Exhibit A

Case 2:15-md-02641-DGC Document 8391-1 Filed 10/25/17 Page 1 of 8
Do Not Disclose - Subject to Further Confidentiality Review

Golkow Technologies, Inc. Page 1

 1 UNITED STATES DISTRICT COURT

 DISTRICT OF ARIZONA

 2

 3

 4 IN RE: BARD IVC FILTERS ) Case No.

 PRODUCTS LIABILITY LITIGATION ) MD-15-02641-PHX-DGC

 5 ____________________________________________________

 6

 7

 8 DO NOT DISCLOSE

 9 SUBJECT TO FURTHER CONFIDENTIALITY REVIEW

 10

 11

 12 VIDEOTAPED DEPOSITION OF ANTHONY JAMES AVINO, M.D.

 13 March 23, 2017

 14 Savannah, Georgia

 15 4:06 p.m.

 16

 17

 18

 19

 20

 21

 22

 23 Reported by: Karen Kidwell, RMR, CRR

 24 GOLKOW TECHNOLOGIES, INC.

 877.370.3377 ph | 917.591.5672 fax

 25 deps@golkow.com

Case 2:15-md-02641-DGC Document 8391-1 Filed 10/25/17 Page 2 of 8
Do Not Disclose - Subject to Further Confidentiality Review

Golkow Technologies, Inc. Page 46

 1 honestly.

 2 Q. And certainly, it was your expectation

 3 that when Bard introduced a new filter model, it

 4 would perform as well or better than the prior ones?

 5 A. Yes.

 6 Q. And that's why you're adopting the newest,

 7 latest model. Right?

 8 A. Right.

 9 Q. If Bard found that there were problems

 10 with the design of one of its filters and was working

 11 on a redesign of the filter, you would want to know

 12 about that, right?

 13 A. If there was -- if the current design that

 14 we were implanting was dangerous, then we would

 15 certainly want to know about it.

 16 Q. And what is -- for all -- globally, to all

 17 the medical devices you use, what is the instructions

 18 for use, or IFU?

 19 A. The IFU is what's printed on all devices,

 20 in terms of what the indications are, with the

 21 approval from the FDA, is my understanding of it.

 22 It's what the approved -- basically, it's the

 23 approved indications, and it's not -- but that's

 24 different than what we consider the standard of care.

 25 A lot of things are not -- a lot of things are used

Case 2:15-md-02641-DGC Document 8391-1 Filed 10/25/17 Page 3 of 8
Do Not Disclose - Subject to Further Confidentiality Review

Golkow Technologies, Inc. Page 47

 1 out of an IFU, cautiously, and just have become

 2 standard of care.

 3 There's lots of examples of things we

 4 still use appropriately that might not be in the IFU.

 5 But, in general, we certainly consider the IFU, and

 6 -- because that's what the research was done on for

 7 certain devices, and that's what the FDA is

 8 recommending, and that's what the company -- and

 9 typically, that's very strongly what the company

 10 recommends.

 11 Q. And do you read the IFU?

 12 A. Sometimes. I mean, I have read them. I

 13 don't -- certainly don't read them on every package,

 14 because they're the same from the same device, but --

 15 you know, not -- not all the time, but it does come

 16 up, for example, at meetings, or you're reading about

 17 and someone's discussing an issue with an IFU. You

 18 know, if something is within the IFU or not, to help

 19 define things that might be outside of the IFU but

 20 still medically indicated.

 21 Q. Do you know if you ever read the IFU for

 22 the Eclipse IVC filter?

 23 A. Not that I recall.

 24 Q. Okay. And IFUs have warnings on them of

 25 side effects, complications, things like that, also?

Case 2:15-md-02641-DGC Document 8391-1 Filed 10/25/17 Page 4 of 8
Do Not Disclose - Subject to Further Confidentiality Review

Golkow Technologies, Inc. Page 48

 1 A. Yes.

 2 Q. And even if you haven't read the Eclipse

 3 IFU, you're probably generally familiar with IVC

 4 filter IFUs, if they warn of things like fractures,

 5 migration, perforation, tilt; complications like

 6 that. Right?

 7 A. Yes. Yes.

 8 Q. But is it your understanding these

 9 complications are rare, for IVC filters?

 10 A. Well, depends how you define "rare." I

 11 mean, back -- originally, when we were implanting

 12 filters 15, 20 years ago, everyone thought they were

 13 rare.

 14 Now people think they're -- reached a

 15 peak, and reached a peak in frequency, and then we

 16 think that now they're -- they're less frequent than

 17 they were before. So it's been a migrating target in

 18 terms of what the risks are or what our understanding

 19 of the risks are.

 20 Q. If you can recall your mindset in

 21 August 2010, when you implanted the Eclipse in Doris

 22 Jones, what was your understanding of the rarity of

 23 complications from IVC filters then?

 24 A. I don't have independent recollection of

 25 placing that particular filter, but the best I can

Case 2:15-md-02641-DGC Document 8391-1 Filed 10/25/17 Page 5 of 8
Do Not Disclose - Subject to Further Confidentiality Review

Golkow Technologies, Inc. Page 64

 1 based on one study, and then there's retrospective

 2 studies; there's the meta-analyses of combining

 3 multiple studies.

 4 So there is -- there just is no one

 5 answer, you know, to tell you that there was any

 6 specific number. But I don't have a specific number

 7 in my mind. But certainly not back years ago.

 8 Q. Right. Do you -- do you have any, like,

 9 ballpark in your head of what would be an acceptable

 10 rate of fractures for an IVC filter?

 11 A. No. I mean, obviously we want it to be

 12 very low. Our initial understanding was that the

 13 fracture rate was very low, in the 5 percent range;

 14 and then at some point, you know, maybe in the last

 15 four years or so, is when we learned that they were

 16 higher than that. Or maybe six years, or three,

 17 or ...

 18 Q. Let's see here. Get stuff together here.

 19 (Exhibit 4019 was marked for identification.)

 20 BY MR. COMBS:

 21 Q. And you know what, we'll make it easy --

 22 we can use that one. That's fine.

 23 MR. STOLLER: It's been previously marked.

 24 You can use the same number, but that's okay.

 25 MR. COMBS: Are we using the same number?

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Do Not Disclose - Subject to Further Confidentiality Review

Golkow Technologies, Inc. Page 90

 1 chain between David Ciavarella and some other Bard

 2 people. And I will -- I don't know if it says it in

 3 this chain or not; I think -- it doesn't look like it

 4 does, but I'll represent to you that David Ciavarella

 5 was the medical director for Bard at this time

 6 period, in December 2005.

 7 And at the bottom of the first page, he

 8 states: "The G2 is a permanent filter; we also have

 9 one (the SNF) that has virtually no complaints

 10 associated with it. Why shouldn't doctors be using

 11 that one rather than the G2?"

 12 And my question is: Is that information

 13 that would have been important to you, to know that

 14 the medical director for Bard in 2005 was questioning

 15 why Bard was pushing the G2 as a permanent filter

 16 when they already had the SNF one?

 17 MS. DALY: Object to the form. Lack of

 18 foundation.

 19 THE WITNESS: You know, again, all

 20 information is helpful, if there's -- if it is

 21 information regarding concern about one filter

 22 being better than the other.

 23 BY MR. COMBS:

 24 Q. And certainly, Doris could have received

 25 an SNF or another permanent filter instead of an

Case 2:15-md-02641-DGC Document 8391-1 Filed 10/25/17 Page 7 of 8
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Golkow Technologies, Inc. Page 91

 1 Eclipse or other retrievable filter. True?

 2 A. Well, not necessarily. Like I said in the

 3 op note at the beginning, we still wanted -- there

 4 was a -- there was a -- there was a reason I

 5 mentioned for putting the retrievable filter in, just

 6 to have the option to then take it out. So they're

 7 not completely equivalent.

 8 Q. Right. But the option for retrievability

 9 is balanced against the risk of using a retrievable

 10 versus a permanent filter; right?

 11 MS. DALY: Object to the form.

 12 THE WITNESS: Right. There's the risk of

 13 using the retrievable one when we know that the

 14 Simon Nitinol was a good filter, and then

 15 there's the risks of putting the Simon Nitinol

 16 in, but you can't ever take it out.

 17 BY MR. COMBS:

 18 Q. Right. And knowing that the medical

 19 director of Bard, as far back as 2005, was

 20 questioning why people weren't using the Simon

 21 Nitinol filter more, that would be important

 22 information to that calculation?

 23 MS. DALY: Object to the form. Lack of

 24 foundation.

 25 THE WITNESS: It's all additional pieces

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