Deposition 1 - Deposition of doctor by plaintiff in med mal suit

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BY MR. SULLIVAN:

Q. Doctor, you don't happen to have a curriculum vitae with you today?

A. My partner is getting it for us.

Q. Okay. Just the short form of it, can you tell me where you went to medical school?

A. I went to the University of Illinois, 1969-1973. I did my residency in internship at the University of Illinois Hospital from 1973 to 1980, I have been here at Mercy Hospital ever since as the program director, assistant program director of the surgery residency.

We are a University of Illinois sponsored residency.

Q. Are you board certified?

A. Correct.

Q. What areas?

A. General surgery and surgical critical care.

Q. Do you recall when you became board certified?

A. 1981 in general surgery and 1989 in critical care.

Q. What exactly is encompassed in the critical care aspect of that?

A. Critical care relates to the area of expertise in the hemodynamic or cardiodynamic management of ill patients and it includes things like cardiac assessment pulmonary assessment, antibiotics, nutrition and the like.

Q. Okay.

A. So it's intensive care medicine related to surgery patients.

Q. Can you tell me on an average week how much time you spend teaching as opposed to clinical care?

A. It's impossible to answer that because the teaching is in the clinical care. We do an hour at least of didactic a day and sometimes that extends to two or three hours, and then the clinical encompasses a minimum of two, three hours per day.

Q. Are you affiliated with any hospitals besides Mercy currently?

A. No, this is the only one.

Q. Have you ever published any articles?

A. I have 17 or 18 in my CV.

Q. Okay. This case and this deposition focus on the problems Miss Peterson had with her arm.

Have you published any articles that you believe deal with the issues related to this case?

A. No.

Q. Okay. Is there an area of specialty that you published in?

A. Bowel obstruction, my greatest -- I have a chapter with the chief of surgery at the Mayo clinic for two books and various five volume set of surgery. That's my expertise.

Q. And you are partners with Dr. Perez?

A. Yes.

Q. Perez Tamayo?

A. Perez Tamayo, she graduated her residency here in '86. We have been partners for 11 years now.

Q. It's my understanding you also know Dr. Currie?

A. I have known Dr. Currie since my University of Illinois days dating back into the '60s, actually preresidency.

Q. And during that time has your relationship been strictly professional or do you also enjoy a social relationship?

A. I don't have a social relationship with most people. It's been strictly professional. Look at me.

Q. Do you still share patients or refer patients to Dr. Currie?

A. Yes.

Q. We're here obviously to talk about Sharon Peterson's treatment. Do you have an independent memory of Miss Peterson?

A. I reviewed the case with Dr. Perez Tamayo in anticipation of the deposition and reviewed the notes and that I do have independent memories of what happened, although I need the cheat sheet.

Q. The notes that we have here are notes that you and Dr. Perez compiled together?

A. She wrote them down, I sifted through the notes and gave my thoughts on what happened during the times.

Q. Okay. I'm going to leave these in front of you. Feel free look at these anytime you want.

A. Sure.

Q. When was your first contact with Miss Peterson?

A. September 27th, 1991.

Q. And what was the occasion?

A. She came in with a breast mass that was at least an inch on the left side.

Q. It's my understanding, and I'm going to try to curtail this as much as possible because I believe we know most of the answers through your partner, but just to make sure I still have to cover certain things, you have treated her for breast lumps in both breasts, correct?

A. Correct.

Q. Can you tell me the first time that you treated her for problems related to her arm as opposed to the breast?

A. I have to look through my notes. It was in June of 1994.

June 10th, 1994.

I must tell you something about myself in there. I wasn't feeling good that week and I found out that week I had a heart attack, and I can't even tell you the date, so I was around, but Dr. Perez Tamayo did most of the work with her, but I did see Sharon at that time, she had pain in her arm and some area of necrosis.

I don't know if you want me to -- I'll just tell you what I remember about it.

Q. That's fine.

A. She had some area of necrosis on her arm. I don't know how long it had been there. We tried some topical steroids without a lot of success, although I do think it helped a little bit and then took her on the 14th of June for incision and drainage of the residual necrotic area.

We did not clean it quote, unquote, “To the bone,” we didn't clean it to the red muscle, because a lot of that tissue that looked nonviable was actually viable, and so once we opened it, I know it still hurt her after that, but a lot of that stuff came back and was able to heal.

Q. Okay. The problem area, necrotic area that you saw did not go down to the bone?

A. No, it did not go down to the bone nor did it go down to the muscle, as I best remember.

Q. Is there a name for the area that it did affect?

A. Subcutaneous tissue.

Q. And the reason that you performed the incision and debridement --

A. And drainage.

Q. And drainage, it was because the topical steroid you did not believe were enough to cure the problem?

A. Well, there definitely was an element of dead cell in the area underneath skin. Now how much of that material by virtue of its own death was irritating her and causing her pain and how much residual chemotherapy could have been in that was problematic, we had no way of knowing, so the approaches would be to do nothing to take everything out or just to make a sufficient amount of holes in there to allow what's in there to drain out and let her heal herself up. We took the middle course.

Q. It's my understanding, speaking with Dr. Perez earlier, that you both are surgeons and you both shared the responsibilities and duties during this surgery?

A. Correct.

Q. So there is no specific role that you were playing as opposed to her and you both may have been debriding?

A. Correct.

Q. Was there anything that you did in particular in the surgery that you recall specifically as opposed to anything Dr. Perez did?

A. No, I couldn't tell you.

Q. Was it a fairly routine surgery or were there any complications?

A. No, it was relatively easy.

Q. The wound site was left open?

A. Correct.

Q. Was that a proper way to term it?

A. Correct.

Q. That was done purposely?

A. To allow whatever bad stuff was inside that wound, be it necrotic debris or possible chemotherapy agent, to continue to come out.

Q. Okay.

A. That's standard care for this type of thing.

Q. And am I correct that even the fact that or given the fact that it was left open it will heal on its own over time?

A. Correct.

Q. Would the time frame be somewhere in a few weeks to a month?

A. Correct.

Q. As far as you know, were there any complications as far as the healing process for the surgical site?

A. I was out with my heart attack shortly after that.

Q. Sure.

A. And I can't speak to a precise date when things started to turn around for her.

Q. Okay.

A. But I think she pursued a relatively normal course after that debridement.

Q. The debridement was June 14th of 1994. You, obviously, indicated you had a heart attack at that point.

Do you know from memory or from records were you on a leave of absence or after that -- I mean I don't want to keep asking you questions if you are not around.

A. I really don't even know the date of my heart attack. I just didn't feel good. I have had Hodgkin's disease, I have had pericarditis before relative to radiation to my Hodgkin's, I didn't know what was what, and about a week into the illness I had another EKG gone and I had an echocardiogram done, and they confirmed the heart attack, so I actually came back to work the next day ‘cause that's the way I am, and saw the silliness of that, went home and I stayed home for about a month after that. I came back around the 25th of July.

Q. Based on your knowledge of this case and Miss Peterson's treatment, do you have any reason to believe that the occurrence involving the arm in any way affected Miss Peterson's breast problems or her cancer?

A. No, I can't say that.

Q. So you have no reason to believe that they affected the breast in any way?

A. I have no reason to believe that.

Q. Okay. Do you have any reason to believe that the surgery or -- strike that.

Do you have any reason to believe that the problems she had with her arm and your surgery affected her use of the arm today?

A. I have no reason to believe that.

Q. Were you involved in any care after June of 1994?

A. We saw Sharon into and through August of '94 and once again September of '94, and that was it.

Q. When you said “we” that could have been you or your partner?

A. Correct.

Q. It is my understanding that one of the last notations indicate that a second lump was found in the right breast?

A. Correct.

Q. And then follow-up treatment, if any, occurred somewhere else, correct?

A. I think Sharon Ford Peterson and we had a pretty good relationship, and Sharon was upset with Dr. Currie, and she was seeing a fella named Mike Warsaw at the University of Illinois.

I knew Mike Warsaw at the University of Illinois, and I didn't make judgments as to the right or wrongness of this, but I was comfortable that Mike was a very competent person to handle this if that had to be done, and I had down-scaled my own practice to the point where I wasn't looking to take on any big challenges for the rest of 1994, so when she expressed to me the desire to go see Mike, I had no problems with that, given that she wouldn't go back to see Dr. Currie.

Q. Right. We have taken Sharon Peterson's deposition already and she indicated in that deposition it was her memory that when you or

Dr. Perez saw her arm condition, you told her that she needed surgery within 24, 48 hours. Do you recall ever telling her anything like that?

A. No. In fact, I gave her steroid cream that was in an attempt to calm down or maybe even obviate the need for an operation.

Q. Okay. There was also a comment that she attributed to you or your partner, and this is a quote, I'm not trying to be a wise guy about it, but it was along the lines of you saying “Oh, shit” or “Oh, my God” when you saw her.

Do you recall any statements along those lines?

A. The only time I said “Oh, shit” that month was when I heard I had a heart attack, to the best of my knowledge.

Q. Have you formed any opinions or criticism of Dr. Currie in her treatment of this case?

A. Yeah, I do. Actually, let me give you the background. When you look at our CV's you will see in April of '91 we, Perez Tamayo and myself, had just come back with another chemotherapist from this hospital, who is not in this lawsuit, never saw Sharon, we came back from a consensus conference on breast cancer at Sloan Kettering Cancer Memorial, Sloan Kettering in New York, and the type of therapy that was being applied to Sharon Ford Peterson was called neoadjuvant.

Neoadjuvant is chemotherapy given prior to an operation and then subsequently following it, and there were some brilliant results put out by the Italian workers in this field and embraced by the people at Memorial Sloan Kettering, and Sharon was a very likable, personable lady who seemed like the ideal candidate to participate in the neoadjuvant therapy.

The advantages would be to allow her to undergo minimal breast surgery for the same benefits that might accrue from say taking her breast off, and the real advantages in my mind for neoadjuvant was it gave the doctor a chance to see how chemotherapy acted on the tumor, so if you have a bacterial infection, we culture some of the bugs from your body, we put them in a dish, we put antibiotics on it, and we get some idea how well the antibiotics work against the bacteria.

We don't have anything like that in cancer, so neoadjuvant therapy allows us to look at the effects of the chemotherapy on the human body and they were very, very encouraging.

Whatever the chemotherapy was that Dr. Currie was giving her, I believe melted that tumor down so that there was no residual disease and her lymph nodes, which had been clinically positive or appeared to us to be very much involved, were negative, and so there was the advantage of giving her the chance to have minimal surgery but also the certainty that the chemotherapy surely was going to be effective and wasn't going to be a waste of time, and I believe it takes a little bit of -- well, it takes guts and insight to be able to apply that, and so if you want to apply the phrase “State of the art,” that was in '91 state of the art therapy for the lesion that she had.

And, actually, the result on that side on her first breast tumor was quite excellent.

Q. Am I correct then that you are complementing Dr. Currie's treatment?

A. Yes, I use the word “State of the art” putting into the context of what was espoused at the Memorial Sloan Kettering symposium in April of 1991.

Q. Okay. So the treatment that Dr. Currie was giving to the plaintiff you believe was state of the art treatment?

A. Correct.

Q. You threw me a little bit. It's my fault for the way I phrased the question. I asked you if you had criticisms or opinions. Obviously, that was an opinion, correct?

A. That's an opinion.

Q. Do you have any criticisms of Dr. Currie's treatment of Mrs. Peterson?

A. I don't know the words that were exchanged or the -- see, I like Sharon Ford Peterson a lot. I don't know what it was about the dynamics between those two that set them off from each other. I know them both as very decent people, very warm, decent, caring people, so there was something that went wrong in there and whether it was availability or whether it was tones in the conversations or something, there was something that wasn't right there.

I'm not perfect. I have those same problems in my own practice, and it's no accident that I practice with a lady. We seek to find the best fit for patients. Some patients have no use for her. Some patients have no use for me. We have the luxury of being able to afford them a choice. Dr. Currie didn't have that luxury.

I suspect it would have worked better for her if somewhere when this relationship went awry, they had been able to get into a more productive mood.

Q. Obviously, there is aspects of Dr. Currie's treatment that you are not privy to, and I'm not asking to you guess or speculate on what occurred there.

I do need to ask you though, as we sit here today based on all of the knowledge you have today, do you have any criticisms of Dr. Currie for his treatment of the plaintiff?

A. No.

Q. Extravasations?

A. Yes.

Q. Do you see those in other patients?

A. It happens in everybody. I was a patient with Hodgkin's disease in my third year of residency in 1976, and I had to go in for major surgery at the University of Illinois Hospital and my friends took care of me over there, who are residents and attendings, and they blew all of the veins in my arms right under my nose and right under their nose.

Extravasation happens, and it happens not just with chemotherapy. It happens with crystallite or saline or innocuous solutions as well as more dangerous solutions like parental nutrition or chemotherapy.

Sometimes it's not obvious to see that there has been an extravasation, and the reason why I'm putting myself up as an example is it happened right in front of my nose and I didn't know about it.

If you look, I'm not a skinny guy, but I got veins in my arms and those veins were blown to the point of not being useful for several weeks.

Q. Okay. I'm obviously a layman with no medical training. Do I understand extravasation simply means that the chemical agent did not go into the vein?

A. It may have gone through the vein, but it came out of the vein, so there is either a hole in the vein that allowed it to leak out or it never got into the vein in the first place.

Q. Okay.

A. Sometimes it's hard to know.

Q. Am I correct that it is your professional opinion that the fact that an extravasation occurs does not necessarily mean that a doctor was negligent?

A. That's correct.

Q. And that even with the best of care extravasations can occur?

A. That's correct. I offer my own example.

Q. Okay. Doctor, you indicated earlier that you had met Mr. Bernstein before?

A. Five minutes to 1:00.

Q. Oh, before today, I see.

A. We haven't met before.

Q. I may have asked you and I apologize, did you review anything besides the records with your partner before thisdeposition?

A. No.

Q. You haven't seen any deposition transcripts of Miss Peterson or Dr. Currie?

A. No, sir. No, sir.

MR. SULLIVAN: Okay. Those are all of the questions I have. Thank you. Mr. Bernstein may have some.

MR. BERNSTEIN: No, I have no questions. That's fine.

MR. SULLIVAN: Thank you, Doctor.

The only thing we need as far as signature goes, you have the right to review this transcript and determine whether everything was taken down accurately or you can waive that and you don't have to review it.

THE WITNESS: I should look at it.

MR. SULLIVAN: Signature will be reviewed, and we will send a copy for you to review. Thank you very much, Doctor. I appreciate your time.

THE WITNESS: Thank you very much.

(FURTHER DEPONENT SAITH NOT.)

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