0001 1 IN THE COURT OF COMMON PLEAS 2 OF CUYAHOGA COUNTY, OHIO 3 - - - - - 4 JAMES BERRY, 5 Plaintiff, 6 vs. Case No. CV-06-590509 7 HELEN S. HAN, M.D., 8 et al., 9 Defendants. 10 - - - - - 11 DEPOSITION OF HELEN S. HAN, M.D. 12 WEDNESDAY, APRIL 25, 2007 13 - - - - - 14 Deposition of HELEN S. HAN, M.D., a 15 Defendant herein, called by the Plaintiff for 16 examination under the statute, taken before me, 17 Cynthia A. Sullivan, a Registered Professional 18 Reporter and Notary Public in and for the State 19 of Ohio, pursuant to notice and stipulations of 20 counsel, at the offices of Bonezzi, Switzer, 21 Murphy, Polito & Hupp, 1300 East Ninth Street, 22 Suite 1950, Cleveland, Ohio, on the day and date 23 set forth above, at 10:00 a.m. 24 - - - - - 25 0002 1 APPEARANCES: 2 On behalf of the Plaintiff: Becker & Mishkind Co., LPA, by 3 JESSICA PERSE, ESQ. Skylight Office Tower 4 1660 West Second Street Suite 660 5 Cleveland, Ohio 44113 (216) 241-2600 6 On behalf of the Defendants Dr. Han, University 7 Primary Care Practices, Inc., and Sherilynn Sage: 8 Bonezzi, Switzer, Murphy, Polito & Hupp, by 9 WILLIAM BONEZZI, ESQ. Suite 1950 10 1300 East Ninth Street Cleveland, Ohio 44114 11 (216) 875-2767 12 On behalf of the Defendants Dr. Barry Peskin and Cleveland Clinic Ob/Gyn Specialties: 13 Roetzel & Andress, by BEVERLY A. SANDACZ, ESQ. 14 1375 East Ninth Street One Cleveland Center - Ninth Floor 15 Cleveland, Ohio 44114 (216) 615-4834 16 On behalf of the Defendant Dr. John Thompson: 17 Reminger & Reminger, by DAVID H. KRAUSE, ESQ. 18 1400 Midland Building 101 Prospect Avenue West 19 Cleveland, Ohio 44115 (216) 687-1311 20 ---- 21 22 23 24 25 0003 1 HELEN S. HAN, M.D., of lawful age, called 2 for examination, as provided by the Ohio Rules 3 of Civil Procedure, being by me first duly 4 sworn, as hereinafter certified, deposed and 5 said as follows: 6 EXAMINATION OF HELEN S. HAN, M.D. 7 BY MS. PERSE: 8 Q. Doctor, my name is Jessica Perse. 9 We've never been formally introduced. I am the 10 attorney representing the plaintiff in the 11 matter that's pending before the court, the 12 Berry case. 13 A. Yes. 14 Q. Have you ever had your deposition 15 taken before? 16 A. In the past, no. 17 Q. This is your first deposition? 18 A. Yes. 19 Q. Let's review some ground rules, so 20 to speak. Just because this is on the record, 21 it's important to kind of understand the 22 territory; okay? 23 I would like you to make sure that 24 you listen carefully to all my questions. While 25 your attorney has reviewed the rules with you, I 0004 1 want to make sure that you and I are on the same 2 page from start to finish, and I assure you that 3 my intent is to make sure that you understand 4 all of my questions and that you answer only 5 after that question is clear to you; okay? 6 A. Yes. 7 Q. If at any time you don't understand 8 the question, tell me, and I'll do my best to 9 clarify it. Is that agreeable? 10 A. Yes. 11 Q. Answer all of the questions 12 verbally, no nods or shakes of the head. 13 Because this is recorded on the record, it's 14 important to get a verbal answer. Is that 15 understandable? 16 A. Yes. 17 Q. Try to wait until I'm done with my 18 question, that may be painful, so that we don't 19 talk over each other. Don't assume what I'm 20 asking, so give me a chance to get the whole 21 question out. I will do my best to let you 22 answer the question fully before I ask another 23 question. Is that okay with you? 24 A. Yes. 25 Q. It's important that you make sure 0005 1 that you understand each and every question 2 because I'm going to rely on your answers that 3 you provide today at trial when this matter goes 4 to court. Do you understand that? 5 A. Yes. 6 Q. I have a document here that I 7 believe is your CV. It was produced by your 8 attorney. I'm going to ask you to take a look 9 at it and see if it's current. 10 MR. BONEZZI: You're going to mark 11 that? 12 MS. PERSE: Yes. 13 A. My current position has changed. I 14 am still working with the Department of Veterans 15 Affairs, but in Connecticut, and the address is 16 just add another five, 555 Willard Avenue, 17 Newington, Connecticut. 18 Q. Why don't we start with could you 19 state your full name for the record. 20 A. My name is Helen Han. 21 Q. Could you spell the last name for 22 us. 23 A. H-A-N. 24 Q. I'll take that back. We will mark 25 this as an exhibit. I'll use it as a reference 0006 1 point, and you can kind of correct me if there's 2 any additional changes beyond what we spoke of; 3 okay? 4 A. Okay. 5 Q. Now, this document identifies that 6 your current position is on West Waterloo Road, 7 Akron, Ohio. You've indicated that that 8 location has changed? 9 A. Yes. 10 Q. How long were you at the Akron 11 address? 12 A. From January 2005 to December 2006. 13 Q. A year-and-a-half? 14 A. Two years. 15 Q. I'm trying to do some math here, and 16 I always get confused at the new year. Where 17 were you before your employment at the West 18 Waterloo Road? 19 A. I was with UPCP. 20 Q. For how long were you with UPCP? 21 A. From 2003 -- 2002 -- 2003 through 22 December of 2004. 23 Q. You spoke a little bit under your 24 breath. Can you clarify for me is it 2002 or 25 2003? 0007 1 A. 2003. 2 Q. What time of year? 3 A. It was February when I started. 4 Q. To 2005? 5 A. December 2004. 6 Q. So from December 2004 to June 2005 7 where were you practicing? I may have taken 8 some dates down wrong. 9 A. December 2004 through June 2005 I 10 was with the VA in Akron. 11 Q. So when did you begin at the VA in 12 Akron? 13 A. January of 2005. 14 Q. That's where I was confused. I 15 thought you said June. 16 A. January. 17 Q. January 2005 to December 2006? 18 A. Yes. 19 Q. Now, you identified you were working 20 at UPCP. Can you tell me what those initials 21 stand for? 22 A. University Primary Care Practices. 23 Q. Were you an employee of UPCP? 24 A. Yes. 25 Q. What location was your office 0008 1 practice at during February 2003 through 2 December 2004? 3 A. The address is 22750 Rockside Road 4 in Bedford, Ohio. 5 Q. Did you have any other office 6 locations? 7 A. No. 8 Q. Looking at your CV, you graduated 9 medical school in 1993? 10 A. Yes. 11 Q. What did you do subsequent to 12 medical school? 13 A. Subsequently meaning? 14 Q. After. 15 A. After, I went to residency. 16 Q. You did an internship here; is that 17 correct? 18 A. Yes. 19 Q. Where did you do your internship? 20 A. At University Hospitals in 21 Cleveland. 22 Q. That was from when to when? 23 A. That was from July of 1993 to June 24 of 1994. 25 Q. Following that you continued your 0009 1 training; is that true? 2 A. That's right. 3 Q. That was at University Hospitals? 4 A. Yes. 5 Q. And you completed your residency in 6 1996. Was that June of 1996? 7 A. Yes. 8 Q. Did you do a chief year at 9 University Hospitals? 10 A. No. 11 Q. So your training, your residency and 12 internship was in what specialty? 13 A. Internal medicine. 14 Q. Was your internship in internal 15 medicine as well? 16 A. Yes. 17 Q. You did one year of internship and 18 how many years of residency? 19 A. Two. 20 Q. Did you complete a chief year of 21 residency in internal medicine? 22 A. No. 23 Q. Following your residency completed 24 in 1996, tell me about your work experience. 25 What did you do following your residency? 0010 1 A. I joined University Mednet. At the 2 time I graduated, it was July of 1996, I had 3 joined that group. It was a multispecialty 4 group. 5 Q. Where was your practice located at 6 that time? 7 A. It was the same location, same 8 address, in Bedford, Ohio. 9 Q. For how long did you continue with 10 University Mednet at that Rockside location? 11 A. Up until the time that I became an 12 employee of UPCP. 13 Q. Is it fair to say that your practice 14 transitioned into the UPCP practice? 15 A. Yes. 16 MR. BONEZZI: Objection. Go ahead. 17 Go ahead. 18 A. Yes. 19 Q. So you were working for University 20 Mednet as an internal medicine physician; 21 correct? 22 A. Correct. 23 Q. Then when you became an employee of 24 UPCP, you were also working as an internal 25 medicine physician for UPCP? 0011 1 A. That's right. 2 Q. I got my dates wrong before. 3 University Mednet continued from 1996 to 4 February of 2003; correct? 5 A. It ended in December of 2002, and I 6 was on maternity leave, so I had the month of 7 January off. I started then in February, but I 8 did become an employee as of January of 2003 9 with UPCP. 10 Q. Was that your first child? 11 A. No, second. 12 Q. Did you have any other children 13 during your stint at UPCP? 14 A. No. 15 Q. Did you take any other time off from 16 UPCP during the time from February 2003 through 17 December of 2004? 18 A. No. 19 Q. Going back to your CV, you are board 20 certified in internal medicine; is that true? 21 A. Yes. 22 Q. That was 1996 is what your CV says. 23 Have you had an opportunity to recertify? 24 A. Yes. I have recertified already in 25 October of 2006, and I passed. 0012 1 Q. You just found out? It takes a 2 while. 3 A. Yes. I just found out a couple 4 months ago. 5 Q. When you originally boarded in 6 internal medicine, is there an examination 7 required the first time through? 8 A. For the board exam? 9 Q. Yes. 10 A. Yes. Yes. 11 Q. Did you pass that exam on the first 12 attempt? 13 A. Yes. 14 Q. Is there an oral examination for 15 internal medicine? 16 A. (Indicating.) No, not at the time 17 that I took that. 18 Q. You're remembering no shakes. I see 19 here the professional societies that you belong 20 to. It lists the American College of 21 Physicians, Phi Beta Kappa, and Korean American 22 Medical Association of Northeast Ohio. 23 Can you tell me what the American 24 College of Physicians is? Can you explain that 25 body for me, what that is? 0013 1 A. Well, it is a group of physicians, 2 and I believe it's mostly -- it can be any 3 specialty. It's a group that encourages 4 continuing education as well as, not 5 camaraderie, but just to support each other as 6 colleagues, but mostly with education purposes 7 and assistance to physicians that way. 8 Q. Is it composed of only internal 9 medicine physicians, or is it primary care 10 specialties? 11 A. It is primary care specialties and 12 subspecialties that I am familiar with. Since 13 then I am no longer part of the group because of 14 the membership dues being expensive, so it's 15 been a while. 16 Q. When did you discontinue your 17 membership? 18 A. That was approximately 2000 or 1999. 19 Q. Then Phi Beta Kappa, is that a 20 fraternity? 21 A. That is a fraternity from my 22 undergraduate studies. 23 Q. Do you still belong to that 24 organization? 25 A. I do, but I am not an active member. 0014 1 Q. The Korean American Medical 2 Association, are you still an active member? 3 A. I am active but have not 4 participated with my move to Connecticut. It is 5 an association that includes Korean physicians 6 in the Cleveland community; again, meetings, 7 education, outings together. 8 Q. Do you belong to the American 9 Medical Association? 10 A. I did at one point but, again, 11 because of the dues it's not active, and it's 12 been, again, about the same time I let the ACP 13 membership go. 14 Q. Are there any other organizations 15 that you belong to? 16 A. No. 17 Q. You identified that you moved to 18 Connecticut in -- I'll probably get this wrong 19 -- December of 2006? 20 A. Yes. 21 Q. What was the reason for that move? 22 A. Transfer of job. 23 Q. Do you have family in Connecticut? 24 A. Yes. 25 Q. The move from UPCP to the VA, what 0015 1 was the reason for that? 2 A. To have a workplace with more 3 structured hours as well as benefits including 4 no on-call duties because of my family 5 responsibilities, so seeking a better balance 6 between work and home. 7 Q. In 2006 is it fair to say that you 8 had two children? I think we reviewed two 9 pregnancies. 10 A. Yes. 11 Q. Tell me, while you were employed 12 with UPCP, what kind of hours did you have? 13 A. I worked about 35 hours, scheduled 14 hours, in the office which included every other 15 Saturday and included full call which we took 16 one week out of the month, and I was considered 17 part time because I had Mondays off. 18 Q. So you didn't have any office 19 responsibilities or call duties on Monday? 20 A. No office responsibilities, but if I 21 was on call, I would still have to go and round 22 at the hospital. 23 Q. The call went from what day of the 24 week to what day of the week? 25 A. It went from Friday night to the 0016 1 following Friday. 2 Q. What were your hospital privileges 3 at that time? 4 A. Well, my privileges were at Bedford 5 Hospital, UHHS Bedford Medical Center, and I was 6 on courtesy staff for the time I was there since 7 1996. 8 Q. Courtesy staff where? 9 A. At Bedford Hospital. 10 Q. Did you have any privileges at the 11 main campus in Cleveland? 12 A. Yes. I had privileges, but I did 13 not ever need to go and see patients there 14 because we had our group that was closer, and 15 eventually they went to a hospital system, so I 16 did not ever have to admit to University 17 Hospitals. 18 Q. When you took call, what practice 19 were you covering? 20 A. We covered our Rockside internal 21 medicine group as well as occasionally some of 22 the subspecialty calls, but basically it was our 23 group at the Rockside internal medicine clinic. 24 Q. Did you ever have occasion to cover 25 at University downtown? 0017 1 A. No. 2 Q. When you worked the 35 hours during 3 the week, that was you were supposed to be 4 working covering your office practice during 5 that time? 6 A. Yes. Correct. 7 Q. Was hospital rounds above and beyond 8 that -- 9 A. Yes. 10 Q. -- 35 hours? 11 A. Yes. 12 Q. When you had a patient in the 13 hospital when you were not on call, whose 14 responsibility was it to round? 15 A. That was one of my other partners 16 who was on call at the time to see that patient. 17 Q. Who were your partners during that 18 time? 19 MR. BONEZZI: Objection. Go ahead 20 and answer if you can. I don't see the 21 relevance of her partners. 22 A. My partners' names? 23 Q. Yes. 24 A. Dr. Latha Pillai, Dr. Ghai Lu, 25 Roxanne Sukol, Suzanne Schaffer, myself. 0018 1 Q. You all shared the office practice 2 at the Rockside location; is that true? 3 A. Yes. 4 Q. Do you have a current license, 5 current valid license, for the state of Ohio? 6 A. Yes. 7 Q. So you've maintained an active 8 license here in Ohio since you relocated to 9 Connecticut? 10 A. Yes. 11 Q. Do you have a Connecticut license? 12 A. No. 13 Q. Explain to me how you can practice 14 in Connecticut without a Connecticut license. 15 A. I work with the government. With 16 the VA you can practice with any valid license. 17 You don't have to switch over to the state that 18 you're practicing in unless you choose to, so I 19 have kept my Ohio license as of this date. 20 Q. Do you have any other licenses for 21 any other state in the U.S.? 22 A. No. 23 Q. Do you have any restrictions on your 24 license to practice medicine? 25 A. No. 0019 1 Q. Has your license been restricted, 2 revoked, or called into question in any way? 3 A. No. 4 Q. You've had your license since you 5 completed your residency in 1996? 6 A. Yes. 7 Q. When we first started talking, you 8 mentioned that you had never provided a 9 deposition before. Any prior lawsuits? 10 A. No. 11 Q. So you've never been named in a 12 complaint? 13 A. That's correct. 14 Q. Have you ever been a plaintiff in a 15 case, any legal matter? 16 MR. BONEZZI: Objection. 17 A. No. 18 Q. Have you ever been asked to review 19 any materials for medical-legal purposes? 20 A. No. 21 Q. Subsequent to your residency, any 22 fellowship? 23 A. No. 24 Q. Have you had any teaching experience 25 with medical students? 0020 1 A. No. 2 Q. Other than your employment with UPCP 3 and the VA and Mednet, is there any other work 4 experience that you have, any moonlighting or 5 anything outside the field of medicine? 6 A. I did moonlight, but it was with 7 University Mednet at the time at their urgent 8 care facility, but it was still the practice I 9 was with. 10 Q. That was with University Mednet. 11 When you were working for UPCP did you do any? 12 A. No. It was when I was working for 13 University Mednet. 14 Q. At this Rockside location, you 15 shared office space with fellow physicians, and 16 you listed them before. Were they all in the 17 practice of internal medicine? 18 A. Yes. 19 Q. Was there any other specialty 20 available at that location? 21 A. Yes. 22 Q. Were they in different office 23 suites, so to speak? 24 A. That's correct. 25 Q. What other specialties were 0021 1 available at that location? 2 A. There were pediatrics, Ob/Gyn, and 3 at different days of the week we had surgery, 4 urology, podiatry. Did I say urology? 5 Q. Yes, you did. 6 A. And neurology subspecialties. 7 Q. Were all those physicians members of 8 UPCP? 9 MR. BONEZZI: Objection. You may 10 answer, if you know. 11 A. Most all of them. 12 Q. You had mentioned an Ob/Gyn 13 subspecialty. Who was in practice at that time 14 at that Rockside location? 15 MR. BONEZZI: Objection. You may 16 answer, if you know. 17 A. It was UPCP Ob/Gyn. 18 Q. Do you remember any of the 19 physicians? 20 A. Yes, I do. I remember Phil 21 Brzozowski, Sherilynn Sage, John Thompson, Marty 22 Wiczorek, Nancy Cossler, Tia Melton, Joi 23 Robinson. There's more. That's all I remember. 24 Q. Did you refer patients to that 25 location or to physicians in that location on a 0022 1 regular basis? 2 A. Yes, I did. 3 Q. Did people refer patients to you 4 likewise from that location given your specialty 5 of internal medicine? 6 A. Yes. 7 Q. Did you have occasion to refer 8 outside of that medical practice? 9 A. Yes. 10 Q. For what things? 11 A. Meaning? 12 Q. Let me phrase that a little bit 13 better. What would be your basis for referring 14 patients? Would you typically refer patients to 15 that location, or would other factors determine 16 where you were sending patients for other 17 problems? 18 A. Depending on insurance, if they 19 preferred to go to Bedford Hospital or a 20 different facility, that might be one that would 21 be one of the reasons to refer outside of UPCP. 22 Also, if there were high risk 23 issues, that would be referred to University 24 Hospitals, but they would probably first go to 25 an Ob/Gyn closer to Bedford and then be referred 0023 1 over. Me being the primary care physician, I 2 would maybe make the referral that way. 3 Q. How is it that patients would come 4 to you? 5 A. New patients? 6 Q. Yes, new patients. 7 A. They would either select me as their 8 PCP from one of the listings with their 9 insurance, and since we were affiliated with 10 University Hospitals, they would set up an 11 initial appointment. Sometimes they were 12 referred from friends or family. 13 Q. Okay. Have you reviewed any 14 material in preparation for today's deposition? 15 MR. BONEZZI: Material meaning this 16 (indicating)? 17 MS. PERSE: Well, any materials. 18 A. Yes. 19 MR. BONEZZI: Any materials meaning 20 this (indicating)? 21 MS. PERSE: I'm specifically -- 22 MR. BONEZZI: No. She's not going 23 to answer any question that I may have provided 24 her materials on. 25 MS. PERSE: I understand. 0024 1 MR. BONEZZI: No, you didn't. If 2 you did, you wouldn't have interrupted me. She 3 has reviewed these materials, and the only other 4 materials that she has reviewed are those that I 5 have supplied. So go ahead and answer. 6 Q. Again, my question is -- I'll be 7 more specific for purposes of the question. 8 Have you reviewed any independent notes for 9 today's deposition? 10 A. No. 11 Q. Have you reviewed any textbooks for 12 today's deposition? 13 A. No. 14 Q. So what materials have you reviewed 15 other than what has been prepared or what you 16 have communicated with your attorney about? 17 A. Basically what I reviewed with my 18 attorney about my notes. 19 Q. Well, you're referring to your 20 medical records? 21 A. Yes. 22 Q. Are there any journal articles or 23 have you reviewed any medical literature? 24 A. No. No. 25 Q. Do you own textbooks in the area of 0025 1 medicine? 2 A. Yes. 3 Q. What textbooks do you own? 4 A. I own Harrison's and Cecil's. 5 Q. Do you receive any journals in the 6 area of internal medicine? 7 A. Yes. I receive the New England 8 Journal of Medicine and the journal, J-A-M-A, 9 JAMA. 10 Q. Do you receive anything else, 11 anything having to do with primary care practice 12 in general? 13 A. There is another journal, American 14 Family Practice -- I can't exactly remember, but 15 it's a family practice journal. 16 Q. American Family Physician? 17 A. Yes, I believe so. 18 Q. Do you find those journals to be 19 good resources of information on current topics 20 in the area of medicine? 21 MR. BONEZZI: Objection. You may 22 answer. 23 A. Yes, when I read them. 24 Q. Do you use these journals in the 25 management of your patients? 0026 1 MR. BONEZZI: Objection. Go ahead. 2 A. Sometimes. Meaning if it's a 3 relevant issue, I will use it as a resource. 4 Q. Do you consider any journals or 5 books or book chapters to be reasonably reliable 6 on the topics that are relevant to this lawsuit, 7 meaning breast cancer or the management of 8 breast masses in a patient? 9 MR. BONEZZI: Objection. Go ahead. 10 A. I'm sorry. What was the question 11 again? 12 Q. Do you consider any journals or 13 books or book chapters to be reasonably reliable 14 on the topics that are relevant to this lawsuit 15 as you understand it? 16 MR. BONEZZI: Objection. Go ahead. 17 A. The New England Journal of Medicine 18 is one of the best resources. 19 Q. Will you be relying on any 20 literature to support your opinions that you 21 hold in this case? 22 A. Nothing specific. 23 Q. As the case evolves, you may come to 24 determine that there's reliable literature or 25 something that you may feel is important to the 0027 1 case. I just want to make a record that it is 2 important for me to receive that. 3 MR. BONEZZI: If there comes a point 4 in time that she has reviewed something that she 5 will be relying upon at the time of trial, I 6 will provide that to you. 7 Q. For your information, the reason 8 that I would need this information is that I 9 might return and ask you some questions on that. 10 I would want to know well in advance of trial if 11 that information is available or certainly 12 before trial. I'm just making a formal request 13 for that. 14 A. Okay. 15 Q. Is that agreeable to you? 16 A. Yes. 17 Q. Back during your employment at UPCP, 18 are you aware of any policies or procedures in 19 place regarding the intake management of new 20 patients? 21 A. Official policies? 22 Q. Yes. 23 A. Nothing official, no. 24 Q. Tell me how Rhonda became a patient 25 of yours. 0028 1 A. She had changed insurances and was 2 now part -- and was now receiving care with 3 University Hospitals Health Systems, and she 4 made an appointment to see me. 5 Q. Do you remember Rhonda? 6 A. I do. 7 Q. Tell me what you remember as you sit 8 here today. 9 A. I remember she was very quiet, 10 reserved, a very pleasant woman. She was fairly 11 tall, as I remember, and she mostly had a quiet 12 demeanor about her. 13 Q. Do you remember if Rhonda came to 14 you because a physician sent her to you? 15 A. No. No. I was not aware that she 16 was referred by anybody. 17 Q. So is it fair to say that your 18 understanding is that she came to see you as a 19 new patient for internal medicine purposes? 20 A. Yes. 21 Q. When she initially came to you on 22 the first visit, do you recall -- I know you 23 have your records available to you, but do you 24 recall was there anything specific that prompted 25 her visit to you, or was it for a general 0029 1 medical evaluation? 2 A. It was her first visit, so she 3 needed a primary care physician to have listed 4 with her insurance, and she was coming in to 5 meet me because I would now be the one to 6 continue her internal medicine care. 7 Q. The way her insurance was 8 structured, was it important for her to have a 9 primary care physician to orchestrate referrals? 10 MR. BONEZZI: Objection to 11 important. Go ahead. 12 A. Yes. 13 Q. Just to follow up on that, would she 14 be able to see anybody without your referral in 15 the UPCP system? 16 A. Her insurance had changed. It was 17 HMO Health Ohio, and that insurance had changed 18 their rules, and it was extremely confusing at 19 the time. So I would ask my assistance to put a 20 referral in with this insurance in that 21 sometimes they needed a referral and sometimes 22 they didn't. We could never -- and for Ob/Gyn I 23 believe they didn't, but we would double-check 24 that to make sure that it was covered, that it 25 was a covered visit for them to see a 0030 1 subspecialist. So yes and no. 2 Q. By that, I kind of got lost a little 3 bit. Was the Ob/Gyn the primary care for 4 insurance purposes and referral purposes, or are 5 you telling me that maybe there was some 6 crossover between internal medicine and Ob/Gyn? 7 MR. BONEZZI: Objection. Go ahead. 8 A. This insurance allowed a woman to 9 have a primary care physician as well as a 10 primary OB. And from what I remember, even 11 though I was double-checking this, I remember 12 that HMO Health Ohio would allow them to pick 13 their primary Ob/Gyn physician as also one of 14 their providers in addition to internal medicine 15 or family practice. 16 Q. Your visit wasn't necessary to refer 17 her to a gynecologist, is that true, or an 18 obstetrician? 19 A. That is true, but she did come to me 20 and I did put down that I was going to make sure 21 that she got referred to an Ob/Gyn. 22 Q. You're using the records to refresh 23 your recollection of that; true? 24 A. Yes. 25 Q. With that first visit, when was that 0031 1 first visit with Mrs. Berry? 2 A. June 2nd, 2003. 3 Q. At that point did you consider 4 yourself Mrs. Berry's internal medicine 5 physician? 6 A. Yes. I became her internal medicine 7 physician on this date. 8 Q. Did you have an occasion to see 9 Mrs. Berry any time after that visit? 10 A. I saw her one more time in 11 September, September 19th, 2003. 12 Q. After June 2003 and September 2003, 13 did you see Mrs. Berry on any other occasions? 14 A. No. 15 Q. Did you ask Mrs. Berry to come back 16 and see you? 17 MR. BONEZZI: Excuse me. Which 18 visit? 19 Q. We'll start with the June 2003. Did 20 you ask Mrs. Berry to come back and see you? 21 A. No, just as needed. 22 Q. In September 2003 did you instruct 23 Mrs. Berry to return for a follow-up? 24 A. Yes. 25 Q. Tell me what instructions she 0032 1 received. 2 A. She was told to follow up in three 3 months. 4 Q. I mentioned earlier or asked you 5 what you had reviewed, and I asked if you had 6 reviewed any independent notes. Did you 7 maintain any independent notes, independent of 8 those medical records, regarding Mrs. Berry? 9 A. No. 10 Q. In general a primary care 11 physician's role is to maintain preventative 12 health; correct? 13 A. Yes. 14 Q. Also, a primary care physician is 15 available to the patient to manage various 16 medical concerns; true? 17 A. Yes. 18 Q. In your role as a primary care 19 physician, would you agree that it is important 20 for you to have a sense of the general physical 21 history and physical exam with regards to 22 managing patients? 23 A. Can you repeat that again? 24 Q. As a primary care physician, your 25 role is to examine the patient and know the 0033 1 patient from head to toe; true? 2 MR. BONEZZI: Objection. Go ahead. 3 A. Yes. 4 Q. If there was a problem that you 5 couldn't handle, you would make a referral to a 6 specialist; is that a fair statement? 7 A. Yes. 8 Q. So when it comes to the management 9 of a patient's breast health, a primary care 10 physician is the general or is the initial 11 person that a patient may seek assistance from 12 to evaluate a breast problem; is that a fair 13 statement? 14 MR. BONEZZI: Objection. 15 Q. If you followed that. 16 MR. BONEZZI: Do you understand the 17 question? If you don't, ask her to repeat it or 18 rephrase it. 19 A. Yes. Could you just -- I think I 20 do, but can you repeat that? 21 Q. Sure. As a primary care physician, 22 you would manage a woman's breast health, at 23 least initially, with a breast complaint; is 24 that a fair statement? 25 A. Not all the time only in that 0034 1 sometimes they have already seen another 2 provider before the visit with me. 3 Q. Do you consider a breast exam part 4 of a general physical exam for an internal 5 medicine physician? 6 MR. BONEZZI: Objection. These are 7 all hypothetical questions. 8 MS. PERSE: Yes. 9 Q. I'm just trying to get a sense of 10 what your scope of practice is. 11 MR. BONEZZI: These do not delineate 12 between a pregnant and not pregnant patient. 13 These are hypothetical questions. 14 A. Hypothetical, okay. Well, for a 15 preventative well physical for a woman, a young 16 woman, a breast exam is included with the 17 physical exam. 18 Q. As a primary care provider, is the 19 breast exam recommended on a regular basis, a 20 clinical breast exam? 21 A. It is recommended monthly with 22 self-breast exams as well as every year with a 23 medical provider after the age of I believe it's 24 18 or 21 because that's the population that I 25 see. 0035 1 Q. Tell me about your patient 2 population in general. 3 MR. BONEZZI: No. No. Today or 4 back then? 5 Q. Back then while you were working at 6 UPCP, tell me what types of patients you were 7 dealing with. 8 A. I would see patients from the age of 9 18, sometimes 17, and older. I would see women 10 and men with internal medicine issues for 11 preventative health and addressing specific 12 medical issues. 13 Q. Things like hypertension, blood 14 sugar, problems or things like that? 15 A. Yes. 16 Q. As a primary care provider, again 17 speaking in generalities, would it be unusual 18 for a patient to present to their primary care 19 physician with a complaint of a breast mass? 20 A. Would it be unusual, no. 21 Q. During your time at UPCP, did you 22 see patients with a complaint of breast masses? 23 A. Yes, I did. 24 Q. When a patient comes to a doctor 25 with a complaint of a breast lump, it's 0036 1 important to rule out breast cancer; is that 2 true? 3 MS. SANDACZ: Objection. 4 MR. KRAUSE: Join. 5 MR. BONEZZI: Objection. Go ahead. 6 You may answer. 7 A. What was the question again? 8 Q. Objections are distracting. When a 9 patient comes to a primary care physician with a 10 complaint of a breast lump, it's important to 11 rule out breast cancer; is that true? 12 MS. SANDACZ: Same objection. 13 MR. KRAUSE: Objection. 14 MR. BONEZZI: Objection. 15 A. That's correct. 16 Q. It's important also to follow up on 17 that patient's complaint until it's completely 18 resolved; is that true? 19 MR. BONEZZI: Objection. Go ahead. 20 MR. KRAUSE: Objection. 21 MS. SANDACZ: Objection. 22 A. It's generally true, yes. 23 Q. You agree that the most common cause 24 of a breast lump especially in a young woman is 25 benign disease; is that true? 0037 1 A. Yes. Yes. The majority of it is 2 benign breast disease. 3 Q. Now, when a patient, again, it's a 4 hypothetical question, when a patient presents 5 to you with a complaint of a breast lump, tell 6 me what you would do. Review for me in general 7 what you would do. 8 MS. SANDACZ: Objection. 9 MR. BONEZZI: Objection. Go ahead. 10 A. I would take a history and ask them 11 or ask this woman how long it had been there, 12 what part of the cycle she might be on, if she's 13 ever had a history of this before as well as do 14 a breast exam to start with. 15 Q. Why is the timing of the breast lump 16 important relative to the woman's cycle? 17 A. There can be changes usually a week 18 or two before a menstrual cycle that oftentimes 19 can resolve after the menses, so it's good to 20 correlate the timing of what she's noticing, the 21 lump, because it can resolve if she were at a 22 phase -- it can resolve if checked at a 23 different phase in her cycle. 24 Q. Tell me about the breast exam. What 25 does that entail? 0038 1 A. There's visualization for gross 2 abnormalities, dimpling of the skin, one side 3 being significantly larger than the other, as 4 well as examining the entire breast tissue in 5 kind of a circular motion all the way to the 6 aureole and nipple, expressing the nipple to see 7 if there's any discharge, as well as checking 8 the axilla areas basically. 9 Q. So following the history and 10 physical exam, in a patient that complains of a 11 breast lump is there anything else that you 12 would do? 13 A. Yes. If a breast lump was detected 14 on exam, it would be something that would 15 require a follow-up, and that could be either a 16 return to the office in a short period of time 17 or further testing with different imaging 18 modalities or even a referral to a specialist. 19 Q. Tell me what criteria you would use 20 to refer a patient for a follow-up diagnostic 21 test versus a return in -- what was it you said? 22 A. A short period of time whether it be 23 a month or three months. 24 The criterion would be the mass, the 25 lump itself, if it was of a more concerning 0039 1 quality of a fixed nodular feeling to it versus 2 more of a mobile kind of a more nondiscrete 3 area. But if there were even in -- in any woman 4 if there was a palpable discrete mass, that 5 would -- I would refer them for imaging, either 6 ultrasound, mammography as well as follow-up 7 with the breast specialist or general surgeon. 8 Q. Do you do all three of those things 9 at the same time, the diagnostic tests, order 10 the diagnostic tests and make the referral, or 11 do you determine the referral based on the 12 outcome of those tests? 13 A. If I do feel a discrete mass that 14 can be drained or aspirated, if there's 15 something definite, I would order the tests and 16 put the referral in hoping that the testing 17 would be finished before the specialty 18 evaluation, so all kind of in the same -- 19 initiating them at the same time. 20 Q. Can we agree that a dominant mass or 21 a solid mass, I'll say dominant mass, you can't 22 determine the consistency of that mass without 23 further testing? Is that true? 24 MR. BONEZZI: Objection. Go ahead. 25 MS. SANDACZ: Objection. 0040 1 A. No. On exam there's different 2 qualities of masses, there's different textures, 3 and they do feel -- I mean, you can sometimes 4 have a working diagnosis with the exam itself. 5 Q. That working diagnosis is not always 6 100 percent accurate; is that true? 7 A. That's correct. 8 Q. Is it fair to say that you can't say 9 short of a breast aspiration or an ultrasound 10 whether a breast mass is cystic or solid? 11 A. Can you just repeat that again? 12 Q. Is it fair to say that short of a 13 breast aspiration or an ultrasound, you cannot 14 tell with certainty whether a dominant breast 15 mass is cystic or solid? 16 A. That's correct, if there's a 17 dominant breast mass. 18 Q. Just to clarify, a cystic mass, what 19 does that mean to you? 20 A. A cystic mass is felt to be mobile 21 and fluid filled delineated with a sac versus 22 something that was nodular and hard and more 23 solid. 24 Q. But fluid filled or solid is 25 determined either by cyst aspiration or 0041 1 ultrasound; is that true? 2 A. Yes, basically. 3 Q. Is a patient's past breast history 4 of significance when evaluating for a complaint 5 of a breast mass? 6 A. Yes. 7 Q. Tell me of what significance it is. 8 A. Well, if there is a history of 9 having a breast cyst and it was evaluated and 10 found to be benign, there sometimes is 11 recurrence of benign breast cysts in the future. 12 It would be important for that woman 13 to have regular exams monthly as well as with a 14 clinician, monthly with the patient and yearly 15 with the clinician, and overall I don't -- I 16 think the recurrence rate of having this is more 17 frequent in a woman who has had a history of 18 cysts. 19 Q. In a patient that has a breast cyst 20 that either spontaneously resolved or resolves 21 with aspiration, is there a recurrence rate 22 specifically of that cyst in that patient? 23 MR. KRAUSE: Objection to form. 24 MR. BONEZZI: If you understand that 25 question. 0042 1 A. You're asking if there has been an 2 aspirate if that same cyst could come back? 3 Q. Correct. 4 A. There is a chance that it could, but 5 it doesn't have to be that way. It's not 6 100 percent that it's going to come back. 7 Q. Is it any more suspect when a mass 8 comes back after a cyst aspiration? Should 9 anything more be done? 10 MR. BONEZZI: Objection. 11 MR. KRAUSE: Objection to form. 12 THE WITNESS: Should I answer? 13 MR. BONEZZI: Yes. 14 A. It should be aspirated again. It 15 should be reevaluated by aspiration. 16 Q. Is there any concern in a patient 17 that has a breast aspiration where the breast 18 cyst comes back that that may be a sign of a 19 cancer? 20 MR. BONEZZI: Objection. 21 MS. SANDACZ: Objection. 22 MR. KRAUSE: Objection. 23 A. I would have to say no. It doesn't 24 have to be cancer. 25 Q. I understand that it doesn't mean 0043 1 that it is cancer. 2 A. Right. It doesn't mean that it's 3 cancer. 4 Q. Is it a higher risk breast lesion if 5 a breast cyst recurs after aspiration? 6 MR. BONEZZI: Objection. 7 MR. KRAUSE: Objection. 8 MS. SANDACZ: Objection. 9 A. I don't believe so. I don't think 10 so. 11 Q. Let's talk again about the history. 12 Is family history important in evaluating a 13 patient with a complaint of a breast mass? 14 A. Yes. 15 Q. Tell me what things are important in 16 terms of family history. 17 A. The family history is important to 18 find out who had breast cancer, if it was a 19 first degree relative, the age of when that 20 family member had been diagnosed with breast 21 cancer, if it was premenopausal versus 22 postmenopausal, and along that line just how 23 many members, if it's a pattern of different 24 generations having breast cancer would be 25 important to find out. 0044 1 Q. Those facts would be important to 2 find out because those things that you 3 specifically mentioned would put a patient at a 4 higher risk of the occurrence of breast cancer? 5 MR. BONEZZI: Objection. Go ahead. 6 MR. KRAUSE: Objection. 7 MS. SANDACZ: Objection. 8 A. It could. Yes, it could. 9 Q. If a primary care physician is 10 unsure about a dominant mass on physical 11 examination, it's important for that primary 12 care physician to refer that patient for a 13 second opinion; is that true? 14 MR. BONEZZI: Objection. 15 A. If the mass is felt to be concerning 16 to the point where it would need further testing 17 or procedures by a specialist, yes, it would be 18 important to refer. 19 Q. Procedures, what are you referring 20 to when you use that term? 21 A. Either aspiration or biopsy, 22 excisional biopsy. 23 Q. Do you ever do breast aspirations -- 24 at the time in 2003 with UPCP, did you have 25 occasion to do breast aspirations? 0045 1 A. No. 2 Q. So then every woman that had a 3 suspect dominant mass you would refer to a 4 specialist? 5 A. Yes, I would. 6 Q. In a patient that has a clinically 7 nonsuspicious mass and she's a young woman, is 8 it reasonable to ask her to return seven to ten 9 days after her menstrual period to reassess? 10 MS. SANDACZ: Objection. 11 MR. BONEZZI: Read that back, 12 please. 13 (Record read.) 14 MR. KRAUSE: Objection. 15 MR. BONEZZI: Objection. Go ahead. 16 MS. SANDACZ: Same objection. 17 A. Yes. It would be reasonable. 18 Q. If that patient were to return seven 19 to ten days after her menstrual period and the 20 mass persisted, would you agree that further 21 intervention would be necessary at that point? 22 MR. KRAUSE: Objection. 23 MS. SANDACZ: Same objection. 24 A. I would agree, yes. 25 Q. Is it reasonable to tell a patient 0046 1 to return for an exam only if she felt the lump 2 to persist after her period? 3 MR. BONEZZI: Objection. 4 MS. PERSE: Objection. 5 MS. SANDACZ: Objection. 6 A. Can you repeat that again? 7 Q. In a patient that has a clinically 8 nonsuspicious mass, is it reasonable to tell the 9 patient to return for exam only if the lump 10 persists? 11 MR. BONEZZI: Objection. 12 MS. SANDACZ: Objection to the 13 vagueness of the possibilities. Go ahead. 14 MR. KRAUSE: Objection. 15 A. No. I would want that patient to 16 come back regardless if she felt it was there or 17 not. 18 Q. Would you be critical of a physician 19 that does not recommend that a patient return at 20 a certain interval even in the face of a 21 nonclinically suspicious mass? 22 MR. BONEZZI: Objection. 23 MS. SANDACZ: Objection. 24 MR. KRAUSE: Objection. 25 A. Depending on the individual patient. 0047 1 Each patient's scenario is different and has to 2 be individualized, so I can't say that I would 3 have to -- what was the question again? 4 What I'm trying to say is not 5 necessarily because every patient is different 6 depending on that individual case. 7 MR. BONEZZI: Nothing is absolute is 8 what you're saying. 9 THE WITNESS: Yes. 10 Q. Do you agree that a negative 11 mammogram should not prevent the further 12 investigation of a persistent mass? 13 MR. BONEZZI: Objection. 14 A. No. Even with a negative mammogram, 15 the breast mass should still be investigated. 16 Q. Is there a diagnostic test that is 17 better in evaluating a dominant breast mass in a 18 woman that is less than 35 years old? 19 MR. BONEZZI: Objection. 20 MS. SANDACZ: I didn't hear the 21 question. Could you read that? 22 (Record read.) 23 MR. BONEZZI: Objection. 24 MR. KRAUSE: Objection. 25 MS. SANDACZ: Objection, time, 0048 1 relevance. 2 MR. BONEZZI: She can answer the 3 question, but I am starting to question these 4 questions given the fact that not one question 5 you have asked her so far in these hypotheticals 6 has anything to do with her care because there 7 is no dominant breast mass that was evident at 8 the time that she saw this patient in June and 9 September of 2003. 10 I have this feeling that you're 11 attempting to use this witness as an expert 12 against others, and I won't allow that. If you 13 want to ask her questions as it relates to her 14 care, go ahead and do it, but not as it relates 15 to hypotheticals that have open-ended areas. I 16 haven't objected to this point. 17 MS. PERSE: I understand. 18 MR. BONEZZI: But there's going to 19 be a time where I'm just going to say enough. 20 MS. PERSE: We haven't reviewed the 21 records yet, and I understand the point that 22 you're making, but these questions are relevant 23 to a primary care physician's management of a 24 breast mass. That's what I'm asking. 25 MR. BONEZZI: They may be to 0049 1 somebody else; however, not when it deals with 2 this particular physician given the fact that 3 she is dealing with a patient who is 20 weeks 4 pregnant at the first visit and she is two weeks 5 post delivery in the second visit. If you want 6 to couch your questions as it relates to include 7 that scenario, I have no problem with the 8 questions. 9 MS. PERSE: This is the deposition 10 of the doctor, not her attorney. 11 MR. BONEZZI: I understand that. 12 But I'm not going to let you ask her questions 13 as it pertains to others. I'm not going to let 14 you do that. We'll put a stop to it, and if we 15 need to, we'll go right back to Judge Villanueva 16 which I have no problem doing. 17 MS. SANDACZ: If I might add, all of 18 the scenarios that you are giving here have no 19 relevance to the facts here unless there is 20 going to be somebody who is going to come in and 21 say there was a dominant mass that persisted. 22 To this date you have not provided 23 plaintiff's husband or the mother, and you have 24 indicated to me that they have no testimony as 25 to that issue. 0050 1 MS. PERSE: No. I did not indicate 2 that to you. 3 MS. SANDACZ: Yes, you did. 4 MS. PERSE: I indicated they were 5 not at the doctor's visits. That's all I 6 indicated. 7 MS. SANDACZ: Absolutely not. And 8 it is interesting that you have not provided us 9 with those depositions -- wait a minute. You 10 have not provided us with the depositions of the 11 plaintiffs, and they are going to come in here 12 and controvert all of the records that say there 13 was no evidence of a dominant mass. I think 14 that's incredible and unprofessional to do that. 15 MS. PERSE: For the record, I have 16 made my clients available on multiple occasions. 17 I have documentation of that. Right now we are 18 presently working on trying to get the 19 depositions of my clients scheduled. I have 20 been -- there have been dates in February and in 21 November, I could go through with specifics, 22 that my clients have been made available. It is 23 not a matter of, you know, who is supposed to be 24 available first. 25 I'm not asking any questions 0051 1 specific to what may or -- at this point in time 2 I'm not asking any questions specific as to what 3 may or may not have happened with Mrs. Berry. I 4 think it's important to review her management, 5 the doctor's management, of a breast mass. That 6 is what I'm asking. 7 MR. BONEZZI: We haven't even gotten 8 into that. The problem that I'm having, and I'm 9 really questioning whether or not I'm going to 10 allow the deposition to continue, and I'll bring 11 Dr. Han back if necessary, but I am concerned 12 that these are questions that there may be 13 records or there may be information that we have 14 not been provided that you have. 15 MS. PERSE: I'll make it clear. 16 There is no record that I'm aware of that I'm 17 withholding in any way that the patient had a 18 breast mass or breast lump. I think it's 19 discretionary. It's a judgment call on the part 20 of the physician as to what the exam findings 21 are. 22 I'm just trying to review what the 23 appropriate management of a patient with a 24 breast mass is. If you are dissatisfied with 25 that and want to bring that before the judge, 0052 1 that's fine. Again, I'm asking some general 2 questions. I do have some specific questions 3 relative to the record, and if we can, we should 4 move on. 5 MS. SANDACZ: I also want to add 6 here that this case was filed in May or sometime 7 maybe in April, we got service in May of '06, 8 and I know that with an answer that I provided 9 that I've asked for the depositions of the 10 plaintiff and anybody else who is going to 11 testify clearly as to relevant issues such as 12 anyone is going to come in and say there was 13 something going on with this woman's breast 14 contrary to every record that we have obtained 15 to date. 16 I think it's a little bit 17 disingenuous to come into a deposition and 18 assert that somebody is going to make that 19 statement when we have not been provided that. 20 MS. PERSE: I told you, I don't know 21 what they are or are not going to say. 22 MR. BONEZZI: Jessica, I'm not 23 trying to also jump on your back here, but you 24 have been asking questions for literally the 25 last 20 minutes to 30 minutes as it relates 0053 1 particularly to a dominant breast mass. 2 MS. PERSE: I would like to get to 3 those questions and hear what the defendant 4 doctor has to say as to her physical exam 5 findings. 6 MR. BONEZZI: That has nothing to do 7 with this particular physician unless you're 8 suggesting that there was a dominant breast mass 9 in June of 2003 that should have been picked up 10 by this physician during an examination. I will 11 allow those questions to be asked. However, 12 what you're doing is asking her questions that 13 pertain to hypothetical situations involving 14 presumably other physicians and what other 15 physicians should have done or could have done 16 at a time in which this doctor was not treating 17 Mrs. Berry, and I think that's improper. I 18 don't think you can do that, although you're 19 trying to. 20 MS. PERSE: I don't know -- 21 MR. BONEZZI: But it's my job as her 22 attorney. 23 MS. PERSE: I understand that, and I 24 don't know that you know what I'm trying to do 25 or not. How about we move on? The point is 0054 1 well taken. 2 A. What was the question again? 3 Q. I didn't have one. 4 MR. BONEZZI: There's no question 5 right now. 6 Q. Could you clarify for me what a 7 dominant breast mass means to you? 8 A. It would be a well-circumscribed 9 measurable mass. Other qualities that would be 10 important would be if it moved or if it was 11 fixed and of course how large the dimensions 12 were, but something palpable. 13 Q. Can a patient have a palpable breast 14 thickening, would that be considered a dominant 15 breast mass? 16 A. Not in -- no, no. 17 Q. Would you consider that an abnormal 18 finding? 19 MR. BONEZZI: Objection. 20 A. It doesn't necessarily have to be 21 abnormal depending on other circumstances, like 22 I mentioned before, again, if she was 23 premenstrual or even pregnant. 24 Q. I guess since you brought up 25 pregnancy, postpartum patients often have areas 0055 1 of thickening within their breast that may be 2 new to their breasts but present in the 3 postpartum period; is that a fair statement? 4 MR. BONEZZI: In what part of the 5 postpartum period are you speaking of; one week, 6 two weeks, a month, two months? 7 THE WITNESS: I'm going to use the 8 term postpartum period, and if you'd like me to 9 clarify, we can narrow it down. 10 MR. BONEZZI: I would like you to 11 narrow it down. 12 Q. In a woman's breast in the 13 postpartum -- how long would you consider a 14 patient postpartum after delivery? 15 A. Well, generally six weeks is when 16 they have their postpartum checkup, but 17 postpartum can go on longer than that with 18 different illnesses like depression. But the 19 physiological changes are generally resolving or 20 have resolved by six weeks. 21 Q. So a woman's breast changes that 22 occur in the postpartum period, would you expect 23 them to be resolved at about six weeks? 24 A. Well, it depends on if she were 25 nursing. That's primarily it because, again, 0056 1 that would continue as long as she was 2 lactating. 3 Q. If a woman was not nursing in the 4 postpartum period, you would expect the 5 postpartum breast changes to subside by six 6 weeks? 7 MR. BONEZZI: Objection. Go ahead. 8 A. Most all, but maybe not all of the 9 changes would be resolved by then. 10 Q. What time frame would you expect all 11 the changes to have resolved? 12 A. Well, in general it would take about 13 nine months for the physiologic changes to 14 revert back to the woman's prepregnancy state, 15 but in direct answer to the breast, I don't know 16 if it would be sooner. I'm not quite sure. 17 Q. Would you defer that to an 18 obstetrician-gynecologist to answer that 19 question? 20 MR. BONEZZI: Objection. Go ahead. 21 A. I would or to -- yes, a specialist, 22 yes. 23 Q. If a woman feels a breast 24 abnormality and it is not palpable to the 25 clinician, what sort of management should 0057 1 follow? How would you approach a patient that 2 complains of a breast mass that you can't 3 appreciate on physical exam? 4 MR. BONEZZI: Objection. 5 MS. SANDACZ: Objection. 6 A. Would it be that the breast exam 7 would be -- if the breast exam was normal and I 8 felt that it was normal, then I would reassure 9 the patient that this is the texture of the 10 breast and so forth and so on. 11 If there was something there that 12 the patient was concerned about, even with my 13 low suspicion, because of the patient's concern 14 I might -- I would have that patient follow up 15 again within a short period of time to 16 reevaluate would be the first step. 17 Q. Do you ever in a patient that has a 18 nonsuspicious breast exam, a clear breast exam 19 by your physical examination, and they are 20 concerned about a breast lump or a breast 21 abnormality, is there an indication for 22 follow-up diagnostic testing? 23 MR. BONEZZI: Objection to form. 24 MR. KRAUSE: Objection to form. 25 MS. SANDACZ: Objection. 0058 1 MR. BONEZZI: Did you understand 2 that? 3 THE WITNESS: Yes. 4 A. In a patient who feels a nondiscrete 5 mass, is there some type of testing that is 6 proven to be helpful in making the diagnosis or 7 something like that? 8 Q. Let me pose the question because 9 you're not supposed to be the one forming your 10 own questions. I appreciate your help. 11 In a clinically normal breast exam, 12 a patient feels a breast abnormality, are there 13 other diagnostic tests that you would recommend 14 to reassure the patient? 15 MS. SANDACZ: Objection. 16 MR. KRAUSE: Objection. 17 A. Again, it would be individualized. 18 If there were more risks involved, possibly 19 ordering testing, a mammogram or ultrasound. 20 However, in younger women the testing is not as 21 accurate because of the density of the breast 22 tissue. So, again, I might not order them 23 depending on that. 24 Q. You kind of lumped those two 25 together, the mammogram and ultrasound. Those 0059 1 are two diagnostic modalities that are available 2 to evaluate a woman's breast; true? 3 MS. SANDACZ: Objection. 4 A. Yes, and there's also MRI, although 5 I was not aware of that being a recommended 6 guideline as a screening tool. 7 Q. So in 2003 the two screening tools 8 that you would have available to you would be 9 ultrasound and mammogram? 10 MS. SANDACZ: Objection. 11 A. Mostly mammogram, and ultrasound 12 would be more for diagnostic purposes. 13 Q. Is the sensitivity of the ultrasound 14 in the woman's breast impaired by the density of 15 the woman's breast? 16 MR. BONEZZI: Objection. Wait. 17 Q. Is the sensitivity -- do you 18 understand? 19 MR. BONEZZI: The question is very 20 straightforward. You haven't asked one question 21 yet in regards to her -- 22 MS. PERSE: Stop. 23 MR. BONEZZI: -- involvement. Stop? 24 You want me to stop? I'll stop. I have no 25 problems in stopping, Jessica. I have no 0060 1 problem in stopping this deposition. 2 MS. PERSE: But I don't understand. 3 I'm trying to just figure out how an internal 4 medicine doc would evaluate a woman's breast. 5 MR. BONEZZI: Why don't you ask her 6 how you evaluate a breast in a patient who is 7 20 weeks pregnant? That's when she saw this 8 patient. You keep on asking questions that have 9 nothing to do with this physician's involvement. 10 MS. PERSE: She just explained that 11 a woman's breasts, the density of a woman's 12 breasts affect the sensitivity of diagnostic 13 tests. I want to know if an ultrasound's 14 sensitivity is affected, and I believe that is 15 applicable in the pregnant patient, the 16 postpartum patient, and the young or old 17 patient. It is a general question that is 18 applicable to this fact pattern. 19 MR. BONEZZI: No, it's not. Why 20 don't you ask her -- 21 MS. PERSE: I will ask her. 22 MR. BONEZZI: -- if there is a mass, 23 if there is a mass palpable, whether or not a 24 diagnostic test is going to have an impact on 25 the information that is obtained? 0061 1 Q. Again, are you aware of the 2 sensitivity of an ultrasound in a dense breast? 3 If you don't understand my question or you don't 4 know -- 5 A. I don't. Yeah, I don't know. 6 MR. BONEZZI: If it's outside of the 7 area of your expertise, you also tell her that. 8 I don't want you guessing. 9 Q. Do you order ultrasounds on women 10 with breast problems? 11 A. Yes. 12 MR. BONEZZI: Who are pregnant? No? 13 Pregnancy doesn't have a role in this, your 14 question? 15 MS. PERSE: Pregnancy may or may 16 not, but she saw the patient pregnant and 17 postpartum. 18 MR. BONEZZI: Why don't you 19 delineate your questions relative to pregnant 20 and postpartum as opposed to going ahead and 21 asking these questions that have nothing to do 22 with this patient? 23 MS. PERSE: How about if we move on 24 to the chart to review? 25 MR. BONEZZI: That would be fine. 0062 1 Q. I have four pages of patient records 2 that I believe are from your management of 3 Mrs. Berry. Is that true? 4 A. Yes, that's true. 5 Q. Two pages on two occasions; is that 6 fair? 7 A. Yes. 8 Q. We already established that the two 9 visits, there was a June 2003 visit and a 10 September 2003 visit; true? 11 A. Yes. 12 Q. How about if we look at your records 13 for June 2nd, 2003. It's a two-page document. 14 Is that true that it's two pages? 15 A. Yes. It's two pages. 16 Q. Can you identify those two pages? 17 How are the documents titled? 18 A. The first visit is to meet the 19 doctor which was the initial visit. 20 Q. What I'm looking for, my records 21 have a University Hospital -- 22 A. University Hospitals Health Systems, 23 University Mednet at the Bedford site. 24 Q. How about if you review for me the 25 writing on this page just so that I can 0063 1 understand. 2 A. Okay. Like the patient name? 3 Q. Yes. 4 A. Patient name Rhonda Berry, birth 5 date 11-27-68, date of visit 6-2-03. She has no 6 allergies, no known allergies. Social history, 7 no cigarettes, no alcohol. She's married. Her 8 chief complaint is to meet the doctor. 9 Past history, no hypertension, no 10 diabetes. Medications included prenatal 11 vitamins. She's 34-year-old woman. She's 20 12 weeks pregnant. She is a new patient to me. 13 She is an LPN. She has changed insurance. 14 Q. I'm going to ask you to slow down a 15 little bit. Direct me to specifically where 16 you're reading. 17 A. HPI. Do you want me to go back 18 further? 19 Q. The stuff that you reviewed, the 20 information you reviewed initially, that was in 21 the first several lines of the record of the 22 6-2-03 visit; is that true? 23 A. Yes. 24 Q. Allergies, chief complaint, 25 medications? 0064 1 A. Yes. 2 Q. Who entered that information? 3 A. My assistant entered the blood 4 pressure and weight and allergy question and 5 medications, and I was the one to input the past 6 history questions. 7 Q. Past history or is that family 8 history? 9 A. The past history is underneath the 10 chief complaint, and the family history is 11 underneath the medication list. 12 Q. Thank you. Who is your assistant? 13 Are they identified in this record? 14 A. Yes. 15 Q. What is their name? 16 A. Her name is Rose Szitas, MA. 17 Q. What does MA stand for? 18 A. Medical assistant. 19 Q. Moving on, you've already identified 20 you took the past history. Family history, what 21 are your entries under family history? 22 A. Family history, no hypertension and 23 diabetes in her mother. 24 Q. The next line under family history, 25 there's some entries on the right-hand side that 0065 1 are your entries; is that true? 2 A. In my writing, yes. 3 Q. How about if you review those slowly 4 for me. 5 A. On the side? 6 Q. Yes, starting with 34-year-old. 7 A. A 34-year-old woman. She is a new 8 patient. Ob/Gyn listed as Dr. Thompson. She 9 had changed insurance. 10 Q. There's something right adjacent to 11 new patient. Can you read that for me? 12 A. Working as an LPN at and then it was 13 cut off, but that was where she was working. 14 She was an LPN. 15 Q. Is it cut off on your records as 16 well? 17 A. Yes. 20 weeks pregnant. 18 Dr. Thompson Ob/Gyn. She changed insurance. I 19 believe the previous doctor was Dr. Greenspan. 20 I just happened to write that down. She is due 21 on October 18th, '03. This is her first 22 pregnancy. 23 Should I go across, would that be 24 easier, or just go down? 25 Q. That's a good question. Explain for 0066 1 me what that vertical line is in the HPI 2 section. 3 A. Okay. The vertical line is where I 4 would put notes pertaining to her history that 5 might include her past medical history in 6 addition to what I've already asked and also 7 additional notes like other doctors she's seen 8 or notes that I would be able to know this 9 patient better. 10 Q. How about if we talk about the 11 material that is to the left of that vertical 12 line -- 13 A. Okay. 14 Q. -- under the HPI section? 15 A. All right. So she's 20 weeks 16 pregnant. She's due on October 18th, '03. This 17 is her first pregnancy. She had an ultrasound 18 recently due to a borderline AFP, feeling well, 19 no significant fatigue, feels movement, no chest 20 pain, no shortness of breath, and no edema. Do 21 you want me to go to the other side? 22 Q. Yes. That would be great. 23 A. Again, she has changed insurances. 24 Her previous doctor was Dr. Greenspan. She's 25 had a history of a cyst in the breast that was 0067 1 benign as well as a history of fibroids. She is 2 gravida one, para zero, and she's had no 3 surgeries. 4 Q. Then under the review of systems, 5 can you review your entries there? 6 A. Yes. She had no fatigue. She had 7 no shortness of breath, swelling, or chest pain, 8 like I mentioned previously, and no abdominal 9 pain. 10 Q. Did she have any specific chief 11 complaint when she came and visited you on 12 June 2nd, 2003? 13 A. No. She had no chief complaint 14 other than to establish care with me. 15 Q. Is it fair to say that you were not 16 managing her pregnancy during that time? 17 A. Yes. 18 Q. That was Dr. Thompson? Her care was 19 under Dr. Thompson's care; true? 20 A. Yes. 21 Q. Moving on to her physical exam, can 22 you review your entries for me? 23 A. Her constitutional or general 24 appearance, she is a well-developed, 25 well-nourished woman. Affect was normal. Neck, 0068 1 no JVD, no thyroid abnormalities. Respirations 2 were normal. Chest was clear to auscultation 3 bilaterally. Cardiovascular exam, I repeated 4 the blood pressure was 110 over 70. Her heart 5 rhythm, regular rate and rhythm, no S3, no heart 6 murmurs. She had no leg edema. On abdomen 7 exam, she was a gravid woman at the time of my 8 exam. 9 Q. Just let me interrupt you there. By 10 gravid, can you just explain what that 11 terminology means? 12 A. She was obviously pregnant. 13 Q. Any other findings? 14 A. Not on physical. 15 Q. I see adjacent to the physical exam 16 there's a square box that includes labs and 17 X-rays. Are there any entries there? 18 A. The only entry was to have my 19 medical assistant make sure that the referral 20 was in place if needed with her insurance to 21 Dr. Thompson. 22 Q. In your physical exam, did you do a 23 breast exam? 24 A. No, I did not. 25 Q. There's entries above that. The 0069 1 eye, ENT, did you make any record in that? 2 A. There's no record, but on 3 examination there were no apparent 4 abnormalities. 5 Q. So you made no entries there because 6 there were no apparent abnormalities; is that 7 what your understanding is? 8 A. Yes. 9 Q. Now, under gynecologic exam, did you 10 do any gynecologic exam? 11 A. No. 12 Q. Would you feel that it is the role 13 of the primary care physician seeing a pregnant 14 patient to do those examinations or to defer 15 those examinations to their 16 obstetrician-gynecologist? 17 MR. KRAUSE: Objection. 18 MR. BONEZZI: Objection to the form. 19 Go ahead. 20 A. I would defer this to an Ob/Gyn 21 provider. 22 Q. How about if we review page 2, I 23 believe, of the June 2nd, 2003. Help me out 24 here. Is there anything identifying this sheet 25 as page 2; i.e., is there a page 2 listed 0070 1 somewhere on it? 2 A. Actually, I believe what I did is -- 3 on the chart it was the same page. 4 Q. It's like a flowsheet? 5 A. It was copied front and back, so it 6 was one page. 7 Q. So this would be the back of your -- 8 A. First page. 9 Q. -- first page. How about if you 10 review for me your entries on that page. 11 A. Assessment and plan, 34-year-old 12 woman in excellent health. Exams within normal 13 limits. She's pregnant and recommend follow-up 14 with Ob/Gyn. Continue her multivitamin. Blood 15 pressure on recheck within normal limits. 16 Old records were reviewed. She 17 brought them with her at the visit from 18 Dr. Greenspan. Follow-up as needed. 19 Q. Do you have Dr. Greenspan's records 20 in your office chart? 21 A. The records she brought to me I 22 believe are in here. It's just that there's no 23 mention of the doctor's name that I can 24 interpret on the chart. So I'm assuming this is 25 what she had brought to me from previously 0071 1 because it was dated from 1998. It was hard to 2 read the doctor's name or signature on the 3 record. 4 Q. I'm just going to request a complete 5 copy of your office records. I have what I 6 received during discovery or prior to filing the 7 suit which were the pages of your documentation. 8 Just for completeness sake, I want to make sure 9 that I have what you had of Dr. Greenspan's or 10 other treating physicians. 11 The records that you have, when do 12 those go from, from when to when? 13 A. February 3rd of 1998 to 14 October 14th, 2002. 15 MR. BONEZZI: What were the dates 16 again? 17 THE WITNESS: February 3rd of '98 to 18 October 14th, 2002. 19 A. Actually, I think there are two 20 records because this writing goes from February 21 '98 to September 2000, and then this was another 22 doctor. Whether it was part of the Clinic, it 23 was July 9th, 2001, to October 14th, 2002. 24 Q. Can you recognize that signature? 25 I'm not asking you to. 0072 1 A. No. No. 2 Q. Is it fair to say that at the time 3 you saw Mrs. Berry, based on that entry, you 4 reviewed those records from February of '98 to 5 October of 2002? 6 A. Right. Yes. 7 Q. At the time of this evaluation in 8 June of 2003, and I apologize because you may 9 have said it, did you instruct Mrs. Berry to 10 return? 11 A. As needed. 12 Q. What does that mean to you as a 13 primary care physician? Do you want those 14 patients to come back on any regular basis? 15 A. Well, generally if I put that down, 16 there were no specific issues that I was going 17 to follow up within approximately a year's time, 18 so I would maybe hope that the patient would 19 call if there were any further issues or 20 problems. Of course, knowing that she was 21 pregnant, she was going to be seeing providers. 22 Q. I don't know if I established this, 23 but is it your recollection or would it be -- I 24 guess, first, is it your recollection that you 25 deferred the breast exam on Mrs. Berry to 0073 1 another provider? 2 MR. BONEZZI: Objection. 3 MR. KRAUSE: Objection. 4 MR. BONEZZI: Go ahead. 5 A. At the time of the visit, I would 6 have to say I did defer it because of the timing 7 of her pregnancy. 8 Q. Because she was 20 weeks pregnant, 9 you elected not to perform the breast 10 examination? 11 A. Yes. 12 Q. I'm going to mark these as an 13 exhibit so they can be attached to the record. 14 I just want to verify that these two pages are 15 the pages that we just reviewed of her 6-2-2003 16 visit. 17 A. Yes. This is it. 18 - - - - - 19 (Thereupon, Plaintiffs Deposition 20 Exhibits 1 and 2 were marked for purposes 21 of identification.) 22 - - - - - 23 MS. PERSE: Plaintiff's Exhibit 1 24 will be her CV, and Plaintiff's Exhibit 2 will 25 be the two pages of her 6-2-2003 visit. 0074 1 MR. BONEZZI: Are you going to have 2 that 2 and 3? 3 MS. PERSE: The two pages will be 4 Exhibit 2. 5 MR. BONEZZI: And the next exhibit 6 will be? 7 MS. PERSE: We'll mark that next 8 two-page document as Exhibit 3. 9 - - - - - 10 (Thereupon, Plaintiff's Deposition 11 Exhibit 3 was marked for purposes 12 of identification.) 13 - - - - - 14 Q. You agree that your next office 15 visit with Mrs. Berry was September 19th, 2003? 16 A. Yes. 17 Q. I'll show you the document that I'm 18 working from, and let me know if that's what you 19 understand to be your documentation from that 20 visit. 21 A. Yes. That's correct. 22 Q. It's a two-page document. Whether 23 it was front and back, it was two pages of 24 documentation? 25 A. Yes. That's correct. 0075 1 Q. Is there any other documentation for 2 the visit that you have? 3 A. No. 4 Q. Similarly, these are identified in 5 the upper left-hand corner with University 6 Hospital Primary Care Physicians, Dr. Helen Han 7 progress note? 8 A. Yes. It's the same group, but we 9 were still using the letterhead from Mednet, and 10 then we switched to the official. 11 Q. UPCP? 12 A. Yes. 13 Q. When you just made that reference, 14 you were referring back to Plaintiff's 15 Exhibit 2. But your initial visit with 16 Mrs. Berry on June 2nd, 2003, that's identified 17 by a University Hospital Health System logo in 18 the upper left-hand corner? 19 A. Yes. 20 Q. How about if we review your entries 21 on this two-page document. Actually, if you 22 don't mind identifying what is handwritten, if 23 you can read it if it's not by you, but just be 24 clear as to who made the entry. 25 A. Okay. Again, name Rhonda Berry, 0076 1 birth date and date. Blood pressure 130 over 2 96, weight 185. She had no known drug 3 allergies. Chief complaint, medical follow-up. 4 This is a follow-up visit. 5 Q. Let me stop you there. That's the 6 upper third of your sheet. Did you make those 7 entries? 8 A. No, I did not. 9 Q. Is there anything that would 10 identify who made those entries? 11 A. This was not my first assistant. 12 This was another assistant working in the 13 office. She -- I don't remember her name. 14 Q. Is there anything other than the 15 blood pressure, weight, allergies, and medical 16 follow-up entry that is entered by that medical 17 assistant? 18 A. As well as her name, birth date, and 19 date, yes, that was from the assistant. 20 Q. Let's continue. Under medications 21 there are some entries on the mid right-hand 22 side. Can you review those for me? 23 A. She was taking vitamins and Motrin. 24 Q. Is that in your writing? Did you 25 make those entries? 0077 1 A. Yes. 2 Q. Moving on, I have a punch hole 3 there, but FH I guess that is? 4 A. Family history. 5 Q. Did you make any entries specific to 6 MI, CVA, hypertension, diabetes, prostate, 7 colon, or breast CA? 8 A. No. Should I go on? 9 Q. Yes. Why don't you go ahead and 10 review for me what the entries under HPI are? 11 A. She's a 34-year-old woman. Again, 12 her GYN is Dr. Thompson. She had to be induced 13 due to toxemia with elevated blood pressures. 14 She had a C-section. She complained of ankle 15 pain since yesterday. She is able to walk 16 without problems. There's no swelling. She's 17 two to three weeks postpartum. She's not 18 nursing currently. That relates to the next 19 line. 20 She noticed left breast lumpiness 21 for approximately one week also with left axilla 22 swelling. No complaints of pain. Still with 23 some milk from her breasts. 24 Q. That section, that's a review of her 25 history; true? 0078 1 A. It's HPI, yes. 2 Q. Does that include your findings 3 relative to a chief complaint? 4 A. The chief complaint was not 5 delineated at first, but after my discussion 6 with her, the initial chief complaint was her 7 ankle pain for one day. 8 Q. Were there any other complaints? 9 A. She mentioned she noticed that her 10 left breast was lumpy for approximately one week 11 and that her axilla was swollen. 12 Q. Under review of systems, did you 13 make any entries there? 14 A. Yes. She had no chest pain, no leg 15 swelling, no abdominal pain. 16 Q. Then moving on to the physical 17 examination which is the bottom third of that 18 Dr. Helen Han progress note, how about if you 19 review slowly with me, if you will, your 20 entries? 21 A. Her physical exam, her 22 constitutional appearance, she was a 23 well-nourished woman, affect normal, no JVD, no 24 thyromegaly. Her respiratory effort was within 25 normal limits. Her chest was clear to 0079 1 auscultation bilaterally. Then her breast exam 2 was written on the bottom because there was more 3 to write. 4 Q. Okay. 5 A. Again, should I read that? 6 Q. I'm going to ask you to read that. 7 Adjacent to the lab and the X-ray box there's 8 two written entries, one adjacent to 9 liver/spleen? 10 A. Yes. 11 Q. On that line, could you tell me what 12 that reads? 13 A. That says ace wrap for her ankle and 14 three months follow up. That was my note to 15 kind of make sure I let the medical assistant 16 know that she needed an ace wrap and she was to 17 follow up in three months. 18 Q. Is there anything, because again 19 this is your writing, so does it say three 20 months follow up, or does it say three months? 21 A. It says three months. 22 Q. Under other you have an entry 23 regarding breasts? 24 A. Yes. Her breasts, there was mild 25 engorgement bilaterally with a few cystic areas. 0080 1 There was also axillary engorgement. I'm sorry. 2 Ankle, mild soft tissue swelling, full range of 3 motion. 4 Q. Can you explain to me what your 5 understanding of that breast exam was? What 6 were your findings? Both breasts had mild 7 engorgement? Is that a B? 8 A. That is a B, yes. 9 Q. Did you delineate where the few 10 cystic areas are? 11 A. No, but I do remember that was on 12 the left breast. 13 Q. Then on the axillary engorgement, 14 was there any delineation as to side for that? 15 A. That was the left side. 16 Q. Was it your understanding that that 17 correlated with her complaints of the left 18 breast lumpiness? 19 A. Yes. I attributed that to be 20 related. 21 Q. To her symptoms? 22 A. (Indicating.) 23 Q. Now let's move on to page 2. 24 A. Assessment and plan. 25 Q. Yes. Again, this is Dr. Helen Han 0081 1 progress note, and in the upper left-hand corner 2 is an A/P. Does that mean assessment plan? 3 A. And plan. 4 Q. How about if we review your entries? 5 A. Increased blood pressure, history of 6 toxemia, recheck three months, blood pressure 7 better meaning from when she was -- the blood 8 pressure was better at this visit compared to 9 when she was delivering because they were higher 10 then. 11 Breast tenderness, still with some 12 milk engorgement. Patient reassured. Cool 13 compresses. Continue Motrin. Ankle sprain, 14 form filled out, ace wrap, Motrin is needed, 15 follow up is three months. 16 Q. Back up to the second line. Just 17 clarify for me, is that RE three months? 18 A. Recheck three months. 19 Q. That's the extension of the E? 20 A. Yes. 21 Q. Again, I'm looking at the copy here. 22 A. Yes. 23 Q. Does this record indicate -- well, 24 let's review the statement, patient reassured. 25 Tell me what that may have entailed. Do you 0082 1 recall reassuring Mrs. Berry? 2 A. Uh-huh. Yes, I do. 3 Q. Was Mrs. Berry concerned about the 4 lump or the breast changes that she had? 5 MR. BONEZZI: Objection to the form. 6 Go ahead and answer. 7 A. Initially she was. And, again, 8 because of her quiet nature, it's hard to tell. 9 But after I did the exam and explained what the 10 changes were from, after my exam she looked like 11 she was relieved, as I remember. 12 Q. When you reassured her, do you 13 recall how you reassured her? 14 A. Yes. With her being just two weeks 15 after having her baby, she was not nursing, but 16 there was still some milk expression, so that 17 was correlated with the texture and the fullness 18 that she was feeling, the lumpiness. And after 19 explaining that to her and explaining that in 20 time that should resolve when she was further 21 away from just being postpartum, she again was 22 reassured. 23 Q. Did you offer Mrs. Berry any tests 24 with regard to her breast at that time? 25 A. No, not at that time. I didn't feel 0083 1 it was necessary. 2 Q. Did you instruct Mrs. Berry in 3 self-breast examination? 4 A. I didn't -- I remember instructing 5 her to check the breast as she was doing. 6 Q. That's not an entry here, but this 7 is a recollection? 8 A. Right. As I was reassuring her and 9 telling her that this should resolve, that she 10 should continue to check because it should 11 resolve if related to her postpartum period. 12 Q. With regard to the follow up in 13 three months, what is your understanding as to 14 why you wanted to see Mrs. Berry in three 15 months? 16 A. I wanted to follow up with her blood 17 pressure, again, because this was related to her 18 pregnancy, and I wanted to make sure that it 19 also continued to resolve. 20 Q. Her hypertension? 21 A. Yes. 22 Q. Do you recall instructing Mrs. Berry 23 to return if the breast problem didn't go away? 24 A. That I don't remember because it 25 wasn't an issue at the time. 0084 1 Q. Did you understand Mrs. Berry to -- 2 was she going to be seeing anybody else 3 subsequent to your visit that you're aware of? 4 A. Yes. She was going to have her six 5 week postpartum check with her OB. 6 Q. Is that indicated on your record at 7 all, or is that maybe based on your review of 8 the records? 9 A. That would be when I put the GYN 10 doctor again at the top, Dr. Thompson, and 11 knowing she was only two weeks postpartum, that 12 was upcoming in the next four weeks. 13 Q. Is it fair to say that your breast 14 findings were consistent with typical postpartum 15 changes? 16 A. Yes. 17 Q. At what point would you expect those 18 changes to resolve if they were simply due to 19 postpartum changes? 20 MR. KRAUSE: Objection. Asked and 21 answered. 22 MS. PERSE: Now I'm looking towards 23 specifically Mrs. Berry. I think we had a long 24 discussion over the fact that I was spending too 25 much time on hypotheticals. 0085 1 Q. I'm just trying to ask what was your 2 thinking with Mrs. Berry as to when you might 3 expect those changes to resolve? 4 MR. KRAUSE: Same objection. You 5 may answer. 6 A. With her not nursing, I would assume 7 the changes to be nearly resolved at least by 8 six to eight weeks. 9 Q. Did you have any opportunity to 10 speak with Dr. Thompson regarding Mrs. Berry? 11 A. No. No. 12 Q. Other than these two office visits, 13 did you have any communication with Mrs. Berry 14 either before or after, telephone calls or 15 anything like that that you can recall? 16 A. No. 17 Q. Again, is there any reference in 18 your record as to communications your office 19 staff may have had with Mrs. Berry? 20 A. No. I mean, after the visit? 21 Q. Again, because I'm at a little bit 22 of a loss because I only have these two pages, I 23 just wanted to verify are there any telephone 24 entries from your office staff? 25 A. No. 0086 1 Q. Is there any other record of 2 communication with Mrs. Berry? 3 A. No. 4 Q. Did you see Mrs. Berry outside of 5 your office setting -- again, recognizing I'm 6 looking for as a health care provider -- after 7 the September 19th, 2003, visit? 8 A. No. I had no contact with her after 9 that. 10 Q. At either of these visits were there 11 any family there? 12 A. No. There were no family members 13 there. 14 Q. Did you speak with any family 15 members, either on the telephone, before or 16 after these visits? 17 A. No. 18 Q. At the time that you were a care 19 provider for Mrs. Berry -- let me ask how long 20 did you continue with UPCP after that 21 September 19th, 2003, visit? 22 MR. BONEZZI: Objection. Until 23 December. 24 A. December of -- 25 Q. 2004 or 2003? 0087 1 A. 2004. 2 Q. That was just a lapse of my memory. 3 I know it may seem long to you. 4 A. I know. 5 Q. I should be winding down. Were you 6 aware of any future health issues with regard to 7 Mrs. Berry? Aside from what you may have 8 learned subsequent with the litigation, were you 9 aware of any health problems that Mrs. Berry may 10 have had? 11 MR. BONEZZI: Other than what you 12 and I have discussed when you and I met. She's 13 asking absent my involvement. 14 A. I had no follow-up, and I knew 15 nothing of her subsequent developments. 16 Q. Is it fair to say that as of 17 September 19th, 2003, that's your last 18 interaction with Mrs. Berry and last knowledge 19 of her aside from the process of what you may 20 have learned from your attorney? 21 A. Yes. That's correct. 22 Q. Not to belabor the point, but did 23 you have any conversations with any family 24 members subsequent to the September 19th, 2003, 25 visit? 0088 1 A. No. 2 Q. Were there any friends at the office 3 visits? 4 A. No. 5 Q. In the postpartum period, we can 6 agree that a woman's breast goes through many 7 physical changes; true? 8 A. Yes. 9 Q. And in the postpartum patient, a 10 breast exam may be more difficult; is that a 11 fair statement? 12 A. Yes. 13 Q. In a patient, a postpartum patient 14 with a breast abnormality that persists beyond 15 six weeks, can we agree that that abnormality 16 should be investigated? 17 MR. BONEZZI: Objection. 18 MR. KRAUSE: Objection. 19 MS. SANDACZ: Objection. 20 MR. BONEZZI: Go ahead and answer. 21 A. Yes. 22 Q. Would an ultrasound be a more 23 sensitive test in a postpartum patient, an 24 ultrasound of the breast be a more sensitive 25 examination in the postpartum patient -- 0089 1 MR. BONEZZI: Objection. 2 MR. KRAUSE: Objection. 3 MS. SANDACZ: Objection. 4 Q. -- than a mammogram? 5 MR. BONEZZI: Objection. 6 MR. KRAUSE: Objection. 7 MS. SANDACZ: Same objection. 8 A. I'm not sure, but I -- 9 MR. BONEZZI: No. No. Let me just 10 caution you before you answer. If you don't 11 know the answer or it's not in your expertise, 12 tell her that. However, if you do have an 13 answer, you can answer. 14 A. I don't know. 15 MR. BONEZZI: Nobody wants you to 16 guess. 17 MS. PERSE: Likewise, I don't want 18 you to guess. 19 A. Yeah, I don't know. 20 Q. In the postpartum patient, is there 21 a preferred diagnostic modality that you're 22 aware of? 23 A. Not that I'm aware of. 24 Q. Can we agree that mammography is not 25 contraindicated in a postpartum patient to 0090 1 evaluate the breast? 2 MS. SANDACZ: Objection. 3 A. Yes, I agree. 4 Q. While you were taking care of 5 Mrs. Berry, Mrs. Berry was also being seen by 6 Dr. Thompson; true? 7 A. Yes. 8 Q. Do you have any criticisms of 9 Dr. Thompson at this juncture as you know the 10 facts of the case? 11 A. No. 12 Q. Were you aware that Mrs. Berry was 13 being treated by Dr. Barry Peskin? 14 MS. SANDACZ: Objection. 15 Q. Let's narrow it down. Prior to your 16 interaction with her in June of 2003. 17 MR. BONEZZI: She's asking that 18 question, again, absent the records or absent 19 what you and I discussed. 20 A. No. I did not know that she was 21 under the care of Dr. Peskin. 22 MS. PERSE: I believe that's all my 23 questions. They may have some. 24 MS. SANDACZ: No questions. 25 MR. KRAUSE: No questions. 0091 1 MR. BONEZZI: Good. What I'd like 2 you to do is get her home address because she's 3 leaving in the next couple days to go back to 4 her home state, and she will read this. 5 - - - - - 6 (Deposition concluded at 12:05 p.m.) 7 (Signature not waived.) 8 - - - - - 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 0092 1 AFFIDAVIT 2 I have read the foregoing transcript from 3 page 1 through 92 and note the following 4 corrections: 5 PAGE LINE REQUESTED CHANGE 6 7 8 9 10 11 12 13 14 15 16 17 _____________________ 18 HELEN S. HAN, M.D. 19 20 Subscribed and sworn to before me this 21 _______ day of _______, 2007. 22 23 _____________________ 24 Notary Public 25 My commission expires ______________. 0093 1 CERTIFICATE 2 3 State of Ohio, ) 4 ) SS: 5 County of Cuyahoga. ) 6 7 8 9 I, Cynthia A. Sullivan, a Notary Public within and for the State of Ohio, duly 10 commissioned and qualified, do hereby certify that the within named HELEN S. HAN, M.D. was by 11 me first duly sworn to testify to the truth, the whole truth and nothing but the truth in the 12 cause aforesaid; that the testimony as above set forth was by me reduced to stenotypy, afterwards 13 transcribed, and that the foregoing is a true and correct transcription of the testimony. 14 I do further certify that this deposition 15 was taken at the time and place specified and was completed without adjournment; that I am not 16 a relative or attorney for either party or otherwise interested in the event of this 17 action. I am not, nor is the court reporting firm with which I am affiliated, under a 18 contract as defined in Civil Rule 28(D). 19 IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal of office at Cleveland, 20 Ohio, on this 2nd day of May 2007. 21 22 23 Cynthia A. Sullivan, Notary Public 24 Within and for the State of Ohio 25 My commission expires October 17, 2011. 0094 1 INDEX 2 DEPOSITION OF HELEN S. HAN, M.D. 3 4 BY MS. PERSE:.............................. 3:7 5 6 Plaintiffs Deposition 7 Exhibits 1 and 2 were marked............. 73:19 8 9 Plaintiff's Deposition 10 Exhibit 3 was marked..................... 74:10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25