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.