Gar CIA Lawsuit Exhibits 2

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08-126

PHILIP MICHELS, ESQ. (Bar No. 57802) SHIRLEY K. WATKINS, ESQ. (Bar No. 106462) JIN N. LEW, ESQ. (Bar No. 136578)

LAW OFFICES OF MICHELS & WATKINS 11755 Wilshire Boulevard, Suite 1300

Los Angeles, California 90025-1540

(310) 444-1200

SUPERIOR COURT OF THE STATE OF CALIFORNIA

FOR THE COUNTY OF ORANGE - CENTRAL JUSTICE CENTER

••

Attorneys for Plaintiff

MATTHEW GARCIA, and minor, ETHAN) GARCIA, a minor, REBECCA GARCIA, a )

minor, by and through their Guardian Ad )

Litem, Gonzalo Garcia, ~

Plaintiffs, )

~

) HARRELL ROBINSON, M.D., HARRELL) ROBINSON, M.D., INC., PHYSICIANS & )

SURGEONS OF ORANGE COUNTY, )

INC., HILLS SURGICAL INSTITUTE, )

ROYAL TY PERFECTIONS GLOBAL l MEDICAL SURGERY CENTER,

GLOBAL MEDICAL SURGICAL

CENTER, ROYALTY PERFECTIONS )

COSMETIC INSTITUTE, DOES 1 )

THROUGH 30, INCLUSIVE, j

Defendants. ~

--~----------------------~ )

MATTHEW GARCIA, a minor, ETHAN )~ GARCIA, a minor, REBECCA GARCIA, a

minor, by and through their Guardian Ad )

Litem, Gonzalo Garcia, MARCUS LE )

CROIX, MELISSA LE CROIX, MARK LE CROIX, and GONZALO GARCIA AS SUCCESSOR IN INTEREST TO DECEDENT MARIA GARCIA

v.

Plaintiffs,

••

FILED

SUPERIOR COURT OF CALIfORNIA COUNTY Or- ORANGE CEr.JTQAt .JlJSTrCE C2NTER

JUL 29 2010

ALAN (;AHI..~UN. {;lefK 01 the COUIt

C:::- cL F

C_ ,

BY E. V LOJ-.

CASE NO. 30-200800105390

(consolidated with 30-2008 00113392)

Judge Luis Rodriguez, Dept C6 [Complaint Filed: Apri115,2008] Plaintiffs' Evidence in Opposition to Defendant Gutierrez' MSJ

DATE:

TIME:

DEPT:

8112/10 1:30 p.m. C6

1

F:\08-126\MTN\plts evidence gutierrez.wpd PLAINTIFFS' EVIDENCE IN OPPOSITION TO DEFENDANT GUTIERREZ' MS.!

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

••

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V. j

HARRELL ROBINSON, M.D., HARRELL ) ROBINSON, M.D., INC., PHYSICIANS & )

SURGEONS OF ORANGE COUNTY, )

INC., HILLS SURGICAL INSTITUTE, )

ROY ALTY PERFECTIONS· GLOBAL )

MEDICAL SURGERY CENTER, )

GLOBAL MEDICAL SURGICAL )

CENTER, ROYALTY PERFECTIONS )

COSMETIC INSTITUTE, LAWRENCE HANSON, M.D.; GUSTAVO

GUTIERREZ, CRNA, DOES 1 THROUGH 30, INCLUSIVE,

Defendants.

--------------------------)

2

F:\08-126\MTN\plls evidence gutierTeZ.wpd PLAINTIFFS' EVIDENCE IN OPPOSITION TO DEFENDANT GUTIERREZ' MSJ

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1 Declaration of Ronald Katz, M.D Exhibit 1

2 Deposition Transcript of Aruna Singhania, M.D, Volume 1 .. , . . . . . . . . . . . . . . . .. Exhibit 2 3 Deposition Transcript of Arona Singhania, M.D., Volume 2. . . . . . . . . . . . . . . . . .. Exhibit 3

4 Deposition Transcript of Gustavo Gutierrez, M.D., Volume 1 Exhibit 4

5 Deposition Transcript of Gustavo Gutierrez, M.D., Volume 2 . . . . . . . . . . . . .. Exhibit 5

6 Deposition Transcript of Lawrence Hansen, M.D Exhibit 6

7 Deposition of Harrell Robinson, M.D, Volume 1. Exhibit 7

8 Deposition of Harrell Robinson, M.D, Volume 2. . . . . . . . . . . . . . . . . . . . . . . . . . .. Exhibit 8

9 Curriculum Vitae of Ronald Katz, M.D Exhibit 9

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F:\08-126\MTN\pltsevLdence gutierrez.wpd PLAINTIFFS' EVIDENCE IN OPPOSITION TO DEFENDANT GUTlERREZ' MSJ

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2

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I Declaration of Jin N. Lew

3 I, Jin N. Lew, declare:

4

5

1.

I am an attorney at law duly licensed to practice before all the courts of the State

6 of California.

7 8

2.

I have examined the certified copies of the following depositions. True and correct

9 copies of pages from those deposition transcripts are attached to this declaration.

10 11 12 13 14 15 16 17 18

(a) Deposition of A. Singhania, M.D. Volume 1 (Ex. 2)~ (b) Deposition of A. Singhania, M.D. Volume 2 (Ex. 3);

(c) Deposition Transcript of Gustavo Gutierrez, M.D., Volume 1 (Ex. 4) (d) Deposition Transcript of Gustavo Gutierrez, M.D., Volume 2 (Ex. 5) (d) Deposition Transcript of Lawrence Hansen, M.D. (Ex. 6)

(e) Deposition of Harrell Robinson, M.D, Volume 1 (Ex. 7)

(f) Deposition of Harrell Robinson, M.D, Volume 2 (Ex. 8)

19 I declare under penalty of perjury that the foregoing is true and correct.

20

21 Executed on July 29,2010, at Los Angeles, California

22

23 24 25 26 27 28

F\08-126\MTN\plts evidence guncrrez.wpd PLAINTIFFS' EVIDENCE IN OPPOSITION TO DEFENDANT GUTIERREZ' MSJ

•• ••

EXHIBIT

\

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Exhibit 1

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I 2 3

4 I, Ronald Katz, M.D,. declare:

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Declaration of Ronald Katz, M.D.

In Opposition to Motion for Summary Judgment

5

6 1. I am a physician licensed to practice medicine in the State of California. I am 7 currently a Clinical Professor in the Department of Anesthesiology at the University of California 8 Los Angeles Medical Center. I received my medical degree from Boston University School of 9 Medicine in 1956 and completed my residency in anesthesiology at Columbia University

10 Presbyterian Medical Center in 1959. I am board certified by the American Board of 11 Anesthesiology. I have been specializing in spine surgery including surgeries of the cervical spine. 12 I have authored and contributed to publications in the field of anesthesiology. I routinely lecture 13 in the field of anesthesiology and the medicine to medical students, residents and postgraduate 14 fellows. I have also given numerous presentations to the medical community across the United 15 States on the topics of anesthesiology and medicine. More detailed information about my training, 16 skills and experience is included in my curriculum vitae; a copy of which is attached to this 17 declaration as Exhibit 3__ and incorporated by reference here.

18

19

2.

Since completing my residency in 1959, and up to the present, I have been practicing

20 full time providing anesthesia medical care and treatment to patients and teaching anesthesiology 21 as a physician specializing in anesthesiology. I am familiar with the standard of care applicable to 22 the practice of anesthesiologists, anesthetists and the medical community in the United States and 23 as it applies to the circumstances and events surrounding and including the medical care and 24 treatment rendered to Maria Garcia in March 2008. I have also served as Chief of the Medical 25 Staff at UCLA Medical Center. As such, I have had extensive experience with and have served 26 as a consultant in the credentialing, recommendations and referrals of physician and surgeons who 27 are applying for practice privileges in a surgical setting, and am familiar with the standard of 28 practice applicable to the credentialing, referrals, recommendations and staffing of physicians and

Declaration of Ronald Katz, MD.

1

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1 surgeons under circumstances similar to the events leading up to and involving the subject surgeries 2 performed on Maria Garcia.

3

4 5 6 7 8

3.

I have reviewed the following materials regarding this case:

a.

Deposition of Lawrence Hansen, M.D.;

Deposition of Gustavo Gutierrez, Volumes I and II; Deposition of Harrell Robinson, M.D., Volumes I and II; Deposition of Aruna Singhania, M.D., Volumes I and II;

b.

c.

d.

9 e. Documents asserted to be medical records of Maria Garcia from

10 Harrell Robinson, M.D. submitted with defendant Gustavo Gutierrez's Motion for

11 Summary Judgment.

12 f. The credential file of Lawrence Hansen, M.D. produced by Gustavo Gutierrez

13 in his verified responses to Request For Documents.

14 g. The evidence, declarations and exhibits submitted with defendant

15 Gustavo Gutierrez's Motion for Summary Judgment.

16

17

4.

I have formulated opinions concerning the care rendered by Gustavo Gutierrez,

18 including his involvement in the credentialing, staffing, recommendation and referral of Lawrence 19 Hansen, M.D. for the surgery performed on Maria Garcia on March 13, 2008 at Hills Surgical 20 Institute. These are not the only opinions that I have concerning the surgery or to which I may 21 testify at the time of trial. I understand that the purpose of this declaration is solely to oppose the 22 motion for summary judgment filed by Gustavo Gutierrez.

23

24 5. It is my opinion as set forth in more detail below, that Gustavo Gutierrez, Certified 25 Registered Nurse Anesthetist, fell below the standard of care in regards to his involvement in the 26 credentialing, staffing, recommendation and referral of Lawrence Hansen, M.D. and leading up to 27 the surgery and death of Maria Garcia on March 13,2008.

28


2

1

The following facts appear from the depositions and the documents including those

••

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6.

2 submitted with Gustavo Gutierrez's motion for summary judgment:

3 (a) Gustavo Gutierrez owned and was an officer and shareholder of Hills

4 Surgical Institute, Inc. which is a surgery center that opened in January 2008.

5 (b) In 2008~ Dr. Lawrence Hansen was an 83 years old gynecologist who

6 in 1999 had retired from his private practice after 30 years.

7 (c) In February 2008~ Dr. Lawrence Hansen submitted an application to

8 obtain surgical privileges and perform gynecologic surgeries including vaginoplasties

9 and posterior colporrhaphies at Hills Surgical Institute.

10 (d) Dr. Lawrence Hansen had not performed a posterior colporrhaphy or

11 vaginoplasty on a patient for approximately 5 years when he submitted his

12 application for surgical privileges to Hills Surgical Institute.

13 ( e) Gustavo Gutierrez participated and was involved in the screening of

14 physicians who applied for surgical privileges at Hills Surgical Institute including Dr.

15 Lawrence Hansen.

16 (f) Gustavo Gutierrez did not know whether Dr. Lawrence Hansen had

17 performed a posterior colporrhaphy or vaginoplasty on a patient in the last 5 years.

18 (g) Neither Gustavo Gutierrez nor anyone else from Hills Surgical Institute

19 ever interviewed or contacted Dr. Lawrence Hansen to discuss his application for

20 surgical privileges

21

(h)

Gustavo Gutierrez referred Dr. Lawrence Hansen to Dr. Harrell

22 Robinson and insisted that Dr. Hansen perform a vaginoplasty/posterior

23 colporrhaphy surgical procedure on the patient Maria Garcia.

24 (i) Gustavo Gutierrez never informed Dr. Harrell Robinson that Dr.

25 Lawrence Hansen had not performed a vaginoplasty/posterior colporrhaphy

26 procedure for approximately 5 years.

27 U) Dr. Lawrence Hansen first learned he had been granted privileges to

28 perform surgery at Hills Surgical Institute the day before Ms. Garcia's scheduled


3

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1 surgical procedures on March 13,2008.

2 (k) Dr. Lawrence Hansen first learned he was going to perform surgery on

3 Maria Garcia on or about the day before her scheduled surgical procedures.

4 (1) If Dr. Harrell Robinson had been informed that Dr. Lawrence Hansen

5 had not performed a vaginoplasty/posterior colporrhaphy procedure in nearly 5 years,

6 he would have had Maria Garcia's vaginoplasty procedure done at a different surgery

7 center with a different surgeon.

8 (m) On March 13, 2008, Dr. Lawrence Hansen performed a

9 vaginoplasty/posterior colporrhaphy procedure on Maria Garcia.

10 (n) Gustavo Gutierrez paid Dr. Lawrence Hansen for the vaginoplasty/posterior

II colporrhaphy procedure he performed on Maria Garcia.

12 (0) By the end of the surgery, Maria Garcia's condition became unstable

13 resulting in a loss of heart rate and extremely low blood pressure resulting in her

14 transport to an Emergency Room where she was pronounced dead.

15 (P) The Orange County coroner conducted an autopsy and

16 concluded that Maria Garcia died from massive blood loss into the abdominal cavity

17 secondary to a perforation in the vaginal wall caused by the vaginoplasty/posterior

18 colporrhaphy.

19 (q) Gustavo Gutierrez was serving as the anesthetist administering anesthesia for

20 Ms. Garcia when he left Ms. Garcia during surgery and was found at the doorway

21 to the surgical suite when Ms. Garcia's condition was first discovered to be unstable.

22

23

7.

Based upon my education, training, skill and experience in the field of anesthesia and

24 medicine as set forth in this declaration, it is my opinion that Gustavo Gutierrez, a certified 25 registered nurse anesthetist, violated the standard of care as follows:

26 (a) Mr. Gutierrez failed to appropriately credential Dr. Lawrence Hansen when he

27 applied for surgical privileges with the surgery center that Mr. Gutierrez owned and

28 operated. Because Dr. Hansen applied for privileges to perform vaginoplasties and posterior


4

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I colporrhaphies, the standard of care obligated Mr. Gutierrez to speak with and interview Dr.

2 Hansen to obtain information ascertaining his experience and ability in performing such

3 surgical procedures. This is particular1y true when no one else from his surgery center

4 interviewed or spoke with Dr. Hansen about his abilities, qualifications or experience in

5 performing such surgeries.

6 (b) Mr. Gutierrez recommended Dr. Hansen and insisted that Dr. Hansen perform

7 Ms. Garcia's vaginoplasty/posterior colporrhaphy procedure. In doing so, the standard of

8 care required Mr. Gutierrez to know Dr. Hansen's recent experience and current ability to

9 perform such surgeries. Instead, Mr. Gutierrez claims he did not know Dr. Hansen's

10 experience regarding vaginoplasty/posterior colporrhaphy procedures. Because Mr.

11 Gutierrez recommended and referred Dr. Hansen for Ms. Garcia's vaginoplasty procedure,

12 Mr. Gutierrez violated the standard of care by failing to ascertain the fact that Dr. Hansen

13 had not performed such surgical procedures for nearly 5 years; and then failing to inform

14 Dr. Robinson of this fact.

15 (c) Mr. Gutierrez had also violated the standard of care during the surgery by leaving

16 Ms. Garcia unattended by an anesthetist while under general anesthesia and prior to the

17 discovery that she had become medically unstable. As the anesthetist, the standard of care

18 required Mr. Gutierrez to monitor and document Ms. Garcia's condition including her vital

19 signs throughout the surgery. His departure from his station constitutes a violation of that

20 standard of care and calls into question the reliability of the anesthesia record documenting

21 Ms. Garcia's condition and when and how she started to deteriorate during the surgery ( See

22 paragraph 3(1) of this declaration).

23

24 9. Based upon my education, training, skill and experience in the field of anesthesia and 25 medicine as set forth in this declaration, it is my further opinion that as a reasonable medical 26 probability, if Mr. Gutierrez had complied with the standard of care by informing Dr. Robinson that 27 Dr. Hansen had not performed vaginoplasties and posterior colporrhaphies for nearly five years, 28 Dr. Hansen would not have performed the vaginoplasty/posterior colporrhaphy procedure that


5

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

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1 resulted in the massive loss of blood into the intra-abdominal space. This opinion is based on Dr. 2 Robinson's deposition in which he testified to the effect that ifhe been told that Dr. Hansen had 3 not performed a vaginoplasty/posterior colporrhaphy in nearly five years, he would not have 4 permitted Dr. Hansen to perform the vaginoplasty/posterior colporrhaphy procedure on Ms. Garcia.

5

6 I declare under penalty of perjury under the laws ofthe State of California that the foregoing

7 is true and correct.

8 Executed this ]uly~7, 2010, in Santa Monica, California.

ROnKatz, M.D.


6

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EXHIBIT 'J....

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EXHIBIT

.. _,i1

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Exhibit 2

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REC'D JUN 29 2009

CERTIFIED COpy


FOR THE COUNTY OF ORANGE

CENTRAL JUSTICE CENTER .

MATTHEW GARCIA, a minor, ETHAN } GARCIA, a minor, REBECCA GARCIA I a ) minor, by and through their guardian) ad item,GonzaloGarcia,. )

)

Plaintiffs, }

}

vs , ) No. 30-2008-

) 00105390

. HARRELL ROB INS ON , M . D ., HARRELL )

ROBINSON, M.D., INC., PHYSICIANS & )

SURGEONS OF ORANGE COUNTY, INC., )

HILLS SURGICAL INSTITUTE, ROYALTY )

PERFECTIONS GLOBAL MEDICAL SURGICAL ) CENTER, ROYALTY PERFECTIONS COSMETIC )

INSTITUTE, DOES 1 THROUGH 30, )

INCLUS IVE ( )

)

Defendants. )

----------------------------------)

DEPOSITION OF ARUNA SINGHANA1 a witness herein,

taken by Carroll, Kelly, Trotter, Franzen &

McKenna, at 1071 West Santa Ana Boulevard,

Santa Ana, California, at·l:05 p.m., Wednesday,

June 17, 2009, before Candace Bush, CSR 11579.

Hutchings Number 223385

HUTCHINGS~ COURT REPORTERS

GLOBAL LEGAL SERVICES

HEADQUARTERS:

6055 E. WASHINGTON BLVD~ 8TH FlOOR los ANGELES, CA 900ll0-2429

80D_697.3210 323.888.6300

FAX: 323.888.6333· \WfW.hutchlngs.com

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13:08

1

autopsies each year.

2

Q. Each year. Okay.

3

A. So ltve been doing for the last 26 years.

4 Q. Here in Orange County?

5 A. Yes.

6 Q. And can you tell from looking at your report

7 when you did this autopsy?

8 A. Yes.

9 Q. When?

10 A. I did in March 14, 2008.

11 Q. And when did you dictate your report?

12 A. Same time.

13 Q. March 14, 2008?

14 A. Right.

13:08

15

Q. It says that the autopsy, as far as I can tell

16 from the beginning of it, it provides a time, autopsy

17 date, and time was 8:31?

18 A. That's correct.

19 Q. SO is that when you started the autopsy?

20 A. Yes, thatls correct.

21 Q. And then there's a page in the report of a

22 fellow named Grant Fry who takes photographs at 9:00.

23 A. Okay.

24

Q. Thatts what he says there anyways. On 3/14, at

25 9:00 a.m. he took 73 pictures.

5

HUTCHINGS COURT REPORTERS, LLC - GLOBAL LEGAL SERVICES 800.697.3210

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13:11

1

unless it is important, I don't get the medical record.

2

Q. I see.

3 So when did you dictatel at least, the March 14th

4 version of your autopsy report?

5 A. Okay_

6 What happens is like r did my external, I dictate

7 my external first, then I open the body_ I dictate

8 right after I finish the internal examination, so that

9 dictation get transcribed later aD, sometime a week, two

10 weeks. But it is on the tape same day when I took the

11 autopsy.

12 Q_ I understand.

13 And then like on this autopsy, for example, it

14 indicates there's an amendment on May 2nd, 2008. Do you

15

know what that amendment was?

16 A. Well, there's really -- it's Dot amendment.

17 After the autopsy, you want to do further work, for

18 example, in this case we were doing toxicology, we did

19 the chemical analysis on vitrous fluid, and then this is

20 the case, the kind of case in which the investigator

21 more work on the case, so the case is not finished.

It's like open file. So when they

the case; after

22

23 the -- most of the work is done; then there is like a

24 finally the cause of death get filed, and that is 5/22.

25

Q. So it was on 5/22 that the cause of death was

8


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13:13

1

arrived at and dictated?

2 A. Right.

3 Q. Okay.

4 And in the intervening time frame between March

5 14th and May 22nd, you1ve got the toxicology results and

6 the chemical analysis of the vitrous fluid and the rest

7 of the investigation?

8 A. Yes, that1s correct.

9 Q. And it was based on the totality of that that

10 you came up with a cause of death; right?

11 A. Thatrs right.

12 Q. Let me ask you just some quick questions about

13 some of these photographs. There were 73 photographs

14 that were produced. Is that consistent with your

13:13

15

memory?

16

A. Whatever it is, itrs there.

17 Q. Okay.

18 Can you just look at the photographs in general and

19 tell me if indeed these are the photographs from this

20 autopsy. Irm placing before you all 73.

21

A. That1s fine.

22

MR. MacRILL: And you got those pursuant to a

23 subpena?

24

MR. CARROLL: Yes.

25

MR. LEW. Well, reprint, but it might be best

9


13: 14

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2

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evidence problem, so --

MR. CJ>...RROLL: Well, I think. we ~

c::>n I t have any

trouble stipulating to the foundatior'::l. for
the pictures.
THE WITNESS: Some of them look .:::t ike
a repeat of
the same thing, but pretty much this ..:::i_ s.
MR. CARROLL: 7 Q. But are they fair and accurat::. ~

representations

8 of that body?

9 A. Yes, that's correct.

10

Q. And youve taken the time to

So ahead and

11 carefully --

12 A. Yes.

13

14

13 ~ 15

15

Q. __ look through all of them,

that.

<::tl"ld r appreciate I just wanted to ask you about..

Let me break that one open

q couple of them. and W"~ I 11

mark this

16

separately as Exhibit 1 to the

deposi t:.:l

on transcript [

17

and ask you what is on the top?

The.:c~ I

s two pictures on

18

Exhibit Number 1.

What r S the picture on the

top of the

19

page? [EXH-l]

20

A. This is the abdomen. Okay? "r-.

-L..J.l..k:e th [ ,

~s lS the

21 bowel (indicating).

22 Q. The large bowel?

23

24

A. Well, I cannot say. but this is a bowel. This

This could b

e small bowel,

could be pO:t't:.

~on of a small

25 bowel too (indicating).

10

HUTCHINGS COURT REPORTERS, LLC - GLOBAL

800[697.3210 LEGAL SERVICES

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13:l6

1

Q. You're pointing to different things on the

2 photograph.

3 A. If you see this, this is how it should be here.

4 This is the chest plate here. And when you open the

5 belly, the first thing is the bowel is sitting and it's

6 kind of protruding out. So this is superficially, this

7 could be small bowel, large bowel, but this is the

8 bowel. And then you see this liquid blood in the belly,

9 and this is the abdominal wall. See, here, this is the

10 abdominal wall (indicating).

11

Q. I see.

12 And then it says here, yeah, on page 9 of your

13 report, there's an indication that there's about 2/000

14 ecs of liquid bloody content?

13:17

15

A. It should be page 4.

16

Q. Okay.

17 Page 4, I see. I'm looking at the bottom

18 right-hand corner. That IS probably Bates-stamped from

19 my copy company, but you're right, it's page 4, And

20 under the category IIDiaphragm,H it says nUnremarkable,"

11

21 and it describes 2,000 ees of liquid bloody content from

22 the abdomen; right?

23 A. That's what these are (indicating).

24 Q. In that same exhibit that live handed you

25 there's two -- they look like pitchers to me.


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13:17

1

A. That's what they are.

2 Q. And that's the bloody content that you took

3 from the abdominal cavity?


5 Q. And then the other picture on that page, is

6 that blood still in there or blood taken out already?

7 A. No, this is the photograph when you open it,

8 the bloodr it start seeping out, and then you collect

9

it. Otherwise, it I S very hard to saYr then we have to
measure how much blood it is, so these are the
Q. 2,000 ccs?
A. 2,000 cc of
Q. That are referenced on page 4?
A. That's ·it.
Q. And what's the white stuff on the top?
A. When you're taking out stuff, that could be 10

11

12

13

14

13:18

15

16

17 just a reflection, it could be some more stuff. I don't

18 know. I cannot say what it is. It is a bloody fluid,

19 that's all I can say. When you're collecting blood,

20 there1s some other kind of fatty tissue maybe.

21 Q. SO is this fat?

22

A. I cannot say that definitely. No, I cannot say

23

what it is in there.

I don't know.

24

Q. Okay.

25

A. But if it would be fat, I would be -- when

12


._--_ .. _-_._. - ---

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1 STATE OF CALIFORNIA ) ss

2

3

I, Candace Bush, CSR 11579, do hereby declare:

4

5 That, prior to being examined, the witness named in

6 the foregoing deposition was by me duly sworn pursuant

7 to Section 2093(b} and 2094 of the Code of Civil

8 Procedure i

9

10 That said deposition was taken down by me in

11 shorthand at the time and place therein named and

12 thereafter reduced to text under my direction.

13

14 I further declare that I have no interest in the

15 event of the action.

l6

17 I declare under penalty of perjury under the laws

18 of the State of California that the foregoing is true

19 and correct.

20

21

WITNESS my hand this

23rd

day of

June

2009

22

24

23

24

25

HUTCHINGS COURT REPORTERS, LLC - GLOBAL 800.697.3210

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EXHIBIT

:2_

EXHIBIT 3

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Exhibit 3

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•• REC'D JUN 1 8 2010



)30-2008 00105390 }

) Volume .11 )

Plaintiffs, )Pages 25 - 93 )

v. )

)

HARRELL ROBINSON, M.D., )

HARRELL ROBINSON, M.D., INC., ) ORIGINAL PHYSICIANS & SURGEONS OF ORANGE)

COUNTY, INC., HILLS SURGICAL )

INSTITUTE, ROYALTY PERFECTIONS )

GLOBAL MEDICAL SURGERY CENTER, )

GLOBAL MEDICAL SURGICAL CENTER,)

ROYALTY PERFECTIONS COSMETIC )

INSTITUTE, DOES 1 THROUGH 30, )

INCLUSIVE, )

MATTHEW GARCIA, a minor,

ETHAN GARCIA, a minor, REBECCA GARCIA, a minor, by and through their Guardian Ad Litem, Gonzalo Garcia,

CASE No.

Defendants.

CONTINUED DEPOSITION OF:

ARUNA SINGHANIA THURSDAY, JUNE 10, 2010 12:59 P.M. - 2:08 P.M.

PORTER SIPES & ASSOCIATES

'-COURT REPORTERS-

File No. 10-321-8 Reported by:

Michael W. Sipes CSR No. 3572

3045 STONER AVENUE

Los ANGELES CALIFORNIA 90066-1107

,

PHONE 310-787·4499 FAX 310-915-0090 pmpcsr@earthlinknet

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1

2

A.

That's correct.

Q.

You brought with you here today a complete

3 copy of your autopsy report?

4

5

A.

Yes, I did.

Ol:03:54PM

6 custodian of records for the Orange County Coroner's

7

Okay.

Q.

We have marked as Exhibit 2 to the

8 look at it, actually Exhibits 2 and 3 collectively.

office an autopsy report.

Is this -- feel free to

9 Is that a true, complete and accurate copy of the

10

original autopsy report that you prepared with

11 respect to the autopsy that you performed on Maria

12 Garcia?

13

A.

Thatrs correct.

14 (The documents referred to

15 were previously marked as Holland

16 Deposition Exhibits 2 and 3 for

17 identification and copies attached

18 hereto.}

19 BY MR. LEW:

20

Q.

Okay.

Now, when you performed this

Ol:04:19PM

01: 04: 42PM

21 autopsy, you did so in your capacity as the forensic

22 pathologist for the Orange County Coronerrs office;

23 lS that correct?

24

25

A.

That's correct.

Q.

And the autopsy itself was performed March

Ol:04:59PM

••

••

1 14, 2008, 13 that true?

2

3

A.

That's what my record shows, yes.

performed.

Q.

Okay. Although your records show that,

4 itrs also true that was the date of the autopsy you

5

Correct?

A.

That's correct.

6

7

Q.

.

Was that autopsy performed starting

Okay.

8 at about 8:30 in the morning?

9

10

11 day?

12

13

A.

That's correct.

Q.

Was that your very first autopsy for the

A.

That's probably true.

Q.

All right.

So when you performed

Okay.

14 this autopsy, what did you do generally speaking?

15

A.

Well, when I do autopsy, first I read an

16 investigator who goes to the scene and prepare the

17

18

19

20

21

22

23

24

25

investigator report.

So in this case like BB is the

initial, Brooke Beasley is the investigator.

this case.

In

Case number here is on the top right

(Indicating) 081619.

Ol:05:10PM

Ol:05:19PM

Ol:05:32PM

Q.

I see.

·Ol:05:57PM

Ol:06:07PM

A.

BB 15 initial for the investigator.

BB.

Q.

I'm sorry, can you spell the name for me?

A.

It's Brooks

Q.

Brooks?

PORTER SIPES & ASSOCIA'T'F',S (~ln) 7R7-4.1.QQ

1 2 3 4 5 6

••

••

A. Beasley. Q. Beasley.

A. Yes.

Q. All right.

A.

So she's the coroner investigator.

And she 01: 06: 11 PM

goes to the scene, she prepares notes for us.

On

7 that basis we do autopsies.

8 So she -- and then first thing which I do

9 is go and do the external examination of the body.

10

Q.

Okay.

What is involved in the external

11 examination of the body?

12

A.

External examination means examination of

13 the body from the top to bottom or top to toes, to

14 15

see anything other than normal.

So any kind of

hospital intervention line, anything there, I

16 document it.

17

Q.

So if I understand your testimony, then, as

01:06:32PM

01:06:50PM

18 part of your external examination you would visually

19 20 21 22

look over the external aspect of Maria's body. that correct?

Is

A. Q.

Correct.

I see.

If there is anything that you think

23 to be significant, that's something you would

24 25

document. True?

A. That r s correct.

PORTER SIPES & ARRorTATPR (~ln\ 7R7-Jdqq ~~

01:07:1QPM

••

••

1 was surrounded by bruising?

2 3 4 5 6 7 8 9

10 11 12 13

A.

That's correct.

Q.

And what significance did you attach to

that?

A.

Well, the person is alive.

T hat f s why 0 n 1 y 01 : 14 : 47 PM

bruising when person heart is circulating, then they can bruise.

Q. So the fact the bruises were present around each of those liposuction puncture marks tells you the punctures occurred while the patient was still alive.

A.

That's correct.

nkriv. All right.

Got it.

Then

Q.

Okay.

14 fur~hpr down in the section for primary incision,

15

you note here that there's a fracture of the

01:15:02PM

01:15:19PM

16 mid-sternum around the fourth intercostal space with

17 hemorrhage in the soft tissue under the breast plate

18

and on the surface of the pericardial sac.

This

19 fracture and hemorrhage are related to

20 21 22 23 24 25

cardiopulmonary resuscitation.

Do you see that?

Yes, I do.

A. Q.

Okay.

So during your exam you physically

observed after you opened up the body a fracture in the mid-sternal area around the fourth intercostal

space, correct?

PORTER SIPES & ASSOCIATES (310) 787-4499 44

01:15:35PM

01:15:48PM

••

••

1 2

A.

Right.

Q.

And you also saw in that same area a

3 presence of hemorrhage in the soft tissue under the

4 breast plate.

5

Yes.

That's the same, under the fracture

A.

6 there's a hemorrhage.

7 8 9

10

Q.

Okay.

And you also saw some hemorrhaging

on the surface of the pericardial sac?

A. That's part of the same resuscitation.

Q.

Based upon your observations of what you

11 were seeing you concluded that that fracture and

12 hemorrhage was related to chest compressions.

13 14 15

A.

That's correct.

Q.

Got it.

But you saw no other evidence of

trauma or fracture to any other aspect of the rib

16 cage. Is that true?


18 Q. In your examination of the cardiovascular

19 20

system, did you find everything to be within normal limits?


22 Q. SO in effect, you saw no evidence of heart

23 disease. Correct?

24 A. Correct.

25

Q.

Heart looked perfectly well to you.


Ol:15:56PM

Ol:16:09PM

01:16:20PM

01:16:33PM

01:16:38PM

••

••

1 True?

2

3

4

5

6

and spine.

A.

That's true.

Ol:19:14PM

7 the fracture in the sternum consistent with the CPR

Q.

You also examined and evaluated the ribs

True?

A.

That's correct.

Q.

You found the ribs and spine, except for

8 you mentioned earlier, other than that everything

9 seemed to be within normal limits?

10

11

12

13

14

15

or trauma.

A.

That's correct.

Q.

No evidence or signs of disease or injury

True?

A.

That's correct.

Q.

All right.

So returning to the autopsy

findings and your evaluation of the respiratory

16 system.

17

18

A.

Okay.

01:19:24PM

01:19:37PM

Q.

Now, it states here that you found 360 cc's

19 of hemorrhagic fluid in the right pleural cavity and

20

21

22

90 cc in the left pleural cavity.

Correct?

A.

Right.

Q.

That pleural cavity that you're referring

23 to, that's superior to the diaphragm?

24

25

A.

That's correct.

01:19:52PM

Ol:20:02PM

Q.

Okay.

Did the presence of that fluid, did

PORTER SIPES & ASSOCIATES (31G) 787-4499

49

••

••

1 you think that to be secondary to the CPR? Or did

2 you not?

3 4 5 6 7 8 9

10 11 12

A.

Most likely.

Q.

Most likely.

That was your opinion at the

A. Q.

That's correct.

time?

Okay.

You also took sections of the

pulmonary artery?

A. That's correct.

Q. And you reviewed and evaluated them?

A. Q.

I did. Okay.

And you found a blood clot in the

13 right pulmonary artery?

14 15

A. Q.

Right.

Okay. And you evaluated and assessed that,

16 correct?

17 18 19 20

A. Q.

That's correct.

And is it was your conclusion that blood

clot occurred after death.

True?

A. That's how it grossly appeared to me.

21 Microscopically it looked different.

22 23 24 25

Q. A.

What do you mean by that?

Well, later on we do sectioning.

Then it

appears to be antemortem rather than postmortem.

Q. Do you have a record of that anywhere?

01:20:15PM

01:20:26PM

01:20:35PM

01: 20: 43PM

01:20:57PM


4 5

••

••

1 A. I am describing the pulmonary arteries on

2 left and right. So right has a clot and left

3 doesn't have it.

Q.

Got it.

Your final sentence in the

Okay.

section for respiratory system on the autopsy

6 report, it says section of the lung parenchyma

7 reveals congested atelectic

8 9 10 11 12 13 14 15 16 17 18

A. Q.

Atelectatic.

atelectatic, thank you, slightly

hemorrhagic lung without any gross consolidation,

tumor or trauma.

And what was that significance of

that finding, if any?

A. That shows that it's a negative finding.

01:38:41PM

01:38:54PM

Q. A.

Negative for what you mean?

Mea n s the ref s no con sol ida t ion, the rei s no 01 : 39 : 11 PM

trauma, there is no tumor. describing it.

That's what it is

Q. So In

other words, the lung seemed healthy

19 otherwise.

20 21 22 23 24 25

A.

Right. Got it.

All right.

Q.

Okay.

Going on to the bottom of that page

four of your autopsy report, paragraph that starts there is about 2,000 cc's of liquid bloody content collected from the abdominal cavity suggesting


01:39:21PM

01: 39: 40PM

••

••

1 2 3 4 5 6

That is the 2,000 ccls of blood that is contained in the stainless steel buckets, that's Exhibit 1 to your deposition (Indicating)?

A. Thatls correct.

Q. And that photo of the two steel buckets

7 containing the blood is a true and accurate

8 depiction of what you observed in terms of how much

9 blood you found in the abdominal cavity?

10 11 12 13 14 15 16 17

A.

That's the amount we collected.

Ol:40:05PM

01:40:17PM

01:40:33PM

Q.

So your answer would be yes to my question?

18 state here that you had, as part of the autopsy,

19 removed the uterus, cervix, the tubes, ovaries,

20 vagina, and anterior and posterior cul-de-sac, true? 01:41:02PM

21 22

A.

Yes.

Thank you.

Doctor, going on to page five of your report in the section for the genitourinary system?

Q.

A. Q.

Right.

In the second paragraph of that section you

A.

Correct.

Q.

Then you conducted a close examination of

23 the posterior cul-de-sac?

24 25

A.

Correct.

Q.

You found a through-and-through injury to


01:41:11PM

12 13

••

••

2 3

1 the wall of that organ?

A.

It's a puncture wound, yes.

Q.

And the puncture wound was through and

4 through?

5 6

A. Q.

Right. 01: 41: 19PM

And in terms of the puncture wound, you

7 measured the wound itself to be about 1.5 by one

8 centimeter in size?

9 10

Well, it's not the wound.

A.

It's the

hemorrhagic area.

That's all you can see because

11 tissue is collapsed, not like a tunnel-shaped

defect.

It's not there.

It's a puncture wound.

Q.

So it's a hole and around it you found a

14 collection of blood.

15 16

A. Right.

That redness you can measure.

17 Q. The presence of blood around the wound,

18 does that signify to you that that occurred prior to

19 her death?

20 21

That's about it.

A.

That's correct.

Q.

Could you time for me when that wound

22 occurred?

23 24 25

A.

No.

Other than just to say prior to death. Right.

Q. A.


01:41:33PM

01:41:48PM

01:41:56PM

01:42:04PM

•••

••

1

Q.

Got it.

Now, moving on to page SlX of your

2 report, after removing all the various organs from

3 the genitourinary system, you conducted a

4 pathological examination of the vagina itself,

5 cor r e c t ? 01 : 42 : 29 PM

6 A. Right.

7 Q. You saw during your exam signs of a

8 9 10 11

surgical repair with sutures in the posterior

vaginal vault.

True?

A.

Right.

Q.

Okay. And this sutured area that you

12 observed extended from the external cervical os down

13 to the external posterior vaginal area measuring

14 15 16

about three inches in total length.

True?

A.

That's correct.

Q.

That's what you observed during the

17 autopsy.

18 19 20 21 22 23 24 25

A.

That's correct.

Q.

And in the proximal area of the sutures you

found or discovered a loose blood clot.

Correct?

A. Q.

Right.

And this area corresponded to the puncture

wound in the posterior cul-de-sac.

Correct?

Right. Okay.

A. Q.

So whatever surgery -- strike that.


01:42:37PM

01:42:54PM

01: 43: 02PM

01: 43: 14 PM

••

••

1 It is your opinion based upon this

2 evaluation that whatever surgery was being performed

3 in the area of the vagina, it extended into and

4 caused the puncture wound to the posterior

5 6 7 8 9

10 11 12

cul-de-sac?

A.

That's just what my guess is, yes.

Q.

That was your opinion.

A.

Yes.

Q.

The opinion that you reached as the

forensic pathologist conducting the autopsy in this case.

A.

Based on the information that I had prior

13 to examination.

14 15 16 17 18 19 20

Q. Has your opinion changed since in this

regard?

A.

No.

Q.

Okay.

Doctor, looking at the -- Strike

that.

Doctor, before we leave the subject of the clot in the pulmonary artery, the clot that you saw

21 in the pulmonary artery, the only one clot, that was

22 on the right pulmonary artery as you mentioned.

23 Correct?

24 25

A. Q.

Correct.

And it was only confined to the right lung.


01: 43: 29PM

01:43:36PM

01:43:46PM

01: 44: 22PM

01:44:33PM

15 16 17

••

••

2 3

pulmonary congestion, irregularly dilated bronchial

1 integrity and patency and health of the left lung?

A. Q.

All right.

Doctor, going into your

4 microscopic examination report of the respiratory

5 6

system.

It says section of the lung reveals

7 alveolar spaces and mUltiple areas of fat embolism

8 with blood clot. Do you see that?

9 10 11 12 13

A. Q.

Yes, I do.

So in your microscopic exam of the lung

sections you saw a fat embolus?

A. Yes, I did.

Q.

Did you think that had any contribution to

14 Maria's death?

A.

No.

Q.

Why?

A.

Because with any kind of surgical

18 manipulation, especially liposuction, you see fat

19 20

embolisms very common.

Q. And so the presence,

just the fact that

21 there's the presence of a fat embolism in the lung

22 doesn't mean it caused or contributed to Maria's

23 death. True?

24 A. Not in this case.

25

Q.

Okay.

Did you see any sign of fat embolus


01:45:54PM

01:46:0BPM

01: 46: 19PM

01: 46: 31PM

01:46:42PM

1 2 3 4 5 6 7 8 9

10 11 12

••

••

in the sections of the brain, microscopic sections of the brain?

A. No.

Okay.

Now, in the -- Strike that.

Q.

Did you see any presence of fat embolus or emboli in any other organ of the body?

A.

Yeah, they are there. But they are

insignificant.

Q. Insignificant.

Okay.

No contribution to

Maria's death.

A. That's correct.

Q.

All right.

And in the -- for your

13 microscopic examination of the spleen, I noted here

14 that you state here that there's parenchymal

15 16 17 18 19 20 21 22 23 24 25

congestion, fat emboli present in the splenic

parenchyma, which is irregularly distributed within

the red pulp.

What significance did you attach to

that?

A. Again, that's a part of the fat embolism,

which is going in circulation.

So spleen is the one

which again, these organ entraps the fat and filters it. So you can see the fat in the spleen.

Q.

Okay. Again, you thought it to be

insignificant for purposes of determining the cause of death.


01:47:05PM

01: 47: 17PM

01: 47: 28 PM

01:47;41PM

Ol:47:55PM

1 2

••

••

A.

Especially in this case.

All right.

Doctor, when you were

Q.

3 evaluating or performing the autopsy on Maria, did

4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

you see any evidence of injury or defects to any of the other organs in the abdominal cavity?

A. Q.

No, I did not.

The only one that you saw was the puncture

wound to the posterior cul-de-sac.

A. That's correct.

Q.

Did you see anything that suggested to you

that there was any oozing permeating through the walls of any of the organs?

A. No, I didn't.

Q. Did you see anything that you thought to be petechiae anywhere?

A. Q. A. Q.

What does petechiae mean? P-e-t-e-c

I know. What

Well, anything that suggested to you that

some abnormal clotting problems in the abdomen, apart from obviously the blood clot you saw in the pulmonary artery.

A. When you say blood clot, you have to, again

when you use petechiae is different. different thing.

Totally


01:48:14PM

01: 48: 25PM

01: 48: 34 PM

01: 48: 46PM

01:49:01PM

••

••

1 2

So we

will mark this as Exhibit 7

A.

That's correct.

MR. LEW;

3 to this deposition.

4 (The document referred

5 to was marked as Deposition

6 Exhibit 7 for identification

7 and is attached hereto.)

8 BY MR. LEW:

9 10 11 12 13 14 15 16

Q.

So what significance did you attach to the

results of the toxicology report in terms of the question of the cause of death?

A. Q.

None.

Okay.

What about the timing of death?

it have any significance on that issue?

A. Q.

No. Okay.

Doctor, did you do anything else as

17 a part of your autopsy examination of Maria Garcia,

18 19 20 21 22 23 24 25

other than what we have covered thus far?

A. Not that I know.

Q.

Okay.

And Doctor, your final opinion and

conclusion as to the cause of death for Maria Garcia is what?

A. As it is in my report.

Q. Okay. I have here the cause of death being an intra-abdominal hemorrhage due to posterior


Did

Ol:55:03PM

01;S4:27PM

Ol:54:39PM

Ol:S5:16PM

••

••

2

Q. A.

What fluid are you referring to?

Well, she has -- I don't know how much,

1 vaginoplasty?

Right.

A.

And then other condition is status

3 post liposuction.

4 5 6 7

Q. A.

What did you mean by that?

Well, in the liposuction, I don't know how

much fluid she has lost.

So that may have

contributed to the death also.

But I don't know

8 how, but it can.

9 10

Ol:55:28PM

Ol:55:41PM

11 because I'm not there and I don't have no evidence

12 either. But she has the history that was provided

13 that she has -- they are taking out what, 3,000 cc

14 or 2,000 cc of fluid? I don't have accurate

15 numbers. But she already had the procedure. And Ol:SS:59PM

16 then I have evidence of puncture wounds. So she had

17 the procedure done. And there's a bruising around

18 these tells me there's some trauma produced by that.

19 20

That has contributed.

That's a traumatic event.

Q. But in terms of what you believe to be the

21 cause of death, you ascribe that to the blood loss

22 that you found in the abdomen of 2,000 cc which you

23 felt was caused by the puncture wound through the

24 posterior cul-de-sac.

25

That's the physical evidence I have it --

A.


Ol:56:20PM

Ol:56:36PM

••

••

1 based on the physical evidence.

2 Q. This is all related to the posterior

3 vaginoplasty. Correct?

4 5 6 7 8 9

10 11 12 13

A. That's in the close vicinity of that

procedure.

Q. That was your opinion. A. That • s correct.

Q. And that continues to be your opinion. A. Right.

Q. And that's your opinion to a reasonable

medical certainty?

A. Right.

Q.

Got it.

That's your signature on the

14 bottom of this final report?

15 16

01: 56: 48PM

Ol:56:54PM

A . T hat's cor r e ct. 01 : 57 : 03 PM

MR. LEW: We will mark this as Exhibit 8 to

17 this deposition.

18 (The document referred

19 to was marked as Deposition

20 Exhibit 8 for identification

21 and is attached hereto.)

22 23

BY MR. LEW:

Q. Doctor,

going back to the blood test, any

24 other blood tests that you had ordered in this case?

25

A. No.


01:57:16PM

••

••

4 MS. SAMUELSON: I just have a couple of

5 que s t ion sIn e edt 0 ask. 01 : 57 : 37 PM

6

7 8 9

10 11

1 2 3

I have no questions.

MR. LEW: anything further.

Doctor, I don't think I have Anyone else?

MR. MACRILL:

EXAMINATION

BY MS. SAMUELSON:

Q. Good afternoon, Doctor, my name is Heather Samuelson and I represent Dr. Hansen, one of the

surgeons involved in this matter.

I just have some

12 follow-up questions I'd like to ask you.

13 14 15 16 17 18

You took slides of the lung, correct?

A. Yes.

Q. Now, would you agree that the slides of the lung reveal a large amount of fat embolism in the lung?

A.

There is a fat embolism, but is it large

19 amount, I cannot say because in the slides it is

20 21

yeah, there is fat embolism.

Q.

Would you say it is a significant amount or

22 small amount of fat embolism?

23

MR. LEW:

Vague and ambiguous.

24 BY THE WITNESS:

25

A.

I cannot pay importance to it.

There's a


01: 57: 40PM

01:57:51PM

Ol:58:02PM

01: 58: 09PM

1

••

••

definite fat embolism is there.

But on the basis of

2 the slide, I cannot say that it is significant.

3 BY MS. SAMUELSON:

4

5

6

Q.

Can you quantify it in any way?

A.

No, I cannot.

Q.

When you say you cannot say the fat

7 embolism is significant, what do you mean by that?

8

A.

Well, because after I "have done so many

9 liposuction patients, almost every case has a fat

10

embolism.

Body can't take up to 25 milligram

11 gram of fat and not produce any symptomatology.

12

Q.

Do you usually see fat embolism in the

13 lungs after liposuction?

14

15

Right.

A.

You do.

Very common.

25

01:5B:57PM

Ol:58:39PM

Q.

And in this ca se you don r t thin kit had any 01: 59: 20PM

16 significance?

17

A.

Based on the 2,000 cc of blood, that

18 significance goes down.

19

20

Q.

Would you agree that the fat got into the

lungs from being injected into the patient's

21 bloodstream?

22

A.

Yes.

23 (Remarks off the record.)

24 BY MS. SAMUELSON:

25

Q.

Would you agree that the fat that flowed


01:59:57PM

02:00:32PM

••

••

1 circulate with the blood.

2

Q.

Would you agree that the cause of death was

3 a fat mass, fat, massive fat embolism?

4 5 6 7 8 9

MR LEW:

No foundation.

Calls for

speculation.

BY THE WITNESS:

A. Based of the physical evidence of 2,000 cc of blood that's in the abdomen, you cannot say that fat embolism is the cause of death here.


11

Q.

Now, if an ultrasound was performed in the

02:02:17PM

12 ER and it didn't reveal any fluid in the abdomen,

13 wouldn't you conclude that the fluid in the abdomen

14 found on autopsy was due to resuscitation efforts in

15 16 17

the ER?

MR. LEW:

Incomplete hypothetical.

No

foundation.

Calls for speculation as phrased.

18 BY THE WITNESS:

19 20

A. This patient died in OR, not in ER.

Patient was in operating room when she passed.


22 23

Q.

Is that your understanding of this case?

A.

Well, whatever, she passed out when she was

24 having procedure. The -- that's the time she is

25

passed out. And CPR or resuscitation, as I said,


02:03:12PM

02:03:24PM

02:03:37PM

••

••

1 may have caused some blood in the chest cavity, not

2

in the abdomen.

And 2,000 cc of fluid -- 2,000 cc

3 of blood in the abdomen, I haven't seen any

4 resuscitated case.

5

Q.

So are you say in g the res usc ita t ion e f for t s 02 : 04 : 02 PM

6 may have caused fluid in the chest, not the abdomen?

7

8

A. Right.

Q. And you have never seen a case where

9 resuscitation efforts have caused fluid to build in

10 the abdomen? 02: 04: 16PM

11

A.

Well, unless there is a tear to the liver,

12 tear to the spleen, or any, yeah, CPR can cause

13

different abdominal

can tear, and then cause the

14 blood, then I can see, yes, I would say definitely

15

16

17

18

19

20

it can do it.

Q.

But you don't see that as the case here?

A.

No, I don't.

MS. SAMUELSON: I think that is all I have.

MS. RICHARDSON: I have a follow-up.

21 EXAMINATION

22 BY MS. RICHARDSON:

23

Q.

Have you seen the patient's records from

24 Kaiser Anaheim?

25

A.

I may have seen, but I don't recall when I


02:04:29PM

02: 05: 04PM

••

••

1 sit here now.

2

Q.

At the time you did the autopsy or right

3 before you did the autopsy, did you have the Kaiser

4 records?

5

I had all the information.

A.

As I said, my

6 investigator is the one who collected that

7

information.

And that's how I do the autopsy.

8 she may have provided me all the information.

9

10

Q.

And do you know one way or the other

whether or not they had any information with regard

11 to the ultrasounds that were performed in the ER?

12

13

14

15

16

A.

Well, even it is performed ultrasound, I

So

02;OS;46PM

have physical evidence.

So you know, all these

02:05:14PM

02:05:29PM

17 see my naked eye is more important than all the eTs,

modality are great.

I have no reservation or

anything.

But based on the physical evidence, all

these modalities to me is insignificant.

So what I

18 all the scans, everything, is become secondary.

21

22

23

19

20

They are there.

They are very diagnostic

procedure, there is no doubt, but there is always

what's take the first is physical.

So when I see

the body, I see the blood.

That's how I go on it.

Q.

Okay.

Do you know what the results of

24 those ultra sounds were that were performed in the

25

ER?


02:06~lOPM

02:06:47PM

••

••

1

MR. LEW; Couple of real quick questions,

A. Again, as I sit here, I don't remember

2 everything.

MS. RICHARDSON: Okay.

I don't think I have

3

4 5

6

7 Doctor.

anything else.

MR. MACRILL:

I have nothing.

8

9 FURTHER EXAMINATION

10 BY MR. LEW:

11

Q.

It's true that when the heart stops

12 beating, all bleeding stops, true?

13 A. Again, you have to ask the right question.

14 15

You said heart to stop what?

Q. When the heart stops beating, all bleeding

16 stops.

17 18

A.

Right.

Q.

You didn't see during the autopsy any

19 evidence of injury to the diaphragm, did you?

20 21

A. Q.

No, I did not.

02:06:56PM

02: 07: 11 PM

02:07:18PM

22 in Exhibit 1 of your deposition represents the 2,000

23 ec's of blood that you found in the autopsy of Maria

24 25

Okay.

The two pails of blood that we see

Garcia, correct, in the abdomen?

A. That's correct.


02~07:35PM

••

••

4


-----------------

1 STATE OF CALIFORNIA

2 ss

3 COUNTY OF LOS ANGELES

5 I, MICHAEL W. SIPES, CSR No. 3572 in and

6 for the State of California, do hereby declare:

7 That, prior to being examined, the

8 witness named in the foregoing deposition, to wit,

9 ARUNA SINGHANIA, was by me duly sworn/affirmed to

10 testify to the truth, the whole truth, and nothing

11 but the truth;

12 That said deposition was taken down by

13 me in shorthand at the time and place therein named,

14 and thereafter reduced to printing under my

15 direction, and the same is a true, correct and

16 complete transcript of said proceedings.

17 I further certify that I am not

18 interested in the event of the action.

19 WITNESS MY HAND this 16th day of June,

20 2010.

21

22

____uiJ»

Certified Shorthand Reporter

23

24

For the State of California

25

••

••

EXHIBIT

EXHIBIT 4

•• ••

Exhibit 4

SUPERItt~RT OF THE STATE O~~FORNIA FOR THE COUNTY OF ORANGE

MATTHEW GARCIA, a minor,

ETHAN GARCIA, a minor, REBECCA GARCIA, a minor, by and through their Guardian Ad Litem, Gonzalo Garcia,

Plaintiffs,

CASE No.

v.

)30-2008 00105390 )

)Volume I )Pages 1- 205 )

HARRELL ROBINSON, M.D.,

HARRELL ROBINSON, M.D., INC., PHYSICIANS & SURGEONS OF ORANGE) COUNTY/ INC., HILLS SURGICAL ) INSTITUTE, ROYALTY PERFECTIONS )

GLOBAL MEDICAL SURGERY CENTER, )

GLOBAL MEDICAL SURGICAL CENTER/}

ROYALTY PERFECTIONS COSMETIC }

INSTITUTE, DOES 1 THROUGH 30, }

INCLUSIVE, )

Defendants.

)

DEPOSITION OF GUSTAVO GUTIERREZ, Taken on Wednesday, March 3, 2010

REPORTED BY:

PATRICIA M. PORTER CSR No. 3730

File No: 10-184


.... COURT REPORTERS-

3045 STONER AvENUE

Los ANGELES, CALIFORNIA 90066-1107 PHONE 310·787-4499

FAX 310·915·0090 pmpcsr@earthlink.net

1 2 3 4 5 6

flQ.

Prior to meeting

Dr. Dizon, had you ever had the power to your understanding of being able to hire or fire a staff member?" )

THE WITNESS:

Not officially, no.

7 BY MR. LEW:

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Q.

You and Dr. Dizon eventually started Hills

Surgical Institute,

Inc., correct?

A. Yes.

Q.

And you -- one of you hired an attorney to

assist you in this regard, A. Yes.

true?

Q. A. Q.

Mr. Norm Davis?

Yes.

You had used Mr. Davis for other projects

before Hills Surgical Institute, is that true?

A. I had dealt with Norm Davis, yes.

Q. He was your attorney before ever meeting

11: 29: o SAM

11: 29: 35AM

11:29:43AM

11; 30: aDAM

11: 30: 1SAM

Dr.

Dizon, true?

to help you

A. Q.

Yes.

Okay.

Did Mr. Davis, did you ever hire him to assist you in opening or creating

any sort of medical entity, be it a corporation or facility of any type?


A. Nope.
Q. Okay. And of course, we include Exhibit 6
as well?
A. Right.
Q. Okay. So Mr. Gutierrez, when Hills 02:20:42PM 1 these are the shareholder's meeting minutes, these

2 two pages we'll mark these collectively as Exhibit 6

3 to this deposition.

4 (The document referred to was marked

5

as Deposition Exhibit 6 for

6 identification and attached hereto.)

7 BY MR. LEW:

8 9 10

Doctor, referring It's not doctor.

Q. A. Q.

You're correct.

Mr. Gutierrez,

I'm sorry.

11 apart from Exhibit Number 5, Exhibit Number 4, and

12 specifically, the documents that are contained in --

13 therein, are you aware of any other documents that

14 would be responsive to request number seven of your

15 16 17 18 19 20

notice of deposition, Exhibit Number 2?

21 Surgical Institute, Inc. came in existence, you were

22 the secretary of the corporation, correct?

23 24 25

A.

Yes.

Q.

And you were also the chief financial

officer, correct?


02:19:14PM

02:20:01PM

02:20;28PM

02: 21: 11 PM

1 2

A.

Yes.

Q.

Dr. Dizon was the chief executive officer,

3 true?

4 5

A. Q.

Yes.

You were also -- served as the agent for

6 service of process, identified as -- on behalf of

7 the corporation, correct?

8 9 10 11 12

A. If that's what it says, yes. that, but --

I didn't know

Q.

I notice there is an address here, 902

suite 100 in Santa Ana? was a typo by Norm Davis.

North Grand Avenue, A. Yeah, that

He

13 corrected that.

14 15

Q.

Okay.

And that's -- that is your signature

there at the bottom of the statement of information

16 that is contained in Exhibit Number 4?

17 18 19 20

A.

Yes.

I saw it.

That's my signature.

Q. In Exhibit Number 5, attached as part of Exhibit A to this response to request for production of documents, set three amended, I see that the

21 bylaws of Hills Surgical Institute, Inc. are

22

contained in this set.

To your understanding, these

23 are the bylaws that were in effect when Hills

24 Surgical Institute, Inc. came into existence, up

25

through the date it was finally --


02:21:17PM

02:21:32PM

02:21:48PM

02:22:59PM

02:23:19PM

1

2 discovery, but I don't think we've seen a record of

3 the shareholder agreement relative to Hills Surgical

4 5 6

Q.

So I think we've gone through the

03:1l:08PM

7 exactly like the one Norm Davis produced except it's

8 9 10

Institute, Inc., but you know that one exists, correct?

Yeah, one does exist.

Like I said, it's

A.

for the wrong corporation. thatfs all it is.

He has a template,

Q.

So in terms of the terms of the agreement,

11 it's identical to the one for the Anaheim Hills

12 Surgery Center?

13 14 15 16

A. Q.

It's exactly the same.

Okay.

Turning our attention to Exhibit 6,

the second page, shareholder meeting, this one is

dated March 15, 2008.

Were there any shareholder

17 meetings between January and March of 2008?

18 19 20 21 22 23 24 25

A. Q.

Not that I can recall.

And again, it was just you and Dr. Dizon

that was present during this shareholder meeting on March 15, 2008?

A. He and I were the only shareholders.

Q. A. Q.

Was there anyone else present though? Not that I recall.

And this meeting lasted from 1730 to 2040,


03: 11: 20PM

03: 11: 36PM

03: 11: 52PM

03:12:04PM

1 2 3 4 5 6

that information in response to question 13?

A. Every person taking the test should answer that question or have -- write --

Should write the answer themselves? Correct.

So your understanding of the taking of this

7 test, Dr. Robinson should have written the answer

8 himself, correct?

9 A. Yes.

10

Q. A. Q.

Q.

That was the policy and procedure that was

Q.

11 being followed at Hills Surgical at the time,

12 correct?

13 A. Yes.

14 15 16 17 18 19 20 21

Okay.

No variation from that policy and

procedure to your knowledge, correct?

A.

Of taking the test?

Q. A. Q. A. Q.

Right. No.

So 11m correct? Youlre correct.

Okay.

And Dr. Robinson provides a TB skin

22 test, correct?

23 24 25

A.

Yes.

Q. By the way, do you know who grades the orientation and annual education post test?

04:24:20PM

04:24:26PM

04:24:39PM

04:24:49PM

04:25:00PM


1 State of California

2 County of Los Angeles

3

4 If PATRICIA M. PORTER, a certified shorthand

5 reporter licensed by the State of California,

6 certify:

7 That the foregoing deposition of GUSTAVO GUTIERREZ

8 was taken before me pursuant to Notice at the time

9 and place therein set forth, at which time the

10 witness was put under oath by me;

11 That the testimony of the witness and all objections

12 made at the time of the examination were recorded

13 stenographically by me and were thereafter

14 transcribed;

15 That the foregoing 1S a true record of the testimony

16 and of all objections at the time of the

17 examination.

18 In witness whereof, I have subscribed my name this

19 20 21 22 23 24 25

License No. 3730

11th day of March, 2010.

205

•• ••

EXHIBIT

__ S

•• ••

Exhibit 5

1



2

3

4 MATTHEW GARCIA, a minor; ETHAN GARCIA, a minor; REBECCA GARCIA,)

5 a minor; by and through their )

Guardian Ad Litem, GONZALO )

6 GARCIA, )

)

7 Plaintiffs,)

)

8 vs. ) No. 30-2008 00105390 )

9 HARRELL ROBINSON, M.D.; HARRELL) VOLUME II

ROBINSON, M.D., INC.; )

10 PHYSICIANS & SURGEONS OF ORANGE }

COUNTY, INC.; HILLS SURGICAL )

11 INSTITUTE; ROYALTY PERFECTIONS ) GLOBAL MEDICAL SURGERY CENTER; ) 12 GLOBAL MEDICAL SURGICAL CENTER; )

ROYALTY PERFECTIONS COSMETIC )

13 INSTITUTEi DOES 1 through 30, )

inclusive, )

14 )

Defendants. )

15 )

16

17

18

19 Deposition of GUSTAVO GUTIERREZ, CRNA, VOLUME II,

207

20 taken on behalf of the Plaintiffs, at the Law Offices of

21 Michels & Watkins, located at 11755 Wilshire Boulevard,

22 Suite 1300, Los Angeles, California, commencing at

23 11:06 a.m., on Saturday, May 01, 2010, before Amber Dawn

24 Castaneda, RPR, CRR, CSR No. 7640.

25

11:21:34

11:21:35

11:21:36

11:21:37

11:21:38

11:21:39

11:21:41

11:21:44

11:21:47

11:21:47 10 11:21:51 11 11:21:51 12 11:21:55 13

11:21:58 14
1:22:07 15
11:22:09 16
11: 22: 12 17
11:22:16 18
11:22:18 19
11:22:19 20
11:22:20 21
11:22:21 22
11:22:21 23
11:22:24 24
11:22:28 25 1 2 3 4 5 6 7 8 9

MR. STOCKALPER:

Specifically with this

witness?

MR. LEW:

To his knowledge.

THE WITNESS:

BY MR. LEW:

With me?

Q.

With you being present, was there ever a

discussion about what type of surgeries Dr. Hansen would be performing at Hills Surgical if he was given privileges?

GYN surgeries.

I don't recall any

A.

specific, but, obviously, he's an OB/GYN.

Q.

Did you ever discuss with him vaginoplasty

procedures prior to the surgery with Maria Garcia?

A. I donlt recall specifically talking about vaginoplasties.

Q. Do you have a general recollection of ever discussing with him vaginoplasties prior to the surgery with Maria Garcia?

A. No.

MR. STOCKALPER:

Don't guess or speculate.

THE WITNESS: No.

BY MR. LEW:

Q. Did you ever interview Dr. Hansen for a position at Hills Surgical?

A. I didnlt interview any physicians.

225

11:27:40 1
11:27:43 2
11:27:44 3
11:27:47 4
11:27:50 5
11: 27: 51 6
11: 27: 55 7
11:27:57 8
11:27:59 9
11:28:02 10
11:28:37 11
11:28:40 12
11:28:43 13
11:28:44 14
1:28:44 15
11:28:47 16
11:28:49 17
11:28:50 18
11:28:51 19
11:28:55 20
11:28:58 21
11:28:59 22
11:29:00 23
11:29:01 24
11:29:02 25 Q. Similar to a vaginoplasLy? A. Very similar.

Q. Had you ever had a discussion with anyone concerning Dr. Hansen performing colporrhaphies at Hills Surgical?

A. I donlt believe so.

Q. Did you have an understanding as to when the last time Dr. Hansen had ever performed either a vaginoplasty or colporrhaphy?

A. I do not.

Q. Had Hills Surgical ever had on its staff a physician that could perform vaginoplasties?

Well, objection.

Vague

MR. STOCKALPER:

and ambiguous.

Do you mean other than Dr. Hansen?

MR. LEW:

Sure.

Other than Dr. Hansen.

MR. STOCKALPER:

Okay.

THE WITNESS:

To my knowledge, there was

not another physician that was credentialed to do that procedure.

BY MR. LEW:

Q. So your answer would be no.

True?

A. My answer would be no.

Q.

Okay.

Had Hills Surgical ever had a

230

1

409

REPORTER'S CERTIFICATE

2


55.

4 COUNTY OF SAN BERNARDINO

5

6

I, AMBER DAWN CASTANEDA, RPR, CRR, a Certified

7 Shorthand Reporter within and for the County of

8 San Bernardino, State of California, do hereby certify:

9

That prior to being examined the witness named

10 in the foregoing deposition was sworn by me to testify

11 to the truth, the whole truth and nothing but the truth;

That the said deposition was taken down by me

12

13 in shorthand at the time and place therein stated and

14 was thereafter reduced to print by Computer-Aided

15 Transcription under my direction;

16 I further certify that I am not of counselor

17 attorney for any of the parties hereto or in any way

18 interested in the event of this cause and that I am not

19 related to any of the parties thereto.

20

Dated this 18th day of May, 2010.

21

22

23

AMBER DAWN CASTANEDA, RPR, ~ CSR No. 7640

24

25

1

AMBER DAWN CASTANEDA, RPR, CRR, CSR No. 7640

REPORTER'S CERTIFICATION OF CERTIFIED COpy

2

3 I, AMBER DAWN CASTANEDA, RPR, CRR, CSR No.

4 7640, a Certified Shorthand Reporter in the State of

5 California, certify that the foregoing pages 206 through

6 409, constitute a true and correct copy of the original

7 deposition transcript of GUSTAVO GUTIERREZ, CRNA, taken

8 on Saturday, May 01, 2010.

9 I declare under the penalty of perjury under

10 the laws of the State of California that the foregoing

11 is true and correct.

12

13

Dated this 18th day of May, 2010.

14

15

16

17

18

19

20

21

22

23

24

25

410

legal Tabs Co. 1-800-322-3022

••

••

EXHIBIT

Recycled @ Stock # R-EX-5-B

•• ••

Exhibit 6

••

• tCD JUL 06 2010

SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF ORANGE-CENTRAL JUSTICE CENTER

MATTHEW GARCIA, and minor,

ETHAN GARCIA, a minor, REBECCA GARCIA, a minor, by and through) their Guardian Ad Litem, ) Gonzalo Garcia,

Plaintiffs,

v.

Case No.

30-2008 00105390 (consolidated with 30-2008 0011392)

HARRELL ROBINSON, M.D., et al.,

Defendants.

Volume I

AND RELATED CROSS-ACTION.

CERTIFIED COpy

Deposition of Harrell Robinson, M.D.,

Taken on Thursday, June 24, 2010

Reported By:

SANDRA D. ORTIZ CSR No. 6048 File No. 10-342

PORTER SIPES & ASSOCIATES·

'- COURT REPORTERS-

3045 STONER AVENUE

Los ANGELES, CALIFORNIA 90066-1107 PHONE 310-787·4499

FAX 310-915-0090 pmpcsr@earthlink.net

1

2

••

••

1 lD your hand?

A

That's a good question. Yeah. I think so,

3 yes. Yes.

4

Q

Okay. Now, in terms of what's checked off

5 and applied for, did you check that off?

8 approved, who checked that off?

9 10 11 12 13 14 15 16

A I don't know.
Q Okay. Did you glve this to Mr. Gutierrez?
A Yes.
Q Okay.
A I gave this to him.
Q Okay. Did you ever have a discussion with 13:35
Dr. Dizon about applying for p r i v i Leqe s > 6 7

17

A Q

Applied for? Yes.

Yes. Okay. Now, In the column for

A

No, I did not.

Q

The only person you ever spoke to from

18 Hills Surgical about your application for privileges

19 was Mr. Gutierrez?

20 21

A

Yes.

Q

Was it your understanding that it was

22 Mr. Gutierrez that was going to assess your

23 credentials for purposes of giving you privileges at

24 Hills Surgical?

2S

A

Well, I -- I do know that Dizon was the

PORTER SIPES & ASSOCIATES (310) 787-4499

117

13:36

10

11

12

13

14

15

17

18

19

20

21

22

24

••

••

1

medical director and that he informed me that he
would -- you know, they would have a meeting and --
and they would go through this process of
credentialing me. So I don't know if -- if Gus did
the approval line or Dr. Dizon.
Q Okay. It was Mr. Gutierrez that told you
that he was gOlng to have -- with Dr. Dizon to
discuss whether or not.you would be granted
privileges?
A Yes. He did tell me that, you know, he has
a medical director and that they -- you know, they
wanted to -- to do that and they do that with all
doctors, yeah.
Q Okay. Did he say -- did Mr. Gutierrez say
if anyone else was going to participate lTI the
decision to grant you privileges?
A He did not say. He did not tell me.
Q So to your understanding, it was
Mr. Gutierrez and Dr. Dizon that were going to
determine whether you were going to get privileges
to practice at Hills Surgical; correct?
A To my understanding, yes.
Q Okay.
A It may have been somebody else there, but I
donTt know.
118 13:36

2

3

4

5

6

7

8

9

16

23

25 13:37


1 2 3 4 5 6 7 8 9

10 11 12

••

••

Q Okay. All you know lS Mr. Gutierrez and

Dr.

Dizon; correct?

A Correct.

Q Okay. Let me show you another document.

Weill mark this as Exhibit 3 in order. (Plaintiffs' Exhibit 3 was marked for identification. )

BY MR. LEW:

Q This is a otolaryngology request for

privileges.

A

Okay.

MR. MAC RILL: Excuse me. Was the form we

13 just went over -- was that 2 or 3?

14 MR. LEW: This was 2. So No.3 is a

15 different--

16 17 18 19 20 21 22

MR. MAC RILL: Okay. Thank you.

THE WITNESS: Yeah. You gave it 2, yeah.

BY MR. LEW:

Q And lS that your signature on the bottom of

Exhibit 3?

A It is.

Q

Okay. And did you fill out this request

23 for otolaryngology privileges?

24 A Hold on just a second. Let me just check

25 'cause I know what procedures I do. Yes.


119

13:38

••

••

1 he was being shown around a couple days before the

2 procedure?

3 4

A Q

Correct.

And you -- did you ever speak to

5 Dr. Rheinschild about Dr. Hansen prior to the day of

6 surgery?

7 8

A

No, I did not.

Do they know each other? I mean, did they

9 prior to -- I don't know.

10 Q Unfortunately, I can't answer your

11 question.

12 13

Okay.

I'm sorry.

A Q

Were you asked at all to participate In any

14 of the privileging or credentialing for Dr. Hansen

15 so that he could perform surgeries at Hills

16 Surgical?

17 18 19 20 21 22 23 24 25

had

you know, he's known him for a while. He

A Q

No, I didn't.

Was it your understanding that it was

Mr. Gutierrez that was performing the credentialing for Dr. Hansen?

A

Yes.

Q Okay. That's based upon his

representations to you to that effect?

Yeah. Yes. He said he knew him. He


235

16:59

16:59

10

11

12

••

••

2

know, like, early afternoon, but it may have been

1 could attest to his abilities.

Q

Okay. All right. So the day of surgery,

3 what time is it that you arrived at Hills Surgical?

4

A

Probably in the morning.

5

Q

Okay. By the way, was there any further

6 contact with Maria Garcia between March 9 and

7 March 12 other than that one preoperative contact on

8 March 12?

9

A

With myself? I don't recall at this time.

17:00

17:01

Q

Okay. 17: 00

A

But --

Q

Fine.

I'm sorry. What time was it you

13 arrived at Hills Surgical on the morning of

14 March 13?

15

16

17

18

A

I believe it was in the mornlng.

Q

What time?

A

Typically I arrlve about

between 7:00

and 9:00. If I have surgery, it'd be 7:00.

If it's

19 just seeing patients, 9:00.

20

Q

Okay. But it was your understanding

21 Maria's procedure was scheduled to start at what

22 time?

23

24

A

I believe -- well, I thought it was, you

25 late morning, you know, with all of the plethora of

236


8 9 10 11 12 13 14 15 16 17 18 19 20

••

••

1 Between January 1 of 2008 up to the time of

2 Maria Garcia's case, had you used any other

3 anesthetist or anesthesiologist besides

4 5 6

Mr. Gutierrez?

A No.

No,

I did not.

Q

Okay. And that would be including your --

7 your specific patients; true?

A Q

Yes.

Okay.

It was part of the understanding

between you and Mr. Gutierrez is that they would have you perform cosmetic procedures on Hills Surgical patients, and in turn you would use

Mr. Gutierrez as the anesthetist on your patients?

A

Yes.

Q

That was part of the arrangement?

A

Yes.

Q All right.

A Yes.

Q Now, the next document I see, apparently

dated March 5 of 2008, is an anatomical form

21 diagram.

22 Do you recognize whose handwriting is on

23 this form?

24 We'll mark this as Exhibit 9.

25

A

Looks like my handwriting on this form.


171

14:56

14:55

••

••

1 of used. There was -- I mean he couldn't get rid of

2 every single little thing, but we utilized his

3 form.

4

Q

To your understanding, because

5 Mr. Gutierrez had assumed the lease of the premises,

6 could he exclude you from the premises? Is that

7 your --

8 9 10 11 12

A

He said he could, yeah.

Q

That was your understanding?

A

Yes, it was.

Q Okay. Now -- and Mr. Gutierrez wanted you

to use the Hills Surgical Institute form even if

13 they're your patients?

14

A

Yes. He wanted everything comlng through

15 that office, Hills, you know. I can operate out of

16 17

it,

you know, but --

Q Did you ever use any other anesthetist or

18 anesthesiologist for procedures at Hills Surgical

19 besides Mr. Gutierrez?

20 21 22 23 24

A Q

At some time before or after?

Well, we'll take it before Maria Garcia's

case.

A Q

Oh, yeah. Before he got there, sure.

No, no.

I'm sorry. Let me restate the

25 question.


170

14:55

14:54

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

••

••

1 about that, but this was -- but I don't have the

2 diagrams in that -- for that 'cause I don't do that

3 procedure, you know.

4

Q

Okay. So as of March 5, 2008, the very

5 first visit you had with Maria at Hills Surgical, it

6 7

was your understanding at that time that Dr. Hansen was going to be the doctor to perform the

8 vaginoplasty?

A

It was my understanding. Now, it

Yes.

could be -- I mean

Q Okay.

I think so.

A Q

I believe so.

Was Mr. Gutierrez present when you did this

assessment on March 5, 2008?

A Not in the room.

Q

did you have any

Okay. Was

conversations with Mr. Gutierrez on that day concerning Maria, March 5, 2008?

A Q A

Yes.

Was that In Maria's presence? No, it was not.

Q What conversation did you have with

Mr. Gutierrez about Maria on March 5, 2008?

A Well, I was telling them the procedures

that we're going to be doing, and that, you know,


181

15:39

15:40

••

••

1 we -- we are planning a vaginoplasty. Dr. Chen,

--

2 I've known him for years, and I'd like him to do it.

3

And he said, "No. We don't want him. We

4 want Hansen." He's older, and he -- he's done a lot

5

of them, and, you know, he's -- he's a good guy, and

6 he's on staff here.

10

7

8

9

Q

Did he tell you how many he had done?

A

No.

Q

Did

A

I assume, because he's in his 80s, he must

11 have done tons of them.

12

Q

That was your understanding as to what his

13 age was when you had the discussion with

14 Mr. Gutierrez?

15

A

I saw him a few days before. So, I mean,

16 he looked at least 75. Yeah.

17

Q

All right.

Did Mr. Gutierrez ever tell you

18 when the last time he had performed vaginoplasty?

19

20

A

No, sir.

Q

Other than telling you that he had done a

21 lot of vaginoplasties, did he provide you any other

22 information about his -- Dr. Hansen's experience in

23 performing vaginoplasty?

24

25

A

No, he did not.

Vaginoplasty, counsel, is a very -- you


-:r.82

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1

know, a common procedure. And, you know, OB/GYNs do
.
r-
a lot of those, I mean, during the course of their
career. So it would never bring up to me a question
of, you know, his competence in that -- in that
regard so --
And also, secondly, it's not my -- it was
not my position at the center to question him. I
didn't do the credentialing process. Gus did and --
and his people so --
Q Did you -- did you feel at the time that if
you wanted Dr. Chen instead of Dr. Hansen,· that was
within your prerogative?
.
A No.
Q You felt you had no choice but to accept
Dr. Hansen?
A Yeah. I mean, if you -- are you talking
about credentialing, and, you know, we don't -- we
have this malpractice insurance here. We've got
this and that, you know. It's not our position, but
both -- me and my wife both protested it mildly
but -- I mean, because we knew Dr. Chen.
Q Okay. Did you have any understanding of
what type of financial arrangement Dr. Hansen had
with Mr. Gutierrez?
A I had no knowledge of that.
183 2

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7

8

9


15:41

15:42

15:42

15:43

••

••

1 2 3 4

Q A Q A

Okay.

If it's a short and easy procedure -Uh-huh.

-- you know, we don't want a guy coming in

5 there waiting all day just to do the shortest,

6 7

quickest procedure.

Q Did Mr. Gutierrez give you any further

8 information about Dr. Hansen's abilities or --

9 10 11 12 13 14 15 16 17 18 19

A

No.

Q

-- skills or training?

A

No. No, he didn't.

Q All right. Did you communicate to him your

thinking that you would still rather have Dr. Chen perform vaginoplasty?

A I -- I may have mentioned it. My wife

probably mentioned it more times. But she has a strong personality. So, you know -- but it was mentioned more than once to him.

Q

Okay.

In that window of time between

20 March 9 and the day of surgery?

21 22 23 24 25

A

I don't know if it was in that window of

233

all of that, necessarily.

It may have been

time,

brought up once or twice.

Q Okay. All right.

A

I really did not feel that he was, you


16:56

16:57

16:57

••

••

1 know -_ would have any problems with it. I've never

2 seen any problems with vaginoplasties ever. It's

3 such a benign procedure so --

4

Q

Your only source of information as to

5 Dr. Hansen's abilities to perform vaginoplasties was

6 through Mr. Gutierrez; true?

7

8

A

Yes. True.

Q

Okay. So you were relying upon

9 Mr. Gutierrez's representations when permitting

10 Dr. Hansen to perform the vaginoplasty part of the

11 procedures on Maria Garcia; true?

12

13

A

That's true.

14 competent Dr. Hansen wa~. for performing vaginoplasty

Q

You had no independent basis to know how

15 procedures; true?

16

17

A

That's correct.

Q

Any other conversations or discussions you

18 had with Mr. Gutierrez between March 9 and the day

19 of surgery?

20

21

A

That was the gist of it.

Q

Okay. Now, I think you told me earlier you

22 never had any discussions with Dr. Hansen up until

23 the day of the surgery; correct?

24

25

A

Yes, that's correct.

Q

You only saw him on that one occasion when 234


16:58

16:58

10

••

••

1 2 3

Q A Q

Is that this record? It lS.

Okay. We'll mark this as Exhibit No. 24.

4 And it's entitled "History, Physical and Operative

5 Report." This again is on a Hills Surgical

6 Institute form.

7 (Plaintiffs' Exhibit 24 was marked for

8 identification.)

9 BY MR. LEW:

Q

Did you use this form because Mr. Gutierrez

11 insisted that you use the form?

12 13

A

Yes. This is for the surgery center side,

and when we're doing preoperative and su~gery, this

14 is the form that they use.

15 16 17 18 19 20 21 22 23 24 25

Q A

I see. Yeah.

Q Okay. By the way, when Mr. Gutierrez said

that you had to use Dr. Hansen, did he offer you any other options by way of a doctor who could perform the vaginoplasty?

A No.

Q Okay. All right. So going, then, the

handwriting in the box that says "Patient compliant," is that meant to be "complaint"?

A

Yes.


245

17:13

••

••

14

1 I, SANDRA D. ORTIZ, CSR No. 6048, Certified

2 Shorthand Reporter, certify:

3 That prior to being examined, the witness named

4 In the foregoing deposition declared under oath to

5 testify to the truth, the whole truth, and nothing but

6 the truth;

7 That said deposition was taken down by me in

8 shorthand at the time and place herein set forth and was

9 thereafter transcribed by computer under my direction;

10 said transcript being a true and correct transcription

11 of my shorthand notes.

12 I further certify that I have no interest in

13 the outcome of this action.

\ day of

, 2010.

Dated this

15

16

I

/ r">. (kt' ./

.' I

)tvfif(U;!Y In

17

18

19

20

21

22

23

24

25

••

EXHIBIT I

••

EXHIBIT

"

•• ••

Exhibit 7

••

••

JUL 0 6 2010

SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF ORANGE-CENTRAL JUSTICE CENTER

MATTHEW GARCIA, a mlnor, ETHAN GARCIA, a minor, REBECCA GARCIA, a minor, by and through their Guardian Ad Litem, Gonzalo Garcia,

Case No: 30-2008-00105390 (Consolidated with 30-2008 00113392)

Plaintiffs,

VS.

HARRELL ROBINSON, M.D., et al.

Defendants.

CERTIFIED COpy

AND RELATED CROSS-ACTION

VIDEOTAPED DEPOSITION OF HARRELL E. ROBINSON M.D.

Taken on Friday, June 25, 2010 VOLUME II


'-COURT REPORTERS-

SUSAN R. BISCHOFF, CSR No. 4171

Job No. 10-345

3045 STONER AVENUE

Los ANGELES, CALIFORNIA 90066-1107 PHONE 310·787·4499

FAX 310-915 ·0090 pmpcsr@earthlink.net

253

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13:50;08 5
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••

A. I believe so, yes.

Q. Okay, all right.

A. She probably was given a, you know, some dos and don'ts of some medications; vitamins, if she is on

any, not to take.

But we always give that, but that's

usually just patient information.

Q. Okay.

A. And not prescription things and not part of the chart.

Q.

I see.

Now, yesterday you were telling us

that you bad a conversation at some point with Maria where you told her that for purposes of her vaginoplasty you were going to have -- see if Dr. Chen

was available.

Do you recall that testimony?

A. Yes.

Q.

Okay.

But in the end it was Dr. Hansen that

was going to be performing the procedure, correct?

A. That's correct.

Q. Did you tell Mrs. or tell Maria that

Dr. Hansen was actually going to be the doctor to perform the vaginoplasty?

A. Yes.

Q.

Okay.

When did you tell her that?

A. I don't remember the exact date that I told

her but it probably was that Sunday, the 9th.

?7~

1
2
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4
13:51:18 5
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13:51:34 10
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13:51:47 15
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13;52:05 25 ••

••

Probably.

Q. I see.

A. Yeah.

Q.

Okay.

Now, at any time prior to the start of

surgery had anyone ever told you that Dr. Hansen had not performed a vaginal tightening or posterior colporrhaphy for at least five years prior to that day?

A. No, sir.

Q. Did you ever learn from any source that that

in fact was the case prior to the start of surgery?

A. No, not prior to.

Q. Oh. If you had been told that Dr. Hansen --

well, strike that.

First of all, the vaginoplasty procedure that was envisioned and anticipated for Maria Garcia, that is an elective procedure, correct?

A. Yes, sir.

Q. It didn't have to go forward on March 13 if

you wanted to cancel it and reschedule for a different day, true?

Yeah.

She didn't have to have any of the

A.

surgeries for that matter.

Q. Okay.

A. Yeah.

Q. Now, if you had been told that Dr. Hansen had


274

1
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13:52:20 5
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2l
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••

not performed that type of procedure for around five years, or approximately five years, prior to the date of that surgery, what do you believe you would have done?

A. Are you kidding, I would not have allowed my

patient to undergo a surgery, no matter how simple, if

a guy hadn't done it in five years.

I would have

either A, taken her to another facility if he demanded and insisted on Hansen having do that procedure at his facility, I would have just taken her to another

facility, or B, do my portion of the procedure and then, you know, have him go to -- have her go to Chen at some time later.

Q. I see.

A. But keep in mind, you know, she wanted to

have them both done at the same time.

You know, she

wanted all of it done, but so we tried to acquiesce to the patient1s desires as much is prudent and safe.

Q. Now, it was decided that her various cosmetic

procedures were going to be done in two phases though, correct?

A. Yes.

Q. And there was going to be a second phase of

procedures involving the breast augmentation; is that right?


275

1
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13:53:51 5
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13: 54: 12 10
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21
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13:54:51 25 ••

••

A. Yes, correct.

Q. Could vaginoplasty have been done as part of

the second phase?

A.

It

yes, it could have; however, when we

are putting in implants it's extremely under sterile

conditions.

The vaginal -- the vaginal area and the

buttocks area is not as clean as the tummy tuck and the breast.

So if there was any, if there was any bacteria that flowed in the bloodstream while we are doing a breast augmentation we don't want that so we try to keep those things clean.

Q. SO it could be staged as a --

A. Yeah.

Q. -- third stage of a procedure.

A. Yeah.

Q.

Okay, all right.

Nothing about that that

would contraindicate a third staging, such that the vaginoplasty

A. No.

Q. could be done independently of the other

procedures?

A. No, nothing at all.

Q.

Okay.

Did Mr. Gutierrez ever tell you that

Dr. Hansen had not performed a vaginal tightening or

POR~~R RTPES & ASROCIATES (310) 787-4499

276

1
2
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13;55;03 5
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••

posterior colporrhaphy for at least five years prior to

the date of the procedure?

A. He never told me before or after .

.. ~~- .~----_.-~. --~ .. ~ _ .. _ _ -- .

Q. Is that something that you would have wanted

to have known at the time?

A.

Yes.

Absolutely.

Q. For the reasons you've told us earlier?

A. That's correct.

I mean that's tantamount to a resident not

having any experience in it.

I mean even though you

have done a few, five years is a long time when you're

working in a small vaginal vault.

And you have to know

your anatomy, refresh your anatomy on things so.

Q. Doctor, I think you mentioned that you spoke

to Dr. Hansen yourself before the procedure, correct?

A. Yes.

Q. And he -- tell me everything that was

discussed between you and Dr. Hansen prior to the start

of the surgery.

A.

Prior to the start? Okay.

Urn, I think, as I

mentioned yesterday, we, we, we kind of discussed the

operative planning, we both agreed that he should go

first, and his procedure would take anywhere from 45

minutes to an hour, approximately. And that he would

have a catheter inserted, you know, after the


277

••

••

3

C.S.R. No. 4171


2 COUNTY OF LOS ANGELES

4

I, Susan Ruocco Bischoff, Certified

5 Shorthand Reporter No. 4171, for the State of

6 California, do hereby certify:

7

That prior to being examined, the witness

8 named in the foregoing deposition was by me duly sworn

9 to testify the truth, the whole truth and nothing but

10 the truth;

21

24

25

11 That said deposition was taken down by me

12 in shorthand at the time and place therein named and

13 thereafter reduced to typewriting under my direction

14 and the same is a true, correct and complete transcript

15 of said proceedings.

16 I further certify that I am not interested

17 in the outcome of the action.

18 Witness my hand this 30th day of June,

19 2010.

20

22

d~R~~

-~---------------------

Susan Ruocco Bischo f

23


371

••

Legal Tabs Ca. 1-800-322-3022

••

EXHIBIT

EXHIBIT 8

Recycled @ Stock # R-EX-5-B

••

Exhibit 8

••

SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF ORANGE

MATTHEW GARCIA, and minor, ETHAN GARCIA, a minor, REBECCA GARCIA, a minor, by and through their Guardian Ad Litem, Gonzalo Garcia,

) CASE No. )

)30-2008 00105390 )

)

)

)

)

) HARRELL ROBINSON, M.D., ) HARRELL ROBINSON, M.D., INC., ) PHYSICIANS & SURGEONS OF ORANGE) COUNTY, INC., HILLS SURGICAL ) INSTITUTE, ROYALTY PERFECTIONS ) GLOBAL MEDICAL SURGERY CENTER, ) GLOBAL MEDICAL SURGICAL CENTER,) ROYALTY PERFECTIONS COSMETIC ) INSTITUTE, DOES 1 THROUGH 30, )

INCLUSIVE, )

Defendants. )

--------------------~----~-----)

Plaintiffs,

v.

DEPOSITION OF LAWRENCE HANSEN, M.D.,

Taken on Friday, April 3, 2009

REPORTED BY:

PATRICIA M. PORTER

CSR No. 3730

File No. 09-248


1 2 3 4

A. La Palma.

Q. Apart from La Palma, anywhere else? A. No.

Q. And by La Palma, you're referring to the La

Page 17

5 Palma Intercommunity Hospital?

6 A. Correct. Well, I have privileges at the

7 clinic, sorry.

8 Q. I see on page two of your CV, Exhibit A, a

9 section for present hospital appointments, and

10 you've listed Los Alamitos General, La Palma 11 Intercommunity, Anaheim General and Memorial

12 Hospital in Long Beach. At this time, the only

13 thing that you're holding is the courtesy privileges 14 at La Palma Intercommunity. Correct?

15 16

A. Yes.

Q. Have you ever had your hospital privileges

17 suspended or revoked?

18 19

A. No.

Q. What happened to the privileges with the

20 other hospitals?

21 A. Well, they weren't renewed.

22 Q. Okay.

23 24

A. I sold my practice. And

Q. I see. You had your own private practice

25 at one time?


1 2 3 4

A. Yes.

Q. When was that?

A. From 1969 to 1999.

Q. I see. Why you did you sell your practice?

Page 18 i

5 Retirement?

6 7

A. Yes, I thought it was time.

Q. And upon selling your practice, that's when

8 you relinquished your various hospital privileges?

9 10 11

A. As they expired.

Q. Okay.

MR. LEW: Let's take a quick break.

12 (Brief recess.)

13 BY MR. LEW:

14

Q. Dr. Hansen, what were the circumstances

15 that prompted you to start working at Hills Surgical 16 Institute?

17

A. I was hoping to develop some additional

18 income and practice outside of the work I was doing.

19

Q. And how did you find out about Hills

20 Surgical Institute?

21 22 23 24 25

A. A friend of mine told me about it.
Q. And who was that?
A. Gary Rheinschild.
Q. Can you spell his last name for me, please?
A. R-h-e-i-n-s-c-h-i-l-d, M.D. PORTER SIPES & ASSOCIATES (310) 787-4499

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