Patricia 1

Case 2:08-cr-00427-MCE Document 437
Filed 07/06/11 Page 1 of 15
IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA.
---oOo--BEFORE THE HONORABLE MORRISON C. ENGLAND, JR., JUDGE
---oOo--UNITED STATES OF AMERICA,
Plaintiff,
vs.
No. 2:08-cr-00427
ALEXANDER POPOV,
RAMANATHAN PRAKASH, LANA
LE CHABRIER,
Defendants.
---oOo--REPORTER'S PARTIAL TRANSCRIPT

CROSS-EXAMINATION OF PATRICIA HOWARD-FOREMAN
TUESDAY, JUNE 21, 2011
---oOo---
Reported by:
DIANE J. SHEPARD, CSR #6331, RPR
DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

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APPEARANCES
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For the Government:

BENJAMIN B. WAGNER
UNITED STATES ATTORNEY
501 I Street, Suite 10-100
Sacramento, California 95814
BY: PHILIP A. FERRARI
JEAN M. HOBLER
Assistant U.S. Attorneys
For the Defendant, Lana Le Chabrier

JAN DAVID KAROWSKY
Attorney at Law
716 19th Street, Suite 100
Sacramento, California 95811
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For the Defendant, Alexander Popov:

RICHARD ALAN MOSS
Attorney at Law
255 South Marengo Avenue
Pasadena, California 91101
For the Defendant, Ramanathan Prakash:

RONALD NEIL RICHARDS
Attorney at Law
P.O. Box 11480
Beverly Hills, California 90213
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SACRAMENTO, CALIFORNIA
TUESDAY, JUNE 21, 2011
PARTIAL TRANSCRIPT
---oOo---
PATRICIA HOWARD-FOREMAN,
a witness called by the Government, having been first duly
sworn by the Clerk to tell the truth, the whole truth, and
nothing but the truth, testified as follows:
CROSS-EXAMINATION
10
BY MR. RICHARDS:
11
Q.
Good afternoon, Ms. Howard, how are you doing?
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A.
Hi.
13
Q.
Isn't it true you're the type of physician's
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assistant that handles things on her own with respect to you
15
have a lot of experience?
16
A.
Handles things on my own?
17
Q.
Do you remember telling the Government that doctors
18
like you because you're self-sufficient and independent?
19
A.
Self starter and I do thorough work, yes.
20
Q.
I mean, you're certainly a very experienced
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physician's assistant, right?
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A.
Now I am, yes.
23
Q.
You weren't in 2006?
24
A.
I am more experienced now than I was in 2006.
25
Q.
But in 2006 did -- when you didn't get a description
of services -- do you remember that testimony, you said you
don't remember if you received one or not?
A.
Correct.
Q.
You had your own in the interview?
them what you were capable of doing?
A.
Yes.
Q.
And when you had the interview, the people that were
interviewing you didn't say we're here to commit some sort of
fraud, did they?
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MS. HOBLER:
11
THE COURT:
Objection.
Didn't you tell
Vague.
Sustained.
12
Q.
BY MR. RICHARDS:
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interview there was something illegal going on?
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MS. HOBLER:
15
THE COURT:
Did anybody tell you during the
Objection.
Vague as to interview.
Sustained.
16
Q.
BY MR. RICHARDS:
Before you started working at the
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Los Angeles clinic, did anybody tell you that something illegal
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was going to occur?
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A.
No.
20
Q.
And during that interview you were trying to get the
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job, weren't you?
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A.
Yes.
23
Q.
And weren't you trying to instill confidence in the
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clinic that was hiring you that you are a very capable,
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self-starter physician's assistant?
A.
Yes.
Q.
And when you met Dr. Prakash, didn't you convey to
him that you were capable of seeing patients?
A.
Yes.
Q.
And the one time that you felt you needed to talk to
him, you were able to get ahold of him, correct?
A.
Yes.
Q.
And the testimony that you made about when you got
the charts that you signed, do you remember the testimony where
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you said you saw observations and then you signed the charts?
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Do you remember that testimony?
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A.
Yes.
13
Q.
Isn't it true you never called Dr. Prakash and told
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him, "when I signed the charts, I never observed those
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patients," you never had a conversation like that?
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A.
I didn't have a conversation like that.
17
Q.
And so isn't it true when Dr. Prakash -- if
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Dr. Prakash had looked at the charts that you had signed, he
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could reasonably think that you had observed those patients,
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correct?
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A.
I would think so.
22
Q.
And when you were -- when you went up to the Folsom
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clinic and met Dr. Prakash, you thought you were going into a
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legitimate medical clinic, didn't you?
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A.
Yes.

1
Q.
let me strike that.
And there was nothing in the clinic that -- I mean --
You were coming all the way up to Sacramento to work
three days a week, I take it?
A.
Yes.
Q.
And if you had walked in the clinic and saw something
that made you feel this was a bogus clinic or something,
wouldn't you have just left?
A.
Yes.
10
Q.
And when -- the three months that you were at the
11
clinic, isn't it true that at no time someone told you we're
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running a bogus clinic here?
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A.
No one told me that.
14
Q.
And no one told you they were running a fraudulent
15
clinic either, did they?
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A.
Absolutely not.
17
Q.
And when you met Dr. Prakash, it's fair to say you
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never said to him, hey, I want a protocol because my protocol
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is no good, you never had a conversation like that, did you?
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A.
No.
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Q.
Isn't it true you told the Government that you liked
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to work for smaller clinics?
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A.
Yes, I do.
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Q.
And how many years have you been a physician's
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assistant up to today?
A.
Eleven.
Q.
Eleven.
assistant for about six years?
A.
Almost.
Q.
And do you remember telling the Government that
Dr. Prakash was in the Sacramento clinic once per week?
A.
I saw him once there.
Q.
Do you want me to show you your statement to see if
it refreshes your recollection?
So at the time you were a physician's
If he -- okay.
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A.
No.
I saw my statement.
Let me clarify.
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Q.
I don't want to get you mad.
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statement.
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A.
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the office.
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for the doctor.
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doctor here?
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anything to discuss with him about the patients at the time, so
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I didn't.
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here.
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I'm working.
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Q.
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time where if you needed to see the doctor, someone told you
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you couldn't talk to the doctor?
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A.
No.
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Q.
Do you remember telling the Government that after the
I'm just reading the
I'm just saying what it says.

Let me clarify.
I was told that the doctor was in
I did not see him.

I'm working.
I'm working.
I'm not looking
And I would say, well, is the
Yeah, the doctor's here.
Okay.
I didn't have
But they would always say, yeah, well, the doctor's
That was at least once a week.
I did not see him.
But
Is it fair or unfair to say that there was never a
There was no time.
first time you met Dr. Prakash, you saw him in the office
briefly one or two additional times?
A.
I know it was at least once.
Q.
Do you remember telling the Government that you could
call Dr. Prakash on the telephone if there was something in the
chart that did not make sense?
A.
Yes.
Q.
And isn't it true, just so the jury has perspective,
that it's very normal, if you're a good physician's assistant,
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you don't need to be running in and bothering the doctor every
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five seconds, correct?
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A.
Yes.
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Q.
And one of the reasons why you are a good physician's
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assistant is because you know how to see the patients, examine
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them and then treat them, correct?
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A.
Yes.
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Q.
And it's nothing out of the ordinary -- let me strike
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that question.
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Isn't it true that it's nothing out of the ordinary
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that if you're a good physician's assistant, and you see
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patients, and you see patients all day long, it's very normal
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that you may not talk to the doctor the entire day?
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A.
Correct.
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Q.
Do you remember telling the Government that, in your
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experience, doctors like to work with PAs who are independent
and know how to run a clinic by themselves?
A.
Usually they do.
Q.
And so in -- and that's because if you're seeing the
patients, the doctor could be free doing other things, that
that allows him to do -- him or her to do other things while
you're doing your job, is that fair to say?
A.
Yes.
Q.
While you were at the clinic from -- for those first
few months, if you had seen anything suspicious, you would have
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reported it to Dr. Prakash, correct?
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A.
Yes.
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Q.
Like if you had seen some sort of fabrication with
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files or something that was, you know, fraudulent, you would
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have had no problem calling Dr. Prakash, right?
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MS. HOBLER:
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THE COURT:
Objection.
Vague.
Sustained.
17
Q.
BY MR. RICHARDS:
Do you know what the word
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trepidation means?
19
A.
Yes.
20
Q.
Isn't it true you would have had no trepidation to
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call Dr. Prakash if you had seen something sinister going on at
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the clinic, right?
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A.
Yes.
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Q.
And when you met Dr. Prakash in the clinic during the
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interview, did he come across to you as someone that -- someone
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Filed 07/06/11 Page 10 of 15
that would sort of be in a position to where if you had told
him there's some sort of fraud going on in his clinic, that he
would have been non-responsive to that?
MS. HOBLER:
THE COURT:
Objection.
Vague.
Foundation.
Sustained.
Q.
BY MR. RICHARDS:
Well, you testified about the
conversation where you told him that you were concerned about a
result in the file, do you remember that?
A.
Yes.
10
Q.
And isn't it true that when you had that
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conversation, that Dr. Prakash told you that he was going to
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contact the patient right away?
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A.
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that he would be contacting the patient.
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Q.
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follow-up after that, right?
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A.
No.
18
Q.
And then do you remember also once there was a
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problem with a patient's blood pressure, and you had the office
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get Dr. Prakash on the phone and let him know that the patient
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was going to the emergency room?
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A.
It's been so long ago.
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Q.
Well, let me just try to refresh your memory.
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remember telling the Government that you had a standing order
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that -- you had your own standing order in the clinic to give
He said it would be taken care of, and I just assumed
And he could have called the patient, you didn't
Do you
Filed 07/06/11 Page 11 of 15
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clonidine if a patient's blood pressure was too high?
A.
Correct.
Q.
Because you didn't want him to have a stroke?
A.
Right.
Q.
And that one time you were having a problem in the
clinic, and you called Dr. Prakash to let him know that you
administered clonidine, does that refresh your memory?
A.
Yes.
Q.
And that after the patient's blood pressure failed to
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calm down, you gave the patient clonidine again, do you
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remember that?
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A.
Yes.
13
Q.
And then the patient's blood pressure was still high,
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so you had the office staff get Dr. Prakash on the phone and
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you guys decided that the patient needs to go to the emergency
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room.
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A.
Okay.
18
Q.
All right.
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at the medical clinic, if there was a problem with supplies
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that you would need, you would have no problem calling
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Dr. Prakash or the office manager and saying we need supplies,
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right?
23
A.
The office manager would take care of that.
24
Q.
And if the officer manager said I'm not giving
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supplies to you, Ms. Foreman, you would have then had no
Does that refresh your recollection?

Yes.
Thanks.
When you were treating patients

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Filed 07/06/11 Page 12 of 15
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problem calling Dr. Prakash, right?
MS. HOBLER:
THE COURT:
Objection.
Vague.
Foundation.
Sustained.
Q.
office manager handled supplies is because that's who you would
ask for supplies?
A.
Yes.
Q.
Just one second.
you knew Dr. Prakash's title as the medical director?
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A.
BY MR. RICHARDS:
Is the reason why you know the
Just lastly, and isn't it true that
Yes.
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MR. RICHARDS:
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THE COURT:
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MR. MOSS:
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THE COURT:
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MR. KAROWSKY:
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THE COURT:
Thank you.
How long will your examination be.

Close to ten minutes.
Will you have cross, Mr. Karowsky?
Just a little, Your Honor.
I need to take a matter up outside the
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presence of the jury.
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I will see counsel here for the next few minutes.
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We'll go ahead and stop at this point.
Ladies and gentlemen, I'm going to excuse you for the
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evening and have you return for your final day this week,
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tomorrow at 9:00 a.m.
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Please remember the admonitions I've given you
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previously in this case.
Thank you.
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You may step down, too, ma'am.
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morning at 9:00 a.m.
See you tomorrow morning.
We'll also see you tomorrow

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(Jury out.)
THE COURT:
We're outside the presence of the jury.
Mr. Richards?
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MR. RICHARDS:
Yes.
Thank you, Your Honor.
Your
Honor, I'm not --
THE COURT:
MR. RICHARDS:
THE COURT:
MS. HOBLER:
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Filed 07/06/11 Page 13 of 15
Excuse me.
Sorry.
Go ahead.
We still also do have a witness in the
courtroom.
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MR. RICHARDS:
We do.
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THE COURT:
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MR. RICHARDS:
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Your Honor, in no way am I trying to be combative,
Thank you.
Sorry.
Thank you.
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but I'm just a little concerned.
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the questions on Ms. Zoya Belov, I was really trying to parrot
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the Government's questions on instructions.
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When the Court cut me off on
And I know that they're statements in furtherance of
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a conspiracy, and that's why the Court was letting it in.
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when I was trying to discuss it, the Court felt maybe that I
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was offering statements of a party, and so then it would be
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hearsay.
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And
But I purposely didn't object because the Government
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opened the door and let in the hearsay.
And I would have
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cross-examined her on those same exact instructions and just
Filed 07/06/11 Page 14 of 15
asked her why did she do those things.
disrespectful or discourteous to the Court when it sustained
the objection or explain why.
and ask her about those specific instructions, especially
dealing with getting the clinic ready for Dr. Prakash's
arrival.
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And I didn't want to be
But I would like to just reopen
Because all I was going to ask her was what
instructions did she get, and why were they trying to get it
ready.
So she could explain that we were trying to, you know,
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make the clinic look organized.
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to do.
12
get into that area.
And that was what I was trying
And I didn't understand why the Court wasn't letting me

And that's what my concern was.
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THE COURT:
14
MR. FERRARI:
Mr. Ferrari, anything?

Statements in furtherance of a
15
conspiracy are a species of an admission of a party opponent,
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and the defense is not able to offer statements in furtherance
17
of a conspiracy.
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MR. RICHARDS:
And I would agree except when the
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Government opens the door under the rule of completeness to be
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able to ask about those same statements and instructions.
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That's why -- I don't see why that's not the same
22
subject matter.
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to hear instructions that the Government elicits, but I can't
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ask about the same instructions.
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It allows this perception that the jury gets
And I don't think that's what the rule -- the rule is
Filed 07/06/11 Page 15 of 15
not a preclusive rule like that.
is a little bit different than the other admissions under
801(d).
into so many instructions, that it would be fair to have the
defense be allowed to just ask about those type of
instructions, what she was being instructed about.
The co-conspirator exception
And I felt like, on that, because the Government went
I mean there were so many instructions during that
direct, that I wanted a little latitude on being able to ask
about a couple of those instructions.
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THE COURT:
Anything else?
Did you wish to respond
to his request?
MR. FERRARI:
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THE COURT:
Well, we oppose it.

I understand.
noted for the record, Mr. Richards.
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MR. RICHARDS:
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THE COURT:
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(4:30 p.m.)
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And I would just ask if
I could just ask them those.
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15
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I'll just submit.
Your objections have been

Your request is denied.
Thank you.
Court's adjourned.
CERTIFICATION
I, Diane J. Shepard, certify that the foregoing is a
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correct transcript from the record of proceedings in the
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above-entitled matter.
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/S/ DIANE J. SHEPARD

DIANE J. SHEPARD, CSR #6331, RPR
Official Court Reporter
United States District Court

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Case 2:08-cr-00427-MCE Document 437

Filed 07/06/11 Page 1 of 15

IN THE UNITED STATES DISTRICT COURT

---oOo--REPORTER'S PARTIAL TRANSCRIPT

DIANE J. SHEPARD, CSR #6331, RPR

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 437

Filed 07/06/11 Page 2 of 15

For the Government:

For the Defendant, Lana Le Chabrier

For the Defendant, Alexander Popov:

For the Defendant, Ramanathan Prakash:

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 437

Filed 07/06/11 Page 3 of 15

TUESDAY, JUNE 21, 2011

a witness called by the Government, having been first duly

nothing but the truth, testified as follows:

Good afternoon, Ms. Howard, how are you doing?

Isn't it true you're the type of physician's

assistant that handles things on her own with respect to you

have a lot of experience?

Handles things on my own?

Do you remember telling the Government that doctors

like you because you're self-sufficient and independent?

Self starter and I do thorough work, yes.

I mean, you're certainly a very experienced

physician's assistant, right?

Now I am, yes.

You weren't in 2006?

I am more experienced now than I was in 2006.

But in 2006 did -- when you didn't get a description

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 437

Filed 07/06/11 Page 4 of 15

of services -- do you remember that testimony, you said you

don't remember if you received one or not?

You had your own in the interview?

them what you were capable of doing?

interviewing you didn't say we're here to commit some sort of

fraud, did they?

Didn't you tell

interview there was something illegal going on?

Did anybody tell you during the

Before you started working at the

was going to occur?

And during that interview you were trying to get the

job, weren't you?

And weren't you trying to instill confidence in the

self-starter physician's assistant?

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 437

Filed 07/06/11 Page 5 of 15

And when you met Dr. Prakash, didn't you convey to

him that you were capable of seeing patients?

him, you were able to get ahold of him, correct?

Do you remember that testimony?

Isn't it true you never called Dr. Prakash and told

him, "when I signed the charts, I never observed those

patients," you never had a conversation like that?

I didn't have a conversation like that.

And so isn't it true when Dr. Prakash -- if

could reasonably think that you had observed those patients,

I would think so.