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HomeMy WebLinkAboutMINUTES - 07251989 - 1.16 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you s your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuagctorGovei�nment Code Amount: $10 , 000 . 00 Section 913 and 915.4. Please note all "Warnyr%g'u( CLAIMANT: RODRICK CRAIG COWARD JUN 3,o 1989 ATTORNEY: 145 Towna&ric CountrynDrive #102 �artl nez' C'9 94553 Danville, CA 94526 Date received ADDRESS: BY DELIVERY TO CLERK ON June 26 , 1989 CAO BY MAIL POSTMARKED: .Tune 21 , 1989 Certified P 088 181 761 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. C DATED:_ June 29 , 1989 gaIl Bep�tyLOR, Clerk L. Hall FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on.ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: / �() r BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admini for (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUL 2 5 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. . AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JUL 2 7 1989 Dated: BY: PHIL BATCHELOR by Zeputy Clerk CC: County Counsel County Administrator 1 rJ/ MERRILL, RESEN & MAZER ATTORNEYS AT LAW IA5 TOWN AND COUNTRY DPIVE W PATRICK RESEN' SUITE 102 MARC S. MAZER" DANVILLE, CALIFORNIA 94326 CHARLES E. MERRILL NANCY A. KELLEY'•• TELEPHONE (415) 837-0777 STANLE`• A. FIS-!MAN June 2Q, 1989 •_SG.U."'iCD i0.R.C`C[ Iry N. , NCl. 01S'n'Cl 01 CO,U.01. .LSO.D.11CO 10 e..Ci1C[ 1 u1C wiO.ry .LSG. CCR71Fi E0 EJ0.1C ACCOUNTANT City of Danville �� c� 510 La Gonda Way, Danville, CA 94526 v County of Contra Costa Adminstrative Office ��� .• 651 Pine St. Martinez, CA 94553 Secretary of State Contra Costa County State of California RECEIVED Executive Office 1230 J St. JUN 221989 Sacramento, CA 95814 Office of Re: Claim of Rodrick Craig Coward Ccun:y Administretor To the addressees as stated above: Rodrick Craig Coward hereby makes claim against the above-named governmental entities for damages resulting from a false arrest. At approximately 10: 00 a.m, on the morning of March 18, 1989 Mr. Coward was stopped for a routine traffic stop by a member of the Danville Police Department on Interstate Highway 680 near the Stone Valley Rd. exit. Members of the Danville Police Department advised Mr. Coward that there was a warrant for his arrest for failure to pay a traffic fine. Mr. Coward was handcuffed and placed in a patrol car. At this time Mr. Coward needed to urinate; he was not allowed to do so until approximately noon. Mr. Coward's vehicle was towed and impounded and Mr. Coward was taken first to the Danville Police Department and then to the Contra *Costa County jail. At the time of his arrest Mr. Coward also informed the law enforcement personnel that he was a medication-maintained diabetic and was required to eat lunch every day between 11: 00 and 11: 30 a.m. Mr. Coward has a requirement for 3 , 500 calories per day in order to avoid complications and/or diabetic seizures. Law enforcement personnel concerned failed to provide Mr. Coward with food throughout his incarceration. Upon Mr. Coward's arrival at City of Danville, County of Contra Costa, State of California Page Two June 20, 1989 Contra Costa County jail he again informed 'personnei of his• need for food. None was forthcoming. He advised personnel that he needed to immediately have some sugar as a minimum; approximately one-half hour or more later sugar was finally provided to him. At approximately 1: 15 p.m. Mr. Coward was released from the county jail without the necessity of posting any bail and merely with a citation to appear concerning driving while suspended and for speeding. Because Mr. Coward's vehicle had been impounded it was approximately 4 : 00 p.m. before he could obtain something to eat and then procure his vehicle. Due to these actions Mr. Coward was required to pay $65. 00 towing and impounding fee; lost approximately $100. 00 lost wages from his second job, which he was proceeding to at the time of his arrest; and an additional $50. 00 due to having to miss work on the following Monday because of his condition resulting from depravation of nourishment and becoming rain soaked during the process of the arrest and transportation. Mr. Coward had been notified of a potential suspension by letter from the Department of Motor Vehicles dated January 10, 1989 (Exhibit 1) which Mr. Coward received on-or about January 16, 1989 . As that letter indicates, Mr. Coward's drivers license would be suspended effective February 9 , 1989 for failure to appear or pay a fine following the citation. The letter, by its terms, directed Mr'. Coward ' s attention to the "attached notice" , Exhibit 2 . The letter further indicated: " You can avoid or end the suspension when you clear the failure to pay (FTP) fine. " Exhibit 2 indicates that a citation docketed in the Justice Court, Coalinga, California and a citation docketed in Municipal Court, Walnut Creek, California, Danville Judicial District, were outstanding. On January 18 , 1989 Mr.Coward personally appeared at the Walnut Creek- Danville Judicial District and paid the outstanding fine by cashiers check. On the same date he mailed to the Justice Court in Coalinga a check for payment of fine which that court indicated to him was due and owing. Exhibit 3 is Mr Coward's receipt for payment of the above-described fine on January 18 , 1989 ; Exhibit 4 is the receiptreceived by Mr. Coward from the Justice Court in Coalinga indicating that payment was received and posted by them on January 24 , 1989 . Mr. Coward has no notice and had not received any communication from Department of Motor Vehicles indicating any other citations due and owing. On March 18 , 1989 the events as described above occurred. At his first available date, April 6, 1989, Mr. Coward proceeded to an office of the Department of Motor Vehicles and made an information request. Such was provided and is attached as Exhibit 5 hereto indicating that Mr. Coward had a valid license (interestingly, the Walnut Creek-Danville matter as described City of Danville, County of Contra Costa, State of California Page Three June 20, 1989 above, does not even appear on this printout. ) It appears that the State of California, by its agency the Department of Motor Vehicles, failed to properly maintain records indicating Mr. Coward' s true status and improperly provided such inaccurate information to members of the Danville Police Department thus leading to Mr. Coward' s improper arrest and incarceration. As a result of these actions Mr. Coward sustained the special damages as described previously, his injuries resulting from his deprivation of nourishment, and other general damages. For all such damages Mr. Coward hereby demands a sum of $10, 000. 00. This claim is presented under the provisions of California Government Code Section 910. All notices or other communications with regard to this claim should be sent to claimant' s attorney; W PATRICK RESEN, MERRILL, RESEN AND MAZER, 145 Town and Country Drive, Suite 102 , Danville, CA 94526. Claimant's address is: 1559 Gilboa Drive, Walnut Creek, CA 94598 . The name of the arresting officer is: J. Dzanda ; the names of the other public employees causing such injuries are unknown but such names are known to the public entities involved. . You v ry trul , W PATRICK RESEN WPR: smo cc: Roderick Craig Coward STATE OF CALIFORNIA-SUSINE".TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF MOTOR VEHICLES :. ( 916 ) 732-7856 PLEASE ADDRESS CORRESPONDENCE TO: DIV. OF HEADQUARTERS OPERATIONS ORDER OF SUSPENSION • P. 0. BOX 944278 SACRAMENTO. CA. 94244-2780 PLEASE SHOW THESE !AMBERS ON YOUR CORRESPONDENCE i RODRICK CRAIG COWARD DRIVERS LICENSE NO. C0644354 1559 GILBOA DR FINANCIAL RESPONSIBILITY WALNUT CREEK, CALIFORNIA 94598 CASE NO. **-SB-850** YOUR PRIVILEGE TO OPERATE A MOTOR VEHICLE WILL BE SUSPENDED EFFECTIVE FEB 09, 1989 UNDER THE AUTHORITY OF SECTION 16031A OF THE VEHICLE CODE (V.C. ) BECAUSE YOU VIOLATED YOUR PROMISE TO AFPEAR OR PAY A FiiiE FOLL5WlHG 'i CUR CITATION FOR NCT r;zovIDING EVIDENCE OF FINANCIAL RESPONSIBILITY TO A PEACE OFFICER (SECTION 16028 V.C.). SEE ATTACHED NOTICE. YOU CAN AVOID OR END THE SUSPENSION WHEN YOU CLEAR THE FAILURE TO PAY (FTP) FINE. SECTION 14904 V.C. REQUIRES PAYMENT OF A $15 REISSUE FEE BEFORE A DRIVER LICENSE CAN BE ISSUED OR RETURNED TO YOU. IF THE FTP IS CLEARED BEFORE THE EFFECTIVE DATE OF THIS ORDER, A $15 REISSUE FEE WILL NOT BE DUE FOR THIS ACTION. ANY OTHER ORDER ALREADY TAKEN IN YOUR NAME IS NOT AFFECTED BY THIS ACTION AND CONTINUES IN FULL FORCE AND EFFECT. THERE ARE NO PROVISIONS IN THE LAW FOR ISSUANCE OF ANY TYPE OF LICENSE WHILE THE OTHER ACTION IS IN EFFECT. IF YOU DRIVE WHILE YOUR DRIVING PRIVILEGE IS SUSPENDED OR REVOKED, YOU CAN BE ARRESTED FOR VIOLATION OF SECTION 14601, 14601.1 OR 14601.2 V.C. AND IF CONVICTED OF THESE VIOLATIONS, IT MAY RESULT IN JAIL, FINE OR BOTH. . DATED: JAN 10, 1989 DEPARTMENT OF MOTOR VEHICLES ENCLOSURES OSC/207G106I DEPARTMENT OF MOTOR VEHICLES DIV. OF HEADQUARTERS OPERATIONS P. 0. BOX 942890 SACRAMENTO, CALIFORNIA 94290-0001 ( 916 ) 732-7408 -JAN 10 , 1-989 PAGE 1 OF 1 RODRICK CRAIG COWARD LICENSE NO. C0644354 1559 GILBOA DR WALNUT CREEK, CALIFORNIA 94598 THE COURT(S), INDICATED BELOW, HAS NOTIFIED THIS DEPARTMENT THAT YOU HAVE FAILED TO ANSWER YOUR SIGNED PROMISE TO APPEAR IN COURT OR PAY FINE(S) AFTER i,CING CITED FOR :'IOLATI`:C THE TRAFFIC LAWS. A LICENSE CANNOT BE ISSUED UNTIL THE PROPER CLEARANCE(S) HAS BEEN RECEIVED IN THIS DEPARTMENT FROM THE COURT(S) SHOWING THAT YOU HAVE CLEARED THE CITATIONS) LISTED BELOW. TO CLEAR THE OUTSTANDING CITATION(S), YOU MUST CONTACT EACH COURT SHOWN BELOW. THEY WILL INFORM YOU OF THE AMOUNT OF FINES) DUE. ONLY THE COURTS LEVY AND COLLECT FINES. THE DEPARTMENT OF MOTOR VEHICLES DOES NOT HAVE INFORMATION AS TO THE AMOUNT OF FINE OR BAIL DUE. UPON RECEIPT OF THE PROPER CLEARANCE(S) , A LICENSE MAY BE ISSUED TO YOU. IF IT IS NECESSARY FOR YOU TO CONTACT YOUR LOCAL DEPARTMENT OF MOTOR VEHICLES FIELD OFFICE REGARDING THIS MATTER, PLEASE BE SURE TO BRING THIS LETTER AND ANY FAILURE TO APPEAR (FTA) RELEASE FORM(S) DL106R AND/OR ANY FAILURE TO PAY (FTP) RELEASE FORM(S) DL515 THAT ARE GIVEN TO YOU BY THE COURT(S). IF THE CITATIONS HAVE BEEN CLEARED WITHIN THE LAST 60 DAYS, PLEASE DISREGARD THIS LETTER . VIOL/CONV COURT DOCKET t DATE SECTIONS VIOLATED �t JUSTICE COURT 164808 02/13/88 22356 VC ( 166 W ELM ST (FTA) / .� 16028A VC COALINGA, CA ' 93210 �.� [� r_.,.Lf_ 40508A VC (209) 935-20171 +== MUNICIPAL COURT ,/ Q 0 2140168 08/18/88 16028A VC 640 YGNACIO, PO BX 5128 __--- (FTP) 22350 VC l 4IALHUT CREEK, CA 94596 (415) 646-6572 E pL2g .ppe- • . . 89005 Q434. - MIINIC:IrAL I_QI_IRT iIF C:CINTRA CCIST:, Ci-i IfJT ' - =;ThTE CIF C:ALIFCIRfJ.I .WALNUT CREEK-MANVILLE TUDICIAL i I�TF;ZC:T -D -.TE i.+l % lc::' 9 CASE t4PF: 2: 14i71r i NAME COWARD RODRIC:F: CRAIG REC. NPR 13 ?:3C. CI; 1Cr2, AMT 146, Ctit CLERK 9 6c. CI CI - --•i 1 . 110 —11 —FE 1% _!4. ll Ct TY`E M,_• TC,IAL 3;4. 0C.' I DOCXFT OR 01ATION NO COMPLF E NAME AND COMPLETE ADDRESS DRIVER IIC.N0. 164808 COWARD RODRICK CRAIG C0644354 VIOLATION DATE 1559 GILBOA DRIVE BIRTHDATE 02/13/88 WALNUT CREEK, CA. 94598 05/28/64 SECTIONS VIOLATED KG 61946 223569 16028 (A) & 40508 (A) V.C. VEHICLE LIC.NO z Z Restriction Term Swpmtion Term 1FPCO15 f Probation Term BAC CONVICTION DATE U' 01/24/89 ; B CONDITIONS OF DUI PROBATION 1 • I CERTIFY correct obavoc+of on action and the dote thereof rendered in my court. xc 1 4r COUrtCode 10627 p�R (SIGNED) C. HANCOCK ATE o¢CALIIFOE In COURT JUSTICE A CT URTdE ORD CITY COALINGA �yASDI COUNTY FRESNO I RIVER SAFETY AND UCENSIW—DEPARTMENT Of MOTOR VEHICLES DL 1068(Rf DEC% P.O. Box 12590,SACRAMEMo,CA 95852 i r CALIFORNIA DEPARTMENT OF MOTOR VEHICLES f "*CUSTOMER RECEIPT COPY}** 1 DRIVER LICENSE/IDENTIFICATION CARD I INFORMATION REQUEST _ 04/06/89 DAK99933624K4CD644354 f DATE:04-06-89*TIME:11:45* DL/ND:C0644354*B/D:05-28-64*NAME:CDWW RODRICK CRAIG* ADDR AS OF 03-21-89:1559 GILBOA DR WALNUT CREEK 94598* IDENTIFYING INFORMATION: SEX:MALE"IR:BtOWNtEYES:HZL+HT:6-00*WT:165f � OTH/ADDR AS OF 02-09-87:1682 CLAYTON RD APT 40 CONCORD* ID CARD MLD:08-26-66*EXP/BD:92* LIC/ISS:09-17-B7*EXPIBD:91*CLASS:3* LICENSE STATUS: VALID* DEPARTMENTAL ACTIONS: FR PROOF ON FILE* FR PRF REG 081888 TERM 012492* CONVICTIONS: VIOL/DT CONY/DT SEClVIOL DKT/NO DISP COURT VEH/LIC 10-17-83 04-17-84 14601A VC 0463802 07480 UPDATED DURING WM. OF:06-05-84* 02-09-87 03-17-87 221011) VC 3884913 07410 1FPCO15 UPDATED:03-27-87* 11-28-87 01-07-88 X349 VC 0121480 48430 IMSG984 UPDATED:01-28-88* 02-13-88 01-24-89 1602BA VC 164808 10627 IFPC015 42356 VC 40508A VC UFDATED:02-21-89* 07-07-88 08-18-88 16028A VC 2140168 07480 26TW930 -:-350 VC UPDATED:09-08-88* FAILURES TO APPEAR: NONE* ACCIDENTS: NONE* * * • END * * 624 WA89 05 0010 VIR f 1.00 • CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Ag.«inst the County, or District governed by) BOARD ACTION the Beard of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $250, 000 . 00 Section 913 and 915.4. � Please note all 1=WAr nr� s U iy Counsel CLAIMANT: JANE DILLARD c/o Ned--Robinson JUN 3.0 1989 ATTORNEY: Attorney at Law Martinez 3730 Mt . Diablo Blvd. #330 Date received , CA 94553 ADDRESS: Lafayette, CA 94549-7057 BY DELIVERY TO CLERK ON June 28 , 1989 hand del . BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: June 29 , 1989 gy!L BAATTCYELOR, Clerk epuL. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( . ) 'This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days. (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of .claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ho /�j� BY: I Deputy County Counsel —� III. FROM: Clerk of the Board TO: County Counsel (1) County Admin (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (J( ) This Claim is rejected in full . ��( ��) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: J U L 2 5 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the-United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JUL 2 7 1989 Dated: BY: PHIL BATCHELOR by LIC�y Clerk CC: County Counsel County Administrator 5. What are the names of county or district officers, servants or employees causing the damage or injury? 1. Medical Records 'staff.,, Merrithew Memorial Hospital . 2. Hye-Kyung Kim, M.D., Pathologist, Merrithew Memorial Hospital . ----------------------------------------------------------------------------- ---- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ' See No. 4 plus mental suffering and anguish in not knowing where my mother's remains are now; not knowing cause of death; and not knowing if death was preventable. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Mental pain 'and anguish $1009000 Punitive Damages $1509000 L , ----NN----------------------------v-------------------------------------------------- 8. Pace Banjo?gddresses of witnesses, doctors and hospitals. gham; M.D., 3300 Webster St.,• Oakland, CA. Dr. Tremaine, Dr.~Michael Harris,�•Dr, Terry Myers,' all of Merrithew Memorial Hospital. Dr. Timiras, Older Adult Clinic, Concord, CA. ,Ye Rev. Mary McKnight, St. Andrews Presbyterian Church 1601 Mary Dr., Pleasant Hill, CA. Ar_ and Margaret Milllers -'L Pleasant Hill Village L 106-aQyc� �cj",�],p, t,, H_1l ^ CA. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT None, so far. Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of :Attorney IQ Ned Robinson zt/ it Attorney at Law Claimant's Signa ) 3730 Mt. Diablo Blvd., Suite 330 2087 Norse Dr. #100 Lafayette, Calif, 94549-7057 Address Pleasant Hill, CA 94523 Telephone No. (415) 284-3304 Telephone No. (415) 682-3482 " `NOTICE ' Section 72 of the Penal Code provides: "Every person who, with intent to defraud,, presents for allowance or, for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent ' claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state-prison, by ,a fine of not exceeding .ten thousand dollars ($10,000, .or ,by both such, imprisonment and fine. i r CERTIFIED MAIL 2087 Norse Dr. #100 RETURN RECEIPT REQUESTED Pleasant Hill , California 94523 June 12, 1989 Mr. Frank Puglisi, Administrator Merrithew Memorial Hospital 2500 Alhambra Avenue Martinez, California 94553 RE: RHODA L. BIRKHOLM, DECEASED 3/28/89, MERRITHEW MEMORIAL HOSPITAL AUTOPSY REPORT #4427993 OF 3/30/89 (RECEIVED BY ME 6/1/89) Dear Sir: Please refer to Autopsy Report #4427993 dated March 30, 1989, in which the first paragraph states: "The body is that of a well-developed and slightly obese white female appearing as the recorded age of 90 years old. . .and the weight is approximately 180 lbs. The head has a moderate growth of brown hair of fine texture." Mr. Puglisi, the above description is not that of EX mother. The autopsy was performed on someone else! ! My mother was a petite 124 pounds and had a full growth of snow-white hair of thick texture. Literally hundreds of people can attest to this, includ- ing everyone at Merrithew who took care of her for two weeks. (Incidentally, have you ever seen a 90-year-old female with (natural) brown hair? ) Further, the autopsy revealed that the female had an "...old myocardial infarction." My mother had no history of a previous myocardial infarction. Then, on whose mother was the autopsy performed on 3/30/89 - #4427993? And, where is my mother? It had been my intention to have my mother's ashes placed in the Memorial Garden at the church to which I belong- - Lafayette-Orinda Presbyterian Church. My mother would have been very happy to be there,- near my church, and where I could have "visited with her" in such lovely surroundings at any time. It grieves me deeply to know that I will not be .able to do this inasmuch as the ashes that I have are those of a stranger. (Incidentally, what disposition should be made of these ashes? At the present time they are at Bryant and Moore Funeral Home.) Now, please refer to Certificate of Death, #38907001752, signed by Roger Barrow, 110., on April 5, 1989. This document is also invalid because it applied to the other female on which the autopsy was performed - in place of my mother. Consequently, at this point in time there is no Certificate of Death nor is there an Autopsy Report on Rhoda L. Birkholm. Mr. Frank Puglisi, Administrator -2- June 12, 1989 Further, on Saturday, April 8, at 11:00 .m., Dee from Medical Records, telephoned and demanded that I have my mother's remains removed. I explained to her that I was waiting for the results of the autopsy before releasing the body. She was very rude to me and insisted that I release the remains. On Tuesday, April 11, 1989, at 8:00 a.m., Joanna from Medical Records, telephone me with the same request and I again explained my position. Later that same morning Dr. Roger Barrow telephoned me and was very insist- ent that I have my mother's body removed. He said all the work had been completed and that I could not continue to keep the remains there while awaiting the results of the autopsy. He also was quite rude and unpleasant. Inasmuch as I had been harassed about this since April 8th, I subsequently visited Bryant and Moore later in the morning of April 11th, and they picked up the body that afternoon. It was cremated on April 13, 1989. In light of the gross negligence and mis-handling of this whole matter, I have been advised to file a malpractice suit against the county for a very large sum of money, including punitive damages. However, in lieu of filing a .malpractice suit, I am hereby requesting a one-time payment from the county of one hundred thousand dollars ($100,000), together with a letter to me explaining that this payment is in compensation for extreme mental suffer- ing and anguish in not knowing: a The cause of my mother's death, as the Certificate of Death is invalid; �b� why my mother died, when I believe that it may have been a preventable death (but no testing was done in order to prove or disprove this); and (c) where my mother's remains are now. Very truly yours, /T G'LYtG Jane E. Dillard cc: Mr. Ted Signet, Director, Contra Costa County Health Services Mr. Ned Robinson, Attorney at Law Enclosures: 1. My letter of 4/3/89 to Dr. Kim. 2. Autopsy Report #4427993 of 3/30/89. 3. Certificate of Death #38907p01752 of 4/5/89. jd 2087 Norse Dr. #100 Pleasant Hill , CA 94523 April 3, 1989 Hye-Kyung Kim, M.D., Pathologist Contra Costa County Health Services Pathology Laboratory Merrithew Memorial Hospital 2500 Alhambra Avenue Martinez, California 94553 RE: RHODA BIRKHOLM, DECEASED MARCH 28, 19899 7:40 P.M. Dear Doctor Kim: My mother, Rhoda Birkholm, was admitted to ER at Merrithew Memorial Hospital at approximately noon on March 28, 1989, in an extreme and acute state of convulsions. Several doctors at Merrithew consulted off and on for five hours in ER and again while trying to determine which ward should take care of my mother. (Incidentally, I very much appreciate the concern and caring that was exhibited by these doctors.) She was admitted into I.C.U. at 6:00 p.m. Dr. Terry Myers was assigned to my mother's case and was her doctor for about 21' hours before my mother expired. Inasmuch as all those concerned about my mother were puzzled as to the cause of death, we mutually agreed that an autopsy was in order. Following receipt of your Provisional Diagnosis of March 30th and before Dr. Myers left for a week's vacation, she was going to request that you check the levels of sine-quern in the remains and also the level of body fluids. Dr. Myers was going to request that the brain be examined as well . Sine-quan was administered orally once a day beginning on March 15th, and the strength was 25 mg. It was discontinued March 21, 22, and 23. It was resumed at double the strength (50 mg) once a day March 24, 25 and 26. It was discontinued on March 27th. The convulsions increased in intensity over time (41 days); they were uncon- trollable, causing hallucinations and eventually an inability to communicate because of the violence of the shaking. (It's possible that the severe bruising of my mother's forearms that you observed was due to banging against the bed rails.) Fluids were restricted to 1200 cc per 24 hours beginning on March 15th. I believe this to be an untimely death because, although my mother was 90 years old, highly successful hip replacement surgery had been performed by Dr. Paul Nottingham on February 21, 1989. He checked it at Merrithew's .Ortho Clinic on March 21st and said that it was perfect. Incidentally, the results of the extensive pre-op examinations, blood tests, EKG, x-rays, etc., were all more than satisfactory. These results indicated that surgery would not adversely affect my mother - quite the contrary, it was expected that the quality of her life would be greatly improved. ilai to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating td cause`s ,of action for death 'orifor injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented'not later than six months after the accrual of the cause of action. Claims relating to any other cause of'action,must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,, 651 Pine Street, ..Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against °more than one'publio entity, separate claims''must be filed 'against each public entity. i E. Fraud. See penalty for fraudulent claims,' Penal Code 'Seci 72 at,the end of this form. RE: Claim By ) Reserved for .Clerk's filing stamp JANE DILLARD ) 2087 Norse Dr. #100, Pleasant Hill, CTI) 7BATCHELOR Contra Costa County ) � N.I Against the County of Contra Costa ) J89 or ) District) CLERK RVISORSFill in name ) �csvDeputy The undersigned claimant hereby makes claim against the County of Contra Costa or;,; the above-named District in the sum of $,250,000.00 and in support.of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? I (Give exact date and hour) Autopsy performed March 30, 1989. I ------------------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county) Pathology Dept. , Merrithew Memorial Hospital, Martinez, bA, Contra Costa County. --------------------------`------------------- ------------------------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if requited) For £ull 'details, please see attached letters, with enclosures, to Frank Puglisi and to Ted Signet, both dated June 12, 1989, and both written by ,claimant. -------------------------------------------------------------------------- 4. What particular `act or omission on the part of county or district officers, servants or employees caused the injury or damage? Following my mother's death; I requested an autopsy to determine cause of death and to determine if death-was preventable. The physical description in the autopsy report clearly indicated that the female examined by the pathologist was not my mother and the body released to the funeral home for' cremation was not my mother. (over) J Hye-Krung Kim, M.D. -2- April 3, 1989 I hope that the above information will assist you in your efforts to deter- mine the cause of my mother's death. Sincerely, v/ Jane Dillard cc: Terry Myers, M.D. Paul Nottingham, M.D. HOUSE MEDICAL STAFF PHYSICIAN AUTOPcY : 9 A 89 RTRKHOLM, R "InA WERS M.D. 4427993 X PROCEDURE DOB : 1/31/99 Win: 3/28,189 AUTOPSY, GROSS ONLY DOA, 3/30/89 AUTOPSY, INCL. CNS GROSS ONLY i AUTOPSY, EXCL. CNS GROSS AND MICROSCOPIC PATIENT I.D. AREA MUST BE READABLE ON ALL COPIES. I AUTOPSY, INCL. CNS GROSS AND MICROSCOPIC PROSECTOR: AUTOPSY, SINGLE ORGAN STUDY X OTHER PROCEDURES (SPECIFY) Hye-Kyunct Rim, %L4 T). AUTOPSY REPORT I PBOVIS ONAL DIAnNOSIS : I. PULMONARY EDEMA, MILD, LEFT LUNG I IT. OLD CALCIFIED GRANULOMA, RIGHT LOWER LOBE III . OLD MYOCARDIAL INFARCT, SMALL, POSTERIOR WALL D: 3/30 T: 3/30/89 HKK:sk T?Y -KY:JNG KI-f, M.D. PATHOLOC'IST CONTRA COSTA COUNTY HEALTH SERVICES-PATHOLOGY LABORATORY HYE-KYUNG KIM, M.D., PATHOLOGIST IRCHG-403 (5/83) PHYSICIAN AUTOPSY: 9 A89 BIRKHOLM, RHODA C MYERS M.D. 4427993 X PROCEDURE DOB : 1/31/99 AUTOPSY, GROSS ONLY DOD: 3/28/89 DOA: 3/30/89 AUTOPSY, INCL. CNS GROSS ONLY AUTOPSY, EXCL. CNS GROSS AND MICROSCOPIC v„T{E NT {.O. AgEI{MVST BE RF.Ot OIE ON I,LL COV\ES. AUTOPSY, INCL. CNS GROSS AND MICROSCOPIC PROSECTOR: AUTOPSY, SINGLE ORGAN STUDY Hye-Kyung Kim, M.D. X OTHER PROCEDURES SPECIFY AUTOPSY REPORT FINAL DIAGNOSIS \� I . BRONCHOPNEUMONIA, PATCHY II . CHONDROHAMARTOMA, RIGHT LUNG III . MYOCARDIAL INFARCT, OLD, SMALL, POSTERIOR WALL C D: 5/1 T: 5/2/89 HKK:sk C . rG 'tel HYE-K7CU�NG KIM, M.D'�(. PATHOLOGIST CONTRA COSTA COUNTY HEALTH SERVICES-PATHOLOGY LABORATORY HYE-KYUNG KIM,M.D., PATHOLOGIST IRCHG-403 (5/83) . . i X111 1 1 AUTOPSY: 9 A 89 PHYSICIAN BIRKHOLM, RHODA CMYERS M.D. 4427993 DOB: 1/31/99 X PROCEDURE DOD: 3/28/89 AUTOPSY, GROSS ONLY DOA: 3/30/89 AUTOPSY, INCL. CNS GROSS ONLY AUTOPSY, EXCL. CNS GROSS AND MICROSCOPIC PATIENT 1.0. AREA MUST BE NEAOABLE ON ALL COPIES. AUTOPSY, INCL. CNS GROSS AND MICROSCOPIC PROSECTOR: AUTOPSY, SINGLE ORGAN STUDY X OTHER PROCEDURES SPECIFY Hye-Kyung Kim, M.D. AUTOPSY REPORT GROSS EXAMINATION PND DESCRIPTION: GENERAL EXAMINATION: The body is that of a well-developed and c slightly obese white female appearing as the recorded age of 90 years old. The body measures 63. 5 inches in length and the weight is approximately 180 lbs . Rigor mortis is present in extremities and post mortem . lividity is present in dependent parts. There is a reddish purple discoloration of the medial aspect of the left arm. The head has a modeate growth of brown hair of fine C testure. Body hair has the usual female sexual distribution. There is no palpable mass in either breast. Abdomen is slightly protuberant. There is no cyanosis or clubbing of the fingers.- INITIAL INCISION: The usual Y-shaped incision is made through the subcutaneous fat measuring 3 . 5 cm thick in the midabdomen. The peritoneal cavity is free of fluid or adhesion and exposed portion of the right lobe of liver is pinkish red and smooth. The autopsy was limited to the examination of heart and lungs as requested by T. Myers, M.D. HEART: The heart weighs 325 grams . The epicardial surface shows normal fat distribution. Rightcoronary artery shows approximately 50-60% luminal stenosis 3.5 cm away fromits orifice by calcified atheromatous tissues. Left coronary artery is widely patent. Serial sections of myo-Cardium show yellowish tanmottled area in the posterior inferior wall consistent with old myocardial. infarct. There is no gross evidence of acute infarct. Tricuspid, pulmonic and aortic .' , :valves are unremarkable and free of vegetation. Mitral valve shows calcific masses at the base ofthe mitral valve probably age-related. Chordae tendeniae and papillary muscles are unremarkable. LUNGS: The right lung weighs 425 grams and the left lung weighs 475 grams. Careful examination of the right and left pulmonary arteries reveal no evidenceof thromboembolism. Right lung shows hard calcified nodules measuring 2 cm in maximum dimension near the diaphragmatic surface of the lower lobe. REst of the lung is CONTINUED ON PAGE 2 CONTRA COSTA COUNTY HEALTH SERVICES-PATHOLOGY LABORATORY HYE-KYUNG KIM, M.D.,PATHOLOGIST IRCHG-403 151831 t t PHYSICIAN AUTOPSY: 9 A 89 CM D BIRKHOLM, RHODA X PROCEDURE 4427993 AUTOPSY, GROSS ONLY AUTOPSY, INCL. CNS GROSS ONLY AUTOPSY, EXCL. CNS GROSS AND MICROSCOPIC PATIENT J.D. AREA MUST BE READABLE OR ^LL COPIES. AUTOPSY, INCL. CNS GROSS AND MICROSCOPIC PROSECTOR: AUTOPSY,SINGLE ORGAN STUDY X OTHER PROCEDURES (SPECIFY)- AUTOPSY SPECIFY - AUTOPSY REPORT GROSS EXAMINATION AND DESCRIPTIONS PAGE 2)_ essentially unremarkable. Left lung shows moderate pulmonary Cedema with fluid exuding from the cut surfaces. There is no gross evidence of bronchopneumonia. D: 3/31 T: 3/31/89 HKK :sk — ` F HYE-KY JNG KIM, ' M.7/ PATHOLOGIST CONTRA COSTA COUNTY HEALTH SERVICES-PATHOLOGY LABORATORY HYE-KYUNG KIM,M.D., PATHOLOGIST IRCHG-403 15/833 • i:r!AH T 6� PHYSICIAN AUTOPSY: 9 A 89 BIRKHOLM, RHODA C MYERS M.D. 4427993 X PROCEDURE DOB: 1/31/99 DOD: 3/28/89 AUTOPSY, GROSS ONLY DOA: 3/30/89 AUTOPSY, INCL. CNS GROSS ONLY AUTOPSY, EXCL.CNS GROSS AND MICROSCOPIC PATIENT I.D. AREA MUST 9E READABLE ON ALL COPIES. AUTOPSY, INCL. CNS GROSS AND MICROSCOPIC PROSECTOR: AUTOPSY, SINGLE ORGAN STUDY Hye-Kyung Kim, M.D. X OTHER PROCEDURES SPECIFY AUTOPSY REPORT MICROSCOPIC DESCRIPTION:— HEART: ESCR�ITI ON:_ HEART: Sections of the posterior myocardium show stellate areas of interstitial fibrosis and hyalinization with loss of myocardial fibers consistent Lith old myocardial infarct. There are scattered macrophages containing lipofluxen pigment . Focal areas of cal- cific deposits are also present in the area of hyalinization. There is no evidenceof acute myocardial infarction. Random sections taken from the rest of the left myocardium are essentially Cunremarkable. LUNGS: Sections of both lungs reveal patchy areas of acute bronchopneumonia. The dilated bronchi and bronchioles contain neutrophilic exudates mixed with clumps of bacteria. Rest of the lungs show areas of interstitial fibrosis with hyalinization and focal areas of bronchoalveolar cell hyperplasia associated with increased mucus production. Sections of the calcified nodule in the right lung reveals benign chondrohamartoma with areas of ossification. The vessels are congested and some of the alveolar spaces contain proteinatous fluid indicating pulmonary edema. D: 5/1 T: 5/2/89 HKK:sk HYE-KYO KI PATHOLOGIST CONTRA COSTA COUNTY HEALTH SERVICES-PATHOLOGY LABORATORY W VG-W V,IMr. V IAA nn n PATI-In. nr'or CERTIFICATE OF DEATH - ,(( ^ �; } :1 STATE OF CAUFORNIA Jy V I V V I I .J STATE FILE NUMBER USE BLACK INR ONLY LOCK "MIFTRATION DETNICT AND CERTIFICA,E MUNRRK • I.A. NAME OF DECEDENT—PURR IB. MOaA IF 4ii IFAYYT 2A DATE OF DEATIH—. El NIUR 3. SEX IoYOHt 1f errK DAY.Yw R RHODA Leona BiRKHOL�I MARCH 28 1989 11940 : FEMALE L RACE S. SPAMSIVNIEPANIC 6 DATE OP BIRTH— T. AOE IN INDu2w IOURE MOwYw DAY. YW YEARS 1IOMTME DAY[ FJUwf PHARE/ White °Y[' S.1v. �"° Jan 31, 1899 90 1 1 DECEDENT S STATE OF 9. CITIZEN OF WHAT IOA. PULL NAME OF FATHER ;I OIL STATI[d 1/A. PULL MAIDEN NAME OF MOTHER 116 STAT[OF PERSONAL BIRTH COUNTRY I BRM I BIRTH DATA CA USA William Pascoe IUNK Johanna Durst JUNK 12 MILITARY SERVICE? li SOCIK SECURITY, 14. MARITAL I IS NAME OF SURVIVING SPOUSE N WEIL pTER MAIDEN KAMM 19_ To ,9_ 34 NONa556 NUMBER 01-2747 Widowed - 1 BA. USUAL OCCY►AYION 168. UWAL KiMO OF SUYR91 I I Sr-UEIYL Eld"OYEZ ,aO.YEAIH w UwIAI 17.NIAOq w MEREST GRAD[COw I Ow INOWTRY I OCCUFATION PUIT1D11-12011COLRJW 1}17.1 Insurance Clerk ; Insurance ; Unknown 4 10 ISR[EDEnTE-3TR1R APO NUME[R OR LOCAYION I taw CRY IBC.ZIP COW I I USUAL 100 Boyd Rd # 107 ' Pleasant Hill ' 94523 RESIDENCE 1110.CO I I SIL NUMBER OF YEARS: I SF.SFAYE OR FORION COUNTRY 20.NAML RELATIONSHIP. MAG➢N9 AOORED9 IN THIS Ca AND ZIP COW OF INFORYAM Contra Costa ; 60 CA Jane E. Dillard-Daughter ISA PLACE OF DEATH r1WLF NOGPITAI SlRGlT 1 ISG COUNTY 2087 Norse Dr ,YT 100 Ow v.MUIOP.DOA Fuca Merrithew Manorial : IP Cmtra Costa Pleasant Hill,CA 94523 OF DEATH 190.STREET wDORISB--9i1�f MO HIA�ER OR LOCATION1 19w CITY TRIG INTCRK 2E:.WAS 04TH REPORTED 10 COROROT 2500 Alhambra Ave 1 Martinez APE DLATN Q Y!E RTR�awL IAAeEa ND III.DEATH WAS CAUSED BY: (@ITER ONLY ONE CADS!PER Lom FOR A R AND 4-Tvm OR PIR9,T 1 2i WA9/SPIT PERFORM? RAMEDIATEf W BRADYCARDIA cAusa MINUTE O Yu No L CAUSE 24A.WA9 AUI PuMPORM1001 OF ACUTE PULMONARY EDEMA : DAYS --a DEATH ITRJE TO C a'A .. .... ,1 .. . A ONo a. ljl` 2a .t sriW"R USED RR DartERrw• 1 BIa:CAUY OF DEATH . t'xPE TD (Ia'. �i Oro-, ND 21 OTIm1 3mlw:A CODR1010 CONTw Krrw9 TO DEATH GUY NOT RILATED TD GYRE CANE/IN El 26 WAS OmmiATKRI PEFOIBIED FOR ANY CAIORION IN ITE,21OR 2M Yrw R HYPERTENSION MONTH,DAY.NO TWO 1 CERTIFY THAT OGATN OCCURRED AT THE Naw.DATE am RRu AND DEBBIE OR TRta OF17G PHHYECIANS LRCDua MATEY 770.DAA 919:® PHYSL AND RACE STATED FROM THE CAUIM STATED. SCAR 77A.CHROEDESY ATTp01m lPCal OCIODHT LAST>®1 MAUY111 1 1 CERTIFICA. MONTH. DAY.YEAR t MONTH,DAY,YEAR 1 27w Fgl'WMA NAMa.AND ADOR<!.3 TION 03728-89 1 03-28-89, :ROGER I. MD, 2500 ALHAMBRA,AVE;.:MARTrb=',.EA -94553 I CERPY THAT DEATH OCCWRED AT THR HOUIL own AND 28A. SISHATEI!OF COORl1 w OiEVrY COwONY 1 2118.DATE SEIED PIAC[STATED PRORI THE CAUSER STATED. I CORONERS 26 MwNNE1 OF DEAYw—%oDIT=NOR'EaIM. 30A PUCK OF EHAER1 301L INAIRT AT WOR 1 30C.DATE OF INJURY 31.'Haw U212 "CdL nNwIL m EDt Il ashpbw E Cam M beO,E/BIE! YONM DAY. ONLY , Oro ❑No , 32. LOCATION(STREET AND NUA001 OR LOCATION AND CRT 31 DOC111W NOW INIUwY OCCURRED PIVOIT9 WHICH REEUATED IN IIUURTI FUN31IA. DISPOSITION 34E. PLACE OF P,IHAL DISPOSITION 34c.DATE OF ORB►OfITIOIH 3EA SIGNATVM OF �•� SEB.LICENSE ! ' •T�na �E. D htetl EIoNTL DRY.YEAR 1 NUMBER CR-RTF 1 ZUS 7 Norse Dr P CAS ; Apr 12,1989 Not Embalmed :AND LOCAL 311PL NAME W FUNERAL DIRECTORDTOR TOR"0111ACTINGOH ACTAS SUCH Saw r. 34HATURE OF LOCAL REGISTRAR 3w REGISTRATION DATE � TR Bryant bI Moore Concord,CA F 873 I.ICEN3E N0. APR 1 i i989Yc STATE Aw C. 0. L F. CENSUS TRACT y REOIETRAR l/'/-7'yC VS-I1 OMM 14M MAKE NO ERASURES WHREOVTS.OR OTHER ALTERATIONS P -certification This is to certify that the above is a true and correct coot' of facts Statement recorded on the death record of the above named decedent as registered in this office. Signature of Certifying ying Official Official Title Local Registrar Place of Certification Date of Certification Contra Costa County Health Services- Public Health Division MAY 10 1989 Martinez, California r State of California, Health Services-Public Health D°sision, Bureau of Vital Statistics CERTIFIED MAIL 2087 Norse Dr. #100 RETURN RECEIPT REQUESTED Pleasant Hill, California June 12, 1989 Mr. Ted Signet, Director Contra Costa County Health Services Medical Records 2500 Alhambra Avenue Martinez, California 94553-3191 RE: RHODA L. BIRKHOLM, DECEASED 3/28/89 Dear Sir: Following extensive pre-op testing at Merrithew Memorial Hospital, highly successful total hip replacement surgery was performed on my mother, Rhoda Birkholm, by Dr. Paul Nottingham on February 21 , 1989, at Merrithew Memorial Hospital. The healing process proceeded nicely, but my mother became depressed. . She was moved from D Ward to H Ward for a week to receive specialized care. On March 69 1989, my mother was released and entered Hillhaven Willow Pass, a skilled nursing home. On the recommendation of the admitting officer at Hillhaven, Dr. Dennis Stone was assigned to my mother's case. Apparently Dr. Stone visited with my mother some time on March 6, 1989. See attached copies of billings for nursing home visits of March 6, 159 20, 24 and 28. The only one that I knew about in advance was the March 15th visit, because I requested it. (Also, numerous blood samples were ordered by Dr. Stone during my mother's 21-day stay at Hillhaven. What happened to them? Where are the results? Where are the billings?) My mother continued to be depressed and so I talked with Dr. Stone at Hill- haven on March 15th regarding this problem. He prescribed an antidepres- sant; discontinued the diuretic (which she had been taking for many, many years); and reduced her liquid intake because of swollen ankles. On March 20th I telephoned Lucy, the assistant director of nursing at Hill- haven, and requested that the antidepressant be discontinued. On March 21st, when we were at the orthopedic clinic at Merrithew, my mother was very unsteady on her feet while Dr. Nottingham was having her stand and walk. She seemed to be terrified that she was going to fall. She said her legs felt as if they would not hold her up. On my visit of Friday, March 24th, I observed that the tremors were present. On Sunday, March 26, one of the visitors to Room 108 told me that my mother had been hallucinating the day before, and calling out that someone was trying to kill her. He informed the nurse. Indeed, by Sunday she was convulsing. I was told that it was the after effects of the antidepressant and that the agitation would cease in a day or two. Mr. Ted Signet, Director, Health Services -2- June 12, 1989 March 2 Monday evening I found my mother in a much worse condition, with severe and uncontrollable convulsing and a fever of 1030F at 7:00 p.m. I asked what they were doing about this and was told they would have to call Dr. Stone before they could take action. I also asked to see the records regarding the antidepressant. For the first time I learned that 25 mg of sinequan had been prescribed and given once a day at bedtime March 16, 17, 18, 19, and 20. It was discontinued (per my request of March 20th) on March 21 , 22 and 23. Sinequan was resumed, without my knowledge or consent, March 24, 259 26 - this time at double the dosage, or 50 mg once a day at bedtime! ! (I have the LVN's notes on this.) When I left I was assured that they would get in touch with the doctor and let me know what action he would take to alleviate my mother's extreme suffering. No one called. I telephoned Hillhaven at 10:00 p.m. and learned that Dr. Stone had them discontinue sinequan; he prescribed 20 cc Septra (an antibiotic) every 12 hours for ten days; he ordered a blood sample to be taken that night for blood culture work; and ordered a urine test for March 28th to deter- mine if fever was caused by urinary tract infection. March 28 I telephoned at 1:15 a.m. Temp. was 100°F; pulse 96; B.P. 126/80. Blood sample was taken at midnight. I commented to the gal who answered the telephone at the nursing station that "I wonder how long you think that a 90-year old heart can withstand the effects of the severe convulsing?" I telephoned at 7:00 a.m. and asked about fever: Midnight, 101°F; 3:00 a.m., 101°F; and 5:00 a.m., 1010F. They inserted catheter at seven o'clock because my mother did not void during the night. My telephone rang at about 10:30 a.m. on March 28th. It was Dr. Stone, telling me that he had ordered a chest x-ray at 9:30 that morning. He said the portable unit had shown that my mother had "double pneumonia" and that the ".. .liver was pushed high against the diaphragm" He said he would be sending her back to Merrithew by ambulance. I asked him, "Is this going to be a case where the surgery was successful but the patient died?" I arrived at Hillhaven at eleven o'clock, just as they were settling my mother into the ambulance. One of the ambulance attendants told me that she had never seen anything like my mother's condition, with uncontrollable convulsing and with both forearms completely covered with dark, purplish bruises. The convulsing was so sevesb that my mother was unable to communi- cate with me. Mr. Ted Signet, Director, Health Services -3- June 12, 1989 When I arrived at the hospital , I found my mother in ER. The nurses were trying to make her as comfortable as possible. The ER doctor in charge asked me when she had first begun to convulse. When I told him 41 days ago, he was indeed shocked. My mother was eventually taken to x-ray, where the large machine showed her lungs to be clear - no pneumonia; no fluid; and no liver displacement. She was returned to ER. Doctors consulted together regarding her condi- tion until about 5:30 p.m., when they had her sent to D Ward. The nurse in charge said that there was no way they could take care of someone so acutely ill. Dr. Tremaine then consulted for some time with other col- leagues. He decided, with my urging, to have my mother taken to I.C.U. He asked me to be thinking about what decision to make if her condition worsened and if she could only be kept alive by means of a life-support system. I told Dr. Tremaine that the decision had already been made by my mother - she had a Living Will. He breathed an audible sigh of relief and said, "Oh, that's good!" I told him that I would bring him a copy of this document. At 6:00 p m. my mother was taken to I.C.U., where they immediately padded the bed rails with pillows to protect her badly bruised forearms, admin- istered oxygen, and did whatever else they could to make her as comfortable as possible. At 6:45 p.m. I told my mother that I would be leaving for awhile but that I would return soon. I went home to look for the Living Will to give to the personnel in I.C.U. At 7:30 p.m. my mother expired, before I had had an opportunity to see her again. How sad. You may wish to investigate to determine if: 1. Dr. Dennis Stone is a sincere, hardworking, honest gerontologist, whose first concern is for the frail elderly. 2. If Dr. Dennis Stone is abusing the Medicare/Medi-Cal and nursing home programs for his own financial gain, at the expense of the frail elderly. 3. If our county Ombudsman, Lois McKnight, should investigate the practices at Hillhaven Willow Pass. Ve y trul yy/o//urs99, 7�� F e E. Dillard cc: Mr. Frank Puglisi, Administrator, Merrithew Memorial Hospital Ms. Priscilla Tudor., L.C .S.W., Merrithew Memorial Hospital Mr. Ned ggobinson, Attorney at. Law Enclosures: 1. Physician s Orders of 3/6/89-3/9/89. 2. Bills from Dr. Dennis Stone, together with Medicare Statements. 3. Bill from Dr. Camarda, Podiatrist. 4. Excerpts from "Worst Pills/Best Pills", by S. M. Wolfe, M.D., 1988. jd P�11` U =M99 bRDERS �O`3 �` 3 io:I m . ioi z fi D/C DATE ORDER DATE Cd ORDER TEXT FREQUENCY "c _ E� ER I :x EQ F`VALt`�1Ta hq '� E<�p�JSECC3ES �^yyH R > '�' t .yb ty .,,, ♦ L Lti. )yv1 r n M 1< .. ? 3 _y .,t/M. I �ry.ea, f:i.N. r.s J....G .b',y. 4✓.'...'1�r',. 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YTr'.x �•• iJ 7t.. ...+ v" t. 8 b t :k:Yt 7 �t ,e♦'y, a �� 7 ^T`!.1# 'i r ^r.. ♦ -.:.Rt 3�a4� .b:' 4��' 7t.:X�. ..C7C:?Z: .t:k. -:e , „m'. •',CHARTING FROM }_?f�THRU �`.+(','= ntr`' ;S-Y"'�.v' -""'T-'.t'. �T:.•=�.., .i^♦ "FACILiTY.NAMEarf:+ '. _, .,t.ak:�' t .._°r''°"J,'r ,° �'..;,LAST..P,NYS�EXAM':'''. ' j15181414!- 's.02101:189:: x. .y. ♦.vim ti .<. t•.:,v „ CIA PHYSINA + ";. NMEx',,'.�.'a" t'tt"'s �`;.'z 5"� '3f4:t` "` ,` ' -:.e eam�� , �v �• , . .. .. _ ,�,.'� . , ,� ,y,ePHYSIGANiPH�IVE s � . + �:.s.� •.Ak�C:'QHV31GiAN dd,f�6E �'' .„-' +�.a(�'aPaYs;F�O,� . `^, 1 y y•,. S �?.. ttt :«, , y Y.•., , r a a. J , 'Y„,� 31 . STONEr DF_NNIS- hi 7 1 E`dG1-t iJGE, ;STU�RT 'F M` F ai: S.IRYc P •'vil S :N' 4T .. p !hr el ; alis cJ.(iy�Ja”' d<�� �.�•� G"� 3/ L/� �f� s n, 'u'`e'.,`y nn'a` ::1. s.'.:� _ F ALLRGIESd.. •r' ,r: >, r .i.. t..lj.�LS�oG��G�,�-.t� ✓�a�;1"te No ,k;nown .AI i ar<a �"i� zf! p r... x . *., f?u ' .• ti «"�,;?'T i4�?t�`,!. 'S.="^ � PATIENTNO"d ,� `$S'Ar�,,. �r «.. QMJBED ♦},� pA ` .•` "''.-" .,.PATIENT NAM£j,,*'x,.^k �' f E; iPV.H 1LMt E,c .;' 4oF.. �LOo.Jnd A/Li iU �iti.L C_J(Dd1/ 'e7 PHYSICIAN OR SUPPLIER STATEMENT OENNES L . STONE , M . D. OFACCOUNT GERONTOLOGIST 978 '2ND, STREET, SUITE 1Q0 , LAFAYETTE CA 94549 • • • • 415-283-7777 • • • • • • • • • • vJFi3fi05 PATIENT'S NAME ACCOUNT NO. CHARGES AND PAYMEN DE AFTER B E RK0 1 DI LL02 THE STATEMENT DATE R ON INSURED NEXT MONTHS STATE C ,dA JANE DILLARD Cp� R1719� 2087 NORSE, DR . #100 PLEASANT HILL , CA 94523 ATEMENT DATE AMOUNT OF / PAYMENT m 03- - 9 ENCLOSED DATE PLACE PROCEDURE DIAGNOSIS TYPE SEROV CE EROVICE CPTCaBE O E S C R I PT I O N C�BD�9 SERV. CHARGES PAYMENTS ------- RHODA BIRKHOLM 3-06-89 NF 903-20 HISTORY & PHYSICAL/COMP. 111305 1 117 . 21 3- 1 :,-89 NF 90360 NURSING HOME VISIT/INTERM ' 13 . 6 1 :3 . 64 3- 15-89 NF 90360 9620 1 - --- - 165 . 85 U.00 -V= ES INSLRANCE FILED i� D lcj �3 t. ,L. sCLU / L r Q t.°,A CCH BU INESS SER ICES lul F YOU ll'WtF—XNY QL'ESTWNti RKGA�RD! Y�AlA� �s 19� IS L. STONE, M. D. CCOUNT , CALL MARIE AT 415-283-77 7 . N `J78 2ND STREET, SUITE 100 (FAYETTE CA 94519 31 - 60 61 - 90 91 -120 121 -> 0 . 00 0 . 00 0. 00 0 . 00 • 165 . 85 YOUR .EXPLANATION OF MEDICARE'BENEFITS READ THIS NOTICE CAREFULLY AND KEEP IT FOR YOUR RECORDS THIS IS NOT A BILL — HEALTH CARE FINANCING ADMINISTRATION APRIL 04, 1989 Heed help? Contact: — ## RHODA BIRKHOLM Medicare - Chico, California 95976 100 BOYD ROAD 107 Telephone 800-952-8627 HORTHERH CALIF . PLEASANT HILL CA 94523 800-848-7713 SOUTHERN CALIF . If you write or call , please give us: Claim Control Humber (marked ** below) STATEMENT HUMBER 044377623-1 CHECK NUMBER 087450835 ^PARTICIPATING^ DOCTORS AHD SUPPLIERS ALWAYS ACCEPT ASSIGNMENT OF MEDICARE CLAIMS . SEE THE BACK OF THIS NOTICE FOR AH EXPLANATION OF ASSIGNMENT. WRITE OR CALL US FOR -THE NAME OF A PARTICIPATING DOCTOR OR SUPPLIER . OR FOR A FREE_ LIST- OF PARTICIPATING DOCTORS AND SUPPLIERS . Your doctor o -.-9'uppb, ex did not accept assignment of your claim totalling $165. 85 . (See item 4 on the back . ) Claim Con of Humb ** 200489079174660 ** STOKE DE Billed Approved 01 HH Visit(s ) 90320 1 AR 06 , 1989 $ 117 . 21 $ 100 . 00 Approved amount limited by item 5b on back. 01 KH Visit(s ) 90460 1 M 1 989 $ 48 . 64 $ 35 . 90 Approved amount limited by item 5c on back. APR 17 1989 . T . . $ 13 0 . Total approved for all sexvices on this claim . . Medicare payment (80% of the approved amount) $ 8 . 7 CCHP•BUSINE'SS SERVICES � We are paying a total of T 8 . 72 t you on the enclosed check . Please cash it as soon as possible . If you have other insuran may help with the paxt Medicare did not pay. (You have met the deductible fox 1989 ) Next time you request payment, use your MEDICARE CLAIM HUMBER as it is shown on this notice . IMPORTANT: If you do not agree with the amounts approved, you may ask for a review . To do this , you must WRITE to us before OCT 04, 1989 . (See item 1 on the back. ) DO YOU HAVE A QUESTION ABOUT THIS NOTICE? If you believe Medicare paid for a service you did not receive, or there is an error, contact us immediately. MEDICARE CLAIM H0 . 556012747D ir 1111111111""jjiloo C3e78 k51881 �i I� / i ., Y, YOUR EXPLANATION OF MEDICARE BENEFITS READ THIS NOTICE CAREFULLY AND KEEP IT FOR YOUR RECORDS THIS 1S NOT A BILL HEALTH CARE FINANCING ADMINISTRATION APRIL 11 , 1989 Need help? Contact: ## RHODA BIRKHOLM Medicare - Chico , California 95976 100 BOYD ROAD 113 Telephone 800-952-8627 NORTHERN CALIF . PLEASANT HILL CA 94523 800-848-7713 SOUTHERN CALIF . If you write or call , please give us: Claim Control Humber (marked ** below) STATEMENT HUMBER 044462954- 1 CHECK HUMBER 087507046 "PARTICIPATING" DOCTORS AND SUPPLIERS ALWAYS ACCEPT ASSIGNMENT OF MEDICARE CLAIMS . SEE THE BACK OF THIS NOTICE FOR AN EXPLANATION OF ASSIGNMENT . WRITE OR CALL US FOR THE NAME. OF A PARTICIPATING DOCTOR OR SUPPLIER OR FOR A FREE LIST OF PARTICIPATING DOCTORS AND SUPPLIERS . Your doctor or supplier did not accept assignment of your claim totalling $48 . 64 . (See item 4 on the back. ) Claim Control Humber ** 200489087023210 ** STONE DE Billed Approved 01 HH Visit( s) 90460 1MAR 20 , 1989 $ 48. 64 $ 35 . 90 Approved amount limited by item 5c on back . Total approved for all services on this claim . . . . . . . . . . . . $ Medicare payment (80.% of the approved amount) . . . . . . . . . . . . $ ' 28 . 72 We are paying a total of $ 28. 72 to you on the enclosed check . Please cash it a5 soon as possible . If you have other insurance , it may help with the part Medicare did not pay . (You have met the deductible for 1989 ) Next time you request payment, use your MEDICARE CLAIM HUMBER as it is shown on this notice . IMPORTANT: If you do not agree with the amounts approved , you may ask for a review . To do this , you must WRITE to us before OCT 11 , 1989 . (See item 1 on the back . ) DO YOU HAVE A QUESTION ABOUT THIS NOTICE? If you believe Medicare paid for a service you did not receive , or there is an error , contact us immediately . MEDICARE CLAIM HO . 556012747D APR 17 1989 D CCHP BUSINESS SERVICES C3878 (6/88) PHYSICIAN OR SUPPLIER •� I Y/ �'� i DENNIS L. STONE, M:D. dIERONTOLOGIST ' OF ACCOUNT ,9'18 2ND STREET , SUITE 100 LAFAYETTE CA 94549 • • • • 415-283-7777 • • • • • • • � • • 680063605 PATIENT'S NAME ACCOUNT No. CHARGES AND PAYMENTS MADE AFTER BIRK01 DILL02 THE STATEMENT DATE WILL APPEAR ON INSURED NEXT MONTHS STATEMENT. JANE DILLARD 2087 NORSE DR. #100 PLEASANT HILL, CA 94523 STATEMENT DATE AMOUNT OF PAYMENT M 04-24-89 ENCLOSED DATE PLACE PROCEDURE DIAGNOSIS TYPE SEgVICE ERv+cE CPc�iD9 DESCRIPTION Irt�l SERV. CHARGESr3l YMENTS RHODA BI KHO M Items not Detailed from 03-22-89 214 . 49 -------- RHODA BIRKHOLM 03-24-89 SNF 90360 NURSING HOME VISIT/INTERM 514 1 48 .64 03-24-89 SNF 90360 276 . 1 1 ,f y 03-24-89 SNF 90360 71505 1 03-28-89 SNF 90360 NURSING HOME VISIT/INTERM 486 1 48 . 64 ------- ------- 311 . 77 0 .00 * DENOTES INSURANCE FILED IF YOU HAVE ANY QUESTIONS REGARDING YOUR DENNIS L. STONE, M. D. ACCOUNT, CALL MARIE AT 415-283-7777 . 978 2ND STREET, SUITE 100 LAFAYETTE CA 94549 31 - 60 61 - 90 91 -120 121 -> 165 . 85 0 .00 0 . 00 0 . 00 311 . 77 t 1, i I /I YOUR EXPLANATION OF MEDICARE-BENEFITS / READ THIS NOTICE CAREFULLY AND KEEP IT FOR YOUR RECORDS l ` THIS IS NOT A BILL — HEALTH CARE FINANCING ADMINISTRATION APRIL 18, 1989 Heed help? Contact: — ## RHODA BIRKHOLM Medicare - Chico , California 95976 2087 HORSE DR 100 Telephone 800-952-8627 NORTHERN CALIF . PLEASANT HILL CA 94523 800-848-7713 SOUTHERN CALIF . If you write or call , please give us: Claim Control Humber (marked ** below) STATEMENT HUMBER 044546035- 1 CHECK HUMBER 087561787 "PARTICIPATING" DOCTORS AND SUPPLIERS ALWAYS ACCEPT ASSIGNMENT OF MEDICARE CLAIMS . SEE THE BACK OF THIS NOTICE FOR AH EXPLANATION OF ASSIGNMENT. WRITE OR CALL US FOR THE NAME OF A PARTICIPATING DOCTOR OR SUPPLIER OR FCR A FREE LIST OF PARTICIPATING DOCTORS AND SUPPLIERS . Your doctor or supplier did not accept assignment of your claim totalling $97 . 28 . (See item 4 on the back . ) Claim Control Number ** 200489093230510 ** STONE DE Billed Approved 02 HH Visit(s ) 90460 1 AR 24-MAR 28, 1989 97 28 $ CL. 80 Approved amount limited by item c on Total approved for all services on this claim . . . . . . . . . . . $ Medicare payment (80% of the approved amount) . . . . . . . . . . . . $ We are paying a total of $ 57 . 44 to you on the enclosed check . Please cash ity, as soon as possible . If you have other insurance , it may help with the part Medicare did not pay . Assignment was taken on your claim, for $87 . 00 from CAMARDA DO . (See item 4 on the back . ) Claim Control Number *�* 202289093127450 ** Billed Approved 01 HH Sur ery 1170 2 MAR 28, 1989 $ 65 . 00 $ 46 . 00 Approve`d amount limited by item Sc on back. 01 HH Lab 87102 5 MAR 28, 1989 . $ 22 . 00 $ 13 . 36 Approved amount limited by item 5b on back . CAMARDA DO agreed to charge no more for the approved services than the amount approved by Medicare . Total approved for all services on this claim . . . . . . . . . . . . $ 59 . 36 Amount for services paid at 80% of the approved amount . . . . . . . . $ 46 . 00 Medicare payment for services paid at 80% of approved amount . . . . . $ 36 . 80 Amount for services paid at 100% of approved amount . . . . . . . . . $ 13 . 36 C8878 (6/88) • y PHYSICIAN OR SUPPLIER STATEMENT DONALD J. CAMARDA, D.P.M. OF ACCOUNT PODIATRIST 978 2ND STREET, SUITE 100 LAFAYETTE CA 94549 • " • • ' 415-283-7777 ' • ' • • • • • • • r PATIENT'S NAME ACCOUNT NO. CHARGES AND PAYMENTS MADE AFTER THE STATEMENT-D-ATE WILL A INSURED NEXT MOFFkS STAT�E�E�NNTT��-.��//� Ja�� RHODA BIRKHOLMJ 2087 NORSE DRIVE #100 PLEASANT HILL, CA 94523 STATEMENT DATE ;L r0UM OF M ENCLOSED DATE PLACE PROCEDURE A SEROF VICE OF DESCRIPTION C PT&A ca*r 9 SERV. ------- IHODA BIRKHOLM 3-28-89 NF 1170OXMW2 NAIL DEBRIDEMENT 1-5 10 . 1 2 65 .00 3-28-89 NF 87102 DTM CULTURE 10 . 1 5 22 . 00 3-28-89 SNF 87102 40 . 9 5 5-01-89 4DJ AREWO MEDICARE WRITE—OFF 19 . 00 5-01-89 MA MEDICARE PAYMENT 36 . 80 5-01-89 kDJ AREWO MEDICARE WRITE—OFF 8 . 64 5-01-89 MA MEDICARE PAYMENT 13 . 36 87 . 00- --77 . 80 IN qLAIMS UNIT MW 5 19 9 WELCOME TO OUR NEW BILLING SYSTEM. IF YOU HAVE DONALD J. CAMARDA, D.P.M. NY QUESTIONS ABOUT THIS BILL, PLEASE CALL 978 2ND STREET, SUITE 100 ARIE AT 415-283-7777 LAFAYETTE CA 94549 31 — 60 61 — 90 91 —120 121 —> 9 . 20 0 . 00 0 . 00 0 . 00 • 9 . 20 w i )No ]is I Y'll I is fflE,Slr i ]PIlLisis THE OLDER ADULT'S GUIDE TO AVOIDING DRUG-INDUCED DEATH OR ILLNESS i 104 Pills Older Adults Should Not Use 183 Safer Alternatives Sidney M. Wolfe, M.D. Lisa lbgate Elizabeth P. Hulstrand Laurie E. Kamimoto Public Citizen Health Research Group i ' 1 167 WHI EPRESSION: WHEN ARE DRUGS CALLED FOR AND WHICH ONES SHOULD YOU USE? � ? Y SHOULD EVERYONE WHO IS SAD SAN R DEPRESSED TAKE though depression is the most common mental illness in older adults, everyone who d or depressed is not a candidate for these powerful drugs. TO `- Kinds of Depression f .induced Depression 1? )tonically,one of the kinds of depression that should not be treated with drugs is depres- coused by other kinds of drugs. If someone is depressed and the depression started beginning a new drug, it may well be drug-caused. Commonly used drugs known to "HAT a depression in the following: (see full list on p.21, chapter 2) `:•Barbiturates such as phenobarbital S- • Tranquilizers such as diazepam (Valium) and triazolam (Halcion) • Heart drugs containing reserpine (Serpasil and others) • Beta-blockers such as propranolol (Inderal) •High blood pressure drugs such as clonidine (Catapres), methyldopa (Aldomet), -_ and prazosin (Minipress) '. • Drugs for treating abnormal heart rhythms such as disopyramide (Norpace) . • Ulcer drugs such as cimetidine (Tagamet) and ranitidine (Zantac) • Antiparkinsonians such as levodopa (Dopar) and bromocriptine (Parlodel) • Corticosteroids such as cortisone and prednisone • Anticonvulsants such as phenytoin (Dilantin), ethosuximide (Zarontin), and primidone (Mysoline) • Antibiotics such as cycloserine (Seromycin), isoniazid (INH), ethionamide (Trecator-SC), and metronidazole (Flagyl) ` • Diet drugs such as amphetamines (during withdrawal from the drug) • Painkillers or arthritis drugs such as pentazocine (Talwin), indomethacin (In- docin), and ibuprofen (Motrin, Rufen, Advil, Nuprin) t i> • Other drugs including metrizamide (Ampaque), a drug used for diagnosing slipped 57 discs, and disulfiram (Antabuse), the alcoholism treatment drug. li The remedy for this kind of depression is to reduce the dose of the drug or stop it al- together if possible. If necessary, switch to another drug that does not cause depression. 169 • WHAT IS THE BEST AND WORST TREATMENT FOR SEVERE DEPRESSION? Everyone with the kind of severe depression described above should be evaluated by a mental health professional to determine what kind of psychotherapy would be best to 3 supplement the antidepressant drugs that are going to be used. =r rThe decision as to which drug is best will depend largely on choosing one with the .s fewest g�verse effects, since all of the so-called tricyclic antidepressants are equally ef- t. fective. If depression has occurred previously and responded to one of the drugs 1, without too many adverse effects, that would be the best one to try first. Otherwise, the table below compares the eight tricyclic antidepressants that are listed in this book. It is a compolit58 ffiyomparative ratings of these eight drugs by four other re- searchers. , of ` _ Types of Adverse Effects ia; ho The four most common groups of adverse effects are anticholinergic, sedative,hypoten- :ne sive (blood pressure-lowering), and those effects on heart rate or rhythm. .�a Anticholinergic Effects ent WARNING: SPECIAL MENTAL AND PHYSICAL ADVERSE EFFECTS led Older adults are especially sensitive to the harmful anticholinergic effects of 'he "" tricyclic antidepressants. These drugs should not be used unless absolutely elf- necessary. lis- MENTAL EFFECTS: confusion, delirium, short-term memory problems, dis- ,ith ,. orientation, and impaired attention. PHYSICAL EFFECTS: dry mouth, constipation, difficulty urinating (espe- in cially for a man with an enlarged prostate), blurred vision, decreased sweat- rno s' fir;, ing with increased body temperature, sexual dysfunction, and worsening of iis- a _ : glaucoma. ind " Sedative Effects 3or ' Most older adults who think they have a sleeping problem do not have the kind of •A. ;severe depression that justifies the use of these drugs. (See p. 152 for a discussion of non- )�- ,drug treatments for sleeplessness.) Nevertheless, if the sleep disorder is a consequence of severe depression, the "side effect' of sedation may be useful as long as it does not produce too much sedation, with the risk of falling. This is an important consideration ntle especially in people who already have some impairment of thinking,increased confusion, Y disorientation, and agitation."' Hypotensive Effects: Lowering of Blood Pressure to Levels That Are Too Low Orthostatic (postural) hypotension, or the drop in blood pressure that occurs when e meone stands up suddenly, is a common side effect of antidepressants, especially in .Older adults. It can be even more troublesome if the person is already at increased risk F this problem because he or she is taking other drugs to treat high blood pressure. As ;. `result of such a drug-induced drop in blood pressure, falls that result in injury, heart lc ` hacks, and strokes can occur.5 For this reason, before starting treatment with one of irSt+ e antidepressants,blo d pressure should be taken both in the lying position and after ding for two minutes. This This should be repeated after using the drug for several weeks. r 170 . Effects on Heart Rate and Rhythm t These drugs can cause the heart to speed up. They can also cause a slowing down in the conduction of electricity through the heart, which is especially dangerous if some- : 3i one already has heart block.31 For this reason, a baseline electrocardiogram should be taken before starting any antidepressant therapy. ADVERSE EFFECTS OF ANTIDEPRESSANTS IN OLDER ADULTS Generic/ Antichol- Sedative Hypotensive Heart Rate/ Brand Names inergic* Rhythm .r desipramine/ mild mild mild mild Norpramin ' nortriptyline/ moderate mild mild mild Aventyl, 1.� Pamelor amoxapine/ moderate mild moderate moderate Asendin <. maprotiline/ moderate moderate moderate mild Ludiomil V. trazodone/ mild moderate moderate moderate Desyrel imipramine/ moderate moderate moderate moderate Tofranil oxepin moderate strong moderate moderate apin, Sinequan . amitriptyline/ strong strong moderate strong Elavil mild = mild adverse effects moderate = moderate adverse effects strong = strong adverse effects *seep. 169 As can be seen from this chart, the two drugs with the fewest overall adverse effects in older adults are desipramine (Norpramin), which has a "mild" for all four kinds of ad- verse effects, and nortriptyline (Aventyl, Pamelor), which is "mild" for three of the four. Unfortunately, neither is available generically as yet. The drug with the worst adverse ef- fects profile in older adults is amitriptyline (Elavil),with"strong"adverse effects for three of the four categories. We list this drug as DO NOT USE. If the adverse effects of whichever drug is selected are too severe, or if the drug does not seem to be working, a discussion with your doctor about switching to a drug less like- ly to cause the troublesome effects is in order. HOW TO REDUCE THE ADVERSE EFFECTS OF ANY OF THESE ANTIDEPRESSANTS ` �� • Have a baseline electrocardiogram and blood pressure taken before starting.30 i 171 • Start with a dose of one-third to one-half the usual adultdose, meaning 15-25 mil- k T • ligrams a day, at bedtime. Increase the dose very slowly.3 It may take 3 weeks to i in see an effect. A trial with one of tese drugs should continue until it either works me- or causes persistent side effects.s be At • Get a prescription for only 1 week's worth of pills since more pills increase the chance of a successful suicide attempt by people who are severely depressed. • Lower tl�e dose gradually, as symptoms dictate, after successful treatment for several months. LIMITED USE Doxepin (dox e pin) ADAPIN (Pennwalt) SINEQUAN (Roerig) :k Trazodone (traz oh done) DESYREL (Mead Johnson) Maprotiline (ma proe ti leen) LUDIOMIL (CIBA) Amoxapine (a mox a peen) ASENDIN (Lederle) ti Imipramine (im ip ra meen) in TOFRANIL (Geigy) ad- our' Generic: not available Family: Antidepressants (See p. 166 e of for discussion of de res- iree p sion.) t loes t ike- These five drugs are used to treat severe depression that is not caused by other drugs, by alcohol, orby emotional losses (such as a death in the family). You should notbe taking them for anxiety or mild depression, or as a sleeping RiL11. Because these drugs ave more harmful side effects see c art, p. 170 tan e wo antidepressants desipramine and nortriptyline (see p. 180), we consider them to be of limited use to older adults. . If you are over 60, you will generally need to take one-third to one-half the dose used by younger adults. If the initial dose is not enough and needs to be increased,this should be done very slowly. 172 - .. t i Trazodone can cause painful, prolonged penile erections (priapism) in men. If you suf. fer this reaction, stop taking the drug and notify your doctor. Amoxapine can cause tar. dive dyskinesia—uncontrolled movements of the jaws,tongue, and lips—an effect also seen with antipsychotic drugs (see p. 161). Doxepin has especially strong sedative effects. " d fv WARNING: SPECIAL MENTAL AND PHYSICAL ADVERSE EFFECTS Older adults are especially sensitive to the harmful anticholinergic effects of antidepressant drugs such as doxepin, trazodone, maprotiline, amoxapine, and imipramine. These drugs should not be used unless absolutely neves- sari= t NbNTAL EFFECTS: confusion, delirium,short-term memory problems, dis- orientation, and impaire attention PHYSICAL EFFECTS: dry mouth, constipation, difficulty urinatingg (espe- cially for a man with an en arge prostate), blurre vision, ecrease3 sweat- ing with increased body temperature, sexual dysfunction, and worsening of glaucoma. BEFORE YOU USE THIS DRUG Tell your doctor if you have or have had O epilepsy or seizures, not for maprotiline Oalcohol dependence or doxepin O asthma* O fever or sore throat; blood in urine, for Ohlood disorders* trazodone O heart or blood vessel disease* * not for trazodone C3 stomach or intestinal disease* Tell your doctor if you are taking any Oglaucoma* drugs, including vitamins and other non- 0 kidney or liver disease prescription products. O thyroid disease* Ask your doctor to check your blood pres- 0manic-depressive illness, sure, once while you are lying down and schizophrenia, or paranoia* once after you have been standing up for at 0retention of urine or enlarged prostate* least 2 minutes, and to do an electrocar• diagram. WHEN YOU USE THIS DRUG • Do not stop taking your drug suddenly. • You may feel dizzy when rising from a Your doctor must give you a schedule flying or sitting position. When getting ✓ to lower your dose gradually, to out of bed, hang your legs over the side prevent withdrawal symptoms such as of the bed for a few minutes, then get headache, mood change, nausea, vomit- up slowly. When getting up from a ing, diarrhea, cr trouble sleeping and chair, stay beside the chair until you vivid dreams. are sure that you are not dizzy. (See p. • Until you know how you react to your 18.) drug, do not drive or perform other ac- • Check with your doctor before taking ! tivities requiring alertness. These drugs /any other drugs, prescription or non- may cause blurred vision and drowsi- prescription. These drugs frequently in- ness. teract with other drugs. • It may take several weeks before you • The effects of these drugs may last for can tell that these drugs are working. If up to a week after you stop taking them. the drug works, talk with your doctor Avoid alcohol and heed all other warn- about lowering the dose gradually. ings for this time period. • Do not smoke. Smoking may increase • If you plan to have any surgery, includ- ' Y the drug's effects on your heart. ing dental, tell your doctor that you x j take this drug. . Do not drink alcohol or use other drugs g ' that can cause drowsiness. two 173 HOW TO USE THIS DRUG • Take with food to reduce stomach If you are taking more than one dose a upset. For trazodone, taking with food day of one of these drugs other than will also reduce dizziness and light- trazodone, take the missed dose as soon headedness. as you remember, but skip it if it is al- If you are taking any other drugs, take ° most time for the next dose. them 1 to 2 hours before you take your If you are taking more than one dose a l antidepressant. day of trazodone, take the missed dose as soon as you remember, but skip it if r • Capsules may be opened and mixed it is less than 4 hours until your next with food or drink. scheduled dose. • Do not store in the bathroom. Do not ex- ° If you are taking your drug only once a pose to heat, moisture, or strong light. day at bedtime, and you go to sleep • If you miss a dose, use the following without taking that dose, do not take it s guidelines: in the morning. Instead, call your doc- tor. • Do not take double doses. INTERACTIONS WITH OTHER DRUGS = The following drugs are listed in Evaluations of Drug Interactions, Thud Edition, 1985 t >c as causing "highly clinically significant" or "clinically significant" interactions when used together with imipramine. They may interact with most,if not all, drugs in this fami- ly. There ma be other drugs, especially those in the families of drugs listed below, that also inn— 11 react wi't�i Tiese anti epressants to cause severe adverse effects. a e sure to Y as your odor or a comp e em an a er m ow if you are taking any of these interacting drugs. }� 4 CYTOMEL PARNATE epinephrine PRIMATENE MIST liothyronine tranylcypromine 4 ADVERSE EFFECTS Call your doctor immediately: O prolonged, painful, inappropriate r overdose: confusion; severe drowsi- penile erection ness; fever; hallucinations; restlessness Oskin rash, hives, or itching and agitation; seizures; s ortness of Oabnormally slow or fast heartbeat breath; frouble re-a-t 'ng; unusually For amoxapine only: 'a fast, slow, or irregular heartbeat; un- O tardive dyskinesia: lip smacking; chew- usual tiredness, weakness; vomiting ing movements; puffing of cheeks; C3 blurred vision or eye pain rapid, darting tongue movements; un- 5;(confusion, delirium, or hallucinations controlled movements of arms or legs O constipation If continues, call your doctor: O fainting O dizziness Oirregular heartbeat or slow or fast pulse Odrowsiness 'P,feeling nervous or restless O dry mouth 0impaired sexual function Oheadache %shakiness Onausea or vomiting Ptrouble sleeping 0increased appetite for sweets* Xtrouble urinating 0unpleasant taste in mouth* N O sore throat and fever O weight gain* O yellow eyes or skin O muscle aches or pains; unusual tired- For trazodone only: ness or weakness,for trazodone O confusion ' not for trazodone 0 muscle tremors CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to The copy of this document mailed to you is your hotice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $98 . 00 Section 913 and 915.4. ! Please note adpuiGbt�nsei CLAIMANT: CHESTER THOMAS JUN 3.0 1989 3820 Waller Avenue ATTORNEY: Richmond, CA 94804 Martinez, CA 94553 Date received ADDRESS: BY DELIVERY TO CLERK ON June 28 , 1989 BY MAIL POSTMARKED: June 27 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. June 29 , 1989 HHIL BATCHELOR, Clerk DATED: Y: Deputy L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors �v) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �7 0� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (y) This Claim is rejected in full. /( \) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: J U L 2 5 1989 PHIL BATCHELOR, Clerk, By �� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JUL 2 7 1989 Dated: � BY: PHIL BATCHELOR by Q � L/,��s�ary Clerk CC: County Counsel County Administrator t J CLAIM_ TO. BOARD OF SUPERVISORS OF CONTRA ur�2CO'RTegiT e i i Sd'l appllcatlen 10,. +.' "• Instructions to Claimant Clerk of the Board P.O.Box 911 A. Claims relating to causes of action for death or Zor�einCuryhto,53� person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) B. Claims must be- filed with the Clerk of the Board of Supervisors at its office- in Room 106 , County _Administration Building, 651 Pine Street, Martinez , California 94553. C. If claim is against a district governed by the Board of Supervisors , rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims mast be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. RE: Claim by ,) Reserved for Clerk' s filing stamps � RLEA 7 Against thK COUNTY OF CONTRA COSTA) JU9 2 1989 or DISTRICT) - (Fill in name) ) CO, !T C Deputy-41 . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ , [�Q and in support of this claim represents as follows- ------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) 2. Where dial the damage or injuryEoccur? (Include city and county) ---------------------------------------------------------- ---------- 3. How did the damage or injury occur? ({Give full details--, -use= extra . sheets if `required) _rt9cl Lo /►0(� �1�" �J �� -- -- _ ��- - --- --- 9 What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? R.►10( L ciS a- vK (over) '.:5..:.>•J� zat ar.e.,the...names of county or district officers, servants or +' I employees::causing the damage or injury? L-C -------- -' -- o �°r------ - '----� ____ 6. L9hat damage or in;1ii s do you claimlresulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) — - -------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) ------------------------------------------------------------------------- 8. Names and addresses of witnesses , doctors and hospitals. ------------------------------------------------------------------------- 9 . List the expenditures you made on account of this accident or injury: DATE MMOUNT 41��, Com. ••E,�f Her- �r�-s �:. Sweq 'Sun ' y -o0 sweat Sir4 ..ate R Govt. Code Sec. 910 . 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some oerson on his behalf. " Name and Address of 'Attorney Claimant' s Signature 3e?2qc Address Telephone No. Telephone No. i-40 744? NOTICE Section 72 of the Penal Code provides: "Every person who, with intert to defraud, presentz for allowance or for payment to any state.• board or officer, or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine , anv false or fraudulent claim, bill , account , voucher , or writing , is guilty of a felony. " � � �.. �, r,� q�, � w a ��� 9 � � `_' "� � s LO O ����-_ � a. s::,,o � �-�-� . �.� � � o N .r�� '� n ++ a[� _`(�� �f S \ / Qj{ A+� " �.� ■■11 i'Y�JJ� .. ......� �, . � y ti� � a. 9 / " -� � L � � "'s„� �� � �` "' ,dam Vv' ��� '� ,.1.we`�..,,,,,,� �yp�7 :,t Ji ' r r' .> m 'F S 3 t f iC i '.^5. ... '"'f • �� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10_,:000 . 00 Section 913 and 915.4. Please n��fityl(a�ryig'� CLAIMANT: MELINDA MARIE DOUGLAS JUN 3,0 1989 c/o Colin J. Coffey ATTORNEY: Norris and Norris Martinez, CA 94553 3260 Blume Drive #200 Date received ADDRESS: Richmond, CA 94806-1394 BY DELIVERY TO CLERK ON June 27 , 1989 . BY MAIL POSTMARKED: June 26 , 1989 Certified P 159 022 753 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. W_, z4z� DATED: June 29 , 1989 BYIL DeputyLOR, Clerk L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: � �1 Y Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. (� �) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: J U L 2 5 1989 PHIL BATCHELOR, Clerk, By 6�) , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code'Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimantas shown above. Dated: JUL 2 7 1989 1 BY: PHIL BATCHELOR by G Deputy Clerk CC: County Counsel County Administrator LAW OFFICES RICHARD E.NORRIS NORRIS AND Nasals MELANIE REYNOLDS NORRIS* M.JEFFREY MICKLAS HILLTOP OFFICE PARK TELEPHONE DOUGLAS C.STRAUS 3260 BLUME DRIVE, SUITE 200 (415)222-2100 CY EPSTEIN RICHMOND, CALIFORNIA 94806-1394 COLIN J.COFFEY FACSIMILE JOSHUA G.GENSER (415) 222-5992 SUSAN K. NORRIS S. MARIE HARTSFIELD PERRY P. OEI MATTHEW E.McCABE June 23, 1989 C 'CERTIFIED FAMILY LAW SPECIALIST UN 2 71989 Clerk, Board of Supervisors Contra Costa County IL County Administration Building De 651 Pine Street Martinez, California 94553 Re: Tort Claim By Melinda Marie Douglas (California Government Code Section 910) Dear Clerk: Comes now, Melinda Marie Douglas, by and through her court appointed guardian, Freddie Douglas, and submits this Tort Claim against Contra Costa County in compliance with Government Code Section 910: (a) Claimant's name is Melinda Marie Douglas whose address is 1641 6th Street, Richmond, California 94801. (b) All notices with regard to this claim should be sent to claimant's attorneys, law offices of Norris and Norris at 3260 Blume Drive, Suite 200, Richmond, California 94806. (c) On or about April 12, 1989, Contra Costa County, through the District Attorney's Family Support Division, levied upon claimant's deposit account at Wells Fargo Bank in Richmond, California. The sum of $12, 641. 69 was withdrawn and delivered to Contra Costa County in response to the levy. The levy sought attachment of the personal assets of the named judgment debtor, Freddie Douglas, whom Contra Costa County alleges owes the County sums derived from an AFDC dispute arising between County and Freddie Douglas between 1980 and 1984 . Contra Costa County nevertheless levied upon the personal assets of claimant, Melinda Douglas, despite the fact that claimant is not a judgment debtor, nor in any way involved in the dispute between County and Freddie Douglas. Moreover, .the County' s levy upon claimant' s funds was unlawful under California Code of Civil Procedure Section 699 .720 (a) (10) , as claimant's deposit account was established as her guardianship account. Levies on guardianship assets are absolutely prohibited by California law. One (1) year prior to the subject levy, Wells Fargo Bank had notified Contra Costa County that the claimant's account was a guardianship asset. Contra Costa County therefore undertook the subject levy knowing it was an unlawful levy upon guardianship assets. After the levy and within the time period allowed by law to file, claimant's guardian filed a Claim of Exemption. The County Clerk's office of Contra Costa County, however, returned claimant's claim of exemption by mail, without establishing a hearing date, alleging that claims of exemption were not available in "domestic matters. " County's refusal to allow claimant to file a claim of exemption and have the hearing thereon, violated California Code of Civil Procedure Section 703 . 070, and deprived claimant of due process of law. Demand has been made upon Contra Costa County for return of the unlawfully levied sums, but the County has refused and ignored these demands. (d) Contra Costa County has converted the sum of $12 , 641. 69 and deprived claimant of her interest earnings thereon since April 12 , 1989. Claimant has suffered severe anxiety, humiliation, worry and mental and emotional distress. Claimant has been deprived of her civil rights established to guarantee her property rights, as well as being deprived of due process of law. Claimant has been forced to seek recovery of the converted funds from Wells Fargo Bank, and has thus incurred legal costs and fees. Claimant will seek punitive damages from presently unknown County officers or employees responsible for the unlawful levy. (e) The names of public employees causing claimants losses and injuries are presently unknown, but are believed to be personnel in the District Attorney and County Clerk' s offices. (f) Claimant's losses exceed $10, 000. 00 and jurisdiction over her claims will rest in the Superior Court. Very trul ours NORRIS AND NORRIS BY COLIN J. - Attorneys for Melinda Marie Douglas by and through her Guardian, Freddie Douglas CJC:kw CERTIFIED MAIL/RETURN RECEIPT REQUESTED 0 § ° ( t 0 \ \ « \ % { { ® \ § ! } \ \ ilk «§ a 0 eo \ � @ / u q 00 � ■ . w1;\ 0 � 4 R t\V � f \ e® ® \ / $ \ / G?.\ i g \ § , > ® m \ A0 LP ® w® \ o m 3 0 ® Ul to CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant toLGa e►r�nm��ent Code Amount: 1, 050. 00 Section 913 and 915.4. Please note all "Waar tX' Cs�q BOOKER T. HALL unsel CLAIMANT: c/o Linda Fullerton JUL (. 1989 145 Park Place ATTORNEY: Pt . Richmond, CA 94801 a�10e�, Cq 94553 Date received ADDRESS: BY DELIVERY TO CLERK ON July 5 , 1989 BY MAIL POSTMARKED: July 3 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. FH DATED: July 5, 1989 EY BATCHELOR, Clerk L. Hall I1. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis or (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. p� Dated: J U L 2 5 19n PHIL BATCHELOR, Clerk, By �� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant, as_shown above. Dated: JUL 2 1989 ! BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator :LAIMr TC?• BOARD OF SUPERVISORS OF CONTRA e ur i i in applicctlon to; Instructions to Claimant Clerk of the Board P.O. Boz 911 A. Claims relating to causes of action for death or rorninju ynto�53y pe-'son or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2 , Govt. Code) B. Claims must be- filed with the Clerk of the Board of Supervisors at its office in Room 106 , County Administration Building, 651 Pine Street, Martinez , California 99553: C. If claim is against a district governed by the Board of Supervisors , rather than the County, the name of the District should be filled in D. I.E the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims , Penal Code Sec. 72 at end of this form. RE: Claimby . ) Reserved;, Sr.Ctamp r : i5.gr p�s rrr ?ice i�J�� ��I^C1 �: C f ,� - G . j JUL 51989 Against the COUNTY OF CONTRA COSTA) or ��j�rlTl �.� � DI5TR3CT) f c,;;:=':, _;;,:;; — (Fill in(narae) - ) - . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and .in support of this claim represents as follows : ------------------------------------------------------- - 1 . Whe;Z' did the damage or injury occur? (Give exact date----and----h-o-ur--) ---- ----- +- 1--- -----------------------------------------•----------------- 2. Whe:.e did the damage or injury occur? (Incluae city and county) _i2'it� ---- - 3 . How dic )the damage or injury/ occur? - (Give-full aetails, use extra sheets if required) D hf, D,rh e nY /OZ tm -�� ----------------------- -- ---- 9 . Wha _ particular a,ct ,or omission on the part ofcounty or district officers , servants or employees caused the injury or damage? r , Pe�f" y (over) f 5.:. •f iat: are*'the-names of county or district officers, servants or I' ' I employees.; causing the damage or injury? 6 . 7-7hat damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto dapage) 7 . How was th amount claimed above computed? '(Include the estimated amount of any prospective injury or d�agnage. / &-/f - l Pe. 6kks -und�ir�,v�vr� ---------- ----------------------------------------------------------- S. Names :nd addresses of witnesses , doctors and hospitals . �O/27`I'Y� .Co�7u, <S�l�r�^�-� i`�'l��n •�11ti� �1c1 C�c�rf �fre�t . -------------------------------------------------------------- ---------- 9 . List the expenditures you mane on account of this accident or injury : DATE _" ITE14 7--MOUNT 8q �YC�G f Govt. Code Sec. 910 . 2 provides : "The claim signed by the claimant SEND NOTICESD TO: (Attorney) or by some person on his behalf . " Name and Address of 'Attorney n laima t ' s Sign ture p « A°c%l S �z-1 2D2- Telephone r!o.C�/�i 22 Z z100 Telephone N�`.�i5 �5 Z NOTICE Section 72 of the Penal Code provides: ` "Every person who , with intert to defraud, presents for allowance or Ir payment to any state. board or officer , or to any county , town, city district , ward or village board or officer, authorized to allow or pay the same if genuine , anv false or fraudulent claim, bill , account , voucher or writing , is guilty of a felony . " N ¢ co y n,u: CLAIM f '/� 'BOARD OF SUPERVISORS `OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: JOHNIE M. WOODWARD County COunsef 901 Court Street D/C-9 ATTORNEY: Martinez, CA 94553 JUL G 1989 Date received A4aginj,, � office ADDRESS: BY DELIVERY TO CLERK ON July A ,yr— —Q BY MAIL POSTMARKED: no date on envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 5 , 1989 gyIL gep �tyLOR, Clerk Li( l //�✓�G(�l / L. Hall I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7 q BY. I \ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (/U This Claim is rejected in full. (� )� Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUL 2 5 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant -as shown above. Dated: JUL 2 7 1989 11 I BY: PHIL BATCHELOR by G{�C�De�uty Clerk CC: County Counsel County Administrator J U, 51989 ! / -- Te7L- e_ ��av ri7G-.L ecos In 0/2 - - !peke j 1/_.� J. e� �_Foci - - -- - i9s__97Lii} T i9l�Ic�_��/�i�ZL 7 - /�C U �✓�'1 . - -- - - OR - - - ---/6 Ak2 ��/� _ Oco- -7 zZ z9 Aeo - — -- �vC- - 60.0 o ,�u�e s •� _Fi��- - - - --- __ —I P-(fsIA9- cc7��-oll- [FORM 5:A] CLAIM AGAINST GOVERNMENT ENTITY FOR DAMAGES TO PERSON OR PROPERTYL (CITY OF-69S-14N6� [Ed. Note: Instruction #1 on the City Claim Form is incorrect. Effective for injury and death act' Mg,,on or after January 1, 1988,the claim must be filed no later t an six mon ter the occurrence;see 95:16.] IN.t.,1001 CLAIM FOR DAMAGES RESERVE FOR FILING STAMP TO PERSON OR PROPERTY CLAIM No. ratnlurt FOR CLAIMANTn.n .In x on.1.ar n..."III b On c.ur INSTRUCTIONS 1. Claims for death,Injury to person or to personal proyerly must be filed not later than 100 days after the occurrence. (Gov.Code Sec. 911,2) 2. Claims for damages to real properly must be filed not later than 1 year after the recur- a tt.(Gov.Code Sec 911.21 2. Reed entire claim before lilting. a. See page 2 for diagram upon which to locale place of Accident. S. This claim form must be signed on page 2 at bottom. d. Attach separate sheets. if necessary, to give full details. SIGN EACH SHEET. 1. Claim must be filed with City Clerk.0".Code Sec.915.1 TO:sill� Ca K,EQ,,aJ ChimsntO ZJ�X29, 6�.� Age of Claimant(if natural person) Home Address of Claimant City and State Home Telephone Number Business Address of Claimant City and S41e I Business Telephone Number Give address to which you desir notices CDU/e Somm/un/ nto be sen eg ing this ci /�✓ ���3q0/ ))/7 � � 0 How did DAMAGE or INJURY occur?Give full particular. sed ®When did DAMAGE or INJURY..curt Give full particulars,date,time of day: ere did DAMAGE or INJURY occur?Describe fully,and locale on diagram on reverse side of this sheet,where appropriate,give alrcel names and address and m al.lement, from landmarks: I u 1 /. hal particular ACT or OMISSION do you claim caused the injury or damage?Give names of City employees causing the injury or damage,if known: t� What DAMAGE or INJURIES tlo yeu.Ilim resulted?Cive full eztent of injuries or damages claimetl: hot AMOUNT do you claim on account of each item of Injury or damage as of date of presentation of this claim,giving basis of � comDulsli.n: VGive ESTIMATED AMnrJN'P As f as kap-n••^u c!ef-: m e.c:.:x, L:CrosV :i:v iniu:y ar 6unage,givuug bats of SEE PAGE 2 (OVER) THIS CLAIM MUST BE SIGNED ON REVERSE SIDE Rev.q1198 8 5-141 8 Insurance payments received.it any,and nomess of Insurance Company: xpenditures made on account of accident Or injury: (Date—Item) (Amount) arse and address of Witnesses,Docion and Hospitals: READ CAREFULLY For all accident claims place on following dia¢ram names of streets, including North,East,South,and West;indicate place of accident by"X"and by shuwing house numbers of distances to street corners. If City Vehicle was involved,designate by letter"A"location of City vehicle when you first saw it.and by"B"location of yourself or your vehicle when you first saxCity vehmie:location of City vehicle at time of accident by"A-1"and location of yourself or your vehicle at the time of the accident by '13•1"and the point of impact by"X' NOTE:If diagrams below do not fit the situation,attach hereto a proper diagram signed by claimant. FOR OTHER ACCIDENTS LZ SIDEWALK R RB PARKWAY SIDEWALK 7 FO UTOMOBILE ACCIDENTS � UUP 7A I F SigqAure of Claimant or person filing on his behalf giving T ped Name: Dale relationship to Claimant: ' .2 / dhni ?NO&TE:AIIimants may be required to be examined as to their claim under oath.(Charter Sec.67).Pres<nlalion of•false claim is a felony(Cal.Pen.Code Sec.) CLAIMS MUST BE FILED WI' A1TY CLERK (GOV. CODE SEC. 915a) 5-142 Rev.#11988 -- - O-U 90/ COUip7g�- S , ,1��A11 fez 09._ 9Y5S53- - v?O/ e � d e �19(�Rc���� ed �d �7,ie .iW. W199/? - cio-Ste. _ � - � ,�� o� SRO A� , y _ &OS e_sc0lq74ecl -/lk)7Zo /�S7/e - e 77 7gc' Z . y 0' 7X e,-.CT7�q sso e /?,9 / --- Gv�Is jv �� wfgs se�iU�c1e� �05�. e - - /�'C�,9 100 C�Jf S 15 19Cli--e i9 /)�5 e lqr?d ode we���s cons/s fed 0/4---- -C f-d �JeP�fy 19R-g e ofd/-,is. escoi2f-r1_e�e�2�ed � Hi7d- h e Jit so eves . o� he �9s5ls7- i22e . This co121*i�7�d _ RCSU� oF /yJy jjurle,s. 7o- ox, �i9 -/com /orae 71-n �..9ce ,fie 195sI 191)7 7k � _ . fufhe ear orae, ..z� min ,s//e�j�h -- _. _ _ ex7k 2e. cc�sfody.negli5 ��ce occufi/leed .5s. .g Wes017L 717�1s c%v�zl ode c�i.n> ocl/2ecl _ All�r _fie i_ ins�s �1.47L/�sSfAci/ d sows -r r - _ A*e, 1-�e 40S 1,1k 121q 771 �. ek e _S/ 74ec o lie hJ92is �/d-e�_7gg717 OCC 0R� �d o� �qy _ -- - - 19 r, ,De,+/.-) on /%c/lo '7L" -- r Li Cvs ody �9/;5.��C C, �� �MI16, cowed/�r,e ss , hips Lis celqjc�ho 7'a �i�i}S`/o i7S 740 7��J oc - / �� fo 7(,;rg e he/� ol. s •�'e .� cv ss/oma e Sv CeRe s/i 7L he�c/gc/ es -) //a PWOPeR 0 e �io� C.,91-9 /?o 7' = ©lq - 15r)s weed - - - - lqeot-7eA- 7'0 of 4� e /�i� e/rI e�7it�r� - 74/i e heS74 my15 f7906JeF EX cr/fed on a6 <lNc.-.) O 1 r N �p J 9 V _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA V' Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant .o Government Code Amount: $2 , 000. 00 Section 913 and 915.4. Please note a9UR&nQgVnSe1 CLAIMANT: FRANCES BLANTON JUL (j 19x9 1346 Monterey Street ATTORNEY: Richmond, CA 94804 Martinez, CA 94553 Date received ADDRESS: BY DELIVERY TO CLERK ON June 30, 1989 BY MAIL POSTMARKED: June 29 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH q DATED: July 5 , 1989 BYIL BATCHELOR, Clerk eputy L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present X) This Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: J U L 2 5 1989 PHIL BATCHELOR, Clerk, ByDeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and. Notice to Claimant, addressed to the claimantas shown above. Dated: JUL 2 7 199 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator EC1"VE D JUN 7, 0 1989 Clerk, Board of Supervisors Room 106 QEnR OvA.iJ '• Martinez , Calif. 94553 a. UIZ19M The purbpse of this claim is to gather damages as a result of the injury caused by the Richmond office of Social Services , which had, for three out 6f five months repeatedly delayed issuance of fmod stamps. People. on welfare are chronically short of both food and cash, and for the county to leave them without due to their ineptitude. exacerbates an already difficult situation. This slovenl&ness must be stopped. The enclosure dated 3/9/89 was heard by the Hon. Judge Charles Ferguson, who , because the county finally issued food stamps 23 days late, dismissed this issue from the Fair Hearing. The enclosure dated 5/10/89 is evid- ence of withdrawl from a Fair Hearing concerning the lateness of food stamps for the ,month of April. I have requested a Fair Hearing for the food stamp 'delay this month, June , and as yet haven' t received a date. Since Fair HAarngs are merely administrative reviews and as such make no effort to garner damages , I have elected to bring this claim. If this is being done to me, how many others who haven' t the understanding to do soldon' t ask to have the&r rights acknowledged? I demand this county be stopped further practice of inhumanity to man. Going humgry for 23 days or 11 or 9 is inhumanity. I have therefore elected to begin referring to the Department of Anti-social Services;; to put an end to the Big Lie which currently calls that place the Department of Social Services. Sincereljz, Frances Blanton Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or .for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the, accrual of the cause of action. . (Govt. Code §911.2.) . B. Claims must be filed with the Clerk of the Board of Supervisor's at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C`. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp Against the County'of Contra Costa ) or ) LREGEHIvEDT 3 11989AP'HEIOR. District) untovlo"Fill in name The undersigned claimant hereby makes cla' agains�he County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) -----1� �----------------------------------- 2. Where did the damage or injury. cur? (Include city and county) _�c�. o �-==- a=- --&-�`"/------------------------------- 3. How did the damage or injury occur? (Give full det ils; use lextra paper if required) �-� �1� --- --------------- 4. What particular act or omission on the part 'of co ty or district officers, servants or eemployeeb caused the injury or damage? `�' �c'�G.G-wiG�d�/� l-e�vt� Oy���ca Q�C✓��u �t �,c.-¢�v (over) 5. What are the names of county or district officers, servants or e loyees causing the damage or injury? ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two pstiTte for auto d �� 1 -� ; .7. How was the amount claimed above computed? (Include the estimated amount of an prospective injury o ��� G�G/JGua� �csirf/ �-ee..� ------------------------------------------------------------------------------------- 8. Names and addresses of Ltnesses, doctors and hospitals. 4P -- - - �------ ------------- 9. 'st the �esyou ma e on� ount 6f f ii �ident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and A ress of Attorney _ 4/^;0V (fjv� Claimant's Signature 6� 5 &e Address Telephone No. Telephone No. Z1115- -46 N 0 T I C E Section 72' of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by' a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. NAME Frances Blanton CASE NUMBER. 404978 COUNTY Contra Costa PROBLEM In Feb, 1989, I went w&thout food stamps for 23 days because of ineptitude by someone in the county office at Richmond. I had mmiist originally submitted both a CA-7 and a Status re®prt fimx in January but the worker told me that they had not been received. I went to the office and got another two and placed them into the drop box. My warker didn't get those,. either. I: called around and found out that mail is picked up by one clerk and taken to the unit.. and another clerk there is responsible for delivering them to the workers. I had been previously assured by fa�6worker that she would get anything I put into the drop box; aftdr I told her I had done so she then advised me I had to deliver it to her hand or E188 it might not get to her. The fact that I had submitted one set of forms r and that the Jan. was missing is not my fault, and the fact that I went to the office and filled out another set and she didn't get them isn't my fault. either. In all. I submitted THREE SETS of forms .lust to receive food stamps for Feb. I. never received any CA-7's or Status reports in the mail but always had to go to the office to pick them up and place them into the drop box. They are supposed to be mailed from Martinez but mine never were. My interview with S, Decauter was 12123/88 and it was then I was given 2 CA-$!'s and 2 Status reports, one for Dec & one for Jan. I filled them both out and mailed them in but somehow the one for Jan was missing. As I said above. I went in and filled out another set that never got delivered to the worker and so my case was terminated. That is. I received food stamps for half of Dec, and for all' of Jan, but Feb was delayed by 23 days and not from non-eompliance on my part. SIGNATURE. 1- - DATE If dissatisfied with this decision, please see last page for appeal rights. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES ) In the Matter of the Hearing of Claimant ) DECISION FRANCES BLANTON ] Admin. Hearing No. : 89073022 CC 1346 Monterey ) State No. : Richmond, CA 94804 ] District: ] Issue Code: 020 2 163 2 Administrative Law Judge: CHARLES L. FERGERSON County Representative: BARBARA 14IEDENFELD Authorized Representative: NONE Place: RICHMOND Date of County Notice:. 03/09/89 and 03/24/89 Admin. Hearing Filing Date: 03/13/89 and 03/14/89 Date of Hearing: 04/21/89 Aid Paid Pending: Not Applicable - Denial STATE OF CALIFORNIA DEPARTMENT OF SOCIAL SERVICES MAY 10, 1989 744 P3TREET SACRAMENTO, CALIFORNIA 95814 1% 1 ,iir CASE NUMBER: 89102104 07 BLANTON, FRANCES 1346 MONTEREY RICHMOND' CA 94804 THIS OFFICE HAS BEEN ADVISED THAT YOU HAVE VERBALLY WITHDRAWN FROM YOUR HEARING SCHEDULED FOR MAY 5, 1989. WE HAVE ACCEPTED THIS AS A WITHDRAWAL. THEREFORE, WE WILL NOT RESCHEDULE A HEARING FOR YOU BASED ON YOUR ORIGINAL REQUEST AND YOUR STATE CASE IS BEING CLOSED. IF YOU HAVE ANY QUESTIONS, OR WISH TO DISPUTE THE ABOVE STATE- MENT, PLEASE CONTACT A DEPARTMENTAL REPRESENTATIVE WITHIN TEN (10) DAYS OF TODAY'S DATE AT (916) 445-8525. YOU MAY CALL COLLECT. ADMINISTRATIVE ADJUDICATION DIVISION. SE HA NOTIFICADO A ESTA OFICINA QUE USTED HA RETIRADO DE PALABRA SU AUDIENCIA PROGRAMADA PARA EL DIA MAYO 5, 1989. NOSOTROS HEMOS ACEPTADO ESTO COMO UNA RET,IRADA. POR LO TANTO, NO PROGRAMAREMOS DE NUEVO UNA AUDIENCIA PARA USTED BASADA EN SU PETICION ORIGINAL Y SU CASO CON EL ESTADO ESTA SIENDO CERRADO. SI USTED TIENE ALGUNAS PREGUNTAS 0 NO ESTA DE ACUERDO CON LA DECLARACION DE ARRIBA, POR FAVOR, PONGASE EN CONTACTO CON UN REPRESENTANTE DEL DEPARTAMENTO DENTRO DE LOS DIEZ (10) DIAS DE LA FECHA DE HOY, EN EL TELEFONO (916) 445-8525. USTED NOS PUEDE CARGAR EL COSTO DE LA LLAMADA. DIVISION DE AUDIENCIAS ADMINISTRATIVAS. W t� _ 1 � rn O O > M En Q, E w 44 O *4 i a +) U ro vi �q 1D� 4U N O U Q1 • V4 q {-r NOrlm Oen c0. ua �o � 0 co rn to44 o �+ 41 (dHU 0) Co 4j V) r at Z o w .C ' t0 d' U 3fM • I W ri C4 ` CLAIM /Al BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $284. 9 8 Section 913 and 915.4. Please note all Narnings". CLAIMANT: IRRILLIBA EVANS ountyCOUnSel 1639 Giaramita Street , ATTORNEY: Richmond, CA 94801 JUS (� X989 Date received A4art1f1Q � ADDRESS: BY DELIVERY TO CLERK ON June 30 , 19 � CA 94553 BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHH gg DATED: July 3 , 1989 BYIL DeputyLOR, Clerk L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: _ q BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. A Dated: JUL L 2 5 1989 PHIL BATCHELOR, Clerk, By Clerk WARNING (Gov. code section 9I3) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. �' JUL 2 7 1989 %,/� Dated: BY: PHIL BATCHELOR by uty Clerk CC: County Counsel County Administrator :j�,p,IM% TC? BOARD OF SUPERVISORS OF CONTRA C0epturRRiTgvl applicatlen to; Instructions to Claimant Clerk of the Board P.O.Boz 911 A. Claims relating to causes of action for death or morninjurynto4533 person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual -of the cause of action. (Sec. 911. 2 , Govt. Code) B. Claims must be- filed with the Clerk of the Board of Supervisors at its office in Room 106 , County Administration Building, 651 Pine Street, Martinez , California 94553: C. If claim is against a district governed by the Board of Supervisors , rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims mast be filed against each public entity. " E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. RE: Claim by � ���?�� ) Reserved .for Clerk' s filing stamps / �ymu. RET E �ut�� M©J Against the COUNTY > OF CONTRA COSTA)- JUNJAP /17 ?1212vzE ) QD orb6JAJ Ab RCl l U DISTRICT) CLERK o"' o 7F `LO (Fill in name) Zqd ) c F ORO BY .... ..... .. Deputy I . The undersigned claimant hereby makes claim against the CO ty of Contra Costa or the above-named District in the sum of $ , :� F - and in support of this claim represents as follows : --- -- ------------------------------------------------------------------ 1. When did the damage or injury occur? (Give exact date and hour) _1�6, 1 t 2. -Where aid the d ge or in 'uryfoccur. (Include city and county) ejj 3. How did the damage or injury occur? (Give dull details , use extra sheets if required) -----------=------------------------------------------------------------ 4 . What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? (over) i '.:5..:..•J� iat: ar.e...the..names of county or district officersv servants -or r'. J employees causing the damage or injury? -------- -- - -- - - --- -- -- --- --- - -- - - 6 . What damage or injuries do you claim resulted? (Give---f-ull-ex-t-en-t- of injuries or damages claimed. Attach two estimates for auto damage) -----------s--------------------------------------------------------------- 7 . How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) S-. --Kia-m--es---S. Names and addresses of witnesses , doctors and hospitals . c o7) PL, �Kv to ------------------------------------------------------------------------- 9 . List the expenditures you made on account of this accident or injury: DATE ITEM 7--MOUNT r Govt. Code Sec. 910 . 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some oerson on his behalf. " Name and Address of 'Attorney C �mant' s Cignature - Addren Telephone No. Telephone No. 33`(53�2 NOTICE Section 72 of the Penal Code provides: "Every person who, with intert to defraud, presents for allowance or for payment to any state board or officer , or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill , account , voucher , or writing , is guilty of a felony. " JA l-V4A-J I` IML b-c5 -,5F/o—r /7s� T 6 ll C a o 9F -Cfc� s1� 00& 3 _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuantb �Coverrnmment Code Amount: $745 . 00 Section 913 and 915.4. Please note all "WatnQ9ftSe( CLAIMANT: WILLIAM EDWARD SMITH JUL (i j9$9 P. O. Box 2210 ATTORNEY: Susanville, CA 96130 �a�l�e2, CA 94553 Date received ADDRESS: BY DELIVERY TO CLERK ON July 5 , 1989 BY MAIL POSTMARKED: June 29 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 5, 1989 ggIL BAATTCHELOR, Clerk L. Hall ROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated;: Deputy County Counsel l� III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOX ARDD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full . ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUL 2 5 1989 PHIL BATCHELOR, Clerk, By Ze. eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to .the ciaimant as shown above. JUL 2 7 1989 Dated: BY: PHIL BATCHELOR by _�? uty Clerk CC: County Counsel County Administrator r LATMf1 TO BOARD OF SUPERVISORS OF CONTRA C(�ERTeptur�ig�iyJTi nppiicaUantO: " r ' Instructions to`Claimant Clerk of the Board f. P.O.Box 911 A. Claims relating to causes of action for death or =ortrnelnCuryn o�533 person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez , California 94553. C. If claim is against a district governed by the Board of Supervisors , rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. ************************************************************************ RE: Claim by ) Reserved for Clerk' s filing stamps ) Against the COUNTY OF CONTRA COSTA) JUL 51989 ) R or DISTRICT) C:: (Fill in name) er _e f . The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ , 7 L/r. p Q _ and in support of this claim represents as follows : -------------------------------------------------------------^---------- 1.-} When did the damage or injury occur? (Give exact date and our J-, Q ^.i C•ryE,� Y'i /c 5 7" 5 T O F CID t h G 5 /f•�`•5 S s'46, u161 to rte i Sf Xt -gid, X"P_y rP-4 •` 0.r.& VAJ SeCOno( SET 00'S S, A<S OkSA T WO ;�sh s . 2. Where d1d the damage or inury occur:' (Include city and county) __►'YI!A c2-� IV �:"'� C6 w.A Thr A 7-eT T�' rt �c4 C ►'L -�� --------------------------------------------^------------------------ 3 How did the damage or injury occur? (Give full details , use extra sheets if required) ---------------------- 9 -------^------- - - - - - - - - -. What particular act or omission on---the---part----of--county-- ---or--dist--r-ict- --- officers , . servants or employees caused the injury or damage? 7' t� � C U is l c� ✓�'4- F•r► �Q ��� Ce l o +��5 (over) 5.:-:•r iat: ar.e._the..:names of county or district officers , servants 'or i., employees: causing the damage or injury? ----------------------------------------------------------- 6 . What damage or injuries do you claim resulted? (Give fullextent of injuries or damages claimed. Attach two estimates for auto damage) tia CA-V1 ' ' 1:� I n61 t- 4 a, 1ooll Toa J ---------------------------------------------- ------------------------- 7. How was the amount claimed above computed?-- (Incl ude the estimated amount of any prospective injury or damage. ) z ,,` ust had m ------------------------------------------------------------------------- 8. Names and addresses of witnesses , doctors and hospitals. -------------------------------------------------------------------- ----- 9 . List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT G l cd, i ✓dl 74{5 Govt. Code Sec. 910 . 2 provides : "The claim signed by the claiman- SEND NOTICES TO: (Attorney) or by some Derson on his behalf. Name and Address of Attorney Claimant ' s Signature P0. /,3 UX 21/10 Address s�s �r, �,•��� C,a . 9� /3a Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or Ir payment to any state board or officer , or to any county , town, city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill , account , voucher or writing , is guilty of a felonv. " i sl T ( � 4b 6'C�9 kc GQ (�t.b n� fAl SNS-- Go — :' v- ST , l �. vi S6- 1 - CONTRA C05TA DETEL4TION.FACILI.T_Y___.__- h.,, -CLOTHIING RECEIPT DATE: U;? ✓' 3 d t4 REC: 128706 TIME: 2,148FACILITY: ti0F NAME (L, F, M): Spli'm mmiallimilorms,c • BOOKING NBR: L6®t14740J Q SHIRT/BLOUSE QPANTS/SKIRT COAT/JACKET []SHOES/BOOTS —Q SHORTS/•PANTIES. _ _. _ _ _ . _Q7—SH1RI/BRA— SOCKS/NYLONSHDRESS HAT/PURSE 0 SWEATER/SWT. SHIRT 0 OTHER INMATE SIGNATURE RELEASE 4 DATE: I HAVE RECEIVED ALL OF MY CLOTHING. REL OFC: X INMATE SIGNATURE \ � p � » C> / �] } } >& / / 2 . � 71Z) � 7CZ m } � C-*5 C7 . G � � . ) � � { ( 2 � � ) � \ � / fes ) �� � | i � / . i .. CLAIM 'BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $74. 00 Section 913 and 915.4. Please notQ(aUnp " ©�t�s61 CLAIMANT: JOE W. BELL �U 3 Quentin 0 1989 ATTORNEY: Martinez, CA 94553 Date received ADDRESS: BY DELIVERY TO CLERK ON June 28 , 1989 Inter—office BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. / D DATED: June 29 , 1989 EaIL eputyLOR, Clerk : L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: S— 30 / ��1 BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER': By unanimous vote of the Supervisors present (x) This Claim is rejected in full . ( \) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. p Dated: JU L 2 5 989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.ry Dated: JUL 2 / 1989 BY: PHIL BATCHELOR by ` 4�4��Puty Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM T0: �r7.Qe W. Bell Quent-in Re: Claim of W. BELL Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: X 1 . The claim fails to state the name and post office address of the claimant. x 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the circumstances of the occurrence or transaction which gave rise to the claim asserted. _4 . The claim fails to state the name(s) of the public employee(s ) causing the injury, damage, or loss, if known. 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000 ) . If the claim totals less than ten thousand dollars ($10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. _6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: WESTMAN, County Counsel IJ By: Deputy Ca ty Co CERTIFICATE OF SERVICE BY MAIL C.C.P. S§ 1012, 1013a, 2015 .5; Evid. C. §§ 641, 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s) having delivery service by U.S . Mail )-, which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: 1i � , at Martinez, California. cc: Clerk of the Board of Supervisors (ori inal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8) C A,IM:.TC?• BOARD OF SUPERVISORS OF CONTRA CoVeur i I dl RF17i i�' a PF -.--' a Ilcatlen to; +.' "• Instructions to Claimant Clerk of the Board P.O.Boz 911 A. Claims relating to causes of action for death or morn injurynitto4533 person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to anj other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2, Govt. Code) B. Claims must be" fi_ led with the Clerk of the Board of Supervisors at its office in Room 106 , CountyAdministrationBuilding, 651 Pine Street, Martinez , California 94553: C. If claim is against a district governed by. the Board of Supervisors , rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims mast be filed against each public entity. .- E. ntity. -E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. ************************************************************************ RE: Claim by ) Reserved .for Clerk' s filing stamps ECE V EID Against the COUNTY OF CONTRA CcsTA) JUN 2� 1989 or C D -CU^ C G�+`��L DISTRICT) PHIL BATCHELOR (Fill in name) CLERK BOARD OF SUPERVISORS B �eCO'�1TRA STA CO. p The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 1 7 C/ and in support of this claim represents as follows: . 1�—��' .------------------------------------------------------------------------- .L. When cid the damage or injury occur? (Give exact date and hour) 10 400 _w. _-----------------------------------------•--------•----------=------ Where did the damage or injury occur? (Include city and county) 3. How did the 4affiage or injury occur? (Give full details , use extra / sheets it required) 1 - ---------=-------------------_�-•------------------------------------ 4 . What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? • (over) '.:5..:,:•/� lat ar.e._the..names of county or district officers, servants or- �' ' I employees causing the damage or injury? -------------------------------------------------------- -f---- ------ 6 . What damage or injuries do you ;claim resulted? (Gi e Tull-extent-_ of injuries or damages claimed. Attach two estimates for auto damage) ----------=-------------=------------------------------------------------ 7 . How was the amount claimed bre computed? (Include the estimated amount of any prospective injury or damage. ) -------------------------------------------------------------------------- 8. Names and addresses of witnesses , doctors ,and hospitals . ------------------------------------------------------------------------- 9 . List the expenditures you made on account of this accident or injury: DATE ITEM 7--MOUNT Govt. Code Sec. 910 . 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some oe-son on his behalf. " Name and Address of "Attorney t�tliC� P Cla mane' s Signature ad r^S^ Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intert to defraud, presents for allowance or for payment to any state board or officer , or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if .genuine , any false or fraudulent claim, bill, account , voucher, or writing , is guilty of a felony. " CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July . 2 5 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV belff��w�,),, given pursuant to Government Code Amount: $50, 000 . 00 Section 913 and 9Y�`)Alpt)olQ06jRG) all "Warnings". CLAIMANT: JO DAVILA JUN 3.0 1989 c/o Mary Nolan Esq. ATTORNEY: 16020 Carolyn Street Martinez, CA 94553 San Leandro, CA 9.4578 Date received ADDRESS: BY DELIVERY TO CLERK ON June 23 , 1989 hand del . BY MAIL POSTMARKED: no envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHH BB DATED: June 29 , 1989 BYIL DepuiyLOR, Clerk L. Hall Il. FROM: County Counsel TO: Clerk of the Board of Supervisors (� ) This claim complies substantially with Sections 910 and 910.2. C ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: GT�19 BY: I Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUL 2 5 1989 PHIL BATCHELOR, Clerk, By � Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:_ JUL 2 7 1989 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator 5. What are the names of county or district officers, servants or employees causing the damage or injury? / o vtf n/fix, fV uc7 ----- �CortlT%G1/��%�llcr------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or Aamages claimed. Attach two est mantes for auto damage.. --------------------- ---------------------------------------------- 7. How was the amount claimedabo a computed? (Include the estimated amount of any prospective injury or damage.) OiCR-(� '`'° < �'q�X• lC5s ��v.v� s .4ivn ,�rKrc�c -------------------------------- - - --e - n ----------- 8. --------8. Names and addresses of witnesses, doctors and hospitals. -------------- -------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM , -AMOO7UN—T �-e�vf� ' c i -( n / M MZ4; lciQ� /o ss ���LN i`��774*Ilf�1}� Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: ' (Attorney) or ? some person on his behalf." Attorney Name and Address of ._ � o �a C 's Signat � - eo 6A_ Addre Telephone No, 45 a78 - Silo Telephone No. N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. 4 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not . later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp Against the County of Contra Costa ) JUN_ 3 1989, v a�/cam �A/CO�P District) CL K N B FHELO 0.IAC;; Fill i name ) gy op�sv The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $Sof(7�0 dv y--6t7J1;NA-and in support of this claim represents as follows: t NJ --------------------------------------------------- ------------------ 1. When did the damage or injury occur? (Give exact date and hour) --------------------L--—------- --------------- 2. Where did the damage or injury occur? (Include city and county) AT7_HL-------------------------------- _�` GG ,gJSt�����//V 3• How did the damage or injury occur? (Give full details; use extra paper if required) 0.(.q�M AA& k)45 fiti°(I✓%/� L�9�6'0�� � �G�i�v� ,� 7kC Ai1 �or z�J whc.✓- bye v G�, rJ�s � 81/ A- ��-p•�er�l�c>v2�Qu� AA,e&A, a�� z- -----al&St�z 4. What particular act or omission on the part of county or district officers, //�� servants or employees caused the injury or damage?WTD l'a i�c �/Y�� l�Stw ,:!Sty fX (it slavJ cry /n�,es���v, /vv Y�oc� �y- � � ��F 7 Ca MtzrltA�)I_`6e�oc�s'� l �g cUA �3 �4 5 KMJW SWG � r/V�A / ��PnAy�F fi Ara_ s O88x_ ��S .� C(Mh�, `flcs �-ivibv�" ' CLAIM � BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA `Claim Against the County, or District governed by) BOARD ACTION t.�e Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Gov¢"oUh Code Amount: $163 . 00 Section 913 and 915.4. ; Please note all "Warnings"l. CDunse, ` CLAIMANT: MARC DELANEY ARMSTEAD JUN 1'a 1989 141 Golf Club Pleasant Hill, CA94523 Rd �art�ne2, Cq 94553 ATTORNEY: Date received ADDRESS: BY DELIVERY TO CLERK ON June 28 , 1989 BY MAIL POSTMARKED: June 27 , 1989 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pQH gg / DATED: June 29 , 1989 BYIL DeputyLOR, Clerk L. Hall 11. FROM: County Counsel TO: Clerk of the Board of Supervisors lv ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: G /3n 129 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( X) This Claim is rejected in full. (/\) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. n Dated: J t 2 5 1989 PHIL BATCHELOR, Clerk, By �eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order an otice to Claimant, addressed to the claimant as shown above_ . Dated: JUL 2 7 1989 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator AIM)TO. BOARD OF SUPERVISORS OF CONTRA C0� A c� TY WeYurr 2RN al appilcatlon to: Instructions to ,Claimant Clerk of the Board P.O.Box 911 rtinez,Californ�l 94553 A. Claims relating to causes of action for death or or injury o person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of . action must be presented not later than one year, after the. accrual of the cause of. action`. (Sec. 911.,2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106 , County Administration Building, 651 Pine Street, Martinez , California 94553. ; C. If claim is against a district governed by the Board of Supervisors , rather than the County, the name of the District should be filled in. D. If the claim is against more than -one public' entity, ' separate claims mast be filed against each public entity. " E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at end of this form. RE: Claim by ) Reserved for Clerk' s filing stamps r G ebeto 1-1 r m 5 1 Ai . �a.. ' =Against the COUNTY OF CONT-RA COSTA) . . . ). JUN 2 71989 DISTRICT) (Fill in name) ) iLe,•;c;.:1OP p ONTO _ . C . The undersigned claimant hereby makes claim against c..E 'C5 ." Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows : --------------- -------------- 1. When did, -the..•damage -,or injury occur? (Give exact date and hour) 2'. Where. did• the damage or i jury occur? (Include city and county) ean7� C�- o. .�TJ �c ----------- --------------------------------------- 3. How did the damage or injury occur? (Give full details , use extra sheets if r uired) Sm e.- oy,e ------ - ------------------------------------------------------------- 4 . Wh-at-pa--=rticular act or omission on the part of county or district officers , . servants or employees caused the injury or damage? (over) 1 r 5.::•? iat: ar.e.,tbe..;names of county or district officers , servants ox? ' i employees:causing(' the damage or injury?'' ----------- ------------------------- ---- -------------------------------- 6 . What damage or injuries do you claim-resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) 7�.. J �10-�( b�� 'ane. G� 0-1 --.--H-o-w--w-a-s--t-h-e--a-m-o-u-n-t--c-l-a-i-m-e-d--a-b-o-v-e--c-o-mp--u-t-e-d-?=----n-c--ud-e--h-e-e--sti-m-ated - amount of an i prospectve injury or damage� 1`�►am'8 `7cF.o �u,6pP Ccs ----------------------------------0--------pp-------------------------------- 8. N es and addresses of witnesses , doctors and hospitals . f - - - - ---------------------- - ---__...�_.--------,-----------_---- 9 .--L-is-t--the---expendi------tures you made on account of this accident or �n0ury: DATE ��j��!�T��EM• A-MOUNT �croBS, J1ZC� V7 .: a +6+- LE.-C9 40 0 1G3°" rho T6 C aloe lo`c ***t***********************fir*��'•�*y*s��*�****************��********** Govt. Code Sec. 910 . 2 proviae5 : "The claim signed by the claiman- SEND NOTICES TO: (Attorney) or by some person on his behalf . ' Name and Address of Attorney G P, 4 4nm 5te4� �n �-�e-� Claima�t' rSMtu/e d ss, Telephone No: 'lelepnone' No.� NOTICE Section 72 of the Penal Code provides : "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer , or to any county, town, , city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill , account , voucher or writing , is guilty 0f a felony. " * INCIDENT REPORT CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT INCIDENT INCIDENT. T FACILITY: 4�9,0L REPORT # : - D4 16) DATE/TIME DATE/TIME LOCATION: � OS~/�� OS-��-�r% � Cfq.,C� OCCURRED: - �� fir, - REPORTED: HOUSING INMATE: �� � BOOKING #: , --/ ;SA r ASSIGNMENT: Las i st Middle WITNESS(E$) -- LIST -- Name - Address If an inmate, give booking #, : SYNOPSIS: lte Ss NARRATIVE:' i� �f_.G //'� :221 022 C 7 W-S)- izTn)e gez2:z=tjz, r LIA-, z �n 7 /4-z2'42. L"Z'o . ,2�a*C 2% 4 F 4e-)Abe eJLi T_ 14� -giOOA: �o -AAJ1-9 75/ i-v 70 eOc 7- 11f- 7�Q c ACTION TAKEN/RECOMMENDED: (C,9-�-r/� REPORTING EMPLOYEE # SUPERVISOR # 1 s OPER NS DIRECTUR # O.D. ROUTING INSTRUCTIONS: White to Facility Manager Yellow to Booking File - Goldenrod to Inmate By: :. Pink to Lineup Board > r Page one of n a.' 4 err ry ! i i. 'S ^ -�i '- .- �'yC• yS. !� Rev. 3/85 s10_ .. w�..r+:L<:.w_..'�a...aGiN�+YT.',.�.,.....+tjit�H�L.-�X.�l..>-i.>'-".a. C..+.'•rC`.:isa'atl.x�.....:i...Lv'+„-i..[wee.',e"w'f�cbiS. .SeLt'54�`GiYw.a:..•.r.'t!M . CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT July 25 , 1989 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $355 . 00 Section 913 and 915.4. 1 Please note all "WX ".0 CLAIMANT: FELIZ DIAZ RODRIGUEZ OUnse/ 1517E Adams Blvd,. JUN 3.o ATTORNEY: !!-Los Angeles , CA 90011 Matting IsBg Date received 2' Cq ADDRESS: BY DELIVERY To CLERK ON Sune 28 , 1989 4553 BY MAIL POSTMARKED: June 26 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg o� DATED: June. 29 , 1989 BYIL DeputyLOR, Clerk L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: G �3Q 111 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administ for (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (x This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. O Dated: JUL 2 5 1989 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JUL -2-7-1989 Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator i BOARD OF SUPERVISORS OF CONTRA C0 'A �gv e ur i Z Sl application to: Y' Instructions to Claimant Clerk of the Board P.O.Boz 911 A. Claims relating to causes of action for death or =oroinjuryn o�533 person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Sec. 911. 2 , Govt. Code) B. Claims must be- filed with the Clerk of the Board of Supervisors at its office in Room 106 , County Administration Building, 651 Pine Street, Martinez , California 94553: C. If claim is against a district governed by the Board of Supervisors , rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. - E. Fraud. See penalty for fraudulent claims, Penil 'Code Sec. 72 at end of this form. RE: Claim by ) Reservedrf 1-er*Lsa--f4-Z4-ng stamps j JUN 2b' 1989 Against the COUNTY OF CONTRA COSTA) or DISTRICT) (Fill in name) ) ` . The undersigned claimant hereby makes claim against th County of Contra Costa. or the above-named District in the sum of $ ��$, A d and in support of this claim represents as follows : -------------------------------------------------------------------------- 1. When .did the damage or injury occur? (Give exact date and hour) -- - - ------ ----- ---- 7,- Where did the f!FVnRn,P n+' 2,n.,11rY occ ir? (Tnrlud P. City an,! coon,ty) q 3. -How did the damage or injury occur? (Give full details , use extra , sheets if required) / C11 A/C�£ /WY'GLD7;V6 jj Fid M 6044tT; 0Z.444 JAgt C, � DT1fiF,STO S CCOT?�£S, / NAD 7WO SE%S d G<OTf/tS //4� AVY Aj D,F GLOTN'iA(& 13401 Wh/ A I(:OORC, a4G/G F"A?6poeT TN£ 47744C,Z .9/U.0 %LI y . D, �,.C4OY-/iAI& .94 , . 601j/ 4 . What particular act or omission on the part of county or district officers , servants or employees caused the injury or damage? (over) r O V YI :n c � r :r �y ;S { 4 t, -� CP t a� ti0 �hrJ LA" '•� "� 4$UW Y lY ` r '.:5..:.:•j�zat. ar.e..the..names of county or district officers , servants or j employeescausing the damage or injury? - - f D, L>/VC -------=--------------------------------------------- -------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages / claimed. Attach two estimates for auto damage) ^� 61d/l� � zli12c L DSS ., 1Z�P1�cC/J�ivT_ _Ca<sT _x,551 -____-- 7-.--How was-the amount claimed above comput d? (Include the estimated - amount of any prospective injury or damage. ) ----- ---------------------------------------------- N -- 8. ames-----and-----addresses----------of witnesses , doctors and hospitals. 41 --------------------------------------------------------------------- ---- 9 . List the expenditures you made on account of this accident or injury: DATE ITEM PMOUNT F Govt. Code Sec. 910. 2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some oerson` on his behalf. " y Name and Address of Attorney ����X �Z;Wl&& 2-� Claimant' s Signature A dress� � 0 Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intert to defraud, presentz for allowance or for payment to any state board or officer , or to any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine , any false or fraudulent claim, bill , account , voucher , or writing , is guilty of a felony. " APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT July 25 , 1989 Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. County Counsel Claimant: George Raymond Baca 1530 Sutter Avenue JUN 3.0 1959 Attorney: San -Pablo, CA 94806 Martinez, CA 853 Address: Amount: $30 , ODO, 000. 00 By delivery to Clerk on June 26 , 1989 Date Received:June 26 , 1989 By mail, postmarked on June 23 , 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application Y'r a Late Claim. DATED: June 29, 1989 PHIL BATCHELOR, Clerk, By Deputy L. Hall II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). The Board should deny this Application to File Late A- (, ection 911.6). DATED VICTOR WESTMAN, County Counsel, By Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). This Application to File Late Claim is denied (Section 911 .6). /\ I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE:—JUL 2 5 1989 PHIL BATCHELOR, Clerk, B3�__ Deputy WARNING (Gov. Code 5911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Goverment Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. -- - JUL 2 7 1989 DATED: _ ! PHIL BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: 'County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM 'VED I i u N > 61989 y-- — — — - - --- . '7Z4,o5E —' y----- — - ---- — —-�i9 �` - C/i9i - l..i os+ 0 2. _ %s ai•25 f_s- -- ------- -- --�'o-�^.��� -�-�-- /�,,�-,�_„ l �� --- Rives_%iJJ� r % w QY0 61?W1117 -- - �94d� --_-- ---- • - —-- - ---- fes.f. - -o ' Com_/,` '� ,� Aa zzi - - -- 21 '109 c - -- - - -- ---� - - - -- -- ---- 1s3_� SL, +44 fz- tUf - -- - go i The Board of Supervisors Contra PtiliBatchei°` Clerk of the Board and Costa County Administrator County Administration Building - -_- (415)646-2371 Pine St., Room 106 Ma County Martinez, California 94553 Tom Powers,1R District .c..s.€..c._.o Nancy C.Fanden,2nd District Robert I.Schroder,3rd District Sunne Wright McPeak.4th District Tom Torlakeon,5th District 9U� •a A COVNn June 8 , 1989 TO: George Raymond Baca 1530 Sutter Avenue San Pablo, CA 94806 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911.3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa and/or District, June 2 1989 on is being *'ett:t•71c.i 1-n ....�. herewith r•.,, 1. w ,.,.. ...,. e..i„t. .,acauaa: _ Your claim for an injury to person or personal property which arose on or before December 31, 1987 was not presented within 100 days after the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) X Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government Code sections 901 and 911.2.) Your claim relating to a cause of action other than injury to person, personal property or growing crops was not presented within one year after the event or occurrence as required by law. (See Government Code sections 901 and 911.2) Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay for leave to pre- zen' a late Cid2 f'. -�occ vuvCituuetl* Code Sections 911.4 to 912.2 and 946.0.) Under some circumstances leave to present a late claim will be granted. (See Government Code Section 911.6.) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so imme- diately. PHIL BATCHELOR, Clerk of the Board of Supervisors,ang County Administrator By: Deputy Clerk Dated: June 8 , 1989 'Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp �,Eoa96 ,Q,,yM�ad 8,a�,� �� � Mkt�Fa v6 . ) OET) S,9,i Abi o, CA . %y 80- ) Against the County of Contra Costa ) or ) JUIN ' 1989�,�p District) ^P A- Z: R 4 CLE:. P SGAS Fill in name ) ,j R T ey .. opiny The undersigned claimant hereby makes claim against the County of Contra Cos a or the above-named District in the sum of $ 30 M 0f ivr 6,,? M vaa and in support of t S-/r claim repr7ents as follows: ClVN e,,4 is °%�°/Ht"'^%S� aM.rN /y/,tl �+%b/nf:ors� "700 OA SrI(r/1AI •77i ��iNS �SO /�Il �y AINIt' �i'7f L�fE C04 o� C4✓'F'.t.O COS A✓�� S .rY- 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 5y9,J r'A6/0 C/9 A,A0'r V1.9, CovtP.� Cis ��, C0uaJ7L y ------------------------------------------------------------------------------------ 3. How did the damage or injury occur? (Give full details; use extra paper if required) /�?yXw, o,., 6 -J769 7- w-2l 76/ e/y Aw cJ fh/r.v /L�-�� Cou...fy �R�e.�d.�./ i.✓./f ti/ ��7,�.2 ✓'=,�n/FRrrI •qNd -��J�r' ��w� �K/r (r dRO )k'N f�Cj A/'" �4✓ ,'�l C�u �i i�cJ' fj 4/h itv /�'y/, is U/'p�ro7�ini'!� C r✓%l R'S 4 r3 V zdA+,or ,� ANcI 5Ro5S ntk1i 9,9,v ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? cRiMftPV) � N691/jOrCi 0657/1C4Cfio✓ vyCyN,gf Ch: 4i IA � L,I'D 9f'a.aS / O F �[c� RA� 9.vt� S1,9f,C /'�/�Wt A�9ir1��7� /4�C. T�� CON�fiy c/'� ^,ot J dkff�9p�F T IE tjhDO}iP9 0 My A5 ,% t 5L1o,(/6, 4l'w4- 61x6%% �6/r SEI ia�'I�Cfsel y4 �:�a AL1 -AA& r/ X130, coal/y did w0f ft' • d� 9vaFoP/F� Vkft.J 1 l A VA5 )SF%y ih,��iS�"�EC/� 9 50 ��4./�Y /1 4JJ'�I✓`e Mb.�7� (over) �41"FpX,r'j 4.% /t{ My �ryW� rMffC/ici^ yY 5. What are the names of county or district officers, servants or- employees causing the dapage or injury? .S41,gjf. R:�bAaa Ra;,�ry (Awtj A*,) AMaMis,f O r4PQ,1Yi D, AAN<.6 AtOciAis /Iffvty ' /y �y J OTH/Ck 09,0/O�. ) I NGIHp�NJ!' �NS/�scfoic l is CApK/1NGi � - --------------------- -------------------------------------------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. fkr� ex/ J✓f o -I/ rHlr,.4s �,(,d/CNou.fN/ �YlfaFkt,�„i� fi Ph'eSfl.Jn/ c/r�MSyhs UI+�/CNo�t!//�� 04� y/I Ueaq M.sioe� ESP�c. �//7 pdara.tly/c��1/ryr,9d ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ------------------------------------------------------------------------------------- 8. . Names and addresses of witnesses, doctors and hospitals. �ANc1`} C� /SZ9, -F,e 09L,,'' . S.J.+ Pn6/o _ Re slds ��`s V�C' /f 3 Sti f fAk i7vd ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO:: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimantls Signature S 3�— S� ffce AV% Address Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. c x > o } r a cs� i-1 O U wnh ! I ls'VO r , a� RSM � 1 z " �:<�w . . . . � • " . . y•�w�� � C g m « � 0\N .% � \ v �4 / \ /\ $ » r ( § 7 . 4 ( ® ° )4-1 \ / mJ q 4J{ i 0 - 0 Lo �- / � « 2 m _ ( ¥ / . \) ! 0 7 xpDo0 \ j \ ( j m $ ! In § ( \ � \ \ ` m .