1 1 IN THE COURT OF COMMON PLEAS 2 CUYAHOGA COUNTY, OHIO 3 JOHN C. NEWELL, et al., 4 Plaintiffs, 5 JUDGE MATIA 6 -vs- CASE NO. 390126 7 KULDEEP SINGH, M.D., 8 et al., 9 Defendants. 10 - - - - 11 Deposition of DAVID M. GRISCHKAN, M.D., taken as 12 if upon cross-examination before Laura L. Ware, a 13 Notary Public within and for the State of Ohio, at 14 The Hernia Center of Ohio, 24025 Commerce Park Road, 15 Beachwood, Ohio, at 4:50 p.m. on Tuesday, November 16 28, 2000, pursuant to notice and/or stipulations of 17 counsel, on behalf of the Plaintiffs in this cause. 18 19 - - - - 20 WARE REPORTING SERVICE 21 21860 CROSSBEAM LANE ROCKY RIVER, OH 44116 22 (216) 533-7606 FAX (440) 333-0745 23 24 25 2 1 APPEARANCES: 2 Larry S. Klein, Esq. Klein & Carney Co., LPA 3 Leader Building - Suite 230 526 Superior Avenue 4 Cleveland, Ohio 44114 (216) 861-0111, 5 - and - 6 Ellen Hobbs Hirshman, Esq. 7 Linton & Hirshman Hoyt Block Building - Suite 300 8 700 West St. Clair Avenue Cleveland, Ohio 44113 9 (216) 781-2811, 10 On behalf of the Plaintiffs; 11 Ronald A. Rispo, Esq. Weston, Hurd, Fallon, Paisley & Howley 12 2500 Terminal Tower 50 Public Square 13 Cleveland, Ohio 44113 (216) 241-6602, 14 On behalf of the Defendant 15 Kuldeep Singh, M.D. 16 17 18 19 20 21 22 23 24 25 3 1 DAVID M. GRISCHKAN, M.D., of lawful age, 2 called by the Plaintiffs for the purpose of 3 cross-examination, as provided by the Rules of Civil 4 Procedure, being by me first duly sworn, as 5 hereinafter certified, deposed and said as follows: 6 - - - - 7 MR. RISPO: Before we go forward, Tom 8 Kilbane, counsel for Dr. Basa, called shortly, 9 just a few minutes ago, saying that he was 10 unable to be here with us this evening due to 11 an illness in his family. He would like to 12 reserve his rights to examine the witness at a 13 later time, if appropriate. I have no 14 objection. 15 MR. KLEIN: All right. 16 - - - - 17 CROSS-EXAMINATION OF DAVID M. GRISCHKAN, M.D. 18 BY MR. KLEIN: 19 Q. Doctor, you know who I am. 20 A. I'm thinking. 21 Q. Larry Kline. 22 A. Yes. 23 Q. Ellen Hirshman and I represent John Newell. 24 You've authored a report for Ronald Rispo dated 25 July 7, 2000, correct? 4 1 A. Yes. 2 Q. All right. Ellen and I have some questions to ask 3 you pertaining to that report. 4 A. Okay. 5 Q. And probably some other questions as well. I assume 6 what you're holding there in front of you is the 7 same thing I have, and that's your report. Is that 8 your only report? 9 A. Yes. 10 Q. All right. 11 MR. RISPO: Excuse me. There was 12 another report prior to that, April 26th of the 13 same year, 2000. 14 THE WITNESS: That really wasn't a 15 report though. 16 MR. RISPO: Preliminary comments. 17 THE WITNESS: It was a discussion you 18 and I had on the phone which you asked me to 19 memorialize. 20 Q. Why don't you, since this is the first I'm seeing 21 this, why don't we take a break here. If you want 22 to -- 23 A. I'll make you a copy of that too. 24 25 - - - - 5 1 (Thereupon, a discussion was had off 2 the record.) 3 - - - - 4 Q. Doctor, before I even read that report, in the pile 5 that you have in front of you are the materials you 6 considered for the preparation of your report; is 7 that correct? 8 A. Correct. 9 Q. And let's go through each document, all right. Why 10 don't you tell me what each document is that you 11 considered. 12 A. This was the original letter forwarded to me by Mr. 13 Rispo. 14 Q. That is dated March 16th, 2000? 15 A. Correct. This is a chronology of Cleveland Clinic 16 treatments provided to me by Mr. Rispo. 17 Q. Okay. 18 A. There's a report authored by Armin Green, another 19 report authored by Dr. Clayton. 20 Q. Okay. 21 A. And then we have a set of records from Dr. Singh, 22 Dr. Velloze and Dr. Basa, and we have depositions of 23 Dr. Singh, Dr. Velloze and Dr. Basa, and there will 24 be one more after that from Dr. McClarren, I'm 25 sorry, Dr. Hadley Morgenstern-Clarren and Dr. 6 1 Steele. 2 Q. All right. Now, out of the materials -- 3 A. And my report too. 4 Q. Why don't you tell us which materials you reviewed 5 after writing your report. I see that some of those 6 materials, in fairness, came to you afterwards. 7 A. That's correct, some of the depositions, but I'm not 8 sure what sequence I received records. 9 Q. All right. Can we be comfortable in saying that in 10 preparation for your report you've reviewed the 11 documents you set forth in your July 7th, 2000 12 letter? 13 A. Correct. 14 Q. So that would mean you reviewed and considered, 15 number one, Mr. Rispo's cover letter; number two, 16 his CCF treatment chronology, correct? 17 A. That I received much later, just recently. 18 Q. The CCF chronology you received after your report, 19 correct? 20 A. Yes. 21 Q. All right. And did you receive that at your request 22 of him or he just sent it to you? 23 A. It was actually provided today. 24 Q. Today. The letter from Dr. Green would have come, 25 obviously, after your report, correct? 7 1 A. Correct. 2 Q. Because of the date. 3 A. Correct. 4 Q. The letter from Dr. Morgenstern-Clarren, the report 5 from him, probably came after your report, correct? 6 A. Correct. 7 Q. All right. And you did read Dr. Singh's records, 8 Velloze's records, the records of Dr. Basa, the 9 deposition of Dr. Singh in preparation for your 10 report, to help you -- 11 A. Yes. 12 Q. -- formulate your opinions, correct? 13 A. Yes. 14 Q. And Dr. Velloze's deposition in preparation for your 15 report, you read it, correct? 16 A. Yes. 17 Q. Along with the deposition of -- 18 A. Mr. Newell. 19 Q. -- Mr. Newell. Dr. Morgenstern-Clarren's deposition 20 was provide to you afterwards, as was Dr. Robert J. 21 Steele, correct? 22 A. Correct. 23 Q. The documents that were provided to you after the 24 preparation of your report, were those provided to 25 you today or prior to today? 8 1 A. Well in advance of today. 2 Q. All right. So the only document you received today 3 was the CCF chronology? 4 A. Chronology, yes. 5 Q. Correct, okay. By the way, do you know Dr. Singh? 6 A. No. 7 Q. Let's take a look at your report here. You would 8 have mailed your report to Mr. Rispo sometime soon 9 after April 26th of 2000? 10 A. Correct. 11 MR. RISPO: Can you excuse me for a 12 second. 13 MR. KLEIN: Sure. 14 - - - - 15 (Thereupon, a discussion was had off 16 the record.) 17 - - - - 18 Q. All right. Now, since we know each other, I'm not 19 going to take you through all the details of your 20 experience and what you do, but just give me some 21 idea of your practice in medicine in the 1990s. Can 22 we say, first of all, before you answer that, that 23 it's pretty much the same in that decade? 24 A. No, it's changed markedly. Early '90s would have 25 reflected more of about 50 percent general surgery 9 1 and maybe 40, 50 percent related to hernia surgery, 2 hiatal hernias, internal hernias with bowel 3 resections, all kinds of bowel resections. In the 4 later '90s, I think it became 70 to 80 percent 5 general surgery, 20 or 10 percent hernia surgery. 6 Q. In that breakdown, did you practice any family 7 medicine? 8 A. No. 9 Q. And you have not held yourself out to be a primary 10 care physician to anybody during that decade, 11 correct? 12 A. That's correct. 13 Q. And with respect to general medicine care to your 14 patients, what, if any, general medicine care do you 15 provide your patients or have you provided them in 16 the last ten years? By the way, if you need to 17 answer any phone calls -- 18 A. No, it's all taken care of by the -- I sign the 19 phones out. 20 I think, in answer to your question, the 21 medical care I provide as a surgeon is very much 22 parallel to what an internist or general 23 practitioner would do as well. We do provide an 24 extra service in that we provide surgical services, 25 but we still write antibiotics, we still order 10 1 various medical and blood tests and interpret them 2 and do the very same things internists do. 3 Q. So for your patients when you're performing surgery 4 you're a surgeon and you're a general medical 5 practitioner or internist? 6 A. Not quite. As surgeons we're also functioning in 7 the same capacity as an internist. 8 Q. So you deal with internal medicine problems for 9 patients that are surgical patients? 10 A. To the degree it affects a surgical problem. 11 Q. Fine. Now, do you see a difference in the 12 definition of a family doctor versus a general 13 practitioner, or is it pretty much the same? 14 A. In my mind they function the same. 15 Q. And is there any distinction between an internist 16 and a family doctor, other than an additional board 17 certification? 18 A. Again, not being either one, continuity of care for 19 a family practitioner spans the young child to 20 geriatrics, the internist would be related to adult 21 medical care. 22 Q. And they all fall under the category of family care 23 physicians, correct? 24 A. Correct. 25 Q. Now, your practice, which you've described, has been 11 1 a surgical practice. Have you had opportunities to 2 perform PSAs on patients? When I say perform, take 3 blood for a PSA. 4 A. Not in the capacity that you would call an internist 5 or a GP, in other words, just doing it as purely a 6 preventative screen. I have done it for patients 7 with colon cancers and other problems and as part 8 and parcel of the complete battery of cancer tests. 9 Q. So the answer is yes when it comes to in hospital? 10 A. But not as a routine. It would be very unusual. 11 Q. Do you also order PSA tests for patients in this 12 suite here that we're located in? 13 A. No. 14 Q. In other words, they're here for a problem. You've 15 never ordered a PSA out of this office? 16 A. No. 17 Q. And your practice in the last ten years does not 18 include general medical patients who are not 19 surgical patients of yours, correct? 20 A. Correct. 21 Q. All right. And you recognize that there are some 22 surgeons that do a third or two-thirds surgery and a 23 third or two-thirds general medicine, correct? 24 A. I think, yes, that's correct. 25 Q. And if I'm not mistaken, from Dr. Singh's deposition 12 1 in his case he had a surgery practice and then he 2 had a general medicine practice, correct? 3 A. Correct. 4 Q. And that's different than your practice, correct? 5 A. Yes. 6 Q. All right. Roughly speaking then, can you tell me 7 in the year 1992 how many PSAs you would have 8 ordered for patients under any circumstances? 9 A. Yes. 10 Q. You can? 11 A. Yes. 12 Q. How many? 13 A. Zero. 14 Q. Okay. That's probably why you can give me the 15 answer. All right. 16 In the years 1992 through 1995 is there a 17 higher average per year than zero? 18 A. It pretty well is close to that. I think I've done 19 it no more than two or three times in a ten-year 20 period. 21 Q. Have you ever performed a complete physical 22 examination on one of your patients, let me strike 23 that, who is not here for surgery? 24 A. Probably not. 25 Q. In the course of your practice in the last ten 13 1 years, do you do digital rectal examinations? 2 A. I do, yes. 3 Q. And do you do those for particular reasons or for 4 screening, or tell us under what circumstances you 5 would do it? 6 A. There are two instances when I do them, one is in 7 the examining room for various conditions from 8 patients who complain of potential colon problems to 9 patients that I do colonoscopies and sigmoidoscopies 10 on as part and parcel of that kind of testing. 11 Q. Do you still perform colonoscopies? 12 A. Yes. 13 Q. All right. Do you do occult blood testing as well, 14 and have you done that in the last ten years in this 15 practice? 16 A. Yes. 17 Q. And that is done to patients within, inside of this 18 suite, as opposed to in hospital? 19 A. The colonoscopies? 20 Q. No, the digital rectal examinations and the occult 21 blood testing. 22 A. Yes. 23 Q. And it's also done in hospital as well, correct? 24 A. Correct, when you're doing colonoscopy. 25 Q. And with regard to other screening procedures, I 14 1 assume you've done breast exams as well over the 2 last ten years for patients who were coming to you 3 for various reasons? 4 A. Yes. 5 Q. All right. And pap smears? 6 A. No. 7 Q. Now, we've been provided with your two reports, the 8 April 26th report and the July, 2000 report. Is 9 this the first you've learned that your April 26, 10 2000 report was not provided to the lawyers for Mr. 11 Newell? 12 A. Frankly, it was not a report and was never sent as a 13 report. It was simply a -- 14 Q. This letter, is this the first time you've learned 15 that Mr. Newell's lawyers didn't have the April 16 26th, 2000 letter? 17 A. I wasn't aware whether you had it or not. 18 Q. So if I tell you that this is the first time we've 19 seen it, this is the first you've learned this is 20 the first time we've seen it? 21 A. Right. 22 Q. Looking at -- and I may refer to these, both of 23 these, as letters or reports and whatever they are. 24 We'll just, if I misspeak, understand that I'm just 25 referring to these two, the April 26th letter -- 15 1 MS. HIRSHMAN: Do you need a copy? 2 THE WITNESS: I can just take his. 3 Q. The April 26th letter and the July 7th letter. 4 Does that letter incorporate all the opinions 5 that you expect to testify to in this case? 6 A. I think that's too broad a question for me to 7 answer. It highlights specific discussions that Mr. 8 Rispo and I had on the phone that he asked me to 9 memorialize on paper. It is not meant to be a 10 report. 11 Q. Which one are we talking about, the April 26th? 12 A. The April 26th. 13 Q. All right. Then let's move to the July 7th, 2000. 14 I will take your word for it that the April 26th, 15 2000 letter is not a report. Do we agree that the 16 July 7th, 2000 letter is an expert report? 17 A. Yes. 18 Q. All right. And with regard to the opinions set 19 forth in that report, are those all the opinions you 20 plan on testifying to in this case? 21 A. I was asked to review this case with a purpose of 22 discussing whether Dr. Singh met the standard of 23 care. It is not meant to be complete in terms of 24 all the other personnel involved in this case. 25 Q. Well, and that's why we're here, in case there are 16 1 other opinions we want to hear them. So I'm not 2 sure I understood your question, but let me ask it 3 again. 4 MS. HIRSHMAN: You mean his answer. 5 Q. Your answer. 6 With regard to this July 7th, 2000 letter, have 7 you -- I take it you've discussed this letter with 8 Mr. Rispo since you authored the letter, correct? 9 A. Yes. 10 Q. All right. Do any additional opinions come to mind 11 that you have not included in the letter? 12 A. Well, the parameters of my report were restricted 13 strictly to Dr. Singh. 14 Q. Right. 15 A. And obviously if there are any other questions 16 relating to other issues or other physicians I may 17 have other opinions. 18 Q. Well, let me ask you some more specific questions. 19 You have reviewed medical records from Dr. Basa, 20 Singh -- 21 A. Velloze. 22 Q. -- and Velloze, correct? 23 A. Correct. 24 Q. And you've reviewed no other medical records, 25 correct? 17 1 A. There were depositions as well. 2 Q. No, I mean medical records. 3 A. No. 4 Q. You've reviewed no other medical records? 5 A. No. 6 Q. And Mr. Rispo has not provided to you today any 7 other medical records, correct? 8 A. That's correct. 9 Q. And the extent of anything else you have is his own 10 summary of treatment at The Cleveland Clinic, 11 correct? 12 A. Correct. 13 Q. Now, I know you're affiliated with Hillcrest, which 14 is part of the Cleveland Clinic, correct? 15 A. Yes. 16 Q. And you've certainly worked with The Cleveland 17 Clinic and referred patients and they've probably 18 referred patients back and forth to you; you have a 19 relationship with them? 20 A. To some degree. 21 Q. But you're not employed by them at all, correct? 22 A. Correct. 23 Q. As we sit here today, based on your -- based on the 24 documents you've reviewed and the medical records 25 you have reviewed, you do not have opinions that The 18 1 Cleveland Clinic and the physicians at The Cleveland 2 Clinic committed medical malpractice in this case, 3 do you? 4 A. That's correct. 5 Q. All right. And you don't have opinions, based on 6 reading your report, that any other physician 7 committed medical malpractice in this case, 8 correct? 9 A. I don't -- 10 Q. I'm talking about medical malpractice. 11 A. I don't have any opinion on these areas outside of 12 my own field. We have a urological situation here 13 and chemotherapy situations. I'm not qualified to 14 give opinions on those. 15 Q. Perfectly understandable. And it isn't as if I 16 don't know what your opinions are, because I've read 17 your July 7th, letter. We just want to make sure 18 that when this case goes to trial that there aren't 19 any surprises, okay. 20 So you're offering no opinions with regard to 21 any medical malpractice committed by anyone, you're 22 offering no opinions based on, what did you say, 23 chemotherapy or cancer treatment, correct? 24 A. No. 25 Q. So your opinions strictly will deal with whether or 19 1 not, in your view, Dr. Singh comported to the 2 standard of care? 3 A. That's correct. 4 Q. Okay. You can probably -- off the record. 5 - - - - 6 (Thereupon, a discussion was had off 7 the record.) 8 - - - - 9 Q. Now, as a surgeon, you see patients before surgery 10 typically in your office, certainly sometimes you 11 see them at the hospital, but often you see them in 12 a presurgical office visit, correct? 13 A. Correct. 14 Q. And you do most of your surgeries where, at 15 Hillcrest Hospital? 16 A. At Hillcrest. 17 Q. And after surgery you often see your surgical 18 patients for follow-up here, correct? 19 A. Yes. 20 Q. And that's pretty standard for a surgeon, correct? 21 A. Yes. 22 Q. Now, in the course of seeing patients for surgery, 23 seeing them in your office, sometimes you learn from 24 the history you take from that patient of medical 25 complaints that were not the primary reason for that 20 1 patient's visit to you in the first place, correct? 2 A. That's fair. 3 Q. Okay. My questions will all be fair. When you get 4 those complaints that are not the presenting 5 complaint or not necessarily related to the surgery 6 you performed, you as a physician have to make a 7 determination as to whether or not those complaints 8 are important, correct? 9 A. Yes. 10 Q. And why is that? 11 A. They may or may not affect the quality of the 12 outcome of any proposed surgery. 13 Q. And let's go one step beyond. Even if you have a 14 patient who's a post-op hernia and you've fixed his 15 hernia and he's saying, well, you know, Doc, I'm 16 having chest pain and it's going into my jaw, even 17 if that has nothing to do with the hernia that would 18 be a complaint where you as a physician would say, 19 wait a minute, let me -- I've got to deal with this 20 issue, correct, while he's in this office? 21 A. But deal with it in the sense of treating it? 22 Q. Not necessarily. Deal with it in the sense of 23 treating it or referring him, correct? 24 A. That's a fair statement, yes. 25 Q. So when a patient comes to you with a complaint that 21 1 is not part of the presenting complaint, you listen 2 to it because you're responsible to determine 3 whether or not it's something that has to be either 4 treated by you or immediately referred to some other 5 specialist, correct? 6 A. That's correct. 7 Q. And just as an example, if a male patient comes to 8 you in his 50s with pain in the left groin and as 9 you're taking a history you learn that he also has 10 urinary complaints of incontinence at times, the 11 standard of care would require you as a physician to 12 either investigate the issue or refer to someone to 13 investigate the issue? 14 MR. RISPO: Objection. 15 Q. Correct? General question. 16 A. I understand, and it's really hard to answer a very 17 broad question. Obviously, if he's incontinent to 18 the degree that he's soiling two, three times a day 19 in the course of his work time or not making it to 20 the bathroom, that's one issue. If there's just a 21 little bit of dribbling here and there, that's a 22 separate issue. If it's just been a recent event, 23 you may tell him to modify his drinking, or whatever 24 the case, and see if that ameliorates things. 25 There's a whole gamut of symptomatology. I'm not 22 1 trying to be coy. 2 Q. Well, you would agree that a new complaint in a 3 patient, a urinary complaint of incontinence, is 4 something that you, no matter what you decide, would 5 take seriously when it comes to you as a secondary 6 complaint for one of your patients, correct? 7 A. And I'll agree with you, with the understanding 8 there are different grades, different severities of 9 issues. 10 Q. Yes. 11 A. And to make your life simpler, you're talking about 12 incontinence, we can talk about constipation, we can 13 talk about bloating, we can talk about a whole host 14 of issues. Many of those can be just supported 15 symptomatically and not necessarily even treated, 16 modify a person's habits, exercise, eating, 17 drinking, so on. 18 Q. The point is, if a patient came to you with left 19 groin pain and said all of a sudden that he's having 20 incontinence at times, you would do something about 21 it, you may not determine that it is serious or you 22 may determine it's semi-serious, but you'd do 23 something about it, you'd follow it at the very 24 least, correct? 25 MR. RISPO: Objection for the record on 23 1 the grounds that, first of all, it has no 2 relationship to the facts presented in this 3 case, and secondly, the question is unduly 4 vague and misleading. 5 Go ahead, if you can answer. 6 MR. KLEIN: You can note your 7 objection. 8 A. I understand the question. 9 Q. Do you understand? 10 A. Understand my answer, too. In some situations I may 11 just watch the patient and do nothing and monitor, 12 in some severe instances I may refer him to a 13 urologist. There's the whole gamut in between. 14 Q. So the gamut is to, number one, refer him to a 15 urologist or watch the condition yourself, correct? 16 A. Yes. 17 Q. And in either situation incontinence, and I'm going 18 to ask you to assume it's a little more, it's more 19 than just a little dribble, is something that on the 20 next visit that he would see you at you would follow 21 up to see if it was still happening, correct? 22 A. Probably, yes. 23 Q. And if it was, you would have him off to the 24 urologist as soon as you could, correct? 25 A. Depending, again, if the situation worsened or it 24 1 affected his life-style very much or there was 2 evidence of urinary infection or any of those 3 situations. 4 Q. How long would you treat or follow a patient of 5 yours for incontinence without getting better 6 without referring him or sending him out for 7 testing? 8 A. You know, I can't give you an honest answer to 9 that. It's not a very common situation for me. 10 What I see are more patients -- 11 Q. But -- 12 A. Let me finish my question. What I see is frequently 13 patients with abdominal complaints. The urologic 14 situations I find with older men, 70s, 80s, 90s, are 15 pretty static situations where they've had 16 incontinence for a large number of years or they've 17 had a prostatectomy and they have incontinence as a 18 result, and you just follow those patients. 19 Q. Let's assume that this patient, in this example, 20 didn't have a prostatectomy and wasn't incontinent 21 for a long period of time, it's a new complaint, he 22 still has his prostate. You, in the back of your 23 mind in your differential diagnosis as a good 24 physician, say maybe it's his prostate, not for 25 sure, but maybe it's his prostate, correct? 25 1 A. It would be very unusual. 2 Q. But you would still keep it near the bottom of your 3 differential diagnosis, if at all, correct? 4 A. Prostatism usually isn't causing incontinence, it's 5 just the opposite, you're unable to void. 6 Q. It usually doesn't, but it is a urinary symptom that 7 has to be considered? 8 A. More related to infections or other issues, pressure 9 on the bladder, but not necessarily from a prostate 10 condition. Prostate conditions, again, would cause 11 you to be in retention so you're not able to void. 12 Q. Would you rule out incontinence, the sign of 13 incontinence, would you rule it out of your 14 differential diagnosis in a patient complaining of 15 incontinence at times as a new complaint; you 16 wouldn't rule it out of your differential diagnosis, 17 would you? 18 A. What are we ruling out again? 19 MR. RISPO: Objection. Again, vague 20 and general. 21 Q. Ruling out a problem with the prostate, either BPH 22 or prostate cancer? 23 A. Yeah, I come across a lot of these patients because 24 of the type of surgeries I do in the pelvic area and 25 the groin area. I don't normally see patients who 26 1 come in complaining of incontinence who end up 2 having prostate problems, so again, I think the -- 3 Q. Have you ever? 4 A. -- most incontinence I've seen have been related to 5 other issues, underlying urinary infections, 6 low-grade infections, previous surgeries. 7 Q. And I understand and we're going to move on 8 eventually, I promise you. You keep on saying most 9 of the situations, but it still falls somewhere -- 10 prostate cancer or benign, what is the word? 11 A. Prostatic hypertrophy, BPH. 12 Q. Those two things still fit into the differential 13 diagnosis? 14 A. I would agree with you, yes. 15 Q. And the one way -- are there ways to rule out a more 16 serious problem like prostate cancer? There are, 17 aren't there, tests that you can do? 18 A. Oh, yeah, physical exam or ultrasound testing. 19 Q. The way to rule out prostate cancer, you say, is 20 physical exam, which is a digital rectal? 21 A. Are we talking about in the office or just in 22 general? 23 Q. What's the difference? 24 A. Well, in the office you're going to do a digital 25 exam, in general you need to do testing, ultrasound, 27 1 PSAs, all that confirming stuff. 2 Q. But you would do PSAs within the confines of an exam 3 as well? 4 A. You first do a rectal exam. You don't do anything 5 before that. Obviously, the gland that's small and 6 has no knobby appearance, or whatever the case is, 7 very low symptomatic -- or low tolerance for any 8 kind of cancer. 9 Q. So in a gentleman in his 50s who has a normal 10 digital rectal examination, all right, but he's 11 complaining of incontinence, which is in your 12 differential diagnosis, wherever you put it, the 13 standard of care in the mid and beginning '90s was 14 to also do a PSA just to make sure, correct? 15 MR. RISPO: Objection, again on the 16 same grounds as previously. 17 A. I think we're tying too much in here. I think, 18 again, the issue of incontinence doesn't necessarily 19 reflect a prostate problem. 20 Q. And -- 21 A. Just so you understand my thinking, what we normally 22 do in these kinds of situations is just monitor the 23 patient. Many of those resolve, many of those 24 issues resolve on their own. 25 Q. In patients where prostate cancer is in your 28 1 differential diagnosis -- 2 MR. RISPO: You're changing this 3 question now. 4 MR. KLEIN: I'm asking the question. 5 MR. RISPO: You're assuming prostate 6 cancer is in the diagnosis. 7 MR. KLEIN: This is a hypothetical 8 question. 9 MR. RISPO: Yeah, but you keep changing 10 the question. 11 MR. KLEIN: No, I'm not changing 12 anything. 13 MR. RISPO: Well, you may not be 14 deliberately. 15 THE WITNESS: I'll follow it. 16 MR. KLEIN: The doctor is following it, 17 and if you're not following it I'm sorry. 18 MR. RISPO: I want the record to be 19 clear because you are changing the question. 20 MR. KLEIN: Of course I'm changing the 21 question. 22 THE WITNESS: He prefaced a different 23 situation. I follow that clearly. 24 MR. KLEIN: Could you read that back. 25 - - - - 29 1 (Thereupon, the requested portion of 2 the record was read by the Notary.) 3 - - - - 4 Q. In a hypothetical situation where you see a patient 5 of yours and, for whatever reason, whatever you 6 listen to, you come to the conclusion that prostate 7 cancer is somewhere in the differential diagnosis, 8 what you do is you refer the patient, correct? 9 A. Almost always, yes. 10 Q. All right. Because, in all fairness, you don't 11 treat prostate cancer, correct? 12 A. Correct. 13 Q. And you don't make the tissued diagnosis of prostate 14 cancer? 15 A. Correct. 16 Q. So that's what you do, all right. Now, let me move 17 on to some additional questions. 18 In your review of Dr. Singh's office record, 19 was the extent and/or severity -- first of all, did 20 you recognize any complaints in Dr. Singh's notes of 21 incontinence? 22 A. Yes. 23 Q. All right. And do you want to show us what date you 24 saw that on? 25 A. I believe it was February, '92. 30 1 Q. Okay. 2 MR. RISPO: Are we talking Velloze? 3 MR. KLEIN: No, we're talking -- if you 4 want to -- 5 MS. HIRSHMAN: He said February of 6 '92. That doesn't correspond. 7 MR. KLEIN: Well, so. 8 A. Again, my copies here have part of this cut off, 9 but -- 10 Q. Here, I'll tell you, in all fairness, you are 11 looking at 10-9, which is the date. 12 A. Okay. 13 Q. So September of '92. So this is 10-9-92. That is 14 the only place you see complaints of incontinence, 15 correct? 16 A. Yes. 17 Q. And in any subsequent visits of Mr. Newell to Dr. 18 Singh, is there any reference to him following up on 19 whether the incontinence has gotten better, worse, 20 or gone away? 21 A. There is none. 22 Q. And as a good physician, the standard of care, if 23 you choose to monitor the incontinence, would be to 24 follow it up, as you said earlier? 25 A. No, what I said was depending on the severity you 31 1 can just monitor the patient. 2 Q. Monitor it, I'm sorry. 3 A. See if it disappears. 4 Q. Monitor it, okay. 5 A. If the patient comes back, doesn't complain, has no 6 issues with it, it's not an event. 7 Q. And if it does continue you refer? 8 A. Obviously, yes. 9 Q. Is there any evidence, in your review of Dr. Singh's 10 subsequent records, of him inquiring of any urinary 11 complaints on the part of Mr. Newell? 12 A. I'm sorry, could you repeat that for me? 13 Q. That's probably not worded correctly. 14 A. No, I think -- 15 Q. In your review of the records after October of '92 16 but prior to Dr. Singh receiving the PSA results by 17 fax, were there any findings or any discussions in 18 his notes of him asking the patient how are you 19 doing from a urinary complaint standpoint? 20 A. There is none. 21 Q. And as a good physician, when you monitor a 22 condition that you're watching in a patient in order 23 to know if it's better or worse you must put those 24 notes in your record, correct? 25 A. Assuming that the condition is something that you're 32 1 following and assuming the patient has ongoing 2 complaints. 3 Q. Correct. From your review of the records, what did 4 you know -- the records and Dr. Singh's deposition, 5 what, if anything, did you know about Dr. Singh's 6 practice? 7 A. He ran four hospitals, basically had predominantly a 8 surgical practice, and did a little bit of general 9 practice. 10 Q. Now, from your review of these records, were you 11 able to ascertain who Mr. Newell's family doctor was 12 in 1996? 13 A. I don't know there ever was a designation of a 14 family doctor. 15 Q. Were you able to determine who Mr. Newell's family 16 doctor was in 1997? 17 A. No. 18 Q. Were you able to determine who Mr. Newell's family 19 doctor was in 1998? 20 A. No. 21 Q. Were you able to determine who his family doctor has 22 been since 1998? 23 A. I don't have any records related to that. 24 Q. And from reading your report, I think the same is 25 your opinion prior to 1995, that you're unable to 33 1 tell us who his family doctor was, correct? 2 A. Correct. 3 Q. Now, in your report you come to certain opinions 4 with regard to whether or not Dr. Singh served as, 5 let's see what the words you used were, did not act 6 as an internist in his care of Mr. Newell. That is 7 your opinion in the last paragraph of your report, 8 correct? 9 A. Yes. 10 Q. And when you say as an internist, do you mean as a 11 family doctor? 12 A. Yeah, it's kind of -- 13 Q. Okay. And in basing that opinion -- in determining 14 that opinion, what, other than your review of Dr. 15 Singh's medical records, did you look at? 16 A. Strictly his medical records. 17 Q. All right. So you did not consider Mr. Newell's 18 testimony in that regard? I'm not suggesting you 19 had to, I'm just asking you. 20 A. I think the premise for my conclusion was basically 21 the medical records reflecting more of a surgical 22 care of this patient. This was also corroborated by 23 the depositions. 24 Q. All right. But your opinion -- which depositions, 25 Dr. Singh's deposition? 34 1 A. Dr. Singh, correct. 2 Q. Aside from Dr. Singh's deposition -- strike that. 3 Your opinion as to whether or not he was Mr. 4 Newell's family doctor in the early '90s then is 5 based upon your review of Dr. Singh's deposition and 6 his office chart, correct? 7 A. Correct, and Mr. Newell's deposition as well, which 8 I was provided. 9 Q. Okay, fine. May I see your Dr. Singh record? 10 A. Here's Singh. 11 Q. Okay. That's fine. 12 MR. KLEIN: Off the record. 13 - - - - 14 (Thereupon, a discussion was had off 15 the record.) 16 - - - - 17 A. I have no handwritten notes. 18 Q. I'm not looking for handwritten notes. I couldn't 19 read them. Let me just take a minute. 20 - - - - 21 (Thereupon, a discussion was had off 22 the record.) 23 - - - - 24 Q. As part of the record you also read letters written 25 by Dr. Gittinger and Dr. Basa who were doctors that 35 1 over the years Dr. Singh had referred this patient 2 to, correct? 3 A. Correct. 4 Q. And some letters from The Cleveland Clinic and some 5 reports from cardiologists as well, correct? 6 A. That's correct. 7 Q. Certainly had your review of these records uncovered 8 a specialist who had taken a referral from Dr. Singh 9 who referred to Dr. Singh as a primary care doctor, 10 your opinions would change? It's not in here, but 11 if such a report would exist, your opinions would 12 change, correct? 13 MR. RISPO: Objection. 14 A. No, I disagree with that. 15 Q. So if Dr. Singh had referred this patient to other 16 types of doctors who then wrote letters back saying 17 dear doctor so-and-so I'm writing you this letter as 18 a primary care physician, you would not consider 19 that in determining whether or not, in fact, Dr. 20 Singh was Mr. Newell's primary care physician in the 21 first five years of the 1990s; is that correct? 22 MR. RISPO: Objection. 23 A. Absolutely not. 24 MR. RISPO: Objection. 25 Mischaracterization. 36 1 Q. Why not? 2 A. The fact that you refer a patient to another 3 specialist and you get a letter back doesn't qualify 4 that person as an internist or general 5 practitioner. I send patients to a gynecologist. 6 That doesn't mean I'm a general practitioner. 7 Q. Would you have liked to know if there were such 8 letters? Would you like Mr. Rispo to have sent you 9 those letters to review if there were such letters? 10 A. I would expect there would be letters. You get a 11 referral, you have to send a letter. 12 Q. No, that's not what I'm saying. In your review of 13 these records that we will mark as Plaintiffs' 14 Exhibit 1 for this deposition, these office records 15 of Dr. Singh, would you have expected Mr. Rispo to 16 have provided you with the full chart for Dr. Singh 17 so that you could give your opinion in the report of 18 July of 2000? 19 - - - - 20 (Thereupon, Plaintiffs' Exhibit 1 was 21 mark'd for purposes of identification.) 22 - - - - 23 A. My opinions are based on the medical records which 24 transpired in the various office visits. Dr. 25 Singh's conduct was really to be determined strictly 37 1 by how he managed this patient and for what 2 conditions he managed him, not necessarily for the 3 kinds of letters he received or the kinds of 4 referrals he made. 5 Q. So you would not find it helpful in determining -- 6 in coming to a conclusion as to whether or not Dr. 7 Singh was the primary care physician or the family 8 physician to Mr. Newell, you would not find it 9 helpful at all to look at referral letters from 10 other doctors, correct? 11 A. Well, if there were referral letters -- 12 Q. All right. You are being handed now a document that 13 Mr. Rispo has been aware of for some time now. Now, 14 is this the first time you have seen that note? 15 A. Yes. 16 MR. RISPO: Let's let the record 17 reflect I was aware of it for the last two 18 weeks. Let's not overstate the case. 19 MR. KLEIN: Well, I will overstate the 20 case because I believe you had it beforehand. 21 Q. But in any event, Doctor, let's mark that as 22 Plaintiffs' Exhibit 2 and then we'll let you look at 23 it, okay. 24 MS. HIRSHMAN: Just for the record, 25 whether or not he has it and whether or not he 38 1 knows he has it is different. 2 - - - - 3 (Thereupon, Plaintiffs' Exhibit 2 was 4 mark'd for purposes of identification.) 5 - - - - 6 Q. Doctor, this document has been handed to you by Mr. 7 Rispo in the midst of this deposition. Why don't 8 you take a look at it. 9 MR. RISPO: So we can stop playing 10 games. 11 MR. KLEIN: I believe Dr. Grischkan 12 would want to look at a full chart before 13 giving an opinion. 14 MR. RISPO: That's why I just handed it 15 to him. 16 MR. KLEIN: That's why you just handed 17 it to him. 18 Q. Doctor, is this the first time you have seen 19 Plaintiffs' Exhibit 2? 20 A. Yes. 21 Q. And based upon your review -- first of all, can you 22 determine, I'll help you if you can't, but can you 23 determine whose note that is? 24 A. It must be some kind of orthopedist. 25 Q. Correct. In the records that we have and that Mr. 39 1 Rispo had prior to this deposition today, Dr. Singh 2 had that note in his office record, and this is the 3 first time you've seen it, correct? 4 A. Yes. 5 Q. Now, I'm going to ask you to look at that note. I'm 6 going to ask you to assume this is an orthopedics 7 note from a Dr. Basa, okay. Now, that was not in 8 the chart you have before you, was it? 9 A. No, it was not. 10 Q. And if I may, the records that you looked at had Dr. 11 Basa's records but they only, and his practice's 12 records, they only began in 1996? 13 A. Correct. 14 Q. As a person who wants to be fair in reviewing 15 records on behalf of an attorney, you would want to 16 see Dr. Singh's full chart and then determine what 17 is important and what isn't important, correct? 18 A. I think that's fair, yes. 19 Q. All right. Now, looking at that note, would you 20 agree that at least from an orthopedics standpoint 21 within days, if not on the same day, of the visit to 22 Dr. Singh this Dr. Basa was under the understanding 23 from his note that Dr. Singh was the primary care 24 physician, correct? 25 A. I can't comment on what his thinking was. 40 1 Q. Well, based on a comment, not on his thinking. Can 2 you read and make that determination based on his 3 notes the way you did Dr. Singh? 4 A. Well, there's a highlighted area here that refers to 5 a primary care physician. 6 Q. What does it say? 7 A. It says, "Patient's primary physician, Dr. Singh." 8 Q. All right. And that was highlighted by Mr. Rispo? 9 A. I don't know. 10 MR. RISPO: That's correct. 11 Q. Did you find, in your review of the contemporaneous 12 cardiologist's records that, or deposition, that he 13 also felt that Dr. Singh was the primary care doctor 14 to Mr. Newell? 15 MR. RISPO: Objection. That's not the 16 case. 17 A. I didn't see any specific verbiage to that effect. 18 Q. In the deposition? 19 A. Correct. 20 MR. RISPO: You're taking about the 21 deposition? 22 MR. KLEIN: Yes. 23 MR. RISPO: Okay. I thought you meant 24 records. Yes, I understand that was his 25 deposition testimony. 41 1 MR. KLEIN: Well, I'm not asking you. 2 MS. HIRSHMAN: We'll put you under oath 3 next. 4 MR. KLEIN: Yeah. 5 Q. So in all fairness, for you to conclude that the 6 primary care -- that whether or not Dr. Newell was 7 the primary care, slash, family doctor -- 8 MS. HIRSHMAN: Dr. Singh. 9 Q. Dr. Singh was the primary care or family doctor to 10 Mr. Newell from 1991 to 1995, it is not important 11 for you to consider the contemporaneous records of 12 specialists treating Mr. Newell; is that what you -- 13 A. No, that's a mischaracterization. 14 Q. Then I want you to explain. That's why I asked it. 15 A. I think you're simply throwing a couple 16 consultations at me and saying because these 17 individuals refer -- 18 Q. But -- 19 A. Well, let me answer. Because they referred to this 20 particular referral as a primary care physician or 21 internist or glorified whatever else, you still have 22 to look at the office visits and judge, based on 23 those office visits, whether Dr. Singh was actually 24 an internist, and the office records are clearly 25 devoid of full examinations, examinations such as 42 1 diabetes, lipid profiles, hypertensions and so on. 2 What they are is directed to certain specific 3 target areas, the patient has pain in the soft 4 palate, he describes an aphthous ulcer, the guy has 5 pain in the knee, he goes on to do lipomas, there's 6 pain in the groin, he rules out a hernia, there's 7 dizziness, he talks about a vascular problem with 8 the carotid, but it's completely devoid of what an 9 internist would do. 10 Q. And an internist and/or a family doctor practicing 11 standard of care family medicine in the early '90s 12 would do all those testings that you found were not 13 part of Dr. Singh's chart, correct? 14 A. If he were truly acting as a primary care physician 15 for this patient? 16 Q. Correct. 17 A. Then you would expect to see repeated examinations 18 of full examinations targeted to heart, lungs, 19 kidneys, everything else. 20 Q. And anything short of that would be inappropriate 21 family medical care, correct? 22 A. I totally disagree. Anything short of that reflects 23 this patient being treated as a surgical patient. 24 Q. I'm not talking about this case. I'm not talking 25 about this case, Doctor. I'm saying you're talking 43 1 about what a family doctor is supposed to do. 2 MR. RISPO: You don't -- 3 Q. And I'm saying to you not this case. 4 MR. RISPO: You're talking about a 5 hypothetical? 6 MR. KLEIN: Yeah. 7 Q. If a family doctor doesn't do all that, he or she is 8 acting below the standard of care? 9 A. You know, I can't comment on the standard care 10 for -- 11 Q. For a family doctor? 12 A. Sure. I don't practice in that capacity. 13 MR. KLEIN: I might have a few more 14 questions if we take a little break. 15 - - - - 16 (Thereupon, a recess was had.) 17 - - - - 18 MR. KLEIN: Why don't we mark this as 19 Plaintiffs' Exhibit 3, the chronology CCF 20 treatment that Mr. Rispo provided for Dr. 21 Grischkan. 22 MR. RISPO: Off the record. 23 - - - - 24 (Thereupon, a discussion was had off 25 the record.) 44 1 - - - - 2 (Thereupon, Plaintiffs' Exhibit 3 was 3 mark'd for purposes of identification.) 4 - - - - 5 Q. In your practice, Doctor, when you take on a new 6 patient, as a surgeon, aside from introducing 7 yourself, you take a history, correct? 8 A. Yes. 9 Q. And you want to know, as a surgeon, if he's here for 10 a hernia or if he's here for a mole removal, 11 whatever, you take a complete history, correct? 12 A. Yes. 13 Q. And you find out his allergies and his family 14 history and you go through the whole nine yards of 15 learning about the patient, correct? 16 A. Yes, with a proviso. As long as it's not just a 17 little local procedure, like a cyst removal or a 18 mole, in those situations we dispense with it. 19 Q. But otherwise you take a complete medical history? 20 A. If it's a more extensive procedure. 21 Q. And when you say you take it, do you record it? 22 A. Yes. 23 Q. And do you have a particular form you use or do you 24 just use a piece of doctor paper? 25 A. I have a standard form. 45 1 Q. You have a standard form. Could you pull one so I 2 could see it? 3 A. Sure. 4 - - - - 5 (Off the record.) 6 - - - - 7 Q. Now, this form that you use, it looks like it's a 8 two-page form that you use when you take on a new 9 patient. I say two pages, meaning back and front. 10 A. Yes. 11 Q. All right. And let me just take a look. 12 A. Again, so we understand, these are patients 13 undergoing gallbladder surgery, breast surgery or 14 hernia surgery. 15 Q. Oh, this is only for patients who are going to be 16 admitted to the hospital for a procedure? 17 A. No, they're not admitted. What this is is it can be 18 for outpatient surgery or inpatient surgery, but 19 that's for the more invasive procedures. For minor 20 procedures, I just use a blank sheet and put down 21 pertinent positives. 22 Q. Either way, you take a history with regard to their 23 medical history, allergies, et cetera, correct? 24 A. Again, assuming that we're doing a more major 25 procedure. 46 1 Q. All right. Now, no matter what kind of procedure, 2 when you take on a new patient do you determine who 3 his primary care doctor is so you have some 4 continuity in the care, in his care? 5 A. Generally I do, yes. 6 Q. And you do that -- strike that. 7 And you've done that since you've been 8 practicing, or is that something relatively -- 9 A. Not faithfully, but I think most of the time. 10 Q. It's important for the surgeon to know who the 11 primary care physician is? 12 A. Yes. 13 Q. Now, with regard to Dr. Singh, do you know whether 14 he recorded who Mr. Newell's primary care doctor was 15 anywhere in his chart? 16 MR. RISPO: Objection. 17 A. No. 18 MR. RISPO: It presumes there was one. 19 A. I don't think there was reference to one. 20 Q. If, indeed, he had a primary care doctor, would it 21 have been Dr. Singh's responsibility to know who his 22 primary care doctor was, given the extent of the 23 medical care in the years that he treated him? 24 A. Based upon my understanding, Dr. Singh felt that The 25 Cleveland Clinic was providing his primary medical 47 1 care. 2 Q. And that was his feeling, according to his 3 deposition, correct? 4 A. Yes. 5 Q. Did he write anywhere in his record that The 6 Cleveland Clinic was acting as the primary care 7 physician for John Newell between 1992 and 1995? 8 A. I think there was reference to the fact he was 9 receiving medical care at The Cleveland Clinic. 10 Q. With regard to the medical records from 1992 to 1995 11 though, was there any specific written reference in 12 that record identifying The Cleveland Clinic as the 13 primary care doctor? 14 A. Not specific notation. 15 Q. All right. Now, looking at Dr. Singh's chart that 16 you have before you and including the additional 17 record that Mr. Rispo handed you in the midst of 18 this deposition, what document in Dr. Singh's record 19 identifies doctor -- identifies who the primary 20 care -- makes reference to who Mr. Newell's primary 21 care physician is? 22 A. I don't believe there was any reference. 23 Q. There was a reference in Dr. Basa's notes that were 24 part of Dr. Singh's records of Mr. Newell, wasn't 25 there? 48 1 A. There is notation, yes. 2 Q. Yeah. So that reference in Dr. Singh's records 3 between 1990 and -- 1992 and 1995 that Dr. Singh was 4 Mr. Newell's primary care doctor is the only 5 reference written in the records of Dr. Singh 6 between '92 and '95 as to who the primary care 7 doctor was, correct? 8 A. That's correct. 9 Q. And again, we're really almost over and you've not 10 been asked questions like how much expert work 11 you've done, and I know you've done defense work, 12 you've done plaintiffs' expert work, correct? 13 A. Yes. 14 Q. I said I wasn't and now I'm asking it. 15 And you are not giving any opinions with regard 16 to the doctors you've already mentioned, you're not 17 giving any opinions with regard to Dr. Basa or any 18 of those Southwest General doctors or any 19 radiologists; am I correct? 20 A. Yes. 21 Q. You're not giving any opinions of standard of care; 22 is that correct? 23 A. Correct. 24 Q. All right. And that applies to -- 25 MR. RISPO: Other than Dr. Singh. 49 1 Q. The only standard of care opinions you're giving are 2 the ones you have with regard to Dr. Singh, correct; 3 is that right? 4 A. Yes. 5 MR. KLEIN: Are we done or do you want 6 to step out? 7 Q. And what are your charges for deposition, Doctor? 8 A. For you or most other attorneys? 9 Q. For the -- off the record. 10 - - - - 11 (Thereupon, a discussion was had off 12 the record.) 13 - - - - 14 A. It's a thousand dollars flat rate for the first two 15 hours. 16 Q. So even if we leave now it's still a thousand 17 dollars? 18 A. Correct. 19 Q. And what were your charges up and through today, not 20 including your meeting with Mr. Rispo? 21 A. I'm not really sure. I don't keep tabs on the 22 cumulative amount. I would assume there's probably 23 four or five hours, six hours of total time. 24 Q. All right. And what's your hourly rate for that? 25 A. $300 an hour. 50 1 Q. Do you keep a card on this case, on cases? 2 A. No, as soon as it's paid the bill is just 3 destroyed. 4 Q. Before you leave, and if you have to take a call or 5 two, we should attempt at least to look at your 6 handwriting. 7 A. I was afraid you were going to ask that. 8 Q. And we might have a question or two. 9 A. Do you want me to make it easy for you? 10 Q. What? 11 A. I could read it. 12 Q. Well, maybe we should ask you to read it. 13 A. What you're actually reading, whether it's on or off 14 the record, is a chronology. There's absolutely no 15 opinions written down. It's strictly dates and 16 verbatim on what appears in the records. 17 Q. Okay. 18 - - - - 19 (Thereupon, a discussion was had off 20 the record.) 21 - - - - 22 MR. KLEIN: Let's mark this as an 23 exhibit, the report, the letter that you 24 referred to as a document you read in 25 preparation. 51 1 MS. HIRSHMAN: Are you on 4? 2 MR. KLEIN: Plaintiffs' Exhibit 4, a 3 letter from Mr. Rispo. 4 MS. HIRSHMAN: What's the date on it? 5 THE WITNESS: It's dated March 16th, 6 2000. 7 - - - - 8 (Thereupon, Plaintiffs' Exhibit 4 was 9 mark'd for purposes of identification.) 10 - - - - 11 A. You can go right to the depositions. There's 12 nothing else. 13 Q. Were there any other physicians involved -- strike 14 that. I don't want to ask you that question. 15 Okay. I think we're done. Oh, one more. 16 Do you have a particular lab that you use for 17 blood work out of this office? 18 A. No. 19 Q. Does the Hillcrest lab do your blood work? 20 A. Generally, they do. I've also used or used to use 21 Mt. Sinai. 22 Q. Okay. Thank you very much. 23 MS. HIRSHMAN: Obviously, defense 24 counsel and plaintiffs' counsel are going to 25 waive signature on each other's expert depos 52 1 since we're taking their depositions within one 2 week of the first date of trial. Correct? 3 MR. RISPO: In exchange for that Ellen 4 has promised and agreed to be nice to me from 5 now on. 6 MS. HIRSHMAN: Within reason. 7 (Signature waived.) 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 53 1 2 C E R T I F I C A T E 3 The State of Ohio, ) SS: 4 County of Cuyahoga.) 5 6 I, Laura L. Ware, a Notary Public within and for the State of Ohio, do hereby certify that the 7 within named witness, DAVID M. GRISCHKAN, M.D., was by me first duly sworn to testify the truth, the 8 whole truth, and nothing but the truth in the cause aforesaid; that the testimony then given was reduced 9 by me to stenotypy in the presence of said witness, subsequently transcribed into typewriting under my 10 direction, and that the foregoing is a true and correct transcript of the testimony so given as 11 aforesaid. 12 I do further certify that this deposition was taken at the time and place as specified in the 13 foregoing caption, and that I am not a relative, counsel or attorney of either party or otherwise 14 interested in the outcome of this action. 15 IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal of office at Cleveland, 16 Ohio, this 30th day of November, 2000. 17 18 Laura L. Ware, Ware Reporting Service 19 21860 Crossbeam Lane, Rocky River, Ohio 44116 My commission expires May 17, 2003. 20 21 22 23 24 25