1 1 2 The State of Ohio, ) 3 ) SS: County of Lake. ) 4 5 IN THE COURT OF COMMON PLEAS 6 7 Jane Mastro, et al., 8 Plaintiffs; 9 vs. No. 99 CV 001337 10 Judge Mitrovich 11 Thomas S. Wilson, M.D., et al., 12 Defendants. 13 - - - - 14 Deposition of STEPHEN BAUM, M.D., a Defendant 15 herein, taken as if under cross-examination before 16 Debra A. Butzer, a Notary Public within and for the 17 State of Ohio, at the offices of Gallagher, Sharp, 18 Fulton & Norman, 7th Floor, Bulkley Building, 1501 19 Euclid Avenue, Cleveland, Ohio, commencing at 1:30 20 p.m., Friday, February 11, 2000, pursuant to notice 21 and stipulations of counsel, on behalf of the 22 Plaintiffs. 23 24 - - - - 25 2 1 2 3 E X A M I N A T I O N 4 5 Witness Cross 6 STEPHEN BAUM, M.D. 7 By Mr. Lancione..........................4 8 - - - - 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 3 1 2 APPEARANCES: 3 Lancione & Lancione, by 4 Mr. John A. Lancione 2945 BP Tower 5 200 Public Square Cleveland, Ohio 44114 6 (216) 623-4949 7 On behalf of the Plaintiffs; 8 Gallagher, Sharp, Fulton & Norman, by 9 Mr. Ernest W. Auciello, Jr. 7th Floor, Bulkley Building 10 1501 Euclid Avenue Cleveland, Ohio 44115 11 (216) 241-5310 12 On behalf of the Defendants. 13 - - - - 14 15 16 17 18 19 20 21 22 23 24 25 4 1 P R O C E E D I N G S 2 - - - - 3 STEPHEN BAUM, M.D., of lawful 4 age, a Defendant herein, called by 5 the Plaintiffs for the purpose of 6 cross-examination, as provided by the 7 Ohio Rules of Civil Procedure, being by 8 me first duly sworn, as hereinafter 9 certified, deposed and said as follows: 10 - - - - 11 CROSS-EXAMINATION OF 12 STEPHEN BAUM, M.D. 13 BY MR. LANCIONE: 14 Q. Would you state your full name for the record, 15 please? 16 A. Stephen Alexander Baum. 17 Q. Doctor Baum, have you ever had your deposition 18 taken before? 19 A. Yes, I have. 20 Q. On how many occasions? 21 A. I'm not sure. 22 Q. More than once? 23 A. Yes. 24 Q. More than twice? 25 A. Yes. 5 1 Q. Three times? 2 A. Yes. 3 Q. Four times? 4 A. Yes. 5 Q. More than 10? 6 A. Yes. 7 Q. More than 15? 8 A. I don't think so. 9 Q. Okay. The ground rules are, as I'm sure you 10 know, if you don't understand a question that 11 I ask you, stop me and tell me that you don't 12 understand it and I'll rephrase the question, 13 because if you do answer a question, we're 14 going to assume you understood it. 15 Do you understand that? 16 A. Yes. 17 Q. Also, answer verbally and don't talk over me, 18 I won't talk over you. That way Debbie can 19 get both my questions and your answers and it 20 will be a clear record. 21 Is that fair? 22 A. Yes. 23 Q. Okay. What is your professional address? 24 A. 8945 Mentor Avenue, Mentor, Ohio 44060. 25 Q. What is the name of that building or practice? 6 1 Does it have a corporate name or a trade 2 name or something like that? 3 A. PrimeHealth Internal Medicine, Mentor, and the 4 building's name is the Mentor Medical Campus. 5 Q. Is PrimeHealth the corporate name of the 6 medical practice that you're affiliated with? 7 A. Yes. 8 Q. Is that an incorporated entity? 9 A. Yeah. 10 MR. AUCIELLO: You're talking 11 now? 12 Q. Now. 13 A. I believe so. 14 Q. Okay. Is that incorporated entity affiliated 15 with any type of an HMO or other health plan? 16 A. They're a member of the PHO for Lake Hospital 17 System. 18 Q. How long have you been affiliated with 19 PrimeHealth? 20 A. Four days. 21 Q. Four days? 22 A. (Witness nodding affirmatively.) 23 Q. I know that. 24 So are you a partner or an associate or 25 an employee of PrimeHealth? 7 1 A. I believe that I'm an employee. 2 Q. And before you started to work for 3 PrimeHealth, by whom were you employed? 4 A. University Mednet. 5 Q. And for how long were you employed by 6 University Mednet? 7 A. Fourteen years. 8 Q. What was your reason for leaving University 9 Mednet and going to work with PrimeHealth? 10 A. They were changing the way that the practice 11 was run, and I was not happy with the 12 direction that they were going. 13 Q. Were there several physicians who left Mednet 14 and went to other practices? 15 A. Yes. 16 Q. Would you describe for us the nature of your 17 medical practice? 18 Do you have a specialized area of 19 practice? 20 A. I practice internal medicine, and I have an 21 interest in geriatric medicine. 22 Q. How many doctors are in the PrimeHealth group 23 on Mentor Avenue? 24 A. I'm not sure right at the moment, being 25 relatively new. 8 1 Q. Is there more than just the Mentor Avenue 2 address? 3 Are there several offices or is there 4 just one office? 5 A. There are several offices. 6 Q. Are they all in Lake County? 7 A. To my knowledge. 8 Q. And they're all affiliated with the Lake 9 Hospital System? 10 A. Yes. 11 Q. Is it a multi-disciplinary group? 12 A. Yes. 13 Q. Do you currently, in your capacity as an 14 employee of PrimeHealth, have any professional 15 relationship with Doctor Wilson, the other 16 defendant in this case? 17 A. As of this incident? 18 Q. As of right now. 19 A. No. 20 Q. Is he still with University Mednet? 21 A. To my knowledge. 22 Q. Okay. Can you tell me about your educational 23 background starting with medical school? 24 When did you go and where? 25 A. I went to Penn State Medical School at 9 1 Hershey, 1975 to 1979. I performed my 2 internship and residency at the UCLA 3 San Fernando Valley program, which would be 4 '79 to '82, and I took a fellowship in 5 geriatric medicine 19 -- I'm sorry -- '79 to 6 '82, and the fellowship was '82 to '84. 7 Q. And in '84 did you enter the private practice 8 of medicine? 9 A. Yes. 10 Q. With whom? 11 A. Toluca Lake Medical Group. 12 Q. Toluca? 13 A. Yeah. 14 Q. Is that here in Lake County? 15 A. No; that's in Toluca Lake. 16 MR. AUCIELLO: Oh, Tolupa? 17 THE WITNESS: Toluca. 18 Q. Toluca Lake? 19 A. Yes. 20 Q. Is that in California? 21 A. Yes, it's next to Burbank. 22 Q. And for how long did you practice out there? 23 A. A little over a year. 24 Q. Then where did your practice take you? 25 A. Then I joined University Mednet. 10 1 Q. Are you from the Ohio area? 2 A. No, I'm not. 3 Q. Okay. What brought you to Ohio? 4 A. I was looking at various practice 5 opportunities and that was the one that I 6 chose. 7 Q. Are you married? 8 A. Yes. 9 Q. Do you have any children? 10 A. Yes. 11 Q. How many? 12 A. I have a son. I had a daughter who died from 13 leukemia. 14 Q. Oh, I'm sorry to hear that. 15 Your age and date of birth? 16 A. I was born December 27th, 1952, so I guess 17 that makes me 47. 18 Q. Okay. Have you ever been a defendant in a 19 medical malpractice case before this case? 20 A. I've had a couple of 180-day letters. 21 Q. Okay. But you've never actually had a lawsuit 22 filed against you in court? 23 A. Do you mean something that went to court? 24 Q. What I mean, have you ever received a 25 Complaint and a Summons of an actual medical 11 1 malpractice case being filed in court against 2 you? 3 A. Yes. 4 Q. How many times? 5 A. I believe twice. 6 Q. What were the outcomes of those suits? 7 Were they settled, dismissed, was there a 8 payment, a trial and a verdict? 9 A. I was let out of them before it ever went to 10 trial. 11 Q. Have you ever been an expert in a medical 12 malpractice case before? 13 A. Yes. 14 Q. How many times? 15 A. Probably about 10. 16 Q. And for whom have you -- have you ever acted 17 as an expert for an attorney in Cleveland? 18 A. Yes. 19 Q. Who? Do you remember the names of the 20 attorneys? 21 A. Not off the top of my head. 22 Q. What about the law firms? 23 A. Uh -- 24 Q. Reminger & Reminger? 25 A. I don't recall. 12 1 Q. Jacobson, Maynard, Tuschman & Kalur? 2 A. I don't recall. 3 Q. Gallagher, Sharp, Fulton & Norman? 4 A. I don't recall. 5 Q. When was the last time you acted as an expert 6 in a medical malpractice case? 7 A. About a week ago. 8 Q. And who was that for? 9 A. Attorney Sinclair. 10 Q. Was that a plaintiffs' case or a defendants' 11 case? 12 A. I believe he was representing the plaintiff. 13 Q. Sinclair in Strongsville? 14 A. I thought he was in Youngstown. 15 Q. Okay. What kind of a case was it -- or what 16 kind of a case is it, I should say? 17 A. It was a woman -- 18 MR. AUCIELLO: Is this one you've 19 been deposed in? 20 THE WITNESS: Yes. 21 MR. AUCIELLO: I guess there is 22 no sense stumbling on somebody else's 23 experts that they don't want to 24 disclose, but if you can answer, go 25 ahead. 13 1 A. It was a woman that was admitted to a nursing 2 home. The nursing home made an error in one 3 of her medicines, which resulted in her ending 4 up in the hospital. 5 Q. Okay. Of the cases in which you've been an 6 expert, have you done more for plaintiffs' 7 attorneys or more for defense attorneys? 8 A. It's probably about 50/50. 9 Q. Okay. And are the types of cases that you act 10 as an expert in generally geriatric medicine 11 cases? 12 A. Yes. 13 Q. When I asked you about depositions, you said 14 somewhere between 10 and 15. Were most of 15 those as expert witnesses? 16 A. Yes. 17 Q. And in the two suits that were filed against 18 you, were you deposed in those cases? 19 A. No. 20 Q. Have you ever been an expert in a malpractice 21 case involving issues concerning coronary 22 artery disease and angina and heart attacks 23 and issues similar to this case? 24 A. No. 25 Q. Have you ever given a deposition on behalf of 14 1 the patient in an injury case, a car accident 2 case or -- as a treating doctor? 3 A. No. 4 Q. Are you involved in the administration of or 5 as like a medical director of any nursing 6 homes or any nursing home work? 7 A. Yes. 8 Q. Which nursing homes? 9 A. I'm medical director of Heartland of Mentor 10 Nursing Home in Mentor, and I attend patients 11 at Wickliffe Country Place. 12 Q. What percentage of your practice is geriatric 13 medicine? 14 A. Sixty percent, approximately. 15 Q. Of the 40 percent that's non-geriatric, can 16 you describe the nature of that practice? 17 A. I perform general internal medicine. 18 Q. What is the age range of your patients in 19 general internal medicine? 20 A. Generally, we accept them at 16 years old, and 21 I'll take them up to any age. 22 Q. Do you have any teaching responsibilities 23 currently? 24 A. Currently, I occasionally supervise nurse 25 practitioner students from the Case Nurse 15 1 Practitioner Program. 2 Q. At any time since you've been in the Cleveland 3 area, have you had any teaching 4 responsibilities? 5 A. Yes. 6 Q. Tell me about them. 7 A. I was attending physician at the Foley Elder 8 Health Center for a couple of years, and I was 9 ward attending at the VA, I believe for two 10 years, on the geriatrics ward. I taught in 11 the second year COPS, and you'll have to 12 forgive me, I don't remember what COPS stands 13 for, but for the second-year medical students. 14 Q. All right. 15 A. I've had students from other institutions, on 16 occasion, who were doing electives and clinic. 17 Q. When you saw Jane Mastro, was your practice 18 still divided approximately 60 percent 19 geriatrics and 40 percent internal medicine, 20 back in '97-'98? 21 A. I would assume so. 22 Q. I mean, has that always been the breakdown of 23 your practice, generally? 24 A. Yeah. It tends to vary. 25 Q. Okay. What have you reviewed in preparation 16 1 for your deposition today? 2 A. I was shown the Lake Hospital System records 3 for two admissions. 4 Q. Which admissions were those? 5 A. One was -- 6 THE WITNESS: Can I look at the 7 dates, please? 8 MR. AUCIELLO: Is it okay if he 9 looks at them? 10 MR. LANCIONE: Oh, yeah. He can 11 look at anything he wants to. 12 THE WITNESS: This is both of 13 them. 14 MR. AUCIELLO: No; here's the 15 other one. 16 THE WITNESS: Okay. 17 A. The first one was an admission from 9/19/97 to 18 9/20/97, and the other was from 10/13/98 to 19 10/14/98. 20 Q. Have you done any research into medical 21 literature with regard to this lawsuit? 22 A. No. 23 Q. Have you had any discussion with your 24 co-defendant, Doctor Wilson, about this 25 lawsuit? 17 1 A. He mentioned to me that he had gotten a letter 2 on it, and that was the extent of our 3 conversation. 4 Q. Have you had any discussions with him in 5 anticipation of this deposition? 6 A. No. 7 Q. What is your working definition of "angina"? 8 A. Angina's a clinical syndrome where the patient 9 experiences a constellation of symptoms 10 associated with ischemia to the heart. 11 Q. When you use the term "angina," is the 12 constellation of symptoms always due to 13 coronary ischemia? In other words, is angina 14 synonymous with coronary ischemia when you 15 talk about a patient who's having angina? 16 A. Say the question for me one more time. 17 Q. In other words, I could have chest pain that's 18 due to GI syndrome. So when you use angina to 19 describe a patient's symptoms or symptom 20 complex, are you working under the assumption 21 that it's due to coronary ischemia? 22 A. Yes. 23 Q. And you said it's a complex of symptoms? 24 What are the symptoms, the clinical 25 symptoms, that you would expect to hear in 18 1 order to arrive at a diagnosis of angina? 2 A. It can include symptoms such as chest 3 discomfort, nausea, sweating, palpitations, 4 shortness of breath. 5 Q. What about pain radiating into the neck and 6 jaw? 7 A. I believe I said that they could have pain. 8 Q. Well, you said chest discomfort. 9 A. Okay. 10 Q. I don't know if you said radiating -- 11 A. Well, people describe it as many different 12 things, including pain. 13 Q. Arm weakness or arm heaviness? 14 A. Sometimes they describe a sensation as it 15 being heavy. 16 Q. What about unstable angina? What is your 17 definition of "unstable angina"? 18 A. Unstable angina is a change in the pattern of 19 angina that a patient with coronary artery 20 disease has. 21 Q. What is the change? 22 A. It depends on who you talk to. Any change in 23 the pattern can be considered unstable angina. 24 Q. I've heard it described as crescendo chest 25 pain, increasing from one level, increasing in 19 1 frequency and severity and duration. Is that 2 consistent with your understanding of unstable 3 angina? 4 A. My understanding is crescendo angina is 5 somewhat different. 6 Q. Okay. And what's atypical chest pain? 7 A. Atypical chest pain is a term that we use when 8 people have discomfort in their chest that 9 would not be typical of coronary artery 10 disease. 11 Q. Are you aware of the outcome in this case with 12 Jane Mastro, why she filed this suit against 13 you and what her current condition is? 14 A. No. 15 Q. Okay. Are you aware that she was admitted to 16 the Cleveland Clinic and had a vascularization 17 procedure in 1999? 18 A. I was told that just today. 19 Q. Did you have a chance to look at the records 20 that I've provided Mr. Auciello? 21 A. I read the discharge summary. 22 Q. And what did you take from that? 23 What is your understanding based on 24 reading the discharge summary from the 25 Cleveland Clinic? 20 1 A. That she had repeat cardiac catheterization, 2 her prior coronary artery grafts had occluded, 3 and that she underwent a revascularization 4 procedure. 5 Q. Do you know what the incidence is of bypass 6 graft stenosis post bypass graft surgery? 7 A. I believe it depends on multiple factors, the 8 degree of which blood pressure, diabetes and 9 cholesterol are controlled and whether you 10 smoke or not, as well as the kind of vascular 11 procedure that was done. 12 Q. Is Doctor Wilson a cardiologist? 13 A. Yes. 14 Q. To your knowledge, is that all he sees as far 15 as his patients, cardiology patients? If you 16 know. 17 A. Yeah, I'm not sure. 18 Q. All right. Would you expect that a 19 cardiologist would have a higher degree of 20 knowledge or understanding about the incidence 21 of bypass graft stenosis following bypass 22 surgery, as opposed to someone like you, in 23 general internal medicine and geriatrics? 24 A. Yes. 25 Q. How does one differentiate between non-cardiac 21 1 chest pain and chest pain due to coronary 2 ischemia? 3 A. Well, there's a number of ways that that could 4 be done. 5 Non-invasively, you could perform a 6 stress test, various kinds of scanning. 7 Invasively, you could do cardiac 8 catheterization. 9 Q. What type of scans? 10 A. A spec scan. 11 Q. Spec scan? 12 What value does standard 12-lead 13 electrocardiogram have in ruling out a 14 myocardial ischemia in a patient with chest 15 pain? 16 A. Some, although the test is not particularly 17 sensitive nor specific. 18 Q. Okay. Can you have a patient who is actually 19 having chest pain due to coronary ischemia and 20 have a non-diagnostic electrocardiogram? 21 A. Yes. 22 Q. Is post bypass graft recurrent angina a 23 clinical symptom consistent with graft 24 stenosis? 25 A. Say that one for me one more time. 22 1 Q. Sure. 2 Is post bypass graft recurrent angina a 3 clinical symptom that is consistent with graft 4 stenosis? 5 A. I'm not sure of the -- of that wording. 6 After bypass grafting, people have lots 7 of things that can cause chest discomfort, one 8 of which would be restenosis of their grafts. 9 Q. Are there other known complications or 10 conditions following the surgical procedure 11 that also cause chest discomfort? 12 A. Yes. 13 Q. Syndromes that they've named? 14 A. I'm not sure of the names. 15 Q. Okay. 16 A. I guess maybe that's where we're getting hung 17 up. 18 Q. Would you consider coronary angiography to be 19 the gold standard for diagnosing coronary 20 artery stenosis or bypass graft stenosis? 21 A. Yes. 22 As of 1998, I assume? 23 Q. Yeah, during this time period. 24 A. Yes. 25 Q. Do you consider yourself competent and capable 23 1 in the interpretation of electrocardiograms? 2 A. Yes. 3 Q. Would you consider or do you think that a 4 cardiologist such as Doctor Wilson would have 5 a higher degree of skill and a higher level of 6 competence in interpreting electrocardiograms? 7 A. Yes. 8 Q. All right. When was your first contact with 9 Jane Mastro? 10 And you can look at the chart. It's not 11 a memory test. 12 A. Okay. 13 MR. AUCIELLO: There's an older 14 one that I don't think we went over 15 today, but it was 3/25/97. 16 Q. And to answer any of these questions that 17 pertain to this patient, you can feel free to 18 look at anything you want, okay? It's not a 19 memory test. I want you to answer based on 20 the information you have available to you in 21 the records. 22 A. According to the records, I saw her on 23 3/25/97. 24 MR. AUCIELLO: And I pointed that 25 out to him. If there's an earlier 24 1 one, I'm not aware of it. Just tell 2 me about it and I'll pull it out. 3 Q. And that's the first time she came into Lake 4 Hospital System because of symptoms of 5 myocardial infarction? 6 A. She came into the urgent care with a chief 7 complaint of chest pain that had been present 8 for 12 hours, and she described it as dull 9 substernal chest pressure. 10 Q. Okay. 11 A. There was no palpitations and shortness of 12 breath, and she had URI symptoms earlier that 13 week, and the EKG that had been done in the 14 urgent care was changed from before, from an 15 old tracing that they must have. 16 Q. And the EKG indicated there was borderline 17 criteria for lateral infarct and inferior 18 posterior infarct? 19 A. Which one are you talking about? 20 Q. This one. 3/25/97, at 21:25 hours. 21 A. That's what the interpretation says. 22 Q. Okay. Now, these interpretations up on top 23 here, is this a computer-generated 24 interpretation or is that physician generated? 25 A. It's hard to say. When it's been reviewed by 25 1 another physician, sometimes they will 2 override what the computer generates and put 3 in their own interpretation. 4 Q. All right. Can you turn back to the emergency 5 room record report for that admission? 6 It's the 3/25/97 admission. 7 MR. AUCIELLO: All right. 8 MR. LANCIONE: This is the 9 history and physical. 10 MR. AUCIELLO: Oh. 11 MR. LANCIONE: It's the ER record 12 as well. It should be in there. 13 MR. AUCIELLO: Let's see. 14 MR. LANCIONE: I think these are 15 probably the records I sent you. Do 16 you mind if I flip through them? 17 MR. AUCIELLO: Yeah, there's 18 nothing in there. 19 I don't know if they're the ones 20 you gave me or the ones Mednet sent 21 me, but they're the same. 22 Off the record. 23 - - - - 24 (Discussion off the record.) 25 - - - - 26 1 Q. So your assessment when you saw her on 2 3/25/97 -- was this Lake East or Lake West? 3 A. I'd have to look. 4 Q. Yeah, can you tell? 5 A. This is Lake East. 6 Q. What do you use to tell that? What are you 7 looking at? 8 A. The little "E" before the "CC" here. 9 Q. All right. Your impression was "Chest pain 10 with symptoms suggestive of gastritis, but 11 with EKG changes, rule out myocardial 12 ischemia." 13 So your impression, based on suggestive 14 complaints, was gastritis? 15 A. Yes. 16 Q. But due to EKG changes, your plan was to rule 17 out myocardial ischemia? 18 A. Yes. 19 Well, my plan was to rule out myocardial 20 infarct. 21 Q. Okay. And you ordered enzymes? 22 A. Yes. 23 Q. And those are consistent with myocardial 24 infarction? 25 A. The order sheet is not here. 27 1 It would be my practice to order cardiac 2 enzymes and serial EKGs. 3 Q. All right. How was it that you came to see 4 her on March 25th, '97? 5 Were you covering the emergency 6 department or were you an attending on call at 7 the hospital? 8 A. I saw her in the urgent care -- 9 THE WITNESS: Can I look at this 10 one more time? 11 MR. AUCIELLO: Yeah. 12 Which one do you want to see? 13 THE WITNESS: The urgent care 14 note. 15 MR. AUCIELLO: Oh, Mednet. This 16 is it. 17 A. You're talking 3/25/97? 18 Q. Yes. 19 A. I saw her in the urgent care, and when we see 20 people in the urgent care, to save the guy 21 who's on call a trip in, we will sometimes do 22 the history and physical and dictate it. 23 Q. Okay. Is the urgent care connected to Lake 24 East Hospital? 25 A. No. 28 1 Q. So how did your -- your dictation was made in 2 the urgent care and made into the hospital 3 chart or Lake East? 4 A. Yes. 5 Q. Did you go with the patient or see her in the 6 hospital during that hospitalization? 7 A. The only records that I have here is from when 8 I saw her in the urgent care. 9 Q. Okay. 10 A. I don't recall if I was on hospital duty that 11 week or not. 12 Q. So you dictated the history and physical for 13 her. 14 Did you know she was going to be admitted 15 or was it your order to admit her to rule out 16 MI, acute MI? 17 A. It was my order to admit her -- 18 Q. Okay. 19 A. -- and I believe the admitting order -- 20 admitting diagnosis was rule out myocardial 21 infarction. 22 Q. Was her strong family history of coronary 23 artery disease made known to you in the urgent 24 care? 25 A. It says here that I -- that this woman notes 29 1 that she has been treated for hypertension and 2 that her family history is strongly positive 3 for coronary artery disease. 4 Q. So hypertension is one of the risk factors for 5 coronary artery disease? 6 A. Yes, it is. 7 Q. And so's a strong family history? 8 A. Yes. 9 Q. All right. Any contact with the patient 10 between March of 1997 and the September '97 11 admission, to your knowledge? 12 A. September -- you mean September 19th? 13 Q. Yes. 14 A. Not that I remember. 15 Q. Okay. 16 MR. AUCIELLO: And I haven't 17 found it in the records either, so -- 18 MR. LANCIONE: Neither have I. 19 Q. Jane Mastro was not your regular patient; is 20 that true? 21 A. No. 22 Q. Okay. Now, she came to Lake Hospital East on 23 September 19th, 1997 through the emergency 24 department? 25 A. September 19th, you said? 30 1 Q. Yes. 2 A. Okay. 3 Q. I'm just going to give you what I've marked as 4 Exhibit 1. 5 Just for the record, Exhibit 1 is a copy 6 of the emergency department typed note by 7 Terry Fortune, D.O. In that history, physical 8 and impression it says "She developed 9 substernal chest discomfort with radiation to 10 the left shoulder, associated diaphoresis and 11 shortness of breath. She took a sublingual 12 nitro with relief of her pressure. Still felt 13 a little short of breath, and was having pain 14 that continued in the left shoulder. Then 15 repeated a nitro and was pain free in the 16 chest area, but pain remains in the shoulder 17 and still feels a little bit short of breath." 18 Those were her presenting complaints to 19 the emergency department; is that fair? 20 A. That's what it says. 21 Q. Now, that description alone, is that angina or 22 unstable angina? 23 A. It would be consistent with angina. 24 Q. Okay. And you would agree that Doctor 25 Fortune's impression was appropriate, "Chest 31 1 pain, rule out MI," myocardial infarction? 2 A. Yes. 3 Q. Now, in the bottom of the ER report, 4 Exhibit 1, under the hospital course, it says 5 Doctor Fortune said "I have had a 6 teleconference with Doctor Wilson. This 7 patient will be referred to Doctor Baum. He 8 recants a lot of stories about this particular 9 patient, who is quite concerning to him, and 10 there has been a lot of anxiety in regard to 11 return to work, which reportedly happened 12 today." 13 How is it and why is it that Doctor 14 Wilson referred this patient to you that day? 15 A. Doctor Wilson's practice is -- at that time, I 16 believe, was only at Lake West Hospital. 17 Q. And your practice was at Lake East? 18 A. Yes. 19 Q. Was there some kind of a system set up where 20 if a doctor at University Mednet, who had a 21 practice at Lake West, had a patient being 22 seen at Lake East, there would have to be some 23 kind of a referral to a Lake East physician? 24 A. What do you mean by "system"? 25 The general practice was for a physician 32 1 in the group who practiced at another facility 2 and didn't go to Lake East, we would admit the 3 patient and -- actually, let me go back a 4 second. 5 Q. Sure. 6 A. If they were appropriate and stable for 7 transfer and that was the patient's desire, 8 they would be transferred to another hospital, 9 and if any of those conditions made it so that 10 they -- it was more appropriate for them to 11 stay at Lake East, they would, you know, refer 12 the patient to us, who would evaluate the 13 patient and admit them and then treat them 14 appropriately for their condition at that 15 time. 16 Q. Why would Doctor Wilson refer his cardiology 17 patient to you, an internist? 18 Weren't there other cardiologists at Lake 19 East? 20 A. None that were associated with him. 21 Q. Okay. And you accepted this patient for this 22 admission to Lake East on September 19th, 23 1997? 24 A. Yes. 25 Q. Did you have any discussions, that you recall, 33 1 with Doctor Wilson relative to his stories 2 about this particular patient that were quite 3 concerning to him or this patient who was 4 quite concerning to him and about the anxiety 5 with regard to her return to work? 6 A. Not that I recall. I might have; I just don't 7 remember. 8 Q. Is there any significance to the fact that the 9 sublingual nitro relieved the chest pain? 10 A. With her in particular or with anybody? 11 Q. Well, let's talk with her in particular. 12 A. I'm not sure. 13 Q. All right. Isn't that the purpose of 14 prescribing nitroglycerin to a patient who has 15 angina, is for relief of chest pain? 16 A. It's given under the possibility that if 17 they're having significant angina, that it may 18 increase blood flow to the area of ischemia. 19 Q. By dilating the blood vessels or relaxing the 20 blood vessels to allow for dilatation? 21 A. Well, there's many different methods of 22 action. In somebody who has coronary bypass 23 grafting, it may work by other methods. 24 Q. The fact that it relieved her chest pain or 25 granted some relief of her pressure, did that 34 1 suggest that her pressure was likely due to 2 ischemia? 3 A. It might, although there's other diagnoses and 4 conditions that nitroglycerine would treat. 5 Q. Such as? 6 A. Esophageal spasm. 7 Nitroglycerine has a fair amount of 8 placebo effect as well. 9 Q. Okay. Was she ever diagnosed, to your 10 knowledge, with any kind of GI problems, upper 11 GI problems? 12 A. Not to my knowledge. 13 Q. This description in the emergency department 14 report, that's more chest pain typical of 15 myocardial ischemia as opposed to atypical 16 chest pain; would you agree? 17 A. That's the history that the emergency room 18 doctor took. 19 Q. All right. Exhibit 2 is the Lake Hospital 20 Patient Admission Data Record, and under the 21 question "What is the reason you are in the 22 hospital," the statement of "Mid chest to left 23 arm discomfort, weak, dizzy and nauseated, 24 took one NTG, felt slightly better, but 25 nauseated," is that also consistent with 35 1 myocardial chest pain, as opposed to atypical 2 chest pain? 3 A. I would think that if it was typical angina, 4 that one nitroglycerine would make her 5 completely better, but other than that, yes. 6 Q. Okay. I don't know if I heard you, there's 7 this blower motor going up above our heads, 8 but you said you would expect if it was 9 typical angina, that nitroglycerin -- 10 A. Well, nitroglycerine would make it better. 11 Q. Completely better? 12 A. Yes. 13 Q. Okay. Then in your history, physical and 14 impression of 9/19/97 you indicate that this 15 is a woman with a strong family history for 16 coronary artery disease. 17 A. Excuse me; where are you reading? 18 Q. I'm on your -- 19 MR. AUCIELLO: This. 20 A. Oh, I thought you were looking at the 21 impression. 22 Q. Okay. Then about halfway down you state 23 "Today was her first day in going back to 24 work. As she was starting work, there was 25 vague chest discomfort, and this was increased 36 1 by taking a deep breath. She drove herself 2 home and then, after waiting some time, the 3 pain did not resolve, so she drove to the ER. 4 The nitroglycerin may have helped somewhat. 5 She is being admitted for observation." 6 Now, your description of chest pain is 7 different than the description of the 8 emergency department and the Patient Admission 9 Data Record, correct? 10 A. Yes. 11 Q. Do you know why it's different? 12 A. I suspect it's because she told me something 13 different than she told the emergency room 14 doctor. 15 Q. All right. So your impression is based on 16 what she told you? 17 A. Yes. 18 Q. Would you have looked at any of the records 19 that were generated on this patient earlier to 20 make this statement? 21 A. I generally review all the records that are 22 available to me. 23 Q. On the physician progress note, do you know 24 whose signature this is on this page? 25 A. Realizing that it's upside-down, that looks 37 1 like Doctor John Baniewicz. 2 Q. Baniewicz? 3 Looking at it right side-up? 4 A. Still looks like Doctor John Baniewicz. 5 Q. All right. Can you read what he wrote here? 6 I don't know if that's "Objective" or 7 what that is there. 8 A. "Chest pain, no evidence of myocardial 9 infarction, probable either --" I believe 10 that's "musculoskeletal versus pericardial 11 pain." 12 Q. Okay. 13 A. Let me see. 14 Okay. 15 Q. Baniewicz discharged her from the 16 September 19th admission on the next day? 17 A. Do you have the order sheet where it has the 18 discharge order, please? 19 Q. (Indicating.) 20 A. Yes, Doctor Baniewicz discharged her. 21 Q. During that admission, were there any findings 22 consistent with myocardial ischemia? 23 A. I would have to look at the chart. I don't 24 believe that I had any contact with her after 25 I admitted her. 38 1 Q. Why is that? 2 Did Doctor Baniewicz take over? 3 A. Yes. 4 Q. Do you know why? 5 A. I suspect I was on call for that night and he 6 had the hospital rounding duty the next day. 7 Q. Okay. Is this your written order here, 8 9/19/97? 9 A. Yes. 10 Q. Can you just go through what the order was, 11 please? 12 A. Observation status, I wanted a repeat EKG stat 13 for chest pain. Prednisone, 20 milligrams -- 14 Could I turn it straight? 15 Q. Yes. 16 A. My bifocals I'm still getting used to. 17 Q. Sure. 18 A. Prednisone, 20 milligrams now and then 10 19 milligrams per day. Lasix, 40 milligrams per 20 day. Indocin, 50 milligrams tid. Dilantin, 21 100 milligrams tid, with an additional 30 22 milligrams HS. Cardizem CD, 180 milligrams 23 per day. Neurontin, 300 milligrams tid. 24 Ativan, one milligram tid prn. And on the 25 labs that had been done already, I wanted a 39 1 Dilantin level and then erythrocyte 2 sedimentation rate. Nitroglycerin paste, two 3 inches q six hours, and then she must have 4 complained of headache or something like that, 5 because we stopped the nitroglycerin paste and 6 placed her on Imdur, 60 milligrams a day. 7 And, in addition, there were preprinted 8 dysrhythmia protocol sheets and stepdown 9 standing order sheets which I also signed. 10 Q. All right. You called in a telephone order to 11 hold the cardiac enzymes? 12 Can you read that? 13 That was on the 19th also? 14 A. It says "Hold cardiac enzymes with isoenzyme 15 and sedimentation rate till a.m." 16 Q. Why were they held till the morning? 17 A. I don't recall. I could speculate that maybe 18 they didn't have enough blood that had been 19 done in the emergency room or that too much 20 time had passed from the time that it was 21 drawn in such a way that the specimen was 22 not -- not usable. 23 Q. What are the important cardiac enzymes 24 considering myocardial ischemia or infarction 25 as a cause of chest pain? 40 1 A. You would look for the total CK and the 2 percentage of that which is in the MB 3 fraction. 4 Q. Okay. And her enzymes that were done on -- it 5 looks like they were done on the 19th and some 6 on the 20th. 7 A. Yes. 8 Q. How do you interpret the reading on the 9 enzymes? 10 A. Her total CK the first time was 59, which was 11 normal -- 12 Q. All right. 13 A. -- and the MB fraction was normal -- was zero. 14 The second one, which was done at 5:00 in 15 the morning, 9/20/97, her total CK was 44, of 16 which there was no MB fraction. 17 Q. Do you recall whether you had any discussions 18 with Doctor Wilson about his patient after 19 this September 1997 admission? 20 A. Immediately after -- 21 Q. Yeah. 22 A. -- or later? 23 Q. Immediately after. 24 A. I don't recall. 25 Q. What about between September of '97 and 41 1 October of 1998? 2 A. I don't recall. 3 Q. All right. The next time you saw her was in 4 October of 1998; is that correct? 5 A. Yes. 6 Q. This is Lake East, correct? 7 A. Yes. 8 Q. And she came in through the emergency 9 department -- 10 A. Yes. 11 Q. -- because of chest pain? 12 A. Yes. 13 Q. And it says at the bottom of the emergency 14 center record "Admit Doctor Baum's service, 15 observation status, stepdown unit." 16 I think it's right on the bottom of the 17 page you have in front of you. 18 A. Oh, no, I -- was that a question? 19 Q. Yes. 20 A. That's what it says. 21 Q. How was it that she was admitted to your 22 service, instead of Doctor Wilson, the third 23 time? 24 A. Unfortunately, I must have been on call. She 25 must have liked coming in on the days that I 42 1 was on call. 2 Q. Okay. It looks like Michael May was the M.D. 3 in the emergency department. 4 A. Yes. 5 Q. And his physician notes say "Two months 6 crushing with walking, two weeks to back and 7 arms, rest okay since CABG," C-A-B-G. "Pain 8 after getting out of -- on tub --" or -- do 9 you see that down there? 10 A. Actually, I think this is Boris' note, but I 11 really can't tell. It looks like tuba to me. 12 Q. Okay. "Awakened better with nitroglycerin, 13 six to seven times." There's a mention of 14 "sweating, diaphoresis, shortness of breath 15 and nausea." 16 A. Yes. 17 Q. Okay. Then the typed note says "Complaining 18 of chest pains. She has had for the last two 19 months chest pains with any minimal walking, 20 substernal described as crushing. In the past 21 two weeks these symptoms have progressed so 22 that there is no radiation to her back and 23 arms. Although she has had similar mild 24 symptoms --" they must have omitted the word 25 since "-- since her open heart surgery in 1997 43 1 her symptoms have increased in severity since 2 the past time interval as stated above. Today 3 after she was awakened with chest pains and 4 was better with the nitroglycerine again after 5 just getting out of the bathtub she had an 6 episode of similar pains that were better with 7 nitroglycerine. She has had six to seven 8 episodes in the past 12 hours of these 9 episodes associated with some diaphoresis, 10 nausea and shortness of breath. Usually takes 11 five to six nitroglycerine per day for the 12 last two months. At the time of arrival in 13 the ER the patient is asymptomatic." 14 Now, those symptoms that Doctor May 15 described or that Doctor Boris -- I guess that 16 would be the physician's assistant -- 17 A. Yes. 18 Q. -- described that Doctor May signed off on, 19 would you agree those symptoms are consistent 20 with coronary chest pain? 21 A. Yes. 22 Q. Okay. Then "Disposition," it says "IV, 02 23 cardiac monitor and normal sinus rhythm and 24 no --" how do you pronounce that "-- ectopy"? 25 A. Where are you talking? 44 1 Q. On "Disposition," down there. "IV, 02 --" 2 A. Ectopy. 3 Q. Ectopy, okay. 4 "Case discussed with Doctor Baum on call 5 for Doctor Bowersox," and she was admitted to 6 telemetry observation based on your telephone 7 order, I take it? 8 A. Yes. 9 Q. All right. Now, what was described was not 10 atypical chest pain, would you agree, that 11 description we just went over? 12 A. Yes. 13 Q. You would agree that it is not? 14 You would agree that that description is 15 not atypical chest pain? 16 A. Yes. 17 Q. We just went over Exhibit 7, which is the 18 emergency room report. Would you -- is that 19 the document we just described? 20 A. Yes. 21 Q. All right. And Exhibit 6 is the emergency 22 center record, which states "Patient states 23 past two months severe chest pain with 24 exertion, associated with nausea, dizziness, 25 weakness, usually relieved by one 45 1 nitroglycerine in five to 10 minutes. Pain 2 has progressively increased in intensity and 3 frequency. Presently pain free." 4 Again, is that description consistent 5 with angina or unstable angina? 6 A. Yes, it would be consistent with an angina. 7 Q. Angina, okay. 8 And that would be inconsistent with 9 atypical chest pain? 10 A. Less likely. 11 Q. All right. Then your history and physical, 12 you noted that she was a woman with a long 13 history of coronary artery disease, that she 14 is status post CABG in March of '97. You 15 noted she had her last cardiac catheterization 16 in 7/97. 17 Where did you obtain that information 18 from? 19 A. I suspect that she told me. 20 Q. Okay. And you indicated the results were not 21 available, and apparently she was not able to 22 tell you what the results were? 23 A. No. 24 Q. She also told you she had a treadmill stress 25 test in July of '97 -- or, no, July of '98? 46 1 Again, she was not sure of the results; 2 is that correct? 3 A. Yes. 4 Q. All right. And you noted she had been using 5 increasing nitroglycerine for past three to 6 four months, and particularly over the last 7 several weeks. 8 Is that conduct consistent with a person 9 who's having an increase in chest pain due to 10 myocardial ischemia? 11 A. Yes. 12 Q. What about the fact that her discomfort 13 awakened her from sleep the night before? 14 Is that -- I guess a lot of pain can 15 awaken you from sleep. Any significance to 16 that fact relative to her heart? 17 A. I don't think it has any significance. 18 Q. What about her moderate chest pain relieved by 19 nitroglycerine and rest; is that significant 20 relative to her coronary artery disease or the 21 cause of the chest pain? 22 A. That would be consistent with myocardial 23 ischemia. 24 Q. Okay. Then you indicated there was some 25 shortness of breath. She came into the ER, 47 1 where her EKG was noted to have changed 2 slightly from the prior finding, and therefore 3 she was being admitted for observation. 4 Do you know what her tracings were 5 compared to the September 19th tracings? 6 A. I'm not sure. 7 Q. Do you know what the changes were? 8 A. My note, I said there are T wave inversions 9 laterally. 10 Q. And what's the significance of T wave -- 11 A. That's a nonspecific finding, but it could be 12 consistent with myocardial ischemia. 13 Q. Okay. Initial CK, is that the total or -- 14 A. I would assume that it's normal. 15 Q. At what point does it become abnormal and 16 consistent with myocardial damage, the CK 17 enzymes? 18 A. There's two questions there. 19 Q. I'm sorry. 20 A. For their lab, at the time that they did this 21 test, their normal was 24 to 107 -- I'm sorry; 22 170. There's many things that can make the 23 total CK go up, so even if you have an 24 elevated CK, that's not specific for 25 myocardial infarction. 48 1 Q. What is specific for myocardial infarction, as 2 far as the enzymes; the CK/MB? 3 A. Generally, yes, but there are some times that 4 people have elevated CK/MBs and haven't had 5 myocardial infarction. 6 Q. What causes that? 7 A. Again, there's many different ways to 8 interpret these numbers, but, for instance, 9 suppose you have a fall and can't get up and 10 you have muscle necrosis and your total CK is 11 very elevated. You can have an elevated 12 CK/MB, even though their heart is probably 13 okay. 14 Q. Okay. But in a patient like Jane, if you'd 15 see an elevated CK or CK/MB, it would be 16 likely consistent with myocardial infarction? 17 A. Yes. 18 Q. Because there is no other history that we see 19 here in the record that would indicate any 20 reason for an elevated enzyme like that? 21 A. Yes. 22 Q. Okay. Your impression was "Rule out MI"? 23 A. Yes. 24 Q. Did you give an order to effectuate that plan? 25 A. Excuse me? 49 1 Q. Did you give an order to effectuate that plan? 2 A. "Effectuate" meaning --? 3 Q. To rule out MI. 4 A. Yes. 5 Q. Can you read that? I can't read your writing. 6 I'm assuming this is your writing. 7 A. Yes. 8 Q. Okay. 9 A. "Observation status, telemetry, MI dysrhythmia 10 protocols, Lasix 40 milligrams per day, 11 Dilantin 300 milligrams q a.m., transdermal 12 nitroglycerine 0.4 milligrams per hour, 13 Cardizem CD 180 milligrams per day, K-Dur 20 14 milliequivalents, and Indocin 25 milligrams 15 tid with food. 16 Q. Okay. In your view, was there anything 17 atypical about her chest pain during this 18 admission? 19 A. No. 20 Q. In the October 13th, 1998 EKG it says 21 "Nonspecific T wave abnormality," and in your 22 note you described it as "T wave inversions 23 laterally." Were you looking at the 10/13 EKG 24 for the inverted T waves? 25 A. Yes. 50 1 Q. Show me the -- 2 A. Well, like I -- I would assume, because she 3 has inverted T waves in V4, V5 and V6. 4 Q. Okay. And you pointed to what part of the 5 tracing in V4, V5 and V6 for the inverted 6 T waves? 7 A. This. 8 Q. Right here? 9 A. Yes. 10 Q. That's the inverted T wave? 11 A. Yes. 12 Q. All right. Now, in the October 14th EKG, it 13 says "T wave abnormality, consider interior 14 lateral ischemia, prolong Q-T interval. When 15 compared with the EKG of 10/13/98, inverted T 16 waves have replaced nonspecific T wave 17 abnormality in the interior lateral leads." 18 Can you point out to me what's being 19 described here on this 10/14/98 EKG? 20 A. I assume you're still talking about these 21 inverted T waves here. 22 Q. Is there any difference in the degree of 23 inversion between the 13th of October and the 24 14th of October? 25 A. To my eye, they look about the same. There 51 1 may be some more T wave inversion in V3 which 2 was not present here. That could be due to 3 lead placement. 4 Q. But in a patient like Jane Mastro, on October 5 13th and 14th, '98, with her history and 6 complaints, the number one consideration and 7 concern is these changes are due to myocardial 8 ischemia; is that correct? 9 A. Yes. 10 Q. Now, do you recall having any conversations 11 with Jane Mastro during this admission? 12 A. When she was admitted, I must have talked to 13 her. I don't recall it specifically, though. 14 Q. Okay. If you don't recall any specific, then 15 I take it you couldn't answer, either admit or 16 deny making any particular statements to her 17 during that admission? 18 MR. AUCIELLO: I'll object to 19 that. I mean, he may not be able to 20 recall, but if you say "Did you say 21 something," he might say "No, I would 22 never say that." 23 MR. LANCIONE: All right. I'm 24 going to ask him that. 25 Q. She has stated that you made some comments to 52 1 her during this admission to the effect of 2 crying wolf about her chest pain, that "You'd 3 better stop crying wolf about this chest 4 pain." 5 Do you recall anything like that? 6 A. I have no recollection. 7 Q. Okay. Doctor Baum, is there any evidence of 8 infarction on the October 13th or October 14th 9 EKG? 10 A. T wave inversions can sometimes be an 11 indication of infarction. 12 Q. New infarct or old infarct? 13 A. You don't know. 14 Q. You don't know? 15 And in your note, when you -- you don't 16 know what you were comparing the October 13th 17 '98 tracing to, to say that there's been a 18 change? 19 A. No; I just put down that it was from past 20 tracings. 21 Q. Okay. When you're reading a tracing, where do 22 you typically get the previous tracing from; 23 the patient's hospital chart -- 24 A. Yes. 25 Q. -- from that facility, from the Lake East 53 1 facility? 2 A. Yes. 3 Q. Okay. 4 A. Sometimes people bring their own tracings 5 along. 6 Q. Just happen to have their own tracings with 7 them. 8 A. Uh-huh. 9 Q. I'm sure you've seen that. 10 Okay. With the benefit of the 11 retrospectoscope, since we have the clinic 12 chart and we know what they found when they 13 did the coronary angiogram, is it reasonable 14 to conclude that her chest pain was indeed due 15 to bypass restenosis or bypass stenosis? 16 A. Realizing that sometimes people have ischemic 17 disease and have symptoms that are sometimes 18 attributable to something else, in her it 19 would seem reasonable to say that yes, that 20 she had chest pain that was ischemic in 21 nature. 22 Q. Would it have been your place with this 23 patient, in October of '98 and September of 24 '97, to recommend other diagnostic procedures 25 or did you consider that to be Doctor Wilson's 54 1 responsibility, specifically relating to her 2 heart? 3 A. I would suspect that that would be Doctor 4 Wilson's responsibility. 5 Q. Would it be routine for you, with a patient 6 like this, as the attending for the admission 7 in September of '97 or October of '98, to 8 order a cardiac catheterization or a treadmill 9 stress test, or would you first seek input 10 from her cardiologist, before making that kind 11 of recommendation or order? 12 A. I can't order a catheterization and I can't 13 order a stress test. You have to have a 14 cardiologist to consult first. 15 Q. Is that because of the parameters of your 16 privileging at Lake East or is that some other 17 rule or protocol? 18 A. I don't have privileges to do cardiac 19 catheterizations or stress tests. 20 Q. Well, I know you don't have the privileges to 21 do them, but can you order them? 22 You know, if you knew your patient needed 23 a catheterization, would you make that order 24 or would you say "You first have to see a 25 cardiologist to --" 55 1 A. That's not an order. That's a -- 2 Q. Recommendation? 3 A. You could say, perhaps, "Yes I think you need 4 a catheterization; this is the number of ways 5 you can do it. There are a number of ways 6 that can be --" what was that word you used, I 7 liked that "-- effectuated." 8 Q. Effectuated. 9 Was it your understanding during the time 10 of the '97, September of '97, admission and 11 October '98 admission that this patient was 12 under the care of Doctor Wilson, the 13 cardiologist? 14 A. Yes. 15 Q. Did you make any recommendations to her to 16 follow up with her cardiologist after 17 discharge? 18 A. Could I see the progress notes, please? 19 Q. Sure. 20 Maybe they weren't tabbed. I'll let you 21 take a look. 22 A. So this tab is where this admission would 23 start? 24 Q. Yes. It should. 25 Here, I found them. 56 1 A. I believe that's from the other admission. 2 Q. Yeah, you're right. 3 MR. AUCIELLO: Maybe you don't 4 have them either, because I don't 5 think they gave them to me. 6 MR. LANCIONE: Okay. 7 If you want an authorization, if 8 you want to subpoena them, send it. 9 MR. AUCIELLO: Yeah, because we 10 seem to have spotty records, and we 11 need a whole set, so I'll have the 12 paralegal do that. 13 MR. LANCIONE: Okay. 14 Q. So there's nothing that would lead you to 15 believe or nothing that would help you recall 16 whether you told her to see Doctor Wilson 17 after discharge? 18 A. In the discharge summary written sometime 19 after she was discharged, I indicated that she 20 should follow up with Doctor Wilson. 21 Q. Okay. "Follow with Wilson." 22 Is that what you're referring to? 23 A. Yes. 24 Q. All right. Who's Bowersox? 25 A. Bowersox is another one of the primary care 57 1 physicians at the clinic, and I believe he was 2 her attending -- or her primary care doctor. 3 Q. Do you feel that your care of Jane Mastro 4 complied with the acceptable standards of care 5 in 1997 and 1998? 6 THE WITNESS: Could I ask you 7 what the implications of that is? 8 MR. AUCIELLO: Well, I mean, to 9 some extent he's asking you a legal 10 question. He's asking whether you 11 were negligent in your care of Jane 12 Mastro. 13 Q. Do you think your care was appropriate and 14 commensurate with the standard of care of a 15 physician practicing internal medicine in 1997 16 and 1998? 17 A. Yes. 18 Q. Do you have any criticisms of Doctor Wilson 19 and his care of Jane Mastro? 20 A. I'm not sure I'm in a position to comment on 21 his care. 22 Q. Because of the difference in specialty 23 practice? 24 A. Yes. 25 Q. Do you have any criticisms of Jane Mastro and 58 1 her conduct relative to her health and 2 well-being? 3 A. No. 4 Q. Do you have any criticisms of any physician 5 who cared for her relative to her heart 6 disease? 7 A. No. 8 Q. Okay. 9 A. Or I -- no, I don't have the information that 10 it would take to make that kind of 11 determination. 12 Q. Those are all the questions I have. Thank 13 you. 14 MR. AUCIELLO: Okay. We'll read 15 it, and I'll buy a copy. You can send 16 me a copy and I'll give it to Doctor 17 Baum to read. 18 - - - - 19 _______________________ STEPHEN BAUM, M.D. 20 _______________________ 21 Date 22 23 24 25 59 1 The State of Ohio, ) 2 ) SS: County of Cuyahoga. ) 3 4 C E R T I F I C A T E 5 I, Debra A. Butzer, a Notary Public 6 within and for the State aforesaid, duly commissioned and qualified, do hereby certify 7 that the above-named STEPHEN BAUM, M.D. was by me, before the giving of his deposition, 8 first duly sworn to testify the truth, the whole truth and nothing but the truth; 9 That the deposition as above set forth was 10 reduced to writing by me by means of stenotypy, and was later transcribed upon a 11 computer by me; 12 That the said deposition was taken in all respects pursuant to the stipulations of 13 counsel herein contained; that the foregoing is the deposition given at said time and place 14 by said STEPHEN BAUM, M.D.; 15 That I am not a relative or attorney of either party or otherwise interested in the 16 event of this action. 17 IN WITNESS WHEREOF, I hereunto set my hand and seal of office, at Cleveland, Ohio this 18 29th day of February, A.D. 2000. 19 20 ________________________________ Debra A. Butzer, Notary Public 21 Classic Court Reporters East Ohio Building, Suite 1625 22 1717 East Ninth Street Cleveland, Ohio 44114 23 (216) 436-4107 24 My Commission expires: January 10, 2003 25