UT Southwestern Medical Center Responses from Dr. Edward Livingston, M.D.

To Questions from Dallas Morning News Reporter Brooks Egerton July 23, 2010

1. When we spoke yesterday, you said that [the faculty trauma surgeon on duty] had been paged at the start of [the patient’s] gallbladder surgery but failed to answer the page. How do you know that? What else can you tell us, based on your direct knowledge, about the [patient’s] surgery, including the involvement of the three other doctors? (Please note that we have copies of [the patient’s] medical records, as well as a signed release from [the patient] authorizing us to receive information about her case. If you want to discuss this case with me, and need a copy of this release, please let me know.) At the time I spoke the reporter, I do not recall his mentioning to me the name of the patient – only an incident in which I was called into the operating room at Parkland to repair a common bile duct injury in a surgery being supervised by the faculty trauma surgeon on duty. I recall the incident the reporter asked about, but I would have no way of knowing or confirming the name of the patient without checking old medical records, which I have not done. If I told the reporter that the faculty trauma surgeon on duty had been paged but failed to answer, I was mistaken. Trauma surgeons call in specialists, as appropriate, when issues arise in the OR. In the instance of the severed common duct, there apparently was severe inflammation of the cystic and common ducts and, because of their close proximity, both ducts were inadvertently cut, rather than doing just the cystic duct cut. The resident physicians told me that the faculty trauma surgeon on duty had been supervising the surgery in the OR at the time, and that he had instructed them to call me. I arrived and performed a reconstructive procedure to repair the severed common duct, and it went without complications. Although there may be other details, this summarizes my recollection of this case. 2. In a document released to us by UT Southwestern, generated as part of the Gentilello grievance review in May 2007, you are said to have been "uncomfortable with the PMH system: residents teaching residents" and that you "did not like or approve of the system." The document then says that you have "now changed [your] mind to a more neutral position. Sees both strengths and weaknesses. Still wants to be more comfortable with this method." Does this record accurately reflect what you said at the time? If so, can you please explain what made you uncomfortable at first, what changed your mind and what was needed for you to feel more comfortable with the system of resident supervision at Parkland? I never gave any direct testimony or statement regarding the Gentilello grievance, but I was interviewed as part of an information gathering process initiated by the Dean. The reporter must be quoting from

notes made during my interview, which I never reviewed and really have no idea what the notes themselves actually say. As I watched the practices at UT Southwestern, I realized that the model of supervision results in excellent training and superb patient outcomes. I went far beyond a ‘neutral position’ to a full appreciation of how UT Southwestern’s utilization of the ACGME model of a graduated development schedule enables resident physicians to become accomplished surgeons while simultaneously providing high quality patient care.