Dorothy S. Nesmith, M.D., P.A. v. Valley Baptist Medical Center N/K/A VB Harlingen Holdings and VHS Harlingen Hospital Company, LLC

• Court: Court of Appeals of Texas
• Decided: September 30, 2015
• Docket: 13-15-00207-CV
• Status: Published

Opinion

ACCEPTED 13-15-00207-CV THIRTEENTH COURT OF APPEALS CORPUS CHRISTI, TEXAS 9/30/2015 9:44:07 AM Dorian E. Ramirez CLERK

No. 13-15-00207-CV ————————— IN THE COURT OF APPEALS FILED IN 13th COURT OF APPEALS FOR THE THIRTEENTH DISTRICT OF TEXAS CORPUS CHRISTI/EDINBURG, TEXAS ————————————————————————————————— 9/30/2015 9:44:07 AM DOROTHY S. NESMITH, M.D., P.A. DORIAN E. RAMIREZ Clerk

Appellant

v.

VALLEY BAPTIST MEDICAL CENTER n/k/a VB HARLINGEN HOLDINGS and VHS HARLINGEN HOSPITAL COMPANY, LLC

Appellees ————————————————————————————————— On Appeal from Cameron County Court at Law Number 1 Arturo McDonald, Judge Presiding ————————————————————————————————— APPELLANT’S BRIEF —————————————————————————————————

Chad M. Ruback State Bar No. 90001244 chad@appeal.pro The Ruback Law Firm 8117 Preston Road Suite 300 Dallas, Texas 75225 (214) 522-4243 (214) 522-2191 fax

ORAL ARGUMENT REQUESTED IDENTITY OF PARTIES AND COUNSEL Appellant Appellees

Dorothy S. Nesmith, M.D., P.A. Valley Baptist Medical Center n/k/a VB Harlingen Holdings and Appellant’s Trial Counsel VHS Harlingen Hospital Company, LLC

David Casso Appellees’ Trial and Appellate Counsel 108 N. Jackson Road Suite 2 Blaine A. Holbrook Edinburg, Texas 78541 Nikki K. Elgie 10101 Reunion Place David Kithcart Suite 900 222 E. Van Buren Street San Antonio, Texas 78216 Suite 101 Harlingen, Texas 78551

Appellant’s Appellate Counsel

Chad M. Ruback 8117 Preston Road Suite 300 Dallas, Texas 75225

i TABLE OF CONTENTS

INDEX OF AUTHORITIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

STATEMENT OF THE CASE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

ISSUE ON APPEAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

STATEMENT OF FACTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SUMMARY OF THE ARGUMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

ARGUMENT.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

I. A summary judgment is reviewed de novo, so no deference should be given to the trial court’s decision to grant summary judgment. . . . . 12

II. If a court is unable to give effect to all provisions in a contract—as with the contract at issue here—the contract is ambiguous, and summary judgment is inappropriate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

III. The federal regulations which were the basis for the contract are further justification for the contract at issue here being ambiguous. . . . . . . 16

IV. Also favoring Dr. Nesmith is the well-established principle that a contract must be construed against the drafter. . . . . . . . . . . . . . . . . . 19

V. Conclusion: Valley Baptist was not entitled to traditional summary judgment or no-evidence summary judgment. . . . . . . . . . . . . . . . . . 19

PRAYER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

CERTIFICATE OF COMPLIANCE.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

CERTIFICATE OF SERVICE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

ii APPENDIX A: the order granting summary judgment [CR vol. 5 pp. 273-274]

APPENDIX B: the contract at issue [CR vol. 1 pp. 381-403]

iii INDEX OF AUTHORITIES

Coker v. Coker, 650 S.W.2d 391 (Tex. 1983).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Columbia Gas Transp. Corp. v. New Ulm Gas, Ltd., 940 S.W.2d 587 (Tex. 1996).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Henkel v. Norman, 441 S.W.3d 249 (Tex. 2014).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Innovate Tech. Solutions, L.P. v. Youngsoft, Inc., 418 S.W.3d 148 (Tex. App.—Dallas 2013, no pet.). . . . . . . . . . . . . . . . . . 14

J.M. Davidson, Inc. v. Webster, 128 S.W.3d 223 (Tex. 2003).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13, 14

Killeen v. Lighthouse Elec. Contractors, L.P., 248 S.W.3d 343 (Tex. App.—San Antonio 2007, pet. denied). . . . . . . . . . 14

Lewis v. Davis, 199 S.W.2d 146 (Tex. 1947).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Progressive County Mut. Ins. Co. v. Kelley, 284 S.W.3d 805 (Tex. 2009).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Quick v. City of Austin, 7 S.W.3d 109 (Tex. 1998).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Reilly v. Rangers Mgmt., Inc., 727 S.W.2d 527 (Tex. 1987).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Sage St. Associates v. Northdale Constr. Co., 863 S.W.2d 438 (Tex. 1993).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Seaview Hosp., Inc. v. Medicenters of Am., Inc., 570 S.W.2d 35 (Tex. Civ. App.—Corpus Christi 1978, no writ).. . . . . . . . 18

iv Solis v. Evins, 951 S.W.2d 44 (Tex. App.—Corpus Christ 1997, no writ). . . . . . . . . . . . . 19

Temple-Eastex, Inc. v. Addison Bank, 672 S.W.2d 793 (Tex. 1984).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

White v. Moore, 760 S.W.2d 242 (Tex.1988). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

v STATEMENT OF THE CASE

This suit involved a dispute over a contract by which a hospital hired a

physician to serve as its director of rehabilitation. [CR vol. 1 p. 142] The physician

filed suit against the hospital entities, and the hospital entities moved for summary

judgment on both traditional and no-evidence grounds. [CR vol. 1 pp. 141, 147, 160]

The trial court granted summary judgment. [CR vol. 5 pp. 273-274]

vi ISSUE ON APPEAL

The trial court committed reversible error in granting Valley Baptist’s motion for summary judgment.

vii STATEMENT OF FACTS

Pursuant to a merger, the interests of Appellee Valley Baptist Medical Center

were assumed by Appellee VHS Harlingen Hospital Company LLC d/b/a Valley

Baptist Medical Center. [CR vol. 1 pp. 141-142 n.1] In the trial court, for ease of

reference, these two entities referred to themselves collectively as if they were one

entity called “Valley Baptist.” [CR vol. 1 pp. 141-142 n.1]

Federal regulations require an inpatient rehabilitation unit—such as Valley

Baptist’s—to have a director of rehabilitation who provides at least eighty hours per

month of services in the unit. [CR vol. 1 pp. 141-142; CR vol. 3 p. 58]1 In fact,

compliance with these federal regulations is a prerequisite for a hospital to bill

Medicare and Medicaid for services provided. [CR vol. 3 p. 58] To ensure

compliance with these federal regulations, Valley Baptist entered into a contract

(effective May of 2009) with Appellant Dorothy S. Nesmith, M.D., P.A. to serve as

1 Valley Baptist asserted “One of the services that Valley Baptist provides . . . is an inpatient rehabilitation unit. . . . Federal regulations require that such a unit have a director of rehabilitation who provides services to the rehabilitation unit and to the unit’s patients . . . for at least eighty hours per month.” [CR vol. 1 pp. 141-142] 1 its director of rehabilitation. [CR vol. 1 pp. 142, 394]2 In the trial court, for ease of

reference, Valley Baptist referred to Appellant Dorothy S. Nesmith, M.D., P.A. as if

this entity were synonymous with its sole member, a rehabilitation physician named

Dorothy Nesmith.3 [CR vol. 1 pp. 142, 143-144 n.2] In doing so, Valley Baptist used

female pronouns and the name “Dr. Nesmith.” [CR vol. 1 pp. 143-144 n.2] For the

sake of consistency, this appellate brief will refer to the parties by using the same

references as were used in the trial court.4

The contract provides that Valley Baptist would pay Dr. Nesmith $130 per hour

(up to eighty hours per month). [CR vol. 1 p. 142] In light of the fact that Valley

2 Valley Baptist asserted “To maintain compliance with those federal requirements . . . Valley Baptist entered into a Medical Director Agreement . . . with the Plaintiff.” [CR vol. 1 p. 142]

Valley Baptist sometimes refers to this position as “director of rehabilitation” and sometimes as “medical director.” [CR vol. 1 p. 142] Dr. Nesmith, as director of rehabilitation / medical director, reported to someone whose title is “program director.” [CR vol. 3 pp. 33-34, 49, 58, 60, 64, 69, 71] 3 To be clear, the physician named Dorothy Nesmith is the sole member of Appellant Dorothy S. Nesmith, M.D., P.A. [CR vol. 1 pp. 143-144 n.2] 4 To be clear, the contract was not with the physician named Dorothy Nesmith, and the physician named Dorothy Nesmith was never a party to this case. [CR vol. 1 pp. 9, 142, 394] The contract was with the professional association Dorothy S. Nesmith, M.D., P.A. [CR vol. 1 pp. 142, 394] Both the physician and the professional association are being referred to herein as “Dr. Nesmith” for the purposes of (1) being consistent with the parties’ summary judgment briefing in the trial court and (2) aiding in the readability of this brief. 2 Baptist entered into the contract for the purpose of satisfying the federal requirement

of a director of rehabilitation working at least eighty hour per month, not surprisingly,

the contract expressly states that there would be a “Minimum Number of Hours 80

hours per month.” [CR vol. 1 p. 395] And, likely to keep Valley Baptist’s costs to

an absolute minimum, the contract also expressly states that there would be a

“Maximum Number of Hours 80 hours per month.” [CR vol. 1 p. 395]

The contract provides that Dr. Nesmith was to submit a monthly form detailing

how much time she spent on each day of the preceding month on each of twenty-six

specified administrative services. [CR vol. 1 pp. 142-143, 396-399]5 Even for

months where Dr. Nesmith may have recorded less than eighty hours on the twenty-

six specified administrative services, it is undisputed that she was working as the

medical director on the rehabilitation unit eighty hours per month or more during each

5 Valley Baptist asserted: “Plaintiff was required to submit a form, called a ‘Summary Report’ . . . that detailed the daily time spent for the preceding month on each of the twenty-six enumerated services.” [CR vol. 1 p. 143] The twenty-six specified administrative services are listed in Appendix B to the contract. [CR vol. 1 pp. 396-398] 3 of those months.6 [CR vol. 2 pp. 12-13]7 However, for months when the total hours

allocatable to the twenty-six specified administrative services was less than eighty

hours, Valley Baptist paid Dr. Nesmith only for the number of hours allocatable to

the twenty-six specified administrative services (i.e., paying her for less than eighty

hours). [CR vol. 1 p. 144]

Valley Baptist indicated that it took the position that Dr. Nesmith was supposed

to perform other administrative services (in addition to the twenty-six specified

administrative services) for Valley Baptist’s rehabilitation unit, but that Valley

6 It is also undisputed that, throughout Dr. Nesmith’s tenure as director of rehabilitation, she performed all of the services necessary to keep the rehabilitation unit in full compliance with federal regulations. [CR vol. 1 p. 429] 7 Jennifer Bartnesky-Smith is an attorney who was Valley Baptist’s “hospital compliance officer” and was designated by Valley Baptist as its corporate representative for this litigation. [CR vol. 2 pp. 7-8] When asked in her deposition about Dr. Nesmith, Ms. Bartnesky-Smith testified: “I don’t think that we’re disputing that she’s performed time under this contract that meets the [federal] requirements” (i.e., at least 80 hours per month). [CR vol. 2 p. 12]

Moreover, Ms. Bartnesky-Smith acknowledged that Dr. Nesmith fulfilled all of “the duties as articulated by the contract.” [CR vol. 2 p. 70] As indicated above, one of these duties under the contract would be a “Minimum Number of Hours 80 hours per month.” [CR vol. 1 p. 395]

Additionally, Dr. Nesmith’s affidavit indicated that there was always at least “80 hours a month of service provided” to Valley Baptist. [CR vol. 3 p. 70] In fact, Dr. Nesmith regularly worked ten hours per day at the hospital, eating lunch and dinner at her desk, and then spent an additional one to two hours working from home. [CR vol. 3 p. 60] 4 Baptist would simply refuse to pay for those other services which she performed as

medical director. [CR vol. 2 p. 13]8 Consistent with that position, Valley Baptist

provided Dr. Nesmith with timekeeping forms which only had spaces for her to

record hours allocatable to the twenty-six specified administrative services. [CR vol.

1 pp. 214-215, 428; CR vol. 3 pp. 12, 46, 60-74]9 These forms provided no blank

lines for Dr. Nesmith to record the other time she spent performing medical director

tasks other than the twenty-six specified administrative services. [CR vol. 1 pp. 134,

8 Jennifer Bartnesky-Smith is an attorney who was Valley Baptist’s “hospital compliance officer” and was designated by Valley Baptist as its corporate representative for this litigation. [CR vol. 2 pp. 7-8] Ms. Bartnesky-Smith was asked in her deposition about Dr. Nesmith: “She was to do administrative work on the unit without compensation from Valley Baptist?” Ms. Bartnesky-Smith candidly replied: “That’s correct.” [CR vol. 2 p. 13] Ms. Bartnesky-Smith emphasized that the work performed by Dr. Nesmith “would need to tie somehow to one of those [twenty-six] articulated duties” for Dr. Nesmith to be paid by Valley Baptist. [CR vol. 2 p. 13] However, the record does not reflect that Dr. Nesmith ever agreed to perform other administrative services (in addition to the twenty-six specified administrative services) for Valley Baptist without compensation. To the contrary, Dr. Nesmith testified in her deposition “I never agreed to do any of those hours for free.” [CR vol. 3 p. 29] 9 Sometime during the month of September of 2012, Valley Baptist provided Dr. Nesmith with new timekeeping forms that allowed her to record her time spent on all tasks—rather than merely her time spent on the twenty-six specified administrative services. [CR vol. 1 p. 428; CR vol. 2 p. 14; CR vol. 3 pp. 18, 74] Dr. Nesmith has no complaints about payments made by Valley Baptist for her work from that time forward. [CR vol. 1 p. 428; CR vol. 3 pp. 19, 74] Rather, Dr. Nesmith sought breach of contract damages only from the commencement of the contract in May of 2009 up until the timekeeping form was changed in September of 2012. [CR vol. 1 pp. 395, 428] 5 214-215, 428; CR vol. 3 pp. 12, 46, 60-74] And there were certainly other duties Dr.

Nesmith had to perform. [CR vol. 3 p. 58]10 Dr. Nesmith repeatedly raised this issue

with Valley Baptist. [CR vol. 2 pp. 19, 23] She even asked whether she could add

other tasks to the timekeeping form or submit an addendum to the form, but the

answer was “No.” [CR vol. 3 p. 32] The record does not indicate why Valley Baptist

would not permit Dr. Nesmith to other tasks to the timekeeping form or submit an

addendum to the form.11 This is especially notable in light of the fact that, during the

pendency of the exact same contract with Dr. Nesmith, Valley Baptist later reversed

10 In her affidavit, Dr. Nesmith stated that “the list of duties on the director timesheet was not all inclusive” of the duties she had to perform. [CR vol. 3 p. 58] Valley Baptist’s corporate representative Ms. Bartnesky-Smith acknowledged that Valley Baptist did expect Dr. Nesmith to perform duties in addition to the twenty-six duties listed on the timekeeping forms. Specifically, Ms. Bartnesky-Smith was asked: “She was to do administrative work on the unit without compensation from Valley Baptist?” Ms. Bartnesky-Smith candidly replied: “That’s correct.” [CR vol. 2 p. 13]

It appears that Valley Baptist has taken the position that it does not have to pay Dr. Nesmith for the eighty hours specified in the contract, even though it is undisputed that Dr. Nesmith worked at least eighty hours as medical director every month. In the trial court, Dr. Nesmith characterized Valley Baptist’s position as not being in good faith. [CR 96] 11 The timekeeping form is not the only curious form which was utilized by Valley Baptist. Valley Baptist also used a form which specified “maximum payable/expected = 80 Hours”. [CR vol. 5 p. 69] It is notable that Valley Baptist’s form referenced the “Maximum Number of Hours 80 hours per month” provided in the contract but wholly ignored the “Minimum Number of Hours 80 hours per month” language provided on the exact same page of the contract. [CR vol. 1 p. 395] 6 its position and began allowing Dr. Nesmith to record all of her time—rather than

merely her time spent on the twenty-six specified administrative services—beginning

sometime during the month of September of 2012. [CR vol. 1 p. 428; CR vol. 2 p.

14; CR vol. 3 pp. 18, 74] The record does not reflect why Valley Baptist apparently

interpreted the contract one way from the commencement of the contract in May of

2009 until September of 2012 (only paying Dr. Nesmith for time spent on the twenty-

six specified enumerated services), then apparently changed its interpretation of the

contract in September of 2012 (at which time Valley Baptist began paying Dr.

Nesmith for all of her time spent up to the eighty-hour maximum), and now

apparently changed its interpretation of the contract once again (once again taking the

position that it should only pay Dr. Nesmith for time spent on the twenty-six specified

enumerated services).

Ultimately, Dr. Nesmith filed a breach of contract suit against Valley Baptist.

[CR vol. 1 p. 95] Dr. Nesmith alleged that Valley Baptist breached the contract by

failing to pay her approximately $129,000 owed to her under the contract. [CR vol.

1 p. 79; vol. 3 p. 58]12

In her petition, Dr. Nesmith stated that she sustained “[d]irect economic loss 12

under the Agreement in the amount of $129,415.” [CR vol. 1 p. 99] In her affidavit, Dr. Nesmith stated that she “was underpaid $129,000.” [CR vol. 3 p. 58] 7 Valley Baptist filed a motion for summary judgment. [CR vol. 1 p. 142] In its

motion, Valley Baptist sought (1) traditional summary judgment, claiming that Valley

Baptist established as a matter of law that it did not breach the contract and (2) no-

evidence summary judgment, claiming that there is no evidence that Valley Baptist

breached the contract. [CR vol. 1 pp. 147, 162]13 Although the parties disagreed

about the amount that Valley Baptist owed to Dr. Nesmith,14 the parties do not dispute

the amount that which was actually paid by Valley Baptist to Dr. Nesmith. [CR vol.

1 pp. 57-58, 425] Valley Baptist even provided summary judgment evidence (copies

of the checks by which it paid Dr. Nesmith) of the amounts it paid to Dr. Nesmith.

[CR vol. 1 pp. 147, 212-364] Rather, Valley Baptist’s argument revolves around

Valley Baptist’s interpretation of the contract. In fact, Valley Baptist’s motion for

summary judgment devotes 17 pages to arguing Valley Baptist’s interpretation of the

contract. [CR vol. 1 pp. 142-145, 147-159]

13 Valley Baptist’s motion also sought summary judgment as to several tort causes of action pleaded by Dr. Nesmith. [CR vol. 1 pp. 165-177] However, Dr. Nesmith is not seeking reversal of the summary judgment as to her tort causes of action. 14 Dr. Nesmith argued that the payments made by Valley Baptist did not constitute the full amount owed to her pursuant to the contract (a/k/a the “Medical Director Agreement”) and Valley Baptist argued to the contrary. [CR vol. 1 pp. 57- 58, 142, 425] 8 Valley Baptist’s argument as to breach of contract attempts to justify how

Valley Baptist’s interpretation of the contract is plausible despite the “Minimum

Number of Hours” provision in the contract. First, Valley Baptist repeatedly suggests

that the “Minimum Number of Hours” provision in the contract should be disregarded

because it was merely in “the definition section” of the contract. [CR vol. 1 pp. 144-

145, 148, 159] However, as Valley Baptist candidly acknowledges, the “Maximum

Number of Hours” provision—upon which Valley Baptist heavily relies for its

interpretation of the contract—is also in the definition section of the contract. [CR

vol. 1 p. 151] (“The definition section, in turn, defines ‘maximum number of hours’

as ‘80 hours per month.’ ”)

Second, Valley Baptist claims that the “Minimum Number of Hours” provision

should be disregarded because it is merely a “drafting error.” [CR vol. 1 p. 159]

However, Valley Baptist does not cite to any affidavit, deposition testimony, or other

evidence in the summary judgment record to support the assertion that inclusion of

this provision is a “drafting error.”

Third, Valley Baptist suggests that giving effect to the “Minimum Number of

Hours” provision would “render . . . meaningless” a provision in the contract which

“unambiguously provides that Plaintiff would only be paid for substantiated time

spent on one of the twenty-six enumerated services.” [CR vol. 1 p. 145] Yet, Valley

9 Baptist’s motion for summary judgment does not cite to any provision in the contract

which allegedly provides this. [CR vol. 1 pp. 141-178] And nowhere in the contract

does it expressly state “that Plaintiff would only be paid for substantiated time spent

on one of the twenty-six enumerated services.” [CR vol. 1 pp. 381-403]

Moreover, as noted above, Valley Baptist’s motion suggests that it would be

inappropriate to give effect to a provision in the contract relied upon by Dr. Nesmith

(the minimum hours provision) if doing so would render meaningless another

provision (the supposed provision that Dr. Nesmith would only be paid for work

performing one of the twenty-six specified services). [CR vol. 1 p. 145] However,

notably, Valley Baptist’s motion does not explain how it could be appropriate to give

effect to a provision relied upon by Valley Baptist (the supposed provision that Dr.

Nesmith would only be paid for work performing one of the twenty-six specified

services) when doing would render meaningless the minimum hour provision. [CR

vol. 1 pp. 141-178]

10 SUMMARY OF THE ARGUMENT

A summary judgment is reviewed de novo, so no deference should be given to

the trial court’s decision to grant summary judgment. If a court is unable to give

effect to all provisions in a contract—as with the contract at issue here—the contract

is ambiguous, and summary judgment is inappropriate. The federal regulations which

were the basis for the contract are further justification for the contract at issue here

being ambiguous. Also favoring Dr. Nesmith is the well-established principle that

a contract must be construed against the drafter. In conclusion, Valley Baptist was

not entitled to traditional summary judgment or no-evidence summary judgment.

11 ARGUMENT

I. A summary judgment is reviewed de novo, so no deference should be given to the trial court’s decision to grant summary judgment.

When a trial court grants a defendant’s motion for summary judgment—as

occurred in this case—the appellate court uses a de novo standard of review. See

Henkel v. Norman, 441 S.W.3d 249, 250 (Tex. 2014). And, in using a de novo

standard of review, the appellate court gives no deference to the trial court’s decision.

See Quick v. City of Austin, 7 S.W.3d 109, 116 (Tex. 1998). Instead, the appellate

court (1) examines the record in the light most favorable to the plaintiff; (2) indulges

every reasonable inference against the defendant; and (3) resolves any doubts against

the defendant. See Henkel v. Norman, 441 S.W.3d 249, 250 (Tex. 2014).

II. If a court is unable to give effect to all provisions in a contract—as with the contract at issue here—the contract is ambiguous, and summary judgment is inappropriate.

There is a provision in the contract providing: “Minimum Number of Hours 80

hours per month.” [CR vol. 1 p. 395] In its motion for summary judgment, Valley

Baptist repeatedly suggests that this provision should simply be disregarded. [CR

vol. 1 pp. 144-145, 148, 159] In fact, in its motion for summary judgment, Valley

Baptist (1) claims that the provision “is mere surplus” and (2) urges the trial court to

“strike down the inclusion of that [provision] as a drafting error.” [CR vol. 1 p. 159]

12 That would be wholly inconsistent with Texas Supreme Court precedent.

Specifically, the Texas Supreme Court has held that, in reviewing a contract, a court

must attempt to “give effect to all provisions of the contact so that none will be

rendered meaningless.” J.M. Davidson, Inc. v. Webster, 128 S.W.3d 223, 229 (Tex.

2003).15 If the court is unable to harmonize and give effect to all provisions in the

contract—such as the “Minimum Number of Hours” provision in the contract at issue

15 Valley Baptist repeatedly suggests that the “Minimum Number of Hours” provision in the contract should be disregarded because it is merely in “the definition section” of the contract. [CR vol. 1 pp. 144-145, 148, 159] However, when the Texas Supreme Court held that a court must attempt to “give effect to all provisions of the contact so that none will be rendered meaningless,” the Supreme Court did not carve out an exception to this rule for provisions which are in the definition section of a contract. Moreover, as Valley Baptist candidly acknowledges, the “Maximum Number of Hours” provision—upon which Valley Baptist heavily relies for its own interpretation of the contract—is also in the definition section of the contract. [CR vol. 1 p. 151] (“The definition section, in turn, defines ‘maximum number of hours’ as ‘80 hours per month.’ ”)

Additionally, when the Texas Supreme Court held that a court must attempt to “give effect to all provisions of the contract so that none will be rendered meaningless,” the Supreme Court did not carve out an exception to this rule for a provision alleged to be a “drafting error.” Moreover, Valley Baptist does not cite to any affidavit, deposition testimony, or other evidence in the summary judgment record to support the assertion that inclusion of the “Minimum Number of Hours” provision in the contract was a “drafting error.” 13 here—the contract is ambiguous.16 See Innovate Tech. Solutions, L.P. v. Youngsoft,

Inc., 418 S.W.3d 148, 151 (Tex. App.—Dallas 2013, no pet.); Killeen v. Lighthouse

Elec. Contractors, L.P., 248 S.W.3d 343, 349 (Tex. App.—San Antonio 2007, pet.

denied); see also J.M. Davidson, Inc. v. Webster, 128 S.W.3d 223, 229 (Tex. 2003).

When a contract is ambiguous, interpretation of the contract is a fact issue. See J.M.

Davidson, Inc. v. Webster, 128 S.W.3d 223, 229 (Tex. 2003). Consequently, when

a contract is ambiguous, “the granting of a motion for summary judgment is improper

16 It is appropriate for a court to consider whether a contract is ambiguous even if the parties did not argue ambiguity. See Progressive County Mut. Ins. Co. v. Kelley, 284 S.W.3d 805, 808-09 (Tex. 2009) (reversing summary judgment due to there being an ambiguity in the contract even though neither party had argued the contract was ambiguous); J.M. Davidson, Inc. v. Webster, 128 S.W.3d 223, 231 (Tex. 2003) (The dissent “implies that, because the parties do not contend the contract is ambiguous, we may not hold that it is. This is contrary to Texas law.”); Sage St. Associates v. Northdale Constr. Co., 863 S.W.2d 438, 445 (Tex. 1993) (holding that a contract is ambiguous and noting that a “court may conclude that a contract is ambiguous even in the absence of pleading by either party”); White v. Moore, 760 S.W.2d 242, 243 (Tex.1988) (reversing summary judgment due to there being an ambiguity in the document even though both parties had argued that, as a matter of law, there was no ambiguity); Coker v. Coker, 650 S.W.2d 391, 393 (Tex. 1983) (reversing summary judgment due to there being an ambiguity in the contract even though both parties had moved for summary judgment based on the contract being unambiguous).

In this case, while Dr. Nesmith argued in the trial court that the contract was unambiguous (with an interpretation favoring her rather than favoring Valley Baptist), she also argued in the alternative that the contract was ambiguous and that Valley Baptist’s motion for summary judgment be denied based on the contract being ambiguous. [CR vol. 1 p. 435] 14 because the interpretation of the instrument is a question for the jury.” Reilly v.

Rangers Mgmt., Inc., 727 S.W.2d 527, 529 (Tex. 1987).

Valley Baptist suggests that giving effect to the “Minimum Number of Hours”

provision would “render . . . meaningless” a provision in the contract which “provides

that Plaintiff would only be paid for substantiated time spent on one of the twenty-six

enumerated services.” [CR vol. 1 p. 145] Even if there were such provision in the

contract,17 pursuant to the Texas Supreme Court case law cited above, a contract is

ambiguous if it is not possible to give effect to every provision in the contract. That

would, of course, include contractual provisions favorable to Valley Baptist (such as

the supposed provision that Dr. Nesmith would only be paid for work performing one

of the twenty-six specified services) and also contractual provisions favorable to Dr.

Nesmith (such as the minimum hours provision).

17 Valley Baptist’s motion for summary judgment does not cite to any provision in the contract which allegedly provides—as Valley Baptist claims—“that Plaintiff would only be paid for substantiated time spent on one of the twenty-six enumerated services.” [CR vol. 1 pp. 141-178] And nowhere in the contract does it expressly state “that Plaintiff would only be paid for substantiated time spent on one of the twenty-six enumerated services.” [CR vol. 1 pp. 381-403] Of course, as the drafter of the contract, [CR vol. 2 p. 50] Valley Baptist could certainly have included such a provision in the contract. But, for whatever reason, Valley Baptist did not include such a provision when it drafted the contract. 15 III. The federal regulations which were the basis for the contract are further justification for the contract at issue here being ambiguous.

The circumstances under which a contract was entered can also be used to

support holding that the contract is ambiguous. See Columbia Gas Transp. Corp. v.

New Ulm Gas, Ltd., 940 S.W.2d 587, 589 (Tex. 1996). And the circumstances under

which this contract was entered support a holding that the contract is ambiguous—not

a summary judgment in favor of Valley Baptist. Specifically, Valley Baptist

acknowledges that federal regulations require an inpatient rehabilitation unit—such

as Valley Baptist’s—to have a director of rehabilitation who works at least eighty

hours per month in the unit. [CR vol. 1 pp. 141-142]18 Valley Baptist acknowledges

18 Without a director of rehabilitation working at least eighty hours per month in the unit, Valley Baptist would have jeopardized its entitlement to be paid under the federal government’s Medicare and Medicaid programs. [CR vol. 3 p. 58] Specifically, compliance with the federal regulations (including the eighty-hour-per- month requirement) is a prerequisite for a hospital to bill Medicare and Medicaid for services provided. [CR vol. 3 p. 58] And Valley Baptist is required to document that it has satisfied the eighty hours per month requirement. [CR vol. 3 p. 60] Because the contract with Dr. Nesmith has a “Minimum Number of Hours 80 hours per month” provision, Valley Baptist could rely on the contract as documentation that it had a director of rehabilitation working at least eighty hours per month. Without that provision in the contract, Valley Baptist would appear to have no documentation to support having a director of rehabilitation working at least eighty hours per month. Specifically, Valley Baptist could not rely on the timekeeping form filled out by Dr. Nesmith each month because, as discussed above, that form indicates only the time Dr. Nesmith spent on twenty-six specified administrative services—sometimes less than eighty hours—rather than indicating all of the time she spent working in the unit. 16 entering into the contract at issue with Dr. Nesmith for the purpose of satisfying this

requirement. [CR vol. 1 p. 142]

While Valley Baptist notes that the federal regulations permit the medical

director’s eighty-hour monthly minimum to be satisfied by both administrative tasks

and patient care, [CR vol. 1 pp. 40-41]19 the contract does not provide for Dr. Nesmith

to provide care to Valley Baptist patients, and the summary judgment record does not

reflect that Dr. Nesmith was ever hired by Valley Baptist to provide any patient care.

To the contrary, Valley Baptist acknowledged that to the extent Dr. Nesmith was

doing work to care for Valley Baptist patients, Valley Baptist did not pay her for that

work. [CR vol. 2 p. 13]20 As such, Valley Baptist’s position—that the contract is not

ambiguous and summary judgment in favor of Valley Baptist is appropriate because

the “Minimum Number of Hours 80 hours per month” language in the contract can

19 Valley Baptist asserted: “Federal regulations required that such a unit have a director of rehabilitation who provides services to the unit and the units patients, in any combination of patient services and administration, for at least twenty hours per week.” [CR vol. 1 pp. 141-142] Similarly, Dr. Nesmith stated in her affidavit: “The 80 hours per CMS [federal regulations] can be any combination of administrative and patient care duties.” [CR vol. 3 p. 58] (emphasis in original) 20 Jennifer Bartnesky-Smith is an attorney who was Valley Baptist’s “hospital compliance officer” and was designated by Valley Baptist as its corporate representative for this litigation. [CR vol. 2 pp. 7-8] Ms. Bartnesky-Smith was asked in her deposition about Dr. Nesmith: “So she was to do clinical work [patient care] on the unit without compensation?” Ms. Bartnesky-Smith candidly replied: “That’s right.” [CR vol. 2 p. 13] 17 simply be ignored—flies in the face of the circumstances under which the contract

was entered.

In fact, if summary judgment were appropriate in this case, that summary

judgment would need to be in favor of Dr. Nesmith rather than in favor of Valley

Baptist. Specifically, the Texas Supreme Court has held “When two constructions

of a contract are possible, preference will be given to that which does not result in

violation of law.” Lewis v. Davis, 199 S.W.2d 146, 149 (Tex. 1947); see Seaview

Hosp., Inc. v. Medicenters of Am., Inc., 570 S.W.2d 35, 39 (Tex. Civ. App.—Corpus

Christi 1978, no writ). And, in this case, Valley Baptist’s interpretation of the

contract (that the “Minimum Number of Hours 80 hours per month” language in the

contract should simply be ignored) would conflict with the federal regulations that

require Dr. Nesmith to work in Valley Baptist’s rehabilitation unit a minimum of

eighty hours per month.21 On the other hand, Dr. Nesmith’s interpretation of the

contract (giving effect to the “Minimum Number of Hours 80 hours per month”

language in the contract) would be consistent with the federal regulations.

21 Of course, Valley Baptist is not free to re-write the federal regulations. By definition, federal regulations define a party’s responsibilities as a matter of federal law. 18 IV. Also favoring Dr. Nesmith is the well-established principle that a contract must be construed against the drafter.

There is another reason that, if summary judgment were appropriate in this

case, that summary judgment would need to be in favor of Dr. Nesmith rather than in

favor of Valley Baptist. Specifically, the contract was drafted by Valley Baptist. [CR

vol. 2 p. 50]22 And, under Texas law, a contract should be “construed most strictly

against its author.” Temple-Eastex, Inc. v. Addison Bank, 672 S.W.2d 793, 798 (Tex.

1984); see Solis v. Evins, 951 S.W.2d 44, 50 (Tex. App.—Corpus Christ 1997, no

writ) (“In this case, as in other cases under Texas law, the contract must be construed

most strictly against its author.”).

V. Conclusion: Valley Baptist was not entitled to traditional summary judgment or no-evidence summary judgment.

In its motion, Valley Baptist sought (1) traditional summary judgment,

claiming that Valley Baptist established as a matter of law that it did not breach the

contract and (2) no-evidence summary judgment, claiming that there is no evidence

that Valley Baptist breached the contract. However, Valley Baptist’s entitlement to

summary judgment (both traditional and no-evidence) turns on interpretation of the

contract. Specifically, the parties do not dispute the amount that which was actually

22 Matt Wolthoff, who was Valley Baptist’s vice president of operations, testified at his deposition that “our obligation, again, is to produce the agreement and give it to the physician for her review.” [CR vol. 2 pp. 44, 50] 19 paid by Valley Baptist to Dr. Nesmith (although the parties do dispute whether this

was the full amount owed to Dr. Nesmith pursuant to the contract). In fact, Valley

Baptist even provides summary judgment evidence (copies of the checks by which

it paid Dr. Nesmith) of the amounts it paid to Dr. Nesmith. [CR vol. 1 pp. 147, 212-

364]

Because Valley Baptist has not established its interpretation of the contract as

a matter of law, it is not entitled to traditional summary judgment as to whether it

breached the contract. Specifically, if the “Minimum Number of Hours” provision

in the contract were given effect, the undisputed amount which Valley Baptist paid

to Dr. Nesmith would be less than was required by the contract.

Similarly, because Valley Baptist has not established its interpretation of the

contract as a matter of law, it is not entitled to no-evidence summary judgment as to

whether it breached the contract. Specifically, if the “Minimum Number of Hours”

provision in the contract were given effect, Valley Baptist’s own evidence of what it

paid to Dr. Nesmith would be some evidence of breach (as this was less than what

would be required by the contract).

20 PRAYER

Dr. Nesmith respectfully prays that this Court reverse the trial court’s summary

judgment and remand for a trial as to her breach of contract cause of action. Dr.

Nesmith also prays for her costs and for all other relief to which she may be entitled.

Respectfully submitted,

/s/ Chad M. Ruback Chad M. Ruback State Bar No. 90001244 chad@appeal.pro The Ruback Law Firm 8117 Preston Road Suite 300 Dallas, Texas 75225 (214) 522-4243 (214) 522-2191 fax

CERTIFICATE OF COMPLIANCE

I certify that, according to my word processor’s word-count function, in the sections of this brief covered by TRAP 9.4(i)(1), there are 5,340 words.

/s/ Chad M. Ruback Chad M. Ruback

21 CERTIFICATE OF SERVICE

I certify that, on September 30, 2015, I served a copy of this Appellant’s Brief to the following counsel for Appellees:

Blaine A. Holbrook Nikki K. Elgie Evans, Rowe & Holbrook, P.C. 10101 Reunion Place Suite 900 San Antonio, Texas 78216

22 r

t Ilj f FOR RECORD AT O'CLOCK~fvl

CAUSE NO. 2013-CCL-00785 L.'J 2 4 ''015 § 'EFiEZ t-· DOROTHY S. NESMITH, M.D., P.A. ... fY CLERK PLAINTIFF § By.~~...A'~~--Depwl)' § § AT LAW NO.1 V. § VALLEY BAPTIST MEDICAL CENTER § AND VHS HARLINGEN HOSPITAL § COMPANY, LLC § § CAMERON COUNTY, TEXAS DEFENDANTS

ORDER GRANTING ICAL CENTER AND DEFENDANTS, VALLEY BAPTIST MED Y. LLC'S VHS HARLINGEN HOSPITAL COMPAN FOR SUMMARY JUDGMENT SECOND AMENDED HYBRID MOTION e on to be heard Defendants, Valley On the 21st day of January, 2015, cam d Hospital Company, LLC's Second Amende Baptist Medical Center and VHS Harlingen The Court, having considered the Motion, Hybrid Motion for Summary Judgment. ment pleadings timely filed, the summary judg Plaintiff's Response, Defendants' Reply, y by GRA NTS the Motion for Summar evidence, and argument of counsel, here __ Judgment on each and every cause of action plead by Plaintiff in its _ _

Amended Petition. ED AND DECREED that Plaintiff take IT IS THEREFORE ORDERED, ADJUDG s and that each and every of Plaintiff's claim nothing against Defendants in this lawsuit are hereby dismissed with prejudice. and causes of action against Defendants

e in this litigation prevailing partie under the contract at is sts incurred in sue ssfully defending

. A hearing for attorney's fees i therefore GRANTE

Order on Defendants' Second Amended Hybrid Motion for Summary Judg ment - Page 1 273 APPROVED AS TO FORM ONLY:

FLORES & CASS O EVANS, ROWE & HOLBROOK, P.C. 108 N. Jackson Road, Suite 2 101 01 Reunion Place, Suite 900 Edinburg, Texas 78541 San Antonio, Texas 78216 Phone: {956) 383-5000 Phone: {21 0) 340-6555 Fax: {956) 383-5007 Fax: {210) 340-6664 Email: cassodavid@ gmail.com Email: bholbrook@ evans-rowe.com Email: nelgie@ evans-rowe .com By: ____ ____ ____ ____ _____ DAVID CASS O By: ____ ____ ____ ____ _____ State Bar No. 03980250 BLAINE A. HOLB ROOK State Bar No. 24008446 ROUNTREE & KITHCART NICKI K. ELGIE 222 E. Van Buren, Suite 101 State Bar No. 24069670 Harlingen, Texas 78550 Phone: {956) 440-1234 ATTOR NEYS FOR DEFENDANTS Fax: (956) 440-1235 Email: kithcart@bizrgv.rr.com

By: ____ ____ ____ ____ _____ DAVID KITHCART State Bar No. 11541300

ATTOR NEYS FOR PLAIN TIFF

Copies sent~all

3 /a pftrties of re :\shr4fl. /.· 1 L/\ ) ~ Date Deputy Order on Defendants' Second Amended Hybrid Motion for Summary Judgme nt - Page 2 274 - \ • J ... .

- (J• .;;:.

,;

~:

.MEDICAL DIREC:T-OR AGREE1)1ENT Wl'P!. PI!YSi.CIAN

381 75213BOQ:3 . 'i • .,\ .. ... ~ ~

YAlley J?~P.~i~l M.:.t~i¢~tG.~nt~t js. ~. ~~J.tkP.Q~~~.~ cpllU,liYJ!itY ·h~.alth ~efvice ihstitl.!tion o~~(Uiized. tO.:J1fll~fo.rm htalth, .re~&J:ous~ .cbari.hiole~· .scientifi~, litenur,;,~ml educational pro:grnms !n t.~e &io..'.Gt.ttP.,d~ Y~ll~y. li.b>.t~.fft. :«?...¢..Mi)t·¢ ~qr~.i,lt.lted~ :high qynnty..pat~~ht qare tb.e "J:i.9~pJt.a.1 (9,~fi.P.~d;· :9~tow) '·lP.~1~$~)ti"el~f 4f:(s .·d~eitni!~ed· fhiit. the· n:e~d '*i~t~ for certain metltcd- . ·~d~.~niS.trativ.~ ~ervi~~~~ 1\S·.-~~~H~~~. ~:J {it~J.~~l:~l~,t~ .atta~~e;Q .~~~rfi~O ~Q? i~c.QrpQ.ra~~P .herein. ~y referev.~~. ~9 be prpvrded:.l.1.Y fi,P.J.lY.~W~~J.l.W,.ljJ\ ·~p,~~,l~}lze~ tr.~~nmg- a~1d 9X.P~T.l~~9e for tt~,e ~.rowmn (defined helo:w). As a.resttlt1 this_.A.greement 1s.beiug.. entered .into with the p:~ysician ideutif3ed bereh1.

.T.liis Medical Plr,~cto.r Agree~.~nt .{tho '~f\gt;e~m.enf:) is e~tered into. effe.ctive as o{ 1he !'Hffectiv.~..Datet ~s·.d~~l).¢d· IJl;l .:A ··--eiidiX ..A,,J>y,i1!1a P.~£W~.ep "Ho.§pitae' l\P.~ nphysician," each a~: d~##f.d·:~n~~~':l~j~,~. ~~bs~ft~>~1flf iy,sic~mi are referred lo '·at tin:i¢s·lh this Agreeri1~11t a~· a. ~!fartY,'lnclrv.faJJ.Iil]y; ·~ . ~d.t!Sktbe 'fP.a.thes~'·· . . c;pllectively. ..

../t.. Hospi~l9P·~t~t¢,s·~..~c~~~.C?.@re·. B~Il,~~a1 ho~P.it.~llo.~~~ed· in tbe·lO~flti.oil s~t f~qll on, Appendfrx ...A. and requ·Jres .certaln .a·om4Iisfrati~o services for the i'Prograrn/' as dtdilled. on AiJti?"~aiJc A. fl~~,P.jijtl r~gt!i.r~~ ~~~· :s~o/w~·s . Qf. a PhY.~]c~~ll with .Sll.~daliZ.ep... fl·~ining and ei;p~ti~nc~· t~..provjde rne.dic~..Jt9m~~s~ri'\~iy.e·4ii'e9tj.o~ f~r ~}.~· Pro:gr.~n~. 'Physlchm is. licens~d. t~ pra~tiQ.El .n:~,e<:'Hpfue .i.n ·~be: Sl~f~ .o.f t~.J:(as, pmrs.es..a~S. sp.eciaH~ed ttai.ni.ng· and· e.~perlence. in tb.e ''Speeia1tY;~' ~ 9.~l.iti~;aP..Append1x A;A~~~._i~: q~a@~C) to_ pri;)yid~ s.qcb $ervices; anq ....B. . . Ho.~~j~i ·~ir~s .:tQ ~r~~.~.e-:Phls{gj~n ~s. Mf4ic·al ~ftJ.~l¢~ o.r. ·the fro&(~~;. (ll;d :Ph..Y~lqii\n .d~sp:ss·:to sror.t!_m ·1bat ~ac.1ty to,.prQylde nledJC.Q"agm~m~trnttve scr.v1ces under the te·.;t:i;ir ·]s.. ahd c~riaitiorts· . ""• eement of tWs: ········ .. . ........ •.. .Agr .. · . .

NOW, THEREFORE; in consjd~ratiou ofthe· gremis~. and the·mutual cov~auts and coJ.lditi9h.s co:n1aJne~Jiririin; .i[ospit~l·~Pt<;IJ?.hysician agree ~s..foUow.s:

Engngc~epJ.

Hospital hereby nppofntS· .a:nd ·e~lga~~s P~y~id~n: .~ serve ~s 1\'{e~~cal Director of tl)~ .frogri}.Pl (the. ···Me~ie¥~: Direqt~r') ~nd P.l~ysic.U\n. ·b.ereby acc.ep.ts snc1J. appointment and. ~ttgageP,i.~IJJj .aJf ·suHj ~ct"r6 #i~ teP.l~s·.~a .c.ot1~ition~ Q.fthi~· A.sr~e}n~tit. :.· Title.

Pbysiciatt~s title ~h~lJb.e de.scrib.f!d QU Apf?endix A.

75213800.3

382 .. .. .... .

Duties· .o{Phy$icj~Il. il.l ·Senr.ices, -rh.y!ijpian.ng~:e~fi to _pPt"fQxro tlw S!m'ic.e1i. (it~fined. b~low) pursua11t· to th~ 1PPJlS )p~ ,B()J,l.§.i_~j_q~l$ ·9f ;_t~s . A~~~ijJ~I).t~ ~nd. fo ..~~~·~ I~~~pJt~l .f.~it~~f11l.ly· ~d dilig~ntly, ·a.ccordfug .to tile h.est llf· his/frer· ab'llitk~$, In ful.' l'QJe of Medical Director, Phyaic.lian wlll .h.ll.Y~ ..!Jl~,~lQ,ll~'YiP..~~m~jp,r ar~JJ.$._.Qf :r"aJ?.P~~~~WPo/: @ ,~~~istil)~ J-~,o,p.ital 1n .~eJivf;lrina the ~,~zyj~e~·~tP.)@~~..1Jl;.f4e'.»t9~q~. in. -~tl .~G~~rt.-li1_PQIJP! tn ¢AWPlJQtic~ wi~1 ~pplic~:Di'e ~~~~~- and acer~.ditation-. -l'.e~p~11ement~;, _.{p)._. usststin~..memb:~rs .of the med1ca1 ·s~nff of .Hg_spit~l .(t:he ~'Medl~.~~ ~1~~'>: .\Y.~tb }?.r~'Vil~g~s.· i~ ·tli~ P+p·gi~m :in dey~Jqp~g cljnfMl ].?r.9toeol~ IJ~l~- cnl'~~pi\fus:ln' djso~p,l1n·es:.p·rae.t:foed· in tlt~- P.rb&f~n1_{ (~)- assjstiitS,·a~~pftal 'i n {be.- . aev~1opm~n.i1~ .irtJpl~n.lent~tiP.n -.E4.tTd ·cnu:.yll~;g Qtlt: of p.e~forma.uce ip);proye.memt and ·g:~~lity ~~~M-~ej},\ -~!lo:4lr.QF fh~_f,r.9g~(iJ1:;' W1d .(gJ. m!mnq~H:lg ~~1~· ~l~i~~J ~M.- b~~j~q§$ operations · or'the .Pro~~; :Wla -i:n ca-rrying out such res_pon·sibi~iHes, .Physicia-n shal1 p_e.rfQan·lhe s~.w.i~~ s~ffC?rf11 o(~.jmenc1f~ B -~tta~lled l1~~tQ ~~d-· 4}qprpqrat((d herein QY r~f¢J:~rtqe (~J.l~C.ljy~lt;. th~-f'S,etv.ic~'-'). T!fe S¢TV~Ges are adm.inist~atiy~ in Jj.att,lre and do not·constltute, th~·~ni.v.tice.:of.nre.cliqb)e, · Ili:~ Hours. :Physi.~fa_n.:. {lgr~~s :to ~QY.Qt.e·· LJP'.to the mroefm.Jltn JlU_m}?er:,. of.hours P.-~r- month as ile.#tib~.d:'91fApp~d1i A,tq: 14~·.\lt)t(Q.rh'i~n~~ ~f the. S,erVip_~G;.''WiJlj. th~ e~~ct 9a~~s i}nd times to 'be CQQtdin.aied' :h.y- Pbysleiau lU1d :·Ho~pital in nccoraance wJth ·the lJeeds of ll9.~pital, ~)lyAl~~n _agrc;~ ·-.~~ i?,rgyjp~ s~.rvic.cs .1.n ~c.~s Qf this -.tnaxhJJtun as ~nay be r~q~it~~·:by {fQ'@it~Lf§r JlP -~d~i ~OT!~r9Q)npei'i.!,i,ation. IJ,3. Reports and. :Records. Phxsicilm. =&gre.es ·to. provide liospital with. a written-summary rq)Q.U. pf tM 'S~ic~.s j~~a,ei~fl h~r~-~ijd~, ~~ w.rHten r_epQrt shf:l4 be· sQ.bmitt~d- tO J{()spj.tal 9.~ ~· rfi9.1Jf~lY.l?,Mi~ i:fl.th.~-:~9fW.·- ~c~ :fqfth ii!· Api>'~ndix ~ .to · this Agr~me11t _(the ~~ummacy Report::); l.'he Summary·R:e,port shall CQlltain:tbe inf(mnatlon requested by ijq~Q.i.iaJ.)~l--Qr.~et '!9'.~9.-~P1Y.:!I!~4 a,RP.lic@J,e fed~·n:~ ~nd st~-~ la.ws.J.r~g41a.t1o~s aiJd m.les or substantiation of th(f perf(jifum1·ce of,the .Setv1ces. ·The Summary· Report sluill be pl'.QYlQ~d :_lo li9BPiJal wijlliP.- tl~irty (B.Q). cal_ep~-~r ql,lys Qftlie eno- of ~flch nlQnth. ~b - p.i'i:~~9f.-:F~··~1Jl'.be :Pa!·ct'py Hp~p~~fi._l ~6 .P.hy~,\gj~1~~~fqre:_H~spital_~ec~~v~ the .Silm~1i~ry Rep.or:f =ftom. Physician for- tllat moiltlt; Physician ·will maintaih and retain records ~\IQ,~~a~,ti~tll)g t.M-:?.-~tll.l:e.)~Q_ p.~fr;>rrganc~ ·:Pn1.ie_Ser:vi~~s fo.r ·a period· Qf at 1.east forty- ·eight..(4~1 . m.wi.Qg:tfi¢ m911;t!i .in -w.m~~lh ~ ~ervi_~es . wete p~rform ~d~ II./4· Reporthr~:Relationships. J?~ysician.-. asrees to.report to the Cl1~ef Executive :officer qf!;l;!;!~p.it~l ·'(fh·e· ~~CEO;') :wifli . reSJ.~~t .to. ~11 . ~atter~. Ph)lsi.cian, also shall maintain _·effecpy~ .li~i~ot_l Wi~~ Y.!~ ~e~ipaJ ::Qit~.g_tots ·of·all ·(!linJc~J Q.e_paa1n1e_ irts-in ~osp.jtal_ for cllil:ic~l f!Jld. professional matters .r,elated 'to, as approprfate,, clinica1integration, quality iii1Ri'ov¢m~.Ut;-p~ti~~t c,~, ,rese~c~ anq_te~cp.iug.

TI.S Editcation-Piogrninll: Pllysi.oia1i -~grees to·pa)iicip_ate in the ed1:1cationai and training -pro_gr~rns conduc~. 'by Hospital, and shpll perfonn· $UC~l other teachiog nnd training func~ions witbh:l ~ospi.t.al re~ated to servite·s· _prp,vided in tb~ Prpgram as -the CEO r~asonably regiiests. .P.hysi.cfim shalLmonitor cJeveJopme·nts and improve111ents in the Spe~iaJty, - ~nd wQl wor~ w'i~1t.HO$.P.ltal 4l :_tpe impl~m.en{fl;t_ion of developing-._tecbnologies and methods of-diagnosis aud treatment relating to that specialty.

75213800.3 2 383 .. ..

n.6 _·:.~!!.~- ,'.~~~;a.n~e. ,:Ph~i~~·.a~reeS:ia:~o~pern.te with.ana~¢1~c·i.pate. in.fhe quaiity MS~$.SI.V.!;Ul ~~ltpe.rl.o~"l)·~~~:.tmprpv.~m!'I,lt'~~tl~ltt~.~ P,{HQsJ?Jt.gl~ ~~qutr.r.4:~y ~P.P~.i~~b.le q~l~~$.1 ·.!'Ql~l :~f.l. J:~~~~~.~l1~ ~ ·Qi¢ .~~d'9.~1 .~qre Pl~cJ..?.o..J.~~.ie~ . a·M. ~o·~~-P.~te,1 9r Ho~1t1tl1_ as. ar~ .m' effe~t .:from tin1e t.o·..ttm~~ :by law or rul~s or .r~~laho:ns- ·under Qr .E!.PP.i~aP.J.~; tpJJl~;M~cli9w;~ .Q.~·r.e~w.~-M~di9.P.irl ffe~~ Med)9,a1 M~@uuce) P.tog~ams. by tn~ .s~~~®~~~ hP~ .,ij99f.~~lt~ti.~~·.-·®t.v~y r~port~ p:f t~~ :Joint' Cornmis!don, .aridlor by other Te-g.uiatory.licensm:~. o.r ·a~.cre.dlong :ngetlC).~fl o.f Ho.s.px.tnl. n.7· Ethics .and. Professional.standArds, .Pb}i$1.cian t\gre.flS to CQtilply wit;li th~ ethi,c~l and ;PFofessi'~fiai :#~~!tdfo~:~fi~ ~-e.9~~ti ~~d.icii! A11so¢iation, 11Ie::Joii~1t. Gommissio~,. ibe Centers. for- Medicare. an:q_MecUc.ard. B'ervtce.s (''GMS~!) 'the TfiXJtS .Department of State ti~.~JJb S~p'i~;!l . ·CW,SHS'~)J., ~~e ~~i~ar ~!'1)\¢:§ ·Q..~iJt~ ~1 ·;gg~i.tt.'!l .ati'd ~Qier profeilsionat. an·dJor sp~.etrtin~bcrdies·'identified by·t11e CEO fronr time to time. · R~pr~eiltn tiatts and W.nrtantfcs.,of.]b.ysicl.nn.

!l~S· Lic~p~ur~: Qert.i~-~~~!P.~. :·~n.d Enf~rcemerit._ Action, llbY~igi@. -.r.ep.re!!eUis· .cmd ·!imr~~ 'i_it~t ~1§1!~::~~~ ~9' ~»~r~4~- t~:l!:f'Pf ~N~ ~~~~I:D.~At. ~1i8JI .r.emafr~ {a) duly 1i~.ens¢.Ci.Jmd.1n .8o.od. SiiUlClittg. uni:ler ·the: Iaw.s· o.f U\er Sb.lte· of.-Tex~s :to enga·ge ·in tile tmr¥-~ttim~d p~~Pli'q.e qf:4:i~4imP,f;, (P,)--~;¢glsJ~r~d ·:~9 ~~Jnii?l~ter ~rip pr~scrH~e ci>l'lti:Qll~d intb$tll~)ces1 -an~· (~). c~.tiiilea. 'by-.Qle 11Bb-~rc1··· as. defined ou Aruteb.dix A. Phy$lcian z:epr~ents· ·!Ulcf w~a.nt!l· fl)at JP.wJ1er lkense to· ;pr!'l~ti~e: m.edidne and · regis~ratjpn t:o l>~.sct~be ~d ;a,d~ili.i.~~r pj~q~-9.i\t~o1l's -~prl P,Qntrtl~~~d s~l)~tance~ !n ~h.e ~~~te qf T}»c.as. qr ill ~y other- jurisdiction' has never b.een demed~ suspen.ded) revoked~. terminated, ·volll.ptari.l;y r~llll9~ishe~:.un~~ ~eat of Q.r. ~\lbjeqt t? cHs.Qjplinan:- .actiq.n, .probated, or ·r~ttJ.ct~tfin a~l)"'W~y; :Pliy$i9i}i~.fu~the(repte~!eQ.ts '~ll~ ~arri)flts·that. h~/~h:e,has 11ot·been ·subj¢ct to·.discjp1inary .or. corrective action ~Y aiJY hospital or licensing ~gency. Upon r~qu~t;- J>.t\ys!Qhm. ·~~!J p,rq~d~ ·to lJoppit~l thira~P'!-rtY clocl,lQlfl!J.tnt)o~ to evid~nc~ the ac:c'Ql'll~Y· Qf tb'e .f~r¢gQi.I\g .repr.esentatl'ims apd waian~~. and,. upon req1;1~t; sh~ll a.utbori~e (tn vmti.ng '•i t regueste4). H.ospit~J to. ~bt~in ver.ificnti

75213800.~

384 ~ .. .:,··

n::u _p~~~~~i~~~e;;:~m~:, !:-".!.:and ~Accre.dita:t10n~ · .ht~?~~~!A·s. ·;p~y.,~l~bm -r~pr~.sept3 and .W:{l~_,, · ···:ants .. :, .. ..·.tt:l'l'tf lt'~~t · ·· ''::mft.i~ trs· .., . . ~_,._: nf'n·.,l.~ .... rYJ~~ ,!' -:-·~.-w\.... --~-,,..~-·~·''-":··· J. ra -~: · · "!Y~.. '1l.·.9.QP,~l.tfU..~ f ;?~.,)~{p~IJt . • .... . . •• · .. . A:-· .. ·~ Jo I,. ·

satl~f¥.-'-~lfi·'S~~(d~r~s: 'Md reqn.tre1n:~nts tt~l~J:tc~61e. to· ·n mc.dicltl·din~_c.tot of the· Progr~tn ~t.:~n~~~4 ~-~--~~~P.J!-~t-~'T;l~!;.f.r?.~-nt,~in·t~tJ~inS.·«!~_;:P;.o$J~f. . Jl} w~c;~~d-~t~Jg~-~~jh ·th~.-~Jp.ndanls ...... ·?f · · ·_ ..,.... ,~ ~(>itfw!~.~~~} .tli~ .·{\.~ar~~j_t!i'i!Qp: -~;;~t.~; . ,for 9f~~uat~ .M·~~U.i,cal Education (H_ .... . . . }j.,. i~;Ql?;P.lJ.o4!b1~i ·thcft'D~.NS; :ana the CMS, un.d oth~r app.hc!ll.!l{) .gov~rning ~ 6~~~:'ftr~)lt{:ft~~- _\fy.m:~$pititl;

' . . :U;~~ p~~ ·.!!.n~9.e· ::y.~~P J~~s...\~~~ ~ ~o~~c,iir .... I?.P.-Y.~i~}~n l!~r~es to ~QPll?.~Y _Wit4 t~e :~,ppllP.~ ·Je;;prQ.V.lS.JQJl~:·o! m~ Eyla.w~~-'1'\lle~r an.d.re,&ula1lQilS'Of' the. Medlcal Staff,: aud the f'i ·l""dL '-'(l,.''f't\.'eA··~e· ."f.'r::r'&s"'fJ.·s··"'·;- j". effh~ffj .• tj· eto.ti .. "Db" ''j'·. l· 11 ttJMQJ~..., ® .. ,p_l,l~...!:tru:.. s ,9. fi+< )J?..l~-~ -~· -~f.--~- ...... ~-· t'Qlll__ m.. . . .mY• + . YID.J.H,l~A~-~1" . ~~.ow t.e.$,P.e.cftQ· ~~-W~t~· ca:9~~~~tiy.ety.~vtth ·tlle-_p·Qrs9imel offJo.~pftal; ·anCI hi. p1.1rtictilat, those peraons·woi'RiV,.g!In or. an b.~l1alf offli~:'Pr,ogram. lJ.. l~ Fraud~and..AbLlse Related Sanctions.. ;Pbysi:cia~:n:epre~epts arid warrants that b~/she hijS not 'B~~;}~~Ct:P.uffiig·:ui~'teP!f~Nliis ~f:.A:.gre~m~•1t shali not be: (a) ~~uctimi~d within tb~ n1e~ing ·~f U>~- <$~iStilrs.~gtlrl'~ 'Act. $_egtion tt~~A o.~ any· arpeJl£bnents tliereof; (b) copvjc_tM· cf(vi91~~m~. t~~ ..f9.P~.f-.~l J~o/ ~·own ~s t~e ·"~~~k ~w/' fc:get4l f.ah;~ .~laims- a9'ts; :fea~ral·MecUca'r~: a1)£fMeclicnid' ~riti~kickbae1c ~ta~ute, EMTALA; redetal civil m_9rtetary p.eJipJ.{i~. ~t~fu~c;, ~4>,~g_,gjyal~ri('t~X!1.$'-la:'N~j QJ.'(g)...oeban;~d~ CX:Cl\l~~4· Q.r SlJSpend~d :ft:ODJ. .. .. ... .~tf ... P...aij6.ff11t ''"atti'cl:' P ,. , ..., ot:Stafu'~health ..,Y·: fei-fg.tal . .. . . . . .. ·c~ke· ... . P . S.rain~ . . ro. . tL14· biscios1\te·.. :.Pltysicia,n agf~f?s:to notify Hpspita.l wHhli1 three ($)·days in· the ~:vent qiJ:YX!!pr~:S:~!)tij\i®..p):.\Y'J).Tl1niy·;~y f.hy~ipian.~ctJ'OJith·-in :thi.s A~e!3)11e:nJ sha'lt:no longer-b~ tnl~~ C'Qfre·y~ or:.C@.lp1¢t~.

JI.:t.s E~pioY,ee$. Pl~ysician

~i1a~$iu~~:~!r~!~t.:~t!!;~jWe~~~t;~!~r~-~~;~ii~1~~~~~~;i~!-~:::!~lh: -:~~ ~.!~~Q.Jwwg.: 9,;r:~iJY :~.t!.c.h -~Q!P.J.9Y(::.~. §.p~Q bC. ~ J>r~Acli -.~ftl~i.~- re$.tdc~V.e, co_vr::m~nt .and sllall ·~rttij):~ ~9.~P.~t~ tpd,pJ~~~c~jJ~ -~~!ie~ ~,itllO_ut n,e9~~i!Y Q!' ~~i.1d':· _y1 ~-~d#i9n thysipi_~ll -~~ .any'of l*/P.¥f #lJi;n~-~1:1~~ f~i!Y=.¢~b.~r~ ;11as ~i~h Ho.sp:H~T on~ny -o~ tb~·-otlie~ _c;lltilies. af.filnded· with Vallfly

7521.380~ ..3 .4 385 . .: ·.. ·· ... . ,..,, .

ln~ur.illil lfui~~J;~~~ 9b]~g~fftmfE~P.'~tl-$~s. FJf.y.Sician ma;r-n~t illcurany.._fi.~lrulcial ob.lj~ation ·on behi.\lf af.Hos_pit.al without the·_prior ?.~ ~~~-.- ~'!!:.:·.- ·-:~'_r-~.,.~~ "!!::·:" ,__, t~~~~-··:-- "·.::·::· P~..- ·':· -~P ....... _~ ~:n. . tT:.-':'· ~~ :--~~ur~~-er itt a . r : . l ~+'1-\e IJIT;1'Q. JU1:'"''jo1· . -·-'-iU. be:·•e '··dngible:fl · · d11 e .... ense '.j cu '· eA 'b h'..;,n;, '!0: .r;;~ .~:~p.._.9.Y.Jl. l

.m PF'.9'Y.l~WP.· .$etvW~~ ·~t~tJ~li 1!¥!1 l\~~~l.P,:~~~, 4tll~ss S!Jeh ~xpens.es are Jlc·counted fur m ·the · P.udget·offfi~.Prq~~am .. fl!.t'd/oJ;~.ammrvetl-J:tt·;a.llva.M.e.:.l~y:th~ . .. . o.:ao. .. ~ ,F.rivate.Me'd~caJ:Jl.r.n#1~w~

pri~at;~~~ :f~& ~~~~~~~:lI*~~~4f, !;r~~tur;~rt"/(m~~~~~:: ~M1es.- !ll>;lV.1~

..;f.kY:~(pjJ!1:F:C~,l?f~.tilit~~~nt)Y.lW::~lfiJQ:J;lo~~\1fi~ ti~p,fPlJ~~igh~JJ ba~: ~Q:·:!in~oial· Jela.ii m~s.llil:' .c:wJ+~~-~t· :Qt.~t. or w.t!tt~b)tW~~~~~:~.P.i t~,, -~~~l~ · --~».~H~tge.~m~·--~)'s~¢~n.· q·r .a.PY ·Affili~.te.~ pther thiiii tliis A$.fefmfent or- as st~~ fortlL on Ap~;ert~x D .a:ttnched..hereto and .iucoryotated. herein by re.fereJw~ ·

InsltrJtiJ,ee~'l..QJJ. -~i,l.ij,~~njp,C@,f.i!lJ(~ !l;,l6 P.tofessiotlal I::.~ ability Insurmice;- J.lrth'c! ~Y.~nt ·P.hysip,j~W i.s eng~g-~ in 1.), p~hi;tt$ 'ined:l'c~Fpracfibe~ 'i?Jixs1i:lan, .aH1'i'~~- OW.Il cos.t and.'~pcnse•.:sha1fru.aintiiin. -in full :force. :and Ct v.lL ......,k !tffi..,~,.- ~- dh_., 'tli~-:~·e ... Kw .. ~~- f:, •.ttP Tt:~1il5.cA ,... -Q. "ee·i ... , .-.. g;l, t:-f;.,ofessfbriar1iah'lit 'f -n .. rn.~, ' s.. 'IJ..rfl·nc::e ... ,..., ........,., ... .-. ..f-J.. ,.Y w. . · .- d.. ,,B. y_· .....~!i>M an::~insu~·!'r ~c~~~~~~l~'fcFHo~!~~- :~o.v~~i~~~~~tsi,o.f~.~~~f~st' a~l ~}~~ms .~f~iti~ q~t of the ~p.erf~tl'WPc.e: Q!-~!Y!~~~- ,g~p~,rJfll.$.~~~- tl)e::wa~mce-. ~f ~e.aw~~~ (~·~a.lp~.ao.tt~,~, ~l'!~ur~.ce~l)~ M. ;:i ··r··.. ··•tlOe_. T;.;g·~::iific'e ·;ran :bC- 'ii;:am:OJilllS 'Qif' CQ,Ve_ra· 0 ·no leS'S: ma· ·"·t]J'"af-t'"''.. •u'· fr'e~ iior ·n;ZS.1>~~~rp: ::i\.;M~;:·tr.Jf~irsr~t}~---iil:~;;:~a~P.iia~tic~---~~u:r~~~ b~-ei~~-·is ~~~~~i~m~~ J~'lj.Q.~·'b~~Js .~4; ~lJY~~Jljl~....~~~~~~- 'ti?. _,t!iii:h~fp,1.p t~i§. p.r.~:f~~~jQJ.t~f .U~hflity · qov.~tage or ~b.@.g:~s· ip~pr~nce·:9aJ.:1i~~i.P..~Y.s.i~~~ .·~6~fl_ QQt~ih ~m-~n ·ipsu;n~1 ce cfl:qie:·r ·a·cc:ei?Jable ~o Hci-~plt{l1 a.n ·lllllinii t~ci r~,e~.rtin~ enaorsemcn~ or ~xt.ended co.ve.tage poii cy ("tan!•) in·_ the ~mc:i.!ih:t qf th¢ ·,p#Qr PP.U cy 6ov~i1.M, .a:J~ '~~~- ~{ _qcpJ.Jrr6.~~c~ ~u.ting .t.I~e T eJ-r:t). 0 f flus Agre·~ment .as_ to wfif6h. c1aims-ma;y.-a(Ili ·be.as~ei'te~·. On ot';b~fot~ the:Efi~ctiy~::P~tc,_ -~~d the1~aft¢r ~p,on~ r.equest, :Pby~fcJau ~hall pr~mptly ·deliver to "Hospital certincates of iP.$\!f.~P~*: f)vi4~n(!.lrtg: ~t;ph ·. ~Q~~t~~~~ ·· · - ·· it1.7 .bi'rectors- and. om cets inslltant:e; Hpspl_.talAvill ·provi4~ Dlr~ctot' ~ an.d Offic;;;r·s (l]l.d ;g_~~tir 'lh\bjii{fJ~~ui?.nc~ ·c(lvera·g~· for :"PJtysician iQr ·th~· Services.· provided·· ~Y P.Jty#~!~·:P.~r~~MJt-=(6 .t~J_§ A.~~~JJi'~:nt_.i,~ .~·~r~h. ~p;i:P~~.t.s ~~:- ti!.ay _be deem~a._ ~~s~ary_·or detitabl~·by.Ho~pitat Said."Uisutaue.e Sl1t1ll 11ot cover .iUlJ':pto:fessioillil services provided Q.y :?ltY~~c.iW:i. ·· II.-18 _IildemniJiciition. f.[o"Sp"ita) ·sha.H ind~~!lllify aJJd hqld Jlliysician haftnJ~ss from _any JQ~s l'by§~~iu~_.njiglit iu#.er· or an,y )iabitity Pjtysician might hav.e to ~Y person arjsing as a; t~$.u1r of the $.~f.Vi~~~ pr9vid~~- by.:P.hY.§.t~J~j p-~rs\Hlil( t9. !J* A.greement Jlmt 4.o. i~qt arise .as.· .a.:r~s.ult of-an ·!fct :Qr omission- .or:P~y.sitian;_· provided, ll.owever, ·"nothing .herem

752JJ8DD.3 5 :. 386 ' ' ...

slla1l be. c.onstru~d as :provi41ng .indelmti:I:icatioll .far auy ma~>ractice action or other ·p~Q.c~~-di.Pl~~Js#lg .~i.it.g);f; .qf .m· ,WlY W..~Y c.®.~~,r.l~d with, ·.~h~ ·vrQ.f~~~iotl~l. s~rvice~ by -~11Y,sl~j~l. :t1.o~J?iJA1··Wi·H 'Pro~t~~'~J~~~~i.a)f'I;Vfth 1~&AJ t~pr~~~nta!i:gn:~s n.e~:eu~nt:r.~ e~~ept to ·the exteiJt :fhat to do . so -w..o.u1d be QOlltrary to the ·Texas ltul~s of Rr:ofessJonal ~~f:;$-}~~:~r}fti@l[~· ~~l~1\b~ ~~;~i~l!!qi!~~~e:e~·~J~!~~m~~e~~1:~~~~i:: . prmd.o.~o b@ft.mmi~r.. · · · ·· ·

Own~l.'~ltip Qf/-Ac~·es.s·tp no.o~s a~~J..R~c.l,lrd~.

)J:l9 -~~V~t:'fl!ll~~t -kce~~s .t~ B:o.ciks ·and ·~ec~r~. Pllys.ic:iij.n ~$re~s· tq cp~:npiy witb ~11 ap.p1i"C:lable fu.del!cii~and. Texas-.laws $~Vtmling:·the,maintenance of documentation to_verizy 'tb.e C.~$~ ofS~rVi.!il¥~Lt~MRJ:~d lin~~J.'tbjs: Ag+~·e.me11t Vri.~il the ~jmtion qf:f6ur (4) y~ars a-h~;r- tire. !umi~hi~j~ · of Seffle¢s .P.'U~$lJ?1~t to '!h~~ .Agrt;:,eJP.e!Jt, -PbY~ioian shriP, make !lYfliJ~bl.~ ·upon-wr.itt~IJ-Jeq-ue~t·.ofthe,SePl'(:WY Qfthe D.:epatill,ent of Health. uo:d Ruman. .S~w!~~s OJl!f.~ .~gn~P.tn~!l~~ G~Mifll.9.fH~~ U,:P.it~.cJ Stat~, or .~Iiy qf tP.~.ir duly P4.Qlo.rized ·represerttatiYes; ·this .A-gr~~men~ mid bo6k~, doe~tmentsl· and records .dfPhysician that .are geq~.s~~ry·t~ cQ~:t1~~1laf~i~·atid··¢x~~lt o.f suph cp!!t!l.

}1.20 · Notice to H6Sjjitit1, If':Pby~~~~~n· r~ceiveS' ~ request or dernru1d to di.sclo~.e i}lly bc>.oks;_ -doca1ments or recordS:rel~vant to -this Agi'eement for the plli}lose of a.n a.u.ciit or iuy~~ilg~Jjon-l?y ~y pAr~y, l?oy.sici~l aarees. to no.tify Uo.spHa1 h1 writing of fhe nature aM sciqp,e.· ·orsu:cll req~~-~t l:>f Q.elll.an~ W!t'bin t)V<;i (2)'busi~ess d_ays a~er receipt of..s~~ .reques't.or demand·. Ph?'sician shall make- avaihioi.e to "!Iesp~tal,; upon-writteiHequest of l;lqspitnJ, ~n SU9h ~:0~~. QQ.9W.11e:.Qts.qz:~reP,ord~., P:Pysicil.»l wm CQpper~te Witli.Hos_pital in ~y acti'on ~ro~&ht by Ol' Qil b¢l~glf'9.f.tlosp_ita\ in qgpt~~itfo~· tq sut.:h request _or P.ema.l?d.

ll.2:1 Ownership ofReeords. Ail .Pro~'am records. are· and shall remain the _pJ·operty· of .l'lo.$pJt!ll: · . :Firi;u~~i.al:A,rr~_~g~nic~ts.

h.22 D.i:rector Re~: llf:ex~baAgtifol" ~h~ p.erfotn1a~~~ ·by Physicim1 ofthe Se.rvi ces1 an.d ~pn.Qitio.n!ild. up.on P_bysi:cj!lll!.s.,prqper cpmp)~tion· and timely submission of the Summary R;.~port.lio@i.~l agr~~~-.tf?. P~~Jo)~lJy~ic~~ii. 9_omp~p~al.io1:1 ~ -~~~ fqrth jn _Appendix E (~he '~irector Fee!!), Hospit~l and Phys.ician acknowledge ruid agre·e that· the compensation prq,_v.i_d$"d bym?spit~J.i9...BJi_y~iqia_n '(p,r tpe S,~~c;_e,s performeg;by Pl)ysician.is intende~. to be fait market vaUl6 -f:9r. ·s·ucJi -~:ervice~; ~4'¢at :gQile ·oflh!' t;

Term nnd TcrmhHtdon.

U.23 Teni1 of Aw:eement. Th.~ prigina!. l~r.m Qft}li~AgFee.ment sb.all b~ for a period of one. (1) year; coinmenbi.tlg. on tl1e .~ffective Date (tlie '~Ori gi i1a1· Terin,.), u~ less t~nrtinated 7521380().3 6 387 ~~·H~r :~1 ~~gc.qrclijilg~ wHb .t.b.~ J~tQ,yi_s.i¢'1~ .gftJ;~_is .Ast~eltl~J.H. 'f.!~~~ A~~;~_e.!.:nen.t ~~~au·v~e :~~~wow_ij_t.!9~!Jj ~~~~~J~~~ -:for- ~\l(l_oe:fsive oim -(1)- yca1· tc1111s. :c~ndb,. t~ •iftcnewal ·T·ett::\1 ;;) \.Jll.cfer the. snn~.t; Je;'.llJS. nu:d 1l!Jlldi11o.ns_ ~mle~~ ·th~ fthis:,f-\g~~-~m~WJ,

It25.- ,d£!tion9r-termtiuitieni !1~.1~·-Agt~~mgutm~y :b.~-1~r~l}illtMd ·~;y ejt!w.r .of H.os1~lt~J q}: P.lJY~i:PJ~ti,:W~d~§Ht ~}I~ i~~qP,lt§Jll?~l_itf .st~f!n~.~ij:ljy #tlJ.~e tljt;rel~re. br, g~y{t~g ~be tith-er ~at~):- at .least~onc'.hlltiCired'.dz~tt~r'(LB:O) tlay.s~ prior:wdtlen·nO.·tice·.

'l..t26 ·terru1nnthm Jbt .Breach... .Either- .f.!b..~J~it~i :qr 'P)J.yaiC?,i_a]l ,lllfJY l~11~1jpar.~ thi.s t\g(~ili~!iU)iWf~j~(i,1Y. f~t]f:~~9.!i ;eyr ~-~~-'Jt!~t~~·~n~: te~·ill': p~~ :cQn-~NPu Phhi~ _Agt.~~tile nt. IJ.S'tht:::t:itl~ew.P:ar~y (~:Sw~a~hrn:g:;P."n.rtV;'·')•:ifthe breacli is not corrected. to the·satisfactiOlJ of. th~ :o.odc!ng: :Pm-i¥ ~Jtlilu Jeji./~;Q). .4PY~ .oft~r ydi@Jt .-.t1o~·Q~, ·w~reo~ W:r¢c~i:Vect ·by .t)le .~i~~ch~~gP~r!y:, :fh¢· p'Q.Ji_'¢fof' Gt"~a~l ~n1der ihi_s _seeUort shE\11 ~peclfy··\vHh reasonable .pattimtlarity. the.· nature· HJid"·:extent :Qf the lllflt~Ihll b~~~Cll f~n:· Wlii cb: PQJ.l:lp.] ~ipt];.as. b.eep., JP,~ge, . JI;27 . Ter.niiriati'O'h by Hosl)ifn\,.. Hti.s.Pit~_( (\if!;y t~t,lhinn1e this Agreemei,ti effe-bth'e· ·iJti~eai·atel~·~pon·--ilati·ceJ((l?,urslt:ianrfilr·.ihe:-~v.e.IJ'f pfi· · · !C27..l ~r.w '1.eo.l1iJWti.o,n,, sp~p..~~-~ion.. wii119mwal \1~-~e_r t_lne_a,f pf ~i'S.~ip~i!l.~.t¥." -~S@l!l. P.rqMtH?.l~i: l.i)fihali9J! 9( ~:~gtl¢U'9it {pther than_ a ·wllo1iy -voluntary· actfmi..by P.hysicfanJ 'in .Physi'Chnfs·medlc;al··st~iff 1nemb~r~llip. or t>.dvi l~ge~:. ~t. Ho.~pjt_al o_r. ~my .o.tlt~r Ji.o.~pJt~l. od:J.~~Jfh::~!lr~.J~9.Ui.1~;. . · · '·

U::27;~, . -~h~ '·~rt\,ijl~t_rO.i'~ .~.L~p~t~~·cm (.'Nh¢t~).et ot u:Ot ·stayt;d), _ptobcit10"n:~ 1ii1li1~tiC>.U.frcV.6caWm or lapse:ofP.h~siciru.1:1·s.,(~).licens!3::.to. prnotice m.cdidt)~. i~ th~ :Stat~­ of T~?Cas:, (b) ,!ltat~ o.:r J~_de.r9l. nulh9r-~z.;tJi

JI:27A - ch{)rg_irtg qr: i.ntlictmeilt pfP.hysi~Jan· ot~u~t crinie.ilf,io}ving fraud~ moral fitrpitude or il:i1tn6rai. conduct;

I{,2,7,.S the ·d.e.ath ofPJ_tY.sician; .pr

752(3800:3 1 388 .. .,.

It27,6 ·~1;1e di~l(W,liW, of' ~~~w~chu1. s~•oh t11at1 'iVhh or without .. · ... d ·.: · J~l · ·1 ·-·· J~QP.QP:l~R9...."~9JlJ,.,JY~.~ft» 9~1!:1. ]).!P.P:e··a <·,.~-'Or-"}_,_, ··--.~· u· · · ··tr s· · ·.. · 1\~y-p.~ .PXI11·.-- ~~- .. ~rY~9~~;

.u~~~ . ·~H}t-~~~ :·R.:~J~1l\~ffil2:--~f~jl~4~~\1f;L{Y~~P..~r~p~1L~~.1Y;.I?_~e_ ;pr~~es_s, . .M~~i"~~ f?.t~ff ·xuem~ers )· :f~ -~ ..~.c"Q~.~.. f-O.P. 9 :· Jili ~~.erf.~t~n~e-: of:~tuY.iti.¢g· ~l1ldr:r tlits A&reem.e.nt. "'f>P;'JYa·· 'm'. t~i's A_S ve.r1.;;;e~..l~- .t-·re-e·~· .c;-lf,.;·; ...,,.....~n,;.~.qy. ~~~ · ~i"'1 1'. fh ·e tt. da· .· i1"1 Ji·· · :·f-· ·· · · · _)iLf#:. ~_p. ,.,_e ~U';I~. ,~~-- .•}~ p._...1 .m:w -~- :·~~r~m~~ o.r .b.. _..~,.._.... ~-.'.1-t' t;r-·:t~~••W'i"Jl.'h·!l'l-:lY ~6 tM te¢1l~1~ti9ii ofJldJ;_Agr¢~~'1ent il'z9·. P..

Legal Conum~mce.·

Jitbe~::~.J~:~r C11;m.ge i.Q_;~py.J~wi-.regql~~ion o_r;~Je) ~t~tc Q.r fe_4er.al, W.]1ipl1 E!dY~rs!flY. ~ffect~ ~i$, ~t1~.~J9.¢~lt ,s;?{ ·.t~r)PlfYi,Ji~~: ,_(lf_·;~tt~1P.r.-P.arty ··qr.P,~r .tlli~ Am~-~,i1Wtit, .or a~y ~b~ng~ :ill t!le .JUd1cral or -adinu'i1stratm: tntewretatto.n of ..any such law) regulation or rule or tf any o.f the .provis!o1i~_.qffqi$.f..gr,~fij~l~lfli~·fq®¢{o. b.~-m vlol~Jlo'lf-Oftlie law.s eX.isting at th~ time of S!JCh Qet~rtp.ij~a~i.Pni ~sf ~Hh~- ~~J'!Y· -r~~~gi;(~\i:tY Q.~·l~,~Y~~-~1u ~9'a~ f~Jh th_~~ t~e chang¥, iut~rpg:t_ati~n or detei.niinatio~ wi.IL.hav~~a s:ubslinlti.~ adver~e effe.ct on that Party's business ·operations· or its rigl1t~ ·q~:; . ob)}ga!i99.~J-!ti~~f- tl_t_i_s t}gr~~P\~~t.t; tli((J:l. ~b-~ P:~rty n1ay, up{?~ wijtten notice, ;rfE94h:~ th~ otl1er Party to enter 1nto good faith n¢_gotiations ·to reneg_otia_te the temis Of this Agreement-a~1q· to tnke any, a~ti_Q.n P.-~.Q~-~~!1&. to -:in~n.tah~ ~g.ro:t~li.~mc~ wHh _s_uqb. law~, :nlles ~r :t:_egu,lations. If ·tbvit;l;ed ~y ~hysi~Jan ll_n~pr ~ltiS· A8i:¢~n.i~n~, J?hy~~ciart may be acq~idng an_d.ma~i~g us~. of c.ertarn: COIJ.fi~eD.tiaLI.nrommtiou "Qf Ho~p]Jal whicil includes, puj i~ Ii~t l_iuiit~p ..f.o, p'1_~u~ge¢enf ~eport.~. ;Qn~n_cigl_..s~tc(i:lC~-!lts; inler.na1 memora.n.da, reports, _patient fu!onnatlo.n~ and ofher..ma-t.etials or records of a -proprietary p.ature ("Confidentiall?formation")! 'l:lter:efore, in Ql'der to protect the Confidential InfolJll~tim~, ·• t·. ,.. -~·, 152lJ8!J0.3 8 389 .. ..... ... .. . .....·.·· ::... . ~ .

:~R~~!.j;~- -~h~. ~~t._u9r .;~~~-i.' ~~~~~~~~.~~!: ~~m~~t~~o~_ l}.~c~~t-. ~~.:~onn~~ti~~ w.ith _the ·:R-~~f~l}WJ~~~':o.f. ::e~t~t~l~tt~ ~qf.i~f.. P.llt§.\l~U~. to tb1~ ...Aaf~e;.n~n~; .or g{v,ltlg~ tQe 'C6itiiUt:~ti~llli.furnlatfli!ti to- :aP.y~tllltd;~a~•.:.~Jil~ss·:t:tospiraJ . ~o;ns~J1ts in writiug to ·s.uob !:... :ijs,~..,ar ·:U~i:VQ~.~~n~~- .PJ?·, P,.i~§J'q.~~~e. ~.s r~gmt~l~. ~~ ·1~~, :~liY!?iQJn~ :shall· ~~riti ~Jtb the t· 'a···t.;rfcf'kra·.·"' fl'brat -attd.-. s~'a-¥....-.·1 ·· · · :<~~'d :tem~faflf'ns··.· ..e··~·· · ···. t.h. -~,:;>-i· . .·····1· ;, ···f · -- ~~·M'.,.~"'"'·~A~···:r·:~·-·.--_:-:··,·:":~:~'::-~t" ~FJ.W~ ~f · ·..!.'lrr :..~·w}t SP.::V., Q:~~P.:S . ~ 9!l~~J.~~po~ l~.r· ~ a. j!, . .. .. n.. ~t ' I' paflGpt·m~thcntr.ec.or.4~ an~:~ .~e.r ro.YlO.W Jri(QrmatlO.Il·· In tl1e.·-evQnt;11)y:;~a1alhr~oe.wes .a ;.. · . -f.~~~~$1 ~f'-:·~~m~~-~r -~~~ ~i~ .1 -:·,a:..~.~rtt f,qf ·~P,.e :~j~~lo.s~e. :~!. C9.~~-~,e)ltj.~l .p)f.9.m1~1i.'~, Pbys.~c~an· s~1~ll_.~r~1~~t.1~·'. (>Yl.t .~l::two..(~~ pllstn'~.s~ a(t)'~· atc"er rec~1pt of $tJcb l'e(J.uest. or d.eh~~~d):. P!~V.~~e. w~ttea~.:~~rJtic.e· -~~:·~~i~n~. ~f ~_uc~l.' re.q~~.st or d~~u~, i~~tu?i~g a co~y qf UU:Y W.rJ.tt~n., ~-~~. X;QJ ~.9-h i~~H~Jt Qr 'tJ~nltll1,d. 'Qpon t.tmlll.WlllQO ·g:f ~lus ,~greernen;, llhxs~ciitii ·s J1l·'not· t~te atr tet~in}. wHllout y:rlot written :autho~ation fr{)m -~~~~:till,. -~~:_.; ·· _ . :~;?.~-~1 p9~~·: . ~-~t~~l).~..c.~~J.9.~ :.~ta ?-f ~~O~t!tiQn,~ ..P~~i,~J)t (]_~t, ,F~p..e~;. J~~-: ~- ~ .,~httl~~--.~r ·Q~Mr·-49~~.m~pf~ nr cc;>p.1_ es thereof ·qr o_t1,1~ G911P.d~n#·~J Jiifonuari~n.::ot. ~y ~~na 'B:~l~m~il1$.::ttj l:1o.sjlital 'P.erta:in~&. ·to patje.nts, b.usim~s$.;. salt$~ . :~r~r!~~:::;:i· . ~:wrrfrt¥~'~;~P.~;~Q~~~:~f~~,~--;:;::;~l}t·P.;i:~~;,~:ct;r ~?:;.rs !·: oov~nant;-:l:b:e P¢1~~ ~~e~ 11JnHJ;ljp1\ctive.or oth~r eqtiitali)e re!icf $ha11 be avaihible 'to ~.bf9ic:~ flllf'q.9y¢Jfqnt, s.UPll relj~{'\Q 'Qe wJtnqut tM ;neces~.itY <;>r'pQ~ting· a'bo~1d, cash or otherwise. n.-3.1 :~nwi~ance:·':'f.itli,~AA.,. Rh_ysician shall comp1r·w.ifh .all requirements of the :a~.ll:1!4 ·JP.~uttiti¢¢: :-p·~~Al?ilj~y- .~nti· ~·e9o~m.t~l:1iliJy Ac·t of ·199.6 C'HIPAA'') an'd its ro~Jation~,.as:artrencled,from tiiite·to·tlm~i as-set-forth on Appendix- 6, attached hereto.

R~latiouddp. of the.F.nr.tles.

·1;n. ~th.e . P..~f.Q.I111~!19.~· oj tb;~ .SS:ffi!;~~ lJP.g!;r: fhl.s ,A.gr~e~~l~t. as w~IJ ~ .il.l· ~ p,riv;;t~ tt ·p_r!lcb,ce. .ofm~i9iue: ~Y.:?~yll_f¢)~lh j~ p~~~~!t Jj'J.iq~r§~p~d an9·agr,~~ ·th_a.r_~11y~i.9.i~-.n ·~s,;;·#.fld .a~ all times $ha:1l.be, an·fudepen:iient ¢onl;racfor::and..11ot·an agent-or ein'ylayee· ofl.Hospitnt Hospffal sl1a;ll n¢~tMr :h~~e l;lflf·9~Pfoi~¢. MfcQ.4h,;.oJ:QK·- 4~trir,;ti on Q.y~ ~y i)iedj~!.ll jll4went ·of Phy~icia_n~ nor over ii1e titethod~· or ~nat!liet 'hy which _Pl1ysfci'oil ~og~ge~ -i.n the practice of nieaieine or c~rri~s o·9f fh~:.:S~liYjC.~$...:Wo#ii:Qg,h,~r~jn: is i,nte.p.d~ or shalt.be! .~onstrued as givjng that ·d·egree of ~~nti-ql 9f'4ire~J~l1.ffil:.fue P.~ ~r:J-tii~J?jJ~~-~~~ ct~-~Jes}J;l· ~Q~P.1Qyer-:ei))J?19Y~~' j9N~ -v.e1;1hire, '?r agenGy r.elt~tionsllJp..bet:w.eei.'l'·H~.~pital:.!UiO P.hy~ic~·an witlrt~~pe¢t to the ,~ei'Vlc~s. 11o$pital wm n_Qt wi4jJJpl4 ·tr:Q.~ !IP.Y. ·ahW~IJ.lS pai~. t9 ~hysiciim fQ1' .S~rv.i~es pro_vidv.d pur&tlant ·to fhis A8l:el'ln;~nt· any .s4ftl for ·1ncdJ)J~- iAx,, ~,n~~p.pl~~~t )~.u.r(i!!c*; sQ.ci~l se~t1i:ity or ~.nY Qther withhdfding ·pursua~t lo any:·'linv 9r -requirement' of any· govenll]1enta1 body nQt applic'a~ie io fu.d.~pe1i~i:m:l .CPA.:~tvtof·r~~tioJ!~MPS. ;?.~ysic.i~Jt. sht\11 · s~ffu~iit :r:epo.i.ts, and· 1·eturos,' make anx rteces·~ncy paY-!11~1~si. aM .m~infain ~Y' r~cott;ls reg~tire

..- 7~2)3800.3

390 .. ~ ~ I~ ~

No.ticcs..

Nqfip~~ or ·ggmmuniqu~ip.uQ. Jp b~:$.iV.eJl. lll).Q~r tlii~ Asre.eme.~1t 9h~ll be provfdod. !.o the ~pprqprj~~ P.~r!Y. ·i~ Wri~fft.;g, ~ith:e:r -~y .J-?~rJon)il d~_live~y~ ·c~lJ.!l~rcifl~ c;l~Jjv~r.Y. s.~rv~ce, .qi' 1·e~lstered. or .c.erttfi~d. ~~lh·:U~~t~r~~ :p.t~p.a~q1 l~, tb.e~ add!¢s.s s:et; forth. Oll lh<:l·Bi8,Juttt~re, P-~&C.l or· at. "'l·\er · 1:~ .!lf.L!.! St.lC. · .;rd en~s· •••. !l~J ···ar ... ~-·:·· !!:R... Jt·s"sn· t'l;oe:r.--~S J-l'-•.... ·9.:~~~- ~- s. .._ J?)COIL{l_g e,..M'i!·.Y"""''· ··a~ ,ft ,h, .... ·-·~~.!-~~-¥'·.Oro. · e.t. .Q· ·r·Jm~; .'~~~~~ijt~ ti-~.:·· 1 .- ·• .

by ~of!oe Jt.!vei:i:~~- J~er.~f.t'i:)?:~9Y{d'~~~ .S.!1ph,·J!f?A~~~ 9[. pc!tJ.U:!t.'I'P~t9al~.P.1'i.$'·. ~],;~lfpc'·'d!\:~ln,eU to l~~:Ve been· giv,_en ~pon: re.c.~pt. jf .b.·. ·QfSPi'uil.-i;lelivel·y, tlm~e. ($.1 .business· .dg,ys. -after. .deposit ·in the V.nlt¢(~.1\\~~:-·~~i.L.if ~e.!ltb.Y.;: .J~t~-~ Q.r _get.tt~:~g, m~-u~. ~P~tas~·-Pi~P.~id., one (~) J;i!.r~ine~s .CJ.~y after· dellvet.r .if l?y an nvem~~l1t· ·deUvew se.tvic~? or -'l.Jj?oii trmiSli:lission confir.tna:ti~n if by tcl~f~qshn.j]Q, A ~'b.Q~it1ea~·4ay1' lS Ji ~ELY ~m wli.ipJl.th~ Unltc.d States P.ostal$e,r.vice delivers:maii .in Hatl~h,gen, T~tN1; ¢eneral Provisions. 1!.32 En:tire..A.weernent;;lteprmslilntation;..Constmtltion. 'tins. Agreement, any amendments Qr lld4i.9.!f.t--~~t~tg, ·Mi.9,~~}( ~mmt§ ~P.~,qUi¢~JlY m~~1~igv.e.4 ~~r~in cQn~~wt~: 111~

U.3_4 Further Acts. The P~i~s ·~~gh ~gree to :cqgperate fLilly )Vi_th ea~;h .otper to i~e such ii.trlher· .1!-Ptlbn- and .execute such other .documents .or -instruments as neces·sary ·or 9ppiop(i~~~ to impl~~,!m.t tl;l}.$ .Am;eemen~., · ll.35.. Anie)ldlhe_nts. Th!.S: Agreem~nt ~ily .be arij~ded' ,orily py ~ w.ri.tfe11 htstrument · sl_~ea by Hospital and:Pl.lysician. .

rr.~.6 Assignment. Eliy~ician m,ay 11qt a~sigtl or delegate the rights, du·ties and oblig~tiolis'ofPhy~ci~ ~:ri~~r' tlus Agre~ai1el)t to:any other perso11,. SJ.'(Yilp or profess~onal associa11on. .Hospital1nay not a:ss.ign or. delegate the· rights, duties obligations of or UQ~pit~l uilP,er ~~-s.:.f...gr.e~tiie~_tJQ.a~y· ot)ler·per~on 9r en#lywjthout.prlor written consent . of Physician; provided; howev.er, that tliis Aga·eement may-~~ .!J.SSigrie~ to ~ny coryoration qr oth~r en~hy sUQ!1eciilh.1g _to the b1,1sines~ of HospJtar -in connection whb the mergerJ. consolidntiori ot ljAJ1~.fet of ~11 or-:.~!-l.b.$faJ1t,ally a~l ,of Uie 81.!set~ Fl.n.d b~~iness of Hospitai or with. a .corpomte .reorganization ]nvoJVill.g Hospital. This Agreement may also be ~!!¢,gne_q to anY s~q~id~~cy; P.~rt;~At Cqrppratiotr oi'. other affiliate of Hospital that has responsibility· for the operations. of the Pr~~am.

7521~BQ0,3

391 l.I-!3:7 ~~· X~1r~~~~·· ., .:Ben· · ·· · ~~·· ·'l'lds.A-w.-eQml'nt s:iu1ll-.b~~.biuding up,on .~d inw·o ·to tp~ ~P.e.ne.Jft P.%. :t.b·¢: . .•• .. ·~tt~9~§tOl'f ~il~l p.~ttn.it~¢d E\Salgps; )q:OthiJ)B .ln (h;is Asre,~~W~~t j,$~m~Jt.~~~tf;.: P,:ot ·~11.~~1 ·b~~a~~~~q~ tei ~6n_f~r an.y- &.~.fits on: any third party; .iuclndil!g;.. wiibo.m lltuitilfJo'9,:ttny putie.n.ts of.llof>pi.tall·nor ~}lall a~Qll :p.~r&po or enfi:ty Jurve im.}':'~t =to st;_ek,_ ~llfotc~ O.r t'P.¢oV.~t il\lY rtgl.lJ or-,r~med'Y \"Vl'th te.specl1wr~to.

ll.aB .P.a~j~_nt C:m!Ul_la!.~lfs1 'f.lle P.iirtie§: ·Mree Jp ;CQQp~£1te Wilh. eacl\ o1her in tho ·resolution of·nilY pnttt)rit Qo.xnpl.aints -mds~ng o~tt of -the. per:fo.r::mance by Pl1ysiaian of .the Servi~~$.·.. S.l.lClli.l,iitj~l}tqo¢:pla~nl"$ .~J1ijU be ·.r~s:olvcd in ~c~pr:di)ncc wlth t4e polici~s nml ..' pro¢

~.~0 ...~~~,~~a~~Hg:·· lf.~nY}7Fm. :or FovJ~on ~I.t~is. A~ree~nt ·is: tp be: he'ld 'ilt~gqJ, ~llY~.M. QP :q~p{q~g~~gJ~ tQ. il.'tlY· .Q~~~.pt, ·tP:t? ;rQntillQU.~r of tllw A,gr~.Y.m~n.t sball llP.t be fl:ffec.t~d :tp~r~PY ®~·· -~e~h t¢rm :~ma :provision of tlii's ,A.greeme,nt shoJi h~ ·valid and cnfoi9¢ab1~·-to fu~::£uile§t·c~.t~l)lp:e.miitted..'by.1mv.;~ll.tl.d in.lleu. Qf CflCh·..:!l,lcll. il1~gtU1 mvl!lid or JJ!!enf9~ge~bJ.~·~fo.vJilton-the l!.~rtl~ ~P"~n iliie-.th~irbe~.t ~e~t,Jn1ilile e:fl:o,rt~ 'fq add as.. a of part thl_s· Agfeement a provision· as- shnilar m terms to :mch illegal; irivaJid.. or i:u,1~.Worceatll~·pro.;V.:j$lop as:lll!LY b.~ 1.~g1i'l, v~.lid; 1.md enfo~aeable .in ~ccord;mce wit11 the pt~ov.:!.~ipris Qf:Section. t-3. ·

U,41' W:ai:varr W~iv~r l>y ~ltMr l'arty. of~: bre!lch or violqt!.o.ll o:f.any provisjon of'this .Agre.~m.c~:nj ~ha.ll.not gpwate -a;:;,. Qr b~ _qo.:n~.tl.1J.~d- t.P b~; .a waiver ()J'·any p.ri9r, .~onc~rr~nt .Qt f;l\JP~~IliJ:AA~ b.r~n~h. iJ.f Ui~ ·s.ID,l.l~ 9r ~~m:il.m:. PW.Yi~iqn. 'ijo.ne of the. provi~i.o.D,s. .Q{ Jhis Agreement shaft:be consldercd,waivei! by ·either Party except when such waiver is given .in~mt4lg. · II.4Z Govetn:irig .Lnw; Venu.e. Tl1i~ Agr~emeut shnll be c;on~tnted and gover..o~d according· to· the 1aws of the- State of Texa~, -.vithout gi:ving effect to its confljct of law provis.ions. ·The .Parties express~y agr~e that thill Agrecru~It is ex;~cuted and shall be pedorowd i~ Gaplef,QP ¢o~q!~; ~exa~ aild vellue .of n,il .disputes. cl~lins and Jaws~1it$ nrising)1ereunder. sllalllie fn Cnme.ron· CountY, Texas. 0.43. Remedies. 1'h.v 1'ep1.ej:ji~s. p,tqv.i~l~4 ·~o t)1e P·art\.es hy tli:is Agre~meQ.t arc not ·e~.t;lusive· Q.r y}Cl1_ajl~~i~e1 but ~re .c~ilJ~l.qtive Of e!,lch othet' :an~d in nadjtiptJ ~o a,ny ot1ler remedies the Parties mny have. .U.44 Attorney's .Fees, lf e.it_her :Pa.rty b.~:n$s. ~n action n.guhlS.t the o.ther to enferc.~ any .con~ijtionor c·ovq~wnt of .tqis A,grcerpent. the .Prevailing ?arty~ in addition to other relief awarded. by a court or arbitrator, :~ball be ent.it1ed tp recover .from tl1e other Party its court/arbitrat~on cos!$ f:!Dd_reasoimble a~tq¢t;:y's fees -inc).ltred in such ~eli on.

ll.4S _Con:fidentialily of Aweeme11t. Physichm !>hnll keep the tenus ofthis Agreement confid~n.ttaJ and no.i discl.ose .!)UCh tenns to any lhi.rd party other than his/her legal and

752138(!0•.3 ... 11 ·.•:·r:: 392 ~~ao.R~l\tadv~~Qt~, ··9r ·Q'tb.erwisol as requited. bylaw~ witl10U.t ·the prit;>r written eon~ent· of HOf "t..al. .....PJ. ·. · · II.46 C±!onJ'orate· P-ractie-e oLMetlicine, NotijjM .~tnrtuined herein is iute11ded to (~).conlifit~t~ 'tlie~:u~~·af:'~.¢(a:ti~rnO.~se fo~· ui~ jmictlc~~'o'f~nieci{biiie ~y anyoll~-~th~r 1

ffi9b ··a_U~-~!!.~U.$l1~~igj:~1 (~~;#.ta;liiO.mfjtal PT· al}y-.oth(:.r qprpPJ;9.tjo.t) to ~p,r~c~ice .m~~HP.ine r·. wMn ip,.'f~ct ~?9b ~GQW.9t&~J,~~~. i~ .~':lirJi~~t)S.:e.d t'o. pracpQ.p ~\~~icin_e; of (c) C.Qil~flfljtp Qr .resuli.hl.n.u.ro.th~ f.IQ~'.Q.t:'~xe~t-~;a_qf: other.:ar.ral1~ements in violation.of-the Texas Medical ;Pr,a~th;¢'Act f.rY.~.. Oc.g,_:_C,qtle G,l_iJtp:tpr S.l). · · _

..{ TI.4? :.€ottdt'atice,witlLi·· Jrc:a]:;J:e•. Fe!ier 1-tf dBrte L·w. Th.e:·:r.arUe.s enter in.to U1is .A;¥.f.~~~ti~iitwfflf: i~e h~;·4~: :O'f;~ ~:Olid1H!~i~~.: their .relnti.~~·~ljJ?... :iu iuli ca~p]·ian:ce ~lth ~RPlf.M~e. s.t~t~;}~~~J~ . ~'n. ~-f~,~~;«\J~W::~n~.l~~i-~~· tl},~ .f~.CJ~11~Jlaw _c.p~OJ:JJ_y:J~now~ iJS the t'f:t -:;~-.n"•~· ~ll'P•'If'"·~·,;; ··· ;·--.. ·d··Met1fc '•1 A'i!fi.F•"'u·J · i.ld .A:t. 'se J<>:W' tl1e·T sHe ·ttl ~. ~,~~y,··6~4~~~;#~~:~r~h~r~n~~~~faw~~ai~a ~~;~i.~~i-5.01l~)'(s:)~o; t1l.e-lni~~"al it:v~~:e Co'i'l' .. · ·N· ·:....~c;:;· •tt: ·'>:imr · ·u....,. ·a, -~~, ...~U-.\~~;,p.~:~J:.'W~,.. ·--w, ···-' tl' t"t --tf d ·rn' t ·· · ftl .. A · . · .1~:';!-P.q,,~J. 9.9g...,t}.C, ;,1,.§.~ •. -gn .e~ .e· enns.o. ·.l~ ·greem~n~u~ a·,nimmer·to-' c®~Utufe'a·'VJo· ·?in lif.'suoJr1aws. U.4S No- Referra1 .Gblfgrtfion. Phy~i.Qlllll_ .aglCJJOWleqgc:;:s and_ ilp.derstaods that this J\grMi#.¢.iH ~~~~;i)9.,t~!~~i\1!~~.i~i!~;. ~lj~I,i ~.Ptbe- cQ.Ps.tnlecHo x:~q~ir~. (9ir~v.t.1y or. h1d.ir~ct1y, ~~plicitly oi ·ilup1icitly).,_ I?.ll:V.sip.Hui'!'s use of ~ospitiil or any .qth~ facility pr s~.rvice .r~l~t~d. tC? Hqspi,tal~ p~: tll,~. a:dmi~sipn or referriJ of any patients tre~ted 'by Physician. to Hq~pi_tf)~ or ¢1~~~ f~9jlitit?S tC,l~t.gg.. ~o ._:f.l.9~>ptt~l. 'f.~tis t.\gre_¢¢~nt ~pe~: t~oi_ prol1il:ii~ pj1ysioian.from obta1iii_ng~metP.b_ership ·on t11e1nedical stafi':or any other hospital or.healtll cw~ sntity· Of .from .rfifQ)g_p·@tfc;n.ts to or ut.Uizlng: the··services-..of·any othor imspital or lleaith care enllo/; /S.iQJtatllre. Page Follows]

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752l3BOO.J. 12 393 ·.

lN. ·~SS Wf.m1.Ulg)~1 t.M :R~.rtle~ :h&v~ d.u,ty. ~x~.cpt¢d thl:Ei Agr¢.~n1#nt .a~ of ~~~e. E£fe~tivt'l,Dat~;

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~9c~tiQfi (P.~&e l) H~r1in~~~' Teta s·

Effective Date. (Pa~e 1): 5/1/2069 "l?l~si.c.iail (p.~~e. ~): DP.rPt}ly$l~Slmth, M.p., P.A.

:P.togi:am.(pgge 1): E;~J;lll~Ui_tat.i:_on..~~ Pby~i~nl M~d'i.~ine

sp~o.iptty CP~.s~ 1J: ~~h.al#Jit~~:Qri .tu\4 F~1ysjcnl Medi~ine

··p~lYsiciatt'.s Tid~ _(plige. t): Mqdlcal Dh·eclor ofRehabilitatio.)l and }?1iysica1 'Medicine

)'441~W$.1. N~IPb.er ofH.QJ.\1;$ 80"!10I)IS.per lll~!lth (20 p.~r w~ek/48 'Y~eks) ·M.:P.::JmtmrN.umtie.r ~fHours (page 2); ~0. hQ~u'S' p~r me·~~

B:oard (pag~ 3): .American Board of Rehabilitation aud ·r.h;y~ic~I·Mc;.clicjne ·

.a:~w:lY Ccnbp.Qn$~ti9.n $1.30 .00 .AnniJal Maximum Conl.P~~lsation. ;·. r ,. ~- . ' t L'~ .

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l.l A.FPEND.IX B ~: rtf· MEDICAL DIR.ECTO.ii-RESPO NSIDILiT.IES .• It... . J ·-::_. :.· ' .PROGRAM

" l~o~p,i :~~1 Pr?~~Jll)_JJP:l:U?es -~!Wmti~? _ 9.f _qu ~ lhp;~\j~~~ Reh~P.J.lV~t\sm prijt ("th~ ~~f'} ~nd the qperatmn of an Qut,patLent -Re'1J,ahd1tat1Dn Serv1ce (''the:r Setvrce'?· As used herem ibe tetm ;RQbabUf~~ti_on !S¢.~J.q® ;!?Jogr.~rn ('~the ·:g~om:am~ 2) slill:ll wf9r to botJ1 ~4e JJJ.J.H aml th~ .Service. M~41~ai' DJre:c~Qr, -~4~l1 p~: Q_l1;;S~te at the 'f~t9g't~JD w·ov.Jo4ls -~4mhris~rati'Ve services for a ·minl.n'1\1Ul of'twenty·.bour.s per· week. ns req\Jired·b)iMedioare:.r.~~latfons.

I. ~~d.g~t 1. AssisHutii_e deveionnient of an nt:n'iuaf bi.1dget'for .tlie Pro grain.

2. Direct resecn;ch. activities. in the Prosram1 workh1g: with. the CEO~ and help de.ve:Jop fl,nati~!E!l suppw,t fo,~ .$\;lqh_ r~_sp[~~ll. l'lff.ott~.. . R. ! r·f . 3.. Wotk W.i·U1. t~e Y~itw :S)p~sp-I;~alth Sy~tem Fou.I1chithm to· ~~_coi.~~fWgi!t givit)g for t~1e . ':Prowam1 Hospital-and other-Af.fi.liaws.

iL U~it'P~,U~y J)evelop.~~~t~'.il!l,PI~m-~ni!lt~on 1. ._!?e ~toWl~~g¢q!~· of .~nd proy~qp ~O.~~~_lt~~tou a~cl i~p1,1t pn 4C\'~lopment and, iinp_lementation .of' opera:timuil policies and programs to comply· with qirectives pf the ~4-~rlll~J;c:J.:.~iat~ .a~~Jl~~~ll·~hat m~y ~ov.ern tli~tPrq~~nn.

2. Pr~pAre r~pp(ts t0.1{os'P.it~I .a~td ~;~vnllu~t,~ ~ep!:!lts, l?,y qth~rs to :tJospital witll re!>p~ct to the .Progtntn and· cooperate .w'ith the adrhinistrators pf .}iospitql as :neces_sary to carry Q'ilt eff~ctively mlQ efficieotly the obllgntiQ.O!'! of the Medical D.irector in accordance with Section 3:.3 9f ~rls Agr~ejnep~, 3; Assist Hospit!!l in formulatj4g· ~qd hi1plenten'til,lg·poiicjes al)il: pro~~cl~Jres for paticmt c~e . d6.liv~ry. !!rE.ospi~;li, which.1n91ud.~.p~re:Path.s and .ciiniclil ptotocols. 4. Pr9viqe ,a4rnily~ixn~iv~ di~·~Jiol;l r~Jath1g- tp physical·me(licine m1d rehaQilitation serv1ces provided in tl1e ~r~gtun~; in,c;ll!~~-tg' t4e d~yelppiu~itt of ·n~ _a11d existing programs, ser:vi~es:and poliC.1e~Jor- the .Program.

IlL Eijuc_f.!tioil

1. Assist HospitaJ)n orgauizi~g ~oq .coni:Ju,ct~g mei:li~1i1 -~du·ca~fon p.r:ograms· go_yemi~g .all aspects ofPhysi~al M.edjqiu.e;and R:ehabilltalion-Program .services for medical residents, fellows .and tlie p)lys_icinns wiflfprhiileges to pr~Q~ice. iil the Program at E:ospit~:~l, andloJ Affiliates.

7,Sli-3B00.3 rd. 396 -~ e··--~·--. 'W ~ ~ - ' 1 ,.,,...-

2. U_pon:reauest of l-lb~.p.ita~, ).>f!i'tic-U?tll~- ih anci cqndupt c.outim.1itr~ J>rofessjo~1a1 e.ducntion a~it m~ig~1.e..(l~Qati9.n ·!JsitivlfJ.~s. off¢x~dJ;y "th~~:Pi'Q~fron,. ·_py HQ.~p#al . ~na ·by Af.fi.lint~s.

3. Pat:P·~~j~J.~ iP · c:c>.rttJn~jng· :P!qf~j_c;nr~l ~9P':'atipn ~nd .m~~jc~l ~~.nc!ltioti ~c;.tjyiH:~s includingjournat. .nrtiahHmd l>o.ol< ri3V1cw .. to 'ixJ;~:Pl'OV.e patient care and staff lmowled.ge P~.se.

4. As§iP.·~ H.~sv..it.~l ·~~ ~~pi)J.ilig: M.d ~~~qiltilut f.J:.()spjtill P.~~spb.i1el ~·¢gnt·ding Frcmra,m .PrOcedures and teciuliCJ,~tes. attd u~e. of e~utpment.itt the Program. 5,· .A.$sistHo~pita1,..as. .Jeq~te.st~.d:l>y Hospital, in comnlttnity edug~tion, J?Ublic rel!ltions and ..Il'lm:l,(eting. efforts t~ga.~diM Phy~iCt\l M~~.l~ine iil}d ·ReMbil.it~tio·n services.and Hospital. IV. Mccti~g Attcntl4P.C~

•. 1. Attend proSfant leadership and perfon'11ance improvem~t meetings ns teqnested by ..Hospital.

2.. : ~~pre~ept the·P~ogr.~l ·.Q.~ t!Je l'yiedicql S(~~f coll1l11iU~es ofHq_spita1, and serye ~s liaison bcpv.een Pro~tam.-tuttl.othc:r. Pl'O~rruns ofllc;>spital. ~·· V; Qttlllity Care A..ssurauce i. Make·r~co.mmer~Mti.cm~ -to "ij;~spit~l qn .spape pl!llming, cap.ihll equipme.nt n.~eds, flt~d any oth~r. pr9,Cess il;l~proy'en,.eht. ~t~~tiyes~ · · · · 2. L~ad.t~am ·coJjferences wjth.utus~~~ dischat.g_e ]>lanners £ind·therapists. 3. M~k~H~connnQlldS:tii;ms to Bospit.y.J .o!l.re9rui.tment~ cmploY.Jil~nt .or other engagement of R~Me~$i9.1J~l $Jl'cl;..~~f~fs~ti:Y~. p#~p1mel who w~~til~ P.~fotm patient c~e··.tll,rough the .Prog_tan1: 4. Partlcipnte ii1 pllnical s~~tem jhte$.Ciiti.on. and _b11siness process rcdesig~1 pro~ams at lfo.~pJtal ~n~ tlu"o~gbPJ,it ·n1e V ;1I~j(l3~pfi~t H~lth.'System.

?. Wf!tk. ~o~per~~iyely 'rvitl'i qther n1emh~f~· d_f tl~~ Med!~al S~~f; Ptogr~tns anCI Hospital ·admin1&trntiordn the.~trat~gi.c_:plannillg_.efforts for.Progrrun and Hospital. 6. f.~s.ist ~o~pit.!!Hn.m_aiptajoing accrc;dltati9.n J:?y,the· JQ.it~t Commission on Accre~itati.on of :f[ea1_~pare Org~~J~l!UIJ~"s, - [qARF,, A.C

9, . .Supe~_i,s~ !!Od coorgin!J.t~ clinical c~_re of Progt:!lm paJients by other rehabilitation speeiai.ists, cross coveJ:ag_!' phy~i<}iat1s and ·censultapts.

7~2 13800.3

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. ·····-· .. ,......,.. . ..... ·-- . . . -·- _ .., .. , . .10. ~~$~· di~v.ute re~.qluti911 .betw.ee~l plinical. provider~.~· .stnff, pati.e11t~ _patients a11d lmrtil)e.s.. Yl,.'f;J.f!U~iffl.Pft :R!l:Y!e~v

1.. M~!,et:}ips,p,i~al i1i. r.qr1nui.~tit;i,Si in~pl~nwnti~g· ~ild ·Jii9Uit~rJ:Q!r.P.oJjcJes·an~ ]>:tO:ifA'mS (or : \~fr~i~:.~;~:2~~~J~!i. _.P~~9.!~~1l:9~ :i~P,l'~!'~'~~llt~. ~l:~i~atjon r~vi~w, dsk n1au~gen1ent P1l1~!YJ1.§.l\!.l. :.. ~~..}1~9g.s·:.,~~ .. 1.';~Y. t)~ti!l@~~~ u~ ~r9gr~QJ.•

Y;U, ~jl.l@t.DJttj~~ < • • • 1. Pe.r;t'9~ other t1MJ;!ef1 .~n9.:serv.ic.es l\5 .Ii:Ul,Y from titue. to· til:l.le be i·easonabJy reguest.c:d by • ..~'a·. g· ~fb ·t_.we."f-'mf). . -'J~.'HQ~·"If~:l. ...... ijt. •' . .

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~.V~;NlltXE .,:. 'j~. . eiD~;w!§.#,PI~~ lll 'QOl.WHl~j:~UP.P fgr; M~f QPPI) .~HJJJ$tP.D:tl.!!tio~ Qt th~· p~rfoo:n.l!nce of tl}e SeJvic.es, .. :. ·l>.J.l~~i~~JitrWltl:)?e.p,.~~d in .~1t,rt~ts 9il: ~g.)IP.\l.tly .1.?~~1~ l~ .th~· ~ ·:.f.ltj;·~ ~~~ 'lej snti·o·. t ~a~t;:· -~~! I,o.tt~ .Qn-Aen~qdhU~.-, whi"ch ~moutlt·:shn.lllll!lW-·eY~.t ox~~~d· Ute·!. · o11lnr;x:,M~!m'LJln.02VJ_l?ensatiQ'1'! ' ~~t fa~:~, P~l.Am~~nltix .A:. ~lw~rc.l~·p,,~J~gtl .~~~P .:~. w~ltt~4 r.¢..~Qr:~: hi 't!~e. .for.p..i;.4t~4~~.r,cl.l~~r~tp ~~ Aj)M1idl:t B,. mee'ti~g ·the req~rcm.l'eJUs:·.o.f-thl.S Agreement fot th.e substant'iotion o.f'Physicliin~s tit~l:e. j:l~vQt~.a· tQ fl:l~·.v.eili~J;{I.l(l.llq~.oftb~ So,.!'Vic.e~..

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