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., et al., 8 Defendants. 9 10 - - - - - 11 DEPOSITION OF JOHN THOMPSON, M.D. 12 THURSDAY, MAY 24, 2007 13 - - - - - 14 Deposition of JOHN THOMPSON, M.D., a 15 Defendant herein, called by counsel on behalf of 16 the Plaintiff for examination under the statute, 17 taken before me, Vivian L. Gordon, a Registered 18 Diplomate Reporter and Notary Public in and for 19 the State of Ohio, pursuant to agreement of 20 counsel, at the offices of Reminger & Reminger, 21 1400 Midland Building, Cleveland, Ohio, 22 commencing at 10:30 o'clock a.m. on the day and 23 date above set forth. 24 - - - - - 0002 1 APPEARANCES: 2 On behalf of the Plaintiff Becker & Mishkind 3 JESSICA A. PERSE, ESQ. Skylight Office Tower Suite 660 4 1660 W. 2nd Street Cleveland, Ohio 44113 5 216-241-2600 6 On behalf of the Defendant Dr. Helen S. Han, University Primary Care Practices, Inc. and 7 Dr. Sherilynn Sage Bonezzi, Switzer, Murphy, Polito & Hupp 8 WILLIAM D. BONEZZI, ESQ. Suite 1905 9 1300 East Ninth Street Cleveland, Ohio 44114 10 216-875-2767 11 On behalf of the Defendant Dr. Barry Peskin and Cleveland Clinic OB/GYN Specialties 12 Roetzel & Andress BEVERLY A. SANDACZ, ESQ. 13 One Cleveland Center Tenth Floor 1375 East Ninth Street 14 Cleveland, Ohio 44114 216-623-0150 15 On behalf of the Defendant Dr. John Thompson 16 Reminger & Reminger MARILENA DISILVIO, ESQ. 17 1400 Midland Building 101 Prospect Avenue West 18 Cleveland, Ohio 44115 216-687-1311 19 20 - - - - 21 22 23 24 0003 1 JOHN THOMPSON, M.D., a witness herein, 2 called for examination, as provided by the Ohio 3 Rules of Civil Procedure, being by me first duly 4 sworn, as hereinafter certified, was deposed and 5 said as follows: 6 EXAMINATION OF JOHN THOMPSON, M.D. 7 BY MS. PERSE: 8 Q. Dr. Thompson, I'm Jessica Perse and 9 I'm the attorney representing the plaintiff in 10 this matter. 11 A. Okay. 12 Q. Have you ever had your deposition 13 taken before? 14 A. Yes, I have. 15 Q. Even though you have had your 16 deposition taken before, I just want to review a 17 few rules with you before we begin. 18 A. Okay. 19 Q. If at any time you don't understand 20 a question, tell me and I'll clarify it. Is 21 that okay with you? 22 A. Okay. 23 Q. Please try to answer all questions 24 verbally and not with a nod of the head, as the 0004 1 court reporter has to record our answers and 2 take down everything that we say. Is that 3 understood? 4 A. Yes. 5 Q. This is the challenging one. Try to 6 wait until I am done with my question before you 7 start to answer, okay? 8 A. Yes. 9 Q. And I'll do my best to wait until 10 you are done answering all of my questions. 11 This way we don't talk over each other and it 12 makes the court reporter's job easier and it's 13 an easier record to read. Is that okay with 14 you? 15 A. Yes. 16 Q. It's important that you make sure 17 that you understand each and every one of my 18 questions because I'm going to rely on your 19 answers that you give today in this deposition 20 when this case goes to trial. Do you understand 21 that? 22 A. Yes. 23 Q. Just a few background questions. 24 Could you state your full name for the record 0005 1 with the correct spelling. 2 A. Yes. John McKee Thompson, J-O-H-N, 3 M-C-K-E-E, T-H-O-M-P-S-O-N, M.D. 4 Q. And could you provide us with your 5 business address? 6 A. You know, I don't know that off the 7 top of my head. 8 Q. Where is your business address 9 presently? 10 A. Charlotte, North Carolina. 11 Q. Okay. And how long have you been in 12 North Carolina? 13 A. Approximately eight months. 14 Q. And before you were in Charlotte, 15 where were you employed or working? 16 A. I was at OB/GYN of the Reserve in 17 Bath, Ohio, for two years. 18 Q. And then before that, where were you 19 working? 20 A. Under different names in part of the 21 University of Cleveland Hospital System. 22 Q. University Hospitals of Cleveland? 23 A. Yes. 24 Q. And when did you start with 0006 1 University Hospitals of Cleveland and when did 2 you end? 3 A. I started, I believe it was August 4 of 1994 until -- I'm trying to recall if it was 5 April of 2004, I believe. 6 Q. And was that your office location at 7 the Rockside Road address? 8 A. That was one of two sites I 9 practiced at, yes. 10 Q. The Rockside Road address, do you 11 know the street address for that? 12 A. Rockside Road. 13 Q. That's fine. That's in Bedford; is 14 that correct? 15 A. Yes. I can't remember if it was 16 22750 or what? 17 Q. Okay. And the other office address 18 during that time was where? 19 A. The Mentor office of our group. 20 Q. I'm sorry, I didn't catch that. 21 A. The Mentor office of our group 22 practice. I don't recall the address. 23 Q. And for that entire looks like 24 almost ten years, did you have offices at both 0007 1 those locations for the entire ten years? 2 A. Yes, I did. 3 Q. Was there part of that time that you 4 were working with the Mednet Group? 5 A. Yes. 6 Q. Do you know what years that was 7 from? 8 A. Well, Mednet was an entity that I 9 joined when I first came to Cleveland. The 10 Mednet entity itself was dissolved while I was 11 still working for them. 12 Q. Do you know when that was? 13 MS. DISILVIO: Don't guess. 14 A. I don't recall dates at all. 15 Q. Was your stint with Mednet prior to 16 1994 or was it inclusive of 1994? 17 A. From 1994 until it dissolved. 18 Q. All right. Could you provide me 19 with your present address of residence -- 20 A. Yes. 21 Q. -- for the record? 22 A. 5064 Cambridge Oaks Drive, Matthews, 23 North Carolina, 28104. 24 Q. Do you work in private practice now 0008 1 or work for a hospital? Can you describe your 2 practice today? 3 A. It's a private practice that's part 4 of the Carolinas Health Care System. 5 Q. And what hospital are you affiliated 6 with? 7 A. Carolinas Medical Center - Union. 8 Q. Any others? 9 A. No, just the one. 10 Q. Are you an obstetrician and 11 gynecologist? 12 A. Yes. 13 Q. At any time during your practice 14 from 1994 to present date, did you limit your 15 practice in any way outside of within the field 16 of obstetrics/gynecology? 17 A. No, I was a generalist. 18 Q. Outside of your present clinical 19 duties in private practice, do you have any 20 academic responsibilities? 21 A. Clarify. 22 Q. Do you teach medical students or 23 residents? 24 A. I'm involved in teaching the family 0009 1 practice residents at our hospital, yes. 2 Q. Do you have any relationship with 3 the University in North Carolina? Are you a 4 professor? 5 A. No, not yet. 6 Q. Do you expect -- 7 A. I'm going to start those duties in 8 the future, yes. 9 Q. Do you know when? 10 A. No. 11 Q. Otherwise, you are in full-time 12 practice? 13 A. Yes. 14 Q. So 100 percent of your clinical 15 duties are patient care at the present time? 16 A. My clinical duties, yes. 17 Q. Going back to April 2003, it appears 18 to be -- again, in 2003 were you an employee of 19 any corporation? 20 A. I don't recall exactly when the 21 dates changed; whether it was still Mednet or it 22 was MacDonald OB/GYN at this point in time. 23 Q. And was MacDonald OB/GYN part of 24 UPCP at that time? 0010 1 A. Yes, it was. 2 Q. And were you an employee? 3 A. Yes. 4 Q. Did you hold any position in the 5 corporation? 6 MS. DISILVIO: Which corporation? 7 MS. PERSE: Of UPCP or MacDonald 8 OB/GYN. 9 A. Just a staff member. 10 Q. I neglected to ask you to bring a CV 11 today, but if you could provide one -- do you 12 have a current CV? 13 A. I don't have one with me, no. 14 Q. If you could provide one to your 15 attorney that she can forward to me, that would 16 be helpful. 17 A. Okay. 18 Q. In terms of your licensure, do you 19 still maintain a current license in the State of 20 Ohio? 21 A. No, I do not. 22 Q. When did you relinquish that? 23 A. I'm not sure of the date. It would 24 have moved from active to inactive. Probably 0011 1 fairly recently. 2 Q. And what licenses do you currently 3 hold? 4 A. Inactive in New York and Ohio, 5 active in North Carolina. 6 Q. And when did your North Carolina 7 license become active? 8 A. September 2006. 9 Q. The New York license, when did you 10 practice medicine in New York, if at any time? 11 A. From the time I finished residency 12 in 1992 through 1994. 13 Q. Were you in private practice at that 14 time? 15 A. Yes. 16 Q. And practicing obstetrics and 17 gynecology? 18 A. Yes. 19 Q. Just in terms of a little bit of 20 your educational background, where did you go to 21 medical school? 22 A. My first two years of medical school 23 was at Albany Medical College in Albany, 24 New York, and the third and fourth years at 0012 1 State University of New York Health Sciences 2 Center at Syracuse. 3 Q. And then following your -- so what 4 year would you say you graduated med school? 5 A. 1988. 6 Q. And between 1988 and 1992, you did 7 an obstetrical/gynecology residency? 8 A. From 1988 to '89 I did one year of 9 family medicine in Williamsport, Pennsylvania, 10 and then 1989 to 1992 the OB/GYN residency in 11 Buffalo, New York. 12 Q. And you did a chief residency year 13 in OB/GYN? 14 A. Yes. 15 Q. And that was at Buffalo, New York? 16 A. Yes. 17 Q. Okay. And did you become board 18 certified in OB/GYN, obstetrics and gynecology? 19 A. Yes. 20 Q. And what year did you become board 21 certified? 22 A. I passed the final part in 1994. 23 Q. And when you refer to the final 24 part, are you referring to the oral boards? 0013 1 A. Yes. 2 Q. Did you pass that on the first 3 attempt? 4 A. Yes. 5 Q. And then when did you take the 6 written part of the exam? 7 A. The completion of chief residency in 8 1992. 9 Q. Is it typical to take two years 10 between your written and your oral boards? 11 A. Yes. 12 Q. And did you pass your written exam 13 on the first attempt? 14 A. Yes. 15 Q. Are you board certified -- well, 16 that would mean that you are board certified in 17 OB/GYN. 18 Have you recertified at all? 19 A. Yes. 20 Q. And when did you recertify? 21 A. Starting in 2004, I'm doing the 22 annual recertification. 23 Q. Can you explain that to me a little 24 bit what that entails -- 0014 1 MS. DISILVIO: Recertification? 2 Q. -- this annual recertification. 3 A. The American Board of OB/GYN sends 4 out a list of articles to be read and test 5 questions to be answered. 6 Q. And so you complete those articles 7 and then answer the test questions and then what 8 happens? 9 A. If you obtain a certain score, you 10 are recertified for another additional year. 11 Q. And then does that fulfill your CME 12 requirement as well? 13 A. Not completely. 14 Q. How many credits do you think you 15 would roughly get from that? 16 A. You can do the annual 17 recertification one of two ways: Either the 18 minimum requirement would give you 25 hours of 19 CME or do additional articles and obtain 35. I 20 always do the additional articles. 21 Q. It sounds like it's a good way to 22 keep up to date in current literature in OB/GYN, 23 would you agree? 24 A. They usually choose fairly good 0015 1 articles, yes. 2 Q. Now, you mentioned that you provided 3 your deposition before. How many times? 4 A. I don't recall exactly. Four, five, 5 maybe six. 6 Q. On those occasions, do you remember 7 if you were a defendant in those matters or what 8 was the subject matter of that litigation? 9 MS. DISILVIO: Objection. 10 Q. Were they medical negligence 11 actions? 12 MS. DISILVIO: Objection. First, do 13 you want to establish what they were? 14 MS. PERSE: That's what I am trying 15 to do with that question. 16 Q. Were they all in the area of medical 17 negligence? 18 MS. DISILVIO: Objection. You may 19 answer. 20 A. I don't understand. Do you want me 21 to mention what they were? 22 Q. How about if we -- I think rather 23 than doing a blanket review, let's review each 24 one that you can recall, each deposition that 0016 1 you can recall. 2 MS. DISILVIO: I'm going to object. 3 Vivian, would you let the record 4 reflect a continuing objection to this line of 5 questioning so I don't have to keep 6 interrupting. 7 MS. SANDACZ: Note my continuing 8 objection also. 9 Q. Your first deposition was when? 10 A. This was a case in residency, a baby 11 case. 12 Q. And were you a defendant in that 13 case? 14 A. Yes. 15 Q. And do you remember the name of the 16 injured party or the baby? 17 A. No, I don't. 18 Q. And do you remember approximately 19 what year it was? 20 A. I don't recall exactly. It would 21 have been one of the last couple years of 22 residency. 23 Q. And so that took place in New York? 24 A. Yes. 0017 1 Q. And do you know the outcome of that 2 litigation? 3 A. Yes. It went to trial and returned 4 with a defense verdict. 5 Q. And so during that case, did you 6 give trial testimony; as well? 7 A. Yes. 8 Q. Moving on to the next deposition 9 that you can recall, when was the next one that 10 you gave? 11 MS. DISILVIO: The next one he 12 recalls? 13 MS. PERSE: The next one he recalls 14 giving. 15 A. The next one I believe was actually 16 your firm in 1994. 17 Q. That was before my time. And you 18 were a defendant in that litigation? 19 A. One of several, yes. 20 Q. Do you remember the name of the 21 attorney that was questioning you? 22 A. I was questioned by several 23 attorneys from that firm, but, no, I don't 24 recall exactly. 0018 1 Q. And what was the subject matter of 2 that litigation? 3 A. It was a bad baby also. 4 Q. And that was during your tenure at 5 University Hospitals? 6 A. Yes. 7 Q. Did that matter go to trial? 8 A. No. 9 Q. So you obviously didn't give trial 10 testimony in that situation? 11 A. Correct. 12 Q. And do you recall the resolution of 13 that? 14 A. It was settled. 15 Q. Moving on to the next deposition 16 that you can recall. 17 A. The next one I'm able to recall was 18 just fairly recently, within the last two years. 19 Q. What was the subject matter of that 20 litigation? 21 A. It was allegations of care in an 22 emergency department setting. 23 Q. Did it involve a pregnant patient? 24 A. No, it did not. 0019 1 Q. A gynecologic patient? 2 A. Yes. 3 Q. Do you remember the party's name? 4 A. Yes. 5 Q. And could you tell me that? 6 A. Her name was Capers. 7 Q. Is that with a C? 8 A. With a C. 9 Q. I guess I could ask you to spell the 10 entire name just for the record. 11 A. I believe it was C-A-P-E-R-S. 12 Q. Was that a female patient? 13 A. Yes. 14 Q. Was she a gynecologic patient of 15 yours? 16 A. She was a GYN patient of our 17 group's, yes. 18 Q. And if you could just briefly 19 explain to me what happened to that patient. 20 A. It was a young woman presenting to 21 the emergency room complaining of bleeding after 22 a procedure done by one of my partners, who was 23 asked to come down to the emergency room to be 24 seen. 0020 1 Q. Is she still alive today? 2 A. I'm not sure. 3 Q. And what happened to her following 4 the bleeding episode? 5 A. There were questions whether she 6 received an antibiotic in the emergency 7 department that caused subsequent problems. 8 Q. And do you remember the attorneys on 9 that case; your attorney as well as the attorney 10 representing Ms. Capers? If you remember. 11 MS. DISILVIO: You better. It's me. 12 And the lawyer representing the plaintiff was 13 Bob Passov and the case was dismissed. 14 Q. It didn't go to trial? 15 A. No. 16 Q. No trial testimony then? 17 A. No. 18 Q. Any other depositions? 19 A. I'm not sure if I had another one 20 somewhere in the past that I'm not recalling. 21 Q. Any depositions involving the 22 management of patients with breast cancer? 23 A. No. 24 Q. Any prior lawsuits involving 0021 1 patients, obstetrical/gynecologic patients and 2 their management of breast cancer? 3 A. No. 4 Q. Have you ever served as an expert 5 witness in a professional negligence action or 6 medical malpractice? 7 A. No. 8 Q. Have you ever reviewed cases? 9 A. No. 10 Q. Have you completed any Fellowships 11 in addition to your OB/GYN residency? 12 A. No. 13 Q. Is your license to practice medicine 14 restricted in any way in North Carolina? 15 A. No. 16 Q. Prior to changing your status to 17 inactive status here in Ohio, was your license 18 under any restrictions? 19 A. No. 20 Q. Are you a member of the American 21 College of OB/GYN? 22 A. Yes. 23 Q. Do you belong to any other 24 professional associations? 0022 1 A. At this point I believe the North 2 Carolina Medical Society. 3 Q. Your present practice, are you in a 4 group practice? 5 A. Yes. 6 Q. And how many other people are in 7 practice? 8 MS. DISILVIO: Objection. 9 Relevance. You may answer if you can. 10 A. There are six of us doing OB/GYN, 11 one doing GYN only, and then two nurse 12 practitioners. 13 Q. While you were employed with 14 MacDonald OB/GYN, did you have any teaching 15 responsibilities? 16 A. Yes. 17 Q. And what were those? 18 A. We were considered a private 19 practice group but taking care of our patients 20 at University Hospitals, so the residents would 21 be involved in their care. 22 We didn't have specific delineated 23 duties that we had to involve the residents or 24 topics to cover, but they would help us 0023 1 co-manage the patients. 2 Q. Outside of the employment history 3 that we have reviewed, did you do any activities 4 outside of the area of medicine, employment 5 activities outside of the area of medicine? 6 A. Such as? 7 Q. Any moonlighting? Let's go with any 8 moonlighting? 9 A. No. 10 Q. Any other job experience in general 11 between '92 to the present date? 12 A. The one other practice in Upstate 13 New York from 1992 to 1994. 14 Q. During your time with MacDonald 15 OB/GYN, what hospital privileges did you 16 maintain? 17 A. Could you clarify? 18 Q. I'm trying to just delineate what 19 hospitals you worked out of when you were 20 working with MacDonald OB/GYN. Let's say from 21 2000 to the time you left in 2004. 22 A. We were at University Hospital, at 23 the main hospital the whole time. There was a 24 period in there -- and I don't recall exactly 0024 1 how many months -- we were also at Bedford 2 Hospital. 3 Q. But that was a shorter period of 4 time? 5 A. I don't recall exactly. I believe 6 that was less than a year, a year's worth of 7 involvement there. 8 Q. Anything in Lake County with your 9 Mentor office or you brought everything to 10 University downtown? 11 A. Everything was brought down to the 12 main hospital. 13 Q. Okay. You mentioned we. Who were 14 you in practice with from 2000 to 2004? 15 A. Do you want everybody's names? 16 Q. Yes. 17 MS. DISILVIO: Do you want to look 18 at the letterhead, maybe that would make it 19 easier. 20 A. Let me see if I could come up with 21 everybody. Barrett, Bruzowski, Cossler, 22 Wieczorek, Melton, Sage, Hinnes, Lucas, Cory. 23 MS. DISILVIO: Impressive. 24 Q. And I take it that that was a group 0025 1 practice, but did you share call with all those 2 people? 3 A. Yes. 4 Q. Out of your Bedford location, did 5 you co-manage patients or share patients with 6 all those physicians? 7 MS. DISILVIO: Objection to the 8 term. If you know what she means. 9 A. We shared patients, but not all of 10 my partners went to that location. 11 Q. Who primarily worked at that 12 location with you? 13 A. Besides myself, Bruzowski, Melton, 14 Wieczorek, and Sage. 15 Q. And in that practice, was it typical 16 for you to take care of a patient as the primary 17 care provider or did you all share patients, so 18 one visit the patient would see one doctor in 19 the practice and the next visit they may not? 20 MS. DISILVIO: Primary OB/GYN? 21 MS. PERSE: Primary OB/GYN. Thank 22 you for your clarification. 23 A. GYN patients would usually choose 24 one person to see for most of their work, but 0026 1 even then if they weren't available they would 2 quite often see one of the partners. 3 Obstetric patients would do one of 4 either options: Either stay with one person as 5 much as they could or see everybody on a 6 rotating basis, and they were given that option. 7 Q. But you didn't set it as a protocol 8 that the patient had to see everybody in the 9 practice? 10 A. No. 11 Q. And it would be fair then to say 12 that the patient could choose a primary OB/GYN 13 in the practice, but it would not necessarily be 14 guaranteed that they would have that physician 15 do the delivery? 16 A. Correct. 17 Q. And can you explain to me what your 18 typical week would be like during your stay at 19 MacDonald OB/GYN. How many days of office would 20 you have? 21 A. That was variable. The full 22 workweek consisted of ten half day sessions. 23 Typically, most of us would have four days in 24 the office and one day that was at the hospital. 0027 1 Q. And the day at the hospital, would 2 that be for surgeries? 3 A. That would be for surgeries and 4 covering labor and delivery. 5 Q. Did you have in-house, in-house call 6 duties? 7 A. I don't recall that we were 8 specifically required to be in-house at all 9 times, but most of us chose to stay in-house 24 10 hours at a time. 11 Q. And the four days of office, from 12 when to when would you see patients? 13 A. I'm forgetting these hours, but I 14 believe we typically started at 8:00 o'clock in 15 the morning and would usually go until about 16 5:00 in the afternoon. 17 Q. How many patients would you 18 typically see? 19 MS. DISILVIO: Objection. The 20 reason for the presentation -- 21 A. That was highly variable. That 22 could be ten in a half day session to 25 in a 23 half day session. 24 Q. And I kind of gave you a broad range 0028 1 when I said between 2000 and 2004. Is that 2 characteristic of what your workweek was like? 3 Would that be pretty accurate during the year 4 2003, if you remember? 5 A. I believe so. In addition to night 6 call duties, yes. 7 Q. And how often did you take night 8 call? 9 A. We shared call pretty evenly, so 10 three or four times a month. 11 Q. And the person that was on call was 12 responsible to cover labor and delivery; 13 correct? 14 A. Correct. 15 Q. And that physician would be 16 responsible to do the rounds on the patient? 17 A. Morning rounds were usually shared 18 by whoever was in the hospital at that time. 19 Quite often there were two of us there at the 20 time during the day. 21 Q. Have you reviewed any material in 22 preparation for this deposition? 23 A. Yes. 24 Q. And what material have you reviewed? 0029 1 A. My office notes, summaries by this 2 firm of the case. 3 MS. DISILVIO: You don't have to 4 tell them about my letters to you. Those are 5 privileged. 6 THE WITNESS: Okay. 7 Q. Have you reviewed any literature? 8 A. No, I have not. 9 Q. Do you maintain any independent 10 notes on this case, aside from what you may have 11 prepared for your attorney? 12 A. No, I have not. 13 Q. Have you reviewed any -- you 14 mentioned records. Have you reviewed your 15 records? 16 A. Whatever has been forwarded by this 17 firm to me, yes. 18 Q. Have you reviewed other physician's 19 records? 20 A. Yes. 21 Q. And could you tell me what those 22 records are that you have reviewed? 23 A. We have copies of records from 24 Dr. Peskin's office. 0030 1 MS. DISILVIO: I don't know if the 2 index will help you. Tell her everything that 3 was on there. 4 That's where it starts. 5 A. Do you want me just to sit here and 6 read these? 7 Q. We can just take those and mark 8 those as an exhibit. 9 MS. DISILVIO: I will copy those. 10 I'll copy them at the end of the deposition. 11 - - - - - 12 (Thereupon, THOMPSON Deposition 13 Exhibit 1 was marked for 14 purposes of identification.) 15 - - - - - 16 MS. PERSE: That will be our 17 Plaintiff's Exhibit 1 is what is characterized 18 as the index of medical records that you've 19 reviewed in preparation for today's deposition. 20 THE WITNESS: Yes. 21 Q. Had you seen any of those records 22 before, in addition to your own records? Prior 23 to this litigation, were you privy to any of 24 those records in the care of Rhonda Berry? 0031 1 A. Dr. Peskin's notes would have come 2 to us at some time during our care. 3 Q. Do you have an independent 4 recollection of seeing Dr. Peskin's notes during 5 your care of Mrs. Berry? 6 A. They would have come to us at some 7 point, yes. 8 Q. My question is, do you recall seeing 9 them in the course of your treatment of 10 Mrs. Berry? 11 A. Yes. 12 Q. And while we are on that, what 13 specifically do you recall seeing? 14 A. I believe we had a copy of the ACOG 15 prenatal forms and some lab results. 16 Q. And actually I just want to go with 17 your recollection right now as to what you 18 recall seeing at that time. 19 Anything specific from those forms 20 that you recall that you would have looked for? 21 MS. DISILVIO: Objection. I don't 22 understand the question. If you understand it, 23 you may answer. 24 A. I looked at -- got a sense of what 0032 1 her care up to that point in time had been. 2 Q. And was there anything striking to 3 you in that assessment? Do you recall anything 4 specific from Dr. Peskin's records that would 5 have helped you or was necessary to know in the 6 management of Mrs. Berry? 7 MS. DISILVIO: Objection to form and 8 otherwise. 9 MS. PERSE: That's not unusual. 10 A. The positives that would have come 11 to mind was the fact that this was an 12 infertility patient that had undergone IVF; that 13 she had a large fibroid uterus. 14 Q. We are jumping way ahead. But had 15 you seen Mrs. Berry prior to her pregnancy at 16 any time in 2003? 17 A. Prior to when I first saw her in 18 June? 19 Q. Right. 20 A. No, I had not. 21 Q. In addition to Dr. Peskin's records, 22 do you recall having seen any other records for 23 Mrs. Berry when you saw her as a patient? 24 A. I don't believe so, no. 0033 1 Q. Do you own any textbooks in the area 2 of OB/GYN? 3 A. Yes. I have some things in the 4 office. 5 Q. What would those be? 6 A. I mean, do you want all the titles? 7 Q. Yes, the titles. Let me ask, are 8 they ones that you find to be reliable 9 references in the management of your patients? 10 A. I use a lot of reference materials. 11 I tend not to use textbooks so much anymore. 12 Q. So is there any text that you would 13 go to to answer a question that you might have 14 in the care of your patients that you kind of 15 would routinely reference? 16 MS. DISILVIO: Objection. Asked and 17 answered. You may answer again. 18 A. I use a number of sources as 19 reference materials. 20 Q. And what would those sources be? 21 A. Quite often now I tend to use 22 Medline search of current articles more than 23 anything. 24 Q. Okay. Would you say that you use 0034 1 the ACOG articles provided to you for your 2 recertification? 3 MS. DISILVIO: Use them in what 4 fashion? 5 MS. PERSE: As a reference in terms 6 of assisting in the management of the care of 7 patients. 8 A. As one resource, yes. 9 Q. And just trying to delineate, are 10 there any texts that you might go to? 11 MS. DISILVIO: I think he told you 12 twice, no. 13 MS. PERSE: I don't know if he said 14 no. He said there are some and I'm trying to 15 delineate what those might be. 16 MS. DISILVIO: You may answer if you 17 can. 18 A. In my practice I tend to use 19 textbooks very little anymore, if at all. 20 Q. So the answer is no? 21 A. For the most part, yes. 22 Q. On those rare occasions that you 23 might use a textbook, what would that be? 24 MS. DISILVIO: Assuming he uses one. 0035 1 MS. PERSE: I said on the rare 2 occasions. 3 MS. DISILVIO: Go ahead. 4 A. For direct patient care I tend to 5 use them more sometimes to show patients 6 illustrations and to use them as a patient 7 education tool more than anything else. 8 Q. Again, I'm just asking what would 9 that textbook be? 10 A. There is a whole host of them. 11 Q. Again, none of them come to mind? 12 A. Quite often it's the first book I 13 can grab off the shelf. 14 Q. What books do you have on your 15 shelf? 16 MS. DISILVIO: Go ahead, doctor, 17 enumerate the books you have on your shelf. 18 MS. PERSE: That's fine. 19 A. Williams OB, Robbins Pathology. I 20 have a number of textbooks on urodynamics, a 21 number of anatomy textbooks that I use. 22 Q. And you mentioned journal articles 23 or other materials. Do you subscribe to any 24 peer reviewed journals? 0036 1 A. Yes. 2 Q. And what are those? 3 A. The College of OB/GYN Screen 4 Journal. I also receive the Gray Journal from 5 the American Journal of Obstetrics and 6 Gynecology. I can't even recall the other 7 journals I receive. 8 Q. Is the Green Journal something 9 distinct from the Gray Journal? 10 A. They are two different publications, 11 yes. 12 Q. Do you receive the Green Journal? 13 A. Yes. 14 Q. Do you know the name of that? 15 A. I believe it's just Obstetrics and 16 Gynecology. I'm not even sure. I don't even 17 look at the cover anymore. 18 Q. Do you consider any of these 19 journals to be reasonably reliable on the topics 20 that are relevant to this lawsuit as you 21 understand it? 22 MR. BONEZZI: Objection. 23 MS. DISILVIO: Objection. You may 24 answer. 0037 1 MS. SANDACZ: Objection. 2 Q. Maybe I should clarify. The 3 question would be more pertinent if I qualify 4 with, do you consider any journals to be 5 reasonably reliable on the topics that are 6 relevant to the management of an obstetrical and 7 gynecological patient? 8 MS. DISILVIO: Objection. 9 A. These are articles and journals 10 written by people subject to human 11 fallabilities. I don't think anything is above 12 fail. 13 Q. Will you be relying on any 14 literature supporting your opinions that you may 15 hold in this case? 16 MS. DISILVIO: He, himself? 17 A. Myself directly, no. 18 Q. I just want to make a request on the 19 record that if you come to determine that there 20 is some article or literature that you, 21 yourself, would rely on, that I would be made 22 aware of that literature well in advance of 23 trial so I could redepose you or inquire further 24 as to your position on that article. Would you 0038 1 agree with that? 2 A. Yes. 3 MS. DISILVIO: He doesn't have to 4 agree with anything. The request comes to me. 5 Doctor, you don't have to answer that. 6 I will take your request under 7 advisement and respond appropriately if and when 8 the time should come as to what the rules 9 require. 10 MS. PERSE: Again, in light of Rule, 11 what is it, 803.16 is what I'm specifically 12 referencing. Okay? 13 MS. DISILVIO: I will take your 14 request under advisement and determine -- 15 Q. In 2003, are you aware of any 16 policies or procedures that were in place at 17 MacDonald OB/GYN regarding the intake of 18 management of new patients? 19 A. I'm not even sure what you are 20 asking. 21 Q. Again, when a new patient comes to 22 the practice at MacDonald OB/GYN, were you aware 23 of any policies or procedures as to how that 24 intake would occur? 0039 1 MS. DISILVIO: By him or by another 2 staff member? 3 MS. PERSE: I'm asking in general, 4 was he aware of how that intake would occur. 5 A. I have no direct knowledge of how 6 the front office would verify insurances or 7 coverage or what. 8 Q. Okay. But when a patient would call 9 to make an appointment, would they request a 10 visit with a specific physician? 11 A. I have no idea. 12 Q. In 2003, you cared for Mrs. Berry; 13 is that correct? 14 A. Yes. 15 Q. And what was the name of your group 16 practice at that time? 17 A. I believe we were already MacDonald 18 Community OB/GYN. 19 Q. And that corporation you were an 20 employee of; is that correct? 21 A. Yes. 22 Q. Do you recall how Rhonda became a 23 patient of yours? 24 A. My recollection is from what is in 0040 1 the record, indicating she was a transfer 2 patient. 3 Q. And do you have any independent 4 recollection of Mrs. Berry herself? 5 A. Not over and above the records. 6 Q. And what is your understanding as to 7 why Mrs. Berry came to you? 8 MS. DISILVIO: Objection. Asked and 9 answered. You may answer again. 10 A. She would have come to us indicating 11 that she was transferring care for the reason of 12 insurance. 13 Q. The reason you know that is because 14 of something specific in the records? 15 A. Ultimately when the records did 16 come, they indicated that it was a transfer, but 17 I certainly would have asked why somebody was 18 transferring care late in their pregnancy 19 already. 20 Q. Is that documented anywhere on your 21 initial note with Mrs. Berry? 22 MS. DISILVIO: If you have anything 23 with you, and it would save some time, if you 24 could show him. 0041 1 MS. PERSE: I'm just trying to 2 establish what he recalls based on his review. 3 MS. DISILVIO: You asked him if it's 4 in his notes. If you have it and could give it 5 to him, it would save some time. 6 MS. PERSE: I'm trying to clarify. I 7 don't have it. 8 Q. Again, if it is there and you read 9 the records and that refreshed your 10 recollection, that's what I want to know. 11 MS. DISILVIO: What? Objection. 12 A. What are you asking? 13 Q. You had mentioned that you would 14 have known, or based on your review of the 15 records, your understanding of Mrs. Berry's 16 presentation to you as a new patient was because 17 of a change in insurance. That's what I'm 18 looking for, is what part of the records 19 indicate that to you? 20 A. I'm looking at my note on a progress 21 sheet dated 6-2-03, transfer OB at 22 weeks. 22 Q. Is there a reference in there as to 23 insurance? 24 A. No, I don't have anything written 0042 1 there. 2 Q. Is there anything else in your 3 initial records that would indicate that her 4 transfer was for change of insurance? 5 MS. DISILVIO: I'm going to object 6 for the simple reason Dr. Thompson has already 7 testified that he learned it from Dr. Peskin's 8 records once those records arrived and that he 9 would have inquired of the patient as to what 10 brought her to his practice. 11 MS. PERSE: I apologize. I just 12 don't recall that testimony. 13 MS. DISILVIO: With that objection, 14 you can answer again. 15 A. My custom would have been to ask a 16 woman who is transferring her care late in 17 pregnancy like this, why she would have been 18 transferring; what the circumstances were. 19 There had to be a reason why she came to us. 20 Q. Okay. And why did she come to you? 21 A. Because her insurance coverage would 22 not cover obstetrics at The Cleveland Clinic. 23 Q. So is it fair to say she came to you 24 to complete the management of her pregnancy; is 0043 1 that true? 2 A. To complete the pregnancy, yes. 3 Q. Did you have any direct 4 communication with Dr. Peskin when you assumed 5 Mrs. Berry's care? 6 A. Such as? 7 Q. Did you speak with Dr. Peskin when 8 you first saw Mrs. Berry? 9 A. No, I did not. 10 Q. Is it fair to say that your office 11 chart indicates that your office communicated 12 with Dr. Peskin's office in order to get his 13 medical records up to that point? 14 A. I can't say the sequence of events, 15 whether we communicated with them or she said 16 that the records had already been transferred. 17 Q. How far along was Mrs. Berry? You 18 mentioned 22 weeks? 19 A. Approximately. 20 Q. What stage of the pregnancy is that? 21 A. Mid second trimester. 22 Q. Did you ever see Mrs. Berry after 23 her pregnancy? 24 A. My last meeting with Rhonda Berry 0044 1 was on October 13th, 2003. 2 Q. And how would you characterize that 3 visit? What kind of visit was that? 4 A. It was approximately a six week 5 postpartum visit. 6 Q. And what is typically done in a six 7 week postpartum visit? What would your routine 8 be? 9 A. I have a fairly regular pattern of 10 questions I go through first as part of what the 11 interval history has been since delivery. 12 Q. So you take a history on the 13 patient? 14 A. Yes. 15 Q. And that history, just looking for 16 your routine, what would that history include? 17 A. Questions regarding pain, fever, 18 bleeding, any breast complaints, any postpartum 19 depression and what kind of help she is getting 20 at home. And also ask how the baby is doing, 21 any issues regarding the pediatricians. 22 Q. Would you ask if the patient is 23 nursing? 24 A. Yes. 0045 1 Q. Was Mrs. Berry nursing? 2 A. No, she was not. 3 Q. Moving on from the history, what 4 things would you do following a history? 5 A. Well, this would have to be adjusted 6 depending on individual circumstances, but 7 typically it would involve vital signs. I would 8 usually do a neck exam, abdomen and extremities 9 check. Depending on other issues, I would 10 usually do a brief pubic exam at that time. 11 Q. Would you do a PAP smear at that 12 time? 13 A. No, I would not. 14 Q. Mrs. Berry had a C-section. Would 15 that modify your evaluation on the typical 16 postpartum C-section patient? 17 A. Well, during the abdominal exam to 18 include any evidence of abnormal healing with 19 the surgical scar. 20 Q. And following that, would you do any 21 other testing? 22 A. That would depend on circumstances. 23 Q. In a routine -- and I know that's 24 broad -- but in a routine C-section patient that 0046 1 comes in for a postpartum check at six weeks, 2 are there any routine laboratories that you 3 order? 4 MS. DISILVIO: Objection. You can 5 answer. 6 A. As I said, it would depend on the 7 patient's circumstances. If there were no other 8 complaints or pertinent findings, I would not do 9 any other labs at that time. 10 Q. What would your recommendation be 11 for the patient in terms of follow-up? 12 MS. DISILVIO: Same objection. You 13 may answer 14 Q. Again, a routine, normal delivery, 15 no complications. 16 A. Again, if there were no other 17 pertinent findings or anything, we would discuss 18 further activity, diet; contraception would 19 usually be brought up at this time. 20 Q. And then when would you ask the 21 patient to return for an evaluation? 22 MS. DISILVIO: Same objection. You 23 can answer. 24 A. If this was a patient I was going to 0047 1 continue caring for, she would be told to return 2 for annual exams. 3 Q. Can we agree from your review of the 4 records -- or let's start with an independent 5 recollection. 6 Do you recall Mrs. Berry failing to 7 come in and see you at scheduled appointments?? 8 MS. DISILVIO: During prenatal care 9 with Dr. Thompson? 10 MS. PERSE: During his care. 11 MS. DISILVIO: Did she ever fail to 12 present? 13 MS. PERSE: Does he recall Mrs. 14 Berry -- 15 A. My recollection is that we saw her 16 frequently. I think the records bear out that 17 we saw her frequently during the portion of 18 prenatal care we were taking care of her for. 19 Q. Do you have any reason to believe 20 that she was not compliant with the return 21 visits? 22 MS. DISILVIO: During the prenatal 23 care? 24 MS. PERSE: During the duration of 0048 1 his care with Mrs. Berry. 2 A. I have no reason to believe that. 3 Q. Did you deliver Mrs. Berry's child? 4 A. No, I did not. 5 Q. And who did? 6 A. My partner, Dr. Sage. 7 Q. Did Dr. Sage see Mrs. Berry during 8 the prenatal course? 9 MR. BONEZZI: Look at July 21st. 10 A. Yes. July 21st. 11 Q. But otherwise, would you agree that 12 you were her primary health care provider during 13 her pregnancy and the postpartum period? 14 MS. DISILVIO: Objection. You can 15 answer to your role as an 16 obstetrician/gynecologist during the pregnancy. 17 A. I was the obstetrician in the group 18 that she saw the majority of the time, yes. 19 Q. And Mrs. Berry returned to see you 20 following her delivery; is that correct? 21 A. Yes. 22 Q. Now, after her prenatal course and 23 her postpartum course -- and I apologize if I 24 may have asked you this -- but did you have an 0049 1 occasion to see Mrs. Berry any time after that? 2 MS. DISILVIO: After October 13th? 3 A. I believe that was my last encounter 4 with the patient. 5 Q. Now, after October 13th, 2003, how 6 much longer did you remain with MacDonald 7 OB/GYN? 8 A. I believe I left in April of 2004. 9 Q. And that's when you relocated to 10 Akron? 11 A. Yes. 12 Q. Other than with your attorney, have 13 you reviewed with anyone the circumstances of 14 Mrs. Berry's care? 15 A. No. 16 Q. Any other office staff? 17 A. No. 18 Q. Any other physicians? 19 A. No. 20 Q. This is just in general terms. Is 21 it true that an obstetrician/gynecologist can 22 act as a woman's primary health care provider? 23 A. In certain situations and by some 24 entities they are considered primary care 0050 1 practitioners, yes. 2 Q. Would you agree or disagree with 3 whether or not you were Mrs. Berry's primary 4 health care provider during her prenatal and 5 postpartum course? 6 MS. DISILVIO: Was he her primary 7 OB? 8 MS. PERSE: My question is very 9 specific. 10 A. Ask me again. 11 Q. Would you agree that during your 12 care of Mrs. Berry you were acting as her 13 primary health care provider; yes or no? 14 A. No. 15 Q. And can you tell me why? 16 A. I was her primary obstetric care 17 provider, but myself and my partners coordinated 18 her obstetric care. But I wouldn't have taken 19 care of things out of the purview of obstetrics 20 and gynecology. 21 Q. As an obstetrician/gynecologist, in 22 that role, can we agree that it's important to 23 screen that patient, an obstetrical patient or 24 postpartum patient, and maintain preventative 0051 1 health care during that time period? 2 MS. DISILVIO: Objection. 3 MS. SANDACZ: Objection. 4 MS. DISILVIO: He managed her for 5 pregnancy. There was no preventative care. 6 With that objection, you may answer, Dr. 7 Thompson. 8 A. When you talk about screening and 9 preventative care, you are talking about an 10 incredibly broad topic. 11 I had nothing to do with the 12 screening for heart disease or anything like 13 that. 14 Q. I recognize that. But for women's 15 health issues, specifically with regard to 16 women's health issues, would you agree as her 17 obstetricion/gynecologist it's your duty to 18 maintain preventive health? 19 MS. DISILVIO: Is she going to 20 continue to be his patient; is she seeing him 21 for just a period of time? Let's be fair to the 22 facts of this case. With those parameters, 23 doctor, you can answer. 24 MS. PERSE: That's not my question. 0052 1 MS. DISILVIO: Have him answer 2 truthfully. She was there for her pregnancy. 3 Everyone in this room knows that and he has told 4 you that twice now. You are trying to broaden 5 his role as a preventative care provider and he 6 wasn't. 7 Q. Again, I'm not speaking -- maybe 8 this will help. I'm not speaking specifically 9 of Mrs. Berry. I'm saying as an 10 obstetrician/gynecologist in dealing with a 11 pregnant patient, can we agree that it is your 12 duty as a primary -- I don't want to rehash 13 it -- as that care provider, you have a role in 14 terms of managing preventative health? 15 MS. DISILVIO: I'm going to object 16 again and let me tell you why. There are 17 pregnancies he follows all the way through, 18 pregnancies that start at 22 weeks. There are 19 pregnancies that he has followed before and 20 after the pregnancy. With those variables, now 21 you may answer. 22 Q. Again, you are answering my 23 question, not with her caveats. 24 MS. DISILVIO: If you can't answer, 0053 1 tell her to rephrase it. 2 THE WITNESS: Read it back, please. 3 MS. GORDON: QUESTION: I'm saying 4 as an obstetrician/gynecologist in dealing with 5 a pregnant patient, can we agree that it is your 6 duty as a primary -- I don't want to rehash it 7 -- as that care provider, you have a role in 8 terms of managing preventative health? 9 MS. DISILVIO: Objection to form. 10 MS. SANDACZ: Same objection. 11 MR. BONEZZI: Objection. 12 A. Amongst others, I would have a role. 13 I would also be one of the people that she would 14 address specific complaints to and hope that I 15 could either manage these myself or obtain the 16 appropriate outside consultations that she would 17 need. 18 Q. Let's take, for example, smoking 19 cessation. That's an instruction that a 20 physician would give a patient in terms of 21 preventative health; is that true? 22 MS. DISILVIO: If the patient is a 23 smoker. You can answer. 24 A. If the patient is a smoker, yes, I 0054 1 would talk to her in respect to pregnancy. 2 Q. That's what I'm getting at. In terms 3 of issues at hand in a pregnant patient, you 4 have a role in terms of managing and instructing 5 the patient in terms of preventative health; is 6 that true? 7 MS. DISILVIO: Objection. Assuming 8 the patient has complaints. You may answer, 9 doctor. 10 A. Among other people I would be one of 11 the people that might be addressing some of 12 these issues, yes. 13 Q. And in general, again -- not 14 speaking of Mrs. Berry -- as an 15 obstetrician/gynecologist, even dealing with a 16 pregnant patient during her pregnancy and in the 17 early postpartum period, it would not be unusual 18 for a patient to address a breast complaint with 19 her obstetrician/gynecologist; is that a fair 20 statement? 21 A. Correct. 22 Q. Can we agree that all women should 23 have a clinical breast exam annually as part of 24 their physical exam? Is that true? 0055 1 MS. SANDACZ: Objection. 2 A. There are a number of different 3 recommendations out there, none of which are 4 considered definitive, but most of us do do 5 breast exams on a regular basis, yes. 6 Q. And a regular basis is annual? Is 7 that a fair recommendation or characterization 8 of that? 9 A. I would say approximately annually. 10 Q. I'm going to ask that we turn 11 specifically to your records and I'm going to 12 ask that we review the records just so I can 13 understand the entries. 14 You had referred me to your initial 15 handwritten note on 6-22-2003. I'm sorry, 16 that's 6-2-2003. 17 A. Correct. 18 Q. Is that your first and only entry 19 for her -- let's put it this way. Is that your 20 only entry for her; a June 2, 2003 visit? 21 A. No. 22 Q. Looking at the progress notes, can 23 you read to me your entry on that progress note 24 sheet? 0056 1 A. Yes. Dated 6-2-03. Transfer OB at 2 22 weeks. No complaints. All labs done and 3 within normal limit - ultrasound done multiple 4 times. Return to office four weeks. PN2 stands 5 for prenatal 2 labs and recheck ultrasound. And 6 then to the right I have indicated that this was 7 an in vitro fertilization pregnancy, 8 multi-fibroid uterus, 14 centimeter fundal in 9 parenthesis. 10 Q. Prenatal 2 labs, what does that 11 mean? 12 A. Prenatal 2 labs we did at the time 13 involved rechecking a CBC, complete blood count, 14 and doing the 50 gram glucola gestational 15 diabetes screen. 16 Q. At what point of the pregnancy are 17 prenatal 2 labs performed? 18 A. Usually approximately 26 weeks. 19 Q. So during the second trimester they 20 get prenatal 2 labs? 21 A. At the end of the second trimester, 22 yes. 23 Q. And then would prenatal 1 labs be 24 done on obstetrical patient? 0057 1 A. That was usually considered the labs 2 done at the initial initiation of obstetric 3 care. 4 Q. So at the OB1 visit they would get 5 the prenatal labs 1; is that true? 6 A. Maybe not necessarily that visit, 7 but one of the earliest visits, yes. 8 Q. Since you hadn't seen Mrs. Berry for 9 that initial OB visit, you would not have done 10 prenatal one labs; is that a fair statement? 11 A. Correct. 12 Q. Are there any other entries from you 13 on this page that you are reading from? 14 A. Yes. 15 Q. And what are those entries? 16 A. July 2nd, 2003. 17 Q. And could you read your entry for 18 me? 19 A. No complaint of now. Fetus active. 20 Return to office three weeks. Prenatal 2's 21 then. And then the mention that the June 13th 22 ultrasound was reviewed with her. Grossly 23 normal anatomy and growth. 24 Q. And we are going to mark this as an 0058 1 exhibit. So can you identify this form further 2 for me? 3 I see some writing on the right-hand 4 lower corner vertically that states it's an ACOG 5 antepartum record form F. Is that a routine 6 sheet that you would record progress notes on 7 for your obstetrical patients? 8 A. Yes. 9 Q. Okay. There is a note from June 22, 10 2003. Do you know who that note is by? 11 A. I don't believe it's June 22nd. I 12 believe it's June 24th. 13 Q. Thank you. Do you know who wrote 14 that note? 15 A. That would be Dr. Melton. 16 Q. And do you know what the purpose of 17 that note was? 18 A. Just what she is describing under 19 the subjective findings. 20 Q. And could you explain that to me? 21 A. Under subjective, patient was 22 complaining of no fetal movement times two days, 23 no contractions, no bleeding, no PIH symptoms. 24 Q. And then there is a similar note at 0059 1 7-17-2003. Is that also Dr. Melton? 2 A. Yes. 3 - - - - - 4 (Thereupon, THOMPSON Deposition 5 Exhibit 2 was marked for 6 purposes of identification.) 7 - - - - - 8 Q. And with regards to your June 2nd, 9 2003, entry, you refer to the fact that -- did 10 you make some other entries in your chart on 11 that June 2nd date? 12 A. Yes. 13 Q. Where are those entries? 14 A. ACOG antepartum record form C. 15 Q. And how about if you further 16 describe it to me. I think I'm looking at what 17 you are looking at. I'll hand it to you just to 18 confirm. 19 A. Yes, that's the same one. 20 Q. Okay. And for the record, it's got 21 in the upper left-hand corner, there is a Berry, 22 Rhonda's name recorded and then there is some 23 entries for drug allergy, religious 24 consideration in the top left-hand corner. I 0060 1 may have misspoke. I don't know if I said right 2 or left before. We are looking at the same 3 sheet? 4 A. Yes. 5 Q. You mentioned that it's form C. 6 Review for me where, what your 7 entries are on this sheet for June 2nd, 2003. 8 A. Running down at the beginning of the 9 flowsheet there, off to the left there was a 10 hole punch, so the June 2nd was scrolled in that 11 little box there. 12 Mentioning 22 weeks, fundal height 13 of 27 centimeters. Fetal heart rate was 148. 14 Fetal movement was positive for the patient. 15 Cervix exam -- no complaint -- so it was not 16 done. Blood pressure 124 over 80. Weight was 17 192. Urine was negative for glucose and 18 albumin. Next appointment in four weeks. And 19 then I signed my initials. 20 Q. Anything else on this record for 21 that date of June 2nd, 2003 that you entered? 22 A. Some of the issues under problem and 23 plan at the top I probably would have filled the 24 first couple of items in there. 0061 1 Q. And those items would be? 2 A. IVF, transfer 22 weeks, 3 multi-fibroids, largest 14 centimeter fundal. 4 Q. And jumping to the upper right-hand 5 side of the problems and plans box, if you will, 6 there is a notation, has received steroids. Was 7 that entered at the time of your initial visit 8 or was that a later visit, if you know? 9 A. These lists are amended as the care 10 is continuing, so there probably would have been 11 a later entry. 12 MS. DISILVIO: Is this an okay time 13 for a break? 14 MS. PERSE: Sure. 15 (Recess had.) 16 - - - - - 17 (Thereupon, THOMPSON Deposition 18 Exhibit 3 was marked for 19 purposes of identification.) 20 - - - - - 21 Q. During the break I took the liberty 22 of marking what we were referring to earlier on 23 the record as the ACOG antepartum record form C 24 as Plaintiff's Exhibit 3 so that we will be able 0062 1 to speak the same language. 2 This ACOG antepartum record appears 3 to me to have multiple parts. Is it one long 4 sheet or are there several pages to this record? 5 A. There are individual pages. 6 Q. With your initial visit, are there 7 any other sheets that you would complete? 8 A. Specifically for this patient or for 9 any patient? 10 Q. Great question. On an initial OB 11 visit, during the first trimester, would you be 12 completing any additional sheets? 13 A. If this was an initial OB visit, 14 whether first trimester or whenever, the record 15 would have been filled out. 16 Q. So if the patient had not been seen 17 by another prenatal care provider, you would be 18 completing other sheets; is that fair? 19 A. We would at least be starting to 20 fill out the record at that point, yes. 21 Q. And do you have those sheets in your 22 record? 23 A. The ones from our office are forms 24 A, B, C and D. 0063 1 Q. Okay. So the initial visit is a 2 four part sheet. The initiation of a patient, 3 OB patient's care with you would entail 4 completion of a four page record? 5 MS. DISILVIO: She indicated for 6 those four pages to be completed. With that 7 objection, you can answer. 8 Q. Just again, to clarify, I'm not 9 speaking with reference to Mrs. Berry, 10 specifically. I'm just trying to organize the 11 record as you would keep it in a general initial 12 OB patient that you would assess. 13 MS. DISILVIO: A patient presenting 14 for the first prenatal care visit for a 15 pregnancy. You may answer. 16 A. This is a record of her prenatal 17 care with that practitioner, so the form may not 18 be completed, but it would be started to be 19 filled out at that point, yes. 20 Q. And so you have a form A of the ACOG 21 antepartum record for Mrs. Berry? 22 A. Yes. 23 Q. Generated from your office; is that 24 fair? 0064 1 A. Yes. 2 Q. And I'm looking at a sheet here that 3 I'm going to hand to you to just make sure we 4 are speaking of the same sheet. 5 A. That's correct. 6 Q. Okay. And this is the ACOG 7 antepartum record form A and in the upper 8 left-hand corner, Berry, Rhonda is listed to 9 identify whose patient's record that is. Is 10 that an accurate characterization of the sheet? 11 A. Yes. 12 Q. And are there any entries on this 13 sheet from your office? 14 A. Some of the basic demographics at 15 the top would have been filled out by somebody. 16 Q. Okay. Is it fair to say that 17 Mrs. Berry, because she came to you later in her 18 pregnancy and had received prenatal care 19 elsewhere, you would refer to the doctor that 20 did the initial OB visit? For the information, 21 you would look to his sheet for the information 22 that's absent on this sheet? 23 MR. BONEZZI: Objection. 24 A. We would obtain those records and 0065 1 typically these forms would not be refilled out 2 if they had already been started by somebody 3 else, yes. 4 Q. Thank you for your assistance there. 5 I was trying to figure out and perhaps you just 6 clarified for me why. 7 This sheet has no information under 8 menstrual history, past pregnancy and past 9 medical history. Do you know why that is? 10 MS. DISILVIO: Objection. Asked and 11 answered. 12 A. As she would have indicated, she was 13 making sure the records were transferred or our 14 office was obtaining these records. We would 15 have waited to see what information came before 16 we filled them out again. 17 Q. Okay. And is it important for a 18 patient's initial obstetrical evaluation to 19 complete this sheet? 20 MS. SANDACZ: Objection. 21 A. Even at an initial visit, by 22 whichever practitioner, it's not maybe necessary 23 to have these filled out at that moment. 24 Q. But that's important information for 0066 1 a patient's obstetrical care; is that a fair 2 statement? 3 MS. SANDACZ: Objection. 4 MS. DISILVIO: Objection. 5 A. I believe a history is important 6 information. Whether it's filled out at that 7 moment or not, it's available. 8 Q. But this information in general, 9 whether it's filled out at that moment or not, 10 is important to the patient's care, is that a 11 fair statement? 12 MS. SANDACZ: Objection. 13 MS. DISILVIO: The only reason I'm 14 objecting, which information? With that 15 objection, if you know what the question is, you 16 may answer. 17 Q. Again, going along with the trend or 18 the line of questioning specific to this page, 19 this form A of the ACOG antepartum record. 20 A. This antepartum record is just 21 trying to put down in writing what would 22 normally be a typical medical history from any 23 patient. 24 Q. And it's important to have this 0067 1 information in dealing with an obstetrical 2 patient; is that true? 3 A. Yes. 4 Q. Are there any entries from you on 5 this sheet? 6 A. No, there is not. 7 MS. PERSE: And I guess just to be 8 complete, so we look back at the record, we will 9 mark this also as Plaintiff's Exhibit 4. 10 - - - - - 11 (Thereupon, THOMPSON Deposition 12 Exhibit 4 was marked for 13 purposes of identification.) 14 - - - - - 15 Q. At the time of your visit with that 16 initial OB visit with Mrs. Berry, do you have -- 17 strike that. 18 We spoke earlier about your initial 19 visit with Mrs. Berry and you had mentioned that 20 you were aware that she came to you from 21 Dr. Peskin's office. 22 Do you recall seeing the ACOG 23 antepartum record form A from Dr. Peskin at the 24 time of your initial assessment? 0068 1 A. I don't recall for sure, but, 2 typically, it would not be uncommon to not have 3 those records at that appointment. 4 Q. And is there anything in your record 5 that would indicate that you reviewed 6 Dr. Peskin's records at the time of your initial 7 assessment? 8 A. No. 9 Q. Is there a second page in your 10 records of the ACOG antepartum record, form B, 11 if you will? 12 A. Yes. 13 Q. And are there any entries on your 14 record for the ACOG antepartum record form B? 15 A. No. 16 Q. And why is that? 17 A. Again, if care has already been 18 initiated somewhere else, we would wait for a 19 copy of the records to put in the chart in lieu 20 of recopying all this information. 21 Q. And did you note anywhere in 22 Mrs. Berry's record to indicate that you were 23 awaiting the records from Dr. Peskin's office at 24 the time of your initial OB assessment? 0069 1 A. I believe you already asked me that 2 and the answer was no. 3 Q. And I was referring specifically to 4 form B and I may have not made that clear. You 5 are right, I did ask you that. 6 With regards to form B, is there any 7 notation that you saw Dr. Peskin's form B at the 8 time of your initial assessment? 9 A. No. 10 MS. PERSE: And we will mark this as 11 an exhibit, Dr. Thompson's office ACOG 12 antepartum form B. 13 - - - - - 14 (Thereupon, THOMPSON Deposition 15 Exhibit 5 was marked for 16 purposes of identification.) 17 - - - - - 18 Q. Are there any other entries in your 19 office record for Mrs. Berry's June 2nd, 2003 20 visit? 21 A. I believe that's all that we have. 22 Q. And can you tell me where your 23 physical exam would be for your initial 24 evaluation of Mrs. Berry on June 2nd, 2003? 0070 1 MS. DISILVIO: Other than what he 2 has already read to you? 3 A. My first contact with the patient on 4 June 2nd, 2003 was indicated on form C. 5 Q. Okay. And so the extent of your 6 physical exam would be on form C? 7 MS. DISILVIO: That he documented or 8 that he did? 9 MS. PERSE: That he documented. 10 A. Yes. 11 Q. And is there any additional physical 12 examination that you would have performed on 13 Mrs. Berry that was not documented? 14 A. Without any other complaints, no. 15 Q. So what portions of the physical 16 exam did you do on June 2nd, 2003, just to 17 clarify? 18 MS. DISILVIO: Objection. Asked and 19 answered. You may answer again. 20 A. The physical exam portion would 21 include her blood pressure, fundal height, 22 auscultation and fetal heart tones and a 23 urinalysis and weight. 24 Q. When was your next visit with Mrs. 0071 1 Berry to the practice of MacDonald Community 2 OB/GYN? 3 A. Are you referring specifically to 4 me? 5 Q. Yes, Dr. Thompson. 6 A. I believe my next contact with her 7 was July 2nd, 2003. 8 Q. And could you direct me to the 9 sheet? Did you make an entry at that time? 10 A. Yes. 11 Q. And what sheet identifies that 12 entry? 13 A. This is documented on the flowsheet 14 on form C and also a narrative in form F. 15 Q. And so it would be Plaintiff's 16 Exhibit 3, the entry for July 2nd. That was 17 your evaluation; is that correct? 18 A. Yes. 19 Q. And can you tell me your findings at 20 that time? 21 A. July 2nd, 24 weeks and five days. 22 Fundal height 29 centimeters. Fetal heart rate 23 was in the 160s. Active fetal movements. She 24 had no complaints, so no cervical exam was done. 0072 1 Blood pressure was 130 over 80. Edema of the 2 feet only. Weight was 206 pounds. Urine 3 negative for glucose and protein. Make note of 4 her next appointment in three weeks. Signed my 5 initials. 6 And on form F, July 2nd, 2003, no 7 complaint now. Fetus active. Return to office 8 in three weeks. Prenatal 2's then. And then I 9 mentioned that I reviewed the June 13th 10 ultrasound with her showing gross normal anatomy 11 and growth. 12 Q. That was very redundant. That's off 13 Plaintiff's Exhibit 2; is that correct? 14 A. I'm not sure which number exhibit it 15 was. 16 Q. I guess for the record, that's been 17 previously marked as Plaintiff's Exhibit 2, that 18 entry. And we already discussed that but thank 19 you very much for your patience there. 20 And when would your next visit, your 21 next personal visit with Mrs. Berry be? 22 A. I have to be careful of these 23 chronologies for a second here. My next 24 encounter with her was on July 30th. 0073 1 Q. And can you direct me to the page 2 that you are looking at? 3 A. Again, the flowsheet on form C and 4 continuation of the narrative on form F. 5 Q. And I think we are on the right 6 page. I'm going to hand you this just to make 7 sure we are looking at the same page here. 8 A. Correct. 9 MS. PERSE: Okay. And what you just 10 handed me again is ACOG antepartum record form F 11 and it has a comma, continued, I guess to 12 distinguish it from the previous format. And we 13 will mark this as the next Plaintiff's Exhibit, 14 - - - - - 15 (Thereupon, THOMPSON Deposition 16 Exhibit 6 was marked for 17 purposes of identification.) 18 - - - - - 19 Q. Can you read for me your entry? 20 A. On which sheet? 21 Q. Form F, marked continued. I'm 22 sorry, on form F. 23 A. July 30, 2003. Released from 24 hospital on Aldomet, 250 milligrams TID. Today 0074 1 no PIH complaint of, and then I have in 2 parentheses vision changes, headache, et cetera. 3 Recheck blood pressure. 135 over 84. Protein 4 negative. Fetus active per patient - recheck 5 ultrasound at UH for biophysical profile this 6 week. CBC today with prenatal 2's and return to 7 office in one week. Start Q weekly NST's. 8 Q. The next line indicates no 9 complaints, beginning with no complaints. Is 10 that the entry for August 8th? 11 A. That's a different date, yes. 12 Q. Now, at the time of that July 30th 13 visit, you mentioned there was another entry in 14 your record for Mrs. Berry by you? 15 A. Yes, this was still in the 16 flowsheet, form C. 17 Q. And that's referring to Plaintiff's 18 Exhibit 3 for the record. 19 And if you could read for me your 20 entries for that date. 21 A. July 30th. 28 and I believe that's 22 a five for 5/7. 23 Fundal height 30 centimeters. Fetal 24 heart rate 150. Active movement palpated by 0075 1 myself. Initial blood pressure was -- I can't 2 read this -- 150 something over 100. Recheck by 3 myself was 135 over 84. No edema. Her weight 4 is 208 pounds. No protein, no glucose in the 5 urine. Next appointment one week. And my 6 initials. 7 Q. Okay. Can you explain to me the 8 extent of your physical exam on that date, if 9 one was done? 10 A. Obstetric portions of an exam. 11 Weight, vital signs, abdomen check, feeling for 12 movements, auscultation of fetal heart tones and 13 urinalysis. 14 Q. And your next visit with Mrs. Berry 15 was when? 16 A. This looks like August 8th. 17 Q. And you are referring to your 18 antepartum record form C? 19 A. Form C and form F. 20 Q. Okay. How about if we look at form 21 C, Plaintiff's Exhibit 3, and just read for me 22 your entries. 23 A. August 8th. 29 plus weeks 24 gestation. Fundal height 31 centimeters. I 0076 1 can't read the heart rate on this. 2 Q. Does NST help you? 3 A. I mean, it might be, but I'm not 4 sure exactly. That's what I'm saying. 5 Q. I understand that. 6 A. Fetal movements, active movements. 7 Initial blood pressure is 154 over 100; recheck 8 myself 142 over 93. No edema. Weight 211 9 pounds. Urine is negative for glucose but one 10 plus protein. Next appointment in one week and 11 I signed my initials again. 12 Q. And your other entry for that date 13 on form F? 14 A. Correct. 15 Q. Can you read that for me? 16 A. August 8th, 2003. No complaints. 17 Feels well. Fetus active. Biophysical profile 18 on August 6th was 6 out of 8. Parenthesis, some 19 breathing but not sustained. NST today shows 20 good baseline, positive variability, no 21 decelerations. Okay for 29 and a half weeks. 22 Continue bed rest, kick counts, blood pressure 23 and urine checks. Return to office one week 24 with NST and labs, plan ultrasound and BPP in 0077 1 one to two weeks. 2 Q. And just to clarify, the 3 parenthetical after the BPP on 8-6, six over 4 eight, that's referring to the BPP? 5 A. Correct. 6 Q. Does that have something to do with 7 the baby or is that part of Mrs. Berry's 8 physical exam? 9 A. It was part of what was being done 10 to evaluate the status of the fetus. 11 Q. And what is that terminology? 12 A. Biophysical profile. 13 Q. Other than assessing fundal height, 14 height and weight, any other physical exam 15 findings that you noted? 16 MS. DISILVIO: Other than what he 17 already told you? 18 A. No. 19 Q. Did you do any other examination at 20 that time that's not recorded? 21 A. No. 22 Q. Let's move on to our next office 23 visit entry. Your next entry for the next 24 office visit for Mrs. Berry? 0078 1 A. August 13th. 2 Q. You saw Mrs. Berry on August 13th, 3 2003. Where are your entries? 4 A. Again, the flowsheet on form C and 5 form F. 6 Q. Okay. Any other entries for that 7 day? 8 A. The transcribed note I have also 9 from that date. 10 Q. And let me hand that to you, what I 11 think is the same thing we are talking about. 12 A. Correct. 13 Q. Okay. And what I just handed you 14 was a dictated or transcribed note from 15 MacDonald Community OB/GYN and there is a title 16 in the center indicating office note and then 17 the upper left-hand corner would be name of the 18 patient, Berry, Rhonda, M. And at the bottom of 19 it there is a notation indicating August 13th, 20 2003. Does that fairly characterize this entry? 21 A. Yes. 22 Q. And in the bottom right-hand corner, 23 there is some pen markings. Is that your 24 signature or initial? 0079 1 A. Those are my initials. 2 Q. Can you review for me the portion of 3 that dictated note that would include your 4 examination? 5 A. Well, these three elements would 6 have all gone together. 7 Q. On that note, though, if you could 8 direct me to what would include your physical 9 exam findings. 10 A. Her blood pressures though are a 11 little more elevated today. Diastolic 12 persisting mid to the high 90's. Still one plus 13 protein in the urine. 14 This is being read here as the 15 anesthesia. These notes were being transcribed 16 in India. English is rather poor quality. 17 This is supposed to be referenced I 18 believe to the NST. Rather shows a lack of 19 variability of a prolonged strip. No -- instead 20 of excels it should be accels, acceleration. 21 Q. Those would be more characterized as 22 testing results; is that a fair statement? 23 MS. DISILVIO: Objection. You asked 24 him to tell you his physical. That's part of 0080 1 his physical. 2 MS. PERSE: I'm not sure. Is it part 3 of his physical? 4 MS. DISILVIO: He was answering your 5 question. 6 A. That is part of my exam for the day, 7 yes. 8 MS. PERSE: We will mark this as 9 Exhibit 7. 10 - - - - - 11 (Thereupon, THOMPSON Deposition 12 Exhibit 7 was marked for 13 purposes of identification.) 14 - - - - - 15 Q. Going to the other entries for that 16 date. Let's go to form C. Can you read your 17 entry for the August 13th date? 18 A. August 13th. 30 and 2 weeks of 19 gestation. Initial blood pressure was 160 over 20 90. Recheck by myself 157 over 98. No edema. 21 Weight 212 pounds. Urine negative for glucose. 22 One plus protein. Next appointment one week, 23 JT. 24 Q. And you mentioned there is another 0081 1 entry for that day of August 13th, 2003. Is 2 that on Plaintiff's Exhibit 6? I'm sorry. Form 3 F, continued of the ACOG antepartum record. 4 A. Yes. 5 Q. Okay. And that's also known as 6 Plaintiff's Exhibit 6 having been previously 7 marked. Can you read for me your entry? 8 A. 8-13-03. Patient states fetal 9 movements positive. Denies PIH complaints. 10 Blood pressure is 150 to 158 over 94 to 98. One 11 plus protein. NST extended. No accelerations, 12 multiple small variable decelerations. To labor 13 and delivery for monitoring BPP and labs. 14 Q. And is that your signature in the 15 lower right? 16 A. Yes. 17 Q. Can we agree that those three 18 entries include the extent of your evaluation of 19 Mrs. Berry in the office on August 13th, 2003? 20 A. I believe it is, yes. 21 Q. Did you do any additional 22 examination that is not recorded? 23 A. I do not believe so. 24 Q. And why is that? 0082 1 MS. DISILVIO: Why is what? 2 MS. PERSE: Why is there no other 3 physical exam? 4 MS. DISILVIO: Beside the part -- 5 MS. PERSE: Don't read in the record. 6 He already read in the record. 7 Q. You just said there is no other 8 physical exam. Did that complete your 9 assessment for the day? Was that an adequate 10 assessment for that day? 11 A. That was the -- 12 MS. DISILVIO: Objection to form and 13 otherwise. You may answer. 14 A. As part of her antepartum care for 15 the day, that was going to be the extent of the 16 office assessment, but she was being sent to 17 labor and delivery for further assessment. 18 Q. Did you assess her that day in labor 19 and delivery? 20 A. No. 21 Q. Is her assessment for that day in 22 your part of your office record? It may be, I'm 23 not sure. 24 A. No, that wouldn't be here. This was 0083 1 an office chart. 2 Q. Now, just to be clear here, I'm 3 going to hand you a sheet just because I'm 4 trying to move chronologically and I'm not sure 5 we are. But I have a sheet from University 6 Hospitals Health System, University Primary 7 Care, Primary and Specialty Care Practices, 8 MacDonald OB/GYN with a notation in the upper 9 right-hand corner, Rhonda Berry, birth date 10 11-27-68 for July 22nd, 2003. 11 I'm just going to hand it to you and 12 see -- this is not referral to the August 13th 13 date, but I just want to see if that's part of 14 your record? 15 A. We had that in the record here. 16 Q. And have you seen that record 17 before? 18 A. Yes. 19 Q. And did you see that record at the 20 time that you cared for Mrs. Berry, if you 21 recall. 22 A. I don't recall at the moment, no. 23 Q. Okay. And so upon your review of 24 the record you saw that as part of your records; 0084 1 is that a fair statement? 2 A. Yes. 3 Q. At the bottom of that entry, there 4 is an entry from August 3rd. I'm reading upside 5 down and from memory. Is it August 3rd? 6 A. September 3rd. 7 Q. September 3rd. That's probably why 8 I thought I was looking at August 3rd and we 9 were beyond that already with our August 13th. 10 How about if you read that entry for me. 11 A. September 3rd, 2003. 33 and 4/7 12 weeks. Blood pressure is elevated. No 13 headache, vision change, nausea, vomiting. 14 Fetus active. Two plus protein. And in 15 parentheses I have new. BPP yesterday was 8 out 16 of 8. Platelets 66,000. Uric acid 7.5. To 17 labor and delivery. For delivery, Dr. W. 18 called. 19 Q. And so that entry, your findings the 20 day of that office visit, is that what 21 prompted -- is it fair to say that prompted you 22 to deliver Mrs. Berry or recommend delivery? 23 A. I was extremely concerned about 24 these findings and that's why I sent her down to 0085 1 the hospital. And at that point in time a 2 further evaluation and I thought it was looking 3 like delivery was going to be indicated but that 4 would depend on what her evaluation was at the 5 hospital. 6 Q. Did you evaluate her at the hospital 7 that day? 8 A. No. 9 - - - - - 10 (Thereupon, THOMPSON Deposition 11 Exhibit 8 was marked for 12 purposes of identification.) 13 - - - - - 14 Q. Now, trying to be chronologic, which 15 I messed that up by throwing that note at you. 16 The next note that you have a notation in your 17 record for your visits of Mrs. Berry would be? 18 A. Where were we before? 19 Q. We were on August 13th, 20 A. The next one I have is August 20th. 21 Q. And what sheet is that on? 22 A. Again, on form C with a narrative on 23 form E. 24 Q. Okay. So how about if we go to form 0086 1 C, also known as Plaintiff's Exhibit 3. Can you 2 read your entries for me? 3 A. Let me make sure I don't have 4 anything else. 5 August 20th. 31 and a quarter. 6 Fundal height of 33 centimeters. Fetal heart 7 rate 140. Active fetus. No complaints. 8 Initial blood pressure 200 over 110; rechecking 9 138 over 90. No edema. 211 pounds. Protein is 10 negative for glucose. One plus protein. Next 11 appointment one week and my initials. 12 Q. And then you indicated that there 13 was an additional sheet. Would that be ACOG 14 antepartum record form E? 15 A. Yes. 16 Q. And that's entitled supplemental 17 visits. The heading in the middle would be 18 supplemental visits? 19 A. Yes. 20 Q. I'm going to hand this to you and 21 then I'll have you read it to the record if that 22 corresponds. 23 A. Okay. August 20th, 2003. No 24 complaints. Fetus active. Was sent to UH last 0087 1 week. Several biophysical profiles; all eight 2 out of eight. Labs rechecked but not available 3 due to computers down. Rechecked blood 4 pressure. Now 138 over 90. One plus protein 5 unchanged. NST today. Positive variability, no 6 decelerations. Multiple movements were 7 palpated. So we'll have maternal fetal medicine 8 consult arranged for this week. 9 MS. PERSE: And we will mark this as 10 Plaintiff's Exhibit 9. 11 - - - - - 12 (Thereupon, THOMPSON Deposition 13 Exhibit 9 was marked for 14 purposes of identification.) 15 - - - - - 16 Q. Is it fair to say that the two 17 entries that we just reviewed on form C and this 18 form F include the extent of your physical 19 findings or your physical exam for Mrs. Berry on 20 that visit? 21 A. No. It was form C and form E. 22 Q. I'm sorry. I don't know what I 23 called it. Form E would be Plaintiff's Exhibit 24 9. Okay. Is that a fair statement otherwise? 0088 1 A. Yes. 2 Q. Moving on to your next office visit. 3 Could you read to me your entries in your office 4 record for your next office visit for 5 Mrs. Berry? 6 A. This was dated August 24th. 32 7 weeks gestation. Fetal heart rates 140's. 8 Active movements. No complaints. Initial blood 9 pressure is 180 over 110; recheck was 142 over 10 91. No edema. 213 pounds. Urine was negative 11 for glucose. One plus protein. Next appointment 12 one week, JT. 13 Q. And you were reading from ACOG 14 antepartum record form C? 15 A. Correct. 16 Q. Also known as Plaintiff's Exhibit 3. 17 Any other entries in your progress notes or 18 elsewhere for that date? 19 A. I don't have a record of any others. 20 Q. And you indicated that was 8-24? 21 A. Correct. 22 Q. I'm going to hand you a form E 23 continued that I have and it just may be my 24 interpretation of the dates. It's also entitled 0089 1 supplemental visits. I have something for 2 August something and I just wonder if those 3 correlate? 4 A. This looks like August 29th, 2003. 5 I could be mistaken on form C that that record 6 might have been August 29th. 7 Q. Would it be fair to say that every 8 time you saw a patient -- strike that. 9 Every time you saw Mrs. Berry, would 10 you have made a record of that visit on form C 11 and perhaps an additional record, either a 12 transcribed note or a handwritten note? It 13 seems to me that's the pattern. 14 A. I think that's fair to say. 15 Q. And how about if you read for me the 16 form E continued for I'm going to call that 17 August 29th, 2003. 18 A. Okay. 19 Q. Does that correlate? 20 A. That's what it looks like, yes. 21 No complaints. Fetus active. No 22 PIH complaints. Recheck blood pressure 142 over 23 91. One plus protein unchanged. Maternal fetal 24 medicine consult done on 8-26. Continue 0090 1 expected management per same. Return to office 2 one week. Ultrasound and BPP next week. 3 Recheck labs that day. Continue bed rest and 4 kick counts. 5 And over to the right side I have 6 noted multiple movements palpated. Patient 7 reports same while on monitor. 8 Q. Okay. And for those two entries for 9 August 29th -- I'm including what we determined 10 on form C was August 29th -- does that cover 11 your physical exam for that day's visit on Mrs. 12 Berry? 13 A. Yes. 14 - - - - - 15 (Thereupon, THOMPSON Deposition 16 Exhibit 10 was marked for 17 purposes of identification.) 18 - - - - - 19 Q. I have one additional dictated note 20 for Mrs. Berry. I'll hand that to you. It's 21 for August 30th, 2003. 22 A. Okay. 23 Q. And that's, again, an office note 24 that's transcribed for Rhonda Berry and the date 0091 1 on the bottom is August 30th, 2003. There is a 2 marking at the lower right-hand corner. Is that 3 your initial? 4 A. Correct. 5 Q. And can you explain to me what the 6 substance of this note is? Let me step back a 7 second. Did you see Mrs. Berry that day? 8 A. No. 9 Q. Can you explain to me the purpose of 10 this note? 11 A. This would have been a summarization 12 of my discussion with the maternal fetal 13 specialist about this patient's care, where 14 things stood at the time. 15 Q. Okay. Your next visit with Mrs. 16 Berry was? I'm looking at form C. Plaintiff's 17 Exhibit 3 was September 2nd; is that fair? 18 A. I believe that was September 3rd. 19 Q. Okay. I'm looking at form C, 20 Plaintiff's Exhibit 3. There is an entry there 21 under 8-29. 22 A. That looks like September 3rd to me. 23 Q. Okay. And is that your entry? 24 A. Yes. 0092 1 Q. And can you just read me your 2 findings? 3 A. 33, 4/6 weeks. Fundal height 36 4 centimeters. Fetal heart rate 144. Active 5 fetal movements. No complaints. Initial blood 6 pressure 170 over 120; rechecking myself 158 7 over 108. No edema. Weight 211 pounds. Urine 8 is negative for glucose. Now has two plus 9 protein. Next appointment to labor and delivery 10 and then my initials. 11 And I also note at the end there too 12 a BPP on September 2nd was eight out of eight. 13 Q. And just to clarify, this cross 14 references with, you also made an entry on 15 September 9th, 2003 at the bottom -- 16 A. September 3rd, 2003. 17 Q. -- of University Hospital Health 18 Systems page, sheet you made an entry on 19 September 3rd, 2003 and that you previously 20 identified as Plaintiff's Exhibit 8 and we 21 reviewed that entry. 22 Is it fair to say that that's the 23 record of your physical exam findings for Mrs. 24 Berry on that September 3rd, 2003 date? 0093 1 A. That was the extent of my exam and 2 evaluation, yes. 3 Q. Are there any other entries in the 4 record from you on Mrs. Berry? 5 A. I don't believe so. 6 MS. DISILVIO: You mean including 7 initials and check marks? 8 Q. Prenatal care. Let's start first 9 with prenatal care, antenatal care. I'm not 10 going to include your initials on testing, but 11 did you make any other entries? 12 MS. DISILVIO: Go page by page, 13 doctor. 14 MS. PERSE: Thank you. 15 MS. DISILVIO: You start at H. 16 A. Let's see, I have a telephone 17 message dated June 16th. 18 Q. June 16th? Can you review for me -- 19 I don't believe I have that in my record. Can 20 you review for me the substance of that message? 21 A. Whoever was taking the message they 22 had gotten a phone call. Patient's name written 23 down. I was indicated as the doctor. The 24 question was ultrasound fetal anatomy on June 0094 1 13th; did we get results? 2 Somebody else notes on the right 3 side, told patient normal, has an appointment 4 July 2nd. 5 Q. Okay. Any other entries from you? 6 A. I don't believe so. 7 Q. I have one other telephone message 8 from August 13th, 2003 that I believe has your 9 signature. Let me show it to you. 10 A. Here we go. I'm sorry. Yes, I do 11 have that. 12 Q. For what date? This is for August 13 3rd, 2003? 14 A. This was dated August 6th. 15 Q. Oh, August 6th. I'm doing it again. 16 August 6th, 2003. And what is your entry there? 17 A. Again, whoever took the message 18 noted her name and phone number, date of birth, 19 indicating me as the doctor. Second test was 20 six out of eight, 29 and four weeks. My advice 21 on the right side, keep scheduled appointment, 22 need hard copy of the ultrasound and 23 metaphysical profile done and then I signed my 24 initials. 0095 1 Q. Looking at the ACOG antepartum 2 record form C, with the notations for each 3 visit, it appears that you saw Mrs. Berry on 4 every occasion that she came to your office 5 except for two; is that a fair statement? 6 A. No. 7 Q. Please clarify that for me. 8 A. Well, I think we have other 9 partners' signatures at different times on some 10 of the other narrative notes. 11 Q. I'm looking at form C, Plaintiff's 12 Exhibit 3. There is an entry for June 24th, 13 2003. 14 A. Correct. 15 Q. Is that your entry? 16 A. No. 17 Q. Who is that? 18 A. Dr. Melton. 19 Q. Okay. And is there a progress note 20 for that date in your record? 21 A. There is the note that I'm looking 22 at that we were talking about. 23 Q. I was looking at the form C, so 24 that's why. We discussed that before; correct? 0096 1 So Dr. Melton saw Mrs. Berry on June 2 24th. And then looking at, using form C as a 3 reference, I see that on July 21st, 2003, there 4 was another physician that rendered care to Mrs. 5 Berry. Who was that? 6 A. Dr. Sage. But you missed a date. 7 Q. Please clarify. Did I misspeak the 8 date or is there another entry? 9 A. You missed a date. The narrative 10 includes a date July 13th, 2003. 11 Q. That's what I'm looking for. 12 And that was Dr. Melton, if I'm 13 reading the signatures right; is that fair? 14 A. Correct. 15 Q. Okay. Any other dates that 16 Mrs. Berry was seen in your office and not by 17 you? 18 A. You mentioned July 21st by Dr. Sage, 19 July 22nd by Dr. Wieczorek. 20 Q. Did Dr. Wieczorek see Mrs. Berry in 21 your office that day? 22 A. Yes. 23 Q. And what was the substance of 24 Dr. Wieczorek's visit and plan at that time? 0097 1 MS. DISILVIO: Do you want him to 2 read the note? 3 MS. PERSE: He can. 4 MS. DISILVIO: Just read the note 5 into the record, doctor. 6 A. I can't say what was going through 7 his mind, but this was July 22nd of '03. See 8 the previous notes. 9 Patient seen yesterday with blood 10 pressure 180 over 98. She declined to go to 11 hospital. Today 152 over 92 by me with patient 12 resting on left side. Labs from yesterday 13 showed low platelets 111,000. Impression 27 14 week gestation. IVF. Large fibroids. Probable 15 preeclampsia. Plan to labor and delivery for 16 evaluation and signed Wieczorek. 17 Q. So that covers the other physicians 18 that saw Mrs. Berry in her antenatal period. 19 MS. DISILVIO: There may have been 20 others for the biophysical profile. 21 MS. PERSE: Again, I'm speaking from 22 his office notes, to clarify. 23 Q. In your office. 24 A. In our office, I believe that was 0098 1 all, yes. 2 Q. Okay. And then we have already 3 established that you didn't deliver Mrs. Berry; 4 is that correct? 5 A. Correct. 6 Q. Who delivered Mrs. Berry? 7 MR. BONEZZI: Objection. Dr. Sage 8 did. He told you that about two hours ago. 9 MS. PERSE: Again, I apologize if 10 that was redundant. 11 Q. Did you see Mrs. Berry in the 12 hospital? 13 MS. DISILVIO: At what point? For 14 delivery? 15 Q. At the time of the delivery. 16 A. For delivery, no. 17 Q. The next visit that you have for 18 Mrs. Berry was when? That you, yourself, have a 19 visit for Mrs. Berry, Dr. Thompson. 20 A. September 8th, 2003. 21 Q. And you are looking at a sheet 22 entitled University Hospitals Health System, 23 University Primary and Specialty Care Practice 24 with the patient name Rhonda Berry and her birth 0099 1 date 11-27-68 in the upper right-hand corner. 2 A. Correct. 3 Q. I'll hand it to you and make sure we 4 are looking at the same thing. 5 A. Correct. 6 Q. Okay. And can you read your entries 7 that you have made on this sheet. 8 A. No complaints since discharge and 9 then in parentheses, fever, abnormal bleeding or 10 orthostasis. Abdomen soft, incision clear, 11 staples out, steri-strips applied. Return to 12 office four weeks for postpartum exam. Continue 13 follow-up with her internist for hypertension 14 and then signed my initials. 15 Q. Do you have any other record in your 16 office chart for that visit? 17 A. I don't believe so, no. 18 Q. Can we agree that your entries on 19 this September 8th, 2003 sheet include the 20 extent of your physical examination? 21 A. Yes. 22 Q. Was there a breast exam noted at 23 this office visit? 24 A. No. 0100 1 Q. Do you know if you did a breast exam 2 on Mrs. Berry at the time of that office visit? 3 A. If she had no complaints, I wouldn't 4 have, no. 5 MS. PERSE: And let's mark this as 6 Plaintiff's Exhibit 11. 7 - - - - - 8 (Thereupon, THOMPSON Deposition 9 Exhibit 11 was marked for 10 purposes of identification.) 11 - - - - - 12 Q. Any other times that you saw 13 Mrs. Berry in your office after delivery? 14 A. I saw her October 13th, 2003. 15 Q. And you have entries in your record 16 for that date? 17 A. Yes. 18 Q. Okay. And to my read of the record, 19 there were two entries for October 13th, 2003. 20 One handwritten. There is a note from 10-13, 21 but I'm not sure if there is any writing of 22 yours on that sheet. 23 MS. DISILVIO: Objection to form and 24 otherwise. 0101 1 A. Which one are you looking at? 2 Q. The University Hospitals Health 3 System sheet with a typewritten nameplate of 4 Berry, Rhonda in the upper right-hand corner and 5 under the heading of department of OB/GYN the 6 date, there is an entry there of 10-13-2003. 7 Let me hand that to you, because I 8 think we are looking at the same thing. 9 A. Yes. 10 Q. Are there any entries from you on 11 that sheet? 12 A. Not on that sheet, no. 13 Q. And do you know who prepared that 14 sheet, if you know? 15 A. Whoever's signature that is. I'm 16 not sure. 17 Q. Do you recognize that signature? 18 A. Not really. 19 Q. Did you see that sheet at the time 20 of your visit with Mrs. Berry? 21 A. Yes. 22 Q. And any other entries -- or where is 23 your entry for your visit of October 13th, 2003 24 with Mrs. Berry? 0102 1 A. I dictated my note that day. 2 Q. Okay. 3 MS. DISILVIO: You know, we 4 discussed this in great detail. We are not 5 going over it again. 6 MS. PERSE: We didn't discuss it in 7 great detail. We are going to go over it. 8 MS. DISILVIO: At some juncture we 9 will let the judge decide how many times you are 10 going to ask him the same question over and over 11 again. 12 MS. PERSE: I didn't. 13 MS. DISILVIO: I have some pretty 14 detailed notes. And anyone in the room, if you 15 want to correct me if I am wrong. We have 16 addressed this note; his custom and practice for 17 visits for October 13th. 18 Q. Let's identify this note for the 19 record. I'm going to hand it to you. 20 MS. DISILVIO: We have been here two 21 and a half hours and I think we discussed this 22 probably at the one hour mark. 23 Q. Is this your office entry, dictated 24 office entry for October 13th, 2003? 0103 1 A. Yes. 2 Q. And there is a marking in the lower 3 right-hand corner. Is that your initial? 4 A. Correct. 5 MS. PERSE: We will mark this as 6 Plaintiff's Exhibit 12. 7 - - - - - 8 (Thereupon, THOMPSON Deposition 9 Exhibit 12 was marked for 10 purposes of identification.) 11 - - - - - 12 Q. Did you do a breast examination at 13 the time of that postpartum visit? 14 A. No. 15 Q. Did Mrs. Berry have any complaints 16 at the time of that visit? 17 MS. DISILVIO: Other than what is 18 noted in the record? 19 MS. PERSE: Yes. To your knowledge. 20 A. I note in the record that she had no 21 complaints. 22 Q. Were you aware if Mrs. Berry was 23 seeing any other physician at the time of that 24 October 13th, 2003 visit? 0104 1 MS. DISILVIO: Other than they say 2 note to follow up with the internist for her 3 blood pressure. 4 MS. PERSE: I didn't want to belabor 5 the record so I'm asking him that question. 6 A. I mean, we knew she was following up 7 with the internist for hypertension control, but 8 I didn't know if she was seeing anybody else 9 that day or not. 10 Q. Do you know who the internist was? 11 A. I knew that Dr. Han was her primary 12 care person. 13 Q. At the time you were caring for 14 Mrs. Berry, did you have access to Dr. Han's 15 records? 16 A. No, that's a different practice. 17 Q. I'm just checking that. Since that 18 time, have you seen Dr. Han's records? 19 A. I have. 20 Q. Were you aware at the time you cared 21 for Mrs. Berry, were you aware that she had 22 complained of a problem with her left breast to 23 Dr. Han? 24 A. No. 0105 1 MR. BONEZZI: Objection. Go ahead. 2 Q. Did you at any time during your 3 treatment of Mrs. Berry speak directly with Dr. 4 Han about Mrs. Berry? 5 A. Not that I recall. 6 Q. Do you recall Mrs. Berry -- and I 7 apologize because I may have asked this -- did 8 Mrs. Berry mention to you that she had seen 9 Dr. Han for a breast problem? That may have 10 been precisely what I just asked you and I 11 forgot. 12 MR. BONEZZI: Objection to the 13 characterization that that patient saw Dr. Han 14 for a breast problem. That is not what she saw 15 Dr. Han for. Go ahead, doctor. 16 A. I think I mentioned earlier that I 17 had my usual list of topics to touch on at a 18 postpartum exam and she didn't mention anything 19 being positive, didn't mention anything about an 20 exam with Dr. Han. 21 Q. When Mrs. Berry came to visit you, 22 was she accompanied by anybody -- 23 MS. DISILVIO: When? 24 MS. PERSE: Let me finish the 0106 1 statement. 2 Q. -- that you recall during the time 3 that you cared for her when she was pregnant and 4 in her early postpartum period? 5 A. I don't have any specific 6 recollection, no. 7 Q. Do you recall what Mrs. Berry looked 8 like? 9 A. Not now. 10 Q. Were there any family members that 11 came with Mrs. Berry to any appointments during 12 your time of treatment, your course of 13 treatment? 14 A. I don't recall. 15 Q. In a patient who is pregnant or in 16 the early postpartum period, do you routinely do 17 breast exams? 18 A. Rephrase that. 19 Q. In a patient who is pregnant or in 20 the early postpartum period, do you routinely do 21 a breast exam? 22 MS. DISILVIO: Objection. 23 A. Where in the pregnancy? 24 Q. I'm just wondering if there is a 0107 1 point in time that you would do a breast exam? 2 A. I customarily will do a breast exam 3 around the time of her initial OB visit if she 4 hasn't had one recently, but there are plenty of 5 circumstances she might have been examined in a 6 time close to that that I wouldn't do one. 7 If she had any specific complaints, 8 yes, they would have to be addressed. 9 Q. In a patient during the postpartum 10 period, it would not be your practice to do a 11 breast exam as part of their final postpartum 12 visit; is that a fair statement? 13 A. Again, I usually don't do them at 14 that time unless there is a complaint. 15 Q. Can we agree that in a postpartum 16 patient, their breasts go through extensive 17 changes during that postpartum period? 18 MS. DISILVIO: Objection to 19 extensive. You may answer. 20 A. That's kind of a blanket term, but, 21 yes, there are changes in the breast. 22 Q. If I take out the extensive changes, 23 there are changes that occur in a woman's breast 24 during the postpartum period; is that a fair 0108 1 statement? 2 A. Yes. 3 Q. In a woman not nursing, what time 4 frame would you consider that those changes 5 would be resolved? 6 MS. DISILVIO: Objection. If you 7 can give a time frame. 8 A. I don't think you can generalize 9 that. It's variable. Did she nurse at all, how 10 big the woman is, age, anything else happening 11 with her. This can go weeks or months. 12 Q. Okay. If at any time you need to 13 take a break, feel free. 14 Are you aware of whether Mrs. Berry 15 had attempted to nurse for any period of time 16 during her postpartum period? 17 A. At this point, I don't recall, no. 18 Q. Would you agree that a reasonably 19 prudent obstetrician/gynecologist would do a 20 breast exam as part of their initial gynecologic 21 exam? 22 MS. DISILVIO: Objection. You may 23 answer. 24 MR. BONEZZI: Objection. 0109 1 MS. SANDACZ: Objection. 2 A. I think it's important, but a lot of 3 it depends on multiple variables; when she was 4 last seen for an annual exam, did she have any 5 relevant recent exams for other reasons, so it 6 wouldn't have to be at the initial OB exam. 7 Q. We can agree that during pregnancy, 8 and even the early postpartum period, a breast 9 is constantly changing; is that true? 10 MS. DISILVIO: Objection to 11 constantly changing. You can answer if you can. 12 A. There are changes in the breasts, 13 pregnancy and postpartum, yes. 14 Q. Can breast cancer occur during 15 pregnancy? 16 A. Yes. 17 Q. And can breast cancer occur in the 18 postpartum patient? 19 A. Yes. 20 Q. So can we agree -- let me step back. 21 A patient would note, if they are going to 22 complain -- strike that. 23 If a patient were to note a breast 24 problem and complained to their obstetrician 0110 1 about that breast complaint, would it be 2 important to have a baseline breast exam to 3 accurately assess that lump? Is that a fair 4 statement? 5 MS. DISILVIO: Objection. If you 6 can possibly even answer. 7 MR. BONEZZI: Objection. 8 MS. SANDACZ: Objection. 9 A. What do you mean by baseline? Are 10 you talking about doing the exam at that time? 11 Q. No, I'm talking about -- breast 12 exams are subjective; is that a fair statement? 13 A. To some degree, yes. 14 Q. And so to assess a woman's complaint 15 of a breast lump, it would be important for that 16 clinician to have a baseline exam? 17 MS. DISILVIO: Here is why I'm going 18 to object. Let's assume your question to be a 19 hypothetically accurate description of any event 20 in this case. If the patient had a breast 21 complaint on June 2 when she first presented to 22 Dr. Thompson, he would have no way of having a 23 baseline. 24 So your question is flawed because 0111 1 it varies from patient to patient from when the 2 patient is seen in a particular practice, et 3 cetera. So with all those variables, if you can 4 possibly answer that question, go ahead. 5 MS. SANDACZ: Same objection as it 6 relates to variables and patient's menstrual 7 cycles and otherwise. 8 MS. DISILVIO: If you can't answer 9 it, say you can't answer it with those 10 variables. 11 A. I think there's definitely 12 multi-variables in there. But at the same time 13 too it may or may not be helpful. It may be 14 nice to have it but not necessary, I don't 15 think. 16 Q. Can you explain for me what changes 17 you might expect to occur in an antepartum 18 woman's breast? 19 A. Not being the expert in physiology, 20 just because of the significant changes in 21 hormone levels, there are changes in the size 22 and consistency of the glandular portion of the 23 breast and in the supporting tissues surrounding 24 it. 0112 1 Q. And would you agree that those 2 changes could potentially obscure a breast mass 3 on physical examination? 4 A. I think changes in the breast 5 certainly could make it more difficult to 6 examine, yes. 7 Q. In a patient that complains of a 8 breast lump, can we agree that it's important 9 for the clinician to take that breast lump 10 seriously? 11 A. I take any complaints seriously. 12 Q. Would you say that you practice by 13 ACOG guidelines? 14 MS. DISILVIO: Objection. 15 MS. SANDACZ: Objection. 16 A. That's kind of an amorphous term. 17 What do you mean? 18 Q. Just in general, do you follow ACOG 19 guidelines and recommendations? 20 MS. DISILVIO: Objection. 21 A. I use ACOG guidelines exactly as 22 that term guidelines -- I use them to help guide 23 how I take care of patients, yes. 24 Q. If ACOG proposed that a breast 0113 1 examination should be part of an initial 2 obstetrical visit, would you have any reason to 3 disagree with that? 4 MR. BONEZZI: Objection. 5 MS. SANDACZ: Objection. 6 MS. DISILVIO: Objection. I think 7 he already told you how he feels about it. 8 A. I think we just said that these are 9 guidelines to help guide, to help guide how you 10 care for people. It depends on a lot of other 11 factors; such as when she had her last exam. 12 Q. Again, I'm just asking, would you 13 have a reason to disagree with that? 14 MS. DISILVIO: Objection. Move on. 15 He is not going to answer this. We are going to 16 stop this. 17 MS. PERSE: I think his answer is it 18 depends. 19 A. That's what I'm saying, it depends; 20 there is no yes or no. 21 MS. PERSE: I'm going to ask for a 22 little break. It shouldn't be much longer. I 23 want to review my notes. 24 (Recess had.) 0114 1 MS. PERSE: Back on the record. I 2 don't believe I have any more questions for you. 3 MS. DISILVIO: Anyone else? 4 MS. SANDACZ: No questions for me. 5 EXAMINATION OF JOHN THOMPSON, M.D. 6 BY MS. DISILVIO: 7 Q. Doctor, with respect to your care 8 and treatment of Mrs. Berry, did you meet the 9 standard of care? 10 A. I believe we did. 11 Q. And was any conduct on your part a 12 cause of injury to her? 13 A. No, I don't believe it was. 14 MS. DISILVIO: Thank you. I don't 15 have any other questions. 16 We will read. 17 - - - - - 18 (Deposition concluded at 1:20 p.m.) 19 (Signature not waived.) 20 - - - - - 21 22 23 24 0115 1 AFFIDAVIT 2 I have read the foregoing transcript from 3 page 1 through 114 and note the following 4 corrections: 5 PAGE LINE REQUESTED CHANGE 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 JOHN THOMPSON, M.D. 21 22 Subscribed and sworn to before me this 23 day of , 2007. 24 Notary Public My commission expires . 0116 1 CERTIFICATE 2 State of Ohio, SS: 3 County of Cuyahoga. 4 5 I, Vivian L. Gordon, a Notary Public within and for the State of Ohio, duly 6 commissioned and qualified, do hereby certify that the within named JOHN THOMPSON, M.D. was by 7 me first duly sworn to testify to the truth, the whole truth and nothing but the truth in the 8 cause aforesaid; that the testimony as above set forth was by me reduced to stenotypy, afterwards 9 transcribed, and that the foregoing is a true and correct transcription of the testimony. 10 I do further certify that this deposition 11 was taken at the time and place specified and was completed without adjournment; that I am not 12 a relative or attorney for either party or otherwise interested in the event of this 13 action. I am not, nor is the court reporting firm with which I am affiliated, under a 14 contract as defined in Civil Rule 28(D). 15 IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal of office at Cleveland, 16 Ohio, on this 30th day of May, 2007. 17 18 19 Vivian L. Gordon, Notary Public 20 Within and for the State of Ohio 21 My commission expires June 8, 2009. 22 23 24 0117 1 INDEX 2 EXAMINATION OF JOHN THOMPSON, M.D. 3 4 BY MS. PERSE: 3 7 5 BY MS. DISILVIO: 114 6 6 7 EXHIBITS 8 9 Exhibit 1 was marked 30 13 10 Exhibit 2 was marked 59 5 11 Exhibit 3 was marked 61 18 12 Exhibit 4 was marked 67 12 13 Exhibit 5 was marked 69 15 14 Exhibit 6 was marked 73 16 15 Exhibit 7 was marked 80 12 16 Exhibit 8 was marked 85 11 17 Exhibit 9 was marked 87 13 18 Exhibit 10 was marked 90 16 19 Exhibit 11 was marked 100 9 20 Exhibit 12 was marked 103 9 21 22 23 24