vvch hearing

PUBLIC HEARING PROCEEDINGS

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4 ATTORNEY GENERAL'S PUBLIC HEARING

5 RE SALE OF VICTOR VALLEY COMMUNITY HOSPITAL (VVCH)

6 HELD WEDNESDAY, AUGUST 17, 2011

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15 Reporter's transcript of public hearing

16 proceedings, taken on behalf of the Attorney General, at

17 Victorville City Hall, Council Chambers, 14343 Civic

18 Drive, Victorville, commencing at 3:01 p.m., Wednesday,

19 August 17, 2011, before Diana L. Porter, Certified

20 Shorthand Reporter No. 12729.

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1 APPEARANCES:

2 HEARING OFFICER:

3 WENDI A. HORWITZ Deputy Attorney General

4 State of California Department of Justice

5 Office of the Attorney General 300 South Spring Street, Suite 5000

6 Los Angeles, California 90013 (213)897-2178

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8 ALSO PRESENT:

9 AND VARIOUS MEMBERS OF THE AUDIENCE

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1 INDEX

2 EXAMINATION BY PAGE

3 BY CATHERINE M. PELLEY ...............................19

4 BY MIKE SARRAO .......................................23

5 BY DANIEL VILLAROSA ..................................35

6 BY SUMAN THAWKER .....................................37

7 BY VICTOR SABO, MD ...................................38

8 BY DR. ERIC HANSEN ...................................39

9 BY GURPAL PHAGUDA ....................................43

10 BY DR. MAKALA REDDY ..................................45

11 BY DR. RAKESH GROVER .................................48

12 BY DR. VIJAY ARORA ...................................49

13 BY DR. BRADLEY GILBERT ...............................52

14 BY ADAM WEISBERG .....................................54

15 BY LISA DEMIDOVICH ...................................63

16 BY HELEN BOUMAN ......................................68

17 BY MAYOR RYAN McEACHRON ..............................69

18 BY WILLIAM THOMAS ....................................72

19 BY CARL TATE .........................................80

20 BY MICHELLE SPEARS ...................................83

21 BY RUSS BLEWETT ......................................84

22 BY DR. JOSEPH MORRIS .................................88

23 BY DR. PATRICIA LUTHER ...............................90

24 BY ARDIS KULYAS ......................................92

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1 INDEX (cont.)


3 BY MARK KULYAS .......................................97

4 BY HESPERIA COUNCIL MEMBER THURSTON SMITH ...........101

5 BY LIONEL DEW .......................................103

6 BY JOSEPH BRADY .....................................104

7 BY CAROL KOELLE .....................................108

8 BY KEN ANDERSON .....................................110

9 BY JOE RANGE ........................................113

10 BY DAWN SIKES .......................................117

11 BY VAL CHRISTENSEN ..................................119

12 BY REBECCA TENNISON .................................124

13 BY BLAIR BRYSON .....................................126

14 BY MICHAEL FELDMAN ..................................130

15 BY PETER MORT .......................................142

16 BY JOHN PETTY .......................................152

17 BY MARTHA BRODIE ....................................156

18 BY PAUL RUSS ........................................161

19 BY SHERRY HALL ......................................164

20 BY DIANA PASILLAS ...................................165

21 BY PAT AGUIRRE ......................................169

22 BY GREG ZUMBRUNN ....................................173

23 BY VALERIE JOHNSON ..................................176

24 BY STEVEN SCHWARTZ ..................................178

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1 INDEX (cont.)


3 BY CHARLES SLYNGSTAD ................................179

4 BY SUZANNE RICHARDS .................................188

5 BY LEX REDDY ........................................191

6 BY HECTOR GONZALEZ ..................................199

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8 EXHIBITS

9 EXHIBIT DESCRIPTION

10 Exhibit 1 LETTERS SUBMITTED AT HEARING

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1 VICTORVILLE, CALIFORNIA; WEDNESDAY, AUGUST 17, 2011

2 3:01 P.M.

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4 HEARING OFFICER: Hello, everybody. Can you

5 take a seat so we can get started, please.

6 Hi, everybody. So glad to see everybody here

7 today. My name is Wendi Horwitz. I'm a Deputy Attorney

8 General for the State of California.

9 The purpose of today's meeting is to receive

10 comments about the proposed transaction between the

11 Seller, Victor Valley Community Hospital, a California

12 Nonprofit Public Benefit Corporation, and the Buyers,

13 Prime Healthcare Services Foundation, Inc., and PHSF

14 Victor Valley, LLC, both of which are organized

15 exclusively for charitable purposes under Internal

16 Revenue Code Section 501C3. Representatives from the

17 buyers and sellers will be making brief presentations.

18 As you can see to my right here, we have a

19 court reporter who will be preparing a transcript of

20 today's meeting. Use of a court reporter is necessary

21 to ensure that we have a complete record of what

22 everyone has to say. There are a few rules that must be

23 complied with when the court reporter is used.

24 First, before speaking, please say and spell

25 your last name for the reporter. Each speaker must

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1 speak audibly and not too fast so that the court

2 reporter can record what you say.

3 Also, the court reporter can only record one

4 speaker at a time, so it is not helpful for two people

5 to talk at once.

6 If you have a prepared comment, please provide

7 the court reporter with a copy as well. Often, when you

8 have a prepared statement and you're reading something

9 like I am right now, you tend to speak quickly and it's

10 difficult for her to get down everything that you say.

11 My office -- there's two cameras over here to

12 my right. My office has granted a request from the

13 Center for Investigative Reporting to videotape today's

14 public meeting. The Center has set up its camera to my

15 right and its microphone is at the podium.

16 Is that right?

17 THE VIDEOGRAPHER: Yes.

18 HEARING OFFICER: And also, we have another

19 individual who wanted to record today. That's fine.

20 The Foundation wanted to also record today's public

21 meeting. So just so you know, there are two cameras to

22 the right here.

23 In addition, there is a -- there is a

24 telephone connection that is hooked up with all of the

25 microphones today, and an individual from my office --

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1 his name is Travis La Blanc [phonetic]; he's a special

2 assistant to the Attorney General. He'll be on the

3 line, listening to today's comments.

4 The service area and patients for this

5 facility, Victor Valley Community Hospital, includes a

6 Spanish-speaking population. We've arranged for a

7 translator today. At this time, I would like the

8 Spanish-language translator to ask if anyone needs the

9 translator's services.

10 (Interpreter addressed the audience

11 in Spanish.)

12 HEARING OFFICER: Okay.

13 THE INTERPRETER: No one has raised their

14 hand.

15 HEARING OFFICER: Okay. Thank you very much.

16 In addition, we have prepared sign-up sheets

17 in English and Spanish for anyone who would like to

18 speak. Be sure to hand them to -- I've got a helper in

19 the back of the room, Billy right here, who -- and I

20 would like to encourage everyone to keep their comments

21 to no more than five minutes. We have a number of

22 people who would like to speak today.

23 Unless there's any questions about the

24 procedure, I would like to discuss the Attorney

25 General's role in reviewing this transaction.

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1 Victor Valley Community Hospital owns and

2 operates a general acute care hospital licensed for a

3 101 beds, that includes an emergency department with 13

4 beds or treatment bays. It's located in Victorville,

5 California, and operates the Victor Valley Community

6 Hospital, Women's Health Center, and Outpatient Imaging

7 as well.

8 Under Corporations Code Section 5920 et seq.,

9 Victor Valley Community Hospital filed a notice and a

10 request for the Attorney General's approval of the

11 proposed sale of this facility. The key agreements

12 governing the proposed transaction include an Asset Sale

13 Agreement for the transfer of assets and an interim

14 management and lease-back agreement under which the

15 Buyers would manage the Hospital for a period of time.

16 The main provisions of the Asset Sale

17 Agreement are Buyers will purchase the Hospital, real

18 property, and personal property associated with its

19 buildings, including equipment, associated intangible

20 assets and accounts receivable, and the Victor Valley

21 Community Hospital Women's Health Center.

22 Excluded assets are cash and investments held

23 by Victor Valley Community Hospital, including any

24 charitable funds.

25 The purchase price is $35 million. This

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1 amount does not include the additional $25 million of

2 capital improvements, equipment, information technology,

3 infrastructure improvements, and for working capital,

4 with at least $15 million of that going for capital

5 improvements, equipment, information technology, and

6 infrastructure improvement at Victor Valley Community

7 Hospital.

8 Buyers will retain all current members of

9 Victor Valley Community Hospital's medical staff in good

10 standing and offer employment to substantially all

11 current Hospital employees at benefit levels that are

12 not less favorable than those provided to similarly

13 situated employees of Buyers. And as I recall, the

14 salaries will be the same as well.

15 Buyers have agreed to operate the Hospital as

16 an acute-care hospital and continue to provide

17 emergency, obstetrical, and pediatric services.

18 Buyers have agreed to continue to provide

19 charity care and community benefits at historical

20 levels.

21 Buyers will form a local governing board.

22 Now, by statute, the Attorney General must

23 review and consent to any transfer of control or

24 ownership of a general acute-care hospital from a

25 nonprofit corporation to either a for-profit entity or a

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1 nonprofit entity as we have here.

2 The Attorney General has three options in

3 acting upon this notice. First, to approve, disapprove,

4 or approve with conditions. The Attorney General is

5 required by law to consider a number of issues before

6 deciding among these options. These issues range from

7 technical, legal matters to the broad question of

8 whether the transaction is in the public interest.

9 Ordinarily, the most significant question is

10 whether the proposed transaction will adversely affect

11 the availability and accessibility of healthcare

12 services in the affected community.

13 Now, with respect to this most significant

14 question, we have a Healthcare Impact Report that was

15 prepared by Medical Development Specialists for the

16 Attorney General, and copies are available out on the

17 desk. If you -- you can also get it on our Website,

18 which I'll announce later. But it's also -- there are

19 copies available if anyone needs one. On our Website,

20 the AG's Website is

21 www.ag.ca.gov/charities/nonprofithosp, so it's

22 N-O-N-P-R-O-F-I-T-H-O-S-P -- dot-php. And you will see

23 all the notices for the Victor Valley transaction as

24 well as the Healthcare Impact Report. I --

25 The report describes the possibility effects

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1 that the proposed transaction may have on the

2 accessibility and availability of healthcare services in

3 the area served by the Hospital.

4 We have Phil Dalton who's to my left. He is

5 the president of Medical Development Specialists, and

6 he's here to speak about the report and conclusions.

7 We invite you to comment on the report or any

8 other issue that you may have concerning the proposed

9 transaction.

10 As far as a schedule goes, it is anticipated

11 that the Attorney General will issue her decision on or

12 before August 30th. It will be posted again on the AG's

13 Website, the same Website I gave you before,

14 www.ag.ca.gov/charities/nonprofithosp.

15 Let me just give you a brief summary of the

16 conduct of the meeting today so that everybody knows how

17 this goes if you weren't here before. After

18 Mr. Dalton's presentation, we will a brief presentation

19 from the representative from the Seller as well as from

20 the Buyer. Then, I will call anyone who, whether you

21 signed up on the list or not -- I want to call anybody

22 that works at the Hospital, any employees or doctors

23 that have a time constraint that they need to -- you

24 know, if they're starting work at 5:00 o'clock at the

25 Hospital, I want those folks, whether you've done a

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1 sign-up sheet or you've called me ahead of time, I would

2 like you -- and I'll let you know. But I will call you

3 first, but you're going to need to come up to the podium

4 because I don't know who you are. But you can just come

5 up and line up at the podium and we'll have you folks

6 testify -- or not testify, but comment first.

7 Now, there's one option that I want to offer

8 people. If anyone has contacted me prior to today and

9 asked me to speak and they would like to remain

10 anonymous, I would like -- so anybody who sent me

11 an e-mail, who -- phone call, anyone who asked to be on

12 the list before today, if anybody wants to be anonymous,

13 I would like you just to come forward really quickly and

14 let me know that and I will just use a different name or

15 a different -- or a number or some other kind of

16 reference if you would prefer that. And that way, I

17 just need some way to call you up to the podium.

18 So just want to take a minute. Is there

19 anybody who would like to remain anonymous?

20 Okay. Okay. That's fine. If somebody

21 changes their mind -- we're going to be taking a break.

22 Our court reporter really just transcribes for about an

23 hour and then she needs to just take a short break, so

24 we will be taking breaks. So I'm going to call the

25 people on the list, but I wanted to give anyone that

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1 option. And the option was on the sheet as well, so I

2 will be calling people by whatever name or alternative

3 name that you've used on the sheet.

4 Okay. First -- oh, just in case anybody's

5 curious, this is a colleague of mine. Her name is Jamie

6 Cantori [phonetic]. She's a Deputy Attorney General,

7 and she's here to observe what happens at one of these

8 public meetings today.

9 So, Phil, go ahead. Thank you.

10 MR. DALTON: Thank you. Good afternoon. MDS

11 is a healthcare policy and planning consultant for --

12 that was retained to examine the effect of the

13 acquisition by Prime Healthcare Services Foundation,

14 Inc., of Victor Valley Community Hospital on the

15 availability and accessibility of healthcare services.

16 In this regard, we reviewed various

17 transaction documents, Hospital data, state data, and

18 conducted interviews of different Hospital and community

19 representatives. The results or analyses were made

20 available on the California Attorney General Website on

21 August 5th, 2011, and as Wendi mentioned, copies are

22 available in the back of the room.

23 Victor Valley Community Hospital, as Wendi

24 mentioned, is licensed for 101 beds and has a range of

25 services available that are typical for a small

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1 community hospital and also has pediatric services, a

2 neonatal intensive care unit, and a cardiac

3 catheterization lab. Victor Valley Community Hospital

4 sees about 32,000 emergency visits per year. Victor

5 Valley admits about 6,700 patients a year, and runs an

6 average daily census of about 58 patients. The Hospital

7 delivers about 1700 babies per year. It also has an

8 active medical staff of over 100 physicians and over 550

9 Hospital employees.

10 Victor Valley Community Hospital is very

11 important to the community. The High Desert has a

12 shortage of hospital beds, and both St. Mary Medical

13 Center and Desert Valley Hospital are the only two other

14 hospitals in the immediate area and they run at higher

15 occupancy. Also, many parents from the area receive

16 healthcare services out of the area at other facilities,

17 many of which are located down the hill in San

18 Bernardino.

19 Both St. Mary Medical Center and Desert Valley

20 Hospital have expansive -- have expansion plans to add

21 beds to their hospitals. And additionally, St. Mary

22 Medical Center has a plan to establish a new hospital

23 along the freeway, but this is not to open until plan

24 date of the 2016.

25 Victor Valley Community Hospital is viewed as

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1 especially important for providing emergency services,

2 obstetrical services, pediatric services. It is also

3 important in terms of the community of patients that it

4 provides services to, and these include Inland Empire

5 Health Plan, Medi-cal and Medicare, commercial

6 insurance, and uninsured patients. Without Victor

7 Valley Community Hospital, many patients would have

8 difficulty accessing healthcare services and the other

9 hospitals in the area, which are running higher

10 occupancy, would also be impacted without Victor Valley

11 Community Hospital. Many people would be forced to get

12 services out of the area without the availability of

13 Victor Valley Community Hospital.

14 One important mention is that our analysis of

15 the impact of this sales transaction, and our impact

16 analysis is focused on this sales transaction, is

17 considered in light of a few important premises and

18 these include:

19 Number 1, that Victor Valley Community

20 Hospital has struggled financially to survive for years

21 and has not made needed capital investments and, last

22 year, filed for bankruptcy protection.

23 Number 2, it was the reasonable conclusion of

24 the board management and its advisers that without a

25 sales transaction, the Hospital would be required to

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1 close.

2 Victor Valley Community Hospital's recent

3 ability to continue to operate has been based on special

4 funds that have been made available by a state federal

5 government for distressed hospitals and those serving

6 uninsured and Medi-cal patients. These funds are a

7 temporary solution and cannot be counted on to continue

8 in the future.

9 The Purchaser has made certain guarantees, and

10 we, MDS, have also made certain recommendations for the

11 continuation of services, and we believe that many of

12 these recommendations and the guarantees which pertain

13 to continuing services charity care, the maintenance of

14 IEHP contracts and other items are important to minimize

15 the potential negative impacts of the transaction.

16 While there is a possibility of negatively

17 impacting access for managed care patients, St. Mary

18 Medical Center contracts with most of the same managed

19 care companies that contract currently with Victor

20 Valley Community Hospital.

21 In summary, and in conclusion, we believe that

22 the negative impacts of this -- potential negative

23 impacts from this transaction would be much less than if

24 the Hospital were to close, and we recommend that if the

25 Attorney General approves the transaction, that our

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1 recommendations be accepted in order to minimize the

2 potential negative impacts.

3 HEARING OFFICER: Thank you very much. Cathy,

4 why don't we have you go first.

5 CATHERINE M. PELLEY: Okay.

6 HEARING OFFICER: Cathy Pelley, she's the CEO

7 of Victor Valley Community Hospital and well-respected

8 member of the community.

9 COMMENTS BY CATHERINE M. PELLEY

10 CATHERINE M. PELLEY: Good afternoon. My name

11 is Catherine, C-A-T-H-E-R-I-N-E, M, Pelley, P as in

12 Patrick, E-L-L-E-Y.

13 I am the chief executive officer of Victor

14 Valley Community Hospital. I feel it's important to

15 tell you my contract as head of the Hospital expires

16 next month on September 30th, and I will retire on

17 September 30th. I am not going to be an employee of the

18 Buyer, Prime Healthcare Services Foundation, if the sale

19 of Victor Valley to Prime is approved by the Attorney

20 General.

21 I would also like to add my thanks to the

22 Attorney General in making such a careful analysis and

23 doing it more than once. I really do appreciate that

24 you've had to consider all the views of the interested

25 parties and all of the documents submitted, so thank you

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1 very much.

2 It has always been the goal of the board and

3 the management of Victor Valley Community Hospital to

4 protect this asset for the community so that the people

5 of the High Desert would have access to medical care.

6 The fact that the area is woefully under-bedded just

7 makes this more important.

8 Victor Valley Community Hospital's plant is 45

9 years old. Maintaining it is very costly. Equipment

10 needs are substantial, and it's very clear that there's

11 not enough revenue to sustain the business or to upgrade

12 it. The subsequent cash-flow crisis led us into

13 bankruptcy protection last year under Chapter 11, and

14 our operations simply are not improving from a financial

15 point of view.

16 I believe that this transaction should be

17 approved because Prime will not delay a closing of the

18 purchase and will bring the funds necessary for plant

19 and equipment needs. The sale keeps the Hospital doors

20 open, the 101 beds are available for the community, and

21 millions of dollars will be invested in the Hospital by

22 Prime. Approval of this transaction also protects jobs

23 in the High Desert, where unemployment is still

24 extremely high.

25 Prime will continue to provide services that

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1 the area needs, including the emergency department,

2 obstetrics, pediatrics, women's services. Prime will

3 also enter into a new contract with Inland Empire Health

4 Plan, or IEHP, which provides for the many Medi-Cal

5 patients in the area. Medi-Cal, Medicare, charity care,

6 together comprise more than 70 percent of the our

7 patient population. We just don't get many admissions

8 of patients who are covered by other insurances.

9 Although there have been a lot of statements

10 made against Prime, many of which are unsubstantiated, I

11 want to say for the record that when Victor Valley

12 Community Hospital over the years, and most especially

13 over the two and a half years that I have been the

14 CEO -- whenever we have needed help for patients,

15 whether it was pharmaceuticals, equipment, tests,

16 whatever, Prime Healthcare Services, Desert Valley

17 Hospital never said no to a patient need when other

18 hospitals in the area did. They have always been

19 unselfish in that regard, and to me that shows that the

20 best interest of the community and the patients is

21 foremost for them.

22 The Hospital must have a closed sale because

23 we are under a September 1st deadline by the Federal

24 Centers for Medicare and Medicaid Services, or CMS. CMS

25 says that it will revoke our certificate to operate the

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1 laboratory. It's referred to as CLIA, C-L-I-A. If we

2 do not have a deal that CMS thinks is substantially

3 likely to close very soon, then CMS will not extend the

4 deadline on the revoking of the CLIA certificate. You

5 cannot treat patients in a hospital without a

6 laboratory.

7 While some have told the Attorney General's

8 office that this issue is a red herring and that it

9 would be very easy to outsource the laboratory, I'm here

10 to tell you that's not an option. I've been trying for

11 two and a half years. And so if more than one day

12 passes after the CLIA deadline, if we do not have a

13 commitment from CMS to extend that deadline, in my

14 capacity as chief executive officer of the Hospital, I

15 will begin the procedure to close the Hospital. I will

16 notify the California Department of Public Health.

17 The approval of the California Attorney

18 General will serve the community, the patients, the

19 employees, the medical staff, and very well it will

20 continue the access to healthcare that will save lives

21 in this High Desert. Please approve the sale in the

22 favor of Prime as soon as you can.

23 HEARING OFFICER: Great. Thank you, Cathy.

24 Mike Sarrao.

25 COMMENTS BY MIKE SARRAO

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1 MICHAEL SARRAO: Good afternoon. My name is

2 Michael Sarrao, and I serve as the --

3 HEARING OFFICER: Mike, can we have you spell

4 your last name for the court reporter?

5 MICHAEL SARRAO: Sure, S-A-R-R-A-O.

6 I serve as the secretary and treasurer of the

7 Prime Healthcare Services Foundation, and I'll also act

8 as an attorney for the Foundation. I'm speaking today

9 on behalf of the Foundation regarding its proposed

10 purchase of Victor Valley Community Hospital.

11 DEPOSITION OFFICER: Can you move the

12 microphone up? Thank you.

13 MICHAEL SARRAO: A little background. Prime

14 Healthcare Services Foundation is a 501(c)(3) nonprofit

15 public charity that was formed in 2006. The Foundation

16 has more than $100 million in assets and is governed by

17 a board of directors consisting of Dr. Prem Reddy,

18 Dr. Kavitha Reddy Bhatia, a board-certified pediatrician

19 who grew up in the High Desert, retired Chino Police

20 Chief Eugene Hernandez, Montclair City Councilman

21 William Ruh, and David Thorson, a community leader from

22 the San Fernando Valley. Chief Hernandez, Councilman

23 Ruh, and Mr. Thorson are all independent members of the

24 board which means that the majority of the board are

25 independent directors. Each of these individuals is

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1 highly qualified and has a long track record of being

2 involved in the community.

3 So there is no confusion, Prem Reddy, Prem

4 Reddy's family, Desert Valley Hospital, and Prime

5 Healthcare Services, Inc., have no ownership interest in

6 the Foundation and do not stand to profit from the

7 Foundation acquiring Victor Valley Community Hospital.

8 Rather, the Foundation is a community asset and its

9 assets would be distributed to other charities in

10 accordance with federal and state law if it ever ceased

11 to exist.

12 The Foundation owns two nonprofit hospitals,

13 Encino Hospital Medical Center and Montclair Hospital

14 Medical Center. Encino Hospital is a 151-bed hospital

15 that was donated to the Foundation December 2009 by

16 Prime Healthcare Services, and Montclair Hospital is a

17 102-bed hospital that was donated to the Foundation this

18 past December 2010 by Prime Healthcare Services.

19 The Foundation has formed PHSF Victor Valley,

20 LLC, a nonprofit entity that is 100 percent owned by the

21 Foundation to be the licensed operator of the Hospital.

22 It is fairly typical for a subsidiary to be formed like

23 PHSF Victor Valley was in the case of hospital

24 acquisitions. The Foundation stands behind be PHSF

25 Victor Valley and will ensure that the commitments the

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1 Foundation has made to the Victor Valley Community

2 Hospital are fulfilled.

3 PHSF Victor Valley will be managed by a

4 three-person board of managers, of which two of the

5 three will be independent members. While we seek

6 candidates to serve on this board, the board of the

7 directors of the Foundation will serve as the board of

8 managers.

9 As many members of the audience know,

10 Dr. Reddy and his family have lived and worked in the

11 High Desert for the past 30 years and are deeply

12 committed to the success of the High Desert and

13 healthcare in the High Desert.

14 Over the years, Dr. Reddy and his family, the

15 Dr. Prem Reddy Foundation, a separate nonprofit entity

16 formed by Dr. Reddy and his family back in 1991, and the

17 Prime Healthcare services Foundation have provided a

18 substantial amount of support to the High Desert,

19 including:

20 Donations of more than $2 million to Victor

21 Valley Community College;

22 Providing college scholarships to hundreds of

23 deserving students from the High Desert so that they can

24 pursue education and healthcare. These scholarships are

25 primarily based on financial need and play important

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1 role in helping students attend college each year. More

2 than 40 students received scholarships this past year;

3 Operating a community medical library in

4 Victorville that provides education classes to residents

5 each year;

6 Opening a senior wellness center at Jess Ranch

7 in Hesperia that more than 500 seniors visit a month to

8 knit, garden, exercise, and where they also have access

9 to health screenings and education programs.

10 Under the terms of the Asset Sale Agreement

11 and the conditions we expect the Attorney General to

12 impose as part of the sale, the Foundation has made the

13 following commitments to Victor Valley Community

14 Hospital:

15 The Foundation will keep Victor Valley

16 Community Hospital open as a nonprofit hospital. I will

17 note that other buyers wanted to make Victor Valley a

18 for-profit hospital;

19 The Foundation will offer employment to

20 substantially all of Victor Valley's current employees;

21 The Foundation will invest at least

22 $25 million into Victor Valley for things such as a new

23 computer system and new medical equipment, and we expect

24 to spend at least 15 million over the first three years;

25 The Foundation will provide charity care at

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1 the same or greater levels than those historically

2 provided at Victor Valley. We expect the levels of

3 charity care will increase due to improved efficiencies

4 in the emergency department;

5 The Foundation will maintain all essential

6 services, including emergency services, medical/surgical

7 services, labor and delivery, and pediatrics;

8 The Foundation will form a local governing

9 board for Victor Valley which will include members of

10 the medical staff and local community members. We look

11 forward to receiving input from Victor Valley's current

12 board regarding potential candidates for the local

13 governing board;

14 The Foundation will recognize the independent

15 medical staff of Victor Valley, which means that all

16 physicians with privileges at the time the sale closes

17 will have the same privileges after the sale;

18 The Foundation will maintain the services

19 offered by the Women's Health Center;

20 The Foundation will contract with IEHP for

21 five years so that IEHP members can continue to receive

22 care at Victor Valley. PHSF Victor Valley signed a

23 contract with IEHP yesterday;

24 The Foundation will maintain contracts with

25 the County of San Bernardino.

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1 In addition to what may be required under the

2 Asset Sale Agreement and the Attorney General

3 conditions, the Foundation also wants to start a number

4 of initiatives at Victor Valley that will benefit the

5 community. These initiatives include:

6 Increasing efficiencies in the emergency

7 department so that the time a patient must wait to see a

8 physician is decreased and the overall time patients

9 spend in the emergency department is decreased. Since

10 our emergency departments operate more efficiently, more

11 patients can be seen each and every day than in other

12 hospitals, which is particularly important in terms of

13 access to care as many individuals are forced to seek

14 care in emergency departments due to a lack of

15 insurance;

16 Improving Victor Valley's scores on Medicare

17 Core Measures, which are quality-of-care indicators

18 measured by Medicare;

19 Developing outreach and education programs

20 with local schools and community organizations;

21 And working with the County of San Bernardino

22 to see whether Victor Valley could be a hub for the

23 County's medically indigent adult program so that

24 patients do not have to travel down the Cajon Pass to

25 receive care.

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1 I also want to provide some background

2 regarding Prime Healthcare. Above all else, Prime

3 Healthcare is committed to providing quality healthcare

4 and has received numerous awards over the past few years

5 recognizing these efforts, including being ranked as a

6 top-ten health system in the nation in a major study.

7 Prime Healthcare was the only for-profit system to be

8 ranked among the top ten and the only system west of the

9 Mississippi to be ranked above the top ten. According

10 to this study, 47,000 Medicare patients would be saved

11 each year, and more than 92,000 patient complications

12 could be avoided if all hospitals provided the same

13 level of care we provide.

14 Desert Valley Hospital has been ranked as a

15 Top 100 Hospital in the Nation five different times --

16 in 2004, 2005, 2007, 2008, and 2009. West Anaheim

17 Medical Center has been ranked as a Top 100 Hospital in

18 the Nation in 2008 and 2010. Montclair Hospital Medical

19 Center has been ranked as a Top 100 Hospital in the

20 Nation in 2009.

21 In addition to providing quality care, Prime

22 Healthcare is committing to -- committed to providing

23 access to care to all members of the community.

24 Hospitals operated by Prime Healthcare and the

25 Foundation regularly provide more charity care than

29


1 other for-profit and nonprofit hospitals, and these

2 hospitals provided more than $180 million in charity

3 care in 2009 alone.

4 Regarding contracts with HMOs and insurance

5 companies, Prime Healthcare hospitals contract with them

6 if the rates are fair and reasonable. For example,

7 Desert Valley Hospital maintains contracts with at least

8 18 different HMOs or insurance companies, and several

9 other Prime Healthcare hospitals maintain contracts with

10 various HMOs and insurance companies.

11 The Foundation is happy to speak with any HMO

12 or insurance company regarding contracts at Victor

13 Valley so long as they offer rates that are fair and

14 reasonable and do not lead to millions of dollars in

15 losses like those set by Victor Valley in 2009 with

16 respect to managed care business. It is simply unfair

17 for Victor Valley to lose so much money in favor of

18 these HMOs and insurance companies.

19 On a related note, some of you may have seen

20 or heard the campaign one particular union SEIU-UHW has

21 embarked upon the slander Prime Healthcare with

22 misstatements, distortions, and outrageously false

23 allegations. Let me make several points to put that

24 misguided effort into perspective.

25 SEIU-UHW does not represent a single employee

30


1 at either Victor Valley Community Hospital or Desert

2 Valley Hospital. SEIU-UHW does not represent a single

3 doctor who actually diagnoses the patients. Remember,

4 doctors, not hospitals, are the ones who practice

5 medicine.

6 SEIU-UHW's claims about blood infections or

7 sepsis, malnutrition, ER admission rates, and Medicare

8 fraud are nothing more than false and fraudulent

9 propaganda put out by SEIU to harm Prime Healthcare.

10 Joint Commission or HFAP, two Medicare

11 accreditation organizations, surveyed ten of Prime

12 Healthcare's hospitals, including Desert Valley

13 Hospital, and found no evidence to support SEIU's

14 allegations regarding blood infections. And unlike

15 SEIU-UHW, which simply relied on distorted statistics,

16 these accreditation organizations reviewed actual

17 patient records.

18 SEIU-UHW has ignored the embarrassing fact

19 that there are other hospitals in Southern California,

20 at which SEIU has contracts, which have set the senior

21 rates similar to those at Prime Healthcare Hospitals.

22 In response to SEIU-UHW's allegation regarding

23 malnutrition rates at Prime Healthcare Hospitals, Joint

24 Commission, a Medicare accreditation organization,

25 conducted a review of the allegations and found no

31


1 evidence to support the allegations.

2 SEIU has also ignored the fact that a hospital

3 a which SEIU has a contract has the highest malnutrition

4 rate in the state of California.

5 SEIU's claims about admission rates of Prime

6 Healthcare Hospitals failed to indicate that there are

7 more than 142 hospitals in California with admission

8 rates above the state average, including several

9 hospitals which have higher admission rates than Prime

10 Healthcare hospitals.

11 SEIU-UHW has also claimed that Prime

12 Healthcare is the subject of an investigation by

13 Medicare's Office of Inspector General, that California

14 Department of Public Health will not issue a hospital

15 license to Prime Healthcare, and that the Attorney

16 General will not approve the sale of Victor Valley

17 Community Hospital. These are also false statements.

18 Medicare's attorney stated in bankruptcy court

19 on July 12th that there's nothing that prevents Prime

20 Healthcare from participating Medicare.

21 CDPH, the California Department of Public

22 Healthcare, has actually encouraged Prime Healthcare to

23 submit an application for a hospital license for Victor

24 Valley and has not indicated that it will not issue a

25 hospital license to Prime Healthcare.

32


1 There may also be parties with vested economic

2 interests who stand up today and complain that the

3 Foundation will cancel all of the HMO and insurance

4 company contracts. It is important to remember that

5 many of these parties have a financial interest in these

6 very same contracts and that these HMOs and insurance

7 companies paid such low rates to Victor valley that it

8 lost millions of dollars each year providing care to HMO

9 patients. It is also important to remember that

10 patients can seek emergency care at Victor Valley or any

11 other hospital regardless of whether or not their HMO or

12 insurance company has a contract with Victor Valley.

13 There may also be some parties who stand up

14 today and say that they are interested in acquiring

15 Victor Valley and should be given the opportunity to bid

16 for the Hospital. To any such comments, we say where

17 have you been?

18 Victor Valley held an extensive due diligence,

19 bidding, and auction process almost a year ago and there

20 were only two bidders who actually participated in the

21 auction: The Foundation and the for-profit Victor

22 Valley Hospital Acquisition. Victor Valley Hospital

23 Acquisition won the auction and was given more than six

24 months to close the transaction, but did not close the

25 transaction for whatever reason. It's a bit late for

33


1 these bidders to now say they're interested.

2 United States Bankruptcy Judge Catherine Bauer

3 -- excuse me -- already heard these same comments and

4 rejected them when she approved the sale of Victor

5 Valley to the Foundation on July 12th, 2011.

6 Prime Healthcare Services Foundation is ready,

7 willing, and able to acquire the assets of Victor Valley

8 Community Hospital and looks forward to operating the

9 Hospital as a first-class community hospital which

10 provides quality healthcare to all members of the

11 community. Thank you.

12 HEARING OFFICER: Thank you. Mike, can you --

13 and also, Cathy -- can you make sure that you give the

14 reporter a copy your comments there?

15 MICHAEL SARRAO: I already did.

16 HEARING OFFICER: Perfect, perfect. Thank

17 you.

18 MICHAEL SARRAO: Thank you.

19 HEARING OFFICER: Okay. Is there anyone

20 who -- I just want to --

21 Before I get to my list, is there anyone

22 who -- I have one doctor, Villarosa, Daniel. I may be

23 mispronouncing it. Why don't come on up, and Dr. Reddy

24 and Dr. -- oh, okay.

25 And if there's anyone else who's working at

34


1 the hospital, just go ahead and just line up. And

2 again, I only want one of you to speak at a time. But

3 if anyone who works at the hospital, who's going to

4 start on a shift at 5:00 o'clock -- employees, doctors,

5 anyone else who works at the hospital -- just please

6 come up and line up and let me just hear from you first.

7 And then, I'm going to get to the list of people who

8 asked to speak today.

9 But again, I want you to say and spell your

10 last name so the court reporter can get your name.

11 Thank you.

12 COMMENTS BY DANIEL VILLAROSA

13 DANIEL VILLAROSA: My name is Daniel

14 Villarosa, V as in Victor, I-L-L-A-R-O-S-A. I'm one of

15 the OBGYNs who work at the hospital and vice chief of

16 staff at Victor Valley Hospital.

17 And I wanted to point out that the hospital is

18 running at a deficit. However, the -- they do provide a

19 lot of free charity care for the hospital. They have

20 inappropriate -- I mean, in- -- disproportionate share

21 of self pay, which means no pays to the hospital. And

22 in other hospitals, these patients are quickly shuffled

23 out of the hospital, because we get them; that's how we

24 know. And I'm not going to say specifically Desert

25 Valley, but both hospitals, they end up somehow at

35


1 Victor Valley.

2 And I also know that whenever we try to look

3 into a HMO contract to book patients at Desert Valley,

4 even though they take so many HMO patients, we never

5 seem to be able to book any patients over there. They

6 always send them to either Victor Valley or St. Mary's

7 Hospital. I don't -- I've never heard of them taking a

8 lot of (unintelligible) patients.

9 I've heard they've canceled most of their

10 contracts. And I understand that, you know, they have a

11 right to run their business as they run their business.

12 But I know that a lot of the patients we try to book for

13 HMO patients, we end up having Victor Valley or

14 St. Mary's.

15 So that's from a practical point of view, so

16 that -- I don't know what their arrangements are, their

17 legal agreements are. But that's what I know ends up

18 happening usually when we try to book patients.

19 HEARING OFFICER: Okay. Is there anything

20 further?

21 DANIEL VILLAROSA: No. I think that's all I

22 really wanted to point out.

23 HEARING OFFICER: Well, thank you very much

24 for coming. I appreciate it very much. Thank you,

25 Doctor.

36


1 COMMENTS BY SUMAN THAWKER

2 SUMAN THAWKER: My name is it Dr. Suman

3 Thawker, S-U-M-A-N, T-H-A-W-K-E-R. I'm a practicing

4 rheumatologist, and I've been in this community for more

5 than 25 years. I raised my family here. And being in

6 the community for all these years, I'm quite cognizant

7 of the healthcare requirements and needs of this

8 community.

9 All the three hospitals are running at full

10 capacity, and Desert Valley and St. Mary both have opted

11 and have decided to add more beds. So to consider a

12 closure of a hospital would really be a catastrophe to

13 the healthcare needs of our society.

14 From some of the information that I saw, the

15 accusation that the hospitals by law are not allowed to

16 put the diagnosis or recommendation to the doctors.

17 It's the hospital physician's, admitting physician's

18 duty and requirement to write the diagnosis. So the

19 whole accusation that the Prime Care is putting the

20 diagnosis is totally incorrect.

21 It seems the whole discussion right now is

22 based more on the control of the personnel and the

23 healthcare environment rather than medicine, rather

24 than, you know, worrying about the healthcare

25 requirements of our community.

37


1 On a personal note, I do know -- I have known

2 Dr. Reddy for more than 26 years. He's an excellent

3 physician. He's been a very good friend, and he has

4 devoted a lot of his time, money, energy, and his

5 resources to the well-being of this community. So I

6 would hope and implore that all these issues are taken

7 into account before you make any decisions. Thank you.

8 HEARING OFFICER: Thank you very much.

9 COMMENTS BY VICTOR SABO, MD

10 VICTOR SABO, MD: Thank you. My name is

11 Victor Sabo, S-A-B-O, MD, Chief of Staff at the Desert

12 Valley Hospital. I am in support of the Prime

13 Healthcare Foundation acquiring Victor Valley Community

14 Hospital.

15 I have been on staff of Victor Valley

16 Community Hospital since 197- -- since 1988. I have

17 built my practice from the ground up by taking call at

18 Victor Valley Community Hospital in the emergency room

19 starting back in September 1988.

20 This community needs Victor Valley Community

21 Hospital to continue to serve and keep up with the

22 growing demands of the increased population of the High

23 Desert.

24 I am also the medical director of Desert

25 Knolls Convalescent Hospital, a skilled nursing facility

38


1 one block away from the Victor Valley Community

2 Hospital, which fills the emergent needs of the patients

3 of that facility.

4 The three emergency rooms in the High Desert

5 currently deal with a high volume of patients. The loss

6 of a facility would be devastating to the residents of

7 the High Desert, including the seniors in these nursing

8 homes.

9 As Chief of Staff at Desert Valley Hospital,

10 I've had the privilege of working with the medical staff

11 and have intimate knowledge of the data which reflects

12 only the highest standards of care being delivered to

13 our patients. Allegations being made by those who only

14 wish to create doubt and mistrust are false and

15 shouldn't be believed. As physicians, we determine the

16 course of action for delivery of care, and the

17 individual making these allegations -- the individuals

18 that make these allegations do not understand how

19 medical care is delivered within a Hospital. Thank you.

20 HEARING OFFICER: Great. Thank you very much,

21 Dr. Sabo.

22 Hi.

23 COMMENTS BY DR. ERIC HANSEN

24 DR. ERIC HANSEN: Hello. Dr. Eric Hansen,

25 family medicine doctor in Hesperia for the last nine

39


1 years. It's spelled H-A-N-S-E-N; first name is Eric,

2 E-R-I-C.

3 I'm in agreement with my colleagues as far as

4 the need for this hospital. It would be a huge travesty

5 if this hospital was lost, and I think that everyone

6 realizes that.

7 I think it's important to -- and it maybe

8 could have been even more important to hear in the

9 openings about the other offers that are on the table

10 regarding the hospital, because it's kind of presented

11 initially that this hospital will close if this deal

12 does not go through. There are other deals that have

13 been on the table, and it might have been, and could

14 still be, important for everyone here to -- to have a

15 little bit background on that.

16 The major concern for myself, and there may be

17 some conflict of interest because I have a large

18 population in my practice of HMO patients. There is a

19 large population in the High Desert. I know that --

20 well, I actually don't have the statistics on the amount

21 of HMO admissions to Victor Valley Community Hospital

22 compared to private insurance admissions, but I know

23 that my HMO patients have been impacted directly by the

24 way the business model is run through the Desert Valley

25 Hospital. So my concerns with Prime Health taking over

40


1 a second hospital and potentially monopolizing the High

2 Desert, it's a major concern.

3 The case in point is that when my HMO

4 patients, on more than one occasion, have shown up in

5 the emergency room, I was not contacted when I had

6 privileges at Desert Valley Hospital. The patient would

7 come to me after follow-up and wonder why I didn't come

8 see them and that they were told by the ER doctor that I

9 had been paged and I never called back. And hopefully,

10 this, you know, is -- that's hearsay, nevertheless, but

11 this was something that prompted me to cancel my

12 privileges and not renew them through that hospital,

13 because this happened more than one time and these

14 patients were admitted through their hospital list

15 service, not to any knowledge of my own, and studies

16 were ordered and done that had been done elsewhere, and

17 only I had that information because I was the treating

18 physician, but was left out of the loop.

19 So if this is a way that this practice could

20 occur through Victor Valley Hospital, now I'm very

21 concerned about my patients, the utilization of

22 healthcare in general, not to mention the potential

23 problem with not contracting with the HMO or medical

24 groups that these HMO patients are -- are ensured by.

25 HEARING OFFICER: Now, which HMO groups are

41


1 you talking about? Can you just give me a couple names?

2 DR. ERIC HANSEN: Well, there's -- I know even

3 some private PPOs. But the HMO group through Choice

4 Medical Group, for instance.

5 HEARING OFFICER: Okay. Choice. Okay.

6 DR. ERIC HANSEN: Yeah. Which is a large

7 medical group in the High Desert;

8 HEARING OFFICER: Right.

9 DR. ERIC HANSEN: And so these -- these

10 patients, if they're not seen at this hospital under a

11 contracted rate, there's essentially no limit on what

12 can be billed for services without a contracted rate.

13 So I know that the initial impact report

14 stated that most physicians agree, but I know I was not

15 asked. I know probably 60 other doctors that would be

16 directly impacted that have a high quantity of HMO

17 patients in their practice that would also be directly

18 impacted as far as where they would be able to go to do

19 surgical procedures as outpatients, things that are

20 negotiated basically on contracted rates. And that

21 would basically overburden St. Mary's Hospital,

22 potentially, because they would be, then, the only

23 hospital left in the High Desert that potentially is

24 contracted with that medical group, for instance.

25 So this is a major issue. And yet, I

42


1 understand the emotional aspect of the hospital could

2 close. This is -- we can't lose the hospital. I agree

3 with that entirely. But definitely, this isn't the only

4 option unless there was some stipulation put in about

5 potentially contracting with all parties and not

6 necessarily having a monopoly and control over that

7 entire aspect of patients that are treated, because it's

8 a large population. I don't have the numbers, but I'm

9 sure it can be found. So it's just an important aspect

10 you need to be aware of.

11 HEARING OFFICER: Okay. Great. Thank you

12 very much. I appreciate it.

13 DR. ERIC HANSEN: Thank you.

14 COMMENTS BY GURPAL PHAGUDA

15 DR. GURPAL PHAGUDA: Dr. Gurpal. First name

16 is G-U-R-P-A-L; last name is Phaguda, P-H-A-G-U-D-A.

17 I'm also a family physician practicing in this area for

18 the last 18 years, and I want to support everything

19 Dr. Hansen has said. Being a private-practice

20 physician, all the things he said, I do want to support

21 that.

22 As physicians, we don't want Victor Valley

23 Hospital to close. That's why we supported, uh,

24 Dr. Kali Chaudhuri coming in nine months ago. We want

25 that hospital to stay open; no question about that.

43


1 Our main request to the Attorney General's

2 office is that allow our HMO patients admission

3 opportunity to that hospital. We don't have a

4 problem -- at least, I don't have a problem with

5 Dr. Prem Reddy or Prime Care. I just want to make sure

6 when it's time for contracting that our HMO patients do

7 have an opportunity to come to that hospital.

8 The attorney who spoke for Prime Care mentions

9 that they'll accept, look into reasonable rates, but

10 that's a very open statement. It doesn't really say

11 much. And I think it needs to be reasonable. I don't

12 think any HMO or IPA or a group is going to ask for

13 unreasonable rates, but it needs to be something that

14 the Attorney General needs to put some provisions that

15 would assist the groups to allow their HMO patients

16 access to that hospital.

17 So again, I want to stress as physicians,

18 there's no doctor in the High Desert who wants Victor

19 Valley Hospital to close. Our patients -- we need beds

20 in this community. Our emphasis is fortunately, or

21 unfortunately, HMO is here to stay. That market is

22 here, and we have a large HMO market in this community.

23 So our concern is that if you have a monopoly

24 of a business practice -- I mean, Dr. Reddy's open to do

25 whatever he prefers. It's his hospital at Prime Care

44


1 and -- but my request is that the kind of care and the

2 kind of business model that is practiced at Victor

3 Valley Hospital should be open to HMO patients and not

4 have restrictions where patients don't have access to

5 that Hospital. Thank you.

6 HEARING OFFICER: Thank you very much. I

7 appreciate it.

8 It looks like a Dr. Reddy, Mekala Reddy. Oh,

9 great, and if there's anybody else. Other than that,

10 I'm going to start with my list.

11 COMMENTS BY DR. MAKALA REDDY

12 DR. MAKALA REDDY: I'm Dr. Makala Reddy.

13 HEARING OFFICER: Again, could you spell your

14 last name for the record, please.

15 DR. MAKALA REDDY: Reddy, I don't need to

16 spell out; right? Last name, Makala, M-A-K-A-L-A. I've

17 been in this community almost 30 years. I started

18 for -- 30 years ago here when there was an air force

19 base. And then, after I finished my term, I decided

20 this is a good place to settle down and practice, and

21 I've been practicing every since.

22 I know Prime Care. Before it was Prime Care,

23 it was Desert Valley Medical Group, Desert Valley

24 Hospital. And, in fact, me and Dr. Reddy, along with a

25 few other physicians who started the whole group, that

45


1 was almost 28 years ago. For various reasons, we got

2 separated and we are in separate group, and I have my

3 own practice since then.

4 What is happening right now is before, we had

5 three hospitals. (Unintelligible.) Patients have good

6 choice.

7 DEPOSITION OFFICER: I'm sorry.

8 DR. MAKALA REDDY: Parents also had a good

9 choice to go to various hospitals. With the hospital

10 turmoil of Victor Valley Hospital, now it's being taken

11 over, possibly taken over by Prime Care. That, kind of

12 a creating a lot of anxiety among the physicians. The

13 reason being the model Desert Valley -- I'm sorry --

14 Prime Care that they've chosen has been a little bit of

15 problem for us.

16 We have another hospital that is Desert Valley

17 Hospital. In town, what I hear is that they cancel all

18 the contract, keep the emergency room open, and whoever

19 comes, uh, that has private insurance, you bill them at

20 full rate and make good profit. Whereas with patient

21 who need elective procedures, because they don't have a

22 contract with that insurance, they cannot go there.

23 HEARING OFFICER: Sir, could you -- I'm sorry.

24 Could you just talk a little bit closer to the

25 microphone? Why don't you just pull it down a little

46


1 bit closer to you. That way, everyone can hear you, and

2 she can hear you. Thank you.

3 DR. MAKALA REDDY: Whereas Victor Valley

4 Hospital has been treating almost every possible

5 insurance, all the Medi-Cal, HMOs -- that is, IEHP

6 Advantage, Molina. Even St. Mary Hospital that we have

7 in town does not accept Medi-Cal [phonetic], Molina, or

8 Advantage. So it's only hospital that has been

9 providing the care for the poorest of the poor.

10 Patients -- I can speak about the surgical

11 aspect because I'm in that area. People with the breast

12 cancers, colon cancers, they can't go any other place

13 with Advantage or Molina. They can only go to Victor

14 Valley Hospital.

15 So with their track record of the Prime Care,

16 there's a huge concern. What will happen with these

17 people? The nearest hospital down below, that is in

18 Los Angeles, is 40, 50 miles. So many times, they can't

19 even find a car to bring the patient to the hospital or

20 the doctor's office. And driving that far down with the

21 gasoline prices going up is a huge problem.

22 So my opinion to you is if there's a third

23 player in the ballgame, you should consider it very

24 seriously. Thank you.


47


1 COMMENTS BY DR. RAKESH GROVER

2 RAKESH GROVER: Good afternoon. My name is

3 Rakesh Grover. I'll spell it. It's R-A-K-E-S-H, and

4 the last name is Grover, G-R-O-V-E-R.

5 I'm the chairperson of the Department of

6 Surgery at Victor Valley Hospital. I am also a

7 chairperson of various committees functioning at base

8 levels. And I'm also part of the Medical Executive

9 Committee that's the highest branch in the hospital for

10 conducting physician affairs. I also had the privilege

11 of being the past president of the Indian American

12 Cultural Society in the High Desert. And I have been in

13 practice of 15 years in the department of surgery in

14 this wonderful High Desert community.

15 I wish to thank you, allowing us to give this

16 opportunity and to be able to come here and express our

17 concerns.

18 It's a deep concern we have for the healthcare

19 delivery here in the High Desert. We all like good --

20 to do good things. We all would want to, um -- we all

21 have gone through tough times, and this is one such.

22 It is indeed a test of our prudence to

23 exercise non-biased judgement in a very cool manner for

24 the benefit of this community, that this community so

25 richly deserves. We owe it to this community.

48


1 A decision that is made without exploring

2 other viable options that are available would not be

3 appropriate. It is our general responsibility, and

4 we owe it to them.

5 I have been a member of this community. I am

6 part of this community. And it is a deep concern that I

7 have that the healthcare delivery not be disrupted or

8 all viable options be please be explored. It is very

9 vital that this hospital stays open. All my respectable

10 colleagues across the board have expressed those views

11 and agree with all of those, especially Eric Hanson, who

12 very ably spoke. Please, please listen to us. Thank

13 you very much for your attention.

14 HEARING OFFICER: Thank you very much, Dr.

15 Grover.

16 So you're a doctor?

17 DR. VIJAY ARORA: Yes.

18 HEARING OFFICER: Okay. Great. Is there any

19 other doctors? Okay. Great. This is going to be our

20 last one. We're going to take a short break, and then

21 we're gonna get to the list. Okay? Okay. Thank you.

22 COMMENTS BY DR. VIJAY ARORA

23 DR. VIJAY ARORA: Doctor Vijay Arora.

24 HEARING OFFICER: Yeah. You need to move the

25 mic. Thank you.

49


1 DR. VIJAY ARORA: My name is Dr. Vijay Arora.

2 First name is Vijay, V as in Victor, I-J-A-Y; last name,

3 Arora, A-R-O-R-A.

4 I'm an OBGYN physician in private practice in

5 the High Desert for more than 25 years. I, just like

6 Dr. Tucker, consider Dr. Prem Reddy and several of the

7 senior members of his group to be very close friends.

8 I would like to talk about the impact report

9 that you said at the very beginning was a very important

10 piece of evidence to consider. The vast majority of

11 doctors listed in that impact report, in a meeting with

12 you have basically expressed very serious reservations

13 about the possible disruption of care. I would like

14 your office to take that seriously. I would like your

15 office to look at every and all other option that may be

16 available. Our goal as physicians is to provide the

17 best care and the most accessible care to our patients.

18 It was stated by the consultant earlier that

19 recommendations could be made about keeping certain

20 departments open and mandating those -- that those

21 departments stay open. Keeping the departments open

22 alone does not allow access to the patients on an

23 elective basis. Patients can certainly come in through

24 the emergency room. There are federal laws that

25 obligate hospitals to provide care, but at what cost?

50


1 Several of my colleagues have mentioned HMOs,

2 and I reiterate that fact very strongly, but we also

3 have to consider several PPOs. Number one in those is

4 Blue Cross of California. We have Blue Shield of

5 California. There is United Healthcare that renders

6 care to about 70 million people in the United States.

7 There is Aetna; the only hospital that has a contract in

8 the High Desert currently is Victor Valley Hospital.

9 Several of the state employees, school teachers, highway

10 patrolmen, police officers -- a vast majority of those

11 people have these particular insurances that I just

12 listed.

13 It would be my humble request to you to look

14 at all, every option and, number two, require, make it

15 an absolute requirement of whoever acquires this

16 valuable asset for the community to continue to provide

17 the same level of care across the board, including PPOs,

18 including HMOs. Of course, in the process, trying to

19 make contracts more competitive if they have to be,

20 because we certainly do not want the hospital to lose

21 any revenue. Thank you very much.


23 Okay. We're going to just take a quick

24 five-minute break. We're going to start back at 4:10.

25 Thank you.

51


1 (A recess was taken.)

2 HEARING OFFICER: Okay. First person we're

3 going to be calling today -- let me grab my list -- is

4 Dr. Gilbert. And after Dr. Gilbert -- oh, we already

5 heard from Dr. Sabo. And then, Adam, we're going to

6 have you come up, and Lisa from UNAC, we're going to

7 have you come up.

8 COMMENTS BY DR. BRADLEY GILBERT

9 DR. BRADLEY GILBERT: Thank you. My name is

10 Dr. Bradley Gilbert, B-R-A-D-L-E-Y-G-I-L-B-E-R-T, and I

11 am the CEO of Inland Empire Health Plan, or IEHP.

12 IEHP is a not-for-profit health plan that

13 serves over 515,000 individuals in our two counties,

14 including over 60,000 members in the High Desert. All

15 of our members are low-income, vulnerable families,

16 adults, and children. Those are the only type of

17 members that we serve.

18 Victor Valley, as clearly documented in the

19 MDS is report, is a critical hospital in the High Desert

20 and, in particular, is a critical hospital for

21 low-income, vulnerable families and children served by

22 IEHP.

23 We have had a 15-year relationship. We are

24 coming up on our 15th anniversary on September 1st. We

25 started on September 1st, 1996. And that entire time,

52


1 we've had a relationship with Victor Valley Community

2 Hospital. We have supported them. We helped them

3 renovate their emergency department. When we weren't

4 paid for three months in last year, when the budget

5 wasn't passed by the State, we continued to pay them

6 regardless of the fact that we were not being paid. So

7 our relationship with them has been good, it's been

8 strong, and it's been ongoing.

9 I think people have said it very clearly, that

10 survival of this hospital is absolutely critical for the

11 community. We spongily support the recommendations in

12 the MDS report that were previously included in the AG

13 conditions, that include the maintaining of services,

14 the critical services to Victor Valley provides, and,

15 most importantly for IEHP, the maintaining of a contract

16 with Inland Empire Health Plan so that our members can

17 get the service that they need.

18 We have reached an agreement as Mr. Strow

19 [phonetic] said. We have reached an agreement with the

20 potential buyer, and we think that agreement will

21 support the hospital going forward. We look forward to

22 continuing to work with the new buyer for our patients

23 and the doctors that serve them in the community.

24 HEARING OFFICER: Great.

25 DR. BRADLEY GILBERT: Thank you.

53


1 HEARING OFFICER: Thank you very much,

2 Dr. Gilbert.

3 Adam, and then after Adam, Lisa, if you could

4 come up too. If we just have a couple people like that,

5 it seems to go faster.

6 Again, I want to tell everyone, you know, try

7 to keep your comments three to five minutes. I

8 appreciate it. Adam may go a little longer, but I'm

9 going to try to keep everyone at three to five because

10 we to have a whole lot of people not only on the list,

11 but as well on the sign-up sheets. Thank you.

12 Adam.

13 COMMENTS BY ADAM WEISBERG

14 ADAM WEISBERG: I'm Adam Weisberg. That's

15 W-E-I, S as in Sam, B as in boy, E-R-G. And I am a data

16 analyst and researcher with Service Employees

17 International Union -- United Healthcare Workers West.

18 I want to address briefly -- and I've got quasi-prepared

19 remarks, so I'll have to try to e-mail you some of the

20 text if you miss anything.

21 I want to address briefly some of the issues

22 that were raised by the Seller and prospective buyer.

23 The first is around the CLIA license issue. So while I

24 accept that as a serious question, the agreement that

25 the Hospital hammered out with CMS extending the

54


1 deadline to September 1st also requires CMS -- requires

2 CMS to extend the deadline further for cause.

3 Obviously, if the Attorney General were to deny this

4 sale, that would be cause. It wouldn't be any fault of

5 Victor Valley Community Hospital, because, you know,

6 clearly, they've been doing what they're supposed to do

7 in trying to find a buyer for this hospital.

8 The second issue I want to address is

9 around -- that came up in the earlier remarks is around

10 the board of Prime Healthcare Services Foundation and

11 the decision making of that nonprofit organization to

12 invest in Victor Valley Community Hospital. That board,

13 until very recently, did not have three independent

14 members or Dr. Reddy's daughter on -- on it. It now

15 does. But the decision to purchase Victor Valley

16 clearly came far, far before then. And so the

17 decision -- it cannot be reasonably stated that decision

18 was made without -- you know, entirely by independent

19 individuals.

20 Certainly, Prime does stand to gain through

21 the purchase of Victor Valley Community Hospital. They

22 will dominate the market. They will have tremendous

23 ability to negotiate contracts should they decide to do

24 that.

25 So on to the prepared remarks. In deciding

55


1 whether to let Prime buy Victor Valley, the Attorney

2 General must consider whether the sale is in the public

3 interest.

4 HEARING OFFICER: Adam, go slowly if you're

5 going to read. Thank you.

6 ADAM WEISBERG: We believe it's not, and I

7 want to brief you on the reasons why not.

8 Prime's business practices are controversial

9 and they're damaging. Prime's chairman has referred to

10 the emergency room as a gold mine according to sworn

11 testimony.

12 The company refuses to bargain contracts with

13 insurers. Why is that? Because California law protects

14 patients facing an emergency by requiring their insurers

15 to pay out-of-network emergency rooms usual and

16 customary charges. What Prime has done is they've

17 turned this law into a cynical business model to extract

18 as much profit as possible from an emergency when an

19 insured patient enters the emergency room.

20 Once in the hospital, patients are billed for

21 extraordinarily serious conditions at extraordinary

22 rates. Septicemia is an example. Septicemia is a

23 life-threatening blood infection. Around 20 percent of

24 seniors who get it do not survive. It also pays very

25 well under the Medicare system. Whatever the reason,

56


1 five of the six hospitals with the highest rates of

2 septicemia in the United States of America were operated

3 by Prime Healthcare in 2008. In 2009, Prime again

4 operated 7 out of the top 12. This was out of around

5 3,000 hospitals, and at the time Prime only operated 13

6 U.S. Hospitals.

7 California's Department of Public Health

8 recently looked at a sample of septicemia charts at

9 Prime hospitals, and some -- some of the septicemia

10 patients did not even have a fever or get antibiotics.

11 Others had urinary tract infections.

12 Another example is severe malnutrition. We

13 just got 2010 numbers on this, and what you're looking

14 at here are the 12 highest hospitals with the highest --

15 are the 12 hospitals with the highest rates of severe

16 malnutrition in the state of California. The ones in

17 yellow are operated by Prime. That's 10 out of the

18 highest 12. These are numbers that come from OSHBID

19 [phonetic]. Again, Medicare generally pays more for

20 people whose care is complicated by severe malnutrition.

21 It can mean thousands of dollars per hospital stay.

22 If you look at these numbers, we're talking

23 about a 31 percent rate of severe malnutrition at Shasta

24 Regional Medical Center; 17 percent, Huntington Beach

25 Hospital; 16 percent at West Anaheim Medical Center;

57


1 12.6 percent of seniors at Paradise Valley; 11 percent

2 of seniors at Centinella; 11 percent of seniors at

3 Desert Valley. Those are the top six in the state of

4 California, and they're all operated by Prime

5 Healthcare. They're just the numbers.

6 Even though Prime tells Medicare its patients

7 are extremely sick, managed care plans like Kaiser and

8 Heritage, as well as former employees and physicians

9 have alleged that Prime actually admits patients who do

10 not even need to be admitted. In other words, Prime is

11 allegedly admitting patients who could be treated in the

12 emergency room and then sent home. The numbers seem to

13 back that up.

14 We've got another chart here, and what this

15 chart shows is all 94 health systems in the United

16 States of America that had at least 10,000 general

17 medical claims that they billed Medicare for in 2009.

18 So each of those X's is a health system, plus the

19 circle. The circle is the same as the others except

20 it's Prime. On the Y axis, going up and down, what you

21 have are the number of stays, the number of hospital

22 stays that are very, very short, two days or less.

23 The green line is the national median. You

24 can see that Prime is very far above the national

25 median. They have, you know, a very large number of

58


1 short stays. There's probably five or so health systems

2 in the U.S. out of 94 that had more short stays.

3 But then, on going from left to right there on

4 the X axis, what you're looking at is the severity level

5 that Prime is billing Medicare for for its general

6 medical care. So in order to compare apples, oranges --

7 apples to -- compare hospitals apples to apples, what

8 we're looking at are not the surgeries, but the medical

9 care, and we're taking out burn centers, um, HIV, um,

10 cancer and other highly specialized areas that each

11 hospital doesn't have. That's all your just general

12 medical care. It's a metric that we've used for many

13 years and did not create for this purpose.

14 The -- if you look, Prime has -- while it has

15 a very large number of short stays, it's severity level

16 is where -- it would be off the chart if you drew the

17 chart, you know, without Prime, far, far higher than all

18 of those other systems in the United States. That's the

19 Mayo Clinic, the Cleveland clinic. Prime has a far more

20 severe patients than them according to their Medicare

21 bills. So all this adds up to a lot of money that Prime

22 is obtaining and draining out of the healthcare system.

23 California Watch estimates that the extra

24 admissions from the emergency room may have cost

25 taxpayers over $200 million. Then, there's what it --

59


1 then, there's the cost to insure patients. And I

2 don't -- to my knowledge, no one has been able to

3 calculate that number. In addition, there's the extra

4 money that they're able to get by billing Medicare on

5 the inpatient side for such severe illnesses. And you

6 can get a sense of that amount from this chart.

7 So what you're looking at here are, again, the

8 same health systems, all 94 in the country that had at

9 least 10,000 qualifying inpatient stays, so general

10 medical care. And Prime is four standard deviations

11 above the mean in what it gets paid per the case -- four

12 standard deviations above the mean. Nobody else is

13 higher than about two; again, Mayo Clinic, Cleveland

14 Clinic, all these folks. That's for every case. And

15 when you add this up, we're talking about 50 million or

16 so dollars over two years. And, you know, the more

17 concerning thing about this is in addition to the

18 potential for excess admissions, which you would expect

19 to reduce in -- result in lower community stays, we're

20 seeing higher community stays. Now, we see the lower

21 community stays when we look at the length of the stay.

22 And one of the things that would happen if, in fact,

23 Prime were saying that their patients are significantly

24 sicker than they really are is that their outcomes, the

25 patients' outcomes would be much better than Prime says

60


1 they are, you know, than they would be.

2 So, for example, if you have septicemia,

3 you're a senior, there's about a 20 percent chance

4 you're going to die. At Prime, there's a 13 percent

5 chance. Right? So it makes your quality look

6 fantastic. If you're not really that sick, you're much

7 less likely to die. And that is the -- that is, you

8 know, a possible reason for the high scores under

9 Thompson Lawyers rating, so they have to rely, when they

10 do their risk adjustment, on what people are billing

11 Medicare.

12 I just want to mention one more thing. A new

13 issue was reported on the Riverside Press Enterprise

14 just yesterday, and that was fundamentally about the

15 governance of Prime Healthcare Services Foundation,

16 which is the nonprofit arm that's trying to buy Victor

17 Valley. We're concerned that this might be the tip of

18 the iceberg and that issues at Prime's nonprofit may

19 extend well beyond this story.

20 For example, why does Prime want to put its

21 nonprofit direct -- why does Prime want to put its

22 nonprofits in direct competition with its for-profits?

23 Victor Valley is the nearest competitor to Prime's

24 for-profit Desert Valley Hospital, and this fits a

25 pattern. Prime has two other nonprofits, and each is

61


1 located within five miles of a Prime-owned for-profit

2 hospital. So they've got two nonprofits right now.

3 This would be the third. And in each case, they're

4 setting themselves up as the nearest competitor to a

5 Prime for-profit hospital. We think this is a strong

6 indication that Prime's nonprofit organization is being

7 used to benefit the for-profit operations in a

8 competitive environment for the for-profit, and that

9 would be a serious violation of public trust.

10 In closing, this sale is not in the public

11 interest. If a health system is abusing laws meant to

12 protect patients in an emergency to maximize its

13 profits, it is not in the public interest to allow that

14 model to grow.

15 If a health system is falsely documenting or

16 coding care at the expense of taxpayers and seniors, it

17 is not in the public interest to reward that kind of

18 behavior.

19 If a health system is admitting patients who

20 do not need to be admitted, even making some of them

21 feel ted, which is what the report says -- it's not our

22 report -- it is not in the public interest to expand

23 that model.

24 And now, Prime's tax-exempt foundation may be

25 involved in, you know, this scheme that's in the paper

62


1 yesterday.

2 We're citizens and we're caregivers. We're

3 union members. We're taxpayers, Republicans and

4 Democrats, and every one of us is a human being and

5 human beings get sick.

6 You know, my brother's actually in the

7 hospital. He's fine, but you remember that moment when

8 who's going to take care of the kids. You got to trust

9 your family and you got to trust certain institutions,

10 and you've got to be able to trust the hospital that

11 your family member gets rushed to. And you can't trust

12 Prime. We can't. And, you know, fundamentally that's

13 the problem.

14 Please defend the public interests and block

15 the sale. Thank you.

16 HEARING OFFICER: Thank you.

17 Lisa. And then, after Lisa is going to be

18 Helen Bowman.

19 COMMENTS BY LISA DEMIDOVICH

20 LISA DEMIDOVICH: Good afternoon. My name is

21 Lisa Demidovich, D-E-M-I-D-O-V-I-C-H. And I'm from

22 United Nurses Association of California, Union of

23 Healthcare Professionals. We're affiliated with NUHHCE,

24 AFSCME, and AFL-CIO. Thank you for the opportunity to

25 speak here today.

63


1 UNAC/UHCP is a labor organization that

2 represents more than 20,000 healthcare professionals

3 throughout Southern California, including the registered

4 nurses at the Prime-Healthcare-Services-owned facilities

5 Garden Grove Hospital and Chino Valley Medical center.

6 I have come to Victorville today to voice

7 UNAC/UHCP's opposition to the proposed sale. Based on

8 our experience of Prime Healthcare Services in Garden

9 Grove and Chino, we strongly urge the Attorney General

10 to not approve the proposed sale of Victor Valley

11 Community Hospital because it is not in the public

12 interest for the healthcare professionals, patients, and

13 citizens of Victorville and the surrounding area.

14 UNAC/UHCP has represented the RNs of Garden

15 Grove since 1981 and has had collective bargaining

16 agreements, CBAs, with them since that time. The last

17 CBA expired on September 30th, 2010. And although

18 negotiations began well in advance of the expiration

19 date, a new contract was not reached until July of this

20 year because Prime's negotiators proposed massive cuts

21 for RNs in benefits and other packages, particularly for

22 the most experienced RNs who had served the hospital for

23 20 years or more. Such aggressive proposed cuts are not

24 given by income downturns, but, rather, to further

25 increase profits to grow the Prime empire at the expense

64


1 of the Garden Grove community. Helen Bowman, an RN at

2 Garden Grove, will explain more about her experience

3 next.

4 The Chino Valley RNs, in a secret-ballot

5 National-Labor-Relation-Board-conducted election in

6 April 2010, voted overwhelmingly for representation by

7 UNAC/UHCP, but Prime has ignored that decision and,

8 instead, has entered into a four-front legal battle in

9 an effort to avoid its legal obligation to bargain with

10 the registered nurses.

11 First, Prime filed meritless objections to the

12 election, which the National Labor Relations Board

13 rejected in January 2011 when it certified UNAC/UHCP as

14 a representative. The NRLB's certification --

15 HEARING OFFICER: Lisa, can I just get you to

16 talk a little bit slower?

17 LISA DEMIDOVICH: Sure.

18 HEARING OFFICER: Thanks.

19 LISA DEMIDOVICH: The NLRB's certification is

20 attached to these comments as Exhibit 1, and the NRLB's

21 published decision finding that Chino Valley has

22 unlawfully refused to bargain with UNAC/UHCP is attached

23 as Exhibit 2.

24 Prime is now challenging the NRLB's unanimous

25 decision in the U.S. Court of Appeals for the D.C.

65


1 Circuit.

2 Second, shortly after the election, Prime

3 engaged in egregious unfair labor practices, including

4 termination of a lead organizer who's an RN at the

5 hospital for many years, widespread discipline, threats,

6 surveillance, and taking away benefits as it had

7 threatened to do during it's aggressive anti-union

8 campaign.

9 After a neutral investigation, the NRLB

10 decided to prosecute these violations, and a six-day

11 hearing occurred in June of 2011 where the NRLB

12 presented evidence of the violations. We expect a

13 favorable decision finding the unfair labor practices

14 were committed to be issued soon.

15 Third, the National Labor Relations Board in

16 Washington, D.C., believed that these unfair labor

17 practices were so egregious that it sought the

18 extraordinary remedy of injunctive relief while the

19 underlying hearing and appeal occurred. Just to put

20 this in context, in 2010, of the more than 23,500

21 unfair-labor-practice charges that were filed in

22 America, the NRLB sought this remedy in only 23 of those

23 case. The issue of injunctive relief here requires

24 immediate reinstatement of the terminated union

25 supporter and remediation of the other

66


1 unfair-labor-practice violations and is currently before

2 the United States Court of Appeal for the Ninth Circuit.

3 The fourth front of this legal attack on

4 representation was in response to UNAC/UHCP's peaceful,

5 informational visits to the hospital lobby, where candle

6 and jewelry sales occurred. Prime called the police to

7 remove our representatives, but the police sergeant

8 refused, stating that union representatives have a right

9 to be present. Prime then filed a trespass lawsuit in

10 San Bernardino Superior Court. That lawsuit is

11 currently stayed by the court.

12 These legal actions are expensive and divert

13 resources that could be spent on patient care to lawyers

14 located throughout the country. In the end, we're

15 confident that the law will prevail and Prime will be

16 forced to comply with its legal duties to negotiate with

17 the employees' chosen representative, but at what cost

18 to the community.

19 If the Attorney General approves the sale of

20 Victor Valley Community Hospital to Prime Healthcare

21 Services Foundation, Prime will similarly fight the

22 wishes of its Victor Valley staff if they vote to

23 organize, taking hundreds of thousands of dollars,

24 possibly millions of dollars, away from Victorville to

25 pay for out-of-town lawyers to fight their right to

67


1 organize. Without representation, Prime would also make

2 working conditions intolerable for the experienced staff

3 at Victor Valley so that Prime can bring in cheaper

4 replacements, thereby depriving the Victorville

5 community of the quality patient care on which it

6 depends and current employees of their income that is

7 spent at local businesses.

8 Notably, Prime Healthcare Services Foundation

9 has not committed to keeping all employees, but, rather,

10 substantially all, an unspecified amount, and that is

11 only at the time of purchase. It's not an ongoing

12 commitment for even a month later, two months later, or

13 a year down the road.

14 Selling Victor Valley Community Hospital to

15 Prime is decidedly not in the public interest, and we

16 strongly urge the Attorney General to not approve the

17 prosed sale. Thank you.


19 Helen. And then after Helen is going to be

20 the mayor and then Bill Thomas after that.

21 COMMENTS BY HELEN BOUMAN

22 HELEN BOUMAN: Good afternoon. My name is

23 Helen Bouman, B-O-U-M-A-N. I'm a registered nurse at

24 Garden Grove Hospital. I've been there 12 years.

25 Prime bought the hospital in July of 2008.

68


1 Excuse me. And the day that he took over ownership of

2 the hospital, several physicians left, not wanting to be

3 associated with that facility for that -- for the reason

4 that Prime owned it.

5 Also, we have nurses that had come from other

6 hospitals that Prime had bought, particularly Huntington

7 Beach and west Anaheim. When he took over, they left.

8 They didn't want to work for him.

9 In our recent round of negotiations, it was

10 earlier stated by Lisa that there was proposed cut that

11 would significantly impact nurses that had been there

12 for a long time, more than 20 years.

13 We've got multiple new hires which causes

14 concern with the skill mix on our units, and he's hiring

15 new grads at a significantly lower rate than what is in

16 the community. They stay there for about a year and

17 then they leave as soon as they get their experience.

18 They don't want to stay. That's all I have.

19 HEARING OFFICER: All right. Thank you very

20 much for coming. I appreciate it.

21 And then, after the mayor is Bill Thomas and

22 Carl Tate?

23 COMMENTS BY MAYOR RYAN McEACHRON

24 MAYOR RYAN McEACHRON: Well, good afternoon.

25 My name is Ryan McEachron. That's M-C-E-A-C-H-R-O-N.

69


1 I'm the mayor of this great City of Victorville, and

2 welcome to you and your colleagues here.

3 You know, after hearing those recent comments,

4 it's almost as if you should not approve this and Cathy

5 Pelley should shut down the hospital. But to me, as the

6 mayor of this city, that is completely unacceptable.

7 That hospital needs to stay open, and the only way it

8 will stay open is if the Attorney General approves this

9 sale.

10 We've been through this for the last eight

11 months, it seems like. And the previous bidder was

12 given the opportunity to close; they did not. And we do

13 know that Prime Healthcare will close, and they'll do it

14 quickly.

15 So my -- my two issues are this. The jobs

16 that would be lost should you not approve this sale,

17 it's in excess of 500 and could possibly be more,

18 because I know with Prime Healthcare's commitment,

19 Dr. Reddy's commitment to this community, everyone in

20 this room knows that Dr. Reddy's committed to this

21 community. He's been here for over 30 years, and

22 he's -- and he's done a lot for this community and many

23 will speak to that here today. But we cannot lose over

24 500 higher and better-paying jobs in Victorville, so

25 that's number one.

70


1 Number two, we cannot be without this

2 facility, not just for Victorville. It is our community

3 hospital. It's been our community hospital for over

4 half a century. But if we were to lose that hospital,

5 the entire Victor Valley would suffer at the loss of

6 beds here in the High Desert. And although Desert

7 Valley Hospital is currently expanding and should see

8 their expansion come to a completion here in the very

9 near future, St. Mary Medical Center and the St. Joseph

10 Health System is looking to build a Victorville campus

11 and add another hundred-plus beds to the Victor Valley,

12 it's still not enough for what we need here in the High

13 Desert.

14 So I agree with Mr. Dalton and his report and

15 what -- what they're -- what he's asking the Attorney

16 General to consider as certain requirements set forth

17 for the purchase of the hospital. But without the

18 Attorney General's approval of this purchase, the

19 hospital will shut down. I've known Cathy Pelley for

20 several years. She is a woman of her word. She will

21 shut it down.

22 So that is unacceptable to me as the mayor of

23 this city. I need that facility open. I need the jobs.

24 I need the healthcare provided to the citizens of the

25 Victor Valley, the city of Victorville. And, uh, I just

71


1 urge the Attorney General to approve the sale. Thank

2 you.

3 HEARING OFFICER: Great. Thank you very much.

4 Bill and then Carl Tate after that.

5 Bill, if you can just come up too, so we don't

6 have any lull, I would appreciate it.

7 COMMENTS BY WILLIAM THOMAS

8 WILLIAM THOMAS: Thank you, Wendi. William

9 Thomas, T-H-O-M-A-S. I'm the executive vice president

10 and general counsel of two organizations: Victor Valley

11 Hospital acquisition, Inc., and Victor Valley Hospital

12 Real Estate, LLC. As I'm describing these, I'm going to

13 talk to them -- about them collectively as VVHA and see

14 if we can keep the acronym straight, because we also

15 have VVCH for Victor Valley Community Hospital.

16 I've been listening to the proceedings here,

17 and listened to the honorable mayor and I -- but I

18 was -- and I've listened to Cathy Pelley. And I thought

19 what I was hearing loud and clear was if we don't sell

20 to Prime, the hospital will close.

21 Phil, I think that was what you said, that it

22 was better to sell to Prime than to close the hospital.

23 That's the MDS conclusion in its report.

24 And then, the second thing I think that

25 Ms. Pelley said was, in a nice way, that Dr. Chaudhuri,

72


1 VVHA, you've had your opportunity to close and you

2 didn't, so we need to move on. So I'd like to address

3 both of those subjects in my -- in my remarks.

4 First, let's talk about the hospital closing.

5 I heard Dr. Eric Hansen, Dr. Arora, Dr. Grover. They

6 were raising what I thought was a very intelligent

7 remark, is -- is that the alternative, that if we don't

8 sell to Prime the hospital closes?

9 Uh, I would like the record to be very clear

10 that there is an alternative, probably more than one

11 alternative, but certainly the alternative of selling to

12 VVHA. I've filed papers with the Attorney General.

13 I've provided documents to counsel to -- to Victor

14 Valley Community Hospital. The VVHA has made a

15 virtually non-contingent offer. It is fully financed,

16 so there's no execution risk. It is sufficient in all

17 respects to get Victor Valley Community Hospital out of

18 bankruptcy. So it is a viable alternative to, uh, the

19 Prime transaction. I'll get into the details about that

20 offer in -- in a minute, but I just want to be very

21 clear that we have put on the table for the Hospital's

22 consideration a alternative that is fully financed,

23 non-contingent, a done deal, essentially. So there is

24 no reason to believe that we -- that if Prime is not

25 approved that this transaction cannot go down very

73


1 quickly. As you know, VVHA had previously been approved

2 by the Attorney General, with conditions, and we're

3 prepared to accept those conditions for closing.

4 So let's back up for just a moment. As

5 everybody knows, VVHA was in contract to -- to buy these

6 assets. We did have a bankruptcy court approval. We

7 did have Attorney General approval with conditions. So

8 what happened? That was back in November, and the deal

9 didn't close by June 1st, which was the deadline set by

10 the Attorney General, and transaction never happened.

11 Well, was that because VVHA got cold feet, decided to

12 delay, didn't have the money? What -- what was behind

13 all that?

14 We have a dispute with the Victor Valley

15 Hospital on the reasons why we didn't close. However, I

16 would -- and I'm not going to sit here and debate in

17 this forum who's right or who's wrong about our dispute.

18 But what is undisputed -- what is undisputed with

19 respect to this -- this transaction is that after --

20 shortly after we went into contract, Medicare violations

21 came to light, which Victor Valley Community Hospital

22 took six months to -- to resolve. They literally could

23 not have met the closing conditions until the end of May

24 at the earliest. There was no way that Victor Valley

25 was in any position to close this transaction before

74


1 the -- the end of May. There are other issues on the

2 table that we have between -- between ourselves. But it

3 should be very clear that the allegation that somehow

4 our -- our situation was a delay in the transaction is

5 simply not sported by the evidence. We have spent a ton

6 of money, well over a million dollars in trying to close

7 this transaction; enormous effort trying to deal with

8 issues that arose post -- post closing that were

9 challenging to -- to both ourselves and -- and to the

10 Seller. We did everything possible to get this done.

11 We're still fighting to get this deal closed.

12 So the allegation that somehow these people

13 came in and just, you know, fell apart, didn't close,

14 that is obviously false and we're here to put our new

15 offer on the table. It's -- they --

16 The Hospital's had it since August 2nd. I

17 just heard a couple days ago from their counsel that

18 they will consider it at the end of the month. I would

19 like to see them consider it sooner. There's no reason

20 in the world why it -- it shouldn't be in the best

21 interest of the Seller to lock in a -- a no-contingent

22 backup offer, fully financed, so that if Prime will not

23 or cannot close, they -- the Hospital can move on with a

24 successful transaction.

25 Let me move on to the offer itself. It's

75


1 $30 million. We're not asking for the $3 million credit

2 that -- that Prime is asking for. We've modeled it on

3 the same contract that has been previously approved by

4 the Attorney General in the bankruptcy court. We're

5 waiving all of the issues that were obstacles to closing

6 in -- in the past. We've accepted all the conditions

7 that were previously imposed upon us by the Attorney

8 General. And most importantly, we've offered to escrow

9 the cash necessary to close the transaction so there can

10 be no doubt about the execution risk. It's a done deal.

11 So we would like the Hospital to -- to

12 consider that -- that transaction. We think it's in

13 their fiduciary duty to do so. But clearly, in this

14 proceeding, we would like the Attorney General to be --

15 to have this on the record, because it's not in the --

16 to some degree, this offer developed after the impact

17 report, so I want -- I want to be fair to Phil and MDS.

18 But to frame the issue as you don't sell to Prime, the

19 hospital closes is -- is -- is just not fair. It's an

20 unfair characterization of the situation.

21 Also, I would like to point out that if we

22 were to buy, we -- I'll just point out a few

23 large-picture things about the -- about us versus Prime.

24 When we were in contract, we had agreed to maintain and

25 improve the hospital. We had agreed to open access. We

76


1 had agreed to assume and maintain the managed care

2 contracts. We worked out a mutually acceptable

3 arrangement with IEHP. And most importantly, we had the

4 overwhelming support of the medical staff. Eighty-seven

5 physicians wrote letters of support of our -- of our

6 deal.

7 So how do you make a hospital successful if

8 you don't have your doctors behind them? We were the

9 ones that had the very strong support of the majority of

10 the medical staff in the -- and the medical groups.

11 Prime, in comparison, is under state and federal

12 investigation, has a record of canceling the managed

13 care contracts. It already owns a hospital, as you've

14 heard, in the area. So it's obvious, it's common sense

15 that it will tend to lessen competition. Whether it

16 moves to a monopoly or not, I don't know, but it will

17 certainly lessen competition, which is one of the

18 elements that the AG is supposed to take into

19 consideration. But again, most importantly, it is

20 opposed by most of the medical staff and most of the

21 medical groups.

22 You heard here today by several doctors that

23 have come forth to echo their opposition. I know you

24 have in the Attorney General's files over 40 letters

25 from respected members, senior leadership of the -- of

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1 Victor Valley Community Hospital medical staff opposing

2 the sale. So the doctors do not want the Prime deal.

3 And let me finally make a mention about CLIA.

4 I love Cathy Pelley, but I respectfully disagree with

5 her about whether it's a red herring or not. When we

6 were in contract, this CLIA issue was clearly something

7 that the government was going to work with us. We had

8 many discussions with the government where the last

9 thing they wanted to do was close down the hospital.

10 They were always cooperative to try to work with a bona

11 fide buyer to make sure that this transitioned properly.

12 That's what the government attorneys told the bankruptcy

13 judge on July 12th. And I certainly invite the Attorney

14 General to pick up the phone, call Seth Shapiro

15 [phonetic] at the Department of Justice, just verify for

16 yourself whether or not they are willing to -- to be

17 cooperative. I think that's -- you're going to find

18 that the government -- the last thing they want to do is

19 shut down a hospital. They want to smooth transition.

20 That was certainly the way they dealt with us.

21 And again, when we were in contract, the --

22 the backup plan was always to outsource. So, you know,

23 I'm surprised to hear that outsourcing is not an option.

24 Well, again, we don't have to speculate.

25 Let's -- let's call, uh, Lab Corp. [phonetic]. Let's

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1 call Quest to see if they can outsource the lab under

2 these circumstance.

3 So I think there's investigation that can be

4 done on both those points that make it not a matter of

5 debate, but the Attorney General can determine for

6 themselves with firsthand evidence from the Department

7 of Justice and from the independent lab corporations

8 whether or not there is a solution to the -- to the CLIA

9 situation. I respectfully believe that that is a

10 absolute red herring. It's just added pressure to say

11 that you don't have to consider Prime on the merits.

12 Don't do that for heaven sakes. What you really need to

13 do is be panicked by the circumstance that we're going

14 to close if we don't take the Prime offer. It's

15 ridiculous. Take our offer, look at other alternatives.

16 There's $10 million in the bank for this hospital.

17 There is no absolute deadline here that we need to work

18 against.

19 So we would respectfully request that the --

20 after review of all these matters, that the Attorney

21 General deny the Prime application. Thank you.


23 Carl Tate. And after Carl is going to be

24 Michelle Spears and then Mayor Blewett.

25 COMMENTS BY CARL TATE

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1 CARL TATE: Thank you, Ms. Horwitz. My name

2 is Carl Tate, T-A-T-E. I'm the executive director of

3 Valley Crest Residential Care in Apple Valley.

4 And before I continue with my prepared

5 remarks, I wasn't going to say anything personal, but I

6 was shocked beyond belief after hearing the gentleman

7 representing the union speak on many things medical. I

8 spent my entire life since 1960 in the healthcare field.

9 I have run skilled nursing homes, acute psychiatric

10 hospitals, acute general hospitals on both local and

11 regional basis, and semi-retired when I decided to get

12 back into the healthcare field and take care of seniors

13 with Alzheimer's disease. But one thing that really

14 shocked me was when he was harping on malnutrition in an

15 acute hospital.

16 I, unfortunately, but fortunately for me,

17 spent three days at Desert Valley Hospital about three

18 years ago with a kidney stone, and I can tell you the

19 food was good and you cannot become malnourished in two

20 or three days, which is the average length of stay. You

21 have to be mal-nurtured -- malnourished at the time of

22 admission, because you can't gain wait, you can't lose

23 weight in two or three days.

24 Now, on with my prepared remarks. I want to

25 thank you for giving me a few minutes to speak in favor

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1 of Victor Valley Community Hospital being purchased by

2 Prime Healthcare Services Foundation. Valley Crest, the

3 facility I run, is a 64-bed residential care facility

4 licensed by the State of California, Department of

5 Social Services to care for 64 seniors who have suffered

6 from Alzheimer's disease or related dementia.

7 Valley Crest has a longstanding relationship

8 with Victor Valley Community Hospital. And since their

9 filing for bankruptcy last year, I've been very

10 concerned that due to their continuing financial

11 problems that they might have to close.

12 Mr. Horwitz, we cannot afford to lose the 101

13 licensed beds that Victor Valley Community Hospital

14 currently has. Our High Desert communities currently

15 have less than 50 percent of the recommended beds per

16 thousand residents that the federal health system's

17 agency uses for planning purposes, which is

18 approximately two beds per thousand residents. With

19 close to 400,000 residents in the High Desert, we should

20 have around 800 beds, but yet we have less than 400

21 beds. So the loss of 25 percent of the beds would have

22 a devastating effect on our healthcare delivery system

23 and the ability of Valley Crest to obtain the type of

24 acute care our residents sometimes need.

25 After several failed attempts by -- excuse

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1 me -- by Victor Valley Community Hospital's management

2 to find the qualifying buyer, they now have an accepted

3 offer from Prime Healthcare Services Foundation. I

4 believe if this sale is approved by your office, it will

5 ensure that Victor Valley Community Hospital will be

6 able to provide Valley Crest with the level of care

7 we've long come to expect for our residents. This

8 purchase will also be of great benefit to the growing

9 population to the Victor Valley as well as the dedicated

10 employees and medical staff at Victor Valley Community

11 Hospital. Excuse me. The pages are stuck.

12 During the past few years, Dr. Prem Reddy,

13 Prime Healthcare Services, and the Prime Healthcare

14 Foundation have developed a nationally recognized

15 reputation for being able to turn failing hospitals into

16 valuable community assets that provide a high level of

17 quality care. I see no reason why they cannot be -- do

18 the same thing for Victor Valley Community Hospital,

19 making it a win-win situation for all concerned. Thank

20 you.

21 HEARING OFFICER: Thank you very much. Would

22 you mind leaving a copy. Thank you.

23 Michelle Spears. And then after Michelle,

24 we'll have Mayor Blewett.

25 COMMENTS BY MICHELLE SPEARS

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1 MICHELLE SPEARS: Hi, my name is Michelle

2 Spears, S-P-E-A-R-S. The chamber, the Victorville

3 Chamber recognizes the health education outreach that

4 Desert Valley Hospital and Dr. Prem Reddy and the

5 Foundation have provided to the community and is willing

6 to invest in an -- institutions that struggled in order

7 to enhance and expand those services.

8 I've served as the president and CEO of the

9 Victorville Chamber of Commerce for over 21 and a half

10 years and have seen firsthand Desert Valley Hospital's

11 commitment to supporting local charities, providing

12 scholarships to students interested in medical careers,

13 financial support to our local community college in the

14 health sciences department, and much more. Our

15 residents and businesses have benefited from their

16 commitment to promote the well-being of our community.

17 If Victor Valley Community Hospital closes, it

18 will adversely affect the local community because of

19 loss of jobs, which primarily are local residents. If

20 it closes, it will cause -- place undue burden on our

21 overcrowded other two hospitals and the ERs in the High

22 Desert. The number of beds in the High Desert is

23 already underserved for our population. Thank you very

24 much for your time.

25 HEARING OFFICER: Thank you very much. Okay.

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1 And after Mayor Blewett, then we're gonna have

2 Dr. Morris and Dr. (unintelligible).

3 COMMENTS BY MAYOR PRO TEM RUSS BLEWETT

4 MAYOR PRO TEM RUSS BLEWETT: Hello, Russ

5 Blewett, B-L-E-W-E-T-T. First of all, welcome to the

6 High Desert. We're grateful to have you here. I'm

7 going to get a little bit pointed a little later,

8 because anybody that knows me knows that's my style.

9 I'm going to go after a couple people in a little bit.

10 But first of all, I want to start off with

11 something nice. 1992, I had a grandson that graduated

12 from Hesperia High School, and I came up here. I didn't

13 live up here at the time; I lived down the hill. And I

14 went to the graduation at Hesperia High School, and the

15 man that paid for that graduation was Dr. Prem Reddy.

16 And I didn't know Prem Reddy. He was a little man with

17 a funny hat, and he's -- he paid $10,000 so those kids

18 could have a graduation. Because as the schools are

19 having a tough time now, they were having a very tough

20 time then.

21 This man, since that time, has put millions of

22 dollars into this desert, into helping people. The word

23 Hesperia stands for star of the desert. Dr. Prem Reddy

24 is a real star of this desert. I wish we had -- I wish

25 we could clone him and put it into a lot of other

84


1 people's lives.

2 Hospitals -- I've been in many hospitals,

3 unfortunately, some for myself. I have over 30

4 relatives that live up here in the High Desert, and I

5 had a wife that was ill for some time. So believe me,

6 I've been in hospitals a long time.

7 There's two things that impress me in life:

8 Efficiency and effectiveness. I myself was in Desert

9 Valley Hospital, and by the way, I don't think anybody

10 would say that I'm malnourished.

11 (Laughter and applause.)

12 Because I'm truly not. And actually, the food

13 was pretty good there.

14 Let me address -- let me address this issue in

15 the hospitals of the infection rate. 2002, I was in a

16 unionized hospital, I might add, where I was given MRSA,

17 and I darn near died. I spent 90 days in ICU and was

18 very fortunate to emerge alive. They thought I was not

19 going to, but I surprised everybody -- much to some

20 people's sadness.

21 But let me tell you something. When I was --

22 when I checked into Desert Valley Hospital for the

23 seven -- for my seven days that I stayed there -- I had

24 to -- believe it or not, I had a foot problem. Anyway,

25 they checked me for MRSA. They checked me. But when I

85


1 went into that hospital and they found out that I had

2 had it and they put me -- and they quarantined me. I

3 was literally quarantined for seven days, which was kind

4 of good, actually.

5 But the one thing it learned, because when I'm

6 in a place for any length of time, the one thing I do, I

7 get bored, and the one thing that I do is I start

8 looking at how well it's run. Desert Valley Hospital is

9 a very, very well-run hospital. I was very impressed

10 with how they run. And I'm a very -- some of these

11 people in the audience know that I'm not exactly easy to

12 please.

13 But I want to talk about something that's very

14 important to this High Desert, and it's really

15 important. There's basically a 60-bed deficiency that's

16 not being used at Victor Valley Hospital. Desert Valley

17 Hospital is building, and I believe it's an additional

18 60 beds.

19 Well, let me tell you what's happened up here

20 and the reason why I want Dr. Reddy to keep this

21 hospital and get it going because I know he'll make it

22 operate and operate well. We have a major problem. The

23 city of Hesperia alone operates four paramedic

24 ambulances in our City at all times. Well, when they go

25 to a hospital with a patient, they -- our paramedics

86


1 have to stay with that patient until they get a bed. It

2 costs us hundreds of thousands of dollars in downtime

3 because they have to stay at the hospital because there

4 isn't adequate beds in the High Desert. This is an

5 imperative -- and not only that, it puts my citizens in

6 my community at risk.

7 So I think it's in the best interest for

8 less -- let's make this thing happen. Let's get

9 Dr. Reddy in that hospital.

10 And by the way, the way you solve an escrow --

11 this gentleman that just talked about it -- is you close

12 it on time. I've done hundreds of millions of dollars

13 in escrows. And when they don't close on time, there's

14 usually a reason, and the reason usually is the buyer.

15 The other thing is with Dr. Reddy, he will

16 bring unemployment in this desert down. We have an

17 18 percent unemployment rate up here. That is

18 devastating to peoples and their lives. And if we have

19 Dr. Reddy, he will hire local people, as he's done, and

20 that will help this community, not just Hesperia, but

21 the entire Victor Valley. It is a real imperative to

22 us. And thank you for your time.

23 HEARING OFFICER: Thank you very much. Okay.

24 Dr. Morris and Dr. Luther.

25 Okay. Do we have Ardis Kulyas? Oh, sorry. I

87


1 mispronounced that.

2 Oh, sorry. Go ahead.

3 COMMENTS BY DR. JOSEPH MORRIS

4 DR. JOSEPH MORRIS: Hi, I'm Dr. Morris,

5 Joseph, M-O-R-R-I-S. And I represent Victor Valley

6 College Nursing Program, and Allied Health chair -- I'm

7 sorry -- director.

8 Over the past 30 years, Victor Valley Nursing

9 Program has maintained an excellent reputation in the

10 community and continues to produce skilled and qualified

11 registered nursing and healthcare providers throughout

12 the high desert and Inland Empire. As of today, the

13 Victor Valley College Nursing Program has graduated and

14 produced more than 2500 registered nurses.

15 Desert Valley Hospital was first approved by

16 the Board of Registered Nursing on August 4th, 1995.

17 For the past 16 years, Victor Valley College has

18 fostered a close relationship with assigning student

19 nurses to Desert Valley Hospital for their clinical

20 experience.

21 In 2003, Dr. Prem Reddy's School of Health

22 Science was established due to the gracious

23 contributions of $1 million to the nursing and allied

24 health programs. The funds that were donated by

25 Dr. Reddy were used to provide equipment, staff,

88


1 development, and remodeling of the nursing program and

2 paramedic, respiratory therapy, and other allied health

3 programs.

4 In fact, in May of this year, the school of

5 nursing was recently surveyed by the Board of Registered

6 Nursing for reaccreditation, and one of the Board of

7 Registered Nurses' recommendations were that we replace

8 old equipment with new equipment. And with the support

9 of Dr. Reddy, the school is scheduled to receive new

10 medical equipment, including high fidelity simulation

11 mannequins, which were featured in the recent desert

12 valley -- I'm sorry -- Daily Press.

13 So throughout the years, the partnership with

14 Desert Valley Hospital and Prime are thankful for their

15 support and has been significant support in the students

16 at Victor Valley College and the college program of

17 nursing. Their support has allowed for increased

18 student enrollment and scholarships, including 68

19 students in the partnership weekend program in the

20 nursing program. Students enrolled in the college,

21 particularly the nursing program, also benefit from the

22 student workers program. Through the student workers

23 program, which is a co-op ed program, the student nurses

24 are paid a stipend which also allowed them have

25 increased clinical experience.

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1 In addition to the financial support, Victor

2 Valley College has maintained an excellent working

3 relationship with the staff at Desert Valley Hospital.

4 The nursing staff at the hospital also work as

5 instructors at the college, which provides a very

6 effective and positive advisory counsel relationship.

7 So with that being said, Victor Valley Nursing

8 Program and the Allied Health Program supports the

9 purchase of the Victor Valley Hospital which will allow

10 the college to continue to train nurses and future

11 allied health professionals. Thank you.

12 HEARING OFFICER: Great. Thank you.

13 We've got Dr. Patricia Luther.

14 COMMENTS BY DR. PATRICIA LUTHER

15 DR. PATRICIA LUTHER: Yes, your Honor,

16 Patricia Luther, L-U-T-H-E-R.

17 Thank you for the opportunities to speak today

18 on behalf of Victor Valley Community College. And I've

19 been the -- I've been employed at the college for 21

20 years, 12 years as the director of the nursing and now

21 I'm the dean of Health Sciences/Public Safety.

22 I cannot say enough about the support that we

23 have been given by Dr. Prem Reddy over the last 16 years

24 since he has become a member of our advisory and is a

25 member of our clinical placement places. We really

90


1 appreciate everything he has come forward with. And as,

2 you know, your Honor, at this time, when the budgets for

3 the community colleges are being cut severely by the

4 state, I don't know what we would do without the kind of

5 support he has given us, mostly the sole support from

6 our community, to continue to increase the quality of

7 the registered nurses.

8 I want to just reiterate -- I don't want to

9 reiterate everything that Dr. Morris has said, but I

10 really, strongly support everything that he has put

11 forward on what we have seen from the support that he

12 has given us.

13 And just as an example of that, also, that I

14 truly believe that he'll continue to support this

15 community because he supported hundreds of our students

16 with hundreds of thousands of dollars. And he's -- when

17 the foster care program at Victor Valley was really

18 going to be discontinued, he stepped forward and

19 provided a place for these parents to learn how to

20 become foster parents. And that's just another example

21 outside of the health community where he has really led

22 the way for us.

23 I -- I just want to let you know that he has

24 lived up to his commitment after he committed a

25 hundred -- $1 million to the college, and we still bear

91


1 the name of Dr. Prem Reddy's School of Health Sciences,

2 and we look forward to continuing support --

3 gazuntite -- in the future. Okay. Thank you, your

4 Honor.


6 Okay. And why don't we have Mark come after

7 you. That would be fine.

8 COMMENTS BY ARDIS KULYAS

9 ARDIS KULYAS: Sure. Hi, my name is Ardis

10 Kulyas, K-U-L-Y-A-S.

11 DEPOSITION OFFICER: Spell your first name.

12 ARDIS KULYAS: Oh, A-R-D-I-S.

13 I'm totally new to this. First time I've ever

14 done it. I just want to let everyone know I am totally

15 opposed to Prime Healthcare's purchasing another

16 hospital. Their hospitals are you run for the almighty

17 dollar and not for the patient. My daughter was held

18 there and charged a quarter of a million dollars for 12

19 days, a quarter of a million.

20 Prime Healthcare will not contract with

21 insurance companies. My daughter had Blue Cross PPO.

22 She was not an HMO.

23 Prem Reddy is stated to be worth 300 million.

24 I can see why.

25 He also removes anything that is profitable

92


1 from his hospitals like chemotherapy because it does not

2 make him any money.

3 Prime Healthcare has been found guilty by the

4 Medical Board of misdiagnosing. And as you stated --

5 seen here today, they're also being checked for

6 malnutrition issue. Well, you can keep your beds really

7 full that way, when you keep patients there for no

8 reasons.

9 My daughter could have been diagnosed with

10 leukemia right away, but one -- by one simple test. The

11 test was done after seven days they let her lay there.

12 Okay? That test was done right in the ICU room. Took

13 nothing to do that test. For seven days, that cost her

14 in the bill $144,834, because they charge over $20,000 a

15 day for ICU.

16 Okay. Then, they refused for a transfer to

17 get her out of there to go to a chemotherapy hospital to

18 get treatment for her cancer.

19 Okay. Also, they state in the medical reports

20 that I've gotten from the hospital they checked with

21 seven hospitals to find a transfer for her. I contacted

22 all seven of those hospitals. Several of them have told

23 me they had no contact with them. I have a paper here

24 from the hospital, from Verdugo Hills, where they said

25 they had absolutely no call from Desert Hospital --

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1 Desert Valley Hospital, trying to get her a cancer room.

2 On my cell phone, I wasn't able to get it in writing,

3 but I have an answer from City of Hope. They said

4 Desert Valley Hospital never tried to contact them in

5 February to transfer my daughter. At $20,000-plus a

6 day, it's probably more profitable to keep her there.

7 And do I have this paper if you'd like to have a copy of

8 it. Okay. It was the City of Hope that I have on the

9 telephone if you'd like to listen to it.

10 HEARING OFFICER: That's okay. I'll take your

11 word for it, ma'am.

12 ARDIS KULYAS: They say pictures are worth a

13 million dollars. I have pictures I'd like to present to

14 you, if I may.

15 HEARING OFFICER: Sure.

16 ARDIS KULYAS: Okay. As you can see in these

17 pictures, I've covered up my daughter's private areas.

18 The first pictures that are marked "A" are my daughter's

19 pictures after two days in a regular room at Desert

20 Valley Hospital. She was removed from an ICU after they

21 found out that she had leukemia. She laid in that room,

22 with no care. Her throat was closing up on her. I was

23 there. I left the hospital for only three hours to go

24 home, get clothes, because I was going to follow her to

25 the hospital where she was going to be transferred.

94


1 I told them she needed to go back into ICU and

2 that her throat was closing up on her. The head nurse

3 said I was wrong. Vickie kept getting worse, and I

4 asked the nurse to call the doctor. I was un- --

5 ushered out of the daughter's -- out of my daughter's

6 room by a security guards, told I could not stay in my

7 daughter's room.

8 The second set of pictures marked "B" were

9 taken at Scripps Hospital in La Jolla, where I finally

10 found a transfer for my daughter. After three days in

11 ICU at Desert Valley Hospital, this is what she still

12 looked like. Of course, Scripps took these pictures to

13 show that this was not their negligence, this was done

14 from the previous hospital, the abuse and neglect of my

15 daughter.

16 Dr. Nanda [phonetic] assured me that she had

17 75 to 80 percent chance of survival, but they let my

18 daughter die. I don't believe the nurse ever called the

19 doctor that I asked her to call. I don't think he ever

20 came to see her, but I can't prove that yet. And I say

21 yet because they're withholding the documents from that

22 day. I have all the records from the hospital except

23 the day they let my daughter's throat close up and put

24 her back in the ICU. They can't coincidently find the

25 records of that day. They're hiding this. They're

95


1 hiding it to cover their guilt.

2 You -- if you allow Prime Healthcare to

3 purchase Victor Valley Hospital, then all ambulance as

4 well as most doctors will have to send their patients to

5 one of their hospitals where there is no insurance

6 contracts, where there is no value of human life, and no

7 one warns you what will happen when you go there. These

8 are the only two hospitals in Victorville.

9 I hear the Mayor say that they've been through

10 this for months. I have suffered six months after

11 losing my daughter, and my suffering's just started, so

12 their few months doesn't mean a lot to me.

13 I keep hearing everybody saying he gave this

14 money, he gave that money, he did this and he did that,

15 and he gave hundreds here and thousands there. It

16 sounds to me like you're buying friends. Oh, I think

17 you've earned enemies. Is this a compliment, that

18 someone gives away millions of dollars when their

19 hospitals do what they're doing to our loved ones?

20 Okay. I'm asking that you please stop the

21 sale, prevent others from suffering the loss of a child.

22 My daughter's death was caused by the doctors, the

23 nurses, and the staff. Her leukemia was curable. And I

24 ask you to please deny them to buy another hospital and

25 ruin more lives. Thank you.

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1 HEARING OFFICER: Thank you very much. I

2 appreciate it very much.

3 (Applause.)

4 COMMENTS BY MARK KULYAS

5 MARK KULYAS: Hi, my name is Mark Kulyas, and

6 I'm here today because my sister was intentionally

7 murdered at Desert Valley Hospital for financial gain.

8 Everybody keeps talking about, you know, money

9 this, money this, I gave money here, he gave money

10 there. Why -- if he's such a good doctor, Prem Reddy,

11 why isn't he taking the money to putting it into the

12 hospitals to save our loved one's life?

13 What he did is my sister was in ICU for seven

14 days. They finally diagnosed with her with an acute

15 leukemia. The very day they find out that she has an

16 acute leukemia -- every doctor knows that the word acute

17 means severe, short course, and you need to get somebody

18 medical chemotherapy immediately. What do they do?

19 They take her out of ICU the very day that they find out

20 she has an acute leukemia. What doctor does that? They

21 put her in a regular room. My mom is begging Dr. Jose

22 Lewis Naranja [phonetic] that my sister's throat is

23 closing up, she can't breathe. And Lewis Jose Naranja

24 looks at my mother in the face and says, "What do you

25 want me to do, throw somebody else's daughter on the

97


1 floor so your daughter can have a bed," and then strolls

2 off down the hall. That's the kind of hospital we have

3 here? No. What --

4 The deciding factor you see here is money.

5 These people live in very rich houses and it's all about

6 money. That's all we talked about in the beginning, is

7 money, money, money. I have a full book here showing

8 all the evidence that they intentionally murdered my

9 sister for profit.

10 When Monday came, when -- when they had my mom

11 thrown out of the hospital by a security guard, when my

12 mom's asking for help, my sister's asking for help, that

13 her throat is closing up and she can't breathe, they

14 throw my mom out of the hospital by a security lard --

15 yard -- guard and let my -- let my sister suffocate for

16 seven hours, until they return her to ICU. And then

17 they call my mom on the phone down in the parking lot,

18 because that's where she was waiting after being thrown

19 out, and -- excuse me -- and then they -- then they call

20 her up and, say oh, you're daughter's asking for her.

21 Well, she goes up there. My daughter -- my sister is

22 lifeless and they have to intubate her to save her life.

23 And here's a real kicker. She had a transfer

24 for UC Irvine for chemotherapy to save her life on

25 Monday. You want to know what they did on Monday? You

98


1 want to know what Ver Cumar Nanda [phonetic] did and

2 Lewis Jose Naranja did and Oliver Sabo, who spoke here

3 today did? They refused her transfer for financial

4 gain. You tell me what doctor refuses an acute patient

5 that's dying a transfer to a hospital, for financial

6 gain. And then, they held her hostage in ICU until

7 Thursday and they shipped her down to Scripps La Jolla

8 and refused a helicopter.

9 This isn't a hospital. What you're hearing

10 from these doctors -- they don't care about people's

11 lives. All you're hearing is about money.

12 My sister's dead. She lost her life. She

13 paid for her own medical insurance, her own PPO. I

14 submitted all this evidence to the California Medical

15 Board. You know what they told me? Oh, that's the

16 standard of care in your community. So I need you to

17 talk to Camilla D. Harris and explain to her that this

18 is a corrupt organization with money. The California

19 Medical Board is a corrupt organization. It's all about

20 money. The evidence you submit -- our citizens are not

21 being protected. They're not -- they're not being cared

22 for. Do you have family members? Do you have loved

23 ones? Do you have brothers and sisters? All this talk

24 about money -- oh, it's going to give jobs here and jobs

25 here and jobs here. How about the death of somebody for

99


1 money? That's what it's about. That's what Prime

2 Healthcare is about. That's what Prem Reddy is about --

3 money.

4 You can't deny refusing somebody's transfer to

5 hold them hostage in ICU. There's no medical excuse,

6 none whatsoever.

7 And I would like you to sit down with

8 Camilla D. Harris and read this book with her and ask if

9 this is how your loved one would want to be treated, and

10 then maybe you can form some type of organization that's

11 beyond the California Medical Board. The California

12 Medical Board is a bunch of doctors overseeing doctors.

13 They all admit here that they're all friends. Well, of

14 course, they're all friends, because they all live in

15 rich mansions -- that's why -- over the blood of our

16 loved ones. That's how they're doing it.

17 So I beg you, do not sell this hospital,

18 because these are death camps. These are not -- these

19 are not doctors that are trying to save lives, when you

20 have a doctor that says I don't care and walks down the

21 hall. My sister had to sit and write a note on a piece

22 of paper that says help me, help me, please help me.

23 Somebody's thrown my mom out of the hospital with a

24 security guard, let me sister lie in her own urine, and

25 suffocate for seven hours. I can just imagine the

100


1 horror that she felt while she layed there.

2 Prem Reddy is corrupt and these doctors are

3 corrupt. And I beg of you not to let this happen. And

4 please, would you take this to Camilla D. Harris and set

5 up some type of overseeing agent that's not doctors

6 overseeing doctors? Would you please do that for us?

7 HEARING OFFICER: Sure. Do you have anything

8 else to say? Mark, is there anything else?

9 MARK KULYAS: No, thank you.

10 HEARING OFFICER: Okay. Great. We're going

11 to take a break right now for ten minutes. Thank you.

12 (A recess was taken.)

13 HEARING OFFICER: Okay. We're going to go

14 back on the record. We've got Thurston Smith, and then

15 we're going to have Lionel Dew and Joseph Brady.

16 COMMENTS BY HESPERIA COUNCIL MEMBER THURSTON SMITH

17 HESPERIA COUNCIL MEMBER THURSTON SMITH: Good

18 afternoon. My name is Thurston Smith, S-M-I-T-H. I'm a

19 Hesperia City Council member. I am -- currently sit on

20 the governing board for Desert Valley Hospital. I've

21 lived in a High Desert for over 22 years, and I've seen

22 the growth and the economic shift over the years in the

23 High Desert.

24 If Victor Valley Community Hospital were to

25 close, it would be detrimental as to -- as to the

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1 economy and to the construction industry that pretty

2 much goes with the High Desert, almost as bad as George

3 Air Force Base in the '90s to this economy. The closure

4 would severely impact the service sector of the service

5 products that the hospitals buy in the local community,

6 not to mention the employees and their families.

7 As a business owner myself, I feel that it

8 would be a benefit for Victor Valley Community Hospital

9 to have a local owner that understands the need of our

10 community. Prime Healthcare has a proven track record

11 in turning around bankrupt and distressed hospitals, and

12 the Victor Valley certainly has had its challenges in

13 need and infusion of both experience and investment that

14 they would bring to the table. Basically, it would be a

15 shot in the arm that this hospital needs to be viable

16 and support the growing needs of the Victor Valley.

17 Having served on the board of Victor Valley

18 Hospital for over three years, I have witnessed

19 firsthand the commitment to quality and health

20 education, the outreach services that they provide to

21 our community. This is extended only through the

22 donations to charitable causes, but resources that give

23 back and help our community's health. Thank you very

24 much.


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1 Okay. Next we're going to have Lionel Dew.

2 COMMENTS BY LIONEL DEW

3 LIONEL DEW: Good evening. Thank you for

4 having this hearing. My name is Lionel Dew. That's

5 D-E-W.

6 As a civic leader of the Victor Valley, I'm in

7 favor of the purchase of the Victor Valley Community

8 Hospital by Prem -- by Prime Healthcare Services for the

9 following reasons. It is essential that the Victor

10 Valley maintain three viable, vibrant inpatient medical

11 facilities. Prime Healthcare has a tremendous track

12 record of success. Prime Healthcare is viable, stable,

13 and is noted for high-quality care and services. Prime

14 Healthcare provides opportunities for employment and is

15 considerably generous in charities. Ownership for

16 Victor Valley Community Hospital remains local. The

17 opportunity to preserve the rich history of both

18 intuition is important.

19 My view of the transaction between Prime

20 Healthcare Services and Victor Valley, it's less than an

21 acquisition but is more of a partnership that has the

22 confidence of the community and the confidence of

23 patients. Thank you.


25 And next we're going to have Joe Brady, and

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1 then would Carol Koelle -- Koelle come up also. Thank

2 you.

3 COMMENTS BY JOSEPH BRADY

4 JOSEPH BRADY: Good evening. My name is

5 Joseph Brady. I'm the president of the BRADCO

6 Companies.

7 HEARING OFFICER: Could you spell your last

8 name, sir?

9 JOSEPH BRADY: Oh, Brady, just like "The Brady

10 Bunch."

11 HEARING OFFICER: Thank you. Yes, I am hold

12 enough to know about "The Brady Bunch."

13 JOSEPH BRADY: Some in here are not hold

14 enough to remember those days. I think our mayor --

15 he's left -- or I don't know if Ryan got a chance to

16 watch that show.

17 I also publish the BRADCO High Desert Report.

18 I'm president of the Brad- -- the Barstow Real Estate

19 Group and Alliance Management.

20 I'm pleased to stand before you tonight,

21 endorsing the efforts of Prime Healthcare Services

22 Foundation and PHSF in their acquisition of the

23 hospital. I've been in the High Desert since

24 May 13th of 1988, and only during a short period of my

25 tenure was Victor Valley Hospital a viable hospital.

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1 Since Dr. Benjamin Nepomuceno retired, Victor Valley

2 Hospital's continued to struggle not only financially,

3 but, I believe, overwhelmed with an increased amount of

4 social problems that the High Desert has seen, as

5 evidenced by our high unemployment. I stand to -- wish

6 to stand and correct my good friend and Mayor Pro Tem

7 Russ Blewett. He says 18 percent. We believe it's

8 actually he about 25.7 percent. And last week, our

9 favorite paper, The Daily Press, evidenced that our

10 welfare and food stamp rate is now about 35 percent per

11 capita for the High Desert region.

12 It is unfortunate after -- after the

13 bankruptcy court approved an auction on November 5th,

14 2010, (unintelligible) medical group -- and I know a

15 good group -- for profit, was selected for the proposed

16 purchase of the hospital but was not able to close. In

17 my business, because I'm in the real estate business, I

18 understand deposits and I understand when you're

19 supposed to close, and if you don't close, unfortunately

20 you don't close. And unfortunately in my business, when

21 you have a refundable or nonrefundable deposit up, when

22 it's nonrefundable, if you don't close, you don't close

23 and usually in our instances you lose those deposits,

24 and those are unfortunate.

25 I've been a resident and a business leader in

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1 the High Desert for a long period, long before Prime --

2 Prime Healthcare Services was created under the

3 leadership of Dr. Reddy and his family. I've known

4 Dr. Reddy. I've worked with Dr. Reddy on multiple

5 issues to improve the High Desert economy. At the end

6 of the day, there's not one person in the medical

7 industry that has done more for the High Desert region

8 in trying to improve the economy in a way of grand

9 scholarships, donations, forward thinking as Dr. Prem

10 Reddy and his team have done.

11 Victor Valley Community Hospital needs a local

12 owner who will make Victor Valley Community Hospital his

13 ultimate legacy, not only in a local owner, but a

14 committed owner. Victor Valley Community Hospital needs

15 a business person that understands the community and its

16 finances. I can assure you that he is not purchasing

17 this hospital to make a return on his investment. As a

18 local businessman, recognizing the long history of

19 Victor Valley Hospital's financial problems, investing

20 the type of money that will be required to bring this

21 facility to the standards that Dr. Prem Reddy and his

22 associates require will never yield any type of return.

23 I basically think it's a bad investment if you're

24 looking at it from a monetary standpoint. From a

25 business standpoint, it's a bad deal for Dr. Reddy to

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1 invest, and Dr. Reddy's not investing in this facility

2 to make a quick buck. I believe this will be his

3 legacy.

4 While I believe that Dr. Reddy and his family

5 are extremely proud of what they've attained in the

6 creation of Prime Healthcare Services Foundation, and

7 Victor Valley Community Hospital's close to his home, it

8 will ultimately be the biggest challenge that he will

9 face as chairman of Prime Healthcare Services and Prime

10 Healthcare Services Foundation.

11 It's hard for me to believe as a High Desert

12 businessman that there will be any groups that would

13 oppose a financial injection of money, time, energy, and

14 dedication to improving Victor Valley Community

15 Hospital. The issues should not be about Dr. Reddy or

16 those unions that would like to become a part of Reddy's

17 hospitals. It should be about the right and what right

18 it is from the Attorney General to independently make

19 decisions out of the political realm, not to look at

20 those who have made political contributions to the

21 Attorney General's office, but to do what the citizens

22 of the Victor Valley need -- a doctor, a philanthropist,

23 a businessman, and a visionary that wants to make Victor

24 Valley Community Hospital the Victor Valley's hospital.

25 I'd like to close and say this. I've seen a

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1 lot of old friends from the medical industry here

2 tonight, and some of them we've done business with and

3 some we haven't. And I'm sure my comments will have

4 a -- have a profound hit to possibly our bottom line for

5 making this endorsement. I would hope that at the end

6 of the day that our hospital, that the medical industry

7 come together, because at the end of the day, we are one

8 and what we do sends, I think, a strong message to

9 everybody in this valley. Thank you.


11 Okay. Carol. And then, after Carol is going

12 to be Loise Sanders and then Ken Anderson.

13 COMMENTS BY CAROL KOELLE

14 CAROL KOELLE: Good evening. I was going to

15 say good afternoon, but it's a little late now.

16 DEPOSITION OFFICER: Move the microphone down.

17 CAROL KOELLE: My name is Carol Koelle; last

18 name, K-O-E-L-L-E. I am a registered nurse of 17 years

19 and a charge nurse on an 81-bed cardiac unit at

20 St. Bernardine's Hospital in San Bernardino. I am also

21 on the board of directors for the California Nurses

22 Association, National Nurses United, and affiliated with

23 the AFL-CIO, who represent 180,000 nurses across our

24 nation. However, I live here in the High Desert. This

25 is where I receive my medical care. I'm very, very

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1 concerned about the quality of medical care that we have

2 locally.

3 Twelve years ago in Long Beach, I lost my

4 father to a staff infection at the hands of medicine and

5 a lack of services provide for him. This happened

6 despite my pleading and protesting to those directly

7 responsible for his well-being. I believe selling the

8 hospital to Prem Reddy, while he is under investigation

9 for Medicare and Medi-Cal fraud, whether it's true or

10 it's not, and with the incidents of cited infections

11 that he has in these hospitals, would put the community

12 in the same peril that my dad -- my dad faced. Selling

13 this hospital gives Mr. Reddy a near monopoly, leaving

14 St. Mary's as the only other choice, which already has

15 its ER overcrowded, in large part due to local -- locals

16 avoiding Desert Valley Hospital, with its poor

17 reputation.

18 As a patient advocate, I have spoken to dozen

19 of Desert Valley nurses regarding patient safety

20 conditions and their facility. Their hands --

21 HEARING OFFICER: Carol, can I just have you

22 slow down --

23 CAROL KOELLE: Oh, sorry.

24 HEARING OFFICER: -- because you're reading,

25 and the court reporter's trying to take it all down.

109


1 CAROL KOELLE: I'll give it to you.

2 HEARING OFFICER: And I know you have a lot of

3 passion. That's good. I like that. Just a little bit

4 slower. Okay. So --

5 CAROL KOELLE: Anyway, let's go back.

6 Spoken to dozens of these nurses. Their hands

7 are tied, their voices silenced by the intimidation if

8 they attempt to suggest improvements. This is not a

9 friendly or cooperative work environment. I personally

10 know three nurses who have been fired for being vocal.

11 I would much rather know that the new potential owner of

12 Victor Valley Hospital puts patients ahead of profit. I

13 believe that Victor Valley Hospital must stay open, but

14 there must be choices in the High Desert.

15 (Applause.)

16 HEARING OFFICER: Okay. Loise, are you here?

17 Okay. How about Ken Anderson. And after Ken, we're

18 going to have Joe Range.

19 COMMENTS BY KEN ANDERSON

20 KEN ANDERSON: Good afternoon. My name is Ken

21 Anderson, A-N-D-E-R-S-O-N. I'm a district

22 representative for California Senator Sharon Runner. I

23 have a letter in her behalf, dated August 16th,

24 addressed to the Attorney General, and it's addressed to

25 the Attorney General Harris. It says:

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1 "As you are aware, on July 5th, 2011,

2 the Victor Valley Community Hospital and

3 Prime Healthcare Services Foundation

4 entered into an agreement to allow the

5 Foundation to acquire Victor Valley

6 Community Hospital and to continue to

7 operate as a nonprofit hospital.

8 "The Foundation, a nonprofit public

9 charity founded by High Desert residents

10 Dr. Prem Reddy, owns and operates two

11 other nonprofit hospitals, Encino Hospital

12 Medical Center and Montclair Hospital

13 Medical Center, a Top 100 Hospital in the

14 Nation in 2009, and is governed by an

15 independent board of directors. Prime

16 Healthcare services, Inc., Desert Valley

17 Hospital, and Dr. Prem Reddy have no

18 ownership interest in the Foundation.

19 "I fully support this agreement

20 be- -- because as one of the Victor

21 Valley's two nonprofit hospitals, Victor

22 Valley Community Hospital provides

23 much-needed emergency, surgical, obst- --"

24 I knew I was gonna do that.

25 HEARING OFFICER: Obstetrical?

111


1 A -- "obstetrical" -- thank you -- "and

2 pediatric services to the area residents.

3 Unfortunately, the growing Victor Valley

4 has an alarming low 1:1 ratio of beds per

5 thousand people within its service area

6 compared with the state average of 2:1.

7 In real numbers, the Victor Valley has

8 three hospitals with a combined of 378

9 beds. Victor Valley Community Hospital

10 represents 27 percent of the region's beds

11 and accepts patients from all income

12 levels. In a community suffering from

13 insufficient medical access and a high

14 unemployment rate, it is critically

15 important that this hospital remain in

16 full operation.

17 "As the state senator representing

18 the Victor Valley, I urge you to approve

19 the sale of Victor Valley Community

20 Hospital to the Foundation on

21 August 17th because the Foundation has

22 proven it has successfully run other

23 nonprofit hospitals in accordance with

24 conditions imposed by the Attorney

25 General. I must also point out that the

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1 opponents have put out inac- -- inad- --

2 inaccurate and misleading information

3 regarding Prime Healthcare Services and

4 Prime Healthcare Services Foundation that

5 has created concern over this sale.

6 However, not approving the sale of Victor

7 Valley Community Hospital will do great

8 disservice to the residents of the Victor

9 Valley who rely heavily on the services

10 provided by this hospital.

11 "Sincerely, Sharon Runner, Senator,

12 17th district."

13 HEARING OFFICER: Great. Thank you. Could

14 you leave us a copy of that letter, please?

15 KEN ANDERSON: Yes, I did.

16 HEARING OFFICER: Okay. Joe Range, and then

17 after Joe is going to be Dawn Sikes.

18 COMMENTS BY JOE RANGE

19 JOE RANGE: I don't have any prepared remarks.

20 HEARING OFFICER: No worries on that account,

21 sir. Speak your heart.

22 JOE RANGE: That's what I'm going to do. I'm

23 a businessman. I've been in the valley here since

24 October 17th -- October 21st of 1989. My corporation's

25 in its 40th year. That's not important here, but that

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1 just means I have access to a lot of people, a lot of

2 people have access to me. We have employees. We have

3 folks that need -- that have needs, and they have used

4 the facilities that are here in the valley. The problem

5 that you run into many times, and in my own case, myself

6 and my wife have ended up staying in the aisles on a

7 bed, on a gurney, waiting for a room. I think there's

8 an overriding need for these beds, and I think that

9 the -- the problems that have been brought up today can

10 be mitigated, that those are things that are operational

11 things that can make things better.

12 What we're talking about is people. We're not

13 talking about machines. We're not talking about

14 businesses. We're not talking about -- what we're

15 talking about is people. And people have the needs and

16 need to be able to address those needs, and hospitals

17 have a large responsibility in making that happen.

18 Now, this takes me to the next point. I am

19 currently vice president of the governing board of

20 Victor Valley College. You heard some of our folks

21 speak here earlier about our current students in our

22 nursing program. We have a fantastic nursing program,

23 and you'll forgive me for bragging. Our nurses

24 generally graduate in the top -- top of the class. We

25 deliver between 40 and 60 a year. That's not a lot, but

114


1 those 40 and 60 are -- are vitally needed. And the

2 responsibility for our school, our Victor Valley

3 College, our medical component, which -- which is

4 nursing, we have to draw on the staffs of the hospitals.

5 And so we do have contracts with all of the hospitals to

6 provide employees that are going to go to school and

7 come out with their degree for nursing. And so we have

8 an interworking relationship with all the hospitals and,

9 in particular, Dr. Prem Reddy.

10 Dr. Prem Reddy has given our school

11 $1 million. I was there when it happened. I was

12 serving on the Foundation board at the time as president

13 of that board at that time. I'm now emeritus on that

14 board. I'm currently serving, as I said, as a trustee,

15 governing board member as vice president.

16 It's very important that we keep in mind that

17 these students need to get this education, need to get

18 this training, and then they need to be able to go

19 someplace. They need to be able to go to a hospital and

20 begin to apply their trade. And that is the most

21 important component, and that's what I say, when we talk

22 about people, we're talking about young people entering

23 the profession.

24 I've heard all kind of comments about

25 administrative problems and other folks who have special

115


1 interests in -- in -- in the programs and the way things

2 are administered and that sort of thing. I would just

3 like to remind people it's all about people and that

4 when you go to a hospital, you have only one concern and

5 that is you want to be taken care of. And sometimes it

6 doesn't happen, and that's really unfortunate. But we

7 need to redouble our efforts and produce the kinds of

8 nurses from our school that will do better in the future

9 based on the learning and the experience they're going

10 to get from these hospitals and, in particular, Dr. Prem

11 Reddy's Victor Valley Hospital.

12 So with that, I can go on about other things.

13 But I think it's most important that we have 15,000

14 students at our school and us, like everybody else, is

15 faced with these money problems, but we have to go on.

16 And by the same token, this hospital needs to stay open.

17 It can not lapse. There needs to be a place for people

18 to go. And we want to -- well, my personal feeling is

19 that it must stay open. From the -- from my position as

20 a governing board member of the college, we need a place

21 for our students to go. And so with that, I'll close

22 and thank you for listening.


24 Appreciate it.

25 COMMENTS BY DAWN SIKES

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1 DAWN SIKES: Good evening. My name is Dawn

2 Sikes, D-A-W-N-S-I-K-E-S. I'm district director for

3 County Supervisor Brad Mitzelfelt, and I'll be reading a

4 letter prepared by the Supervisor.

5 "As First District Supervisor, I am

6 writing to express my support for the

7 Office of the Attorney General in its

8 process to find a qualified buyer for

9 Victor Valley Community Hospital in order

10 to keep this critical medical facility

11 operating.

12 "The impact of closing Victor Valley

13 Community Hospital would be catastrophic

14 for the community's economic and medical

15 health.

16 "Closure of the hospital would cause

17 a severe economic impact on the High

18 Desert, which has already been hard hit by

19 the recession. The High Desert of

20 San Bernardino County suffers from an

21 unemployment rate of more than 17 percent,

22 with one local city at 21.3 percent, which

23 is almost twice the state average.

24 "Victor Valley Community Hospital is

25 one of the area's largest employers.

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1 Closure would put 400 employees out of

2 work, leaving them without a stable source

3 of income. Many local vendors would also

4 suffer from the loss in business generated

5 by the hospital.

6 "As widespread as the negative

7 economic impacts of the closure would be,

8 the medical impacts are of even greater

9 concern. The High Desert is already a

10 community underserved by medical

11 facilities. The region served by Victor

12 Valley Community Hospital includes a large

13 uninsured and underinsured population.

14 Many of these citizens rely solely on the

15 services provide by Victor Valley

16 Community Hospital. If the hospital were

17 to close, other regional hospitals would

18 be overburdened with the resulting influx

19 of patients. Some of these patients would

20 have to travel down the Cajon Pass to the

21 already overcrowded county hospital in

22 Colton, Arrowhead Regional Medical Center.

23 The result would be more people with less

24 access to quality medical care.

25 "I do not want to see anyone in our

118


1 community, from seniors to expectant

2 mothers, suffer simply because we allow

3 this vital facility to close.

4 "Signed, Brad Mitzelfelt,

5 Vice-Chairman, Board of Supervisors,

6 San Bernardino County."

7 HEARING OFFICER: All right. Thank you.

8 DAWN SIKES: Thank you.

9 HEARING OFFICER: After Val, we're going to

10 have Rebecca Tennison and then Blair Bryson.

11 COMMENTS BY VAL CHRISTENSEN

12 VAL CHRISTENSEN: Thank you. My name is Val,

13 V-A-L, Christensen, C-H-R-I-S-T-E-N-S-E-N. Currently, I

14 have the honor of the serving as president of the Victor

15 Valley College Foundation.

16 I'm sorry. I have some notes, but I can't

17 imagine what it would be like to lose your child. And I

18 really didn't mean to be emotional. I must deviate from

19 my notes, you know.

20 And in May of 2009, my daughter, a mature

21 mother with two children, was in the hospital in

22 question here. And the doctor came to us and said,

23 "Mr. Christensen, you need to make plans because your

24 daughter's probably not going to live the week." I had

25 forgotten about that until just a few minutes ago, and I

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1 feel myself trembling and shaking. I just --

2 HEARING OFFICER: Take your time. Okay?

3 VAL CHRISTENSEN: I just can't tell you how

4 that affected me. The doctor went away that day, and I

5 know he spent the rest of the studying and learning

6 about diabetes. He came back six hours later, and he

7 told me my daughter was a brittle diabetic and that her

8 chances of survival were very slim. But after those six

9 hours, he learned something that I -- I don't know what

10 he did, but I know he changed her treatment. She

11 weighed 90 pounds that day. I will tell that you today

12 she weighs 130 pounds, and she's 37-year-old mother of

13 two. I'm thankful that I have my daughter. I'm sorry

14 you don't.

15 I've known Prem Reddy for maybe 30 years.

16 I've been in Apple Valley and Victorville area since

17 1962, probably longer than anyone in the room, I

18 suspect, probably older than anyone in the room. I put

19 my walker aside to talk to you.

20 And I apologize for being emotional, but I --

21 thinking about my daughter and that day, it was a hard

22 day for our family. It's not today. We had a birthday

23 party with her Monday night. How great it was.

24 I say I've known Dr. Reddy for a long time and

25 I have. And I know that in his heart, I know that he

120


1 does not serve our community for capital gain. I know

2 that he cares about people. I know him personally, and

3 I know that to be true. I know that when there's a

4 loss, you feel that something's different than that.

5 You want to think that maybe money is the motivator. I

6 honestly can't say, and I believe in my heart that

7 that's not the case with the Dr. Prem Reddy that I know.

8 I've been to his home. I've met his family. Very

9 gracious and kind people that think about serving our

10 community.

11 I know that if you're a graduate of Victor

12 Valley College Nursing, you go to the head of the class

13 when it comes time to get a job. It takes money to run

14 that program and, yes, we've talked about money a lot

15 here today and a lot of that money has come from

16 Dr. Prem Reddy. Those nurses that graduate are on

17 scholarships; a great many of them are. But the

18 facilities they use, somebody paid for, and that money,

19 a lot of that money came from Dr. Prem Reddy and I'm

20 thankful for that. I'm thankful that when you say

21 Victor Valley College and you ask anybody what are we

22 famous for, we're famous for graduating top nurses. And

23 as I say, they go to the head of the class when it comes

24 time to get a job anyplace.

25 I know that Dr. Reddy has employed hundreds of

121


1 people locally; and across the nation, I have no idea,

2 but many. And I know and you've heard the unemployment

3 statistics in our town. You know that we can't lose the

4 beds. You know that Victor Valley Hospital needs to

5 stay open.

6 I once served as a -- on an advisory counsel

7 to Victor Valley Hospital several years ago, when

8 Dr. Nepomuceno owned the hospital or operated the

9 hospital. I was here before the hospital was built,

10 when it was the Presbyterian hospital and that hospital

11 failed and closed for several months before a group of

12 doctors bought it and put it back into operation. I've

13 seen a lot happen to Victor Valley Hospital over the

14 years, for sure.

15 You know, there seems to be in our nation

16 today, unfortunately, a feeling that we need to penalize

17 success, as though someone that has achieved success

18 have done it off the backs of the poor and the

19 downtrodden and their employees and that sort of thing.

20 And I say that is a lot of bunk. I believe you become

21 successful in the medical field or in the real estate

22 business or in the motor home business or any business

23 you're in -- you become successful by serving people.

24 That's how you become successful, by performing great

25 service to people. I say you become successful by

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1 employing the top people you can get your hands on. If

2 you're going to expand your business and expand your

3 hospitals or whatever business you're in, you need top

4 people or you can't grow your business. I've been,

5 again, associated with some of the professionals at some

6 of these hospitals, and I believe they are some of the

7 top people in our area, and I think that's the goal of

8 the people here, Prime Healthcare. I don't know the

9 exact name. I'm sorry.

10 HEARING OFFICER: That's all right.

11 VAL CHRISTENSEN: That they try to have the

12 top people. And I've employed a lot of people over the

13 years, certainly more than thousands. I know some of my

14 ex-employees don't think the best of me. But my

15 customers really like me, and I think that's because I

16 expect my employees to be the very best they can be at

17 all times. I will not tolerate mediocre performance or

18 incomp- -- employees that are incompetent. And

19 sometimes, those kinds of employees can leave and have

20 something negative to say about you. There's no

21 question of that.

22 Prem Reddy lives in the community, invests in

23 the community, employs people in the community, trains

24 people in the community, donates to charities in the

25 community, and contributes to the community. I think

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1 that it would be a great thing to have our hospital

2 owned by a local instead of somebody from out of town.

3 And I would give you these, but they're not

4 what I said. Thank you.


6 Okay. Rebecca Tennison. And after remember

7 Rebecca is going to be Blair Bryson and then Michael

8 (unintelligible). We're going to get to you too, so

9 just hang on.

10 COMMENTS BY REBECCA TENNISON

11 REBECCA TENNISON: Good evening. My name is

12 Rebecca Tennison, T-E-N-N-I-S-O-N. I'm the Victor

13 Valley field representative for State Assemblyman Steve

14 Knight. I will read a letter from the Assemblyman to

15 the Attorney General.

16 "As the Assemblyman of the Victor

17 Valley, I have been following events

18 relative to Victor Valley Community

19 Hospital with great interest as many of my

20 constituents rely on Victor Valley

21 Community Hospital for healthcare

22 services.

23 "The Victor Valley residents need

24 reliable healthcare facilities, and

25 without Victor Valley Community Hospital

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1 the options become increasingly scarce.

2 "Prime Healthcare has rescued many

3 hospitals in financial distress, in

4 bankruptcy, and on the verge of closure

5 and turned them into successful community

6 hospitals. Without Prime Healthcare's

7 intervention, most of these hospitals

8 would have closed.

9 "In these times of high unemployment

10 and uncertainty in healthcare, the High

11 Desert needs to maintain good-paying jobs

12 and quality health facilities. In this

13 marketplace, we need to support those who

14 are willing to take on risks and invest in

15 their community. The stable

16 administration of the hospital would be a

17 welcome addition to the Victor Valley.

18 "I support ensuring that my

19 constituents have access to their

20 healthcare needs, which includes Victor

21 Valley Community Hospital. Prime

22 Healthcare seems to hold the most promise

23 in keeping the facility open and

24 functioning to meet the needs of our

25 communities."

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1 Thank you.

2 HEARING OFFICER: Thank you very much. Did

3 you give a copy to my court reporter? Thank you.

4 Okay. Blair. And then after Blair is going

5 to be Michael Fermin and Vicky Cabriales.

6 COMMENTS BY BLAIR BRYSON

7 BLAIR BRYSON: Hello. I'm Blair Bryson,

8 B-R-Y-S-O-N. I'm the administrator for Choice Medical

9 Group. As I stand here today, I've got to say Choice

10 Medical Group has been a long time supporter of Victor

11 Valley Hospital, charitable -- and the charitable

12 contributions in patients that are submitted -- admitted

13 to the hospital, services that are performed at the

14 hospital, in many ways Choice Medical Group has

15 supported Victor Valley Hospital over the years.

16 But today, I think I'm really representing not

17 Choice Medical Group. I'm representing 23,000 of our

18 fellow citizens here in the High Desert. They're the

19 one element that I haven't heard much about. We've

20 heard about all the access that's important to the

21 underserved class, which certainly is important. But

22 the 23,000 patients that we have, we are dictated by the

23 health plan where those patients will go. So the health

24 plans tell us where they have contracts for those

25 patients to go to the hospital, and that's where those

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1 patients have to go.

2 We've talked about the fact that if Victor

3 Valley Hospital were to close, it eliminates 25 percent

4 of the beds in the valley. Well, de facto, if there are

5 no contracts for the HMOs, then there are -- there's a

6 de facto elimination of 25 percent of the beds for the

7 commercial members, for these HMO members.

8 I know HMO does not have a positive

9 connotation, so we're not really talking about HMOs.

10 Who are the member of the HMOs? They are people who,

11 through their employer, sign up for the insurance that

12 they can best afford through their employer, and they've

13 chosen the various health plans in the HMO industry.

14 We've already been contacted by HMOs asking us

15 where are we going to send our patients if -- if this

16 deal goes through as it's currently instituted. And the

17 answer is, well, I heard from MDS the answer is they can

18 go to St. Mary's because St. Mary's has the contracts.

19 But we've already heard that St. Mary's does not have

20 capacity for additional members, to see that many

21 additional patients. So where will they go? They will

22 go down the hill.

23 We have almost 5,000 senior patients. Will we

24 send them down the hill, in a car. When their family

25 members are in the hospital, will they have to go down

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1 the hill to visit their members -- their patients in the

2 hospital? So it's a vital concern that the HMO

3 contracts to us our extended or made available.

4 I understand that there's concern about rates.

5 I heard that it was implied by Mr. Strow [phonetic] that

6 these health -- these HMO contracts were causing

7 millions of dollars in losses to the hospital. But I'm

8 an accountant, and when I see in the MDS report that

9 90 percent of the admissions are for Medi-Cal and

10 indigent, I don't -- I'm not sure how I can understand

11 how 10 percent of the admissions could be costing the

12 millions of dollars of losses.

13 In the -- in the MDS report, under one of the

14 conditions, potential conditions, Number 7, it says:

15 "Purchaser should negotiate a

16 contract with IEHP effective at the time

17 of closing date and maintain said contract

18 least for five years on similar terms and

19 conditions as other similarly situated

20 hospitals."

21 Well, we know why that's important, because so

22 many members go to -- IEHP members go to the Victor

23 Valley Hospital. And I applaud that that's been

24 accomplished. I'm very happy about that. But why not

25 have that -- the new buyer be mandated to follow similar

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1 language where they would have to affect contracts with

2 the HMO contracts at terms and conditions as other

3 similarly situated hospitals? How can it be that most

4 of the hospitals in southern California have contracts

5 with the HMOs? So it must be possible to get rates that

6 are considered to be fair. Our own St. Mary's Hospital

7 has rates with most of the commercial contracts, HMO

8 contracts, so it must be possible.

9 If we don't, we put our members at risk. Yes,

10 there is access for emergency services. But if there's

11 access without any idea or control of what the price of

12 that access would be, it is not really access. So

13 without commercial contracts, we know where the health

14 plans will tell us that we have to send our patients,

15 and many times that will be down the hill.

16 We've heard a lot of people here talk about

17 how important it is to keep services, keep business,

18 keep jobs up here. We agree. But if Victor Valley

19 Hospital does not have HMO contracts, many of tho- --

20 many of that business-related -- that relates to the

21 care of those members will be done down the hill, and

22 those dollars and services will happen down in

23 San Bernardino County or Los Angeles.

24 So in short, I ask you that you will consider

25 the fact that there is a need for our commercial

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1 members. They're not nameless. Our HMO members need to

2 have representation, need to be -- have access to

3 services in this valley just like the other people who

4 currently access Victor Valley Hospital. The other

5 buyer -- they agreed to that stipulation, that the HMO

6 contracts can be extended. So I ask that you make that

7 a condition also for the sale of the hospital, that the

8 new buyer will seek to negotiate HMO contracts at rates

9 similar to other hospitals in this area. Thank you.


11 Appreciate it.

12 Michael Feldman. And after Michael is going

13 to be Vicky Cabriales and then Peter Moore.

14 COMMENTS BY MICHAEL FELDMAN

15 MICHAEL FELDMAN: I'll move that microphone a

16 lot further down. My apologizes. Good evening. It is

17 now evening, Ms. Horwitz, Ms. Cantoni, Mr. Dalton, and

18 Special Assistant Attorney General La Blanc, if you're

19 still with us. And I assume he is.

20 Last, I should actually say hello to my high

21 school American history professor or teacher, Terry

22 Kurtz, who's actually manning a camera. It should tell

23 me -- tell you what roots I have in this community, too.

24 My name is Michael Fermin, and I'm a

25 Supervising Deputy District Attorney for the County of

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1 San Bernardino. I'm the supervisor over the special

2 units division of the county, handling matters like

3 consumer protection, environmental crime, major fraud

4 prosecutions.

5 Tell me if I'm going too fast.

6 DEPOSITION OFFICER: Just keep that mic --

7 there you go.

8 MICHAEL FELDMAN: Okay. Child abduction, cold

9 case homicide, and asset forfeiture (inaudible) among

10 others.

11 I've been a board member of Victor Valley

12 Community Hospital on and off since 1997, and I was

13 actually present and on the board of directors back in

14 1998, very much like the situation we have today, when

15 there was an asset purchase sale agreement between

16 Victor Valley Community Hospital and Community Health

17 Systems. And it was initially negotiated for

18 $53 million and went to $40 million. And this was in

19 February of 1999. And at that public hearing, actually,

20 Cathy Pelley was there too, then at St. Mary's. Much

21 like this one, I endorse that transaction.

22 Many things have returned from those days.

23 Mr. Dalton, then, I think, with the Camden Group,

24 actually wrote the health impact statement back in 1998.

25 At the time, it was not you, Ms. Horwitz. And I'll say

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1 it's Horwitz because I've heard people mispronouncing it

2 and it bothers me.

3 HEARING OFFICER: Thank you. I appreciate

4 that.

5 MICHAEL FELDMAN: It's H-O-R-W-I-T-Z, and I

6 get that.

7 It was actually, then, Attorney -- Deputy

8 Attorney General Chester --

9 HEARING OFFICER: Ed Horn, yeah.

10 MICHAEL FELDMAN: -- who is now a

11 Los Angeles Superior Court judge.

12 At that time, the Attorney General's office

13 placed a condition on the sale and that condition was to

14 have $5 million in charity care as a requirement in

15 perpetuity. We've noticed that transactions since then

16 don't have that, in large part because those are the

17 nearly impossible for people to buy on -- buy into.

18 Now, I bring that up not because I'm critical

19 of what Chet did, what the Attorney General's office

20 did, not at all. Certainly, your authority by law

21 permits that, especially in situations like that one.

22 It was a transfer from a not-for-profit to a profit

23 hospital. And their obligation to the community and its

24 healthcare deserve such oversight. In fact, I thought

25 that it was for the best of the community that you did

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1 that, and I don't have a problem with it. But why I

2 bring it up is because it gives some context to where we

3 are today.

4 While I wasn't interviewed for its most -- his

5 most recent health impact report, I was one who served

6 the community's interests back then. And I was the

7 chairman who was selected after it was aborted to try to

8 pick up the pieces, and then, again, I was brought back

9 on the board sometime later.

10 But through those processes, there are several

11 observations I needed to make that I think will be

12 helpful to explain why I do support the sale as I did --

13 deja vu all over again. I think it was in February of

14 this year.

15 Back in 1998, Mr. Dalton pointed out several

16 key factors, and I quote actually from that report.

17 One, the hospital needs to increase census. Two, it

18 needs to increase patient flow within the hospital.

19 Three, it has to acquire modernized equipment. Four, it

20 has to get physician support. Five, it can't repeat

21 historical mistakes.

22 Very telling statements from 1998. It was a

23 hospital at the time that just got out of bankruptcy,

24 involved with litigation with, ironically enough,

25 Dr. Reddy. It was a hospital that had a lot of

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1 regulatory issues involving the Attorney General's

2 office, concerns that -- that were brought to light.

3 And I thought that those key factors are important

4 because it gives context to some of the things that we

5 are trying to do not to make historical mistakes in the

6 past.

7 I come not just as someone who sat on the

8 board. My mother is a physician who still practices.

9 And I don't think there's any other physician in this

10 room that you've heard to or any other that you will

11 hear from that is exclusively and has always been

12 exclusively a medical staff member of Victor Valley

13 Community Hospital alone. I am one of Dr. Nepomuceno's

14 last remaining family members who actually gives a care

15 about the community. I am someone who grew up in that

16 hospital. I played ball at its front while waiting for

17 my mom to finish rounds. I volunteered there. I worked

18 there as a short order cook and I sat on its board.

19 And many problems that Mr. Dalton saw back in

20 1998 exist today, and a lot of the comments that we

21 heard don't necessarily address those things. We heard

22 about payer-mix concerns. It's one of the things

23 Mr. Dalton pointed out in his report. He talked about

24 the fact that now, some 13 years later, it is now a

25 45-year-old plant that is in need of repair, that

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1 there's reductions in reimbursement rates.

2 Reimbursement rates from HMOs, I might add.

3 I must at this moment at least take some

4 exception to Mr. Bryson's -- the prior speaker's

5 comments. He talked about access to healthcare. I find

6 that to be an intriguing argument when he quoted from

7 Mr. Dalton's report that in reviewing the hospital

8 financials, you saw that 90 percent was Medi-Cal or

9 Medicare only -- at least that's what he said -- and

10 10 percent were HMO. Well, if we were at to take that

11 as true, and we know that the hospital isn't at full

12 capacity and St. Mary's is, then why is the hospital

13 only having 10 percent of its population, if we believe

14 that to be the case, simply HMO? Is there really an

15 access problem in that instance? I don't think so.

16 They made a choice to go to other places.

17 In his most recent evaluation, Mr. Dalton has

18 done an exceptional job pointing out some of the

19 advantages and some significant concerns. But I do come

20 today to urge approval of this sale for three reasons.

21 First and most directly, without that sale, the hospital

22 will lose its CLIA license -- and by CLIA, I'm referring

23 to the Clinical Laboratory Improvement Amendments

24 certificate -- and it will no longer be able to

25 participate in the Medicare or Medi-Cal program. That's

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1 what losing that license means. As Mr. Dalton pointed

2 out on page 54 of his report, the hospital will be

3 forced to close. We heard that from Ms. Pelley.

4 I don't believe that it would be time. As a

5 board member making -- being part of the body that

6 endorsed this decision, I don't think it would be a time

7 to find a proposed buyer anywhere near the price that

8 the Attorney General's office, that the bankruptcy court

9 has authorized. If you remember, the last time we did

10 this dance it took ten months and it didn't complete

11 until Mr. Thomas. My comment to simply res ipsa

12 loquitur, it speaks for itself. It didn't complete.

13 But unlike that prior transaction, Prime Care has

14 stepped in very quickly. It has tried to prevent this

15 disaster from happening.

16 And I think you, Deputy Attorney General

17 Horwitz -- as a board member, I know you're familiar

18 with the steps that are required to complete this

19 transaction. You made a lot of concessions and

20 considerations when we were to doing this earlier in the

21 year. You made a lot of great steps to try to make it

22 work the first time, and it didn't. And I don't put

23 blame on you. We know you worked hard at it. We were

24 there. We were part of that negotiation team.

25 I take exception to Mr. Thomas characterizing

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1 it as the Hospital's fault. I sat there month after

2 month after November, listening to being nickel and

3 dimed about every little thing, and I think you know

4 that. I know the bankruptcy court knows that's the way

5 it went. They weren't prepared. They didn't have

6 contracts with the other HMOs. They didn't have the

7 things that the bankruptcy court wanted. That is

8 inaccurate to imply that they were ready it close,

9 because the fact of the matter is, Deputy Attorney

10 General Horwitz, that's what you wanted. That's what we

11 wanted as a board. That's what we thought the community

12 wanted. It didn't happen.

13 What they say is let's challenge CLIA.

14 Perhaps, like other deadlines that we're supposed to

15 happen on June 1st, let's not take the government

16 seriously when they make deadlines. I think that's what

17 Mr. Thomas was getting at. In his position, I -- maybe

18 he can do that. As a prosecutor, I'm not inclined to do

19 that. I know you're not as a government official. And

20 certainly, as a board member of that hospital, I am not

21 inclined to challenge CMS and question if, when they say

22 you will close, you will close. That would be the

23 greatest breach of fiduciary duty. And for him to imply

24 that should I do that is difficult. It's impossible.

25 And that would only require additional investigation by

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1 your office for my breach of fiduciary duty, and I chose

2 not to do that.

3 Since 1998, when the emergence of hospitals

4 from bank- -- the emergence of this hospital from

5 bankruptcy in the mid-1990s, we have struggled to exist.

6 You heard Doctor -- or Mr. Brady tell you about that.

7 Long-term viability of stand-alone hospitals

8 like Victor Valley Community Hospital's seriously in

9 doubt. Not just Mr. Dalton knows the reality, economic

10 reality as an expert in that field. But in Trustee

11 Magazine, in September of 2007, Ryan Gish -- that's

12 G-I-S-H -- and Kit Kamholz -- and that's

13 K-A-M-H-O-L-Z -- forecasted the viability of stand-alone

14 hospitals in the future. They noted that stand-alone

15 hospitals -- that 45 percent of the hospitals in 2004

16 were part of a larger organization. And the next year,

17 it grew to 55 percent. And it's even greater today.

18 In 2009, 85 percent of the hospital mergers

19 around the United States involved the consolidation of a

20 stand-alone hospital into a larger entity. Expert after

21 expert after expert have cautioned board members of

22 stand-alone hospitals that their days are numbered.

23 Why? For us as Victor Valley Community Hospital,

24 unresolved regulatory issues from the 1980s, reductions

25 in reimbursement rates, as Mr. Dalton has pointed out,

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1 compliance issues not just with the lab, but medical

2 staff, nursing ratios, pyramids. Others have commented

3 about the economy. All of those, and increasing

4 regulations, have made it difficult, if not impossible,

5 for any stand-alone hospital to survive. No one has

6 addressed that. And that, as a board member, is

7 something that concerned me and I know many of my

8 colleagues who voted in favor of this sale. Standard &

9 Poors released a report last year showing the very bleak

10 economic picture for a stand-alone institution.

11 By approving this sale, Victor Valley

12 Community Hospital will be part of a large and

13 financially strong healthcare system. There's a

14 commitment by the purchaser to enhance the facility.

15 You've discussed it yourself. You've put it in your

16 conditions, to modernize it and to keep jobs. In

17 addition to that, they have promised $25 million

18 separate from the purchase price to make improvements to

19 the facility. Not a single suitor has done that to

20 date. And to say that there are other options

21 available, I think you know the truth about that, Deputy

22 Attorney General Horwitz.

23 We were not silent when we declared

24 bankruptcy. We did not keep it under the rug. It was

25 public. You have been present at those discussions. We

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1 have made all of our financials available to anyone of

2 interest. To say that we limited it to anyone is

3 incredible. We were looking for what's best for the

4 community, and that's what the board is discharged with

5 a duty to do.

6 Through this sale, modernization will bring

7 more confidence to this hospital. There will be

8 opportunities for economies of scale with a larger

9 organization and opportunities to provide more services

10 to the community. There are things that we do that

11 Desert Valley doesn't do as well as us. There are

12 things that we don't do as well as Desert Valley does.

13 Our hope is to create, I think -- at least I should say

14 not ours. Theirs, I think, is to create centers of

15 excellence, to provide more services so that we can have

16 enhancement of services. And I think that that is a

17 good synergy and that makes economic sense in this

18 economically depressed community.

19 Finally, I would be remiss if I didn't mention

20 Prime Care itself. Their principal, Dr. Reddy, is

21 himself a community member and you've heard the

22 extensive history of altruism. But not only has he been

23 bold enough to step into this breach with Victor Valley

24 Community Hospital, he has done so under your scrutiny

25 in other transactions that were reviewed by your office.

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1 Paradise Valley in Sherman Oaks come to mind, hospitals

2 that were steeped in a tradition altruistic caring and

3 community involvement. And also, before Prime Care,

4 they were on the verge of collapse. Their accusations

5 were reviewed and authorized by you and your office.

6 And, Ms. Horwitz, how did they perform? What was their

7 grade then? They have a record with those hospitals of

8 keeping the promises they made to you and to their

9 employees and the community. That is something they

10 have to document with you, and you have that before you.

11 And not only did they do it in the time frame that you

12 had requested, they had done it beforehand. I know that

13 you have experienced that personally. You have placed

14 restrictions and regulations, and I know that they've

15 met them. And this was not lost on the board when we

16 had to come to the difficult decision in late June. And

17 I hope it's not lost on you, and I hope that that has

18 some impact on your decision.

19 I don't speak here because of some closeness I

20 have with Dr. Reddy. We're colleagues. He was, at one

21 time, a mortal enemy of my family. $5 million of my

22 inheritance went his way.

23 (Laughter.)

24 If there was someone who would have a reason

25 and an ax to grind, I guess it would be me. But I have

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1 a greater duty. As I do as an officer for the State of

2 California, the County of San Bernardino, and as an

3 elected board member, I have a duty to this community

4 and I feel good about that transaction. I think it's

5 the right thing. And I hope that you take serious

6 consideration in that. And I thank you for the

7 opportunity to speak to you.


9 Okay. We have Vicky Cabriales. Are you here,

10 Vicky? No. How about Peter Mort. And then, after

11 Peter is Eric Jenson.

12 COMMENTS BY PETER MORT

13 PETER MORT: Good evening. Yes, my name is

14 Peter Mort, spelled M-O-R-T. I appear this evening on

15 behalf of Victor Valley Hospital Acquisition, as you

16 know now, an alternative bidder to this transaction.

17 The notice and impact report prepared by

18 Medical Development Specialists are both designed to

19 inform the Attorney General and the public of the

20 possible effects that the proposed transaction may have

21 on the delivery, accessibility, availability, and

22 availability of healthcare services in this service

23 area. Using that information, it is incumbent upon the

24 Attorney General to decide whether this transaction is

25 in the public interest. Before making that decision,

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1 the Attorney General is required to consider whether

2 sufficient information or data has been provided by the

3 applicant to evaluate adequately the agreement or

4 transaction or the effects hereon -- herein -- here of

5 public. That is Section 995, subsection F7 of Code of

6 Regulations. In fact, the Attorney General has the

7 authority to request at any time additional information

8 that it might need to render its decision.

9 And my point this evening will be that indeed

10 you need additional information. The notice in the

11 impact report failed to provide the Attorney General

12 with information which will enable you to conclude that

13 this transaction is indeed in the best interest of the

14 public.

15 The notice and impact report failed to

16 adequately address at least three issues. First, it

17 failed to directly address how the relationship between

18 Prime Healthcare Services, Inc., and Prime Healthcare

19 Services Foundation might impact the delivery and

20 availability of the medical services to the Victorville

21 community. Secondly, the application fails to explain

22 how PHS's control of two of the three hospitals in the

23 community will impact competition. Third, they failed

24 to address how PHS Foundation likely cancellation of

25 both managed care contracts and other insurance

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1 contracts will impact the citizens of this community.

2 Stated otherwise, the issue that has been

3 discussed here this evening again and again is that the

4 hospital should not close. But what has never been

5 adequately addressed is whether or not the hospital

6 should be closed to some. Without added consideration

7 of the cancellation of these contracts, you are

8 acknowledging that there will be the closure of this

9 hospital to some people, just not to others. That has

10 not been evaluated.

11 Let me address these issues. Of critical

12 importance to the Attorney General's evaluation of this

13 transaction is the understanding of who the buyer really

14 is. Now, it has been, just a moment ago, addressed to

15 the fact of kind of the history and the goodwill and all

16 these things going on with PHS and that the Attorney

17 General has already had the opportunity to it review

18 transactions concerning Prime Healthcare Services. But,

19 in fact, it's not Prime Healthcare Services that is the

20 buyer. It is the Foundation. And that has never been

21 before the Attorney General. The two hospitals that it

22 currently owns did not come before the Attorney General

23 for approval, because they were donated by a for-profit

24 entity to a not-for-profit entity and were not reviewed

25 and ruled upon. This is actually the first opportunity

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1 that you have to address PHS Foundation -- that is, this

2 particular buyer. And their has been, perhaps

3 unintentionally, a blurring of the lines between what is

4 PHS and what is PHS Foundation.

5 The impact report and other available

6 information reveal that PHS Foundation is run as part of

7 an overall network of PHS. Indeed, if you look at the

8 Website for PHS, you'll see all these hospitals listed

9 without distinction. If you look at the section

10 required under 995D9 of the notice, Prem Reddy is listed

11 as the sole director of the Foundation, and we know he

12 is the director of the PHS. Likewise, Dr. Reddy is the

13 president, and Michael Sarrao, the secretary and

14 treasury of both the Foundation and of PHS.

15 We've heard recently that a new board has been

16 proposed and is being added to the Foundation. What was

17 not disclosed is that if you look at the bylaws of the

18 Foundation under Section 2.2, you will find that

19 notwithstanding any other members being appointed, no

20 decision may be made unless Dr. Reddy is personally in

21 the majority of that decision. He controls the vote.

22 So this board which has recently been added nonetheless

23 will be powerless in the face of Dr. Reddy's discretion

24 and what he wishes to do.

25 The recent addition of this board also gives

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1 rise to another issue. Under the statute, the Attorney

2 General's required to take a look at the issue of both

3 inuring and self-dealing, and that has been done with

4 respect to the nonprofit seller. But neither in the

5 application nor in the report has there been any

6 discussion of the nonprofit buyer. The Attorney

7 General, indeed, has both authority and responsibility

8 for reviewing that entity and whether or not this

9 transaction is in the best interest and could, in fact,

10 inure to the benefit or self-dealing as between PHS and

11 the PHS Foundation, the nonprofit.

12 This confusion between PHS and PHS Foundation

13 is also contained within the report, the impact report.

14 For example, the blurring of these lines creates some

15 issues on the financials. When I look at the report

16 under the key statistics regarding PHS Foundation, MDS

17 suggests that the PHS Foundation had a net income last

18 year of 10.6 million based upon financials from the

19 hospitals in Encino and Montclair. The report then

20 states that the income for these two hospitals was,

21 quote, up 104 percent from 2009. But these numbers are

22 incorrect. At the end of 2010, they may have owned two

23 hospitals, but the data that is being provided is for

24 four years -- two years for Encino, two years Montclair.

25 The two years for Montclair, during that period of time,

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1 the Foundation didn't own those hospitals. The Encino

2 Hospital is only owned for one of those two years. So

3 three of the four years for financial data being

4 referenced as being the financial data of PHS Foundation

5 are, in fact, financial data for PHS. This confusion

6 needs to be straightened out and evaluated. In fact, if

7 one backs out those other years, it is not that they had

8 a 10-million-dollar profit; but, in fact, you look at

9 Encino's performance in that one period, and you find

10 that their income -- net income went down from

11 4.6 million to a little under 3 million, for a reduction

12 of about 35 percent.

13 The issue here is not whether this is good

14 business for PHS, whether or not their financials are

15 good. The issue is whether or not this is being

16 properly evaluated for this buyer, the Foundation.

17 In California Code of Regulations Section

18 99E3, requires the notice to address that possible

19 (unintelligible) and self-dealing. And the section

20 specifically says as for any nonprofit corporation

21 involved in the transaction. I would -- I would invite

22 you to review that regulation. Elsewhere, it will talk

23 about the applicant or it will talk about the transferee

24 to distinguish between those parties. But here, it

25 doesn't do that. It speaks only to the issue of any

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1 nonprofit. There has been no analysis whatsoever

2 anywhere with respect to Foundation.

3 I think it's particularly important here where

4 this relationship between the Buyer and PHS, a

5 for-profit and a not-for-profit are so intertwined. For

6 example, we know that there has been a positive issue

7 that has been presented that, quote, the Buyer here is

8 going to make contributions in the future of $25 million

9 for improvements to this facility, an honorable thing

10 indeed. But what is not revealed is how this is it

11 going to incur -- or occur, pardon me. Will there be,

12 in fact, additional funding coming from PHS, recognizing

13 that in the past all funds to PHS Foundation has come

14 from either PHS or Dr. Reddy? Are there agreements for

15 this additional funding to flow? Are there loans that

16 are going to be occurring? Are there relationships

17 between these two entities and agreements between the

18 two which need to be disclosed, which need to be

19 evaluated for you to have a proper evaluation of whether

20 or not this is in the public interest. Imagine, if you

21 will, that there are such agreements. We don't know at

22 this point because nothing's been disclosed. But if

23 there are, the ability for PHS, given its

24 cross-directorship, cross-officership, and any financial

25 arrangements between PHS and PHS Foundation really means

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1 that this Foundation will be directly controlled by not

2 its board, but by PHS, something which needs to be

3 evaluated.

4 If, in fact, there is this control, then a

5 second issue is presented, about whether or not it is in

6 the public's interest that two of the three hospitals in

7 this community are, in fact, under the control of one

8 board, one set of officers.

9 In the Attorney General's requirement to

10 consider, it says that the Attorney General shall

11 consider whether the effect of the agreement or

12 transaction may be substantially -- or could be

13 substantially to lessen competition or tend to create a

14 monopoly. There's actually been nothing in either the

15 evaluation by the impact report nor in the notice

16 application which has addressed the issue of that

17 section, except on behalf of the seller -- pardon me,

18 except on behalf of the following comment that, quote,

19 there's no Hard Scott Rodino [phonetic] filing. That's

20 the beginning and the end of the analysis of

21 competition. No Hard Scott Radino filing is required

22 for this transaction.

23 So we do not have the information available to

24 the Attorney General, to the public to evaluate what the

25 real impact on competition will be, because no analysis

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1 has been done, no information has been forthcoming.

2 The last issue, I touched on briefly already,

3 but let me just mention it again and that is the

4 cancellation of contracts. It's no longer an issue as

5 to whether it is the practice of PHS to cancel

6 contracts. As I was listening to the comments of

7 others, particularly the Nursing Association, they refer

8 to one of the other hospitals that they were involved

9 in, which was Garden Grove.

10 So I looked up the counter-data for Garden

11 Grove. In 2005, the period of time prior to the

12 acquisition of that hospital by PHS, the encounter data

13 for the emergency room show that 54.18 percent of those

14 people entering the emergency room were under HMO

15 contracts. Following the acquisition by PHS,

16 2.82 percent of those people were now HMO admittees. A

17 vast number of people were simply no longer going to

18 that hospital. HMOs had been locked out. And even

19 essentially, when they have this business plan of going

20 into the emergency room, people learned to go elsewhere

21 or they go without services.

22 Centinella Hospital is the another one where

23 these contracts were canceled. It started in '05.

24 Before the acquisition by PHS, over 30 percent were

25 HMOs. After the acquisition by PHS, less than

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1 7 percent.

2 So there's not a question here of whether

3 there is a practice of canceling the contracts. And in

4 this particular instance, at the time that the report

5 was done, it was noted that they would have the

6 opportunity to be using the bankruptcy system whereby it

7 would be the rejection of the contracts. That could

8 happen. We now know that, in fact, all of those

9 contracts were canceled. They've been rejected by the

10 debtor to free up the buyer to negotiate whatever new

11 contract it wants to. Now, it his good to hear that

12 they recently concluded one with IEHP. But they have

13 not with Choice. They have not with others. So there

14 is, in fact, a pattern and practice which will show that

15 there will be a significant number of people who will

16 not receive services from this hospital if, in fact, you

17 allow this transaction to go forward.

18 So let me just conclude by saying again there

19 is no one in this room who wants this hospital to close.

20 But there is a group in this hospital -- in this

21 auditorium today that would close this hospital to a

22 significant number of the members of this community.

23 There is an alternative plan. There is an alternative

24 buyer which has not been considered, that would, in

25 fact, allow for service to all of its community. I

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1 would endorse what everybody said. Don't close the

2 hospital. Don't close it to anyone. Thank you.


4 Eric Jenson, are you here?

5 Diana, do you need a break?

6 We'll, okay. I'm going to call from folks

7 that signed up. Is John Petty here?

8 COMMENTS BY JOHN PETTY

9 JOHN PETTY: Thank you, Ms. Horwitz. John

10 Petty, J-O-H-N-P-E-T-T-Y. I think it's interesting as

11 I've sat here today, listening to this testimony, that

12 as someone who purports to be a committed member of this

13 community is not here. Where is Dr. Prem Reddy today?

14 In full disclosure, I represent Dr. Kali

15 Chaudhuri. Dr. Chaudhuri was here for three hours. He

16 drove a hundred miles to be here. In fact, he actually

17 cut short a trip to India to come back to be here today.

18 And my colleagues, Mr. Mort and Mr. Thomas,

19 have indicated that there is an alternative on the

20 table. It's no secret that there is a cloud hanging

21 over the County of San Bernardino, and there's a cloud

22 with this hospital. It's a dark cloud. I would suggest

23 that the last thing that this community needs is a

24 furthering, a darkening of that cloud.

25 One the things that has been discussed here

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1 today has been information provided by a periodical

2 called "California Watch." I'd like to submit for the

3 record, if I may approach, a series of -- a series of

4 five articles that have been developed over the last

5 several months. In my opinion, it's some of the best

6 investigative journalism that I've seen in quite some

7 time. Don't believe the SCIU. Don't believe anybody

8 else that you've heard here today, because I suppose you

9 could say that we all have, you know, dogs in this

10 fight. But an independent investigative journalist --

11 actually, more than one, actually, more than two -- have

12 taken a look at this, taken a look at this transaction,

13 taken a look at Dr. Reddy, and developed a series of

14 articles that, I think, are fairly irrefutable.

15 If the question is what is motivation of Prime

16 Healthcare in acquiring this hospital, I think --

17 And, Ms. Horwitz, you -- you indicated before

18 to another speaker, you know, come up here and speak

19 your heart. And I appreciated that. I can tell from

20 watching you here today, this is not a fait accompli.

21 This is not a proforma exercise. You genuinely want to

22 hear from this community and want to here other

23 viewpoints.

24 I was most struck by the series of articles,

25 and I'm sure you've read this before; but if you

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1 haven't, I want to repeat it. Where it's not somebody

2 that's having hearsay evidence, it's a quote from

3 Dr. Reddy, who is on the stand. When asked by an

4 attorney in a case in San Bernardino Superior Court,

5 during the period of time when he was actually in the

6 emergency room at one of the hospitals that he acquired,

7 did he not say, "This is a gold mine," while holding up

8 a series of patient files, indicating higher Medicare

9 reimbursements. "This is a gold mine," an impromptu

10 statement by someone who owned the hospital, actually

11 shuffling patients in and out of an emergency room.

12 What does that tell you about how this

13 hospital's going to be run? My colleague, Mr. Mort,

14 indicated that competition something -- or lack thereof

15 is something that has not been properly addressed.

16 Mr. Dalton, I -- I went through your report.

17 With all due respect, there was a short paragraph on any

18 kind of pending investigation on Mr. -- on Dr. Reddy and

19 Prime Healthcare and almost nothing on the competitive

20 issue of if Dr. Reddy gets control of Victor Valley

21 Hospital. Those are key elements that need to be

22 investigated.

23 And I think when the Attorney General does its

24 proper due diligence of this transaction, in light of,

25 hopefully, the testimony that's been provided here

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1 today, it will conclude that the other alternative on

2 the table is a better alternative. Victor Valley

3 Community Hospital cannot stand another cloud.

4 And I was particularly moved by the testimony

5 of -- I want to make sure I pronounce it right -- Kulyas

6 and her son Mark.

7 And the statement that has stuck with me after

8 listening to the people that were paid to appear here

9 for Dr. Reddy today, and that is the friends have been

10 purchased; the enemies have been earned. Thank you.


12 (Applause.)

13 HEARING OFFICER: (Unintelligible.)

14 DEPOSITION OFFICER: I didn't hear you.

15 HEARING OFFICER: Oh, okay. Why don't you

16 just make a quick announcement, and then you can go.

17 UNIDENTIFIED MAN: The interpreter?

18 HEARING OFFICER: Oh, you're not the

19 interpreter, are you? No, she already left. That's

20 okay.

21 Okay. Sharon Magma, Magama. Okay. How about

22 Martha Brodie. Great. And after Martha, if

23 Mary-Ellen Olivas is here. Please just come on up and

24 wait behind her.

25 COMMENTS BY MARTHA BRODIE

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1 MARTHA BRODIE: Good evening.

2 HEARING OFFICER: Good evening?

3 MARTHA BRODIE: We spoke before. I --

4 HEARING OFFICER: Martha, can you say and

5 spell your first name?

6 MARTHA BRODIE: My first name is Martha,

7 M-A-R-T-H-A. My last name is Brodie, B as in boy,

8 R-O-D-I-E.

9 HEARING OFFICER: Great, thank you.

10 MARTHA BRODIE: I am not only a 27-year

11 resident of the High Desert, I am the director of

12 business development for Homestead Senior Care. We

13 provide nonmedical care for seniors in their home. I am

14 the cofounder of the High Desert Senior Forum for the

15 High Desert. And I'm also a member of the Foundation

16 board for Victor Valley Community Hospital.

17 First, I want you to know, and I want it on

18 the record, I was not paid or asked by Prime Care or by

19 Victor Valley Community Hospital to speak today. I want

20 you to know I'm first going to speak to you on a

21 personal level, and I'm going to try and keep my

22 emotions in check.

23 Three years ago, um, my father became ill and

24 we called 911. And, um, he has Kaiser Permanente. And

25 if you know anything about Kaiser Permanente, they only

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1 have a clinic here in the High Desert. So if you get

2 sick and you're a patient of theirs, they're contracted

3 with St. Mary's in Apple Valley.

4 And when we called the paramedics, at the time

5 my dad was 80 years old, and I'm his power of attorney

6 for medical. Um, I asked the paramedics what was the

7 waiting time at St. Mary, and it was six hours and I was

8 not going to have an 80-year-old senior, my father lay

9 on a gurney and wait to be seen by a doctor. I made the

10 choice to take my father to Desert Valley on Thursday

11 night. And anyone who knows the HMO industry and you're

12 out of area and you're out of hospital, you have to get

13 permission. And, um, my dad had a heart condition, and

14 Kaiser approved him to stay there for -- through the

15 weekend, because my dad was not stable enough to be

16 moved. And because I'm such a community involved

17 person, everybody just assumes that it's because of who

18 I am. Well, those people didn't know who I was from

19 Adam. And my dad got excellent care at Desert Valley

20 Hospital.

21 And not too many people know this, but I want

22 you to know this. Two and a half years ago, I collapsed

23 at home. And my son-in-law's a paramedic, fireman for

24 San Bernardino County Fire Department, and he was there

25 when I collapsed. And he told the paramedics, after my

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1 husband had called them and they worked on me, to take

2 me to Victor Valley Hospital because that's my hospital

3 of choice. On my insurance card, that is my hospital of

4 choice, and I have an HMO and I pay dearly for that

5 coverage through my employer.

6 That was a Monday morning at 7:00 o'clock.

7 And my husband is my power of attorney and made all the

8 decisions on my care. And when I woke up, it was

9 Wednesday afternoon, and my husband told me, "Your

10 picture doesn't hang on a wall here as being on the

11 Foundation board and none of these nurses knew who you

12 were and you got phenomenal care."

13 So I've had the experience of both hospitals.

14 That's my personal story.

15 My professional interest here is the seniors

16 that I represent in this community for the last 27

17 years. And I'm a senior myself, and I am an advocate

18 for them because there are a lot of seniors out there

19 that can't speak for themselves because they don't know

20 the system or where to go or what to do or what to ask

21 for and that's why I'm proud of who I am and what I do

22 in this community.

23 And I stood before you I don't know how many

24 months ago, saying let's approve and sell this hospital

25 and let's move on. Because, like some people say, you

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1 know, kind of irritating me when you said there's a

2 black cloud hanging over this High Desert. I want you

3 to know something. I worked very hard for the

4 Foundation of Victor Valley Community Hospital, and

5 people like me raised a lot of money for that hospital,

6 and a lot of doctors from every medical group gave

7 donations to that hospital. There's no black cloud in

8 this High Desert. There's just a little confusion. And

9 we're tired and we're tired of asking and it's just --

10 it's --

11 Every community leader in this High Desert

12 spoke here today. We're -- it's time to be over. It's

13 time to move on. It's time to put this hospital back

14 together for our people that need it, for the seniors

15 that need it, for the children that need it. And let's

16 move on. Let's sell this hospital.

17 I don't want to be here three or six months

18 from now going through the same thing. I don't. I'm a

19 community leader. I'm an advocate. I'm supposed to

20 help people. I shouldn't be here again all evening

21 because the last sale didn't go through for whatever

22 reason. And I didn't ask. I'm just -- I'm done. And

23 as a community leader -- and I speak for a lot of

24 people -- we just want it to be over with. We want the

25 sale of this hospital to go through in 13 or 14 days. I

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1 want my dear friend Cathy Pelley to retire, enjoy life.

2 I do, Cathy.

3 CATHERINE M. PELLEY: I know.

4 MARTHA BRODIE: We're tired. I want to

5 continue to be involved in this hospital. All I ask you

6 is to, in 13 days, please don't tell all of us in the

7 High Desert that there is no sale. We need to sell this

8 hospital. We need to rebuild this hospital. And people

9 in the community like myself, we want to raise money for

10 those less fortunate and continue to do what we do in

11 this High Desert. And I thank you for your time once

12 again.


14 Appreciate it.

15 Is Mary-Ellen here, Mary-Ellen Olivas? Okay.

16 How about Dr. Mamo? Okay. Paul Russ? Great.

17 Just before you start speed, Paul, is Sherry

18 Gill --

19 UNIDENTIFIED WOMAN: Hall.

20 HEARING OFFICER: Hall?

21 UNIDENTIFIED WOMAN: H-A-L-L.

22 HEARING OFFICER: Okay. Great. Sherry, why

23 don't you just come forward.

24 Paul, please say and spell your name.

25 COMMENTS BY PAUL

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1 PAUL RUSS: Good evening. My name is Paul

2 Russ. The last name is spelled R-U-S-S, as in Sam Sam.

3 I don't have any prepared remarks today either, but I'm

4 going to come up here and speak from my heart.

5 I've been a resident of the High Desert since

6 1988. I am a member of the Hesperia Planning

7 Commission, and I'm a senior vice president and regional

8 manager for American Security Bank bank up here. So I

9 spend a lot of my time in community banking and being a

10 businessman up here. As a matter of fact, I made

11 Dr. Reddy his first loan in a nonmedical venture

12 20-something years ago to buy an Arco, of all things.

13 That was back when a million dollars was a million

14 dollars.

15 So I've had a business and personal

16 relationship with Dr. Reddy and Prime Healthcare for

17 many years, and I would speak in favor of this. And I

18 can tell you, as a cancer survivor myself and someone

19 that's unfortunately had many other medical illnesses

20 throughout my life, the local access and local care is

21 very important to me and my family.

22 Now, a lot of things have been said here today

23 and tonight, a lot of cons, a lot of pros, substantially

24 more pros, I think, than con. And I think that would --

25 you could translate that throughout the community.

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1 A couple things. One is when you look at the

2 employment, that the impact in employment, this hospital

3 cannot close. Whether it's Prime Care that buys it or

4 you had an alternative, whatever that one was, it cannot

5 close. One of the things that was discussed here today

6 was the impact of jobs. Well, yeah, we're going to lose

7 500 jobs if that happens, and that -- that would be

8 devastating. But one of the theories in economics, of

9 which I am a trained economist by trade also, it would

10 tell that you in private sector, when you're looking at

11 jobs like this, not only will you lose those jobs,

12 there's a multiple effect. And probably in the private

13 sector here, you could probably estimate that that's

14 about seven times. So if you look at that, that's an --

15 not only 500 jobs. You're probably looking at an

16 additional 3500. So this is probably -- if that

17 hospital ended up closing, you're probably looking at

18 4,000 job in all of Victor Valley and community, which

19 would be absolutely devastating for us up here. Whether

20 you believe Mr. Russ Blewett or Councilman Russ or Joe

21 Brady, is it 18 or 25? Regardless, you add 4,000 people

22 on top of that. And a couple others like that. That

23 could be the nail in the coffin for this beautiful area.

24 So we don't want to -- we cannot allow that to happen.

25 The other thing I'd like to talk to you about

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1 is that I kind of notice, listening through all this

2 stuff here and listening to all the comments, SCIU that

3 came up with these numbers and the old adage "Numbers

4 don't lie, but those that figure to do" comes to my mind

5 on that, because they just don't logically add up.

6 Okay? And one of the things here is they said, well,

7 they made over $200 million for diagnoses on one area,

8 and they made 50 million on another from the diagnoses

9 and -- well, another gentleman came up here and said,

10 well, their company only made $10 million. Well,

11 logically, looking at that, without digging into any of

12 the numbers -- and you have all the numbers; you can

13 probably look at that -- that would mean if you took

14 that money out that he actually lost over 200 million in

15 operations because they didn't have that extra money.

16 He only made ten -- it's just not a credible case.

17 Maybe you have one case and they extrapolate it out and

18 came up with some ridiculous number. But if you

19 actually look at the numbers, logically they can't

20 happen. And if one says something that is incorrect

21 about something, I think you as an attorney would

22 probably say they would discredit and throw out all that

23 information because they have a vested interest in the

24 outcome. So I would look at that with a little

25 sceptical eye and implore the Attorney General to ignore

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1 all that information from the SCIU.

2 Again, I'd like to thank you. It looks like,

3 again just coming into this process, looking at it, that

4 you spent many hours, you and your staff and the state

5 and buyer, seller, community. And it looks like you've

6 really put your heart and soul, from your report, what

7 you've done, into this and I'm sure that you will come

8 up with the proper decision. And I think that the

9 community, if anything is said from here today, it would

10 be to do that, and this area cannot lose that hospital.

11 It would just be devastating. So thank you very much

12 and have a good evening.


14 Okay. Sherry. And then, is Joseph Monte

15 here? How about Diana Basiles? Okay. Diana, why don't

16 you just come on up here.

17 COMMENTS BY SHERRY HALL

18 SHERRY HALL: Thank you for my -- taking my

19 comments.

20 HEARING OFFICER: Could you spell and -- say

21 and spell your last name.

22 SHERRY HALL: I'm Sherry Hall, H-A-L-L. I'm a

23 High Desert homeowner. My family has lived in the High

24 Desert for over 21 years. We have a problem in

25 San Bernardino County with too many public officials and

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1 institutions that we just can't trust. It seems every

2 time I open my paper, another County official is under

3 indictment for something, and we just get used to it.

4 When it comes to a hospital, this problem gets

5 real personal. I'm expecting my first baby this

6 February. I've heard over at Death Valley -- I mean

7 Desert Valley that they send their pregnant women

8 through the ER to give birth, and that probably means

9 automatic c-sections. That's really scary. There are

10 sick people there. Also, these -- you know, these -- it

11 looks like the procedures aren't necessary, but they are

12 risky.

13 There are other buyers in this area. There

14 are other buyers that would like the chance to purchase

15 this hospital. They'd like to step up.

16 And I just want to say that my baby and I, we

17 are not a gold mine. We are people and we need good

18 care. So thank you for taking my comments.


20 Appreciate it.

21 COMMENTS BY DIANA PASILLAS

22 DIANA PASILLAS: Good evening. I'm Diana

23 Pasillas, D-I-A-N-A-P-A-S-I-L-L-A-S. Before I go, my

24 condolences to the family and the people here that have

25 lost loved ones, especially to cancer, because I too

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1 know what it's like to lose a loved one or a good

2 friend. So God bless.

3 I currently hold the position of manager of

4 provider and public relations for Choice Medical Group

5 up here in the High Desert. However, I'm really here

6 today as a long-time citizen of this community. I've

7 been a resident of the High Desert since 1960, when my

8 dad was transferred out here to the then-George Air

9 Force Base and where he retired and then further retired

10 from a large school district up here.

11 Growing up here, I went to high school, went

12 on to Victor Valley College, and went on with my career,

13 my degree and, um, have always worked in healthcare. My

14 family and I have maintained residences up here in the

15 High Desert since that time, when my dad originally

16 moved here in the '60s, and my family and I have all

17 personally received medical services from Victor Valley

18 Community Hospital.

19 Most recently, I received an incisional biopsy

20 and a lumpectomy surgery for treatment of breast cancer

21 in 2004 at Victor Valley Community Hospital and followed

22 with more treatment from a local oncologist,

23 Dr. Vernanda, and radiation oncologist here in the High

24 Desert. And I'm proud to say that the quality and the

25 coordination of care that I received. I am a survivor,

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1 although the journey was scary.

2 With that said, I'm very passionate about

3 healthcare. Being in the healthcare delivery system and

4 working in contracting, in marketing, and knowing how

5 the system does work, we do have some great positions up

6 here in the High Desert, a lot that are very dedicated

7 to this community, not only from Desert Valley Hospital,

8 but to Victor Valley Community Hospital and St. Mary

9 Medical Center, and I've worked with all of them.

10 My background has always been in managed

11 healthcare marketing, and I have maintained employment

12 in this local medical community since 1985. I formerly

13 worked at Victor Valley Community Hospital. I've also

14 worked for the City of Victorville, where we're standing

15 here today, in addition to owning and operating my own

16 healthcare consulting business where I helped set up

17 physician offices and got them going on their

18 independent way.

19 My passion for these local physicians and

20 their affiliated medical groups and their patients is

21 very strong. I'm very committed to the success of their

22 well-being as well. Many of our local residents utilize

23 Victor Valley Community Hospital via their physician's

24 care through many of the independent medical groups up

25 here. The coordination of care between the physicians

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1 and the hospitals is so important for the positive

2 outcome of the health of the patient, and I'm living

3 proof of that.

4 One last concern is our seniors and the access

5 that they have to care as well. My father, who I

6 mentioned earlier, who brought us here to this High

7 Desert community, was battling lung cancer a couple of

8 years ago and received his treatment through one of our

9 local oncologists and received some care here at Victor

10 Valley Community Hospital as well. Luckily, he battled

11 it. He's over it. He's not yet out of the clear, but

12 you know, he's living proof that the care was very good

13 and he's living on. However, what I don't want him to

14 do, because he has macular degeneration disease -- he

15 can't drive at night. He can't really drive long

16 distances. So he has to have care local, and that's why

17 he stayed in this community, because the community did

18 provide good healthcare.

19 So in closing, as a citizen of this community,

20 my concern is not necessarily who the buyer is, but,

21 more importantly, that continued access to care and a

22 continued commitment of this hospital to its existing

23 carriers, meaning the health plans, much less the needs

24 of the patients. Therefore, I'm requesting that the

25 local residents via their health plan carriers and the

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1 local physicians continue to have access to Victor

2 Valley Community Hospital. Thank you.

3 HEARING OFFICER: Thank you very much. Do

4 have any written statement? Could you hand it to my --

5 DIANA PASILLAS: You know what? It's all --

6 I've been writing. I've been writing as I've been

7 listening so --

8 HEARING OFFICER: That's okay.

9 Okay. Okay. Pat Aguirre. And is Gregory

10 Zumbrunn here? Great.

11 Are you okay, Diana.

12 DEPOSITION OFFICER: Yeah.

13 COMMENTS BY PAT AGUIRRE

14 PAT AGUIRRE: Hello. My name is Pat Aguirre,

15 and that's A-G-U-I-R-R-E.

16 HEARING OFFICER: Sorry for the

17 mispronunciation.

18 PAT AGUIRRE: I'm currently -- currently an

19 employee at Encino Hospital, which is a Prime facility

20 and has been mentioned here quite a few times as being a

21 nonprofit. I'd like to talk to you about what I have

22 experienced since becoming a Prime employee.

23 I've been in healthcare for about 35 years,

24 and I work at a -- I've worked as Encino Hospital for

25 about 13 years.

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1 HEARING OFFICER: And what do you do at the

2 hospital?

3 PAT AGUIRRE: I am a phlebotomus, and before I

4 was a phlebotomus, I was a lab technician.

5 What I have scene since, um, July 2008, uh,

6 are just closures, closures and more closures. I spoke

7 to Lex Reddy about this a couple months ago when he came

8 to our hospital. When Encino Hospital became Prime, we

9 saw many physicians. We had, um -- we were known for

10 doing hips and knee surgeries. We had a surgical floor,

11 a medical floor. We had a sniff [phonetic] unit that

12 was always and still is full. We had mental healthcare

13 floor that is pretty full. And we had a rehab. But we

14 were known for our ortho work. And we had surgeons and

15 we had quite a bit.

16 What has since happened is that we lost our

17 surgeons and, because we don't have many surgeons now,

18 we lost our surgical floor. And when our patients were

19 healing, they would go to a rehab floor where we had an

20 excellent physical therapy department and would get them

21 up walking right a away. We don't have the rehab floor,

22 nor do we have many physical therapists anymore.

23 I've seen changes in the employees or, I

24 should say, the change in what employees are paid. Um,

25 it worries me because you get people who -- you get

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1 employees who are right out of school, that don't really

2 have experience and are kind of learning on the job.

3 That affects healthcare.

4 Um, I've seen, um, people have come -- I work

5 in the laboratories. So what I've seen directly is

6 patients are coming to the laboratory who used to come

7 once a month. They may have been patients from other

8 facilities, especially like Cedar-Sinai or other

9 facilities, but they lived in Encino, and they would

10 come to Encino Hospital to have their lab work done.

11 Well, they came to us and said I'm sorry; what used to

12 cost $50 of a co-pay is now costing me $500 because my

13 insurance carrier no longer allows me to come here

14 because insurances have been cut. Carriers have --

15 carrier contracts have been cut. That has affected

16 people in the community. I see and I -- and I wonder

17 about this. I'm not a nurse, but I see patients who,

18 when they become ill in -- more ill than they have been

19 before, say, someone from the mental health unit or

20 someone from our lung care unit, they're taken right

21 away to the emergency room instead of going to the

22 intensive care, instead of going to a medical floor.

23 They're taken to an emergency room where they're given a

24 battery of tests that could also be done in the

25 intensive care. But there's a little sidestep, a little

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1 extra trip to the ER.

2 Um, all of these things that I'm saying from

3 what I have seen. I'm trying to -- I don't have any

4 prepared notes. But I -- I see, you know, my fellow

5 employees come to work every day, asking what is the

6 census? How many people do we have? I heard today that

7 our hospital is officially -- has a 150 beds. We see 50

8 patients. We get really worried when we see 49, 48, 47.

9 You know, I hear from employees in the cafeteria, "I

10 only had to make 27 meals." It's --

11 And I've heard people here today say I don't

12 want to see this hospital close. But yet for many

13 people who had different insurances, our hospital is

14 closed to them, and that will happen here. For those

15 people who have insurances other than Prime or who are

16 not Medicare, Medi-Cal, this hospital will be closed to

17 them, so will all the other Prime facility. And that

18 will impact the community. It impacts the community

19 when you're -- when Prime employees are hired at way

20 below market level. And they have done studies on -- I

21 come from the San Fernando Valley. I've seen employees

22 that went from being a per-diem employee, making a

23 certain amount of money, and now want to become a

24 full-time employee and cut from $42 to $26. That is

25 outrageous -- and almost had their homes lost. That

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1 affects employees, what they can spend in this

2 community, and how they live. And I have seen people in

3 this room laugh in that employee's face.

4 I'm sorry for this.

5 HEARING OFFICER: It's okay. Don't worry

6 about it.

7 PAT AGUIRRE: As a healthcare worker, I see

8 myself as a patient advocate, because many of the

9 patients we see in our facility, they don't have a

10 voice. I have spoken up for patients and been ignored.

11 Many of us -- you know, I hear all these things about

12 Generation X and we're all getting older and there's

13 going to be a tremendous burden on the healthcare

14 facilities. But we're all going to be at a hospital

15 in -- sometime in our lives. I hope that each of us can

16 get the kind of care that we need, and not the care of

17 care that your daughter got. Thank you.


19 COMMENTS BY GREG ZUMBRUNN

20 GREG ZUMBRUNN: Good evening.

21 (Applause.)

22 GREG ZUMBRUNN: My name is Greg Zumbrunn.

23 DEPOSITION OFFICER: I'm sorry.

24 HEARING OFFICER: You're going to have to

25 definitely spell that one.

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1 GREG ZUMBRUNN: Z-U-M-B-R-U-N-N. I -- I'm not

2 an advocate for or against Prem Reddy. He's a

3 successful businessman. I admire him for that. I've

4 just been a resident of the Victor Valley for 37 years.

5 Two of my three children were born at Victor Valley

6 Hospital.

7 And I'm concerned about this sale. I'm

8 concerned mostly about not profit. I don't think

9 it's -- our only choices here are whether the hospital

10 stays open or whether it's -- closes. I think we're

11 unanimous we want it to stay open.

12 But what I'm concerned about is diversity.

13 We're looking at, now, two of the three hospitals that

14 are going to be controlled by, if not exactly the same

15 entity -- although there's some confusion. I see

16 references to, well, it's not actually going to be owned

17 by Prem Reddy as if that's a selling point. But then,

18 throughout these proceedings and in the press, then it's

19 also -- and it seems to be a selling point. It is

20 controlled by that. But nevertheless, I think we're

21 going to have the shared philosophy. And I am concerned

22 about the lack of access for my family, for my friends,

23 for my neighbors and having that philosophy control two

24 of the three hospitals up here. Um, I -- I'm concerned

25 about the lack of diversity, the lack of contracts that

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1 this hospital and its management will have to honor.

2 And as a resident here, I've been here 37

3 years. I plan on being here another 37 years. I want

4 to make sure that there is access and even the best, uh,

5 and most well-intentioned person, if they are

6 controlling and have a virtual monopoly on basically all

7 of the western High Desert here, Victor Valley as well

8 as Desert Valley, that is of great concern to me.

9 I would ask that this committee particularly

10 evaluate the other alternative so that we have the

11 diversity of three different philosophies in the High

12 Desert. Give the people here a choice so that we have

13 access to contracts that benefit all members of the

14 community. Thank you very much.


16 You know what? I think we have one other

17 person.

18 DEPOSITION OFFICER: Okay.

19 HEARING OFFICER: So we're almost done. Is

20 that all right?

21 DEPOSITION OFFICER: That's fine.

22 HEARING OFFICER: Okay. Valerie Johnson, are

23 you here? (Inaudible) she's out there.

24 And just as a quick note, is there anyone else

25 who wants to speak, who didn't fill out a sign-up sheet?

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1 Oh, yeah, there's -- I've got -- actually, you know

2 what? Let's hear from Valerie. We're going to just

3 take a super short break. I got a couple of people

4 more. I forgot about that.

5 Go ahead, Valerie, and then we're going to

6 just take, really, like, five minutes. And then we're

7 going to finish up hopefully by eight o'clock tonight.

8 Go ahead, Valerie. I want to hear from you.

9 COMMENTS BY VALERIE JOHNSON

10 VALERIE JOHNSON: Okay. I'm Valerie Johnson.

11 It's V-A-L-E-R-I-E-J-O-H-N-S-O-N. And I'm sorry for the

12 way I appear. I didn't know we were going to comment

13 here.

14 HEARING OFFICER: No worries.

15 VALERIE JOHNSON: But we actually -- I

16 actually e-mailed your office, too, about this.

17 But I've been a resident here in Victorville

18 for 26 years. My husband and I are homeowners here. My

19 husband is a teacher for Victor Elementary School

20 District. And for all of the teachers in our district,

21 we're on Blue Shield contracts. So if you're not HMO,

22 you're Blue Shield. And this sale to Dr. Reddy will

23 severely limit where we can go. I mean, we're all going

24 to be funneled into St. Mary's, which we know they can't

25 take the overflow. They're already overcrowded there.

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1 So this really affects us. And also, I'm sure -- I'm

2 not positive, but other school districts must have the

3 same issue up here, with having contracts that won't

4 be -- that will be canceled for them too as well.

5 So, I mean, as far as money goes, it's sounds

6 like a lot of people here are talking about the money

7 aspect of it. But even if you think about just the

8 money aspect of it, we would have to take our business

9 down the hill, you know, if we can't find our healthcare

10 services up here.

11 And then, just on a personal note about Victor

12 Valley, my last child was born there and I almost died

13 having here. And if it weren't for that hospital and my

14 doctors there that were able to quickly get me into

15 surgery and get the care I needed, I wouldn't even be

16 here today. So I just wanted to say it's a great

17 hospital. And this is not the only option, we've been

18 told, for the sale. I mean, obviously we know it has to

19 be sold. But is this the only option? No. So this

20 seems to be the worst option, and we want another

21 option. And that's it.

22 HEARING OFFICER: Okay. Great. Thank you.

23 Okay. We're going to go ahead and go through.

24 Chung, did you want to say something? Yeah, come on up.

25 UNIDENTIFIED MAN: Is that okay with you?

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1 HEARING OFFICER: Yeah.

2 COMMENTS BY STEVEN SCHWARTZ

3 STEVEN SCHWARTZ: Hi. My name is Steven

4 Schwartz. I'm an attorney with the Law Office of

5 Danning, Gill, Diamond & Kollitz. My last name is

6 Schwartz, S-C-H-W-A-R-T-Z. First name is Steven,

7 S-T-E-V-E-N. I represent the official committee of

8 creditors holding unsecured claims in the Victor Valley

9 bankruptcy case.

10 One of the important considerations in

11 approval of a bankruptcy sale is the benefit to the

12 unsecured creditors in the bankruptcy estate. Now,

13 Dr. Reddy's company, at the initiation of the bankruptcy

14 proceeding, was the stalking-horse bidder, and was

15 involved in an auction sale and was outbid by VVHA, whom

16 you've heard from in various iterations here today.

17 That deal, the winning bid was to provide a

18 full payment to the unsecured creditors of this estate.

19 And after six months of negotiation and frustration,

20 VVHA failed to close and it looked like all hope was

21 lost for my constituents. And Dr. Reddy, to his credit,

22 stuck with the transaction and offered to continue as

23 the backup bid for $35 million, which will provide a

24 significant distribution to the unsecured creditors.

25 Now, VVHA had the opportunity to close, but it failed to

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1 do so.

2 We believe that doctor -- Dr. Reddy has shown

3 integrity in sticking with the transaction and providing

4 something significant to creditors, many of which will

5 continue to do business with the hospital and provide

6 jobs and money into the local economy. By contrast,

7 VVHA now comes here and advocates to buy the hospital

8 for $7 million less than it bargained for, doing so on

9 the backs of the unsecured creditors and wiping out any

10 hope of a significant distribution in this bankruptcy

11 case.

12 The committee supports the sale and recommends

13 the approval. Thank you.


15 Charlie?

16 COMMENTS BY CHARLES SLYNGSTAD

17 CHARLES SLYNGSTAD: Thank you. My name is

18 Charles. Last name is Slyngstad. It's spelled

19 S-L-Y-N-G-S-T-A-D. I'm an attorney for Victor Valley

20 Community Hospital and have been for 16 years. I have

21 worked on its behalf on various matters adverse to the

22 Buyer in this transaction. Actually the -- not the

23 Buyer, but Dr. Reddy and his profit company. And I

24 speak only because certain matters have been stated by

25 lawyers that need a response on behalf of the Hospital.

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1 And I will be short because I have noted that the

2 lawyers talk the longest, so I'm going to be short.

3 I need to specifically address the CLIA

4 certificate as a matter of record. The legal obligation

5 of the Centers for Medicare and Medicaid Services is

6 that it will not, quote, unreasonably refuse to extend,

7 unquote, the revocation of the CLIA certificate, quote,

8 for good cause, unquote. It is not any clause, which is

9 what Mr. Weisberg, I believe, said when he spoke earlier

10 today.

11 When the prior transaction failed to close on

12 May 31, we did not hear from the Federal Centers for

13 Medicare and Medicaid services about the CLIA

14 certificate for approximately five full weeks, while we

15 wondered whether or not that certificate was going to --

16 at that time, subject to a future revocation date,

17 whether that certificate would be extended or would not.

18 So when Ms. Pelley speaks of jeopardy to the hospital

19 based upon the CLIA certificate's status, that is real

20 jeopardy. It is not something that can be outsourced,

21 because we have made all of those phone calls through

22 the chief financial officer and the chief executive

23 officer of the hospital to try to get the outside

24 laboratories to take over those functions and they will

25 not do so. Outsourcing is not an option. And when

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1 Mr. Thomas said it was one during the VVHA sale

2 transaction earlier that failed, he misspoke.

3 There are no promises to extend that

4 certificate, and Mr. Seth Shapiro's statement from the

5 Department of Justice in Washington is not a promise

6 that is enforceable, as Mr. Shapiro will probably tell

7 you against the interests of his client, the Centers for

8 Medicare and Medicaid Services. Only that organization

9 can speak on its behalf through it's representatives,

10 and they are only committed to what's in writing.

11 That writing came as a result of an

12 administrative law judge's decision nearly over a year

13 ago now, and CMS did not seek that decision by the ALJ

14 judge simply for the sake of letting it be a piece of

15 paper that they will extend forever.

16 The alternatives we have if we do not close

17 are to go and take what is, in effect, the Victor Valley

18 Hospital Assoc- -- Hospital Acquisition offer that, as

19 Mr. Schwartz just said, is $7 million less. It is not

20 just $7 million less, but it is also far inferior.

21 The transaction with Prime is for $35 million,

22 subject to a potential credit of approximately

23 $3 million. As of today, that credit is less than

24 $100,000. So unless we get a lot of reimbursement money

25 from the supplemental payment due in another week under

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1 the 2010 supplemental payment program, or unless we get

2 money from SB90 before August 31, which is not

3 anticipated, that's -- money is due in September, we

4 will have a credit of, in all likelihood, less than

5 $500,000. And as I say now, it's less than 100,000. So

6 this transaction is far and above the best transaction

7 for the board of the directors of the comm- -- of the

8 Victor Valley Community Hospital to accept.

9 If the transaction goes through, I have heard

10 now, late, various statements made about monopolization.

11 Those statements are substantially uninformed, but

12 they're substantially voiced by Victor Valley Hospital

13 Acquisition, which has its own interest in mentioning

14 them. I noticed Mr. Mort spoke about how the

15 application to your office for approval of this sale did

16 not address enough the issue of lessening the

17 competition because it only referred to the Hard Scott

18 Rodino Act. That comment was never made when the exact

19 same disclosure was made to your office in November of

20 2010 in connection with Victor Valley Hospital

21 Acquisition's submission. They didn't think it needed

22 further examination or explanation then, but they do now

23 because it's in their interest.

24 But if one looks at simply a straightforward

25 comparison of the numbers of beds, if this transaction

182


1 goes through, there will be 184 beds between Desert

2 Valley Hospital and the acquired Victor Valley Community

3 Hospital. St. Mary's will still have 187 beds and will

4 have more than 50 percent of the market for beds.

5 And I apologize to people who have spoken

6 personally of interactions with the hospital on a

7 personal note, because from Victor Valley Community

8 Hospital's point of view, all we're left with at the end

9 of the day is money. So I know we affect patients'

10 lives in healthcare. But, really, as the seller, we end

11 up with cash, and that's the fact of it. But we will

12 not lessen competition in this marketplace.

13 And to the argument that we will lessen

14 competition because HMO contracts will either not be

15 renewed or entered into by the Prime Healthcare Services

16 Foundation organization, I just have a simple question.

17 Where were these doctors, the HMOs, and the PPOs for the

18 last dozens of years? Where were they the last five

19 years for this facility? They weren't admitting

20 patients. Dr. Eric Hansen spoke and stated how there

21 had been or there would be a monopolization.

22 (Interruption by cell phone.)

23 HEARING OFFICER: Can you hang on one second?

24 I'm sorry.

25 CHARLES SLYNGSTAD: Sure. Do you wish to take

183


1 that call?

2 HEARING OFFICER: Sorry. I couldn't find my

3 phone.

4 CHARLES SLYNGSTAD: Are you okay?

5 HEARING OFFICER: Yeah. No, I'm fine.

6 CHARLES SLYNGSTAD: I just need to make a

7 remark that Dr. Eric Hansen made the monopolization

8 remark about how this would impact Choice Medical Group.

9 He admitted three inpatients in 2009 to Victor Valley

10 Community Hospital, four in 2010, and one this year.

11 Dr. Gurpal Phaguda also spoke that he agreed

12 with Dr. Hansen. He admitted no patients in 2009, no

13 patients in 2010, and four this year. So I have to ask

14 again: Where have they been?

15 The commercial members of these HMOs and PPOs

16 may or may have not access as members of their group,

17 but they will still have access to medical care in the

18 community and from Victor Valley Community Hospital. It

19 may have a different interaction with them commercially,

20 but those members have not been coming to this hospital.

21 They just haven't been there.

22 We are largely supportive of the Medi-Cal and

23 Medicare and charity care in this community, and that is

24 the fact of it. So we are not going to impact

25 substantially the HMOs and Choice Medical Group and the

184


1 others. What it will cause them to do is go back to

2 St. Mary's, which is where they came from when this came

3 to Victor Valley.

4 Finally, to Victor Valley Hospital

5 Acquisition, I heard I forget which representative say

6 their interests have not been considered, and I just had

7 to smile the smile only someone who went through seven,

8 eight months of trying to deal with them to get them to

9 close the transaction kind of can have. All of their

10 interests have been considered throughout these

11 proceedings, and they did not close when they had the

12 ability to close. They kept negotiating, as -- as I

13 know you know, Ms. Horwitz, throughout those many months

14 and their price kept dropping. It started at 37 million

15 and then was readjusted downward so that it ended up

16 that we ended up having to agree to loan them $6 million

17 to try to make the sale close, and they still didn't

18 close.

19 Shortly after the transaction, Mr. Thomas

20 stated the Medicare problems came to light, and that is

21 not a correct statement. The transaction was due to

22 close on December 31. On December 18, they requested a

23 continuance and would not close it on December 31. We

24 extended it to February 28. The issues came up with

25 Medicare approximately a couple of weeks before that

185


1 closing date, which we then extended to the end of

2 April. We resolved within 60 days all of our regulatory

3 problems, not the six-month period that I heard at least

4 Mr. Thomas and perhaps one other speaker for Victor

5 Valley Hospital Acquisition refer to. And we resolved

6 those under a 4.5-million-dollar agreement to pay the

7 Centers for Medicare and Medicaid Services upon the

8 closing of this transaction.

9 They had until June 1 to finally close after

10 the regulatory issues were resolved. And they still, up

11 to the moments before that closing, a week before --

12 they still had no deals with Heritage, no deals with

13 IEHP, no deals with Choice, and no deals with the

14 Centers for Medicare and Medicaid Services on the terms

15 of taking over the Medicare Provider Agreement, all of

16 which was brinksmanship by them to drive the price down

17 and threaten not to close. They came up with many

18 issues.

19 And when you hear, now, statements by

20 Mr. Moore that there's some kind of information needed,

21 that there's some kind of confusion that he might have,

22 they are doing what they did for seven months. They are

23 making up more issues to delay the sale transaction at

24 the risk of this community hospital's existence, whether

25 that's from the CLIA closure or because of the

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1 diminishing balance of funds. We had, I believe it was,

2 approximately $8 million and its declining balance of

3 cash left.

4 There's no question, and we're not trying to

5 hide, Dr. Reddy -- Prem Reddy's relationship to Prime

6 Healthcare Services foundation or to Prime Healthcare.

7 But I can trust that the Attorney General's office, in

8 the oversight of this transaction, if it's approved over

9 the next five years, will have all of the capability to

10 acquire information regarding the relationship between

11 the for-profit Desert Valley Hospital and the

12 not-for-profit Victor Valley hospital, or Victor Valley

13 Community Hospital or whatever it is named after close.

14 But you should not allow someone who didn't

15 close the transaction after seven months come in and say

16 that there's an alternative, that they are it, and that

17 they have not be considered as an alternative. They are

18 using the allegations against Prime, and their comments

19 and criticisms of the application or the healthcare

20 impact report here in this case as a cover to try to

21 drop the price to 7 million -- by $7 million to

22 $30 million, resulting in net benefit to the

23 not-for-profit funds of Victor Valley Community Hospital

24 of close to $5 million in less money derived from that

25 alternative.

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1 And the board, when considering that

2 alternative or part of it, because they kept changing it

3 and they still do up to this date -- the board, when it

4 considered whether to approve this sale transaction,

5 fully considered the Victor Valley Hospital Acquisition

6 agreement, and one from DeanCo [Phonetic] as well, that

7 resulted in a substantial difference in price. And

8 unfortunately, that price is all we're left with, and

9 those $5 million will help get all of our creditors

10 paid. It will help get the settlement paid to the

11 Centers for Medicare and Medicaid Services, which goes

12 back, in some measure and some way, to the benefit of

13 the community. And we urge to you to approve the sale.


15 COMMENTS BY SUZANNE RICHARDS

16 SUZANNE RICHARDS: Good evening. Thank you

17 for giving me this opportunity to speak. My name is

18 Suzanne Richards, S-U-Z-A-N-N-E, Richards,

19 R-I-C-H-A-R-D-S.

20 First, I would like to offer my condolences to

21 both of you. The word cancer --

22 MARK KULYAS: No, it's not cancer. My sister

23 was intentionally murdered for financial gain, not

24 cancer.

25 HEARING OFFICER: Okay. Ma'am, really, just

188


1 stick with me here.

2 SUZANNE RICHARDS: Go ahead.

3 HEARING OFFICER: Great. You go ahead.

4 SUZANNE RICHARDS: Okay. Mr. Dalton, I've

5 heard a couple of times that they felt the report was

6 lacking in a few areas. I've seen several of your

7 reports, and I just want to say I think you did a very

8 thorough job, and MDS has always done an excellent job.

9 Little bit about myself. I am a registered

10 nurse. I worked a majority of my time in the intensive

11 care unit. And I do have a master's degree in

12 statistics.

13 One of the things I just wanted to bring to

14 the attention of the Attorney General is statisticians

15 are not doctors. We know you can't take means and

16 medians and draw inferences and conclusions off of them.

17 You should have confidence intervals. You should have

18 P-values, and you need to do more digging. You can't

19 just take a percentage and draw an inference and

20 compare. There's a lot of bias in that. Many variables

21 need to be controlled for when you want to make

22 comparisons.

23 Other things I wanted to mention. As you're

24 aware, there are many places that hospitals have to

25 report statistics. The National Health and Safety

189


1 Network, which will record all of our infections. CMS

2 has core measures. They have hospitalcompare.org.

3 A few things about the -- the reports with

4 CDPH. They didn't have infection-control issues on

5 them. They were looking at the doctors' diagnoses. We

6 would like the SCIU to take a look at the hospitals that

7 had higher values than Prime did, because they didn't

8 look at those and the hospitals that the SCIU

9 represents.

10 Let's see here. We have many agencies that do

11 review our hospitals. We are fully accredited by the

12 joint commission. We are fully accredited at three of

13 our hospitals and with HFAP, the Health Facilities

14 Accreditation Program. When these allegations occurred,

15 we did have them come out. Ten of our hospitals were

16 reviewed, and they didn't find deficiencies in these

17 areas.

18 We -- we just want to state that when you say

19 that the state is investigating, the state is

20 investigating because they are required to investigate

21 every anonymous complaint. And every time an anonymous

22 complaint is made to the state, it does cost a lot of

23 taxpayer dollars. That's my comments. Thank you.


25 Lex, and then we have one last person after

190


1 Lex.

2 COMMENTS BY LEX REDDY

3 LEX REDDY: Ms. Horwitz, Ms. Cantori, and

4 Mr. Dalton, thank you all for being in my community too.

5 I've lived here for 27 years. My name is Lex Reddy,

6 L-E-X; last name, Reddy, R-E-D-D-Y.

7 I am the president and chief executive officer

8 for Prime Healthcare Services and the one that will be

9 involved, if this transaction gets approved, in the

10 transition process of making sure that Victor Valley

11 Community Hospital complies and stands up to all of the

12 regulations that your offices will be imposing on us.

13 While I do believe in the process and I do

14 believe in what you have to do to go through the

15 approval criteria required, I would like to emphasize

16 that we at Prime Healthcare are willing to live with any

17 decision you make. Approval, denial is in your hands.

18 One thing that's very important for us is that

19 this hospital stays open. As most of you have gone

20 through this process, we were not the selected bidder to

21 buy the facility. We gracefully exited. We wanted the

22 vote of Victor Valley to make the right decision in its

23 best financial interests. The reason we were asked or

24 re-approached by the board was because of the failure of

25 the previous transaction. Why are we involved in it

191


1 when we have heard time and time again, when 80 to

2 90 percent of the business is uncompensated Medi-Cal,

3 Medicare? Why are we still interested in it?

4 I think someone asked a question where is

5 Dr. Reddy? He doesn't have to be physically here. He

6 lives, breathes in this community.

7 I take a lot of passion in this community,

8 along with him, because he cares for the community. Why

9 did we decide to keep it as a not-for-profit? Because

10 we want the oversight. We want to make sure that the

11 community understands that we're here to keep it open,

12 make sure we keep our commitments in this community

13 which are monitored.

14 All the charitable work that Dr. Reddy has

15 done in this community, all of the not-for-profit work

16 that the Foundations do are all done below, in a very

17 what I call hidden way because there are things that you

18 don't need to keep bragging about. Charity begins at

19 home. This is his community. It's not a charity when

20 you are saving the lives of so many people that depend

21 on this facility. He is in this room. I know for sure,

22 having worked with him for 26 years, his heart is here,

23 wondering what's happening to that hospital and what's

24 happening in the process. It's not about Dr. Reddy.

25 What they have done in this process is

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1 belittle the 9,000 employees that work for this

2 institution. Dr. Reddy does not sit and be there at

3 every single facility, doing the work. It's my 9,000

4 employees that contribute to the success or the failure

5 of our institutions.

6 And at the end of the day, the buck does stop

7 with Dr. Reddy because he takes the responsibility of

8 making sure these facilities are kept open, deal with

9 all of the -- for example, lack of a better word, the

10 trash that is thrown at us, because we have to respond

11 to regulatory agencies whom we keep in high regard.

12 I want to make sure that this community

13 understands we stood by the board of Victor Valley

14 Community Hospital to do what is right by the board for

15 Victor Valley. There's nothing much grateful for me to

16 sit here and listen to Mr. Fermin say the same thing,

17 whom I've seen and has been my competitor for the long

18 time, sitting on the board of Victor Valley, pay

19 comments and commend us for what we are here for.

20 On the other issue of all these physicians

21 that have come by and said they don't have access,

22 there's not one physician that Prime has terminated from

23 its medical staff. Medical staff is an independent

24 body. Physicians can come and practice.

25 I heard one of these physicians talk about not

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1 getting access to services at Desert Valley. That

2 physician has never made an attempt.

3 All the physicians in this community know me.

4 They know I've lived here for 27 years, been accessible

5 to them. Whether they practice at Desert Valley, Victor

6 Valley, or St. Mary was never an issue. All these

7 physicians that have complained about we're are the

8 managers of Victor Valley Community Hospital, for lack

9 of a better word. The community does not understand the

10 intricacies of what has gone on behind the scenes.

11 I'm not going to stand here and talk for four

12 or five hours, defending every single issue that has

13 been brought up. And all I can say is these physicians

14 know better. They have taken advantage of this facility

15 financially. They have brought it to the state of

16 affairs in which it is today.

17 And what Prime or Dr. Reddy is trying to do is

18 leave a mark of keeping a hospital -- community hospital

19 opened so the community take care of the indigents. We

20 provide the highest amount of charity care even though

21 we are for-profit hospital like everybody contends us to

22 be. And that data is available in public records of

23 OSHWA [phonetic], CMS, and all of the reports that we

24 file like every other hospital on a day-to-day basis.

25 So if profit was the motive, we would have

194


1 kept it as a for-profit entity and left it that way.

2 It's not. We want it to be not-for-profit. We want it

3 to be a community asset. We want to make sure that

4 every year we are [phonetic] converting hospitals to

5 not-for-profit, not for any other reason. They all

6 require your oversight, regulatory agency's oversights.

7 And I know how strict you are about monitoring all of

8 this covenants and how you expect us to file reports on

9 an annual basis to make sure you're monitoring us and

10 respond to every issue you receive.

11 So I want to reassure, without going through

12 the whole history of what, where healthcare is headed,

13 that these physicians -- I respect them. They are

14 physicians for a reason. But when they stand up here

15 and talk about Victor Valley, it really saddens me

16 because these are the very same physicians who have been

17 brought into this community by Victor Valley Hospital

18 and, to some extent, the previous founder,

19 Dr. Nepomuceno, and they have brought this hospital to

20 this state of affairs. And we do want to serve this

21 community and keep it open.

22 And the last, but not the least important,

23 point I want to make sure we talk about this the lot of

24 other vested, interested parties who keep here accusing

25 us of all of the allegations about septicemia,

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1 malnutrition. I'm not a physician. All I know is I

2 have 9,000 employees that participate, right from a

3 janitor who's very important for us from the

4 infection-control process, all the way up to the nurse

5 and to the CEO of the facility, that runs these

6 facilitates. And believe me, all of them, I work with

7 on a day-to-day basis. I was at all my 14 hospitals on

8 holidays and weekends and visit the patients and the

9 families as much as we could. Not me, all my executives

10 do that.

11 I want to reassure that quality is taken for

12 granted by us at Prime, because that's what we expect to

13 provide. As much as there are some negative outcomes

14 that happen, we are not God to help everybody do the

15 right thing at all times. There are certain outcomes

16 that aren't in our controls. But we do provide the

17 highest quality of care. The Top 10 Healthcare System

18 in the Nation is Prime. Nobody west of Mississippi.

19 The Top 100 Hospitals are all quality indicators. I

20 mean, these are all the data that's available.

21 And someone said that Victor Valley's -- is

22 all indigent care, nobody's going to care for the

23 indigent. We will care for them. We are going to stand

24 by this community. Dr. Reddy has made a commitment,

25 right -- if the process is approved. Of course, we

196


1 don't take anything for granted. If you approve the

2 sale to Prime Healthcare Foundation, on day one you will

3 start seeing the changes we need to make. And we will

4 keep our commitments, not just in terms of the financial

5 commitment, but in terms of the quality of care to make

6 it a Top 100 hospitals [sic] if we can. But with that

7 goes a lot of effort, a lot of resources, and to

8 maintain staff we have. Victor Valley, for example,

9 does not have consistency of staff, and there is no

10 continuity of care because they depend on registries,

11 per diems, because of the financial situation they're

12 in. Yes, we would be trying to recruit full-time staff

13 to work in this community.

14 I have seen some of the community leaders whom

15 I have witnessed and have -- some of them have been my

16 role models in this community, of how they have been

17 successful. Like they said, they have been successful.

18 They care for this hospital. They have been on the

19 board of Victor Valley Community Hospital, not Desert

20 Valley, and they're the ones that want to make sure that

21 this hospital is kept open. And these are longstanding

22 members of this community.

23 And one last point I wanted to mention,

24 talking about the employees. Employees are my

25 responsibility. We have made a commitment to retain

197


1 substantially all of the employees. We have given you

2 the assurance we are not going to reduce what they're

3 making as of today. We have given you that assurance.

4 As far as the benefits goes, nobody's involved

5 other than me. I have a plan. We are going to provide

6 better benefits than what they have. There will be some

7 changes, but for the betterment of the employees. And

8 the employees have to give us a chance to go in and

9 present, which will be done after the transaction is

10 done.

11 So for everyone to speak on behalf of what

12 Prime is going to do, what Prime is not going to do is

13 not fair. The history has proven itself with the 40

14 [phonetic] distressed hospitals that we have bought.

15 And with your oversight and guidance on the two

16 hospitals, the Sherman Oaks Hospital and Paradise Valley

17 Hospital, we have proved that we do stand by our

18 commitments.

19 So I would like you to keep those factors in

20 mind and make the decision appropriate. And as one of

21 the doctors said, I hope you will be making a non-biased

22 judgement in a cool manner that best serves the

23 community needs. Thank you very much.

24 HEARING OFFICER: Thank you very much. We

25 just have one last speaker, Hector Gonzales.

198


1 COMMENTS BY HECTOR GONZALEZ

2 HECTOR GONZALEZ: Thank you very much. My

3 name is Hector Gonzalez, G-O-N-Z-A-L-E-Z. I'm a

4 lifelong resident of the High Desert. So looking at me,

5 you know I was here before any of the hospitals were

6 built. I'm a pastor at God's Garden Church.

7 DEPOSITION OFFICER: I'm sorry?

8 HECTOR GONZALEZ: I am the pastor of God's

9 Garden Church and a volunteer chaplin at Desert Valley

10 Medical. As a pastor and as a chaplin, I have been

11 called to visit patients at our local hospitals at all

12 hours of the day and night. I see the great need that

13 we have here in the High Desert. We need to keep our

14 hospitals opened and operating, and we must operate in a

15 safe -- in a safe and professional manner.

16 And I have personally witnessed the workers

17 and the staff at Desert Valley Medical. And in my

18 estimation, they are truly committed, dedicated, and

19 professional in every sense of the word. I believe this

20 is why Desert Valley Medical has been ranked as one of

21 the Top 100 Hospitals in the Nation by Thompsons Routers

22 [phonetic] in five of the past seven years.

23 I come to voice my support for Prime

24 Healthcare in their effort to purchase Victor Valley

25 Hospital. The might be some who will voice their

199


1 opposition to this purchase, but I've done some

2 research, and I want to say that I would hate to think

3 that a decision could be made in support of a union

4 whose own president once proudly stated and I quote, "If

5 we can use -- if we can't use the power of persuasion,

6 we will use the persuasion of power." Again, I come to

7 voice my support for Prime Healthcare in their effort to

8 purchase Victor Valley Hospital. Thank you --


10 HECTOR GONZALEZ: -- and god bless you.

11 HEARING OFFICER: Is there anybody else who

12 would like to speak, who didn't fill out a sign-up

13 sheet?

14 Okay. Well, this will conclude our public

15 meeting. Any written comments must be received no later

16 than noon tomorrow. My e-mail address is

17 [email protected], and my facsimile number is

18 (213)897-7605.

19 I want to thank everybody for coming tonight

20 and giving me your comments and attending today's

21 meeting. Thank you.

22 (The hearing concluded at

23 8:02 p.m.)

24 -oOo-

25

200

Attorney General Public Meeting PUBLIC HEARING PROCEEDINGSAugust 17, 2011

$

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Min-U-Script® Barkley Court Reporters (3) admire - Arco


Ardis (7) 87:25;92:8,9,9,12; 94:12,16A-R-D-I-S (1) 92:12area (26) 9:4;13:3;16:14,15,16; 17:9,12;20:6;21:1,5,18; 43:17;47:11;64:13; 77:14;112:2,5;120:16; 123:7;130:9;142:23; 157:12;162:23;163:7; 164:10;165:13areas (4) 59:10;94:17;189:6; 190:17area's (1) 117:25argument (2) 135:6;183:13arm (2) 61:16;102:15ARORA (8) 49:17,22,23,23;50:1,1, 3;73:5A-R-O-R-A (1) 50:3arose (1) 75:8around (8) 54:23;55:9,9;56:23; 57:4;81:20;102:11; 138:19arranged (1) 9:6arrangement (1) 77:3arrangements (2) 36:16;148:25Arrowhead (1) 118:22articles (3) 153:4,14,24aside (1) 120:19aspect (6) 43:1,7,9;47:11;177:7, 8Assemblyman (3) 124:13,14,16Asset (10) 10:12,16;20:4;24:8; 26:10;28:2;51:16;131:9, 15;195:3assets (8) 10:13,20,22;23:16; 24:9;34:7;74:6;82:16assigning (1) 88:18assist (1) 44:15assistant (2) 9:2;130:18

Assoc- (1) 181:18associated (4) 10:18,19;69:3;123:5associates (1) 106:22Association (3) 63:22;108:22;150:7assume (2) 77:1;130:19assumes (1) 157:17assurance (2) 198:2,3assure (1) 106:16assured (1) 95:16attached (2) 65:20,22attack (1) 67:3attained (1) 107:5attempt (2) 110:8;194:2attempts (1) 81:25attend (1) 26:1attending (1) 200:20attention (2) 49:13;189:14Attorney (86) 7:7;9:2,24;10:10; 11:22;12:2,4,16;13:11; 15:6,20;18:25;19:19,22; 22:7,17;23:8;26:11; 28:2;32:15,18;44:1,8,14; 55:3;56:1;64:9;67:19; 68:16;70:8;71:15,18; 72:1;73:12;74:2,7,10; 76:4,7,14;77:24;78:13; 79:5,20;107:18,21; 110:24,25;112:24; 117:7;124:15;130:18, 25;132:7,8,12,19;134:1; 136:8,16;137:9;139:22; 142:19,24;143:1,6,11; 144:12,16,21,22;146:1, 6;149:9,10,24;154:4,23; 157:5;158:7;163:21,25; 178:4;179:19;187:7; 189:14attorneys (1) 78:12auction (5) 33:19,21,23;105:13; 178:15audibly (1) 8:1audience (3)

9:10;25:9;86:11auditorium (1) 151:21AUGUST (8) 7:1;13:12;15:21; 75:16;88:16;110:23; 112:21;182:2authority (3) 132:20;143:7;146:7authorized (2) 136:9;141:5automatic (1) 165:9availability (7) 12:11;13:2;15:15; 17:12;142:21,22;143:20available (16) 12:16,19;15:20,22,25; 18:4;20:20;49:2;50:16; 128:3;139:21;140:1; 145:5;149:23;194:22; 196:20average (5) 16:6;32:8;80:20; 112:6;117:23avoid (1) 65:9avoided (1) 29:12avoiding (1) 109:16awards (1) 29:4aware (3) 43:10;111:1;189:24away (8) 39:1;66:6;67:24; 93:10;96:18;120:4; 170:21;171:21ax (1) 141:25axis (2) 58:20;59:4

B

babies (1) 16:7baby (2) 165:5,16back (28) 9:19;15:22;25:16; 38:19;41:9;51:24;58:13; 74:4,8;80:12;95:1,24; 101:14;102:23;110:5; 120:6;122:12;131:13, 24;133:6,8,15;134:19; 152:17;159:13;161:13; 185:1;188:12background (4) 23:13;29:1;40:15; 167:10backs (3)

122:18;147:7;179:9backup (3) 75:22;78:22;178:23bad (3) 102:2;106:23,25balance (2) 187:1,2ball (1) 134:16ballgame (1) 47:23bank (3) 79:16;161:8,8bank- (1) 138:4banking (1) 161:9bankrupt (1) 102:11bankruptcy (23) 17:22;20:13;32:18; 34:2;73:18;74:6;76:4; 78:12;81:9;105:13; 125:4;133:23;136:8; 137:4,7;138:5;139:24; 151:6;178:9,11,12,13; 179:10bargain (3) 56:12;65:9,22bargained (1) 179:8bargaining (1) 64:15Barstow (1) 104:18base (4) 45:19;48:7;102:3; 166:9based (7) 18:3;25:25;37:22; 64:7;116:9;146:18; 180:19basically (7) 42:20,21;50:12;86:15; 102:14;106:23;175:6Basiles (1) 164:15basis (5) 50:23;80:11;194:24; 195:9;196:7battery (1) 171:24battle (1) 65:8battled (1) 168:10battling (1) 168:7Bauer (1) 34:2bays (1) 10:4be- (1)

111:20Beach (3) 57:24;69:7;109:3bear (1) 91:25beautiful (1) 162:23became (2) 156:23;170:8become (11) 80:19;90:24;91:20; 107:16;122:20,23,24,25; 125:1;171:18;172:23becoming (1) 169:22bed (3) 87:1;98:1;114:7beds (32) 10:3,4;15:24;16:12, 21;20:20;37:11;44:19; 71:6,11;81:13,15,18,20, 21,21;83:22;86:18;87:4; 93:6;112:4,9,10;114:8; 122:4;127:4,6;172:7; 182:25;183:1,3,4beforehand (1) 141:12beg (2) 100:17;101:3began (1) 64:18begging (1) 97:21begin (2) 22:15;115:20beginning (3) 50:9;98:6;149:20begins (1) 192:18behalf (10) 23:9;90:18;110:23; 142:15;149:17,18; 179:21,25;181:9;198:11behavior (1) 62:18behind (5) 24:24;74:12;77:8; 155:24;194:10beings (1) 63:5belief (1) 80:6belittle (1) 193:1below (3) 47:17;172:20;192:16Benefit (13) 7:12;11:11;28:4; 48:24;62:7;82:8;89:21; 102:8;146:10;175:13; 178:11;187:22;188:12benefited (1) 83:15

Min-U-Script® Barkley Court Reporters (4) Ardis - benefited


benefits (5) 11:19;64:21;66:6; 198:4,6Benjamin (1) 105:1Bernardine's (1) 108:20Bernardino (14) 16:18;27:25;28:21; 67:10;108:20;117:20; 119:6;129:23;131:1; 142:2;152:21;154:4; 157:24;164:25best (16) 21:20;50:17;75:20; 87:7;123:14,16;127:12; 132:25;140:3;143:13; 146:9;153:5;175:4; 182:6;191:23;198:22better (9) 60:25;72:22;114:11; 116:8;155:2;193:9; 194:9,14;198:6betterment (1) 198:7better-paying (1) 70:24beyond (3) 61:19;80:6;100:11Bhatia (1) 23:18bias (1) 189:20bid (3) 33:15;178:17,23bidder (4) 70:11;142:16;178:14; 191:20bidders (2) 33:20;34:1bidding (1) 33:19biggest (1) 107:8bill (6) 46:19;68:20;69:21; 72:4,5;93:14billed (3) 42:12;56:20;58:17billing (3) 59:5;60:4;61:10bills (1) 59:21Billy (1) 9:19biopsy (1) 166:19birth (1) 165:8birthday (1) 120:22bit (11) 33:25;40:15;46:14,24;

47:1;65:16;84:7,9; 110:3;170:15;189:9black (2) 159:2,7Blair (7) 119:10;124:7;126:4,4, 6,7,7blame (1) 136:23Blanc (2) 9:1;130:18bleak (1) 139:9bless (2) 166:2;200:10Blewett (8) 79:24;82:24;84:1,3,4, 5;105:7;162:20B-L-E-W-E-T-T (1) 84:5block (2) 39:1;63:14blood (4) 31:6,14;56:23;100:15Blue (5) 51:4,4;92:21;176:21, 22blurring (2) 145:3;146:14board (67) 11:21;17:24;20:2; 23:17,24,24;25:4,6,6,7; 27:9,12,13;49:10;51:17; 55:10,12;65:12;66:15; 88:16;89:5,6;93:4; 99:15,19;100:11,12; 101:20;102:17;108:21; 111:15;114:19;115:12, 13,14,15;116:20;119:5; 131:11,13;133:9;134:8, 18;136:5,17;137:11,20; 138:21;139:6;140:4; 141:15;142:3;145:15,22, 25;149:2,8;156:16; 158:11;182:7;188:1,3; 191:24;193:13,14,18; 197:19board-certified (1) 23:18body (2) 136:5;193:24bold (1) 140:23bona (1) 78:10book (6) 36:3,5,12,18;98:7; 100:8bored (1) 86:7born (2) 174:5;177:12both (18)

7:14;16:12,19;35:25; 37:10;73:3;75:9;79:4; 80:10;102:13;103:17; 142:18;143:25;145:14; 146:2,7;158:13;188:21bothers (1) 132:2bottom (1) 108:4bought (4) 68:25;69:6;122:12; 198:14BOUMAN (3) 68:21,22,23B-O-U-M-A-N (1) 68:23Bowman (2) 63:18;65:1boy (2) 54:15;156:7Brad (2) 117:3;119:4Brad- (1) 104:18BRADCO (2) 104:5,17BRADLEY (4) 52:8,9,10;53:25B-R-A-D-L-E-Y-G-I-L-B-E-R-T (1)

52:10Brady (12) 101:15;103:25;104:3, 4,5,9,9,9,12,13;138:6; 162:21bragging (2) 114:23;192:18branch (1) 48:9breach (3) 137:23;138:1;140:23break (7) 14:21,23;49:20;51:24; 101:11;152:5;176:3breaks (1) 14:24breast (2) 47:11;166:20breathe (2) 97:23;98:13breathes (1) 192:6brief (4) 7:17;13:15,18;56:7briefly (3) 54:18,21;150:2bring (10) 20:18;47:19;68:3; 87:16;102:14;106:20; 132:18;133:2;140:6; 189:13brinksmanship (1) 186:16brittle (1)

120:7broad (1) 12:7Brodie (8) 155:22,25;156:1,3,6,7, 10;160:4brothers (1) 99:23brother's (1) 63:6brought (8) 114:9;133:8;134:2; 168:6;194:13,15;195:17, 19Bryson (5) 119:10;124:7;126:6,7, 7B-R-Y-S-O-N (1) 126:8Bryson's (1) 135:4buck (2) 107:2;193:6budget (1) 53:4budgets (1) 91:2build (1) 71:10building (1) 86:17buildings (1) 10:19built (3) 38:17;122:9;199:6bunch (3) 100:12;104:10,12bunk (1) 122:20burden (2) 83:20;173:13burn (1) 59:9business (33) 20:11;30:16;36:11,11; 40:24;44:24;45:2;56:8, 17;102:7;105:17,17,20, 25;106:15,25;108:2; 118:4;122:22,22,22; 123:2,3,4;129:17; 147:14;150:19;156:12; 161:15;167:16;177:8; 179:5;192:2businesses (3) 68:7;83:15;114:14businessman (6) 106:18;107:12,23; 113:23;161:10;174:3business-related (1) 129:20buy (11) 56:1;61:16;74:5; 76:22;96:24;102:5;

132:17,17;161:12; 179:7;191:21Buyer (27) 13:20;19:18;53:20,22; 54:22;55:7;78:11;82:2; 87:14;117:8;128:25; 130:5,8;136:7;144:13, 20;145:2;146:6;147:16; 148:4,7;151:10,24; 164:5;168:20;179:22,23Buyers (12) 7:12,17;10:15,17; 11:8,13,15,18,21;26:17; 165:13,14buying (1) 96:16buys (1) 162:3bylaws (1) 145:17

C

Cabriales (3) 126:5;130:13;142:9cafeteria (1) 172:9Cajon (2) 28:24;118:20calculate (1) 60:3CALIFORNIA (31) 7:1,8,11;10:5;15:20; 22:16,17;31:19;32:4,7, 13,21;51:4,5;56:13; 57:16;58:4;59:23;63:22; 64:3;81:4;99:14,18; 100:11,11;108:21; 110:22;129:4;142:2; 147:17;153:2California's (1) 57:7call (18) 13:20,21;14:2,11,17, 24;38:17;78:14,25;79:1; 93:25;95:4,19;98:17,19; 152:6;184:1;192:17called (9) 14:1;41:9;67:6;95:18; 153:2;156:24;157:4; 158:1;199:11calling (2) 15:2;52:3calls (1) 180:21Camden (1) 131:23came (21) 55:9,16;74:21;75:13; 84:12;95:20;98:10; 119:22;120:6;121:19; 163:3,9,18;170:7; 171:11;181:11;185:2,2,

Min-U-Script® Barkley Court Reporters (5) benefits - came


20,24;186:17camera (2) 8:14;130:22cameras (2) 8:11,21Camilla (3) 99:17;100:8;101:4campaign (2) 30:20;66:8camps (1) 100:18campus (1) 71:10Can (78) 7:4,5,18;8:2,3;12:17; 14:4;22:22;23:3,11; 25:23;27:21;28:11; 33:10;34:12,13;35:10; 42:1,12;43:9;47:1,2,10, 13;50:23;53:16;57:21; 58:24;60:6;65:15;68:3; 72:5,14;75:23;76:9; 79:1,3,5;80:18;92:24; 93:6;94:16;98:1;100:10, 25;106:16;109:21; 114:9,11;116:12,17; 123:1,16,19;127:12,17; 128:10;129:3;130:6; 137:18;140:15;153:19; 155:16;156:4;161:18; 163:12;173:1,15; 176:23;180:20;181:9; 183:23;185:9;187:7; 193:24;194:13;197:6; 200:5cancel (4) 33:3;41:11;46:17; 150:5canceled (4) 36:9;150:23;151:9; 177:4canceling (2) 77:12;151:3cancellation (3) 143:24;144:7;150:4cancer (10) 59:10;93:18;94:1; 161:18;165:25;166:20; 168:7;188:21,22,24cancers (2) 47:12,12candidates (2) 25:6;27:12candle (1) 67:5Cantoni (1) 130:17Cantori (2) 15:6;191:3capability (1) 187:9capacity (4) 22:14;37:10;127:20;

135:12capita (1) 105:11capital (5) 11:2,3,4;17:21;121:1car (2) 47:19;127:24card (1) 158:3cardiac (2) 16:2;108:19care (115) 10:2;11:19;16:2; 18:13,17,19;20:5;21:5; 26:25;27:3,22;28:13,14, 25;29:13,21,23,25;30:3, 16;33:8,10;35:19;37:19; 39:12,16,19;44:5,8,25; 45:1,22,22;46:11,14; 47:9,15;50:13,17,17,25; 51:6,17;57:20;58:7; 59:6,9,12;60:10;62:16; 63:8;67:13;68:5;77:1, 13;80:3,12;81:3,5,24; 82:6,17;91:17;94:22; 99:10,16;100:20; 103:13;108:25;109:1; 116:5;118:24;129:21; 132:14;134:14;136:13; 140:20;141:3;143:25; 156:12,13,18;157:19; 158:8,12;161:20;162:3; 165:18;166:25;167:24, 25;168:5,9,12,16,21; 171:20,22,25;173:16,16, 17;177:15;184:17,23; 189:11;194:19,20; 196:17,22,22,23;197:5, 10,18cared (1) 99:21career (1) 166:12careers (1) 83:12careful (1) 19:22caregivers (1) 63:2cares (2) 121:2;192:8caring (1) 141:2Carl (7) 69:22;72:4;79:23,23, 25;80:1,2Carol (11) 104:1;108:11,11,13, 14,17,17;109:21,23; 110:1,5carrier (2) 171:13,15carriers (3)

168:23,25;171:14case (17) 15:4;24:23;41:3; 60:11,14;62:3;66:23; 114:5;121:7;131:9; 135:14;154:4;163:16, 17;178:9;179:11;187:20cash (4) 10:22;76:9;183:11; 187:3cash-flow (1) 20:12catastrophe (1) 37:12catastrophic (1) 117:13CATHERINE (6) 19:5,9,10,11;34:2; 160:3C-A-T-H-E-R-I-N-E (1) 19:11catheterization (1) 16:3Cathy (11) 19:3,6;22:23;34:13; 70:4;71:19;72:18;78:4; 131:20;160:1,2cause (6) 55:2,4;83:20;117:16; 180:8;185:1caused (1) 96:22causes (2) 69:13;102:22causing (1) 128:6cautioned (1) 138:21CBA (1) 64:17CBAs (1) 64:16CDPH (2) 32:21;190:4ceased (1) 24:10Cedar-Sinai (1) 171:8cell (2) 94:2;183:22census (3) 16:6;133:17;172:6Center (22) 8:13,14;10:6,21; 16:13,19,22;18:18; 24:13,14;26:6;27:19; 29:17,19;57:24,25;64:5; 71:9;111:12,13;118:22; 167:9Centers (9) 21:24;59:9;140:14; 180:5,12;181:7;186:7, 14;188:11

Centinella (2) 58:2;150:22century (1) 71:4CEO (5) 19:6;21:14;52:11; 83:8;196:5certain (8) 18:9,10;50:19;63:9; 71:16;172:23;179:24; 196:15certainly (12) 50:23;51:20;55:20; 73:11;77:17;78:13,20; 102:12;123:13;126:21; 132:20;137:20certificate (9) 21:25;22:4;135:24; 180:4,7,14,15,17;181:4certificate's (1) 180:19certification (2) 65:14,19certified (1) 65:13chair (1) 88:6chairman (3) 56:9;107:9;133:7chairperson (2) 48:5,7challenge (3) 107:8;137:13,21challenges (1) 102:12challenging (2) 65:24;75:9chamber (3) 83:2,3,9chance (6) 61:3,5;95:17;104:15; 165:14;198:8chances (1) 120:8change (1) 170:24changed (1) 120:10changes (4) 14:21;170:23;197:3; 198:7changing (1) 188:2chaplin (2) 199:9,10Chapter (1) 20:13characterization (1) 76:20characterizing (1) 136:25charge (2) 93:14;108:19

charged (1) 92:18charges (2) 56:16;66:21charitable (6) 7:15;10:24;102:22; 126:11,11;192:14charities (4) 24:9;83:11;103:15; 123:24charity (15) 11:19;18:13;21:5; 23:15;26:25;27:3;29:25; 30:2;35:19;111:9; 132:14;184:23;192:18, 19;194:20CHARLES (6) 179:16,17,18;183:25; 184:4,6Charlie (1) 179:15chart (5) 58:14,15;59:16,17; 60:6charts (1) 57:8Chaudhuri (4) 43:24;72:25;152:15, 15cheaper (1) 68:3check (1) 156:22checked (5) 85:22,25,25;93:5,20chemotherapy (4) 93:1,17;97:18;98:24Chester (1) 132:8Chet (1) 132:19chief (10) 19:13;22:14;23:20,22; 35:15;38:11;39:9; 180:22,22;191:7child (4) 96:21;119:17;131:8; 177:12children (5) 52:16,21;119:21; 159:15;174:5Chino (5) 23:19;64:5,9;65:4,21Choice (19) 42:3,5;46:6,9;109:14; 126:8,9,14,17;135:16; 151:13;157:10;158:3,4; 166:4;175:12;184:8,25; 186:13choices (2) 110:14;174:9chose (1) 138:1

Min-U-Script® Barkley Court Reporters (6) camera - chose


chosen (3) 46:14;67:17;127:13CHRISTENSEN (6) 119:11,12,13,23; 120:3;123:11C-H-R-I-S-T-E-N-S-E-N (1) 119:13Chung (1) 177:24Church (2) 199:6,9circle (2) 58:19,19Circuit (2) 66:1;67:2circumstance (2) 79:2,13cited (1) 109:10citizen (2) 166:6;168:19citizens (9) 63:2;64:13;71:24; 87:5;99:20;107:21; 118:14;126:18;144:1City (12) 23:20;70:1,6;71:23, 25;86:23,24;94:3,8; 101:19;117:22;167:14civic (1) 103:6claimed (1) 32:11claims (4) 31:6;32:5;58:17;178:8class (4) 114:24;121:12,23; 126:21classes (1) 26:4clause (1) 180:8clear (6) 20:10;72:19;73:9,21; 75:3;168:11clearly (6) 52:18;53:9;55:6,16; 76:13;78:6Cleveland (2) 59:19;60:13CLIA (15) 22:1,4,12;54:23;78:3, 6;79:8;135:22,22; 137:13;180:3,7,13,19; 186:25C-L-I-A (1) 22:1client (1) 181:7clinic (5) 59:19,19;60:13,14; 157:1clinical (4)

88:19;89:25;90:25; 135:23clone (1) 84:25close (72) 18:1,24;22:3,15; 33:24,24;40:11;43:2,23; 44:19;50:7;70:12,13; 72:20,22;73:1;74:9,15, 25;75:6,13,23;76:9; 78:9;79:14;81:11,19; 87:11,13;88:18;95:23; 101:25;105:16,19,19,20, 22,22;107:7,25;116:21; 118:17;119:3;127:3; 136:3;137:8,22,22; 144:4;151:19,21;152:1, 2;162:3,5;172:12; 178:20,25;180:11; 181:16;185:9,11,12,17, 18,22,23;186:9,17; 187:13,15,24closed (7) 21:22;75:11;122:11; 125:8;144:6;172:14,16closeness (1) 141:19closer (2) 46:24;47:1closes (6) 27:16;73:8;76:19; 83:17,20;174:10closing (18) 20:17;62:10;73:4; 74:3,23;75:8;76:5; 94:22;95:2;97:23;98:13; 117:12;128:17;162:17; 168:19;186:1,8,11closure (8) 37:12;102:3;117:16; 118:1,7;125:4;144:8; 186:25closures (3) 170:6,6,6clothes (1) 94:24cloud (7) 152:20,21,22,24; 155:3;159:2,7CMS (12) 21:24,24;22:2,3,13; 54:25;55:1,2;137:21; 181:13;190:1;194:23Code (4) 7:16;10:8;143:5; 147:17coding (1) 62:16coffin (1) 162:23cofounder (1) 156:14cognizant (1)

37:6coincidently (1) 95:24cold (2) 74:11;131:8collapse (1) 141:4collapsed (2) 157:22,25colleague (2) 15:5;154:13colleagues (7) 40:3;49:10;51:1;70:2; 139:8;141:20;152:18collective (1) 64:15collectively (1) 72:13College (23) 25:21,22;26:1;83:13; 88:6,13,17;89:16,16,20; 90:2,5,10,18,19;91:25; 114:20;115:3;116:20; 119:15;121:12,21; 166:12colleges (1) 91:3colon (1) 47:12Colton (1) 118:22combined (1) 112:8coming (9) 36:24;43:24;52:24; 69:20;148:12;164:3; 171:6;184:20;200:19comm- (1) 182:7commend (1) 193:19comment (7) 8:6;13:7;14:6;136:11; 149:18;176:12;182:18commented (1) 139:2comments (70) 7:10;9:3,20;19:9; 22:25;33:16;34:3,14; 35:12;37:1;38:9;39:23; 43:14;45:11;48:1;49:22; 52:8;54:7,13;63:19; 65:20;68:21;69:23;70:3; 72:7;79:25;82:25;84:3; 88:3;90:14;92:8;97:4; 101:16;103:2;104:3; 108:3,13;110:19; 113:18;115:24;116:25; 119:11;124:10;126:6; 130:14;134:20;135:5; 142:12;150:6;152:8; 155:25;160:25;163:2; 164:17,19;165:18,21;

169:13;173:19;176:9; 178:2;179:16;187:18; 188:15;190:23;191:2; 193:19;199:1;200:15,20Commerce (1) 83:9commercial (6) 17:5;127:7;129:7,13, 25;184:15commercially (1) 184:19Commission (4) 31:10,24;161:7; 190:12commitment (13) 22:13;68:12;70:18,19; 83:11,16;91:24;102:19; 139:14;168:22;196:24; 197:5,25commitments (5) 24:25;26:13;192:12; 197:4;198:18committed (12) 25:12;29:3,22;66:14; 68:9;70:20;91:24; 106:14;152:12;167:21; 181:10;199:18Committee (4) 48:9;175:9;178:7; 179:12committees (1) 48:7committing (1) 29:22common (1) 77:14communities (2) 81:14;125:25Community (271) 7:11;9:5;10:1,5,9,21, 23;11:6,9,19;12:12; 15:14,18,23;16:1,3,10, 11,25;17:3,7,11,13,19; 18:2,20;19:7,8,14;20:3, 4,8,20;21:12,20;22:18; 23:10,21;24:2,7,8;25:1, 21;26:3,13,16;27:10; 28:5,20;29:23;31:1; 32:17;34:8,9,11;37:4,6, 8,25;38:5,13,16,18,20, 20;39:1;40:21;44:20,22; 45:17;48:14,24,24,25; 49:5,6;51:16;53:1,11,23; 55:5,12,21;60:19,20,21; 64:11;65:1;67:18,20; 68:5,14;69:16;70:19,21, 22;71:2,3;72:15;73:14, 17;74:21;78:1;81:1,8, 13;82:1,5,10,16,18;83:5, 13,16,17,18;87:6,20; 88:10;90:18;91:3,6,15, 21;99:16;101:24;102:5, 8,10,21;103:7,16,22;

106:11,12,14,15;107:7, 14,24;109:11;111:2,6, 22;112:9,12,19;113:7; 117:9,13,24;118:10,12, 16;119:1;121:1,10; 123:22,23,23,24,25,25; 124:18,21,25;125:5,15, 21;130:23;131:12,16,16; 132:23,25;134:13,15; 137:11;138:8,23; 139:12;140:4,10,18,21, 24;141:3,9;142:3; 143:21,23;144:1;149:7; 151:22,25;152:13,23; 153:22;155:3;156:16, 19;157:16;158:16,22; 159:4,11,19,23;160:9; 161:9,25;162:18;164:5, 9;166:6,18,21;167:7,8, 12,13,23;168:7,10,17,17, 19;169:2;171:16; 172:18,18;173:2; 175:14;179:20;182:8; 183:2,7;184:10,18,18, 23;186:24;187:13,23; 188:13;191:4,11;192:6, 7,8,11,12,15,19;193:12, 14;194:3,8,9,18,19; 195:3,17,21;196:24; 197:13,14,16,19,22; 198:23community's (3) 102:23;117:14;133:6companies (8) 18:19;30:5,8,10,18; 33:7;92:21;104:6company (7) 30:12;33:4,12;56:12; 163:10;178:13;179:23compare (3) 59:6,7;189:20compared (2) 40:22;112:6comparison (2) 77:11;182:25comparisons (1) 189:22competition (11) 61:22;77:15,17; 143:23;149:13,21,25; 154:14;182:17;183:12, 14competitive (3) 51:19;62:8;154:19competitor (3) 61:23;62:4;193:17complain (1) 33:2complained (1) 194:7complaint (2) 190:21,22complete (4)

Min-U-Script® Barkley Court Reporters (7) chosen - complete


7:21;136:10,12,18completely (1) 70:6completion (1) 71:8compliance (1) 139:1complicated (1) 57:20complications (1) 29:11complied (1) 7:23complies (1) 191:11compliment (1) 96:17comply (1) 67:16component (2) 115:3,21comprise (1) 21:6computer (1) 26:23con (1) 161:24concern (15) 40:16;41:2;44:23; 47:16;48:18;49:6;69:14; 113:5;116:4;118:9; 128:2,4;168:4,20;175:8concerned (11) 41:21;61:17;81:10; 82:19;109:1;139:7; 174:7,8,12,21,24concerning (3) 13:8;60:17;144:18concerns (5) 40:25;48:17;134:2,22; 135:19concessions (1) 136:19conclude (4) 143:12;151:18;155:1; 200:14concluded (2) 151:12;200:22conclusion (3) 17:23;18:21;72:23conclusions (2) 13:6;189:16condition (4) 130:7;132:13,13; 157:13conditions (18) 12:4;26:11;28:3; 53:13;56:21;68:2;74:2, 3,7,23;76:6;109:20; 112:24;128:14,14,19; 129:2;139:16condolences (2) 165:24;188:20

conduct (1) 13:16conducted (2) 15:18;31:25conducting (1) 48:10confidence (4) 103:22,22;140:7; 189:17confident (1) 67:15conflict (1) 40:17confusion (6) 24:3;146:12;147:5; 159:8;174:15;186:21connection (2) 8:24;182:20connotation (1) 127:9cons (1) 161:23consent (1) 11:23consider (17) 12:5;19:24;37:11; 47:23;50:6,10;51:3; 56:2;71:16;75:18,19; 76:12;79:11;129:24; 143:1;149:10,11considerably (1) 103:15consideration (4) 73:22;77:19;142:6; 144:6considerations (2) 136:20;178:10considered (8) 17:17;129:6;151:24; 185:6,10;187:17;188:4,5considering (1) 188:1consistency (1) 197:9consisting (1) 23:17consolidation (1) 138:19constituents (3) 124:20;125:19;178:21constraint (1) 13:23construction (1) 102:1consultant (2) 15:11;50:18consulting (1) 167:16consumer (1) 131:3contact (2) 93:23;94:4contacted (4)

14:8;41:5;93:21; 127:14contained (1) 146:13contends (1) 194:21context (3) 66:20;133:2;134:4continuance (1) 185:23continuation (1) 18:11continue (19) 11:16,18;18:3,7; 20:25;22:20;27:21; 38:21;51:16;80:4;90:10; 91:6,14;111:6;160:5,10; 169:1;178:22;179:5continued (4) 53:5;105:2;168:21,22continues (1) 88:10continuing (4) 18:13;53:22;81:10; 92:2continuity (1) 197:10contract (24) 18:19;19:15;21:3; 27:20,23;30:5;32:3; 33:12;36:3;46:18,22; 51:7;53:15;64:19;74:5, 20;76:3,24;78:6,21; 92:20;128:16,17;151:11contracted (5) 42:11,12,20,24;157:2contracting (4) 41:23;43:5;44:6;167:4contracts (49) 18:14,18;27:24;30:4, 7,9,12;31:20;33:4,6; 36:10;51:19;55:23; 56:12;77:2,13;96:6; 115:5;126:24;127:5,18; 128:3,6;129:1,2,4,7,8,13, 19;130:6,8;137:6; 143:25;144:1,7;150:4,6, 15,23;151:3,7,9;171:15; 174:25;175:13;176:21; 177:3;183:14contrast (1) 179:6contribute (1) 193:4contributes (1) 123:25contributions (4) 88:23;107:20;126:12; 148:8control (9) 11:23;37:22;43:6; 129:11;143:22;149:4,7; 154:20;174:23

controlled (4) 149:1;174:14,20; 189:21controlling (1) 175:6controls (2) 145:21;196:16controversial (1) 56:8Convalescent (1) 38:25converting (1) 195:4cook (1) 134:18cool (2) 48:23;198:22co-op (1) 89:23cooperative (3) 78:10,17;110:9coordination (2) 166:25;167:25co-pay (1) 171:12copies (3) 12:16,19;15:21copy (6) 8:7;34:14;82:22;94:7; 113:14;126:3Core (2) 28:17;190:2Corp (1) 78:25Corporation (3) 7:12;11:25;147:20Corporations (2) 10:8;79:7corporation's (1) 113:24corrupt (4) 99:18,19;101:2,3cost (7) 50:25;59:24;60:1; 67:17;93:13;171:12; 190:22costing (2) 128:11;171:12costly (1) 20:9costs (1) 87:2COUNCIL (3) 101:16,17,19Councilman (3) 23:20,22;162:20counsel (5) 72:10;73:13;75:17; 90:6;122:6counted (1) 18:7counter-data (1) 150:10

counties (1) 52:13country (2) 60:8;67:14County (14) 27:25;28:21;117:3,20; 118:21;119:6;129:23; 130:25;131:2;142:2; 152:21;157:24;164:25; 165:2County's (1) 28:23couple (11) 42:1;54:4;75:17;84:9; 162:1,22;168:7;170:7; 176:3;185:25;189:5course (6) 39:16;51:18;95:12; 97:17;100:14;196:25court (24) 7:19,20,23;8:1,3,7; 14:22;23:4;32:18;35:10; 65:25;67:2,10,11;74:6; 76:4;105:13;109:25; 126:3;132:11;136:8; 137:4,7;154:4covenants (1) 195:8cover (2) 96:1;187:20coverage (1) 158:5covered (2) 21:8;94:17create (5) 39:14;59:13;140:13, 14;149:13created (2) 106:2;113:5creates (1) 146:14creating (1) 46:12creation (1) 107:6credible (1) 163:16credit (5) 76:1;178:21;181:22, 23;182:4creditors (7) 178:8,12,18,24;179:4, 9;188:9Crest (5) 80:3;81:2,7,23;82:6crime (1) 131:3crisis (1) 20:12criteria (1) 191:15critical (7) 52:19,20;53:10,14;

Min-U-Script® Barkley Court Reporters (8) completely - critical


117:10;132:18;144:11critically (1) 112:14criticisms (1) 187:19Cross (2) 51:4;92:21cross-directorship (1) 148:24cross-officership (1) 148:24c-sections (1) 165:9Cultural (1) 48:12Cumar (1) 99:1curable (1) 96:23curious (1) 15:5current (6) 11:8,11;26:20;27:11; 68:6;114:21currently (18) 18:19;39:5;51:8;67:1, 11;71:7;81:14,14; 101:19;114:19;115:14; 119:13;127:16;130:4; 144:22;166:3;169:18,18customary (1) 56:16customers (1) 123:15cut (6) 69:10;91:3;152:17; 171:14,15;172:24cuts (2) 64:20,23cynical (1) 56:17

D

dad (8) 109:12,12;157:5,13, 15,19;166:8,15daily (3) 16:6;89:12;105:9Dalton (15) 13:4;15:10;71:14; 130:17;131:23;133:15; 134:19,23;135:17; 136:1;138:9,25;154:16; 189:4;191:4Dalton's (2) 13:18;135:7damaging (1) 56:9dance (1) 136:10Daniel (5) 34:22;35:12,13,13;

36:21Danning (1) 178:5dark (1) 152:22darkening (1) 152:24darn (1) 85:17data (12) 15:17,17;39:11;54:15; 143:2;146:23;147:3,4,5; 150:12;194:22;196:20date (7) 16:24;64:19;128:17; 139:20;180:16;186:1; 188:3dated (1) 110:23daughter (17) 55:14;92:17,21;93:9; 94:5;95:10,15,18;96:11; 97:25;98:1,21;119:20; 120:7,13,21;173:17daughter's (9) 94:17,18;95:5,5,7,23; 96:22;98:20;119:24David (1) 23:21Dawn (5) 113:17;116:25;117:1, 1;119:8D-A-W-N-S-I-K-E-S (1) 117:2day (22) 22:11;28:11;69:1; 93:15;94:6;95:22,23,25; 97:15,19;106:6;108:6,7; 120:4,11,21,22;172:5; 183:9;193:6;197:2; 199:12days (20) 58:22;75:17;80:17,20, 23;85:17,23;86:3;92:19; 93:11,13;94:19;95:10; 97:14;104:14;131:22; 138:22;159:25;160:6; 186:2day-to-day (2) 194:24;196:7DC (2) 65:25;66:16de (2) 127:4,6dead (1) 99:12deadline (8) 21:23;22:4,12,13; 55:1,2;74:9;79:17deadlines (2) 137:14,16deal (15) 22:2;39:5;40:11;

73:23;74:8;75:7,11; 76:10;77:6;78:2;106:25; 127:16;178:17;185:8; 193:8deals (5) 40:12;186:12,12,13,13dealt (1) 78:20dean (1) 90:21DeanCo (1) 188:6dear (1) 160:1dearly (1) 158:4death (4) 96:22;99:25;100:18; 165:6debate (2) 74:16;79:5debtor (1) 151:10December (5) 24:15,18;185:22,22,23decide (3) 55:23;142:24;192:9decided (5) 37:11;45:19;66:10; 74:11;80:11decidedly (1) 68:15deciding (3) 12:6;55:25;98:4decision (24) 13:11;49:1;55:11,15, 17,17;65:7,21,25;66:13; 136:6;141:16,18; 142:25;143:8;145:20, 21;164:8;181:12,13; 191:17,22;198:20;200:3decisions (3) 38:7;107:19;158:8declared (1) 139:23declining (1) 187:2decreased (2) 28:8,9dedicated (3) 82:9;167:6;199:18dedication (1) 107:14deep (2) 48:18;49:6deeply (1) 25:11defend (1) 63:14defending (1) 194:12deficiencies (1) 190:16

deficiency (1) 86:15deficit (1) 35:18definitely (2) 43:3;173:25degeneration (1) 168:14degree (4) 76:16;115:7;166:13; 189:11deja (1) 133:13delay (4) 20:17;74:12;75:4; 186:23deliver (1) 114:25delivered (2) 39:12,19delivers (1) 16:7delivery (8) 27:7;39:16;48:19; 49:7;81:22;142:21; 143:19;167:3demands (1) 38:22dementia (1) 81:6DEMIDOVICH (5) 63:19,20,21;65:17,19D-E-M-I-D-O-V-I-C-H (1) 63:21Democrats (1) 63:4denial (1) 191:17deny (4) 55:3;79:21;96:24; 100:4department (19) 10:3;21:1;22:16;27:4; 28:7,9;32:14,21;48:5,13; 53:3;57:7;78:15;79:6; 81:4;83:14;157:24; 170:20;181:5departments (5) 28:10,14;50:20,21,21depend (2) 192:20;197:10depends (1) 68:6deposit (1) 105:21DEPOSITION (11) 23:11;46:7;92:11; 108:16;131:6;155:14; 169:12;173:23;175:18, 21;199:7deposits (2) 105:18,23depressed (1)

140:18depriving (1) 68:4Deputy (7) 7:7;15:6;130:25; 132:7;136:16;137:9; 139:21derived (1) 187:24describes (1) 12:25describing (1) 72:12Desert (141) 16:11,13,19;20:5,23; 21:16;22:21;23:19;24:4; 25:11,12,13,18,23; 29:14;30:7;31:1,12; 35:24;36:3;37:10;38:11, 23,24;39:4,7,9;40:19,24; 41:2,6;42:7,23;44:18; 45:23,23;46:13,16; 48:12,14,19;50:5;51:8; 52:14,19;58:3;61:24; 71:6,6,13;80:17;81:14, 19;83:4,10,22,22;84:6, 22,23,24;85:4,8,22;86:8, 14,16;87:4,16;88:12,15, 19;89:11,14;90:3;93:25; 94:1,4,19;95:11;97:7; 101:20,21,23;102:2; 104:17,23;105:4,11; 106:1,5,7;107:11; 108:24;109:16,19; 110:14;111:9,16;117:18, 19;118:9;125:11; 126:18;140:11,12; 156:11,14,15;157:1,10, 19;159:2,8,11;160:7,11; 161:5;164:23,24;165:7; 166:5,7,15,24;167:6,7; 168:7;175:7,8,12;183:1; 187:11;194:1,5;197:19; 199:4,9,13,17,20deserve (1) 132:24deserves (1) 48:25deserving (1) 25:23designed (1) 142:18desk (1) 12:17despite (1) 109:6details (1) 73:19determine (2) 39:15;79:5detrimental (1) 101:25devastating (6)

Min-U-Script® Barkley Court Reporters (9) critically - devastating


39:6;81:22;87:18; 162:8,19;164:11developed (4) 76:16;82:14;153:4,13Developing (1) 28:19Development (5) 12:15;13:5;89:1; 142:18;156:12deviate (1) 119:18deviations (2) 60:10,12devoted (1) 38:4Dew (5) 101:15;103:1,2,3,4D-E-W (1) 103:5diabetes (1) 120:6diabetic (1) 120:7diagnosed (2) 93:9;97:14diagnoses (4) 31:3;163:7,8;190:5diagnosis (3) 37:16,18,20Diamond (1) 178:5Diana (8) 152:5;164:15,15; 165:21,22,22;169:5,11D-I-A-N-A-P-A-S-I-L-L-A-S (1)

165:23dictated (1) 126:22die (3) 61:4,7;95:18died (2) 85:17;177:12diems (1) 197:11difference (1) 188:7different (9) 14:14,15;15:18;29:15; 30:8;121:4;172:13; 175:11;184:19difficult (4) 8:10;137:24;139:4; 141:16difficulty (1) 17:8digging (2) 163:11;189:18diligence (2) 33:18;154:24dimed (1) 137:3diminishing (1) 187:1

direct (2) 61:21,22directly (8) 40:23;42:16,17;109:6; 135:21;143:17;149:1; 171:5director (8) 38:24;80:2;88:7; 90:20;117:2;145:11,12; 156:11directors (7) 23:17,25;25:7;108:21; 111:15;131:13;182:7disagree (1) 78:4disapprove (1) 12:3disaster (1) 136:15discharged (1) 140:4discipline (1) 66:5disclosed (3) 145:17;148:18,22disclosure (2) 152:14;182:19discontinued (1) 91:18discredit (1) 163:22discretion (1) 145:23discuss (1) 9:24discussed (4) 139:15;144:3;152:25; 162:5discussion (2) 37:21;146:6discussions (2) 78:8;139:25disease (3) 80:13;81:6;168:14disproportionate (1) 35:20dispute (2) 74:14,17disrupted (1) 49:7disruption (1) 50:13disservice (1) 113:8distances (1) 168:16distinction (1) 145:9distinguish (1) 147:24distorted (1) 31:15distortions (1)

30:22distress (1) 125:3distressed (3) 18:5;102:11;198:14distributed (1) 24:9distribution (2) 178:24;179:10district (8) 110:21;113:12;117:2, 5;130:25;166:10; 176:20,20districts (1) 177:2diversity (3) 174:12,25;175:11divert (1) 67:12division (1) 131:2doctor (21) 31:3;34:22;36:25; 39:25;41:8;44:18;49:16, 23;95:4,19;97:10,16,20; 99:4;100:20;107:22; 119:22;120:4;138:6; 157:9;179:2doctors (26) 13:22;31:4;35:4; 37:16;42:15;49:19; 50:11;53:23;77:8,22; 78:2;96:4,22;99:10; 100:12,12,19;101:2,5,6; 122:12;159:6;177:14; 183:17;189:15;198:21doctor's (1) 47:20doctors' (1) 190:5document (1) 141:10documented (1) 52:18documenting (1) 62:15documents (4) 15:17;19:25;73:13; 95:21dogs (1) 153:9dollar (1) 92:17dollars (21) 20:21;30:14;33:8; 57:21;60:16;67:23,24; 75:6;84:22;87:2,12; 91:16;92:18;94:13; 96:18;128:7,12;129:22; 161:13,14;190:23dominate (1) 55:22donated (4)

24:15,17;88:24; 144:23donates (1) 123:24Donations (4) 25:20;102:22;106:9; 159:7done (40) 13:25;41:16,16;56:16; 70:22;73:23;75:10; 76:10;79:4;87:12,19; 92:14;93:11,12;95:13; 106:7,10;108:2;122:18; 129:21;135:18;139:19; 140:24;141:12;146:3; 150:1;151:5;159:22; 164:7;171:10,24; 172:20;175:19;189:8; 192:15,16,25;198:9,10; 200:1doors (1) 20:19dot-php (1) 12:22doubt (3) 39:14;76:10;138:9down (36) 8:10;16:17;28:24; 45:20;46:25;47:17,20; 58:20;68:13;70:5;71:19, 21;73:25;78:9,19;84:13; 87:16;98:2,17;99:7; 100:7,20;108:16;109:22, 25;118:20;127:22,24,25; 129:15,21,22;130:16; 147:10;177:9;186:16downtime (1) 87:2downtrodden (1) 122:19downturns (1) 64:24downward (1) 185:15dozen (1) 109:18dozens (2) 110:6;183:18Dr (141) 23:17,18;25:10,14,15, 16;34:23,24;37:2;38:2; 39:21,23,24,24;42:2,6,9; 43:13,15,15,19,24;44:5, 24;45:8,11,12,12,15,24; 46:8;47:3;48:1;49:14, 17,22,23;50:1,1,6,6; 52:4,4,5,8,9,10;53:25; 54:2;55:14;70:19,20; 72:25;73:5,5,5;82:12; 83:4;84:2,2,15,23;86:20; 87:9,15,19,24,24;88:3,4, 4,21,25;89:9;90:13,14, 15,23;91:9;92:1;95:16;

97:21;105:1;106:3,4,4,9, 21,25;107:1,4,15; 111:10,17;115:9,10; 116:10;120:24;121:7,16, 19,25;122:8;133:25; 134:13;140:20;141:20; 145:12,20,23;148:14; 152:13,14,15;153:13; 154:3,18,20;155:9; 160:16;161:11,16; 166:23;176:22;178:13, 21;179:2,23;183:20; 184:7,11,12;187:5; 192:5,14,24;193:2,7; 194:17;195:19;196:24draining (1) 59:22draw (3) 115:4;189:16,19drew (1) 59:16drive (3) 168:15,15;186:16driving (1) 47:20drop (1) 187:21dropping (1) 185:14drove (1) 152:16due (11) 27:3;28:14;33:18; 81:10;88:22;109:15; 154:17,24;181:25; 182:3;185:21during (6) 66:7;82:12;104:24; 146:25;154:5;181:1duties (1) 67:16duty (7) 37:18;76:13;137:23; 138:1;140:5;142:1,3dying (1) 99:5

E

earlier (8) 50:18;55:9;69:10; 114:21;136:20;168:6; 180:9;181:2earliest (1) 74:24earned (2) 96:17;155:10easy (2) 22:9;86:11echo (1) 77:23economic (8) 33:1;101:22;117:14,

Min-U-Script® Barkley Court Reporters (10) developed - economic


17;118:7;138:9;139:10; 140:17economically (1) 140:18economics (1) 162:8economies (1) 140:8economist (1) 162:9economy (6) 102:1,3;106:5,8; 139:3;179:6ed (2) 89:23;132:9education (7) 25:24;26:4,9;28:19; 83:3;102:20;115:17effect (5) 15:12;81:22;149:11; 162:12;181:17effective (2) 90:6;128:16effectiveness (1) 85:8effects (3) 12:25;142:20;143:4efficiencies (2) 27:3;28:6Efficiency (1) 85:8efficiently (1) 28:10effort (6) 30:24;65:9;75:7; 197:7;199:24;200:7efforts (3) 29:5;104:21;116:7egregious (2) 66:3,17eight (3) 70:10;176:7;185:8Eighty-seven (1) 77:4either (7) 11:25;31:1;36:6; 148:14;149:14;161:3; 183:14elected (1) 142:3election (3) 65:5,12;66:2elective (2) 46:21;50:23element (1) 126:19Elementary (1) 176:19elements (2) 77:18;154:21eliminates (1) 127:3elimination (1)

127:6E-L-L-E-Y (1) 19:12else (11) 29:2;34:25;35:5;45:9; 60:12;101:8,8;116:14; 153:8;175:24;200:11else's (1) 97:25elsewhere (3) 41:16;147:22;150:20e-mail (3) 14:11;54:19;200:16e-mailed (1) 176:16embarked (1) 30:21embarrassing (1) 31:18emerge (1) 85:18emergence (2) 138:3,4emergency (35) 10:3;11:17;16:4;17:1; 21:1;27:4,6;28:6,9,10, 14;33:10;38:18;39:4; 41:5;46:18;50:24;53:3; 56:10,14,15,18,19; 58:12;59:24;62:12; 111:23;129:10;150:13, 14,20;154:6,11;171:21, 23emergent (1) 39:2emeritus (1) 115:13emotional (3) 43:1;119:18;120:20emotions (1) 156:22emphasis (1) 44:20emphasize (1) 191:15Empire (6) 17:4;21:3;52:11; 53:16;64:25;88:12employed (3) 90:19;121:25;123:12employee (6) 19:17;30:25;169:19, 22;172:22,24employees (38) 11:11,13;13:22;16:9; 22:19;26:20;35:4;51:9; 54:16;58:8;68:6,9; 82:10;102:6;114:2; 115:6;118:1;122:19; 123:16,18,19;141:9; 170:23,24;171:1;172:5, 9,19,21;173:1;193:1,4; 196:2;197:24,24;198:1,

7,8employee's (1) 173:3employees' (1) 67:17employer (3) 127:11,12;158:5employers (1) 117:25employing (1) 123:1employment (6) 11:10;26:19;103:14; 162:2,2;167:11employs (1) 123:23enable (1) 143:12Encino (11) 24:13,14;111:11; 146:19,24;147:1;169:19, 24;170:8;171:9,10Encino's (1) 147:9encounter (1) 150:12encourage (1) 9:20encouraged (1) 32:22end (15) 35:25;36:13;67:14; 74:23;75:1,18;106:5; 108:5,7;146:22;149:20; 183:8,10;186:1;193:6ended (4) 114:6;162:17;185:15, 16endorse (2) 131:21;152:1endorsed (1) 136:6endorsement (1) 108:5endorsing (1) 104:21ends (1) 36:17enemies (2) 96:17;155:10enemy (1) 141:21energy (2) 38:4;107:13enforceable (1) 181:6engaged (1) 66:3English (1) 9:17enhance (2) 83:7;139:14enhancement (1)

140:16enjoy (1) 160:1enormous (1) 75:7enough (9) 20:11;71:12;90:22; 104:12,14;133:24; 140:23;157:15;182:16enrolled (1) 89:20enrollment (1) 89:18ensure (3) 7:21;24:25;82:5ensured (1) 41:24ensuring (1) 125:18enter (1) 21:3entered (3) 65:8;111:4;183:15entering (2) 115:22;150:14Enterprise (1) 61:13enters (1) 56:19entire (5) 43:7;52:25;71:5;80:8; 87:21entirely (2) 43:3;55:18entities (1) 148:17entity (10) 11:25;12:1;24:20; 25:15;138:20;144:24, 24;146:8;174:15;195:1environment (3) 37:23;62:8;110:9environmental (1) 131:3equipment (12) 10:19;11:2,5;20:9,19; 21:15;26:23;88:25;89:8, 8,10;133:19ER (5) 31:7;41:8;109:15; 165:8;172:1E-R-G (1) 54:15ERIC (14) 39:23,24,24;40:1; 42:2,6,9;43:13;49:11; 73:5;142:11;152:4; 183:20;184:7E-R-I-C (1) 40:2ERs (1) 83:21escrow (2)

76:8;87:10escrows (1) 87:13especially (6) 17:1;21:12;49:11; 132:21;165:25;171:8essential (2) 27:5;103:9essentially (3) 42:11;73:23;150:19establish (1) 16:22established (1) 88:22Estate (6) 72:12;104:18;105:17; 122:21;178:12,18estimate (1) 162:13estimates (1) 59:23estimation (1) 199:18et (1) 10:8Eugene (1) 23:20evaluate (3) 143:3;149:24;175:10evaluated (5) 144:10;147:6,16; 148:19;149:3evaluation (4) 135:17;144:12; 148:19;149:15even (17) 36:4;40:8;42:2;47:6, 19;57:10;58:6,10;62:20; 68:12;118:8;138:17; 150:18;175:4;177:7,15; 194:20evening (19) 103:3;104:4;108:14; 117:1;124:11;130:16, 17;142:13,14;143:9; 144:3;156:1,2;159:20; 161:1;164:12;165:22; 173:20;188:16events (1) 124:17everybody (15) 7:4,6,6;13:16;74:5; 85:19;96:13;97:8;108:9; 116:14;152:1;157:17; 194:21;196:14;200:19everyone (10) 7:22;9:20;40:5,14; 47:1;54:6,9;70:19; 92:14;198:11evidence (10) 31:13;32:1;50:10; 66:12;75:5;79:6;98:8; 99:14,20;154:2

Min-U-Script® Barkley Court Reporters (11) economically - evidence


evidenced (2) 105:5,9exact (2) 123:9;182:18exactly (2) 86:11;174:14examination (1) 182:22examine (1) 15:12example (11) 30:6;56:22;57:12; 61:2,20;91:13,20; 146:14;148:6;193:9; 197:8excellence (1) 140:15excellent (6) 38:2;88:9;90:2; 157:19;170:20;189:8except (4) 58:19;95:22;149:17, 18exception (2) 135:4;136:25exceptional (1) 135:18excess (2) 60:18;70:17Excluded (1) 10:22exclusively (3) 7:15;134:11,12excuse (6) 34:3;69:1;81:25; 82:11;98:19;100:5execution (2) 73:16;76:10executive (7) 19:13;22:14;48:8; 72:9;80:2;180:22;191:7executives (1) 196:9ex-employees (1) 123:14exercise (3) 26:8;48:23;153:21Exhibit (2) 65:20,23exist (3) 24:11;134:20;138:5existence (1) 186:24existing (1) 168:22exited (1) 191:21expand (4) 62:22;83:7;123:2,2expanding (1) 71:7expansion (2) 16:20;71:8

expansive (1) 16:20expect (9) 26:11,23;27:2;60:18; 66:12;82:7;123:16; 195:8;196:12expectant (1) 119:1expecting (1) 165:5expense (2) 62:16;64:25expensive (1) 67:12experience (9) 64:8;65:2;69:17; 88:20;89:25;102:13; 116:9;158:13;171:2experienced (4) 64:22;68:2;141:13; 169:22expert (4) 138:10,20,21,21expiration (1) 64:18expired (1) 64:17expires (1) 19:15explain (4) 65:2;99:17;133:12; 143:21explanation (1) 182:22explored (1) 49:8exploring (1) 49:1express (2) 48:16;117:6expressed (2) 49:10;50:12extend (7) 22:3,13;55:2;61:19; 180:6;181:3,15extended (6) 102:21;128:3;130:6; 180:17;185:24;186:1extending (1) 54:25extensive (2) 33:18;140:22extent (1) 195:18extra (4) 59:23;60:3;163:15; 172:1extract (1) 56:17extraordinarily (1) 56:21extraordinary (2) 56:21;66:18

extrapolate (1) 163:17extremely (3) 20:24;58:7;107:5eye (1) 163:25

F

F7 (1) 143:5face (4) 97:24;107:9;145:23; 173:3faced (2) 109:12;116:15facilitates (1) 196:6facilities (13) 16:16;64:4;103:11; 114:4;118:11;121:18; 124:24;125:12;171:8,9; 173:14;190:13;193:8facility (28) 9:5;10:11;38:25;39:3, 6;69:3;71:2,23;81:3,3; 106:21;107:1;109:20; 117:10;119:3;125:23; 139:14,19;148:9; 169:19;172:17;173:9; 183:19;191:21;192:21; 193:3;194:14;196:5facing (1) 56:14facsimile (1) 200:17fact (31) 20:6;31:18;32:2; 45:24;51:2;53:6;60:22; 89:4;127:2;129:25; 132:24;134:24;137:9; 143:6;144:15,19;146:9; 147:5,6,8;148:12;149:4, 7;151:8,14,16,25; 152:16;161:10;183:11; 184:24facto (2) 127:4,6factor (1) 98:4factors (3) 133:16;134:3;198:19failed (11) 32:6;81:25;122:11; 143:11,15,17,23;178:20, 25;180:11;181:2failing (1) 82:15fails (1) 143:21failure (2) 191:24;193:4fair (6)

30:6,13;76:17,19; 129:6;198:13fairly (2) 24:22;153:14fait (1) 153:20false (5) 30:22;31:8;32:17; 39:14;75:14falsely (1) 62:15familiar (1) 136:17families (4) 52:15,21;102:6;196:9family (23) 24:4;25:10,14,16; 37:5;39:25;43:17;63:9, 11;99:22;106:3;107:4; 120:22;121:8;127:24; 134:14;141:21;161:21; 164:23;165:24;166:14, 16;174:22famous (2) 121:22,22fantastic (2) 61:6;114:22far (14) 13:10;40:3;42:18; 47:20;55:16,16;58:24; 59:17,17,19;177:5; 181:20;182:6;198:4fast (2) 8:1;131:5faster (1) 54:5father (5) 109:4;156:23;157:8, 10;168:5fault (2) 55:4;137:1favor (6) 22:22;30:17;80:25; 103:7;139:8;161:17favorable (2) 11:12;66:13favorite (1) 105:9featured (1) 89:11February (5) 94:5;131:19;133:13; 165:6;185:24federal (7) 18:4;21:23;24:10; 50:24;77:11;81:16; 180:12feel (6) 19:14;62:21;102:7; 120:1;121:4;142:4feeling (2) 116:18;122:16feet (1)

74:11Feldman (6) 130:12,14,15;131:8; 132:5,10fell (1) 75:13fellow (2) 126:18;172:4felt (2) 101:1;189:5Fermin (3) 126:5;130:24;193:16Fernando (2) 23:22;172:21fever (1) 57:10few (12) 7:22;17:17;29:4; 45:25;76:22;80:25; 82:12;96:12;119:25; 169:20;189:6;190:3fide (1) 78:11fidelity (1) 89:10fiduciary (3) 76:13;137:23;138:1field (5) 80:8,12;122:21; 124:13;138:10fight (3) 67:21,25;153:10fighting (1) 75:11figure (1) 163:4file (2) 194:24;195:8filed (6) 10:9;17:22;65:11; 66:21;67:9;73:12files (2) 77:24;154:8filing (3) 81:9;149:19,21fill (2) 175:25;200:12fills (1) 39:2finally (6) 78:3;95:9;97:14; 140:19;185:4;186:9financed (3) 73:15,22;75:22finances (1) 106:16financial (21) 20:14;25:25;33:5; 81:10;83:13;90:1;97:7; 99:3,5;106:19;107:13; 125:3;147:3,4,5;148:24; 180:22;188:23;191:23; 197:4,11

Min-U-Script® Barkley Court Reporters (12) evidenced - financial


financially (4) 17:20;105:2;139:13; 194:15financials (5) 135:8;140:1;146:15, 18;147:14find (16) 47:19;55:7;78:17; 82:2;93:21;95:24;97:15, 19;117:8;135:5;136:7; 145:18;147:9;177:9; 184:2;190:16finding (2) 65:21;66:13fine (6) 8:19;14:20;63:7;92:7; 175:21;184:5finish (2) 134:17;176:7finished (1) 45:19Fire (1) 157:24fired (1) 110:10fireman (1) 157:23First (34) 7:24;12:3;14:3,6;15:4; 19:4;26:24;35:6;40:1; 43:15;50:2;52:2;54:23; 65:11;73:4;84:5,10; 88:15;92:11,13;94:18; 117:5;135:21;136:22; 143:16;144:25;156:5,6, 17,20;161:11;165:5; 178:6;188:20first-class (1) 34:9firsthand (3) 79:6;83:10;102:19fits (1) 61:24five (17) 9:21;27:21;29:15; 54:7,9;57:1;59:1;62:1; 128:18;133:20;153:4; 176:6;180:14;183:18; 187:9;194:12;199:22five-minute (1) 51:24floor (8) 98:1;170:10,11,13,18, 19,21;171:22flow (2) 133:18;148:15focused (1) 17:16folks (7) 13:25;14:5;60:14; 114:3,20;115:25;152:6follow (2) 94:24;128:25

followed (1) 166:21following (5) 26:13;103:9;124:17; 149:18;150:15follow-up (1) 41:7food (3) 80:19;85:12;105:10foot (1) 85:24force (3) 45:18;102:3;166:9forced (4) 17:11;28:13;67:16; 136:3forecasted (1) 138:13foremost (1) 21:21forever (1) 181:15forfeiture (1) 131:9forget (1) 185:5forgive (1) 114:23forgot (1) 176:4forgotten (1) 119:25form (3) 11:21;27:8;100:10formed (4) 23:15;24:19,22;25:16former (1) 58:8formerly (1) 167:12for-profit (15) 11:25;26:18;29:7; 30:1;33:21;61:24;62:1, 5,7,8;144:23;148:5; 187:11;194:21;195:1for-profits (1) 61:22forth (2) 71:16;77:23forthcoming (1) 150:1fortunate (2) 85:18;160:10fortunately (2) 44:20;80:16forum (2) 74:17;156:14forward (12) 14:13;27:11;34:8; 53:21,21;91:1,11,18; 92:2;106:9;151:17; 160:23foster (2)

91:17,20fostered (1) 88:18found (7) 31:13,25;43:9;86:1; 93:3;94:21;95:10Foundation (89) 7:13;8:20;15:13; 19:18;23:7,8,9,14,15; 24:6,7,8,12,15,17,19,21, 24;25:1,7,15,17;26:12, 15,19,21,25;27:5,8,14, 18,20,24;28:3;29:25; 30:11;33:3,21;34:5,6; 38:13;55:10;61:15; 62:24;67:21;68:8;81:2; 82:3,14;83:5;104:22; 107:6,10;111:3,5,8,18; 112:20,21;113:4; 115:12;119:15;143:19, 24;144:20;145:1,4,6,11, 14,16,18;146:11,12,16, 17;147:1,4,16;148:2,13, 25;149:1;156:15; 158:11;159:4;183:16; 187:6;197:2Foundations (1) 192:16founded (1) 111:9founder (1) 195:18four (9) 60:10,11;86:23; 133:19;146:24;147:3; 184:10,13;194:11four-front (1) 65:8fourth (1) 67:3frame (2) 76:18;141:11fraud (3) 31:8;109:9;131:3fraudulent (1) 31:8free (2) 35:19;151:10freeway (1) 16:23friend (4) 38:3;105:6;160:1; 166:2friendly (1) 110:9friends (7) 50:7;96:16;100:13,14; 108:1;155:9;174:22front (2) 67:3;134:16frustration (1) 178:19fulfilled (1)

25:2full (11) 37:9;46:20;93:7;98:7; 112:16;135:11;152:14; 170:12,13;178:18; 180:14full-time (2) 172:24;197:12fully (7) 73:15,22;75:22; 111:19;188:5;190:11,12functioning (2) 48:7;125:24functions (1) 180:24fundamentally (2) 61:14;63:12funding (2) 148:12,15funds (8) 10:24;18:4,6;20:18; 88:24;148:13;187:1,23funneled (1) 176:24funny (1) 84:17further (6) 36:20;55:2;64:24; 130:16;166:9;182:22furthering (1) 152:24future (8) 18:8;71:9;90:10;92:3; 116:8;138:14;148:8; 180:16

G

gain (7) 55:20;80:22;97:7; 99:4,6;121:1;188:23garden (11) 26:8;64:5,8,14;65:1,2; 68:24;150:9,10;199:6,9gasoline (1) 47:21gave (7) 13:13;96:13,14,15; 97:9,9;159:6gazuntite (1) 92:3General (71) 7:8;9:2;10:2;11:22,24; 12:2,4,16;13:11;15:6,20; 18:25;19:20,22;22:18; 26:11;28:2;32:13,16; 41:22;44:14;49:3;55:3; 56:2;58:16;59:5,11; 60:9;64:9;67:19;68:16; 70:8;71:16;72:1,10; 73:12;74:2,7,10;76:4,8, 14;78:14;79:5,21;80:10; 107:18;110:24,25;

112:25;117:7;124:15; 130:18;132:8;136:16; 137:10;139:22;142:19, 24;143:1,6,11;144:17, 21,22;146:7;149:10,24; 154:23;163:25;189:14generally (2) 57:19;114:24General's (15) 9:25;10:10;22:7;44:1; 71:18;77:24;107:21; 132:12,19;134:1;136:8; 144:12;146:2;149:9; 187:7generated (1) 118:4Generation (1) 173:12generous (1) 103:15gentleman (3) 80:6;87:11;163:9genuinely (1) 153:21George (1) 102:2gets (5) 60:11;63:11;154:20; 165:4;191:9Gilbert (7) 52:4,4,8,9,10;53:25; 54:2Gill (2) 160:18;178:5Gish (1) 138:11G-I-S-H (1) 138:12given (13) 33:15,23;64:24;70:12; 85:16;90:23;91:5,12; 115:10;148:23;171:23; 198:1,3gives (6) 96:18;109:13;133:2; 134:4,14;145:25giving (3) 80:25;188:17;200:20glad (1) 7:6goal (3) 20:2;50:16;123:7God (3) 166:2;196:14;200:10God's (2) 199:6,8goes (11) 13:10,17;98:21;102:2; 127:16;177:5;182:9; 183:1;188:11;197:7; 198:4gold (4) 56:10;154:7,9;165:17

Min-U-Script® Barkley Court Reporters (13) financially - gold


gonna (3) 49:21;84:1;111:24Gonzales (1) 198:25GONZALEZ (5) 199:1,2,3,8;200:10G-O-N-Z-A-L-E-Z (1) 199:3good (50) 11:9;15:10;19:10; 23:1;38:3;45:20;46:5,8, 20;48:2,19,20;53:7; 63:20;68:22;69:24; 80:19;85:13;86:4;97:10; 101:17;103:3;104:4; 105:6,15;108:14,15; 110:3,20;117:1;124:11; 130:16;140:17;142:4, 13;147:13,15;151:11; 156:1,2;161:1;164:12; 165:17,22;166:1;168:12, 18;173:20;180:8;188:16good-paying (1) 125:11goodwill (1) 144:15governance (1) 61:15governed (2) 23:16;111:14governing (8) 10:12;11:21;27:8,13; 101:20;114:19;115:15; 116:20government (7) 18:5;78:7,8,12,18; 137:15,19grab (1) 52:3gracefully (1) 191:21gracious (2) 88:22;121:9grade (1) 141:7grads (1) 69:15graduate (3) 114:24;121:11,16graduated (2) 84:11;88:13graduating (1) 121:22graduation (3) 84:14,15,18grand (1) 106:8grandson (1) 84:11granted (3) 8:12;196:12;197:1grateful (2) 84:6;193:15

Great (31) 22:23;39:20;43:11; 45:9;49:18,19;53:24; 70:1;72:3;82:8;90:12; 101:10;113:7,13; 120:23;121:17;122:24; 124:1,19;136:21; 155:22;156:9;160:16, 22;167:5;169:10;175:8; 177:16,22;189:3;199:12greater (4) 27:1;118:8;138:17; 142:1greatest (1) 137:23green (1) 58:23GREG (5) 173:19,20,22,22;174:1Gregory (1) 169:9grew (3) 23:19;134:15;138:17grind (1) 141:25ground (1) 38:17group (24) 42:3,4,7,24;44:12; 45:23,25;46:2;50:7; 104:19;105:14,15; 122:11;126:9,10,14,17; 131:23;151:20;159:6; 166:4;184:8,16,25groups (8) 41:24,25;44:15;77:10, 21;107:12;167:20,24Grove (8) 64:5,9,15;65:1,2; 68:24;150:9,11GROVER (6) 48:1,2,3,4;49:15;73:5G-R-O-V-E-R (1) 48:4grow (3) 62:14;64:25;123:4growing (5) 38:22;82:8;102:16; 112:3;166:11growth (1) 101:22guarantees (2) 18:9,12guard (3) 98:11,15;100:24guards (1) 95:6guess (1) 141:25guidance (1) 198:15guilt (1) 96:1

guilty (1) 93:3gurney (2) 114:7;157:9GURPAL (4) 43:14,15,15;184:11G-U-R-P-A-L (1) 43:16

H

half (5) 21:13;22:11;71:4; 83:9;157:22hall (8) 98:2;100:21;160:19, 20;164:17,18,22,22H-A-L-L (2) 160:21;164:22hammered (1) 54:25hand (3) 9:14,18;169:4handling (1) 131:2hands (5) 109:4,20;110:6;123:1; 191:17hang (3) 124:9;158:10;183:23hanging (2) 152:20;159:2HANSEN (12) 39:23,24,24;42:2,6,9; 43:13,19;73:5;183:20; 184:7,12H-A-N-S-E-N (1) 40:1Hanson (1) 49:11happen (16) 47:16;60:22;87:8; 96:7;101:3;114:17; 116:6;122:13;129:22; 137:12,15;151:8; 162:24;163:20;172:14; 196:14happened (7) 41:13;74:8,10;86:19; 109:5;115:11;170:16happening (5) 36:18;46:4;136:15; 192:23,24happens (2) 15:7;162:7happy (2) 30:11;128:24hard (8) 107:11;117:18; 120:21;136:23;149:19, 21;159:3;182:17harm (1) 31:9

harping (1) 80:14Harris (4) 99:17;100:8;101:4; 110:25hat (1) 84:17hate (1) 200:2head (4) 19:15;95:2;121:12,23headed (1) 195:12healing (1) 170:19Health (52) 10:6,21;17:5;21:3; 22:16;26:9;27:19;29:6; 32:14;40:25;52:11,12; 53:16;57:7;58:15,18; 59:1;60:8;62:11,15,19; 71:10;81:16;83:3,14; 88:6,21,24;89:2;90:8,11, 21;91:21;92:1;102:19, 23;117:15;125:12; 126:23,23;127:13; 128:6;129:13;131:16, 24;133:5;168:2,23,25; 171:19;189:25;190:13Healthcare (135) 7:13;12:11,14,24; 13:2;15:11,13,15;16:16; 17:8;19:18;21:16;22:20; 23:7,14;24:5,16,18; 25:13,17,24;29:2,3,3,7, 22,24;30:5,9,21;31:9,21, 23;32:6,10,12,15,20,22, 22,25;34:6,10;37:7,13, 23,24;38:13;41:22; 48:18;49:7;51:5;54:17; 55:10;57:3;58:5;59:22; 61:15;63:23;64:2,8,12; 67:20;68:8;70:13;71:24; 80:8,12;81:2,22;82:3,13, 13;88:11;92:20;93:3; 96:2;100:2;102:10; 103:8,11,12,14,20; 104:21;106:2;107:6,9, 10;111:3,16;113:3,4; 123:8;124:21,24;125:2, 10,20,22;132:24;135:5; 139:13;142:22;143:18, 18;144:18,19;153:16; 154:19;161:16;166:13; 167:3,3,11,16;168:18; 169:23;170:12;171:3; 173:7,13;177:9;183:10, 15;187:6,6,19;191:8,16; 195:12;196:17;197:2; 199:24;200:7Healthcare's (4) 31:12;70:18;92:15; 125:6

hear (17) 35:6;40:8;46:17;47:1, 2;78:23;96:9;134:11; 151:11;153:22;155:14; 172:9;173:11;176:2,8; 180:12;186:19heard (37) 30:20;34:3;36:7,9; 52:5;73:5;75:17;77:14, 22;114:20;115:24; 122:2;126:19,20;127:17, 19;128:5;129:16;132:1; 134:10,21,21;136:3; 138:6;140:21;145:15; 153:8;165:6;172:6,11; 178:16;182:9;185:5; 186:3;189:5;192:1; 193:25HEARING (122) 7:4;8:18;9:12,15;19:3, 6;22:23;23:3;34:12,16, 19;36:19,23;38:8;39:20; 41:25;42:5,8;43:11; 45:6,13;46:23;47:25; 49:14,18,24;51:22;52:2; 53:24;54:1;56:4;63:16; 65:15,18;66:11,19; 68:18;69:19;70:3;72:3, 19;79:22;80:6;82:21; 83:25;87:23;90:12;92:5; 94:10,15;96:13;97:1; 99:9,11;101:7,10,13; 102:25;103:4,24;104:7, 11;108:10;109:21,24; 110:2,16;111:25;113:13, 16,20;116:23;119:7,9; 120:2;123:10;124:5; 126:2;130:10;131:19; 132:3,9;142:8;152:3; 155:11,13,15,18;156:2, 4,9;160:13,20,22; 164:13,20;165:19;169:3, 8,16;170:1;173:5,18,24; 175:15,19,22;176:14; 177:22;178:1;179:14; 183:23;184:2,5;188:14, 25;189:3;190:24; 198:24;200:9,11,22hearsay (2) 41:10;154:2heart (8) 113:21;120:25;121:6; 153:19;157:13;161:4; 164:6;192:22heaven (1) 79:12heavily (1) 113:9Hector (6) 198:25;199:1,2,3,8; 200:10held (4) 10:22;33:18;92:17;

Min-U-Script® Barkley Court Reporters (14) gonna - held


99:6Helen (7) 63:18;65:1;68:19,19, 21,22,23helicopter (1) 99:8Hello (6) 7:4;39:24;84:4;126:7; 130:20;169:14help (12) 21:14;87:20;98:12,12; 100:22,22,22;102:23; 159:20;188:9,10;196:14helped (2) 53:2;167:16helper (1) 9:18helpful (2) 8:4;133:12helping (2) 26:1;84:22herein (1) 143:4hereon (1) 143:4here's (1) 98:23Heritage (2) 58:8;186:12Hernandez (2) 23:20,22herring (3) 22:8;78:5;79:10Hesperia (11) 26:7;39:25;84:12,14, 23;86:23;87:20;101:16, 17,19;161:6HFAP (2) 31:10;190:13Hi (7) 7:6;39:22;83:1;88:4; 92:9;97:5;178:3hidden (1) 192:17hide (1) 187:5hiding (2) 95:25;96:1High (91) 16:11;20:5,23,24; 22:21;23:19;25:11,12, 13,18,23;38:22;39:4,5,7; 40:19;41:1;42:7,16,23; 44:18;48:12,14,19;50:5; 51:8;52:14,19;61:8; 71:6,12;81:14,19;82:16; 83:21,22;84:6,12,14; 85:4;86:14;87:4;88:12; 89:10;101:21,23;102:2; 104:17,23;105:4,5,11; 106:1,5,7;107:11; 108:24;110:14;111:9; 112:13;117:17,19;

118:9;125:9,10;126:18; 130:20;156:11,14,15; 157:1;159:2,8,11;160:7, 11;161:5;164:23,23; 166:5,7,11,15,23;167:6; 168:6;175:7,11;193:11; 199:4,13higher (9) 16:14;17:9;32:9; 59:17;60:13,20;70:24; 154:8;190:7highest (10) 32:3;39:12;48:9;57:1, 14,14,15,18;194:20; 196:17highly (2) 24:1;59:10high-quality (1) 103:13highway (1) 51:9hill (8) 16:17;84:13;127:22, 24;128:1;129:15,21; 177:9Hills (1) 93:24himself (1) 140:21hips (1) 170:10hire (1) 87:19hired (1) 172:19hires (1) 69:13hiring (1) 69:14historical (3) 11:19;133:21;134:5historically (1) 27:1history (7) 103:17;106:18; 130:21;140:22;144:15; 195:12;198:13hit (2) 108:4;117:18HIV (1) 59:9HMO (43) 30:11;33:3,8,11;36:3, 4,13;40:18,21,23;41:3, 23,24,25;42:3,16;44:2,6, 12,15,21,22;45:3;92:22; 127:7,8,13;128:2,6; 129:2,7,19;130:1,5,8; 135:10,14;150:14,16; 157:11;158:4;176:21; 183:14HMOs (20) 30:4,8,10,18;33:6;

47:5;51:1,18;127:5,9,10, 14;129:5;135:2;137:6; 150:18,25;183:17; 184:15,25hold (5) 100:5;104:11,13; 125:22;166:3holding (2) 154:7;178:8holidays (1) 196:8home (8) 58:12;94:24;107:7; 121:8;122:22;156:13; 157:23;192:19homeowner (1) 164:23homeowners (1) 176:18homes (3) 39:8;80:9;172:25Homestead (1) 156:12homicide (1) 131:9honestly (1) 121:6Honor (5) 90:15;91:2;92:4; 119:14;175:1honorable (2) 72:17;148:9hooked (1) 8:24hope (12) 38:6;94:3,8;108:5; 140:13;141:17,17; 142:5;173:15;178:20; 179:10;198:21hopefully (3) 41:9;154:25;176:7Horn (1) 132:9horror (1) 101:1Horwitz (14) 7:7;80:1;81:12; 130:17;131:25;132:1; 136:17;137:10;139:22; 141:6;152:9;153:17; 185:13;191:3H-O-R-W-I-T-Z (1) 132:5Hospital (472) 7:11;9:5;10:1,2,6,9,15, 17,21,23;11:7,11,15,16, 24;13:3,22,25;15:14,17, 18,23;16:1,3,6,9,10,12, 13,20,22,25;17:7,11,13, 20,25;18:20,24;19:7,14, 15;20:3,19,21;21:12,17, 22;22:5,14,15;23:10; 24:4,7,13,13,14,14,16,

17,21,23;25:2;26:14,16, 16,18;29:14,15,17,18, 19;30:7;31:1,2,13;32:2, 14,17,23,25;33:11,16,22, 22;34:8,9,9;35:1,3,5,15, 16,17,19,21,23;36:7; 37:12,17;38:12,14,16, 18,21,25;39:2,9,19;40:4, 5,10,11,21,25;41:1,6,12, 14,20;42:10,21,23;43:1, 2,23,25;44:3,7,16,19,25; 45:3,5,24;46:9,10,16,17; 47:4,6,8,14,17,19;48:6, 9;49:9;51:7,8,20;52:19, 20;53:2,10,21;54:25; 55:5,7,12,21;56:20; 57:21,25;58:21;59:11; 61:24;62:2,5;63:7,10; 64:5,11,22;66:5;67:5,20; 68:14,24,25;69:2;70:5,7; 71:3,3,4,7,17,19;72:11, 11,15,20,22;73:4,8,14, 17;74:15,21;75:23; 76:11,19,25;77:7,13; 78:1,9,19;79:16;80:15, 17;81:1,8,13;82:5,11,18; 83:4,17;85:9,16,22;86:1, 8,9,16,17,21,25;87:3,9; 88:15,19;89:14;90:3,4,9; 92:16;93:17,20,24,25; 94:1,4,20,23,25;95:9,11, 14,22;96:3,24;97:7;98:2, 11,14;99:5,9;100:17,23; 101:20,24;102:8,15,18; 103:8,16;104:23,25,25; 105:16;106:11,12,14,17; 107:15,24,24;108:6,20; 109:8,13,16;110:12,13; 111:2,6,7,11,12,13,17, 22;112:9,15,20;113:7, 10;115:19;116:4,11,16; 117:9,13,16,24;118:5, 12,16,16,21;119:21; 122:4,7,8,9,9,10,10,13; 124:1,19,21,25;125:16, 21;126:11,13,14,15,25; 127:3,25;128:2,7,23; 129:6,19;130:4,7; 131:12,16;132:23; 133:17,18,23,25;134:13, 16;135:7,11,12,21; 136:2;137:20;138:4,18, 20,23;139:5,12;140:7, 24;142:15;144:4,5,9; 147:2;150:12,18,22; 151:16,19,20,21;152:2, 22;153:16;154:10,21; 155:3;156:16,19;157:12, 20;158:2,2,3,24;159:4,5, 7,13,16,25;160:5,8,8; 162:2,17;164:10;165:4, 15;166:18,21;167:7,8, 13,23;168:10,22;169:2,

19,24;170:2,8,8;171:10; 172:7,12,13,16;173:14; 174:6,9;175:1;177:13, 17;179:5,7,20,25; 180:18,23;181:18,18; 182:8,12,20;183:2,3,6; 184:10,18,20;185:4; 186:5;187:11,12,13,23; 188:5;191:11,19; 192:23;193:14;194:8,18, 18,21,24;195:17,19; 197:18,19,21;198:16,17; 199:25;200:8hospitalcompareorg (1) 190:2hospitals (114) 16:14,21;17:9;18:5; 21:18;24:12;28:12; 29:12,24;30:1,2,5,9; 31:4,12,19,21,23;32:6,7, 9,10;35:22,25;37:9,15; 46:5,9;50:25;57:1,5,6,9, 14,15;59:7;69:6;80:10, 10;82:15;83:21;85:2,2,6, 15;92:16;93:1,21,22; 96:5,8,19;97:12;102:5, 11;107:17;109:11; 111:11,21;112:8,23; 114:16;115:4,5,8; 116:10;118:17;123:3,6; 125:3,6,7;128:20;129:3, 4;130:9;138:3,7,14,15, 15,22;141:1,7;143:22; 144:21;145:8;146:19,20, 23;147:1;149:6;150:8; 154:6;158:13;168:1; 174:13,24;189:24;190:6, 8,11,13,15;195:4;196:7, 19;197:6;198:14,16; 199:5,11,14,21Hospital's (15) 11:9;18:2;20:8;73:21; 75:16;82:1;83:10;105:2; 106:19;107:7;137:1; 138:8;154:13;183:8; 186:24hostage (2) 99:6;100:5hour (1) 14:23hours (10) 94:23;98:16;100:25; 120:6,9;152:15;157:7; 164:4;194:12;199:12houses (1) 98:5hub (1) 28:22huge (3) 40:4;47:16,21human (3) 63:4,5;96:6humble (1)

Min-U-Script® Barkley Court Reporters (15) Helen - humble


51:13hundred (2) 91:25;152:16hundred-plus (1) 71:11hundreds (8) 25:22;67:23;87:2,12; 91:15,16;96:15;121:25Huntington (2) 57:24;69:6husband (5) 158:1,7,9;176:18,19

I

iceberg (1) 61:18ICU (12) 85:17;93:12,15;94:20; 95:1,11,24;97:13,19; 98:16;99:6;100:5idea (2) 122:1;129:11IEHP (15) 18:14;21:4;27:20,21, 23;47:5;52:11,12,22; 53:15;77:3;128:16,22; 151:12;186:13ignore (1) 163:25ignored (4) 31:18;32:2;65:7; 173:10I-J-A-Y (1) 50:2ill (4) 85:5;156:23;171:18, 18I-L-L-A-R-O-S-A (1) 35:14illnesses (2) 60:5;161:19imagine (3) 100:25;119:17;148:20Imaging (1) 10:6immediate (2) 16:14;66:24immediately (1) 97:18Impact (31) 12:14,24;17:15,15; 42:13;50:8,11;69:11; 76:16;102:4;117:12,17; 131:24;133:5;141:18; 142:17;143:11,15,19,23; 144:1;145:5;146:13; 149:15,25;162:2,6; 172:18;184:8,24;187:20impacted (4) 17:10;40:23;42:16,18impacting (1) 18:17

impacts (7) 18:15,22,23;19:2; 118:7,8;172:18imperative (2) 87:5,21implied (1) 128:5implore (2) 38:6;163:25imply (2) 137:8,23importance (1) 144:12important (37) 16:11;17:1,3,14,17; 18:14;19:14;20:7;25:25; 28:12;33:4,9;40:7,8,14; 43:9;50:9;86:14,15; 103:18;112:15;113:25; 115:16,21;116:13; 126:20,21;128:21; 129:17;134:3;148:3; 161:21;168:1;178:10; 191:18;195:22;196:3importantly (5) 53:15;76:8;77:3,19; 168:21impose (1) 26:12imposed (2) 76:7;112:24imposing (1) 191:12impossible (3) 132:17;137:24;139:4impress (1) 85:7impressed (1) 86:9impromptu (1) 154:9improve (3) 76:25;106:5,8improved (1) 27:3improvement (2) 11:6;135:23improvements (6) 11:2,3,5;110:8; 139:18;148:9improving (3) 20:14;28:16;107:14in- (1) 35:20inac- (1) 113:1inaccurate (2) 113:2;137:8inad- (1) 113:1inappropriate (1) 35:20inaudible (2)

131:9;175:23Inc (6) 7:13;15:14;24:5; 72:11;111:16;143:18incidents (1) 109:10incisional (1) 166:19inclined (2) 137:18,21include (7) 10:12;11:1;17:4,18; 27:9;28:5;53:13included (1) 53:12includes (4) 9:5;10:3;118:12; 125:20including (16) 10:19,23;21:1;25:19; 27:6;29:5;31:12;32:8; 39:7;51:17,18;52:14; 64:3;66:3;89:10,18income (8) 64:24;68:6;112:11; 118:3;146:17,20;147:10, 10incomp- (1) 123:18incompetent (1) 123:18incorrect (3) 37:20;146:22;163:20increase (5) 27:3;64:25;91:6; 133:17,18increased (4) 38:22;89:17,25;105:3Increasing (2) 28:6;139:3increasingly (1) 125:1incredible (1) 140:3incumbent (1) 142:23incur (1) 148:11indeed (6) 48:22;143:9,13;145:7; 146:7;148:10independent (12) 23:23,25;25:5;27:14; 55:13,18;79:7;111:15; 153:10;167:18,24; 193:23independently (1) 107:18India (1) 152:17Indian (1) 48:11indicate (1)

32:6indicated (4) 32:24;152:19;153:17; 154:14indicating (1) 154:8indication (1) 62:6indicators (2) 28:17;196:19indictment (1) 165:3indigent (4) 28:23;128:10;196:22, 23indigents (1) 194:19individual (3) 8:19,25;39:17individuals (5) 23:25;28:13;39:17; 52:13;55:19industry (6) 102:1;106:7;108:1,6; 127:13;157:11infection (3) 56:23;85:15;109:4infection-control (2) 190:4;196:4infections (5) 31:6,14;57:11;109:10; 190:1inference (1) 189:19inferences (1) 189:16inferior (1) 181:20influx (1) 118:18inform (1) 142:19information (18) 11:2,5;37:14;41:17; 113:2;142:23;143:2,7, 10,12;145:6;149:23; 150:1;153:1;163:23; 164:1;186:20;187:10informational (1) 67:5infrastructure (2) 11:3,6infusion (1) 102:13inheritance (1) 141:22initial (1) 42:13initially (2) 40:11;131:17initiation (1) 178:13initiatives (2)

28:4,5injection (1) 107:13injunctive (2) 66:18,23Inland (5) 17:4;21:3;52:11; 53:16;88:12inpatient (3) 60:5,9;103:10inpatients (1) 184:9input (1) 27:11Inspector (1) 32:13instance (4) 42:4,24;135:15;151:4instances (1) 105:23instead (4) 65:8;124:2;171:21,22instituted (1) 127:16institution (2) 139:10;193:2institutions (4) 63:9;83:6;165:1;193:5instructors (1) 90:5insufficient (1) 112:13insurance (21) 17:6;28:15;30:4,8,10, 12,18;33:3,6,12;40:22; 46:19,22;47:5;92:21; 96:5;99:13;127:11; 143:25;158:3;171:13insurances (5) 21:8;51:11;171:14; 172:13,15insure (1) 60:1insured (1) 56:19insurers (2) 56:13,14intangible (1) 10:19integrity (1) 179:3intelligent (1) 73:6intensive (4) 16:2;171:22,25; 189:10intentionally (3) 97:6;98:8;188:23interaction (1) 184:19interactions (1) 183:6interest (26)

Min-U-Script® Barkley Court Reporters (16) hundred - interest


12:8;21:20;24:5;33:5; 40:17;56:3;62:11,13,17, 22;64:12;68:15;75:21; 87:7;111:18;124:19; 140:2;142:25;143:13; 146:9;148:20;149:6; 158:15;163:23;182:13, 23interested (6) 19:24;33:14;34:1; 83:12;192:3;195:24interesting (1) 152:10interests (8) 33:2;63:14;116:1; 133:6;181:7;185:6,10; 191:23interim (1) 10:13Internal (1) 7:15International (1) 54:17Interpreter (4) 9:10,13;155:17,19Interruption (1) 183:22intertwined (1) 148:5intervals (1) 189:17intervention (1) 125:7interviewed (1) 133:4interviews (1) 15:18interworking (1) 115:8intimate (1) 39:11intimidation (1) 110:7into (37) 20:12;21:3;26:22; 30:24;36:3;38:7;44:9; 56:17;65:8;73:19;74:20; 77:18;80:12;82:15; 84:22,22,25;85:22;86:1; 95:1;97:11;111:4;114:5; 122:12;125:5;132:17; 138:20;140:23;150:20; 163:11;164:3,7;176:24; 177:14;179:6;183:15; 195:17intolerable (1) 68:2intricacies (1) 194:10intriguing (1) 135:6intubate (1) 98:22

intuition (1) 103:18inure (1) 146:10inuring (1) 146:3invest (5) 26:21;55:12;83:6; 107:1;125:14invested (1) 20:21investigate (1) 190:20investigated (1) 154:22investigating (2) 190:19,20investigation (7) 32:12;66:9;77:12; 79:3;109:8;137:25; 154:18Investigative (3) 8:13;153:6,10investing (2) 106:19;107:1investment (3) 102:13;106:17,23investments (2) 10:22;17:21invests (1) 123:22invite (3) 13:7;78:13;147:21involved (12) 24:2;62:25;133:24; 138:19;147:21;150:8; 157:16;160:5;178:15; 191:9,25;198:4involvement (1) 141:3involving (1) 134:1IPA (1) 44:12ipsa (1) 136:11ironically (1) 133:24irrefutable (1) 153:14irritating (1) 159:1Irvine (1) 98:24issue (32) 13:8,11;22:8;32:14, 24;42:25;54:23;55:8; 61:13;66:23;76:18;78:6; 85:14;93:6;144:2;146:1, 2;147:13,15,25;148:6; 149:5,16;150:2,4; 154:20;177:3;182:16; 193:20;194:6,12;195:10

issued (1) 66:14issues (22) 12:5,6;38:6;54:21; 61:18;70:15;75:1,8; 76:5;106:5;107:15; 134:1;138:24;139:1; 143:16;144:11;146:15; 185:24;186:10,18,23; 190:4items (1) 18:14iterations (1) 178:16

J

Jamie (1) 15:5janitor (1) 196:3January (1) 65:13Jenson (2) 142:11;152:4jeopardy (2) 180:18,20Jess (1) 26:6jewelry (1) 67:6job (7) 121:13,24;135:18; 162:18;171:2;189:8,8jobs (17) 20:22;70:15,24;71:23; 83:19;99:24,24,25; 125:11;129:18;139:16; 162:6,7,11,11,15;179:6Joe (8) 103:25;110:18; 113:16,17,18,19,22; 162:20John (4) 152:7,8,9,9J-O-H-N-P-E-T-T-Y (1) 152:10Johnson (5) 175:22;176:9,10,10,15Joint (3) 31:10,23;190:12Jolla (2) 95:9;99:7Jose (3) 97:21,23;99:2Joseph (11) 71:9;88:3,4,5;101:15; 104:3,4,5,9,13;164:14journalism (1) 153:6journalist (1) 153:10journey (1)

167:1Judge (4) 34:2;78:13;132:11; 181:14judgement (2) 48:23;198:22judge's (1) 181:12July (7) 32:19;34:5;64:19; 68:25;78:13;111:1; 170:5June (5) 66:11;74:9;137:15; 141:16;186:9Justice (3) 78:15;79:7;181:5

K

Kaiser (4) 58:7;156:24,25; 157:14Kali (2) 43:24;152:14Kamholz (1) 138:12K-A-M-H-O-L-Z (1) 138:13Kavitha (1) 23:18keep (31) 9:20;26:15;38:21; 46:18;54:7,9;72:14; 86:20;93:6,7;94:6; 96:13;115:16;117:10; 129:17,17,18;131:6; 139:16,24;156:21;192:9, 11,12,18;193:11;195:21, 24;197:4;198:19;199:13keeping (6) 50:19,21;68:9;125:23; 141:8;194:18keeps (2) 20:19;97:8Ken (7) 108:12;110:17,17,19, 20,20;113:15kept (7) 95:3;185:12,14;188:2; 193:8;195:1;197:21key (5) 10:11;133:16;134:3; 146:16;154:21kicker (1) 98:23kidney (1) 80:18kids (2) 63:8;84:17kind (20) 14:15;40:10;45:1,2; 46:11;62:17;86:3;91:4;

98:2;115:24;121:9; 144:15;154:18;159:1; 163:1;171:2;173:16; 185:9;186:20,21kinds (2) 116:7;123:19Kit (1) 138:12knee (1) 170:10knew (2) 111:24;158:11Knight (1) 124:14knit (1) 26:8Knolls (1) 38:25knowing (1) 167:4knowledge (3) 39:11;41:15;60:2known (7) 38:1;71:19;106:3; 120:15,24;170:9,14knows (9) 13:16;70:20;74:5; 84:8,8;97:16;137:4; 138:9;157:11Koelle (9) 104:1,1;108:13,14,17, 17;109:23;110:1,5K-O-E-L-L-E (1) 108:18Kollitz (1) 178:5Kulyas (13) 87:25;92:8,9,10,12; 94:12,16;97:4,5,5;101:9; 155:5;188:22K-U-L-Y-A-S (1) 92:10Kurtz (1) 130:22

L

La (4) 9:1;95:9;99:7;130:18lab (7) 16:3;78:25;79:1,7; 139:1;170:4;171:10labor (7) 27:7;64:1;65:12;66:3, 13,15,16laboratories (2) 171:5;180:24laboratory (5) 22:1,6,9;135:23;171:6lack (8) 28:14;109:5;154:14; 174:22,25,25;193:9; 194:8

Min-U-Script® Barkley Court Reporters (17) interested - lack


lacking (1) 189:6laid (1) 94:21language (1) 129:1lapse (1) 116:17lard (1) 98:14large (13) 40:17,19;42:6;43:8; 44:22;58:25;59:15; 109:15;114:17;118:12; 132:16;139:12;166:10largely (1) 184:22large-picture (1) 76:23larger (3) 138:16,20;140:8largest (1) 117:25last (47) 7:25;17:21;20:13; 23:4;35:10;39:25;43:16, 18;45:14,16;48:4;49:20; 50:2;53:4;64:16;70:10; 78:8,18;81:9;90:23; 104:7;105:8;108:17; 130:20;134:14;136:9; 139:9;146:17;150:2; 152:23;153:4;156:7; 158:16;159:21;161:2; 164:21;168:4;177:12; 178:5;179:18;183:18, 18;190:25;191:6; 195:22;197:23;198:25late (4) 33:25;108:15;141:16; 182:10later (8) 12:18;68:12,12;84:7; 120:6;133:9;134:24; 200:15laugh (1) 173:3Laughter (2) 85:11;141:23law (9) 12:5;24:10;37:15; 56:13,17;67:15;132:20; 178:4;181:12laws (2) 50:24;62:11lawsuit (2) 67:9,10Lawyers (5) 61:9;67:13,25;179:25; 180:2lay (2) 93:11;157:8layed (1)

101:1lead (2) 30:14;66:4leader (6) 23:21;103:6;105:25; 159:11,19,23leaders (1) 197:14leadership (2) 77:25;106:3learn (1) 91:19learned (3) 86:5;120:9;150:20learning (3) 116:9;120:5;171:2lease-back (1) 10:14least (14) 11:4;26:21,24;30:7; 44:4;58:16;60:9;128:18; 135:3,9;140:13;143:16; 186:3;195:22leave (4) 69:17;113:14;123:19; 194:18leaving (3) 82:22;109:13;118:2led (2) 20:12;91:21left (13) 13:4;41:18;42:23; 59:3;69:2,7;94:23; 104:15;155:19;183:8; 187:3;188:8;195:1legacy (2) 106:13;107:3legal (8) 12:7;36:17;65:8,9; 67:3,12,16;180:4length (3) 60:21;80:20;86:6less (19) 11:12;18:23;58:22; 61:7;81:15,20;87:8; 103:20;118:23;150:25; 160:10;168:23;179:8; 181:19,20,23;182:4,5; 187:24lessen (5) 77:15,17;149:13; 183:12,13lessening (1) 182:16letter (4) 110:23;113:14;117:4; 124:14letters (2) 77:5,24letting (1) 181:14leukemia (6) 93:10;94:21;96:23;

97:15,16,20level (8) 29:13;51:17;59:4,15; 82:6,16;156:21;172:20levels (6) 11:11,20;27:1,2;48:8; 112:12Lewis (3) 97:22,23;99:2Lex (6) 170:7;190:25;191:1,2, 3,5L-E-X (1) 191:6library (1) 26:3license (6) 32:15,23,25;54:23; 135:22;136:1licensed (5) 10:2;15:24;24:21; 81:4,13lie (2) 100:24;163:4life (9) 80:8;85:7;96:6;97:12; 98:22,24;99:12;160:1; 161:20lifeless (1) 98:22lifelong (1) 199:4life-threatening (1) 56:23light (5) 17:17;74:21;134:2; 154:24;185:20likelihood (1) 182:4likely (3) 22:3;61:7;143:24Likewise (1) 145:12limit (2) 42:11;176:23limited (1) 140:2line (6) 9:3;14:5;35:1,6;58:23; 108:4lines (2) 145:3;146:14Lionel (5) 101:15;103:1,2,3,4Lisa (11) 52:6;54:3;63:17,17, 19,20,21;65:15,17,19; 69:10list (10) 13:21;14:12,25;34:21; 35:7;41:14;45:10;49:21; 52:3;54:10listed (4)

50:11;51:12;145:8,10listen (3) 49:12;94:9;193:16listened (2) 72:17,18listening (10) 9:3;72:16;116:22; 137:2;150:6;152:11; 155:8;163:1,2;169:7literally (2) 74:22;86:3litigation (1) 133:24little (20) 23:13;40:15;46:14,24, 25;54:8;65:16;84:7,7,9, 16;108:15;110:3;137:3; 147:11;159:8;163:24; 171:25,25;189:9live (8) 84:13;85:4;98:5; 100:14;108:24;119:24; 173:2;191:16lived (8) 25:10;84:13;91:24; 101:21;164:23;171:9; 191:5;194:4lives (11) 22:20;85:1;87:18; 96:25;99:11;100:19; 123:22;173:15;183:10; 192:6,20living (3) 168:2,12,13LLC (3) 7:14;24:20;72:12loan (2) 161:11;185:16loans (1) 148:15lobby (1) 67:5local (34) 11:21;27:8,10,12; 28:20;68:7;80:10;83:11, 13,18,19;87:19;102:5,9; 103:16;106:11,13,18; 109:15;117:22;118:3; 124:2;161:20,20; 166:22;167:12,19,22; 168:9,16,25;169:1; 179:6;199:11locally (2) 109:2;122:1locals (1) 109:15located (4) 10:4;16:17;62:1;67:14lock (1) 75:21locked (1) 150:18logically (3)

163:5,11,19Loise (2) 108:12;110:16long (13) 24:1;30:13;69:12; 82:7;85:6;106:1,1,18; 109:3;120:24;126:10; 168:15;193:17longer (6) 54:8;120:17;135:24; 150:4,17;171:13longest (1) 180:2longstanding (2) 81:7;197:21Long-term (1) 138:7long-time (1) 166:6look (29) 27:10;36:2;44:9; 50:15;51:13;53:21; 57:22;59:14;60:21;61:5; 79:15;92:2;107:19; 145:7,9,17;146:2,15; 147:8;153:12,12,13; 162:1,14;163:13,19,24; 190:6,8looked (4) 57:8;95:12;150:10; 178:20looking (16) 57:13;59:4,8;60:7; 71:10;86:8;106:24; 140:3;162:10,15,17; 163:11;164:3;174:13; 190:5;199:4looks (7) 34:8;45:8;97:24; 164:2,5;165:11;182:24loop (1) 41:18loquitur (1) 136:12Los (3) 47:18;129:23;132:11lose (15) 30:17;43:2;51:20; 70:23;71:4;80:22;81:12; 105:23;119:17;122:3; 135:22;162:6,11; 164:10;166:1losing (2) 96:11;136:1loss (7) 39:5;71:5;81:21; 83:19;96:21;118:4; 121:4losses (3) 30:15;128:7,12lost (13) 33:8;40:5;70:16; 99:12;109:3;141:15,17;

Min-U-Script® Barkley Court Reporters (18) lacking - lost


163:14;165:25;170:16, 18;172:25;178:21lot (46) 21:9;35:19;36:8,12; 38:4;46:12;54:10;59:21; 70:22;84:25;96:12; 98:17;108:1;110:2; 114:1,1,25;121:14,15, 19;122:13,20;123:12; 129:16;130:16;133:25; 134:20;136:19,21; 158:18;159:5,6,23; 161:9,22,23,23;167:6; 177:6;181:24;189:20; 190:22;192:7;195:23; 197:7,7loud (1) 72:19love (1) 78:4loved (7) 96:19;97:12;99:22; 100:9,16;165:25;166:1low (2) 33:7;112:4lower (3) 60:19,20;69:15low-income (2) 52:15,21Luckily (1) 168:10lull (1) 72:6lumpectomy (1) 166:20lung (2) 168:7;171:20Luther (5) 87:24;90:13,14,15,16L-U-T-H-E-R (1) 90:16

M

ma'am (2) 94:11;188:25machines (1) 114:13macular (1) 168:14Magama (1) 155:21Magazine (1) 138:11Magma (1) 155:21main (2) 10:16;44:1maintain (10) 27:5,18,24;30:9; 76:24;77:1;103:10; 125:11;128:17;197:8maintained (4)

88:9;90:2;166:14; 167:11Maintaining (3) 20:9;53:13,15maintains (1) 30:7maintenance (1) 18:13major (6) 29:6;40:16;41:2; 42:25;86:22;131:3majority (6) 23:24;50:10;51:10; 77:9;145:21;189:10MAKALA (7) 45:11,12,12,15,16; 46:8;47:3M-A-K-A-L-A (1) 45:16makes (3) 20:7;61:5;140:17making (16) 7:17;19:22;39:17; 55:11;62:20;82:19; 108:5;114:17;136:5; 142:25;172:22;186:23; 191:10;193:8;198:3,21malnourished (3) 80:19,21;85:10mal-nurtured (1) 80:21malnutrition (10) 31:7,23;32:3;57:12, 16,20,23;80:14;93:6; 196:1Mamo (1) 160:16man (5) 84:15,16,21;155:17; 177:25manage (1) 10:15managed (9) 18:17,18;25:3;30:16; 58:7;77:1,12;143:25; 167:10management (6) 10:14;17:24;20:3; 82:1;104:19;175:1manager (2) 161:8;166:3managers (3) 25:4,8;194:8mandated (1) 128:25mandating (1) 50:20mannequins (1) 89:11manner (3) 48:23;198:22;199:15manning (1) 130:22

mansions (1) 100:15many (57) 16:15,17;17:7,11; 18:11;21:4,7,10;25:9; 28:13;33:5;36:4;47:18; 59:12;66:5;70:22;78:8; 80:7;85:2;114:5;118:3, 14;121:17;122:2; 124:19;125:2;126:14; 127:20;128:22;129:15, 19,20;131:22;134:19; 139:7;157:21;158:23; 161:17,19;164:4,25; 167:22,24;170:9,17,22; 172:6,12;173:8,11; 179:4;185:13;186:17; 189:20,24;190:10; 192:20Mark (9) 92:6;97:4,5,5;101:8,9; 155:6;188:22;194:18marked (2) 94:18;95:8market (5) 44:21,22;55:22; 172:20;183:4marketing (2) 167:4,11marketplace (2) 125:13;183:12Martha (10) 155:22,22,25;156:1,3, 4,6,6,10;160:4M-A-R-T-H-A (1) 156:7Mary (10) 16:12,19,21;18:17; 37:10;47:6;71:9;157:7; 167:8;194:6Mary-Ellen (3) 155:23;160:15,15Mary's (14) 36:6,14;42:21;109:14; 127:18,18,19;129:6; 131:20;135:12;157:3; 176:24;183:3;185:2massive (1) 64:20master's (1) 189:11matter (4) 79:4;137:9;161:10; 180:4matters (5) 12:7;79:20;131:2; 179:21,24mature (1) 119:20maximize (1) 62:12may (29) 13:1,8;28:1;30:19;

33:1,13;34:22;40:16; 50:15;54:8;59:24;61:18; 62:24;74:23;75:1;89:4; 94:14;104:24;119:20; 142:20;145:20;146:22; 149:12;153:3;171:7; 180:12;184:16,16,19maybe (6) 40:7;100:10;120:15; 121:5;137:17;163:17Mayo (2) 59:19;60:13mayor (16) 68:20;69:21,23,24; 70:1,6;71:22;72:17; 79:24;82:24;84:1,3,4; 96:9;104:14;105:6McEACHRON (3) 69:23,24,25M-C-E-A-C-H-R-O-N (1) 69:25MD (3) 38:9,10,11MDS (11) 15:10;18:10;52:19; 53:12;72:23;76:17; 127:17;128:8,13; 146:16;189:8meals (1) 172:10mean (13) 35:20;44:24;57:21; 60:11,12;96:12;119:18; 163:13;165:6;176:23; 177:5,18;196:20meaning (1) 168:23means (9) 23:24;27:15;35:21; 97:17;114:1;136:1; 148:25;165:8;189:15meant (1) 62:11measure (1) 188:12measured (1) 28:18Measures (2) 28:17;190:2median (2) 58:23,25medians (1) 189:16Medicaid (7) 21:24;180:5,13;181:8; 186:7,14;188:11medical (100) 11:9;12:15;13:5;16:8, 12,19,22;18:18;20:5; 22:19;24:13,14;26:3,23; 27:10,15;29:17,18; 38:24;39:10,19;41:23; 42:4,7,24;45:23;48:8;

57:24,25;58:17;59:6,8, 12;60:10;64:5;71:9; 77:4,10,10,20,21;78:1; 80:7;82:10;83:12;89:10; 93:4,19;97:18;99:13,14, 19;100:5,11,12;103:10; 105:14;106:6;108:1,6, 25;109:1;111:12,13; 112:13;115:3;117:10, 14;118:8,10,22,24; 122:21;126:8,10,14,17; 134:12;139:1;142:18; 143:20;157:6;159:6; 161:19;166:4,17;167:9, 12,20,24;170:11;171:22; 184:8,17,25;193:23,23; 199:10,17,20Medi-cal (13) 17:5;18:6;21:4,5;47:5, 7;109:9;128:9;135:8,25; 172:16;184:22;192:2medical/surgical (1) 27:6medically (1) 28:23Medicare (35) 17:5;21:5,24;28:16, 18;29:10;31:7,10,24; 32:20;56:25;57:19;58:6, 17;59:5,20;60:4;61:11; 74:20;109:9;135:9,25; 154:8;172:16;180:5,13; 181:8;184:23;185:20, 25;186:7,14,15;188:11; 192:3Medicare's (2) 32:13,18medicine (4) 31:5;37:23;39:25; 109:4mediocre (1) 123:17meet (1) 125:24meeting (8) 7:9,20;8:14,21;13:16; 50:11;200:15,21meetings (1) 15:8Mekala (1) 45:8member (22) 19:8;49:5;63:11; 90:24,25;101:16,17,19; 115:15;116:20;127:10; 131:11;134:12;136:5, 17;137:20;139:6; 140:21;142:3;152:12; 156:15;161:6members (38) 11:8;23:23;25:5,9; 27:9,10,21;29:23;34:10; 50:7;52:14,15,17;53:16;

Min-U-Script® Barkley Court Reporters (19) lot - members


55:14;63:3;77:25;99:22; 127:7,7,20,25;128:1,22, 22;129:9,21;130:1,1; 134:14;138:21;145:19; 151:22;175:13;184:15, 16,20;197:22mental (2) 170:12;171:19mention (9) 17:14;41:22;61:12; 78:3;102:6;140:19; 150:3;189:23;197:23mentioned (5) 15:21,24;51:1;168:6; 169:20mentioning (1) 182:13mentions (1) 44:8mergers (1) 138:18meritless (1) 65:11merits (1) 79:11message (1) 108:8met (3) 74:23;121:8;141:15metric (1) 59:12mic (2) 49:25;131:6MICHAEL (17) 23:1,2,5,13;34:15,18; 124:7;126:5;130:12,12, 14,15,24;131:8;132:5, 10;145:13Michelle (6) 79:24;82:23,23,25; 83:1,1microphone (5) 8:15;23:12;46:25; 108:16;130:15microphones (1) 8:25mid-1990s (1) 138:5might (9) 40:13;61:17;81:11; 85:16;135:2;143:8,19; 186:21;199:25Mike (4) 22:24,25;23:3;34:12miles (3) 47:18;62:1;152:16million (51) 10:25;11:1,4;23:16; 25:20;26:22,24;30:2; 51:6;59:25;60:15;75:6; 76:1,1;79:16;88:23; 91:25;92:18,19,23; 94:13;115:11;131:18,

18;132:14;139:17; 141:21;146:18;147:11, 11;148:8;161:13,13; 163:7,8,10,14;178:23; 179:8;181:19,20,21,23; 185:14,16;187:2,21,21, 22,24;188:9millions (9) 20:21;30:14;33:8; 67:24;84:21;87:12; 96:18;128:7,12mind (6) 14:21;82:22;115:16; 141:1;163:4;198:20mine (5) 15:5;56:10;154:7,9; 165:17minimize (2) 18:14;19:1minute (2) 14:18;73:20minutes (6) 9:21;54:7;80:25; 101:11;119:25;176:6misdiagnosing (1) 93:4misguided (1) 30:24misleading (1) 113:2mispronounced (1) 88:1mispronouncing (2) 34:23;132:1mispronunciation (1) 169:17miss (1) 54:20Mississippi (2) 29:9;196:18misspoke (1) 181:2misstatements (1) 30:22mistakes (2) 133:21;134:5mistrust (1) 39:14mitigated (1) 114:10Mitzelfelt (2) 117:3;119:4mix (1) 69:14model (6) 40:24;45:2;46:13; 56:17;62:14,23modeled (1) 76:2models (1) 197:16modernization (1) 140:6

modernize (1) 139:16modernized (1) 133:19Molina (3) 47:6,7,13mom (6) 97:21;98:10,14,17; 100:23;134:17moment (4) 63:7;74:4;135:3; 144:14moments (1) 186:11mom's (1) 98:12Monday (5) 98:10,25,25;120:23; 158:6monetary (1) 106:24money (48) 30:17;38:4;59:21; 60:4;74:12;75:6;93:2; 96:14,14;97:8,9,9,9,11; 98:4,6,7,7,7;99:11,18,20, 24;100:1,3;106:20; 107:13;116:15;121:5,13, 14,15,18,19;159:5; 160:9;163:14,15; 172:23;177:5,6,8;179:6; 181:24;182:2,3;183:9; 187:24monitored (1) 192:13monitoring (2) 195:7,9monopolization (3) 182:10;183:21;184:7monopolizing (1) 41:1monopoly (6) 43:6;44:23;77:16; 109:13;149:14;175:6Montclair (8) 23:20;24:13,16;29:18; 111:12;146:19,24,25Monte (1) 164:14month (7) 19:16;26:7;68:12; 75:18;137:1,2;171:7months (20) 33:24;43:24;53:4; 68:12;70:11;74:22; 96:10,10,12;122:11; 136:10;153:5;158:24; 159:17;170:7;178:19; 185:8,13;186:22;187:15Moore (2) 130:13;186:20more (61) 9:21;19:23;20:7;21:6;

22:11;23:16;25:20;26:1, 7;28:10,10;29:11,25; 30:2;31:8;32:7;33:23; 37:4,11,22;38:2;40:8; 41:4,13;50:5;51:19; 57:19;59:2,19;60:16; 61:12;64:2,23;65:2; 66:20;69:12;70:17; 73:10;83:14;88:14;94:6; 96:25;103:21;106:7; 117:21;118:23;123:13; 140:7,9,15;153:11,11; 161:24;166:22;168:21; 170:6;171:18;176:4; 183:4;186:23;189:18morning (1) 158:6Morris (6) 84:2;87:24;88:3,4,4; 91:9M-O-R-R-I-S (1) 88:5Mort (7) 142:10,12,13,14; 152:18;154:13;182:14M-O-R-T (1) 142:14mortal (1) 141:21most (29) 12:9,13;18:18;21:12; 36:9;42:14;50:17;53:15; 64:22;76:8;77:3,19,20, 20;96:4;115:20;116:13; 125:7,22;129:3,7;133:4, 5;135:17,21;153:24; 166:19;175:5;191:19mostly (2) 91:5;174:8mother (4) 97:24;119:21;120:12; 134:8mothers (1) 119:2motivation (1) 153:15motivator (1) 121:5motive (1) 194:25motor (1) 122:22move (10) 23:11;49:24;73:2; 75:23,25;108:16; 130:15;158:25;159:13, 16moved (3) 155:4;157:16;166:16moves (1) 77:16MRSA (2) 85:16,25

much (59) 9:15;18:23;19:3;20:1; 30:17;36:23,24;38:8; 39:20;43:12;44:11;45:6; 47:25;49:13,14;51:21, 22;54:1;56:18;60:25; 61:6;68:18;69:20;72:3; 79:22;82:21;83:14,24, 25;85:19;87:23;92:5; 97:1,2;102:2,24;108:10; 110:11;116:23;124:5; 126:2,19;130:10;131:14, 20;160:13;164:11; 165:19;168:23;169:3; 173:18;175:14,15; 193:15;196:9,13;198:23, 24;199:2much-needed (1) 111:23multiple (3) 69:13;106:4;162:12murdered (3) 97:7;98:8;188:23must (17) 7:22,25;11:22;21:22; 28:7;56:2;110:13,14; 112:25;116:19;119:18; 129:5,8;135:3;177:2; 199:14;200:15mutually (1) 77:2myself (11) 40:16;85:3,8;102:7; 114:5;120:1;158:17; 160:9;161:18;173:8; 189:9

N

nail (1) 162:23name (66) 7:7,25;9:1;14:14;15:2, 3,5;19:10;23:1,4;35:10, 10,13;37:2;38:10;40:1; 43:15,16;45:14,16;48:2, 4;50:1,2,2;52:9;63:20; 68:22;69:25;80:1;83:1; 92:1,9,11;97:5;101:18; 103:4;104:4,8;108:17, 18;110:20;117:1; 119:12;123:9;124:11; 130:24;142:13;156:5,6, 7;160:24;161:1,2; 164:21;169:14;173:22; 178:3,5,6;179:17,18; 188:17;191:5,6;199:3named (1) 187:13nameless (1) 130:1names (1) 42:1

Min-U-Script® Barkley Court Reporters (20) mental - names


Nanda (2) 95:16;99:1Naranja (3) 97:22,23;99:2nation (10) 29:6,15,18,20;108:24; 111:14;122:1,15; 196:18;199:21national (6) 58:23,24;65:12;66:15; 108:22;189:25National-Labor-Relation-Board-conducted (1)

65:5nationally (1) 82:14near (4) 71:9;85:17;109:13; 136:7nearest (3) 47:17;61:23;62:4nearly (2) 132:17;181:12necessarily (3) 43:6;134:21;168:20necessary (4) 7:20;20:18;76:9; 165:11need (67) 13:23;14:3,17;21:17; 25:25;40:4;43:10;44:19; 45:15;46:21;49:24; 53:17;58:10;62:20; 71:12,23,23,24;73:2; 79:12,17;81:24;97:17; 99:16;102:9,13;107:22; 114:3,8,16;115:17,17, 18,19;116:7,20;119:23; 122:16;123:3;124:23; 125:13;129:25;130:1,2; 134:25;143:8,10;148:18, 18;152:5;154:21; 159:14,15,15;160:7,8; 165:17;173:16;179:25; 180:3;184:6;189:18,21; 192:18;197:3;199:12,13needed (8) 17:21;21:14;95:1; 115:1;133:11;177:15; 182:21;186:20needs (34) 9:8;12:19;14:23; 20:10,19;21:1;37:7,13; 38:20;39:2;44:11,13,14; 70:7;102:15,16;106:11, 14;114:3,15,16;116:16, 17;122:4;125:11,20,24; 133:17,18;147:6;149:2; 152:23;168:23;198:23negative (7) 18:15,22,22;19:2; 118:6;123:20;196:13negatively (1) 18:16

neglect (1) 95:14negligence (1) 95:13negotiate (5) 55:23;67:16;128:15; 130:8;151:10negotiated (2) 42:20;131:17negotiating (1) 185:12negotiation (2) 136:24;178:19negotiations (2) 64:18;69:9negotiators (1) 64:20neighbors (1) 174:23neither (1) 146:4neonatal (1) 16:2Nepomuceno (3) 105:1;122:8;195:19Nepomuceno's (1) 134:13net (3) 146:17;147:10;187:22network (2) 145:7;190:1neutral (1) 66:9nevertheless (2) 41:10;174:20new (18) 16:22;21:3;26:22,23; 53:22;61:12;64:19; 69:13,15;75:14;89:8,9; 92:13;110:11;128:25; 130:8;145:15;151:10next (7) 19:16;65:3;103:1,25; 114:18;138:16;187:9nice (2) 72:25;84:11nickel (1) 137:2night (4) 120:23;157:11; 168:15;199:12nine (2) 39:25;43:24Ninth (1) 67:2NLRB's (1) 65:19Nobody (2) 60:12;196:18nobody's (2) 196:22;198:4no-contingent (1) 75:21

non-biased (2) 48:23;198:21non-contingent (2) 73:15,23none (2) 100:6;158:11nonetheless (1) 145:22nonmedical (2) 156:13;161:11Nonprofit (25) 7:12;11:25;12:1; 23:14;24:12,20;25:15; 26:16;30:1;55:11;61:16, 18,21;62:6;111:7,8,11, 21;112:23;146:4,6,11; 147:20;148:1;169:21N-O-N-P-R-O-F-I-T-H-O-S-P (1)

12:22nonprofits (3) 61:22,25;62:2nonrefundable (2) 105:21,22noon (1) 200:16nor (3) 146:5;149:15;170:22Notably (1) 68:8note (7) 26:17;30:19;38:1; 100:21;175:24;177:11; 183:7noted (4) 103:13;138:14;151:5; 180:1notes (3) 119:16,19;172:4not-for-profit (10) 52:12;132:22;144:24; 148:5;187:12,23;192:9, 15;195:2,5nothing's (1) 148:22notice (9) 10:9;12:3;142:17; 143:10,15;145:10; 147:18;149:15;163:1noticed (2) 132:15;182:14notices (1) 12:23notify (1) 22:16notwithstanding (1) 145:19November (4) 74:8;105:13;137:2; 182:19NRLB (3) 66:9,11,22NRLB's (3) 65:14,20,24

NUHHCE (1) 63:23number (22) 9:21;12:5;14:15; 17:19,23;28:3;51:3,14; 58:21,21,25;59:15;60:3; 70:25;71:1;83:22; 128:14;150:17;151:15, 22;163:18;200:17numbered (1) 138:22numbers (14) 43:8;57:13,18,22; 58:5,12;112:7;146:21; 163:3,3,12,12,19;182:25numerous (1) 29:4nurse (9) 68:23;95:2,4,18; 108:18,19;171:17; 189:10;196:4Nurses (22) 63:22;64:4;65:10; 69:5,11;88:14,19;89:23; 90:10;91:7;96:23; 108:21,22,23;109:19; 110:6,10;114:23;116:8; 121:16,22;158:11Nurses' (1) 89:7nursing (25) 38:25;39:7;80:9;88:6, 8,11,13,16,23;89:1,5,6, 17,20,21;90:4,7,20; 114:22,22;115:4,7; 121:12;139:2;150:7

O

Oaks (2) 141:1;198:16OBGYN (1) 50:4OBGYNs (1) 35:15objections (1) 65:11obligate (1) 50:25obligation (3) 65:9;132:23;180:4observations (1) 133:11observe (1) 15:7obst- (1) 111:23obstacles (1) 76:5obstetrical (4) 11:17;17:2;111:25; 112:1obstetrics (1)

21:2obtain (1) 81:23obtaining (1) 59:22obvious (1) 77:14Obviously (3) 55:3;75:14;177:18occasion (1) 41:4occupancy (2) 16:15;17:10occur (2) 41:20;148:11occurred (4) 66:11,19;67:6;190:14occurring (1) 148:16o'clock (4) 13:24;35:4;158:6; 176:7October (2) 113:24,24off (6) 59:16;84:10;98:2; 122:18;131:12;189:16offer (15) 11:10;14:7;26:19; 30:13;73:15,20;75:15, 22,25;76:16;79:14,15; 82:3;181:18;188:20offered (3) 27:19;76:8;178:22offers (1) 40:9office (24) 8:11,12,25;22:8; 32:13;44:2;47:20;50:14, 15;82:4;107:21;117:7; 132:12,19;134:2;136:8; 138:1;140:25;141:5; 176:16;178:4;182:15, 19;187:7OFFICER (128) 7:4;8:18;9:12,15;19:3, 6,13;22:14,23;23:3,11; 34:12,16,19;36:19,23; 38:8;39:20;41:25;42:5, 8;43:11;45:6,13;46:7, 23;47:25;49:14,18,24; 51:22;52:2;53:24;54:1; 56:4;63:16;65:15,18; 68:18;69:19;72:3;79:22; 82:21;83:25;87:23; 90:12;92:5,11;94:10,15; 97:1;101:7,10,13; 102:25;103:24;104:7, 11;108:10,16;109:21,24; 110:2,16;111:25;113:13, 16,20;116:23;119:7,9; 120:2;123:10;124:5; 126:2;130:10;131:6;

Min-U-Script® Barkley Court Reporters (21) Nanda - OFFICER


132:3,9;142:1,8;152:3; 155:11,13,14,15,18; 156:2,4,9;160:13,20,22; 164:13,20;165:19;169:3, 8,12,16;170:1;173:5,18, 23,24;175:15,18,19,21, 22;176:14;177:22; 178:1;179:14;180:22, 23;183:23;184:2,5; 188:14,25;189:3; 190:24;191:7;198:24; 199:7;200:9,11officers (2) 51:10;149:8offices (2) 167:17;191:12official (3) 137:19;165:2;178:7officially (1) 172:7officials (1) 164:25Often (1) 8:7old (5) 20:9;89:8;108:1; 157:5;163:3older (2) 120:18;173:12Olivas (2) 155:23;160:15Oliver (1) 99:2once (7) 8:5;19:23;56:20; 122:6;160:11;171:7; 200:4oncologist (2) 166:22,23oncologists (1) 168:9one (93) 8:3;9:13;12:19;14:7; 15:7;17:14;22:11;30:20; 34:22;35:2,14;39:1; 41:4,13;48:21;49:20; 51:3;60:2,22;61:12; 63:4;70:25;73:10;77:17; 80:13;86:5,6,7;89:6; 93:10,10;96:5,7;100:9; 106:6;108:7;111:20; 116:4;117:22,25; 126:19;128:13;131:21; 132:21;133:5,17;134:13, 22;139:5;141:20;147:2, 7,9;149:7,8;150:8,22; 151:12,19;152:25; 153:11;154:6;162:1,4,5, 8;163:6,7,17,20;166:1; 168:4,8;173:25;175:16; 178:10;181:1;182:24; 183:23;184:10;186:4; 188:6;189:13;190:25;

191:8,18;193:22,25; 197:2,23;198:20,25; 199:20ones (8) 31:4;57:16;77:9; 96:19;99:23;100:16; 165:25;197:20one's (1) 97:12ongoing (2) 53:8;68:11only (52) 8:3;16:13;29:7,8; 33:20;35:2;39:12,13; 41:17;42:22;43:3;47:8, 13;51:7;52:16;54:10; 57:5;66:22;68:11;70:7; 87:5;94:23;96:8;102:21; 104:24;105:2;106:13; 109:14;116:4;135:9,13; 137:25;140:22;141:11; 147:2,25;156:10,25; 162:11,15;163:10,16; 167:7;172:10;174:9; 177:17,19;179:24;181:8, 10;182:17;185:7oOo- (1) 200:24open (29) 16:23;20:20;26:16; 43:25;44:10,24;45:3; 46:18;49:9;50:20,21,21; 70:7,8;71:23;76:25; 110:13;116:16,19; 122:5;125:23;165:2; 174:10,11;191:19; 192:11;193:8;195:21; 197:21opened (2) 194:19;199:14Opening (1) 26:6openings (1) 40:9operate (8) 11:15;18:3;21:25; 28:10;86:22,22;111:7; 199:14operated (7) 29:24;57:2,4,5,17; 58:4;122:8operates (4) 10:2,5;86:23;111:10Operating (5) 26:3;34:8;117:11; 167:15;199:14operation (2) 112:16;122:12operational (1) 114:10operations (3) 20:14;62:7;163:15operator (1)

24:21opinion (2) 47:22;153:5opponents (1) 113:1opportunities (4) 90:17;103:14;140:8,9opportunity (14) 33:15;44:3,7;48:16; 63:24;70:12;73:1; 103:17;142:7;144:17, 25;151:6;178:25;188:17oppose (1) 107:13opposed (2) 77:20;92:15opposing (1) 78:1opposition (3) 64:7;77:23;200:1opted (1) 37:10option (13) 14:7;15:1,1;22:10; 43:4;50:15;51:14;78:23; 177:17,19,20,21;180:25options (6) 12:2,6;49:2,8;125:1; 139:20oranges (1) 59:6order (5) 19:1;59:6;83:6;117:9; 134:18ordered (1) 41:16Ordinarily (1) 12:9organization (11) 31:24;55:11;62:6; 64:1;99:18,19;100:10; 138:16;140:9;181:8; 183:16organizations (4) 28:20;31:11,16;72:10organize (2) 67:23;68:1organized (1) 7:14organizer (1) 66:4originally (1) 166:15ortho (1) 170:14OSHBID (1) 57:18OSHWA (1) 194:23Others (10) 57:11;58:19;96:21; 131:10;139:2;144:9; 150:7;151:13;162:22;

185:1otherwise (1) 144:2ours (1) 140:14ourselves (2) 75:2,9out (62) 12:16;16:16;17:12; 31:9;35:17,23;36:22; 41:18;45:16;54:25;57:4, 4,17;59:2,9,22;73:17; 76:21,22;77:2;86:1; 93:17;94:21;95:5,5; 97:15,19,19;98:11,14, 19;100:23;107:19; 112:25;113:1;115:7; 118:1;124:2;133:15,23; 134:23;135:18;136:2; 138:25;147:6,7;150:18; 154:11;157:12,12; 158:18;163:14,17,22; 166:8;168:11;171:1; 175:23,25;179:9; 190:15;200:12outbid (1) 178:15outcome (2) 163:24;168:2outcomes (4) 60:24,25;196:13,15out-of-network (1) 56:15out-of-town (1) 67:25Outpatient (1) 10:6outpatients (1) 42:19outrageous (1) 172:25outrageously (1) 30:22outreach (3) 28:19;83:3;102:20outside (2) 91:21;180:23outsource (3) 22:9;78:22;79:1outsourced (1) 180:20outsourcing (2) 78:23;180:25over (54) 8:11;16:8,8;21:12,13; 25:14;26:24;29:4;36:5; 40:25;43:6;46:11,11; 52:13,14;59:25;60:16; 69:1,7;70:21,23;71:3; 75:6;77:24;83:9;85:3; 88:8;90:23;93:14; 100:15;101:21,22; 102:18;113:5;122:13;

123:12;126:15;131:1; 133:13;150:24;152:21; 153:4;159:2,12,24; 163:7,14;164:24;165:6; 168:11;180:24;181:12; 186:15;187:8overall (2) 28:8;145:7overburden (1) 42:21overburdened (1) 118:18overcrowded (4) 83:21;109:15;118:21; 176:25overflow (1) 176:25overriding (1) 114:8overseeing (3) 100:12;101:5,6oversight (5) 132:24;187:8;192:10; 195:6;198:15oversights (1) 195:6overwhelmed (1) 105:3overwhelming (1) 77:4overwhelmingly (1) 65:6owe (2) 48:25;49:4own (11) 41:15;46:3;99:13,13; 100:24;114:5;129:6; 147:1;167:15;182:13; 200:4owned (8) 24:20;69:4;122:8; 124:2;146:22;147:2; 154:10;174:16owner (6) 102:7,9;106:12,13,14; 110:11ownership (5) 11:24;24:5;69:1; 103:15;111:18owning (1) 167:15owns (5) 10:1;24:12;77:13; 111:10;144:22

P

packages (1) 64:21page (1) 136:2paged (1) 41:9

Min-U-Script® Barkley Court Reporters (22) officers - paged


pages (1) 82:11paid (14) 33:7;53:4,6;60:11; 84:15,17;89:24;99:13; 121:18;155:8;156:18; 170:24;188:10,10panicked (1) 79:13paper (7) 62:25;93:23;94:7; 100:22;105:9;165:2; 181:15papers (1) 73:12Paradise (3) 58:1;141:1;198:16paragraph (1) 154:17paramedic (3) 86:23;89:2;157:23paramedics (4) 86:25;157:4,6,25pardon (2) 148:11;149:17parents (4) 16:15;46:8;91:19,20parking (1) 98:17part (12) 26:12;48:8;49:6; 107:16;109:15;132:16; 136:5,24;138:16; 139:12;145:6;188:2participate (2) 135:25;196:2participated (1) 33:20participating (1) 32:20particular (7) 30:20;51:11;52:20; 115:9;116:10;145:2; 151:4particularly (8) 28:12;64:21;69:6; 89:21;148:3;150:7; 155:4;175:9parties (7) 19:25;33:1,5,13;43:5; 147:24;195:24partnership (3) 89:13,19;103:21party (1) 120:23PASILLAS (4) 165:21,22,23;169:5Pass (2) 28:24;118:20passed (1) 53:5passes (1) 22:12

passion (3) 110:3;167:19;192:7passionate (1) 167:2past (12) 24:18;25:11;26:2; 29:4;48:11;76:6;82:12; 88:8,17;134:6;148:13; 199:22pastor (3) 199:6,8,10Pat (7) 169:9,13,14,14,18; 170:3;173:7patient (22) 21:7,17;28:7;29:11; 31:17;41:6;46:20;47:19; 56:19;67:13;68:5;86:25; 87:1;92:17;99:4;109:18, 19;133:18;154:8;157:2; 168:2;173:8patients (97) 9:4;16:5,6;17:3,6,7; 18:6,17;21:5,8,14,20; 22:5,18;28:8,11,24; 29:10;31:3;33:9,10; 35:22;36:3,4,5,8,12,13, 18;39:2,5,13;40:18,23; 41:4,14,21,24;42:10,17; 43:7;44:2,6,15,19;45:3, 4;46:5;47:10;50:17,22, 23;53:22;56:14,20; 57:10;58:6,9,11;59:20; 60:1,23;62:12,19;64:12; 93:7;96:4;103:23; 110:12;112:11;118:19, 19;126:12,22,23,25; 127:1,15,21,23;128:1; 129:14;154:11;167:20; 168:24;170:18;171:6,7, 17;172:8;173:9,10; 183:20;184:12,13; 196:8;199:11patients' (2) 60:25;183:9Patricia (4) 90:13,14,15,16Patrick (1) 19:12patrolmen (1) 51:10pattern (2) 61:25;151:14Paul (6) 160:16,17,24,25; 161:1,1pay (7) 35:21;53:5;56:15; 67:25;158:4;186:6; 193:18payer-mix (1) 134:22payment (3)

178:18;181:25;182:1pays (3) 35:21;56:24;57:19peaceful (1) 67:4pediatric (4) 11:17;16:1;17:2;112:2pediatrician (1) 23:18pediatrics (2) 21:2;27:7PELLEY (15) 19:5,6,9,10,11;70:5; 71:19;72:18,25;78:4; 131:20;136:3;160:1,3; 180:18penalize (1) 122:16pending (1) 154:18people (85) 8:4;9:22;14:8,25;15:2; 17:11;20:4;35:7;47:11, 17;51:6,11;53:9;54:4, 10;57:20;61:10;75:12; 84:9,22;86:11;87:19; 98:5;112:5;114:1,2,12, 15,15;115:22,22;116:3, 3,17;118:23;121:2,9; 122:1,23,25;123:1,4,7,8, 12,12,23,24;127:10; 129:16;130:3;132:1,17; 144:9;150:14,16,17,20; 151:15;155:8;157:18, 21;158:25;159:5,14,20, 24;160:8;162:21; 165:10,17,24;170:25; 171:4,16;172:6,11,13, 15;173:2;175:12;176:3; 177:6;183:5;192:20peoples (1) 87:18people's (3) 85:1,20;99:10per (9) 16:4,7;57:21;60:11; 81:15,18;105:10;112:4; 197:11percent (39) 21:6;24:20;56:23; 57:23,24,25;58:1,1,2; 61:3,4;81:15,21;87:17; 95:17;105:7,8,10; 112:10;117:21,22;127:3, 6;128:9,11;135:8,10,13; 138:15,17,18;146:21; 147:12;150:13,16,24; 151:1;183:4;192:2percentage (1) 189:19per-diem (1) 172:22perfect (2)

34:16,16perform (1) 141:6performance (2) 123:17;147:9performed (1) 126:13performing (1) 122:24Perhaps (3) 137:14;145:2;186:4peril (1) 109:12period (8) 10:15;104:24;106:1; 146:25;147:9;150:11; 154:5;186:3periodical (1) 153:1Permanente (2) 156:24,25permission (1) 157:13permits (1) 132:21perpetuity (1) 132:15person (7) 52:2;106:6,15;157:17; 175:5,17;190:25personal (10) 10:18;38:1;80:5; 116:18;156:21;158:14; 161:15;165:5;177:11; 183:7personally (7) 110:9;121:2;141:13; 145:20;166:17;183:6; 199:16personnel (1) 37:22perspective (1) 30:24persuasion (2) 200:5,6pertain (1) 18:12Peter (6) 130:13;142:10,11,12, 13,14Petty (4) 152:7,8,9,10PHAGUDA (4) 43:14,15,16;184:11P-H-A-G-U-D-A (1) 43:16pharmaceuticals (1) 21:15phenomenal (1) 158:12Phil (4) 13:4;15:9;72:21;76:17philanthropist (1)

107:22philosophies (1) 175:11philosophy (2) 174:21,23phlebotomus (2) 170:3,4phone (7) 14:11;78:14;94:2; 98:17;180:21;183:22; 184:3PHS (32) 143:24;144:16;145:1, 4,4,6,7,8,12,14;146:10, 11,12,12,16,17;147:4,5, 14;148:4,12,13,14,23,25, 25;149:2;150:5,12,15, 24,25PHSF (7) 7:13;24:19,23,24; 25:3;27:22;104:22PHS's (1) 143:22physical (2) 170:20,22physically (1) 192:5physician (14) 28:8;38:3;41:18; 43:17,20;48:10;50:4; 133:20;134:8,9;167:17; 193:22;194:2;196:1physicians (25) 16:8;27:16;39:15; 42:14;43:22;44:17; 45:25;46:12;50:16;58:8; 69:2;77:5;167:19,25; 169:1;170:9;193:20,24, 25;194:3,7,13;195:13, 14,16physician's (3) 37:17,17;167:23pick (2) 78:14;133:8picture (2) 139:10;158:10pictures (7) 94:12,13,17,18,19; 95:8,12piece (3) 50:10;100:21;181:14pieces (1) 133:8place (7) 45:20;47:12;83:20; 86:6;91:19;116:17,20placed (2) 132:13;141:13placement (1) 90:25places (3) 90:25;135:16;189:24plan (14)

Min-U-Script® Barkley Court Reporters (23) pages - plan


16:22,23;17:5;21:4; 52:11,12;53:16;78:22; 126:23;150:19;151:23; 168:25;175:3;198:5planning (3) 15:11;81:17;161:6plans (7) 16:20;58:7;119:23; 126:24;127:13;129:14; 168:23plant (3) 20:8,18;134:25play (1) 25:25played (1) 134:16player (1) 47:23pleading (1) 109:6please (20) 7:5,24;8:6;22:21;35:5; 45:14;49:8,12,12;63:14; 86:12;96:20,24;100:22; 101:4,6;113:14;155:23; 160:6,24pleased (1) 104:20plus (1) 58:18PM (2) 7:2;200:23podium (4) 8:15;14:3,5,17point (16) 20:15;35:17;36:15,22; 41:3;76:21,22;112:25; 114:18;143:9;148:22; 174:17,19;183:8; 195:23;197:23pointed (5) 84:7;133:15;134:23; 136:1;138:25pointing (1) 135:18points (2) 30:23;79:4Police (4) 23:19;51:10;67:6,7policy (1) 15:11political (2) 107:19,20poor (3) 47:9;109:16;122:18poorest (1) 47:9Poors (1) 139:9population (10) 9:6;21:7;38:22;40:18, 19;43:8;82:9;83:23; 118:13;135:13

position (4) 74:25;116:19;137:17; 166:3positions (1) 167:5positive (5) 90:6;127:8;148:6; 168:1;177:2possibility (2) 12:25;18:16possible (9) 47:4;50:13;56:18; 61:8;75:10;129:5,8; 142:20;147:18possibly (4) 46:11;67:24;70:17; 108:4post (2) 75:8,8posted (1) 13:12potential (10) 18:15,22;19:2;27:12; 41:22;53:20;60:18; 110:11;128:14;181:22potentially (4) 41:1;42:22,23;43:5pounds (2) 120:11,12power (4) 157:5;158:7;200:5,6powerless (1) 145:23PPO (2) 92:21;99:13PPOs (5) 42:3;51:3,17;183:17; 184:15practical (1) 36:15practice (15) 31:4;38:17;40:18; 41:19;42:17;44:24; 45:20;46:3;48:13;50:4; 150:5;151:3,14;193:24; 194:5practiced (1) 45:2practices (5) 56:8;66:3,13,17;134:8practicing (3) 37:3;43:17;45:21prefer (1) 14:16prefers (1) 44:25pregnant (1) 165:7Prem (37) 23:17;24:3,3;25:15; 44:5;50:6;82:12;83:4; 84:15,16,23;88:21; 90:23;92:1,23;97:10;

100:2;101:2;103:8; 106:9,21;109:8;111:10, 17;115:9,10;116:10; 120:15;121:7,16,19; 123:22;145:10;152:13; 174:2,17;187:5premises (1) 17:17prepared (14) 8:6,8;9:16;12:15; 55:25;74:3;80:4,24; 113:19;117:4;137:5; 142:17;161:3;172:4preparing (1) 7:19Presbyterian (1) 122:10present (5) 67:9;94:13;131:13; 139:25;198:9presentation (2) 13:18,18presentations (1) 7:17presented (4) 40:10;66:12;148:7; 149:5preserve (1) 103:17president (14) 13:5;48:11;72:9;83:8; 104:5,18;114:19;115:12, 15;119:14;145:13; 161:7;191:7;200:4Press (4) 61:13;89:12;105:9; 174:18pressure (1) 79:10pretty (3) 85:13;102:1;170:13prevail (1) 67:15prevent (2) 96:21;136:14prevents (1) 32:19previous (4) 70:11;95:14;191:25; 195:18previously (4) 53:12;74:1;76:3,7price (9) 10:25;129:11;136:7; 139:18;185:14;186:16; 187:21;188:7,8prices (1) 47:21primarily (2) 25:25;83:19Prime (177) 7:13;15:13;19:18,19; 20:17,22,25;21:2,10,16;

22:22;23:7,13;24:4,16, 18;25:17;29:2,2,7,21,24; 30:5,9,21;31:9,11,21,23; 32:5,9,11,15,19,22,25; 34:6;37:19;38:12;40:25; 44:5,8,25;45:22,22; 46:11,14;47:15;55:10, 20;56:1,16;57:3,3,5,9, 17;58:4,6,9,10,20,24; 59:5,14,17,19,21;60:10, 23,25;61:4,15,20,21,25; 62:5;63:12;64:8,25; 65:7,11,24;66:2;67:6,9, 15,20,21;68:1,3,8,15,25; 69:4,6;70:13,18;72:20, 22;73:8,19,24;75:22; 76:2,18,23;77:11;78:2; 79:11,14,21;81:2;82:3, 13,13;89:14;92:15,20; 93:3;96:2;100:1;102:10; 103:8,11,12,13,19; 104:21;106:1,2;107:6,9, 9;111:3,15;113:3,4; 123:8;125:2,6,21; 136:13;140:20;141:3; 143:18,18;144:18,19; 153:15;154:19;156:18; 161:16;162:3;169:19, 22;170:8;172:15,17,19; 181:21;183:15;187:5,6, 18;190:7;191:8,16; 193:22;194:17;196:12, 18;197:2;198:12,12; 199:23;200:7Prime-Healthcare-Services-owned (1)

64:4Prime-owned (1) 62:1Prime's (7) 56:8,9;61:18,23;62:6, 24;64:20principal (1) 140:20prior (5) 14:8;135:4;136:13; 150:11;180:11private (7) 40:22;42:3;46:19; 50:4;94:17;162:10,12private-practice (1) 43:19privilege (2) 39:10;48:10privileges (4) 27:16,17;41:6,12PRO (3) 84:3,4;105:6probably (16) 42:15;59:1;73:10; 94:6;119:24;120:17,18; 162:12,13,15,16,17; 163:13,22;165:8;181:6problem (13)

41:23;44:4,4;46:15; 47:21;63:13;85:24; 86:22;114:4;133:1; 135:15;164:24;165:4problems (9) 81:11;105:4;106:19; 114:9;115:25;116:15; 134:19;185:20;186:3procedure (2) 9:24;22:15procedures (3) 42:19;46:21;165:11proceeding (2) 76:14;178:14proceedings (3) 72:16;174:18;185:11process (11) 33:19;51:18;117:8; 164:3;191:10,13,20; 192:24,25;196:4,25processes (1) 133:10produce (2) 88:10;116:7produced (1) 88:14products (1) 102:5profession (1) 115:23professional (3) 158:15;199:15,19Professionals (5) 63:23;64:2,12;90:11; 123:5professor (1) 130:21profit (11) 24:6;46:20;56:18; 98:9;105:15;110:12; 132:22;147:8;174:8; 179:23;194:25profitable (2) 92:25;94:6profits (2) 62:13;64:25proforma (1) 153:21profound (1) 108:4program (21) 28:23;88:6,9,13;89:1, 16,19,20,21,22,23,23; 90:8,8;91:17;114:22,22; 121:14;135:25;182:1; 190:14programs (5) 26:9;28:19;88:24; 89:3;116:1promise (2) 125:22;181:5promised (1) 139:17

Min-U-Script® Barkley Court Reporters (24) planning - promised


promises (2) 141:8;181:3promote (1) 83:16prompted (1) 41:11pronounce (1) 155:5proof (2) 168:3,12propaganda (1) 31:9proper (3) 148:19;154:24;164:8properly (3) 78:11;147:16;154:15property (2) 10:18,18proposed (16) 7:10;10:11,12;12:10; 13:1,8;23:9;64:7,10,20, 23;69:10;105:15;136:7; 142:20;145:16pros (2) 161:23,24prosecute (1) 66:10prosecutions (1) 131:4prosecutor (1) 137:18prosed (1) 68:17prospective (1) 54:22protect (2) 20:4;62:12protected (1) 99:21protection (3) 17:22;20:13;131:3protects (2) 20:22;56:13protesting (1) 109:6proud (3) 107:5;158:21;166:24proudly (1) 200:4prove (1) 95:20proved (1) 198:17proven (3) 102:10;112:22;198:13provide (31) 8:6;11:16,18;20:25; 26:25;29:1,13,25;35:18; 50:16,25;51:16;82:6,16; 88:25;102:20;109:5; 115:6;118:15;140:9,15; 143:11;156:13;168:18; 178:17,23;179:5;

194:20;196:13,16;198:5provided (14) 11:12;25:17;27:2; 29:12;30:2;71:24;73:13; 83:5;91:19;113:10; 143:2;146:23;153:1; 154:25provider (2) 166:4;186:15providers (1) 88:11provides (8) 17:4;21:4;26:4;34:10; 53:14;90:5;103:14; 111:22providing (9) 17:1;25:22;29:3,21, 22;33:8;47:9;83:11; 179:3provisions (2) 10:16;44:14prudence (1) 48:22psychiatric (1) 80:9Public (32) 7:12;8:14,20;12:8; 15:8;22:16;23:15;32:14, 21;56:2;57:7;62:9,10,13, 17,22;63:14;64:11; 68:15;111:8;131:19; 139:25;142:19,25;143:5, 14;148:20;149:24; 164:25;166:4;194:22; 200:14public's (1) 149:6publish (1) 104:17published (1) 65:21pull (1) 46:25purchase (20) 10:17,25;20:18;23:10; 55:15,21;68:11;71:17, 18;82:8;90:9;96:3; 103:7;105:16;131:15; 139:18;165:14;199:24; 200:1,8purchased (2) 81:1;155:10Purchaser (3) 18:9;128:15;139:14purchasing (2) 92:15;106:16purports (1) 152:12purpose (2) 7:9;59:13purposes (2) 7:15;81:17pursue (1)

25:24put (26) 30:23;31:9;37:16; 43:4;44:14;61:20,21; 66:19;73:21;75:14; 84:21,25;86:2;91:10; 95:23;97:21;109:11; 113:1;118:1;120:18; 122:12;129:9;136:22; 139:15;159:13;164:6puts (2) 87:5;110:12putting (2) 37:19;97:11P-values (1) 189:18pyramids (1) 139:2

Q

qualified (3) 24:1;88:10;117:8qualifying (2) 60:9;82:2quality (16) 29:3,21;34:10;61:5; 68:5;82:17;91:6;102:19; 109:1;118:24;125:12; 166:24;196:11,17,19; 197:5quality-of-care (1) 28:17quantity (1) 42:16quarantined (2) 86:2,3quarter (2) 92:18,19quasi-prepared (1) 54:18Quest (1) 79:1quick (4) 51:23;107:2;155:16; 175:24quickly (7) 8:9;14:13;35:22; 70:14;74:1;136:14; 177:14quite (4) 37:6;153:6;169:20; 170:15quote (8) 133:16;146:21;148:7; 149:18;154:2;180:6,7; 200:4quoted (1) 135:6

R

radiation (1)

166:23Radino (1) 149:21raise (1) 160:9raised (4) 9:13;37:5;54:22;159:5raising (1) 73:6RAKESH (3) 48:1,2,3R-A-K-E-S-H (1) 48:3Ranch (1) 26:6range (7) 12:6;15:24;110:18; 113:16,18,19,22ranked (7) 29:5,8,9,14,17,19; 199:20rate (11) 32:4;42:11,12;46:20; 57:23;69:15;85:15; 87:17;105:10;112:14; 117:21rates (22) 30:6,13;31:7,21,23; 32:5,8,9;33:7;42:20; 44:9,13;56:22;57:1,15; 128:4;129:5,7;130:8; 135:1,2;138:25Rather (6) 24:8;37:23,23;64:24; 68:9;110:11rating (1) 61:9ratio (1) 112:4ratios (1) 139:2reaccreditation (1) 89:6reached (3) 53:18,19;64:19read (4) 56:5;100:8;124:14; 153:25reading (3) 8:8;109:24;117:3readjusted (1) 185:15ready (2) 34:6;137:8real (12) 10:17;72:12;84:24; 87:21;98:23;104:18; 105:17;112:7;122:21; 149:25;165:5;180:19reality (2) 138:9,10realizes (1) 40:6

really (36) 14:13,22;19:23;36:22; 37:12;44:10;60:24;61:6; 79:12;80:13;86:14; 90:25;91:10,17,21;93:6; 116:6;119:18;123:15; 126:16;127:9;129:12; 135:14;144:13;148:25; 164:6;165:9;166:5; 168:15;171:1;172:8; 176:6;177:1;183:10; 188:25;195:15realm (1) 107:19re-approached (1) 191:24reason (16) 33:25;46:13;56:25; 61:8;69:3;73:24;75:19; 82:17;86:20;87:14,14; 141:24;159:22;191:23; 195:5,14reasonable (5) 17:23;30:6,14;44:9,11reasonably (1) 55:17reasons (6) 46:1;56:7;74:15;93:8; 103:9;135:20reassure (2) 195:11;196:11Rebecca (6) 119:10;124:6,7,10,11, 12rebuild (1) 160:8recall (1) 11:13receivable (1) 10:20receive (8) 7:9;16:15;27:21; 28:25;89:9;108:25; 151:16;195:10received (8) 26:2;29:4;166:17,19, 25;168:8,9;200:15receiving (1) 27:11recent (7) 18:2;69:9;70:3;89:11; 133:5;135:17;145:25recently (7) 55:13;57:8;89:5; 145:15,22;151:12; 166:19recess (2) 52:1;101:12recession (1) 117:19recognize (1) 27:14recognized (1)

Min-U-Script® Barkley Court Reporters (25) promises - recognized


82:14recognizes (1) 83:3recognizing (3) 29:5;106:18;148:12recommend (1) 18:24recommendation (1) 37:16recommendations (6) 18:10,12;19:1;50:19; 53:11;89:7recommended (1) 81:15recommends (1) 179:12record (20) 7:21;8:2,3,19,20; 21:11;24:1;45:14;47:15; 73:9;76:15;77:12; 101:14;102:10;103:12; 141:7;153:3;156:18; 180:4;190:1records (4) 31:17;95:22,25; 194:22recruit (1) 197:12red (3) 22:8;78:5;79:10Reddy (92) 23:17,18;24:3;25:10, 14,15,16;34:23;38:2; 44:5;45:8,8,11,12,12,15, 15,24;46:8;47:3;50:6; 82:12;83:4;84:15,16,23; 86:20;87:9,15,19;88:25; 89:9;90:23;92:23;97:10; 100:2;101:2;106:3,4,4, 10,21,25;107:4,15; 109:8,13;111:10,17; 115:9,10;120:15,24; 121:7,16,19,25;123:22; 133:25;140:20;141:20; 145:10,12,20;148:14; 152:13;153:13;154:3,18, 20;155:9;161:11,16; 170:7;174:2,17;176:22; 178:21;179:2,23;187:5; 191:2,3,5,6;192:5,14,24; 193:2,7;194:17;196:24R-E-D-D-Y (1) 191:6Reddy's (13) 24:4;44:24;55:14; 70:19,20;88:21;92:1; 107:1,16;116:11; 145:23;178:13;187:5redouble (1) 116:7reduce (2) 60:19;198:2reduction (1)

147:11reductions (2) 135:1;138:24refer (2) 150:7;186:5reference (1) 14:16referenced (1) 147:4references (1) 174:16referred (3) 22:1;56:9;182:17referring (1) 135:22reflects (1) 39:11refundable (1) 105:21refuse (1) 180:6refused (5) 65:22;67:8;93:16; 99:3,8refuses (2) 56:12;99:4refusing (1) 100:4regard (3) 15:16;21:19;193:11regarding (12) 23:9;27:12;29:2;30:4, 12;31:14,22;40:10; 109:19;113:3;146:16; 187:10regardless (3) 33:11;53:6;162:21region (3) 105:11;106:7;118:11Regional (5) 57:24;80:11;118:17, 22;161:7region's (1) 112:10registered (11) 64:3;65:10;68:23; 88:11,14,16;89:5,7;91:7; 108:18;189:9registries (1) 197:10regular (2) 94:19;97:21regularly (1) 29:25regulation (1) 147:22regulations (5) 139:4;141:14;143:6; 147:17;191:12regulatory (6) 134:1;138:24;186:2, 10;193:11;195:6rehab (3)

170:13,19,21reimbursement (4) 135:1,2;138:25; 181:24reimbursements (1) 154:9reinstatement (1) 66:24reiterate (3) 51:2;91:8,9rejected (3) 34:4;65:13;151:9rejection (1) 151:7related (2) 30:19;81:6relates (1) 129:20Relations (3) 65:12;66:15;166:4relationship (13) 52:23;53:1,7;81:7; 88:18;90:3,6;115:8; 143:17;148:4;161:16; 187:5,10relationships (1) 148:16relative (1) 124:18relatives (1) 85:4released (1) 139:9reliable (1) 124:24relied (1) 31:15relief (2) 66:18,23rely (4) 61:9;113:9;118:14; 124:20remain (3) 14:9,19;112:15remaining (1) 134:14remains (1) 103:16remark (3) 73:7;184:7,8remarks (8) 54:19;55:9,25;73:3; 80:5,24;113:19;161:3remediation (1) 66:25remedy (2) 66:18,22Remember (7) 31:3;33:4,9;63:7; 104:14;124:6;136:9remind (1) 116:3remiss (1)

140:19remodeling (1) 89:1remove (1) 67:7removed (1) 94:20removes (1) 92:25render (1) 143:8renders (1) 51:5renew (1) 41:12renewed (1) 183:15renovate (1) 53:3repair (1) 134:25repeat (2) 133:20;154:1replace (1) 89:7replacements (1) 68:4Report (40) 12:14,24,25;13:6,7; 42:13;50:8,11;52:19; 53:12;62:21,22;71:14; 72:23;76:17;104:17; 128:8,13;133:5,16; 134:23;135:7;136:2; 139:9;142:17;143:11, 15;145:5;146:5,13,13, 15,19;149:15;151:4; 154:16;164:6;187:20; 189:5,25reported (1) 61:13reporter (12) 7:19,20,23,25;8:2,3,7; 14:22;23:4;34:14;35:10; 126:3reporter's (1) 109:25Reporting (1) 8:13reports (5) 93:19;189:7;190:3; 194:23;195:8represent (7) 30:25;31:2;88:5; 108:23;152:14;158:16; 178:7representation (4) 65:6;67:4;68:1;130:2representative (6) 13:19;65:14;67:17; 110:22;124:13;185:5Representatives (5) 7:16;15:19;67:7,8;

181:9represented (1) 64:14representing (4) 80:7;112:17;126:16, 17represents (3) 64:2;112:10;190:9Republicans (1) 63:3reputation (3) 82:15;88:9;109:17request (7) 8:12;10:10;44:1;45:1; 51:13;79:19;143:7requested (2) 141:12;185:22requesting (1) 168:24require (4) 51:14;106:22;137:25; 195:6required (11) 12:5;17:25;28:1; 106:20;136:18;143:1; 145:10;146:2;149:21; 190:20;191:15requirement (4) 37:18;51:15;132:14; 149:9requirements (3) 37:7,25;71:16requires (4) 55:1,1;66:23;147:18requiring (1) 56:14res (1) 136:11rescued (1) 125:2research (1) 200:2researcher (1) 54:16reservations (1) 50:12residences (1) 166:14resident (8) 105:25;156:11;161:5; 166:7;174:4;175:2; 176:17;199:4Residential (2) 80:3;81:3residents (15) 26:4;39:6;81:16,18, 19,24;82:7;83:15,19; 111:9;112:2;113:8; 124:23;167:22;168:25resolve (1) 74:22resolved (3) 186:2,5,10

Min-U-Script® Barkley Court Reporters (26) recognizes - resolved


resources (4) 38:5;67:13;102:22; 197:7respect (7) 12:13;30:16;74:19; 146:4;148:2;154:17; 195:13respectable (1) 49:9respected (1) 77:25respectfully (3) 78:4;79:9,19respects (1) 73:17respiratory (1) 89:2respond (2) 193:10;195:10response (3) 31:22;67:4;179:25responsibility (6) 49:3;114:17;115:2; 146:7;193:7;197:25responsible (1) 109:7rest (1) 120:5restrictions (2) 45:4;141:14result (3) 60:19;118:23;181:11resulted (1) 188:7resulting (2) 118:18;187:22results (1) 15:19retain (2) 11:8;197:25retained (1) 15:12retire (2) 19:16;160:1retired (4) 23:19;105:1;166:9,9return (3) 98:16;106:17,22returned (1) 131:22reveal (1) 145:6revealed (1) 148:10Revenue (3) 7:16;20:11;51:21review (6) 11:23;31:25;79:20; 144:17;147:22;190:11reviewed (6) 15:16;31:16;140:25; 141:5;144:24;190:16reviewing (3)

9:25;135:7;146:8revocation (2) 180:7,16revoke (1) 21:25revoking (1) 22:4reward (1) 62:17rheumatologist (1) 37:4rich (3) 98:5;100:15;103:17RICHARDS (6) 188:15,16,18,18; 189:2,4R-I-C-H-A-R-D-S (1) 188:19richly (1) 48:25ridiculous (2) 79:15;163:18right (37) 7:18;8:9,12,15,16,22; 9:19;36:11;37:21;42:8; 45:16;46:4;59:3;61:5; 62:2;67:8,25;69:19; 74:17;93:10,12;101:11; 107:17,17;119:7; 123:10;142:5;155:5; 170:21;171:1,20; 175:20;191:22;193:14; 196:2,15,25rise (1) 146:1risk (6) 61:10;73:16;76:10; 87:6;129:9;186:24risks (1) 125:14risky (1) 165:12Riverside (1) 61:13RN (2) 65:1;66:4RNs (4) 64:14,21,22;65:4road (1) 68:13R-O-D-I-E (1) 156:8Rodino (2) 149:19;182:18role (3) 9:25;26:1;197:16room (32) 9:19;15:22;38:18; 41:5;46:18;50:24;56:10, 19;58:12;59:24;70:20; 93:12;94:1,19,21;95:6,7; 97:21;114:7;120:17,18; 134:10;150:13,14,20;

151:19;154:6,11;171:21, 23;173:3;192:21rooms (2) 39:4;56:15roots (1) 130:23round (1) 69:9rounds (1) 134:17Routers (1) 199:21rug (1) 139:24Ruh (2) 23:21,23ruin (1) 96:25ruled (1) 144:25rules (1) 7:22run (14) 16:14;36:11,11;40:24; 80:9;81:3;86:8,10; 92:16;112:22;114:5; 121:13;145:6;154:13Runner (2) 110:22;113:11running (3) 17:9;35:18;37:9runs (2) 16:5;196:5rushed (1) 63:11RUSS (9) 84:3,4,4;105:7; 160:16;161:1,2;162:20, 20R-U-S-S (1) 161:2RYAN (5) 69:23,24,25;104:15; 138:11

S

SABO (6) 38:9,10,11;39:21; 52:5;99:2S-A-B-O (1) 38:11saddens (1) 195:15sadness (1) 85:20safe (2) 199:15,15Safety (3) 90:21;109:19;189:25sake (1) 181:14sakes (1)

79:12salaries (1) 11:14sale (56) 10:11,12,16;19:18; 20:19;21:22;22:21; 26:10,12;27:16,17;28:2; 32:16;34:4;55:4;56:2; 62:10;63:15;64:7,10; 67:19;68:17;70:9,16; 72:1;78:2;82:4;96:21; 112:19;113:5,6;130:7; 131:15;132:13;133:12; 135:20,21;139:8,11; 140:6;159:21,25;160:7; 174:7;176:22;177:18; 178:11,15;179:12; 181:1;182:15;185:17; 186:23;188:4,13;197:2sales (4) 17:15,16,25;67:6Sam (3) 54:15;161:2,2same (21) 11:14;13:13;18:18; 27:1,17;29:12;33:6; 34:3;51:17;58:19;60:8; 76:3;82:18;109:12; 116:16;159:18;174:14; 177:3;182:19;193:16; 195:16sample (1) 57:8San (16) 16:17;23:22;27:25; 28:21;67:10;108:20; 117:20;119:6;129:23; 131:1;142:2;152:21; 154:4;157:24;164:25; 172:21Sanders (1) 108:12Sarrao (9) 22:24,25;23:1,2,5,13; 34:15,18;145:13S-A-R-R-A-O (1) 23:5sat (4) 134:7,18;137:1; 152:11save (5) 22:20;97:12;98:22,24; 100:19saved (1) 29:10saving (1) 192:20saw (4) 37:14;134:19;135:8; 170:9saying (5) 60:23;96:13;151:18; 158:24;172:2

SB90 (1) 182:2scale (1) 140:8scarce (1) 125:1scary (2) 165:9;167:1scene (1) 170:5scenes (1) 194:10sceptical (1) 163:25schedule (1) 13:10scheduled (1) 89:9scheme (1) 62:25scholarships (7) 25:22,24;26:2;83:12; 89:18;106:9;121:17school (18) 51:9;84:12,14;88:21; 89:4,9;92:1;115:2,6,10; 116:8,14;130:21;166:10, 11;171:1;176:19;177:2schools (2) 28:20;84:18SCHWARTZ (5) 178:2,3,4,6;181:19S-C-H-W-A-R-T-Z (1) 178:6Science (1) 88:22sciences (2) 83:14;92:1Sciences/Public (1) 90:21SCIU (5) 153:7;163:2;164:1; 190:6,8scores (2) 28:16;61:8Scott (3) 149:19,21;182:17screenings (1) 26:9Scripps (3) 95:9,12;99:7scrutiny (1) 140:24seat (1) 7:5second (7) 41:1;55:8;66:2;72:24; 95:8;149:5;183:23Secondly (1) 143:21secret (1) 152:20secretary (2)

Min-U-Script® Barkley Court Reporters (27) resources - secretary


23:6;145:13secret-ballot (1) 65:4Section (8) 7:16;10:8;143:5; 145:9,18;147:17,19; 149:17sector (3) 102:4;162:10,13security (5) 95:6;98:11,14;100:24; 161:8seeing (2) 60:20;197:3seek (5) 25:5;28:13;33:10; 130:8;181:13seem (2) 36:5;58:12seems (8) 37:21;54:5;70:11; 122:15;125:22;165:1; 174:19;177:20sees (1) 16:4SEIU (4) 31:9,20;32:2,3SEIU's (2) 31:13;32:5SEIU-UHW (6) 30:20,25;31:2,15,18; 32:11SEIU-UHW's (2) 31:6,22selected (3) 105:15;133:7;191:20self (1) 35:21self-dealing (3) 146:3,10;147:19sell (8) 72:19,22;73:8;76:18; 100:17;158:24;159:16; 160:7Seller (9) 7:11;13:19;54:22; 75:10,21;146:4;149:17; 164:5;183:10sellers (1) 7:17Selling (6) 68:14;73:11;109:7,12; 174:17,19semi-retired (1) 80:11Senator (3) 110:22;112:17;113:11send (6) 36:6;96:4;127:15,24; 129:14;165:7sends (1) 108:8senior (11)

26:6;31:20;50:7;61:3; 77:25;127:23;156:12, 14;157:8;158:17;161:7seniors (15) 26:7;39:7;56:24;58:1, 2,2;62:16;80:12;81:5; 119:1;156:13;158:15, 18;159:14;168:4sense (4) 60:6;77:14;140:17; 199:19sent (2) 14:10;58:12separate (3) 25:15;46:2;139:18separated (1) 46:2sepsis (1) 31:7September (10) 19:16,17;21:23;38:19; 52:24,25;55:1;64:17; 138:11;182:3Septicemia (7) 56:22,22;57:2,8,9; 61:2;195:25seq (1) 10:8sergeant (1) 67:7series (5) 153:3,3,13,24;154:8serious (5) 50:12;54:24;56:21; 62:9;142:5seriously (4) 47:24;50:14;137:16; 138:8serve (10) 22:18;23:2,6;25:6,7; 38:21;52:17;53:23; 121:1;195:20served (8) 13:3;52:21;64:22; 83:8;102:17;118:11; 122:6;133:5serves (2) 52:13;198:22service (10) 9:4;41:15;53:17; 54:16;102:4,4;112:5; 122:25;142:22;151:25Services (93) 7:13;9:9;11:17;12:12; 13:2;15:13,15,25;16:1, 16;17:1,2,2,4,8,12; 18:11,13;19:18;20:25; 21:2,16,24;23:7,14;24:5, 16,18;25:17;27:6,6,7,18; 34:6;42:12;53:13,14; 55:10;61:15;64:8;67:21; 68:8;81:2,5;82:3,13; 83:7;102:20;103:8,13,

20;104:21;106:2;107:6, 9,10;109:5;111:3,16; 112:2;113:3,4,9;118:15; 124:22;126:13;129:10, 17,22;130:3;140:9,15, 16;142:22;143:18,19,20; 144:18,19;150:21; 151:16;166:17;177:10; 180:5,13;181:8;183:15; 186:7,14;187:6;188:11; 191:8;194:1serving (6) 18:5;115:12,14; 119:14;121:9;122:23set (9) 8:14;30:15;31:20; 71:16;74:9;95:8;101:4; 149:8;167:16Seth (2) 78:14;181:4setting (1) 62:4settle (1) 45:20settlement (1) 188:10seven (15) 85:23,23;86:3;93:11, 13,21,22;97:13;98:16; 100:25;162:14;185:7; 186:22;187:15;199:22several (18) 30:8,23;32:8;50:6; 51:1,3,9;69:2;71:20; 77:22;81:25;93:22; 122:7,11;133:10,15; 153:5;189:6severe (8) 57:12,15,20,23;59:20; 60:5;97:17;117:17severely (3) 91:3;102:4;176:23severity (2) 59:4,15shaking (1) 120:1shall (1) 149:10Shapiro (2) 78:14;181:6Shapiro's (1) 181:4share (1) 35:20shared (1) 174:21Sharon (3) 110:22;113:11;155:21Shasta (1) 57:23sheet (5) 14:1;15:1,3;175:25; 200:13

sheets (2) 9:16;54:11Sherman (2) 141:1;198:16Sherry (7) 160:17,22;164:14,17, 18,22,22Shield (3) 51:4;176:21,22shift (2) 35:4;101:22shipped (1) 99:7shocked (2) 80:6,14short (15) 14:23;49:20;58:22; 59:1,2,15;97:17;104:24; 129:24;134:18;152:17; 154:17;176:3;180:1,2shortage (1) 16:12shortly (3) 66:2;74:20;185:19shot (1) 102:15show (4) 95:13;104:16;150:13; 151:14showing (2) 98:7;139:9shown (2) 41:4;179:2shows (2) 21:19;58:15shuffled (1) 35:22shuffling (1) 154:11shut (4) 70:5;71:19,21;78:19sick (5) 58:7;61:6;63:5;157:2; 165:10sicker (1) 60:24side (1) 60:5sidestep (1) 171:25sign (1) 127:11signed (4) 13:21;27:22;119:4; 152:7significant (9) 12:9,13;89:15;135:19; 151:15,22;178:24;179:4, 10significantly (3) 60:23;69:11,15sign-up (5) 9:16;14:1;54:11;

175:25;200:12Sikes (5) 113:17;116:25;117:1, 2;119:8silenced (1) 110:7silent (1) 139:23similar (4) 31:21;128:18,25; 130:9similarly (4) 11:12;67:21;128:19; 129:3simple (2) 93:10;183:16simply (10) 20:14;30:16;31:15; 75:5;119:2;135:14; 136:11;150:17;181:14; 182:24simulation (1) 89:10Sincerely (1) 113:11single (5) 30:25;31:2;139:19; 193:3;194:12sister (8) 97:6,13;98:9,15,21; 100:21,24;188:22sisters (1) 99:23sister's (3) 97:22;98:12;99:12sit (6) 74:16;100:7,21; 101:19;193:2,16sitting (1) 193:18situated (3) 11:13;128:19;129:3situation (6) 75:4;76:20;79:9; 82:19;131:14;197:11situations (1) 132:21six (10) 33:23;57:1;58:3; 74:22;96:10;120:6,8; 157:7;159:17;178:19six-day (1) 66:10six-month (1) 186:3skill (1) 69:14skilled (3) 38:25;80:9;88:10slander (1) 30:21slim (1) 120:8

Min-U-Script® Barkley Court Reporters (28) secret-ballot - slim


slow (1) 109:22slower (2) 65:16;110:4slowly (1) 56:4SLYNGSTAD (6) 179:16,17,18;183:25; 184:4,6S-L-Y-N-G-S-T-A-D (1) 179:19small (1) 15:25smile (2) 185:7,7Smith (4) 101:14,16,17,18S-M-I-T-H (1) 101:18smooth (1) 78:19sniff (1) 170:11Social (2) 81:5;105:4society (2) 37:13;48:12sold (1) 177:19sole (2) 91:5;145:11solely (1) 118:14solution (2) 18:7;79:8solve (1) 87:10somebody (7) 14:20;97:17,25;99:25; 121:18;124:2;154:1somebody's (2) 100:4,23somehow (3) 35:25;75:3,12someone (14) 96:18;122:17;134:7, 15;141:24;152:12; 154:10;161:18;171:19, 20;185:7;187:14;192:4; 196:21someplace (1) 115:19something's (1) 121:4sometime (2) 133:9;173:15sometimes (3) 81:24;116:5;123:19son (1) 155:6son-in-law's (1) 157:23soon (4)

22:3,22;66:14;69:17sooner (1) 75:19sorry (19) 46:7,13,23;87:25; 88:2,7;89:12;109:23; 119:16;120:13;123:9; 169:16;171:11;173:4, 23;176:11;183:24; 184:2;199:7sort (2) 116:2;122:19sought (2) 66:17,22soul (1) 164:6sounds (2) 96:16;177:5source (1) 118:2Southern (3) 31:19;64:3;129:4Spanish (2) 9:11,17Spanish-language (1) 9:8Spanish-speaking (1) 9:6speak (32) 8:1,9;9:18,22;13:6; 14:9;30:11;35:2,8; 47:10;63:25;70:23;80:7, 25;90:17;113:21; 114:21;141:19;142:7; 153:18;156:19,20; 158:19;159:23;161:4, 17;175:25;179:24; 181:9;188:17;198:11; 200:12speaker (5) 7:25;8:4;153:18; 186:4;198:25speaker's (1) 135:4speaking (2) 7:24;23:8speaks (3) 136:12;147:25;180:18Spears (5) 79:24;82:23,25;83:1,2S-P-E-A-R-S (1) 83:2special (5) 9:1;18:3;115:25; 130:18;131:1Specialists (3) 12:15;13:5;142:18specialized (1) 59:10specifically (3) 35:24;147:20;180:3speculate (1) 78:24

speed (1) 160:17spell (13) 7:24;23:3;35:9;45:13, 16;48:3;92:11;104:7; 156:5;160:24;164:20, 21;173:25spelled (4) 40:1;142:14;161:2; 179:18spend (4) 26:24;28:9;161:9; 173:1spent (8) 67:13;68:7;75:5;80:8, 17;85:17;120:5;164:4spoke (10) 44:8;49:12;99:2; 156:3;159:12;170:6; 180:9;182:14;183:20; 184:11spoken (4) 109:18;110:6;173:10; 183:5spongily (1) 53:11sported (1) 75:5St (26) 16:12,19,21;18:17; 36:6,14;37:10;42:21; 47:6;71:9,9;108:20; 109:14;127:18,18,19; 129:6;131:20;135:12; 157:3,7;167:8;176:24; 183:3;185:2;194:6stable (4) 103:12;118:2;125:15; 157:15staff (31) 11:9;16:8;22:19; 27:10,15;35:16;38:11, 15;39:9,10;67:22;68:2; 77:4,10,20;78:1;82:10; 88:25;90:3,4;96:23; 109:4;134:12;139:2; 164:4;193:23,23;197:8, 9,12;199:17staffs (1) 115:4stalking-horse (1) 178:14stamp (1) 105:10stand (14) 24:6;33:2,13;55:20; 104:20;105:5,6;126:9; 154:3;155:3;194:11; 195:14;196:23;198:17stand-alone (7) 138:7,13,14,20,22; 139:5,10standard (4)

60:10,12;99:16;139:8standards (2) 39:12;106:21standing (2) 11:10;167:14standpoint (2) 106:24,25stands (3) 24:24;84:23;191:11star (2) 84:23,24start (8) 28:3;35:4;45:10; 51:24;84:10;86:7; 160:17;197:3started (7) 7:5;45:17,25;52:25; 96:11;150:23;185:14starting (2) 13:24;38:19State (26) 7:8;15:17;18:4;24:10; 32:4,8;51:9;53:5;57:16; 58:3;77:11;81:4;91:4; 93:19;112:6,17;117:23; 124:13;142:1;164:4; 190:18,19,19,22;194:15; 195:20stated (12) 32:18;42:14;50:18; 55:17;69:10;92:23;93:4; 144:2;179:24;183:20; 185:20;200:4statement (8) 8:8;44:10;131:24; 154:10;155:7;169:4; 181:4;185:21statements (6) 21:9;32:17;133:22; 182:10,11;186:19States (8) 34:2;51:6;57:2;58:16; 59:18;67:2;138:19; 146:20stating (1) 67:8statisticians (1) 189:14statistics (6) 31:15;40:20;122:3; 146:16;189:12,25status (1) 180:19statute (2) 11:22;146:1stay (19) 43:25;44:21;50:21; 57:21;60:21;69:16,18; 70:7,8;80:20;87:1,3; 95:6;110:13;116:16,19; 122:5;157:14;174:11stayed (3) 67:11;85:23;168:17

staying (1) 114:6stays (12) 49:9;58:21,22;59:1,2, 15;60:9,19,20,21; 174:10;191:19steeped (1) 141:2step (2) 140:23;165:15stepped (2) 91:18;136:14steps (2) 136:18,21Steve (1) 124:13STEVEN (4) 178:2,3,3,6S-T-E-V-E-N (1) 178:7stick (1) 189:1sticking (1) 179:3still (16) 20:23;40:14;71:12; 75:11;91:25;95:11; 130:19;134:8;170:12; 183:3;184:17;185:17; 186:10,12;188:3;192:3stipend (1) 89:24stipulation (2) 43:4;130:5stone (1) 80:18stood (2) 158:23;193:13stop (2) 96:20;193:6story (2) 61:19;158:14straight (1) 72:14straightened (1) 147:6straightforward (1) 182:24stress (1) 44:17strict (1) 195:7strolls (1) 98:1strong (6) 53:8;62:5;77:9;108:8; 139:13;167:21strongly (4) 51:2;64:9;68:16;91:10Strow (2) 53:18;128:5struck (1) 153:24

Min-U-Script® Barkley Court Reporters (29) slow - struck


struggle (1) 105:2struggled (3) 17:20;83:6;138:5stuck (3) 82:11;155:7;178:22student (5) 88:18;89:18,22,22,23students (12) 25:23;26:1,2;83:12; 89:15,19,20;91:15; 114:21;115:17;116:14, 21studies (2) 41:15;172:20study (2) 29:6,10studying (1) 120:5stuff (1) 163:2style (1) 84:8subject (3) 32:12;180:16;181:22subjects (1) 73:3submission (1) 182:21submit (3) 32:23;99:20;153:2submitted (3) 19:25;99:14;126:12subsection (1) 143:5subsequent (1) 20:12subsidiary (1) 24:22substantial (3) 20:10;25:18;188:7substantially (11) 11:10;22:2;26:20; 68:10;149:12,13; 161:23;182:11,12; 184:25;198:1success (6) 25:12;103:12;122:17, 17;167:21;193:4successful (10) 75:24;77:7;122:21,23, 24,25;125:5;174:3; 197:17,17successfully (1) 112:22suffer (3) 71:5;118:4;119:2suffered (2) 81:5;96:10suffering (2) 96:21;112:12suffering's (1) 96:11

suffers (1) 117:20sufficient (2) 73:16;143:2suffocate (2) 98:15;100:25suggest (2) 110:8;152:22suggests (1) 146:17suitor (1) 139:19SUMAN (3) 37:1,2,2S-U-M-A-N (1) 37:3summary (2) 13:15;18:21super (1) 176:3Superior (3) 67:10;132:11;154:4Supervising (1) 130:25Supervisor (4) 117:3,4,5;131:1Supervisors (1) 119:5supplemental (2) 181:25;182:1support (34) 25:18;31:13;32:1; 38:12;43:18,20;53:11, 21;77:4,5,9;83:13;89:8, 15,15,17;90:1,22;91:5,5, 10,11,14;92:2;102:16; 111:19;117:6;125:13, 18;133:12,20;199:23; 200:3,7supported (4) 43:23;53:2;91:15; 126:15supporter (2) 66:25;126:10supporting (1) 83:11supportive (1) 184:22supports (2) 90:8;179:12suppose (1) 153:8supposed (5) 55:6;77:18;105:19; 137:14;159:19sure (29) 9:18;23:5;34:13;43:9; 44:5;65:17;78:11;92:9; 94:15;101:7;108:3; 122:14;128:10;153:25; 155:5;164:7;175:4; 177:1;183:25;191:10; 192:10,12,21;193:8,12;

195:3,9,23;197:20surgeons (3) 170:14,17,17surgeries (2) 59:8;170:10Surgery (4) 48:6,13;166:20; 177:15surgical (5) 42:19;47:10;111:23; 170:10,18surprised (2) 78:23;85:19surrounding (1) 64:13surveillance (1) 66:6surveyed (2) 31:11;89:5survival (3) 53:10;95:17;120:8survive (3) 17:20;56:24;139:5survivor (2) 161:18;166:25suspect (1) 120:18sustain (1) 20:11SUZANNE (5) 188:15,16,18;189:2,4S-U-Z-A-N-N-E (1) 188:18sworn (1) 56:10synergy (1) 140:17system (18) 26:23;29:6,7,8;56:25; 58:18;59:22;62:11,15, 19;71:10;81:22;139:13; 151:6;158:20;167:3,5; 196:17systems (5) 58:15;59:1,18;60:8; 131:17system's (1) 81:16

T

table (8) 40:9,13;73:21;75:2, 15;102:14;152:20;155:2talk (21) 8:5;46:24;50:8;65:16; 72:13;73:4;86:13;99:17, 23;115:21;120:19; 129:16;147:22,23; 162:25;169:21;180:2; 193:25;194:11;195:15, 23talked (6)

87:11;98:6;121:14; 127:2;134:23;135:5talking (13) 42:1;57:22;60:15; 97:8;114:12,13,13,14, 15;115:22;127:9;177:6; 197:24Tate (6) 69:22;72:4;79:23,25; 80:1,2T-A-T-E (1) 80:2tax-exempt (1) 62:24taxpayer (1) 190:23taxpayers (3) 59:25;62:16;63:3teacher (2) 130:21;176:19teachers (2) 51:9;176:20team (2) 106:10;136:24technical (1) 12:7technician (1) 170:4technology (2) 11:2,5ted (1) 62:21telephone (2) 8:24;94:9telling (1) 133:22tells (1) 58:6TEM (3) 84:3,4;105:6temporary (1) 18:7ten (7) 29:8,9;31:11;101:11; 136:10;163:16;190:15tend (3) 8:9;77:15;149:13Tennison (5) 119:10;124:6,10,11,12T-E-N-N-I-S-O-N (1) 124:12tenure (1) 104:25term (1) 45:19terminated (2) 66:24;193:22termination (1) 66:4terms (8) 17:3;26:10;28:12; 128:18;129:2;186:14; 197:4,5

Terry (1) 130:21test (5) 48:22;93:10,11,12,13testify (2) 14:6,6testimony (4) 56:11;152:11;154:25; 155:4tests (2) 21:15;171:24thankful (4) 89:14;120:13;121:20, 20thanks (2) 19:21;65:18THAWKER (3) 37:1,2,3T-H-A-W-K-E-R (1) 37:3Theirs (2) 140:14;157:2then-George (1) 166:8theories (1) 162:8therapists (1) 170:22therapy (2) 89:2;170:20thereby (1) 68:4Therefore (1) 168:24thereof (1) 154:14thinking (2) 106:9;120:21third (4) 47:22;62:3;66:15; 143:23tho- (1) 129:19Thomas (12) 68:20;69:21;72:7,8,9; 136:11,25;137:17; 152:18;181:1;185:19; 186:4T-H-O-M-A-S (1) 72:9Thompson (1) 61:9Thompsons (1) 199:21thorough (1) 189:8Thorson (2) 23:21,23though (4) 36:4;58:6;122:17; 194:20thought (6) 72:18;73:6;85:18;

Min-U-Script® Barkley Court Reporters (30) struggle - thought


132:24;134:3;137:11thousand (3) 81:16,18;112:5thousands (6) 57:21;67:23;87:2; 91:16;96:15;123:13threaten (1) 186:17threatened (1) 66:7threats (1) 66:5three (35) 12:2;25:5;26:24;37:9; 39:4;46:5;53:4;54:7,9; 55:13;80:17,17,20,23; 94:23;95:10;102:18; 103:10;110:10;112:8; 133:19;135:20;143:16, 22;147:3;149:6;152:15; 156:23;159:17;174:5,13, 24;175:11;184:9;190:12three-person (1) 25:4throat (5) 94:22;95:2,23;97:22; 98:13throughout (9) 64:3;67:14;88:11; 89:13;161:20,25; 174:18;185:10,13throw (3) 97:25;98:14;163:22thrown (4) 98:11,18;100:23; 193:10Thursday (2) 99:7;157:10Thurston (4) 101:14,16,17,18tied (1) 110:7times (12) 29:15;47:18;48:21; 86:24;114:5;123:17; 125:9;129:15;162:14; 169:20;189:5;196:15tip (1) 61:17tired (3) 159:9,9;160:4today (60) 7:7;8:19,25;9:7,22; 13:16;14:8,12;15:8; 23:8;33:2,14;35:8;52:3; 63:25;64:6;70:23;77:22; 88:12;90:17;93:5;97:6; 99:3;114:9;120:11,22; 121:15;122:16;126:9, 16;131:14;133:3; 134:20;135:20;138:17; 151:21;152:11,13,17; 153:1,8,20;155:1,9;

156:19;159:12;161:3, 22;162:5;164:9;166:6; 167:15;172:6,11; 177:16;178:16;180:10; 181:23;194:16;198:3today's (6) 7:9,20;8:13,20;9:3; 200:20together (3) 21:6;108:7;159:14token (1) 116:16told (11) 22:7;41:8;78:12; 93:22;95:1,6;99:15; 120:7;157:25;158:9; 177:18tolerate (1) 123:17tomorrow (1) 200:16ton (1) 75:5tonight (5) 104:20;108:2;161:23; 176:7;200:19took (7) 69:1,7;74:22;93:12; 95:12;136:10;163:13top (20) 29:8,9,15,17,19;57:4; 58:3;111:13;114:24,24; 121:22;123:1,3,7,12; 162:22;196:17,19; 197:6;199:21top-ten (1) 29:6totally (3) 37:20;92:13,14touched (1) 150:2tough (3) 48:21;84:19,19town (4) 46:17;47:7;122:3; 124:2track (4) 24:1;47:15;102:10; 103:11tract (1) 57:11trade (2) 115:20;162:9tradition (1) 141:2train (1) 90:10trained (1) 162:9training (1) 115:18trains (1) 123:23

transaction (68) 7:10;9:25;10:12;12:8, 10,23;13:1,9;15:17; 17:15,16,25;18:15,23, 25;20:16,22;33:24,25; 73:19,25;74:10,19,25; 75:4,7,24;76:9,12; 103:19;131:21;136:13, 19;142:4,16,20,24; 143:4,13;144:13;146:9; 147:21;149:12,22; 151:17;153:12;154:24; 178:22;179:3,22; 180:11;181:2,21;182:6, 6,9,25;185:9,19,21; 186:8,23;187:8,15; 188:4;191:9,25;198:9transactions (3) 132:15;140:25;144:18transcribes (1) 14:22transcript (1) 7:19transfer (11) 10:13;11:23;93:16,21; 94:5;95:10;98:23;99:3, 5;100:4;132:22transferee (1) 147:23transferred (2) 94:25;166:8transition (2) 78:19;191:10transitioned (1) 78:11translate (1) 161:25translator (2) 9:7,8translator's (1) 9:9trash (1) 193:10travel (2) 28:24;118:20travesty (1) 40:4Travis (1) 9:1treasurer (1) 23:6treasury (1) 145:14treat (1) 22:5treated (3) 43:7;58:11;100:9treating (2) 41:17;47:4treatment (6) 10:4;93:18;120:10; 166:20,22;168:8trembling (1)

120:1tremendous (3) 55:22;103:11;173:13trespass (1) 67:9tried (2) 94:4;136:14trip (2) 152:17;172:1true (3) 109:9;121:3;135:11truly (3) 85:12;91:14;199:18trust (7) 62:9;63:8,9,10,11; 165:1;187:7trustee (2) 115:14;138:10truth (1) 139:21try (14) 36:2,12,18;54:6,9,19; 78:10;123:11;133:7; 136:21;156:21;180:23; 185:17;187:20trying (16) 22:10;51:18;55:7; 61:16;75:6,7;94:1; 100:19;106:8;109:25; 134:5;172:3;185:8; 187:4;194:17;197:12Tucker (1) 50:6turmoil (1) 46:10turn (1) 82:15turned (2) 56:17;125:5turning (1) 102:11Twelve (1) 109:3twice (1) 117:23two (50) 8:4,11,21;16:13; 21:13;22:11;24:12;25:4; 31:10;33:20;51:14; 52:13;58:22;60:13,16; 61:25;62:2;68:12;70:15; 71:1;72:10;80:19,23; 81:18;83:21;85:7;94:19; 96:8;111:10,21;119:21; 120:13;133:17;143:22; 144:21;146:20,22,24,24, 25;147:2;148:17,18; 149:6;153:11;157:22; 174:5,13,23;198:15type (6) 52:16;81:23;100:10; 101:5;106:20,22typical (2)

15:25;24:22

U

UC (1) 98:24uh (8) 43:23;46:19;71:25; 73:9,18;78:25;170:5; 175:4ultimate (1) 106:13ultimately (1) 107:8um (15) 48:20;59:9,9;156:23, 24;157:6,13;166:13; 170:5,9,24;171:4,4; 172:2;174:24un- (1) 95:4UNAC (1) 52:6UNAC/UHCP (5) 64:1,14;65:7,13,22UNAC/UHCP's (2) 64:7;67:4unacceptable (2) 70:6;71:22unanimous (2) 65:24;174:11uncertainty (1) 125:10uncompensated (1) 192:2under (27) 7:15;10:8,14;20:13; 21:23;26:10;28:1;42:10; 56:25;61:8;77:11;79:1; 106:2;109:8;128:13; 139:24;140:24;145:10, 18;146:1,16;147:11; 149:7;150:14;165:2; 181:25;186:6under-bedded (1) 20:6underinsured (1) 118:13underlying (1) 66:19underserved (3) 83:23;118:10;126:21understands (4) 102:9;106:15;192:11; 193:13undisputed (2) 74:18,18undue (1) 83:20unemployment (8) 20:23;87:16,17;105:5; 112:14;117:21;122:2; 125:9

Min-U-Script® Barkley Court Reporters (31) thousand - unemployment


unfair (5) 30:16;66:3,13,16; 76:20unfair-labor-practice (2) 66:21;67:1unfortunate (3) 105:12,24;116:6unfortunately (9) 44:21;80:16;85:3; 105:19,20;112:3; 122:16;161:19;188:8UNIDENTIFIED (4) 155:17;160:19,21; 177:25uninformed (1) 182:11uninsured (3) 17:6;18:6;118:13unintelligible (7) 36:8;46:5;84:2; 105:14;124:8;147:19; 155:13unintentionally (1) 145:3union (8) 30:20;54:17;63:3,22; 66:24;67:8;80:7;200:3unionized (1) 85:16unions (1) 107:16unit (6) 16:2;108:19;170:11; 171:19,20;189:11United (11) 34:2;51:5,6;54:17; 57:2;58:15;59:18;63:22; 67:2;108:22;138:19units (2) 69:14;131:2unlawfully (1) 65:22Unless (5) 9:23;43:4;145:20; 181:24;182:1unlike (2) 31:14;136:13unquote (2) 180:7,8unreasonable (1) 44:13unreasonably (1) 180:6unresolved (1) 138:24unsecured (5) 178:8,12,18,24;179:9unselfish (1) 21:19unspecified (1) 68:10unsubstantiated (1) 21:10

up (106) 8:14,24;13:21;14:3,5, 5,17;23:12,19;33:2,13; 34:23;35:1,6,6,25;36:13, 17;38:17,21;41:4;47:21; 52:6,7,24;54:4;55:9; 58:13,20;59:21;60:15; 62:4;72:5;74:4;78:14; 84:12,13;85:4;86:19; 87:17;91:24;94:17,22; 95:2,23;97:23;98:13,20, 21;101:5;104:1;105:21; 114:6,9;127:11;129:18; 132:18;133:2,8;134:15; 146:21;150:10;151:10; 152:7;153:18;154:7; 155:23;158:8;161:4,8, 10;162:17,19;163:3,5,9, 18;164:8,16;165:15; 166:5,10,11,14;167:5, 16,24;170:21;173:10; 174:24;176:7;177:3,10, 24;183:11;185:15,16,24; 186:10,17,23;188:3; 191:11;194:13;195:14; 196:4upgrade (1) 20:11upon (8) 12:3;30:21;76:7; 142:23;144:25;146:18; 180:19;186:7urge (6) 64:9;68:16;72:1; 112:18;135:20;188:13urinary (1) 57:11urine (1) 100:24Use (6) 7:20;14:14;121:18; 200:5,5,6used (10) 7:23;15:3;59:12;62:7; 86:16;88:25;114:3; 165:3;171:6,11uses (1) 81:17ushered (1) 95:5Using (3) 142:23;151:6;187:18usual (1) 56:15usually (4) 36:18;87:14,14; 105:23utilization (1) 41:21utilize (1) 167:22

V

Val (6) 119:9,11,12,12;120:3; 123:11V-A-L (1) 119:13Valerie (8) 175:22;176:2,5,8,9,10, 10,15V-A-L-E-R-I-E-J-O-H-N-S-O-N (1)

176:11Valley (328) 7:11,14;9:5;10:1,5,9, 20,23;11:6,9;12:23; 15:14,23;16:3,5,10,13, 19,25;17:7,10,13,19; 18:2,20;19:7,14,19;20:3, 8;21:11,16;23:10,22; 24:4,7,19,23,25;25:1,3, 21;26:13,15,17,22;27:2, 9,15,22,22;28:4,22; 29:14;30:7,13,15,17; 31:1,2,12;32:16,24;33:7, 10,12,15,18,22,22;34:5, 7;35:16,25;36:1,3,6,13; 37:10;38:12,13,15,18, 20;39:1,9;40:21,24;41:6, 20;43:22;44:19;45:3,23, 23;46:10,13,16;47:3,14; 48:6;51:8;52:18;53:1, 14;55:5,12,15,21;56:1; 58:1,3;61:17,23,24;64:5, 10;65:4,21;67:20,22; 68:3,14;71:5,7,11,25; 72:10,11,15;73:14,17; 74:14,21,24;78:1;80:3,3, 17;81:1,2,7,8,13,23; 82:1,5,6,9,10,18;83:4,10, 17;85:9,22;86:8,16,16; 87:21;88:5,8,13,15,17, 19;89:12,14,16;90:2,3,7, 9,18;91:17;94:1,4,20; 95:11;96:3;97:7;101:20, 24;102:8,12,16,17; 103:6,7,10,16,20; 104:25;105:1;106:11,12, 14,19;107:7,14,22,24; 108:9;109:16,19;110:12, 13;111:2,5,16,22;112:3, 7,9,18,19;113:7,9,23; 114:4,20;115:2;116:11; 117:9,12,24;118:12,15; 119:15;120:16;121:12, 21;122:4,7,13;124:13, 17,18,20,23,25;125:17, 21;126:11,15;127:3,4; 128:23;129:18;130:3,4; 131:11,16;134:12;138:8, 23;139:11;140:11,12,23; 141:1;142:15;154:20; 155:2;156:16,19;157:3,

10,19;158:2;159:4; 162:18;165:6,7;166:12, 17,21;167:7,8,13,23; 168:10;169:2;172:21; 174:4,5;175:7,8;177:12; 178:8;179:19;181:17; 182:8,12,20;183:2,2,7; 184:9,18;185:3,4;186:5; 187:11,12,12,23;188:5; 191:10,22;193:13,15,18; 194:1,5,6,8;195:15,17; 197:8,19,20;198:16; 199:9,17,20,24;200:8Valley's (6) 26:20;27:11;28:16; 107:24;111:21;196:21valuable (2) 51:16;82:16value (1) 96:6values (1) 190:7variables (1) 189:20various (9) 15:16;30:10;46:1,9; 48:7;127:13;178:16; 179:21;182:10vast (3) 50:10;51:10;150:17vendors (1) 118:3venture (1) 161:11Ver (1) 99:1Verdugo (1) 93:24verge (2) 125:4;141:4verify (1) 78:15Vernanda (1) 166:23versus (1) 76:23vested (3) 33:1;163:23;195:24via (2) 167:23;168:25viability (2) 138:7,13viable (7) 49:2,8;73:18;102:15; 103:10,12;104:25vibrant (1) 103:10vice (5) 35:15;72:9;114:19; 115:15;161:7Vice-Chairman (1) 119:5Vickie (1)

95:3Vicky (4) 126:5;130:13;142:9, 10Victor (260) 7:11,14;9:5;10:1,5,9, 20,23;11:6,9;12:23; 15:14,23;16:3,4,10,25; 17:6,10,13,19;18:2,19; 19:7,13,19;20:3,8;21:11; 23:10;24:7,19,23,25; 25:1,3,20;26:13,15,17, 20,22;27:2,9,11,15,22, 22;28:4,16,22;30:12,15, 17;31:1;32:16,23;33:7, 10,12,15,18,21,22;34:4, 7;35:14,16;36:1,6,13; 38:9,10,11,13,15,18,20; 39:1;40:21;41:20;43:22; 44:18;45:2;46:10;47:3, 13;48:6;50:2;51:8; 52:18;53:1,14;55:5,12, 15,21;56:1;61:16,23; 64:10;67:20,22;68:3,14; 71:5,11,25;72:10,11,15; 73:13,17;74:14,21,24; 78:1;81:1,8,13;82:1,5,9, 10,18;83:17;86:16; 87:21;88:5,8,13,17; 89:16;90:1,7,9,18;91:17; 96:3;101:24;102:8,12, 16,17;103:6,7,9,16,20; 104:25;105:1;106:11,12, 14,19;107:7,14,22,23, 24;110:12,13;111:2,5, 20,21;112:3,7,9,18,19; 113:6,8;114:20;115:2; 116:11;117:9,12,24; 118:11,15;119:14; 121:11,21;122:4,7,13; 124:12,16,18,20,23,25; 125:17,20;126:10,15; 127:2;128:22;129:18; 130:4;131:11,16; 134:12;138:8,23; 139:11;140:23;142:15; 154:20;155:2;156:16, 19;158:2;159:4;162:18; 166:12,17,21;167:8,13, 23;168:9;169:1;174:4,5; 175:7;176:19;177:11; 178:8;179:19;181:17; 182:8,12,20;183:2,7; 184:9,18;185:3,4;186:4; 187:12,12,23;188:5; 191:10,22;193:13,15,18; 194:5,8;195:15,17; 196:21;197:8,19; 199:24;200:8VICTORVILLE (19) 7:1;10:4;26:4;64:6,13; 67:24;68:4;70:1,24; 71:2,10,25;83:2,9;96:8;

Min-U-Script® Barkley Court Reporters (32) unfair - VICTORVILLE


120:16;143:20;167:14; 176:17VIDEOGRAPHER (1) 8:17videotape (1) 8:13view (4) 20:15;36:15;103:19; 183:8viewed (1) 16:25viewpoints (1) 153:23views (2) 19:24;49:10VIJAY (7) 49:17,22,23,23;50:1,1, 2Villarosa (5) 34:22;35:12,13,14; 36:21violation (1) 62:9violations (4) 66:10,12;67:1;74:20virtual (1) 175:6virtually (1) 73:15visionary (1) 107:23visit (4) 26:7;128:1;196:8; 199:11visits (2) 16:4;67:5vital (3) 49:9;119:3;128:2vitally (1) 115:1vocal (1) 110:10voice (5) 64:6;173:10;199:23, 25;200:7voiced (1) 182:12voices (1) 110:7volume (1) 39:5volunteer (1) 199:9volunteered (1) 134:17vote (3) 67:22;145:21;191:22voted (2) 65:6;139:8vu (1) 133:13vulnerable (2) 52:15,21

VVCH (1) 72:15VVHA (12) 72:13;73:1,12,14; 74:1,5,11;178:15,20,25; 179:7;181:1

W

wait (4) 28:7;80:22;155:24; 157:9waiting (4) 98:18;114:7;134:16; 157:7waiving (1) 76:5walker (1) 120:19walking (1) 170:21walks (1) 100:20wall (1) 158:10wants (7) 14:12;28:3;44:18; 107:23;151:11,19; 175:25warns (1) 96:7Washington (2) 66:16;181:5Watch (3) 59:23;104:16;153:2watching (1) 153:20way (25) 14:16,17;40:24;41:19; 47:1;70:7;72:25;74:24; 78:20;85:9;87:10,10; 91:22;93:7;106:8;116:1; 137:4;141:22;167:18; 172:19;176:12;188:12; 192:17;195:1;196:4ways (1) 126:14Website (7) 12:17,19,20;13:13,13; 15:20;145:8WEDNESDAY (2) 7:1;158:9week (4) 105:8;119:24;181:25; 186:11weekend (2) 89:19;157:15weekends (1) 196:8weeks (2) 180:14;185:25W-E-I (1) 54:15

weighed (1) 120:11weighs (1) 120:12weight (1) 80:23WEISBERG (5) 54:13,14,14;56:6; 180:9welcome (3) 70:2;84:5;125:17welfare (1) 105:10well-being (4) 38:5;83:16;109:7; 167:22well-intentioned (1) 175:5wellness (1) 26:6well-respected (1) 19:7well-run (1) 86:9Wendi (4) 7:7;15:21,23;72:8wendihorwitz@dojcagov (1) 200:17weren't (5) 13:17;53:3;137:5; 177:13;183:19west (6) 29:8,16;54:17;57:25; 69:7;196:18western (1) 175:7what's (5) 86:19;140:3;181:10; 192:23,23whatsoever (2) 100:6;148:1whenever (2) 21:14;36:2Whereas (2) 46:20;47:3whereby (1) 151:6whole (5) 37:19,21;45:25;54:10; 195:12who's (9) 13:4;34:25;35:3;63:8; 66:4;74:17,17;130:22; 196:3whose (2) 57:20;200:4widespread (2) 66:5;118:6wife (2) 85:5;114:6William (4) 23:21;72:7,8,8willing (5)

34:7;78:16;83:5; 125:14;191:16winning (1) 178:17win-win (1) 82:19wiping (1) 179:9wish (6) 39:14;48:15;84:24,24; 105:5;183:25wishes (2) 67:22;145:24withholding (1) 95:21within (6) 39:19;62:1;112:5; 133:18;146:13;186:2Without (24) 17:6,10,12,24;22:5; 42:12;49:1;55:18;59:17; 68:1;71:1,17;91:4; 118:2;124:25;125:6; 129:11,13;135:21; 144:6;145:9;150:21; 163:11;195:11witnessed (3) 102:18;197:15;199:16woefully (1) 20:6woke (1) 158:8woman (3) 71:20;160:19,21women (1) 165:7Women's (4) 10:6,21;21:2;27:19won (1) 33:23wonder (2) 41:7;171:16wondered (1) 180:15wonderful (1) 48:14wondering (1) 192:23word (8) 71:20;84:22;94:11; 97:16;188:21;193:9; 194:9;199:19words (1) 58:10work (23) 13:24;35:15;53:22; 69:8;78:7,10;79:17; 90:4;110:9;118:2; 136:22;167:5;169:24; 170:14;171:4,10;172:5; 192:14,15;193:1,3; 196:6;197:13worked (15)

25:10;77:2;106:4; 134:17;136:23;158:1; 159:3;166:13;167:9,13, 14;169:24;179:21; 189:10;192:22worker (1) 173:7Workers (4) 54:17;89:22,22; 199:16working (7) 11:3;28:21;34:25; 39:10;68:2;90:2;167:4works (3) 13:22;35:3,5world (1) 75:20worried (1) 172:8worries (3) 113:20;170:25;176:14worry (1) 173:5worrying (1) 37:24worse (1) 95:3worst (1) 177:20worth (2) 92:23;94:12write (2) 37:18;100:21writing (6) 94:2;117:6;169:6,6; 181:10,11written (2) 169:4;200:15wrong (2) 74:17;95:3wrote (2) 77:5;131:24wwwagcagov/charities/nonprofithosp (2)

12:21;13:14

X

X's (1) 58:18

Y

yard (1) 98:15year (28) 16:4,5,7;17:22;20:13; 26:1,2,5;29:11;33:8,19; 53:4;64:20;68:13;69:16; 81:9;89:4;113:25; 114:25;133:14;136:21; 138:16;139:9;146:18; 181:12;184:10,13;195:4years (78)

Min-U-Script® Barkley Court Reporters (33) VIDEOGRAPHER - years


17:20;20:9;21:12,13; 22:11;25:11,14;26:24; 27:21;29:4;37:5,6;38:2; 40:1;43:18;45:17,18; 46:1;48:13;50:5;59:13; 60:16;64:23;66:5;68:24; 69:12;70:21;71:20; 80:18;82:12;83:10;88:8, 17;89:13;90:20,20,23; 101:21,22;102:18; 108:18;109:3;120:15; 122:7,14;123:13; 126:15;128:18;134:24; 146:24,24,24,25;147:2, 3,7;156:23;157:5,22; 158:17;161:12,17; 164:24;168:8;169:23, 25;174:4;175:3,3; 176:18;179:20;183:18, 19;187:9;191:5;192:22; 194:4;199:22yellow (1) 57:17yesterday (3) 27:23;61:14;63:1yield (1) 106:22young (1) 115:22

Z

Zumbrunn (6) 169:10;173:19,20,22, 22;174:1Z-U-M-B-R-U-N-N (1) 174:1

Min-U-Script® Barkley Court Reporters (34) yellow - Z-U-M-B-R-U-N-N

vvch hearing

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