CASE 0:10-cv-04636-JRT-AJB Document 151-10 Filed 07/10/12 Page 1 of 17

Exhibit 10

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Alfonso Morales, M.D., 4/24/2012

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 vs. and vs.

UNITED STATES DISTRICT COURT DISTRICT OF MINNESOTA

Spine Imaging MRI, L. L. C. , a Minnesota limited liability company, Plaintiff,

Liberty Mutual Fire Insurance Company, a Wisconsin corporation, and Allstate Insurance Company, an Illinois corporation,

Defendants,

Liberty Mutual Fire Insurance Company, Third-Party Plaintiff,

Eduardo Bullon, individually; Rafael Mendez, Clinic, individually, Central Medical LLC; Dr. Alfonso Morales, M. D. ,

individually; Northstar Radiology

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Alfonso Morales, M.D., 4/24/2012

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Corporation, P. A. ; Dr. William Ford, M. D. , individually and Dr. Hans Michael

Castro, D. C. , individually, Third-Party Defendants.

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DEPOSITION OF ALFONSO MORALES, M. D. Taken April 24 , 20 12 Commencing at 9:05 a. m.

REPORTED BY:
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KELLEY E. ZILLES, RPR

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Alfonso Morales, M.D., 4/24/2012

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Q.

Okay.

And what knowledge or understanding do

you have as MRI machines compare to one another, in other words, a Fonar versus a Picker versus a Toshiba? A. I think that's minutia, really. I mean, I think

it's minutia to look at every single type of scanner, whether it's Toshiba or Siemens or GE. I think a

scanner, as long as you have a good resolution and you can see the scans correctly, I think that's what I was looking at. Q. Okay. And you made reference to getting a

report of findings or an interpretation report done A. Q. A. Q. Yes. -- of the scan? Yes. Okay. Is that one of the things you accept when

you refer a patient of yours to Spine Imaging? A. To have an adequate interpretation and

professionally done, yes. Q. A. Okay. Who do you expect that to come from?

At the time it was Dr. Ford, Dr. Johnson, there

was another doctor that I can't remember his name. Q. Okay. Would you ever refer a patient of yours

to an MRI facility that did not provide a report of findings? A. No.

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Q. A. Q. A. Q.

That's a given, in other words? Yes. Is that fair? Yeah, you have to have that. Okay. And does that report of findings have to

come from a medical doctor who's a radiologist? A. Q. It has to be from a radiologist, yes. Okay. And so would it be fair to understand

then when you determined you were going to refer patients of Central Medical to Spine Imaging that you knew Dr. Ford and/or Dr. Johnson would be interpreting those scans and you were satisfied they were competent radiologists? A. Q. A. That is correct, yes. And you were in fact counting on that?

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Q.

Did you have any concern about the ownership of

the MRI facilities you were referring patients of yours to? A. Q. No, that was not my business. What use are you making of the MRI scans and the

report of findings issued to you by Spine Imaging? A. Q. A. What use? Yes. It's important to know what is the anatomy and
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 no.

A.

I don't know what kind of relationship he has,

Q.

Did you ever see any kind of contract or

agreement between Spine Imaging and Dr. Ford? A. Q. No. I think you indicated earlier that to the extent

that there were reports generated following some diagnostic testing done at Spine Imaging, that would come to you on Spine Imaging letterhead, is that correct? A. Q. Yes. Would that report be signed by a physician or

some qualified person interpreting the, the results? A. Q. Yes. Do you recall on any of those reports that you

would receive was there any indication that the person signing it was not an employee of Spine Imaging? A. Q. No. Was there any indication that the person signing

those reports was somehow an independent contractor to Spine Imaging? A. Q. No. So looking at the report you would assume that

that person worked for Spine Imaging, whoever was signing it?
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A.

That the MRI tech would call and say this is not If

understandable or can we do a better resolution. they can't I would just send them somewhere else. Q.

So the, so the image would be provided to you,

you'd have an opportunity to at least try to get it corrected, and if it couldn't get corrected you would send them somewhere else? A. Q. at all? A. Q. No, they had excellent resolution. Have you ever provided any medication to any of Yes. And do you recall doing that with Spine Imaging

the patients that were undergoing scans? A. Yes, some of them are claustrophobic or severely

anxious so I have to give them something. Q. Okay. How are you made aware of this

claustrophobic or this anxiety that they are going through? A. we were faxed something that the patient is requires maybe some

claustrophobic or oversized, sedative. Q. A. Q.

So that would come from Spine Imaging? They would fax something, yeah, to us, yes. And did you ever prescribe some medication for

any patients that weren't your patients that you

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I

referred to Spine Imaging? A. Q. Numerous times, yes. So you would prescribe medication for patients

that were not your patients? A. Q. Imaging? A. Q. A. Yes. And would you examine these patients? No, I would just try to get a history from them That were not my patients, yeah. And that would have been at the request of Spine

of what's going on, are they already taking other medications, do they have any problems, and just go ahead and give them a very low dose sedative. I'm

usually very conservative, so most of the time it worked very well, even if they were oversized I would give them a low dose. Q. A. So you would talk with these patients? No, no talking, no. I just get a history from

the person who is faxing it, like from Jason or from one of the techs that's doing the MRI. Typically it would

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be one of the techs that would do that. Q. Okay. So a technician would be there taking a

medical history? A. Q. Yes. From the patient and then relaying that to you
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and requesting that you give some kind of medication for the purpose of A. Q. Yes. -- relieving the anxiety for that particular

patient going through the MRI scan? A. Q. A. Q. Yes. And you would not have seen that patient? No. You would not have reviewed any medical records

relating to that patient? A. Q. No. You would have relied upon a history that would

have been taken by an MRI technician? A. Q. Yes. Okay. I have no further questions. FURTHER EXAMINATION BY MR. LOWDEN: Q. Mr. Morales, again, Michael Lowden. I just have

a few follow-up questions.

I want to jump on that

issuing medications for some of the Spine Imaging patients. A. Q. No. Did you have some kind of an agreement with Did you get paid for that?

Spine Imaging that you would provide that medical service?

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A.

Did that on my own.

And I have other practices

that, that I knew were LLC's that I never, I thought PLLC was something attorneys used. Q. Okay. But my question was, you didn't have the

advice of counsel at that time? A. Q. No. You were asked questions about contrast, MRI's You don't send patients down to Spine

with contrast.

Imaging, but are you aware whether Spine Imaging performs MRI's with contrast or not? A. Q. I'm not aware of that, no. The, in terms of the anxious or obese patient You would get a fax and then you

line of questioning.

would have a telephone call with a tech at Spine Imaging, that's how that would work, right? A. Q. Yes. Okay. And someone asked you whether you would

actually examine the patient and you said no, it was the telephone call. medication? A. Oh, I would prescribe the medication through a But who would actually deliver the

pharmacy, we used to have a pharmacy down, or upstairs in the first floor, and I would write the prescription to give them a tablet or half a tablet of something. Q. Mm-hmm.
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A.

And to sedate the patient.

Usually it was a

safe medication and they would give me the weight of the patient to make sure I was giving an adequate dose. then the receptionist would come up and pick it up or Jason would come up and pick it up or they would send somebody to come up and pick it up. Q. So how many times during the 12 years has that And

happened? A. I can't tell you how many times, but it happened

several times. Q. A. Q. A. Q. A. Q. A. Q. A. Q. More than a hundred? I don't think a hundred. All right. So less than a hundred?

Much less, yes. Okay. More than ten?

More than ten. All right. And more than 50?

Not more than 50. All right. Yes. And on none of those occasions did you ever So somewhere between 50 and ten?

actually witness physically the patient, right? MR. MYERS: A. Object to the form.

A few times they had to come in because I was I mean, I can think of maybe a handful of
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concerned.

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times where I said send them over because I need to see if they had too many medical problems that I was concerned with, I would go through that and do an exam, but usually most of the time they did well. Q. Okay. So in what, bear with me, what percentage

of these people who needed some sedatives did you actually meet with in person? A. Q. I'd say a quarter of them, 25 percent. Okay, 25 percent. And the question, you had the

question earlier, you never received payment for this service even, even in those circumstances where you actually had to evaluate the patient? A. No. I, I think we couldn't really code on that

and sometimes I, I don't know if we would ever get paid on it, so we would write it off. Q. service? A. Q. A. No. And you weren't paid or -I think the person would have to directly bill You wouldn't bill Spine Imaging though for that

the insurance company, but I don't think the insurance company would pay. Q. What about, last question on this topic, when

some of the patients that needed this sedative treatment were actually patients of yours, you said some were from
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other referral sources but some were yours? A. Q. Yeah, a lot of them were ours. And on those occasions where you had your own

Central Medical patient who ends up at the MRI and is nervous or what have you and you get this fax and you go through this machination of sedating them, you would agree we would expect to find that fax and any other documentation of that episode in the patient's chart, right? A. Q. A. Q. Doctor. FURTHER EXAMINATION BY MR. MORAN: Q. I just have a couple more here. Going back to Yes. That would end up in the chart? It's in the chart, yes. That's it. I have nothing further. Thank you,

this issue of, of prescription of medication, Doctor, to patients that were not being treated by you. You would

rely on the information that was provided to you by a tech over the phone or pursuant to a fax, correct? A. Q. Yes. You would rely on that tech then to properly

relay to the patient what kind of medication was going to be administered to the patient?
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A. Q.

Yes. You would rely on the tech to properly advise

the patient as to potential complications that the medication might have? MR. MYERS: A. Q. Object to the form.

Was I, can you repeat that. Would you rely on the tech to provide

information to the patient as to potential complications? MR. MYERS: A. Q. A. Q. Object to form.

Certain history, yes. But Get a certain history out of it. But in terms of communicating to the patient,

you're relying on the tech to be the conduit of information to that patient as well? A. Yes. MR. MYERS: Q. Object to form.

It's not just the patient's information coming

to you, but you providing information to the tech which in turn is relayed to the patient, correct? MR. MYERS: A. Q. Yes. And that might include complications from the Object to the form.

medication?
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A. Q. Yes. A. A.

MR. MYERS:

Object to the form.

If we think there were any complications or

things that were sensitive, I would have them be checked. Q. But generally speaking, most medication has

stated indications and complications, correct? A. Q. Right. And would you rely on the tech to relay the

typical, this could cause you nausea, this could cause you dizziness, that type of thing? MR. MYERS: Object to the form. yes. And the MRI scan you you can have Yes,

Including the scan,

can be claustrophobic, noise,

you can pass out,

you can have problems with the scan.

there's, it's their responsibility to talk to them about this. Q. And so at least in terms of when, when you were

prescribing medication to patients that weren't your patients that you hadn't seen, you were relying on the tech to provide this medical information to the patients? MR. MYERS: Same objections.

And then you would also rely on the tech to

provide information as to the purpose behind the

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medication? A. Q. Yes. I have no further questions. MR. LOWDEN: Mr. Myers, I don't believe

there's any further questions. MR. MYERS: and sign. (Proceedings concluded at 2:5 1 p. m. ) Okay. The witness will read

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REPORTER'S CERTIFICATE

STATE OF MINNESOTA 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

) ) COUNTY OF WASHINGTON )

SS.

I hereby certify that I reported the deposition of Alfonso Morales on the 24th day of April 2012, in Minneapolis, Minnesota, and that the witness was by me first duly sworn to tell the whole truth; That the testimony was transcribed by me and is a true record of the testimony of the witness; That the cost of the original has been charged to the party who noticed the deposition, and that all parties who ordered copies have been charged at the same rate for such copies; That I am not a relative or employee or attorney or counsel of any of the parties, or a relative or employee of such attorney or counsel; That I am not financially interested in the action and have no contract with the parties, attorneys, or persons with an interest in the action that affects or has a substantial tendency to affect my impartiality; That the right to read and sign the deposition by the witness was reserved. WITNESS MY HAND AND SEAL THIS 24th day of April 2012.

Kelley E. Zilles, RPR Notary Public, Washington County, Minnesota My commission expires 1-31-2015
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lquo, fp.