When Dr. Stephen Bartlett, then one of the top officials at the University of Maryland Medical System, arrived at the Capital Grille in downtown Baltimore for dinner with medical malpractice attorney Stephen L. Snyder, he was guided to the bar where the maître d’ handed him an envelope.

It contained graphic images of a hospital patient whose transplant surgery had gone wrong. Snyder said he wanted $25 million to keep it quiet. They eventually sat down to eat with their significant others.

Snyder was red-faced with bloodshot eyes and said multiple times to Bartlett’s wife, “As long as he does what I want him to do, you’ll be OK,” Bartlett, who was the chief medical officer at UMMS, testified.

“I was sick inside,” Bartlett recalled. “I felt as if I had just had dinner with a very bad person.”

Bartlett was among the hospital system leaders who have testified at the federal extortion trial of Snyder, who earned hundreds of millions of dollars in his career and was regarded as one of the top plaintiffs attorneys in the state. Federal prosecutors say he went too far in 2018, demanding $25 million for a sham consultant position or else he would expose what he alleged were severe problems in the hospital’s organ transplant program.

Bartlett, who was one of the highest-paid employees in the state when he departed in late 2018, defended the hospital’s program. He said the hospital recognized in the 1990s that more people’s lives could be saved or extended by using kidneys that were being discarded.

“People were not getting transplants who should have,” Bartlett testified.

Another official, Dr. Depriest Whye, testified Wednesday that Snyder’s accusations contained “inaccuracies, falsehoods and distortions.” Alicia Reynolds, director of claims and litigation for UMMS’ insurer, said a video Snyder played for officials that compared alleged problems to other hospital scandals was “one-sided” and “designed to inflame and incite.”

Snyder counters that data shows the University of Maryland was out on a limb, and that he consulted with experts who agreed. Two of them are expected to testify during his defense presentation. He also said he consulted with legal experts to make sure the arrangement was ethical.

Reynolds said that UMMS deals with more than 100 malpractice claims at any given time, and that 85% are resolved. She said the hospital takes a number of factors into account when deciding to settle, including the cost to litigate.

The hospital system agreed to pay settlements of $8.5 million and $5 million to two of his clients, which Snyder said was far above what would be expected. He called it a “Snyder premium” because he was known as an effective litigator.

Snyder said he had settled other previous claims with UMMS for $12.5 million and $10 million. He said one hospital official had helped him to identify another “target” at a different institution that netted another $1 million.

During his questioning of Reynolds, Snyder implied that those types of settlements would have made the $25 million at issue in his case a cost savings to the hospital if he had stopped bringing cases. “I’d certainly make much more on future cases,” he said.

Bartlett took part in a settlement conference for one of Snyder’s clients in early 2018, and said Snyder asked him to step out into the hallway where he said he knew of deeper problems at the hospital. He asked for Bartlett’s cellphone number.

“I really wanted to learn what it is he knew,” Bartlett testified.

That led to the dinner in March 2018. Bartlett’s wife testified that Snyder told the couple they could come to Miami and ride around in his Rolls-Royce, but also kept directing the conversation back to her husband’s need to comply with his demand. She said she was “scared and threatened,” and believed Snyder was “unstable.”

“If you felt threatened, why didn’t you get up and leave?” Snyder, who is representing himself, asked her on cross-examination.

“I didn’t want to be rude,” she said.

At one point, Snyder asked Bartlett about what he said were “serious infections” of a kidney transplanted into a patient who died. Bartlett said he disagreed with Snyder’s assessment of the organ.

“Are you saying I made that up?” Snyder asked.

“I’m suggesting you don’t understand the medicine,” Bartlett replied.