Académique Documents
Professionnel Documents
Culture Documents
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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
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 4
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 5 of 93
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26 EXHIBIT 1
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 6
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 7 of 93 7
",.,
FROM:
SUBJECT:
Peter K. Bryan, CEO
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.
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)
the chief executive officer without hearing and appeal rights set forth in
Article XII.
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.
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:
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.
OOOj4~
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~ ;.1
Kern County
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:
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.
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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.
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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.
(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.
0001.481.
-----------~----~
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.
(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.
4. PROFESSIONAL FEES
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collecting all professional fees for Core Physician's services. Each Core
, Physician or practice group will have a separate tax identification number.
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.
5. OTHER INCOME
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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.
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.
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.
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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
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.
Core Physician will receive paid leave for holidays, vacation, sick leave and
educational leave.
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A. Holidays:
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
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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.
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 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
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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
preceding Plan year, Core Physician's mandatory employee contribution required
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.
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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.
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8. KERN$FLEX PLAN
9. EXPENSE REIMBURSEMENT
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.
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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. .
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.
2. CORRECTIVE ACTION
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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
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
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0001.492- I
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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.
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.
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
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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.
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.
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:
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0001.494
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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
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.
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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
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. .
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.
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0001.496
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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
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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.
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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.
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0001.49~
K~KNCOUNTYPERSONNELDEPARTMENT
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REQUEST FOR LEAVE OF ABSENCE
DATE 3/~!at:,
>
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)
:!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
A.PPROVED DATE) L
1y I" ''0
o 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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 32 of 93
1
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)
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)
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:
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).
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.
0001.504
,
...,
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 36 of 93
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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 37 of 93
KERN COUNTY PERSONNEL DEPARTMENT
REQUEST FOR LEAVE OF ABSENCE
:>ARTMENT _ _ (_<_P_C!-_·~
__·~--r~7-7r-----'------'-- DATE
~-l,J,-O t _
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)
_-....,.--~;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 ~
o DATE _
o NOT APPROVED DATE _ NOT APPROVED
ignature _ Signature
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~
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" .
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 39 of 93
. .
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
REQUEST FOR LEAVE OF ABSENCE
_~-+.'_(,_._~
__W-L-5-f-'1~ _ 3/~!O It?
.,vlENT
-+ NMlE
J
I SOCIAL SECURITY NUMBER
DATE
)
JOB TITLE
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)
·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.)
Signature of Employee
APPROVED DATE
?j I"·'V
) L o APPROVED DATE _
I
N TAPPROVED} DATE _ o NOT APPROVED DATE _
lature I
C
,
_/.!!
. .-'. i '
Signature~ _
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
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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 43 of 93
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. (
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..-3;3-r:'O .0 .0 34.6 .0 59.7 .0 .0 ,4.2~j'
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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
Core Physician's Department Chair and the Medical Director.
1
4. UNPAID LEAVE OF ABSENCE
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
by County shall not be a breach of this Agreement.
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
Document) under the amended and restated Plan document shall be as follows:
County shall contribute as County's required contribution the sum of Seventeen
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
preceding Plan year, Core Physician's mandatory employee contribution required
1
9
1
0001.51.3 .
1
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 45 of 93
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)
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)
'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·
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 46 of 93
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:
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)
0001.51. 5
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 47 of 93
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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 48 of 93
· '
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,
0001517
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 49 of 93
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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 50 of 93
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)
1202.10 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)
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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 51 of 93
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)
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)
00015 2 0
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 52 of 93
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)
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~
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 53 of 93
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)
0001.522
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 54 of 93
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) .
1202.10 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
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 55 of 93
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..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)
0001524
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 56 of 93
• KERN
MEDICAL
• CENTER
AFFILIATED WITH UNIVERSI1Y OF CALIFORNIA SCHOOLS
OF MEDICINE AT LOS ANGELES, SAN DIEGO, AND IRVINE
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
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
L
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 ~
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
0001.527
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 59 of 93
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 60 of 93
'JAME IJADWIN,DAVID FRANK I I KERN MEDICAL CENTER liTEM NO. I 0706 I JOB TITLE !CHMN/PATHOLOGY-
30C.SEC. # b76-S0-H77 I HOMEDEPT.# 18719 I I MEDICAL STAFF-PATHOLOGY I PAY PERIODGi] E~~ 11l/11/0~ EMPLOYEE
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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 INSTRUCTIONS
Ul1'
·YOURHOME ENTER DEPT # OF OTHER LOCATIONS WORKED SICK TIME COMMENTS
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0001529 OTHER
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 61 of 93
I ,-- - • __m . I I KERN MEDICAL CENTER liTEM NO. I 0706 I JOB TITLE I CHMN/PATHOLOGY-
SOC. SEC. # 1376-50-8177 I HOME DEPT. # I 8719 II MEDICAL STAFF-PATHOLOGY I PAY PERIODW] E~~ Ill/25/ol E:SEE [i]
, .
NOTE: IF YOU FAIL TO RECORD HOURS OR DAVS PROPERLY. NO CORRECTIONS WILL BE MADE UNTIL THE FOLLOWING PAYDAY. SEE REVERSE FOR ADDITIONAL INSTRUCTIONS
YOUR HOME ENTER DEPT 1/1 OF OTHER LOCATIONS WORKED SICK TIME COMMENTS
lSI" OTHER PAY CODES LEAVE (I.E. REASON FOR OVERTIME
TIME TIME ON· SHFT DEPT. ONLY HOl OFF VACA· CF DAILY
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 62 of 93
NAME IJADWIN, DAVID FRANK I KERN MEDICAL CENTER liTEM NO. I I
0706 JOB TITLE I I ICHMN/PATHOLOGY - I
SOC. SEC. ", 1376-50-8177 I HOME DEPT. r I 81l~ II MEDICAL STAfF-PATHOLOGY I PAY PERIOD~ E~ 112/09/0. E~E [D
NOTE: IF YOU FAIL TO RECORD HOURS OR DAYS: PROPERLY, NO CORRECnONS WILL BE MADE UNnL THE FOLLOWING PAYDAY. SEE REVERSE FOR ADDITIONAL INSTRUCnONS
YOUR HOME ENTER DEPT" OF OTHER LOCATIONS WORKED SICK TIME CQMMENT~
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ITIFY THAT THE, RREC~THcl. BEST OF MY KNOWLEDGE.
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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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I
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PHYS.I I
AME I
JADWIN, DAVID FRANK I I
Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 64JOB
KERN MEDICAL CENTER lITEM NO. 0"06
of 93
TITLE I I I CHMN/PATHOLOGY- I
DC. SEC. # 1376-50-8177 I HOME DEPT. I 8719 I I
# MEDICAL STAFF-PATHOLOGY I PAY PERIOD[2£] E~~ I
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."f\Mt: I..JADWIN,DAVID FRANK I KERN MEDICAL CENTER lITEM NO. 0706I JOB TITLE I I !CHMN/PATHOLOGY-
soc. SEC. # 1376-50-8177 I HOME DEPT. # 18719 II MEDICAL STAFF-PATHOLOGY I PAY PERIODG:] E~ 101/20/04
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lAME IJADWIN, DAVID FRANK I I KERNDocument 277 Filed 12/01/2008
MEDICAL CENTER I liTEM NO.
Page 67 of 93
0706 .\ JOB TITLE I CHMN/PATHOLOGY-
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~JD 1:07-cv-00026-OWW-TAG Document 277
I I KERN MEDICAL CENTER liTEM NO. I I
Filed 12/01/2008 Page 69 of 93
JOB TITLE 11.0..---_ _
JC. SEC. # 114 ~£>- yl Jl I HOMEDEPT. # I II I PAY PERIODtlof..j~~ I I EMPLOYEE D' STATUS
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 70 of 93
CES Time Balance Change Fonn Page I of I
.. ~" -
\~\~ Change of Employee Status
I
DEPARTMENT # DEPARTMENT NAME DATE PREPARED
8997 KERN MEDICAL CENTER' 03/23/2006
SOCIAL SECURITY NBR EMPLOYEE NAME
376-50-8177 JADWIN DAVID fRANK
EFFECTIVE DATE
03/2312006
CORRECTJONOF TJME OFF BALANCES
TYPE OF TIME OFF BALANCE ACTION NUM BER OF HOURS
EMPLOYEE SICK LEAVE Add 6.4
FAMILY SICK LEAVE
VACATION Add 16.1
COMPENSATORY TIME
DATE.. SIGNATljRE
ACKNOWLEDGMENT BY THE EMPLOYEE: I ACKNOWLEDGE AND CERTIFY
THAT THE STATEMENTS ON THIS FORM ARE TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE.
-
DEP,\RTMENT HEAD OR OTHER AUTHORIZED SIGNATURE
REQUESTED CHANGE IS: RECOMMENDED NOT RECOMMENDED .1/zJIr.te. ( l-L r ,~
.-
DIRECTOR Of PERSONNEL AND SECRETARY. CIVIL SERVICE COMMISSION
APPROVED NOT ..W PROVED
0001539
3/2312006
!:>'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
X.SEC.# 1376-50-8177 I HOME DEPT. # I 87J 9 II MEDICAl, STAFF-PATHOl!~GY I PAY PERIODW E~~ I Q3/17IQtE~nJ.:E GJ .
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NAME ,~IN,DAVIDCase 1:07-cv-00026-OWW-TAG
FRANK KERN Document
MEDICAL277 FiledliTEM
CENTER 12/01/2008
NO. 0706
Page 72 I I
ofTITLE
JOB 93 I I I CHMN/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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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 74 of 93
I • ...., _ n •• Lon II' ~M NU. I V tVb I .lUI:' 111Lt: I ~tiMNl r'ATHULU<..>:{-·
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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
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 75 of 93
II KERN
. II MEDICAL
...::
. CENTER
AFFILIATED WITH UNIVERSITY OF CALIFORNIA SCHOOLS
OF MEDICINE AT lOS ANGELES. SAN DIEGO.. AND IRVINE
o _ _--,-__ Ibs.
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.
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c0ad~i() ~o...\,)~d
·
Page 76 of 93 . F.
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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)_
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~ .
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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
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 78 of lof
Page 93 1
"
He gets paid for 20.5 hours. The' remaining time will be in a'no pay status. Thanks for your
patience.
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?" '
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Case 1:07-cv-00026-OWW-TAG Document 277 Filed 12/01/2008 Page 81 of 93
viE I JADWIN,DAVID FRANK I I
KERN MEDICAL CENTER IITEM NO. 107061 JOBTITLE I CHMN/PATHOLOGY- I
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l·''..l''-L\.
--1 IVlcUll.,;AL277 FiledliTEM
lrtN I t.H NO. I lfiv::.J
12/01/2008 Page,JOB
92 of 93
TITLE I CHI'1Nf PP-.THOLC·CY II
_...J
SOC. SEC. # r-;-6-S0-S177 I HOME DEPT. # [8719 II MEDICAL STAFF- PATHOLOGY I PAY PERIOD[EJ E~f+~G Ill/I0/0~ EMPLOYEE ~I
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Case 1:07-cv-00026-OWW-TAG
11/ 1::/~'Ol)t; 1 (I "7 F,",j:: :::282:~ i4 Document 277
r:.rn.- t"' ,", I HULIJI) 'j Filed 12/01/2008 Page 93 of4:!J 93
".'\'-... .,.....
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
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
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 4
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 5 of 245
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 2
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 7
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 7 of 245
288
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
17
18
19
20
22
23
24
25
BryanP2
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 8 of 245
332
4 style and his lack of insight into how his own behavior
16 completed those.
BryanP2
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 9 of 245
333
4 department of pathology?
9 things?
24 CEO?
BryanP2
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 10 of 245
334
4 you, correct?
10 schedule?
19 Q. Philip Dutt?
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
13 that time.
16 of said action.
17
18 IN WITNESS WHEREOF, I have subscribed my name
20
21
23
24
25
vs. COUNTY
& RANDALL (800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 12 of 245
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 3
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 8
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 13 of 245
1
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 14 of 245
110
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 15 of 245
230
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 16 of 245
231
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 17 of 245
249
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 18 of 245
250
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 19 of 245
261
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 20 of 245
262
BryanP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 21 of 245
08-14-08
BRYAN
w
o
Page 287 R
D
1 STATE OF CALIFORNIA
ss. I
2 COUNTY OF KERN
3
4 I, Cindee L. LeFevre, a Certified Shorthand
9 Thursday, August 14, 2008, at the time and place set forth
20 Bakersfield, California.
21
22 .
23
/
~L)~
24 Cindee L. LeFevre, CSR No. 7974
25
vs. COUNTY
NDALL (800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 22 of 245
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 4
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 9
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 23 of 245
263
3 ______________
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
DFJ2
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 24 of 245
290
7 BY MR. WASSER:
8 Q. Anything more?
10 narrative.
DFJ2
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 25 of 245
384
1 BY MR. WASSER:
3 days a week?
14 Q. Um-hmm.
24 improvement work.
25 ////
DFJ2
515
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 26 of 245
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
'OB
I, Susan R. Wood, a Certified Shorthand
10 Bakersfield, California.
.
'm
23 rsi
j
24 Susan R. Wood, CSR No. 6829
5 Ion
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 5
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 10
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 28 of 245
838
3 ______________
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
DFJ5
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 29 of 245
854
6 09:11:42 6 should I do, which could have all been done by phone.
8 09:11:51 8 from -- at least for part of the week, away from the
12 09:12:12 12 her so severely that she moved out of the room? You
DFJ5
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 30 of 245
855
5 5 possible.
18 09:14:17 18 four phone calls that probably didn't last very long
20 09:14:27 20 the Website and the design of a logo for the company
DFJ5
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 31 of 245
983
2 13:34:32 2 A. Yeah.
4 13:34:42 4 accommodation?
DFJ5
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 32 of 245
984
1 13:35:45 1 faster.
14 13:36:12 14 understand.
18 13:36:22 18 department had run well. I think it's been cited now
DFJ5
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 33 of 245
985
12 13:37:34 12 it.
15 13:37:41 15 Dr. Shertudke could handle the work, but Dr. Dutt was
DFJ5
1001
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 34 of 245
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
9 March 12, 2008, at the time and place set forth on the
20 Bakersfield, California.
21
22
23
Susan No. 6829
24
25
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 6
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 11
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 36 of 245
1002
3 3
4 4
11 11
12 12
13 13
14 14 VIDEOTAPED DEPOSITION
15 15 OF
18 18 GLENDALE, CALIFORNIA
19 19
20 20
21 21
23 23
24 24
25 25
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 37 of 245
1034
2 2 you down to --
24 24 contract.
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 38 of 245
1035
6 14:27 6 about?
12 12 BY MR. WASSER:
16 16 trying --
18 18 A Okay.
21 21 questions.
24 24 about.
25 25 / / /
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 39 of 245
1036
1 1 BY MR. WASSER:
4 4 A Oh, okay.
6 6 A Okay.
15 15 look like.
16 16 BY MR. WASSER:
22 22 Q In 2000?
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 40 of 245
1041
1 1 BY MR. WASSER:
7 7 BY MR. WASSER:
24 24 A It's --
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 41 of 245
1044
1 1 BY MR. WASSER:
6 6 too bad.
11 11 important ones.
12 12 BY MR. WASSER:
18 18 mind?
21 21 not to answer.
25 25 for?
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 42 of 245
1060
3 3 BY MR. WASSER:
11 11 2006.
15 15 Q What's changed?
18 18 where?
19 19 BY MR. WASSER:
23 23 BY MR. WASSER:
25 25 further" if I --
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 43 of 245
1096
1 1 A Yes.
6 6
7 7 EXAMINATION
8 8 BY MR. LEE:
14 14 A Yes.
DFJ6
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 44 of 245
1097
3 3 A Yes.
11 11 deposition of David --
16 16 the FRCP.
23 23 record.
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:
21
Ii
/ I l
22 ()L/1L(JL~~
SANDRA D. ORTIZ,
23
24
25
VS. KERN
RANDALL (800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 46 of 245
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 7
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 12
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 47 of 245
1
3 ______________
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 48 of 245
22
1 1 BY MR. LEE:
9 13:36:09 9 2006.
20 13:36:53 20 of responsibility.
25 13:37:06 25 Center?
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 49 of 245
26
21 13:42:15 21 chair?
24 13:42:19 24 Right?
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 50 of 245
27
21 13:43:26 21 had in her mind for votes that she cast in her
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 51 of 245
30
10 13:46:41 10 on?
12 13:46:45 12 have a chair in place, and he was not there and had
14 13:46:54 14 Q. I understand.
17 13:46:58 17 A. Yes.
20 13:47:02 20 A. Yes.
21 13:47:03 21 Q. Yes.
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 52 of 245
70
6 14:26:02 6 A. No.
7 7 Q. No.
9 14:26:15 9 documents.
13 14:26:22 13 Q. 2007.
14 14:26:23 14 A. Um-hmm.
23 14:26:47 23 A. No.
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 53 of 245
71
6 14:27:10 6 Q. Sure.
15 14:27:39 15 A. No.
17 14:27:41 17 A. Right.
22 14:27:57 22 Q. Everything.
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 54 of 245
72
15 14:28:35 15 A. Yes.
19 14:28:44 19 Q. I see.
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 55 of 245
73
3 14:29:29 3 day?
4 14:29:30 4 A. No.
7 7 Q. Thrown out.
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 56 of 245
75
20 14:32:43 20 that the deadline that was imposed on Dr. Jadwin was
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 57 of 245
76
1 14:33:02 1 near the deadline and asking for more time to decide?
10 14:33:26 10 A. I do not.
15 14:33:42 15 were quite short. But that would have been in the
21 14:34:07 21 meeting?
22 14:34:07 22 A. I do not.
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 58 of 245
77
1 14:34:15 1 A. I do not.
16 14:34:56 16 A. Yes.
19 14:35:01 19 chairmanship?
23 14:35:09 23 it happened?
PatrickB1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 59 of 245
78
8 14:35:25 8 discussion.
13 14:35:36 13 happen?
19 14:35:58 19 A. I don't.
22 14:36:04 22 mind.
PatrickB1
169
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 60 of 245
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
Bakersfield, California.
Susan ~-N-O-'-6-8-2-9----
WOOD & RANDALL
(800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 61 of 245
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 8
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 13
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 62 of 245
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 )
Defendants. )
10 __________________________)
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
16 GILBERT R. MARTINEZ
18 Bakersfield, California
19
20
21
22
23
24
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 63 of 245
111
3 10:17:58 3 Q. I see.
9 10:18:08 9 A. Yes.
11 10:18:11 11 A. Yes.
24 10:19:04 24 that time that he came into my office and let me know
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 64 of 245
112
1 10:19:11 1 inspection.
10 10 A. Yes.
11 11 Q. Okay.
14 10:19:44 14 inspection.
21 10:19:58 21 Q. I see.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 65 of 245
113
16 10:21:01 16 Q. In 2006?
21 10:21:10 21 A. Yes.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 66 of 245
114
14 10:22:08 14 Okay. Did David Hill ask you how you knew
17 10:22:18 17 me.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 67 of 245
121
1 1 BY MR. LEE:
6 10:42:11 6 overbearing?
9 10:42:19 9 overbearing?
11 10:42:27 11 Q. By whom?
16 10:42:37 16 A. No.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 68 of 245
122
1 10:43:13 1 Q. Supplies?
6 10:43:25 6 differential.
16 10:43:57 16 Q. Okay.
21 10:44:05 21 A. No.
23 10:44:08 23 A. Yes.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 69 of 245
123
1 10:44:11 1 A. Yes.
4 10:44:20 4 Q. Yes.
5 10:44:20 5 A. Unprofessional.
7 10:44:23 7 A. Yes.
11 10:44:32 11 lab.
12 10:44:32 12 Q. I see.
14 10:44:35 14 knowledge?
24 10:45:06 24 A. No.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 70 of 245
124
3 10:45:11 3 Q. I see.
7 10:45:20 7 Q. Correct.
9 10:45:23 9 personnel.
19 10:46:04 19 self-righteous?
20 10:46:04 20 A. No.
21 10:46:06 21 Q. No.
25 10:46:13 25 A. Overbearing.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 71 of 245
127
4 4 Thornton?
5 10:48:21 5 A. Yes.
11 10:48:28 11 Q. I see.
13 10:48:30 13 A. Yeah.
21 10:49:05 21 A. No.
24 10:49:23 24 A. Yes.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 72 of 245
128
4 10:49:52 4 the inspection team came up, and I showed them -- the
10 10:50:14 10 Q. At you?
11 10:50:14 11 A. Yes.
13 10:50:16 13 what -- what was visible about his upset? How did
18 10:50:26 18 A. No.
21 10:50:33 21 someone.
23 10:50:34 23 A. Yes.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 73 of 245
129
3 10:50:44 3 A. No.
14 10:51:03 14 left.
15 10:51:04 15 Q. I see.
24 10:51:29 24 A. Yeah.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 74 of 245
130
6 10:51:53 6 A. Correct.
9 10:51:56 9 A. Physically?
10 10:51:57 10 Q. Yeah.
11 10:51:58 11 A. No.
15 10:52:08 15 you?
16 10:52:08 16 A. No.
21 10:52:16 21 A. No.
MartinezG
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 75 of 245
133
2 10:54:38 2 together?
12 10:55:05 12 Q. Brief?
16 10:55:15 16 wanted.
19 10:55:18 19 A. Yes.
22 10:55:27 22 A. Yes.
25 10:55:36 25 Analytics?
MartinezG
139
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 76 of 245
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
Bakersfield, California.
~-
Susan R. Wood, CSR No. 6829
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 9
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 14
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 78 of 245
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13 VIDEOTAPED DEPOSITION
14 OF
17 Bakersfield, California
18
19
20
21
22
23
24
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 79 of 245
8
3 3 Q. Okay. What --
10 09:21:08 10 this wrong all the time. Just please refrain from
15 09:21:20 15 A. Yes.
17 09:21:23 17 hospital?
20 09:21:31 20 A. Correct.
22 09:21:34 22 A. Correct.
25 09:21:38 25 A. Yes.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 80 of 245
9
3 09:21:44 3 A. Yes.
5 09:21:48 5 staff?
13 09:22:19 13 A. Yes.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 81 of 245
23
6 09:34:11 6 A. Sure.
9 09:34:17 9 competence?
10 09:34:18 10 A. No.
12 09:34:19 12 A. No.
17 09:34:32 17 A. Okay.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 82 of 245
24
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 83 of 245
54
1 10:00:58 1 complete --
7 10:01:14 7 whom?
10 10:01:19 10 A. Yes.
25 10:01:54 25 A. Yes.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 84 of 245
61
4 10:08:24 4 Okay?
8 10:08:31 8 action?
9 10:08:36 9 A. No.
12 10:08:46 12 produced?
13 10:08:50 13 A. No.
17 10:09:04 17 A. No.
19 10:09:11 19 A. Yes.
22 10:09:23 22 A. No.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 85 of 245
63
1 10:10:32 1 A. No.
9 10:11:07 9 no one?
12 10:11:12 12 question.
15 10:11:15 15 A. No.
17 10:11:19 17 A. Yes.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 86 of 245
69
1 10:16:01 1 of your eyes, and then take the document away? They
14 10:16:23 14 Q. Where?
17 10:16:27 17 to you?
20 10:16:32 20 A. Yes.
23 10:16:37 23 anybody?
25 10:16:42 25 lawyers.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 87 of 245
70
4 10:16:49 4 Q. Why?
13 10:17:16 13 through all the stuff and see if she had that
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 88 of 245
71
3 10:17:58 3 you --
6 10:18:01 6 A. No.
10 10:18:07 10 hospital.
12 10:18:09 12 lawyers asking you for any and all documents relating
18 10:18:26 18 A. Yes.
20 10:18:29 20 didn't ask you, you just volunteered it, didn't you?
21 10:18:32 21 A. Yes.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 89 of 245
138
1 11:39:29 1 it.
10 11:39:45 10 A. Absolutely.
18 18 BY MR. LEE:
20 11:40:04 20 A. Correct.
23 23 A. Correct.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 90 of 245
149
3 11:50:55 3 A. No.
9 11:51:15 9 July 1st being the change date; now a past president.
12 11:51:39 12 report?
13 11:51:43 13 A. No.
14 11:51:43 14 Q. No.
18 11:52:00 18 accurately?
19 11:52:00 19 A. Yes.
24 11:52:15 24 correct?
25 11:52:16 25 A. No.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 91 of 245
171
3 12:11:13 3 data, and you said no. I've asked you if you've had
8 12:11:32 8 reads from UCLA, and they really were not able to be
10 12:11:40 10 the final dates of issue were after the final -- the
13 12:11:48 13 that Dr. Jadwin was going back and changing his
15 12:11:57 15 correct?
19 12:12:03 19 came after the UCLA report had come in; is that
20 12:12:06 20 correct?
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 92 of 245
172
24 12:13:06 24 successful?
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 93 of 245
173
1 12:13:08 1 events. I would get up and leave the room like I did
10 12:13:29 10 A. Accommodating?
18 12:13:46 18 not.
23 12:14:05 23 A. No.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 94 of 245
174
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
13 12:14:46 13 you?
14 12:14:46 14 A. No.
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.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 95 of 245
175
5 12:15:24 5 UCLA?
6 12:15:25 6 A. No.
8 12:15:26 8 A. Why?
15 12:15:41 15 data.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 96 of 245
176
2 12:16:14 2 A. No.
9 12:16:28 9 would have been if the final dates had been, you
14 12:16:43 14 interpret data if the final report came out after the
17 12:16:50 17 Couldn't you have called UCLA and asked them was
19 12:16:55 19 with the slides, and were you coming out with a
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 97 of 245
177
4 12:17:26 4 A. Absolutely.
7 12:17:30 7 A. Absolutely.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 98 of 245
178
12 12:18:34 12 A. No.
19 12:18:49 19 A. Yes.
24 24 Q. Right.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 99 of 245
181
3 12:20:35 3 A. No.
7 12:20:41 7 the slides should have been sent blindly to UCLA, not
10 12:20:53 10 the second slide, and you take the reading from
12 12:21:00 12 report is seen, and you take the UCLA report, and
17 12:21:10 17 A. Yes.
19 12:21:13 19 A. No.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 100 of 245
182
5 12:21:43 5 there?
6 12:21:44 6 A. Correct.
8 12:21:46 8 Dr. Jadwin was gone -- are you talking about December
16 12:22:00 16 A. Okay.
23 12:22:34 23 so.
25 12:22:37 25 might have and let's talk about what was done.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 101 of 245
219
2 14:25:20 2 A. Correct.
18 18 instead of a pathologist?
24 14:26:14 24 A. Correct.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 102 of 245
220
14 14:26:50 14 A. Yes.
15 14:26:51 15 Q. Okay.
23 14:27:17 23 A. No.
RaglandA
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221
16 14:29:31 16 Q. Okay.
20 14:58:58 20 when the last spoken statement was said, the time?
22 22 BY MR. LEE:
25 14:59:18 25 right?
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 104 of 245
222
1 14:59:18 1 A. Yes.
4 14:59:22 4 contents?
5 14:59:23 5 Q. No.
10 14:59:44 10 right?
11 14:59:45 11 A. Yes.
14 14:59:49 14 A. Yes.
23 15:00:04 23 A. No.
RaglandA
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226
4 15:03:06 4 answered?
RaglandA
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230
7 15:07:35 7 A. Yes.
13 15:07:50 13 pathologist?
14 15:07:50 14 A. Yes.
15 15:07:51 15 Q. Okay.
20 15:08:08 20 non-diagnostic --
24 15:08:16 24 what did you find Dr. Lieu's conclusion was there?
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 107 of 245
325
3 17:12:12 3 A. Yes.
9 17:12:24 9 A. Yes.
13 17:12:34 13 many?
14 17:12:34 14 A. No.
17 17:12:38 17 A. No.
19 17:12:41 19 Counsel.
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 108 of 245
332
1 1 Q. Okay.
20 17:33:03 20 physician?
RaglandA
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333
12 17:33:40 12 right?
16 17:33:45 16 like they thought I had already known about it, but I
17 17:33:48 17 didn't.
19 17:33:50 19 A. No.
20 17:33:51 20 Q. No?
24 17:33:56 24 Q. No?
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 110 of 245
334
12 17:34:28 12 physician?
15 17:34:33 15 right?
RaglandA
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 111 of 245
361
2 18:01:32 2 patient.
5 18:01:42 5 A. Okay.
10 18:01:50 10 unnecessarily?
15 18:01:56 15 A. Of course.
20 18:02:05 20 it?
25 18:02:18 25 A. Yes.
RaglandA
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
Bakersfield, California.
1
2
3
4
5
6
7
8
9
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 10
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 15
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 114 of 245
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13 VIDEOTAPED DEPOSITION
14 OF
16
18
19 Bakersfield, California
20
21
22
23
24
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 115 of 245
7
2 14:03:55 2 it's for the sake of the reporter. She can only
7 14:04:06 7 a jury. You are under the same duty to tell the
9 14:04:11 9 A. Yes.
16 14:04:27 16 A. Yes.
23 14:04:45 23 A. Yes.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 116 of 245
10
6 14:09:24 6 A. Yes.
9 14:09:24 9 department.
15 14:09:24 15 this JCC meeting where Dr. Jadwin was being removed
17 14:09:24 17 A. Yes.
24 14:09:24 24 of pathology?
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 117 of 245
11
7 14:09:24 7 preference.
9 14:09:24 9 question.
16 14:09:24 16 time, and that I did not believe that a manager can
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 118 of 245
12
2 14:09:24 2 Q. Okay. And how did you know that Dr. Jadwin
9 14:09:24 9 A. Yes.
14 14:09:29 14 A. No.
23 14:09:55 23 A. Yes.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 119 of 245
30
1 14:31:52 1 board.
2 14:31:53 2 Q. Are you aware that Dr. -- and what was the
12 14:32:42 12 then?
13 14:32:43 13 A. Yes.
15 14:32:45 15 yourself?
21 14:33:01 21 A. I --
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 120 of 245
39
11 14:43:24 11 Dr. Jadwin was notified that this JCC closed session
15 14:43:35 15 testimony.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 121 of 245
110
2 16:32:27 2 recall what the reason was for placing Dr. Jadwin on
8 16:32:44 8 Q. Right.
10 16:32:48 10 but I can't recall what the -- what the reasons for
19 16:33:16 19 you.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 122 of 245
111
1 16:33:34 1 A. Right.
17 16:34:06 17 A. Yes.
24 16:34:30 24 position.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 123 of 245
113
18 16:36:11 18 or --
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
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 124 of 245
114
4 16:37:00 4 A. Yes.
13 16:38:01 13 Q. Okay.
16 16:38:12 16 Peter Bryan was, and so, you know, I don't know any
20 16:38:24 20 medical staff bylaws and the fact that under those
25 16:38:41 25 A. Yes.
WatsonR
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 125123
of 245
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
10 August 25, 2008, at the time and place set forth on the
21 Bakersfield, California.
22
23
Sandra L. Edmonson, CSR No. 7704
24
25
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 11
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 16
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 127 of 245
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 128 of 245
10
8 09:18:27 8 Q. I see.
11 09:18:36 11 correct?
CulbersonD
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11
22 09:20:33 22 understanding?
CulbersonD
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42
17 09:54:55 17 that?
22 09:55:01 22 Q. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 131 of 245
43
1 09:55:10 1 lawsuit?
14 09:55:40 14 right?
17 09:55:43 17 A. Yes.
20 09:55:50 20 estimating?
24 09:56:02 24 Q. Six?
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 132 of 245
44
15 09:56:53 15 discussion.
17 09:56:56 17 A. I did.
18 09:56:56 18 Q. Okay.
21 09:57:00 21 I need to --
25 09:57:07 25 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 133 of 245
45
9 09:57:35 9 A. Yes.
16 09:57:51 16 office? Did you carry them around with you in your
24 09:58:10 24 at all.
25 09:58:10 25 Q. Uh-huh.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 134 of 245
46
3 09:58:18 3 Q. Uh-huh.
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
19 19 Q. Okay.
23 09:59:01 23 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 135 of 245
47
3 3 Q. Yes.
CulbersonD
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61
10 10:16:21 10 A. Yes.
13 10:16:24 13 A. No.
15 10:16:26 15 A. Yes.
18 10:16:30 18 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 137 of 245
62
19 10:17:30 19 Dr. Harris tell you? What was his story, his
20 10:17:32 20 perception?
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 138 of 245
63
12 10:18:27 12 correct.
18 10:18:37 18 Q. Yes?
19 10:18:38 19 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 139 of 245
73
2 10:27:42 2 issue?
4 10:27:49 4 and also the way the second opinions were being
11 10:28:07 11 the entire medical staff and has the duty to go out
18 10:28:27 18 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 140 of 245
98
17 11:12:03 17 one more time? What did he report regarding the path
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 141 of 245
99
1 11:12:33 1 future.
8 11:12:49 8 just --
10 11:12:51 10 physicians.
13 11:12:59 13 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 142 of 245
102
2 11:15:57 2 raising?
5 11:16:05 5 that the lab management may have taken at that time.
18 11:16:32 18 you did not take notes at this meeting with Steve
19 11:16:34 19 O'Connor?
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 143 of 245
157
3 12:09:59 3 discussion.
12 12:10:25 12 proven?
13 12:10:30 13 A. Some were, some were not. Some had not been
CulbersonD
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25 12:11:57 25 physicians?
CulbersonD
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2 12:11:59 2 Q. Okay.
CulbersonD
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2 12:13:13 2 interpretations.
4 12:13:18 4 yourself?
14 12:13:40 14 A. Yes.
24 12:13:59 24 not take notes at this meeting with Dr. Dutt where he
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 147 of 245
161
2 12:14:07 2 notes.
11 12:14:31 11 A. A yellow --
12 12:14:31 12 Q. Pad?
13 12:14:32 13 A. -- pad.
15 15 A. Sure.
18 18 Q. Okay. So this --
22 12:14:48 22 A. Yes.
25 12:14:50 25 way?
CulbersonD
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11 12:15:10 11 sorry.
CulbersonD
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1 12:15:43 1 knowledge Dr. Jadwin did not know that Dr. Dutt was
3 12:15:48 3 him?
7 12:16:00 7 A. Sorry?
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.
23 23 Q. Uh-huh.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 150 of 245
164
2 12:16:59 2 as well.
7 12:17:06 7 correct?
8 12:17:07 8 A. Yes.
19 12:17:28 19 A. Correct.
CulbersonD
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165
8 12:18:01 8 correct.
17 12:18:24 17 A. Yes.
20 12:18:28 20 A. Yes.
CulbersonD
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 152 of 245
166
9 12:19:05 9 honestly.
11 12:19:09 11 did Dr. Dutt report to you about the findings of the
15 12:19:26 15 clear the outside consultant did not believe that the
21 12:19:47 21 Q. Both?
CulbersonD
177
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 153 of 245
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
August 21, 2008, at the time and place set forth on the
Bakersfield, California.
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 12
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 17
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 155 of 245
1
PMK DuttP1
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10
PMK DuttP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 157 of 245
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PMK DuttP1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 158 of 245
14
PMK DuttP1
Case 1:07-cv-00026-OWW-TAG
P LEE DUTT, M. D. Document 277-2 Filed 12/01/2008 Page 159 of 245
08-29-08
Page 95
1 STATE OF CALIFORNIA
SSe
2 COUNTY OF KERN
3
4 I, Cindee L. LeFevre, a Certified Shorthand
9 Friday, August 29, 2008, at the time and place set forth
20 Bakersfield, California.
21
,
22
23 ~~~
24 Cindee L. LeFevre, CSR No. 7974
25
vs. COUNTY
RANDALL (800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 160 of 245
1
2
3
4
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6
7
8
9
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13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 13
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 18
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 161 of 245
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 )
Defendants. )
10 _____________________)
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
ChesterS
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 162 of 245
115
1 16:01:05 1 A. Yes.
4 16:01:11 4 A. Correct.
7 16:01:17 7 leave, you're saying that they have to fill out this
9 16:01:26 9 A. Yes.
14 16:01:48 14 acceptable.
15 16:01:48 15 Q. Okay.
19 16:01:48 19 Q. Right.
23 16:01:57 23 A. No.
ChesterS
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 163 of 245
120
5 16:08:43 5 A. Yes.
6 16:08:44 6 Q. -- and let you know that Dr. Jadwin had made
9 16:08:52 9 A. Absolutely.
16 16:09:17 16 A. Absolutely.
20 16:09:26 20 A. No.
23 16:09:39 23 Dr. Jadwin had failed to notify him of his need for
ChesterS
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 164 of 245
167
1 1 STATE OF CALIFORNIA )
) ss.
2 2 COUNTY OF KERN )
3 3
4 4
10 10 August 28, 2008, at the time and place set forth on the
21 21 Bakersfield, California.
22 22
23 23 _____
Erika Addis, CSR No. 11621
24 24
25
25 WOOD & RANDALL
(800) 322-4595
ChesterS
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 165 of 245
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2
3
4
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6
7
8
9
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11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26 EXHIBIT 14
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 19
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 166 of 245
1
PMK KercherE
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 167 of 245
27
PMK KercherE
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 168 of 245
28
PMK KercherE
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 169 of 245
32
PMK KercherE
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 170 of 245
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
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92
PMK KercherE
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PMK KercherE
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99
PMK KercherE
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100
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
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
4
5 I, Cindee L. LeFevre, a Certified Shorthand
21 Bakersfield, California.
22
23
24
25
vs. COUNTY
RANDALL (800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 176 of 245
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
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 20
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
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 177 of 245
(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:
(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
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
To: 213-596-0487 From: Law OFFice of Eugene Lee Pg 4/ 7 04/05/07 4:50 pm
To: 213-596-0487 From: Law Office of Eugene Lee Pg 3/ 3 03/29/07 4:09 pm
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 179 of 245
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.
2
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 21
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 181 of 245
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
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Job Information
Delivered : 3
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Call Detail for Item 00000 ID 3109078 Sent To 6618683809 0006 Pages Delivered
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===============================================================================
End Of Report
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1
To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee Pg I/ 6 06/29/06 3:38 pm
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:
( 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
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:
(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;
(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;
Please note that the foregoing list is preliminary and subject to change. Additional causes of
action will likely materialize as more facts become known.
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.
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.
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
To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee
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.
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.
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.
To: Eugene Lee @ 213-596-0487 From: Law OFFice o f Eugene Lee
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.
June 27,2006
David F. Jndwin, DO
3 184 Beaudly Terrace
Glendale, California 91208-174.5
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 188 of 245
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 22
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 189 of 245
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.
14 REQUEST FOR PRODUCTION NO. 2
15 Any and all DOCUMENTS RELATING TO the Second Affirmative Defense listed in
18 Defendants object to this request on the grounds that it calls for the production of
20 Without waiving those objections, after diligent search, Defendants’ have not been able to locate
23 Any and all DOCUMENTS RELATING TO the Third Affirmative Defense listed in
26 Defendants object to this request on the grounds that it calls for the production of
28
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1 Without waiving those objections, after diligent search, Defendants’ have not been able to locate
2 any documents that are responsive to this request.
3 REQUEST FOR PRODUCTION NO. 4
4 Any and all DOCUMENTS RELATING TO the Fourth Affirmative Defense listed in
5 Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.
6 RESPONSE TO REQUEST NO. 4
7 Defendants object to this request on the grounds that it calls for the production of
8 documents that are protected by the attorney-work-product and attorney-client privileges.
9 Without waiving those objections, after diligent search, Defendants’ have not been able to locate
10 any documents that are responsive to this request.
11 REQUEST FOR PRODUCTION NO. 5
12 Any and all DOCUMENTS RELATING TO the Fifth Affirmative Defense listed in
13 Defendants’ Answer to Plaintiff’s Second Supplemental Complaint.
14 RESPONSE TO REQUEST NO. 5
15 Defendants object to this request on the grounds that it calls for the production of
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
25 Defendants object to this request on the grounds that it calls for the production of
27 Without waiving those objections, after diligent search, Defendants’ have not been able to locate
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
23 Defendants object to this request on the grounds that it calls for the production of
25 Without waiving those objections, after diligent search, Defendants’ have not been able to locate
28
4
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
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
27 interactive process, personal leave, administrative leave, medical leave, retaliation, investigations
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.
4 RESPONSE TO REQUEST NO. 12
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.
11 REQUEST FOR PRODUCTION NO. 13
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
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.
25 Defendants object to this request to the extent it requests documents that contain
26 confidential personnel information, documents protected from disclosure by state or federal law,
27 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
28 Without waiving these objections, Defendants will produce documents responsive to this request
6
1 by December 21, 2007. Defendants will redact confidential peer review and personnel
2 information as appropriate.
3 REQUEST FOR PRODUCTION NO. 14
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.
8 RESPONSE TO REQUEST NO. 14
9 Defendants object to this request to the extent it requests documents that contain
10 confidential personnel information, documents protected from disclosure by state or federal law,
11 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
12 Without waiving these objections, Defendants will produce documents responsive to this request
13 by December 7, 2007.1. Defendants will redact confidential peer review and personnel
14 information as appropriate.
16 Any and all DOCUMENTS RELATING TO any training provided by YOU to YOUR
18 a) disability discrimination
22 e) whistleblower retaliation
27 j) defamation
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
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.
7 REQUEST FOR PRODUCTION NO. 17
8 Any and all DOCUMENTS RELATING TO the search, recruitment, application,
9 interviewing, and hiring process that resulted in Plaintiff’s employment by YOU.
10 RESPONSE TO REQUEST NO. 17
11 Defendants object to this request to the extent it requests documents that contain
12 confidential personnel information, documents protected from disclosure by state or federal law,
13 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
14 Without waiving these objections, Defendants will produce all documents responsive to this
17 Any and all DOCUMENTS RELATING TO the terms, conditions and privileges of
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
25 Defendants will produce all documents responsive to this request by December 21, 2007.
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.
3 RESPONSE TO REQUEST NO. 20
4 Defendants will produce all documents responsive to this request by December 7, 2007.
5 REQUEST FOR PRODUCTION NO. 21
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.
10 RESPONSE TO REQUEST NO. 21
11 Defendants will produce all documents responsive to this request by December 21, 2007.
12 REQUEST FOR PRODUCTION NO. 22
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.
16 Defendants will produce all documents responsive to this request by December 21, 2007.
18 Any and all DOCUMENTS RELATING TO Dr. Phillip Dutt’s timesheets, from April 20
21 Defendants object to this request to the extent it requests documents that contain
22 confidential personnel information, documents protected from disclosure by state or federal law,
23 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
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
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1 Any and all DOCUMENTS RELATING TO Dr. Savita Shertukde’s timesheets, from
2 January 4, 2005 to present.
3 RESPONSE TO REQUEST NO. 24
4 Defendants object to this request to the extent it requests documents that contain
5 confidential personnel information, documents protected from disclosure by state or federal law,
6 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
7 Without waiving these objections, Defendants will produce all non-privileged documents
8 responsive to this request by December 21, 2007. Defendants will redact confidential
9 information, in any, as appropriate.
10 REQUEST FOR PRODUCTION NO. 25
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.
16 Defendants object to this request to the extent it requests documents that contain
17 confidential personnel information, documents protected from disclosure by state or federal law,
18 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
19 Without waiving these objections, Defendants will produce all non-privileged documents
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.
6 REQUEST FOR PRODUCTION NO. 27
7 Any and all DOCUMENTS RELATING TO any meetings RELATING TO Plaintiff or
8 Plaintiff’s employment at Kern Medical Center.
9 RESPONSE TO REQUEST NO. 27
10 Defendants object to this request to the extent it requests documents that contain
11 confidential personnel information, documents protected from disclosure by state or federal law,
12 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
13 Without waiving these objections, Defendants will produce documents responsive to this request
14 by December 7, 2007. Defendants will redact confidential peer review and personnel
19 Medical Center Pathology Department, whether formal or informal, from October 24, 1995 to
20 the present.
22 Defendants object to this request to the extent it requests documents that contain
23 confidential personnel information, documents protected from disclosure by state or federal law,
24 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
25 Without waiving these objections, Defendants will produce documents responsive to this request
26 by December 7, 2007. Defendants will redact confidential peer review and personnel
27 information as appropriate.
15 Without waiving these objections, Defendants will produce documents responsive to this request
16 by December 21, 2007. Defendants will redact confidential peer review and personnel
17 information as appropriate.
21 violation of medical leave rights, whistleblower retaliation, medical leave retaliation, defamation,
24 Defendants object to this request to the extent it requests documents that contain
25 confidential personnel information, documents protected from disclosure by state or federal law,
26 including the peer-review privilege, or documents that are subject to the attorney-client privilege.
27 Without waiving these objections, Defendants will produce documents responsive to this request
28
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1 by December 21, 2007. Defendants will redact confidential peer review and personnel
2 information as appropriate.
3 REQUEST FOR PRODUCTION NO. 31
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).
9 RESPONSE TO REQUEST NO. 31
10 Defendants will produce all documents responsive to this request by December 21, 2007.
11 REQUEST FOR PRODUCTION NO. 32
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
17 Defendants object to this request on the grounds that it requests documents that contain
18 confidential personnel information, documents protected from disclosure by state or federal law,
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
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
16 Defendants believe all documents responsive to this request have been previously
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
25 Defendants believe all documents responsive to this request have been previously
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.
4 RESPONSE TO REQUEST NO. 36
5 Defendants object to this request on the grounds that it calls for the production of
6 documents that contain confidential personnel information that is not relevant to any issues in
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
19 Defendants object to this request on the grounds that it calls for the production of
20 documents that contain confidential personnel information that is not relevant to any issues in
21 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
22 Defendants also object to this request to the extent it requests information protected from
23 disclosure by state or federal law, including HIPAA and the peer review privilege, and
24 documents that are subject to the attorney-client privilege. Without waving these objections,
27 appropriate.
1 Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and
2 evaluation of candidates for the position of locus tenens pathologist at Kern Medical Center
3 during the period from January 1, 2006 to present.
4 RESPONSE TO REQUEST NO. 38
5 Defendants object to this request on the grounds that it calls for the production of
6 documents that contain confidential personnel information that is not relevant to any issues in
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 OB-GYN at Kern Medical Center
19 Defendants object to this request on the grounds that it calls for the production of
20 documents that contain confidential personnel information that is not relevant to any issues in
21 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
22 Defendants also object to this request to the extent it requests information protected from
23 disclosure by state or federal law, including HIPAA and the peer review privilege, and
24 documents that are subject to the attorney-client privilege. Without waving these objections,
27 appropriate.
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.
3 RESPONSE TO REQUEST NO. 40
4 Defendants object to this request on the grounds that it calls for the production of
5 documents that contain confidential personnel information that is not relevant to any issues in
6 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
7 Defendants also object to this request to the extent it requests information protected from
8 disclosure by state or federal law, including HIPAA and the peer review privilege, and
9 documents that are subject to the attorney-client privilege.
10 REQUEST FOR PRODUCTION NO. 41
11 Any and all DOCUMENTS RELATING TOYOUR search for, recruitment, of and
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.
14 RESPONSE TO REQUEST NO. 41
15 Defendants object to this request on the grounds that it calls for the production of
16 documents that contain confidential personnel information that is not relevant to any issues in
17 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
18 Defendants also object to this request to the extent it requests information protected from
19 disclosure by state or federal law, including HIPAA and the peer review privilege, and
20 documents that are subject to the attorney-client privilege. Without waving these objections,
22 December 21, 2007. Defendants will redact confidential and privileged information as
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.
1 Defendants object to this request on the grounds that it calls for the production of
2 documents that contain confidential personnel information that is not relevant to any issues in
3 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
4 Defendants also object to this request to the extent it requests information protected from
5 disclosure by state or federal law, including HIPAA and the peer review privilege, and
6 documents that are subject to the attorney-client privilege. Without waving these objections,
7 Defendants will produce non-privileged documents responsive to this request, if any, by
8 December 7, 2007. Defendants will redact confidential and privileged information as
9 appropriate.
10 REQUEST FOR PRODUCTION NO. 43
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.
13 RESPONSE TO REQUEST NO. 43
14 Defendants will produce all documents responsive to this request by December 7, 2007.
15 REQUEST FOR PRODUCTION NO. 44
16 Any and all DOCUMENTS RELATING TO YOUR decision to demote Plaintiff from
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
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
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
21 Defendants believe all documents responsive to this request have been previously
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
1 Defendants believe all documents responsive to this request have been previously
2 produced to Plaintiff. Defendants will confirm this, or produce additional documents if
3 necessary, by December 7, 2007.
4 REQUEST FOR PRODUCTION NO. 49
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.
7 RESPONSE TO REQUEST NO. 49
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.
12 REQUEST FOR PRODUCTION NO. 50
13 Any and all DOCUMENTS RELATING TO any discipline, coaching, reprimand or
14 corrective action taken against Plaintiff by YOU.
16 Defendants believe all documents responsive to this request have been previously
20 Any and all DOCUMENTS RELATING TO Kern Medical Center’s Disruptive Physician
23 Defendants object to this request to the extent it requests documents that contain
24 confidential personnel information, documents protected from disclosure by state or federal law,
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
18 Defendants believe all documents responsive to this request have been previously
23 TO patient fatalities at Kern Medical Center from October 24, 2000 to the present.
25 Defendants object to this request on the grounds that it calls for the production of
26 documents that contain confidential personnel information that is not relevant to any issues in
27 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
28 Defendants also object to this request to the extent it requests information protected from
23
1 disclosure by state or federal law, including HIPAA and the peer review privilege, and
2 documents that are subject to the attorney-client privilege. Without waving these objections,
3 Defendants will produce non-privileged documents responsive to this request, if any, by
4 December 21, 2007. Defendants will redact confidential and privileged information as
5 appropriate. If the redaction process renders the resulting document useless, Defendants will
6 inform Plaintiff.
7 REQUEST FOR PRODUCTION NO. 55
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.
11 RESPONSE TO REQUEST NO. 55
12 Defendants object to this request on the grounds that it calls for the production of
13 documents that contain confidential personnel information that is not relevant to any issues in
14 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
15 Defendants also object to this request to the extent it requests information protected from
16 disclosure by state or federal law, including HIPAA and the peer review privilege, and
17 documents that are subject to the attorney-client privilege. Without waving these objections,
19 December 21, 2007. Defendants will redact confidential and privileged information as
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.
25 Defendants object to this request on the grounds that it calls for the production of
26 documents that contain confidential personnel information that is not relevant to any issues in
27 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
28 Defendants also object to this request to the extent it requests information protected from
24
1 disclosure by state or federal law, including HIPAA and the peer review privilege, and
2 documents that are subject to the attorney-client privilege. Without waving these objections,
3 Defendants will produce non-privileged documents responsive to this request, if any, by
4 December 21, 2007. Defendants will redact confidential and privileged information as
5 appropriate.
6 REQUEST FOR PRODUCTION NO. 57
7 Any and all DOCUMENTS RELATING TO product chart copy-related quality assurance
8 reports from October 24, 2000 to the present.
9 RESPONSE TO REQUEST NO. 57
10 Defendants object to this request on the grounds that it calls for the production of
11 documents that contain confidential personnel information that is not relevant to any issues in
12 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
13 Defendants also object to this request to the extent it requests information protected from
14 disclosure by state or federal law, including HIPAA and the peer review privilege, and
15 documents that are subject to the attorney-client privilege. Without waving these objections,
17 December 21, 2007. Defendants will redact confidential and privileged information as
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.
23 Defendants object to this request on the grounds that it calls for the production of
24 documents that contain confidential personnel information that is not relevant to any issues in
25 this case and is not reasonably calculated to lead to the discovery of admissible evidence.
26 Defendants also object to this request to the extent it requests information protected from
27 disclosure by state or federal law, including HIPAA and the peer review privilege, and
28 documents that are subject to the attorney-client privilege. Without waving these objections,
25
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
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
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.
5 REQUEST FOR PRODUCTION NO. 62
6 Any and all DOCUMENTS RELATING TO Peter Bryan’s appointment calendar from
7 January 1, 2004 to September 1, 2006.
8 RESPONSE TO REQUEST NO. 62
9 Defendants will produce all documents responsive to this request by December 7, 2007.
10 REQUEST FOR PRODUCTION NO. 63
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
18 f) Transfusion Committee
21 Defendants object to this request to the extent it requests documents that contain
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
28
27
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
22 Defendants object to this request to the extent it requests documents that contain
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
25 information as appropriate.
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.
3 RESPONSE TO REQUEST NO. 67
4 Defendants object to this request to the extent it requests documents that contain
5 privileged peer review information. Without waiving this objection Defendants will produce all
6 documents responsive to this request by December 7, 2007. Defendants will redact all privileged
7 information as appropriate.
8 REQUEST FOR PRODUCTION NO. 68
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.
12 RESPONSE TO REQUEST NO. 68
13 Defendants object to this request to the extent it requests documents that contain
14 privileged peer review information. Without waiving this objection Defendants will produce all
15 documents responsive to this request by December 7, 2007. Defendants will redact all privileged
16 information as appropriate.
21 Defendants object to this request to the extent it requests documents that contain
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,
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.
4 RESPONSE TO REQUEST NO. 70
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.
11 REQUEST FOR PRODUCTION NO. 71
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.
14 RESPONSE TO REQUEST NO. 71
15 Defendants object to this request to the extent it requests documents that contain
16 information that is confidential under HIPAA. Defendants also object to the extent that it
17 requests documents that contain privileged peer review information. Without waiving these
18 objections Defendants will produce all documents responsive to this request by December 7,
21 Any and all DOCUMENTS RELATING TO paper accession logs at Kern Medical
24 Defendants object to this request to the extent it requests documents that contain
25 information that is confidential under HIPAA. Defendants also object to the extent that it
26 requests documents that contain privileged peer review information. Without waiving these
27 objections Defendants will produce all documents responsive to this request by December 7,
16 information that is confidential under HIPAA. Defendants also object to the extent that it
17 requests documents that contain privileged peer review information. Without waiving these
18 objections Defendants will produce all documents responsive to this request by December 7,
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.
3 REQUEST FOR PRODUCTION NO. 76
4 Any and all DOCUMENTS RELATING TO dictation transcription logs for Plaintiff
5 from June 14, 2006 to the present.
6 RESPONSE TO REQUEST NO. 76
7 Defendants will produce all documents responsive to this request by December 7, 2007.
8 REQUEST FOR PRODUCTION NO. 77
9 Any and all DOCUMENTS RELATING TO dictation transcription logs for Dr. Philip
10 Dutt from June 14, 2006 to the present.
11 RESPONSE TO REQUEST NO. 77
12 Defendants will produce all documents responsive to this request by December 7, 2007.
13 REQUEST FOR PRODUCTION NO. 78
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,
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26 EXHIBIT 18
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 23
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
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 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
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 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 225 of 245
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
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 226 of 245
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21
22
23
24
25
26 EXHIBIT 19
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 24
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 227 of 245
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.
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
0016940
0016940
Case 1:07-cv-00026-OWW-TAG Document
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.
.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
0016941
0016941
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 229 of 245
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.
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:
0016942
0016942
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 230 of 245
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26 EXHIBIT 20
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 25
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 231 of 245
)
-
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 232 of 245
/
/
Sincerely,
Marvin o. Kolb, MD
Chief Medical Officer
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
1
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 234 of 245
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
,-.
/-
Marvin O. Kolb, MD
Chief Medical Officer
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 235 of 245
..
,.
, ..
ARTICLE VII
CORRECTIVE ACTION
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
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.
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
37
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 236 of 245
/
r
.
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
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 237 of 245
"
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
0000682
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 238 of 245
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26 EXHIBIT 21
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 26
CES Job Classfication Chang 'om
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 239 of 245
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
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
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.
DFJ00247
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 240 of 245
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25
26 EXHIBIT 22
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 27
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 241 of 245
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:
(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;
1. Services.
0026379
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 242 of 245
3. Payment.
9. Notices. The service and delivery of all notices and/or papers shall be
0026380
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 243 of 245
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:
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.
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.
0026381
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 244 of 245
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.
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.
0026382
Case 1:07-cv-00026-OWW-TAG Document 277-2 Filed 12/01/2008 Page 245 of 245
COUNTY OF KERN
Office of County Counsel
"COUNTY"
Dated:~b By
IA)d ('{gil.&-- 11\0
"CONSULTANT"
AgreemeotCvlbum.050206
0026383
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 1 of 191
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
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 4
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 5 of 191
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26 EXHIBIT 23
27
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 28
i
l'
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 7 of 191
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 9 of 191
~•
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.
B. ENDOCERVICAL CURETTAGE:
0025928
Page 1 of2
0025928
II
W~c\fn~
WILLIAM J. C
URN, M.D.
Holscherlkern/wjc/lIc/8-6-o6
0025929
5-05-1347 2
Page 2 of2
0025929
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 13 of 191
0,
I'
t
I. CLINICAL HISTORY:
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.
0025930
Page lof3
0025930
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 14 of 191
B. S-04-4674
A. S-04-4674; 08-25-04
ATTENDING PHYSICIANS:
Joseph Mansour, M.D., Kurt Finberg, M.D., Roy William, M.D.
I. CLINICAL HISTORY:
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.
0025933
I
,
0025933
Page 1 of2
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 17 of 191
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 18 of 191
CASE #: S-05-755l
UNIT #: KOOOl146283
ACCT #: K0533500457
ATTENDING PHYSICIANS: William Roy, M.D.
I. CLINICAL HISTORY:
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).
0025935
Page 1 of2
0025935
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 19 of 191
F. OMENTUM:
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 20 of 191
CASE #: S-04-7471
UNIT #: KOOOI138692
ACCT # K0435100474
ATTENDING PHYSICIANS: Nicola Spirtos, M.D.
I. CLINICAL HISTORY:
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 21 of 191
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:
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 22 of 191
I. CLINICAL HISTORY:
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.
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.
0025939
0025939
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 23 of 191
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
CASE #: S-05-812
UNIT #: K0001142312
ACCT #: K0503500023
ATTENDING PHYSICIANS: Joseph Mansour, M.D., William Roy, M.D.
I. CLINICAL HISTORY:
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.
0025942
t . . ) l..1JJ.bM. ~CoJA,--
WILLIAM J. BBURN, M.D.
KaurlkemlwjclllclS-S-06
0025943
S-oS-SI2
0025943 Page2of2
2
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 27 of 191
I. CLINICAL HISTORY:
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.
The patient's TAHBSO was performed on 5-26-05 without complications and the patient
left the operating room in stable condition.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 28 of 191
- 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.
adenomyosis, myometrium.
B. PERITONEAL WASHINGS:
- slides not available for review.
0025945
S-05-3265; 5-26-05
0025945 Page 2 of3
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 29 of 191
NOTE: Slides "FI" and "F3" demonstrate the presence of multiple particles
ofMMMT which do not involve lymph node structures.
DIAGNOSIS:
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
."
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 30 of 191
i'
•
WILLIAM J. COLBURN, M.D.
21114 Vanowen Street, Canoga Park, CA 91303 -
Telephone: 818-708-5528
Fax: 818-708-5546
I. CLINICAL HISTORY:
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 31 of 191
0025948
S-05-2176 Mathis 08-25-06
Pagc2of4
0025948
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 32 of 191
H. PERIUMBILICAL TUMOR:
I. ILEAL NODULES:
K. UMBILICAL TUMOR:
G. Terminal Ileum:
- Serosal surface of ileum with clear cell carcinoma.
- Unremarkable colonic mucosa.
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.
w ~ ~-.JCa..aJ.LAJ.U·===:",--_ _
WILLIAM J. C~BURN, 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.
A. 8-06-757:
1. CERVICAL LESION:
0025951
Page 10f4
0025951
..
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 35 of 191
B. S-06-981:
7. OMENTUM:
9. APPENDIX:
C. N-06-51
W~~CQJ.l.w--
WILLIAM J. C
BURN, M.D.
I. CLINICAL HISTORY:
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).
0025955
Page I of2
0025955
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 39 of 191
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 40 of 191
I. CLINICAL HISTORY:
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.
The patient had a relatively uneventful hospital stay x three days and was discharged
home with a follow-up visit scheduled.
0025957
Page 1 of3
0025957
i
•
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 41 of 191
Diagnosis:
- Large cell nonkeratinizing invasive squamous carcinoma of the cervix,
nuclear grade 3 / 3.
0025958
5-06·541 Borquez 08·15-06
Page 2 of3
0025958
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 42 of 191
w~ ~ Cd1J.,v----=- _
WILLIAM J. COj:BURN, M.D.
I. CLINICAL HISTORY:
The patient was admitted to Kern Medical Center on 02-10-05 for scheduled radical
hysterectomy.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 44 of 191
B. VAGINAL MARGIN:
!
1
I
IV. EXTRAMURAL CONSULTATION OPINION - DR. LYDIA BALATIAN-
FLORES, GENZYME IMPATH LABORATORIES, LOS ANGELES,
0025962
S-oS·923 Rodriguez 08·22-06
Page 3 of3
0025962
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 46 of 191
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.
0025963
Page 1 of2
0025963
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 47 of 191
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 48 of 191
I. CLINICAL HISTORY:
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.
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
I Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 49 of 191
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 50 of 191
CASE #: 8-05-592
UNIT #: K0001141122
ACCT#: K0502700459
ATTENDING PHYSICIANS: William Roy, M.D., Fangluo Liu, M.D.
I. CLINICAL HISTORY:
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.
0025967
Page 1 00
0025967
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 51 of 191
i
- inactive endometrium.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 52 of 191
I. CLINICAL HISTORY:
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.
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
D. LEFTPELVICLYMPHNODES:
- benign reactive lymph nodes (5 ).
F. APPENDIX:
- representative sections vennifonn appendix showing reactive serous
surface / peritoneal change, well established fibromembranous adhesions
without other clinically significant histopathologic abnonnality.
0025970
S05-2186; 4·8-05
0025970 Page 2 of5
,ll
J. OMENTUM:
- reactive serous surface change / fibromembranous adhesions; negative for
metastatic tumor.
F. APPENDIX:
appendix with no pathologic diagnosis.
- no tumor seen.
H. BLADDER BIOPSY:
- urothelial mucosa with mild atypia.
- no definitive tumor seen.
0025971
S05-2186; 4-8-05
Page 3 of5
0025971
•
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 55 of 191
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 56 of 191
CASE #: S-06-91
UNIT # KOOO1100262
ACCT #: K0600600245
ATTENDING PHYSICIANS: Antonio Garcia, M.D., George Alkhouri, M.D.
DATE: 1-6-06
I. CLINICAL HISTORY:
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.
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.
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
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 58 of 191
•
-It
CASE: S-05-2246
UNIT #: K0001146465
ACCT #: K0510100660
ATTENDING PHYSICIANS: Miguel Lascano, M.D., Nbalia Soumah, D.O.
I. CLINICAL HISTORY:
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.
Right ovary:
- ovary ( 1630 grams) with papillary serous cystadenoma of uncertain
malignant potential ( borderline malignant potential ).
0025975
Page 1 of3
0025975
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 59 of 191
- mesothelial lined fibrovascular and adipose tissue consistent with an origin from
a hernia sac; surgical repair of umbilical hernia.
- 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
.'
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 60 of 191
W~ .
WILLIAM J. C
~ ~
BURN, M.D.
Martinezlkemlwjc/lIcl8-9-o6
0025977
S-05-2246 3
Page 3 of3
0025977
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 61 of 191
I. CLINICAL HISTORY:
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 62 of 191
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
.~
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 63 of 191
I. CLINICAL HISTORY:
0025980
Page lof2
0025980
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 64 of 191
This pathologist agrees with the original pathologist's microscopic and diagnosis
as rendered.
W ,Ill",.", ~~
WILLIAM J. CHURN, M.D.
0025981
S-06·728 Perales 08·14-06
Page 2 of2
0025981
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 65 of 191
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 29
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 66 of 191
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 )
Defendants. )
10 __________________________)
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14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
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HarrisI1
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22 10:08:01 22 issue.
HarrisI1
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11 10:11:45 11 concerns?
17 10:12:30 17 accurate.
HarrisI1
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14 10:13:27 14 A. No.
21 21 A. Um-hmm.
22 10:13:45 22 Q. Correct?
HarrisI1
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60
1 10:14:01 1 Q. And they were the ones you believe who may
17 10:14:39 17 2006.
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.
HarrisI1
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6 15:00:59 6 Q. Right.
HarrisI1
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2 15:22:09 2 A. Yeah.
9 15:22:28 9 Correct?
HarrisI1
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 73 of 191
232
3 3 said.
13 16:08:13 13 A. Yes.
16 16 Q. Okay.
HarrisI1
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 74 of 191
331
15 18:42:43 15 A. Yes.
23 18:43:05 23 KMC?
24 18:43:06 24 A. In essence.
HarrisI1
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 75 of 191
332
2 18:43:14 2 then?
5 18:43:21 5 recall --
17 18:43:58 17 written.
24 19:05:50 24 p.m.
HarrisI1
335
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 76 of 191
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
Bakersfield, California.
susa~-R N-o.---
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 30
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 78 of 191
336
3 ______________
11
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14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
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HarrisI2
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 79 of 191
409
24 10:51:58 24 in 2006, you recall that the results came back that
HarrisI2
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 80 of 191
410
10 10:52:32 10 raised.
13 10:52:37 13 A. Exactly.
24 10:53:03 24 Jadwin.
HarrisI2
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 81 of 191
411
1 10:53:06 1 been?
12 10:53:41 12 competency.
20 10:54:00 20 before.
23 10:54:02 23 of time.
25 25
HarrisI2
472
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 82 of 191
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
Bakersfield, California.
» /J~~~_
Erik~ ~ . .£.fl621
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 31
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 84 of 191
DFJ00251
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Table of Contents
DFJ00252
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 86 of 191
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
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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.
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.
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
2
DFJ00254
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 88 of 191
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.
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.
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
3
DFJ00255
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 89 of 191
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.
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.
4
DFJ00256
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 90 of 191
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:
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
5
DFJ00257
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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.
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
6
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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.
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.
7
DFJ00259
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Radiologist Aspiration
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
8
DFJ00260
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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%.
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
9
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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.
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.
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.
10
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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.
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.
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.
11
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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.
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
12
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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.
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.
13
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14
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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.
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.
15
DFJ00267
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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.
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.
16
DFJ00268
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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.
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.
17
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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.
18
DFJ00270
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 32
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1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 )
Defendants. )
10 __________________________)
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14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
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AbrahamJ
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11 14:09:24 11 file --
12 14:09:24 12 Q. We do.
22 14:09:58 22 is my remembrance.
23 14:10:00 23 Q. Sure.
AbrahamJ
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63
1 14:18:00 1 was the reason for the request for -- for overreads;
4 14:18:14 4 Q. Okay.
9 14:18:27 9 Q. Okay.
12 14:18:42 12 trust.
13 13 BY MR. LEE:
17 14:18:52 17 A. Yes.
22 14:19:02 22 Q. Okay.
AbrahamJ
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67
3 14:21:54 3 Aspiration.
4 4 A. Um-hmm.
6 14:21:56 6 A. Yes.
10 14:22:11 10 problem.
11 14:22:12 11 Q. Um-hmm.
13 14:22:15 13 problem.
14 14 Q. Right.
24 24 A. Right.
AbrahamJ
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72
2 14:26:59 2 in him? And I don't know. And that was the purpose
4 14:27:04 4 trust.
8 14:27:11 8 Q. Okay.
20 14:27:37 20 still didn't go all the way for some reason. So that
AbrahamJ
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73
4 14:28:03 4 thing. You know, you have to sort of earn it, and
6 14:28:06 6 Q. I see.
8 14:28:09 8 that Dr. Jadwin was sending his FNAs out to UCLA for
17 14:28:28 17 with --
21 14:28:36 21 Q. Hearsay.
25 14:28:49 25 Q. I see.
AbrahamJ
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1 1 A. So --
4 14:28:55 4 the --
5 14:28:56 5 Q. Evidence?
11 14:29:09 11 A. Right.
13 14:29:12 13 A. Right.
18 14:29:21 18 A. No.
21 14:29:24 21 A. Chatter.
22 14:29:26 22 Q. Chatter?
23 14:29:26 23 A. Chatter.
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
4 14:31:22 4 Q. Okay.
13 14:31:44 13 Correct?
14 14:31:44 14 A. No.
15 14:31:45 15 Q. No.
17 14:31:48 17 but, no. Because I don't have the evidence one way
18 14:31:53 18 or another.
22 14:32:15 22 happening.
23 14:32:15 23 A. Probably.
AbrahamJ
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9 16:09:21 9 Q. Okay.
14 16:09:37 14 Q. Diplomacy.
16 16 Q. Professional respect.
22 16:09:56 22 relationships.
AbrahamJ
218
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STATE OF CALIFORNIA
ss.
COUNTY OF KERN
Bakersfield, California.
susan~R--N-O-. - 6-8-2-9----
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27 EXHIBIT 28
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 33
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~ • MEDICAL
.KERN
CENTER
Affiliated with University o/California Schools 0/ Medicine
at Los Angeles, San Diego and Irvine
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**
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,
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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
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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
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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
15:15:22 5 Q. Okay. Are you aware of any instances where
6 Dr.
7 15:15:26 6 Jadwin was insulting people?
8 15:15:28 7 A. No.
9 15:15:29 8 Q. Okay. Are you aware of any instances where
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
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Case M.D.
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08-15-08
Page 109
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
9 Friday, August 15, 2008, at the time and place set forth
20 Bakersfield, California.
21
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24
~L:)~
LeF~O.
Cindee L. 7974
25
VS. COUNTY
& RANDALL (800) 322-4595
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 35
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 142 of 191
19 October 2005
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.
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
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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
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 36
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 144 of 191
· .- - ..... ..,.
.. Dept
-~
0
C
til
~
~
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 146 of 191
• KERN
MEDICAL
• CENTER ONCOLOGY CQNFERNCE
DATE: October 12,2005
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 147 of 191
• KERN
• MEDICAL
. CENTER ONCOLOGY CQNFERNCE
DATE: October 12; 2005
Case Presenter
Organization of Presentation
Quality of Visual Presentation
,
A B
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
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
ooeoSi.6 Ar
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 148 of 191
• KERN
. MEDICAL
• CENTER ONCOLOGY CONFERNCE
1)ATE: October 12,2005
,,
Case Presenter A B
Organization ofPresentation ( -
Quality of Visual Presentation I
Quality of Oral Case Presentation
Quality of Subsequent Clinical Management Discussion
Impact of Management Discussion on KMC Patient Care
\
\
,
\
,.
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? - <
How would you rate the overall presentation from Radiology?
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:
000051.7
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 149 of 191
• 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
"-
How would you rate the overall presentation from Radiology?
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 150 of 191
· KERN
II,MEDICAL
CENTER ONCOLQOYCQNFERNCE
1)ATE: October 12,2005
------~-
~------
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
Impact of Management Discussion on KMC Patient Care
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
o Nursing 0 Pharmacy 0 Other:
------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
SIgnature: ) ~l' [ )
OOOOS~9
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 151 of 191
• M.EDICAL
KERN
.• CENTER ONCOLOGYCONFERNCE
DATE: October 12, 2005
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- ")
Comments:
Department:
o E.R. 0 F.P. DI.M. DOB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
-------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
00005~O
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 152 of 191
· ... KERN
•••. MEDICAL
"'II. CENTER QNCOLOC;YCQNFERNCE
DATE: October 12,2005
Case Presenter
Organization ofPresentation ,
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
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
o Nursing 0 Pharmacy 0 Other:
------------
Position:
o Staff Physician ~Medical Resident 0 Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
000052~
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 153 of 191
• KERN
• MEDICAL
. CENTER ONCOLQGYCONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation
Quality ofVisual Presentation
t
J ,
~
t
Quality of Oral Case Presentation
Quality of Subsequent Clinical Management Discussion
/
,
J ,
Impact of Management Discussion on KMC Patient Care
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 Pathology?
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 154 of 191
• KERN
,MEDICAL
• CENTER ONCOLO(rY CONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization ofPresentation
Quality of Visual Presentation
, 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 Staff Physician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
0000523
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 155 of 191
• KERN
MEDICAL
• CENTER ONCOLOGY CQNFERNCE
DATE: October 12,2005
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
o R.N. 0 Other Healthcare Associate
Signature: ('J)£~YJ..i'\nvltitU!-'Whi_
==
(Optional)
0000524
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 156 of 191
ONCOLOGY CONFERNCE
lJATE: October 12,2005
Case Presenter
Organization of Presentation , A
/
B
Comments:
Department:
o E.R 0 F.P. 0 I.M. 0 OB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
-----~-------
Position:
o StaffPhysician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000525
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 157 of 191
. KERN
I MEDICAL
I. CENTER ONCOLOGYCONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization ofPresentation I V .I
Quality of Visual Presentation ( I
Quality of Oral Case Presentation I '7 _
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 158 of 191
• KERN
MEDICAL
• CENTER ONCOLOGY CONFERNCE
l)ATE: October 12,2005
Case Presenter
Organization of Presentation
A
~~ I .,B (
Quality of Visual Presentation
Quality of Oral Case Presentation
Quality of Subsequent Clinical Management Discussion
Impact of Management Discussion on KMe Patient Care
Overall Presentation Rating
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?
How would you rate the overall presentation from Radiology?
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:
------------
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 159 of 191
··KERN
• MEDICAL
• CENTER ONCOLOGY CONFERNCE
l)ATE: October 12, 2005
Case Presenter
Organization of Presentation
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
How would you rate the overall presentation from Pathology?
How would you rate the overall presentation froiD Radiology?
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
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000528
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 160 of 191
w.o., • KERN
MEDICAL
~ • CENTER
o
ONCOLOGY CONFERNCE
DATE: October 12, 2005
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
Comments:
Department:
o E.R. 0 F.P. DI.M. OOB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
------------
Position:
o Staff Physician 0 0 Medical Resident 0 Other Healthcare Provider ~edical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000529
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 161 of 191
KERN
. MEDICAL
• CENTER ONCOLOGY CONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation
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
How would you rate the overall presentation from Radiology?
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
o R.N. 0 Other Healthcare Associate
Signature: ~
(Optional)
0000530
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 162 of 191
. _-.--- KERN
~:MEDCAL
- . CENTER ONCOLOOYCONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation ~ I z
Quality of Visual Presentation I I
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
How would you rate the overall presentation from Pathology?
~ 8etl+T(j)
How would you rate the overall presentation from Radiology?
~
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
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000531.
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 163 of 191
- KERN
•---MEDICA
- L
• CENTER ONCOLOGY CONFERNCE
DATE: October 12, 2005
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 \ -)
Department:
D E.R. D F.P. 0 I.M. OOB/GYN 0 Pathology D Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider D Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000532
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 164 of 191
. KERN·
I.
·.MEDICAL
I CENTER ONCOLOGYCONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation I J
Quality of Visual Presentation
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
How would you rate the overall presentation from Pathology?
I iJM-~5?".lb ~ &.
How would you rate the overall presentation from Radiology?
~
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 165 of 191
• -. ·~~~AL
. ~.CENTER ONCOLOGY CONFERNCE
1>A TE: October 12, 2005
Case Presenter A B
Organization of Presentation I ·11
Quality ofVisual Presentation
Quality of Oral Case Presentation
Quality of Subsequent Clinical Management Discussion
/
.-1
I
"
--:.(_
~./
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
0000534
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 166 of 191
.. .~
• KERN
• MEDICAL
. CENTER ONCOLOGYCONFERNCE
DATE: October 12,2005
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
o Nursing 0 Pharmacy 0 Other:
-------------
Position:
o StaffPhysician ;< Medical Resident D Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
00005~5
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 167 of 191
·.,... KERN
• . MEDICAL •• • •
Case Presenter A B
Organization of Presentation
Quality of Visual Presentation
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 / '/
Overall Presentation Rating I
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 Pathology?
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 168 of 191
• KERN
.~ ONCOLQQYCQNFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation / I
Quality of Visual Presentation I 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
How would you rate the overall presentation from Pathology?
J
How would you rate the overall presentation from Radiology?
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 169 of 191
•. MEDICAl
KERN
•. CENTER ONCOLOGY CONFERNCE
DATE: October 12. 2005
Case Presenter A B
Organization of Presentation
Quality of Visual Presentation
Quality of Oral Case Presentation
,
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:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000538
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 170 of 191
·KEAN
:rvEDCAl
. CENTER ONCOLQGYCONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation l . (
Quality of Visual Presentation 1 f
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 171 of 191
. KERN
II M.ED.leAL
. CENTER ONCOLOGY CONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation I '7
Quality of Visual Presentation I I
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-
How would you rate the overall presentation from Radiology?
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
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000540
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 172 of 191
. KERN
• MEDICAL
• CENTER ONCOLOGY CONFERNCE
l)ATE: October 12,2005
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
How would you rate the overall presentation from Radiology?
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.
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 173 of 191
........ KERN
~:~ ONCOLQGY CONFERNCE
DATE: October 12, '2005
,
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
Overall Presentation Rating I
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
0000542
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 174 of 191
- . ·.·~~~AL
~ • CENTER ONCOLOGY CONFERNCE
DATE: October 12, 2005
Case Presenter
Organization of Presentation
Quality of Visual Presentation
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
,
How would you rate the overall presentation from Pathology?
---: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
o Nursing 0 Pharmacy 0 Other:
-------------
Position:
o Staff Physician ><Q. Medical Resident 0 Other HeaIthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
()000543
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 175 of 191
- .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 Visual Presentation I I
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
o Nursing 0 Pharmacy 0 Other:
-------------
Position:
o Staff Physician -0 Medical Resident 0 Other Healthcare Provider rAMedical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000544
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 176 of 191
•·~~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
{
How would you rate the overall presentation from Pathology?
How would you rate the overall presentation froiD Radiology?
Comments:
Department:
o E.R. . gil>. 0 I.M. DOB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
-------------
Position: /.
o Staff Physician ~dical Resident 0 Other Healthcare Provider 0 Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000545
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 177 of 191
• KERN
MEDICAL
• CENTER ONCOLQGY CONFERNCE
DATE: October 12,2005
Case Presenter A B
Organization of Presentation <~
'I
r{
~
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 178 of 191
• KERN
. MEDICAL
• CENTER ONCOLOGY CONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation ../ .;) ')
Quality of Visual Presentation ~
Comments:
Department:
o E.R. II F.P. 0 I.M. OOB/GYN 0 Pathology 0 Radiology 0 Surgery
o Nursing 0 Pharmacy 0 Other:
-------------
Position:
o Staff Physician 0 Medical Resident 0 Other Healthcare Provider d Medical Student
o R.N. 0 Other Healthcare Associate
Signature:
(Optional)
0000547
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 179 of 191
·. KERN
:MBJCAL
. CENTER ONCOLOGY CONFERNCE
DATE: October 12, 2005
Case Presenter A B
Organization of Presentation
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
Overall Presentation Rating
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 from Pathology?
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
o Nursing 0 Pharmacy 0 Other:
----~-------
Position:
o Staff Physician 0 Medical Resident 'kther Healthcare Provider 0 Medical Student
o RoN. 0 Other Healthcare Associate
Signature:
(Optional)
0000548
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 180 of 191
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.
Regards.
Laura Heredia-Quinonez
Oncology Clinic Coordinator
Cancer Registry/Kern Medical Center
(661) 326-5692
(661) 862-7623 (fax)
heredial@kernmedctr.com
Thank you,
Serena
Serena Sepulveda-Rini
Office Services Assistant
Lab - Pathology
0000549
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 181 of 191
1
2
3
4
5
6
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27 EXHIBIT 32
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 37
1
Case 1:07-cv-00026-OWW-TAG
I!'E"%AL
CENTER
Document 277-3
ONCOLOGY CONFERNCE
Filed 12/01/2008 Page 182 of 191
Case Presenter A B
Organization of Presentation I
,
Quality of Visual Presentation f.-
Quality of Oral Case Presentation
Quality of Subsequent Clinical Management Discussion 1
Impact of Management Discussion on KMC Patient Care - 5
Overall Presentation Rating
I learned new information while attending this conference:
?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
How would you rate the overall presentation from Pathology?
How would you rate the overall presentation from Radiology?
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
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 183 of 191
1
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27 EXHIBIT 33
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 38
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 184 of 191
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13 VIDEOTAPED DEPOSITION
14 OF
17 Bakersfield, California
18
19
20
21
22
23
24
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 185 of 191
10
1 09:04:18 1 A. Correct.
7 09:04:31 7 people.
9 09:04:34 9 A. Correct.
11 09:04:37 11 inappropriately?
12 09:04:38 12 A. No.
19 09:05:20 19 A. Uh-huh.
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 186 of 191
98
1 11:05:43 1 A. Yes.
13 11:06:24 13 A. Correct.
15 11:06:26 15 A. Right.
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 187 of 191
99
12 11:07:22 12 A. Correct.
18 11:07:32 18 A. No.
22 11:07:47 22 A. I --
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 188 of 191
100
1 11:07:55 1 Q. Okay.
5 11:08:05 5 issue.
11 11:08:25 11 Mr. Bryan, did you ever discuss this issue with
25 11:08:59 25 Memorial.
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 189 of 191
101
4 11:09:20 4 A. Yeah.
7 11:09:28 7 A. Correct.
13 11:09:48 13 A. Correct.
17 11:09:56 17 A. Correct.
21 11:10:04 21 do that. So --
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 190 of 191
104
2 11:13:07 2 aware?
13 11:13:36 13 still?
16 11:13:43 16 canceled.
18 11:13:46 18 A. Yeah.
25 11:14:06 25 away.
MansourJ
Case 1:07-cv-00026-OWW-TAG Document 277-3 Filed 12/01/2008 Page 191189
of 191
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
10 August 25, 2008, at the time and place set forth on the
21 Bakersfield, California.
22
23
Sandra L. Edmonson, CSR No. 7704
24
25
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
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 4
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 5 of 209
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 39
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 7 of 209
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
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?*!
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 8 of 209
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,
0027084
2
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 9 of 209
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).
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.
Respectfully submitted,
£X.?4O
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 10 of 209
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).
October 16,2006
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.
Respectfully submitted,
jU—« 7Lu^
Irwin Harris, M.D.
Chief Medical Officer
/
0027097
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 11 of 209
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. 9 9 -
660).
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 12 of 209
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.
Respectfully submitted,
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
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 1966 (P.L. 9 9 -
660).
March 12,2007
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.
0027102
N=i
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 14 of 209
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
%
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 15 of 209
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.
Respectfully submitted,
i ^*->r-l*\ fid-
0027104
3
&-**±J?
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 16 of 209
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
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).
April 12,2007
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.)
Susan R. Wood, CSR # 6829
08/13/08
Irwin Everett Harris, M.D.
0027105
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 17 of 209
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.
Respectfully submitted,
0027106
1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 18 of 209
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 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).
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.
Respectfully submitted,
0027109
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 19 of 209
1
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27 EXHIBIT 35
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 40
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 20 of 209
1
3 ______________
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
SmithT1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 21 of 209
14
7 09:18:24 7 removal.
12 09:18:39 12 Q. Okay.
SmithT1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 22 of 209
15
2 09:19:28 2 can't tell you the amount of time. And as you might
8 09:19:47 8 A. Correct.
14 09:20:12 14 Q. No idea?
16 09:20:16 16 unavailability.
SmithT1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 23 of 209
82
12 10:51:14 12 government --
19 10:51:26 19 answer.
23 23 up.
SmithT1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 24 of 209
83
14 10:52:15 14 Q. Okay.
18 10:52:32 18 period. So they did not find any fault with the
23 10:52:46 23 reports.
SmithT1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 25 of 209
85
1 10:54:03 1 jeopardy --
2 10:54:04 2 Q. Okay.
7 10:54:21 7 A. Correct.
12 10:54:40 12 Q. Right.
SmithT1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 26 of 209
87
2 10:56:35 2 A. Yes.
5 10:56:42 5 derive?
9 10:56:48 9 other?
21 10:57:27 21 wouldn't want to sit there and say oh, that's fine.
SmithT1
101
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 27 of 209
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
21 Bakersfield, California.
~-N-O-'--=6-=8-=2'--9=-----
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23
S us a n
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27 EXHIBIT 36
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 41
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 29 of 209
1
3 ______________
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
MartinM1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 30 of 209
34
7 09:40:55 7 a pathologist.
12 09:41:09 12 A. I would.
17 09:41:20 17 disappointment.
20 09:41:26 20 turn the other way and just pretend like you didn't
22 09:41:30 22 A. No.
25 09:41:34 25 A. I do.
MartinM1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 31 of 209
35
2 09:41:37 2 A. I do.
5 09:41:47 5 Dr. Jadwin called you up and said, hey, can we meet
25 09:42:49 25 A. Yes.
MartinM1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 32 of 209
91
3 12:08:20 3 report --
4 12:08:20 4 Q. I see.
10 12:08:36 10 request?
13 12:08:41 13 at hand.
14 12:08:42 14 Q. I see.
20 12:08:54 20 Q. I see.
23 12:09:05 23 meetings with him, you didn't feel the need to report
MartinM1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 102
33 of 209
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
21 Bakersfield, California.
a~g-R-N-O-.--=-6-=-8-=-2-=9----
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 42
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 35 of 209
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 )
Defendants. )
10 __________________________)
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
16 EVANGELINE F. GALLEGOS
18 Bakersfield, California
19
20
21
22
23
24
GallegosE
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 36 of 209
23
7 13:30:50 7 A. Yeah.
9 13:30:59 9 add to this issue about him putting more work on your
16 13:31:19 16 A. Yes.
23 13:31:55 23 very kind and generous man, but in the workplace he's
GallegosE
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 37 of 209
24
8 13:32:33 8 opinion?
19 13:33:17 19 uncooperative?
GallegosE
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 38 of 209
25
1 13:33:55 1 him.
8 13:34:13 8 Q. I see.
13 13:34:21 13 uncooperative.
15 13:34:24 15 intimidating?
16 13:34:31 16 A. No.
24 13:34:47 24 A. No.
GallegosE
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 39 of 209
26
1 13:34:53 1 overbearing?
2 13:35:02 2 A. Sometimes.
3 13:35:03 3 Q. Sometimes.
6 13:35:09 6 self-righteous?
7 13:35:16 7 A. Yes.
13 13:35:30 13 Q. Okay.
16 13:35:39 16 thought.
19 13:35:46 19 A. No.
GallegosE
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 40 of 209
27
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.
9 13:36:20 9 A. Yes.
18 13:36:54 18 you?
20 13:36:56 20 Q. Okay.
22 13:37:05 22 I work with him and then how he is at work and then
24 13:37:14 24 Q. Um-hmm.
GallegosE
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 41 of 209
28
9 13:37:52 9 A. Yes.
11 13:37:57 11 angry?
12 13:37:58 12 A. Yes.
14 13:38:02 14 many instances did you see him get angry on?
15 13:38:08 15 A. Twice.
17 13:38:11 17 instance.
21 13:38:22 21 Q. Sure.
GallegosE
98
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 42 of 209
R
1 STATE OF CALIFORNIA D
ss.
2 COUNTY OF KERN I
N
3 D
E
X
4
1 Bakersfield, California.
3
Susan R. Wood, CSR No. 6829
4
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 43
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 44 of 209
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13 13 OF
17 17
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25 25
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 45 of 209
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1 1 professional?
7 7 BY MR. LEE:
9 9 Dr. Jadwin?
11 11 everybody.
18 18 arrogant to you?
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 46 of 209
19
2 2 know.
16 16 BY MR. LEE:
19 19 conceited?
20 10:26 20 A No.
22 22 A From my perspective?
23 23 Q Yes.
24 24 A No.
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 47 of 209
20
1 1 patronizing?
3 3 interactions?
6 6 Dr. Jadwin.
9 9 BY MR. LEE:
10 10:26 10 Q Or in general?
15 10:27 15 Q Uh-huh.
16 16 A No.
23 23 BY MR. LEE:
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 48 of 209
21
3 3 Q Uh-huh.
10 10 BY MR. LEE:
14 14 vague.
21 21 BY MR. LEE:
25 10:28 25 or no. The witness can answer the question any way they
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 49 of 209
22
3 3 BY MR. LEE:
7 7 argumentative.
13 13 in Dr. Jadwin.
17 17 just discussed.
18 18 BY MR. LEE:
24 24 at this point.
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 50 of 209
23
2 2 BY MR. LEE:
12 12 him.
14 14 Dr. Taylor?
21 21 A Personally?
22 22 Q Uh-huh.
23 23 A No.
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 51 of 209
36
1 1 Q Of pathology?
6 6 A Correct.
19 19 Center?
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 52 of 209
37
2 2 needed? Yes.
3 3 BY MR. LEE:
21 21 BY MR. LEE:
23 23 of Dr. Jadwin.
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 53 of 209
62
2 2 A I don't know.
8 8 again?
9 9 BY MR. LEE:
12 12 Medical Center?
16 16 BY MR. LEE:
22 22 improve quality?
24 24 ambiguous.
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 54 of 209
75
2 2 BY MR. LEE:
14 14 A I did.
20 20 Medical Center?
KolbM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 55 of 209
76
6 6 the issues.
12 12 BY MR. LEE:
16 16 A That's correct.
17 17 Q -- as CMO?
18 18 A That's correct.
23 23 A No.
KolbM
KOLB, M.D. 04-19-08
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 56 of 209
Page 134
C E R T I F I CAT E
transcription thereof.
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 44
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 58 of 209
1
LindseyT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 59 of 209
8
LindseyT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 60 of 209
9
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 61 of 209
10
LindseyT
INDSEY
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page02-26-08
62 of 209
Page 92
1 STATE OF CALIFORNIA
2 ss.
3 COUNTY OF KERN
4
5 I, Cindee L. LeFevre, a Certified Shorthand
10 Tuesday, February 26, 2008, at the time and place set forth
21 Bakersfield, California.
22
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 45
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 64 of 209
1
3 ---------
10
11
12
13
16 Bakersfield, California
17
18
19
21
22
23
24
25
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 65 of 209
8
6 David F. Jadwin?
14 A. Uh-huh.
24 office and you just see a tall person. I was entry level
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 66 of 209
10
6 would say things, and I am, like, okay.so that was funny or
11 A. Yeah.
12 Q. Okay.
14 Q. Right.
23 Q. Uh-huh.
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 67 of 209
11
1 Q. Right.
2 A. So --
5 A. Uh-huh.
12 I know there was some people who did like him. There was
18 Q. Uh-huh.
20 Q. Uh-huh.
23 Rachelle Dirui.
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 68 of 209
12
5 generally?
13 She had one way of doing them, and he wanted them done one
14 way.
17 A. Yes.
19 A. Yes.
24 with. So those are probably the ones that I would hear the
25 most.
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 69 of 209
15
1 would go and ask him something, and I would see that, you
6 then?
8 BY MR. LEE:
11 A. Such as what or --
25 you?
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 70 of 209
16
4 A. I am not sure.
10 A. I don't recall.
13 A. Unprofessional, no.
17 A. I am not sure.
LopezI
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 71 of 209
LOPEZ 02-26-08
Page 26
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 46
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 73 of 209
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
NaderiJ
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 74 of 209
38
3 10:55:58 3 A. No.
5 10:56:08 5 A. Three.
8 10:56:18 8 A. Yes.
10 10:56:21 10 at KMC?
11 10:56:22 11 A. Yes.
17 10:57:15 17 involved with that, but I was on and off, back and
20 10:57:28 20 continuous.
NaderiJ
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39
20 10:58:45 20 schedule?
NaderiJ
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43
1 11:02:01 1 that?
23 23 BY MR. LEE:
24 11:03:22 24 Q. Now.
NaderiJ
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51
1 11:11:44 1 answer.
4 11:11:48 4 necessary.
14 11:12:29 14 didn't.
17 11:12:43 17 KMC?
24 11:13:05 24 that because that was very bad accident, and they
NaderiJ
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63
1 11:39:22 1 Q. Okay.
17 11:40:26 17 is fine.
NaderiJ
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64
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
16 11:42:02 16 But those are just the usual routine things, nothing
19 11:42:15 19 professional.
NaderiJ
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75
5 11:58:35 5 know this, but I don't know this. But this is what I
16 11:59:07 16 A. He know --
18 11:59:10 18 Dr. Jadwin's ability to get along with people was any
22 11:59:21 22 others. And also I don't get the end result of his
NaderiJ
159
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 81 of 209
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
21 Bakersfield, California.
22
23 ~ ~ * 7704
S r a ~ons
CQy"( ;o~
24
25
II
1
2
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27 EXHIBIT 42
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 47
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 83 of 209
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
PatelR
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 84 of 209
16
PatelR
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24
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
13 17:20:40 13 and so I felt that, you know, the purpose, this issue
21 17:21:12 21 second?
PatelR
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 86 of 209
38
8 17:50:21 8 Q. Okay.
11 17:50:25 11 A. Yes.
25 17:51:10 25 KMC?
PatelR
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 87 of 209
41
14 17:54:58 14 experience?
21 17:55:24 21 A. Yes.
PatelR
86
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1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
21 Bakersfield, California.
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27 EXHIBIT 43
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 48
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 90 of 209
1
RamosA1
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RamosA1
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RamosA1
Case 1:07-cv-00026-OWW-TAG
BARBARA RAMOS-ANINION Document 277-4 Filed 12/01/2008 Page 95 of 209
08-15-08
Page 119
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
3
4 I, Cindee L. LeFevre, a Certified Shorthand
20 Bakersfield, California.
21
22 .
23
24
~L)~ Cindee L. LeFevr , CSR No. 7974
25
VS. COUNTY
RANDALL (800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 96 of 209
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 49
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 97 of 209
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
TaylorE1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 98 of 209
88
1 18:07:32 1 A. Okay?
20 18:08:13 20 A. Estimate?
22 18:08:16 22 20 minutes.
24 18:08:23 24 paragraph you say, "In general I get along fine with
TaylorE1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 99 of 209
89
10 18:08:54 10 with the path reports and told me. I really -- yes,
15 18:09:07 15 A. No.
23 18:09:30 23 Dr. Jadwin prior to -- well, let's just say for the
TaylorE1
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90
1 18:09:39 1 Q. So --
18 18:10:31 18 A. No.
21 18:10:35 21 A. No.
TaylorE1
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93
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
9 18:12:56 9 you -- I don't know if you are aware of this, but you
17 18:13:20 17 A. Okay.
TaylorE1
128
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1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
21 Bakersfield, California.
22
23 S
~J3 GJ ~J~--cA. ~
ra L. Edmonson, CSR No. 7704
24
25
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 50
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 104 of 209
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
WrobelJ
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 105 of 209
12
8 08:12:28 8 A. No.
13 08:12:39 13 year.
21 08:12:52 21 arrogant?
WrobelJ
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 106 of 209
13
11 08:13:28 11 arrogant?
15 08:13:34 15 believe.
18 08:13:39 18 A. No.
21 08:13:48 21 A. No.
23 08:13:53 23 at KMC, 19 --
24 08:13:54 24 A. '91.
25 08:13:54 25 Q. -- 91?
WrobelJ
46
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 107 of 209
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
21 Bakersfield, California.
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28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 51
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 109 of 209
1
3 ______________
5 F. JADWIN, D.O., )
)
6 Plaintiff, )
)
7 vs. ) No. 1:07-cv-00026-OWW-TAG
)
8 Y OF KERN; et al. )
)
9 Defendants. )
__________________________)
10
11
12
13
14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
19
20
21
22
23
24
YooT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 110 of 209
9
1 13:13:45 1 Q. Okay.
3 13:13:52 3 Q. Okay.
4 13:13:53 4 A. Yes.
6 13:13:55 6 right?
7 13:13:56 7 A. Right.
10 13:14:03 10 Center?
16 13:14:25 16 department.
17 13:14:25 17 Q. Okay.
YooT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 111 of 209
10
7 13:15:01 7 with the County of Kern you were -- you were hired as
9 13:15:06 9 A. Yeah.
10 13:15:06 10 Q. Okay.
15 13:15:24 15 A. Yes.
17 13:15:27 17 A. Uh-huh.
19 13:15:30 19 A. Yes.
21 13:15:33 21 you have with Dr. Jadwin during your tenure or during
YooT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 112 of 209
11
1 13:15:58 1 once-a-month --
2 13:15:59 2 Q. I see.
7 13:16:18 7 members.
10 13:16:22 10 A. Right.
YooT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 113 of 209
12
6 13:17:46 6 A. No.
10 13:18:02 10 Hospital for quite some time, and overall I was with
17 13:18:44 17 didn't know him, and I knew he was there only when we
21 13:18:57 21 A. No.
23 13:19:04 23 right?
YooT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 114 of 209
15
2 13:21:17 2 A. Uh-huh.
6 13:21:25 6 Q. Sure.
13 13:21:46 13 A. No.
15 13:21:48 15 A. Uh-huh.
17 13:21:57 17 meetings did you witness -- you saw Dr. Jadwin, you
19 13:22:03 19 A. Right.
YooT
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 115 of 209
20
1 13:27:58 1 Q. Okay.
18 13:29:14 18 Q. Right.
20 13:29:16 20 agencies.
22 13:29:32 22 became ill and just couldn't work because you're sick
YooT
94
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 116 of 209
1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
10 August 21, 2008, at the time and place set forth on the
21 Bakersfield, California.
22
23
Sandra L. Edmonson, CSR No. 7704
24
25
1
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7
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27 EXHIBIT 47
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 52
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 118 of 209
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DuttP1
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DuttP1
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36
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
17
09:47:11 15 implication.
18
09:47:11 16 Q. What's that legal implication?
19
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
22
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
25
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
27
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 122 of 209
38
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
7
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
17
09:49:33 14 was being pending or threatened?
18
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
26
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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DuttP1
08-20-08
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 127 of 209
w
Page 351 o
R
1 STATE OF CALIFORNIA o
ss.
2 COUNTY OF KERN I
N
3 o
E
4 I, Cindee L. LeFevre, a Certified Shorthand X
9 Wednesday, August 20, 2008, at the time and place set forth
20 Bakersfield, California.
21
22
23
24 Cindee L. LeFevre,
25
vs. COUNTY
(800) 322-4595
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 128 of 209
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27 EXHIBIT 48
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 53
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 129 of 209
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. .
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
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
0000830
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 130 of 209
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27 EXHIBIT 49
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 54
Page 1 of 1
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 131 of 209
-
David Jadwin, DO Pathology Look Back Study
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.
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.
I am pulling all of these slides, the path history and all subsequent PSAs to determin followup status.
David
DFJ00589
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 132 of 209
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27 EXHIBIT 50
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 55
Untitled 04/19/2006 12:30 PM
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 133 of 209
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 134 of 209
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27 EXHIBIT 51
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 56
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 135 of 209
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.
-----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:
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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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 57
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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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8 Y OF KERN; et al. )
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Defendants. )
10 __________________________)
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14 VIDEOTAPED DEPOSITION
15 OF
18 Bakersfield, California
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ShertukdeS
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17 13:29:48 17 like, you know. I told Dr. Dutt I'm scared, like,
25 13:30:04 25 2005?
ShertukdeS
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1 13:49:07 1 know.
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....
22 13:50:03 22 presented.
23 13:50:03 23 Q. Again?
ShertukdeS
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14 17:14:39 14 Q. Okay.
23 23 off --
ShertukdeS
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2 17:15:15 2 finished.
9 17:15:38 9 A. Yeah.
21 17:16:07 21 the CMO or the CEO, like, you know. I would know
ShertukdeS
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11 17:17:39 11 A. Yeah.
13 17:17:43 13 A. Yeah.
21 17:18:00 21 Q. Okay.
24 17:18:07 24 that.
ShertukdeS
220
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 143 of 209
STATE OF CALIFORNIA
ss.
COUNTY OF KERN
Bakersfield, California.
----------------_41
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DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 58
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5 Medical Center.
9 somehow impaired.
10 Q. Impaired.
12 impaired?
23 session.
24 Q. Fine.
DFJ4
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1 Q. Tai Yoo.
5 please.
7 please.
9 BY MR. WASSER:
11 time?
13 Q. All right.
18 Q. Some worrisome?
19 A. Worrisome features.
24 Q. They do?
DFJ4
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2 anything else?
11 BY MR. WASSER:
13 of that nature?
14 A. Yes. Um-hmm.
19 BY MR. WASSER:
DFJ4
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4 problem.
20 e-mail.
21 Q. To him?
22 A. Yes.
25 retaliatory to you?
DFJ4
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2 make sense.
14 letter?
19 all made sense. And all he could say was, oh, I'm
24 Counsel.
DFJ4
837
California.
Susan ~-N-o-.-6-8-2-9----
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USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 59
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/
I
~ • MEDICAL
.KERN
CENTER
HUMAN RESOURCES DEPARTMENT
Memorandum
To: Dr. Marvin Kolb, Chief Medical Officer
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.
Attachment
0000031.
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 154 of 209
• 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.
0000032
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 155 of 209
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 156 of 209
Conclusions
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 157 of 209
DATE: 8/ 12!2003
[ ,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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 158 of 209
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: 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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 159 of 209
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?
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 160 of 209
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: 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?
-3- 0000038
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 161 of 209
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?
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.
-4-
0000039
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 162 of 209
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: 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?
MICHAEL EWALD: So, were you surprised when he pulled your tie? Was that one of
the feelings that you had when he did that?
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 163 of 209
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: 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.
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 164 of 209
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.
MICHAEL EWALD: And if Dr. Jadwin attempts to talk to you about it, I would ask that
-7-
0000042
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 165 of 209
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: The time is 3: 16 p.m. and this is the conclusion of the interview.
-8-
0000043
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 166 of 209
~ • MEDICAL
.KERN
CENTER
Human Resources Department
Memorandum
To: File
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
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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: 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
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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.
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
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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
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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?
MICHAEL EWALD: Not a badge? Not any other article of clothing? 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
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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?
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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 172 of 209
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.
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-
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 173 of 209
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: 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.
MICHAEL EWALD: Alright. That's fine. That was a couple of months ago.
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,
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 174 of 209
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.
ERIN BALDWIN: Not that day, but I believe one or two days later he did talk to me
about that.
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 -
MICHAEL EWALD: Urn - did you go down there with Dr. Jadwin?
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?
-4- 0000052
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 175 of 209
MICHAEL EWALD: And then started speaking loudly and forcefully to Dr. Jadwin?
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?
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 -
ERIN BALDWIN: Not the very lowest, but towards the end.
-5- 0000053
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 176 of 209
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: 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?
MICHAEL EWALD: Okay. Well, have you ever seen anything like thisbefore?
ERIN BALDWIN: Just - you know - discussing things - you know - but -
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 177 of 209
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-
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 178 of 209
MICHAEL EWALD: What did Dr. Lau specifically tell you happened?
DR. NADERI: Well, as I recall, it was about a couple months ago, right?
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) -
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 179 of 209
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?
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 180 of 209
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. 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.
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 181 of 209
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.
-5- 0000059
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 182 of 209
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 183 of 209
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 -
DR. JADWIN: Calm the whole time. I never raised my voice - at any rate -
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.
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 184 of 209
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 185 of 209
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-
-4- 0000063
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 186 of 209
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: 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.
MICHAEL EWALD: Okay. Do - is this something you have done before to him or to
anyone else?
- 5- 0000064
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 187 of 209
DR JADWIN: No.
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: 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 -
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 188 of 209
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.
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.
-7- (\OO~066
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 189 of 209
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
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 190 of 209
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: 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-
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 191 of 209
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.
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-
Case 1:07-cv-00026-OWW-TAG Document 277-4 Filed 12/01/2008 Page 192 of 209
MICHAEL EWALD: Okay. Good. Thank you very much. The conclusion of the
interview is 10:24 a.m., October 17, 2003.
- 11 -
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5 16:04:00 5 all, I don't know what her competency level is, and
12 16:04:23 12 have thought that she was -- I would not have thought
21 16:05:09 21 yourself?
22 16:05:09 22 A. No.
25 16:05:20 25 Mr. Bryan that other members of the medical staff had
DFJ1
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STATE OF CALIFORNIA
ss.
COUNTY OF KERN
hereof.
i
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Bakersfield, California .
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PMK DuttP2
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2 12:13:49 2 transcription.
8 12:14:31 8 A. No.
9 12:14:32 9 Q. No?
20 12:14:57 20 question.
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25 12:15:01 25 objection.
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3 12:20:24 3 A. Well, I did not tell the CEO. I'm not sure
6 12:20:41 6 did you -- how did you become aware that he found
18 12:21:24 18 nature?
PMK DuttP2
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11 12:28:29 11 circumstances.
15 12:28:36 15 Q. I'm not asking for the law. I'm asking for
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1 STATE OF CALIFORNIA
ss.
2 COUNTY OF KERN
Bakersfield, California.
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5 F. JADWIN, D.O., )
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OConnorS
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1 09:53:02 1 any preparation for the meeting with the CEO and with
10 09:53:26 10 meeting?
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16 09:53:39 16 meeting.
OConnorS
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10 09:58:28 10 department. So . . .
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15 10:00:02 15 No. 2?
20 10:00:22 20 was Pat Perez, and then Renita Nunn signed off on it
OConnorS
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1 STATE OF CALIFORNIA
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I, Sandra L. Edmonson, a Certified Shorthand
23 ~dJOe (3 arLm.ct!C-cA.
nQra L. Edmonson, CSR No.
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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
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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;
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
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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
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 9 of 56
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
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 10 of 56
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
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IN WITNESS WHEREOF, the: PC3rtie~ have executed this Amendnwnt No.1 to the
Agreement as oftheday and year fir~;{written·.above. .
Pete~72~~ Chairman'
Chief8xecUtl~tCer Board of Supervisors
APPROVED AS TO FORM:
OFFICE OF COUNTY COUNSEL
By rft/lbv'\/ A. lY~VVLt:t:-
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.
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:
0026199
· .Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 13 of 56
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.
0026200
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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
0026201
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 15 of 56
fNWITNESS WHEREOF, the parties have ente~d into this Amendment No; 2 to
the Ag.reemeritasof the day and yearfirstwlittenabove.
APPRO\JEDAS TO CONTENT:
KERN MEDICAL CENTER
By ill ·2[U2~-----~··
David KGulberson
Interim Chief Executive Officer
-
J,', /\
, ,. '. ./.?
'). ,,---'-J",
''';''.-''',.'-".,Z410:~''''-'''''_!.7:, ~
i( //}
:' .. {
By .
KayF. Madden /;.~<{~ .(l;(,
Director
APPROVED AS TO FORM:
OFFICE OF OOUNTY COUNSEL
BY&~VZ.~
Deputy ,
Amend2.Dutt,111506
0026202
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 16 of 56
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 59
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 64
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 17 of 56
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
),
RECITALS.
WHEREAS:
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
Core Physician shall render services as set forth in Exhibit "A," which is attached
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
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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).
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
sale discretion of County, as is reasonable and convenient for County.
D. 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 Seven Hundred Seventy-Three Thousand Three
Hundred Forty-One Dollars ($773,341) per the five-year term of this Agreement.
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.
0026230
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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
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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.
(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.
4. PROFESSIONAL FEES
0026232
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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
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 22 of 56
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
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.
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.
0026234
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 23 of 56
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
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.
Core Physician will receive paid leave for holidays, vacation, sick leave and
educational leave.
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
7
0026235
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 24 of 56
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.
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
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 account of 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 under the Plan
8
0026236
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 25 of 56
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,
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. 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. 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 service by Core Physician. If Core Physician's Compensation was at least
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 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.
0026237
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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. •
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.
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
employees of KMC. Any such change by County shall not be a breach of this
Agreement.
10
0026238
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9. EXPENSE REIMBURSEMENT
Article IV.
TERMINATION AND CORRECTIVE ACTION
1. TERMINATION OF AGREEMENT
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
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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.
2. CORRECTIVE ACTION
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.
2. ASSISTANCE IN LITIGATION
12
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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.
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
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
Kem.
6. 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 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.
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, 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
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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
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 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.
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
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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.
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
15
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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.
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
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 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
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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.
17
0026245
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 34 of 56
By (1;;,~- Q, !~
C~ilJ.-.....peter K. Bryan
IJ Chief Executive Officer
APPROVED AS TO FORM:
OFFICE OF COUNTY COUNSEL
I I-
S y NIl£·
~C/Vj// "'\
\,
Deputy
AgrcerncntShertuKcc.1G0305
IS
0026246
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 35 of 56
Exhibit II A"
Job Description
Savita P. Shertukde. M.D.
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 and hematopathology
services on a rotational basis with one or more pathologist.
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.
Administrative Responsibilities:
19
0026247
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 36 of 56
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 department.
20
0026248
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1
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27 EXHIBIT 60
28
USDC, ED Case No. 1:07-cv-00026 OWW TAG
DECLARATION OF EUGENE D. LEE IN OPPOSITION TO ∆’S MOTION FOR SUMMARY JUDGMENT 65
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 38 of 56
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:
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
Core Physician shall render services as set forth in Exhibit "A," which is attached
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
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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).
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.
D. The maximum payable under this Agreement, including base salary and
professional fees paid by County to Core Physician pursuant to Article II, section 5,
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.
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
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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
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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.
(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.
4. PROFESSIONAL FEES
0026178
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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.
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.
6. OTHER INCOME
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
employees of KMC. Any such change by County shall not be a breach of this
Agreement.
0026180
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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 polley applicable to other regular County
employees of KMC regarding use of sick leave shall apply to Core Physician.
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
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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
Document) under the amended and restated Plan document shall be as follows:
County shall contribute as County's required contribution the sum of SeventeeFl
Thousand Five Hundred Dollars ($17,500) for the account of Core Physician for
each complete Plan year of service (as defined in the Plan Document) by Core
Physician. Core Physician's mandatory employee contributions required under the
amended and restated Plan Document shall be as follows:
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0026183
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determined by Core Physician. County shall not be liable for the Investment
experience of Core Physician's Plan account.
Core Physician is exempt from payment of Social Security taxes as the Kern County
Pension Plan for Physician Employees is a qualified alternative to the insurance
system established by the federal Social Security Act. Core Physicians employed
before March 31, 1986, will continue to be exempt from the payment of Medicare
taxes.
8. KERN$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
10
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Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 48 of 56
Article IV.
TERMINATION AND CORRECTIVE ACTION
1. TERMINATION OF AGREEMENT
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.
2. CORRECTIVE ACTION
11
0026185
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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.
2. ASSISTANCE IN LITIGATION
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.
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.
12
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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
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 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.
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, 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
13
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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 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.
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.
14
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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 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.
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
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.
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
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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
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.
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.
16
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Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 54 of 56
,---.,
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Chalrnlan Gran A. Yakoub, 0.0/
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Board of Supervisors
APPROVED AS TO CONTENT:
KERN MEDICAL
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CENTER
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By !-, j .j .
Paul J. Hensler
Chief Executive Officer
Interim Director
APPROVED AS TO FORM:
OFFICE OF COUNTY COUNSEL
!\greement.Yilkoub.053007
17
0026191
Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 55 of 56
Exhibit "A"
Job Description
Gian A. Yakoub, D.O.
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 and hematopathology
services on a rotational basis with one or more pathologist.
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.
Administrative Responsibilities:
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Case 1:07-cv-00026-OWW-TAG Document 277-5 Filed 12/01/2008 Page 56 of 56
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 department.
19
0026193