Rather than admit that they had made mistakes in their data interpretations, Dr. Chandrasena testified sixteen times under oath to the Judicial Review Committee that my takeback rate was 20%.[14],[15], [16] Members of the MEC, the AHC, and the JRC believed that Dr. Chandrasena had the correct data directly from the Sequoia Hospital QA computer printout, as she repeatedly insisted.[17]

 

The JRC said that the decision against me was not based of the rate data debated before the hearing, but these rate misrepresentations were used to initiate the action against me, and they further very reasonably biased every colleague who heard such a terrible accusation coming from Sequoia authority figures.

 

Once it became clear to the CMO that her rate allegations were probably wrong, she suddenly urged the AHC and the MEC to switch focus to the severity of six of my complications to support their expulsion.

 

The Judicial Review Panel (JRC) trial was procedurally unjust in that the administrative judge refused to allow me to submit exculpatory evidence into the JRC trial discovered during the trial or necessitated by trial testimony, or to even refer to it in order to present my defense.[18],[19] When I vigorously protested, the judge went off the record to make it further clear to my lawyer and me that I could not introduce any evidence in my testimony.[20]

 

The Judicial Review Committee (JRC) was conducted with multiple (25) infractions of Sequoia Bylaws and Rules and Regulations which doomed my appeal. The JRC also did not require the outside Gyn Oncologist to be questioned by us.

​

Nine doctors and the head OR nurse for Gynecology, all very familiar with my care testified in my support and explained the six cases. The JRC ignored uncontested witness testimony.

 

Had I been allowed to submit evidence,[13],[14]to provide testimony,[21] the JRC would have come to the same conclusions that all of our experts, a senior Gynecologic Oncologist, Sequoia’s senior General Surgeon, three Anesthesiologists including two Anesthesia chairs, two senior General Gynecologists, (one a former 10-year Chief Medical Officer) and two Medical Oncologists came to: that I met or exceeded the standard of care.

 

Sequoia alleges I failed to provide standard of care for four patients:

1. A 43-year-old patient consented to TLH only. The RN conducting the surgical timepout pause read the scheduling form which included removal of the ovaries, not the consent and twice instructed me that the ovaries were to come out. I removed them, apologized and replace her hormones for years. Sequoia never took responsibility for the RN’s error to the patient or her family.

2. A 45-year-old patient with endometriosis had the unforeseen observation of a chronic appendicitis with fistulization of the appendix to the small bowel. I had offered her a free appendectomy, but this one was for disease, so the General surgeon removed the appendix and stapled both bases. The patient had hemoperitoneum later that day and after 45 minutes of searching and examining every surgical site, I dictated that no active bleeding was found. Overnight the patient did well and packed to depart then next day, meeting all qualifications of discharge by nurses. I saw her socially before she left, but was called an hour later by the husband saying she was not doing well. We together decided to keep an eye on her and see how she improved. He called back two hours later saying she was still not doing well and had passed blood-tinged stool, and we together decided she would come back to sequoia for my laparoscopic care. I repaired the hole in her small bowel where the appendix had been excised from, and she recovered well after that.

3. A 61-year-old patient had an episode of syncope at 1am with a decreased H/H then. All her vitals remained normal after that and she looked great and felt well and wanted discharge the next morning.[22]  Instead of repeating the blood count, I allowed the discharge to go forward, and she returned later that day with hemoperitoneum.  During her takeback, there was no active bleeding, but the source was likely her uterine artery.

4. A 65-year-old patient had a recurrence of endometrial cancer in a lymph node adherent on her aorta. After viewing her films, a vascular surgeon was contacted for possible intraoperative repair of the aorta. His instruments were ordered and in the room. The surgery went well—he was needed and came in and replaced the aorta where the cancer had invaded, and the patient recovered well and is cured. This case was called a “near miss” by the Chief of Staff (gastroenterologist) and the Chief Medical Officer (pulmonologist) and after informal discussions with the vascular surgeon, I was summarily suspended. Of note, this case was reviewed by a cardiac anesthesiologist for the QA committee and rated it “no issue with physician care.”

 

The two experts who reviewed the above four charts before the Medical Board of California confirmed that the quality of my clinical decision-making, attention to detail, case planning, and honesty in documentation met or exceeded the standard of care, except that they thought that I should have repeated the blood test and retained the 61 year-old patient, and I concur: I wish I had, but she did not appear to be bleeding seven hours after the solitary syncopal event, because the symptoms of internal bleeding do not usually disappear, but get steadily worse.

 

Had there been a Gynecologic Oncologist on the JRC panel, as required by the Bylaws, more accurate decisions would have been made by the JRC.

 

Was there “substantial noncompliance with the standards or procedures required by these Bylaws, or applicable law, which has created demonstrable prejudice”?

Yes.

• There was never any accurate indication provided for the investigation.[23], [24]

• I was denied access to the available Sequoia Hospital QA rate data of concern, al of which was reassuringly good..

• The NSQIP QA data, while accurate, compared my practice data with that of benign non-cancer-gynecologists.[25]

• The AHC was biased by Dr. Torosis and Dr. Chandrasena at their first meeting, inaccurately confirming to them I had high complications, infections, and takebacks.

• The administrative judge’s prohibition to submit exculpatory evidence during the JRC precluded many truths about my practice.[26], [27], [28], [29], [30]  

• No journal data was allowed to be admitted as evidence that my practice was “literature-based” and norm-compliant.

• There was no Gynecologic Oncologist on the AHC or the JRC panels as required,[31] and she was not made available for cross-examination.[32]

• QA Confidentiality was breached. The AHC chair contacted Dr. Dwight Chen who was a remotely prior peer reviewer, but not involved in this AHC.[33] Dr. Chen told a Santa Cruz Gynecologist that my privileges were revoked at Sequoia, who told another Gynecologist.

• The administrative judge had worked for CHW-Dignity Health) for 17 years.[34]

• The Board of Directors Appeal refused to allow for the presentation of evidence that was precluded from the JRC by the administrative judge.[35]

 

Were the factual findings of the Hearing Committee su pported by substantial evidence based upon the hearing record or such additional information as may be permitted pursuant to this section?

No.

 

• Dr. Torosis grossly misrepresented the interactions between me and the former and current Chief of Staff to the AHC first meeting. I was highly collaborative in seeking practice data to prepare for my meeting with both her and him.

• Dr. Torosis requested an AHC before ever meeting with me or providing me their concerns.

• Dr. Chandrasena incorrectly alleged my takeback rate was 20%.

• The JRC Decision was not based on facts from peer-reviewed Gynecologic Oncology journal data or comparisons with other Gynecologic Oncology data. The NSQIP published Gyn Oncology evidence would have shown that my complication rates were within or below the published NSQIP Gynecologic Oncology norm, and that my individual cases were reasonably and safely managed.

• There was no ethical lapse in my dictating two “drafts” of the aorta case. Neither was signed or dated, both were designated to be discarded before even provided to me, and neither became part of the patients record because they were never read, edited, or signed and dated.[36]

• There was never any complication in the Aorta case, no indication for summary suspension. They disregarded and suppressed the favorable review by the QA-assigned physician.[37] The Vascular surgeon, Dr. Zimmerman, did not plan for his availability by requesting the necessary equipment or desired nursing team.

• The required consultation with vascular surgery was made by text and by personal phone conversation.[38] My arrangement for possible intraoperative consultation with Dr. Zimmerman was executed appropriately per Sequoia standards.[39] We obtained his basic set of instruments before the case. He was responsible for obtaining whatever additional instruments he needed for proper care of this patient.

• Dr. O’Holleran’s and my billing plans and dictations was entirely above board, but our sworn statement was not allowed into evidence.[40]         

• The AHC and MEC received false information about the Aorta case from Dr. Zimmerman, Dr. Torosis and Chandrasena influencing them to expel me or to continue the summary suspension.[41]

• Every patient of mine was seen every day by me or a covering physician. I did not write notes on discharged patients whom I was not required to see, in accordance with Sequoia standards, and acknowledged by the AHC. I did not write notes on patients on another physician’s service, without proper consultation.[42]

• The Ad Hoc Committee and the Judicial Review Committee interviewed and disregarded substantial evidence from every single physician that I worked with on a regular basis. Every colleague (O’Holleran, Wilson, Havard, Noblett, Parris, Bradley, Keshavacharya, Fisher, Beingesser, Charvonia, Sueldo, Emeney) confirmed that my practice was respectful, careful, and without undue complication, and that I attended my rare complications with detailed care and attention. Not even one felt that any of my complications were “egregious” as asserted.

• The Ad Hoc Committee and the Judicial Review Committee disregarded all these physicians and nurses most familiar with my work, and put their only credence in a single remote physician reviewer, who could not be cross-examined.

• The panel was required to have had a Cancer-Gynecologist on it. A Cancer-Gynecologist would have offered a more legitimate perspective on the surgeries that none of the panel understood or performed or even knew that I performed routinely.

• Exculpatory evidence was prohibited from submission during the JRC trial.

 

 

Was there any bias introduced into the case that would affect the decision?

Yes.

 

• The AHC and JRC members’ Decisions were biased by multiple misrepresentations propounded by Dr. Chandrasena and Dr. Torosis.[43]

• The subjective view of the non-Gyn-Oncologist hospital staff members that the Aorta case was a “near miss” should not have constituted an indication for summary suspension. None of the evidence or testimony by all present in the case supported such a decision.[44]

• The JRC disregarded my and Dr. O’Holleran’s objective responses to the outside reviewer, while the subjective reviews of physicians who had little-to-no familiarity with my practice or Cancer-gynecology standards, were accepted.

• The JRC panel refused my request to allow me to submit exculpatory evidence during the proceedings, removing any chance to show that my practice was entirely literature-based.

• The hospital’s legal counsel purposely suppressed information about the exculpatory QA review in the Aorta case. (Nov 5 JRC: Mr. Schulman: “There was no peer-review form in evidence—and I would submit there never was one. No form. No peer-review form”)

• The JRC Decision disregarded incontrovertible evidence that my dictated templates which I did not edit or sign into the patient’s medical record were entirely ethical.[45]

• The JRC would not accept into evidence that Dr. Aboian dictated for Dr. Zimmerman at least once (897774, DOS 8/24/2015) which became part of the patient’s record.

 

 

Were the correct standards applied in making the decision?

No.

 

• It is standard to compare NSQIP practice data of Gynecologic Oncologists with NSQIP data from other Gynecologic Oncology practices. Sequoia had this data. The investigation by an Ad Hoc Committee was never indicated ab initio because the allegations sent to the MEC requesting formation of an AHC were based on comparisons with Dignity-wide non-cancer-gynecologists’ data.[46]

• All published NSQIP data on complications, infections, takebacks and enterotomies show that my rates are NOT increased over any of my peers (see attached exhibit).[47]

• Discovery documents provided to me were incomplete. A letter from an MEC member to Bill Graham alleging false evidence and member bias at the MEC was not provided to me.

• Exculpatory discovery was wrongfully prohibited from evidence.[48]

 

The MBC hired a General Surgeon, not a Gynecologic Oncologist, (and there are many in CA) to review the four cases of concern reported by Sequoia, out of the 628 performed. The General Surgeon found multiple severe deviations from the standard of care. Our consulting Gynecologic Oncologist and former Chief of Staff reviewed the same four cases and found that my care met or exceeded the standard of care in every case except for one, with a mild deviation from the standard of care.

 

It is typical for every surgeon to have rare (<5-10%) complications, which are reviewed monthly by one’s Department for educational and quality assessment purposes. None of my complications warranted expulsion and review by the MBC per a qualified Gynecologic Oncologist. Because I was nearing retirement age and had spent over $200,00 defending my reputation, I gave up and surrendered my license, with the MBC stipulation that they acknowledged that I had a significant defense.

 

I have provided evidence that Sequoia showed substantial noncompliance with its own Bylaws and Rules & Regulations, which created undeniable prejudice against me. I have provided evidence that the findings of the AHC and JRC Hearing Committees were not supported by the facts or substantial evidence I could have provided, but was prevented from doing so. I further allege that the bias introduced into the case by multiple false allegations affected the decision and that incorrect standards were used to wrongly condemn my career.

 

Were there procedural errors and injustice in the JRC process?

Yes.

• The JRC forgot my testimony in the JRC hearings in the case of patient #3. Dr. Tene said that she read in the chart that I was called by nursing staff about LO’s blood levels. I said that I was not called. Dr. Tene could not show evidence that I was called in the patient chart, but she called me dishonest to the JRC. To prove I was correct and honest, I ordered my phone log for that date and found myself incorrect. I immediately corrected this to the JRC at my very next testimony: that my phone logs showed that I remembered wrongly and should have said “I did not remember being called” instead of “I wasn’t called.”[49]  This is the case in which I made a mild deviation from the standard of care. While it cannot be confirmed when this patient developed internal bleeding after her surgery, a repeat blood count prior to her discharge might have shown if it had already started before she was discharged even though she had all normal vital signs and activities. In retrospect, it likely started after her discharge, later needing a return to surgery.

 

• The Gynecologic Oncologist and former Chief of Staff who reviewed my charts in my defense to the Medical Board of California confirm that in the case of Patient KM, I met or exceeded the standard of care in every way. A pulmonologist (the Sequoia QA manager) and a gastroenterologist (the Sequoia chief of staff) did not have sufficient knowledge or basis for summarily suspending privileges after a carefully planned and successful Gynecologic Oncology surgery. They never questioned me or the assistant surgeon or another Gynecologic Oncologist, who was present for the entire case. Because of Dr. Chandrasena’s insistent and repeated misrepresentations about my takeback rates to the MEC behind my back, the MEC upheld my summary suspension.

 

• The JRC disregarded uncontested witness’s testimony in Patient KM’s case: Nurse Charvonia, Dr. O’Holleran and I all testified that there was no uncontrolled bleeding, and no unanticipated event in the aorta case. As Nurse Charvonia, Dr. O’Holleran and I all testified the surgery went exactly as planned and as stated during the Surgical Pause prior to the surgery. The vascular surgeon, Dr. Zimmerman, also confirmed that he observed complete vascular control. This was no “near miss.”

 

• The vascular surgeon did not contest my saying that I texted and spoke with him in consultation the day before. The patient did not have any vascular disease per se, but might need a graft, I told him. He asked me for nothing in advance (e.g., no request to see the patient, to view the films, to order any equipment, to request his nursing team). I was surprised that he was so casual in his approach, and texted him the patient’s MR number in case he wanted to confirm the findings of my review of the patient’s MRA.[50] If he felt sub-optimally prepared, he should have taken responsibility for it.

 

• Dr. Zimmerman testified to the JRC that he affirmed to me in my consultative phone call with him that he would be at the hospital all day long, never telling me that he had surgical cases of his own all day.

 

• Also, in the case of Patient KM, the JRC disregarded Dr. O’Holleran’s and my testimony that we had agreed on an accurate and entirely ethical co-surgeon billing scheme after the very successful surgery. It was entirely ethical that we changed our minds about the billing scheme, even after my two draft dictations, which I never read, never edited, and never signed or dated. It was ethical for me to dictate a third and final dictation that I did edit and sign and date into the chart. It was truthful that Dr. O’Holleran and I mutually wrote and signed a statement about the above facts, and that I presented this signed statement to the MEC. It was unethical that the JRC disregarded our uncontested testimony, and more unethical that the JRC refused to allow me to submit Dr. O’Holleran’s and my signed statement into evidence. The Gynecologic Oncologist and former Chief of Staff who reviewed my charts for the Medical Board of California confirm that there was no dishonesty or breach of ethics in this issue.

 

• The JRC wrongly decided that the 2mm hole in the aorta was an accident, a complication. It was incidental to the removal of the cancer, anticipated for appropriately.  I knowingly and purposely dissected the cancer that had invaded the aorta wall to remove it completely, consistent with published evidence that such meticulous surgery could be life-saving from an otherwise terminal reoccurrence of cancer.

 

• There was no doubt in anyone’s minds that I alone made the hole. The need for vascular graft was not a complication, but a planned possible outcome, as well-described by others in Gynecologic Oncology literature. The patient and our entire staff were always aware that she might need a graft, as both Dr. O’Holleran and I and Beth Charvonia testified and the chart verified. That was the only reason I contacted the vascular surgeon.

 

• It was unethical that Sequoia’s counsel purposely suppressed a second exculpatory document: the QA review of the KM case, in which Sequoia’s randomly assigned QA reviewer, Dr. Tarang Safi, filed the QA case review form finding “no issue with physician care.” I desperately asked that his form be found in JRC’s evidence book, but Mr. Shulman insisted that it was not in evidence, when it was.[51]  Dr. Chandrasena also acted as if she did not know about this form generated by her own department.

 

• Dr. Chandrasena issued grossly inaccurate testimony about the KM case. She alleged that the vascular instruments were not available, when Nurse Charvonia’s and my own testimony clearly stated that Nurse Charvonia had obtained them for our room after she heard about the possibility of a vascular graft in the Surgical Pause, keeping them unopened in case we did not need them. Dr. Chandrasena inaccurately said that Dr. Zimmerman rushed over to our OR leaving his own patient on the table. He did not. He was not surprised that we called him.

 

• Dr. Chandrasena inaccurately implied that a vascular scrub team is critical for a vascular case. Every surgeon prefers to have their usual team, but such teams are neither essential nor critical.

 

• Dr. Zimmerman had no expertise to suggest to the JRC that my surgical privileges be “trimmed.” He and the JRC knew nothing about the published literature support for typical Gynecologic and Vascular Surgery collaboration in cases such as this one. I tried to submit these articles, but was prohibited from doing so by the JRC trial judge. He and the JRC knew nothing about my surgical privileges, or procedural or academic expertise that I also was blocked from submitting. Without my being able to submit evidence that I had performed 145 lymphadenectomies at Sequoia during the 32-month time of my investigations, the panel could not know that the procedure was well-established in my armamentarium. Without my being able to submit into evidence my five abstracts/posters,[52]  my two publications,[53] my three videos at international meetings,[54] all on comprehensive lymphadenectomy, the panel could not know that I was an international and national expert on comprehensive high aortic lymphadenectomy, even by laparoscopy.

 

• The consulting Gynecologic Oncologist and former Chief of Staff for my MBC defense concluded that my care in Patient KM’s case exceed the established standard of care in this case.

 

• Regarding the case of Patient SS, whose ovaries were removed without consent: Had Sequoia done a careful review of this patient’s chart, they would have found that there were six areas where the Sequoia nursing staff falsely signed off on the removal of the patient’s ovaries as being in her consent prior to mis-instructing me to remove them.

 

• The JRC remained unaware that the sole purpose of the Surgical Pause is that the nursing staff review the consent themselves, with the surgeon standing in sterile gown, adjacent to the patient, and remote from the chart. The surgeon relies on the Nurse entirely, as the final and last affirmation of the consent, with the sole goal of a final prevention of wrong-site surgery. I did my part to listen to her, to even question her if it was correct, and finally to believe her in this sacrosanct procedure, which the Sequoia Registered Nurses repeatedly abominated.

 

• Furthermore, it was entirely unethical that the Sequoia QA Staff inquire about this event only with the Registered Nurse who used the surgery requisition in place of the consent. When the Registered Nurse accused me of causing “chaos” in the OR with the meticulous Surgical Pause that Sequoia Nursing Staff have routinely conducted in my OR’s for 15 years, and 3,500 cases, certainly I should have been questioned. Additionally, Nurse Charvonia, the Manager for the Gyn OR, should have been questioned, given such an accusation of chaos over 15 years.

 

• The JRC was wrong to disregard the testimony from Nurse Charvonia, Dr. O’Holleran and me that the Surgical Pauses conducted in my OR are meticulous, thorough, and benefit the patient. The consulting Gynecologic Oncologist and former Chief of Staff for the MBC defense concluded that my care met and exceed the established standard of care.

 

• In the case of patient #2, the consulting Gynecologic Oncologist and former Chief of Staff for the MBC defense concluded that my care met and exceed the established standard of care.

 

All surgeons make mistakes that are noted retrospectively in QA meetings, analyzed, and tabulated. If the mistakes are too frequent or show negligence, the Committee makes a specific plan for correction with the surgeon. Failing this plan, the Medical Board is notified. I made no error that would justify my expulsion or summary suspension from the hospital. It is easy to relook at cases through the “retrospectoscope” and make second-guessing accusations based on the outcomes and results that were not obvious at the time, especially if there is animus toward that surgeon.

 

There was also no “egregious case,” no “near miss” that resulted in my expulsion and subsequent investigation by the MBC. The senior Gynecologic Oncologist and former long-term Chief of Staff who reviewed these same cases before the MBC identified only one minor deviation from the standard of care, as happens in any practice, and typically is adjudicated at the local hospital’s monthly QA meetings. There was never a practice pattern that warranted MBC alert. Had the MBC used a Gynecologic Oncologist to my cases, instead of a General Surgeon, the MBC would have made more accurate and fewer accusations.

 

I retired and closed my practice in May 2020, unable to operate locally on my patients, having spent over $300,000 defending my license and my reputation. I did not know that not having an active practice precluded me from receiving a public letter of reprimand or probation from the MBC.

 

Newly realizing that my retirement precluded me from obtaining any desired outcome from the MBC, I negotiated with the MBC to specifically stipulate that our defense was significant and would go unaddressed due to costs. The MBC accepted surrender of my license to reduce costs to both sides, but this detail is only in the settlement agreement.

​

____________________________

 

1. Torosis August 25, 2017 email listing 28 total complications, 15 of which were takebacks.

2. AHC meeting #4, January 12, 2017 minutes: 628 total cases.

3. MEC 523-530: slide deck prepared by Dr. Chandrasena in December 2015, shared with Ad Hoc Committee, Medical Executive Committee, Judicial Review Committee.

4. MEC 150: AHC session #3, December 8, 2016: “Dr. Chandrasena reported that the information included in the packet was provided to the Department Chair about 1 year ago.” ((i.e., December, 2015)

5. MEC 523-530: slide deck showing NSQIP data.

6. AHC meeting #4, January 12, 2017 minutes: 628 total cases.

7. Torosis August 25, 2017 email listing 28 total complications, 15 of which were takebacks.

8. Minutes of MEC session August 28, 2017: return-to-surgery rate was “20.968% compared to Dignity Health Gyn-Onc of 3.243%.”

9. AHC meeting#3, December 8, 2016: “Return to OR in the same hospitalization was 20 out of 110. % return to surgery was 17-26% January 2015 thru December 2015 compared to other Dignity Health Gyn-Onc 3.46-3.57%”

10. MEC session October 23, 2017 Mp3 audio recording (termed inaudible in typed transcript)

11. MEC 689, Medical Executive Committee session August 28, 2017: Dr. O’Hanlan “I have asked you six times to share your numbers with me and you never shared any.” Dr. Chandrasena “People on our medical staff, attorney and our colleague in the department and they collectively advised me not to re-review the data.”

12. MEC session October 23, 2017: Member “…I’m sure you’ve seen that, the graph showing your complication rate…” Dr. O’Hanlan “Nobody has ever shown me any results of my complications. I’ve asked seven times. Dr. Chandrasena said the lawyers said they didn’t have to show them to me.” Dr. Chandrasena “I’m not going to argue with you, Kate.”

13. Emails from my colleague, on file.

14. JRC, Nov5 p103, “This data is the truth. …I’ve shared it with the Ad Hoc Committee, and it was shared with the MEC.”

15. JRC, Nov 5, p449: p449 “No, because it is accurate. By our definition from Midas, that data is accurate. It's not wrong. You can use -- you can use the numerator and denominator to change the percentage, but that data is by a standard definition from quoted data. It's not something we can change.”

16. JRC, Nov5 p103, “This data is the truth. …I’ve shared it with the Ad Hoc Committee, and it was shared with the MEC.”

17. JRC, Nov 5, p24:  DR. CHANDRASENA: ··This is the data. I haven't done anything to it. It is what it is. It's from Midas, which is our database that looks at inpatients only. ··It is designed and used in 800 hospitals across the country. That’s the report that was pulled – that was used to look at Dr. O'Hanlan's performance, so I didn't do anything to it. ··It is just what's pulled from the systems. ··You cannot edit it.”

18. JRC, Nov 5, page 166: HEARING OFFICER JOHNSON: ··You can't refer to something that's not in evidence.

19. Ibid

20. JRC, Nov 5, page 166: HEARING OFFICER JOHNSON: ··Well, there's a bigger problem. ··Let's go off the record for a minute. This was where I argued strongly that I could not defend myself if I could not submit journal and chart evidence.

21. JRC, Nov5 p166: HEARING OFFICER JOHNSON: ··Any more questions from the committee? ··No questions. Any more questions from either counsel? MR. FLEER: ··No. MR. SHULMAN: ··No. HEARING OFFICER JOHNSON: ··Then the evidentiary portion of this hearing is concluded. DR. O’HANLAN: ··May I make a comment? HEARING OFFICER JOHNSON: ··No. Off the record. ·---oOo---

22. See Baker letter to Mercer at MBC attached.

23. Bylaws, page 21: The President of the Medical Staff, a department chair, the Medical Executive Committee, or the Hospital President may request an investigation of a member whenever reliable information indicates a member may have exhibited acts, demeanor, or conduct reasonably likely to be 1) detrimental to patient safety or to the delivery of quality patient care within the hospital; 2) unethical; 3) contrary to the Medical Staff Bylaws, Rules and Regulations, or Medical Staff and Hospital administrative policy; 4) below applicable professional standards; or 5) disruptive of hospital operations.

24. Bylaws, page 22: A request for action or for an Investigation under the auspices of the Medical Executive Committee must be supported by reference to specific activities or conduct alleged.

25. Bylaws, page 33: The practitioner may inspect and copy, at his or her expense, any documentary information relevant to the charges that the Medical Executive Committee has in its possession or under its control.

26. Bylaws, page 298: Technical, insignificant, or non-prejudicial deviations from the procedures set forth in these Bylaws shall not be grounds for invalidating the action taken or recommended by the bodies whose decisions prompted hearing.

27. Bylaws, page 28: discretion is granted to the Medical Staff and Board of Directors to create a hearing process which provides for the least burdensome level of formality in the process while still providing a fair review and to interpret these Bylaws in that light.

28. Bylaws, page 32: The hearing officer shall endeavor to assure that all participants in the hearing have a reasonable opportunity to be heard and to present relevant oral and documentary evidence in an efficient and expeditious manner.

29. Bylaws, page 34: Judicial rules of evidence and procedure relating to the conduct of a trial regarding the examination of witnesses, and presentation of evidence shall not apply to a hearing conducted under these provisions. Any relevant evidence, including hearsay, may be admitted if it is the sort of evidence on which responsible persons are accustomed to rely in the conduct of serious affairs, regardless of the admissibility of such evidence in a court of law.

30. Bylaws, page 36. The decision of the Hearing Committee shall be based on the evidence and written statements introduced at the hearing, including all logical and reasonable inferences from the evidence.

31. Bylaws, page 31: Such appointment shall include at least one member who has the same healing arts licensure and practices in the same specialty as the Practitioner involved.

32. Bylaws, page 34: Within reasonable limitations, both parties may call and examine witnesses for relevant testimony; introduce relevant exhibits or other documents; cross-examine or impeach witnesses who have testified orally on any matter relevant to the issues, and otherwise rebut evidence;

33. AHC meeting notes December 8, 2016

34. Bylaws, page 32: An attorney regularly utilized by the hospital or medical staff for legal advice regarding its affairs and activities shall not be eligible to serve as hearing officer.

35. Bylaws, page 58: the appeal board may accept additional oral or written evidence, subject to a foundational showing that such evidence could not have been made available to the Hearing Committee in the exercise of reasonable diligence, and subject to the same rights of cross-examination or confrontation that are provided at a hearing.

36. R & R, page 4: The provider’s signature and time stamp will be captured electronically when the provider signs or accepts documentation in the electronic health record; or, if on paper, all entries must be dated, timed, and authenticated in a timely fashion. The use of signature stamps is strictly prohibited.

37. Bylaws, page 23: A member’s clinical privileges may be summarily suspended or restricted where the failure to take such action may result in an imminent danger to the health or safety of any individual, including current or future hospital patients.

38. R & R, page 4: Consultations should be performed as soon as possible after requested by the attending physician.

39. Sequoia R&R, page 4. Consultation is required in the following situations: Where the diagnosis is obscure after diagnostic procedures have been completed. In unusually complicated situations where specific skills or other practitioners may be needed.

40. Bylaws, page 34: Any relevant evidence, including hearsay, may be admitted if it is the sort of evidence on which responsible persons are accustomed to rely in the conduct of serious affairs, regardless of the admissibility of such evidence in a court of law.

41. Bylaws, page 25: The Medical Executive Committee shall reverse any action that was based on a material mistake of fact as to the existence of the grounds for such special action.

42. Sequoia R&R, page 1: In instances of absence from practice, the practitioner must provide or arrange for comparable coverage by another qualified staff member, within the same specialty, who has agreed to accept responsibility for care of the patient.

43. Bylaws, page 34: The body whose decision prompted the hearing shall bear the burden of persuading the Hearing Committee, by a preponderance of the evidence, that its action or recommendation is reasonable and warranted.

44. Bylaws, page 25: This initial written notice shall include a statement of the reasons why the summary suspension was deemed necessary.

45. R&R, page 1: The provider’s signature and time stamp will be captured electronically when the provider signs or accepts documentation in the electronic health record; or, if on paper, all entries must be dated, timed, and authenticated in a timely fashion.

46. Torosis and Joyce to MEC, October 3, 2016 (MEC 139-140): “series of complications and what seems to be unusually frequent returns to surgery and post-op infections… and what seem to be unusually frequent returns to surgery and post-operative infections.” See also Torosis to AHC#1 meeting, November 3, 2016 (MEC 146), AHC letter to MEC, September 29, 2017 (MEC 007, 023), Dr. Chan to JRC, August 21, 2017 (MEC 321).

47. Bylaws, page 22: A request for action or for an Investigation under the auspices of the Medical Executive Committee must be supported by reference to specific activities or conduct alleged

48. Bylaws, page 34: In ruling on discovery disputes, the factors that may be considered include: a. whether the information sought may be introduced to support or to defend against the charges; b. whether the information is “exculpatory” in that it would dispute or cast doubt upon the charges, or “inculpatory” in that it would prove or help support the charges and/or recommendation;

49. JRC, Nov 5, page 158: I checked my phone log, and I was wrong when I reported that earlier. I was reporting what I remembered instead of what the fact was. ·

50. JRC, Nov 5, page 72: Dr. Chandrasena: So my recollection of this case was there was a complication, and they were very worried about the logistics of the equipment.··So it so happened that the card -- the CV team was actually in a case with the cardiac surgeons and happened to have just finished this case when Dr. Zimmerman, like, rushed from the OR – or from the cath lab to come into this room.··He left a patient on the table to come into this room to do the case, and so it was that they didn't have the right equipment in and they were scrambling to get it.

51. JRC, Nov 5, page 66: MR. SHULMAN: ··I object. ··There was no peer-review form in evidence, and I would submit there never was one. ··No form -- no peer-review form considering this case, so these questions don't make any sense. THE WITNESS: ··Reviewed by a peer-review body at Sequoia Hospital? DR. O’HANLAN: ··This is in evidence. ··I just don't know what page it is. ··It's not the page -remember, we got the shuffled pages. ··Yulia can find it. MR. FLEER: ··My question, did you hear it? DR. CHANDRASENA: ··I'd like to see what you’re referring to because I don't know what you're asking me.

52. O'Hanlan KA, O’Holleran M. Morbidity of total laparoscopic hysterectomy +/-staging lymphadenectomy for uterine neoplasia. Proceedings from the Society of Gynecologic Oncologists Annual Clinical Meeting. March 22-26 2006.
    O'Hanlan, KA, J. Ferry, M. Chivukula, M. Harrington, M. O'Holleran, Transperitoneal versus retroperitoneal approach for staging aortic lymphadenectomy, poster at Society for Gynecologic Oncologists Annual Meeting, Los Angeles, CA, March 9-12, 2013.
    O'Hanlan, KA, J. Ferry, M. Chivukula, M. Harrington, M. O'Holleran, Impact of obesity on surgical outcomes of laparoscopic radical pelvic lymphadenectomy for women with cervical, endometrial or ovarian cancer, poster at Society for Gynecologic Oncologists, Los Angeles, CA, March 9-12, 2013.
    O'Hanlan, KA, M.S. Sten, N.N. Ford, M. Chivukula, S.P. McCutcheon, Laparoscopic retroperitoneal therapeutic pelvic to infrarenal lymphadenectomy, poster #317 at Society for Gynecologic Oncologists, Chicago, IL, March 27-29, 2015.
    O'Hanlan, KA, M.S. Sten, N.N. Ford, M. Chivukula, S.P. McCutcheon, Laparoscopic comprehensive therapeutic pelvic to infrarenal lymphadenectomy, poster #319 at Society for Gynecologic Oncologists, Chicago, IL, March 27-29, 2015.

53. O'Hanlan KA. Comprehensive, therapeutic retroperitoneal pelvic and infrarenal aortic lymphadenectomy for advanced cervical carcinoma. Gynecologic Oncology. 2013;130(3):634-635.
    O'Hanlan KA, Sten MS, Halliday DM, Sastry RB, Struck DM, Uthman KF. Comprehensive laparoscopic lymphadenectomy from the deep circumflex iliac vein to the renal veins: Impact on quality of life. Gynecologic Oncology. 2017;144(3):592-7.

54. O'Hanlan, KA, O’Holleran, Michael “Radical Pelvic Lymphadenectomy” video, Society of Gynecologic Oncologists, Miami Beach, FL, March 3-5, 2005.
    O'Hanlan KA. Comprehensive, therapeutic retroperitoneal pelvic and infrarenal aortic lymphadenectomy for advanced cervical carcinoma. Video Gynecologic Oncology. 2013;130(3):634-635.
    O’Hanlan, KA, Comprehensive therapeutic pelvic to infrarenal aortic lymphadenectomy, video, Society for Gynecologic Oncologists Annual Clinical Meeting, San Diego CA, March 19-22, 2016