law rights & civil resource

posted by admin on Jun 5

40

1 including the F articles? Really it’s not based

2 on your own research.

3 A Yeah, my opinion is, but I just chose not

4 to — not to cite those articles because the other

5 articles I wrote, the review articles, incorporate my

6 own research plus others’ research.

7 Q So there are other articles on your CV now

8 that indicate you did personally your own research

9 which backs up your theory of this critical threshold,

10 correct?

11 A Well, I think they’re consistent with it.

12 I think that the ones that I cited are the — are

13 better ones because they’re broader. They cover a

14 wider range.

15 Q So the articles you cited on your CV at the

16 beginning of the deposition mention your personal

17 research about this critical threshold theory, correct?

18 A Right.

19 Q Okay. Do all the articles you cited at the

20 beginning mention that, or is there one or two

21 particular articles that mention your personal research

41

1 into the theory of the critical threshold being

2 reached?

3 A I’d say probably half of them do.

4 Q Can you identify for us which of the half

5 describe your personal research into the critical

6 threshold theory?

7 A No, I don’t think so.

8 Q Why not?

9 A Well, because it would — I’d have to go –

10 go over them in more detail to make an accurate –

11 Q Okay.

12 A – description.

13 Q If one would want to read those articles,

14 would it be clear from the plain language in the

15 articles that you’re describing your personal research

16 into the critical threshold theory?

17 A Yeah, I’m sure it would.

18 Q Okay. Now, you also mentioned another

19 article, the F article, describes this critical

20 threshold theory, correct?

21 A Right.

42

1 Q Is there any other article you can think of

2 in the world that describes the critical threshold

3 theory that you are a proponent of?

4 A I think most of the literature in this area

5 talks about the same thing.

6 Q Can you identify any of the articles that

7 you believe most subscribe to this critical threshold

8 theory?

9 A No.

10 Q Okay. You mention, “The outcome was

11 already determined at the time of the placenta previa

12 and slow heart rate was documented on ultrasound.”

13 What outcome are you referring to, the child’s current

14 condition?

15 A Yeah. The intracranial hemorrhages and the

16 white matter injury.

17 MR. G: Okay. Sir, I don’t have any

18 other questions for you. I thank you for your time as

19 always.

20 THE WITNESS: Okay. Thanks.

21 MR. J: Anybody else?

43

1 MR. G: Madam Reporter, we’d like a

2 minuscript and an ASCII disk, please.

3 MR. J: Anybody else? Hello?

4 MR. R: Yeah, I’d like a copy of the

5 transcript. This is Greg R. S, what’s your

6 phone number?

7 MR. K: I think I may have some

8 questions, Greg, actually.

9 MR. R: Oh, okay.

10 EXAMINATION BY MR. K:

11 Q Dr. J, my name is J.k. I

12 represent Dr. S. Can you hear me okay?

13 A Yeah.

14 Q Okay. I’ll be very brief. I want to make

15 sure that we — that I get a good understanding of your

16 credentials. First, I assume you’re licensed to

17 practice medicine?

18 A Yes.

19 Q And what states are you licensed to

20 practice medicine in?

21 A In Maryland and Pennsylvania.

44

1 Q Okay. And I see you’re affiliated with the

2 KK Institute and also Js H

3 University School of Medicine?

4 A Yes.

5 Q How long have you been affiliated with each

6 of those institutions?

7 A I did all my training at H, so I was

8 there for seven years, and then I have been back as a

9 professor for 13 years.

10 Q And are you board certified in any

11 specialties and/or subspecialties?

12 A Yeah. I’m board certified in pediatrics

13 and in pediatric neurology.

14 Q And do you dedicate greater than 50 percent

15 of your time to either the active clinical practice of

16 medicine and/or teaching?

17 A Yeah. It’s about 60 percent patient care,

18 20 percent research, 15 percent administration and five

19 percent classroom teaching.

20 Q And you and I have never met before this

21 deposition here today, correct?

45

1 A I don’t think so. I can’t see you, but I

2 don’t think we have.

3 Q I like to tell people that I look like Tom

4 Cruise, but since I’m technically under oath, I guess

5 we can’t.

6 A Okay.

7 Q I want to ask you some very brief questions

8 about your CV and then your opinions just so I have a

9 clear understanding.

10 A Okay.

11 Q I see from your curriculum vitae that you

12 have lectured all over the — all over the world

13 actually on pediatric neurology topics, correct?

14 A Right.

15 Q That includes places like Harvard

16 University, Stanford University as well as abroad,

17 correct?

18 A Right.

19 Q I see that you served in the U.S. Army, it

20 appears?

21 A Right.

46

1 Q I also see that you have authored more than

2 100 — or been part of the authoring of more than 100

3 peer review articles; is that correct?

4 A Right, right.

5 Q In addition, to greater than 50 book

6 chapters, correct?

7 A Right.

8 Q And all of these are on the specialty –

9 within the specialty and/or subspecialty of pediatric

10 neurology, correct?

11 A Correct.

12 Q Within the KK Institute, which

13 we got a description of and the volume of conference

14 rooms there, I understand you hold several offices.

15 What offices do you hold?

16 A I’m the medical director and chief medical

17 officer, and then I’m a senior vice president. So I’m

18 part of the management, and I’m the — responsible for

19 the medical care.

20 Q Okay. I want to briefly address your

21 opinions, and I want to make sure that I have an

47

1 understanding of your opinions to a medical

2 probability. Okay?

3 A Okay.

4 Q It is my understanding that you hold the

5 opinion, based upon a constellation of things, not any

6 one thing from the review of the records, but

7 specifically including the slow heart rate, the

8 placenta previa and the abruption, that the injury to

9 this child or the threshold for this injury had

10 occurred by the time the ultrasound was taken; is that

11 true?

12 A Yeah, by the time or during the time of

13 that — that the bradycardia was documented. That the

14 blood — that the blood loss had reached the point

15 where it had associated with a bradycardia where it had

16 reached the threshold for injury in a premature infant

17 like this.

18 Q Okay. So when we apply it to this specific

19 patient, in a premature infant between 28 and 31 weeks,

20 based upon the heart rate that was observed on

21 ultrasound, the placenta previa and/or abruption, you

48

1 are able to state to a medical probability that the

2 threshold for injury, neurologic injury, had already

3 been surpassed by that time?

4 A Yeah. I think that’s the prominent event

5 that — that was related in this case to the — to the

6 brain injury, to the white matter and to the –

7 Q Let that ambulance go by.

8 A To the brain injury — the injury to the

9 white matter and to the intraventricular hemorrhages.

10 Q Okay. And the time that the ultrasound was

11 taken was actually between 11:38 and 12:06, correct?

12 A Right. That’s what I have down.

13 Q Okay. So to put a time on this for when we

14 explain this to a jury, you believe that the damage to

15 this child — there was neurologic damage to this

16 child, and that being, as you described, the threshold

17 for injury having been surpassed, by some period of

18 time between 11:38 and 12:06, correct?

19 A Yeah. In other words, I think this was the

20 trigger. And often then it takes some time for the

21 injury to evolve later on, but that was the time in the

49

1 record where there’s a clear-cut evidence of — of an

2 insult that probably went on to injury.

3 Q Okay. And you aren’t able to say how long

4 before the ultrasound this threshold for neurologic

5 injury had occurred, correct?

6 A Right. In other words, I think this was

7 certainly sufficient to cause the injury, and whether

8 there had been previous episodes associated with

9 abruption, I don’t know.

10 Q Okay. And that opinion is based on all of

11 the training and accomplishments and research you’ve

12 done throughout your practice, correct?

13 A Yeah. And it’s consistent with the — the

14 primary theory for these hemorrhages and injury, which

15 is oscillations or abrupt changes in cerebral blood

16 flow. And based on the idea that I think is pretty

17 well-established that in the premature infant the

18 cerebral circulation is fairly passive and reflects the

19 infant’s heart rate.

20 MR. K: Dr. J, I thank you very

21 much for your time. I have no further questions.

50

1 MR. G: Anyone else on the defense?

2 MR. R: No, no questions. Greg R.

3 No questions.

4 MR. G: Then this is Z. I’m just

5 going to follow up on one thing that I didn’t ask

6 beforehand.

7 EXAMINATION BY MR. G:

8 Q Doctor, did you make any notes upon your

9 review of any of this material?

10 A Yeah. I have a page of notes here. I can

11 give it to the court reporter.

12 Q Perfect. Is that the only page of notes

13 you ever made?

14 A Yes.

15 MR. G: Okay. We’ll mark that as

16 P’ next exhibit, and I have no other

17 questions.

18 THE WITNESS: Okay.

19 (Examination concluded at 4:36 p.m.)

20 (J Deposition Exhibits Nos. 1 and

21 2 were marked by the reporter.)

51

1 STATE OF MARYLAND)

) ss

2 COUNTY OF BALTIMORE)

3 I, S M. Wright, a Notary Public in and

4 for the County and State aforesaid, duly commissioned

5 and qualified, do hereby certify that the above named,

6 M V. J, M.D., was by me first duly sworn

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

8 the truth, and that his deposition as set forth above,

9 which was reduced to writing under my direction and

10 control, is a true record of the testimony given and/or

11 as corrected by said witness.

12 I certify that I am not of counsel,

13 attorney, or relative of any party, or otherwise

14 interested in the event of this suit.

15 In witness whereof I have hereunto set my

16 hand and affixed my notarial seal this 19th day of

17 September 2001.

18 _____________________

S M. Wright

19 Notary Public

20 My commission expires:

21 July 1, 2003.

52

1 INDEX

2

3 WITNESS EXAMINATION BY PAGE

4 M V. J Mr. G 3

5 Mr. K 43

6 Mr. G 50

7

8 EXHIBITS

9 NUMBER PAGE DESCRIPTION

10 1 50 Curriculum Vitae

11 2 50 Dr. J’s

page of notes

12

13

14

15

16

17

18

19

20

21