Downing M.D. Deposition PDF

GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 1 ·1· · · · · · · · · · ·CAUSE NO.· DC-19-18636 ·2 ·3· ·CICILY JOHN and TONY JOHN,· · ·) IN THE DISTRICT COURT · · ·Individually, and as Parents· ·) ·4· ·and N...

GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 1 ·1· · · · · · · · · · ·CAUSE NO.· DC-19-18636 ·2 ·3· ·CICILY JOHN and TONY JOHN,· · ·) IN THE DISTRICT COURT · · ·Individually, and as Parents· ·) ·4· ·and Next Friends of S.T.,· · · ) · · ·a minor child,· · · · · · · · ·) ·5· · · · · · · · · · · · · · · · · ) · · · · · · Plaintiffs,· · · · · · ·) ·6· · · · · · · · · · · · · · · · · ) · · ·V.· · · · · · · · · · · · · · ·) DALLAS COUNTY, TEXAS ·7· · · · · · · · · · · · · · · · · ) · · ·TOUCHSTONE MEDICAL IMAGING,· · ) ·8· ·LLC; TOUCHSTONE MEDICAL· · · · ) · · ·IMAGING, LLC d/b/a TOUCHSTONE· ) ·9· ·IMAGING RICHARDSON;· · · · · · ) · · ·TOUCHSTONE IMAGING OF· · · · · ) 10· ·MESQUITE, LP d/b/a TOUCHSTONE· ) · · ·IMAGING RICHARDSON; BTDI· · · ·) 11· ·JV, LLP d/b/a TOUCHSTONE· · · ·) · · ·IMAGING RICHARDSON;· · · · · · ) 12· ·RICHARDSON PEDIATRIC· · · · · ·) · · ·ASSOCIATES; GREGORY C.· · · · ·) 13· ·DOWNING, M.D.; GDX, P.A.;· · · ) · · ·and NORAH K. RANDLES, M.D.,· · ) 14· · · · · · · · · · · · · · · · · ) · · · · · · Defendants.· · · · · · ·) 191ST JUDICIAL DISTRICT 15· ·~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 16 17· · · · · · · ·ORAL AND VIDEOTAPED DEPOSITION OF 18· · · · · · · · · ·GREGORY C. DOWNING, M.D. 19· · · · · · · · · · · · ·March 5, 2021 20 21· · · · · ORAL DEPOSITION OF GREGORY C. DOWNING, M.D., 22· ·produced as a witness at the instance of the Plaintiff, 23· ·and duly sworn, was taken in the above-styled and 24· ·numbered cause on the 5th day of March, 2021, from 9:10 25· ·a.m. to 12:31 p.m. before Donna L. Johnston, CSR in and 800.211.DEPO (3376) EsquireSolutions.com  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 2 ·1· ·for the State of Texas, reported by stenographic machine ·2· ·shorthand, in the City of Tulsa, County of Tulsa, State ·3· ·of Oklahoma, pursuant to the Texas Rules of Civil ·4· ·Procedure, the First Emergency Order Regarding the ·5· ·COVID-19 State of Disaster, and the provisions stated on ·6· ·the record or attached hereto. ·7 ·8 ·9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 800.211.DEPO (3376) EsquireSolutions.com  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 3 ·1· · · · · · · · · · Appearances of Counsel ·2 · · ·On Behalf of Plaintiffs, CICILY JOHN and TONY JOHN: ·3 · · ·Russell Button, Esq. ·4· ·Ashley Washington, Esq. · · ·THE BUTTON LAW FIRM ·5· ·4315 W. Lovers Lane, Suite A · · ·Dallas, Texas 214.888.2216 ·6· ·[email protected] · · ·[email protected] ·7 ·8· ·On Behalf of Defendants, GREGORY C. DOWNING, M.D. and · · ·GDX, P.A.: ·9 · · ·Jeffrey W. Ryan, Esq. 10· ·CHAMBLEE RYAN, P.C. · · ·2777 Stemmons Freeway, Suite 1257 11· ·Dallas, Texas· 75207 · · ·214.905.2003 12· ·[email protected] 13 · · ·On Behalf of Defendants, NORAH RANDLES, M.D. and 14· ·RICHARDSON PEDIATRIC ASSOCIATES: 15· ·Rikki L. Hirshman, Esq. · · ·KERSHAW ANDERSON, PLLC 16· ·12400 Coit Road, Suite 570 · · ·Dallas, Texas· 75251 17· ·214.347.4993 · · ·[email protected] 18 19· ·On Behalf of Defendants, TOUCHSTONE MEDICAL IMAGING, · · ·LLC, TOUCHSTONE IMAGING OF MESQUITE, LP, AND TDI JV, LLP 20· ·d/b/a TOUCHSTONE IMAGING RICHARDSON: 21· ·Cathy F. Bailey, Esq. · · ·STEED DUNNILL REYNOLDS BAILEY STEPHENSON, LLP 22· ·1717 Main Street, Suite 2950 · · ·Dallas, Texas 75201 23· ·469.698.4200 · · ·[email protected] 24 25· ·ALSO APPEARING:· · · Barrett Parker, videographer 800.211.DEPO (3376) EsquireSolutions.com  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 4 ·1· · · · · · · · · · · · · · Index ·2 · · ·WITNESS:· GREGORY C. DOWNING, M.D. ·3 · · ·EXAMINATION· · · · · · · · · · · · · · · · PAGE ·4· ·By Mr. Button· · · · · · · · · · · · · · · ·6 · · ·By Ms. Bailey· · · · · · · · · · · · · · · ·94 ·5 · · ·Signature and changes sheet· · · · · · · · ·101 ·6 · · ·Reporter's certification· · · · · · · · · · 103 ·7 ·8 ·9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 5 ·1· · · · · · DEPOSITION ON GREGORY C. DOWNING, M.D. ·2· · · · · · · · · · · · ·March 5, 2021 ·3 ·4· · · · · THE VIDEOGRAPHER:· Good morning.· We are on the ·5· ·record.· Today's date is March 5, 2021; the current time ·6· ·is 9:10 a.m.· This is the videotaped deposition of Greg ·7· ·Downing, et al versus Touchstone Medical Imaging, LLP, ·8· ·et al.· This case is being heard in the District Court ·9· ·of Dallas County, Texas 191st Judicial District, Case 10· ·Number is DC-19-18636.· My name is Barrett Parker; I'm 11· ·your remote videographer.· The remote court reporter is 12· ·Donna Johnston. 13· · · · · ·Will you please introduce yourselves and the 14· ·witness will be sworn in. 15· · · · · ·MR. BUTTON:· I'm Russell Button on behalf of the 16· ·plaintiffs. 17· · · · · ·MR. RYAN:· Jeffrey Ryan for Dr. Downing and GDX, 18· ·P.A. 19· · · · · ·MS. HIRSHMAN:· Rikki Hirshman for Norah K. 20· ·Randles and Richardson Pediatric Associates. 21· · · · · ·MS. BAILEY:· And Cathy Bailey on behalf of the 22· ·Touchstone defendants. 23· · · · · · · · · ·GREGORY C. DOWNING, M.D., 24· ·having been first duly sworn, testified as follows: 25· · · · · · · · · · · · · EXAMINATION 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 6 ·1· ·BY MR. BUTTON: ·2· · · Q.· ·Dr. Downing, my name is Russell Button, and I'm ·3· ·gonna be taking most of your deposition today.· I wanted ·4· ·to go ahead and make sure we go over a couple of things ·5· ·for Zoom.· Can you hear me okay? ·6· · · A.· ·Yes, I can. ·7· · · Q.· ·Great.· Can you state your name for the record? ·8· · · A.· ·Greg Downing. ·9· · · Q.· ·And do you have a middle name, Mr. Downing? 10· · · A.· ·My formal name is Gregory C. Downing. 11· · · Q.· ·Okay.· And what does the "· C" -- What's the 12· ·word with the "C"?· What's the name? 13· · · A.· ·Cyril. 14· · · Q.· ·And how you spell that? 15· · · A.· ·C-Y-R-I-L. 16· · · Q.· ·Okay.· And what's your date of birth, Dr. 17· ·Downing? 18· · · A.· ·1/8/52. 19· · · Q.· ·All right.· And Dr. Downing, just because this 20· ·is via Zoom, the expectations are going to be the same 21· ·as if we were in person; do you understand that? 22· · · A.· ·Yes. 23· · · Q.· ·So no texting, no communication with counsel or 24· ·other people while I'm asking you questions while we're 25· ·on the record; do you agree to that? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 7 ·1· · · A.· ·Yes. ·2· · · Q.· ·Okay.· And is there anyone in the room there ·3· ·with you today other than yourself? ·4· · · A.· ·No. ·5· · · Q.· ·Okay.· Now, Dr. Downing, you're doing a great ·6· ·job letting me get my whole question out.· There is that ·7· ·lag at times on Zoom, so I'm gonna, you know, pause a ·8· ·little bit once you finish to make sure that you're ·9· ·done, and if you'll do the same thing for me, to let me 10· ·get my whole question out, that way we're not over 11· ·talking each other; is that fair? 12· · · A.· ·Yes. 13· · · Q.· ·All right.· If at any point you need a break and 14· ·I haven't already taken one, just let me know.· And if I 15· ·have a question or two on the table, if you could answer 16· ·those, then we'll take a break.· But this isn't going to 17· ·be a marathon, okay? 18· · · A.· ·All right.· That's fine. 19· · · Q.· ·Dr. Downing, where do you currently live? 20· · · A.· ·I just accepted a job March 1st with Web 21· ·Partners, and I am working primarily in Doctors Hospital 22· ·in Laredo, Texas. 23· · · Q.· ·Okay.· And is that your cell phone next to you? 24· · · A.· ·Yes. 25· · · Q.· ·Do you mind clicking it -- clicking the silence 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 8 ·1· ·off, please? ·2· · · A.· ·Okay. ·3· · · Q.· ·All right.· So can you clean that up? ·4· · · · · ·Who did you accept a job with; what was the name ·5· ·of the company, ·6· · · A.· ·Rad Partners, R-A-D P-A-R-T-N-E-R-S. ·7· · · Q.· ·Okay.· And is that going to be in addition to ·8· ·your work through GDX PA? ·9· · · A.· ·No, we've closed GDX PA. 10· · · Q.· ·Okay.· When did GDX PA close? 11· · · A.· ·March 1st. 12· · · Q.· ·Okay.· So did Rad Partners buy GDX, or did GDX 13· ·just close? 14· · · A.· ·Just closed. 15· · · Q.· ·Okay.· Is there a reason why you closed GDX? 16· · · A.· ·I've gone from a 1099 with GDX to an employee 17· ·position with Rad Partners. 18· · · Q.· ·Okay.· So now you are going to be a W-2 employee 19· ·of Rad Partners? 20· · · A.· ·Yes. 21· · · Q.· ·Okay.· Will you be doing the same work that you 22· ·were doing for GDX? 23· · · A.· ·For the most part, yes. 24· · · Q.· ·Okay.· So let's back up one second.· You are in 25· ·Tulsa.· I believe you live in Frisco; is that correct? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 9 ·1· · · A.· ·Yes. ·2· · · Q.· ·Okay.· And where do you live in Frisco? ·3· · · A.· ·Where did I live? ·4· · · Q.· ·Yes, sir, where did you live in Frisco? ·5· · · A.· ·6078 Norwood, N-O-R-W-O-O-D, Drive in Frisco ·6· ·74034. ·7· · · Q.· ·Where -- When you were working with GDX PA and ·8· ·living in Frisco, where would you typically do your ·9· ·radiology work? 10· · · A.· ·Probably 99 percent of it was at Touchstone 11· ·Imaging in Lewisville. 12· · · Q.· ·Okay.· And what address of the facility in 13· ·Lewisville would you typically work at? 14· · · A.· ·I've got no idea.· I would have to look it up. 15· · · Q.· ·Okay.· Was it one particular area in Lewisville 16· ·that you would go to? 17· · · A.· ·Yes. 18· · · · · ·THE REPORTER:· Excuse me.· Excuse me. 19· · · Q.· ·(BY MR. BUTTON)· And can you find that 20· ·information for us and provide that to your counsel? 21· · · · · ·THE REPORTER:· Excuse me, Counsel. 22· · · · · ·MR. BUTTON:· Yes. 23· · · · · ·THE REPORTER:· The videographer has dropped off. 24· ·Can we go off of the record for a moment and let him get 25· ·back on, please? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 10 ·1· · · · · ·MR. BUTTON:· No problem. ·2· · · · · ·THE REPORTER:· Thank you.· We are going off the ·3· ·record at 9:17. ·4· · · · · ·THE VIDEOGRAPHER:· I'm back on. ·5· · · · · ·THE REPORTER:· One second, Mr. Parker, and I ·6· ·will make you host. ·7· · · · · ·THE VIDEOGRAPHER:· Okay.· I've got mine hooked ·8· ·back up.· Okay.· We are back on the record; the time is ·9· ·9:17. 10· · · · · ·MR. BUTTON:· Was there anything missed, Ms. 11· ·Johnston or -- 12· · · · · ·THE REPORTER:· Yes.· Mr. Button -- 13· · · · · ·THE VIDEOGRAPHER:· It continued to record. 14· · · · · ·THE REPORTER:· I'm sorry? 15· · · · · ·THE VIDEOGRAPHER:· Okay.· We're off the record. 16· · · · · ·(Recess taken) 17· · · · · ·THE VIDEOGRAPHER:· We are now on the record; the 18· ·time is 9:18. 19· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, we had to go off 20· ·the record for just a moment.· Where we left off was you 21· ·were -- I asked you if you knew the address for the 22· ·facility that you typically did 99 percent of your work 23· ·for Touchstone at in Lewisville; do you have that 24· ·address for us? 25· · · A.· ·Yes, I do. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 11 ·1· · · · · ·MS. BAILEY:· Objection, form. ·2· · · Q.· ·(BY MR. BUTTON)· And what is that address? ·3· · · A.· ·190 Civic Circle, Suite 125, Lewisville, Texas ·4· ·75067. ·5· · · Q.· ·And the facility you just gave us the address ·6· ·for was the Touchstone facility that you would do 99 ·7· ·percent of your work at? ·8· · · A.· ·Yes. ·9· · · · · ·MS. BAILEY:· Hold on.· Object to form. 10· · · Q.· ·(BY MR. BUTTON)· Go ahead and answer now. 11· · · A.· ·Yes, it was a Touchstone Imaging center. 12· · · Q.· ·And were you doing your work at that Touchstone 13· ·Imaging facility as of November of 2017? 14· · · · · ·MS. BAILEY:· Form. 15· · · A.· ·Yes. 16· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, GDX PA, was that 17· ·your company? 18· · · A.· ·Yes, it was an S Corp. that I would use for tax 19· ·purposes primarily. 20· · · Q.· ·Okay.· Did GDX stand for anything, those 21· ·letters? 22· · · A.· ·Well, GD is my initials, and then X is for 23· ·X-ray. 24· · · Q.· ·And were you the only employee under GDX PA? 25· · · A.· ·I was not an employee; I was a 1099. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 12 ·1· · · Q.· ·Okay.· Were you the only either 1099 employee or ·2· ·W-2 employee under GDX PA? ·3· · · A.· ·I was the only employee under GDX. ·4· · · Q.· ·So there were no other radiologists that worked ·5· ·for GDX? ·6· · · A.· ·Correct. ·7· · · Q.· ·How did GDX work with imaging facilities such as ·8· ·Touchstone; what was the relationship? ·9· · · · · ·MS. BAILEY:· Object to form. 10· · · A.· ·GDX contracted with Touch -- with ARA, American 11· ·Radiology Associates. 12· · · Q.· ·(BY MR. BUTTON)· And when you say GDX would 13· ·contract with ARA, would ARA place you with certain 14· ·facilities such as the Touchstone facility in 15· ·Lewisville? 16· · · A.· ·Yes, when I first came on board, they would also 17· ·send me to Denton and Richardson, but they found 18· ·radiologists to staff those locations so I was stationed 19· ·at the Lewisville facility from then on. 20· · · Q.· ·And when was the time that you were pulled off 21· ·of the Richardson and Denton facilities? 22· · · A.· ·I've got no idea.· I would have to go back and 23· ·look at the records. 24· · · Q.· ·Sure.· Can you do that for us and provide that 25· ·to your counsel? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 13 ·1· · · A.· ·Sure. ·2· · · Q.· ·All right.· Do you know what facilities you were ·3· ·assigned to work at for Touchstone in November of 2017? ·4· · · A.· ·I'd have to look at my records. ·5· · · · · ·MS. BAILEY:· Form. ·6· · · Q.· ·(BY MR. BUTTON)· How many other facilities did ·7· ·GDX do imaging review work for? ·8· · · A.· ·During that time span, it was only for ARA. ·9· · · Q.· ·Okay.· And what's your understanding of who ARA 10· ·is? 11· · · A.· ·Well, it's a large radiology group in Dallas, 12· ·Texas. 13· · · Q.· ·Are there facilities other than Touchstone 14· ·Imaging that are a part of ARA? 15· · · · · ·MS. BAILEY:· Objection, form. 16· · · A.· ·Yes. 17· · · Q.· ·(BY MR. BUTTON)· But you were only assigned to 18· ·work at Touchstone facilities through ARA? 19· · · A.· ·Yes. 20· · · · · ·MS. BAILEY:· Form. 21· · · Q.· ·(BY MR. BUTTON)· So what was the nature of your 22· ·relationship with GDX and Dr. Downing, as the 23· ·radiologist with Touchstone Imaging facilities; how 24· ·would that relationship work? 25· · · A.· ·Well, Greg Downing was an employee of GDX, and 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 14 ·1· ·GDX had a contract with ARA, and I'm assuming that ARA ·2· ·had a contract with Touchstone. ·3· · · Q.· ·And then would you communicate directly with ·4· ·Touchstone employees during that time for your work? ·5· · · A.· ·Well, it was a small facility so I saw ·6· ·technologists all day long. ·7· · · Q.· ·So you were at the Touchstone facilities in ·8· ·person, correct? ·9· · · A.· ·Please restate that. 10· · · Q.· ·Sure.· You would be at the Touchstone facilities 11· ·in person, correct? 12· · · A.· ·Yes. 13· · · Q.· ·Would you only review imaging at the facility 14· ·that you were in person working at? 15· · · · · ·MS. BAILEY:· Form. 16· · · A.· ·Yeah, please restate that. 17· · · Q.· ·(BY MR. BUTTON)· Sure.· Earlier you stated that 18· ·you would go to a location such as Touchstone 19· ·Richardson, Touchstone Denton, Touchstone Lewisville and 20· ·you would work out of that facility to do your work as a 21· ·radiologist, correct? 22· · · A.· ·Yes. 23· · · Q.· ·Would you only review the imaging that was 24· ·gathered at that facility when you were there in person? 25· · · A.· ·No. 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 15 ·1· · · Q.· ·So you would also review imaging that would be ·2· ·sent to you that was taken at a different Touchstone ·3· ·facility, correct? ·4· · · A.· ·I was primarily onsite for Touchstone Imaging ·5· ·for contrast reactions, in case a patient had a reaction ·6· ·to contrast that was injected, and my secondary duty was ·7· ·to read X-rays.· And I had privileges through certain ·8· ·imaging centers by ARA.· So they would create a filter ·9· ·of sites that I had credentials and that would show up 10· ·on my work list. 11· · · Q.· ·Okay.· Let me go back over that and clean that 12· ·up.· Are you ready? 13· · · A.· ·Yes. 14· · · Q.· ·When you were onsite at a Touchstone facility, 15· ·your primary function there was to be there for contrast 16· ·reactions; is that true? 17· · · A.· ·Yes. 18· · · Q.· ·Then as a part of a Touchstone radiology 19· ·specialist, you would review X-rays that would be sent 20· ·to you from various facilities, correct? 21· · · · · ·MS. BAILEY:· Object, form. 22· · · A.· ·I was -- I had a contractural arrangement with 23· ·ARA, and they put me onsite at Touchstone Imaging 24· ·centers, and I would do interpretations of Touchstone 25· ·studies.· And it would come from multiple -- I'm not 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 16 ·1· ·sure how many sites Touchstone had.· I had privileges at ·2· ·some of them and not all of them. ·3· · · Q.· ·(BY MR. BUTTON)· Who made the decisions of what ·4· ·Touchstone facilities you had privileges at versus not ·5· ·having privilege at others? ·6· · · A.· ·I've got no idea. ·7· · · Q.· ·But that wasn't a choice by you; that was ·8· ·decided for you by ARA; would that be accurate? ·9· · · A.· ·Yes. 10· · · Q.· ·Can you explain to me the relationship of how 11· ·you would be chosen to be given an X-ray to read; how 12· ·would you get those X-rays? 13· · · A.· ·Well, as I said, there was a list, a filter that 14· ·filtered out the cases for me to read.· And so I read 15· ·the studies that were on my list, and I've got no idea 16· ·who or how those were assigned. 17· · · Q.· ·Do you know if there were other subspecialty 18· ·radiologists that would also be given films by 19· ·Touchstone? 20· · · · · ·MS. BAILEY:· Object, form. 21· · · A.· ·I'm sure there were.· I primarily -- Well, all 22· ·that I read were plain films.· Do you understand what 23· ·that is. 24· · · Q.· (BY MR. BUTTON)· Yes, sir, but why don't you go 25· ·ahead and explain for us what plain films are. 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 17 ·1· · · A.· ·They're what everybody thinks of as X-rays. ·2· · · Q.· ·So your primary function was to read plain film ·3· ·X-rays for Touchstone Imaging, correct? ·4· · · · · ·MS. BAILEY:· Object to form. ·5· · · A.· ·My primary responsibility was contrast reaction ·6· ·coverage. ·7· · · Q.· ·(BY MR. BUTTON)· Your second primary function ·8· ·was to read plain film X-rays for Touchstone Imaging, ·9· ·correct? 10· · · · · ·MS. BAILEY: Object, form. 11· · · A.· ·My secondary responsibility was to read plain 12· ·film X-rays for ARA. 13· · · Q.· ·(BY MR. BUTTON)· And the only ARA facilities 14· ·that you were assigned to read imaging for was 15· ·Touchstone, correct? 16· · · A.· ·Yes. 17· · · · · ·MS. BAILEY:· Form. 18· · · Q.· ·(BY MR. BUTTON)· How did your relationship work 19· ·with regard to your contract with ARA; were you paid on 20· ·a per film read basis, or how were you paid? 21· · · A.· ·Yes, primarily on a paid -- I would get a 22· ·certain amount of money paid compensation and then it 23· ·was anything over and above that that I would read, so 24· ·on a productivity. 25· · · Q.· ·Okay.· And we'll get to productivity shortly. 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 18 ·1· · · · · ·Were you also paid to be your primary function ·2· ·for ARA at the Touchstone facilities you had privileges ·3· ·at to be a contrast reactor backup doctor? ·4· · · A.· ·Yes, I received $500 a day. ·5· · · Q.· ·So you received $500 a day to be there for ·6· ·contrast reactions from -- at the Touchstone facilities ·7· ·you had privileges at, correct? ·8· · · · · ·MS. BAILEY:· Form. ·9· · · A.· ·Yes. 10· · · Q.· ·(BY MR. BUTTON)· And then how much would you 11· ·receive per plain film X-ray that you would review for 12· ·ARA at the Touchstone facilities you had privileges at? 13· · · · · ·MR. RYAN:· Doctor, hold on a second.· I don't -- 14· ·I'm going to instruct you not put on the record 15· ·financial information that is a privileged nature, 16· ·contractual nature. 17· · · · · ·Russell, we can talk after the deposition and 18· ·figure out if you're entitled to that.· Let's figure out 19· ·a way to do that where it's not on a sworn deposition. 20· ·At some -- Yeah, don't answer that.· We'll get into that 21· ·later, Russell, and we'll see if we can't figure out a 22· ·way to circumvent it.· But how much people get paid and 23· ·all that stuff, I'm not going to have on a sworn record. 24· ·We can figure out a different way to do it. 25· · · · · ·MR. BUTTON:· No, I don't really see the point in 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 19 ·1· ·that.· I have a right to ask how much -- ·2· · · · · ·MR. RYAN:· I'm just telling you that he's not ·3· ·going to answer his financial details of exactly how ·4· ·much he was paid under the contract.· I'm saying I'm ·5· ·happy to work with you, and I'll get you that ·6· ·information somehow, some way, but it's going to be in a ·7· ·protective order.· He's not gonna answer it today. ·8· ·That's okay.· We'll figure it out later. ·9· · · · · ·MR. BUTTON:· Okay. 10· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, your attorney 11· ·wanted you to not answer the question about how much you 12· ·made per film.· Do you know the answer to that question, 13· ·though? 14· · · A.· ·Pretty much.· But I am not going to answer that 15· ·question. 16· · · Q.· ·No problem.· But it's easy for you to know that 17· ·information, correct? 18· · · A.· ·Yes. 19· · · Q.· ·Okay. 20· · · A.· ·I could dig out the contract. 21· · · Q.· ·Sure.· So the more plain film X-rays that you 22· ·would review for ARA at the Touchstone facilities, the 23· ·more you would get paid, correct? 24· · · A.· ·I will not answer that question. 25· · · Q.· ·Well, did you make more money with the more film 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 20 ·1· ·that you would review or was it the same amount? ·2· · · A.· ·I yield to my counsel's request. ·3· · · Q.· ·He's only talking about the exact amount.· I'm ·4· ·asking you with a generalized question.· You would get ·5· ·paid by per film that you would review; do you ·6· ·understand that? ·7· · · A.· ·I received $500 a day for sitting onsite.· If I ·8· ·read zero cases, I would get $500, and if I read any ·9· ·cases over and above that, even if it was one, I got a 10· ·per click. 11· · · Q.· ·A per what? 12· · · A.· ·Click. 13· · · Q.· ·And can you spell that for me? 14· · · A.· ·C-L-I-C-K.· It means I got paid for reading a 15· ·study. 16· · · Q.· ·Gotcha.· And so when you say you would get paid 17· ·per click, that means you would get paid per plain film 18· ·X-ray that you would review, correct? 19· · · · · ·THE WITNESS:· Jeff? 20· · · · · ·MR. RYAN:· Yeah, I don't have any problem with 21· ·you generally talking about if you got paid per study or 22· ·whatever.· I don't want to get into the specific 23· ·amounts; I think that's privileged -- 24· · · A.· ·Okay.· Yes, I would get paid. 25· · · · · ·MR. RYAN:· -- and confidential. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 21 ·1· · · A.· ·I would get paid on a study if I read it. ·2· · · Q.· ·(BY MR. BUTTON)· And would that be a flat amount ·3· ·no matter how long it took you to read the image and ·4· ·come up with your final report? ·5· · · A.· ·I got paid for reading a study.· It doesn't take ·6· ·-- There was no time frame put on it. ·7· · · Q.· ·Right, that's my point.· You could have taken ·8· ·one minute or you could have taken three hours; you ·9· ·would get the same amount of money per reading film, 10· ·correct? 11· · · A.· ·Yes. 12· · · Q.· ·When you said per click per reading of X-ray 13· ·film, did that also include interpretation and 14· ·finalizing your written report? 15· · · A.· ·That's the process of reading a case. 16· · · Q.· ·Right, so the answer would be yes, right? 17· · · A.· ·Yes. 18· · · Q.· ·Okay.· Let me clean this up.· I'm not asking for 19· ·specific dollar amounts so you don't need to give me 20· ·numbers, okay? 21· · · A.· ·Okay. 22· · · Q.· ·You would be paid a flat fee number for each 23· ·plain film X-ray that you would read, interpret and 24· ·provide a finalized report regardless of how long it 25· ·took you to read that report and finalize it, correct? 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 22 ·1· · · A.· ·Yes. ·2· · · Q.· ·How long did you have privileges at Touchstone ·3· ·Imaging facilities? ·4· · · A.· ·I was assigned to Touchstone by ARA for nearly ·5· ·three -- well, it was right at three years. ·6· · · Q.· ·Do you know which year that would have started? ·7· · · A.· ·Three years ago. ·8· · · Q.· ·Okay.· So three years ago from March 1st is when ·9· ·you first would have started working for Touchstone 10· ·Imaging facilities through ARA? 11· · · A.· ·Approximately. 12· · · Q.· ·What imaging facilities were you working for 13· ·before you started working for Touchstone Imaging 14· ·facilities? 15· · · · · ·MR. RYAN:· Object, form. 16· · · · · ·MS. BAILEY:· Object to form. 17· · · Q.· ·(BY MR. BUTTON)· You can answer. 18· · · · · ·MS. BAILEY:· Form. 19· · · A.· ·I read for a teleradiology group. 20· · · Q.· ·(BY MR. BUTTON)· And what was the name of the 21· ·teleradiology group? 22· · · · · ·THE WITNESS:· Am I supposed to answer that, 23· ·Jeff. 24· · · · · ·MR. RYAN:· Yes. 25· · · A.· ·Teleradiology Associates. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 23 ·1· · · Q.· ·(BY MR. BUTTON)· Okay.· And how long did you ·2· ·work for Teleradiology Associates? ·3· · · A.· ·Two and a half to three years. ·4· · · Q.· ·Okay.· And would you do the same thing, read ·5· ·plain film X-rays for them as well? ·6· · · A.· ·That's all they did, yes. ·7· · · Q.· ·So fair to say for at least the last five to six ·8· ·years, your one job other than being there for contrast ·9· ·reactions at imaging facilities person, your one job is 10· ·to read plain film X-rays; is that correct? 11· · · · · ·MS. BAILEY:· Object, form. 12· · · A.· ·My job is to cover contrast reaction and then 13· ·read plain films. 14· · · Q.· ·(BY MR. BUTTON)· At Touchstone Imaging, do you 15· ·know who you would work with at the facility you would 16· ·be in person with; do you remember any of their names? 17· · · · · ·MS. BAILEY:· Form. 18· · · A.· ·Are you talking about the techs? 19· · · Q.· ·(BY MR. BUTTON)· Sure.· I mean who would you 20· ·typically work with at Touchstone Imaging facilities? 21· ·Let's start with the one in Richardson; who do you 22· ·remember there? 23· · · · · ·MS. BAILEY:· Form. 24· · · A.· ·I really didn't work there very long so I can't 25· ·really remember anybody's name. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 24 ·1· · · Q.· ·(BY MR. BUTTON)· When you say you didn't work at ·2· ·the Touchstone Imaging facility in Richardson very long, ·3· ·how long did you work there for? ·4· · · · · ·MS. BAILEY:· I'll object to the form. ·5· · · A.· ·Probably three or four months.· They found ·6· ·another radiologists that lived closer to Richardson and ·7· ·the same in Denton, so they assigned me primarily to the ·8· ·Lewisville office. ·9· · · Q.· ·(BY MR. BUTTON)· When you were at the Touchstone 10· ·Imaging facility in Richardson, were there any other 11· ·radiologists that would also be there? 12· · · A.· ·Only on assigned days when I was somewhere else. 13· · · Q.· ·So at the Touchstone Imaging facility in 14· ·Richardson, there would only be one radiologist in 15· ·person on staff, correct? 16· · · A.· ·One radiologist -- 17· · · · · ·MS. BAILEY:· Form. 18· · · A.· ·-- at a time on staff. 19· · · Q.· ·(BY MR. BUTTON)· At any of the other Touchstone 20· ·Imaging facilities you worked at in either Denton or 21· ·Lewisville, were there ever more than one radiologist on 22· ·staff in person while you were there? 23· · · A.· ·No. 24· · · · · ·MS. BAILEY:· Object, form. 25· · · · · ·MR. BUTTON:· Cathy, just so we're not talking 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 25 ·1· ·over -- because I know there's that lag, I know you want ·2· ·to get your objections in.· I'll agree that if -- ·3· ·Because it seems there's a big lag -- if you can object ·4· ·after his answer so it's not cutting off his answer, ·5· ·that would probably -- because I'm going to have to ·6· ·repeat a lot of these questions at some point. ·7· · · · · ·MS. BAILEY:· Okay.· I'll do that.· Sorry about ·8· ·that, Russell.· I just don't want to waive any ·9· ·objections. 10· · · · · ·MR. BUTTON:· I agree that you're not waiving an 11· ·objection if it's right after his answer, as long as Ms. 12· ·Donna gives us the thumbs up.· Donna, just stop me if 13· ·it's not clear. 14· · · · · ·THE WITNESS:· Excuse me. 15· · · · · ·THE REPORTER:· I have dogs too. 16· · · · · ·THE WITNESS:· Sorry.· Can y'all hear me?· That's 17· ·my puppy. 18· · · Q.· ·(BY MR. BUTTON)· That's okay.· Generally, we 19· ·can. 20· · · · · ·MR. RYAN:· It sounds like a big puppy. 21· · · · · ·THE WITNESS:· Just a minute, please.· He's part 22· ·of my legal team. 23· · · Q.· ·(BY MR. BUTTON)· All right.· Mr. Downing, are 24· ·you -- Dr. Downing, I apologize.· Dr. Downing, are you 25· ·ready to get going? 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 26 ·1· · · A.· ·Yes. ·2· · · Q.· ·Dr. Downing, part of your legal team is the dog ·3· ·in the background; would that be accurate? ·4· · · A.· ·Well, no, that was facetious. ·5· · · Q.· ·Okay.· So Dr. Downing, who do you communicate ·6· ·with? ·7· · · · · ·MR. RYAN:· Are you serious?· I mean we're all ·8· ·facetious, right? ·9· · · · · ·MR. BUTTON:· Yeah, I'm just messing with him. 10· · · · · ·MR. RYAN:· Yeah. 11· · · Q.· ·(BY MR. BUTTON)· Okay.· Dr. Downing, are you 12· ·ready? 13· · · A.· ·Yes. 14· · · Q.· ·Dr. Downing, who did you communicate with at 15· ·Touchstone when you were working there?· When you would 16· ·get films if you had a question, who would you 17· ·communicate with? 18· · · A.· ·Well, if I had a question, we were hooked up to 19· ·communicate with other radiologists that were on 20· ·different sites, so if I had a question -- 21· · · · · ·MS. BAILEY:· Form. 22· · · A.· ·-- I could IM them, and they would take a look 23· ·at the film and give me an opinion, and I would do the 24· ·same for them. 25· · · · · ·MS. BAILEY:· Hey, Russell, give me a minute. 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 27 ·1· ·Let me get audio on my phone.· Because I don't want to ·2· ·mess up your video, and I'm messing up your video on ·3· ·this audio. ·4· · · · · ·MR. BUTTON:· I'll tell you what, let's just take ·5· ·a break.· Dr. Downing, you can get your legal team ·6· ·situated. ·7· · · · · ·Cathy, you can call in. ·8· · · · · ·If we could, just take a short break to get this ·9· ·straightened out. 10· · · · · ·MS. BAILEY:· Thank you. 11· · · · · ·THE VIDEOGRAPHER:· Okay.· Let's go off the 12· ·record.· We are off the record; the time is 9:43. 13· · · · · ·(Recess taken) 14· · · · · ·THE VIDEOGRAPHER:· We're back on the record; the 15· ·time is 9:52. 16· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, could you lower 17· ·your camera just a little bit?· I can only see kind of 18· ·the top of your head.· Doctor? 19· · · · · ·MS. BAILEY:· Dr. Downing?· Hello?· Dr. Downing, 20· ·all right.· Mr. Parker, you want to call him? 21· · · · · ·THE VIDEOGRAPHER:· We're off the record; the 22· ·time is 9:53. 23· · · · · ·(Recess taken) 24· · · · · ·THE VIDEOGRAPHER:· We're back on the record; the 25· ·time is 9:56. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 28 ·1· · · Q.· ·(BY MR. BUTTON)· All right.· Dr. Downing, are ·2· ·you ready to get started? ·3· · · A.· ·Yes. ·4· · · Q.· ·Dr. Downing, we left off on a break, and I had ·5· ·just asked you who would you communicate with if you had ·6· ·an issue on something for a film you received; do you ·7· ·remember that? ·8· · · A.· ·For filming receipt? ·9· · · Q.· ·For a film you received, X-ray film that you 10· ·would have received.· Do you remember where we left off 11· ·our conversation? 12· · · A.· ·As I said, they gave me a particular work list; 13· ·they filtered it out.· But the imaging centers for which 14· ·I have had privileges and it just showed up on my work 15· ·list.· I've got no idea.· They set that up the first 16· ·time, and I don't know that anyone would have changed 17· ·it. 18· · · Q.· ·So Dr. Downing, you would receive a list of 19· ·X-ray films that you were to read, interpret and 20· ·finalize a report for; you don't know how those films 21· ·got to you, correct? 22· · · A.· ·They were routed to me by ARA IT, and my list 23· ·wasn't exclusively for me; other ARA radiologists could 24· ·read it as well. 25· · · Q.· ·Okay.· So Dr. Downing, when you would show up at 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 29 ·1· ·a Touchstone Imaging facility for your work, your ·2· ·primary function on those days was to be there if ·3· ·somebody had a reaction to contrast, right? ·4· · · A.· ·Right. ·5· · · · · ·MS. BAILEY:· Form. ·6· · · Q.· ·(BY MR. BUTTON)· Secondarily, on the side of ·7· ·that, you would read, interpret and finalize reports for ·8· ·plain film X-rays for Touchstone Imaging patients, ·9· ·correct? 10· · · · · ·MS. BAILEY:· Object, form. 11· · · A.· ·I worked through ARA; it was Touchstone 12· ·patients. 13· · · Q.· ·(BY MR. BUTTON)· Correct.· You would read, 14· ·interpret and finalize reports for Touchstone patients, 15· ·correct? 16· · · A.· ·Yes. 17· · · · · ·MS. BAILEY:· Form. 18· · · Q.· ·(BY MR. BUTTON)· And when you were at the 19· ·facilities, you would on your computer be given a list 20· ·of films that you were to read, interpret and finalize a 21· ·written report for Touchstone patients, correct? 22· · · A.· ·Yes. 23· · · · · ·MS. BAILEY:· Form. 24· · · Q.· ·(BY MR. BUTTON)· And on that list, if you had a 25· ·question about something on a film or a question about 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 30 ·1· ·something that you were provided, you were in ·2· ·communication with other Touchstone radiologists, ·3· ·correct? ·4· · · A.· ·Yes. ·5· · · · · ·MS. BAILEY:· Object, form. ·6· · · A.· ·Yes, and vice versa. ·7· · · Q.· ·(BY MR. BUTTON)· And these other radiologists, ·8· ·were any of them subspecialists as well, or were they ·9· ·all general radiologists? 10· · · A.· ·I think we had subspecialists, but I'm not sure 11· ·that any subspecialists were reading plain film.· They 12· ·would read higher end studies like MRI, mammo, CT.· ARA 13· ·was primarily a subspecialty group. 14· · · Q.· ·So to the best of your understanding, the 15· ·radiologists that would also be in communication with 16· ·you while you were working and had privileges at 17· ·Touchstone Imaging facilities, there were not 18· ·subspecialists such a pediatric radiologist or a 19· ·neuroradiologist for the X-rays you were reviewing, 20· ·correct? 21· · · · · ·MS. BAILEY:· Form. 22· · · A.· ·I think anybody in the ARA group would have been 23· ·available to me. 24· · · Q.· ·(BY MR. BUTTON)· Okay.· So Dr. Downing, you feel 25· ·that anybody in the ARA radiologist group with 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 31 ·1· ·subspecialties and general radiologist would have been ·2· ·available to you if you had questions about something on ·3· ·an X-ray that you were assigned to review for Touchstone ·4· ·Imaging, correct? ·5· · · · · ·MR. RYAN:· Objection. ·6· · · · · ·MS. BAILEY:· Object, form. ·7· · · A.· ·I think I would have had access to anyone. I ·8· ·communicated with general diagnostics.· I can't remember ·9· ·ever consulting with a subspecialty radiologist. 10· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, you can't remember 11· ·consulting with a subspecialty radiologist while you had 12· ·privileges to review imaging for Touchstone patients, 13· ·correct? 14· · · A.· ·I did not recall any. 15· · · · · ·MS. BAILEY:· Form.· Object, form. 16· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, what sorts of 17· ·questions or things would you have questions about that 18· ·you would consult other radiologists before finalizing 19· ·your report? 20· · · A.· ·I would ask them if they saw any positive 21· ·findings on something that I thought may be positive but 22· ·I wasn't sure. 23· · · Q.· ·And was there a typical type of patient that you 24· ·you would have questions about more than another; for 25· ·example, was there an age or a gender that you would 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 32 ·1· ·have more questions about, or would this just be in ·2· ·general? ·3· · · A.· ·In general. ·4· · · Q.· ·And when you would run your imaging by a ·5· ·different radiologist, would they also sign your report, ·6· ·or would you note down that you ran it by another ·7· ·radiologist? ·8· · · A.· ·I would note that I had consulted or got a ·9· ·second opinion from another radiologist. 10· · · Q.· ·And you mentioned instant message, IM'g.· How 11· ·would that operate when you were at Touchstone 12· ·facilities?· Explain that to us. 13· · · A.· ·Well, we had an IM that I could choose which 14· ·radiologist I would like to consult and choose that, 15· ·sent him a link, him or her, send them a link, ask them 16· ·to look at it, and then we would communicate back by IM 17· ·as to that radiologist's opinion. 18· · · Q.· ·Would you ever pick up the phone and talk to the 19· ·radiologist that you would consult with? 20· · · A.· ·I could have.· I'm not sure that I remember any 21· ·time that I did that. 22· · · Q.· ·Where on the report itself would you note that 23· ·you consulted with a different radiologist to come to 24· ·your conclusions? 25· · · A.· ·I would have put that in my conclusion or 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 33 ·1· ·potentially I would have done an addendum to the report ·2· ·and put it in there. ·3· · · Q.· ·So would there be an instance where you would ·4· ·have finalized your report and sent it off and then ·5· ·subsequently consulted with a radiologist and done an ·6· ·addendum? ·7· · · A.· ·That's possible. ·8· · · Q.· ·And do you recall ever doing that for ·9· ·Touchstone? 10· · · A.· ·No. 11· · · Q.· ·When you would be provided films, you mentioned 12· ·that there would be a list on there for you; do you 13· ·remember that? 14· · · A.· ·Yes. 15· · · Q.· ·And when you would then look at the films that 16· ·you were assigned to read, was there ever an instance 17· ·that you would say I'm probably not the best person for 18· ·this; did that ever happen? 19· · · A.· ·Yes. 20· · · Q.· ·What sort of circumstances would have happened 21· ·where you would have said I'm not the best person to 22· ·read this X-ray? 23· · · A.· ·Usually lumbar spine X-rays where they had had 24· ·surgery. 25· · · Q.· ·And why would that be something that you didn't 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 34 ·1· ·feel comfortable reading X-rays on? ·2· · · · · ·MR. RYAN:· Objection, form. ·3· · · A.· ·That's when I thought it ought to be assigned to ·4· ·a neuroradiologist and probably recommend additional ·5· ·examinations like CT or MRI. ·6· · · Q.· ·(BY MR. BUTTON)· And so when that sort of ·7· ·circumstance would happen, would you -- how would you ·8· ·communicate that; like, what would be the steps you ·9· ·would go through? 10· · · A.· ·I would IM the IT people and tell them to 11· ·reassign it. 12· · · Q.· ·And IT, meaning like information technology 13· ·people? 14· · · A.· ·Yes. 15· · · Q.· ·And was there a particular person that you would 16· ·work with or was it a particular name on your IM screen? 17· · · A.· ·No, there were three or four, as I believe, and 18· ·I can't recall any of their names. 19· · · Q.· ·So you would just communicate to the IT 20· ·department at Touchstone ARA that you didn't feel like 21· ·you were the most qualified? 22· · · A.· ·Correct. 23· · · · · ·MS. BAILEY:· Object, form. 24· · · Q.· ·(BY MR. BUTTON)· Sorry.· Say that again, Doctor. 25· · · A.· ·Correct. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 35 ·1· · · · · ·MS. BAILEY:· Form. ·2· · · Q.· ·(BY MR. BUTTON)· I can't hear you. ·3· · · · · ·MR. BUTTON:· Cathy, I'm going to clean it up. I ·4· ·promise; I'm just trying to hear what he said. ·5· · · · · ·MS. BAILEY:· Well, there's nothing such as ·6· ·Touchstone ARA, so I'm going to object form. ·7· · · Q.· ·(BY MR. BUTTON)· Doctor, I'm not asking about ·8· ·anything with Touchstone ARA.· I'm just trying to ·9· ·understand.· I cannot hear your question for the life of 10· ·me.· Can everybody not object, so I can hear your 11· ·answer? 12· · · · · ·What did you say to that question that I asked 13· ·you? 14· · · A.· ·Please repeat the question. 15· · · · · ·MR. BUTTON:· Ms. Johnston, can you repeat the 16· ·question, please? 17· · · · · ·THE REPORTER:· Yes, give me one second.· Yes, 18· ·give me one second to toggle over to my other software. 19· · · · · ·MR. RYAN:· Take your time. 20· · · · · ·(The requested portion was read.) 21· · · A.· ·That's correct. 22· · · · · ·MS. BAILEY:· Object, form. 23· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, if you didn't feel 24· ·like you were the most qualified to review a film, you 25· ·would communicate with the IT on your instant message 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 36 ·1· ·portal at your Touchstone facility, correct? ·2· · · A.· ·Yes, and I would ask for the case to be ·3· ·reassigned. ·4· · · Q.· ·Were there any other types of films other than ·5· ·the lumbar spine that you would recommend for a ·6· ·subspecialist to review it? ·7· · · A.· ·I'm sure there were, but I don't recall. ·8· · · Q.· ·Dr. Downing, earlier you were describing for us ·9· ·the amount of films that you would review, and you 10· ·mentioned the word productivity; do you remember that? 11· · · A.· ·Yes. 12· · · Q.· ·How did Touchstone Imaging measure your 13· ·productivity? 14· · · · · ·MS. BAILEY:· Form. 15· · · A.· ·They would keep track of what cases I read and 16· ·then pay me accordingly.· I never kept track myself. 17· · · Q.· ·(BY MR. BUTTON)· So on each day, you would get 18· ·through as many films as you could during that work day; 19· ·would that be fair? 20· · · A.· ·As many as I felt comfortable with. 21· · · Q.· ·What would be the average hours of your work 22· ·day; when would you start and when would you finish? 23· · · A.· ·I would start at 8 o'clock.· I was supposed to 24· ·work 8 o'clock to noon or 1 o'clock to 5; although I 25· ·very seldom took more than a 15-minute break at lunch. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 37 ·1· · · Q.· ·So fair to say you would work between the hours ·2· ·of 8 to 5 minus a small break for lunch? ·3· · · A.· ·Correct. ·4· · · Q.· ·And during that time on your average day, how ·5· ·many X-ray films would you be able to read, interpret ·6· ·and finalize the written report on? ·7· · · A.· ·Depends on the day and the number of studies ·8· ·that Touchstone had, but anywhere from 80 to 150. ·9· · · Q.· ·So on an average day, you would read between 80 10· ·to 150 X-ray films while you were working at the 11· ·Touchstone facilities, correct? 12· · · A.· ·Yes. 13· · · · · ·MS. BAILEY:· Form. 14· · · Q.· ·(BY MR. BUTTON)· And when -- What would be the 15· ·factors that would make the number be on the lower end 16· ·of that range, in the 80 range; what would be the 17· ·factors? 18· · · A.· ·Well, usually, if that's the number of cases 19· ·that were presented to me, there wasn't always a huge 20· ·volume and especially right before or past COVID hit, I 21· ·was down to 40 cases a day.· So it was based upon how 22· ·many cases.· If I had to go back and check a patient for 23· ·contrast reaction, depended on the -- I don't want to 24· ·say severity -- but the complexity of the case that was 25· ·left for me to read. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 38 ·1· · · Q.· ·So a couple of the factors that would increase ·2· ·the range or decrease the range that you provided for us ·3· ·how many X-rays films that you would read on an average ·4· ·day would be how many patients you had to treat or check ·5· ·on that had contrast reaction as well as how many films ·6· ·you were actually provided by Touchstone to review, ·7· ·correct? ·8· · · A.· ·That's correct. ·9· · · Q.· ·How many days a week would you typically work? 10· · · A.· ·Five. 11· · · Q.· ·Would it be a Monday through Friday, or were you 12· ·also there on weekends? 13· · · A.· ·Monday through Friday. 14· · · Q.· ·Were you required to document the time that you 15· ·took from starting a particular -- I'll call it a case 16· ·-- on to read a patient X-ray until the time you 17· ·finished the case? 18· · · A.· ·No. 19· · · Q.· ·Would that be documented in the computer system? 20· · · A.· ·Well, I don't know.· But these days, you can go 21· ·back and look at everything on computers. 22· · · Q.· ·When you would be given a case to read the X-ray 23· ·film on, would you start it and make sure you got all 24· ·the way to the written report before moving on to a 25· ·different patient's case? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 39 ·1· · · A.· ·Unless there was an interruption such as a ·2· ·contrast reaction. ·3· · · Q.· ·But as far as reading the X-ray films, when you ·4· ·started reading it, interpreting it and finalizing the ·5· ·report, you wouldn't be also looking at another ·6· ·patient's during that time? ·7· · · A.· ·No, there was no way on the pack system that ·8· ·they had to look at two different patients at the same ·9· ·time. 10· · · Q.· ·And what would happen if there was a contrast 11· ·reaction while you were in the middle of reading a film 12· ·or finalizing a report; would it just stay open and then 13· ·you would resume it when you got back, or how would that 14· ·operate? 15· · · A.· ·Yes. 16· · · Q.· ·It would stay open during the whole time? 17· · · A.· ·Yes.· I could have closed out of it.· I think 18· ·primarily I tried to finish up what I was doing or close 19· ·out of it.· It is conceivable that it could have stayed 20· ·open. 21· · · Q.· ·Each day that you arrived at the Touchstone 22· ·Imaging facilities to start your work as a contrast 23· ·reaction doctor as well as reading X-ray films for 24· ·Touchstone patients, would you have a certain number of 25· ·X-rays like a minimum number that you had to get through 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 40 ·1· ·for that day? ·2· · · A.· ·No. ·3· · · · · ·MS. BAILEY:· Object, form. ·4· · · A.· ·I didn't have to read any.· All I had to do was ·5· ·be there for contrast reactions. ·6· · · Q.· ·(BY MR. BUTTON)· Let me clean that up.· You ·7· ·ready, Doctor? ·8· · · A.· ·Yes. ·9· · · Q.· ·When you were working at the Touchstone 10· ·facilities, you did not have to read any X-ray films 11· ·while working there; you just had to show up for the -- 12· ·to be there for contrast reactions; is that correct? 13· · · A.· ·Yes. 14· · · · · ·MS. BAILEY:· Form. 15· · · Q.· ·(BY MR. BUTTON)· Did Touchstone Imaging or ARA 16· ·keep track of your turnaround time as a radiologist? 17· · · A.· ·I don't know. 18· · · Q.· ·Were there any expectations on you as a 19· ·radiologist with regard to turnaround time while you had 20· ·privileges at Touchstone facilities? 21· · · A.· ·Well, there's a turnaround time that they wanted 22· ·a case to be done so that it would be a good service for 23· ·ARA.· I don't know that I know a specific time frame of 24· ·what that is, no. 25· · · Q.· ·Was that ever communicated to· you at any point? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 41 ·1· · · A.· ·No. ·2· · · Q.· ·Did Touchstone Imaging or ARA measure your ·3· ·productivity in relative value units, RVU? ·4· · · A.· ·I don't think so.· Because it was just on how ·5· ·many studies I read.· I don't know whether they put that ·6· ·into RVUs or not. ·7· · · Q.· ·Is there was a measurement for your productivity ·8· ·in the RVUs, it was not communicated to you by ARA or by ·9· ·Touchstone, correct? 10· · · A.· ·No, it was irrelevant.· They were paying me on a 11· ·per case basis, not on an RVU value. 12· · · · · ·MR. BUTTON:· And I'll object to the 13· ·nonresponsive portion of the answer. 14· · · · · ·THE WITNESS:· Would you please explain that? 15· · · · · ·MR. BUTTON:· It's fine.· It's an objection for 16· ·the record that counsel has to make. 17· · · · · ·MR. RYAN:· Doctor, occasionally, lawyers have to 18· ·make objections to protect the record.· It's -- You can 19· ·still answer unless somebody tells you not to, okay? 20· · · · · ·THE WITNESS:· Okay. 21· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, on average how 22· ·long would it take you to read over an X-ray film? 23· · · A.· ·It depends on what the X-ray was. 24· · · Q.· ·Well, let's take the knee, for example.· On a 25· ·knee, how long would it take you to read over the X-ray 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 42 ·1· ·film? ·2· · · A.· ·A couple of minutes. ·3· · · Q.· ·Okay.· So if it took you approximately two ·4· ·minutes to read over the X-ray film, how long would it ·5· ·take you to finalize your written report on average? ·6· · · A.· ·Three minutes. ·7· · · Q.· ·So Doctor, in a matter of on average five ·8· ·minutes, two to read an X-ray report and three to ·9· ·finalize your written report, you would have a finalized 10· ·X-ray case done, correct? 11· · · A.· ·Again, it depends on the severity of the 12· ·findings. 13· · · Q.· ·The more severe -- 14· · · A.· ·If I had to report arthritis or a bone tumor, 15· ·that would take longer.· If I had a normal knee, that 16· ·would take less time. 17· · · Q.· ·So Doctor, if you had a normal knee, upon 18· ·average, it would take you five minutes from the time 19· ·you read the X-ray and finalized your written report and 20· ·finished the case, correct? 21· · · A.· ·You read the study, and then you check your 22· ·report and then you sign it. 23· · · Q.· ·And that, on average would take you five 24· ·minutes, correct? 25· · · A.· ·Correct. 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 43 ·1· · · Q.· ·So Doctor, let's go over your -- your process as ·2· ·a radiologist, okay? ·3· · · A.· ·Okay. ·4· · · Q.· ·You would pull up the X-ray film on your ·5· ·computer, correct? ·6· · · A.· ·Yes. ·7· · · Q.· ·You would look at the X-ray film for ·8· ·abnormalities, correct? ·9· · · A.· ·Yes. 10· · · Q.· ·Did you have a checklist that you would use when 11· ·looking at an X-ray film for abnormalities? 12· · · A.· ·Yes. 13· · · Q.· ·And would that be a written checklist or a 14· ·digital checklist? 15· · · A.· ·In my head checklist. 16· · · Q.· ·So the checklist you would use when looking for 17· ·abnormalities would be in your head, correct, not 18· ·written down? 19· · · A.· ·Yes. 20· · · Q.· ·And you would go through this checklist in your 21· ·head as you were reading the X-ray film, and then you 22· ·would note down any abnormalities you found, correct? 23· · · A.· ·Normally, there -- We had standard reports.· And 24· ·I'll take a chest X-ray, PA and lateral views, which I 25· ·could change, show no abnormality of the heart, 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 44 ·1· ·mediastinal or pulmonary abnormality vascularity. I ·2· ·looked at the heart, and I looked at the mediastinum, ·3· ·and I looked at the pulmonary vascularity.· The lungs ·4· ·are well expanded and clear.· So I'm looking at the ·5· ·lungs.· There's no plural fluid.· The costogenic angles ·6· ·are sharp.· So I'm looking at plural diseases.· And then ·7· ·I would look at bony structures.· Bony structures are ·8· ·normal for age, or there's a compression fracture on ·9· ·that thoracic vertebra. 10· · · · · ·So my checklist, again, after having done this 11· ·since the eighties, it was pretty much ingrained in my 12· ·head, and it made me go through and look at specific 13· ·things to make sure that everything was covered. 14· · · Q.· ·Okay.· Great, great.· So I appreciate you just 15· ·giving that to me. 16· · · · · ·Did you have a standard checklist that you can 17· ·recite like that for other body parts? 18· · · A.· ·Most of them. 19· · · Q.· ·Did you have a standard checklist like that for 20· ·the knee? 21· · · A.· ·Yes. 22· · · Q.· ·And would your checklist be dependant on the age 23· ·of the patient? 24· · · A.· ·Yes. 25· · · Q.· ·And so age would be something that you would pay 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 45 ·1· ·attention to, correct? ·2· · · A.· ·Yes. ·3· · · Q.· ·Would you look at any other factors of the ·4· ·patient in order to know how to change your checklist of ·5· ·what to look for? ·6· · · A.· ·If I was given appropriate clinical information. ·7· · · Q.· ·What would be the appropriate clinical ·8· ·information you would want to see from a doctor when ·9· ·knowing how to adjust your checklist of what to look for 10· ·in a knee? 11· · · · · ·MS. BAILEY:· Objection, form. 12· · · A.· ·Very often the doctors communication did not get 13· ·to me, and I would look at the age of the patient; that 14· ·was always available to me, and trauma versus blunt 15· ·trauma and where they hurt, how long they hurt. 16· · · Q.· ·(BY MR. BUTTON)· Okay.· I'll break that down for 17· ·a second.· I saw you moving on your head.· Are you okay 18· ·to keep going? 19· · · A.· ·Yeah, yes, sir. 20· · · Q.· ·Why would the doctor's information not get to 21· ·you? 22· · · A.· ·Because the correct information didn't come 23· ·through. 24· · · Q.· ·Why would the correct information not come 25· ·through from the doctor to you? 800.211.DEPO (3376) EsquireSolutions.comYVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 46 ·1· · · A.· ·I've been working on that for 30 years, and I ·2· ·don't have an answer. ·3· · · Q.· ·Is that something that is being held up at ARA ·4· ·or Touchstone, or is that from the doctor's office to ·5· ·the imaging facility? ·6· · · A.· ·I think it's multifactorial. ·7· · · Q.· ·What are the factors that you see as a ·8· ·radiologist as to why you're not getting the information ·9· ·you want for the patient that you're going to be looking 10· ·at the films for from the doctor to the radiology 11· ·facility? 12· · · · · ·MS. BAILEY:· Form, object, form. 13· · · A.· ·Usually, the technologist would take a history 14· ·right before they were going to do the exam, and they 15· ·would pass that on to me.· I found that much more 16· ·reliable, and the techs at Touchstone were very good 17· ·about that. 18· · · Q.· ·(BY MR. BUTTON)· Doctor, so the history that you 19· ·would get before you would read and review a report 20· ·would be from the tech at Touchstone Imaging, correct? 21· · · A.· ·It would be from the tech and/or information 22· ·that came from the doctor's office. 23· · · Q.· ·One of the factors you mentioned was age that is 24· ·important for your checklist when getting ready to 25· ·review films to look for abnormalities; why is age 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 47 ·1· ·important? ·2· · · A.· ·Age is important because I'm primarily looking ·3· ·for bone tumors.· And usually if it's an obese person ·4· ·who complains of pain for five years, a totally ·5· ·different scenario. ·6· · · Q.· ·Another factor that you mentioned was important ·7· ·was trauma.· Why is knowing whether or not there was ·8· ·trauma important? ·9· · · A.· ·You would be concerned more for fractures, but 10· ·you still look at the entire image. 11· · · Q.· ·One of the factors you mentioned was the 12· ·location of the pain.· Why is the location of the pain 13· ·important to you as the radiologist? 14· · · A.· ·I'm not sure I made that statement, but it would 15· ·be generally true.· I mean if somebody -- as in this 16· ·case that hopefully we'll get to soon -- comes in with 17· ·knee pain, so you look at the knee.· That's the study 18· ·that's done. 19· · · Q.· ·I believe you said where it hurts, where the 20· ·patient was having -- I interpreted that as pain, so I 21· ·apologize.· I'll rephrase it for you, okay? 22· · · A.· ·Okay. 23· · · Q.· ·One of the pieces of information that you would 24· ·want to know is where the patient was hurting; is that 25· ·correct? 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 48 ·1· · · A.· ·Usually you could tell where the patient was ·2· ·hurt by the body part that was examined; it's not rocket ·3· ·science. ·4· · · Q.· ·Would you want to know specifically where on ·5· ·that body part the patient is getting pain from; is that ·6· ·something that's important to you as a radiologist? ·7· · · A.· ·The more clinical information you have, the ·8· ·better idea of what is being looked for. ·9· · · Q.· ·Okay.· And, Dr. Downing, why is the length of 10· ·time that the patient was in pain important to you as a 11· ·radiologist? 12· · · A.· ·Well, if it's an older patient and they've had 13· ·pain for the last 30 years, that means one thing to me, 14· ·probably arthritis.· If it was somebody who injured 15· ·their ankle or knee yesterday, then that would be a 16· ·whole new -- a whole different scenario. 17· · · Q.· ·What would be the scenario if somebody said that 18· ·they injured their ankle or knee yesterday, what do you 19· ·mean by that? 20· · · A.· ·Probably looking for a fracture. 21· · · Q.· ·And a fracture would show up as a line or a 22· ·crack in the X-ray film, an abnormality? 23· · · A.· ·Usually. 24· · · Q.· ·Dr. Downing, do you have a -- 25· · · · · ·So I don't have to go over all of your, you 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 49 ·1· ·know, education, employment history, et cetera, I could ·2· ·fast track that today. ·3· · · · · ·Do you have a current copy of your CV you could ·4· ·provide your attorney? ·5· · · A.· ·I think I have given it to him. ·6· · · Q.· ·Great.· And so if we can get that from him. ·7· ·That would be great. ·8· · · · · ·MR. RYAN:· Yeah, we'll get it for you. ·9· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, the one that I do 10· ·want to know is where did you go to residency at? 11· · · A.· ·Wesley Medical Center in Wichita Kansas. 12· · · Q.· ·And you practiced in Kansas, I believe, until -- 13· ·was that 2011, I believe I saw earlier? 14· · · A.· ·I think it was closer to 1999 or 2000 is when I 15· ·started traveling. 16· · · Q.· ·And when you were at residency at Wesley Medical 17· ·Center, did you do any imaging rotations with 18· ·subspecialties like pediatrics or geriatrics, any of 19· ·those types? 20· · · A.· ·That's the purpose of residency. 21· · · Q.· ·Great.· So you did a rotation at a pediatric 22· ·imaging facility, correct? 23· · · A.· ·The head of our department was in charge of 24· ·pediatrics. 25· · · Q.· ·And pediatrics is children under the age of 18, 800.211.DEPO (3376) EsquireSolutions.com YVer1f  GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 50 ·1· ·correct? ·2· · · A.· ·Well, I think that they changed the definition; ·3· ·it was always, for me, 15. ·4· · · Q.· ·So 15 was the top end of the pediatric range for ·5· ·you? ·6· · · A.· ·Yes. ·7· · · Q.· ·So children under or 15 and under would be ·8· ·deemed pediatric for purposes of your work as a ·9· ·radiologist, correct? 10· · · A.· ·That's -- yes. 11· · · Q.· ·And Dr. Downing, did you do any fellowships 12· ·after your residency? 13· · · A.· ·I did a visiting fellowship at the University of 14· ·Zurich. 15· · · Q.· ·And what was your visiting residency in? 16· · · A.· ·Etiology. 17· · · Q.· ·And what's that? 18· · · A.· ·The study and treatment of vascular diseases. 19· · · Q.· ·Do you have any subspecialties in radiology? 20· · · A.· ·No. 21· · · Q.· ·Any certifications? 22· · · A.· ·I have certification for reading mammography. 23· · · · · ·THE REPORTER:· I'm sorry; could you repeat that, 24· ·sir? 25· · · Q.· ·(BY MR. BUTTON)· Dr. Downing, what is your 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 51 1· ·certification in? 2· · · A.· ·Mammography. 3· · · Q.· ·And can you spell that? 4· · · A.· ·Excuse me? 5· · · · · ·MR. BUTTON:· Ms. Johnston, do you need that 6· ·spelled or are we good. 7· · · · · ·THE REPORTER:· I'm good. · · · · · · MR. BUTTON:· Okay.· We're good. · · · · · · MR. RYAN:· Russell? · · · · · · MR. BUTTON:· We're good. · · · ·Q.· ·(BY MR. BUTTON)· Dr. Downing, you ready to go? · · · ·A.· ·I thought we were. · · · ·Q.· ·How often while you were working at the · · Touchstone facilities would you look at the imaging for · · children? · · · ·A.· ·You would have to ask Touchstone counsel of what · · their population of pediatrics is.· I have no idea. · · · ·Q.· ·While you were reviewing imaging when you were · · working at the Touchstone facilities, would you look at · · the X-ray films for children under the age of 15? · · · ·A.· ·I've got no idea. · · · · · · MS. BAILEY:· Form. · · · ·A.· ·I have no recollection of that. · · · ·Q.· ·(BY MR. BUTTON)· Do you remember ever looking at · · any -- I'll call them -- pediatric X-ray films while 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 52 working at Touchstone? · ·A.· ·Oh, sure.· It was part of their normal demographics. · · · · MS. BAILEY:· Form. · ·Q.· ·(BY MR. BUTTON)· So Dr. Downing, while you were reading films for Touchstone facilities, you would look at all age groups of X-ray films, correct? · ·A.· ·Correct. · · · · MS. BAILEY:· Object, form. · · · · MS. HIRSHMAN:· Form. · ·Q.· ·(BY MR. BUTTON)· Dr. Downing, if you didn't have the information that you needed from a tech with regard to any of the factors you listed above such as age, history, trauma, gender, location of the pain, would you go back to the tech to get that information from the patient and/or the doctor prior to reviewing the X-ray film, or would you just proceed? · · · · MR. RYAN:· Objection, form. · ·A.· ·Most of the time proceed, although if there was a question -- a patient in this day and age, there has to be an indication for the study before it can be done or interpreted.· And so that information, no matter how brief it was, had to be there before the examination could be done. · ·Q.· ·(BY MR. BUTTON)· And the indication for the 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 53 study would be at the treating physician's office that they would recommend that, correct? · ·A.· ·It would come in under requisition, and the staff would put that in for an indication of study, and that would be available to me. · ·Q.· ·And what would be included in this indication study; what information would you be provided? · ·A.· ·Pain, cough, trauma.· You have to have an indication, what symptoms are the patient having to justify the order. · ·Q.· ·And would the indication for the study be provided to you from Touchstone Imaging's portal? · ·A.· ·Yes. · ·Q.· ·And the information on the indication of study, would that be input by the tech that actually saw the patient and took the films, or would it be done by others at the Touchstone Imaging facilities? · · · · MS. BAILEY: Objection, form. · · · · THE REPORTER:· I'm sorry; I did not hear the answer. · ·A.· ·I don't know who put that information in for me. It's probably not the techs because they should have had also the indication -- the symptoms to justify the test. · ·Q.· ·(BY MR. BUTTON)· So part of the tech's job at a imaging facility like the Touchstone ones you were 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 54 working at would be to actually verify that there was an indication for the study with symptoms with that patient, correct? · ·A.· ·I don't think the test would have gotten to the techs had there not been an indication. · ·Q.· ·So somebody, before the patient comes into the Touchstone facility, would -- Somebody's gotta relay the background. · · · · MR. BUTTON:· Cathy, it might be you. · ·A.· ·You'd have to check with the Touchstone legal counsel on how that happened. · ·Q.· ·(BY MR. BUTTON)· Dr. Downing, the techs at the Touchstone facilities, would they have a checklist of questions to ask to gather information for you to review the films? · ·A.· ·Mostly they checked for identification, they were doing the right patient and the right body part. They would always ask the patient what kind of symptoms they had, and very often symptoms that the patient told them are not on the indication that came from the doctor's office. · ·Q.· ·What do you mean by that?· Give me an example. · ·A.· ·Well, on a chest X-ray, it may have said SOB, shortness of breath, and when the techs talked to them, it may have been chest pain. 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 55 · ·Q.· ·As a radiologist reviewing films, Dr. Downing, the more information you have the better, correct? · ·A.· ·Yes. · ·Q.· ·If you had a question about other symptoms or reasons why a patient was getting imaging films other than knee pain, chest pain, did you have the ability to pick up the phone and call the doctor? · ·A.· ·Yes. · ·Q.· ·And had you done that while you had privileges at Touchstone facilities at any point? · ·A.· ·Yes. · ·Q.· ·On what occasions would you pick up the phone and call the referring doctor to ask them questions? · ·A.· ·I have no recollection. · ·Q.· ·Can you give me an example of an occasion that you would have a question about the information provided to you that you didn't feel comfortable proceeding to read the imaging film? · ·A.· ·If the information that I had was totally discoordinate from findings or didn't make sense for the examination done. · ·Q.· ·When you would call the referring physician, would it be after you had already looked at the films? · ·A.· ·Well, yes, that would precipitate the reason I would call. 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 56 · ·Q.· ·So the process for you to gather more information would be to look at the indications of study information provided to you, look at the films, and then if you had a question about why that patient was there, then you would -- you could reach out to the referring physician and ask for more information, correct? · ·A.· ·I could. · ·Q.· ·As part of the process at the Touchstone facilities that you would be reading films at, would you get to decide whether certain views of X-rays got taken such as AP or lateral view; would that be your decision or the techs? · ·A.· ·Touchstone had a very well-defined -- · · · · MS. BAILEY:· Form. · ·A.· ·Touchstone had a very well-defined procedure manual so that the techs at all other sites would be doing the same.· If there was a case where I felt another study, another image would be helpful for the diagnosis, I would ask for that to be done. · ·Q.· ·(BY MR. BUTTON)· Let me clean that up, Dr. Downing, okay?· Can you hear me, Dr. Downing? · ·A.· ·Okay.· Yeah, clean it up. · ·Q.· ·The Touchstone facilities that you would read X-rays at had policies and procedure manuals that would dictate to the techs what views to take for a particular 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 57 body part or injury, correct? · ·A.· ·Correct. · ·Q.· ·And then when you got the film, after you would look at it, if you wanted additional views taken to verify your findings, you could request those, correct? · ·A.· ·Correct. · ·Q.· ·When you would finalize your report, was that in the Touchstone portal? · ·A.· ·In the Touchstone what? · ·Q.· ·Portal? · · · · MS. BAILEY:· Form. · ·A.· ·I don't know if it's Touchstone.· I think it was ARA's pack system. · ·Q.· ·(BY MR. BUTTON)· So you would write your report in the standard reporting forms for the Touchstone facilities, correct? · · · · MS. BAILEY:· Form. · ·A.· ·Yes. · ·Q.· ·(BY MR. BUTTON)· And on those standard forms, you would fill out a field for information such as your impressions and your findings, correct? · ·A.· ·Sometimes. · ·Q.· ·When would you not fill out those forms? · ·A.· ·When the form did not fit the examination, in which I would dictate the entire thing free form. 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 58 · ·Q.· ·So you had two options when filling out a report while you were doing work for Touchstone Imaging.· One would be you would fill out the fields with the information there that fit what you had, or two, it would be you could dictate the report if it didn't fit, correct? · ·A.· ·Yes. · · · · MS. BAILEY:· Object, form. · ·A.· ·Are we going to get to the case at hand soon? · ·Q.· ·(BY MR. BUTTON)· Oh, absolutely, absolutely. · ·A.· ·I see kind of a pointless -- I know it's about billable hours, but, you know.· How a radiologist works, you know, you should know that by now. · · · · MR. RYAN:· Doctor, I know why -- I know why this is frustrating, but. · · · · THE WITNESS:· Is this Jeff? · · · · MR. RYAN:· Yeah, it's Jeff.· I know why this is frustrating, but... · · · · THE WITNESS:· I know it's all billable hours, Jeff. · · · · MR. RYAN:· Well, you know, it's -- · · · · THE WITNESS:· It's billable hours. · · · · MR. RYAN:· It's all right. · ·Q.· ·(BY MR. BUTTON)· You're doing great, Dr. Downing.· I appreciate it.· We're going to keep going 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 59 and speed this up, okay? · ·A.· ·I hope so. · ·Q.· ·Dr. Downing, what does the term chronic pain mean to you as a radiologist when you see that as an indication? · ·A.· ·Please say that again. · ·Q.· ·Dr. Downing, what does chronic pain mean to you as an indication when you see that as a radiologist? · ·A.· ·They've had it for a while. · ·Q.· ·What is a while for a radiologist; what do you mean by that? · · · · MR. RYAN:· Objection. · ·A.· ·A couple of weeks to years. · ·Q.· ·(BY MR. BUTTON)· So chronic pain can be something that is causing pain to a patient that you're about to look at the X-ray for between a couple of weeks to a couple of years, correct? · ·A.· ·Generally. · ·Q.· ·And Dr. Downing, if you wanted to compare the imaging from one knee to the other knee, would you have that ability as a radiologist reviewing the films to recommend that? · ·A.· ·Yes.· You have to keep in mind how much additional radiation is necessary. · ·Q.· ·What would be the circumstances that you would 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 60 compare one knee that they were having an indication of pain for to the other knee? · ·A.· ·Usually age and you want to see the apophysis ad the epiphysis to see if that is normal for that patient or not; although that's usually not necessary because we have all sorts of anatomy books that show what's normal for a particular age group.· And again, you don't want to give the patient twice as much radiation unless it's absolutely necessary, especially in a pediatric group. · ·Q.· ·So for you, Dr. Downing, if you were provided imaging for a pediatric patient age 15 and below, you would refer to the anatomy books for what is a normal knee versus the knee that's on the image that you're looking at, correct? · ·A.· ·If I had something that I questioned. · ·Q.· ·And what types of anatomy books, like what's the title of the book that you used the most? · ·A.· ·I don't remember the author, but it's normal Radiographic Normal Variance. · ·Q.· ·Radiographic Normal Variance? · ·A.· ·Yes. · ·Q.· ·And that's the title of the book? · ·A.· ·I believe so. · ·Q.· ·Is there a volume or edition or year on that one? 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 61 · ·A.· ·I don't know. · ·Q.· ·Okay.· But that's something that you would keep in a hard copy, or would you have the digital version? · ·A.· ·Touchstone provided that in the reading room. · ·Q.· ·So at the Touchstone facility, you would have the actual manuals that you would need to compare films at, correct? · ·A.· ·Yes. · · · · THE WITNESS:· Jeff, do I have to sit here much longer?· He's getting absolutely nowhere. · · · · MR. RYAN:· Yeah, Doctor, I apologize.· I tried calling him yesterday to give him a heads up so that this would speed up, but -- Actually, a few times this week, so best laid planned, but, you know. · · · · THE WITNESS:· It's going to be a big bill to his client; I know that's what matters. · · · · MR. RYAN:· That's okay.· Hang tight.· He'll get to the fundamental question.· A lot of these are questions are meaningless. · · · · THE WITNESS:· Today? · · · · MR. RYAN:· Yeah, he will.· Just be patient, Doc. · ·Q.· ·(BY MR. BUTTON)· Dr. Downing, I'm going to take a short break. · ·A.· ·No, let's just get this over with. · · · · MR. BUTTON:· No, I'm going to take a break. 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 62 I've got people at my door that's going to make a lot of noise right now, and I will come back and finish this, and you will be done. · · · · THE WITNESS:· So that's more important than this? · · · · MR. RYAN:· Doctor, just hang tight, okay?· Just take a five-minute break; let's stretch, put your thing on mute real quick. · · · · THE VIDEOGRAPHER:· Okay.· We're off the record; the time is 10:49. · · · · (Recess taken) · · · · THE VIDEOGRAPHER:· We are back on the record; the time is 11:24. · ·Q.· ·(BY MR. BUTTON)· Dr. Downing, just in case there's a lag, if you could pause a little bit to make sure I finished my question, I'll do the same for you, okay? · ·A.· ·Okay. · ·Q.· ·Dr. Downing, on November 22nd of 2017, on your radiology report, you diagnosed Sandra Tony with a negative, right normal knee, correct? · ·A.· ·Yes. · ·Q.· ·And that was not correct, true? · ·A.· ·True. · ·Q.· ·On the X-ray that you looked at of Sandra Tony, 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 63 November 22nd of 2017, Sandra Tony actually had classic OCD lesion in her right knee, correct? · ·A.· ·ACD? · ·Q.· ·OCD? · ·A.· ·Okay.· Yes. · ·Q.· ·And I'll clean that up just so it's clean for the record, okay? · ·A.· ·Okay. · ·Q.· ·Dr. Downing, on the X-ray that you looked at for Sandra Tony's right knee on November 22nd of 2017, Sandra Tony clearly had an OCD lesion that you missed, correct? · ·A.· ·Correct. · ·Q.· ·And the OCD lesion was in the classic location, the medial femoral condyle, correct? · ·A.· ·For the knee, yes. · ·Q.· ·Dr. Downing, when did you find out that you had misdiagnosed Sandra Tony after reading the X-ray of 11/22/2017? · ·A.· ·When the lawsuit was filed. · ·Q.· ·And what was your first thought when you got the lawsuit? · ·A.· ·Well, I wanted to go back and look at it. · ·Q.· ·And when you looked at the X-ray for Sandra Tony's knee that you had previously reviewed, what did 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 64 you determine upon reviewing it? · ·A.· ·There was an OCD lesion in the medial femoral condyle. · ·Q.· ·And when you autopsied the X-ray upon review, did you determine the root cause of why it was missed in the first place by you? · ·A.· ·I didn't do an autopsy. · ·Q.· ·Do you have an explanation for why it was missed? · ·A.· ·No. · ·Q.· ·But it's obvious -- · ·A.· ·Yes. · · · · THE REPORTER:· I'm sorry; Mr. Button, I did not hear your question.. · · · · MR. BUTTON:· I'll repeat it, Ms. Johnston. Thank you. · ·Q.· ·(BY MR. BUTTON)· Dr. Downing, the OCD lesion that you missed was obvious on the X-ray for Sandra Tony November 22, 2017, correct? · ·A.· ·Correct. · ·Q.· ·Dr. Downing, do you believe that doctors must take the time necessary to understand the patient and their symptoms to prevent misdiagnosing them? · ·A.· ·Yes. · ·Q.· ·And do you believe that patients have a right to 800.211.DEPO (3376) EsquireSolutions.com YVer1f GREGORY C. DOWNING M.D. March 05, 2021 JOHN & JOHN V. TOUCHSTONE MEDICAL IMAGING 65 expect that of their doctors, to take the time necessary to understand? · ·A.· ·Yes. · ·Q.· ·And that applies to radiologists as well, correct? · ·A.· ·Yes. · ·Q.· ·And that's in place for patient safety, correct? · ·A.· ·Patient care, yes. · ·Q.· ·And that would have been a standard of care for a doctor to take the time necessary to understand the patient and their symptoms and properly diagnose the patient, correct? · ·A.· ·Correct. · ·Q.· ·Is that another way -- it's a patient safety rule, correct? · ·A.· ·It's a what? · ·Q.· ·Patient safety rule in place to protect the patients, correct? · ·A.· ·Yes. · ·Q.· ·And consequences can happen when a patient is misdiagnosed b