Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_05-cv-01104/USCOURTS-caed-1_05-cv-01104-10/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 42:1983 Civil Rights Act

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

BRENDA ALLEN, CASE NO. CV-F-05-1104 OWW LJO

Plaintiff, ORDER ON PLAINTIFF’S MOTION TO 

vs. COMPEL DOCUMENTS FROM

MUHAMMAD ANWAR, M.D.

JEANNE WOODFORD, et al,

Defendants.

 /

Plaintiff brings three motions to compel documents from each defendant:

(1) First Set RPD to Muhommad Anwar, M.D.,

(2) First Set RPD to Madera Community Hospital, 

(3) First Set RPD to Jeanne Woodward, Richard Rimmer, Rosanne Campbell, Gwendolyn

Mitchell, Sampath Suryadevara, M.D., and Juan Jose Tur, M.D. 

This order addresses the motion to compel Muhammad Anwar, M.D. (“Dr. Anwar”) to supplement

responses and produce documents. 

Plaintiff filed her notice of motion on December 22, 2006. The parties filed a joint statement

re discovery dispute pursuant to Local Rule 37-251 on January 9, 2007 (Doc. 112). The Court took this

matter under submission without oral argument on January 17, 2007. Dr. Anwar supplemented the

statement on January 19, 2007. (Doc. 125). Having considered the joint statement, and supplemental

papers filed, as well as the Court’s file, the Court issues the following order.

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FACTUAL AND PROCEDURAL BACKGROUND

General Allegations

Plaintiff is a prisoner at Central California Women’s Facility (CCWF). She alleges that the

California Department of Corrections (“CDC”)/CCWF sent her to Madera Community Hospital for an

unnecessary surgery. Plaintiff requested and was denied non-surgical treatment to treat boils in her arm

pit region. Despite being notified of Dr. Anwar’s injury to another CCWF prisoner, the CDC Defendants

sent Plaintiff to Dr. Muhammad Anwarfor surgery. Plaintiff received invasive, improper treatment from

Dr. Anwar and Madera Community Hospital. The surgery left Plaintiff with limited mobility, flexibility,

sensation and pain in her arms. 

Plaintiff alleges that each of the Defendants exhibited a deliberate indifference to her medical

needs by subjecting her to surgery that mutilated her body and caused severe and permanent

disfigurement and disability. Plaintiff further contends that Defendants’ actions constitute cruel and

unusual punishment. Plaintiff additionally contends that subjecting Plaintiff to the surgical treatment

without her informed consent and by performing surgery far more invasive and than necessary or proper

without apprising her ofthe risks ofsurgery constituted battery. Plaintiff also alleges that all Defendants

engaged in gross negligence when they breached their duty of care to Plaintiff with reckless disregard

or deliberate indifference to harm Allen.

Plaintiff alleges claims for:

- 42 U.S.C. § 1983 - all defendants

- Eighth and Fourteenth Amendments - all defendants

- Professional Negligence - against Anwar, Madera, Tur, Suryadevara

- Civil Battery - all defendants

- Gross Negligence - all defendants

- Intentional Misrepresentation & Negligent Misrepresentation - all defendants

- Intentional Infliction of Emotional Distress- all defendants

- Negligent Infliction of Emotional Distress - all defendants

Plaintiffs served the Requests for Production of Documents on August 16, 2006. Defendant responded

with objections on September 18, 2006, and produced some documents. The motion to compel was filed

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on December 22, 2006 and Dr. Anwar supplemented with more objections on January 9, 2007.

Consolidation

This case has been consolidated with other women inmates on whom Dr. Anwar performed boil

excisions – Ms. Boyce, Ms. Holmes and Ms. Scott - for discovery purposes by District Judge Oliver W.

Wanger.

SCOPE OF DISCOVERY

The purpose of discovery is to make trial “less a game of blind man’s bluff and more a fair

contest with the basic issues and facts disclosed to the fullest practicable extent possible,” United States

v. Procter & Gamble, 356 U.S. 677, 683, 78 S.Ct. 983, 987 (1958), and to narrow and clarify the issues

in dispute, Hickman v. Taylor, 329 U.S. 495, 501, 67 S.Ct. 385, 388 (1947).

Fed.R.Civ.P. 26(b) establishes the scope of discovery and states in pertinent part:

Parties may obtain discovery regarding anymatter, not privileged, that is relevant

to the claim or defense of any party, including the existence, description, nature, custody,

condition, and location of any books, documents, or other tangible things and the identity

and location of persons having knowledge of any discoverable matter. For good cause,

the court may order discovery of any matter relevant to the subject matter involved in the

action. Relevant information need not be admissible at trial if the discovery appears

reasonably calculated to lead to the discovery of admissible evidence.

“The party who resists discovery has the burden to show that discovery should not be allowed,

and has the burden of clarifying, explaining, and supporting its objections.” Oakes v. Halvorsen Marine

Ltd., 179 F.R.D 281, 283 (C.D. Cal. 1998); Nestle Foods Corp. v. Aetna Casualty & Surety Co., 135

F.R.D. 101, 104 (D. N.J. 1990). 

REQUEST FOR PRODUCTION STANDARDS

Fed.R.Civ.P. 34(b) requires a written response to a request for production to “state, with respect

to each item or category, that inspection and related activities will be permitted as requested, unless the

request is objected to, in which event the reasons for the objection shall be stated.” The request is

sufficient if the documents or things to be produced are of a category described with 'reasonable

particularity' in the request. Id. A party is obliged to produce all specified relevant and nonprivileged

documents or other things which are in its “possession, custody or control” on the date specified in the

request. F.R.Civ.P. 34(a); Norman Rockwell Int’l Corp. v. H. Wolfe Iron & Metal Co., 576 F.Supp. 511,

512 (W.D. Pa. 1983). The propounding party may seek an order for further disclosure regarding “any

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objection to or other failure to respond to the request or any part thereof, or any failure to permit

inspection requested.” F.R.Civ.P. 34(b).

MAJOR OBJECTIONS MADE BY ANWAR

California Evid. Code § 1157 - Peer Review Privilege

Dr. Anwar argues that documents requested are protected by the peer review privilege.

Except as otherwise provided by federal law, testimonial privileges in federal question cases are

governed by federal common law. Fed.R.Evid. 501; United States v. Zolin (1989) 491 US 554, 562, 109

S.Ct. 2619, 2625 (attorney-client privilege). No specific privileges or requirements are provided in the

Federal Rules. Rather, testimonial privileges in federal question cases are governed by principles of the

common law as interpreted by federal courts ‘in the light of reason and experience.” Fed.R.Evid. 501.

This provides federal courts ‘with the flexibility to develop rules of privilege on a case-by-case basis.’

Trammel v. United States (1980) 445 US 40, 47, 100 S.Ct. 906, 911; University of Penn. v. E.E.O.C.

(1990) 493 US 182, 189, 110 S.Ct. 577, 582 (declining to recognize privilege for academic peer review

proceedings).

Dr. Anwar argues that the documents requested from him are protected by California Evidence

code §1157. Cal. Evid. Code § 1157(a) states:

“Neither the proceedings nor the records of organized committees of

medical . . . staffs in hospitals, or of a peer review body . . . having the

responsibility of evaluation and improvement of the quality of care

rendered in the hospital, . . . shall be subject to discovery.” 

In medical malpractice cases, medical peer review materials (e.g., minutes of hospital staff meetings

discussing treatment given and procedures to improve patient care) may be protected from disclosure

under this privilege. Jones and Rosen, Fed.Civ.Trials & Ev., CH 8; §8:42409 (The Rutter Group 2006).

Courts have recognized that there is an important public interest in having hospitals critically evaluate

the quality of the care they provide. (Id.) In addition, most states have statutes protecting medical peer

review conferences from disclosure. See Bredice v. Doctors Hosp., Inc. (DC Cir. 1970) 50 F.R.D. 249,

250–251; and Weekoty v. United States (D NM 1998) 30 F.Supp.2d 1343, 1347–1348. 

However, there is no privilege for medical peer review recordsin federal discrimination actions.

 Most federal courts that have considered the existence of a federal peer review privilege have rejected

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it. See e.g., Nilavar v. Mercy Health System–Western Ohio (SD OH 2002) 210 FRD 597, 602–610

(collecting cases).

The parties did not discuss or cite a controlling Ninth Circuit case on the issue. See Agster v.

Maricopa County, 422 F.3d 836, 838–839 (9th Cir. 2005). In Agster, parents of a prisoner who died in

custody of county sheriff's department brought action against county. Plaintiffs sought discovery of the

mortality review and defendant declined asserting the peer review privilege. The Ninth Circuit declined

to create peer review privilege for county correctional health services' ‘mortality review’ of

circumstances of prisoner's death. The reason asserted by the Ninth circuit is compelling in the instant

case:

“Whereas in the ordinary hospital it may be that the first object of all

involved in patient care is the welfare of the patient, in the prison context

the safety and efficiency of the prison may operate as goals affecting the

care offered. In these circumstances, it is peculiarly important that the

public have access to the assessment by peers of the care provided.” Id.

At 839.

Thus, the Ninth Circuit denied the peer review privilege in the prison context for the reasons plaintiff

has argued - to have access to the assessment of the care provided. In Leon v. County of San Diego, 202

F.R.D. 631 (S.D.Cal. 2001), a § 1983 action against the county, sheriff's department, and sheriff, alleging

deliberate indifference to detainee's medical condition, failure to train and supervise, and existence of

policy, practice or custom creating constitutional violations, the court held (1) nursing peer review

records from county detention facility were relevant to municipal liability and, therefore, were

discoverable; (2) provision of California Evidence Code privileging medical peer review records did not

apply to protect records from discovery; and (3) self-critical analysis privilege under federal common

law did not apply to protect records from discovery.

Thus, this privilege is not recognized by the Ninth Circuit in the context of the instant case.

Privilege Log

Dr. Anwar produced a privilege log, which plaintiff argues is inadequate under Fed.R.Civ.P. 26.

Fed.R.Civ.P. 26(b)(5) addresses claims of privilege and provides:

When a party withholds information otherwise discoverable under these rules by

claiming it is privileged or subject to protection as trial preparation material, the party

shall make the claim expressly and shall describe the nature of documents,

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communications or things not produced or disclosed in a manner that, without revealing

information itself privileged or protected, will enable other parties to assess the

applicability of the privilege or protection.

Fed.R.Civ.P. 26(b)(5) requires parties to provide a log or its equivalent when they withhold information

on grounds of privilege or work product protection. Etienne v. Wolverine Tube, Inc., 185 F.R.D. 653,

656 (D. Kan. 1999). To facilitate its determination of privilege, a court may require “an adequately

detailed privilege log in conjunction with evidentiary submissions to fill in any factual gaps.” United

States v. Construction Products Research, Inc., 73 F.3d 464, 473 (2 Cir.), cert. denied, 519 U.S. 927, nd

117 S.Ct. 294 (1996) (quoting Bowne of New York City, Inc. v. AmBase Corp., 150 F.R.D. 465, 471

(S.D.N.Y. 1993)).

The privilege log should provide as to a document for which privilege is claimed:

1. The document’s general nature and description;

2. Identity and position of its author;

3. Date it was written;

4. Identity and position of all addressees and recipients;

5. Document’s present location; and

6. Specific reasons it was withheld, that is, privilege invoked and grounds thereof.

See Construction Products, 73 F.3d at 473-474.

The sole privilege log provided by Dr. Anwar consists of five entries which groups documents

by correspondence, pleadings, billing, research and expert witness. The individual documents are not

itemized or in any way described according to the requirements of Rule 26(b)(5). In In re Grand Jury

Investigation, 974 F.2d 1068, 1071 (9 Cir. 1992), the Ninth Circuit held an adequate logs identifies, th

at a minimum, (a) the persons involved, (b) the nature of the document, (c) all persons or entities shown

on the document to have received or sent the document, (d) all persons or entities known to have been

furnished the document or informed of its substance, and (e) the date the document was generated,

prepared, or dated. Here, a concomitant requirement with a claim of privilege is an adequate privilege

log. Dr. Anwar’s privilege log does not meet the requirements of the Rule. He will be compelled to

provide an adequate log or face waiving the privilege.

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Boilerplate Objections

The Federal Rules of Civil Procedure contemplate that the party responding to requests for

documents will provide as much information as possible event to an objectionable document request,

setting forth the reason for objection, including claims of privilege or work product protection.

Fed.R.Civ.P. 34(b); see Eureka Financial Corp. v. Hartford Acc. & Indem. Co. (ED CA 1991) 136 FRD

179, 185 (counsel has to identify specifically the evidence requested for which a privilege applies.). 

The Rule requires that the “reasons” for the objection be stated, which Dr. Anwar did not state.

Certainly, standardized objections interposed by defendants do not satisfy the obligation under the Rules.

These objections are overruled.

Equally Available: The objection is overruled. A party is not in 'control' of records that the

requesting party has equal ability to obtain from public sources. See Estate of Young Through Young v.

Holmes, 134 FRD 291, 294 (D NV 1991). “However, the Court can see no justifiable reason why

Plaintiffs should not produce, or at least identify, documents that support Plaintiffs' allegations in the

FAC, whether they are in Defendants' possession or in the public domain.” Plumbers & Pipefitters

Local 572 Pension Fund v. Cisco Systems, Inc., 2005 WL 1459555, *6 (N.D.Cal. 2005); See, e.g., St.

Paul Reinsurance Co. V. Commercial Fin. Corp., 198 F.R.D. 508, 513 (N.D.Iowa 2000) ("It is not

usually a ground for objection that the information is equally available to the interrogator or is a matter

of public record."). Compare In re Pintlar Corp., 1995 WL 472117, *5 (Bkrtcy.D.Idaho,1995)

(information which consists of decisions by the courts and other tribunals is public information equally

available to the Plaintiffs; however, Cigna has collected opinions or other reference material regarding

the exclusion may be relevant to Cigna's interpretation of the exclusion at issue and therefore should be

produced.)

HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104-191, 110

Stat. 1936, (“HIPAA”) restricts health care entities from disclosure of “protected health information”

(“PHI”). Regulations authorized by the HIPAA, 42 USC § 1320d et seq., prohibit ex parte

communications with health care providers regarding patients' medical condition without their consent

or a "qualified protective order" (45 CFR § 164.512). HIPAA's privacy provisions allow for disclosure

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of medical information in the course of administrative or judicial proceedings; however, the Act places

certain requirements on both the medical professional providing the information and the party seeking

it. See 45 C.F.R. § 164.512(e) (2004). Under HIPAA, disclosure is permitted, inter alia, pursuant to a

court order, subpoena, or discovery request when the healthcare provider “receives satisfactory assurance

from the party seeking the information that reasonable efforts have been made by such party to secure

a qualified protective order.” 45 C.F.R. § 164.512(1)(e)(ii)(b). The protective order must prohibit “using

or disclosing the protected health information for any purpose other than the litigation,” and “[r]equire

[ ] the return to the [physician] or destruction of the protected health information ··· at the end of the

litigation or proceeding.” 45 C.F.R. § 164.512(1)(e)(v).

Here, the parties have stipulated to a protective order which protects the third parties’ medical

records. (Doc. 131.) The protective order satisfies the requirements of HIPAA because it (1) Prohibits

the parties from using or disclosing the protected health information for any purpose other than the

litigation or proceeding for which such information was requested; and (2) requires the return of the

protected material at the conclusion of the litigation. 45 C.F.R. § 164.512 (e)(v). Thus, the protective

order is adequate under HIPAA to protect third party medical records.

Right of Privacy in Medical Records

Federal courts generally recognize a right of privacy that can be raised in response to discovery

requests. Johnson by Johnson v. Thompson, 971 F2d 1487, 1497 (10th Cir. 1992); DeMasi v. Weiss, 669

F2d 114, 119–120 (3rd Cir. 1982). Unlike a privilege, the right of privacy is not an absolute bar to

discovery. Rather, courts balance the need for the information against the claimed privacy right. Ragge

v. MCA/Universal Studios (CD CA 1995) 165 FRD 601, 604 (right of privacy may be invaded for

litigation purposes). A patient's constitutional right of privacy in receiving medical treatment may be

an alternative source of protection to the physician-patient privilege. However, this right is not absolute.

Doe v. Southeastern Pennsylvania Transp. Authority (SEPTA) 72 F3d 1133, 1138 (3rd Cir. 1995)

(privacy right in patients' prescription records);see Caesar v. Mountanos (9th Cir. 1976) 542 F2d 1064,

1067.

In federal civil rights action, law of California, as forum state, did not inform federal privilege

law. Jackson v. County of Sacramento, 175 F.R.D. 653 (E.D.Cal.,1997) (overruling cases that held as

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a “matter of comity” state privacy privilege controls.)

“Despite defendant's repeated assertions to the contrary, the law of

California, the forum state, does not inform federal privilege law. See

Jaffee v. Redmond, 518 U.S. 1, 116 S.Ct. 1923, 135 L.Ed.2d 337 (1996)

(finding a federal psychologist-patient privilege without mention of the

law of the forum state vis-a-vis the law of the whole 50 states). In this

respect, Cook v. Yellow Freight System, Inc., 132 F.R.D. 548

(E.D.Cal.1990), Martinez v. City of Stockton, 132 F.R.D. 677

(E.D.Cal.1990), and Pagano v. Oroville Hospital, 145 F.R.D. 683

(E.D.Cal.1993), cited by defendant, have been overruled.”

Jackson v. County of Sacramento, 175 F.R.D. at 654. 

Thus, the privacy involves a balancing of interests under federal law.

In the instant case, privacy has been argued for medical records. Dr. Anwar also argues privacy

for limited financial records requested by plaintiff. For these records, the Court finds, on balance, the

need for the documents outweighs the privacy issues. The case involves alleged abuse of medical

treatment for financial gain. Plaintiff seeks comparable medical records for third parties and financial

records for the procedures. One opportunity to show deliberate indifference is by a pattern and practice

of medical abuse, as alleged by plaintiff. The Court finds that a protective order and proper redaction

will safeguard third parties’ privacy issues. The Court has very wide discretion in handling pretrial

discovery. Under F.R.Civ.P. 26(c), this Court “may make any order which justice requires to protect a

party or person from annoyance, embarrassment, oppression, or undue burden or expense,” including:

1. Prohibiting disclosure or discovery;

2. Conditioning disclosure or discovery on specified terms, “including a designation of the

time or the place”;

3. Permitting discovery be had by a method other than selected by the party seeking

discovery; or

4. Limiting the scope of disclosure or discovery to certain matters.

To enforce the limit on discovery, a parties may seek a protective order under Fed.R.Civ.P.26( c) or the

court may act upon its own initiative. 

Here, the Court will direct the parties to meet and confer on a suitable protective order to protect

the relevant privacy interests.

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 Dr. Anwar did not specifically argue the attorney client and work product privilege in the parties’ joint statement 1

of discovery disputes. Dr. Anwar submitted a supplemental letter brief arguing these issues. (Doc. 125.) Plaintiff requests

the letter brief be stricken. The Court has considered Dr. Anwar’s points.

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DISPUTED DOCUMENT REQUESTS

DOCUMENT REQUESTS TO DEFENDANT ANWAR

Plaintiff contends that Dr. Anwarimproperly treated her and other inmates for financial gain and

that he exploited the terms of the contract with the CDC which allowed him to charge whatever he

wanted for unlisted procedures.

Herein below, the Court summarizes the document requests and the parties’ contentions and rules

on the requests. 

1. Document Request 1: Documents related to Dr. Anwar’s contract and agreement with the CDC.

Anwar’s response to the Request: Broad, Irrelevant, attorney-client attorney/work , product, 1

privacy. Plaintiff produced the contract and correspondence.

Plaintiff contends: Dr. Anwar produced one contract while the CDCR defendants produced an

amendment. Dr. Anwar’s production is missing key documents (1) the HCSD Rate Approval Memo,

(2) contracts before 2001, (3) negotiations, (4) electronic versions.

Relevant to the issue of financial gain to Dr. Anwar for performing unnecessary procedures,

because the contract allowed Dr. Anwar to charge increased fees for procedures not coded in the

contract. The boilerplate objections are not made with specificity and he does not provide any reason

for the litany of objections.

Dr. Anwar provided a privilege log, after a meet and confer. The log lumps broad categories of

correspondence together into five entries. The court should order Dr. Anwar to produce a privilege log

that complies with Rule 26(b)(5).

No electronic documents were produced, although several hard copies were clearly electronically

prepared. Dr. Anwar should be compelled to conduct a thorough electronic review and to produce all

responsive documents in electronic format.

It isimpossible to discern the basis of Dr. Anwar’s various privacy objections because he simply

objects on “violation of privacy under the California and US Constitution.” Objections based on state

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law privileges have no place in federal court. See, e.g., Burrows v. Redbud Commun. Hosp. Dist., 187

F.R.D. 606, 610-611 (N.D. Cal. 1998). There is no privacy right which could be implicated by the

request for contractual documents.

Defendant contends: Plaintiff requests copies of all documents relating to negotiations and

potential contracts, as well as contracts in effect prior to and after Plaintiff’s surgery. A full and

complete and unredacted copy of the final contract in effect at the time of Plaintiff’s care and treatment

has been produced, including correspondence.

Order: The Court GRANTS the motion to compel and requires production of documents

described in Rule 34(a), and production of a detailed privilege log as required by Rule 26(b)(5).

2. Document Request 3: Documents showing Dr. Anwar lost $100,000/mth from the loss of his

CDC contract. 

Anwar’s response to the Request: Same objections.

Plaintiff contends: Dr. Anwar alleges in a different lawsuit that he lost this amount of money

from the cancellation of his contract with the CDC. How much income Dr. Anwar made by performing

improper surgeries is directly relevant to Ms. Allen’s claim. She is alleging that Dr. Anwar performed

improper and unnecessary surgeries on her and other inmates for financial gain. His privilege log is

insufficient -as described above. State based privacy is inapplicable in federal court. In any event, any

privacy implicated is outweighed by the need for the information.

Defendant contends: Defendant’s right to privacy is protected under the California constitution.

Cal. Const. art. I, § 1. A defendant’s right to privacy in his financial information has specifically been

recognized by federal courts. See Soto v. City of Concord, 162 F.R.D. 603, 616 (N.D. Cal. 1995).

Plaintiff’s unfounded allegations do not warrant inquiry into Dr. Anwar’s private and protected financial

affairs. Dr. Anwar’s filing of a complaint against the CDC for, among other things, damages for lost

income, does not operate as a wholesale waiver in this action of his right to privacy in his personal

financial information.

Order: The scope of the document requests will be limited to the documents indicating the

monies lost as a result of the termination of his contract with the CDC. In this limited respect, the Court

GRANTS the motion to compel and requires production of documents described in Rule 34(a). 

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3. Document Request 4: Documents reflecting your employment status.

Anwar’s response to the Request: vague and ambiguous, over broad.

Plaintiff contends: Dr. Anwar refused to produce any documents in response to this request.

“Employment,” is a common word with an ordinary definition and without ambiguity. any documents

reflecting any position(s) Dr. Anwar holds at Madera Community, the CDCR, or MMSG would be

responsive.

Defendant contends: Plaintiff clarified in the meet and confer that “employment” means his

positions in any medical group. This “clarification” of what documents she intended to seek reinforces

the ambiguity of her original request. Hospital privileges and medical licensing are different from

“employment.” He responded that he is not employed.

Order: Dr. Anwar’s position is well-taken. Employment is different from privileges Dr. Anwar

may enjoy or partnerships of which he may be a part. Therefore, the Court DENIES the request.

4. Document Request 7: Documents re Anwar’s medical training to do excision axillae.

Anwar’s response to the Request: broad, burdensome, oppressive.

Plaintiff contends: Plaintiff seeks discovery into Dr. Anwar’s specific training in that particular

procedure. Further, Dr. Anwar has not made any objection with sufficient specificity.

Defendant contends: This request is so broad as to encompass text books, course outlines,

notes, research papers, certificates of completion, and other similar documents which Dr. Anwar may

have accumulated over the entire course of his medical studies and career as a physician and surgeon.

There is no allegation that he is improperly trained.

Order: The request is for training for a specific area of surgery, as opposed to general

experience. The request is therefore narrowly defined. In this limited respect, the Court GRANTS the

motion to compel and requires production of documents described in Rule 34(a). 

5. Document Request 8: Document re Anwar’s membership on a panel of approved healthcare

providers. 

Anwar’s response to the Request: Broad, Irrelevant, attorney-client attorney/work, product,

privacy; Evid Code 1157. Anwar’s Supplemental response: same objections and some documents

were produced.

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Plaintiff contends: The approved provider lists for 2000 and 2006 are responsive. His ability

to perform unnecessary procedures is connected to his membership on the CDC’s list of approved

providers and also why CDC removed him from those lists. His litany of conclusory and boiler plate

objections should fail.

Defendant contends: After a diligent search and reasonable inquiry, Dr. Anwar has produced

all known documents in his care, custody and control responsive to this request.

Order: Dr. Anwar states that he has produced all the documents. On that basis, the Court

DENIES the request.

6. Document Request 9: Documents re any medical investigation of Anwar by any medical

agency.

Anwar’s response to the Request: Broad, Irrelevant, attorney-client attorney/work, product,

privacy, HIPAA. Anwar’s Supplemental response: he produce correspondence to the Medical Board

by Ms. Scott and Ms. Holmes and some other correspondence.

Plaintiff contends: Documentation of investigations into Dr. Anwar is relevant. He produced

some documents but he did not produce copies of the correspondence from the Medical Board that Dr.

Anwar was responding to. He asserted boiler plate objections, and his privilege log is inadequate.

Defendant contends: Plaintiff already has the documents and he produced all known documents

in his care, custody and control, outside applicable privileges.

Order: While Dr. Anwar says that he has produced all documents he states that he has done so

except for privileged documents. The privilege log is inadequate for plaintiff to determine which

documents are being withheld on the basis of privilege, and on what privilege. Accordingly, the Court

GRANTS production of a detailed privilege log as required by Rule 26(b)(5).

7. Document Request 10: Documents re disciplinary actions re his medical services.

Anwar’s response to the Request: vague and ambiguous, broad, attorney/client/work product.

No documents are responsive.

Plaintiff contends: His response is inadequate. The common sense definition of “disciplinary

action” is not vague. Dr. Anwar’s response is insufficient because he attempts to omit any disciplinary

action that he may have been subject to (either by the CDC, Madera, or MMSG) such as reduced

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compensation, written or verbal warnings, or being required to attend extra training.

Defendant contends: Dr. Anwar has no documents responsive to this request.

Order: Dr. Anwar says he has no documents, but with the broad definition of the term

“disciplinary actions,” he will be compelled to re-respond. Accordingly, the Court GRANTS this

request.

8. Document Request 11: All insurance policies.

Anwar’s response to the Request: privacy; produced certificate of insurance for his

professional liability insurance policy and in a supplemental response, his declarations page.

Plaintiff contends: Dr. Anwar’s objections based on privacy fail: any privileges based on the

California Constitution are irrelevant in federal court and any alleged privacy interest in one’s insurance

information is outweighed by Ms. Allen’s need for discovery. It is unclear whether this policy covers

incidents that occurred in calendar year 2005 or claims made policy.

Defendant contends: Dr. Anwar has produced the declaration page of his professional liability

insurance policy in effect.

Order:The Court GRANTS the request to compel only as to the extent of additional information

to indicate whether the policy period is a claims made or incidents occurred policy.

9. Document Request 12: Daily calendar/schedule from 2000 to the present.

Anwar’s response to the Request: Broad, Irrelevant, attorney-client attorney/work, product,

privacy, HIPAA. 

Plaintiff contends: This request seeks documents that bear on the issue of Dr. Anwar’s motive.

Ms. Allen is claiming that Dr. Anwar implemented a pattern and practice of deliberately performing

unnecessary surgeries on her and others for financial gain. If Dr. Anwar’s calendar shows that he

performed 100 excision axillae operations on the 200 inmates he saw since 2000, this evidence tends

to support a finding that Dr. Anwar was over-diagnosing this condition and performing unnecessary

surgeries.

None of Dr. Anwar’s general objections have merit. No privacy rights are implicated and even

if they are, the documents should be produced. The information called for is relevant and should be

produced despite any claims of undue burden and expense by Dr. Anwar.

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Defendant contends: Aside from information relating to any named Plaintiff, the information

is irrelevant to any material issue in the case. Dr. Anwar’s other patient’s privacy in their medical

information outweighs the alleged need for this information. First, the information in such calendars,

appointment books and office visit lists, etc., related to medical care rendered by Dr. Anwar, and patient

medical conditions and treatment choices are protected by the physician-patient privilege. There is no

compelling public interest in requiring production of Dr. Anwar’s daily calendars, appointment books

or office visit lists.

The burden and expense involved in the production of Defendant’s daily calendars and/or

appointment books from 2000 to present outweigh the benefit that will be derived. A conservative

estimate is in the range of 150 to 375 hours (0.10 to 0.25 hours to redact each work day).

Order: The Court DENIES this request. The request is overly broad, implicates other’s personal

information and requests information that far exceeds the express purpose of the Request for Production

of Documents. In addition, there are more direct and less intrusive ways to obtain the requested

information.

10. Document Request 13: His bills, invoices for his procedures dealing with boils and folliculitis.

Anwar’s response to the Request: Broad, Irrelevant, attorney-client attorney/work, product,

privacy, HIPAA. 

Plaintiff contends: The documents go to Dr. Anwar’s motive and practice of performing

improper surgeries on CDCR inmates for financial gain. None of Dr. Anwar’s general objections have

merit. No privacy rights are implicated and even if they are, the documents should be produced. The

information called for is relevant and should be produced despite any claims of undue burden and

expense by Dr. Anwar. His medical bills are maintained in computerized format, which include both

procedure and diagnosis codes. Dr. Anwar or his staff could run a simple search of his medical billing

system to sort for specific procedures and diagnosis codes.

Dr. Anwar does — albeit generally — raise three objections which may relate to third party

privacy concerns: (i) rights under the California Constitution, (ii) rights under the U.S. Constitution,

and (iii) rights under HIPAA.

HIPAA does not create substantive rights that act as a bar on discovery. It merely establishes

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procedural mechanisms which have been complied with in the instant case. HIPAA regulations is

purely procedural in nature and does not create a federal physician-patient or hospital-patient

privilege. Northwestern Memorial Hospital v. Ashcroft, 362 F.3d 923, 925-926 (7th Cir. 2004). The

private information could be redacted. HIPAA does not preclude production where an adequate

protective order is in place. 45 C.F.R. § 164.512(e). Here, the parties entered a protective order

designed explicitly to protect the interests of third parties. 

While there is no federal physician-patient privilege, federal courts do recognize a limited

right of privacy in one’s medical information. Ms. Allen is seeking medical information regarding

third parties — but in redacted form only.

Defendant contends: The production of medical bills for procedures dealings with boils,

folliculitis, and hidradenitis, is unduly burdensome and outweighs the benefit derived. First, there is 

no time limit to the request. As of January 8, 2007, Dr. Anwar has over 17,700 patient charts. 

Billings after the date of plaintiff’s surgery are irrelevant.

An electronic search can be performed for those years when Dr. Anwar’s medical bills were

computerized, but the bills from 1989 to 1993 are not computerized and will require a manual

search. This is estimated to be 650 man hours.

Order: The Court GRANTS the motion to compel for years 1994 to July 2004, with

redaction. The parties are DIRECTED to meet and confer as to an appropriate protective order, or

amendment of the existing protective order. 

11. Document Request 14: Documents re diagnosis and treatment of Ms. Boyce.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157. Produced the medical chart.

Plaintiff contends: It is not clear from his response whether he has produced all responsive

documents in his custody and possession — which he is required to do regardless of whether the

documents may already be in Ms. Allen’s possession.

Defendant contends: Dr. Anwar has no other non-privileged documents relating to Regina

Boyce’s diagnosis and treatment.

Order: While Dr. Anwar states he as produced non-privileged documents, the privilege log

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needs to be supplemented with specific documents in compliance with Rule 26(b)(5).

The Court GRANTS the motion to compel and requires production of documents described

in Rule 34(a), and production of a detailed privilege log as required by Rule 26(b)(5). 

12. Document Request 15: Documents re diagnosis and treatment of Ms. Allen.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157. Produced the medical chart.

Plaintiff contends: Same as Document Request 14.

Defendant contends: Same as Document Request 14.

Order: While Dr. Anwar states he as produced non-privileged documents, the privilege log

needs to be supplemented with specific documents in compliance with Rule 26(b)(5).

The Court GRANTS the motion to compel and requires production of documents described

in Rule 34(a), and production of a detailed privilege log as required by Rule 26(b)(5). 

13. Document Request 16: Documents re diagnosis and treatment of Julie Holmes.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157. Produced the medical chart.

Plaintiff contends: Same as Document Request 14.

Defendant contends: Same as Document Request 14.

Order: While Dr. Anwar states he as produced non-privileged documents, the privilege log

needs to be supplemented with specific documents in compliance with Rule 26(b)(5).

The Court GRANTS the motion to compel and requires production of documents described

in Rule 34(a), and production of a detailed privilege log as required by Rule 26(b)(5). 

14. Document Request 17: Documents re diagnosis and treatment of Genea Scott.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157. Produced the medical chart.

Plaintiff contends: Same as Document Request 14.

Defendant contends: Same as Document Request 14.

Order: While Dr. Anwar states he as produced non-privileged documents, the privilege log

needs to be supplemented with specific documents in compliance with Rule 26(b)(5).

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The Court GRANTS the motion to compel and requires production of documents described

in Rule 34(a), and production of a detailed privilege log as required by Rule 26(b)(5). 

15. Document Request 18: All documents not already produced relating to consent for treatment

from Brenda Allen, Regina Boyce, Julie Holms or Genea Scott.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157. Referred plaintiff to Madera Community Hospital.

Plaintiff contends: The attorney-client privilege, attorney work product doctrine is

improperly asserted. Dr. Anwar’s privilege log is insufficient. Dr. Anwar has not produced all the

responsive documents in his possession, custody or control - regardless of whether the documents

may already be in Ms. Allen’s possession.

Defendant contends: Dr. Anwar has no other non-privileged documents in his care,

custody, or control responsive to this request.

Order: While Dr. Anwar states he as produced non-privileged documents, the privilege log

needs to be supplemented with specific documents in compliance with Rule 26(b)(5).

The Court GRANTS the motion to compel and requires production of documents described

in Rule 34(a), and production of a detailed privilege log as required by Rule 26(b)(5). 

16. Document Request 19: All documents not already produced relating to medical billing for

treatment of Brenda Allen, Regina Boyce, Julie Holms or Genea Scott.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157. Referred plaintiff to Madera Community Hospital.

Plaintiff contends: Dr. Anwar only produced one version of paper bills with hand-marked

revisions. It is unclear whether Dr. Anwar has produced all responsive documents.

Defendant contends: Dr. Anwar has produced all non-privileged documents in his care,

custody, or control responsive to this request.

Order: Since it is unclear whether Dr. Anwar has produced all responsive documents, he

will be compelled to re-respond. The Court GRANTS the motion to compel and requires production

of documents described in Rule 34(a), and if Dr. Anwar withholds documents based on privilege,

production of a detailed privilege log as required by Rule 26(b)(5). 

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17. Document Request 20: All documents re any patient who received treatment for boils,

folliculitis, or hidradenitis.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157, HIPAA.

Plaintiff contends: Ms. Allen is entitled to discovery into the medical conditions at issue.

His litany of general objections should not be considered. His privilege log is inadequate. Plaintiff

alleges Dr. Anwar treated her and other inmates for improper financial reasons. The records

regarding his treatment and diagnoses of those conditions —including before and after Ms. Allen’s

surgery was performed — are relevant. Such evidence would demonstrate that Dr. Anwar had a long

history of deliberatively performing unnecessary surgeries for financial gain. Any burden is

outweighed by the need for this information. 

Defendant contends: unduly burdensome and outweighs the benefit derived. There is no

time limit to the request. Dr. Anwar has 17,700 patient charts. An electronic search can be

performed for those years when Dr. Anwar’s medical bills were computerized, but the bills from

1989 to 1993 are not computerized and will require a manual search. This is estimated to be 804

man hours.

Patient charts subsequent to the date of Plaintiff’s surgery are irrelevant to Plaintiff’s claims.

The number of same or similar surgeries Defendant performed on other patients with these

conditions is irrelevant to the issue of whether Dr. Anwar performed the appropriate procedure on

Plaintiff or if he had an alleged financial motive to perform a more complex surgery than was

medically necessary.

The information is subject to privacy.

Order: Care provided to non-incarcerated patients is not relevant. The care was given under

different contractual arrangements from that of an incarcerated patient. Therefore, the Court

DENIES the request for further production as to non-incarcerated patients.

For incarcerated patients, the Court GRANTS the motion to compel and requires production

of documents described in Rule 34(a), for years 1994 to July 2004, and production of a detailed

privilege log as required by Rule 26(b)(5). The parties are DIRECTED to meet and confer as to an

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appropriate protective order, or amendment of the existing protective order. 

18. Document Request 21: All documents re billing for any patient who received treatment from

Anwar for boils, folliculitis, or hidradenitis.

Anwar’s response to the Request: Broad, attorney-client attorney/work, product, privacy, 

Evid. Code 1157, HIPAA.

Plaintiff contends: Same as Document Request 20.

Defendant contends: Same as Document Request 20

Order: Care provided to non-incarcerated patients is not relevant. The care was given under

different contractual arrangements from that of an incarcerated patient. Therefore, the Court

DENIES the request for further production as to non-incarcerated patients.

For incarcerated patients, the Court GRANTS the motion to compel and requires production

of documents described in Rule 34(a), for years 1994 to July 2004, and production of a detailed

privilege log as required by Rule 26(b)(5). The parties are DIRECTED to meet and confer as to an

appropriate protective order, or amendment of the existing protective order. 

19. Document Request 22: All documents re complaints made against Anwar by Brenda Allen,

Regina Boyce, Julie Holms or Genea Scott.

Anwar’s response to the Request: attorney-client attorney/work, product, privacy, Evid.

Code 1157. Supplemental Response all known documents have been produced or are already in

plaintiff’s possession. 

Plaintiff contends: the work product doctrine and attorney-client privilege are improperly

asserted and Dr. Anwar’s privilege log is insufficient. State law privileges should not be recognized. 

His response points to possible other sources of the documents requested and curiously notes

that “[d]iscovery is continuing,” it not clear whether Dr. Anwar has produced all the responsive

documents in his possession. 

Defendant contends: Dr. Anwar has clearly stated that all responsive non-privileged

documents have been produced in discovery or are already in Plaintiff’s possession. Complaints, if

any lodged subsequent to Plaintiffs care and treatment by Dr. Anwar cannot serve to demonstrate

that Dr. Anwar acted with deliberate indifference as to Plaintiff.

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Order: While Dr. Anwar says that he has produced all documents he states that he has done

so except for privileged documents. The privilege log is inadequate for plaintiff to determine which

documents are being withheld on the basis of privilege, and on what privilege. Accordingly, the

Court GRANTS production of a detailed privilege log as required by Rule 26(b)(5).

20. Document Request 23: All documents re complaints made against Anwar by any inmate

from 1995 to the present.

Anwar’s response to the Request: Overbroad, burdensome, oppressive, attorney-client

attorney/work, product, privacy, Evid. Code 1157, HIPAA. Supplemental Response: reasonable

search performed but no documents in his custody, care and control.

Plaintiff contends: Same as Document request 13. Briefly: The documents go to Dr.

Anwar’s motive and practice of performing improper surgeries on CDCR inmates for financial gain. 

None of Dr. Anwar’s general objections have merit. No privacy rights are implicated and even if

they are, the documents should be produced. The information called for is relevant and should be

produced despite any claims of undue burden and expense by Dr. Anwar. His medical bills are

maintained in computerized format, which include both procedure and diagnosis codes. Surely Dr.

Anwar or his staff could run a simple search of his medical billing system to sort for specific

procedures and diagnosis codes.

Dr. Anwar does — albeit generally — raise three objections which may relate to third party

privacy concerns: (i) rights under the California Constitution, (ii) rights under the U.S. Constitution,

and (iii) rights under HIPAA.

Defendant contends: Complaints by other patients, if any, arising after Dr. Anwar’s care and

treatment of named Plaintiffs have no relevance to the claims asserted by Plaintiff. The complaint

alleges events “[o]n or around 1996 through the events of this complaint.”

Patient complaints, if any, relating to surgeries performed for medical conditions other than

those suffered by Plaintiffs are also not relevant to the claims or defenses in this action.

Order: Documents should not be limited to just similar medical conditions. Complaints by

inmates for unnecessary medical treatment of conditions may show that Dr. Anwar had a practice of

treating inmates as plaintiffs allege. Events, however, after the last of the injury to plaintiff are not

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relevant to show deliberate indifference to this plaintiff. Accordingly, the Court GRANTS the

motion to compel for years 1996 to July 2004, with redaction. The parties are DIRECTED to meet

and confer as to an appropriate protective order, or amendment of the existing protective order. 

21. Document Request 24: All documents re complaints made against Anwar by any nonincarcerated patient from 1995 to the present.

Anwar’s response to the Request: Overbroad, burdensome, oppressive, attorney-client

attorney/work, product, privacy, Evid. Code 1157, HIPAA. 

Plaintiff contends: Same as document request 23.

Defendant contends: Same as document request 23.

Order: Care provided to non-incarcerated patients is not relevant. The care was given under

different contractual arrangements from that of an incarcerated patient. Therefore, the Court

DENIES the request for further production as to non-incarcerated patients.

22. Document Request 25: Documents relating to written policies and procedures concerning

medical care: patient assessment, treatment, referrals, self-referrals, notification to patients.

Anwar’s response to the Request: Overbroad, attorney client/work product, Evid. Code

1157. No documents within his possession, custody or control.

Plaintiff contends: The objections based on the work product doctrine and attorney-client

privilege is improperly asserted, and Dr. Anwar’s privilege log is insufficient. Dr. Anwar’s response

is insufficient. Dr. Anwar merely points to the (partial) contract that he has provided, which does not

cover the relevant time period. Same as Document Request no. 1.

Defendant contends: Dr. Anwar has responded that he has no documents responsive to this

request, except to the extent the contract for provision of medical care to inmates which was in effect

during the events in issue in the action could be construed as responsive.

Order: Anwar states that he has produced all the documents. On that basis, the Court

DENIES the request.

23. Document Request 26: Documents on medical treatment on any nonincarceratent patient for

boils, folliculitis hiradenitis or for lancing.

Anwar’s response to the Request: Overbroad, burdensome, oppressive, attorney-client

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attorney/work, product, privacy, Evid. Code 1157, HIPAA.

Plaintiff contends: Same as document request 23.

Defendant contends: Communications relating to non-incarcerated patients are not relevant. 

Dr. Anwar has 17,700 patient charts. An electronic search can be performed for those years when Dr.

Anwar’s medical bills were computerized, but the bills from 1989 to 1993 are not computerized and

will require a manual search. This is estimated to be 804 man hours.

Order: Care provided to non-incarcerated patients is not relevant. The care was given under

different contractual arrangements from that of an incarcerated patient. Therefore, the Court

DENIES the request for further production as to non-incarcerated patients.

24. Document Request 27: All documents re how Anwar charged the CDC and nonincarcerated patients for lancings, and related surgeries.

Anwar’s response to the Request: Overbroad, burdensome, oppressive, attorney-client

attorney/work, product, privacy, Evid. Code 1157, HIPAA.

Plaintiff contends: Same as document request 23. If the rates Dr. Anwar charged CDCR

for unlisted procedures were much higher than the rates he charged in other contexts, that would tend

to show that he exploited the MMSG Contract. 

Defendant contends: Communications relating to charges for nonincarcerated patients are

not relevant to the claims and defenses in this action and, thus, this request is overly broad. Dr.

Anwar’s charges for non-incarcerated patients necessarily depends on his negotiated rates with

various providers and insurers. This is proprietary information not subject to disclosure.

Order: Care provided to non-incarcerated patients is not relevant. The care was given under

different contractual arrangements from that of an incarcerated patient. Therefore, the Court

DENIES the request for further production as to non-incarcerated patients.

For incarcerated patients, the Court GRANTS the motion to compel and requires production

of documents described in Rule 34(a), for years 1994 to July 2004, and production of a detailed

privilege log as required by Rule 26(b)(5). The parties are DIRECTED to meet and confer as to an

appropriate protective order, or amendment of the existing protective order. 

25. Document Request 28: Documents relating to bill schedules for patients.

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Anwar’s response to the Request: Overbroad, burdensome, oppressive, attorney-client

attorney/work, product, privacy, irrelevant.

Plaintiff contends: Same as document request no. 23.

Defendant contends: Dr. Anwar produced the billing statement for all plaintiffs which

shows the amount charged for incarcerated patients. Communications relating to charges for

nonincarcerated patients are not relevant to the claims and defenses in this action and, thus, this

request is overly broad. Dr. Anwar’s charges for non-incarcerated patients necessarily depends on his

negotiated rates with various providers and insurers. This is proprietary information not subject to

disclosure.

Order: The Request is vague in that the Court cannot determine what is being requested. 

Accordingly, the request is DENIED. To the extent the request seeks billing statements, the

statements for plaintiffs have been produced. Non-incarcerated patient billing statements are not

relevant.

26. Document Request 29: Documents of medical bills for patients who received identical

procedures to Brenda Allen, Regina Boyce, Julie Holmes, and Genea Scott within the past 11

years.

Anwar’s response to the Request: Overbroad, burdensome, oppressive, attorney-client

attorney/work, product, privacy, Evid. Code 1157, HIPAA.

Plaintiff contends: Same as document request 23.

Defendant contends: Same as document request 23.

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Order: Care provided to non-incarcerated patients is not relevant. The care was given under

different contractual arrangements from that of an incarcerated patient. Therefore, the Court

DENIES the request for further production as to non-incarcerated patients.

For incarcerated patients, the Court GRANTS the motion to compel and requires production

of documents described in Rule 34(a), for years 1994 to July 2004, and production of a detailed

privilege log as required by Rule 26(b)(5). The parties are DIRECTED to meet and confer as to an

appropriate protective order, or amendment of the existing protective order. 

IT IS SO ORDERED.

Dated: January 30, 2007 /s/ Lawrence J. O'Neill 

b9ed48 UNITED STATES MAGISTRATE JUDGE

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