at any earlier stage of the proceedings there are two adverse recommendations that issue in this case in this hearing below the first resulted from a study done by the department o pending the outcome of the other but the the outcome of the of the ever fragmentation from before they act that was sent to him and this other adverse action recommendation and he had human rights and took advantage of those fundamental complaint alleges these two actions it alleged that doctors on the hearing committee participated actively participated in initiating or investigating the underlying matter of issue at an earlier they cost the average fragmentation if they were involved in study now if they were involved in discussing dr trans application for credentialing and formally what was going to happen the investigate the matter or even if they're involved the initial study for example department worth it if they were involved actually involved in initiating the matter if not simply the formal process so if i wanted to say only people who vote for example they could own previous involvement as essentially and so active position from our point of view is if you are in that line of events and you get involved in in investigating it with study or discussing the credential application or if you get involved by proposing or discussing remediation plans they're actually adopted then you have actually they participated in that process there are a number of doctors who can serve on these pan we further allege that it let me go back with respect to their active participation the minutes which are legit showed that dr smith was present at the number of the department of the peace means where the study which led to the first there it's not just it's not if they were studied by the study it's if they participated in discussing the study and potentially mediation for the alleged outliers so if people weren't at the committee meetings if they were the  involved in those meetings were not discussed in the study we're not discussing those things involved now process they could certainly serve on the panel simply because the visual study doesn't it doesn't eliminate that it's if the involvement in the investigations involvement in the g we've got the study here's what it shows what do we do sort of discussions that are out there and we haven't missed a show or the caucus misses at these meetings where these these the study and these outlier discuss similar with depression committee meeting it's not the doctors put up or credentialing it's that the committee members people who are deciding what to do with people's requests for credentials they have to recruit ensure every on a regular basis those people who are discussing that and and deciding and formulating what they're going to do what actions should be taken in making a recommendation what action should be taken on the applications are disqualified so it's not it's not that they were studied is that they were volved in the investigation that let's be at risk actually if you if you trace it back the adverse action was taken what led to it you look at that path from beginning to end by from the formal process which is what the defendants stress they will say well no formal process had  the data back and that's not there that's important because of a report of course that's important but what that means is the only reason that decision would have been reported will is if the formal process had already  committee that's formed a make a recommendation which is the adverse recommendation defendants argue below that the earlier study by the department one reason it shouldn't matter is because he wasn't part of the formal process we say first that doesn't matter because america is formal or informal it's part of the chain that leads the average recommendation investigation but at the second point if it matters in the formal process again then complaint the only reason that letter gets sent in say you're going to be reporting is if the form if they consider the formal process can't be done so if they're going to argue that the formal process is required then i would submit and you agree with that i would submit that the form but they weren't there when the vote and so therefore it is now that's their theory we strongly disagree that you don't have to just be there for the vote if they said vote they would say that they these are your serious active participation includes being present list right even by listening you are taking evidence in one form and your example is perfectly appropriate if you were to listen to a trial court and taking evidence that way without rule with our course right and then come here and decide t case based on whatever is for you which may or may not include what you heard or may or may not include your thought process down there you have you i would trust that the judges here would obviously tutor judy but there would be they please the council my name is christopher on the why didn't i represent the us that health care system and the other defendants that were named in this case really just appeal this from two separate the solutions made by sutures to separate trial judges on this case both of them dealing in gingerly with me directly with fundamental fairness the other dealing with the violence question both at least the first doctor training has allowed from from my reading of it you know one was in action talked about fundamental fairness but also talked about there were relief so it with respect to the issue that was raised and has been talked about here in terms of the bylaws it is fifteen point eight and that is that is the focus of this particular matter we're talking about and he refer whole going with a corrective action in a first recommendation would counsel in like a printer would like to do is to suggest to this court that the credentialing committee had a direct relationship to the corrective action in the in the it was recommendation i the course of action to be taken and or recommendations to be made as to the plaintiff's medical privileges that's the allegation in the county and when you are when reviewing this it justice holder's mentioned this earlier the question is what is the evers recommendation or action and our position is very clearly that that adverse recommendation action is something that's in and there is a part and the allegation is that they were part of these other committee and and i was right yesterday absolutely it's their right in it and i like to address that because that's really the crux of the whole thing they're saying well because they were question is when does this whole process start by the time it got to the credentialing committee it was it was already in the process in other words the ad hoc committee had already proceeded through we had gone through with the e c the executive committee and when the book was actually taken neither of them were there but what i'm trying to say here is and i think any construct about it now is of any particular event and this goes back to some earlier questions knowledge of earlier events these days doesn't necessarily mean that they cannot then participate because if that's the case everybody would be very trying about the fundamental  when the entire department was reporting refute the entire department and looking at all these statistics he was present when they were doing that this was long before all of this began long before the corrective action was suggested or the first recommendation in at that time all they're doing is looking at statistics not to training would like to suggest to you that while that starts the process and that amounts to initiating investigating underlying matter dition we would submit to th trainer two physicians were found to be what we call outliers they in this case dr train was more than two to three times likely to hit revisions and need replacements then all the others were the period surgeons with the exception of one or two people and so at that point in the comparison group is internal to the department or is that it was a comparison group to what's called best practices or some standard in the that you can do one of the things that's not mentioned i don't know why it is that he was given an opportunity for remediation within the department to work with other surgeons to improve the problem that he had he chose not to do that it was his right he was also given the other two opportunities he was given the hearing he was given all the rights afforded to any hearing he was given the opportunity to help counsel he was president he was able to cross examine was able to put himself on the stand he had a witness all of this was proceeded with under the violence and it isn't being complained about what we're talking about here is the issue about the the initial quality assurance during that number three this particular ruling this particular recommendation from the eventually committee simply continue the status quo back to training i asked for his for privileges which he was a lot he was allowed not involved in that recommendation that's correct and in what you type when they did they should all agree with you you know there was an objection made before the hearing right three people recommendation he didn't make any decision about an adverse recommendation rehabbers recommendations are done by the board in one and  in particular in the ad hoc committee committee is the one who recommends that it be done in this case the initial letter going to dr crane was to simply advise him of the circumstances of what happened and to say this is what we recommend it wasn't at that time a corrective action by i have a question who are we this is what we've got who made up the we this is the medical the the orthopaedic department after reviewing all of this had a head of recommendation but it wasn't a an adverse recommendation as found in fifteen point eight it was a suggestion of how to resolve the problem corrective action is only encountered and started with the ad hoc committee which was a another year and a half later time one of them was on the committee from the beginning who looked at a number of statistics that wasn't focused on doctor training at all what i know was a focus but at the end of that investigation they focused on two so haven't they injected themselves into that investigation and process no i don't really want to because at that point first of all they don't take any vote and they had nothing to do with their actual that they said you can go ahead with your privileges if you broke the t want to but we're taking no action with respect to anything else pending approval of somebody else they're taking no position at all they're only role here their only rule is not investigate or do anything further if the only role is to determine whether those privileges should be allowed that are being requested and they said they could or privileges were  and they simply said go ahead we'll keep the status quo you can have the status you can have your work privileges but we're not going to be addressing the other until for another part of it because it's not their job so to me prior meetings in august and september always were it was present for those two meetings in which there was no decision made regarding dr and and there was a discussion of it of the plainest request for a new norm that was  it any other questions you'll find in here we're talking about a two six one five two six one nine motion which looks at the allegations made by the play which we were doing this do you know yes yes you are we i think we could be just the one thing we all agree everything right yes it's not an art you're saying it's the whole box they're saying it's just a box with the boss that process has not done it does not have any fifteen point eight  with regard to three and there's and the hearing committee consisted of three doctors objecting to yes now fifteen point eight talks about anyone who investigated the underlying stamp or change or reject the aggression committee's decision ok so the army see of the one ultimately it ultimately yes they they're the ones that ultimately impose it but they take the recommendation from the correction committee and that's