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Filing # 79954475 E-Filed 10/26/2018 05:00:21 PM
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT
IN AND FOR CHARLOTTE COUNTY, FLORIDA
DAVID T. LUCEY and CASE NO. 2016-CA-001509
MONICA LUCEY,
Plaintiffs,
vs.
SOVI JOSEPH, M.D.;
SOVI JOSEPH, M.D. P.A;
STEVEN GOLDIN, M.D.; and
21% CENTURY ONCOLOGY, LLC,
Defendants.
/
PLAINTIFFS’ NOTICE OF FILING
COME NOW, the Plaintiffs, DAVID T. LUCEY and MONICA LUCEY, His Wife, by
and through the undersigned counsel and hereby give notice of filing of the following for
purposes of discovery, motions, trial, or for such other purpose(s) as authorized by law and the
Florida Rules of Civil Procedure:
1 Transcript of deposition of Neil L. Julie, M.D. taken July 6, 2018.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished
this 26" day of October, 2018, filed with the Clerk of the Court using the ECF system, and by E-
Mail designations to:
Kevin Crews, Esquire
Andrew Vogt, Esquire
Wicker Smith O’Hara McCoy & Ford PA
9128 Strada Place, Suite 10200
Naples, FL 34108-2683
Tel: (239) 552-5300
Fax: (239) 552-5399
Email: napertpleadings@wickersmith.com
Attorneys for Steven B. Goldin, M.D. and 21" Century Oncology, LLC
Jeffrey M. Goodis, Esquire
Goodis Thompson & Miller
150 2™¢ Avenue North — 15" Floor
St. Petersburg, FL 33701
Tel: (727) 823-0540
Email: gimservice@gtmlegal.com; fmoschenik@gtmlegal.com:
choopes@gtmiegal.com
Attorneys for Sovi Joseph, M.D. and Sovi Joseph, M.D., P.A.
/s/ Kevin J. Carden
J. Clancey Bounds
FBN: 0981631
Kevin J. Carden
FBN: 451071
BOUNDS LAW GROUP
1751 North Park Avenue
Maitland, Florida 32751
Tel: (407) 644-5151
Fax: (407) 644-4566
kevin@boundslawgroup.com
Servic boundslawgroup.com
deedee@boundslawgroup.com
Counsel for Plaintiffs
Transcript of Neil L. Julie, M.D. 1 (1 to 4)
Conducted on July 6, 2018
IN THE CIRCUIT COURT OF THE APPEARANCES
TWENTIETH JUDICIAL CIRCUIT IN AND FOR 2 ON BEHALF OF PLAINTIFFS
CHARLOTTE COUNTY, FLORIDA 3 KEVIN J CARDEN, ESQUIRE
Bounds Law Group
DAVID T LUCEY and
MoNTCA LUCEY, 1751 North Park Avenue
Plaintiffs,
Sov s0SEPH, H.0 Maitland, Florida 32751
SOVI JOSEPH, M.O 5 case No 16-001529-CA 877.644.5122
STEVEN GoLomN, H.0
and ON BEHALF OF DEFENDANT JOSEPH, ¥.D
he 2ist CENTURY ONCOLOGY, Jo JEFFREY M. GOODTS, ESQUIRE
ha tte, a Goodis Thompson & Miller
h2 Defendants 15@ Second Avenue North
13 a3 Suite 150¢
4 st Petersburg, Florida 33781
1s Deposition of NEIL L JULIE, M.D Hs 727. 823.0540
6 Rockville, Maryland 16
17 Friday, July 6, 2018
he 12:57 p.m 18
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22. Tob No 192519
23 Pages 1 - 95 23
24 Reported By: Roanna Ossege 24
25 bs
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Deposition of NEIL L JULIE, M.D : held at the APPEARANCES CONTINUED
offices of a ON BEHALF OF DEFENDANT GOLDIN, ¥.D . and 2ist
CENTURY ONCOLOGY (Via teleconference)
‘4 ANDREW VOGT, ESQUIRE
Planet Depos ~ Rockville Wicker, Smith, O'Hara, McCoy & Ford, P.A
1 Chureh Street ‘6 9128 Strada Place
Suite 601 a Suite 1020¢
Rockville, Maryland 20850 is Naples, Florida 34108
888.433.3767 9 239. $2.5300
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4 Pursuant to notice, before Roanna L Ossege, a4
15 Notary Public in and for the State of Maryland Hs
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Transcript of Neil L. Julie, M.D. 2 (5 to 8)
Conducted on July 6, 2018
5
CONTENTS this area, and I've been in practice here since that
EXAMINATION BY PAGE time.
Mr. Goodis Q What years were you at USC San Francisco?
Mr. Vogt 75 A '80 to '83.
Q From my review of the materials that are
available online, it appears as if the majority of
your expert witness work is done in Pennsylvania.
EXHIBITS
Do you know why that is?
(The exhibits are attached to the transcript.) A I would say that's not -- you know, I
he JULTE DEPOSITION EXHIBITS PAGE
0 wouldn't say it's the majority of my work. So, you
ha Exhibit 1 Dr, Julie depositions and
1 know, it's been around various states so --
he trials list 2012-2017
13 Exhibit 2 List of materials sent to 12 Q Okay. You're probably right.
4 Dr. Julie 13 3 ‘The plurality of your work. The most cases
1s 4 you have over the years appear to be in
6 5 Pennsylvania; is that true or not true?
h7 6 A Hard to say. I think probably Florida and
he 7 Pennsylvania are probably the two states where there
19 8 have been the most cases.
pe 9 Q Why is that?
21 0 A Idon't know. I mean, I think probably I
22 1 just have been, you know, known to law firms up in
23 2, the Pennsylvania area. I don't know if it's because
24 3 I trained at the University of Pennsylvania or what,
25 4 whether that made -- was a factor.
25 And how about Fl ida, what's
PROCEEDINGS connection to Florida? Do you know?
WHEREUPON, A Again, that's, you know, hard to say. I
NEIL L. JULIE, M.D. think that probably some of the -- you know, some of
called as a witness, and having been first duly the -- you know, some of the case work that I've
sworn, Was examined and testified as follows: gotten is through word of mouth so probably it's
EXAMINATION BY COUNSEL FOR DEFENDANT JOSEPH, just been one law firm and a lawyer talking to a
M.D. friend at another law firm, and then I get calls
BY MR. GOODIS: (8 from different law firms.
Q State your name, please. 9 Q How does your work split up plaintiff versus
10 A My name is Neil Julie. 0 defendant?
il Q And what's your business address? 1 A It's about 60 percent plaintiff
and 40
2 A It's 15225 Shady Grove Road, Apartment -- or 2 percent defense.
13 Suite 103, Rockville, Maryland 3 Q What do you base those numbers on?
14 Q And can you just give us a quick benefit of 4 A Just my memory. And basically that really
15 your educational background: College, med school, 5 pertains to deposition and trials of which I have a
16 internship -- 6 list over the last few years.
17 A Sure. 7 I mean, every case starts with a plaintiff,
18 Q ~ residency, fellowship, et cetera. ; 8 so I've probably reviewed a fair number more
19 A Yes, So I went to City College in New York “19 plaintiff cases; but, you know, there, I'm an
20 and then went on to Cornell University Medical impartial evaluator, and a lot of times I just tell
21 College, now called Weill Cornell, W-E-I-L-L. -21 people that you've got no case.
22 And then from there, I went to UC San 22 So far as cases that get to actual
23 Francisco for my internship and residency, went to (23 deposition and trial, it's about 60 percent
24 the University of Pennsylvania for my GI fellowship 4 plaintiff, 40 percent defense.
25 and completed that in '86, and then came down to 5 Q Do you have that list here with you today?
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Transcript of Neil L. Julie, M.D. 3 (9 to 12)
Conducted on July 6, 2018
9 i
A Ido, of depositions and trials. testify by the Bounds Law Firm before this case?
Q And does that list split up 60-40 A Yes.
approximately? Q How many times?
A I would say about that. I mean, I would A Let me actually look at that list, if]
have to count. Maybe it's 65/35, but we can do -- could. And you're asking how many times have I been
we can count it now. So this is from 2012 January asked to review cases?
to 2017 July, and I'd say it's between 60/40 and Q Sure.
70/30, just to look at it, but if you want, I can do A Probably about 10 to 15.
it. Q Is there any other law firm that you work
10 Q We'll just attach
and it figure it out. We 10 with that you've done 10 to 15 reviews for?
11 can do the math. Anybody can do the math any time 11 A Yes.
12 later. We'll call that Defendant's No. 1. 12 Q What other firms?
13 (Exhibit 1 was marked for identification and 13 A Let's see, I think probably there is the
14 is attached to the transcript.) 14 Morgan & Morgan firm; the Beasley firm up in
15 BY MR. GOODIS: 15 Philadelphia; that is -- and probably there's a
16 Q Do youkeep that as a result of testifying 16 group called Armstrong Donohue, which is a defense
17 in federal court? 17 firm, that I have done that same number of cases
18 A Correct. 18 for.
19 Q Your opinion at one point was excluded from 19 Q Where's Armstrong Donohue?
20 a federal court case, a Rezulin multi-district 20 A They are here in Montgomery County,
21 litigation, I guess? 21 Maryland.
22 A That's -- that's correct. It was actually (Cell phone interruption.)
23 just a question of the judge excluding a whole class 23 BY MR. GOODIS:
24 ofa particular type of injury with his assertion 4 Q Do you want to answer that?
25 that that type of injury can't be caused by the 25 A Yeah, let me get that. I'm sorr,
mn so a vs
10 12
drug. So he just excluded the class and the three Q That's okay.
experts who were -- who were describing the (Off-the-record discussion.)
scientific basis that this drug could cause that BY MR. GOODIS:
type of injury. Q ‘The Beasley firm in Philadelphia, is it a
Q Have you had your opinion excluded in any plaintiffs’ firm?
other case? 6 A ltis.
A Do you need to number this? 7 Q Okay. And at the Armstrong Donohue firm, is
Q I'll just put a "1" on it. ‘8 there any particular lawyer that you work with?
A Okay. No. A Oh, let's see. Who did I work with? Well,
10 Q Has your opinion been challenged, to your 10 there's a guy, Larry Ceppos, C-E-P-P-O-S, and
11 knowledge, in any other case? 11 another guy -- oh, gosh. God.
12 A I don't know what that really constitutes, 12 Q That's all right. If it pops into your
13 so I'm not sure. What do you mean by "challenged"? 13 head, just let me know.
14 Q Fair enough. Do you knowif J anyone has 14 A Yeah.
15 brought a motion in an effort to exclude your 15 Q Okay. Before we started your depo today
16 opinion in any other lawsuit in which you were 16 here in Rockville, Maryland, you had an opportunity
17 retained to testify? /17 to meet with Mr. Quick, counsel for the plaintiff?
18 A I think there was -- there was one case, 18 A Yeah.
19 which was a Reaulin case, where there was a “19 Q What did you meet with Mr. Quick about?
20 plaintiff verdict which got appealed to the Oklahoma 20° A We just went over some of the documents to
21 Supreme Court, and the judge said that I was 21 the case and the document -- the inventory of
22 completely qualified and threw out the motion. But 22 documents that I reviewed, and that was basically
23 Lassume that was a challenge, as you would define 23 it.
24 it. 24 Q Did you discuss your opinion?
25 Q Have you testified having been retained to (25 A Yeah.
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Transcript of Neil L. Julie, M.D. 4 (13 to 16)
Conducted on July 6, 2018
13 1S
Q And what documents did you go over with Mr. A Well in terms of my own patients, I will
Carden? have opinions and I'll discuss those opinions with
A We looked at the color pictures from the the surgeons.
colonoscopy and the colonoscopy report, and the (Cell phone interruption.)
surgical op notes and the preoperative history taken THE WITNESS: Excuse me, sir.
by Dr. Joseph in September of 2014. That was (Off-the-record discussion.)
basically -- those were the main ones. THE WITNESS: So in terms of my own
Q And as long as we're talking about the patients, I will have some ideas as to what
inventory, what was -- what are the materials you've surgeries are appropriate.
10 reviewed? 10 And in terms of this particular case, you
11 A Well, actually, here's a summary that's been 11 know it gets down to questions of organs and vital
12 printed out that lists all the items. /12 blood supply to organs, and I have opinions about
13 MR. GOODIS: Okay. Great. I'll just take a 13 that based on the same, you know, scientific basis
14 look. T'll just mark that as Defendants No. 2. 14 and set of facts that a surgeon uses when he makes
15 (Exhibit 2 was marked for identification and 15 his decisions.
16 is attached to the transcript.) 16 BY MR. GOODIS:
17 BY MR. GOODIS: 17 Q Have you ever done a colonic resection of
18 Q What were you asked to do relative to this 18 any type?
19 case? What was your task? 19 A No. I mean, I've resected polyps, but
20 A Well, you know my task was to review all of 20 that's not what you're really, I think --
21 the records of what transpired in a certain time in 21 Q No, it's not what I'm asking.
22 this patient's medical history, which was all of the Have you ever done an anastamosis?
23 GI things that went on between, I guess, you know, 23 A No.
24 August 2014 and now, and to review those documents 4 Q Was Mr. Lucey's surgery open or
Ps my -- and records of various treaters and come to
14
25 laparoscopic?
mn ss ve sr
16
se
conclusions and opinions as to whether I thought A Let me see the op note and I will tell you.
there had been any deviations in the standard of Okay. Here we go. It looks -- from the way that
care. this was described, it looks like it was open.
Q As they relate to who? Q Have you ever made an abdominal incision for
A Primarily to the GI guy, Sovi -- his first a laparotomy?
name, S-O-V-I -- Joseph. 6 A I think as a medical student I may have
Q Allright. And did you reach opinions or do 7 started one, you know, but that's about it.
you feel like you're qualified to reach opinions ‘8 Q Have you done one in the last five years?
with regard to Dr. Goldin? A No.
10 A I would not offer any standard of care 10 Q Last ten years?
11 opinions on Dr. Goldin. 11 A Nope.
12 Q Do you have opinions other than standard of 12 Q Last 20 years?
13 care opinions on Dr. Goldin? 13 A No.
14 A Well, I mean, I think I have 0) ns in the 14 Q Have you participated in a laparoscopic
15 extent that we as gastroenterologists identify 15 colon resection in the last 20 years?
16 patients with problems that may or may not be 16 A No.I mean, I've parti pated maybe close to
17 surgical and we'll send people for surgery, and /17 20 years ago where I got called into the operating
18 though we don't do the surgery ourselves, we know 8 room by a surgeon who wanted to find a bleeding
19 what the appropriate surgeries are in given sets of “19 source. So, you know, in that circumstance, they
20 circumstances. 120 asked me to come in with a colonoscope and actually
21 Q So is it your opinion that as a 21 guide them as to where the lesion was.
22 gastroenterologist you can appropriately opine on 22 Q So you did an intraoperative colonoscopy?
23 what is the appropriate surgery for a surgeon to 23 A Right.
24 undertake when referred by a gastroenterologist to a 24 Q Have you done that more than that one time
25 surgeon? (25 20 years ago?
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Transcript of Neil L. Julie, M.D. 5 (17 to 20)
Conducted on July 6, 2018
17 19
A Probably in my whole career, less than five Fourth opinion is, as a result of that and
times. Maybe two or three. the subsequent operations, patient ended up with
Q Do you have opinions on whether that was less remaining viable colon with more frequent bowel
required in this case for anyone to meet the movements and diarrhea and, you know, other things
standard of care? that we can go into in terms of impacting his
A I would say what was required was for the -- quality of life that were to the patient's detriment
I would say really it would depend on the surgeon's and were the direct result of his losing all of the
thoughts in the operating room as to whether they bowel above the 2004 anastamosis.
thought they were able to successfully identify the Let's see. What else? I think that if--
10 tumor. 10 finally, if Dr. Joseph hae lentified the bowel and
ll Q Okay. 11 the tumor had been identified correctly that the
12 A And that would be their judgment to call. 12 patient could have had a left hemicolectomy that
13 Q Ihad a professor in law school who used to 13 would have successfully removed the tumor and
14 tell me that the way to best respond to question was 14 eliminated the risk of subsequent cancer recurrence
15 to be able to signpost or list the tenets of my 15 and would have left the patient with a significant
16 response before I went on to respond fully. He 16 portion of the right colon and better bowel function
17 called it signposting. |still do it to some degree 17 at this point.
18 when I make opening statements. 18 Q Allright. You indicated that you went over
19 MR. CARDEN: Was that the guy who said don't 19 some documents with Mr. Carden prior to the
20 come see me after class? 20 deposition starting today, and one of the documents
21 MR. GOODIS: No. That was a different 21 you indicated you reviewed were the color pictures
22 professor. of the colonoscopy from -- October 3rd, is that the
23 THE WITNESS: That's another story. 23 dates of the --
24 MR. GOODIS: Sorry. Let's go off the 24 A October 2nd, I think.
25 record. 25 Q October 2nd. Okay.
mn vs se
18 20
(Off the record.) A Yeah.
BY MR. GOODIS: Q And how did those pictures figure into your
Q So all that having been said, are you able opinion?
to kind of list for me your opinions so that I could A Well, you know, probably the pictures
go back and ask you about them in more depth? themselves didn't really -- they pretty much showed
A Sure. 6 the description of the -- the appearance of the
Q Okay. 7 tumor itself. So the big issue with the -- that
A The first opi onis that Dr. Joseph ‘8 particular document was the incorrect identification
9 misidentified the location of the 3-centimeter of location.
10 cancer and misidentified it as being in the hepatic 10 But the color pictures -- you know, the
11 flexure, when, in fact, it was more in the region of 11 biggest problem with color pictures is that every
12 the splenic flexure. 12 one of them that showed that 3-centimeter tumor,
13 Second opinion is that as a result of that 13 underneath it said "hepatic flexure" so --
14 misidentification, the surgical approach that was 14 Q Can you see the flexure in the pictures?
15 initiated by Dr. Goldin was a right hemicolectomy 15 ANo.
16 that he then had to extend when he realized that the 16 Q Howdo you think it was that Dr. Joseph made
17 tumor was not in the original specimen, unfrozen. 117 the mistake between the hepatic flexure and the
18 Third opinion is as a result of performing a 18 splenic flexure?
19 right hemicolectomy and therefore sacrificing the “19 A Youknow, that's kind of asking me to
20 take-off point of the middle colic artery, he ended 20 speculate, which I think is probably never a good
21 up effectively devascularizing the descending colon 21 idea so --
22 above the 2004 anastamosis, which -- which 22 Q Well, I'm asking you for your opinion, not
23 predictably resulted in dying bowel or dead bowel in 23 to speculate. See, you're an expert witness. If
24 the descending colon within a few days of the right 24 you don't know, you can just tell me that.
25 hemicolectomy. (25 A Okay. So repeat the question.
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Transcript of Neil L. Julie, M.D. 6 (21 to 24)
Conducted on July 6, 2018
21 23
Q Yeah. What do you think happened? Why did Q Have you reviewed anything to support your
he indicate hepatic flexure instead of splenic possibility that the doctor was in a hurry and had
flexure? What's your opinion of why he did it many, many cases to do that day?
wrong? A I don't have a copy of the doctor's schedule
A I'll give you a couple possibilities. You that day. I'd be delighted to look at one, but I do
know, I mean, I think that, first of all, it's kind not have it. So without that, I can't speculate on
of like a fool's errand to try and really be precise how many cases. So I don't know what the start time
about -- you know, when you're above the sigmoid was. I don't know what the completion time was. I
colon and you're going all the way up to the hepatic don't know what the total number of cases he did
10 flexure, it's very, very hard to accurately predict 0 that day was. But those are -- may be all relevant
11 the precise location of a tumor anatomically, and it 1 facts which I don't have.
12 is avery risky thing to do, and probably 12 Q Did you ask for those materials?
13 ill-advised, as it was in this case. So that's the 3 A Ididn't. Idid not. I mean, I think that
14 first thing. So it's just a very difficult thing to 4 I did, actually, in the discussion before. I asked
15 do. if Mr. Carden knew, and he said he didn't know. So
16 Second, you know, and maybe that he was ina 6 we don't have -- it sounds like that information is
17 hurry and doing many, many cases and he was being 7 not in our possession.
18 sloppy. You know, there's another area in his 8 Q Did you ask for those materials prior to
19 report where he also makes an incorrect statement 9 today?
20 about the surgical anastamosis and the sigmoid colon 0 A I don't -- I don't recall.
21 which means that there's two errors in the report 1 Q What was the other mistake in the procedure
22 and not just one. So, you know, I think it's 2 report that you're referring to?
23 anatomically very hard to do, and I think that's the 3 A The other mistake was under "Findings." In
24 best answer I can give you. 4 the October 2nd report, he says: There was evidence
25 What id that "he 2 f id-t I 1 ti
hurry and doing many, many cases"? the sigmoid colon, but this was not an ileocolonic
A No. I gave you two possibilities. So I anastamosis. It was a colocolonic anastamosis.
said it could be this. It could be that so -- Neocolonic is a totally different connection, which
Q Maybe I misunderstand your role in the case. this patient does not have.
My understanding is that you're here to give me your Q Did that mistake, calling it an ileocolonic
opinions relative to what happened in this case, the anastamosis rather than a colocolonic anastamosis
breaches of the standard of care, causation, affect the outcome, in your opinion?
prognosis, et cetera. Am I wrong about that? ‘8 A No. No. I mean, it's just sloppy. That's
A Well, I think you're wrong to say when I 9 all.
10 asked you -- said I that didn't want to speculate, 0 Q Allright. If a doctor is making an effort
1 then to invite me to, you know, speculate. 1 to describe the location of a tumor -- let me ask it
12 Q So~ 2 this way: Was Dr. Joseph correct in believing that
13 A So, you know, I think that, you know, it's a 3 the mass at issue might be cancerous? Was that the
14 little bit, you know, you're trying to have it both 4 appropriate differential diagnosis?
15 ways. 5 A Yes, he was correct in his suspicion and in
16 So what I would say is my opinion is that he 6 his diagnosis of what the anatomical lesion was.
17 misidentified the location of the tumor, and that's
7 Q And was he correct in making a referral
18 really as much as I can say. And it's just very 8 post-procedure to a surgeon?
19 difficult to be precise about location in that part 49 A Yes, he was correct.
0 of the colon. 0Q Inyour review of the materials, you
21 Q Allright. So is that ultimately your -21 expressed five opinions at my request -- or you
22 opinion, that it's just very difficult to be precise /22 expressed five opinions when I asked you to kind of
23 in that area of the colon? (23 signpost your opinions for me or list your opinions
24 A That -- that, I think, is the most likely 4 for me, and you've now indicated that at least two
25 explanation for what happened. '5 things Dr. Joseph did were -- was -- were correct.
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Transcript of Neil L. Julie, M.D. 7 (25 to 28)
Conducted on July 6, 2018
25 27
Is there anything else Dr. Joseph did in 1 Q And if he had said that, would he have met
your opinion that was correct or appropriate? 2. the standard of care in your opinion?
A It was correct for him to go ahead and 3 A Well, I think that -- I think he would have,
tattoo the lesions. 4 yeah.
Q Allright. Anything else? Q Ifhe said somewhere in the transverse colon
A It was appropriate for him to decide to do 6 and met the standard of care, how was it, then, that
the colonoscopy in the first place. 7 the surgeon was to identify where the mass was?
I would just kind of modify and just put, 8 A Well, first, I said somewhere in the region
19 you know, a little bit of a stipulation on the 9 ofthe transverse colon, so I just want to make sure
10 tattooing. It would have been better if he would 10 the wording is correct.
11 have been more precise about the way in which he did 11 But ifhe would have said that, how would
12 the India ink injections because he really just says 12 the surgeon have found the mass, is that what you're
13 2 milliliters of Indian ink, and we don't know if 13 asking me?
14 that was a single injection. I think later in his 14 Q Well, if he had said somewhere in the region
15 deposition he described it as four, five -- 5 ml 15 of the transverse colon, what would have then been
16 injections. But it was the right thing to do. 16 necessary to identify the mass for surgical
17 Q Is that an appropriate methodology to make 17 planning?
18 four .5 ml injections? 18 A Well, I think then the surgeon would have to
19 A Itis. 19 had -- you know, had a couple of options. One would
20 Q Did not describing
that in his procedure 20 be for the surgeon, if they were really confident,
21 report cause any damage to the patient in your 21 to just say: Okay. I'm going to go in there and
22 opinion? 22 I'm going to run and palpate the bowel until I, one,
23 A No. 23 either feel the mass, or, two, find the tattoos,
24 Q Okay. Anything else on the list of 24 right, and then I will know based on that what
25 appropriate things Dr. Joseph di 25 surgery I need to do.
ve vs se
26 28
A Well, I mean, I think that he -- you've gone Q Okay.
over it. You've gone over those things so -- A So the surgeon could have done that knowing
Q Okay. That's why L asked if there was that the, you know, localization of the tumor was
anything else. not 100 percent a sure thing.
A Yeah. Q Did Dr. Goldin know that the localization of
Q If there's not, you can just say no. 6 the tumor was not 100 percent a sure thing? Did you
You said it's a fool's errand to try to be 7 review anything which suggested that that was the
precise, was the phrase you used. What -- ‘8 case?
A Well-- A Well, he went in there in his operative note
10 Q -- should he have said? 10 with the assumption that the -- this was a hepatic
11 A No, I mean, that was a fragment of what I 11 tumor.
12 said. I mean, it's never wrong to be precise except 12 Q That wasn't my question.
13 when you're being precise about something where you 13 Did you review anything which suggests that
14 don't really know what you're talking about. 14 Dr. Goldin knew that it was not 100 percent certain
15 Q Well, did he not know what he was talking 15 that the tumor was in the hepatic flexure?
16 about or was he mistaken? Is there a difference to 16 A Well, I mean, I think a lot of doctors would
17 you, or is that the same? a7 tell you, like, very little in medicine is 100
18 A Well, I-- yeah. I mean, that's maybe not a 8 percent. So, I mean, 100 percent is kind of a high
19 very artful way for me to say it. But I just think (19 benchmark.
20 that if you don't know something, you should remain (20 Q What operation did Dr. Goldin plan?
21 silent about it rather than -- 21 A Well, he -- based on the assumption that
22 Q So what should he have said? 22 this was a hepatic flexure tumor, he went in with
23 A He should have said that this patient has a 23 the plan of doing a right hemicolectomy.
24 3-centimeter lesion, looks like a cancer, somewhere 24 Q It's your understanding
that Dr. Goldin's
25 in the region of the transverse colon. “25 plan was a right hemicolectomy?
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Transcript of Neil L. Julie, M.D. 8 (29 to 32)
Conducted on July 6, 2018
29 3
A I said based on the assumption that this was A Huh?
a hepatic flexure tumor, then I think his plan was Q Boredom.
to go in and do a right hemicolectomy. A All right. So, anyway, the tumor was noted
Q Okay. What's the basis for that statement? in the -- to be in the hepatic flexure,
A Well, let me look at his operative note. preoperatively. I assume he's referring to the --
Well, the preoperative diagnosis was a hepatic Dr. Joseph's notations.
flexure tumor so that was what he went in expecting He made a careful search of the entire right
to find. That was his -- that was his expectation. colon, mobilized the right colon, palpated the whole
Q Yeah, that's not my question. My question thing, couldn't feel the tumor. And then he sai
10 is what -- 10 We did not feel any obvious abnormalities.
11 A Well, I didn't finish my answer. 11 But the documentation was clear. This was a
12 Q -- operation -- 12 hepatic flexure lesion. And so he went ahead and
13 A I didn't finish my answer. 13 did his right hemicolectomy.
14 Q Okay. Well, I'm going to redirect you. 14 Q Do you know what the word "plan" means?
15 What operation -- 15 A Well, you could probably elucidate that for
16 MR. CARDEN: Hang ona second. He -- 16 me.
17 MR. GOODIS: All I'm trying -- Kevin, I'm 17 Q Well, you're the one who told me earlier you
18 just trying to get an answer and -- 18 had some opinions about what surgeries were
19 MR. CARDEN: I know. He's entitled to 19 appropriate, remember that?
20 finish. 20 A Yeah.
21 MR. GOODIS: He doesn't like to answer 21 Q Okay. When a surgeon goes into a situation
22 questions directly. like Dr. Goldin went into with Mr. Lucey, he has a
23 MR. CARDEN: He's entitled to finish. He's 23 plan, right? You know what that means medically?
24 entitled to finish. 24 A Yeah.
PS MR. GOODIS: But he doesn't answer questions
30
25
mn Okay, And my questionfor you Dr Juli 32
directly. He just goes and goes a
Preview
Filing # 79954475 E-Filed 10/26/2018 05:00:21 PM IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR CHARLOTTE COUNTY, FLORIDA DAVID T. LUCEY and CASE NO. 2016-CA-001509 MONICA LUCEY, Plaintiffs, vs. SOVI JOSEPH, M.D.; SOVI JOSEPH, M.D. P.A; STEVEN GOLDIN, M.D.; and 21% CENTURY ONCOLOGY, LLC, Defendants. / PLAINTIFFS’ NOTICE OF FILING COME NOW, the Plaintiffs, DAVID T. LUCEY and MONICA LUCEY, His Wife, by and through the undersigned counsel and hereby give notice of filing of the following for purposes of discovery, motions, trial, or for such other purpose(s) as authorized by law and the Florida Rules of Civil Procedure: 1 Transcript of deposition of Neil L. Julie, M.D. taken July 6, 2018. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished this 26" day of October, 2018, filed with the Clerk of the Court using the ECF system, and by E- Mail designations to: Kevin Crews, Esquire Andrew Vogt, Esquire Wicker Smith O’Hara McCoy & Ford PA 9128 Strada Place, Suite 10200 Naples, FL 34108-2683 Tel: (239) 552-5300 Fax: (239) 552-5399 Email: napertpleadings@wickersmith.com Attorneys for Steven B. Goldin, M.D. and 21" Century Oncology, LLC Jeffrey M. Goodis, Esquire Goodis Thompson & Miller 150 2™¢ Avenue North — 15" Floor St. Petersburg, FL 33701 Tel: (727) 823-0540 Email: gimservice@gtmlegal.com; fmoschenik@gtmlegal.com: choopes@gtmiegal.com Attorneys for Sovi Joseph, M.D. and Sovi Joseph, M.D., P.A. /s/ Kevin J. Carden J. Clancey Bounds FBN: 0981631 Kevin J. Carden FBN: 451071 BOUNDS LAW GROUP 1751 North Park Avenue Maitland, Florida 32751 Tel: (407) 644-5151 Fax: (407) 644-4566 kevin@boundslawgroup.com Servic boundslawgroup.com deedee@boundslawgroup.com Counsel for Plaintiffs Transcript of Neil L. Julie, M.D. 1 (1 to 4) Conducted on July 6, 2018 IN THE CIRCUIT COURT OF THE APPEARANCES TWENTIETH JUDICIAL CIRCUIT IN AND FOR 2 ON BEHALF OF PLAINTIFFS CHARLOTTE COUNTY, FLORIDA 3 KEVIN J CARDEN, ESQUIRE Bounds Law Group DAVID T LUCEY and MoNTCA LUCEY, 1751 North Park Avenue Plaintiffs, Sov s0SEPH, H.0 Maitland, Florida 32751 SOVI JOSEPH, M.O 5 case No 16-001529-CA 877.644.5122 STEVEN GoLomN, H.0 and ON BEHALF OF DEFENDANT JOSEPH, ¥.D he 2ist CENTURY ONCOLOGY, Jo JEFFREY M. GOODTS, ESQUIRE ha tte, a Goodis Thompson & Miller h2 Defendants 15@ Second Avenue North 13 a3 Suite 150¢ 4 st Petersburg, Florida 33781 1s Deposition of NEIL L JULIE, M.D Hs 727. 823.0540 6 Rockville, Maryland 16 17 Friday, July 6, 2018 he 12:57 p.m 18 hs ag 26 fe 21 21 22. Tob No 192519 23 Pages 1 - 95 23 24 Reported By: Roanna Ossege 24 25 bs ss npn sv es se vs soe Deposition of NEIL L JULIE, M.D : held at the APPEARANCES CONTINUED offices of a ON BEHALF OF DEFENDANT GOLDIN, ¥.D . and 2ist CENTURY ONCOLOGY (Via teleconference) ‘4 ANDREW VOGT, ESQUIRE Planet Depos ~ Rockville Wicker, Smith, O'Hara, McCoy & Ford, P.A 1 Chureh Street ‘6 9128 Strada Place Suite 601 a Suite 1020¢ Rockville, Maryland 20850 is Naples, Florida 34108 888.433.3767 9 239. $2.5300 he ue ha In h2 a2 13 a3 4 Pursuant to notice, before Roanna L Ossege, a4 15 Notary Public in and for the State of Maryland Hs 16 pe 7 ay 18 ho ng 2e ie 21 fat 22 (22 23 (23 24 pe 25 (25 PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 2 (5 to 8) Conducted on July 6, 2018 5 CONTENTS this area, and I've been in practice here since that EXAMINATION BY PAGE time. Mr. Goodis Q What years were you at USC San Francisco? Mr. Vogt 75 A '80 to '83. Q From my review of the materials that are available online, it appears as if the majority of your expert witness work is done in Pennsylvania. EXHIBITS Do you know why that is? (The exhibits are attached to the transcript.) A I would say that's not -- you know, I he JULTE DEPOSITION EXHIBITS PAGE 0 wouldn't say it's the majority of my work. So, you ha Exhibit 1 Dr, Julie depositions and 1 know, it's been around various states so -- he trials list 2012-2017 13 Exhibit 2 List of materials sent to 12 Q Okay. You're probably right. 4 Dr. Julie 13 3 ‘The plurality of your work. The most cases 1s 4 you have over the years appear to be in 6 5 Pennsylvania; is that true or not true? h7 6 A Hard to say. I think probably Florida and he 7 Pennsylvania are probably the two states where there 19 8 have been the most cases. pe 9 Q Why is that? 21 0 A Idon't know. I mean, I think probably I 22 1 just have been, you know, known to law firms up in 23 2, the Pennsylvania area. I don't know if it's because 24 3 I trained at the University of Pennsylvania or what, 25 4 whether that made -- was a factor. 25 And how about Fl ida, what's PROCEEDINGS connection to Florida? Do you know? WHEREUPON, A Again, that's, you know, hard to say. I NEIL L. JULIE, M.D. think that probably some of the -- you know, some of called as a witness, and having been first duly the -- you know, some of the case work that I've sworn, Was examined and testified as follows: gotten is through word of mouth so probably it's EXAMINATION BY COUNSEL FOR DEFENDANT JOSEPH, just been one law firm and a lawyer talking to a M.D. friend at another law firm, and then I get calls BY MR. GOODIS: (8 from different law firms. Q State your name, please. 9 Q How does your work split up plaintiff versus 10 A My name is Neil Julie. 0 defendant? il Q And what's your business address? 1 A It's about 60 percent plaintiff and 40 2 A It's 15225 Shady Grove Road, Apartment -- or 2 percent defense. 13 Suite 103, Rockville, Maryland 3 Q What do you base those numbers on? 14 Q And can you just give us a quick benefit of 4 A Just my memory. And basically that really 15 your educational background: College, med school, 5 pertains to deposition and trials of which I have a 16 internship -- 6 list over the last few years. 17 A Sure. 7 I mean, every case starts with a plaintiff, 18 Q ~ residency, fellowship, et cetera. ; 8 so I've probably reviewed a fair number more 19 A Yes, So I went to City College in New York “19 plaintiff cases; but, you know, there, I'm an 20 and then went on to Cornell University Medical impartial evaluator, and a lot of times I just tell 21 College, now called Weill Cornell, W-E-I-L-L. -21 people that you've got no case. 22 And then from there, I went to UC San 22 So far as cases that get to actual 23 Francisco for my internship and residency, went to (23 deposition and trial, it's about 60 percent 24 the University of Pennsylvania for my GI fellowship 4 plaintiff, 40 percent defense. 25 and completed that in '86, and then came down to 5 Q Do you have that list here with you today? PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 3 (9 to 12) Conducted on July 6, 2018 9 i A Ido, of depositions and trials. testify by the Bounds Law Firm before this case? Q And does that list split up 60-40 A Yes. approximately? Q How many times? A I would say about that. I mean, I would A Let me actually look at that list, if] have to count. Maybe it's 65/35, but we can do -- could. And you're asking how many times have I been we can count it now. So this is from 2012 January asked to review cases? to 2017 July, and I'd say it's between 60/40 and Q Sure. 70/30, just to look at it, but if you want, I can do A Probably about 10 to 15. it. Q Is there any other law firm that you work 10 Q We'll just attach and it figure it out. We 10 with that you've done 10 to 15 reviews for? 11 can do the math. Anybody can do the math any time 11 A Yes. 12 later. We'll call that Defendant's No. 1. 12 Q What other firms? 13 (Exhibit 1 was marked for identification and 13 A Let's see, I think probably there is the 14 is attached to the transcript.) 14 Morgan & Morgan firm; the Beasley firm up in 15 BY MR. GOODIS: 15 Philadelphia; that is -- and probably there's a 16 Q Do youkeep that as a result of testifying 16 group called Armstrong Donohue, which is a defense 17 in federal court? 17 firm, that I have done that same number of cases 18 A Correct. 18 for. 19 Q Your opinion at one point was excluded from 19 Q Where's Armstrong Donohue? 20 a federal court case, a Rezulin multi-district 20 A They are here in Montgomery County, 21 litigation, I guess? 21 Maryland. 22 A That's -- that's correct. It was actually (Cell phone interruption.) 23 just a question of the judge excluding a whole class 23 BY MR. GOODIS: 24 ofa particular type of injury with his assertion 4 Q Do you want to answer that? 25 that that type of injury can't be caused by the 25 A Yeah, let me get that. I'm sorr, mn so a vs 10 12 drug. So he just excluded the class and the three Q That's okay. experts who were -- who were describing the (Off-the-record discussion.) scientific basis that this drug could cause that BY MR. GOODIS: type of injury. Q ‘The Beasley firm in Philadelphia, is it a Q Have you had your opinion excluded in any plaintiffs’ firm? other case? 6 A ltis. A Do you need to number this? 7 Q Okay. And at the Armstrong Donohue firm, is Q I'll just put a "1" on it. ‘8 there any particular lawyer that you work with? A Okay. No. A Oh, let's see. Who did I work with? Well, 10 Q Has your opinion been challenged, to your 10 there's a guy, Larry Ceppos, C-E-P-P-O-S, and 11 knowledge, in any other case? 11 another guy -- oh, gosh. God. 12 A I don't know what that really constitutes, 12 Q That's all right. If it pops into your 13 so I'm not sure. What do you mean by "challenged"? 13 head, just let me know. 14 Q Fair enough. Do you knowif J anyone has 14 A Yeah. 15 brought a motion in an effort to exclude your 15 Q Okay. Before we started your depo today 16 opinion in any other lawsuit in which you were 16 here in Rockville, Maryland, you had an opportunity 17 retained to testify? /17 to meet with Mr. Quick, counsel for the plaintiff? 18 A I think there was -- there was one case, 18 A Yeah. 19 which was a Reaulin case, where there was a “19 Q What did you meet with Mr. Quick about? 20 plaintiff verdict which got appealed to the Oklahoma 20° A We just went over some of the documents to 21 Supreme Court, and the judge said that I was 21 the case and the document -- the inventory of 22 completely qualified and threw out the motion. But 22 documents that I reviewed, and that was basically 23 Lassume that was a challenge, as you would define 23 it. 24 it. 24 Q Did you discuss your opinion? 25 Q Have you testified having been retained to (25 A Yeah. PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 4 (13 to 16) Conducted on July 6, 2018 13 1S Q And what documents did you go over with Mr. A Well in terms of my own patients, I will Carden? have opinions and I'll discuss those opinions with A We looked at the color pictures from the the surgeons. colonoscopy and the colonoscopy report, and the (Cell phone interruption.) surgical op notes and the preoperative history taken THE WITNESS: Excuse me, sir. by Dr. Joseph in September of 2014. That was (Off-the-record discussion.) basically -- those were the main ones. THE WITNESS: So in terms of my own Q And as long as we're talking about the patients, I will have some ideas as to what inventory, what was -- what are the materials you've surgeries are appropriate. 10 reviewed? 10 And in terms of this particular case, you 11 A Well, actually, here's a summary that's been 11 know it gets down to questions of organs and vital 12 printed out that lists all the items. /12 blood supply to organs, and I have opinions about 13 MR. GOODIS: Okay. Great. I'll just take a 13 that based on the same, you know, scientific basis 14 look. T'll just mark that as Defendants No. 2. 14 and set of facts that a surgeon uses when he makes 15 (Exhibit 2 was marked for identification and 15 his decisions. 16 is attached to the transcript.) 16 BY MR. GOODIS: 17 BY MR. GOODIS: 17 Q Have you ever done a colonic resection of 18 Q What were you asked to do relative to this 18 any type? 19 case? What was your task? 19 A No. I mean, I've resected polyps, but 20 A Well, you know my task was to review all of 20 that's not what you're really, I think -- 21 the records of what transpired in a certain time in 21 Q No, it's not what I'm asking. 22 this patient's medical history, which was all of the Have you ever done an anastamosis? 23 GI things that went on between, I guess, you know, 23 A No. 24 August 2014 and now, and to review those documents 4 Q Was Mr. Lucey's surgery open or Ps my -- and records of various treaters and come to 14 25 laparoscopic? mn ss ve sr 16 se conclusions and opinions as to whether I thought A Let me see the op note and I will tell you. there had been any deviations in the standard of Okay. Here we go. It looks -- from the way that care. this was described, it looks like it was open. Q As they relate to who? Q Have you ever made an abdominal incision for A Primarily to the GI guy, Sovi -- his first a laparotomy? name, S-O-V-I -- Joseph. 6 A I think as a medical student I may have Q Allright. And did you reach opinions or do 7 started one, you know, but that's about it. you feel like you're qualified to reach opinions ‘8 Q Have you done one in the last five years? with regard to Dr. Goldin? A No. 10 A I would not offer any standard of care 10 Q Last ten years? 11 opinions on Dr. Goldin. 11 A Nope. 12 Q Do you have opinions other than standard of 12 Q Last 20 years? 13 care opinions on Dr. Goldin? 13 A No. 14 A Well, I mean, I think I have 0) ns in the 14 Q Have you participated in a laparoscopic 15 extent that we as gastroenterologists identify 15 colon resection in the last 20 years? 16 patients with problems that may or may not be 16 A No.I mean, I've parti pated maybe close to 17 surgical and we'll send people for surgery, and /17 20 years ago where I got called into the operating 18 though we don't do the surgery ourselves, we know 8 room by a surgeon who wanted to find a bleeding 19 what the appropriate surgeries are in given sets of “19 source. So, you know, in that circumstance, they 20 circumstances. 120 asked me to come in with a colonoscope and actually 21 Q So is it your opinion that as a 21 guide them as to where the lesion was. 22 gastroenterologist you can appropriately opine on 22 Q So you did an intraoperative colonoscopy? 23 what is the appropriate surgery for a surgeon to 23 A Right. 24 undertake when referred by a gastroenterologist to a 24 Q Have you done that more than that one time 25 surgeon? (25 20 years ago? PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 5 (17 to 20) Conducted on July 6, 2018 17 19 A Probably in my whole career, less than five Fourth opinion is, as a result of that and times. Maybe two or three. the subsequent operations, patient ended up with Q Do you have opinions on whether that was less remaining viable colon with more frequent bowel required in this case for anyone to meet the movements and diarrhea and, you know, other things standard of care? that we can go into in terms of impacting his A I would say what was required was for the -- quality of life that were to the patient's detriment I would say really it would depend on the surgeon's and were the direct result of his losing all of the thoughts in the operating room as to whether they bowel above the 2004 anastamosis. thought they were able to successfully identify the Let's see. What else? I think that if-- 10 tumor. 10 finally, if Dr. Joseph hae lentified the bowel and ll Q Okay. 11 the tumor had been identified correctly that the 12 A And that would be their judgment to call. 12 patient could have had a left hemicolectomy that 13 Q Ihad a professor in law school who used to 13 would have successfully removed the tumor and 14 tell me that the way to best respond to question was 14 eliminated the risk of subsequent cancer recurrence 15 to be able to signpost or list the tenets of my 15 and would have left the patient with a significant 16 response before I went on to respond fully. He 16 portion of the right colon and better bowel function 17 called it signposting. |still do it to some degree 17 at this point. 18 when I make opening statements. 18 Q Allright. You indicated that you went over 19 MR. CARDEN: Was that the guy who said don't 19 some documents with Mr. Carden prior to the 20 come see me after class? 20 deposition starting today, and one of the documents 21 MR. GOODIS: No. That was a different 21 you indicated you reviewed were the color pictures 22 professor. of the colonoscopy from -- October 3rd, is that the 23 THE WITNESS: That's another story. 23 dates of the -- 24 MR. GOODIS: Sorry. Let's go off the 24 A October 2nd, I think. 25 record. 25 Q October 2nd. Okay. mn vs se 18 20 (Off the record.) A Yeah. BY MR. GOODIS: Q And how did those pictures figure into your Q So all that having been said, are you able opinion? to kind of list for me your opinions so that I could A Well, you know, probably the pictures go back and ask you about them in more depth? themselves didn't really -- they pretty much showed A Sure. 6 the description of the -- the appearance of the Q Okay. 7 tumor itself. So the big issue with the -- that A The first opi onis that Dr. Joseph ‘8 particular document was the incorrect identification 9 misidentified the location of the 3-centimeter of location. 10 cancer and misidentified it as being in the hepatic 10 But the color pictures -- you know, the 11 flexure, when, in fact, it was more in the region of 11 biggest problem with color pictures is that every 12 the splenic flexure. 12 one of them that showed that 3-centimeter tumor, 13 Second opinion is that as a result of that 13 underneath it said "hepatic flexure" so -- 14 misidentification, the surgical approach that was 14 Q Can you see the flexure in the pictures? 15 initiated by Dr. Goldin was a right hemicolectomy 15 ANo. 16 that he then had to extend when he realized that the 16 Q Howdo you think it was that Dr. Joseph made 17 tumor was not in the original specimen, unfrozen. 117 the mistake between the hepatic flexure and the 18 Third opinion is as a result of performing a 18 splenic flexure? 19 right hemicolectomy and therefore sacrificing the “19 A Youknow, that's kind of asking me to 20 take-off point of the middle colic artery, he ended 20 speculate, which I think is probably never a good 21 up effectively devascularizing the descending colon 21 idea so -- 22 above the 2004 anastamosis, which -- which 22 Q Well, I'm asking you for your opinion, not 23 predictably resulted in dying bowel or dead bowel in 23 to speculate. See, you're an expert witness. If 24 the descending colon within a few days of the right 24 you don't know, you can just tell me that. 25 hemicolectomy. (25 A Okay. So repeat the question. PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 6 (21 to 24) Conducted on July 6, 2018 21 23 Q Yeah. What do you think happened? Why did Q Have you reviewed anything to support your he indicate hepatic flexure instead of splenic possibility that the doctor was in a hurry and had flexure? What's your opinion of why he did it many, many cases to do that day? wrong? A I don't have a copy of the doctor's schedule A I'll give you a couple possibilities. You that day. I'd be delighted to look at one, but I do know, I mean, I think that, first of all, it's kind not have it. So without that, I can't speculate on of like a fool's errand to try and really be precise how many cases. So I don't know what the start time about -- you know, when you're above the sigmoid was. I don't know what the completion time was. I colon and you're going all the way up to the hepatic don't know what the total number of cases he did 10 flexure, it's very, very hard to accurately predict 0 that day was. But those are -- may be all relevant 11 the precise location of a tumor anatomically, and it 1 facts which I don't have. 12 is avery risky thing to do, and probably 12 Q Did you ask for those materials? 13 ill-advised, as it was in this case. So that's the 3 A Ididn't. Idid not. I mean, I think that 14 first thing. So it's just a very difficult thing to 4 I did, actually, in the discussion before. I asked 15 do. if Mr. Carden knew, and he said he didn't know. So 16 Second, you know, and maybe that he was ina 6 we don't have -- it sounds like that information is 17 hurry and doing many, many cases and he was being 7 not in our possession. 18 sloppy. You know, there's another area in his 8 Q Did you ask for those materials prior to 19 report where he also makes an incorrect statement 9 today? 20 about the surgical anastamosis and the sigmoid colon 0 A I don't -- I don't recall. 21 which means that there's two errors in the report 1 Q What was the other mistake in the procedure 22 and not just one. So, you know, I think it's 2 report that you're referring to? 23 anatomically very hard to do, and I think that's the 3 A The other mistake was under "Findings." In 24 best answer I can give you. 4 the October 2nd report, he says: There was evidence 25 What id that "he 2 f id-t I 1 ti hurry and doing many, many cases"? the sigmoid colon, but this was not an ileocolonic A No. I gave you two possibilities. So I anastamosis. It was a colocolonic anastamosis. said it could be this. It could be that so -- Neocolonic is a totally different connection, which Q Maybe I misunderstand your role in the case. this patient does not have. My understanding is that you're here to give me your Q Did that mistake, calling it an ileocolonic opinions relative to what happened in this case, the anastamosis rather than a colocolonic anastamosis breaches of the standard of care, causation, affect the outcome, in your opinion? prognosis, et cetera. Am I wrong about that? ‘8 A No. No. I mean, it's just sloppy. That's A Well, I think you're wrong to say when I 9 all. 10 asked you -- said I that didn't want to speculate, 0 Q Allright. If a doctor is making an effort 1 then to invite me to, you know, speculate. 1 to describe the location of a tumor -- let me ask it 12 Q So~ 2 this way: Was Dr. Joseph correct in believing that 13 A So, you know, I think that, you know, it's a 3 the mass at issue might be cancerous? Was that the 14 little bit, you know, you're trying to have it both 4 appropriate differential diagnosis? 15 ways. 5 A Yes, he was correct in his suspicion and in 16 So what I would say is my opinion is that he 6 his diagnosis of what the anatomical lesion was. 17 misidentified the location of the tumor, and that's 7 Q And was he correct in making a referral 18 really as much as I can say. And it's just very 8 post-procedure to a surgeon? 19 difficult to be precise about location in that part 49 A Yes, he was correct. 0 of the colon. 0Q Inyour review of the materials, you 21 Q Allright. So is that ultimately your -21 expressed five opinions at my request -- or you 22 opinion, that it's just very difficult to be precise /22 expressed five opinions when I asked you to kind of 23 in that area of the colon? (23 signpost your opinions for me or list your opinions 24 A That -- that, I think, is the most likely 4 for me, and you've now indicated that at least two 25 explanation for what happened. '5 things Dr. Joseph did were -- was -- were correct. PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 7 (25 to 28) Conducted on July 6, 2018 25 27 Is there anything else Dr. Joseph did in 1 Q And if he had said that, would he have met your opinion that was correct or appropriate? 2. the standard of care in your opinion? A It was correct for him to go ahead and 3 A Well, I think that -- I think he would have, tattoo the lesions. 4 yeah. Q Allright. Anything else? Q Ifhe said somewhere in the transverse colon A It was appropriate for him to decide to do 6 and met the standard of care, how was it, then, that the colonoscopy in the first place. 7 the surgeon was to identify where the mass was? I would just kind of modify and just put, 8 A Well, first, I said somewhere in the region 19 you know, a little bit of a stipulation on the 9 ofthe transverse colon, so I just want to make sure 10 tattooing. It would have been better if he would 10 the wording is correct. 11 have been more precise about the way in which he did 11 But ifhe would have said that, how would 12 the India ink injections because he really just says 12 the surgeon have found the mass, is that what you're 13 2 milliliters of Indian ink, and we don't know if 13 asking me? 14 that was a single injection. I think later in his 14 Q Well, if he had said somewhere in the region 15 deposition he described it as four, five -- 5 ml 15 of the transverse colon, what would have then been 16 injections. But it was the right thing to do. 16 necessary to identify the mass for surgical 17 Q Is that an appropriate methodology to make 17 planning? 18 four .5 ml injections? 18 A Well, I think then the surgeon would have to 19 A Itis. 19 had -- you know, had a couple of options. One would 20 Q Did not describing that in his procedure 20 be for the surgeon, if they were really confident, 21 report cause any damage to the patient in your 21 to just say: Okay. I'm going to go in there and 22 opinion? 22 I'm going to run and palpate the bowel until I, one, 23 A No. 23 either feel the mass, or, two, find the tattoos, 24 Q Okay. Anything else on the list of 24 right, and then I will know based on that what 25 appropriate things Dr. Joseph di 25 surgery I need to do. ve vs se 26 28 A Well, I mean, I think that he -- you've gone Q Okay. over it. You've gone over those things so -- A So the surgeon could have done that knowing Q Okay. That's why L asked if there was that the, you know, localization of the tumor was anything else. not 100 percent a sure thing. A Yeah. Q Did Dr. Goldin know that the localization of Q If there's not, you can just say no. 6 the tumor was not 100 percent a sure thing? Did you You said it's a fool's errand to try to be 7 review anything which suggested that that was the precise, was the phrase you used. What -- ‘8 case? A Well-- A Well, he went in there in his operative note 10 Q -- should he have said? 10 with the assumption that the -- this was a hepatic 11 A No, I mean, that was a fragment of what I 11 tumor. 12 said. I mean, it's never wrong to be precise except 12 Q That wasn't my question. 13 when you're being precise about something where you 13 Did you review anything which suggests that 14 don't really know what you're talking about. 14 Dr. Goldin knew that it was not 100 percent certain 15 Q Well, did he not know what he was talking 15 that the tumor was in the hepatic flexure? 16 about or was he mistaken? Is there a difference to 16 A Well, I mean, I think a lot of doctors would 17 you, or is that the same? a7 tell you, like, very little in medicine is 100 18 A Well, I-- yeah. I mean, that's maybe not a 8 percent. So, I mean, 100 percent is kind of a high 19 very artful way for me to say it. But I just think (19 benchmark. 20 that if you don't know something, you should remain (20 Q What operation did Dr. Goldin plan? 21 silent about it rather than -- 21 A Well, he -- based on the assumption that 22 Q So what should he have said? 22 this was a hepatic flexure tumor, he went in with 23 A He should have said that this patient has a 23 the plan of doing a right hemicolectomy. 24 3-centimeter lesion, looks like a cancer, somewhere 24 Q It's your understanding that Dr. Goldin's 25 in the region of the transverse colon. “25 plan was a right hemicolectomy? PLANET DEPOS 888.433.3767 | WWW.PLANETDEPOS.COM Transcript of Neil L. Julie, M.D. 8 (29 to 32) Conducted on July 6, 2018 29 3 A I said based on the assumption that this was A Huh? a hepatic flexure tumor, then I think his plan was Q Boredom. to go in and do a right hemicolectomy. A All right. So, anyway, the tumor was noted Q Okay. What's the basis for that statement? in the -- to be in the hepatic flexure, A Well, let me look at his operative note. preoperatively. I assume he's referring to the -- Well, the preoperative diagnosis was a hepatic Dr. Joseph's notations. flexure tumor so that was what he went in expecting He made a careful search of the entire right to find. That was his -- that was his expectation. colon, mobilized the right colon, palpated the whole Q Yeah, that's not my question. My question thing, couldn't feel the tumor. And then he sai 10 is what -- 10 We did not feel any obvious abnormalities. 11 A Well, I didn't finish my answer. 11 But the documentation was clear. This was a 12 Q -- operation -- 12 hepatic flexure lesion. And so he went ahead and 13 A I didn't finish my answer. 13 did his right hemicolectomy. 14 Q Okay. Well, I'm going to redirect you. 14 Q Do you know what the word "plan" means? 15 What operation -- 15 A Well, you could probably elucidate that for 16 MR. CARDEN: Hang ona second. He -- 16 me. 17 MR. GOODIS: All I'm trying -- Kevin, I'm 17 Q Well, you're the one who told me earlier you 18 just trying to get an answer and -- 18 had some opinions about what surgeries were 19 MR. CARDEN: I know. He's entitled to 19 appropriate, remember that? 20 finish. 20 A Yeah. 21 MR. GOODIS: He doesn't like to answer 21 Q Okay. When a surgeon goes into a situation 22 questions directly. like Dr. Goldin went into with Mr. Lucey, he has a 23 MR. CARDEN: He's entitled to finish. He's 23 plan, right? You know what that means medically? 24 entitled to finish. 24 A Yeah. PS MR. GOODIS: But he doesn't answer questions 30 25 mn Okay, And my questionfor you Dr Juli 32 directly. He just goes and goes a