California Spine And Neurosurgery Institute v. Flo Services USA

• Court: District Court, C.D. California
• Decided: March 20, 2024
• Docket: 2:23-cv-07473
• Status: Unknown

Opinion

1 COURTNEY CULWELL HILL (SBN: 210143) cchill@grsm.com 2 SHANNON L. ERNSTER (SBN: 264940) sernster@grsm.com 3 HELA VAKNIN (SBN: 342083) hvaknin@grsm.com 4 GORDON REES SCULLY MANSUKHANI, LLP 633 West Fifth Street, 52nd Floor 5 Los Angeles, CA 90071 Telephone: (213) 576-5000 6 Facsimile: (213) 680-4470 7 Attorneys for Defendant AETNA LIFE INSURANCE COMPANY 8 9 JONATHAN A. STIEGLITZ (SBN 278028) Jonathan@stieglitzlaw.com 10 THE LAW OFFICES OF JONATHAN A. STIEGLITZ 11845 W. Olympic Blvd., Suite 800 11 Los Angeles, California 90064 Telephone: (323) 979-2063 12 Facsimile: (323) 488-6748 13 Attorney for Plaintiff CALIFORNIA SPINE AND 14 NEUROSURGERY INSTITUTE 15 16 UNITED STATES DISTRICT COURT 17 CENTRAL DISTRICT OF CALIFORNIA 18 19 CALIFORNIA SPINE AND ) CASE NO. 2:23-cv-07473 FLA (AJRx) NEUROSURGERY INSTITUTE, ) Judge: Mónica Ramírez Almadani 20 ) Magistrate Judge: A. Joel Richlin PLAINTIFF, ) 21 ) VS. [PROPOSED] STIPULATED 22 ) PROTECTIVE ORDER ) 23 FLO SERVICES USA, AETNA LIFE ) INSURANCE COMPANY, AND ) 24 DOES 1-10, ) ) 25 DEFENDANTS. ) ) 26 27 1 1. GENERAL 2 1.1 Purposes and Limitations. Discovery in this action will involve 3 production of confidential, proprietary, or private information for which special 4 protection from public disclosure and from use for any purpose other than 5 prosecuting this litigation may be warranted. Accordingly, Plaintiff California 6 Spine and Neurosurgery Institute (“Plaintiff”) and Defendant Aetna Life Insurance 7 Company (“Aetna”) (Plaintiff and Aetna are collectively referred to herein as “the 8 Parties”) hereby stipulate to and petition the Court to enter the following Stipulated 9 Protective Order. This Protective Order shall govern any record of information 10 produced in this action and designated pursuant to this Protective Order, including 11 all designated deposition testimony, all designated testimony taken at a hearing or 12 other proceeding, all designated deposition exhibits, interrogatory answers, 13 admissions, documents and other discovery materials, whether produced 14 informally or in response to interrogatories, requests for admissions, requests for 15 production of documents or other formal methods of discovery. 16 This Protective Order shall also govern any designated record of information 17 produced in this action pursuant to required disclosures under any federal 18 procedural rule or local rule of the Court and any supplementary disclosures 19 thereto. 20 This Protective Order shall apply to the Parties and to any nonparty from whom 21 discovery may be sought who desires the protection of this Protective Order. 22 The parties further acknowledge, as set forth in Section 12.3, below, that this 23 Stipulated Protective Order does not entitle them to file confidential information 24 under seal; Civil Local Rule 79-5 sets forth the procedures that must be followed 25 and the standards that will be applied when a party seeks permission from the court 26 to file material under seal. 27 / / / / / / 1 1.2 Good Cause Statement. 2 This action arises out of a dispute between Plaintiff and Defendant regarding 3 payment for medical services rendered by Plaintiff to a single patient (“Patient”) 4 enrolled in a health care plan insured and administered by Defendant. Discovery in 5 this action will involve the disclosure of private information of the Patient, 6 including personal health information and information regarding the medical 7 services provided, trade secrets, and other valuable commercial, financial, 8 technical and/or proprietary information for which special protection from public 9 disclosure and from use for any purpose other than prosecution of this action is 10 warranted. Such confidential and proprietary materials and information includes, 11 among other things, confidential business or financial information, information 12 regarding confidential business practices, information implicating privacy rights of 13 third parties, information otherwise generally unavailable to the public, or which 14 may be privileged or otherwise protected from disclosure under state or federal 15 statutes, court rules, case decisions, or common law. 16 Accordingly, to expedite the flow of information, to facilitate the prompt 17 resolution of disputes over confidentiality of discovery materials, to adequately 18 protect information the Parties are entitled to keep confidential, to ensure that the 19 Parties are permitted reasonable necessary uses of such material in preparation for 20 and in the conduct of trial, to address their handling at the end of the litigation, and 21 serve the ends of justice, a protective order for such information is justified in this 22 matter. It is the intent of the Parties that information will not be designated as 23 confidential for tactical reasons and that nothing will be so designated without a 24 good faith belief that it has been maintained in a confidential, non-public manner, 25 and there is good cause why it should not be part of the public record of this case. 26 / / / 27 / / / / / / 1 2. DEFINITIONS 2 2.1 Action: California Spine and Neurosurgery Institute v. Flo Services 3 USA, et al., Central District of California, Case No. 2:23-cv-07473 FLA (AJRx). 4 2.2 Challenging Party: a Party or Non-Party that challenges the 5 designation of information or items under this Order. 6 2.3 “CONFIDENTIAL” Information or Items: information (regardless of 7 how it is generated, stored or maintained) or tangible things that qualify for 8 protection under Federal Rule of Civil Procedure 26(c), and as specified above in 9 the Good Cause Statement. 10 The term Confidential Information shall include confidential or proprietary 11 technical, scientific, financial, business, health, or medical information designated 12 as “CONFIDENTIAL” by the producing party. 13 The term “Confidential Health Information” shall constitute a subset of 14 Confidential Information, and shall be designated as “CONFIDENTIAL” and 15 subject to all other terms and conditions governing the treatment of Confidential 16 Information. Confidential Health Information shall mean information supplied in 17 any form, or any portion thereof, that identifies an individual or subscriber in any 18 manner and relates to the past, present, or future care, services, or supplies relating 19 to the physical or mental health or condition of such individual or subscriber, the 20 provision of health care to such individual or subscriber, or the past, present, or 21 future payment for the provision of health care to such individual or subscriber. 22 Confidential Health Information shall include, but is not limited to, claim data, 23 claim forms, grievances, appeals, or other documents or records that contain any 24 patient health information required to be kept confidential under any state or 25 federal law, including 45 C.F.R. Parts 160 and 164 promulgated pursuant to the 26 Health Insurance Portability and Accountability Act of 1996 (see 45 C.F.R. §§ 27 164.501 & 160.103), and the following subscriber, patient, or member identifiers: a. names; 1 b. all geographic subdivisions smaller than a State, including street address, 2 city, county, precinct, and zip code; 3 c. all elements of dates (except year) for dates directly related to an 4 individual, including birth date, admission date, discharge date, age, and 5 date of death; 6 d. telephone numbers; 7 e. fax numbers; 8 f. electronic mail addresses; 9 g. social security numbers; 10 h. medical record numbers; 11 i. health plan beneficiary numbers; 12 j. account numbers; 13 k. certificate/license numbers; 14 l. vehicle identifiers and serial numbers, including license plate numbers; 15 m. device identifiers and serial numbers; 16 n. web universal resource locators (“URLs”); 17 o. internet protocol (“IP”) address numbers; 18 p. biometric identifiers, including finger and voice prints; 19 q. full face photographic images and any comparable images; and/or 20 r. any other unique identifying number, characteristic, or code. 21 2.4 Counsel: Outside Counsel of Record and House Counsel (as well as 22 their support staff). 23 2.5 Designating Party: a Party or Non-Party that designates information 24 or items that it produces in disclosures or in responses to discovery as 25 “CONFIDENTIAL” or “CONFIDENTIAL – ATTORNEYS’ EYES ONLY.” 26 2.6 Disclosure or Discovery Material: all items or information, regardless 27 of the medium or manner in which it is generated, stored, or maintained (including, 1 among other things, testimony, transcripts, and tangible things), that are produced 2 or generated in disclosures or responses to discovery in this matter. 3 2.7 Expert: a person with specialized knowledge or experience in a 4 matter pertinent to the litigation who has been retained by a Party or its counsel to 5 serve as an expert witness or as a consultant in this Action. 6 2.8 House Counsel: attorneys who are employees of a Party to this 7 Action. House Counsel does not include Outside Counsel of Record or any other 8 outside counsel. 9 2.9 Non-Party: any natural person, partnership, corporation, association, 10 or other legal entity not named as a Party to this action. 11 2.10 Outside Counsel of Record: attorneys who are not employees of a 12 Party to this Action but are retained to represent or advise a Party to this Action 13 and have appeared in this Action on behalf of that Party or are affiliated with a law 14 firm that has appeared on behalf of that Party, including support staff. 15 2.11 Party: any Party to this Action, including all of its officers, directors, 16 employees, consultants, retained experts, and Outside Counsel of Record (and their 17 support staffs). 18 2.12 Producing Party: a Party or Non-Party that produces Disclosure or 19 Discovery Material in this Action. 20 2.13 Professional Vendors: persons or entities that provide litigation 21 support services (e.g., photocopying, videotaping, translating, preparing exhibits or 22 demonstrations, and organizing, storing, or retrieving data in any form or medium) 23 and their employees and subcontractors. 24 2.14 Protected Material: any Disclosure or Discovery Material that is 25 designated as “CONFIDENTIAL” or “CONFIDENTIAL-ATTORNEYS’ EYES 26 ONLY.” 27 2.15 Receiving Party: a Party that receives Disclosure or Discovery Material from a Producing Party. 1 3. SCOPE 2 The protections conferred by this Stipulation and Order cover not only 3 Protected Material (as defined above), but also (1) any information copied or 4 extracted from Protected Material; (2) all copies, excerpts, summaries, or 5 compilations of Protected Material; and (3) any testimony, conversations, or 6 presentations by Parties or their Counsel that might reveal Protected Material. 7 Any use of Protected Material at trial shall be governed by the orders of the 8 trial judge. This Order does not govern the use of Protected Material at trial. 9 10 4. DURATION 11 Once a case proceeds to trial, all of the court-filed information to be 12 introduced that was previously designated as confidential or maintained pursuant 13 to this protective order becomes public and will be presumptively available to all 14 members of the public, including the press, unless compelling reasons supported 15 by specific factual findings to proceed otherwise are made to the trial judge in 16 advance of the trial. See Kamakana v. City and Cty. of Honolulu, 447 F.3d 1172, 17 1180-81 (9th Cir. 2006) (distinguishing “good cause” showing for sealing 18 documents produced in discovery from “compelling reasons” standard when 19 merits-related documents are part of court record). Accordingly, the terms of this 20 protective order do not extend beyond the commencement of the trial. 21 22 5. DESIGNATING PROTECTED MATERIAL 23 5.1 Exercise of Restraint and Care in Designating Material for Protection. 24 Each Party or Non-Party that designates information or items for protection under 25 this Order must take care to limit any such designation to specific material that 26 qualifies under the appropriate standards. The Designating Party must designate for 27 protection only those parts of material, documents, items, or oral or written communications that qualify so that other portions of the material, documents, 1 items, or communications for which protection is not warranted are not swept 2 unjustifiably within the ambit of this Order. 3 Mass, indiscriminate, or routinized designations are prohibited. 4 Designations that are shown to be clearly unjustified or that have been made for an 5 improper purpose (e.g., to unnecessarily encumber the case development process 6 or to impose unnecessary expenses and burdens on other parties) may expose the 7 Designating Party to sanctions. 8 If it comes to a Designating Party’s attention that information or items that it 9 designated for protection do not qualify for protection, that Designating Party must 10 promptly notify all other Parties that it is withdrawing the inapplicable designation. 11 5.2 Manner and Timing of Designations. Except as otherwise provided in 12 this Order (see, e.g., second paragraph of section 5.2(a) below), or as otherwise 13 stipulated or ordered, Disclosure or Discovery Material that qualifies for protection 14 under this Order must be clearly so designated before the material is disclosed or 15 produced. 16 Designation in conformity with this Order requires: 17 (a) for information in documentary form (e.g., paper or electronic 18 documents, but excluding transcripts of depositions or other pretrial or trial 19 proceedings), that the Producing Party affix, at a minimum, the legend 20 “CONFIDENTIAL” (hereinafter “CONFIDENTIAL legend”), to each page that 21 contains protected material, including Confidential Health Information. If only a 22 portion or portions of the material on a page qualifies for protection, the Producing 23 Party also must clearly identify the protected portion(s) (e.g., by making 24 appropriate markings in the margins). 25 A Party or Non-Party that makes original documents available for inspection 26 need not designate them for protection until after the inspecting Party has indicated 27 which documents it would like copied and produced. During the inspection and before the designation, all of the material made available for inspection shall be 1 deemed “CONFIDENTIAL.” After the inspecting Party has identified the 2 documents it wants copied and produced, the Producing Party must determine 3 which documents, or portions thereof, qualify for protection under this Order. 4 Then, before producing the specified documents, the Producing Party must affix 5 the “CONFIDENTIAL legend” to each page that contains Protected Material. If 6 only a portion or portions of the material on a page qualifies for protection, the 7 Producing Party also must clearly identify the protected portion(s) (e.g., by making 8 appropriate markings in the margins). 9 (b) for testimony given in depositions that the Designating Party 10 identify the Disclosure or Discovery Material on the record, before the close of the 11 deposition. 12 (c) for information produced in some form other than documentary 13 and for any other tangible items, that the Producing Party affix in a prominent 14 place on the exterior of the container or containers in which the information is 15 stored the legend “CONFIDENTIAL.” If only a portion or portions of the 16 information warrants protection, the Producing Party, to the extent practicable, 17 shall identify the protected portion(s). 18 (d) for information disclosed at a hearing or trial that the Designating 19 Party requests the Judge, at the time the information is proffered or adduced, to 20 receive the information only in the presence of those persons designated to receive 21 such information and Court personnel, and to designate the transcript 22 appropriately. A Party may also designate Confidential Information as 23 “CONFIDENTIAL - ATTORNEYS’ EYES ONLY.” Confidential Information 24 marked as “CONFIDENTIAL - ATTORNEYS’ EYES ONLY” may be used solely 25 for the purpose of conducting this Litigation and not for any other purpose 26 whatsoever. The parties may designate Confidential Information as 27 “CONFIDENTIAL - ATTORNEYS’ EYES ONLY” in the same manner set forth above with an added reference to “ATTORNEYS’ EYES ONLY.” Information 1 designated “CONFIDENTIAL—ATTORNEYS’ EYES ONLY” may be viewed 2 by, copied by, exhibited to, or disclosed to only the persons described in Paragraph 3 7.2(a), (d), (i), and (j) and Retained Experts and Consultants, all subject to the 4 requirements of Paragraph 7.1. “Retained Experts and Consultants” means third 5 party experts or consultants actually retained by a party, and does not include 6 purely percipient experts or party employees. 7 5.3 Inadvertent Failures to Designate. If timely corrected, an inadvertent 8 failure to designate qualified information or items does not, standing alone, waive 9 the Designating Party’s right to secure protection under this Order for such 10 material. Upon timely correction of a designation, the Receiving Party must make 11 reasonable efforts to assure that the material is treated in accordance with the 12 provisions of this Order. 13 14 6. CHALLENGING CONFIDENTIALITY DESIGNATIONS 15 6.1 Timing of Challenges. Any Party or Non-Party may challenge a 16 designation of confidentiality at any time that is consistent with the Court’s 17 Scheduling Order. 18 6.2 Meet and Confer. The Challenging Party shall initiate the dispute 19 resolution process under Local Rule 37-1, et seq. Any discovery motion must 20 strictly comply with the procedures set forth in Local Rules 37-1, 37-2, and 37-3. 21 6.3 Burden. The burden of persuasion in any such challenge proceeding 22 shall be on the Designating Party. Frivolous challenges, and those made for an 23 improper purpose (e.g., to harass or impose unnecessary expenses and burdens on 24 other parties) may expose the Challenging Party to sanctions. Unless the 25 Designating Party has waived or withdrawn the confidentiality designation, all 26 parties shall continue to afford the material in question the level of protection to 27 which it is entitled under the Producing Party’s designation until the Court rules on the challenge. 1 7. ACCESS TO AND USE OF PROTECTED MATERIAL 2 7.1 Basic Principles. A Receiving Party may use Protected Material that 3 is disclosed or produced by another Party or by a Non-Party in connection with this 4 Action only for prosecuting, defending, or attempting to settle this Action and for 5 no other action. A Receiving Party shall hold such information received from the 6 disclosing Party in confidence, shall not use it for any business or other 7 commercial purpose, shall not use it for filing or prosecuting any patent application 8 (of any type) or patent reissue or reexamination request, and shall not disclose it to 9 any person, except as hereinafter provided. Such Protected Material may be 10 disclosed only to the categories of persons and under the conditions described in 11 this Order. When the Action has been terminated, a Receiving Party must comply 12 with the provisions of section 13 below (FINAL DISPOSITION). 13 All documents, including attorney notes and abstracts, which contain another 14 party’s Confidential Information, shall be handled as if they were designated 15 pursuant to paragraph 5. 16 Protected Material must be stored and maintained by a Receiving Party at a 17 location and in a secure manner that ensures that access is limited to the persons 18 authorized under this Order. 19 7.2 Disclosure of “CONFIDENTIAL” Information or Items. Unless 20 otherwise ordered by the Court or permitted in writing by the Designating Party, a 21 Receiving Party may disclose any information or item designated 22 “CONFIDENTIAL” only to: 23 (a) the Receiving Party’s Outside Counsel of Record in this Action, 24 as well as employees of said Outside Counsel of Record (excluding experts and 25 investigators) to whom it is reasonably necessary to disclose the information for 26 this Action; 27 (b) the officers, directors, and employees (including House Counsel) of the Receiving Party to whom disclosure is reasonably necessary for this Action; 1 (c) Experts (as defined in this Order) of the Receiving Party to whom 2 disclosure is reasonably necessary for this Action and who have signed the 3 “Acknowledgment and Agreement to Be Bound” (Exhibit A); 4 (d) the Court and its personnel; 5 (e) court reporters and their staff; 6 (f) professional jury or trial consultants, mock jurors, and Professional 7 Vendors to whom disclosure is reasonably necessary for this Action and who have 8 signed the “Acknowledgment and Agreement to Be Bound” (Exhibit A); 9 (g) the author or recipient of a document containing the information 10 or a custodian or other person who otherwise possessed or knew the information; 11 (h) during their depositions, witnesses, and attorneys for witnesses, in 12 the Action to whom disclosure is reasonably necessary provided: (1) the deposing 13 party requests that the witness sign the form attached as Exhibit A hereto; and (2) 14 they will not be permitted to keep any confidential information unless they sign the 15 “Acknowledgment and Agreement to Be Bound” (Exhibit A), unless otherwise 16 agreed by the Designating Party or ordered by the Court. Pages of transcribed 17 deposition testimony or exhibits to depositions that reveal Protected Material may 18 be separately bound by the court reporter and may not be disclosed to anyone 19 except as permitted under this Stipulated Protective Order; 20 (i) Stenographers and videographers engaged to transcribe or record 21 depositions conducted in this action provided that such individuals agree in 22 writing, in the form attached at Appendix A, to be bound by the terms of this 23 Order; and 24 (j) any mediator or settlement officer, and their supporting personnel, 25 mutually agreed upon by any of the parties engaged in settlement discussions, 26 provided that such individuals agree in writing, in the form attached at Appendix 27 A, to be bound by the terms of this Order. 1 8. PROTECTED MATERIAL SUBPOENAED OR ORDERED 2 PRODUCED IN OTHER LITIGATION 3 If a Party is served with a subpoena or a court order issued in other litigation 4 that compels disclosure of any information or items designated in this Action as 5 “CONFIDENTIAL,” that Party must: 6 (a) promptly notify in writing the Designating Party. Such notification shall 7 include a copy of the subpoena or court order; 8 (b) promptly notify in writing the party who caused the subpoena or order to 9 issue in the other litigation that some or all of the material covered by the subpoena 10 or order is subject to this Protective Order. Such notification shall include a copy 11 of this Stipulated Protective Order; and 12 (c) cooperate with respect to all reasonable procedures sought to be pursued 13 by the Designating Party whose Protected Material may be affected. 14 If the Designating Party timely seeks a protective order, the Party served 15 with the subpoena or court order shall not produce any information designated in 16 this action as “CONFIDENTIAL” before a determination by the court from which 17 the subpoena or order issued, unless the Party has obtained the Designating Party’s 18 permission. The Designating Party shall bear the burden and expense of seeking 19 protection in that court of its confidential material and nothing in these provisions 20 should be construed as authorizing or encouraging a Receiving Party in this Action 21 to disobey a lawful directive from another court. 22 23 9. A NON-PARTY’S PROTECTED MATERIAL SOUGHT TO BE 24 PRODUCED IN THIS LITIGATION 25 (a) The terms of this Order are applicable to information produced by a 26 Non-Party in this Action and designated as “CONFIDENTIAL.” Such information 27 produced by Non-Parties in connection with this litigation is protected by the 1 remedies and relief provided by this Order. Nothing in these provisions should be 2 construed as prohibiting a Non-Party from seeking additional protections. 3 (b) In the event that a Party is required, by a valid discovery request, to 4 produce a Non-Party’s confidential information in its possession, and the Party is 5 subject to an agreement with the Non-Party not to produce the Non-Party’s 6 confidential information, then the Party shall: 7 (1) promptly notify in writing the Requesting Party and the Non- 8 Party that some or all of the information requested is subject to a confidentiality 9 agreement with a Non-Party; 10 (2) promptly provide the Non-Party with a copy of the Stipulated 11 Protective Order in this Action, the relevant discovery request(s), and a reasonably 12 specific description of the information requested; and 13 (3) make the information requested available for inspection by the 14 Non-Party, if requested. 15 (c) If the Non-Party fails to seek a protective order from this Court within 16 14 days of receiving the notice and accompanying information, the Receiving 17 Party may produce the Non-Party’s confidential information responsive to the 18 discovery request. If the Non-Party timely seeks a protective order, the Receiving 19 Party shall not produce any information in its possession or control that is subject 20 to the confidentiality agreement with the Non-Party before a determination by the 21 Court. Absent a court order to the contrary, the Non-Party shall bear the burden 22 and expense of seeking protection in this Court of its Protected Material. 23 24 10. UNAUTHORIZED DISCLOSURE OF PROTECTED MATERIAL 25 If a Receiving Party learns that, by inadvertence or otherwise, it has 26 disclosed Protected Material to any person or in any circumstance not authorized 27 under this Stipulated Protective Order, the Receiving Party must immediately (a) notify in writing the Designating Party of the unauthorized disclosures, (b) use its 1 best efforts to retrieve all unauthorized copies of the Protected Material, (c) inform 2 the person or persons to whom unauthorized disclosures were made of all the terms 3 of this Order, and (d) request such person or persons to execute the 4 “Acknowledgment and Agreement to Be Bound” that is attached hereto as Exhibit 5 A. 6 7 11. INADVERTENT PRODUCTION OF PRIVILEGED OR 8 OTHERWISE PROTECTED MATERIAL 9 When a Producing Party gives notice to Receiving Parties that certain 10 inadvertently produced material is subject to a claim of privilege or other 11 protection, the obligations of the Receiving Parties are those set forth in Federal 12 Rule of Civil Procedure 26(b)(5)(B). This provision is not intended to modify 13 whatever procedure may be established in an e-discovery order that provides for 14 production without prior privilege review. Pursuant to Federal Rule of Evidence 15 502(d) and (e), insofar as the Parties reach an agreement on the effect of disclosure 16 of a communication or information covered by the attorney-client privilege or 17 work product protection, the Parties may incorporate their agreement in the 18 stipulated protective order submitted to the Court. 19 20 12. MISCELLANEOUS 21 12.1 Right to Further Relief. Nothing in this Order abridges the right of 22 any person to seek its modification by the Court in the future. 23 12.2 Right to Assert Other Objections. By stipulating to the entry of this 24 Protective Order, no Party waives any right it otherwise would have to object to 25 disclosing or producing any information or item on any ground not addressed in 26 this Stipulated Protective Order. Similarly, no Party waives any right to object on 27 any ground to use in evidence of any of the material covered by this Protective Order. 1 12.3 Filing Protected Material. A Party that seeks to file under seal any 2 Protected Material must comply with Civil Local Rule 79-5. Protected Material 3 may only be filed under seal pursuant to a court order authorizing the sealing of the 4 specific Protected Material at issue; good cause must be shown in the request to 5 file under seal. If a Party’s request to file Protected Material under seal is denied 6 by the Court, then the Receiving Party may file the information in the public record 7 unless otherwise instructed by the Court. 8 9 13. FINAL DISPOSITION 10 After the final disposition of this Action, within 60 days of a written request 11 by the Designating Party, each Receiving Party must return all Protected Material 12 to the Producing Party or destroy such material. As used in this subdivision, “all 13 Protected Material” includes all copies, abstracts, compilations, summaries, and 14 any other format reproducing or capturing any of the Protected Material. Whether 15 the Protected Material is returned or destroyed, the Receiving Party must submit a 16 written certification to the Producing Party (and, if not the same person or entity, to 17 the Designating Party) by the 60 day deadline that (1) identifies (by category, 18 where appropriate) all the Protected Material that was returned or destroyed, and 19 (2) affirms that the Receiving Party has not retained any copies, abstracts, 20 compilations, summaries or any other format reproducing or capturing any of the 21 Protected Material. Notwithstanding this provision, counsel are entitled to retain 22 an archival copy of all pleadings, motion papers, trial, deposition, and hearing 23 transcripts, legal memoranda, correspondence, deposition and trial exhibits, expert 24 reports, attorney work product, and consultant and expert work product, even if 25 such materials contain Protected Material. Any such archival copies that contain 26 or constitute Protected Material remain subject to this Protective Order as set forth 27 in Section 4 (DURATION). 1 |}14. VIOLATION OF ORDER 2 Any violation of this Order may be punished by any and all appropriate 3 ||measures including, without limitation, contempt proceedings and/or monetary 4 || sanctions. Dated: March 20, 2024 GORDON REES SCULLY 6 MANSUKHANI, LLP 8 By: /s/ Shannon L. Ernster Courtney C. Hill 9 Shannon L. Ernster Hela Vaknin 10 Attorneys for Defendant AETNA LIFE INSURANCE COMPANY

13 a

Dated: March 20, 2024 15 THE LAW OFFICES OF < JONATHAN A. STIEGLITZ

17 By: /s/ Jonathan A. Stieglitz 18 Jonathan A. Stieglitz Attorney for Plaintiff 19 BRAND SURGICAL INSTITUTE 20 21 22 FOR GOOD CAUSE SHOWN, IT IS SO ORDERED. 23 24 25 || DATED: 3/20/24 Un HONAQA. JOEL RICHLIN 26 United States Magistrate Judge 27 28 17.

1 EXHIBIT A 2 ACKNOWLEDGMENT AND AGREEMENT TO BE BOUND 3 4 I, _____________________________ [full name], of _________________ 5 [full address], declare under penalty of perjury that I have read in its entirety and 6 understand the Stipulated Protective Order that was issued by the United States 7 District Court for the Central District of California on ____________ [date] in the 8 case of California Spine and Neurosurgery Institute v. Flo Services USA, et al., 9 Central District of California, Case No. 2:23-cv-07473 FLA (AJRx). I agree to 10 comply with and to be bound by all the terms of this Stipulated Protective Order 11 and I understand and acknowledge that failure to so comply could expose me to 12 sanctions and punishment in the nature of contempt. I solemnly promise that I will 13 not disclose in any manner any information or item that is subject to this Stipulated 14 Protective Order to any person or entity except in strict compliance with the 15 provisions of this Order. 16 I further agree to submit to the jurisdiction of the United States District 17 Court for the Central District of California for the purpose of enforcing the terms 18 of this Stipulated Protective Order, even if such enforcement proceedings occur 19 after termination of this action. I hereby appoint __________________________ 20 [full name] of _______________________________________ [full address and 21 telephone number] as my California agent for service of process in connection 22 with this action or any proceedings related to enforcement of this Stipulated 23 Protective Order. 24 Date: ______________________________________ 25 City and State where signed: _________________________________ 26 27 Printed name: _______________________________ Signature: __________________________________ 1 CERTIFICATION PURSUANT TO LOCAL RULE 5-4.3.4(A)(2)(I) 2 Pursuant to section 2(f)(4) of the electronic case filing administrative 3 policies and procedures manual, I hereby certify that the content of this document 4 is acceptable to Jonathan A. Stieglitz, counsel for Plaintiff, and I have obtained his 5 authorization to affix his electronic signature to this document. 6 By: /s/ Shannon L. Eernster 7 Shannon L. Ernster 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27