Desmond Erasmus, MD

2618 Sabercat Court Fremont, California, 94539

William Dugoni, MD 2012 Washington Outpatient Surgery Center Fremont, California, 94538 Re: Physician Affirmation and Certification Statement Dear Dr. Dugoni,

May 2,

Thank you for your letter of April 20, 2012 reviewing the Affirmation/ Certification and Performance Standards as applicable to me. As my practice pattern is weighted heavily towards spinal procedures in Neurosurgery, it is my intention that as the Minimally Invasive Spine Procedures become widely applied to the cervical and lumbar spine and begin to include fusions with overnight stays, I should be able to develop a program of performing a larger volume of cases at WOSC. The cervical procedures have been tested at Washington Hospital over the past year and have been seen to have no complications with a 23 hour stay. Therefore I expect that with some nursing assistance we are ready to trial one level fusions at WOSC. Some of the single level lumbar fusions are beginning to show the promise of shorter stays, although we have not quite achieved a 23 hr stay in the past year. My surgery scheduler advises me that the Lumbar Microdiscectomy cases have often been scheduled at the main hospital after a failure to get a favorable time slot at WOSC. Greater efforts will be made here so as to attempt to meet the One Third Income Standard allude to in your letter. I shall certainly make every effort to continue to support WOSC in our effort to improve patient care and improve outcomes while reducing the cost of medical care.

Sincerely,

Desmond Erasmus, MD