antoine dental - dr. irwin ornish deposition 05.09.13

7/28/2019 Antoine Dental - Dr. Irwin Ornish Deposition 05.09.13

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800. 829. 6936 * 512. 472. 0880ken@kenowen. com * www. kenowen. com

Page 2

1 A P P E A R A N C E S2 3 FOR PETI TI ONER4 J . A. "TONY" CANALES

Bar Number 037370005 CANALES & SI MONSON, P. C.

2601 Mor gan Avenue6 Cor pus Chr i st i , Texas 78465- 5624

Phone: ( 361) 883- 06017 Fax: ( 361) 884- 7023

t onycanal es@canal essi monson. com8 9 OSCAR X. GARCI A

Bar Number 0764006010 LAW OFFI CES OF OSCAR X. GARCI A

302 Ki ngs Hi ghway11 Sui t e 112

Br ownsvi l l e, Texas 7852112 Phone: ( 956) 554- 3000

Fax: ( 956) 554- 324813 14 FOR RESPONDENT15 DANI EL L. HARGROVE

Bar Number 0079082216 WATERS & KRAUS, L. L. P.

600 Navar r o17 Sui t e 500

San Antoni o, Texas 7820518 Phone: ( 210) 349- 0515

Fax: ( 210) 349- 366619 dhargr ove@waterskr aus. com20 J AMES R. MORI ARTY

Bar Number 1445900021 MORI ARTY LEYENDECKER, P. C.

4203 Mont r ose Boul evard22 Sui t e 150

Houst on, Texas 7700623 Phone: ( 713) 528- 0700

Fax: ( 713) 528- 139024 j i m@mor i ar t y. com25 Cont i nued


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1 A P P E A R A N C E SCont i nued

2

3 FOR RESPONDENT

4 CAI TLYN SI LHANBar Number 24072879

5 WATERS & KRAUS, L. L. P.3219 McKi nney Avenue

6 Dal l as, Texas 75204Phone: ( 214) 357- 6244

7 Fax: ( 214) 357- 7252csi l han@wat er skr aus. com

8

9 KETAN U. KHAROD

Bar Number 2402710510 KHAROD LAW FI RM, P. C.

P. O. Box 15167711 Aust i n, Texas 78715

Phone: ( 512) 293- 155612 ket an@kharodl awf i r m. com

13

14

15

16

17 ALSO PRESENT:

18 BEHZAD NAZARI , D. D. S, Pet i t i oner

19 J OHN R. MEDLOCK, Associ ate Counsel , Sanct i onsHeal t h & Human Ser vi ces Commi ssi on, OI G

20 ENRI QUE M. VARELA, Associ at e Counsel , Sanct i ons

21 Heal t h & Human Ser vi ces Commi ssi on, OI G

22 OI RAM SALI NAS, Par al egal , Canal es & Si monson

23

24

25


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1 I N D E X

2

3 Ti t l e Pages 1

4 Appearances 2

5 I ndex 4

6 Pr oceedi ngs Begun 5

7 I RWI N K. ORNI SH, D. D. S. , M. S

8 EXAMI NATI ON BY MR. HARGROVE 13

9 Deposi t i on Concl uded 87

10 Changes and Si gnat ure 88

11 Cour t Repor t er ' s Cer t i f i cat e 90

12 Fur t her Cer t i f i cat i on 92

13

14 * * * * * *

15

16 17 E X H I B I T S

18

19 NO. DESCRI PTI ON PAGE

20 ( No Exhi bi t s Of f er ed. )

21

22

23 * * * * * *

24

25


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1 P R O C E E D I N G S

2 ( Mr . Gar ci a, Mr . Sal i nas, and Dr . Or ni sh not

3 pr esent . )

4 MR. CANALES: My name i s Tony Canal es. I ' m

5 t he l awyer f or Dr . Nazar i . We have been wai t i ng out si de

6 si nce 8: 50. We sent us a - - a not i ce t o everybody we were

7 gonna be her e at 8: 50. The deposi t i on was schedul ed t o st ar t

8 at 9: 00 o' cl ock. We have been be r eady t o st ar t f r om

9 9: 00 o' cl ock. I t i s now 9: 35. We have been summoned t o

10 at t end t hi s meet i ng. I have avai l abl e and r eady t o be

11 deposed Dr . Or ni sh, pur suant t o our Rul e 11 agr eement .

12 Dr . Or ni sh i s out si de.

13 I have wi t h me my cl i ent , Dr . Behzad Nazar i .

14 I have al so wi t h me my par al egal , Or i Sal i nas. And al so have

15 wi t h me my cocounsel , Oscar Garci a; and my ot her cocounsel ,

16 Tony Goodal l .17 I have been i nf or med by r epr esent at i ve of

18 OI G - - I do not know hi s name - - t hat Mr . Gar ci a and

19 Mr . Goodal l ar e not wel come at t hi s deposi t i on. And I do not

20 know why.

21 I ' d l i ke t o have an expl anat i on, f i r st of

22

al l , as t o why has ther e been a del ay. Ver y unpr of essi onal .23 We wer e not t ol d why.

24 Second reason i s i f you don' t wanna gi ve an

25 expl anat i on, so be i t . But I have Dr . Or ni sh, who' s r eady t o


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1 be deposed, and I need t o have my cocounsel here. Mr . Garci a

2 has been wi t h me i n t hi s case f r om day one. He has not

3 wi t hdr awn f r om t he case. He i s a l awyer i n t he case. And

4 I ' d l i ke t o know what your obj ect i on i s t o Mr . Gar ci a so we

5 can pi ck up t he phone and cal l t he j udge.

6 MR. HARGROVE: My name i s Dan Har gr ove. We

7 r epr esent t he Of f i ce of I nspect or Gener al , Heal t h/ Human

8 Ser vi ces Commi ss i on.

9 And i t ' s our under st andi ng, Tony, t hat

10 J udge Gar ci a i s on t he bench.

11 MR. CANALES: No, he' s not .

12 MR. HARGROVE: Okay.

13 MR. CANALES: He' s not been swor n i n.

14 MR. HARGROVE: What ' s hi s st at us?

15 MR. CANALES: He has not been swor n i n. He

16 wi l l be swor n i n at t he end of t he mont h.17 MR. HARGROVE: Okay.

18 MR. CANALES: He' s i n - - some cases he' s

19 st i l l on. I n some cases he' s not on. I n t hi s par t i cul ar

20 case, he' s st i l l a l awyer i n t he case, deal i ng wi t h t he

21 pl eadi ngs. He has not f i l ed any t ype of mot i on t o wi t hdr aw.

22

He' s not a j udge.23 MR. HARGROVE: And Mr . Sal i nas i s. . . .

24 MR. CANALES: Mr . Sal i nas i s my f ul l - t i me

25 par al egal . Been wor ki ng wi t h me f or 25 year s.


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1 MR. HARGROVE: Okay. And i s t her e an - - a

2 nonpar t y exper t t hat you woul d l i ke t o have si t i n i n t hi s

3 pr oceedi ng?

4 MR. CANALES: No.

5 MR. HARGROVE: Okay. So i t ' s Mr . Sal i nas,

6 Tony Goodal l , and Oscar Garci a.

7 MR. CANALES: Yes.

8 MR. HARGROVE: Okay. Wel l , i t was our

9 under st andi ng t hat J udge Garci a was on t he bench, so

10 t her ef or e he was not per mi t t ed t o - -

11 MR. CANALES: He i s not on t he bench.

12 MR. HARGROVE: Okay. Al l r i ght .

13 Anythi ng el se?

14 MR. MORI ARTY: I f you' r e st at i ng t o us - -

15 MR. CANALES: I s my what ?

16 MR. MORI ARTY: I f you are st at i ng t o us as an17 at t or ney - -

18 MR. CANALES: Who ar e you, s i r ? I i dent i f i ed

19 mysel f - -

20 I t hought I r ecogni zed you. And you wer e

21 ver y r ude a whi l e ago t o me. And I ' d l i ke t o know why you

22

were r ude t o me. Now t hat I ' ve seen you, I say, " I know who23 t hat guy i s. " I don' t know what your posi t i on - - or why you

24 di d t hat .

25 And who ar e you agai n, f or t he record?


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1 MR. MORI ARTY: Here' s my quest i on - -

2 MR. CANALES: I don' t know who you ar e.

3 MR. MORI ARTY: - - ar e you st at i ng - -

4 MR. CANALES: I don' t know who you ar e. He

5 i dent i f i ed hi msel f . I i dent i f i ed mysel f . Who ar e you, si r ?

6 MR. MORI ARTY: I ' m not her e t o answer

7 quest i ons.

8 MR. CANALES: Wel l , I ' m not , ei t her .

9 MR. MORI ARTY: You' r e sayi n' t he j udge i s not

10 a j udge as of t hi s moment ?

11 MR. CANALES: Yes, si r .

12 MR. MORI ARTY: Al l r i ght . I see no r eason

13 why he cannot appear .

14 MR. CANALES: Wel l , I don' t care what you

15 say, si r .

16 MR. MORI ARTY: I s Goodal l counsel i n t hi s17 case?

18 MR. CANALES: He has appeared - - he i s my

19 cocounsel . He has not made an appearance i n t he case.

20 MR. MORI ARTY: And have you gi ven us not i ce

21 t hat he woul d appear ?

22

MR. CANALES: No.23 MR. MORI ARTY: Okay. Have you r ead r ul e - -

24 wel l - -

25 MR. CANALES: I f you don' t want hi m, we' l l


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1 ask hi m t o l eave. Not a pr obl em.

2 MR. MORI ARTY: Al l r i ght . And you' ve got

3 your par al egal her e?

4 MR. CANALES: Yes, si r .

5 MR. MORI ARTY: You may br i ng J udge Gar ci a

6 back and your paral egal .

7 MR. CANALES: I ' l l - - I ' l l do what I need t o

8 do.

9 Can you i dent i f y your sel f , si r ?

10 MR. MORI ARTY: I ' m J i m Mor i ar t y.

11 MR. CANALES: Very, ver y r ude of you guys t o

12 do t hi s. Tot al l y unpr of essi onal . Tot al l y - - i s t hi s t he way

13 we' r e gonna - - we have never had any pr obl em at al l wi t h OI G,

14 wi t h Mr . Var el a, or anybody el se. I cannot bel i eve t hat

15 we' r e st ar t i ng t hi s way.

16 MR. MORI ARTY: Ar e you r eady t o proceed wi t h17 t he deposi t i on?

18 MR. HARGROVE: I ' m not t al ki ng t o you.

19 Who' s gonna be t aki ng t o t he deposi t i on? I

20 t hought he was ( i ndi cat i ng) . Who i s - - who' s gonna be t he

21 guy i n char ge of t he deposi t i on?

22

You ar e, si r ?23 MR. HARGROVE: Yeah.

24 Ar e you f eel i n' okay, Tony? You l ook a

25 l i t t l e - -


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1 MR. CANALES: I ' m pi ssed. Because i t ' s ver y,

2 ver y unpr of essi onal on you guys' par t t o do t hi s. Ver y, ver y

3 unpr of essi onal . Uncal l ed f or - -

4 MR. HARGROVE: You' r e br i ngi ng a j udge and

5 you' r e br i ngi ng a nonpar t y - -

6 MR. CANALES: A j udge. He' s not a j udge.

7 MR. HARGROVE: You' r e br i ng a nonpar t y t o t he

8 deposi t i on.

9 MR. CANALES: Nonpar t i es have at t ended t hese

10 deposi t i ons f or bot h si des.

11 MR. HARGROVE: Wel l . . . .

12 MR. CANALES: Fr om both si des. There has

13 never been an obj ect i on.


15 MR. CANALES: I f t her e i s an obj ect i on r i ght

16 now, so be i t .17 MR. HARGROVE: Al l r i ght .

18 MR. CANALES: And I under st and t he r ul es.

19 But al l I ' m sayi ng i s a si mpl e cal l or a si mpl e i nqui r y t o us

20 woul d have sol ved t he pr obl em. I ' m not f i ght i ng over

21 Goodal l . Goodal l - - I di d not gi ve - - I di d not gi ve not i ce

22

r egar di ng Goodal l , so t her ef or e, you know, i f you obj ect t o23 hi m, I wi l l ask hi m not t o appear .


25 MR. CANALES: Now, Oscar Garci a i s not a


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1 j udge yet . Al l r i ght .

2 MR. HARGROVE: When i s he gonna t ake t he

3 bench, do you know?

4 MR. CANALES: 24t h, somethi ng l i ke t hat .

5 MR. HARGROVE: Of May?

6 MR. CANALES: Yeah.

7 MR. HARGROVE: ' Kay. So, I mean, i t was

8 al r eady - -

9 MR. CANALES: And I don' t know why you guys

10 are aski ng t hi s quest i on. You guys t hought I was gonna br i ng

11 a j udge i n here? You got t a be ki ddi ng.

12 MR. HARGROVE: The pr ess r epor t s t hat he' s on

13 t he bench.

14 MR. CANALES: No, t here' s no pr ess r epor t .

15 Anyway. Ar e you r eady t o proceed?

16 I cannot bel i eve t hi s. Thi s - - t hi s i s what17 makes l awyer s, by t he way, despi se each ot her . Anyway.

18 MR. MORI ARTY: You know, you' ve been r unni n'

19 your mout h si nce you wal ked i n here. Ar e you about done?

20 MR. CANALES: You shut up.

21 Al l r i ght , s i r . I ' m gonna br i ng my cl i ent s

22

i n. Okay?23 Come on, Doct or .

24 I ' l l be r i ght back.

25 Someone gonna escor t me out si de?


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1 ( Mr . Canal es and Dr . Nazar i l ef t t he r oom at

2 9: 43 a. m. )

3 ( Mr . Canal es, Dr . Nazar i , Mr . Gar ci a,

4 Mr . Sal i nas, and Dr . Or ni sh ent er ed t he r oom

5 at 9: 49 a. m. )

6 MR. HARGROVE: Why don' t you have t he

7 par t i es - - ever ybody i n t he r oom announce t hei r pr esence.

8 I ' m Dan Har gr ove. I ' m wi t h t he l aw f i r m of

9 Wat ers & Kr aus, and I r epr esent OI G.

10 MR. MORI ARTY: I ' m J i m Mor i ar t y, and I al so

11 r epr esent OI G.

12 MS. SI LHAN: I ' m Cai t l yn Si l han wi t h Wat er s

13 and Kr aus, r epr esent i ng OI G.

14 MR. KHAROD: My name i s Ket an Kharod. Al so

15 r epr esent i ng OI G i n t hi s.

16 MR. MEDLOCK: J ohn Medl ock. I am an at t orney17 f or OI G.

18 MR. VARELA: Enr i que Var el a, al so at t or ney

19 f or OI G.

20 MR. SALI NAS: Oi r am Sal i nas wi t h Canal es &

21 Si monson. Par al egal ; vi deogr apher .

22

DR. NAZARI : Behzad Nazar i . Ant oi ne Medi cal23 Cent er .

24 MR. GARCI A: Oscar Garci a on behal f of

25 Ant oi ne Dent al Cent er .


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1 MR. CANALES: Tony Canal es, counsel f or

2 Ant oi ne Dent al Cent er .

3 MR. HARGROVE: J udge Garci a, i t ' s our

4 under st andi ng t hat you' ve been appoi nt ed t o t he

5 di st r i ct - cour t j udgeshi p and I ' ve you' ve been conf i r med by

6 t he senate.

7 I s t hat cor r ect ?

8 MR. GARCI A: Cor r ect .

9 MR. HARGROVE: But you have not been swor n i n

10 t o t he bench yet ?

11 MR. GARCI A: I have not .

12 MR. HARGROVE: And t hat swear - i n dat e i s on

13 or about 24 May, 2013?

14 MR. GARCI A: As i t cur r ent l y st ands.


16 MR. GARCI A: Coul d change.17 I RWI N K. ORNI SH, D. D. S. , M. S. ,

18 havi ng been cal l ed as a wi t ness her ei n, havi ng been f i r st

19 dul y swor n, was exami ned and t est i f i ed as f ol l ows:

20 EXAMI NATI ON

21 BY MR. HARGROVE:

22

Q. Woul d you pl ease st ate your f ul l name?23 A. I r wi n Kennet h Or ni sh.

24 Q. And wher e do you l i ve?

25 A. I n Dal l as, Texas.


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1 You need speci f i c addr ess?

2 Q. Sur e.

3 A. 8511 Edgemer e, Number 302, Dal l as, Texas 75225.

4 Q. And what do you do f or a l i vi ng?

5 A. I ' m an or t hodont i st .

6 Q. And how l ong have you been an or t hodont i st ?

7 A. On J une t he 16t h i t ' l l be 48 year s.

8 Q. And where do you pr act i ce or t hodont ur e?

9 A. I n Dal l as, Texas.

10 Do you need an addr ess?

11 Q. Yeah.

12 A. 11661 Pr est on Road, Number 106, Dal l as, Texas

13 75230.

14 Q. What ' s t he name of t he busi ness?

15 A. I r wi n K. Or ni sh, D. D. S. , M. S. , Cl i ni c.

16 Q. And what ki nd of busi ness i s i t ?17 A. I t ' s a or t hodont i c pr acti ce.

18 Q. Okay, Dr . Or ni sh. What i s your r ol e wi t h t hi s

19 case?

20 A. My r ol e was t o eval uat e t he cases f or Dr . Nazar i

21 r el at ed t o t he HLD i ndex.

22

Q. And who i s payi ng you?23 A. Dr . Nazar i .

24 Q. Al l r i ght . How much have you been pai d i n t hi s

25 case?


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1 A. Oh. At t hi s poi nt , I . . . I - - I don' t know

2 of f hand, but I woul d say appr oxi mat el y . . . $7, 000.

3 Appr oxi mat el y.

4 Q. When were you f i r st hi r ed t o wor k on t hi s case?

5 A. Oh, t he exact dat e, I don' t know. I bel i eve I was

6 cont act ed i n March.

7 Q. Who cont act ed you?

8 A. Mr . . . .

9 Q. Canal es?

10 A. Mr . Canal es. I ' m sor r y. Tony Canal es cont act ed

11 me.

12 Q. Mar ch of 2013?

13 A. I bel i eve i t was.

14 Q. Or Mar ch of 2012?

15 A. No, no. Of t hi s year .

16 Q. Al l r i ght .17 A. Yes.

18 Q. And . . . and what was di scussed about r et ai ni ng

19 you?

20 A. He asked me i f I woul d be - - consi der worki ng on a

21 case, and he asked me t o send hi m my f ees f or act i ng as a

22

exper t wi t ness, and, you know, i t was agr eeabl e t o hi m and23 hi s cl i ent , t hey woul d empl oy me t o act as an expert wi t ness.

24 Q. Di d you have a schedul e of f ees f r om pr i or cases?

25 A. I sent hi m a schedul e of f ees.


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1 Q. Have you pr ovi ded exper t consul t i ng or t est i f yi ng

2 ser vi ces i n ot her dent al or or t hodont i c Medi cai d cases?

3 A. Yes.

4 Q. Li st t hose f or me.

5 A. There was one case f or a Wayne Casson t hat I di d

6 ear l y i n 2012, and t hen f or M&M Or t hodont i cs.

7 Q. Wayne . . . l et me - - Wayne Casson?

8 A. Yes.

9 Q. I s t hat t he name of a dent i st ?

10 A. Yes.

11 Q. K or C?

12 A. C- A - - I bel i eve i t ' s C- A- S- S- O- N.

13 And t hat was al l I di d, was eval uat ed some

14 cases f or t hat .

15 Q. What was t he nat ur e of t hat case? Was i t a

16 Medi cai d - -17 A. I t was a Medi cai d case.

18 Q. Hol d- payment case? Fr aud case?

19 A. I have no i dea.

20 Q. So Dr . Wayne Casson. Was t hat t he ver y f i r st t i me

21 t hat you act ed as a exper t consul t ant or t est i f i ed?

22

A. Yes.23 Q. Okay. And when were you f i r st hi r ed by Dr . Casson?

24 A. I wasn' t r eal l y hi r ed by Dr . Casson. I was hi r ed

25 by anot her at t or ney.


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1 Q. Who was t hat ?

2 A. Dr . Rober t Ander t on.

3 Q. When wer e you hi r ed?

4 A. You know, I wanna say i t was i n t he - - I ' m t hi nki ng

5 i t ' s i n t he spr i ng of 2012. I don' t have t hat i nf or mat i on

6 avai l abl e. I can cer t ai nl y get t hat f or you when I r evi ew

7 t he cases.

8 Q. And what happened wi t h Dr . Casson' s case?


10 Q. Di d you i ssue a r epor t i n Dr . Casson' s case?

11 A. Yes.

12 Q. Di d you pr esent t hat repor t t o anybody other than

13 Mr . Ander t on?

14 A. No.

15 Q. Do you have t hat r epor t at your of f i ce?

16 A. Yes. I ' m t r yi ng t o r emember . I - - I - - you know17 what ? I - - I - - I wanna st and . . . put t hat i n quest i on as

18 t o I can' t r emember whet her I i ssued a repor t i n t hat case or

19 not . Because I r evi ewed t he cases, and t hen i t became

20 st agnant . And i t al so happened f r om my st andpoi nt i n t hat .

21 And I can' t r emember i f I di d a r epor t f or t hat .

22

Q. Dr . Casson: Where does he pr act i ce dent i st r y?23 A. I don' t even know.

24 Q. I s i t a dent i st - - i s i t a dent i str y case or an

25 or t hodont i c case?


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1 A. I t ' s an or t hodont i c case.

2 Q. Di d you consul t wi t h Dr . Casson about your repor t ?

3 A. No.

4 Q. And Mr . Ander t on hi r ed you - -

5 A. Mm- hmm.

6 Q. - - t o - - as a consul t ant or t est i f yi ng exper t i n

7 t hat case?

8 A. Wel l . . . he asked me t o r evi ew t he cases. And

9 I ' m not sur e how you def i ne i t .

10 Q. Wel l , what exact l y was your servi ce t hat you

11 pr ovi ded to Mr . Ander t on?

12 A. I eval uat ed t he cases based upon t he HLD i ndex

13 as . . . pr ovi ded i n t he Texas Medi cai d Di r ect or y.

14 Q. You don' t r ecal l i f you di d or di d not pr ovi de a

15 report?

16 A. I - - I can' t r emember - - I - - I know I sent i n17 copi es of my eval uat i on, and I cannot r emember i f t hey

18 r equest ed a r epor t , ot her t han t he eval uat i on sheet s.

19 Q. And i n t hat case, t he Dr . Casson case, di d you

20 pr ovi de any sworn t est i mony i n t hat case?

21 A. No.

22

Q. The Dr . Casson case, t hat was your ver y f i r st t i me23 t o act as - -

24 A. Mm- hmm.

25 Q. Hol d on. So l et me f i ni sh my - -


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1 A. I ' m sor r y.

2 Q. - - quest i on, and t hen I ' l l gi ve you t he cour t esy of

3 answer i ng.

4 The Dr . Casson case was t he ver y f i r st case

5 you have pr ovi ded exper t ser vi ces of any ki nd i n an

6 or t hodont i a case; cor r ect ?

7 A. Yes.

8 Q. Have you pr ovi ded any t ype of exper t servi ces - -

9 t est i f yi ng; consul t i ng - - i n any ot her mat t er ot her t han

10 ort hodont ur e?

11 A. No.

12 Q. Now, t he Dr . Casson case, you don' t know what

13 happened, t he r esol ut i on of t hat case; cor r ect ?

14 A. I have no - - no i dea.

15 Q. And t o sum up, you may or may not have i ssued a

16 repor t . . . .17 A. Ri ght . I - - I can' t be posi t i ve, so I don' t wanna

18 swear under oat h t hat I di d.

19 Q. What woul d you have t o l ook at t o see i f you

20 act ual l y di d i ssue a r epor t ?

21 A. I have some r ecords at home of . . . and I have t o

22

l ook and see i f t hat i ncl uded a r epor t i n t her e or not .23 Q. And you woul d have mai nt ai ned t hose r ecor ds had you

24 i ssued a r epor t i n t hat f i l e?

25 A. Yes.


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1 Q. Okay. Now, so t he f i r st case, Dr . Casson.

2 What was t he second case t hat you pr ovi ded - -

3 A. I n - -

4 Q. Hol d on. We got t a - - can' t t al k over each ot her .

5 A. Sor r y.

6 Q. So what was t he second case you provi ded exper t

7 ser vi ces i n?

8 A. M&M Or t hodont i cs.

9 Q. Where were - - when were you f i r st hi r ed f or M&M?

10 A. Agai n, I don' t have t he exact dat e, but somet i me i n

11 t he spr i ng of 2012. I bel i eve.

12 Q. And who hi r ed you?

13 A. Agai n, i t was t hr ough Dr . Ander t on. And t hen l at er

14 wi t h Mr . Canal es.

15 Q. Al l r i ght . I n t he M&M case . . .

16 A. Mm- hmm.17 Q. . . . t el l me exact l y what you - - what ser vi ces you

18 pr ovi ded.

19 A. I di d t he same ser vi ces. I eval uat ed cases r el at ed

20 t o t he HLD i ndex. I di d pr ovi de a r epor t on t hat . And I was

21 deposed i n t hat case.

22

Q. Di d you pr ovi de more t han one r epor t i n t he M&M23 case?

24 A. Ot her t han deposi t i on, no.

25 Q. And Dr . Ander t on hi r ed you? He was t he at t orney


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1 f or M&M?

2 A. He was one of t he at t orneys f or M&M.

3 Q. And t hen Mr . Canal es got i nvol ved?

4 A. I l ear ned t hat Mr . Canal es was i nvol ved.

5 Q. And what ' s t he st at us, i f you know, of t he M&M

6 case?

7 A. As I under st and r i ght now, i t i s schedul ed

8 t ent at i vel y f or t r i al somet i me i n - - or hear i ng i n - -

9 somet i me i n J ul y of t hi s year .

10 Q. Sounds l i ke t he st ar t of your car eer as a

11 t est i f yi ng exper t was t hr ough Dr . Ander t on.

12 A. Mm- hmm.

13 Q. What ' s your r el at i onshi p wi t h Dr . Ander t on?

14 A. Dr . Ander t on i s a l ongt i me f r i end. We wer e i n

15 col l ege t oget her . We wer e cl assmat es i n dent al school . And

16 over t he past 48 years, we have had pat i ent s i n common.17 Q. Okay.

18 A. As a gener al dent i st , he r ef er r ed pat i ent s t o me as

19 a speci al i st .

20 Q. Okay. Al l r i ght . Ot her t han t he M&M case and t he

21 Dr . Casson case, what other or t hodont i a cases have you

22

pr ovi ded exper t consul t i ng or t est i f yi ng ser vi ces i n?23 A. J ust t hi s par t i cul ar one, t he Nazar i case.

24 Q. Okay. So you' ve been hi r ed t o do - - t o pr ovi de

25 t est i f yi ng ser vi ces i n t hr ee cases; r i ght ?


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1 A. Cor r ect .

2 Q. That ' s i t .

3 A. That ' s i t .

4 Q. Ar e you . . . ar e t her e any on t he hor i zon t hat

5 you' r e gonna pr ovi de exper t servi ces?


7 Q. Okay.

8 A. I ' ve not been - -

9 Q. Have you been asked t o pr ovi de addi t i onal servi ces?

10 A. No.

11 Q. Have you ever been accept ed by a cour t as a

12 t est i f yi ng exper t ?

13 A. Do you consi der deposi t i on a - -

14 Q. Mm- mm.

15 A. No, t hen I guess not .

16 Q. Okay.17 A. I ' ve never been t o cour t .

18 Q. And i n t hi s case, who i s payi ng your f ees?

19 A. Dr . Nazar i .

20 Q. Al l ri ght . And what i s your hour l y r at e?

21 A. The hour l y r at e i s - - f or r evi ewi ng cases i s $300

22

an hour . And t hen f or deposi t i ons and cour t appearances,23 i t ' s $400 an hour .

24 Q. Al l r i ght . I wanna t al k about your credent i al s.

25 Okay?


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1 A. Sur e.

2 Q. What qual i f i es you t o be - - or what do you consi der

3 your exper t i se to be?

4 A. Wel l , I am a uni ver si t y- t r ai ned or t hodont i st . I

5 have been pr act i ci ng or t hodont i cs - - or t hodont i st - -

6 or t hodont i cs excl usi vel y f or 48 year s. I . . . I have . . .

7 r ecei ved some t r ai ni ng by t he f or mer di r ect or J i m Or r on

8 ut i l i zi ng t he HLD eval uat i on syst em as pr ovi ded i n t he Texas

9 Medi cai d . . . Pr ovi der ' s Manual . And. . . .

10 So I f eel t hat t hat gi ves me t he abi l i t y t o

11 qual i f y cases based on t he HLD i ndex.

12 Q. Okay. So your educat i on.

13 A. Educat i on.

14 Q. So j ust t o sum up, what you bel i eve t o be your

15 qual i f i cat i ons t o of f er exper t t est i mony i n t hi s case i s

16 you' ve been t o dent al school , and you have a mast er ' s17 i n. . . .

18 A. I was i n dent al school f or f our year s. Two year s

19 i n a r esi dency pr ogr am i n or t hodont i cs.

20 Q. Okay. Your educat i on.

21 A. Mm- hmm.

22

Q. Your 45 year s of pr act i ce?23 A. 48.

24 Q. 48 year s of pr act i ce.

25 A. Mm- hmm.


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1 Q. I n t hat 48 years had you ever done anyt hi ng el se?

2 Any other t ype of pr of essi on? Deal wi t h any other t ype of

3 l i censes, f or exampl e?

4 A. Wel l , I do have a r eal est at e l i cense, whi ch i s

5 i nact i ve.

6 Q. Were you a r eal est at e sal esman?

7 A. I t ' s a r eal - est at e- sal esman l i cense, but I ' ve never

8 sol d r eal est at e.

9 Q. When di d you get your r eal - est at e- sal esman l i cense?

10 A. Oh, my god. I t ' s been 30 year s ago, pr obabl y.

11 Q. And di d you have a r eal est at e . . . sal es

12 busi ness?

13 A. No.

14 Q. Why' d you get a r eal - est at e- agent / - sal esman

15 l i cense?

16 A. To hel p me eval uat e i nvest ment s.17 Q. Okay. What ki nd of i nvest ment s?

18 A. Wel l , any t i me somebody came t o me wi t h . . . seems

19 l i ke doct or s are al ways good sour ces f or peopl e t o t r y and

20 pawn of f deal s on, and I f el t l i ke i t woul d be ver y hel pf ul ,

21 and gi ve me a pot ent i al t o i nvest some i n r eal est at e wi t h

22

some under st andi ng.23 Q. I n addi t i on t o pr act i ci ng or t hodont i cs, do you al so

24 have a si de busi ness of i nvest ment s or r eal est at e

25 i nvest ment s?


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1 A. Wel l , i t ' s not a si de busi ness. I t ' s j ust what I

2 t r y and do t o pr eser ve my ret i r ement i n t he f ut ur e i s l ooki ng

3 t o di f f er ent t ypes of i nvest ment s.

4 Q. What t ype of i nvest ment s? Fi nanci al pr oduct s?

5 Real est at e? What ?

6 A. Wel l , I do have some r eal est at e i nvest ment s. I do

7 have st ocks. But we r ecei ve hel p i n i nvest i ng wi t h t hose.

8 Q. So goi ng back t o what you bel i eve your cr edent i al s

9 ar e t hat qual i f y you t o be an exper t i n t hi s case, t al ked

10 about your educat i on; 48 year s of pr act i ce.

11 A. Mm- hmm.

12 Q. You ment i oned t hat you went to a semi nar? That J i m

13 Or r pr esent ed?

14 A. Wasn' t a semi nar . I t was a t r ai ni ng sessi on wi t h

15 Dr . Or r .

16 Q. Tel l me about t hat .17 A. Wel l , he sat down. Went over many cases wi t h me.

18 Showed me how t o eval uate these - - how t o ut i l i ze t he

19 syst em. And t o use my own j udgment i n doi ng t hese.

20 That ' s - - t hat ' s basi cal l y what i t was.

21 Q. When . . . you sai d i t ' s a t r ai ni ng sessi on?

22

A. I t was - - i t was a i nst r ucti on sessi on. Not a23 f or mal t r ai ni ng sessi on. I t was an i nst r uct i on on how t o

24 ut i l i ze and how t o scor e t he syst em.

25 Q. Al l r i ght . An i nst r uct i on sessi on. I s t hat - -


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1 A. Ri ght . I t ' s not - - i t wasn' t a f or mal i zed - -

2 f or mal i nst r uct i on i n t he sense t hat i t was document ed as t he

3 t hi ng t hat you pai d f or , a l i st ed sessi on. I t was on a

4 one- t o- one basi s.

5 Q. So i n t hi s meet i ng wi t h Mr . Or r , i t was a

6 one- on- one sessi on wi t h you?

7 A. Mm- hmm.

8 Q. Al l r i ght . So . . . wher e di d t hi s i nf or mal

9 i nst r uct i on sessi on occur ?

10 A. I t occur r ed i n Aust i n.

11 Q. Where i n Aust i n?

12 A. I t was i n a conf er ence r oom at t he of f i ce - - wel l ,

13 i t wasn' t i n t he of f i ce. I n t he of f i ce bui l di ng t hat

14 Dr . Ander t on had i n Aust i n.

15 Q. I t was i n Dr . Ander t on' s - -

16 A. Wel l , yeah, the conf er ence r oom wasn' t i n hi s17 of f i ce. I t was downst ai r s i n t he bui l di ng.

18 Q. I t was i n t he bui l di ng t hat Dr . Ander t on of f i ced

19 i n; r i ght ?

20 A. Ri ght . One of hi s of f i ces.

21 Q. So not a St at e bui l di ng?

22

A. No.23 Q. Do you r ecal l t he name of t he bui l di ng, or . . . .

24 A. No, I don' t .

25 Q. Where i t was l ocated? Downt own Aust i n?


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1 A. I t ' s - - no. I - - I r eal l y am not f ami l i ar . . .

2 i t ' s . . . I get l ost when I come her e - -

3 Q. Sur e.

4 Thi s mi ght hel p. I s Dr . Ander t on i n t hat

5 same bui l di ng?

6 A. Yes . I n hi s. . . .

7 Q. I ' m sor r y?

8 A. I was j ust gonna say hi s of f i ce i s up on . . .

9 t hi r d or f i r st f l oor . The conf er ence r oom' s down on t he

10 f i r st or basement . Somet hi ng l i ke t hat .

11 Q. Wer e t her e ot her . . . I t was j ust t he t wo of you

12 t oget her i n t hi s conf er ence r oom?

13 A. Mm- hmm.

14 Q. How di d t hat sessi on come t o be?

15 A. I t was - - when I was f i r st empl oyed by

16 Dr . Ander t on, I met wi t h J i m Or r , i n Aust i n, so t hat I woul d17 under st and how t o ut i l i ze t he HLD scor i ng syst em.

18 Q. So t hat woul d have been i n t he spr i ng of 2012;

19 r i ght ?

20 A. Mm- hmm. I bel i eve i t was.

21 Q. Do you have any r ecor ds r ef l ect i ng when t hat

22

meet i ng exact l y occur r ed?23 A. I mi ght be abl e t o - - yeah, I mi ght be abl e t o come

24 up wi t h t hat .

25 Q. And what were t hose r ecords - - what mi ght they be?


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1 A. Onl y t he dat e t hat t hey wer e t her e.

2 Q. I mean, woul d t hi s be l i ke a cal endar ent r y or a

3 memor andum or - -

4 A. I t woul d be a - - no. I t woul d be act ual l y . . .

5 a . . . on my account i ng ent r y of t he t i me t hat I spent i n

6 Aust i n.

7 Q. Okay. You bi l l ed Dr . Ander t on f or at t endi ng t hi s

8 sessi on wi t h Mr . Or r ?

9 A. Yes. Because i t was i n - - r el at ed t o - - i n

10 r el at i on t o one of t he cases.

11 Q. So I ' m st i l l mi ssi ng somet hi ng. How di d t hi s

12 meet i ng come t o be? I n ot her words, di d you pi ck up t he

13 phone and cal l Or r or di d - - di d someone - -

14 A. No, I was i n - - I was . . . f aci l i t at ed - - someone

15 f aci l i t at ed t he meet i ng.

16 Q. Who?17 A. Dr . Ander t on.

18 Q. Okay. So j ust t o - - I wanna be f ai r about t hi s.

19 A. Mm- hmm.

20 Q. Dr . Andert on had you meet wi t h Mr . Or r .

21 A. Mm- hmm.

22

Q. Cor r ect ?23 A. Mm- hmm.

24 Q. And - - got t a answer "yes. "

25 A. Yes . I ' m sor r y.


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1 Q. And t hat meet i ng occur r ed i n spr i ng of 2012 i n

2 Aust i n, Texas; cor r ect ?

3 A. Ri ght .

4 Q. And i t occur r ed i n Dr . Ander t on' s bui l di ng;

5 correct?

6 A. Cor r ect .

7 Q. And you may have some r ecor ds t hat ref - - - t hat

8 basi cal l y memor i al i ze t hat meet i ng; cor r ect ?

9 A. Yes. I t won' t speci f i cal l y say t hat I met wi t h J i m

10 Or r . But I was t her e meet i ng wi t h Dr . Ander t on.

11 Q. And you bi l l ed Dr . Casson f or t hat meet i ng;

12 correct?

13 A. No.

14 Q. Dr . - - you bi l l ed Dr . Ander t on f or t he meet i ng?

15 A. Let me t hi nk about t hat . I bel i eve I di d - - i t

16 woul d have been - - you' r e r i ght . I t was Dr . Casson t hat I17 bi l l ed. That ' s r i ght . Because t hat ' s t he f i r st t i me - - yes,

18 i t was i n t hat case.

19 Q. Pr i or t o t he f ace- t o- f ace meet i ng wi t h J i m Or r , di d

20 t he t wo of you exchange any e- mai l s or cor r espondence?

21 A. Wi t h who?

22

Q. Or r . Di d I say J i m? What ' s hi s name?23 A. Oh, J i m Or r . I t hought you sai d Moor e.

24 No, I had never met nor t al ked t o J i m Or r

25 bef or e.


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1 Q. I don' t wanna keep sayi ng spr i ng of 2012.

2 Do you have - - do you have, l i ke, a pi npoi nt

3 date?

4 A. I don' t .

5 Q. Mar ch? Apr i l ?

6 A. I - - I r eal l y don' t r emember . I - - I don' t mean t o

7 be evasi ve. I t was j ust somet i me . . . I can' t r emember

8 exact l y whi ch dat es t hat I was i n Aust i n f or t hat .

9 Q. You l i ve i n Dal l as; r i ght ?

10 A. Yes.

11 Q. So you - - di d you f l y down/ dr i ve down t o Aust i n f or

12 t hi s?

13 A. I f l ew.

14 Q. And comi ng t o Aust i n, t he sol e pur pose of comi ng t o

15 Aust i n was t o have t hi s meet i ng wi t h Or r ; cor r ect ?

16 A. Not j ust wi t h Or r . But wi t h Dr . Ander t on, Mr . Or r ,17 and a f ew ot her peopl e.

18 Q. At t hi s meet i ng wi t h Or r , di d he gi ve you r ecor ds,

19 i nf or mat i on . . . handout s? Anyt hi ng?

20 A. Yes.

21 Q. What di d he gi ve you?

22

A. He gave me copi es of t he Texas Medi cai d Provi der ' s23 Manual .

24 Q. What el se?

25 A. And . . . t hat ' s t he onl y handout he gave me.


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1 Q. Okay.

2 A. And speci f i cal l y t he sect i ons r el at ed t o t he

3 HL ( si c) i ndexi ng.

4 Q. Do you know i f he was get t i ng compensat ed by

5 somebody - - Mr . Or r was get t i ng compensat ed f or t hi s meet i ng?

6 A. I don' t know f or sur e.

7 Q. Do you have a r eason t o bel i eve he was get t i ng pai d

8 f or t hi s meet i ng?

9 A. I woul d t hi nk so.

10 Q. By whom?

11 A. That I don' t know.

12 Q. Woul d i t most l i kel y be t hat he was get t i ng pai d by

13 Dr . Ander t on?

14 A. I don' t know i f he' s get t i ng pai d di r ect l y by

15 Dr . Ander t on or f r om somewher e el se. I have no i dea.

16 Q. But i t ' s your bel i ef t hat he was get t i ng pai d t o17 have t hi s meet i ng wi t h you; r i ght ?

18 A. I . . . i t ' s my bel i ef .

19 Q. I mean, he wasn' t doi ng i t out of t he goodness of

20 hi s hear t ; r i ght ?

21 A. I woul dn' t t hi nk so.

22

Q. So at t hi s meet i ng he gave you pr i nt out s f r om t he23 Texas Medi cai d Provi der Procedur es Manual ?

24 A. Mm- hmm.

25 Q. Pr i or t o t hi s meet i ng had you ever r evi ewed t he


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1 Texas Medi cai d Provi der Procedur es Manual ?

2 A. Sect i ons of i t , yes.

3 Q. So I ' m gonna - - f or goi ng f or war d, I ' m gonna cal l

4 t hat " t he manual . " So we' r e on t he same page. Okay?

5 A. Okay.

6 Q. So at t hi s meet i ng, do you r ecal l what sect i ons of

7 t he manual he gave you?

8 A. I t hi nk he gave me a whol e copy of - - a copy of t he

9 whol e manual . But speci f i cal l y we wor ked on t he par t t hat he

10 showed me, and t he par t t hat we were revi ewi ng was r el at ed t o

11 t he scor i ng of t he HLD i ndex.

12 Q. Do you r emember whi ch edi t i on - - whi ch

13 ver si on/ year - - of t he manual he gave you?

14 A. No, I don' t .

15 Q. And what sect i on of t he manual ?

16 A. I - - I can' t gi ve you - - quot e t he number s, but17 i t ' s - -

18 Q. Yeah.

19 A. - - t he sect i on r el at ed t o t he HLD scor i ng. And

20 r el at ed t o t he qual i f yi ng f or or t hodont i c t r eat ment under

21 Medi cai d.

22

Q. And sounds l i ke he was gi vi ng you some t r ai ni ng on23 basi cal l y how t o scor e t he HLD scor i ng? Or score sheet?

24 A. Yes.

25 Q. And t el l me. I mean, what - - what was he sayi ng or


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1 i nst r uct i ng you about how t o scor e t he HLD scor e sheet ?

2 A. Basi cal l y j ust read - - he r ead t he manual , t r i ed t o

3 descr i be what each one was sayi ng, and t hat was i t .

4 Q. How l ong di d t hi s meet i ng l ast ?

5 A. I woul d say . . . appr oxi mat el y an hour .

6 Q. Ot her t han how t o score t he HLD score sheet , what

7 el se di d y' al l t al k about i n t hi s meet i ng?

8 A. Af t er we di d t hat , we went over some cases.

9 Q. Okay.

10 A. That he want ed me t o eval uat e.

11 Q. That was Or r ?

12 A. Mm- hmm.

13 Q. Okay. So Or r want ed you t o eval uat e cases?

14 A. They were not hi s cases. They were cases t hat he

15 was wor ki ng on.

16 Q. Ar e t hose cases di f f er ent than t he t hr ee cases you17 ment i oned ear l i er ?

18 A. No.

19 Q. So t hey' r e new cases; r i ght ?

20 A. They' r e - -

21 Q. Cases t hat we have not di scussed yet ; r i ght ?

22

A. No. They' r e - - I t hi nk t hey wer e Wayne Casson' s23 cases.

24 Q. When you say "cases, " ar e you r ef er r i ng t o pat i ent

25 cases, or ar e you r ef er r i ng t o - -


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1 A. Pat i ent cases. Cases t hat Wayne Casson had

2 t r eat ed.

3 Q. Got i t . Al l r i ght . As i t r el at es t o some of t he

4 speci f i c def i ni t i ons i n t he - - t hat ar e appl i cabl e t o t he HLD

5 scor e sheet t hat you and Or r di scussed, I mean . . . what

6 t erms was he - - were . . . I - - I j ust don' t get i t . I ' m - -

7 I ' m j ust - - I can' t pi ct ur e what was goi n' on i n t hat r oom.

8 And you wer e t her e, and I wasn' t t her e. So I need you t o

9 t el l me. What he was t el l i n' you as i t r el at es t o t he HLD

10 scor e sheet . I t ' s been pr et t y vague so f ar .

11 But speci f i cal l y what was he t el l i n' you

12 about t he HLD score sheet ?

13 A. He was r e- - - showi ng me, " Thi s i s - - t hi s i s a

14 f or m you use. These ar e t he i nst r uct i ons t hat you f ol l ow.

15 Thi s i s how you f i l l out t he f or ms. " And t hat ' s basi cal l y

16 what i t was.17 Q. And di d you - - di d he go over t he speci f i c t er ms?

18 For exampl e, "ect opi c er upt i on, " "mal occl usi on, "

19 "handi cappi ng, " t er ms l i ke - -

20 A. He went over hi s - - as t hey wer e l i st ed i n t he

21 manual i t sel f .

22

Q. Di d he have any of t he mater i al s wi t h hi m when he23 was goi n' over t he manual ? For exampl e, an or t hodont i a

24 t ext book?

25 A. No.


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1 Q. Okay. I t was j ust t he manual .

2 A. Ri ght .

3 Q. Al l r i ght .

4 A. I mean, he coul d have had ' em, but he di dn' t show

5 ' em t o me.

6 Q. I mean, i f you' r e a pr act i ci ng or t hodont i st , why do

7 you need t o go get t hi s t r ai ni ng i n 2012?

8 A. The Texas Medi cai d - - or t he manual doesn' t

9 necessar i l y f ol l ow t r ai ni ngs or qual i f i cat i ons t hat we

10 det er mi ne - - or r at her t hat we use i n det ermi ni ng t he need

11 f or t r eat ment .

12 Q. I wanna - - we got ki nd of si det r acked her e. I

13 wanna go back t o - - we st ar t ed of f her e wi t h your - - your

14 cr edent i al s, t o - -

15 A. Sur e.

16 Q. - - t o pr ovi de exper t t est i mony i n t hi s case.17 A. Sur e.

18 Q. Tal ked about your educat i on. Tal ked about your 48

19 year s of pr act i ce. We t al ked about t hi s t r ai ni ng sessi on

20 wi t h Or r t hat he gave you i n t he spr i ng of 2012. What ot her ,

21 you know - - what - - what el se i n your backgr ound makes you an

22

exper t i n t hi s case?23 A. Wel l , I ' m not sur e what ot her qual i f i cat i ons I

24 need, ot her t han t he f act t hat I am a pr act i ci ng

25 or t hodont i st . I ' ve done i t f or 48 year s. I shoul d have t he


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1 or t hodont i st s i n Dal l as r espect my opi ni on and wi l l come to

2 me f or a second opi ni on when t hey' r e havi ng pr obl ems.

3 Q. Have you ever used an occl usi oni st i n your

4 pr act i ce?

5 A. I ' m not sur e what an occl usi oni st i s.

6 Q. Have you ever pi cked up t he phone and cal l ed an

7 occl usi oni st ?

8 A. I ' m not sur e what an occl usi oni st i s. I t ' s not a

9 r ecogni zed speci al t y i n dent i st r y.

10 Q. What about . . . you haven' t served i n any

11 educat i onal capaci t y si nce 1969; cor r ect ?

12 A. Tr ue. Not a f or mal educat i onal pr act i ce.

13 Q. Now, you' r e not boar d cer t i f i ed i n or t hodont i cs;

14 correct?

15 A. That ' s cor r ect .

16 Q. But ar e you boar d el i gi bl e?17 A. Yes.

18 ( Mr . Khar od r et ur ned. )

19 Q. ( BY MR. HARGROVE) What does t hat mean?

20 A. I n or der t o become boar d cer t i f i ed, you have t o

21 pr esent a cer t ai n number of cases and do a exami nat i on,

22

wr i t t en exami nat i on, and pr esent a number of cases t o t he23 Amer i can Boar d of Or t hodont i cs. I n 1965, t her e were ver y f ew

24 or t hodont i st s - - a smal l - - onl y a smal l er per cent age of

25 or t hodont i st s became boar d cer t i f i ed, because i t was a ver y


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1 t i me- consumi ng t hi ng t o do, and t her e was a l ot of f i nanci al

2 i nvol vement i n i t . So i t wasn' t as i mpor t ant i n t he ear l y

3 st ages of my pr act i ce as i t has become t oday.

4 Today t he qua- - - i n or der t o qual i f y f or i t ,

5 you' r e al l owed t o - - t o do some of t he t est i ng whi l e you' r e

6 st i l l i n your r esi dency. Year s ago, you had t o be i n

7 pr act i ce f or a number of year s bef or e you coul d even appl y t o

8 be test ed f or your boar ds.

9 Wel l , back i n t he ' 60s, t hey' r e - - get t i ng a

10 pr act i ce goi ng, r ai si ng a f ami l y, t he t i me and t he r ewar d was

11 not t hat cri t i cal t o me j ust t o have anot her cer t i f i cat e.

12 That ' s t he onl y di f f er ence.

13 Q. Ar e you boar d el i gi bl e?

14 A. Boar d el i gi bl e, yes.

15 Q. What does t hat mean?

16 A. I t means t hat you meet al l t he qual i f i cat i ons,17 ot her t han t aki ng t he t est i ng, t o be boar d cer t i f i ed. I have

18 t he educat i on/ I have t he t r ai ni ng t hat al l ows me t o t ake t he

19 t est i ng.

20 Q. Woul d i t be f ai r t o say t hat somebody who' s boar d

21 cer t i f i ed i n or t hodont i cs mi ght have, you know, credi bi l i t y

22

t o be a t est i f yi ng exper t i n a case l i ke t hi s?23 A. They' d have credi bi l i t y. I don' t know i t woul d be

24 any mor e t han nonboar d cer t i f i ed. Most of t he

25 or t hodont i st s - - mat t er of f act , t her e' s a l ar ge gr oup of


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1 or t hodont i st s t hat wer e t r ai ned year s ago t hat ar e not boar d

2 cer t i f i ed, but t hey' r e cer t ai nl y qual i f i ed.

3 Q. I f you coul d pi ck out an exper t f or a case l i ke

4 t hi s, I mean, what cr i t er i a woul d you - - woul d you want i n

5 t hat exper t ?

6 A. I woul d want someone who i s boar d qual i f i ed,

7 someone who I r espect as a . . . r esponsi bl e or t hodont i st ,

8 who I r espect t hei r abi l i t y i n t r eat i ng cases. Those ar e t he

9 mai n t hi ngs t hat I woul d l ook at .

10 Q. What about i f t hey wer e boar d cert i f i ed? Woul d

11 t hat i ncr ease t he - -

12 A. That - -

13 Q. Hol d on.

14 - - t hat i ncrease t hei r st at ur e i n your eyes?

15 A. Not i n my eyes, but i t mi ght i n someone el se' s

16 eyes. And agai n, as I sai d, year s ago boar d cer t i f i cat i on17 was not a cri t - - - wel l , I shoul dn' t say cri t i cal . Was not

18 st r essed as i t i s t oday.

19 Q. Al l ri ght . Let ' s go back t o t hi s meet i ng.

20 Wel l , f i r st of al l , have you . . . have

21 you . . . done Medi cai d . . . have you bi l l ed Medi cai d?

22

Texas Medi cai d?23 A. Not di r ectl y.

24 Q. What do you mean?

25 A. I ' ve wor ked wi t h a f r i end of mi ne at a cl i ni c f or


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1 about ei ght or ni ne mont hs i n whi ch t hey di d Medi cai d

2 t r eat ment . Now, I . . . was not r esponsi bl e f or bi l l i ng

3 Medi cai d i n t he cl i ni c t hat I wor ked i n.

4 Q. Your f r i end - - who' s your f r i end?

5 A. Dr . Pat Br ady.

6 Q. Pat Br ady?

7 A. Mm- hmm.

8 Q. Mal e or f emal e?

9 A. Mal e.

10 Q. So ni ne t o t en mont hs?

11 A. I t was ar ound ni ne t o t en mont hs, appr oxi mat el y.

12 Q. When?

13 A. Thi s was i n . . . par t of 2011 and 2012.

14 Q. Okay. And Pat Br ady, a f r i end of your s who' s an

15 or t hodont i st - -

16 A. Mm- hmm.17 Q. - - i nvi t ed you t o j oi n hi m wi t h t he pr act i ce?

18 A. Ri ght . He act ual l y was wi t h a cl i ni c t hat he was

19 r esponsi bl e f or t he or t hodont i c ser vi ces of t he cl i ni c.

20 Q. What was t he cl i ni c' s name?

21 A. Bear Cr eek Dent al - -

22

Q. Bear Cr eek?23 A. I bel i eve i t ' s Bear Cr eek Fami l y Dent i st r y. I

24 bel i eve t hat ' s what i t i s.

25 Q. Where are t hey l ocat ed?


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1 A. They have sever al of f i ces i n Dal l as.

2 Q. Do you know how many of f i ces?

3 A. Of f hand, no.

4 Q. Mor e t han f i ve?

5 A. I don' t t hi nk mor e t han f i ve.

6 Q. So . . . t hr ee?

7 A. I ' d say t hey may - - t hr ee t o f our . I don' t - - I

8 woul dn' t - - i t coul d be f i ve, but I don' t bel i eve i t ' s any

9 mor e t han f i ve. I haven' t been i n . . . i nvol ved wi t h ' em

10 f or some t i me, so I don' t know i f t hey' ve expanded or not .

11 Q. Whi ch of f i ce di d you wor k at ?

12 A. The one on Spr i ng Val l ey and Coi t .

13 Q. Spr i ng Val l ey and . . . spel l t hat ?

14 A. C- O- I - T.

15 Q. Does i t have an addr ess?

16 A. I ' m sur e i t does, but I coul dn' t t el l ' ya.17 Q. When you go . . . so Dr . Br ady i nvi t ed you t o Bear

18 Cr eek Fami l y Dent i st r y t o wor k i n hi s or t hodont i cs cl i ni c

19 t her e.

20 A. Mm- hmm.

21 Q. And . . . di d you st i l l have your pr act i ce?

22

A. Oh, yes.23 Q. So di d you mai nt ai n t wo pr act i ces dur i ng t hi s

24 per i od?

25 A. Wel l , I was - - mai nt ai ned my pr act i ce, but I wor ked


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1 i n t he cl i ni c f or hi m.

2 Q. Do you st i l l have a or t hodont i cs pr act i ce?

3 A. Oh, yes.

4 Q. Do you r ecal l t he mont h t hat you st ar t ed at Bear

5 Cr eek?

6 A. No, I don' t .

7 Q. Al l r i ght . I wanna go back - - so you sai d t hat you

8 di d Medi cai d pat i ent s. You per f or med or t hodont i c ser vi ce f or

9 Medi cai d benef i ci ar i es at Bear Cr eek; r i ght ?

10 A. Ri ght .

11 Q. But I ' m a l i t t l e bi t conf used. You sai d you di dn' t

12 bi l l di r ect l y.

13 A. That ' s r i ght . I di dn' t - -

14 Q. So t el l me about t hat .

15 A. I di dn' t do t he bi l l i ng. I was pai d by Dr . Br ady,

16 and t he pat i ent s . . . t he bi l l i ng was done by Bear Cr eek.17 Q. Who . . . i s Br ady t he owner of Bear Cr eek?

18 A. No.

19 Q. Who i s t he owner ?

20 A. Gi ve me a mi nut e, I ' l l t hi nk about i t .

21 Q. Okay.

22

A. I ' m sor r y. But . . . .23 Q. Mal e? Femal e?

24 A. I t ' s a mal e.

25 Q. Ol der gent l eman? Younger?


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1 A. I t depends. Rel at i ve.

2 Q. Yeah, I - - t r ust me.

3 A. I t hi nk he' s ar ound hi s 50' s.

4 Q. Okay.

5 A. I - - I ' l l t hi nk about i t i n a mi nut e.

6 Q. Okay. We' l l ci r cl e back.

7 A. Okay.

8 Q. Get on t he I nt er net i f we have t o.

9 Okay. The - - t he . . . Tel l me what you di d

10 at Bear Cr eek.

11 A. I per f or med or t hodont i c ser vi ces i n t he f or m of

12 t r eat i ng pat i ent s. I al so di d some eval uat i on usi ng t he HLD

13 i ndex.

14 Q. Sounds l i ke t hat st ar t ed maybe i n t he summer of

15 2011? Or 20- - -

16 A. Pr ox- - - appr oxi mat el y. Coul d have been spr i ng or17 summer .

18 Q. Of 2011.

19 A. Yes.

20 Q. And i t car r i ed over i nt o 2012; r i ght ?

21 A. Ri ght .

22

Q. Was your - - what was t he nat ur e of your - - how were23 you get t i n' pai d?

24 A. From Dr . Br ady.

25 Q. From Dr . Br ady?


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1 A. On a dai l y basi s.

2 Q. Was he your empl oyer ?

3 A. He was . . . Yes, he was my empl oyer .

4 Q. Di d he cut you a - - were you a W- 2 empl oyee or di d

5 he gi ve you 1099?

6 A. Yes, I di d get a 10- . . . uh . . . t r yi ng t o

7 r emember di d he gi ve me a W- 2 or 1099. Whatever i t was, I

8 got i t .

9 Q. Wel l , were you an i ndependent cont r act or or were

10 you an empl oyee?

11 A. No, I was an i ndependent cont r act or . So I guess i t

12 woul d have been a 1099.

13 Q. Was t hi s your f i r st exper i ence wi t h ser vi ng a

14 Medi cai d benef i ci ar y?

15 A. Yes.

16 Q. So pr i or t o j oi ni ng Bear Cr eek i n t he summer of17 2011, you had never t r eat ed a Medi cai d benef i ci ar y; cor r ect ?

18 A. Cor r ect .

19 Q. And si nce you' ve l ef t Bear Cr eek, you have not

20 t r eat ed a Medi cai d benef i ci ar y; cor r ect ?

21 A. Cor r ect .

22

Q. So t he ent i r e uni ver se of your Medi cai d exper i ence23 i s t he ni ne or t en mont hs at - - whi ch you wer e at Bear Cr eek;

24 correct?

25 A. Cor r ect .


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1 Q. And at Bear Cr eek, you were an i ndependent

2 cont r act or of Dr . Br ady; cor r ect ?

3 A. Mm- hmm.

4 Q. Or were you an i ndependent cont r act or of Bear

5 Cr eek?

6 A. The checks came f r om Br ady. So I assume I was

7 i ndependent cont r act or of Br ady' s.

8 Q. Whose TPI / NPI number wer e you usi ng? Whose

9 pr ovi der i dent i f i er wer e you bi l l i ng under ?

10 A. Act ual l y . . . you know what ? They had t o be

11 bi l l ed under Bear Cr eek.

12 Q. Al l r i ght . So t he ser vi ces you per f or med - -

13 A. But act ual l y, my . . . I had a pr ovi der number , but

14 t hey wer e bi l l ed under Bear cr eek, so I ' m not sur e.

15 Q. Sounds l i ke t he - - t he bi l l i ng submi t t ed t o

16 Medi cai d f or ser vi ces t hat you pr ovi ded t o Medi cai d17 benef i ci ar i es at Bear Cr eek wer e bi l l ed under Bear Cr eek' s

18 pr ovi der number ? I s t hat f ai r ? Does t hat sound cor r ect ?

19 A. I woul d t hi nk so, because I never saw any of t he

20 bi l l i ng.

21 Q. Al l r i ght . And . . . was t hi s a f ul l - t i me posi t i on

22

at Bear Cr eek?23 A. No.

24 Q. How many days a week wer e you wor ki ng t her e?

25 A. One.


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1 Q. One day a week? What day was t hat ?

2 A. Tuesdays.

3 Q. And t hen t he ot her days of t he week you were at

4 your pr i vat e pr act i ce?

5 A. Mm- hmm.

6 Q. And on average, how many ki ds. . . .

7 What was t he - - t he popul at i on at Bear Cr eek?

8 A. I ' m not sure what you mean by t hat .

9 Q. The - - t he per cent age of Medi cai d benef i ci ar i es at

10 Bear Cr eek rel at i ve - - compar ed or - -

11 Was i t excl usi vel y Medi cai d?

12 A. I don' t know. I t was a hi gh per cent age, but I have

13 no i dea.

14 Q. So we know i t was a - - t hat pat i ent popul at i on at

15 Bear Cr eek was a hi gh per cent age of Medi cai d benef i ci ar i es;

16 correct?17 A. I n t he or t hodont i c sect i on.

18 Q. I n t he or t hodont i c sect i on?

19 Di d you wor k i n t he dent al sect i on?

20 A. No.

21 Q. You - - you do not do dent i st r y or pedi at r i c

22

dent i st r y; cor r ect?23 A. No.

24 Q. You do or t hodont i cs; r i ght ?

25 A. Ri ght .


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1 Q. And you don' t know t he exact - - was i t - - I mean,

2 i s i t cl oser t o 100 per cent of t he pat i ent popul at i on at Bear

3 Cr eek i n your exper i ence f or Medi cai d benef i ci ar i es?

4 A. Cl oser t han what ? I have r eal l y no i dea. I woul d

5 t hi nk t hat t he maj or i t y wer e Medi cai d pat i ent s, but I have no

6 way of knowi ng what - -

7 There wer e some pr i vat e- pay pat i ent s t here,

8 but I have no i dea whi ch ones were whi ch.

9 Q. So, I mean, we have maj or i t y. So we' r e above 50.

10 And . . . you don' t t hi nk i t ' s qui t e 100 per cent . So - -

11 A. I know i t wasn' t 100 per cent .

12 Q. Okay. So i n t hat r ange, we' r e above - - a l i t t l e

13 bi t above 50, a l i t t l e bi t above ( si c) 100. Hol d on.

14 Was t he percent age cl oser t o 100 percent or

15 was t he per cent age cl oser t o 50 percent ? Of Medi cai d

16 benef i ci ar i es?17 A. I can' t t est i f y . . . t r ul y t o t hat , because I

18 don' t r eal l y know.

19 Q. What ' s your bel i ef ?

20 A. My bel i ef , i t woul d be - -

21 ( Mr . Medl ock l ef t t he r oom. )

22

THE WI TNESS: - - cl oser t o 100 t han cl oser t o23 50.

24 Q. ( BY MR. HARGROVE) Di d you t r ansf er any of your

25 pat i ent s f r om your pr i vat e pr act i ce t o Bear Cr eek?


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1 A. No.

2 Q. And how di d you get your pat i ent s at Bear Cr eek?

3 A. They weren' t my pat i ent s. They were Bear Cr eek

4 pat i ent s.

5 Q. Wel l , you had a . . .

6 A. I n ot her wor ds - -

7 Q. . . . a pr of essi onal rel at i onshi p wi t h t he chi l d

8 t hat you' r e t r eat i ng; r i ght ?

9 A. Yes, but t her e wer e ot her or t hodont i st s t hat saw

10 t he pat i ent s.

11 Q. You wer e one of sever al or t hodont i st s?

12 A. That ' s t r ue.

13 Q. How many?

14 A. I don' t know t he number .

15 Q. Mor e t han f i ve?

16 A. No. I know - - I know of . . . Dr . Br ady.17 Q. Have you f i gur ed out who t he owner i s?

18 A. I t ' s comi ng t o me. I ' m sor r y. I ' l l get back t o

19 you.

20 Q. Okay.

21 A. Yes. Taf el . Rober t Taf el i s t he owner .

22

Q. He' s t he owner?23 A. Yes. I ' m sor r y. Seni or moment s.

24 Q. Di d you have t o. . . .

25 Wel l , i t ' s st ar t i ng t o happen t o me.


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1 Di d you . . . when you . . . I mean, di d

2 Taf el i nt er vi ew you or . . . .

3 A. No.

4 Q. Okay. Di d he have anyt hi ng t o do wi t h you comi ng

5 i nt o hi s cl i ni c?

6 A. No.

7 Q. Di d you ever t al k t o Taf el ?

8 A. Oh, yes.

9 Q. About - -

10 A. Af t er - - af t er I - - af t er I went to wor k wi t h

11 Dr . Br ady, I met and vi si t ed wi t h Taf el sever al t i mes.

12 Q. And what - - what - -

13 A. Soci al basi s.

14 Q. Soci al basi s? Woul d you ever di scuss pr of essi onal

15 mat t er s or . . . .

16 A. Onl y i n t he f act that he woul d come i n per i odi cal l y17 and say, "You' r e doi ng a good j ob. I l i ke t he way t he

18 or t hodont i c depar t ment i s wor ki ng. I appr eci at e you bei ng

19 her e. " That t ype t hi ng.

20 Q. I s he a dent i st or or t hodont i st ?

21 A. He' s a dent i st .

22

Q. Di d he ever di scuss your compensat i on wi t h you?23 A. No.

24 Q. Di d he ever di scuss pr oduct i on wi t h you?

25 A. No.


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1 Q. And what was t he - - how were you pai d? I mean, I

2 know you were pai d on a - -

3 A. I was pai d on a dai l y basi s.

4 Q. Ever y - - dai l y - - ever y Tuesday t hey pai d you?

5 A. Mm- hmm.

6 Q. For t he wor k t hat you per f or med t hat day or f or - -

7 A. For t he dai l y ser vi ce.

8 Q. Was i t a per cent age of - -

9 A. No.

10 Q. - - pr oduct i on?

11 A. No.

12 Q. How' d t hey - -

13 So sal ar y?

14 A. I t was a st r ai ght sal ar y per day.

15 Q. And how much was i t ?

16 A. I t was $1500.17 Q. $1500?

18 A. St ar t ed out at 1400, and t hen af t er a f ew mont hs,

19 Dr . Br ady f el t l i ke i t shoul d be - - i t - - he f el t l i ke t he

20 goi ng r at e was 1500.

21 Q. Okay.

22

A. So he r ai sed i t .23 Q. I ' m sor r y. I mi ssed t he l ast par t . I mean, t he

24 f i r s t par t . You star t ed of f at - -

25 A. 1400 a day.


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1 Q. Why' d you l eave?

2 A. Because Medi cai d qui t accept i ng or t hodont i c

3 pat i ent s, t hey di d not have t he pat i ent f l ow t o j ust i f y me

4 bei ng ther e.

5 Q. Al l r i ght . So you woul d have l ef t , i t sounds l i ke,

6 maybe Apr i l or - - at t he l at est of 2012?

7 A. I t hi nk i t was bef or e t hat . I don' t r emember when

8 Medi cai d st opped accept i ng or t hodont i c cases.

9 Q. What r ecor d woul d show your l ast day of empl oyment

10 wi t h Bear Cr eek?

11 A. I woul d have t o go back and t r y and check i n my

12 checkbook . . . t o see when t he l ast t i me I saw - -

13 Q. Maybe t hat l ast 1099 woul d r ef l ect your . . .

14 A. Probabl y woul d.

15 Q. . . . your l ast day of empl oyment ?

16 A. Not necessar i l y. I t j ust shows t he - - t he 109917 j ust shows t he annual t hi ng. So i t doesn' t show a dat e.

18 Q. Mm. Okay.

19 And di d you ever - - whi l e you were at Bear

20 Cr eek ever l ook at or see or t al k about pr oduct i on r epor t s?

21 A. No.

22

Q. Di d . . . di d you - - so t el l me t he ci r cumst ances23 of your - - of your - - of , you know, l eavi ng Bear Cr eek. I

24 mean . . . di d you j ust get up and l eave? Di d you qui t ?

25 A. No. Dr . Br ady sai d, "Hey, t hi ngs have sl owed


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1 down. I can' t af f or d t o pay you anymor e. Sor r y. "

2 Q. Okay. And you sai d t hat Medi cai d st opped

3 t aki ng. . . .

4 A. St opped appr ovi ng or t hodont i c cases.

5 Q. When di d t hat occur?

6 A. You' d pr obabl y know bet t er t han I woul d. I can' t

7 r emember t he dat e. But i t happened shor t l y af t er Channel 8

8 st ar t ed i nvest i gat i ng t he or t hodont i c Medi cai d pr ogr ams.

9 Q. But - - I mean, i t . . . f r om what you' r e t el l i n'

10 me, t he - - t he change i n any Medi cai d pol i cy had t o occur

11 bef or e you l ef t Bear Cr eek; r i ght ?

12 A. Yes.

13 Q. And t hat ' s what I ' m t r yi ng t o get at , i s, you know,

14 when exact l y you l ef t Bear Cr eek.

15 A. I - - as I sai d, when Medi cai d put t he hol d on al l

16 t he new cases, bef ore t hey swi t ched t o i nsur ance- company17 admi ni st r at i on of ' em, at t hat poi nt was when I was no l onger

18 empl oyed t her e.

19 Q. The whol e - - was i t - - t hat hol d uni que t o Br ady or

20 Bear Cr eek or was i t - -

21 A. No, i t was uni que t o ever ybody t hat di d Medi cai d

22

or t hodont i cs.23 Q. Al l r i ght . Al l r i ght . So . . . and Br ady j ust

24 sai d, " I can' t af f or d t o keep you anymor e, " and you went

25 back?


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1 A. Ri ght .

2 ( Mr . Medl ock l ef t t he r oom. )

3 Q. ( BY MR. HARGROVE) What happened t o t hose pat i ent s

4 t hat you had st ar t ed br aces?

5 A. Wel l , t hey wer en' t my pat i ent s, as I sai d. I was

6 one of t he or t hodont i st s t r eat i ng t hose pat i ent s. So t hey

7 wer e st i l l r ecei vi ng t r eat ment by Dr . Br ady, and t her e was

8 anot her f ul l - t i me or t hodont i st t her e, at t he t i me.

9 Q. We wer e gonna l i st t he names of t he or t hodont i st s.

10 Do you r emember who t hey wer e?

11 A. One of ' em was Dr . J ack Bel l .

12 Q. Who el se?

13 A. Dr . Randy Ray. And . . . J ason . . . I ' m sor r y.

14 Agai n, anot her seni or moment . I can' t r emember . I ' m

15 t er r i bl e wi t h names. J ason . . . was a young or t hodont i st

16 who was t her e f ul l - t i me. He' s no l onger t her e f ul l - t i me. I n17 f act, none of ' em ar e.

18 Q. None of ' em ar e?

19 A. Except Dr . Br ady.

20 Q. Dr . Br ady' s st i l l t her e?

21 A. Yes.

22

Q. Okay. But t he pat i ent s t hat you st ar t ed . . . I23 woul d t hi nk t hat t her e' s some, you know, bi l l i ng i dent i f i er

24 or pr ovi der i dent i f i er on t hose - -

25 A. I t pr obabl y - -


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1 Q. - - associ at ed wi t h t hose pat i ent s; r i ght ?

2 A. There has t o be wi t h Bear Cr eek, yeah.

3 Q. Okay. So I - - goi ng back t o a coupl e quest i ons

4 bef ore - - ear l i er . . .

5 A. Mm- hmm.

6 Q. . . . you l ef t . You di dn' t t ake t hose pat i ent s

7 wi t h you; r i ght ? To your pr act i ce.

8 A. They wer en' t my pat i ent s.

9 Q. Okay. They di dn' t f ol l ow you t o your pr act i ce;

10 r i ght ?

11 A. No.

12 Q. They j ust cont i nued wi t h t hei r t r eat ment , you

13 t hi nk, at Bear Cr eek; r i ght ?

14 A. Yes.

15 Q. Okay. How di d t he - - t hat pat i ent popul at i on at

16 Bear Cr eek - - how i s i t t he same or di f f er ent t han t he17 pat i ent popul at i on i n your pr i vat e pr act i ce?

18 A. Pat i ent i n my pr - - - pr i vat e pr act i ce ar e ei t her

19 pr i vat e- pay or pai d - - r ei mbur sed somewhat by i nsurance

20 compani es. And . . . doesn' t r equi r e St at e aut hor i zat i on

21 pr i or t o begi nni ng t r eat ment .

22

Q. You have t o excuse me. I ' m not f ami l i ar wi t h23 Dal l as. ' Kay?

24 A. Mm- hmm.

25 Q. I gr ew up on t he bor der . Dal l as - - so your . . .


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1 your nei ghbor hood, i n your pr act i ce, I mean, what ar e t he - -

2 what ' s i t l i ke? I mean, t er ms of af f l uence or demogr aphi cs.

3 What ' s i t l i ke?

4 A. I t ' s . . . an af f l uent ar ea of pr act i ce.

5 Q. And t hat ' s how t hose par ent s can af f or d t o pay an

6 or t hodont i st and put br aces on t hei r ki ds?

7 A. I t ' s not necessar i l y al l af f l uent pe- - - pat i ent s.

8 Q. Al l r i ght .

9 A. We have pat i ent s t hat al so ar e l abor er s. They

10 don' t have t o be af f l uent .

11 Q. But t hey have money t o pay f or braces.

12 A. They pay f or i t , yes.

13 Q. Okay.

14 A. We wor k out f i nanci al ar r angement s wi t h ' em. To

15 t r y and make i t af f or dabl e f or ' em al l .

16 Q. Goi n' back t o Bear Cr eek. What t r ai ni ng, i f any,17 di d you get on how t o bi l l Medi cai d?

18 A. I - - as f ar as bi l l i ng, I have no i dea. I have no

19 i dea what t he Medi cai d f ees were. I have no i dea how

20 Medi cai d was bi l l ed.

21 Q. And as i t rel at es t o whet her a Medi cai d benef i ci ar y

22

was ent i t l ed t o br aces, what t r ai ni ng di d you get at Bear23 Cr eek?

24 A. I was shown t he HLD char t s, as wel l . And af t er I

25 was t her e f or sever al mont hs, and some of t he t r ai ni ng - -


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1 af t er some of t he t r ai ni ng I had wi t h Dr . Or r , t hey asked me

2 t o eval uate ' em on t he HLD i ndex.

3 Q. Wel l , I t hought your meet i ng wi t h Or r was af t er you

4 l ef t Bear Cr eek.

5 A. Let me t hi nk about t hat . Wel l , i t ' s . . . l et ' s

6 see. Wi t h t he - - you' r e absol ut el y r i ght . I ' m sor r y.

7 I - - my t r ai ni ng, t hen, was j ust basi cal l y

8 shown by Dr . Br ady at t hat poi nt , how he f i l l ed ' em out . He

9 woul d t hen - - af t er he f i l l ed ' em out he asked me t o t r y and

10 do i t i n a si mi l ar manner ; gi ve my opi ni on based upon t hose.

11 Q. At Bear Cr eek di d you act ual l y r ead t he manual ?

12 A. I r ead t hose par t s of the manual .

13 Q. But your t r ai ni ng on how t o i nt erpr et t hat manual

14 came f r om Dr . Br ady?

15 A. Agai n, not how t o i nt er pr et i t . J ust t o r ead what

16 i t says and t he r ul es t o f ol l ow.17 ( Mr . Medl ock r et ur ned. )

18 THE WI TNESS: The i nter pret at i on was on my

19 own.

20 Q. ( BY MR. HARGROVE) At Bear Cr eek, di d you

21 r equest - - t hey' r e Bear Cr eek pat i ent s. But di d you submi t

22

any pr eaut hor i zat i on to TMHP t o - -23 A. I di d not .

24 Q. Okay.

25 A. Per sonal l y.


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1 Q. Al l r i ght . Let me f i ni sh t he quest i on, ' cause

2 we' r e gonna be tal ki n' over each ot her .

3 A. Oh, sur e. Go ahead.

4 Q. You know how depo. ' s wor k.

5 So at Bear Cr eek - -

6 A. Mm- hmm.

7 Q. - - di d you per sonal l y submi t any pr eaut hor i zat i on

8 t o TMHP t o - - t o do or t hodont i a work on a Medi cai d

9 benef i ci ar y?

10 A. No.

11 Q. Di d you ever si gn any HLD score sheet s at Bear

12 Cr eek?

13 A. Yes.

14 Q. Okay. How many?

15 A. I coul dn' t t el l you.

16 Q. Mor e t han 100?17 A. I don' t t hi nk so.

18 Q. Less t han 100?

19 A. Yeah.

20 Q. Bet ween 50 and 100?

21 A. I woul d say . . . yeah, between 50 and 75.

22

Q. And . . . di d you have a dent al assi st ant who woul d23 hel p you scor e t he HLD scor e sheet s?

24 A. No.

25 Q. You di d i t your sel f ?


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1 A. Yes. I scor ed ' em. She - - I had dent al assi st ant s

2 t her e, because . . . t hey . . . a number of t he pat i ent s

3 di dn' t speak Engl i sh; t hey spoke Spani sh. And I speak no

4 Spani sh. So I had an i nt er pr et er . Or a dent al assi st ant

5 woul d be t here t o hand me i nst r ument s when I was eval uat i ng

6 ' em. But not do any of t he scor i ng.

7 I ' m sor r y.

8 Q. And so you' ve t r eat ed - - i t sounds l i ke you' ve

9 compl et ed i n your - - i n your pr of essi onal capaci t y - - not as

10 an exper t . But you' ve compl et ed bet ween 50 and l ess t han 100

11 HLD score sheet s; cor r ect ?

12 A. Yes. I n - - i n t he - - at Bear Cr eek.

13 Q. Whi l e at Bear Cr eek.

14 A. Yeah.

15 Q. And your t r ai ni ng on how t o compl ete t hose score

16 sheet s came f r om - - f r om Dr . Br ady.17 I s t hat f ai r t o say?

18 A. Basi cal l y j ust showi ng me t he - - yes. The scor e

19 sheet s and t he i nst r uct i ons. And r eadi ng t he i nst r uct i ons.

20 Q. Ot her t han Dr . Br ady at Bear Cr eek, di d you r ecei ve

21 i nst r ucti on f r om any ot her - -

22

A. No.23 Q. Hol d on.

24 A. I ' m sor r y agai n.

25 Q. So ot her t han Dr . Br ady' s t r ai ni ng at Bear Cr eek,


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1 di d you r ecei ve any ot her i nst r uct i on - -

2 A. I woul dn' t r eal l y cal l that t r ai ni ng - -

3 Q. Wel l , what woul d you cal l i t , t hen?

4 A. J ust basi cal l y, "Thi s i s how you do i t . Thi s i s

5 t he f or m. Thi s i s t he f or m t o f i l l out . " Ther e was no

6 i nst r uct i on of , "Now, you l ook at t hi s f or m and you measur e

7 her e and you measur e her e. " I t was a mat t er of , "Thi s i s t he

8 f or m. "

9 ( A woman ent ered t he r oom, t o adj ust

10 t her most at , and l ef t . )

11 THE WI TNESS: "You f i l l i t out . You have t o

12 put i n t hese squar es. " Not t he i nt er pr et at i on of i t .

13 Q. ( BY MR. HARGROVE) Okay.

14 A. The i nt er pr et at i on was ent i r el y mi ne.

15 Q. Al l r i ght . Di d you . . . di d you - - what ot her

16 st eps di d you per f or m t o submi t t he pr eaut hor i zat i on f or a17 Bear Cr eek pat i ent ?

18 A. None.

19 Q. None?

20 Di d Bear Cr eek st af f t ake car e of t hat f or

21 you?

22

A. Yes. Not f or me. For Bear Cr eek.23 Q. For Bear Cr eek.

24 And j ust t o sump sum up. Your . . . You

25 know, as i t r el at es t o t he pr eaut hor i zat i on, your - - your


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1 r ol e at Bear Cr eek was l i mi t ed t o f i l l i ng out t he HLD scor e

2 sheet s; cor r ect ?

3 A. Cor r ect .

4 Q. Do you know how many of your 50 t o 100 pat i ent s

5 were appr oved f or or t hodont i a work by Medi cai d?

6 A. No.

7 Q. Do you know i f any of ' em were r ej ect ed?

8 A. Possi bl e. I have no way of knowi ng.

9 Q. I s i t your bel i ef t hat any had been r ej ect ed?

10 A. I have no i dea. Woul dn' t even specul at e on i t .

11 Q. Di d you ever have a parent t el l you t hat , you know,

12 or di d you ever have t o t el l a pat i ent t hat t hei r

13 preauthor i zat i on had been deni ed by TMHP?

14 A. No. That was not my j ob.

15 Q. Al l r i ght . What di d Dr . Br ady say about t he - -

16 t he - - t he - - t he - - t he pr obabi l i t y of t hese17 pr eaut hor i zat i ons bei ng appr oved by TMHP?

18 A. Never di scussed.

19 Q. Okay. Do you know i f any of hi s pat i ent s had ever

20 been deni ed based upon a pr eaut hor i zat i on?

21 A. I don' t know f or a f act , but I woul d i magi ne t hat

22

had he been doi ng i t f or sever al year s, t her e had t o be some23 r ej ecti ons.

24 Q. But you don' t know.

25 A. I don' t know f or sur e. I can' t t el l you t hat .


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1 Q. And at Bear Cr eek you di dn' t have t o cover your

2 cost . You wer e j ust pai d a dai l y wage. Ri ght ?

3 A. Bear Cr eek I was j ust pai d a dai l y wage.

4 Q. So goi n' back t o your - - your pr i vat e pr act i ce.

5 A. Mm- hmm.

6 Q. Sound l i ke . . . al most - - t her e' s no Medi cai d

7 popul at i on at al l .

8 A. None.

9 Q. Okay. And i n - - t hese are ki ds whose parent s or

10 guar di ans can af f or d t o pay f or br aces, or t hey have

11 i nsur ance; r i ght ?

12 A. I t ' s not j ust chi l dr en. I t ' s adul t s .

13 Q. Okay. So . . . t hat ' s i nt er est i ng. So t he - - what

14 i s t he . . . t he per cent age of pedi at r i c or t hodont i a you do

15 compared wi t h adul t or t hodont i a?

16 A. Oh, I ' d say i t ' s about 50/ 50 now. May even be - -17 yeah, about 50/ 50.

18 Q. And how does an adul t or t hodont i a pat i ent - - I

19 mean, what ' s - - j ust gener al l y speaki ng, what ar e the

20 di f f erences bet ween an adul t or t hodont i a pat i ent compared

21 wi t h, you know, a chi l d?

22

MR. CANALES: Obj ect i on t o t he f orm.23 Q. ( BY MR. HARGROVE) You can answer .

24 A. Okay. Wel l . . . adul t . . . t he - - one of t he

25 maj or di f f er ence ( si c) bet ween adul t and chi l dr en i s you


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1 don' t have gr owt h wor ki ng f or you. You al so - - adul t s can be

2 much more compl i cat ed cases because of mi ssi ng teet h, worn

3 t eet h, and t her e ar e a l ot of ot her f act or s i nvol ved i n

4 t hat . Adul t s have por cel ai n cr owns; met al cr owns that ar e

5 di f f i cul t t o get at t achment s t o st ay on.

6 So adul t cases i n many areas can be much mor e

7 di f f i cul t .

8 Q. And t hr oughout your pr act i ce, has about hal f your

9 pat i ent popul at i on been adul t s?

10 A. No.

11 Q. Maj or i t y chi l dr en?

12 A. Ear l i er year s i t was chi l dr en. But as t he - - as

13 t he pr of essi on changed and t he . . . soci al aspect of . . .

14 i n the popul at i on, peopl e became - - adul t s became more and

15 mor e awar e of t he avai l abi l i t y of or t hodont i cs and what can

16 be done wi t h or t hodont i cs f or adul t s has expanded, I bel i eve17 t he st at i st i cs show t hat mor e and mor e pr act i ces have a

18 hi gher percent age of adul t s t han t hey di d year s ago.

19 Q. So f r om about 2005 t o t he pr esent , your pr act i ce,

20 i s i t about 50/ 50 now adul t - -

21 A. Even bef or e t hat .

22

Q. Bef ore t hat ? Okay.23 So when di d i t st ar t ?

24 A. Oh, I ' d - - i t ' s har d t o say. J ust gr adual l y over

25 t i me. I ' ve seen - - seems l i ke I ' ve seen mor e adul t


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1 pat i ent s. I - - I wor k wi t h a l ot of r est or at i ve dent i st s who

2 need teet h moved around bef ore t hey can do t he rest orat i ons.

3 So my pr act i ce - - and I can' t t el l you exact l y what t hat i s.

4 As you mat ur e i n a pr act i ce, t her e ar e a l ot of dent i st s who

5 go mor e and mor e t o r est or at i ve, so i t ' s dent i st s t hat I ' ve

6 known f or a l ong t i me. And t hey need t eet h moved bef ore t hey

7 coul d do t he r est or at i ve wor k.

8 So j ust gr adual l y i t ' s gone t o wher e I have a

9 l ar ger per cent age of adul t s t han chi l dr en.

10 Q. Woul d i t be f ai r t o say t hat over the past t en

11 year s maj or i t y of your pat i ent s ar e adul t pat i ent s?

12 A. I f you mean by maj or i t y more t han 50 percent - -

13 Q. Yeah.

14 A. Pr obabl y. Yeah, i t ' s gonna be cl ose.

15 Q. Okay. Goi n' back t o your pr act i ce and how i t

16 compares wi t h Bear Cr eek, what are the demogr aphi cs, t he17 r aci al demogr aphi cs, of your pr act i ce? Ar e t hey most l y

18 Angl i cans?

19 A. I t ' s a combi nat i on. The . . . Hi spani cs,

20 Af r o- Amer i cans, and Angl os. But we al so have some Asi ans.

21 We have mi d- East er ner s. So I can' t say i t ' s j ust i n - - you

22

know, pr i mar i l y Angl o.23 Q. At Spr

antoine dental - dr. irwin ornish deposition 05.09.13

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