vol. 2 antoine dental centers vs. thhsc, oig -dr. orr cross-exam

7/28/2019 Vol. 2 Antoine Dental Centers vs. THHSC, OIG -Dr. Orr Cross-Exam

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

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SOAH DOCKET NO. 529- 13- 0997HHSC- OI G CASE NO. : P20111316523848911

ANTOI NE DENTAL CENTER, ( BEFORE THE(

Pet i t i oner ((

vs. ( STATE OFFI CE OF(

TEXAS HEALTH AND HUMAN (SERVI CES COMMI SSI ON, (OFFI CE OF I NSPECTOR (GENERAL, (

(Respondent ( ADMI NI STRATI VE HEARI NGS

______________________________________

HEARI NG

VOLUME I I

WEDNESDAY, MAY 29, 2013

______________________________________

BE I T REMEMBERED t hat on t hi s t he 29t h day of May,

2013, bet ween 9: 02 a. m. and 5: 49 p. m. , t he above- ent i t l ed

mat t er cont i nued f or hear i ng at t he St at e Of f i ce of

Admi ni st r at i ve Hear i ngs, Wi l l i am P. Cl ement s Bui l di ng, 300

West 15t h St r eet , Four t h Fl oor , Aust i n, Texas, bef or e t he

Honor abl e J udge Howard Sei t zman and Honor abl e J udge

Cather i ne Egan; and t he f ol l owi ng pr oceedi ngs were

r epor t ed by Renea Seggern, Cert i f i ed Shor t hand Repor t er .


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1 A P P E A R A N C E S2

3 ADMI NI STRATI VE LAW J UDGES:4 Honor abl e Howar d Sei t zman

Honorabl e Cather i ne Egan5 STATE OFFI CE OF ADMI NI STRATI VE HEARI NGSWi l l i am P. Cl ement s Bui l di ng

6 300 West 15t h St r eet , Sui t e 504Aust i n, Texas 78701

7

8 FOR THE PETI TI ONER:9 CANALES & SI MONSON, P. C.

Mr . J . A. "Tony" Canal es10 Mr . Hect or Canal es

2601 Mor gan Avenue11 Cor pus Chr i st i , Texas 78465

( 361) 883- 060112

13 ROBERT M. ANDERTON, D. D. S. , J . D.Mr . Rober t M. Ander t on

14 1909 Wal nut Pl zCar r ol l t on, Texas 75006

15 ( 972) 416- 525116

17 HI LDER & ASSOCI ATES, P. C.Mr . Phi l i p H. Hi l der

18 Mr . Wi l l i am B. Gr ahamMr . J ames G. Ryt t i ng

19 819 Lovet t Bl vd.Houst on, Texas 77006

20 ( 713) 655- 911121

22 BROWN MCCARROLL

Mr . Thomas Wat ki ns23 111 Congress Avenue

Sui t e 140024 Aust i n, Texas 78701

( 512) 703- 575225


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1 A P P E A R A N C E S

2

3 FOR THE RESPONDENT:

4 WATERS & KRAUS, L. L. P.Mr . Dan Hargrove

5 600 Navar r o, Sui t e 500San Ant oni o, Texas 78205

6 ( 210) 349- 0515

7

8 WATERS & KRAUS, L. L. P.Ms. Cai t l yn Si l han

9 3219 McKi nney AvenueDal l as, Texas 75204

10 ( 214) 357- 624411

12 MORI ARTY LEYENDECKER, P. C.Mr . J ames R. Mor i ar t y

13 4203 Mont r ose, Sui t e 150Houst on, Texas 77006

14 ( 713) 528- 0700

15

16

KHAROD LAW FI RM, P. C.Mr . Ketan Kharod17 P. O. Box 151677

Aust i n, Texas 7871518 ( 512) 293- 1556

19

20 ATTORNEY GENERAL OF TEXASMr . Raymond C. Wi nt er , Chi ef

21 Ms. Mar gar et M. Moor e, Assi st ant At t or ney Gener alCI VI L MEDI CAI D FRAUD DI VI SI ON

22 P. O. Box 12548Aust i n, Texas 78711- 2548

23 ( 512) 936- 1709

24

25


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1 A P P E A R A N C E S2

3 FOR THE RESPONDENT:

4 HEALTH AND HUMAN SERVI CES COMMI SSI ON - OFFI CE OFI NSPECTOR GENERAL

5 Mr . Enr i que Var el aMr . J ohn R. Medl ock

6 11101 Met r i c Bl vd.Bui l di ng I

7 Aust i n, Texas 78708( 512) 491- 2000

8

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1 I N D E X - VOLUME I I

2 Appear ances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Pr oceedi ngs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

4 WI TNESSES FOR RESPONDENT:5 J AMES W. ORR, D. D. S.

6 Cr oss- exami nat i on by Mr . Mor i ar t y. . . . . . . . . . . . . . . . . 6Di r ect Exami nat i on by Mr . Ander t on. . . . . . . . . . . . . . 165

7 Recr oss- Exami nat i on by Mr . Mor i ar t y. . . . . . . . . . . . . 228Redi r ect Exami nat i on by Mr . Ander t on. . . . . . . . . . . . 234

8

9 Repor t er ' s Cer t i f i cat e. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

10 E X H I B I T I N D E XFOR THE PETI TI ONER

11 NO. DESCRI PTI ON PAGE

12 82 Let t er dat ed Apr i l 14, 2012 by J ames Or r 162

13

14 E X H I B I T I N D E XFOR THE RESPONDENT

15 NO. DESCRI PTI ON PAGE

16 57 Emai l by J ames Or r dat ed November 6, 2002 164

17 58 Emai l by J ames Or r dat ed J anuary 31, 2007 164

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

2 J UDGE SEI TZMAN: Let ' s go on t he r ecord. I t

3 i s 9 o' cl ock on Wednesday, May 29t h, 2013. Thi s i s Day 2

4 of t he hear i ng i n Ant oi ne Dent al Cent er ver sus Texas

5 Heal t h and Human Servi ces Commi ssi on, Of f i ce of I nspect or

6 General , SOAH Docket Number 529- 13- 0997. J udges Sei t zman

7 and Egan pr esi di ng.

8 At t hi s t i me, I wi l l i ndi cat e t hat we had a

9 br i ef conver sat i on of f t he r ecor d. Ther e ar e no

10 pr el i mi nar y mat t er s, so we ar e r eady t o go t o t he11 I nspect or Gener al ' s next wi t ness.

12 And, Mr . Mor i ar t y, ar e you quest i oni ng t he

13 wi t ness?

14 MR. MORI ARTY: I am, Your Honor .

15 J UDGE SEI TZMAN: You may pr oceed. And Dr .

16 Or r i s your next wi t ness; i s t hat cor r ect ?17 MR. MORI ARTY: That i s cor r ect .

18 J AMES ORR, D. D. S. ,

19 havi ng been f i r st dul y swor n, t est i f i ed as f ol l ows:

20 CROSS- EXAMI NATI ON

21 BY MR. MORI ARTY:

22

Q Woul d you i nt r oduce your sel f t o t he J udges,23 pl ease.

24 A Yes, si r . My name i s J ames W. Or r , D. D. S. , of

25 Aust i n, Texas.


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1 Q What i s t he pur pose of t he HLD i ndex?

2 A I woul d t hi nk t hat t he HLD i ndex i s a f ee- dr i ven

3 scor i ng syst em t o al l ow f or account abi l i t y of an

4 or t hodont i c case t o be est abl i shed f or t r eat ment .

5 Q I woul d t hi nk. Do you know what t he HLD i ndex i s

6 fo r?

7 J UDGE SEI TZMAN: Mr . Mor i ar t y, coul d you

8 pul l t he mi c a l i t t l e bi t cl oser t o you.

9 MR. MORI ARTY: Yes.

10 Q ( BY MR. MORI ARTY) Dr . Or r , my quest i on i s pr et t y11 si mpl e. What i s t he HLD i ndex f or ?

12 A I woul d say i t ' s f or account abi l i t y of submi ssi on

13 of an or t hodont i c case t o t he Texas Medi cai d pr ogr am.

14 Q You hesi t at e when you say t hat . You have

15 hesi t at ed on bot h of t hose answers. Do you not know what

16 t he HLD i ndex i s f or ?17 A I probabl y know.

18 Q You probabl y know. Woul d you be ki nd enough t o

19 shar e t hat knowl edge.

20 A The HLD i ndex has - - goes way back bef ore al l of

21 our t i mes and has, I t hi nk, di f f er ent pur poses at

22

di f f er ent t i mes t hr ough t he year s.23 Q What i s i t used f or t oday?

24 A I t i s used f or submi ssi on of scor i ng an

25 or t hodont i c case f or t he Texas Medi cai d pr ogr am.


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1 Q Wel l , l et ' s see i f we can si mpl i f y t hi ngs because

2 t hese J udges need t o underst and what i s goi ng on. The HLD

3 i ndex i s a scor i ng syst em t hat ' s been i n exi st ence f or 30

4 or 40 year s t o ai d St at es i n di f f er ent i at i ng bet ween

5 chi l dr en who qual i f y f or Medi cai d br aces and chi l dr en who

6 do not ; i s t hat t r ue?

7 A That sounds l i ke an excel l ent expl anat i on t o me.

8 Q So my quest i on, si r , i s: I s i t t r ue?

9 A I woul d say i t ' s t r ue.

10 Q Okay. Now, when someone l i ke Dr . Tadl ock or11 someone who i s act ual l y qual i f i ed t o do or t hodont i cs

12 eval uates a chi l d f or br aces, why do t hey use t he HLD?

13 A I ' m not cl ear what you ar e aski ng, si r .

14 Q Wel l , when woul d a dent i st use t he HLD f or m?

15 A I n t he Texas Medi cai d pr ogr am?

16 Q I s t he HLD f or m used onl y i n Texas?17 A I under st and i n ot her f or ms i t i s used i n ot her

18 St at es.

19 Q Wel l , you know i t ' s used i n ot her St at es, don' t

20 you?

21 A I don' t know t hat per sonal l y.

22

Q Meani ng, you haven' t per sonal l y l ooked i n t he23 l aws f or Cal i f or ni a, f or exampl e, t o know, but you know,

24 as a mat t er of f act , ot her St at es use var i ous f or ms of t he

25 HLD i ndex, don' t t hey?


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1 A I can agr ee t o t hat .

2 Q Al l r i ght . When an or t hodont i st want s t o

3 eval uat e a chi l d f or whet her t hat chi l d needs br aces, do

4 t hey use t he HLD i ndex?

5 A I n t he Texas Medi cai d pr ogr am?

6 Q No, si r , t hat wasn' t my quest i on. When an

7 or t hodont i c i s eval uat i ng a chi l d t o see i f t hat chi l d

8 needs br aces, do t hey use t he HLD i ndex?

9 A Si r , I t hi nk t hey mi ght or mi ght not . I have no

10 way of knowi ng i n pr i vat e pr act i ce i f t hey don' t use i t .11 Q You j ust don' t know much about or t hodont i cs

12 pr act i ce, do you?

13 A Di f f er ent i ndi vi dual s ar ound t he St at e, I

14 cer t ai nl y don' t know i f t hey use t hat f or m or ot her f or ms.

15 Q Wel l , a r eal i t y i s t hat i f an or t hodont i st want s

16 t o eval uat e a chi l d f or br aces, i f he wasn' t seeki ng17 payment under Medi cai d, t here woul d be no r eason t o use

18 t he HLD i ndex; i sn' t t hat t r ue?

19 A That i s ver y possi bl e.

20 Q I di dn' t ask you whet her i t was possi bl e, Dr .

21 Or r ; I asked you whet her i t was t r ue.

22

A I don' t know i f t hat ' s t r ue or not , si r .23 Q Wel l , l et me appr oach i t l i ke t hi s: The t est of

24 whet her a chi l d i s qual i f i ed f or br aces or needs br aces i s

25 compl et el y di f f er ent f r om anal ysi s of whet her t hat chi l d


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1 qual i f i es f or br aces under Medi cai d; t r ue or f al se?

2 A Let ' s go t hr ough t hat one more t i me.

3 Q When an or t hodont i st i s eval uat i ng a pat i ent t o

4 det er mi ne whet her t hat chi l d has cr ooked t eet h or coul d

5 benef i t cosmet i cal l y or ot her wi se f r om br aces, t hey don' t

6 need t he HLD i ndex unl ess t hey are seeki ng payment f r om

7 t he St at e of Texas t o pay f or t hose br aces; t r ue or f al se?

8 A I can' t answer t hat . Ever y or t hodont i st i n

9 pr i vat e pr act i ce woul d have di f f er ent ways of doi ng i t .

10 Q Name some of t hem.11 A Scr at ch pad, but he may or may not want t o use

12 t hat par t i cul ar f or mat , whi ch we al l know t hat .

13 Q Do you bel i eve t hat t he HLD t est i s a good t est

14 f or qual i f yi ng a chi l d f or Medi cai d pai d f or br aces?

15 A Yes and no. That ' s a ver y compl i cat ed quest i on,

16 ver y compl i cat ed.17 Q Why don' t you gi ve me a si mpl e answer .

18 A Wel l , I t hi nk i t ' s a ver y good f or m t o use f or

19 t he Texas Medi cai d syst em. Out si de of t he Texas Medi cai d

20 syst em, i t mi ght have l i mi t at i ons of not bei ng compl ex

21 suf f i ci ent l y.

22

Q Why woul d t hat be a l i mi t at i on?23 A Wel l , obvi ous f r om t he f i r st , t hat t he Texas

24 Medi cai d syst em r est r i ct s us t o t he ant er i or 12 t eet h.

25 And as we l ear ned f r om t he excel l ent pr esent at i on


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1 yest er day mor ni ng, t hat t he anal ysi s f or ect opi c er upt i on

2 and el i gi bi l i t y f or or t hodont i c t r eat ment may wel l be

3 consi der ed f r om t he whol e mout h.

4 Q When you were payi ng or denyi ng cl ai ms f or

5 Nat i onal Her i t age I nsurance Company, what syst em di d you

6 use t o det er mi ne whet her t hose chi l dr en wer e qual i f i ed or

7 not qual i f i ed f or St at e f unds?

8 A The onl y syst em t hat I used was t he chapt er i n

9 t he Texas Medi cai d pr ovi der manual of - - dent al chapt er .

10 That was t he onl y syst em t hat we had or coul d use.11 Q Let me see i f I can cl ar i f y your answer . The

12 Texas Medi cai d provi der manual di dn' t exi st t en year s ago

13 when you were wor ki ng f or Nat i onal Her i t age I nsurance

14 Company; i sn' t t hat t r ue?

15 A Di d not exi st ?

16 Q You worked at Nat i onal Her i t age I nsur ance Company17 f r om 1995 unt i l 2004?

18 A Yes, si r .

19 Q And t hey had t hei r own manual of pol i ci es t hat

20 t hey had been gi ven by t he St ate t hat t hey were t o

21 enf or ce, t r ue?

22

A Wel l , we had - - and I have - - I possess f r om t he23 1995 - - Texas Medi cai d Provi der Procedur es Manual f r om

24 1995 on, and I - - t o me, t hat ' s t he Medi cai d manual .

25 Q Al l r i ght . And your j ob wor ki ng f or Nat i onal


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1 Her i t age I nsur ance Company was t o accept or deny cl ai ms,

2 true?

3 A That was one of my j obs, yes, si r , t r ue.

4 Q And you have cl ai med at var i ous t i mes t o be t he

5 f or mer di r ect or of t he Texas Medi cai d pr ogr am; t r ue t hat

6 you have cl ai med i t ?

7 A No, not t hat I have cl ai med i t . Ot her peopl e

8 cer t ai nl y have and I was t ol d I was t hat when I was t her e,

9 but I woul d not say and agr ee t hat I have cl ai med t hat .

10 Q You wer e t ol d by who t hat you wer e t he Texas11 Medi cai d dent al di r ect or ?

12 A By my bosses.

13 Q Wel l , how many - - speci f i cal l y, who t ol d you

14 that?

15 A I had a dozen bosses at t hat syst em.

16 Q Al l r i ght . Name one.17 A And t hey changed f r equent l y.

18 Q Gi ve me t he name of one t hat t ol d you t hat you

19 wer e t he di r ect or of t he - - t he Texas Medi cai d dent al

20 di r ect or ?

21 A Wel l , I can' t r emember t he l ast name, but her

22

f i r st name was Sal l y. She was one of t he admi ni st r at or s.23 Q How much wer e you maki ng when you wer e hi r ed i n

24 1995?

25 A I t woul d have been cl ose t o $100, 000 a year .


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1 Q Now, was t he pr ocess f or Nat i onal Her i t age

2 I nsur ance Company t o qual i f y chi l dr en f or br aces any

3 di f f er ent t hen t han i t i s t oday?

4 A Si r , I have no i dea what i t i s t oday. I can onl y

5 specul at e.

6 Q So you don' t prof ess t o be an exper t on how a

7 chi l d qual i f i es f or br aces i n Texas t oday, cor r ect ?

8 A I coul d r ead t he manual t hat says i t ' s t he

9 compr ehensi ve gui de and I can go by t hat .

10 Q But t hat ' s al l you know, i s pi cki ng up a book and11 r eadi ng i t ?

12 A As much as anybody el se. I do not know t he

13 i nt er nal wor ki ngs of t he cont r act or t hat does i t now.

14 Q I ' m not sur e - - I have t hi s f eel i ng t hat your

15 answer and my quest i on aren' t mat chi ng, so l et me go back

16 and see i f I can cover t hat .17 Ar e you or are you not an exper t on pr esent

18 day Texas Medi cai d pol i ci es regar di ng el i gi bi l i t y f or

19 br aces?

20 A I know you want a yes or no, but i f i t ' s i n t he

21 manual , I woul d consi der mysel f t o be an exper t ,

22

cer t ai nl y, as much as anybody el se.23 Q So t o be f ai r , i f I r ead t he manual , I ' m an

24 exper t ; i f you r ead t he manual , you ar e an exper t ; i s t hat

25 what you are sayi ng?


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1 A I suspect I ' m mor e of one si nce I ' m a dent i st .

2 Q But you ar e not an or t hodont i st , ar en' t you?

3 A No, si r .

4 Q And you have never been an or t hodont i st , have

5 you?

6 A No, si r .

7 Q And you are not an exper t on or t hodont i st work?

8 A No, si r .

9 Q What qual i f i cat i ons does someone need t o have t o

10 be abl e t o competent l y score an HLD score?11 A Basi cal l y, t hey shoul d have a doct or of dent al

12 sur ger y or doct or of medi cal dent i st r y degr ee.

13 Q Anyt hi ng el se?

14 A Wel l , t hat was basi cal l y. I mean, you coul d go

15 on and have l ot s of post gr aduat e educat i on.

16 Q I ' m aski ng a si mpl e quest i on. What17 qual i f i cat i ons woul d someone need t o have t o be abl e t o

18 competent l y scor e an HLD i ndex?

19 A A DDS degr ee.

20 Q Any DDS?

21 A Wel l , yes. Our school s ar e qui t e t he same al l

22

over t he Uni t ed St at es.23 Q So your answer i s t hat any gr aduate of a dent al

24 pr ogr am i s compet ent t o score t he HLD?

25 A Counsel or , I ' m not sur e I woul d say yes because


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1 t here mi ght be some school s t hat have shor t cour ses and

2 ot her s t hat have extensi ve cour ses.

3 Q I ' m not t r yi ng t o pi n you down t o ever y si ngl e

4 dent i st i n t he wor l d. I am t al ki ng gener al l y speaki ng.

5 Most dent i st s t hat get out of school ought t o be abl e t o

6 scor e an HLD?

7 A Yes, si r .

8 Q And I suppose t hat woul d - - Dr . Or ni sh i s a

9 dent i st ; i s he not ?

10 A Yes, si r .11 Q You ar e a dent i st , r i ght ?

12 A Yes, si r .

13 Q Dr . Nazar i i s a dent i st , r i ght ?

14 A Yes, si r .

15 Q And so accor di ng t o your st andard, you guys woul d

16 be qual i f i ed t o pr oper l y and compet ent l y scor e an HLD?17 A I ' m not sur e t hat I woul d - - I woul d be abl e t o

18 say yes t o al l t he adj ect i ves t hat you t hr ow i n t her e.

19 Q Wel l , pi ck out t he ones you don' t want t o say yes

20 t o.

21 A One dent i st mi ght have a dent al degr ee and onl y

22

st udi ed mi ni mal or t hodont i cs i n school , t hat ' s my obvi ous23 answer . And others may have t aken el ect i ves and st udi ed

24 i t i nt ensi vel y.

25 Q Wel l , f i ve mi nut es ago, t he answer t o my quest i on


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1 was you need t o be a dent i st . Now, t he answer i s you need

2 t o be a dent i st and you need post gr aduat e wor k; i s t hat

3 what you are sayi ng?

4 A No, I di dn' t say t hat .

5 Q Wel l , t el l me what you are sayi ng, because I

6 don' t under st and i t .

7 A You have t o r ephr ase t he quest i on. I ' m not wi t h

8 you.

9 Q Shoul d any dent i st r easonabl y be abl e t o

10 compet ent l y scor e an HLD?11 A I ' l l go on a l i mb and say yes.

12 Q Can onl y a dent i st compet ent l y score an HLD?

13 A As opposed t o an at t orney or an engi neer ?

14 Q A human bei ng. A dent i st over here and a human

15 bei ng over here, coul d an or di nary human bei ng be t r ai ned

16 t o compet ent l y score an HLD?17 A I woul d say no.

18 Q And I don' t mean t o pi ck on t he J udges - -

19 J UDGE SEI TZMAN: But you ar e.

20 MR. MORI ARTY: You' r e pr obabl y r i ght .

21 Q ( BY MR. MORI ARTY) Let me st ar t wi t h me.

22

Obvi ousl y, I woul dn' t be compet ent t o scor e an HLD under23 your st andar d, r i ght ?

24 A Obvi ousl y, you woul d not be?

25 Q I s t hat what you are sayi ng?


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1 A I agr ee.

2 Q And t hese peopl e back here, t hey woul dn' t be abl e

3 t o do i t ei t her , woul d t hey?

4 A I don' t know who t hey are.

5 Q I don' t t hi nk any of t hem i s a dent i st except Dr .

6 Al t enhof f . The ot her s woul dn' t be abl e t o t el l a

7 di f f er ence bet ween qual i f i ed and unqual i f i ed, woul d t hey?

8 That ' s what you ar e sayi ng, i sn' t i t ?

9 A Yes.

10 Q Now, l et me make a poi nt about t he HLD scor i ng.11 Whether t hey score a t wo or a 20, at t he end of t he day,

12 t hat doesn' t make any di f f er ence, does i t ?

13 A I don' t under st and t he quest i on.

14 Q I f t hey scor e a t wo or i f t hey scor e a 20, t hey

15 get t ur ned down, r i ght , t hey don' t get br aces under

16 Medi cai d?17 A I under st and what you ar e sayi ng, t he st andar d i s

18 26 poi nt s i n Texas.

19 Q That wasn' t my quest i on. I f t hey get a t wo or a

20 20, t hey don' t get br aces i n Texas, r i ght ?

21 A Ri ght .

22

Q And t hen you don' t get t en t i mes as much money i f23 you go f r om a t wo t o a 20, r i ght ?

24 A I ' m not sure what t hat means.

25 Q Ther e i sn' t f unct i onal l y any di f f er ence bet ween a


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1 scor e of t wo and a scor e of 20, cor r ect ?

2 A The case i s not appr oved i f i t ' s not 26 poi nt s.

3 Q So t he answer t o my quest i on i s, t her e i sn' t any

4 f unct i onal di f f er ence bet ween get t i ng a t wo and a 20,

5 correct?

6 A Ther e i s not any di f f er ence.

7 Q And t her e i sn' t any di f f er ence bet ween get t i ng a

8 26 and a 40, i s t her e?

9 A Not f r om an admi ni st r at i ve st andpoi nt t o appr ove

10 t he case, t he case woul d be appr oved.11 Q Okay. Now, how much var i at i on f r om one dent i st

12 t o anot her woul d be accept abl e bef or e you st ar t cal l i ng

13 f oul ?

14 A I ' m wi t h you, but I don' t under st and how t o

15 answer .

16 Q Wel l , some of t he t est s ar e pr et t y obj ect i ve,17 ar en' t t hey?

18 A Some of t hem are, t hey are measur abl e.

19 Q But even i f t hey are measur abl e, somet i mes peopl e

20 get of f a l i t t l e bi t on t hei r measur ement s, r i ght ?

21 A Some, yes, si r .

22

Q And some of i t i s subj ect i ve, r i ght ?23 A Compl et el y so.

24 Q Compl et el y so?

25 A Yes, si r .


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1 Q What does compl et el y so mean?

2 A Ther e ar e ar eas of t he ni ne cr i t er i a i n Texas

3 Medi cai d t hat ar e ver y, ver y subj ect i ve.

4 Q You sai d t he word, compl et el y?

5 A They ar e compl et el y subj ect i ve.

6 Q What does compl et el y subj ect i ve mean?

7 A To me, i t means t hat t he per son and hi s t r ai ni ng

8 and hi s at t i t udes and hi s ment al f unct i ons i n t hi s ar ea,

9 t hat he comes up wi t h a cer t ai n scor e.

10 Q What does t hat mean i n Engl i sh? My quest i on i s11 t hi s, si r : What does - - t he J udges need t o know - - you

12 ar e cl ai mi ng par t of t he t est i s compl et el y subj ect i ve,

13 what do you mean?

14 A I mean, i t depends on t he i nt el l ect ual

15 det er mi nat i on of t he per son and hi s emot i onal and

16 i nt el l ect ual capaci t y t o r ead t hose wor ds and deci de how17 he want s t o admi ni st er t hat .

18 Q Let me r ead t o you somet hi ng f r om Thr ough t he

19 Looki ng Gl ass; maybe you don' t r emember your chi l dr en' s

20 poems.

21 " I don' t know what you mean by gl or y, " Al i ce

22

sai d. Humpt y Dumpt y sai d - -23 MR. ANDERTON: Obj ect i on, Your Honor . I t ' s

24 a host i l e wi t ness.

25 Q ( BY MR. MORI ARTY) Humpt y Dumpt y smi l es


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1 cont empt uousl y, "Of cour se you don' t , unt i l I t el l you. I

2 meant t here i s a ni ce knock- down argument f or you. "

3 "But gl ory doesn' t mean a ni ce knock- down

4 ar gument , " Al i ce obj ect ed.

5 "When I use t he wor d, " Humpt y Dumpt y sai d i n

6 a r at her scor nf ul t one, " i t means j ust what I sai d.

7 Choose i t t o mean nei t her mor e nor l ess. "

8 I s t hat your def i ni t i on of compl et el y

9 subj ect i ve?

10 A Of cour se not .11 Q But t hat ' s what i t sounds l i ke you ar e sayi ng

12 when you say t he t est par t of t he t est i s compl et el y

13 subj ect i ve.

14 A I don' t bel i eve t he Texas Medi cai d manual

15 i ncl udes t hat ar ea t hat you j ust r ead.

16 Q I ' m aski ng you i f you ar e suggest i ng - -17 MR. ANDERTON: Obj ect i on, Your Honor ,

18 argument at i ve.

19 J UDGE SEI TZMAN: Over r ul ed.

20 I ' m goi ng t o gi ve you a l i t t l e t i me, but not

21 a l ot of t i me t o cover t hi s.

22

Q ( BY MR. MORI ARTY) Her e i s my poi nt : Ar e23 or di nar y peopl e capabl e of l ooki ng at t he evi dence, t he

24 mol ds, t he pi ct ur es and dr awi ng, concl usi ons about whet her

25 chi l dren have real l y messed up mout hs or not messed up


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1 mout hs at al l ? I s t hat wi t hi n t he ski l l and exper t i se of

2 ordi nary human bei ngs?

3 A Counsel , I woul dn' t have any way of knowi ng what

4 an i ndi vi dual coul d know when t hey see. I s t hat any way

5 - - woul dn' t have any way of knowi ng that .

6 Q I f you wer e goi ng t o t r ai n peopl e t o scor e t he

7 HLD, how woul d you t r ai n t hem?

8 A I woul d not t r ai n anybody f or HLD unl ess they

9 were a dent i st . There woul d be t oo much backgr ound

10 knowl edge t hey woul d have t o know t o even under st and the11 t er mi nol ogy.

12 Q Okay. What was my quest i on?

13 A I t ' s been a l ong t i me ago.

14 Q How woul d you t r ai n peopl e t o scor e t he HLD?

15 A A dent i st ?

16 Q Wel l , you have sai d onl y dent i st s ar e qual i f i ed17 t o do i t . So accept i ng t hat def i ni t i on of qual i f i ed, how

18 woul d you t r ai n t hem t o do i t ?

19 A And you are speaki ng of t he Texas Medi cai d HLD?

20 Q Sure.

21 A I woul d st ar t wi t h havi ng t hem r ead t he dent al

22

chapt er of t he Texas Medi cai d manual and l ear n i t .23 Q How woul d you f i ni sh?

24 A We woul d go t hr ough st andard t eachi ng t echni ques,

25 quest i ons and answer s and cl i ni c pr obl ems.


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1 Q Let ' s swi t ch subj ect s. Di d you get empl oyed by

2 t he St at e of Texas as an exper t i n t he Al l Smi l es/ Mal ouf

3 case?

4 A I bel i eve t hat i s cor r ect .

5 Q You say you bel i eve t hat i s cor r ect . I ' m not

6 underst andi ng why you ar e hedgi ng on me. I s i t cor r ect or

7 i s i t not cor r ect ?

8 A Ther e' s been a l ot of cases t hr ough t he year s.

9 Q Were you hi r ed by t he St at e of Texas t o r evi ew

10 dent al cases f or t he St at e of Texas agai nst Al l Smi l es?11 A I ' l l say yes, because I never ref er r ed t o i t as

12 Al l Smi l es. I t hi nk we ar e t al ki ng of t he same one, i s

13 why I was hesi t at i ng.

14 Q How di d you r ef er t o i t ?

15 A You ment i oned a name and I t hi nk t hat was what I

16 r ecogni ze as t he doct or ' s name.17 Q Dr . Ri chard Mal ouf ?

18 A Never hear d Ri char d.

19 Q Dr . Mal ouf ?

20 A Yes.

21 Q From Dal l as?

22

A I don' t know.23 Q And when were you hi r ed i n t hat case?

24 A I t hi nk t hat - - I r ecol l ect t hat was i n 2008.

25 Q Al l r i ght . Why wer e you hi r ed?


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1 A I was pr obabl y hi r ed because I have done

2 ext ensi ve wor k i n t hat t ype of act i vi t y t hr ough t he year s.

3 Q What t ype of act i vi t y?

4 A Of r evi ewi ng cases.

5 Q Al l r i ght . And why were you t o r evi ew t hese

6 cases?

7 A I woul dn' t know, Counsel . Somebody want ed i t

8 done.

9 Q Okay. Do you have some r ecol l ect i on of who i t

10 was you t al ked t o? You don' t have t o r emember t hei r names11 maybe, i f I r emember who t hey wor ked f or .

12 A I know t hat t hi s was usual , an i nvest i gat or

13 br ought me t he mat er i al and pi cked i t up.

14 Q What mat er i al di d he br i ng?

15 A That woul d have been t he dent al char t s and

16 mat er i al t hat we usual l y l ook at .17 Q Al l r i ght . And l et me r epr esent t o you t hat I

18 have got t hese char t s over her e i n boxes and mol ds and we

19 have got t he phot ogr aphs her e and we have t he dent al

20 r ecor ds her e and we have t hi s st uf f pr oper l y redact ed so I

21 can ask you some quest i ons about i t . Let me r epr esent t o

22

you, i t l ooks l i ke i t ' s about 50 f i l es.23 A I ' m sor r y?

24 Q I t ' s about 50 f i l es. Does t hat r ef r esh your

25 r ecol l ect i on?


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1 A No, si r .

2 Q You don' t have any i dea how many i t was?

3 A I mean, a r evi ew case coul d be anywhere f r om 40

4 t o 70 or 80. They ar e di f f er ent .

5 Q Okay.

6 A I don' t know.

7 Q Our r ecords show t hat there were 49. Now, you

8 don' t have t o t ake my word f or anyt hi ng. I f you want us

9 t o go t hr ough ever y r ecor d t o ver i f y that you r evi ewed

10 t hat , I ' ve got t i me t o do i t ; t hey pr obabl y don' t . But11 l et me repr esent , we have t hose r ecords and t her e' s 49 of

12 t hem, okay?

13 A I ' l l t ake your wor d f or i t , Counsel .

14 Q Now, any t i me you don' t want t o t ake my word f or

15 i t and you want t o go i nt o t he r ecor d, we wi l l because

16 i t ' s here, al l r i ght ?17 A Okay.

18 Q 40 of t hose Al l Smi l es/ Mal ouf cases you deni ed,

19 ni ne of t hose you appr oved; i s t hat consi st ent wi t h your

20 memor y?

21 A No, si r .

22

Q Do you di sagr ee wi t h t hat ?23 A I do not di sagr ee, t hough.

24 Q Okay. Now, you j ust don' t r emember ?

25 A I j ust don' t r emember .


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1 Q And l et me r epr esent t o you t hat t he f i l es

2 t hemsel ves, whi ch t he J udges wi l l be abl e t o r evi ew, wi l l

3 show how many i t i s, but t hat ' s not par t i cul ar l y r el evant

4 r i ght now. When you gave your f i ndi ngs t o t he St ate, what

5 happened was Ri char d Mal ouf or Al l Smi l es ended up bei ng

6 i ndi ct ed by t he Dal l as Count y Di st r i ct At t or ney' s Of f i ce

7 f or cri mi nal vi ol at i ons out of your case; i s t hat t r ue?

8 A I have no i dea of t hat , s i r . Never hear d of

9 that.

10 Q Di d you t est i f y i n a cr i mi nal case or wer e you11 wi l l i ng t o t est i f y i n a cr i mi nal case?

12 A I di d not and I have never heard or had t hat

13 proposed.

14 Q And were t here ot her exper t wi t nesses i n t hat

15 case besi des your sel f ?

16 A I have no i dea, Counsel .17 Q And ar e you awar e t hat Mal ouf ended up payi ng

18 mor e t han a mi l l i on- dol l ar f i ne f or conduct t hat I bel i eve

19 st emmed f r om your i nvest i gat i on?

20 A No, si r , I ' m not awar e of t hat .

21 Q Ar e you awar e t hat Al l Smi l es/ Mal ouf wer e

22

publ i cl y r epor t ed l i ke, I t hi nk, a year , year - and- a- hal f23 go as payi ng 1. 2 mi l l i on f i ne f or dent al mi sconduct ?

24 A No, si r , I ' m not awar e of t hat .

25 Q Do you know Ri char d Mal ouf ?


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1 A No, si r , I do not .

2 Q Let ' s t ake a l ook at some of t hese f i l es. What I

3 want t o do i s, I want t o see i f we can vi sual l y under st and

4 why you deny cases when you ar e hi r ed by t he St at e and you

5 appr ove cases when you ar e hi r ed by somebody el se. I want

6 t o - - I ' l l l et you t ake a l ook at t hem and we can l ook i n

7 t he f i l es as much as you want t o.

8 MR. MORI ARTY: Can I have R- 78, pl ease.

9 MR. ANDERTON: Obj ect i on, Your Honor ,

10 r el evance.11 J UDGE SEI TZMAN: You haven' t made an

12 appear ance on t he r ecor d.

13 MR. ANDERTON: Rober t Ander t on.

14 J UDGE SEI TZMAN: You are obj ect i ng t o t he

15 r el evancy of quest i ons about Exhi bi t 78?

16 MR. ANDERTON: Yes.17 J UDGE SEI TZMAN: I t hi nk we deal t wi t h t hi s

18 ear l i er on. These where t he r ebut t al i mpeachment

19 document s.

20 MR. MORI ARTY: Yes, si r .

21 J UDGE SEI TZMAN: And t hat ' s al l t hey are

22

bei ng of f er ed f or .23 MR. MORI ARTY: Yes, si r .

24 J UDGE SEI TZMAN: The obj ect i on i s deni ed. I

25 bel i eve we had deal t wi t h t hese exhi bi t s ear l i er i n t he


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1 pr oceedi ngs and t hey are bei ng of f ered f or i mpeachment

2 pur poses onl y.

3 Q ( BY MR. MORI ARTY) Let me - - Doct or , when we have

4 t hese si de- by- si de, t he ones t hat ar e over her e on t he

5 l ef t ar e f r om your exper t wor k i n t he Al l Smi l es case

6 where you were worki ng f or t he St at e of Texas, and one

7 over her e on t he r i ght i s f r om Ant oi ne Dent al .

8 Now, l i ke I say, we have t hese el ect r oni c

9 r ecor ds, so i f you need t o see more or want t o see more,

10 maybe we have a mol d.11 MR. MORI ARTY: Do you have a mol d f or t hi s

12 l ady on t he r i ght ? That woul d be P- 17.

13 MR. ANDERTON: Obj ect i on, Your Honor . He' s

14 aski ng Dr . Or r t o make a deci si on based on t hese

15 phot ogr aphs. We need t o see - - Dr . Or r i s goi ng t o need

16 t o see t he whol e f i l e.17 J UDGE SEI TZMAN: I f Dr . Or r want s t o see t he

18 whol e f i l e, he' s of f er ed hi m t he oppor t uni t y t o do so. We

19 wi l l l eave t hat up t o t he doct or .

20 Q ( BY MR. MORI ARTY) What I ' m goi ng t o show you i s

21 a vi deo of t he Ant oi ne case.

22

MR. CANALES: Ther e i s no vi deo i dent i f i ed23 i n t he exhi bi t s anywhere, even f or i mpeachment pur poses.

24 J UDGE SEI TZMAN: I haven' t seen a vi deo yet .

25 Q ( BY MR. MORI ARTY) Let ' s t ake a l ook at t hi s one


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1 t hat you r ej ect and - - l et me r epr esent t o you t hat you

2 f ound f our ect opi c er upt i ons and an over j et , so you scor ed

3 t hat at 14 poi nt s and you deni ed t hat case; do you agr ee?

4 A What i t shows t her e, I agr ee.

5 Q Now, l et ' s l ook over her e. And do you see a

6 crossbi t e on t he r i ght - hand si de, r i ght t her e?

7 A You know, Counsel , I want t o t ake back what you

8 of f er ed me ear l i er . I woul d have t o see t he r est of t he

9 mat er i al , t he model s, t he char t s. I spend an hour on a

10 char t .11 Q Let ' s t ake a l ook at t he phot ogr aphs. Let ' s l ook

12 at R- 19- 32, Page 22. These are t he phot ogr aphs of t hat

13 chi l d. I s t hat phot ogr aph i n t he upper l ef t hel p you

14 under st and t hat chi l d' s condi t i on?

15 A I t pr obabl y hel ps.

16 Q Wel l , I don' t under st and pr obabl y. Does t hat17 phot ogr aph hel p you?

18 A No, si r , not wi t hout t he r est of t he char t .

19 Q We wi l l go t hr ough t he whol e char t .

20 MR. MORI ARTY: Let ' s go back t o t hat

21 phot ogr aph, St acey. Let ' s have a bl ow- up of t hi s.

22

Q ( BY MR. MORI ARTY) Now, what do we see r i ght23 t her e?

24 A I don' t know what you ar e aski ng, si r .

25 Q Do you see a cr ossbi t e r i ght t her e?


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1 A That appear s t o be a cr ossbi t e, but I do not

2 r evi ew cases i n t hi s manner and I don' t t hi nk I can hel p

3 you wi t h t hi s unl ess I have t hi ngs set out i n t he di dact i c

4 way t hat I ' m used t o doi ng.

5 Q Wel l , I have t he f ol der s over t her e. Do you want

6 me t o pul l t hem out ?

7 A I t woul d be ni ce, because I ' m used t o spendi ng an

8 hour goi ng over ever y si ngl e char t , ever y page, as I

9 t est i f i ed pr evi ousl y, and t he model s.

10 Q We are goi ng t o go t hr ough t hese pi ct ur es, and we11 ar e goi ng t o see i f you can dr aw any concl usi on f r om t hese

12 pi ct ur es t hat you have seen bef ore and t hat you have

13 scored. I f you want t o do i t t he har d way, we ar e goi ng

14 t o go di g t he f i l e out , we ar e goi ng t o l et you t ake t hat

15 hour t o go t hr ough t hat f i l e.

16 MR. ANDERTON: Obj ect i on, Your Honor . Dr .17 Or r has sai d t hat he can' t make a deci si on based on t he

18 phot ogr aphs. Why are we goi ng t o go t hr ough t he

19 phot ogr aphs?

20 J UDGE SEI TZMAN: I t ' s cr oss- exami nat i on. I f

21 Dr . Or r want s al l t he mat er i al s, Mr . Mor i ar t y has of f er ed

22

hi m al l t he mat er i al s.23 Q ( BY MR. MORI ARTY) That i s cr ossbi t e r i ght t her e,

24 i sn' t i t ?

25 A I pr ef er t o see t he case t he way I di d i t


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1 pr evi ousl y and t he way I ' m used t o doi ng i t .

2 Q I under st and how you have been t aught t o answer

3 t hat quest i on, but you di dn' t even l ook at t he pi ct ur e i f

4 t hat was a cr ossbi t e. Wi l l you l ook at t hat pi ct ur e and

5 t el l me i f t hat i s a cr ossbi t e?

6 A I woul d r at her see t he model s, t he posi t i on t hat

7 t hose t eet h coul d be and t hat bi t e depends ent i r el y on t he

8 occl usi on.

9 MR. MORI ARTY: Let ' s go back t o 22.

10 Q ( BY MR. MORI ARTY) Do you see t hat r i ght t her e on11 t hat r i ght - hand si de of t hat l i t t l e gi r l ' s mout h?

12 A I ' m sor r y, ar e you speaki ng t o me? I di dn' t get

13 that.

14 Q I ' m aski ng you a quest i on. Do you see t hat r i ght

15 t her e?

16 A I see what you ar e poi nt i ng at , yes, si r .17 Q That ' s a cr ossbi t e, i sn' t i t ?

18 A I woul d not say t hat unl ess I saw t he r est of t he

19 mat er i al , Counsel .

20 Q Do you deny you are t est i f yi ng under oat h bef ore

21 t hese peopl e? Do you deny t hat your own eyes show you

22

evi dence of a cr ossbi t e?23 A I deny t hat , because I know t hat t hat may not be

24 t he cor r ect bi t e and posi t i on of t he upper and l ower j aws

25 t oget her .


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1 Q Al l r i ght . Let ' s go t o t he f i r st page?

2 A Gi ve me t he model s, t he f i l ms, t he r adi ogr aphs.

3 Q Does t hat hel p you?

4 A No, si r .

5 Q Okay. Let ' s go t o t he second page. Does t hat

6 hel p you?

7 A No, si r .

8 Q Let ' s go t o t he t hi r d page. Does t hat hel p you?

9 A No, si r .

10 Q Let ' s go t o t he f our t h page. Does t hat hel p you?11 A No, si r .

12 Q Next page?

13 A No, si r .

14 Q Okay. That hel p you?

15 A I t mi ght i f I sat and l ooked at i t awhi l e.

16 Q How l ong i s i t goi ng t o t ake t o r ead i t ?17 A I ' m a har d copy, I can' t have i t i n f r ont of me?

18 Q Yes, si r , you can have i t i n f r ont of you. And I

19 have got t hose r ecords bei ng pul l ed and we ar e goi ng t o

20 gi ve you your 50 hour s t o go t hr ough t hem.

21 A Excel l ent .

22

Q So t he next page. Anyt hi ng on t hat page hel p23 you?

24 A No, si r .

25 Q Next page. Does t hat hel p you?


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1 A Wel l , not i n t hat f or m. I t ' s not of di agnost i c

2 val ue.

3 Q Al l r i ght . That hel p you?

4 A No, si r .


6 A I woul d want t hat besi de me.

7 Q Now, l et me ask you a quest i on. They scor ed 30

8 on t hat , t hat ' s t he pr ovi der at Mal ouf ' s oper at i on. Ar e

9 t her e t en ectopi c t eet h f or t hat chi l d?

10 A I have no i dea, si r .11 Q Wel l , but you l ooked at t he pi ct ur es?

12 A No, I di dn' t .

13 Q Al l r i ght . Let ' s l ook at t he next one.

14 A You l ooked at t hem.

15 Q Look at t he next page. Does t hat hel p you?

16 A I t mi ght i f I had i t i n f r ont of me.17 Q Does t hat hel p you under st and whet her t hat chi l d

18 i s qual i f i ed f or br aces?

19 A Al ong wi t h t he ot her mat er i al , i f I sat and

20 st udi ed i t al l t oget her . These ar e not i sol at ed event s.

21 Q What i s t hat pi ece of paper ?

22

A I t says i t ' s an ar ch wi r e sequence.23 Q Tel l us what t hat means.

24 A That ' s not my ar ea, si r . That i s appar ent l y a

25 t r eat ment modal i t y.


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1 Q Let ' s go t o t he next page. Al l r i ght . Does t hat

2 hel p you under st and t hi s case?

3 A I t mi ght i f I had ever yt hi ng el se l ai d out .

4 Q Let ' s go t o t he next page. Does t hi s hel p you?

5 A I t pr obabl y woul d, yes, si r .

6 Q What on t here woul d be hel pf ul ?

7 A The posi t i on of t he j aws and t he t eet h i n t he

8 j aws.

9 Q And can you see t hat r eadi l y f r om t hat dat a?

10 A You can see some of i t , but not compl ete.11 Q Woul d t hat show a cr ossbi t e?

12 A Not necessar i l y at al l . I t i s not supposed t o.

13 Q Wel l , what mat er i al do you l ook at t o det er mi ne

14 crossbi t e?

15 A Al l of t he whol e char t .

16 Q Okay.17 A I ncl udi ng t he wr i t t en not es of descr i pt i on by t he

18 doct or .

19 Q Okay. Does t hi s hel p you underst and t hat case?

20 A I woul d say no.

21 Q Al l r i ght . Does t hi s medi cal hi st or y or anyt hi ng

22

on t hat f or m hel p you?23 A I f I got t o si t and st udy i t , i t mi ght ver y wel l .

24 Q Al l r i ght . The consent f or m, does t hat hel p you?

25 A Pr obabl y not , no, si r .


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1 Q Does t hi s f or m hel p you, what ' s been appr oved by

2 t he TMHP?


4 Q Thi s l ooks l i ke a consent f or m, does i t hel p you?

5 A No, si r .

6 Q And t hi s l ooks l i ke t he ar ch wi r e sequence t hat

7 we t al ked about bef or e, does t hat hel p you?

8 A No, si r .

9 Q And t hi s l ooks l i ke i nst r uct i ons t o t he chi l d,

10 does t hat hel p you?11 A No, si r .

12 Q Thi s l ooks l i ke a bl ank pi ece of paper . I

13 suppose i t ' s not much hel p.

14 Now, we ar e at t he pi ct ur es, do t hey hel p

15 you at al l ?

16 A No, si r .17 Q Thi s down here where you see t hat t oot h over t hat

18 t oot h and t hat t oot h over t hat t oot h, does t hat t el l you

19 anythi ng?

20 A No, si r .

21 Q Al l r i ght . Now, do you know what occl usi on i s?

22

A Yes, si r .23 Q What i s occl usi on?

24 A Thi s coul d t ake awhi l e.

25 Q I ' ve got al l day.


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1 A Okay. Wel l , occl usi on begi ns wi t h t he

2 r el at i onshi p of a t oot h t o t oot h, si de- t o- si de, and wi t h

3 t he opposi ng t eet h, an upper ar ch agai nst a l ower ar ch.

4 I t pr ogr esses f r om t her e as t o how t hey f unct i on agai nst

5 each ot her , and especi al l y si nce t he l ower j aw i s t he onl y

6 f r ee- f l oat i ng j aw i n t he body.

7 When you l ook at a phot ogr aph of t eet h put

8 t oget her , t hat i s l i t er al l y one posi t i on of mi l l i ons of

9 posi t i ons t hat t hose t eet h coul d meet each ot her , upper

10 and l ower , because of t he numerous set s of muscl es t hat we11 al l know, i n dent i st r y anyway, t hat ar e pul l i ng on t hat

12 j aw and al l owi ng i t t o seat , whet her under st r ess or at

13 ease.

14 So t he occl usi on i s det er mi ned t hat you see

15 at t hat moment , i t i s j ust what i t i s at t hat moment . And

16 i t can depend ent i r el y on what we cal l i nt er f er ences of17 wher e teet h meshi ng ot her t eet h ar e at di f f er ent posi t i ons

18 i n space, ever y si ngl e t i me t hey meet a di f f er ent way.

19 Q Let me see i f I under st and what you' r e t el l i ng

20 me. Occl usi on i s how t he t eet h f i t t oget her ?

21 A Wel l , I was qual i f yi ng i t at a par t i cul ar moment

22

i n or t i me, not necessar i l y - - i t mi ght be di f f er ent when23 you t ook anot her pi ct ur e.

24 Q Let me ask t he quest i on l i ke t hi s: Occl usi on i s

25 how t he t eet h f i t t oget her ; t r ue or f al se?


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1 A Tr ue t o a l i mi t ed poi nt .

2 Q Okay.

3 A A l i mi t ed descr i pt i on.

4 Q Mal occl usi on i s when t he t eet h don' t f i t t oget her

5 r i ght , r i ght ?

6 A As dent i st s, we woul d want t o have some

7 descr i pt i ve phr ases or manner s i n whi ch t hey di d not f i t

8 t oget her .

9 Q Okay. Mal occl usi on i s when t eet h r eal l y don' t

10 f i t t oget her , r i ght ?11 A Oh, I l i ke t hat .

12 Q I s t hat t r ue?

13 A Yes, si r .

14 Q Now, do we see mal occl usi on r i ght t here?

15 A I can' t t el l wi t h t he pi ct ur e l i ke t hat .

16 Q Oh, gi ve me a br eak. You can' t see mal occl usi on17 r i ght t her e?

18 A Wel l , gi ve me t he model s and t he char t .

19 Q These peopl e r eal l y need t o know what ' s goi ng on

20 here and t hey need t o know t he t r ut h. What I want you t o

21 do i s l ook at t hem and swear under oat h t hat t hose

22

pi ct ur es don' t show mal occl usi on. Wi l l you do t hat ?23 A No, I can' t do t hat i nt el l ect ual l y, si r . Wi t h

24 al l due r espect t o you and t he Cour t , i f you can' t do i t ,

25 you can' t do i t .


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1 Q Let ' s go back t o R- 78. Let me of f er a

2 hypot hesi s. Some peopl e mi ght see cr ossbi t e r i ght t her e,

3 and under t he Texas Medi cai d r ul es, t hi s chi l d woul d

4 qual i f y f or br aces i f t he doct or submi t t ed t he pr oper f or m

5 doesn' t have t o have an HLD score of 26, and t hi s chi l d

6 coul d r ecei ve l egi t i mat e car e under t he Texas pol i ci es f or

7 crossbi t e t her apy i f t hat ' s a cr ossbi t e, t r ue?

8 A I f - - yes, si r . I assume so, I don' t know.

9 Q So we ar e i n agr eement t hat i f t hi s chi l d i s

10 suf f er i ng f r om cr ossbi t e on t he r i ght or l ef t , t hi s chi l d11 woul d act ual l y qual i f y f or br aces, f or l i mi t ed br aces?

12 A No, si r , I do not agr ee wi t h t hat f ur t her

13 st at ement . I woul d have t o see t he model s and t he chart .

14 Q Al l r i ght . Let ' s t ake a l ook at t he l i t t l e gi r l

15 on t he r i ght . You deni ed t he case on t he l ef t , you

16 appr oved t he case on t he r i ght . Let ' s l ook at t he17 pi ct ur es. Let ' s l ook at P- 17- 04, pl ease. Can we agr ee

18 t hose t eet h ar e crooked?

19 A Not wi t hout my compl et e char t t o anal yze, l i ke I

20 di d bef or e.

21 Q You can' t t el l f r om t hat , t hat t hat ' s a l i t t l e

22

cr ooked?23 A No, si r .

24 Q You can' t t el l f rom t hat , t hat ' s a l i t t l e

25 cr ooked?


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1 A No, si r .

2 Q Let ' s go back t o t he pi ct ur e. Let ' s l ook at t hi s

3 one. Can you t el l i f t hat ' s a l i t t l e crooked?

4 A No, si r .

5 Q Let ' s go back. And do you see any ot her dent al

6 condi t i ons t hat ' s obvi ous i n t hose pi ct ur es?

7 A No, si r .

8 Q Do you see any ect opi c erupt i ons?

9 A Not t hat I can i sol at e t her e f r om t hose pi ct ur es.

10 Q What ' s an open bi t e?11 A What i s an open bi t e?

12 Q Yes, si r .

13 A I n Medi cai d?

14 Q What i s an open bi t e?

15 A I t ' s di f f er ent t hi ngs t o di f f er ent peopl e i n

16 di f f er ent si t uat i ons. Ther e' s a l ot of answer s t o t hat .17 I n Texas Medi cai d i n t he HLD scor i ng sheet , i s t hat - -

18 Q Ar e you a dent i st ?

19 A Yes, si r .

20 Q Do dent i st s deal wi t h t hi ngs l i ke open bi t es?

21 A Yes, si r .

22

Q Tel l us what an open bi t e i s t o a dent i st .23 A I suspect you ar e aski ng an open bi t e i s when

24 t eet h f ai l t o meet at a t er mi nal posi t i on.

25 Q Okay. So t hi s pi ct ur e r i ght her e woul d gi ve us


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1 an i ndi cat i on of an open bi t e i f open bi t e exi st ed i n t hi s

2 case; woul d i t not ?

3 A I t woul d not .

4 Q Open bi t e i s when t he t eet h ar e - - t he f r ont

5 t eet h ar e open, t r ue?

6 A Not l i ke you ar e doi ng i t . That ' s not - - i t ' s

7 not enough i nf or mat i on, l i ke model s and cephs and f i l ms,

8 t hat I coul d make t hat det er mi nat i on.

9 Q There' s no space bet ween t he t op t eet h and t he

10 bot t om t eet h i n t hi s pi ct ur e, t r ue?11 A I woul dn' t know. I woul d have t o l ook at t he

12 compl et e case. I don' t make t hese det er mi nat i ons wi t h one

13 pi ct ur e.

14 Q I want t o be f ai r t o you, Dr . Or r . I hear you

15 sayi ng what ever you do - - you ai n' t answer i ng not hi ng

16 unt i l I put t hi s st uf f i n f r ont of you, but my quest i on i s17 a di f f er ent quest i on. Ar e peopl e l i ke us capabl e of

18 f i gur i ng - - l et ' s go back t o t hat pi ct ur e.

19 Ar e peopl e l i ke t he peopl e i n t hi s r oom

20 capabl e of f i gur i ng out t hat i s not an open bi t e?

21 A No, si r .

22

Q Okay. Onl y a dent i st can f i gur e t hat out ?23 A Yes, s i r .

24 Q And i f I was a dent i st and we wer e t al ki ng on t he

25 phone and you wer e goi ng t o descr i be t o me what you saw i n


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1 t hi s pat i ent i f you t hought t hat was an open bi t e, how

2 woul d you descr i be t hat t o me?

3 A Wel l , I woul d want you t o have t he model s and

4 f i l ms and mat er i al and char t s i n f r ont of you.

5 Q Let ' s go t hr ough t he f i r st page of t hat . We wi l l

6 go t hr ough - - you' ve been t hr ough t hi s f i l e, so we wi l l go

7 t hr ough i t . Does t hat hel p you?

8 A Pr obabl y so, yes, si r .

9 Q Next page, t hat hel p you?

10 A Pr obabl y so, yes, si r .11 Q Page 3, does t hat hel p you?


13 Q Next page, t hat hel p you?

14 A No, si r .

15 Q Now, l et ' s go back a page. What are t hese

16 phot ogr aphs cal l ed?17 A I ' m sor r y?

18 Q Do t hese phot ogr aphs have a descr i pt i on, a t i t l e?

19 What do dent i st s cal l pi ct ur es l i ke t hi s?

20 A Phot ogr aphs.

21 Q Wel l , i s i t cal l ed i nt r aor al phot ogr aphs?

22

A They coul d be. Those ar e not al l i nt r aor al , so I23 don' t know t hat .

24 Q Have you ever seen a set of phot ogr aphs l i ke t hi s

25 bef or e?


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1 A Yes, si r .

2 Q When and wher e do you see i t ?

3 A They ar e al l di f f er ent i n al l di f f er ent doctor s'

4 pr esent at i ons.

5 Q I sn' t t hi s t he mat er i al t hat ' s r equi r ed t o be

6 gi ven t o t he St at e t o qual i f y t he chi l d f or br aces?

7 A I t does speci f y phot ogr aphs, yes, si r .

8 Q Let ' s go t o Page 5. Does t hi s hel p you

9 under st and whet her t hi s chi l d has an open bi t e?

10 A No, si r .11 Q What woul d you need t o know?

12 A I t woul d be ni ce t o have model s.

13 Q Let ' s go t o Page 6. Does t hat show an open bi t e?

14 A No, t hat doesn' t hel p me.

15 Q My quest i on was: Does i t show an open bi t e?

16 A No.17 Q Does i t show an over j et ?

18 A I t mi ght .

19 Q Wel l , I ' m not aski ng you whet her i t mi ght , I ' m

20 aski ng you whet her i t does.

21 A My answer i s, i t mi ght .

22

Q An over j et i s what or di nar y peopl e cal l buck23 t eet h, wher e t hey ar e st i cki ng out ; i s t hat r i ght ?

24 A To you.

25 Q How about anybody t hat ' s ever used t he t erm, buck


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1 t eet h, what ar e t hey gener al l y ref er r i ng t o?

2 A I suppose t eet h t hat st i ck out , Counsel .

3 Q Li ke t hat of - -

4 A Not necessar i l y at al l .

5 Q Okay. So t hat doesn' t show an over j et ei t her ?

6 A I coul dn' t det er mi ne t hat f r om t hat si ngul ar

7 pi ct ur e t hat way.

8 Q Let ' s l ook at t he next one. Woul d i t hel p you i f

9 we bl ew t hi s up?

10 A No, si r .11 Q Do you see anyt hi ng t hat hel ps you underst and

12 t hi s chi l d' s condi t i on?

13 A Wel l , i t shows t he l at er al - - t he si de vi ew of

14 t he t eet h.

15 Q Does t hat hel p you under st and whet her t hi s chi l d

16 qual i f i es f or br aces?17 A I t mi ght hel p, al ong wi t h al l t he ot her mat er i al .

18 The probl em i s i t ' s a f l at pi ct ure of a t hree- di mensi onal

19 obj ect .

20 Q Al l r i ght . Let ' s go t o Page 8. Now, t hi s i s a

21 br aces- i n- pr ogr ess phot ogr aph?

22

A Yes, si r .23 Q Next - - and t hat pi ct ur e woul dn' t hel p you

24 under st and whet her t he chi l d act ual l y qual i f i ed f or

25 br aces?


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1 A That i s cor r ect , s i r . I n my mi nd, once t hey ar e

2 i n br aces, ever yt hi ng i s changed.

3 Q Okay. Next pi ct ur e, and t hi s woul dn' t hel p you?

4 A No, si r .

5 Q Next pi ct ur e, does t hat hel p you?

6 A No, si r .


8 A No, si r .


10 A No, si r .11 Q That hel p you?

12 A No, s i r , no, s i r .

13 Q That hel p you?

14 A No, si r .

15 Q That hel p you?

16 A No, si r .17 Q Does t hi s hel p you?

18 A Wel l , I usual l y r ef er t o t hat at some poi nt when

19 I ' m goi ng t hr ough t he char t .

20 Q Now, t hi s doct or act ual l y f i nds an over j et , t r ue?

21 A Yes, si r , he di d.

22

Q And he f i nds 12 ect opi c t eet h?23 A I t woul d appear that way, yes, si r .

24 Q Let ' s go t o t he next sl i de. Now, I ' m not sur e

25 why t hi s i s i n t her e. Ther e wer e t wo HLD score sheet s i n


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1 t hi s case. I ' m not exact l y sur e why t hat i s. Let ' s go t o

2 t he next page. Does t hat hel p you?

3 A No, si r .

4 Q Next page?

5 A No, si r .

6 Q Next page?

7 A No, si r .

8 Q Next page?

9 A No, si r .

10 Q Next page?11 A No, si r .

12 Q Next page - - so we ar e now at t he end of t he

13 f i l e. Do you see t hi s number down here?

14 A Yes, s i r .

15 Q That P- 17 means t hat t hat came f r om t he

16 Pet i t i oner ' s f i l e. That i s t he Pet i t i oner ' s f i l e on t hat17 case. Whi ch pi eces of paper or i nf or mat i on i n t hat f i l e

18 woul d you have t o have or r evi ew t o be abl e t o det ermi ne

19 whet her t hat chi l d act ual l y qual i f i ed f or br aces or not ?

20 A Wel l , I ' m used t o havi ng what i t says i n t he

21 manual , t hey are supposed t o submi t , whi ch used t o be

22

model s, phot ogr aphs, r adi ogr aphs, t he paper r equest s.23 Q When you r evi ewed t hi s f i l e, i t act ual l y di dn' t

24 have or i gi nal r adi ogr aphs i n i t , di d i t ?

25 A I don' t know, si r .


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1 Q Wel l , but t hi s i s t he f i l e t hat you have r evi ewed

2 t o t est i f y i n t hi s case?

3 A Yes, s i r .

4 Q You don' t r emember whether i t had x- r ays i n i t or

5 not ?

6 A I do not , s i r .

7 Q So i t wasn' t i mpor t ant whet her i t had x- r ays or

8 not , cor r ect ?

9 A I ncor r ect , no, s i r .

10 MR. MORI ARTY: May I approach t he wi t ness,11 Your Honor ?

12 J UDGE SEI TZMAN: You may.

13 MR. MORI ARTY: Let ' s go back t o t he

14 phot ogr aphs set , St acey. I t hi nk i t ' s 22.

15 Q ( BY MR. MORI ARTY) I ' m goi ng t o show you - -

16 J UDGE SEI TZMAN: Do you need some l i ght s?17 THE WI TNESS: Yes.

18 Q ( BY MR. MORI ARTY) I ' m goi ng t o show you t he

19 or i gi nal of t hat f i l e t hat we got f r om Dr . Nazar i . I want

20 you t o make t wo pi l es. I want you t o make a pi l e of t he

21 st uf f on one si de t hat hel ps you under st and t hat case and

22

a pi l e of t he st uf f on t he second si de t hat doesn' t hel p23 you under st and whet her t hat chi l d qual i f i ed f or br aces.

24 J UDGE SEI TZMAN: Whi l e he' s doi ng t hat ,

25 l et ' s go of f t he r ecor d a second.


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1 ( Of f t he r ecor d. )

2 J UDGE SEI TZMAN: Al l r i ght . Let ' s go back

3 on t he r ecord at 10: 09.

4 Dr . Or r , you have had a chance t o segr egat e

5 t he paper s you need t o l ook at f r om t he paper s you don' t

6 need t o l ook at ; i s t hat cor r ect ?

7 THE WI TNESS: I have done so, yes, si r .

8 J UDGE SEI TZMAN: So, Mr . Mor i ar t y, do you

9 want t o pi ck up your quest i oni ng?

10 MR. MORI ARTY: Yes, si r .11 Q ( BY MR. MORI ARTY) Here i s what I want t o do so

12 t hat we ar e not t aki ng t hei r t i me and t o be f ai r t o you.

13 Or di nar y human bei ngs can compar e t hose

14 pi ct ur es si de by si de of one cl i ent t o anot her and t hey

15 can see a gr eat deal of di f f er ence i n t hose pi ct ur es,

16 can' t t hey?17 A I can' t answer t hat , Counsel . I don' t know i f

18 t hey coul d or not .

19 MR. MORI ARTY: Al l r i ght . May I appr oach

20 t he wi t ness?

21 J UDGE SEI TZMAN: You may. I t woul d be

22

hel pf ul t o f ocus on what Dr . Or r sees or doesn' t see.23 MR. MORI ARTY: We l ost our t r ue t r i al

24 par t ner , J udge. She wi l l be r i ght back.

25 J UDGE SEI TZMAN: Okay. Let ' s go of f t he


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1 r ecor d.


3 J UDGE SEI TZMAN: Let ' s go back on t he r ecord

4 at 10: 12.

5 Mr . Mor i ar t y.

6 Q ( BY MR. MORI ARTY) Dr . Or r , you had asked f or

7 access t o your scor e sheet on bot h t hi s Al l Smi l es case

8 and t he Ant oi ne Dent al case. I ' l l r epr esent t o you t hat

9 t he document t hat ' s on t he scr een, whi ch i s R- 20- 032, i s

10 your score sheet f r om t he Al l Smi l es case wher e you deni ed11 t hat t hat chi l d qual i f i ed f or br aces. Then I have handed

12 you your score sheet marked P- 73- 017, and you have t hat i n

13 f r ont of you. So you now have t he score sheet s where you

14 can see how you scor ed t hem.

15 Now, what I woul d l i ke t o do i s I woul d l i ke

16 t o go back t o R- 78, pl ease. And I want t o appr oach you,17 i f I may.

18 J UDGE EGAN: You wi l l need t o speak up, I

19 can' t hear you.

20 MR. MORI ARTY: Yes.

21 Q ( BY MR. MORI ARTY) Do you have a quest i on?

22

A Ar e t hey pr i nt i ng my scor e sheet on t hi s so I can23 st udy i t ?

24 Q Yes, si r .

25 A Thank you.


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1 MR. MORI ARTY: What I woul d l i ke t o do, Your

2 Honor s, ar e t hese ar e t he or i gi nal unr edact ed phot ogr aphs.

3 These ar e t he same phot ographs t hat we have al r eady mar ked

4 i n evi dence t hat ar e r edact ed, but I woul d l i ke t o have

5 t he Cour t see t he or i gi nal of t he act ual phot ogr aphs whi l e

6 I quest i on hi m.

7 J UDGE SEI TZMAN: That ' s f i ne, i f t he wi t ness

8 doesn' t need t hem.

9 Q ( BY MR. MORI ARTY) I s t hat okay?

10 A Say agai n car ef ul l y.11 Q I want t o show t he or i gi nal of t hese phot ogr aphs

12 f r om t hese f i l es t o t he J udges; i s t hat okay wi t h you?

13 A Absol ut el y.

14 MR. MORI ARTY: Okay. That ' s t he Al l Smi l es.

15 J UDGE EGAN: I t ' s R- 20 and P- 73- 17.

16 MR. MORI ARTY: The Nazar i document i s17 P- 73- 017. The Al l Smi l es document i s R- 20- 032.

18 MR. ANDERTON: Do you have dat es on t hese?

19 J UDGE SEI TZMAN: As I underst and i t , t he

20 pr obl em i s t hey ar e not r edact ed, so l ook at t he or i gi nal s

21 whi l e you l ook at t he r edact ed ver si on.

22

MR. ANDERTON: The quest i on i s on t he - -23 THE REPORTER: I ' m not get t i ng what y' al l

24 ar e sayi ng.

25 J UDGE SEI TZMAN: Of f - t he- r ecor d di scussi on.


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1 ( Of f - t he- r ecor d di scussi on. )

2 J UDGE SEI TZMAN: Al l r i ght .

3 Q ( BY MR. MORI ARTY) Dr . Or r , I have - - t he J udges

4 have t he or i gi nal s of R- 22- 032, whi ch i s your Al l Smi l es

5 young l ady, and t hey have t he or i gi nal s of t he phot ogr aphs

6 of t he P- 17- 004, f or t he case that you deni ed wi t h

7 Ant oi ne.

8 Now, her e i s my poi nt about t hese f i l es: I

9 don' t under st and how you ar e denyi ng cases l i ke t he l i t t l e

10 gi r l on t he l ef t and you ar e appr ovi ng cases l i ke t he11 l i t t l e gi r l on t he r i ght , suggest i ng t hat she' s got a

12 t ot al of 34 poi nt s. Can you expl ai n t hat t o t he J udge,

13 why t he pat i ent - - t he Al l Smi l es pat i ent doesn' t qual i f y

14 and t he Ant oi ne Dent al pat i ent does qual i f y?

15 A Wel l , wi t h al l due r espect , si r , I can under st and

16 why you woul dn' t under st and. I t ' s an occl usi on, an17 or t hodont i c quest i ons t hat a dent i st a t r ai ned t o l ook at .

18 I mean t hat wi t h al l due r espect . I n summat i on, t hese

19 cases ar e t ot al l y di f f er ent , ever y case i s di f f er ent , and

20 t hey scor e wi t h r esul t ant scor es di f f er ent .

21 J UDGE SEI TZMAN: I t hi nk t he quest i on t o you

22

i s why. Can you expl ai n what t he di f f er ence i s bet ween23 t he t wo cases? That wi l l get us where we need t o be.

24 THE WI TNESS: Yes, s i r . I t ' s what ' s on t he

25 scor e sheet of each. I di dn' t get t he paper scor e sheet


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1 on t he Al l Smi l es.

2 Q ( BY MR. MORI ARTY) Let ' s br i ng i t back up agai n,

3 a scor e sheet on Al l Smi l es.

4 A I have a paper on t he ot her one and I woul dn' t

5 mi nd havi ng t he paper on t he ot her one si nce t hat ' s t he

6 way I ' ve been worki ng si nce 1974.

7 MR. MORI ARTY: He want s hi s Al l Smi l es score

8 sheet , R- 20- 032.

9 J UDGE SEI TZMAN: Whi l e we ar e wai t i ng on

10 t hat , do you want hi m t o answer t he quest i on wi t h r espect11 t o t he paper t hat he does have i n f r ont of hi m?

12 MR. MORI ARTY: Yes, si r .

13 Q ( BY MR. MORI ARTY) My quest i on i s r eal si mpl e.

14 We don' t have t o underst and scor i ng t o under st and t hat t he

15 Al l Smi l es case has ever y appear ance of bei ng a l ot hi gher

16 i n need f or br aces t han t he Ant oi ne Dent al case t hat you17 approved.

18 A But you must t hi nk you underst and because t hat ' s

19 what you j ust sai d i n spi t e of my scor i ng.

20 Q Okay. Let ' s go t o R- 77. Her e i s t he score sheet

21 t hat we asked f or f or t hat l ady.

22

A Thank you.23 Q Now, agai n - - l et ' s go t o R- 77.

24 A I have an answer f or you, si r , on t he pr evi ous

25 quest i on.


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1 Q Okay. I don' t have a quest i on f or you, so we

2 don' t have t o wor r y about i t .

3 J UDGE SEI TZMAN: Wel l , we can wai t and t ake

4 i t out of pl ace, Mr . Mor i ar t y, but I t hi nk t he quest i on

5 t hat was phr ased t o hi m, at l east t hat I di d, and I don' t

6 know i f t hat was your quest i on, but can you expl ai n t he

7 scor i ng i n each of t hose t wo cases?

8 THE WI TNESS: Yes, s i r .

9 J UDGE SEI TZMAN: Woul d you do so?

10 THE WI TNESS: Thank you. That ' s why I11 want ed t o see my score sheet i n case I had any not es. And

12 t he not es conf i r m what I was hol di ng her e wi t h t he model s

13 f r om t he Al l Smi l es case, because on my notes you want ed

14 t o know a di f f er ence. The not e says, excess pl ast er

15 cannot ar t i cul at e. That means t hat t he upper and l ower

16 model s cannot be put t oget her t o demonst r at e how t he t eet h17 come t oget her .

18 They ar e an F qual i t y school pr oj ect or set

19 of model s. They cannot be pl aced t oget her t o conf i r m or

20 deny what he was ear l i er t r yi ng t o say di d I see

21 crossbi t e, di d I see t hat , di d I see t hat . They ar e

22

wor t hl ess; i t was a f ai l ur e.23 Q ( BY MR. MORI ARTY) And model s ar e not r equi r ed by

24 THMP t o appr ove cases, ar e t hey?

25 A As I r ecal l , t he bul l et i n t hat ot her peopl e i n


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1 t hi s r oom coul d quot e bet t er t han I i n 2005, t hat t hey

2 di dn' t have t o be sent i n. I don' t bel i eve t he bul l et i n

3 speci f i ed t hat t hat r el i eved you f r om t he t echni cal aspect

4 of maki ng model s, i f t hey were necessary.

5 Q Act ual l y, t he r ul e woul d be t hat t hey ar e

6 r equi r ed t o keep model s, ar en' t t hey?

7 A I bel i eve t hat i s cor r ect , si r .

8 Q They ar e j ust not r equi r ed t o send t hem i n t o t he

9 cont r act or f or appr oval , t r ue?

10 A I bel i eve t hat i s cor r ect , si r .11 MR. MORI ARTY: Coul d I see R- 77? Al l r i ght .

12 Q ( BY MR. MORI ARTY) Now agai n, we have got Al l

13 Smi l es cases where you were t he exper t f or t he St ate on

14 t he l ef t and we have Ant oi ne Dent al where you are the

15 exper t f or Ant oi ne Dent al on t he r i ght .

16 Now, what I want you t o do i s, I want you t o17 expl ai n t o t he J udges why the case on t he l ef t appear s t o,

18 i n your opi ni on, not be qual i f i ed and t he case on t he

19 r i ght qual i f i ed.

20 A Yes, si r . Coul d I ask a per sonal f avor t hat I

21 coul d pol i ce up and not get t hese conf used.

22

Q Yes, si r . Can I hel p you wi t h t hat ?23 A Of cour se. I l i ve i n f ear of mi xi ng t hese

24 t hi ngs. And t hen t hey ar e get t i ng al l t he mat er i al and

25 pr i nt out s on t hi s case.


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1 Q Now, we ar e on t wo new cases, one t hat you deni ed

2 on t he l ef t when you were an exper t f or t he St ate and one

3 t hat you appr oved on t he r i ght .

4 Now, l et me ask you t o t ake a l ook at t he

5 phot ogr aphs on t he l ef t . Does that space r i ght t her e,

6 t hat space r i ght t her e, and t hat space r i ght t her e, t hat

7 bei ng on t hat par t i cul ar exhi bi t , t hat exhi bi t bei ng

8 R- 19- 27- 005, i sn' t t hat a cl assi c open bi t e?

9 MR. ANDERTON: Obj ect i on, Your Honor . We

10 have no way of knowi ng who i s on t he r i ght . Can we have11 i t i dent i f i ed?

12 J UDGE SEI TZMAN: Can you i dent i f y t he

13 exhi bi t number on t he r i ght , Mr . Mor i ar t y?

14 Q ( BY MR. MORI ARTY) The exhi bi t - - t he phot ogr aph

15 on t he r i ght i s f r om R- 00010.

16 MS. SI LHAN: I t ' s Pat i ent L- 8.17 Q ( BY MR. MORI ARTY) Doct or , her e i s my quest i on - -

18 J UDGE SEI TZMAN: Can we go one mor e? Can

19 you make i t t hr ough one more set of quest i ons.

20 THE WI TNESS: Not at my age.

21 J UDGE SEI TZMAN: Let ' s t ake a t en- mi nut e

22

br eak.23 THE WI TNESS: You don' t have t o do t hat

24 much. Ever ybody el se had one except you and I .

25 J UDGE SEI TZMAN: We wi l l make i t t en.


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2 J UDGE SEI TZMAN: Let ' s go back on t he r ecord

3 at 10: 37.

4 Mr . Mor i ar t y.

5 MR. MORI ARTY: Thank you, J udge.

6 Q ( BY MR. MORI ARTY) What I have done dur i ng t he

7 br eak, Dr . Or r , i s I have gi ven you t he or i gi nal f i l es f or

8 Pat i ent Number 19 f r om Al l Smi l es and Pat i ent Number 8

9 f r om Ant oi ne Dent al . And I have got up on t he boar d a

10 gr aphi c t hat ' s R- 77 t hat r ef l ect s pi ct ur es t hat wer e t aken11 of f of t hat . And I have gi ven you oppor t uni t y t o r evi ew

12 t he f i l es and r evi ew t he mol ds. What I woul d l i ke t o do

13 i n t hi s case i s I woul d l i ke t o have t he Cour t r evi ew t he

14 or i gi nal of t he phot ogr aphs and t he or i gi nal of t he mol ds.

15 Now, l et ' s agr ee on t he mol ds f or t he Al l

16 Smi l es case, t hat mol d f or t he Al l Smi l es case i s of no17 di agnost i c val ue at al l , t r ue?

18 A I ' m sor r y. The pr evi ous case?

19 Q No, si r . We ar e t al ki ng about t hi s case t hat ' s

20 up on t he boar d r i ght now.

21 A I don' t t hi nk I sai d t hat about t hi s case.

22

Q No, s i r , you di dn' t . I ' m t r yi ng t o get you t o23 wher e we ar e now. Do you see t he f i l es i n f r ont of you?

24 A Yes, s i r .

25 Q Have you had a chance t o r evi ew t hem?


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1 A Yes, si r .

2 Q Can we agr ee t hat t he mol d - - t he Al l Smi l es

3 mol d, t hat ' s t he mol d r i ght t her e wi t h t he pi nk on i t ,

4 t hat mol d i sn' t di agnost i c and woul dn' t hel p anybody

5 under st and anyt hi ng, woul d i t ?

6 A I don' t t hi nk we ar e t oget her , si r . The pi nk

7 her e, I bel i eve t hi s i s and t hese set of model s ar e

8 Ant oi ne Dent al , her e.

9 Q I st and cor r ect ed, si r . You ar e exact l y r i ght .

10 The Ant oi ne Dent al model i s di agnost i c. The model t hat ' s11 over her e t o your l ef t , t he Al l Smi l es model , t hat model

12 i s br oken and cracked and i sn' t of any val ue, i s i t ?

13 A Wel l , i n my r epor t , I sai d t hat t he model s wer e

14 of di agnost i c qual i t y, back i n ' 08. Now, t hey ar e at

15 mi ni mum di agnost i c qual i t y, but I st i l l ut i l i zed t hem and

16 t hey ar e ver y i nt er est i ng, I mi ght say, especi al l y when17 compar ed t o t he phot ogr aphs.

18 Q Okay. And when we l ook at t he phot ogr aphs, what

19 i s i t t hat we see on t hese photogr aphs? And you have t he

20 or i gi nal s i n t he f i l e i n f r ont of you. What i s i t we see

21 r i ght her e?

22

A What we see i s what I r ecorded i n 2008, t hat t he23 upper si x f r ont t eet h ar e ect opi cal l y er upt ed and out of

24 posi t i on.

25 Q Do we see what a dent i st cal l an open bi t e; t hat


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1 i s, open space bet ween t he f r ont t eet h?

2 A Not necessar i l y, because i f I mi ght , t hi s i s a

3 per f ect exampl e of t he di f f er ent bi t e posi t i ons i n

4 occl usi on t hat I can put t hese model s so t hat t hat i s

5 compl et el y cl osed and he pr obabl y bi t es t hi s way and bi t es

6 i n many ot her ways, t oo. A bi t e l i ke t hi s and t eet h l i ke

7 t hi s, t hey may wel l mesh and I can make t hem mesh, i s one

8 r eason we t ake t hese model s.

9 We t each st udent s t o t ur n ar ound and t hi nk

10 of t hemsel ves as a smal l dent i st on t he t ongue l ooki ng11 out , and t hat ' s one of t he mai n ways t hat you eval uat e t he

12 i nt er act i on bet ween t he upper and l ower t eet h. I can see

13 t hat t hey can mesh i n di f f er ent posi t i ons, so t hey t ook a

14 phot ogr aph i n one posi t i on and t hen, t hank goodness, t hey

15 t ook t he model and I can see t hat we have t he 18 poi nt s

16 cont r i but ed by t he upper t eet h and t hat was i t . Not al l17 cases ar e t he same. These t wo cases ar e l i ke appl es and

18 or anges.

19 Q I don' t doubt t hat . And t hi s over her e, what

20 does t hat show? You have t he pi ct ur es and model i n f r ont

21 of you. What does t hat show?

22

A That bi t e i s appar ent l y i n a crossbi t e wi t h t he23 mout h i n t hat posi t i on.

24 Q And over here?

25 A That ' s j umbl ed t eet h.


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1 Q That i s not a cr ossbi t e?

2 A Not necessar i l y.

3 Q You' ve got t he pi ct ur e i n f r ont of you and t he

4 model . Cr ossbi t e or not cr ossbi t e?

5 A No, I woul dn' t say t hat . I can put t hese i n

6 di f f er ent posi t i ons and ar t i cul at e t he pl ast er ed t eet h i n

7 di f f er ent bi t es.

8 Q So you ar e t el l i ng t hese J udges t hat t hi s i s not

9 an open bi t e and t hese t eet h r i ght t her e ar e not i n

10 cr ossbi t e, t hat ' s what you ar e t el l i ng t hese J udges under11 oat h?

12 A Absol ut el y. And t hat ' s what I sai d on t hat paper

13 and t hat ' s what I can show t hem r i ght her e.

14 Q Okay. And when you were wor ki ng f or t he Stat e,

15 you deni ed t he young man on t he l ef t was appr opr i atel y

16 t r eat ed and pai d f or by Medi cai d, t r ue?17 A I don' t know i f he was or not . What do you mean?

18 Q You' ve got t he score sheet - -

19 A Treat ed?

20 Q - - you sai d t hat young man was not qual i f i ed t o

21 be pai d f or Medi cai d; t r ue or f al se?

22

A That i s cor r ect , he di d not qual i f y.23 Q Okay. And on t he r i ght , t hi s young man - - and

24 you' ve got t he mol d and t he phot ogr aphs i n f r ont of you

25 f or t hi s young man on t he r i ght , wher e you say t hat t hi s


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1 young man had a f our - mi l l i met er open bi t e and 11 poi nt s

2 f or a l abi o- l i ngual spr ead, r i ght ? That ' s what your

3 r epor t says, r i ght ?

4 A They ar e al l di f f er ent .

5 J UDGE SEI TZMAN: I t hi nk you need t o answer

6 t he quest i on. I s t hat what your r epor t says?

7 THE WI TNESS: Yes, si r .

8 J UDGE EGAN: Whi ch pat i ent i s t hi s one

9 agai n?

10 Q ( BY MR. MORI ARTY) So t hi s ki d doesn' t have an11 open bi t e and t hi s ki d does have an open bi t e. Pat i ent

12 Number 19 does not have an open bi t e; Pat i ent Number 8

13 does have an open bi t e?

14 A That i s cor r ect , s i r .

15 Q I ' m sor r y. I have made a mi st ake. Thi s i s Al l

16 Smi l es, AS Pat i ent 27, and t he pat i ent over her e i s17 Pat i ent Number 8?

18 A Yes, si r .

19 Q So t hi s shows an open bi t e?

20 A Cor r ect , si r .

21 Q So now t hat we under st and t he concept of open

22

bi t e, l et us see i f we can si mpl i f y t hi ngs. A di me i s23 about a mi l l i met er ?

24 A I never measur ed i t , si r .

25 Q Wel l , we di d.


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1 A Good.

2 Q Not al l of us have t hose Bol ey Gauges. Do you

3 see t he di me up t her e?

4 A Al l r i ght , si r .

5 Q And do you see t hat l i t t l e mar k r i ght t her e t hat

6 shows j ust a hai r over a mi l l i met er ?

7 A I ' m not sur e what you ar e poi nt i ng at , si r .

8 Q Ri ght t her e. Do you see t hat l i ne?

9 A Got you. Yes, si r .

10 Q So can we agr ee t hat a

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