0001
 1   State of Ohio,          )
                             )   SS:
 2   County of Cuyahoga.     )
 3                             - - -
 4                 IN THE COURT OF COMMON PLEAS
 5                             - - -
 6   Gerald Lasko,                 )
                                   )
 7                  Plaintiff,     )
                                   ) 
 8               vs.               ) Case No. 429614 
                                   ) Janet Burnside, J.
 9   William Bohl, M.D., et al.,   )
                                   )
10                  Defendants.    )
11                             - - -  
12                  
13   
14        Deposition of William Bohl, M.D., a Defendant 
15   herein, called by the Plaintiff for cross-examination, 
16   pursuant to the Ohio Rules of Civil Procedure, taken
17   before Constance Versagi, Court Reporter and Notary Public
18   in and for the State of Ohio, taken at the offices of
19   William Bohl, M.D., 1730 West 25th Street, Cleveland, 
20   Ohio, on Thursday, January 24th, 2002,
21   commencing at 2:14 p.m.
22                             - - -
23                               
24   
25   
0002
 1                             INDEX
 2   WITNESS:                                     CROSS
 3   William Bohl, M.D.          
 4        by Ms. Kolis                              4       
 5                             - - -
 6                        E X H I B I T S
 7   Plaintiff's:                                Marked
 8        1                                         6
 9        2                                        22
10        3                                        28
11        4                                        37
12        5                                        41
13        6                                        43
14        7                                        54
15        8A & B                                   57
16                             - - -
17                      O B J E C T I O N S
18   ATTORNEY                                  PAGE-LINE
19        MR. WILT                              26 -  5
20        MR. WILT                              29 -  9
21        MR. WILT                              34 - 20
22        MR. WILT                              39 - 21
23        MR. WILT                              40 -  5
24        MR. WILT                              50 -  2
          MR. WILT                              63 - 22
25        MR. WILT                              69 - 23 
0003
 1   APPEARANCES:  
 2   On behalf of the Plaintiff:       
 3        Donna Taylor-Kolis, Esq.
          Donna Taylor-Kolis Co., L.P.A.
 4        1370 Ontario Street
          330 Standard Building
 5        Cleveland, Ohio  44113
          216-861-4300
 6   
 7   On behalf of the Defendants:       
 8        Ronald M. Wilt, Esq.
          Buckingham, Doolittle & Burroughs
 9        1375 East Ninth Street
          1700 One Cleveland Center
10        Cleveland, Ohio  44114
          216-621-7040
11               
12                             - - -
13   
14   
15   
16   
17   
18   
19   
20   
21   
22   
23   
24   
25   
0004
 1                      WILLIAM BOHL, M.D. 
 2   of lawful age, being first duly sworn, as hereinafter 
 3   certified, was examined and testified as follows:
 4                      CROSS-EXAMINATION
 5   By Ms. Kolis:
 6   Q      For purposes of the record, my name is Donna Kolis. 
 7          As you are undoubtedly aware I've been retained to 
 8          represent your patient, who is now my client, 
 9          Gerald Lasko.
10                  My purpose in deposing you today is to 
11          basically find out some factual information that 
12          may not be clear to me from your records.
13                  I gather, Doctor, this is not the first 
14          time you've ever been deposed?
15   A      No.
16   Q      Having said that, however, I'm going to make a 
17          couple of remarks to remind you what deposition 
18          rules are, see if we could secure a couple of 
19          agreements.
20                  I would suspect that you understand that 
21          you are required to answer every question verbally?
22   A      Yes.
23   Q      You probably are aware that today is the only time 
24          that I would be able to speak with you under oath 
25          before trial; is that your understanding?
0005
 1   A      I didn't know that was a fact, usually happens that 
 2          way.
 3   Q      If I ask a question, Doctor, inartfully, trust me, 
 4          if you knew me, it is a distinct possibility you 
 5          won't understand some of my questions.  In any 
 6          event, if I do ask a question, you don't understand 
 7          what information I'm seeking, would you please let 
 8          me know you don't understand my question; can I 
 9          secure that agreement from you?
10   A      Yes.
11   Q      If at any time you wish to confer with your 
12          counsel, Mr. Wilt, although most attorneys object 
13          to that during a deposition, I do not.  Simply 
14          indicate for the record you wish to confer with 
15          your attorney, I'll get up and leave the room, you 
16          guys can work it out; do you understand that you 
17          have that right?
18   A      Okay.
19   Q      Lastly, it's unlikely, but there may come a point 
20          when I ask a question, Mr. Wilt will object.  If he 
21          does so, please do not answer the question on the 
22          table until your attorney tells you to do so; can I 
23          also secure that agreement from you?
24   A      Okay.
25   Q      You have just handed me your CV.  It is my fault, I 
0006
 1          did not ask for it prior to today.  We'll have the 
 2          court reporter mark that as Plaintiff's Exhibit 1. 
 3                  (Plaintiff's Exhibit 1 
 4                  marked for identification.)
 5   Q      I know you want to tell your life story, we're 
 6          going to make this part short hopefully.
 7                  You graduated from Case Western Reserve 
 8          Medical School in 1972, correct?
 9   A      Yes.
10   Q      Following that you entered into an internship at 
11          University Hospitals according to your CV from '72 
12          to '73?
13   A      Yes.
14   Q      Surgical of course.  Then '73 to '74 you were in a 
15          general surgical residency at UH, correct?
16   A      Yes.
17   Q      Who was the chairman of the department at that 
18          time, if you have a recollection?
19   A      Charles Hubay.
20   Q      Then you switched programs, you went over to the 
21          Cleveland Clinic; is that right?
22   A      Yes.
23   Q      '74 to '77, correct?
24   A      Yes.
25   Q      Why did you -- I see.  At that point did you 
0007
 1          determine you wanted to specialize in orthopedics, 
 2          is that why you transferred programs?
 3   A      Yes.
 4   Q      Who was the director of the orthopedic surgery 
 5          program when you were at Cleveland Clinic?
 6   A      Initially Roy Collins, then secondarily Allen Wild.
 7   Q      Subsequent to 1977 I assume that you became Board 
 8          certified.  I see I'm correct.
 9                  You are Boarded, Doctor, in orthopedic 
10          surgery, correct?
11   A      Yes.
12   Q      1978 is what your curriculum vitae indicates.
13                  Are you Board eligible in any other medical 
14          subspecialties?
15   A      No.
16   Q      Why don't you briefly run me through your medical 
17          career, beginning at the time you finished your 
18          orthopedic Fellowship at the Cleveland Clinic?
19   A      Pretty easy.  I've been in private practice at  
20          this location since 1977, doing general orthopedics 
21          and a number of specialty things.  Primarily 
22          arthroscopy, joint replacement, the last number of 
23          years, a lot of spine work.
24   Q      Let me break that out for you.  At the time that 
25          Mr. Lasko was your patient -- he was your patient 
0008
 1          for a substantial period of time.  In the summer of 
 2          1999 when he was your patient, you were a member of 
 3          a group called Ohio City Orthopedics, correct?
 4   A      Yes.
 5   Q      When was that entity formed, to the best of your 
 6          recollection?
 7   A      I think it was 1976.
 8   Q      So you've always been with Ohio City Orthopedics?
 9   A      Yes.
10   Q      If my memory reserves me well from the days I used 
11          to do plaintiff automobile work, over the years 
12          there have been different combinations of 
13          physicians in this group, correct, some have gone, 
14          some have left?
15   A      Little bit of a change.
16   Q      Essentially this has always been your practice?
17   A      Yes.
18   Q      In the answer that you gave previously you 
19          indicated that for the last several years, I'm 
20          paraphrasing, you did more spine work.
21                  What kind of spinal surgery do you do?  
22          When did you begin doing them actively I suppose is 
23          the easy way to phrase it?
24   A      From the time I was in practice in 1977.  I've done 
25          spine work, all the cervical spine work for our 
0009
 1          practice.  A lot of lumbar work.  When instrumented 
 2          spine work came along, I was one that was doing 
 3          that.
 4   Q      The only reason I asked that was the way you 
 5          phrased it for the last several years, perhaps you 
 6          were trying to communicate to me you became more 
 7          involved in spine work in the last several years 
 8          than you had previously been?
 9   A      What's happened differently in the last few years, 
10          my partners have never done anything but simple 
11          diskectomies on the lumbar spine.  When the newer 
12          fusion techniques and instrumented techniques for 
13          the lumbar spine came along, I was the only one 
14          doing them.
15                  Additionally there is a number of other 
16          procedures on the spine, I'm the only one in the 
17          group that does percutaneous, arthroscopic 
18          diskectomies.  I do vertebral body replacement.  
19          Most of the major things that are done in spine.  
20          So I would get all of their referrals.
21                  In addition to that, there is a Cleveland 
22          Orthopedic and Spine Hospital, that now has a 
23          section on spinal surgery, which I'm one of the 
24          members of.
25   Q      I was going to ask you about that in a second.  
0010
 1          Forgive my ignorance, I don't profess to understand 
 2          how people become experts in their fields at 
 3          certain procedures.  Was there a special 
 4          certification class or additional training past 
 5          your Fellowship you took to become competent in 
 6          fusion and instrumentation procedures, the ones you 
 7          are describing that your other partners don't do?
 8   A      For virtually every one of those things I've done, 
 9          except the cervical spine, I learned to do in my 
10          training.  All the instrumented spines and 
11          techniques with the electrodes and percutaneous 
12          things I have taken courses for.
13   Q      The courses that you took to get you I suppose to a 
14          different level of competence are not listed here 
15          on your CV, correct?
16   A      No.  There is a huge number of courses that I have 
17          had, there are too many to put on a CV.
18   Q      Currently, Doctor, you have privileges at what 
19          hospitals?
20   A      Lutheran Hospital, Saint Vincent Charity Hospital, 
21          Deaconess Hospital and Saint Michael's Hospital.
22   Q      Do you perform surgeries more regularly at any one 
23          of the four of those?
24   A      About 90 percent of what I do has been at Lutheran 
25          Hospital.
0011
 1   Q      The other hospitals only on occasion; is that a 
 2          fair statement?
 3   A      The other hospitals are pretty much things we get 
 4          through the emergency room at those hospitals, 
 5          consults from physicians at those hospitals.
 6   Q      Trauma surgery if they come in and are you on call, 
 7          consultations from other physicians practicing out 
 8          of that hospital?
 9   A      Yes.
10   Q      I generally try to take a short deposition.  I know 
11          that probably shocks you, but I do.
12                  Dr. Bohl, you have been sued for medical 
13          negligence prior to this occasion, correct?
14   A      Yes.
15   Q      I don't want to know about all those cases.  The 
16          only thing I want to ask you is has there been any 
17          other claims against you filed, I'm not talking 
18          about letters of intent to sue, regarding a dorsal 
19          column stimulator?
20   A      No.
21   Q      This is the only case that has been an issue for 
22          you, correct?
23   A      Yes.
24   Q      Are you generally acquainted with what my 
25          allegations of negligence are against you?
0012
 1   A      I think so.
 2   Q      I guess we could talk a little bit about that.  I 
 3          like to give you a chance first before I pick 
 4          through the records.
 5                  Upon reflection, Doctor, do you agree with 
 6          me that in some respects the care and treatment 
 7          which you rendered to Jerry Lasko beginning in 
 8          August of 1999, continuing through September of 
 9          1999, did not meet the accepted standards of 
10          medical care?
11   A      No, not at all.
12   Q      So you don't believe that there is anything which 
13          you should have done differently than you did do?
14   A      Not on the basis of accepted standards of medical 
15          care.  If you look retrospectively, you might 
16          change something that did you.
17   Q      We'll get into that.  I wanted to see how you felt 
18          about it.
19                  Also I guess because I'm curious to ask the 
20          question, it doesn't have anything to do with 
21          medicine, Mr. Lasko seems rather fond of you, he 
22          fairly communicated that to your counsel at his 
23          deposition.  Do you have the same feelings for 
24          Mr. Lasko?  He's been your patient for a pretty 
25          long time, I guess I was curious?
0013
 1   A      Yes, I do.
 2   Q      Subsequent to the time Mr. Lasko had me file this 
 3          lawsuit, you in fact had an opportunity to 
 4          physically examine him; is that right?
 5   A      After you filed the lawsuit?  
 6   Q      Yes.
 7   A      Yes, I did.
 8   Q      How many times have you seen him since that?  I 
 9          don't think I have the updated portion of your 
10          record.  
11                  MR. WILT:           What date did you file 
12          the lawsuit?  
13   Q      I filed the lawsuit February 7, 2001.  
14   A      Yes, I have seen him one time since then.
15   Q      We will talk about that later.  I do not know 
16          whether or not I have your complete medical chart, 
17          so let me ask this question:  What is the first 
18          occasion that you ever had to see Mr. Lasko as a 
19          patient?
20   A      I wish I could tell you.  I believe it was probably 
21          sometime in the late '70s.  Somehow we had a large 
22          number of our charts, without my permission, 
23          purged.  They threw out old charts.  My records 
24          concerning Mr. Lasko, my office records, 
25          handwritten notes actually start in 1990.  I had 
0014
 1          been seeing him at least 10 years before that.
 2   Q      That was my understanding.  I wanted your 
 3          explanation on the record whey when I sent a 
 4          subpoena for the production of records the 
 5          treatment began in 1990, however you just advised 
 6          me somehow charts in your office got purged?
 7   A      Yes.
 8   Q      His was probably one of them?
 9   A      Yes.
10   Q      This is a strange question to ask, do you have 
11          reason to believe that there is any medical 
12          information in the purged charts that would be 
13          relevant to the issues that we're discussing about 
14          the placement of this dorsal column stimulator?
15   A      I don't think so.  I'm sure there are a number of 
16          his spinal surgeries and findings from them in 
17          those charts.
18   Q      Doctor -- 
19                  MR. WILT:           Were you done?
20   A      I don't see how they would have any relation to the 
21          dorsal column stimulator.
22   Q      Fair enough, so we're not worried about those 
23          records being available.
24                  In anticipation of today's deposition, 
25          Doctor, what materials did you review?
0015
 1   A      My office notes, hospital records for the last 
 2          couple admissions, x-rays.
 3   Q      Did you physically look at the x-ray films?
 4   A      Yes.
 5   Q      When you say x-rays, which x-rays are you referring 
 6          to?
 7   A      The ones that were done basically on that 
 8          admission.
 9   Q      We will be able to discuss those.  Did you go back 
10          and look at x-rays, CT's, or MR's taken prior to 
11          August 24 1999?
12   A      No.
13   Q      Fair enough.
14   A      I may have between -- in the last year or since 
15          this happened, I may have looked at them.  I don't 
16          recall doing that though.  I didn't in order to 
17          prepare for this deposition.
18   Q      Do you retain those films in your office?
19   A      They are normally kept down in x-ray.  I happen to 
20          have them signed out right now.  They are in my 
21          office.
22   Q      For what purpose do you have them signed out?
23   A      To look at them.
24   Q      I was curious.  
25   A      Also try and organize.
0016
 1   Q      Fair enough.  I'm assuming there is a goodly number 
 2          of x-rays from over the years?
 3   A      Yes.
 4   Q      Do you have any idea approximately how many x-rays 
 5          there are?
 6   A      Probably hundreds.
 7   Q      You didn't look at all those hundreds, did you?
 8   A      No.
 9   Q      Fair enough.  Doctor, in anticipation of today's 
10          deposition, did you review any medical literature?
11   A      Not in preparation for today's deposition, no.
12   Q      When is the first time that you, as I'll call you a 
13          spine surgeon if that is okay with you, when was 
14          the first time you ever inserted a dorsal column 
15          stimulator?
16   A      I actually didn't know.  I noticed in here it was 
17          about 10 years ago I first started suggesting it to 
18          him.  I had put in a number of them before that.  I 
19          would have to say more than 10 years.
20   Q      I was just curious.  This isn't a contest to trick 
21          you, because there would be no way I would even 
22          know the true answer.  In the last decade, 
23          approximately how many dorsal column stimulators 
24          have you placed in patients?
25   A      I would estimate between 20 and 30.
0017
 1   Q      So not a huge number, maybe two or three a year?
 2   A      Correct.
 3   Q      What is the purpose of a dorsal column stimulator?
 4   A      Used for people who have pain, usually lower 
 5          extremity or back pain, which you are not able to 
 6          relieve by other methods, by further surgery, or in 
 7          some cases the pain isn't due to a spinal problem, 
 8          may be due to a vascular problem, or one of my 
 9          recent patients had a knee operation, had a reflex 
10          sympathetic dystrophy over a four year period of 
11          time, couldn't be helped.  The purpose is primarily 
12          pain relief.
13   Q      Is a dorsal column stimulator something that a 
14          physician recommends when they believe that their 
15          patient has intractable pain syndrome?
16   A      It can be one of the things they might recommend.
17   Q      Is it more or less an option of last resort in pain 
18          management?  If it isn't let me know, I'm curious 
19          how you view them?
20   A      Yes, I guess it would be.
21   Q      In Mr. Lasko's case, what was the primary reason 
22          you recommended this particular device for him?
23   A      He had a number of spinal surgeries in his lower 
24          back.  There did not appear to be anything -- over 
25          the years he would have an operation, he would get 
0018
 1          better and develop a new problem, because things 
 2          tend to shift up in the lower back.
 3                  At the point we did his dorsal column 
 4          stimulation there did not appear to be anything 
 5          further in his lower back treatable surgically, or 
 6          that he had a good chance of getting a good result 
 7          from. He had a lot of scar tissue you can't 
 8          correct, arachnoiditis.  He had significant back 
 9          and leg pain.
10   Q      You felt this was in his best interest, correct?
11   A      I suggested it to him a number of times as an 
12          option.  He tried other things.  This particular 
13          time he decided to use this option.
14   Q      Do you have a recollection, or it doesn't have to 
15          be a recollection, something that you may have 
16          reviewed in the last day or so, that would give you 
17          some indication as to why on prior occasions he 
18          declined your suggestion for this stimulator?
19   A      Yes.
20   Q      I can't read your handwriting.  Not that it's bad, 
21          I have faded copies. 
22   A      You can't tell from anything in the chart why the 
23          reason is.
24                  The reason is for a long period of time the 
25          Bureau of Workmen's Compensation I believe was 
0019
 1          covering his injuries.  Until very recently you 
 2          could not get approval from them to insert a dorsal 
 3          column stimulator.  They wouldn't pay for it.
 4   Q      In the past you would be suggesting it, you would 
 5          be writing letters to the Bureau's medical review 
 6          committee saying I believe this is a necessary 
 7          medical procedure, they would say forget it, 
 8          Dr. Bohl, you can't do that, right?
 9   A      That's correct.
10   Q      What would they, in lieu of a dorsal column 
11          stimulator, allow you to do for the patient?
12   A      They don't suggest other options.
13   Q      They said no, didn't give you any medical options; 
14          is that right?
15   A      Yes, they had reasons for not allowing them, but 
16          it's historical.
17   Q      Fair enough.  To the best of your knowledge, 
18          although as you indicated it's not documented, 
19          there was never a reluctance on Mr. Lasko's part to 
20          follow your advice, simply that he couldn't get 
21          approval for the procedure?
22   A      Yes, initially.  Then other times it wasn't 
23          indicated.  He had reasons that you could identify 
24          why he was having the pain, such as the 
25          degeneration would progress up to another level, he 
0020
 1          had instability and spinal stenosis at another 
 2          level.
 3   Q      Mr. Wilt asked Mr. Lasko a question at his 
 4          deposition, I'm not sure I know the answer because 
 5          of the records.  How many surgeries did you perform 
 6          upon Mr. Lasko?
 7   A      Actually I don't know without his whole chart.  I 
 8          know there were a number of surgeries on his 
 9          ankles.  I know I operated on both of his 
10          shoulders.  He kept getting additional levels in 
11          his neck.  I honestly couldn't tell you.
12   Q      None of us actually as we sit in this room today 
13          know how many procedures he underwent with you; is 
14          that right?
15   A      No.
16   Q      You are indicating in the general sense, first of 
17          all you did his cervical spine, correct?  I don't 
18          want to say first as in time.  
19   A      First thing I ever did to him was a -- I believe it 
20          was a decompression.  His spinal cord was being 
21          compressed by an old compression fracture at L-1 I 
22          think.
23   Q      Not to confuse the record.  All I was indicating is 
24          that over the period of time starting somewhere -- 
25          couldn't have been before 1977, but from '77 
0021
 1          forward you operated on his lumbar spine, cervical 
 2          spine, you're today indicating shoulders and ankles 
 3          also?
 4   A      Both shoulders, both ankles, hands.
 5   Q      During the entire time that you treated him up to 
 6          the point that he arrives for the placement of the 
 7          stimulator on August 24th, did you ever have reason 
 8          to evaluate his thoracic spine?
 9   A      No.
10   Q      Why was that?
11   A      He really never had any symptoms that were 
12          attributable to it.
13   Q      Do you believe, based upon your review of the 
14          records, it is obviously clear to me now you were 
15          able to look at x-rays, that Mr. Lasko had 
16          degenerative disk disease?
17   A      Yes.
18   Q      Through what areas of his body did he have 
19          degenerative disk disease?
20   A      Probably his entire spine.
21   Q      Therein lies my question.  I just asked you about 
22          the thoracic.  You are indicating that you really 
23          didn't evaluate that because there were no specific 
24          complaints to the thoracic spine, correct?
25   A      That's correct.
0022
 1   Q      However, it would have been clear to you, prior to 
 2          the time that you took him in for the dorsal column 
 3          stimulator on August 24th, that did he in fact have 
 4          degenerative disk disease as you just testified 
 5          probably throughout his entire spine?
 6   A      Probably.  But the disks in the thoracic spine are 
 7          usually very small, don't cause problems.
 8   Q      Sometimes do they cause problems however?
 9   A      They can.
10   Q      I guess I'm going to -- before we get into that 
11          issue, if you would look at your office notes.  I 
12          made it easy, I copied the ones I wanted to talk 
13          about.
14                  (Plaintiff's Exhibit 2 
15                  marked for identification.)
16   Q      Doctor, I'm going to let you use this one for 
17          reference so you don't have to dig for them, or you 
18          can look at your original if it's better.  I would 
19          like to have read into the record what appears to 
20          be your progress note of -- let me guess on the 
21          date, July something 1999, where it says insurance 
22          Anthem.
23   A      Looks like July 7th.
24   Q      Mine I can't tell what the date is.  I do apologize 
25          for that.  Would you read into the record what your 
0023
 1          note of that date says?
 2   A      Pain worse, back left leg.  Right leg gives way.  
 3          Discussed dorsal column stimulator.  Surgery, 
 4          laminectomy to insert dorsal column stimulator 
 5          electrode 8-24-99.  Surgery to implant dorsal 
 6          column stimulator 8-26-99.  Vicodan ES number 50.
 7   Q      Let me ask you a couple questions about this note.
 8                  If it is as you indicate July 7, 1999, at 
 9          that point he's back in your office for 
10          evaluation.  Had you concluded what he was 
11          suffering from was a failed back syndrome from your 
12          surgery of the prior December?
13   A      That is one name for it.
14   Q      I don't want to give it the wrong name.  What was 
15          your diagnosis for your patient based upon his 
16          symptoms of presentation on July 7, 1999?
17   A      Well, failed back syndrome covers a lot of the 
18          things he has.  He was having symptoms from 
19          arachnoiditis, scar tissues around the spinal 
20          cord.  Arthritic changes in the lower spinal cord.  
21          Probably from some degenerative disk disease from 
22          the disks themselves since he hadn't had anterior 
23          fusions, except at a couple levels.
24   Q      I hope I didn't seem like I was being difficult.  I 
25          borrowed that phrase because I saw it somewhere in 
0024
 1          your notes you were calling it failed back 
 2          syndrome.  I was trying to identify.  On this 
 3          particular date you didn't recognize a new 
 4          independent operable orthopedic problem that would 
 5          be accounting for the back left leg pain worse; is 
 6          that right?  
 7   A      No.
 8   Q      Did you do any additional diagnostic testing at 
 9          that time to determine what the probable or 
10          possible causes could have been for what he was 
11          experiencing?
12   A      Not on that date.
13   Q      When prior to July 7, 1999 was the last time that 
14          you performed an x-ray, CAT scan or MRI on 
15          Mr. Lasko's spine?
16   A      We had an x-ray March 26, 1999.
17   Q      You had an x-ray done of his lower back; is that 
18          correct?
19   A      Yes.
20   Q      Prior to July 7, 1999, at any time were you in 
21          possession of diagnostic studies that indicated 
22          that there was degenerative disease in the thoracic 
23          spine?
24   A      I don't know.
25                  MR. WILT:           Take a second and look, 
0025
 1          Doctor.
 2                  MS. KOLIS:          You can have more than 
 3          a second.  I know the records are voluminous, that 
 4          is why I'm not in a rush.
 5   A      Are you aware of anything in my notes?  
 6   Q      I would love to answer questions.  
 7   A      Sometimes I say no, then somebody points out 
 8          something in my notes I didn't see.
 9   Q      The truth of the matter is I'm not, but that 
10          doesn't mean it's not there.
11   A      I actually don't recall ever -- I had several 
12          x-rays over the years of the L-1 area.
13                  MR. WILT:           There is a CT scan of 
14          the thoracic spine on 10-8-90.
15                  MS. KOLIS:          About a decade before 
16          this procedure.  
17                  MR. WILT:           What's your question?  
18                  MS. KOLIS:          I asked if at any point 
19          he was aware of degenerative disease in the 
20          thoracic spine area.
21   A      I would assume that he would have degenerating 
22          disks in the thoracic spine.  A lot of the x-rays 
23          that had been taken in the area around his L-1 
24          would have shown the thoracic spine.  All you 
25          really see on the regular x-ray is sort of a flat 
0026
 1          disk.
 2   Q      You didn't have any independent or specific MR or 
 3          CT studies done of the thoracic spine up to the 
 4          point of July 7, 1999 is that -- 
 5                  MR. WILT:           Let me object.  This is 
 6          a CT scan of the lower thoracic spine.  
 7                  THE WITNESS:        In 1990.  
 8                  MR. WILT:           If you are saying up to 
 9          that point.
10   Q      You had one done in 1990 evaluating what parts of 
11          the body?  I don't know that I have that report.  I 
12          may have it.  
13   A      Lower thoracic spine post myelogram and CT of the 
14          lumbar spine.  They have a section for the mid body 
15          at T-9 to mid body of T-12.  It says there is a 
16          large calcified spur seen laterally at T-10/11 on 
17          the left.  Posterior bulging of the disk at the 
18          T-11 level to the left of midline obliterating 
19          subarachnoid space.
20   Q      Can I inquire the date of that study, because I am 
21          fairly certain I do not have that one?
22   A      October, 1990.  October 8, 1990.
23   Q      To the best of your knowledge, between October 8, 
24          1990, up to July 7, 1999, did you ever have another 
25          occasion to examine or evaluate findings in the 
0027
 1          thoracic spine on Mr. Lasko?
 2   A      No, not that I'm aware of.
 3   Q      We will let counsel look for a minute.  I thought I 
 4          had the records from 1990 through present.
 5   A      That particular one was directed at looking at the 
 6          level of the fusion.  It was incidental that you 
 7          saw the thoracic spine.
 8   Q      That was going to be my next question.  In terms of 
 9          this examination of October 8, 1990, you did not 
10          order that study to evaluate the thoracic spine.  
11          The thoracic spine was an incidental finding 
12          because you were hooking at what was below it, 
13          correct?
14   A      Yes, just below it.
15   Q      On July 7th you evaluate Mr. Lasko, you discuss 
16          with him again regarding his pain syndrome, a 
17          dorsal column stimulator, correct?
18   A      Yes.
19   Q      Doctor, at what point did you advise Mr. Lasko as 
20          to what the risks were for the placement of a 
21          dorsal column stimulator?
22   A      I probably told him about them several times over 
23          the -- at the different times I talked to him about 
24          the dorsal column stimulator.  I don't remember 
25          specifically which time I did, which times I 
0028
 1          didn't.  I would have described the procedure to 
 2          him at those times too.
 3   Q      Would you agree with me there is nothing in the 
 4          narrative portion of your office notes indicating 
 5          that you advised Mr. Lasko of risks and what those 
 6          risks specifically were?
 7   A      I would agree with that.
 8   Q      Have you had an opportunity to review the informed 
 9          consent that you had Mr. Lasko sign prior to 
10          surgery?
11   A      No.
12   Q      Let me mark that 3.
13                  (Plaintiff's Exhibit 3 
14                  marked for identification.)
15   Q      Doctor, I'll hand you what I believe to be the 
16          informed consent signed by Mr. Lasko relative to 
17          this surgery.  Can you identify this document?
18   A      It says consent to surgery or other procedures, 
19          Fairview Health System.
20   Q      Lutheran Hospital was Fairview Health Systems on 
21          August 17, 1999?
22   A      Yes.
23   Q      That is the date when he signed it, correct?
24   A      Yes.
25   Q      Doctor, do you have an independent recollection of 
0029
 1          seeing Mr. Lasko on that date, explaining to him 
 2          the risks of the procedure?
 3   A      On August 17th?
 4   Q      Right.  I didn't see a companion office note, I was 
 5          curious.  
 6   A      I wouldn't have seen him then.
 7   Q      Who explains the risks to the patient that allows 
 8          the patient to sign this document?
 9                  MR. WILT:           Objection.  
10   A      I explain the risks to him in the office.  
11          Sometimes I tell them about things immediately 
12          pre-op if I think I've forgotten to.  The nurse 
13          clinicians will a lot of times explain the risks to 
14          them in pre-anesthesia, where this is normally 
15          signed, or actually in preadmission testings.
16   Q      PAT they go through these things.
17                  Would you agree with me that on the 
18          particular document that Mr. Lasko signed, there is 
19          not an explanation of the specific risks of this 
20          procedure; would you agree with that?
21   A      This is a general document that is used for all 
22          surgeries.  Nobody signs one that outlines all the 
23          specific risks of a procedure they are undergoing.
24   Q      No one at Lutheran Hospital, or no one in the 
25          universe?
0030
 1   A      No one at Lutheran Hospital.
 2   Q      Let me ask you then if I can have this document 
 3          back, although there is no notes that confirm the 
 4          same, what you would have told him the risks of the 
 5          placement of the dorsal column stimulator were?
 6   A      I combine that with a description of the procedure.
 7   Q      Why don't you go through that for me?
 8   A      I tell him what we're going to do.  I tell them we 
 9          do it under local anesthetic.  The reason we do it 
10          under local anesthetic is to minimize the risks 
11          because we're putting something in his spinal 
12          canal, there is only a only certain amount of room 
13          there.  We also need to do it while he's awake in 
14          order to get the electrode placed optimally.  If 
15          you stick it in there under general, you don't know 
16          if it's the right place or not.
17                  We do a screening procedure then.  The 
18          physical therapist is the one who actually programs 
19          it.  Sometimes somebody from Medtronic is there to 
20          help them.
21   Q      Medtronic being the provider of the product itself?
22   A      Yes.
23   Q      Go ahead.  
24   A      What they do is they check -- they try different 
25          settings on the electrode to see if they can get 
0031
 1          optimal coverage of his pain.  If they can't, I 
 2          would move the electrode appropriately to try to 
 3          get that coverage.
 4                  I close it up.  He gets off the table, goes 
 5          home.  Doesn't go home that day.
 6                  What we also do is  bring the electrodes 
 7          out through the skin.  I tell them that it may be 
 8          we'll have to remove the electrodes, that they may 
 9          not work.  They may have problems from the presence 
10          of the electrodes.  There is a fairly high risk of 
11          infection because of the electrodes coming out 
12          through the skin, repeating the procedure two days 
13          later, where you then cut the electrodes off, bury 
14          them.
15   Q      Out of curiosity, once again my ignorance is 
16          showing, originally as written in your office note 
17          of July 7th, it looked like you were planning a two 
18          part surgery.  Surgery, the laminectomy to insert 
19          the dorsal column electrodes was to be on the 24th?
20   A      Yes.
21   Q      The implantation of the stimulator itself was to be 
22          two days later?
23   A      That's correct.
24   Q      I wanted to make sure I read it correctly, that 
25          wasn't a miswrite, you really planned it that way?
0032
 1   A      That is the way I put them in.
 2   Q      Back to where we were.  You explained to the client 
 3          that there is a very high risk of infection?
 4   A      Higher than other operations because we are taking 
 5          electrodes that come out through the skin.  We put 
 6          special dressings on there that are never violated 
 7          until the second surgery.
 8                  Then we spend two days screening them where 
 9          they are actually sitting up, walking, sometimes 
10          that changes things.  It changes because the 
11          electrode changes in position during that period.  
12          So we're trying to see if we're still able to get 
13          the area blocked that we're interested in.  To see 
14          if the patients have any problems.
15                  Sometimes the patients will get pain or 
16          excessive stimulation or muscle spasm in areas that 
17          are uncomfortable and we can't use the electrode.
18   Q      Before you fix it in a permanent position, you want 
19          to make sure the stimulator is giving the patient 
20          optimum relief for the symptoms that you 
21          contemplated the procedure, correct?
22   A      The stimulator itself is very expensive, runs 
23          between 6 and 8,000.  Prior to implanting the 
24          stimulator itself, we want to make sure it's going 
25          to work the way we want it to.  There is a two-day 
0033
 1          screening period.
 2                  Under general anesthesia, we have to tunnel 
 3          this electrode all the way around to their 
 4          abdomen.  I prefer they do that under general 
 5          anesthesia.  Two days later we put them to sleep, 
 6          cut the skin and open the incision, put in a new 
 7          connector, implant the actual device.
 8   Q      So you would have told the patient risk of 
 9          infection.  Would you have given him a percentage, 
10          X percent of persons who undergo this?  
11   A      No.
12   Q      You tell him it is higher than the average 
13          operation?
14   A      Yes.
15   Q      Did you discuss with him there was a potential that 
16          there would be no therapeutic value gained by 
17          attempting to place this in there?
18   A      Yes.  The way I describe that actually is I say 80 
19          to 85 percent of people will get a good result from 
20          it.  The others we have to remove the electrode.
21   Q      When you are quoting him 80 to 85 percent, are you 
22          relying on your personal experience as a physician, 
23          or are you referring to literature that discusses 
24          success rates in dorsal column stimulator 
25          placement?
0034
 1   A      If are you looking at the way I do it, with the 
 2          wide electrode that is sent through the 
 3          laminectomy, it's both, my personal experience and 
 4          apparently the literature.
 5   Q      Do you, Doctor, have an opinion, as to the 
 6          percentage of persons who experience hemiplegia, 
 7          paraplegia, or paresthesia from the insertion of 
 8          these stimulators; do you know?
 9   A      As to paraplegia, I don't know the percentage.  
10          Everybody has paresthesia, the goal is to change 
11          your pain into a paresthesia.
12   Q      I asked it incorrectly I suppose then.
13                  In other words, you can dispute me, that is 
14          why we're here, if I told you that my expert will 
15          testify to, and I've confirmed it through 
16          independent literature, that the risk of a person 
17          becoming paraplegic from the placement of a 
18          stimulator is less than .05 percent, do you have a 
19          reason to dispute that figure?
20                  MR. WILT:           Objection.
21   A      No, I don't.
22   Q      Do you have any idea why it is that some people 
23          experience paraplegia after the placement of these 
24          stimulators?
25   A      I can think of some reasons why they could.  
0035
 1   Q      Tell me why they could.  
 2   A      An expanding hematoma, epidural abscess, or too 
 3          narrow a canal where there is pressure on the 
 4          spinal cord.
 5   Q      How about the displacement of a disk that was not 
 6          previously known to the physician during the 
 7          procedure?  
 8   A      That would be narrowing of the spinal cord or 
 9          narrowing of the spinal canal.  
10   Q      Mr. Lasko, I'm sort of jumping ahead.  I like to 
11          clean up details when we're there.
12                  He did not, from my review of the records, 
13          have an expanding hematoma subsequent to this 
14          procedure; would you agree with that?
15   A      Didn't appear that he did.
16   Q      He did not have an epidural abscess, would you 
17          agree with that?
18   A      Yes.
19   Q      He did in fact however have a narrowing of the 
20          spinal canal?
21   A      He had what is called a hard disk, which is a bony 
22          spur that was quite large -- he actually had two.  
23          One larger than the other, at two of the levels we 
24          put the electrodes in.  
25                  MR. WILT:           Let me take a break now 
0036
 1          and talk to the doctor. 
 2                  (Recess taken.)
 3   By Ms. Kolis:
 4   Q      Dr. Bohl, prior to placing the dorsal column 
 5          stimulator, you had a plan as to what level you 
 6          were going to do your laminectomy for the insertion 
 7          of the electrodes, correct?
 8   A      Yes.
 9   Q      That level was where?
10   A      T-9/10.
11   Q      Why did you elect that level?
12   A      That is the usual level.
13   Q      Good answer.
14   A      I mean where you get the best distribution.
15   Q      You want to insert it there so you can get maximum 
16          relief for the patient should this procedure end up 
17          being effective, correct?  I believe the operation 
18          was going to be at T-10, T-11?
19   A      I'll tell you I always have to think about that.  I 
20          usually end up pulling a previous patient's chart 
21          to get the right one.  T-10/11, you slip the 
22          electrode up past T-9/10.
23   Q      Would you agree with me the standard of care 
24          required that you know what the spinal column 
25          architecture and spinal cord itself looked like in 
0037
 1          that area prior to performing this procedure?
 2   A      No.
 3   Q      Why do you think that is not the standard of care?
 4   A      Because I'm not aware of anyone anywhere who 
 5          recommends that that be done as a routine.  A 
 6          thoracic spine MRI be done as a routine before you 
 7          put in a dorsal column stimulator.
 8   Q      Let me ask the question a different way.  
 9          Subsequent to the procedure you in fact had an MRI 
10          performed that scanned the thoracic spine; is that 
11          a fair statement?
12   A      I don't know.
13   Q      We will mark this Plaintiff's 4, MR of the thoracic 
14          spine dated 8-26.  
15                  (Plaintiff's Exhibit 4 
16                  marked for identification.)
17                  MR. WILT:           This is interesting 
18          because I got these records from you, Donna, and I 
19          was never provided this MR.
20                  MS. KOLIS:          Pages 40 and 41.
21                  MR. WILT:           I don't have that.  All 
22          the radiology studies that I have --
23                  MS. KOLIS:          It's reported in his 
24          summary of the case.  I'm a little surprised you 
25          wouldn't have it in his chart.  I think it was in 
0038
 1          his chart.  
 2                  MR. WILT:           Not in the hospital 
 3          records you gave me.
 4                  MS. KOLIS:          In his own office 
 5          chart.  That is where I originally got it from.  
 6                  MR. WILT:           All right.
 7   A      This is misdated.  I never -- this is the one I 
 8          ordered postop.
 9   Q      I would -- 
10   A      I never ordered one pre-op.
11   Q      I understand that.  This is postop, dated 8-26-99.
12   A      Okay.
13   Q      Are you with me?
14   A      Yes.
15   Q      Here is my question, I'm going to try to make it 
16          simple:  If you had known prior to the surgery that 
17          there was multiple level -- I'm reading right out 
18          of the report, at the bottom says multiple level 
19          diskogenic disease is present at the lower thoracic 
20          spine.  This is most severe at T-9/10 where there 
21          is a focal right paracentral disk protrusion 
22          indenting into the ventral thecal sac.  Disk height 
23          loss is present, yadda, yadda, yadda, et cetera.  
24          That is how far I'm going to read it.
25                  If you had known this disk was there in 
0039
 1          this presentation, would you have done something 
 2          differently in approaching the installation of this 
 3          dorsal column stimulator and/or electrodes?
 4   A      If it had been large enough, I probably would have 
 5          not done the procedure.
 6   Q      Explain in layman's terms why you wouldn't do the 
 7          procedure, quote, unquote, if it, being the disk, 
 8          was large enough?
 9   A      It might not leave enough room in the spinal canal.
10   Q      For?
11   A      For the electrode.
12   Q      Is there some other risk that you can perceive of 
13          proceeding with the insertion of dorsal column 
14          electrodes in anticipation of a stimulator in the 
15          face of a disk at that location?
16   A      What was the question, some other reason?  
17   Q      In addition to you saying there might not be enough 
18          room for the electrodes, the mere act of attempting 
19          to place them in, do you see it causing a problem 
20          with the disk of size at that level?
21                  MR. WILT:           Objection.  I still 
22          don't understand.  If you don't understand, she can 
23          rephrase it.  
24   A      I think I know what you are getting at.
25   Q      Is there some other complication that can be 
0040
 1          encountered other than there not being enough room 
 2          for the electrodes if you attempt to install these 
 3          electrodes at that level in the face of a disk 
 4          described on the MR report?
 5                  MR. WILT:           Objection.  
 6   A      If you are not careful about taking the lamina off, 
 7          you can damage the spinal cord.  I'm always very 
 8          careful as if the canal is narrow.
 9   Q      I'll take that back, let's talk about your op 
10          report for a minute.  See if I can find your 
11          operative report, have that marked 5.
12                  Before we do that, Doctor, as part of 
13          pre-operative testing, PAT some people call it, 
14          there are a number of tests you have ordered; is 
15          that correct?
16   A      Yes.
17   Q      To make sure the person is a suitable candidate for 
18          surgery; is that probably a fair statement?
19   A      A reasonable candidate, yes.
20   Q      In Mr. Lasko's case you would have ordered a chest 
21          film, correct?
22   A      Yes.
23   Q      I'll mark this 5.  
24                  (Plaintiff's Exhibit 5 
25                  marked for identification.)
0041
 1   Q      Doctor, I'm handing you what I believe to be the 
 2          x-ray report from 8-17; do you agree with me that 
 3          is apparently what this is?
 4   A      Yes.
 5   Q      In the conclusion the radiologist says segmental 
 6          scarring both bases, referring to the lungs of 
 7          course; would you agree with that?
 8   A      Yes.
 9   Q      And then his second finding is scoliosis and 
10          degenerative changes involving the thoracic spine; 
11          am I reading that correctly?
12   A      Yes.
13   Q      Would you have seen this before you performed the 
14          procedure on Mr. Lasko?
15   A      No.
16   Q      Why wouldn't you as a physician involved in making 
17          certain a patient is ready for surgery not have 
18          seen this x-ray reading?
19   A      I normally don't.  It's the anesthesiologist who 
20          checks it before he puts the patient to sleep.  The 
21          operating surgeon doesn't normally look at x-ray 
22          reports.
23   Q      Wouldn't a copy of this have gone to you since you 
24          were the doctor requesting it?
25   A      It probably would have gotten into my office 
0042
 1          eventually, but not before the surgery.
 2   Q      You have no recollection of seeing that document 
 3          before the surgery?
 4   A      I didn't see it before the surgery.
 5   Q      If you would have seen it, would you have been 
 6          curious as to the nature of the degenerative 
 7          changes in the thoracic spine knowing that was the 
 8          area of the body where you would be placing the 
 9          dorsal column stimulator?
10   A      It wouldn't have changed anything.  I assumed all 
11          along he has degenerative changes in his thoracic 
12          spine.
13   Q      You assume he did, you didn't know the nature and 
14          extent of those changes; is that a fair statement?
15   A      Almost everybody in Mr. Lasko's condition has 
16          degenerative changes in the thoracic spine.  It's 
17          very unusual to have a spur that size.
18   Q      That wasn't my question.  You assumed he had 
19          disease but did not know the nature and extent of 
20          it because there weren't any diagnostic tests 
21          ordered by yourself to define that prior to the 
22          surgery?
23   A      That's correct.
24                  (Plaintiff's Exhibit 6 
25                  marked for identification.)
0043
 1   Q      This I believe, Dr. Bohl, is your operative summary 
 2          from Mr. Lasko from August 24th.  There were a 
 3          couple of questions that I wanted to ask you about 
 4          this.
 5                  You had mentioned earlier in your testimony 
 6          that upon occasion the technicians from Medtronic 
 7          are in attendance at the procedure, were they in 
 8          attendance at Mr. Lasko's procedure?
 9   A      I don't remember.
10   Q      You don't have any recollection of that?
11   A      No.
12   Q      Where it says anesthesia standby, can I assume they 
13          were standby because you were only giving him a 
14          local, had them ready in case anything rent wrong?
15   A      They usually give him a little sedation then.  Not 
16          so much he can't answer the questions, can't tell 
17          us he's having pain somewhere.
18   Q      You didn't use the word, I used the word in 
19          twilight, so he doesn't feel all the pain, he can 
20          cooperate so that you know whether what you are 
21          doing is effective, is that -- 
22   A      I would say they are less than twilight.  They are 
23          really pretty able to tell you what is going on.
24   Q      You remember being able to talk to Mr. Lasko?
25   A      I don't have an independent recollection of the 
0044
 1          conversation, but I know that things went okay.
 2   Q      If he had been unable to cooperate with you by 
 3          answering your questions or anything else during 
 4          surgery, you would have noted it some place; is 
 5          that right?
 6   A      We would have woken him up enough so he was 
 7          cooperative.
 8   Q      Fair enough.  I was just asking.
 9                  Describe for me, if you will, exactly how 
10          you did this procedure, you can read from your note 
11          if you want to, then I can ask you some questions 
12          about it.  
13   A      Normally I put in some local anesthetic.  Then you 
14          make an incision from the spinous process of T-10 
15          to T-11.  Use what is called a Cobb elevator to 
16          strip the soft tissue off that level.  Then I 
17          normally take a rongeur to open up the space 
18          between the two levels so you can get down to the 
19          lamina.
20                  Then what I normally do is take something 
21          called a ganglion knife, which isn't really a 
22          knife, very thin elevator, I try and work my way 
23          down to the back of the lamina, so that I can get 
24          the ganglion knife just under the back of the 
25          lamina.  So as not to compress anything, but so 
0045
 1          that I can get what is called a Kerrison punch, 
 2          very small instrument, just under the lamina and 
 3          start trimming it away.
 4                  Usually I trim enough lamina away so I 
 5          don't have to disturb the ligamentum flavum.  Once 
 6          I have the lamina opened up, enough of a 
 7          laminectomy wide enough that I can put the spatula 
 8          in, we slip the spatula in.  They are used to make 
 9          sure there aren't adhesions and make sure there is 
10          enough room in the spinal canal to accommodate the 
11          electrode.  Normally the spatula slips right in.
12   Q      When you are saying the spatula, in this version is 
13          this the paddle or not?  I wanted to be sure what 
14          I'm looking at.  I was with you so far, you got me 
15          through the ligamentum flavum, then you are saying 
16          a Medtronic syntax lead paddle, that is the same as 
17          spatula?
18   A      Yes, rigid plastic thing with a curve on it.
19   Q      Approximately what size is the Medtronic lead 
20          paddle?
21   A      Approximately the size of the electrode, only you 
22          can put it in further up, it's longer.
23   Q      A Medtronic syntax lead paddle was inserted beneath 
24          the lamina of T-10, pushing it upward, noting what 
25          felt to be a block part way in.
0046
 1                  What do you believe that block was at the 
 2          time as you are in surgery?
 3   A      Well, it can be adhesions.  It can be a narrow 
 4          area.
 5   Q      Narrow area caused by a disk?
 6   A      Could be.
 7   Q      Did you give any thought as to why it was you were 
 8          feeling a blockage?
 9   A      Well, I know it could be one of those things.  It 
10          was up fairly high.  I didn't have any trouble 
11          slipping the electrodes in.  It was up above, kind 
12          of at the upper end of where the paddle slipped.  
13          So that I probably would not have been able to move 
14          his electrodes up like you need to do in some 
15          patients.  I didn't have any trouble slipping them 
16          into the space that was there.
17   Q      So you felt this blockage.  What did you do once 
18          you encountered the blockage?
19   A      I took the paddle out, slipped the electrode in, 
20          called a syntax lead.
21   Q      Today, based upon your evaluation of the records 
22          and all the diagnostic tests that were done 
23          subsequent to this procedure, do you know what that 
24          blockage was you encountered at the time of 
25          surgery?
0047
 1   A      I'm not sure.  Could have been a spur on the T-8/9 
 2          disk.
 3   Q      Could it have been anything else?
 4   A      Adhesions.
 5   Q      Do you find any adhesions at that level when you 
 6          went in to do the laminectomy, diskectomy later in 
 7          August?
 8   A      You can't see that.
 9   Q      So you wouldn't see that.
10                  According to your operative -- when I say 
11          your operative report, I'm talking about this 
12          typewritten report that was referred to as document 
13          number 6, you indicate that following the procedure 
14          the patient was transferred to the recovery room in 
15          satisfactory condition.
16                  Have you examined the medical records 
17          sufficiently enough to show me where in the medical 
18          record it shows that following the procedure 
19          Mr. Lasko had motor and sensory function from T-10 
20          and below?
21                  MR. WILT:           Other than what he is 
22          stating in his operative report?
23   A      I didn't follow him to the recovery room.  He 
24          assisted us.  I put the patients on the cart 
25          myself.  Mr. Lasko climbed on the cart, got on the 
0048
 1          cart.  Did not mention anything about numbness or 
 2          any -- certainly didn't have any weakness when he 
 3          was climbing on the cart, or all the while he was 
 4          being screened for 10 to 15 minutes.
 5   Q      When you say screen, you are talking still on the 
 6          table, you've got the electrodes inserted, you   
 7          are -- I don't know what word you want me to use, 
 8          measuring activity or monitoring the activity, is 
 9          that the screening portion you are discussing?
10   A      What happens is the physical therapist, Medtronic 
11          rep -- actually if the Medtronic rep is there the 
12          physical therapist is usually there too anyway.  
13          Yes, they check the different settings, try and 
14          find the optimal distribution of pain.  As the 
15          patient is blocked, when they say yes, we think we 
16          have the optimal spot, we close up, which takes 
17          another probably 15 minutes, so you are talking 
18          total time the electrodes are in approximately 25 
19          minutes before the patient climbs himself back onto 
20          the table.
21   Q      Are you saying you have an independent recollection 
22          following the procedure you were still in the room 
23          and you saw him get onto this cart by himself?
24   A      I certainly did.
25   Q      So my question was, I don't see that documented any 
0049
 1          place other than your written summary.  I was 
 2          curious, did you place any note in the chart, a 
 3          hand written note regarding that fact?
 4   A      Patients all do that.  I don't put it in the op 
 5          note or anything.
 6   Q      When were you first aware that he had lost motor 
 7          and sensory function following the procedure?
 8   A      I think I was in another case, the one that 
 9          followed that one.  Somebody from the recovery room 
10          called me, told me that.
11   Q      Is it your understanding, based on your review of 
12          the records and/or your recollection, that this was 
13          his situation when he actually arrived in the 
14          recovery room?
15   A      I don't know.  I don't recall whether it was in the 
16          recovery room or very shortly after.
17   Q      All you are indicating to me by your answer is 
18          you've not reviewed these records prior to today 
19          carefully enough to know with precision at what 
20          time the first report was that there was a loss of 
21          motor and sensory function?
22   A      I guess that is right.
23   Q      From your best recollection of your own personal 
24          notes, how long after you finished Mr. Lasko's case 
25          do you believe that became evident to the support 
0050
 1          staff in the hospital?
 2                  MR. WILT:           Objection.
 3   Q      You can answer it.  
 4   A      I remember seeing some note from the recovery room 
 5          that looked like it was early on.  Indicates that 
 6          it was about the time he got over or shortly after.
 7   Q      To the recovery room?
 8   A      Yes.
 9   Q      Doctor, when they reported to you this set of 
10          symptoms, what was your belief as to what 
11          Mr. Lasko's problem was?
12   A      We thought it was the epidural effect of some local 
13          anesthetic I just put in his wound.
14   Q      In how many patients prior to Mr. Lasko had you 
15          ever seen them lose motor and sensory function due 
16          to epidural medication?
17   A      There haven't been more than one or two patients I 
18          put the additional medication in.  The answer is 
19          none I remember.
20   Q      Sometimes I don't ask good questions.  I try to.
21                  Did you have anything else in what we 
22          lawyers love to use the phrase differential 
23          diagnosis what the cause of the problem could have 
24          been at that point?
25   A      Yes.
0051
 1   Q      What was it?
 2   A      In my mind the differential diagnosis initially, 
 3          was effect of the epidural, effect of the 
 4          anesthesia, or possible constriction.
 5   Q      Constriction due to?
 6   A      To not being enough space in the canal.
 7   Q      For?
 8   A      For the electrode.
 9   Q      Those were the two things you were thinking about?
10   A      Yes, initially.
11   Q      You can correct me any place I'm wrong.  I really 
12          prefer to do depositions this way, the stream of 
13          consciousness.
14                  It's my understanding based upon a review 
15          both of the progress notes and then a document that 
16          you typed, I think a discharge summary, there was 
17          approximately a three hour period of time between 
18          onset of symptoms and decision to undergo an 
19          emergency removal of the epidural electrodes; am I 
20          stating that accurately?
21   A      Yes.
22   Q      Was there a reason why you wanted to wait for three 
23          hours?
24   A      Yes.
25   Q      What was the reason?
0052
 1   A      We wanted to see if it was the epidural effect.  
 2          What we did, we initially decided to wait an hour, 
 3          see what would happen.  In that hour he got all of 
 4          his sensation back, a lot of the motor use of his 
 5          left leg.  So, we figured, well, it's probably the 
 6          epidural effect.  We will wait longer, see what 
 7          happens.  We did wait longer, when it stopped 
 8          getting better, that is when we made the decision, 
 9          three hours postop.  We still didn't know for sure 
10          it wasn't the epidural effect, but we decided we 
11          didn't want to take the risk.
12   Q      So you decided to go ahead and do an emergency 
13          removal of the electrodes?
14   A      Took them out.
15   Q      Was there any improvement in the patient's symptoms 
16          that he presented with following the insertion of 
17          the electrodes?
18   A      There was some.
19   Q      What to the best, you can refer to your notes, to 
20          the best of your recollection was the improvement 
21          that you experienced by removing the electrodes?  
22          This isn't a hidden ball trick.  Let me mark this 
23          for you.  Do it either way.
24   A      My note following removal of the electrode, 
25          sensation returned, motor still gone, voiding.  It 
0053
 1          was primarily sensory return.
 2   Q      He had a sensory turn.  Did he not, Doctor, I'm 
 3          just sort of making it faster for us, as I read 
 4          your note, discharge note, after you removed the 
 5          electrodes did he regain more motor function in the 
 6          left leg, none in the right; would you agree with 
 7          that?
 8   A      Yes, he did.
 9   Q      I think subsequent to removal of the electrodes a 
10          portion of this motor use, particularly in the left 
11          leg, rapidly returned, some minimal return on the 
12          right side?
13   A      Yes.  I should make a correction.  If I look at my 
14          notes, apparently before we removed the electrodes 
15          sensation had come back, motor had not.
16   Q      Fair enough.  I think the notes were 
17          self-explanatory.
18                  In your discharge summary you indicate, I 
19          think we already looked at it, I want to go over 
20          this again, MRI was done which showed a large hard 
21          disk at T-10/11 interspace occluding approximately 
22          half the canal.
23   A      T-9/10.  
24                  (Plaintiff's Exhibit 7 
25                  marked for identification.)
0054
 1   A      I'm looking at the note in the chart.
 2   Q      We will go through both of them to make sure which 
 3          is correct.
 4                  Can you identify that is the discharge 
 5          summary which you prepared for Mr. Lasko?
 6   A      Appears to be.
 7   Q      It shows dictated on September 20, 1999, 
 8          transcribed October 14th, at the bottom your name, 
 9          correct?
10   A      Yes.
11   Q      You don't have residents who dictate these for you?
12   A      No.
13   Q      In that one, you're indicating on what you dictated 
14          at that time, an MRI was done which showed a large 
15          hard disk at T-10/11 interspace, occluding 
16          approximately half the canal?
17   A      Yes, T-10/11 is incorrect, it would be T-9/10.  
18          Where I say I re-explored it is T-9/10.  It 
19          wouldn't make sense.
20   Q      I was just asking.  I thought I would try to find 
21          out what you believed the situation was.
22                  Doctor, based upon what you saw at MRI, two 
23          days subsequent to this procedure, is it your 
24          opinion that his loss of motor function and 
25          sensation was caused by that large disk at the 
0055
 1          T-9/10 space?
 2   A      Well, initially that is what I thought it was.  I 
 3          thought it was the pressure of the electrode, and 
 4          the disk compressing the spinal cord.
 5   Q      Fair enough to say prior to him getting up on your 
 6          table on August 24, 1999 he had motor and sensation 
 7          function T-10 and lower, correct?
 8   A      He had some left-sided weakness, but that was 
 9          residual from the previous surgery.
10   Q      That immediately following the surgery -- when I 
11          say immediately, let's call it within 45 minutes, 
12          do you think that is fair from the time you 
13          finished the procedure until it was appreciated he 
14          lost motor and sensory function, correct?
15   A      Yes.
16   Q      So I'm asking you as we sit here, is it clear to 
17          you that by pushing those electrodes or using the 
18          paddle the way that you did, the disk was pushed 
19          into the canal, therefore become occluded, that is 
20          why this situation occurred?
21   A      Actually I think that the posture had something to 
22          do with it.  It was an occlusion of the electrode 
23          and the disk.
24   Q      I'm sorry, because I have a bad habit of listening 
25          and moving papers, you think it was posture?
0056
 1   A      When we do the surgery the patient's back is flexed 
 2          like this.  We put the electrode in, there is 
 3          plenty of space, he lays there for another 20 
 4          minutes or so.  No problem.
 5                  When we get him off the frame, his back 
 6          goes like this, his back extends, which shortens 
 7          the spinal canal.  If the electrode happens to be 
 8          near the disk, it's possible by that change in 
 9          posture for it to actually be pushed into it.  That 
10          could explain why nothing happened until he got 
11          over to the --
12   Q      It would be the postural change as it relates to 
13          the electrodes being near the disk the causes this 
14          problem?
15   A      That would be the explanation for why he didn't 
16          have problems on the table, but did when he got to 
17          the recovery room.
18   Q      Suffice it to say if the disk was not at that 
19          location, that usually wouldn't be a complication; 
20          would you agree with that?
21   A      That is probably correct.
22   Q      In retrospect, wouldn't it have been preferable to 
23          have done a diskectomy at the level prior to this 
24          procedure being performed?
25   A      You would have to know there was a disk there 
0057
 1          first.
 2   Q      Of course you would.  If you had known there was a 
 3          disk there, can you medically agree under those 
 4          circumstances the disk we have described in the 
 5          studies, a diskectomy being performed prior to the 
 6          insertion would have been the medically appropriate 
 7          way to go in this situation?
 8   A      You probably would not have done the insertion.  
 9          You probably would not have done a diskectomy to do 
10          the insertion.  Especially in this patient.  Much 
11          too high risk.
12   Q      To do the diskectomy?
13   A      Yes.
14   Q      Therefore you could have given the client the 
15          medical option not to undergo the dorsal column 
16          stimulator because of the disk?
17   A      That's correct.
18   Q      Fair enough.  That is what I wanted to know.  The 
19          next documents are 8A and 8B.  
20                  (Plaintiff's  Exhibits 8A & B 
21                  marked for identification.)
22   Q      I would like for you, Doctor -- I believe this is 
23          your progress note dated 8-26, starts on this page 
24          and continues; am I identifying that document 
25          correctly?
0058
 1   A      Yes.
 2   Q      What we're going to do is read this progress note 
 3          of 8-26-99 into the record.  So if you begin I'll 
 4          try not to interrupt you.  Go back and ask you 
 5          questions afterwards.
 6   A      Sensation still good, has early pressure area left 
 7          heel.  Have instituted decubitus precautions.  
 8          Yesterday had only flexion/extension of the left 
 9          foot.  Today better active motion left foot.  Some 
10          recovery of other muscles.  Right side now has 
11          flicker of plantar flexion.  No BM yet.  
12          Spontaneously voids.  Appears to be gradually 
13          recovering.  Reviewed MRI, which shows large hard 
14          disk at T-9/10 protruding approximately halfway 
15          across canal.  Apparently flexible electrode strip 
16          put in at T-10/11 slipped upward, causing 
17          additional compromise of cord blood supply at upper 
18          tip, resulting in anterior cord syndrome.  
19          Compromise lasted about three and a half hours, 
20          probably partial because deficit was not present on 
21          OR table.  Developed after went to recovery.  Have 
22          informed patient of probable scenario and 
23          likelihood of at least partial recovery, although 
24          no way to know if it would be complete.  Reviewed 
25          neurology note, laminectomy not indicated since  
0059
 1          source of acute compression has been removed.  
 2          Patient is improving, problem is anterior, not 
 3          posterior.  At this time further trauma to cord 
 4          would compromise recovery.  Will observe now for 
 5          improvement.  If significant deficit persists, will 
 6          consider thoracotomy for removal of disk at T-9/10 
 7          and anterior decompression, once initial cord 
 8          swelling diminishes, making increased injury less 
 9          likely.  Will taper steroids, start physical 
10          therapy, bowel management, start prophylaxis, my 
11          associates will follow until Monday
12   Q      Were you going out of town over the weekend?
13   A      Apparently.
14   Q      You stand by that note as you wrote it?
15   A      Yes.
16   Q      It is my understanding that you then did carefully 
17          watch the patient for an additional week or so in 
18          looking for some additional functional recovery, 
19          because that did not occur, you did make a decision 
20          to perform an additional surgery; am I stating that 
21          fairly?
22   A      There was a precipitating event for deciding to 
23          perform the additional surgery.
24   Q      Tell me about that precipitating event.  
25   A      There was an occasion when I was called and told 
0060
 1          that Mr. Lasko had been put in a chair, sitting 
 2          upright, that when they came in, I don't know, I 
 3          don't know the exact circumstances, but the way it 
 4          boiled down he was sitting in this chair for a 
 5          period of time, it was noted that when they went to 
 6          move him he had no sensation or motor function at 
 7          all.  The same as the time when he had come off the 
 8          table.
 9   Q      Not to be trite about it, sort of a reversal of 
10          fortunes, he was making progress, then this episode 
11          occurred?
12   A      Yes, complete reversal.
13   Q      So you made a decision in spite of what you 
14          perceived to be some risk perhaps in doing a 
15          diskectomy, you thought that would be his best 
16          opportunity for some recovery, correct?
17   A      Well, the initial thought was to wait and see how 
18          much recovery he had and possibly hopefully not do 
19          anything further surgery-wise.
20                  This event made us realize we were not 
21          going to be able to do that.  We took an additional 
22          period of time in which we did not allow him to the 
23          sit up or get up.  To allow things to still 
24          improve.  Then we took him to the operating room, 
25          did the surgery.
0061
 1   Q      The first surgical procedure that you did in 
 2          response to the situation occurred on -- do you 
 3          happen to recall the date of the surgery, Doctor?  
 4          I might have it. 
 5                  MR. WILT:           9-9.
 6   Q      He was always in the hospital, in different 
 7          departments.  This was his return to this surgery.  
 8          Do you know if that surgery was done 9-9?
 9                  MR. WILT:           Yes, 9-9.  
10   Q      That sounds familiar.
11   A      It was 9-9.
12   Q      The surgery which you were to perform on 9-9 was a 
13          T-9, T-10 diskectomy, posterior decompression, 
14          right?
15   A      Yes.
16   Q      That is what you were planning?
17   A      That was the plan.
18   Q      Doctor, as we both know, you ended up doing surgery 
19          T-8, T-9 inadvertently is the way you phrased it on 
20          the 9th; is that correct?
21   A      Yes.
22   Q      Tell me how that happened?
23   A      We put the patient in the lateral position.  I 
24          asked Dr. Rastgoufard, a thoracic surgeon, since 
25          this is a particularly difficult level to get to, I 
0062
 1          asked him to do the exposure.  He did the 
 2          thoracotomy.
 3                  We had, I remember we had difficulty with 
 4          x-ray, we took five sets of x-rays because they had 
 5          a new x-ray tech, we were having difficulty with 
 6          visualization.  There was a lot of altered anatomy.
 7                  Both of us decided on the level that we 
 8          felt was the appropriate level.  Then 
 9          Dr. Rastgoufard -- it's just a little opening, kind 
10          of take turns looking in, he went and did an 
11          incision through the pleura, removed the base of 
12          the rib, exposed the level that I presumed that we 
13          decided on.  I don't know whether he got the right 
14          level or not, it was the one I thought we decided 
15          on.  Did the surgery.
16                  There was a disk at that level.  The level 
17          above also had a disk on the MRI too.  I wasn't 
18          surprised.  In fact, it was a fairly sizeable 
19          disk.  Did the decompression.  Closed up the 
20          patient, sent him to the recovery room.
21   Q      The operation that you intended to do, once again, 
22          was T-9, T-10, correct?
23   A      Yes.
24   Q      You wanted to do T-9, T-10 because you believed 
25          that was the source of the problem?
0063
 1   A      I believe that was the primary source.
 2   Q      You can correct me any time.
 3                  I guess I'm going to have to ask this 
 4          question simply.  Do you take responsibility for 
 5          the fact that a procedure occurred at the wrong 
 6          disk level on September 9th?
 7   A      Well, I realized it occurred at the wrong level.  I 
 8          feel that at the time of surgery we did all the 
 9          normal things to insure that we were at the right 
10          level.  I don't know what Dr. Rastgoufard did when 
11          he got in there.  Whether he inadvertently incised 
12          over the wrong rib or not.  The level he exposed is 
13          the one I did.  It appeared to be the proper level 
14          at the time I did it because there was a big spur.  
15          I obviously took responsibility for it.  I 
16          explained the problem to Mr. Lasko, did the right 
17          level.
18   Q      That was truly my question.  Ultimately, Doctor, 
19          since you were the surgeon, is it your 
20          responsibility to insure that you were operating at 
21          the right level?  
22                  MR. WILT:           Objection.  
23   A      It's my responsibility to take the normal 
24          precautions to try and insure I'm operating at the 
25          right left, yes.
0064
 1   Q      What made you suspect, or did anything make you 
 2          suspect subsequent to that surgery on September 
 3          9th, that you operated on an unintended disk level?
 4   A      The thing that made me realize it was probably the 
 5          wrong level was that I got -- he made a partial 
 6          recovery from the level I did.  Then was just 
 7          partial recovery.
 8                  I subsequently got x-rays to check the 
 9          location of the graft and everything.  When I went 
10          and reviewed them with the radiologist, actually 
11          the radiologist had mislabeled the levels too 
12          because of his altered anatomy, I was able to 
13          determine from the rib base we resected it was 
14          probably the wrong level.
15   Q      A couple of questions along what you have said.
16                  When you said he had a partial recovery, as 
17          I read your discharge -- I believe your discharge 
18          summary, the only recovery he had following the 
19          surgery of September 9th was motor use of his right 
20          foot; is that right?
21   A      Yes, which had been very resistant to recovery 
22          before.
23   Q      That wasn't recovery you were expecting from doing 
24          that diskectomy, correct?
25   A      I was hoping to get some recovery.  I didn't know 
0065
 1          if I would get any.  There is no way of telling how 
 2          much damage was done.
 3   Q      Do you read plain film x-rays?
 4   A      Yes.
 5   Q      Do you make surgical decisions upon your 
 6          interpretation of them?
 7   A      Yes.
 8   Q      Did you mention anywhere in your discharge report, 
 9          or in a summarization note that you believed that a 
10          radiologist had mislabeled the disk levels?
11   A      No.  Actually what I was referring to is when I was 
12          reviewing them with the radiologist, she had 
13          mislabeled them.  I pointed out to her the correct 
14          levels.  There was no problem as a result of that.
15   Q      That is what I -- unfortunately sometimes I hear 
16          things, I say am I going to hear that at trial.
17                  You are not saying the radiologist in 
18          mislabeling something was a cause or contributing 
19          cause to the fact the wrong disk level was operated 
20          on?
21   A      No.  I was pointing out it was difficult to tell 
22          where you were from the x-rays, even if you are a 
23          radiologist in the radiology department.
24   Q      Have you ever operated on the wrong disk level in 
25          any other patient?
0066
 1   A      Once.
 2   Q      Did that result in a lawsuit, out of curiosity?
 3   A      No.
 4   Q      Subsequent to the correct procedure being 
 5          performed, Mr. Lasko did have some additional 
 6          improvement in his right leg; is that a fair 
 7          statement, after you got to the right disk?
 8   A      He had some improvement with the first disk and 
 9          second disk.
10   Q      The first disk we discussed was a partial recovery 
11          of the motor use of the right foot.  What I'm 
12          trying to make clear for the record is following 
13          the diskectomy at the correct level, T-9, T-10, he 
14          had more improvement?
15   A      Yes, eventually he had a lot of improvement.
16   Q      Eventually down the road -- we get to come back 
17          full circle.  When he came to see you after I filed 
18          the lawsuit, did you do a physical examination?
19   A      Yes, I did.
20   Q      Counsel has graciously provided me with that note 
21          some time in the past, it never made it into my 
22          notebook.  Can you tell us the date of that note 
23          and read it into the record?
24   A      April 11, 2001.
25   Q      What does the note say?
0067
 1   A      It says doing better, uses wheel walker for 
 2          balance.  Strength back to normal.  Numbness gone, 
 3          no significant back pain.  Complains of pain in 
 4          both knees only.  That is what he told me.
 5                  Then the back when I actually examined him, 
 6          there was no specific tenderness in his back.  He 
 7          was able to bend forward to 45 degrees, unable to 
 8          completely straighten.  He had slight motor 
 9          weakness in the left foot flexors only, which is 
10          what he had before surgery.  It was better than 
11          what he had before surgery.
12                  Sensory exam was normal.  I examined his 
13          right knee.  He had a small effusion in, tenderness 
14          under the patellar facets.  Range of motion 10 to 
15          125 degrees.  Tender joint line medially.  Negative 
16          McMurray sign.  Left knee no effusion, tender 
17          facets, range of motion 5 to 135 degrees.  Unable 
18          to get x-ray without referral.  Discussed 
19          happenings in the hospital.  Would follow-up in 
20          three months.
21   Q      Out of curiosity, what does it mean when you say 
22          discussed happenings in hospital?
23   A      Actually I brought up the lawsuit with him.  I 
24          thought I told him it was sort of unusual that 
25          somebody would come back to me after suing me.  He 
0068
 1          said he wasn't sure he had yet.  It was just being 
 2          looked into.  I informed him in fact he had.  I 
 3          asked him if there were some things he didn't 
 4          understand that I told him in the hospital, because 
 5          I thought we had gone over everything fairly 
 6          thoroughly.  I reviewed that with him.
 7   Q      Based upon, once again I'm trying to listen and 
 8          look, you indicate based upon your physical 
 9          examination that his motor strength had returned.
10                  Doctor, are you testifying under oath 
11          Mr. Lasko has today all of the same motor strength 
12          he had in both of his lower extremities prior to 
13          the events of August and September of 1999?
14   A      Well, he's got a little more strength in his foot. 
15          He had dorsiflexion weakness in the foot before.  I 
16          couldn't say for sure he did.  He may have some hip  
17          weakness, it's a little hard to tell because he's a 
18          little unsteady.
19   Q      To the best of your recollection, or based upon 
20          your documents, in terms of Mr. Lasko --
21   A      Let me add one thing.
22   Q      Sure.  
23   A      He said his strength was back to normal.
24   Q      You didn't do a physical examination to test for 
25          all of that, did you?
0069
 1   A      Not all of it.
 2   Q      The reason I'm asking is, prior to the surgery, are 
 3          you aware of what Mr. Lasko's abilities were to 
 4          live independently?
 5   A      No, not specifically.
 6   Q      Do you know if he had to walk with assistance of 
 7          any sort?
 8   A      I think I recall times when he came in with a cane, 
 9          but I'm not sure.
10   Q      That wasn't a cane you prescribed for him, was it?
11   A      I don't remember.
12   Q      Would it surprise you -- your attorney is going to 
13          object to that -- we haven't seen all the records 
14          yet, would it surprise you based upon Mr. Lasko's 
15          physical status when he left the hospital, it took 
16          a year plus in a nursing home to get him to the 
17          point he could transfer in and out of a bed, walk 
18          not incredibly long distances but walk with a four 
19          wheel walker?  I think what I'm getting at is in 
20          your own initial note you didn't know what his 
21          outcome would be given his cord had been compressed 
22          for about three and a half hours initially?
23                  MR. WILT:           Objection.  
24   A      Correct.
25   Q      You have not seen any medical records or notes with 
0070
 1          regard to his course of recovery at the nursing 
 2          home?
 3   A      I haven't seen nursing home notes, no.  I did see 
 4          some of the notes down at the Cleveland 
 5          Metropolitan General Hospital when I visited him 
 6          there.
 7   Q      How many times did you visit him at Metro?
 8   A      Two or three times.
 9   Q      Who was in charge of his rehab at Metro, do you 
10          recall?
11   A      No, I don't recall.
12                  MS. KOLIS:          Doctor, I don't have 
13          any further questions for you.  Your attorney 
14          obviously is going to tell you, you have the right 
15          to read your deposition, and you are going to 
16          because I won't let you waive.
17                  THE WITNESS:        I don't anyway.            
18                  (Deposition concluded at 3:44 p.m.) 
19                  (Signature not waived.)
20                             - - -
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0071
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                                        ____________________
20                                      William Bohl, M.D.
21        Subscribed and sworn to before me this _______ day
22   of _____________________, 2002.
23                                                                              
                                        ____________________
24                                      Notary Public
25        My commission expires:  ___________________________.
0072
 1   State of Ohio,        )
                           ) SS:  CERTIFICATE
 2   County of Cuyahoga.   )
 3        I, Constance Versagi, Court Reporter and Notary 
 4   Public in and for the State of Ohio, duly commissioned and 
 5   qualified, do hereby certify that the within named 
 6   witness, William Bohl, M.D., was by me first duly sworn to 
 7   testify the truth, the whole truth, and nothing but the 
 8   truth in the cause aforesaid; that the testimony then 
 9   given by him was by me reduced to stenotypy/computer in 
10   the presence of said witness, afterward transcribed, and 
11   that the foregoing is a true and correct transcript of the 
12   testimony so given by him as aforesaid.
13        I do further certify that this deposition was 
14   taken at the time and place in the foregoing caption
15   specified, and was completed without adjournment.
16        I do further certify that I am not a relative, 
17   counsel, or attorney of either party, or otherwise 
18   interested in the event of this action.
19        IN WITNESS WHEREOF, I have hereunto set my hand 
20   and affixed my seal of office at Cleveland, Ohio, on 
21   this 4th day of February, 2002.
22   
23             
          ___________________________________________ 
24        Constance Versagi, Court Reporter and                     
          Notary Public in and for the State of Ohio.
25        My Commission expires January 4, 2003.