1 1 IN THE COURT OF COMMON PLEAS 2 CUYAHOGA COUNTY, OHIO 3 RODNEY L. McCLENDON, 4 Plaintiff, 5 JUDGE McGINTY -vs- CASE NO. 374136 6 7 KAISER FOUNDATION HEALTH PLAN OF OHIO, et al., 8 Defendants. 9 10 - - - - 11 Deposition of FELIX J. MARTIN, M.D., taken as if 12 upon cross-examination before Laura L. Ware, a 13 Notary Public within and for the State of Ohio, at 14 the offices of Mazanec, Raskin & Ryder, 100 15 Franklin's Row, 34305 Solon Road, Solon, Ohio, at 16 9:35 a.m. on Thursday, July 15, 1999, pursuant to 17 notice and/or stipulations of counsel, on behalf of 18 the Plaintiff in this cause. 19 20 - - - - 21 WARE REPORTING SERVICE 22 3860 WOOSTER ROAD ROCKY RIVER, OH 44116 23 (216) 533-7606 FAX (440) 333-0745 24 25 2 1 APPEARANCES: 2 Mark W. Ruf, Esq. Hoyt Block Building, Suite 300 3 700 West St. Clair Avenue Cleveland, Ohio 44113 4 (216) 687-1999, 5 On behalf of the Plaintiff; 6 Douglas G. Leak, Esq. Mazanec, Raskin & Ryder 7 100 Franklin's Row 34305 Solon Road 8 Cleveland, Ohio 44139 (440) 248-7906, 9 On behalf of the Defendant 10 Kaiser Foundation Health Plan of Ohio; 11 Victoria L. Vance, Esq. Arter & Hadden 12 1100 Huntington Building 925 Euclid Avenue 13 Cleveland, Ohio 44115 (216) 696-1100, 14 On behalf of the Defendant 15 The Cleveland Clinic Foundation. 16 17 W I T N E S S I N D E X 18 PAGE 19 CROSS-EXAMINATION 3 BY MR. RUF 20 CROSS-EXAMINATION 30 21 BY MS. VANCE 22 23 24 25 3 1 FELIX J. MARTIN, M.D., of lawful age, called 2 by the Plaintiff 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 CROSS-EXAMINATION OF FELIX J. MARTIN, M.D. 7 BY MR. RUF: 8 Q. Could you please state your name and spell your 9 name. 10 A. My name is Felix, F-E-L-I-X, J., middle initial, 11 Martin, M-A-R-T-I-N. 12 Q. Dr. Martin, my name is Mark Ruf. I represent Rodney 13 McClendon in a case that's been brought against 14 Kaiser and the Cleveland Clinic. 15 If at any time I ask you a question and you do 16 not understand my question, please tell me. If you 17 give me an answer to a question, I'll assume that 18 you have understood my question. Okay? 19 A. Okay. 20 Q. Could you tell me what your address is? 21 A. My home address? 22 Q. Sure. 23 A. 3256 Stockholm Road, S-T-O-C-K-H-O-L-M. That's in 24 Shaker Heights, Ohio, 44120. 25 Q. Who's your current employer? 4 1 A. Kaiser Permanente. 2 Q. Is it Ohio Permanente -- 3 A. OPMG, I mean. OPMG, right. We say Kaiser but it's 4 really OPMG. 5 Q. So just so I'm clear, your employer is Ohio 6 Permanente Medical Group? 7 A. Right. 8 Q. As opposed to -- 9 A. Kaiser. 10 Q. -- Kaiser? 11 A. Kaiser Health Insurance or whatever, right. 12 Q. How long have you been employed by Ohio Permanente 13 Medical Group? 14 A. Since 1973. 15 Q. What is your position with Ohio Permanente Medical 16 Group? 17 A. At the present time I have been in -- an emergency 18 physician. At the present time I am working out of 19 the facility at Willoughby, which are doing what you 20 may call urgent care and same day appointments also, 21 which is emergencies. 22 Q. But back in February of 1998 you were working at the 23 Kaiser facility at the Cleveland Clinic? 24 A. Yes. 25 Q. How long did you work at the Kaiser facility at the 5 1 Cleveland Clinic? 2 A. Since they opened. It was '94. I can't remember 3 exactly. '94, when they opened. 4 Q. And when were you transferred to the Willoughby 5 location? 6 A. About a year ago. So June, about June. 7 Q. June of '98? 8 A. Yeah, more or less. 9 Q. Do you know why you were transferred to the 10 Willoughby facility? 11 A. We were there -- I was there because we had to 12 reduce the number of doctors working in the 13 emergency room due to budgetary constrictions. 14 Because I had been working a long time and it was 15 not going to mean anything for me as far as money, 16 it was decided that I would go over there. 17 Q. Are you paid a salary by Ohio Permanente Medical 18 Group? 19 A. Right. 20 Q. You're paid on an hourly basis? 21 A. No, only monthly. 22 Q. Just a fixed salary? 23 A. Fixed salary, right. 24 Q. And that is not dependent on the number of patients 25 you see? 6 1 A. Right, it has nothing to do with that. 2 Q. Is your compensation at all based on tests that are 3 done on a patient? 4 A. No, no, nothing to do with that. It's just a 5 salary. Nothing to do with number of patients seen, 6 nothing to do with tests ordered, et cetera, et 7 cetera. 8 Q. What did you review prior to your deposition today? 9 Did you review any medical records? 10 A. They sent me the medical records, yeah. 11 Q. Did you review anything other than medical records? 12 A. No. 13 Q. I'm handing you what's been marked as Plaintiff's 14 Exhibits 28 through 33. Could you please take a 15 look at those exhibits and tell me if those are the 16 records that you reviewed. 17 A. Yeah, I received that before, yes. 18 Q. Why don't you look through all those, Doctor. 19 MR. LEAK: For the record, I believe -- 20 I think he's only gone over the emergency room 21 stuff, since that was his only care. So if 22 that's all the emergency stuff, that's 23 definitely what he's reviewed. 24 A. That's it. 25 Q. That's all the emergency stuff? 7 1 A. Yeah, I assume, you know. 2 Q. Are you board certified in any area of medicine? 3 A. Yeah, emergency medicine. 4 Q. When did you receive board certification? 5 A. '94, I believe. 6 Q. Before 1994 were you board certified in any area of 7 medicine? 8 A. No. I was practicing emergency medicine for a long 9 time but, no, I wasn't board certified until '94. 10 Q. What area of medicine did you practice in between 11 1973 and 1994? 12 A. For two years, 1973 to 1975, I did practice, which 13 was my original training, urology, with Kaiser. And 14 then for a number of reasons I switched to emergency 15 medicine. 16 Q. When did you make the switch? 17 A. '75. And then, you know, I continued practice. 18 Q. But you waited until 1994 to get board 19 certification? 20 A. Yeah, I had to take the boards and, you know, you 21 had to take -- pass two tests before you are board 22 certified, so I eventually, you know, I passed those 23 two tests and eventually I was certified in '94. 24 Q. How many times did you take the boards for board 25 certification? 8 1 A. Well, there are two tests. The last one -- I think 2 the first one I took two or three times and then the 3 last -- the second one was the first time, one 4 time. 5 Q. And there's also an oral examination? 6 A. That's the second time, yeah, the second part. 7 Q. Which part did you have to take two or three times, 8 the written part or the oral? 9 A. The written part. 10 Q. Does the written part include any testing on 11 orthopedics? 12 A. There's testing on everything, or questions, 13 questions. 14 Q. Do you regularly review any orthopedic literature? 15 A. No. 16 Q. Do you regularly review any orthopedic textbooks? 17 A. No. 18 Q. In your education and experience have you studied 19 any orthopedics textbooks? 20 A. As far as emergency medicine there are -- you may 21 call it orthopedic textbook, we sort of referred to 22 emergency medicine, and, yes, I do that. 23 Q. So there's orthopedic sections in emergency room 24 textbooks that you've studied? 25 A. There are books specific about emergency treatment 9 1 in orthopedics, emergencies or orthopedic 2 emergencies, and those are the ones I was referring 3 to. 4 Q. What emergency room textbooks have you studied in 5 your education and experience? 6 A. Oh, I don't remember. Several. I cannot tell you. 7 Q. What about Rosen's book on emergency medicine? 8 A. Well, that's the one textbook. That's not 9 orthopedics, that's a textbook -- 10 Q. Correct. 11 A. -- in emergency. Yeah, I also read those books. 12 Q. That was a book you used in your education and 13 experience? 14 A. That and many others. 15 Q. Do you consider the information in Rosen's book to 16 be accurate and reliable? 17 MS. VANCE: Objection. 18 A. I don't know. I assume so. 19 Q. What about Tintinalli? Did I pronounce it 20 correctly? 21 A. That's another popular book, yeah. 22 Q. You're familiar with that book? 23 A. Sure. 24 Q. Have you used that book in your education and 25 experience? 10 1 A. Yeah, I've used it, I read it. 2 Q. Do you consider the information in that book to be 3 accurate and reliable? 4 MS. VANCE: Objection. 5 A. I have to assume so. I don't know. I assume so, 6 you know. 7 Q. At the Kaiser facility at the Cleveland Clinic are 8 there any emergency room textbooks in the emergency 9 room area? 10 A. There are textbooks there, yeah, if I recall, yeah. 11 Q. Do you know what textbooks are in there? 12 A. No. 13 Q. Do you ever consult those textbooks? 14 A. Occasionally. 15 Q. Did you consult any textbooks when you evaluated and 16 treated Rodney McClendon? 17 A. I have to tell you, I don't remember anything about 18 this case. 19 Q. So you have no independent recollection of -- 20 A. Absolutely zero. 21 Q. Let me finish the question, please. 22 A. Oh, I'm sorry. 23 Q. You have no independent recollection of Rodney 24 McClendon? 25 A. No. 11 1 Q. So you have no independent recollection of what you 2 discussed with Rodney McClendon? 3 A. None. 4 Q. And you have no independent recollection of what you 5 discussed with Todd Richards? 6 A. None. 7 Q. And you have no independent recollection of 8 discussing Rodney McClendon with any other physician 9 or Kaiser employee? 10 A. None. 11 Q. When did you receive your license to practice 12 medicine? 13 A. 1960. 14 Q. Was that in the State of Ohio or a different state? 15 A. Well, excuse me. When I was -- you are asking me to 16 practice medicine in the United States, you mean 17 licensed in -- 18 Q. Let's first start with Ohio. Is Ohio 1960? 19 A. No, no, no. I was thinking medical school. I 20 misunderstood that. 21 Q. When did you first receive a medical license to 22 practice in any state in the United States? 23 A. About '71 or '72, something like that. 24 Q. Was there a time period between medical school and 25 your actually obtaining a license to practice 12 1 medicine? 2 A. Oh, sure, yeah. First I worked in England, then I 3 came to the States. I did residency program here, 4 and then I got my license in Maryland. That's where 5 I was first when I got the license, my first 6 license. 7 Q. Did you work in England as a physician? 8 A. Yeah. 9 Q. When did you obtain a license to practice medicine 10 in Ohio? 11 A. By reciprocity when I moved to Cleveland with 12 Kaiser. That's '73. 13 Q. Has your license to practice medicine ever been 14 subject to any type of disciplinary action in any 15 state? 16 A. Never. 17 Q. I assume that in your years of practicing medicine 18 you have diagnosed and treated patients with elbow 19 fractures? 20 A. Diagnosed, not treated. I am not an orthopedic 21 doctor. I have diagnosed fractures of the elbow, 22 yes. 23 Q. Over the years do you know how many times you have 24 made the diagnosis of an elbow fracture? 25 A. No. 13 1 Q. Could you give me any kind of estimate? 2 A. No, I don't have no idea. 3 Q. Do you regularly see patients with fractures in the 4 emergency room? 5 A. Oh, sure. 6 Q. Could you tell me how you would make the definitive 7 diagnosis for a fracture of the elbow? 8 MS. VANCE: Objection. 9 A. Well, it's an x-ray. 10 Q. Have you ever made a definitive diagnosis of a 11 fracture without confirmation by x-ray? 12 A. No. 13 Q. You've never made a definitive diagnosis based 14 purely on your clinical findings? 15 A. No. 16 Q. Do you know if there are fractures of the elbow that 17 will not show up on x-ray? 18 A. Nondisplaced fractures sometimes don't show up on 19 x-rays. I mean they're difficult to see. They will 20 show up, but they are difficult, let me rephrase 21 that, difficult to detect. 22 Q. Do you know if a fracture of the radial head will 23 show up on a forearm view? 24 A. The forearm view including the radius, including the 25 radial head, you should be able to see it. 14 1 Q. How does the forearm view differ from an elbow 2 view? 3 A. Well, it's more detailed. The elbow view is more 4 detailed of the area. The head of the radius is in 5 the area of the elbow, so, you know, it's just a 6 more localized x-ray, more detailed x-ray. 7 Q. So if a patient was suspected of having an elbow 8 fracture, you'd want to take an elbow view because 9 it's more detailed, correct? 10 A. Yeah. 11 Q. Now, as a physician you order diagnostic tests for 12 patients, correct? 13 A. Sure. 14 Q. And that includes x-rays, correct? 15 A. Sure. 16 Q. Does the standard of care for a physician require 17 that physician to follow up on the tests that are 18 ordered? 19 A. I'm not sure what you mean. 20 Q. Well, if you order an x-ray, does the standard of 21 care require you to make sure that x-ray is done? 22 A. Oh, sure. 23 Q. And does the standard of care also require you to 24 find out what the results are when an x-ray has been 25 ordered? 15 1 A. If somebody read the x-rays, sure. 2 Q. Now, when you order an x-ray for a patient, do you 3 actually review the films or do you rely on the 4 report of the radiologist? 5 MS. VANCE: Objection. 6 A. If there is a radiologist, of course I rely on the 7 radiologist. 8 Q. And why do you rely on the radiologist as opposed to 9 reading the films yourself? 10 A. Because he's the expert. 11 Q. That's because a radiologist has specialized 12 training in radiology -- 13 A. Right. 14 Q. -- that you do not have? 15 MS. VANCE: Objection. 16 A. Right. 17 Q. If you make the diagnosis of an elbow fracture at 18 that point, do you bring in an orthopedic consult to 19 determine how to treat the patient? 20 A. No. 21 Q. How would -- 22 A. Not automatic. It depends on the fracture. 23 Q. How would you treat a patient with a fracture of the 24 radial head? 25 A. Put him in a sling. I maybe can put it in a splint, 16 1 it makes not much difference, and then I will send 2 him home and someone, depends where you work, the 3 orthopedic clinic or the orthopedic doctor, it all 4 depends on the circumstances, would be notified and 5 they will call the patient and they will see the 6 patient and do the definitive treatment of the 7 fracture. 8 Q. Would you also order physical therapy? 9 A. No. We are discussing a fracture, aren't we? 10 Q. Yes, a fracture of the radial head. 11 A. Well, that's what, you know, as far as an emergency 12 physician, that's all I will do. 13 Q. So you would immobilize the extremity and then refer 14 the patient to another physician for follow-up 15 treatment? 16 A. Yeah. 17 Q. Do you know what the symptoms are for an elbow 18 fracture? 19 A. It could be many. Depends on the kind of fracture 20 we are talking about. It could be pain, it could be 21 swelling. I mean, symptoms you said? 22 Q. Yes. 23 A. It could be pain. It's not specific. I mean, there 24 is no specific symptom, as I mentioned before, which 25 will tell me, ah, this is a fracture. 17 1 Q. Would you agree with me that a patient that came in 2 complaining of severe elbow pain a fracture of the 3 elbow would be part of the differential diagnosis? 4 A. Oh, sure, if there is history of trauma. We are 5 talking about trauma? 6 Q. Yes, with a history of trauma. 7 A. Yeah. 8 Q. And would you agree that in the example that I gave 9 you an elbow fracture would be part of the 10 differential until it is ruled out? 11 MS. VANCE: Objection. 12 A. If somebody is complaining of pain in the elbow you 13 say? 14 Q. Complaining of pain with a history of trauma to the 15 elbow. 16 A. Yeah, sure. 17 Q. For a patient that has elbow pain with a history of 18 trauma, how would you rule out an elbow fracture? 19 A. X-ray. 20 Q. And what views would rule out an elbow fracture? 21 A. Well, different views. They take different views. 22 We are talking about the elbow x-rays? 23 Q. Yes. 24 A. Usually -- I don't decide what views to take. You 25 know, the radiologist, they have a protocol for all, 18 1 as you know, for all of these things, so they take 2 different views, AP, lateral, sometimes oblique. 3 Usually those three, in general, are, you know, the 4 standard views. 5 Q. So you just order x-rays for a specific area of the 6 body and you leave it up to the x-ray department as 7 to how they're actually going to take those x-rays? 8 A. Yeah, I say left elbow x-ray, for instance, you 9 know, or right elbow, or right wrist or whatever. 10 Q. How many times did you see Rodney McClendon as a 11 patient? 12 A. I have no idea. 13 Q. Well, did you see him other than the one time in the 14 Kaiser emergency room at the Cleveland Clinic? 15 A. I seen him more than -- I don't remember anything, 16 so what do you mean? 17 MR. LEAK: Just so we're clear, I think 18 we've looked at the records. His only 19 involvement was on February 6th. In terms of I 20 think what he's saying in terms of on the 6th 21 how many times, he doesn't know. 22 Q. Okay. 23 A. Yeah. 24 MR. LEAK: But just for the record, we 25 have reviewed the records and his only 19 1 involvement was February 6th, 1998. 2 Q. Could you take a look at Exhibits 28 through 32 and 3 tell me if you prepared or dictated any of the 4 information in those records. 5 A. Uh-uh, no. 6 Q. Did Todd Richards dictate Plaintiff's Exhibits 28 7 and 29? 8 A. Yes. 9 Q. And did you review Exhibits 28 and 29 before you 10 signed Exhibit 29? 11 A. I don't remember. I am assuming I did, but I do not 12 remember, as I told you, anything. 13 Q. Is it your regular practice to sign medical records 14 without reviewing those records? 15 A. No, no. That's what I said, I assume. You're 16 asking me specifically if I recall reviewing this 17 and my answer is no because I don't remember 18 anything. In general, I review the records before I 19 sign it, sure. 20 Q. Is that your signature on Exhibit 29? 21 A. Certainly, it is. 22 Q. And by signing a medical record, does that mean that 23 you agree with what is dictated in the record? 24 A. That is correct. 25 Q. And if you would not agree with what was in the 20 1 record, you would correct the record? 2 A. Or discuss it, yeah. We do something, yeah. 3 Q. Or you would take some kind of action to correct any 4 statements that you did not agree with in the 5 record? 6 A. Sure. 7 Q. Is that something that you have done in the past, 8 corrected a medical record when you did not agree 9 with something? 10 A. I guess I don't remember specifics. I will do it. 11 I don't remember now any specific case. 12 Q. Did you take the history and physical examination 13 for Rodney McClendon or did Todd Richards? 14 A. Todd Richards did. 15 Q. And then Todd Richards reported to you the results 16 of his history and physical examination? 17 A. According to these, yes, he did. 18 Q. Did you perform your own independent history and 19 physical examination or did you rely on the history 20 and physical examination performed by Todd 21 Richards? 22 A. Let me tell you again that I don't remember anything 23 about this case. I just can go only by what is in 24 the records, so I cannot answer that question. 25 Q. But you agreed that you did not actually dictate the 21 1 medical record? 2 A. Oh, yes, absolutely, yes. 3 Q. Were you aware, based on the history that was taken, 4 that Rodney McClendon fell jumping over a fence onto 5 concrete? 6 A. Well, what the record said, you know. 7 Q. According to the record, what was the history of 8 trauma that was taken? 9 A. The history of trauma, well, what happened is he 10 fell. It just was written here. 11 Q. He attempted to jump over a fence? 12 A. Fence, right, to break a fight between two youths in 13 his neighborhood and fell, both elbows breaking his 14 fall on the concrete. 15 Q. Were you aware of that fact when you saw Rodney 16 McClendon? 17 A. I can't remember. 18 Q. Were you aware that he had a great deal of pain to 19 the right elbow which came in waves? 20 A. I can't remember. 21 Q. Were you aware that his pain was severe at times? 22 A. I can't remember. 23 Q. Were you aware that he had intermittent tingling to 24 the right forearm which starts at the elbow and 25 radiates to the wrist? 22 1 A. I can't remember. 2 Q. Were you aware that based on the physical 3 examination Rodney McClendon had several episodes 4 during the examination where he winced in pain? 5 A. I don't remember. 6 Q. And were you aware that he had a great deal of 7 tenderness to the posterior elbow? 8 A. I don't remember. You're asking me for personal 9 recollections; is that what you're asking me? 10 Q. I'm asking you that either based on your personal 11 recollection or based on your review of the medical 12 record whether you were aware of those facts at the 13 time you treated Rodney McClendon. 14 A. As I say, I don't remember anything. Just reading 15 the, you know, the only thing I can say is what is 16 written here. I have no -- you're asking me for 17 personal recollection, I don't have any. 18 Q. Do you agree that the standard of care for a 19 physician requires the physician to take a thorough 20 history and physical examination for a patient? 21 A. If I see the person, yes. If I am the one who sees 22 the patient, yes, if I am the one who sees the 23 patient first. 24 Q. Did you order x-rays for Rodney McClendon? 25 A. I don't remember. Again, according to this I did 23 1 not, but I don't remember personally. 2 Q. According to the record you did not personally order 3 x-rays? 4 A. Right. 5 Q. Todd Richards was the person who actually ordered 6 the x-rays? 7 A. I think according to the records actually they were 8 ordered by -- from the triage, and it must have been 9 the nurse. 10 Q. Doctor, what exhibit are you referring to when you 11 say that the triage nurse ordered x-rays? 12 A. I see 30. 13 MR. LEAK: Yep, that's it. 14 Q. And you're referring to the statement under triage 15 nursing action, x-ray right and left forearm, slash, 16 elbow, slash, wrist? 17 A. That is correct. 18 Q. Is that an order for an x-ray of three views to be 19 taken of each of Rodney McClendon's arms? 20 MS. VANCE: Objection. 21 A. Not really. This, to me, describes what the nurse 22 did, you know. She must have filled out an actual 23 form. She cannot -- the patient cannot take this to 24 the x-ray. She must have written a form. 25 Q. A requisition -- 24 1 A. A requisition. 2 Q. -- form must be filled out? 3 A. Yeah, some kind of form, yeah. You can't go to the 4 x-rays with this thing. 5 Q. Did you ever see the requisition form for Rodney 6 McClendon? 7 A. I don't remember. 8 Q. And it's the requisition form that is actually sent 9 to x-ray? 10 A. With the patient, yes. 11 Q. Is the requisition form put into the computer that's 12 in the emergency department? 13 A. To be very honest with you, I don't know. 14 Q. Do you know who would have knowledge as to whether a 15 requisition form is put into the computer? 16 A. No, I don't. I don't. I don't know. Somebody 17 must, but I don't know. I cannot tell you. 18 Q. Have you ever tried to put up a requisition form on 19 the computer? 20 A. No, I don't know if you can do it. 21 Q. When the patient has returned from radiology is the 22 requisition form returned with the patient? 23 A. Possibly, possibly, with the x-rays. Possibly. I 24 cannot say for sure, I cannot say for sure. Most 25 likely yes, but I cannot say 100 percent. 25 1 Q. Do you know whether you saw Rodney McClendon as a 2 patient before or after he went to the x-ray 3 department? 4 A. I don't remember. 5 Q. When you order x-rays that -- strike that. 6 When you order x-rays and you ask for specific 7 views to be taken, do you expect the radiologist to 8 actually take those views? 9 A. If I order specific views, yes, if I order it. If I 10 write, as I mentioned to you, x-ray of chest, AP and 11 lateral, yes, if I order that. 12 Q. And if you order a specific view, is it your habit 13 or practice to check to see that that view is 14 actually taken? 15 A. Yes, if I order a specific view. 16 Q. Do you know if at the time you saw Rodney McClendon 17 you were aware that no specific view of his right or 18 left elbow was taken? 19 A. I don't remember. 20 Q. You cannot tell me if that is something that you 21 checked on? 22 A. No. 23 Q. Are you able to tell me whether you checked the 24 x-ray results with any of the other medical 25 records? 26 1 A. No. 2 Q. Do you know if you checked the actual views that 3 were taken on x-ray with the requisition form or any 4 order for x-rays? 5 A. No. 6 Q. Do you agree that Rodney McClendon was given an 7 injection for the pain in his elbow? 8 A. What do you mean if I agree? 9 Q. Based on the medical record. 10 A. He was given the pain medication on the elbow? 11 Q. Yes. 12 MR. LEAK: Toradol. 13 A. Toradol, yes, but not his elbow because it was given 14 IM means intramuscular, not in the elbow. That's 15 somewhere in the arm or in the leg. 16 Q. I just asked was he given an injection for pain. 17 A. According to the records, he was given an injection 18 for the pain. 19 Q. And the pain he was complaining of is pain in both 20 elbows? 21 MS. VANCE: Objection? 22 A. That's the chief complaint, bilateral elbow pain. 23 That's the chief complaint. 24 Q. Do you know if you gave the order for pain 25 medication? 27 1 A. I don't remember. 2 Q. And Rodney McClendon was given a sling for his arm 3 while he was in the Kaiser emergency room? 4 A. His arm was in a sling, according to the records. 5 Q. What was the purpose of placing his arm in a sling? 6 A. Well, as I mentioned earlier, there was no evidence 7 of fracture, according to these. He had pain, so 8 you always try to rest the part which has pain, even 9 if there's no, to your knowledge, it's not broken, 10 you know, rest, immobile. So that's a general rule 11 in any trauma, though it may not be a fracture. 12 Q. Did you obtain an orthopedic consult for Rodney 13 McClendon? 14 A. I don't remember. 15 Q. If you had obtained an orthopedic consult, is that 16 something that would have been noted in the medical 17 record? 18 A. It should be in the medical record if I -- yeah. 19 Q. When you're working in the emergency room department 20 is an orthopedic consult available 24 hours a day? 21 A. Oh, yes, it is. 22 Q. Do you ever obtain an orthopedic consult to actually 23 make the diagnosis of a fracture of the extremity? 24 A. No. 25 Q. Do you know if you told Rodney McClendon that it was 28 1 your impression that he had fractures of the 2 elbows? 3 A. I don't remember. 4 Q. Are you aware of whether or not there was a request 5 by the radiologist to reread the x-rays? 6 A. No. 7 MR. LEAK: Did you say a request by the 8 radiologist? 9 Q. I'm sorry. Are you aware of whether or not there 10 was a request by any emergency room employee for the 11 radiologist to reread the x-rays? 12 A. No, I just don't remember. 13 Q. Have you ever asked a radiologist to reread x-rays? 14 A. To reread an x-ray? 15 Q. Yes. 16 A. Usually no. 17 Q. Is that something that you have done in the past? 18 A. I may have done in the past, I may. 19 Q. And would you do that because you thought there was 20 a discrepancy between the x-ray finding and the 21 clinical findings? 22 A. I can do that sometimes, yeah, depends on the case, 23 as you can just not generalize, depends on what case 24 we are talking about and, you know, so every case is 25 different. So, you know, you cannot make rules. In 29 1 medicine there is no rules as far as this is 2 concerned. Every case is in general. If the 3 radiologist tells me there is nothing wrong, there 4 is nothing wrong. 5 Q. But have you had cases where you questioned the 6 radiologist's finding because the clinical findings 7 were so strong? 8 A. Not in general. Particularly we are talking about 9 fractures? 10 Q. Yes. 11 A. If the radiologist tells me there is no fracture, 12 there is no fracture. 13 Q. Have you ever asked a radiologist to take additional 14 views? 15 A. Not in general. 16 Q. Do you know if it was your determination that Rodney 17 McClendon was to follow up if the pain to his elbow 18 did not resolve within five days? 19 A. I don't remember personally or recall anything about 20 it, what is written in the record. I just can tell 21 you what is written in the record. 22 Q. But based on the medical record, that was the 23 instruction that Rodney McClendon was given? 24 A. Based on the medical records, yes. 25 Q. Do you agree that Rodney McClendon was not diagnosed 30 1 with a fracture of his elbows on February 6th, 2 1998? 3 A. According to the records it appears that, referring 4 to the x-ray readings in Exhibit 29, it is read as 5 negative. 6 Q. The diagnosis was contusion of the right and left 7 elbow? 8 A. That is correct, yeah. 9 Q. So the diagnosis was not bilateral elbow fractures, 10 correct? 11 A. At that time, yes. 12 MR. RUF: That's all I have for now, 13 Doctor. 14 THE WITNESS: Oh, thank you. 15 MR. LEAK: You're not done. 16 THE WITNESS: What do you mean you are 17 not done? 18 MR. RUF: She has some questions for 19 you, Doctor. 20 THE WITNESS: Okay. 21 - - - - 22 CROSS-EXAMINATION OF FELIX J. MARTIN, M.D. 23 BY MS. VANCE: 24 Q. Doctor, my name is Vicki Vance. I represent the 25 Cleveland Clinic. 31 1 When you worked in the emergency room at the 2 Cleveland Clinic you were working in the Kaiser 3 emergency room? 4 A. Right, at that time, yeah, at the time that we are 5 talking about, sure. 6 Q. When the patient was sent to x-ray and after they 7 had x-rays they would come back into the Kaiser 8 emergency room to be followed up? 9 A. Absolutely, yes. 10 Q. And after the patient came back from x-ray, the 11 x-ray films themselves would also be brought back 12 into the emergency room or somebody would go and get 13 them and bring them back in? 14 A. Probably, yes. Probably, yes, yes. 15 Q. The patient's x-ray jacket would be back in the 16 emergency room before the patient was discharged 17 from the emergency room? 18 A. Yeah, I would say yes. 19 Q. And as an emergency room physician you would have 20 the ability, if you thought it appropriate, to order 21 additional x-ray films if you thought it was 22 necessary for your patient? 23 A. Probably if I wanted to -- yes, yes, if I had the 24 opportunity, sure. 25 Q. And you would also have the ability to look at the 32 1 x-ray films themselves for a patient if you chose 2 to? 3 A. Always if I chose to, absolutely. 4 Q. Or if you chose to you could always call the 5 radiologist and speak directly physician to 6 physician with the radiologist to check on or 7 clarify an interpretation of a film? 8 A. Absolutely. 9 MS. VANCE: Nothing further. 10 MR. RUF: No further questions. 11 MR. LEAK: You know something, Doctor, 12 I think you can waive signature here unless you 13 want to read this deposition again. Do you 14 want to read it? 15 THE WITNESS: No, thank you. 16 MR. LEAK: He'll waive signature. 17 (Signature waived.) 18 19 20 21 22 23 24 25 33 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, FELIX J. MARTIN, M.D., was by me first duly sworn to testify the truth, the whole 8 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 day of , 1999. 17 18 Laura L. Ware, Ware Reporting Service 19 3860 Wooster Road, Rocky River, Ohio 44116 My commission expires May 17, 2003. 20 21 22 23 24 25