Medical Staff Executive Committee Fact Finding Investigation

Paul A. Kearney, M.D.

Conducted by Susan McDowell, M.D. and Louis Bezold, M.D.

Dr. Kearney was first appointed at the University Of Kentucky College Of Medicine on July 1, 1988.

Review of provided Personnel File Dr. Kearney has multiple letters in his personal file dealing with performance issues related to professionalism. (See Appendix A)

• March 18, 1992 written by Byron Young M.D. who was the Johnson Wright chair of surgery at the time. It indicates that Dr. Kearney was "rude, offensive, impolite, arrogant and loud" to an office staff member. Dr. Kearney is aware of this document in his file.

• July 20, 1995 written to Byron Young M.D. Chairman Department of surgery from Douglas A. Milligan M.D. Obstetrics and Gynecology expressing concerns over Dr. Kearney's behavior when he "publicly announced on patient care rounds that a patient's deterioration was due to OB not delivering the patient early enough and because the OB attending was too lazy to get up in the middle of the night." Dr. Kearney is aware of this document in his file.

• August 18, 2000 multiple letters are written by several operating room nurses describing one incident of banter among physicians in the operating room including Dr. Kearney that was felt to be a "crude, unprofessional, loud, disruptive, inappropriate, unwelcome, unwarranted, vile, offensive, inexcusable, discompassionate verbal exchange" that compromises our ability to provide patient care and something must be done to stop it. Dr. Kearney is aware of this document in his file.

• September 5, 2000 letter by Byron Young M.D. associate Dean of Clinical Affairs and Chief of Staff University Hospital to Dr. Kearney offering "voluntary remediation" based on the conduct in the operating room as described above. Requirements included evaluation by mental health professional, formal written apology to each member the surgical team, attendance at his own expense to a sexual harassment and sensitivity conference, and a five-day vacation from medical staff duties. "Failure to meeting the requirements of the voluntary remediation or acting in a similar fashion in the future will result in additional corrective action which could include termination of your medical medical staff privileges and your termination from the University Kentucky." There is no follow-up documentation provided. Dr. Kearney is aware of this document in his file. He completed the required anger management course.

• July 8, 2005 written by Jay A. Perman M.D. Dean College of medicine, vice president for clinical affairs requesting a one-on-one meeting to discuss reports of a "profanity laced, totally uncalled for, outburst" during the care of a trauma patient June 25, 2005. The letter references a discussion from December 2004 during which "I told you that I would have zero tolerance for continued inappropriate b~havior on your part which demeans the entire institution." Dr. Kearney is aware of this document in his file.

• January 7, 2009 letter signed by Joseph B. Zwischenberger, M.D., Chairman Department of Surgery, Patrick McGrath M.D., chief general surgery, Colleen H Schwartz, chief nurse executive, and Paul De Priest, M.D., chief medical officer to Ors. Karpf, Lofgren, and Perman indicating "Dr.

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Paul Kearney has continued to exhibit aggressive and humiliating behavior around colleagues and staff. There have been numerous complaints which are serious and which require management intervention. In addition, his attitude toward colleagues is perceived as derogatory and impacts on student education." A request for referral to the Kentucky Physicians Health Foundation for the Impaired Physicians Program was requested. Dr. l<earney became aware of this document in his file only after his suspension and subsequent request for a copy of his file.

• February 5, 2010 letter from Dr. Kearney to Joseph B. Zwischenberger, M.D., Chairman Department of surgery, indicating "I will voluntarily agree to the recommended remediation course. After completion of the course, the current allegations will be expunged from the record." Dr. Kearney is aware of this document in his file. He completed the required anger management course.

• May 7, 2010 what appears to be a draft document from Joseph B. Zwischenberger, M.D., Chairman Department of Surgery, referencing a February 17, 2010 entry into a voluntary remediation action plan that included referral to the l<entucky Physicians Health Foundation. It indicates Dr. l<earney contact in the Foundation and was advised that the recommended program would involve being away from home for several weeks. Dr. l<earney indicated he would not be able to make suitable arrangements for his family to accommodate the program during the school year. There are additional amendments to the plan but there is no indication that this draft was ever signed and that any additional follow-up occurred. Dr. Kearney became aware of this document in his file only after his suspension and subsequent request for a copy of his file.

• December 12, 2012 letter from Joseph B. Zwischenberger, M.D., Chairman Department of Surgery, as a written reprimand and action plan regarding unprofessional conduct. In summary there were complaints by 3 operating room nurses regarding unprofessional conduct in the operating room. As part of this written reprimand Dr. Kearney was required to "refrain from such unprofessional conduct when interacting with other UK personnel. Specifically, you shall not slap, smack or touch another UK employee with whom you are angry or frustrated. In addition, you show not direct profane comments toward UI< personnel if, in your opinion, they fail to perform the duties adequately." Violations of the terms of this written reprimand were subject to corrective action. The document is signed and dated by Dr. l<earney January 9, 2013

• Undated Faculty performance evaluation and copy of resident and medical student evaluation of Dr. Kearney. with complementary comments and scoring.

On an alleged patient care incident occurred violatin~ the above written reprimand involving a male trauma patient with new spinal cord injury.

rehabilitation he was scheduled for

Based on our interviews with individuals the following events occurred during the . Any contradictions to this outline are noted in individual(s) report sections. The patient was

taken to the procedure room midday to early afternoon on this date for the procedure. He was reportedly anxious about the procedure according to multiple individuals. Individuals present for the

included Dr. Kearney, attending physician, Tamara Cox, M.D., resident, Justin Peterson, M.D. resident, , M3 medical student, and endoscopy tech Caitlyn Rice.

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During the procedure Dr. Peterson was handling the endoscope standing at the head of the bed, Dr. Cox and were prepared for insertion standing at the middle of the bed, and Dr. Kearney was primarily positioned toward the foot of the bed. The patient was sedated prior to beginning the procedure. Upon attempts to advance the endoscope the patient began gagging and resisting scope advancement. Some additional sedation may have been given. There were issues related to advancing the endoscope including the patient gagging, movement of his arms in an attempt to resist the procedure and increased secretions that required additional directions from the attending to advance the scope into the correct position. There were efforts made by several to hold the patient's arms still to facilitate scope advancement. Once the scope was placed correctly there were repeated difficulties maintaining inflation of the stomach so as to allow appropriate identification of the insertion site, focal anesthetic infusion with lidocaine, skin opening made by scalpel insertion and subsequent insertion of the Infusion of lidocaine and skin opening was performed by the medical student who additionally attempted insertion 2-3 times without success requiring Dr. Cox to complete the insertion portion of the procedure. Once insertion was completed the remainder of the procedure went without difficulty, other than similar issues to above with endoscope reinsertion to verify procedural success.

A complaint was filed by the patient's mother with Customer Relations Specialists, Mr. Glenn White on •••••••••• , As per the OSE Physician Complaint Algorithm that complaint was forwarded to all applicable parties. That report has been reviewed and indicates the following.

Background/ Assessment: Patient's mother came to our office and stated the following:

• My son was getting a scope procedure& •• and woke up when the tube was being inserted because it hurt

• We were told he would be put to sleep for this procedure.

• She heard Dr. Kearney call him a "fk'ing~ and "fk'ing idiot" and told the person about to make an incision "Just fk'ing cut him."

• She said the resident (I assume) who had the scalpel backed away and another doctor, a female had to do it.

• He said someone got on top of him to hold him down while the incision was made. • My son has struggled with self-esteem and being called names his whole life and with this injury

this is the last thing he needs.

• When I talked to the nurses in the unit and asked how this could happen, they kept exchanging glances like they were not surprised.

• I don't want this Dr. touching my son even in my room anymore.

• My lawyer for the car accident told me to contact Margaret Pisacano about this.

There is documented one other interaction between the mother and a customer relations specialists ••••• 111' ... which revolved around access to the waiting area closest to the ICU. The mother was apparently asleep in the waiting area during a time frame in which the area was closed.

On Friday, September 5, 2014 Dr. Kearney was placed on indefinite paid administrative leave pending additional investigation of the above allegation. On Monday, February 2, 2015 Dr. Kearney was summarily suspended leading to this fact finding investigation.

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INTERVIEWS

Bernard Boulanger, M.D. Chief Medical Officer: Dr. Boulanger was interviewed February 2, 2015. Dr. Boulanger served as Associate Chief Medical Officer prior to assuming the role of Chief Medical Officer so he has participated in or been aware of the disciplinary and/or complaint related issues in Dr. Kearney's personnel file as reviewed above. Dr. Boulanger was notified of the patient and family related complaint through the customer relations specialist He along with Mr. Cliff lier, Ms. Margaret Pisacano, and Jan Davis, RN interviewed the patient in the presence of his mother the next morning. Dr. Boulanger indicates that the patient remembered fine details of the procedure including the green bite block being placed and one attempt at making an incision followed by a second attempt by another individual. Dr. Boulanger indicates the patient reported that Dr. Kearney said "pry his fucking mouth open" when there were issues with the endoscope. The patient also reported to Dr. Boulanger that Dr. Kearney said "we do not do that you fucking Idiot" in response to the patient's request for additional sedation. The patient indicates that there is no doubt in his mind that Dr. Kearney was talking to him when he made these remarks. The patient also recalls Dr. Kearney cursing at the residents in the room during the procedure. Dr. Boulanger indicates that the patient felt that Dr. Kearney was holding him down but in his investigation he was not able to corroborate that accusation. The patient and mother also recalled an incident in the days prior where Dr. Kearney was heard outside the room calling the patient a "fucking _, while talking to the residents after rounding on the patient. In reviewing both accusations with Dr. Kearney, he denied calling the patient a "fucking idiot" during the procedure but does indicate he did use the term "fucking 16/1' outside of the patient's care room but was correcting the resident who referenced the patient isJ (5) •J The patient and mother requested no additional care be provided by Dr. Kearney. At that time a new attending faculty member was identified to care for the patient.

Dr. Boulanger was also made aware of a Facebook post by the mother later that day which read as follows:

Livid will not even touch what I am right now!/ I I don't normally posts my rants but I feel it's necessary Dr. Kearneyearney to post this! I Just because my son wakes up during your procedure last night it doesn't give you the right to fight a defenseless man while he's on the table begging to be put back to sleep and then you call him and I quote, "a Fu$&@?/& idiot" and then proceed to cut him ... nor does it give you the right while your making rounds 3 days ago to call him and I quote "a Fu$&@_.' because he can't life his hand!! UK is aware of this man's behavior because he's done it before!!!! My son is traumatized 11 I I just wish he had told me sooner . ..... I knew something was wrong but I just thought he was depressed from all that he is having to accept . .. believe me when I say and I quote, "/ won't stop until I have this man removed from this hospital I I II!!! II I

On Friday, September 5, 2014 Dr. Kearney was placed on indefinite paid administrative leave pending additional investigation of the above allegation. On Monday, February 2, 2015 Dr. Kearney was summarily suspended leading to this fact finding investigation.

In addition, during Dr. Boulanger's investigation of this accusation he became aware of another incident unrelated to this patient involving a nursing intern indicating unprofessional conduct by Dr. Kearney that occurred following the written reprimand from December 2012.

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Frederick De Beer, M.D., Dean College of Medicine

Dr. De beer was interviewed February 2, 2015. He shared a written complaint from a medical student toward Dr. Kearney regarding the use of offensive words and derogatory remarks about individuals including the medical student during a lecture given August 8, 2014. {See appendix)

Jan Davis, R.N., Patient Care Manager: Ms. Davis was interviewed February 2, 2015. Mrs. Davis is the patient care manager for the surgical ICU and surgical patient care beds. She remembers clearly the patient and his mother throughout their ICU and progressive care stay. She recalls the patient has at least 1 child (maybe more) and that his mother was not only caring for the patient in the hospital but also trying to manage these young children at home. She recalls mother having talked to the other staff on the floor and Customer Relations Specialists in the hospital prior to this event related to patient care issues. She felt that the mother was having difficulty coping with these numbers of issues. Mom had reported irritation with the repeated neurological exams feeling that asking her son to 11move his legs" was unnecessary. She reports counseling the mother on the need for repeated neurological exams by both the staff and the physicians in order to document any changes. Mrs. Davis reports the patient went for the that day in the late afternoon and returned later in the evening at about shift change. She had no interactions with the patient or mother until the following morning. When she arrived that next morning she was told by her staff that the mother was very upset about the . Miss Davis indicates that according to the staff upon return to the floor from the procedure the patient was sleepy and complained of nausea which was managed by the staff. She indicates that mom raised concerns about the procedure to nursing staff that evening but got no answers from them indicating that the staff just 11 looked at each other". Mrs. Davis indicates that mom was told by the consenting physician the night prior to the procedure that the patient would be asleep for the procedure. Mrs. Davis feels there was communication disconnect between conscious sedation versus complete anesthesia. Per Mrs. Davis the mom stated that the patient woke up later that night expressing concerns about the procedure. He indicated he woke up during the procedure at the time of scope insertion at which point he heard somebody say 11Hey stop, he is awake." Someone then asked what he had been given for medications. At that point the 11gray-haired physician" reportedly said "that is not fucking going to touch him, he is. -, Mom indicated the patient 11felt trapped, unable to defend himself." She additionally indicated he said "someone was lying across his legs and holding him down during the procedure." Mrs. Davis indicates that the mother said there were several expletives using the 11F word" but there was no indication at the time of the conversation with mom that the patient was called anything but a 11Fucking ••I" This conversation was between Ms. Davis and the mother with little to no information provided by the patient. Ms. Davis subsequently contacted Margaret Pisa ca no, Risk Management to make her aware of the patient complaint.

Additionally Ms. Davis is aware of a concern raised by mom in the days prior to the procedure where Dr. Kearney reportedly called the patient a 11fucking-' outside of the patient's room after completing rounds.

Ms. Davis was also present at a subsequent interview of the patient by Bernie Boulanger, M.D. chief medical officer, Mr. Cliff lier, legal counsel, Margaret Pisacano, Risk Management and the patient's mother. During this interview done by Dr. Boulanger, Ms. Davis made no remarks and remembers that mom made little comment. Ms. Davis indicates the patient gave his own account of the events related to the procedure. Ms. Davis does indicate that the details of the event seemed to 11grow" between the

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versions told by mom to her the previous day and what the patient indicated during this interview. Ms. Davis indicates she has l<nown Dr. Kearney for many years and feels he is "irreplaceable" given the care that he provides to his patient's and the teaching that he does for both the hospital staff and the resident's. She notes he always sees every one of his patients every day, including dealing with many very difficult patients. She stated Dr. Kearney is "opinionated but is always doing the right thing for the patient and staff despite his behavior not always being professional."

, M3 Medical Student: was interviewed February 2, 2015. rotated onto the general surgery service for

the first day on the date of the above procedure. His only previous clinical experience was the preceding 2 months of pediatrics. He was made aware of the planned procedure for the patient and asked if he would like to participate with supervision. His recollections of the steps involved in the procedure are the same as those dictated above. He is aware that the patient was given sedation for the procedure but does not know what. He indicates that a white or possibly light blue circular bit was placed in the patient's mouth through which the endoscope was passed. He indicates as soon as the scope entered the patient's mouth, the patient became obviously uncomfortable and was gagging. He was not able to understand any of the vocal utterances made by the patient. He remembers Dr. Kearney cursing at the residents during the procedure as he attempted to guide them through the required steps. He does not remember what words exactly were said as he remained focused on his attempts to anesthetize the skin and make the insertion. He remembers the patient struggling during the procedure, including moving his arms. He indicates Dr. Kearney told the staff and residents to hold his arms still during the procedure. He recalls that cursing by Dr. Kearney during these instructions was largely directed at the residents, and not him. He indicates he had difficulty passing the into the stomach due to repeated stomach deflation's requiring Dr. Cox to complete that step. He indicates the patient is awake during the whole procedure.

In the days following the procedure he had little contact with the patient.

Caitlyn Rice, Endoscopy Equipment Specialist Mrs. Rice was interviewed February 3, 2015. Ms. Rice is the endoscopy tech that participated in the

for the patient. In this role her responsibilities are to set up the equipment, assist .. the,r,oom nurse or physician with equipment related issues and then to clean the equipment and room for the next patient. If the nurse is busy during the procedure she may participate in suctioning/as required. For the majority of the procedure she was positioned on the patient's right at the head of the bed. She indicates both residents and the medical student were on the patient's left and the Dr. Kearney was at the foot of the bed just inside the opening of the door. Ms. Rice indicates that she remembers the case was not an easy procedure due to difficulty passing the endoscope. The patient was initially sedated forthe procedure; the medication used she is not aware of. She indicates the patient was awake for the majority of the procedure including the initial placement of the green bite block in his mouth. The patient was experiencing some initial difficulties opening his mouth which required her assistance. Once the scope was passed through the .. bite block into the patient's mouth he began to struggle which she felt indicated the sedation was not yet working. She does remember an additional dose of medication being given and then after a short period of time the scope was reintroduced and the patient continued to struggle until the scope was passed. She was at the head of the bed talking to the patient through the vast majority of the procedure and indicates that his eyes were open whole time until the very end of the procedure at which point he relaxed. She indicates that the patient "looked distressed" during the procedure. Ms. Rice indicates throughout the procedure Dr. Kearney was "yelling at the residents including calliog them names like dumb and retarded." She remembers comments

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being made to the nurse in the room about the patient's.._....... She also remembers Dr. Kearney saying "stuff to the patient that was very unprofessional" and included using profanity but does not remember his exact words, She does remember at one point the bite block came out of the patient's mouth and when she asked him to open his mouth to put it back and he complied with her request. At one point in the procedure when they were working on the abdominal incision the patient attempted to lift his head off of the bed and also began to move his arms which required them to be restrained. She remembers having her hands on his chest encouraging him to lay still. She remembers his arms needing to be restrained as he was grabbing for the equipment. She does not remember if physical restraints were applied at that point. She is also uncertain as to whether Dr. Kearney physically touched the patient's legs during the procedure as the patient began to move, although as the interview was concluding she recalled that he may have placed his hands on the patient's shins. She does indicate that all efforts to restrain the patient were done by everyone in an effort to ensure the patient's own safety and not inconsistent with what may have been necessary for other patients. She does indicate that is not unusual for them to actually apply soft restraints to the wrist and ankles of patient's prior to entering the endoscopy room who they believe may have difficulty with the sedation or become confused and combative during the procedure. She does remember that this particular patient did not have restraints applied prior to coming into the endoscopy suite. She assumes this was because of his known neurological injury. Mrs. Rice indicates that for the near majority of the entire procedure Dr. Kearney stood at the foot of the patient bed just inside the door frame of the room. Ms. Rice indicates that other than difficulty with passing the scope and making the incision there were no other issues in and around the procedure specifically she indicates that the amount of secretions for the patient were normal. Mrs. Rice indicates the patient finally closed his eyes once the was in position. At the end of the procedure the patient was taken to the prep and recovery area and handed off to that staff. Ms. Rice had no additional contact with the patient after that time. Mrs. Rice has participated in multiple endoscopic procedures supervised by Dr. Kearney. She indicates that she does not look forward to doing these procedures with Dr. Kearney because there is always "a lot of yelling, cussing and inappropriate behavior in the way he carries himself."

Justin Peterson, M.D. General Surgery Resident, PGY2

Dr. Peterson was interviewed February 3, 2015. Dr. Peterson has had multiple interactions with Dr. Kearney during the preceding 18 months of his residency training. These experiences have been both in the outpatient, inpatient and operating room setting. His recollection of the patient is good. He indicates that he was on the rotation in the surgery ICU for the month of •u$Nhere he did care for the patient. He rotate!b ' •ti___ 1£1 into the endoscopy rotation and was the resident performing the endoscopic portion of the procedure for the patient. Dr. Peterson remembers shortly after the patient was wheeled into the room that there was a conversation about what medications would be given to the patient " He remembers the decision was made to but he does not know the doses or exactly what meds were given. He indicates that passing the scope "did not go well." There were initial difficulties with advancing the scope beyond the patient's mouth. He remembers the patient asking to be "put to sleep." He remembers Dr. Kearney responding directly to the patient using a 11derogatory term" which in essence indicated that he was not going to put the patient asleep for the procedure. He does not remember the exact-words that were used by Dr. Kearney. He does remember additional medications were given to the patient and the scope was subsequently able to be passed and the procedure continued. He remembers the patient struggling during the passing of the scope including attempts to use his arms to grab the scope and at some point he was restrained, but he does not remember for certain if actual wrist restraints were placed. He does not remember at any point during the procedure Dr. Kearney touching the patient. He remembers the medical student having difficulty attempting to make the

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incision in order to pass the and that Dr. Cox had to step in for him to perform that portion of the procedure. He remembers Dr. Kearney being "ornery with lots of cussing and name calling" throughout the entire procedure. When questioned as to exactly what words were said, Dr. Peterson deferred on being specific. He indicates this was the first he had done with Dr. Kearney. Dr. Peterson had participated in other prior to this and felt that the patient was "more awake than usual" during this procedure. Dr. Peterson indicates that as the normal routine the endoscope is passed, the is placed requiring the endoscope to be removed, and then the endoscope is reinserted to assure her that the is in the correct position by viewing from within the stomach. Dr. Peterson indicates that he again struggled with passing the endoscope for the second view at which point Michael Bounds, M.D., PGY 4 resident stepped into the room to complete the scope insertion. By Dr. Peterson's recollection Dr. Bounds may have been in the room during the entire procedure, but he is not certain.

Tamara Cox M.D., General Surgery, PGY 4

Dr. Cox was interviewed February 4, 2015. Dr. Cox does remember the done on the patient. In general, she was unable to recall a lot of detail in around the procedure. She indicates that it was "one of the top 10 most difficult she has done". Dr. Cox indicates that there was difficulty passing the endoscope by the other resident. She remembers the patient was "fighting" the procedure but that that was not uncommon. She indicates based on the patient's known neurological level that no initial restraints were used. She does remember Dr. Kearney speaking during the procedure and that the words used were "nothing abnormal for Dr. Kearney". She believes there was some profanity used but does not recall the exact words. She does not recall Dr. Kearney specifically addressing the patient during the procedure. She recalls during the second passing of the endoscope that again there were difficulties in passing the scope by Dr. Peterson. At that point she indicates Dr. Ross Strong M.D., General Surgery PGY 5 happen to step into the room and finish the second passing of the endoscope. Dr. Cox indicates that Dr. Strong was not present for the entire procedure. Dr. Cox said that Dr. Kearney is "crass but a good educator and we miss him. He cares for residents more than most."

, R.N., Endoscopy Suite Nurse was interviewed February 4, 2015 by Dr. McDowell only. has worked with Dr.

Kearney on numerous occasions in the endoscopy suite as well as in the 1990s as a trauma nurse. does remember the patient and the procedure. She recalls he was

••••• She remembers that he was a difficult sedation that required additional medication compared to other patients but she does not remember what doses of medication were provided. She remembers the patient having issues with coughing and gagging as well as requiring suctioning for secretions during the procedure. When asked about Dr. Kearney's participation and behavior she indicated he was being "typical Dr. Kearney." Specifically she indicated he "talks firmly to the resident's and uses frequent profanity" she additionally indicates that he did speak directly to the patient during the procedure but does not remember exactly what was said. She indicates the overall jest of what Dr. Kearney said was in an effort to make the patient aware that "we are just trying to help you." does not remember the patient talking during the procedure. She indicates that Dr. Kearney "did not gown or glove" into the procedure which was performed by the resident's.

-~ ,patient was interviewed February 5, 2015. He indicates that he •• ]; r• fMIPf rtl bl 7 His

care was provided at the University of Kentucky MP I 1 · Jlmd included the need for a He was asked to provide details about that procedure. •Pl 'BJ stated that he was initially

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asleep but then woke up as they began to attempt to pass the scope. He indicates that he became aware of "a lot of people around him including Dr. Kearney and the residents". He stated the resident was attempting to pass the scope which he was fighting. He states that he remembers Dr. Kearney talking to the resident telling him to "hurry up". He states the resident then said "the patient was awake and was fighting him." At that point he heard Dr. Kearney say pry his "Fk'ing mouth open." •••1111 then states he asked to be put back to sleep to which Dr. Kearney responded "we do not put you to sleep for this you fucking idiot." J I asked again to be put back to sleep and was told "no we do not do that" at that point he just stopped fighting and allowed the scope to be passed. He does remember Dr. Kearney asking the staff what had been given to the patient at which point Dr. Kearney responded ' He remembers Dr. Kearney instructing the residents to "make the

:~~~:;di:~i;,~en:at~n:~~~:~~t~ ~:sii::~~~~~:;:;::~~:r;1;:~:;tif!81M .,:~~~~~~:~~~<;;~:~ieep and does not remember any of the remainder.of the procedure. indicates he then at some point later on told his mother what happened and that he did not wish to have Dr. Kearney back in his hospital room. b Sb indicates a couple days after the procedure Dr. Kearney name to the patient's room and apologized saying Dr. Kearney was not yelling at [ h but was just trying to get the in place because he knew he wanted the tube out of his nose and that he wanted to start eating. Dr. Kearney indicated at that time that he would get him some soft food. 8 &•tasked Dr. Kearney to "get out, mom will be pissed" to whicl t - b indicates Dr. Kearney said she is not here, ..... ., ............ " • 9 b indicates that his experience during his has made him "scared to have anything done by you !<."

•••• also recalls another incident with Dr. Kearney that occurred in his hospital room in the days preceding his . J $indicates that Dr. Kearney and a female resident were standing beside his hospital bed when Dr. Kearney asked him to "lift your hands." f) ft stated he picked his arms up at which time they just flopped over. At that point Dr. Kearney turned to the resident, and under his breath said "yeah, he's a fucking .. "

Paul Kearney, M.D., General Surgery

Dr. Kearney was interviewed February 5, 2015.

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persistent difficulties with swallowing and eating. Dr. Kearney indicates that the patient and mother consented to the . Dr. Kearney indicates that the procedure was done with 3 resident's including Justin Peterson M.D., Tamara Cox M.D. and Ross Strong M.D. There was also a medical student and to assisting nurse is in the room for the procedure. During the procedure Dr. Peterson was primarily responsible for the endoscope while Dr. Cox was at the "gastric side" of the procedure ready to insert the . Dr. Kearney states the patient was given at the start of the procedure. Upon introduction of.the endoscope into the patient's mouth t e patient began to gag eventually spitting out the bite block, biting on the scope and flailing around. Dr. l<earney indicates Dr. Peterson was working to get the scope out of the patient's mouth and he expressed concerned for risk of a bite wound given the patient's history. The patient then stated "need to be put to sleep". At that point Dr. Kearney ordered additional medications to be given. Sl;iortly,.,after that the scope was reintroduced and the patient continued to struggle including attemp~ to:reac_b,up and grab the scope and flailing his head around. There were efforts by the nursing staff.'(lnd hi.. believes the residents to physically restrain the patient's arms. Dr. Kearney stated that he reminded the staff and residents that significant force was·not needed because. l 2 IQ! rand encouraged them to be gentle. At this point Dr. Kearney states he did speak to the patient saying "Hey dum)J-ass we are trying to help you just relax." The scope eventually passed, the stomach was inflated and there were some additional difficulties with insertion by the resident at which point Dr,. Kearoney,ordered an additional m .I. At that point the patient relaxed.and the procedure was completed. Dr. Kearney stated

that as part of the normal process·there. is a second insertion of the scope to assure that the is correctly positioned. This second passing of the scope was again attempted by Dr. Peterson who struggled and at this point Dr. Kearney ordered Dr. Ross to take the scope and finish the insertion. Dr. Kearney states he stayed at the foot of the bed for the entire procedure and did not touch the patient. Dr. Kearney indicates that overall the pr.pcedure took a little longer than usual secondary to teaching the residence and allowing them an opportunity to attempt the procedure. He indicated Ire pro,v~ed feedback to the residents during the procedure and that he "can be harsh with residents" but was not certain what he said, however stated: "I can almost guar~tee I used profanity". Dr. Kearney indicated he was his "usual self' and likely "yelled." Dr. Kearney stated his normal routine is to try to go light on the sedation during these procedures because that was how he was trained. He indicated that it is more problematic to over-sedate patients that can lead to significant issues including for people to stop breathing. He indicated that he was b·eing-<very vigilant of all that was going on in the room recognizing that the patient's level of spinal eord injury put him at risk for adverse events related to excessive sedation and a risk of bradycardia with vagal stimulation. Dr. Kearney indicated that he himself has been scoped on several occasions and it is "uncomfortable, but not very painful." Dr. Kearney stated that he saw the patient the next day and apologized saying "things got hairy, my apologies.1

' Dr. Kearney states that he was not requested by the patient to leave the room.

R.N.1 nursing intern was not interviewed after she did not respond to multiple attempts to contact her. Documents

provided by Cliff lier, legal counsel for review. (See appendix)

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