryan Depo, 258:12-16)
3
4
170
5
171 2. 42 U.S.C. 1983 Requirements
6
172 It is incontrovertibly established that “Any acts or Lee Supp. Decl. (Doc. 267), Exh.
7 omissions of the individual Defendants were under color of 19 (SCO at 9:22-23)
law.” See Scheduling Order, 9:22-23.
8
9 173
10 174 3. 14th Amendment Elements
11
175 4. Demotion & Paycut
12
176 Plaintiff’s employment contract expressly set forth a Lee Decl. (Doc. 266), Exh. 2
mutually explicit understanding with Defendant County (Jadwin Employment Contract,
13 that Plaintiff would receive Base Pay of $287,529, and that p.2, 20)
Plaintiff would be chair of KMC’s pathology department.
14
15
16
177 Moreover, the employment contract barred Defendant Lee Supp. Decl. (Doc. 267), Exh.
17 County from reducing Plaintiff’s Base Pay, removing 20 (RFA No. 227 at 46:22-26);
Plaintiff from chair or terminating or otherwise modifying Lee Decl. (Doc. 266), Exh. 2
18 the Contract at will, without cause, or without Plaintiff’s (Jadwin Employment Contract at
consent. DFJ164, DFJ165, DFJ168,
19 DFJ169)
20
178 Defendant County has not removed a department chair Lee Supp. Decl. (Doc. 267), Exh.
21 without cause since at least October 2000 20 (RFA No. 227 at 46:22-26)
22
23
24 179 Defendants County and Harris told Plaintiff several times Lee Supp. Decl. (Doc. 267), Exh.
that the Demotion “necessitated” the Paycut, and that he 20 (RFA No. 228 at 46:27-47:3);
25 would have to agree to it to continue working at KMC. Lee Decl. (Doc. 266), Exh. 3
(Barnes email to Lee of 9/15/06
26 at DFJ1390); Lee Decl. (Doc.
266), Exh. 20 (Harris Letter to
27 Jadwin of 9/1/06 at DFJ1383)
28

1 180 Having no other choice, Plaintiff executed the Paycut Lee Supp. Decl. (Doc. 267), Exh.
amendment to his employment contract. 18 (Jadwin depo, 1025:4-7); Lee
2 Decl. (Doc. 266), Exh. 22
(Amendment No. 1 to
3 Employment Contract dated
10/3/06)
4
5
6
7
181 Defendant County was subjectively aware of Plaintiff’s Lee Supp. Decl. (Doc. 267), Exh.
8 contractual interest in Base Pay, as evidenced by the 3 (Barnes Letter to Lee of 9/15/06
numerous reminders by Defendants Bryan and County that at DFJ1390), Lee Decl. (Doc.
9 Plaintiff would have to expressly amend his employment 266), Exh. 20 (Harris Letter to
contract to implement the Paycut resulting from his Bryan of 9/1/06 at DFJ1383)
10 Demotion.
11
12
182 There was nearly a month gap between the time Defendant Lee Decl. (Doc. 266), Exh. 15
13 Bryan informed Plaintiff he was initiating demotion (Bryan Letter to Jadwin of
procedures to the time the JCC voted to demote Plaintiff. 6/14/06 at DFJ1181); Lee Decl.
14 (Doc. 266), Exh. 17 (JCC
Minutes of 7/1/06 at 0009820-
15 0009821, item 10)
16 183 Defendants never notified Plaintiff of the time or place of Jadwin Supp. Decl. (Doc. 272),
the JCC vote to demote Plaintiff, gave him an explanation para 3
17 of the evidence against him, or provided him an opportunity
to tell his side of the story,
18
19
184 Before the JCC vote occurred, Plaintiff sent a letter to Lee Supp. Decl. (Doc. 267), Exh.
Defendant County legally challenging the Demotion. 2 (Lee Letter to Barnes of 6/29/06
20 at DFJ1349)
21
185 Nor did Defendant County ever offer Plaintiff a post- Jadwin Decl. (Doc. 265), para 4,
22 deprivation hearing. Lee Decl. (Doc. 266), Exh. 17
(JCC Minutes of 7/1/06 at
23 0009820-0009821, item 10)
24
25
26
27
28

1 186 More importantly, the JCC did not constitute an impartial Lee Decl. (Doc. 266), Exh. 17
tribunal since it comprised individuals who had been (JCC Minutes of 7/1/06 at
2 harassing and retaliating against Dr. Jadwin and/or 0009819); Jadwin Decl. (Doc.
individuals on whom Dr. Jadwin was blowing the whistle. 265), Exh. 1 (Jadwin email to
3 Bryan of 2/28/05 at DFJ355); Lee
Decl. (Doc. 266), Exh. 8 (Bryan
4 email to Harris of 11/8/05 at
0000503); Lee Decl. (Doc. 266),
5 Exh. 11 (Ragland email to Bryan
of 2/23/06 at 0000507); Jadwin
6 Decl. (Doc. 265), Exh. 5 (Jadwin
memos to Smith of 3/23/06); Lee
7 Supp. Decl. (Doc. 267), Exh. 13
(Ragland depo, 332:14-21)
8
9
10
11
12
13
14
15
16
17
187 Nor was Defendant Bryan – who invited Plaintiff to contact Lee Decl. (Doc. 266), Exh. 15
him, and only, him regarding the Demotion he himself had (Bryan Letter to Jadwin of
18 instigated – an impartial adjudicator given his demonstrated 6/14/06 at DFJ1181); Lee Decl.
bias against Plaintiff. (Doc. 266), Exh. 16 (Bryan Letter
19 to Jadwin of 6/26/06 at
DFJ1346); Lee Decl. (Doc. 266),
20 Exh. 17 (JCC Minutes of 7/1/06
at 0009821); Jadwin Decl. (Doc.
21 265), Exh. 1 (Jadwin email to
Bryan of 2/28/05 at DFJ355); Lee
(Ragland Depo at 332:14-21);
23 Lee Decl. (Doc. 266), Exh. 8
(Bryan email to Harris of 11/8/05
24 at 0000503); Lee Decl. (Doc.
266), Exh. 11 (Ragland email to
25 Bryan of 2/23/06 at 0000507)
26
188
27
189 5. Admin Leave
28

1 190 Plaintiff’s employment contract expressly set forth a Lee Decl. (Doc. 266), Exh. 2
mutually explicit understanding with Defendant County (Jadwin Employment Contract, at
2 that Plaintiff would be paid Professional Fees. DFJ00154, DFJ00156)
3
191 Defendant County was subjectively aware of Plaintiff’s Lee Decl. (Doc. 266), Exh. 21
4 contractual interest in Professional Fees, as evidenced by (Culberson Letter to Jadwin of
the then-CEO’s letter to Plaintiff regarding the Paycut. Mr. 9/20/06 at DFJ01398)
5 Culberson explained that, as a demoted staff pathologist
with a drastically reduced base salary, Plaintiff would
6 nevertheless be able to take advantage of his reduced
administrative duties in order to increase his Professional
7 Fees-based income.
8
9
10
11
192 Mr. Culberson participated in the decision to to place Lee Supp. Decl. (Doc. 267), Exh.
Plaintiff on Admin Leave, which denied Plaintiff the 22 (Rog. No. 42, 28:3-9)
12 opportunity to earn Professional Fees.
13
14 193 Defendants failed to provide Plaintiff any pre- or post- Jadwin Decl. para 5; Lee Decl.
deprivation procedure when placing him on Admin Leave. (Doc. 266), Exh. 24 (Culberson
15 Letter to Jadwin of 12/7/06 at
DFJ01482)
16
194 When Defendant County sent a letter to Plaintiff placing Lee Decl. (Doc. 266), Exh. 24
17 him on Admin Leave, the letter stated only that the Admin (Culberson Letter to Jadwin of
Leave was “pending resolution of a personnel matter”. 12/7/06 at DFJ01482)
18
19
195 At no time did Defendants County or Harris inform Jadwin Decl. para 6; Lee Supp.
20 Plaintiff of the nature of the charges against him, give him Decl. (Doc. 267), Exh. 4 (Lee
an explanation of the evidence against him, or provide him Letter to Barnes of 4/4/07 at
21 an opportunity to tell his side of the story. DFJ01619)
22
23 196 Even when Plaintiff protested the lack of due process, Lee Supp. Decl. (Doc. 267), Exh.
Defendant County refused to respond. 4 (Lee Letter to Barnes of 4/4/07
at DFJ01619)
24
25 197 Since 1995, only one other department chair at KMC had Lee Supp. Decl. (Doc. 267), Exh.
ever been placed on administrative leave in excess of 1 22 (Rog. No. 27, 19:23-20:6)
26 month.
27
28

1 198
2 199 6. Nonrenewal
3 200 Defendant County customarily renews the contracts of all Lee Supp. Decl. (Doc. 267), Exh.
of its KMC medical staff. 22 (Rog. No. 28, 20:8-21);
5 201 When Plaintiff asked Defendant County to identify all Lee Supp. Decl. (Doc. 267), Exh.
members of the KMC medical staff – which comprises 22 (Rog. No. 28, 20:8-21
6 roughly 60 full-time faculty physicians at any given time –
who had employment contracts which were not renewed
7 during the period from October 24, 2000 to the present,
Defendant County was able to name only one doctor.
8
9
10
202 At no time did Defendant County inform Plaintiff of the Jadwin Decl. para 8
11 nature of the charges against him, give him an explanation
of the evidence against him, or provide him an opportunity
12 to tell his side of the story.
13
14 203 Defendant County denies that anyone even participated in a Lee Supp. Decl. (Doc. 267), Exh.
decision not to renew Plaintiff’s employment contract. 21 (Rog No. 45, 53:16-20
15
16
204 Even when Plaintiff protested the lack of due process, Lee Supp. Decl. (Doc. 267), Exh.
17 Defendant County refused to respond. 7 (Lee Letter to Wasser of 5/1/07
at DFJ1703-DFJ1704); Jadwin
18 Supp. Decl. para 4; Jadwin Decl.
para 13
19
205
20
206 F. SEVENTH DEFENSE: 2 YEAR SOL
21
207 Defendant County itself admits that no relevant event Lee Supp. Decl. (Doc. 267), Exh.
22 occurred on or before January 6, 2005. 23 (Rog. No. 5, 5:17-25)
23
24
208
25
209 G. EIGHTH DEFENSE: ADMINISTRATIVE
26 EXHAUSTION
27
28

1 210 Defendant County admits that Plaintiff has Exh.austed his Lee Supp. Decl. (Doc. 267), Exh.
administrative remedies as to all claims except for the new 20 (RFA1 at 4:23-27); Lee Supp.
2 FMLA/CFRA/FEHA retaliation claim added via the Decl. (Doc. 267), Exh. 23 (Rog.
Second Amended Complaint, filed on October 7, 2008 No. 6, 6:1-3); Lee Supp. Decl.
3 (Doc. 241). (Doc. 267) para 7
4
5 211 Plaintiff Exh.austed his CFRA & FEHA Lee Supp. Decl. (Doc. 267) para
oppositional/participation retaliation claims by filing a 7
6 timely complaint with the California Department of Fair
Employment & Housing (“DFEH”) on September 3, 2008,
7 and obtaining a right to sue letter that same day.
8
9
10 212
11 213 PERSONS
12 214 Defendant Bryan was the Chief Executive Officer at KMC Lee Supp. Decl. (Doc. 267), Exh.
from September of 2004 until September of 2006. 19 (SCO at 7:4-6); Lee Supp.
13 Decl. (Doc. 267), Exh. 21 (Rog
No. 11 at 9:20)
14
215 Eugene Kercher, M.D. was the President of KMC Medical Lee Supp. Decl. (Doc. 267), Exh.
15 Staff from July 2004 to June 2006, and a member of the 19 (SCO at 7:7-10); Lee Supp.
JCC Decl. (Doc. 267), Exh. 21 (Rog
16 No. 11 at 9:4-5)
17 216 Defendant Irwin Harris, M. D., was Chief Medical Officer Lee Supp. Decl. (Doc. 267), Exh.
at KMC from July of 2005 to September of 2007 , and a 19 (SCO at 7:11-14); Lee Supp.
18 non-voting member of the JCC. Decl. (Doc. 267), Exh. 21 (Rog
No. 11 at 10:24)
19
20 217 Jennifer Abraham, M.D. was Immediate Past President of Lee Supp. Decl. (Doc. 267), Exh.
KMC Medical Staff during 2004-2006, and President Elect 19 (SCO at 7:15-17); Lee Supp.
21 in July 2006 to December of 2007 Decl. (Doc. 267), Exh. 21 (Rog
No. 11 at 9:4, 9:7, 10:2, 10:6)
22
23 218 Scott Ragland, D.O. was President-Elect of the KMC Lee Supp. Decl. (Doc. 267), Exh.
Medical Staff from 2004-2006, Chair of the Quality 19 (SCO at 7:18-21); Lee Supp.
24 Management Committee, and a member of the JCC. Decl. (Doc. 267), Exh. 21 (Rog
No. 11 at 9:3, 9:6, 10:1, 11:3-4)
25
26
27
28

1 219 Toni Smith was the Chief Nurse Executive of KMC, and a Lee Supp. Decl. (Doc. 267), Exh.
member of the JCC 19 (SCO at 7:22-24)
2
3
220 William Roy, M.D., was Chief of the Division of Lee Supp. Decl. (Doc. 267), Exh.
4 Gynecologic Oncology at KMC. 19 (SCO at 7:25-27)
5
6 221 Marvin Kolb, M.D. was former Chief Medical Officer at Lee Supp. Decl. (Doc. 267), Exh.
KMC who left in September of 2004. 21 (Rog No. 11 at 9:21)
7
8
9 222 Phillip Dutt, M.D., became Chair of Pathology at KMC in Lee Supp. Decl. (Doc. 267), Exh.
August of 2006 21 (Rog No. 11 at 10:16)
10
11
223 David Culberson was Interim Chief Executive Officer from Lee Supp. Decl. (Doc. 267), Exh.
12 September of 2006 to May of 2007. 21 (Rog No. 11 at 10:22)
13
14 224 Paul Hensler became Chief Executive Officer at in May of Lee Supp. Decl. (Doc. 267), Exh.
2007. 21 (Rog 11 at 10:23)
15
16
17 225 Gilbert Martinez was and is the Manager of Laboratory Lee Supp. Decl. (Doc. 267), Exh.
Services at KMC. 9 (Martinez Depo at 10:2-7)
18
19
20
21 OPPOSITION TO DEFENDANTS’ MOTION FOR
SUMMARY JUDGMENT
22
226 Beginning January 2006, Defendant County did not pay Decl. of Eugene Lee in
23 Plaintiff for the days he did not work. Opposition to Defendants’
Motion for Summary Judgment
24 (“Lee Opp. Decl.”), Exh.
Bryan’s Memo to JCC of
25 7/10/06 at 0001476); Rizzardi
Decl. (Doc. 271) at Table 6
26 showing dramatic Plaintiff’s
earnings decrease starting
27 1/17/06.
28

1 227 Bryan testified that testified that “actual functioning of the Lee Opp. Decl., Exh. 3 (Bryan
department of [pathology] actually was fairly good” as of Depo at 332:12-22).
2 April 17, 2006.
3
4 228 Plaintiff testified several times that Bryan had ordered him Lee Opp. Decl., Exh. 2 (Bryan
off of part-time and onto full-time medical leave on April Depo at 249:24-250:19; Exh. 4
5 28, 2006 so as to burn up Plaintiff’s medical leave (Jadwin Depo. at 384:9-13); Exh.
entitlement. Bryan’s Depo. testimony did not refute this. 5(Jadwin Depo. at 983:23-984:1,
6 94:23-985:4).
7
229 According to Defendant County’s verified response to Lee Supp. Decl. (Doc. 267), Exh.
8 Plaintiff’s Interrogatory No. 42, Harris participated in the 21 (Rog No. 42 at 52:24-53:2).
decision to place Plaintiff on Admin Leave.
9
10
11 230 On June 29, 2006, Plaintiff’s counsel sent a letter to Kern Lee Opp. Decl., Exh. 15 (Lee
County counsel Karen Barnes (“Barnes”) which was Letter to Barnes of 6/29/06 at pp.
captioned “Re: Preservation / no spoliation of evidence 1 and 2).
12 Jadwin v. County of Kern, Peter Bryan, et al.”. This letter
pre-dated the Demotion of July 10, 2006 by almost a
13 month.
14
231 Plaintiff’s counsel’s letter to Barnes of June 29, 2006 Lee Opp. Decl., Exh. 15 (Lee
15 outlined in detail Plaintiff’s pending claims for Letter to Barnes of 6/29/06 at pp.
whistleblower and medical leave retaliation and disability 1 and 2).
16 discrimination and formally demanded Defendant County
take all appropriate affirmative steps to preserve evidence
17 relating to those claims, including “notes taken at meetings
with or concerning Dr. Jadwin”.
18
232 On March 29, 2007, Plaintiff’s counsel again sent a letter to Lee Opp. Decl., Exh. 16 (Lee
19 Barnes stating, “I would like to remind you that KMC is Letter to Barnes of 3/29/07 at p.
under a strict legal obligation to preserve and prevent 2).
20 spoliation . . . .”.
21
233 Barbara Patrick is a former Chair of the Kern County Board Lee Opp. Decl., Exh. 7 (Patrick
22 of Supervisors and member of the JCC who voted to Depo. at 22:2-12; 26:20-27:3).
demote Plaintiff.
23
24
25 234 At Plaintiff’s 8/19/08 Depo. of Patrick, she testified that she Lee Opp. Decl., Exh. 7 (Patrick
had taken notes at every JCC meeting. Depo. at 70:8-73:7).
26
27
28

had shredded all of her documents upon leaving office on Depo. at 70:8-73:7).
2 January 8, 2007.
3
had thrown out documents which included JCC meeting Depo. at 70:8-73:7).
5 agendas on the margins of which she had taken notes.
6
7
237 At Plaintiff’s 8/19/08 Depo. of Patrick, she testified that Lee Opp. Decl., Exh. 7 (Patrick
8 Kern County counsel had never contacted her regarding Depo. at 70:8-73:7).
preservation of documents and evidence in connection with
9 Plaintiff’s lawsuit.
10
11 238 Defendants failed to produce a single JCC meeting agenda Lee Opp. Decl., para. 6; Exh. 17
in response to Plaintiff’s numerous discovery demands. (RPD No. 44 at 20:15-21).
12
13
14 239 At Plaintiff’s 8/19/08 Depo. of Patrick, she was able to Lee Opp. Decl., Exh. 7 (Patrick
recall very little in the absence of her spoliated notes about Depo. at 75:16-78:19).
15 the JCC meeting at which the Demotion was approved.
16
17
240 David Culberson is former CEO of KMC who decided to Lee Opp. Decl., Exh. 11
18 place Plaintiff on Admin Leave. (Culberson Depo. at 10:13-16;
10:23-11:1).
19
20
241 At Plaintiff’s 8/21/08 Depo. of Culberson, he testified that Lee Opp. Decl., Exh. 11
21 he had taken notes at each of up to 10 meetings of the KMC (Culberson Depo. at 42:24-47:9).
“leadership team” regarding Plaintiff and the Pathology
22 department.
23
24 242 At Plaintiff’s 8/21/08 Depo. of Culberson, he testified that Lee Opp. Decl., Exh. 11
Culberson destroyed those notes prior to January 2007, by (Culberson Depo. at 42:24-47:9).
25 shredding them, ripping them up, crumpling them up and
throwing them in the trash.
26
27
28

no one ever contacted him regarding preservation of (Culberson Depo. at 42:24-47:9).
2 documents and evidence in connection with Plaintiff’s
lawsuit.
3
4 244 At Plaintiff’s 8/21/08 Depo. of Culberson, Culberson – in Lee Opp. Decl., Exh. 11
the absence of his spoliated notes – was unable to recall (Culberson Depo. at 61:7-19;
5 important details regarding the allegations against Plaintiff 63:4-6).
that led to the Demotion as related to him by Harris.
6
7
245 At Plaintiff’s 8/21/08 Depo. of Culberson, Culberson – in Lee Opp. Decl., Exh. 11
8 the absence of his spoliated notes – was unable to recall (Culberson Depo. at 102:16-21;
important details regarding the HR director’s investigative 98:4-15; 99:2-10).
9 findings as to disruption and chaos in the Pathology
department at the end of 2006 just prior to the Admin
10 Leave.
11 246 At Plaintiff’s 8/21/08 Depo. of Culberson, Culberson – in Lee Opp. Decl., Exh. 11
the absence of his spoliated notes – was unable to recall (Culberson Depo. at 160:23-
12 important details regarding Dr. Dutt’s investigative findings 161:2; 159:9-13; 157:15-158:4).
regarding Plaintiff’s alleged misconduct at the end of 2006.
13
14
247 Scott Ragland is the former President of the Medical Staff Lee Opp. Decl., Exh. 9 (Ragland
15 and member of the JCC (“Ragland”). Depo. at 8:23-9:10).
16
17
248 Ragland testified at his 8/22/08 Depo. that no one ever Lee Opp. Decl., Exh. 9 (Ragland
18 contacted him regarding preservation of documents and Depo. at 61:10-25).
evidence in connection with Plaintiff’s lawsuit
19
20
21 249 Ragland testified at his 8/22/08 Depo. that he deleted all of Lee Opp. Decl., Exh. 9 (Ragland
his emails, including emails relating to Plaintiff, and Depo. at 63:13-23).
22 sneered at Plaintiff’s consternation over the spoliation
23
24 250 At Ragland’s 8/22/08 Depo., he sneered at Plaintiff’s Lee Opp. Decl., Exh. 9 (Ragland
consternation over the spoliation of evidence. Depo. at 63:13-23).
25
26
27
28

Ragland had investigated Plaintiff just prior to the Admin (Culberson Depo. at.73:9-18).
2 Leave.
3
4 252 Ragland testified at his 8/22/08 Depo. that he produced Lee Opp. Decl., Exh. 9 (Ragland
only a single document in all of discovery in this action, Depo. at 69:21-71:1).
5 and even that was not in response to any request from an
attorney (as he never received one) but on his own
6 initiative.
7
253 At Ragland’s 8/22/08 Depo., he was able to recall very little Lee Opp. Decl., Exh. 9 (Ragland
8 in the absence of his spoliated documents about material Depo. at 23:13-24:24).
events.
9
10
11 254 At the Depo. of PMK Eugene Kercher, he testified that Lee Opp. Decl., Exh. 14 (Kercher
KMC did not renew John Digges’ employment contract Depo. at 27:1-12).
because Digges was asking for an unacceptable salary
12 increase.
13
14 254 Plaintiff testified on 10/21/08 that he would have accepted Lee Opp. Decl., Exh. 6 (Jadwin
renewal of his contract as of October 4, 2007, albeit under Depo. at 1096:9-14; 1096:22-
15 protest over his demoted status and reduced Base Pay. 1097:3).
16
17
255 Dr. Philip Dutt, Acting Chair of Pathology, testified as Lee Opp. Decl., Exh. 12 (Dutt
18 PMK for the County on 8/29/08 that by the Monday Depo. at 10:5-24).
following Thanksgiving 2006, he had had a conversation
19 with Harris regarding Plaintiff’s statement to Martinez that
“he was going to report the hospital to JCAHO, CNPS [sic]
20 . . . either the Friday before Thanksgiving that year or the
Monday after that weekend.”
21
256 Dr. Philip Dutt, Acting Chair of Pathology, testified as Lee Opp. Decl., Exh. 12 (Dutt
22 PMK for the County on 8/29/08 that he had suggested to Depo. at 13:1-14:6).
Harris that KMC retain someone who had experience with
23 CAP inspections to conduct a mock unannounced
inspection. Harris quickly approved Dutt’s proposal on
24 either the Friday or the Monday before Thanksgiving 2006.
25 257 JCC minutes regarding the contemplated demotion of the Lee Opp. Decl., Exh. 18 (JCC
chair of the OB-GYN department stated: “The problem is Meeting Minutes of 9/10/07 at
26 we have tied a portion of the chair’s compensation to that Agenda Item 6 on Bates
position, that is a property right. Dr. Perez is entitled to due 0009221).
27 process hearing for this reason.”
28

1 258 Paragraph 139 (“Disciplinary Actions”) of the Manual Lee Opp. Decl., Exh. 19 (Kern
states in relevant part: County Policy & Administrative
2 Procedures Manual at Section
“Any employee may be dismissed, suspended, reduced in 139 (Disciplinary Actions) and
3 rank and/or compensation, reprimanded or otherwise 139.6 (Administrative Leave with
disciplined for any action or conduct which in the Pay) on Bates 0016940-16941).
4 judgment of the appointing authority provides good
cause for discipline under the Civil Service Rules or other
5 laws, regulations, or policies [. . . .] .6 Administrative Leave
with Pay. A department head may place an employee on
6 administrative leave with pay if the department head
determines that the employee is engaged in conduct
7 posing a danger to County property, the public or other
employees, or the continued presence of the employee at
8 the work site will hinder an investigation of the
employee’s alleged misconduct or will severely disrupt
9 the business of the department [. . . .]”. (emphasis added).
10 259 At his Depo. of 8/25/08, Watson testified that Defendant Lee Opp. Decl., Exh. 10 (Watson
County decided not to renew Plaintiff’s contract in Depo. at 110:12-111:5; 111:15-
11 retaliation for his filing the instant lawsuit. Watson was 24).
asked twice if he recalled clearly that this was the case and
12 each time he answered yes:
13 Q. Okay. What about the nonrenewal? I

mean, do you recall Dr. Jadwin’s physical
14 absence being a reason for his nonrenewal
of his contract?
15 A. Well, it could be that. It could be the fact
that I think by then he was -- probably was
16 suing us. So why would you want to
establish a contractual relationship with
17 somebody who’s suing you.
Q. Okay. Well, he was also suing you at the
18 time of his removal or actually at the time
of his --no, he wasn’t. He wasn’t. Okay. But
19 I mean, you say why would you establish a
contractual relationship with someone
20 who’s suing you, right?
A. Right.
21 Q. Was that -- does that mean -- are you
just speculating now, just guessing, or was
22 that a consideration for his nonrenewal?
23
[…]
24
Q. Okay. But you recall it being discussed
25 at the JCC meetings?
A. Yes.
26
27
28

1 260 At his Depo. of 8/25/08, Watson re-affirmed a third time – Lee Opp. Decl., Exh. 10 (Watson
volunteering it on his own initiative – that oppositional Depo. at 113:15-114:4).
2 retaliation was an additional motivating factor for the
Nonrenewal:
3
Q. So the question is: You’ve mentioned that for the
4 nonrenewal one of the reasons was that Dr. Jadwin wasn’t
available for work; is that correct or --
5 A. My understanding was that he had -- he had been on
medical leave, family leave, and had requested even more
6 leave, and that for that reason and the fact that he was suing
us, that we decided not to renew his contract.
7
8 261 Defendants claim Watson gave confused testimony and Lee Opp. Decl., Exh. 10 (Watson
suggest that his testimony regarding Nonrenewal was Depo. at 12:10-14; 13:17-14:2).
9 likewise confused even though the allegedly confused
testimony is elicited by a completely different line of
10 questioning regarding Demotion that occurs over 100 pages
and 2 hours earlier in the Depo. transcript.
11
262 Bryan could not have “granted” Plaintiff 90-day personal
12 necessity leave because he never asked for it. His request
for extension of leave of absence of March 16, 2006 was
13 for extension of his reduced work schedule medical leave.
14
15 263 Plaintiff’s request of March 16, 2006 for leave extension
requested an extension of reduced work schedule leave, as
established by Plaintiff’s later submitted medical
16 certification.
17
18 264 Plaintiff’s leave extension request of March 16, 2006 asked Jadwin Decl. (Doc. 265), Exh. 6
for extension of Plaintiff’s protected medical leave, not (Jadwin’s Request for Leave
19 personal leave. Extension of 4/26/06 at
DFJ00157); Exh. 4 (Jadwin’s
20 Email to Bryan, Chester, & Dutt
of 3/16/06 at DFJ00752); Lee
(Chester Depo at 120:1-16)
22
265 Defendants’ own Separate Statement (Doc. 259) admits, Defendants’ Separate Statement
23 Plaintiff’s letter to Bryan of May 31, 2006 was requesting (Doc. 259), DMF 23
more time to decide whether he would be returning full-
24 time or resigning. It was not requesting more leave past
September 16, 2006. [DMF 23]
25
26
27
28

1 266 The prostatectomy patient ultimately elected not to proceed Lee Opp. Decl., Exh. 52
with prostatectomy based on the second set of biopsies (Shertudke Depo. at 42:17-20)].
2 recommended by Plaintiff coming back negative for cancer.
3
4 267 Disability Was A Motivating Factor in Administrative Lee Decl. (Doc. 266), Exh. 22
Leave. (Amendment No. 1 to
5 Employment Contract dated
10/3/06 at “Assignments” on
6 DFJ01420); Lee Opp. Decl., Exh.
58 (Pathologist Chair Phlip Dutt
7 employment contract amendment
no. 1 of 10/10/05 at
8 “Assignments” on Bates
0026200; Exh. 59 (Pathologist
9 Savita Shertukde employment
contract of 11/1/05 at
0026248; Exh. 60 (Pathologist
11 Gian Yakoub employment
contract of 6/19/07 at
0026193.
13
[Lee Decl., Exh. 17 (JCC
14 Minutes of 7/10/06 meeting at ¶
10 on 0009830-9831); Lee Opp.
15 Decl., Exh. 7 (Patrick Depo. at
27:5-8 & 30:2-20); Lee Opp.
16 Decl., Exh. 14 (Kercher Depo. at
99:20-100:17); Lee Opp. Decl.,
17 Exh. 35 (Smith Depo. at 14:22-
15:8); Lee Opp. Decl., Exh. 48
18 (emails between Dutt & Barnes
of 9/14/06 at 0000830)].
19
Lee Opp. Decl., Exh. 56 (PMK
20 Dutt Depo. at 243:7-11)
(sometimes appropriate to punish
21 an employee for taking medical
leave)].
22
See DMF 69-190 re Defendants'
23 pattern and practice of subjecting
Plaintiff to smear campaign
24 continued on Jadwin's return
from medical leave on October 4,
25 2006.
26
27
28

1 268
2
3
4 269
5
6
7
8 270
9
10
11
12
13 Date: December 1, 2008
14
/s/ Eugene D. Lee
15 LAW OFFICE OF EUGENE LEE
555 West Fifth Street, Suite 3100
16 Los Angeles, CA 90013
Phone: (213) 992-3299
17 Fax: (213) 596-0487
email: elee@LOEL.com
18 Attorney for Plaintiff DAVID F. JADWIN, D.O.
19
20
21
22
23
24
25
26
27
28


3 Phone: (213) 992-3299
Fax: (213) 596-0487
6
7
10 FRESNO DIVISION
12 Plaintiff, DECLARATION OF EUGENE LEE IN
OPPOSITION TO DEFENDANTS’ MOTION
13 v. FOR SUMMARY JUDGMENT
[Fed. R. Civ. P. 56(a)]
Judge: Hon. Oliver W. Wanger
16 Courtroom: 3
18
19
I, Eugene D. Lee, declare as follows:
20
1. I am an attorney at law duly licensed to practice before the Federal and State Courts of
21
California and admitted to practice before the U.S.D.C. for the Eastern District of California. I am
22
counsel of record for Plaintiff David F. Jadwin in this matter.
23
2. I am making this declaration in opposition to Defendants’ Motion for Summary
24
Judgment. I have personal knowledge of the matters set forth below and I could and would competently
25
testify thereto if called as a witness in this matter.
26
3. Attached hereto as Exhibits are true and correct copies of the following documents:
27
28
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 1
Exh. Date Description

1
1 7/10/2006 Memo from Mr. Bryan to JCC re Recommendation of
2 Demotion of Dr. Jadwin
3 2 8/14/2008 Deposition Transcript of Peter Bryan, Vol I
3 8/26/2008 Deposition Transcript of Peter Bryan, Vol II
4 4 1/9/2008 Deposition Transcript of David Jadwin, Vol II
5 5 3/12/2008 Deposition Transcript of David Jadwin, Vol V
6 10/21/2008 Deposition Transcript of David Jadwin, Vol VI
6
7 7 8/18/2008 Deposition Transcript of Former Supervisor Barbara Patrick,
Vol I
8
8 4/16/2008 Deposition Transcript of Former Lab Mgr Gilbert Martinez
9
10 9 8/22/2008 Deposition Transcript of Former President Scott Ragland
11 10 8/25/2008 Deposition Transcript of Supervisor Ray Watson

12
11 8/21/2008 Deposition Transcript of Former CEO David Culberson
13
14 12 8/29/2008 Deposition Transcript of PMK Philip Dutt, Vol. I
15
13 8/28/2008 Deposition Transcript of Former COO Sandra Chester
16
17 14 9/4/2008 Deposition Transcript of PMK Eugene Kercher
18 15 6/29/2006 Letter from Lee to Barnes re Spoliation of Evidence

19
16 3/29/2007 Letter from Lee to Barnes re Spoliation of Evidence
20
21 17 11/20/2007 Defendants’ Responses to Plaintiff’s Request for Production,
Set One
22
18 9/10/2007 Joint Conference Committee Meeting Minutes re Demotion of
23 OB/GYN Chair
19 Kern County Policy & Administrative Procedures Manual,
24
Section 139 (Disciplinary Actions)
25 20 3/12/2002 CMO Marvin Kolb Memo to Jose Perez re Pathologist Elsa
Ang Accusations
26
21 12/26/2003 Change of Employee Status
27
28
22 5/15/2006 Expert Consulting Services Agreement, between Consultant

1
William Colburn and Kern County
2 23 8/30/2006 Consultant William Colburn Report to Kern County re
Review of Jadwin cases
3
24 8/13/2008 Deposition Transcript of Former Chief Medical Officer Irwin
4 Harris, Vol. I
5 25 8/27/2008 Deposition Transcript of Former Chief Medical Officer Irwin
Harris, Vol. II
6 26 5/3/2004 KMC FNA Consulting Project by UCLA Consultant David
7 Lieu
27 8/18/2008 Deposition Transcript of Former President of Medical Staff
8 Jennifer Abraham
9 28 Cancer Conference Presenter Guidelines
10
29 8/15/2008 Deposition Transcript of Former Cancer Committee Director
11 Albert McBride
12 30 10/19/2005 Exh. 202: Jadwin letter to Albert McBride, Cancer
Conference Director re October Conference
13 31 October Conference attendee feedback
14
32 11/9/2005 Oncology Conference attendee feedback of Savita Shertukde
15
16 33 8/25/2008 Deposition Transcript of OB-GYN Physician Joseph Mansour
17
34 5/10/2006 Harris Memos to File re Mansour Behavior
18 to
4/12/2007
19 35 8/19/2008 Deposition Transcript of Nurse Executive Antoinette Smith,
20 Vol. I
36 8/18/2008 Deposition Transcript of Chair of Surgery Maureen Martin,
21 Vol. I
22 37 4/16/2008 Deposition Transcript of Histotech Evangeline Gallegos
23
38 4/19/2008 Deposition Transcript of Former CMO Marvin Kolb
24
25 39 2/26/2008 Deposition Transcript of Pathology Secretary Tracy Lindsey
26 40 2/26/2008 Deposition Transcript of Clerk Irene Lopez

27
28
41 12/6/2007 Deposition Transcript of Radiology Chair Javad Naderi

1
2 42 12/6/2007 Deposition Transcript of Cancer Committee Chair Ravi Patel
3
43 8/15/2008 Deposition Transcript of Former CEO Secretary Arlene
4 Ramos-Aninion
5 44 12/5/2007 Deposition Transcript of Surgeon Edward Taylor
6 45 12/6/2007 Deposition Transcript of Neurosurgeon Charles Wrobel

7
46 8/21/2008 Deposition Transcript of Psychiatry Chair Tai Yoo
8
9 47 8/20/2008 Deposition Transcript of Acting Pathology Chair Philip Dutt
10
48 9/14/2006 Acting Pathology Chair Philip Dutt Email to Barnes re
11 Plaintiff’s Paycut Amendment
12 49 10/17/05 Plaintiff email to Bryan re Serious Biopsy Errors
13 50 3/2/2006 Exh. 271: Plaintiff email to Bryan re Serious Biopsy Errors

14
51 4/21/2006 Emails between Plaintiff and Bryan re Serious Biopsy Errors
15
16 52 8/7/2008 Deposition Transcript of Pathologist Savita Shertukde
17
53 3/11/2008 Deposition Transcript of David Jadwin, Vol. IV
18
19 54 10/21/2003 Confidential Report on Lau Complaint against Jadwin
20 55 1/8/2008 Deposition Transcript of David Jadwin, Vol. I

21
56 9/9/2008 Deposition Transcript of PMK Acting Pathology Chair Philip
22 Dutt, Vol. II
23 57 12/4/2007 Deposition Transcript of HR Director Steven O’Connor
24
58 10/10/2005 Amendment No. 1 to Employment Contract of Acting
25 Pathology Chair Philip Dutt
59 11/1/2005 Employment Contract of Pathologist Savita Shertukde
26
27
28
60 6/19/2007 Employment Contract of Pathologist Gian Yakoub

1
2
4. Attached hereto as Exhibits 2-14, 24-25, 27, 29, 33, 35-47, 52-53 and 55-57 are true and
3
correct certified copies of deposition transcripts which I either personally conducted or attended.
4
5. Attached hereto as Exhibits 15-16 are true and correct copies of letters which I authored
5
and faxed to Karen Barnes, Chief Deputy County Counsel for the County of Kern on the dates indicated.
6
6. I have served four sets of written discovery on Defendants which included Document
7
Request No. 44. asking for “Any and all DOCUMENTS RELATING TO YOUR decision to demote
8
Plaintiff from Chair of Kern Medical Center’s Pathology Department to staff pathologist.” To date,
9
Defendants have not produced any of the agendas for any JCC meetings including the meeting at which
10
the JCC voted to approve Plaintiff’s demotion from chair. Defendants have engaged in a level of
11
discovery obstruction that is more excessive than I have ever encountered in my 13 years practicing as
12
an attorney, of which this is but the latest example.
13
7. Attached hereto as Exhibits 17 is a true and correct copy of Defendants’ responses
14
received by me in response to Plaintiff’s Request for Production of Documents, Set One, propounded by
15
me on behalf of Plaintiff.
16
17
I declare under penalty of perjury under the laws of the State of California and the United States
18
that the foregoing is true and correct.
19
20
21 Executed on: December 1, 2008
22
23 /s/ Eugene D. Lee
24 EUGENE D. LEE
Declarant
25
26
27
28
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 1
27
28
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 7 of 93 7
",.,
KERN MEDICAL CENTER

ADMINISTRATION
OFFICE MEMORANDUM
TO: Joint Conference Committee DATE: July 10,2006
FROM:
SUBJECT:
Peter K. Bryan, CEO
Chairmanship, Department of Pathology ---

Under the provisions ofparagraph 9.7-4 ofthe Medical StaffBylaws (enclosure 1) I recommend that
Dr. David Jadwin be removed as Chairman, Department of Pathology. This recommendation is
based on Dr. Jadwin's unavailability for service because of extended medical leaves for non-work
related ailments.
The pertinent facts related to this recommendation are as follows:
1. Dr. Jadwin is employed through an Agreement for Professional Services,

Contract Employee, dated November 12, 2002 with the term of agreement
running from October 5, 2002 through October 4,2007. He has been employed
at KMC as a department chairman since October 24, 2000 (see enclosure 2).
2. Dr. Jadwin's job duties are identified in Exhibit A ofthat employment agreement
and in paragraph 9.7-5 of the Medical Staff Bylaws. His usual work schedule
calls for him to work an average of 48 hours each week. He is subject to the
terms of his contract and all policies of the County, KMC and the medical staff
governing documents.
3. As chairman ofa department, Dr. Jadwin is a key member ofthe leadership team.
His physical presence is necessary on a regular basis for not just the effective
functioning ofhis department, but also for institutional decision making through
daily interactions with members of the medical and administrative staff.
4. Dr. Jadwin accrues vacation time at the rate of 6.15 hours per pay period for a
maximum accrual of 160 hours per year. He accrues sick leave at the rate of2.46
hours per pay period with a maximum accrual of 64 hours per year. By the
beginning ofpay period 05-23 (after a little more than five years of service), Dr.
Jadwin had used 784 Clfthe 802 hours ofvacatiori accrued leaving a balance ofl8
hours, and he had used 272 of the 320 hours of sick leave accrued leaving a
balance of about 48 hours.
5. In mid November 2005 Dr. Jadwin continued using vacation and sick time at a
relatively high rate such that beginning in January 2006 he began to be paid for
fewer than 80 hours per pay period. In other words, his rate ofabsence exceeded
his accrual rates for vacation and sick leave.
6. On March 2,2006 Dr. Jadwin submitted a request for a 90-day medical leave
retroactive to December 16,2005 and running through March 15,2006 with a
return to duty on Thursday, March 16, 2006 (enclosure 3). This requestow,As I'
approved in accordance with County Policy (enclosure 4). . U0147\)
" Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 8 of 93
"
7. Dr. Jadwin did not report for work until March 23, 2006, working only two days
that pay period and a total of only 50 hours during the entire month of April.
8. On April 22, 2006 Dr. Jadwin submits another requestfor a six-month medical
leave retroactive to March IS, 2006 and extending through September IS, 2006
(see enclosure 5). Based on this request, on April 28, 2006 I met with Dr.
Jadwin, Steve O'Connor from Human Resources, and Karen Barnes to discuss
Dr, Jadwin's medical leave status and expectations for return to work. Dr.
Jadwin was informed that County Policy allowed him a total of 480 hours of
intermittent leave over a 12-month period. Also, that at his rate of use, he had
only 137 hours of medical leave left available which would take him through
June 16,2006, by which time he was instructed to give me his decision about his
employment status. His options were to either return full time or resign his
position. Dr. Jadwin indicated that he understood the conditions and that he
would not be at work from May 1,2006 until his return (see enclosure6).
9. In early June 2006 Dr. Jadwin informed me in writing that he had another
medical incident, could not return to work by June 16, 2006 and that he needed to
extend his medical leave. This prompted my memorandum to him dated June 14,
2006 in which I informed him of two things. First, that pursuant to County
Policy I would approve a Personal Necessity Leave of up to 90 days (enclosure
7). Second, that because of his continued absences, I was going to invoke the
provisions ofthe Medical StaffBylaws and rescind his appointment as Chairman,
Department of Pathology. Should he decide to return to work by the end of this
90 days period his contract would be changed to reflect a regular staffpathologist
duty assignment as mutually agreed (see enclosure 8).
10. Since the middle of November 2005 Dr. Jadwin has worked only 32% of the
hours normally expected ofa full time pathologist (enclosure 9). Since my notice
of June 14,2006 Dr. Jadwin has made no attempt to contact me concerning my
decision to relieve him of his chairman duties nor has he indicated any desire to
negotiate a new contract.
This recommendation to rescind Dr. Jadwin's appointment as Chairman, Department ofPathology is

based solely on his continued non-availability to provide the leadership necessary for a contributing
member ofthe medical staffleadership group. KMC must have its key personnel available, and Dr.
Jadwin has provided no indication that he is committed to return to work or resume his duties as
chairman. Other than his latest written communication requesting an extension ofmedical leave, Dr.
Jadwin hasmade no attempt in the last two months to contact me concerning his employment status
or how the Department of Pathology should be managed during his extended absence.
I therefore request that the Joint Conference Committee act pursuant to paragraph 9.7-4 of the
Medical Staff Bylaws and, by majority vote, endorse my recommendation to rescind Dr. Jadwin's
appointment as Chairman, Department of Pathology.
Enclosures (9)
cc: Bernard Barman, County Counsel

Karen Bames, Deputy County Counsel
Irwin Harris, M.D., Chief Medical Officer 0001.471
the chief executive officer without hearing and appeal rights set forth in
Article XII.
9.7-3 TERM OF OFFICE
Each department chair shall serve until he/she resigns, is removed from
office, or loses his or her medical staff membership or clinical privileges
in that department.
9.7-4 REMOVAL
Removal of a department chair may occur with or without cause upon the
recommendation of the chief executive officer with the majority vote of the
Joint Conference Committee.
9.7-5 RESPONSIBILITIES AND DUTIES OF DEPARTMENT CHAIRS
Each department shall have a chair that shall be responsible for the
overall supervision of clinical activity within the department. The chief
executive officer shall review service by the department chair no less than
biennially.
The chair shall be responsible to the board, through the medical executive
committee, for the following:
A. High quality professional management and care of patients under

the jurisdiction of the department.
B. Establishing systems to monitor the quality of patient care and

professional performance in the department through a planned and
systematic process.
C. Specific recornmendations and suggestions regarding the

improvement of patient care in his or her department.
D. Review of professional performance of all members with respectto

clinical privileges.
E. Recommending delineated clinical privileges for each member of

the department, including practitioner appointment and
classification, reappointment, criteria for clinical privileges, and
corrective action.
F. Discipline of members and staff pursuant to Article XI.
G. Evaluation of all full- and part-time medical staff and other members
of the medical staff who are active clinically, or teach on an annual
basis.
Bylaws of the Medical Staff of Kern Medical Center

Page 48
OOOj4~
~ ;.1
Kern County
AGREEMENT FOR PROFESSIONAL SERVICES

CONTRACT EMPLOYEE
(County of Kern - David F. Jadwin, D.O.)
This Agreement is made and entered into this I ~ -eA day of M{~'t.tIt- , 2002,
between the County of Kern, a political subdivision of the State of California (hereinafter
"County"), which owns and operates Kern Medical Center (hereinafter "KMC"), and
David F. Jadwin, D.O. (hereinafter "Core Physician"), a contract employee.
RECITALS
WHEREAS:
A. County is authorized, pursuant to Government Code section 31000, to

contract with specially trained persons, and further authorizes the payment of.
compensation for the services rendered; and
B. County requires assistance in the performance of professional medical

services at KMC as such services are unavailable from County resources; and
C. Core Physician has special training, knowledge and experience a"nd is

licensed by the State of California to practice medicine and is qualified to render
medical services.
NOW, THEREFORE, it is agreed between County and Core Physician as

follows:
Article I.
TERM AND CONDITIONS
1. TERM
The existing Agreement for Professional Services between County and Core
Physician (Kern County Agt. #1012-2000, dated October 24, 2000) is terminated
effective October 5,2002.
This Agreement shalt be effective on October 5,2002, and shall remain in effect
through" October 4, 2007.
2. SERVICES
Core Physician shall render services as set forth in Exhibit "A," which is attached
"and made a part of this Agreement.
0001.47 9
Article II.
COMPENSATION
1. SALARY (BASE)
Core Physician shall be entitled to the following base compensation (as defined
in Article II, Section 3):
A. Core Physician will work full-time (i.e., according to AMA survey data for
specialty but no less than forty [40] hours per week) and will be compensated
with cash and other value as follows: Core Physician will be paid Eleven
Thousand Twenty-One Dollars and Eight Cents ($11,021.08) biweekly not to
exceed Two Hundred Eighty-Seven Thousand Five Hundred Twenty-Nine
Dollars ($287,529) annually. The maximum payable under this Agreement shall
not exceed One Million Four Hundred Thirty-Seven Thousand Six Hundred Forty-
Five Dollars ($1,437,645) per the five-year term of the Agreement. County will
withhold, from said daily compensation of Core Physician, all applicable federal,
state and local payroll taxes. County will pay the Employers portion of the
hospital insurance portion of Social Security ("FICA 2").
B. Core Physician will be paid biweekly on the same schedule as regular full-
time County employees. The exact date of said biweekly payments will be at the
sole discretion of County, as is reasonable and convenient for County.
C. No adjustment in compensation will be effective without a written

amendment to this Agreement.
2. OVERALL COMPENSATION STRUCTURE
A. The purpose of this compensation plan is to provide market-based,

performance-driven compensation that recognizes a Core Physician's efforts and
contributions toward promoting the mission and values of KMC. Core Physicians
will be identified as such in their contracts with KMC.
B. Total compensation for Core Physicians will be composed of a base salary

paid by the County, professional fee payments from third-party payors, and
potential other income generated due to the individual's status as a physician.
These ihree sources of income shall he. referred to in this Agreement as total
Core Physician compensation. The structure for determining total Core
Physician compensation shall be referred to in this Agreement as the
compensation plan.
2
0001.48 0
C. A Kern County clearing account and a KMC compensation budget unit will
be established to account for all funds generated and received to pay total Core
Physician compensation and to pay all expenses associated with this
compensation plan. These will act as trust accounts and will be solely used for
this purpose.
D. A Plan Administrator will be retained by KMC to administer this

compensation plan and will report to the Faculty Practice Board.
E. A Board of Directors will be established to oversee the compensation plan

and the Plan Administrator of the compensation plan. This Board of Directors
shall be referred to in this Agreement as the Faculty Practice Board. The Faculty
Practice Board will establish bylaws including powers, duties and responsibilities·
to be approved both by a simple majority of the Faculty Practice Board and the
CEOofKMC.
F. An assessment for administrative expenses shall be made on total Core

Physician compensation to support the administrative expenses of the
compensation plan.
(1) The amount or percentage of the assessment shall be determined

annually by the Faculty Practice Board..
(2) Administrative expenses shall include the salary and benefits for
the Plan Administrator and any staff hired by KMC to support the Plan
Administrator, expenses of the Kern County Pension Plan for Physician
Employees, and other business expenses as determined by the Plan
Administrator and the Faculty Practice Board.
(3) The amount or percentage of the assessment shall not exceed one
percent of Core Physician's total compensation (as defined in Article II,
Section 2, paragraph B) during the first two years of this Agreement.
G. County will cover all professional services rendered by Core Physicians at

KMC and at sites designated by the CEO and Plan Administrator under County's
liability and malpractice coverage program. Such liability and malpractice
coverage program shall not extend to any conduct, actions or activities, which do
.not arise directly from the performance of this Agreement. As a matter of law,
County shall defend and indemnify Core Physician to the same extent as would
be afforded to a regular full-time County employee.
0001.481.
-----------~----~
3. BASE SALARY (ITEMS INCLUDED AND METHOD OF PAYMENT)
A.· Base salary is compensation paid to Core Physician by the County for. (1)
patient care for Medically Indigent Adults (MIA), as defined by California Welfare
and Institutions Code section 17000 et seq., and adults ahd juveniles
incarcerated and detained in County facilities; (2) as a safety-net provider, partial
compensation for under-compensated and uninsured patients; (3) teaching; (4)
administrative duties; and (5) other activities approved by the CEO of KMC and
the Faculty Practice Board. County shall fund the clearing account unit biweekly
with an amount equal to Core Physician's biweekly base salary. The base
salary, less the assessment for administrative expenses, will be reported as
wages and subject to all appropriate federal and state taxes. The base salary
will be considered the minimum compensation that a Core Physician shall
receive under this compensation plan.
B. The base salary will be based on a benchmark salary in proportion to the

Core Physician's full-effort commitment.
(1) The structure of benchmark salaries is based upon a national

standard with four salary steps: "An, "B", "COl and "D." There are three
criteria for step placement: level of clinical service, teaching, and
administrative duties. This benchmark salary structure and criteria for
step placement are set forth in the KMC Faculty Practice Administrative
Policies and Procedures Manual.
(2) The Faculty Practice Board shall establish the criteria for measuring
the full-effort commitment. The Department Chairs, with approval of the
Faculty Practice Board, will establish the expected levels of the criteria to
meet a full-effort commitment. The criteria for measurement of full-effort
commitment is set forth in the KMC Faculty Practice Administrative
Policies and Procedures Manual.
(3) Research shall not be considered as part of a Core Physician's full-

effort. commitment. Research activity will be compensated as set forth in
the KMC Faculty Practice Administrative Policies and Procedures Manual.
4. PROFESSIONAL FEES
Professional fees include all professional fee collections or payments associated

with direct patient care by Core Physician. This shall be· referred to in this
Agreement as professional fees. Core Physician, or in cases where Core
Physician is part of a practice group entering into an agreement for services with
the County, Core Physician's practice group, is responsible for billing and
0001.482
collecting all professional fees for Core Physician's services. Each Core
, Physician or practice group will have a separate tax identification number.
Professional fees shall be collected and dispersed as follows:
A. Professional fee billing by Core Physician or his or her practice group shall
be made by a billing service company, approved in advance by the Faculty
Practice Board, and based' upon minimum performance standards set by the
Faculty Practice Board. All professional fees collected by the billing service for
Core Physician (Le., gross professional fees, collected) shall be paid to the
clearing account. The billing service will maintain individual and practice group
records on professional fee billing and collections and will account for suchto the
Plan Administrator.
B. The assessment for administrative expenses will be deducted from gross

professional fees collected.
C. Overhead and expenses for a practice group or a Core Physician who is a

sale practitioner, as deterr:nined by an overhead distribution formula established
by the Plan Administrator and the Faculty Practice Board, will be deducted from
the gross professional fees collected and returned to the practice group or Core
Physician who is a sole practitioner.
D. Each Department within KMC, at its option, may establish a Departmental,

Pool in which a percentage of the remaining gross professional fees collected will
be distributed to all Core Physicians within that Department based upon specific
criteria approved by the Faculty Practice Board.
E. Gross professional fees collected, less the assessment for administrative

expenses, overhead, and an optional Departmental pool (Le., net professional
fees collected) will be paid monthly as wages and will be subject to all
appropriate federal and state taxes; however, practice groups (consistent with
their practice group agreements with the County), Core Physicians who are sole
practitioners, or Core Physicians not associated with a practice group may direct
the Plan Administrator as to the distribution of net professional fees collected,
subject to review by the Faculty Practice Board.
5. OTHER INCOME
A. Other income IS Income generated due to, the individual's status as a

physician, which includes, but is not limited to, royalties, grants, speaker fees,
professional witness fees, and other nonprofessional fees.
00014S3
B. All other income will be paid to the Cqre Physician in accordance with
instructions provided the clearing account by Core Physician or Core Physician's
practice group. Expenses properly incurred by the Core Physician in. generating
other income will be reimbursed to the Core Physician prior to the balance being
channeled through the clearing account. This remainder, less assessment for
administrative expenses, will be paid monthly to Core Physician as wages. Other
income shall be reported as wages and subject to all appropriate federal and
state taxes.
C. Income generated by a Core Physician that is deposited to the Community

Medical Education and Research Foundation ("CMERF") for department
educational use shall not be included as other income and shall not be subject to
the assessment fot administrative expenses.
6. PRACTICE GROUPS
A. All practice groups will contract with KMC for the provision of community
. clinic services, which shall be integrated into the KMC teaching program. The
contract between each pr~ctice group and KMC will define the responsibilities
and funds flow, including professional fee distribution, between each
organization.
B. Practice group overhead and business-related expenses will be paid by

the practice group in accordance with predetermined instructions. Practice
groups will determine the policy for expense limits and reimbursable items.
County is not responsible for the amount of group overhead and business-related
expenses claimed.
7. SOLE PRACTITIONERS
A. Sole practitioners are Core Physicians who are sole proprietors or have
their own professional corporation. Core Physicians who are sole practitioners
will be responsible for the cost of professional fee billing as negotiated by the
Core Physician with the billing service company. Sole practitioner overhead and
business-related expenses will be paid by the sole practitioner. Sole
practitioners will determine the policy for expense limits and reimbursable items.
County is not responsible for the amount of overhead and business-related
expenses claimed.
B. Any other overhead amount for use of space, supplies and personnel at
KMC-owned or -contracted sites will be negotiated with the CEO of KMC.
000:14S4
8. OTHER CORE PHYSICIANS
Core Physicians who -are not part of a practice group and who are not sole
practitioners and who practice exclusively at KMC-owned or -contracted sites will
be responsible for the cost of professional fee billing as negotiated by the Core .
Physician with the billing seiVice company.
9. DEPARTMENTAL POOL
Each Department of KMC, by simple majority of Core Physicians within that

Department, may opt on a yearly basis to participate in a departmental pool. The
departmental pool is a group incentive pool funded by net professional fees from
a participating. Department to reward· Core Physicians within that Department for
activities not recognized by other parts of this compensation plan. Each
Department participating in a pool will establish criteria with the approval of the
Faculty Practice Board for pool distribution. The percentage of net professional
fees to be allocated to the departmental pool will be determined on a yearly basis
by the Department with the approval of the Faculty Practice Board. The
departmental pool will be distributed quarterly as wages· and will be subject to all
appropriate federal and state taxes.
Article III.
BENEFITS
1. EFFECTIVE DATE OF BENEFITS
The date of employment for the purpose of receiving and accruing benefits listed
in this Article III shall not be affected by the date of this Agreement, but shall be
the date the Core Physician was first continuously employed by KMC.
2. HEALTH INSURANCE
County shall provide to Core Physician and eligible dependents medical, dental
and vision insurance as provided. to other regular County employees of KMC.
Core Physicians first hired by the County of Kern after April 15, 1997 must pay
twenty (20) percent of the cost of their health benefits. County may change the
benefits proVided under this insurance as such benefits shall change for other
County employees of KMC. Any such change by County shall not be a breach of
this Agreement.
3. PAID LEAVE OF ABSENCE
Core Physician will receive paid leave for holidays, vacation, sick leave and
educational leave.
0001.485
A. Holidays:
Core Physician shall be entitled to such holidays as provided to full-time County

employees of KMC. County may change the holidays provided under this section
as such holidays change for other County employees of KMC. Any such change
by County shall not be a breach of this Agreement.
B. Vacation:
For each pay period of service, Core Physician shall be credited with a vacation
entitlement of 6.15 hours, for a maximum accrual of 160 hours per year. Total
unused vacation accumulated shall not exceed a maximum of 320 hours. No
further vacation entitlement shall be credited so long as Core Physician has the
maximum hours credited. If Core Physician is presently employed by the County
of Kern, accrued vacation entitlement shall be credited to a maximum of 320
hours. Unused vacation benefits will be credited to Core Physician to a
maximum of 320 hours if this Agreement is renewed. Core Physician will be paid
for accrued and unused vacation hours upon termination of employment.
C. Sick Leave:
For each pay period of service, Core Physician shall be credited with sick leave
credit for illness or accident of 2.46 hours, for a maximum accrual of 64 hours per
year. After five years of employment, including full-time employment prior to the
effective date of this Agreement, Core Physician shall earn and accrue sick leave
credit for illness or accident at the rate of 3.07 hours for each pay period of
service for an annual accrual of 80 hours per year. Total unused sick leave
accumulated shall not exceed a maximum of 1152 hours. No further sick leave
entitlement shall be credited so long as Core Physician has the maximum hours
credited. If Core Physician is presently employed by the County of Kern. accrued
sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will
be credited to Core Physician to a maximum of 1152 hours if this Agreement is
renewed. Core Physician will not be paid for accrued and unused sick leave
·upon termination of employment. County policy applicable to other regular
County employees of KMC regarding use of sick leave shall apply to Core
Physician.
D. Educational Leave:
Core Physician shall receive 80 hours paid education leave annually. The first
80 hours shall be credited on the effective date of the Core Physician's
employment contract. On each successive anniversary date of that contract, an
additional 80 hours shall accrue. Education leave must be used within the year
that it is accrued and unused education leave does not accrue to the following
0001.486
contract year. Unused education leave will not be paid upon termination of
employment. All education leave must be approved in advance of use by the
Core Physician's Department Chair and the Medical Director.
4. UNPAID LEAVE OF ABSENCE
County shall provide Core Physician the right to unpaid leave of absence
provided to other regular County employees of KMC pursuant to County policy.
County may change its policy regarding leave of absence, as its policy for leave
of absence shall change for other County employees of KMC. Any such change
5. RETIREMENT PLAN
A. Core Physician shall participate in the Kern County Pension Plan and
Trust Agreement for Physician Employees (the "Plan"),a qualified defined
contribution pension plan, pursuant to the terms of the instrument under which
the Plan has been established (the "Plan Document"), as from. time-to-time
amended. County shall withhold 3.1 percent of Core Physician's biweekly gross
salary (that is, before deductions including taxes) and pay such amount within a
reasonable time as the Core Physician's mandatory employee contribution
required under the Plan Document. County shall contribute an additional amount
equal to 12.5 percent of Core Physician's biweekly gross salary (that is, before
deductions including taxes) as County's required contribution under the Plan
Document. Total contributions by Core Physician and County will not exceed the
yearly amount allowed by law; provided, however, if any amounts are contributed
in excess of such permissible amounts, the excess contribution shall be
corrected as provided in the Plan Document or under law. Any changes in the
Plan Document will control the terms of this Agreement.
B. Subject to the receipt ofa favorable determination letter from the Internal
Revenue Service, County will amend and restate the Plan Document to
substitute a fixed-dollar contribution by County and Core Physician in lieu of the
contributions provided in the immediately preceding paragraph A. County and.
Core Physician contributions for each Plan' year (as defined In the Plan
Document) under the amended and restated Plan document shall be as follows:
County shall contribute as County's required contribution the sum of Seventeen
Thousand Five Hundred Dollars ($17,500) for the accountof Core Physician for
each complete Plan year of service (as defined in the Plan Document) by Core
Physician. Core Physician's mandatory employee contributions required under
the amended and restated Plan Document shall be as follows: If Core
Physician's Compensation (as defined under the Plan Document) was One
Hundred Fifty Thousand Dollars ($150,000) or less during the immediately
preceding Plan year, Core Physician's mandatory employee contribution required
0001.487
under the Plan Document shall be $4,000 for a complete Plan year of service by
Core Physician. If Core Physician's Compensation was more than One Hundred
and Fifty Thousand Dollars ($150,000) but less than One Hundred and Seventy
Thousand Dollars ($-170,000), during the immediately preceding Plan year, Core
Physician's mandatory employee contribution required under the Plan Document
shall be Nine Thousand Dollars ($9,000). If Core Physician's Compensation was
One Hundred Seventy Thousand Dollars ($170,000) or more but less than One
Hundred Eighty Thousand Dollars ($180,000) during the immediately preceding
Plan year, Core Physician's mandatory employee contribution required under the
Plan Document shall be Twelve Thousand Five Hundred Dollars ($12,500) for a
complete Plan year of services. If Core Physician's Compensation was One
Hundred and Eighty Thousand ($180,000) or more but less than One Hundred
Ninety Thousand Dollars ($190,000)during the immediately preceding Plan year,
Core Physician's mandatory employee contribution required under the Plan
Document shall be Seventeen Thousand Five Hundred Dollars ($17,500) for a
complete Plan year of services. If Core Physician's Compensation was at least
One Hundred Ninety Thousand Dollars ($190,000) during the immediately
under the Plan Document shall be the maximum amount permitted by Internal
Revenue Code section 415(c)(1 ) (which is currently $40,000) reduced by the
County contribution for the account of Core Physician for the Plan year. Core
Physician's mandatory employee contributions shall be withheld by County from
Core Physician's biweekly salary in relatively equal amounts. Total contributions
by Core Physician and County will not exceed the yearly amount allowed by law;
provided, however, if any amounts are contributed in excess of such permissible
amounts, the excess contribution shall be corrected as provided in the Plan
Document or under law. Any changes in the Plan Document will control the
terms of this Agreement. County's required contribution for the account of Core
Physician and Core Physician's mandatory employee contributions are also
subject to all of the transition rules contained in the Plan as it now exists or niay
be hereafter amended which may reduce the amount of contribution. The
transition rules include, but are not limited to, those contained in sections 3.3(b),
3.3(d), 3.5, and 3.6 of the amended and restated Plan Document. Core
Physician (together with all Plan participants) shall be responsible for a pro rata
share of the annual costs of administering the Plan. Due to the manner in which
Plan participantaccounts are held and invested, most such costs cannot be paid
directly from Plan assets. To facilitate payment of such costs, County shall
advance such costs for so long as County determines such an arrangement is
necessary or desirable. To offset such costs, County shall reduce its contribution
to the Plan for Core Physician by Core Physician's pro rata share of such costs
as determined under the Plan Document.
10
0001.4SB
C. If the fixed contribution structure described in the immediately preceding

paragraph B results, or would result, in the Internal Revenue Service not issuing
a favorable determination letter for the Plan under the amended and restated
Plan Document, the County reserves the right to substitute another contribution
structure which will be designed to maximize benefit to Core Physician on a cost-
neutral basis to County, and such substitute contribution structure shall control
the terms ofthis Agreement. County will consult with the Pension Committee, as
identified in the Plan Document, with respect to such substitute contribution
structure.
D. County's reqUired contribution and all mandatory employee contributions

will be paid to such financial services firm(s) as determined under the Plan
Document. If, pursuant to the Plan Document, Plan assets are allocated to
separate accounts for each Plan participant, such financial services firm(s) shall
be solely responsible for allocating Core Physician's contribution amount and
investment experience to his or her account. If, pursuant to the Plan Document,
Plan participants control the investment of their accounts at such financial
services firm(s), the investment of Core Physician's Plan account through such
financial services firm shall be determined by Core Physician, County shall not
be liable for the investment experience ofeore Physician's Plan account.
E. Core Physician is not eligible to participate in any other retirement plan

established or funded by the County for its employees, including but not limited to
the Kern County Employees' Retirement Association, and this Agreement does
not confer upon Core Physician any right to claim entitlement to benefits under
any such retirement plan(s).
6. SOCIAL SECURITY AND MEDICARE TAXES
Core Physician is exempt from payment of Social Security taxes as the Kern
County Pension Plan for Physician Employees is a qualified alternative to the
insurance system established by the federal Social Security Act. Core
Physicians employed before March 31,1986, will continue to be exempt from the
payment of Medicare taxes.
7. DEFERRED COMPENSATION PLAN
Core Physician shall be eligible to participate in the Kern County Deferred

Compensation Plan I on the same basis and to the same extent as full-time
County employees. County may change its Deferred Compensation Plan as it
shall change for other County employees of .KMC. Any such change by County
shall not be a breach of this Agreement.
11
0001.4S 9 ,
8. KERN$FLEX PLAN
Core Physician shall be eligible to participate in the Kern$Flex Plan I on the

same basis. and to the same extent as eligible County employees. County may
change its Kern$Flex Plan, as its policy for Kern$Flex shall change for other
County employees of KMC.· Any such change by County shall not be a breach of
this Agreement.
9. EXPENSE REIMBURSEMENT
A. Core Physician will be reimbursed for approved and necessary

expenditures related to continuing education including seminar fees, travel and
study materials. Reimbursement for travel, lodging and meals shall be upon the
same terms and rates as allowed for County employees of KMC. Core Physician
will be reimbursed expenses and materials not to exceed $2,500 per year.
B. Core Physician will be reimbursed for approved and necessary

expenditures related to education and training as directed by KMC.
Reimbursement for travel, lodging and meals shall be upon the same terms and
rates as allowed for County employees of KMC.
C. County will pay reasonable moving expenses (defined as the moving of

household goods and vehicles) for Core Physician to relocate from Philadelphia,
Pennsylvania, to Bakersfield, California, in an amount not to exceed Twenty
Thousand Dollars ($20,000). Core Physician shall provide three written bids for
moving expenses and County shall reimburse Core Physician for the lowest of
the three bids. In order to be reimbursed for said moving expenses, Core
Physician shall submit the three written bids along with the invoice{s} for actual
services performed by the low bid contractor(s).
D. Reimbursement for expenses incurred in generating professional fees will

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

reimbursed as set forth in Article II, Section 5, above.
Article IV.
TERMINATION AND CORRECTIVE ACTION
1. TERMINATION OF AGREEMENT
A. Core Physician may terminate this Agreement, without cause, upon ninety
{gO} days' prior written notice to County.
12
0001.4 90
B. County may terminate this Agreement at any time for cause. Cause is
defined as a violation of administrative policy of the County of Kern or KMC,
unsatisfactory clinical performance, failure to meet department accountability or
performance standards, or reduction of need. County may terminate this
Agreement based upon reduction of need upon ninety (90) days' prior written
notice to Core Physician. .
C. Termination of this Agreement by County does not per se affect medical

staff membership. Actions affecting medical staff membership and clinical
privileges· are governed solely by the medical staff bylaws.
D. In the event of termination of this Agreernent for any reason, County shall
have no further obligation to pay for any services rendered or expenses incurred
by Core Physician after the effective date of the termination. Core Physician
shall be entitled to receive base salary from County for services satisfactorily
rendered, calculated on a prorated basis up to the effective date of termination.
E. Professional fees earned prior to termination and collected within twelve

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

policy of the County of Kern or KMC, unsatisfactory clinical performance, or
failure to meet department accountability or performance standards. Such
corrective action may include, without limitation, additional training and
education, a verbal or written warning, a written reprimand, suspension with or
without pay, and termination.
B. Corrective action for unsatisfactory clinical performance is governed by .

the medical staff bylaws.
C. Corrective action is not required if the problem involves a serious ethical

or clinical breach, a violation of law or a serious violation of County of Kern or
KMC policy that merits immediate termination for cause.
13
0001.491
3. REVIEW AND APPEAL PROCESS
Review and appeal of the decision to impose corrective action or terminate for.
cause shall follow the process set forth in the KMC Faculty Practice Board policy
and procedure. titled Corrective Action and Termination Review Process. or the
medical staff bylaws. whichever is applicable.
Article V.
GENERAL PROVISIONS
1. ASSI.GNMENT
Core Physician shall not assign or transfer this Agreement or its obligations
hereunder, or any part thereof. Core Physician shall not assign any money due
or which becomes due to Core Physician under this Agreement without the prior
written approval of County.
2. ASSISTANCE IN LITIGATION
Core Physician agrees to be available to County, at no cost to County, to testify

as an expert witness or otherwise, in the event of litigation under any cause of
action being brought against County or KMC, its directors, officers or employees
except where the Core Physician is a named party. KMC will credit the time
spent in preparation and testimony as administrative time as defined in the
compensation plan.
3. AUTHORITY TO BIND COUNTY
It is understood that Core Physician. in Core Physician's performance of any and

all duties under this Agreement, has no authority to bind County or KMC to any
agreements or undertakings.
4. CAPTIONS AND INTERPRETATION
Paragraph headings in this Agreement are used solely for convenience. and shall
be wholly disregarded in the construction of this Agreement. No provision of this
Agreement shall be interpreted for or against a party because that party or its
legal representative drafted such provision, and this Agreement shall be
construed as if jointly prepared by the parties.
5. CHOICE·OF LAWNENUE
The parties hereto agree that the provisions of this Agreement will be construed
pursuant to the laws of the State of California. This Agreement has been entered
14
0001.492- I
into and is to be performed in the County of Kern. Accordingly, the parties agree
that the venue of any action relating to this Agreement shall be in the County of
Kern.
6. CONFLICT OF INTEREST
The parties to this Agreement have read and are aware of the provisions of
section 1090 et seq. and section 87100 et seq. of the California Government
Code relating to conflict of interest of public officers and employees. All parties
hereto agree that they are unaware of any financial or economic interest of any
public officer or employee of County relating to this Agreement. It is further
understood and agreed that if such a financial interest does exist at the inception
of this Agreement, County may immediately terminate this Agreement by giving
written notice thereof. Core Physician shall comply with the requirements of
California Government Code section 87100 et seq. during the term of this
Agreement.
7. COMPLIANCE WITH KMC AND COUNTY POLICIES
Core Physician will comply with all applicable KMC and County policies and
procedures. Core physician will keep daily time sheets on forms supplied, and in
the manner specified, by KMC. Core Physician will conform to office policy and
routine as established by the Department of which Core Physician is a member, .
including, but not limited to orientation, attendance at case conferences,
supelVision, in service education, patients' rights functions and performance.
improvement activities. Core Physician shall submit to drug testing, other
laboratory testing and physical examinations as may be required by County.
8. COMPLIANCE WITH LAW
Core Physician shall obselVe and comply with all applicable County, state and
federal laws, ordinances, rules and regulations now in effect or hereafter
enacted, including but not limited to JCAHO, Title 22, California Code of
Regulations, EMTALA, all federal and state billing requirements including Medi-
CallMedicaidand Medicare billing regulations, EEOC, HIPM, FEHA and Cal-
OSHA. Core Physician will at all times meet state and federal licensure and
County personnel qualifications for the practice of medicine.
9. COUNTERPARTS
This Agreement may be executed simultaneously in any number of counterparts,

each of which shall be deemed an original but all of which together shall
constitute one and the same instrument.
15
2001493
10. EMPLOYMENT STATUS
Core Physician shall be employed by the County of Kern pursuant to the terms of
this Agreement and the medical staff bylaws of KMC. Core Physician
acknowledges that he or she will not be deemed a classified employee, or have
any rights or protections under the County's· Civil Service Ordinance, rules or
regulations.
11. ENFORCEMENT OF REMEDIES
No right or remedy herein conferred on or reserved to County is exclusive of any

other right or remedy herein or by law or equity provided or permitted, but each
shall be cumulative of every other right or remedy given hereunder or now or
hereafter existing by law or in equity or by statute or otherwise, and may be
enforced concurrently or from time to time.
12. MEDICAL RECORDS
Any and all patient medic~1 records and charts produced as a result of either
party's performance under this Agreement shall be and remain the property of
County. During the term of this Agreement, Core Physician shall be permitted to
inspect and/or duplicate any patient's medical record or chart to the extent
necessary to meet professional responsibilities to such patient and/or to assist in .
the defense of any malpractice or similar claim to which such medical record or
chart may be pertinent, provided such inspection and/or duplication is permitted
and conducted in accordance with applicable legal requirements and pursuant to
commonly accepted standards of patient confidentiality. Core Physician shall be
solely responsible for maintaining patient confidentiality with respect to any
information obtained pursuant to this paragraph and will comply with all federal
and state laws and regulations regarding patient confidentiality.
13. MEDICAL STAFF MEMBERSHIP
Core Physician will at all times be a member in good standing of the medical staff
of Kern Medical Center and governed as such by the medical staff bylaws. This
Agreement may be immediately terminated if· Core Physician's privileges/
membership are modified or restricted pursuant to action under the medical staff-
bylaws such that services performed by Core Physician are limited or restricted.
Prior to performing duties. Core Physician will complete the following:
(a) Application for medical staff membership;

(b) Provide proof of current license from Medical Board of California;
(c) Provide proof of current DEA certificate; and
16
0001.494
(d) Meet with the medical staff office to ensure appropriate

documentation is present for credentialing of medical staff
privileges.
14. MODIFICATIONS OF AGREEMENT
This Agreement may be modified in writing only, signed by the parties in interest
at the time of the modification.
15. NON-APPROPRIATION
County reserves the right to terminate this Agreement in the event insufficient
funds are appropriated or budgeted for this Agreement in any fiscal year due to
closing of a clinical department or KMC. Upon such termination, County will be
released from any further financial obligation to Core Physician, except for
services performed prior to the date of termination or any liability due to any
default existing at the time this section is exercised. Core Physician will be given
thirty (30) days' written notice in the event that such an action is required by
County.
16. NON-DISCRIMINATION
The parties mutually agree to abide by all laws, federal, state and local, and by
all policies of the County of Kern respecting discrimination. The parties shall not
discriminate on the basis of race, color, national origin, age, religion, marital
status or sexual preference.
17. NON-WAIVER
No covenant or condition of this Agreement can be waived except by the written

consent of County. Forbearance or indulgence by County in any· regard
whatsoever shall not constitute a waiver of the covenant or condition to be
performed by Core Physician. County shall be entitled to invoke any remedy
available to County under this Agreement or by law or in equity despite said
forbearance or indulgence.
18. NOTICES
Notices to be given by one party to the other under this Agreement shall be given
in writing by pe·rsonal delivery, by certified mail, return receipt requested, or
express delivery service at the addresses specified below. Notices delivered
personally shall be deemed received upon receipt; mailed or expressed notices
shall be deemed received four (4) days after deposit. A party may change the
address to which notice is to be given by giving notice as provided above.
17
0001.49 5
Core Physician County
David F. Jadwin, D.O. Peter K. Bryan

26900 Monet Lane Chief Executive Officer
Valencia, CA 91355 Kern Medical Center
1830 Flower Street
Bakersfield, CA 93305-4197
19. PROFESSIONAL RESPONSIBILITIES
Core Physician will perform the services and duties set forth in this Agreement in
a diligent and conscientious manner in accordance with accepted professional
and ethical standards of the medical profession and the medical staff bylaws of
KMC.
20. RELATIONSHIP
County and .Core Physician recognize that Core Physician is rendering·

specialized, professional services. The parties recognize that each is possessed
of legal knowledge and skill, and that this Agreement is fully understood by the
parties, and is the result of bargaining between the parties. Each party
acknowledges their opportunity to fully and independently review and consider
this Agreement and affirm complete understanding of the effect and operation of
its terms prio"r to entering into the same.
21. SEVERABILITY
Should any part, term, portion or provision of this Agreement be decided finally to
be in conflict with any law of the United States or the State of California, or
otherwise be unenforceable or ineffectual, the validity of the remaining parts,
terms, portions, or provisions shall be deemed severable and shall not be
affected thereby, provided such remaining portions or provisions can be
construed in substance to constitute the agreement which the parties intended to
enter into in the first instance. .
22. SOLE AGREEMENT
This Agreement, including all attachments hereto, contains the entire agreement
between the parties -relating to the services, rights, obligations and covenants
contained herein and assumed by the parties respectively. No inducements,
representations or promises have been made. other than those recited in this
Agreement. No oral promise, modification. change or inducement shall be
effective or given any force or effect.
18
0001.496
IN WITNESS TO THE FOREGOING. the parties have signed this Agreement

upon the dates indicated.
APPROVED AS TO CONTENT: COUNTY OF KERN

KERN MEDICAL CE
KERN COUNTY PERSONNEL CONTRACT EMPLOYEE
BY·~>-·~ ~l~!P
Kay F. Madden, Director ty'./I· # - vid F. Jadwin. D.o../
APPROVED AS TO FORM:
OFFICE OF COUNTY COUNSEL
By ~A.~
Deputy .
Agreemenl.Jadwin. OB1202
19
0001.49?
EXHIBIT "A"
JOB DESCRIPTION
DAVID F. JADWIN, M.D.
PATHOLOGY CHAIRMAN
The pathology chairman shall serve as the medical director for the anatomic pathology
service and clinical laboratories at KMC. The pathology chairman will report to the KMC
Medical Director. This is a full-time position requiring 48 hours of service, on average,
per week.
1. Administrative responsibilities include: The pathology .chairman, together with

the laboratory manager(s), will ensure that the Department:
a. Is in compliance with federal and state regulations regarding clinical laboratory

operation.
b. Meets standards for accreditation by the College of American Pathologists (CAP)
and the American Association of Blood Banks (MBB).
c. Operates within the policies established by KMC and the medical staff bylaws,
rules and regulations. .
d. Operates effectively and smoothly, and provides timely reports, provided
adequate resources are provided.
2. Administrative duties include:
a. Oversees the development, implementation and maintenance of

department policies and procedures for the clinical laboratory and pathology
department, including surgical pathology, cytopathology and autopsy pathology.
b. Operates and manages the pathology department quality assessment and
improvement program.
c. Oversees the performance of the clinical laboratory in the CAP laboratory
proficiency survey program.
d. Ensures that performance deficiencies are addressed in a timely manner.
e. Reviews department budgets and major expenditures for appropriateness.
f. Monitors performance and prepares annual evaluations for staff
pathologists and the laboratory manager.
g. Serves as a member of the Medical Executive Committee, the Chairmen's
Council, the Faculty Practice Board, the Quality Management Committee, the Blood
Usage Committee. and other committees that may be assigned by the president of the
medical staff.
h. Through participation in the Blood Usage Committee, ensures adequate
transfusion service and utilization.
i. Coordinates and monitors department faculty involvement in hospital
committees.
20
j. Conducts and monitors regular department meetings, in compliance with

medical staff bylaws, and provides timely department reports, including an annual
department report for the medical staff.
k. Coordinates medical student and resident. training for students and
residents on training rotation within the department.
I. Meets with the KMC medical director at least monthly.
m. Oversees the scheduling and effectiveness of pathology educational
conferences for outside departments, including the oncology conference and the
oncology clinic.
n. Completes clinical pathology and anatomic pathology service work as may
be required.
3. Teaching duties include:
a. Coordinates and participates in teaching conferences to include weekly

gynecology conference, oncology conference, and surgery conference.
b. Prepares and presents didactic lectures.
c. Actively participates in and presents departmental, interdepartmental,and
interdisciplinary programs within KMC.
4. Patient care duties include:
a. Performs anatomic pathology services as assigned.

b. Documents care provided consistent with CMS requirements for
professional fee billing.
5. Other duties as assigned by the chief executive officer or medical director.
6. A standard workweek will be 48 hours per week. Actual hours may vary week-to-
week according to specific assignments; however, the objective is to achieve 2112
worked hours during a twelve-month period.
21
0001.49~
K~KNCOUNTYPERSONNELDEPARTMENT
REQUEST FOR LEAVE OF ABSENCE
DATE 3/~!at:,
>
NAME ( SOCIAL SECURITY NUMBER JOB TITLE
I
INITIAL REQUEST o EXTENSION REQUEST I
DATE LEAVE OF ABSENCE STARTS DATE LEAVE OF ABSENCE ENDS RETURN TO WORK DATE
:: OF LEAVE: (Reference Civil Service Rule 1201.00 et. seq. and Ke.rn Co. Admin. Proc. Manual Chapter 3)
iANDATORY LEAVE OTHER MANDATORY LEAVES 2. PAY STATUS

FMLAoICFRA- o Military (Reserve) eSRI201.~0 ~ithPay
o
Non-Job Related/Illness or Disability and o Family School Activity Leave eSR 1201.60 ~ick Leave Accrual
re nancy Disability Leave eSR 1201.20
:!o
,E?vacation Accrual
Intermittent-Employee eSR 1201.30 DISCREllONARYLEAVES o Compensatory Time
oamity Care Leave-FamilyesR 1201.30 o Personal Necessity eSR 1202.20 o Catastrophic Leave
Intermittent Leave-Family eSR 1201.30 o Military (Enlistment) CSR 1202.30 o Without Pay
o
Compensable Disability eSR 1201.50 o Education/Personal Enrichment eSR 120VO 3. Physician's Note
o Non-Promotional Probationer eSR 1205.00
* ,
~Yes 0 No
L I~ ",,-J~
, L ·7
CIFIC REASON FOR LEAVE OF ABSENCE
Jest a leave of absence for the reason stated above and understand that I will receive no wages during this absence, Ifall applicable
Jals have been exhausted; further, that my rate of pay will be subject to any general increases or decreases in wage rates that become
tive during my absence from work: and that my return to work will be subject to employment conditions existing at the time of such
1.
erstand that leaves taken for Non-Job Related/Illness or Disability and Pregnancy Disability, Compensable Disability, orCataslrophic
e require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided
nittently to cover all periods of leave taken. Also, I may be required to pass a medical. physical and lor psychological examination
,(mty expense prior to returning to duty if the illness or disability may affect job performance or the health or safety of fellow workers
~ public.
understand that if my leave of absence is approved, the payment of premiums for my medical and dental benefits may become my
msibility to continue coverage during the leave of absence. (Contact Health Benefits (868-3182) for information concerning your
:JUon and options in this malter.)
Signature of Employee
'RTMENTHEAD RECOMMENDAT~N CIVIL SERVICE COMMISSION ACTION
A.PPROVED DATE) L
1y I" ''0
o APPROVED DATE ~ _
~TAPPROVE6) OATE _ o NOT APPROVED DATE _
:ure f
8/".1
, "
-<g"
lily nntl-;ttedicnl Lem'e .4cr of1993 DISTRIBUTION:
WHITE· P€RSONtIEl DEPARTMENT
[ornin Fnmi/.I· Rights Aer CANARY • HEAlTH BENEFITS
;:'I!:K· At=';::CUHnlG CE.F";;:':T'.~E!:r
,c 8£.:0 395-5230 \10IOCl) (F,onl) GOLOENROD·EMPlOYEE
1
RULE 1200 LEAVES OF ABSENCE WITHOUT PAY
1201.00 MANDATORY LEAVES OF ABSENCE
1201.10 Noticc of Lca,·c. An)' Counl)' cmploycc rcqucsting a leavc of abscncc without pa}'
.under Sections 1201.20, 1201.30, or \'Olulltal)' Ieavc under Scclion 1201.'1.0 shall, when
possible, gi,·c noticc of that requcst to UlC appointing aUlhorily, in wriLing, not less than
30 days prior to thc datc tllC Ica,'c is 10 commcncc. Such noticc shall bc forthwilh
ronvardcd to tllC Dircclor by tllC appointing autllOril}'. Thc noticc shall bc submilled on
a form prcscribcd by tllC Commission and shall spccify tllC Ica,'c to bc lakcn, tllC rcason
or rcasons tllCrcforc, and, to tllC cxlcnt possiblc, Ihc beginning and cnding datcs of the
Ica,·c. (Rc\'. 8/92)
1201.20 Non-Job-Relalcd IIIncss or DisabililY and PrC!,'11al!c\, Disabilih·. A Counl)' cmploycc

shall bc grantcd a Icavc without pay for an incapacilating non-job related illncss or
disabililY ofthc cmploycc, including a disability rcsulting from prq,'llancy, childbirlll, or
relaled condiLion. Thc Icavc cntilJcmcnt shall bc subjccllo tllC following conditions: (I)
111e ncccssity for UIC Icavc shall bc ccrtificd by a mcdical doctor, who shall also stalc ulat
UIC cmployce will bc mcdically ablc 10 return 10 work at tllC expiratioll of UIC leavc
pcriod; and, (2) thc Icavc pcriod(s) authorizcd by Rulc 1201.20 shall not cumulati,·cJy
cxcced six (6) months during any twelvc (I 2) montll pcriod exccpt as rcquircd by law.
(Hc,·.01/97)
Usc of tllis Ica,'c is subjcct to IJlC cmployce using all sick lca\'c accrucd prior tOtllC
cffcClivc datc of the Ica,'c of abscllcc. Employccs shall bc cntitled to usc anyolllcr
acaucd Iea,'c balances, concurrcntly with tllC Ica,'c gi"cn by this scction.
Vcrilication from a 111cdical doclor of continued incapacity 10 perform tllc job duties
shall bc rcqucstcd by tllC appointing aul1lOrity. Thc employec mar bc required to pass a
physical, mcdical and/or psychological examination dcsignalcd by Coullly, at Counly
cxpcnsc, prior 10 relurnillg to dUly if the iIIncss or disability may affcct job performancc
or thc hcall1l ami safct}' of tllC cmployee, co-workcrs, onhe public.
(Rc\,. 01/97)
To thc maximum cxtent pcrmillcd by law, alllea,·cs autllorizcd by tllis Hulc shall run
cOllcurrcnlly \\;th Ieavcs takcn pursuant 10 Rulc 1201.30 and shall count against111c
twch'c (12) wcek limit contained in Rulc 1201.30. (Re,'. 01/97)
1201.:-30 l\'landalcd Famil\' and Medical Lca\'cs - (Emplorccs and Familr)
The purpose of this Rulc is to implcmcntlca\'cs ",hidl arc mandated by the Family and
Mcdical Lca,'c Act of 1993 ("gILA") and tllC California Family Hi~hts Act "CFRN').
Eligible cmployces may usc Ica,'cs autllol;zcd by this Hulc on an inlcnnillcIlt basis 10 IJIC
exlent that l1lC County is rcquired 10 permit inlcrmillcllt Icaves undcr FML\ all(Vor
CFHA. "'hcn permilled, intermillentlca,'c may be laken in periods from onc hour to
sC"cral wceks, up 10 a tOlal of '~80 hours· for full-timc employccs and prorated
accordingl}' lor part-timccmployces. (Hc\,. 01/97)
0001. 5 01.
eNCL~\::;()£C Lj"
"- Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 33 of 93
f .
F;unily and mcdical IC;I\"cS of abscncc arc ;l\'ailablc Oil an uupaid basis 10 eligiblc
cmployccs. In ordcr 10 qualify for a Iea\"c, an cmploycc must: (a) ha\"c bccn cmploycd for
atlcastlwch'e (12) moulhs rIlle tweke (12) moulhs do nol need 10 hcconsecuti\"c); ;lIld
(b) workcd at Icast 1,250 hours ofsen'ice duriug UIC 12-molllh pcriod illllncclialdy hcforc
the commcncemcnt of the Ica\"c. (Rcv. 01/97)
An eligible cmployee may request up to Iweh'e (/2) weeks Icavc iu a twckc (12) 1I10nlh
period for UIC followiug reasons:
I. 'IllC carc of a newborn child;
2. Thc carc of it child who has becu placcd willi an employce lor adoption or
foslcr care;
3. The care of a spousc, child or parent (including, but not limilcd to, persons
who stand "in loco parcntis") who has aserious hcalth condition; or
:t The serious healLlI condition of UIC e1ihriblc cmploycc which prC\'cIIIs the
employec from performing onc or morc of LlIC essential functions of his or
hcr job. (HC\'. 01/97)
\Vhen both parcnts arccrnplo)'ed by Ihe County, Lllcamount ofleavc for bonding (i.
e" birLll, adoplion,or foslcr carc placcmcut) is limitcd to an aghrrcgale of Iwel\'c (/2)
wccks, betwccn Lllc parenLe;, in a twelvc (12) month period. For any other leavc
aUUlOrizccl by Lllis Rule, cach parcnt is allowed twelve (12) weeks leave, in a tweh'c
(12) monLlI period, less any bonding leavc laken by lhat parcnt during thaI lwelve
(12) mouLlI period. (12/05)
The twelve (12) month period uscd 10 measurc the I,,"ckc (12) week limitation will be
thc rolling twelve (12) month pcriod measurcd backward from Llle dale Llle Iea\'c is used,
Under UIC rolling twch'e (12) monul period, each time an employce takcs lea\"e, Llle
remaining Iea\'e balance consists of the portion of ule twekc (12) weeks thal was not
uscd during Llle immedialel). preceding tweh'e (12) months. me\'. 01/9i)
Employces shall cxhausl all accrucd sick leave 10 the miL\:imUlll cxtcnl permilled, at the
commcncemcnL of LllC Icavc. Employees shall be cntitled 10 use any other accrued
Ica\'c balanccs, concurrently willI UIC Ieavc givcn by this section. This Hulc is nol
intcndcd to supersede tllC pro\"isions of Kcrn COUlll)' Ordinallcc Code Section
3.28.0·-1-0, which limits Llle ilmOUlll of sick Icavc which all cmployee may use lor illncss of
members 01" Ihe employee's immediatc family. (HC\'.O 1/97)
If an cmployce requests a Ieavc oue to a serious health coudition 01" lhe employcc or a
family membcr, LllC employee must support tllC request wiLll a legally sunicicnt
0001502
,
-- Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 34 of 93
ccrLilicalioll isslIcd by Lhc heahh rarc pro\'idcr of Lhc individual willi Lhc serious healLh
condition. The appointing ;lUlJlOrity may rcqucsL suhscqucnL re-ccrtilication of mcdical
condilions as pcnnilled by law. (Hc\,. 01/97)
For leavcs granled duc Lo a serious heahh condilion oflhe employcc, Ihe employec may
be rcquired 10 pass a physical, medical and/or psychological cxamination dcsih'llaled by
County, at I1lc CounlY's cxpense, prior 10 reLurning for dULy if thc scrious hcalth
condilion ma}' a{fecljob perfonnance or lhe hcalLh, sately oflhc employec, co-workcrs
or lhe public, (Hc\,.0l/!)7)
To the maximum exlenl permilled by law, ;U1Y Icm'c laken by an cmployee undcr lhis or
any olhcr Hule or aUlhority shall bc credilcd ag"<linsl Lllc lweh,c (12) weck limit containcd
in Lllis Hulc. Thc Icavc pro\'idcd by lhis Rulc shall run concurrcnllr wilh all oLhcr
lea\'es, ,,'hich applr 10 the employec's abscnce. (He\'. 01/97)
1201..tO Temporal'\' Mililarv Le:l\'c Pursuanlto California f\liIilary and Velcrans Codc sections
395 a1l<1 395.0 I, any Counl)' employec ",hois a member of lhe reser\"c corps of lhe
Armcd Forces of lhc Uniled Stiles or of the National Guard or lhc Nm'al Militia, is
enLiLlcd 10 a Lemporal}' mililary Ica\'c ofabscnce whilc cngagcd in mililary dUly ordered
for LllC purposes of active miliLal1' lraining, inacLi\'c dul)' lraining, encampmelll, lIa\'a[
cruises, special excrcises or [ike aClivil)', prO\'ided lhallhe period of ordercd dUl)' docs
noL excced [90 calendar dars, includiug time in\'Oh-cd in going Lo and rClurning from
Ihal dul)'; and, provided a copy of Lllc milital)' orders accompany LlIC rcquesl for mililal)'
ka\"e.
Any cmploree who has becn in LllC scn'icc of Lhc COllnly for al Ieasl one year,
immcdiaLely prior lo Lhe dale upon which a Icmporary military Ica\'c ofabscncc bcgins,
shall, Lo lhc extenL required by law, be entiLlcd lo receivc his/her salary for LllC firsl 30
calendar days of such leave and, shall accrue the same \'acalion, sick Icavc and holiday
pri\"i1eges and LlIC same righls and pri\"ilcges 10 promotion, continuancc in office,
cmpioymcnL, rcappoinlmenllo ollice, or rc-cmploymenllhaL lhe cmployee would h;\\,c
enjoycd had hc/shc nol been abscnt Lllercfrom; howc\'cr, any lIncomplcLcd probation:uy
period musl be complelcd upon reinslalcmenl. (for purposcs of Lllis scclion, in
dclermining Ihc one year of sen'ice willi lhe CounLy, all scn'jce of Lllc public cmployee
in Ihc rccogllized military sen,icc shall be coullied as CounLy ser\'ice). 11lc cmployce's
seniorilY dales (i,e" Counly, Vacation and Incrcmcnl) ",ill nol be adjusled for Llle
duration of Llle leave. Thc cmploye-c may utilize \'acation and compcnsatory Limc on'
accruals beforc beginning in a non-pay slatus. Nol\\"jlhsLandill~ the abovc, an cmployee
011 lemporary mililary leavc for LllC purpose of "inacti"e dUly lraining" is nol entillcd lo
ha\'c auy of his/her salary paid as dcscribcd abO\'e. (Hc\'. /0 I).
1201..1.0.10 }>ursuanllo California MililalT:lnd Veler;lllsCode scction395(c), upon cxpiration of

;lIIY lemporary military leave of abscnce, au cmployce has a righllo be reslored Lo
his/hcr fOrlllCr officc or class position and stalus formcrly held by the employee in
LlIC same locality and in Lhe same County dcparlmcnt. If lhe ollice or class position
0001.503
-.... Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 35 of 93
t
has becn abolished or olherwise has ceased 10 cxiSI during the employec's abscnce,
hc/she shall be rcinslalcd 10 a position of likc seniority, st;ltuS, and pay if a position
exists or, if no posilion exists, thc cmploycc sha/l ha\'c tllC samc rightc; and pri\'ilcgcs
lhal hc/she would have had ifhc/shc had occupied lhc dass posilion whcll il ccased
10 cxisl and had nollakcn a tcmporary military lea\'cof abscncc. (Hc\', /0 I)
120 I AS Othcr Militan' Lcaves Any Counly cmploycc who \'olunlcers for oris rcquired lo scr\'c
as a mcmbcr of any branch of the armed forccs (including, bUI nol limitcd to, initial
cnlistment), shall bcgrantcd a military leavc of abscncc witholll pay for a pcriod ofone
cnlislmenl, nollo cxcccd fivc (5) years' duration, prm'idcd a copy of tllC military ordcrs
accompany tllC request for military leavc. Thc cmploycc's scniority elatcs (i,c" County,
Vacation and Incrcmcnt) will not be adjustcd for UlC duration ofthc Icavc; howc\'cr, tllC
cmployce willnol accrue bcncfits, which arc bascd on mcrit or hours workcd (including,
but not limitcd to mcation and sick Icave). IVlilit;Il')' leavcs of abscncc arc gm'crncd by
both lhc California l\1ilital')' and Vetcrans Codc scctions 389 ct scq. and Tille 38 oflhc
Unitcd Slatcs Code, sections i~30 I ct scq. (Hc\', /01)
120 I A5.1 () Pursmmt to titlc 38 of UIC Unitcd Slatcs Codc, section 1312, an cmploycc rcturning
from an appro\'cd militaJ)' Icavc of abscncc shall be cntilled to rcturn to his/hcr
formcrly held class position wilh the County, without loss of standing, as dcscribcd
abovc, providcd thc rcturning cmploycc notilics tllC County of his/hcr intcnt to
return to work in accordancc witll UIC noticc prm'isiolls listcd below:
An cmploycc who hasbecn on milital')' Ica\'c for less than tllirly-onc (31) days mllst
notify tllC County's Pcrsonnel DcpartmclIl,in writing, of his/her intcntto rcturn to
work no latcr tlla)) thc beginning of thc first full pay pcriod on UIC first fuJI calendar
day following tllC complction of thc pcriod of scrvice and thc cxpiration of cighl
hours alicr a pcriod allowing for thc safc lransporlation of the cmployee from tllC
placc of scn'icc 10 tllC cmployee's rcsidcncc; or, if ulrough no fault of his/llcr own,
thc employcc cannot rcport as scl fortll abo\'c, he/shc must do so as soon as possible.
An cmploycc who has becn on military lcavc for more than lhirty (30) days, b)Jlless
than 181 days will be retaincd on thc County pa}ToJlin an inactivc status. ·Thc
cmployec must notify thc County's Pcrsonnel Dcpartmcnt, in writiJig, of his/llcr.
intcntto rcturn to work no latcr than fourlccn (1,1) days aftcr tlle complcLioll oflhc
scn·icc; or, if tl Irough no fault of his/llcr own, thc employce is unablc to providc tllC
",rillcn noticc in tllC manner dcscribed, Ulell he/shc must do so by thc lirsl full
calcJl(.!ar day possiblc.
An employcc ",ho has bccn on mililal')' Icavc for morc than 180 days mustnoLify tllC
County, in writing, or his/hcr intcntlo rcturn lo work no later tllan nincly (90) days
after complction of the sen·icc.
NOlwiulstanding thc foregoing, the Coullty may refuse to re-employ an cmployee

rcturning from mililal')' leavc if: 1) Thc Coullty's circumstanccs havc changcd so
0001.504
,
...,
murh as to makc thc rc-cmploymcnt impossiblc or unrcasonablc; 2) Thc class

position from which the pcrson prcviously held has bcen dclclcd atHllhcrc arc no
similar or comparable positions; :~) Hc-cmploymcnt would causc undue hardship on
thc COllnty; and/or Ii) Thc employmcnt from which thc pcrsoll Jell was for ahrief,
non-rccurrcnt period and therc was no rcasonablc expcl"lalion the job ,,;ould
continue iJl(lclinitcl}' or for an)' significant pcriod. (Rcv.II/OI)
1201.50 Lc;l\'c lor Compcnsahle Disabililv. County cmployccs shall hm'c an automatic \cave of
abscnce from employment during such pcriod as the cmployec is eligiblc to rcccivc
temporary disabilily compcnsation undcr thc workcrs' compcnsation laws of thc Statc.
Said Ieavc shall aUlomaucally lcrminatc when lhcrightto such compcnsation tcnninalcs,
thc cmploycc is dctcrmincd b)' UIC Risk l\1ilnagcmcllt Division of thc Counl)' Counsel's
Ol1ice not to bc c1i/,rihlc for workcrs' compcnsation bcnclits, thc cmploycc has heen
released to rcturn to work by a doctor aUUlOrizcd by thc Hisk I\'lanagemcllt or a Counl)'
doclor, orUlc cmploycc rctires from Coullty sen'ice, whichcvcr occurs firs!.
Employecs may usc sick lca\'c during thc Ica\'c herc prm'ic1cd for ill accordancc ",ilh
Ordinancc Codc Scction 3.28.110. Employees dclermillcd 1I0t to be eligible for
\Vorkcr's Compcnsation bcncfits shall havc all Icavc timc taken undcr Ulis scctioJl
cOJlvcrtcd 10 allowablc lca\'es under Scctions 1201.20, or 1202.20 of the Civil Sc....·icc
Hulcs, as applicablc. (Rcv.01/97)
To thc maximum cxtcnt pcrmiLlcd by law, alllcavcs aUUlOrized by ulis Rulc shall run
collcurrently wilh Ieavcs takcn pursuant to Rule 1201.30 and shall COUllt against the
twelvc (12) wcck limit containcd in Hulc 1201.30. (Rcv. 01/97)
1201.50.10 Employccs who arc on a compensable disability Iea\'c of abscnce shall submit a
slatcmcnt of their condition from ulcir doctor to their appoillting authoril)' as long as
the)' rcmain on such Icavc of abscncc. (Rcv. 8/92)
1201.50.20 i\ny cmploycc who is gralltcd a scn'ire-conncctcd disability retircmcnt 'Uld who later
is dctcrmincd by the Rctircmcnt Board to bc no longcr in('apacitate(\;md who dcsires
to rcturn to acu\'c Count)' cmploymcnt and·is re-cmploycd shall bc decmcd to havc
bccn on an approvcd lca\'c of abscnce withoul pay for thc pcriod of Limc hc/shc
rccci\'cd said sen,j('c-conncclcd disability. (Rc\'. 8/92)
1201.GO Familv School And Liccnscd Child nay Care Activitv Leavc. Any fun-time or part-time
County cmploycc who is a parcnl, /",.mrdian or grandparent WiUl custody of a child in
gradcs Kindcrgartcn uuough Twch'c or allcnding a liccnscd child day carc facility, shall
bc cntiucd to, upon propcr wriUcn requcst to thc appointing authority, a )ca\'c froril
work up 10 a maximum of forty (:to) hours pcr ycar, but no more Ulan cight (8) hours ill
any calendar mOllth, to participatc ill UIC artivitics of UlC school or liccnscd child carc
/:lCilily of any of his or hcr childrcn. The cmployee shall use vacation, compcnsatory
time-olr or an)' othcr paid leave allowallces othcr Ul,l\l sick IC;l\'c. If the employcc has
0001505
KERN COUNTY PERSONNEL DEPARTMENT
:>ARTMENT _ _ (_<_P_C!-_·~
__·~--r~7-7r-----'------'-- DATE
~-l,J,-O t _
SOCIAL SECURITY NUMBER JOB TITLE
o INITIAL REQUEST EXTENSION REQUEST
DATE LEAVE OF ABSENCE STARTS DATE LEAVE OF ABSENCE ENDS RETURN TOWORK DATE
PE OF LEAVE: (Reference Civil Service Rule 1201.00 et. seq. and Kern Co. Admin. Proc. Manual Chapter 3)
MANDATORY LEAVE OTHER MANDATORY LEAVES 2. PAY STATUS

FMLA·/CFRA...· o Military (Reserve) CSR1201.40 OWithPay
~ Non-Job Relatedllilness or Disability and o Family School Activity Leave CSR 1~01.60 oSick Leave Accrual
, 'pregnancy Disability Leave CSR 1201.20 oVacation Accrual
o Intermittent-Employee CSR 1201.30 DISCRETIONARY LEAVES oCompensatory Time
o Family Care Leave-Family CSR 1201.30 o Personal Necessity CSR 1202.20 OCatastrophic Leave
o Intermittent Leave-Family CSR 1201.30 o Military (Enlistment) CSR 1202.30 ~ithoutPay
o Compensable Disability CSR 1201.50 o Education/Personal Enrichment CSR 1202.40 3. Physician's Note
o Non-Promotional Probationer CSR 1~05.00 ·~es DNa
~ECIFIC REASON FOR LEAVE OF ABSENCE
_-....,.--~;rJ ~ ft /[ v:dI~~~---'I--:----'f""""~-r-lj-tt.---·-,
~ I
----
equest a leave of absence for the reason stated above and understand that I will receive no wages during this absence, If all applicable
:cruals have been exhausted; further, that my rate of paywill be SUbject to any general increases or decreases in wage rates that become
fective during my absence from work; and that my return 10 work will be subject to employment conditions existing at the time of such
tum.
Inderstand that leaves taken for Non-Job Related/Illness or Disability and Pregnancy Disability, Compensable Disability, or Catastrophic
~ave require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided
termiltently to cover all periods of leave taken.. Also,l may be required to pass a medical, physical and lor psychological examination
: County expense prior to returning to duty if the illness or disability may affect job performance or the health or safetyof fellow workers
• the public.
31so understand that if my leave of absence is approved, the payment of premiums for my medical and dental benefits maybecome my
lsponsibility to continue co~erage during the leave of absence. (Contact Health Benefits (868-3182) for information concerning your
bligation and options in this matter.)
APR 2 6 ~
,EPARTM EHT HEAD RECOMMENDATION

cs ..,£udJ~_. -.:"'~
CIVIL SERVICE COMMISSION ACTION

o APPROVED DATE _ o APPROVED

DATE _
o DATE _
o NOT APPROVED DATE _ NOT APPROVED
ignature _ Signature
, Fam;~I' mId Medical Len\'e Act of 1993 DISTRIBUTION:

WHITE. PERSONNEL oeP"'RTM~NT
•• Californin Fami(I' R(f{ll/s Act
000:150' CANARY - HEALTH BENEFITS
F:NK. ~?~Jt~T't:G OEPAF.n.~EtlT
INSTRUCTIONS ON REVERSE SIDE GOLOENROD· EMPlOyEE
"
.
'
Wi
'J
. \
4
KERN MEDICAL CENTER

ADMINISTRATION
OFFICE MEMORANDUM
C-O-N-F-I-D-E-N-T -I-A-L
TO: David Jadwin, D.O. DATE: April 28, 2006
Chairman, Department of Pathology .... ~
//'-7~
::::~: :::~c: :::' CEO (~ ----
The purpose of this memorandum is to summarize our brie~ng today concerning your medical
leave of absence. In attendance were you, Karen Barnes, Steve O'Conner, and I.
I provided you with the summary ofyour medical leave history (see attached). This packet contain~
the calculations and policies related to how the County ofKem handles medical leaves. In essence,
you have 137 hours available to be taken before you hit the 480-hour limitation. Medical Leaves also
run for a maximum of six months so this criterion sets June 16, 2006 as the last day available to you
under this status. You said that you did not have any questions and I referred you to Human
Resources, Steve 0' Conner, should you have any questions about how to interpret the leave
provisions.
You also mentioned that you were scheduled to work on Monday May 1,2006 and asked if! wanted
you to be present. You also indicated that from that date, you would be out until further notice. I
left the option of working on Monday to you and asked that you coordinate with Dr.. Dutt about
coverage. I also mentioned that after Monday it would be preferable for you not to have an
intermittent work schedule and it would be easier on the department to just have you on leave until
your status is resolved.
Finally, I said that by June 16, 2006 you needed to give me your decision about your employment
status. Your options were to either return full time or resign your position. As chairman, your
department and the hospital needs you here full time. You indicated that you understood the
deadline.
PKB:abra
O:\Pcrsonnel\042806Jadwin.doc
cc: Karen Bames, Deputy County Counsel
Sandra Chesler, Chief Operating Officer
0001.507
.
'4 ,
\
I" .
. .
CONFIDENTIAL
0001.508
4
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0001.50 9
Case 1:07-cv-00026-OWW-TAG Document
KERN COUNTY 277 DEPARTMENT
PERSONNEL Filed 12/01/2008 Page 41 of 93
_~-+.'_(,_._~
__W-L-5-f-'1~ _ 3/~!O It?
.,vlENT
-+ NMlE
J
I SOCIAL SECURITY NUMBER
DATE
)
JOB TITLE
INITIAL REQUEST o EXTENSION REQUEST
DATE LEAVE OFABSENCE STARTS DATE LEAVE OF ABSENCE ENDS RETURN TO WORK DATE
YPE OF LEAVE: (Reference Civil Service Rule 1201.00 et. seq. and Kern Coo Admin. Proc. Manual Chapter 3)
I. MANDATORY LEAVE OTHER MANDATORY LEAVES 2. PAY STATUS

FMLA*/CFRA- o Military (Reserve) CSRl20140 ~ithPay
o Non-Job RelatedllJlness or Disability and o Family School Activity Leave CSR 1201.60 ~ick leave Accrual
e. nancy Disability leave CSR 1201.20 . ,E?Jacalion Accrual
o :! Intermittent-Employee CSR 120UO

amily Care Leave-Family CSR 1201.30
o
Intermittent Leave-Family CSR 1201.30
DISCRETIONARY LEAVES
o
o
Personal NecessitycsR 1202.20
Military (Enlistment) CSR 120230 o
o
o
Compensatory Time
Catastrophic Leave
Without Pay
o Compensable Disability CSR 1201.50 o Education/Personal Enrichment CSR 120VO 3. Physician's Note
o .,
Non-Promotional Probationer CSR 1205.00 ~Yes 0 No
L I;? /. 1-i-t..
r l . 7
;PECIFIC REASON FOR LEAVE OF ABSENCE
·equest a leave of absence forthe reason stated above and understand that I will receiveno wages during this absence,lf all applicable
::cruals have been exhausted;further, that my rate of pay will be subject to any general increases or decreases in wage rates that become
iective during m:y absence from work: and that my return to work will be subject to employment conditions existing at the time of such
·!um.
~nderstand that leaves taken for Non-Job Related/lilness orDisabilityand Pregnancy Disability, Compensable Disability, or Catastrophic
lave require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided
~ermitlenlly to cover all periods of leave taken. Also, I may be required to pass a medical, physical and lor psychological examination
County expense prior to returning to duty if the illness or disability may affect job performance or the health or safety of fellow workers
the pUblic.
Iso understand that if my leave of absence is approved. the payment of premiums for my medical and dental benefits may become my
iponsibilily to continue coverage during the leave of absence. (Contact Health Benefits (868-3182) for inforl11ation concerning your
ligation and options in this mailer.)
P&ARTMENTHEADRECOMMENDATiJN CIVIL SERVICE COMMISSION ACTION
APPROVED DATE
?j I"·'V
) L o APPROVED DATE _
I
N TAPPROVED} DATE _ o NOT APPROVED DATE _
lature I
C
,
_/.!!
. .-'. i '
Signature~ _
·nmity nntf-:>Tedicn/ Lemoe Act 01/993 DISTRIBUTION:

·nlifornin Fnm;~I' Rights Act 0001.51.0 WHITE ·PERSOIItIEL DEPARTI.tEIIT
CANARY .HEALTH BENEFITS
FH:K ~;"PPCItHIUG DE.?ARiUE~H
.'80 8!:-'0 39S-5230(10!OO)(Fron'l INSTRUCTIONS ON REVERSESIDE GOLDENROD·EMPLOYEE
KERN COUNTY PERSONNEL DEPARTMENT
DEPARTMENT _ _ t:._=_D_, _(2._~_.

__ k>-r-
~
7-+'1_-_--'-------'--
(
DATE
SOCIAL SECURITYNUMBER JOB TITLE
o INITIAL REQUEST \J.1EXTENSION REQUEST

I'
DATE LEAVE OF ABSENCE STARTS DATE LEAVE OF ABSENCE eNDS RETURN TOWORK DATE
(3J~J&t) i-;-s- tJl., Cf-=jt. - b~

TYPE OF LEAVE: -- ,
(Reference Civil Service Rule 1201.00 et. seq. and Kern Co. Admin. Proc. Manual Chapter 3)
1. MANDATORY LEAVE OTHER MANDATORY LEAVES 2. PAY STATUS

FMLA*'CFRA H
o Mililary (Reserve) CSR 120140 DWithPay
~On-JOb Relatedllllness or Disability and o Family School Activity Leave CSR 1201.60 o
Sick Leave Accrual
regnancy Disability Leave CSR 120120 o
Vacation Accrual
oIntermittent-Employee CSR 1201.30 DISCRETIONARY LEAVES o
Compensatory Time
0 Family Care Leave-Family CSR 1201.30 o Personal Necessity CSR 1202.20 o
Catastrophic Leave
oIntermittent Leave-Family CSR 1201.30 o Military (Enlistment) CSR 120230 ~ithoutPay
0 Compensable Disability CSR 1201.50 o Education/Personal Enrichment CSR 1202.40 3. Physician's Note
o Non-Promotional PrObationer CSR 1205.00 ~es oNo
SPECIFIC REASON FOR LEAVE OF ABSENCE . ~

/2 . ~~__
. jda:J;_.. ~_/-::----:>....--_~ _
___=1;r J t-W-n= Y ~ ~V' . _,.vr--'-r G_r_Lj-f-._t<---
__' _
I
I request a leave of absence for thereason stated above and understand that I will receive no wages during this absence, If all applicable
accruals have been exhausted; further, that my rate of paywill be subject to any general increases or decreases in wage rates that become
effective during my absence from work; and that my return to work will be subject to employment conditions existing at the time of such
retum.
Iunderstand that leaves tak~n forNon-Job Relatedllliness or Disability and Pregnancy Disability, Compensable Disability, or Catastrophic
Leave require verification from a medical doctor of incapacity to perform the job duties and such written verification shall be provided
intermittently to cover all periods of leave taken. Also, I may be required to pass a medical, physical and lor psychological examination
at County expense prior to returning to duty if the illness or disability may affect job performance or the health or safety of fellow workers
or the public.
I also understand that if my leave of absence is approved, the payment of premiums for my medical and dental benefits may·become my
responsibility to continue coxerage during the leave of absence. (Contact Health Benefits (868-3182) for information concerning your
obligation and options in this matter.)
APA 2 6 2Xl6
c:::=:-1
~~J~_.
II. ~ n~
~ Signature or Employee
DEPARTMENT HEAD RECOMMENDATION CIVIL SERVICE COMMISSION ACTION
DATE _ o APPROVED DATE _

o APPROVED
DATE _ o NOT APPROVED DATE _

o NOT APPROVED
Signature _ Signaturec-- _
DISTRIBUTION;
000151.1.
, Fami~)" and Medical Lem'e Act of /993
WHITE·PERSONNElDEPARTP.tEIIT
,. California Fallli~I' Rig/liS Act CANARY· HEALTH BENEFITS
PIIIK· A?Pon~TltjGDEPARTMEtlT
INSTRUCTIONS ON REVERSE SIDE GOLDENROO·EMPLOYEE
JADWIN DAVID FRANK 376-50-8177 8997
VACATION S/L VACATION S/L CT C

BW REG B/2 C/3 S/L FSL VAC OT ;< CTT TOTAL EARNED EARNED BALANCE BALANCE EARNED BA
05-25 1'0: 0 _ \.-;r LU k 'J.Qt aYI w.'l 8.0 16.0 80.0 5.23077 3.07000 9.78148 9.73040 0.0 O •.
05-26 40.0 9.7 8.0 57.7 3.77269 2.21423 5.55417 2.24463 0.0 O. '
06-01 57.5 2.2 59.7 3.90346 2.29098 9.45763 2.33561 0.0 O. I
06-02 60.3 60.3 3.94269 2.31401 13.40032 4.64962 0.0 O. (
06-03 41.5 41.5 2.71346 1.59256 16.11378 6.24218 0.0 O. (
06-04 16.0 6.2 16.1 38.3 2.50423 1.46976 2.51801 1. 51194 0.0 O. (
06-05 12.0· 1.5 2.5 16.0 1.04615 0.61400 1.06416 0.62594 0.0 o. (
06-06 17.7' 7.0 17 .1 41.8 2.73307 1.60407 2.79723 1.63001 0.0 O. (
06-07 30. O. 30.0 1.96153 1.15125 4.75876 2.78126 0.0 o. (
'1/ /'f ==::= ===== ===== ===== ===== ===== ===:.= ===== ======
..-3;3-r:'O .0 .0 34.6 .0 59.7 .0 .0 ,4.2~j'
316"
~/
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it P1~ tuw M'J 4~u
Cv\t{~ ~
D?/25 = 12./~ _ (2·/Z:) ~'? q~ .~ - YCGa ~W e~ {s ,'()01',tt)
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~~-----1
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 44 of 93 1
141009
1
1
contract year. Unused education leave will not be paid upon termination of
employment. All education leave must be approved in advance of use by the
1
1
1
county shall provide Core. Physician the right to unpaid leave of absence
provided to other regular County employees of KMC pursuant to County policy. 1
County may change its policy regarding leave of absence, as its policy for leave
of absence shall change for other County employees of KMC. Any such change 1
1
5. RETIREMENT PLAN
1
A. Core Physician shall participate in the Kern County Pension Plan and
Trust Agreement for Physician Employees (the "Plan"), a qualified defined 1
contribution pension plan, pursuant to the terms of the instrument under which
the Plan has been established (the "Plan Document"), as from time-to-time 1
amended. County shall withhold 3.1 percent of Core Physician's biweekly gross
salal)'(that is, before deductions inclUding taxes) and pay such amount within a 1
reasonable time as the Core Physician's mandatory employee contribution
reqUired under the Plan Document. County shall contribute an additional amount 1
equal to 12.5 percent of Core Physician's biweekly gross salary (that is, before
deductions including taxes) as County's required contribution under the Plan 1
Document. Total contributions by Core Physician and County will not exceed the
yearly amount allowed by law; provided, however, if any amounts are contributed 1
in excess of such permissible amounts, the excess contribution shall be
corrected as provided in the Plan Document or under law. Any changes in the 1
Plan Document will control the terms of this Agreement.
1
B. Subject to the receipt of a favorable determination letter from the Internal
Revenue Service, County will amend and restate' the Plan Document to 1
substitute a fixed-dollar contribution by County and Core Physician in lieu of the
contributions provided in the immediately preceding paragraph A. County and 1
Core Physician contributions for each Plan yea( (as defined in the Plan
1
1
Thousand Five Hundred Dollars ($17,500) for the account of Core Physician for
each complete Plan year of service (as defined in the Plan Document) by COfe
1
Physician. Core Physician's mandatory employee contributions required under
the 3mended and restated Plan Document shall be as follows: If Core 1
Physician's Compensation (as defined under the Plan Document) was One
Hundred Fifty Thousand Dollars ($150,000) or less during the immediately 1
1
9
1
0001.51.3 .
1
1201.00 I"'JANDATOHY LEAVES OF ABSENCE
1201.10 Noticc of Lca\'c. Any Count)'cmploycc rcqucsling a IC;I\'c of absence without pay
ulllb Sl:djons 1201.20, 1201.30, on-olullta!')' leave umler Section }20 1.,'10 shall, when
possiblc, gi\'c noticc of that rcqucstlO Ihe appointing authority, in writing, 1I0tiess than
30 days prior 10 the date LJIC lea\'cis 10 commcncc. Such lIoticc shall bcforLJlwith
forwarded 10 UtC Director by the appointil 19 autllOrity. The notice shall be suhmillcd on
a form prcscribcd by UIC Commission and shall spccify t1IC lea\'c to bc lakcn, UIC rcason
or rcasons Ulcrcforc, and, to t1le cxtent possible, tIle beginning and CI lding dales of thc
Ica\'c. (He\,. 8/92)
1201.20 Non-}oh-Hclatcd IIIncss or Disabilit\' and Prq,'Jlanc" Dis;,bilit\·. A Counly cmployee

shall bc granted a lea\'c without pay for an incapacitating non-job relatcd illness or
disability ofthc cmploycc, including a disability resulting from prcgnancy, childbirul, or
relatcd condition. The Ica\'c entitlemcnt shall he subjcct to LJlcfollowing conditions: (I)
thc nccessity for tllC Iea\'c shall bc ccrtificd by a mcdical doctor, \\,ho shall also stale LJlat
tlIC'; clllpluycc will bc mcdically aule to returll to work at tllC expiration of tllC ka\'c
period; and, (2) thc Iea\'c period(s) aut1lOrizcd by Hulc 1201.20 shall not cumulatively
cxceed six (6) months during any twel\'c (12) montll period exccpt as required by law.
(HC\·. 01/97)
lIsc of t1lis lea\'c is subjcct to tllC cmployce using all sick Iea\'c accnlcd prior to the
cffeCli\'c date of thc Iea\'c of abscllcc. Employccs shall bc cntitlcd to usc any othcr
accrued lea\'c balanccs, concurrcntly with LJIC Ica\'c gi\'cn by this scction.
Vcrilic;ltion from a medical doctor of continued incapacity to perform tllC job dUljcs
shall!.>c rcquested by tllC appointing aUlhority. Thc employec lIlar bc requircd to pass a
physical, mcdical alldlor psychological cxamination desi,!,'llaled by County, at Counly
cxpensc, prior to returning to uuty if thc illness or disability may alTectjob performancc
or thc hcalt11 and safcty of tllC cmployee, eo-workcrs, or t11C public
(Hc\,.01/97)
To the maXill1ll1l1 cxtent pcrmitlcd by law, alllca\'{~s authorizcd by t1lis Hulc shalll1.lIl
concurrcntly \\;th Ica\'cs takcn pursuant to Hule 1201.30 and shall count against thc
twelrc (12) wcek limit containcdin Hulc 1201.30. (He\·, 01/97)
1201.:~O t\J;lIIdatcd Famih' and ivledicaJ LC;I\'cs - (Emplorccs and Famild
'I 'he purposc of lhis Hulc is to implemcnt lean~s which are lIland;ltcd by thc Family and
Mcdical Lea\'c Act of 1993 ("F~IL.A") and LJIC C;I1ilornia Family Hights Act "CFRN').
Eli,!,~hlc cmployccs may lISC 1c;I\'cs aut1lorized by ulis Hulc 011 an intcrmiltcllt basis to thc
extcnt that thc Counly is rcquircd to pcrmit intcrmiltcnt lea\'cs undcr I'M LA and/or
CFI0\. \VhclI pcrmiltcd, illtcnnitlcnt learc lIlay bc lakcn in pcriods fromonc hour (0
se\'cral wceks, up (0 a lotal of ·j·80 hours for full-timc cmployees and prora(cd
accordingly lor part-timc employccs. (Hc\,. 01/97)
00015j.4·
Family alld mcdical Ieavcs of abscncc arc ;I\'ailablc 011 all ullpaid basis 10 eligible
cmployecs, III ordcr 10 qualify for a Iea\'c, all cmployec musl: (a) ha\'c bccn cmploycd for
atleasl lwdvc (12) mOIlI1,s (rhc twelvc (12) mOlllhs do !!illllccd 10 bc COIISCCUU\'c); and
(b) workcd at least 1,250 hours of scn'icc during thc I 2-muJllh pcriod immcdialely before
UIC commcllccmcnt ofthc leave, (Hc\', 01/~)7)
:\ n c1igi hlc cmploycc may rCCJllcslllp 10 I\\'ch'c (12) wccks 1c;I\'c in a twelvc (I2)molllh
period for tJIC following reasoJlS:
I, Thc carc of a ncwborn child;
2. Thc careol" a child who has bccn placcd wiul an cmploycc for adoption or
fostcr carc;
3. Thc carc of a spousc, child or parcnt (including, bUI not limitcd to, pcrsons
who stand "in loco parcntis") who has a scrious hcalth colldiuon; or
·L Thc scrious hcalth condition of thc eligible cmploycc which prc\"Cllts thc
cmployce from performing onc or morc of UlC esscntial funclions of his or
hcr job, (Hc\', 01/97)
\Vhcn both parellts arc cmployed by UIC CoulIly, UIC amoullt ortca\"c for bonding (j;
c., birul, adoption, or fostcr care pbcemcnt) is limitcd to all aggrcgatc of twelrc (12)
\rccks, betwcen U'C parcnts, ill a twckc (12) monU1 pcriod. For allY oUlcr Icarc
auulOrizcd by Lhis Hule, cach parcnt is allowed twelve (12) wccks IC;I\'c, in a twelre
(12) 11101lU, pcriod, less any bonding lea\'c takcn by Ih;,t parellt during thattwcl\"c
(12) 1110nth period. (I 2/05)
Thc twch'c (12) month period uscd to mcasurc thc twch'c (12) wcck limitatioJl will hc
Lhe rolling twch'c (12) monu, period mcasurcd backward from the datc thc !ca\'c is lIsed.
UIIdcr UIC rollillg twch'c (12) monlh pcriod, cach limc an cmploycc takes leave, lhe
rcmaining learc balancc consists of UIC porlionof thc lwch'c (12) wccks that was not
lIscd d ming U'C immcdiately prcceding twcke (12) months. (HC\'. 01/97) .
Employccs shall exhaust all accrued sick Ieavc 10 the m;L\:imum cxlcllt pcrmillccI, ;Iltlle
COlllnJCllccmcnt of UIC lean:. Employccs shall be elltitled to usc ilny oth<:r accrucd
!c;\\,c balances, concurrcnuy WiUI UIC Icavc gi,'clI by this section. This Hulc iSllol
intcnded to supcrsedc u,c pro\'isiolls of Kcrn County Ordinancc Codc Section
3.28.010, which limits u'c amount of sick lea\'c which an cmploycc ma}' usc lor illncss of
mcmbers of the cmploycc's immcdiatc family. (He\', 01/97)
If an cmployec rcqucsts a Iea,'c due to a serioushcalth condition ofLhccmployec or a

I;unily lllCIll bcr, UIC cm ployec IJ1 ust su pport UIC request with a lega II)' sufficicnl
0001.51. 5
n:rlificalion issued by lhe heahh carc prm'ider of lhc individual will uhc serious heallh
cond ilion. Tllc appointing aUlhorily mar rcquesl subscqucnl re-ccrtilicatioll of mcdicill
mlidilions ;IS pennilled b}' law. (Hc\'. () 1/97)
For ka\'es granlcd duc 10 a serious heahh condition of the cmployee, lhc employee may
be required 10 pass a ph)'sical, medical and/or psychological cxamination dcsignaled by
Counl}', at thc COllnly's cxpcnsc, prior 10 rClurning for dULl' if lhc scrious hcallh
condition may aOcctjob performancc or thc hcalth, satel)' of llic cm ployec, co-workers
or lhe public. (He\,. 01/!}7)
To lhc maximum cxtcnl pcrmillcd by law, ;Ulr !c;I\'c lilken by an cmploycc undcr 1I1is or
any olhcr Rulc or authorilY shall bc crcdilcd ag<linstlllc l"'ckc (12) wcck limil conlaincd
ill uJis Hule. The Ieavc pro\'ided br Ihis Rule shall rUIl concurrently wilh all othcr
lea\'Cs, \\'hich applr 10 1I1e cmploycc's abscncc. (Hc\,. 01/97)
120lAO TemJlorar\' Militarv Lca\'c Pursuallilo California l\Iililarr alld VClcrans Codc SCCtiOIlS
3!}S alld 395.01', any County cmployce who is a mcmbcr of lhc rCSCITC corps of thc
.\nncd Forccs of lhc Unilcd Stales or of 1I1c National Guard or thc Na\'al i\lilitia, is
cnlillcd to a tcm porar)' mililalJ Iea\'c of abscncc whilc cngagcd illmililarr duty ordcrcd
for thc purposcs of ;ICti\·C military trailling, inactivc dutr training, Cnc;Un!Hllellt, na\'al
cruises, special cxcrci'scs or likc acti\'ily, prO\'idcd t.hallhc pcriod ofordercd dUly docs
nol excccd 190 calendar days, including timc in\'oh'cd in going 10 and reluruing from
lhal duly; and, prO\'idcd a copr of 1IlC militalT ordcrs accompany lhc rcqucst for milil;lI)'
Ieavc.
Any cmploycc who has bccn ill UIC scn'ice of lhc Counl)' for at Ieasl OIlC ycar,
immcdialcly prior 10 lhc dalc UpOll which a lcmpor;IIT mililiuy Ica\'c of abscncc bcgins,
shall, 10 1I1c cxtcnl rcquircd by la\\', bc entiucd 10 rccci\'c Ilis/her salary for 1IlC firsl.30
calendar days of such Iea\'c and, shall accrue UIC samc \'acalion, sick Ica\'c and holiday
pri\'ilegcs and 1I1e samc righls and pri\'ilcges 10 promotion, colltilluailCc in ollicc,
employment, rcappoinlmclltlo oflice, or re-employmclltUlal UIC cmploycc would ha\'e
cnjoyed had hc/she nol bccn abscnlUtercfrom; hO\\'c\'er, ;U1y uncompletcd probational)'
period must be completcd upon rcillslatcmcnl. (fl)r purposcs of ulis seclioll, in
dclcrmining UIC onc year of scrvicc wilh lhe Coullly, all sen'ice of lItC public cmploycc
inlhe rccognized mililary scrvice shall bc coulltcd as COli/II)' scrvice). Thc cmployce's
sellioril)' dalcs (i.c., COUllty, \'acalion ami Incrcmcnl) will nol be adjustcd lor thc
duration of 1IlC Ieavc. Thc cmployec ma)' ulilize \,;\calion and compcnsatory limc oIl"
accruals bcfore beginning in a non-pay slatus. N olwilllsianding thc aho\'c, an Clilplo}'ce
011 lemporal r lIIilitary lea\'c for lhc purpose of"inaclj\'c dUl}' trailling" is not. cntitled 10
ha\'e all}' or his/llcr salary paitl as describcd abo\'c. (Hc\'. /0 I).
1201..1·0.1 () Pursuanllo Califomia j\Iililal)' and Vctcrans Codcseclion 395(c), upon cxpiralion of
an}' tcmporary mi/itarylea\'c of ahsellCc, an cmployec has a right 10 bc rcstorcd 10
his/hcr fOrlncr officc or class posilion and slat us formcrly held by t.hc cmploycc in
1I1e same localily and ill Ihc same Coullty deparullcnl. If thc orJice or class posilioll
000:151.6
· '
has hccn abolishcd or othcrwisc has ccaseel to cxist e1l1rin~ thc cmplo)'ec's ;lhsencc,
hc/shc shall hc rcinstatcd 10 a position of like scniority, st;ltus, and pay if a position
exists or, if no position cxists, thc cmploycc shall ha\'c thc samc righL~ and pri\'ilcgcs
lhat hc/shc would h;l\'C~ had if he/shc had occupied the class position when it ceaseel
to cxist ;lIId had notlakcn a tClllporary milital1' Ica\'c of abscncc, (He\', /0 J)
120 I AS Olher T\fililarv Lcavcs Any Count}' cmplo)'ee who mlllntccrs for or is required to sc.....c
as a mcmbcr of an}' branch of thc armcd forces (including, 'but not limilcd to, initial
enJi5IJllcI1I), shall bc granted a militall' /ca\'c of absencc \rithoLJt p;iy for a pCl'iodof OIlC
cnlistmcnt, not to cxcccd firc (5) ycars' duration. prO\'idcd a copy of the miJitall' ordcrs
accOlnpany thc rcqucst for military !carc, Thc cmplo)'ec's scniority dates (i,c., County,
Vacatioll and Illnemcnt) will not bc adjustcd for UIC duration ofthc Ica\'c; howc\'cr, tJIC
cmplo}'ce will not accruc hcncfits, which arc bascd ollmcrit or hours workcd (including,
but not limitcd to \'acation amI sick leal-c), Xlilitary !carcs of abscncc arc gO\'crucd by
hath tJIC California Mililall' alld Vctcrans Code scctions 389 ct scq. and Titlc 38 ofthc
lJllilcd Stalcs Codc, scctions ,130 I ct scq. (Hc\', /0 J)
1201..15.10 Pursuant to tiuc 38 of thc Ullitcd Slatcs Code, scction '1312, an cmploycc relurning
from an approvcd military Ica\'c of abSCllCC shall be clltitled to rcturn to his/hcr
formcrly held r1ass position with the County, without loss of standing, as dcscribcd '
abo\'c, prO\'idcd tllc rClurning cmploycc notifics UIC County of his/ltcr intcnt to
rcturn to \\'ork ill accordancc with UIC not icc provisions listed bclO\r:
All cmploycc wlto has bccn on mililary lea\'c for less lhan ulirtY-OIIC (31) days musl
1I0tify thc Coullly's Personnel Departmcnt. in wrilillg, of his/her intcllt to return to
,,'ork no later thanthc bcginning of thc first full pay pcriod on tJIC first full calendar
day following UIC completion of UIC pcriod of scrvicc and lhc expiration of cight
hours alicr a pcriod allowing for thc safc lransportation of thc cmployec from lhc
placc of sen'icc to thc cmploycc's residcnce; or, if through 110 fault of hi4hero\\'II,
lhc cmploycc cannot rcport as scl forth abovc, he/shc musl do 50 as soon as possible.
An cmployce who has bccn on mililal1' Icavc for morc than thirty (30) days. bu~ Icss
Ulan 181 days will bc rctaincd OlltJlC Coullty payroll in. ,Ill inacti\'cstatus. Thc
cmploYcc must notify thc County's Personnel Deparlmcllt, ill writing, of his/her
intentlo rcturu to work no latcr thall fourteen (J ,1) days Clncr thc complclioll of tJlC
sCITit'c; or, if tJlrough no falllt of his/hcr own,lhc cmploycc is ullablc to providc tJIC
writtcn noticc in LIlc manllcr dcscribed, thcn he/shc must do so by UIC first full
calcndar day possible.
An cmployce who has bccn on military lea\'c fOl' morcthan 180 dars lll11slllOtify UIC
COllllly, in writing, of his/he-r inlcnlto rctum to work no later tJlall nincly (90) days
ancr completion of thc scn'icc,
Not\\'iulstancling thc forq~oing, tllc COllnly may rcfuse to re-cmploy an clllploycc

rctumillg from military Ica\'c if: I) The County's rirclllllslall{'cs ha\'c challgcd so
0001517
Illuch as to make the re-emplopl1cnt impossible or ullrca!:onablc; 2) Thc class

position from which 111e pcrson pre\'iously held has bccn delctcd ;Illd 111erc arc 110
similar or comparable positions; :~) He-cmploymcllt would cause lIl1due hardship 011
the Coullty; illld/or 'I) The employmellt from \rhirh the person len was for a hrief,
1I0n-recurrcnt pcriod and thcrc was no rcasonablc cxpcctation thc job would
cOlltillllC illdclinitely or for allY signilicallt pcriod. (Rc\,.II/O I)
1201.50 Lea\'e lor Compensablc DisabiJit\,. Coullty employccs shall ha\'c an automatic !carc of
abscllce from employmellt during slIch period as the cmployee is eligible to rccci,'c
temporal)' disability compclIsation under the workcrs' compensation laws oflhc State.
Said Ica\'c shall automatically tcrmillatc whentJlc right to such compcnsationtcrminatcs,
the cmployec is detcrmined by lhc Hisk l\1anagclllclIl Di"ision of the Coullty COUIIScl'S
Ollicc not to bc e1igiblc for workcrs' compcnsaLion bcnefits, 111c cmployce has bcell
released to rcturn to work by a doctor authorizcd by thc Hisk Managcmcllt or a County
doctor, or UIC cmploycc rctires from COllnl)' sen'icc, whicllc\'cl: occurs first.
Employecs may usc sick !care during the Ica\'cherc pro\'ided for in accordancc wilh
Ordillance Codc Scction 3.28.110. Employecs dctcrmined not to bc c1i/:,';blc for
\ Vorkcr's Compcnsalion bcncfits shall ha,'c all Ica,'c Limc lakcn undcr ulis scctioll
COII\'crlcd to allowablc Ic;\\,cs under SecLiolls 1201.20, or 1202.20 of UtC Ci\'il Scr\'icc
Huks, as applicable. (Rc\,. 01/97)
To lhc maximum cxtcnt pcnnillcd by law, alllca\'cs authorizcd by tllis Rulc shall nlll
concurrcntly with Iea\'cs takcn pursuant to Hulc 1201.30 and shall ('ounl against thc.
lweh'c (12) weck limil containcd in Hulc 1201.30. (HC\', 01/97)
1201.50,10 Employccs who arc on a compcll$ablc disability Ica"c of abscncc shall submit a
statcmcnt of ulcir condilion fromlhcir doctor to their appointing authority as long ilS
they rcmain on such Ieaye of abscncc. (HCY. 8/92)
1201.50.20 Any cmployce who is granlcd a scrvicc-connectcd disability reLircmcnl ,U1el who latcr
is dctcnnincd by thc HcLircmcnl Board to bc JlO longcr incapacitatcd and who dcsircs
to rcturn to acLi\'c Counl)' cmploymcnt and is rc-cmploycd shall bc dccmedto ha\'c
bccn on iln appro\'cd Ica,'c of abscncc without pay for the pcriod of limc hc/shc
rccei\'cu said scnicc-conncctcd disabilit),. (Rc\'.8/92)
1'201.GO FamilY School And Liccnscd Child Day Carc Acti\'ilY Lea\'c. Any full-Lime or part-limc
COllllty cmploycc who is a parcllt, guardian or grandparcllt "'itll custod)' of a child in
grades Kindcrgarlcn ulrough Twelvc or allcllding a liccnsed child day carc facility, shall
hc entitled to, upon propcr wrillcn rcqllcstto thc appoinLing aUlhoril}', a Ieaye from
work up to a maximum of fort)' (.to) hours per year, but no morc Ulan cight (8) hours in
an)' calendar mOllth, to parLicipatc 'in UIC acli\'iLics of UIC school or liccnscd child care
1;lcility of any of his or hcr childrcn, The employcc shall usc \'acation, compcnsalol)'
limc-olr or any oUlcr paid Ieayc allowanccs Olhcr tJliln sick Ica\'C. If thc cmploycc has
000:15:18
110 paid ka\'c Limc accmcd, kll\'c without pay shall bc takcn. The cmployee shall, h~\"C
Iloticc of that rcqucst in writing to thc Dcpartmcllt Hcad no less thallthrce (3) working
days prior to tllC datc of tllC schcduled school or day care activity. If Loth parellL~ work
for thc samc departmeul, the departme!ll head Ill:!y limillhc lea\"e to the parent initially
making thc requcst. If rcquested to do so by thc dcpartmcllt head, tllC cmployce shall
pro\"idc wrillcll vcri/icalion of his or her participation in the school or day care aCli\·ily.
(Rcv.02/98)
1202.00 DISCRETIONARY LEAVES OF ABSENCE \VITHOUT PAY
1202.10 Hc(]uest for Lca\·c. Any Coullty employcc who occupics a rcgular r1assilied position
may apply for the discretiollary Ieavcs providcd ror inlhis Rule. Rcqucsts fOJ- all)' such
leave without pay shall bc made upon forms prcscribcd by the Commission and shall
statc spccilically the rcason for the rcqucst, thc datc whcn the employee desircs thc
Ieavc 10 commcncc, am) the specilic date of rcturn. The rcquest shall be dcli\'crcu to
tlle appointing authority for wrillcn rccommcndation that it be granted, modi/jed, Or
dcnied, and both the requcst and the rccommcndation shall bc promptly transmillcd to
tllC Dircctor by tllC appoiuting autllOrity. If tllC appointing alllhority recommcnds dcnial
or modilication of tlle lea\"c rcqucstcd, thcrcasons tllcrcfore shall bc commul\icatcd to
tllC Dircctor in writing. No such requcst shall Le dcnicd or modi/icd witllOUt notice to
the cmployec, who mar appcal tlle dcnial or modilication to thc Commissioll. (HC\·.
8/92)
1202.20 Pcrsonal Nccessitv Lca\·c.:\ny pcrmancntfull.lime or pcrmancnt part-Limc cmployec ill

tllC dassilicu scrvicc may bc grantcd, upon propcr \\'rillcll rcqucst and apprO"al of thc
appointing autllOrit)' and tllC Director, a Ica\"c of abscncc without pay not Lo excecd
thrce (3) months for pcrsollal reasons. <Hc\'. 8/92)
Appro\'al of such leavc wilhout p;l)' under this section shaH hc cOI\{Jiliollccl on lilldillgs
that:
l202.20.1 () TlIc situation or condition ncccssit;Jting Ica\'e is rcmcdial \\'itllin thc pcriod rcquesled.
(Hc\·.8/92)
1202.20.20 The situ;JLion or condition ncccssitating lea\'c is not remcdial by olhcr means.
(Rc\,. 8/92)
I 202.20.:~0 Rcfllsalto authorizc Ica\'c will rcsult in pcrson"l hardship or su/Terillg /e)r the employec
or the cmployec's immcdiate family. (Hc\,. 8/92)
1202.20.·H) Thc cmployec's ausencc will not substantially interfcre with the business or the afleeted
departmcnt. (Rc\,. 8/92)
000:151.9
1202,20.50 Thc elllployec shall usc all vacation bl\'C, holiday limc, and compcnsalory limc otT to
his/hcr credil prior 10 thc clTeco\"e elate ofthc Ica\'c or
ahscncc. (Hc\". 8/!)2)
1202.20~GO Thc employcchas cxhauslcd thc Iea\'c prm'ided fOl iii Section 1201.20 or $cclioll
1201,:10, or both, or is othcrwisc not eligihle for cither of such lca\·cs. (Re\'. 8/92)
1202.31,20 The posilion still exists and thc cl'nplo'ycc is olherwisc qualificd for the position. (Rc\,.
8/92)
1202.·10 Educational/Personal Enrichmenl Lea\'c. Any pcnnancnt full-timc or permancnt parl-

timc employcc in thc classified scn'icc may bc !{ranted, upon propcr wrillcn request and
appro\'al of thc appointing authority and the Dircctor, a le;\\'c of abscnce without pay
not to excecd onc (I) ycar lor cducalional or pcrsonal cnrichment purposes. Thc
cducational or pcrsonal cnrichment IC;l.\'c may bc cxtended, upon tJle proper writtcn
rcquest and appro\'al, one (I) additional ycar. (Hc\,. 01/9a)
1202.·11 An employcc granted an cducational/personal enriclnllcnt!c;\\,c ofabscncc without pay

shall, lor two (2) ycars, retain the right to bc appointcd to. thc lirst \"acant position
availablc in thc apprO\'ing department in the class of position which he/shc had
pre\'iollsly occupied prior to tJ1C lca\'c of absencc. (He\,. 01/93)
1~02.,12 During U1C pcriod of thc cducational/pcrsonal cnrichmcllt Ieavc of ahscnce, and for a
pcriod or two (2) ycars following thc completion orthc Iea\'c, if tJ1C cmployee is awaiting
a \'acancr in thc department which approvcd thc Ieaye in thc class of position which
hc/she had prcriously occupied, tJle employec shall bc retaincd on the payroll in an
illacti\'c statlls. During this period, tllc cmployec retains the same bcnefits as other
employccs 011 leave of abscncc for other purposcsundcr Rule 1202. If, alter two (2)
years following completion of thc educationaVor personal enrichmcnt leavc ofabsence,
a vacancy has not bccome a\'ailable to which thc cmployec can be appointed, then
payroll status will be terminatcd. If such occurs, the cmployec shall automatically be
placed on thc re-cmploymcnt list for tJ1C class OJ' classes in which the employee
previously held regular status. mC\·. 01/93)
1202A:~ Thc employec is obligated to accept tJ1C lirst appointmcnt ollcrcd rollowing completion
ofthc cuucation/pcrsollal cmicllJllcnllcave. Failurc to do so will rcsult ill tJlC forfeiture
of all rights undcr ulis Rule. (Re\,. 01/93)
1202,·H Rights undcr this Rule arc conditioned 011 thc cmplovec:
1202.H.IO lJsin~ all vacationlc;l\'e, holiday time, alld compcnsalory time o!T to his/her credit prior
to tJle cl1c(ti\'c date of the Ica\'e or abscnce. (Hc\,. 8/92)
1202,·(.·1..20 If thc cmployec fails 10 acti\'c!Y, continuously, ami succcssfully pursue an

euucatiolla!/pcrsollal cmiclullellt goal, tJ1C lea\'c or abscncc shall be imll1ediately
00015 2 0
canceled, amI tllc employee will losc thc rigllt to return 10 a posilion wilhin tltc
dassilicd sen·ice. (Hc\·.01/93)
1202..t·UlO Upon return from such !c;weol" absence to a positioi! within the r1a~sifi('c1 scn'icc, illI
employee shall bc clltillcu to, amI have reillslated to his/her credit, all sick Ica\'c
acculllulated hy him/hCJ" at UIC Limcof thc granting of Ihc leave of ahscncc; The
employce shall also relain the \'acation accrual ratc cnjoyed prior to thc Ieavc of
abscnce. The cmployec shall also havc his/her scniority c1atc rcslorcd, minus the
length of timc he/shc was on the leavc or absencc. me\'. 8/92)
120:1.0{) DLJR..\TION/EXTENSION OF 1,E:\VE.s \VITH0 l.lT PAY Lea\"Cs ofabscncc without

pay may bc approvcd for UIC maximum pcriod ofLimc as spccilicd illthcsc Rules bascd upon
thc rcason for tltc rcqucst. If tllc on!,,'inallcilvc of abscnce is not for thc maximum dur.llion
allowctl and thc cmployce dcsircs all cxtcnsion OfU1C oribrlnallcavc of abscntc, U1C cmployee
must rcqucst said cxtcnsion 011 the Ieavc of abscncc form and rcturn UIC complclcdform 10
thc appointing authority tCIl (10) days prior to thc cxpiration of the oril,rlllal Ieavc. Thc
appointing auulOrity, withappro\"al of thc Dircctor, may exlend such Ieavcs only to UIC
maximum time pcriodsspccificd hcrcin. (HC\·. 8/92)
120LOO RETURN BEFORE EXPIR:\TION

\ Vhellcvcr all cmploycc who has takcn a Ica\'c wiUlOut pay desircs to rctunJ beforc cxpiralion
of suclllcavc, thc cmployce shall so 1I0til)·thc appointillg authorilY ill writing at Ieavc Iivc (5)
calendar days in a<h'allCC or thc rcturn. The Dircctor shall bc notilied promptly oftlle
employcc's rClurn.
1205.00 LEAVES OF ABSENCE FOR NON-PROr-,lOTIONAL PROB:\TIONAHY

El'\,IPLOYEES
Notwilhslanding any othcr provision of Rule 1201.20 or Hule 120210 thc contrary, Ica\'cs of
abscncc for probationary cmployccs shall bc adminislcred according to the following:
1205.10 Non-promotional probational1' cmployccs shall becnLitlcd to a lea\'c of abscnce without

pay for non-job-connccted illncss or disability, including disability resulting from
prcgnancy, childbirth, or relatcd condition. Such lea\'c shall not cxcecd a maximum of
I'<Hlr (.1.) l1lonllls. ApplicaLion shall bc madc in an'ordancc wiul Rulc 1201.10. Vcrilicatioll
from a medical doclor of continucd disability may bc requcstcd and such \\Tiltcn
verification shall bc prm"idc<! at ,W-day intcr\'als as rcqucsted. Thc cmploycc may he
rcquircd to pass a physical cxamination at County expcnse prior 10 r~llIrning to duty ifthc
illncss or disahility may allcctjob pcrfon~lallrcor thc hcalth or safety orlcllow workcrs or
the public. (Hc\,. 8/92)
1205.20 Non-promotional probaliQnal)' cmployecs shall bc cntitlculo a le;I\'c orabsencc will lOut
pay for family sick lea\'c purposcs. Such Icavc will be awarded at tllC discretion of the
appoinling auulOrily and shall not excccd 15 calendar days. (Hc\,. 8/!12)
000152~
l205.:~0 Non-promotional probationary employces shall not hc granted a discn:Gonary lca\"C of

absence without par for any rcason olllcr lllan spccified in Hulcs 1205.10 and 1205.20.
(Hc\,.8/92)
1205.··10 Non-promotional flrobaGonary cmployces called to ser\'c onjury duty shall be granted
lime olT without loss of pay in accordancc \\;th Onlin:lnce Codc Section 3.20.0:30.
Actualtimc away for jury scrvicc will bc added to the probation pcriod on a day-for-day
basis as prm-ided in Rulc 702.22. (HC\'. 8/92)
1205.50 To the maximum extcnt permilled hy law, alllca\'es authorizeu by Hull: 1205 shall rlIlI
concurrcntly \\;th Iea\'cs taken pursuant to Hulc 1201.30 and shall cOlint against tlte
twel\'e (12) wcek limit containcd in Hulc 1201.30. (Rc\,. 02/98)
I~O(j.OO VACATION OH SICK LE:\VF.l\CCHU;\IS WHILE ON LE:\ VE

No cmploycc who has becn granlcd a Ica\'c without flay for any reason shall accrue
\:;lcation or sick lea\'e during the linlC of such leavc. Ok\'. 8/92)
1207.00 HECOHD OF LEAVE

Heconls oflca\'cs without pay, military Ica\'cs, sick lc;l\'c and \'acaGon accruals, dcducLions,
and balanccs shall bc maintaincd in lllC onice of !J1C Commission. The Dircctor shall
furnish [jIC appointing authority any informaGon from such records as may bc requested.
(Hc\,. 8/92)
0001.522
110 paid leavc timc accmcd, le:l\'c wiLhouL pay shall hc taken. The cmploycc shall, b~"C
noLicc of LhaL rClluest in wriLing to thc Departmcnl Hcad no Icss than three (3) working
days prior to thc datc of the scheduled school or day ("arc activity. Ifboth parents work
for thc same departmcnt, the departmcnt head may limilthe Ic;l\'c to the parclIl initially
making the request If requested to do so by the dcpartmcnt head, thc employec shall
provide wriuen \'crilicatioll of his or her participatiollin the school or day c;u'C acth'ity.
(HC\'. 02/98) .
1202,00 DISCRETIONARY LEAVES OF ABSENCE \VITHOUT PAY
1202.10 Requcst for Lcavc, Any County cmployec who occupies it rcgular classificd position
may apply for thc discretional}' ICa\'cs providcd for in this Rule. Rcquests for any stich
leavc wiUlOut par shall bc madc upon forms prcscribed by the Commission and shall
state spccifically the rcason for the requcst, thc date whcn the employcc desircs the
lea\'c to commence, and the specific date of return. The request shall bc dcli,'cred to
thc appointing authority for wrillcn recommendation that it bc grantcd, modified, or
dcnied, and both UIC rcquest and Ule rccommcndation shall bc prompuy lransmiUcd to
thc Director by the appointing auulority. If Ule appointing auulority recommends denial
or modification of U1C leavc rcqucstcd, the rcasons thcrefore shaH bc communicatcclto
UIC Dircctor in writing. No such rcqucst shall bc dcnicd or modified WiUlOUl noticc to
Ule employce, who may appcal U1C denial or modification to U1C Commission. (He\,.
8/92)
1202,20 Personal Necessity Lea\-e. Any permancnt full-timc or permancnt part-Limc employee in
the classified scn-icc mar be grantcd, upon proper written request and apprO\'al of the
appointing auulOrity and the Director, a Icavc of absencc wiUlOut pay not to cxceed
thrcc (3) months for pcrsonal reasons. (Hcv. 8/92)
ApprO\'al of ~uch le;1\'c wiUlOut pay uncleI' Ulis scction shall hc conditionccl on lindings
thal:
1202.20.10 Thc situation or conditjon ncccssitating Ieavc is remcdial ",iulin U1C period requcstcd.
(He\·.8/92)
1202.20.20 Thc situation or condition nccessitating Ic;l\'c is not rcmcclial br othcr mcans.
(Hc\,. 8/92)
1202.20.30 Hcfusalto authorizc leave will rcsult in pcrsonallmnlship orsulrcling lonhc employce
or thc employce's immediate f;unily. (Hc\,. 8/92)
1202.20AO Thc cmployec's abscncc will not substantially interfere ",iul Ule busincss of thc alleclcd
dcparUllcnl. (Rc\,. 8/92)
0001523
1202.20.5() 'nlc cmployee shall usc all vacation Icavc, holi(lay timc, a1l(1 compcllsatory timc otT to
his/hcr credit prior to thc clTccti\'c datc of tJ\C Icavc of ahscncc. (Hc,·. 8/fJ2)
1202.20.()() Thc employcc has cxhaustcd thc leavc providcd for in Scction 1201.20 or Section
1201.30, or both, or is otJ\crwisc not eligiblc for cit her of such Icavcs. (Rev. 8/92)
1202.31.20 The position still cxists and tJ\C employcc is othcmisc qualificd for tJ\C position. (Hc\'.
8/92)
1202..10 Educational/Pcrsonal Enrichment Lc;wc. Any pcrmancnt full-timc or pennancnt part-

timc employec in tJ\C classified scrvicc may bc granted, upon propCI' writtcn rcqucst and
appro"al of the appointing authority and tJ\e Dircctor, a Icavcof abscnce without pay
not to cxcced onc (1) ycar for cducational or pcrsonal enrichmcnt purposes. Thc
cducational or pcrsonal cnrichmcnt Icavc may be cxtcnded, upon tJ1C propcr written
rcqucst and approval, one (I) additional ycar. (Hc,'. OI/9a)
1202.:1·1 An cmployce /,'Tanted an cducational/pcrsonal enridllncntlcm'c 01" abscnce ",itJlOut pay

shall, lor two (2) ycars, retain the right to bc appointcd to thc lirst vacant position
;\\'ailablc in tJ1C approving departJ11.cntin thc class of position wllich he/shc had
prc"iously occupicd prior to tJ\C Icavc of abscncc. (Rc\,. 01/93)
1202..12 During tJ\C period of the educational/pcrsonal clllichment kavc of ahsence, and for a
period or two (2) ycars following thc complction orthc leave, ifthc cmployec is awaiting
a vacancy in thc dcpartment which approved the Ieavc in thc class of position which
hc/shc had prc\'iously occupied, thc cmployec shall bc retaincd on thc payroll in an
inactive status. DUling this pcriod, the employee retains tJ\C samc benefits as other
employces on lca\'c of abscncc for other purposcs undcr Rule 1202. If, aller two (2)
years following complction oftJ,c cducational/or personal cnrichment lea\"c of absence,
a "acancy has not becomc availablc to which tJle cmploycc can bc appointcd, tJ\cn
pa)Toll status will bc terminatcd. If such occurs, thc cmployec shall automatically bc
placcd on thc re-cmploymcnt list for the class or classes in which thc employee
prcviously held rCb'l.Ilar status. (Hcv.Ol/93)
1202..-1.3 Thc employec is obligated to acccptthc lirst appointmcnt ol1crcd lollowing completioIl
of thc education/pcrsonal enrichmcnt leave. Failurc to do so will rcsult in tJIC forfciture
of all rights undcr tJlis Rule. (Rev. 01/93)
1202.·j.,t Rights undcr this Rule are conditioned 011 ,llc elliplovee:
1202A,tlO Using all \'acationlcavc, holiday timc, and compensatory timc olT to his/her credit prior
to tJ1C elTecti,'c datc of the 1ca\'c or absence. <Hev. 8/92)
1202.·H.20 If thc employce f;\ils to acti\·cly, continuously, and succcssfully pursuc an

educational/pcrsonal enrichmcnt goal, ~IC Ieavc of abscnce shall be immediately
0001524
• KERN
MEDICAL
• CENTER
AFFILIATED WITH UNIVERSI1Y OF CALIFORNIA SCHOOLS
OF MEDICINE AT LOS ANGELES, SAN DIEGO, AND IRVINE
. June 14, 2006
Dr. David F. Jadwin

3184 BeaudJy Terrace
Glendale, CA 91208-1745
RE: Request for extension ofJune 16 deadline
Dear Dr. Jadwin:
I was sony to hear ofyour accident. It seems as though it has been one thing after another for
you and I can imagine your growing frustration with not being healthy.
My response to your request for an extension ofleave has two parts to it. First. I win grant you a
Personal Necessity Leave ofup to 90 days. This is predicated on your providing a physician's
note indicating the ailment. This is comnion practice with the County and I want to make sure
that we are consistent in following policy.
This extension of leave, however, applies only to your employment status. It does not apply to
your appointment as chairman and the associated duty assignments, which brings me to the
second part ofthis extension. You have essentiaUy been out either fuU- or part-time for the past
eight or nine months. You have used all ofyour vacation and sick time in addition to being in a
non-pay status for six months, and while I understand the circumstances, it does not diminish the
fact that the Department ofPathology needs a full-time chairman. For this reason, I am going to
enact the provisions ofthe Medical Staff Bylaws, Paragraph 9.6-4, REMOVAL, and rescind your
appointment as chairman. I regret that I have to do this but KMC is going through some
challenging times and we need a full complement of leaders. Your continued unavailability
creates a void that must be filled. This decision is effective June 17,2006.
The obvious question that I am sure comes to mind is, ''what does this mean for me?" This
essentially means that should you decide to return to work at KMC either within this 9O-day
period or at the end of it, your contract will be changed to reflect a regular staff pathologist duty
assignment. The amount oftime you spend will be mutually agreeable, but your duties will not
include those ofthe chairman.
Ifyou have any questions concerning this please give me a call at 661-326-2106. I wish you a
speedy recovery.
000152 5
cc: Irwin Harris, M.D., CMO
Eugene Kercher, M.D., President, Medical Staff
Karen Barnes, Deputy County Counsel
OWNED AND OPERATED BY THE COUNTY OF KERN
1830 FLOWER STREET· BAKERSFIELD. CALIFORNIA 93305·4197· TELEPHONE (661) 326-2000
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 57 ofJ. 93
J.ao~ VJ. J.
( .
Peter Bryan - Extension of leave
From: Peter Bryan

To: David Jadwin, DO
Date: 6/13/2006 1:08 PM
Subject: Extension of leave
cc: internet:kerchrun@aol.com; Irwin Harris, MD; Karen Barnes
--_._-----,------
I will be sending you a hard copy of this notice.
My response to your request for an extension of medicall,eave has a two part answer. First,
. I will extend leave to a Personal Necessity 'Leave for your employment status only. This
means that you have 90 days of extended leave which will protect your overall employment
status. At the end of this 90 day period, you must either return to duty or resign from
employment.
Second, I will not extend your leave as it relates to your appointment as Chairman,
Department of Pathology. I am implementing the provisions of paragraph 9.6-4, REMOVAL,
Medical Staff Bylaws, and withdrawing your appointment as Chairman, Department of
Pathology. This institution needs to have full time leadership in the department and because
of your leave you have not been able to provide it. Should you return to work after the
completion of your Personal Necessity Leave then your employment contract will be modified
as mutually agreed to reflect that you are still an employed pathologist (should you choose
this option), but you will not retain the duties and appointment of a chairman.
My decision to do this, Dr. Jadwin, is based solely on your inability to prOVide consistent and
stable leadership in the department for most of the past eight to nine months. You have
used all of your sick and vacation time in addition to using all available time under the
medical leave provisions of County policy. It is unfortunate that you had your accident
which delayed your return but the hospital needs to move on. Also recognize that should. you
decide to return to work that I will require your treating physicians to stipulate your ability to
work. This type of stipulation is consistent with what we require of all persons who have
been out on an extended medical leave.
Please let me know if you have any questions. As I indicated, you will be receiving a hard
copy of my decision related to extending your leave.
0001526
file://C:\Documents%20and%20Settings\bryanp\Local%20Settings\Temp\GW} 0000 I.HTM 7/6/2006

~~.~~ rA~ ~O~ tbJU IOIC HR ...o\DMIN III OO~
,
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D. Jadwin. M.D.
i
"
12110/05 thru 06/09/06 Timeline.
I
I PaE PeriodlOates Hours Houl's ne~ded to cObJplete 80 hr PDy
I worked Period
I 05-22 80
05-23 32 40 hours of sick
8 hours of vac
05·24 80
05-25 56 24
12/10/05 thru 12/23/05
05-26 40 40
12124/06 tbm 01/06/06
06-01 57.5 22.5
01/07/06 tbm 01120/06
06-02 60.3 19.7
01/21106 thru 02103/06
06-03 41.5 38.5
02/04/06 tbru 02/17/06
06-04 40 40 Total ofbours used w/ont
02/18/06 thru 03/03/06 ~
• 02123/06, end of 14.5

leave w/pay.
• 02124/06, leave
w/out pay. ..
06-05 12 68 82.5
03/04/06 thm 03/17/06
06-06 17.7 62.3 144.8
03/18/06 thTU 03/31106
06-07 30 50 194.8
04/01/06 tbru 04/14/06
06-08 20.5 59.5 254.3
04/15/06 thru 04/28/06
06-09 0 80 334.3
04/29/06 thrn 05/12/06
06-10 0 80 414.3
05/13/06 thru OS/26/06
06-11 0 80 494.3
05/27/06 thru 06/09/06
06-12
06110/06 tbru 06/23/06
•. Pay Period 06-09, exceeded 12 wk FMLA limitation.

• 6 mo. Leave without pay will exhaust 8/24/06.
0001.527
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Case 1:07-cv-00026-OWW-TAG Document 277
IJAD~IN/DAVID FRANK KERN MEDICAL CENTER liTEM NO. I I
Filed 12/01/2008 Page 63JOB
0706 .,
of 93
TITLE r;;~-;A~HOLOGY - I I
:::lC. SEC. # 1376-S0~8177 I HOME DEPT. # 8719 I MEDICAL STAFF-PATHOLOGY I PAY PERIODG] E:':'~G 112/23/0~ E~J:E
I I GJ
NOTE: IF YOU FAil TO RECORD HOURS OR DAYS PROPERLY. NO CORRECTIONS WILL BE MADE UNTIL THE FOLLOWING PAYDAY. SEE REVERSE FOR ADDITIONAL INSTRUCTIONS
LST YOUR HOME ENTER DEPT II OF OTHER lOCATIONS WORKED SICK TIME
OTHER PAY COOES lEAVE
COMMENTS
OFF (I.E, REASON FOR OVERTIME
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Page 67 of 93
0706 .\ JOB TITLE I CHMN/PATHOLOGY-
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Filed 12/01/2008 Page 69 of 93
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DEPARTMENT # DEPARTMENT NAME DATE PREPARED
8997 KERN MEDICAL CENTER' 03/23/2006
SOCIAL SECURITY NBR EMPLOYEE NAME
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EFFECTIVE DATE
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!:>'ME I JADWIN,DAVID Case
FRANK1:07-cv-00026-OWW-TAG
KERN I I Document 277
MEDICAL FiledITEM
CENTER 12/01/2008
NO; I
Page 71
07061 JOBof 93I
TITLE I CHMN/PATHOLOGY-,_ i
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NO. 0706
Page 72 I I
ofTITLE
JOB 93 I I I CHMN/PATHOLOGY.,
SOC. SEC. # 1376~50-8177 I HOME DEPT. # I 8719 I I MEDICAL STAFF-PATHOLOGY

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Case 1:07-cv-00026-OWW-TAG ~
Document 277
.. _ _- - , .
Filed 12/01/2008
-JI· • ,
Page
-I
73 of 93
SOC. SEC•.. ~ , ~~t~~~:'l ;;lVIjHOME DEPT. I 871~' II # r1EDICAL :~TAFF-PATHOLOGY I P~y,PERIOD~ ~~i~GI03/03/0f Et~~k~J;E 0
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LIST ENTER DEPT # OF OTHER LOCATIONS WORKED COMMENTS
DATE
TI/ylEI TIME ON'ISHFT
CALL Nil
SHIFTS. IMIlKED, REGUlAR
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HOl
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OFF
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err NURSE ETC.•
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wciAKED EARNED TAKEN A'''IOFF c OVERTIME ' CaMP TAKEN _._ _ ------1
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REBY CERTIFY T~AT THE ABOVE'S TRUE AND CORRl:CT TO THl:I~;~~ ..~~~7 .. ..
0001542 RESIDENT P ----l
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CHECKED BY ~?'
PHYS.I
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I
EMPlOYEe r-I
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NOTE: IF YOU FAIL TO RECORD HOURS OR DAYS PROPERLY, NO CORRECTIONS WILL BE MADE UNTIL THE FOLLOWING PAYDAY. SEE REVERSE FOR ADDITIONAL INSTRUCTlONlS
l6I' YOUR HOME ENTER OEPT # OF OTHER lOCAOONS WORKED SICK TIME COMMENTS
TIME TIME (IN. SIFT DEPT. ONLY HOl OFF VACA. OTHER PAY COOES L~VE (I.E. REASON FOR OVERTIME DAilY
CAll fCl. TION AIlSEI«:E WORK. NATURE OF ILLNESS. OR
IN OUT SHIfTS VlOICEO Aallt:N OVER lMR COMP. IQ.IlAY ~ OVER lMA I..... AA OVER lMA ...GW/l MA lMIl OFF OFF ~ FAMILY MEMBER RELATIONSHIP T()TAlS
~ 2.3 n.E TM TNE TIlE IMJIlB) TM TIUE 1H rTiE· TIME TIlAl: ~M TIlE TIlE SELF FAJM.v V IF FAMILY SICK USED. CHARGE
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II KERN
. II MEDICAL
...::
. CENTER
AFFILIATED WITH UNIVERSITY OF CALIFORNIA SCHOOLS
OF MEDICINE AT lOS ANGELES. SAN DIEGO.. AND IRVINE
RELEASE TO RETURN TO WORK
~ Following a Medical leave of Absence

o Following a light-Duty Assignment
Supervisor/Dept: . '"» cdho~H, Date: 3..::13 -aCo

Employee's Name: =1)Q.\)·,d 'F. dcd(.~t,)~f)
The above-named employee has presented a physician's clearance to return to work following a
medical leave of absence or a light-duty assignment.
Return to Work Date: 3 -\ k -0\0

~ Return to full duty with no restrictions.
o Return with the following work restrictions:
o _ _--,-__ Ibs.
o _ _ _ _ _ _ _ _ with minute breaks
o _ _ _ _ _ _ _ _ with minute breaks
D
o
Duration of restrictions: ~~-
Please work with your employee to ensure that he/she does not exce these restrictions, and
inform us if you can no longer accommodate the restrictions.
If you have any questions, please contact the Human Resources office at 326-2640.
~"'h~~,f)e( Phone: 3&- 2~L40

epresentative

1830 FLOWER STREET. BAKERSFIELD. CALIFORNIA 93305-4H17 • TELEPHONE (661)326-2000
Case 1:07-cv-00026-OWW-TAG Document 277 -
Filed 12/01/2008 -
c0ad~i() ~o...\,)~d
·
Page 76 of 93 . F.
'hf'f'C-- ~Cfi7
CERTIFICATION OF HEALTH CARE PROviDER ~ 2:)06 ;

Medical Leave of Absence
1. EmployeeIPatient ~me: _D_O'\_V_I_J__J_~_W '_!I\...- _

(Note: The health care provider Ie NOT to dtscIose the underlying diagnosIs without the consent
01 the patient)
2. Date medicat cancfdlon or need for treatment commen~· }2- I b- 0 ~
3. Probably duration of medical condition or need for treatment ~ - 3> ft'1o.
Approximate datB on .which you ressonably expect employee/patient will be able to retum 10 work
(includIng on light duty): -:--_~~--_-
3-1C,-0&
4. The definitions on the reverse describe what is meant by a ·Serlous Health Condition- under both the
federal Family and Medical Leave Act (FMLA) and the Califomia FamUy Rights Act (CFRA). Does the
patient's condition qualify under any of the categories described? I' so, plesse check the appropriate
category: "I.e.S
(1)_ (2)...! (3)_ (4).i1. (5)_ (6)_
5. Is employee/patlent able to perform wort< of any kind? Yee . X NO_

<If -No·, lkipnext question.)
18 employee uneble to pertonn any on. or more of the essential functions of employee's position?
Answer after reviewing statement from employer of essentlal functions of employee'S posItJon, or, if none
provided. after discussing with employee. Yes _ No _
STATEMENT OF EMPLOYER:
Please answec.the following ONLY If emploYee I.s reQuestfng Intenni\ten1 Leave or a Red!JC8d Worn SChedyle:
8. 18 it medICally necessary for employee/patient to be off work on an intennlttent basis or to work less than
the empk)yee'a normal work schedule in otder to be treated for the Sfri~ health condition?
Yes lL No _ . Desctibe:;;;r; t I~ Mj ~e '1w r- "2-
VvtJt¥= atoi> Sr.,'lI!~ b 'b t~O,*"e ~c.b.Wtlk· n AJ /h.:fy,e,J
OF "l..-~ ~"'1~ .
If yes, pleaSe indicate the apprcoomate number of doctor's visits and/or the estimated duration of medical
treatment n~, and the estimated number of hours per day the employee is able «0 work during ... '/~ A.J
this period. bJPL\f.W V' >,±SJ fAo\/t.\I\j s~·v( J W ~t''= t
-"2.. f)"jS P-ec VV'C.IV--
7. Name of Health Care Provider: ~~1fL ~ I 5-t-! cI Date: I... r3- 0 b

Typo 01 Pla<:tice:£ S."c.~. PhQne: OJ ~) : (0 ...zt!)2I'J • .
Signature of ProvIder. -----...:~ _
.0001.545
ME I JADWIN, DAVID Case
FRANK I I KERN MEDICAL
1:07-cv-00026-OWW-TAG DocumentCENTER
277 Filed
liTEM NO. I 0706 Page
12/01/2008 1 77 TITLE
JOB of 93 ICHMN/PATHOLOGY- ..~
G. SEC.;{I; ~1376-so-8177 I HOME DEPT. # I 87191 I MEDICAL STAFF-PATHOLOGY

I PAY PERIODlJLj
I I ENDING
DATE
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~ EMPLOYEE
STATUS
r-l
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. -.lOTF· 11= VOl F411 TO !-IOURe:: OR n4ve:: PROpERLY, NO CORREkiiONS Will RI; UAnl: InJ' lL..Il:lI: .."', ,"'u, ,,.. PAYDAY. SEE r:nA IIUNAL lJNL-
YOUR HOME ENTER DEPT # OF OTHER LOCATIONS WORKED SICK TIME COMMENTS
lIST OTHER PAY CODES LEAVE (I.e. REASON FOR OVERTIME
TIME TIME ON· SHFT DEPT. ONLY HOl OFF VACA· IF DAILY
'E CALL 00. TJON ABSENCE WORK. NATURE OF ILLNESS. OR
IN OUT SHIFTS 'MR<£D REGLUR OVER OVER COMPo HCI.IDAY REGlA.AR OVER OVER REGUlAR OVER OVER MR MR OFF OfF FAMILY MEMBER RELATIONSHIP TOTALS
TIMl: TIME T1Mf IMR<ED TJ.lE TH TIME TIME TIME IReou-AR TIME Tfli SELF FAMILY .,I IF FAMILY SICK USED, CHARGE
\2,3 TJ.lE PAY CIT OfF PAY CIT
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o
2Pa:-
~~ SHIFTS ON CALL X8~. _
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TIME c¥ LESS HOURS WORKED < > PAID
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HOLIDAY
TIME
tb (BALI STANDBY S
N '000:1546 OTHER
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CHECKED BY -:-_
PHYS.I·
VERIFIED BY
I
~
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 78 of lof
Page 93 1
"
Christine Teutimez - Re: David Jadwin
From: 'Arlene Ramos-Aninion

To: Christine Teutimez
Date: 5/2/20062:23 PM
Subject: Re: David Jadwin
He gets paid for 20.5 hours. The' remaining time will be in a'no pay status. Thanks for your
patience.
»> Christine Teutimez 5/2/2006 9:04:39 AM »>
Hi Arlene,
I received a time sheet for Dr. Jadwin and he only has 20.5 hours worked but across his time
sheet it states "LOA= 59.5 hours" however he doesn't have enough sick or vacation time to
make the difference between the 20.5 and 59.5, or is that what he is to be paid "per
contract?" '
0001.547
file:/IC:\Documents%20and%20Settings\tetimzc\Loca1%20Settings\Temp\GW}0OOl3.HTM 5/2/2006
"ME IJADWIN, DAVIDCase
FRANK I I KERNDocument
1:07-cv-00026-OWW-TAG MEDICAL 277 Filed 12/01/2008
CENTER I liTEM NO. Page
0706 I 79JOB
of 93
IIlLl: I "'0.·...' r ..... u ..... ~..... _ .
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YOUR HOME ENTER OEPT # OF OTHER lOCATIONS WORKEO SICK TIME COMMENTS
LIST . OTHER PAY CODES LEAVE
OFF VACA· (I.E. REASON FOR OVERTIME DAILY
TIME TIME 01/. SHFT DEPT. ONLY HOl (J'
WORK, NATURE OF ILLNESS. OR
~TE CALL Ill. TON ABSEIa FAMILY
IN OUT SHIFTS I'oOI<ED OVER OVER COMP. IIlIlAY REGlA.AR OVER OVER OVER OVER MR MR OFF OFF MEMBER RELATIONSHIP TOTALS
IlEGULAR TIME TIME TIME I'oOI<ED ThE TIME TIME R8llAR TIME TIME ~lllAR
ThE
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HEREBY CERTIFY THAT THE ABOVE IS TRUE AND CORRECT TO
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PHYS.I
0
VERIFIED BY
~
ME IJADWIN/DAVID Case
FRANK I KERN MEDICAL
1:07-cv-00026-OWW-TAG I Document CENTER
277 Filed NO. I 07061Page JOB
12/01/2008
liTEM TITLE
80 of 93 I CHMN/PATHOLOGY-.· I
C.SEC.# 1376.50.6177 I HOME DEPT. # I 8719 IG Enrol. STAFF.PATHQWGY
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ENDING
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TOTALS
1,2,3 1NE TIME TIME 1H TIME 1H TIME TIME TIME TIME SElf fAMilY
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,REBY CERTIFY THAT THE ABOVE IS TRUE AND CORRECT Til THE Bi
N
0001.549 OTHER ----I
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CHECKED BY -;;/l-- PHYS.I
VERIFIED BY --------IIP
viE I JADWIN,DAVID FRANK I I
KERN MEDICAL CENTER IITEM NO. 107061 JOBTITLE I CHMN/PATHOLOGY- I
C. SEC. # I 376-50-8177 I HOME DEPT. # I 871911 MEDICAL STAFF-PATHOLOGY I PAY PERIOOG] G
E:re L}6!09!016 E~V:E Q
NOTE: IF YOU FAIL TO RECORD HOURS OR DAYS PROPERLY, NO CORRECTIONS WILL BE MADE UNTIL THE FOLLOWING PAYDAY. SEE REVERSE FOR ADDITIONAL INSTRUCTIONS
YOUR HOME ENTER DEPT # OF OTHER LOCATlOJ'l~ WORKED SICK TIME COMMENTS
LIST OTHER PAY CODES LEAlIE
TIME TIME ON· SHFT DEPT. ONLY HOL OFF VAI:'.A· (J'
II.E. REASON FOR OVERTIME DAILY
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RESIDENT P . (~'
PHYS.I I
. .- '-.../'---- VERIFIEDBV
~ME I JADWIN, DAVID Case
FRANK1:07-cv-00026-OWW-TAG
·1 KERN I Document
MEDICAL 277 FiledliTEM
CENTER 12/01/2008
NO. I 0706 Page
.I
82 of 93
JOB TITLE I CHMN/PATHOLOGY-,. , I
)C.SEC.#
",,-/
1376-50-8177 I HOME DEPT. I 8719 I I II MEDICAL STAFF- PATHOLOGY I PAY PERIODW E~~~ I06/23/0 ~ ~TUSL~..J
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OFF
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\TE CALL t«l. TION A8SEJa
WORK,NATURE OF ILLNESS. OR
OVER OVER COMP. HlI.IIAY REGll.AA OVER OVER IIEGlAAR OVER OVER OVER OVER FAMILY MEMBER RELATIONSHIP TOTALS
.;
~ I~
IN OUT SHIFTS I'ItW<Bl OFF OFF
lNE TIME 11ME YAR<ED Tt.E lNE TIME TIME T1ME Tt.E Tt.E SELF FAMIlY IF FAMILY SICK USED, CHARGE
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p;
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TIME
t:~:~~Y\~T;Tr~
N
T~UE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

0001·551. 4:. OTHER
RESIDENTP
CHECKED BY _--.,.- ~;_,..-
PHYS.I
--------------- VERIFIED BY
JM",1E L.~ADvnN, D.;VIDCase 1:07-cv-00026-OWW-TAG
FR}i.NK Document
~c.nl'\l IVIl_UlvML. . ._ _J J " 12/01/2008
Filed 277
I v ' v v Page
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".'\'-... .,.....
From: David Jadwin, DO

To; Tracy Lindsey
Date: 11/13/200610:45:19AM
SUbJect: Sick Time
Tracy.
Because the time sheets are completed before the week is done, I forgot that I had a d tor's appointment
Friday morning (and wouldn't have known how much time I was away).
Please adjust my hours to reflect the use of 4 hours sick time on Friday,' November 10
Thanks.
0.1
,
I
1'1 0001.562
III
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 1 of 245

3 Phone: (213) 992-3299
Fax: (213) 596-0487
6
7
10 FRESNO DIVISION
[Fed. R. Civ. P. 56(a)]
16 Courtroom: 3
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1
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Vol I
8
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Set One
22
23 OB/GYN Chair
24
Ang Accusations
26
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28

1
3
4 Harris, Vol. I
Harris, Vol. II
7 Lieu
8 Jennifer Abraham
10
11 Albert McBride
14
15
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18 to
4/12/2007
20 Vol. I
21 Vol. I
23
24

27
28

1
3
4 Ramos-Aninion

7
8
10

14
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18

21
22 Dutt, Vol. II
24
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2
3
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5
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24 EUGENE D. LEE
Declarant
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26 EXHIBIT 2
27
28
288
2 FOR THE EASTERN DISTRICT OF CALIFORNIA
4
DAVID F. JADWIN, D.O., ) Volume II
5 ) Page 288
Plaintiff, )
6 )
vs. ) Case No. 1:07-cv-00026-OWW-TAG
7 )
COUNTY OF KERN; et al.,)
8 )
Defendants. )
9 _______________________)
10
11
12 Videotaped Deposition
13 of
14 PETER K. BRYAN
15 Tuesday, August 26, 2008
16 San Diego, California
17
18
19
20
21 Reported by: Vivian R. Weiss, RPR, CSR No. 12380
22
23
24
25
BryanP2
332
1 Q. Sure. The April 28th memo, I don't know if
2 you remember it, but you did detail quite a few
3 difficulties Dr. Jadwin was having in his communication
4 style and his lack of insight into how his own behavior
5 was contributing to the problem with his peers. That's
6 all detailed in the April 28 memo. But I'm not
7 interested in that. I'm interested in this statement
8 you made that the department of pathology functions
9 well, as it has for many years, and, yes, you continue
10 to make positive changes to the department.
11 What were you basing that statement on?
12 A. In pathology, I looked at really a couple
13 things. The key thing is whether or not the department
14 passed the CAP inspection, College of American Pathology
15 inspection, and the department had successfully
16 completed those.
17 And number two, there was no documented
18 evidence to me that the department was not fulfilling
19 its clinical obligations to the staff. There were
20 interactive challenges with Dr. Jadwin as an individual
21 and as a chairman, but the actual functioning of the
22 department of laboratory [sic] actually was fairly good.
23 Q. Okay. So, in other words, the issues with
24 Dr. Jadwin's extended to his responsibilities and
25 effectiveness outside the department of pathology?
BryanP2
333
1 A. Fundamentally, that's correct.
2 Q. But you didn't have any -- you didn't see any
3 issues with Dr. Jadwin's leadership within the
4 department of pathology?
5 A. Not overtly. And, again, it did not
6 contribute to the decision asking him to step down.
7 Q. Okay. Well, what do you mean by "not
8 overtly"? What do you mean? Covertly you were hearing
9 things?
10 A. No. To me it's like our interaction here. It
11 would be very difficult for me to be polite and
12 congenial with you and turn around in a session with
13 Mark and be a pit bull. You know, people don't change
14 their style that dramatically. So that's the basis of
15 my saying I did not see or hear a lot of complaints from
16 the staff within pathology, other than the pathologists
17 that left, about interactive problems.
18 Q. If there were complaints within the department
19 of pathology, who would they have gone to?
20 A. A number of avenues. They could have gone to
21 the chief medical officer, to me, to human resources
22 would probably be the three primary points of contact.
23 Q. Would it eventually bubble up to you as the
24 CEO?
25 A. Yes. If they weren't resolved and became a
BryanP2
334
1 major issue, yes, they would have.
2 Q. Okay. So as of April 28th, 2006, when you
3 wrote this memo to Dr. Jadwin, nothing had bubbled up to
4 you, correct?
5 A. Nothing had bubbled up to me other than I knew
6 general uncertainty in the pathologist's staff about how
7 things were being run only because of the absence of
8 Dr. Jadwin. Is he here today, or is he not here today?
9 Is he going to be on the schedule or not be on the
10 schedule?
11 Q. Now, was there anything communicated, to your
12 knowledge, to the department of pathology regarding
13 Dr. Jadwin's absence?
14 A. I did not -- well, I don't recall giving any
15 specific written guidance or verbal guidance to the
16 department of pathology. I do recall having some
17 conversations with -- I'm going to space out his name
18 here -- with one of the pathologists who was there.
19 Q. Philip Dutt?
20 A. Yes, with Dr. Dutt, about how to cover the
21 department and what I would expect him to do, in a very
22 general sense, in Dr. Jadwin's absence.
23 Q. Okay. And did Dr. Dutt express any complaints
24 to you at that time?
25 A. Well, we were most concerned about the
BryanP2
Case
K. 1:07-cv-00026-OWW-TAG
BRYAN, VOL. II Document 277-2 Filed 12/01/2008 Page 11 of 245
08-26-08
Page 346
1 STATE OF CALIFORNIA
2 COUNTY OF SAN DIEGO
4 I, Vivian R. Weiss, RPR, a Certified Shorthand
5 Reporter for the State of California, do hereby certify
6 that the witness in the foregoing proceeding was by me
7 duly sworn; that the proceeding was then taken before me
8 at the time and place herein set forth; that the
9 testimony and proceedings were reported stenographically
10 by me and later transcribed by computer-aided
11 transcription under my direction; that the foregoing is
12 a true record of the testimony and proceedings taken at
13 that time.
14 I further certify that I am a disinterested
15 person and that I am in no way interested in the outcome
16 of said action.
17
18 IN WITNESS WHEREOF, I have subscribed my name
19 this 8th day of September 2008.
20
21
22 Vivian R. Weiss, RPR, CSR No. 12380
23
24
25
vs. COUNTY
& RANDALL (800) 322-4595
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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22
23
24
25
26 EXHIBIT 3
27
28
1
1 1 UNITED STATES DISTRICT COURT

2 2 FOR THE EASTERN DISTRICT OF CALIFORNIA
3 3 ---------
4 4 DAVID F. JADWIN, D.O., ) Volume I
)
5 5 Plaintiff, )
) No. 1:07-cv-00026-OWW-TAG
6 6 vs. )
)
7 7 COUNTY OF KERN; et al. )
)
8 8 Defendants. )
___________________________)
9 9
10 10
11 11
12 12
13 13 VIDEOTAPED DESPOSITION
14 14 OF
15 15 PETER K. BRYAN
16 16 Thursday, August 14, 2008
17 17 Bakersfield, California
18 18
19 19
20 20
21 21 Reported by: Cindee L. LeFevre, CSR No. 7974
22
23 22
24
25 23
26
27 24
28
29 25
BryanP1
110
1 12:17:38 1 recollection of what Dr. Jadwin said to Dr. Raglan about

him
2
12:17:42 2 not being qualified to be the president of the medical
3
12:17:44 3 staff. Can you think of any other specific -- well, do
4 you
5 12:17:48 4 have any other specific regulations of what Dr. Jadwin
said
6
12:17:51 5 to the other participants or any of the participants
7 that he
8 12:17:54 6 was insulting?
9 12:17:56 7 A. My recollection was, and it's stated in, I
10 12:17:59 8 believe, that memorandum, that he offended everyone in
that
11
12:18:02 9 meeting. Not me, but all of his colleagues and medical
12
12:18:07 10 staff officers.
13
12:18:08 11 Q. So it was -- did Dr. Jadwin insult you at the
14
12:18:13 12 mediation meeting?
15
12:18:14 13 A. No.
16
12:18:15 14 Q. Okay. So what other comments did Dr. Jadwin
17 make
18 12:18:19 15 to Dr. Raglan, comments of insult, at the mediation
meeting?
19
12:18:27 16 A. The general tenor of that meeting, the intent
20 of
21 12:18:31 17 that meeting was to have adults sit down and have a
dialogue
22
12:18:38 18 with the objective of leaving there with an
23 understanding of
24 12:18:42 19 how people would communicate with each other, and Dr.
25 12:18:47 20 Kercher was very instrumental in trying to move that
meeting
26
12:18:53 21 along.
27 12:18:53 22 And Dr. Kercher repeatedly tried to apologize
to
28 12:18:58 23 Dr. Jadwin, and it took awhile, and by awhile, I mean
12:19:02 24 probably at least 30 minutes for Dr. Jadwin to finally
29 12:19:06 25 acknowledge what Dr. Kercher was attempting to do, and
at
BryanP1
230
1 1 Q. Okay. Do you think Dr. Jadwin was being

2 2 unreasonable in any way in taking the stance as
manifested
3
3 by those two sentences?
4
16:45:59 4 A. Well, if you take -- if you put it in context
5 of
6 16:46:03 5 Toni Smith's response and what nursing did and what Dr.
7 16:46:07 6 Jadwin's position is.
8 16:46:08 7 And again, I get back to that collaborative
nature
9
16:46:11 8 between two critical leaders in your organization where
10
16:46:15 9 there's a clear difference of opinion and an
11 unwillingness
12 16:46:17 10 to communicate, and I remember private conversations Dr.
13 16:46:20 11 Jadwin and I had where he challenged Toni Smith's
competency
14
16:46:24 12 as chief nursing officer.
15
16:46:26 13 Now, that was never communicated with Toni
16 because
17 16:46:29 14 that's a private conversation that -- but Dr. Jadwin did
18 16:46:33 15 make those comments to me.
19 16:46:36 16 Q. Okay.
20 16:46:36 17 A. And -- but that is not something I would share
21 16:46:39 18 with Toni Smith, understanding where she is in things.
22 16:46:43 19 But this, to me, says -- particularly when you
put
23
16:46:46 20 it in the context of Toni Smith's memorandum -- the two
24 have
25 16:46:50 21 a distinct difference of opinion on how to handle
things,
26
16:46:53 22 and because it's not what Dr. Jadwin perceives as the
27 right
28 16:46:58 23 solution, things are amok. They are not running the way
16:47:02 24 they should be running.
29 25 Q. So you reviewed this issue of PCC's as a
breakdown
BryanP1
231
1 1 in internal communications between Dr. Jadwin and Toni

2 2 Smith, perhaps?
3 3 A. I would categorize it as an inability of two
4 16:47:16 4 professionals to sit down and have a constructive
dialogue,
5
16:47:19 5 to come up with a satisfactory solution.
6
16:47:22 6 Q. Okay. Do you recall what your response was,
7 if
8 16:47:28 7 any, to Exhibit 295?
9 16:47:31 8 A. I'm sorry. No, I don't.
10 16:47:32 9 Q. Okay. The next one is 296.
11 16:47:34 10 (Plaintiff's Exhibit Number 296
12 16:47:34 11 marked for identification.)
13 16:47:34 12 I would ask you review this a little more
14 16:47:55 13 carefully, Mr. Bryan.
15 16:47:56 14 You have been handed a document marked for
16 16:47:58 15 identification as Exhibit 296.
17 16:47:59 16 A. Okay.
18 16:50:27 17 Q. Thank you. Do you recognize this document?
19 16:50:31 18 A. Yes, I do.
20 16:50:32 19 Q. Tell me what it is.
21 16:50:35 20 A. It is a memorandum from me to Dr. Jadwin
22 16:50:38 21 summarizing the meeting held among the three of us, Dr.
23 16:50:44 22 Jadwin, myself, and Karen Barnes.
24
25 16:50:49 23 Q. So in short, this is a memorandum from you to
26
27 16:50:52 24 David Jadwin dated April 17, 2006; correct?
28
29 25 A. That's correct.
BryanP1
249
1 1 previous where I said I need to know by June 16th

whether or
2
2 not he wanted to return full-time or resign his
3 position.
4 3 Q. Okay.
5 17:15:34 4 A. And the response -- his letter to me doesn't
give
6
17:15:39 5 me any hint at all as to whether or not he wants to
7 return.
8 17:15:43 6 Q. Okay.
9 17:15:44 7 A. Regardless, secondary, to when he is
physically
10
17:15:46 8 able to return. And to me, that was a key missing
11
17:15:51 9 ingredient there, what do you want to do.
12
17:15:53 10 Q. Okay. Did you pick up the phone and call Dr.
13
17:15:58 11 Jadwin after receiving this?
14
17:15:59 12 A. At this point, I, as probably Dr. Jadwin, was
15
17:16:02 13 frustrated with the issues. I do not recall having a
16
17:16:05 14 conversation with Dr. Jadwin after receiving this. I
17 don't,
18 17:16:10 15 because Dr. Jadwin, in essence, had not been physically
19 17:16:14 16 present much during the preceding six months.
20 17:16:17 17 Q. Okay. Well, on April 28, you had -- actually,
21 17:16:22 18 looking back at Exhibit 303, you had asked that Dr.
Jadwin
22
17:16:26 19 go on full-time leave. Isn't that correct? Take a look
23
17:16:30 20 there.
24
17:16:34 21 I am going to direct your attention to the
25 last
26 17:16:36 22 sentence of the third paragraph on Exhibit 303.
27 17:16:39 23 A. Right. That's what I am reading. Yes.
28 17:16:52 24 Q. Okay. Now, this request for Dr. Jadwin to go
off
29 25 to full-time, that's what it means; right, that
sentence?
BryanP1
250
1 1 It was saying it would be better for the Pathology

2 2 Department for Dr. Jadwin to go from an intermittent
work
3
3 schedule to a full-time leave. Is that correct?
4
17:17:14 4 A. That's correct.
5
17:17:15 5 Q. Whose idea was that?
6
17:17:17 6 A. Essentially, it was mine, reviewing the manner
7 in
8 17:17:21 7 which Dr. Jadwin was present or absent from the
Department,
9
17:17:23 8 and my perception was it was creating some issues of
10
17:17:28 9 scheduling within the Department.
11
17:17:30 10 Q. Okay.
12
17:17:32 11 A. I also was not aware when he would or would
13 not be
14 17:17:36 12 present. Now, in this case, it says May 1, and I
accepted
15
17:17:40 13 that, but I was never certain as to when Dr. Jadwin,
16 prior
17 17:17:44 14 to that, was present in the hospital or not.
18 17:17:47 15 Q. Okay. So you made the decision that Dr.
Jadwin
19
17:17:51 16 should be on intermittent work schedule, instead, to
20
17:17:55 17 full-time leave; correct?
21
17:17:56 18 A. No, what I indicated was it would be
22 preferable,
23 17:17:59 19 which infers a decision.
24 17:18:02 20 Q. Okay.
25 17:18:02 21 A. And if I am not mistaken, Dr. Jadwin made a
26 17:18:06 22 decision not to be present.
27 17:18:11 23 Q. Okay.
28 17:18:14 24 A. There was no dialogue back from Dr. Jadwin
that
29 25 said, no, I still want to continue the intermittent
schedule
BryanP1
261
1 1 to be ratified and approved by the Board of Supervisors?

2 2 Would that be Karen Barnes?
3 3 A. Karen Barnes or somebody in counsel's office.
4 17:33:00 4 Q. I'm sorry. Before we get to that, 324.
5 17:33:00 5 (Plaintiff's Exhibit Number 324
6 17:33:00 6 marked for identification.)
7 17:33:00 7 Mr. Bryan, you are being handed a document
marked
8
17:33:31 8 for identification as Exhibit 324.
9
17:33:36 9 A. Okay.
10
17:33:39 10 Q. Well, this is a little bit confusing. DFJ1345
11 is
12 17:33:46 11 an e-mail from Renita Nunn to David Jadwin with a CC to
you,
13
17:33:51 12 and it's dated June 26, 2006. Is that correct?
14
17:33:55 13 A. That is correct.
15
17:33:56 14 Q. And you recall receiving this e-mail at or
16 around
17 17:33:59 15 June 26, 2006?
18 17:34:06 16 A. The e-mail doesn't say anything other than --
19 17:34:13 17 excuse me -- maybe I wasn't listening well. This is an
20 17:34:17 18 e-mail from Renita Nunn who was in the HR Department, to
Dr.
21
17:34:23 19 Jadwin, and in it, she is referencing the attached
22 letter
23 17:34:27 20 that I wrote to Dr. Jadwin.
24 17:34:30 21 Q. The attached letter is DFJ1346; correct?
25 17:34:35 22 A. Yes.
26 17:34:35 23 Q. And this letter attachment is from you to
David
27
17:34:40 24 Jadwin dated June 26, 2006; correct?
28
29 25 A. Yes.
BryanP1
262
1 1 Q. It's not signed, but do you recall drafting

this
2
2 letter at or around June 26, 2006?
3
3 A. Yes.
4
17:34:51 4 Q. Okay. And drafting letters such as this was
5 part
6 17:34:55 5 of performing your duties as CEO; correct?
7 17:34:57 6 A. Yes.
8 17:34:58 7 Q. And you did, in fact, draft this letter as
part of
9
17:35:02 8 performing your duties as CEO; correct?
10
17:35:04 9 A. Yes.
11
17:35:05 10 Q. Okay. And when Miss Nunn forwarded that
12
17:35:07 11 attachment to Dr. Jadwin, I assume she was doing it on
13 your
14 17:35:11 12 authority?
15 17:35:12 13 A. Yes, and the applicable potions in the middle
16 17:35:15 14 paragraph, paragraph three.
17 17:35:18 15 Q. Of DFJ1346?
18 17:35:20 16 A. That's correct. I say out of concern for your
19 17:35:22 17 welfare, you are not to feel obligated to work while on
20 17:35:27 18 leave, which led me to say stay away. You have
subsequent
21
17:35:31 19 medical issues that need to be cleared.
22
17:35:33 20 Q. So by June 26, 2006, you are aware that Dr.
23 Jadwin
24 17:35:38 21 had medical issues?
25 17:35:39 22 A. Sure. I didn't challenge the fact that he
broke
26
17:35:42 23 his foot. I mean, I take people at their word on that.
27
17:35:46 24 Q. Well, a broken foot would take maybe two weeks
28 for
29 25 it to heal. So it's not major. Well, actually, it's
not a
BryanP1
08-14-08
BRYAN
w
o
Page 287 R
D
ss. I
2 COUNTY OF KERN
3
4 I, Cindee L. LeFevre, a Certified Shorthand
5 Reporter in the State of California, holding certification
6 No. 7974, do hereby certify that PETER K. BRYAN,
7 the witness named in the foregoing deposition,
8 was by me duly sworn; that said deposition was taken
9 Thursday, August 14, 2008, at the time and place set forth
10 on the first page hereof.
11 That upon the taking of the deposition, the
12 words of the witness were written down by me in stenotypy
13 and thereafter transcribed by computer under my supervision;
14 that the foregoing is a true and correct transcript of the
15 testimony given by the witness.
16 I further certify that I am neither counsel for
17 nor in any way related to any party to said action, nor in
18 any way interested in the result or outcome thereof.
19 Dated this 2nd day of September, 2008, at
20 Bakersfield, California.
21
22 .
23
/
~L)~
24 Cindee L. LeFevre, CSR No. 7974
25
vs. COUNTY
NDALL (800) 322-4595
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
25
26 EXHIBIT 4
27
28
263
3 ______________
5 DAVID F. JADWIN, D.O., ) VOLUME II

) Page 263
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 COUNTY OF KERN; et al. )
)
9 )
Defendants. )
10 _______________________________)
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
16 DAVID FRANK JADWIN, D.O.
17 Wednesday, January 9, 2008
18 Bakersfield, California
19
20
21
22
23
24
25 Reported by: Susan R. Wood, CSR No. 6829
DFJ2
290
1 that she lost her position. And I told -- I told
2 her -- or at least meant to imply that I'm sorry you
3 lost your position, but I'm not the fault of that.
4 And she continued to be sort of abrasive. And quite
5 frankly I just said, you act like a nasty person.
6 And this was a mediation session.
7 BY MR. WASSER:
8 Q. Anything more?
9 MR. LEE: Vague and ambiguous. Calls for a
10 narrative.
11 THE WITNESS: Dr. Ragland was -- has also,
12 as I've mentioned in the past, not been that
13 objective. And in one instance I reported --
14 reported some concerns to Mr. Bryan, and Scott
15 Ragland was nasty as a result of that, I think.
16 At the end of that meeting both Dr. Kercher
17 and Dr. Harris gave rather, on the face of it at
18 least, sincere apologies for the behavior that they
19 had undertaken to me. And I remember actually
20 saying, when Dr. Harris apologized, that -- I said
21 now that's an apology. And when Dr. Kercher then
22 apologized he -- afterwards the meeting terminated.
23 He got up and literally slugged me so hard on the
24 shoulder that had I not been the size that I was I
25 would have been knocked over.
DFJ2
384
1 BY MR. WASSER:
2 Q. Was that when you were working one or two
3 days a week?
4 A. I believe so, yes.
5 Q. Then you went on full-time leave after that?
6 A. I had surgery, and then I had an injury to
7 my foot where I broke one of the bones in my foot,
8 ripped several ligaments in my ankle, and when I
9 recovered -- let's see. I'm losing track of the
10 sequences here, but there was a point when Mr. Bryan
11 told me that he did not want me to take any more
12 part-time leave and that he wanted me to go on
13 full-time leave so I could use up my sick benefit.
14 Q. Um-hmm.
15 And so when you -- had you been thinking
16 about forming a corporation, a business like Columbia
17 Healthcare Analytics for some time?
18 MR. LEE: Vague and ambiguous.
19 THE WITNESS: I can't exactly when --
20 remember exactly when I decided to form it, but my
21 wife is in the I.T. industry, she's an executive at
22 Disney, and I think she encouraged me to think about
23 developing an I.T. company to do some of this quality
24 improvement work.
25 ////
DFJ2
515
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
'OB
I, Susan R. Wood, a Certified Shorthand
Reporter in the State of California, holding
Certificate No. 6829, do hereby certify that
DAVID FRANK JADWIN, D.O., the witness named in the
foregoing deposition, was by me duly sworn; that said
deposition was taken Wednesday, January 9, 2008, at the
time and place set forth on the first page hereof.
2 words of the witness were written down by me in
3 stenotypy and thereafter transcribed by computer under
4 my supervision; that the foregoing is a true and correct
5 transcript of the testimony given by the witness.
.7 nor in any way related to any party to said action, nor
.8 in any way interested in the result or outcome thereof .
,9 Dated this 24th day of January, 2008, at
.
'm
23 rsi
j
24 Susan R. Wood, CSR No. 6829
5 Ion
WOOD & RANDALL

(800) 322-4595
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26 EXHIBIT 5
27
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838
3 ______________
5 F. JADWIN, D.O., ) VOLUME V

) Page 838
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 )
Defendants. )
10 __________________________)
11
12
13
15 OF
16 DAVID F. JADWIN, D.O.
17 Wednesday, March 12, 2008
19
20
21
22
23
24
25 ted by: Susan R. Wood, CSR No. 6829
DFJ5
854
1 09:11:26 1 home. There was no need to particularly direct
2 09:11:30 2 onsite, directly supervise the hematology supervisor.
3 09:11:32 3 That was all done by the laboratory manager. The
4 09:11:35 4 pathologists were pretty much autonomous. The most
5 09:11:39 5 direction they would need is in this situation what
6 09:11:42 6 should I do, which could have all been done by phone.
7 09:11:46 7 And I think the important part was to remove me away
8 09:11:51 8 from -- at least for part of the week, away from the
9 09:11:56 9 hostility of the environment in the hospital.
10 09:12:00 10 You had mentioned Dr. Shertudke, would I be
11 09:12:03 11 surprised if she made some claim that I criticized
12 09:12:12 12 her so severely that she moved out of the room? You
13 09:12:16 13 know, I don't remember any such incidents of any
14 09:12:19 14 severity whatsoever, but I haven't been provided with
15 09:12:23 15 enough facts to -- to really assess that situation to
16 09:12:26 16 provide any comment about it.
17 09:12:30 17 Regarding my request on May 30th for an
18 09:12:39 18 extension of my decision to decide whether or not to
19 09:12:43 19 remain on as chair occurred one day after I broke my
20 09:12:47 20 ankle. I was in quite a bit of severe pain, and it
21 09:12:53 21 was just a request to be able to defer my decision
22 09:12:59 22 past -- beyond June 16th. The extension that I'd
23 09:13:03 23 already put in was placed earlier and -- and was
24 09:13:07 24 terminated on April 28th, when Mr. Bryan told me that
25 09:13:14 25 he wanted me to stop going on -- working on a one- to
DFJ5
855
1 09:13:17 1 two-day schedule per week and to take my leave full
2 09:13:20 2 time so I could exhaust it as soon as possible.
3 09:13:27 3 THE REPORTER: So I could --
4 09:13:27 4 THE WITNESS: Exhaust it as soon as
5 5 possible.
6 09:13:27 6 And I think the last thing that I want to
7 09:13:30 7 mention is that there had been some mention of my
8 09:13:37 8 activities during 2006, particularly in early 2006,
9 09:13:43 9 regarding Columbia Healthcare Analytics, and I think
10 09:13:48 10 I've mentioned several times that I did mostly setup
11 09:13:51 11 work and mostly directing other people, such as the
12 09:13:55 12 person that I hired for setting up the I.T. system
13 09:13:58 13 and my cousin and my stepdaughter to perform work,
14 09:14:02 14 and that work consisted of perhaps, at the most,
15 09:14:06 15 three or four e-mails a day. Most of those e-mails
16 09:14:10 16 were probably in the nature of one, two, or three
17 09:14:12 17 sentences long. And I maybe made less than three or
18 09:14:17 18 four phone calls that probably didn't last very long
19 09:14:20 19 either. Those activities dealt with the design of
20 09:14:27 20 the Website and the design of a logo for the company
21 09:14:30 21 that was being done by other people.
22 09:14:31 22 It had to do with the direction of
23 09:14:35 23 developing an I.T. system; purchasing office
24 09:14:39 24 equipment, which was largely managed again through
25 09:14:42 25 that person and later on my cousin; developing a
DFJ5
983
1 13:34:31 1 Center at that time?
2 13:34:32 2 A. Yeah.
3 13:34:39 3 Q. And at no time did you ask anyone for an
4 13:34:42 4 accommodation?
5 13:34:43 5 MR. LEE: That calls for a legal conclusion.
6 13:34:45 6 That's vague and ambiguous as to accommodation.
7 13:34:47 7 But you can answer, if you think you know.
8 13:34:49 8 THE WITNESS: Actually, we did. I talked
9 13:34:52 9 with my therapist, Dr. Riskin, and mentioned at a
10 13:34:58 10 point later on that it would be -- it was very
11 13:35:04 11 difficult to be there all the time facing all this
12 13:35:06 12 hostility but that I could potentially work one to
13 13:35:10 13 two days a week. He agreed with that. He actually
14 13:35:14 14 found it therapeutic that I would be away from the
15 13:35:17 15 hospital at least part of the week, and that was
16 13:35:21 16 reflected, I think, in my medical leave request.
17 13:35:25 17 BY MR. WASSER:
18 13:35:26 18 Q. And you were allowed to take intermittent
19 13:35:28 19 leave, weren't you?
20 13:35:29 20 MR. LEE: That calls for a legal conclusion.
21 13:35:31 21 That misstates -- assumes facts not in evidence.
22 13:35:33 22 But you can answer, if you think you know.
23 13:35:35 23 THE WITNESS: I was allowed up until April,
24 13:35:39 24 when Mr. Bryan told me that he wanted me to go on
25 13:35:42 25 full-time leave so that I would use up my leave
DFJ5
984
1 13:35:45 1 faster.
2 13:35:47 2 BY MR. WASSER:
3 13:35:48 3 Q. You were -- you were actually working one or
4 13:35:50 4 two or three days a week for some period of time,
5 13:35:54 5 weren't you?
6 13:35:55 6 A. For some period of time, yes. Um-hmm.
7 13:35:57 7 Q. And did you consider that to have been in
8 13:36:00 8 response to your request to work one or two or three
9 13:36:03 9 days a week?
10 13:36:04 10 MR. LEE: That's vague and ambiguous as to
11 13:36:06 11 request, response. Speculative as to Mr. Bryan or
12 13:36:10 12 the administration's motives.
13 13:36:11 13 But please answer, if you think you
14 13:36:12 14 understand.
15 13:36:13 15 THE WITNESS: It was an agreement that we
16 13:36:17 16 worked out. Mr. Bryan actually thought it would be
17 13:36:19 17 a good working agreement. He had said that the
18 13:36:22 18 department had run well. I think it's been cited now
19 13:36:26 19 in at least two different documents, plus all the
20 13:36:28 20 other evidence that I showed. Actually, the
21 13:36:32 21 department was running very well with me only being
22 13:36:35 22 there one or two days a week.
23 13:36:37 23 And then in April, I believe it might be
24 13:36:41 24 April 28th, I met in his office and he instructed me
25 13:36:47 25 to use up my leave so that we could get past this
DFJ5
985
1 13:36:51 1 period because he felt that it was -- there was a
2 13:36:55 2 need for a full-time pathologist, which I did not
3 13:37:00 3 agree with because, as he said in two different
4 13:37:03 4 places, the department was running just fine.
5 13:37:06 5 I think the one problem I had with all of
6 13:37:12 6 this was that we had made attempts much earlier to
7 13:37:15 7 get a locum tenens pathologist in place. Two
8 13:37:19 8 pathologists can certainly handle the work of that
9 13:37:22 9 department if they're productive and -- and
10 13:37:27 10 organized. I mean, certainly I ran the department
11 13:37:29 11 by myself with no help for weeks at times and managed
12 13:37:34 12 it.
13 13:37:36 13 But I -- rather than having people
14 13:37:39 14 potentially be stressed out -- I know that
15 13:37:41 15 Dr. Shertudke could handle the work, but Dr. Dutt was
16 13:37:44 16 not nearly as efficient in completing his work.
17 13:37:49 17 I had asked some period of time before that,
18 13:37:52 18 knowing that I was going to go have sinus surgery in
19 13:37:55 19 March, I believe, which was subsequently put off
20 13:37:58 20 until May because my mother had a diagnosis of
21 13:38:01 21 lymphoma and there was a prohibition against flying
22 13:38:07 22 for up to a year, I believe, as I recall, following
23 13:38:12 23 the sinus surgery. And so if I'd had the sinus
24 13:38:15 24 surgery in March and my mother became deathly ill,
25 13:38:18 25 I wouldn't be able to fly to Michigan to -- to attend
DFJ5
1001
ss.
2 COUNTY OF KERN
4 I, Susan R. Wood, a Certified Shorthand Reporter in
5 the State of California, holding Certificate No. 6829,
6 do hereby certify that DAVID FRANK JADWIN, D.O., the
7 witness named in the foregoing deposition, was by me
8 duly resworn; that said deposition was taken Wednesday,
9 March 12, 2008, at the time and place set forth on the
10 first page hereof.
17 nor in any way related to any party to said action, nor
18 in any way interested in the result or outcome thereof.
19 Dated this 9th day of April, 2008, at
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Susan No. 6829
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WOOD & RANDALL

(800) 322-4595
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5 5 DAVID F. JADWIN, D.O., )VOLUME VI

)Page 1002
6 6 Plaintiff, )
)
7 7 vs. )NO.: 1:07-cv-00026-OWW-TAG
)
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9 9 Defendants. )
________________________)
10 10
11 11
12 12
13 13
14 14 VIDEOTAPED DEPOSITION
15 15 OF
16 16 DAVID FRANK JADWIN, D.O.
17 17 TUESDAY, OCTOBER 21, 2008
18 18 GLENDALE, CALIFORNIA
19 19
20 20
21 21
22 22 REPORTED BY: SANDRA D. ORTIZ, CSR NO. 6048
23 23
24 24
25 25
DFJ6
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1 1 Q What what was called? I mean I need to pin
2 2 you down to --
3 3 A The faculty practice plan. I don't know
4 4 how to describe it other than that. There was the
5 5 core physician arrangements that were set up for all
6 6 the physicians that were core physicians,
7 7 essentially permanent physicians.
8 8 Q So getting back to the question, the
9 9 question is what terms do you want to see in the
10 10 contract that you believe should have been renewed?
11 11 And you mentioned that you want --
12 12 A I want to see or would have seen?
13 13 Q Well, that you expect to have seen. You're
14 14:27 14 suing -- the tenth and eleventh claims are the
15 15 contract was not renewed.
16 16 I want to know what terms you want to see
17 17 in that contract that should have been renewed.
18 18 You're in the process of --
19 19 A You're talking about it in the future tense
20 20 as opposed to what I wanted at the time. That's why
21 21 I'm a little concerned.
22 22 Q I don't care what tense we're in, sir. I
23 23 simply want to know what terms you want in the
24 24 contract.
25 25 A That I wanted in the contract --
DFJ6
1035
1 1 MR. LEE: Hold on.
2 2 Objection. Vague and ambiguous. You mean,
3 3 sitting here today, what does he want to see in
4 4 those contracts, or do you mean as of the time his
5 5 contract expired? What time period are you talking
6 14:27 6 about?
7 7 MR. WASSER: Well, I think I'm talking
8 8 about October 7, 2008, when the Second Amended
9 9 Complaint was filed.
10 10 MR. LEE: Does that clarify it, Dr. Jadwin?
11 11 THE WITNESS: October, 2006; right?
12 12 BY MR. WASSER:
13 13 Q Sir, I don't really care what date. This
14 14 is your lawyer's issue. It's not my issues.
15 15 A I thought you said 7. That's why I was
16 16 trying --
17 17 Q I said October 7, 2008, because --
18 18 A Okay.
19 19 Q -- I'm trying to respond with your lawyer
20 20 who keeps trying to prevent you from answering
21 21 questions.
22 22 MR. LEE: Hold on. You mean 13 days ago?
23 23 THE WITNESS: That's what I'm confused
24 24 about.
25 25 / / /
DFJ6
1036
1 1 BY MR. WASSER:
2 2 Q That's when the Second Amended Complaint
3 14:28 3 was filed.
4 4 A Oh, okay.
5 5 Q That's when you've alleged this.
6 6 A Okay.
7 7 Q That's what I'm talking about.
8 8 What is it that you're alleging as of
9 9 October 7, 2008, not renewing plaintiff's employment
10 10 contract? What terms should be in that contract
11 11 that you want to see renewed?
12 12 MR. LEE: Hold on. That calls for a legal
13 13 conclusion. Dr. Jadwin is not an attorney. He
14 14 can't sit here and dictate what a contract would
15 15 look like.
17 17 Q What terms do you want, sir?
18 18 A I'm still confused about "want." You mean
19 19 wanted at the time?
20 20 What I wanted were the terms that I
21 14:28 21 originally had that were taken away from me.
22 22 Q In 2000?
23 23 A In 2006 when this amended thing came --
24 24 this amendment came up.
25 25 Q Okay. I'm asking you what terms are those?
DFJ6
1041
1 1 BY MR. WASSER:
2 2 Q Please answer it, sir.
3 3 MR. LEE: If you think you understand,
4 4 answer it. But if you don't, don't answer.
5 5 THE WITNESS: Can you clarify the time
6 6 period that you're talking about?
7 7 BY MR. WASSER:
8 14:32 8 Q Well, I did that. October 7, 2008, when
9 9 you filed the Second Amended Complaint.
10 10 A Okay. It had to do with the fact that I
11 11 was -- the chair was taken away from me, actually,
12 12 and the demotion in salary.
13 13 Q Exhibit 581 took the chair away from you;
14 14 correct? And lowered your salary; correct?
15 15 A It mentioned -- I don't believe that this
16 16 took away the chair --
17 17 Q Okay. That's correct. The JCC did that.
18 14:32 18 A Yes. Uh-huh.
19 19 Q Okay. Well, I'm asking you. When you say
20 20 you want your original contract back --
21 21 A The terms of my original contract.
22 22 Q Well, your original contract made you
23 23 chair, didn't it?
24 24 A It's --
25 25 MR. LEE: Hold on. Vague and ambiguous as
DFJ6
1044
1 1 BY MR. WASSER:
2 2 Q We've clarified that three times. The time
3 3 reference, sir, is October 7, 2008.
4 4 MR. LEE: Mr. Wasser, I'm allowed to lodge
5 5 my objections. Okay? If you don't like it, that's
6 6 too bad.
7 7 MR. WASSER: Right.
8 14:34 8 THE WITNESS: The -- without sitting here
9 9 with the contract side by side, those would be the
10 10 ones that I can think of right now, the most
11 11 important ones.
13 13 Q So when you think about this renewed
14 14 contract that you're suing for, your thought is you
15 15 would -- you would what? -- you would negotiate
16 16 terms of some new arrangement with Kern Medical
17 17 Center to get a new deal? Is that what you have in
18 18 mind?
19 19 MR. LEE: Hold on. First of all, that's
20 20 strategy. That's attorney work product and instruct
21 21 not to answer.
22 22 MR. WASSER: You're instructing him not to
23 23 answer that question? On what grounds?
24 24 MR. LEE: You're asking what he's suing
25 25 for?
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1 1 MR. LEE: Hold on. Objection. Let him
2 2 finish the answer, please, before you interrupt.
3 3 BY MR. WASSER:
4 4 Q My question, October 7, '08, October 7,
5 5 '08 -- that's the date we're talking about in all
6 6 these questions, sir. We've made that very clear.
7 14:47 7 You don't want to go work there again, do you?
8 8 A I don't want to work under the conditions
9 9 that I was there before at -- you know, the
10 10 conditions that I had from October to December of
11 11 2006.
12 12 Q Those two months?
13 13 A And some other periods prior to that,
14 14 actually. Going back to, actually, October, 2005.
15 15 Q What's changed?
16 16 MR. LEE: It's vague and ambiguous.
17 17 THE WITNESS: I'm sorry. What's changed
18 18 where?
20 20 Q At Kern Medical Center. Anything changed?
21 21 You said it's gotten worse.
22 22 MR. LEE: It's vague and ambiguous.
24 24 Q I believe your word was "deteriorated
25 25 further" if I --
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1 1 A Yes.
2 2 MR. WASSER: That's all the questions I've
3 3 got. Thank you very much.
4 4 MR. LEE: I'd like to ask some questions.
5 5 MR. WASSER: All right.
6 6
7 7 EXAMINATION
8 8 BY MR. LEE:
9 9 Q Okay. Dr. Jadwin, as of October 4 of 2007,
10 10 did you expect your contract, Exhibit 577 as amended
11 11 by Exhibit 581, to be renewed by the County of Kern?
12 12 A During October of 2007?
13 16:01 13 Q As of October 4 of 2007.
14 14 A Yes.
15 15 Q Had the contract been renewed, Exhibit 581,
16 16 as amended by Exhibit -- I'm sorry -- Exhibit 577 as
17 17 amended by Exhibit 581, had the contract been
18 18 renewed on and as of October 4 of 2007, would you
19 19 have continued with litigating this lawsuit, among
20 20 other things? And --
21 21 A With -- with the 581 as well?
22 16:01 22 Q Yeah. Exhibit 570 -- I'm sorry.
23 23 Exhibit 577 as amended by Exhibit 581, had the
24 24 County had, in fact -- had the County, in fact,
25 25 renewed that contract as amended, would you have
DFJ6
1097
1 1 continued with your lawsuit in pursuing legal
2 2 remedies against the County and other defendants?
3 3 A Yes.
4 4 MR. LEE: Okay. No further questions.
5 5 MR. WASSER: I have no questions.
6 6 Thank you, Dr. Jadwin.
7 7 THE WITNESS: Thank you.
8 8 THE VIDEOGRAPHER: Off the record?
9 9 MR. WASSER: Yep.
10 10 THE VIDEOGRAPHER: This concludes today's
11 11 deposition of David --
12 12 MR. LEE: I'm sorry. Just one more thing I
13 13 want to add. I apologize.
14 16:02 14 Plaintiff would like to have the 30 days
15 15 under the statute to correct the transcript. Under
16 16 the FRCP.
17 17 MR. WASSER: That's fine.
18 18 MR. LEE: Okay.
19 19 THE VIDEOGRAPHER: This concludes today's
20 20 deposition of David Jadwin, D.O., Volume 5. The
21 21 number of tapes used was one.
22 22 The time is 4:02 P.M. We are off the
23 23 record.
24 24 (Whereupon, the deposition proceedings
25 25 concluded at 4:02 P.M.)
DFJ6
DCase
FRANK JADWIN, D.O., VOL.Document
1:07-cv-00026-OWW-TAG VI 277-2 Filed 12/01/2008 Page 45 of 245
10-21-08
Page 1099
1 I, SANDRA D. ORTIZ, CSR No. 6048, Certified
2 Shorthand Reporter, do hereby certify:
3 That the foregoing proceedings were taken
4 before me at the time and place herein set forth, at
5 which time the witness declared under penalty of
6 perjury; that the testimony of the witness was
7 recorded stenographically by me and was thereafter

8 transcribed under my direction.
9 That the foregoing is a true and correct
10 transcript of my shorthand notes so taken and of the

11 testimony so given.
12 ( ) That no review of the transcript was

requested.
13 ( X ) That review of the transcript was
requested.
14 ( ) That the witness has failed or refused to
approve the transcript.
15
16 I further certify that I have no interest in

17 the outcome of this action.
18 In witness whereof, I have hereunto subscribed
19 my name this 28th day of October, 2008.
20
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/ I l
22 ()L/1L(JL~~
SANDRA D. ORTIZ,
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VS. KERN
RANDALL (800) 322-4595
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3 ______________
5 F. JADWIN, D.O., ) VOLUME I

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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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Defendants. )
10 __________________________)
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15 OF
16 BARBARA ELIZABETH PATRICK
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PatrickB1
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1 1 BY MR. LEE:
2 13:35:49 2 Q. I think I misheard. Thank you.
3 13:35:53 3 And were you at any point the chair of the
4 13:35:55 4 Board of Supervisors.
5 13:35:56 5 A. Yes, I was. Three times.
6 13:35:59 6 Q. Can you tell us the terms of your
7 13:36:01 7 chairmanship of the board?
8 13:36:04 8 A. Sure. It would have been in 1996, 2001, and
9 13:36:09 9 2006.
10 13:36:11 10 Q. And these are, what, two-year terms?
11 13:36:13 11 A. Just one year.
12 13:36:18 12 Q. One-year term.
13 13:36:20 13 What -- how would you describe your -- the
14 13:36:26 14 job functions of your position as County supervisor?
15 13:36:32 15 A. How much time do you have? We did budgets;
16 13:36:37 16 we did meetings; we had committees that we served on.
17 13:36:41 17 I also represented the board on the Valley Air
18 13:36:44 18 District and also represented the valley on the
19 13:36:47 19 California Air Resources Board. So I -- I had a lot
20 13:36:53 20 of responsibility.
21 13:36:56 21 Q. What were your job functions with respect
22 13:37:01 22 to -- bless you -- strike that.
23 13:37:01 23 What were your job functions as a member of
24 13:37:04 24 the Board of Supervisors with respect to Kern Medical
25 13:37:06 25 Center?
PatrickB1
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1 13:41:11 1 chair of the Board of Supervisors?
2 13:41:13 2 A. Typically, yes.
3 13:41:14 3 Q. So in 2006 when you were the chair of the
4 13:41:19 4 Board of Supervisors, you were attending the joint
5 13:41:23 5 conference committees in your role as a chair of the
6 13:41:25 6 Board of Supervisors?
7 13:41:27 7 A. I'm sure I attended most of them.
8 13:41:32 8 Q. Okay. Do you recall at a joint -- do you
9 13:41:37 9 recall the joint conference committee meeting
10 13:41:39 10 occurring on July 10, 2006, at which Dr. Jadwin's
11 13:41:43 11 removal from chairmanship of the pathology department
12 13:41:46 12 was considered and voted upon by the JCC?
13 13:41:49 13 A. I couldn't verify that it was on that date,
14 13:41:52 14 but I do remember the discussion, yes.
15 13:41:54 15 Q. Well, I'll represent to you that the joint
16 13:41:56 16 conference committee met on July 10, 2000- -- did I
17 13:41:59 17 say '8? I meant '6 -- 2006 to vote to consider and
18 13:42:03 18 to approve removal of Dr. Jadwin from chair of the
19 13:42:06 19 department of pathology at Kern Medical Center.
20 13:42:11 20 Did you vote on Dr. Jadwin's removal from
21 13:42:15 21 chair?
22 13:42:15 22 A. I imagine that I did.
23 13:42:17 23 Q. You have no reason to believe you did not.
24 13:42:19 24 Right?
25 13:42:19 25 A. I have no reason to believe I did not.
PatrickB1
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1 13:42:21 1 Q. Okay. Do you recall how you voted? Was it
2 13:42:25 2 for? against? Did you --
3 13:42:27 3 A. I imagine I would have voted in favor of it.
4 13:42:29 4 Q. Favor of it.
5 13:42:30 5 Okay. What I'm interested in knowing today
6 13:42:33 6 is the basis for your decision to approve or to vote
7 13:42:36 7 in favor of removal of Dr. Jadwin.
8 13:42:39 8 What did you base that decision on?
9 13:42:41 9 MR. WASSER: As an elected County
10 13:42:46 10 supervisor, Supervisor Patrick has a legislative
11 13:42:49 11 immunity which extends to the rationale for votes
12 13:42:52 12 that she cast in her capacity as supervisor. That
13 13:42:56 13 immunity is based upon separation of powers.
14 13:42:58 14 So it is Ms. Patrick's -- I mention this as
15 13:43:03 15 a privilege that she holds. It's personal to her as
16 13:43:07 16 a local legislator. If she wishes to waive that
17 13:43:11 17 privilege and answer the question, it is a privilege
18 13:43:13 18 she holds herself. If she wishes to assert the
19 13:43:16 19 privilege, she can assert the privilege and can
20 13:43:20 20 decline to answer questions regarding the reasons she
21 13:43:26 21 had in her mind for votes that she cast in her
22 13:43:29 22 capacity as a local legislator.
23 13:43:31 23 MR. LEE: Okay. I'm going to state that --
24 13:43:33 24 MR. WASSER: And that is the separation of
25 13:43:35 25 powers privilege. It's not based upon State statute.
PatrickB1
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1 13:45:48 1 (Requested portion of record read.)
2 13:46:14 2 THE WITNESS: He wasn't there.
3 13:46:20 3 BY MR. LEE:
4 13:46:21 4 Q. So simply physical unavailability from the
5 13:46:25 5 workplace at Kern Medical Center. Is that correct?
6 13:46:27 6 A. Over an extended period of time.
7 13:46:33 7 Q. Okay. You've stated physical
8 13:46:35 8 unavailability. He wasn't there.
9 13:46:37 9 What other bases did you base your decision
10 13:46:41 10 on?
11 13:46:43 11 A. Well, it was my feeling that we needed to
12 13:46:45 12 have a chair in place, and he was not there and had
13 13:46:52 13 not been there for an extended period of time.
14 13:46:54 14 Q. I understand.
15 13:46:55 15 So physical unavailability for an extended
16 13:46:57 16 period of time.
17 13:46:58 17 A. Yes.
18 13:46:59 18 Q. Is that the sole reason then that you based
19 13:47:00 19 your vote on, or are there others?
20 13:47:02 20 A. Yes.
21 13:47:03 21 Q. Yes.
22 13:47:04 22 Okay. Now, regarding the physical
23 13:47:06 23 unavailability of Dr. Jadwin, are you aware of the
24 13:47:11 24 reasons for Dr. Jadwin's physical unavailability at
25 13:47:14 25 Kern Medical Center?
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1 14:25:47 1 Q. Don't recall.
2 14:25:50 2 Is there any documents you can think of that
3 14:25:53 3 would help you to recall whether or not there was
4 14:25:56 4 discussion or whether you asked any questions at that
5 14:25:58 5 removal meeting to remove Dr. Jadwin?
6 14:26:02 6 A. No.
7 7 Q. No.
8 14:26:12 8 A. When I left office, I shredded all my
9 14:26:15 9 documents.
10 14:26:16 10 Q. When did you leave office again,
11 14:26:17 11 Ms. Patrick?
12 14:26:18 12 A. It was on January 8th of 2007.
13 14:26:22 13 Q. 2007.
14 14:26:23 14 A. Um-hmm.
15 14:26:24 15 Q. Were you aware that plaintiff had sent the
16 14:26:26 16 request to defendants asking them not to destroy any
17 14:26:28 17 evidence, that we were intending to file a lawsuit?
18 14:26:33 18 Were you aware of that?
19 14:26:34 19 A. I received nothing.
20 14:26:37 20 Q. Did legal counsel at any point ever discuss
21 14:26:39 21 with you plaintiff's request that no documents be
22 14:26:43 22 destroyed relevant to Dr. Jadwin's litigation?
23 14:26:47 23 A. No.
24 14:26:49 24 Q. To this day you have not been contacted
25 14:26:51 25 regarding preservation of documents and evidence in
PatrickB1
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1 14:26:54 1 connection with this litigation?
2 14:26:55 2 A. No. Not that I can recall.
3 14:27:03 3 Q. Do you think you might have been contacted
4 14:27:04 4 before you shredded the documents?
5 14:27:07 5 A. I would not have shredded documents --
6 14:27:10 6 Q. Sure.
7 14:27:10 7 A. -- had I remembered it, but I -- not that I
8 14:27:13 8 recall. I don't remember.
9 14:27:14 9 Q. Okay. Do you recall -- is there a custom to
10 14:27:29 10 take notes at any JCC meetings?
11 14:27:32 11 A. Typically I did.
12 14:27:32 12 Q. Typically you did.
13 14:27:35 13 Do you have any recollection of whether you
14 14:27:36 14 took notes at the JCC removal meeting?
15 14:27:39 15 A. No.
16 14:27:39 16 Q. No reason to believe you didn't. Right?
17 14:27:41 17 A. Right.
18 14:27:42 18 Q. Okay. Were those notes among the documents
19 14:27:45 19 you shredded upon your -- your leaving your
20 14:27:50 20 supervisor position?
21 14:27:53 21 A. I shredded everything when I left.
22 14:27:57 22 Q. Everything.
23 14:27:57 23 So it would have included your notes from
24 14:27:59 24 the JCC meetings?
25 14:28:02 25 A. It might have. I don't know that I would
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1 14:28:04 1 have -- I don't know that I would have taken notes on
2 14:28:07 2 an executive session-type thing but....
3 14:28:10 3 Q. Oh, so there are some JCC meetings you would
4 14:28:12 4 not have taken notes for. Correct? Is that what
5 14:28:15 5 you're saying?
6 14:28:16 6 A. No. I'm just saying I would have just sort
7 14:28:19 7 of doodled something on the side of -- you know, a
8 14:28:22 8 date or something like that on the side of a -- of
9 14:28:25 9 the agenda, probably.
10 14:28:26 10 Q. So you consider doodles to be notes, then?
11 14:28:28 11 A. That would -- that would be pretty much what
12 14:28:31 12 I would have done.
13 14:28:32 13 Q. So when you say notes, you actually mean
14 14:28:34 14 doodles in the margin?
15 14:28:35 15 A. Yes.
16 14:28:36 16 Q. Sort of like cartoon figures or --
17 14:28:38 17 A. Oh, no, no, no. Not cartoon figures. But
18 14:28:41 18 maybe a date or something underlined or --
19 14:28:44 19 Q. I see.
20 14:28:44 20 A. -- something like that.
21 14:29:12 21 Q. So when you say doodles, you mean notes --
22 14:29:15 22 little written notes on the sides of the agendas
23 14:29:17 23 then. Correct?
24 14:29:18 24 A. Yes. It wouldn't have been something like
25 14:29:20 25 this because we would get meeting minutes. It would
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1 14:29:23 1 be more or less reminders to myself about something.
2 14:29:26 2 Q. Okay. And do you have those doodles to this
3 14:29:29 3 day?
4 14:29:30 4 A. No.
5 14:29:30 5 Q. Were they destroyed?
6 14:29:33 6 A. They were probably just thrown out.
7 7 Q. Thrown out.
8 14:29:47 8 Do you recall discussing job abandonment at
9 14:29:51 9 the removal meeting?
10 14:29:56 10 A. I remember there was discussion of that.
11 14:29:58 11 Q. What do you remember of that discussion?
12 14:30:00 12 A. I don't remember specifics.
13 14:30:03 13 Q. You just remember the term job abandonment
14 14:30:06 14 and that's it?
15 14:30:07 15 A. I remember that there was discussion of that
16 14:30:10 16 in relationship to the item at hand, but I don't
17 14:30:16 17 remember the specifics of it.
18 14:30:18 18 Q. Well, can you recollect how job abandonment
19 14:30:22 19 related to the item at hand with respect to
20 14:30:25 20 Dr. Jadwin's removal?
21 14:30:40 21 A. He had been gone a long time.
22 14:30:45 22 Q. Okay. And what's that mean? How does that
23 14:30:48 23 relate to job abandonment? And if you don't recall,
24 14:30:54 24 just say you don't recall.
25 14:30:55 25 A. I don't. I don't recall. But he had been
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1 14:32:09 1 certain date? Do you recall that?
2 14:32:09 2 A. I believe so.
3 14:32:09 3 Q. You believe so.
4 14:32:09 4 Okay. Do you recall how you learned of
5 14:32:09 5 that, this deadline that was imposed on Dr. Jadwin?
6 14:32:14 6 A. Not specifically.
7 14:32:16 7 Q. Okay. Do you recall the basis for that
8 14:32:18 8 deadline, whether -- what the rhyme or rationale was
9 14:32:22 9 for that deadline, that particular deadline?
10 14:32:28 10 A. I'm assuming that -- I should probably not
11 14:32:31 11 assume things.
12 14:32:32 12 Q. You should not.
13 14:32:33 13 MR. WASSER: Do not guess.
14 14:32:34 14 BY MR. LEE:
15 14:32:35 15 Q. If you don't recall, just say --
16 14:32:36 16 A. I do not recall.
17 14:32:38 17 Q. Do not recall.
18 14:32:39 18 Okay. Do you recall that at or near the
19 14:32:40 19 deadline that -- well, I'm going to represent to you
20 14:32:43 20 that the deadline that was imposed on Dr. Jadwin was
21 14:32:46 21 that he was to render a decision to Mr. Bryan by June
22 14:32:48 22 16, 2006, as to whether he was going to return as a
23 14:32:51 23 full-time chair or resign his chairmanship.
24 14:32:55 24 Okay. Do you recall whether Dr. Jadwin
25 14:32:58 25 reported having some kind of physical ailment at or
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1 14:33:02 1 near the deadline and asking for more time to decide?
2 14:33:07 2 Do you recall that?
3 14:33:07 3 A. That, I do not remember.
4 14:33:09 4 Q. Don't recall.
5 14:33:09 5 Do you recall how long the discussion was at
6 14:33:18 6 the removal meeting regarding Dr. Jadwin's removal?
7 14:33:20 7 A. No, sir, I don't.
8 14:33:21 8 Q. You don't recall whether it was more than an
9 14:33:24 9 hour, less than an hour?
10 14:33:26 10 A. I do not.
11 14:33:26 11 Q. When agenda items were discussed at the JCC,
12 14:33:31 12 can you put, like, an average time on each agenda
13 14:33:34 13 item in terms of discussion time?
14 14:33:40 14 A. Some of them were quite lengthy and others
15 14:33:42 15 were quite short. But that would have been in the
16 14:33:46 16 executive session, and we did not typically even have
17 14:33:50 17 executive sessions at that. So it would be difficult
18 14:33:55 18 to fit that into any kind of a continuum of time.
19 14:34:01 19 Q. Okay. Now, do you remember the -- who
20 14:34:03 20 raised the issue of job abandonment at the removal
21 14:34:07 21 meeting?
22 14:34:07 22 A. I do not.
23 14:34:08 23 Q. Do you recall whether there was any
24 14:34:10 24 significant amount of discussion regarding job
25 14:34:13 25 abandonment at the removal meeting?
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1 14:34:15 1 A. I do not.
2 14:34:15 2 Q. So what do you recall what was discussed at
3 14:34:22 3 the removal meeting besides a little bit of job
4 14:34:25 4 abandonment and the fact that Dr. Jadwin was
5 14:34:27 5 physically unavailable due to medical leave? Do you
6 14:34:31 6 recall anything else being discussed?
7 14:34:35 7 A. I think what was discussed was the need to
8 14:34:41 8 have present chair of pathology.
9 14:34:44 9 Q. So do you recall any discussion about due
10 14:34:47 10 process rights of Dr. Jadwin?
11 14:34:50 11 A. I don't. Again, it was a long time ago.
12 14:34:51 12 Q. So, in other words, you can't say one way or
13 14:34:53 13 the other.
14 14:34:54 14 A. That's right.
15 14:34:54 15 Q. It may have been discussed but not --
16 14:34:56 16 A. Yes.
17 14:34:58 17 Q. Do you recall anything about Dr. Jadwin
18 14:34:59 18 having a property right or property interest in the
19 14:35:01 19 chairmanship?
20 14:35:04 20 A. I don't recall any such discussion.
21 14:35:06 21 Q. Don't recall.
22 14:35:08 22 Okay. So, in other words, you don't believe
23 14:35:09 23 it happened?
24 14:35:10 24 MR. WASSER: She didn't say that, Counsel.
25 14:35:11 25 THE WITNESS: No. I said I don't recall any
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1 14:35:13 1 such discussion.
2 14:35:14 2 BY MR. LEE:
3 14:35:15 3 Q. Okay. So -- I just want to clarify.
4 14:35:18 4 So does that mean you don't know one way or
5 14:35:20 5 the other or --
6 14:35:21 6 A. I don't know. The meeting was a long time
7 14:35:23 7 ago. I don't remember that being part of the
8 14:35:25 8 discussion.
9 14:35:29 9 Q. Okay. So I'm just -- again, there is a fine
10 14:35:31 10 distinction for me.
11 14:35:33 11 So are you saying that you don't know one
12 14:35:34 12 way or the other or, to your recollection, it did not
13 14:35:36 13 happen?
14 14:35:38 14 A. I don't remember enough specifics of the
15 14:35:42 15 meeting to tell you whether it occurred or not.
16 14:35:46 16 Q. Okay. Thank you. That's perfectly fine.
17 14:35:52 17 Do you recall if Dr. Irwin Harris was at the
18 14:35:55 18 removal meeting, chief medical officer?
19 14:35:58 19 A. I don't.
20 14:36:00 20 Q. Do you recall if Jennifer Abraham was at
21 14:36:02 21 the -- well, she wouldn't have been there. Never
22 14:36:04 22 mind.
23 14:36:05 23 Do you recall receiving a memorandum from
24 14:36:13 24 Peter Bryan sometime around early 2006 regarding
25 14:36:17 25 Dr. Jadwin?
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ss.
2 COUNTY OF KERN
5 I, Susan R. Wood, a Certified Shorthand
6 Reporter in the State of California, holding
7 Certificate No. 6829, do hereby certify that
8 BARBARA ELIZABETH PATRICK, the witness named in the
9 foregoing deposition, was by me duly sworn; that said
o deposition was taken Tuesday, August 19, 2008, at the
1 time and place set forth on the first page hereof.
my supervision; that the foregoing is a true and correct
I further certify that I am neither counsel for
nor in any way related to any party to said action, nor
in any way interested in the result or outcome thereof.
Dated this 2nd day of September, 2008, at
Bakersfield, California.
Susan ~-N-O-'-6-8-2-9----
WOOD & RANDALL
(800) 322-4595
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26 EXHIBIT 8
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3 ______________
5 F. JADWIN, D.O., )
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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Defendants. )
10 __________________________)
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15 OF
16 GILBERT R. MARTINEZ
17 Wednesday, April 16, 2008
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1 10:17:52 1 A. I just knew that that was occurring. I did
2 10:17:55 2 not participate in obtaining the documents.
3 10:17:58 3 Q. I see.
4 10:17:59 4 Who did?
5 10:18:01 5 A. That was the clerical staff up in the
6 10:18:03 6 pathology office.
7 10:18:04 7 Q. Okay. Was this a substantial amount of
8 10:18:07 8 work, to your knowledge, for this?
9 10:18:08 9 A. Yes.
10 10:18:09 10 Q. To the clerical staff?
11 10:18:11 11 A. Yes.
12 10:18:20 12 Q. Okay. Now, do you recall ever having a
13 10:18:26 13 discussion with Dr. Jadwin around end of November,
14 10:18:29 14 right before Thanksgiving of 2006, regarding an audit
15 10:18:35 15 coming from CAP, JCAHO, or the Department of Health
16 10:18:39 16 Services? I'm sorry. The California Department of
17 10:18:42 17 Health Services.
18 10:18:48 18 A. An audit regarding?
19 10:18:49 19 Q. Well, did he ever tell you that an audit was
20 10:18:52 20 coming to the hospital?
21 10:18:54 21 A. An audit or an inspection?
22 10:18:55 22 Q. An inspection. I'm sorry. An inspection.
23 10:18:57 23 A. I believe around -- it may have been around
24 10:19:04 24 that time that he came into my office and let me know
25 10:19:07 25 that there was going to probably be some type of
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1 10:19:11 1 inspection.
2 10:19:12 2 Q. Can you recall what exactly he told you?
3 10:19:21 3 A. The gist of it was to make sure I had the
4 10:19:25 4 department ready, inspection ready.
5 10:19:29 5 Q. Okay. But -- so you don't recall how he
6 10:19:32 6 said it to you or what he said?
7 10:19:34 7 A. Not the specific words, no.
8 10:19:35 8 Q. Basically, the message was you should get
9 10:19:39 9 ready; there's an audit coming?
10 10 A. Yes.
11 11 Q. Okay.
12 10:19:41 12 A. More an inspection.
13 10:19:43 13 Q. An inspection. Yeah. I apologize. An
14 10:19:44 14 inspection.
15 10:19:44 15 What's the difference between inspection and
16 10:19:46 16 audit, actually?
17 10:19:46 17 A. Well, an audit is more like for accounting
18 10:19:49 18 purposes. When we think of an inspection,
19 10:19:51 19 inspection's a survey to make sure that you're in
20 10:19:54 20 compliance with all of the regulatory requirements.
21 10:19:58 21 Q. I see.
22 10:20:00 22 Did you ask Dr. Jadwin how he knew an
23 10:20:02 23 inspection was coming?
24 10:20:07 24 A. I do not recall if I did or not.
25 10:20:10 25 Q. Okay. Did he mention any of the agencies
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1 10:20:17 1 that might be doing these inspections?
2 10:20:21 2 A. He may have, but I don't recall if it was a
3 10:20:23 3 specific agency.
4 10:20:24 4 Q. Okay. Well, after Dr. Jadwin told you to
5 10:20:27 5 get ready for an inspection -- well, did he say it
6 10:20:31 6 would be multiple inspections or one inspection?
7 10:20:33 7 A. He did not say it would be multiple.
8 10:20:35 8 Q. So when Dr. -- after Dr. Jadwin told you to
9 10:20:40 9 get ready for an inspection around November,
10 10:20:45 10 Thanksgiving of 2006, what did you do next?
11 10:20:50 11 A. I informed my administrative supervisor.
12 10:20:55 12 Q. Who was that?
13 10:20:57 13 A. I believe that was Dr. Kolb at the time.
14 10:21:00 14 Q. Marv Kolb?
15 10:21:01 15 A. I believe so.
16 10:21:01 16 Q. In 2006?
17 10:21:02 17 A. Or David Hill. One of the two.
18 10:21:04 18 Q. I think Marv Kolb left --
19 10:21:07 19 A. If he had left, it was David Hill, then.
20 10:21:09 20 Q. David H-i-l-l?
21 10:21:10 21 A. Yes.
22 10:21:10 22 Q. What's David Hill's position or was it?
23 10:21:12 23 A. He was the admin- -- he was the
24 10:21:14 24 administrator over ambulatory care.
25 10:21:16 25 Q. Okay. What did David Hill tell you? What
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1 10:21:18 1 was his response?
2 10:21:19 2 A. Oh, I believe he asked me about the
3 10:21:34 3 readiness of the laboratory for an inspection.
4 10:21:38 4 Q. Okay. And when was the date of your meeting
5 10:21:41 5 with David Hill?
6 10:21:42 6 A. I do not recall.
7 10:21:43 7 Q. Was it -- how many days or was it
8 10:21:45 8 immediately after you had the meeting with
9 10:21:47 9 Dr. Jadwin?
10 10:21:47 10 A. Probably within a few days.
11 10:21:49 11 Q. Within a few days. Okay.
12 10:21:51 12 Well, let me check something. I want to see
13 10:21:57 13 when Thanksgiving was.
14 10:22:08 14 Okay. Did David Hill ask you how you knew
15 10:22:12 15 there was an inspection coming?
16 10:22:16 16 A. I had told him that Dr. Jadwin had talked to
17 10:22:18 17 me.
18 10:22:19 18 Q. Okay. And then do you recall what happened
19 10:22:23 19 next or do you know what happened next?
20 10:22:26 20 A. No. I just made sure that we were -- for
21 10:22:30 21 the most part, we're pretty much ready for
22 10:22:32 22 inspections just about any time. Just -- just
23 10:22:36 23 double-checked to make sure we were okay.
24 10:22:37 24 Q. Okay. Did Dr. Jadwin specify whether it
25 10:22:41 25 would be like a hospital-wide inspection or whether
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1 1 BY MR. LEE:
2 10:41:46 2 Q. Mr. Martinez, did you find Dr. Jadwin to be
3 10:41:48 3 arrogant during the time working with him?
4 10:42:05 4 A. Not arrogant.
5 10:42:07 5 Q. Okay. Did you find Dr. Jadwin to be
6 10:42:11 6 overbearing?
7 10:42:15 7 A. Not with me.
8 10:42:17 8 Q. Okay. With other people you found him
10 10:42:25 10 A. There was a complaint.
11 10:42:27 11 Q. By whom?
12 10:42:29 12 A. Jane Thornton.
13 10:42:29 13 Q. Jane Thornton.
14 10:42:31 14 Okay. I mean -- what about intimidating?
15 10:42:34 15 Did you find Dr. Jadwin to be intimidating?
16 10:42:37 16 A. No.
17 10:42:37 17 Q. How about uncooperative? Did you find
18 10:42:41 18 Dr. Jadwin to be uncooperative?
19 10:42:52 19 A. There was an occasion or two, yes.
20 10:42:54 20 Q. Can you tell me those occasions?
21 10:42:57 21 A. One occasion was with the -- there was a --
22 10:43:00 22 another compliance issue regarding a -- the ordering
23 10:43:04 23 of a CBC versus a CBC in dif.
24 10:43:09 24 Q. That's lab equipment?
25 10:43:10 25 A. That's lab -- a lab test.
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1 10:43:13 1 Q. Supplies?
2 10:43:14 2 A. The test itself.
3 10:43:15 3 Q. Oh, okay.
4 10:43:17 4 A. CBC is a complete blood count. CBC with
5 10:43:21 5 differential is a complete blood count with a
6 10:43:25 6 differential.
7 10:43:26 7 Q. Okay. What happened?
8 10:43:27 8 A. What he wanted to do was delete the CBC and
9 10:43:33 9 only offer the CBC with differential, which would
10 10:43:36 10 have been a compliance issue, because then the CBC is
11 10:43:40 11 less expensive. So that's another one that I had to
12 10:43:45 12 take up to the compliance committee.
13 10:43:47 13 Q. Okay. And what was the outcome?
14 10:43:51 14 A. The CBC and CBC with differential remained
15 10:43:55 15 on the test menu.
16 10:43:57 16 Q. Okay.
17 10:43:58 17 A. So we did not delete it.
18 10:43:59 18 Q. Did not delete it.
19 10:44:00 19 A. Did not.
20 10:44:02 20 Q. Okay. Did Dr. Jadwin hold that against you?
21 10:44:05 21 A. No.
22 10:44:06 22 Q. So he took it in stride?
23 10:44:08 23 A. Yes.
24 10:44:08 24 Q. Was he respectful -- was Dr. Jadwin
25 10:44:10 25 respectful toward you?
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1 10:44:11 1 A. Yes.
2 10:44:12 2 Q. Was Dr. Jadwin unfriendly at any time?
3 10:44:16 3 A. Towards me?
4 10:44:20 4 Q. Yes.
5 10:44:20 5 A. Unprofessional.
6 10:44:22 6 Q. He was unprofessional to you?
7 10:44:23 7 A. Yes.
8 10:44:24 8 Q. How was Dr. Jadwin unprofessional to you?
9 10:44:27 9 A. Well, he had wanted me to step down and he
10 10:44:29 10 wanted to put the medical secretary in charge of the
11 10:44:32 11 lab.
12 10:44:32 12 Q. I see.
13 10:44:33 13 Why would he want to do that, to your
14 10:44:35 14 knowledge?
15 10:44:36 15 A. That, I do not know. He did not discuss
16 10:44:37 16 that with me.
17 10:44:38 17 Q. Which secretary did he want to elevate to
18 10:44:41 18 the head of the laboratory?
19 10:44:43 19 A. That was before Tracy. I forget her name.
20 10:44:56 20 Q. That's fine.
21 10:44:57 21 Did he ever explain -- so Dr. Jadwin never
22 10:45:02 22 explained to you why he wanted to elevate the
23 10:45:04 23 secretary to the lab management position?
24 10:45:06 24 A. No.
25 10:45:06 25 Q. And what position was he proposing to put
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1 10:45:08 1 you in?
2 10:45:09 2 A. He did not specify.
3 10:45:11 3 Q. I see.
4 10:45:12 4 A. But I told him I would not -- I would step
5 10:45:16 5 down and be in charge of the laboratory information
6 10:45:18 6 system, which was one of my previous duties --
7 10:45:20 7 Q. Correct.
8 10:45:21 8 A. -- and maybe some bench work, but no
9 10:45:23 9 personnel.
10 10:45:28 10 Q. You said there was another incident as well
11 10:45:30 11 with Dr. Jadwin being unprofessional. What was that?
12 10:45:33 12 A. No. That was it.
13 10:45:34 13 Q. That was it.
14 10:45:35 14 Okay. When did that happen roughly?
15 10:45:38 15 Dr. Jadwin came to the hospital around 2000.
16 10:45:45 16 A. I don't know. Maybe 2004, 2005, somewhere
17 10:45:48 17 around there.
18 10:45:49 18 Q. Okay. Did you ever find Dr. Jadwin to be
19 10:46:04 19 self-righteous?
20 10:46:04 20 A. No.
21 10:46:06 21 Q. No.
22 10:46:06 22 Okay. Earlier you said that other people
23 10:46:08 23 found Dr. Jadwin to be intimidating? Or was it -- I
24 10:46:12 24 can't remember which one it was.
25 10:46:13 25 A. Overbearing.
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1 10:48:09 1 A. I believe it was some of the techs in the
2 10:48:11 2 hematology department, but I don't recall which ones.
3 10:48:18 3 Q. These are people working beneath Jane
4 4 Thornton?
5 10:48:21 5 A. Yes.
6 10:48:22 6 Q. And there were how many techs in the
7 10:48:22 7 hematology department?
8 10:48:23 8 A. There was only about two others.
9 10:48:25 9 Q. Okay. So both of them would complain?
10 10:48:26 10 A. I'm not sure specifically.
11 10:48:28 11 Q. I see.
12 10:48:28 12 You heard through the grapevine that --
13 10:48:30 13 A. Yeah.
14 10:48:30 14 Q. -- they were complaining.
15 10:48:31 15 Did you hear it through Jane Thornton?
16 10:48:36 16 A. I don't know if it was through Jane Thornton
17 10:48:38 17 or through others.
18 10:48:41 18 Q. Okay. Are you aware of any of the lab
19 10:48:51 19 personnel leaving the hospital because Dr. Jadwin was
20 10:48:55 20 driving them out?
21 10:49:05 21 A. No.
22 10:49:10 22 Q. Did you have any occasion to see Dr. Jadwin
23 10:49:13 23 lose his temper, become angry?
24 10:49:23 24 A. Yes.
25 10:49:42 25 Q. Can you describe the incident when he lost
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1 10:49:43 1 his temper?
2 10:49:44 2 A. Well, it was when he became pretty angry
3 10:49:47 3 when we had an inspection and he was not present. So
4 10:49:52 4 the inspection team came up, and I showed them -- the
5 10:49:57 5 inspectors around -- I gave them a general tour of
6 10:49:59 6 the laboratory. And then he came in after they were
7 10:50:01 7 already here and he -- he was extremely upset, said
8 10:50:07 8 it was totally mishandled, et cetera. He was pretty
9 10:50:12 9 visibly upset.
10 10:50:14 10 Q. At you?
11 10:50:14 11 A. Yes.
12 10:50:14 12 Q. Well, when you say he was visibly upset,
13 10:50:16 13 what -- what was visible about his upset? How did
14 10:50:19 14 you know he was upset?
15 10:50:20 15 A. Well, the comment that he made.
16 10:50:24 16 Q. What was the comment? Just the comment you
17 10:50:25 17 just said. Right?
18 10:50:26 18 A. No.
19 10:50:27 19 Q. Okay. What was his comment?
20 10:50:29 20 A. If he had a gun -- a gun he would have shot
21 10:50:33 21 someone.
22 10:50:33 22 Q. That's what he said?
23 10:50:34 23 A. Yes.
24 10:50:34 24 Q. So did you take that to literally mean he
25 10:50:37 25 would bring a gun to the hospital and shoot somebody?
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1 10:50:39 1 A. I just dismissed it and....
2 10:50:42 2 Q. So you didn't go to the police and file a --
3 10:50:44 3 A. No.
4 10:50:44 4 Q. -- report or you didn't go to administration
5 10:50:46 5 and file a workplace violence complaint or anything
6 10:50:49 6 like that?
7 10:50:49 7 A. No. Because at the time Mr. Bryan had said
8 10:50:52 8 specifically either the manager's going to go or the
9 10:50:55 9 director's going to go.
10 10:50:56 10 Q. Who said that?
11 10:50:57 11 A. Mr. Bryan, Peter, the CEO.
12 10:51:00 12 Q. Oh, I see. I see.
13 10:51:01 13 A. So it would have meant that I would have
14 10:51:03 14 left.
15 10:51:04 15 Q. I see.
16 10:51:05 16 Okay. Now, when -- when did this incident
17 10:51:10 17 with Dr. Jadwin happen where he got angry at you?
18 10:51:14 18 A. I think it was an inspection about three
19 10:51:16 19 inspections -- three inspections ago.
20 10:51:20 20 Q. So, what, three years ago?
21 10:51:23 21 A. About three years ago, yeah. Well, no.
22 10:51:25 22 Maybe longer than that.
23 10:51:27 23 Q. So perhaps before 2005?
24 10:51:29 24 A. Yeah.
25 10:51:30 25 Q. Okay. Did Dr. Jadwin ever apologize to you
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1 10:51:36 1 about that or did you ever discuss it again with
2 10:51:37 2 Dr. Jadwin?
3 10:51:38 3 A. No. No one ever brought it up again.
4 10:51:42 4 Q. Okay. So he didn't say he would shoot you;
5 10:51:50 5 he just said I'll shoot someone?
6 10:51:53 6 A. Correct.
7 10:51:53 7 Q. So he wasn't necessarily threatening you
8 10:51:55 8 physically, was he?
9 10:51:56 9 A. Physically?
10 10:51:57 10 Q. Yeah.
11 10:51:58 11 A. No.
12 10:52:00 12 Q. Dr. Jadwin's a tall man. I believe he's
13 10:52:03 13 around six, three, six, four.
14 10:52:05 14 Was he ever physically aggressive toward
15 10:52:08 15 you?
16 10:52:08 16 A. No.
17 10:52:09 17 Q. How tall are you, roughly?
18 10:52:11 18 A. About five, ten.
19 10:52:12 19 Q. Okay. Did you ever feel a little bit
20 10:52:15 20 intimidated because of his physical size?
21 10:52:16 21 A. No.
22 10:52:22 22 Q. Had there been a lot of defections in the
23 10:52:24 23 laboratory in the last few years? When I say
24 10:52:27 24 defections, I mean personnel leaving the laboratory.
25 10:52:30 25 A. It's probably normal attrition, but the --
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1 10:54:35 1 Dr. Jadwin on, say, a weekly basis while working
2 10:54:38 2 together?
3 10:54:41 3 A. Most of them were informal, just mainly in
4 10:54:44 4 the hallway, or he might just come into my office or
5 10:54:46 5 I might go into his office. So at least once every
6 10:54:51 6 two days or so.
7 10:54:53 7 Q. Relatively frequent?
8 10:54:55 8 A. Frequently frequent, yes.
9 10:54:57 9 Q. And when you did interact, was it for pretty
10 10:55:00 10 extended periods of time or was it just quickly?
11 10:55:04 11 A. It was brief.
12 10:55:05 12 Q. Brief?
13 10:55:05 13 A. Yeah. Maybe some issue would come up or
14 10:55:08 14 he'd want a chair or whatever. He'd usually just
15 10:55:13 15 come to me first, and then I'd get whatever he
16 10:55:15 16 wanted.
17 10:55:15 17 Q. So relatively frequent interactions with
18 10:55:18 18 Dr. Jadwin?
19 10:55:18 19 A. Yes.
20 10:55:19 20 Q. So you feel -- did you feel like you got to
21 10:55:22 21 know him pretty well as a general?
22 10:55:27 22 A. Yes.
23 10:55:29 23 Q. Were you aware Dr. Jadwin was attempting to
24 10:55:32 24 start a company up called Columbia Healthcare
25 10:55:36 25 Analytics?
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STATE OF CALIFORNIA
ss.
COUNTY OF KERN
GILBERT R. MARTINEZ, the witness named in the foregoing
deposition, was by me duly sworn; that said deposition
was taken Wednesday, April 16, 2008, at the time and
place set forth on the first page hereof.
That upon the taking of the deposition, the
words of the witness were written down by me in
stenotypy and thereafter transcribed by computer under
transcript of the testimony given by the witness.
Dated this 19th day of May, 2008, at
~-
Susan R. Wood, CSR No. 6829
WOOD & RANDALL

(800) 322-4595
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26 EXHIBIT 9
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3 ______________
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 Defendants. )
__________________________)
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14 OF
15 ALAN SCOTT RAGLAND, M.D.
16 Friday, August 22, 2008
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25 ted by: Sandra L. Edmonson, CSR No. 7704, RPR, CRR
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1 09:20:49 1 drugs, medication or alcohol in the last 24 hours?
2 09:20:52 2 A. No. Well, no -- yes.
3 3 Q. Okay. What --
4 09:20:55 4 A. I took two aspirin this morning.
5 09:20:57 5 Q. Okay. That's not going to affect your
6 09:21:00 6 testimony today, correct?
7 09:21:01 7 A. I don't believe so.
8 09:21:01 8 Q. Okay. And the last thing I just have to --
9 09:21:04 9 just as a reminder, but even expert deponents get
10 09:21:08 10 this wrong all the time. Just please refrain from
11 09:21:11 11 speaking until I finish my question, and the reason
12 09:21:13 12 why is it is a courtesy to the reporter, she can only
13 09:21:17 13 record one person speaking at a time.
14 09:21:19 14 Do you understand?
15 09:21:20 15 A. Yes.
16 09:21:20 16 Q. Doctor, what's your current position at the
17 09:21:23 17 hospital?
18 09:21:24 18 A. Faculty in the internal medicine department.
19 09:21:28 19 Q. You're not a chair of a department, correct?
20 09:21:31 20 A. Correct.
21 09:21:31 21 Q. You're not a vice chair either, right?
22 09:21:34 22 A. Correct.
23 09:21:34 23 Q. Okay. Are you currently the past president
24 09:21:37 24 of the medical staff?
25 09:21:38 25 A. Yes.
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1 09:21:38 1 Q. And that is a -- that's a medical staff
2 09:21:43 2 officer position, correct?
3 09:21:44 3 A. Yes.
4 09:21:44 4 Q. When were you the president of the medical
5 09:21:48 5 staff?
6 09:21:52 6 A. My term ended in July 1st of '08. So it
7 09:21:57 7 would be two years before that.
8 09:21:58 8 Q. Okay. So the -- I understood that --
9 09:22:02 9 A. July 1st, '06, would be the beginning; July
10 09:22:06 10 1st, '08, would be the end.
11 09:22:07 11 Q. Okay. Did you have any interactions with
12 09:22:18 12 Dr. Jadwin?
13 09:22:19 13 A. Yes.
14 09:22:19 14 Q. Please estimate the frequency with which you
15 09:22:21 15 had interactions with Dr. Jadwin throughout his
16 09:22:25 16 tenure at Kern Medical Center.
17 09:22:27 17 A. Twice a week.
18 09:22:29 18 Q. Twice a week.
19 09:22:31 19 Why were you interacting? What were the --
20 09:22:32 20 what was the nature of those meetings or interactions
21 09:22:36 21 with Dr. Jadwin?
22 09:22:38 22 A. Perhaps to discuss a case, perhaps to work
23 09:22:40 23 on blood usage, any other functions of patient care.
24 09:22:43 24 Q. And so many of your interactions with
25 09:22:48 25 Dr. Jadwin were in his capacity as the director of
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1 09:34:05 1 competence, right?
2 09:34:05 2 A. I remember he was generally insulting to
3 09:34:07 3 everybody in the room.
4 09:34:08 4 Q. Okay. But then you said he tailored it to
5 09:34:10 5 each individual, right?
6 09:34:11 6 A. Sure.
7 09:34:11 7 Q. Okay. So you recall him giving a -- an
8 09:34:15 8 individualized insult to Mr. Bryan regarding his
9 09:34:17 9 competence?
10 09:34:18 10 A. No.
11 09:34:18 11 Q. You don't?
12 09:34:19 12 A. No.
13 09:34:20 13 Q. Then what was the individualized compe- --
14 09:34:25 14 insult to Mr. Bryan about then?
15 09:34:30 15 A. Okay. I don't remember the words.
16 09:34:31 16 Q. I'm not asking you for the words.
17 09:34:32 17 A. Okay.
18 09:34:32 18 Q. I'm asking for what the content was.
19 09:34:35 19 A. I already told you that.
20 09:34:37 20 Q. No, you didn't.
21 09:34:38 21 A. Insulting to everybody in the room. Okay?
22 09:34:40 22 I don't remember the details.
23 09:34:41 23 Q. Doctor, you just said a minute ago that he
24 09:34:45 24 said to everybody that they were incompetent in the
25 09:34:47 25 room. I'm asking you -- and then you said he
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1 09:34:50 1 specialized that insult to each person.
2 09:34:52 2 I'm asking you, did he give a specialized
3 09:34:55 3 insult to Mr. Bryan regarding his competence or not?
4 09:34:59 4 A. I don't recall.
5 09:34:59 5 Q. Okay. Now, how about Jennifer Abraham, what
6 09:35:03 6 specialized insult regarding competence did he direct
7 09:35:06 7 at Ms. Abraham?
8 09:35:07 8 A. I don't remember.
9 09:35:08 9 Q. You just recall that he insulted her
10 09:35:10 10 competence then?
11 09:35:11 11 A. I recall that he insulted my competence.
12 09:35:13 12 Q. What about -- I'm talking about Dr. Abraham
13 09:35:16 13 right now.
14 09:35:16 14 A. I understand that.
15 09:35:18 15 Q. Okay. So did he insult Dr. Abraham's
16 09:35:21 16 competence, then, to your recollection?
18 09:35:23 18 Q. Okay. How about Dr. Harris, how did he
19 09:35:27 19 direct a specialized insult regarding Dr. Harris'
20 09:35:30 20 competence at him?
21 09:35:31 21 A. I don't recall.
22 09:35:32 22 Q. Did he insult Dr. Harris' competence on an
23 09:35:35 23 individualized basis?
24 09:35:37 24 A. I don't recall.
25 09:35:37 25 Q. Okay. So as far as you can recall, the only
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1 10:00:58 1 complete --
2 10:00:59 2 Q. Yeah. Do you know why the president did not
3 10:01:02 3 restore confidence in the pathology department during
4 10:01:05 4 Dr. Jadwin's tenure at the hospital?
5 10:01:07 5 A. Because Dr. Jadwin wasn't very cooperative.
6 10:01:11 6 Q. So -- because he wasn't cooperative with
7 10:01:14 7 whom?
8 10:01:15 8 A. With everybody.
9 10:01:16 9 Q. Everybody. You mean that literally, right?
10 10:01:19 10 A. Yes.
11 10:01:19 11 Q. You -- when you say "he wasn't cooperative
12 10:01:23 12 with everybody," you mean to include every chair of
13 10:01:29 13 every department for instance, right?
14 10:01:31 14 A. As far as I know.
15 10:01:32 15 Q. Okay. Doctor, to your knowledge, Dr. Jadwin
16 10:01:34 16 didn't get along or cooperate with any department
17 10:01:36 17 chair, right?
18 10:01:37 18 A. Not that I'm aware of.
19 10:01:38 19 Q. Okay. He didn't get along or cooperate with
20 10:01:40 20 any core physician at Kern Medical Center, right?
21 10:01:42 21 A. Not that I'm aware.
22 10:01:45 22 Q. Do you -- to your knowledge, did the
23 10:01:51 23 president take any steps to restore confidence in the
24 10:01:53 24 pathology department during --
25 10:01:54 25 A. Yes.
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1 10:08:18 1 Q. I wasn't complete, Doctor.
2 10:08:19 2 And I'm asking you to do that for the sake
3 10:08:22 3 of the court reporter actually, not for my sake.
4 10:08:24 4 Okay?
5 10:08:24 5 You don't recall handing this -- a copy of
6 10:08:26 6 this E-mail you've just referenced to your attorneys
7 10:08:29 7 in response to any request for documents in this
8 10:08:31 8 action?
9 10:08:36 9 A. No.
10 10:08:36 10 Q. Were you aware that in this action documents
11 10:08:42 11 were requested with regard to Dr. Jadwin to be
12 10:08:46 12 produced?
13 10:08:50 13 A. No.
14 10:08:50 14 Q. No one came to you and told you to not -- to
15 10:08:56 15 collect evidence and not destroy it in connection
16 10:09:02 16 with this case?
17 10:09:04 17 A. No.
18 10:09:04 18 Q. And you're certain about that, right?
19 10:09:11 19 A. Yes.
20 10:09:11 20 Q. Okay. If -- could you produce this E-mail
21 10:09:16 21 you've just referenced today?
22 10:09:23 22 A. No.
23 10:09:23 23 Q. Why not?
24 10:09:29 24 A. I don't have it.
25 10:09:30 25 Q. Why not?
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1 10:10:32 1 A. No.
2 10:10:32 2 Q. Okay. So you sent Dr. Jadwin this alleged
3 10:10:48 3 E-mail asking who he could trust to sit on a
4 10:10:52 4 committee, but that no longer exists. And you told
5 10:10:54 5 him -- and he responded that no one, he couldn't
6 10:10:57 6 think of anybody, that they would all rubber stamp
7 10:11:00 7 decisions, right? And you don't have -- do you have
8 10:11:04 8 Dr. Jadwin's E-mail that he responded to you saying
9 10:11:07 9 no one?
10 10:11:08 10 A. That's two questions.
11 10:11:09 11 Q. Okay. Well, why don't we take the second
12 10:11:12 12 question.
13 10:11:12 13 Do you have this E-mail where Dr. Jadwin
14 10:11:14 14 told you no one?
15 10:11:15 15 A. No.
16 10:11:15 16 Q. Is that because you deleted it as well?
17 10:11:19 17 A. Yes.
18 10:11:19 18 Q. Why did you delete these E-mails?
19 10:11:23 19 A. Because I delete my E-mails.
20 10:11:24 20 Q. You delete -- what was -- I'm sorry, Doctor.
21 10:11:29 21 You just engaged in a facial expression.
22 10:11:31 22 What was the significance of that?
23 10:11:33 23 A. I think your question's silly.
24 10:11:34 24 Q. Okay. I will try to do better, Doctor.
25 10:11:37 25 Now, how do you choose which E-mails to
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1 10:16:01 1 of your eyes, and then take the document away? They
2 10:16:04 2 don't hand it to you?
3 10:16:05 3 A. Sure, they hand it to me.
4 10:16:06 4 Q. Okay. So you did have documents in your
5 10:16:08 5 possession in connection with this investigation,
6 10:16:10 6 didn't you?
7 10:16:10 7 A. Define what you mean by "in my possession."
8 10:16:13 8 Q. You were holding it, weren't you?
9 10:16:14 9 A. No. Are you talking about holding it in my
10 10:16:16 10 hand or holding it for storage in a file?
11 10:16:18 11 Q. Okay. In this investigation when someone
12 10:16:21 12 gave you a document, what did you do with it?
13 10:16:22 13 A. Read it.
14 10:16:23 14 Q. Where?
15 10:16:24 15 A. Where they handed it to me.
16 10:16:25 16 Q. Standing in front of the person who gave it
17 10:16:27 17 to you?
18 10:16:28 18 A. Most likely, yes.
19 10:16:29 19 Q. And then you would hand it back to them?
20 10:16:32 20 A. Yes.
21 10:16:32 21 Q. Okay. Did you give any documentation
22 10:16:34 22 regarding this investigation into Dr. Jadwin to
23 10:16:37 23 anybody?
24 10:16:40 24 A. Yes, I gave that one form that I had to the
25 10:16:42 25 lawyers.
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1 10:16:42 1 Q. Oh, so now you do recall -- how was it that
2 10:16:46 2 you gave this document to the lawyers?
3 10:16:48 3 A. I handed it to them.
4 10:16:49 4 Q. Why?
5 10:16:51 5 A. Because it was part of this lawsuit.
6 10:16:54 6 Q. Oh, so now you do recall the lawyers asking
7 10:16:57 7 for documents as part of this lawsuit? You recall
8 10:16:59 8 that now? A minute ago you said they didn't.
9 10:17:06 9 A. I don't think they asked me for it because I
10 10:17:09 10 don't think they knew it existed.
11 10:17:10 11 Q. So how did you end up giving it to them?
12 10:17:14 12 A. I asked the secretary if she could go
13 10:17:16 13 through all the stuff and see if she had that
14 10:17:21 14 document from the fine needle information, and she
15 10:17:27 15 dug it out and I handed it to them.
16 10:17:29 16 Q. And why would you hand it to the lawyers?
17 10:17:32 17 Did they ask for it?
18 10:17:33 18 A. No. They didn't know it existed.
19 10:17:36 19 Q. Then why would you hand it to them?
20 10:17:39 20 A. Because I was being sued by Dr. Jadwin.
21 10:17:41 21 Q. And so you just felt it appropriate to, on
22 10:17:44 22 your own initiative, just produce this one fine
23 10:17:47 23 needle report -- fine needle aspiration report to
24 10:17:49 24 your attorneys?
25 10:17:51 25 A. I felt it was more appropriate than keeping
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1 10:17:53 1 it in my possession solely, yes.
2 10:17:56 2 Q. Okay. When did this happen? When did
3 10:17:58 3 you --
4 10:17:59 4 A. I don't recall.
5 10:17:59 5 Q. You don't recall the year, right?
6 10:18:01 6 A. No.
7 10:18:01 7 Q. You don't recall whether it was before or
8 10:18:03 8 after Dr. Jadwin had left of the hospital, right?
9 10:18:05 9 A. It was after Dr. Jadwin had left the
10 10:18:07 10 hospital.
11 10:18:07 11 Q. Oh, okay. But -- and you don't recall the
12 10:18:09 12 lawyers asking you for any and all documents relating
13 10:18:12 13 to Dr. Jadwin in this action?
14 10:18:14 14 A. I don't recall.
15 10:18:14 15 Q. But you do recall feeling it made sense for
16 10:18:20 16 you to give this fine needle aspiration report to the
17 10:18:22 17 lawyers, right?
18 10:18:26 18 A. Yes.
19 10:18:26 19 Q. Nobody asked you to do that; the lawyers
20 10:18:29 20 didn't ask you, you just volunteered it, didn't you?
21 10:18:32 21 A. Yes.
22 10:18:32 22 Q. All right. Why that particular document?
23 10:18:35 23 Why not anything else?
24 10:18:36 24 A. Because that's all I had.
25 10:18:37 25 Q. You destroyed everything else, right?
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1 11:39:29 1 it.
2 11:39:30 2 Q. You just didn't think about it, huh? Okay.
3 11:39:33 3 A. Dr. Jadwin made no complaint to me about the
4 11:39:35 4 breach of his investigation.
5 11:39:36 5 Q. How would he have known?
6 11:39:38 6 A. How would he have known?
7 11:39:40 7 Q. Yeah, that it was breached?
8 11:39:42 8 A. He's all knowing.
9 11:39:43 9 Q. You're being sarcastic now?
10 11:39:45 10 A. Absolutely.
11 11:39:46 11 Q. Okay. Were you sarcastic like this at the
12 11:39:48 12 meeting where Dr. Jadwin called you incompetent?
13 11:39:51 13 A. No, I got up and left, an option I don't
14 11:39:53 14 have here.
15 11:39:54 15 Q. You consider this a professional or a
16 11:39:56 16 personal setting?
17 17 MR. WASSER: You're asking me?
18 18 BY MR. LEE:
19 11:40:00 19 Q. This is a professional setting, right?
20 11:40:04 20 A. Correct.
21 11:40:04 21 Q. You're being -- you're being sarcastic in a
22 22 professional setting, correct?
23 23 A. Correct.
24 11:40:09 24 Q. That's not what you said earlier, wasn't it?
25 25 You said you're never sarcastic -- you're not
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1 11:50:49 1 so four to eight. So May?
2 11:50:52 2 Q. Yes, May of 2004.
3 11:50:55 3 A. No.
4 11:50:56 4 Q. You were not a -- you were not an immediate
5 11:51:01 5 past president, you weren't a president elect, you
6 11:51:04 6 weren't a president, correct?
7 11:51:06 7 A. I believe I was president elect in July 2004
8 11:51:11 8 to 2006; president, 2006 to 2008, July being the --
9 11:51:15 9 July 1st being the change date; now a past president.
10 11:51:19 10 Q. Is it a part of the skills of a medical
11 11:51:35 11 staff officer to be able to accurately read an FNA
12 11:51:39 12 report?
13 11:51:43 13 A. No.
14 11:51:43 14 Q. No.
15 11:51:49 15 Is it -- is it part of the skills of a
16 11:51:52 16 medical staff officer to be able to interpret an
17 11:51:57 17 outside F -- outside consultant FNA report
18 11:52:00 18 accurately?
19 11:52:00 19 A. Yes.
20 11:52:00 20 Q. Yes. Okay.
21 11:52:04 21 So your conclusion, based upon your careful
22 11:52:07 22 review of Dr. Lieu's FNA consultant report, is that
23 11:52:13 23 Dr. Jadwin was the source of the problem; is that
24 11:52:15 24 correct?
25 11:52:16 25 A. No.
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1 12:11:07 1 A. No, I said I had no objective data.
2 12:11:10 2 Q. I asked you if you had any non-objective
3 12:11:13 3 data, and you said no. I've asked you if you've had
4 12:11:15 4 any objective data, and you said no.
5 12:11:19 5 A. All right. I don't know if you want to term
6 12:11:23 6 this objective or non-objective data. I had a stack
7 12:11:26 7 of FNA reports that I went through that were double
8 12:11:32 8 reads from UCLA, and they really were not able to be
9 12:11:36 9 interpreted because all of -- almost 90 percent of
10 12:11:40 10 the final dates of issue were after the final -- the
11 12:11:43 11 read came back from UCLA.
12 12:11:45 12 Q. And in your mind that raised the possibility
13 12:11:48 13 that Dr. Jadwin was going back and changing his
14 12:11:53 14 initial diagnosis to match that of UCLA's; is that
15 12:11:57 15 correct?
16 12:11:57 16 A. No, I'm telling you that it doesn't make it
17 12:12:00 17 objective data.
18 12:12:00 18 Q. Because the final report from Dr. Jadwin
19 12:12:03 19 came after the UCLA report had come in; is that
20 12:12:06 20 correct?
21 12:12:07 21 A. That's correct.
22 12:12:07 22 Q. And you couldn't be sure whether Dr. Jadwin
23 12:12:09 23 was just issuing a final report that just matched
24 12:12:12 24 UCLA's, right?
25 12:12:15 25 A. That's correct.
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1 12:12:15 1 Q. You couldn't be sure that Dr. Jadwin was not
2 12:12:17 2 waiting for the UCLA report to come in to then make
3 12:12:22 3 sure that he could issue his final report to have a
4 12:12:26 4 hundred percent congruence with UCLA, correct?
5 12:12:27 5 A. That's correct.
6 12:12:28 6 Q. Did you ever talk to Dr. Jadwin?
7 12:12:29 7 A. Not after that point.
8 12:12:30 8 Q. At any point regarding this issue?
9 12:12:34 9 A. He handed me this stack of them and said
10 12:12:36 10 "Look at them," in a rather angry tone.
11 11 Q. Yeah. And you were --
12 12:12:40 12 A. He gave them to me to look at.
13 12:12:42 13 Q. You were very calm and peaceable with him,
14 12:12:45 14 weren't you?
15 12:12:45 15 A. Tried to be.
16 12:12:46 16 Q. Very temperate and moderate, right?
17 12:12:49 17 A. As much as possible.
18 12:12:50 18 Q. Right. Whenever he yelled at you, you were
19 12:12:53 19 extremely calm and composed whenever you dealt with
20 12:12:55 20 him, right?
21 12:13:00 21 Is that a yes or no?
22 12:13:02 22 A. The best of my ability.
23 12:13:03 23 Q. What does that mean? You weren't
24 12:13:06 24 successful?
25 12:13:06 25 A. It means I don't remember any specific
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1 12:13:08 1 events. I would get up and leave the room like I did
2 12:13:11 2 when he called me incompetent, because I couldn't,
3 12:13:15 3 you know, be objective at that point, so I would get
4 12:13:17 4 up and leave.
5 12:13:18 5 Q. You were very patient with Dr. Jadwin,
6 12:13:21 6 weren't you?
7 12:13:21 7 A. As patient as I could be.
8 12:13:22 8 Q. You were very accommodating and
9 12:13:25 9 understanding to Dr. Jadwin always, right?
10 12:13:29 10 A. Accommodating?
11 12:13:35 11 Q. I'll ask you another question.
12 12:13:36 12 You were always very reasonable in the way
13 12:13:38 13 you dealt with Dr. Jadwin, right?
14 12:13:40 14 A. Tried to be.
15 12:13:40 15 Q. Tried to be. Does that mean you weren't
16 12:13:43 16 always successful?
17 12:13:44 17 A. I can't recollect any incidents where I was
18 12:13:46 18 not.
19 12:13:47 19 Q. So you never -- you never thought to speak
20 12:13:53 20 to Dr. Jadwin as to whether or not he was issuing his
21 12:13:56 21 final FNA reports after UCLA's report had come in to
22 12:14:01 22 have an artificial hundred percent congruence?
23 12:14:05 23 A. No.
24 12:14:06 24 Q. Why not?
25 12:14:07 25 A. Well, he handed me the data. I assume he
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1 12:14:09 1 was aware of it.
2 12:14:10 2 Q. You make a lot of assumptions, don't you?
3 12:14:12 3 A. Well, when there's like 11 months between
4 12:14:14 4 when the pathology sample was selected and the review
5 12:14:19 5 was done, and the final didn't come out for that 11
6 12:14:22 6 months, what conclusion would you draw?
7 12:14:26 7 Q. When Dr. Jadwin sent reports out to UCLA,
8 12:14:29 8 the FNAs, he never sent initial diagnoses, did he?
9 12:14:35 9 A. I don't know. I was handed a stack of
10 12:14:36 10 papers that had his reading -- I was handed a stack
11 12:14:40 11 of papers that had his reading and UCLA's reading.
12 12:14:43 12 Q. You never thought to ask Dr. Jadwin, did
13 12:14:46 13 you?
14 12:14:46 14 A. No.
15 12:14:47 15 Q. You didn't think it was important to know
16 12:14:48 16 that, right?
17 12:14:49 17 A. To know what?
18 12:14:50 18 Q. To know whether or not he was issuing an
19 12:14:53 19 initial diagnosis on the FNAs to UCLA, and then they
20 12:14:57 20 were then issuing their diagnosis in congruence with
21 12:15:00 21 his. You never thought to ask that, did you?
22 12:15:03 22 A. All I do is look at the dates of the final
23 12:15:05 23 report, which should have been out long before that,
24 12:15:07 24 and the dates of the UCLA. It made the data useless.
25 12:15:11 25 Q. And then you made your assumptions?
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1 12:15:13 1 A. I made no assumptions. The data was
2 12:15:16 2 useless, you couldn't decide one way or the other
3 12:15:19 3 whether he could read fine needles or not.
4 12:15:21 4 Q. Did you ever pick up the phone and call
5 12:15:24 5 UCLA?
6 12:15:25 6 A. No.
7 12:15:25 7 Q. Why not?
8 12:15:26 8 A. Why?
9 12:15:26 9 Q. To find out what the story was.
10 12:15:28 10 A. I had their readings. It was supposed to be
11 12:15:31 11 double-blinded. You're supposed to send them the
12 12:15:33 12 slide and no other information, and they're supposed
13 12:15:35 13 to send it back with their reading, and then you
14 12:15:38 14 compare it to his reading. That would be objective
15 12:15:41 15 data.
16 12:15:41 16 Q. And you know this because --
17 12:15:43 17 A. But to -- I know that because that's simple
18 12:15:46 18 scientific method.
19 12:15:47 19 Q. Uh-huh. So you have no knowledge -- sitting
20 12:15:59 20 here today, you have no knowledge that -- of whether
21 12:16:01 21 Dr. Jadwin sent his initial diagnosis of slides to
22 12:16:05 22 UCLA prior to their issuing their report, their
23 12:16:08 23 outside report on FNAs; you don't know that, right?
24 12:16:11 24 A. That's correct.
25 12:16:11 25 Q. Sitting here today, do you think that would
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1 12:16:13 1 be important to know that?
2 12:16:14 2 A. No.
3 12:16:15 3 Q. Why not?
4 12:16:16 4 A. Well -- okay, I'm sorry. I misunder- -- no,
5 12:16:18 5 no, because I thought you said -- I meant -- I
6 12:16:20 6 thought you were asking me whether it was important
7 12:16:22 7 that you send the information down to UCLA.
8 12:16:26 8 Was it important that I would know that? It
9 12:16:28 9 would have been if the final dates had been, you
10 12:16:32 10 know, before they had gone to UCLA, yes.
11 12:16:35 11 Q. What's your fixation with these final dates,
12 12:16:38 12 if there's an initial --
13 12:16:39 13 A. It makes the data useless. You can't
14 12:16:43 14 interpret data if the final report came out after the
15 12:16:46 15 UCLA report.
16 12:16:47 16 Q. Well, couldn't you have done this, Doctor:
17 12:16:50 17 Couldn't you have called UCLA and asked them was
18 12:16:54 18 Dr. Jadwin sending you his initial diagnosis along
19 12:16:55 19 with the slides, and were you coming out with a
20 12:16:57 20 report that was in 100 percent congruence with his
21 12:17:02 21 initial diagnosis? Couldn't you have done that?
22 12:17:03 22 A. What would be the reason for doing that?
23 12:17:06 23 Q. To confirm with them that they were actually
24 12:17:09 24 finding a diagnosis that matched Dr. Jadwin's.
25 12:17:12 25 A. Their job was just to read the slide and
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1 12:17:15 1 provide the data, not provide the comparison.
2 12:17:22 2 Q. You believe in the power of objective data,
3 12:17:24 3 don't you, Doctor?
4 12:17:26 4 A. Absolutely.
5 12:17:26 5 Q. It's very important to draw conclusions on
6 12:17:28 6 objective data?
8 12:17:30 8 Q. Subjective data's not a good -- it's
9 12:17:34 9 garbage, right?
10 12:17:36 10 A. Well, sometimes it's all you have, but
11 12:17:38 11 generally, it's not good to base some -- you know, to
12 12:17:39 12 base decisions on only subjective data, yes.
13 12:17:42 13 Q. Certainly not?
14 12:17:43 14 A. Certainly not.
15 12:17:44 15 Q. So in order to come to a conclusion as to
16 12:17:46 16 whether or not Dr. Jadwin was intentionally issuing a
17 12:17:50 17 final diagnosis on the FNAs so as to create an
18 12:17:54 18 artificial 100 percent congruence with UCLA, wouldn't
19 12:17:58 19 it have behooved you to find out whether he, in fact,
20 12:18:01 20 was sending initial diagnoses out to UCLA along with
21 12:18:05 21 the slides?
22 12:18:06 22 A. I never drew that conclusion.
23 12:18:07 23 Q. You didn't?
24 12:18:08 24 A. I did not.
25 12:18:08 25 Q. You said you suspected it, right?
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1 12:18:10 1 A. I didn't think I said that either.
2 12:18:12 2 Q. Sitting here today, do you think that
3 12:18:15 3 Dr. Jadwin may have done that?
4 12:18:17 4 A. I have no opinion on that.
5 12:18:18 5 Q. You have no opinion on that?
6 12:18:20 6 A. Not particularly.
7 12:18:20 7 Q. Did you ever voice that suspicion to anybody
8 12:18:22 8 that he was doing that, that he was artificially
9 12:18:25 9 creating a 100 percent congruence with UCLA by
10 12:18:29 10 ensuring that the final report was only released
11 12:18:31 11 after the UCLA report had come in?
12 12:18:34 12 A. No.
13 12:18:34 13 Q. You never stated that to anybody, right?
14 12:18:36 14 A. I don't believe so.
15 12:18:37 15 Q. You never sent an E-mail or --
16 12:18:40 16 A. I don't believe so. It's useless data.
17 12:18:43 17 Q. Well, that suspicion's pretty useless, too,
18 12:18:48 18 isn't it?
19 12:18:49 19 A. Yes.
20 12:18:49 20 Q. It's just rumor, gossip and speculation,
21 12:18:52 21 isn't it?
22 12:18:52 22 A. No, it's fact that the final reports weren't
23 12:18:55 23 issued till after the UCLA reports were issued.
24 24 Q. Right.
25 12:18:59 25 A. That's fact.
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1 12:20:30 1 Q. -- wouldn't Dr. Jadwin have then reflected
2 12:20:32 2 that in the final report? Isn't that reasonable?
3 12:20:35 3 A. No.
4 12:20:35 4 Q. Why not?
5 12:20:35 5 A. Because this was not sent out for that, it
6 12:20:37 6 was sent out for quality, okay? To be done properly,
7 12:20:41 7 the slides should have been sent blindly to UCLA, not
8 12:20:45 8 having Dr. Jadwin's initial pathology report, so
9 12:20:49 9 there's prejudicing of the pathologist who's reading
10 12:20:53 10 the second slide, and you take the reading from
11 12:20:56 11 Dr. Jadwin, which should be finalized before the UCLA
12 12:21:00 12 report is seen, and you take the UCLA report, and
13 12:21:02 13 then you compare them to see if there's a
14 12:21:05 14 discrepancy. That's not what happened, so the data
15 12:21:06 15 was useless.
16 12:21:08 16 Q. And you're sure of that, right?
17 12:21:10 17 A. Yes.
18 12:21:10 18 Q. And you never talked to Dr. Jadwin, did you?
19 12:21:13 19 A. No.
20 12:21:13 20 Q. Did you ever speak to Dr. Dutt about this
21 12:21:16 21 UCLA FNA double read?
22 12:21:23 22 A. I don't recall.
23 12:21:24 23 Q. Did you think it was important to speak to
24 12:21:28 24 Dr. Dutt about it?
25 12:21:29 25 A. I asked -- at that point, no, because I
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1 12:21:35 1 think Dr. Jadwin was already gone.
2 12:21:37 2 Q. So the issue was moot?
3 12:21:39 3 A. At that point, yes.
4 12:21:40 4 Q. Yeah. The person in question was no longer
5 12:21:43 5 there?
6 12:21:44 6 A. Correct.
7 12:21:44 7 Q. All right. So there was no need -- once
8 12:21:46 8 Dr. Jadwin was gone -- are you talking about December
9 12:21:49 9 7th, 2006?
10 12:21:50 10 A. I don't know the date he left.
11 12:21:51 11 Q. That's the date he was placed on
12 12:21:53 12 administrative leave.
13 12:21:55 13 A. I don't know.
14 12:21:56 14 Q. Okay. I'm going to represent to you that
15 12:21:58 15 was the date he was placed on administrative leave.
16 12:22:00 16 A. Okay.
17 12:22:01 17 Q. So after December 7, 2006, with Dr. Jadwin
18 12:22:06 18 gone, there was no need to conduct any investigation
19 12:22:07 19 of Dr. Jadwin, was there?
20 12:22:25 20 A. There might have been a need if you felt he
21 12:22:27 21 was incompetent and you needed to report it to the
22 12:22:30 22 medical board. But other than that, I don't think
23 12:22:34 23 so.
24 12:22:34 24 Q. Okay. Well, let's -- let's get away from
25 12:22:37 25 might have and let's talk about what was done.
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1 14:25:18 1 unsatisfactory, right?
2 14:25:20 2 A. Correct.
3 14:25:20 3 Q. Why not?
4 14:25:21 4 A. Why didn't it answer the question?
5 14:25:23 5 Q. Didn't you pay the -- I mean, I assume this
6 14:25:28 6 consultant was paid a certain amount of money to do
7 14:25:30 7 this -- this report, time was spent with this
8 14:25:32 8 consultant, he -- he finalized a report, he did a
9 14:25:35 9 grand rounds lecture to which only a few people
10 14:25:38 10 showed up.
11 14:25:39 11 What was all that exercise for if not to at
12 14:25:41 12 least resolve that issue?
13 14:25:42 13 A. To try to find a civilized, common pathway
14 14:25:46 14 so pathology and radiology could work together so we
15 14:25:52 15 could care for the patients.
16 14:25:52 16 Q. You didn't think what -- couldn't you have
17 14:25:53 17 hired a behavioral consultant to do that for you
18 18 instead of a pathologist?
19 14:25:57 19 A. I don't think the behavioral consultant
20 14:26:00 20 could assess the needles used or the competency of
21 14:26:04 21 the radiologist in the number of passes taken.
22 14:26:07 22 Q. Or the competency of Dr. Jadwin in reading
23 14:26:13 23 FNA slides?
24 14:26:14 24 A. Correct.
25 14:26:14 25 Q. Okay. So that's why you -- that's why this
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1 14:26:17 1 consultant was brought in, right?
2 14:26:18 2 A. No, the consultant was brought in, I
3 14:26:21 3 believe -- at least the overall purpose was to try to
4 14:26:25 4 find a common pathway to see if we could improve the
5 14:26:29 5 relationship between pathology and radiology so we
6 14:26:32 6 could get fine needle aspirations on our patients
7 14:26:35 7 instead of having them feud all the time.
8 14:26:39 8 Q. Right. And determining the competency of
9 14:26:41 9 Dr. Jadwin and/or the radiologist, wasn't that part
10 14:26:44 10 of the study, the purpose of the study too?
11 14:26:47 11 A. I don't know.
12 14:26:47 12 Q. You don't know?
13 14:26:49 13 You read the report though?
14 14:26:50 14 A. Yes.
15 14:26:51 15 Q. Okay.
16 14:26:52 16 A. If we're talking about the same report.
17 14:26:57 17 As I stated, the two things I took away from
18 14:26:59 18 the report is that Dr. Jadwin could improve on his
19 14:27:03 19 communication, and that we should use -- the
20 14:27:06 20 radiologists should use different needles. Those are
21 14:27:08 21 the two things I remember from reading the report.
22 14:27:10 22 Q. Do you recall how long the report was?
23 14:27:17 23 A. No.
24 14:27:42 24 MR. LEE: I'm going to get an exhibit.
25 14:28:12 25 Could you mark this as 110, please?
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1 14:28:12 1 (Plaintiff's Exhibit No. 110
2 2 marked for identification.)
3 14:28:14 3 THE WITNESS: Thank you.
4 14:28:14 4 BY MR. LEE:
5 14:28:14 5 Q. Doctor, you've just been handed a document
6 14:28:16 6 marked for identification as Exhibit 110. Please
7 14:28:20 7 take a moment to review it.
8 14:28:23 8 A. Are we done with these?
9 14:28:25 9 Q. You can leave them there.
10 14:28:26 10 Actually, Doctor, I don't want to waste your
11 14:29:21 11 time. I don't think you need to read that report,
12 14:29:23 12 it's about 30 or 40 pages long. I'm just going to
13 14:29:25 13 ask you if you can -- if you recognize it.
14 14:29:28 14 A. Oh, I'd have to read it to see if I
15 14:29:30 15 recognize it.
16 14:29:31 16 Q. Okay.
17 17 (Witness reviewed document.)
18 14:58:55 18 THE WITNESS: Okay.
19 14:58:56 19 MR. LEE: Madame Reporter, can you state
20 14:58:58 20 when the last spoken statement was said, the time?
21 21 THE COURT REPORTER: 2:29.
22 22 BY MR. LEE:
23 14:59:07 23 Q. Okay. Doctor, you've spent 31 minutes
24 14:59:15 24 reviewing that document, correct? It is what it is,
25 14:59:18 25 right?
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1 14:59:18 1 A. Yes.
2 14:59:19 2 Q. Okay. How many pages in that document?
3 14:59:21 3 A. Do you want me to include the table of
4 14:59:22 4 contents?
5 14:59:23 5 Q. No.
6 14:59:31 6 A. There are nine pages front and back.
7 14:59:34 7 Q. Nine pages.
8 14:59:36 8 A. Eighteen single-faced pages.
9 14:59:39 9 Q. Okay. So you've reviewed it carefully now,
10 14:59:44 10 right?
11 14:59:45 11 A. Yes.
12 14:59:45 12 Q. And you reviewed it this carefully when you
13 14:59:48 13 first -- do you recognize this report?
14 14:59:49 14 A. Yes.
15 14:59:50 15 Q. What is it?
16 14:59:51 16 A. It's the report from the fine needle
17 14:59:53 17 consultant brought in to solve our problems.
18 14:59:55 18 Q. So this is the consultant report we've been
19 14:59:58 19 discussing this morning, correct?
20 15:00:00 20 A. Yes, it is.
21 15:00:00 21 Q. Okay. And you recall receiving a copy of
22 15:00:04 22 this report?
23 15:00:04 23 A. No.
24 15:00:04 24 Q. Did you ever recall reading this report?
25 15:00:07 25 A. I read a copy of this report.
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1 15:03:04 1 BY MR. LEE:
2 15:03:04 2 Q. Either. Either or both.
3 15:03:05 3 A. Why don't you ask which question you want
4 15:03:06 4 answered?
5 15:03:08 5 Q. Okay. What about Dr. Jadwin's competency?
6 15:03:10 6 A. It says that no dis- -- difficulties were
7 15:03:12 7 found, but it was a limited study and it was
8 15:03:12 8 retro-prospective, and a prospective study would be
9 15:03:13 9 more useful. It also gave a method suggesting it
10 15:03:18 10 that, you know -- right here, "All imaging guided
11 15:03:23 11 that are determined unsatisfactory or limited should
12 15:03:26 12 be automatically referred to UCLA for a second
13 15:03:28 13 opinion; all relevant clinical, radiologic
14 15:03:31 14 information, including scan reports, should be sent
15 15:03:33 15 along with the slides."
16 15:03:35 16 Q. Okay. What page are you reading from, sir?
17 15:03:38 17 A. Page 15 DFG 00267.
18 15:03:42 18 Q. Okay. So in other words, did Dr. Lieu
19 15:03:45 19 determine whether or not Dr. Jadwin's diagnoses were
20 15:03:48 20 correct or not?
21 15:03:49 21 A. He determined that he had sufficient skill
22 15:03:52 22 based on what he had.
23 15:03:54 23 Q. I'm sorry, based on what he had?
24 15:03:57 24 A. "No major discrepancies were discovered in
25 15:04:00 25 the slide reviews of previous unsatisfactory or
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1 15:07:19 1 non-diagnostic samples; isn't that correct?
3 15:07:23 3 Q. Okay. So that -- that question as to
4 15:07:28 4 Dr. Jadwin's competency in recognizing non-diagnostic
5 15:07:31 5 and unsatisfactory samples, that was answered by
6 15:07:33 6 Dr. Lieu, wasn't it?
7 15:07:35 7 A. Yes.
8 15:07:35 8 Q. Okay. And that's -- that's certainly an
9 15:07:39 9 answer -- that's certainly an indicator of
10 15:07:42 10 Dr. Jadwin's competence as a pathologist, isn't it?
11 15:07:46 11 A. His ability to read slides, yes.
12 15:07:47 12 Q. Well, isn't that important for a
13 15:07:50 13 pathologist?
14 15:07:50 14 A. Yes.
15 15:07:51 15 Q. Okay.
16 15:07:52 16 A. But it doesn't mean that that was the reason
17 15:07:54 17 they were inadequate. It was the radiologist.
18 15:08:00 18 Q. Well, does it mean that the pathologist was
19 15:08:03 19 still the reason then? Who's responsible for
20 15:08:08 20 non-diagnostic --
21 15:08:09 21 A. Well, in this case I would say yes, because
22 15:08:11 22 the major issues were communication.
23 15:08:13 23 Q. What about the radiologists' competence,
24 15:08:16 24 what did you find Dr. Lieu's conclusion was there?
25 15:08:18 25 A. That there could be some improved technique.
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1 17:12:05 1 today, Dr. Jadwin's removal would have been justified
2 17:12:09 2 by his conduct and communication failures, correct?
3 17:12:12 3 A. Yes.
4 17:12:12 4 Q. Okay. Well, why didn't you raise them at
5 17:12:15 5 the vote to demote him?
6 17:12:16 6 A. It wasn't necessary.
7 17:12:17 7 Q. In other words, his physical absence was
8 17:12:22 8 enough, it was a sufficient reason to demote him?
9 17:12:24 9 A. Yes.
10 17:12:24 10 Q. There was no need for -- in your mind, there
11 17:12:27 11 was no need to discuss his misconduct or many
12 17:12:31 12 communication failures of which you witnessed so
13 17:12:34 13 many?
14 17:12:34 14 A. No.
15 17:12:34 15 Q. Didn't -- you didn't feel the need to
16 17:12:37 16 mention a single one?
17 17:12:38 17 A. No.
18 17:12:39 18 MR. WASSER: We've been over this a lot,
19 17:12:41 19 Counsel.
20 17:12:41 20 THE WITNESS: As I stated earlier, the rules
21 17:12:43 21 and regs and the bylaws said he could be removed
22 17:12:44 22 without reason, there was no reason to discuss any of
23 17:12:50 23 it. We needed leadership in the laboratory in the
24 17:12:51 24 pathology department to maintain its ongoing
25 17:12:54 25 certification. You can't do that if he's not there.
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1 1 Q. Okay.
2 17:32:11 2 A. It's basically a verbal confirmation -- or a
3 17:32:15 3 written confirmation of what I've been telling you.
4 17:32:17 4 Q. Now, you -- do you recall Dr. Jadwin ever
5 17:32:22 5 accusing you of being an impaired physician?
6 17:32:25 6 A. He did not accuse me.
7 17:32:26 7 Q. I'm sorry?
8 17:32:29 8 A. He didn't accuse me to my face.
9 17:32:30 9 Q. Okay. But -- well, did you -- you are aware
10 17:32:33 10 that he said or he thought you were an impaired
11 17:32:37 11 physician, right?
12 17:32:38 12 A. I was made aware of that sometime after the
13 17:32:40 13 event, yes.
14 17:32:41 14 Q. All right. Now, do you recall stating to
15 17:32:45 15 Dr. Jadwin something about being an impaired
16 17:32:49 16 physician during the October 17 reprimand meeting?
17 17:32:55 17 A. I probably had some kind of remark.
18 17:32:57 18 Q. Right. So you knew by then at least that
19 17:33:00 19 Dr. Jadwin had suggested you were an impaired
20 17:33:03 20 physician?
21 17:33:04 21 A. Oh, yes.
22 17:33:04 22 Q. Do you recall how you learned about this --
23 17:33:07 23 A. You know, no, I don't. Somebody had
24 17:33:09 24 mentioned it to me, I think it was months -- but I
25 17:33:12 25 can't really testify to the time -- after it
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1 17:33:14 1 occurred, and then it was probably a year or so later
2 17:33:16 2 that somebody told me why because I didn't -- I said,
3 17:33:20 3 "Where did that come from?" But I wasn't aware of
4 17:33:22 4 the process, I didn't know that he had made the
5 17:33:24 5 accusation, I didn't know at the time of that meeting
6 17:33:28 6 that he had called the licensing board, I didn't know
7 17:33:31 7 any of that.
8 17:33:32 8 Q. Well, how --
9 17:33:34 9 A. Then when they told me, I just didn't really
10 17:33:36 10 care because I just said "Whatever."
11 17:33:37 11 Q. Okay. So they did eventually tell you,
12 17:33:40 12 right?
13 17:33:40 13 A. Not officially.
14 17:33:41 14 Q. Unofficially they did tell you all --
15 17:33:43 15 A. Somebody made mention of it or something,
16 17:33:45 16 like they thought I had already known about it, but I
17 17:33:48 17 didn't.
18 17:33:48 18 Q. Do you recall who this was?
19 17:33:50 19 A. No.
20 17:33:51 20 Q. No?
21 17:33:52 21 Do you recall when this was that you finally
22 17:33:55 22 learned all the details?
23 17:33:55 23 A. Not really, no.
24 17:33:56 24 Q. No?
25 17:33:57 25 You didn't think it was important, right?
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1 17:33:59 1 A. That's, you know, out of my hands.
2 17:34:01 2 Q. So being -- Dr. Jadwin suspecting you were
3 17:34:05 3 an impaired physician didn't bother you that much,
4 17:34:08 4 did it?
5 17:34:09 5 A. Well, it was so far after the fact that --
6 17:34:11 6 well, you know, I found it insulting. So, yeah, it
7 17:34:14 7 bothered me. Yeah, it bothered me, of course it
8 17:34:18 8 bothered me.
9 17:34:19 9 Q. Okay. Well, aside from this October 17
10 17:34:21 10 reprimand meeting, did you ever talk to Dr. Jadwin
11 17:34:24 11 about why he had suggested you were an impaired
12 17:34:28 12 physician?
13 17:34:29 13 A. I never spoke to him even then why.
14 17:34:31 14 Q. But you thought it was inappropriate always,
15 17:34:33 15 right?
16 17:34:34 16 A. I -- you know, that's his decision.
17 17:34:37 17 Q. I'm asking for your opinion.
18 17:34:40 18 MR. WASSER: What's your question?
19 17:34:41 19 BY MR. WASSER:
20 17:34:41 20 Q. You thought it was un- -- inappropriate for
21 17:34:42 21 Dr. Jadwin to call you or to suggest you were an
22 17:34:45 22 impaired physician, right?
23 17:34:47 23 A. Based on an E-mail, a spelling, yes, I
24 17:34:50 24 thought that was inappropriate.
25 17:34:52 25 Q. Did -- how did you know which E-mail
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1 18:01:29 1 A. Because I needed the X-ray to evaluate the
2 18:01:32 2 patient.
3 18:01:32 3 Q. If Dr. Jadwin needed to ensure that the FNAs
4 18:01:38 4 were being collected properly by the radiologist --
5 18:01:42 5 A. Okay.
6 18:01:42 6 Q. -- what's the difference?
7 18:01:43 7 Patient -- you don't think patients are
8 18:01:44 8 impacted when the FNAs aren't collected properly by
9 18:01:48 9 radiologists and they have to do multiple passes
10 18:01:50 10 unnecessarily?
11 18:01:51 11 A. Yes, I do.
12 18:01:51 12 Q. That is a patient care issue, isn't it?
13 18:01:54 13 A. Yes, it is.
14 18:01:54 14 Q. Did you recognize that before?
15 18:01:56 15 A. Of course.
16 18:01:57 16 Q. You understood that the FNA issue was a
17 18:01:59 17 patient care issue from the beginning, right?
18 18:02:01 18 A. It was a patient care issue, yes.
19 18:02:03 19 Q. It wasn't just a communication problem, was
20 18:02:05 20 it?
21 18:02:05 21 A. The patient care issue -- well -- okay, no,
22 18:02:12 22 it was both.
23 18:02:13 23 Q. Just like your dispute with the radiologist
24 18:02:17 24 was both, right?
25 18:02:18 25 A. Yes.
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Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 382 of 245
Page 112
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
I, Sandra L. Edmonson, a Certified Shorthand
ALAN SCOTT RAGLAND, M.D., the witness named in the
deposition was taken Friday, August 22, 2008, at the
stenotype and thereafter transcribed by computer under
Dated this 8th day of September, 2008, at
Sandra L. Edmonson, CSR No. 7704
WOOD & RANDALL

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15 RAYMOND ALBERT WATSON
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WatsonR
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1 14:03:51 1 my question. It's very unnatural to do that, but
2 14:03:55 2 it's for the sake of the reporter. She can only
3 14:03:56 3 record one person speaking at a time.
4 14:03:58 4 The oath you've been administered
5 14:04:00 5 requires -- has the same force and effect as an oath
6 14:04:03 6 administered in a court of law before a judge and/or
7 14:04:06 7 a jury. You are under the same duty to tell the
8 14:04:09 8 truth and the whole truth. Do you understand?
9 14:04:11 9 A. Yes.
10 14:04:11 10 Q. If at any time you don't understand a
11 14:04:15 11 question that's being asked, please ask me to restate
12 14:04:17 12 or rephrase the question, and I'll be happy to do so.
13 14:04:20 13 If you answer the question, it will be presumed that
14 14:04:22 14 you understood the question; so please be sure you
15 14:04:25 15 understand before you answer. Do you understand?
16 14:04:27 16 A. Yes.
17 14:04:27 17 Q. Okay. We are entitled to your best
18 14:04:31 18 estimates. If I ask -- but not your guesses or
19 14:04:35 19 speculation. If I ask you the length of this table,
20 14:04:37 20 you could estimate it's 12 feet or so. If I ask you
21 14:04:41 21 how many cats I have at home, you'd have to say I
22 14:04:43 22 don't know; it would be a guess. Do you understand?
23 14:04:45 23 A. Yes.
24 14:04:45 24 Q. Okay. Is there any reason you're aware of
25 14:04:49 25 why today's deposition cannot proceed?
WatsonR
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1 14:09:24 1 Q. Okay. I'll represent to you that there was
2 14:09:24 2 a vote by the JCC on July 10 of 2006 at which it was
3 14:09:24 3 considered and approved to remove Dr. Jadwin from
4 14:09:24 4 chair of pathology at KMC.
5 14:09:24 5 Okay. Do you know who Dr. David Jadwin is?
6 14:09:24 6 A. Yes.
7 14:09:24 7 Q. Okay. Well, who was he?
8 14:09:24 8 A. He was the chairman of the pathology
9 14:09:24 9 department.
10 14:09:24 10 Q. Did you have a lot of interaction with him?
11 14:09:24 11 A. None whatsoever.
12 14:09:24 12 Q. You never met him personally?
13 14:09:24 13 A. Not that I know of.
14 14:09:24 14 Q. And do you recall why -- did you vote at
15 14:09:24 15 this JCC meeting where Dr. Jadwin was being removed
16 14:09:24 16 from chair?
17 14:09:24 17 A. Yes.
18 14:09:24 18 Q. Okay. For the sake of brevity, I'm just
19 14:09:24 19 going to refer it to as the removal meeting. Is that
20 14:09:24 20 okay with you?
21 14:09:24 21 A. That's fine.
22 14:09:24 22 Q. Okay. So at the removal meeting do you
23 23 recall why you voted to remove Dr. Jadwin from chair
24 14:09:24 24 of pathology?
25 14:09:24 25 MR. WASSER: Now, as to Supervisor
WatsonR
11
1 14:09:24 1 Patrick -- let me just mention-- Supervisor Watson,
2 14:09:24 2 as a member of the board of supervisors, has a
3 14:09:24 3 privilege to not disclose the reasons for votes he's
4 14:09:24 4 cast as a member of the board of supervisors. The
5 14:09:24 5 privilege is personal to Supervisor Watson, and he
6 14:09:24 6 may assert it or he may not depending upon his own
7 14:09:24 7 preference.
8 14:09:24 8 THE WITNESS: Would you restate the
9 14:09:24 9 question.
10 14:09:24 10 BY MR. LEE:
11 14:09:24 11 Q. Sure. Do you recall the reasons why you
12 14:09:24 12 voted to approve the removal of Dr. Jadwin from chair
13 14:09:24 13 at the removal meeting?
14 14:09:24 14 A. I was -- we were told that he had not been
15 14:09:24 15 in attendance to his duties for an extended period of
16 14:09:24 16 time, and that I did not believe that a manager can
17 14:09:24 17 perform their functions unless they are present.
18 14:09:24 18 Q. Okay. So just to be very clear, you
19 14:09:24 19 understood that Dr. Jadwin was not physically present
20 14:09:24 20 at the hospital for an extended period of time?
21 14:09:24 21 A. That's correct.
22 14:09:24 22 Q. And that was -- and your view was that a
23 14:09:24 23 manager cannot perform his duties as a manager unless
24 14:09:24 24 he is physically present at the hospital, correct?
25 14:09:24 25 A. For at least a portion of the time to carry
WatsonR
12
1 14:09:24 1 out their duties.
2 14:09:24 2 Q. Okay. And how did you know that Dr. Jadwin
3 14:09:24 3 was not physically present at the hospital. How was
4 14:09:24 4 that told to you?
5 14:09:24 5 A. We were told by the chairman -- by the CEO.
6 14:09:24 6 Excuse me.
7 14:09:24 7 Q. Okay. Just to be clear, the CEO was Peter
8 14:09:24 8 Bryan at this time?
9 14:09:24 9 A. Yes.
10 14:09:24 10 Q. Okay. You've mentioned Dr. Jadwin's lack of
11 14:09:24 11 physical presence at the hospital as one reason. Are
12 14:09:25 12 there any other reasons whatsoever for your vote to
13 14:09:27 13 remove him as chair?
14 14:09:29 14 A. No.
15 14:09:29 15 Q. No. So at this meeting were you told by
16 14:09:35 16 anybody about Dr. Jadwin's conduct or misconduct at
17 14:09:39 17 the hospital aside from being physically absent from
18 14:09:42 18 the hospital?
19 14:09:44 19 A. At that meeting I don't recall. It was
20 14:09:47 20 discussed at different times over a period of months
21 14:09:52 21 before that.
22 14:09:53 22 Q. Dr. Jadwin's misconduct?
23 14:09:55 23 A. Yes.
24 14:09:55 24 Q. Okay. Can you recall those meetings where
25 14:09:58 25 Dr. Jadwin's misconduct was discussed? Were these
WatsonR
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1 14:31:52 1 board.
2 14:31:53 2 Q. Are you aware that Dr. -- and what was the
3 14:32:07 3 final resolution of this discussion regarding
4 14:32:09 4 nonrenewal of Dr. Jadwin's contract? Was there a
5 14:32:13 5 decision, in fact, not to renew his contract then?
6 14:32:20 6 A. I don't recall a specific vote being taken,
7 14:32:24 7 although I imagine it was. I can tell you that I
8 14:32:27 8 would have supported that because I didn't feel that
9 14:32:30 9 he was doing his job.
10 14:32:31 10 Q. Okay. So you don't recall a specific vote,
11 14:32:39 11 but there was a decision not to renew his contract
12 14:32:42 12 then?
13 14:32:43 13 A. Yes.
14 14:32:43 14 Q. You can't recall who was there besides
15 14:32:45 15 yourself?
16 14:32:46 16 A. No, I can't.
17 14:32:46 17 Q. And you can't recall whether this was --
18 14:32:50 18 well, clearly this meeting at which his nonrenewal
19 14:32:54 19 was discussed, it must have been after he was placed
20 14:32:57 20 on paid administrative leave, right? Or was it not?
21 14:33:01 21 A. I --
22 14:33:02 22 Q. Don't know?
23 14:33:02 23 A. I could not tell you a timeline at all.
24 14:33:04 24 Q. Do you recall whether Dr. Jadwin was ever
25 14:33:06 25 placed -- that he was placed on paid administrative
WatsonR
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1 14:42:54 1 the economic impact of the paid administrative leave
2 14:42:58 2 on Dr. Jadwin then?
3 14:43:03 3 A. I don't recall that.
4 14:43:03 4 Q. Okay. And again, Dr. Jadwin, to your
5 14:43:08 5 recollection, he wasn't present at this closed
6 14:43:11 6 session of the JCC regarding his placement on paid
7 14:43:15 7 administrative leave, correct?
8 14:43:18 8 A. I -- I don't believe I've ever met
9 14:43:21 9 Dr. Jadwin.
10 14:43:22 10 Q. And are you aware of whether or not
11 14:43:24 11 Dr. Jadwin was notified that this JCC closed session
12 14:43:29 12 meeting was going to occur regarding placement of him
13 14:43:32 13 on paid administrative leave?
14 14:43:33 14 MR. WASSER: That misstates the witness'
15 14:43:35 15 testimony.
16 14:43:35 16 THE WITNESS: I don't know.
17 14:43:35 17 MR. WASSER: There's no --
18 14:43:37 18 MR. LEE: I'll ask --
19 14:43:38 19 MR. WASSER: There's no foundation for your
20 14:43:39 20 statement that administrative leave was discussed at
21 14:43:42 21 the closed session, Counsel.
22 14:43:43 22 MR. LEE: I'm asking.
23 14:43:44 23 BY MR. LEE:
24 14:43:46 24 Q. You want me to repeat --
25 14:43:47 25 A. I'm not aware of that.
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1 16:32:24 1 Q. Well, then how do you explain -- do you
2 16:32:27 2 recall what the reason was for placing Dr. Jadwin on
3 16:32:29 3 paid administrative leave? That had nothing to do
4 16:32:33 4 with his leaves, I assume, right?
5 16:32:34 5 A. You know, I -- I'm really not familiar with
6 16:32:37 6 that aspect of -- of it. I -- I don't recall what
7 16:32:43 7 the reason was.
8 16:32:44 8 Q. Right.
9 16:32:45 9 A. I assume there's a memo in there somewhere,
10 16:32:48 10 but I can't recall what the -- what the reasons for
11 16:32:51 11 that were.
12 16:32:52 12 Q. Okay. What about the nonrenewal? I mean,
13 16:32:58 13 do you recall Dr. Jadwin's physical absence being a
14 16:33:02 14 reason for his nonrenewal of his contract?
15 16:33:05 15 A. Well, it could be that. It could be the
16 16:33:06 16 fact that I think by then he was -- probably was
17 16:33:10 17 suing us. So why would you want to establish a
18 16:33:12 18 contractual relationship with somebody who's suing
19 16:33:16 19 you.
20 16:33:17 20 Q. Okay. Well, he was also suing you at the
21 16:33:19 21 time of his removal or actually at the time of his --
22 16:33:23 22 no, he wasn't. He wasn't. Okay.
23 16:33:26 23 But I mean, you say why would you establish
24 16:33:29 24 a contractual relationship with someone who's suing
25 16:33:34 25 you, right?
WatsonR
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1 16:33:34 1 A. Right.
2 16:33:35 2 Q. Was that -- does that mean -- are you just
3 16:33:35 3 speculating now, just guessing, or was that a
4 16:33:38 4 consideration for his nonrenewal?
5 16:33:39 5 A. Well, I remember it being discussed.
6 16:33:41 6 Q. Do you recall who was at that discussion?
7 16:33:45 7 A. It would have been in one of the joint
8 16:33:47 8 conference -- one or more of the joint conference
9 16:33:50 9 committee meetings along with all the other
10 16:33:52 10 discussions about him.
11 16:33:53 11 Q. Do you recall if David Culberson was in any
12 16:33:56 12 of those meetings?
13 16:33:57 13 A. You know, I couldn't tell you who was in
14 16:34:00 14 what meetings. I don't know the answer to that.
15 16:34:02 15 Q. Okay. But you recall it being discussed at
16 16:34:05 16 the JCC meetings?
17 16:34:06 17 A. Yes.
18 16:34:06 18 Q. Okay. And do you recall what other reasons
19 16:34:09 19 were discussed for the nonrenewal besides
20 16:34:14 20 Dr. Jadwin's lawsuit?
21 16:34:15 21 A. The -- the -- that and the fact that he just
22 16:34:20 22 wasn't available for work. He wasn't -- he wasn't
23 16:34:26 23 available to put in the hours for a full-time
24 16:34:30 24 position.
25 16:34:30 25 Q. Well, he was working full time from October
WatsonR
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1 16:35:30 1 Q. And then he was -- he was placed on paid
2 16:35:34 2 administrative leave, quote/unquote, pending
3 16:35:36 3 personnel issues, which he was never told. And then
4 16:35:40 4 by the time his contract was expiring, he was not
5 16:35:43 5 renewed. So getting back to the nonrenewal, this is
6 16:35:47 6 during the time Dr. Jadwin's been placed on paid
7 16:35:50 7 administrative leave. So if he was not available to
8 16:35:52 8 work, it was because he was ordered to stay home.
9 16:35:57 9 A. Yeah, I wouldn't--
10 16:35:57 10 MR. WASSER: There's no question,
11 16:35:59 11 Mr. Watson. He's making statements.
12 16:36:01 12 MR. LEE: The question is -- no, there is a
13 16:36:03 13 question actually.
14 16:36:03 14 BY MR. LEE:
15 16:36:04 15 Q. So the question is: You've mentioned that
16 16:36:05 16 for the nonrenewal one of the reasons was that
17 16:36:08 17 Dr. Jadwin wasn't available for work; is that correct
18 16:36:11 18 or --
19 16:36:12 19 A. My understanding was that he had -- he had
20 16:36:16 20 been on medical leave, family leave, and had
21 16:36:24 21 requested even more leave, and that for that reason
22 16:36:33 22 and the fact that he was suing us, that we decided
23 16:36:40 23 not to renew his contract.
24 16:36:42 24 Q. Okay. And when you say "we," this is a
25 16:36:46 25 joint conference committee meeting, correct?
WatsonR
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1 16:36:48 1 A. And it -- it probably came up at a closed
2 16:36:51 2 session of the board of supervisors.
3 16:36:53 3 Q. As well as a closed session of the JCC?
4 16:37:00 4 A. Yes.
5 16:37:06 5 MR. LEE: Okay. Anything else?
6 16:37:13 6 (Plaintiff's counsel conferred.)
7 16:37:44 7 BY MR. LEE:
8 16:37:44 8 Q. So you do recall Mr. Culberson being
9 16:37:48 9 involved in the decision to put Dr. Jadwin on paid
10 16:37:50 10 administrative leave? He was the interim CEO from --
11 16:37:56 11 A. I know who he was. I -- again, I don't
12 16:38:00 12 remember the timeline.
13 16:38:01 13 Q. Okay.
14 16:38:06 14 A. But if he were involved in that, he
15 16:38:09 15 apparently was experiencing the same problems that
16 16:38:12 16 Peter Bryan was, and so, you know, I don't know any
17 16:38:18 17 more than that.
18 16:38:18 18 Q. Okay. And do you recall at the removal
19 16:38:21 19 meeting whether there was any discussion of the
20 16:38:24 20 medical staff bylaws and the fact that under those
21 16:38:28 21 bylaws a department chair, specifically Dr. Jadwin,
22 16:38:32 22 could be removed with or without cause upon
23 16:38:34 23 recommendation of the CEO and a majority vote of the
24 16:38:39 24 JCC? Do you recall any discussion like that?
25 16:38:41 25 A. Yes.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 125123
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2 COUNTY OF KERN
5 I, Sandra L. Edmonson, a Certified Shorthand
6 Reporter in the State of California, holding Certificate
7 No. 7704, do hereby certify that RAYMOND ALBERT WATSON,
8 the witness named in the foregoing deposition, was by me
9 duly sworn; that said deposition was taken Monday,
10 August 25, 2008, at the time and place set forth on the
14 stenotype and thereafter transcribed by computer under
20 Dated this 8th day of September, 2008, at
22
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WOOD & RANDALL

(800) 322-4595
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26 EXHIBIT 11
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 Defendants. )
__________________________)
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15 OF
16 DAVID KIRKER CULBERSON
17 Thursday, August 21, 2008
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CulbersonD
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1 09:18:05 1 Q. How long have you been employed by the
2 09:18:06 2 Camden Group or since when?
3 09:18:08 3 A. I've been employed with the Camden since
4 09:18:11 4 November of 2007.
5 09:18:12 5 Q. You weren't employed with the Camden Group
6 09:18:24 6 when you were assigned to Kern Medical Center?
8 09:18:27 8 Q. I see.
9 09:18:30 9 Okay. Well, you worked at Kern Medical
10 09:18:33 10 Center at some point in, I believe, 2006; is that
11 09:18:36 11 correct?
12 09:18:36 12 A. Yes, it is correct.
13 09:18:37 13 Q. Okay. What were your dates of employment at
15 09:18:41 15 A. Approximately August 25th, 2006, through May
16 09:18:47 16 15th, 2007.
17 09:18:48 17 Q. I'm sorry. Was Paul Hensler not at Kern
18 09:18:56 18 Medical Center starting January of '07?
19 09:18:59 19 A. Not to my knowledge.
20 09:19:00 20 Q. So to your knowledge, Paul Hensler came in
21 09:19:03 21 as the CEO around May of 2007?
22 09:19:05 22 A. Yes, that's correct.
23 09:19:12 23 Q. How is it that you came -- you were -- what
24 09:19:25 24 was your position at Kern Medical Center? Was it
25 09:19:28 25 interim CEO?
CulbersonD
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1 09:19:30 1 A. Yes, it was, interim CEO, that's correct.
2 09:19:33 2 Q. How was it that you became the interim CEO
3 09:19:36 3 of Kern Medical Center?
4 09:19:38 4 A. Through the Camden Group I was a consultant,
5 09:19:42 5 independent contractor with the Camden Group, and a
6 09:19:44 6 contract was let between the County of Kern on behalf
7 09:19:47 7 of Kern Medical Center and the Camden Group for
8 09:19:52 8 interim chief executive officer leadership as well as
9 09:19:57 9 strategic planning activities.
10 09:19:59 10 Q. Okay. So in -- and I assume you had a
11 09:20:05 11 contract then with Camden Group separately?
13 09:20:08 13 Q. Okay. So when you were being paid, you
14 09:20:11 14 weren't being paid directly through -- by the County
15 09:20:14 15 of Kern, you were being paid through the Camden
16 09:20:16 16 Group; is that correct?
18 09:20:17 18 Q. Okay. And this contract you entered into
19 09:20:24 19 with Camden Group, was it exclusively and solely for
20 09:20:28 20 the purpose of your assignment to Kern Medical Center
21 09:20:31 21 or was it a broader agreement to your knowledge or
22 09:20:33 22 understanding?
23 09:20:35 23 A. I can't recall the full scope of the details
24 09:20:37 24 there. The principal assignment would have been here
25 09:20:38 25 at Kern Medical Center, yes.
CulbersonD
42
1 09:54:11 1 Q. '-6 you mean, right?
2 09:54:12 2 A. 2006, thank you. And I would have made some
3 09:54:14 3 handwritten note sometime thereafter and then
4 09:54:17 4 shredded it or destroyed it shortly when I felt it
5 09:54:20 5 was appropriate to -- I no longer needed that piece
6 09:54:23 6 of paper for my notes or for whatever purpose I was
7 09:54:26 7 working on.
8 09:54:26 8 Q. Okay. I'm asking you to estimate the dates
9 09:54:29 9 you shredded these notes regarding your investigation
10 09:54:31 10 of Dr. Mansour's behavior as complained about to
11 09:54:35 11 Dr. Perez. Please estimate those dates.
12 09:54:37 12 A. September 2006 through May 2007.
13 09:54:39 13 Q. Were you aware that plaintiff had requested
14 09:54:45 14 that evidence in this case, including with respect to
15 09:54:49 15 other comparatories, not be destroyed, that not --
16 09:54:52 16 they not be dis-spoliated, were you ever advised of
17 09:54:55 17 that?
18 09:54:57 18 A. No, I was not.
19 19 Q. Okay. Did there --
20 09:54:58 20 A. I'm sorry. In this case rel- -- the
21 09:55:00 21 Dr. Jadwin matter versus --
22 09:55:01 22 Q. Yes.
23 09:55:01 23 A. Yes, I was not aware of that.
24 09:55:05 24 Q. Okay. No one ever instructed you not to
25 09:55:06 25 destroy any evidence in connection with Dr. Jadwin's
CulbersonD
43
1 09:55:10 1 lawsuit?
3 09:55:14 3 Q. Okay. You're sure about that, right?
4 09:55:20 4 A. Yes, I am.
5 09:55:20 5 Q. Had you been so instructed, you would not
6 09:55:23 6 have destroyed any notes -- well, did you -- were
7 09:55:25 7 there any notes regarding Dr. Jadwin's case that
8 09:55:28 8 you're aware of?
9 09:55:29 9 A. That I took, yes, I'm sure I would have
10 09:55:31 10 taken some handwritten notes during discussions, yes.
11 09:55:34 11 Q. Okay. Regarding Dr. Jadwin, correct?
13 09:55:37 13 Q. And you don't have those notes anymore,
14 09:55:40 14 right?
15 09:55:40 15 A. That's correct.
16 09:55:41 16 Q. They've been destroyed, right?
17 09:55:43 17 A. Yes.
18 09:55:43 18 Q. Okay. These notes regarding Dr. Jadwin, can
19 09:55:47 19 you recall when they were destroyed and how,
20 09:55:50 20 estimating?
21 09:55:50 21 A. My notes with Dr. Jadwin would have been
22 09:55:53 22 sometime after September 2007, probably prior to
23 09:56:00 23 January of -- I'm sorry, September 2006 --
24 09:56:02 24 Q. Six?
25 09:56:03 25 A. -- prior to January of 2007.
CulbersonD
44
1 09:56:05 1 Q. Okay. Let's just -- let's talk about these
2 09:56:11 2 handwritten notes on Dr. Jadwin. When did you take
3 09:56:13 3 these notes? Were they -- were they at meetings?
4 09:56:16 4 A. Yes, they were.
5 09:56:17 5 Q. Okay. Describe the meetings, please.
6 09:56:20 6 A. There were a number of staff core physicians
7 09:56:27 7 and staff that would have expressed concerns about
8 09:56:31 8 activities within the department, including
9 09:56:34 9 Dr. Jadwin.
10 09:56:35 10 Q. You mean the pathology department?
11 09:56:37 11 A. That's correct. And at that time I would
12 09:56:40 12 have brought the leadership team in to talk about it,
13 09:56:46 13 and I would have taken notes just for my process. I
14 09:56:51 14 would have taken notes just so I could follow the
15 09:56:53 15 discussion.
16 09:56:53 16 Q. Okay. Would have or did?
17 09:56:56 17 A. I did.
18 09:56:56 18 Q. Okay.
19 09:56:57 19 A. Yeah, thank you.
20 09:56:58 20 Q. I'm not trying to give you a hard time, but
21 09:57:00 21 I need to --
22 09:57:01 22 A. No, I understand.
23 09:57:01 23 Q. Yeah. Okay. So when you took these notes,
24 09:57:03 24 was your custom to take notes at every such meeting?
25 09:57:07 25 A. Yes.
CulbersonD
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1 09:57:08 1 Q. Okay. How many meetings did you attend
2 09:57:11 2 regarding Dr. Jadwin and the pathology department to
3 09:57:16 3 your estimation?
4 09:57:21 4 A. No more than ten.
5 09:57:23 5 Q. So it stands to reason there should have
6 09:57:27 6 been around ten sets -- well, ten discreet items of
7 09:57:31 7 handwritten notes regarding each of these meetings,
8 09:57:34 8 correct, that you took?
9 09:57:35 9 A. Yes.
10 09:57:35 10 Q. Okay. And do you recall whether any of
11 09:57:40 11 these notes were ever produced to anybody, given to
12 09:57:42 12 anybody by you?
13 09:57:44 13 A. They were not given to anybody.
14 09:57:45 14 Q. Okay. So -- I mean, where did you keep
15 09:57:48 15 these notes? Did you keep them in a binder in your
16 09:57:51 16 office? Did you carry them around with you in your
17 09:57:53 17 briefcase? Where did you typically leave these notes
18 09:57:56 18 in your office or anywhere?
19 09:57:58 19 A. Frequently I --- I did shred -- I did rip
20 09:58:01 20 them up or crumple them up and throw them in the
21 09:58:05 21 trash can at the end of the meeting.
22 09:58:06 22 Q. Why would you do that?
23 09:58:08 23 A. Because I didn't need to refer to the notes
24 09:58:10 24 at all.
25 09:58:10 25 Q. Uh-huh.
CulbersonD
46
1 09:58:11 1 A. I -- I used my notes to refresh my memories
2 09:58:17 2 during discussion.
3 09:58:18 3 Q. Uh-huh.
4 09:58:18 4 A. Found as an interim CEO it's very important
5 09:58:22 5 to get the characters and the activities down as
6 09:58:25 6 quickly as possible, and so I would take notes to
7 09:58:29 7 follow the actors and the actions during the
8 09:58:32 8 discussions we're having. Once I think I understand
9 09:58:35 9 the processes, who the players are, what the issues
10 09:58:38 10 are, I find that I no longer need the notes, and I'd
11 09:58:42 11 crumple it up and throw it away at that time.
12 09:58:44 12 Q. Oh, so you -- actually your practice was to
13 09:58:46 13 destroy and shred all of your notes immediately at
14 09:58:49 14 the end of each meeting in which you were taking
15 09:58:50 15 those notes?
16 09:58:51 16 A. No, that's not correct.
17 09:58:53 17 Q. That's correct?
18 09:58:53 18 A. That's correct.
19 19 Q. Okay.
20 09:58:56 20 A. That's -- I'm sorry, that's not correct.
21 09:58:57 21 Q. Okay. Well, then, you said that you
22 09:58:59 22 sometimes did it then, right?
23 09:59:01 23 A. Yes.
24 09:59:01 24 Q. Okay. So can you estimate percentage-wise
25 09:59:03 25 the number of times you would shred these notes
CulbersonD
47
1 09:59:06 1 immediately after the meeting?
2 09:59:06 2 A. Specific to Dr. Jadwin --
3 3 Q. Yes.
4 09:59:08 4 A. -- or the lab department?
5 09:59:09 5 Q. We're talking specific to Dr. Jadwin.
6 09:59:12 6 A. No, I cannot estimate that.
7 09:59:13 7 Q. Okay. You can't even say if it's more than
8 09:59:16 8 half or less than half?
9 09:59:17 9 A. No, I could not.
10 09:59:18 10 Q. Okay. Okay. Let's talk about the notes
11 09:59:22 11 that survived the shredding at the end of a meeting
12 09:59:25 12 regarding Dr. Jadwin.
13 09:59:26 13 MR. WASSER: He says he crumpled them up,
14 09:59:30 14 Counsel. He didn't talk about shredding.
15 09:59:32 15 MR. LEE: I'm sorry, crumpled it up and
16 09:59:35 16 disposed of.
17 09:59:35 17 BY MR. LEE:
18 09:59:36 18 Q. Let's talk about the notes that weren't
19 09:59:39 19 crumpled up and disposed of after the meetings.
20 09:59:41 20 What did you do with those notes?
21 09:59:42 21 A. In this case I had a file for "lab
22 09:59:44 22 pathology, Dr. Jadwin," I believe, and I would have
23 09:59:47 23 put them there.
24 09:59:48 24 Q. I'm sorry. What was the name of the file,
25 09:59:50 25 the lab --
CulbersonD
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1 10:15:53 1 When you spoke to Dr. Harris, what was that
2 10:15:55 2 discussion about? What did you discuss with him?
3 10:15:58 3 A. I asked for some background relative to the
4 10:16:01 4 medical staff and Dr. Harris' perception of what
5 10:16:07 5 occurred that would have resulted in Dr. Jadwin's
6 10:16:10 6 removal as department division chair of pathology.
7 10:16:13 7 Q. Okay. So you were investigating what led to
8 10:16:15 8 the removal of Dr. Jadwin from chair of pathology
9 10:16:20 9 then informally?
10 10:16:21 10 A. Yes.
11 10:16:21 11 Q. Okay. Did you take a written statement from
12 10:16:24 12 Dr. Harris?
13 10:16:24 13 A. No.
14 10:16:25 14 Q. Did you take notes?
15 10:16:26 15 A. Yes.
16 10:16:26 16 Q. Did you -- did you crumple those notes or
17 10:16:28 17 dispose of them after a meeting with Dr. Harris?
18 10:16:30 18 A. Yes.
19 10:16:31 19 Q. Okay. Why did you do that?
20 10:16:33 20 A. I understood the nature of what I -- I
21 10:16:35 21 understood the nature of what had occurred.
22 10:16:38 22 Dr. Jadwin, new to me, write it down so I remember.
23 10:16:42 23 Matters -- I don't recall specifically what they
24 10:16:44 24 were, asked the date of the contract, date of the
25 10:16:47 25 issues, matter's over, crumple it up, throw it away,
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1 10:16:50 1 no need to retain that.
2 10:16:52 2 Q. Okay. You didn't think it would -- it would
3 10:16:54 3 be helpful at all to have a written documentation of
4 10:16:57 4 what you and Dr. Harris discussed?
6 10:17:00 6 Q. You didn't consider it evidence in this
7 10:17:01 7 case, right?
9 10:17:02 9 Q. Okay. Were you advised by anybody that that
10 10:17:05 10 was evidence in this case?
11 10:17:11 11 A. What was? The piece of paper when I
12 10:17:14 12 initially -- I was identified that I -- my meeting
13 10:17:19 13 with Dr. Harris?
14 10:17:20 14 Q. The notes you took during your meeting with
15 10:17:22 15 Dr. Harris.
16 10:17:23 16 A. No, I would not have. No one notified me
17 10:17:25 17 that that was evidence in this case.
18 10:17:27 18 Q. That's fine. Okay. Let's -- so what did
19 10:17:30 19 Dr. Harris tell you? What was his story, his
20 10:17:32 20 perception?
21 10:17:33 21 A. Dr. Harris told me that Dr. Jadwin had been
22 10:17:35 22 removed from the department chairperson for a number
23 10:17:39 23 of issues relative to clinical, as well as behavioral
24 10:17:43 24 management activities, occurring at the hospital
25 10:17:47 25 sometime prior to me coming into Kern Medical Center.
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1 10:17:50 1 Q. He -- he didn't specify when any of these
2 10:17:57 2 activities or conduct were?
3 10:18:06 3 A. At that meeting, no, I cannot recall.
4 10:18:07 4 Q. You can't recall one way or another?
5 10:18:09 5 A. At that very initial meeting, I cannot
6 10:18:11 6 recall what the allegations were at that point.
7 10:18:14 7 Q. You mean you can't recall sitting here
8 10:18:17 8 today, correct?
9 10:18:18 9 A. I cannot recall sitting here -- sitting here
10 10:18:21 10 today, I cannot recall what the specifics would have
11 10:18:23 11 been briefed of me at that very first meeting, that's
12 10:18:27 12 correct.
13 10:18:27 13 Q. Would the specifics have been contained in
14 10:18:29 14 the notes which you disposed of after the meeting?
15 10:18:33 15 A. They might have, yes.
16 10:18:34 16 Q. Yes, that's correct?
17 10:18:37 17 A. They might -- yes.
18 10:18:37 18 Q. Yes?
19 10:18:38 19 A. Yes.
20 10:18:38 20 Q. Okay. Now, let's talk about Dr. Dutt. What
21 10:18:42 21 did you speak about with him, same thing?
22 10:18:46 22 A. Different matter.
23 10:18:47 23 Q. Dif- -- okay. Well, what did you talk about
24 10:18:49 24 with Dr. Dutt?
25 10:18:50 25 A. Dr. Dutt relayed to me substantial concern
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1 10:27:36 1 Q. Dr. Jadwin's diagnoses then, was that the
2 10:27:42 2 issue?
3 10:27:43 3 A. Yes, that's correct. And also the way --
4 10:27:49 4 and also the way the second opinions were being
5 10:27:51 5 requested or not followed up on.
6 10:27:52 6 Q. How would Dr. Ragland have a basis for
7 10:27:56 7 commenting on the operation of the pathology
8 10:27:58 8 department? He's not a pathologist?
9 10:28:00 9 A. That's correct. Dr. Ragland is -- at the
10 10:28:04 10 time was chief of staff, and as such he represents
11 10:28:07 11 the entire medical staff and has the duty to go out
12 10:28:12 12 and receive input from everybody in the department --
13 10:28:16 13 everybody in the hospital -- all the physicians in
14 10:28:18 14 the hospital about the quality of medical care that's
15 10:28:20 15 being delivered.
16 10:28:21 16 Q. To your knowledge, was that what Dr. Ragland
17 10:28:24 17 was doing with respect to Dr. Jadwin?
18 10:28:27 18 A. Yes.
19 10:28:27 19 Q. Do you recall when Dr. Ragland was doing
20 10:28:29 20 this, speaking to various members of the medical
21 10:28:31 21 staff regarding Dr. Jadwin's diagnoses, the way
22 10:28:34 22 second opinions were not being sent out, et cetera?
23 10:28:36 23 A. No, I don't recall Dr. Ragland's sequencing
24 10:28:41 24 of meeting with physicians.
25 10:28:42 25 Q. Okay. You just know that they were
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1 11:11:18 1 A. I believe Mr. O'Connor and myself.
2 11:11:20 2 Q. No one else?
3 11:11:21 3 A. I don't recall anybody else, no.
4 11:11:22 4 Q. Okay. What did Mr. O'Connor tell you?
5 11:11:26 5 A. The general lab operations relative to the
6 11:11:30 6 pathology staff and several of the lab employees was
7 11:11:36 7 extremely disruptive, chaotic and unstable.
8 11:11:39 8 Q. Due to Dr. Jadwin, right? Was he
9 11:11:46 9 specifically attributing this to Dr. Jadwin?
10 11:11:49 10 A. No, I don't believe he did, no.
11 11:11:51 11 Q. So he was just giving you a general report
12 11:11:54 12 on the status of the pathology department?
13 11:11:58 13 A. Yes, that's correct. The status relative to
14 11:11:59 14 the employees and the pathology department and
15 11:11:59 15 several of the lab employees.
16 11:12:01 16 Q. Okay. I'm sorry, sir. Can you repeat that
17 11:12:03 17 one more time? What did he report regarding the path
18 11:12:06 18 department operation?
19 11:12:07 19 A. He reported to the concerns expressed
20 11:12:09 20 relative to the lab and pathology department.
21 11:12:12 21 Q. And what were his findings then?
22 11:12:14 22 A. That there -- the department was extremely
23 11:12:17 23 chaotic, disruptive, potentially resulting in
24 11:12:23 24 resignation of many of the -- or several of the staff
25 11:12:28 25 if the situation were not resolved in the immediate
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1 11:12:33 1 future.
2 11:12:33 2 Q. So his report was that the department was in
3 11:12:35 3 crisis, essentially?
4 11:12:37 4 A. That there was substantial concerns being
5 11:12:41 5 expressed by non-physician staff, that's correct.
6 11:12:43 6 Q. Oh, okay. So the physicians -- he didn't
7 11:12:46 7 have anything to report regarding the physicians,
8 11:12:49 8 just --
9 11:12:49 9 A. I don't recall anything specific to the
10 11:12:51 10 physicians.
11 11:12:52 11 Q. Does the name Vangie Gallegos mean anything
12 11:12:56 12 to you, G-a-l-l-e-g-o-s?
13 11:12:59 13 A. Yes.
14 11:12:59 14 Q. Okay. Was she one of the people that was
15 11:13:02 15 complaining to Mr. O'Connor?
16 11:13:06 16 A. I don't recall specifically Vangie talking
17 11:13:08 17 to Mr. O'Connor. I do recall Vangie as a lab
18 11:13:12 18 employee or a pathology department employee.
19 11:13:14 19 Q. Did you ever meet Vangie?
20 11:13:16 20 A. I think I did, yes.
21 11:13:17 21 Q. Okay. What was that in the context of?
22 11:13:20 22 A. Generally I try to tour the hospital
23 11:13:23 23 regularly, and I believe I met Vangie. That's one of
24 11:13:27 24 those just kind of --
25 11:13:29 25 Q. How do you do?
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1 11:15:53 1 the path department issues that Mr. O'Connor was
2 11:15:57 2 raising?
3 11:16:01 3 A. I don't recall any specific actions that I
4 11:16:02 4 took. I don't recall -- nor do I recall any action
5 11:16:05 5 that the lab management may have taken at that time.
6 11:16:08 6 Q. Okay. So in other words, you may have taken
7 11:16:13 7 action, but you just don't recall what it was or
8 11:16:16 8 whether you did?
10 11:16:17 10 Q. Okay. Did you take notes during your
11 11:16:19 11 meeting with Steve O'Connor?
12 11:16:20 12 A. I don't recall.
13 11:16:21 13 Q. It was your custom to take notes at your
14 11:16:25 14 meetings with people, right?
16 11:16:26 16 Q. Okay. So you don't have a specific
17 11:16:30 17 recollection, but do you have any reason to believe
18 11:16:32 18 you did not take notes at this meeting with Steve
19 11:16:34 19 O'Connor?
20 11:16:35 20 A. That's correct, I have -- I have no reason
21 11:16:36 21 to believe I did not, right.
22 11:16:38 22 Q. Okay. That's fine.
23 11:16:39 23 Okay. So -- and you did not ask Steve
24 11:16:43 24 O'Connor to formalize his findings in writing in a
25 11:16:47 25 report or an E-mail?
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1 12:09:55 1 A. I'm aware of that meeting, yes.
2 12:09:56 2 Q. Okay. I'm going to call that buyout
3 12:09:59 3 discussion.
4 12:09:59 4 A. That's fine, yes.
5 12:10:00 5 Q. Okay. Now, did you know as of the buyout
6 12:10:03 6 discussion, the time it occurred, did you know
7 12:10:06 7 whether or not the allegations against Dr. Jadwin as
8 12:10:08 8 expressed by numerous people, Dr. Ragland, Harris,
9 12:10:14 9 Dutt, Ms. Barnes, Mr. O'Connor, Ms. Raison,
10 12:10:18 10 Dr. Naderi, Dr. Kercher, numerous people, did you --
11 12:10:23 11 did you know whether these allegations were actually
12 12:10:25 12 proven?
13 12:10:30 13 A. Some were, some were not. Some had not been
14 12:10:33 14 investigated upon.
15 12:10:34 15 Q. So there was an investigation, then, wasn't
16 12:10:36 16 there, of Dr. Jadwin prior to the buyout --
17 12:10:39 17 between -- between December 7 of 2006, and the buyout
18 12:10:45 18 discussion, there was an investigation of Dr. Jadwin,
19 12:10:48 19 wasn't there?
21 12:10:49 21 Q. Okay. And what did the -- what did the
22 12:10:52 22 investigation conclude?
23 12:10:53 23 A. I can't recall the specifics.
24 12:10:54 24 Q. You don't recall which allegations were
25 12:10:57 25 proven and which weren't?
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1 12:11:00 1 A. I remember there was a lot -- rather
2 12:11:03 2 extensive letter, but I don't recall which one, that
3 12:11:06 3 had a number of matters. I don't recall specifically
4 12:11:09 4 which ones were found which way, quite honestly.
5 12:11:15 5 Q. You said a letter from Dr. Dutt?
6 12:11:17 6 A. Yes, that's -- I believe that's where -- the
7 12:11:19 7 letter I'm referring to, yes.
8 12:11:20 8 Q. Was this a letter to the peer-review
9 12:11:22 9 committee by any chance?
10 12:11:23 10 A. I can't recall where the -- who the intended
11 12:11:26 11 recipient of that letter was.
12 12:11:27 12 Q. And it listed problems in Dr. Jadwin's
13 12:11:34 13 pathologic diagnoses?
15 12:11:36 15 Q. And did this letter also list disruptive
16 12:11:40 16 behavior by Dr. Jadwin?
17 12:11:42 17 A. I can't recall specifically what was
18 12:11:43 18 contained in the letter.
19 12:11:44 19 Q. Did it recall -- do you recall this letter
20 12:11:46 20 discussing hostile work environment created by
21 12:11:50 21 Dr. Jadwin?
22 12:11:50 22 A. I don't recall that, no.
23 12:11:51 23 Q. Do you recall whether this letter discussed
24 12:11:53 24 retaliation by Dr. Jadwin against several core
25 12:11:57 25 physicians?
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1 12:11:59 1 A. I can't recall the specifics, no.
2 12:11:59 2 Q. Okay.
3 12:12:00 3 A. That specifically.
4 12:12:01 4 Q. Did -- do you recall whether Dr. Dutt's
5 12:12:09 5 letter included any mention of computer sabotage or
6 12:12:12 6 any other kind of sabotage by Dr. Jadwin?
7 12:12:15 7 A. I cannot recall the contents of that
8 12:12:18 8 component in the letter, that's correct.
9 12:12:20 9 Q. Okay. Who conducted this investigation into
10 12:12:23 10 the allegations of Dr. Jadwin between December 7,
11 12:12:27 11 2006, and the buyout discussion?
12 12:12:29 12 A. I believe Dr. Dutt was involved in
13 12:12:31 13 investigating a large portion of the matters.
14 12:12:33 14 Q. Who else?
15 12:12:34 15 A. I -- I would not -- I'd just have to
16 12:12:38 16 speculate beyond that.
17 12:12:39 17 Q. Okay. Don't do that.
18 12:12:41 18 And how did -- to your knowledge, how did
19 12:12:45 19 Dr. Dutt conduct this investigation into the
20 12:12:48 20 allegations? Did he speak to --
21 12:12:50 21 A. Personal investigation, and I also believe
22 12:12:51 22 he contacted two or three experts in the field -- and
23 12:12:57 23 I don't recall where those experts were, whether it
24 12:12:59 24 was USC, UCLA, UCSF, I don't recall the specifics.
25 12:13:04 25 But he did make some outreach to other fairly renown
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1 12:13:09 1 pathologists about proper policies, procedures and
2 12:13:13 2 interpretations.
3 12:13:14 3 Q. Did you actually see these reports then
4 12:13:18 4 yourself?
5 12:13:19 5 A. No, I did not.
6 12:13:19 6 Q. Okay. So how did you learn of the results?
7 12:13:23 7 Did Dr. Dutt create a summary report or did he just
8 12:13:26 8 orally report?
9 12:13:27 9 A. I don't recall whether it was written or
10 12:13:28 10 oral, but I certainly would have come back and
11 12:13:30 11 reported something about his findings, yes.
12 12:13:33 12 Q. Did you take notes at any of these -- did
13 12:13:37 13 you meet with Dr. Dutt to hear his findings?
14 12:13:40 14 A. Yes.
15 12:13:40 15 Q. Did you take notes at these meetings?
16 12:13:42 16 A. Not that I recall, no.
17 12:13:43 17 Q. Why is it that you take notes at certain
18 12:13:45 18 meetings but not at others? Why not this meeting?
19 12:13:48 19 A. I don't recall specifically taking notes at
20 12:13:50 20 that meeting. It's -- my general behavior is
21 12:13:53 21 frequently to take notes. But I do not recall
22 12:13:55 22 specifically taking notes at that meeting.
23 12:13:57 23 Q. Do you have any reason to believe you did
24 12:13:59 24 not take notes at this meeting with Dr. Dutt where he
25 12:14:03 25 gave you the results of his investigation?
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1 12:14:05 1 A. I have no reason to believe I did not take
2 12:14:07 2 notes.
3 12:14:07 3 Q. Okay. When you take notes -- when you take
4 12:14:13 4 these notes, is it in your own handwriting?
5 12:14:16 5 A. Yes, it is.
6 12:14:16 6 Q. Okay. Do you ever type these notes up?
7 12:14:19 7 A. Very rarely.
8 12:14:20 8 Q. Okay. And what kind of paper did you take
9 12:14:24 9 your notes on? Was it like college-ruled line paper?
10 12:14:28 10 You want to hold up an example of it like that?
11 12:14:31 11 A. A yellow --
12 12:14:31 12 Q. Pad?
13 12:14:32 13 A. -- pad.
14 12:14:33 14 Q. Just hold it up for the camera.
15 15 A. Sure.
16 12:14:36 16 Q. Show -- I mean, you can just hold it up.
17 12:14:38 17 A. It says your location on here.
18 18 Q. Okay. So this --
19 12:14:42 19 A. Similar to that, yes, correct.
20 12:14:42 20 Q. So that's the kind of paper you took your
21 12:14:46 21 notes on, correct?
22 12:14:48 22 A. Yes.
23 12:14:48 23 Q. Okay. Thank you.
24 12:14:49 24 Is that your handwriting on there, by the
25 12:14:50 25 way?
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1 12:14:50 1 A. No, it's not.
2 12:14:51 2 Q. It's not? Okay.
3 12:14:53 3 So Dr. Dutt, he met with you to report
4 12:14:56 4 orally the findings of his investigation of
5 12:14:59 5 Dr. Jadwin; is that correct?
7 12:15:00 7 Q. How many times did he meet with you?
8 12:15:02 8 A. I can't recall that.
9 12:15:02 9 Q. More than one?
10 12:15:08 10 A. I'd have to speculate more than one, I'm
11 12:15:10 11 sorry.
12 12:15:10 12 Q. Don't do that.
13 12:15:12 13 And do you recall when this meeting with
14 12:15:18 14 Dr. Dutt occurred?
15 12:15:19 15 A. No, I don't.
16 12:15:19 16 Q. Okay. Was it -- it was after the paid
17 12:15:22 17 administrative leave, right? Or was it?
18 12:15:25 18 A. I'd have to speculate on that.
19 12:15:27 19 Q. You don't know which way?
20 12:15:30 20 A. No, I don't know.
21 12:15:31 21 Q. Okay. So it could have been right around
22 12:15:34 22 the time of the paid administrative leave then? You
23 12:15:38 23 don't know?
24 12:15:39 24 A. It could have been, but I don't know.
25 12:15:41 25 Q. Okay, then, that's fine. And to your
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1 12:15:43 1 knowledge Dr. Jadwin did not know that Dr. Dutt was
2 12:15:46 2 conducting an investigation into allegations against
3 12:15:48 3 him?
4 12:15:51 4 A. I don't know one way or the other, no.
5 12:15:53 5 Q. Okay. You didn't check to know -- to find
6 12:15:58 6 out, right?
7 12:16:00 7 A. Sorry?
8 12:16:00 8 Q. You didn't -- you didn't think to find out
9 12:16:02 9 whether Dr. Jadwin was aware of the allegations
10 12:16:04 10 against him that were being made?
11 12:16:07 11 A. I don't recall checking on that, no.
12 12:16:15 12 Q. Did it concern you that Dr. Dutt might be
13 12:16:19 13 biased against Dr. Jadwin because Dr. Jadwin was the
14 12:16:22 14 previous chair and now Dr. Dutt was the interim
15 12:16:25 15 chair?
16 12:16:26 16 A. Yes.
17 12:16:26 17 Q. Okay. So how did you deal with this concern
18 12:16:33 18 about potential bias on Dr. Dutt's part? Or did you
19 12:16:37 19 do anything about it?
20 12:16:38 20 A. Well, I -- I certainly turned to Dr. Dutt as
21 12:16:45 21 department chair and asked for his objective opinion
22 12:16:48 22 to the matter.
23 23 Q. Uh-huh.
24 12:16:48 24 A. Also weighed credence to the fact that
25 12:16:52 25 outside consultants were being brought in to evaluate
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1 12:16:55 1 practices and -- up to and including results of tests
2 12:16:59 2 as well.
3 12:16:59 3 Q. Okay. And you never saw these outside
4 12:17:01 4 consulting reports, right?
5 12:17:03 5 A. Not to my knowledge, no.
6 12:17:04 6 Q. They were relayed to you through Dr. Dutt,
7 12:17:06 7 correct?
8 12:17:07 8 A. Yes.
9 12:17:07 9 Q. You're not a pathologist?
10 12:17:09 10 A. That's correct.
11 12:17:10 11 Q. You have no pathologic training?
12 12:17:12 12 A. That's correct.
13 12:17:12 13 Q. So when you looked at -- if you -- let's say
14 12:17:15 14 you even had a chance to look at these outside expert
15 12:17:18 15 reports, you would not have been able to discern
16 12:17:21 16 their meaning or significance, would you have?
17 12:17:24 17 A. That's correct, I would not.
18 12:17:24 18 Q. Because they're pathologic reports, right?
19 12:17:28 19 A. Correct.
20 12:17:28 20 Q. So in other words, you had to depend on
21 12:17:30 21 Dr. Dutt for his interpretation or summary of the
22 12:17:34 22 outside consulting reports, correct?
23 12:17:38 23 A. Yes, and perhaps any other physician that
24 12:17:41 24 might be knowledgeable of the subject matter.
25 12:17:42 25 Q. Who else would be knowledgeable about
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1 12:17:44 1 pathology reports?
2 12:17:46 2 A. Generally surgeons.
3 12:17:47 3 Q. So who else did you speak to then?
4 12:17:51 4 A. I don't recall speaking to anybody about the
5 12:17:53 5 results of -- of any outside investigation.
6 12:17:55 6 Q. You spoke only to Dr. Dutt then, right?
7 12:17:58 7 A. To my recollection, only Dr. Dutt, that's
8 12:18:01 8 correct.
9 12:18:01 9 Q. Now, at the time of this meeting with
10 12:18:03 10 Dr. Dutt, we don't recall the date, but can we at
11 12:18:10 11 least establish that Dr. -- that this meeting with
12 12:18:12 12 Dr. Dutt occurred sometime in 2006, or can you even
13 12:18:16 13 say that?
14 12:18:17 14 A. No, I can't even say that, no.
15 12:18:18 15 Q. Okay. Anyway, it was somewhere during your
16 12:18:21 16 tenure as interim CEO, right?
17 12:18:24 17 A. Yes.
18 12:18:24 18 Q. Okay. Which was between August of '06 to
19 12:18:27 19 May of 2007, correct?
20 12:18:28 20 A. Yes.
21 12:18:28 21 Q. So we don't know exactly when that was,
22 22 right? It wasn't towards the beginning, middle, or
23 12:18:31 23 end of your tenure?
24 12:18:31 24 A. Right, I can't -- I can't state that, right.
25 12:18:33 25 Q. That's fine. At the time of this meeting
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1 12:18:35 1 with Dr. Dutt where he was reporting the findings of
2 12:18:37 2 his investigation into the allegations about
3 12:18:43 3 Dr. Jadwin, did Dr. Jadwin -- do you know that
4 12:18:46 4 Dr. Dutt had reports of outside experts regarding
5 12:18:50 5 Dr. Jadwin's diagnoses? You knew that for a fact?
6 12:18:55 6 A. I know that there were attempts made to add
7 12:18:59 7 outside opinions. I don't recall if anything else --
8 12:19:02 8 the specific findings were brought back, quite
9 12:19:05 9 honestly.
10 12:19:06 10 Q. Okay. Do you recall whether Dr. -- so what
11 12:19:09 11 did Dr. Dutt report to you about the findings of the
12 12:19:11 12 outside consultants as to Dr. Jadwin's competence, if
13 12:19:16 13 anything? Did he tell you what the results were?
14 12:19:21 14 A. Yes. There were several matters that it was
15 12:19:26 15 clear the outside consultant did not believe that the
16 12:19:31 16 way matters were handled was proper.
17 12:19:34 17 Q. Okay. Are we talking about pathologic
18 12:19:38 18 diagnoses or are we talking about policy,
19 12:19:41 19 administration, protocol within pathology?
20 12:19:45 20 A. Actually, I believe there was both.
21 12:19:47 21 Q. Both?
22 12:19:48 22 A. Yes. But, again, I'm going to have to say I
23 12:19:51 23 can't recall specifically what they were on, so --
24 12:19:54 24 Q. You mean -- so you're not sure whether
25 12:19:57 25 Dr. Dutt hired a consultant to the pathology
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2 COUNTY OF KERN
7 No. 7704, do hereby certify that DAVID KIRKER CULBERSON,
9 duly sworn; that said deposition was taken Thursday,
August 21, 2008, at the time and place set forth on the
first page hereof.

WOOD & RANDALL

(800) 322-4595
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26 EXHIBIT 12
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3 3 ---------
4 4 DAVID F. JADWIN, D.O., ) Case No. 1:07-cv-00026-OWW-TAG
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5 5 Plaintiff, )
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6 6 vs. )
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8 8 Defendants. )
_________________________)
9 9
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13 13 OF
14 14 COUNTY OF KERN
15 15 THROUGH PERSON MOST KNOWLEDGEABLE,
16 16 PHILIP LEE DUTT. M.D.
17 17 Friday, August 29, 2008
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PMK DuttP1
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1 09:28:38 1 Q. Did you speak with Dr. Harris?

2 09:28:41 2 A. I have not.
3 09:28:42 3 Q. Okay. Did you review any documents?
4 09:28:47 4 A. No.
5 09:28:48 5 Q. Okay. Dr. Dutt, please tell us about the
County's
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09:28:56 6 response to Gilbert Martinez -- Gilbert Martinez's
7 notice to
8 09:29:01 7 David Hill in November of 2006 regarding upcoming
regulatory
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09:29:06 8 audit.
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09:29:09 9 A. I'm not sure I am -- I'm not sure I was aware
11 that
12 09:29:15 10 Gilbert had given notice to David Hill.
13 09:29:19 11 What I know is that I know I had the
conversation
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09:29:26 12 with Irwin Harris in which Dr. Jadwin had made a comment
15 to
16 09:29:40 13 Gilbert Martinez, at least, that he was going to report
the
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09:29:48 14 hospital to JCAHO, CNPS. Not necessarily in that order.
18
09:30:00 15 Q. Do you recall when you had this conversation
19 with
20 09:30:02 16 Dr. Harris? An estimate, please.
21 09:30:06 17 A. It was either the Friday before Thanksgiving
that
22
09:30:09 18 year or the Monday after that weekend. So the Monday
23 before
24 09:30:15 19 Thanksgiving. One of those two days, I believe.
25 09:30:18 20 Q. And do you know or -- do you know when Dr.
Jadwin
26
09:30:25 21 supposedly made this comment to Mr. Martinez?
27 09:30:28 22 A. I don't know when he made that comment to
09:30:35 23 Mr. Martinez. Let me supplement what I said earlier;
28 that
09:30:39 24 he may have also spoken to Dr. Harris. I am not sure
29 about
09:30:43 25 that.
PMK DuttP1
13
1 09:33:39 1 A. By that time, I had already talked to Dr.

Harris.
2
09:33:42 2 Q. I see. Okay. And did you -- what did you and
3 Dr.
4 09:33:50 3 Harris decide to do, if anything?
5 09:33:55 4 A. I suggested that I could look for someone who
had
6
09:34:03 5 experience with CAP inspections to see if they would be
7
09:34:10 6 willing to give us a mock unannounced inspection.
8
09:34:15 7 Q. Was that Stacy Garry?
9
09:34:18 8 A. She agreed to do that.
10
09:34:20 9 Q. G-a-r-r-y.
11
09:34:23 10 Okay. And do you recall when you spoke to
12 Miss or
13 09:34:28 11 was it Dr. Gary?
14 09:34:34 12 A. Well, the -- I do, but when -- the
conversation
15
09:34:38 13 where she agreed to do that was on Christmas day.
16
09:34:48 14 Q. And she agreed to do the mock, unannounced,
17 CAP
18 09:34:52 15 inspection?
19 09:34:55 16 A. She did not want to use the word "CAP" because
she
20
09:34:59 17 was not acting as representative of CAP, but I wanted
21
09:35:03 18 someone who had experience to give us a tough
22 inspection.
23 09:35:11 19 Q. Of the Pathology Department?
24 09:35:15 20 A. And portions of the laboratory.
25 09:35:18 21 Q. Okay. Okay. And Dr. -- I assume -- I am not
26 09:35:27 22 going to assume anything. Did Dr. Harris then approve
this?
27
09:35:32 23 A. At what time?
28
09:35:35 24 Q. At any time.
29 09:35:38 25 A. Well, on the -- on either the Friday --
whenever
PMK DuttP1
14
1 09:35:44 1 we had that first conversation, on either the Friday

before
2
09:35:47 2 Thanksgiving or the Monday before Thanksgiving, he
3 thought
4 09:35:51 3 it was a good idea and gave approval if I could find
someone
5
09:35:59 4 to agree to do that.
6
09:36:03 5 Q. So Dr. Harris agreed with you it was a good
7 idea?
8 09:36:09 6 A. Yes.
9 09:36:12 7 Q. How much cost was -- never mind.
10 09:36:23 8 Okay. And besides the retention of Dr. Garry
to
11
09:36:29 9 do a mock, unannounced inspection, what other steps, if
12 any,
13 09:36:34 10 did you or Dr. Harris decide to do?
14 09:36:41 11 A. I believe that was it.
15 09:36:42 12 Q. That was it?
16 09:36:43 13 A. That was the response that I am aware of.
17 09:36:46 14 Q. Was there any discussion -- strike that.
18 09:36:51 15 When you heard -- when you understood that Dr.
19 09:36:54 16 Jadwin was intending to report KMC to the authorities,
to
20
09:36:59 17 your understanding, did that include the tissue bank
21
09:37:03 18 licensing, slash, skull flap issue?
22
09:37:07 19 A. That came up later.
23
09:37:09 20 Q. Okay. How did the skull flap issue come up?
24
09:37:13 21 A. It was one of the items in a letter, I
25 believe,
26 09:37:18 22 addressed to David Culbertson.
27 09:37:21 23 Q. By Dr. Jadwin?
28 09:37:22 24 A. Correct.
29 09:37:28 25 Q. And this was a letter dated after Dr. Jadwin
was
PMK DuttP1
P LEE DUTT, M. D. Document 277-2 Filed 12/01/2008 Page 159 of 245
08-29-08
Page 95
SSe
2 COUNTY OF KERN
3
6 No. 7974, do hereby certify that PHILIP LEE DUTT, M.D.,
9 Friday, August 29, 2008, at the time and place set forth
21
,
22
23 ~~~
24 Cindee L. LeFevre, CSR No. 7974
25
vs. COUNTY
RANDALL (800) 322-4595
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 13
27
28
1
3 ______________
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
)
9 )
Defendants. )
10 _____________________)
11
12
13
15 OF
16 SANDRA MARIE CHESTER
19
20
21
22
23
24
25 ted by: Erika Addis, CSR No. 11621
ChesterS
115
1 16:01:05 1 A. Yes.
2 16:01:05 2 Q. All right. Before it could be designated as
3 16:01:09 3 medical leave and processed at KMC?
4 16:01:11 4 A. Correct.
5 16:01:12 5 Q. I see. Right.
6 16:01:15 6 And when you say a written request for
7 16:01:17 7 leave, you're saying that they have to fill out this
8 16:01:21 8 particular form that is reflected in Exhibit 819?
9 16:01:26 9 A. Yes.
10 16:01:26 10 Q. All right. So would a request in writing in
11 16:01:31 11 the form of a letter requesting medical leave be
12 16:01:34 12 insufficient under KMC's policies and procedures?
13 16:01:39 13 A. I personally would have deemed it as
14 16:01:48 14 acceptable.
15 16:01:48 15 Q. Okay.
16 16:01:48 16 A. At least it would have started the process.
17 16:01:48 17 Maybe we would have been formally notified that he
18 16:01:48 18 was needing a leave.
19 16:01:48 19 Q. Right.
20 16:01:48 20 And under KMC's policies and procedures,
21 16:01:50 21 would a verbal request for leave be sufficient to put
22 16:01:54 22 KMC on notice that Dr. Jadwin required leave?
23 16:01:57 23 A. No.
24 16:01:58 24 Q. All right. Under no circumstances would a
25 16:02:01 25 verbal request for medical leave be deemed
ChesterS
120
1 16:08:31 1 if I understand your testimony correctly, the fact
2 16:08:35 2 that he did provide this notice to Mr. Bryan in the
3 16:08:40 3 normal course of matters you would have expected
4 16:08:43 4 Mr. Bryan to contact you --
5 16:08:43 5 A. Yes.
6 16:08:44 6 Q. -- and let you know that Dr. Jadwin had made
7 16:08:47 7 a good-faith effort to try and get an extension of
8 16:08:50 8 his leave the day after it expired. Correct?
10 16:08:54 10 Q. You know, so this e-mail, under your normal
11 16:09:05 11 program in your tenure at KMC, would constitute
12 16:09:09 12 reasonable notice of the need for an extension of his
13 16:09:12 13 medical leave that should have generated an employee
14 16:09:15 14 information packet being sent to him at that time.
15 16:09:17 15 Is that correct?
16 16:09:17 16 A. Absolutely.
17 16:09:18 17 Q. Did Mr. Bryan ever inform you during your
18 16:09:22 18 conversations with him that he had received this
19 16:09:24 19 e-mail from Dr. Jadwin?
20 16:09:26 20 A. No.
21 16:09:27 21 Q. Did Mr. Bryan represent to you he had not
22 16:09:34 22 heard -- did Mr. Bryan represent to you that
23 16:09:39 23 Dr. Jadwin had failed to notify him of his need for
24 16:09:44 24 another -- for an extension of his medical leave at
25 16:09:48 25 the time that you wrote Exhibit 297?
ChesterS
167
1 1 STATE OF CALIFORNIA )
) ss.
2 2 COUNTY OF KERN )
3 3
4 4
5 5 I, Erika Addis, a Certified Shorthand Reporter
6 6 in the State of California, holding Certificate
7 7 No. 11621, do hereby certify that SANDRA MARIE CHESTER,
8 8 the witness named in the foregoing deposition, was by me
9 9 duly sworn; that said deposition was taken Thursday,
10 10 August 28, 2008, at the time and place set forth on the
11 11 first page hereof.
12 12 That upon the taking of the deposition, the
13 13 words of the witness were written down by me in
14 14 stenotypy and thereafter transcribed by computer under
15 15 my supervision; that the foregoing is a true and correct
16 16 transcript of the testimony given by the witness.
17 17 I further certify that I am neither counsel for
18 18 nor in any way related to any party to said action, nor
19 19 in any way interested in the result or outcome thereof.
20 20 Dated this 10th day of September, 2008, at
21 21 Bakersfield, California.
22 22
23 23 _____
Erika Addis, CSR No. 11621
24 24
25
25 WOOD & RANDALL
(800) 322-4595
ChesterS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 14
27
28
1

3 3 ---------
)
5 5 Plaintiff, )
)
6 6 vs. )
)
)
8 8 Defendants. )
_________________________)
9 9
10 10
11 11
12 12
14 14 OF
15 15 COUNTY OF KERN
16 16 THROUGH PERSON MOST KNOWLEDGEABLE,
17 17 EUGENE KERCHER, M.D.
18 18 Thursday, September 4, 2008
19 19 Pasadena, California
20 20
21 21
22
24
25 23
26
27 24
28
29 25
PMK KercherE
27
1 13:54:06 1 Q. Okay. And this is Item 18 of the PMK notice.

2 13:54:14 2 What do you understand about the nonrenewal of John
Digges'
3
13:54:18 3 employment contract?
4
13:54:18 4 A. My understanding was that he was asking for a
5
13:54:22 5 salary increase that was -- that was not acceptable, and
6
13:54:30 6 that's all I know about it.
7
13:54:32 7 Q. Okay.
8
13:54:35 8 A. In other words, what he was asking for didn't
9 seem
10 13:54:38 9 to match what he was actually doing and his job and the
11 13:54:43 10 amount of hours he was spending. There was a strong
opinion
12
13:54:46 11 that his asking price was above and beyond what was
13
13:54:49 12 appropriate.
14
13:54:50 13 Q. Okay. So when you say it didn't match what he
15 was
16 13:54:55 14 doing, is that because his contribution wasn't good
enough?
17
13:55:00 15 I mean --
18
13:55:01 16 A. No, I think he contributed in, you know, the
19 best
20 13:55:05 17 way he could. I dealt with him probably more than most
21 13:55:09 18 physicians at Kern because we did have lots of abused
22 13:55:12 19 children that come into the Emergency Medicine
Department,
23
13:55:17 20 and he was there, but my understanding is that the
24
13:55:22 21 administration made the decision that the asking price
25 -- in
26 13:55:28 22 fact, I had called him a couple weeks ago to just -- on
27 13:55:33 23 another issue -- and he related the same thing.
28 13:55:36 24 He said can you believe they didn't think I
was
29 13:55:39 25 worth what I asked for. So it sort of confirms the
whole
PMK KercherE
28
1 13:55:44 1 issue that --

2 13:55:47 2 Q. Has he -- now, to your knowledge, is Dr.
Digges
3
13:55:51 3 retired?
4
13:55:52 4 A. No, I think he is still working in some
5 capacity.
6 13:55:55 5 I do know that he does do forensic stuff. I don't know
7 13:56:00 6 whether he does it on a locum tenens basis or
case-by-case
8
13:56:05 7 basis, but he still has expertise in that area.
9
13:56:09 8 Q. Is he working then, do you know?
10
13:56:11 9 A. I -- I have never asked him that personally,
11 but
12 13:56:15 10 he is not working for Kern Medical Center.
13 13:56:18 11 Q. Okay. Was he pretty close to retirement age?
14 13:56:21 12 A. No.
15 13:56:23 13 Q. Okay. And do you recall what -- you don't
have to
16
13:56:28 14 give me an exact amount, but can you give me a rough
17 idea.
18 13:56:32 15 A. I have no idea.
19 13:56:33 16 Q. No idea?
20 13:56:33 17 A. No idea.
21 13:56:33 18 Q. Who made the decision not to renew his
contract?
22
13:56:36 19 A. That was an administrative decision. It may
23 have
24 13:56:40 20 been a Chief Medical Officer decision. I have no idea.
25 13:56:45 21 Q. Okay. But before the decision not to renew
his
26
13:56:48 22 contract was made, was there a negotiation then with
27
13:56:52 23 Dr. Digges?
28 13:56:54 24 A. And I can't really tell you much about that.
I
29 13:56:58 25 would suspect there was some attempt to negotiate with
him
PMK KercherE
32
1 14:00:45 1 that don't belong to you to do an evaluation on you, and

you
2
14:00:51 2 don't interrupt their work process.
3
14:00:53 3 You find a time when they have got time to
4 think
5 14:00:55 4 about it and have an opportunity to -- but I mean, he
handed
6
14:00:58 5 it to me. He came up to me afterwards and thanked me.
7 So
8 14:01:03 6 to me -- to me, that was disruptive. Okay. It was
9 14:01:07 7 disruptive. And they -- they invaded my Department.
They
10
14:01:11 8 invaded my residents' privacy.
11
14:01:13 9 Okay. And that's -- but I -- I don't ever
12
14:01:18 10 remember David specifically treating me in a sassy,
13 mean,
14 14:01:24 11 horrible way.
15 14:01:25 12 Q. Okay.
16 14:01:26 13 A. I mean, he was always nice to me, but I will
tell
17
14:01:28 14 you something. I have oftentimes wondered what he said
18 when
19 14:01:32 15 I wasn't around about me, but I never -- but -- and I
have
20
14:01:37 16 been in situations where he has been absolutely caustic
21 with
22 14:01:40 17 other folks, but, fortunately, somehow, I never was the
kind
23
14:01:47 18 of recipient of that behavior as others have been at
24 Kern
14:01:51 19 Medical Center.
25 14:01:52 20 And I was an elected officer, I was a Chair.
I
26 14:01:55 21 heard about all the stuff. And I kept reminding him,
David,
27 14:01:59 22 stop it. You are building enemies. I don't know how
many
28 14:02:06 23 times I said that.
14:02:08 24 Q. How did he respond?
29 14:02:09 25 A. Well, you know, the usual way. You know,
David
PMK KercherE
33
1 14:02:13 1 was one that would listen, not necessarily respond all
the
2
14:02:17 2 time, but he didn't yell at me or, you know, slam me in
3 the
4 14:02:23 3 face or anything like that. I thought he listened.
5 14:02:28 4 Q. Well, so -- I mean, in your opinion, did you
ever
6
14:02:30 5 witness Dr. Jadwin do something that would trigger the
7
14:02:36 6 Disruptive Physician Policy that's in place today?
8
14:02:39 7 A. Oh, yeah.
9
14:02:40 8 Q. Okay. So would it be this evaluation?
10
14:02:42 9 A. That would have been one.
11
14:02:44 10 Q. Okay.
12
14:02:45 11 A. Then the other incident would have been his
13
14:02:48 12 outright blasting of two elected medical officers in a
14
14:02:53 13 meeting.
15
14:02:54 14 Q. Okay. Tell me about that.
16
14:02:56 15 A. And where he shared with the president of the
17
14:03:01 16 medical staff, who happened to be a woman, that --
18
14:03:05 17 Q. Is this Dr. Abraham?
19
14:03:07 18 A. Yes. And I don't know what the language was,
20 but
21 14:03:10 19 it was pretty demeaning in front of her, but more
important,
22
14:03:14 20 just absolutely destroyed Dr. Ragland, who was president
23
14:03:21 21 elect.
24
14:03:22 22 Actually, I was past -- no. How did it
25 happen?
26 14:03:25 23 No, I think Jennifer was past president, I was
president,
27
14:03:29 24 and Scott was president elect.
28
14:03:32 25 But David just absolutely pulverized Scott
29 Ragland
PMK KercherE
92
1 15:25:28 1 Okay. There was an e-mail exchange in which

you
2
15:25:31 2 were CC'd, and I am referring to Exhibit 263, Bates
3 stamped
4 15:25:37 3 507. And it states -- this is a letter, an e-mail --
sorry
5
15:25:44 4 -- an e-mail from Peter Bryan to the medical staff
6 officers,
7 15:25:50 5 stating thank you for participating in today's noontime
8 15:25:53 6 meeting. I know it was really challenging to remain
cordial
9
15:25:58 7 and not combative, and, goodness knows, a couple of you
10
15:26:01 8 could have really hit back. Thank you for your
11 restraint
12 15:26:05 9 and the professional manner in which you participated.
And
13
15:26:07 10 it goes on. And Mr. Bryan concludes, anyway, thanks --
14
15:26:11 11 thank you for your efforts. And then Mr. -- well, I
15 don't
16 15:26:14 12 know if this ever got to you, but Dr. Ragland responded,
17 15:26:18 13 that was one of the most distasteful events I have ever
18 15:26:22 14 participated in.
19 15:26:23 15 Do you recall what meeting this e-mail was
20 15:26:26 16 referencing to? And I will tell you this e-mail is
dated
21
15:26:30 17 February 22.
22
15:26:31 18 A. I don't remember. I don't recall that e-mail
23 and
24 15:26:32 19 I have no idea what that was referencing.
25 15:26:35 20 Q. So you don't recall a meeting where Dr.
Ragland
26
15:26:39 21 leaned back in his chair and said, here we are again,
27
15:26:42 22 Mr. Perfect?
28
15:26:43 23 A. I do not recall.
29 15:26:47 24 Q. All right. Do you recall a meeting where Dr.
15:26:51 25 Jadwin told Dr. Abraham that you are just a fat doctor?
PMK KercherE
93
1 15:26:58 1 A. I don't recall that comment any time.

2 15:27:01 2 Q. Okay. Do you recall -- do you recall a
meeting
3
15:27:03 3 where Dr. Jadwin told Dr. Raglan you are not competent
4 or
5 15:27:08 4 qualified to be a president of the medical staff?
6 15:27:11 5 A. Now, this was not in February. These were
some of
7
15:27:14 6 the comments that were made back at that meeting when we
8
15:27:18 7 presented him the letter.
9
15:27:19 8 Q. October 17?
10
15:27:21 9 A. This was not in February. These are some
11 comments
12 15:27:23 10 that were made at the meeting in October.
13 15:27:26 11 Q. Okay. Now, do you recall a meeting where you
and
14
15:27:30 12 Dr. Harris apologized to Dr. Jadwin, and you shook his
15 head
16 15:27:35 13 and kind of slugged him in the arm?
17 15:27:37 14 A. Huh? I have done that so many times to
Jadwin.
18
15:27:40 15 You know, I used to punch him in the side, I used to
19
15:27:43 16 choke-hold him. I mean, I did a lot of crazy stuff with
20
15:27:48 17 him.
21
15:27:48 18 I don't remember this particular --
22
15:27:50 19 Q. But do you remember apologizing to Dr. Jadwin?
23
15:27:53 20 A. I apologize all the time, sir. I apologize to
24
15:27:55 21 everybody. Sorry. Have I been an asshole today,
25 Jadwin?
26 15:28:00 22 You seem to be upset. I really apologize. Are you
angry
27
15:28:04 23 with me because I have done something wrong? I
28 apologize.
15:28:07 24 I do it all the time.
29 15:28:08 25 Q. Okay. Well, I am just trying to recall -- I
am
PMK KercherE
99
1 15:34:25 1 me, there's no better explanation for why he couldn't

build
2
15:34:31 2 friendships, why he couldn't become part of the team,
3 why he
4 15:34:34 3 never felt a peace at KMC, why -- I mean, that's just my
5 15:34:40 4 opinion.
6 15:34:40 5 Q. Okay.
7 15:34:41 6 A. And it could be totally wrong. I am not being
8 15:34:44 7 dogmatic about it. I won't insist on it. I am just
giving
9
15:34:48 8 you a very honest opinion.
10
15:34:49 9 Q. I understand.
11
15:34:50 10 MR. WASSER: As you know, this is a PMK, and I
12
15:34:52 11 have given you enormous latitude in the last couple
13 hours
14 15:34:55 12 because Dr. Kercher's testimony is, frankly, something
you
15
15:34:58 13 need. You didn't notice his deposition, and I didn't
16 know
17 15:35:00 14 why, and that's not my business, but if you want to do
the
18
15:35:04 15 PMK, don't forget this is the PMK, and we are way afield
19 of
20 15:35:04 16 that.
21 15:35:06 17 MR. LEE: I understand. I understand. And
we're
22
15:35:11 18 going to wrap this up pretty soon anyway, but thanks.
23
15:35:13 19 BY MR. LEE:
24
15:35:16 20 Q. Did you vote to remove Dr. Jadwin at the Joint
25
15:35:19 21 Conference Committee on July 10, 2006?
26
15:35:24 22 MR. WASSER: As Chair?
27
15:35:27 23 A. Was it 2006?
28
15:35:29 24 BY MR. LEE:
29 15:35:29 25 Q. July 10, 2006. That's when Dr. Jadwin was
voted
PMK KercherE
100
1 15:35:33 1 to be removed as Chair of the Department by the JCC.

2 15:35:35 2 A. Yes, I did.
3 15:35:36 3 Q. You did. Okay. What was your basis for doing
4 15:35:41 4 that?
5 15:35:44 5 A. He wasn't around anymore.
6 15:35:51 6 Q. Physical absence?
7 15:35:52 7 A. Yeah, he wasn't doing his job.
8 15:35:55 8 Q. Okay.
9 15:35:55 9 A. He was gone.
10 15:35:56 10 Q. Okay.
11 15:35:57 11 A. I mean, he was not there anymore. I didn't
have
12
15:36:00 12 any Chair of Pathology to argue with me about blood
13 usage or
14 15:36:05 13 I had nobody to hit in the back or punch in the
shoulder.
15
15:36:08 14 I didn't have anybody around. He's not there.
16
15:36:11 15 He's gone, and extended periods of gone.
17
15:36:16 16 Q. Well, what periods of absence did you notice?
18
15:36:19 17 A. He was just not there.
19
15:36:21 18 Q. Okay. Physically?
20
15:36:23 19 A. And I know, having been chair at that time,
21 that
22 15:36:31 20 if I would have taken -- and I am just going on my own,
the
23
15:36:35 21 way I handle my business -- if I would taken as long of
24
15:36:40 22 extended leave of absence as Jadwin did, for whatever
25
15:36:43 23 reason, and I have no reason -- I have no idea what that
26 is
27 15:36:47 24 -- I would have made it a little clearer to my boss,
which
28
15:36:55 25 he didn't make clear to the boss, as to what his plans
29 were
PMK KercherE
CaseKERCHER,
1:07-cv-00026-OWW-TAG
M.D. Document 277-2 Filed 12/01/2008 Page 175 of 245
09-04-08
Page 113
ss.
2 COUNTY OF KERN
4
7 No. 7974, do hereby certify that EUGENE KERCHER, M.D.,
10 Thursday, September 4, 2008, at the time and place set
11 forth on the first page hereof.
22
23
24
25
vs. COUNTY
RANDALL (800) 322-4595
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 15
27
28
To: 213-596-0487 From: Law OFFice of Eugene Lee Pg 2/ 7 04/05/07 4:50 pm
To: 213-596-0487 From: Law Office of Eugene Lee Pg 1/ 3 03/29/07 4:09 pm
(213) 992-3299 ELEE@LOEL.COM
TELEPHONE
LAW OFFICE OF EMAIL
E UG E N E LEE
(213) 50;16-0467 555 WEST F'IFTH STREET SUITE 3100 WWW.LOEL.COM
FACSIMILE Los ANGELES, CAL.IFORNIA 9001 3-1 01 0 WEBSITE
FAX
To: From: Law Office of Eugene Lee
Fax Number: 2135960487 Date: 03/29/2007
Pages: 3 (including cover page)
Re: Jadwin/County of Kern et al.
Comments:
Karen:
Transmitted herewith is a letter regarding Dr. Jadwin's visit to his

office at KMC yesterday and KMC's duty to preserve evidence.
Please contact me if you have questions.

(Z 1 3J gg 2-3 299
LAW OFFICE OF ELEE@LOEL.COM
E-MAIL
TELEPHONE
EUGENE LEE
(21:3) 596-0487 555 WEST FIFTH STREET, SUITE:31 00 WWW.LOEL.COM
FACSIMILE LOS ANGELES, CALIFORNIA 9001 :::3-1010 WEBSITE
March 29, 2007

VIA fACSIMILE & US MAIL
Ms. Karen S. Barnes 100011.001

Deputy County Counsel
Kern Medical Center
1830 Flower Street
Bakersfield, CA 93305-4197
Re: Dr. Jadwin's Access to His Personal Materials at KMC

Jadwin I County of Kern (USDC EDCA No. 1:07-cv-00026-0WW/TAG)
Dear Ms. Barnes:
following is brief summary of Dr. Jadwin's trip to KMC yesterday.
Dr. Jadwin arrived at KMC at 2:00 p.m. on March 28,2006 and proceeded to go to the Medical
Staff Office, as per your instructions. Steve, the KMC Head of Security escorted Dr. Jadwin
from there to his office. The locks to Dr. Jadwin's office had apparently been changed during Dr.
Jadwin's absence and Steve was therefore unable to open the door. Dr. Dutt then appeared and
proceeded to unlock Dr. Jadwin's office.
Upon entering his office Dr. Jadwin immediately noticed that his file cabinet and his desktop
computer were both missing. Regarding the missing filing cabinet Dr. Dutt stated that he had
"needed it". When Dr. Jadwin said that the cabinet had been filled with his personal items,
including his personal scrubs, Dr. Dutt immediately denied it.
Dr. Jadwin mentioned that a Bluetooth transmitter for his personal wireless keyboard and mouse
had been attached to the back of the now-missing desktop computer. Dr. Dutt stated that it was
"easy to make a mistake" when personal and county property were mixed.
Regarding the missing computer, Dr. Dutt explained that the computer had been taken for use
with the microscopy camera. Or. Jadwin mentioned to Or. Dutt that the computer had contained
the personal and other information which Dr. Jadwin required for his Grand Rounds talk at
UCLA next month. Dr. Dutt then interrogated Dr. Jadwin, asking where he was giving the talk,
what the subject ofthe talk was going to be, what he needed from his computer, etc. Or. Dutt
asserted that neither Dr. Jadwin nor I, his attorney, had been specific about what was needed. As
such, he asserted it was "our fault" that the computer files were unavailable.
Dr. Jadwin stressed that he was very short oftime and needed the materials to prepare for the
lecture. When Dr. Jadwin explained that the items he sought were things that he needed to sort
through on the computer to find, Dr. Dutt replied that this was something "for the attorneys to
sort out".
Dr. Jadwin then collected several personal items in a box and turned over several items to Dr.
Dutt that were County property. Steve escorted Dr. Jadwin off the campus.
At this point, Dr. Jadwin has very little time left to prepare for his grand rounds lecture. Dr.
Jadwin has irreplaceable case studies and images that he has collected through the years on his
computer. He requires immediate access to these and other personal files. As I had previously
explained to you in my email of March 21:
It will be very time consuming, not to mention uncomfortable, for Dr. Jadwin to
have to inventory the personal items he needs access to. Dr. Jadwin has a lot of
personal information - including personal items predating his employment at
KMC - stored on his computer in the office.
Put another way, it does not seem reasonable to expect Dr. Jadwin to recall every single personal
file contained on his computer and specify which exact files he requires, not to mention their
filenames and folder locations on his computer. This is why I had requested Dr. Jadwin be
permitted to personally access his office and retrieve the files from his computer. Apparently,
you had agreed in your reply email of March 22, when you requested I provide you with Dr.
Jadwin's preferred date and time.
Given the shortness of time, unless you have a different proposal in mind, I would request that
ALL of Dr. Jadwin's files contained on his computer be mailed to him on CDs by overnight
express mail.
On a closing note, I would like to remind you that KMC is under a strict legal obligation to
preserve and prevent spoliation of electronic evidence relating to Dr. Jadwin's lawsuit against the
County ofKem et al. This includes the emails and files contained on Dr. Jadwin's computer. I
am very disturbed to hear that Dr. Dutt has expropriated Dr. Jadwin's computer for other use and
that, apparently, no measures have been taken to backup or protect any of the data contained
thereon.
Your prompt response is appreciated.
cc: David F. Jadwin, DO
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Eugene D. Lee
From: MaxEmail Send [SendAdmin@maxemail.com]
Sent: Thursday, June 29, 2006 3:42 PM
To: elee@LOEL.com
Subject: MaxEmail Send Delivery Report Job 20183519-100011.001
===============================================================================
Maxemail Send Job Confirmation For Job ID 20183519-100011.001
===============================================================================
Job Information
Maxemail Job ID : 20183519-100011.001

Number of Pages : 0006
Recipient Count : 3
Total Charges : $0.65
Report Time Zone: America/Los_Angeles (GMT-0700)
Recipient Delivery Summary
Delivered : 3
Errorred : 0
Rec Fax Number Pgs* Duration Calls Status Charge

0000 6618683809 0006 00:01:50 1 Delivered $0.20
0001 8182499682 0006 00:01:49 1 Delivered $0.20
0002 2135960487 0006 00:02:07 1 Delivered $0.25
================================================================================
Individual Call Detail
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Call Detail for Item 00000 ID 3109078 Sent To 6618683809 0006 Pages Delivered
Date/Time Duration Pgs* Status Charge
06/29-15:42 00:01:50 6 Transmission Successful $0.20
===============================================================================
End Of Report
===============================================================================
1
To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee Pg I/ 6 06/29/06 3:38 pm
Case 1:07-cv-00026-OWW-TAGL A rDocument

O F277-2
F I Filed
C E12/01/2008
O F ELEE@LCIEL.ECIM
Page 182 of 245
rm t'dA1 L
E U G E N E L E E
12 131 506-0407 4 4 5 SOUTH F I G U E R O A S T STE 2 7 0 0 W.LCIEL.ECIM
FACSIMILE LOS ANGELES, CALIFORNIA 9 0 0 7 1 - 1 6 3 2 WE~EITE
FAX
To: Eugene Lee From: Law Office of Eugene Lee
Fax Number: 21 35960487 Date: 06/29/2006
Pages: 6 (including cover page)
Re: Jadwin v Kern Medical Center et al.
Comments:
Please see the attached letters.

To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee Pg 2/ 6 06/29/06 3:38 pm
( a 131 ~ m a - 0 4 8 a
TELEPHONE
L A WOFFICE OF ELEE@LOEL.COM
E-MAIL
E U G E N E L E E
12 131 6 9 e . 0 4 0 7 4 4 6 E O U T H FImULROA ET, E U I T L 2 7 0 0 WWW.LOLL.UOM
FAUEIMILL LOU ANmLLLE. UALIFORNIA 9 0 0 7 1 . 1 - 3 2 WLEEITL
June 29,2006
VIA US MAIL. FAX & EMAIL
Ms. Kasen S. Basnes

Deputy County Counsel
Office of the County Counsel, County of Kern
Administrative Center
1115 Truxtun Avenue, Fourth Floor
Bakersfield, California 93301
Re: Preservation i no spoliation of evidence

Jadwin v. County of Kern, Peter Bryan, et al.
Dear Ms. Barnes:
I am writing to inform you that my office has been retained by Dr. David F. Jadwin to represent
him in the above-captioned pending matter. We are currently preparing to bring suit against the
County of Kern, Mr. Peter Bryan, Dr. William Roy, and other defendants whose identities are to
be determined, and will soon be submitting the appropriate filings under the California Tort
Claims Ad, California Fair Employment & Housing A d , etc.
Dr. Jadwin is seeking to prosecute various employment-, tort- and contract-related claims arising
out of, among other things:
(i) Retaliation in Violation of Cal. Familv Riehts A d : Retaliatory adions engaged in by

Kern Medical Center (hereinafter referred to as " K M C ) et al. against Dr. Jadwin for
taking medical leaves, in violation of the Cal. Family Rights A d ;
(ii) Wrongful Demotion i Termination in Violation of Cal. Bus, & Prof. C. 12056 &
Conspiracy Relating Thereto: Retaliatory actions engaged in by KMC et al. against
Dr. Jadwin in violation of Cal. Bus, & Prof. C. 5 2056 (Protection against Retaliation
for Physicians Who Advocate for Medically Appropriate Health Care), and
conspiracy relating thereto by certain members of KMC's medical staff;
(iii) Per Se Defamation & Ratification: Various communications made by certain

members of KMC's medical staff which were per se defamatory of Dr. Jadwin's
professional competence, and which KMC subsequently ratified and condoned;
(iv) Disabilitv Discrimination / Failure to Accommodate in Violation of Cal. Fair

Employment & Housing Act: Disability-based discriminatory harassment by KMC et
al. of Dr. Jadwin, and failure to accommodate disability in violation of the Cal. Fair
Employment & Housing A d ;
To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee
(v) Breach of Contract 1 Good Faith & Fair Dealing: Breach of Dr. Jadwin's employment
contract (and implied covenant of good faith & fair dealing) by KMC et al. for failure
to comply with KMC's bylaws and failure to permit Dr. Jadwin until June 16,2006 to
decide whether to resign chairmanship (see Mr. Bryan's email to Dr. Jadwin of June
14,2006, where he informs Dr. Jadwin that he is abrogating the June 16 deadline and
unilaterally initiating Dr. Jadwin's removal fiom chairmanship), among other things;
(vi) Negligent Hiring I Su~ervisionI Retention
(vii) Intentional Infliction of Emotional Distress
Please note that the foregoing list is preliminary and subject to change. Additional causes of
action will likely materialize as more facts become known.
I. DEMAND FOR PRESERVATION OF EVIDENCE
This letter serves as a formal demand that you take, and cause to be taken, all appropriate
a r m a t i v e steps to preserve any and all evidence relating to the foregoing claims. This includes
but is not limited to, all emails, oncology conference-related feedback forms and documentation,
memos, letters, reports, committee and other meeting minutes, notes taken at meetings with or
concerning Dr. Jadwin (including those of Dr. Marvin Kolb, Dr. Irwin Harris and Mr. Peter
Bryan), administrative records (including those of Dr. Kolb and Dr. Harris), etc. Failure to do so
may constitute negligent or intentional spoliation of evidence and result in, among other things,
monetary, evidentiary, issue, and terminating sanctions in the pending lawsuit.
In addition, intentional spoliation of evidence constitutes a criminal offense pursuant to

California Penal Code 5135. That provision states:
Every person who, knowing that any book, paper, record, instrument in writing,
or other matter or thing, is about to be produced in evidence upon any trial,
inquiry, or investigation whatever, authorized by law, willfully destroys or
conceals the same, with intent thereby to prevent it fiom being produced, is guilty
of a misdemeanor.
Please kindly advise us of the identity, address, and telephone number of any party who may
possess any evidence relating to the foregoing claims.
11. DEMAND FOR ACCESS TO CREDENTIALS FILE
Turning to other matters, please note that KMC is currently in violation of both Cal. Labor C. 5
1198.5 and KMC Bylaws 5 14.9(E) regarding Dr. Jadwin's written request for access to his
credentials file, dated May 19, 2006. Dr. Jadwin submitted his request in writing to Dr. Kercher
more than a month ago, yet KMC continues to deny Dr. Jadwin (i) physical access to his
credentials file, and (ii) a meaningful summary of the contents of the documents which KMC is
refusing Dr. Jadwin access to. Please note, the mere recitation of titles of documents referenced
in the foregoing subsection (ii), as KMC has provided to Dr. Jadwin, does not constitute a
meaningful summary.
In addition, I would like to relay Dr. Jadwin's request that I be provided access to his Kern
County personnel file as soon as possible. Enclosed herewith is Dr. Jadwin's written request
relating thereto.
111. DEMAND FOR ACCOUNTING OF CUMULATIVE MEDICAL LEAVE HOURS
As you may know, at the meeting of April 28,2006 (and in Mr. Bryan's subsequent confirmation
by fax of even date), Mr. Bryan had directed Dr. Jadwin to contact Mr. Steve O'Conner in the
Human Resources department at KMC regarding all leave-related questions. Pursuant to that
instruction, Dr. Jadwin spoke by phone with Mr. O'Conner on June 13,2006, and asked him to
provide him with a full accounting of the actual hours of medical leave he has thus far exhausted.
Dr. Jadwin has yet to receive any response.
According to Kern County Civil Service Commission Rule 1201.20, Dr. Jadwin is entitled to up
to 6 months' cumulative unpaid sick leave in any given 12-month period. Dr. Jadwin simply
seeks to determine where he stands in terms of medical leave hours.
IV. MR. BRYAN'S EMAIL OF JUNE 26,2006
In his email to Dr. Jadwin of June 26,2006, Mr. Bryan directs Dr. Jadwin as follows:
(i) "you are to refrain from entering the facility for any reason other than seeking
medical attention"
(ii) "you are also to refrain from contacting any employee or faculty member of Kern
Medical Center for any reason other than seeking medical attention"
(iii) "In accordance with KMC policy, usage of any and all equipment as well as access to
any and all systems has been suspended while you are on your approved personal
necessity leave of absence"
Regarding instruction (i), please note that Dr. Jadwin had absolutely no prior notice that his leave
would preclude him from access to KMC's facilities. Dr. Jadwin has a number of valuable and
important personal documents and effects in his office at KMC which he requires immediate
access to. For instance, Dr. Jadwin needs to retrieve CME certificates from his office so that he
may submit them in response to a compliance audit, which requires submissions by early next
week. Dr. Jadwin will require physical access to his office in order to retrieve these and other
personal items. Please let me know what immediate arrangements can be made so that Dr.
Jadwin can recover such items.
Regarding instruction (ii), please provide me with the legal grounds for imposing on Dr. Jadwin
(or any other KMC employee) such overbroad and blanket prohibition against association with
other KMC personnel.
Regarding instruction (iii), please provide me with the specific provisions in KMC's bylaws,
KMC's rules and regulations, Kern County's Employee Manual, Kern County's Civil Service
Commission Rules, or other appropriate rules and regulations, which establish that employee
access to all equipment will be suspended for the duration of personal necessity (or any other)
leaves. I must admit to being unable to locate any such provision.
Please note, as mentioned previously, Dr. Jadwin is permitted under Kern County CSC Rules to
take up to 6 months' cumulative unpaid sick leave. As we have reason to believe that such 6
month maximum has not been exhausted, we do not acknowledge nor necessarily agree that Dr.
Jadwin's current leave can be characterized as personal necessity leave vis-a-vis sick leave.
Finally, I would like to speak on Mr. Bryan's claims that he acts out of a "concern" for Dr.
Jadwin's welfare, and that "we do not want to you to feel obligated to do work while on a leave
of absence", which claims are followed by salient threats of formal termination and other
penalties should Dr. Jadwin fail to comply. As Mr. Bryan is aware, the doctor's certification
which Dr. Jadwin previously submitted in connection with his medical leave stated that Dr.
Jadwin was capable of working 1 to 2 days per workweek. Indeed, KMC had previously
reasonably accommodated Dr. Jadwin's disability by permitting Dr. Jadwin to come into work 1
to 2 days a week for several months. I fail to comprehend the sudden change in circumstance
that necessitated KMC's recent decision to lock Dr. Jadwin out of the KMC campus. Mr.
Bryan's expressions of concern for Dr. Jadwin's welfare strike me as particularly disingenuous.
V. CONCLUSION
Litigation is always a measure of last resort and Dr. Jadwin does not undertake it lightly. It is
unfortunate that events have compelled Dr. Jadwin to consider litigation at all.
If you wish to discuss the foregoing with us, please feel free to contact me anytime at (213) 453-
1781 or at elee@,LOEL.com. We look forward to working with you toward resolution of Dr.
Jadwin's claims.
enc: Request for Kern County Personnel File
cc: Dr. David F. Jadwin

To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee Pg 6/ 6 06/29/06 3:38 pm
06/28/2006 12;41 18182499682
PAGE 01/01
June 27,2006
To Whom It May Concern:
Please turn over my county personnel file to:

'Eugkne Lee
445 South Figueroa Street, Suite 2700
Los Angeles, California 90071 -1632
David F. Jndwin, DO
3 184 Beaudly Terrace
Glendale, California 91208-174.5
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1 Mark A. Wasser CA SB #60160

LAW OFFICES OF MARK A. WASSER
2 400 Capitol Mall, Suite 1100
Sacramento, CA 95814
3 Phone: (916) 444-6400
Fax: (916) 444-6405
4 E-mail: mwasser@markwasser.com
5 Bernard C. Barmann, Sr.
KERN COUNTY COUNSEL
6 Mark Nations, Chief Deputy
1115 Truxton Avenue, Fourth Floor
7 Bakersfield, CA 93301
Phone: (661) 868-3800
8 Fax: (661) 868-3805
E-mail: mnations@co.kern.ca.us
9
10 Attorneys for Defendants County of Kern,
Peter Bryan, Irwin Harris, Eugene Kercher,
11 Jennifer Abraham, Scott Ragland, Toni Smith
and William Roy
12
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16 DAVID F. JADWIN, D.O. ) Case No.: 1:07-cv-00026-OWW-TAG
)
17 Plaintiff, ) DEFENDANTS’ RESPONSES TO
) PLAINTIFF’S REQUEST FOR
18 vs. ) PRODUCTION OF DOCUMENTS (SET
) ONE)
19 COUNTY OF KERN, et al., )
) Date Action Filed: January 6, 2007
20 Defendants. ) Trial Date: August 26, 2008
)
21 )
)
22 )
)
23 )
24 PROPOUNDING PARTY: Plaintiff DAVID F. JADWIN, D.O., F.C.A.P.
25 RESPONDING PARTY: Defendant COUNTY OF KERN
26 SET NUMBER: ONE (1)
27
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1
DEFENDANTS’ RESPONSES TO PLAINTIFF’S

REQUEST FOR PRODUCTION OF DOCUMENTS
1 Defendants hereby submit these responses to Plaintiff David F. Jadwin’s Request for
2 Production of Documents, Set One. Defendants have not located all the documents that are
3 responsive to this request and, for that reason, many of the production dates set forth herein are
4 estimates. Defendants will supplement or amend this response, if necessary, as additional
5 documents are located and reviewed.
6 REQUEST FOR PRODUCTION NO. 1
7 Any and all DOCUMENTS RELATING TO the First Affirmative Defense listed in
8 Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.
9 RESPONSE TO REQUEST NO. 1
10 Defendants object to this request on the grounds that it calls for the production of
11 documents that are protected by the attorney-work-product and attorney-client privileges.
12 Without waiving those objections, after diligent search, Defendants’ have not been able to locate
13 any documents that are responsive to this request.
15 Any and all DOCUMENTS RELATING TO the Second Affirmative Defense listed in
23 Any and all DOCUMENTS RELATING TO the Third Affirmative Defense listed in
28
2

4 Any and all DOCUMENTS RELATING TO the Fourth Affirmative Defense listed in
12 Any and all DOCUMENTS RELATING TO the Fifth Affirmative Defense listed in
17 Without waiving those objections, Defendants will produce all non-privileged documents
18 responsive to this request on or before December 21, 2007. This request is duplicative of other
19 requests contained in Plaintiff’s request for production, set one, and the documents produced in
20 response to this request may refer to the documents produced in response to other requests.
22 Any and all DOCUMENTS RELATING TO the Sixth Affirmative Defense listed in

3


2 Any and all DOCUMENTS RELATING TO the Seventh Affirmative Defense listed in
10 Any and all DOCUMENTS RELATING TO the Eighth Affirmative Defense listed in
15 Without waiving those objections, Defendants will produce all non-privileged documents
16 responsive to this request on or before December 21, 2007. This request is duplicative of other
17 requests contained in Plaintiff’s request for production, set one, and the documents produced in
18 response to this request may refer to the documents produced in response to other requests.
20 Any and all DOCUMENTS RELATING TO the Ninth Affirmative Defense listed in
28
4

1 Any and all DOCUMENTS RELATING TO YOUR organizational structure during

2 Plaintiff’s employment with YOU, including but not limited to organizational charts, diagrams
3 and drawings.
5 Defendants will produce all documents responsive to this request. Production may occur
6 in stages. The first stage of production will be on November 20, 2007 and may include all
7 responsive documents. If other responsive documents are discovered, they will be produced by
8 December 7, 2007.
10 Any and all DOCUMENTS RELATING TO Kern Medical Center personnel directories
11 or lists, including but not limited to names, direct work phone numbers, departments, etc. which
12 were maintained by YOU during Plaintiff’s employment with YOU.
14 Defendants will produce all non-privileged documents responsive to this request.
15 Production may occur in stages. The first stage of production will be on November 20, 2007 and
16 may include all responsive documents. If other responsive documents are discovered, they will
17 be produced by December 7, 2007. Defendants will redact personal or confidential information
18 as appropriate.
20 Any and all DOCUMENTS RELATING TO YOUR personnel policies, guidelines, fact
21 sheets, posters, employee and/or employer handbooks, training materials, and employee and/or
22 employer manuals maintained by YOU that YOU contend governed Plaintiff’s terms and
23 conditions of employment at any time during the period from October 1, 2000 to October 4,
24 2007. These include but are not limited to YOUR ordinances, Kern Medical Center’s
25 Administrative Procedures Manual, Kern Medical Center’s Policy & Administrative Procedures
26 Manual, policies RELATING TO disability discrimination, reasonable accommodation,
27 interactive process, personal leave, administrative leave, medical leave, retaliation, investigations
28 into complaints of unlawful employment practices, discipline of employees, investigation of

5

1 employees, appointment of Kern Medical Center acting department chairs, hiring of Kern
2 Medical Center department chairs, demotion of Kern Medical Center department chairs, and
3 policies RELATING TO Kern Medical Center’s Pathology Department.
5 Defendants object to this request to the extent it requests documents that contain
6 confidential personnel information, documents protected from disclosure by state or federal law,
7 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
8 Without waiving these objections, Defendants will produce documents responsive to this request
9 by December 21, 2007. Defendants will redact confidential peer review and personnel
10 information as appropriate.
12 Any and all DOCUMENTS RELATING TO YOUR personnel policies, guidelines, fact
13 sheets, posters, employee and/or employer handbooks, training materials, and employee and/or
14 employer manuals maintained by YOU that YOU contend was distributed or made available to
15 YOUR employees, whether management or non-management, from October 24, 200 to the
16 present and the date of such asserted distribution. These include but are not limited to YOUR
17 ordinances, Kern Medical Center’s Administrative Procedures Manual, Kern Medical Center’s
18 Policy & Administrative Procedures Manual, policies RELATING TO disability discrimination,
19 reasonable accommodation, interactive process, personal leave, administrative leave, medical
20 leave, retaliation, investigations into complaints of unlawful employment practices, discipline of
21 employees, investigation of employees, appointment of Kern Medical Center acting department
22 chairs, hiring of Kern Medical Center department chairs, demotion of Kern Medical Center
23 department chairs, and policies RELATING TO Kern Medical Center’s Pathology Department.
6

4 Any and all DOCUMENTS RELATING TO peer review, quality management and
5 quality assurance policies and procedures at Kern Medical Center, included but not limited to
6 Kern Medical Center’s Quality Management and Performance Improvement Plan, from October
7 24, 2000 to the present, and the effective dates.
13 by December 7, 2007.1. Defendants will redact confidential peer review and personnel
16 Any and all DOCUMENTS RELATING TO any training provided by YOU to YOUR
17 officers, directors, agents or employees on the following subjects:
18 a) disability discrimination
19 b) accommodation of an employee’s disability
20 c) the interactive process regarding accommodation of an employee’s disability
21 d) medical leave rights
22 e) whistleblower retaliation
23 f) medical leave retaliation
24 g) due process required for demotion
25 h) due process required for pay cut
26 i) due process required for termination of employment
27 j) defamation
28 k) Fair Labor Standards Act

7


6 by December 21, 2007.
8 Any and all DOCUMENTS RELATING To the PERSONNEL FILES of the following
9 people.
10 a) Plaintiff David F. Jadwin
11 b) Elsa Ang
12 c) Ellen Bunyi-Teopengco
13 d) Philip Dutt
14 e) Carol Gates
15 f) Adam Lang
16 g) Fangluo Liu
17 h) Savita Shertukde
18 i) Navin Amin
19 j) Kathy Griffith
20 k) Alice Hevle
21 l) Denise Long
22 m) Gilbert Martinez
23 n) Albert McBride
24 o) Javad Naderi
25 p) Jane Thornton
26 q) Nitin Athavale
27 r) Chester Lau
28 s) Jennifer J. Abraham
8

1 t) Bernard C. Barmann
2 u) Karen S. Barnes
3 v) Peter K. Bryan
4 w) David Culberson
5 x) Irwin E. Harris
6 y) Royce Johnson
7 z) Eugene K. Kercher
8 aa) Alan Scott Ragland
9 bb) William Roy
10 cc) Maureen Martin
11 dd) Steven O‘Connor
12 ee) Antoinette Smith
13 ff) Edward Taylor
14 gg) Marvin Kolb
15 hh) Dianne McConnehey
16 ii) Renita Nunn
17 jj) Ravi Patel
18 kk) Jose Perez
19 ll) Evangeline Gallegos
20 mm) Sergio Perticucci
21 nn) Bonnie Quinonez
22 oo) James Sproul
23 pp) Rebecca Rivera
24 qq) Sheldon Freedman
25 rr) Joseph Mansour
26 ss) George Alkouri
27 tt) Nicole Sharkey

9

1 Defendants have already produced the personnel file of David F. Jadwin. Defendants
2 will confirm that the personnel file previously produced was complete as of the time of its
3 production and, on or before December 7, 2007, will augment the documents previously
4 produced with any additional materials, if any, that have been added into Mr. Jadwin’s personnel
5 file since the file was produced. Plaintiff has narrowed the scope of this request by eliminating
6 all other documents initially requested.
8 Any and all DOCUMENTS RELATING TO the search, recruitment, application,
9 interviewing, and hiring process that resulted in Plaintiff’s employment by YOU.
14 Without waiving these objections, Defendants will produce all documents responsive to this
15 request by December 21, 2007.
17 Any and all DOCUMENTS RELATING TO the terms, conditions and privileges of
18 Plaintiff’s employment with YOU.
20 Defendants will produce all documents responsive to this request by December 21, 2007.
22 Any and all DOCUMENTS RELATING TO Plaintiff’s job duties and responsibilities for
23 each position held by Plaintiff during this employment with YOU.
27 Any and all DOCUMENTS RELATING TO Plaintiff’s payroll, compensation, base
28 salary and “professional fee payments”, as that term is defined in Plaintiff’s employment
10

1 contracts with YOU, including but not limited to any and all changes in compensation and the
2 reasons for changes, throughout Plaintiff’s employment with YOU.
6 Any and all DOCUMENTS RELATING TO YOUR policies, guidelines and practices
7 regarding base salary steps, salary guidelines, deferred compensation plans, pension plans, health
8 insurance and employment benefits applicable to Plaintiff’s position s held throughout his
9 employment with YOU.
13 Any and all DOCUMENTS RELATING TO Plaintiff’s work schedule and/or removal
14 there from, including but not limited to timesheets, from October 24, 200 to present.
18 Any and all DOCUMENTS RELATING TO Dr. Phillip Dutt’s timesheets, from April 20
19 2005 to the present.
24 Without waiving these objections, Defendants will produce all non-privileged documents
25 responsive to this request by December 21, 2007. Defendants will redact confidential
26 information, in any, as appropriate.
28
11

1 Any and all DOCUMENTS RELATING TO Dr. Savita Shertukde’s timesheets, from
2 January 4, 2005 to present.
11 Any and all DOCUMENTS RELATING TO performance reviews, comments,
12 complaints, warnings, reprimands, counseling, advisory notices or evaluations of Plaintiff’s
13 performance of his job duties throughout his employment with YOU, whether formal or
14 informal.
23 Any and all DOCUMENTS maintained by Plaintiff at Kern Medical Center during his
24 employment by YOU, including any and all e-mails, Groupwise calendars, memoranda, written
25 materials, and computer files stored on Plaintiff’s computer at Kern Medical Center’s servers.
27 After diligent search, Defendants believe Groupwise calendar information was deleted
28 many months ago as part of the routine 90-day cycling of the Groupwise software. Defendants
12

1 are continuing to search for other materials that were on the computer that was assigned to
2 Plaintiff. Some material was archived before the computer was reassigned. Defendants have
3 identified about 3,000 pages of documents that appear to be responsive to this request but have
4 not yet concluded their search. Defendants will produce all documents responsive to this request
5 by December 7, 2007.
7 Any and all DOCUMENTS RELATING TO any meetings RELATING TO Plaintiff or
8 Plaintiff’s employment at Kern Medical Center.
15 information, if any, as appropriate.
17 Any and all DOCUMENTS RELATING TO performance reviews, comments,
18 complaints, warnings, reprimands, counseling, advisory notices or evaluations of the Kern
19 Medical Center Pathology Department, whether formal or informal, from October 24, 1995 to
20 the present.

13

1 Any and all DOCUMENTS RELATING TO Plaintiff’s complaints of:

2 a) disability discrimination
3 b) failure to accommodate
4 c) failure to engage in an interactive process
5 d) violation of medical leave rights
6 e) whistleblower retaliation
7 f) medical leave retaliation
8 g) deprivation of property without due process
9 h) defamation
10 i) Fair Labor Standards Act violations
19 Any and all DOCUMENTS RELATING TO any investigation of Plaintiff’s complaints
20 of disability discrimination, failure to accommodate, failure to engage in an interactive process,
21 violation of medical leave rights, whistleblower retaliation, medical leave retaliation, defamation,
22 and/or deprivation of property without due process.
28
14

4 Any and all DOCUMENTS RELATING TO any procedures available to YOUR
5 employees to complain of corruption, fraud and other wrongful, illegal or unethical conduct, that
6 YOU contend was distributed or made available to YOUR employees, whether management or
7 non-management, from October 24, 2000 to the present, and the date of such asserted
8 distribution(s).
12 Any and all DOCUMENTS RELATING TO YOUR discipline of any employee against
13 whom a complaint or grievance of discrimination, harassment, defamation, retaliation, failure to
14 accommodate, and/or failure to engage in an interactive process in their employment was made
15 from October 24, 2000 to date.
17 Defendants object to this request on the grounds that it requests documents that contain
19 including HIPAA and the peer-review privilege, and documents that contain information that is
20 subject to the attorney-client privilege. Defendants do not believe these objections can be
21 resolved by redaction. Defendants also object on the grounds that the request is not reasonably
22 calculated to lead to the discovery of admissible evidence.
24 Any and all DOCUMENTS RELATING TO complaints or grievances made by YOUR
25 past or present employees against YOU for defamation, retaliation, disability discrimination,
26 failure to accommodate, and/or failure to engage in an interactive process, including but not
27 limited to any informal or internal complaints, grievances or charges to any state or federal
28 agency, and complaints filed in any state or federal court from October 24, 2000 to date.
15


3 documents that contain confidential personnel information that is not relevant to any issues in
4 this case. Consequently, this request is not reasonably calculated to lead to the discovery of
5 admissible evidence. Defendants also object on the ground that the phrase, “informal or internal
6 complaints” is vague and, depending on interpretation, could include any off-hand gripe by any
7 employee, to the extent it was memorialized in writing. Defendant County of Kern employs
8 several thousand employees. In the past seven years, there could be many documents that fit the
9 description of this request yet none have anything to do with the issues in this case. This request
10 is, accordingly, overbroad and burdensome. Defendants do not believe redaction would resolve
11 these objections.
13 Any and all DOCUMENTS RELATING TO any complaints or grievances made to YOU
14 by Plaintiff.
16 Defendants believe all documents responsive to this request have been previously
17 produced to Plaintiff. Defendants will confirm this, or produce additional documents if
18 necessary, by December 7, 2007.
20 Any and all DOCUMENTS RELATING TO Plaintiff which YOU sent to or received
21 from any governmental or regulatory authority, including but not limited to the California
22 Department of Fair Employment and Housing, the California Labor and Workforce Development
23 Agency, and the U.S. Department of Labor.

16

1 Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and
2 evaluation of candidates for the position of staff pathologist at Kern Medical Center during the
3 period from January 1, 2006 to present.
7 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
8 Defendants also object to this request to the extent it requests information protected from
9 disclosure by state or federal law, including HIPAA and the peer review privilege, and
10 documents that are subject to the attorney-client privilege. Without waving these objections,
11 Defendants will produce non-privileged documents responsive to this request, if any, by
12 December 7, 2007. Defendants will redact confidential and privileged information as
13 appropriate.

16 evaluation of candidates for the position of Chair or Chief of Pathology at Kern Medical Center
17 during the period from January 1, 2006 to present.
27 appropriate.

17

2 evaluation of candidates for the position of locus tenens pathologist at Kern Medical Center
13 appropriate.

16 evaluation of candidates for the position of Chair or Chief of OB-GYN at Kern Medical Center
27 appropriate.

18

1 Any and all DOCUMENTS RELATING TOYOUR removal of Dr. Royce Johnson from
2 the position of Chair or Chief of Medicine at Kern Medical Center.
9 documents that are subject to the attorney-client privilege.
12 evaluation of candidates for the position of Chair or Chief of Medicine at Kern Medical Center
13 during the period from October 24, 2000 to present.
23 appropriate.
25 Any and all DOCUMENTS RELATING TO presentations made at the Kern Medical
26 Center oncology conference in May 2005, including but not limited to participant evaluation
27 forms.

19

9 appropriate.
11 Any and all DOCUMENTS RELATING TO Plaintiff’s presentations made at the Kern
12 Medical Center oncology conference on or about October 12, 2005.
16 Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from
17 Chair of Kern Medical Center’s Pathology Department to staff pathologist.
19 Defendants object to this request to the extent it requests documents that are privileged
20 under the attorney-client privilege. Without waiving this objection Defendants will produce all
21 non-privileged documents responsive to this request by December 7, 2007.
23 Any and all DOCUMENTS RELATING To the “packets containing information about
24 Dr. Jadwin” which Peter Bryan collected at the end of Kern Medical Center’s Joint Conference
25 Committee discussion and vote on removal of Plaintiff from Chair of Pathology on July 10,
26 2006.
28
20

1 Defendants are searching for documents responsive to this request. Because of

2 administrative and management changes at Kern Medical Center, it may not be possible to
3 reconstruct the “packets” requested. Defendants object to this request to the extent it requests
4 information protected by the peer-review or attorney-client privileges. Defendants also object to
5 this request to the extent it seeks documents that contain confidential personnel information.
6 Without waiving these objections, and to the extent that the “packets” can be reconstructed,
7 Defendants will produce all documents responsive to this request, if any, by December 21, 2007.
9 Any and all DOCUMENTS RELATING TO YOUR decision to place Plaintiff on
10 administrative leave on or about December 7, 2006.
12 Defendants object to this request to the extent it requests information protected by the
13 attorney-client privilege. Without waiving that objection, Defendants believe all documents
14 responsive to this request have been previously produced to Plaintiff. Defendants will confirm
15 this, or produce additional documents if necessary, by December 7, 2007.
17 Any and all DOCUMENTS RELATING TO YOUR decision to restrict Plaintiff to his
18 home during working hours from on or about December 7, 2006 to on or about May 1, 2007
19 while he was on administrative leave.
25 Any and all DOCUMENTS RELATING TO YOUR decision to lift the restriction of
26 Plaintiff to his home during working hours from on or about December 7, 2006 to on or about
27 May 1, 2007 while he was on administrative leave.

21

5 Any and all DOCUMENTS RELATING TO YOUR decision not to renew Plaintiff’s
6 employment contract with YOU that was purportedly made on or about May 1, 2007.
8 Defendants object to this request to the extent it requests information protected by the
9 attorney-client privilege. Without waiving that objection, Defendants believe all documents
10 responsive to this request have been previously produced to Plaintiff. Defendants will confirm
11 this, or produce additional documents if necessary, by December 7, 2007.
13 Any and all DOCUMENTS RELATING TO any discipline, coaching, reprimand or
14 corrective action taken against Plaintiff by YOU.
20 Any and all DOCUMENTS RELATING TO Kern Medical Center’s Disruptive Physician
21 Policy, including but not limited to Bylaw Committee meeting minutes.
25 including the HIPAA and the peer-review privilege, or documents that are subject to the
26 attorney-client privilege. Without waiving these objections, Defendants will produce documents
27 responsive to this request by December 7, 2007. Defendants will redact confidential peer review
28 and personnel information as appropriate.

22


2 Any and all DOCUMENTS RELATING TO Dr. Rebecca Rivera’s lawsuit against Kern
3 Medical Center filed in Kern County California Superior Court.
5 Plaintiff has narrowed this request to eliminate any documents that have been filed with
6 the Kern County Superior Court. As so limited, this request seeks documents in the County
7 Counsel’s litigation file, many of which are protected by the attorney work product and attorney-
8 client privileges. To the extent this request seeks information that is protected by the attorney-
9 client privilege, Defendants object to it. Defendants also object to this request on the grounds
10 that it is not reasonably calculated to lead to the discovery of admissible evidence. Defendants
11 are in the process of reviewing documents that are may be responsive to this request and, without
12 waiving these objections, will produce non-privileged documents, if any, by December 21, 2007.
13 Defendants may redact privileged information if appropriate.

15 Any and all DOCUMENTS RELATING TO services provided to YOU by the Camden
16 Group RELATING TO Kern Medical Center.
22 Any and all DOCUMENTS RELATING TO statistics maintained by YOU RELATING
23 TO patient fatalities at Kern Medical Center from October 24, 2000 to the present.
23

5 appropriate. If the redaction process renders the resulting document useless, Defendants will
6 inform Plaintiff.
8 Any and all DOCUMENTS RELATING TO the review of Kern Medical Center’s
9 placental evaluations and billing activity as conducted by outside consultants, including but not
10 limited to ProPay Physician Services, LLC, from October 24, 2000 to the present.
20 appropriate.
22 Any and all DOCUMENTS RELATING TO blood bank monthly reports, included but
23 not limited to reports generated by Michelle Burris, from January 2006 to present.
24

5 appropriate.
7 Any and all DOCUMENTS RELATING TO product chart copy-related quality assurance
8 reports from October 24, 2000 to the present.
18 appropriate.
20 Any and all DOCUMENTS RELATING TO prostate needle biopsy reports produced by
21 Dr. Elsa Ang for which Plaintiff had requested a lookback study in October 2005.
25


3 appropriate.
5 Any and all DOCUMENTS RELATING TO sign-in sheets for Kern Medical Center’s
6 Cancer Clinic from January 1, 2003 to the present.
10 Any and all DOCUMENTS RELATING TO Workplace Violence or Threat Incident
11 Reports for all Kern Medical Center personnel from October 24, 2000 to the present.
13 Defendants object to this request to the extent it seeks documents that contain
14 confidential personnel information or information protected by the attorney-client privilege.
15 Defendants also object to the extent the documents contain information protected by the peer-
16 review privilege and on the grounds that the request is not reasonably calculated to lead to the
17 discovery of admissible evidence. Without waiving these objections, Defendants will produce
18 all documents responsive to this request by December 21, 2007. Defendants will redact
19 confidential or privileged information as appropriate.
21 Any and all DOCUMENTS RELATING TO Fine Needle Aspiration policies at Kern
22 Medical Center from October 24, 2000 to the present, including but not limited to
23 DOCUMENTS RELATING TO the outside consultant study conducted by Dr. David Lieu in
24 2004.
26 Defendants object to this request to the extent it seeks documents that contain
27 confidential personnel information or information protected by the attorney-client privilege.
28 Defendants also object to the extent the documents contain information protected by the peer-
26

1 review privilege and on the grounds that the request is not reasonably calculated to lead to the
2 discovery of admissible evidence. Without waiving these objections, Defendants will produce
3 all documents responsive to this request by December 21, 2007. Defendants will redact
4 confidential or privileged information as appropriate.
6 Any and all DOCUMENTS RELATING TO Peter Bryan’s appointment calendar from
7 January 1, 2004 to September 1, 2006.
11 Any and all DOCUMENTS RELATING TO meeting minutes for the following Kern
12 Medical Center committees or groups from October 24, 2000 to the present:
13 a) Medical Executive Committee
14 b) Joint Conference Committee
15 c) Quality Management Committee
16 d) Cancer Committee
17 e) Second Level Peer Review Committee
18 f) Transfusion Committee
19 g) Executive Staff Meetings
22 confidential personnel information or information that is protected from disclosure by state or
23 federal law, including HIPAA and the peer review privilege, or documents that are subject to the
24 attorney/client privilege. Without waiving these objections, Defendants will produce documents
25 responsive to this request by December 21, 2007. Defendants will redact confidential or
26 privileged information as appropriate.
28
27

1 Any and all DOCUMENTS RELATING TO policies of Kern Medical Center’s

2 Pathology Department from October 24, 2000 to the present.
6 Any and all DOCUMENTS RELATING TO case send-out logs for Kern Medical
7 Center’s Pathology Department from January 1, 1999 to the present, including but not limited to
8 corresponding Kern Medical Center pathology reports and reports from outside consultants.
11 confidential personnel information or information that is protected from disclosure by state or
12 federal law, including HIPAA and the peer review privilege, or documents that are subject to the
13 attorney/client privilege. Without waiving these objections, Defendants will produce documents
14 responsive to this request by December 7, 2007. Defendants will redact confidential or
15 privileged information as appropriate.
17 Any and all DOCUMENTS RELATING TO monthly turn-around-time reports and logs
18 – by pathologist – for pathology reports processed at Kern Medical Center, including but not
19 limited to Pathology Department Semi-annual Reports to the Medical Staff, for the time period
20 from January 1, 1999 to the present.
23 privileged peer review information. Without waiving this objection Defendants will produce all
24 documents responsive to this request by December 7, 2007. Defendants will redact all privileged
27 Any and all DOCUMENTS RELATING TO monthly or semi-monthly turn-around-time
28 reports and logs – for Kern Medical Center’s Pathology Department as a whole – for pathology
28

1 reports processed at Kern Medical Center including but not limited to surgical pathology,
2 cytology and bone marrow reports, for the time period from January 1, 1999 to the present.
9 Any and all DOCUMENTS RELATING TO PATHOLOGY REPORTS authored,
10 reviewed or approved by Plaintiff which YOU sent to any outside pathologists for outside review
11 from June 14, 2006 to the present.
18 Any and all DOCUMENTS RELATING TO PATHOLOGY REPORTS RELATING TO
19 Case Numbers S06-4131, S06-4619, S06-5229, S06-73276.
22 information that is confidential under HIPAA. Defendants also object to the extent that it
23 requests documents that contain privileged peer-review information. Without waiving these
24 objections Defendants will produce all documents responsive to this request by December 7,
25 2007. Defendants will redact confidential and privileged information as appropriate.
27 Any and all DOCUMENTS RELATING TO peer review RELATING TO Kern Medical
28 Center’s Pathology Department during the time period from January 1, 1995 to the present,
29

1 including but not limited to computer-generated data, monthly peer review records completed by
2 pathologists, and peer review comment sheets that are completed by pathologists upon discovery
3 of a discrepancy.
5 Defendants object to this request on the ground that it requests privileged peer-review
6 information. Defendants also object on the ground that it requests information that is
7 confidential under HIPAA and not reasonably calculated to lead to the discovery of admissible
8 evidence. Without waiving these objections, Defendants will produce documents responsive to
9 this request by January 7, 2008 if it is possible to redact the confidential and privileged
10 information without rendering the resulting document useless.
12 Any and all DOCUMENTS RELATING TO exceptional event logs for histology and
13 pathology on Kern Medical Center’s Pathology Department from January 1, 2006 to the present.
17 requests documents that contain privileged peer review information. Without waiving these
21 Any and all DOCUMENTS RELATING TO paper accession logs at Kern Medical
22 Center’s Pathology Department from January 1, 2006 to present.

30


2 Any and all DOCUMENTS RELATING TO tissue disposal records for skull-flaps from
3 January 1, 2006 to the present.
11 Any and all DOCUMENTS RELATING TO audits of Kern Medical Center’s Pathology
12 Department by outside consultants, including but not limited to Dr. Stacey Garry, from October
13 24, 2000 to the present.
21 Any and all DOCUMENTS RELATING TO Kern Medical Center laboratory personnel
22 defections from June 14, 2006 to the present, including but not limited to exit interview notes.
24 Defendants object to this request on the grounds that it is vague. Defendants do not know
25 what “personnel defections” means. If Plaintiff intends to request a list of employees who have
26 separated from County employment or transferred out of the laboratory, Defendants can prepare
27 such a list but Defendants believe such a list will need to be redacted to remove confidential
28 personnel information. Defendants will produce a list of employees who have separated from
31

1 County employment or transferred out of the laboratory by December 21, 2007 and will redact
2 the information as appropriate.
4 Any and all DOCUMENTS RELATING TO dictation transcription logs for Plaintiff
9 Any and all DOCUMENTS RELATING TO dictation transcription logs for Dr. Philip
10 Dutt from June 14, 2006 to the present.
14 Any and all DOCUMENTS RELATING TO placental evaluations conducted by Plaintiff
17 Plaintiff has attempted to narrow this request but the revised request is broader, more
18 burdensome and less calculated to lead to the discovery of admissible evidence than the original
19 request. Defendants object to it for that reason. Defendants object to this request because it is
20 not reasonably calculated to lead to the discovery of admissible evidence and is burdensome.
21 Defendants also object to this request on the grounds that it seeks information that is shielded
22 from disclosure under HIPAA. There are thousands of placental evaluations for the time period
23 specified and they are not centrally filed or maintained. Locating ones conducted by Plaintiff
24 will require writing a computer program that will sort the files. After the files are sorted, it will
25 require a manual review of each file to find the placental evaluation. It will have to be copied
26 and redacted and copied again. Defendants estimate it will take approximately 90 days to
27 comply with this request. Without waiving these objections, Defendants will attempt to locate,
28 copy and produce the documents requested

32


2 Any and all DOCUMENTS RELATING TO Golden Empire Pathology Associates.
4 After diligent search, Defendants’ have not been able to locate any documents that are
5 responsive to this request.
7 Any and all DOCUMENTS RELATING TO Golden Empire Medical Group.
9 After diligent search, Defendants’ have not been able to locate any documents that are
10 responsive to this request.
11
12
13
14 Dated: November 20, 2007 LAW OFFICES OF MARK A. WASSER
15
16 By: /s/ Mark A. Wasser
17 Mark A. Wasser
Attorney for Defendants, County of Kern, et al.
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26 EXHIBIT 18
27
28
CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement activities of Kern Medical
Center. Such activities are privileged and confidential and are not discoverable or admissible in a court of law pursuant to California Evidence
Case
Code Section 1:07-cv-00026-OWW-TAG
1157. Document
Further protections are afforded the quality 277-2
management Filed 12/01/2008
and performance Page
improvement processes 223
under the of 245Care
Health
Quality Improvement Act of 1986 (P.L 99-660).
~•
.KERN JOINT CONFERENCE COMMITTEE MEETING MINUTES
MEDICAL September 10, 2007
CENTER Call to order: 12:10 p.m. Adjournment: 1:30 p.m.
Attendance Record: J F M A M J J A S a N D
Supervisor Don Maben* P P P - P P P - P
Supervisor Ray Watson* P P P - P P P - P
Paul J. Hensler, CEO* - -
- P - P P - P
Toni Smith, R.N.* P P P - P P P - E
Eugene Kercher, MD * P P P - P P P - P
Scott Ragland, DO * P P P - P E P - P
Jennifer Abraham, MD* - - - - - - - - P
Fred A. Plane, CFO - -- - - - - - P
Ron Errea, CAO P P P - P P P - P
-
*Votmg Committee member.
Guests: Karen Barnes, Chief Deputv County Counsel
ITEM CONCLUSION ACTION!
FOLLOW-UP
1. Call to order Dr. Kercher announced that Jennifer Abraham, M.D. has been appointed
as the President-Elect of the medical staff. Therefore, the meeting was
called to order at 12:10 p.m. by Dr. Abraham as Dr. Ragland was going to
be late.
2. Approval of The minutes from July 9, 2007 were approved as written. M/S/C to
minutes from June approve
11,2007 minutes
3. Board of Supervisor Maben commented that the contract with SEIU has been
Supervisors ratified by the members and it will go to the BOS in the near future.
4. President The Medical Executive Committee had recent discussion on placement of
Elect/Past patients and this is a work in progress. They are working diligently on the
President credentialing piece, proctoring of folks immediately without waiting,
following the bylaws so they are in compliance with the law - Dr. Abraham
Eugene Kercher, is personally welcoming the opportunity for improvement. KMC had a
MD local doctor who worked Friday and Saturday to work on proctoring the
current anesthesia group. We brought in locum tenens because we don't
have anything in place to proctor locum tenens. We will put something in
place for this to not happen in the future. This was a learning experience.
Both Drs' Kercher and Abraham will fix this. On the positive side, when
the locum tenens came and there were issues, there was a process put in
place for them to be ALS certified, etc. Paul has not been pleased how
Somnia is handling this. The chair they appointed did not like the way
KMC told them that they cannot proctor, it must be done outside of
Somnia. They are still to this day not being friendly about this issue. They
think they can choose their own proctor. They need to have six cases
proctored. Once the first three doctors are proctored, then they can
proctor the rest. There is a perceived conflict of interest if we are
proctoring these three and they can proctor the remaining. If these 3
cannot pass the proctoring, they cannot proctor the remaining. Dr.
Abraham's been told the experienced anesthesiologists are on call in the
evening and the weekends. Maybe our proctorer can come in for a whole
week to proctor all of them. Paul said that we're asking CMS to come
back on Friday to do a re-survey. It would be great if we can show these
three physicians have been proctored. Supervisor Watson said that the
most important thing is for Somnia to know who's in charge and it's not
0009919
0009919
Case
Code Section 1:07-cv-00026-OWW-TAG
1157. Document
Further protections are afforded the quality 277-2
management Filed 12/01/2008
and performance Page
improvement processes 224
under theof 245Care
Health
Qualitv Improvement Act of 1986 (P.l. 99-6601.
them. The hospital can reject their Chair and two physicians without
cause. The appointment of a chair requires approval of the CEO and the
hospital has the opportunity to reject two doctors per year, for any reason.
If things don't shape up, we'll need to talk with the MEC about it. The first
thing we should do is reject the Chair. The rejection should come from the
MEC, but can come from the CEO.
5. Psych Issues Psychiatric issues have been longstanding. Issues revolve around 5150s
that have been escaping and the fact that we're holding them because we
Paul Hensler don't have beds to move them into. The State has visited us over the
year. The Mental Health department became concerned. Paul had one
meeting with them, they wanted us to move them to beds, we couldn't do
this without going through the right channels. Paul said patients are better
off if we're closed and the MH advocate agreed. The MH advocate filed
complaints with the state, they saw us in between a rock and a hard place,
he made 5 complaints that were unsubstantiated, then he made 2 more,
they came out and did a review, and that put us in "immediate jeopardy."
The Feds came in on 8/30 and did a survey, they found credentialing
errors and our plan of correction had not been carried out. The psych
portion is the facility capacity, we are using a portion of ER for emergency
psych (EPAC) and upstairs for in-patients. ED is over-crowded, we don't
have the proper facility, making it easy for escapes. They end up
spending more than 24 hours downstairs, sometimes more than a few
days. A lot of their findings were surrounded around capacity issues, not
protecting patient privacy, safety issue of escape and employees. We
failed to organize the emergency services under a qualified medical
director. By running two operations down there, communications broke
down. The MH people are trying to contract for more services, including
Good Sam who has 10 beds. We put ED under Dr. Kercher and Dianne
McConnehey's control to do what must be done. Since then, we've had
no elopements. One is controversial, we are to divert ambulance traffic
once we don't have capacity. We are to the point we are doing everything
we can do. We will submit a final report, they return in two days to
determine if we are sufficiently in compliance to remove the fast track.
They gave us until 9/30, then they can cease Medicare funding. The back-
up is to schedule a Belienson Hearing to terminate psych patients at the
hospital. If everything we have done is not effective and they are ready to
pull our funding, we are better to terminate psych services rather than
having the whole ship come down. Where the patients would go is the
problem. We hope not to do it, but we can't survive on 25% of what
Medicare pays us. A lot of local people would have to go out of the area.
We are seeing families dropping off Grandma because they can't care for
her anymore. We must bring a lot of the county services together for
these populations. Supervisor Watson asked what it would take to license
beds upstairs. That's not feasible. We are not making headway in the
MKS bldg. Dr. Kercher said the MKS bldg would be perfect. It's solid,
stone, you can add stories to it and the ED is close by. He doesn't know
what the obstacles are, but possibly the current occupants don't want to
give it up. Dr. Kercher has been talking about this for two years.
Supervisor Watson said that he, Ron Errea and Supervisor Maben need to
talk with Diane Koditek. Dr. Kercher said that would be a huge unloading
from our ED if patients could be done at MKS. Paul said that another
immediate thing we can do it to take some of the 2C rooms and convert
them to in-patient rooms, 4 per room, 2 staff members per 4 patients. Ron
Errea said that Paul and Fred are working with Diane on a MH contract for
provider beds with Good Sam. Good Sam seems to recognize that we are
over a barrel and may take advantage of that financially. Should that fall
through, we may have to move patients out of the county to address the
problem. This is not a preferred option. The county will get stuck with the
transportation tab if we go out of county. It might be better to pay what we
have to and work hard to not utilize them more than we have to. Paul
0009920
0009920
Code Section 1157. Further protections are afforded the quality management and performance improvement processes under the Health Care
Qualitv Improvement Act of 1986 (P.L. 99·660\.
Hensler said that we are also looking at construction of a free-standing
facility. General Services is looking at property and an architect to see the
feasibility. It can be done in 18-24 months. A better payer mix can come
out of that also. Although we are focusing on psych, capacity issues will
hit us in other areas as well, Le., trauma issues. Dr. Yoo has also shared
an IDT team that comes in to help facilitate discharges.
6. OB Issues Good news in OB. Dr. Wallace has done a good job getting discipline.
The RRC Survey was done recently and there was a lot of concem from
Paul Hensler the residents who are being torn in the middle, but interviewing residents
they are in support of the changes Wallace has imposed. Somebody had
broken into the residency coordinator's office, vandalized the computer
and monitor. When Dr. Wallace announced he wanted the place
fingerprinted, Dr. Perez went and put his fingerprints on everything. Dr.
Wallace decided to write it up as disruptive physician, it then went to MEC,
they decided it was beyond them. Regarding the chainnanship issue,
Karen is renegotiating a new contract. The problem is is that he can
appeal. Dr. Kercher said that he and Dr. Ragland got together with Dr.
Perez and Perez denied the significance of the issue. Dr. Perez said that
"when Lascano leaves, I'll be next." MEC recommended the three of them
meet with letters of concern. Dr. Kercher was impressed that the
secretaries confinned that he did touch the computer. MEC made a
decision to not get into a political fight, and for Karen to write a letter of
reprimand. The DA's office is investigating the incident. Investigator met
with Dr. Wallace and will come back to meet with secretarial staff this
Thursday. Can this be used to get Perez out of chainnanship? This is
concerning that the CEO does not have the authority to decide who is
going to chair a department. The problem is we have tied a portion of the
chair's compensation to that position, that is a property right. Dr. Perez is
entitled to due process hearing for this reason. Karen proposes drafting a
policy similar to the Faculty Practice Plan that will give him the opportunity
to ask for a hearing, with the CEO having authority over the outcome.
What if we give him additional clinical duties for the money we are giving
him as chair? The appeals process needs to go into effect immediately.
How can we legally give the CEO more authority to hire and fire chairs.
We need to get out of this problem. Karen Barnes is looking into this.
Contract given to recruiter for pennanent chair position and Dr. Wallace is
interested. Selection committee is directed by the Bylaws. Except for the
property rights issue, everything else will be governed by the Medical Staff
Bylaws. The appeals process should be completed within the month,
putting it on the fast track.
7. Adjournment The meeting adjourned at 1:30 p.m. The next meeting is scheduled for
October 8,2007.
Submitted by:
~
Scott Ragland, D.O.
Chairman
abra
Minutes recorded and transcribed by Arlene B. Ramos-Aninion, Office Services Coordinator
0009921
0009921
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26 EXHIBIT 19
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Kern County Policy and Administrative Procedures Manual 1:21
to changes in job requirements, increase the effectiveness of supervision and management, and improve
employee-management relations through increased understanding of organization objectives. Continuing
education programs are subject to the provisions in Chapter 3.
136. Performance Evaluations. Employee performance evaluation reports are submitted to the Personnel
Department at the three and six month probationary dates, and annually on the hiring anniversary date. For those
etnployees subject to a twelve month probationary period (Fire Fighters, Sheriff's Deputies, and Park Rangers),
evaluation reports are filed at three, six, nine and twelve month intervals from date of hiring, and thereafter
annually on the hiring anniversary. The evaluation foIm, which specifies the due date, will be sent to each
department head approximately two pay periods in advance. Those performance evaluations that are completed
by a department or agency head are submitted to the County Administrative Office for review. The affected
employee may meet with the County Administrative Officer to discuss the evaluation
.1 Process. The mechanics of the performance evaluation are explained in the Rater's Guide for
Employee Performance Reports. Department heads are to ensure the employees are counseled on their
performance. The employee's signature is required on the report. An employee who disagrees with the rating
may file a written statement of reasons within 30 days after the date the evaluation is prepared. This statement
must be signed by the employee and department head, and attached to each copy of the rating form.
.2 Record Maintenance. The Personnel Director maintains records of evaluation ratings for use in
promotional examinations, determining order of layoff and reinstatement, and for recommendations relating to
transfer, demotion, and removal. The department retains a copy for the employee's file.
.3 Tennination. A performance evaluation report must be completed when employment is terminated,

including retirement. These reports may be used if reinstatement or reemployment is considered.
137. Special Performance Evaluations. A special performance evaluation should be completed when a
change ofraters occurs within an annual cycle and at any time for commendation or disciplinary action.
138. Service Awards. The Personnel Department will send a packet containing the employee's name,
service length, and a catalogue from which the employee may select an award. Service awards are presented
upon 10, 20, 25, 30 and 35 years of service and are recommended to be presented to the employee by the
department head during a department meeting.
.1 Board of Supervisors' Resolution. Employees receiving a 25 year service award and employees
retiring with 25 or more years of service will receive a Board of Supervisors Resolution. A request for
Resolution should be placed on the departmental sub-agenda. Public presentation of the Resolution is at the
option of the employee.
.2 Retiring Reserve Deputy Sheriffs. A reserve deputy sheriff retiring after 15 or more years of service
will receive a retirement badge or other suitable item in recognition of the deputy's meritorious service. The
design, engraving, and type and manner of presenting of the badge is at the discretion of the Sheriff, except that
the badge must clearly show that the bearer is not a County employee or a reserve deputy sheriff.
139. Disciplinary Actions. Any employee may be dismissed, suspended, reduced in rank and/or
compensation, reprimanded or otherwise disciplined for any action or conduct which in the judgment of the
appointing authority provides good cause for discipline under the Civil Service Rules or other laws, regulations,
or policies. Civil Service Rule 1700 et. seq. specifies the procedures for dismissal, suspension or reduction in
rank or compensation for employees in the classified service.
.1 County Counsel Review ofProposed Disciplinary Action. The department head must consult with
County Counsel prior to any suspension without pay, demotion, compensation reduction, or termination. County
Counsel will evaluate the merits of, and evidence to support, the disciplinary action and make a
recommendation. County Counsel, as a rule, will not represent a department before the Civil Service
Commission unless that office has been afforded an opportunity to make a thorough assessment of the discipline
case before the disciplinary action is commenced by the issuance of a notice of proposed action letter (i.e., Skelly
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Kern County Policy and Administrative Procedures 277-2
Manual Filed 12/01/2008 Page 228 of 245
1:22
letter) by the department. If County Counsel determines that the proposed disciplinary action is warranted, it
may represent the department in disciplinary actions before the Civil Service Commission.
.2 Reprimand. Reprimands may be verbal and/or written, and in caSes where the reprimand does not
require any action of dismissal, suspension, or compensation or rank reduction for employees in the classified
service, the department head is not compelled to follow the Civil Service Rule 1700 procedures.
A performance evaluation report, or formal written memorandum or letter should be used in cases of reprimands
to provide a permanent record of the cause of the disciplinary action, discussion with the employee, time limits
for correction of the problem, suggestions for improving performance, and any other related items. The
completed report, memorandum, or letter should be forwarded to the Personnel Department and a copy placed in
the departmental file. The employee may file a written response within 30 calendar days of the date of
reprimand.
.3 Demotion-Step Level. An employee who is demoted for disciplinary pmposes from one class
position to another class position with a lower pay range shall receive the step level compensation determined by
the department head unless otherwise established by the Civil Service Commission after an appeal of the
disciplinary action. The anniversary date of the employee will not change.
.4 Compensation Reduction. The department head may, for disciplinary purposes, reduce an
employee's compensation without a demotion to a lower classified position by ordering the employee's step
level changed to a lower step level.
.5 Voluntary Demotion. Any employee who takes a voluntary demotion from one class position to
another class position, with a lower range of pay, shall receive a step level compensation agreeable to both the
employee and the Department. The employee must have permanent status with the County prior to the demotion
and will demote with permanent status. The anniversary date of any employee so demoted shall remain the same
as it existed prior to his/her demotion.
.6 Administrative Leave with Pay. A department head may place an employee on administrative leave
with pay if the department head determines that the employee is engaged in conduct posing a danger to County
property, the public or other employees, or the continued presence of the employee at the work site will hinder
an investigation of the employee's alleged misconduct or will severely disrupt the business of the department.
During the administrative leave, the employee shall be ordered to remain at home and available by telephone
during the normally assigned work day. A department head may, if necessary, adjust the employee's work
schedule to provide availability during normal business hours, Monday through Friday, 8:00 AM to 5:00 PM. A
department head may not order an administrative leave with pay for a period in excess of five assigned workdays
within a single pay period without the written authorization of the Employee Relations Officer in the County
Administrative Office. Changes in duty status following the issuance of a notice of proposed action are as
provided in Civil Service Rule 1700 et. seq., not this section.
140. Hearings and Appeals.
.1 Suspension, Demotion, Compensation Reduction, or Termination. A permanent employee is entitled

to appeal a suspension, compensation reduction, demotion, or termination as a disciplinary action to the Civil
Service Commission.
.2 Step Level Increment Denials. Any employee who has not received a step level advancement as
provided in section 110 because of the refusal or failure of the employee's department head to recommend such
advancement or because of the refusal or failure of the Personnel Director to approve such advancement, may
appeal to the Civil Service Commission for a hearing on the question of the right of the employee to receive such
step increase by filing a written appeal with the Personnel Director.
The Commission shall set and conduct a hearing on the matter in due course in accordance with its rules, policies
and practices. Within 10 days of the conclusion of the hearing the Civil Service Commission shall determine
whether or not the appellant has capably and conscientiously performed the duties of his position for the period
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Kern County Policy and Administrative Procedures Manual 1:23
of one year immediately preceding the employee's anniversary date, and whether or not the failure or the refusal
of the department head or the Personnel Director to approve the step level increase was arbitrary or
unreasonable. The decision of the Commission shall be fmal for all purposes.
.3 Salary Range Adjustment Denial. Whenever the salary range for a classification is adjusted, and the
department head determines under section 109.6 that there is cause not to grant the compensation increase, the
department head may deny the raise to the employee and may place the employee at a step level within the salary
range for the position which most closely corresponds to but is not less than the compensation that the employee
was receiving prior to the salary range adjustment for the position. The employee may appeal the department
head's decision to the Civil Service Commission, which shall here the matter in accordance with the procedures
and rules for reductions in compensation generally.
.4 Performance Evaluation Reports. Performance evaluation reports represent the judgment and
opinion of the department head with respect to an individual's performance on the job and are not subject to a
formal appeal and hearing.
141. Physical Examinations. An employee may be required at any time to take a medical, physical, and/or
psychological examination to determine whether the employee meets the medical and physical standards
prescribed for the position. The department head or the Personnel Department may request an examination.
142. Conflict of Interest. Ordinance Code Chapter 2.02 establishes the policy and procedures relating to
activities of officers and employees that are inconsistent, incompatible, or conflicting with the duties of public
office or employment. Department heads are responsible for developing "regulations determining and
prescribing employments, activities, and enterprises which are prohibited as being inconsistent, incompatible or
in conflict with their duties as employees." Each employee must sign and date a statement that he/she has read,
understood, and is in compliance with the Ordinance Code and the departmental regulation relating to conflict of
interest. The department maintains an internal file of its employees' statements.
143. OvetpaymentlUndetpayment of Wages or Benefits--Correction. If an administrative error results in an

employee receiving payment for wages or benefits in excess of that legally due, the employee will reimburse the
County. Corrections are initiated by completion of a Request for Correction of Payroll form signed by the
department head and the employee which the department shall forward to the Personnel Department for review
and approval. The Personnel Department shall forward the form to the Auditor-Controller-County Clerk for
approval and processing. The correction will be by one or more of the following methods as deemed appropriate
for the circumstances by the Auditor-Controller-County Clerk:
1. Repayment in cash, net of taxes, in full or by a fixed installment plan agreed to by the
employee and the Auditor-Controller-County Clerk;
2. Repayment in full, deducted from the next payroll warrant issued to the employee;
3. Repayment by the reduction of accumulated vacation hours and/or compensatory time off
hours by the number of hours calculated to produce a dollar amount, net of taxes, to repay
the County;
4. Repayment by fixed installment deductions from sequential payroll warrants, with the
number and amount of installments to be determined by the Auditor-Controller-County
Clerk, with due consideration of the amount of the overpayment and the amount of
disposable earnings available to the employee; or
5. Any combination of the above, as mutually agreeable to the employee and the Auditor-
Controller-County Clerk.
If, as a result of an administrative error, any employee of the County receives payment of monies or benefits less
than that legally due, the County will reimburse the employee by one or more of the following methods:
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26 EXHIBIT 20
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March 12, 2002
Jose Perez Jr., MD

President Medial Staff
1830 Flower Street
Bakersfield, CA 93305
RE: Corrective Action Investigation Special Meeting Report
Dear Jose Perez Jr., MD,

~
Pursuant to Kern Medical Centers, Medial Staff Bylaws articl£ &>rrective~tion~

7.I-3;r;vestigation5'a special meeting was convened upon receipt of a compliant from"
Elsa P. Ang, MD, agaiJ:t.sl David Jadwin,DQ, Chair of the department ofPatbology._'~ ;4
meeting was held on March 11, 2002 chaired by 'myself Chief Medical Officer, Jose
Perez, Jr., MD, President ofthe Medical Staff, Royce Johnson, MD, Past President of the
Medical Staff, Navin Amin, MD, President Elect of the Medical Staff, J~m~.~p.f2\lI,
MD, secretary treasure of the Medical Staff, and Mr. Peter Bryan, CEO;,~ allegations
-were itptified in the Febr;uary 20, 2002 letter to Jose Perez, MD from Elsa P. Ang, MD.
Ther~ ~ aUegatio~~fraudulent billing in the department ofPathology;'a pathology
assistant engaging in the practice of medicine without a license; ~t David Jadwin,
DO, failed a quarterly proficiency test on cervical pap smears', and that David Jadwin,
DO, engages in frivolous spending by sending work outside of the laboratory.
After thorough investigation of all documents submitted by both parties and after
extensive interviews with both physicians, David Jadwin, DO, Chair of theJlepartment of
Pathology and Elsa PAng, MP, <:0II:1plaj!!anj. frhe f()~lo_\\Ti!lg c()nclusions ~c:~
unanimously concluded./,Fraudulent biJlin~lJ.o eVidence of fraudulent billing could be
,.- id~ntified.J Pathology.assistant. en~g-mgjnr.-~e ~~!~c~!If Predicine withou! a license; dO,: .'..
eVIdence to support this allegatlOn,""f: the pathology asSIstant P,;:' ,: "' 1.-"'(::;"-:~; , j""
wor~ undefdefmed pr~tgcol approved by the department~~l}.!!Yff;T a;ear ago! The :r-if';~\;in;':
quarterly profici:ncy tests'n"ot ~wa~~~oJ?~te)~dgment as ili'ejPi-oe:e~~~ i~ e,l~c: by the "
College of Amencan Pathologlst ~Ys mdlvIdual pathology vanatIon but.ffie eIghty
percent requirement is for the entire laboratory service at KM<; for which~~lias been
compliant for years.'1Frivolous spending outside of the department; fib inappropriate
expenditures have been identifieJ!JU1d as per the contract David J~win, Mo, has
complied by no payments made'~ his personal reference lab and'n~ payment has been·
verified.
)
-
/
/
In conclusion;the committee in compliance with~cle fJJ~n th~

of Kern Medical Center
bylaws 7.1-3j'nvestigation and 7.1-4 Executive~ommitteei'3ction, the recommendation is
No corrective action.
Complete documentation of the detailed investigation is in the Medial Staff office.
Sincerely,
Marvin o. Kolb, MD
Chief Medical Officer
1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 233 of 245 1
- 1
1
Minutes from investigation
1
Minutes from the Investigation of the allegations-£.Elsa P. Ang, MD against David
1
Jadwin, DO, Chainnan of the department of Pathology. " I . . . . . , •
This investigation is iiitd¢{i~' ~pMis ~~ h;fa~si~i~l~ ~'c!Orrective Action 7.1- 1
3)nvestigatiom This investigation was convened within fifteen business days and
I
1
included the officers of the Medical Staff, Chair of the department involved, Medical
Director, and the CEO. Present at this meeting,Peter Bryan, CEO, Jose Perez Jr., MD, 1
President ofthe Medical StatI, Royce Johnson, MD, Past President of the Medical Staff,
1
Navin Amin, MD, President Elect of the Medical Staff, James Sproul, MD, Secretary
treasure to the Medial Staff, and Marvin O. Kolb, MD, Chief Medical Officer. During 1
the investigation both David Jadwin,~, Chair of Pathology and Elsa P. Ang, MD were
~tensively interviewed at separate times.. I (f 1
Compliant #1 fraudulent ~?lIing. .,di.;/ ~u';.~': . 1
Numerous documentationi!~.d the complainant identified billing code 88342 for an
examination and interpretation ofa~inoperioida1e strain<;d by a pathologist which 1
David Jadwin, MD, Chair of Pathology had'asked the Pathologist to continue to bill for 1
even though the service was discontinue4{in~'April of2001. As identified during our
i~vestigati0I)the ~eason for ~s conti?ued bill~g by KMC ~s because KM~ .is being ,f , .'./
1
bIlled by the outSIde PatholOgIst that IS now domg that servIce - therefore It IS past_ 'hv~{;"VP; 1
billing. Th~=mvestigation p~s did identify that this pass through process needs to be .
reevaluated to ensure that aU proper billing procedures and past due activities are " 1
consistent and appropriate. Di' ;~(,.; .,_~'i. . ... " i . , " ,,' I c.' {' .
1
Conclusion: No evidence of fraudulent billing was identified.
The complainant also expressed':~etibe CPT cod~PYth~t'a13innanof the department. 1
This was a process put into place by the Cha}~~~~.~~(~er~;~!,f?llRw3~~,~~ ~.; rl
discussion with the individual members and;qt a;e department 'meetings~ • ~
1
deparim~~ with the intent being consistent and appropriate 1

coding1Woc~intation.~~~fb[,thup codes and down codes and code changes 1
involving all department members.
The complainant did state, "She did not have any problems with the changing ofthe 1
codes" but was more concerned with the fraudulent billing regarding compliant # 1. 1
... .. . fall-the documentsthecomnrittee telfthere--was-no
evidenceofnaudulent·billing. 1
CQ!l.f~fm~~at.fue.1>athologydepMtmeitt nee<Bt('FteViewthe present "
1
billiDg proc~~ji:@aktrSiiie_the pass.through~'appfopnafe-ari(rproper billing-forthe
appropriate procedures occur. 1
Compliant #2: Patbology assistant is engaging in tbe practice of medicine witbout
license. 1
The pathology assistant does a gross description as per protocol. The protocol was 1
approved by the department on March 1,2001. 2001, which identifies the
1
responsibilities and duties of the pathology assistant. Further documentation
by the department Chair on June 4, 2001, July 10,2001, July 23l~~9J~,and September 1
14,2001, consistently clarified this issue for all pathologis~1fis not appropriate to have
Angie gross the specimen without pathology supervision". The pathologist will scan 1
1
requisition cards for all placenta's first in order to identify those placenta's which Angie
should or should not gross' and 'placenta's associated with f e t a l . should be
completed by the pathologisf'. \
Conclusion # 2: After revieWQ,f the policy, which ha$. been discussed by the department
in March of200]1fie'dis~U'~sibn ~ in variouS,fueetings it appears there was no evidence
to substantiate the allegation that the pathology assistant was working beyond the scope
~fined in the policy.
" ,_ ,/ Allegation #3
./ David Jadwin, DO, failed to pass quarterly proficiency tests on cervical pap. The
allegation was the other three Pathologist had maintained proficiency.
The College of American Pathologist provide a service that KMC has participated in
whereby quarterly cervical pap smears are forwarded to Pathologist for review. We were
given by Elsa P. Ang, MD one quarters reports which showed David Jadwin, DO at sixty
percent and two of the other pathologist at eighty percent and one with one hundred
percent. Not included in Elsa P. Ang, MD, packets were two other quarter reports from
2001 which identified variations; one quarter all ~!hologist scored between eighty and
one hundred percent and another quarter showed ':!Pathologist (not David Jadwin, DO, or
Elsa P. Ang, MD) at only twenty percent.
The issue is the cervical pap survey given by the College of American Pathologist is a
continuing education process for the pathologist.amt1Jie eighty percent complianc~ is for
the entire lab-~ KMC has been in compliance with over eight percent during thtd'it-ation
, of the testing by CAP. It also ShR}~~~')b~p5}tej that since KMC has only a~proximately
i}" five thousand pap smears a year ~prohciency of close to ten thousang ~s needed for
continued competenc, so- therefme the service has been out sourceg{~dlh~s this CME
,-.
/-
i'~' activity with the College of American Pathologist will be discontinued.

Conclusion # 3: Misinterpretation ofthe data,Ho evidence of deficiency in proficiency
testing from the College of the American College of Pathologist were identified.
Allegation # 4: David Jadwin, DO, Chair of Pathology engages in frivolous spending by _
spending work to outside laboratories when not necessary. This allegation-thaHhere i-:-;O:;{;-! -- .,: :.'
were a few cases that were sent out to other Pathologist for evaluation, a process that has
been ongoing at Kern Medical Center forever. The allegation that David Jadwin, DO
.,:.,- sent this to his private laboratory in New Jersey, Lakewood Pathology Associates for a
,
-~:'\~. remu,nira-tion was unfounded. We documented no payments to David Jadwin, DO,
Lakeview Pathology Lab, nor was if felt the referrals to outside Pathologist were A'
~~"\.\,\· ..lL;:
:,!:-'. _,' ; ..< '.-f i
inappropriate. However there were a few de.:m•..,1 path slides!to Lakewood pathology tt/ j ".J
done without charge by~the lal>O~atory pn-DtnioWudw4h, ~fBf¥CCf8C9t: '.IJ;.:_" -';,', ,_

Conclusion # 4: Allegations regarding outsid~ ~~fe.JElI\V.o~~~~not s!l:bstantia~· \ " ','
/~ The conclusion of our investigation incompliance with,&-ticle ~ of the Kern Medical ,'- tj !,~ '"
,,' Center 'Bylaws for correctivelclctionJti~estigation7.1-3·b.ecutiveComrnittee$ivestigation
7.13-4', our.;\:;e~~iiimendation iii A. no correction actionindicated.
-
:} ;.1',/
I, j .'
Marvin O. Kolb, MD
..
,.
, ..
ARTICLE VII
CORRECTIVE ACTION
7.1 ROUTINE CORRECTNE ACTION
7.1-1 CRITERIA FOR INITIATION
Whenever a practitioner with clinical privileges shall engage in, make, or exhibit acts,
statements, demeanor, or professional conduct, either within or outside of the Medical
Center, and the same is, or is reasonably likely to be, detrimental to patient safety or to the
delivery of quality patient care within the Medical Center, to be disruptive to Medical
Center operations, or to constitute fraud or abuse; or the same results in the. imposition
of sanctions by any governmental authority, and investigation or corrective action
against such person may be requested by any Medical Staff member, by the Board,
or by the Chief Executive Officer.
7.1-2 INITIATION
Proposed corrective action, induding a request for an investigation, must be initiated

by the Executive Committee on its own initiative or by a written request which is
submitted to the Executive Committee and identifies the specific activities or conduct
which are alleged to constitute the grounds for proposing an investigation or specific
corrective action. The President shall promptly notify the Chief Executive Officer and
Board of all proposals for corrective action so initiated and shall continue to keep them
fully informed of all action taken in conjunction therewith.
Complaints regarding a member of the Resident Staff shalf be made to the Medical
Director who may, if necessary, convene a special meeting of the Education
Committee.
7.1-3 INVESTIGATION
Upon receipt of a written complaint, the President of the Medical Staff in order to cause
such complaint to be investigated shall thereupon convene within fifteen (15) business
days a special meeting of the elected officers of the Medical Staff, the Chair of the
Department involved, the Medical Director, and the Chief Executive Office, to which the
member in question shall be requested to attend.
No such investigative process shall be deemed to be a 'hearing" as described in Article

VIII.
7.1-4 EXECUTIVE COMMlITEE ACTION
As soon as is practicable after the conclusion of the investigative process, if any, but in any
event within twenty (20) business days after the initiation of proposed corrective action the
above Committee shall make a report of findings together with appropriate
recommendations of action to the Executive Committee. The Executive Committee may
forward to the Board, through the Chief Executive Officer, their own recommendations
as to action to be taken, if any.
, ooo()680
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r
.
Such action may include, without limitation, recommending:

I
a.
b.
No corrective action.
Rejection or modification of the proposed corrective action.
I
c. Letter of admonition, letter of reprimand, or waming.
d.
e.
Terms of probation or individual requirements of consultation.
Reduction or revocation of dinical privileges.
I
f. Suspension of clinical privileges until completion of specific conditions or
g.
requirements.
Reduction of membership status or limitation of any prerogatives directly related
I
to the practitioner's delivery of patient care.
h. Suspension of Medical Staff membership until completion of specific conditions
or requirements. . .
I
i. Revocation of Medical Staff membership.
j. Other actions appropriate to the facts which prompted the investigation. I
Nothing set forth herein shall inhibit the Executive Committee from implementing summary
suspension at any time, in the exercise of its discretion pursuant to Section 7.2. I
7.1-5 PROCEDURAL RIGHTS
I
Any recommendation by the Executive Committee, pursuant to Section 7.1-4 which
constitutes grounds for a hearing as set forth in SeCtion 8.2 shall entitle the practitioner
to the procedural rights as provided in Article VIII. In such cases, the President shall give I
the practitionerwritten notice of the adverse recommendation within seven (7) calendar
days of such an adverse recommendation and of hislher right to request a hearing in the
manner specified in Section 8.3-2. (
7.1-6 OTHER ACTION
I
a. If the Executive Committee's recommended action is to recommend no
corrective action, such recommendation, together with such supporting
documentation as may be required by the Board, shall be transmitted thereto. I
Thereafter, the procedure to be followed shall be the same as that provided
for applicants in Sections 3.8-6, 3.8-7 and 3.8-8, as applicable.
I
b. If the Executive Committee's recommended action is an admonition,
reprimand, or waming to a practitioner, it shalt, at practitioner's request, grant
him/her an interview as provided in Section 7.4. Following the interview, if I
one is requested, if the Executive Committee's final recommendation to the
Board is an admonition, reprimand, or waming this shall condude the matter
when approved by the Board without substantial modification, and notice Of the I
final decision shall be given to the Board, Chief Executive Officer,
Executive Committee, the Chair of each Committee concemed, and the
practitioner. I
c. If any proposed corrective action by the Board will ·substantially modify the
Executive Committee's recommendation, the Board may submit the matter
I'
tothe Joint Conference Committee for review and recommendation before
making its decision final. Any recommendation of the Board which constitutes
"I'
grounds fora hearing as set forth in Section 8.2,~hall entitle the practitioner to
the p'rocedural rights as provided in Article VIII. In such cases, the Board shall
38
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give the practitioner written notice of the tentative adverse recommendation

and of his/her right to request a hearing in the manner specified in Section 8.3-2.
d. Should the Joint Conference Committee determine that the Executive Committee's
failure to investigate or initiate disciplinary action, is contrary to the weight of
the evidence, the Joint Conference Committee may direct the Executive
Committee to initiate an investigation or a disciplinary action, but only after
consultation with the Executive Committee. In the event the Executive
Committee fails to take action in response to a directive from the Joint
Conference Committee, the Joint Conference Committee, after notifying the
Executive Committee in writing, may take action on its own initiative. If such
action is favorable to the practitioner, or constitutes an. admonition.
reprimand or warning to the practitioner, it shall becOme effective as the finaJ
decision of the Joint Conference Committee. If such action is one of those set
forth in Section 8.2, the Joint Conference Committee shall give the practitioner
written notice of the adverse recommendation and of hislher right to request
a hearing in the manner specified in Section 8.3-2 and hislher rights shall be
as provided in Artide VIII.
SUMMARY SUSPENSION
Wh ever a practitioners conduct requires immediate action to be taken to re ce

a sub ntial likelihood of imminent impairment of the health or safety 0 any
patient, spective patient, employee or other person present in th edical
Center, an person or body authorized to initiate proposed co ve action
pursuant to S ·on 7.1-1 hereof shall have the authority to summ y suspend or
restrict the Medi Staff membership status or all or any Po n of the dinicat
privileges of such ctitioner, provided, however, that Joint Conference
Committee or· Chief cutive Officer, before the susp Ion or restriction, made
reasonable attempts to co ct the Executive Committe suspension or restriction
by the Joint Conference C mittee or Chief Ex·ve Officer which has not been
ratified by the Executive C mittee withi two (2) working days, exduding
weekends and holidays, after e susQ sion or restriction shall automatically
terminate. '
Such summary suspension or immediatefy upon

imposition, and the person or, dy responsibl therefore shalf promptly give oral or
written notice thereof to e practitioner, Join Conference Committee, Executive
Committee, and Chief ecutive Officer. The notice f the suspension or restriction
given to the Exec· Committee shall constitute a re est for corrective action and
the procedures t forth in Section 7.1 shall be followed, cept that the procedures
set forth in S ·on 7.1 shall be completed as soon as practi . In the event of any
suCh sus nsion or restriction, the practitioners patients whose atment by such
practi . er is terminated by the summary suspension or restriction s be assigned
to ther practitioner by the Department Chair or by the Chief of Staff. e wishes
the patient shall be considered, where feasible, in choosing a substitute p ·tioner.
0000682
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26 EXHIBIT 21
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CES Job Classfication Chang 'om
Change of Employee Status

DEPARTMENT #
8997
SOCIAL SECURITY NBR
DEPARTMENT NAME
KERN MEDICAL CENTER
EMPLOYEE NAME
I DATE PREPARED
1211912003
376-50-8 177 JADWIN DAVID F

JOB CLASSIFICATION CHANGES
F
EFFECTIVE DATE
1211312003
DEPARTMENT
I TYPE OF CHANGE
Change of Salary
CLASSIFICATION
I TYPE OF APPOINTMENT
Temporary
BASIS OF
I
0
8997 KERN MEDICAL 0706 CHMNIPATHOLOGY- RANGE STEP SALARY UNIT RATE
CENTER C $10,679.43 $10,679.43 Biweekly
M
DEPARTMENT CLASSIFICATION
RANGE STEP SALARY UNIT RATE BASIS OF
8997 KERN MEDICAL 0706 CHMNIPATHOLOGY-
0
CENTER C S 1 1,021.08 $1 1,021.08 Biweekly
TYPE OF WORK REQUIRED

-
A Full Time I IF PART TIME, HOURS BIWEEKLY
I
r
EMPLOYEE'S EARNINGS
WILL BE SUBJECT TO: I
I
SOCIAL SECURITY?
NO I I
I
SDI? RETIREMENT?
NO I NO I
I
TYPE OF RETIREMENT MEMBER
SPECIAL ALLOWANCE CHANGES

ACTION
PAY CODE
TIMES PAID
AMOUNT
DATE SIGNATURE
ACKNOWLEDGMENT BY THE EMPLOYEE: 1 ACKNOWLEDGE AND CERTIFY
THAT THE STATEMENTS ON THIS FORM ARE TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE.
APPROVED NOT APPROVED 1 ' I

Personnel Date To ITS
Approval
Arrnida Armida 12/19/2003 11:53:00 AM (Personnel ApprovedfAwaiting
Barbara Lynch
+
Smith Smith )
DFJ00247
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26 EXHIBIT 22
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AGREEMENT
FOR
EXPERT CONSULTING SERVICES
THIS AGREEMENT is made and entered into by and between the County
of Kern, a political subdivision of the state of California (hereinafter "County").
and William J. Colburn, M.D.• an individual (hereinafter ·Consultant").
RECITALS
WHEREAS:
(a) Resolution Number 87-706 by the Kern County Board of

Supervisors empowers the County Counsel to contract for needed expert
consulting services; and
(b) From time to time. the County Counsel needs consulting services
to defend against or reduce the risk of possible lawsuits against County; and
(c) County has need for consulting services with respect to the manner
and quality of care given to certain patients in the department of pathology at
'e Kem Medical Center ("KMC"). and desires recommendations for how to care for
such patients in the future; and
(d) Consultant is willing and able to provide said services to County for
the consideration and upon the terms set forth herein;
NOW. THEREFORE, in consideration of the mutual covenants contained

herein, the parties hereto agree as follows:
1. Services.
1.1 County agrees that Consultant is to render independent consulting

services for the County Counsel. Consultant agrees to perform a quality
assessment review of the KMC department of pathology. Said review will
include review and evaluation of a selected sample of twenty-one (21) medical
records including slides that relate to pathology findings of gynecologic oncology
patients who were seen and treated at KMC. Consultant will provide KMC with a
written report stating Consultant's findings and recommendations.
1.2 Consultant will at all times be a member in good standing of the

medical staff of KMC and governed as such by the medical staff bylaws, rules
and regulations. Consultant will be assigned to the advisory staff category.
2. Fees and Expenses.
2.1 Consultant will be paid an hourly rate of Three Hundred Dollars

($300) per hour for medical records review, consultation and report preparation.
0026379
Consultant will not be reimbursed for any costs incurred by Consultant in

providing said services.
2.2 The maximum payable under this Agreement will not exceed Ten
Thousand Dollars ($10,000).
3. Payment.
3.1 Invoices for payment will be submitted in a form approved by

County and list each service performed. Invoices will be sent to KMC for review
and processing. Payment will be made to Consultant within thirty (30) days of
receipt and approval of each invoice by KMC.
3.2 To ensure compensation is reported as paid to the proper party.

Consultant will complete and execute IRS Form W-9 (Exhibit "A," attached
hereto and incorporated herein by this reference), which identifies the taxpayer
identification number for Consultant.
4. Representations. Consultant makes no warranty, ·either expressed or

implied. as to Consultant's findings, recommendations, or professional advice
except that the services or work product were performed pursuant to generally
accepted standards of practice in effect at the time of performance.
5. Independent Contractor. Nothing in this Agreement shall be construed

or interpreted to make Consultant anything but an independent contractor and in
all Consultant's activities and operations pursuant to this Agreement, Consultant
shall for no purposes be considered an employee or agent of County.
6. Authority to Bind County. It is understood that Consultant, in

Consultant's performance of any and all duties under this Agreement has no
authority to bind County to any agreements or undertakings with respect to any
and all persons or entities with whom Consultant deals in the course of
Consultant's business.
7. Non-disclosure of Information. Consultant shall not disclose, without

the express written consent of County, any information relating to any patient
records or any other information or documentation that has been submitted by
County to Consultant pursuant to the services to be rendered pursuant to this
Agreement. Upon request by County or in the event that this Agreement is
terminated, Consultant shall immediately retum to County all records. documents
and the like belonging to County.
8. Termination. County reserves the right \0 terminate this Agreement at

any time or to discharge Consultant at any time. In the event of such discharge,
County shall compensate Consultant for services actually rendered up to and
inclUding the date of discharge. Consultant may terminate this Agreement at any
time by giving written notice of termination to the County Counsel.
9. Notices. The service and delivery of all notices and/or papers shall be
0026380
deemed dUly and properly given or made five (5) days after being mailed via the
U. S. Postal Service. postage prepaid and addressed as follows:
To County: B.C. Barmann, Sr.• County Counsel

Attention: Karen S. Barnes, Deputy County
Counsel
Kern County Administrative Center
Bakersfield. California 93301
To Consultant: William J. Colburn, M.D.

Tarzana Regional Medical Center
Department of Anatomic Pathology
18321 Clark Street
Tarzana, California 91356
10. Assignment. Consultant shall not assign any right, title or interest
Consultant rnay acquire by reason of this Agreement except upon first obtaining
written consent of County.
11. Subcontracting. Consultant may not subcontract any portion or the

services to be provided hereunder without the written approval of County.
12. Modifications. This Agreement may be modified or amended only by

written agreement of the parties. No waiver or modification of this Agreement or
of any covenant, condition or limitation herein contained shall be valid unless in
writing and duly executed by the parties hereto.
13. Non-waiver. No covenant or condition of this Agreement can be waived

except by the written consent of County. Forbearance or indulgence by County
in any regard whatsoever shall not constitute a waiver of the covenant or
condition to be performed by Consultant. County shall be entitled to invoke any
remedy available to County under this Agreement or by law or in equity despite
said forbearance or indulgence.
14. Venue. If any party herein initiates an action to enforce the terms hereof
or declare rights hereunder, the parties agree that venue thereof shall be the
County of Kern, state of California.
15. Construed Pursuant to California Law. The parties hereto agree that
the provisions of this Agreement will be construed pursuant to the laws of the
state of California.
16. Captions. Paragraph headings in this Agreement are used solely for
convenience and shall be Wholly disregarded in the construction of this
Agreement.
17. Time of Essence. Time is hereby expressly declared to be of the
0026381
essence in this Agreement and of each and every provision thereof, and each
such provision is hereby made and declared to be a material, necessary and
essential party of this Agreement.
18. Officials Not to Benefit. No member of any governing body or

government. nor any employee of County shall be allowed or permitted to benefit
personally from any part of or performance under this Agreement.
19. Conflict of Interest. The parties to this Agreement have read and are
aware of the provisions of sections 1090 et seq. and sections 87100 et seq. of
the Government Code relating to conflict of interest of pUblic officers and
employees. All parties hereto agree that they are unaware of any financial or
economic interest of any public officer or employee of County relating to this
Agreement. It is further understood and agreed that if such a financial interest
does exist at the inception of this Agreement. County may immediately terminate
this Agreement by giving written notice thereof. Consultant shall comply with the
requirements of Government Code sections 87100 et seq. during the term of this
Agreement.
[Intentionally left blank]
0026382
IN WITNESS WHEREOF, the parties hereto have executed this

Agreement on the dates indicated below.
COUNTY OF KERN
Office of County Counsel
Dated: tl5 -/5'~(j (.

B.C. Barmann, Sr., County Counsel
"COUNTY"
William J. Colburn, M.D.
Dated:~b By
IA)d ('{gil.&-- 11\0
"CONSULTANT"
AgreemeotCvlbum.050206
0026383

3 Phone: (213) 992-3299
Fax: (213) 596-0487
6
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10 FRESNO DIVISION
[Fed. R. Civ. P. 56(a)]
16 Courtroom: 3
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Set One
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23 OB/GYN Chair
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Ang Accusations
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4 Harris, Vol. I
Harris, Vol. II
7 Lieu
8 Jennifer Abraham
10
11 Albert McBride
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18 to
4/12/2007
20 Vol. I
21 Vol. I
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Declarant
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26 EXHIBIT 23
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i
l'
WILLIAM J. COLBURN, M.D.

Women's Cancer Center
- 21114 Vanowen Street, Canoga Park, CA. 91303 -
Telephone: 818-708-5528
Fax: 818-708-5546
August 30, 2006
B. C. Barmann, Sr., County Counsel

By Karen S. Barnes, Deputy County Counsel
OFFICE OF THE COUNTY COUNSEL - COUNTY OF KERN
Administrative Center
Bakersfield, CA. 93301
RE: Expert Review - David F. Jadwin, D.O.

Exhibit "A"
Dear Mr. Barmann,
The 21 pathology cases forwarded to me for extramural consultation review have been
completed in what I believe to be a timely manner. Dr. Judwin's pathology reports to be
authoritative in all aspects rendering concise tissue diagnoses. The standardized reports
issued by the Department of Anatomic Pathology Kern Medical Center, Bakersfield,
California, satisfy all requirements for the pre-analytic, analytic and post-analytic phases
for reporting of anatomic pathology cases. In all instances immunohistochemistry special
stains were appropriately ordered and microscopically evaluated for those difficult and
challenging diagnostic cases. Dr. Judwin appropriately solicited "expert" extramural
consultation opinions from noted local-regional and national gynecologic pathologists
and to his credit constantly up-dated the primary surgeon of record in all instances as to
their progress. This reviewing pathologist concurs with Dr. Judwin's final diagnosis in 20
of21 cases. The only discordant case (S05-1347; 2-25-05) concerned the interpretation
of a colposcopic biopsy of the cervix, which was initially interpreted as showing focal
severe dysplasia. I find no evidence for a high grade squamous intraepitheliallesion,
favoring a diagnosis of mild koilocytotic dysplasia ( CIN I / LGSIL). A subsequent
LEEP conization; in view of the aforementioned, may have been averted.
In regards to the 20 concordant cases, appropriate surgery was performed. In no

instances was post-operative patient care in any way compromised.
In view of the aforementioned, I would assess Dr. Judwin's overall performance as a

practicing anatomic and surgical pathologist to exceed the usual standard ofcare
exercised by a practicing surgical pathologist in a busy tertiary community hospital.
0025924
1
0025924
----------------------
If I can be of any further service to you regarding this matter, please do not hesitate to
contact me at your convenience.
Respectfully,
Wi.U,·o~ .\ <Au.uv--
WILLIAMJ. C URN,M.D.
Senior Pathologt
Women's Cancer Center, Tarzana Regional Medical Center,
Tarzana, California
WJCIIlcIKemcountymed1eg
Enclosures: 21 reports; statement of fees (microscopic slides to be returned under separate cover)
0025925
0025925
2
Page I of2 0025926

0025926
..
19) 805-923 08-22-06 1100 - 1155 hours 55 minutes
1
20) 805-2176 08-23-06 1345 - 1435 hours 95 minutes
08-24-06 1300 - 1345 hours
21) 805-2176 08-24-06 1415 - 1435 prep work 75 minutes

1445 - 1540
Review 10 08-28-06 60 minutes

Cases
Review 11 08-29-06 60 minutes

cases
Total Time 1135 min = 18.917 hours

@ $3001hour = $5675.00
Billing Statement 0025927

Pagc20f2
0025927
r _. Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 11 of 191
1
~•

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-05-1347
UNIT #: KOOOl135192
ACCT #: K0505600194
ATTENDING PHYSICIANS:
Joseph Mansour, M.D., Nbalia Marie-Ange Soumah, M.D.
I. CLINICAL HISTORY:
33-year old GO PO female referred from Tulare, California for recurrent low grade
squamous intraepitheliallesion. Status post cryotherapy, April of 2002. Cone biopsy
September of 2003 revealed a low grade squamous intraepitheliallesion.
II. GYNECOLOGIC PROCEDURES:
A. Colposcopic biopsy of the cervix (S-05-1347; 2-25-05).

- Ectocervical mucosa with focal severe dysplasia.
III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY MEDICAL

CENTER CASE: S-05-1347; 2-25-05; WILLIAM J. COLBURN, M.D., WOMEN'S
CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA,
CALIFORNIA; 8-4-06
A. COLPOSCOPIC BIOPSY UTERINE CERVIX (ANATOMIC SITE NOT

OTHERWISE SPECIFIED):
- mild koilocytotic dysplasia ( CIN 1/ LGSIL ).
- there is no evidence for high grade mucosal dysplasia or malignancy.
B. ENDOCERVICAL CURETTAGE:
- isolated strips of endocervical canal mucosa and portions of metaplastic

squamous epithelium showing mild cytologic atypia ( ASCUS ).
- there is no definitive microscopic evidence for HPV-induced epithelial

virocytopathic effect, mucosal dysplasia or malignancy.
0025928
Page 1 of2
0025928
II
IV. ANATOMIC PATHOLOGY SUMMARY COMMENT:
There is no definitive microscopic evidence for a high grade squamous epithelial

lesion as eluded to in the diagnosis rendered by the initial pathologist referable to
cervical biopsy ( Part A). The ECC material shows squamous metaplasia
exhibiting mild cytologic atypia ( ASCUS ), which is most likely secondary to
inflammatory-induced changes. There is no definitive cytologic evidence for
HPV-induced virocytopathic effect, or mucosal dysplasia.
W~c\fn~
WILLIAM J. C
URN, M.D.
Holscherlkern/wjc/lIc/8-6-o6
0025929
5-05-1347 2
Page 2 of2
0025929
0,
I'
t

- 21114 Vanowen Street, Canoga Park, CA 91303 -
Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-04-4674; 08-19-04/ N-04-222; 08-19-04

UNIT #: KOOO1000548
ACCT #: K0423000867
ATTENDING PHYSICIANS: William J. Roy, M.D., Nicola M. Spiros, M.D.,
Basem Z. Bemaba, M.D.
82-year-old female with a history of a complex left adnexal mass further scheduled
for an exploratory laparotomy, bilateral salpingo-oophorectomy, retroperitoneal
dissection, and repair of umbilical hernia. Tentative date of surgery 08-19-04.
II. GYNECOLOGIC SURGERY / HOSPITAL COURSE:
The patient underwent an exploratory laparotomy on 08-19-04, where a dominant left

adnexal mass of primary ovarian origin was found adherent to the left pelvic sidewall.
The right tube and ovary were grossly unremarkable. Frozen section of the left ovary
interpreted as "mucinous cystadenofibroma with focal cytologic atypia (which may
lead to upgrade to mucinous borderline tumor on permanent sections)." In view of
the aforementioned rendered intraoperative frozen section diagnosis findings, the
surgeons in attendance decided to terminate the procedure. The patient tolerated the
surgery well and left the operating room in good condition. The patient remained
hospitalized for five days and was discharged to home on 08-24-04.
III. EXTRAMURAL CONSULTATION REVIEW, KERN COUNTY

MEDICAL CENTER, CASE N-04-222; 08-19-04 AND S-04-4674; 08-19-04,
WILLIAM J. COLBURN, M.D., WOMEN'S CANCER CENTER,
TARZANA REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA;
08-12-06
A. N-04-222 - PERITONEAL WASHINGS FOR CYTOLOGIC

EVALUATION (CYTOCENTRIFUGE PREPARATIONS X 2,
PAPANICOLAOU STAIN AND CELL BLOCK PREPARATION XI,
H&ESTAIN):
- Amid a bloody proteinaceous background containing the usual leukocyte

constituents of blood are portions of cellular debris, fibrin threads and
0025930
Page lof3
0025930
particles of adipose tissue, with rare poorly preserved grouped arrays of

reactive mesothelial cells encountered.
No cytologically unequivocally neoplastic cells are identified.
B. S-04-4674
1. LEFT OVARY AND FALLOPIAN TUBE:
Clear cell adenocarcinoma exhibiting rare isolated complex

glomeruloid papillae, as well as demonstrating, in some areas, an
accompanying adenofibromatous stroma; left ovary.
- Representative cross section of histopathologically unremarkable left
fallopian tube.
2. RIGHT OVARY AND FALLOPIAN TUBE:
- Cortical serous cystic inclusion rests without other significant

histopathologic abnormality; right ovary
Representative cross sections of histopathologically unremarkable
right fallopian tube.
3. NODULE FROM HERNIA:
- Adipose tissue with saponification of fat / fat necrosis and interstitial

iatrogenic induced hemorrhage; negative for metastatic tumor.
IV. EXTRAMURAL EXPERT CONSULTATION OPINION - DR. JUAN

FELIX, WOMEN AND CHILDRENS HOSPITAL, KECK SCHOOL OF
MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA, LOS
ANGELES:
A. S-04-4674; 08-25-04
Clear cell carcinoma.
B. N-04-222; 08-30-06; PERITONEAL WASHINGS
Peritoneal washings containing scattered mesothelial cells showing

reactive changes.
- No cytologic evidence of tumor is identified.
S-04-4674 N-04-222 Kirsch 08·14-06

0025931
Page 2 of3
0025931
v. REVIEWING PATHOLOGIST'S SUMMARY COMMENT:
Original pathologist intraoperative frozen section diagnosis indicates that the

tumor demonstrates atypical cytomorphologic features, which may result in
upgrading the left ovarian neoplasm to a carcinoma. Review of permanent
sections of the frozen section material shows a dominant adenofibromatous
architecture with minimal cytologic atypia. The true nature of this neoplasm was
revealed by the subsequent multiple tissue sections submitted from appropriately
fixed and processed. tumor tissue. Appropriate second opinion was sought in a
timely manner.
S-04-4674 N-04-222 Kirsch 08-14-<J6 0025932

Page 3 00
0025932
,
). .
~

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-06-1066;3-7-06 CASE #: S-06-1680; 4-13-06

UNIT #: KOOO1029137 UNIT #: KOOOI029137
ACCT: K0606600818 ACCT: K0610300618
Joseph Mansour, M.D., Kurt Finberg, M.D., Roy William, M.D.
44-year old female, G3, P3,.presenting with pain and swelling of the left vulva since 1-
06. Clinical impression: 3.5 cm mass left labia residing 1 cm from the mid-line
posteriorly. Cervix and vagina - within normal limits. Uterus - normal size, shape and
configuration without mass effect. Pap smear 3-21-06 - within normal limits. Vulvar
mass biopsy (S-06-1066; 3-7-06): squamous cell carcinoma in situ with probable
microinvasive carcinoma.
II. GYNECOLOGICAL SURGERY / HOSPITAL COURSE:
Modified radical hemi-vulvectomy performed 4-13-06. Patient tolerated the procedure

well and without complications. Length of hospital stay - 5 days.

CENTER- CASES # S-06-1066; 3-7-06 AND S-06-1680; 4-13-06, WILLIAM J.
COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL
MEDICAL CENTER, TARZANA, CALIFORNIA; 8-4-06
A. CASE S-06-1066, BIOPSY, LEFT VULVAR MASS:
- basaloid squamous cell carcinoma.

- superficial nature of the biopsy and tangential nature of sectioning precludes
definitive microscopic diagnosis of a micro- / macro-invasive dermal tumor
component.
B. CASE S-06-1680; 4-13-06, LEFT VULVECTOMY:
infiltrating moderately differentiated basaloid squamous cell carcinoma.
0025933
I
,
0025933
Page 1 of2
high-grade vulvar intraepithelial neoplasia ( VIN II-Ill ); 6:00 - 9:00 vulvar

cutaneous margin of excision.
angio-Iymphovascular invasion by tumor; interface of deep dennis and superficial
hyperdennis..
C. LEFf VULVAR MASS, INFERIOR - LATERAL MARGIN EXCISION:

multiple sections of histopathologically unremarkable hirsute skin; negative for
vulvar intraepithelial neoplasia (VIN) or malignancy.
IV. REVIEWING PATHOLOGIST'S SUMMARY COMMENT:
This reviewing pathologist concurs in toto with the initial pathologist's diagnoses
referable to cases S-06-1066 and S-06-1680.
w·
WILLIAMJ.C
Thompson/kem/wjc/1lc/8-4-2006
I
I
~
I 0025934
I
\
0025934
S-06-1066; 3-7-06 / S-06-1680; 4-13-06
Page 2 of2

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-05-755l
UNIT #: KOOOl146283
ACCT #: K0533500457
ATTENDING PHYSICIANS: William Roy, M.D.
52-year old G2, P2, referred to CSB Clinic for vaginal bleeding x 2 years. EMB,9-l4-05
reported as endometrioid adenocarcinoma. ECC, 10-28-05 - negative for neoplasm.
Patient reported as menopausal since 2003. On honnone replacement therapy from 1982
to 2002.
Patient was scheduled for a total abdominal hysterectomy and bilateral salpingo-
oophorectomy and bilateral pelvic and peri-aortic lymph node dissection on 12-1-05.
Patient tolerated the surgery well and had a fairly uneventful post-operative hospital
course and was discharged home on post-op day 3 (12-4-05).

CENTER, CASE #: S-05-7551; 12-01-05; WILLIAM J. COLBURN, M.D.,
WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER,
CALIFORNIA
A. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES AND OVARIES:
- Infiltrating endometrioid adenocarcinoma; FIGO II, penetrating greater

than 50% of the mural thickness of the uterine wall.
- Isolated mural angiolymphatic channels show the presence of intraluminal

free-floating tumor emboli which may represent a fictitious iatrogenic-
induced phenomena.
- Benign leiomyomata exhibiting degenerative architectural features
- Nabothian cysts and tunnel cluster fonnation; endocervical canal mucosa.
Squamous metaplasia: transition zone of cervix.
0025935
Page 1 of2
0025935
Unremarkable well glycogenated exocervical squamous mucosa.
Cortical serous cystic inclusion rests; right and left ovaries.
Representative tangential sections ofhistopathologically unremarkable

right and left fallopian tubes.
B. RIGHT PELVIC LYMPH NODE DISSECTION:
- benign reactive lymph nodes ( 11 ).
C. RIGHT PARA-AORTIC LYMPH NODES:
D. LEFf PELVIC LYMPH NODE DISSECTION:
E. LEFf PERI-AORTIC LYMPH NODES:
F. OMENTUM:
- unremarkable omental fat pad.
G. CLINICAL ABDOMINAL LESION EXCISION:
hyperkeratotic verrucoid keratosis; not otherwise specified.

there is no evidence for malignancy.
This consulting pathologist concurs with the diagnoses as rendered by the initial
examining pathologist of record.
w ~ ,
WILLIAMJ.C
Voss/kem/wjc/l1c/S-11-o6
0025936
S-05-7551 2
0025936 Page 2 of2

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-04-7471
UNIT #: KOOOI138692
ACCT # K0435100474
ATTENDING PHYSICIANS: Nicola Spirtos, M.D.
86-year old Caucasian female G5, P4 with a chief complaint of post-menopausal bleeding
x 8 days beginning November, 2004. Scheduled for D&C.
Fractional dilatation and curettage performed at Kern Medical Center, Bakersfield,

California on 12-16-04 under general anesthesia. Separate and distinct EMB and ECC
tissue samples forwarded to pathology for tissue analysis ( surg. path. # S-04-7471; parts
A and B).
PATHOLOGY DIAGNOSIS - S-04-7471; 12-17-04:
A. ENDOCERVICAL CURETTAGE:
- scanty detached fragments of hypersecretory endometirum.
- mucin and endocervical mucosa with no pathologic findings.
B. ENDOMETRIAL BIOPSY:
small fragments of endometrium, mixed with blood and
endocervical mucus.
- focal, limited areas suspicious for adenocarcinoma with
squamous differentiation and possibly containing mixed clear
cell carcinoma.
- The tissue is insufficient for accurate grading or further
diagnosis.
0025937
Page 1 of3
0025937

CENTER CASE: S-04-7471; 12-17-04; WILLIAM J. COLBURN, M.D.,
TARZANA, CALIFORNIA, 8-4-06
A. ENDOCERVICAL CURETTAGE:
isolated rare strips of mechanically distorted endocervical canal mucosa
are encountered with the overall quantitative - qualitative features of the
specimen deemed inadequate in order to render a definitive tissue
diagnosis.
B. ENDOMETRIAL CURETTAGE:
endometrioid adenocarcinoma exhibiting clear cell cytomorphologic
features and accompanying squamous metaplasia.
The findings of clear cell features warrant strong consideration of a high grade
endometrioid adenocarcinoma; FIGO Grade 3.
This reviewing pathologust concurs with the initial pathologist's final diagnosis:
Part A - endocervical curettage ( not additional levels ) is deemed both

quantitatively and qualitatively insufficient and therefore a definitive tissue
diagnosis is not possible.
Part B - endometrial curettage shows fragmented portions of endometrial gland

and stromal tissue showing a moderate degree of epithelial atypia with a vague
fenestrated gland architecture with isolated rare mitotic figures encountered. The
nucleus to cytoplasmic ratio is moderately increased. Of note: Clear cell
tumoral cytomorphologic features are noted at the surface of some frond-like
structures. In the differential diagnosis is atypical complex hyperplasia with
associated clear cell / squamous metaplasia vs endometrioid adenocarcinoma
exhibiting clear cell features; FIGO Grade 3. This reviewer favors the latter
diagnosis. This case is difficult as eluded to in the descriptive microscopic and
diagnosis rendered by the original pathologist described as "hypersecretory
endometrium exhibiting papillary, clear cell and eosinophilic metaplasia to focal
limited areas suspicious for adenocarcinoma with squamous differentiation and
possibly containing mixed clear cell carcinoma". The only criticism that can be
made is the somewhat protracted delay in procuring an extramural consultation
opinion (approximately 3 months). This in no way however should be considered
to have negatively impacted the clinical course of this patient's disease process.
tJJ JJ.1.lo..
WILLIAM J.
~LBURN,
Cc:l L&-=
M.D.
assoni/kem/wjcnlcl8-4-o6
S-<l4-7471 0025938
Page 2 00
0025938

Telephone: 818-708-5528
Fax: 818-708-5546
CASES #: 8-05-1514; 3-4-05

8-05-2811; 5-5-05
8-05-3286; 5-26-05
UNIT #: K0000870589
Joseph Mansour, M.D., Preete Bhanot, M.D., William Roy, M.D.
34 year old G2 PO female with history of status post previous vaginal biopsy reported as
VAIN III and dated 2-2-05. Most recent-antecedent pap smear ( 2-15-05 ) was reported
as within normal limits. The patient was scheduled for a wide radical excision of this
lesion on 5-5-05.
II. GYNECOLOGICAL SURGERY I HOSPITAL COURSE:
Radical wide excision of vulva was performed on 5-05-05. The pathology report
reported the findings of an invasive moderately differentiated squamous cell carcinoma
with submucosal microinvasion to a measured depth of 2.2 mm. A subsequent staging
procedure with right groin lymph node dissection was performed on 5-26-05. Post-op
convalescence uneventful.

CENTER, CASES: S-05-1514, 3-4-05; S-05-2811, 5-5-05; S-05-3286, 5-26-05;
WILLIAM J. COLBURN, M.D. WOMEN'S CANCER CENTER, TARZANA
REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA; 8-8-06
1). CASE #: S-05-1514:
A. PUNCH BIOPSY, VULVA (NOS):
- VIN III with evolution to microinvasive moderately differentiated

submucosal microinvasion to a measures depth of 0.8 mm.
- Dermal lymphatic invasion by tumor is identified.
0025939
0025939
B. UTERINE CERVIX, 12:00 POSITION:
Superficially biopsied and tangential sections of histopathologically

unremarkable well glycogenated exocervical squamous mucosa.
Reserve cell change / immature squamous metaplasia; transition zone of

cervix.
There is no evidence ofHPV-induced epithelial virocytopathic effect,

mucosal dysplasia or malignancy.
2). CASE #: S-05-2811
A. VULVA, MEDIAL MARGIN, 12:00 - 6:00 EXCISION:
Hirsute vulvar skin, negative for vulvar intraepithelial neoplasia or

malignancy.
B. RIGHT VULVA, RADICAL VULVECTOMY:
VIN III with evolution to infiltrating moderately differentiated

keratinizing squamous carcinoma; submucosal depth of invasion
greater than 2 mm ( slide section B5 ).
All newly re-established circumferential cutaneous, dennal and

central superficial hypodermal margins of excision are noted to
be free of tumor.
3). CASE #: S-05-3286
A. RIGHT FEMORAL LYMPH NODES:
Benign reactive lymph nodes ( 2 ).
B. RIGHT FEMORAL LYMPH NODES:
C. RIGHT INGUINAL / FEMORAL LYMPH NODES:
0025940
8-05-1514; 3-4-05/8-05-2811; 5-5-05/ 8-05-3286; 5·26-05
2
0025940
.. Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 24 of 191
This reviewing pathologist concurs with the initial pathologist's diagnoses as rendered.
W~~Co1JJ,...-
WILiiAMJ:
LBURN, M.D.
Dawson/kernlwjclllc/8-9-o6
0025941
S-05-1514; 3-4-05 /5-05-2811; 5-5-05 / 5-05-3286; 5-26-05
3
0025941
.-... ..
I Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 25 of 191

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-05-812
UNIT #: K0001142312
ACCT #: K0503500023
ATTENDING PHYSICIANS: Joseph Mansour, M.D., William Roy, M.D.
67-year old G4 P3 female with chief complaint of vulvar itching. The patient was
pr~viously treated with antibiotics for infection. The lesion had been increasing in size
over the course of a few months with the patient noting swelling above the clitoris
without associated bleeding.
Biopsy performed 12-4-05 left labia minora, without complications, Kern Medical
Center, Surg. Path. #: S-05-812; 2-4-05. Further review of the chart reveals a wide local
excision of the vulvar lesion performed on 3-3-05. The final pathology referable to the
wide local excision specimen, 3-3-05, is not available at the time of anatomic pathology
consultation review.

CENTER, CASE S-05-812; 2-4-05; WILLIAM J. COLBURN, M.D., WOMEN'S
CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA; .
8-8-06
BIOPSY LEFT LABIA MINORA, 1:00 POSITION:
- skin showing moderate parakeratosis, acanthosis and spongiosis noted in

conjunction with a moderate influx of predominantly small reactive
lymphocytes residing within the underlying dermis proper.
there is no evidence for vulvar intraepithelial neoplasia or malignancy.
0025942
0025942 Page I of2

..
I
Although the aforementioned descriptive histomorphologic features as cited above are

overall nondiagnostic, the histomorphologic features suggest a lichenoid dennatidity, i.e.
early phase of lichen simplex chronicus. There is no evidence for vulvar intraepithelial
neoplasia, cutaneous malignancy or underlying evolving lymphoproliferative process.
The findings of this biopsy should be correlated with those of the definitive local excision
of the reported mass perfonned on 3-3-05.
t . . ) l..1JJ.bM. ~CoJA,--
WILLIAM J. BBURN, M.D.
KaurlkemlwjclllclS-S-06
0025943
S-oS-SI2
0025943 Page2of2
2

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-05-3265; 5-26-05

UNIT #: K0000679293
ACCT #: K0514300893
ATTENDING PHYSICIANS: William J. Roy, M.D., Preete Bhanot, M.D.
66-year old gravida 2, para 2, female referred to Kern Medical Center for post-
menopausal bleeding beginning in late February, 2005. The patient was seen in
gynecologic consultation at Kern Medical Center on 5-19-05. Previous endometrial
biopsy dated 4-28-05 was reported as poorly differentiated carcinoma with an
accompanying ECC noted to reveal sheets of neoplastic undifferentiated small carcinoma
cells. Cervical biopsies at the 5:00 and 12:00 positions were unremarkable. Pertinent
physical examination limited to the pelvis revealed the external genitalia to be within
normal limits, normal urethra and bladder. The vulva and vagina were free of
abnormalities. The cervix was noted to be friable and the uterus was slightly enlarged.
The right and left adnexa were "within normal limits". The patient was scheduled for an
exploratory laparoscopy - total abdominal hysterectomy and bilateral salpingo-
oophorectomy, peritoneal washings and possible lymph node dissection for staging
procedure.
II. GYNECOLOGIC SURGERY I HOSPITAL COURSE:
The patient's TAHBSO was performed on 5-26-05 without complications and the patient
left the operating room in stable condition.
INTRAOPERATIVE FROZEN SECTION DIAGNOSIS (# 1):

malignant neoplasm with high grade nuclear features.
differential diagnosis includes chloroma, high grade sarcoma for anaplastic
undifferentiated carcinoma.
FROZEN SECTION DIAGNOSIS (# 2): - POSTERIOR VAGINAL MARGlN:

no epithelial malignant neoplasm identified.
The patient's hospital course over the next four days was relatively uneventful and she
was discharged to her home on 5-30-06 in stable condition, advised to follow up in the
gyne clinic in approximately one week post-discharge.
0025944
0025944 Page 1 of3
III. EXTRAMURAL CONSULTATION OPINION REVIEW, KERN COUNTY

MEDICAL CENTER, CASE #: S-05-3265; 5-26-05; WILLIAM J. COLBURN,
M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL MEDICAL
CENTER, TARZANA, CALIFORNIA; 8-17-06
A. UTERUS AND ADNEXAE:
- TAH-BSO:
- undifferentiated small cell neoplasm exhibiting a sarcomatoid stroma
and abortive attempts at gland formation; summary histomorphologic
features consistent with a malignant mixed Mullerian tumor ( MMMT );
apparently eminating from the body of the uterus with local regional
metastases to an ovary whose laterality is not further specified.
- angio-Iymphovascuhrr invasion by tumor is identified.
adenomyosis, myometrium.
- histopathologically unremarkable endocervical canal mucosa.
- unremarkable well glycogenated exocervical squamous mucosa.
- sections of atrophic ovary whose laterality is not further specified showing

a lymphatic channel within the meso-ovarium containing a large intra-
luminal free-floating embolus of metastatic undifferentiated carcinoma.
representative cross sections of histopathologically unremarkable right

and left fallopian tubes.
- VAGINA, POSTERIOR MARGIN (SLIDE "B I"):
squamous epithelial lined vaginal mucosa, negative for mucosal dysplasia

or malignancy.
B. PERITONEAL WASHINGS:
- slides not available for review.
c. RIGHT ILIAC LYMPH NODE BIOPSY:

- benign reactive lymph node ( 1 ).
D. RIGHT OBTURATOR LYMPH NODE BIOPSY:

- metastatic MMMT involving multiple fragmented lymph nodes.
F. RIGHT PARA-AORTIC LYMPH NODE BIOPSY:

benign reactive lymph nodes (5 ).
0025945
S-05-3265; 5-26-05
0025945 Page 2 of3
NOTE: Slides "FI" and "F3" demonstrate the presence of multiple particles
ofMMMT which do not involve lymph node structures.
G. LEFT PELVIC LYMPH NODE BIOPSY:

- one of twelve ( 1 /12) lymph nodes almost completely replaced
byMMMT.
H. LEFT PARA-AORTIC LYMPH NODE BIOPSY:

IV. OUTSIDE CONSULTATION OPINION, DR. ROBERT H. YOUNG,

DEPARTMENT OF PATHOLOGY, MASSACHUSETTS GENERAL HOSPITAL I
HARVARD MEDICAL SCHOOL; 6-10-05
DIAGNOSIS:
- undifferentiated carcinoma exhibiting biphasic morphology; summary

histomorphologic features consistent with malignant mixed Mullerian
tumor.
- atrophic phenomena referred to as transitional cell metaplasia; vagina.
V. ANATOMIC PATHOLOGY SUMMARY COMMENT:
This reviewing pathologist agrees with the final diagnosis as rendered by the initial
pathologist of record.
w~ ~BURN,
CoJW----
WILLIAM J. C
M.D.
Burton-kem-wjc-llc-S-22-o6
0025946
S-05-3265; 5-26-05
0025946 Page 3 of3
."
i'
•
21114 Vanowen Street, Canoga Park, CA 91303 -
Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-05-2176; 04-07-05

UNIT #: K0001146515
ACCT #: K0508000982
ATTENDING PHYSICIANS: William J. Roy, M.D., Homayoun Sadeghi, M.D.,
and Preete Bhanot, M.D.
55-year-old female admitted through Kern Medical Center ER on 03-22-05, with

primary history of increasing abdominal girth / distention x two months PTA,
associated with nausea and vomiting two days prior to admission. A pelvic exam
revealed a large pelvic mass resulting in a gynecologic - oncologic consultation. CT
and MRI studies revealed a retroperitoneal mass with associated microcalcifications.
Previous abdominal surgery, ten years PTA, for a reported schwannoma;
retroperitoneal. CA-125 of "666" with other tumor markers reported as negative.
Paracentesis was performed with cytologic evaluation of the fluid, reported as "clear
cell adenocarcinoma, origin most likely of the ovary." Further management of
multiple medical conditions transpired from 03-22-05 through 04-05-05. The patient
was scheduled for exploratory laparotomy, total abdominal hysterectomy, bilateral
salpingo-oophorectomy, and omentectomy, right pelvic lymph node dissection, and
bilateral retroperitoneal lymph node dissection on 04-07-05.
At the time of surgery, widespread carcinomatosis was noted, with involvement of the
omentum and apparent peritoneal surface involvement of the major pelvic organs.
The differential diagnosis at the time of the intraoperative surgical event was primary
ovarian carcinoma versus primary peritoneal carcinoma.
Intraoperative Diagnosis,.. Frozen Section Diagnosis:

Omentum, Hernia Sac, Tumor Excision:
- Papillary serous adenocarcinoma, low grade with psammoma bodies.
A complicated surgical debulking procedure continued and the patient left the
operating room / recovery room in stable, but guarded condition. Subsequently, the
patient developed a pulmonary embolism. Postoperative course was complicated by a
pulmonary embolism and diabetes management, which resulted in a protracted
hospital stay during which the patient received three cycles of chemotherapy prior to
her discharge to home, with the assistance of a home healthcare nurse.
0025947
Page 1 of4
0025947

MEDICAL CENTER, CASE S-05-2176; 04-07-05, WILLIAM J. COLBURN,
A. OMENTUM, HERNIA SAC, AND TUMOR EXCISION:
- Invasive desmoplastic high-grade adenocarcinoma of miillerian serous

membrane origin, with adjuvant extensive immunohistochemistry tumor
marker histiogenesis profile analysis supporting further classification ofthis
tumor as a high-grade clear cell adenocarcinoma.
B. PLAQUE OFF OF ILEUM:
- Invasive desmoplastic adenocarcinoma of miiIlerian serous surface origin.
C. LEFT ANTERIOR ABDOMINAL WALL EXCISION:
- Invasive high-grade adenocarcinoma of miiIlerian serous surface origin.
D. UTERUS AND ADNEXA, TOTAL ABDOMINAL HYSTERECTOMY:
- Invasive desmoplastic "implant" of high-grade serous surface

adenocarcinoma; left ovary and meso-ovarian soft tissue elements.
- Representative cross sections of atrophic left fallopian tube.
- Atrophic right ovary and fallopian tube; negative for tumor.
- Benign leiomyomata exhibiting atrophic architectural features
- Inactive endometrium.
- Nabothian cysts and squamous metaplasia; transition zone of the cervix.
- Unremarkable proximal endocervical canal mucosa and similarly
unremarkable well-glycogenated exocervical squamous mucosa.
E. RIGHT PELVIC LYMPH NODES:
- Benign reactive lymph nodes (6).
F. LEFT SUBCUTANEOUS TISSUE:
- Subcutaneous involvement by invasive high-grade adenocarcinoma.
G. LEFT HERNIA SAC AND TUMOR:
- Invasive high-grade adenocarcinoma.
0025948
S-05-2176 Mathis 08-25-06
Pagc2of4
0025948
H. PERIUMBILICAL TUMOR:
I. ILEAL NODULES:
J. SEGMENTAL RESECTION - TERMINAL ILEUM:
- Mesenteric / serosal "implants" of invasive high-grade adenocarcinoma of

mullerian serous surface origin.
K. UMBILICAL TUMOR:
L. OMENTUM AND HERNIA SAC:
- Invasive desmoplastic high-grade adenocarcinoma of mullerian serous

surface origin.
IV. SURGICAL PATHOLOGY CONSULTATION REPORT - UCLA

MEDICAL CENTER (THEIR SURGICAL PATHOLOGY # R-05-6313; 04-
29-05) - PERTINENT PATHOLOGY DIAGNOSTIC FINDINGS:
A. Uterus and Adnexa:

Left Ovary:
- Ovarian serous surface is positive for metastatic clear cell carcinoma.
Right Ovary:
- Negative for carcinoma.
Uterus and Cervix:
- Inactive endometrium with cystic atrophy.
- Leiomyomata with hyaline fibrosis.
- Focal chronic cervicitis.
Right and Left Fallopian Tubes:
B. Right Pelvic Lymph Nodes:

- Six lymph nodes negative for metastatic carcinoma.
C. Left Subcutaneous Tissue:

- Fibroadipose tissue and skeletal muscle, with clear cell carcinoma.
S-05-2176 Mathis 08-25-06 0025949

Page 3 of4
0025949
D. Clinical Hernia Sac and Tumor, Left:

- Fibroadipose tissue with clear cell carcinoma.
E. Clinical Tumor, Periumbilical:

- Dense fibroadipose tissue with clear cell carcinoma.
F. Clinical Nodule, Ileal:

G. Terminal Ileum:
- Serosal surface of ileum with clear cell carcinoma.
- Unremarkable colonic mucosa.
H. Clinical Tumor, Umbilical:

- Dense fibroadipose tissue with clear cell carcinoma.
I. Omentum and Hernia Sac:

Comment: The bulk of the tumor is noted in the omentum and the left ovary
tumor nodules only on the serosal surface with similar histology. These findings
are supportive of a peritoneum primary. The immunostains are supportive of a
miillerian primary. Clinical - pathologic is suggested.
This reviewing pathologist concurs with the final microscopic diagnosis as

rendered by the initial examining pathologist. Extramural consultation review
was appropriately sought by the Department of Anatomic Pathology, Kern
Medical Center, Bakersfield, California. The original intraoperative pathology
consultation opinion as rendered favored a low-grade miillerian serous surface
carcinoma, with subsequent permanent sections upgraded to reflect a high-grade
adenocarcinoma. Extensive IHC tumor histiogenesis marker profile supports
clear cell differentiation of this miillerian serous surface neoplasm, which is
deemed to be ofprimary peritoneal origin.
w ~ ~-.JCa..aJ.LAJ.U·===:",--_ _
WILLIAM J. C~BURN, M.D.
S-05-2176 Mathis 08-25-06 0025950

Page 4 of4
0025950

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: 8-06-757,02-16-06; 8-06-981, 03-02-06; N-06-51, 03-02-06

UNIT #: K0001155514
ACCT #: K0604600094
ATTENDING PHYSICIANS: Joseph Mansour, M.D., William J. Roy, M.D.
I. CLINICAL m8TORY:
37-year-old female G6 P5 with pertinent medical history of a cervical biopsy showing
papillary serous adenocarcinoma (Kern Medical Center Case # 8-06-757; 02-16-06).
The patient was scheduled for a radical abdominal hysterectomy, bilateral salpino-
oophorectomy, and lymph node dissection on or about 03-02-06.

The patient was admitted to Kern Medical Center, Bakersfield, California, on 03-02-
06 for a radical TAH-B80 and lymph node dissection. The patient tolerated the
surgicai procedure well and left the operating room.in good condition. 8he
experienced an uneventful four day postop hospital course and was discharged home
on 03-06-06, and scheduled for postop follow-up at prescribed intervals.

MEDICAL CENTER, CASES 8-06-757, 02-16-06; S-06-981, 03-02-06; N-06-
51, 03-02-06, WILLIAM J. COLBURN, M.D., WOMEN'S CANCER
CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA,
CALIFORNIA; 08-16-06
A. 8-06-757:
1. CERVICAL LESION:
.,. High-grade papillary adenocarcinoma; endocervical type, mucinous

variant.
* Extramural Expert Consultation Opinions:

a) UCLA Medical Center - Cervical Lesion:
- Mucinous adenocarcinoma, papillary and solid.
- Poorly differentiated (high grade).
b) University o/Southern California -Juan C. Felix; Womens and

Childrens Hospital- Cervical Lesion:
- Adenocarcinoma of the cervix of the usual mucinous type.
0025951
Page 10f4
0025951
..
B. S-06-981:
1. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES AND

OVARIES:
- Invasive high-grade papillary adenocarcinoma; endocervical type,

mucinous variant noted in conjunction with invasive papillary
endocervical adenocarcinoma, usual type, and arising at the transition
zone ofthe cervix.
- Lymphatic invasion by tumor is identified.
- Well-glycogenated unremarkable exocervical squamous mucosa.
- Secretory phase endometrium; endometrial cavity.
- Representative transmural sections of histopathologically unremarkable
uterine myometrium and serosa.
- Physiologic cysts, right and left ovaries, and representative cross
sections of unremarkable right and left fallopian tubes.
2. RIGHT PARA-AORTIC LYMPH NODES:
- Benign reactive lymph nodes ( 4 ).
3. RIGHT COMMON ILIAC LYMPH NODES:
- Subcapsular sinus involvement by micrometastatic endocervical

adenocarcinoma; mucinous variant, involving one offour (1/4) lymph
nodes.
4. RIGHT PELVIC LYMPH NODES:
- Macrometastatic papillary adenocarcinoma; endocervical type,

mucinous variant involving one of fourteen (1/14) lymph nodes.
5. LEFT PARA-AORTIC LYMPH NODE:
- Benign reactive lymph node (1).
6. LEFT COMMON ILIAC LYMPH NODES:
- Macrometastatic high-grade papillary adenocarcinoma; endocervical

type, mucinous variant involving one of three (1/3) lymph nodes.
- A tumor "floater" is identified in immediately adjacent outer mantle of
adipose tissue.
S-06-752 S-06-981 N-06·51 Sanchez 08·17-06

0025952
Page 2 of4
0025952
o'
7. OMENTUM:
- Histopathologically unremarkable omental fat pad.
8. OMENTAL LYMPH NODE:
- Benign reactive lymph node (l); totally embedded.
9. APPENDIX:
- Repre~entative sections of histopathologically unremarkable vermiform

appendix.
- Periappendiceal fat pad shows the presence of a solitary (1) benign
reactive lymph node.
10. LEFT PELVIC LYMPH NODES:
* Extramural Expert Consultation Opinion

aJ UCLA Medical Center, Los Angeles, California:
- Agreement in toto with the referring pathologist's interpretation; refer
to UCLA Medical Center, Department of Pathology and Laboratory
Medicine Surgical Pathology Consultation Report # R06-05528; 03-
13-06 for your further edification.
bJDr. Juan C. Felix, Keck School 0/Medicine, University o/Southern

California, Los Angeles:
Diagnosis - Radical Hysterectomy, Bilateral Salpingo-oophorectomy,
Appendectomy, and Multiple Lymphadenoectomy Specimens:
- Deeply invasive adenocarcinoma of the cervix.
- Several foci of vascular space involvement are identified.
- Paracervical margins negative for tumor.
- Sections of uterus, fallopian tubes, ovaries, and appendix are negative
for tumor.
- Lymph node status: one right pelvic, one left common iliac, one right
para-aortic, and one right common iliac lymph node are involved by
metastatic adenocarcinoma of the cervix.
C. N-06-51
1. ABDOMINAL WASHINGS FOR CYTOLOGIC EVALUATION:

- Fibrin debris, red cells, and the usual leukocyte constituents of blood;
with no atypical / neoplastic cells identified.
S-06·752 S-06-981 N-06·S1 Sanchez 08-17-06

0025953
Page 3 of4
0025953
"
* Expert Extramural Consultation Opinion:

UCLA Medical Center, their surgicalpathology report # 806-5535; 03-
13-06:
Final Diagnosis
- Negative for malignant cells.
IV. ANATOMIC PATHOLOGY SUMMARY COMMENT
This pathologist agrees with the original pathologist's final diagnoses.
W~~CQJ.l.w--
WILLIAM J. C
BURN, M.D.
S.()6·752 S.o6-981 N.o6·51 Sanchez 08-17.06

0025954
Page 4 of4
0025954
j

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-05-7114; 11-11-05

UNIT #: K001142693
ACCT #: K0519301010
ATTENDING PHYSICIANS: William J. Roy, M.D., Nbalia Soumah, D.O.
35-year-old G5 P5 female presenting at the Gyn-Oncology Clinic with the chief

complaint of passing flatulents and feces per vagina for several years. No remote
history of vaginal laceration / vaginal trauma. Physical examination revealed a uterus
of normal size, shape and configuration. Pertinent past medical history included
cervical biopsies (Quest Diagnostic Laboratories) at the 7 o'clock and 11 o'clock
positions, and endocervical curettings showing high-grade endocervical glandular
dysplasia consistent with AIS and low-grade squamous intraepithelial dysplasia (eIN
I / L8IL). The aforementioned outside diagnoses were confirmed by Kern Medical
Center interdepartmental consultation slide review (case C-05-22; 07-20-05).
The patient was scheduled for conization biopsy of the cervix and perineal
reconstruction of the vaginal laceration, the procedure carried out on 06-23-05. The
patient experienced an unremarkable postoperative course and was discharged from
Kern Medical Center on 06-25-05. The pathology results of the cold conization of
the cervix (Kern Medical Center case No. 8-05-3830; 06-23-05) revealed focal high-
grade squamous dysplasia and endocervical glandular dysplasia, high grade. A
formal TAH-B80 in view of the aforementioned was performed 11-10-05, with
pathology slides corresponding to the current case submitted for extramural
consultation opinion (8-05-7114; 11-11-05).

CENTER, TARZANA, CALIFORNIA; 08-11-06 .
0025955
Page I of2
0025955
A. UTERUS AND CERVIX (TOTAL LAPAROSCOPIC

HYSTERECTOMY):
- Focal high-grade endocervical intraepithelial neoplasia; distal endocervical

canal mucosa residing near the transition zone; totally embedded cervix.
- The most distal ectocervical / vaginal margin of hysterectomy is free of
HPV-induced epithelial virocytopathic change, mucosal dysplasia or
malignancy.
- Histopathologically unremarkable secretory phase endometrium.
- Gross absence of right and left adnexal structures.
This reviewing pathologist agrees with the initial pathologist's final summary
diagnoses.
l .) ; LiI.a...
WILLIAM J. C
li Ci:!J» -
BURN, M.D.
0025956
S-05-7114 Cisneros 08·14-06
Page 20f2
0025956

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-06-541; 02-02-06

UNIT #: K0000871307
ACCT #: K063300535
ATTENDING PHYSICIANS: Nbalia Soumah, D.O., William 1. Roy, M.D.
40-year-old female, status post Pap smear, Fall 2005, interpreted as HSIL; cannot rule
out invasion (outside Pap smear, un-named laboratory). Status post colposcopic
biopsies of the cervix further revealed CIS. The patient to be scheduled for a radical
hysterectomy, bilateral salpingo-oophorectomy, with bilateral pelvic and possible
periaortic lymph node dissection, appendectomy / or suprapubic placement of a
catheter.
The patient was admitted to Kern Medical Center on 02-02-06 for a radical
hysterectomy. TAH-BSO with pelvic lymph node dissection was performed without
complication.
Intraoperative pathology consultation diagnosis (frozen section diagnosis):

A. Left pelvic lymph nodes
- Six lymph nodes negative for malignancy.
B. Right pelvic lymph nodes
- Eight lymph nodes negative for malignancy.
The patient had a relatively uneventful hospital stay x three days and was discharged
home with a follow-up visit scheduled.

A. LEFT PELVIC LYMPH NODE DISSECTION:
0025957
Page 1 of3
0025957
i
•
C. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES, AND

OVARIES:
- Infiltrating moderate - poorly differentiated squamous carcinoma, large cell

type invading to a measured depth of 9 - 10 mm and arising at the transition
zone of the cervix.
- There is no evidence for angio -lymphovascular invasion by tumor;
however fictitious inoculation of lymphatic spaces are identified due to
iatrogenic sectioning at the time of pathology processing.
- Basilar proliferative phase endometrium.
- Immature / mature squamous metaplasia and accompanying moderate acute
and chronic endocervicitis; transitional zone of the cervix.
- Nabothian cysts and tunnel cluster formation; endocervical canal mucosa.
- Unremarkable well-glycogenated cervical squamous mucosa.
- Multiple cortical cysts of follicular derivation, right and left ovaries.
- Representative cross sections of histopathologically unremarkable right and
left fallopian tubes.
- Appendix: Representative sections of histopathologically unremarkable
vermiform appendix.
IV. EXTRAMURAL EXPERT CONSULTATION OPINION - DR. JUAN

FELIX, WOMEN AND CHILDRENS HOSPITAL, KECK SCHOOL OF
MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA, LOS
ANGELES, PATHOLOGY # S-06-541; 07-07-06:
Diagnosis:
- Large cell nonkeratinizing invasive squamous carcinoma of the cervix,
nuclear grade 3 / 3.
V. ANATOMIC PATHOLOGY SUMMARY COMMENT
This reviewing pathologist agrees with the initial pathologist's diagnosis of a

high-grade invasive squamous cell carcinoma of the cervix, but would not
0025958
5-06·541 Borquez 08·15-06
Page 2 of3
0025958
"subspeciate" the neoplasm as a true "glassy cell" carcinoma, connoting an

extremely poor prognosis.
w~ ~ Cd1J.,v----=- _
WILLIAM J. COj:BURN, M.D.
S-06-541 Borquez 08-15-06 0025959

Page 3 of3
0025959

- . 21114 Vanowen Street, Canoga Park, CA 91303 -
Telephone: '818-708-5528
Fax: 818-708-5546
CASE #: S-05-923; 02-10-05

UNIT #: KOOO1128182
ACCT #: K0504000959
ATTENDING PHYSICIANS: William J. Roy, M.D., Cary Freeman, M.D., Nbalia
Soumah, D.O., and Margarett Ellison, M.D.
49-year-old gravida 4, para 4 female presenting at the Gynecology/Oncology Clinic,

Kern Medical Center, on 01-20-05, with the chief complaint of vaginal bleeding for
seven months, PTA. Antecedent Pap smear, 06-16-04 reported as showing
endometrial adenocarcinoma. Endometrial biopsy on 01-07-05 was reported as
"mildly" differentiated endometrioid adenocarcinoma with cervical biopsy reported
as squamous cell carcinoma. Radical hysterectomy with bilateral salpingo-
oophorectomy, bilateral pelvic and periaortic lymph node dissection was scheduled
on or about 02-10-05.
The patient was admitted to Kern Medical Center on 02-10-05 for scheduled radical
hysterectomy.
Intraoperative Pathology Consultation Diagnosis - Frozen Section Diagnosis

Uterus, Cervix, Bilateral Ovaries and Fallopian Tubes:
- Uterus and Cervix, 182 grams, received.
Primary endometrial adenocarcinoma (grade 2), with endocervical and lower
uterine segment extension.
- Neoplasm infiltrates approximately 20% of the myometrial wall thickness.
The patient tolerated the surgery well and left the OR and subsequent recovery in
stable condition. Postop hospital course for 8 days was eventful with respect to
postop moderate normochromic, normocytic anemia requiring four units of packed
RBCs and bilateral lower lobe pneumonia with pleural effusions at day 3 - 4 postop.
The remainder of the patient's hospital course was fairly uneventful and she was
discharged home on day 8 (02-18-05), with instructions for a scheduled postop visit at
the Ob/Gyn Clinic in one week.
0025960
Page I of3
0025960

M.D., WOMEN'S CANCER CENTER, TARZANA REGIONAL
MEDICAL CENTER, TARZANA, CALIFORNIA; 08-22-06
A. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES, AND

OVARIES:
- Villoglandular endometrioid adenocarcinoma exhibiting composite well -

moderate and poorly differentiated carcinoma components analogous to a
high-grade infiltrating endometrioid adenocarcinoma; FIOO III.
- Lymphovascular space invasion by tumor is identified.
- Tumor penetrates 35% of the mural thickness of the uterine wall.
- High-grade adenocarcinoma involves the upper aspects of the
endocervical canal ( proximal endocervical canal )
- Paracervical / paraendometrial margins of hysterectomy are free of tumor.
- Deeply penetrating adenomyosis
- Nabothian cysts; distal endocervical canal mucosa.
Squamous metaplasia; transitional zone of cervix.
- Well-glycogenated unremarkable exocervical squamous mucosa.
- Representative sections of histopathologically unremarkable left and right
ovaries and fallopian tubes.
B. VAGINAL MARGIN:
- Histopathologically unremarkable squamous epithelial-lined vaginal

mu~osa; negative for malignancy.
C. RIGHT PELVIC LYMPH NODES:
- Benign reactive lymph nodes ( 10).
D. RIGHT AORTIC LYMPH NODES:
E. LEFT PELVIC LYMPH NODES:
F. PERIAORTIC LYMPH NODES:
- Benign reactive lymph nodes ( 3 )
5-05·923 Rodriguez 08·22-06 0025961

Page 2 of3
0025961
I{ Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 45 of 191
!
1
I
IV. EXTRAMURAL CONSULTATION OPINION - DR. LYDIA BALATIAN-
FLORES, GENZYME IMPATH LABORATORIES, LOS ANGELES,
! CALIFORNIA ( THEIR CONSULTATION # LA-05-007015; 02-21-05 ):
I - Moderately differentiated adenocarcinoma of the endometrium associated

with a poorly differentiated carcinoma, with necrosis and hemorrhage.
( Refer to extensive immunohistochemistry tumor histiogenesis marker profile
I
!
analysis for your further edification ).
i~
I
~ V. REVIEWING PATHOLOGIST'S SUMMARY COMMENT:
I
j
l
This pathologist concurs with the final pathology diagnosis as rendered by the
I initial examining pathologist.
I
Ij
0025962
S-oS·923 Rodriguez 08·22-06
Page 3 of3
0025962
rw WILLIAM J. COLBURN, M.D.

I
I
Telephone: 818-708-5528
Fax: 818-708-5546
I
j CASE #: C-04-28
I
1
UNIT #: KOOOI097368
I ACCT #: K0422600627
ATTENDING PHYSICIANS: Joseph Mansour, M.D. ,Basem Bernaba, M.D.,
I
I
William Roy, M.D.
II I. CLINICAL HISTORY:
34-year old female,GO, PO, referred to the Kern Medical Center for gynecologic follow-
up, status post laparoscopic ovarian cystectomy 3-5-04 performed in Mexico. Referring
diagnosis: serous cystadenocarcinoma of low malignant potential.
Consultation diagnosis: DJ, Staff Pathologist, Kern Medical Center, Bakersfield,

California. Case #: P-04-410, their consultation case #: C-04-28.
A. Clinical Cyst Fluid, Left Ovary (P-04-410):

Hypercellular proteinaceous substance with limited epithelial cells and mildly
Atypical.
B. Clinical Cyst, Left Ovary (P-04-41O, Consultation Case #: P-04-28):

Proliferating borderline serous tumor of the ovary, high grade (non-invasive
micropapillary serous carcinoma ).
II. EXTRAMURAL CONSULTATION OPINION, DR. JUAN FELIX, WOMEN'S

AND CHILDREN'S HOSPITAL, KECK SCHOOL OF MEDICINE, UNIVERSITY
OF SOUTHERN CALIFORNIA, LOS ANGELES, CALIFORNIA
LEFT OVARIAN CYST:
Cyto / histomorphologic findings diagnostic of a serous tumor of low

malignant potential.
Comment: I find no evidence for the diagnosis of micropapillary carcinoma.
0025963
Page 1 of2
0025963
III. EXTRAMURAL CONSULTATION REVIEW, KERN MEDICAL

CENTER, CONSULTATION CASE: C-04-28; 8-17-04; WILLIAM J.
COLBURN, M.D., WOMEN'S CANCER CENTER, TARZANA
REGIONAL MEDICAL CENTER, TARZANA, CALIFORNIA
The reported 14 slides of this cystic left ovary, consultation case C-04-28, are not
available for microscopic evaluation. I see little substantive difference in the initial
reported consultation opinion rendered by Dr. Jadwin, as a proliferating borderline serous
tumor of the ovary, high grade (non-invasive micropapillary serous carcinoma) and that
rendered by Dr. Juan Felix at the University of Southem California, Keck School of
Medicine reported as a serous tumor of low malignant potential with no evidence for the
diagnosis of micropapillary carcinoma. As reported by the Borderline Ovarian Tumor
Workshop, Bethesda, Maryland, August 27 - 28,2003, published as an editorial in
Human Pathology, volume 35, # 8, August, 2004, some participants objected to the use of
the term "micropapillary serous carcinoma" (MPSC) and nonmicropapillary serous
carcinoma (NMPSC) as they believe these lesions to be akin to the routine - typical
serous borderline ovarian tumors (S-BOT). Micropapillary S-BOT and typical S-BOT's
show the same risk factors for recurrence and have similar prognoses. Some participants
therefore objected to using terms implying potential for distant spread (carcinoma), i.e.
preferring to call these lesions serous borderline tumors with micropapillary features; not
otherwise specified. By definition showing at least one microscopic area, uninterrupted
micropapillary growth exceeding >5mm and lacking stromal micro / macro invasion
constituted a serous borderline tumor with micropapillary featUres. Not having the slides
for review precludes this reviewer's substantiating the presence or absence of a non-
hierarchial papillary mucosal architecture and / or micropapillary structures whose length
exceeds five times their width. As you can see little is to be gained by "splitting hairs" in
this case. Furthermore, a micropapillary / cribriform ml,1cosal architecture may co-exist
with typical S-BOT. Tumors with more focal micropapillary features, i.e. measuring
less than 5 mm in one dimension, are typically classified as S-BOT. Many studies have
found no difference in survival for a worse survival in patients with micropapillary serous
borderline ovarian tumors vs S-BOT's.
w~ ~Co..th--
WILLIAM J. C
BURN, M.D.
CarpiolKem/wjclllcl8-9-Q6
0025964
C-Q4-28 2
0025964 Page 2 of2

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-04-6857; 11-18-04

UNIT #: K0000633431
ACCT #: K0432100805
ATTENDING PHYSICIANS: William J. Roy, M.D., Nbalia Soumah, D.O.
40-year-old female with a diagnosis of cervical adenocarcinoma, status post LEEP

conization procedure with pathology reviewed at an outside institution, not otherwise
specified. The patient was scheduled for radical hysterectomy, bilateral salpingo-
oophorectomy, bilateral pelvic node dissection, with suprapubic catheter placement.
Tentative date of surgery 11-18-04.
The patient was admitted to Kern Medical Center on 11-18-04 for a radical
hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic node dissection,
which was performed without complication.
Gross Intraoperative Pathology Consultation Opinion:
A. Cervix, uterus, bilateral ovaries and tubes:

- No gross residual tumor in cervix.
- Frozen section diagnosis: Residual tumor seen microscopically on frozen
section slide.
B. Right pelvic lymph node:
Frozen section diagnosis: Half of the largest lymph node and four smaller
lymph nodes are negative for metastasis.
The patient's postoperative course was uneventful x 4 days and the patient was
discharged to home on 11-22-04 with follow-up medical visits scheduled in clinic.

0025965
0025965
A. UTERUS AND ADNEXA (TOTAL ABDOMINAL HYSTERECTOMY):
Invasive adenocarcinoma of the cervix; endocervical type; submucosal

depth of invasion 8 nun.
There is no definitive microscopic evidence for angio - lymphovascular
invasion by tumor.
Isolated endocervical glands are involved by squamous carcinoma in situ
(CIS). .
The paracervical soft tissue margins of hysterectomy are free of tumor.
Well-glycogenated exocervical squamous mucosa; negative for HPV-
induced epithelial virocytopathic change, mucosal atypia of malignancy.
Histopathologically unremarkable early secretory phase endometrium;
endometrial cavity.
Solitary diminutive / microscopic cellular leiomyoma; endometrium.
Histopathologically unremarkable uterine serosa.
Multiple follicular cysts and involuting corpus luteum cysts; right and left
ovaries.
Representative cross sections of histopathologically unremarkable right
and left fallopian tubes.
C. LEFT PELVIC LYMPH NODE DISSECTION:
IV. ANATOMIC PATHOLOGY SUMMARY COMMENT
This reviewing pathologist agrees with the final diagnoses as rendered by the
original pathologist.
0025966
S-04-6857 Spillers 08-14-06
Page 2 of2
0025966

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: 8-05-592
UNIT #: K0001141122
ACCT#: K0502700459
ATTENDING PHYSICIANS: William Roy, M.D., Fangluo Liu, M.D.
49-year old female, status post conization of cervix with a diagnosis of adenocarcinoma
ofthe endocervix. CT of pelvis (12-04) - no pelvic mass or adenopathy.
II. ONCOLOGIC SURGERY:
TAR, lymph node dissection (1-27-05).

CENTER, CASE #: S-05-592; 1-27-05; WILLIAM J. COLBURN, M.D. ,
TARZANA, CALIFORNIA; 8-9-06
A. RIGHT PELVIC LYMPH NODE DISSECTION:
- benign reactive lymph nodes (9).
B. LEFT PELVIC LYMPH NODE DISSECTION:
benign reactive lymph nodes ( 10 ).
C. UTERUS, CERVIX, BILATERAL FALLOPIAN TUBES AND OVARIES:
endocervical adenocarcinoma in situ ( AI8 ) exhibiting retrograde

cancerization of endocervical glandular apparati; the bulk ofthe
tumefaction concentrated at the transition zone of the cervix.
an accompanying microinvasive tumor component is identified invading

to a maximum depth of 4 mm.
- scattered endocervical gland necks and glands are involved by moderate

dysplasia ( CIN II / HSIL ).
0025967
Page 1 00
0025967
i
there is no evidence for angio-Iymphovascular invasion by tumor.
granulomatous inflammation; status post conization of the cervix.
the most distal ectocervical margin of hysterectomy is free of tumor.
- inactive endometrium.
- corpus luteum cyst; left ovary.
- histopathologically unremarkable right ovary.
- representative tangential/cross sections of histopathologically

unremarkable left and right fallopian tubes.
IV. PRIOR EXTRAMURAL CONSULTATION OPINION - DR. JUAN FELIX,

WOMEN'S & CHILDREN'S HOSPITAL, DEPARTMENT OF PATHOLOGY,
KECK SCHOOL OF MEDICINE, UNIVERSITY OF SOUTHERN CALIFORNIA,
LOS ANGELES, CALIFORNIA
DIAGNOSIS:
UTERINE CERVIX:
- extensive "in situ~~ adenocarcinoma of the cervix and several
foci of invasive adenocarcinoma of the cervix (greatest depth
of invasion - 4 mm ).
- no vascular space involvement is identified.
- multiple lymph node specimens reveal no evidence for
malignancy.
This reviewing pathologist concurs with the initial pathologist~s final diagnoses.
Narinderlkem/\\jc/llc/8-10-o6
0025968
S-05-592
Page 2 of3
0025968

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S05-2186; 4-8-05

UNIT #: KOOOl145729
ACCT #: K0509700494
ATTENDING PHYSICIANS: William J. Roy, M.D., Chang Lee, M.D.
54-year old female G3, P3, with last LMP 2001, presenting with chief complaint ofpost-
menopausal bleeding ( x 6 weeks). Pertinent Past Medical History: Carcinoma, status
post colectomy 2000 (Dukes' B) without adjuvant treatment. Reported low AlCC stage
disease. Recent colonoscopic examination: date and time unknown, reported as an
"extrinsic" left sided colonic pelvic mass. Abdominal CT (2-15-05) revealed a large
mixed density predominantly cystic pelvic mass arising apparently from the left with a
hypodense ovoid mass in the right adnexa suggestive of a dermoid. The patient was
scheduled for a total abdominal hysterectomy, bilateral salpingo-oophorectomy with
possible modified posterior exenteration, possible bilateral pelvic retro-peritoneallymph
node dissection omentectomy, peritoneal biopsies and tumor debulking as indicated.
The patient was admitted to Kern Medical Center on 4-7-05 where an exploratory
laparotomy was performed resulting in a TAH-BSO and appendectomy.
INTRAOPERATIVE CONSULTATION DIAGNOSIS:
Right ovary and fallopian tube (gross only):

ovarian cyst, likely a dermoid cyst or cystic teratoma, mature.
FROZEN SECTION DIAGNOSIS:
- ovarian stroma, no cyst lining or germ cell elements identified - further
diagnosis pending routine tissue processing.
Left ovary and fallopian tube (gross only):

largely necrotic hemorrhagic mass; no malignant neoplasm identified.
- smaller nodule with adenocarcinoma, high grade, possible representing
metastases to a lymph node - further diagnosis pending routine processing.
The patient tolerated the procedure well and left the operating I recovery room in good
condition. The remainder of her hospital course was relatively uneventful and the patient
was discharged to her home on 4-14-05 and instructed to keep her scheduled appointment
at the Women's Health Center in one week post-discharge.
0025969
0025969 Page I of5


CENTER CASE # S05-2186; 4-8-05; WILLIAM J. COLBURN, M.D., WOMEN'S
CANCER CENTER, TARZANA REGIONAL MEDICAL CENTER,
CALIFORNIA; 8-23-06
A. RIGHT OVARY AND FALLOPIAN TUBE:

- mature cystic teratoma ( dennoid cyst) and ofnote, residing within the
ovarian corticular substance is a microscopically demonstrable 5.5 mm
focus ofmetastatic adenocarcinoma; high grade, of probable colonic
epithelial origin.
- representative cross sections histopathologically unremarkable right
fallopian tube.
B. LEFT OVARY AND FALLOPIAN TUBE:

- metastatic high grade colonic adenocarcinoma exhibiting extensive tumoral
necrobiosis (Krukenberg's tumor); left ovary and fallopian tube.

D. LEFTPELVICLYMPHNODES:
- benign reactive lymph nodes (5 ).
E. LEFT PARA-AORTIC LYMPH NODES:

F. APPENDIX:
- representative sections vennifonn appendix showing reactive serous
surface / peritoneal change, well established fibromembranous adhesions
without other clinically significant histopathologic abnonnality.
G. LEFT URETERAL NODULE:

- metastatic high grade colonic adenocarcinoma further eliciting a marked
reactive stromal desmoplastic response.
H. BIOPSY, URINARY BLADDER:

- acute - chronically inflamed transitional epithelial lined bladder mucosa
showing nests of Von Brunn / cystiticcystica; negative for significant
urothelial cells, atypia, dysplasia or malignancy.
- there is no evidence for metastatic tumor.
I. UTERUS AND CERVIX:

- metastatic high grade colonic adenocarcinoma; lower uterine segment and
left parametrium.
0025970
S05-2186; 4·8-05
0025970 Page 2 of5
,ll
inactive basilar endometrium showing subsurface mild glandular cystic

transfonnation.
- Representative transmural sections ofhistopathologically unremarkable
myometrium and overlying serosa.
- Nabothian cysts and squamous metaplasia; transition zone of cervix.
- histopathologically unremarkable proximal endocervical canal and well
glycogenated exocervical squamous mucosa.
gross absence of right and left adnexal structures (refer to parts A and B
for your further edification ).
J. OMENTUM:
- reactive serous surface change / fibromembranous adhesions; negative for
metastatic tumor.
IV. SURGICAL PATHOLOGY CONSULTATION REPORT, UCLA MEDICAL

CENTER, LOS ANGELES, CALIFORNIA; THEIR SURGICAL PATHOLOGY #:
R05-07703; 5-12-06
A. RIGHT OVARY AND FALLOPIAN TUBE:

adenocarcinoma consistent with metastatic colorectal adenocarcinoma.
- mature cystic teratoma.
B. LEFT OVARY AND FALLOPIAN TUBE:

- metastatic adenocarcinoma involving fallopian tube and ovary.

- 21 lymph nodes negative for metastatic tumor.
D. LEFT PELVIC LYMPH NODES:

5 lymph nodes, negative for metastatic tumor.
E. LEFT PARA-AORTIC LYMPH NODES:

- 16 lymph nodes, negative for metastatic tumor.
F. APPENDIX:
appendix with no pathologic diagnosis.
- no tumor seen.
G. LEFT URETERAL NODULE:

- metastatic adenocarcinoma.
H. BLADDER BIOPSY:
- urothelial mucosa with mild atypia.
- no definitive tumor seen.
0025971
S05-2186; 4-8-05
Page 3 of5
0025971
•
I. UTERUS AND CERVIX:

metastatic adenocarcinoma found in the subserosa of the lower uterine
segment and involving the left parametrium.
chronic endocervicitis.
endometrium with cystic atrophy.
J. OMENTUM:
no tumor seen.
V. SUMMARY REVIEW
This pathologist concurs with the final diagnosis as rendered by the initial
examining pathologist.
w t1.t.LnMr,
WILLIAM J. C
~BURN,
Co fLt=.....-
M.D.
Wheatlkemlwjclllcl8-24-06
0025972
S05-2186; 4-8-05
Page 4 of5
0025972

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-06-91
UNIT # KOOO1100262
ACCT #: K0600600245
ATTENDING PHYSICIANS: Antonio Garcia, M.D., George Alkhouri, M.D.
DATE: 1-6-06
47-year old female with history of breast cancer since 3-02. Tissue diagnosis:
infiltrating duct carcinoma 2.5 cm. with clear margins and 5 / 20 lymph nodes positive
for metastatic tumor. mc breast cancer tumor marker profile: ER- positive, PR-
positive, Her2/neu - positive. Status post chemotherapy with CAP and Tamoxifen.
Recurrence of breast cancer ( right breast) via ultrasound-guided biopsy ( 2-05). CT
scan of the chest 8-05 revealed bony osseous metastasis at T-7 through T-11.
II. GYNECOLOGIC HISTORY:
LMP 2002. Thin prep pap smear (005-3131 ) - ASCUS. HPV test utilizing 2nd
generation viral captured technique reported as positive for high-risk HPV serotypes.
Antecedent endocervical curettings ( 8-05-7868 ) - normal histopathology.
III. PATHOLOGY CONSULTATION REVIEW, SURGICAL PATHOLOGY

CASE: 2-06-91; 1-6-06, KERN MEDICAL CENTER, WILLIAM J. COLBURN,
CENTER, TARZANA, CALIFORNIA, 8-04-06
A. CERVICAL BIOPSY, 6:00 POSITION:

- atypical endocervical hyperplasia; negative for HPV-induced epithelial
virocytopathic effect, mucosal dysplasia or malignancy ( x 6; sections
reviewed 6).
B. ENDOCERVICAL CURETTAGE:
- multiple disrupted poorly preserved strips of endocervical canal mucosa
showing atypical squamous cells; favor dysplasia ( CIN I / LSIL ).
there is no evidence for high grade mucosal dysplasia or malignancy.
0025973
0025973 Page I of2

c
I
This reviewing pathologist concurs with the diagnoses rendered by the initial
pathologist of record.
w~ .
WILLIAMJ. LBURN,M.D.
Villarea1/kern - wjc/llc/8-4-2006
S-06-91
0025974
0025974 Page 2 of2
•
-It

Telephone: 818-708-5528
Fax: 818-708-5546
CASE: S-05-2246
UNIT #: K0001146465
ACCT #: K0510100660
ATTENDING PHYSICIANS: Miguel Lascano, M.D., Nbalia Soumah, D.O.
58-year old G3, P3, female, referred to Kern Medical Center 3-21-05 with a chief
complaint of abdominal pain and pelvic mass. Pertinent past medical history: uterine
fibroids 1994 to the present. Pelvic ultrasound reveals an enlarged uterus, multiple
myomas and the right ovary was noted to be predominantly cystic measuring up to 13.2
cm in maximum dimension, appearing complex and septate. The left ovary was not
visualized. The patient was scheduled for total abdominal hysterectomy, bilateral
salpingo-oophorectomy on 4-12-05.
Surgical procedure: TAH-BSO 12-05 without intraoperative / immediate post-operative

complications.
Right ovary:
- ovary ( 1630 grams) with papillary serous cystadenoma of uncertain
malignant potential ( borderline malignant potential ).
GROSS INTRAOPERATNE DIAGNOSIS:
- fallopian tube without gross pathological features.

- further diagnosis pending routine processing.
0025975
Page 1 of3
0025975

CENTER, CASE #: S -05-2246; 4-12-05, WILLIAM J. COLBURN, M.D.,
TARZANA, CALIFORNIA; 8-8-06
A. CLINICAL MASS, RIGHT OVARY, EXCISION:
- complex multilocular serous cystadenofibroma with evolution to serous

borderline ovarian tumor (S-BOT).
- a micro- / macro-invasive tumor component is not identified.
- the peritoneal serosal surface is uninvolved by tumor.
- representative tangential sections of histopathologically unremarkable distal

fallopian tube.
B. HERNIA SAC, SITE NOT SPECIFIED; HERNIORRHAPHY:
- mesothelial lined fibrovascular and adipose tissue consistent with an origin from
a hernia sac; surgical repair of umbilical hernia.
C. UTERUS AND LEFT ADNEXA:
- benign leiomyomata exhibiting degenerating architectural features.
- inactive atrophic endometrium; lower uterine segment.
- squamous metaplasia; transitional zone of cervix.
- unremarkable well glycogenated exocervical squamous mucosa.
- multiple cortical based serous cystic inclusion rests; left ovary.
- representative cross section of histopathologically unremarkable left fallopian

tube.
- gross absence of right and left adnexal structures ( refer to part "A" for your
further edification ).
0025976
S-05-2246 2
0025976 Page 2 of 3
.'
This reviewing pathologist agrees with the initial pathologist's diagnosis.
W~ .
WILLIAM J. C
~ ~
BURN, M.D.
Martinezlkemlwjc/lIcl8-9-o6
0025977
S-05-2246 3
Page 3 of3
0025977
WILLIAM J. COLD"URN, M.D.

21114 Vanowen Street, Canoga Park, CA. 91303 -
Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: 8-05-381; 1-14-05

UNIT #: K0001138812
ACCT #: K0501400249
ATTENDING PHYSICIANS: Preete Bhanot, M.D., Wi111iam Roy, M.D.
47-year old female G5, PI with a diagnosis of well differentiated keratinizing squamous
carcinoma with superficial invasion, dx, 12-16-04. Biopsies at Kern Medical Center;
Gyn-oncology Clinic performed 1-14-05 consisting ofpap smear, endocervical curettage
and colposcopic biopsy of the cervix and vulva. The biopsy results reveal a superficially
invasive squamous carcinoma with microinvasion to 0.6 mm; 3:00 position, vulva VIN I;
7:00 position, vulva. The patient was scheduled for a wide left radical excision of the
vulva, possible vulvectomy, possible left groin, possible left inguinal lymph node
dissection.
Radical unilateral vulvectomy and CUSA contralateral side, performed 4-21-05.

Intraoperative frozen section margin of radical vulvectomy interpreted as negative for
malignancy or lesion. Remainder of hospital course noted to be unremarkable.

CENTER, CASE S-05-381; 1-14-05. W.J. COLBURN, M.D., WOMEN'S CANCER
CENTER, TARZANA REGIONAL MEDICAL CENTER, TARZANA,
CALIFORNIA; 8-4-06
A. Cervical Biopsy, 1200 Position:

serial sections well-glycogenated exocervical squamous mucosa without
definitive microscopic evidence for HPV-induced epithelial virocytopathic
effect, mucosal dysplasia or malignancy; levels (x 2; total sections 6 ).
B. Endocervical Curettage:
- multiple strips of histopathologically unremarkable endocervical canal
mucosa exhibiting reserve cell change I immature squamous metaplasia;
negative for HPV-induced epithelial virocytopathic effect, mucosal
dysplasia or malignancy.
0025978
Page 1 of2
0025978
C. Vulvar Biopsy, 3:00 Position:

- YIN II - III with transition to squamous carcinoma in situ.
Of note: a 0.6 mm microinvasive superficial dermal tumor component is

identified. There is no evidence for dermal angio-Iymphovascular invasion by
tumor.
D. Vulvar Biopsy, 7:00 Position:

vulvar intraepithelial neoplasia; YIN I - II.
an accompanying microinvasive tumor component is not identified.
Anatomic pathology correlation - this reviewing pathologist agrees in toto with

the initial pathologist's diagnoses; parts A - D inclusive.
W.t.J..luJ,., ~ Ct.tlL----
WILLIAM J. C BURN, M.D.
Unkrich-wjc-l1c-8-4-2006
0025979
S-05-381; 1-14-05 2
Page 2 of2
0025979
vt
i :f
.~

Telephone: 818-708-5528
Fax: 818-708-5546
CASE #: S-06-728; 02~ 14-06

UNIT #: K0000800794
ACCT #: K0604100439
ATTENDING PHYSICIANS: William 1. Roy, M.D., Tony Hoang, M.D.
60-year-old Caucasian female admitted to the Gyn~Oncology Service, Kern Medical

Center, with a history of bilateral adnexal masses. Tumor markers CEA and CA-125
were noted to be elevated. Colonoscopy at an outside facility showed diverticular
disease with no evidence for malignancy. An upper GI endoscopic examination was
not performed. The patient was scheduled for an exploratory laparotomy on 02-10-
06.
Exploratory laparotomy was performed 02-10-06. Upon entering the peritoneal

cavity, the surgeons encountered approximately 10.6 liters of ascitic fluid.
Exploration of the abdomen and pelvis revealed peritoneal cake with diffuse
peritoneal carcinomatosis. The right and left ovaries appeared massively enlarged,
each measuring approximately 10.0 cm in maximum diameter. Further exploration of
the upper gastrointestinal tract revealed what was presumed to represent a primary
gastric neoplasm. A subsequent omentectomy and total abdominal hysterectomy,
bilateral salpingo-oophorectomy was performed. Intraoperative frozen section
diagnosis was interpreted as signet ring cell carcinoma; rule out primary gastric
carcinoma. The patient tolerated the procedure well and left the operating room in
stable condition. The patient remained hospitalized for approximately two weeks and
was discharged toa skilled nursing facility on 02-23-06.

A. LEFT OVARY AND FALLOPIAN TUBE:
- Metastatic signet ring cell carcinoma (mucinous adenocarcinoma) of

probable primary upper gastrointestinal tract mucosal origin.
0025980
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0025980
Representative cross section left fallopian tube shows a remnant of mural

mesonephric I paramesonephric cystic remnants without other significant
histopathologic abnormality.
B. RIGHT OVARY AND FALLOPIAN TUBE:
Metastatic signet ring cell carcinoma (mucinous / colloid adenocarcinoma)

of probable upper gastrointestinal tract mucosal origin.
Cross section of right fallopian tube shows extramural presence of
remnant mesonephric / paramesonephric duct apparati; otherwise there is
no significant histopathologic abnormality.
C. OMENTUM, UTERUS AND CERVIX:
Metastatic mucinous I colloid adenocarcinoma exhibiting regional

prominent signet ring cytomorphologic features; omentum.
Atrophic endometrium; endometrial cavity, corpus uterus.
Superficial adenomyosis; myometrium.
Representative sections of histopathologically unremarkable uterine
serosa.
- Nabothian cyst formation and squamous metaplasia; transition zone of
cervix.
Well-glycogenated histopathologically unremarkable exocervical
squamous mucosa.
Gross absence of right and left adnexal structures (refer to A and B for
your further edification).
This pathologist agrees with the original pathologist's microscopic and diagnosis
as rendered.
W ,Ill",.", ~~
WILLIAM J. CHURN, M.D.
0025981
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0025981
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26 EXHIBIT 24
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3 ______________
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 )
Defendants. )
10 __________________________)
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15 OF
16 IRWIN EVERETT HARRIS, M.D.
17 Wednesday, August 13, 2008
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54
1 10:07:03 1 there was a quality concern.
2 10:07:06 2 Q. When was Dr. Jadwin told he was being peer
3 10:07:09 3 reviewed by -- about these cases complained about by
4 10:07:11 4 Dr. Roy?
5 10:07:12 5 A. I don't remember. I don't even know if he
6 10:07:15 6 ever was told.
7 10:07:19 7 Q. Why wouldn't he -- why wouldn't Dr. Jadwin
8 10:07:22 8 be told he was being peer reviewed on these cases
9 10:07:24 9 reported by Dr. Roy?
10 10:07:25 10 A. I had no and still do not recall any concern
11 10:07:29 11 over Dr. Jadwin's quality --
12 10:07:32 12 Q. So when you say --
13 10:07:33 13 A. -- from the peer review mechanism.
14 10:07:37 14 Q. Do you think that's fair? Do you think it's
15 10:07:38 15 fair to peer review somebody without telling them?
16 10:07:41 16 A. Oh, absolutely.
17 10:07:41 17 Q. Why is that?
18 10:07:43 18 A. Because unless there's evidence that there
19 10:07:47 19 is indeed a quality concern, it is purely private and
20 10:07:51 20 confidential among those selected few who have the
21 10:07:57 21 ability to determine whether or not there's a quality
22 10:08:01 22 issue.
23 10:08:02 23 Q. So in Dr. Jadwin's case, peer review was
24 10:08:04 24 conducted on the cases complained about by Dr. Roy,
25 10:08:08 25 cases -- Dr. Jadwin's cases were sent out to outside
HarrisI1
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1 10:11:18 1 attention that there were competence issues with
2 10:11:21 2 Dr. Jadwin?
3 10:11:22 3 A. Prior to his return October 4th, 2006? No.
4 10:11:27 4 Q. Actually, let me -- what about after his
5 10:11:29 5 return to the hospital? After Dr. Jadwin returned to
6 10:11:33 6 the hospital October 4 of 2006, were you aware of any
7 10:11:36 7 competency issues regarding Dr. Jadwin?
8 10:11:38 8 A. I believe there might have been concerns at
9 10:11:40 9 that time.
10 10:11:42 10 Q. And what was -- what were some of these
11 10:11:45 11 concerns?
12 10:11:54 12 A. The concern was that -- that -- well, again,
13 10:12:05 13 I'm in a bit of an awkward position because normally
14 10:12:14 14 I ask for the evidence in order to pursue something.
15 10:12:21 15 So anything that I say is hearsay, but the hearsay
16 10:12:27 16 was is that some of the readings were probably not
17 10:12:30 17 accurate.
18 10:12:31 18 Q. Some of Dr. Jadwin's pathology diagnoses
19 10:12:34 19 were not accurate?
20 10:12:35 20 A. That's what I believe the issue was.
21 10:12:37 21 Q. Was there a peer review conducted on that?
22 10:12:40 22 A. No. Not that I'm aware of.
23 10:12:42 23 Q. And why not?
24 10:12:43 24 A. I don't believe there was sufficient time
25 10:12:45 25 between the date of his return and when he was no
HarrisI1
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1 10:12:50 1 longer providing service to allow that to occur.
2 10:12:55 2 Q. Who made these -- who raised these concerns
3 10:12:57 3 about Dr. Jadwin's diagnoses potentially being
4 10:12:59 4 incorrect after October 4 of 2006?
5 10:13:02 5 A. I don't recall. And one of the reasons why
6 10:13:04 6 I said that it was hearsay is that I only operate
7 10:13:08 7 when I have evidence specifically to guide the peer
8 10:13:14 8 review process, and I don't believe that I had any.
9 10:13:16 9 Q. Okay. Who told -- how did you learn about
10 10:13:18 10 these concerns about Dr. Jadwin's competence after
11 10:13:22 11 October 4, 2006?
12 10:13:23 12 A. I don't recall.
13 10:13:25 13 Q. You don't recall who told you?
14 10:13:27 14 A. No.
15 10:13:27 15 Q. Could it have been Dr. Philip Dutt?
16 10:13:31 16 A. I -- it could have been, yes.
17 10:13:31 17 Q. Could it have been --
18 10:13:36 18 A. But it would not have been him exclusively.
19 10:13:39 19 Q. Well, who does pathology interact with? I
20 10:13:43 20 mean, there is a pathology department itself.
21 21 A. Um-hmm.
22 10:13:45 22 Q. Correct?
23 10:13:45 23 A. The -- the -- the surgeons and other
24 10:13:49 24 physicians that rely on Dr. Jadwin's consultative
25 10:13:55 25 opinions also are knowledgeable of his work.
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1 10:14:01 1 Q. And they were the ones you believe who may
2 10:14:03 2 have been raising concerns about Dr. Jadwin's
3 10:14:06 3 diagnoses being incorrect?
4 10:14:07 4 A. I don't recall, but possibly.
5 10:14:10 5 Q. Okay. Who would recall? Do you know who
6 10:14:11 6 would know about these competency issues being raised
7 10:14:15 7 about Dr. Jadwin after October 4th --
8 10:14:17 8 A. We just discussed that. It would be his
9 10:14:18 9 colleagues and -- and the other physicians with whom
10 10:14:24 10 he works in the institution.
11 10:14:24 11 Q. Well, I guess what I'm asking is to whom
12 10:14:26 12 were these complaints directed, these colleagues?
13 10:14:29 13 A. You'll have to rephrase the question.
14 10:14:31 14 Q. You said there were colleagues and various
15 10:14:33 15 people that were raising competency issues about
16 10:14:36 16 Dr. Jadwin's pathology diagnoses after October 4,
17 10:14:39 17 2006.
18 10:14:39 18 To whom would those complaints have been
19 10:14:41 19 directed?
20 10:14:43 20 A. Me.
21 10:14:43 21 Q. To you?
22 10:14:44 22 A. Yeah.
23 10:14:45 23 Q. And you can't recall -- well, how many --
24 10:14:48 24 how many people were complaining about Dr. Jadwin?
25 10:14:50 25 A. More than one.
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1 15:00:50 1 A. Were any of these cases done after he
2 15:00:54 2 returned from his leave of absence?
3 15:00:56 3 Q. I don't know. Take a look. You have to
4 15:00:57 4 tell me.
5 15:00:58 5 A. Well, I don't think they are.
6 15:00:59 6 Q. Right.
7 15:01:00 7 A. If there is -- what I was trying to say was
8 15:01:02 8 if any of these cases were cases that were processed
9 15:01:06 9 and completed after he returned from his leave of
10 15:01:08 10 absence I cannot speak to those, but any before his
11 15:01:12 11 leave of absence there was no quality concern. I've
12 15:01:16 12 said that four times now. There was no quality
13 15:01:19 13 concern over the cases prior to October of 2006.
14 15:01:23 14 Q. Okay. So can you take a look at this and
15 15:01:26 15 tell me if any of the cases --
16 15:01:28 16 A. Well, that was the job that you're supposed
17 15:01:31 17 to do, but I'd be happy to review the document.
18 15:01:51 18 Can I ask the -- my counsel next to me to
19 15:01:54 19 help me out with some of these dates because I don't
20 15:01:57 20 fully understand them.
21 15:01:59 21 Q. You mean you're finding them illegible or --
22 15:02:02 22 A. No. There's a cervical biopsy here 1/6/06
23 15:02:04 23 and completed 2/17/06, and I don't know whether that
24 15:02:07 24 was before or after the leave of absence or during.
25 15:02:10 25 Q. You don't know -- you're confused about the
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1 15:22:06 1 Q. Remember why you apologized to Dr. Jadwin?
2 15:22:09 2 A. Yeah.
3 15:22:10 3 Q. Okay. Was it a sincere apology to
4 15:22:13 4 Dr. Jadwin?
5 15:22:14 5 A. Yes. I -- I would like to think that all my
6 15:22:18 6 comments are sincere.
7 15:22:22 7 Q. You would never do anything that was
8 15:22:24 8 insincere or fake or meant to please anybody.
9 15:22:28 9 Correct?
10 15:22:29 10 A. I try not to, no. I -- I -- I try to have
11 15:22:34 11 integrity and honesty as my major guiding light.
12 15:22:44 12 Q. So you wouldn't lie, for instance? You
13 15:22:49 13 don't lie. Right?
14 15:22:51 14 A. That is an absolute that has many shades of
15 15:22:55 15 gray, and I'm not going to answer that question.
16 15:22:58 16 Q. I'm asking if you lie, Doctor.
17 15:22:59 17 A. There are all degrees of telling the truth.
18 15:23:03 18 Some people consider omission a lie. So -- I'm
19 15:23:08 19 sorry. This is a hypothetical, philosophical
20 15:23:11 20 question you just asked me that I'm not going to
21 15:23:14 21 respond to.
22 15:23:14 22 Q. So do you engage in shades of lies,
23 15:23:16 23 Dr. Harris?
24 15:23:19 24 A. I'm not going to play this game.
25 15:23:20 25 Q. You're not going to answer?
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1 16:07:49 1 Q. Okay. You don't recall the exact wording,
2 16:07:53 2 but it was something to the effect of what you just
3 3 said.
4 16:07:54 4 A. Paraphrased. That's correct.
5 16:07:56 5 Q. Do you recall what Dr. Jadwin said to
6 16:07:59 6 Dr. Kercher?
7 16:08:01 7 A. No. But I remember that it was negative.
8 16:08:04 8 Q. Did he say anything about -- what about
9 16:08:06 9 Dr. Abraham?
10 16:08:06 10 A. And Dr. Abraham even more so negative.
11 16:08:10 11 Q. Dr. Abraham was present at that meeting of
12 16:08:12 12 February 22?
13 16:08:13 13 A. Yes.
14 16:08:14 14 Q. Okay. You're sure she was present there?
15 16:08:24 15 A. Yeah. I'm pretty sure she was present.
16 16 Q. Okay.
17 16:08:27 17 A. Because I remember there was a lot of
18 16:08:29 18 negative things said about her at that meeting.
19 16:08:31 19 Q. Was anything negative said to Dr. Jadwin by
20 16:08:34 20 anybody at that February 22 meeting?
21 16:08:38 21 A. Yeah. I believe there was.
22 16:08:40 22 Q. Okay. Give me some examples, please.
23 16:08:41 23 A. I think it was offered up as -- as concerns
24 16:08:45 24 and criticism. It was largely tried to be delivered
25 16:08:53 25 in a constructive manner. I suppose there was some
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1 18:41:58 1 wherein the realm of disruptive physicians, one of
2 18:42:05 2 the problems is is that they often think that they're
3 18:42:08 3 right and right about everything. And sometimes -- I
4 18:42:15 4 don't know exactly what it means from there. All I
5 18:42:18 5 know is that disruptive physicians often think that
6 18:42:20 6 they're right and they stick to being right so much
7 18:42:23 7 that they lose the perspectives on collaborative
8 18:42:30 8 aspect of their role.
9 18:42:31 9 The second --
10 18:42:31 10 Q. Sorry. Can I just interrupt one question.
11 18:42:34 11 When you say disruptive physician, do you
12 18:42:36 12 mean that in terms of the formal term, disruptive
13 18:42:40 13 physician as in disruptive physician policy that Kern
14 18:42:43 14 Medical Center has?
15 18:42:43 15 A. Yes.
16 18:42:44 16 Q. Was Dr. Jadwin a disruptive physician under
17 18:42:47 17 that policy?
18 18:42:48 18 A. I considered that the progressive discipline
19 18:42:51 19 that I mentioned about seven hours ago applied to
20 18:42:56 20 Dr. Jadwin, yes.
21 18:42:58 21 Q. So you instituted the disruptive physician
22 18:43:01 22 procedure under the disruptive physician policy at
23 18:43:05 23 KMC?
24 18:43:06 24 A. In essence.
25 18:43:08 25 Q. Well, why do you say in essence? What's the
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1 18:43:10 1 difference? Are you saying that it was informally,
2 18:43:14 2 then?
3 18:43:14 3 A. I'm not sure it was formal then.
4 18:43:17 4 Q. Okay. So at this point you can't really
5 18:43:21 5 recall --
6 18:43:22 6 A. And the second part of this is that you
7 18:43:25 7 cannot make someone respect you or love you. You
8 18:43:29 8 have to earn it by your actions.
9 18:43:32 9 Q. Okay. So is it correct to say that both of
10 18:43:34 10 these statements applied to Dr. Jadwin?
11 18:43:36 11 A. I'm not sure. You gave me some of my
12 18:43:40 12 handwriting out of context, and I'm not sure what it
13 18:43:43 13 applied to.
14 18:43:45 14 Q. So really, you don't have much recollection
15 18:43:46 15 about this Page 494?
16 18:43:48 16 A. I would have to know in what context it was
17 18:43:58 17 written.
18 18:43:58 18 MR. LEE: I'm going to ask -- I'm going to
19 18:44:02 19 ask that we go off the record at this point so we can
20 18:44:04 20 calculate the time precisely. Just one second.
21 18:44:10 21 Okay. We are off the record at 6:43 p.m.
22 19:05:08 22 (Discussion off the record.)
23 19:05:08 23 MR. LEE: We're back on the record at 7:05
24 19:05:50 24 p.m.
25 19:05:52 25 The deposition will be stopped for now, but
HarrisI1
335
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
IRWIN EVERETT HARRIS, M.D., the witness named in the
deposition was taken Wednesday, August 13, 2008, at the
Dated this 15th day of August, 2008, at
susa~-R N-o.---
WOOD & RANDALL

(800) 322-4595
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3 ______________
5 F. JADWIN, D.O., ) Volume II

) Page 336
6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 )
Defendants. )
10 _____________________)
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12
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15 OF
16 IRWIN EVERETT HARRIS, M.D.
17 Wednesday, August 27, 2008
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25 ted by: Erika Addis, CSR No. 11621
HarrisI2
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1 10:50:42 1 there that would suggest --
2 10:50:43 2 MR. WASSER: 708.
3 10:50:44 3 MR. LEE: Sorry. 708.
4 10:50:44 4 BY MR. LEE:
5 10:50:46 5 Q. -- that would suggest this authority exists?
6 10:50:49 6 A. I would have to study that particular
7 10:50:51 7 document. But I would believe that as a medical
8 10:50:57 8 stuff tenet that the officers of the medical staff
9 10:51:01 9 have the ability to -- in their quality roles to
10 10:51:07 10 evaluate and determine whether or not a quality of
11 10:51:12 11 care concern exists or not.
12 10:51:14 12 Q. Did anybody -- after now -- after this list
13 10:51:20 13 of cases by Dr. Roy provided to you were sent out to
14 10:51:23 14 outside review by the medical staff officers and the
15 10:51:26 15 director of quality care -- and by the way, is this
16 10:51:32 16 -- is this -- that committee one of those committees
17 10:51:36 17 -- investigative committees you talked about, you and
18 10:51:37 18 the medical staff officers, performing here?
19 10:51:40 19 A. I don't recall that a formal investigative
20 10:51:48 20 committee was formed.
21 10:51:49 21 Q. Okay. So when you and the medical staff
22 10:51:52 22 officers informally sent out Dr. Jadwin's cases for
23 10:51:55 23 outside review, the list of cases provided by Dr. Roy
24 10:51:58 24 in 2006, you recall that the results came back that
25 10:52:04 25 Dr. Jadwin's patient care issue was not incompetence;
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1 10:52:08 1 that there was no incompetency about Dr. Jadwin's
2 10:52:11 2 reports. Correct?
3 10:52:12 3 A. That is as I recall, yes.
4 10:52:14 4 Q. Okay. So did you relate those findings to
5 10:52:17 5 anybody at all?
6 10:52:18 6 A. I don't -- you've asked me this question in
7 10:52:22 7 a prior deposition. You've asked me this question
8 10:52:24 8 here. I don't recall. I would have felt that there
9 10:52:28 9 was no need to. There was no quality of care concern
10 10:52:32 10 raised.
11 10:52:32 11 Q. So if no concern was raised, then there was
12 10:52:35 12 no need to explain the results to anybody.
13 10:52:37 13 A. Exactly.
14 10:52:41 14 Q. But you knew Dr. Jadwin was concerned?
15 10:52:48 15 MR. WASSER: Counsel, you covered this last
16 10:52:48 16 time. You covered that already this morning. How
17 10:52:48 17 many times are you going to go over this?
18 10:52:48 18 MR. LEE: I'll withdraw the question.
19 10:52:48 19 BY MR. LEE:
20 10:52:49 20 Q. Do you recall having conversations with
21 10:52:52 21 David Culberson regarding Dr. Jadwin?
22 10:52:55 22 A. I'm positive that I would have had numerous
23 10:52:59 23 conversations with Mr. Culberson regarding Dr.
24 10:53:03 24 Jadwin.
25 10:53:03 25 Q. And what would those conversations have
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1 10:53:06 1 been?
2 10:53:06 2 A. At this moment in time I don't have
3 10:53:08 3 recollection of them, but I'm sure that I had them.
4 10:53:11 4 Q. And do you recall -- well, what do you
5 10:53:14 5 recall telling Dr. Culberson about Dr. Jadwin's
6 10:53:18 6 competence or incompetency as a pathologist?
7 10:53:21 7 A. I don't recall -- and, again, I think you
8 10:53:25 8 have to specify in what time period you're talking
9 10:53:28 9 about, but certainly prior to the date that initiated
10 10:53:33 10 his leave of absence, I don't believe that I would
11 10:53:37 11 have made any comment in a negative way regarding his
12 10:53:41 12 competency.
13 10:53:42 13 Q. Okay. Because you had no evidence to show
14 10:53:45 14 that there was an issue of his competency?
15 10:53:49 15 A. That's correct. Well, I wasn't even aware
16 10:53:51 16 that his competency was an issue in this case.
17 10:53:53 17 Q. Well, it certainly wasn't from our view.
18 10:53:57 18 MR. WASSER: It's not from the defense
19 10:53:58 19 either, but keep going, Counsel. We covered that
20 10:54:00 20 before.
21 10:54:00 21 MR. LEE: Okay.
22 10:54:00 22 MR. WASSER: That's why this is all a waste
23 10:54:02 23 of time.
24 10:54:02 24 But keep going.
25 25
HarrisI2
472
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
I, Erika Addis, a Certified Shorthand
IRWIN EVERETT HARRIS, M.D., the witness named in the
foregoing deposition, was by me duly resworn; that said
depo~ition was taken Wednesday, August 27, 2008, at the
» /J~~~_
Erik~ ~ . .£.fl621
WOOD & RANDALL

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26 EXHIBIT 26
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Kern Medical Center FNA Consulting Project
David Lieu, M.D., M.B.A.

Cytopathologist
Assistant Clinical Professor of Pathology
UCLA
May 3, 2004
DFJ00251
Table of Contents
Overview of the Problem 1

External Perspectives 1
Perceptions of the Radiology Department 2
Perceptions of the Pathology Department 2
Perceptions of the Clinicians 3
Illustration of Differences in Perception: Radiology and Pathology 3
Overview of the Solution 3
Recommendation 1 – Existence of an FNA Service 4
Recommendation 2 – Communication in Requesting an FNA 4
Recommendation 3 – FNA Reporting 5
Proportion of Unsatisfactory/Limited FNAs 6
Causes of the High Non-Diagnostic Rate From Statistical Data 7
Recommendation 4 – FNA Data Collection 7
Assistance at FNA Procedures 7
Recommendation 5 – Timing of Assistance at FNA Procedures 8
Radiologist Aspiration 8
Recommendation 6 – Aspiration Technique 8
Sampling of the Mass Using CT Guidance 9
Recommendation 7 – Sampling 9
Caliber of Needle 9
Recommendation 8 – Caliber of Needle for Deep and Superficial FNA 10
Type of Biopsy Needle 10
Recommendation 9 – Type of Biopsy Needle: A Cooperative Study 10
Preparation of Smears for Immediate Cytologic Evaluation 11
Recommendation 10 – Expelling Tissue from Needle onto Slide 11
Recommendation 11 – Types of Slides 11
Recommendation 12 – Determination of Adequacy 11
Number of Passes if Immediate Cytologic Evaluation is not Adequate 12
Recommendation 13 – Number of Passes 12
Core Biopsy 12
Recommendation 14 – Core Biopsy by Organ 12
Recommendation 15 – Core Biopsy: When is it Optional? 13
Laboratory Preparation of Specimen 13
Recommendation 16 – Cell Button and Cytospin 13
Review of Previous Unsatisfactory/Limited FNA Cases 13
Lack of Confidence in Pathology FNA Diagnoses
and Radiology Aspiration Skills 15
Recommendation 17 – New Review System for Imaging Guided FNAs 15
Criticism of FNA Quality 15
Recommendation 18 – New System for Superficial FNAs 16
Concentration of Own Goals 16
Recommendation 19 – Reporting and Follow Up 17
Conclusion 17
DFJ00252
Overview of the Problem
Since 2001 the number of fine-needle aspirations (FNAs) has decreased at Kern
Medical Center (KMC) in Bakersfield, CA. The fraction that is non-diagnostic or less
than diagnostic (unsatisfactory or limited) appears to have increased. As a result, the
clinicians at KMC have lost confidence in the ability of the departments involved,
radiology and pathology, in arriving at a correct FNA diagnosis in their patients with a
mass. Most of the FNAs are imaging guided. They are performed by radiology and
interpreted by pathology. Radiology and pathology in turn blame each other for the
problem. The problems with the FNA service appear to coincide with the arrival of
a new chief of pathology, Dr. David Jadwin, in March 2001. The interventional
radiologists have not changed. Over the past 3 years, 4 other pathologists and 1
cytotechnologist have left KMC for various reasons. To determine the cause of the
problem, the administration at KMC has asked a cytopathologist with expertise in FNA
and affiliated with UCLA for consultation. The methods used in the consultation
included a 1-day onsite visit to KMC on February 13, 2004, observation of an imaging-
guided FNA procedure, interviews with Dr. Jadwin, the interventional radiologists, and
the clinicians, review of some slides on-site, review of 200 unsatisfactory or limited FNA
smears off-site, test staining of FNA smears brought by the consultant, review of some
FNA reports, and delivery of a 1 hour FNA lecture to the medical staff. Administration
has asked the consultant to evaluate various technical aspects of FNA collection,
preparation, staining, and interpretation to try to find the problem. Each of these aspects
will be addressed in the report. However, the consultant has also identified a
behavioral problem that may be the underlying cause of the FNA problem. This will
also be discussed and recommendations will be made.
External Perspectives
The problem of excess non-diagnostic FNAs, both superficial and deep, is not
unique to KMC. It exists in many small hospitals and in outpatient community practice.
At Unilab in California (now Quest Diagnostics), the unsatisfactory (US) rate for
superficial FNAs performed by clinicians is 50%. At Contra Costa Regional Medical
Center in northern California, the non-diagnostic rate was 60% before arrival of a
cytopathologist and an interventional radiologist. After the new specialists came,
the US rate dropped to 10% on imaging guided FNAs and 5% on superficial FNAs.
Professor Lester Layfield (formally a cytopathologist at UCLA and now at the University
of Utah) found that the US rate was 35% for clinicians in west Los Angeles, 15% for
clinicians on the UCLA faculty, and 5% for UCLA cytopathologists.
There are several reasons for the high US rate in many practice environments.
The quality of an FNA is highly correlated with the formal training and experience
of the aspirator. Professor Britt Marie Ljung, director of FNA at UCSF, showed that the
false-negative rate for detecting breast cancer on FNA was 10 times higher for physicians
with no formal FNA training who performed a median of 2 cases per year compared to
formally trained physicians who performed a median of 100 cases per year. Nearly all
false-negatives were due to sampling error.
1
DFJ00253
Not all pathologists are skilled in performing and/or interpreting FNAs. Many are
not experienced in performing superficial FNAs and do not like looking at FNAs. It is
much more difficult to interpret the average FNA than the average core or open biopsy.
An FNA consists of much less tissue and has few architectural clues. Only about 15% of
pathologists in the United States are certified in the subspecialty of cytopathology. Thus,
it is possible for a pathologist inexperienced in cytology to call some FNA cases
unsatisfactory when they are not or negative when they are actually unsatisfactory.
Although the literature is mixed in this area, pathologist assistance of clinicians
for superficial FNAs or radiologists for deep FNAs appears to decrease the fraction of
non-diagnostic cases. However, such assistance is not cost effective from the viewpoint
of the pathologist. The reimbursement from 3rd party payers for immediate cytologic
evaluation of an FNA is inadequate compared to the cost of pathologist time. Professor
Lester Layfield found that the pathology department loses $40-50 per case for assistance
at FNAs. Hence, many pathologists do not want to help at FNAs. However, such
assistance is probably cost effective at the hospital level because some surgical
procedures can be avoided.
Since KMC is a county hospital, cost control at the hospital level is relevant.
Pathologist assistance should continue to be provided to clinicians and radiologists
performing FNAs. This will save money at the hospital level because some operations
can be avoided or the wrong operation will not be performed. However, the pathology
department must be adequately staffed to provide such assistance.
Perceptions of the Radiology Department
There are 2 interventional radiologists at KMC who perform most of the imaging-
guided FNAs. They state that they have extensive training and/or experience in this
procedure. They perceived no problems with FNAs until Dr. Jadwin arrived in 2001.
Since then, they believe that an inordinate number of their aspirations have been
interpreted as US when they are not really US. They believe that Dr. Jadwin is
inexperienced in interpreting FNAs. They no longer have confidence in his pathology
reports. They want to continue performing FNAs rather than referring the cases
out but only if the pathology reports are reliable. There is a large credibility gap. The
radiologists also complain that the FNA reports are difficult to read. The history
section is too long and reflects what the clinicians already know. Most cases have no
microscopic description. The diagnosis is difficult to find.
Perceptions of the Pathology Department
Dr. Jadwin states that he is very experienced in cytopathology and FNA. He feels
that the apparent paradigm shift is due to poor interpretations of FNAs in the past
by the previous pathologists. He believes that many pre-2001 FNAs were called
negative when they were in fact US. The old reports contained no adequacy
statement. He also states that the radiologists do not care about the quality of the
specimens. They do not know the clinical history. They are in an apparent rush to
finish the procedure and do something else. They make additional FNA passes
when Dr. Jadwin is not ready or stop the procedure before adequate tissue has been
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obtained. They refuse to go to pathology to review slides. They do not listen to his
suggestions about FNA technique. In short, he believes that the high US rate is due
to poor technique and failure to listen to advice. Dr. Jadwin wants to continue to
assist in superficial and deep FNA procedures.
Perceptions of the Clinicians
The clinicians believe that the FNA problem is a new one. They do not know if
the problem lies in technique, interpretation, or the system. They think that adequate
clinical history is being provided to the radiology and pathology. In reality, there is
no formal system to insure that clinical information is passed along the proper
channels. They believe that palpable masses are not a problem because there are very
few superficial FNAs. Most of these lesions are surgically excised. Some palpable
masses are still aspirated using CT guidance.
Illustration of Differences in Perception: Radiology and Pathology
There was a recent tumor board in which radiology and pathology participated. A
patient had a CT-guided FNA and core biopsy of a liver mass. The pathology department
interpreted the tissue as suggestive of hepatocellular carcinoma (HCC). On review at
UCLA, it was interpreted as atypical but not diagnostic of hepatocellular carcinoma.
Additional biopsies were suggested. Radiology accused pathology of misdiagnosing the
biopsy. Pathology charged radiology with missing the lesion. Each department blamed
the other.
The consultant reviewed some of the slides and photomicrographs during the
onsite visit. There was adequate liver tissue on the smears and slides. Some cells
showed increased N/C ratio. There were focal areas of endothelial proliferation that
crossed sinusoids. These findings are frequently seen in HCC. However, a definitive
diagnosis would require increased N/C ratio in many more cells and atypical naked
nuclei. A well-differentiated HCC can show modest increased N/C ratio and can be very
difficult to diagnose. Neither department could clearly be “blamed” for this case. There
are limitations to every procedure and limitations to microscopic interpretation. The
correct response would be to learn from the case and proceed to the next step in working
up the patient. Yet radiology and pathology chose to blame each other and learn
nothing.
This incident clearly illustrated that the FNA problem at KMC far exceeds the
high US rate. There is lack of communication and complete distrust between radiology
and pathology with negative ramifications for the clinicians and administration. The
consultant believes this is the core issue. It is not a simple technical issue.
Overview of Solution
In order to solve the problem, new systems must be put in place to increase
the level of communications at the time of FNA request and FNA reporting.
Recommendations will be given both to radiology and pathology to try to increase the
technical quality of the FNA procedure. A new review system for FNAs will be
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suggested to engender trust in the FNA reports. A goal will be set for the radiologists in
their imaging-guided FNAs. A goal will be set for the pathologists for superficial FNAs.
A joint project will be proposed for radiology and pathology to work on together so that
they will be partners instead of adversaries. Finally, a periodic review system will be
suggested so that both departments will be required to report their progress
towards their individual and joint goals.
Recommendation 1 – Existence of an FNA Service
The first question is should KMC even offer an FNA service? An institution of
this size should have many more superficial and imaging-guided FNAs. The procedure is
almost certainly underutilized for various reasons. The opportunity exists to gain
expertise with experience and to reduce the non-diagnostic rate. Both radiology and
pathology want to participate in FNA if trust and open communications can be revived.
KMC should continue to offer superficial and deep FNA procedures rather than referring
them out. Pathology should continue to assist at superficial and deep FNA procedures.
Pathology should be adequately staffed to provide such assistance. Assistance is not cost
effective at the pathology department level but is cost effective at the hospital level.
Recommendation 2 – Communication in Requesting an FNA
There is no formal written system of communication for FNA procedures.

Representatives from clinical medicine, radiology, and pathology should meet to
design a 1-page request form for FNAs. The form should be divided into thirds. The
top third is for the requesting clinician to indicate the requested procedure and to provide
all relevant clinical details. Essential information would include the size and location of
the mass, the clinical impression based on the history and physical examination, and any
history of cancer and subsequent treatment. Other relevant history should be provided on
a case by case basis. For example, if the patient has a liver mass and hepatocellular
carcinoma is a possibility, the results of an AFP and hepatitis markers should be given. If
the patient has enlarged lymph nodes, the duration of the nodes, any growth, and the
presence or absence of anemia or “B” symptoms should be noted. If there are outside
films or slides to be reviewed, their existence should be noted on the form and the
clinician should have the patient sign a release to get them. After the form is filled out by
a clinician, it should be sent to the department doing the aspiration. The form should be
in triplicate (i.e. the original plus 2 carbon copies) so that each participant in the FNA has
a copy.
The middle third of the form is for the radiologist. He should review the written
clinical information and note the radiological findings. At minimum, the size, location,
and character of the mass should be noted. Other relevant imaging findings should be
noted. For example, if a retroperitoneal mass is to be aspirated and the radiologist also
notes an enlarged spleen, that information should be recorded so that the pathologist can
obtain RMPI at the time of aspiration to collect cells for flow cytometry to rule out
lymphoma.
The lower third of the form is for the pathologist. The form should be available to
him at the time of the FNA. He should note the relevant clinical and radiological
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findings. He can use the form to take notes during the FNA procedure and note any
special studies that are done, such as culture, flow cytometry, etc. The pathologist can
attach an additional worksheet for his note if he needs more space.
Recommendation 3 – FNA Reporting
The FNA reports are difficult to read. Part of this problem is due to outdated
software that does not allow different size fonts or bold face type. Part of the problem is
also due to a long clinical history on many FNA reports and lack of a microscopic
description. The microscopic description and the diagnosis are the parts that are of added
value in an FNA report. The solution is 2-part: short run and long run.
In the short run, the software cannot be changed. Although a detailed clinical
history may help the pathologist formulate a diagnosis, it does make the report more
confusing to the clinician and adds little value. In short, the pathologist is writing to
himself. Therefore, the FNA report should be limited to 1 page. In complicated cases,
which should not exceed 10% of cases, the report can be 2 pages. The report should
contain a short microscopic description and an adequacy statement or other
indicator of the quality of the specimen.
The adequacy of a specimen should be categorized by 1 of 3 descriptors: 1)
adequate 2) unsatisfactory or 3) undetermined - pending further work-up. Adequate
describes specimens that are diagnostic of malignancy or benign and explain the patient’s
findings. Unsatisfactory describes specimens that are acellular, consist mostly of blood,
markedly hypocellular, poorly fixed, crushed, very thick, or otherwise impossible to
make any reasonable diagnosis. Indeterminate would be reserved for specimens in which
some cells possibly from the lesion are present but it is not possible to make a definitive
diagnosis. Further work up may be indicated. This would be similar to BIRADS
category 0 on a mammogram. Examples of cases that might be indeterminate on FNA
are as follows:
1. Questionable liver masses on CT scan. FNA shows atypical hepatocytes.

Are these regenerative nodules or well-differentiated HCC? Was a
malignant nodule missed?
2. Lung mass on CT scan. FNA shows caseous necrosis only. Is this a
necrotic tumor or infection?
3. Density in lung on CT scan. Lesion is very fibrous and FNA shows scant
fibrous tissue and chronic inflammatory cells. Is this just a scar or a
carcinoma with desmoplasia?
4. Livers masses on CT scan. FNA shows many PMNs. Are these abscesses
from ascending cholangitis or is there distal tumor causing biliary
obstruction and abscess formation proximally?
The indeterminate category defers the question of whether the lesion was
adequately sampled until the patient has more work up. It also does not count as an
unsatisfactory FNA until more information is obtained. In some cases, the lesion may
have been missed. The size and location of the lesion will have a great influence on the
ease of sampling. If large, easily accessible masses are consistently missed, then there
might be a problem with aspiration technique. If most masses that are missed are small
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and located in difficult-to-aspirate areas, then no such problem exists (see

recommendation 4 regarding FNA data collection). In other cases, the nature of the
lesion can cause an indeterminate FNA. A fibrous mass usually yields few cells no
matter how skilled the aspirator. A biopsy, either via core needle or open, may needed to
find the cause. Tumor or coccidiomycoses can cause caseous necrosis in the lung.
Cultures and further biopsies may be indicated. Cases in the undetermined category can
be subclassified later as to cause – sampling error or nature of the lesion. A
recommendation will follow on how to minimize pathology interpretive error on these
cases (see recommendation 17).
In the long run, the software can be changed. With the new software, the report
can be any length. If the pathologist believes a detailed clinical history is required, he
can dictate one. However, a microscopic description and adequacy statement should still
be done. The diagnosis should be easy to find and highlighted either in a consistent
location, large font, or bold face. The radiologists and clinicians should be able to skip
the long report and find the microscopic description, statement of adequacy, and
diagnosis quickly.
Proportion of Unsatisfactory/Limited FNAs
The initial problem that grew into the present FNA problem was the increased
proportion of unsatisfactory/limited FNA reports after Dr. Jadwin arrived in 2001. The
radiologists and clinicians perceived no problems with the previous pathologists. To
determine if the fraction of non-diagnostic FNAs had really increased, a statistical
analysis was done on the FNA data provided by pathology. It is summarized below.
Year FNAs %Unsatisfactory/Limited
1996 87 39%
1997 81 16%
1998 53 32%
1999 66 9%
2000 62 29%
2001 58 55%
2002 54 39%
2003* 21 38%
* 6 months of data
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From 1996-2000, there were 349 FNAs of which 25% were unsatisfactory or
limited. From 2001-2003, there were 133 FNAs of which 46% were not diagnostic.
The null hypothesis that the fraction of non-diagnostic FNAs had not increased was
tested using a 1-tail z-statistic using a rejection rule of α = 0.05 (z = 1.96). The result was
a z-statistic of 4.28. Therefore, the null hypothesis was rejected and the alternative
hypothesis that the fraction of non-diagnostic FNAs had increased was accepted. The
fraction of non-diagnostic FNAs had increased over the past few years.
Causes of the High Non-Diagnostic Rate From Statistical Data
The pathology department collected extensive data on past FNAs. This data
included the adequacy of the aspiration, the anatomic site, and the pathologist interpreting
the smears. This data was analyzed to determine what factors affected the adequacy of
the specimen. A logistic regression model was devised using the statistical program E-
Views. The dependent variable was the adequacy of the specimen. The independent
variables were the interpreting pathologist and the anatomic site. Since this data was
qualitative, dummy variables were used. The model showed that the anatomic site was
the most important factor in determining the adequacy of a specimen. It was
statistically significant at an α = 0.05 level at most sites. In contrast, none of the
pathologists individually had a statistically significant effect on the outcome.
However, Dr. Jadwin did have a slightly negative effect on adequacy compared to the
other pathologists but it was not statistically significant. A Wald test was performed to
test the hypothesis that the pathologists jointly had no effect on outcome. The test failed
at the α = 0.05 level, which meant that jointly the pathologists had an effect on
outcome but not individually. The most important factor in determining adequacy was
the anatomic site. Liver and abdomen were the sites most likely to be successfully
aspirated.
This model suffers from the flaw of omitted variables. Two important variables
were missing from the data available from the pathology department: the name of
the physician performing the FNA and the size of the mass. As mentioned previously
in this report, the experience of the aspirator is critical in determining the adequacy of an
FNA. Most false-negatives are due to sampling error. Also, the size of the mass is
important. Large masses are much easier to aspirate than small ones. Dr. Anwar Padhani
found that the diagnostic accuracy for masses < 1.0 cm. in the lung was 50% compared to
80% for masses > 3.0 cm.
Recommendation 4 – FNA Data Collection
In addition to the data currently collected, the pathology department should

also record the name of the aspirator and the size of the lesion (either the largest
dimension or all 3 dimensions). This data may be useful in future analyses of FNA
adequacy.
Assistance at FNA Procedures
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Radiology currently notifies pathology of a scheduled FNA during the morning of

the aspiration. It then calls again about 5 minutes before a pathologist is actually needed.
The pathology department sends a technician to radiology first. After she has labeled the
slides or even made some of the smears, she calls the pathologist. The pathologist
usually arrives within 1-2 minutes. He makes at determination of adequacy after
examining one or more slides stained by rapid H&E.
There is some disagreement about when the actual aspirations should be done –
when the technician is ready or when the pathologist is present? Dr. Jadwin has
complained about the radiologists performing aspirations when he is not ready or
even completing the procedure and leaving the CT scan room before he arrives. On
the other hand, the arrival of the pathologist at the last minute could be perceived as an
elitist approach. Therefore, the following procedure is recommended to put an end to the
bickering of who should do what and when.
Recommendation 5 – Timing of Assistance at FNA Procedures
Radiology should notify pathology of an FNA procedure requiring pathologist

assistance no later than the morning of the procedure. Twenty-four hours notice should
be given if possible. Rare emergency FNAs would be an exception. Approximately 5-
10 minutes before the first pass will be done, radiology should call pathology again.
At that time both the pathologist and technician will go to radiology. The technician
will label slides, set up the stains, focus the microscope, and check the paperwork. The
pathologist will review the clinical history and scans with the radiologist. They should
discuss the differential diagnosis and the approach to the aspiration. Should the
edge or center of the lesion be aspirated? Will a core biopsy be needed? Should cultures
be done? If necessary, the clinician should be contacted to get additional information.
After the history and scans have been reviewed and the slides, microscope, and stains are
ready, the radiologist will perform the first pass when the pathologist states that he
is ready. If additional passes are needed, the radiologist will perform each subsequent
aspiration when the pathologist states that he is ready.
Radiologist Aspiration
The consultant observed one of the radiologists performing a CT-guided FNA of a

non-palpable neck mass. He appeared to be skilled in performing the procedure. He was
also receptive to suggestions that might improve the quality of tissue obtained.
However, Dr. Jadwin and radiologists do not communicate at this level. This suggests
that a breakdown in communication is the fundamental problem. This bridge was burned
down long ago. Therefore, the following recommendations will be made to try to
improve the technical quality of the aspirations.
Recommendation 6 – Aspiration Technique
The first pass on most masses should be performed using the French (or
Zajdela) technique. This is essentially FNA without aspiration. After the needle is
placed into the mass and the stylet is removed, the needle should be moved back and
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forth 10-15 times in the mass while no syringe is attached (i.e. no suction). The needle
should then withdrawn from the patient and handed to the pathologist. This technique
obtains tissue by the scraping of the mass by the beveled needle and capillary action.
Less tissue is obtained than FNA with suction but there is much less blood. In many
cases, FNA without suction can yield better tissue than standard technique with
suction. Also, the radiologist can often tell if he is actually in the lesion by the resistance
of the needle in the mass during the FNA. If the pathologist states that the tissue appears
good with this technique, additional passes using the French technique can be done.
After completing 1 or more passes by the French technique, the radiologist can
use standard technique if more tissue is necessary. However, only slight suction (1-2
ml.) should be used. High suction only leads to a lot of blood. If no blood appears in
the hub of the needle during the FNA, make 10-15 back and forth motions of the
needle in the mass. Do not keep moving the needle until blood appears in the hub.
If blood starts to appear in the hub during the FNA, make no more than 10 back and forth
motions in the mass. If blood appears in the hub immediately upon insertion into the
mass, make 5 back and forth motions in the mass.
If suction is used, it must be released for 2-3 seconds before the needle is
withdrawn from the patient. This allows pressure in the syringe to equalize to the
atmosphere. If the needle is pulled out too quickly, the aspirate will be sucked into the
syringe and the non-diagnostic rate will increase to 60%.
Sampling of the Mass Using CT Guidance
During the observed FNA, the radiologist placed several aspiration needles
into the mass using CT-guidance before any aspirations were done. The needles
stayed in place and were removed one by one as each was used do an FNA. This is not a
technique that the consultant has seen done at UCLA or anywhere else. It appears to save
time because several FNA needles can be placed before the pathologist arrives.
However, it could result in increased bleeding since the needles are in the mass for a
long time. This could compromise the quality of the specimen.
Usually the interventional radiologist places a needle at edge of or in a mass and
confirms its location by CT scan. He then proceeds with aspiration. The problem with
this technique is that it takes a lot of time because a scan must be done with each needle
pass.
Recommendation 7 – Sampling
The coaxial technique may be a good compromise. The radiologist places a larger
guide needle (18-gauge) at or near the edge of a mass and confirms its location by CT
scan. He then advances a smaller aspiration needle (22-gauge or 20-gauge) through the
larger needle deeper into the mass and performs the FNA. Several FNAs can be done
this way without the need for re-scanning. This latter technique was used successfully by
an interventional radiologist who worked closely with the consultant for several years in
the Bay Area. The diagnostic rate was over 90%. If several FNAs with the guide
needle in one position do not yield good specimens, the guide needle should be
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repositioned using CT guidance and the FNA repeated. The coaxial technique should be
tried.
Caliber of Needle
Unlike core biopsy, a large caliber FNA needle is not desirable. It results in a
very bloody FNA and clotting in the needle itself. The former obscures cells and
compromises fixation. The latter can cause diagnostic cells to stay in the needle or
syringe and never make it to the slide. The general rule for FNA is to use the smallest
possible needle that gets tissue without a lot of blood. For FNA of deep-seated lesions,
too thin of a needle will not work because it will bend. A reasonable compromise
between bleeding, amount of tissue, and bending of the needle on deep FNAs is as
follows.
Recommendation 8 – Caliber of Needle for Deep and Superficial FNAs
A 22-gauge needle should be used for most CT-guided FNAs. If the lesion is too
fibrous to be aspirated with a 22-gauge needle, a 20-gauge needle should be tried. The
radiologist will be able to feel if a lesion is fibrous if the first 1-2 passes are done using
the French technique.
If a thyroid is aspirated using sonogram guidance, a 27-gauge 1¼” needle should
be used. The French technique is very useful in this organ because it causes very little
bleeding. This is especially significant because excess bleeding can make colloid
difficult to identify. Occasionally, a 25-gauge needle may be needed to obtain tissue.
This can occur in cases of Hashimoto’s disease, subacute granulomatous thyroiditis, and
when draining cysts with thick contents.
Almost all other FNAs of superficial masses can be done using a 25-gauge needle.
Occasionally, a 23-gauge needle will be needed. In general, start with the smaller
needles rather than the larger ones.
Type of Biopsy Needle
There are many types of FNA needles on the market. The one a radiologist might
choose relates to personal preference and availability. Radiologists at KMC currently
use the Turner biopsy needle. This needle appears to have a short bevel, which
could decrease the area available to scrape cells in a mass. Since it is not clear
which needle is best, the radiologists and pathologists at KMC should participate in
a study to determine what works best at KMC. By cooperating in a study, they will be
working together toward a common goal – to determine what needle works best – instead
of blaming each other for problems.
Recommendation 9 - Type of Biopsy Needle: A Cooperative Study
Pathology and radiology should jointly cooperate in a study of FNA needles.

The radiologists should order 4 types of biopsy needles for this study: Turner,
Chiba, spinal, and notched aspiration biopsy. The latter is the needle used by Dr.
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Michael Price, the interventional radiologist who worked closely with the consultant
for many years. It can be ordered from Boston Scientific Medi Tech at 800-225-
3238. The order number is 40-503-M001405030. It is 13 cm. long and is available in
22-gauge and 20-gauge.
The study should be done as follows. All 4 types of these needles should be
ordered in 22-gauge and 20-gauge. Each of these needles of the same gauge should be
used during an imaging-guided FNA if that many passes are being done. A different type
of needle should be used for each pass. The radiologist should let the pathologist know
what needle is being used for each pass. The pathologist should record the needle type
and technique (French or standard) on his worksheet. The pass number should be written
on the slide so that the needle associated with it can be identified later. The order of the
needles being used should be randomized on different patients. After collecting data
from several dozen FNAs, the pathologist and radiologist should have information on the
type of needle that seems to work best. The best needle can then be adopted for future
cases.
Preparation of Smears for Immediate Cytological Evaluation
Dr. Jadwin used standard technique for expelling the aspirate from the slide,
making smears, fixing them, and preparing a cell button. He then reviewed a
stained smear and told the radiologist whether or not it was adequate.
The previous recommendations regarding French technique, caliber of needle, and
number of back and forth motions of the needle can help decrease bleeding. However,
some bleeding is inevitable no matter how skilled the aspirator. If there is significant
blood in the needle, it can clot and make it difficult to expel the aspirate onto a slide.
Recommendation 10 – Expelling Tissue from Needle onto Slide
Instead of using air in a syringe to expel the aspirate, the pathologist should
use the stylet of the needle (which the radiologist has removed and is no longer
using) to gently push the aspirate out of the needle onto the slide in a controlled
manner. This technique will avoid the problem of a clot being forcibly expelled from
the needle due to high air pressure from the syringe followed by all the unclotted
aspirated tissue splashing onto one slide or all over the table. The consultant learned this
technique from an interventional radiologist, not another cytopathologist, and always uses
it for imaging-guided FNAs using a long needle.
Recommendation 11 – Type of Slides
FNA material should be placed on positively charged slides instead of regular

slides. It might help the tissue stick better and minimize the loss of tissue during
processing. These special slides are used by the consultant in his FNA clinic and by
cytopathologists at UCLA.
Recommendation 12 – Determination of Adequacy
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Since a double headed microscope is available in the CT room, both the

pathologist and radiologist should look at the immediately stained smear together.
This will give the radiologist a better idea of what constitutes an adequate specimen and
engender a spirit of teamwork. It will also give positive feedback to the radiologist on
cases in which he has obtained an adequate specimen. As previously recommended, just
prior to the FNA the pathologist and radiologist should look at the scans together.
By looking at each other’s work, pathology and radiology will have a better appreciation
of the challenges that each faces. It will open channels of communication.
Number of Passes if Immediate Cytologic Evaluation is not Adequate
If immediate cytologic evaluation shows that an aspirate is not adequate, there

are no hard guidelines on the number of passes that should be attempted before
giving up. Studies have shown that the marginal yield markedly decreases after 4-5
passes. Patient safety is also an issue. It is more risky to do more passes in the lung
than in the retroperitoneum.
Recommendation 13 - Number of Passes
If diagnostic tissue is not obtained after 1-2 passes on an imaging-guided

FNA, up to 4-6 passes total should be attempted. Fewer passes might be done if
patient safety is an issue or if complications set in. More passes should be attempted if
the patient tolerates the procedure well and both pathologist and radiologist agree
that it is worthwhile to continue.
Core Biopsy
There is a question of when a core biopsy should be done with an FNA. The
answer depends on the clinical situation and site. A core biopsy is easier to interpret than
an FNA. It also gives architecture, which is usually absent or more difficult to detect on
an FNA. However, a core biopsy causes more bleeding and can have more
complications. It also increases costs.
Recommendation 14 – Core Biopsy by Organ
Core needle biopsy should not be performed in the thyroid. It causes excess
bleeding. FNA with a 27-gauge 1¼” or occasionally with a 25-gauge 1” or 1½” needle
will usually suffice. In skilled hands, FNA of the thyroid will be satisfactory about 85-
90% of the time.
Solid non-palpable breast masses should undergo core needle biopsy rather
than be aspirated. The reason is that significant non-palpable lesions detected by
imaging are often atypical hyperplasia, low-grade ductal carcinoma, lobular carcinoma,
or tubular carcinoma. These lesions are diagnosed by evaluating cytology, architecture,
and extent. FNA only gives cytology. That is, FNA might give a false-negative
diagnosis. Non-palpable breast masses, architectural distortions, or asymmetries should
have 6-8 needle cores. Indeterminate or suspicious calcifications should have 8-10
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needle cores. The tissue should be placed in formalin. Pathologist assistance at the core
biopsies is usually not needed. The tissue obtained should be examined at several levels.
An alternative to imaging-guided core biopsy of the breast is excisional biopsy following
needle localization.
A core needle biopsy is very useful when a primary hepatocellular carcinoma
(HCC) is suspected. It is difficult or impossible to diagnose well-differentiated HCC by
cytology alone. Architecture is very helpful. When immediate cytologic evaluation of a
liver FNA raises the possibility of a primary hepatic neoplasm, further generous aspirates
should be submitted for cell button and several core needle biopsies should be done.
Recommendation 15 – Core Biopsy: When is it Optional?
In other sites, the pathologist and radiologist should decide whether a core needle
biopsy should be done along with FNA. After examining one or more smears, the
pathologist should let the radiologist know if a core biopsy is needed. It might be needed
if the FNA is not adequate (e.g. the mass is fibrous), the FNA is adequate but cellularity
is low, architecture is required, IHC stains may be needed, lymphoma is suspected, etc.
If the pathologist requests a core needle biopsy, the radiologist should obtain one or more
cores if he believes it is safe to do so. If a core needle biopsy will be done, it should be
done after all the FNAs have been completed since the former causes more bleeding.
Laboratory Preparation of Specimen
The Pap staining-technique at KMC was tested by the consultant. Three

unstained alcohol-fixed slides from the consultant’s FNA practice were brought to KMC
pathology for staining. The Pap stain was adequate. No cells were lost. The quality
was similar to that in the consultant’s laboratory.
Review of some cytospin and cell button preparations at KMC also showed
that they were adequate. Cell button preparations are routinely done on imaging-
guided FNAs. However, cytospins were also done on a palpable thyroid mass from the
previous day. A recent study by Professor Katherine Liu at Duke University showed that
routine cell buttons had a marginal cost $1906 per additional diagnosis not seen on the
smears. Routine cytospins had a marginal cost of $7736 per additional diagnosis not seen
on the smears. A cell button is cost effective only if an immediate stain of the FNA is not
diagnostic. Routine cell buttons and cytospins are not cost effective.
Both alcohol-fixed and air-dried smears should be prepared on all FNAs. Usually
more of the former should be made. However, extra air-dried smears should be made on
FNAs of the thyroid (to help identify colloid) and in possible cases of lymphoma.
Recommendation 16 – Cell Button and Cytospin
Cell buttons and cytospins should not be routinely done on FNAs. If a serous
fluid is aspirated, a cytospin should be done. If immediate cytologic evaluation is not
diagnostic, a cell button should be made (along with a core needle biopsy in certain
locations – see previous recommendation). In imaging-guided FNA (as opposed to
superficial FNA), the needle and syringe should be rinsed to collect a cell button. It can
be saved and processed if the smears are not diagnostic.
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Review of Previous Unsatisfactory/Limited FNA Cases
The consultant on a blind basis reviewed approximately 200 slides from

previous cases that were deemed unsatisfactory or limited (less than diagnostic).
Minimal clinical information was provided. Overall, the consultant agreed that
nearly all the cases were either non-diagnostic or limited in diagnostic value. The
review diagnoses closely mirrored the original diagnoses in most cases. The
consultant found no obvious problems with the pathologic interpretation of FNAs at
KMC. Many cases had either excess blood or scant cellularity. Some had air-
drying artifact that made interpretation difficult. Some cases had marked necrosis.
Some were fibrous or inflamed. A few showed non-neoplastic tissue. In some cases,
there cells in the middle of thick blood clot that made interpretation difficult or
impossible.
A positive diagnosis of malignancy on FNA has 4 requirements: 1) adequate
cellularity 2) sufficient cytological atypia in well preserved cells 3) monomorphic cell
pattern 4) cellular dyshesion. If fewer criteria are employed to diagnose malignancy, a
false-positive diagnosis can result. Not every FNA of a malignant tumor will have all 4
criteria on the smears. For example, it may be impossible to obtain sufficient cellularity
in a desmoplastic tumor. A low-grade cancer with minimally abnormal cells or cohesive
cell pattern will not result in a positive cytologic diagnosis. There are limitations of
FNA. For example, cases F00-32 and N03-91 had a few very suspicious cells. However,
there was insufficient cellularity to fulfill criterion 1. Case N02-230 had sufficient
cellularity and an abnormal pattern, but all the cells were necrotic and did not fulfill
criterion 2. Case N02-240 had too much air-drying artifact to make any definite
conclusions, which violated criterion 2.
If a case is interpreted correctly but is not diagnostic, the default conclusion
should not be the aspiration was done poorly or unskillfully. In many cases, the nature
of the lesion is the cause of the unsatisfactory FNA. For example, many of the cases
reviewed showed only caseous necrosis. This could be caused TB, coccidiomycoses,
necrotic tumor, etc. The needle indeed sampled the mass. However, the exact cause of
the lesion could not be determined by the smears. If it is recognized at the time of
immediate cytologic evaluation, cultures should be taken and additional aspirates should
be made to look for possible viable tumor cells. There should be cooperation between
radiology and pathology to find the cause, not a rush to blame each other.
If a mass is hypocellular at immediate cytologic evaluation due to apparent
fibrosis, larger needles should be used. Core needle biopsies should be taken. No one is
to blame if adequate cells cannot be obtained. It is caused by the nature of the lesion.
It may not be possible to determine if an FNA is adequate even after all slides are
reviewed. Clearly if the FNA reveals a malignancy or a specific benign cytologic
diagnosis that explains the clinical and radiological findings, the FNA is adequate. What
if only fibrosis or non-neoplastic tissue consistent with origin from the organ sampled is
seen? The patient either has fibrosis only, does not really have a mass, or has a
malignancy in which malignant cells were not obtained (e.g. geographic miss,
desmoplasia, etc.) Cytology by itself will not answer this question. The correct
procedure is to go back to the clinical and radiological findings to decide whether more
14
DFJ00266
invasive procedures should be performed (e.g. laparoscopy, open biopsy, etc.). The
answer to whether an FNA with these findings was really adequate may have to wait until
after an open biopsy (for a suspicious mass) or a period of clinical observation (for a non-
suspicious radiological abnormality). In other words, one may need the final answer
before retrospectively deciding if an FNA was really adequate. The question of adequacy
in FNA is much more difficult to answer than in gynecological Pap smears using
Bethesda 2001.
Lack of Confidence in Pathology FNA Diagnoses and Radiology Aspiration Skills
The problems with FNA at KMC have led to mutual distrust between radiology
and pathology. They have escalated to a breakdown in communications and to mutual
fault finding. Each FNA is an opportunity to blame each other if the case is not
diagnostic. Pathology does not trust radiology to make good aspirations. Radiology
does not trust pathology to make good interpretations. Observation of the
radiologists performing the FNA, watching the pathologists making and staining the
smears, and reviewing previous FNA smears have only limited value in rebuilding lost
confidence. The issue of who did the review, possible bias for one party or the other, and
the limitations of retrospective review (e.g. lack of opportunity to review all the clinical
and radiological findings, second-guessing after the fact, etc.) will always arise. What is
needed is a new prospective system to restore confidence in future FNAs.
Recommendation 17 – New Review System for Imaging-Guided FNAs
No major discrepancies were discovered in a slide review of previous

unsatisfactory/limited FNAs from KMC. However, this is a review of the past. It will
not magically engender trust in the interpretation of future FNAs. A new system is
needed to reestablish trust. To restore confidence, all imaging-guided FNAs that are
deemed to be unsatisfactory or limited (e.g. unsatisfactory or indeterminate) should
be automatically referred to UCLA for a second opinion. All relevant clinical and
radiological information, including scan reports, should be sent along with the
slides. At UCLA, a cytotechnologist screens all FNAs. There are no cytotechnologist
screeners at KMC. At least one cytopathologist reviews every FNA at UCLA. The study
period should be 1 year. The radiologists will know that if pathology calls a case
unsatisfactory or indeterminate (e.g. possible sampling error or poor technique), expert
cytopathologists will review the case. This system will prompt pathology to review all
cases carefully. It would be embarrassing to pathology if many cases initially called non-
diagnostic are called diagnostic by experts. On the other hand, if UCLA agrees that
most of the referrals of non-diagnostic cases are indeed non-diagnostic, radiology
would be embarrassed because it could indicate poor sampling or aspiration
technique. The bottom line is that radiology will be motivated to do careful aspirations.
Pathology will be motivated to make careful interpretations. The goal of this new
system is to have less than 20% unsatisfactory or indeterminate cases due to
geographic misses or sampling error in the first year.
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DFJ00267
There should a number of cases in which it was no one’s “fault” that the FNA was
not diagnostic. For example, a benign fibrous scar or a desmoplastic carcinoma in the
lung could both be interpreted as unsatisfactory or indeterminate on FNA. Only an open
biopsy will reveal the true nature of the lesion. No one is to blame for such a non-
diagnostic FNA.
Criticism of FNA Quality
One of the perceived problems may be that pathology is always the critic and
never an active participant in FNA. It is easy to criticize aspiration technique if one
does not actively perform the aspirations and know of the difficulties. It is similar to
being a movie or theater critic but never being a director or actor. Pathology needs to
participate more fully in the FNA service than only being a judge. By being a
participant as well as a judge, it will have more credibility.
Recommendation 18 – New Superficial FNA Service
Since Dr. Jadwin is experienced in cytology, he should set up a superficial

FNA service at KMC for patients with palpable masses. A pathologist should be
available within 30 minutes to perform an FNA on a patient with a palpable mass on the
hospital grounds during regular working hours. A 2-hour FNA clinic once a week should
also be reserved for pathologist performed FNAs. A nurse or technician should assist the
pathologist. The clinic is for scheduled FNAs for patients who were seen off the hospital
grounds and are being referred for an FNA. It is also for KMC clinic patients with a
palpable mass when an FNA cannot be done be done within 30 minutes due to personnel
shortages, lack of space in a clinic, patient time constraints, etc. The pathology
department should be adequately staffed to provide such a service since other stat
procedures (e.g. frozen sections) also require immediate attention.
The new pathologist FNA service for palpable masses should decrease the
number of excisional biopsies at KMC. Clearly, an institution the size of KMC should
have more superficial FNAs. The clinicians believe that there is no real problem with
superficial FNAs. However, the consultant believes that there is a hidden problem
because it is underutilized. Excisional biopsy may be overutilized. Palpable masses
should not, in general, be aspirated using imaging guidance. The goal of superficial FNA
is to attain a non-diagnostic rate of less than 10%. Since KMC is a teaching hospital, Dr.
Jadwin can teach or supervise residents in doing FNAs on their own patients. The
consultant previously taught many family practice residents to do FNAs. The first few
passes should be done by Dr. Jadwin to assure adequate tissue. The resident should then
perform several passes. Local anesthesia is recommended.
One of the benefits of a pathologist directed and performed superficial FNA
service is to increase the credibility of the department if the service is well run. For
example, if most of the FNAs are adequate and ultimately shown to be correct, physicians
will have confidence in FNAs done at KMC. This will extend to interpretations on
imaging-guided FNAs.
Concentration on Own Goals
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DFJ00268
The new system for review of imaging guided FNAs and the pathologist
performed superficial FNA service will give radiology and pathology new goals on which
to concentrate instead of blaming each other for non-diagnostic FNAs. Radiology needs
to achieve fewer than 20% non-diagnostic cases on imaging-guided FNAs. Expert
review of non-diagnostic cases will be provided by UCLA. Pathology will start a new
superficial FNA service with a goal of fewer than 10% non-diagnostic cases on palpable
masses. Both departments will cooperate in the needle study to determine which type of
needle works best at KMC on imaging-guided FNAs.
Recommendation 19 – Reporting and Follow Up
The ad hoc FNA committee should provide supervision of the implementation of

these recommendations. After all interested parties have had a chance to review the
report, it should meet to determine which recommendations should be implemented.
A time table should be set up. Quarterly meetings for the next year should be scheduled.
At these quarterly meetings, progress should be reported. How many superficial and
imaging-guided FNAs were done last quarter? What was the non-diagnostic rate on
each? What were the non-diagnostic cases called at UCLA? What did the follow up and
subclassification on the indeterminate cases show? What is the progress on the needle
study?
Conclusion
The FNA problem at KMC may have started with a different paradigm for
interpretation of FNAs. It has escalated to a breakdown of communications
between clinical medicine, radiology, and pathology. There is deep mistrust between
radiology and pathology.
The recommendations in this report deal both with technical issues and behavioral
issues. The technical suggestions regarding number of aspirates, type of needle,
aspiration technique, smear technique, etc. are aimed in trying to attain marginal
improvement in technical quality.
More importantly, the recommendations on new systems for FNA are aimed at
correcting the miscommunication and distrust. The new FNA request form should foster
better communication. The FNA report format should give added information and be
more concise. The mandatory review of all non-diagnostic deep FNAs at UCLA will re-
establish trust that the smears are being interpreted correctly. However, radiology now
has an objective on which to concentrate – less than 20% non-diagnostic cases in the
first year. It will report to the ad hoc committee. Similarly, pathology will establish a
new superficial FNA service. It has the opportunity to demonstrate the expertise that it
claims to have in cytology. It has a goal of less than 10% non-diagnostic cases in the
first year. It will also report to the ad hoc committee.
Finally, both radiology and pathology will work together to find the best
needle for deep FNAs. This is a project for which both departments will be
responsible.
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DFJ00269
An effective FNA service is the product of dedication and hard work by all
physicians involved. It will not happen in a few weeks or a few months. Aspirators get
better with experience, even after many years. Pathologists get better with experience,
even after many years. At UCSF, physicians with no experience in FNA started with an
unsatisfactory rate of 60%. Two years later, after much experience and mutual support,
these same physicians had an unsatisfactory rate of 5%. This is not an unreasonable time
frame for KMC. If the recommendations are implemented and the physicians involved
are truly dedicated to improving the service instead of bickering and passing blame, the
FNA service will truly be a service to the physicians and patients of KMC.
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DFJ00270
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27 EXHIBIT 27
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1
3 ______________
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
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9 )
Defendants. )
10 __________________________)
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15 OF
16 JENNIFER JANE ABRAHAM, M.D.
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AbrahamJ
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1 14:09:04 1 the conclusion that he couldn't find any
2 14:09:05 2 discrepancies in Dr. Jadwin's pathology reports?
3 14:09:09 3 A. I don't -- no. I don't think there was
4 14:09:09 4 any -- yeah. I mean, I don't think in the report
5 14:09:12 5 said anything about discrepancies in his pathology.
6 14:09:14 6 I think that's true.
7 14:09:15 7 Q. Okay. So Dr. Lieu -- you recall Dr. Lieu
8 14:09:16 8 finding that he was corroborating Dr. Jadwin's
9 14:09:19 9 pathology reports. Correct?
10 14:09:21 10 A. I'm sure you have this report in your
11 14:09:24 11 file --
12 14:09:24 12 Q. We do.
13 14:09:25 13 A. -- and so I would refer to that because the
14 14:09:29 14 black and white is better than my memory.
15 14:09:30 15 Q. Sure. Sure.
16 14:09:31 16 A. My memory, as I recall the evaluation by
17 14:09:34 17 Dr. Lieu, had more to do with the process of
18 14:09:37 18 obtaining the pathology reports. And when we read it
19 14:09:41 19 I -- I -- my remembrance is that we still were not
20 14:09:47 20 satisfied with whether or not the -- the pathology
21 14:09:50 21 readings of the FNA was -- was -- was adequate. That
22 14:09:58 22 is my remembrance.
23 14:10:00 23 Q. Sure.
24 14:10:00 24 A. And -- and so then I believe what happened
25 14:10:02 25 was that's when we said, let's just send these
AbrahamJ
63
1 14:18:00 1 was the reason for the request for -- for overreads;
2 14:18:04 2 so that -- so that we could improve our ability to
3 14:18:10 3 trust the readings of our pathologist.
4 14:18:14 4 Q. Okay.
5 14:18:15 5 A. So I don't think at the time we had come to
6 14:18:19 6 the conclusion that the pathologist -- that the
7 14:18:22 7 pathology readings were incorrect. The problem was
8 14:18:24 8 that we didn't know.
9 14:18:27 9 Q. Okay.
10 14:18:27 10 A. And I don't recall that having this report
11 14:18:36 11 did -- did an adequate -- did adequately improve that
12 14:18:42 12 trust.
13 13 BY MR. LEE:
14 14:18:43 14 Q. Okay. So, in other words, after Dr. Lieu
15 14:18:46 15 issued this FNA report, there still remained doubts
16 14:18:49 16 about Dr. Jadwin's competence as a pathologist?
17 14:18:52 17 A. Yes.
18 14:18:53 18 Like I said, the purpose was not -- you
19 14:18:55 19 know, you mentioned before peer review, but I'm
20 14:18:58 20 recalling now it wasn't for peer review. It was to
21 14:19:01 21 improve the trust --
22 14:19:02 22 Q. Okay.
23 14:19:02 23 A. -- so that the physicians could then say,
24 14:19:04 24 okay, look. Our pathologist is correct. I mean, it
25 14:19:08 25 was a new pathologist, he'd gotten rid of the ones we
AbrahamJ
67
1 14:21:49 1 Well, take a look at that middle paragraph
2 14:21:52 2 or second from the bottom. It's called Radiologist
3 14:21:54 3 Aspiration.
4 4 A. Um-hmm.
5 14:21:55 5 Q. Do you see that?
6 14:21:56 6 A. Yes.
7 14:21:56 7 Q. And here Dr. Lieu is explaining his
8 14:21:59 8 observation of the radiologists in this report.
9 14:22:07 9 A. Breakdown in communication is a fundamental
10 14:22:11 10 problem.
11 14:22:12 11 Q. Um-hmm.
12 14:22:13 12 A. Yeah. That seemed to be the fundamental
13 14:22:15 13 problem.
14 14 Q. Right.
15 14:22:16 15 A. This bridge was burned down long ago.
16 14:22:20 16 Q. Right. Right.
17 14:22:21 17 Okay. Well, you see here Dr. Lieu observed
18 14:22:23 18 one radiologist performing one C.T. guided FNA on a
19 14:22:27 19 nonpalpable neck mass.
20 14:22:30 20 Do you see that?
21 14:22:30 21 A. Um-hmm. Um-hmm.
22 14:22:33 22 Q. So that was -- that was the extent of
23 23 Dr. Lieu's observation of the radiologists.
24 24 A. Right.
25 14:22:33 25 Q. He looked at 200 samples by Dr. Jadwin. He
AbrahamJ
72
1 14:26:56 1 have trust in him. So why didn't we still have trust
2 14:26:59 2 in him? And I don't know. And that was the purpose
3 14:27:01 3 of the next step was to do something to improve the
4 14:27:04 4 trust.
5 14:27:05 5 Q. Okay. But what was the purpose of the
6 14:27:06 6 report then?
7 14:27:08 7 A. To review the FNA procedure.
8 14:27:11 8 Q. Okay.
9 14:27:11 9 A. But we couldn't get the pathologists and the
10 14:27:13 10 radiologists to play in the sandbox together.
11 14:27:15 11 Q. So one of the reasons for Dr. Lieu's
12 14:27:18 12 reports, wasn't it to find out whether, in fact,
13 14:27:21 13 Dr. Jadwin was competent or not in interpreting FNAs?
14 14:27:25 14 A. That was probably an initial -- one of the
15 14:27:26 15 initial reasons, yeah.
16 14:27:27 16 Q. Okay. And when Dr. Lieu found that he
17 14:27:29 17 didn't disagree with Dr. Jadwin's diagnoses, that
18 14:27:32 18 didn't improve confidence?
19 14:27:36 19 A. Unfortunately, it still didn't get -- it
20 14:27:37 20 still didn't go all the way for some reason. So that
21 14:27:40 21 was part of the reason for -- for -- for getting --
22 14:27:43 22 for continuing to get six -- and we were told we
23 14:27:49 23 would get six months of overreads.
24 14:27:50 24 Q. Okay. Now, did this report from Dr. Lieu
25 14:27:51 25 shake your trust in the radiologists at all?
AbrahamJ
73
1 14:27:54 1 A. See, we -- we'd been with the radiologist --
2 14:27:58 2 the radiologist had been there since I started, since
3 14:27:59 3 all of us had started. And so trust is a funny
4 14:28:03 4 thing. You know, you have to sort of earn it, and
5 14:28:05 5 they'd already earned our trust.
6 14:28:06 6 Q. I see.
7 14:28:07 7 Okay. Well, would it surprise you to know
8 14:28:09 8 that Dr. Jadwin was sending his FNAs out to UCLA for
9 14:28:13 9 overreads from the time he started there?
10 14:28:15 10 A. Yes. It would surprise me.
11 14:28:17 11 Q. And would it surprise you that he continued
12 14:28:18 12 to do that after this --
13 14:28:19 13 A. Yes. It would surprise me 'cause I never
14 14:28:22 14 saw a report.
15 14:28:23 15 Q. Okay. Would it also surprise you that
16 14:28:24 16 Dr. Jadwin was getting a 100 percent conformity
17 14:28:28 17 with --
18 14:28:28 18 A. Yes. That would surprise me because
19 14:28:30 19 actually the ones that did go -- that did go out,
20 14:28:33 20 I have heard -- and this is all --
21 14:28:36 21 Q. Hearsay.
22 14:28:36 22 A. -- hearsay, but that the reports that were
23 14:28:41 23 dictated were dictated -- the final reports were
24 14:28:46 24 dictated after it came back from UCLA.
25 14:28:49 25 Q. I see.
AbrahamJ
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1 1 A. So --
2 14:28:50 2 Q. Dr. Jadwin --
3 14:28:50 3 A. But we still didn't feel that we had the --
4 14:28:55 4 the --
5 14:28:56 5 Q. Evidence?
6 14:28:58 6 A. But once again, that's hearsay. I did not
7 14:29:00 7 see -- I don't have any specific evidence myself.
8 14:29:03 8 Q. So there was a rumor going around that
9 14:29:06 9 Dr. Jadwin was basically retroactively changing
10 14:29:09 10 his -- his FNA --
11 14:29:09 11 A. Right.
12 14:29:10 12 Q. -- reports to match those of UCLA --
13 14:29:12 13 A. Right.
14 14:29:13 14 Q. -- to create the appearance that UCLA was
15 14:29:15 15 agreeing with his initial diagnosis?
16 14:29:17 16 A. And that's all part of trust, isn't it?
17 14:29:19 17 Q. Do you recall who was saying this?
18 14:29:21 18 A. No.
19 14:29:22 19 Q. This is -- this is part of the chatter that
20 14:29:24 20 was going around the hospital?
21 14:29:24 21 A. Chatter.
22 14:29:26 22 Q. Chatter?
23 14:29:26 23 A. Chatter.
24 14:29:27 24 Q. This is part of the chatter that was going
25 14:29:28 25 around the hospital?
AbrahamJ
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1 14:31:17 1 Q. Okay.
2 14:31:18 2 A. And see how that fits in with all the other
3 14:31:20 3 things I was talking about?
4 14:31:22 4 Q. Okay.
5 14:31:23 5 A. The whole purpose of having the overreads
6 14:31:25 6 was to build confidence and trust.
7 14:31:27 7 Q. Okay. To this day do you have confidence or
8 14:31:30 8 trust in Dr. Jadwin's competence as a pathologist?
9 14:31:34 9 A. I don't have evidence one way or another.
10 14:31:37 10 Q. Okay. But you don't trust Dr. Jadwin --
11 14:31:39 11 I mean, if you were to work with Dr. Jadwin today,
12 14:31:41 12 you wouldn't trust his competence as a pathologist.
13 14:31:44 13 Correct?
14 14:31:44 14 A. No.
15 14:31:45 15 Q. No.
16 14:31:45 16 A. And that's probably not fair of me, I admit,
17 14:31:48 17 but, no. Because I don't have the evidence one way
18 14:31:53 18 or another.
19 14:31:55 19 Q. Okay. If -- if Dr. Jadwin -- Dr. Jadwin's
20 14:32:10 20 competence was in question as a pathologist around
21 14:32:12 21 2004. Correct? This is when the FNA thing was
22 14:32:15 22 happening.
23 14:32:15 23 A. Probably.
24 14:32:17 24 Q. Do you recall whether his competence was in
25 14:32:20 25 question throughout his tenure?
AbrahamJ
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1 16:09:02 1 of the conference for the benefit of the residents.
2 16:09:04 2 What was the political point that's
3 16:09:05 3 referenced there?
4 16:09:06 4 A. I think it had something to do with -- like
5 16:09:08 5 we talked about, disagreeing with USC and how they
6 16:09:12 6 are -- you know, that he's so perfect and they're so
7 16:09:13 7 bad and -- political point probably, to my
8 16:09:19 8 understanding, wasn't -- isn't the best term --
9 16:09:21 9 Q. Okay.
10 16:09:22 10 A. -- because it wasn't so much politics as --
11 16:09:31 11 as -- as ego and --
12 16:09:35 12 Q. Lack of diplomacy?
13 16:09:36 13 A. Lack of what?
14 16:09:37 14 Q. Diplomacy.
15 16:09:39 15 A. Right. Oh, that's good.
16 16 Q. Professional respect.
17 16:09:40 17 A. Lack of diplomacy and professional respect.
18 16:09:43 18 I don't know that any politics was involved
19 16:09:46 19 other than the politics between the departments, but
20 16:09:49 20 even that wasn't so much politics as -- as
21 16:09:53 21 interpersonal problems with interpersonal
22 16:09:56 22 relationships.
23 16:10:04 23 Q. Well, in the last sentence it says there in
24 16:10:06 24 the second paragraph: Regardless of the
25 16:10:08 25 justification for your actions of the content of your
AbrahamJ
218
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
JENNIFER JANE ABRAHAM, M.D., the witness named in the
deposition was taken Monday, August 18, 2008, at the
Dated this 2nd day of September, 2008, at
susan~R--N-O-. - 6-8-2-9----
WOOD & RANDALL

(800) 322-4595
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27 EXHIBIT 28
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~ • MEDICAL
.KERN
CENTER
Affiliated with University o/California Schools 0/ Medicine
at Los Angeles, San Diego and Irvine
Dear Cancer Conference Presenter,
In order to promote an informative yet time efficient learning environment, please use this fonnat while
preparing you presentation. **Please limit the number ofslides you prepare to less than 10 slides**
1) Chief Complaint-Presenting Symptoms

2) History of Present Illness
3) History of Past Medical Illness
4) Family History
5) Psychosocial History
6) Physical Exam: include performance scale
(ex: Kamofsky, ECOG, APGAR, other)
#1-6= 5 minutes
7) Briefoverview oftesting ordered (i.e. Diagnostic Radiology, etc...)
#7= 5 minutes
-f-f-f1-7 Should not take up more than 10 minutes ofyour presentation
8) lNM Stage
9) Discuss Treatment Options
-f-f-f #8-9 Are essentialfor prospective case presentation, 10 minutes.
10) Discuss possible follow-up after treatment
11) Early Detection: Discuss possible screening for early detection if available for this site
-f-f-f #1 0-11 For educational purposes, try to include these quickly in your presentation.
A CoS-CaC requires that Oncology Conference be Prospective, which is defined as "presentation at a time
when management ofthe patient could be influenced by the {!iscllssion ofmanagement options at anytime
during the patient's disease".
Included in your presentation you will need to allow time for Pathology and Diagnostic Radiology and any
other specialty involved in the case to present their findings. ** You will be required to meet with hoth the
Pathologist and Radiologist to {Iiscuss the case to be presented at least 4 working day!. before the
conference. It is also your responsibilitv to notify ALL physicians involved in the case you are presenting.
Please let the Cancer Registrar know of any equipment you may need for your presentation. Any equipment
other than a computer or LCD must be specified. You must provide a hard copy of your presentation to the
Cancer Registrar (or Laura) by no later than the Monday preceding the date you are to present. Also, please
arrive at least 15 minutes early in order to download your presentation to the computer prior to the start ofthe
conference. This will cut down on delay time that occurs with multiple presenters.
This guide is provided to assist us in meeting the educational objectives ofthe American College ofSurgeons-
Commission on Cancer (ACoS-CoC) approved programs. Ifyou need any assistance or have any questions do
not hesitate or have any question do not hesitate to call the Cancer Registry Department at ext. 62597.
Sincerely,
Dr. Ravi Patel-Cancer -Committee Chair

Dr. Albert Mc Bride -Cancer Committee Liaison
Bonnie Quiii6nez,RHIT, eTR-Cancer Registrar
1
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27 EXHIBIT 29
28
1

3 3 ---------
)
5 5 Plaintiff, )
)
6 6 vs. )
)
)
8 8 Defendants. )
_________________________)
9 9
10 10
11 11
12 12
14 14 OF
15 15 ALBERT McBRIDE, M.D.
18 18
19 19
20 20
22 22
23
24 23
25
26 24
27
28 25
McBrideA
15
1 13:19:25 1 MR. WASSER: He is responding, counsel. The

letter
2
13:19:27 2 speaks for itself. He has the letter. You want to ask
3 him
4 13:19:32 3 a question about it, ask him a question about it.
5 13:19:32 4 Q. I am going to remind you again, doctor. You
have
6
13:19:37 5 a duty to respond to our questions.
7
13:19:37 6 A. Okay. I will respond to your question.
8
13:19:39 7 Q. Okay. Thank you, doctor. Can you state in
9 your
10 13:19:42 8 own words a summary of what this letter is about.
11 13:19:46 9 A. It's asking Dr. Jadwin to present from the
12 13:19:51 10 Department of Pathology information regarding data that
we
13
13:19:58 11 will need in the conference.
14
13:20:00 12 We're asking the presenters to maintain their
15
13:20:03 13 presentation to a minimum, and there's a reason for that
16
13:20:10 14 which you probably want to go into.
17
13:20:14 15 Q. Dr. McBride, what's the reason?
18
13:20:17 16 A. I was the moderator for -- of the conferences.
19 As
20 13:20:20 17 the moderator, we had two presentations per morning.
Two
21
13:20:26 18 presentations per morning. We tried to get those in
22 within
23 13:20:28 19 one hour's time. That means half an hour per
presentation.
24 13:20:34 20 The departments that were presenting these;
first
25 13:20:37 21 the department that was presenting the case itself, the
--
26 13:20:41 22 one of four departments presented each month. That
13:20:45 23 presenter was a resident, generally, who had collected
27 all
13:20:49 24 the data, presenting the material. Then we had the
28 13:20:52 25 Department of Pathology present the pathologic findings,
and
McBrideA
28
1 13:38:15 1 remind people of what the time limits were?

2 13:38:22 2 A. Yes, sir.
3 13:38:22 3 Q. Okay. And as far as you can recall, did this
memo
4
13:38:26 4 have a purpose of reprimanding anybody in particular?
5
13:38:30 5 A. No.
6
13:38:33 6 Q. Okay. And it wasn't meant -- intended to
7
13:38:36 7 reprimand Dr. Jadwin?
8
13:38:38 8 A. No.
9
13:38:38 9 Q. Okay. Let's turn to 189, please.
10
13:38:41 10 Doctor, we are already a third of the way
11 through.
12 13:39:26 11 Okay. Doctor, you have been handed a document
13 13:39:28 12 marked for identification as 189. Please take a moment
to
14
13:39:31 13 review it.
15
13:40:28 14 Okay. Doctor, now that you have reviewed
16 Exhibit
17 13:40:32 15 189, do you recognize it?
18 13:40:33 16 A. Yes, I do.
19 13:40:34 17 Q. Thank you. Tell me what it is, please.
20 13:40:35 18 A. It's a letter that Dr. Harris asked me to
write at
21
13:40:41 19 the end of that particular conference that day.
22
13:40:45 20 Q. Okay. Just to backup. When you say the
23
13:40:47 21 conference that day, you are referring to the oncology
24
13:40:50 22 conference held monthly, which was for the month of
25 October,
26 13:40:54 23 2005 was held on October 12; correct?
27 13:40:56 24 A. Yes, sir.
28 13:40:57 25 Q. Okay. And after the end of the October
Oncology
McBrideA
29
1 13:41:00 1 Conference, is that when Dr. Harris approached you?

2 13:41:04 2 A. Yes.
3 13:41:05 3 Q. Okay. And can you recall exactly what he told
you
4
13:41:08 4 to do?
5
13:41:09 5 A. Yes, he asked me to write a letter regarding
6 what
7 13:41:15 6 happened at the conference that day and present -- give
it
8
13:41:20 7 to him.
9
13:41:22 8 Q. Okay. And did he give you any other guidance
10
13:41:26 9 beyond just that?
11
13:41:26 10 A. No.
12
13:41:27 11 Q. Okay. Now prior to Dr. Harris asking you to
13 draft
14 13:41:31 12 this letter, Exhibit 189, had you complained to Dr.
Harris?
15
13:41:37 13 A. No.
16
13:41:39 14 Q. No. Okay. Now, writing letters such as this
17
13:41:46 15 Exhibit 189, was that part of your function as -- one of
18
13:41:50 16 your job functions as the cancer committee liaison?
19
13:41:56 17 A. I don't think so.
20
13:41:58 18 Q. Okay.
21
13:41:59 19 A. I was asked to do it because I am Medical
22
13:42:03 20 Director. It's the only letter I have ever written like
23
13:42:06 21 that --
24
13:42:07 22 Q. Okay.
25
13:42:07 23 A. -- in the eight years that I have been there
26 that
27 13:42:08 24 I recall.
28 13:42:09 25 Q. Okay.
McBrideA
30
1 13:42:10 1 A. I was reluctant to write this letter.

2 13:42:13 2 Q. Okay. And why is that?
3 13:42:16 3 A. Well, I just was. I didn't want to -- Dr.
Harris
4
13:42:20 4 was at the conference, Dr. Johnson was -- all these
5 people.
6 13:42:26 5 The conference was -- by the nature of that letter, you
see,
7
13:42:30 6 it went over and we never got the presentations in.
8
13:42:36 7 But no, I did not want to write this letter,
9 but I
10 13:42:41 8 wrote it at the request, direction really, of Dr.
Harris.
11
13:42:49 9 Q. Okay. And is following the direction of the
12 --
13 13:42:54 10 well, the directives of the medical director, in this
case,
14
13:42:58 11 Dr. Harris, is that a part of your job function?
15
13:43:00 12 A. I thought so.
16
13:43:01 13 Q. Okay. So, therefore, that's why you did end
17 up
18 13:43:04 14 drafting this letter, because complying with the
directives
19
13:43:07 15 of the medical director was part of your job; correct?
20
13:43:11 16 A. Yes, sir.
21
13:43:13 17 Q. Okay. Now, were you at all uncomfortable in
22
13:43:16 18 writing Exhibit 189?
23
13:43:18 19 A. Yes.
24
13:43:19 20 Q. And how so?
25 13:43:23 21 A. I just don't like to put myself down in a
position
26 13:43:28 22 like that. If I am going to have a discussion with
13:43:32 23 somebody, I would just as soon discuss it with him
27 directly.
13:43:35 24 It's not my position to -- I don't feel it's my position
28 to
13:43:39 25 be put in a position like this, but I was directed to do
McBrideA
32
1 13:44:41 1 A. Yes, I look at the clock.

2 13:44:43 2 Q. So in order to derive these times which are
3 13:44:45 3 mentioned in 189, you had looked up at the clock on the
4 13:44:48 4 wall?
5 13:44:49 5 A. I was keeping an eye on the clock.
6 13:44:51 6 Q. Now, during the conference, you didn't know
you
7
13:44:54 7 were going to be asked by Dr. Harris to write Exhibit
8 189,
9 13:45:00 8 did you?
10 13:45:00 9 A. No.
11 13:45:01 10 Q. So why is it is you still, nevertheless, had
such
12
13:45:03 11 exact times recorded here? Is it just your practice to
13
13:45:04 12 record times?
14
13:45:05 13 A. My practice is to try to be on time to do
15 things.
16 13:45:09 14 Q. Okay.
17 13:45:09 15 A. I look at the clock a lot.
18 13:45:11 16 Q. Okay. So you just happened to have a very
clear
19
13:45:13 17 recollection of all the times involved when you wrote
20 this
21 13:45:16 18 letter?
22 13:45:16 19 A. When you have two cases to present and you
only
23
13:45:19 20 have half an hour for each one, you have a very good
24 idea of
25 13:45:25 21 how much time pretty much has gone by.
26 13:45:27 22 Q. There's a lot of time pressure on you.
27 13:45:29 23 A. Well, I thought so. Can I tell you why these
time
28 13:45:32 24 pressures are?
13:45:33 25 Q. Sure.
McBrideA
33
1 13:45:33 1 A. Because the other doctors are leaving at 8:30

to
2
13:45:37 2 go to their various rounds and surgical procedures.
3 Surgery
4 13:45:43 3 starts at 8:30 on those Monday -- Wednesdays.
5 13:45:46 4 Q. Uh-huh.
6 13:45:46 5 A. We lose those people. My intent was to try to
get
7
13:45:51 6 as much information to as many people and get as many
8 people
9 13:45:55 7 involved in these discussions, et cetera. It's never
10 13:45:59 8 perfect.
11 13:46:00 9 Q. Okay.
12 13:46:01 10 A. Never perfect.
13 13:46:02 11 Q. So getting back to the times, here, doctor,
are
14
13:46:05 12 you confident these times are accurate in Exhibit 189?
15
13:46:10 13 A. They're roughly accurate.
16
13:46:12 14 Q. Okay. Can you think of a person better
17 situated
18 13:46:14 15 than yourself to know what the times were involved in
that
19
13:46:18 16 conference?
20
13:46:19 17 A. Can I think of a better person for those
21
13:46:22 18 particular conferences?
22
13:46:23 19 Q. At that -- no, I am talking about this October
23
13:46:26 20 12th conference. Was there a person better positioned
24 to
25 13:46:30 21 know the time?
26 13:46:31 22 A. No, this was all me.
27 13:46:38 23 Q. Okay. Thank you. Now, were you upset by Dr.
28 13:46:41 24 Jadwin's going over time at this October 12th, 2005
13:46:45 25 conference?
McBrideA
34
1 13:46:45 1 A. No, I was not upset with Dr. Jadwin. I have

2 13:46:48 2 always had a lot of professional respect for Dr. Jadwin.
3 13:46:54 3 Frankly, I think he is a very good
pathologist.
4
13:46:57 4 He gives a lot of good information. And I've even told
5 him
6 13:46:59 5 that I would like to listen to him the entire hour, and
he
7
13:47:03 6 can tell you that that's a true statement. I told him
8 that.
9 13:47:08 7 But I am not the only one in that conference.
I
10
13:47:10 8 am trying to get a case presented and these other people
11
13:47:12 9 have prepared to present it too.
12
13:47:15 10 So, you know, I come off as the bad guy, but I
13 was
14 13:47:20 11 necessarily the moderator.
15 13:47:21 12 Q. There's no implication, Dr. McBride, that
you're
16
13:47:25 13 the bad guy here, at least not from us. Just to be very
17
13:47:29 14 clear.
18
13:47:30 15 Dr. McBride, I just want to walk through the
19
13:47:32 16 times, because the times have become a very big issue in
20
13:47:36 17 this litigation for some odd reason. Now --
21
13:47:39 18 A. Okay.
22
13:47:40 19 Q. Okay. And I will tell you right now, this is
23
13:47:42 20 probably one of the most important exhibits of today's
24
13:47:46 21 deposition.
25
13:47:46 22 Okay. Now, this conference, the first
26 conference,
27 13:47:49 23 Presentation A of the morning, it started at 7:30, I
assume;
28 13:47:54 24 correct?
13:47:56 25 A. Again, I usually try to start at 7:30.
McBrideA
36
1 13:48:57 1 Q. Okay.
2 13:48:59 2 A. And then when the presenter gets to that point
in
3
13:49:03 3 his presentation, then he asks the pathologist to
4 present
5 13:49:07 4 the findings, and then the pathologist comes and does
that.
6
13:49:10 5 That's depending on the presenter. He may
7 want
8 13:49:13 6 the radiologist to present a little first, but, usually,
the
9
13:49:19 7 pathologist presents first.
10
13:49:20 8 So it was up to Dr. Alkhouri to determine --
11 to
12 13:49:23 9 ask Dr. Jadwin in this case to present.
13 13:49:27 10 Q. I understand. So the moderator --
14 13:49:27 11 A. The presenter is essentially in control of his
15 13:49:31 12 presentation. I am just the moderator, just hoping they
16 13:49:34 13 just kind of get it all in sequence and get it in in
time.
17
13:49:38 14 Q. Understood. And the moderator tends to be a
18
13:49:40 15 resident; correct?
19
13:49:41 16 A. Generally, yes.
20
13:49:42 17 Q. And this is part of the resident's training?
21
13:49:44 18 A. Yes, it is.
22
13:49:44 19 Q. Learning how to stand up and talk?
23
13:49:47 20 A. Absolutely.
24
13:49:48 21 Q. Okay. So the first -- according to your line
25
13:49:50 22 here, the first sentence of your second paragraph,
26 13:49:53 23 Presentation B started at about five minutes -- I am
sorry,
27 13:49:57 24 Presentation A ended a little bit late, went over about
five
28 13:50:00 25 minutes. Does that suggest that presentation A started
at
McBrideA
37
1 13:50:04 1 8:05 a.m.

2 13:50:06 2 A. Yes.
3 13:50:06 3 Q. Okay. Just following your letter, then Dr.
4 13:50:09 4 Alkhouri presented. Now, you must have moderated over,
5 13:50:14 5 well, scores of those cancer committee conferences?
6 13:50:17 6 A. Many, many.
7 13:50:18 7 Q. Many. Typically how long -- well, do you
recall
8
13:50:21 8 specifically how long Dr. Alkhouri took to present
9 salient
10 13:50:25 9 features of the second case?
11 13:50:28 10 A. No, I don't know.
12 13:50:29 11 Q. Well, based upon your experience, how long
would
13
13:50:31 12 that initial introduction be by the resident?
14
13:50:34 13 A. Some do a very fine presentation and do it
15
13:50:39 14 succinctly. Some ramble a little more, and I have to
16 corral
17 13:50:44 15 them in a little bit so we can get it into -- let's get
the
18
13:50:48 16 radiologist. So I kind of say, you know, let's move it
19
13:50:51 17 along a little bit.
20
13:50:54 18 Q. Keep it going. So would it be -- I mean, does
21 it
22 13:50:55 19 sound -- is it typical that the presenter would take
maybe
23
13:50:57 20 about five minutes to introduce the case?
24
13:51:00 21 A. It's a rough estimate.
25
13:51:01 22 Q. Okay.
26
13:51:02 23 A. Just a rough estimate.
27
13:51:03 24 Q. Okay. It ranges all over the place?
28
13:51:04 25 A. Yes, it does.
McBrideA
39
1 13:52:09 1 And finally, I think when we keep going,

perhaps,
2
13:52:13 2 to the last paragraph, second sentence, and finally,
3 there
4 13:52:16 3 was less than five minutes past, and then at 8:25 Dr.
Jadwin
5
13:52:21 4 sat down; correct? Do you see the third paragraph?
6
13:52:25 5 A. Yes, I believe that's how it happened.
7
13:52:27 6 Q. Okay. So I just want to be very clear.
8
13:52:29 7 Presentation B started at 8:05. It ended -- well, Dr.
9
13:52:34 8 Jadwin sat down at 8:25?
10
13:52:37 9 A. Apparently.
11
13:52:37 10 Q. Okay. So during that 20-minute time span,
12 both
13 13:52:41 11 Dr. Alkhouri and Dr. Jadwin spoke. Dr. Alkhouri at
8:05
14
13:52:47 12 stood up to present the case or introduce the case, and
15 then
16 13:52:48 13 he sat down, and then Dr. Jadwin spoke 'til 8:25. Is
that
17
13:52:52 14 correct?
18
13:52:52 15 A. Yes, that's probably correct.
19
13:52:54 16 Q. Okay. Well, is there any reason to believe
20 that
21 13:52:58 17 anything else happened differently?
22 13:53:00 18 A. No.
23 13:53:00 19 Q. No.
24 13:53:00 20 A. That's how I recall it pretty much.
13:53:03 21 Q. Thank you. Now, do you recall a dispute
25 breaking
13:53:09 22 out between Dr. Jadwin and Dr. Roy during the course of
26 Dr.
13:53:14 23 Jadwin's presentation of October 12, 2005?
27 13:53:20 24 A. Well, I -- I think that there were disputes
going
28 13:53:26 25 on between them, but I can't tell you the nature
precisely
McBrideA
46
1 14:01:16 1 write letters is to be abbreviated and not to write War

and
2
14:01:19 2 Peace; right?
3
14:01:20 3 A. True.
4
14:01:21 4 Q. So I guess what I am trying to ask is if Dr.
5
14:01:26 5 Jadwin had engaged in some kind of aberrant behavior at
6 the
7 14:01:31 6 October conference, do you think that's an important
detail
8
14:01:34 7 you would have included in your abbreviated account of
9 what
10 14:01:36 8 happened that day in Exhibit 189?
11 14:01:37 9 MR. WASSER: He's answered the question.
That's
12
14:01:39 10 the third variation of it.
13
14:01:41 11 A. I don't know that he did engage in any
14 aberrant
15 14:01:45 12 behavior. All I know is just the time went by. And I
was
16
14:01:48 13 not unhappy with his presentation. He had a lot of good
17
14:01:52 14 material to present. As I told you before, the whole
18 hour
19 14:01:55 15 could have been with his presentation, but that wasn't
what
20
14:01:58 16 we were trying to get. We're trying to get everything
21 in
22 14:02:02 17 here, and I know that we were running out of time.
23 14:02:06 18 Q. Okay. Let me pose another hypothetical.
Let's
24
14:02:11 19 say Dr. Jadwin strips naked, runs around the conference
25 14:02:17 20 room, and starts assaulting people, do you think that is
a
26 14:02:21 21 detail you would have included in Exhibit 189?
14:02:21 22 MR. WASSER: That is a ridiculous question,
27 14:02:22 23 counsel.
14:02:23 24 MR. LEE: I mean, I know it's a little bit
28 silly,
14:02:26 25 but I do --
McBrideA
49
1 14:04:54 1 Lau actually had presentations to give that day?

2 14:04:58 2 MR. WASSER: Dr. Lau?
3 14:05:00 3 Q. Dr. Chester Lau?
4 14:05:00 4 A. I just assume he did. Radiologists generally
do,
5
14:05:05 5 but --
6
14:05:06 6 Q. You don't know one way for --
7
14:05:07 7 A. I don't know one way or another.
8
14:05:09 8 Q. Okay. And who is Dr. Desai, D-e-s-a-i.
9
14:05:12 9 A. A medical oncologist who works for
10 Comprehensive
11 14:05:18 10 Blood and Cancer Center. He's a radiation oncologist.
12 14:05:25 11 Q. And he was scheduled to give some comments at
this
13
14:05:29 12 presentation?
14
14:05:30 13 A. Yes. I always expected the medical
15 oncologists to
16 14:05:35 14 give some comments. That was very cogent to our review
and
17
14:05:42 15 discussion and what we're to do in terms of management
18 of a
19 14:05:45 16 case. They're very important.
20 14:05:47 17 Q. Now, you mentioned the first presentation of
the
21
14:05:50 18 morning ran over by about five minutes. Were
22 five-minute
23 14:05:53 19 overruns common?
24 14:05:55 20 A. Yeah. Yeah, they were. And I didn't like
that,
25
14:05:58 21 but that happened.
26
14:06:01 22 Q. Sure. So, I mean, it wasn't uncommon to see a
27 14:06:03 23 presentation run over, say, about five minutes. That
was
28 14:06:06 24 not uncommon?
14:06:07 25 A. No, it was not uncommon.
McBrideA
50
1 14:06:12 1 Q. Okay. And to your recollection, do you know

of
2
14:06:15 2 any other physician receiving a letter of reprimand for
3
14:06:19 3 running over time at this cancer committee conference?
4
14:06:23 4 MR. WASSER: At that particular conference?
5
14:06:24 5 BY MR. LEE:
6
14:06:25 6 Q. I am sorry. At any oncology conference.
7
14:06:27 7 A. No.
8
14:06:29 8 Q. It's a really -- you haven't -- have you seen
9 the
10 14:06:32 9 letter of reprimand that was issued to Dr. Jadwin?
11 14:06:35 10 A. No.
12 14:06:36 11 Q. Okay. So we can't even discuss it.
13 14:06:37 12 Okay. You said you don't have a lot of
14 14:06:48 13 familiarity with pathology; correct?
15 14:06:51 14 A. I don't have a lot of familiarity with
16 14:06:54 15 pathology.
17 14:06:54 16 Q. Maybe I misheard you.
18 14:06:56 17 A. I have a lot of familiarity with Pathology. I
am
19
14:07:01 18 a urologist.
20
14:07:01 19 Q. Okay. I am an attorney, so I don't know any
21
14:07:04 20 better.
22
14:07:05 21 Okay. Well, if there is a case where the
23
14:07:11 22 pathology, pathologic findings, for the patient are
24
14:07:16 23 incorrect, based upon poor histology, incorrect
25 orientation
26 14:07:23 24 of the slide, in that particular case, do you think
that's
27
14:07:26 25 important information for the clinician to know before
28 they
McBrideA
51
1 14:07:30 1 operate on the patient?

2 14:07:32 2 A. I don't know where -- I don't know what kind
of
3
14:07:35 3 answer you want from me. I am not a pathologist. We
4 rely
5 14:07:39 4 on the final report from the pathologist as to what is
or
6
14:07:44 5 isn't the pathologic finding, but if I am going to go
7 and
8 14:07:49 6 tell a pathologist, oh, you're wrong, no, that's not my
9 14:07:52 7 position, and I am not that good. I cannot compete with
10 14:07:56 8 them in that realm any more than they can compete with
me in
11
14:08:00 9 cutting out a kidney.
12
14:08:02 10 Q. All right. Well, the October Oncology
13 Conference
14 14:08:06 11 was about a hysterectomy. I don't know if you recall
that.
15
14:08:09 12 I will represent to you that it was about a hysterectomy
16
14:08:12 13 procedure.
17
14:08:13 14 A. All right.
18
14:08:14 15 Q. Okay. And Dr. Jadwin's presentation, which is
19
14:08:18 16 actually that exhibit in front of you -- it's Exhibit
20 181 --
21 14:08:21 17 that presentation pointing out that there was poor
histology
22
14:08:26 18 in the pathology for this hysterectomy patient, that the
23 14:08:30 19 pathology -- the slides were incorrectly oriented and
14:08:35 20 leading to results that he thought should be
24 corroborated,
14:08:39 21 and therefore, that's what the presentation - was about.
25 14:08:43 22 Now that I have laid out what the presentation
was
26 14:08:47 23 about, would you agree that it's an important thing to
have
27 14:08:53 24 the pathology corrected, the pathologic findings be
based
28 14:08:59 25 upon a good histology prior to conducting a hysterectomy
on
McBrideA
52
1 14:09:03 1 a patient?
2 14:09:04 2 A. I couldn't agree with you more.
3 14:09:06 3 Q. Okay. Okay. Would you say it would almost be
4 14:09:10 4 medically irresponsible to conduct a hysterectomy on a
5 14:09:14 5 patient based upon poor histology?
6 14:09:17 6 A. Well, that certainly is a --
7 14:09:20 7 Q. It's a tough question.
8 14:09:21 8 A. It's a tough question, but the answer is,
9 14:09:24 9 obviously, yes. I mean, you want to do the right
operation
10
14:09:30 10 for the right pathology --
11
14:09:32 11 Q. Right.
12
14:09:32 12 A. -- on anything
13
14:09:34 13 Q. Right. I mean, you can't think of a situation
14
14:09:36 14 where it would be advisable to perform surgery on a
15 patient
16 14:09:40 15 based on poor histology; right?
17 14:09:45 16 A. You're asking me personally, yeah, right, I
don't
18
14:09:49 17 think you should operate on something that you don't
19 have a
20 14:09:52 18 good diagnosis on unless you're sure of what you're
doing.
21
14:09:55 19 Q. Okay. And in your opinion -- well, in your
22
14:09:56 20 opinion, can an appropriate treatment plan be based on
23
14:10:00 21 inaccurate pathologic findings based on poor histology?
24
14:10:05 22 A. No.
25
14:10:05 23 Q. No. Okay. Now, actually, this patient which
26 was
27 14:10:12 24 the topic of this Exhibit 181 had a tubal ligation.
28 14:10:17 25 So, in other words, we could that safely
assume
McBrideA
54
1 14:12:47 1 A. Oh, I have never seen this. Not one -- the

first
2
14:12:51 2 time.
3
14:12:51 3 Q. Okay. So --
4
14:12:52 4 A. It was a CC, it never got to my hands.
5
14:12:55 5 Q. Okay. So then, is that your e-mail address,
6
14:12:57 6 AlbertMcBride@msn.com?
7
14:13:02 7 A. No, it's not. Oh, wait. That's a -- yeah,
8 that
9 14:13:05 8 is. That's a -- but that doesn't mean that I saw this.
10 14:13:11 9 Q. Okay. So to the best of my recollection, you
11 14:13:14 10 haven't seen this e-mail before?
12 14:13:17 11 A. To the best of my recollection, this was never
13 14:13:20 12 sent to me.
14 14:13:22 13 Q. Okay.
15 14:13:22 14 A. Despite that that's in there, I have never
seen
16
14:13:23 15 this, on a stack of bibles.
17
14:13:23 16 Q. I am sorry.
18
14:13:26 17 A. I am -- on a bible, I have never ever seen
19 this.
20 14:13:29 18 Q. Not even necessary. I understand, doctor. By
the
21
14:13:30 19 way, just --
22
14:13:31 20 A. What you get from me today is total honesty.
23
14:13:34 21 Q. I can see that, and I appreciate it very much,
24
14:13:37 22 doctor. And I can tell you it's going to speed things a
25
14:13:41 23 long very much.
26
14:13:43 24 Why don't we move on then to 202, please.
27
28 14:14:19 25 Okay. Doctor, you have been handed a document
McBrideA
55
1 14:14:23 1 marked for identification as Exhibit 202. And I am

going to
2
14:14:28 2 ask you to familiarize yourself with this briefly to see
3 if
4 14:14:32 3 you recognize it.
5 14:15:36 4 All right, doctor. Is this -- do you
recognize
6
14:15:38 5 this letter?
7
14:15:38 6 A. Yes, I do. I remember this letter.
8
14:15:41 7 Q. Can you tell me what it is.
9
14:15:42 8 A. Well, briefly, it's describing Dr. Jadwin's
10
14:15:46 9 difficulty with time constraints, getting back from
11 Canada,
12 14:15:49 10 whatever, and finally, realizing that he had a very
13 14:15:52 11 important presentation to make, one of the most
important
14
14:15:55 12 ones that he felt that he had to make, and he had
15 support
16 14:15:59 13 from this Fox or wherever the center was, that
conferences
17
14:16:08 14 requiring pathologic presentation, that the pathologic
18
14:16:12 15 presentation was by far the most important part of that,
19 and
20 14:16:16 16 I -- I didn't disagree with him then.
21 14:16:19 17 Q. Okay.
22 14:16:19 18 A. In fact, Dr. Jadwin and I discussed this
23 14:16:22 19 afterwards. As I said before, I never had disagreement
with
24
14:16:25 20 his ability and even his comments that pathology was
25 that
14:16:32 21 important.
26 14:16:32 22 Quite frankly, I think they are. I think
these
27 14:16:37 23 conferences should be an hour on each case, but they're
not.
28 14:16:41 24 They haven't been over there, and -- but his points are
14:16:45 25 well-taken. I never disagreed with that.
McBrideA
57
1 14:17:39 1 And I am going to ask you, do you think that's

2 14:17:42 2 referring to Dr. Jadwin's assertion that radiology had
no
3
14:17:48 3 pertinent or significant radiologic findings that day?
4
14:17:51 4 A. In retrospect, I did not realize all this
5 until
6 14:17:55 5 the conference was already all over.
7 14:17:56 6 Q. Okay.
8 14:17:57 7 A. Okay. The bottom line is his points were
9 14:17:59 8 well-taken regarding the pathology, this whole thing.
10 14:18:01 9 Q. Okay. So when you look at this -- I am sorry.
11 14:18:04 10 A. No, I am sorry.
12 14:18:05 11 Q. Okay. When you look at Exhibit 202, doctor,
is
13
14:18:09 12 there anything that you disagree with that's contained
14 in
15 14:18:12 13 this letter?
16 14:18:13 14 A. I can't really disagree with -- I think we
have
17
14:18:17 15 talked about most of my disagreements and concerns.
18
14:18:21 16 Q. Okay.
19
14:18:22 17 A. And I think addressed to this letter.
20
14:18:25 18 Q. Okay. So I mean -- actually, is there any
21 aspect
22 14:18:27 19 of this letter that you disagree with or find to be
23 14:18:32 20 untrue?
24 14:18:32 21 A. With what little time I have had to peruse it
25 14:18:36 22 again, I am not in disagreement with anything, but if
you
26
14:18:39 23 want to point out something.
27
14:18:42 24 Q. Actually, doctor, we are getting close to the
28 end,
14:18:45 25 so if you wouldn't mind, could you just read the letter
McBrideA
91
1 15:14:17 1 bit, I think. More so than most, I guess.

2 15:14:24 2 Q. Okay.
3 15:14:25 3 A. Actually, I would see him in the cafeteria and
I
4
15:14:30 4 used to go over there and sit down with him and vice
5 versa.
6 15:14:33 5 I actually -- you know, I used to talk to him. We were
7 15:14:36 6 friendly, communicated.
8 15:14:38 7 Q. Okay.
9 15:14:38 8 A. We had a pretty good professional
relationship.
10
15:14:40 9 Q. Okay. So did you find Dr. Jadwin to ever be
11
15:14:46 10 unprofessional with you?
12
15:14:47 11 A. Never.
13
15:14:48 12 Q. Okay. Are you aware of any instances where
14 Dr.
15 15:14:51 13 Jadwin acted inappropriately in your opinion?
16 15:14:54 14 A. Not to me.
17 15:14:55 15 Q. Okay. Or towards anybody?
18 15:14:56 16 A. I have no idea.
19 15:14:57 17 Q. Okay.
20 15:14:57 18 A. I have no idea what he did with others.
21 15:15:00 19 Q. None that you're aware of?
22 15:15:01 20 A. Not that I am aware of.
23 15:15:03 21 Q. Okay. Are you aware of any instances where
Dr.
24
15:15:07 22 Jadwin just lost his temper with anybody?
25
15:15:09 23 A. No.
26
27 Dr.
28 15:15:14 25 Jadwin threatened anybody?
McBrideA
92
1 15:15:14 1 A. No.
2 15:15:15 2 Q. Are you aware of any instances where Dr.
Jadwin
3
15:15:18 3 raised his voice at anybody?
4
15:15:20 4 A. No.
5
6 Dr.
7 15:15:26 6 Jadwin was insulting people?
8 15:15:28 7 A. No.
Dr.
10
15:15:34 9 Jadwin was making false allegations against people?
11
15:15:37 10 A. No.
12
15:15:39 11 Q. Okay. So would you say -- did you -- can you
13
15:15:42 12 recall any instances where any interactions you had with
14 Dr.
15 15:15:46 13 Jadwin were unpleasant?
16 15:15:47 14 A. They were all very pleasant, and I can comment
17 15:15:50 15 that he helped me a lot up in the operating room. When
I
18
15:15:53 16 would call pathology, come up and see a case, he was
19 always
20 15:15:58 17 right there.
21 15:15:58 18 And I can honestly say he helped me with
getting
22
15:16:02 19 more appropriate biopsies on prostates, helped us with
23 how
24 15:16:06 20 to do that a little better, and how to manage testicular
25 15:16:10 21 tumor pathology reports, you know, specimens.
26 15:16:14 22 No, I can honestly say that the relationship
27 15:16:19 23 professionally was good with me and him. What he did
with
28 15:16:23 24 any other people, I have no idea.
15:16:25 25 Q. Uh-huh. Of course. Okay. What's the -- I am
McBrideA
98
1 15:21:15 1 Q. Okay. Are you aware of any instances of other

2 15:21:17 2 core physicians filing green papers, complaints?
3 15:21:20 3 A. Not that I know of. I have no knowledge of
4 15:21:23 4 anything like that.
5 15:21:24 5 Q. Are you aware of any complaints ever being
lodged
6
15:21:26 6 against you at Kern Medical Center?
7
15:21:29 7 A. No.
8
15:21:33 8 Q. No. Okay. Can you recall a time when Dr.
9 Royce
10 15:21:36 9 Johnson took a medical leave from The Kern Medical
Center?
11
15:21:40 10 A. Dr. Johnson took a medical leave?
12
15:21:41 11 Q. Yes.
13
15:21:42 12 A. Really.
14
15:21:43 13 Q. No?
15
15:21:44 14 A. No.
16
15:21:44 15 Q. Okay. Can you recall a time when Dr. Naderi,
17 his
18 15:21:48 16 son got into a car accident, and he was on some kind of
19 15:21:53 17 leave for about a month or so?
20 15:21:55 18 A. I don't know that -- I didn't know he'd left.
I
21
15:21:58 19 knew I had read about his son getting in an accident.
22 That
23 15:22:01 20 was pretty common knowledge around the hospital.
24 15:22:06 21 Q. Are you familiar with the circumstances of Dr.
25 15:22:09 22 Sheldon Friedman's departure from KMC?
26 15:22:12 23 MR. WASSER: That was one of the first
questions
27
15:22:14 24 you asked him today.
28 15:22:15 25 A. I have no idea. I don't know why he left or
what
McBrideA
McBRIDE,
Case M.D.
1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 140 of 191
08-15-08
Page 109
ss.
2 COUNTY OF KERN
6 No. 7974, do hereby certify that ALBERT McBRIDE, M.D.,
9 Friday, August 15, 2008, at the time and place set forth
21
22
23
24
~L:)~
LeF~O.
Cindee L. 7974
25
VS. COUNTY
& RANDALL (800) 322-4595
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27 EXHIBIT 30
28
Albert MfeBride, MD;

Department of Surgery
Kern Medical Center
19 October 2005
Dear Dr. McBride:
I wish to express my apology for the confusion that occurred at the October Oncology
Conference. I had traveled to Canada on the preceding Saturday to attend a family Canadian
Thanksgiving Holiday on Monday and the return trip on Tuesday night was long and complicated.
I worked on the presentation most of the trip and returned to Bakersfield after midnight on the day
of the conference. With barely four hours of sleep I was intensely focused on the presentation to
be given and because of my absence from the country and fatigue I did not have an opportunity
to discuss this case with you before hand. Since the pathology department has presented
concise, well organized presentations for years, I felt that I would be respectfully given the latitude
to make the presentation without discourteous interruption.
I worked many hours to put together a pathology presentation that would detail the problems
encountered with this patient's care and hopefully improve general awareness about important
KMC patient care issues I feel that this presentation was perhaps the most important that I have
delivered at a KMC Oncology Conference. It was a standard pathology case presentation that
would be found in any oncology conference around the country; a detailing of the specimens
received, gross & microscopic findings, diagnosis and conclusions. The director of the Fox Chase
Cancer Center, one of the very top cancer centers in the world, has stated to me that it is not
reasonable to limit the time of the pathology presentation, but rather that the time spent should
relate to the complexity of the case that is presented.
The guiding operational principle for me was and is that content is more important than the time
the conference is concluded. Certainly other oncology conferences have run over without incident
and most other conferences throughout the institution run over all of the time. It was certainly
difficult for me to focus on continuity issues with the inappropriate distractions that Dr. Harris
made during my presentation. If there had been questions asked in a standard manner, I would
have been glad to respond to any issues at the time in the form of a question, but I was not given
that opportunity. Unfortunately, there were misperceptions that 1 was stealing other people's time,
when such was not the case. As you hopefully now know, there were no management issues or
diagnosis issues other than pathology to be discussed.
Again, I am sorry for the confusion about the issues surrounding my presentation.
David F. Jadwin, DO 1/ "—

Chair, Department of Pathology
CC: Eugene Kercher MD, Scott Ragland DO, Jennifer Abraham MD, Irwin Harris MD, Royce
Johnson MD, Maureen Martin MD, Leonard Perez MD, George Alkouri MD
Exhibit 202
Susan R. Wood, CSR # 6829
08/13/08
Irwin Everett Harris, M.D.
DFJ00591
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27 EXHIBIT 31
28
· .- - ..... ..,.
.. Dept
-~
C ~ Status Organization Visual Oral Clin Disc

F Impact Overall New
R 2 2 Improve Path
2 2 3 2
F R 2 Y Y 3
2 1 1
F R 2 2 y y
1 1 1 2
1 1 1
F 2 Y Y
2 2 2
G R 2 2 Y y
2 3 3 3 3 3
G S 1 N N
1 1 1
G 1 1 Y
1 1 Y
2 1
G 1 2 N N
1 1 1
G 1 1 Y
S 2 1 Y 1
2 2 2
G R 2 2 N N 3
3 3 2
M 2
S
M R y y
1 1 1 1 1 1
M 0 1 1
Y y 1
1 1 1
M 0 1 Y N
1 1 1 3
1 1 1 y
M MS 2 y
1 1 1
M 1 1 y y
R 2 2 1
2 2 2
M MS 2
1 1 1 2
1 2 1
0 MS 1 Y Y 1
1 1 1
Oncol 1 1 Y y
S 1 1 1 1 1
Path S 1 Y Y
2 2 3
Path 2 1 2 y y
S 1 1 1 1 1
Pad MS 1
1 1 1 1 1 1
S S Y y
S MS 1 1 3
2 2 1
S 0 1
2 2 3 3 3 2
2 N N 3
1 2 1 1 2 N
1 1 1 N 2
3 2 2 y
1 1 1 1 1 1
1 Y y
2 2 2
MS
2 2 y y
2 1 2 3 3 2 y
3 3
y 2
3 3 3
1 3 N N
1 1 3
1 1 1
R 1 2 1
Total 2 1 2 y
45 45 N 2
50 50 48
1 47 y:: 21 y:: 18
18 20 17 35
17 17 15
2 12 N=6 N::8 6
8 9 9
3 8 13
1 2 5 5
5 5
Average 1.4 1.4.
2
6
1.6 1.6 1.6 1.6
Attendance: 85 (25 Staff, 35 Residents, 25 Medical Students) 2.0
0
0
0
0
..,.
CI1
N
........ -.. _.. __ .__ ..
· - ...... _... _..- .- """' ......."'wen ~uu~
Dept Status Organization Visual Oral Clin Disc Impact Overall
G R New Improve Path
2 3 3 3 3 3 N N
M S
G S Y Y
1 1 1 1 1 1 Y Y
F R 2 2 2 2 3 2 y
Y 3
2 1 2 1 1 2 N N
1 1 2
1 3 2 2
M R Y
1 1 1 1 1 1 Y Y
M 0 1 1 1
1 1 1 1 Y N 3
1 1 1 1 1 1 Y Y
F R 2 2 1
1 1 2 2 Y Y 2
1 2 2 2 2 2 y Y
G 1 1 2 1 2
0 MS
N N
1 1 1 1 1 1 Y y
M 0 1 1 1 1 1 1
MS Y Y
2 1 2 3 3 2 Y y
Path S 2 2 2
3 2 1 2 y
M MS 2 Y 1
1 1 1 1 1 Y y 1
3 3 3 3 3 3 N N
Ped MS 1 1 3
1 1 1 1
Path Y y
S 1 1 1 1 1 1
M R 2 2 2 2 2 2
S S 2
G 1 1 3
1 1 1 1 Y Y 1
1 1 1 1 1 1
G S 2 1 2 2 2 2
S MS N N 3
1 1 2 2 1 1
Oncol S 1 1 1 1 1 1
R Y y 1
1 2 1 2 1 2 Y N
M MS 1 1 1
2
1 2 1 Y
F R 1 Y 1
1 1 1 1 1 Y Y
G R 2 3 3 2 2
F 2 2 2 2 2 2 y
S 0 2 Y
2 3 3 3
Total 2 N N 3
45 45 50 50 48 47
1 18
Y=21 Y = 18 35
20 17 17 17
2 15 N=6 N=8
12 8 6
9 9 8 13
3 1 2 5
5 5 5
Average 2 6
g 1.4 1.4
Attendance: 85 (25 Staff, 35 Residents, 25 Medical Students)
1.6 1.6 1.6 1.6 2.0
0
C
til
~
~
• KERN
MEDICAL
• CENTER ONCOLOGY CQNFERNCE
DATE: October 12,2005
Sponsoring Department: 0 Dept. ofMed. 0 F.P. IOB/GYN 0 Surgery
Presenter A: Dr. N. Sharkey
Presenter B: Dr. G. Alkhouri
Perfonnance Rating: 1- Very Good 2- Satisfactory 3- Needs Improvement
Case Presenter A B
Organization of Presentation I .."
Quality of Visual Presentation \ ~
Quality of Oral Case Presentation \ 1.
Quality of Subsequent Clinical Management Discussion \ ~
Impact of Management Discussion on KMC Patient Care I '\
Overall Presentation Rating I 1
I learned new information while attending this conference: ~es 0 No DYes ra--No
The information I learned will improve my clinical practice: ~esONo DYes:;O No
How would you rate the overall presentation from Pathology?
How would you rate the overall presentation from Radiology?
Comments:
Department:
o E.R. 0 F.P. D I.M. BOB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
------------
Position:
o StaffPhysician ~edical Resident 0 Other Healtlicare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
000051.5
• KERN
• MEDICAL
. CENTER ONCOLOGY CQNFERNCE
DATE: October 12; 2005
Sponsoring Department: 0 Dept. ofMed. 0 F.P. IOB/OYN 0 Surgery
Presenter B: Dr. O. Alkhouri
Performance Rating: 1- Very Good 2- Satisfactory 3- Needs Improvement
Case Presenter
Organization of Presentation
Quality of Visual Presentation
,
A B
Quality of Oral Case Presentation

Quality of Subsequent Clinical Management Discussion
Impact of Management Discussion on KMC Patient Care
Overall Presentation Rating
I learned new information while attending this conference: ~es 0 No ~~s DNo
The information I learned will improve my clinical practice: )t/Yes 0 No Itftes DNo
\ 1,
Comments: VvV* J/ %{ --n'lvlL De lotW w p~ .
---t7Qffill1Atdm= -. 13 ~ $10 k1 ;) m
Department:
o E.R. 0 F.P..
'&. I.M. o OB/OYN o Pathology o Radiology o Surgery
o Nursing 0 Ph cy o Other:
------------
Position:
~ Staff Physician 0 Medical Resident o Other Healthcare Provider o Medical Student
Signature:
(Optional)
ooeoSi.6 Ar
• KERN
. MEDICAL
• CENTER ONCOLOGY CONFERNCE
1)ATE: October 12,2005
Sponsoring Department: D Dept. of Med. D F.P. IOB/GYN D Surgery
,,
Case Presenter A B
Organization ofPresentation ( -
Quality of Visual Presentation I
\
\
,
\
,.
t I
Overall Presentation Rating \ I
I learned new information while attending this conference: ~sDNo ~esDNo
The information I learned will improve my clinical practice: )d'Yes D No DYes 0 No
How would you rate the overall presentation from Pathology? - <
Comments:
Department:
D E.R.. D F.P. D LM. VOB/GYN D Pathology D Radiology D Surgery
D Nursmg D Pharmacy ~. Other:
----'-----------
~
oS'tion:
: Staff Physician D Medical Resident o Other Healthcare Provider D Medical Student
, D.. N. 0 ~::~ As:.So_c_i_at_e_ _~

SIgnature: ~ ztlD( I-J~_
(Optional)
000051.7
• KERN
• MED.ICAL
CENTER ONCOLOGYCONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation '2-. Z
Quality of Visual Presentation "2...- L,
Quality of Oral Case Presentation L C
,.
Quality of Subsequent Clinical Management Discussion "1...... z.-
Impact ofManagement Discussion on KMC Patient Care ') ?
Overall Presentation Rating ~ 'L
I learned new information while attending this conference: rJYes 0 No 9'Yes 0 No
The information I learned will improve my clinical practice:
,..1JYes 0 No lifYes 0 No
How would you rate the overall presentation from Pathology? "3
"-
7 ~lrl\-
Comments:
Departmenr~· /
o E.R. F.P. 0 I.M. o OB/GYN o Pathology o Radiology o Surgery
o Nursing 0 Phannacy o Other:
-------------
Position: _
o StaffPhysician d Medical Resident o Other Healthcare Provider o Medical Student
o R.N. 0 Other ~althcare Associate
Signature:
(Optional)
OOOOSj.8
· KERN
II,MEDICAL
CENTER ONCOLQOYCQNFERNCE
1)ATE: October 12,2005
------~-
~------
"'S;o~~ringDepartment: 0 Dept. ofMed. 0 F.P. IOB/GYN D Surgery
Case Presenter A B
Organization.of Presentation / .~
Quality of Visual Presentation I I
Quality of Oral Case Presentation ~ all
Quality of Subsequent Clinical Management Discussion ) I
I
I r
Overall Presentation Rating <2r
I learned new information while attending this conference: 'Q'Y'es D No DYes 1QN0
The infonnation I learned will improve my clinical practice: PYcS'O No DYes tlNo'
How would you rate the overall presentation from Pathology? I
~ r
How would you rate the overall presentation from Radiology? '}- .::?"
Comments:
Department:
o E.R. 0 F.P. 0 LM. OOB/GYN 0 Pathology D Radiology 0 Surgery
------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
~ R.N. D Other Healthcar~ As, iate /IJ. I-<>--~

.-.,
SIgnature: ) ~l' [ )
OOOOS~9
• M.EDICAL
KERN
.• CENTER ONCOLOGYCONFERNCE
Case Presenter A B
Organization of Presentation 1- /J
Quality of Visual Presentation '\.- 1-
Ii
Quality of Oral Case Presentation v 1-
--,
Quality of Subsequent Clinical Management Discussion /1- ")
Impact of Management Discussion on KMC Patient Care -2 (1..

Overall Presentation Rating \ 2-
I learned new information while attending this conference: lAYes 0 No ~sONo
The information I learned will improve my clinical practice: . 8Yes 0 No DYes 0 No
How would you rate the overall presentation from Pathology? ~ '(
How would you rate the overall presentation from Radiology? z.. r
M':\-..
/
Comments:
Department:
o E.R. 0 F.P. DI.M. DOB/GYN 0 Pathology 0 Radiology 0 Surgery
-------------
Position:
Signature:
(Optional)
00005~O
· ... KERN
•••. MEDICAL
"'II. CENTER QNCOLOC;YCQNFERNCE
Sponsoring Department: 0 Dept. of Med. D F.p.1 OB/GYN 0 Surgery
Case Presenter
Organization ofPresentation ,
A
,
.
B

,\ , l
,,
,
I
I
\
I learned new information while attending this conference: ~Yes 0 No I~Yes DNo
The information I learned will improve my clinical practice: I2(Yes 0 No I¢,es D No
How would you rate the overall presentation from Pathology? \ r
How would you rate the overall presentation froin Radiology? tJA- N-A----'
Department:
o E.R. D F.P. AM. 0 OB/GYN 0 Pathology 0 Radiology 0 Surgery
------------
Position:
o Staff Physician ~Medical Resident 0 Other Healthcare Provider 0 Medical Student
Signature:
(Optional)
000052~
• KERN
• MEDICAL
. CENTER ONCOLQGYCONFERNCE
.- .. __ _._._--.- __ ._._ -- ..-- .. -~--
Sponsori~gD-;~~~~nt: 0 Dept. ofMed. 0 F.P. IOB/GYN 0 Surgery
Case Presenter A B
Quality ofVisual Presentation
t
J ,
~
t
/
,
J ,
Overall Presentation Rating I
•I
I learned new information while attending this conference: ~Yes 0 No 'DYes 0 No
The information I learned will improve my clinical practice: ---KlYes 0 No DYes OrNo
How would you rate the overall presentation from Radiology? J
(
3
,
Comments:
Department:
D E.R 0 F.P. ~I.M. o OB/GYN o Pathology o Radiology o Surgery
D Nursing 0 Pharmacy o Other:
~-----------
Position:
D Staff Physician 0 Medical Resident ~ Other Healthcare Provider 0 Medical Student
D R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000522
• KERN
,MEDICAL
• CENTER ONCOLO(rY CONFERNCE
SponsoringDepartment: 0 Dept. ofMed. 0 F.P. ;, OB/GYN 0 Surgery
Case Presenter A B
Organization ofPresentation
, I

I
,
,
I
," I
I learned new information while attending this conference: IPYes 0 No 1,..pYes
~,
0 No
The information I learned will improve my clinical practice: &Yes 0 No BYes 0 No
'/
'.
How would you rate the overall presentation from Pathology? 1 J
How would you rate the overall presentation from Radiology? j
1
Comments:
Department:
o E.R. 0 F.P. 0 I.M. 0 OB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nlrrsing 0 Pharmacy 0 Other:
-------------
Position:
o R.N. 0 0J'}rerHe;Jt(~~~ociate / -"' ')

Signature: ~) D ~ {,.J" ~. ------_"'-
0000523
• KERN
MEDICAL
• CENTER ONCOLOGY CQNFERNCE
Sponsoring Department: 0 Dept. of Med. 0 F.P. IOB/GYN 0 Surgery
Performance Rating: 1- Very Good 2- Satisfactory 3.- Needs Improvement
Case Presenter A B
Organization of Presentation ?>. J
Quality of Visual Presentation Q. ')..
Quality of Oral Case Presentation I \
Quality of Subsequent Clinical Management Discussion '2 \
Impact of Management Discussion on KMC Patient Care 1 ')
Overall Presentation Rating ? 7_
I learned new information while attending this conference: ~sONo mes oNo
The information I learned will improve my clinical practice: E1'Yes 0 No l2f\res 0 No
How would you rate the overall presentation from Pathology? Q ~
How would you rate the overall presentation from Radiology? '2- 'L
Comments:
Department:
o E.R. J'F.P. OI.M. o OB/GYN o Pathology o Radiology o Surgery
o Nursing 0 Pharmacy o Other:
------------
Position: j
o Staff Physician Medical Resident o Other Healthcare Provider o Medical Student
Signature: ('J)£~YJ..i'\nvltitU!-'Whi_
==
(Optional)
0000524
ONCOLOGY CONFERNCE
lJATE: October 12,2005
Case Presenter
Organization of Presentation , A
/
B
Quality of Visual Presentation 1 1-

Quality of Oral Case Presentation 1 2-
Quality of Subsequent Clinical Management Discussion t J-
Impact of Management Discussion on KMC Patient Care 1. 2
Overall Presentation Rating 1 2-
I learned new information while attending this conference: BYes 0 No 0Yes 0 No
The information I learned win improve my clinical practice: BYes 0 No gyes 0 No
How would you rate the overall presentation froiD Radiology?
Comments:
Department:
o E.R 0 F.P. 0 I.M. 0 OB/GYN 0 Pathology 0 Radiology 0 Surgery
-----~-------
Position:
o StaffPhysician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
Signature:
(Optional)
0000525
. KERN
I MEDICAL
I. CENTER ONCOLOGYCONFERNCE
SponsoringDepartment: D Dept. ofMed. 0 F.P. IOB/GYN 0 Surgery
Case Presenter A B
Organization ofPresentation I V .I
Quality of Visual Presentation ( I
Quality of Oral Case Presentation I '7 _
Quality of Subsequent Clinical Management Discussion \ I

Impact of Management Discussion on KMC Patient Care I
Overall Presentation Rating I\ 1-
I learned new information while attending this conference: OYes..erNo DYes aN'o
The information I learned will improve my clinical practice: DYes~ OYeserNo
i
Comments:
~~~
Department:
D E.R. D F.P. D I.M. D Pathology D Radiology D Surgery
D Nursing 0 Pharmacy D Other:
~-----------
Position:
o Staff Physician D Medical Resident 0 Other Healthcare Provider D Medical Student
o R.N. D Other Healthcare Associate
Signature:
(Optional)
0000526
• KERN
MEDICAL
l)ATE: October 12,2005
Sponsoring Department: 0 Dept. ofMed. 0 F.p.1 OB/GYN 0 Surgery
~erformance Rating: 1- Very Good 2- Satisfactory 3- Needs Improvement
Case Presenter
A
~~ I .,B (
Impact of Management Discussion on KMe Patient Care
I learned new information while attending this conference:
"
~r ' f
pesONo -6Yes 0 No
The infOnhation I learned will improve my clinical practice: I' ;1Yes 0 No Jates 0 No
How would you rate the ovenill presentation from Pathology?
Comments:
Department:
o E.R 0 F.P. 0 I.M. O~/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy ;6 Other:
------------
··KERN
• MEDICAL
l)ATE: October 12, 2005
Sponsoring Department: 0 Dept ofMed. 0 F.P. IOB/GYN 0 Surgery
Case Presenter
A
I
B, ,
Quality of Visual Presentation , (
I I
Quality of Oral Case Presentation \
I
Quality of Subsequent Clinical Management Discussion (
\
Impact of Management Discussion on KMC Patient Care (
(
Overall Presentation Rating r
I learned new information while attending this conference: ~DNo tJYes 0 No
The information I learned will improve my clinical practice: rEJYes 0 ~ I--QYes 0 No
Comments:
Department: ~
o E.R. 0 F.~ 0 OB/GYN o Surgery
o Nursing 0 Phannacy 0 Other:~-+--+----~---::"e---
Position:
o Staff Physician 0 Medical·Resident o Medical Student
Signature:
(Optional)
0000528
w.o., • KERN
MEDICAL
~ • CENTER
o
ONCOLOGY CONFERNCE
Sponsoring Department: 0 Dept. ofMed. 0 F.P. lIoB/GYN 0 Surgery
Case Presenter A B
Organization of Presentation I -....2
Quality ofVisual Presentation J I
Quality of Oral Case Presentation I :1
Quality of Subsequent Clinical Management Discussion I 3 0
Impact of Management Discussion on KMC Patient Care ~ .~

Overall Presentation Rating I :J..
I learned new information while attending this conference: ~sONo ~DNo
The infonnation I learned will improve my clinical practice: IZPi'eSb No ~ONo
I 'J..
I All ft
Comments:
Department:
o E.R. 0 F.P. DI.M. OOB/GYN 0 Pathology 0 Radiology 0 Surgery
------------
Position:
o Staff Physician 0 0 Medical Resident 0 Other Healthcare Provider ~edical Student
Signature:
(Optional)
0000529
KERN
. MEDICAL
Presenter A: Dr. N.Sharkey
Perfonnance Rating: 1- Very Good 2- Satisfactory 3- Needs Improvement
Case Presenter A B
Quality of Visual Presentation ,
I 2
2
Quality of Oral Case Presentation ~ ~
.,
Quality of Subsequent Clinical Management Discussion ~ 7
Impact ofManagement Discussion on KMC Patient Care 2- J
Overall Presentation Rating I 2-
I learned new information while attending this conference: raVes 0 No ll1'fes 0 No
The information I learned will improve my clinical practice: r1'Yes 0 No £aYes 0 No
How would you rate the overall presentation from Pathology? J I
tV/A- JollA-
Comments:
Department:
o E.R 0 F.P. 0 LM. o OB/GYN ~logy o Radiology o Surgery
o Nursing 0 Phannacy o Other:
-------------
Position:
~Physician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
Signature: ~
(Optional)
0000530
. _-.--- KERN
~:MEDCAL
- . CENTER ONCOLOOYCONFERNCE
Case Presenter A B
Organization of Presentation ~ I z
Quality of Oral Case Presentation I J
Quality of Subsequent Clinical Management Discussion J fA
Impact ofManagement Discussion on KMC Patient Care rJ... \../(J)
Oyerall Presentation Rating l (i)
I learned new information while attending this conference: ~Yes 0 No rPf:¥es 0 No
The information I learned will improve my clinical practice: tiYes 0 No ~es 0 N.Q
~ 8etl+T(j)
~
Comments:
Department:
o E.R. 0 F.P. ~.M. o OB/GYN o Pathology o Radiology o Surgery
o Nursing 0 Pharmacy o Other:
------------
Position:
o Staff Physician 0 Medical Resident o Oilier Healilicare Provider ~Medical Student
Signature:
(Optional)
0000531.
- KERN
•---MEDICA
- L
Sponsoring Department: D Dept. ofMed. 0 F.P. IOB/GYN 0 Surgery
Case Presenter A B
Organization of Presentation i -'\
Quality of Visual Presentation , ")
Quality of Oral Case Presentation \ '\
Quality of Subsequent Clinical Management Discussion ',\
t
Impact of Management Discussion on KMe Patient Care \ -)
Overall Presentation Rating \ -Z

I learned new information while attending this conference: .rJYes 0 No DYes 0"No
The information I learned will improve my clinical practice: ~es DNo DYes ffNo
How would you rate the overall presentation from Pathology? (")
'3
How would you rate the overall presentation from Radiology? \ -
Comments:
Department:
D E.R. D F.P. 0 I.M. OOB/GYN 0 Pathology D Radiology 0 Surgery
------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider D Medical Student
Signature:
(Optional)
0000532
. KERN·
I.
·.MEDICAL
I CENTER ONCOLOGYCONFERNCE
Case Presenter A B
Organization of Presentation I J
Quality of Oral Case Presentation , J t
I
.
Quality of Subsequent Clinical Management Discussion I I
Impact of Management Discussion on KMe Patient Care J I
Overall Presentation Rating I t
I learned new information while attending this conference: ~Yes 0 No IpYes 0 No
The information I learned will improve my clinical practice: )iJYesO No e1Yes 0 No
I iJM-~5?".lb ~ &.
~
A~AI4-'b: n
" -,- '-n ~
Comments:
Department:
o E.R. 0 F.P. 0 I.M. 0 OB/GYN IJ 0 pa.thology o Radiology o Surgery
o Nursing 0 Pharmacy .
0 It!
Other: ---I,~~"...::--,---------
Position:
o Other Healthcare Provider r/!Medical Student
0000533
• -. ·~~~AL
. ~.CENTER ONCOLOGY CONFERNCE
1>A TE: October 12, 2005
Sponsoring Department: D Dept. ofMed. D F.P. IOB/GYN 0 Surgery
Case Presenter A B
Organization of Presentation I ·11
Quality ofVisual Presentation
/
.-1
I
"
--:.(_
~./
Impact of Management Discussion on KMC Patient Care ~ I

-
~
~~sONo
11
DYes D No
The information I learned will improve my clinical practice: mes D No DYes D No
Comments: ~..I()uli:.u"e""d::'-- _
Department:
D E.R. D F.P. D I.M. D OB/GYN ~logY D Radiology D Surgery
o Nursing D Phannacy 0 Other:
-------------
r·
Posi~:
~taffPhysician 0 Medical Resident D Other Healthcare Provider D Medical Student
D R.N. D othe~~ealthCar~ciate
Signature: ~.~; ...)
0000534
.. .~
• KERN
• MEDICAL
. CENTER ONCOLOGYCONFERNCE
Sponsoring Department: D Dept ofMed. D F.P. 1I0B/GYN D Surgery
Case Presenter A B
Organization ofPresentation ?-- .-t-
Quality of Visual Presentation 'v t--
Quality of Oral Case Presentation '1/" /}~
Quality of Subsequent Clinical Management Discussion ;,rz.r ~
Impact of Management Discussion on KMC Patient Care ~ '1--
Overall Presentation Rating 0./ y--
I learned new information while attending this conference: DYes 0 No DYes 0 No
The information I learned will improve my clinical practice: DYes 0 No DYes 0 No
How would you rate the overall presentation from Pathology? ~ 2-
How would you rate the overall presentation from Radiology? rv ~
Comments:
Department:
o E.R. 0 F.P. ~ I.M. DOB/GYN 0 Pathology D Radiology 0 Surgery
-------------
Position:
o StaffPhysician ;< Medical Resident D Other Healthcare Provider 0 Medical Student
Signature:
(Optional)
00005~5
·.,... KERN
• . MEDICAL •• • •
~.• CENTER ONCOLQGYCQNFERNCE

SponsoringDepartment: 0 Dept. ofMed. D F.P. IOB/GYN D Surgery
Case Presenter A B
Quality ofOral Case Presentation
J
,
L
A
9 11 I J
Quality of Subsequent Clinical Management Discussion I / [lIn
Impact of Management Discussion on KMC Patient Care f / '/
I learned new information while attending this conference: ~es DNo ~esONo
The information I learned will improve my clinical practice:
How Would you rate the overall presentation from Radiology?
,
DYes J'SrNo DYes....Q::No
1t--3
~ ~4
Department:
D E.R. 0 F.P. D I.M. D OB/GYN D Pathology
o Nursing D Pharmacy D Other:
------------
Position:
~Physician D Medical Resident. 0 Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare ~SSOcia~_ 4J
SignMille: (&f£ Zjy I ,
0000536
• KERN
.~ ONCOLQQYCQNFERNCE
Sponsoring Department: 0 Dept. ofMed. D F.P. II QBfGYN D Surgery
Case Presenter A B
Organization of Presentation / I
Quality of Oral Case Presentation /
Quality of Subsequent Clinical Management Discussion I j
Impact ofManagement Discussion on KMC Patient Care I ' J
Overall Presentation Rating I I
I learned new information while attending this conference: ,»Yes 0 No Jt!f'Yes 0 No
The information I learned will improve my clinical practice: DYes D No ' DYes 0 No
J
t\>JJ-1 1G) )4-
;'
Comments:
Department:
o E.R. 0 F.P. OI.M. D OBfGYN jVpathology o Radiology o Surgery
D Nursing 0 Pharmacy tJ Other:
-------------
Position:
MStaff Physician D Medical Resident 0 Other Healthcare Provider D Medical Student
~. R.N. 0 Other Healthcare Associate
Signature: =:J)W~
(Optional)
0000537
•. MEDICAl
KERN
•. CENTER ONCOLOGY CONFERNCE
DATE: October 12. 2005
Sponsoring Department: 0 Dept. ofMed. 0 F.P. 1I0B/GYN 0 Surgery
Case Presenter A B
,
1
J
I
\ 1
Quality of Subsequent Clinical Management Discussion } ';J
Impact of Management Discussion on KMC Patient Care 1 I
Overall Presentation Rating 1 I
[ learned new information while attending this conference: ~sDNo @sONo
The information I learned will improve my clinical practice: ~sONo ldYes 0 No
How would you rate the overall presentation from Pathology? \ 1
How would you rate the overall presentation froin Radiology? \ \
Comments:
Department: /'
o E.R. 0 F.P. 0 I.M. BOB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nur~ing 0 Pharmacy 0 Other:------------'---,-
Position:
Signature:
(Optional)
0000538
·KEAN
:rvEDCAl
. CENTER ONCOLQGYCONFERNCE
Sponsoring Department: D Dept. ofMed. D F.P. II OB/GYN D Surgery
Case Presenter A B
Organization of Presentation l . (
Quality of Visual Presentation 1 f
Quality of Oral Case Presentation I I
Quality of Subsequent Clinical Management Discussion I (
Impact ofManagement Discussion on KMC Patient Care I i
Overall Presentation Rating ,f i

I learned new information while attending this conference: I.
DYes D No DYes D No
The infonilation I learned will improve mr clinical practice: DYes DNo DYes DNo
Comments:
Department:
D E.R. D F.P. DJ.M. D OB/GYN D Pathology D Radiology D Surgery
D Nursing D .Pharmacy D Other: _
Position:
D Staff Physician D Medical Resident D Other Healthcare Provider D Medical Student
D R.N. D Other Healthcare Associate
Signature:
(Optional)
0000539
. KERN
II M.ED.leAL
. CENTER ONCOLOGY CONFERNCE
Sponsoring Department: D Dept. ofMed. D F.P. ;, OB/GYN 0 Surgery
Case Presenter A B
Organization of Presentation I '7
Quality of Oral Case Presentation R Z-
Quality of Subsequent Clinical Management Discussion II L
Impact of Management Discussion on KMC Patient Care i L-
Overall Presentation Rating I' 0C:-
I learned new information while attending this conference: DYes k.J1If<) DYes Q-M((
The information I learned will improve my clinical practice: DYes~o DYes ra-No
How would you rate the overall presentation from Pathology? I' :s
#/f-l.- .~/{J-
Comments:
Department:
D E.R. D F.P. D I.M. ~GYN o Pathology 0 Radiology D Surgery
o Nursing D Pharmacy 0 Other:
-----~-------
Pos~n:
rz(Staff Physician 0 Medical Resident D Other Healthcare Provider 0 Medical Student
Signature:
(Optional)
0000540
. KERN
• MEDICAL
l)ATE: October 12,2005
Sponsoring Department: 0 Dept. ofMed. D F.P. IOB/OYN D Surgery
Case Presenter A B
Organization of Presentation ! . (
Quality of Visual Presentation t I
Quality of Oral Case Presentation I '1.
Quality of Subsequent Clinical Management Discussion I '1/
Impact of Management Discussion on KMC Patient Care \ i
Overall Presentation Rating i I
I learned new information while attending this conference: lllYys 0 No DYes 0 No
The information I learned will improve my clinical practice: IDYes D No DYes 0 No
How would you rate the overall presentation from Pathology? '1.- 2J
tJ7JA-- JJm
Comments:
Department:
D E.R. D F.P. D I.M. D OB/GYN D Pathology 0 Radiology ~ery
D Nursing D Pharmacy D Other:
-------------
Position:
o Staff Physician 0 Medical Resident D Other Healthcare Provider . ~cal Student
o R.N. D Other Healthcare Associate
Signature:
(Optional)
0000541.
........ KERN
~:~ ONCOLQGY CONFERNCE
DATE: October 12, '2005
SponsoringDepartment: 0 Dept ofMed. 0 F.P. IOB/GYN 0 Surgery
,
Case Presenter A B
Organization of Presentation I I
Quality of Visual Presentation i
Quality of Oral Case Presentation 1 \
Quality of Subsequent Clinical Management Dis.cussion I I
,
Impact of Management Discussion on KMC Patient Care ( J
f
I leamed new information while attending this conference: !fi.Yes 0 No r:;wes 0 No
The information I learned will improve my clinical practice: ¢'Yes DNo i1Yes 0 No
How would you rate the overall presentation from Pathology? (
How would you rate the overall presentation froin Radiology?
I,
Comments:
Department:
o E~R. 0 F.P. 0 LM. OOB/GYN 0 Pathology 0 Radiology o Surgery
o Nursing 0 Phannacy .P- Other: ()J(aJ?f1
Position: 'I \.
~StaffPhysician 0 Medical Resident 0 Other Healthcare Provider o Medical Student
D. R.N. . 0 Other Healthc.are M~~.. '.

Signature: ~~ \ , _ ( / { '::$'
~~(Opt=--.-.rnal-:);:::;"';lo.4-:~,..l--------------
0000542
- . ·.·~~~AL
~ • CENTER ONCOLOGY CONFERNCE
Case Presenter
A
,
/[
B
{
2-
Quality of Oral Case Presentation 1 I
Quality of Subsequent Clinical Management Discussion &- 2-
Impact ofManagement Discussion on KMC Patient Care I I
Overall Presentation Rating f- 2-
I learned new information while attending this conference: 0)'es 0 No ~Yes 0 No
The information I learned will improve my clinical practice: )QYes 0 No pYes~o
,
---:Jt.-
.. '~.
How would you rate the overall presentation from Radiology? ..
---
Comments:
Department:
o E.R. 0 F.P. OI.M. OOB/GYN 0 Pathology 0 Radiology LD<-Surgery
-------------
Position:
o Staff Physician ><Q. Medical Resident 0 Other HeaIthcare Provider 0 Medical Student
Signature:
(Optional)
()000543
- .KERN
1:
' .. '- . MEDICAL
• CENTER ,?NCOLOGYCONFERNCE
VJATE: October 12, 2005
"-
Sponsoring Department: 0 Dept. ofMed. 0 F.P. II OB/GYN 0 Surgery
Case Presenter A B
Organization of Presentation f t
,,
Quality of Oral Case Presentation I
Quality of Subsequent Clinical Management Discussion I
Impact of Management Discussion on KMC Patient Care I $t
Overall Presentation Rating I 1
I learned new information while attending this conference: Q(Yes 0 No ~Yes 0 No
The information I learned will improve my clinical practice: 'rsjYes 0 No ~Yes 0 No
How would you rate the overall presentation from Pathology? I I
How would you rate the overall presentation from Radiology? I I
Comments:
Department:
o E.R. 0 F.P. ~I.M. OOB/GYN 0 Pathology 0 Radiology 0 Surgery
-------------
Position:
o Staff Physician -0 Medical Resident 0 Other Healthcare Provider rAMedical Student
Signature:
(Optional)
0000544
•·~~AL
cENTER ONCOLOGY CONFERNCE
DAtE: October 12, 2005
Case Presenter A B
Organization of Presentation I f
Quality of Visual Presentation I (
Quality of Oral Case Presentation I I
Quality of Subsequent Clinical Management Discussion i I
Impact of Management Discussion on KMC Patient Care J i
Overall Presentation Rating I I
I learned new information while attending this conference: fJX20 No .gYes 0 No
The information I learned will improve my clinical practice: p'(es 0 No krPfes 0 No
{
Comments:
Department:
o E.R. . gil>. 0 I.M. DOB/GYN 0 Pathology 0 Radiology 0 Surgery
-------------
Position: /.
o Staff Physician ~dical Resident 0 Other Healthcare Provider 0 Medical Student
Signature:
(Optional)
0000545
• KERN
MEDICAL
• CENTER ONCOLQGY CONFERNCE
Sponsoring Department: D Dept. ofMed. D F.P. 1I0B/GYN D Surgery
Case Presenter A B
Organization of Presentation <~
'I
Quality of Visual Presentation '1 .......-'

Quality of Oral Case Presentation «
Quality of Subsequent Clinical Management Discussion -
/J
r{
~
Impact of Management Discussion on KMC Patient Care ..., '"l

.....
I learned new information while attending this conference: '1:1Yes D No DYes D No
The information I learned will improve my clinical practice: EtYes D No DYes 0 No
How would you rate the overall presentation froin Radiology?
Comments:
Department:
o E.R. D F.P. D I.M. D Pathology o Radiology D Surgery
D Nursing D Pharmacy 0 Other:
-------------
Position:
o Staff Physician ~~ical Resident D Other Healthcare Provider D Medical Student
~ R.N. D Other Healthc~e A~~Jiate . ~
SIgnature: .~.
(Optional)
0000546
• KERN
. MEDICAL
Sponsoring Department: 0 Dept. of Med. 0 F.P. II OB/GYN 0 Surgery
Case Presenter A B
Organization of Presentation ../ .;) ')
Quality of Visual Presentation ~
Quality of Oral Case Presentation ..../"

Quality of Subsequent Clinical Management Discussion /'
/
Impact of Management Discussion on KMC Patient Care I
Overall Presentation Rating \£
V
I learned new information while attending this conference: dYes 0 No GlY~s 0 No
The information I learned will improve my clinical practice: ~sONo flYes 0 No
How would you nite the overall presentation from Pathology?
Comments:
Department:
o E.R. II F.P. 0 I.M. OOB/GYN 0 Pathology 0 Radiology 0 Surgery
-------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider d Medical Student
Signature:
(Optional)
0000547
·. KERN
:MBJCAL
. CENTER ONCOLOGY CONFERNCE
Presenter A: Dr. No Sharkey
Case Presenter A B
Quality of Visual Presentation I
Quality of Oral Case Presentation -1
Quality of Subsequent Clinical Management Discussion \
Impact of Management Discussion on KMC Patient Care 1
I learned new information while attending this conference: ",aYes 0 No DYes"¢. No
The information I learned will improve my clinical practice: ijYes 0 No
How would you rate the overall presentation froiD Radiology? N/ft-
Department:
o E.R. 0 FoP. OI.M. DOB/GYN o Pathology 0 Radiology ~Surgery
----~-------
Position:
o Staff Physician 0 Medical Resident 'kther Healthcare Provider 0 Medical Student
o RoN. 0 Other Healthcare Associate
Signature:
(Optional)
0000548
From: Serena Sepulveda-Rini

To: David Jadwin. DO
Date: 10/14120052:43:20 PM
Subject: Fwd: Re: Oncology Conference
Serena Sepulveda-Rioi
Office Services Assistant
Lab - Pathology
Kern Medical Center
rinis@kernmedctr.com
661-326-2259
*********. CONFIDENTIALITY STATEMENT .*******.*
This message is intended only for the use of the individual or entity to which it is addressed and may
contain information that is privileged. confidential and exempt from disclosure under applicable law. If the
reader of this message is not the intended recipient, you are hereby notified that any dissemination.
distribution or copying of the communication is strictly prohibited. If you received this communication in
error. please notify us immediately by telephone and return the original message to us at the e-mail
address above. Thank you.

1830 Flower Street, Bakersfield California 93305-4197
(661) 326-2416
»> Laura Quinonez 10/14/20052:42:51 PM >>>

35 Residents; 25 Medical Students; 25 Staff Members
Note: Staff Members Include the following: Cancer registristry staff; outside physicians
Regards.
Laura Heredia-Quinonez
Oncology Clinic Coordinator
Cancer Registry/Kern Medical Center
(661) 326-5692
(661) 862-7623 (fax)
heredial@kernmedctr.com
>>> Serena Sepulveda-Rini 10/14/20052:10:08 PM »>

Hi Laura.
Dr. Jadwin would like to know how many people attended the conference. How many were staff and how
many were residents?
Thank you,
Serena
Serena Sepulveda-Rini
Office Services Assistant
Lab - Pathology
0000549
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
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22
23
24
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26
27 EXHIBIT 32
28
1
I!'E"%AL
CENTER
Document 277-3
ONCOLOGY CONFERNCE
Filed 12/01/2008 Page 182 of 191
DATE: November 9,2005
Sponsoring Department: I.M. F.P. OBIGYN Surgery
Presenter A: Dr. Ryan Hudson
Presenter B: Dr. Steven Chen
Case Presenter A B
Organization of Presentation I
,
Quality of Visual Presentation f.-
Quality of Subsequent Clinical Management Discussion 1
Impact of Management Discussion on KMC Patient Care - 5
?a
d:s NO d e s NO
The information I learned will improve my clinical practice: d e s CI NO d e s NO
5
Comments:
//
( ,( ~ h ,~ AWL
, U U L k 8138 A M .
Department:
E.R. F.P. I.M. OBIGYN &ology • Radiology CI Surgery
ONursing Pharmacy Other:
Pos' on:
d f Physician Medical Resident Other Healthcare Provider Medical Student
R.N. El Other Healthcare Associate
Signature:
(optional)
DFJ00686
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27 EXHIBIT 33
28
1
3 ______________
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
)
9 Defendants. )
__________________________)
10
11
12
14 OF
15 JOSEPH MANSOUR, M.D.
18
19
20
21
22
23
24
MansourJ
10
1 09:04:18 1 A. Correct.
2 09:04:18 2 Q. Did you ever have any unpleasant
3 09:04:20 3 interactions with Dr. Jadwin?
4 09:04:22 4 A. Personally, no.
5 09:04:23 5 Q. Okay. Well, what about not personally?
6 09:04:26 6 A. I've heard he had interaction with other
7 09:04:31 7 people.
8 09:04:31 8 Q. Okay. But you personally no, correct?
9 09:04:34 9 A. Correct.
10 09:04:34 10 Q. Have you ever witnessed Dr. Jadwin acting
11 09:04:37 11 inappropriately?
12 09:04:38 12 A. No.
13 09:04:39 13 Q. Okay. So what did you hear about
14 09:04:57 14 Dr. Jadwin's inappropriate interactions from others?
15 09:05:08 15 A. I've heard that he had some interaction with
16 09:05:11 16 other physicians regarding some cases on some medical
17 09:05:16 17 issues, and that's basically all that I heard.
18 09:05:18 18 Q. That's all you've heard?
19 09:05:20 19 A. Uh-huh.
20 09:05:21 20 Q. Okay. But how -- why did you think it was
21 09:05:23 21 inappropriate of Dr. Jadwin?
22 09:05:25 22 A. Did I say inappropriate?
23 09:05:26 23 Q. Yes. I was asking if you were aware of any
24 09:05:28 24 inappropriate interactions.
25 09:05:30 25 MR. WASSER: I think you used the word
MansourJ
98
1 11:05:43 1 A. Yes.
2 11:05:44 2 Q. Okay. Is this an accurate account of -- of
3 11:05:48 3 your conversation with Dr. Harris?
4 11:05:51 4 A. Somewhat. The first paragraph it's stated,
5 11:06:02 5 "Dr. Mansour became inappropriately angry and raised
6 11:06:07 6 his voice." I don't agree with that.
7 11:06:09 7 Q. I just want to be very clear. So when you
8 11:06:11 8 say that, that's in the middle of the first page
9 11:06:14 9 where it says, "Dr. Mansour became apparently angry
10 11:06:18 10 and raised his voice to me implying that it is
11 11:06:20 11 outrageous to suggest that he should not go to the
12 11:06:23 12 board with complaints"?
13 11:06:24 13 A. Correct.
14 11:06:25 14 Q. You don't agree with that?
15 11:06:26 15 A. Right.
16 11:06:26 16 Q. You don't agree with that?
17 11:06:28 17 A. I don't agree with that.
18 11:06:29 18 Q. Okay. What about the next paragraph where
19 11:06:30 19 it says, "Dr. Mansour asked me if I was aware that
20 11:06:33 20 the county was paying malpractice coverage for
21 11:06:36 21 doctors to do cases at Memorial and at Mercy"?
22 11:06:39 22 A. Correct, I did ask that.
23 11:06:40 23 Q. Okay. So this was -- this is a practice of
24 11:06:43 24 the county using taxpayer dollars to provide
25 11:06:46 25 malpractice coverage to OB-GYN doctors even though --
MansourJ
99
1 11:06:51 1 even though they were doing work at other hospitals?
2 11:06:54 2 A. Correct. And that was part of the faculty
3 11:06:58 3 practice plan that I was complaining about, that the
4 11:07:00 4 county would provide malpractice coverage for
5 11:07:04 5 everything that's done outside Kern Medical Center
6 11:07:06 6 with the approval and blessing of Peter Bryan.
7 11:07:10 7 Q. Okay. And you -- you -- you explained this
8 11:07:12 8 issue to Mr. Bryan?
9 11:07:13 9 A. Yes. And he said this is business plan.
10 11:07:17 10 Q. Okay. So he -- he basically discounted or
11 11:07:20 11 disagreed with your concern?
12 11:07:22 12 A. Correct.
13 11:07:22 13 Q. Okay. How many times did you go to Peter
14 11:07:25 14 Bryan about this?
15 11:07:27 15 A. No more than once.
16 11:07:28 16 Q. No more than once. Do you recall when you
17 11:07:30 17 went to Mr. Bryan about this issue?
18 11:07:32 18 A. No.
19 11:07:33 19 Q. Okay. Do you recall whether you met with
20 11:07:42 20 Mr. Bryan and expressed this concern about the
21 11:07:44 21 malpractice insurance on or --
22 11:07:47 22 A. I --
23 11:07:48 23 Q. -- on or around the date of this letter?
24 11:07:50 24 A. I do not recall specifically going to
25 11:07:53 25 Mr. Bryan regarding this issue only.
MansourJ
100
1 11:07:55 1 Q. Okay.
2 11:07:56 2 A. It's regarding the whole faculty practice
3 11:08:01 3 plan, and that's probably one of the items on the
4 11:08:03 4 faculty plan. I don't recall going only for that
5 11:08:05 5 issue.
6 11:08:06 6 Q. Okay. And was Mr. Bryan hostile when you
7 11:08:11 7 raised this issue about malpractice insurance?
8 11:08:17 8 A. I can't remember. All I remember is part of
9 11:08:20 9 the business plan that made sense.
10 11:08:22 10 Q. Okay. And did you -- after you talked with
11 11:08:25 11 Mr. Bryan, did you ever discuss this issue with
12 11:08:28 12 anybody else? Obviously you discussed it with
13 11:08:30 13 Dr. Harris, right?
14 11:08:31 14 A. I asked Mr. -- Dr. Harris, yeah, whether he
15 11:08:35 15 was aware of this or not.
16 11:08:36 16 Q. What did he say?
17 11:08:38 17 A. He said he was. I remember he said he was
18 11:08:42 18 aware and he agrees with it.
19 11:08:45 19 Q. He agrees with you?
20 11:08:46 20 A. He agrees with the plan.
21 11:08:47 21 Q. Oh, he thinks the plan is fine?
22 11:08:49 22 A. That's fine. It's a business plan, and he
23 11:08:51 23 doesn't see, like he stated, why I don't take
24 11:08:56 24 advantage of that and do private practice at
25 11:08:59 25 Memorial.
MansourJ
101
1 11:08:59 1 Q. So is this memo -- that discussion regarding
2 11:09:12 2 the malpractice coverage, is that -- do you see that
3 11:09:15 3 last paragraph on 27083, that last paragraph?
4 11:09:20 4 A. Yeah.
5 11:09:20 5 Q. Is that an accurate account of your
6 11:09:22 6 discussion with Dr. Harris?
7 11:09:28 7 A. Correct.
8 11:09:28 8 Q. It says -- you see there on 27084, the
9 11:09:38 9 second page, it's going to be about almost near the
10 11:09:41 10 end of that first big paragraph, it says, "I asked
11 11:09:44 11 Dr. Mansour why he would not also take advantage of
12 11:09:46 12 this and work in the community too"?
13 11:09:48 13 A. Correct.
14 11:09:49 14 Q. So he was suggesting why don't you go use
15 11:09:51 15 this malpractice coverage and work at other hospitals
16 11:09:54 16 and get free coverage, correct?
17 11:09:56 17 A. Correct.
18 11:09:56 18 Q. What did you -- how did you respond to that?
19 11:09:58 19 A. I thought it was -- I don't know if I
20 11:10:01 20 responded or not, but I thought it was outrageous to
21 11:10:04 21 do that. So --
22 11:10:05 22 Q. I think so too.
23 11:10:08 23 Okay. Do you see that last sentence there
24 11:10:15 24 in the same paragraph, "Dr. Mansour said that it is a
25 11:10:18 25 business decision that the board wants to appeal."
MansourJ
104
1 11:13:05 1 Q. Okay. So how do you know that the board was
2 11:13:07 2 aware?
3 11:13:09 3 A. Because it was raised in one of their
4 11:13:12 4 meetings, one of those open session with Peter Bryan,
5 11:13:16 5 that issue was raised.
6 11:13:17 6 Q. I'm sorry, what do you mean open session
7 11:13:20 7 with Peter Bryan?
8 11:13:21 8 A. I mean the regular session of the board of
9 11:13:23 9 supervisors. It was -- that issue was raised one
10 11:13:28 10 time with Peter Bryan.
11 11:13:29 11 Q. Oh, I see. And did the board -- to your
12 11:13:33 12 knowledge, did the board actually approve the plan
13 11:13:36 13 still?
14 11:13:38 14 A. That's gone. That's disappear. The plan
15 11:13:40 15 was can- -- the malpractice coverage, that's all
16 11:13:43 16 canceled.
17 11:13:44 17 Q. Oh, it was canceled?
18 11:13:46 18 A. Yeah.
19 11:13:46 19 Q. So they fixed the problem?
20 11:13:48 20 A. Yeah, it was canceled.
21 11:13:49 21 Q. The board fixed the problem?
22 11:13:51 22 A. Well, yeah, they canceled it before those
23 11:13:54 23 guys resigned, like in maybe to late -- early 2007 or
24 11:14:02 24 late 2006. So that malpractice coverage was taken
25 11:14:06 25 away.
MansourJ
of 191
ss.
2 COUNTY OF KERN
7 No. 7704, do hereby certify that JOSEPH MANSOUR, M.D.,
9 duly sworn; that said deposition was taken Monday,
22
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WOOD & RANDALL

(800) 322-4595

3 Phone: (213) 992-3299
Fax: (213) 596-0487
6
7
10 FRESNO DIVISION
[Fed. R. Civ. P. 56(a)]
16 Courtroom: 3
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Harris, Vol. II
7 Lieu
8 Jennifer Abraham
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21 Vol. I
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27 EXHIBIT 34
28
CONFIDENTIAL: Trfe document was prepared in furtherance of the qualiy management and performance Improvement
activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible In
a court of taw pursuant to California Evidence Code Section 1157. Further protections are afforded the quaKy
management and performance improvement processes under the Health Care Quality Improvement Act of 1988 (P.L. 99-
660).
May 10,2006
Re: Joseph Mansour, MJ>.
Err. Mansour came to talk to me today at 3:30 p.m. and we spoke for about 30 minutes.
In retrospect, what he was really asking was why the department of OB-GYN was not
being run by a committee of four with him being one and I being the fifth member as tie
breaker. Feeling that he has little input into the running of the department, he plans to go
to the Board and state that this structure had not been implemented.
I told Dr. Mansour that he had mentioned this management structure to me about 3
months or so ago. I tried to validate such a proposed structure, but was unable to verify it
with Peter Bryan or others.
I told Dr. Mansour that his statement that he would go to the Board with such a complaint
surprised me. I told him that it would be considered inappropriate for a member of the
medical staff to go to a governing board for a hospital for such a matter, that governing
boards set policy and strategic direction for an institution, and that such a matter of
management is dealt with at an administrative level. Furthermore, when a medical staff
member or employee has a concern, there are mechanisms for dealing with those
concerns without having to go to the board. He said that he is a taxpayer. He said that if
he has exhausted all other means of addressing his concerns, he should go to the board. I
told him that maybe so, but that he has not come to me prior to this, so certainly he had
not exhausted all other means. I still have not heard his specific complaint that he would
present at such a management committee. Dr. Mansour became apparently angry and
raised his voice to me, implying that h is outrageous to suggest that he should not go to
the Board with complaints. He wanted me to put in writing that I said that it is
inappropriate for a medical staff member to go to the board. I did not respond. If every
time a medical staff member had an issue on his or her personal agenda and went to the
Board, nothing would ever get accomplished. I asked him if he had complaints of
improprieties that needed to be addressed at such a high level? I asked if there were non-
compliant issues or issues of ethics? He looked at me strangely and said there were no
issues of ethics. I said that if he needed to bring any improprieties to light, that we have a
compliance officer who would deal with the issue, and that he would have no need to go ,-N
to the Board. He said that he did have examples but that they were not of ethical issue. I S) S
asked him to please give me an example. ^ <g p
Dr. Mansour asked me if I was aware that the County was paying the malpractice m 04 M«
coverage for doctors to do cases at Memorial and at Mercy? I at first said no, as we have +3 cj b
asked doctors to purchase private malpractice coverage for any private practice activity. I :S TS •§
told Dr. Mansour, however, we want in the future to encourage doctors to work in the
* ' — <j - — - — - — — - _
x o-» j ^ -
*s
•»—
community, build relationships, enhance the image and services of our practice groups, „ ^ £
llif
0027083
Be?*!
and bring a more favorable payer mix to KMC. Then I remembered that we had already
begun that transition plan starting with OB-GYN and that the Board had approved and
sanctioned the malpractice coverage for those OB-GYN doctors for work in the
community. Dr. Mansour implied that was a misuse of taxpayer dollars. I explained that
it costs us no more money or no less money regardless of whether the doctor works
outside of KMC. I do recognize that if a payout is made, then indeed it would cost the
County some money, but we had decided that the potential benefits of such a practice
design far outweigh the added risks. Dr. Mansour thought that it was wrong for the
doctors to do this (obviously not unethical though, based on his previous discussion). I
asked Dr. Mansour why he would not also take advantage of this and work in the
community too? He said that he does do work at Memorial. I did not ask him if he felt it
was so wrong that he purchases his own private malpractice. I told Dr. Mansour, that
regardless of how he feels about it, the Board approved the plan. It was and still is
nothing more than a business decision. Dr. Mansour said that h is a business decision
that the Board wants to repeal.
From the comments that Dr. Mansour was making it was obvious that he had an audience
at the Board level.
I asked Dr. Mansour if he had any further examples. None were forthcoming.
Dr. Mansour did mention that he felt that the department secretary kept few minutes and
was of little help to him. He felt that the department secretary was part of the "family
affair" goings on in the department, clouded by secrecy and underhanded dealings. Dr.
Mansour wanted to know why Dr. Perez's resignation was being kept so quiet.
I told Dr. Mansour that with the recruitment and replacement of the Chairmanship of the
Department of OB-GYN that his complaints will likely vanish under new leadership. He
agreed but said that could take months. He said that when tried in the past, no one could
be found that was willing to become the Chair of OB-GYN.
We ended the meeting with me reiterating that I will set up a meeting with him to clarify
whether the managing structure that Dr. Mansour had assumed was going to put into
place was actually what was agreed upon. I thanked him for his input.
Respectfully submitted,
Irwin Harris, M.D.

0027084
2
CONFIDENTIAL: This document was prepared In furtherance of the quality management and performance improvement
activities of Kern Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in
a court of law pursuant to California Evidence Code Section 1157. Further protections are afforded the quality
management and performance improvement processes under the Health Care Quality Improvement Act of 1986 (P.L. 99-
660).
Re. Dr. Joseph Mansour as report by Dr. William Roy
September 12,2006
Dr. Roy came to see me today, Tuesday, September 12, 2006 at 12:30 p.m. with Dr.
Leonard Perez as witness to complain about abuses by Dr. Mansour.
Dr. Mansour accused Dr. Roy of canceling a patient's surgery under the alleged pretense
that Dr. Roy had a case at Memorial. In actuality, the patient required a bowel
preparation which had not been done prior to the planned operation.
Dr. Mansour was said to have been heard stating that Dr. Roy gave renal
failure, when in actuality, the patient had had congenital kidney disorder and a stent had
been replaced. The comment was made by Dr. Mansour in front of students and
residents. It is said that Dr. Mansour often slaps the desk in front of him making for
extreme emphasis of such criticisms. Dr. Roy said that if the event had been true, the
case would have been in peer review. Rather, the comments made by Dr. Mansour were
unprofessional, inappropriate, and of malicious intent.
Dr. Roy feels that he delivers care in prolonged hours and service to KMC and despite
the additional effort and service, he is subjected to Dr. Mansour's ridicule and criticism.
Unless the environment was to change, Dr. Roy states that he will leave.
Irwm E. Harris, M.D.

Plaintiffs Exhibit 740

08/13/08
/
0027094
£X.?4O
CONFIDENTIAL: This document was prepared in furtherance of the quality management and performance improvement
management and performance Improvement processes under the Health Care Quality Improvement Act of 1986 (P.L. 99-
660).
October 16,2006
Re: Dr. Joseph Mansour
Dr. Mansour, in my opinion, was inappropriate at both the OB department meeting and
the resident meeting that followed on Monday, October 16, 2006. Leonard Perez agreed.
Dr. Mansour consumed a large part of the faculty meeting arguing that having the OB
Chair candidates give a lecture on their return visit might alienate them and chase them
away.
He made an issue of lack of coordination for medical students rotating through OB,
despite the fact that last week Hansa Patel volunteered to organize this matter. (Dr.
Mansour did have a good suggestion however, that students be assigned clinic, OR, or
L&D in alternating fashion rather than assigning them to teams. Rounding teams for the
morning could still be assigned.)
Dr. Mansour said that there are sufficient nursing issues in L&D that he could do a write-
up every 5 minutes. Unfortunately, he made this statement in front of all of the residents.
I did do an on the spot counseling of Dr. Mansour, by giving him a note of advice: Do
not criticize the nursing staff in front of the residents.
jU—« 7Lu^
Irwin Harris, M.D.
Plaintiffs Exhibit 742

08/13/08
/
0027097
management and performance improvement processes under the Health Care Quality Improvement Act of 1986 (P.L. 9 9 -
660).
Re: Phil Dutt, M.D. Plaintiffs Exhibit 745 (2 pgs.)

February 6, 2007 08/13/08
Counseling and Considerations Concerning his Role as Acting Chair
On February 6, 2007,1 phoned Dr. Dutt after a meeting with Karen Barnes (on the
phone), David Culberson, and Steve O'Connor, where Dr. Dutt lost his temper on a
couple of occasions while trying to advance a suggestion that recent events could
possibly be leveraged for dealing with a problem supervisor and the potential litigation
by Dr. Jadwin. Dr. Dutt remarked that he has lost his temper on rare occasion.
I mentioned to Dr. Dutt that over the past several months, many have noticed periods
when he has manifested signs of stress. I expressed my concerns for his well being and
suggested several approaches that he consider:
Environmentally, he
1. Needs more staff to do the daily load of cutting in specimens and
reading slides through hiring or locums.
2. Be relieved of exclusive burden to oversee the work of Dr. Sherdetuke.
3. Hire the PA to help with cutting in of specimens
Personally, he
1. May need to find means to mitigate stress.
2. Needs a vacation (has not taken one since May)
3. Find a way to compensate Dr. Dutt for Chair duties.
4. Further counseling to decrease the compulsiveness and unbalanced
approach with which he is consumed and subsumed with the Dr.
Jadwin issues and internal politics within the pathology department
and lab. From his perception it is him, Tracy, and one other? Gilbert
against all the others.
In essence, Dr. Dutt is doing at least three jobs: full time clinical pathologist, overseer
and assumption of responsibility for all of the quality of the product being produced, and
legal consultant to deal with the previous chair. He cannot do all three jobs and have a
manageable life.
I did not discuss with him, but I feel that for now, I would keep Dr. Dutt in the acting
Chair position and try to pay him for the administrative services that he provides. He
appears to not have embraced the broad support of the pathology department and lab and
has on previous occasion prompted complaints from other medical staff members within
0027100
his department. For these two reasons, I believe he should remain acting Chair until he
can demonstrate those administrative demeanors desired of a Chair under conditions of
lower environmental stress.
Irwin Harris, M.D.

0027101
2-
t
CONFIDENTIAL: This document was prepared In furtherance of the quality management and performance Improvement
activities of Kem Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in
management and performance Improvement processes under the Health Care Quality Improvement Act of 1966 (P.L. 9 9 -
660).
March 12,2007
Re: Dr. Joseph Mansour
On Monday late afternoon, Joseph Mansour asked to meet with me as he had some
additional information to share with me regarding ACOG recommendations about the
role of the obstetrician in neonatal resuscitatioa I told him that I would go upstairs to his
office and meet him there.
Earlier in the morning, I had presented what is considered the national standard regarding
a Neonatal Resuscitation Team and to have the OB department endorse the current policy
and use of such a team. Dr. Mansour could hardly keep quiet when I tried to ask the
other members of the department for their opinion first. Dr. Mansour then demanded to
explain the circumstances that he believed prompted this inquiry. I advised him not to
share that information in a common forum as the case is scheduled to be peer reviewed.
Upon entering his office, Dr. Mansour asked if Dr. Lopez could join us and I agreed. Dr.
Mansour initially showed me the three entries in the ACOG guidelines that referred to the
topic of neonatal resuscitation and I listened intently. Things deteriorated from there.
Dr. Mansour obviously was out to get my goat and he certainly did.
First he began to rant and rave about something. In all honesty, I do not recall what he
said. He made me very uncomfortable, as he had raised his voice and was excited. He
said that he did this just to make a point. I asked him if he wanted some feedback from
me as a listener, and how he made me feel. He nodded yes. I told him that he made me
feel uncomfortable, somewhat uneasy, threatened, and that the anxiety I was feeling
made me not be able to listen to him very well.
He proceeded to ask me how his case got into peer review so quickly. I told him the
speed was not important. What I did not tell him was that his actions were perceived to
be so egregious to the NRP Team and the medical staff officers, that Dr.'s Ragland and
Jose Perez were at one point considering suspension, if for no other reason than for
"possible assault" on the respiratory therapist. I told him that when the medical staff
officers feel that a case deserves peer review it goes to peer review. Dr. Mansour said
that he has not had a chance to give his side of the story. I told him, of course not, that
peer review will allow for his side of the story to be told as part of the process. He
thought that if he could tell his side of the story the case would not need to be sent to peer
review at all. I told him that peer review is done regardless and that many peer reviews
find current acceptable practice fulfilled.
Plaintiffs Exhibit 746 (3 pgs.)

08/13/08
0027102
N=i
Dr. Mansour proceeded then to ask me what side I was on. I looked at him puzzled as if
picking a side was the only position someone could take. I told him that I do not pick
sides, but if a line were drawn, I would fall on that side of the line that would have
skepticism as to his behavior. He became more agitated with me and said see, you are
on the side of those who conspire to get me. He went into a long over-reactive tirade that
all along he had been suspicious that I was not on his side and I now admitted that to be
true. I told him that I was giving him an honest answer but that I do not pick sides. I told
him that I wished that I had not been so honest with him as obviously he has exaggerated
my answer and immediately concluded that I am out to get him and in support of Leonard
Perez. All I had said was that if a line had to be drawn, I would fall on the opposite side
of unquestionable support for him as I remain skeptical of his ability to communicate
constructively and to engender the support of others with whom he works.
Dr. Mansour went on to say in his office, how proud he was that he had brought down the
CEO, that for 10 years the other group has taken advantage of the county, that he was in
the right, that he has been awarded the best teacher award for good reason, that I should
speak with the residents to learn what a great obstetrician he is, how Leonard and his
group are manipulative, that I have been duped into believing the Peter Bryan
philosophy, that I confirmed his suspicion that I am against him, and that he plans to
contact his attorney because as a CMOI am not neutral.
I had grown somewhat annoyed with Dr. Mansour; he refused to shake my outstretched
hand, and I went out into the hall disgusted. Sensing that neither of us wanted to part in
such unpleasant state, I asked him if he wanted to go back into his office and talk. He
said yes. When we returned to his office, he tried to make me commit, in front of Dr.
Lopez, that I was against him, on the opposite side of the fence, that I had raised my
voice, that I was frustrated with the conversation because of my guilt in not being
impartial, and other psychological analysis of me.
I asked Dr. Mansour what he had hoped would be a desirable result of our further
conversation. He never really answered that question.
From this point forward, I was largely quiet, except to point out to Dr. Mansour that it is
he who has a problem that only he can solve. He asked me what I meant. I asked him to
try to identify for me what that problem might be so that I could see how much insight he
has. He said that his problem was Leonard and his group. I said that from my point of
view it is a different problem. Dr. Mansour seemed unaware. I explained to him that he
has a problem with the institution, his nursing staff, and many of his patients who have
complained. He seemed surprised to learn of this. He said it is not true, Ifthereisany
such instance, it is precipitated by Leonard and his group. He asked me to produce the
evidence. I told him that I had intended to bring some examples up to his office as it is
my responsibility to counsel him on such matters. In retrospect, it was fortunate for me
that I had not confronted Dr. Mansour with these complaints considering how upset he
became with me even without such provocation.
0027103
%
I reiterated that because of his communication style, he has not contributed to a

communicative, helpful, collegial, and effective environment at the hospital. We
apparently departed company in peace. He said that our conversation will remain only
between us, but within 10 minutes he phoned David Culberson to discuss his concerns. I
remain frustrated by his provocative demeanor, his apparent need to be the boss, his
apparent need to be in control, his apparent need to feel superior to me as Chief Medical
Officer, to intimidate me by his threat of contacting his attorney, and his apparent need to
reassure me that he would not use his power to retaliate against me. He further
patronized me by stating that he feels sorry for me since I have been swayed by being
under the influence of Peter Bryan and was biased by Leonard Perez, and that he
recognizes that this negative bias toward him is not my fault.
I am left with feelings of having been manipulated, not respected for my position or
knowledge as Chief Medical Officer, and that he would only be appeased by my
submission. He is insistent that he is right. I felt pressured to offer him my allegiance. I
have only gotten my blood pressure up once or twice since I began at KMC and I teach
residents and medical staff to never get angry. Frankly, Dr. Mansour twisted the issues
and statements in such a convoluted manner to his liking and at such a fast paced
pressured manner, that it became truly exasperating.
I wonder if consciously or subconsciously, Dr. Mansour classifies each person as with

him or against him as a pre-emptive defensive maneuver to neuter those who may
potentially criticize him or discipline him in the future, so that all he has to do is claim
unfair treatment if he is called on his actions. As a result, he can never be legitimately
criticized, because anyone who would criticize him would have to be out to get him.
i ^*->r-l*\ fid-
Irwin Harris, M.D.

0027104
3
&-**±J?
activities of Kem Medical Center. Such activities are privileged and confidential and are not discoverable or admissible in
management and performance improvement processes under the Health Care Quality Improvement Act of 1986 ( P . L 99-
660).
April 12,2007
Re: J. Mansour, M.D.
The purpose of this report is to document discussion with Joseph Mansour, M.D. held
with Mr. Culberson at 9:20 am for about 45 minutes on Thursday, morning, April 12,
2007.
Two days prior, Mr. Culberson and I decided that we would present the 5 occurrence
reports of quality concerns and one patient complaint to Dr. Mansour and allow him to
have time to think about his response before we met with him to discuss our expectations
for improved working relationships between him, patients, and the nursing staff. We
typed an accompanying letter and made copies of the six complaints which we had
intended to deliver to Dr. Mansour on Wednesday late afternoon before meeting with him
to discuss the matters on Thursday at 5 p.m. The delivery was postponed until Thursday
morning, when Mr. Culberson had time to present them to him in person. Dr. Mansour
could not wait and insisted on receiving the letter first thing Thursday morning. Dr.
Mansour then insisted on meeting with Mr. Culberson immediately thereafter and by so
doing demanded immediate audience. I was asked to join in the discussion at about 9:20
am.
I made notes of the comments made by Dr. Mansour. He said, "that others are out to get
him. Why else would there be a flurry of complaints recently against him? All of the
complaints are of malignant intent. No doctor is more caring than he. In 30 years he has
never been sued. Roughness in case 1 is only in the eye of the beholder. It was the nurse
who refused my order to set up for delivery. The nurse medicated the patient before
delivery against my advice. It is not whether I am a compassionate or a non-
compassionate doctor, rather is a lazy nurse who does not wish to do her job. In case 2, it
was Michelle, the nurse, who stopped pitocin on her own for mild deceleration without
my order. Mansour ordered her to restart the pitocin and she refused to follow Mansour
orders. If a woman is 9 cm as was case 3, of course she should have VBAC instead of C-
section. It is not true in case 4 that I threw instruments. In case 5 the patient had to push
for a while, so what is the big deal? The patient never complained to me. Obviously this
occurrence report is of malicious intent."
I tried to change the tone of the meeting away from a defense of cases, to a more
constructive outcome. I asked Dr. Mansour what he could do differently to improve the
working relationships as a team and to improve quality of patient care. He stated that he
could respond to each allegation more in writing. I reiterated the question, what can you
do to help the situation. He replied, "nothing. I do not need to change. My behavior has
not changed from before, so why now should I have to change. Why is there a flurry of
activity now? I resent the fact that Dr. Harris believes the other side." Mr. Culberson
Plaintiffs Exhibit 747 (2 pgs.)
08/13/08
0027105
stepped up and said that is not true, that both he and Dr. Harris are neutral. Dr. Mansour
then said, " let me meet with the nurses and let us clear this up."
Dr. Mansour went on to complain about Elaine. He stated, "you need to think about this:
why is only Mansour targeted? I have been here for 30 years? Perez is well connected
to the nurses. Cindy Delgado and the other nurses are well connected. Sandy Rebeski is
on top of all this. There is evil spirit at play. All of this is a remnant of Peter Bryan. It
was Mansour who got rid of Peter Bryan. The County has a different opinion about
these matters. I will apply for the Chairmanship. I am the only person who can run this
department. Now, because of these complaints against me, I will be turned down for the
position of chair. My attorney will be able to use this information. Compassionate -1
am. Caring - 1 am. Why are there no complaints from the clinic nurses? It is because
Perez is not there manipulating them. All of this is retaliation."
I suggested that perhaps Dr. Mansour could present a few ideas of how he can be part of
the solution instead of just identifying the problems. He said that he does not feel he has
to do this. So, I asked what have we concluded from this meeting? Dr. Mansour said
that he concludes that he must now respond in writing and in detail to each of the issues.
I told him that I would get him the medical record of the patient complaint and we
adjourned.
Invin E. Harris, M.D.

0027106
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a court of law pursuant to CaEfornia Evidence Code Section 1157. Further protections are afforded the quality
management and performance improvement processes under the Hearth Care Quality Improvement Act of 1986 (P.L. 99-
660).
April 12, 2007
Re: J. Mansour, M.D.
I was asked by David Culberson, who was unfortunately unable to be in attendance, to

investigate from those present in the room with Dr. Mansour regarding the alleged
"throwing of instruments" during the Cesarean-Hysterectomy. On Thursday afternoon,
April 12, 20071 met with Dr. Fahmy first who explained that the pressures were large,
the patient had lost much blood and was continuing to bleed, 9 units of blood had been
transiused, Dr. Mansour had tried to clamp to stop the bleeding with the wrong
instrument and caused more tissue damage without accomplishing hemostasis, the nurses
were unable to find the appropriate instruments, and Dr. Fahmy was surprised that Dr.
Mansour was being scrutinized, when in reality it was the nursing staff that should be
called to task for not having the appropriate instruments available.
When I asked Dr. Fahmy how Dr. Mansour reacted, especially with regard to how he
passed the instruments in his frustration, she stated that he put the wrong instrument
down on the table forcibly like pounding the table, but did not 'throw' the instrument.
I then interviewed Ms. Ramirez, who was the circulator in the room. Her response was
that she and the scrub tech were trying as best they could, and that "no one deserved to be
treated in such a verbally rude manner and to have the instruments be 'flung' at the scrub
tech, no matter how gently or forcibly, as the person can be injured." Although Dr.
Mansour did not throw, toss, or propel the instrument with force, he did release the
instrument such that it passed through the air a short distance before landing on the
instrument table stand.
I later interviewed Dr. Kalifa with Mr. Culberson, and although the resident was trying to
be helpful, he either did not recall the event or came into the room after the event had
occurred. The resident stated that he has seen others toss instruments and I used the
opportunity to emphasize to him, to never, ever, toss instruments. They are either to be
placed into a tray by the surgeon or handed, non sharp end first and outward, toward the
scrub until the scrub takes hold of the instrument from the surgeon's hand. On rare and
unusual circumstances, a surgeon may gently place an instrument down, him or herself,
on the stand.
Irwin E. Harris, M.D.

Chief Medical Officer Plaintiff s Exhibit 749
08/13/08
0027109
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16 ANTOINETTE CATHERINE SMITH
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1 09:18:10 1 MR. LEE: That's a good point. You know,
2 09:18:12 2 I'll look into that later.
3 09:18:14 3 BY MR. LEE:
4 09:18:14 4 Q. Okay. And do you recall how you voted on
5 09:18:16 5 this removal of Dr. Jadwin at the removal meeting?
6 09:18:22 6 A. To my best recollection, I voted for his
7 09:18:24 7 removal.
8 09:18:25 8 Q. And do you recall -- I believe there was a
9 09:18:28 9 couple of abstentions.
10 09:18:29 10 Do you recall who abstained on the vote?
11 09:18:34 11 A. I believe Dr. Ragland abstained.
12 09:18:39 12 Q. Okay.
13 09:18:40 13 A. But I do not remember anyone else.
14 09:18:44 14 Q. Do you believe David Hill might have
15 09:18:46 15 abstained? He was the director of ambulatory care.
16 09:18:49 16 A. David Hill didn't -- is not a voting
17 09:18:55 17 member -- was not.
18 09:18:58 18 Q. Any idea why Dr. Ragland might have
19 09:19:00 19 abstained from the vote?
20 09:19:02 20 A. I have -- I had no conversation with him
21 09:19:04 21 before or after.
22 09:19:05 22 Q. Okay. And why did you vote to remove
23 09:19:11 23 Dr. Jadwin from chair?
24 09:19:14 24 A. My rationale for removing him from chair was
25 09:19:18 25 because of his absence from the premises. He had not
SmithT1
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1 09:19:25 1 been present for quite some time, as I recall. I
2 09:19:28 2 can't tell you the amount of time. And as you might
3 09:19:32 3 know, those positions are extremely important, and we
4 09:19:36 4 need to have a chair who is present to do the work of
5 09:19:42 5 the department.
6 09:19:42 6 Q. When you say absence and presence, you mean
7 09:19:46 7 physical absence and physical presence. Correct?
8 09:19:47 8 A. Correct.
9 09:19:49 9 Q. Okay. And were you aware of why Dr. Jadwin
10 09:19:52 10 was physically absent from Kern Medical Center for a
11 09:19:54 11 large part of 2006?
12 09:19:59 12 A. I have no idea. I believe there was mention
13 09:20:04 13 that it was -- actually, I have no idea.
14 09:20:12 14 Q. No idea?
15 09:20:14 15 A. No idea. It was basically due to his
16 09:20:16 16 unavailability.
17 09:20:19 17 Q. Due to his unavailability.
18 09:20:21 18 And -- okay. Did Dr. -- well, who was --
19 09:20:29 19 who brought this -- this agenda item to the JCC of
20 09:20:32 20 Dr. Jadwin's removal? Do you recall?
21 09:20:36 21 A. To the best of my recollection, it was
22 09:20:38 22 Mr. Bryan.
23 09:20:39 23 Q. Mr. Bryan.
24 09:20:40 24 And do you recall why -- was there any
25 09:20:47 25 explanation given as to why physical presence of a
SmithT1
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1 10:50:32 1 Q. Do you recall whether any regulatory
2 10:50:36 2 authorities ever reviewed the PCC issue?
3 10:50:40 3 A. We've had multiple regulatory agencies
4 10:50:43 4 review our entire blood administration process.
5 10:50:47 5 Q. Okay. Can you name those agencies?
6 10:50:50 6 A. Joint commission, CAP, and CMS.
7 10:50:59 7 Q. I'm sorry. What's CMS?
8 10:51:06 8 A. Shoot. What the heck does it stand for?
9 10:51:08 9 Q. California Medical Society or --
10 10:51:10 10 MR. WASSER: No. It's a welfare --
11 10:51:12 11 THE WITNESS: No. It's a federal
12 10:51:14 12 government --
13 10:51:15 13 MR. WASSER: Social Security.
14 10:51:16 14 MS. BARNES: It's the Centers for Medicare
15 10:51:18 15 and Medicaid Services, formerly HCFA, Healthcare
16 11:23:53 16 Financing Administration.
17 10:51:25 17 THE WITNESS: Thank you.
18 10:51:25 18 MR. LEE: Thank you. That's a very good
19 10:51:26 19 answer.
20 10:51:26 20 THE WITNESS: It's the federal government.
21 10:51:28 21 BY MR. LEE:
22 10:51:28 22 Q. Do you recall if Dr. Jadwin -- let me back
23 23 up.
24 10:51:34 24 Do you recall if the Department of Health
25 10:51:36 25 Services ever looked at the PCC or blood issue --
SmithT1
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1 10:51:39 1 blood administration issue?
2 10:51:40 2 A. That would be Title 22.
3 10:51:42 3 MR. WASSER: DHS.
4 10:51:44 4 THE WITNESS: DHS. I don't recall.
5 10:51:47 5 BY MR. LEE:
6 10:51:49 6 Q. And what do you recall -- were you -- did
7 10:51:56 7 you happen to learn what the findings were or the
8 10:51:58 8 reports were of these multiple regulatory agencies
9 10:52:02 9 looking at the blood administration?
10 10:52:05 10 A. Well, the way -- the way we usually have
11 10:52:07 11 reports from these agencies are if there are -- if
12 10:52:10 12 they review something and there's a deficiency, then
13 10:52:13 13 they write it as a deficiency.
14 10:52:15 14 Q. Okay.
15 10:52:17 15 A. And, I mean, I -- our latest survey of
16 10:52:24 16 CMS -- I know for a fact because I remember very
17 10:52:28 17 clearly that we had no deficiencies in nursing,
18 10:52:32 18 period. So they did not find any fault with the
19 10:52:35 19 blood. Joint --
20 10:52:39 20 Q. What about -- I'm sorry. Go ahead.
21 10:52:41 21 A. I was going to say, I don't believe joint
22 10:52:43 22 commission found any. I would have to refer to those
23 10:52:46 23 reports.
24 10:52:52 24 Q. The same thing with CAP?
25 10:52:56 25 A. The same thing with CAP.
SmithT1
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1 10:54:03 1 jeopardy --
2 10:54:04 2 Q. Okay.
3 10:54:04 3 A. -- which in their mind places the safety of
4 10:54:09 4 patients or staff in immediate harm.
5 10:54:14 5 Q. So, in other words, none of the regulatory
6 10:54:18 6 agencies determined that there was jeopardy?
7 10:54:21 7 A. Correct.
8 10:54:25 8 Q. Nevertheless, a deficiency is never a good
9 10:54:28 9 thing to hear about -- right? -- from a regulatory --
10 10:54:32 10 A. Oh, we want to be perfect and we want our
11 10:54:33 11 patients to have perfect care. That's a goal.
12 10:54:40 12 Q. Right.
13 10:54:40 13 Now, Dr. Jadwin was finding some original
14 10:54:47 14 PCCs that were incomplete or incorrectly filled out.
15 10:54:51 15 Were you aware of whether Ms. Hevle in her
16 10:54:54 16 audits were picking up the same types of errors in
17 10:54:59 17 the original PCCs?
18 10:55:01 18 A. Well, Ms. Hevle's audits certainly reflected
19 10:55:05 19 less than 100 percent compliance. Whether they were
20 10:55:12 20 looking at the same things, I have no idea.
21 10:55:20 21 Q. Okay. But there was some corroboration then
22 10:55:25 22 of Dr. Jadwin's concerns about incomplete or
23 10:55:27 23 inaccurately -- inaccurately filled original PCCs, to
24 10:55:34 24 your knowledge?
25 10:55:34 25 A. Well, I wouldn't call it corroboration
SmithT1
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1 10:56:33 1 you familiar with statistical sampling error?
2 10:56:35 2 A. Yes.
3 10:56:36 3 Q. The size of the sample will determine the
4 10:56:38 4 accuracy or trustworthiness of the average you
5 10:56:42 5 derive?
6 10:56:43 6 A. I'm familiar with that. I'm not sure it
7 10:56:45 7 applies here.
8 10:56:46 8 Q. Okay. But you don't know one way or the
9 10:56:48 9 other?
10 10:56:48 10 A. I don't know one way or the other. I know
11 10:56:50 11 that Ms. Hevle's samples were statistically -- that
12 10:56:57 12 she abided by joint commission regulations on how
13 10:57:00 13 many samples.
14 10:57:02 14 Q. So probably her sample size was large enough
15 10:57:05 15 to yield a pretty accurate finding?
16 10:57:09 16 A. We believe so.
17 10:57:10 17 Q. Okay. Okay. But regardless, finding --
18 10:57:17 18 let's say you find one percent or two percent
19 10:57:21 19 incomplete or inaccurate PCCs being filled out.
20 10:57:25 20 That's still a problem regardless, isn't it? You
21 10:57:27 21 wouldn't want to sit there and say oh, that's fine.
22 10:57:29 22 There's no problem here.
23 10:57:29 23 A. I would never say that was okay.
24 10:57:36 24 MR. LEE: Okay. Would you mind going off
25 10:57:37 25 the record just briefly for a rest room break?
SmithT1
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2 COUNTY OF KERN
8 ANTOINETTE CATHERINE SMITH, the witness named in the
10 deposition was taken Tuesday, August 19, 2008, at the
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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10 __________________________)
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15 OF
16 MAUREEN FRANCES MARTIN, M.D.
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1 09:40:23 1 lot of his presence was either fabricated or not --
2 09:40:33 2 I mean, what he presented himself as and what he, in
3 09:40:36 3 fact, was were very different. And it was quite a
4 09:40:40 4 big disappointment to me over time to realize that,
5 09:40:46 5 you know, aside from the inappropriateness that there
6 09:40:50 6 wasn't a lot of substance and value to his role as
7 09:40:55 7 a pathologist.
8 09:41:02 8 Q. Would you -- if you saw Dr. Jadwin today on
9 09:41:04 9 the street, how would you greet him?
10 09:41:06 10 A. I would say hello.
11 09:41:07 11 Q. Okay. Would you be friendly with him?
12 09:41:09 12 A. I would.
13 09:41:10 13 Q. Okay. So do you have any kind of lingering
14 09:41:14 14 feelings of resentment or anger or disappointment
15 09:41:17 15 with Dr. Jadwin?
16 09:41:18 16 A. If any, of all those words I would say
17 09:41:20 17 disappointment.
18 09:41:21 18 Q. Um-hmm. Um-hmm.
19 09:41:24 19 But if you did see Dr. Jadwin, would you
20 09:41:26 20 turn the other way and just pretend like you didn't
21 09:41:29 21 see him?
22 09:41:30 22 A. No.
23 09:41:30 23 Q. You wouldn't do that.
24 09:41:31 24 Do you like Dr. Jadwin?
25 09:41:34 25 A. I do.
MartinM1
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1 09:41:35 1 Q. Okay. Even today you like Dr. Jadwin?
2 09:41:37 2 A. I do.
3 09:41:38 3 Q. Okay. If Dr. Jadwin wanted to -- you know,
4 09:41:44 4 just speculative, but I'm going to ask it. If
5 09:41:47 5 Dr. Jadwin called you up and said, hey, can we meet
6 09:41:49 6 for a meal, I'm in Bakersfield, would you do it?
7 09:41:51 7 A. Probably not.
8 09:41:52 8 Q. And why is that?
9 09:41:52 9 A. I really don't feel that I have a lot in
10 09:41:58 10 common with him. I think his presence at KMC left
11 09:42:04 11 the department of surgery in a difficult situation
12 09:42:09 12 vis-a-vis pathology. So, quite frankly, my time is
13 09:42:13 13 very important to me, and I would not go out of my
14 09:42:18 14 way to spend additional time with David Jadwin.
15 09:42:21 15 Q. Okay. Okay. Besides -- first of all, let's
16 09:42:32 16 clarify a few statements.
17 09:42:34 17 Now, you said the department -- Dr. Jadwin
18 09:42:35 18 left the department of surgery in a difficult
19 09:42:38 19 position vis-a-vis pathology.
20 09:42:40 20 What does that mean?
21 09:42:41 21 A. Well, he was absent for a long time. The
22 09:42:43 22 department -- the department was without a leader for
23 09:42:46 23 a long time.
24 09:42:47 24 Q. You are talking about pathology. Right?
25 09:42:49 25 A. Yes.
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1 12:08:11 1 A. In that setting it was not counseling; it
2 12:08:16 2 was a professional interaction regarding a pathology
3 12:08:20 3 report --
4 12:08:20 4 Q. I see.
5 12:08:21 5 A. -- that I would ask to either be reviewed,
6 12:08:24 6 sent out, or revisited.
7 12:08:29 7 Q. Oh, I see.
8 12:08:31 8 So Dr. Jadwin's conduct did improve with
9 12:08:33 9 respect to sending pathology reports out at your
10 12:08:36 10 request?
11 12:08:36 11 A. Well, at my request. I usually had a very
12 12:08:39 12 appropriate interaction with him regarding the case
13 12:08:41 13 at hand.
14 12:08:42 14 Q. I see.
15 12:08:42 15 Did Dr. Jadwin's conduct or interactions --
16 12:08:45 16 did he show any kind of improvement, other than that,
17 12:08:47 17 in your interactions with him?
18 12:08:52 18 A. Quite frankly, I never had a bad interaction
19 12:08:54 19 with him.
20 12:08:54 20 Q. I see.
21 12:08:54 21 Okay. So these -- so you didn't feel ever
22 12:09:02 22 the need -- because Dr. Jadwin was responding to your
23 12:09:05 23 meetings with him, you didn't feel the need to report
24 12:09:07 24 him to administration as a patient care issue?
25 12:09:11 25 A. That's correct.
MartinM1
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2 COUNTY OF KERN
8 MAUREEN FRANCES MARTIN, M.D., the witness named in the
10 deposition was taken Monday, August 18, 2008, at the
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10 __________________________)
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15 OF
16 EVANGELINE F. GALLEGOS
17 Wednesday, April 16, 2008
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1 13:30:34 1 A. Or manage their time more effectively.
2 13:30:38 2 Q. Okay. And you felt that comment was
3 13:30:41 3 directed at you somehow?
4 13:30:45 4 A. No. I think he -- it wasn't just directed
5 13:30:47 5 to me. It was everybody.
6 13:30:49 6 Q. It was everybody?
7 13:30:50 7 A. Yeah.
8 13:30:56 8 Q. Okay. Is there anything else you want to
9 13:30:59 9 add to this issue about him putting more work on your
10 13:31:03 10 shoulders when you were already busy?
11 13:31:06 11 A. No. That's it.
12 13:31:07 12 Q. That's it.
13 13:31:08 13 Okay. Well, let's talk about his
14 13:31:10 14 personality or his style of management. Did you find
15 13:31:14 15 him to be -- did you find Dr. Jadwin to be arrogant?
16 13:31:19 16 A. Yes.
17 13:31:20 17 Q. Okay. Can you describe that in any more
18 13:31:23 18 detail? How was he arrogant?
19 13:31:30 19 A. He's approachable, but I guess maybe -- I
20 13:31:39 20 don't mean to be judgmental, but sometimes he would
21 13:31:43 21 say things that were kind of arrogant. I can't
22 13:31:46 22 recall. But, I mean, he's -- outside of work he's a
23 13:31:55 23 very kind and generous man, but in the workplace he's
24 13:31:58 24 just different. You know, it's different when you
25 13:32:01 25 work with people.
GallegosE
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1 13:32:05 1 Q. Perhaps a little demanding, then?
2 13:32:07 2 A. Yes. He wants certain things done and he
3 13:32:11 3 wants them his way.
4 13:32:16 4 Q. Okay. So in that sense he was arrogant,
5 13:32:19 5 then, Dr. Jadwin was arrogant?
6 13:32:25 6 A. Yes. I feel, yes.
7 13:32:26 7 Q. Okay. Was Dr. Jadwin disagreeable, in your
8 13:32:33 8 opinion?
9 13:32:34 9 A. What do you mean by disagreeable?
10 13:32:37 10 Q. That's a good question. I wish we could ask
11 13:32:47 11 your attorney, but that's a little hard. I don't
12 13:32:49 12 know. I'll take a stab at it. I'm going to try to
13 13:32:55 13 give you my understanding of the dictionary meaning
14 13:32:59 14 of that word, but perhaps unpleasant.
15 13:33:02 15 Disagreeable -- was Dr. Jadwin disagreeable
16 13:33:05 16 in the sense of being unpleasant?
17 13:33:10 17 A. No. He's pleasant.
19 13:33:17 19 uncooperative?
20 13:33:29 20 A. Uncooperative as far as with staff or with
21 13:33:34 21 issues, if something was told had to be done this
22 13:33:40 22 way. Is that what you mean?
23 13:33:43 23 Q. I guess uncooperative in the sense that
24 13:33:45 24 maybe not easy to work with.
25 13:33:49 25 A. Yeah. He -- it was not easy working with
GallegosE
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1 13:33:55 1 him.
2 13:33:57 2 Q. All the time or --
3 13:33:58 3 A. Not all the time, no. He would have his
4 13:34:01 4 moments. We all have our moments.
5 13:34:04 5 Q. Moments of being easy to work with or not
6 13:34:07 6 easy to work with?
7 13:34:09 7 A. Moments of not being easy to work with.
8 13:34:13 8 Q. I see.
9 13:34:13 9 So in other words, it wasn't all the time
10 13:34:15 10 that he was uncooperative, but there were times when
11 13:34:18 11 he was uncooperative?
12 13:34:20 12 A. Yes. There were times when he was
13 13:34:21 13 uncooperative.
15 13:34:24 15 intimidating?
16 13:34:31 16 A. No.
17 13:34:33 17 Q. Okay. Well, he's a tall man. He's about
18 13:34:35 18 six three or six four.
19 13:34:37 19 How tall are you?
20 13:34:38 20 A. Five two.
21 13:34:39 21 Q. Five two. So a lot smaller than he is.
22 13:34:42 22 Did you ever feel he was physically
23 13:34:45 23 aggressive or intimidating?
24 13:34:47 24 A. No.
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2 13:35:02 2 A. Sometimes.
3 13:35:03 3 Q. Sometimes.
4 13:35:04 4 There's only a couple more.
5 13:35:07 5 Did you find Dr. Jadwin to be
6 13:35:09 6 self-righteous?
7 13:35:16 7 A. Yes.
8 13:35:18 8 Q. Can you go into that or is it -- I mean, you
9 13:35:20 9 don't have to repeat the examples, if that's what
10 13:35:22 10 you're going to refer to. How was he self-righteous?
11 13:35:26 11 What instances come to mind?
12 13:35:28 12 A. He always thought he was right.
13 13:35:30 13 Q. Okay.
14 13:35:31 14 A. If that's the definition of self-righteous,
15 13:35:34 15 yes. Everything he said was right. Or so he
16 13:35:39 16 thought.
17 13:35:41 17 Q. So you found Dr. Jadwin wasn't exactly open
18 13:35:43 18 to other viewpoints?
19 13:35:46 19 A. No.
20 13:35:48 20 Q. Okay. And when you say that, do you mean
21 13:35:49 21 only in reference to you or is that something you
22 13:35:52 22 felt he was doing with everybody?
23 13:35:55 23 A. I don't know how he does with everybody.
24 13:35:57 24 It's just my point of view.
25 13:35:59 25 Q. Your personal interactions.
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1 13:36:01 1 Okay. And last one, did you find Dr. Jadwin
2 13:36:03 2 to be unfriendly?
3 13:36:05 3 A. No.
4 13:36:06 4 Q. Okay. So when you say he's not unfriendly,
5 13:36:11 5 you mean he was -- so he could be pleasant, then?
6 13:36:14 6 A. He could be pleasant.
7 13:36:15 7 Q. Okay. And you said outside of work he was a
8 13:36:18 8 pretty generous and kind person?
9 13:36:20 9 A. Yes.
10 13:36:20 10 Q. Why do you say that? Based on what?
11 13:36:24 11 A. Because we -- we as the lab or the
12 13:36:30 12 department, he's had barbecues or little outings that
13 13:36:34 13 we would go to his home.
14 13:36:37 14 Q. Okay. And then you thought he was very
15 13:36:41 15 easygoing and sociable at these outings?
16 13:36:45 16 A. Totally different from work.
17 13:36:48 17 Q. Okay. So more relaxed, cracking jokes with
18 13:36:54 18 you?
19 13:36:54 19 A. Not necessarily me.
20 13:36:56 20 Q. Okay.
21 13:36:57 21 A. I just really felt kind of odd because since
22 13:37:05 22 I work with him and then how he is at work and then
23 13:37:10 23 how he is outside of work, he's just different.
24 13:37:14 24 Q. Um-hmm.
25 13:37:15 25 A. I'm the same at work and outside of work. I
GallegosE
28
1 13:37:21 1 don't know how else to phrase that.
2 13:37:23 2 Q. No. It's very clear.
3 13:37:25 3 Okay. So now, do you think that you
4 13:37:32 4 got along generally -- generally, did you feel like
5 13:37:33 5 you got along well with Dr. Jadwin?
6 13:37:37 6 A. I could get along with anybody.
7 13:37:45 7 Q. Okay. So the answer is yes, you felt like
8 13:37:48 8 you got along with Dr. Jadwin?
9 13:37:52 9 A. Yes.
10 13:37:54 10 Q. Okay. Have you ever seen Dr. Jadwin get
11 13:37:57 11 angry?
12 13:37:58 12 A. Yes.
13 13:37:59 13 Q. Okay. Can you tell me about -- well, how
14 13:38:02 14 many instances did you see him get angry on?
15 13:38:08 15 A. Twice.
16 13:38:09 16 Q. Twice. Okay. Let's focus on the first
17 13:38:11 17 instance.
18 13:38:12 18 Can you tell -- please go into detail about
19 13:38:15 19 how he got angry in the first instance.
20 13:38:20 20 A. Give me a minute because I have to think.
21 13:38:22 21 Q. Sure.
22 13:38:23 22 A. It was way far back.
23 13:38:30 23 Q. Take your time.
24 13:38:46 24 A. When you mean angry, what -- you mean angry
25 13:39:02 25 such as shouting or me perceiving him to be angry or
GallegosE
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R
1 STATE OF CALIFORNIA D
ss.
2 COUNTY OF KERN I
N
3 D
E
X
4
8 EVANGELINE F. GALLEGOS, the witness named in the
o deposition was taken Wednesday, April 16, 2008, at the
o Dated this 19th day of May, 2008, at
3
Susan R. Wood, CSR No. 6829
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WOOD & RANDALL

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27 EXHIBIT 38
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3 3
4 4
5 5 DAVID F. JADWIN, D.O., )

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6 6 Plaintiff, )
)
7 7 vs. ) Case No.
) 1:07-cv-00026-OWW-TAG
)
9 9 Defendants. )
)
10 10
11 11
13 13 OF
14 14 MARVIN OTTO KOLB, M.D.
15 15 Saturday, April 19, 2008
16 16 Los Angeles, California
17 17
18 18
19 19
20 20 Reported by: Lynda L. Fenn, CSR No. 12566
21 21
22 22
23 23
24 24
25 25
KolbM
17
1 1 professional?
2 2 MR. PEAKE: That's probably compound.
3 3 MR. LEE: You can answer, Dr. Kolb.
4 4 THE WITNESS: As I would know people who were
5 10:23 5 working there in a similar capacity, I would say
6 6 relatively well, yes.
7 7 BY MR. LEE:
8 8 Q Would you say you were friendly with
9 9 Dr. Jadwin?
10 10:23 10 A I would like to think I was friendly with
11 11 everybody.
12 12 Q Uh-huh. So the answer is yes, you were
13 13 friendly with Dr. Jadwin?
14 14 A I would say yes.
15 10:23 15 Q Did you like Dr. Jadwin?
16 16 A I liked everybody. I liked Dr. Jadwin.
17 17 Q Okay. And you didn't find Dr. Jadwin to be
18 18 arrogant to you?
19 19 A Oh, you're back to that question again. I
20 10:24 20 don't know what you are asking.
21 21 MR. PEAKE: Yeah, it really is vague.
22 22 THE WITNESS: Huh?
23 23 MR. PEAKE: It really is vague.
25 10:24 25 THE WITNESS: Describe for me an arrogant
KolbM
19
1 1 terms not -- you know, not being arrogant, just let me
2 2 know.
3 3 So, conceited, yes or no?
4 4 MR. WASSER: These are supposed to be
5 10:26 5 characteristics of arrogance?
6 6 MR. LEE: Yeah, or synonyms of arrogance.
7 7 MR. PEAKE: Aspects of arrogance, actually.
8 8 MR. LEE: Fine.
9 9 THE WITNESS: So then, are you asking me if I
10 10:26 10 agree with that word as arrogance or if I agree that
11 11 that characterizes David -- Dr. Jadwin?
12 12 MR. LEE: That's a good point.
13 13 THE WITNESS: Well, what are you asking? I
14 14 want to make sure.
15 10:26 15 MR. LEE: Sorry, Madam Reporter.
16 16 BY MR. LEE:
17 17 Q That's a very good point.
18 18 Would you characterize Dr. Jadwin as
19 19 conceited?
20 10:26 20 A No.
21 21 Q Would you characterize Dr. Jadwin as pompous?
22 22 A From my perspective?
23 23 Q Yes.
24 24 A No.
25 10:26 25 Q Would you characterize Dr. Jadwin as being
KolbM
20
1 1 patronizing?
2 2 MR. PEAKE: You are talking about his
3 3 interactions?
4 4 MR. LEE: Based on your interactions. All of
5 10:26 5 these questions are based on your interactions with
6 6 Dr. Jadwin.
7 7 THE WITNESS: That he was patronizing of me?
8 8 MR. LEE: Yeah.
9 9 BY MR. LEE:
10 10:26 10 Q Or in general?
11 11 A Well, my only interaction -- you know, I
12 12 wasn't around him all the time, so I can't answer that.
13 13 I can answer my interaction with him if I
14 14 thought he was patronizing of me.
15 10:27 15 Q Uh-huh.
16 16 A No.
17 17 Q Okay. Would you characterize Dr. Jadwin as
18 18 viewing himself as being better than you?
19 19 MR. WASSER: Better than Dr. Kolb?
20 10:27 20 MR. LEE: Yes, I said "you."
21 21 THE WITNESS: I didn't feel that.
23 23 BY MR. LEE:
24 24 Q So, after hearing all this, would you agree
25 10:27 25 Dr. Jadwin was not arrogant to you?
KolbM
21
1 1 A If you are describing what you just referenced
2 2 as words that would describe arrogance.
3 3 Q Uh-huh.
4 4 MR. PEAKE: And the question really is vague,
5 10:27 5 but go ahead.
6 6 THE WITNESS: So then I would say I answered
7 7 the question as no in my interaction with David -- Dr.
8 8 Jadwin on those issues.
9 9 MR. LEE: Okay.
10 10 BY MR. LEE:
11 11 Q So the question is: Would you agree that
12 12 Dr. Jadwin is not arrogant or arrogant?
13 13 MR. PEAKE: Well, that's overbroad again and
14 14 vague.
15 10:27 15 THE WITNESS: I'll go back to the -- the
16 16 questions that you asked before about the definition of
17 17 arrogance, did I see those characterizes in my
18 18 relationship with David, and I said no to them.
19 19 MR. LEE: Okay. Dr. Kolb, it's really a
20 10:28 20 simple question. Yes or no will do.
21 21 BY MR. LEE:
22 22 Q Do you think Dr. Jadwin was arrogant to you?
23 23 MR. PEAKE: That's actually argumentative.
24 24 The witness is not prepared to answer the question yes
25 10:28 25 or no. The witness can answer the question any way they
KolbM
22
1 1 feel to reflect their state of mind.
2 2 MR. LEE: Okay. Mr. Peake, thank you.
3 3 BY MR. LEE:
4 4 Q Okay. Did you believe that Dr. Jadwin was
5 10:28 5 arrogant to you?
6 6 MR. PEAKE: Well, that's, again,
7 7 argumentative.
9 9 THE WITNESS: I do not feel that in my
10 10:28 10 interaction with Dr. Jadwin in our professional roles
11 11 that the characteristics that you just asked me about
12 12 referencing those describing arrogance, did I see those
13 13 in Dr. Jadwin.
14 14 MR. LEE: Dr. Kolb, we already established
15 15 that. The question again, and I just want an answer,
16 16 is -- I'm not asking about the characteristics that we
17 17 just discussed.
18 18 BY MR. LEE:
19 19 Q I'm asking whether you think Dr. Jadwin was
20 10:29 20 arrogant to you?
21 21 MR. PEAKE: It's vague. It's ambiguous.
22 22 MR. LEE: Okay. You can answer, Dr. Kolb.
23 23 MR. WASSER: This is going to take until 6:00
24 24 at this point.
25 10:29 25 THE WITNESS: I don't believe so.
KolbM
23
1 1 MR. LEE: Thank you.
2 2 BY MR. LEE:
3 3 Q Did you have any interactions with Bill Taylor
4 4 or otherwise known as Edward Taylor, T-a-y-l-o-r?
5 10:29 5 A He was a member of the medical staff, so I
6 6 would have interactions with him, correct.
7 7 Q How often did you have interactions with
8 8 Dr. Taylor, say, on a weekly basis, during your tenure
9 9 at Kern Medical Center?
10 10:29 10 A I couldn't say that. Sometimes it was weekly;
11 11 sometimes it would go weeks without interactions with
12 12 him.
13 13 Q So you had sporadic interactions with
14 14 Dr. Taylor?
15 10:30 15 A I would define it that way.
16 16 Q Okay. And how did you get along with
17 17 Dr. Taylor, in your opinion?
18 18 A We had a very professional relationship.
19 19 Q Okay. Did you ever have reason to dislike
20 10:30 20 Dr. Taylor?
21 21 A Personally?
22 22 Q Uh-huh.
23 23 A No.
24 24 Q How about professional?
25 10:30 25 A There's a difference between liking a person
KolbM
36
1 1 Q Of pathology?
2 2 A -- the pathology department, all of the chairs
3 3 reported to me, correct.
4 4 Q Did you meet with Dr. Jadwin one-on-one as a
5 10:55 5 chair pathologist?
6 6 A Correct.
7 7 Q Would you say it was on a bi-weekly basis or
8 8 how frequently were these one-on-one meetings?
9 9 A I know there was some periodicity to it, but I
10 10:56 10 don't remember exactly what it was.
11 11 Q How often, in general, did you meet with
12 12 department chairs at Kern Medical Center while you were
13 13 the CMO or chief medical officer?
14 14 A My recollection is that I tried to meet with
15 10:56 15 each one of them at least monthly, if not -- and it
16 16 depended on kind of their scope of activities.
17 17 Q Did you meet with Dr. Jadwin more or less
18 18 frequently than other department chairs at Kern Medical
19 19 Center?
20 10:56 20 A I don't think there was any difference.
21 21 Q Did the department of pathology run well under
22 22 Dr. Jadwin's chairmanship, in your opinion?
23 23 MR. PEAKE: May be vague. Overbroad.
24 24 MR. LEE: You can answer.
25 10:57 25 THE WITNESS: By "well," do you mean that it
KolbM
37
1 1 met the expectations that we, as the medical staff,
2 2 needed? Yes.
3 3 BY MR. LEE:
4 4 Q Did you note any problems with the department
5 10:57 5 of pathology operating under Dr. Jadwin?
6 6 MR. PEAKE: Again, it's vague. Overbroad.
7 7 MR. LEE: Okay. You can answer.
8 8 THE WITNESS: I guess I'd have to ask you what
9 9 you mean by "problems."
10 10:57 10 Just the normal operations, there are
11 11 problems, you know, that you have to deal with. And so
12 12 I think it was a large department and there's a large
13 13 clinical laboratory that's part of it.
14 14 So there's problems that exist as part of the
15 10:57 15 normal operation and implementation of that.
16 16 So, did I think that he worked with his people
17 17 that were part of the laboratory to make things run
18 18 fairly effective and the laboratory services at Kern
19 19 Medical Center? Yes.
20 10:58 20 MR. LEE: Okay.
21 21 BY MR. LEE:
22 22 Q Let's get into the circumstances of the hiring
23 23 of Dr. Jadwin.
24 24 Why was Dr. Jadwin recruited to the chair of
25 10:58 25 the department of pathology at Kern Medical Center?
KolbM
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1 1 County would have destroyed those notes?
2 2 A I don't know.
3 3 Q Would you agree that Dr. Jadwin made quality
4 4 changes and improvements to the pathology department at
5 11:21 5 Kern Medical Center?
6 6 MR. PEAKE: Compound. Vague.
7 7 THE WITNESS: Would you repeat the question
8 8 again?
9 9 BY MR. LEE:
10 11:21 10 Q Would you agree that Dr. Jadwin made quality
11 11 improvements in the department of pathology at Kern
12 12 Medical Center?
13 13 MR. PEAKE: Again, vague and ambiguous.
14 14 THE WITNESS: As a general statement, I would
15 11:21 15 say yes.
16 16 BY MR. LEE:
17 17 Q Were you supportive of those quality changes
18 18 that Dr. Jadwin instituted in the pathology department?
19 19 A I would say yes.
20 11:22 20 Q Did you ever oppose any of those changes that
21 21 Dr. Jadwin was making in the pathology department to
22 22 improve quality?
23 23 MR. PEAKE: I think it's vague. May be
24 24 ambiguous.
25 11:22 25 THE WITNESS: I can't remember.
KolbM
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1 1 Mr. Wasser. You don't have to go on the record.
2 2 BY MR. LEE:
3 3 Q Okay. Dr. Kolb, can you answer the question?
4 4 MR. PEAKE: Your personal knowledge.
5 11:33 5 THE WITNESS: I can't remember that for sure.
6 6 MR. LEE: So you think --
7 7 THE WITNESS: I'm afraid to answer it yes.
8 8 There's a piece -- I just can't be a hundred percent
9 9 sure, no. So my answer is I don't remember.
10 11:34 10 BY MR. LEE:
11 11 Q Do you recall ever sending any core physicians
12 12 to anger management therapy during your tenure as CMO at
13 13 Kern Medical Center?
14 14 A I did.
15 11:34 15 Q How many physicians did you send to anger
16 16 management during your tenure as CMO?
17 17 A Less than five.
18 18 Q Did you ever send Dr. Jadwin to anger
19 19 management therapy during your tenure as CMO at Kern
20 20 Medical Center?
21 21 MR. PEAKE: Well, I'm assuming that you are
22 22 allowing him to answer that question, since you are
23 23 posing it as Dr. Jadwin's counsel.
24 24 MR. LEE: Your objection -- just answer the
25 11:34 25 question, Dr. Kolb.
KolbM
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1 1 MR. PEAKE: Well, I just want to make sure any
2 2 privilege is being waived with respect to any actions
3 3 that involve Dr. Jadwin.
4 4 MR. LEE: Mr. Peake --
5 11:34 5 MR. PEAKE: Because I don't know the scope of
6 6 the issues.
7 7 MR. LEE: Mr. Peake, you are not objecting and
8 8 you are not instructing him not to answer yet again.
9 9 Dr. Kolb, you can answer.
10 11:35 10 THE WITNESS: I don't remember.
12 12 BY MR. LEE:
13 13 Q So you don't know for sure one way or the
14 14 other whether you sent Dr. Jadwin to anger management
15 11:35 15 therapy during your tenure --
16 16 A That's correct.
17 17 Q -- as CMO?
18 18 A That's correct.
19 19 Q Do you ever recall an incident where a
20 11:35 20 physician became angry and drove through the parking
21 21 gate at Kern Medical Center -- the parking gate blocker,
22 22 I suppose you call it?
23 23 A No.
24 24 Q Do you recall an incident or a situation where
25 11:35 25 Dr. James -- well, first of all, let's back up.
KolbM
KOLB, M.D. 04-19-08
Page 134
C E R T I F I CAT E
I, the undersigned, a Certified Shorthand
Reporter for the State of California, do hereby certify:
That the foregoing proceedings were taken
before me at the time and place herein set forth; that
any witnesses in the foregoing proceedings, prior to
testifying, were placed under oath; that a verbatim
record of the proceedings was made by me using machine
shorthand, which was thereafter transcribed under my
direction; further, that the foregoing is an accurate
transcription thereof.
I further certify that I am neither
financially interested in the action nor a relative or
employee of any attorney of any of the parties.
IN WITNESS THEREOF, I have this date
subscribed my name this 1st day of May, 2008.
Lynda L. Fenn, CSR No. 12566
vs. COUNTY OF KERN

(800) 322-4595
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27 EXHIBIT 39
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1
1 09:49:49 1 UNITED STATES DISTRICT COURT

2 09:35:04 2 FOR THE EASTERN DISTRICT OF CALIFORNIA
3 09:35:04 3 ---------
4 4 DAVID F. JADWIN, D.O., ) No. 1:07-cv-00026-OWW-TAG
)
5 5 Plaintiff, )
)
6 6 vs. )
)
7 7 COUNTY OF KERN, et al. )
)
8 8 Defendants. )
___________________________)
9 09:35:04 9
10 09:35:04 10
11 09:35:04 11
12 09:35:04 12
13 09:35:04 13
14 09:35:04 14
15 09:35:04 15
16 09:35:04 16
17 09:35:04 17 VIDEOTAPED DESPOSITION
18 09:35:04 18 OF
19 09:35:04 19 TRACY LINDSEY
20 09:35:04 20 Tuesday, February 26, 2008
21 09:35:04 21 Bakersfield, California
22 09:35:04 22
23
24 09:35:04 23
25
26 09:35:04 24
27
28 09:35:04 25 Reported by: Cindee L. LeFevre, CSR No. 7974
LindseyT
8
1 08:09:18 1 Q. Great. Are you aware of any reason why

today's
2
08:09:24 2 deposition cannot proceed?
3
08:09:25 3 A. No.
4
08:09:27 4 Q. Is there anything that prevents you or
5 restricts
6 08:09:29 5 you from giving your best most truthful answers today?
7 08:09:33 6 A. No.
8 08:09:34 7 Q. Have you taken any medication in the last 24
9 08:09:36 8 hours, drugs or alcohol?
10 08:09:38 9 A. No.
11 08:09:40 10 Q. Great. So you stated earlier that you started
12 08:09:45 11 working at KMC in March of '05; correct?
13 08:09:49 12 A. Yes.
14 08:09:51 13 Q. Can you state the people that -- you said you
were
15
08:09:54 14 a secretary to the chair.
16
08:09:56 15 A. Uh-huh.
17
08:09:56 16 Q. Which chairs have you worked for during your
18
08:09:59 17 tenure at KMC?
19
08:10:00 18 A. Dr. Jadwin and Dr. Dutt.
20
08:10:04 19 Q. Dr. Philip Dutt?
21
08:10:05 20 A. Yes.
22
08:10:05 21 Q. Is that spelled with two "L's" or one?
23
08:10:08 22 A. I think it's one.
24
08:10:12 23 Q. Did you find Dr. Jadwin to be arrogant?
25
26 08:10:16 24 A. No.
27
28 08:10:18 25 Q. Did you find him to be overbearing?
LindseyT
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1 08:10:21 1 A. No.
2 08:10:23 2 Q. Did you find Dr. Jadwin to be dismissive of
other
3
08:10:27 3 people's input or opinions?
4
08:10:30 4 A. No.
5
08:10:32 5 Q. Did you ever have reason to believe that Dr.
6
08:10:37 6 Jadwin was engaging in any kind of fraud or dishonesty?
7
08:10:42 7 A. No.
8
08:10:44 8 Q. How did you find Dr. Jadwin as -- he was --
9 Dr.
10 08:10:48 9 Jadwin was your boss; correct?
11 08:10:50 10 A. Yes.
12 08:10:50 11 Q. He was the person that you directly reported
to?
13
08:10:53 12 A. Yes.
14
08:10:53 13 Q. How did you find Dr. Jadwin as a boss?
15
08:11:02 14 A. He was good, approachable.
16
08:11:06 15 Q. Did you have any complaints about Dr. Jadwin
17 as
18 08:11:09 16 your boss?
19 08:11:09 17 A. No.
20 08:11:17 18 Q. How much interaction did you have with Dr.
Jadwin
21
08:11:20 19 on a daily basis, if you could estimate.
22
08:11:26 20 A. Probably about 80 percent.
23
08:11:31 21 Q. You mean 80 percent of your interactions with
24
08:11:34 22 people in the day would be with Dr. Jadwin?
25
08:11:37 23 A. Yeah, I guess.
26
08:11:38 24 Q. So you worked pretty closely with Dr. Jadwin
27 then?
28 08:11:43 25 A. Yes.
LindseyT
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1 08:11:44 1 Q. And would you say he is the person at KMC that

you
2
08:11:48 2 worked the most closely with?
3
08:11:51 3 A. Yes.
4
08:11:55 4 Q. So you worked with Dr. Jadwin from March of
5 '05 to
6 08:12:02 5 October of '06. Is that correct?
7 08:12:05 6 A. Yes.
8 08:12:06 7 Q. Okay. What did you hear was the -- what did
you
9
08:12:11 8 hear about Dr. Jadwin's departure from KMC?
10
08:12:14 9 A. It was just a personal leave.
11
08:12:19 10 Q. So you were consistently told it was a
12 personal
13 08:12:22 11 leave?
14 08:12:23 12 A. Yeah, there wasn't much said about it.
15 08:12:26 13 Q. And what you did hear about Dr. Jadwin's
16 08:12:30 14 departure, who told it to you?
17 08:12:32 15 A. I don't think anyone ever really did say that
he
18
08:12:35 16 was gone.
19
08:12:38 17 Q. So what is your understanding of Dr. Jadwin's
20
08:12:41 18 employment status as of today as you sit here?
21
08:12:45 19 A. Leave of absence.
22
08:12:47 20 Q. Absence. And what is your understanding of
23 Dr.
24 08:12:51 21 Philip Dutt's position at KMC as of today?
25 08:12:55 22 A. He is interim chair.
26 08:12:58 23 Q. Interim chair?
27 08:12:58 24 A. Yes.
28 08:13:11 25 Q. Did you notice any difficulties or problems in
the
LindseyT
INDSEY
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page02-26-08
62 of 209
Page 92
2 ss.
3 COUNTY OF KERN
4
7 No. 7974, do hereby certify that TRACY LINDSEY,
10 Tuesday, February 26, 2008, at the time and place set forth
l I o n the first page hereof.
20 Dated this 18th of March, 2008, at
22
23
24
25
vs. COUNTY OF KERN

RANDALL (800) 322-4595
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3 ---------
4 DAVID F. JADWIN, D.O., ) No. 1:07-cv-00026-OWW-TAG

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5 Plaintiff, )
)
6 vs. )
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7 COUNTY OF KERN, et al. )
)
8 Defendants. )
___________________________)
9
10
11
12
13
14 DESPOSITION OF IRENE LOPEZ
15 Tuesday, February 26, 2008
17
18
19
20 Reported by: Cindee L. LeFevre, CSR No. 7974
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25
LopezI
8
1 blood products that were ordered.
2 Q. Okay. Who was your direct supervisor while you
3 were working at KMC?
4 A. It would be Gilbert Martinez, lab manager.
5 Q. Did you have many interactions with Dr. Jadwin,
6 David F. Jadwin?
7 A. Yeah, I worked with him, I would say, pretty much
8 on a daily basis, whether it be looking for slides or him
9 asking me to pull a prior pathology report, sending out
10 specimens to UCLA, Cedar Sinai. I don't remember the other
11 labs. It's been three and a half years.
12 Q. That's pretty good.
13 Well, if you could just estimate --
14 A. Uh-huh.
15 Q. -- how many interactions in a week you would have
16 had with Dr. Jadwin.
17 A. Pretty much I would say on a daily basis and quite
18 often throughout the day.
19 Q. Okay. Did you find Dr. Jadwin to be arrogant?
20 A. No, I personally did not. I would say I would
21 find him intimidating.
22 Q. What was intimidating about Mr. Jadwin?
23 A. I would say his presence. You come into the
24 office and you just see a tall person. I was entry level
25 clerical, extra help. So --
LopezI
10
1 A. No, but honestly speaking, I would say, you know,
2 we did interact, you know, him being a pathologist and me
3 being clerical, and him needing something.
4 Sometimes he would come through the office, and I
5 would say he would have a dry sense of humor. Sometimes he
6 would say things, and I am, like, okay.so that was funny or
7 something like that. I didn't quite catch it, but it was
8 overall a pleasant experience.
9 Q. So he was trying to be funny, and it didn't quite
10 work out then?
11 A. Yeah.
12 Q. Okay.
13 A. Or I didn't understand it or I missed something.
14 Q. Right.
15 A. I would be, like --
16 Q. I get that reaction with my jokes all the time.
17 Did you ever see Dr. Jadwin emotional, upset,
18 during your tenure at KMC?
19 A. That I recall an incident, no. No, I would hear
20 co-workers within the lab say, oh, you know, just
21 complaining of X, Y, or Z reason, he did this, this
22 happened, but that was it. Nothing that I saw personally --
23 Q. Uh-huh.
24 A. -- finding offensive or harassing, in that nature.
25 I mean, I believe it happens everywhere you go.
LopezI
11
1 Q. Right.
2 A. So --
3 Q. So I mean, the complaints about Dr. Jadwin that
4 you were hearing --
5 A. Uh-huh.
6 Q. -- there was nothing remarkable about them. Just
7 the kind of complaints you would hear in most workplaces?
8 A. Yes, I would be safe to say, yes.
9 Q. Would you agree that Dr. Jadwin then was generally
10 well liked in the Department of pathology?
11 A. I wouldn't necessarily say that he was well liked.
12 I know there was some people who did like him. There was
13 others that verbally voiced their dislikes.
14 Q. Would you mind stating the names of the people who
15 disliked Dr. Jadwin or stated they disliked him?
16 A. There was certain people that I knew that I
17 just -- I worked with on a everyday basis.
18 Q. Uh-huh.
19 A. I know Vangie Tolentino --
20 Q. Uh-huh.
21 A. -- was one, and she had a lot more one-on-one
22 interaction with him. She was a histology tech. I know
23 Rachelle Dirui.
24 Q. Could you spell that.
25 A. Rachelle D-i-r-u-i. I believe she is retired now.
LopezI
12
1 You know, she often complained of this or that, you know.
2 They had different duties than I did, so oftentimes I would
3 just kind of listen and so forth.
4 Q. Miss -- Vangie, does she complain a lot
5 generally?
6 A. She was just, I think -- I mean, I don't really
7 know the nature. I know she assessed specimens, would go
8 pick them up from ER, assess them.
9 He would cut them, whatever they did back there.
10 Oftentimes, I think it was maybe the procedures that were in
11 place. It wasn't anything about personality or harassment.
12 None of that. I think it was more the procedures in place.
13 She had one way of doing them, and he wanted them done one
14 way.
15 Q. So it was more in the nature of disagreements
16 about the way things should be done. Yes?
17 A. Yes.
18 Q. So was it Vangie's then --
19 A. Yes.
20 Q. -- voicing these concerns?
21 A. Yes, there was other people. I mean, those were
22 the ones that I directly, you know -- I would say friends
23 that I could probably sit down, have a everyday conversation
24 with. So those are probably the ones that I would hear the
25 most.
LopezI
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1 would go and ask him something, and I would see that, you
2 know, she would be -- I would say a little bit uneasy, a
3 little bit uncomfortable.
4 Q. Okay. So would you agree that -- well, so you
5 don't think -- do you think Dr. Jadwin was disagreeable
6 then?
7 MR. WASSER: To Dr. Shertukde?
8 BY MR. LEE:
9 Q. Just generally speaking, did you ever find Dr.
10 Jadwin acted in a manner that was disagreeable?
11 A. Such as what or --
12 Q. In your interactions with Dr. Jadwin, did you ever
13 find him to be disagreeable?
14 A. In other words, he had his own mind, his own way
15 of doing things, and are you saying not coming to an
16 agreement or a give and take relationship?
17 Q. Maybe I should switch the word. Did you ever find
18 Dr. Jadwin to be overbearing?
19 A. I don't think I understand.
20 Q. Now, these are kind of SAT words. Let me say --
21 overbearing would be, I guess, intimidating or, you know,
22 speaking in a loud voice in a dominating manner.
23 So with that definition of overbearing, would you
24 say that Dr. Jadwin was overbearing in his behavior towards
25 you?
LopezI
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1 A. Towards me, no.
2 Q. Okay. Well, did you ever witness Dr. Jadwin being
3 overbearing towards other people?
4 A. I am not sure.
5 Q. Okay. Did you ever see Dr. Jadwin act in a manner
6 that was unfriendly towards you?
7 A. Towards me, no.
8 Q. Did you see Dr. Jadwin acting in a manner that was
9 unfriendly toward other people at KMC?
10 A. I don't recall.
11 Q. Did you ever witness Dr. Jadwin acting in an
12 unprofessional manner during your time at KMC?
13 A. Unprofessional, no.
14 Q. Did you ever notice Dr. Jadwin or did you ever
15 witness Dr. Jadwin acting in a manner that was dismissive
16 towards other people's views and ideas at KMC?
17 A. I am not sure.
18 Q. Okay. Did you ever have any interactions with Dr.
19 Jadwin outside of KMC?
20 Q. After I left KMC, he did have a gathering for all
21 the personnel. This was probably -- it was County Fair
22 time, so I am thinking September of '05. The lab personnel.
23 He had a gathering for lab personnel, and he requested, I
24 think it was through Vangie -- the invitation was -- he
25 extended invitations to me and I believe Vangie and I did
LopezI
LOPEZ 02-26-08
Page 26
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
I, Cindee L. LeFevre, a Certified Shorthand

in the State of California, holding certification
7974, do hereby certify that IRENE LOPEZ,
witness named in the foregoing deposition,
by me duly sworn; that said deposition was taken
Tuesday, February 26, 2008, at the time and place set forth
the first page hereof.
the witness were written down by me in stenotypy
and thereafter transcribed by computer under my supervision;
is a true and correct transcript of the
given by the witness.
in any way related to any party to said action, nor in
way interested in the result or outcome thereof.
Dated this 18th day of March, 2008, at
akersfield, California.
Cindee L. LeFevre, CSR No. 7974
VS. COUNTY OF KERN

NDALL (800) 322-4595
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3 ______________
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 Defendants. )
__________________________)
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15 OF
16 JAVAD NADERI, M.D.
17 Thursday, December 6, 2007
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NaderiJ
38
1 10:55:54 1 either of yourself or an immediate family member
2 10:55:57 2 during your employment at KMC?
3 10:55:58 3 A. No.
4 10:55:59 4 Q. Dr. Naderi, do you have any children?
5 10:56:08 5 A. Three.
6 10:56:08 6 Q. Have any of your children experienced an
7 10:56:16 7 accident or been seriously hurt --
8 10:56:18 8 A. Yes.
9 10:56:18 9 Q. -- or injured during your time of employment
10 10:56:21 10 at KMC?
11 10:56:22 11 A. Yes.
12 10:56:22 12 Q. Can you tell me roughly when that occurred?
13 10:56:26 13 A. That was 1998. Three days after his high
14 10:56:33 14 school education -- I mean graduation -- he -- my son
15 10:56:38 15 got involved in accident and he got paralyzed. He
16 10:56:42 16 was in coma for -- excuse me. And so I was -- I was
17 10:57:15 17 involved with that, but I was on and off, back and
18 10:57:18 18 forth to work taking care of him, the hospital, come
19 10:57:25 19 back and forth. It was intermittent, it was not
20 10:57:28 20 continuous.
21 10:57:28 21 Q. So Dr. Naderi --
22 10:57:30 22 A. Does that answer your question?
23 10:57:32 23 Q. Yes, it does, Dr. Naderi. So that was an
24 10:57:35 24 intermittent leave of absence, then, that you took in
25 10:57:37 25 relation to your son's accident?
NaderiJ
39
1 10:57:39 1 A. It was sick leave, vacation or what. I
2 10:57:42 2 think I had enough vacation to take care of that.
3 10:57:47 3 Q. How long did your intermittent work schedule
4 10:57:52 4 continue for?
5 10:57:57 5 A. The subject for me is very difficult. I'm
6 10:58:02 6 not going to answer.
7 10:58:04 7 Q. Well, Dr. Naderi, we do need to know just an
8 10:58:07 8 estimate of the amount of time that you were on
9 10:58:09 9 intermittent leave at the hospital.
10 10:58:11 10 A. Was no continuation, as your question is
11 10:58:16 11 more than two months was no -- at no time was any
12 10:58:20 12 continuation of leave of absence more than two months
13 10:58:25 13 as you wanted to.
14 10:58:27 14 Q. Dr. Naderi, that doesn't answer my question.
15 10:58:30 15 My question is, for how long did the intermittent
16 10:58:33 16 leave of absence -- or I'm sorry -- the intermittent
17 10:58:36 17 work schedule that you were on in connection with
18 10:58:38 18 your son's accident, how long did that continue?
19 10:58:40 19 What was the duration of that intermittent work
20 10:58:45 20 schedule?
21 10:58:47 21 MR. WASSER: I think you're
22 10:58:48 22 mischaracterizing his testimony. He's not testified
23 10:58:50 23 he was on an intermittent work schedule, he said he
24 10:58:54 24 came and went. That may be different from an
25 10:58:56 25 intermittent work schedule, coming and going.
NaderiJ
43
1 11:02:01 1 that?
2 11:02:02 2 A. Yes. Thank you.
3 11:02:04 3 Q. Okay. When you were on this schedule of
4 11:02:10 4 working a few days and taking off a few days in
5 11:02:14 5 connection with your son's accident, were you
6 11:02:18 6 notified of your rights and obligations under the
7 11:02:23 7 Fair -- I'm sorry, the Family Medical Leave Act or
8 11:02:27 8 the California Family Rights Act?
9 11:02:32 9 A. I didn't ask anybody. I just used my sick
10 11:02:36 10 leave and my vacation.
11 11 Q. Are you fam- --
12 11:02:39 12 A. I didn't ask anybody because I didn't want
13 11:02:41 13 to have any leave of absence. I did not want to have
14 11:02:44 14 anything special for me to be gone because my family
15 11:02:49 15 was involved in accident, I just use my sick leave
16 11:02:51 16 and my vacation. When you or me or anybody takes
17 11:02:58 17 vacation, we don't have to ask for favor, we just
18 11:03:04 18 take vacation. So I didn't ask anybody, nobody had
19 11:03:08 19 to explain anything to me.
20 11:03:09 20 Q. Dr. Naderi, was it -- who was your -- who is
21 11:03:15 21 your direct supervisor at KMC?
22 11:03:20 22 MR. WASSER: Now?
23 23 BY MR. LEE:
24 11:03:22 24 Q. Now.
25 11:03:22 25 A. As a chairman, then the next step above you
NaderiJ
51
1 11:11:44 1 answer.
2 11:11:44 2 MR. LEE: Your objection's on the record,
3 11:11:47 3 Mark. Thank you. No further discussion is
4 11:11:48 4 necessary.
5 11:11:49 5 Q. Can you please clarify what you mean by yes
6 11:11:51 6 and no?
7 11:11:51 7 A. Whenever I thought the function of the
8 11:11:53 8 hospital -- I mean the function of the department
9 11:11:58 9 is -- does not need any -- anything from anybody else
10 11:12:07 10 and was a short term, and I was here, so I didn't
11 11:12:13 11 inform. Whenever needed, I informed them. But no
12 11:12:19 12 matter what, those days were marked as vacation or
13 11:12:24 13 sick leave, no matter whether they knew or they
14 11:12:29 14 didn't.
15 11:12:29 15 Q. Well, did you notify anyone that your son
16 11:12:34 16 had been in an accident? Did you notify anyone at
17 11:12:43 17 KMC?
18 11:12:44 18 A. You mean anyone -- what do you mean
19 11:12:47 19 "anyone"? That means employee of the department, or
20 11:12:50 20 what does it mean anyone?
21 11:12:52 21 Q. Okay. Did you notify any employee or staff
22 11:12:55 22 at KMC that your son had been in an accident?
23 11:13:02 23 A. Yes. Even before I informed them, they knew
24 11:13:05 24 that because that was very bad accident, and they
25 11:13:11 25 knew that he is in ICU and he's comatose. They knew,
NaderiJ
63
1 11:39:22 1 Q. Okay.
2 11:39:23 2 A. Not -- no personal relationship, but
3 11:39:26 3 reasonable professional relationship.
4 11:39:29 4 Q. Okay. Well, how would you characterize your
5 11:39:31 5 relationship with Dr. Jadwin?
6 11:39:34 6 A. Okay. Good.
7 11:39:35 7 Q. Did you find Dr. Jadwin to be arrogant?
8 11:39:47 8 A. I don't -- I don't like to characterize
9 11:39:51 9 anybody by, you know, terminology. We all have
10 11:39:55 10 different personalities. I'm sorry I cannot give you
11 11:39:58 11 yes or no answer, but I don't think it's nice -- I
12 11:40:02 12 don't think it's nice to talk about somebody. But we
13 11:40:05 13 have all different personalities. Sometimes, you
14 11:40:10 14 know, each of us we are different, so arrogant to you
15 11:40:17 15 may not be arrogant to me. I think he's okay as he
16 11:40:23 16 has different personality than somebody else, which
17 11:40:26 17 is fine.
18 11:40:27 18 Q. Did you ever experience any difficulty in
19 11:40:31 19 your interactions with Dr. Jadwin?
20 11:40:34 20 A. Not -- not much, as we have case
21 11:40:41 21 relationship, like I have with other departments.
22 11:40:46 22 Surgery, we might have discussions about cases, I
23 11:40:51 23 give him discussion, but not more than that.
24 11:40:53 24 Q. Was -- did you ever -- can you recall any
25 11:40:56 25 instances where Dr. Jadwin was emotional or
NaderiJ
64
1 11:41:00 1 confrontational with you or with anyone else?
2 11:41:05 2 A. Well, each of us may have seen somebody
3 11:41:08 3 getting emotional with somebody else, you know, in
4 11:41:12 4 the meeting, conference or what. Nothing special
5 11:41:17 5 with me is -- that's --
6 11:41:22 6 Q. Okay. So as far as you can recollect, there
7 11:41:25 7 was no particular instance that stands out to you?
8 11:41:29 8 A. Nothing with me, no.
9 11:41:30 9 Q. Okay. Did you find interacting with
10 11:41:37 10 Dr. Jadwin unpleasant in any way?
11 11:41:45 11 A. I don't recall any instance, but I
12 11:41:48 12 characterize it the same as others that, again, you
13 11:41:52 13 deal with attorneys who maybe not like the discussion
14 11:41:56 14 you have with other attorney, but next time you get
15 11:41:59 15 to see each other, then it's okay, is -- like that.
16 11:42:02 16 But those are just the usual routine things, nothing
17 11:42:07 17 specific that, you know, we go head to head or fist
18 11:42:12 18 to fist or something like that, just more
19 11:42:15 19 professional.
20 11:42:16 20 Q. Okay. Well, would you say that there are
21 11:42:19 21 certain physicians at KMC who are arrogant?
22 11:42:24 22 A. Again, I don't like to characterize anybody
23 11:42:26 23 as arrogant, as that's -- so I -- different
24 11:42:33 24 personality, but I don't characterize, you know,
25 11:42:38 25 whatever personality. Because if -- if I want to say
NaderiJ
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1 11:58:20 1 know, what you're doing and what you're -- well,
2 11:58:22 2 nobody is perfect. No matter how good lawyer you
3 11:58:27 3 are, you have your strengths in certain part and
4 11:58:31 4 weakness in certain part, and as honest you are, I
5 11:58:35 5 know this, but I don't know this. But this is what I
6 11:58:37 6 do, I'm willing to work on it, and then I learn it
7 11:58:39 7 and so on. This is all we need to do, and this is
8 11:58:42 8 what we do. And I think we all try to do that. Some
9 11:58:46 9 may do better because of personality, some may do
10 11:58:49 10 better and go along, and some may not because of
11 11:58:51 11 personality. And this is perfectly normal for each
12 11:58:54 12 individual, and this is why we are characterizing,
13 11:58:58 13 characterizing in this society, is what they know us.
14 11:59:00 14 Q. So in the case of Dr. Jadwin, did you see
15 11:59:03 15 Dr. Jadwin's ability to get along with people?
16 11:59:07 16 A. He know --
17 11:59:09 17 Q. Let me finish. Did you notice that
18 11:59:10 18 Dr. Jadwin's ability to get along with people was any
19 11:59:14 19 worse than any other people?
20 11:59:15 20 A. Between us, because I didn't have any
21 11:59:18 21 problem with Dr. Jadwin, but I don't know about
22 11:59:21 22 others. And also I don't get the end result of his
23 11:59:24 23 report; the referring physician will get the result
24 11:59:27 24 of his report. And I don't know how good, bad, or
25 11:59:31 25 how much they believe him or didn't believe him or
NaderiJ
159
ss.
2 COUNTY OF KERN
7 No. 7704, do hereby certify that JAVAD NADERI, M.D., the
10 December 6, 2007, at the time and place set forth on the
20 Dated this 20th day of December, 2007, at
22
23 ~ ~ * 7704
S r a ~ons
CQy"( ;o~
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WOOD & RANDALL

(800) 322-4595
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3 ______________
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 Defendants. )
__________________________)
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15 OF
16 RAVI PATEL, M.D.
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PatelR
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1 17:10:03 1 on other things in the cancer committee.
2 17:10:04 2 Q. Okay. So would you say that you knew
3 17:10:09 3 Dr. Jadwin fairly well, then, on a personal level?
4 17:10:17 4 A. I can -- I knew him enough to be, you know,
5 17:10:20 5 in the cancer committee, and that was my extent of
6 17:10:22 6 knowing him.
7 17:10:23 7 Q. Okay. Did you --
8 17:10:27 8 A. Now, if by "personal" meaning, you know, I
9 17:10:30 9 never had any -- we never socialized or went out or
10 17:10:34 10 met after the cancer committee to discuss a variety
11 17:10:36 11 of things. If there was an issue related to the
12 17:10:39 12 cancer committee or any issues related to that, I
13 17:10:42 13 would make a phone call to him sometimes to discuss,
14 17:10:44 14 you know, what we need to discuss on this particular
15 17:10:47 15 item or whether he had any, you know, comments on a
16 17:10:51 16 particular issue.
17 17:10:51 17 Q. Did you ever find any of your interactions
18 17:10:54 18 with Dr. Jadwin to be unpleasant in any way?
19 17:10:57 19 A. No. My personal interactions were not.
20 17:11:00 20 Q. During the time you were the chair of the
21 17:11:04 21 cancer committee, can you estimate how many times
22 17:11:06 22 Dr. Jadwin gave a presentation at the tumor board?
23 17:11:11 23 A. There's two separate things: The cancer
24 17:11:13 24 committee was the meeting where the cancer committee
25 17:11:16 25 members met to oversee the cancer program, and the
PatelR
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1 17:20:05 1 fact that it was brought to me -- to my attention
2 17:20:08 2 particularly because I was the cancer committee
3 17:20:10 3 chairman, that, you know, look, can we speak to
4 17:20:14 4 Dr. Jadwin because, you know, time runs out. And I
5 17:20:17 5 think that, you know, it was not something that, you
6 17:20:20 6 know, Dr. Jadwin is doing this bad thing and let's
7 17:20:23 7 shake him up, and, you know, we need to talk to him.
8 17:20:25 8 It was just a comment that, you know, look, the time
9 17:20:28 9 is running out, other people don't get enough time to
10 17:20:31 10 discuss it; can we speak to Dr. Jadwin to cut it down
11 17:20:34 11 or whatever. And I said, Okay, well, the person who
12 17:20:36 12 really runs the cancer conference was Dr. McBride,
13 17:20:40 13 and so I felt that, you know, the purpose, this issue
14 17:20:44 14 needs to be brought up by Dr. McBride, who is the
15 17:20:48 15 person normally running the conference, in charge of
16 17:20:51 16 the conference.
17 17:20:51 17 Q. Okay. At Dr. Jadwin's presentation, do you
18 17:20:57 18 recall the sequence of events that happened at the
19 17:21:05 19 conference in question? I mean, for example, do you
20 17:21:08 20 recall whether the resident presenter spoke first or
21 17:21:12 21 second?
22 17:21:12 22 A. Oh, yes. The resident would have spoken --
23 17:21:16 23 the sequence would be always the same. The resident
24 17:21:19 24 would present first; then the imaging would be
25 17:21:24 25 presented, that means the X-ray data would be
PatelR
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1 17:50:06 1 Is that acceptable to you?
2 17:50:07 2 A. Can you repeat that, please.
3 17:50:08 3 Q. When I refer to IPR, I'm referring to
4 17:50:11 4 suggested policy by Dr. Jadwin of having outside
5 17:50:15 5 pathology reports by outside experts reviewed by the
6 17:50:15 6 KMC pathology department.
7 17:50:18 7 A. I got it.
8 17:50:21 8 Q. Okay.
9 17:50:22 9 A. I got it.
10 17:50:22 10 Q. So I'll refer to that as IPR.
11 17:50:25 11 A. Yes.
12 17:50:26 12 Q. Okay. Do you recall when you first
13 17:50:27 13 discussed IPR with Dr. Jadwin?
14 17:50:30 14 A. No, I don't, but I do remember that issue
15 17:50:32 15 very well because of the fact that it was presented
16 17:50:35 16 as a possibly, as far as I can recall, an agenda item
17 17:50:40 17 in the cancer committee, that outside would be
18 17:50:46 18 reviewed by other pathologists or any experts outside
19 17:50:50 19 of the hospital needs to be reviewed within the
20 17:50:52 20 hospital. And I do feel that that policy was
21 17:50:57 21 appropriate and useful, and I supported Dr. Jadwin
22 17:51:01 22 for that.
23 17:51:01 23 Q. Okay. Do you feel that there's a -- that it
24 17:51:06 24 would improve patient quality care to have IPR at
25 17:51:10 25 KMC?
PatelR
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1 17:54:04 1 pathology diagnosis, could that cause to a patient
2 17:54:10 2 fatality at KMC?
3 17:54:11 3 A. It can. If the pathology diagnosis is not
4 17:54:15 4 correct, it can potentially produce a problem.
5 17:54:17 5 Q. How would you rate the probability of -- of
6 17:54:24 6 a -- of a mistaken pathology diagnosis causing a
7 17:54:29 7 patient mortality?
8 17:54:34 8 A. From a probability standpoint, I'm not sure,
9 17:54:36 9 but it would be very small. But it could be -- you
10 17:54:39 10 know, it could affect the outcome of the patient.
12 17:54:47 12 a mistaken pathology diagnosis caused a patient
13 17:54:51 13 death? Not just at KMC, but anywhere in your
14 17:54:58 14 experience?
15 17:54:58 15 A. Yes. Now, you know, if you look at the
16 17:55:10 16 numbers, the numbers could be very different, but it
17 17:55:14 17 can happen.
18 17:55:14 18 Q. Okay. Do you believe that having IPR can
19 17:55:21 19 increase the chance of having an appropriate
20 17:55:23 20 treatment plan?
21 17:55:24 21 A. Yes.
22 17:55:24 22 Q. Okay. Do you have any reason to believe
23 17:55:29 23 that outside experts, such as USC and Stanford, could
24 17:55:34 24 issue mistaken pathology diagnoses on tissue samples
25 17:55:41 25 that have been referred to them by KMC?
PatelR
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2 COUNTY OF KERN
7 No. 7704, do hereby certify that RAVI PATEL, M.D., the
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3 3 ---------
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5 5 Plaintiff, )
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6 6 vs. )
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10 10
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15 15 ARLENE BARBARA RAMOS-ANINION
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RamosA1
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1 1 these one-on-one meetings with Mr. Bryan less frequently

2 09:54:02 2 than other chairs were with Mr. Bryan?
3 09:54:05 3 A. I do not believe so.
4 09:54:08 4 Q. Your -- are you certain of that, or you are
not so
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09:54:11 5 certain?
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09:54:12 6 A. They would all be scheduled on a regular
7 basis, so
8 09:54:14 7 I don't believe this happened any less often than any
other
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09:54:20 8 chairs.
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09:54:21 9 Q. How often did you interact with Dr. Jadwin
11 during
12 09:54:24 10 your tenure at KMC?
13 09:54:27 11 A. Well, you know, if I would see him in the
hallway,
14
09:54:30 12 I would interact with him. He would call or I would
15 call
16 09:54:33 13 him. We didn't interact all the time. You know, I
wouldn't
17
09:54:36 14 say a daily basis, maybe a weekly basis, with him as I
18 do
19 09:54:41 15 all the chairs.
20 09:54:43 16 Q. Okay. And were your interactions with Dr.
Jadwin
21
09:54:46 17 unpleasant?
22
09:54:47 18 A. No.
23
09:54:48 19 Q. Did you like Dr. Jadwin?
24
20 A. I did.
25 21 Q. Why did you like Dr. Jadwin?
22 A. He was very -- always cordial to me. I -- I
26 never
23 had any problems with him. We always got along really
27 well.
24 I believe it was because he was From New Jersey and I
28 was
25 from New Jersey. So I think we had a little -- a little
RamosA1
48
1 1 bond over there.

2 09:55:07 2 Q. I am New York. Almost counts.
3 09:55:10 3 A. Exactly.
4 09:55:12 4 Q. Did -- did you ever witness Dr. Jadwin losing
his
5
09:55:16 5 temper?
6
09:55:17 6 A. I never did witness anything like that.
7
09:55:19 7 Q. Did you ever witness Dr. Jadwin threatening
8
09:55:23 8 physical violence to anybody?
9
09:55:25 9 A. No, I did not.
10
09:55:28 10 Q. Okay. Well, I should -- let me rephrase those
11
09:55:31 11 questions.
12
09:55:31 12 Were you ever aware of any instances where Dr.
13
09:55:34 13 Jadwin became angry with people?
14
09:55:36 14 A. I had heard of a situation, physician and
15
09:55:38 15 physician, but that's hearsay, and I -- I don't -- I'm
16 not a
17 09:55:41 16 hearsay kind of person.
18 09:55:43 17 Q. Okay.
19 09:55:43 18 A. I like --
20 09:55:44 19 Q. So you heard it through the grapevine, and you
21 20 don't know whether it is to be believed or not?
22 21 A. That is correct.
23 22 Q. Okay. And are you aware whether Dr. Jadwin
had
24
23 ever made physical threats against anybody else?
25
26 24 A. No.
27
28 25 Q. Are you aware of whether Dr. Jadwin ever acted
RamosA1
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1 1 inappropriately with anybody?

2 09:56:03 2 A. No.
3 09:56:07 3 Q. Do you -- are you familiar with what Dr.
Jadwin's
4
09:56:11 4 reputation was at the hospital?
5
09:56:12 5 A. Not really, other than -- I don't know how
6 they
7 09:56:16 6 felt about him. I have no idea.
8 09:56:19 7 Q. Do you know what his reputation was with the
9 09:56:21 8 support staff at Kern Medical Center?
10 09:56:24 9 A. No.
11 09:56:25 10 Q. You didn't hear anything -- you didn't hear
any
12
09:56:30 11 negative things about Dr. Jadwin in general, did you?
13
09:56:33 12 A. No.
14
09:56:33 13 Q. Have you ever witnessed any kind of angry
15
09:56:36 14 interaction -- well, let me strike that.
16
09:56:38 15 Are you aware of any angry confrontations
17
09:56:41 16 occurring between any core physicians at Kern Medical
18
09:56:44 17 Center?
19
09:56:46 18 A. Again, I've heard things, but don't know
20 anything
21 09:56:49 19 factual. So nothing I can honestly say that I know.
22 20 Q. Okay. Have you witnessed any angry
confrontations
23
21 between any other core physicians at Kern Medical
24 Center?
25 22 A. No.
26 23 Q. Have you witnessed any -- any confrontations
at
27
24 all at Kern Medical Center?
28
25 A. No.
RamosA1
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1 1 Q. And were you aware of anyone else feeling

2 10:03:12 2 threatened by Dr. Jadwin's physical size?
3 10:03:16 3 A. No.
4 10:03:16 4 Q. So Dr. Jadwin didn't walk around using his
size as
5
10:03:20 5 a way to kind of intimidate people in any way?
6
10:03:23 6 A. Never -- never in front of me.
7
10:03:25 7 Q. What was -- how would you describe Dr.
8 Jadwin's
9 10:03:28 8 demeanor? Was he, you know -- was he walking around
10 10:03:32 9 strutting with his chest out all the time or -- would
you
11
10:03:35 10 just try to put it in your own words how you would
12 describe
13 10:03:36 11 his demeanor.
14 10:03:37 12 A. I always thought Dr. Jadwin was very
professional
15
10:03:39 13 walking down the hallway. Whenever I would see him, I
16 never
17 10:03:43 14 thought him different than any other person. You know,
I
18
10:03:46 15 didn't see him being anything other than the physician
19 that
20 10:03:49 16 he was.
21 10:03:50 17 Q. Did you ever feel physically threatened by Dr.
22 10:03:53 18 Jadwin?
23 10:03:53 19 A. No.
24 20 Q. Did you ever feel scared of Dr. Jadwin?
25 21 A. No.
26 22 Q. Did you ever hear of anyone else being
terrified
27 23 of Dr. Jadwin?
24 A. No.
28 25 Q. Can you imagine any reason why anybody would
be
RamosA1
BARBARA RAMOS-ANINION Document 277-4 Filed 12/01/2008 Page 95 of 209
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Page 119
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2 COUNTY OF KERN
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6 certification No. 7974, do hereby certify that
7 ARLENE BARBARA RAMOS-ANINION, the witness named in the
9 deposition was taken Friday, August 15, 2008, at the
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~L)~ Cindee L. LeFevr , CSR No. 7974
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RANDALL (800) 322-4595
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6 Plaintiff, )
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15 OF
16 EDWARD WILLIAM TAYLOR, M.D.
17 Wednesday, December 5, 2007
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TaylorE1
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1 18:07:32 1 A. Okay?
2 18:07:33 2 Somebody that makes up a word like that -- a
3 18:07:34 3 time like that is confabulating. So if you want to
4 18:07:38 4 confabulate, then you can say anything in the world
5 18:07:42 5 is possible. Okay?
6 18:07:43 6 A plane could land in here right now, and my
7 18:07:46 7 partner would have to take care of us because I'm
8 18:07:48 8 here, but that's kind of not realistic, is it?
9 18:07:52 9 Q. Okay. Well, how long do you estimate it
10 18:07:54 10 took for Dr. Jadwin to present his portion of
11 18:07:59 11 Presentation B of the October oncology conference?
12 18:08:02 12 MR. WASSER: You've asked and answered that.
13 18:08:04 13 This is now the sixth time.
14 18:08:05 14 THE WITNESS: I don't know.
15 18:08:06 15 BY MR. LEE:
16 18:08:06 16 Q. Don't know.
17 18:08:07 17 A. Do you want me to speculate? You've already
18 18:08:09 18 said no. We're going in a circle.
19 18:08:12 19 Q. No. I want you to estimate.
20 18:08:13 20 A. Estimate?
21 18:08:14 21 Okay. I would estimate that his talk took
22 18:08:16 22 20 minutes.
23 18:08:16 23 Q. Okay. Now, at the very end of the last
24 18:08:23 24 paragraph you say, "In general I get along fine with
25 18:08:25 25 Dr. Jadwin."
TaylorE1
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1 18:08:26 1 How would you -- would you say that that's a
2 18:08:28 2 pretty accurate assessment of your --
3 18:08:31 3 A. Yeah. And I really -- I still feel that
4 18:08:33 4 way. I really didn't -- you know, I -- I very
5 18:08:38 5 peripherally knew about, like I said before, some of
6 18:08:41 6 the FNA arguments, and afterwards I realized there's
7 18:08:45 7 something going on between him and Roy. But even
8 18:08:48 8 after that, I really didn't have any problem with
9 18:08:50 9 him. We were cordial in the halls, and he called me
10 18:08:54 10 with the path reports and told me. I really -- yes,
11 18:08:58 11 I completely believe that.
12 18:09:00 12 Q. Okay. And so basically do you recall having
13 18:09:03 13 many problems in your interactions with Dr. Jadwin
14 18:09:06 14 before October 12, 2005?
15 18:09:07 15 A. No.
16 18:09:09 16 Q. How many --
17 18:09:10 17 A. And I had no problem with my interaction
18 18:09:12 18 with him then because I didn't. I just observed
19 18:09:16 19 something that I thought was inappropriate, and I
20 18:09:18 20 commented on it to try to help make things better.
21 18:09:25 21 Nothing personal.
22 18:09:25 22 Q. How many interactions did you have with
23 18:09:30 23 Dr. Jadwin prior to -- well, let's just say for the
24 18:09:33 24 one-year period before October 12 of 2005?
25 18:09:38 25 A. Probably dozens.
TaylorE1
90
1 18:09:39 1 Q. So --
2 18:09:40 2 A. Some are shorter than others.
3 18:09:48 3 There's people that don't know somebody else
4 18:09:50 4 is covering me. Excuse me. I would have to call 100
5 18:09:55 5 people to tell them not to page me.
6 18:09:57 6 Q. Okay. The question was so -- as I
7 18:10:02 7 understood your answer, you're saying that there was
8 18:10:05 8 a pretty significant -- you almost saw him on a,
9 18:10:07 9 what, weekly basis then?
10 18:10:09 10 A. Yeah. A lot of it would be just passing in
11 18:10:11 11 the hall, saying hi. We were on, I think, the
12 18:10:14 12 faculty practice plan committee; so I would see him
13 18:10:18 13 every -- once a month, and then quite a few times
14 18:10:21 14 over the phone with frozen sections or -- or -- or
15 18:10:24 15 path reports that he would call me quite a few times.
16 18:10:27 16 Q. Okay. So do you recall Dr. Jadwin ever
17 18:10:30 17 raising his voice with you?
18 18:10:31 18 A. No.
19 18:10:31 19 Q. Do you recall him ever being
20 18:10:33 20 confrontation -- confrontational with you?
21 18:10:35 21 A. No.
22 18:10:35 22 Q. Okay. Would you say Dr. Jadwin is arrogant?
23 18:10:42 23 A. The only arrogance I felt from him was at
24 18:10:45 24 this conference. Other than that, I never got that
25 18:10:48 25 from him.
TaylorE1
93
1 18:12:27 1 doctor that you consider to be arrogant at KMC?
2 18:12:31 2 A. It's not relevant because I never thought
3 18:12:33 3 Dr. Jadwin was arrogant and so I'm not even part of
4 18:12:37 4 that group that thinks he's arrogant nor part of that
5 18:12:40 5 lawsuit. So me thinking somebody else is arrogant
6 18:12:43 6 has nothing to do with this because I don't think
7 18:12:46 7 Dr. Jadwin's arrogant.
8 18:12:48 8 Q. Okay. Dr. Taylor, I'm just going to remind
9 18:12:56 9 you -- I don't know if you are aware of this, but you
10 18:12:58 10 are here in regard to a lawsuit, and we have a right
11 18:13:02 11 to answers to our questions. And if you refuse to
12 18:13:06 12 answer a question, you will be -- well, we can, at
13 18:13:10 13 our option, bring a motion to the judge and request
14 18:13:12 14 that you be sanctioned for not answering a question
15 18:13:15 15 to which we're entitled to an answer. I just want
16 18:13:19 16 you to understand that.
17 18:13:20 17 A. Okay.
18 18:13:26 18 Q. And I just want to add that it's not --
19 18:13:28 19 you're actually not in a position to say what's
20 18:13:31 20 relevant or not relevant in this deposition.
21 18:13:32 21 A. I know I'm not. I'm also -- in all my time
22 18:13:36 22 with attorneys and depositions, I've never been asked
23 18:13:40 23 something very personal like that that -- and I --
24 18:13:43 24 and I really think that -- that that is just an
25 18:13:49 25 absolutely unfair question to ask.
TaylorE1
128
ss.
2 COUNTY OF KERN
8 EDWARD WILLIAM TAYLOR, M.D., the witness named in the
10 deposition was taken Wednesday, December 5, 2007, at the
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3 ______________
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6 Plaintiff, )
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__________________________)
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15 OF
16 CHARLES JOSEPH WROBEL, M.D.
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WrobelJ
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1 08:12:09 1 A. -- is that correct?
2 08:12:10 2 Q. Well, actually, let's see.
3 08:12:12 3 A. Calendar years.
4 08:12:13 4 Q. Let's say five years. Yeah, that's correct.
5 08:12:16 5 A. Probably ten times.
6 08:12:18 6 Q. Ten times. And were those interactions very
7 08:12:26 7 significant with Dr. Jadwin or --
8 08:12:28 8 A. No.
9 08:12:28 9 Q. No. So were they really more in the nature
10 08:12:31 10 of just saying hello in the hallway?
11 08:12:33 11 A. No, they were to ask about a pathology
12 08:12:36 12 specimen which happened, I believe, probably twice a
13 08:12:39 13 year.
14 08:12:39 14 Q. I'm sorry?
15 08:12:40 15 A. It was to ask about a pathology specimen,
16 08:12:44 16 maybe twice a year, my recollection.
17 08:12:45 17 Q. Okay. So the conversations were strictly
18 08:12:48 18 work-related then, correct?
19 08:12:49 19 A. That is correct.
20 08:12:49 20 Q. Okay. Did Dr. Jadwin ever strike you as
21 08:12:52 21 arrogant?
23 08:12:54 23 Q. Well, we're entitled to your best
24 08:12:58 24 recollection. Is your best recollection that he was
25 08:13:01 25 arrogant at any time with you?
WrobelJ
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1 08:13:02 1 A. On the basis of my limited interactions, I
2 08:13:05 2 would say no.
3 08:13:06 3 Q. Okay. Did Dr. Jadwin ever appear to you to
4 08:13:10 4 be emotional or confrontational?
5 08:13:12 5 A. On the basis of the ten short interactions
6 08:13:14 6 that we had, I don't think so.
7 08:13:16 7 Q. So your best recollection is no, correct?
8 08:13:19 8 A. That is correct.
9 08:13:19 9 Q. Okay. Did you have -- do you have any
10 08:13:24 10 reason to believe that Dr. Jadwin is arrogant or was
11 08:13:28 11 arrogant?
12 08:13:29 12 MR. WASSER: You just asked him that.
13 08:13:30 13 THE WITNESS: No.
14 08:13:32 14 MR. LEE: I'm asking if he has any reason to
15 08:13:34 15 believe.
16 08:13:35 16 Q. Do you have any reason to believe that
17 08:13:36 17 Dr. Jadwin's emotional and confrontational?
18 08:13:39 18 A. No.
19 08:13:39 19 Q. Okay. Have you taken any leaves of absence
20 08:13:47 20 during your time at KMC?
21 08:13:48 21 A. No.
22 08:13:48 22 Q. So since -- I'm sorry. When did you begin
23 08:13:53 23 at KMC, 19 --
24 08:13:54 24 A. '91.
25 08:13:54 25 Q. -- 91?
WrobelJ
46
ss.
2 COUNTY OF KERN
8 CHARLES JOSEPH WROBEL, M.D., the witness named in the
10 deposition was taken Thursday, December 6, 2007, at the
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3 ______________
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6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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__________________________)
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16 TAI YOO, M.D.
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YooT
9
1 13:13:45 1 Q. Okay.
2 13:13:50 2 A. Other than my vitamins this morning.
3 13:13:52 3 Q. Okay.
4 13:13:53 4 A. Yes.
5 13:13:53 5 Q. That will not affect your testimony today,
6 13:13:55 6 right?
7 13:13:56 7 A. Right.
8 13:13:56 8 Q. Okay. Thank you.
9 13:13:59 9 What is your current title at Kern Medical
10 13:14:03 10 Center?
11 13:14:03 11 A. I am the joint chairman of psychiatry at
12 13:14:07 12 Kern Medical Center and the Kern County Mental
13 13:14:12 13 Health, and also residency program director for the
14 13:14:15 14 UCLA Kern psychiatry residency program, and the
15 13:14:22 15 professor and the vice chairman at UCLA psychiatry
16 13:14:25 16 department.
17 13:14:25 17 Q. Okay.
18 13:14:27 18 THE VIDEOGRAPHER: Counsel, can we have the
19 13:14:29 19 witness put on the microphone. I forgot to instruct.
20 13:14:32 20 MR. LEE: I'm sorry. Can you put this
21 13:14:34 21 microphone on.
22 13:14:35 22 THE WITNESS: Oh.
23 13:14:36 23 THE VIDEOGRAPHER: Thank you.
24 13:14:37 24 BY MR. LEE:
25 13:14:46 25 Q. Okay. Doctor, when did you begin your
YooT
10
1 13:14:48 1 employment with the County of Kern?
2 13:14:49 2 A. August the 1st, 2001.
3 13:14:52 3 Q. So you've been employed by the county for
4 13:14:56 4 almost seven years now?
5 13:14:58 5 A. Seven years, yeah.
6 13:14:59 6 Q. Okay. And when you first began employment
7 13:15:01 7 with the County of Kern you were -- you were hired as
8 13:15:04 8 a chair of psychiatry?
9 13:15:06 9 A. Yeah.
10 13:15:06 10 Q. Okay.
11 13:15:07 11 A. First joint chairman for both Kern Medical
12 13:15:13 12 Center and the county mental health.
13 13:15:15 13 Q. Oh, okay. And are you still a joint chair
14 13:15:22 14 of the Kern Medical Center --
15 13:15:24 15 A. Yes.
16 13:15:24 16 Q. -- and -- yes?
17 13:15:27 17 A. Uh-huh.
18 13:15:27 18 Q. Okay. Do you know Dr. Jadwin?
19 13:15:30 19 A. Yes.
20 13:15:30 20 Q. Okay. Did you -- how many interactions did
21 13:15:33 21 you have with Dr. Jadwin during your tenure or during
22 13:15:37 22 his tenure at Kern Medical Center?
23 13:15:40 23 A. I don't know the exact date. I think he
24 13:15:42 24 started soon after I started, and we -- as chair of
25 13:15:53 25 different departments, we had chairs' council
YooT
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1 13:15:58 1 once-a-month --
2 13:15:59 2 Q. I see.
3 13:15:59 3 A. -- meeting. So we had that interaction.
4 13:16:04 4 And since he is -- he was the chairman of the
5 13:16:08 5 pathology department, I had a few discussions about
6 13:16:11 6 some lab testing component for our psychiatry faculty
7 13:16:18 7 members.
8 13:16:18 8 Q. Okay. So you saw him once a month at chair
9 13:16:21 9 council meetings?
10 13:16:22 10 A. Right.
11 13:16:22 11 Q. And then outside of the chair council you
12 13:16:24 12 saw him sporadically?
13 13:16:26 13 A. Sporadically for -- we had some social
14 13:16:31 14 gathering once in a while when the previous chief
15 13:16:36 15 medical officer left.
16 13:16:39 16 Q. Dr. Kolb?
17 13:16:40 17 A. Yeah, Dr. Kolb. We gathered at Peter
18 13:16:45 18 Bryan's house, and I think another time we were
19 13:16:49 19 together at Dr. Martin's house.
20 13:16:52 20 Q. How were your -- how would you characterize
21 13:16:58 21 your interactions with Dr. Jadwin?
22 13:17:01 22 A. Mostly professional interactions, and I
23 13:17:07 23 don't think we had any close social interactions.
24 13:17:14 24 And he doesn't have any residency program, and none
25 13:17:19 25 of our residents, they have to go through his
YooT
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1 13:17:22 1 service, other than some care coordination issues in
2 13:17:27 2 the lab testing. I wanted him to have some drug
3 13:17:31 3 testing for our patients in emergency room.
4 13:17:39 4 Q. Okay. Did you ever have an unpleasant
5 13:17:43 5 interaction with Dr. Jadwin at any time?
6 13:17:46 6 A. No.
7 13:17:46 7 Q. Okay. Did you like Dr. Jadwin?
8 13:17:51 8 A. Well, I learned he was at the same hospital
9 13:17:56 9 working in Michigan, I was chairman of Henry Ford
10 13:18:02 10 Hospital for quite some time, and overall I was with
11 13:18:08 11 Henry Ford about 23 or -4 years, and the last eight
12 13:18:18 12 to ten years I was doing outside joint venture work
13 13:18:23 13 between Henry Ford Health System and Emergency Health
14 13:18:29 14 Services as vice president of behavior services. So
15 13:18:33 15 while I was out doing those work handling several
16 13:18:40 16 hospitals, he was at Henry Ford Hospital. So I
17 13:18:44 17 didn't know him, and I knew he was there only when we
18 13:18:50 18 worked together here.
19 13:18:51 19 Q. Oh. So did you hear anything about
20 13:18:54 20 Dr. Jadwin at Henry Ford Hospital?
21 13:18:57 21 A. No.
22 13:18:57 22 Q. Okay. You don't dislike Dr. Jadwin then,
23 13:19:04 23 right?
24 13:19:05 24 A. No reason to dislike.
25 13:19:06 25 Q. Okay. So as far as you're concerned when
YooT
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1 13:21:13 1 less-than-professional conduct by some residents?
2 13:21:17 2 A. Uh-huh.
3 13:21:19 3 Q. Okay. So that's a yes, correct? To my last
4 13:21:22 4 question, that was a yes?
5 13:21:24 5 A. Repeat the question again.
6 13:21:25 6 Q. Sure.
7 13:21:27 7 So what you heard was some complaints of
8 13:21:30 8 less-than-professional conduct by nurses against
9 13:21:33 9 certain residents, correct?
10 13:21:35 10 A. Right. But none necessarily directly what
11 13:21:40 11 you described, F words, like that.
12 13:21:42 12 Q. Right. But similar? But similar?
13 13:21:46 13 A. No.
14 13:21:47 14 Q. Not even similar?
15 13:21:48 15 A. Uh-huh.
16 13:21:49 16 Q. Okay. Now, at any of the chair council
17 13:21:57 17 meetings did you witness -- you saw Dr. Jadwin, you
18 13:22:00 18 said, once a month at the chair council meetings?
19 13:22:03 19 A. Right.
20 13:22:03 20 Q. Did you ever witness Dr. Jadwin doing
21 13:22:05 21 anything unprofessional or inappropriate in a chair
22 13:22:08 22 council meeting?
23 13:22:11 23 A. I do not recall.
24 13:22:20 24 Q. You saw him 12 times a year at the chair
25 13:22:23 25 council meetings, right?
YooT
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1 13:27:58 1 Q. Okay.
2 13:27:59 2 A. And I'm responsible for all the medical
3 13:28:03 3 services in psychiatry at both system.
4 13:28:10 4 Q. Okay. So how much time do you physically
5 13:28:14 5 spend during working hours at Kern Medical Center?
6 13:28:25 6 A. It's fluctuating depending on overall
7 13:28:32 7 responsibilities. Our county contract stipulates for
8 13:28:40 8 any physicians -- full-time physicians to spend
9 13:28:44 9 minimum 40 hours, and we usually spend roughly about
10 13:28:52 10 50 or 60 hours plus altogether per week, and I split
11 13:29:00 11 the time between.
12 13:29:02 12 Q. So you spend 25 to 30 hours a week at Kern
13 13:29:06 13 Medical Center?
14 13:29:07 14 A. Sometimes more.
15 13:29:07 15 Q. Sometimes more. Okay.
16 13:29:10 16 A. Yeah, uh-huh. And it's more than one
17 13:29:13 17 full-time job --
18 13:29:14 18 Q. Right.
19 13:29:14 19 A. -- when you are responsible for two
20 13:29:16 20 agencies.
21 13:29:16 21 Q. So if you had to be absent from -- if you
22 13:29:32 22 became ill and just couldn't work because you're sick
23 13:29:36 23 and you need to recover, what would you do?
24 13:29:40 24 A. Then I would take medical leave or sick
25 13:29:49 25 leave and our -- Kern Medical Center or Kern County
YooT
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2 COUNTY OF KERN
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27 EXHIBIT 47
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1
1 1 SUPERIOR COURT OF CALIFORNIA, COUNTY OF KERN

2 2 METROPOLITAN DIVISION
3 3 ---------
4 4 DAVID F. JADWIN, D. O. ) Volume 1
)
5 5 Plaintiff, )
) Case No. 1:07-CV-00026-OWW-TAG
6 6 )
vs. )
7 7 )
COUNTY OF KERN, et. al., )
8 8 )
Defendants. )
9 9 _________________________)
10 10
11 11
12 12
14 14 OF
15 15 PHILIP DUTT, M.D.
16 16 Wednesday, August 20, 2008
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DuttP1
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1 09:28:32 1 A. I'm a pathologist, I'm the laboratory

director,
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09:28:36 2 and the interim Chair of pathology.
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09:28:40 3 Q. You have been interim chair since when?
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09:28:46 4 A. Friday, I believe it was July 14 of 2006.
5
09:28:52 5 Q. July 14, 2006?
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09:28:54 6 A. Yes.
7
09:28:56 7 Q. How did you -- how were you made aware that
8 you
9 09:28:59 8 were the interim chair of the Department of Pathology at
11 09:29:04 10 A. There was a meeting in which they said they
needed
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09:29:08 11 a laboratory director, and they asked me to become a
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09:29:13 12 laboratory director.
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09:29:14 13 Q. Who is they?
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09:29:15 14 A. Irwin Harris, Sandy Chester, and David Hill.
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09:29:22 15 Q. What was this meeting?
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09:29:24 16 A. Pardon me.
18
09:29:25 17 Q. You say there was a meeting. Was this a
19 special
20 09:29:28 18 meeting just for you or was this a regularly scheduled
21 09:29:31 19 meeting?
22 09:29:32 20 A. It was not a regularly scheduled meeting.
23 09:29:34 21 Q. So this was a meeting just for the purpose of
24 09:29:37 22 appointing you director, interim chair?
25 09:29:40 23 A. That was not the only purpose. We also
discussed
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09:29:43 24 bringing back Dr. Liu as another pathologist.
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28 09:29:48 25 Q. Dr. Fang Luo Liu?
DuttP1
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1 09:45:16 1 it would cause unnecessary anxiety. Why did you tell

Dr.
2
09:45:20 2 Jadwin that his case was being investigated?
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09:45:23 3 A. I said that -- I think I said it depends on
4 the
5 09:45:26 4 situation. So you might not want to tell the
pathologist.
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09:45:32 5 Q. What about Dr. Jadwin's case. Why did you
7 decide
8 09:45:36 6 to tell him?
9 09:45:37 7 A. Because he asked to look at the slides, and I
said
10
09:45:41 8 it's going to go for peer review, and I wanted the
11 slides to
12 09:45:46 9 be locked up until they were sent for peer review.
13 09:45:49 10 Q. Locked up from Dr. Jadwin too?
14 09:45:52 11 A. Not necessarily from him. I mean, I thought
Dr.
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09:45:58 12 Shertukde was right, but it could have involved her, it
16
09:46:02 13 could have involved him. I just wanted the case -- I
17 wanted
18 09:46:05 14 the slides to be secure.
19 09:46:07 15 Q. Okay. But Dr. Jadwin was asking for access to
20 09:46:11 16 those slides. Isn't that what you just said?
21 09:46:13 17 A. He wanted to see the slides.
22 09:46:14 18 Q. Did you give him access?
23 09:46:16 19 A. No. I told him the case was going for peer
review
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09:46:20 20 and that was the reason he couldn't have the slides.
25 09:46:22 21 Q. I don't understand. I thought peer review,
one of
26 09:46:24 22 the missions was to educate the originating pathologist.
09:46:27 23 Why wouldn't you want to show the slides to the
27 originating
09:46:31 24 pathologist? That's not part of peer review?
28 09:46:34 25 A. The purpose of peer review primarily is to
protect
DuttP1
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1 09:46:37 1 patients.
2 09:46:37 2 Q. I see. So how was locking up the slides
3 09:46:41 3 preventing or denying Dr. Jadwin access to them
protecting
4
09:46:42 4 patients?
5
09:46:43 5 A. I wasn't denying Dr. Jadwin access. The
6 purpose
7 09:46:46 6 was not to --
8 09:46:50 7 Q. Well, did you give him access to the slides?
9 09:46:52 8 A. No.
10 09:46:53 9 Q. Why not?
11 09:46:54 10 A. Because I wanted the slides to be secure and
12 09:46:57 11 locked up. Pathologists frequently will lock up slides
that
13
09:47:02 12 might have a legal implication. That's what I was
14 doing.
15 09:47:07 13 Q. Uh-huh.
16 09:47:07 14 A. I was doing it because there was a potential
legal
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09:47:11 15 implication.
18
09:47:11 16 Q. What's that legal implication?
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09:47:14 17 A. Well, if you know there is going to be a
20 lawsuit
21 09:47:17 18 about a case or an autopsy, there are certain evidence
or
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09:47:22 19 potential evidence that you don't want to get lost, and
23 so
24 09:47:27 20 it's -- I just sort of did it as what I have been
trained to
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09:47:33 21 do in terms of locking up potential evidence.
26
09:47:36 22 Q. So you were acting as an attorney not as
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09:47:40 23 pathologist?
28 09:47:40 24 A. I did not say that.
09:47:42 25 Q. You said you were looking up evidence with
DuttP1
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1 09:48:51 1 sufficient.
2 09:48:51 2 MR. WASSER: I need to remind you of what he
said.
3
09:48:53 3 BY MR. LEE:
4
09:48:54 4 Q. Doctor, the question is how -- you said there
5 was
6 09:48:57 5 a possibility of legal liability and you wanted the
evidence
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09:48:59 6 locked up. How would Dr. Jadwin's viewing the slides
8 have
9 09:49:03 7 interfered with that process?
10 09:49:16 8 A. I'm not sure.
11 09:49:18 9 Q. Now, what legal liability are you talking
about
12
09:49:21 10 with regard to case SO6-4131? Did the patient send you
13 a
14 09:49:26 11 letter threatening suit?
15 09:49:28 12 A. No.
16 09:49:29 13 Q. So what legal liability was there? What
lawsuit
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09:49:33 14 was being pending or threatened?
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09:49:35 15 A. Well, Dr. Jadwin had told me and others that
19 Dr.
20 09:49:42 16 Shertukde had made a mistake. So it seemed to me that
21 09:49:48 17 either he or she was wrong, and, therefore, I thought we
22 09:49:54 18 needed an outside opinion to see who was right.
23 09:50:02 19 Q. Okay. So where's the legal liability in that
24 09:50:05 20 answer?
25 09:50:07 21 A. Well, because there's potential legal
liability in
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09:50:09 22 terms of an incorrect diagnosis.
27 09:50:12 23 Q. So whenever a pathologist makes a mistake,
there
28 09:50:16 24 is legal liability?
09:50:18 25 A. I'm not sure.
DuttP1
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1 10:07:10 1 to be too much.

2 10:07:11 2 Q. It got to be too much. In other words, you
got
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10:07:15 3 too disappointed in Dr. Jadwin?
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10:07:18 4 A. That was part of it.
5
10:07:19 5 Q. What were you disappointed in?
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10:07:32 6 A. Well, he just quit working, and he dumped all
7 his
8 10:07:38 7 work on Dr. Shertukde and me.
9 10:07:43 8 Initially, he was pressure -- trying to
pressure
10
10:07:45 9 the medical staff and the administration into giving him
11 an
12 10:07:53 10 apology by taking a leave of absence or threatening to
take
13
10:07:58 11 a leave of absence.
14
10:07:59 12 Q. How do you know that?
15
10:08:00 13 A. Because he told me.
16
10:08:01 14 Q. He told you, I'm going to take a leave of
17 absence
18 10:08:04 15 to pressure the administration to apologize?
19 10:08:12 16 A. What he said was I'm going to take a leave of
20 10:08:17 17 absence. That occurred in the context where he was
upset
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10:08:20 18 about a letter he had received regarding the October
22 tumor
23 10:08:25 19 conference, and he kept saying all I want is an apology.
24 10:08:30 20 Q. So he didn't say the exact words I'm going to
take
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10:08:34 21 a leave absence in order to force the administration to
26 give
10:08:37 22 me an apologyIs that what he said?
27 10:08:39 23 A. He didn't use those exact words.
10:08:41 24 Q. But did he say something to that effect?
28 10:08:43 25 A. He said I'm going to take a leave of absence
in
DuttP1
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1 16:31:06 1 going. I just needed to inform them. It initially

started
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16:31:09 2 out as a hostile work environment, harassment concern,
3 and
4 16:31:14 3 then, quality concerns came up.
5 16:31:17 4 Q. Did you submit -- how did you initiate this
6 16:31:20 5 meeting? Did you send an e-mail to somebody or did you
make
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16:31:24 6 phone calls?
8
16:31:24 7 A. No, I talked to Dr. Harris.
9
16:31:26 8 Q. Okay. And what was decided at that meeting,
10 if
11 16:31:30 9 anything?
12 16:31:36 10 A. I just informed Dr. Harris that there were
13 16:31:40 11 problems and --
14 16:31:42 12 Q. You mean problems with Dr. Jadwin; right?
15 16:31:45 13 A. Yes.
16 16:31:46 14 Q. Dr. Jadwin was creating a hostile work
environment
17
16:31:50 15 and was harassing people?
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16:31:53 16 A. That was my concern at the time.
19
16:31:54 17 Q. And at this meeting you discussed his
20 harassment
21 16:31:58 18 of Vangie Gallegos?
22 16:32:01 19 A. At the meeting itself? I discussed complaints
I
23
16:32:06 20 had received from both Dr. Shertukde and from Vangie.
24
16:32:10 21 Q. Any other complaints?
25
16:32:14 22 A. And then I was -- at that meeting, I raised
26 some
27 16:32:17 23 concerns about the diagnoses.
16:32:19 24 Q. So his competence as a pathologist was at
28 issue?
16:32:24 25 A. Or that he was issuing certain diagnoses to
DuttP1
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1 16:40:41 1 would say, I have to go to Los Angeles or he would have

to
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16:40:44 2 go to the gym. He made it difficult to talk to him.
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16:40:49 3 Q. So you thought it easier to assign it to the
4 Peer
5 16:40:53 4 Review Committee?
6 16:40:53 5 A. I didn't say that.
7 16:40:55 6 Q. Then why didn't you keep it in the department?
8 16:40:55 7 A. Because Dr. Jadwin would avoid conversations.
9 16:40:58 8 Q. So, therefore, you thought it would be better
to
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16:41:01 9 send it to Peer Review Committee?
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16:41:03 10 A. I didn't think better. It was the only option
12 I
13 16:41:05 11 had.
14 16:41:06 12 Q. You had no other choice?
15 16:41:07 13 A. Right.
16 16:41:08 14 Q. Did you discuss your decision to send cases to
17 16:41:13 15 peer review with Dr. Jadwin at any point?
18 16:41:15 16 A. Well, I mentioned to him the original prostate
19 16:41:16 17 case was going to be peer reviewed.
20 16:41:21 18 Q. By the Peer Review Committee. You told him
21 16:41:22 19 that?
22 16:41:23 20 A. No, by -- at that time, it was going to be
23 16:41:27 21 reviewed by an expert.
24 16:41:28 22 Q. Within the -- I'm talking about the procedure.
25 16:41:30 23 Within the department, according to the Department's
peer
26
16:41:34 24 review proceedings or did you tell him that.
27
28 16:41:36 25 A. No. I mean, two of us thought one thing, the
DuttP1
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1 16:41:40 1 other person thought another thing. So it was obvious

it
2
16:41:44 2 was going to go to an outside expert.
3
16:41:47 3 Q. Okay. And this is under the auspices of the
4 Peer
5 16:41:50 4 Review Committees or was this still department peer
6 16:41:54 5 review?
7 16:41:54 6 A. It was neither. I mean, I just wanted to find
out
8
16:41:59 7 Dr. Epstein's opinion.
9
16:42:00 8 Q. Okay. And this is the case where you denied
10
16:42:02 9 Jadwin, Dr. Jadwin access to the slides?
11
16:42:06 10 A. We went over this this morning.
12
16:42:09 11 Q. I'm just making sure. That's this case;
13 right?
14 16:42:10 12 A. I didn't deny him access. I had the slides
locked
15
16:42:14 13 up.
16
16:42:14 14 Q. When he asked to see the slides, you said no?
17
16:42:17 15 A. I told him the slides were locked up and I did
18 not
19 16:42:20 16 give him the slides.
20 16:42:21 17 Q. What's the difference when I said you denied
him
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16:42:24 18 access. What's the difference?
22
16:42:26 19 A. I was denying everybody access. I wanted the
23
16:42:29 20 slides locked up.
24
16:42:30 21 Q. Including Dr. Jadwin; right?
25
16:42:32 22 A. And including Dr. Shertukde.
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16:42:34 23 Q. What was Dr. Shertukde's complaint that you
27
16:42:38 24 presented at the first meeting in November, 2006?
28 16:42:41 25 A. She had been asking me in late October to go
to
DuttP1
08-20-08
w
Page 351 o
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1 STATE OF CALIFORNIA o
ss.
2 COUNTY OF KERN I
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3 o
E
4 I, Cindee L. LeFevre, a Certified Shorthand X
6 No. 7974, do hereby certify that PHILIP LEE DUTT, M.D.,
9 Wednesday, August 20, 2008, at the time and place set forth
16 I further certify that I'm neither counsel for
21
22
23
24 Cindee L. LeFevre,
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vs. COUNTY
(800) 322-4595
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27 EXHIBIT 48
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From: Karen Barnes

To: Philip Dutt, MD
O",te: 9114/2006 1:14:54 PM
S"-bjeet: Re: Dr. Jadwin's contract (cont'd)
I have made the requested changes to his job description, both your's and Irwin's, and attached the
revised amendment. let me know if further changes are necessary. I need to talk with you and Irwin
about a strategic matter related to the amendment. Are you available this aftemoon before 4 p.m.?
Jadwin can do whatever his contract says he can do, subject to the policies of the county and the needs
of the department. I know that's not the answer you want to hear; however, I do not believe(~-------"
----_.------'
His use of educational leave is subject to approval in advance. His first obligation is to staff the
department. rm not sure how Rae books the CME days. You may want to ask her before pursuing this
further. .
»> Philip Dutt, MD 911412006 8:06:21 AM »>

I think we should add to the job description that when he is on call on weeknights or weekends that he is
able to come to the hospital within 30 minutes if needed. This is a fairly standard expectation of
pathologists nation wide. Also, KMC is a trauma center, and one of the trauma surgeons called me
recently to confirm that the pathologist on call can come to the hospital within 30 minutes; this apparently
is one of their requirements to be a trauma center.
Article 1II.3.B., page 8: Will Dr. Jadwin be allowed to take off days without pay, as he did in 2005, orwill
he be restricted to 20 days of vacation per year like everyone else?
Article III.3.D.,page 8-9: Should his CMEleducationalleave be prorated over an entire year, or will he be
allowed to take 10 days off for CME between now and December 31?
Thank You,
Philip Dutt
Pathologist
Lab
Kern Medical center
duttP@kemmedclr.com
* * * *** * * * * CONFIDENTIALITY STATEMENT ** ** ** ** **
This message is intended only for the use of the individual or entity to which it is addressed and may
contain infonnation that is privileged, confidential and exempt from disclosure under applicable law. If
the reader of this message is not the intended recipient, you are hereby notified that any dissemination,
distribution or copying of the communication is strictly prohibited. If you received this communication in
error, please notify us immediately by telephone and return the original message to us at the E-mail
address above. Thank you
CC: Irwin Harris, MD; Rae McDonald
0000830
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27 EXHIBIT 49
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Page 1 of 1
-
David Jadwin, DO Pathology Look Back Study
From: David Jadwin, DO

To: Peter Bryan
Subject: Pathology Look Back Study
CC: Gene Kercher; Susie Price
Peter:
We have discovered a series of serious diagnostic errors committed by a former pathologist working at KMC
over a period of years. These errors involve the failure to identify frankly invasive adenocarcinoma in several
prostate needle biopsies.
A multi-year look back study will need to be undertaken.
I have identified 95 prostate specimens in the HBO system of which only 10% are malignant. Of prostate needle
biopsies, only 8.6% are malignant.
The expected rate of malignant biopsies is O h .
I am pulling all of these slides, the path history and all subsequent PSAs to determin followup status.
David
DFJ00589
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27 EXHIBIT 50
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Untitled 04/19/2006 12:30 PM
j Reminder: AOL will never ask you to send us your password or credit card number in an email. This message has been scanned for known viruses.
I Prom: David Jadwin, DO

;
!( • 1
i _o: Peter Bryan \
i Cc: RWOODS@co.kern.ca.us, Karen Barnes I
Subject: Cytology Screening at KMC i
Date: Thu, 2 Mar 2006 11:36:58-0800 ]
Peter:
A couple years after I arrived at KMC, Gilbert and I elected to not offer a full time position to the cytotech that had worked at KMC for a couple of
years as a temporary employee. There were some ethical issues involved and I discovered on retrospective review that the cytotech was missing
several high grade lesions and calling them negative.
I received a lot of harsh criticism from the gynecologists and the radiologists. There was a lot of hard feelings in other areas as well.
Some time later, Dr. Schmalhorst from Physicians Automated Laboratory harshly said that cytotech was one of the best, he had seen.
Leonard Perez told me last week that PAL sent a notice out to all of their clients stating that they had to let their cytotech go because of several
missed high grade lesions; and they mentioned that they were going to have to rescreen several past months (years?) of pap smears.
On another issue, I have not received a response from you regarding the need to rescreen 50 prior prostate needle biopsies from a.
former KMC pathologist. What do you want me to do?
David
Exhibit 271
Cindee L LeFevre, CSR # 7974
08/14/08
Peter Bryan, CEO
Pa^lj
DFJ00750
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27 EXHIBIT 51
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From: Peter Bryan <bryanp@kernmedctr.com>

To: djadwin@aol.com
Cc: Irwin Harris, MD <harrisi@kernmedctr.com>
Sent: Fri, 21 Apr 2006 12:46:16 -0700
Subject: Re: Fwd: Cytology Screening at KMC
Work through Irwin Harris on the need for a review of the cases. I have alerted him to
the issue so he will help with what ever the appropriate process should be. It could be
that he will suggest that you also take the issue to the Quality Management Committee for
their information, but I will leave that to the two of you to decide.
»> <djadwin@aol.com> 4/19/2006 12:30:17 PM »>
-----Original Message-----
From: David Jadwin, DO <jadwind@kernmedctr.com>
To: Peter Bryan <bryanp@kernmedctr.com>
Cc: RWOODS@co.kern.ca.us; Karen Barnes <barnesk@kernmedctr.com>
Sent: Thu, 2 Mar 2006 11:36:58 -0800
Subject: Cytology Screening at KMC
Peter:
A couple years after I arrived at KMC, Gilbert and I elected to not

offer a full time position to the cytotech that had worked at KMC for a
couple of years as a temporary employee. There were some ethical issues
involved and I discovered on retrospective review that the cytotech was missing several
high grade lesions and calling them negative.
I received a lot of harsh criticism from the gynecologists and the radiologists. There
was a lot of hard feelings in other areas as well.
Some time later, Dr. Schmalhorst from Physicians Automated Laboratory harshly said
that cytotech was one of the best he had seen.
Leonard Perez told me last week that PAL sent a notice out to all of
their clients s~ating that they had to let their cytotech go because of several missed
high grade lesions; and they mentioned that they were going to have to rescreen several
past months (years?) of pap smears.
On another issue, I have not received a response from you regarding the need to
rescreen 50 prior prostate needle biopsies from a former KMC pathologist. What do you
want me to do?
David
12
DFJ00799
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27 EXHIBIT 52
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1
3 ______________
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
)
9 )
Defendants. )
10 __________________________)
11
12
13
15 OF
16 SAVITA PRASAD SHERTUKDE, M.D.
19
20
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22
23
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ShertukdeS
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1 13:29:03 1 Q. Did you ever submit any complaints about
2 13:29:05 2 Dr. Jadwin at Kern Medical Center?
3 13:29:06 3 A. No, I did not.
4 13:29:08 4 Q. Why is that?
5 13:29:09 5 A. I don't understand. I didn't --
6 13:29:16 6 Q. Okay. Why did you not submit any complaints
7 13:29:18 7 about Dr. Jadwin to Kern Medical Center?
8 13:29:21 8 A. Because there wasn't any reason for me to
9 13:29:22 9 submit any complaint.
10 13:29:25 10 Q. You weren't terrified of him?
11 13:29:28 11 A. Not -- not before this incident.
12 13:29:31 12 Q. Okay. What about after the incident? Did
13 13:29:34 13 you submit -- you didn't submit any complaints about
14 13:29:36 14 Dr. Jadwin at or around the incident in October 2005?
15 13:29:39 15 A. I told Dr. Dutt. I told Dr. Dutt that I'm
16 13:29:42 16 scared, but I -- I didn't submit a formal complaint,
17 13:29:48 17 like, you know. I told Dr. Dutt I'm scared, like,
18 13:29:51 18 you know, and --
19 13:29:52 19 Q. Why didn't you submit a formal complaint
20 13:29:55 20 about Dr. Jadwin scaring you at around the incident
21 13:29:58 21 in October 2005 --
22 13:29:59 22 A. It just didn't seem like, you know --
23 13:30:00 23 Q. Sorry. Just let me finish.
24 13:30:02 24 At or around the incident of October of
25 13:30:04 25 2005?
ShertukdeS
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1 13:49:07 1 know.
2 13:49:07 2 Q. What did he do to you?
3 13:49:10 3 A. This is what he did. He basically called up
4 13:49:13 4 a clinician. Like, you know, it's important
5 13:49:15 5 clinician. A surgeon, like, you know, he's
6 13:49:18 6 important. Dr. McBride used to run the oncology
7 13:49:21 7 conference. Like, you know, it's an important
8 13:49:23 8 clinician. And we want to be on good terms, like,
9 13:49:26 9 you know, we are -- like, you know, all of us, like,
10 13:49:27 10 work here, like, you know. You know, trying to,
11 13:49:30 11 like, you know, say something like that about us,
12 13:49:32 12 like....
13 13:49:34 13 Q. So in your opinion, Dr. Jadwin's behavior
14 13:49:36 14 with regard to the radical prostatectomy case, that
15 13:49:39 15 was completely wrong. Right?
16 13:49:44 16 A. Yeah. Dr. Jadwin was wrong, yeah.
17 13:49:48 17 Q. Do you recall whether that patient
18 13:49:50 18 eventually had a prostatectomy or not?
19 13:49:53 19 A. No. The patient did not. The patient
20 13:49:55 20 refused after that for a prostatectomy. That's what
21 13:49:59 21 I heard during oncology conference. This case got
22 13:50:03 22 presented.
23 13:50:03 23 Q. Again?
24 13:50:03 24 A. Not -- that prostatectomy -- not the
25 13:50:06 25 prostatectomy. The needle biopsies got presented.
ShertukdeS
203
1 17:13:50 1 A. Contract. I think my contract will get
2 17:13:52 2 renewed if I get an evaluation from my peers, like,
3 17:13:58 3 you know, one of the two peers or somebody else in
4 17:14:00 4 the hospital or somebody who is aware of my work,
5 17:14:05 5 like, you know, a permanent physician at present.
6 17:14:09 6 Like, I have a permanent contract, you know. I am
7 17:14:13 7 within the -- within the -- I'm not on a one-year
8 17:14:17 8 contract. I have a permanent contract.
9 17:14:27 9 Q. What do you mean by permanent contract?
10 17:14:29 10 A. It's valid. You have to validate it every
11 17:14:31 11 few years. I don't -- two years or three years you
12 17:14:34 12 have to validate it. It's valid. My contract is
13 17:14:37 13 valid up to a certain date.
14 17:14:39 14 Q. Okay.
15 17:14:44 15 A. And then you have to validate it. That's
16 17:14:46 16 what I know, like, you know.
17 17:14:51 17 MS. BARNES: Madam Reporter, how long have
18 17:14:52 18 we been on the record?
19 17:14:57 19 MR. LEE: Do you want to go off the record?
20 17:15:01 20 THE REPORTER: I can check for sure.
21 17:15:04 21 MS. BARNES: Are you just about finished?
22 22 MR. LEE: Getting very close. But we can go
23 23 off --
24 17:15:10 24 MS. BARNES: We're approaching four hours.
25 17:15:11 25 That's why I'm asking.
ShertukdeS
204
1 17:15:12 1 MR. LEE: Okay. We're very close to
2 17:15:15 2 finished.
3 17:15:21 3 MS. BARNES: We'll go another five minutes
4 17:15:22 4 and see.
5 17:15:22 5 MR. LEE: Okay. We'll go on.
6 17:15:27 6 BY MR. LEE:
7 17:15:33 7 Q. Okay. So your contract is self-validating
8 17:15:36 8 every few years, as you say?
9 17:15:38 9 A. Yeah.
10 17:15:39 10 Q. So why would -- can you think of any reasons
11 17:15:42 11 why your contract would not become -- would not be
12 17:15:46 12 validated at any particular time?
13 17:15:47 13 A. No. I don't think of any reason why it
14 17:15:49 14 shouldn't be validated.
15 17:15:51 15 Q. Okay. Well, what if you were really making
16 17:15:53 16 mistakes like Dr. Jadwin and engaging in all sorts of
17 17:15:56 17 incompetence? Would you then -- would your contract
18 17:15:59 18 then not be validated or --
19 17:16:01 19 A. No. I would know about it from my
20 17:16:03 20 colleagues or from Dr. Dutt or from, you know, like
21 17:16:07 21 the CMO or the CEO, like, you know. I would know
22 17:16:11 22 about it.
23 17:16:12 23 Q. Okay. What's a core physician versus a
24 17:16:20 24 non-core physician?
25 17:16:20 25 A. A core physician is what -- a non-core
ShertukdeS
206
1 17:17:17 1 Q. Now, do -- non-core physicians, do they get
2 17:17:21 2 a self-validating contract like yours?
3 17:17:24 3 A. Non-core physicians? No, they don't.
4 17:17:25 4 Q. They don't get permanent contracts. Right?
5 17:17:28 5 A. They become permanent. They become core
6 17:17:30 6 physicians after a year.
7 17:17:31 7 Q. Okay. So when you become a core physician,
8 17:17:34 8 you're becoming a permanent physician. Correct?
9 17:17:36 9 A. That's right.
10 17:17:37 10 Q. And you get a permanent contract. Correct?
11 17:17:39 11 A. Yeah.
12 17:17:40 12 Q. Permanent contract just like yours. Right?
13 17:17:43 13 A. Yeah.
14 17:17:44 14 Q. Okay. And then you expect that as a core
15 17:17:46 15 physician -- core physicians expect to continue
16 17:17:49 16 working at Kern Medical Center for the rest of their
17 17:17:52 17 careers. Correct?
18 17:17:53 18 A. No. I think many of them have certain years
19 17:17:56 19 contract. Like some people, like, you know, heads of
20 17:17:58 20 departments probably have a five-year contract.
21 17:18:00 21 Q. Okay.
22 17:18:01 22 A. Or some people have a four-year contract,
23 17:18:05 23 some people have a three-year contract, things like
24 17:18:07 24 that.
25 17:18:08 25 Q. Okay. So you think there's a difference
ShertukdeS
220
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
SAVITA PRASAD SHERTUKDE, M.D., the witness named in the
deposition was taken Thursday, August 7, 2008, at the
Dated this 15th day of August, 2008, at
WOOD & RANDALL

(800) 322-4595
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3 ______________
5 DAVID F. JADWIN, D.O., ) VOLUME IV

) Page 549
6 Plaintiff, )
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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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8 COUNTY OF KERN; et al. )
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9 )
Defendants. )
10 _______________________________)
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15 OF
17 Tuesday, March 11, 2008
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25 Reported by: Susan R. Wood, CSR No. 6829
DFJ4
618
1 Q. What is Exhibit 592?
2 A. It's an e-mail that I sent expressing a
3 rather serious concern to the president of the
4 medical staff and to the CEO of medical -- of Kern
5 Medical Center.
6 Q. And what was your serious concern that you
7 expressed in this memo?
8 A. I was very concerned that Dr. Ragland was
9 somehow impaired.
10 Q. Impaired.
11 What is -- what did you mean when you say
12 impaired?
13 A. I think the -- the term relative to a
14 physician is that they may not be able to carry out
15 their duties appropriately.
16 Q. And your reasons for believing that way are
17 set forth in this memo?
18 A. This and the e-mail that was attached, yes.
19 Q. There was an e-mail attached to this?
20 A. I believe so, yes.
21 Q. What was the e-mail that was attached?
22 A. We've actually reviewed that in a past
23 session.
24 Q. Fine.
25 Tell me what it is, sir.
DFJ4
621
1 Q. Tai Yoo.
2 You talked to Dr. Tai Yoo?
3 A. Yes, I did. I showed him the e-mail.
4 MR. LEE: Do you want to spell his name,
5 please.
6 MR. WASSER: Yeah. Let's spell his name,
7 please.
8 THE WITNESS: T-a-i Y-o-o.
9 BY MR. WASSER:
10 Q. Is he -- and what was his position at that
11 time?
12 A. He was the chair of psychiatry.
13 Q. All right.
14 A. So I didn't do this on a lark. I actually
15 went to the chair of psychiatry and expressed my
16 concern with him, and he agreed that there was
17 some -- some worrisome features here.
18 Q. Some worrisome?
19 A. Worrisome features.
20 Q. And that's why you wrote this memo that
21 we've marked as Exhibit 592?
22 A. I think physicians have an obligation to
23 report possible impaired physicians, yes.
24 Q. They do?
25 A. Yes, they do.
DFJ4
622
1 Q. Do physicians have an obligation to report
2 anything else?
3 MR. LEE: That's overbroad.
4 THE WITNESS: Yeah.
5 I -- I don't know what you mean by that, but
6 I do know that physicians -- there have actually
7 been, I believe, cases that I've heard about where
8 physicians were sued because someone was practicing
9 in an aberrant way and the medical staff didn't do
10 anything about it when they should have.
11 BY MR. WASSER:
12 Q. Things like -- like making mistakes, things
13 of that nature?
14 A. Yes. Um-hmm.
15 Q. Physicians have a duty to report that kind
16 of thing, don't they?
17 MR. LEE: And it's overbroad, vague and
18 ambiguous, and it calls for a conclusion.
19 BY MR. WASSER:
20 Q. You can answer, sir.
21 A. During a joint commission inspection of the
22 hospital several years ago, the inspector actually
23 asked the question, what do you do if you see someone
24 who may be impaired down the hall? And it was a test
25 because you do have an obligation to report -- that's
DFJ4
623
1 a serious quality issue. I mean, if someone's
2 intoxicated, they're going to go into the operating
3 room or deliver a baby, that's a -- that's a serious
4 problem.
5 Q. And you drew all those conclusions about
6 Dr. Ragland from the memo he wrote you?
7 MR. LEE: Misstates his testimony.
8 THE WITNESS: I don't think I said that at
9 all. I said I had some concerns based upon the
10 pattern of his behavior, as expressed in words; plus
11 the lack of capability of expressing it, anything
12 above an eighth grade English level; that there may
13 have been -- you know, if someone was on drugs or
14 alcohol, they could well have typed or written
15 something like this. I -- I don't know.
16 It was also, in my opinion, an inappropriate
17 tone in response. It was a punishment or punitive
18 type of response, actually, to some very valid,
19 properly construed questions that I had written in my
20 e-mail.
21 Q. To him?
22 A. Yes.
23 Q. So -- so part of your concern about
24 Dr. Ragland's e-mail was that you thought it was
25 retaliatory to you?
DFJ4
650
1 you know, it's this, this, this, this. It doesn't
2 make sense.
3 Q. Did you ever go just talk to Dr. Perticucci?
4 A. I actually did talk to Dr. Perticucci after
5 the fact, after this letter.
6 Q. After the letter?
7 A. Actually -- well, I don't remember exactly,
8 but I did talk to Dr. Perticucci, and I explained the
9 situation to him. And his response was, oh, I'm
10 sorry. He was high strung. I don't know. But if he
11 had just come directly to me I could have corrected
12 the problem within seconds.
13 Q. You talked to him after you wrote your
14 letter?
15 A. I don't remember if it was before or after.
16 Probably afterwards. But I explained it to him on
17 the telephone, and it was apparently obvious to him
18 once I explained to him what had happened and why it
19 all made sense. And all he could say was, oh, I'm
20 sorry. And that was the end of it, so....
21 MR. LEE: I think we're going to want 30
22 days to correct the transcript.
23 MR. WASSER: Whatever the rules call for,
24 Counsel.
25 Let's mark this as our next one, please.
DFJ4
837

w
STATE OF CALIFORNIA o
ss. R
COUNTY OF KERN D
I
N
D
E
X
Reporter in the State of California, 'holding
foregoing deposition, was by me duly resworn; that said
deposition was taken Tuesday, March 11, 2008, at the
the witness were written down by me in
in any way related to any party to said action, nor
way interested in the result or outcome thereof.
Dated this 31st day of March, 2008, at
California.
Susan ~-N-o-.-6-8-2-9----
WOOD & RANDALL

(800) 322-4595
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/
I
~ • MEDICAL
.KERN
CENTER
HUMAN RESOURCES DEPARTMENT
Memorandum
To: Dr. Marvin Kolb, Chief Medical Officer
From: Michael Ewald, Hospital Human Resources Director
Date: October 21,2003
Re: Confidential Report of Investigative Findings - Complaint of Dr. Chester

Lau Against Dr. David Jadwin
Please find attached a confidential report of the Human Resources Department's investigation
into a formal complaint by Dr. Chester Lau against Dr. David Jadwin.
I am available to discuss with you or anyone else you designate the findings and conclusions of
this investigative report. Please do not hesitate to contact me at Extension 62339.
~/ Michael Ewald, SPHR

Hospital Human Resources Director
Attachment
xc: Peter Bryan, Chief Executive Officer

Linda Nipper, PHR, Hospital Employment Specialist
0000031.
• KERN
MEDICAL
• CENTER October 20,2003
--CONFIDENTIAL-
REPORT OF INVESTIGATIVE FINDINGS
INVESTIGATION OF COMPLAINT
BY DR. CHESTER LAU, DEPARTMENT OF RADIOLOGY
AGAINST DR. DAVID JADWIN, DEPARTMENT OF PATHOLOGY
At the request of Dr. Marvin Kolb, Chief Medical Officer, on October 8, 2003, the Human
Resources Department began investigating Dr. Chester Lau's allegation that he was physically
assaulted and intimidated by Dr. David Jadwin on August 9, 2003 in the Kern Medical Center
Radiology Department.
A fonnal complaint by Dr. Lau was made in a memorandum, dated August 12,2003, addressed to
Dr. Javad Naderi, Chainnan of Department of Radiology, with a copy to Dr. Marvin Kolb, Chief
Medical Officer. Dr. Lau's complaint concerns an August 9, 2003 incident where he alleges
"unprofessional behavior" by Dr. Jadwin when Dr. Jadwin "grabbed" his tie with his hand and
"dragged" him "several feet." Dr. Lau stated in his letter, "I felt that 1 lost my breath for a few
seconds and 1 felt the sudden ripping force around my neck." He said that he "managed to regain
(his) posture by pulling (his) tie out of his (Dr. Jadwin's) hand."
Dr. Lau wrote, "During this incident, I felt physically threatened. Dr. Jadwin's behavior is not
just inappropriate. His behavior is downright unprofessional and dangerous. I am formally filing
a complaint regarding his unprofessional behavior."
Complaint Investigated
Our investigation focused on the August 9, 2003 incident in an effort to determine whether there
was sufficient credible evidence substantiating Dr. Lau's allegation that Dr. Jadwin, without
provocation or warning, forcibly pulled on Dr. Lau's necktie, causing Dr. Lau to take several
involuntary steps across the Radiology reading room into the Radiology hallway before Dr. Lau
pulled his necktie out of Dr. Jadwin's hand. The investigation included an assessment as to
whether the incident constituted a minor physical assault that could reasonably have created in
Dr. Lau excessive, disruptive anxiety and short-termed neck pain during the incident.
Specifically, the investigation sought to determine if there had been a Physical Assault (Minor)
Level 3 violent act inflicted on Dr. Lau in Kern Medical Center in violation of Section 1211 of
the Kern County Policy and Administrative Procedures Manual (Workplace Violence Policy).
The investigation addressed three examples in the Workplace Violence Policy of threats, or acts
of violence for which criminal prosecution and disciplinary action may be taken.
I. Committing an assault or battery.

2. Engaging in any behavior that unreasonably risks the safety of another.
0000032
3. Accosting or harassing another, either face to face, or by telephone, fax, mail,

computer, or other form of communication.
Method of Investigation
The investigation consisted of a review of the August 12, 2003 written complaint and interviews
with those connected with the case. Both the accuser and the accused were separately
interviewed. Two eyewitnesses were also interviewed. Additionally, Drs. Kolb and Naderi were
interviewed about what Dr. Jadwin and/or Dr. Lau told them about the incident.
Investigative Findings
I. There were two eyewitnesses to the incident: Dr. Nitin Athavale of the Department
of Radiology, and Erin Baldwin, a medical student assigned at that time to the
Department of Pathology rotation. Both were interviewed and provided substantially
similar accounts of the incident.
2. The parties to the incident and the eyewitnesses all agree that a verbal argument
immediately preceded the tie-pulling incident. The argument was over the validity of
statistical information gathered and presented by Dr. Jadwin showing, in Dr.
Jadwin's opinion, the inadequacy of biopsy samples submitted by the Department of
Radiology to the Department of Pathology. First Dr. Athavale and then Dr. Lau
vehemently disagreed with the assertions made by Dr. Jadwin that the biopsy samples
were shown by his research to be inadequate. There is some divergence of
recollection and opinion as to who was more angry and vocal, but the witnesses agree
that Dr. Lau and Dr. Jadwin were both involved in an escalating and heated
disagreement that culminated in Dr. Jadwin inviting Dr. Lau to accompany him to the
Department of Pathology to review more research. When Dr. Lau adamantly refused
to accompany Dr. Jadwin, stating that he had a procedure to perform, an evidently
exasperated and angry Dr. Jadwin reached over to take hold of Dr. Lau's necktie with
his hand and pulled Dr. Lau by his necktie about four or five steps from the reading
room to the doorway of the hall before Dr. Lau told him to stop doing that and pulled
his necktie back.
3. According to those prt;:sent, the tie-pulling incident was completely unexpected. No

threats were made before or during the incident, and Dr. Jadwin ceased any contact
with Dr. Lau at the end of the incident. Dr. Jadwin left the Department of Radiology
immediately and reported the incident to the Chief Medical Officer within minutes of
it ending. Neither Dr. Lau nor the two witnesses report that Dr. Jadwin had any
physical contact with Dr. Lau other than to pull his necktie. The action did not
appear premeditated nor did it appear intended to injure or frighten Dr. Lau. Both
parties have avoided each other since the incident.
4. Dr. Lau is seeking assurances that there will not be a repeat incidence from Dr.
Jadwin. Dr. Jadwin has expressed regret over the incident. This appears to be an
isolated incident, and there have been no related complaints against Dr. Jadwin either
before or after this incident.
0000033
Conclusions
The preponderance of evidence shows:
1. During an argument between Dr. Chester Lau and Dr. David Jadwin in the
Department of Radiology on August 9, 2003, Dr. Jadwin reinforced his demand that
Dr. Lau accompany him to the Department of Pathology by unexpectedly taking Dr.
Lau's necktie in his hand and pulling Dr. Lau by his necktie several feet into the
Radiology hallway before Dr. Lau stopped him. It is reasonable to conclude that this
constituted a minor physical battery that at a minimum caused physical discomfort
for Dr. Lau and created excessive, disruptive anxiety for him.
2. Dr. Jadwin's action created a hostile work environment and violates the Workplace
Violence Policy of the County of Kern; specifically, by engaging in a Level 3 act of
violence that unreasonably risked the safety of another physician working at the
hospital. Since Dr. Lau had stated he had to perform a medical procedure on a
patient moments before he was accosted by Dr. Jadwin, it not unreasonable to
conclude that Dr. Jadwin's action could have potentially endangered the quality or
efficiency of care provided to patients, although there is no evidence to suggest that
patient care was compromised or affected.
3. [n accordance with the Workplace Violence Policy of the County of Kern and my
responsibilities as Hospital Human Resources Director, I will attach this report to the
Workplace Violence or Threat Mitigation Report, and forward these documents to
the County Risk Management Division.
~C2~
Director of Human Resources
Kern Medical Center
County of Kern
~ 74r;""
~,PHR
.<
Hospital Employment Specialist
Kern Medical Center
County of Kern
Attachments:
Memo from Dr. Chester Lau to Dr. Javad Naderi, dated August 12, 2003
Transcript of Interview with Dr. Chester Lau
Memo to File - Interview with Dr. Nitin Athavale
Transcript of Interview with Dr. Marvin Kolb
Transcript of Interview with Erin Baldwin
Transcript of Interview with Dr. Javad Naderi
Transcript of Interview with Dr. David Jadwin
0000034
TO: JAVAD NADERI, \I.D, Cf-L\IR.M.AN OF DEPARTMENT OF RADIOLOGY
FROM: CHESTER LAU, i\!.D
SUBJECT: DR.Jl\DWIN'S UNPROFESSIONAL BEHAVIOR
DATE: 8/ 12!2003
cc: MAR\rlN KOLB, M.D., MEDlC'\L DIRECTOR
[ ,un bringing to your attention to an incident regarding of Dr. Jadwin's unprofessional behavIOr.
On August 9 at approximately 10:30 am, Dr. Jadwin and I were debating over some pathology data
he brought over to the department of radiology. Towards the end of the debate, Dr. Jadwin insisted
that I have to go over to his office in Pathology to look over more data. I told him that I could not
leave the department because I was attending to a patient to whom I was going to perform an
angIOgram. He further insisted that I had to go with him He grabbed my tie with his hand and
dragged me for several feet I felt that I lost my breath for a few seconds and I felt the sudden
ripping force arOlmd my neck. I managed to regain my posture by pulling my tie out of his hand. I
warned him not to do that mymore. During the incident, Dr. Athavale and one of the female
medical students who was on the pathology rotation witnessed the entire transaction.
Durmg this incident, I felt physically threatened. Dr. Jadwin's behavior is not just inappropriate.
His behavior is downright unprofessional md dangerous. I am formally fuing a complaint regarding
his lmprofessional behavior
?'4~4-.~
Chester Lau, MD.
0000035
INTERVIEW WITH DR. LAD

October 8, 2003
MICHAEL EWALD: Linda Nipper and I, Mike Ewald, are meeting with Dr. Lau. It is
October 8,2003, at approximately 3:00 p.m. and we are recording
this with Dr. Lau's permission and this has to do with this incident
with Dr. Jadwin where there was apparently some - he pulled an
article of your clothing. Maybe if you could just kind of recap
what exactly happened and maybe what led up to it, and then what
happened and what happened afterwards.
DR. LAU: So, I am Dr. Lau, by the way. The incident happened I would say
about a month ago. I couldn't recall the date now.
MICHAEL EWALD: Okay.
DR. LAU: It was in the morning - late morning. I was waiting to do a

procedure, an angiogram of a patient. Patient was down in the
department and we were getting ready to go, and Dr. Jadwin came
into the department and showing data to Dr. Athavale. I wasn't
paying attention at the time.
MICHAEL EWALD: Was this in the little room where you read the film?
DR.LAU: Yes. Correct. It was in the room right at the end of the Radiology
Department where all the radiologists read their films. He was
showing Dr. Athavale some data regarding how accurate in his
diagnosis of pathological specimens. I wasn't paying attention at
the time and he called to my attention. He said I should look at his
data. And I said, ''I'm busy." But he insisted that I look at his
data. So, I stand by him and start looking at his data and he
pointed out to me that since he got 20% or 30% - wasn't sure the
percentage -less than 50% of his specimens are malignant - core
malignant - then his data should be good to say that his core or
(inaudible) data is minimal. And I couldn't understand that and
argued with him. It was in a way a kind of heated argument. I told
him that you can't say that because it's malignant and the rest or
more than 50% - you don't know - it's not adequate - how can
you say that because you have something that's malignant, you can
imply the rest is okay. You can't say that. And he said, "Okay,
fine. Come to my office." He told me to go to his office to look at
the rest of the data and I wasn't in a mood to see any more data - to
argue any more at that time and I said, "No, I got to stay here
because I have an angiogram coming up and I got to attend to the
patient." It was an unstable patient - a patient from the ICU.
Apparently, he didn't take that for - as a no to go to his office. He
-I -
0000036
grabbed my tie - grabbed my tie - and yanked me out from that

small room into the hallway.
MICHAEL EWALD: So, he actually pulled you -
DR. LAD: Oh, he pulled me out of the room.
MICHAEL EWALD: So, how many steps is that? Three or four?
DR.LAU: Five steps - I would say five steps altogether.
DR. LAD: Until I regained my posture and then ripped my tie back out of his
hand. And I told him, "Don't you do that." I didn't appreciate that
movement at all. I personally don't like to wear ties. I don't wear
ties when I don't need to. I go to formal receptions - I go to work
and wear a tie. When I go home or everywhere I go, I don't like to
wear a tie. The tie is a method of representing of what I do and
maybe my reputation in a way. But, I don't like somebody to pull
on something that could intend danger to my physical being.
When he pulled my tie - and I do feel my neck bend backward
because of the force - you know - he's a big guy. He's a pretty
good size guy. Maybe he didn't realize what he was doing, but that
movement - that does cause me a little bit of pain - a little bit of
pain at the time and when I was doing the angiogram, I could feel
it. After the angiogram, which was about an hour and a half
afterward, I went to lunch and I start thinking of it - I still had a
little bit of pain in my neck and I decided that maybe I should do
something about it. Not that I want to punish the guy. I want to
make sure that he would not do that to me or to anybody else in
this hospital. It is not correct to yank on somebody's tie with that
kind of force to the point that the other person would feel pain in
the neck. I do not have any persistent pain after lunch - afterwards
- but I think that ifhe had just given a little bit stronger yank on
my tie, I might have sustained injury in my neck.
MICHAEL EWALD: After he did that and you grabbed your tie back from him - back
out of his hands, did he do this with his right hand or left hand?
DR. LAD: Oh,jeez. I can't tell. I don't remember. It happened so fast.
MICHAEL EWALD: Okay. But, anyway he had your tie - you took it back from him -
then what did he sayar do?
DR. LAD: He - I told him don't do that any more. He didn't say anything
else. He turned around and walked away.
-2-
0000037
MICHAEL EWALD: He just walked away. He didn't say a thing?
DR. LAU: He didn't say he's sorry. He didn't say anything else. But, he
walked away. I don't remember he say anything. No. Not that I
wanted him to say sorry about it. At that time, I was kind of too
infuriated because of the fact that somebody would do that to me
and something not asking for. No doubt about it, I may have put
him down a little bit by saying his data wasn't correct - the way he
interpreted his data was incorrect. I'm sorry that I belittled him
that way, but I just do it professionally to point out that the way he
interpreted his data is not the way that any other people would see
it. Only he could see that way.
MICHAEL EWALD: So, you had - could I characterize this properly as a heated
professional argument about the data and did you call - did he call
you names or did you call him names - or did he get personal in
anyway?
DR. LAU: No name was called - nothing was personal. Everything was on
the data. I just said the data - the data. You cannot- if anything, I
just said that you cannot say - you cannot conclude from this data
that - that you have enough adequate specimens. I just tried to tell
him that you just have less than 50% of what is going on and how
can you confer 100% of what's going. You have half - I did
mention that you have half of the empty glass. How can you say
that the full glass will be the same. And I did mention those words
to him.
MICHAEL EWALD: And he - and what he was saying to you was he was still insisting
that it was valid data and that he then wanted you to come down to
his office to see more?
DR. LAU: To see more.
MICHAEL EW ALD: Who witnessed this?
DR. LAU: Dr. Athavale was there. He has a female - not sure if she's a
medical student or a technician - along with him. She was there,
too. Two persons there.
MICHAEL EWALD: Do you know her name or could you get us her name?
DR. LAU: I don't know her name.
MICHAEL EWALD: Okay. Have you seen her since then?
DR.LAU: No. I haven't seen her since then.
-3- 0000038
DR. LAU: No, because he brought her along.
MICHAEL EWALD: Alright. Did he say anything to you afterwards?
DR. LAU: Regarding that incident?
MICHAEL EWALD: Yes.
DR. LAD: No. Nothing yet. Nothing.
DR.LAU: I try to avoid him as much as possible, except at the professional

level.
MICHAEL EWALD: Oh, I'm sorry. Dr. Athavale?
DR. LAU: No, I'm - oh, you mean Dr. Athavale?
MICHAEL EWALD: Yes. I'm sorry. I was unclear. Did Dr. Athavale say anything to
you? Did he make any comments.
DR. LAU: Yes. He mentioned to me that - yes, he saw the incident. He saw
exactly what was going on and he can recount what was going on.
He did mention it to me.
MICHAEL EWALD: Okay. Did he express anything to you about being surprised or
upset about that?
DR. LAU: No.
MICHAEL EWALD: But he just basically said that he could be a witness for you, is that
it?
DR. LAU: Yes. He said he saw the incident. Basically, that's what he said.
MICHAEL EWALD: Okay. Now when you were pulled out into the hall, there was
nobody else out in the hall who saw that?
DR. LAU: Vh - okay - oh I remember that. There was - Greg Prince was
there afterwards. Not sure he saw exactly what's going on. He
was in the hallway further down, near by the main hallway.
MICHAEL EWALD: And who was this?
-4-
0000039
DR. LAU: Greg Prince. He's the supervisor.
MICHAEL EWALD: Oh, Greg Prince. Okay.
DR.LAU: He's at the end of the hallway where the reading room is - the
entrance is right here - I flew out into the hallway. Greg Prince
was walking out of his office at the other end of the hallway. I'm
not sure he saw what's going on.
MICHAEL EWALD: Okay. He may have heard though.
DR.LAU: Might have heard.
MICHAEL EWALD: And you say that you said, "Don't pull my tie" or words to that
effect.
DR. LAU: Might have, yes. You may want to call- corroborate it with him.
I'm not sure he saw what was going on, but he was there at the end.
MICHAEL EWALD: Okay. Have you had any other unsatisfactory interactions with Dr.
Jadwin before?
DR. LAU: I just don't like the way that he called the results of the biopsies,
that's the only thing I don't like.
MICHAEL EWALD: But you haven't had any shouting matches or angry words or
anything else with him before that time?
DR. LAU: No.
MICHAEL EWALD: So, were you surprised when he pulled your tie? Was that one of
the feelings that you had when he did that?
DR. LAU: Surprised - infuriated - both.
MICHAEL EWALD: Because he took a part of your clothes and pulled them without any
cause or justification for that?
DR. LAU: Yeah. The other feeling i got in my mind was I was coerced to do
something. I feel that Dr. - to a certain place. Now, I didn't want
to go somewhere. He insist that I got to be there by physical force
and he did it with physical force, even for five steps or so.
MICHAEL EWALD: Uh-huh. And do you think that he knew what he was doing or was
he just so caught up in the moment that he just lost it?
DR. LAD: I don't know. I really don't know. You'd have to ask him on that
-5-
0000040
point. I don't know. I got the feeling that maybe he just didn't
know what he's doing and I - when I report this, I didn't think that
he - I did not think that he know what he's doing and I'm afraid
that he will cause damage to other people or to me or maybe - who
knows - you know. One thing can lead to another and I hate to see
that and I see that in my life - (inaudible) my life and other
people's lives and (inaudible) - and it wasn't a good outcome and
nothing is pretty and I don't want to see that at all. I want to stop
before - at the first step and nothing is going to be (inaudible)
towards the end.
MICHAEL EWALD: Have you heard of any other incidents involving Dr. Jadwin where
he's pulled a tie or touched somebody or been very angry at
somebody?
DR.LAU: No. No. This is the first time I've deal with him in this way.
MICHAEL EWALD: Okay. What happened afterwards? Did he come back and talk to
you or have you heard from him at all? Has he written to you or
telephoned you or talked to you? When you see him, what does he
say or do to you?
DR. LAU: Uh. I try to avoid him as much as I can. I don't even want to have
any eye contact with him in the hallway when I see him walking
the other way. I try to do something - I don't want to get close to
him. The only time that I need to be close to him is when I take a
biopsy of the patient and hand the specimen over to him. That's
the only time that I will be with him and that's on professional
level and there's a lot of people there. And I feel comfortable with
it. If I'm one-an-one with him or even in (inaudible) area, I try to
avoid as much as I can with him. Not that I'm scared or what, it's
just that I don't want to escalate the situation further. That's how I
think of it.
MICHAEL EWALD: Has he tried to talk to you at all about this incident?
DR. LAU: No.
MICHAEL EWALD: Then it's safe to say that he hasn't apologized?
DR.LAU: Not that I want one - no, he didn't. No, I didn't - it doesn't matter
if he apologized or not. All I need to know is - make sure that this
would not happen again. Unless he would say to me that it would
not happen again, so we would not have any future incidents like
that happen. He never talked to me - I'm sorry - to answer the
question.
-6- 0000041.
MICHAEL EWALD: Has he - have you been feeling any other pain or any other affects
after this other than the immediate time when that was happening
and right afterwards where you felt neck pain and - but, you don't
have any stress or any incidents where you're afraid? You're not
afraid of him, or anything like that?
DR. LAU: No. I'm not afraid of him and I don't have any pain now. I have
full function. I wouldn't hold him for anything physically or
emotionally - no, no. It was - I believe it was a spontaneous-
something spontaneous - something that he maybe get used to
doing. I'm not saying he did this before. Maybe he thinks it's so
spontaneous doing it. He didn't know what he's doing. Ijust want
make it plain - to warn him that that's not the right way to do
things and to not do it again. Because if this is a spontaneous thing
that he does and he may do it again - and with his strength he can
do damage.
MICHAEL EWALD: So, if you could just tell me - we usually ask this of anybody in
this situation - what would you like to see the hospital do in this
case?
DR. LAU: I think the hospital has done everything and I don't think the
hospital is liable for anything. There's no damage - no foul- no
harm. I wouldn't hold anybody for it. I just want Dr. Jadwin not to
do that to me again and or to anybody-
MICHAEL EWALD: So, you would like assurances from Dr. Jadwin that he will not do
that again and that he recognizes that that was to you, certainly,
serious breach of decorum by grabbing your tie and pulling you.
DR. LAU: That's all I want. That's all I want.
MICHAEL EWALD: Okay. Linda, do you have any questions?
LINDA NIPPER: No, I don't.
MICHAEL EWALD: Okay. Alright. We will be investigating this and preparing a

report for the Medical Director with our conclusions and
recommendations. If anything else comes to mind - if you think of
anything else - please contact either myself or Linda so that we can
get any other thoughts that you have down. I would ask, as we do
with anybody in an investigation, that from this point on not to
discuss it with anybody until we've completed our investigation.
DR. LAU: Okay.
MICHAEL EWALD: And if Dr. Jadwin attempts to talk to you about it, I would ask that
-7-
0000042
you refer him to us so that we can discuss it with him and not - I
don't think it would be good ifhe attempted to discuss it with you
or anyone else either. We'll be asking him not to talk about it with
other people, too.
DR. LAU: I'm sorry if I caused any alarm or whatsoever by writing this letter.
I didn't mean to cause so much trouble and cause County to spend
so much resources on this matter. I really don't-
MICHAEL EWALD: I think it's an important issue to you. 1- certainly, it was an

unusual - maybe even a frightening incident - that - and I'm glad
that you brought...i t to our attention and we will do everything we
can to investigate it and make sure it doesn't happen again. So, I
think that it's - I don't think that you should be apologetic at all. I
think that it was good that you did that. Well, thank you very
much, Dr. Lau. I appreciate it. And, again, if anything comes to
mind, please let me know. Okay?
DR. LAU: Okay. Thank you very much.
MICHAEL EWALD: Thank you.
MICHAEL EWALD: The time is 3: 16 p.m. and this is the conclusion of the interview.
-8-
0000043
~ • MEDICAL
.KERN
CENTER
Human Resources Department
Memorandum
To: File
From: linda F. Nipper, Hospital Employment Specialist
Date: October 9,2003
Re: Investigative Notes Lau - Jadwin Complaint

Interview with Dr. Nitin Athavale
I met with Dr. Nitin Athavale at 1:50 pm on October 9, 2003 in the Radiology Department. Dr.
Athavale was named as a witness to the alleged workplace violence incident between Drs. Lau
and Jadwin on August 9, 2003.
Dr. Athavale stated he was involved in a discussion with Dr. Lau and Dr. Jadwin regarding
pathology issues with the lab. Drs. Lau and Jadwin continued the discussion, which became a
heated professional disagreement. Dr. Athavale, while no longer involved in the discussion at
that time, remained within a few feet of both doctors. Dr. Athavale heard the doctors arguing,
though not in a loud tone. Dr. Athavale saw Dr. Jadwin pull Dr. Lau by his necktie into the hall.
Dr. Athavale stated that he didn't know why.
Dr. Athavale does recall there was a medical student who entered the reading room with Dr.
Jadwin, who may have also been present during the altercation. He did not know who she was.
Dr. Athavale recalls that after Dr. Jadwin pulled Dr. Lau into the hall by his necktie, the two spoke
briefly and went their separate ways. Dr. Athavale has not spoken to either doctor about the
incident and has heard nothing about it again. He did not hear what was said between the
doctors in the hallway after Dr. Jadwin pulled Dr. Lau there.
0000044
INTERVIEW WITH DR. KOLB

October 10,2003
MICHAEL EWALD: This is an interview - a taped interview with Dr. Marvin Kolb on
October 10,2003, at approximately 9:30 a.m. in Dr. Kolb's office.
Present also is Linda Nipper, Hospital Employment Specialist and
we are here to discuss an alleged incident between Dr. Jadwin and
Dr. Lau and I'd like to ask Dr. Kolb if you could tell us when you
first learned of the incident, who you learned it from, and what you
learned.
DR. KOLB: Okay, this is Marv Kolb and I'm here on October lOth responding
to questions posed. I have to refer to some notes of the date
because, Mike, I don't remember the date or the time, but I do
know that to my recollection it was not too long after this event,
which I see here was on August 9th at 10:30 in the morning, David
came by - David Jadwin came by myoffice to tell me about the
event. I think it was the same day- I'm almost positive - well,
pretty certain it was the same day, but it was - that he came in. He
was pretty excited about it and he said that he'd just had an
interaction with Chester Lau about an issue that I'm very familiar
with, which is the bi-needle aspirations. And that Chester - this
was down in Radiology and David had gone down there to talk
about some of the specimens that they receive from Radiology
which do not have adequate samples on them. The radiologists do
the procedures. Pathologists are there at the time and determine
whether there's enough tissue to make a diagnosis. So, anyway-
and this is a growing issue for us because David has stated that -
this was before the event - that we have a growing problem with
adequacy oftissue by our clinicians who give biopsies. So there's
a debate going on in the institution whether this is a competency
issue of the ''biopsier,'' i.e. radiology, surgery, some of the surgical
sub-specialties, Auggie Munoz or is it a pathology competency
with those guys down in Pathology not knowing what they're
doing. The long and short, David went down there and was talking
to them about a biopsy. Chester got upset immediately - this was
David's version - Chester got upset immediately about it. Very
upset. Angry with him. Called David incompetent and David said
"With that I grabbed his tie and said, Come on down to the lab and
1 will show you what's going on."
MICHAEL EWALD: He specifically said, "I grabbed his tie?"
DR. KOLB: Yup.
MICHAEL EWALD: And what did he say about that incident as far as what did Dr. Lau
do and did he talk about that in any kind of detail?
- 1-
0000045
DR. KOLB: Urn - David felt that it was - that he was just kind ofjoking with
Chester and pulling his tie a little bit and "Come on down to the
lab and I will show you." I asked him if he touched him. He said,
"No. I just grabbed his tie and pulled on it." So, I said, "Well,
how did you pull on it?" "Well, a little bit like this, so it wasn't a
very hard pulL" A little different story from what Chester told me.
So, anyway - and then with that event, then Chester just backed
away from him and I think they both walked away from it. I'm not
really sure, but I think that kind of shook everybody up and they
just walked away from it. So, right after it happened, he came
down here. David talked about it and I told David at that time,
"David, you're wrong. Don't ever touch anybody. I don't care
how mad you get. Don't ever touch anybody. You were wrong." I
told him right from the start and I told him then that I would talk to
Chester - urn - about the event.
MICHAEL EWALD: Did Dr. Jadwin express remorse or concern or anything? Or was
this just sort of a factual report of what he had done?
DR. KOLB: Urn - he was concerned about the event, no doubt about it.
MICHAEL EWALD: He was concerned about the repercussions of the event?
DR. KOLB: Well, the fact that he got angry enough and I made him aware of
the fact that you don't ever touch anybody and he knew that. He
knew he was wrong, but he didn't say, Marvin - he called me
incompetent - I was so angry with him - urn - but he said, "He
provoked me." But, I said, "David, I don't care how mad you get.
I don't care how incompetent. You can't touch anybody." Um-
so, I had to reinforce that. He - the fact that he came in here right
after it happened, he knew that there was something inappropriate
in his actions.
MICHAEL EWALD: Okay. And, you say that you later had a discussion with Dr. Lau.
What did Dr. Lau tell you?
DR. KOLB: It wasn't the same day. It was probably a day or two after this-
urn - because I did - I'm not sure ofthe timing of all this, Mike,
but I did have a conversation with Peter about this - I talked to
Peter about this. So, I told Peter that I was - he and I talked about
it and we decided that we - at this point in time - I can't remember
whether - where you fit into this loop - if I called you about this or
if I talked to Chester first and talked about it - but, anyway, the
long and short of it all is that in conversations - I know with Peter
and I can't remember how much we had involved you as advice
and counsel on it - but, we detennined that I would have a
conversation with Chester. I would see if- where he was with this
- what he wanted to do about this - to validate the event and also
to get David to apologize for this. And I can't remember the
-2-
0000046
sequence. I then - within a short period of time - within a few

days - had a conversation with Chester.
MICHAEL EWALD: And what did Dr. Lau tell you?
DR. KOLB: When I talked to Chester about it, he said that yes it happened. He
said, "He really pulled me tight. It almost took my breath away he
pulled me so tight." Same event. Urn - and I said, "Well, you
.know that was wrong." He said, "Yeah, I know it's wrong." And I
said, "Well, I will get David to apologize to you because - Do you
want it in writing or do you want him to come talk to you?" And
Chester said, "I don't want either. David doesn't have to do
anything." He said, "It's fine. As long as he leaves me alone, I
don't care about him doing anything more about it. I don't want
him to do anything. I just want to leave it alone." So, I told him,
"No, I'll get David to apologize." "No, no. I don't feel that's
necessary. I'd just as soon leave it alone." So, that's where it was
left. And then I've had several conversations with David - urn -
about this issue - urn - because he remains very upset that Chester
continued to challenge his integrity as a physician. And that's -
he's not alone in that issue. That's surfacing as a part of a bigger
picture that I'm dealing with in a separate way. But - um - I then
- somewhere along this line I did go talk to Athavale.
MICHAEL EWALD: Oh, okay. Thank you. And what did Dr. Athavale say?
DR. KOLB: Dr. Athavale confirmed the event. He said David did pull on his
tie - did pull on his tie firm - it was hard. He said he really jerked
on him. And - urn - so that's all I really needed from Athavale-
confirmation that this event really occurred. Urn - and I did not
ask Athavale if Chester was verbally abusing or saying things. I
did not get into that. All I did was ask Athavale what happened
and for him to tell me if this event occurred. I just wanted a
confirmation that a third party had seen this as it had been
described to me.
MICHAEL EWALD: One of the descriptions of the incident is that when Dr. Jadwin
reached and took hold of Dr. Lau's tie, he then stepped back out of
a room into the hallway, approximately three to five steps. Did you
hear anything like that? Did that come out of anybody's report to
you of the incident?
DR. KOLB: Urn - maybe yes and no, because I know this did occur in a room,
hallway kind of situation. Did someone tell me that Jadwin pulled
Lau out of a-
MICHAEL EWALD: We have - you know - it could be one where you grabbed the tie to
get somebody's attention. Another is to step backwards and pull
somebody with the tie.
-3-
0000047
DR. KOLB: Well, I think: David did say that he grabbed his tie and tried to pull
him to come down to the Pathology department with him. He said
- you know - his action was to grab his tie and say, "Come on
down and I'll show you - I'll show you the stuff." So, did I ask
David, "Did you drag him down the hallway?" No, but in essence,
I think: the event was that David said what he was trying to do was
grab his tie and say, "Come on down to the - " yeah - "Come on
with me." He was trying to bring him down to the Pathology
Department to show him the slides to prove to him that there was
nothing there. So, there's probably some truth to that. But, I did
not ask specifically, "Did you drag him?" But he did pull his tie
and was attempting to say, "Come on down to the Pathology
Department with me." So, I would assume he could have very well
stepped back.
MICHAEL EWALD: And just to make very sure in your discussion with Dr. Jadwin, Dr.
Jadwin did admit to you that he pulled Dr. Lau's tie?
DR. KOLB: Correct.
MICHAEL EWALD: Not a badge? Not any other article of clothing? His tie.
DR. KOLB: It was his tie.
DR. KOLB: It was his tie. And he - I said, "Did you touch him?" "No. Ijust
grabbed his tie."
MICHAEL EWALD: Well, I want to thank: you very much. The time is 9:42 and the
interview is concluded. Thank: you.
- 4-
0000048
INTERVIEW WITH ERIN BALDWIN

October 10, 2003
MICHAEL EWALD: It's October 10,2003, and approximately 12:07 p.m. I am here
with Erin Baldwin, a medical student. With me also is Linda
Nipper, Hospital Employment Specialist. And I guess I'll just ask
you on August 9, 2003, there was an incident involving Dr. David
Jadwin and Dr. Lau and can you tell me what you saw?
ERIN BALDWIN: What I witnessed is that I went with Dr. Jadwin to the Department
of Radiology. He wanted to - Dr. Jadwin wanted to discuss with
Dr. Lau some issues about a study that was being done by the
Department of Pathology concerning bi-needle aspirations in the
hospital. Dr. Lau subsequently became upset with the information
being presented to him and was expressing himself in a very loud
voice. Dr. Jadwin attempted to get him to lower his voice - to
keep the conversation between those two. That was my impression
of what had happened. And, because Dr. Lau continued to express
himself in a loud voice, Dr. Jadwin then led Dr. Lau out of the
Department of Radiology by assisting him with his tie out the door.
MICHAEL EWALD: So, he pulled his tie and pulled Dr. Lau out of the Radiology room
into the hallway.
ERIN BALDWIN: Yes. I wouldn't say that it was a forceful pull. It was more leading
him out. It didn't appear to me that Dr. Lau was resisting or there
was a forceful pull on the neck. But, just a leading out of the area
that we were in.
MICHAEL EWALD: Did you have the impression that Dr. Lau anticipated that that
would happen and was not surprised that he was being led out?
ERIN BALDWIN: I'm not sure-
ERIN BALDWIN: - if he anticipated it.
MICHAEL EWALD: Alright. What did Dr. Lau do as he was being led out into the
hallway?
ERIN BALDWIN: He just seemed to allow himself to be led out. He wasn't resisting
and at that point he had quieted down.
MICHAEL EWALD: Okay. Was he talking as he was being led out?
ERIN BALDWIN: I cannot recall like whether he was saying anything particular, but I
do recall the tone in the voice had decreased. And, so, he was
- 1-
0000049
being led out and he didn't seem to be resisting or protesting.
MICHAEL EWALD: Did Dr. Jadwin let go of the tie when he got out to the hallway?
ERIN BALDWIN: I did not witness anything after being led out of the room. I
actually remained in the initial area and there was another
radiologist there - I believe it was Dr. Athavale - but, I'm not
certain - and I remained in the radiology reading area with -
MICHAEL EWALD: So, you didn't see - you saw him going out to the hallway, but you
didn't see what happened after that.
ERIN BALDWIN: No, I didn't see what happened after that.
MICHAEL EWALD: Would you say - what I'm hearing you say is that Dr. Lau was -
his voice was raised - he was very excited and upset with Dr.
Jadwin and Dr. Jadwin was being - was trying to calm things
down?
ERIN BALDWIN: Hush - you know - hush the loudness of the conversation because
the tone in Dr. Lau's voice was such that it was-
MICHAEL EWALD: Carrying everywhere.
ERIN BALDWIN: - carrying out into the hall. I think people were walking by.
think people were wondering what was going on.
MICHAEL EWALD: How long.was this dialogue between them? How long did that go
- about?
ERIN BALDWIN: Urn - not very long. Probably a few minutes. But, I'm not certain.
It wasn't a very long period. It was a short interaction.
MICHAEL EWALD: Did either physician call each other names or use foul language or
say anything inappropriate? Or was it just a heated professional
exchange?
ERIN BALDWIN: I don't recall any profanity being used. I would say it was more-
in my limited experience, I don't know what you call heated
professional exchange. I guess that would be what I would
categorize it - heated professional exchange. I didn't hear any
profanity. There wasn't any profanity.
MICHAEL EWALD: Did you hear either physician call the other incompetent?
ERIN BALDWIN: I don't remember. I don't remember specifically what was said.
MICHAEL EWALD: Okay. Urn -let's see. And did you talk to Dr. Athavale about
this?
-2-
0000050
ERIN BALDWIN: I think when he had them led out the door, we both were surprised.
That's - I remember looking at him with a surprised - you know-
sort of surprised at what had just happened. I think I stated to him
that I was just a medical student. And I think he thought that
maybe I was waiting to ask him a question about a film, but I told
him I was just a medical student in Pathology. And then, he may
have said like one other word and I think I just then walked back to
the Pathology Department.
MICHAEL EWALD: Did you walk back with Dr. Jadwin?
ERIN BALDWIN: No.
MICHAEL EWALD: Had Dr. Jadwin already left?
ERIN BALDWIN: Yes.
MICHAEL EWALD: Okay. Urn - did Dr. Jadwin when he took the tie - what did he
say? Did he say anything?
ERIN BALDWIN: I think he said, "Come here." I'm not sure. I can't say for certain
what was said. I don't know whether he said, "Come here" or - I
don't know.
ERIN BALDWIN: I can't remember.
MICHAEL EWALD: Alright. That's fine. That was a couple of months ago.
ERIN BALDWIN: Yes.
MICHAEL EWALD: So, you were surprised to see this happen and everyone - were
there other people who saw and heard this?
ERIN BALDWIN: I believe there was other people that heard this and Dr. Athavale-
ifI'm recalling this - was the radiologist. He was sitting right
there with us. So, it was Dr. Athavale sitting at the radiation
reading table, myself, Dr. Jadwin, and Dr. Lau. But, I believe other
people heard.
MICHAEL EWALD: And from where Dr. Athavale was, was he in a position to see what
went on out in the hall? Or was he sitting with you or right next to
you?
ERIN BALDWIN: It's possible he may have seen. I can't comment on - I guess - the
geometry of it, it is possible that he may have seen, but I don't
know. And I don't remember him -like - particularly
commenting on that -looking directly outside. I remember him
-3-
0000051,
asking me, "Can I help you?"
MICHAEL EWALD: Afterwards?
ERIN BALDWIN: Yes, because I was standing there. r didn't know-

MICHAEL EWALD: Probably with your mouth open, right? .
ERIN BALDWIN: So-
MICHAEL EWALD: Urn - what did you think of the whole incident?
ERIN BALDWfN: Urn - I was surprised at the incident. r was surprised that it
happened.
MICHAEL EWALD: Did you think it was a natural type of thing that would occur in a
business setting?
ERIN BALDWIN: I'm sure it does occur in a business setting, but I had never
witnessed this type of exchange before.
MICHAEL EWALD: Did Dr. Jadwin talk to you about it afterwards?
ERIN BALDWIN: Not that day, but I believe one or two days later he did talk to me
about that.
MICHAEL EWALD: Okay. What did he say?
ERIN BALDWfN: He just made some comments about the study and he said -
something - I can't remember - and this is why I led him out of the
room - this is why I led him out by the tie. But - he didn't-
MICHAEL EWALD: So, he admitted that he had pulled his tie? There's no question -
ERIN BALDWfN: Yes, he did.
MICHAEL EWALD: Urn - did you go down there with Dr. Jadwin?
ERIN BALDWfN: Yes.
MICHAEL EWALD: So, you saw how it started?
ERIN BALDWIN: Yes.
MICHAEL EWALD: And Dr. Jadwin was pointing out some kind of problem with
specimens or whatever to Dr. Lau and it's then that Dr. Lau
became increasingly excited?
ERIN BALDWIN: Yes.
-4- 0000052
MICHAEL EWALD: And then started speaking loudly and forcefully to Dr. Jadwin?
ERIN BALDWIN: Yes, that's what happened.
MICHAEL EWALD: Okay. Do you have any questions?
LINDA NIPPER: I think the only question I would have is when you witnessed Dr.
Jadwin and Dr. Lau talking, was Dr. Jadwin also loud? I mean did
he raise his voice as they were talking?
ERIN BALDWIN: It's - not to the same level. I believe it did get - I wouldn't say
equally loud, but it seemed to me that Dr. Jadwin was trying to
quiet the situation down. He may have - his voice may have
escalated a little bit when Dr. Lau was yelling, but I can't say
whether it was exactly the same level that -
LINDA NIPPER: Do you know why Dr. Jadwin was leading him out of the room?
ERIN BALDWIN: I think to quiet him down - to say "come over here and discuss this
away." I thought he was leading him into another room where they
were going to talk privately. That's what I thought. That's what I
thought he was doing.
MICHAEL EWALD: When -let me - when he was doing that -let me just - don't
worry, I won't hurt you. Was his neck - was Dr. Lau's neck kirid
of like following there? Or was it just kind of like a "come on-
come on with me" - you know - type of thing?
ERIN BALDWIN: It wasn't-
MICHAEL EWALD: I mean was he trying to stop - or was he trying to pull back - Dr.
Lau was trying to pull back? And he was being really led against
his will?
ERIN BALDWIN: That - I did not witness - I witnessed Dr. Lau just going along with
him and he - actually it didn't seem to be pulled - it was more the
tie just hanging down and it was the lower part that was -
MICHAEL EWALD: So, he grabbed the very lowest part of it?
ERIN BALDWIN: Not the very lowest, but towards the end.
MICHAEL EWALD: Uh-huh.
ERIN BALDWIN: And it wasn't a forceful, jerking-
MICHAEL EWALD: It wasn't forceful-
ERIN BALDWIN: It wasn't - "Oh, come on."
-5- 0000053
ERIN BALDWIN: It wasn't like this. It was - the tie was down and - just leading him
out and Dr. Lau then followed. .
MICHAEL EWALD: So, it's fair to say because we're seeing this that it was not a
forceful thing where Dr. Lau was struggling and following-
ERIN BALDWIN: No.
MICHAEL EWALD: - but struggling. He didn't appear to be struggling, he just kind of

docilely followed the tie -
ERIN BALDWIN: Yes.
MICHAEL EWALD: - where the tie was going.
ERIN BALDWIN: Yes. He did not seem to be physically resisting or resisting at all.
He just seemed to go along and then he quieted down and -
MICHAEL EWALD: Okay. Is there anything else you remember from this?
ERIN BALDWIN: That's about all that I remember.
MICHAEL EWALD: Okay. Well, have you ever seen anything like thisbefore?
ERIN BALDWIN: No.
MICHAEL EWALD: Okay. Have you seen physicians fight before?
ERIN BALDWIN: No.
ERIN BALDWIN: Just - you know - discussing things - you know - but -
MICHAEL EWALD: Sharing opinions -
ERIN BALDWIN: Yes.
MICHAEL EWALD: - maybe forcefully.
ERIN BALDWIN: Yeah, stating their opinions. Stating it strongly. Never like that
before.
MICHAEL EWALD: Okay. Well, thank you very much and the interview is over at
12:22 p.m. And I want to thank you very much for your
cooperation.
-6- 0000054
INTERVIEW WITH DR. NADER!

October 10, 2003
MICHAEL EWALD: This is-
DR. NADERI: Have you tape recorded Dr. Lau?
MICHAEL EWALD: Yes.
DR. NADER£: And also Dr. Athavale?
LINDA NIPPER: Not Dr. Athavale.
DR. NADERI: He said no?
MICHAEL EWALD: No, he didn't say no. We couldn't get the recorder to go. And we
recorded Dr. Kolb, too. Dr. Lau was very forthcoming about the
incident and -let me just start by saying this is October 10,2003.
This is an interview with Dr. Naderi. He has given permission to
record this interview and I'll just start by asking you, when the
incident between Dr. Jadwin and Dr. Lau occurred, when was the
first time you heard about it and who told you and what did you
learn about it?
DR. NADERI: Well Dr. Lau mentioned it to me and I don't know exactly ifit was
the same day or the next day, or whenever it was - that this had
happened and he was embarrassed because Dr. Jadwin did it in
front of - in the department and it was in front of others - and he
was very embarrassed by that. I said, "Okay, as the chairman you
notified me. I'll talk to Pete and I asked him ifhe has talked to
anybody else or not and he said well, he had gone to Dr. Kolb
immediately and Dr. Kolb was not in his office. He went back
again and - a second time - so I don't recall that he finally could
connect with him or not and maybe he has told you ifhe-
MICHAEL EWALD: They did have a discussion.
DR. NADERI: And, well I said, "Fine, then I'm sure they will take care of it."
But, I think it was the following day or whenever it was - the next
day - he gave me that letter. And he said he really doesn't want
this to continue. He thought that Dr. Jadwin might (inaudible)
habit or personality or something. He might do it to almost
anybody and he thought he had to talk to somebody, so he realizes
that it's not a good habit and that's (inaudible). I mentioned it to-
during my meeting with Pete - you know - I mentioned it to him. I
think he was aware of it and -
- 1- 0000055
MICHAEL EWALD: What did Dr. Lau specifically tell you happened?
DR. NADERI: Well, as I recall, it was about a couple months ago, right?
MICHAEL EWALD: It was August 9th •
DR. NADERI: August 9 th ? September, October - yeah - about two months - and
he said he grabbed him in the middle of the room here in the
reading room and apparently he grabbed him by his tie and he
pulled him across the room here while some others were also here
and says he tried to talk to - Dr. Jadwin's a tall man and a strong
man - so he just stopped him - just dragged him out of the room,
through the door, to the hallway and then he said also - anyway, he
felt that he had difficulty - almost had difficulty to breathe because
the tie was around his neck - was fastened to his neck and so on.
And he wanted to pull himself back, but Jadwin was - Dr. Jadwin
was strong and was still pulling him. So, as I recall, that's the way
he told me - (inaudible) - from the room into the hallway - and
then whatever happened after that -
MICHAEL EWALD: Has Dr. Lau complained of any pain or anything else after that?
DR. NADERI: He just had a pressure around his neck - (inaudible) - he felt that
he was going to have some breathing problem and that he couldn't
get himself (inaudible) -
MICHAEL EWALD: As department chair, what do you feel would be an appropriate

response or action by the hospital to this incident?
DR. NADER!: Well, I don't know. I thought Mike, I was concerned about my
duty. My duty was to inform the responsible people in the
hospital, the medical staff. And I tried to be fair - give a chance -
to the hospital officers - so they were both notified. I thought
maybe that Lau should have a fair response within a timely basis,
so that he knows we are taking this seriously and so on, but based
on - he's told me he's not received anything in writing from
anybody up to now. I thought maybe the medical staff office also
should know that if anything they should do - I really don't know
when two physicians are like this, I am sure one part of it as
County, Personnel should take action like they are doing now. But
I don't know if (inaudible) or medical staff should or should not do
anything on top of that or - so, I didn't know. So, after no action
and no response in writing - so, I notified medical office - medical
staff - which was late - you know - it was one and a half months
or something -like that - and that's why I thought there should be
something - some response - somehow that he's assured that this
not going to happen to him or anybody else.
-2- 0000056
MICHAEL EWALD: Well, we've been asked recently to investigate this and we are
going to be preparing an investigative report that will go to Dr.
Kolb, at his request. One final question I have is - there's some
question as to what led up to this incident. Did Dr. Lau - or have
you heard that there was any sort of professional disagreement that
was going on? Not that that would absolve anybody of pulling
somebody's tie, but was there some sort of words being exchanged
or some other problem?
DR. NADERI: Since I wasn't here at that time, I don't really know what Dr.
Jadwin was doing first of all in this department. Suppose it was
something that he was here, but I don't know what was that. I
don't know was a discussion between him and others and or he just
came to talk to Dr. Lau for whatever reason or to talk to somebody
else. He not being clinician and usually we don't have that much
personal patient relationship between Radiology and Lab. As you
just saw, the other physicians they come and review their x-rays
here - we have a lot of relationship with clinicians, but not really
much between us - for example, (inaudible) very seldom do we go
to the Lab for anything that we need and very seldom if he needs
anything in X-ray - recognizing this is a hospital, of course, we
have a relationship and so on, but we don't have that much direct
relationship to go and visit with others - but again I don't know
what the reason for his visit or he came just to talk to Dr. Lau or
Dr. - somebody else. I don't kriow. I don't know what - What do
you feel now in this situation - that's for my education - what
happened between two physicians. Is that part of Human
Resources - should it have been medical staff- maybe it also
should have something to do with this - or not. We're talking how
should we take care of this or what's my role in this - so, what do
you think?
MICHAEL EWALD: Well, we have been asked to investigate it because of the allegation
of workplace violence - of an inappropriate contact - the allegation
of inappropriate contact between two people working here who are
actually County employees. And so we are investigating that as
per the County's policy and a report will be prepared for the
County. We have to submit a report and we also will be
submitting a report to the Medical Director. What he wants to do
with it at that time, or what Peter wants to do with it, as far as
sharing it with anyone, that's up to them. Our report will only
contain findings and conclusions. We do not make
recommendations. Based on our findings and conclusions, then
they can determine what they want to do from there.
DR.NADERI: I see. So, (inaudible) according to bylaws of the hospital and the
staff.
-3 -
000005?
MICHAEL EWALD: I'm not aware of any bylaws, but after the report is done, how
that's handled is fine. We attempt to give as unbiased and neutral
investigation as we can, and let the facts speak for themselves.
DR. NADER!: Right. I know you have done it before. I know that Steve has done
it before. I know that you do an excellent job - you're unbiased
and I really appreciate it. So, that was the thing - because now it's
between two physicians, even though they're both employees - as
compared to two non-physicians - [didn't know how we-
MICHAEL EWALD: Well, we recently investigated one between two physicians down
in Emergency Department. There was allegations which were
proven to be fa~al of inappropriate contact between two
physicians.
DR. NADERI: Was it staff or was it staff and residents?
MICHAEL EWALD: It was two residents.
DR. NADER!: Right. So, there's a little bit of difference, but it's still not the same
as two physicians.
MICHAEL EWALD: So, we do have - it's my understanding that that had already been
agreed to that if there were any types of complaints lodged that a
neutral third party would investigate it and provide the facts. How
it's handled from that point, it's not my- it's not my job to specify
that.
DR. NADERI: No. I didn't know - I know - or at least Isee it as my role - I have
to explore the policies - both sides - medical staff and - I did at
the time.
MICHAEL EWALD: I think you acted appropriately.
DR. NADERI: But, Ijust want to make sure that I don't fail in myresponsibilities~
That's my concern is to take it on or how he didn't receive
anything back - but still I played it low key. I didn't - you know -
I just waited long enough to see what - and I'm glad you are doing
this, so at least somebody will be informed at least that it's not the
proper way-
MICHAEL EWALD: Well, there will be a report and it will be delivered to Peter and Dr.
Kolb and - but not shared with anyone else until they've had a
chance to read it and determine what to do.
DR.NADERI: (Inaudible) - as I recall what I think was in his letter was also
another person with Dr. Jadwin who was rotating in his
department.
-4 - 0000058
MICHAEL EWALD: We've located that individual and she will be interviewed.
DR. NADERI: Oh, good. Then I think that's the best we can do.
MICHAEL EWALD: Thank you very much for your time.
DR. NADERI: r appreciate it.
-5- 0000059
INTERVIEW WITH DR. JADWIN

October 17,2003
MICHAEL EWALD: Okay. It is October 17,2003. This is an interview with Dr. David
Jadwin. Linda Nipper is also present. And we'll just start.
Actually, I think you know what the allegation and the complaint
was from Dr. Lau. Perhaps you could tell us from your perspective
what occurred and we'll have some questions maybe afteIWards,
but why don't you just tell us what happened, what immediately
led up to that, and what actually happened, and what happened
afteIWards.
DR. JADWIN: I was - I went to the Radiology Department with a medical student
to look at some sort of case - uh - I can't remember what it was.
And the day before we had had a quality management committee
meeting and one of the problems that's been at this hospital
probably for years is the collection ofbi-needle aspirations
specimens by CT guide-ins and part of my coming here - they're
sort of cavalier and a lot of times they would just sort of look at it
and say well, maybe it's adequate and go back to the laboratory and
they generate a report that maybe says something to the fact that
the specimen was limited - did not - unsatisfactory for evaluation.
I came on board and started scrutinizing these more thoroughly and
we were having a lot of problems with getting adequate samples to
the point that when I would go down to the CT Scan, the
radiologists would leave before I even got there to tell them it's
adequate. And so -
MICHAEL EWALD: So you went down there for the purpose of discussing that issue?
DR. JADWIN: No. Actually I was just trying to lead up to the circumstances. So,
the quality management committee had been looking at this as a
problem and of course the radiologists were quite defensive about
all of this and we started looking at some data on a spreadsheet,
looking at adequacies and malignancies and I had done a
preliminary study which I was going to share with Dr. Wells. So, I
went down to look at the - I believe, as I recall - I went down to
look at some sort of radiology study with a student and I was also
going to share this data with Dr. Wells. So, I went into the
Radiology Department and asked for Dr. Wells. And they said he
was in another part of the Radiology Department and I was going
to go over there, but Dr. Athavale was there and I know he was
concerned with this data So, I should have just gone to see Dr.
Wells, but I showed the data to Dr. Athavale and basically it
showed that from 1996, which was well before I came here, the
adequacy and malignancy things had changed like this so there was
- 1- 0000060
no recent trend. And I thought Dr. Athavale was a pretty

reasonable person who would at least look at this in a way and
immediately they started getting defensive and Dr. Lau came from
another part and literally started screaming at me. He said, "I'm
getting tired of you changing all the data and making" - I'd never
talked to him before in my life, and he's accusing me-
MICHAEL EWALD: You'd never talked to him at all before?
DR. JADWIN: About this-
MICHAEL EWALD: About that.
DR. JADWIN: About this - any type of data thing - and he started accusing me of
always changing the data, and screaming. Literally being very
hyper. I'm sure maybe you've seen how he behaves, but in his
characteristic manner, and to the point where he was just irrational.
And so finally I said - I was just trying to say this was preliminary
data. We're looking at all the data, etc. And he just went on and
on and on, and finally I said, "Calm down. Calm down. Calm
down" - like this and I got him to calm down to the point where he
literally sat in a chair and was almost whispering, but he was still
agitated. And I tried to explain to him that this was just
preliminary data that - you know - we're collecting all the data
available - radiologists, needle, citing all this type of stuff - and
we're putting it into a spreadsheet to be looking at it, and he started
becoming agitated and various other types of things. He says - and
Dr. Athavale was a little defensive, too. I was trying to mention to
him that - you know - negative cytology means absolutely nothing
which is what the textbooks will tell you, but they're under the
impression that if you get a negative cytology then you don't have
any disease. And, so -
MICHAEL EWALD: Did your voice -
DR. JADWIN: No. I was very calm the whole time.
MICHAEL EWALD: You were calm the whole time?
DR. JADWIN: Calm the whole time. I never raised my voice - at any rate -
MICHAEL EWALD: So, then what happened? He was seated-
DR. JADWIN: Yeah, he was seated and he was going on and he was just - I don't
know if you've had any conversations with the man, but he just
doesn't listen - you know. He just goes off on tangent and gets
very excitable. I probably should have just walked away and
-2-
0000061.
realized that communication with this man is virtually impossible.

And he started up again by saying, "Why don't you do this? Why
don't you do that?" He wasn't hearing a single word that I had
said - a preliminary looking at complete information - all that sort
of stuff. So, literally- I don't remember ifit was his name tag or
his tie - but I said - at that point Ijust got so frustrated with trying
to verbally communicate with him, I said, "Let's go down to my
office" - I literally went something like this - "Let's go to my
office and I'll show you the data sheet." And Dr. Athavale
couldn't possibly have seen what happened. He was sitting back
here and Dr. Lau was here and I was in the middle of this. And we
literally took one or two steps and Dr. Lau (sound of movement)
went straight across the hall like this and he's like this -
MICHAEL EWALD: And he appeared - he got up against the wall?
DR. JADWIN: In the door - he was terrified - he was terrified. And he wasn't
terrified of me. He was terrified - I think - of the data that I was
going to present to him. And, so, he said - well, I said, "Come on
down to my office and look at the data" - just like that. "Come on
down." "No, I can't." Now, I have to give you a little bit of
background on this. This is not the first time that he's done
something like this to me. Urn - in one of these instances where
we went down to the Radiology Department and they collected the
sample, left the room, and the patient was coming off of the CT
Scan. And I get down there and the sample is unsatisfactory for
evaluation. So, I walk down to Dr. Lau and I said, "Well, Dr. Lau,
I'm sorry, but maybe we'll get something on the permanence, but
on the preliminary it was just necrotic" - you know - or whatever
it was - and - you know - "I'm not sure if we're going to have an
adequate specimen." I said, "Would you like to come down and
look at the slides with me?" Because for a year and a half I've
been trying to get these guys to meet with me to discuss this. I've
met the surgeons and various other people. These people - I'm not
sure they have regular meetings. It's been very frustrating for me
because I go down there and try to get them as a group to talk to
them about how best to collect a sample. And he said, "What
needle was in the ." And, "I know I got a good
sample." And I said, "Come on down to the laboratory and look at
it." "No. I'm too busy. Too busy." So, I left and immediately, he
goes down to Kolb's office and complains about the pathology-
you know - and so Marv brings him down finally to my office
where we look at the slides. And there's nothing on the slides. All
of our stuff is double reviewed. Recently, we've been sending
everything to UCLA and they agree with me. So, he's sitting there
with Kolb and the microscope and we've got two sets over here,
and he says "What's that down there? What's that? It's _
-3-
0000062
cells." And I said, "Well those are red blood cells, doctor." And
Dr. Lau said, "What's that I notice over here?" And he doesn't
even know what he's looking at. And, so this happened at least
once and possibly two times where I've asked him to come down
and review things and they just won't have any part of it. To me,
it's, quite frankly, because they don't know what they're doing.
Yes, they know how to put a needle into the lesion, but putting a
needle into the lesion is not the same thing as getting the sample
into the needle, pulling it out and putting it on the slide and getting
a good sample. And that's what they don't understand.
',!:,,,
MICHAEL EWALD: Let's go back to the tie pulling incident, okay? You are testifying
that you did pull his tie - you did take his tie -
DR. JADWIN: Tie and/or name tag - I don't remember what it was -like this.
MICHAEL EWALD: Okay. The witnesses are saying and he's says that it was his tie.
So, you pulled his tie and did you pull him from one room to the
other or out into the hall?
DR. JADWIN: No. I don't think it was more than one or two steps.
DR. JADWIN: It was like this. It was a like a light - like a tug on - "Come down
to my office and look at this stuff."
DR. JADWIN: And I did it because in the past he's not done it and I was hoping
he would-
MICHAEL EWALD: What did you expect when you took his tie and started to pull him
behind you? Were you pulling and backing up?
DR. JADWIN: No. No. No. No. He was like - he's sitting here-
MICHAEL EWALD: Okay. He's seated.
DR. JADWIN: And I said, "Come on down to my office" - like this
DR. JADWIN: Basically, I have two to three fingers -
MICHAEL EWALD: Okay. And then he followed with that -
-4- 0000063
DR. JADWIN: He stood up one or two steps and then charged away.
MICHAEL EWALD: Charged away. Okay. And - urn - did he pull the tie back or did
you-
DR. JADWIN: No. There was nothing - if I grabbed his tie hard - you've seen
him and me - there's no way he would have gotten away. It was
like this - "Come up tD my office."
MICHAEL EWALD: So, what you're showing - since I'm not videotaping this - you're
showing that you took three fingers - four fingers - three fingers
and a thumb and put it on his tie and gave a tug. And then you're
testifYing that he overreacted to that - maybe took a couple of steps
- got out of his chair - took a couple of steps and ran into the
hallway-
DR. JADWIN: Ran out of the room, out into the hallway, into the other doorway.
And Dr. Athavale was behind me, so he had no view of what was
transpiring. The medical student was standing over here, so she
would be the person who would -
MICHAEL EWALD: Right. She's been interviewed.
DR. JADWIN: Okay.
MICHAEL EWALD: As well as Dr. Athavale, too. And the - what did you expect - this
was not a - you're saying this was not an aggressive gesture to hurt
him or anything, but that it was to - why did you take his tie?
DR. JADWIN: I wanted to lead him into my office to see the data. Talking to him
was -
MICHAEL EWALD: You mean you would have led him all the way down the hall ifhe
DR. JADWIN: Not necessarily. I wanted to get him up and out and get him
movmg. It was sort of an encouragement type of thing.
DR. JADWIN: You know - um-
MICHAEL EWALD: Okay. Do - is this something you have done before to him or to
anyone else?
DR. JADWIN: Never. Never in my life.
- 5- 0000064
MICHAEL EWALD: Is this something you would do again?
DR JADWIN: No.
MICHAEL EWALD: Okay. Do you regret doing it?
DR JADWIN: Urn - I'm sort of surprised that it has gotten to this level. Urn - I
regret having even gone past one sentence of conversation with
him because I firmly believe it's impossible to communicate with
this man on a professional basis.
MICHAEL EWALD: Okay. Do you regret pulling his tie?
DR. JADWIN: Yeah, at this point I do.
MICHAEL EWALD: Urn - have you had any discussions about this with him or have
you written to him or has there been any communication between
you about this subject?
DR. JADWIN: There was one time when he was walking out of the hospital and I
was walking out at the same time. And I quite frankly looked at
him very close and I said, "I don't think you're an honest man."
And I walked out ofthe hospital. Because I read that letter he
wrote and I orange highlighted some things on there that were just
outrageously stretched or even factually untrue, I think.
MICHAEL EWALD: In the letter, what do you feel is not factually true?
DR. JADWIN: Well, you know I don't have that letter any more. It was some sort
of something or other -
LINDA NIPPER: I have the letter here.
DR. JADWIN: If you have a yellow highlighter and can make a copy 0 fit -
MICHAEL EWALD: Well, if you'll just point out the parts that you feel are factually
untrue.
DR. JADWIN: "Dr. Jadwin and I were debating over some pathology data." There
was no debate about it. The man was yelling and screaming at me,
and was hysterical.
DR. JADWIN: Urn - "Dr. Jadwin insisted that I go over to his office to look over
more data." I wanted him to come to the office, and -
-6-
A000065
MICHAEL EWALD: Did you invite him to come to your office?
DR. JADWIN: I said, "Come" - when I did this, I said, "Come and see the data."
DR. JADWIN: Because verbal discussion at this point was useless. I was hoping -
and then actually when I left - when he refused to come, I went
down to my office. I brought the spreadsheet and I showed it to the
people. And then I went - the funny thing about all this is that I
then went to Dr. Wells - after all of this - and showed him the
stuff and he was perfectly fine with it. He saw it and saw it as a
reasonable thing and made no comments. He even commented that
maybe part of the problems were the needles that they were using,
because one of the things is a cutting needle and aspiration needle,
and they've been using cutting needle and I've been trying to get
them to use an aspiration needle and etc. So - "I told him I could
not leave the department because I was attending to a patient whom
I was going to perform an angiogram." Well, I think this would
have only taken a couple of minutes. But, this is characteristic of
his behavior when he is confronted with trying to deal with
something objectively, he runs and hides.
MICHAEL EWALD: Do you recall him saying that to you?
DR. JADWIN: Yes, he did. But, I'm not sure that two minutes would have made
much difference one way or other. I mean, he wasn't even invited
into this conversation. I was showing the data to Dr. Athavale,
who was defensive because, quite frankly, he's one of the people
that hasn't been doing the job of collecting the stuff. And Dr. Lau
came from out of nowhere and started screaming at me about
manipulating the data and he was an expert in statistics - that's
something I didn't mention before - and I didn't know what I was
doing. He knew everything about statistics and I was manipulating
the data to show them in a bad light. "He further insisted." I said,
"Come on down to my office and look at the data." If that's
"insisting" then that's "insisting," but I don't think that's what-
"He grabbed me by the tie." Some of this seems a little bit out of
place. "He grabbed me by the tie with his hand and dragged me for
several feet." I didn't drag him for several feet. I got him up to a
standing position - one or two steps and he took off. "I warned
him not to do that any more." I'm not sure ifhe said anything to
that effect.
MICHAEL EWALD: You're not sure ifhe warned you not to do it.
DR. JADWIN: Yeah, I don't-
-7- (\OO~066
MICHAEL EWALD: You don't have any recollection of that?
DR. JADWrN: No. I tell you, I was quite peeved with the man because I walked
over there in a way to show him data. He's been out there saying
different things to medical staff about the problem's actually my
problem and not his problem, when I think we're actually in the
process of collecting all stuff and sending it to UCLA. I think that
they're going to substantiate the fact that we haven't been getting
good material. And, so I've taken this as a personal assault on my
integrity and my character and then he started accusing me of
manipulating the data and - urn - you know -
MICHAEL EWALD: So, would it be fair to say that when you took hold of his tie, you
were upset?
DR.JADWrN: I was upset, but I was in control. I mean, I hadn't raised my voice
to any extent and I think he made a comment during this "debate"
which was not even closely a debate that this data did not mean
anything. And I said, "Well, I think it does mean something." And
I said it with that sort of emphasis - "Well, I think it does mean
something," but that was the most of anything that I ever said in a
way. I was trying to do this in a professional educational manner-
you know - talking with them. And it sort of reflects my
frustration for a year and a half of even trying to meet with these
people, or having even some type of professional interaction to
help them do a better job.
MICHAEL EWALD: Okay. Urn - alright - so it is - what I've heard from you is that
there was a discussion between you and Dr. Lau and Dr. Lau,
according to you, became - his voice raised up, he became pretty
loud and then he sat down - quieted down - and at that point you
reached over, took his tie, started to pull his tie so that he began to
come up out of his seat, taking one or two steps and then he reacted
by - with you dropping the tie, or somehow getting the tie back -
DR. JADWIN: Well, he just pulled way. There was no tension to it.
MICHAEL EWALD: So, he just pulled - did he pull the tie out of your grasp, do you
. think?
DR. JADWIN: Well, he wouldn't have had to try hard. I was holding it with-
MICHAEL EWALD: So, he pulled it back and then went out on his own -
DR. JADWIN: Ran out into the hallway, ran across the hallway and into the other
room.
-8- 0000067
MICHAEL EWALD: He was running?
DR. JADWIN: Running. He was running.
MICHAEL EWALD: Running out to the hallway where he appeared - he went against
the wall and acted as though you were going to -
DR. JADWIN: In the doorway.
MICHAEL EWALD: Oh, in the doorway.
DR. JADWIN: He was in the doorway like this.
MICHAEL EWALD: Okay. Alright. (Inaudible)
DR. JADWIN: He had literal terror on his face.
MICHAEL EWALD: Terror. Okay. And - it was then-
DR. JADWIN: Which caused me - I was sort of dumbfounded when I saw this
reaction. So-
MICHAEL EWALD: So then he got out of your way and you just left without any further
incident.
DR. JADWIN: No. At that point, he went over there and I said, "Come on down
to my office and look at the data." And he said, "No. I'm too
busy." Now, he may have even said that twice. He said, "I've got
to do an angiogram. I can't." At that point, I just walked down to
my office. I got the spreadsheet printouts that we have and I went
over it with Dr. Athavale. He was gone somewhere else. Dr.
Athavale nodded and - I mean - I'm a very compulsive person.
We collected everything. There's nothing left to question on this.
MICHAEL EWALD: So, actually, you pulled the tie, he got up a little bit and then he
went over and he went back in, sat down and then you asked him
again ifhe wanted to come down?
DR. JADWIN: Oh no, no, no. Okay. I tugged him up out of the chair -like
"come down to my office" - I said, "Come down to my office and
see this data." He immediately ran - tugged away - ran out of the
room, across the hall in the crouching position. I walked out into
the hall and said, "Come down to my - why don't you come down
to my office and look at the" - and he said, "I can't." And he
might have even said this twice. "I've got to do a procedure."
-9-
DR. JADWIN: Now, he had to do a procedure before all this started and it didn't
stop him from taking time away from the procedure to do this, but
when I asked him to do the data, he wouldn't. Then I left and went
to get the spreadsheet data to show them the information we were
collecting.
MICHAEL EWALD: He wasn't there when you came back?
DR. JADWIN: I don't remember ifhe was there, but I did show it to Dr. Athavale
and I don't remember seeing him. Even ifhe was there, I wouldn't
have discussed it with him. But I showed Dr. Athavale, who sort
of nodded his head a little bit. And I went to show the information
to Dr. Wells, who was perfectly happy with it.
DR. JADWIN: The type of response that I would have hoped that the other two·
would have been able to display.
MICHAEL EWALD: Okay. Vh - is there any other thing that you'd like to tell us about
this?
DR. JADWIN: Well, again, his behavior was almost hysterical and I had to spend
quite a bit of time to just get him to calm down and I said, "Dr.
Lau, calm down. Calm down. Calm down." Literally, to the point
where I sort of backed him into his chair and over a period ofmany
seconds, he finally calmed down to the point where you could have
a conversation with him, because you couldn't even have a
conversation with him.
MICHAEL EWALD: Do you feel- yet you don't really see your actions as all that
professional either?
DR. JADWIN: I don't - well, I'm not sure - you know - Dr. Kolb's first response
would have been my first response when Dr. Lau went there and he
says, "So, come on Chester. He was just kidding with you" - you
know. And that is the nature of the thing as I saw it. I was trying
to get him to come to my office and review the material. But, I had
zero ability to discuss it with him because of his behavior.
DR. JADWIN: There was nothing physically aggressive or hostile. I was a little
peeved. I will say I was a little peeved, but I've never had this type
of incident before. I never had to work with someone like this
before and-
- 10-
MICHAEL EWALD: Do you have any questions?
LINDA NIPPER: No.
MICHAEL EWALD: Okay. Good. Thank you very much. The conclusion of the
interview is 10:24 a.m., October 17, 2003.
- 11 -
0000070
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5 F. JADWIN, D.O., ) Volume I

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7 vs. ) No. 1:07-cv-00026-OWW-TAG
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9 Defendants. )
__________________________)
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15 OF
17 Tuesday, January 8, 2008
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DFJ1
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1 16:02:47 1 relationships with Dr. Abraham?
2 16:02:50 2 MR. LEE: It's vague and ambiguous.
3 16:02:51 3 THE WITNESS: On clinical matters, they were
4 16:02:54 4 professional. From my perspective, I always treated
5 16:02:59 5 her in a professional manner on -- on clinical
6 16:03:03 6 matters and in medical executive committee meetings.
7 16:03:07 7 Even when she said we have no confidence in the
8 16:03:11 8 pathology department, I did not respond but chose to
9 16:03:15 9 discuss that with her after the fact in confidence --
10 16:03:18 10 in -- in a quiet venue, rather than making a big
11 16:03:23 11 battle out of it in front of the department. And
12 16:03:25 12 that's typically my style.
13 16:03:27 13 BY MR. WASSER:
14 16:03:27 14 Q. And did you ever tell her in the presence of
15 16:03:30 15 others that she was not competent?
16 16:03:32 16 A. In what way? I'm sorry.
17 16:03:34 17 Q. Using words.
18 16:03:36 18 MR. LEE: It's vague and ambiguous and
19 16:03:37 19 argumentative.
20 16:03:39 20 THE WITNESS: I absolutely never said that
21 16:03:41 21 she was clinically incompetent.
22 16:03:43 22 BY MR. WASSER:
23 16:03:44 23 Q. I don't know that you added the adverb.
24 16:03:45 24 I'm just asking did you ever tell
25 16:03:48 25 Dr. Abraham to her face in a meeting with other
DFJ1
223
1 16:03:52 1 doctors present what she was not competent?
2 16:03:54 2 A. Oh, absolutely not. I may have said
3 16:03:56 3 something competent to assess fine needle
4 16:03:59 4 aspirations, but I never would have crit- -- first of
5 16:04:00 5 all, I don't know what her competency level is, and
6 16:04:03 6 it's not my nature to make those types of criticisms,
7 16:04:09 7 especially in a professional venue.
8 16:04:12 8 Now, in a mediation session where you're --
9 16:04:15 9 where you're -- where you're trying to work through
10 16:04:18 10 problems, that's a different issue. But I -- I never
11 16:04:21 11 impugned her clinical skills. And in fact, I would
12 16:04:23 12 have thought that she was -- I would not have thought
13 16:04:27 13 that she had clinical problems with a couple of
14 16:04:31 14 sections -- exceptions that I know about.
15 16:04:34 15 Q. Did you ever tell Dr. Kercher that he was
16 16:04:37 16 unfit to be -- be head of the medical staff?
17 16:04:40 17 A. Absolutely not.
18 16:04:42 18 Q. Was your motive and interest in composing
19 16:05:00 19 the E-mail we see in Exhibit 573 primarily to salvage
20 16:05:06 20 the reputation of the pathology department and
21 16:05:09 21 yourself?
22 16:05:09 22 A. No.
23 16:05:09 23 Q. I think in one of the earlier E-mails we
24 16:05:18 24 have read today you -- you expressed the concern to
25 16:05:20 25 Mr. Bryan that other members of the medical staff had
DFJ1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 197 262
of 209
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
foregoing deposition, Volume I, was by me duly sworn;
that said deposition was taken Tuesday, January 8, 2008,
at the time and place set forth on the first page
hereof.
t I further certify that I am neither counsel for
~ nor in any way related to any party to said action, nor

1
f in any way interested in the result or outcome thereof.
b Dated this 21st day of January, 2008, at
i
.~
Bakersfield, California .
1
I s~~~?at~~:.- 7~
WOOD & RANDALL

(800) 322-4595
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5 F. JADWIN, D.O., ) VOLUME II

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10 __________________________)
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15 OF
16 COUNTY OF KERN THROUGH PERSON MOST KNOWLEDGEABLE,
17 PHILIP LEE DUTT, M.D.
18 Tuesday, September 9, 2008
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PMK DuttP2
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1 12:13:46 1 due to a pathologist shortage and backlogs with
2 12:13:49 2 transcription.
3 12:13:49 3 Is that an accurate representation of what
4 12:13:52 4 Dr. Gerry said at this meeting?
5 12:13:55 5 A. I think so.
6 12:14:16 6 Q. You took a medical leave in 2007. Is that
7 12:14:29 7 correct? Because your mother was sick.
8 12:14:31 8 A. No.
9 12:14:32 9 Q. No?
10 12:14:33 10 What happened? You took a leave because one
11 12:14:35 11 of your parents got ill, passed away?
12 12:14:37 12 A. They both were ill. I took family sick
13 12:14:45 13 leave, as I understand it.
14 12:14:47 14 Q. How did you -- I'm sorry.
15 12:14:49 15 Okay. How did you go about applying for
16 12:14:51 16 this family sick leave?
17 12:14:52 17 MS. BARNES: What does this have to do with
18 12:14:54 18 the PMK designation?
19 12:14:55 19 MR. LEE: I don't need to answer that
20 12:14:57 20 question.
21 12:14:57 21 MS. BARNES: Well, it's outside the scope of
22 22 the --
23 12:14:59 23 THE WITNESS: It does.
24 12:15:00 24 MS. BARNES: Please let me make the
25 12:15:01 25 objection.
PMK DuttP2
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1 12:20:18 1 Q. Okay. Did you tell the CEO at the time or
2 12:20:21 2 any of your superiors?
3 12:20:24 3 A. Well, I did not tell the CEO. I'm not sure
4 12:20:32 4 how Dr. Harris found out.
5 12:20:38 5 Q. Okay. Well, when Harris did find out, how
6 12:20:41 6 did you -- how did you become aware that he found
7 12:20:43 7 out? Did he have a conversation with you?
8 12:20:45 8 A. At some point he said take some time to --
9 12:20:50 9 to work with my parents.
10 12:20:56 10 Q. Okay. Do you recall when he told you that?
11 12:20:59 11 A. I don't remember the exact day.
12 12:21:01 12 Q. Give me an estimate.
13 12:21:03 13 What month? What year?
14 12:21:06 14 A. Well, it was either late 2006 or early 2007.
15 12:21:12 15 Q. Okay. Okay. And you never decided to go
16 12:21:17 16 and get medical leave form and fill it out, go to
17 12:21:20 17 H.R., do a doctor certification, anything of that
18 12:21:24 18 nature?
19 12:21:24 19 A. I didn't even consider it.
20 12:21:27 20 Q. Why not?
21 12:21:27 21 A. Well, for one thing, I didn't want to be
22 12:21:30 22 like Dr. Jadwin. For another thing --
23 12:21:33 23 Q. What does that mean? Hold on.
24 12:21:34 24 A. Well, I didn't want to take off or quit
25 12:21:37 25 working or -- or decrease my workload from anywhere
PMK DuttP2
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1 12:27:51 1 needed me to be there rather than being away for a
2 12:27:54 2 three- or a one-month period solid.
3 12:28:09 3 Q. What do you think of the notion of taking
4 12:28:11 4 medical leave off when you're sick?
5 12:28:16 5 A. Oh, I think -- I think if it's a legitimate
6 12:28:18 6 reason then people have a right to do it.
7 12:28:21 7 Q. Do you think people -- do you think it's
8 12:28:22 8 wrong for an employer to punish an employee for
9 12:28:25 9 taking medical leave for a legitimate reason?
10 12:28:28 10 A. Maybe. It would depend on the
11 12:28:29 11 circumstances.
12 12:28:30 12 Q. So sometimes it would be okay?
13 12:28:31 13 A. I don't know the law in that area. That's a
14 12:28:35 14 legal question.
15 12:28:36 15 Q. I'm not asking for the law. I'm asking for
16 12:28:39 16 your opinion on this.
17 12:28:41 17 A. It would depend on, for example, what led up
18 12:28:49 18 to the medical leave; whether there were, as I said
19 12:28:56 19 in this case, previous statements; and it would
20 12:29:00 20 depend on the nature and legitimacy of the medical
21 12:29:04 21 condition and the seriousness, for example.
22 12:29:14 22 THE WITNESS: Can we take a break?
23 12:29:16 23 MR. LEE: Sure.
24 12:29:19 24 Let's go off the record at 12:29 p.m.
25 12:42:55 25 (Recess taken.)
PMK DuttP2
263
ss.
2 COUNTY OF KERN
8 PHILIP LEE DUTT, M.D., the witness named in the
10 deposition was taken Tuesday, September 9, 2008, at the
--s-u-s-a-n-~~-N-O-. - 6::-:8:-2::-:-9----
WOOD & RANDALL

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__________________________)
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15 OF
16 STEVEN GEORGE O'CONNOR
17 Tuesday, December 4, 2007
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OConnorS
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1 09:53:02 1 any preparation for the meeting with the CEO and with
2 09:53:07 2 Dr. Jadwin and with Karen Barnes?
3 09:53:11 3 A. I did not.
4 09:53:11 4 Q. Okay. What did you understand your role to
5 09:53:13 5 be at the meeting?
6 09:53:14 6 A. I thought my role probably was as a
7 09:53:18 7 representative from human resources.
8 09:53:20 8 Q. Did you expect that you would be asking any
9 09:53:23 9 questions or that you would give any input at the
10 09:53:26 10 meeting?
11 09:53:26 11 A. No.
12 09:53:26 12 Q. Okay. Did you understand that maybe you
13 09:53:29 13 would be expected to be familiar with this packet,
14 09:53:31 14 Exhibit No. 3, before going into the meeting?
15 09:53:37 15 A. I don't believe I said a word or two in the
16 09:53:39 16 meeting.
17 09:53:39 17 Q. Uh-huh. So my -- I guess my -- I'm a little
18 09:53:44 18 confused. Why would Peter Bryan ask you to be there,
19 09:53:47 19 just to be there?
20 09:53:48 20 MR. WASSER: You're asking him to know what
21 09:53:50 21 was in Peter Bryan's mind or what?
22 09:53:53 22 BY MR. LEE:
23 09:53:53 23 Q. Well, based upon your communications with
24 09:53:55 24 Peter Bryan, why did --
25 09:53:56 25 MR. WASSER: He said he didn't recall.
OConnorS
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1 09:58:02 1 A. I didn't ask, no.
2 09:58:03 2 Q. Do you think it could have been because you
3 09:58:05 3 were more familiar with Dr. Jadwin's case than
4 09:58:09 4 Ms. Chester?
5 09:58:11 5 A. I'm sorry, I don't know.
6 09:58:12 6 Q. You don't know. So you just have no idea
7 09:58:17 7 why it was you and --
8 09:58:18 8 A. Well, I've worked at the department for 14
9 09:58:20 9 years and, you know, known as a contact person in the
10 09:58:28 10 department. So . . .
11 09:58:30 11 Q. So is it customary for an HR rep to be
12 09:58:37 12 called into a meeting with the CEO then?
13 09:58:43 13 MR. WASSER: Is it customary?
14 09:58:44 14 THE WITNESS: Is it customary?
15 09:58:45 15 MR. WASSER: What do you mean?
16 09:58:46 16 BY MR. LEE:
17 09:58:46 17 Q. Is it like a -- I mean, what type of meeting
18 09:58:51 18 would you expect to -- for an HR rep to be called
19 09:58:55 19 into a meeting with Peter Bryan?
20 09:58:58 20 A. What -- I'm sorry.
21 09:59:00 21 Q. You said --
22 09:59:00 22 A. Any meeting he asked for.
23 09:59:03 23 Q. Okay. But you said there were some meetings
24 09:59:06 24 with Peter Bryan. Can you tell us what those
25 09:59:08 25 meetings were about where you were called in?
OConnorS
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1 09:59:12 1 A. Well, I mean, I attended a variety of
2 09:59:15 2 meetings with him. Probably the most typical, if you
3 09:59:19 3 will, would be a meeting where the HR department
4 09:59:23 4 prepared for a regular hospital county employee a
5 09:59:28 5 proposal for discipline, for possibly a clerical
6 09:59:31 6 support staff or a nurse or anybody in a regular
7 09:59:35 7 position, and Pete -- Peter Bryan, the CEO, acts as
8 09:59:42 8 the hearing officer. So we would attend the meeting
9 09:59:44 9 with him; we would prepare for the meeting. We would
10 09:59:48 10 be present in the meetings. That would probably be
11 09:59:50 11 the most typical.
12 09:59:51 12 Q. Who was most familiar with Dr. Jadwin's
13 09:59:54 13 case, then, his -- who was most familiar with
14 09:59:57 14 Dr. Jadwin's request for LOA as captured in Exhibit
15 10:00:02 15 No. 2?
16 10:00:13 16 A. I'm not sure who's most familiar with it.
17 10:00:15 17 Q. Okay. Who in your department would know who
18 10:00:17 18 handled that process?
19 10:00:19 19 A. Well, it was -- from the ground floor up it
20 10:00:22 20 was Pat Perez, and then Renita Nunn signed off on it
21 10:00:26 21 as recommending it.
22 10:00:27 22 Q. So really you had almost no involvement in
23 10:00:30 23 the handling of Exhibit No. 2?
24 10:00:32 24 A. That's correct.
25 10:00:32 25 Q. Okay. Did you think -- did you suggest to
OConnorS
228
ss.
2 COUNTY OF KERN
5
7 No. 7704, do hereby certify that STEVEN GEORGE O'CONNOR,
9 dUly sworn; that said deposition was taken Tuesday,

12

20
Dated this 17th day of December, 2007, at
22
23 ~dJOe (3 arLm.ct!C-cA.
nQra L. Edmonson, CSR No.
CQV\.
7704
24
25
WOOD & RANDALL

(800) 322-4595

3 Phone: (213) 992-3299
Fax: (213) 596-0487
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[Fed. R. Civ. P. 56(a)]
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Set One
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Harris, Vol. II
7 Lieu
8 Jennifer Abraham
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18 to
4/12/2007
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21 Vol. I
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24 EUGENE D. LEE
Declarant
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27 EXHIBIT 58
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AMENDMENT NO. 1
TO·
AGREEMENT FQRPROFESSIONALSERVICES·
CONTRACT EMPLOYEE
{County .... Philip Lbutt, M.b.}
This Amendment No.1 to the Agreement for Professional Services is made and
entered into this tott..... day of Oe.Jpber:, 2005. by and between the County of Kern
(hereinafter "Gounty"},a political subdivision of the state of California, which. owns and
operates Kern Medical Center (hereinafter "KMC"), and Philip L DOO, M.D. (hereinafter
"Core Physician"), a contrad employee,
RECITALS
WHEREAS:
(a.) County and Core Physician have heretofore entered into an Agreement for
Professional Services (Kern County Agt.#513~2005, dated June 21, 2005) (hereinafter
"Agreement"), to provide professional medical services in the Department of pathology at
KMC; and
(b) County· and Core Physician desire to amend the Agreement to (i) reflect· the
full time status of Core Physician effective October 15, 2005. (ii) increase the annual
compensation paid to Core Physician, from $155;137 to $186,687, effective October 15,
2005, (iii) clarify the methodology used to pay the professional fee guarantee set forth in
Article II, Section 4 of the Agreement, and (iii) revise Exhibit "N' to refJectcurrent
assignments and incorporate medical record documentation requiremehts;
NOW, THEREFORE, in consideration of the mutual covenants and conditions

hereinafter set forth and incorporating by this reference the foregoing recitals, the parties
hereto agree to amend the Agreement as follows:
1. Effective October 15; 2005, Article II, Compensation, section 1. Salary (Base),
paragraph A, shall be amended as follows:
<lA. Core Physician will work full-time (according toAMA survey data for specialty
but no less than forty [40] hours per week) and will be compensated with cash and
other value as follows: Effective October 15, 2005, COfe Physician will be paid
Seven Thousand One Hundred Fifty-Five Dollars and Seventy-Seven Cents
($7,155.77) biweekly not to exceed One Hundred Eighty-Six Thousand Six Hundred
Eighty-Seven Dollars ($186,687) annually. County will withhold. from said daily
compensation of Core Physician, all applicable federal, state and local payroll taxes.
County will pay the Employer's portion of the hospital insurance portion of Social
Security (FICA 2)."
0026194
2. Effective October 15, 2005, Article II, Compensation, section 1, Salary (Base),
paragraph E, shall be amended as follows:
"E. The maximum payable under this Agreement, including base salary and
professional fees paid by County to Core Physician pursuant to Article II, section 4,
paragraph G, will not exceed Nine Hundred Eighty-One Tho~sand Six Hundred
Sixty-Two Dollars ($981,662) per the fIVe-year term of this Agreement."
3. Effective June 25, 2005, Article II, Compensation, section 4, Professional Fees,
paragraph F, shall be amended as follows:
"F. Based on the assumption that the patient activity of Core Physician will be in
accordance with the attached job description and medical records documentation by
Core Physician regarding supervision of resident physicians a~d care provided will
be consistent with CMS requirements for professional billing, Co.unty agrees that the
amount of professional fees to be paid by County to Core phYsician will not be less
than Fifty-Seven Thousand Nine Hundred One Dollars ($57,901), prorated monthly
in twelve (12) equal installments, for a period not to exceedtwel}Je (12) months from
the effective date of this Agreement. The professional fees collected between June
25, 2005, the effective date of this Agreement, and June 24, 2006, will be paid by
County to Core Phy~ician as follows: July 19, 2005, for the period June 25, 2005
through July 31, 2005; August 16, 2005, for August 2005; September 27,2005, for
September 2005; October 25, 2005, for October 2005; Nov~mber 22, 2005, for
November 2005; December 20, 2005, for December 2005; January 17, 2006, for
January 2006; February 28, 2006, for February 2006; March 28, 2006, for March
2006; April 25, 2006, for April 2006; May 23, 2006, for May 2006; and June 20,
2006, for the period June 1, 2006 through June 30, 2006. The gross professional
fees collected between June 25, 2005 and June 24, 2006, and subsequently paid
by County to Core Physician are subject to the assessment for administrative
expenses and all appropriate federal and state taxes."
4. Effective June 25, 2005, Article II, Compensation, section 4, Professional Fees,
paragraph G, shall be amended as follows:
"G. Core Physiciarn hereby assigns toKMC and agrees that :KMC shall have the
exclusive right to bill and collect for services prOVided by Core Physician under this
Agreement for the twelve (12) month period beginning June 25; 2005 through June
24, 2006, or until such time as the gross professional fees coll~cted by County for
services provided by Core Physician under this Agreement ~ceeds $57,901, in
addition to the cost: of overhead and assessment for admi(:1istrative expenses.
During the period June 25, 2005 through June 24, 2006, or until such time as the
professional fees collected and paid by County to Core Physician for services
provided by Core Physician under this Agreement exceeds $57,901, Core Physician
represents and warrants that Core Physician shall not bill or submit a statement of
charges to, or enter into any agreement or undertaking with, any patient, third
person or entity for the provision of services (With or without consideration), nor
0026195
shall Core Physician initiate any surcharge for care without the prior written
authorization and approval of County and KMC."
5. Effective October 15, 2005, Article III, Benefits, section 3, Paid Leave of Absence,
paragraph 8, shall be amended as follows:
"B. Vacation: Effective October 15, 2005, for each pay period of service, Core
Physician shall be credited with a vacation entitlement of 6.15 hours, for a maximum
accrual of 160 hours per year. Total unused vacation accumulated shall not exceed
a maximum of 320 hours. No further vacation entitlement shall be credited so long
as Core Physician has the maximum hours credited. If Core Physician is presently
employed by the County of Kern, accrued vacation entitlement shall be credited to a
maximum of 320 hours. Unused vacation benefits will be credited to Core
Physician to a maximum of 320 hours if this Agreement is renewed. Core Physician
will be paid for accrued and unused vacation hours upon termination of
employment."
6. Effective October 15, 2005, Article III. Benefits. section 3, Paid Leave of Absence,
paragraph C, shall be amended as follows:
"C. Sick Leave: Effective October 15. 2005. for each pay period of service, Core
Physician shall be credited with sick leave credit for illness or accident of 2.46
hours, for a maximum accrual of 64 hours per year. After fIVe years of employment.
including full-time employment prior to the effective date of this Agreement. Core
Physician shall earn and accrue sick leave credit for illness or accident at the rate of
3.07 hours for each pay period of service for an annual accrual of 80 hours per
year. Total unused sick leave accumulated shall not exceed a maximum of 1152
hours. No further sick leave entitlement shall be credited so long as Core Physician
has the maximum hours credited. If Core Physician is presently employed by the
County of Kern, accrued sick leave shall be credited to a maximum of 1152 hours.
Unused sick leave will be credited to Core Physician to a maximum of 1152 hours if
this Agreement is renewed. Core Physician will not be paid for accrued and unused
sick leave upon termination of employment. County policy applicable to other
regular County employees of KMC regarding use of sick leave shall apply to Core
Physician. n
7. Effective October 15. 2005, Article III. Benefits, section 4. Paid Leave of Absence,
paragraph 0, shall be amended as follows:
"D. Educational Leave: Effective October 15, 2005. Core Physician shall receive
80 hours paid education leave annually. The first 80 hours shall be credited on the
effective date of the Core Physician's employment contract. On each successive
anniversary date of that contract, an additional 80 hours shall accrue. Education
leave must be used within the year that it is accrued and unused education leave
does not accrue to the following contract year. Unused education leave will not be
paid upon termination of employment. All education leave must be approved in
0026196
advance of use by the Core Physician's Department Chair and the Medical
Director."
8. Effective October 15. 2005. Article III. Benefits, section 9. Expense Reimbursement.
paragraph A, shall be amended as follows:
"A. Effective October 15. 2005, Core Physician will be reimbursed for approved
and necessary expenditures related to continuing education including seminar fees,
travel and study mat~rials. Reimbursement for travel, lodging and meals shall be
upon the same terms and rates as allowed for County employees of KMC. Core
Physician will be reimbursed expenses and materials not to exceed· $2,500 per
year."
9. Effective October 15, 2005, Exhibit "A," Job Description, sh~1I be replaced with
Exhibit "A" to Amendment No.1. Job Description, attached hereto and incorporated herein
by this reference.
10. Except as provided herein, all other terms, conditions, and covenants of the
Agreement shall remain in filill force and effect.
0026197
IN WITNESS WHEREOF, the: PC3rtie~ have executed this Amendnwnt No.1 to the
Agreement as oftheday and year fir~;{written·.above. .

KERN MEDICALCENTER .//
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Pete~72~~ Chairman'
Chief8xecUtl~tCer Board of Supervisors
KERN COUNn/ PERSONNEL CORE PHYSICIAN

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Director
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Deputy
Amend1.Dutt081105
0026198
· Case
' 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 12 of 56
Exhibit "An
To
Amendment No.1
Job' Description
Philip L. Dull, M.D.
The Department of Pathology provides professional anatomic and clinical pathology

services to Kern Medical Center and oversees the administration ahd operation of the
clinical laboratory, blood bank and histology and department administriative services. Key
duties center upon providing high quality. timely and cost effective patient care.
Position Summary: Reports to Chairman, Department of Pathology.
Clinical Responsibilities: Provides professional pathology services required to process,

interpret and report of pathology specimens, including but not limited tp surgical pathology
specimens, bone marrow specimens, non-gynecologic and gynecologic cytology
specimens and fine needle aspirates.
1. Performs collection procedures, such as bone marrow aspiration and biopsy. fine
needle aspiration and skin punch biopsies.
2. Performs medical autopsies and prepares complete autopsy reports.
3. Performs professional surgical pathology, cytopathology anp hematopathology
services on a rotational basis with one or more pathologist.
4. Performs call coverage on a proportional basis with two other p~thologists.
5. Serves as a clinical pathologist and co-laboratory directqr covering clinical
laboratory and blood bank services. ,
6. Responsibly examines and interprets clinical microscopy speci~ens, such as body
fluid, urine, sputum. peripheral blood and other clinical specimeps.
7. Completes all seJVice work in a timely, accurate and professional manner.
Administrative Responsibilities:
1. Follows department rules as specified in the pathology department policies and

procedures. i .
2. Attends histology and pathology department meetings as scheduled.
3. Attends other laboratory meetings as appropriate or assigned I by the department
chairman. ,
4. Attends inter-departmental meetings and committees as I assigned by the
department chairman. and president of the medical staff. i
5. Attends general medical staff meetings on a semi-annual basis. i

6. Participates in the training of hospital physician residents an<tl medical students,
including the review of active and past case material as requiredl for patient care.
7. Participates in quality assurance, quality management and quality improvement
activities, including peer review and quality control function~ of the pathology
service. .
0026199
· .Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 13 of 56
8. Participates in proficiency testing and performance improvement programs as

required.
Assignments: Work assignments will be based upon a work schedule of 44 weeks per
year on a flexible basis that fulfills the needs of the deparbTlent.
Medical Record Documentation: Documentation by Core Physician will conform to the

requirements for evaluation 'and management (ElM) services billed by:teaching physicians
set forth in the Medicare earners Manual, Part 3, sections 15016 -15018, inclusive.
0026200
Kem
AMENDMENT NO.. ·2
T0
AGgEEMENT FORPROFESSIONAL SERVICES
CONTRACT"EMPLOYEE
(County~ Philip L Outt, M.D,)
This Amendment No.2, to the Agreement for Professional Services is made and
entered into this ,,;Cff:bday, oflJu.e-rnhe-r--; '2006, by and between the County of Kern
(hereinafter·"County"),a political subdivision ,of the state of California, which owns and
'operates Kern Medical Center (hereinafler "KMC") , and Philip L Dutt, M.D. (hereinafter
"Gore Pbysician"), a· contraCt employee.
RECITALS
WHEREAS:
(a) County and Gore Physician have heretofore entered into an Agreement for
Professional Services (Kern County Agt. #513~2005, dated June 21, 2005) (hereinafter
"Agreement"JandAmendment No.1 (Kern County Agt #857-200.5" dated October 10,
2005); for the period Jun$ 25, 2005 through June 24, 2010, to provide professional
medical services in tbe 'Oepf;lftment of Pathology at KMC; and
(b) County and Gore Physician desire to amend the Agreement to reflect the
handling of professional fees paid to the clearing account effective January 1,2007; and
(c) The Agreement is amended effective January 1, 2007;
NOW, THEREFORE, in consideration of the mutual covenants and conditions

hereinafter set forth and incorporating by this reference the foregoing recitals, the parties
hereto agree to amend the Agreement as follows:
i
1, Notwithstandingany\provision oUhe Agreement to the contrary, effective January 1,
2007, all professiQnalfees bollected by Core Physidan'sbilling service will continue to be
paid to the clearingaccounl. County wilJcontinue, to deduct, from gross professional fees
collected and subsequentty deposited into the clearing account, 'the assessment for
administrative expenses arid the overhead expenses for Core Physioian's practice group.
co,'unty,will no I,onger pay Rrofessional fees as we,ges ,to Core Physician. Net professional
fees will be paid monthly d~rectly from the clearing account, as directed by Core Physician
or Core P,h,ysician's practic$, group, as a distribution to Core PbysiCl,'arl. Core Physician will
be responsible for all appropriate federal and state taxes and withholding requirements.
2, Except. as prbvide~ herein, all other terms,conditions, and covenants of the

Agreement and any andall!amendments thereto shall remain in full force and effect.
0026201
fNWITNESS WHEREOF, the parties have ente~d into this Amendment No; 2 to
the Ag.reemeritasof the day and yearfirstwlittenabove.
COUNTY OFKER.N CORE PHYSICIAN
By<8Ar~~ a~~ By,~M-V

Ohairman PhilipL. >utt,M.D.
Board ofSupervisors
APPRO\JEDAS TO CONTENT:
KERN MEDICAL CENTER
By ill ·2[U2~-----~··
David KGulberson
Interim Chief Executive Officer
KERN COUNTY PERSONNEL

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Director
OFFICE OF OOUNTY COUNSEL
BY&~VZ.~
Deputy ,
Amend2.Dutt,111506
0026202
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27 EXHIBIT 59
28
AGREEM.e~:r_FQR.~RQ.~s.SSiONAL·SERV'CES
CONTRA.CT ISMPLOYEE
(CQuntyof Kern-Savit~tP.Shertukde, M,D,)
This Agreement is. made. and entered into this {at d$Y of~&~, 2005,
between the County of Kern, a political subdivision of the state of California (hereinafter
H
"County"), which owns and operates Kern Medical Center (hereinafter "KMC and Savita
),
P. Shertukde, M.D. (herein$fter "CorePhysician a contract employee.

H
),
RECITALS.
WHEREAS:
A. County is authorized, pursuant to Government Code section 31000, to

contract with specially trained persons, and further authorizes the payment of
compensation for the sef\Jices rendered; and
8. County requires assistance in the performance of professional medical

services at KMCas such services are unavailable from County resoDrces; and
C. Core Physician has special training, knOWledge and experience and is

licensed by the state of California to practice medicine and Is qualified to render medical
services.
NOW, THEREFORE, His agreed between County and Core Physician as follows:
Article I.
rERM AND CONDITIONS
1. TERM
This Agreement shall be effective on November 1, 2005, and shall remain in effect
through October 31, 2010.
2. SERVICES
and made a part of this Agreement.
Article It
COMPENSATION
1. SALARY (BASE)
Core Physician shall be entitled to the following compensation (as defined in Article
II, Section 3):
0026229
A. Core Physician will work full-time (according to AMA survey data for specialty
but no less than forty [40] hours per week) and will be compensated with cash and
other value as follows: Core Physician will be paid Five Thousand Four Hundred
Eighty-Four Dollars and Sixty-One Cents ($5,484.61) biweekly not to exceed One
Hundred Forty-Three Thousand Eighty-Eight Dollars ($143,088) annually. County
will withhold, from said daily compensation of Core Physician, all applicable federal,
state and local payroll taxes. County will pay the employer's portion of the hospital
insurance portion of Social Security (FICA 2).
sale discretion of County, as is reasonable and convenient for County.
C. No adjustment in compensation will be effective without a written amendment

to this Agreement.
D. The maximum payable under this Agreement, including base salary and
paragraph G, will not exceed Seven Hundred Seventy-Three Thousand Three
Hundred Forty-One Dollars ($773,341) per the five-year term of this Agreement.
2. OVERALL COMPENSATION STRUCTURE
A. The purpose of this Compensation Plan is to provide market-based,

performance-driven compensation that recognizes a Core Physician's efforts and
contributions toward promoting the mission and values of KMC. Core Physicians will
be identified as such in their contracts with KMC.
B. Total compensatiQn for Core Physician will be composed of a base salary

paid by the County, professional fee payments from third-party payors, and potential
other income generated due to the individual's status as a physician. These three
sources of income shall be referred to in this Agreement as Total Core Physician
Compensation. The structure for determining Total Core Physician Compensation
shall be referred to in this Agreement as the Compensation Plan.
C. A Kem County clearing account and a KMC compensation budget unit will be
established to account for all funds generated and received to pay Total Core
Physician Compensation and to pay all expenses associated with this
Compensation Plan. These will act as trust accounts and will be solely used for this
purpose.

Compensation Plan and will report to the Faculty Practice Board.
0026230
E. A Board of Directors will be established to oversee the Compensation Plan

and the Plan Administrator of the Compensation Plan. This Board of Directors shall
be referred to in this Agreement as the Faculty Practice Board. The Faculty
Practice Board will establish bylaws inclUding powers, duties and responsibilities to
be approved both by a simple majority of the Faculty Practice Board and the CEO of
KMC.
F. An assessment for administrative expenses shall be made on Total Core

Physician Compensation to support the administrative expenses of the
Compensation Plan.
(1) The amount or percentage of the assessment shall be

determined annually by the Faculty Practice Board. The amount or
percentage of the assessment shall not exceed two percent (2%) of
Total Core Physician Compensation (as defined in Article II, Section 2,
paragraph B) annually.
(2) Administrative expenses shall include the salary and benefits

for the Plan Administrator and any staff hired by KMC to support the
Plan Administrator, expenses of the Kem County Pension Plan for
Physician Employees. and other business expenses as determined by
the Plan Administrator and the Faculty Practice Board.
G. County agrees to assume liability for and indemnify and hold harmless Core
Physician against all claims, losses. expenses, costs, actions, settlements,
attorneys' fees and judgments incurred by Core Physician or for which Core
Physician becomes liable to pay, arising out of or in connection with or related to the
services rendered or which a third party alleges should have been rendered by Core
Physician pursuant to this Agreement. The obligation of County under this
paragraph shall arise as to all incidents occurring on and after November 1, 2005,
and prior to termination or expiration of this Agreement. This paragraph shan
survive the termination or expiration of this Agreement and shall apply to all claims
made during or after the termination or expiration of this Agreement, which allegedly
arise out of services rendered or which should have been rendered by Core
Physician during the term of this Agreement. The liability coverage of this
paragraph shall not apply to services at sites other than KMC unless approved by
the Kern County Board of Supervisors.
H. County shall indemnify and defend Core Physician to the same extent as
would be afforded to a regular full-time County employee. Said duty of defense and
indemnity shall not apply to intentional or willful misconduct, gross negligence,
dereliction or criminal misconduct on the part of Core Physician, and further shall
not extend to any conduct, actions or activities that do not arise directly from the
performance of this Agreement.
0026231
A. Base salary is compensation paid to Core Physician by the County for: (1)
patient care for Medically Indigent Adults (MIA), as defined by Califomia Welfare
and Institutions Code sections 17000 et seq., and adults and juveniles incarcerated
and detained in County facilities; (2) as a safety-net provider, partial compensation
for under-compensated and uninsured patients; (3) teaching; (4) administrative
duties; and (5) other activities approved by the CEO of KMC and the Faculty
Practice Board. County shall fund the clearing account unit biweekly with an
amount equal to Core Physician's biweekly base salary. The base salary, less the
assessment for administrative expenses, will be reported as wages and subject to
all appropriate federal and state taxes. The base salary will be considered the
minimum compensation that a Core Physician shall receive under this
Compensation Plan.
B. The base salary will be negotiated between the parties and set out for each
Core Physician at the end of twelve (12) months by means of an amendment to this
Agreement. The base salary will be based on a benchmark salary in proportion to
the Core Physician's full-effort commitment.

standard with four salary steps: "A", "B", "C" and "D." There are three
step placement are set forth in the KMC Faculty Practice
Administrat.ive Policies and Procedures Manual.
(2) The Faculty Practice Board shall establish the criteria for
measuring the full-effort commitment. The Department Chairs, with
approval of the Faculty Practice Board, will establish the expected
levels of the criteria to meet a full-effort commitment. The criteria for
measurement of full-effort commitment is set forth in the KMC Faculty
Practice Administrative Policies and Procedures Manual.
(3) Research shall not be considered as part of a Core Physician's

full-effort commitment. Research activity will be compensated as set
forth in the KMC Faculty Practice Administrative Policies and
Procedures Manual.
A. Professional fees include all professional fee collections or payments

associated with direct patient care by Core Physician. This shall be referred to in
this Agreement as professional fees. Core Physician's practice group is responsible
for billing and collecting all professional fees for Core Physician's services. Core
Physician's will have a separate tax identifICation number.
4
0026232
B. Professional fee billing by Core Physician's practice group shall be made by

a billing service company, approved in advance by the Faculty Practice Board, and
based upon minimum performance standards set by the Faculty Practice Board. All
professional fees collected by the billing service for Core Physician (i.e., gross
professional fees collected) shall be paid to the clearing account. The billing service
will maintain individual and practice group records on professional fee billing and
collections and will account for such to the Plan Administrator.
C. The assessment for administrative expenses will be deducted from gross

professional fees collected.
D. Overhead and expenses for a practice group, as determined by an overhead

distribution formula established by the Plan Administrator and the Faculty Practice
Board, will be deducted from the gross professional fees collected and returned to
the practice group.
E. Gross professional fees collected, less the assessment for administrative

expenses and overhead, will be paid monthly as wages and will be subject to all
appropriate federal and state taxes; however, practice groups (consistent with their
practice group agreements with the County) may direct the Plan Administrator as to
the distribution of net professional fees collected, subject to review by the Faculty
Practice Board.
F. Based on the assumption that the patient activity of Core Physician will be in
accordance with the attached job description and medical records documentation by
Core Physician regarding supervision of resident physicians and care provided will
be consistent with CMS requirements for professional billing, County agrees that the
amount of professional fees to be paid by County to Core Physician will not be less
than Fifty-Seven Thousand Nine Hundred One Dollars ($57,901), prorated monthly
in twelve (12) equal installments, for a period not to exceed twelve (12) months from
the effective date of this Agreement. The professional fees collected between
November 1, 2005, the effective date of this Agreement, and October 31, 2006, will
be paid by County to Core Physician as follows: November 22, 2005, for November
2005; December 20, 2005, for December 2005; January 17, 2006, for January
2006; February 28, 2006, for February 2006; March 28, 2006, for March 2006; April
25, 2006, for April 2006; May 23, 2006, for May 2006; June 20, 2006, for June
2006; July 18, 2005, for July 2006; August 29,2006, August 2006; September 27,
2006, for September 2006; and October 24, 2006, for October 2006. The gross
professional fees collected between November 1, 2005 and October 31, 2006, and
subsequently paid by County to Core Physician are subject to the assessment for
administrative expenses and all appropriate federal and state taxes.
G. Core Physician hereby assigns to KMC and agrees that KMC shall have the
exclusive right to bill and collect for services provided by Core Physician under this
Agreement for the twelve (12) month period beginning November 1, 2005 through
5
0026233
October 31, 2006, or until such time as the gross professional fees collected by
County for services provided by Core Physician under this Agreement exceeds
$57,901, in addition to the cost of overhead and assessment for administrative
expenses. During the period November 1, 2005 through October 31, 2006, or until
such time as the professional fees collected and paid by County to Core Physician
for services provided by Core Physician under this Agreement exceeds $57,901,
Core Physician represents and warrants that Core Physician shall not bill or submit
a statement of charges to, or enter into any agreement or undertaking with, any
patient, third person or entity for the provision of services (with or without
consideration), nor shall Core Physician initiate any surcharge for care without the
prior written authorization and approval of County and KMC.
5. OTHER INCOME
A. Other income IS Income generated due to the individual's status as a

professional witness fees, and other nonprofessional fees.
B. All other income will be paid to the Core Physician in accordance with
instructions provided the clearing account by Core Physician or Core Physician's
practice group. Expenses properly incurred by the Core Physician in generating
other income will be reimbursed to the Core Physician prior to the balance being
channeled through the clearing account. This remainder, less assessment for
administrative expenses, will be paid monthly to Core Physician as wages. Other
income shall be reported as wages and subject to all appropriate federal and state
taxes.
C. Income generated by a Core Physician that is deposited to the Community

Medical Education and Research Foundation ("CMERF") for department
the assessment for administrative expenses.
6. PRACTICE GROUPS
A. Core Physicians will be members of a practice group. All practice groups will
contract with KMC for the provision of community clinic services, which shall be
integrated into the KMC teaching program. The contract between each practice
group and KMC will define the responsibilities and funds flow, including professional
fee distribution, between each organization.
B. Practice group overhead and business-related expenses will be paid by the

practice group in accordance with predetermined instructions. Practice groups will
determine the policy for expense limits and reimbursable items. County is not
responsible for the amount of group overhead and business-related expenses
claimed.
0026234
7. OTHER CORE PHYSICIANS
Core Physicians who are not part of a practice group and who practice exclusively
at KMC-owned or -contracted sites will be responsible for the cost of professional
fee billing as negotiated by the Core Physician with the billing service company.
Article III.
BENEFITS
The date of employment for the purpose of receiving and accruing benefits listed in
this Article III shall not be affected by the date of this Agreement, but shall be the
date the Core Physician was first continuously employed by KMC.
2. HEALTH INSURANCE
County shall provide to Core Physician and eligible dependents medical, dental and
vision insurance as provided to other regular County employees of KMC. Core
Physicians first hired by the County of Kern after April 15, 1997, must pay twenty
(20) percent of the cost of their health benefits. County may change the benefits
provided under this insurance as such benefits shall change for other County
employees of KMC. Any such change by County shall not be a breach of this
Agreement.
educational leave.
A. Holidays: Core Physician shall be entitled to such holidays as provided to

full-time County employees of KMC. County may change the holidays provided
under this section as such holidays change for other County employees of KMC.
Any such change by County shall not be a breach of this Agreement.
B. Vacation: For each pay period of service, Core Physician shall be credited
with a vacation entitlement of 6.15 hours, for a maximum accrual of 160 hours per
year. Total unused vacation accumulated shall not exceed a maximum of 320
hours. No further vacation entitlement shall be credited so long as Core Physician
County of Kern, accrued vacation entitlement shall be credited to a maximum of 320
hours. Unused vacation benefits will be credited to Core Physician to a maximum
of 320 hours if this Agreement is renewed. Core Physician will be paid for accrued
and unused vacation hours upon termination of employment.
C. Sick Leave: For each pay period of service, Core Physician shall be credited
with sick leave credit for illness or accident of 2.46 hours, for a maximum accrual of
7
0026235
64 hours per year. After five years of employment, including full-time employment
prior to the effective date of this Agreement, Core Physician shall earn and accrue
sick leave credit for illness or accident at the rate of 3.07 hours for each pay period
of service for an annual accrual of 80 hours per year. Total unused sick leave
credited. If Core Physician is presently employed by the County of Kern, accrued
sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will be
credited to Core Physician to a maximum of 1152 hours if this Agreement is
renewed. Core Physician will not be paid for accrued and unused sick leave upon
termination of employment. County policy applicable to other regular County
employees of KMC regarding use of sick leave shall apply to Core Physician.
D. Educational Leave: Core Physician shall receive 80 hours paid education

leave annually. The first 80 hours shall be credited on the effective date of the Core
Physician's employment contract. On each successive anniversary date of that
contract, an additional 80 hours shall accrue. Education leave must be used within
the year that it is accrued and unused education leave does not accrue to the
following contract year. Unused education leave will not be paid upon termination
of employment. All education leave must be approved in advance of use by the
County shall provide Core Physician the right to unpaid leave of absence provided
to other regular County employees of KMC pursuant to County policy. County may
change its policy regarding leave of absence, as its policy for leave of absence shall
change for other County employees of KMC. Any such change by County shall not
be a breach of this Agreement.
5. RETIREMENT PLAN
A. Core Physician shall participate in the Kern County Pension Plan and Trust
Agreement for Physician Employees (the "Plan"), a qualified defined contribution
pension plan, pursuant to the terms of the instrument under which the Plan has
been established (the "Plan Document"), as from time-to-time amended. County
and Core Physician contributions for each Plan year (as defined in the Plan
Physician. Core Physician's mandatory employee contributions required under the
amended and restated Plan Document shall be as follows: If Core Physician's
Compensation (as defined under the Plan Document) was One Hundred Fifty
Thousand Dollars ($150,000) or less during the immediately preceding Plan year,
8
0026236
Document shall be Four Thousand Dollars ($4,000) for a complete Plan year of
service by Core Physician. If Core Physician's Compensation was more than One
Hundred and Fifty Thousand Dollars ($150,000) but less than One Hundred and
Seventy Thousand Dollars ($170,000) during the immediately preceding Plan year,
Document shall be Nine Thousand Dollars ($9,000) for a complete Plan year of
service by Core Physician. If Core Physician's Compensation was One Hundred
Seventy Thousand Dollars ($170,000) or more but less than One Hundred Eighty
Thousand Dollars ($180,000) during the immediately preceding Plan year, Core
shall be Twelve Thousand Five Hundred Dollars ($12,500) for a complete Plan year
of service by Core Physician. If Core Physician's Compensation was One Hundred
and Eighty Thousand ($180,000) or more but less than One Hundred Ninety
Thousand Dollars ($190,000) during the immediately preceding Plan year, Core
shall be Seventeen Thousand Five Hundred Dollars ($17,500) for a complete Plan
year of service by Core Physician. If Core Physician's Compensation was at least
One Hundred Ninety Thousand Dollars ($190,000) during the immediately
under the Plan Document shall be the maximum amount permitted by Internal
Revenue Code section 415(c)(1) reduced by the County contribution for the account
of Core Physician for the Plan year. Core Physician's mandatory employee
contributions shall be withheld by County from Core Physician's biweekly salary in
relatively equal amounts. Total contributions by Core Physician and County will not
exceed the yearly amount allowed by law; provided, however, if any amounts are
contributed in excess of such permissible amounts, the excess contribution shall be
corrected as provided in the Plan Document or under law. Any changes in the Plan
Document will control the terms of this Agreement. County's required contribution
for the account of Core Physician and Core Physician's mandatory employee
contributions are also subject to all of the transition rules contained in the Plan as it
now exists or may be hereafter amended which may reduce the amount of
contribution. The transition rules include, but are not limited to, those contained in
sections 3.3(b), 3.3(d), 3.5, and 3.6 of the amended and restated Plan Document.
Core Physician (together with all Plan participants) shall be responsible for a pro
rata share of the annual costs of administering the Plan. Due to the manner in
which Plan participant accounts are held and invested, most such costs cannot be
paid directly from Plan assets. To facilitate payment of such costs, County shall
advance such costs for so long as County determines such an arrangement is
necessary or desirable. To offset such costs, County shall reduce its contribution to
the Plan for Core Physician by Core Physician's pro rata share of such costs as
determined under the Plan Document.
8. If the fixed contribution structure described in the immediately preceding

paragraph A results, or would result, in the Internal Revenue Service not issuing a
favorable determination Jetter for the Plan under the amended and restated Plan
0026237
Document, the County reserves the right to substitute another contribution structure
which will be designed to maximize benefit to Core Physician on a cost-neutral
basis to County, and such substitute contribution structure shall control the terms of
this Agreement. County will consult with the Pension Committee, as identified in the
Plan Document, with respect to such substitute contribution structure. •
C. County's required contribution and all mandatory employee contributions will

be paid to such financial services firm(s) as determined under the Plan Document.
If, pursuant to the Plan Document, Plan assets are allocated to separate accounts
for each Plan participant, such financial services firm(s) shall be solely responsible
for allocating Core Physician's contribution amount and investment experience to
his or her account. If, pursuant to the Plan Document, Plan participants control the
investment of their accounts at such financial services firm(s), the investment of
Core Physician's Plan account through such financial services firm shall be
determined by Core Physician. County shall not be liable for the investment
experience of Core Physician's Plan account.
D. Core Physician is not eligible to participate in any other retirement plan

established or funded by the County for its employees, inclUding but not limited to
the Kem County Employees' Retirement Association, and this Agreement does not
confer upon Core Physician any right to claim entitlement to benefits under any
such retirement plan(s).
6. SOCIAL SECURITY AND MEDICARE TAXES
Core Physician is exempt from payment of Social Security taxes as the Kern County
Pension Plan for Physician Employees is a qualified alternative to the insurance
system established by the federal Social Security Act. Core Physicians employed
before March 31, 1986, will continue to be exempt from the payment of Medicare
taxes.
Core Physician shall be eligible to participate in the Kem County Deferred

Compensation Plan I on the same basis and to the same extent as full-time County
employees. County may change its Deferred Compensation Plan as it shall change
for other County employees of KMC. Any such change by County shall not be a
breach of this Agreement.
8. KERN$FLEX PLAN
Core Physician shall be eligible to participate in the Kem$Flex Plan I on the same
basis and to the same extent as eligible County employees. County may change its
Kern$Flex Plan, as its policy for Kem$Flex shall change for other County
Agreement.
10
0026238
A. Core Physician will be reimbursed for approved and necessary expenditures

related to continuing education including seminar fees, travel and study materials.
Reimbursement for travel, lodging and meals shall be upon the same temis and
rates as allowed for County employees of KMC. Core Physician will be reimbursed
expenses and materials not to exceed $2,500 per year.
B. Core Physician will be reimbursed for approved and necessary expenditures

related to education and training as directed by KMC. Reimbursement for travel,
lodging and meals shall be upon the same terms and rates as allowed for County
employees of KMC.
C. Reimbursement for expenses incurred in generating professional fees will be

D. Reimbursement for expenses incurred in generating other income will be

Article IV.
A. Core Physician may terminate this Agreement, without cause, upon ninety
(90) days' prior written notice to County.
B. County may terminate this Agreement at any time for cause. Cause is
defined as a violation of administrative policy of the County of Kern or KMC,
unsatisfactory clinical performance, failure to meet department accountability or
performance standards, or reduction of need. County may terminate this
Agreement based upon reduction of need upon ninety (90) days' prior written notice
to Core Physician.
C. Termination of this Agreement by County does not per se affect medical staff
membership. Actions affecting medical staff membership and clinical privileges are
governed solely by the medical staff bylaws.
D. In the event of termination of this Agreement for any reason, County shall
have no further obligation to pay for any services rendered or expenses incurred by
Core Physician after the effective date of the termination. Core Physician shall be
entitled to receive base salary from County for services satisfactorily rendered,
calculated on a prorated basis up to the effective date of termination.
E. Professional fees earned prior to termination and collected within twelve (12)
months of termination will be paid to Core Physician in accordance with current
11
0026239
instructions provided the clearing fund by Core Physician's practice group. These
professional fees will continue to be subject to assessment for administrative
expenses, overhead distribution formula, and all appropriate federal and state taxes
in effect at the time the professional fees are paid.

policy of the County of Kern or KMC, unsatisfactory clinical performance, or failure
to meet department accountability, or performance standards. Such corrective
action may include, without limitation, additional training and education, a verbal or
written warning, a written reprimand, suspension with or without pay, and
termination.
B. Corrective action for unsatisfactory clinical performance is governed by the

medical staff bylaws.
C. Corrective action is not reqUired if the problem involves a serious ethical or

clinical breach, a violation of law or a serious violation of County of Kern or KMC
policy that merits immediate termination for cause.
Review and appeal of the decision to impose corrective action or terminate for
cause shall follow the process set forth in the KMC Faculty Practice Board policy
and procedure, titled Corrective Action and Termination Review Process, or the
medical staff bylaws, whichever is applicable.
Article V.
GENERAL PROVISIONS
1. ASSIGNMENT
Core Physician shall not assign or transfer this Agreement or Core Physician's
obligations hereunder, or any part thereof. Core Physician shall not assign any
money due or which becomes due to Core Physician under this Agreement without
the prior written approval of County.
Core Physician agrees to be available to County, at no cost to County, to testify as

an expert witness or otherwise, in the event of litigation under any cause of action
being brought against County or KMC, its directors, officers or employees except
where Core Physician is a named party. KMC will credit the time spent in
preparation and testimony as administrative time as defined in the Compensation
Plan.
12
0026240
It is understood that Core Physician, in Core Physician's performance of any and all
duties under this Agreement, has no authority to bind County or KMC to any
Paragraph headings in this Agreement are used solely for convenience, and shall
Agreement shall be interpreted for or against a party because that party or its legal
representative drafted such provision, and this Agreement shall be construed as if
jointly prepared by the parties.
5. CHOICE OF LAWNENUE
pursuant to the laws of the state of California. This Agreement has been entered
Kem.
The parties to this Agreement have read and are aware of the provisions of sections
1090 et seq. and sections 87100 et seq. of the California Government Code relating
to conflict of interest of public officers and employees. All parties hereto agree that
they are unaware of any financial or economic interest of any public officer or
employee of County relating to this Agreement. It is further understood and agreed
that if such a financial interest does exist at the inception of this Agreement, County
may immediately terminate this Agreement by giving written notice thereof. Core
Physician shall comply with the requirements of California Government Code
sections 87100 et seq. dUring the term of this Agreement.
procedures. Core Physician will keep daily time sheets on forms supplied, and in
routine as established by the Department of which Core Physician is a member,
including but not limited to orientation, attendance at case conferences, supervision,
in service education, patients' rights functions and performance improvement
activities. Core Physician shall submit to drug testing, other laboratory testing and
physical examinations as may be required by County.
13
0026241
Core Physician shall observe and comply with all applicable County, state and
federal laws, ordinances, rules and regulations now in effect or hereafter enacted,
including but not limited to JCAHO, Title 22, California Code of Regulations,
EMTALA, all federal and state billing requirements including Medi-CaVMedicaid and
Medicare billing regUlations, EEOC, HIPAA, FEHA and Cal-OSHA. Core Physician
will at all times meet state and federal licensure and County personnel qualifications
for the practice of medicine.
9. COUNTERPARTS
This Agreement may be executed simultaneously in any number of counterparts,

each of which shall be deemed an original but all of which together shall constitute
one and the same instrument.
acknowledges that Core Physician will not be deemed a classified employee, or
have any rights or protections under the County's Civil Service Ordinance, rules or
regulations.

other right or remedy herein or by law or equity provided or permitted, but each shall
be cumulative of every other right or remedy given hereunder or now or hereafter
existing by law or in equity or by statute or otherwise, and may be enforced
concurrently or from·time to time.
12. MEDICAL RECORDS
Any and all patient medical records and charts produced as a result of either party's
performance under this Agreement shall be and remain the property of County.
During the term of this Agreement, Core Physician shall be permitted to inspect or
duplicate any patient's medical record or chart to the extent necessary to meet
professional responsibilities to such patient or to assist in the defense of any
malpractice or similar claim to which such medical record or chart may be pertinent,
provided such inspection or duplication is permitted and conducted in accordance
with applicable legal requirements and pursuant to commonly accepted standards
of patient confidentiality. Core Physician shall be solely responsible for maintaining
patient confidentiality with respect to any information obtained pursuant to this
paragraph and will comply with all federal and state laws and regulations regarding
patient confidentiality.
14
0026242
Core Physician will at all times be a member in good standing of the medical staff of
Kem Medical Center and govemed as such by the medical staff bylaws. This
Agreement may be terminated immediately if Core Physician's membership or
privileges are modified or restricted pursuant to action under the medical staff
bylaws such that services performed by Core Physician are limited or restricted.
Prior to performing duties, Core Physician will: (a) complete an application for
medical staff membership; (b) provide proof of current license from the Medical
Board of California; (c) provide proof of current DEA certificate; and (d) meet with
the medical staff office to ensure appropriate documentation is present for
credentialing of medical staff privileges.
This Agreement may be modified in writing only, signed by the parties in interest at
the time of the modification.
County reserves the right to terminate this Agreement in the event insufficient funds
are appropriated or budgeted for this Agreement in any fiscal year due to closing of
a clinical department or KMC. Upon such termination, County will be released from
any further financial obligation to Core Physician, except for services performed
prior to the date of termination or any liability due to any default existing at the time
this section is exercised. Core Physician will be given thirty (30) days' written notice
in the event that such an action is required by County.
The parties mutually agree to abide by all laws, federal, state and local, and by all
policies of the County of Kern respecting discrimination. The parties shall not
discriminate on the basis of race, color, national origin, age, religion, marital status
or sexual preference.
17. NON-WAIVER

consent of County. Forbearance or indulgence by County in any regard whatsoever
shall not constitute a waiver of the covenant or condition to be performed by Core
Physician. County shall be entitled to invoke any remedy available to County under
this Agreement or by law or in equity despite said forbearance or indulgence.
15
0026243
18. NOTICES
Notices to be given by one party to the other under this Agreement shall be given in
writing by personal delivery, by certified mail, return receipt requested, or express
delivery service at the addresses specified below. Notices delivered personally
shall be deemed received upon receipt; mailed or expressed notices shall be
deemed received four (4) days after deposit. A party may change the address to
which notice is to be given by giving notice as provided above.
Notice to Core Physician: Savita P. Shertukde, M.D.

5401 Lennox Avenue, Apt. 20-G
Notice to County: Peter K. Bryan

Chief Executive Officer
Kern Medical Center
1830 Flower Street
Core Physician will perform the services and duties set forth in this Agreement in a
diligent and conscientious manner in accordance with accepted professional and
ethical standards of the medical profession and the medical staff bylaws of KMC.
20. RELATIONSHIP
County and Core Physician recognize that Core Physician is rendering specialized,
professional services. The parties recognize that each is possessed of legal
knOWledge and skill, and that this Agreement is fully understood by the parties, and
is the result of bargaining between the parties. Each party acknowledges their
opportunity to fUlly and independently review and consider this Agreement and
affirm complete understanding of the effect and operation of its terms prior to
entering into the same.
21. SEVERABILITY
be in conflict with any law of the United States or the state of Califomia, or
otherwise be unenforceable or ineffectual, the validity of the remaining parts, terms,
portions, or provisions shall be deemed severable and shall not be affected thereby,
provided such remaining portions or provisions can be construed in substance to
constitute the agreement which the parties intended to enter into in the first
instance.
16
0026244
22. SOLE AGREEMENT
between the parties relating to the services, rights, obligations and covenants
representations or promises have been made, other than those recited in this
Agreement. No oral promise, modification, change or inducement shall be effective
or given any force or effect.
17
0026245
IN WITNESS TO THE FOREGOING, the parties have executed this Agreement as

of the day and year first written above.

KERN MEDICAL CENTER
By (1;;,~- Q, !~
C~ilJ.-.....peter K. Bryan
IJ Chief Executive Officer
KERN COUNTY PERSONNEL CONTRACT EMPLOYEE

/") .
.>;::7di{ £: {"j". ( \
By V- /
Kay F. Madden, Director /,:'
I I-
S y NIl£·
~C/Vj// "'\
\,
Deputy
AgrcerncntShertuKcc.1G0305
IS
0026246
Exhibit II A"
Job Description
Savita P. Shertukde. M.D.

services to Kem Medical Center and oversees the administration and operation of the
clinical laboratory, blood bank and histology and department administrative services. Key
duties center upon providing high quality, timely and cost effective patient care.

interpret and report of pathology specimens, inclUding but not limited to surgical pathology
specimens, bone marrow specimens. non-gynecologic and gynecologic cytology
1. Performs collection procedures, such as bone marrow aspiration and biopsy, fine
3. Performs professional surgical pathology, cytopathology and hematopathology
4. Performs call coverage on a proportional basis with two other pathologists.
5. Serves as a clinical pathologist and co-laboratory director covering clinical
laboratory and blood bank services.
6. Responsibly examines and interprets clinical microscopy specimens, such as body
fluid. urine. sputum. peripheral blood and other clinical specimens.
7. Completes all service work in a timely. accurate and professional manner.

procedures.
3. Attends other laboratory meetings as appropriate or assigned by the department
chairman.
4. Attends inter-departmental meetings and committees as assigned by the
department chairman and president of the medical staff.
5. Attends general medical staff meetings on a semi-annual basis.
6. Participates in the training of hospital physician residents and medical students,
including the review of active and past case material as required for patient care.
activities, including peer review and quality control functions of the pathology
service.
required.
19
0026247
year on a flexible basis that fulfills the needs of the department.
Medical Record Documentation: Documentation by Core Physician will conform to the

requirements for evaluation and management (ElM) services billed by teaching physicians
set forth in the Medicare Carriers Manual, Part 3, sections 15016 -15018, inclusive.
20
0026248
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27 EXHIBIT 60
28
AGREEMENT FOR PROFESSIONAL SERVICES

CONTRACT EMPLOYEE
(County of Kern - Gian A. Yakoub, D.O.)
This Agreement is made and entered into this 19-1-!? day of ,fun e ,2007,
between the County of Kern, a political subdivision of the state of California (hereinafter
"County"), which owns and operates Kern Medical Center (hereinafter "KMC"), and Gien A.
Yakoub, 0.0. (hereinafter "Core Physician"), a contract employee.
RECITALS
WHEREAS:
A. County is authorized, pursuant to Government Code sections 31000 and

53060, to contract for the furnishing of special services with individuals specially trained
and experienced and competent to perform those services; and
B. County requires assistance in the performance of professional medical

services at f<MC as such services are unavailable from County resources: and
C. Core Physician has special training, knowledge and experience and is

licensed by the state of California to practice medicine and is qualified to render medical
services;
NOW, THEREFORE, it is agreed between County and Core Physician as follows:
Article I.
TERM AND CONDITIONS
'1. TERM
This Agreement shall be effective on July 1, 2007 (tile "Effective Date"), and shall
remain in effect through June 30, 2012, unless earlier terminated pursuant to oUler
provisions of this Agreement.
2. SERVICES
and made a part of this Agreement.
Article II.
COMPENSATION
1. SALARY (BASE)
Core Physician shall be entitled to the following compensation (as defined in Article
II, section 3):
0026175
A. Core Physician will work full-time (i.e., according to AMA survey data for
specialty but no less than an annual average of forty [40] hours per week) and will
be compensated with cash and other value as follows: Core Physician will be paid
Four Thousand Twenty-Four Dollars and Eighteen Cents ($4,024.18) biweekly not
to exceed One Hundred Four Thousand Nine Hundred Eighty-Seven Dollars
($104,987) annually. County will withhold from said daily compensation of Core
Physician all applicable federal, state and local payroll taxes. County will pay the
employer's portion of the hospital insurance portion of Social Security (FICA 2).
sole discretion of County, as is reasonable and convenient for County.
C. No adjustment in compensation will be effective without a written amendment

to this Agreement.
D. The maximum payable under this Agreement, including base salary and
paragraph A, will not exceed Five Hundred Ninety-Nine Thousand Nine Hundred
Thirty-Five Dollars ($599,935) over the five-year term of this Agreement.
E. County will reimburse Core Physician for moving expenses (defined as the
moving of household goods and vehicles) associated in moving from Glendora,
California, to Bakersfield, California, in an amount not to exceed Six Thousand
Dollars ($6,000), payable in arrears. in accordance with County policy.
. 2. OVERALL COMPENSATION STRUCTURE
A. The purpose of this Compensation Plan is to provide market-based

compensation that recognizes a Core Physician's efforts and contributions toward
promoting the mission and values of KMC. Core Physician will be identified as such
in this Agreement.
B. Total compensation for Core Physician will be composed of a base salary

paid by County and potential other income generated due to the individual's status
as a physician. These two sources of income shall be referred to in this Agreement
as Total Core Physician Compensation. The structure for determining Total Core
Physician Compensation shall be referred to in this Agreement as the
Compensation Plan.
C. A Kern County clearing account and a KMC compensation budget unit will be
established to account for all funds generated and received to pay Total Core
Physician Compensation and to pay all expenses associated with this
Compensation Plan. These will act as trust accounts and will be solely used for this
purpose.
0026176

Compensation Plan and will report to the Faculty Practice Board.
E. A Board of Directors will be established to oversee the Compensation Plan

and the Plan Administrator of the Compensation Plan. This Board of Directors shall
be referred to in this Agreement as the Faculty Practice Board. The Faculty
Practice Board will establish bylaws including powers, duties and responsibilities to
be approved both by a simple majority of the Faculty Practice Board and the CEO of
KMC.
F. An assessment for administrative expenses shall be made on Total Core

Physician Compensation to support the administrative expenses of the
Compensation Plan.
(1) The amount or percentage of the assessment shall be

determined annually by the Faculty Practice Board.
(2) Administrative expenses shall include the salary and benefits

for the Plan Administrator and any staff hired by KMC to support the
Plan Administrator, expenses of the Kern County Pension Plan for
Physician Employees, and other business expenses as determined by
the Plan Administrator and the Faculty Practice Board.
G. County agrees to assume liability for and indemnify and hold harmless Core
Physician against all claims, losses, expenses, costs, actions, settlements,
attorneys' fees and judgments incurred by Core Physician or for which Core
Physician becomes liable to pay, arising out of or in connection with or related to the
services rendered or which a third party alleges should have been rendered by Core
Physician pursuant to this Agreement. The obligation of County under this
paragraph shall arise as to all incidents occurring on and after July 1, 2007, and
prior to termination or expiration of this Agreement This paragraph shall survive
the termination or expiration of this Agreement and shall apply to all claims made
during or after the tennination or expiration of this Agreement, which allegedly arise
out of services rendered or which should have been rendered by Core Physician
during the term of this Agreement. The liability coverage of this paragraph shall not
apply to services at sites other than KMC unless approved by the Kern County
Board of Supervisors.
H. County shall indemnify and defend Core Physician to the same extent as
would be afforded to a regular full-time County employee. Said duty of defense and
indemnity shall not apply to intentional or willful misconduct, gross negligence,
dereliction or criminal misconduct on the part of Core Physician. and further shall
not extend to any conduct, actions or activities that do not arise directly from the
performance of this Agreement.
0026177
A. Base salary is compensation paid to Core Physician by County for. (1)

patient care for Medically Indigent Adults (MIA), as defined by California Welfare
and Institutions Code sections 17000 et seq., and adults and juveniles incarcerated
and detained in County facilities; (2) as a safety-net provider, partial compensation
for under-compensated and uninsured patients; (3) teaching; (4) administrative
duties; and (5) other activities approved by the CEO of KMC and the Faculty
Practice Board. County shall fund the clearing account unit biweekly with an
amount equal to Core Physician's biweekly base salary. The base salary, less the
assessment for administrative expenses, will be reported as wages and subject to
all appropriate federal and state taxes. The base salary will be considered the
minimum compensation that Core Physician shall receive under this Compensation
Plan.
B. The base salary will be negotiated between the parties and set out for each
Core Physician at the end of twelve (12) months by means of an amendment to this
Agreement. The base salary will be based on a benchmark salary in proportion to
Core Physician's full-effort commitment.

standard with four salary steps: "A", "B", "C" and "D." There are three
step placement are set forth in the KMC Faculty Practice
Administrative Policies and Procedures Manual.
(2) The Faculty Practice Board shall establish the criteria for
measuring the full-effort commitment. The Department Chairs, with
approval of the Faculty Practice Board, will establish the expected
levels of the criteria to meet a full-effort commitment. The criteria for
measurement of full-effort commitment are set forth in the KMC
Faculty Practice Administrative Policies and Procedures Manual.
(3) Research shall not be considered as part of Core Physician's

full-effort commitment. Research activity will be compensated as set
forth in the KMC Faculty Practice Administrative Policies and
Procedures Manual.
A. Professional fees include all professional fee collections or payments

associated with direct patient care by Core Physician. This shall be referred to in
this Agreement as professional fees. Core Physician's practice group is responsible
for billing and collecting all professional fees for Core Physician's services. Core
Physician will have a separate tax identification number.
0026178
B. Professional fee billing by Core Physician's practice group shall be made by

a billing service company, approved in advance by the Faculty Practice Board, and
based upon minimum performance standards set by the Faculty Practice Board. All
professional fees collected by the billing service for Core Physician shall be paid to
the clearing account. The billing service will maintain individual and practice group
records on professional fee billing and collections and will account for such to the
Plan Administrator.
C. From gross professional fees collected, County shall deduct (i) the
assessment for administrative expenses and (ii) overhead expenses for Core
Physician's practice group.
D. Net professional fees will be paid monthly directly from the clearing account,
as directed by Core Physician or Core Physician's practice group, as a distribution
to Core Physician. Core Physician will be responsible for all appropriate federal and
state taxes and withholding requirements.
5. PROFESSIONAL FEE GUARANTEE
A. Notwithstanding any other provision of this Agreement to the contrary,

County agrees that the amount of net professional fees to be paid by County to
Core Physician will not be less than Seventy-Five Thousand Dollars ($75,OOO),
prorated monthly in twelve (12) equal installments, for a period not to exceed twelve
(12) months from July 1, 2007, the effective date of this Agreement rMonthly
Guarantee"). Such Monthly Guarantee is based on the assumption that the patient
activity of Core Physician will be in accordance with the attached job description
and medical records documentation by Core Physician regarding supervision of
resident physicians and care prOVided will conform to the requirements for
evaluation and management (ElM) services billed by teaching physicians set forth in
the Medicare Carriers Manual, Part 3, sections 15016 -15018, inclusive.
B. Core Physician hereby assigns to KMC and agrees that KMC shall have the
exclusive right to collect gross professional fees with a date of service between the
period July 1, 2007 and June 30, 2008, inclusive, for services provided by Core
Physician under this Agreement for the twelve (12) month period beginning July 1,
2007 through June 30, 2008, or until such time during the twelve (12) month period
as the gross professional fees collected by County for services provided by Core
Physician under this Agreement, net of the cost of the assessment for
administrative expenses and overhead, exceeds Seventy-Five Thousand Dollars
($75,000) ("Guarantee Period"). The gross professional fees collected (i) in any
given month during the twelve (12) month period and (ii) with a date of service
between the period July 1, 2007 and June 30, 2008, inclusive, which exceeds the
Monthly Guarantee and any balance owing from prior months and after allocation of
the assessment for administrative expenses and overhead will be paid monthly
directly from the clearing account, as directed by .Core Physician or Core
Physician's practice group, as a distribution to Core Physician. Core Physician will
0026179
. " 1:07-cv-00026-OWW-TAG
Case Document 277-5 Filed 12/01/2008 Page 43 of 56
be responsible for all appropriate federal and state taxes and withholding
requirements.
C. County will undertake a reconciliation of the professional fees collected, for

services provided by Core.Physician through June 30, 2008, no later than the end
of one hundred twenty (120) days from the conclusion of the Guarantee Period.
Any professional fees collected after completion of the reconciliation, regardless of
when the services were provided, will be paid monthly directly from the clearing
account, as directed by Core Physician or Core Physician's practice group, as a
distribution to Core Physician. Core Physician will be responsible for all appropriate
federal and state taxes·and withholding requirements.
6. OTHER INCOME
A. Other income IS Income generated due to the individual's status as a

professional witness fees, and other nonprofessional fees. All other income will be
paid to Core Physician in accordance with instructions provided by Core Physician.
B. Income generated by Core Physician that is deposited to the Community

Medical Education and Research Foundation (UCMERF") for department
the assessment for administrative expenses.
Article III.
BENEFITS
. The date of employment for the purpose of receiving and accruing benefits listed in
this Article III shall not be affected by the date of this Agreement, but shall be the
date Core Physician was first continuously employed by KMC.
2. HEALTH INSURANCE
County shall provide to Core Physician and eligible dependents medical, dental and
vision insurance as provided to other regular County employees of KMC. Core
Physicians first hired by the County of Kern after April .15, 1997, must pay twenty
percent (20%) of the cost of their health benefits. County may change the benefits
provided under this insurance as such benefits shall change for other County
Agreement.

educational leave.
0026180
A. Holidavs: Core Physician shall be entitled to such holidays as provided to

full-time County employees of KMC. County may change the holidays provided
under this section as such holidays change for other County employees of KMC.
Any such change by County shall not be a breach of this Agreement.
B. Vacation: For each pay period of service, Core Physician shall be credited
with a vacation entitlement of 6.15 hours, for a maximum accrual of 160 hours per
year. Total unused vacation accumulated shall not exceed a maximum of 320
hours. No further vacation entitlement shall be credited so long as Core Physician
County of Kern, accrued vacation entitlement shall be credited to a maximum of 320
hours. Unused vacation benefits will be credited to Core Physician to a maximum
of 320 hours if this Agreement is renewed. Core Physician will be paid for accrued
and unused vacation hours upon termination of employment.
C. Sick Leave: For each pay period of service, Core Physician shall be credited
with sick leave credit for illness or accident of 2.46 hours, for a maximum accrual of
64 hours per year. After five years of employment, Including full-time employment
prior to the effective date of this Agreement, Core Physician shall earn and accrue
sick leave credit for illness or accident at the rate of 3.07 hours for each pay period
of service for an annual accrual of 80 hours per year. Total unused sick leave
credited. If Core Physician is presently employed by the County of Kern, accrued
sick leave shall be credited to a maximum of 1152 hours. Unused sick leave will be
credited to Core Physician to a maximum of 1152 hours if this Agreement is
renewed. Core Physician will not be paid for accrued and unused sick leave upon
termination of employment. County polley applicable to other regular County
employees of KMC regarding use of sick leave shall apply to Core Physician.
D. Educational Leave: Core Physician shall receive 80 hours paid education

leave annually. The first 80 hours shall be credited on the effective date of the Core
Physician's employment contract. On each successive anniversary date of that
contract, an additional 80 hours shall accrue. Education leave must be used within
the year that it is accrued and unused education leave does not accrue to the
following contract year. Unused education leave will not be paid upon termination
of employment. All education leave must be approved in advance of use by Core
Physician's Department Chair and the Medical Director. .
County shall provide Core Physician the right to unpaid leave of absence provided
to other regular County employees of KMC pursuant to County policy. County may
change its policy regarding leave of absence, as its policy for leave of absence shall
change for other County employees of KMC. Any such change by County shall not
be a breach of this Agreement
0026181
5. RETIREMENT PLAN
A. Core Physician shall participate in the Kern County Pension Plan and Trust
Agreement for Physician Employees (the "Plan"), a qualified defined contribution
pension plan, pursuant to the terms of the instrument under which the Plan has
been established (the "Plan Document"), as from time-ta-time amended. County
and Core Physician contributions for each Plan year (as defined in the Plan
County shall contribute as County's required contribution the sum of SeventeeFl
Physician. Core Physician's mandatory employee contributions required under the
amended and restated Plan Document shall be as follows:
(1) If Core Physician's Compensation (as defined under the Plan

Document) was One Hundred Fifty Thousand Dollars ($150,000) or
less during the immediately preceding Plan year, Core Physician's
mandatory employee contribution required under the Plan Document
shall be Four Thousand Dollars ($4,000) for a complete Plan year of
service by Core Physician;
(2) If Core Physician's Compensation was more than One Hundred

and Fifty Thousand Dollars ($150,OOO) but less than One Hundred
and Seventy Thousand Dollars ($170,000) during the immediately
preceding Plan year, Core Physician's mandatory employee
contribution required under the Plan Document shall be Nine
Thousand Dollars ($9,000) for a complete Plan year of service by
Core Physician;
(3) If Core Physician's Compensation was One Hundred Seventy

Thousand Dollars ($170,000) or more but less than One Hundred
Eighty Thousand Dollars ($180,000) dUring the immediately preceding
Plan year, Core Physician's mandatory employee contribution
reqUired under the Plan Document shall be Twelve Thousand Five
Hundred Dollars ($12,500) for a complete Plan year of service by
Core Physician;
(4) If Core Physician's Compensation was One Hundred and

Eighty Thousand ($180,000) or more but less than One Hundred
Ninety Thousand Dollars ($190,000) during the immediately preceding
required under the Plan Document shall be Seventeen Thousand Five
Hundred Dollars ($17,500) for a complete Plan year of service by
Core Physician; and
0026182
(5) If Core Physician's Compensation was at least One Hundred

Ninety Thousand Dollars ($190,000) during the immediately preceding
required under the Plan Document shall be the maximum amount
permitted by Internal Revenue Code section 415(c)(1) reduced by the
County contribution for the account of Core Physician for the Plan
year.
B. Core Physician's mandatory employee contributions shall be withheld by

County from Core Physician's biweekly salary in relatively equal amounts. Total
contributions by Core Physician and County will not exceed the yearly amount
allowed by law; provided, however, if any amounts are contributed in excess of such
permissible amounts, the excess contribution shall be corrected as provided in the
Plan Document or under law. Any changes in the Plan Document will control the
terms of this Agreement. County's required contribution for the account of Core
Physician and Core Physician's mandatory employee contributions are also subject
to all of the transition rules contained in the Plan as it now exists or may be
hereafter amended which may reduce the amount of contribution. The transition
rules include, but are not limited to, those contained in sections 3.3(b), 3.3(d), 3.5,
and 3.6 of the amended and restated Plan Document. Core Physician (together
with all Plan participants) shall be responsible for a pro rata share of the annual
costs of administering the Plan. Due to the manner in which Plan participant
accounts are held and invested, most such costs cannot be paid directly from Plan
assets. To facilitate payment of such costs, County shall advance such costs for so
long as County determines such an arrangement is necessary or desirable. To
offset such costs, County shall reduce its contribution to the Plan for Core Physician
by Core Physician's pro rata share of such costs as determined under the Plan
Document.
C. If the fixed contribution structure described in the immediately preceding

paragraph A results, or would result, in the Internal Revenue Service not issuing a
favorable determination letter for the Plan under the amended and restated Plan
Document, the County reserves the right to substitute another contribution structure
which will be designed to maximize benefit to Core Physician on a cost-neutral
basis to County, and such substitute contribution structure shall control the terms of
this Agreement. County will consult with the Pension Committee, as identified in the
Plan Document, with respect to such substitute contribution structure.
D. County's required contribution and all mandatory employee contributions will

be paid to such financial services firm(s) as determined under the Plan Document.
If, pursuant to the Plan Document, Plan assets are allocated to separate accounts
for each Plan participant, such financial services firm(s) shall be solely responsible
for allocating Core Physician's contribution amount and Investment experience to
his or her account. If, pursuant to the Plan Document, Plan participants control the
investment of their accounts at such financial services firm(s), the investment of
Core Physician's Plan account through such financial services firm shall be
0026183
determined by Core Physician. County shall not be liable for the Investment
experience of Core Physician's Plan account.
E. Core Physician is not eligible to participate in any other retirement plan

established or funded by County for Its employees, including but not limited to the
Kern County Employees' Retirement Association, and this Agreement does not
confer upon Core Physician any right to claim entitlement to benefits under any
such retirement plan(s).
6.- SOCIAL ~ECURITY AND MEDICARE TAXES
Core Physician is exempt from payment of Social Security taxes as the Kern County
Pension Plan for Physician Employees is a qualified alternative to the insurance
system established by the federal Social Security Act. Core Physicians employed
before March 31, 1986, will continue to be exempt from the payment of Medicare
taxes.
Core Physician shall be eligible to participate in the Kern County Deferred

Compensation Plan I on the same basis and to the same extent as full-time County
employees. County may change its Deferred Compensation Plan as it shall change
for other County employees of KMC. Any such change by County shall not be a
breach of this Agreement.
8. KERN$FLEX PLAN
Core Physician shall be eligible to participate In the Kern$Flex Plan I on the same
basis and to the same extent as eligible County employees. County may change Its
Kern$Flex Plan, as its policy for Kern$Flex shall change for other County
Agreement.
A. Core Physician will be reimbursed for approved and necessary expenditures

related to continuing education Including seminar fees, travel and study materials.
Reimbursement for travel, lodging and meals shall be upon the same terms and
rates as allowed for County employees of KMC. Core Physician will be reimbursed
expenses and materials not to exceed two thousand five hundred dollars ($2,500)
per year.
B. Core Physician will be reimbursed for approved and necessary expenditures

related to education and training as directed by KMC. Reimbursement for travel,
lodging and meals shall be upon the same terms and rates as allowed for County
employees of KMC.
10
0026184
C. Reimbursement for expenses incurred in generating other income will be

reimbursed as set forth in Article II, section 5, above.
Article IV.
A. Termination without Cause by Core Physician. Core Physician shall have

the right to terminate this Agreement without penalty or cause, by giving not less
than one hundred twenty (120) days' prior written notice to County.
8. Termination without Cause by County.. It is understood and agreed that

County shall have the right to terminate this Agreement as of the first anniversary
date from the Effective Date without penalty or cause, by giving no less than one
hundred twenty (120) days' prior written notice to Core Physician.
C. Termination for Cause. County may terminate this Agreement at any time for
cause. Cause is defined as a violation of administrative policy of the County of Kern
or KMC, unsatisfactory clinical performance, failure to meet department
accountability or performance standards, or reduction of need. County may
terminate this Agreement based upon reduction of need upon ninety (90) days' prior
written notice to Core Physician.
D. Effect of Termination on Medical Staff Membership. Termination of this

Agreement by County does not per se affect medical staff membership. Actions
affecting medical staff membership and clinical privileges are governed solely by the
E. Effect of Termination Generally. In the event of termination of this

Agreement for any reason, County shall have no further obligation to pay for any
services rendered or expenses incurred by Core Physician after the effective date of
the termination. Core Physician shall be entitled to receive base salary from County
for services satisfactorily rendered, calculated on a prorated basis up to the
effective date of termination.

policy of the County of Kern or KMC, unsatisfactory clinical performance, or failure
to meet department accountability or performance standards. Such corrective
action may include, without limitation, additional training and education, a verbal or
written warning, a written reprimand, suspension with or without pay, and
termination.
11
0026185
B. Corrective action for unsatisfactory clinical performance is governed by the

C. Corrective action is not required if the problem involves a serious ethical or

clinical breach, a violation of law or a serious violation of County of Kern or KMG
policy that merits immediate termination for cause.
Review and appeal of the decision to impose corrective action or terminate for
cause shall follow the process set forth In the KMC Faculty Practice· Board policy
and procedure, titled Corrective Action and Termination Review Process, or the
medical staff bylaws, whichever is applicable.
Article V.
GENERAL PROVISIONS
1. ASSIGNMENT
Core Physician shall not assign or transfer this Agreement or Core Physician's
obligations hereunder, or any part thereof. Core Physician shall not assign any
money due or which becomes due to Core Physician under this Agreement without
the prior written approval of County.
Core Physician agrees to be available to County, at no cost to County, to testify as

an expert witness or otherwise, in the event of litigation under any cause of action
being brought against County or KMC, its directors, officers or employees except
where Core Physician is a named party. KMC will credit the time spent in
preparation and testimony as administrative time as defined in the Compensation
Plan.
It is .understood that Core Physician, in Core Physician's performance of any and all
duties under this Agreement, has no authority to bind County or KMC to any
Paragraph headings in this Agreement are used solely for convenience, and shall
Agreement shall be interpreted for or against a party because that party or its legal
representative drafted such provision, and this Agreement shall be construed as if
jointly prepared by the parties.
12
0026186
5. CHOICE OF LAWNENUE
pursuant to the laws of the state of California. This Agreement has been entered
Kern.
The parties to this Agreement have read and are aware of the provisions of sections '
1090 et seq. and sections 87100 et seq. of the California Government Code relating
to conflict of interest of public officers and employees. All parties hereto agree that
they are unaware of any financial or economic interest of any public officer or
employee of County relating to this Agreement. It is further understood and agreed
that if such a financial interest does exist at the inception of this Agreement, County
may immediately terminate this Agreement by giving written notice thereof. Core
Physician shall comply with the requirements of California Government Code
sections 87100 et seq. during the term of this Agreement.
procedures. Core Physician will keep daily time sheets on forms supplied, and in
routine as established by the Department of which Core Physician is a member,
including but not limited to orientation, attendance at case conferences, supervision,
in service education. patients' rights functions and performance improvement
activities. Core Physician shall submit to drug testing, other laboratory testing and
physical examinations as may be required by County.
Core Physician shall observe and comply with all applicable County. state and
federal laws. ordinances, rules and regulations now in effect or hereafter enacted,
including but not limited to JCAHO, Title 22, California Code of Regulations.
EMTALA, all federal and state billing requirements including Medi-CallMedicaid and
Medicare billing regulations, EEOC, HIPAA. FEHA and Cal-OSHA. Core Physician
will at all time meet state and federal licensure and County personnel qualifications
for the practice of medicine.
9. COUNTERPARTS
This Agreement may be executed simultaneously in any number of counterparts.

each of which shall be deemed an original but all of which together shall constitute
one and the same instrument.
13
0026187
acknowledges that Core Physician will not be deemed a classified employee, or
have any rights or protections under the County's Civil Service Ordinance, rules or
regulations.

other right or remedy herein or by law or equity provided or permitted, but each shall
be cumulative of every other right or remedy given hereunder or now or hereafter
existing by law or in equity or by statute or othelWise, and may be enforced
concurrently or from time to time.
12. MEDICAL RECORDS
Any and all patient medical records and charts produced as a result of either party's
performance under this Agreement shall be and remain the property of County.
During the term of this Agreement, Core Physician shall be permitted to inspect or
duplicate any patient's medical record or chart to the extent necessary to meet
professional responsibilities to such patient or to assist in the defense of any
malpractice or similar claim to which such medical record or chart may be pertinent,
provided such inspection or duplication is permitted and conducted in accordance
with applicable legal requirements and pursuant to commonly accepted standards
of patient confidentiality. Core Physician shall be solely responsible for maintaining
patient confidentiality with respect to any information obtained pursuant to this
paragraph and will comply with all federal and state laws and regulations regarding
patient confidentiality.
Core Physician will at all times be a member in good standing of the medical staff of
KMC and governed as such by the medical staff bylaws. This Agreement may be
terminated immediately if Core Physician's membership or privileges are modified
or restricted pursuant to action under the medical staff bylaws such that services
performed by Core Physician are limited or restricted. Prior to performing duties,
Core Physician will: (a) complete an application for medical staff membership; (b)
provide proof of current license from the Medical Board of California; (c) prOVide
proof of current DEA certificate; and (d) meet with the medical staff office to ensure
appropriate documentation is present for credentialing of medical staff privileges.

This Agreement may be modified in writing only, signed by the parties in interest at
the time of the modification.
14
0026188
County reserves the right to terminate this Agreement in the event insufficient funds
are appropriated or budgeted for this Agreement in any fiscal year due to closing of
a clinical department or KMC. Upon such termination, County will be released ffOro
any further financial obligation to Core Physician, except for services performed
prior to the date of termination or any liabnity due to any default existing at the time
this paragraph is exercised. Core Physician will be given thirty (30) days' prior
written notice in the event that County requires such an action.
The parties mutually agree to abide by all laws, federal, state and local, and by all
policies of the County of Kern respecting discrimination. The parties shall not
discriminate on the basis of race, color. national origin, age, religion, marital status
or sexual preference.
17. NON-WAIVER

consent of County. Forbearance or indulgence by County in any regard whatsoever
shall not constitute a waiver of the covenant or condition to be performed by Core
Physician. County shall be entitled to invoke any remedy available to County under
this Agreement or by law or in equity despite said forbearance or indulgence.
18. NOTICES
Notices to be given by one party to the other under this Agreement shall be given in
writing by personal delivery, by certified mail, return receipt requested. or express
delivery service at the addresses specified below. Notices delivered personally
shall be deemed received upon receipt; mailed or expressed notices shall be
deemed received four (4) days after deposit. A party may change the address to
which notice is to be given by giving notice as prOVided above.
Notice to Core Physician: Notice to County:
Gian A. Yakoub, D.O. Kern Medical Center

529 N. Wildwood Avenue 1830 Flower Street
Glendora. California 91741 Bakersfield, California 93305
Attn.: Chief Executive Officer
Core Physician will perform the services and duties set forth in this Agreement in a
diligent and conscientious manner in accordance with accepted professional and
ethical standards of the medical profession and the medical staff bylaws of KMC.
15
0026189
20. RELATIONSHIP
County and Core Physician recognize that Core Physician is rendering specialized,
professional services. The parties recognize that each is possessed of legal
knowledge and skill, and that this Agreement is fully understood by the parties, and
is the result of bargaining between the parties. Each party acknowledges their
opportunity to tully and independently review and consider this Agreement and
affirm complete understanding of the effect and operation of its terms prior to
entering into the same.
21. SEVERABILITY
be in conflict with any law of the United States or the state of California, or
otherwise be unenforceable or ineffectual, the validity of the remaining parts, terms,
portions, or provisions shall be deemed severable and shall not be affected thereby,
provided such remaining portions or provisions can be construed in substance to
constitute the agreement which the parties intended to enter into in the first
instance.
22. SOLE AGREEMENT
between the parties relating to the services, rights, obligations and covenants
representations or promises have been made, other than those recited in this
Agreement. No oral promise, modification, change or inducement shall be effective
or given any force or effect.
16
0026190
IN WITNESS TO THE FOREGOING, the parties have executed this Agreement as

of the day and year first written above.
COUNTY OF KERN CONTRACT EMPLOYEE
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Chalrnlan Gran A. Yakoub, 0.0/
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Board of Supervisors
APPROVED AS TO CONTENT:
KERN MEDICAL
! -,
CENTER
' .t ,i
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By !-, j .j .
Paul J. Hensler
Chief Executive Officer
KERN COUNTY PERSONNEL
By " :~~.,,-}i'(~L",jL<'/" ""~/",__,__ ,,-""R",I""/
Lawrence D. Espinosa ,':; /j ,.;/
Interim Director
!\greement.Yilkoub.053007
17
0026191
Exhibit "A"
Job Description
Gian A. Yakoub, D.O.

services to Kern Medical Center and oversees the administration and operation of the
clinical laboratory, blood bank and histology and department administrative services. Key
duties center upon providing high quality, timely and cost effective patient care.

interpret and report of pathology specimens, including but not limited to surgical pathology
specimens, bone marrow specimens, non-gynecologic and gynecologic cytology
1. Performs collection procedures, such as bone marrow aspiration and biopsy, fine
3. Performs professional surgical pathology, cytopathology and hematopathology
4. Performs call coverage on a proportional basis with two other pathologists.
5. Serves as a clinical pathologist and co-laboratory director covering clinical
laboratory and blood bank services.
6. Responsibly examines and interprets clinical microscopy specimens, such as body
fluid, urine, sputum, peripheral blood and other clinical specimens.
7. Completes all service work in a timely, accurate and professional manner.

procedures.
3. Attends other laboratory meetings as appropriate or assigned by the department
chairman.
4. Attends inter-departmental meetings and committees as assigned by the
department chairman and president of the medical staff.
5. Attends general medical staff meetings on a semi-annual basis.
6. Participates in the training of hospital physician residents and medical students,
including the review of active and past case material as required for patient care.
activities, including peer review and quality control functions of the pathology
service.
required.
18
0026192
year on a flexible basis that fulfills the needs of the department.
Medical Record Documentation: Documentation by Core Physician witl conform to the

requirements for evaluation and management (ElM) services billed by teaching physicians
set forth in the Medicare Carriers Manual, Part 3, sections 15016 -15018, Inclusive.
19
0026193

3 Phone: (213) 992-3299
Fax: (213) 596-0487
6
7
10 FRESNO DIVISION
12 Plaintiff, DECLARATION OF DAVID F. JADWIN IN
[Fed. R. Civ. P. 56(a)]
16 Courtroom: 3
18
19
The undersigned hereby declares as follows:
20
1. I am the Plaintiff in this action. I was employed by Defendant County of Kern from
21
October 2000 to October 2007.
22
2. I am making this declaration in support of Plaintiff’s Opposition to Defendants’ Motion
23
Summary Judgment. I have personal knowledge of the matters set forth below and I could and would
24
competently testify thereto if called as a witness in this matter.
25
3. I have never threatened to take a leave of absence until the KMC medical staff and
26
administration apologized to me. Nor did I ever communicate or suggest any intention to do that to
27
Philip Dutt or anyone else.
28
DECLARATION OF DAVID F. JADWIN IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 1
1 4. I spoke with Peter Bryan in early January 2006 to request a medical leave. He specifically
2 approved my request and told me I could go on my reduced work schedule leave immediately. He told
3 me he would take care of having Human Resources deliver to methe paperwork required for filing of the
4 request. . As it turned out, he either did not communicate this adequately to Human Resources or
5 Human Resources did not act appropriately as I did not receive the paperwork until April 2006. As soon
6 as I obtained the medical leave paperwork, I promptly filled it out and submitted it to Human Resources.
7 I also promptly obtained a medical leave certification from my therapist and submitted that within a
8 short time after. I never needed nor received any prompting from Human Resources to submit the leave
9 request forms and medical certification.
10 5. I issued Fine Needle Aspiration (“FNA”) diagnoses in final form and released for
11 viewing by clinicians PRIOR to sending reports out to UCLA for confirmatory review. When the
12 Pathology department later received UCLA’s confirmatory reports, they were entered them into the
13 KMC computer system, which automatically updates the “Completed” report date to reflect the date of
14 the last modification to any report. The “Completed” date is NOT the date when I issued my own
15 diagnosis to clinicians, it is more analogous to a “last modified” date. This apparent confusion over
16 terminology led to suspicions that I was somehow fraudulently withholding my own diagnoses until
17 UCLA issued their reports so that I could ensure 100% congruence. Nothing could be further from the
18 truth. Had my accusers come to me with their suspicions, I would have been able to explain all this very
19 easily.
20 6. Ms. Figueroa will testify that she did not and does not agree with Philip Dutt’s accusation
21 that I improperly left out two long blades and a scalpel on the morning of 12/7/06. In fact, I was just
22 beginning to prepare my workstation for that day’s work and had set the blades and scalpel out for
23 anticipated work purposes. I was not “finished” with them yet, and would not be for possibly several
24 more hours. The department protocol specifies that sharps should not be left on the cutting board
25 (overnight) when the pathologist is finished grossing. Gallegos could not recall any instances of sharps
26 being left out.
27 7. I never told Scott Ragland that “the only important information on that [October 12, 2005
28
1 Cancer Conference] case was mine”. Rather, I had said that there were NO relevant clinical or radiologic
2 issues to be discussed in this particular case and that all decisions and discussion centered upon the
3 accuracy of the pathologic diagnosis. There were no pertinent clinical history or findings and there were
4 no radiologic findings to present. Therefore all subsequent clinical discussion would be dependent upon
5 the patient’s pathologic diagnosis, which had many processing errors and discordant final diagnoses
6 rendered by four different pathology services.
7 8. At the 10/18/05 meeting, just days after the October Conference, Scott Ragland began by
8 sarcastically saying “So Dr. Jadwin, Mr. Perfect, here we are again, having problems with your behavior
9 again” He said that he had been chosen to give me the letter of reprimand.. I then said that I wanted
10 Peter Bryan to be immediately present and was told by Eugene Kercher that this was a “medical staff
11 issue” that did not need to involve the Bryan..Kercher then inappropriately shouted in a demeaning
12 manner: : “David if you needed more time [for your presentation], why didn’t you tell Dr. [Albert]
13 McBride beforehand?” Ragland appeared to be using the occasion to exact revenge on me for a recent
14 confidential physician health report I had made regarding his suspected impaired behavior, and
15 subsequently learned that Ragland had been told of my reporting, contrary to confidential procedure.
16 Ragland read a letter of reprimand aloud to me in a continued sarcastic derogatory tone, which stated
17 that letters of dissatisfaction from three conference participants would be placed in my file. When I
18 asked to see the letters of dissatisfaction, Irwin Harris said that I could not see them. When I turned to
19 address Kercher, as the President of the Medical Staff and the senior person in the room, Ragland
20 condescendingly barked at me, “Don’t look at him, look at me; I am the person you need to talk to!” and
21 “Noooo, don’t look at [Kercher] look at me. That’s riiight, you don’t need to look at him, you need to
22 look at me.” It was utterly humiliating. Kercher and Ragland did not attend the October conference and
23 were obviously acting on the basis of Harris’s and Abraham’s account of what happened at the October
24 Conference. Kercher, Ragland, and Harris never gave me an opportunity to give my side of the story or
25 otherwise defend myself against their accusations, and had no interest in hearing anything I would have
26 said had I been anything other than speechless by the events that transpired.
27 9. Plaintiff issued a proctoring report on Philip Dutt on 1/18/06, which was completed just
28
1 several weeksafter I had hired him. The proctoring period is analogous to a probationary period during
2 which a preliminary assessment is made about the new staff’s ability to manage specimens in a
3 competent manner. Given the magnitude of required knowledge to handle hundreds of different
4 situations clinical and diagnostic dilemmas, it is not possible to make a full assessment of all
5 competencies the candidate might require, which instead is measured by ongoing peer review..
6 Regardless of proctoring, all pathology work undergoes continuous rigorous quality peer review to
7 ensure that the candidate and all other members of the department handle cases appropriately. As I
8 worked with Dutt more closely during the ensuing months, I was able to form a clearer, and very
9 different, opinion of his performance and determined that Dutt was insecure in his pathology duties and
10 functioned more like a junior pathologist or even a senior resident, than as a pathologist with several
11 years experience. For instance, in an environment where there are, frankly, few difficult or challenging
12 pathology cases, I eventually realized that Dutt submitted roughly 15% of his cases to a peer as
13 consultation to request help with making a diagnosis (category A/all cases); that only roughly 5% of his
14 cases underwent retrospective review (category C/all cases, indicating a reluctance to sign a case out
15 without oversight; that roughly 15% of his cases received additional diagnostics and/or processing
16 comments from other pathologists,both ((B1+C1)/(all B + all C) and (B1/all B). Based on my lengthy
17 experience as a pathology chairperson, I believe Dutt had many more consultations, prospective reviews
18 and discrepancies (As, Bs B1s and C1s) than would be expected for a senior or experienced
19 pathologist.. Dutt was often hesitant to exercise independent judgement and, when acting alone without
20 my oversight late in 2006, had made several professional errors.
21 10. Around 11/1/06, I noticed that fallopian tubes specimens were left sitting on the counter,
22 without a requisition and unprocessed for several days.. I recorded this discovery in the exceptional
23 event log and reported it to Dutt. He responded by erroneously implying that I was responsible because I
24 had been interfering with Vangie Gallegos’s work.
25 11. Around 11/6/06, I was not interfering with Gallegos’s work or in her work area, nor was I
26 creating more work for everybody as I was accused of doing. At no time did I do this.
27 12. I disagree with Dutt that it would be demeaning and time consuming to have an employee
28
1 clock in and out. Further, I did not ask that the assistant clock in and out, but rather inform me when she
2 was going to be absent from the room for prolonged periods of time, a protocol that had been in place
3 for years..
4 13. On or about 11/17/06, I was not escalating the situation with Dutt, blaming others or
5 attacking them. To this day, I do not know the basis for Dutt’s accusations and believe them to be
6 baseless. Whenever I asked him to provide more details, he refused. As for the “rush case” that Dutt
7 accused me of missing, to this day I do not know the basis for Dutt’s accusation and believe the
8 accusation is trivial if not even baseless.
9 14. I disagree with Dutt’s accusations regarding proctoring for FNA and bone marrow
10 procedures, directed toward me in an angry and inappropriate maner.My position is that superficial FNA
11 procedures have no serious complications and are simpler to perform than drawing blood, which does
12 not require credentialing. Proctoring of Dr. Shertudke was performed to the best of my knowledge and
13 would be subsequently evaluated, none-the-less by monitoring the adequacy of her specimen collections.
14 Further, performing a sternal marrow collection using an appropriate needle guard is a safe and routinely
15 performed on children.
16 15. On or about 11/22/06, I did not criticize Savita Shertukde in front of others, particularly
17 so as to demean her as Dutt was implying. I was never told what it was that I was supposed to have said
18 or given an opportunity to discuss this incident with Dr. Shertudke. As for Dutt’s attacks on my
19 character, I believe them to be baseless. Under my chairmanship, the Pathology department ran well and
20 harmoniously without an unusual number of complaints from members.
21 16. On or about 12/4/06, I did not criticize Shertukde’s diagnosis without consulting others
22 first, refuse to get outside consultation on a difficult case, or fail to remove sharps from the cutting area
23 when done. Dutt’s accusations were baseless.
24 17. On or about 12/5/06, I did not engage in “uncooperativeness” with Dutt, nor did I fail to
25 adhere to a “chain of command”, a term that did not exist in the department during my tenure as
26 department chair. Dutt’s accusations were baseless.
27 18. Dr. McBride suggested substituting repeat prostate needle biopsies for the the radical
28
1 prostatectomy with repeat prostate needle biopsies which turned out to be negative, when I expressed
2 my concern regarding the equivocal diagnosis of cancer. The following day Dutt came into my office
3 and sheepishly said that I “had probably done this patient a great service”. Afterwards, Dutt began to
4 focus on and dispute the semantics of the diagnosis, rather than the propriety of the treatment course for
5 the patient (additional biopsies). He became obsessed with proving that the diagnosis was in fact cancer
6 and, ultimately, hoping to prove me wrong. The email he sent me on 12/6/06 is remarkable for its
7 pettiness and malice toward me. I never “stormed into [Dutt’s] office and said angrily ‘this isn’t cancer,
8 she missed it.’”. I didn’t “terminate” the conversation with Dutt as he suggests. Dutt’s accusations
9 contained in his email are too numerous to refute individually. In sum, I disagree with every accusation
10 contained in his email to me of 12/6/06 (Bates DFJ01476). Even had the repeat biopsies revealed cancer,
11 I believe that the equivocal presence of cancer should have required confirmation by a prostate cancer
12 expert and likely should have required repeat biopsies before subjecting a patient to a debilitating
13 prostatectomy. Further detailed conversation with the urologist should have been undertaken by the
14 original pathologist to make sure that the surgeon fully understood how equivocal the original diagnosis
15 was (2% in one out of 12 needle samples). I have subsequently learned that the patient, once informed
16 about the equivocal presence of cancer, elected not to proceed with radical prostatectomy based upon
17 subsequent biopsies which came back negative for cancer. I found no documentation in the medical
18 records that such discussion with the patient had occurred prior to my bringing this issue to the attention
19 of Dr. McBride. Had I not intervened that day and told McBride to consider delaying the radical
20 prostatectomy, I believe a radical prostatectomy based upon questionable pathology would have
21 occurred. That is the point which Dutt was disregarding in his fervor to retaliate against me.
22 19. On or about 12/6/06, Dutt did not “counsel” me for refusing to send out a case, nor did I
23 refuse to send out, any case for consultation that turned out to be missed endometrial cancer, for which I
24 have no recollection and was not provided an opportunity to review even to date. Nor did I then do the
25 reverse and start pushing “a lot of cases out for consultation”. Dutt’s accusations were baseless. My
26 position was that prior to sending a case out for consultation all clinical information and pathology
27 materials should be assembled and sent with the original specimen(s), so as to give the consultant all
28
1 relevant information.
2 20. On or about 12/7/06, I did not “command” Figueroa to treat placentas so as to
3 countermand Dutt’s order that only Gallegos was to work with placentas. Dutt’s acussation is baseless.
4 21. I was not uncooperative with Dutt after returning from leave on 10/4/06. Rather, I found
5 myself the target of an unending flurry of unsubstantiated allegations and generalized personal attacks
6 from Dutt. Dutt’s emails to me literally seemed to have no end, as if he were spending his day drafting
7 them in his office to attack me. I found Dutt’s behavior following my return to KMC in October 2006 to
8 be bizarre, harassing and unexplicably hostile compared to the cordial working relationship we had prior
9 to my medical leave.
10 22. After my return from leave, I was not creating a hostile work environment. Dutt’s
11 accusation was baseless.
12 23. I did not try to avoid conversations with Dutt. We had several email exchanges which
13 demonstrated my willingness to communicate with him and work out the many accusations he was
14 making against me. I did not make excuses to leave the room or hospital so as to evade communicating
15 with Dutt. If Dutt was finding it difficult to talk with me, the problem did not lie with me. I disagree
16 with Dutt’s implication that it did. As for peer review, on numerous occasions, I asked Dutt to give me
17 access to slides and disclose to me so-called diagnostic errors found during peer review of my case
18 diagnoses. He refused to allow me to review these slides, which is contrary to standard peer review
19 principle.. Dutt’s contention that he had no choice but to send my reports to the Peer Review Committee
20 because I wasn’t permitting him to speak with me is patently absurd.
21
22 I declare under penalty of perjury under the laws of the State of California and the United States
23 that the foregoing is true and correct.
24
Executed on: December 1, 2008
25
26
27
28

3 Phone: (213) 992-3299
Fax: (213) 596-0487

6
7
10 FRESNO DIVISION
12 Plaintiff, PLAINTIFF’S OBJECTIONS TO EVIDENCE

SUBMITTED IN SUPPORT OF
13 v. DEFENDANTS’ MOTION FOR SUMMARY
JUDGMENT
14 COUNTY OF KERN, et al., [Fed. R. Civ. P. 56(a)]
15 Defendants. Date: January 12, 2009

Time: 10:00
16 Judge: Hon. Oliver W. Wanger
Courtroom: 3
17
Complaint Filed: January 6, 2007
18 Trial Date: March 24, 2009
19
20
21
22
23
24
25
26
27
28

Π’S OBJECTIONS TO EVIDENCE SUBMITTED IN SUPPORT OF ∆’S MOTION FOR SUMMARY JUDGMENT 1
1
Plaintiff DAVID F. JADWIN, D.O., contends Defendants have failed to lay any foundation
2
whatsoever for any of the over 1,000 pages of documents or deposition transcripts which they attach as
3
exhibits to their Motion. “It is well settled that only admissible evidence may be considered by the trial
4
court in ruling on a motion for summary judgment.” Beyene v. Coleman Sec. Services, Inc., 854 F.2d
5
1179, 1181-1182 (9th Cir. 1988) (citing to Fed.R.Civ.P. 56(e)). A proper foundation must be established
6
for documents used to support or oppose summary judgment motions. Orr v. Bank of America, NT & SA
7
(9th Cir. 2002) 285 F3d 764, 778. As with other documentary evidence, discovery documents must be
8
properly authenticated (e.g., by affidavit or declaration establishing accuracy of copy attached). Id. at
9
774. A portion of a deposition transcript must be properly authenticated by showing the deponent’s
10
name and attaching the court reporter’s certification. Ibid.
11
In submitting their Motion, Defendants have failed to lay any foundation whatsoever for any of
12
the over 1,000 pages of documents or deposition transcripts which they attach as exhibits to their
13
Motion. Other than 5 “sham” declarations intended only to controvert sworn deposition testimony,
14
Defendants have failed to submit a single affidavit or declaration. The deposition transcripts are
15
condensed transcripts intended only for informal attorney use which are not accompanied by reporter
16
certifications. Plaintiff separately submits evidentiary objections to Defendants’ Motion.
17
The complete absence of admissible evidence justifies denial of Defendants’ Motion.
18
Plaintiff hereby submits the following additional objections to, and moves to strike all, evidence
19
submitted by Defendants in support of their Motion for Summary Judgment, including the following:
20
Δ’s MATERIAL FACT Δ’s EVID. Π’S OBJECTIONS TO EVIDENCE
21
1. First Employment Contract between DFJ00025- None.
22 Kern Medical Center (hereinafter 00046
referred to as KMC) and David F.
23 Jadwin, D.O. (hereinafter referred to
as Jadwin) entered into on October 24,
24 2000.
25 2. Employment Verification letter of DFJ00358 None.
3/3/05 (giving original date of hire as
26 December 3, 2000).
27
28

1 3. Memo from Bryan to Jadwin dated 0000202- Lacks foundation. Document not
8/14/01 (showing Jadwin received the 203 authenticated. Document not complete –
2 Medical Staff Bylaws). wrong bylaws effective as of 12/13/04
attached.
3
4. Medical Staff Bylaws, approved as 0000272- None.
4 of 12/13/04. 358
5 5. Exhibit A to Employment Contract DFJ00046 Lacks foundation. Document not

(stating responsibilities and duties of authenticated. Document not complete, the
6 the pathology dept. chair are set out in exhibit is provided without the contract.
the KMC Medical Staff Bylaws,
7 sections 6. through 6.4-3). Hearsay. Best evidence rule.
8 6. Second Employment Contract 0001479- None.

between KMC and Jadwin was 1499
9 effective October 5, 2002.
10 a) Exhibit A to the Second None.
Employment Contract: Job
11 Description, David F. Jadwin, M.D.,
Pathology Chairman.
12
7. Letter to Peter Bryan (hereinafter DFJ00723 Document not complete, second page is
13 referred to as Bryan) from Jadwin, missing.
dated 1/9/06, requesting
14 administrative leave with pay until
hostile environment is corrected. He
15 demanded action on 1) sending
transfusion Product Chart Copies
16 (hereinafter referred to as PCCs) to the
blood bank; 2) KMC’s alleged lack of
17 compliance with their weekly
oncology conferences by reporting
18 themselves (KMC) to the American
College of Surgeons (hereinafter
19 referred to as ACS); 3) reviewing time
limits on pathology presentations; and
20 4) implementing protocol of collection
of Fine Needle Aspiration (hereinafter
21 referred to as FNA) specimens.
22
23
24
25
26
27
28

1 7A. Dutt recalled Jadwin’s threat of Dutt Depo., The transcript is not authenticated. It is not a
taking a leave of absence until the 8/20/08, certified copy, it is a condensed transcript for
2 medical staff and the administration pgs. 52:5- informal attorney use. No reporter certification
apologized to him. 53: 18 is attached to the transcript.
3 Improper Speculation as to Plaintiff’s intent.
4 Misstates the testimony. Dutt was speculating:
5 Q. He told you, I'm going to take a leave of

absence to pressure the administration to
6 apologize?
A. What he said was I'm going to take a leave
7 of absence. That occurred in the context where
he was upset about a letter he had received
8 regarding the October tumor conference, and
he kept saying all I want is an apology.
9 Q. So he didn't say the exact words I'm going
to take a leave absence in order to force the
10 administration to give me an apology? Is that
what he said?
11 A. He didn't use those exact words.
[Lee Opp. Decl., Exh. 47 (Dutt depo, 52:16-
12 23)]
[…]
13 A. I think he was trying to -- he thought he
could pressure the medical staff and the
14 administration into giving him an apology. All
he wanted was an apology.
15 [Id. at 53:8-10]
8. Plaintiff’s email to/from medical DFJ02422- Irrelevant and immaterial.
16 executive recruiters in January 2006. 2459
17 a) “You know, I wish I could go back Jadwin The transcript is not authenticated. It is not a
because I enjoyed that job. I Depo., certified copy, it is a condensed transcript for
18 mentioned multiple times during my 10/21/08, informal attorney use. No reporter certification
recruitment and elsewhere that that pg. 1087:9- is attached to the transcript.
19 was the last position that I wanted to 17
take, that I saw myself retiring out of Irrelevant and immaterial.
20 that position and not moving. And I
was very disappointed when-when
21 things-when people that were in a
position to do the right thing didn’t do
22 the right thing.”
23 9. Sandi Chester effectively refutes Chester The transcript is not authenticated. It is not a
any argument that Jadwin’s letter to Depo., certified copy, it is a condensed transcript for
24 Peter Bryan of January 9, 2006 was 8/28/08, informal attorney use. No reporter certification
notice to KMC that Jadwin needed pgs. is attached to the transcript.
25 medical leave or that, by implication, 135:12137:
Jadwin was absolved of the 6 Pg. Testimony lacks foundation. Improper legal
26 responsibility to notify HR that he was 136:17-18 conclusion as to notice and responsibility to
taking a leave of absence. As Sandi notify HR re leave of absence. Improper
27 Chester said “I mean, anybody can opinion testimony.
write a letter.”
28 Irrelevant and immaterial.

1 10. Certification of Health Care DFJ00726 None.

Provider dated 1/13/06 for Jadwin.
2 Includes the duration of the medical
condition (2-3 months) and the
3 expected date to return to work
(3/16/06). It gives the date the medical
4 condition commenced as 12/16/05.
5 11. Jadwin did not communicate with Chester The transcript is not authenticated. It is not a
Human Resources (hereinafter Depo., certified copy, it is a condensed transcript for
6 referred to as HR) at all, HR 8/28/08, informal attorney use. No reporter certification
discovered that Jadwin ------ had pgs. 75:19- is attached to the transcript.
7 unilaterally assigned himself to 1 to 2 76:10
workdays per week but, per policy, an Misstates the testimony in all respects.
8 employee must use vacation, sick
time, or leave of absence when not Irrelevant and immaterial.
9 working full-time. It was HR that
brought Jadwin into compliance with
10 County policy by putting him on leave
of absence.
11
12. KMC had to designate Jadwin’s Bryan The transcript is not authenticated. It is not a
12 medical leave retroactively because Depo., certified copy, it is a condensed transcript for
Jadwin was late in giving appropriate 8/14/08, informal attorney use. No reporter certification
13 requests. pgs. 195:9- is attached to the transcript.
196: 14
14 Irrelevant and immaterial.
13. Jadwin’s submission of his Chester The transcript is not authenticated. It is not a
15 healthcare provider’s certification was Depo., certified copy, it is a condensed transcript for
not timely and was only provided 8/28/08, informal attorney use. No reporter certification
16 upon prompting from HR. pgs. 113 is attached to the transcript.
:23- 114: 12
17 Lacks foundation. Speculative as to who put
Plaintiff on leave and whether self-imposed.
18
Irrelevant and immaterial.
19 14. Certification of Health Care DFJ01150 None.
Provider, dated 4/26/06, stating that
20 Jadwin’s medical condition goes back
to 10/30/03. The Certification states
21 that Jadwin requires “part-time or less
to avoid worsening of his serious
22 medical condition.”
23 15. Jadwin’s Request for Leave of DFJ00746 None.
Absence (hereinafter referred to as
24 LOA), dated 3/2/06, notes that the
LOA started on 12/16/05.
25
26
27
28

1 16. KMC’s responsive document to DFJ00747- Irrelevant and immaterial.

the LOA request, dated 3/2/06, 748
2 indicating that the leave ends on
3/15/06 and stating “ ... have the right
3 to be reinstated to the same or an
equivalent job with the same pay,
4 benefits and terms and conditions of
employment.”
5
17. E-mails dated 3/16/06. One to DFJ00752- None.
6 Peter Bryan from Jadwin telling him 753
that he (Jadwin) will take Bryan’s
7 suggestion to take 2-3 months
additional leave; the other to Dr.
8 Kercher from Jadwin telling him that
he (Jadwin) is having surgery and will
9 I need 2-3 months of additional leave
for the surgery and requesting
10 apologies from Dr. Ragland
(President-elect), Dr. Abraham and
11 Dr. Taylor and an investigation into
Dr. Roy.
12
18. Notice from Human Resources to DFJ00796 Irrelevant and immaterial.
13 Jadwin, dated 4/20/06, that his leave
of absence expired on 3/15/06.
14
19. Jadwin’s request for Leave of DFJ01158 Irrelevant and immaterial to Defendants'
15 Absence Extension, dated 4/26/06, has argument that Plaintiff failed to give notice of
a starting date of 3/15/06 and an his need for extension of medical leave prior to
16 ending date of 9/16/06. being placed on Forced FT Leave by Bryan as
of 4/28/06. Irrelevant to excusing Defendant's
17 liability under any of Plaintiff's counts.
18 20. Memo from Bryan to Jadwin, DFJ01121 None.
dated 4/28/06, notifying him that his
19 leave would be up on 6/16/06 and he
either returns fulltime or resigns. Also,
20 it notes that Jadwin was provided a
medical leave history, along with the
21 calculations and policies about his
medical leave.
22
21. Bryan noted that he gave the Bryan The transcript is not authenticated. It is not a
23 option to Jadwin whether to go on Depo., certified copy, it is a condensed transcript for
full-time leave, although full-time 8/14/08, informal attorney use. No reporter certification
24 leave was preferable to Bryan. Bryan pgs. 250: is attached to the transcript.
asserts that it was Jadwin’s decision to 15- 251:6,
25 go on fulltime leave and that Jadwin Exhibit 303
never communicated with Bryan any
26 contrary intent.
27
28

1 22. Memo from Bryan to Jadwin dated Bryan The transcript is not authenticated. It is not a
4/28/06, summarizing a meeting held Depo., certified copy, it is a condensed transcript for
2 with Bryan, Karen Barnes, Steve 8114/08, informal attorney use. No reporter certification
O’Connor, and Jadwin. The meeting pgs. is attached to the transcript.
3 was held to “insure that [Jadwin] had 240:9244: 2,
all information available concerning Exhibit 303
4 his status and what was possible and pg 243 :22-
not possible according to County 25
5 policies for leaves of absence.” It was pg.244:1-2
not a disciplinary meeting.
6
23. A letter to Bryan from Jadwin, Bryan The transcript is not authenticated. It is not a
7 dated May 31, 2006, where Jadwin Depo., certified copy, it is a condensed transcript for
requests more time to make the 8/14/08, informal attorney use. No reporter certification
8 decision by June 16th of whether to pgs. is attached to the transcript.
return full-time or resign. Bryan did 248:16249:
9 not have the authority to make an 9 Exhibit Improper legal conclusion. Improper opinion.
exception to County policy by 311
10 extending leave beyond the maximum
period granted for leave. Jadwin
11 wasn’t being asked to return full-time
on June 16th, he just had to give his
12 decision to return full-time by June
16th. He did not do that.
13
24. Letter from Peter Bryan to Jadwin, DFJ01141 None.
14 dated 6/14/06, granting him Personal
Necessity Leave of 90 days, pursuant
15 to Rule 1202.2, but only for his
employment with KMC, not for his
16 position as pathology department
chair.
17
25. Bryan artfully explained why the Bryan The transcript is not authenticated. It is not a
18 Chair of the Department of Pathology Depo., certified copy, it is a condensed transcript for
needs to be present full-time. “It’s not 8/14/08, pg. informal attorney use. No reporter certification
19 just the task orientation of handling a 216:3·22. is attached to the transcript.
duty. It’s being present within the
20 organization to influence the Speculation as to what is “inferred” in a
organization’s policies and practices. position being “full-time”.
21 Organizations tend to drift without the
constancy of leadership, because that
22 is part of what a leader does is monitor
the performance to ensure things stay
23 on track, and without that constant
dialogue present, you can find
24 yourself getting off track. In the
medical arena when patient care is
25 involved, you don’t allow it to get to
the point where you don’t have the
26 leadership necessary. So that’s
inferred in it being a full-time
27 position.”
28

1 a) Responsibilities and duties of the DFJ00046 Lacks foundation. Document not

pathology dept. chair are set out in the authenticated. Document not complete, the
2 KMC Medical Staff Bylaws, sections exhibit is provided without the contract.
6. through 6.4-3.
3 Hearsay. Best evidence rule.
4 26. Mortgage verification of DFJ01343 No foundation. Unauthenticated. Hearsay.

employment for Jadwin, dated
5 6/22/06, noting that the probability of Irrelevant and immaterial.
continued employment for Jadwin was
6 good and he was okay to return to
work when well.
7
27. Letter from Dr. Harris (writing on 0001424 No foundation. Unauthenticated.
8 behalf of Bryan) to Jadwin, dated
6/26/06, stating that he (Jadwin) has
9 been seen in and around KMC and
that while he (Jadwin) is on leave, he
10 is not to enter the hospital except for
seeking medical attention. He is also
11 not to contact any employee or faculty
member of KMC while on leave.
12
28. In his letter of June 14, 2006, Bryan The transcript is not authenticated. It is not a
13 Bryan notifies Jadwin that Jadwin will Depo., certified copy, it is a condensed transcript for
be removed as chair and tells Jadwin 8/14/08, pg. informal attorney use. No reporter certification
14 to call him if he has questions. Bryan 257:9-15 is attached to the transcript.
states that put the burden of
15 challenging the action or asking for Improper conclusion as to burden. Improper
reconsideration on Jadwin who never opinion.
16 called him about the letter.
17 29. According to Exhibit 303, Bryan The transcript is not authenticated. It is not a
Jadwin’s leave and all allowances by Depo., certified copy, it is a condensed transcript for
18 the County expired by June 16th. 8/14/08, pg. informal attorney use. No reporter certification
After that date, Bryan had no authority 244:6-16 is attached to the transcript.
19 to extend Jadwin’s employment
relationship. Improper legal conclusion. Improper opinion.
20
30. By June 2006, Jadwin had fully Bryan The transcript is not authenticated. It is not a
21 exhausted his rights and the Depo., certified copy, it is a condensed transcript for
institutional obligation to grant him 8/14/08, informal attorney use. No reporter certification
22 medical leave. pgs. is attached to the transcript.
280:21281:
23 4 Improper legal conclusion. Improper opinion.
24 31. Adherence to the Medical Staff Bryan The transcript is not authenticated. It is not a
Bylaws afforded Jadwin the due Depo., certified copy, it is a condensed transcript for
25 process that he was entitled to. 8/14/08, pg. informal attorney use. No reporter certification
258:7-16 is attached to the transcript.
26
Improper legal conclusion. Improper opinion.
27
28

1 32. Tort Claims Act Complaint, dated Exhibit 2 to Irrelevant and immaterial.
7/3/06, Jadwin admits that he had used Second
2 up his CFRA leave by June 14th, Amended Improper legal conclusion.
2006. Page 1 of the Attachment (page Complaint
3 3 of the entire complaint), Section A,
paragraph 1, last sentence reads “As of
4 June 14, 2006, Complainant had taken
12 weeks of CFRA sick leave and
5 approximately 3-4 weeks of County
sick leave based on doctor’s
6 certifications which he submitted.”
7 33. Memorandum to the Joint 0001476- Misstates evidence. JCC minutes state only
Conference Committee (JCC) from 1565 that the JCC voted on Bryan’s
8 Bryan, dated 7/10106, recommending 0000073-75 recommendation for demotion and approved it.
that the Committee approve the There is no disclosure of the JCC’s reasons for
9 demotion of Jadwin from chair of the their vote.
pathology department to staff [Lee Decl., Exh. 17 (JCC Minutes of 7/10/06
10 pathologist. “This recommendation to at Item 10 on Bates 0009820-9821)].
rescind Dr. Jadwin’s appointment as
11 Chairman, Department of Pathology,
is based solely on his continued non-
12 availability to provide the leadership
necessary for a contributing member
13 of the medical staff leadership group.
KMC must have its key personnel
14 available, and Dr. Jadwin has provided
no indication that he is committed to
15 return to work or resume his duties as
chairman.” Also, “Dr. Jadwin has
16 made no attempt to contact me
concerning my decision to relieve him
17 of his chairman duties nor has he
indicated any desire to negotiate a new
18 contract.” JCC meeting minutes
confirm that the committee took
19 Bryan’s advice and they did it for the
reason that he gave in his
20 memorandum.
21 34. Ray Watson (hereinafter referred Watson The transcript is not authenticated. It is not a
to as Watson) testified that he only Depo., certified copy, it is a condensed transcript for
22 remembers a discussion on removing 8125/08, informal attorney use. No reporter certification
Jadwin from the department chair pgs. 13:17- is attached to the transcript.
23 position; he was quite clear (and he 14:14
was asked three times) that he did not Misstates testimony.
24 remember any discussion about
Jadwin’s “termination.” He
25 affirmatively stated that he knew of no
discussions about Jadwin resigning or
26 being denied privileges.
27
28

1 35. Watson testified that he became Watson The transcript is not authenticated. It is not a
aware that Jadwin’s contract was not Depo., certified copy, it is a condensed transcript for
2 renewed although he could not give a 8/25/08, informal attorney use. No reporter certification
timeline as to when things happened. pgs. 28:6- is attached to the transcript.
3 He also testified strongly that he does 30:23
not recall a vote taken on the Misstates testimony, Watson did not testify
4 nonrenewal “although [he] imagine[s] “strongly” that he didn’t recall a vote.
it was,”
5
36. Watson testified that the fact that Watson The transcript is not authenticated. It is not a
6 Jadwin was suing KMC was brought Depo., certified copy, it is a condensed transcript for
up in discussions of whether to renew 8/25/08, informal attorney use. No reporter certification
7 Jadwin’s contract although he would pgs. is attached to the transcript.
not say it was a consideration, only 110:12112:
8 that it was discussed. In addition, it 13 Misstates testimony. Watson answered the
became obvious after a few questions question affirmatively. He never denied that
9 that Watson was confused about the Plaintiff’s lawsuit was a consideration for the
sequence of events which can lead to Nonrenewal. In fact, in later testimony,
10 the inference that he does not recall Watson volunteers that Plaintiff’s lawsuit was
anything specifically or correctly. a “reason” for the Nonrenewal.
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

1 a) Kern County Board of Supervisors Decl. of Rubio Decl.: Para. 1: Lacks foundation as to
did not discuss the non-renewal of Michael dates of attendance at JCC meetings. Para. 2:
2 Jadwin’s employment agreement or Rubio, Speculation as to Plaintiff’s being “upset”.
made any decisions regarding the non- 11/10/08, Improper conclusions and speculation
3 renewal of the employment ¶2; Decl. of regarding Board of Supervisors’ discussions,
agreement. The subject never came Raymond decisions re Plaintiff’s agreement.
4 before the Board of Supervisors. Watson,
11/10/08, Watson Decl.: Para. 2 & 3: Sham declaration
5 ¶¶3, 4 and that contradicts sworn deposition testimony
5; Decl. of after the fact that the JCC did in fact make a
6 Mike decision not to renew Plaintiff’s contract. [Lee
Maggard, Opp. Decl., Exh. 10 (Watson Depo. at 30:10-
7 11/10/08, 13; 110:12-111:5; 111:15-24; 113:15-114:4)].
¶2; Decl. of A party cannot create an issue of fact by a
8 Jon declaration contradicting his or her own
McQuiston, deposition or other sworn testimony. See Block
9 11/10/08, v. City of Los Angeles (9th Cir. 2001) 253 F3d
¶2; Decl. of 410, 419, fn. 2. The same rule applies to
10 Don Maben, postdeposition affidavits that contradict the
11/10/08, ¶2 affiant’s deposition testimony. Aerel, S.R.L. v.
11 PCC Airfoils, LLC (6th Cir. 2006) 448 F3d
899, 907–908; Bank of Ill. v. Allied Signal
12 Safety Restraint Systems (7th Cir. 1996) 75
F3d 1162, 1169. Para. 4: Improper conclusions
13 and speculation regarding Board of
Supervisors’ discussions, decisions.
14
Maggard Decl.: Para. 1: Lacks foundation as
15 to dates of attendance at JCC meetings. Para.
2: Speculation as to Plaintiff’s being “upset”.
16 Improper conclusions and speculation
regarding Board of Supervisors’ discussions,
17 decisions re: Plaintiff’s agreement.
18 Maben Decl.: Para. 1: Lacks foundation as to

dates of attendance at JCC meetings. Para. 2:
19 Speculation as to Plaintiff’s being “upset”.
Improper conclusions and speculation
20 regarding Board of Supervisors’ discussions,
decisions re: Plaintiff’s agreement.
21
McQuiston Decl.: Para. 1: Lacks foundation
22 as to dates of attendance at JCC meetings.
Para. 2: Speculation as to Plaintiff’s being
23 “upset”. Improper conclusions and
speculation regarding Board of Supervisors’
24 discussions, decisions re: Plaintiff’s
agreement.
25
26
27
28

1 37. Letter from Karen Barnes DFJ01359- Hearsay. Best evidence rule.
(hereinafter referred to as Barnes) to 1361
2 Plaintiffs attorney Eugene Lee, dated
7118/06, in which she mentions (pg.
3 2) that Jadwin was removed as
pathology department chair on 7/10/06
4 at a regularly scheduled meeting of the
Joint Conference Committee, pursuant
5 to Bylaws article IX, section 9.7-4
“removal of a department chair may
6 occur with or without cause ... “
7 38. Plaintiffs’ attorney Eugene Lee Bryan Irrelevant, immaterial, and is an improper legal
agrees that Jadwin was not removed as Depo., conclusion.
8 chair during his medical leave. 8/14/08, pg.
222:8-13 The transcript is not authenticated. It is not a
9 certified copy, it is a condensed transcript for
informal attorney use. No reporter certification
10 is attached to the transcript.
11 Lacks foundation. Hearsay. A deposition

question is not evidence, particularly when its
12 purpose is solely to elicit testimony from a
deponent.
13 39. Letter to Dr. Harris from Jadwin, DFJ01388- None.
dated 9111/06, stating that he (Jadwin) 1389
14 will be returning to work on 9/18/06
and enclosed was a doctor’s
15 certification that he was able to return
to work full-time.
16
40. Letter from David Culberson to DFJ01398 None.
17 Jadwin, dated 9/20/06, explaining the
reasons for reduction in pay.
18
41. Letter from David Culberson to DFJ01482 None.
19 Jadwin, dated 12/7/06, putting Jadwin
on administrative leave with pay and
20 confining him to his home during
business hours, pursuant to Kern
21 County Policy and Administrative
Procedures Manual section 124.3.
22
a) Kern County Policy and 0016941 Incomplete document – Bates 0016940 and
23 Administrative Procedures Manual, 16943 were omitted. Bates 0016940
pg. 1:22, Section titled establishes that Defendant County can only put
24 “Administrative Leave with Pay.” an employee on administrative leave for “good
“During the administrative leave, the cause”.
25 employee shall be ordered to remain at [Lee Opp. Decl., Exh. 19 (Kern County Policy
home and available by telephone ... “. & Administrative Procedures Manual at
26 Section 139 (Disciplinary Actions) and 139.6
(Administrative Leave with Pay) on Bates
27 0016940-16941)].
28

1 42. Letter from Mark Wasser to DFJ01701 Irrelevant and immaterial to excusing
Eugene Lee, dated 4/30/07, allowing Defendants' liability under any of Plaintiff's
2 Jadwin to pursue his own activities counts, as evidenced by Defendants' failure to
during the work week and retaining cite to this DMF anywhere in their motion
3 him, at his usual salary, for consulting. brief (Doc. 29).
4 Misstates evidence.
43. Letter to Mark Wasser from DFJ01703- None.
5 Eugene Lee, dated 5/1/07, noting that 1704
on 4/28/07 and in several following e-
6 mails he was notified that KMC
wanted to terminate Jadwin’s contract
7 and would not renew it on 10/4/07.
8 44. Exhibit 644 is an e-mail with an Jadwin The transcript is not authenticated. It is not a
amendment attached to it. The Depo., certified copy, it is a condensed transcript for
9 amendment is a contract amendment 3/12/08, informal attorney use. No reporter certification
which Jadwin had to sign before pgs. 969:1- is attached to the transcript.
10 returning to work. Exhibit 581 is also 974:2
the same contract amendment (Exhibits Lacks foundation. Improper speculation.
11 although Exhibit 581 is signed. There 644 and Plaintiff’s testimony that he spoke with his
are differences between Exhibit 644 581) attorney regarding his disagreement about the
12 and 581, in subparagraphs “h” and “i”. pay reduction invades attorney-client
Jadwin confirmed that he had privileged communication, a privilege which is
13 discussions with his attorney about the never waived, and is inadmissible.
amendment; Jadwin does not know if
14 his attorney negotiated any of the
terms in it. Jadwin does not know if
15 his attorney made proposals to KMC
with suggested changes in the
16 language of the amendment. Jadwin
was aware of the changes at the time
17 they occurred but he does not recall
how the changes came about. One
18 change that Jadwin recalls talking
about is the cut in his salary which he
19 didn’t agree with.
20 45. The last two pages of Exhibit 581 Jadwin The transcript is not authenticated. It is not a
is Exhibit A which is a job Depo., certified copy, it is a condensed transcript for
21 description. Jadwin confirms that he 3/12/08, informal attorney use. No reporter certification
read it at the time of signing the 974:3~976:l is attached to the transcript.
22 amendment. Jadwin looked at the 2
tasks listed and does not believe that Improper legal conclusion. Vague and
23 any of those tasks require ambiguous.
accommodation. Jadwin does not
24 recall asking anyone with the County
for an accommodation of any of the
25 tasks listed in Exhibit A.
26
27
28

1 46. Jadwin testified that he wanted his Jadwin The transcript is not authenticated. It is not a
employment contract renewed, but Depo., certified copy, it is a condensed transcript for
2 when presented with the fact that his 10/21/08, informal attorney use. No reporter certification
employment contract in place at the pg. 1011: is attached to the transcript.
3 time of nonrenewal contained his 161016: 19
reduced salary, he denied wanting to Misstates testimony. Plaintiff was testifying
4 renew that contract. that he viewed the Paycut Amendment of
7/10/06 as retaliatory. This testimony had
5 nothing to do with nonrenewal. It was also
outside the scope of Judge Wanger’s order
6 (Doc. 245:3:5-6), which limited the scope of
discovery at that time only to the Plaintiff’s
7 new nonrenewal-related claims.
47. Jadwin said that the contract he Jadwin The transcript is not authenticated. It is not a
8 wanted renewed was his Department Depo., certified copy, it is a condensed transcript for
Chair contract. 10/21/08, informal attorney use. No reporter certification
9 pgs. is attached to the transcript.
1032:16-
10 1033: 3; pg. Improper speculation. Misstates testimony.
1043:12-20 Plaintiff was testifying as to his desires and
11 wants were as of 10/7/08, not as of the time his
contract expired over a year earlier on 10/4/07.
12 [Lee Opp. Decl., Exh. 6 (Jadwin Depo at
1034:13-1035:9; 1036:7-11; 1041:5-9; 1044:2-
13 3; 1060:4-7)].
14 JADWIN’S ALLEGATIONS OF
REGULATORY VIOLATIONS
15
48. Approved Cancer Program 0000623- No foundation. No authentication. Hearsay.
16 Performance Report for KMC, dated 630
7/14/04, with a rating of “I “meaning
17 KMC’s Cancer program-including
number of meetings-is approved for
18 three years with commendation.
19 49. Exchange of e-mails between Toni 0000421- Irrelevant and immaterial to excusing
Smith and Jadwin, dated 6115/05, 424 Defendants' liability under any of Plaintiff's
20 about the PCC issues. In 0000423, counts, as evidenced by Defendants' failure to
Jadwin states that a PCC must not be cite to this DMF anywhere in their motion
21 signed until the time of the infusion, brief (Doc. 29).
or KMC is not meeting American
22 Association of Blood Banks’
(hereinafter referred to as AABB)
23 accreditation standards.
24 50. Typed notes, dated 1/10106, of 0000575 Irrelevant to excusing Defendants’ liability
25 interviews done to rebut Jadwin’s under any of Plaintiff’s counts, as evidenced
claim that the meeting frequency by Defendants’ failure to cite this DMF
26 standard set by the American College anywhere in their motion brief (Doc. 262).
of Surgeons (hereinafter referred to as
27 ACS) was not being met at KMC. No foundation. No authentication. Hearsay.
28

1 51. In meeting on 2/22/06, Jadwin 0000578 No foundation. No authentication. Hearsay.

alleges that KMC is not meeting the Misstates evidence. Improper conclusion as to
2 ACS standard for frequency of staff “rebutted”.
meetings; was rebutted during the
3 meeting that KMC is meeting standard
based on 2 surveys and paperwork.
4
52. In an e-mail to Peter Bryan dated DFJ00784 None.
5 4/10/06, Jadwin brings up non-
compliance with state regulations,
6 Joint Commission for the
Accreditation of Hospital
7 Organizations (hereinafter referred to
as JCAHO), and AABB on the issues
8 of the PCCs.
9 53. Notes of meeting with Peter DFJ00788 Irrelevant and immaterial to excusing
Bryan, Karen Barnes and Jadwin on Defendants’ liability under any of Plaintiff’s
10 4/13/06. There is no problem with the counts, as evidenced by Defendants’ failure to
PCCs because 5 charts were reviewed cite this DMF anywhere in their motion brief
11 (and approved) by JCAHO. (Doc. 262).
12 No foundation. No authentication. Hearsay.

Misstates the evidence.
13 54. E-mail to Peter Bryan from DFJ00793 None.
Jadwin, dated 4/17/06, claiming that
14 the JCAHO review was too small of a
sample so KMC was not in
15 compliance on their handling of the
PCCs and there was a need for action.
16
55. Gilbert Martinez, the Laboratory Martinez The transcript is not authenticated. It is not a
17 manager, recalls Jadwin telling him Depo., certified copy, it is a condensed transcript for
before Thanksgiving in 2006 to 4/16/08, informal attorney use. No reporter certification
18 prepare the laboratory for possible pgs. 111: is attached to the transcript.
inspections (so sometime before 12-118: 22
19 11122/06). He does not recall if Misstates testimony regarding “confide”
Jadwin told him how Jadwin might whistleblowing.
20 know about it. He remembers
inspectors coming in from the
21 California Dept. of Health Services
(hereinafter referred to as DHS) and
22 receiving written inquiries from the
CAP. These inspections occurred
23 several months after Jadwin had
mentioned it. Jadwin did not “confide”
24 in him or tell him that the inspections
were happening because of
25 whistleblowing by Jadwin.
26
27
28

1 a) CAP conducts routine inspections, Martinez The transcript is not authenticated. It is not a
unannounced, on a known periodic Depo., certified copy, it is a condensed transcript for
2 basis. 4/16/08, informal attorney use. No reporter certification
pgs. 118:23- is attached to the transcript.
3 120: 19
Misstates testimony.
4
56. Jadwin first reported concerns to No supporting evidence submitted.
5 JCAHO, CAP, and DHS in November
28, 2006 (more than five years after
6 noticing alleged violations).
7 a) Actual complaint filed with JCAHO DFJ02540- None.

by Jadwin. 2541
8
b) E-mail from JCAHO to Jadwin, DFJ01454 None.
9 dated 11/29/06, acknowledging receipt
of complaint about KMC.
10
c) Letter from DHS to Jadwin, dated DFJ01459 None.
11 12/1/06, acknowledging receipt of
complaint.
12
57. E-mail to JCAHO from Jadwin, DFJ02538- Irrelevant to excusing Defendants’ liability
13 dated 12/8/06, wanting to talk with the 2539 under any of Plaintiff’s counts, as evidenced
JCAHO investigator and requesting by Defendants’ failure to cite this DMF
14 quickness on the investigation because anywhere in their motion brief (Doc. 262).
KMC might be covering up
15 noncompliance evidence. He brings up Misstates evidence.
the issue of skull flaps being stored
16 on-site.
17 58. Letter to KMC from Jadwin dated 0001455- None.
12/13/06 notifying hospital 1458
18 administration that he has notified
governmental and enforcement
19 agencies of alleged violations.
20 59. Letter from Dr. Dutt to Gerald 0020278 Irrelevant to excusing Defendants’ liability
Hoeltge of the CAP, dated 1/11/07, under any of Plaintiff’s counts, as evidenced
21 telling him that Jadwin had never by Defendants’ failure to cite this DMF
informed him (Dutt) that some tissue anywhere in their motion brief (Doc. 262).
22 handling and storage was occurring
but the situation has been taken care No foundation. No authentication. Hearsay.
23 of. Speculation. Improper conclusion. Improper
opinion.
24 60. Letter to Dr. Dutt from CAP, dated 0020279 Irrelevant to excusing Defendants’ liability
3/22/07, informing him that the KMC under any of Plaintiff’s counts, as evidenced
25 laboratory continues to be in by Defendants’ failure to cite this DMF
compliance with the CAP Standards anywhere in their motion brief (Doc. 262).
26 for Laboratory Accreditation.
No foundation. No authentication. Hearsay.
27
28

1 61. Dr. Dutt believed that Jadwin, Dutt Depo., Irrelevant to excusing Defendants’ liability
after returning from leave, might be 8/20/08, pg. under any of Plaintiff’s counts, as evidenced
2 intentionally issuing wrong opinions 296: 10- 19 by Defendants’ failure to cite this DMF
to prove he was a whistleblower. anywhere in their motion brief (Doc. 262).
3
The transcript is not authenticated. It is not a
4 certified copy, it is a condensed transcript for
informal attorney use. No reporter certification
6 No foundation. Hearsay. Improper speculation.

Improper conclusion.
7
DEPRESSION DISABILITY,
8 REASONABLE
9 ACCOMMODATION,
INTERACTIVE PROCESS
10 62. Jadwin described his disability as Jadwin The transcript is not authenticated. It is not a
severe depression, manifested by a Depo., certified copy, it is a condensed transcript for
11 lack of ability to concentrate; loss 1/9/08, pgs. informal attorney use. No reporter certification
DFJ0y in his work; extreme anxiety 414:24418: is attached to the transcript.
12 and difficulty sleeping. Jadwin 12
testified that he told Dr. Kolb, during a
13 meeting he had with him in 2003, that
he was depressed. Jadwin thought this
14 meeting was a one-on-one weekly
meeting that each department chair
15 had with Dr. Kolb. Jadwin said that
Dr. Kolb must have noticed that he
16 was depressed because he would often
ask him if he was alright.
17
63. Jadwin told Dr. Kolb that he Jadwin The transcript is not authenticated. It is not a
18 suffered from depression when he Depo., certified copy, it is a condensed transcript for
notified him of the weekly half-day 1/9108, pgs. informal attorney use. No reporter certification
19 medical leave day off to see his 491:1- is attached to the transcript.
therapist. 493:17
20
64. Jadwin asked Dr. Kolb for Jadwin The transcript is not authenticated. It is not a
21 accommodations for his disability by Depo., certified copy, it is a condensed transcript for
requesting time off for his therapist 1/9108, pgs. informal attorney use. No reporter certification
22 visits. Dr. Kolb granted that 506: 16- is attached to the transcript.
accommodation. 507: 1
23
65. Jadwin had an episode of Jadwin The transcript is not authenticated. It is not a
24 depression in the 1990s before coming Depo., certified copy, it is a condensed transcript for
to work at KMC. Jadwin affirmed his 1/9/08, pgs. informal attorney use. No reporter certification
25 earlier testimony that his recent 452:4- is attached to the transcript.
depression started in 2002 or 2003. 455:19 Pg.
26 Jadwin said that he was taking weekly 455:8-13 Improper medical conclusion re depression.
half-day leaves starting in or about Misstates testimony regarding reasons for
27 2003 and he told Dr. Kolb it was feeling depressed.
because of his problems with
28 radiology and others.

1 66. Bryan does not recall Jadwin Bryan The transcript is not authenticated. It is not a
mentioning to him about depression, Depo., certified copy, it is a condensed transcript for
2 sleeplessness, etc. nor did Bryan 8/14/08, informal attorney use. No reporter certification
notice behavior that he would call pgs. 111: is attached to the transcript.
3 mental illness. 12-113: 2
and 128:16-
4 129:3
5 67. Jadwin only discussed his Jadwin Irrelevant and immaterial in that employer
disability with Dr. Kolb. When asked Depo., does not need to know an employee's
6 whether he had ever told Peter Bryan, 3/12/08, diagnosis, only an employee's limitations, to
Jadwin said that subsequently during pgs. 976: have notice of an employee's disability.
7 one-on-one meetings with Bryan he 13983: 2
had mentioned being depressed by lines 977:5- The transcript is not authenticated. It is not a
8 lack of action on the concerns Jadwin 8 and lines certified copy, it is a condensed transcript for
was raising. When pressed on whether 977:24- informal attorney use. No reporter certification
9 he had ever actually told Peter Bryan 978:8 and is attached to the transcript.
he was disabled, Jadwin said that in lines 981:
10 late 2005 or early 2006, he told Bryan 17-982: 1 Misstates testimony.
that sometimes he was so depressed he and lines
11 couldn’t work at KMC anymore until 982: 18-24
it fixed some of his concerns. Jadwin lines 978:
12 said that he also told Dr. Yoo, head of 15-979:1
psychiatry, that he was depressed from lines
13 working at the hospital. Jadwin does 979:24-
not recall talking to Dr. Dutt about this 980:8 lines
14 issue. Jadwin could not recall any 982:9-24
other people at KMC that he talked to
15 about his disability. In fact, Jadwin
would not use the term “disabled” just
16 that he could not work there.
17 68. When asked what considerations Jadwin The transcript is not authenticated. It is not a
there were in renewing a contract with Depo., certified copy, it is a condensed transcript for
18 KMC, Jadwin replied “All of the 10/21/08, informal attorney use. No reporter certification
working environment situations. The pgs. is attached to the transcript.
19 patient quality issues, the 1055:13-
administration, what-what type of 1056: 15 Improper speculation. Misstates testimony.
20 administrative operation is there. The Irrelevant an immaterial. Plaintiff was
emphasis on quality, interest in testifying as to his desires and wants were as
21 quality. Interest in patient safety. The of 10/7/08, not as of the time his contract
collaborative working environment. expired over a year earlier on 10/4/07. [Lee
22 Are the other physicians going to be Opp. Decl., Exh. 6 (Jadwin Depo at 1034:13-
responsible in working for the 1035:9; 1036:7-11; 1041:5-9; 1044:2-3;
23 betterment of patient care, or are they 1060:4-7)].
just going to be working for their own
24 self-interest.”
25
JADWIN’S ERRORS
26 Failure to Produce Timely or
27 Correct Diagnoses
28

1 69. Dr. Ragland brings up the issue Ragland Irrelevant and immaterial.
that a stack of FNA reports that Depo.,
2 Jadwin had given him had issue dates 8/22/08, The transcript is not authenticated. It is not a
after the date of a double read, in each pgs. 171 :5- certified copy, it is a condensed transcript for
3 case, was done by UCLA. This raises 172:5 and informal attorney use. No reporter certification
the possibility that Jadwin waited to 328:7-329: is attached to the transcript.
4 enter a diagnosis until the double read 14
had come back from UCLA so that he Improper speculation. Improper opinion.
5 could be in 100% agreement with Improper conclusion. No foundation. Misstates
UCLA. testimony.
6
70. Letter from Dr. Ang to Dr. Perez, 0000690- Relevance.
7 Peter Bryan, Dr. Kolb, and Dr. 691,
Munoz, dated 2/20102, containing 0000736 No foundation. No authentication. Hearsay.
8 formal complaints of misconduct
against Jadwin. Complaint #3 states
9 that Jadwin failed to pass the quarterly
proficiency tests on cervical pap
10 smears so those tests are sent out. It
states that this was an unnecessary
11 cost and delay because the other three
pathologists in the department could
12 examine the pap smears because they
have maintained their proficiency.
13
a) Document asserting Jadwin’s 0000737 Irrelevant and immaterial to excusing
14 failing test scores and the fact that the Defendants' liability under any of Plaintiff's
Department of Pathology has not been counts. No foundation. No authentication.
15 sued for medical malpractice in 23 Hearsay. Misstates the evidence.
years.
16
b) Jadwin’s actual (failing) test for Irrelevant. No foundation. No authentication.
17 cervical pap smears. This test is Hearsay. Misstates the evidence.
conducted by the College of American
18 Pathologists (CAP). Of interest, on
Case #3 Jadwin marked
19 “unsatisfactory for evaluation” when
the accurate diagnosis was “squamous
20 cell carcinoma.”
21 71. Report to Maureen Martin from 0001059- Irrelevant. No foundation. No authentication.
Jadwin, dated 11/20/02, on the results 1072 Hearsay. Misstates the evidence. Improper
22 of the evaluations of the pathologists conclusion.
(Jadwin and Lang) by resident
23 physicians and staff physicians in
surgery. On a three-point scale, where
24 2 means satisfactory and 3 means
needs improvement, Jadwin scored
25 low on timeliness (lower than Lang),
IOC quality, completeness, and clarity
26 of diagnosis. Jadwin blamed
unhappiness of a Dr. Prunes for his
27 low scores.
28

1 72. Twenty-nine (29) medical reports 0001163- Irrelevant to excusing Defendants' liability for
from 2004 and 2005 with all of the 1310 any of Plaintiff's counts. Misstates evidence.
2 following in common: 1) all are FNA No foundation.
reports; 2) all were processed in-house
3 and then sent to outside labs for
independent diagnosis; and 3) the
4 turn-around time for the final
diagnosis ranged from three weeks to
5 five or six months.
6 73. Letter from Dr. Roy to Jadwin, DFJ00363 Hearsay.

dated 4/15/05, complaining that
7 samples from 2 cases still had not
been analyzed and diagnosed and were
8 over one week late.
9 74. Letter to Dr. Roy from Jadwin, DFJ00364- Relevance.

dated 4/20/05, in response to his 366
10 complaint about late diagnoses. On Hearsay.
page 3 Jadwin writes “Pathology
11 diagnoses are consensus based, with
few gold standards to affirm accuracy.
12 Consultants offer opinions, not
accurate diagnoses. There is no
13 universally agreed upon definition for
what constitutes an ‘accurate’
14 diagnosis.”
15 75. Notes by Dr. Harris, dated 6/8105, 0027066- Relevance.

of a meeting between himself and Dr. 27068
16 Roy in which Dr. Roy again raises his No foundation. No authentication. Hearsay.
concerns with the pathology Misstates the evidence.
17 department.
18 76. Notes by Dr. Harris, dated 7/1/05, 0027069- Relevance.
of a meeting between himself and Dr. 27070
19 Roy. Dr. Roy had specific examples of No foundation. No authentication. Hearsay.
his complaints about the pathology Misstates the evidence.
20 department including three missed
diagnoses and an example-by name
21 and report number--of a pathology
report changed after the fact by
22 Jadwin.
23 77. Letter from Dr. Roy to Jadwin, DFJ00439, Relevance.
dated 7/15/05, responding to Jadwin’s DFJ00437
24 letter to him dated 6/5/05 and stating Hearsay.
that he (Dr. Roy) has raised pathology
25 department mistakes, delays and
discrepancies with Jadwin many times
26 before.
27 78. Phone message from Dr. Roy, 0000506 Relevance.
dated 11/18/05, identifying a patient
28 error by Jadwin. No foundation. No authentication. Hearsay.
Misstates the evidence.

1 79. Letter from Dr. Roy to Dr. Harris, 0000434- Relevance.

dated 2/22/06, identifying 19 cases 476
2 (with medical records backup) where No foundation. Hearsay. Improper conclusion.
KMC pathology department was Improper opinion. Speculation.
3 wrong in their diagnosis, or very late
in getting a diagnosis, or changing an
4 initial wrong diagnosis.
5 a) Pathology Quality Management 0018516 Relevance.

Policy, September 2005, “Correction
6 of significant error must be made No foundation. No authentication. Incomplete
through a corrected report.” document. Hearsay. Misstates the evidence.
7
c) Two letters from Dr. Felix at USC 0000432- Relevance.
8 to Dr. Roy, dated 3115/06 and 433
3/16/06, with diagnoses of samples No foundation. No authentication. Hearsay.
9 that Dr. Roy sent to him. Handwritten Misstates the evidence. Improper conclusion.
notes on bottom of letters describe Speculation. Improper opinion.
10 discrepancy with KMC pathology
diagnosis and that pathology changed
11 its diagnosis in one instance.
12 80. After returning from leave, Jadwin Dutt Depo., Relevance.

had to be told to slow down on regular 8/20/08, pg.
13 case work because he was going too 285 :6-23 The transcript is not authenticated. It is not a
fast and making errors. certified copy, it is a condensed transcript for
14 informal attorney use. No reporter certification
is attached to the transcript.
15
Other Mistakes
16
81. E-mail from Reyes to Dr. Harris 0000398 Relevance.
17 and Tony Smith, dated 4/17/06,
reporting that Jadwin was making No foundation. No authentication. Hearsay.
18 copies of patient files which is a Title Misstates the evidence.
22 violation.
19
82. Minutes of the meeting of the 0000899 Relevance.
20 pathology/histology department on
10/17/06. It was noted that Dr. Hearsay. Improper speculation. No foundation.
21 Shertukde was concerned that blades
were not being removed once grossing
22 was done. She and Dr. Dutt remove
and discard the blades immediately.
23
83. E-mail from Dr. Dutt to Jadwin, DFJ01449 Relevance.
24 dated 11/22/06, reminding him of a DFJ01446-
rush case that Jadwin failed to process 1447 Hearsay. Speculation. Improper conclusion.
25 promptly and counseling Jadwin to Improper opinion. No foundation.
remember it when criticizing others.
26
27
28

1 84. E-mail from Tracy Lindsey to 0000823 Relevance.

Ramona Case, dated 11/27/06, stating
2 that Jadwin had labeled some (9) No foundation. No authentication. Hearsay.
placentas wrong and she gave the Misstates the evidence.
3 incorrect labels alongside the correct
labels.
4
85. E-mail from Dr. Dutt to Yolanda 0000862 Relevance.
5 Figueroa, dated 12/7/06,
acknowledging her report that Jadwin Hearsay. Speculation. Improper conclusion.
6 had left two long blades and a scalpel Improper opinion. No foundation.
out after he was finished.
7
86. Report from Dr. Dutt to Peer 0000882- Relevance.
8 Review Committee, dated 12/14/06, 895
describing with documentation five Hearsay. Speculation. Improper conclusion.
9 mistakes by Jadwin: 1) missed Improper opinion. No foundation.
diagnosis and failure or refusal to seek
10 outside consultation (with backup
letter from Dr. McBride); 2)
11 misdiagnosis of prostate carcinoma
and of prostatic biopsies; 3) missed
12 diagnosis of thyroid microcarcinoma;
4) performance of sternal bone
13 marrow examination; and 5)
assignment of procedures to physician
14 without privileges.
15
JADWIN’S INABILITY TO GET
16 ALONG WITH OR
17 COMMUNICATE WELL WITH
OTHERS
18 Policy
19 87. Policy Statement of the Disruptive 0010685- Relevance.
Behavior, Discrimination & 10688
20 Harassment Policy “It is the policy of
Kern Medical Center that all
21 associates are expected to conduct
themselves at all times while on
22 hospital premises in a courteous,
professional, respectful, collegial, and
23 cooperative manner. This applies to
interactions and communications with
24 or relating to physicians, nursing and
technical personnel, other caregivers,
25 other hospital personnel, ... “
[emphasis added]
26
27
28

1 88. Section V Item A of the Kern 0010686- Relevance.

Medical Center Procedure on 10687
2 Disruptive Behavior, Discrimination
and Harassment Policy “Examples of
3 prohibited conduct include but are not
limited to the following ...
4
a) 6. Use of racial, ethnic, epithetic or 0010686 Relevance.
5 derogatory comments...
6 b) 8. Use of medical record entries to 0010686 Relevance.

criticize KMC associates, policies or
7 equipment, other practitioners, or
others;
8
c) 14. Persisting to criticize, or to 0010687 Relevance.
9 discuss performance or quality
concerns with, particular KMC
10 associates or others after being asked
to direct such comments exclusively
11 through other channels; ... “
12 89. Jadwin was dealt with pursuant to Harris The transcript is not authenticated. It is not a
the Disruptive Physician Policy. Depo., certified copy, it is a condensed transcript for
13 8/13/08, informal attorney use. No reporter certification
14 332:3
Improper speculation. Misstates testimony.
15 [Lee Opp. Decl., Exh. 24 (Harris Depo at
331:21-332:3)].
16
Pulling Dr. Lau’s Tie
17
90. E-mail to Michael Ewald from 0000260 Relevance.
18 Jadwin, dated 10/9/03, telling Ewald (Exhibit
how to conduct the investigation into 560)
19 the “tiepulling” incident, who to talk
to, and what questions to ask.
20
91. Confidential file of investigation 0000031-70 Relevance. No foundation. No authentication.
21 of Jadwin pulling Dr. Lau by his tie, Hearsay. Misstates the evidence.
dated 10/21/03.
22
a) Portion of Jadwin’s interview 0000061-63 Relevance. No foundation. No authentication.
23 blaming Dr. Lau for the incident, Hearsay. Misstates the evidence.
alleging a prior history of Dr. Lau
24 being afraid of him because Jadwin
(allegedly) points out Dr. Lau’s many
25 mistakes.
26 b) During Jadwin’s interview, 0000063 Relevance. No foundation. No authentication.
27 conducted on 10/17/03, Jadwin Hearsay. Misstates the evidence.
accepts that he pulled the tie, says he
28 cannot really remember.

1 c) The investigator finds, by a 0000034 Relevance. No foundation. No authentication.

preponderance of the evidence, that Hearsay. Misstates the evidence, investigator
2 (Item #2) Jadwin violated the did NOT apply a “preponderance of evidence”
Workplace Violence Policy of the standard.
3 County of Kern and potentially
endangered the quality or efficiency of
4 patient care (because both Jadwin and
Lau testified that Lau told Jadwin that
5 he could not accompany him because
he had patient work to do).
6
92. Letter from Dr. Kolb to Jadwin, DFJ00246 Relevance.
7 dated 11/26/03, reprimanding him for
pulling Dr. Lau by his tie.
8
93. Letter to Dr. Lau from Jadwin, DFJ00590 Relevance.
9 dated 10119/05, apologizing for past
wrongs.
10
11 Dispute with Radiology
12 94. Dr. Ragland implied that Jadwin Ragland The transcript is not authenticated. It is not a
was wrong in the dispute with the Depo., certified copy, it is a condensed transcript for
13 radiology department because the 8/22/08, informal attorney use. No reporter certification
procedurist (the radiologist) should pgs. 155:2- is attached to the transcript
14 chose the equipment he uses (gauge of 156:13
needle is an example) because that is No foundation. Improper opinion. Improper
15 who is performing the task. conclusion.
16 95. Dr. Abraham, while discussing the Abraham The transcript is not authenticated. It is not a
FNA Consulting Report, mentioned Depo., certified copy, it is a condensed transcript for
17 that the radiologists were upset with 8/18/08, informal attorney use. No reporter certification
Jadwin because he was accusing them pgs. 59:6- is attached to the transcript.
18 of too many inadequate specimens 60:2
(“unsatisfactory for evaluation”) when No foundation. Improper speculation.
19 there were relatively few complaints Improper opinion. Improper conclusion.
of that before Jadwin arrived.
20
a) Jadwin’s actual (failing) test for 0000737 Relevance. No foundation. No authentication.
21 cervical pap smears. This test is Hearsay. Misstates the evidence.
conducted by the College of American
22 Pathologists (CAP). Of interest, on
Case #3 Jadwin marked
23 “unsatisfactory for evaluation” when
the accurate diagnosis was “squamous
24 cell carcinoma.”
25 96. Dr. Abraham talked about the lack Abraham The transcript is not authenticated. It is not a
of trust between the other doctors and Depo., certified copy, it is a condensed transcript for
26 Jadwin, which the FNA Consulting 8/18/08, informal attorney use. No reporter certification
Project report addresses as pgs. 62: 16- is attached to the transcript.
27 communication problems. 64:3
No foundation. Improper speculation.
28 Improper opinion. Improper conclusion.

1 97. Kern Medical Center FNA DFJ00251- None.

Consulting Project report by Dr. 270
2 David Lieu, M.D., M.B.A., dated
5/3/04.
3
a) Consultant’s core issue is the lack DFJ00255 Misstates evidence.
4 of communication and complete
distrust between radiology and
5 pathology with negative ramifications
for the clinicians and administration.
6
b) Consultant agreed with radiologists DFJ00257 Misstates evidence.
7 that long clinical history on the FNA
reports was unnecessary.
8
c) “ ... Dr. Jadwin and radiologists do DF100260 Relevance.
9 not communicate at this level. This
suggests that a breakdown in
10 communication is the fundamental
problem. This bridge was burned
11 down long ago.”
12 d) “Finally, both radiology and DFJ00269 Relevance.
pathology will work together to find
13 the best needle for deep FNAs.”
14 98. E-mail to Drs. Kercher and Kolb DFJ00289- Relevance.
from Jadwin, dated 9/3/04, stating 290
15 “You cannot dictate the size of the
needle by policy” and calling Dr. Lieu
16 “unjustifiably pompous,”
17 99. E-mail to Peter Bryan from DFJ00319- None.
Jadwin, dated 2/2/05, listing his 320
18 suggestions for improvement on the
FNA issue. Jadwin also states that the
19 radiology department was
“substantially at fault” for the conflict
20 between the departments. He
requested a formal apology from the
21 radiology department to himself and
the pathology department. He also
22 requested (in bold lettering) a public
announcement at the next Medical
23 Executive Committee (hereinafter
referred to as MEC) meeting that there
24 are no quality issues involving the
pathology department and Drs. Amin,
25 Abraham, Munoz and Naderi should
be standing at the podium during the
26 announcement.
27
28

1 100. Exchange of e-mails between Dr. DFJ00353- None.

Ragland and Jadwin, dated 2/25/05, in 354
2 which Jadwin complains about some
comments made by the radiologists at
3 the February QM meeting and
informing Dr. Ragland to be prepared
4 for Jadwin to request him to call for
supporting documentation from
5 radiology or announce that the
previous comments were unsupported.
6 Dr. Ragland shot back his displeasure
at the continuing conflict between
7 radiology and pathology, and stated
that his committee will not become a
8 battleground for this conflict.
9
Length of Presentations/October
10 2005 Oncology Conference
11 101. Exchange of e-mails between Dr. DFJ00241- Relevance.
Ragland and Jadwin, dated 11/19 & 242
12 11/20/03, about the last Quality
Management meeting. Dr. Ragland
13 contradicted Jadwin’s statement that
the pathology presentation during the
14 meeting was 20 minutes; Dr. Ragland
said it went on much longer than 20
15 minutes and proceeded to give Jadwin
advice on which information was most
16 important to present and how it could
be presented succinctly.
17
102. Memo from Dr. Ragland to None.
18 Jadwin, dated 1/21/04, that
presentations must be concise and that
19 the last Blood Usage Report-52 slides-
will not fit in the allotted time.
20
103. Memo from Dr. McBride to DFJ00381 None.
21 Jadwin, dated 5/9/05, requesting that
22 the time required for the pathology
presentation at the oncology
conference be kept to a minimum.
23
24 104. Instructions for the Cancer Patel Depo., None.
Conference presenters 1) the 12/6/07,
25 presentation is to contain less than 10 Exhibit 25
slides, 2) length not to exceed 20
26 minutes for comprehensive
background and overview of testing,
27 and 3) all physicians involved in the
case being presented must be notified
28 beforehand.

1 105. Pathology Dept.’s oncology DFJ00508- None.

conference presentation----67 slides- 574
2 by Jadwin, reviewing gynecology
cases and alleged errors in diagnosis
3 by University of Southern California
(hereinafter referred to as USC).
4
106. Memo from the Cancer DFJ00578 Relevance.
5 Committee (Drs. Patel, Johnson, and
McBride) to Jadwin, dated 10/12/05,
6 insisting that his presentation take no
more than 5 minutes per patient case.
7
107. Anonymous (redacted) memo DFJ00580 Improper speculation. Improper opinion.
8 (author-Dr. Taylor) of complaint about
Jadwin’s oncology presentation, dated
9 10/12/05. Some quotes: “ ...
inappropriate to bring
10 political/personal battles to an
educational forum filled with residents
11 and students,” and “ ... inappropriate
to ‘bash’ reputable institutions like
12 USC and Stanford,” and “ ...made
[Jadwin] look like a conceited,
13 pompous buffoon.”
14 108. Dr. Royce Johnson also voiced a Harris The transcript is not authenticated. It is not a
complaint. Depo., certified copy, it is a condensed transcript for
16 127: 19
Hearsay. No foundation.
17 109. Oncology Conference Exhibit 190 None.
Performance Evaluations of 10/12/05
18 where criticisms of Jadwin’s
presentation are written in the
19 comments section on the following
Bates-stamped pages:
20 0000516,522,526,536, and 548.
21 110. Dr. Ragland was not present at Ragland The transcript is not authenticated. It is not a
the October Oncology Conference so Depo., certified copy, it is a condensed transcript for
22 his testimony was limited to the 8/22/08, informal attorney use. No reporter certification
comments he heard Jadwin make pgs. 106: is attached to the transcript.
23 regarding the conference (which is an 18-109:14
admission against interest). Dr. and 156:14- Misstates testimony. No foundation. Vague as
24 Ragland said that Jadwin’s excuse for 25 to time.
monopolizing the oncology
25 conference was that “the only
important information on that case
26 was his.”
27
28

1 111. Dr. Abraham testified that Jadwin Abraham The transcript is not authenticated. It is not a
went on much longer than a normal Depo., certified copy, it is a condensed transcript for
2 pathology presentation and she was 8/18/08, informal attorney use. No reporter certification
embarrassed for him and by some of pgs. 14: 10- is attached to the transcript.
3 the things that he said. Her overall 21: 17 and
feeling was one of discomfort. She 131:5- Misstates testimony. Improper opinion.
4 definitely felt that his criticisms of 133:23 and Improper conclusion. Improper speculation.
outside consultants were inappropriate 135:24-
5 and further evidence of his arrogance 138:22
because the issue was not one of who
6 was- right-and-who-was-wrong but of
the actual sample and how it could be
7 read. Jadwin’s position that it is a
patient care issue presumes that
8 Jadwin is right and Dr. Roy and the
outside pathologist are wrong.
9
112. Dr. Dutt believed that Jadwin Dutt Depo., The transcript is not authenticated. It is not a
10 retaliated against Dr. Roy by verbally 8/20/08, certified copy, it is a condensed transcript for
attacking him, angrily, at the October pgs.292:25- informal attorney use. No reporter certification
11 oncology conference. 293:20 is attached to the transcript.
12 Improper speculation. Improper opinion. No

foundation.
13 113. Letter from Drs. Kercher, DFJ00588 No foundation. Improper opinion. Improper
Ragland, Abraham and Harris to conclusion.
14 Jadwin, dated 10/17/05, about
Jadwin’s October oncology
15 presentation. The criticisms of the
presentation were 1) it exceeded the
16 time allotted to it, 2) Jadwin failed to
follow the leader of the conference on
17 brevity, and 3) Jadwin used a public
forum for a personal agenda and/or for
18 making a political statement.
19 114. E-mail from Dr. Ragland to Dr. 0000094 Improper speculation. Improper opinion.
Harris, dated 10118/05, describing
20 Jadwin’s attitude during the meeting
on 10/17/05. When handed the
21 evaluations of his presentation, he
would not look at them. The e-mail
22 states that Jadwin has a “lack of
communication skills” and fails to
23 “extend basic courtesy to his
colleagues.”
24
115. Jadwin’s evaluation of the DFJ00689 Misstates evidence.
25 11/9/05 oncology conference (what he
filled out). He complained that it ran
26 to 8:38 a.m. and he noted he would
discuss the overrun with Dr. McBride.
27
28

1 116. Memorandum to Supervisor 0001566- None.

Michael Rubio, District V, from Peter 1567
2 Bryan, dated 1/17/06, giving him
background on the problems arising
3 from the October oncology
conference. Bryan tells of a meeting
4 he had with Jadwin about a week after
the conference in which Jadwin was
5 extremely angry and making loud,
derogatory comments about various
6 members of the medical staff. He said
he became concerned about Jadwin’s
7 emotional health. He also said that
Jadwin has never been able to state a
8 resolution to the impasse. Bryan also
says that he will meet again with
9 Jadwin and inform him of some
expectations for future conduct, or he
10 will consider removing him as the
chairman of the pathology department.
11
12 PCCs
13 117. PCC issue was a difference in Bryan The transcript is not authenticated. It is not a
professional judgment, the process by Depo., certified copy, it is a condensed transcript for
14 the nursing staff was working for 8/14/08, informal attorney use. No reporter certification
them, and Jadwin failed to work pgs. 205:6- is attached to the transcript.
15 within the institution and committee 206: 25
structure. Also, Bryan inferred that (Exhibit Hearsay. Improper opinion. Improper
16 Jadwin had accused Toni Smith of 291) conclusion. Improper speculation.
ethical lapses which is an example of
17 “a pattern of inability to establish an
effective means of dialogue.”
18
118. E-mail to Toni Smith, R.N. from DFJ00408- None.
19 Jadwin, dated 5/20/05, inquiring after 409
audits of the nursing department of
20 which only one was received and
arguing that PCCs should be sent to
21 the blood bank when complete.
22 119. E-mail to Toni Smith from DFJ02499 None.
Jadwin, dated 5/20/05, recounting
23 Jadwin’s telephone conversation with
Holly Rapp, AABB Accreditation
24 Director.
25
26
27
28

1 120. Exchange of e-mails between 0000421- None.

Toni Smith and Jadwin, dated between 424
2 6/15/05 and 6/28/05, about the PCC
issues. In 0000423, Jadwin states that
3 a PCC must not be signed until the
time of the infusion, or KMC is not
4 meeting AABB accreditation
standards.
5
121. Typed notes, dated 1/10/06, of 0000572 No foundation. No authentication. Hearsay.
6 interviews with various people and Misstates the evidence.
institutions re: sending the Product
7 Chart Copies (PCCs) back to the
blood bank (pathology). The author
8 unknown- interviewed Michelle Burris
who said there is no reason to return
9 PCCs to pathology. The author
interviewed Ann Schadler, UCLA
10 Blood Bank Director, who said their
PCCs are in the patient’s record only,
11 not the blood bank. The author
interviewed Julia, UCSD Blood Bank,
12 who said there was no reason to return
the form to the blood bank. The author
13 also interviewed Dr. Wu and Jay,
supervisor of Mercy Lab and Blood
14 Bank, who said that the PCC goes in
the patient’s record and there is no
15 reason to return the PCC to the blood
bank.
16
122. E-mail to Peter Bryan from DFJ00784 None.
17 Jadwin, dated 4/10/06, about several
issues but he brings up non-
18 compliance with state regulations,
JCAHO, and AABB on the issues of
19 the PCCs.
20 123. Notes of meeting dated 4/14/06 DFJ00788 No foundation. No authentication. Hearsay.

with Peter Bryan, Karen Barnes and Misstates the evidence.
21 Jadwin on 4/13/06. There is no
problem with the PCCs because 5
22 charts were reviewed (and approved)
by JCAHO.
23
124. E-mail to Peter Bryan from DFJ00793 None.
24 Jadwin, dated 4/17/06, claiming that
the JCAHO review was too small of a
25 sample and KMC was in
noncompliance on their handling of
26 the PCCs and there was a need for
action.
27
28

1 a) Bryan criticizes Jadwin’s 57 memos Bryan The transcript is not authenticated. It is not a
to Toni Smith, R.N. as a “way of Depo., certified copy, it is a condensed transcript for
2 flooding the system and seeing what 8/14/08, pg. informal attorney use. No reporter certification
sticks and what doesn’t.” 226: 10-16 is attached to the transcript.
3
125. Memo to Peter Bryan from Toni 0000401- No foundation. Improper conclusion. Improper
4 Smith, dated 4/17/06, responding to 403 opinion. Improper speculation.
Jadwin’s e-mail to Peter Bryan of
5 4/17/06, disagreeing with Jadwin’s
characterization of the PCC situation
6 and stating that Jadwin’s proposals on
this issue were strategies that have
7 previously been rejected by KMC.
8 126. Harris had complaints about Harris The transcript is not authenticated. It is not a
Jadwin’s handling of the PCC issue- Depo., certified copy, it is a condensed transcript for
9 Jadwin was demanding, inflexible, 8/13/08, informal attorney use. No reporter certification
unreasonable in wanting the originals, pgs. 268:8- is attached to the transcript.
10 impatient. 23
No foundation. Improper opinion. Improper
11 speculation.
127. Toni Smith, R.N. explained that Smith The transcript is not authenticated. It is not a
12 the reason that some PCCs looked like Depo., certified copy, it is a condensed transcript for
they were not complete is that the 8/19/08, informal attorney use. No reporter certification
13 PCC form was actually in duplicate pgs. 59:4- is attached to the transcript.
and the nurses were not consistent 60: 13
14 about writing on only one copy and Improper speculation. No foundation.
throwing the blank copy away.
15
128. Toni Smith said that Jadwin was Smith The transcript is not authenticated. It is not a
16 never interested or willing to listen to Depo., certified copy, it is a condensed transcript for
her ideas. When asked what Jadwin’s 8/19/08, pg. informal attorney use. No reporter certification
17 physical demeanor was like in these 65:2-13 and is attached to the transcript.
conversations in which he was 74: 12-22
18 allegedly uncooperative, she said “He Improper speculation. Best evidence rule.
was obviously frustrated, obviously
19 not going to change his mind,
obviously not willing to listen to
20 anything. I presented cases from other
hospitals, some of the lab directors
21 that I hold in high esteem. [He] had no
interest in any of that.”
22
129. Jadwin’s idea to have the PCCs Smith The transcript is not authenticated. It is not a
23 stored in his department may violate Depo., certified copy, it is a condensed transcript for
California law, Title 22, by 8/19/08, pg. informal attorney use. No reporter certification
24 fragmenting the medical record. 71 :2-21 is attached to the transcript.
Jadwin’s idea was opposed by Toni
25 Smith, R.N., the medical records Improper speculation. Improper conclusion.
department, and the medical records Hearsay.
26 committee which ultimately
determines what the contents of a
27 medical record will be.
28

1 130. Toni Smith, R.N. offered a Smith The transcript is not authenticated. It is not a
succinct description of her Depo., certified copy, it is a condensed transcript for
2 conversations with Jadwin on the issue 8/19/08,pgs. informal attorney use. No reporter certification
of PCCs. The conversations were not 72:19-73:17 is attached to the transcript.
3 professional conversations-”It just was
a dead-end conversation. I mean, he Improper speculation. Improper conclusion.
4 had his mind made up that those Hearsay.
things-he had never seen an
5 organization where they hadn’t been
stored in the lab. I had indicated-I
6 indicated to him that I had never seen
an organization where they were
7 stored in the lab. And I questioned
him as to how he was going to be able
8 to locate that if we needed it for
patient care purposes. I think he said
9 he was going to store them in binders
or in notebooks or boxes or
10 something. You know, it was
irrelevant as far as I was concerned. I
11 felt that it was very important to have
that information-one, we needed to
12 know that the patient had-had received
the blood. We needed the vital sign
13 information during the blood
transfusion part, which would leave a
14 huge gaping hole in patient
information if that was stored
15 somewhere in the lab.”
16 131. Toni Smith considered Jadwin’s Smith The transcript is not authenticated. It is not a
conduct at the MEC meeting as Depo., certified copy, it is a condensed transcript for
17 uncooperative, refusal to consider 8119/08, pg. informal attorney use. No reporter certification
other points of view or suggestions, 77:9-20 is attached to the transcript.
18 etc.
Relevance.
19 132. Jadwin’s charges of being out of Smith The transcript is not authenticated. It is not a
compliance with regulatory agencies Depo., certified copy, it is a condensed transcript for
20 were unfounded, and regulatory 8/19108, informal attorney use. No reporter certification
agencies found no jeopardy of KMC’s pgs. 84: 11- is attached to the transcript.
21 level of compliance. 85:7
Misstates testimony. Speculation. No
22 foundation. Improper conclusion.
23 In General Treatment of Other

Staff
24
25
26
27
28

1 133. Dr. Abraham gradually had fewer Abraham The transcript is not authenticated. It is not a
and fewer interactions with Jadwin Depo., certified copy, it is a condensed transcript for
2 because his attitude was pompous and 8118/08, informal attorney use. No reporter certification
arrogant. Since the conversations with pgs. 49: 16- is attached to the transcript.
3 Jadwin were not cordial, it negatively 52:9 and 75
affected patient care. She didn’t :22-76: 19 No foundation. Improper speculation.
4 discuss Jadwin’s attitude with other Improper opinion. Improper conclusion.
doctors because she thought his
5 attitude was evident to everyone.
6 134. Dr. Abraham testified that many Abraham The transcript is not authenticated. It is not a
or most physicians reported Depo., certified copy, it is a condensed transcript for
7 difficulties in getting along with 8118/08, informal attorney use. No reporter certification
Jadwin. pgs. 185:7- is attached to the transcript.
8 187:9
9 Improper opinion. Hearsay.
135. Jadwin’s communication style Bryan The transcript is not authenticated. It is not a
10 was, to some people, offensive and Depo., certified copy, it is a condensed transcript for
abrasive, and he had a hard time 8114/08, informal attorney use. No reporter certification
11 accepting differing opinions from pgs. 90:4- is attached to the transcript.
others. 92:2
12 No foundation. Improper speculation.
Improper opinion. Hearsay.
13 136. “Compromise” was not in Bryan The transcript is not authenticated. It is not a
Jadwin’s vocabulary. It is not enough Depo., certified copy, it is a condensed transcript for
14 to be right; a department chair must 8114/08, informal attorney use. No reporter certification
exercise judgment on how to deal with pgs. 100: is attached to the transcript.
15 others. 12102: 1
16 Improper opinion.
137. Jadwin said Dr. Ragland was not Bryan The transcript is not authenticated. It is not a
17 qualified to be a staff officer, and he Depo., certified copy, it is a condensed transcript for
called Dr. Harris an idiot on several 8114/08, informal attorney use. No reporter certification
18 occasions. pgs. is attached to the transcript.
107:16109:
19 11 Relevance.
20 138. E-mail to Bryan from Jadwin Bryan The transcript is not authenticated. It is not a
asking Bryan what he (Bryan) has Depo., certified copy, it is a condensed transcript for
21 done on the cytotech issue. Bryan said 8114/08, informal attorney use. No reporter certification
that he was not the appropriate person pgs. 171: is attached to the transcript.
22 to resolve this. Jadwin should be 17173: 11
directing this to the chairman; Bryan (Exhibit No foundation. Improper conclusion.
23 only gets involved if approval is 271)
necessary.
24
139. Bryan recalls private Bryan The transcript is not authenticated. It is not a
25 conversations with Jadwin where Depo., certified copy, it is a condensed transcript for
Jadwin challenged Toni Smith’s 8114/08, pg. informal attorney use. No reporter certification
26 competency as chief nursing officer. 230: 10-15 is attached to the transcript.
27
28

1 140. Jadwin was so obsessed with Harris The transcript is not authenticated. It is not a
personnel actions or inactions that he Depo., certified copy, it is a condensed transcript for
2 was distracted in his duties. “ ... his 8113/08, informal attorney use. No reporter certification
behavior threatened a healthy, pgs. 171: is attached to the transcript.
3 productive work environment at the 16174: 8 pg.
hospital.” 173:9-10 No foundation. Improper speculation.
141. In most cases, doctors know how Harris The transcript is not authenticated. It is not a
5 to calm each other down and act Depo., certified copy, it is a condensed transcript for
professionally and collegially. Jadwin 8/13/08,pgs. informal attorney use. No reporter certification
6 was “unusual.” Jadwin was unable to 212:16218: is attached to the transcript.
interact collegially and professionally 11
7 to create a healthy, collaborative pg.215:18- No foundation. Improper speculation.
working environment. 21 Improper opinion. Improper conclusion.
8
142. Jadwin denied referring to Dr. Jadwin The transcript is not authenticated. It is not a
9 Epstein as cavalier. Jadwin said that Depo., certified copy, it is a condensed transcript for
on another matter, at another time, he 3/12/08,901 informal attorney use. No reporter certification
10 said that Dr. Epstein’s diagnoses were :12-903: 1 is attached to the transcript.
a little cavalier.
11
143. Dr. Ragland testified that Jadwin Ragland The transcript is not authenticated. It is not a
12 acted inappropriately in several Depo., certified copy, it is a condensed transcript for
instances. 8/22/08, pg. informal attorney use. No reporter certification
13 12:8-23 is attached to the transcript.
14 No foundation. Improper speculation.
Improper opinion. Improper conclusion.
15 a) The first incident was when Jadwin, pg.16:15- The transcript is not authenticated. It is not a
in a meeting, said Dr. Ragland was 16. certified copy, it is a condensed transcript for
16 incompetent and shouldn’t be the informal attorney use. No reporter certification
medical staff president. is attached to the transcript.
17
b) The second incident was Jadwin pgs. 59:21- The transcript is not authenticated. It is not a
19 taking over the blood usage committee 60: 17 and certified copy, it is a condensed transcript for
and not letting any other physicians on 86:5-25 informal attorney use. No reporter certification
20 it. Jadwin sent Dr. Ragland an e-mail is attached to the transcript.
stating that he thought having other
21 physicians on the committee was a Evidence was spoliated in violation of
waste of time because “they will all preservation request.
22 rubber stamp it.” Dr. Ragland
interpreted this to mean that Jadwin No foundation. Improper speculation.
23 did not think that anyone else at KMC Improper opinion. Improper conclusion.
had the competence or experience to
24 sit on the committee.
25
26
27
28

1 c) The third incident was Jadwin’s pg. 94:16 The transcript is not authenticated. It is not a
fighting with the radiologists and 95:15 and certified copy, it is a condensed transcript for
2 calling them incompetent. According 155:2- informal attorney use. No reporter certification
to Dr. Ragland, Jadwin was wrong 156:13 is attached to the transcript.
3 because the procedurist (the
radiologist) should chose the Hearsay. No foundation. Improper speculation.
4 equipment he uses (gauge of needle is Improper opinion. Improper conclusion.
an example) as that is who is
5 performing the task.
6 d) The fourth incident was Jadwin pgs. 106: The transcript is not authenticated. It is not a
hijacking the presentation at the 18-109: 14 certified copy, it is a condensed transcript for
7 October 2005 oncology conference. and 156:14- informal attorney use. No reporter certification
8
Hearsay. No foundation. Improper speculation.
144. Dr. Ragland observed an incident Ragland The transcript is not authenticated. It is not a
10 involving Dr. Shertukde wherein Depo., certified copy, it is a condensed transcript for
Jadwin intimidated her into giving the 8/22/08, pg. informal attorney use. No reporter certification
11 answer he wanted and then he 110:7-17 is attached to the transcript.
dismissed her from the room.
12
145. Watson describes how Jadwin’s Watson The transcript is not authenticated. It is not a
13 disruptive misconduct was discussed Depo., certified copy, it is a condensed transcript for
at several JCC meetings. 8/25/08, pg. informal attorney use. No reporter certification
14 13:3-16 is attached to the transcript.
15 Hearsay. No foundation. Improper speculation.
16 146. Watson testified to his Watson The transcript is not authenticated. It is not a
impression of Jadwin’s involvement Depo., certified copy, it is a condensed transcript for
17 with KMC management regarding 8/25/08, pg. informal attorney use. No reporter certification
whether to remove him as chair, etc. 32:6-1 0 is attached to the transcript.
18 He felt that Peter Bryan had made a
lot of effort to engage Jadwin but that Hearsay. No foundation. Improper speculation.
19 Jadwin was unresponsive. Improper conclusion.
20
21
22
23
24
25
26
27
28

1 147. Letter to Dr. Ko1b from Jadwin, DFJ00243- Relevance.

dated 11/22/03, complaining about the 245
2 situation at KMC. Jadwin asserted the
following: 1) offense at Dr. Kolb’s
3 counseling of Jadwin that his
leadership style needs to be kinder and
4 gentler; 2) distress at the criticisms he
received from Drs. Ragland and
5 Abraham at a Wednesday meeting; 3)
blame for the schism between
6 pathology and radiology over FNA
was on the radiologists; 4) personally
7 unaware of any inappropriate
interpersonal relations involving
8 himself; 5) hoped to be recognized by
others at KMC as one of the best
9 physicians and directors there; and 6)
any complaints about him were
10 “irresponsible attempts by a few
inadequate individuals.”
11
148. E-mail to Dr. Kercher from DFJ00316 None.
12 Jadwin, dated 2/1/05, requesting Dr.
Abraham be removed from the FNA
13 Committee because she wasn’t (by
implication) honest, objective or
14 impartial.
15 149. E-mail from Dr. Kercher to DFJ00317 Relevance.

Jadwin, dated 2/1/05, telling Jadwin
16 that he was not acting like a team
member.
17
150. E-mail to Peter Bryan from DFJ00319- None.
18 Jadwin, dated 2/2/05, listing his 320
suggestions for improvement on the
19 FNA issue. Jadwin also states that the
radiology department was
20 “substantially at fault” for the conflict
between the departments. He
21 requested a formal apology from the
radiology department to himself and
22 the pathology department. He also
requested (in bold lettering) a public
23 announcement at the next MEC
meeting that there are no quality
24 issues involving the pathology
department and Drs. Amin, Abraham,
25 Munoz and Naderi should be forced to
stand at the podium during the
26 announcement.
27
28

1 151. Exchange of e-mails between Dr. DFJ00353- None.

Ragland and Jadwin, dated 2/25/05, in 354
2 which Jadwin complains about some
comments made by the radiologists at
3 the February QM meeting and
informing Dr. Ragland to be prepared
4 for Jadwin to request him to call for
supporting documentation from
5 radiology or announce that the
previous comments were unsupported.
6 Dr. Ragland shot back his displeasure
at the continuing conflict between
7 radiology and pathology, and stated
that his committee will not become a
8 battleground for this conflict.
9 152. E-mail to Peter Bryan and Dr. DFJ00355 None.

Kercher from Jadwin, dated 2/28/05,
10 forwarding Dr. Ragland’s e-mail of
2/25/05 and asserting that because of
11 spelling, grammar, and syntax errors
in it that Dr. Ragland may be an
12 “impaired physician” with a “level of
intellectual functioning well below the
13 high school graduate level” and
thought processes that are “chaotic
14 and almost incoherent.” Jadwin
alleges that Dr. Ragland may have a
15 substance abuse, emotional and/or
cognitive function disorder, and
16 suggests monitored drug testing and
that Dr. Ragland’s patient care duties
17 be monitored as well.
18 a) Dr. Ragland heard about the e-mail Ragland The transcript is not authenticated. It is not a
although he never saw it. He heard Depo., certified copy, it is a condensed transcript for
19 that the e-mail was turned over to Dr. 8/22/08, informal attorney use. No reporter certification
Yoo, head of psychiatry. He also pgs. 332:4- is attached to the transcript.
20 heard that Jadwin had contacted the 337:2
licensing board about him with this Hearsay.
21 same accusation.
22 b) Letter to Dr. Ragland from Jadwin, [Compare to Relevance.

dated 10/19105, apologizing for past DFJ00355
23 wrongs, although he asserts that he above]
does not know how Dr. Ragland came DFJ00592
24 to dislike him. The irony is that
Jadwin’s letter contains many spelling
25 and grammatical mistakes and a
Freudian slip” ... and I have never
26 treated you and your patients
exceptionally well ...”
27
28

1 153. Letter to Dr. Sergio Perticucci DFJ00356~ Relevance.

from Jadwin, dated 3/3/05, 357
2 complaining about Dr. Perticucci’ s
complaints about the pathology
3 department. In particular, Jadwin
attempted to assert that an original
4 diagnosis of “atypical metaplasia” was
merely a transcription error because
5 the diagnosis should have been
“atypical hyperplasia.” Jadwin also
6 called the diagnosis rendered on the
same case by Dr. Felix of use
7 “nebulous.” Jadwin called Dr.
Perticucci dishonest and demanded an
8 apology.
9 154. E-mail to Dr. Kercher from DFJ00427 None.

Jadwin, dated 6/7/05, complaining
10 about Dr. Abraham’s conduct at an
MEC meeting and accusing her of an
11 “inappropriate personality defect.”
12 155. E-mail to Dr. Kercher from DFJ00436 None.

Jadwin, dated 6/27/05, demanding that
13 Dr. Abraham publicly apologize to
Jadwin at the next MEC meeting.
14
156. Letter to Dr. Roy from Jadwin, DFJ00738 Relevance.
15 dated 2/10/06, demanding apology
“meeting my specifications” if alleged
16 (pathology department) deficiencies
are not received in 14 days.
17
157. Memorandum from Peter Bryan DFJ00740- The transcript is not authenticated. It is not a
18 to Jadwin, dated 2/21/06, chastising 741; Bryan certified copy, it is a condensed transcript for
Jadwin for the tone of voice he used in Depo., informal attorney use. No reporter certification
19 his letter to Dr. Roy of 2/1 0/06 and 8/14/08, is attached to the transcript.
stating that “this method... exemplifies pgs. 137:1-
20 why it is becoming increasingly 144:9
difficult for you to work with key
21 members of the medical staff.”
22 158. Email to Peter Bryan from DFJ00744- None.
Jadwin, dated 2/23/06, following the 745
23 meeting of 2/22/06 urging Bryan to
take the moral high ground and called
24 Drs. Ragland and Abraham
“disgruntled, vindictive individuals.”
25
26
27
28

1 159. Exchange of e-mails with Peter DFJ00783 None.

Bryan from Jadwin, dated 3/24/06,
2 3/27/06, 4/5/06, criticizing Karen
Barnes for insisting on vicarious
3 liability of staffing agency before
placing a temporary pathologist. Also,
4 Jadwin postponed his own surgery
indefinitely because his mother was
5 ill.
6 160. Memo from Peter Bryan to DFJ00794- The transcript is not authenticated. It is not a
Jadwin, dated 4/17/06, telling him that 795; Bryan certified copy, it is a condensed transcript for
7 he must either work on improving his Depo., informal attorney use. No reporter certification
relationships with staff or step down 8/14/08, is attached to the transcript.
8 as chairman of pathology department. pgs. 231 :9-
Bryan states “You have made many 237:25; pgs. Misstates testimony.
9 derogatory comments about some of 233:2-17
the staff members” and “this apparent and 237:2-
10 lack of insight on your part is at the 11
heart of your inability to meaningfully
11 contribute as a member of the medical
staff leadership group.” In Bryan’s
12 Depo., he distinguished between the
department running well on a
13 technical level (which he notes in this
memo) and Jadwin’s deficiencies as
14 department chair
15 161. E-mail from Peter Bryan to 0001581 Relevance.

Jadwin, dated 4/17/06, responding to
16 an e-mail from Jadwin in which
Jadwin pushes an issue of “pathology
17 informatics.” Bryan’s response was
stem, “I clearly indicated to you that
18 your proposed solution of a free
standing system for pathology was not
19 going to happen. I have repeated this
to you many times ... “
20
162. Jadwin wanted to delete the Martinez The transcript is not authenticated. It is not a
21 “Complete Blood Count” from the Depo., certified copy, it is a condensed transcript for
laboratory’s test menu and only offer 4/16/08, informal attorney use. No reporter certification
22 the “Complete Blood Count with pgs. is attached to the transcript.
Differential.” Gilbert Martinez 121:17122:
23 believed Jadwin’s idea would pose a 19
compliance issue so Martinez took the
24 matter to the Compliance Committee.
Both options stayed on the test menu.
25 Martinez felt that Jadwin was being
uncooperative in this incident.
26
27
28

1 163. Gilbert Martinez described an Martinez The transcript is not authenticated. It is not a
incident an unannounced inspection Depo., certified copy, it is a condensed transcript for
2 occurred and Jadwin was not present. 4/16/08, informal attorney use. No reporter certification
Martinez proceeded to show the pgs. is attached to the transcript.
3 inspectors around the laboratory. 127:22130:
Jadwin returned, became upset when 3 Misstates testimony.
4 he discovered the inspectors were
there, stated that the inspection had
5 been mishandled, and then said that if
Jadwin had a gun, he would shoot
6 someone. Jadwin never apologized to
him for making the remark. The
7 incident happened sometime before
2005.
8
164. Dr. Dutt believed that Jadwin Dutt Depo., The transcript is not authenticated. It is not a
9 tried to retaliate against Dr. Taylor 8/20/08 pgs. certified copy, it is a condensed transcript for
who is married to Dr. Abraham. 291 :7-292: informal attorney use. No reporter certification
10 Jadwin’s dislike of Dr. Abraham is 11 is attached to the transcript.
well-known. For instance, Jadwin
11 refused to make the obvious diagnosis Improper speculation. Improper opinion.
on one of Dr. Taylor’s cases. Improper conclusion.
12
165. Dr. Dutt reported to Dr. Harris Dutt Depo., The transcript is not authenticated. It is not a
13 complaints by Dr. Shertukde that 8/20/08, certified copy, it is a condensed transcript for
Jadwin was angry and hostile toward pgs. 298:23- informal attorney use. No reporter certification
14 her. Dutt did so because he was afraid 300:24 is attached to the transcript.
that Dr. Shertukde or Vangie Gallegos
15 would file a case against the County Hearsay. Improper speculation.
for harassment or hostile work
16 environment based on Jadwin’s
behavior.
17
18 Meeting on February 22, 2006
19 166. Dr. Abraham recalled how Abraham The transcript is not authenticated. It is not a
Jadwin insulted her and how he had Depo., certified copy, it is a condensed transcript for
20 insulted Dr. Ragland and, in general, 8118/08, informal attorney use. No reporter certification
that he managed to insult everyone pgs. 198:24- is attached to the transcript.
21 who was there but she did not 207: 17
remember specific statements beyond
22 those directed at her and Dr. Ragland.
23 167. Jadwin insulted, literally, Bryan The transcript is not authenticated. It is not a
everyone at the meeting face-to-face. Depo., certified copy, it is a condensed transcript for
pgs. 109: is attached to the transcript.
25 12111: 10
26
27
28

1 168. Bryan thanked Dr. Ragland for Bryan The transcript is not authenticated. It is not a
showing restraint in the face of Depo., certified copy, it is a condensed transcript for
2 Jadwin’s insults. 8/14/08, informal attorney use. No reporter certification
pgs. is attached to the transcript.
3 156:22157:
12 Improper conclusion.
4
169. Jadwin made attacking Harris The transcript is not authenticated. It is not a
5 statements and charges at attendees of Depo., certified copy, it is a condensed transcript for
2/22/06 meeting. 8/13/08, pg. informal attorney use. No reporter certification
6 159 :2-13 is attached to the transcript.
7 170. Jadwin insulted Dr. Ragland Harris The transcript is not authenticated. It is not a
severely at the 2/22/06 meeting. Depo., certified copy, it is a condensed transcript for
8 8113/08, pg. informal attorney use. No reporter certification
196:7-20 is attached to the transcript.
9
10 171. Jadwin insulted all of the doctors Harris The transcript is not authenticated. It is not a
at the meeting, including Dr. Harris. Depo., certified copy, it is a condensed transcript for
11 8/13/08 pgs. informal attorney use. No reporter certification
230:4232: is attached to the transcript.
12 13
13 172. Harris refused to characterize Harris The transcript is not authenticated. It is not a
Jadwin’s behavior as crazy but he did Depo., certified copy, it is a condensed transcript for
14 offer “excessive” as a description and 8113/08, informal attorney use. No reporter certification
agreed with Eugene Lee’s adjectives pgs. is attached to the transcript.
15 of “unprofessional” and 234:24235:
“unreasonable.” Harris said it was the 23 and
16 most unprofessional, unreasonable, 305:20308:
excessive behavior he has ever seen in 22
17 a physician.
18 173. The first incident of Jadwin’s Ragland The transcript is not authenticated. It is not a
inappropriate conduct was when Depo., certified copy, it is a condensed transcript for
19 Jadwin, during this meeting, said Dr. 8/22/08, pg. informal attorney use. No reporter certification
Ragland was incompetent and 16: 12-16 is attached to the transcript.
20 shouldn’t be the medical staff
president.
21
174. E-mail from Dr. Ragland to Peter 0000507 None.
22 Bryan, dated 2/23/06, stating that the
meeting with Jadwin on 2/22/06 was
23 “one of the most distasteful events I
have ever participated in.”
24
25 Demotion to Staff Pathologist
26
27
28

1 175. Pathology Dept. Proctoring 0000903 - No foundation. Not authenticated. Improper

Report on Dr. Dutt, dated 1/l8/06, and 913 conclusion. Improper opinion.
2 completed by Jadwin who said that
Dr. Dutt’s performance is “responsible
3 and excellent.”
4 176. Exchange of e-mails between Dr. DFJ01430 Hearsay. Speculation.

Dutt and Jadwin, dated 11/6/06,
5 regarding a container of specimen left
sitting out. To remedy the situation,
6 Dr. Dutt instructed that only
Evangeline “Vangie” Gallegos was to
7 process the placentas.
8 177. E-mail from Evangeline 0000824 Hearsay. Improper conclusion. Improper

“Vangie” Gallegos to Dr. Dutt, dated speculation. Improper opinion.
9 11/6/06, thanking him for his support
and complaining about Jadwin
10 interfering in her work area and
“creating more work for everybody.”
11 She asked if she could go home early
as she was feeling sick.
12
178. Exchange of e-mails between Dr. DFJ01439 Hearsay..
13 Dutt and Jadwin, dated 11/13/06 and (000084084
11/14/06, wherein Jadwin requested 1)
14 that he have an assigned assistant and
that the assigned assistant be required
15 to notify him when leaving the lab for
more than 5 minutes. Dr. Dutt’s
16 response was to deny the need for an
assistant as the department had three
17 pathologists and to remark how
“demeaning and time consuming” it
18 would be to constantly clock in and
out.
19
179. E-mail from Dr. Dutt to Jadwin, DFJ01446- Hearsay. No foundation. Improper conclusion.
20 dated 11/17/06, expressing frustration 01447 Improper speculation. Improper opinion.
with Jadwin’s reaction to counseling (0000843)
21 which is to escalate the situation,
blame others, or attack others. Dr.
22 Dutt also promised to find the records
where Jadwin did not submit a “rush”
23 case or most of his other cases that
day. He also asserted that Jadwin had
24 done this before.
25 180. E-mail from Dr. Dutt to Jadwin, DFJ01448 Hearsay. No foundation. Improper conclusion.
dated 11/22/06, discussing their (0000850) Improper speculation. Improper opinion.
26 disagreement on the necessity for
privileges for FNA and the necessity
27 for proctoring.
28

1 181. E-mail from Dr. Dutt to Jadwin, DFJ01449 Hearsay. No foundation. Improper conclusion.
dated 11/22/06, reminding him of a (000085]) Improper speculation. Improper opinion.
2 rush case that Jadwin failed to process
promptly and counseling Jadwin to
3 remember it when criticizing others.
4 182. E-mail from Dr. Dutt to Jadwin, 0000827 Hearsay. No foundation. Improper conclusion.
dated 12/4/06, chastising Jadwin for Improper speculation. Improper opinion.
5 criticizing Dr. Shertukde’s diagnosis
without consulting others first;
6 chastising him for refusing to get
outside consult on a hard case; and
7 chastising him for failing to remove
the sharps from the cutting area when
8 he was done.
9 a) Minutes of the meeting of the 0000899 No foundation. Improper conclusion. Improper

pathology/histology department on speculation. Improper opinion.
10 10/17/06. It was noted that Dr.
Shertukde was concerned that blades
11 were not being removed once grossing
was done. She and Dr. Dutt remove
12 and discard the blades immediately.
13 b) E-mail from Dr. Dutt to Yolanda 0000862 Hearsay. No foundation. Improper conclusion.
Figueroa, dated 12/7/06, Improper speculation. Improper opinion.
14 acknowledging her report that Jadwin
had left two long blades and a scalpel
15 out after he was finished. 183. E-mail
from Dr. Dutt to Jadwin, dated
16 12/5/06, regarding Jadwin’s
uncooperativeness with him and
17 general failure to adhere to a chain of
command.
18
183. E-mail from Dr. Dutt to Jadwin, DFJ01465 Hearsay. No foundation. Improper conclusion.
19 dated 12/5/06, regarding Jadwin’s (0000856) Improper speculation. Improper opinion.
uncooperativeness with him and
20 general failure to adhere to a chain of
command.
21
184. E-mails between Dr. Dutt and DFJ01476- Hearsay. No foundation. Improper conclusion.
22 Jadwin, dated 12/6/06, arguing over a 1478 Improper speculation. Improper opinion.
criticism Jadwin made of a diagnosis (0000857-
23 that Dr. Shertukde did and involving 858)
alleged defamatory and retaliatory
24 statements made by Jadwin. Dr. Dutt
tells Jadwin that people are afraid of
25 him because of his hostility and that it
is Jadwin’s fault for how he treats
26 others.
27
28

1 185. E-mail from Dr. Dutt to David 0001466 Hearsay. No foundation. Improper conclusion.
Culberson, dated 12/6/06, stating that Improper speculation. Improper opinion.
2 he had counseled Jadwin for not
sending out a case for consultation
3 that, in fact, turned out to be a missed
endometrial cancer and now Jadwin
4 was pushing a lot of cases out for
consultation, burdening the staffs time
5 and budget.
6 186. E-mail from Dr. Dutt to Jadwin, 0000863 Hearsay. No foundation. Improper conclusion.
dated 12/7/06, chastising him for Improper speculation. Improper opinion.
7 commanding Yolanda to treat the
placentas when in his e-mail of
8 11/6/06 (0000825 above) specifically
said that only Vangie was to work
9 with placentas.
10 187. Jadwin was uncooperative after Dutt Depo., The transcript is not authenticated. It is not a
returning from leave. He was asked 8/20/08, pg. certified copy, it is a condensed transcript for
11 specifically to resume doing the blood 284:25- informal attorney use. No reporter certification
bank reviews and he did not do them. 285:5 is attached to the transcript.
12
No foundation. Improper conclusion. Improper
13 speculation. Improper opinion.
188. Dr. Dutt, acting Chair of the Dutt Depo., The transcript is not authenticated. It is not a
14 Pathology Department had concerns 8/20/08, certified copy, it is a condensed transcript for
that Jadwin was creating a hostile pgs. 286:6- informal attorney use. No reporter certification
15 work environment. This prompted 289: 1; 290: is attached to the transcript.
meetings with Dr. Perez, David 14-20
16 Culberson, and Dr. Harris. No foundation. Improper conclusion. Improper
speculation. Improper opinion.
17 189. Dr. Dutt would try to counsel Dutt Depo., The transcript is not authenticated. It is not a
Jadwin one-on-one but Jadwin would 8/20/08, certified copy, it is a condensed transcript for
18 avoid the conversation. He would pgs.296:20- informal attorney use. No reporter certification
make an excuse to leave the room or 297:13 is attached to the transcript.
19 leave the hospital. Because Jadwin
made it difficult for Dr. Dutt to talk to No foundation. Improper conclusion. Improper
20 him, Dr. Dutt had no alternative but to speculation. Improper opinion.
send his concerns about Jadwin’s
21 work to the Peer Review Committee.
22 190. E-mail to Dr. Dutt from Jadwin, DFJ01479- None.
dated 12/6/06, with copies to David 1480
23 Culberson, Dr. Harris and Karen
Barnes, alleging that he has been
24 “singled out for non-transparent ‘PCC
r review’“ as well as personal attacks,
25 and he requests the KMC
administration to initiate a formal
26 review.
27
Date: December 1, 2008
28

1 /s/ Eugene D. Lee

3 Phone: (213) 992-3299
Fax: (213) 596-0487
Attorney for Plaintiff DAVID F. JADWIN, D.O.
5
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275-283 D MSJ Opp

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Case 1:07-cv-00026-OWW-TAG Document 275 Filed 12/01/2008 Page 1 of 29

1 Eugene D. Lee (SB#: 236812)

Cal. Labor Code § 1102.6 ........................................................................................................................... 8

USDC, ED Case No. 1:07-cv-00026 OWW TAG

USDC, ED Case No. 1:07-cv-00026 OWW TAG

1 Plaintiff had a constitutional property right to continued employment by Defendant County.

1 Defendants’ legal analysis regarding medical leave retaliation is woefully deficient.

USDC, ED Case No. 1:07-cv-00026 OWW TAG

1 medical leave was “sometimes” appropriate. [PMF 150].

1 leave. Defendants’ allegations of Plaintiff’s noncompliance with FMLA/CFRA are insufficient.

1 (“Presumably, when an individual is given neither a predeprivation hearing nor a postdeprivation

1 Disability Discrimination and Defendant’s Eleventh Affirmative Defense re Workers Compensation

1 Eugene D. Lee (SB#: 236812)

5 Attorney for Plaintiff

9 EASTERN DISTRICT OF CALIFORNIA

11 DAVID F. JADWIN, D.O., Civil Action No. 1:07-cv-00026 OWW TAG

12 Plaintiff, PLAINTIFF’S RESPONSIVE STATEMENT

15 Defendants. Date: January 12, 2009

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 5. Responsibilities and duties DFJ00046 See evidentiary objections.

4 6. Second Employment 0001479- Undisputed.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 7. Letter to Peter Bryan DFJ00723 See evidentiary objections.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 9. Sandi Chester effectively Chester See evidentiary objections: Irrelevant to excusing

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 16. KMC’s responsive DFJ00747 See evidentiary objections: Irrelevant to excusing

19 Chester admitted in Depo. that Plaintiff’s email to Bryan

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

7 21. Bryan noted that he gave Bryan See evidentiary objections.

19 It should be noted that the “issues” within the Pathology

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 22. Memo from Bryan to Bryan See evidentiary Objections

13 Disputed that it was not a disciplinary meeting. [Lee Opp.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 23. A letter to Bryan from Bryan See evidentiary objections.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 25. Bryan artfully explained Bryan See evidentiary objections.

17 Moreover, this responsibility to “influence” policies and

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 a) Responsibilities and duties DFJ00046 See evidentiary objections.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 29. According to Exhibit Bryan See evidentiary objections: Irrelevant to excusing

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 30. By June 2006, Jadwin Bryan See evidentiary objections.

18 31. Adherence to the Bryan See evidentiary objections: Irrelevant to excusing

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

9 33. Memorandum to the Joint 0001476- See evidentiary objections.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 34. Ray Watson (hereinafter Watson See evidentiary objections.

17 Watson then re-affirmed a third time – volunteering it on

19 Q. So the question is: You’ve mentioned that for the

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 35. Watson testified that he Watson See evidentiary objections.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 a) Kern County Board of Decl. of See evidentiary objections.

21 38. Plaintiffs’ attorney Bryan See evidentiary objections: Irrelevant to excusing

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 40. Letter from David DFJ01398 Undisputed.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO

1 44. Exhibit 644 is an e-mail Jadwin See evidentiary objections.

Π’S RESPONSIVE STATEMENT OF MATERIAL FACTS IN OPPOSITION TO