dr. siva arunasalam · siva arunasalam, called as a witness by the plaintiff and cross-defendant,...
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VICTORVILLE, CALIFORNIA; THURSDAY, OCTOBER 6, 2005
A.M. SESSION
DEPARTMENT V-10 HON. STANFORD E. REICHERT, JUDGE
APPEARANCES:
DESERT VALLEY HOSPITAL WAS REPRESENTED
BY ITS COUNSEL, DEBORAH S. TROPP AND
MICHAEL J. SARRAO, ATTORNEYS AT LAW;
TINA BUCHANAN AND LISA CROUCH WERE
REPRESENTED BY THEIR COUNSEL,
VINCENT P. NOLAN, ATTORNEY AT LAW.
(FRED BERZAK, OFFICIAL REPORTER, CSR NO. 5815.)
-O0O-
SIVA ARUNASALAM,
CALLED AS A WITNESS BY THE PLAINTIFF AND CROSS-DEFENDANT,
HAVING BEEN FIRST DULY SWORN, WAS EXAMINED AND TESTIFIED AS
FOLLOWS:
THE COURT ATTENDANT: PLEASE STATE AND SPELL YOUR
NAME FOR THE RECORD.
THE WITNESS: SIVA ARUNASALAM, S-I-V-A,
A-R-U-N-A-S-A-L-A-M.
THE COURT: THANK YOU.
GO AHEAD, PLEASE, MISS TROPP.
MISS TROPP: THANK YOU, YOUR HONOR.
DIRECT EXAMINATION
BY MS. TROPP.
Q DOCTOR, I'LL CALL YOU DOCTOR SIVA. IS THAT ALL
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RIGHT?
A PLEASE DO.
Q IS THAT WHAT YOU'RE CALLED?
A YES.
Q DOCTOR SIVA, ARE YOU AFFILIATED WITH THE HEART
INSTITUTE OF THE HIGH DESERT?
A YES.
Q WHAT IS YOUR AFFILIATION WITH THAT ORGANIZATION?
A I'M THE FOUNDER AND THE DIRECTOR OF THE HEART
INSTITUTE.
Q WHERE'S THE HEART INSTITUTE LOCATED?
A IN VICTORVILLE.
Q HOW LONG HAS THE HEART INSTITUTE OF THE HIGH DESERT
BEEN IN EXISTENCE?
A FOR ABOUT 10 YEARS.
Q DID YOU START THAT 10 YEARS AGO?
A THAT'S CORRECT.
Q SIR, WHAT TYPE OF PHYSICIAN ARE YOU?
A I'M A CARDIOLOGIST.
Q ARE YOU BOARD CERTIFIED?
A YES.
Q IN WHAT FIELDS?
A INTERNAL MEDICINE, CARDIOLOGY, AND INTERVENTIONAL
CARDIOLOGY.
Q WHAT'S THE DIFFERENCE BETWEEN CARDIOLOGY AND
INTERVENTIONAL CARDIOLOGY?
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A IN CARDIOLOGY YOU GO THROUGH INITIALLY ONE YEAR OF
INTERNSHIP AND TWO YEARS OF INTERNAL MEDICINE TRAINING. YOU
HAVE TO BE CERTIFIED IN INTERNAL MEDICINE. THEN YOU GO
THROUGH THREE YEARS OF CARDIOLOGY FELLOWSHIP. AFTER YOU DO
THAT, YOU HAVE TO DO ONE ADDITIONAL YEAR OF INTERVENTIONAL
CARDIOLOGY.
Q THE TYPE OF INTERVENTION THAT YOUR ARE SPEAKING OF
WOULD BE PROCEDURES SUCH AS WHAT?
A ANYTHING AND EVERYTHING TO DO WITH CATHETER-BASED
INTERVENTION, ANYTHING FROM THE CAROTIDS TO THE CORONARY
ARTERIES TO THE LEG, TO THE RENALS. ANYWHERE THE BLOOD FLOWS
WE'RE ABLE TO GO IN WITH CATHETERS AND INTERVENE.
Q HOW LONG HAVE YOU BEEN PRACTICING CARDIOLOGY?
A FOR 10 YEARS.
Q CAN YOU TELL US WHERE YOU WENT TO MEDICAL SCHOOL,
SIR.
A EMORY UNIVERSITY IN ATLANTA.
Q WHERE DID YOU DO YOUR INTERNSHIP AND RESIDENCY?
A HARBOR-UCLA IN TORRANCE.
Q DID YOU DID A FELLOWSHIP?
A YES.
Q WHAT WAS YOUR FELLOWSHIP IN?
A I DID A CRITICAL CARE FELLOWSHIP AT CEDARS-SINAI IN
LOS ANGELES. THEN I FOLLOWED IT WITH A THREE-YEAR FELLOWSHIP
IN CARDIOLOGY ALSO AT CEDARS-SINAI.
Q TAKING A BRIEF LOOK HERE AT YOUR CV, YOU GOT OUT OF
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COLLEGE IN 1980?
A THAT'S CORRECT.
Q AND STUDIED MEDICINE FROM 1980 TO 1994?
A THAT IS CORRECT.
Q 14 YEARS?
A YES.
Q YOU KNOW DOCTOR PREM REDDY?
A YES.
Q WHEN DID YOU FIRST MEET HIM?
A PROBABLY ABOUT 10 YEARS AGO.
Q WHEN YOU CAME TO THE AREA?
A ABOUT SIX MONTHS OR SO AFTER I CAME TO THE AREA.
Q YOU DID NOT KNOW HIM BEFORE THAT?
A NO.
Q WHEN YOU CAME TO THE AREA AND MET DOCTOR REDDY, WHAT
WAS HE DOING HERE?
A AT THAT TIME HE ALREADY HAD BUILT HIS HOSPITAL. HE
WAS PRACTICING CARDIOLOGY.
Q DO YOU HAVE A PROFESSIONAL RELATIONSHIP WITH DOCTOR
REDDY?
A YES.
Q DO YOU HAVE A SOCIAL RELATIONSHIP WITH HIM?
A NO.
Q DO YOU KNOW DOCTOR PANCH JEYAKUMAR?
A YES.
Q DID DOCTOR PANCH JEYAKUMAR EVER WORK FOR YOU, SIR?
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A YES.
Q CAN YOU TELL US WHEN.
A APPROXIMATELY FIVE YEARS AGO WHEN DESERT VALLEY WAS
SOLD TO PHYCOR AT THAT TIME AND HE LEFT THERE AS MEDICAL
DIRECTOR AND JOINED ME FULL-TIME AS A PULMONOLOGIST.
Q HE WORKED AS A PULMONOLOGIST AT THE HEART INSTITUTE?
A YES.
Q HAD YOU KNOWN DOCTOR JEYAKUMAR BEFORE THAT?
A YES.
Q IN WHAT CAPACITY?
A AS THE MEDICAL DIRECTOR OF DESERT VALLEY HOSPITAL.
Q SIR, DO YOU HAVE PRIVILEGES AT DESERT VALLEY
HOSPITAL?
A YES.
Q PRIVILEGES TO DO INTERVENTIONAL CARDIOLOGY IN THEIR
CATH LAB?
A YES.
Q WHEN DID YOU FIRST ACQUIRE PRIVILEGES AT DESERT
VALLEY HOSPITAL?
A TEN YEARS AGO.
Q HAVE THEY EVER BEEN SUSPENDED OR REVOKED?
A NO.
Q HAVE THEY BEEN IN EXISTENCE CONSISTENTLY SINCE THEN?
A YES.
Q WHEN DOCTOR JEYAKUMAR CAME AND WORKED FOR YOU, DID
YOU HIRE SOMEBODY ELSE AT HIS RECOMMENDATION?
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A YES.
Q WHO WAS THAT?
A LISA CROUCH.
Q DID DOCTOR JEYAKUMAR BRING YOU LISA CROUCH AS A
PROSPECTIVE EMPLOYEE?
A AFTER HE CAME AND JOINED ME, ABOUT A MONTH LATER I
NEEDED AN RN, AND HE RECOMMENDED HER AS AN EMPLOYEE; SO I SAID
YES.
Q HOW LONG DID DOCTOR JEYAKUMAR WORK FOR YOU?
A ABOUT 12 MONTHS.
Q DO YOU KNOW WHY HE LEFT AFTER 12 MONTHS?
A PERSONAL REASONS.
Q HOW LONG DID MISS CROUCH WORK FOR YOU?
A ABOUT 10 MONTHS.
Q AFTER DOCTOR JEYAKUMAR LEFT, DID MISS CROUCH LEAVE
YOUR EMPLOYMENT AS WELL?
A THAT'S CORRECT.
Q HAVE YOU EVER BEEN EMPLOYED BY DESERT VALLEY MEDICAL
GROUP?
A NO.
Q YOU DON'T HAVE AN OFFICE IN ANY OF THE DESERT VALLEY
MEDICAL GROUP BUILDINGS?
A I SEE SOME OF THEIR PATIENTS IN THE CARDIOLOGY
DEPARTMENT, BUT I DO NOT HAVE AN OFFICE THERE. MY OFFICE IS
IN THE HEART INSTITUTE.
Q YOU HAVE NEVER HELD CLINICAL HOURS THERE ON A
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REGULAR BASIS?
A OFF AND ON I HAVE DONE SO OVER THE LAST 10 YEARS.
WHENEVER THEY HAVE NEEDED HELP I HAVE PROVIDED THEM HELP.
Q WHEN HAVE YOU BEEN ASKED TO HELP OUT AT DESERT
VALLEY?
A SIX SEPARATE OCCASIONS.
Q OVER WHAT YEARS AND FOR HOW LONG?
A IN 1995 THEY ASKED ME TO HELP BECAUSE ONE OF THEIR
CARDIOLOGISTS LEFT. THEY WERE SHORTHANDED, AND I HELPED THEM
FOR ABOUT SIX MONTHS. THEN I THINK IN 1998 FOR ABOUT SIX
MONTHS AGAIN. THEN IN 2000 AND 2001. I'M NOT VERY FAMILIAR
WITH THE DATES.
ABOUT FOUR OR FIVE TIMES THE CARDIOLOGISTS WERE IN
TRANSITION OR LEAVING THE AREA SO THEY NEEDED HELP, AND I WAS
ABLE TO PROVIDE THEM WITH HELP.
Q WHEN YOU WERE CALLED TO HELP, WHO WAS IT THAT
TYPICALLY CALLED YOU?
A DOCTOR JEYAKUMAR.
Q WHEN YOU HELPED OUT IF THERE WAS A SHORTAGE OF
CARDIOLOGISTS, WHAT DID YOU DO FOR THE GROUP OR THE HOSPITAL?
A ESSENTIALLY CONSULTATIONS IN THE HOSPITAL, EMERGENCY
ROOM COVERAGE FOR CARDIOLOGY AND ALSO IN THE CLINIC.
Q WHEN IS THE LAST TIME THAT YOU FILLED IN, SO TO
SPEAK, AT DESERT VALLEY MEDICAL GROUP AND HOSPITAL AS A
CARDIOLOGIST?
A I'M FILLING IN RIGHT NOW.
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Q BUT YOU HAVE NEVER BEEN EMPLOYED BY THE GROUP?
A I HAVE NOT BEEN EMPLOYED BY THE GROUP. I HAVE A
CONTRACT WITH THEM IN TERMS OF PROVIDING SERVICES, BUT I'M NOT
UNDER THEIR EMPLOYMENT.
Q DID YOU KNOW LISA CROUCH WHEN SHE WAS THE DIRECTOR
OF THE EMERGENCY ROOM AT DESERT VALLEY HOSPITAL?
A YES.
Q DID YOU EVER HAVE AN ISSUE WITH MISS CROUCH WHEN SHE
WAS THE DIRECTOR OF THE EMERGENCY ROOM REGARDING A PATIENT?
A A RUN-IN YOU MEAN?
Q SO TO SPEAK.
A YES.
Q COULD YOU TELL US ABOUT THAT.
A THIS WAS LIKE ON A WEDNESDAY. I GOT A CALL FROM THE
EMERGENCY ROOM AT DESERT VALLEY HOSPITAL, AND WAS WAS LISA ON
THE OTHER LINE STATING THAT A PATIENT OF MINE FROM BARSTOW WAS
SENT BY ME BY PRIVATE CAR, AND THE PATIENT ARRIVED ALMOST IN
DIRE STRAITS IN THE EMERGENCY ROOM. SHE STATED THE PATIENT'S
NAME. I SAID, "THIS DOESN'T SOUND LIKE MY PATIENT. THIS
DOESN'T SOUND LIKE SOMETHING THAT I WOULD DO." AND I SAID,
"LET ME CHECK ON THIS."
I CALLED HER BACK ABOUT 10 MINUTES LATER BECAUSE THE
PATIENT WAS NOT IN MY COMPUTER, AND I SAID, "THIS PATIENT DOES
NOT BELONG TO ME. WHAT IS THE SITUATION WITH THE PATIENT?"
SHE TOLD ME THE PATIENT'S HEMOGLOBIN WAS SIX, WHICH
MEANS THE PATIENT WAS BLEEDING INTERNALLY, AND THE PATIENT WAS
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HYPOTENSIVE. THAT MEANS THEIR BLOOD PRESSURE WAS VERY LOW.
SHE WAS IN THE EMERGENCY ROOM IN FRONT OF ALL THE
PEOPLE IN THE EMERGENCY ROOM ESSENTIALLY BERATING ME FOR THE
CARE I WAS GIVING THE PATIENT. "HOW DARE YOU SEND THIS
PATIENT TO THE EMERGENCY ROOM WHEN THE PATIENT WAS CRITICALLY
ILL?"
I STOPPED HER RIGHT THERE, AND I SAID, "THIS IS NOT
MY PATIENT. YOU HAVE DONE GRANDSTANDING HERE. YOU KNOW THAT
THERE IS ANOTHER DOCTOR SIVA IN THE HIGH DESERT THAT BELONGS
TO DESERT VALLEY. ASK THE PATIENT WHETHER THE PATIENT BELONGS
TO THAT PHYSICIAN OR ME."
AND SHE CAME BACK AND SAID, "YES, THE PATIENT
BELONGS TO THE OTHER PHYSICIAN."
SO I SAID, "BEFORE YOU JUMP TO CONCLUSIONS AND
ACCUSE ME AND RUIN MY REPUTATION, YOU HAVE GOT TO CHECK YOUR
FACTS." AND I HUNG UP ON HER, AND I WROTE A MEMO TO DOCTOR
JEYAKUMAR AT THAT TIME TELLING HIM THAT ANOTHER PHYSICIAN WAS
USING MY NAME SIVA JUST LIKE I HAVE BEEN USING HERE FOR THE
LAST 10 YEARS, AND THAT'S CAUSING A LOT OF CONFLICT IN TERMS
OF PATIENT CARE ISSUES. PATIENTS ARE GETTING CONFUSED, AND
THESE KIND OF ISSUES IS RUINING MY REPUTATION AND WILL NOT BE
TOLERATED. IT WENT UNHEEDED.
Q DID YOU TELL DOCTOR JEYAKUMAR IN THE LETTER THAT YOU
WROTE HIM THE ISSUE THAT YOU HAD WITH MISS CROUCH ON THE
PHONE?
A YES.
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Q DID DOCTOR JEYAKUMAR EVER CALL YOU BACK AND DISCUSS
THIS WITH YOU?
A NO.
Q YOU KNOW DOCTOR AHMED?
A YES.
Q YOU KNOW DOCTOR RAZA?
A YES.
Q IN WHAT CAPACITY DO YOU KNOW THOSE GENTLEMEN?
A AS CARDIOLOGISTS IN THE HIGH DESERT.
Q HAVE YOU WORKED WITH DOCTOR AHMED BEFORE?
A YES.
Q WHAT IS YOUR IMPRESSION OF DOCTOR AHMED AS A
CARDIOLOGIST?
A IF I HAVE NOTHING GOOD TO SAY ABOUT SOMEBODY, I'D
RATHER NOT SAY. BUT IF YOU INSIST, I WILL.
Q DID YOU KNOW DOCTOR AHMED WHEN HE WAS WORKING AT
DESERT VALLEY HOSPITAL?
A YES.
Q HAVE YOU WORKED WITH HIM DIRECTLY?
A YES, I HAVE.
Q I DO WANT TO HEAR WHAT YOU HAVE TO SAY.
A DOCTOR AHMED IS LAZY, AND BECAUSE OF HIS LAZINESS,
HE'S DANGEROUS TO PATIENTS. THAT HAS BEEN BROUGHT UP ON MANY
ISSUES. AND I HAVE HAD PATIENT CARE ISSUE AFTER PATIENT CARE
ISSUE. AND IT COMES THROUGH NOT RESPONDING TO CALLS WHEN
PATIENTS ARE IN DIRE STRAITS, AND, THEREFORE, PATIENTS HAVE
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BAD OUTCOMES BECAUSE OF THOSE ISSUES.
Q THERE'S SOME EVIDENCE IN THIS CASE THAT DOCTOR AHMED
DID NOT RESPOND TO PAGES FOR PATIENTS IN THE ER AT LATE HOURS.
DO YOU HAVE ANY PERSONAL EXPERIENCE WITH HIM IN THAT REGARD?
A ABSOLUTELY.
Q WHAT IS THAT EXPERIENCE?
A THIS WAS ON A SATURDAY ABOUT SIX MONTHS AGO.
PATIENT WAS CAPTAIN OF THE POLICE DEPARTMENT IN BARSTOW. IT
WAS HIS PATIENT. PATIENT CAME IN ACUTE M.I. HE COULD NOT BE
REACHED, REFUSED TO COME TO EMERGENCY ROOM, AND PATIENT
ARRESTED ON TWO SEPARATE OCCASIONS.
Q CARDIAC ARREST?
A YES.
I HAPPENED TO BE BY THE EMERGENCY ROOM. THE
PHYSICIANS IN THE EMERGENCY ROOM REQUESTED WHETHER I CAN DO
SOMETHING ABOUT IT OR NOT. AND I HAD TO TAKE THE PATIENT TO
THE CATH LAB AND PERFORM AN INTERVENTION.
Q DID YOU FILL IN AT DESERT VALLEY HOSPITAL AFTER
DOCTOR AHMED LEFT AS A CARDIOLOGIST?
A I DID NOT FILL IN AFTER DOCTOR AHMED LEFT AS
CARDIOLOGIST. I FILLED IN AFTER DOCTOR RAZA LEFT AS
CARDIOLOGIST.
Q DO YOU HAVE PERSONAL EXPERIENCING IN WORKING WITH
DOCTOR RAZA?
A YES.
Q WHAT'S YOUR EXPERIENCE WITH WORKING WITH DOCTOR
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RAZA?
A SIMILAR TYPE OF EXPERIENCE THAT I HAVE WORKED WITH
DOCTOR AHMED.
Q DOCTOR RAZA TESTIFIED IN THIS COURT THAT HE BELIEVES
THAT DOCTOR REDDY'S CARDIOLOGY SKILLS ARE LACKING, THEY'RE
OLD. DO YOU KNOW DOCTOR REDDY AS A PRACTICING CARDIOLOGIST?
A YES, I DO.
Q BEFORE I ASK YOU ABOUT DOCTOR REDDY'S SKILLS, TELL
ME ABOUT DOCTOR RAZA'S CARDIOLOGY SKILLS.
A AS A CARDIOLOGIST, WE'RE LIKE SURGEONS. WE ALL HAVE
TREMENDOUS AMOUNT OF EGO. I HAVE LOTS OF EGO. I TAKE PRIDE
IN WHAT I DO. IF YOU DON'T HAVE THAT KIND OF PRIDE IN THE
WORK THAT YOU DO, THEN YOU'RE NOT VERY GOOD BECAUSE YOU HAVE
TO TAKE PRIDE. I PRIDE MYSELF IN WHAT I KNOW. IF I DO NOT
KNOW SOMETHING, I'LL ALWAYS SEEK HELP. I'LL GIVE YOU AN
EXAMPLE.
PATIENT OF MINE WITH SEVERE HEART FAILURE COMES TO
ME AND NEEDS HELP. HE HAS GONE TO SEVERAL OTHER
CARDIOLOGISTS. WE PUT HIM ON A THERAPY OF TREATMENT CALLED
NATRECOR INFUSION. IT'S A DRUG THAT HAS BEEN APPROVED BY THE
FDA FOR THE LAST THREE YEARS. SO WE HAVE IMPLEMENTED A
PROGRAM OF PATIENTS WHO ARE IN SEVERE HEART FAILURE WHO HAVE
TAKEN ALL OTHER THERAPY. THEY'RE NOT A CANDIDATE FOR
TRANSPLANT BECAUSE THEY'RE OVER 80 YEARS OLD. THEN WE PUT
THEM ON THIS THERAPY TO HELP THEIR QUALITY OF LIFE.
THIS PATIENT BEFORE SUBMITTING TO THE THERAPY WANTED
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TO GET A SECOND OPINION; SO HE GOES TO DOCTOR RAZA. HE TELLS
THIS PATIENT THAT I'M EXPERIMENTING ON HIM. THE PATIENT COMES
BACK AND TELLS ME, "YOU ARE TRYING TO EXPERIMENT ON ME."
AND I LOOKED AT HIM AND SAID, "SIR, HERE'S THE PDR.
HERE'S THE DRUG THAT I'M GOING TO USE ON YOU. IF THE PDR HAS
IT, THE FDA HAS APPROVED THIS DRUG."
Q PDR MEANING PHYSICIANS' DESK REFERENCE?
A THAT'S CORRECT.
Q A LARGE BOOK WITH LOTS OF DRUGS IN IT?
A THAT'S CORRECT.
THAT DRUG IS IN THE PDR, WHICH MEANS IT'S ALREADY
BEEN AVAILABLE FOR AT LEAST 12 MONTHS IF NOT LONGER BEFORE IT
MAKES IT INTO THE BOOK. THIS DRUG HAS BEEN APPROVED FOR THREE
YEARS FOR THAT PURPOSE.
I SENT THE DRUG REP TO DOCTOR RAZA'S OFFICE TO
EDUCATE HIM AND ESSENTIALLY TOLD HIM THAT AT TIMES IT'S BETTER
TO KEEP ONE'S MOUTH SHUT AND LET PEOPLE WONDER IF YOU'RE A
FOOL RATHER THAN TO OPEN IT AND REMOVE ALL DOUBTS. THIS IS
WHAT I SAID. IT WAS RELATED TO HIM IN SO MANY WORDS. SO
BEFORE HE STARTS POINTING FINGERS AT OTHER PEOPLE'S CLINICAL
SKILLS, HE NEEDS TO OWN UP ON HIS OWN SKILLS.
I HAVE NO LOVE LOST WITH DOCTOR RAZA. HE'S ACCUSED
ME OF STEALING PATIENTS, AND I HAVE TOLD HIM MANY TIMES
"PATIENTS LEAVE YOU TO COME AND SEE ME BECAUSE YOU DON'T
PROVIDE THE RIGHT CARE. YOU HAVE TO BE AVAILABLE FOR PATIENTS
WHEN THEY NEED YOU, NOT WHEN IT'S CONVENIENT FOR YOU."
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SO WE HAVE NEVER SEEN EYE TO EYE.
Q WHAT DO YOU KNOW OF DOCTOR REDDY'S CARDIOLOGY
SKILLS?
A I HAVE OBSERVED HIS CLINICAL SKILLS IN TERMS OF
TAKING CARE OF PATIENTS. I HAVE DISCUSSED CASES WITH HIM.
OTHER THAN MYSELF, WHICH I PRIDE MYSELF -- I'M NOT POMPOUS. I
PRIDE MYSELF IN TERMS OF MY CLINICAL SKILLS, WHICH HAVE GROWN
WELL IN THIS COMMUNITY. I THINK DOCTOR REDDY'S THE ONLY OTHER
CARDIOLOGIST I'LL TRUST IN THIS COMMUNITY. I HAVE NO DOUBTS
IF I'M SICK OR IF ONE OF MY FAMILY MEMBERS IS SICK, I'LL
READILY SEND MY PATIENTS TO HIM.
Q HAS YOUR RELATIONSHIP WITH DOCTOR REDDY ALWAYS BEEN
SMOOTH?
A ABSOLUTELY NOT.
Q CALL ME CRAZY, BUT I'M THINKING YOUR EGOS HAVE
CLASHED BEFORE.
A MANY TIMES.
Q OVER WHAT TYPES OF THINGS?
A MANY THINGS. PATIENT CARE, ISSUES IN TERMS OF
SOMETIMES MY PATIENTS ARE NOT CALLED WHEN THEY COME TO THE
EMERGENCY ROOM. THOSE KINDS OF ISSUES THAT I CLASHED WITH
HIM.
IN TERMS OF ISSUES WITH DOCTOR RAZA, I HAVE CLASHED
WITH HIM. IN TERMS OF DOCTOR AHMED, I HAVE CLASHED WITH HIM.
AND IN TERMS OF HIS MEDICAL DIRECTOR WHO WAS HERE TESTIFYING,
I HAVE CLASHED WITH HIM MANY, MANY TIMES.
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Q DOCTOR THACKER?
A THAT'S CORRECT.
Q WE ACTUALLY SAW A THREE-PAGE LETTER THAT DOCTOR
THACKER WROTE TO YOU CRITICIZING YOUR CARE OF A PATIENT.
A THAT'S BECAUSE I WROTE TO THEM IN A NASTY MANNER OF
THE CARE THAT WAS DELIVERED TO ONE OF MY PATIENTS AT DESERT
VALLEY HOSPITAL.
Q DOCTOR THACKER, AS THE MEDICAL DIRECTOR, HAS THE
RIGHT TO REVOKE THE PRIVILIGES OF DOCTORS AT DESERT VALLEY
HOSPITAL?
A THAT IS CORRECT.
Q WERE YOUR PRIVILEGES EVER REVOKED BECAUSE OF THAT
LETTER OR ANY INVESTIGATION?
A NO.
Q NOW, YOU HAVE CLASHED WITH DOCTOR REDDY BEFORE.
HAVE YOU ARGUED WITH HIM?
A NO.
Q JUST MEDICAL JUDGMENT CLASHING?
A YES, YOU CAN CALL IT THAT. I HAVE NEVER HAD AN
ARGUMENT WITH HIM. I NEVER HAD WORDS WITH HIM. THROUGH THIRD
PARTIES I HAVE EXPRESSED MY OPINIONS.
Q SIR, ARE YOU IN THE PROCESS OF ATTEMPTING TO BUILD A
HOSPITAL IN THE AREA?
A NOT ATTEMPTING. I'M GOING TO BUILD A HOSPITAL IN
THE AREA.
Q WHERE?
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A IT'S GOING TO BE IN APPLE VALLEY AT THE CORNER OF
APPLE VALLEY AND BEAR VALLEY ROAD WHERE THE LOWE'S IS BEING
BUILT RIGHT NOW. IT'S NEXT DOOR TO IT.
Q WHY ARE YOU BUILDING A HOSPITAL?
A THERE'S A TREMENDOUS SHORTAGE OF BEDS. THERE'S
APPROXIMATELY A 400 BED SHORTAGE AT THIS POINT. WHENEVER I
NEED TO GET CERTAIN THINGS DONE, PATIENTS ARE NOT ABLE TO GET
THOSE SERVICES BECAUSE THERE'S A SHORTAGE OF BEDS. THAT'S THE
REASON WHY.
Q YOU HAVE HAD PRIVILEGES BEFORE AT SAINT MARY'S
HOSPITAL?
A THAT'S CORRECT.
Q HAVE YOU HAD ISSUES WITH SAINT MARY'S HOSPITAL AS A
RESULT OF YOUR BUILDING A HOSPITAL?
A THIS GOES BACK THREE YEARS AGO WHEN I WENT TO SAINT
MARY'S AND SAID, "LET'S DO A JOINT PROJECT." SAINT MARY'S
HIRED ME AND BROUGHT ME TO THE HIGH DESERT. SISTER DIANE
ASKED ME TO COME UP HERE. I'M VERY PARTIAL TO SAINT MARY'S.
WITHOUT THEM I WOULDN'T BE HERE, AND WITHOUT THEM I WOULDN'T
BE AS SUCCESSFUL AS I AM TODAY; SO I OWE A LOT TO THEM.
THREE YEARS AGO I WENT TO THEM AND SAID, "THERE'S A
SHORTAGE OF A LOT OF SERVICES THAT WE NEED IN THE AREA THAT WE
DON'T HAVE. LET'S DO A JOINT PROJECT. I HAVE THE FUNDING.
THE BANKERS IN THE COMMUNITY WILL BE ABLE TO FUND THIS. THEY
HAVE ALREADY PROMISED ME THE FUNDING. ALL I NEED IS A BIG
BROTHER TO KIND OF HELP ME ALONG."
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THEY SAID THEY WOULD, AND BEHIND MY BACK THEY WENT
AND TOLD ALL THE FINANCIAL SUPPORTERS NOT TO SUPPORT ME. WHEN
THAT HAPPENED, I WENT BACK TO THEM AND SAID, "YOU DON'T NEED
TO SUPPORT ME. I'LL DO IT ON MY OWN."
WHEN THAT HAPPENED, THE PREVIOUS CEO THREATENED ME.
HE ESSENTIALLY THREATENED TO REVOKE MY PRIVILEGES IN THE
HOSPITAL. AND IT SO HAPPENS THAT WE'LL TAKE LEGAL ACTION
AGAINST THEM.
Q DOES DOCTOR REDDY KNOW YOU'RE BUILDING A HOSPITAL?
A YES.
Q HAS DOCTOR REDDY HAD CONVERSATIONS WITH YOU ABOUT
THE FACT YOU'RE GOING TO BE A DIRECT COMPETITOR WITH HIM?
A HE SAID, "I CANNOT BE HYPOCRITICAL. SINCE I BUILT A
HOSPITAL, IF SOMEBODY ELSE WANTS TO BUILD A HOSPITAL, I CAN'T
STAND IN THEIR WAY."
Q HAS HE EVER TOLD YOU THAT HE WILL REVOKE YOUR
PRIVILEGES FOR BUILDING A HOSPITAL?
A AS A MATTER OF FACT, HE'S MADE ME THE MEDICAL
DIRECTOR AND THE DIRECTOR OF HIS CATH LAB.
Q DOCTOR SIVA, DO YOU RECALL MEETING WITH ME THE OTHER
NIGHT AND GOING OVER THIS PARTICULAR CHART, SIR?
A BRIEFLY, YES.
Q WE HAVE BEEN REFERRING TO THAT PATIENT IN THIS
COURTROOM AS PATIENT B. IT IS A KAISER PATIENT THAT CAME IN
WITH CHEST PAIN; IS THAT RIGHT?
A THAT IS CORRECT.
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Q HAVE YOU REVIEWED THAT CHART?
A YES.
Q WHAT IS THE DIAGNOSIS WRITTEN ON THE CHART BY DOCTOR
REDDY ON THE FACE SHEET?
A SYNCOPE, BRADYCARDIA, HYPOTENSION.
Q THERE'S A PAGE THERE, SIR, THAT SAYS "DIAGNOSTIC
IMPRESSION"?
A YES.
Q WHAT IS WRITTEN THERE?
A "STATUS POSTCARDIAC ARREST, SUDDEN DEATH."
Q ARE YOU FAMILIAR WITH THAT DIAGNOSIS?
A YES.
Q WHAT IS THAT DIAGNOSIS?
A WHEN A PATIENT'S HEART RATE STOPS, THE PATIENT DOES
NOT HAVE ANY BLOOD PRESSURE AND IS NOT RELATED TO LUNG
PROBLEMS OR SEPSIS, AND IT PRIMARILY HAS TO DO WITH CARDIAC
ARRYTHMIA, AND THE PATIENT'S BLOOD PRESSURE DROPS. YOU CAN
CALL IT SUDDEN CARDIAC DEATH.
Q IS THERE ANYTHING IN THAT CHART THAT LED YOU TO
BELIEVE THAT DOCTOR REDDY'S WRITTEN DIAGNOSIS COULD BE
JUSTIFIED?
A YOU CAN CALL IT ANYTHING YOU WANT. LOOKING THROUGH
THE CHART, THERE WERE SEVERAL THINGS HAPPENING TO THE PATIENT.
PATIENT HAD CHEST PAIN; THEREFORE, YOU CAN CALL CHEST PAIN
ACUTE CORONARY SYNDROME. YOU CAN CALL IT UNSTABLE ANGINA.
YOU CAN CALL IT HEART ATTACK. YOU CAN CALL IT WHATEVER I
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WANT. YOU CAN CALL IT PULMONARY EMBOLISM. ALL THIS FITS THE
DIAGNOSIS OF CHEST PAIN. AND WHEN A PATIENT'S HEART RATE
STOPS, WHICH IS SYNCOPE, YOU CAN CALL IT BRADYCARDIA.
VENTRICULAR FIBRILLATION. YOU CALL IT WHATEVER YOU WANT. THE
WORKUP IS STILL GOING TO BE THE SAME NO MATTER WHAT THE
DIAGNOSIS IS.
WE OFTEN ADMIT PATIENTS WITH CHEST PAINS, BUT WE
WORK UP THE PATIENT IN A WISE MANNER. IT DOES NOT MATTER WHAT
THE DIAGNOSIS IS. WHAT MATTERS IS WHETHER THE PATIENT WAS
APPROPRIATELY TREATED. THE PATIENT NEEDED TO BE ADMITTED AND
NEEDED TO HAVE CARDIAC WORKUP.
Q DO YOU TAKE ISSUE WITH DOCTOR REDDY'S DIAGNOSIS?
A NO.
Q WE HAVE HEARD SOME TESTIMONY TO THE EFFECT OF THAT
WOULD JUST BE A TERRIBLE DIAGNOSIS TO GIVE A PATIENT BECAUSE
IT WOULD AFFECT THEIR LIFE IN TERMS OF LIFE INSURANCE AND
THEIR DRIVER'S LICENSE. WHAT ARE YOUR THOUGHTS ON IF A
PATIENT HAD SYNCOPE HOW IT WILL AFFECT THAT?
A IF A PATIENT COMES IN WITH SYNCOPE, I'LL NOT ALLOW
HIM TO DRIVE. HIS DRIVER'S LICENSE HAS TO BE REVOKED UNTIL WE
CAN DETERMINE WHAT IT IS.
IF A PATIENT HAS CHEST PAIN AND VENTRICULAR
FIBRILLATION OR BRADYCARDIA, SLOW HEART RATE, THE PATIENT HAS
TO BE WORKED UP. THIS IS GOING TO AFFECT PATIENT'S LIFE
INSURANCE. MITRAL VALVE PROLAPSE, WHICH IS MOST BENIGN OF
CARDIAC CONDITIONS, IS A DIAGNOSIS THAT NO INSURANCE COMPANY
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WILL INSURE THE PATIENT.
Q THIS PATIENT WAS ADMITTED INITIALLY TO TELEMETRY AND
MY UNDERSTANDING WAS TRANSFERRED LATER TO ICU. BASED ON THE
WORK UP THAT YOU SEE IN THE ER AND THE FINDINGS IN THE ER, WAS
ADMITTING THIS PATIENT TO TELEMETRY WITHIN THE STANDARD OF
CARE OF CARDIOLOGY?
A ABSOLUTELY.
Q WE HAVE HEARD THAT THERE'S NO WAY THIS PATIENT
SHOULD HAVE GONE TO TELEMETRY. THIS PATIENT HAD TO GO TO ICU.
WE HAVE HEARD THAT FROM NURSES. LET ME HAVE YOUR THOUGHTS ON
THAT.
A IT'S MY CALL. IT'S MY CLINICAL JUDGMENT. I'M THE
ONE WHO'S MAKING THE DECISION WHETHER THE PATIENT GETS
ADMITTED OR NOT. I'M THE ONE WHO WILL DECIDE WHAT PROCEDURE
NEEDS TO BE DONE. I'M THE ONE ASSESSING THE PATIENT. SO
WHERE I PUT THE PATIENT IS MY CALL AND NOBODY ELSE'S BUSINESS.
Q WAS DOCTOR REDDY WRONG TO ADMIT THIS PATIENT, IN
YOUR OPINION, TO TELEMETRY?
A ABSOLUTELY NOT.
Q COULD THIS PATIENT ON THE DAY OF THE ER VISIT HAVE
TRAVELED BY AMBULANCE DOWN THE HILL TO KAISER HOSPITAL? WAS
HE ABLE TO DO THAT?
A NO.
Q WHY NOT?
A ANY PATIENT WHO COMES IN WITH CHEST PAIN ON TOP OF
THAT HAS SYNCOPE, I WON'T PUT MY REPUTATION ON THE LINE JUST
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BECAUSE SOME INSURANCE COMPANY WANTS ME TO TRANSFER THE
PATIENT. I'M THE PHYSICIAN WHO'S TRANSFERRING THE PATIENT. I
ULTIMATELY AM RESPONSIBLE FOR THE PATIENT.
WHAT IS THE DOWNSIDE OF KEEPING THE PATIENT FOR 24
TO 48 HOURS IN THE HOSPITAL MAKING SURE NO ADVERSE EVENT
DOESN'T TAKE PLACE? I DON'T SEE ANY DOWNSIDE TO THAT. I SEE
A LOT OF DOWNSIDE TO TRANSFERRING THE PATIENT TO A FACILITY
WHICH IS FONTANA WHICH DOES NOT PROVIDE ALL THE SERVICES THAT
THAT PATIENT MAY END UP REQUIRING ANYWAY.
Q WHAT ABOUT THE FACT THAT THE EMERGENCY ROOM
PHYSICIAN DOCTOR WAS READY TO DISCHARGE THE PATIENT AND THEN
DOCTOR REDDY INTERVENED?
A I WOULD NOT HAVE DISCHARGED THE PATIENT.
THE NUMBER ONE ADMITTING DIAGNOSIS IN THIS COUNTRY
FROM THE EMERGENCY ROOM IS CHEST PAIN. 24 PERCENT OF ALL
ADMISSIONS FROM THE EMERGENCY ROOM TO THE HOSPITAL IS FOR A
DIAGNOSIS OF CHEST PAIN. 12 PERCENT OF ALL ER PHYSICIAN
MALPRACTICE CLAIMS ARE FOR THE MISDIAGNOSIS OF CHEST PAIN.
I DON'T WANT TO TAKE THE RISK OF TRANSFERRING THE
PATIENT OR DISCHARGING THE PATIENT WITHOUT KNOWING ANYTHING
ABOUT THE PATIENT BEFORE HIS PRESENTATION TO THE EMERGENCY
ROOM. IF IT IS MY PATIENT, I KNOW THIS PATIENT. I HAVE TAKEN
CARE OF THIS PATIENT. I HAVE DEFINED THIS PATIENT'S ANATOMY.
THEN I WOULD SAY WHETHER TO ADMIT THE PATIENT OR NOT. IF I DO
NOT KNOW THE PATIENT, I RATHER ERR ON THE SIDE OF CAUTION.
Q BETWEEN 2001 AND 2003, YOU HAD PRIVILEGES AT DESERT
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VALLEY HOSPITAL?
A YES.
Q DID YOU HAVE INTERACTIONS WITH DOCTOR REDDY?
A VERY LITTLE.
Q DURING THE TIME THAT YOU FILLED IN AS A CARDIOLOGIST
WORKING UP PATIENTS IN THE CLINIC, DID DOCTOR REDDY EVER ASK
YOU TO PERFORM WHAT YOU BELIEVED TO BE MEDICALLY UNNECESSARY
TESTS ON PATIENTS?
A NEVER.
Q WHAT ABOUT CARDIOLOGY CONSULTS ON PATIENTS THAT
APPARENTLY ENDED UP NOT NEEDING IT AT ALL?
A NEVER.
Q HAS HE EVER INFLUENCED YOUR DECISION ON HOW TO TREAT
ANY PATIENTS THAT YOU HAVE LAID YOUR HANDS ON?
A ABSOLUTELY NOT.
Q YOU HAVE KNOWN DOCTOR REDDY TO SPEAK ABOUT INSURANCE
OR REIMBURSEMENT?
A YES.
Q DO YOU SEE A PROBLEM WITH THAT?
A NO. I NEED TO BE EDUCATED ON WHAT I CAN AND CAN'T
DO, WHAT THE INSURANCE WILL PAY AND WILL NOT PAY.
WE HAVE TO UNDERSTAND THE ECONOMICS OF THIS
PROFESSION. TO PROVIDE THE BEST CARE FOR THE PATIENTS, WE
HAVE TO UNDERSTAND HOW THE SYSTEM WORKS. IF THE PATIENT'S A
MANAGED CARE PATIENT, WE NEED TO KNOW HOW TO USE THE SYSTEM SO
THE PATIENT BENEFITS. IF I DO NOT AND I DO A PROCEDURE
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WITHOUT GETTING AUTHORIZATION ON A PATIENT, THE PATIENT WILL
END UP WITH THE BILL.
Q I WANT TO TALK TO YOU ABOUT SEEING A PATIENT IN THE
ER, DECIDING TO ADMIT THE PATIENT, AND AT THE TIME OF
ADMISSION ORDERING A STRESS TEST AND AN ANGIOGRAM. FIRST OF
ALL, HAVE YOU EVER SEEN THAT DONE?
A A LOT.
Q WHY?
A FOR SCHEDULING PURPOSES. THE CATH LAB NEEDS TO KNOW
THAT THERE'S A PROCEDURE COMING UP BECAUSE NURSES ARE ON CALL
AND ARE GOING TO COME IN. THE CATH LAB ALWAYS GETS FILLED UP;
SO IF YOU DO NOT SCHEDULE A CASE AND SOMEBODY ELSE TAKES THE
SLOT, THEN THERE ARE TWO, THREE DAYS THAT MAY GO BY BEFORE A
PATIENT CAN BE SCHEDULED FOR A PROCEDURE.
OUR CATH LAB IS OFTEN FILLED; SO I MAY SCHEDULE BOTH
CASES AT THE SAME TIME. WE'LL WAIT FOR THE RESULTS OF THE
TREADMILL TEST BEFORE PROCEEDING WITH THE ANGIOGRAM.
Q YOU HAVE DONE IT THAT WAY?
A ABSOLUTELY.
Q WHAT HAPPENS IF YOU DO THE STRESS TEST AND YOU
DETERMINE THE PATIENT DOES NOT NEED THE ANGIOGRAM?
A YOU CANCEL THE ANGIOGRAM.
Q A PRIOR CARDIOLOGIST CAME IN HERE BEFORE TODAY TO
TESTIFY THAT THE ONLY REASON THEY CAN THINK OF FOR ORDERING
BOTH TESTS AT THE SAME TIME WOULD BE FOR FINANCIAL GAIN.
A THAT CARDIOLOGIST HAS NOT BEEN PRACTICING
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CARDIOLOGY, DOES NOT HAVE A BUSY PRACTICE. I HAVE A VERY BUSY
PRACTICE. I HAVE TO UTILIZE MY TIME THE BEST POSSIBLE WAY. I
NEED TO KNOW WHAT MY OFFICE SCHEDULE IS GOING TO BE LIKE. I
NEED TO PREPARE MYSELF FOR IT. THEREFORE, I WILL SCHEDULE
THOSE CASES, AND THEN MY OFFICE IS AWARE OF WHAT'S HAPPENING.
IT ONLY MAKES SENSE. SINCE PATIENTS ARE NOT KEPT THREE, FOUR
DAYS TO GET PROCEDURE DONE, THEY GET EVERYTHING DONE IN AN
ORDERLY MANNER SO THEY ARE DISCHARGED PROMPTLY. I DON'T SEE
ANY PROBLEMS. I DO THIS ALL THE TIME.
MS. TROPP: THANK YOU, DOCTOR SIVA. THAT'S ALL I
HAVE AT THIS TIME.
THE COURT: THANK YOU.
CROSS-EXAMINATION.
CROSS-EXAMINATION
BY MR. NOLAN:
Q DOCTOR SIVA, THERE'S BEEN TESTIMONY IN THIS CASE
THAT DOCTOR REDDY ORDERED CARDIOLOGISTS TO DO THE STRESS AND
THE ANGIOGRAM -- "DO THEM BOTH AND SEE THE WHAT RESULTS ARE.
DO THEM BOTH."
THE CARDIOLOGIST TESTIFIED THAT THIS WAS DONE FOR
FINANCIAL REASONS. AND YOU SAID THAT THAT CARDIOLOGIST HASN'T
BEEN PRACTICING VERY LONG. IT MAY BE TRUE THAT THAT
CARDIOLOGIST KNOWS DOCTOR REDDY QUITE WELL POSSIBLY?
A YOU ARE ASKING ME FOR AN OPINION THAT I HAVE NO
OPINION ABOUT.
Q WE'LL LEAVE IT AT THAT.
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DID I HEAR YOU SAY THAT YOU TOLD SAINT MARY'S THAT
YOU WOULD TAKE LEGAL ACTION AGAINST THEM?
A YES.
Q DID I ALSO HEAR YOU SAY THAT PREM REDDY IS THE ONLY
CARDIOLOGIST THAT YOU TRUST?
A IN THE HIGH DESERT.
Q HAS ANYONE TOLD YOU THAT YOU AND DOCTOR REDDY ARE A
LOT A LIKE?
A I HAVE NOT HEARD ANYBODY SAY THAT TO ME.
Q I'M THE FIRST?
A YOU MAY BE THE FIRST. ARE YOU SAYING THAT TO ME
NOW?
Q YES, SIR.
A THEN YOU ARE THE FIRST.
Q YOUR PRIVILEGES WERE REVOKED AT SAINT MARY'S, AND
YOU BELIEVE IT'S BECAUSE OF SOME DISPUTE?
A NO, I DON'T BELIEVE. I DON'T BELIEVE ANYTHING. I
DON'T SECOND-GUESS. I DON'T GUESS. IF YOU WANT PROOF, I'LL
SHOW YOU PROOF. IT'S A FACT.
Q I'M JUST ASKING YOU A QUESTION. I THINK YOU JUST
ANSWERED IT.
A THANK YOU.
Q YOU DON'T BELIEVE THAT YOUR PRIVILEGES WERE REVOKED
BECAUSE YOU WERE ORDERING UNNECESSARY PROCEDURES?
A SIR, IF THAT IS THE CASE, WE'LL FIND OUT IN A COURT
OF LAW.
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Q I DON'T HAVE THE TIME TO WAIT FOR THAT, SIR. I'LL
JUST ASK YOU A FEW QUESTIONS TODAY. WHAT YOU DO IN A COURT OF
LAW IS BETWEEN YOU AND WHOEVER.
A THAT IS CORRECT.
Q YOU DON'T BELIEVE YOUR PRIVILEGES WERE REVOKED AT
SAINT MARY'S BECAUSE YOU HAD ENGAGED IN UNSAFE PRACTICES
REGARDING PATIENTS?
A ABSOLUTELY NOT.
Q DOCTOR SIVA, YOU ARE NOT ALLOWED TO ADMIT PATIENTS
AT BARSTOW COMMUNITY HOSPITAL; ISN'T THAT TRUE?
A THAT IS NOT TRUE.
Q YOU ONLY HAVE THE RIGHT TO CONSULT BUT NOT TO ADMIT
AT BARSTOW?
A THAT IS NOT TRUE.
Q YOU DON'T KNOW WHY BARSTOW WOULD BE SAYING THAT THAT
IS TRUE?
A THE SAME THING THAT SAINT MARY'S IS DOING. THEY TOO
HAVE GONE ON AN EXPEDITION TO SUSPEND ME BECAUSE OF MY
BUILDING THE HOSPITAL.
Q EVERYBODY'S AFTER YOU? IS THAT WHAT YOU'RE TELLING
US?
A NO.
Q BARSTOW AND SAINT MARY'S ARE AFTER YOU?
A HOSPITAL ADMINISTRATION, SIR.
Q YOU SOUND A LITTLE LIKE DOCTOR REDDY. ANYBODY EVER
TELL YOU THAT?
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A YOU SOUND LIKE SOMEBODY ELSE. YOU WANT ME TO TELL
YOU WHO YOU SOUND LIKE?
WHY ARE YOU MAKING PERSONAL ATTACKS ON ME, SIR?
THE COURT: HE'S NOT. TAKE IT EASY.
BY MR. NOLAN:
Q YOU TOLD US THAT YOU WERE VERY PARTIAL TO SAINT
MARY'S?
A YES, I WAS.
Q BUT YOU WOULD AGREE THAT IT APPEARS THEY'RE NOT AS
PARTIAL TO YOU?
A NOT THE NEW ADMINISTRATION, NO.
Q I'D LIKE TO SHOW YOU THIS LETTER THAT WAS -- I KNOW
YOU JUST TOLD US A MOMENT AGO THAT THIS WAS WRITTEN IN
RESPONSE TO A NASTY LETTER THAT YOU WROTE TO DESERT VALLEY.
IS THAT A FAIR STATEMENT, SIR?
A THAT IS CORRECT.
Q DO YOU KNOW WHO WROTE THIS LETTER TO YOU?
A I THINK DOCTOR THACKER DID.
Q ARE YOU SURE ABOUT THAT?
A I THINK SO.
Q DOCTOR THACKER SAYS THAT THERE WERE QUALITY OF CARE
CONCERNS ABOUT YOU; RIGHT?
A YES.
Q YOU DISAGREE WITH THAT?
A I ABSOLUTELY DISAGREE WITH THAT, OF COURSE.
Q DOCTOR THACKER SAYS IN THE FIRST PARAGRAPH THAT YOU
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DISCHARGED THE PATIENT VIA A TELEPHONE ORDER. THERE WAS NO
EVIDENCE OF YOU SEEING THE PATIENT ON THE ORDER NOTES. IF
THAT'S TRUE, THAT'S NOT A GOOD THING TO DO, IS IT?
A I HAVE TO LOOK AT THE CHART. ANYBODY CAN SAY
ANYTHING THEY WANT.
Q DO YOU KNOW WHETHER DOCTOR THACKER LOOKED AT THESE
CHARTS BEFORE HE WROTE THIS LETTER TO YOU?
A YOU SHOULD HAVE ASKED HIM THAT QUESTION.
Q I SHOULD HAVE.
WE BLACKED IT ALL OUT, BUT HE REFERENCES SPECIFIC
PATIENTS IN THE LETTER; RIGHT?
A I DO NOT KNOW THESE PATIENTS.
Q I'M NOT ASKING WHETHER YOU KNOW THE PATIENT. I'M
ASKING YOU WHETHER YOU KNOW THAT DOCTOR THACKER REFERENCED
SPECIFIC PATIENTS AND MEDICAL RECORD NUMBERS?
A THAT'S CORRECT.
Q DOWN IN PARAGRAPH THREE, DOCTOR THACKER SAYS THAT ON
A VERY COMPLEX MEDICAL ISSUE, YOU DID NOT EXAMINE THE PATIENT
FOR TWO DAYS.
A THAT IS NOT TRUE.
Q HE'S OUT TO GET YOU TOO, SIR?
A NO. I MAY NOT HAVE EXAMINED MY PATIENT, BUT I HAVE
OTHER ASSOCIATES WHO WORK FOR ME WHO EXAMINE THE PATIENTS. I
DON'T HAVE TO GO AROUND EVERY ONE OF MY PATIENTS, SIR.
Q YOU'RE A PRETTY BUSY GUY, AREN'T YOU?
A I AM.
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Q DOCTOR THACKER SAYS ON THE SECOND PAGE OF THIS
LETTER THAT YOU, DOCTOR SIVA, EMBARKED ON A PATH OF
ACCUSATIONS AGAINST DESERT VALLEY HOSPITAL.
A CERTAIN MEMBERS OF DESERT VALLEY HOSPITAL.
Q WERE THESE ACCUSATIONS?
A THEY WERE DOING THINGS TO MY PATIENT WITHOUT MY
PERMISSION.
Q THEY WERE ENGAGING IN MISCONDUCT?
A CERTAIN CARDIOLOGISTS AT DESERT VALLEY HOSPITAL
WERE.
DO YOU KNOW WHO THE CARDIOLOGISTS WERE AT DESERT
VALLEY HOSPITAL AT THAT TIME, SIR?
Q THERE'S NO QUESTION PENDING RIGHT NOW, DOCTOR SIVA.
A I JUST WANTED TO MAKE SURE YOU KNEW THAT.
Q ALL RIGHT.
DOCTOR THACKER SAYS HE BELIEVES YOU'RE ACTING
RETALIATORY. YOU DID NOT DO THAT, SIR?
A ABSOLUTELY NOT.
Q IN THIS SECOND PARAGRAPH, DOCTOR THACKER POINTS OUT
THERE'S NO MENTION OF YOUR NAME ON THE PATIENT CHART. DO YOU
SEE THAT?
A IF YOU GO DOWN, IT SAYS: "YOUR QUESTIONING OF THE
CLINICAL DECISION MADE BY A BOARD CERTIFIED CARDIOLOGIST
DOCTOR RAZA." THAT IS WHAT I HAD ISSUES ABOUT. WHY DON'T YOU
HIGHLIGHT THAT?
THE COURT: PLEASE ANSWER THE QUESTIONS.
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THE WITNESS: YES.
BY MR. NOLAN:
Q DO YOU WANT TO COME OUT HERE AND DO MY JOB?
A NO.
Q JUST CHECKING.
DOCTOR THACKER SAYS: YOU TOOK IT UPON YOURSELF TO
WRITE IN THE PATIENT CHART TO TRANSFER THE PATIENT TO YOUR
SERVICE. THIS SEEMED, ACCORDING TO DOCTOR THACKER. TO BE A
CONTINUOUS PATTERN ON YOUR BEHALF THAT YOU COME AND WRITE ON
PATIENTS' CHARTS OF OTHER PHYSICIANS, AND THAT YOU ARE
VIOLATING HOSPITAL POLICY.
A THAT IS NOT TRUE. MY PATIENTS' FAMILY MEMBERS WERE
CALLING ME, AND DOCTOR RAZA WAS INTERFERING WITH MY PATIENT
CARE.
Q FROM YOUR EXPERIENCE IN WORKING AT DESERT VALLEY
HOSPITAL, IF YOU ARE SEEING A PATIENT IN THE ER OR ON THE
MED-SURG FLOOR, SAY, FOR AN INTERNAL MEDICINE PROBLEM, AND
ANOTHER DOCTOR, UNBEKNOWNST TO YOU, COMES UP AND STARTS
WRITING ORDERS ON THE CHART FOR THAT PATIENT, WOULD THAT
TROUBLE YOU?
A IT WILL TROUBLE ME IF THE DOCTOR DOES NOT KNOW THE
PATIENT, IF THE FAMILY MEMBERS HAVE NOT REQUESTED THE DOCTOR
TO WRITE ON THE CHART. FAMILY MEMBERS ARE WONDERING WHY THE
PATIENT IS IN THE HOSPITAL, YET ANOTHER DOCTOR BY THE NAME OF
DOCTOR RAZA IS TAKING CARE OF THE PATIENT WHEN THE PATIENT
ACTUALLY SHOULD BE SEEN BY ME BECAUSE THE PATIENT HAS BEEN
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UNDER MY CARE.
Q LET ME COME BACK TO MY QUESTION BECAUSE YOU WENT OFF
ON A BIT OF TANGENT.
A NO, I DID NOT.
Q ALL RIGHT.
WOULD YOU AGREE THAT IT IS WRONG -- I'M NOT TALKING
ABOUT YOU AND I'M NOT TALKING ABOUT DOCTOR RAZA. I'M JUST
ASKING YOU AS A MATTER OF GENERAL PRINCIPAL AS A PHYSICIAN, IS
IT WRONG FOR ANOTHER DOCTOR TO COME UNINVITED AND WRITE ON
ANOTHER PHYSICIAN'S PATIENT'S CHART?
A I HAVE NO OPINION.
Q NO OPINION OF THAT?
A ABSOLUTELY NOT. I'M NOT SPECULATING ON ANYTHING. I
CAN ONLY TALK ABOUT MY PATIENT AND MY CARE, AND THIS
PARTICULAR DOCUMENT, WHICH IS MY PATIENT, FAMILY MEMBERS
CONTACTED ME THAT THE PATIENT IS IN THE HOSPITAL AND WHY ARE
YOU NOT SEEING THE PATIENT? WHY IS DOCTOR RAZA TAKING CARE OF
OUR FATHER OUR OR MOTHER? YOU ARE THE CARDIOLOGIST. WE HAVE
HIRED YOU AS CARDIOLOGIST. WHY IS THAT HAPPENING? ONLY THOSE
SITUATIONS HAVE I RESPONDED, SIR. I'M NOT SPECULATING ON
ANYTHING ELSE.
Q SEE IF YOU CAN GET FOCUSED ON THE QUESTION, DOCTOR
SIVA.
UP AT THE TOP OF THE FINAL PAGE, IT SAYS:
"DOCTOR SIVA, WE HAVE RECEIVED NUMEROUS COMPLAINTS AGAINST
YOUR LACK OF TIMELY RESPONSE TO THE PAGES FROM THE CLINICAL
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STAFF."
I KNOW YOU ACCUSED ANOTHER PHYSICIAN JUST A FEW
MINUTES AGO OF FAILING TO RESPOND TO PAGES. APPARENTLY
SOMEBODY THINKS THAT YOU SUFFER FROM THE SAME DEFICIENCY.
FAIR STATEMENT?
A NO. THE REASON IS SHOW ME THE COMPLAINTS. SHOW ME
THE PATIENTS THAT I HAVE NOT RESPONDED TO. DON'T MAKE AN
ACCUSATION THAT YOU CANNOT SUBSTANTIATE.
Q I'M NOT MAKING ACCUSATIONS, SIR. THIS WAS DESERT
VALLEY HOSPITAL THAT MADE THE ACCUSATION.
A THAT'S WHY I TOLD DOCTOR THACKER TO RESPOND
APPROPRIATELY WITH SPECIFICS NOT JUST GENERALITIES.
Q DOCTOR THACKER GOES ON TO STATE IN THE SECOND LINE
UP THERE FROM THE TOP: "IN ADDITION, WE ALSO RECEIVED SEVERAL
COMPLAINTS ABOUT YOUR INAPPROPRIATE AND RUDE BEHAVIOR WITH OUR
NURSING STAFF AND PHYSICIANS."
A SPECIFICS, PLEASE.
Q I DIDN'T ASK YOU A QUESTION YET.
DOCTOR SIVA, WOULD YOU EVER BE RUDE TO THE NURSING
STAFF?
A ABSOLUTELY NOT.
Q WOULD YOU EVER BE RUDE TO PHYSICIANS?
A YES. I HOLD PHYSICIANS AT A HIGHER LEVEL. THEY ARE
MY EQUAL; THEREFORE, I DEMAND A LOT MORE FROM MY PHYSICIANS.
NURSES ARE SUBORDINATES. THEY ACTUALLY HAVE LITTLE COST IN
TERMS OF HOW TO DEAL WITH PHYSICIANS.
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I TAKE EXTRA PRECAUTION. I'M NEVER RUDE TO ANYBODY
UNLESS THERE'S NEGLIGENCE INVOLVED. WHEN MEDICATIONS NEED TO
BE GIVEN TO THE PATIENT AND HAVE NOT BEEN GIVEN, WHEN PATIENTS
NEED CERTAIN THINGS TAKEN CARE OF AND THEY'RE NOT TAKEN CARE
OF, THAT ADVERSELY AFFECTS THE PATIENT CARE, THEN I'LL TAKE
ISSUE, BUT I NEVER TAKE ISSUE ON AN INDIVIDUAL BASIS WITH
NURSE TO NURSE. I ALWAYS GO TO THE SUPERVISOR, AND I VERY
CALMLY AND COLLECTIVELY TELL THEM EXACTLY WHAT NEEDS TO BE
DONE AND I DO NOT WANT THOSE THINGS REPEATED. YOU CAN ASK
LISA. SHE HAS BEEN WITH ME FOR A LONG TIME. SHE KNOWS ME FOR
A VERY LONG TIME. ASK HER HOW MANY TIMES I HAVE YELLED AT ANY
NURSES.
Q I'LL ASK HER LATER, SIR.
A THANK YOU.
Q DOCTOR THACKER SAYS HE'S GOING TO FORWARD ALL THESE
COMPLAINTS HE HAS ABOUT YOU TO COMMITTEES. DO YOU KNOW
WHETHER THAT WAS DONE?
A NO.
Q HE SAYS HE WANTS YOU TO REFRAIN FROM WRITING
TRANSFER ORDERS TO YOURSELF ON THE CHARTS OF OTHERS. DID YOU
TALK TO DOCTOR THACKER ABOUT THAT?
A YES, I DID.
Q AND HE SAYS: IF YOU DO NOT CORRECT THESE
DEFICIENCIES, THEY'RE GOING TO TAKE APPROPRIATE ACTION AGAINST
YOU, INCLUDING SUMMARY SUSPENSION OF YOUR PRIVILEGES.
A NOTHING HAS HAPPENED, HAS IT?
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Q I DON'T KNOW, SIR.
A OKAY.
Q DOCTOR SIVA, I THANK YOU VERY MUCH, SIR.
A THANK YOU.
THE COURT: REDIRECT, MISS TROPP.
REDIRECT EXAMINATION
BY MS. TROPP:
Q DOCTOR SIVA, DID YOU RESOLVE THESE ISSUES WITH
DESERT VALLEY HOSPITAL THAT WERE RAISED IN DOCTOR THACKER'S
LETTER?
A YES, I HAVE.
Q DID YOU RESOLVE THOSE ISSUES WITH DOCTOR THACKER?
A NO.
Q WITH WHOM DID YOU RESOLVE THEM?
A WITH DOCTOR REDDY.
Q DID IT REQUIRE LEGAL INTERVENTION BY ANYBODY?
A NO.
Q DID HE SUE YOU?
A NO.
Q DID YOU SUE HIM?
A NO.
Q DO YOU STILL WORK THERE?
A I'M STILL THE MEDICAL DIRECTOR AND ALSO THE DIRECTOR
OF THE CATH LAB.
Q YOU TALKED ABOUT SPECIFICS. YOU HAVE SPECIFICS,
SIR, OF DOCTOR AHMED NOT RESPONDING TO PAGES?
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A ABSOLUTELY.
Q LIKE THE BARSTOW SHERIFF THAT YOU MENTIONED?
A CORRECT.
Q WE ACTUALLY SHOWED SOME DOCUMENTATION IN THIS COURT
OF PBX -- WHAT'S PBX?
A THAT'S OUR PAGING SYSTEM.
Q WE SAW SOME DOCUMENTATION IN COURT WHERE PBX PAGED
DOCTOR AHMED AND HE DIDN'T RESPOND.
HAVE YOU EVER HAD THAT SITUATION WITH DOCTOR AHMED
AT DESERT VALLEY HOSPITAL WHERE HE HASN'T RESPONDED?
A YES.
Q ACTUAL SPECIFICS?
A YES.
Q DO YOU THINK IT'S IMPORTANT TO HAVE SPECIFICS OF
PATIENTS, SIR, WHEN YOU'RE ACCUSING PATIENTS' PHYSICIANS?
A THAT'S CORRECT.
Q DO YOU THINK IT'S IMPORTANT FOR NURSES TO HAVE
ACTUAL SPECIFICS OF PATIENTS BEFORE THEY'RE ACCUSING
PHYSICIANS?
A ABSOLUTELY.
Q WHY?
A BECAUSE IT'S HEARSAY. ANYBODY CAN ACCUSE ANYBODY OF
ANYTHING AND GET AWAY WITH IT BECAUSE IT'S HEARSAY RUMORS. I
HEARD THIS FROM SOMEBODY ELSE. BUT NOBODY HAS FIRSTHAND
KNOWLEDGE.
IF YOU HAVE ISSUES WITH SOMEBODY, WRITE IT DOWN.
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TELL ME WHERE IT IS. PUT IT IN A CHART AND SAY YOU HAVE
ISSUES, AND THEN WE'LL RESOLVE THE ISSUE. CALL THE PATIENT.
TALK TO THE PATIENT. DID THE PATIENT HAVE ANY COMPLAINTS
CONCERNING MY CARE? BRING THOSE ISSUES TO ME. GIVE ME
SPECIFICS. THEN I'LL DEAL WITH THE SPECIFICS.
WHEN YOU'RE SIMPLY ACCUSING ME ON NUMEROUS OCCASIONS
THAT SOMETHING WAS SAID BY SOMEBODY SOMEWHERE DOWN THE ROAD,
IT'S ALL NONSENSE.
Q YOU'RE PREACHING TO THE CHOIR, DOCTOR.
THANK YOU.
A THANK YOU.
THE COURT: MR. NOLAN?
MR. NOLAN: I WAS GOING TO GOING TO ASK ABOUT THE
CHOIR, BUT I'LL REFRAIN.
I HAVE NO FURTHER QUESTIONS.
THE COURT: THANK YOU, DOCTOR.
(THAT CONCLUDES THE TESTIMONY OF SIVA ARUNASALAM)
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SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF SAN BERNARDINO
VICTORVILLE DIVISION
DEPARTMENT V-10 HON. STANFORD E. REICHERT, JUDGE
DESERT VALLEY HOSPITAL, INC., ) CASE NO. VCVVS030193)
PLAINTIFF, ))
VS. ))
TINA BUCHANAN AND LISA CROUCH, ))
DEFENDANTS. )___________________________________)TINA BUCHANAN AND LISA CROUCH, )
)CROSS-COMPLAINANTS, )
)VS. )
)DESERT VALLEY HOSPITAL, INC., )ET AL., )
)CROSS-DEFENDANTS. )
)
REPORTER'S TRANSCRIPT OF ORAL PROCEEDINGS
TESTIMONY OF DOCTOR SIVA ARUNASALAM
THURSDAY, OCTOBER 6, 2005
APPEARANCES:
FOR THE PLAINTIFFS DEBORAH S. TROPPAND CROSS-DEFENDANTS: ATTORNEY AT LAW
611 ANTON BOULEVARDSUITE 1050COSTA MESA, CA 92626
-AND-MICHAEL J. SARRAOATTORNEY AT LAW26632 TOWNE CENTER DRIVEFOOTHILL RANCH, CA 92610
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FOR THE DEFENDANTS VINCENT P. NOLANAND CROSS-COMPLAINANTS: ATTORNEY AT LAW
3877 TWELFTH STREETRIVERSIDE, CA 92501
REPORTED BY: FRED BERZAKOFFICIAL REPORTERC.S.R. NO. 5815
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REPORTER'S CERTIFICATE
I, FRED BERZAK, CSR, OFFICIAL REPORTER OF THE
ABOVE-ENTITLED COURT, DO HEREBY CERTIFY:
THAT I AM A CERTIFIED SHORTHAND REPORTER OF THE
STATE OF CALIFORNIA, DULY LICENSED TO PRACTICE; THAT I DID
REPORT IN STENOTYPE ORAL PROCEEDINGS HAD UPON HEARING OF THE
AFOREMENTIONED CAUSE AT THE TIME AND PLACE HEREINBEFORE SET
FORTH; THAT THE FOREGOING PAGES NUMBERED 1 THROUGH 36,
CONSTITUTE TO THE BEST OF MY KNOWLEDGE AND BELIEF A FULL,
TRUE, AND CORRECT COMPUTER-AIDED TRANSCRIPTION FROM MY SAID
SHORTHAND NOTES.
DATED THIS 18TH DAY OF JANUARY, 2012.
______________________________CSR
OFFICIAL REPORTER, CSR NO. 5815
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WITNESS PAGE
SIVA ARUNASALAM
DIRECT EXAMINATION BY MS. TROPP 1CROSS-EXAMINATION BY MR. NOLAN 24REDIRECT EXAMINATION BY MS. TROPP 34
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