Vol. 3 Antoine Dental Centers vs. THHSC, OIG -Dr. Kanaan

7/28/2019 Vol. 3 Antoine Dental Centers vs. THHSC, OIG -Dr. Kanaan

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

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REPORTER' S RECORD

VOLUME 3 OF 4 VOLUMESOAH DOCKET NO. 529- 13- 0997

HHSC- OI G CASE NO: P20111316523848911

ANTOI NE DENTAL CENTER, (

PETI TI ONER, ((

VS. ( BEFORE THE STATE OFFI CE(

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

RESPONDENT ( ADMI NI STRATI VE HEARI NGS

***************************

HEARI NG

***************************

On t he 30t h of May, 2013, t he f ol l owi ng

pr oceedi ngs came on to be hear d i n the above- ent i t l ed

and numbered cause bef or e t he Honorabl e Howar d Sei t zman

and Cather i ne Egan, Associ ate Law J udges pr esi di ng,

hel d i n Aust i n, Tr avi s Count y, Texas.

Proceedi ngs r epor t ed by Machi ne Shor t hand.


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

3 ADMI NI STRATI VE LAWJ UDGES:Honor abl e Howar d Sei t zman

4 Honorabl e Cat her i ne Egan

STATE OFFI CE OF ADMI NI STRATI VE HEARI NGS5 300 West 15t h St r eet , Sui t e 504Aust i n, Texas 78701

6

FOR THE PETI TI ONER:7 Mr . J . A. "Tony" Canal es

Mr . Hect or Canal es8 CANALES & SI MONSON, P. C.

2601 Mor gan Avenue9 Cor pus Chr i st i , Texas 78465

Tel ephone: 361. 883. 060110

- and-Mr . Rober t M. Anderson11 ROBERT M. ANDERTON, DDS, J D

1909 Wal nut Pl z12 Car r ol l t on, Texas 75006

Tel ephone: 972. 416. 525113 - and-

Mr . Phi l i p H. Hi l der14 Mr . Wi l l i am B. Gr aham

Mr . J ames G. Ryt t i ng15 HI LDER & ASSOCI ATES, P. C.

819 Lovet t e Bl vd.16 Houst on, Texas 77006

Tel ephone: 713. 655. 911117 - and-

Mr . Thomas Wat ki ns18 BROWN McCARROLL

111 Congr ess Avenue, Sui t e 140019 Aust i n, Texas 78701

Tel ephone: 512. 703. 575220

FOR THE RESPONDENT:21 Mr . Dan Har grove

WATERS & KRAUSE, L. L. P.22 600 Navar r o, Sui t e 500

San Ant oni o, Texas 7820523 Tel ephone: 210. 349. 0515

- and-24

25


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1 Ms. Cai t l yn Si l hanWATERS & KRAUS, L. L. P.

2 3219 McKi nney AvenueDal l as, Texas 75204

3 Tel ephone: 214. 357. 6244- and-

4 Mr . J ames R. Mor i ar t yMORI ARTY LEYENDECKER, P. C.

5 4203 Mont r ose, Sui t e 150Houst on, Texas 77006

6 Tel ephone: 713. 528. 0700- and-

7 Mr . Ket an KharodKHAROD LAW FI RM, P. C.

8

PO Box 151677Aust i n, Texas 787159 Tel ephone: 512. 293. 1556

- and-10 Mr . Raymond C. Wi nt er

Ms. Mar gar et M. Moore11 ATTORNEY GENERAL OF TEXAS

Ci vi l Medi cai d Fr aud Di vi si on12 PO Box 12548

Aust i n, Texas 78711- 2548

13 Tel ephone: 512. 936. 170914 HEALTH AND HUMAN SERVI CES COMMI SSI ON - OFFI CE OFI NSPECTOR GENERAL:

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

16 11101 Met r i c Bl vd. , Bui l di ng IAust i n, Texas 78708

17 Tel ephone: 512. 491. 200018

19

2021

22

23

24

25


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1 Vol ume 4

2 May 30t h, 2013 Page

3 RESPONDENT' S WI TNESSES Di r ect Cr oss Voi r Di r e

4

Wael Kanaan 5, 177 97, 1845 J ack St i ck 186, 248, 271, 337 275 242, 271

6 Cour t Repor t er ' s Cer t i f i cat e. . . . . . . . . . . . . . . . 341

7 EXHI BI T I NDEX

8 PETI TI ONER' SNO. DESCRI PTI ON OFFERED ADMI TTED

9

77 Spr eadsheet 164 16910

82 ( 82A) Apr i l 4, 2012, payment 315 31611 hol d l et t er

12 83 "Si x Keys t o Nor mal 128 129Occl usi on" by Lawr ence F.

13 Andrews

14 84 "The HLD I ndex and I ndex 131 131Quest i on" by Wi l l i am

15 Par ker

16 RESPONDENT' SNO.

17

37 Dr aker ar t i cl e 132 13218

19

20

21

22

23

24

25


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

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

3 t he r ecor d. I t i s 9: 07 on Thur sday, May t he 30t h,

4 2013. Thi s i s t he cont i nuat i on of t he hear i ng i n SOAH5 Docket Number 529- 13- 0997. J udges Sei t zman and Egan

6 pr esi di ng.

7 And at t hi s t i me we' r e r eady f or t he next

8 wi t ness, Mr . Mor i ar t y.

9 MR. MORI ARTY: Your Honor , I - -

10 MR. HI LDER: The mi c mi ght not be on.11 J UDGE SEI TZMAN: Al l r i ght . We need t o - -

12 MS. SI LHAN: Yes, I ' m Cai t l yn Si l han f or

13 t he r espondent .

14 J UDGE SEI TZMAN: Ms. Si l han, are you

15 cal l i ng Dr . Kanaan as t he next wi t ness; i s t hat

16 correct?17 MS. SI LHAN: I am, yes. Dr . Kanaan, i s

18 that correct?

19 THE WI TNESS: Good mor ni ng. Uh- huh.

20 ( Wi t ness swor n. )

21 WAEL KANAAN,

22

havi ng been f i r st dul y swor n, t est i f i ed as f ol l ows:23 DI RECT EXAMI NATI ON

24 BY MS. SI LHAN:

25 Q. Hi , Dr . Kanaan.


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1 A. Hi , good morni ng.

2 Q. Si nce t hi s i s t he f i r st t i me we' ve hear d f r om

3 you, I ' d j ust l i ke t o gi ve t he J udges a l i t t l e bi t of

4 your backgr ound.5 A. Uh- huh.

6 Q. When di d you become an or t hodont i st ?

7 A. 2005.

8 Q. Okay. And how l ong have you been wor ki ng wi t h

9 Al l Smi l es?

10 A. Al l Smi l es?11 Q. I ' m sor r y. Ant oi ne Dent al Cent er .

12 A. Si nce December , 2006.

13 Q. Okay.

14 A. I st ar t ed one day a week - -

15 Q. Okay.

16 A. - - t hen I t hi nk t wo or t hr ee days a week.17 J UDGE SEI TZMAN: Doct or , can you pul l

18 t hat - - t hat ' s not a ver y sensi t i ve mi c. So, i f you

19 can pul l i t as cl ose t o you as possi bl e, you can t i l t

20 i t or what ever so you don' t get a neck cr amp.

21 THE WI TNESS: Okay.

22

J UDGE SEI TZMAN: Thank you.23 Q. ( BY MS. SI LHAN) Do you wor k at any ot her

24 cl i ni cs?

25 A. I have my own cl i ni c - -


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1 Q. Okay.

2 A. - - and t wo ot her cl i ni cs as a consul t ant once

3 a mont h.

4 Q. What ar e t he names of t hose cl i ni cs?5 A. Ant oi ne Dent al - - ar e you t al ki ng about t hat

6 we t ake Medi cai d or i n gener al ?

7 Q. I n gener al , al l t he cl i ni cs t hat you wor k f or .

8 A. Si ma Dent al , S- I - M- A, Mi l es of Smi l es and my

9 of f i ce i Smi l e Speci al i st .

10 Q. Do you see Medi cai d pat i ent s at al l of t hose11 cl i ni cs?

12 A. J ust at Ant oi ne.

13 Q. J ust at Ant oi ne?

14 A. And Si ma Dent al , t oo.

15 Q. Okay.

16 A. We have a f ew pat i ent s.17 Q. And ar e Si ma, Mi l es of Smi l es and i Smi l es

18 l ocat ed near or i n t he vi ci ni t y of Ant oi ne Dent al ?

19 A. ( Wi t ness shakes head. )

20 Q. No? Wher e ar e t hey?

21 A. Si ma' s i n Channel vi ew. i Smi l e' s i n Sugar Land

22

and Mi l es of Smi l es i n Houst on near t he Gal l er i a.23 Q. Okay. So, not t oo f ar way?

24 A. Wel l , Channel vi ew i s about 30 mi l es f r om Sugar

25 Land.


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1 Q. Okay.

2 A. Yeah.

3 Q. And f or t he r ecord, wher e i s Ant oi ne Dent al

4 Cent er?

5 A. We have t wo of f i ces.

6 Q. Okay.

7 A. One used t o be on 6206 Antoi ne. Anot her one

8 on Hi l l cr of t .

9 Q. Okay.

10 A. They' r e bot h l i ke 15 mi nut es, 20 mi nut es11 apar t .

12 Q. Okay. So, as an or t hodont i st you see bot h

13 pr i vat e- pay pat i ent s - -

14 A. Pr i vat e pay.

15 Q. - - and Medi cai d pat i ent s?

16 A. And Medi cai d, yes, uh- huh.17 J UDGE SEI TZMAN: Doct or , i f you' l l be sur e

18 and l et counsel f i ni sh t hei r quest i on bef or e you answer

19 i t because t he cour t r epor t er onl y br ought t wo ar ms

20 t oday. So. . .

21 MS. SI LHAN: Okay. Let ' s pul l up R82,

22

pl ease.23 MR. RYTTI NG: Do we have R82?

24 MS. SI LHAN: No, not - - not yet .

25 MR. RYTTI NG: And may I see i t bef ore you


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1 pr esent i t t o t he wi t ness?

2 J UDGE SEI TZMAN: I s t hi s a di r ect exhi bi t ,

3 i mpeachment exhi bi t ?

4 MS. SI LHAN: Thi s i s an i mpeachment

5 exhi bi t . I don' t know t he f ul l pur pose of whet her we' d

6 l i ke t o of f er i t yet . I have copi es i f you' d l i ke t o

7 see.

8 J UDGE SEI TZMAN: Be hel pf ul .

9 MS. SI LHAN: Okay.

10 MR. RYTTI NG: And - -11 J UDGE SEI TZMAN: I t woul d al so be hel pf ul

12 f or us t o est abl i sh what we' r e i mpeachi ng ot her t han

13 hi s name and t he l ocat i on of t he of f i ces.

14 MS. SI LHAN: Okay. May I have j ust one

15 moment ?

16 J UDGE SEI TZMAN: You may.17 MS. SI LHAN: One second. I apol ogi ze.

18 MR. RYTTI NG: Obj ect i on, J udge. I see no

19 f oundat i on.

20 J UDGE SEI TZMAN: I appr eci at e you

21 st andi ng; but i f you' l l r emai n seat ed, you' l l be cl oser

22

t o t he mi c. Pul l t he mi c cl ose. Pul l t he mi c cl oser .23 MR. RYTTI NG: They haven' t l ai d a

24 f oundat i on - -

25 J UDGE SEI TZMAN: Pul l t he mi c cl oser .


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1 MR. RYTTI NG: They haven' t l ai d a

2 f oundat i on f or t hi s i mpeachment . They' r e j ust t hr owi ng

3 i t up as an exhi bi t .

4 MS. SI LHAN: Okay. I ' l l be happy t o of f er

5 i t i nt o evi dence, your Honor .

6 J UDGE EGAN: Wel l , I t hi nk i t ' s not - -

7 i t ' s not a cur r ent exhi bi t ; i s t hat cor r ect ?

8 MS. SI LHAN: I t i s not .

9 J UDGE SEI TZMAN: i t ' s bei ng of f er ed f or

10 i mpeachment but t he onl y t hi ng he' s t est i f i ed t o so f ar11 i s hi s name - -


13 J UDGE SEI TZMAN: - - and t he l ocat i on of

14 t he of f i ces. I f you' r e t hi nki ng - -

15 MS. SI LHAN: I apol ogi ze. I t i s out of

16 or der .17 J UDGE SEI TZMAN: - - t o i mpeach t hat - -

18 MS. SI LHAN: Okay. I ' m sor r y. Then we

19 can t ake i t down. I can ask a f ew quest i ons.

20 Q. ( BY MS. SI LHAN) When di d you f i r st l ear n

21 about ect opi c er upt i on?

22

J UDGE SEI TZMAN: Pul l your mi c cl oser ,23 pl ease?

24 A. 2003, dur i ng my r esi dency.

25 Q. ( BY MS. SI LHAN) Okay.


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1 A. Yes.

2 Q. Di d you st udy any par t i cul ar t ext s t hat

3 di scussed ect opi c er upt i on i n school ?

4 A. Of cour se.5 Q. Okay. What were t hose t ext s?

6 A. The same ones t hat Dr . Tadl ock pr esent ed.

7 Q. Okay.

8 A. Pr of f i t , Gr aber , t he l i t er at ur e, of cour se,

9 yes.

10 Q. Okay. Do you r ecal l what t hose t ext s - - how11 t hey def i ne "ect opi c er upt i on"?

12 A. I woul dn' t agr ee t hat t hey def i ne. They

13 descr i be what ect opi c er upt i on was.

14 Q. Okay.

15 A. Yes.

16 Q. I n t hat case, we have a copy of what i s17 al r eady i n evi dence as R30. I t ' s a newer edi t i on.

18 Thi s i s a f our t h edi t i on, whi ch i s t he edi t i on t hat I

19 bel i eve you st udi ed; i s t hat cor r ect ?

20 A. I don' t r emember .

21 Q. You don' t r emember ?

22

A. I don' t know. I don' t r emember .23 MS. SI LHAN: Okay. Then l et ' s pul l up

24 t hat l ast exhi bi t , pl ease.

25 J UDGE SEI TZMAN: 82?


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1 MS. SI LHAN: Yes, s i r .

2 Q. ( BY MS. SI LHAN) Okay. Does t hat r ef r esh your

3 r ecol l ect i on about t he edi t i on of t he Pr of f i t t ext t hat

4 you st udi ed?

5 MR. RYTTI NG: Your Honor , t hi s i s - -

6 A. Thi s i s my - -

7 J UDGE SEI TZMAN: I f you' l l st ay seat ed - -

8 I appr eci at e t he cour t esy. But j ust st ay seat ed.

9 You' l l be a l ot cl oser t o t he mi cr ophone and I ' l l be

10 abl e t o hear you.11 MR. RYTTI NG: I ' d j ust l i ke t o hear her

12 l ay t he pr edi cat e f or t hi s exhi bi t .

13 J UDGE SEI TZMAN: She' s aski ng hi m i f t hi s

14 hel ps r ef r esh hi s memor y as t o whi ch - -

15 J UDGE EGAN: Edi t i on.

16 J UDGE SEI TZMAN: - - edi t i on he st udi ed.17 So, we' l l see wher e - -

18 A. I bought t hi s book af t er I gr aduat ed. That ' s

19 t he new one. So, I di d t he one bef or e but I t hi nk t hey

20 have t he same general - -

21 Q. ( BY MS. SI LHAN) Okay. Gr eat . They have t he

22

same?23 A. They have t he same, yes.

24 Q. Gr eat . Okay. I n t hat case we have excerpt s

25 f r om t he t hi r d edi t i on, whi ch woul d be t he one you


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1 st udi ed.

2 A. That ' s f i ne. That ' s f i ne.

3 Q. Okay. That ' s i n evi dence as R30 and

4 Dr . Tadl ock di scussed t hat .

5 A. Yes, uh- huh.

6 Q. I have a copy, a har d copy of t he edi t i on t hat

7 you hol d i n t hat phot o.

8 A. That ' s f i ne.

9 Q. May I - - you sai d t hat t he def i ni t i on of

10 ect opi c er upt i on i s t he same; i s t hat r i ght ?11 A. I n t hi s book. I t hasn' t changed - -

12 Q. Okay.

13 A. - - t hat much.

14 Q. Okay.

15 A. I di d not put al l - - al l of t hem - - al l t hese

16 t ext books and t r y t o compare pi ece by pi ece.17 Q. Okay.

18 A. But t he gener al concept i s t he same. Pr of f i t

19 di dn' t changes - -

20 J UDGE SEI TZMAN: Doct or , can you pul l t hat

21 mi cr ophone t o you? You' r e goi ng t o have t o act l i ke a

22

si nger wher e i t ' s al most up t o your l i ps. Okay? Thank23 you.

24 MS. SI LHAN: May I appr oach?

25 J UDGE SEI TZMAN: You may.


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1 Q. ( BY MS. SI LHAN) Do you see t he hi ghl i ght ed

2 por t i on her e?

3 A. Uh- huh.

4 J UDGE SEI TZMAN: Woul d you, f or t he5 r ecor d, descr i be whi ch vol ume you' r e - -

6 MS. SI LHAN: Yes.

7 J UDGE SEI TZMAN: - - and what page you' r e

8 showi ng hi m?

9 Q. ( BY MS. SI LHAN) Woul d you l i ke t o do t hat ?

10 THE WI TNESS: I t ' s t he f our t h edi t i on,11 Page 139.

12 J UDGE SEI TZMAN: Thank you.

13 Q. ( BY MS. SI LHAN) Coul d you pl ease - - pl ease

14 r ead t he hi ghl i ght ed por t i on?

15 A. Ect opi c er upt i on occasi onal l y mal posi t i on of a

16 per manent t oot h but can l ead t o er upt i on i n t he wr ong17 pl ace. Thi s condi t i on i s cal l ed ect opi c er upt i on.

18 Q. Okay. Does - - do you agr ee t hat t hat def i nes

19 ect opi c er upt i on as er upt i on i n t he wr ong pl ace?

20 A. That ' s a def i ni t i on of Pr of f i t and I agr ee

21 wi t h i t - -

22

Q. Okay.23 A. - - i n t hat case, yes.

24 Q. You agr ee wi t h i t ?

25 A. Yes. What ' s i n Pr of f i t - - I can' t say I don' t


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1 agr ee what ' s i n Pr of f i t . I t ' s a bi bl e.

2 Q. Okay. I know we' ve hear d a l i t t l e bi t of

3 conf l i ct i ng t est i mony bot h yest er day and on Tuesday

4 about whet her ect opi c er upt i on i s t oo subj ect i ve t o5 meani ngf ul l y def i ne.

6 Wer e you awar e t hat your Pr of f i t t ext

7 di scusses i t on 13 separ at e pages?

8 A. Yes.

9 Q. Yes? Okay.

10 A. I di dn' t know t her e wer e 13; but yes, I know.11 Q. Okay. And t hr ee di f f er ent chapt er s?

12 A. I know at l east t wo chapt er s.

13 Q. Okay.

14 A. Yes, uh- huh.

15 Q. Thank you.

16 I ' d l i ke t o di scuss your pr act i ce of17 scor i ng ect opi c er upt i on i n t hi s case.

18 MS. SI LHAN: Can we pl ease pul l up R83?

19 A. Scor e ect opi c er upt i on on wher e?

20 Q. ( BY MS. SI LHAN) I n t he cases t hat we have,

21 t he sampl es t hat we have.

22

A. On Medi cai d pat i ent s?23 Q. On Medi cai d pat i ent s.

24 A. Based on Medi cai d def i ni t i on.

25 Q. So, you t hi nk - - you' r e asser t i ng t hat


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1 Medi cai d has a di f f er ent def i ni t i on - -

2 A. Yes.

3 Q. - - of ect opi c er upt i on?

4 A. Absol ut el y, yes.

5 Q. What i s t hat def i ni t i on?

6 A. I t ' s an unusual pat t er n of er upt i on such as

7 t he hi gh l abi al and t he t eet h and out si de t he l ower

8 axi s of t he t oot h.

9 Q. Okay. So, you don' t use your or t hodont i c

10 school i ng or backgr ound and t he def i ni t i ons you l ear ned11 t her e when you t r eat Medi cai d pat i ent s?

12 A. No. Of cour se, I use t he def i ni t i on t o t r eat

13 t he pat i ent s. Of cour se I use i t . You ar e t al ki ng

14 about t he di agnosi s. HLD i s di agnosi s. You wer e

15 aski ng me a quest i on about t r eat i ng. Tr eat i ng and

16 di agnosi s ar e di f f er ent . HLD i s an i ndex.17 Q. Okay. So, l et me - - okay. I ' l l r ephr ase.

18 You di agnose Medi cai d pat i ent s wi t h di f f er ent

19 condi t i ons t han you woul d di agnose t he same condi t i on

20 i n a nonMedi cai d pat i ent ?

21 A. That ' s not t r ue.

22

Q. That ' s not t r ue?23 A. No. Di agnosi s i s t he same. Agai n, I don' t

24 consi der HLD as a di agnosi s t ool . I t ' s an i ndex.

25 Q. Okay, okay. I apol ogi ze. I t hi nk t hat you


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1 sai d t hat - - j ust now t hat HLD was a di agnosi s t ool ?

2 A. No, no. I di d not say t hat . HLD i s not a

3 di agnost i c t ool . I t ' s an i ndex.

4 Q. Okay.

5 A. I t ' s a hemat ol ogi cal i ndex.

6 Q. Do you - - do you appl y a def i ni t i on of ect opi c

7 er upt i on when f i l l i ng out t he HLD i ndex?

8 A. Based - - based on t he Medi cai d def i ni t i on,

9 yes, I do.

10 Q. Okay. And you' r e asser t i ng her e t hat Medi cai d11 def i nes ect opi c er upt i on i n a di f f er ent way t han al l 13

12 pages of t hat Pr of f i t t ext i n f r ont of you?

13 A. And I have t hat proof .

14 Q. What i s t he pr oof ? I - - act ual l y I ' l l t ake

15 t hat back. I ' d r at her j ust cl ar i f y t hi s poi nt .

16 A. I woul d l i ke l at er t o expl ai n t o t he J udges17 what ot her pr oof .

18 J UDGE SEI TZMAN: I ' m sur e your counsel has

19 made a not e and wi l l gi ve you t hat oppor t uni t y but i f

20 you can j ust answer t he quest i ons.

21 THE WI TNESS: Yes, I wi l l .

22

Q. ( BY MS. SI LHAN) Okay. So, you do not23 di agnose Medi cai d pat i ent s i n a di f f er ent manner t han

24 you di agnose pr i vat e pay pat i ent s?

25 A. Absol ut el y not .


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1 Q. At i Smi l es - -

2 A. Uh- huh.

3 Q. - - you do not see Medi cai d pat i ent s; i s t hat

4 correct?5 A. No, no.

6 Q. Ar e you f ami l i ar wi t h your websi t e on t he

7 i Smi l es?

8 A. Yes.

9 Q. Do you r ecal l whet her you descr i be any

10 par t i cul ar di agnoses on t hat websi t e?11 A. Can you be, pl ease, mor e speci f i c or i f you

12 can show me what you' r e t al ki ng about because t hi s

13 websi t e has a l ot of t hi ngs - -

14 Q. I ' d be happy t o.

15 A. - - and I don' t r emember what ' s on i t .

16 Q. Absol ut el y. That ' s a f ant ast i c i dea,17 act ual l y.

18 MS. SI LHAN: Can we pul l up R85, pl ease?

19 MR. RYTTI NG: Can I see what you' r e goi ng

20 t o show t he wi t ness?

21 MS. SI LHAN: I - - absol ut el y.

22

J UDGE SEI TZMAN: Let ' s go of f t he r ecord23 j ust a second, pl ease, whi l e we' r e doi ng t hat .

24 ( Of f t he r ecor d)

25 J UDGE SEI TZMAN: Al l r i ght . I s t her e - -


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1 MR. RYTTI NG: She - - she want - - I t ake i t

2 she want s t o r ef r esh hi s memor y. I f she want s t o

3 r ef r esh hi s memor y she can hand hi m t he document , have

4 hi m l ook at i t and t hen she can t ake i t back. I t5 doesn' t need t o be di spl ayed.

6 J UDGE SEI TZMAN: As I under st and i t ' s a

7 document t hat ' s al r eady i n evi dence. I t ' s f r om R28.

8 I t ' s t wo pages.

9 MS. SI LHAN: I t i s.

10 MR. RYTTI NG: I don' t bel i eve i t ' s i n11 evi dence, your Honor .

12 J UDGE SEI TZMAN: Yeah. I t was f or

13 i mpeachment pur poses onl y.

14 J UDGE EGAN: But he asked t o see i t .

15 J UDGE SEI TZMAN: But he asked t o see i t .

16 So, we' r e goi ng - - we' r e goi ng t o al l ow hi m t o l ook at17 i t .

18 MS. SI LHAN: May I put i t on t he scr een - -

19 J UDGE SEI TZMAN: Yes.

20 MS. SI LHAN: - - or woul d you pr ef er t he

21 har d copy?

22

J UDGE SEI TZMAN: Yeah. Wel l , does t he23 wi t ness have a copy?

24 MS. SI LHAN: No. I was asked t o wi t hdr aw

25 t hat copy.


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1 J UDGE SEI TZMAN: Go ahead and hand t he

2 wi t ness a copy. The obj ect i on' s over r ul ed.

3 MR. RYTTI NG: J ust one ot her obj ect i on.

4 I ' m not - - i t ' s st i l l not a pr oper pr edi cat e f or5 i mpeachi ng hi m. I have no i dea - -

6 J UDGE SEI TZMAN: I t ' s not bei ng used f or

7 i mpeachment f or t hi s pur pose. He - - she asked hi m a

8 quest i on about t he websi t e and he asked t o see i t and

9 so, she i s of f er i ng hi m t he por t i on of t hat .

10 MR. RYTTI NG: Yes, si r .11 Q. ( BY MS. SI LHAN) Okay. We' r e l ooki ng at a

12 page f r om your websi t e on i Smi l e; i s t hat cor r ect ?

13 A. Yes.

14 Q. Okay. Up at t he t op of t he scr een you l i st

15 sever al condi t i ons; i s t hat r i ght ?

16 A. Under br aces, yes. Uh- huh.17 Q. For br aces, t hat ' s r i ght .

18 A. Yes, uh- huh.

19 Q. Can you r ead f r om l ef t t o r i ght ?

20 A. Spaci ng, cr owdi ng, over bi t e, open bi t e,

21 cr oss- bi t e, under bi t e.

22

Q. Okay. Now, can you f l i p t o t he next page of23 t hat document ?

24 A. Uh- huh.

25 Q. Okay. And i s t hi s an exampl e of cr owdi ng?


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1 A. Of cour se.

2 Q. Okay.

3 MS. SI LHAN: Can we pul l up P20- 13 next t o

4 t hi s?

5 Q. ( BY MS. SI LHAN) Okay. That ' s cr owdi ng on

6 l ef t , cor r ect ?

7 A. Yes, uh- huh.

8 Q. I n a nonMedi cai d pat i ent ?

9 A. We opened t hi s of f i ce back i n Oct ober . So,

10 when I opened t he of f i ce - -11 Q. Yes or no, si r . Was i t a nonMedi cai d pat i ent ?

12 A. I t ' s a Medi cai d pat i ent .

13 Q. I t ' s a Medi cai d pat i ent ?

14 A. Yes.

15 Q. But you do not t r eat Medi cai d at i Smi l es. I s

16 t hat what you t est i f i ed t o ear l i er ?17 A. Yes. But t hat ' s why I was expl ai ni ng t o you.

18 These pat i ent s ar e f r om Ant oi ne - - Ant oi ne Dent al but

19 because I don' t have a good r ecor d - - when we st ar t t he

20 of f i ce, i t ' s a br and- new of f i ce, bef or e and af t er .

21 Q. Okay.

22

A. So, I t ook my pat i ent s f r om Ant oi ne and I put23 t hem on t he websi t e. So, t hat ' s a Medi cai d pat i ent .

24 Q. Di d you score t hat Medi cai d pat i ent as

25 cr owdi ng?


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1 A. No. I scor ed t hem as ect opi c.

2 Q. You scor ed t hat pat i ent as ect opi c?

3 A. Yes.

4 Q. You gave hi m a di f f er ent di agnosi s because

5 he' s a Medi cai d pat i ent ?

6 A. I t ' s not a di agnosi s. Agai n HLD i s not a

7 di agnosi s. I t ' s an i ndex. Thi s i s one t hi ng; t hi s i s

8 one - - anot her t hi ng.

9 Q. Okay. So, you do not appl y or descr i be a

10 di agnosi s on t he HLD f orm?11 A. On t he bot t om t her e' s a box t hat s t at es

12 di agnosi s.

13 Q. Okay.

14 A. I wr i t e down t her e i t ' s Cl ass I or what t hey

15 have.

16 Q. Okay. What i s ect opi c er upt i on? I s i t a17 di agnosi s?

18 A. I t ' s a descr i pt i on of t he posi t i on of t he

19 t oot h.

20 Q. Okay. I s cr owdi ng a descr i pt i on of t he

21 posi t i on of t he t oot h?

22

A. I t ' s a quant i t at i ve measur ement of how much23 l engt h and space we have. One i s descr i pt i on. One i s

24 a quant i t at i ve measurement of how much l ack of space we

25 have.


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1 Q. Okay.

2 A. I t ' s t wo di f f er ent t hi ngs.

3 Q. Okay. Di d you di agnose cr owdi ng i n t he

4 pat i ent on t he r i ght , do you r ecal l ?5 A. Oh, I don' t know. You need, pl ease, t o show

6 me t he r ecor d.

7 Q. Okay. I ' d be happy t o.

8 A. Let me see al l of i t , pl ease.

9 MS. SI LHAN: Okay. That ' s P20.

10 Q. ( BY MS. SI LHAN) And I bel i eve I can - -11 A. Thi s i s my pat i ent ?

12 Q. I t i s your pat i ent , and I bel i eve I can pul l

13 t hat up f or you. I have t he har d copy as wel l .

14 J UDGE EGAN: Whi l e you' r e doi ng t hat , I

15 j ust want t o - - you sai d cr owdi ng i s a quant i t at i ve

16 measur ement - -17 THE WI TNESS: Yes.

18 J UDGE EGAN: - - of what ? I t ' s - -

19 THE WI TNESS: Of t he l ack of space - -

20 J UDGE EGAN: Of t he l ack of space. Thank

21 you.

22

THE WI TNESS: - - bet ween t he t eet h and t he23 bone t hat suppor t t he t eet h.

24 J UDGE EGAN: Okay. Thank you.

25 THE WI TNESS: Uh- huh.


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1 Q. ( BY MS. SI LHAN) Thi s i s your HLD f or m f or

2 t hi s pat i ent ?

3 A. Cor r ect , ma' am.

4 Q. I s t hat cor r ect ?5 A. Yes, uh- huh.

6 Q. Di d you di agnose cr owdi ng?

7 A. Thi s pat i ent i s not f or t hat HLD.

8 Q. No, i t ' s not .

9 A. Yes.

10 Q. Ri ght . Can you - - okay. On t he l ef t can you,11 pl ease, pul l up t he phot o one mor e t i me? That ' s

12 P20- 13.

13 MR. RYTTI NG: Obj ect i on, your Honor . I - -

14 wi t h al l due r espect I cannot t el l whet her t hat

15 phot ogr aph goes wi t h t he paper work or wi t h - -

16 J UDGE SEI TZMAN: Wel l , i t ' s - - i f t he17 wi t ness can - -

18 MS. SI LHAN: Can we l ook at t he Bat e st amp

19 at t he bot t om?

20 J UDGE SEI TZMAN: I f t he wi t ness can

21 i dent i f y i t - -

22

MR. RYTTI NG: Yes, si r .23 J UDGE SEI TZMAN: - - t hen I guess maybe we

24 can move f r om t her e.

25 MS. SI LHAN: Can we l ook at t he Bat e st amp


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1 at t he bot t om of t he page on t he l ef t ? And t he st amp

2 on t he r i ght i s t he one I ' d l i ke t o l ook, at t he bot t om

3 r i ght of t he page on t he l ef t .

4 Thank you.

5 Q. ( BY MS. SI LHAN) Di d you di agnose cr owdi ng i n


7 A. No. I put i t as ect opi c er upt i on. So, i t i s

8 cr owded, yes; but on t he HLD I put i t as ect opi c.

9 Q. Okay. But t he HLD i s not - -

10 A. A di agnosi s.11 Q. Okay. But t her e i s a di agnosi s f i el d; i s t hat

12 r i ght ?

13 A. On t he bot t om, yes.

14 Q. Okay. Let ' s see t hat - - t hat di agnosi s f i el d.

15 Di d you di agnose crowdi ng on t hi s pat i ent ?

16 A. I di dn' t put i t as over t her e because i t has17 al r eady been descr i bed under t he HLD.

18 Q. Okay.

19 A. I put - -

20 Q. Let ' s go back t o t he HLD and see i f i t

21 di agnosi s cr owdi ng. What di d you scor e f or cr owdi ng on

22

t hi s pat i ent , Dr . Kanaan?23 A. Zer o.

24 Q. Okay. So, you di d not di agnose t hi s pat i ent

25 wi t h cr owdi ng. I s t hat because t hi s i s a Medi cai d


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1 pat i ent ?

2 J UDGE SEI TZMAN: I ' m sor r y. Hang on. We

3 need a ver bal answer , Doct or . You shook your head but

4 we need a ver bal answer f or t he r ecor d.5 A. I ' m sor r y. You keep sayi ng you di d not

6 di agnose on t he HLD and he keep t el l i ng you HLD i s an

7 i ndex t o descr i be.

8 Q. ( BY MS. SI LHAN) Okay. Let ' s - - l et ' s scrol l

9 down.

10 A. We' r e mi xi ng - - mi xi ng t wo t hi ngs.11 Q. Okay. Wel l , I ' d l i ke t o cl ar i f y.

12 A. See, I - -

13 Q. Let ' s l ook at t he di agnosi s f i el d on t he HLD,

14 pl ease.

15 A. And coul d you, pl ease, go al l t he way down

16 because i t wasn' t enough - - I want t o show al l t he way17 down. See I put down Cl ass I I on t he r i ght upper - -

18 ( Cour t r epor t er i nt er r upt ed. )

19 A. I n t he di agnosi s, my di agnosi s cont ai ns what ' s

20 i nsi de t he box and what ' s al l under neat h because t he

21 box i s smal l . So, I put t he pat i ent has Cl ass I I on

22

t he r i ght si de. The upper mi dl i ne i s 2 mi l l i met er t o23 t he r i ght .

24 Q. ( BY MS. SI LHAN) I bel i eve t hat ' s as f ar as

25 you got .


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1 J UDGE EGAN: Al l r i ght . But I want hi m t o

2 r i de hi s di agnosi s.

3 MS. SI LHAN: Okay, okay.

4 THE WI TNESS: And t hen i t says bl ocked

5 upper r i ght t hr ee, cross- bi t e upper l ef t f i ve. The

6 pat i ent need - - has a nar r ow j aw. I expl ai ned as an RP

7 pat i ent needs r api d panel expander . Af t er I ' m done

8 wi t h t he expansi on, I need t o put an open cor e t o f i x

9 t he mi dl i ne f or upper r i ght t hr ee. Pat i ent mi ght need

10 dest abi l i zat i on t o f i x t hat Cl ass I I . And I put a not e11 t hat t he l ower f i ve r oot s ar e shor t based on t he X r ay.

12 We don' t di agnose onl y f r om t he pi ct ur es.

13 Q. ( BY MS. SI LHAN) Okay.

14 A. I t ake t hat whol e and I put a not e t her e

15 because of t he r oot s ar e shor t st ar t onl y - - st ar t at

16 t he t op on t he begi nni ng and t hen l at er cat ch t he17 bot t om because t he t op has most of t he pr obl em.

18 Q. Okay. Let ' s cl ar i f y f or t he J udges.

19 A. Yes.

20 Q. Di d you l i st cr owdi ng as a di agnosi s i n t hi s

21 pat i ent ?

22

A. Al l what I t ol d you i s cr owdi ng.23 Q. Yes or no?

24 A. Yes. I n t he - -

25 Q. You di agnosed cr owdi ng on t hi s HLD?


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1 A. I f I don' t say crowdi ng by i t sel f and descr i be

2 i t bl ock - - what i s bl ock t hr ee? I t ' s crowdi ng. Why

3 ar e you t r yi ng - -

4 Q. Di d you di agnose cr owdi ng on t hi s HLD f orm

5 t hat you submi t t ed t o TMHP?

6 A. Yes.

7 Q. And you - - and you cer t i f i ed t hat i t was t r ue

8 and accurat e?

9 A. Yes. Any dent i st who can r ead t hi s or t hey

10 know t hat i t ' s cr owdi ng.11 Q. Si r - -

12 J UDGE SEI TZMAN: J ust answer t he quest i on,

13 pl ease.

14 THE WI TNESS: Yes, okay.

15 J UDGE SEI TZMAN: Your at t orney wi l l gi ve

16 you a chance t o expl ai n i t i f he want s t o ask you t hose17 quest i ons.

18 Q. ( BY MS. SI LHAN) So, you di d not need t o wr i t e

19 t he di agnosi s i n t he di agnosi s box because your bl ank

20 space f or ant er i or cr owdi ng on t hi s f or m woul d t el l t he

21 r eader of t he f or m t hat you' r e di agnosi ng cr owdi ng i n

22

t hi s pat i ent ?23 A. I shoul d have pl aced zer o. I shoul d have

24 pl aced a zer o.

25 Q. You shoul d have pl aced zer o - -


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1 A. Yes.

2 Q. - - f or cr owdi ng - -

3 A. Yes.

4 Q. - - t o i ndi cat e t her e' s no crowdi ng?5 A. No. See, t he manual says r ecor d t he most

6 sever e condi t i on. So - -

7 Q. The manual al so asks you t o l i st a di agnosi s.

8 You l i st ed - - you r ead sever al l i nes of t ext , cor r ect ,

9 f or t he J udge - - f or J udge Egan?

10 A. Yes, uh- huh.11 Q. Di d any of t hose l i nes say cr owdi ng?

12 A. No, i t doesn' t say - -

13 Q. Wer e al l of t hose l i nes descr i bi ng your

14 di agnosi s - -

15 J UDGE SEI TZMAN: Counsel , Counsel , make

16 sur e he f i ni shes hi s answer s bef or e you cut hi m of f .17 MS. SI LHAN: Oh, I ' m sor r y.

18 Q. ( BY MS. SI LHAN) You sai d no; i s t hat cor r ect ?

19 A. I t doesn' t say cr owdi ng but i t descr i bes

20 cr owdi ng.

21 Q. Okay. Let ' s act ual l y pul l up anot her exampl e.

22

One moment whi l e I f i nd i t .23 MS. SI LHAN: Can we pul l up P5- 0067?

24 Q. ( BY MS. SI LHAN) Okay. Let ' s r ead t he

25 di agnosi s box i n t hi s pat i ent .


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1 A. Cl ass I cr owdi ng.

2 MR. RYTTI NG: What - - par don me. What

3 r ecor d ar e you - -

4 MS. SI LHAN: Thi s i s P - - your Pat i ent5 Number P - - 006 i s t he page number . I t ' s Pat i ent 5 - -

6 I ' m sor r y. I t ' s P5- 006. Woul d you l i ke t o see t he

7 st amp at t he bot t om?

8 MR. RYTTI NG: No. I j ust want ed t o know

9 what t he exhi bi t was. P5?

10 MS. SI LHAN: P5- 006.11 MR. RYTTI NG: Pat i ent 5 and i t ' s your

12 exhi bi t - - i t ' s our exhi bi t number ?

13 MS. SI LHAN: I t ' s your exhi bi t .

14 MR. RYTTI NG: Okay.

15 Q. ( BY MS. SI LHAN) Let ' s go up and l ook at t he

16 space f or cr owdi ng on t hat f or m. Can you t el l t he17 Cour t what you l i st ed f or cr owdi ng on t hi s pat i ent i n

18 t he HLD i ndex?

19 A. I di d not - - I put zer o. I di dn' t put

20 anyt hi ng on t he cr owdi ng because t he - -

21 Q. And di d you score ect opi c er upt i on i nst ead?

22

A. Yes.23 J UDGE SEI TZMAN: Agai n, be sur e he' s

24 f i ni shed hi s answer bef or e you st ar t your next

25 quest i on.


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1 MS. SI LHAN: Okay. I ' m sor r y.

2 J UDGE SEI TZMAN: Bot h - - bot h par t i es need

3 t o sl ow down j ust a l i t t l e bi t f or us.


5 Q. ( BY MS. SI LHAN) I ' m goi ng t o ask you one mor e

6 yes- or - no quest i on. Di d you scor e ant er i or cr owdi ng on


8 A. I di d not .

9 Q. Okay. Di d you i nst ead score ect opi c er upt i on?

10 A. I f ol l owed t he i nst r uct i on on t he manual what11 i t says, onl y r ecor d t he sever e condi t i on.

12 Q. Okay.

13 A. So, I put ect opi c.

14 Q. And - - t hank you.

15 For t hi s di agnosi s, t hough, you l i st ed

16 crowdi ng; i s t hat cor r ect ?17 A. I put t he di agnosi s as crowdi ng and t he

18 descr i pt i on as ect opi c.

19 Q. Okay. Thank you.

20 MS. SI LHAN: And I j ust want t o go back

21 qui ckl y t o P20- 13. Act ual l y I t hi nk t he HLD mi ght be

22

on a di f f er ent page. P20- 11, pl ease. And I ' d l i ke t o23 do a si de by si de bet ween P20- 11 and P05- 006.

24 Q. ( BY MS. SI LHAN) Okay. So, i n some cases you

25 do not t hi nk t he r evi ewer of a f or m coul d t el l i t ' s


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1 crowdi ng; and so, you wr i t e i t i n t he di agnosi s f i el d;

2 i s t hat cor r ect ?

3 A. Coul d you, pl ease, r ephr ase your quest i on?

4 Q. Yes. When we wer e di scuss i ng t he f orm on t he5 l ef t , whi ch i s page - - t he HLD f or Pat i ent 20 - -

6 A. Thi s one.

7 Q. - - you i ndi cat ed - - t hi s i s t he one on t he

8 l ef t .

9 A. Okay.

10 Q. You see i t says P20- 001 or 011 on t he t op?11 A. Yes.

12 Q. Okay. That ' s your HLD f or pat i ent 20.

13 A. Okay.

14 Q. You expl ai ned t hat you di d not need t o l i st

15 cr owdi ng; al t hough - -

16 MS. SI LHAN: I f you scrol l down a l i t t l e17 bi t .

18 Q. ( BY MS. SI LHAN) - - you descr i be sever al ot her

19 condi t i ons?

20 A. I di dn' t say t hat , no.

21 Q. You sai d t hat anyone r eadi ng t hi s f or m woul d

22

be abl e t o t el l i t ' s cr owdi ng; i s t hat cor r ect ?23 A. Yes.

24 Q. Okay.

25 A. Any dent i st - -


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1 Q. Now, on t he f or m on t he r i ght - -

2 MR. RYTTI NG: He needs t o f i ni sh hi s

3 answer , pl ease.

4 MS. SI LHAN: I apol ogi ze. I t hought I was

5 aski ng a yes- or - no quest i on.

6 A. Any dent i st who l ook at t hi s one he wi l l

7 under st and t her e' s sever e cr owdi ng wi t h t he case.

8 J UDGE SEI TZMAN: Doct or , i t ' s goi ng t o go

9 a l ot f ast er and your counsel wi l l have a chance t o ask

10 you quest i ons but i f you' r e asked a yes- or - no11 quest i on - -

12 THE WI TNESS: Yes, si r .

13 J UDGE SEI TZMAN: - - pl ease t r y t o answer

14 yes or no, i f you can.

15 THE WI TNESS: Yes, si r .

16 J UDGE SEI TZMAN: And i f you need t o17 expl ai n i t , you can answer i t and say, "But I need t o

18 expl ai n i t . "

19 THE WI TNESS: Okay. Yes.

20 J UDGE SEI TZMAN: And counsel wi l l f i gur e

21 out what t hey want t o do f r om t her e.

22

THE WI TNESS: Yes, si r . Yes, si r .23 Q. ( BY MS. SI LHAN) But on t he r i ght on t he f or m

24 wi t h subst ant i al l y l ess i nf or mat i on, you needed t o l i st

25 cr owdi ng al t hough you di d not scor e i t ; i s t hat


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1 correct?

2 A. Say i t agai n, pl ease? I don' t under st and - -

3 Q. Sur e.

4 A. - - t he poi nt you' r e t r yi ng t o make.5 Q. Okay. I ' m not so concer ned i f you under st and

6 t he poi nt . I ' d j ust l i ke t o cl ar i f y t he f act s .

7 On t he HLD f or m on t he r i ght - -

8 A. Uh- huh.

9 Q. - - you do not scor e cr owdi ng; i s t hat cor r ect ?

10 A. Cor r ect .11 Q. You di agnose cr owdi ng; i s t hat cor r ect ?

12 A. Cor r ect .

13 Q. You l i st a scor e f or over j et , cor r ect ?

14 A. Cor r ect .

15 Q. A scor e f or over bi t e?

16 A. Cor r ect .17 Q. A scor e f or ect opi c er upt i on?

18 A. Cor r ect .

19 Q. For a t ot al of 27 poi nt s?

20 A. Cor r ect .

21 Q. Okay. But you f el t t hat you needed t o expl ai n

22

t hat t hat was cr owdi ng, cor r ect , al t hough you di d not23 scor e i t ?

24 THE WI TNESS: May I expl ai n somet hi ng?

25 Q. ( BY MS. SI LHAN) Coul d you answer t he quest i on


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1 f i r st and t hen expl ai n, pl ease?

2 A. Say t he quest i on agai n.

3 Q. Coul d you r ead t he quest i on one mor e t i me.

4 ( Request ed mat er i al was r ead back as5 f ol l ows:

6 "QUESTI ON: Okay. But you f el t t hat you

7 needed t o expl ai n t hat t hat was cr owdi ng, cor r ect ,

8 al t hough you di d not scor e i t ?" )

9 J UDGE SEI TZMAN: Hang on. Hang on. Make

10 sur e she has a chance t o get back t o her keyboar d.11 A. Yes.

12 Q. ( BY MS. SI LHAN) Okay. Thank you.

13 A. So, can I expl ai n now or . . .

14 Q. I bel i eve t hat you' ve - -

15 A. That ' s f i ne.

16 Q. - - spoke subst ant i al l y about t hese HLD f or ms.17 A. Okay. That ' s f i ne.


19 I ' d l i ke t o di scuss - - I know we j ust

20 t al ked about cr owdi ng and t he di f f er ence bet ween a

21 di agnosi s f or Medi cai d and an HLD - - I ' m sor r y - - an

22

HLD i ndex f or Medi cai d and a di agnosi s f or pr i vat e- pay23 pat i ent s.

24 I ' d l i ke t o t ur n t o how you appl y t he

25 def i ni t i on of ect opi c er upt i on i n t he 28 pat i ent s of


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1 t he 26 on t hi s sampl e t hat you scor ed.

2 J UDGE SEI TZMAN: You mean 26 of t he 28?

3 MS. SI LHAN: I ' m sor r y. Of t he 63. The

4 28 of t he 63 t hat you scor ed.

5 Q. ( BY MS. SI LHAN) I ' ve got a qui ck vi sual and

6 we can go one by one. So - -

7 A. Excuse me. I ' d l i ke t o st at e one - - what ' s i n

8 t he exhi bi t . I n t he exhi bi t t hat we submi t t ed has onl y

9 21 cases. So, I want t o st i ck, pl ease, wi t h t he 21

10 cases.11 Q. We have 63 cases?

12 A. No, 21 t hat are under my name. The exhi bi t - -

13 Q. Okay. We can - - we can go t hr ough t hese cases

14 i f you - -

15 A. The 21 pl ease, yes.

16 Q. Okay. Di d you scor e Pat i ent 2?17 A. Yes. Ther e - - yes, uh- huh.

18 Q. Okay.

19 A. Yes.

20 Q. Di d you score Pat i ent 5? Woul d you l i ke t o

21 l ook at t he HLD f orms of t hose cases?

22

A. I t hi nk - - I t hi nk so.23 MS. SI LHAN: They' r e your r ecords. Do you

24 need t o see t hem?

25 MR. RYTTI NG: Yeah. I ' d l i ke t o see t hem.


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1 MS. SI LHAN: Your Honor , may I appr oach t o

2 gi ve hi m t he HLD f or m t hat he' s r equest ed t o see?

3 J UDGE SEI TZMAN: Let ' s j ust l et counsel

4 l ook at t hem f i r st . These ar e al l HLD scor es t hat ar e5 i n t he r ecor d, Counsel ?

6 MR. RYTTI NG: Yes, yes. I ' m goi ng t hr ough

7 t hem qui ckl y j ust t o make sur e t he si gnat ur e' s on

8 t hese.

9 MS. SI LHAN: Wel l , I ' d l i ke t he wi t ness t o

10 descr i be hi s si gnat ur e on t he f or ms.11 J UDGE SEI TZMAN: Wel l , but i t was j ust a

12 cour t esy of what you asked t he wi t ness.

13 MS. SI LHAN: Oh, absol ut el y. Yes.

14 Q. ( BY MS. SI LHAN) Okay. So, we' r e goi ng t o

15 l ook at t he HLD f or Pat i ent 5.

16 A. Uh- huh.17 MS. SI LHAN: St acey, can you pul l up

18 P05- 006.

19 Q. ( BY MS. SI LHAN) Okay. Do you see your

20 si gnat ur e on t hat page?

21 A. Yes, uh- huh.

22

Q. Okay. Thank you.23 MS. SI LHAN: St acey, can you - -

24 Q. ( BY MS. SI LHAN) I ' d l i ke t o - - do you r ecal l

25 whet her you scor ed Pat i ent 6, whet her you - - I


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1 apol ogi ze.

2 A. I ' m sor r y.

3 Q. We can - - we can pul l i t up.

4 A. Yes.5 MS. SI LHAN: P06 i s t he f i r st page.

6 Q. ( BY MS. SI LHAN) I s t hat your si gnat ur e down

7 t her e?

8 A. Yes, uh- huh.


10 MS. SI LHAN: P - -11 Q. ( BY MS. SI LHAN) Do you r ecal l whet her you

12 scor ed Pat i ent 7?

13 A. I don' t r emember . Can you show i t t o me? I f

14 i t ' s i n t he l i s t , t hen yes.

15 J UDGE SEI TZMAN: Maybe, Counsel , i f you

16 want t o make i t go a l i t t l e bi t f ast er , you mi ght gi ve17 hi m t he scor i ng sheet s and show hi m t he pat i ent s and

18 j ust get t hat conf i r med. Mi ght be easi er f or hi m j ust

19 t o l ook at hi s si gnat ur e i f you' ve got t hose.

20 MS. SI LHAN: Sur e. Ther e' s j ust sever al .

21 I ' d be happy t o.

22

J UDGE SEI TZMAN: Ri ght . You can do t hat23 al l at one t i me and you can ver i f y t hat t hose ar e t he

24 pat i ent s.



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1 J UDGE SEI TZMAN: Can we go of f t he r ecor d

2 a second whi l e we do t hi s?

3 ( Of f t he r ecor d)

4 Q. ( BY MS. SI LHAN) I t hi nk I can act ual l y

5 cl ar i f y. One moment .

6 J UDGE SEI TZMAN: And l et me j ust not e

7 whi l e you' r e l ooki ng, what we di d whi l e we wer e of f t he

8 r ecor d, you handed t he wi t ness some scor i ng f or ms; and

9 so, he had an oppor t uni t y, whi l e we wer e of f t he

10 r ecor d, t o go t hr ough and conf i r m whet her or not he was11 t he one who scor ed var i ous pat i ent s.

12 I s t hat cor r ect , Doct or ?

13 THE WI TNESS: Yes.

14 Q. ( BY MS. SI LHAN) And you handed me one f or m

15 t hat you di d not scor e, cor r ect ?

16 A. No. You asked me who t he si gnat ur e i s and17 t hat ' s not my si gnat ur e.

18 Q. Ar e you sayi ng you scor ed t he f or m but not

19 si gn i t ?

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

21 Can you show i t t o me agai n? That has Dr .

22

Nazar i ' s si gnat ur e.23 Q. Cor r ect . So, you handed me one f orm t hat you

24 di d not si gn; i s t hat cor r ect ?

25 A. Yes, I handed you one - - one - - not my f or m.


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1 t hi s i s not my f orm. How do you - -

2 Q. I ' m agr eei ng wi t h you.

3 J UDGE SEI TZMAN: Doct or , she' s aski ng you:

4 The f or m t hat you handed her back was a f or m t hat you

5 di d not si gn.

6 THE WI TNESS: Cor r ect . Yes.

7 J UDGE SEI TZMAN: I t was not your

8 si gnat ur e?

9 THE WI TNESS: Yes, uh- huh.

10 Q. ( BY MS. SI LHAN) That was one f or m out of t he11 gr oup t hat I handed you, cor r ect ?

12 A. Yes, uh- huh.

13 Q. You si gned al l t he r est , cor r ect ?

14 A. Yes, uh- huh.

15 Q. Al l r i ght . That was Pat i ent 57. I apol ogi ze

16 f or i ncl udi ng t hat pat i ent .17 So, t o conf i r m, you di d scor e Pat i ent s 2,

18 5, 6, 7, and 8? These ar e pat i ent s - - I mean, I handed

19 you t he f or ms. I can - -

20 J UDGE EGAN: Gi ve hi m a chance t o l ook

21 t hr ough.

22

A. I t doesn' t say 2, 5, 6. But I ' l l go wi t h what23 you sai d t hat I di d. I t doesn' t say her e 2, 5.

24 Ther e' s no numbers. Al l i t says i s 11- 09, 11- 15.

25 Q. ( BY MS. SI LHAN) Okay. We can - - I ' l l be


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1 happy t o pul l up t he HLD on t he scr een. These ar e t he

2 f or ms I j ust handed you.

3 A. Yes, yes.

4 Q. You onl y handed one back and expl ai ned t hat5 you di d not si gn onl y one of t he 28 t hat I gave you.

6 Okay.

7 A. Yes.

8 J UDGE EGAN: And he' s - - he' s sayi ng t hat

9 t he number s t hat you' r e usi ng - - you need t o show hi m

10 wher e t hey ar e on t hat f or m so he can - -11 MS. SI LHAN: The name - - t hese ar e - - i f I

12 mi ght expl ai n t o t he Cour t , t hese ar e pet i t i oner ' s

13 exhi bi t s. They ar e not r edact ed and t hey do not have

14 pat i ent number s on t hem.

15 J UDGE SEI TZMAN: I underst and but you' ve

16 got t he r edact ed el ect r oni c ver si on t hat you' r e goi ng17 t o put up so we - - r i ght ?

18 MS. SI LHAN: Yes. I can - - I can do t hat .

19 J UDGE SEI TZMAN: So, as you go t hrough and

20 t al k t o hi m about i t , you' r e goi ng t o put up t he

21 el ect r oni c ver si on t hat we can conf i r m t he pat i ent and

22

exhi bi t number .23 MS. SI LHAN: Okay. So, I ' ve pr epar ed a

24 summary and we can l ook at t he f i l es.

25 So, St acey, can you pul l up - - yes. Yes,


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1 Pl ease, R83. Thi s i s not i n evi dence. I t ' s a summar y.

2 MR. RYTTI NG: I ' d l i ke t o see t hat summar y

3 bef or e you put i t up.

4 MS. SI LHAN: Your Honor , t hi s i s a summary

5 t o hel p t he Cour t . He j ust - -

6 J UDGE SEI TZMAN: Al l he' s asked t o do

7 i s - - counsel has asked t o see a copy of t he document

8 you' r e put t i ng up.

9 MS. SI LHAN: Okay. I have i t i n

10 spr eadsheet f or m i f he' d l i ke t o see i t .11 MR. RYTTI NG: I t ' s not t he - - t hat ' s not

12 goi ng t o be t he f or m you put i t up?

13 MS. SI LHAN: I can put i t up i n t he

14 spr eadsheet f orm. We pr epared a gr aphi c t hat shows t he

15 exact same i nf or mat i on wi t h Dr . Kanaan' s handwr i t i ng on

16 i t .17 J UDGE SEI TZMAN: I f you' ve got t he

18 spr eadsheet , j ust gi ve hi m a copy of t he spr eadsheet ,

19 pl ease.

20 You can keep - - you can keep t he summar y.

21 MS. SI LHAN: Okay. Can you, pl ease, pul l

22

t he summar y up, R83?23 MR. RYTTI NG: We have some quest i ons about

24 goi ng and quest i oni ng t he wi t ness about a summary t hat

25 t hey' ve - - t hey' ve cr eat ed. I f t hey want t o go pat i ent


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1 by pat i ent , t hey can do so. I do not - - I can' t

2 compr ehend what t hi s i s about . I ' d l i ke t o show i t - -

3 J UDGE SEI TZMAN: You' r e not on t he st and,

4 Counsel . So. . .5 MR. RYTTI NG: May I appr oach t he Cour t - -

6 J UDGE SEI TZMAN: No.

7 MR. RYTTI NG: - - and show you what ' s been

8 summar i zed?

9 J UDGE SEI TZMAN: No. Counsel , i t ' s a

10 summar y. I f i t ' s a summar y of t he dat a t hat ' s i n t he11 r ecor d, we' r e goi ng t o al l ow Counsel on cr oss t o go

12 t hr ough i t and we' l l see what t he wi t ness has t o say

13 about i t but t he f act t hat you don' t under st and i t

14 doesn' t necessar i l y make a di f f er ence at t hi s poi nt .

15 Let ' s go on.

16 MR. RYTTI NG: She' s handed me somet hi ng17 di f f er ent .

18 J UDGE SEI TZMAN: I have r ul ed. I have

19 r ul ed.

20 MR. RYTTI NG: Okay.

21 Q. ( BY MS. SI LHAN) Dr . Kanaan, t o descr i be what

22

we' r e l ooki ng at t hi s i s a bar char t and i t shows t he23 possi bl e poi nt s f or ect opi c er upt i on on t he l ef t . Do

24 you see t hat ?

25 A. Yes, uh- huh.


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1 Q. Okay. Do you see at t he bot t om a number?

2 That ' s t he pat i ent number ; i s t hat cor r ect ?

3 A. Yes, uh- huh.

4 Q. Okay. Do you see bel ow t hat a gr i d?5 A. Yes. That ' s mi ne, t oo.

6 Q. That ' s your s?

7 A. Uh- huh.

8 Q. Okay. So, we' r e l ooki ng at Pat i ent 2 and you

9 scor ed 24 poi nt s f or ect opi c; i s t hat r i ght ?

10 A. Uh- huh.11 Q. And you have t he HLD f or m i n f r ont of you, i f

12 you' d l i ke t o consul t i t .

13 A. Yes, uh- huh.

14 Q. Counsel al so has a copy.

15 J UDGE SEI TZMAN: Doct or - - excuse me - - i f

16 you' r e goi ng t o say somet hi ng, you need t o speak up17 l oud enough f or t he mi c t o pi ck i t up, pl ease.

18 Q. ( BY MS. SI LHAN) Can you expl ai n what t hi s

19 gr i d r epr esent s at t he bot t om?

20 A. You need t o pul l t he pi ct ur es. I cannot j ust

21 do i t of f of t hi s one.

22

Q. You have t he HLD f or ms i n f r ont of you. I ' l l23 be happy t o al so pul l up P02.

24 A. No. I want - -

25 Q. I t ' s t he f i r st HLD f or m i n f r ont of you.


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1 A. - - t he pi ct ur es of t he pat i ent s how I scor ed

2 i t . I can' t - -

3 Q. I ' m not aski ng you t o expl ai n how you scored

4 i t . I ' m aski ng you t o t el l us what t he mar ks t hat you

5 made on t he HLD f orms wi t h your si gnat ure what t hose

6 mar ks mean.

7 A. I t t el l s t hat we have ei ght ect opi c.

8 MR. RYTTI NG: Obj ect i on, your Honor .

9 Thi s - - t hi s summar y i s not a document t hat he cr eat ed.

10 We have document s t hat are - - t hat have exact l y t hat11 i nf or mat i on on i t t hat cont ai n hi s ot her scor es t hat

12 wi l l al l ow hi m t o comment and expl ai n.

13 J UDGE SEI TZMAN: You' l l have your

14 oppor t uni t y.

15 MR. RYTTI NG: Under Rul e 106 I don' t t hi nk

16 t hi s - -17 J UDGE SEI TZMAN: You' l l have your

18 oppor t uni t y on - - I guess I ' m cal l i ng cross di r ect

19 si nce we' r e ki nd of doi ng i t backwar ds. So - - but i t ' s

20 a summar y and i t comes f r om t he evi dence t hat ' s i n t he

21 r ecor d. And she' s ent i t l ed t o ask hi m quest i ons about

22

i t . They' r e hi s mar ks. So. . .23 Go ahead. Woul d you r epose your quest i on,

24 Counsel ?

25 MS. SI LHAN: Yes.


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1 Q. ( BY MS. SI LHAN) Can you expl ai n t o t he Cour t

2 what t he gr i d bel ow Pat i ent Number 2' s bar r epr esent s?

3 A. I t r epr esent s t hat t hi s pat i ent has ei ght

4 ect opi c t eet h based on my compr ehensi ve di agnosi s and5 t hese ei ght t eet h ar e t he upper and l ower cent r al and

6 l at er al i nci sor s .

7 Q. Okay. So, i n l aymen' s t er ms t hose ar e t he

8 upper f our f r ont t eet h?

9 A. Yes.

10 Q. And t he l ower f our f r ont t eet h, cor r ect ?11 A. Yes, uh- huh.

12 Q. But not t he cani nes on ei t her si de; i s t hat

13 correct?

14 A. No cani nes. No.

15 Q. Okay.

16 MS. SI LHAN: Let ' s pul l up P02.17 Q. ( BY MS. SI LHAN) We' r e l ooki ng at your HLD

18 f or m f or Pat i ent 2, cor r ect ?

19 A. Yes, yes. Uh- huh.

20 Q. Okay. Does t he gr i d on t hi s HLD f or m

21 r epr esent t he same i nf or mat i on, i s i t t he same gr i d as

22

t he one on t he gr aph?23 A. Yes.


25 And t o conf i r m, your scor e f or t hi s


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1 pat i ent was 24 poi nt s f or ect opi c t eet h?

2 A. Yes.

3 Q. And t he upper f our t eet h wer e al l ect opi c.

4 The upper f our f r ont t eet h wer e al l ect opi c?5 A. Yes.

6 Q. And t he bot t om f our f r ont t eet h wer e al so

7 ect opi c?

8 A. Yes.

9 MS. SI LHAN: Okay. Let ' s move on t o

10 Pat i ent 5, pl ease. Let ' s j ust l ook at P05- 006 on t he11 l ef t and we can keep R83 on t he r i ght , i f t hat ' s okay.

12 Q. ( BY MS. SI LHAN) Can you r ead your HLD ect opi c

13 er upt i on scor e f or Pat i ent 5?

14 A. Thi s pat i ent based on my compr ehensi ve

15 eval uat i on has ei ght ect opi c t eet h, t he f our f r ont

16 t eet h on t he t op and f our t eet h on t he bot t om. Tot al17 scor e 24.

18 Q. Okay. Thank you. I s t hat t he same score as

19 Pat i ent 2?

20 A. I t ' s t he same scor e as Pat i ent Number 2.

21 Q. And t he same t eet h are ect opi c as Pat i ent

22

Number 2, cor r ect ?23 A. Yes.

24 Q. Thank you.

25 Let ' s l ook at Pat i ent 6 now.


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1 MS. SI LHAN: Pul l up 06 on t he l ef t and we

2 can keep R83 on t he r i ght .

3 Q. ( BY MS. SI LHAN) Can you, pl ease, r ead us your

4 scor e f or ect opi c t eet h on t hi s pat i ent ?

5 A. Thi s pat i ent based on my compr ehensi ve

6 eval uat i on has ei ght ect opi c t eet h, t he f our f r ont and

7 t he f our bot t om, t ot al poi nt 24 poi nt s.

8 Q. I s t hat t he same score - -

9 A. Yes, i t i s.

10 Q. - - f or - - l et me f i ni sh my quest i on one11 moment .

12 - - f or Pat i ent 5?

13 A. Yes, i t i s.

14 Q. And Pat i ent 2?

15 A. Yes, i t i s.

16 Q. Okay. And t he same t eet h ar e ect opi c i n al l17 t hr ee pat i ent s; i s t hat cor r ect?

18 A. Yes.

19 Q. Thank you.

20 MS. SI LHAN: Let ' s do 7 now. That ' s

21 P07- 003 on t he l ef t .

22

Q. ( BY MS. SI LHAN) Can you, pl ease, r ead your23 ect opi c scor e f or t hi s pat i ent ?

24 A. Based on my compr ehensi ve eval uat i on, t hi s

25 pat i ent has ei ght ect opi c t eet h, t he f our f r ont and t he


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1 f our bot t om ones, t ot al scor e 24.

2 Q. I s t hat t he same t ot al scor e - -

3 A. Yes, i t i s.

4 Q. - - as you had f or Pat i ent 6?5 A. Yes, i t i s.

6 Q. Pat i ent 5, Pat i ent 2?

7 A. Yes.

8 J UDGE SEI TZMAN: Counsel , I j ust want t o

9 be cl ear . Ar e you aski ng i f i t ' s t he same t ot al scor e

10 or t he same ect opi c er upt i on scor e?11 MS. SI LHAN: I apol ogi ze. The same score

12 f or ect opi c er upt i on. I ' m sor r y. The same scor e f or

13 ect opi c er upt i on.

14 Q. ( BY MS. SI LHAN) I s t hat cor r ect ?

15 A. Yes.

16 Q. Thank you.17 Wer e t he same t eet h scored as ect opi c i n

18 Pat i ent 7 as Pat i ent 6?

19 A. Yes.

20 Q. As Pat i ent 5?

21 A. Yes.

22

Q. As Pat i ent 2?23 A. Yes.

24 Q. Thank you.

25 MS. SI LHAN: Okay. On t he l ef t l et ' s pul l


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1 up Pat i ent 8, P08. I t ' s t he f i r st page of t he f i l e.

2 Q. ( BY MS. SI LHAN) Dr . Kanaan, can you, pl ease,

3 r ead your ect opi c er upt i on scor e f or t hi s pat i ent ?

4 A. Based on my compr ehensi ve eval uat i on, t hi s5 pat i ent has ei ght ect opi c t eet h, t he f our f r ont ones

6 and f our bot t om ones, t ot al scor e 24 f or ect opi c

7 er upt i on.

8 Q. We can cut t o t he chase here. That ' s t he same

9 scor e f or Pat i ent 2, 5, 6 and 7?

10 A. Yes.11 Q. Okay. And t he same t eet h are ect opi c i n 2, 5,

12 6 and 7 and t he cur r ent Pat i ent 8?

13 A. Yes.


15 I s t hi s a pat t er n, Dr . Kanaan?

16 A. What do you mean by "pat t er n"?17 Q. Wel l , we' r e j ust l ooki ng at t he way you scor e

18 ect opi c er upt i on, whi ch makes up a si gni f i cant number

19 of scores on t hese sheet s t hat we' ve l ooked at .

20 A. That ' s - -

21 Q. I s t hi s a pat t er n?

22

A. That ' s a descr i pt i on of t hese f our pat i ent s23 t hat you pul l ed.

24 Q. Okay. So - - so, you woul dn' t say t hat f i ve

25 pat i ent s r epr esent s a pat t er n?


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1 A. No, absol ut e - -

2 Q. Okay.

3 A. A pat t er n - -

4 MS. SI LHAN: St acey, can you scr ol l

5 over - -

6 J UDGE SEI TZMAN: Excuse me. Hang on. You

7 cut hi m of f .

8 MS. SI LHAN: Oh, I ' m sor r y.

9 THE WI TNESS: Can I expl ai n f ur t her ?

10 J UDGE SEI TZMAN: No. You j ust st ar t ed t o11 say, "No, absol ut el y" and t hen I t hi nk you got cut of f .

12 THE WI TNESS: I ' m okay.

13 J UDGE SEI TZMAN: Do you want t o f i ni sh

14 t hat answer r i ght now?

15 THE WI TNESS: No, no. I t ' s not an answer .

16 I ' m done wi t h my answer .17 Q. ( BY MS. SI LHAN) Thank you.

18 MS. SI LHAN: St acey, can you scr ol l over ?

19 St op, pl ease. Oh, l et ' s keep 9 t hr ough 25 on t he page.

20 Okay. Let ' s pul l up - - can we pul l up on

21 t he l ef t , keepi ng t hi s on t he r i ght , P09- 003?

22

Q. ( BY MS. SI LHAN) Dr . Kanaan, can you, pl ease,23 r ead your ect opi c er upt i on scor e on t hi s pat i ent ?


25 pat i ent has ei ght ect opi c t eet h, f our f r ont , f our


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1 bot t om, t ot al score 24.

2 Q. Okay. Now, do you r ecal l t hat t he pr evi ous

3 pat i ent - - f i ve pat i ent s we l ooked at di d t hey al l have

4 a score of 24 as wel l ?

5 A. Yes.

6 Q. Di d t hey al l have t he same t eet h scored as

7 ect opi c?

8 A. Yes.

9 Q. Thank you.

10 MS. SI LHAN: Pat i ent 18 on t he l ef t now,11 P18.

12 Q. ( BY MS. SI LHAN) Can you, pl ease, r ead your

13 scor e f or ect opi c er upt i on on t hi s pat i ent ?


15 pat i ent has ei ght ect opi c t eet h, t he f our f r ont , f our

16 bot t om, t ot al score 24.17 Q. Thank you.

18 I s t hat t he same as Pat i ent 9 f or bot h t he

19 scor e and t he t eet h t hat wer e ect opi c?

20 A. Yes.

21 Q. I s t hat t he same as Pat i ent 8?

22

A. Yes.23 Q. I s t hat t he same as Pat i ent 7?

24 A. Yes.

25 Q. And 6?


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1 A. Yes.

2 Q. And 5?

3 A. Yes.

4 Q. And 2?5 A. Yes.

6 Q. Okay.

7 J UDGE SEI TZMAN: Counsel - - and I ' m not

8 meani ng t o t el l you how t o do your di r ect or cr oss

9 her e - - but i t ' l l save us a l i t t l e bi t of t i me si nce

10 whoever t he pr evi ous - - we' ve ki nd of got a chai n of A11 t hr ough F now and we know t hat t hey' r e al l equal . So,

12 I don' t t hi nk we have t o go back t hr ough each one, as

13 l ong as t he subsequent one - -

14 MS. SI LHAN: Sur e.

15 J UDGE SEI TZMAN: - - i s t he same - -

16 MS. SI LHAN: Gr eat .17 J UDGE SEI TZMAN: - - as t he pr i or one.

18 MS. SI LHAN: Got i t .

19 J UDGE SEI TZMAN: Then t hey shoul d al l be

20 equal .

21 MS. SI LHAN: Thanks.

22

Let ' s pul l up pat i ent 20 on t he l ef t .23 That ' s 20- 011 i s t he HLD.


25 t ot al HLD ect opi c er upt i on scor e f or t hi s pat i ent ?


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1 A. 27 poi nt s.

2 Q. Thank you.

3 Whi ch t eet h wer e ect opi c i n t hi s pat i ent ?

4 A. The f i ve t op and t he f our bot t oms.5 Q. And of t he f i ve t op, do you mean - -

6 A. I t ' s upper r i ght cani ne, upper r i ght l at er al ,

7 upper r i ght cent r al , upper l ef t cent r al , upper l ef t

8 cent r al l at er al .

9 Q. Thank you.

10 Thi s scor e i s di f f er ent f r om t he ot her s,11 cor r ect , t hat we' ve l ooked at - -

12 A. Yes.

13 Q. - - f or ect opi c er upt i on?

14 Thank you.

15 MS. SI LHAN: Let ' s l ook at 21. 21 i s

16 P21- 006.17 Q. ( BY MS. SI LHAN) Dr . Kanaan, can you, pl ease,

18 r ead your ect opi c er upt i on scor e?

19 A. 24.

20 Q. And whi ch t eet h wer e ect opi c?

21 A. The f our f r ont , f our bot t om.

22

Q. Thank you.23 Now, t hi s i s di f f er ent t han Pat i ent 20,

24 correct?

25 A. The scor e i s di f f er ent , yes.


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1 Q. But t he same as al l t he ot her s we l ooked at ?

2 A. The scor i ng, yes.

3 Q. Thank you.

4 MS. SI LHAN: Pat i ent 24. HLD i s at5 P24- 014.

6 MR. RYTTI NG: Your Honor , I ' d l i ke t o - -

7 I ' m not sur e t hat he di d Pat i ent 24. I ' d l i ke t o

8 conf i r m t hat , l ay t he pr edi cat e f or t hat .

9 J UDGE SEI TZMAN: Can you - - do you have

10 t he scor i ng sheet ? Can - -11 MS. SI LHAN: Yes, we do.

12 J UDGE SEI TZMAN: Pl ease show hi m t he

13 scor i ng sheet . See i f t hat ' s hi s - -

14 Q. ( BY MS. SI LHAN) I s t hat your scor i ng

15 si gnat ur e?

16 A. Yes, i t i s.17 MS. SI LHAN: I s t hat okay?


19 ect opi c er upt i on scor e?

20 A. 24 poi nt s.

21 Q. Whi ch t eet h wer e ect opi c i n t hi s pat i ent ?

22

A. Four f r ont , f our bot t om.23 Q. Okay.

24 MS. SI LHAN: St acey, can we scr ol l t o t he

25 l ef t ? Oh, ot her way.


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1 Q. ( BY MS. SI LHAN) Do t hese t en pat i ent s

2 r epr esent a pat t er n of scor i ng?

3 A. No.

4 Q. Okay. Then l et ' s cont i nue see i f - - i f

5 t her e' s anyt hi ng di f f er ent .

6 MS. SI LHAN: Let ' s st ar t wi t h Pat i ent 25,

7 P64- 025, pl ease.

8 Ther e' s a l i t t l e conf usi on.

9 Q. ( BY MS. SI LHAN) Thi s pat i ent f i l e, P - - P25

10 di d not have an HLD scor e sheet i n i t but t he separ at e11 at t achment s t hat wer e pr ovi ded t o us i n di scover y i n

12 t hi s case or pr ovi ded as exhi bi t s i n t hi s case t hey di d

13 cont ai n an HLD score sheet t hat wasn' t pr ovi ded t o OI G.

14 MS. SI LHAN: Let ' s go t o one down - -

15 MR. RYTTI NG: We need t o obj ect . She

16 needs t o ask hi m i f he r ecogni zes t hi s document .17 Q. ( BY MS. SI LHAN) I s t hi s your si gnat ur e on t he

18 document ?

19 A. Yes.

20 Q. Can you t el l us what you scored f or ect opi c

21 er upt i on on t hi s pat i ent ?

22

A. 24 Poi nt s.23 Q. Can you t el l us whi ch t eet h wer e ect opi c on


25 A. The f our - - f our f r ont , f our bot t om.


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1 Q. I s t hat t he same as al l t he ot her pat i ent s we

2 l ooked at , except one?

3 A. Same scor i ng?

4 Q. Yes.5 A. Same scor i ng number , yes.

6 Q. Thank you.

7 MS. SI LHAN: Let ' s l ook at Pat i ent 27,

8 P27- 005.

9 Q. ( BY MS. SI LHAN) Can you r ead your t ot al

10 ect opi c er upt i on scor e f or t hi s pat i ent ?11 A. 24 poi nt s.

12 Q. Thank you.

13 Can you t el l us whi ch t eet h wer e ect opi c

14 on t hi s pat i ent ?

15 A. The f our f r ont , f our bot t om.

16 Q. Thanks.17 I s t hi s t he same as al l t he ot her

18 pat i ent s, except Pat i ent 20?

19 A. Yes, same scor es.

20 Q. Thanks.

21 MS. SI LHAN: Let ' s l ook at Pat i ent 28.

22

That ' s P28- 013 i s t he HLD.23 Q. ( BY MS. SI LHAN) Can you r ead your t ot al

24 ect opi c scor e f or t hi s pat i ent ?

25 A. 24.


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1 Q. Can you t el l us whi ch f our t eet h you scor ed as

2 ect opi c?

3 A. The f our t op, f our bot t om.

4 Q. Thi s i s t he same - - you know, cut t o t he5 chase - -

6 A. Yes, yes.

7 Q. - - t hi s i s t he same as al l t he ot her s except

8 one?

9 A. Yes.

10 Q. Thanks.11 MS. SI LHAN: Let ' s do 29. Unl ess - - we

12 can hol d of f on t he 29.

13 Q. ( BY MS. SI LHAN) Do you see a pat t ern here?

14 A. I don' t see a pat t er n, no.

15 Q. Okay. 29, what ' s your t ot al scor e f or ect opi c

16 er upt i on?17 MS. STACEY MANELA: What page on 29?

18 MS. SI LHAN: Oh, I apol ogi ze. I t ' s

19 P29- 008.

20 A. 24 poi nt s, t he f our upper , f our l ower .

21 Q. ( BY MS. SI LHAN) The same as al l t he ot her s,

22

except Pat i ent 20; i s t hat r i ght ?23 A. Yes.

24 Q. Okay.

25 MS. SI LHAN: Pat i ent 30, pl ease. That ' s


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1 P30- 008.


3 ect opi c er upt i on scor e f or t hi s pat i ent ?

4 A. 24 poi nt s, f our upper , f our l ower .

5 Q. Agai n, t he same as t he ot her s - -

6 A. Yes, pl ease.

7 Q. - - except t hat one?

8 A. Yes.

9 Q. Okay. We' r e goi ng t o go on - - do you see a

10 pat t er n her e?11 A. I don' t see a pat t er n, no.


13 Let ' s scr ol l over a l i t t l e bi t on t he

14 r i ght and see Number 34. And t here' s t wo 34s because

15 t her e wer e t wo HLD scor e sheet s i n t hi s pat i ent ' s f i l e.

16 So, l et ' s l ook at t he f i r st one. That ' s P34- 017.17 Can you r ead t he scor e f or t hi s pat i ent ?

18 A. 24 poi nt s.

19 Q. Wer e t he same t eet h scor ed as ect opi c as t he

20 ot her s - -

21 A. Yes.

22

Q. - - mi nus 20?23 A. Yes.

24 Q. Thanks. Let ' s l ook at t he second HLD scor e

25 sheet f or t hi s pat i ent . P34- 0008.


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1 Can you r ead your t ot al scor e?

2 A. 27 poi nt s.

3 MR. RYTTI NG: Agai n, j ust f or t he r ecor d,

4 di d she say t ot al ect opi c scor e?5 J UDGE SEI TZMAN: I t hi nk we j ust got a

6 r unni ng under st andi ng t hat we' r e j ust t al ki ng about

7 ect opi c scor es at t hi s poi nt .

8 Q. ( BY MS. SI LHAN) Can you t el l us whi ch t eet h

9 wer e scor ed ect opi c on t hi s pat i ent f or t hi s second

10 HLD?11 A. The f our f r ont , pl us t he upper r i ght cani ne

12 and t he l ower f our t eet h.

13 Q. Okay. So, t hi s one i s not l i ke t he ot her s,

14 except - -

15 A. I added one t oot h.

16 Q. That ' s r i ght .17 J UDGE EGAN: Okay. I s t hat hi s si gnat ur e

18 at t he bot t om?

19 THE WI TNESS: Yes, i t i s.

20 MS. SI LHAN: Yeah. Asi de f r om t he one at

21 t he ver y end of my l i st her e, whi ch we - - we t ook out

22

and you i dent i f i ed, we' ve gone - - t hese ar e f r om t he23 HLDs he' s vi ewed and ver i f i ed hi s si gnat ur e on j ust

24 to - -

25 J UDGE EGAN: J ust want ed t o make sure


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1 because i t l ooked di f f er ent .


3 Let ' s l ook at Pat i ent 35, pl ease.

4 J UDGE SEI TZMAN: We' r e usual l y t r ai ned i n5 handwr i t i ng anal ysi s but somet i mes we sl i p.

6 MS. SI LHAN: P35- 003, pl ease.

7 And I apol ogi ze. On 35, t he i mage bel ow

8 t he scor e i s i ncor r ect on our char t on t he r i ght .

9 You' l l - -

10 Q. ( BY MS. SI LHAN) Can you t el l us what your11 ect opi c er upt i on scor e i s f or t he HLD on Pat i ent 35?

12 A. 24 poi nt s.

13 Q. And whi ch t eet h?

14 A. The f our upper - - t he f our upper and t he f our

15 l ower .

16 Q. Thank you. For t he r ecord under t he summar y17 on 35, t hat ' s not a cor r ect i mage, r i ght ?

18 A. Yes.

19 Q. I nst ead i t ' s t hi s one on your f or m, cor r ect ?

20 A. Yes.

21 Q. Whi ch i s t he f our upper and f our l ower ; i s

22

t hat r i ght ?23 A. Yes, yes.


25 MS. SI LHAN: Let ' s l ook at 36. That i s


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1 P36- 011.


3 ect opi c er upt i on scor e f or t hi s pat i ent ?

4 A. 24 poi nt s, t he f our upper and t he f our l ower .

5 Q. And t hat ' s t he same as al l t he ot her s, except

6 Pat i ent 20 and except f or t he second HLD i n Pat i ent 34?

7 A. Yes.

8 Q. Do you see a pat t ern here?

9 A. No.

10 Q. Okay.11 MS. SI LHAN: Let ' s go t o 37, P37- 015.

12 Q. ( BY MS. SI LHAN) Can you r ead your scor e f or

13 ect opi c er upt i on?

14 A. 21 poi nt s, upper cent r al s, t he upper l ef t

15 cani ne and t he l ower f our f r ont t eet h.

16 Q. Okay. Thank you.17 Bef ore we move on, I j ust want t o do a

18 l i t t l e qui ck mat h.

19 Okay. So, t hi s scor e i s di f f er ent t han

20 most of t he ot her s we' ve l ooked at ; i s t hat cor r ect ?

21 A. Yes.

22

Q. And i t has di f f er ent t eet h, cor r ect ?23 A. Yes.

24 Q. Okay. And t hat ' s Pat i ent 37, r i ght ?

25 A. Yes.


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1 Q. Okay. We' ve l ooked at 20 HLD scor e sheet s and

2 19 pat i ent s so f ar ; i s t hat cor r ect ?

3 A. I ' m assumi ng, based on your cal cul at i ons.

4 Q. Okay. Wel l , I ' l l r epr esent t o you t hat t hat ' s5 what we' ve l ooked at ; and i f you' d l i ke t o count your

6 sheet s, you may.

7 Out of t hose 20 HLDs and 19 pat i ent s, 17

8 have scor ed 24 f or ect opi c er upt i on; i s t hat cor r ect ?

9 We can go back and l ook. I bel i eve t her e' s onl y been

10 t hr ee.11 A. Yes, yes.

12 Q. Has t her e not ?

13 A. Yes.


15 And t hey al l have t he same t eet h descr i bed

16 as ect opi c; i s t hat cor r ect ?17 A. Yes.

18 Q. Do you see a pat t ern?

19 A. No.

20 MS. SI LHAN: Okay. Let ' s go t o t he next

21 one. Pat i ent 39, 39- 008.

22

Q. ( BY MS. SI LHAN) Can you r ead us your ect opi c23 er upt i on scor e f or t hi s pat i ent ?

24 A. 24 poi nt s.

25 Q. Whi ch t eet h ar e t hose t hat ar e scored ect opi c?


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1 A. Four f r ont , f our bot t oms.

2 Q. Okay. The same as al l t he ot her s - -

3 A. Yes, pl ease.

4 Q. - - mi nus t hr ee, cor r ect ?5 A. Yes.

6 Q. Thank you.

7 Now, we can keep goi ng.

8 MS. SI LHAN: Let ' s go t o 41, 41- 012,

9 pl ease.

10 Q. ( BY MS. SI LHAN) Can you r ead us your ect opi c11 er upt i on scor e?

12 A. 24 poi nt s. The f our f r ont t op, f our bot t om

13 ones.

14 Q. Okay. The same as al l t he ot her s mi nus t he

15 t hr ee?

16 A. Yes.17 Q. Thank you.

18 MS. SI LHAN: Let ' s do 42, P42- 016.

19 Q. ( BY MS. SI LHAN) Can you r ead us your ect opi c

20 er upt i on scor e?

21 A. 24 poi nt s, t he f our f r ont , f our bot t oms.

22

Q. Okay. The same as t he ot hers mi nus t hr ee23 agai n, cor r ect ?

24 A. The same, yes.

25 Q. Okay. So, 20 have t he same scor e. Thr ee have


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1 di f f er ent scor es?

2 A. Yes.

3 MS. SI LHAN: Let ' s do 43, P43- 006.

4 Q. ( BY MS. SI LHAN) We' l l get t hr ough t he r est of5 t hese qui ckl y.

6 What ' s your t ot al scor e f or ect opi c her e?

7 A. 24 poi nt s, f our t op, f our bot t om.

8 Q. Okay. Li ke most of t he ot her s, cor r ect ?

9 A. Yes.

10 MS. SI LHAN: Okay. Let ' s go on t o t he11 next pat i ent , 45, P45- 008.

12 Okay. Wel l , can you pul l up 45? I t ' s not

13 on t he gr aph.

14 J UDGE SEI TZMAN: Counsel , di d you say

15 43 - - okay. I see what you' r e sayi ng but i t was t he

16 same scor e. Di d - - was i t t he same t eet h?17 MS. SI LHAN: Yes. I t ' s t he - -

18 J UDGE SEI TZMAN: Okay.

19 MS. SI LHAN: Oh, oh, I ' m sor r y.

20 Dr . Kanaan.

21 J UDGE SEI TZMAN: Dr . Kanaan, was - -

22

THE WI TNESS: Yes, i t was. Yes.23 J UDGE SEI TZMAN: 43 was t he same scor e f or

24 ect opi c as al l t he ot her s?

25 THE WI TNESS: Yes, si r . Yes.


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1 J UDGE SEI TZMAN: The gr aph i sn' t showi ng

2 that.

3 THE WI TNESS: Thi s doesn' t go wi t h t hat

4 one.

5 J UDGE SEI TZMAN: I know. But I ' m j ust

6 l ooki ng at t he gr aph f or 43 ver sus 42 and 43 on t he

7 gr aph.

8 THE WI TNESS: The bar ' s - - t he bar ' s

9 i ncor r ect .

10 J UDGE SEI TZMAN: 43 seems hi gher t han 42.11 MS. SI LHAN: Yeah, you' r e r i ght . I t

12 shoul d be - - i t shoul d j ust go up t o t he 24. I bel i eve

13 t hat - - act ual l y what ' s l abel ed as 43 i s meant t o be

14 t hi s Pat i ent 45.

15 Q. ( BY MS. SI LHAN) Can you r ead your t otal scor e

16 f or 45 on t he l ef t ?17 A. 27 poi nt s.

18 Q. Okay. And whi ch t eet h were ect opi c?

19 A. The f our f r ont pl us t he upper l ef t cani ne and

20 t he f our bot t om ones.

21 Q. Thank you.

22

Let ' s l ook at 46.23 J UDGE SEI TZMAN: So, j ust so t he r ecor d' s

24 cl ear , we had 42 and 45 as 43, j ust a pat i ent of hi s

25 t hat he scor ed t hat ' s not - - i s omi t t ed f r om t he gr aph


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1 or was i t - -

2 MS. SI LHAN: I t i s. I t ' s mi snumber ed and

3 what ' s l i st ed t her e, t he pat i ent number and what ' s

4 bel ow i t , t he gr i d, t hose ar e f or pat i ent - - t hat ' s5 cor r ect . The gr aph i s - - i s what shoul d be 45, whi ch

6 i s on t he l ef t her e and i t ' s scor ed at 27.

7 J UDGE SEI TZMAN: So, we have a mi ssi ng

8 t oot h her e; i s t hat cor r ect ? Okay.

9 MS. SI LHAN: We have a mi ssi ng

Documents

Vol. 3 Antoine Dental Centers vs. THHSC, OIG -Dr. Kanaan