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MINUTES - 10081996 - C15
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $1,700,000.00 Section 913 and 9I5.4. Please note all "War TXCZIIWgJ0 CLAIMANT: Edward Lee Turner SEP .2 3 1996 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON September 19, 1996 Martinez, CA 94553 BY !TAIL POSTMARKED: September 18, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted claim. ppHH 8g 17 DATED: September 23, 1996 BYIL Depu-ty�' Clerk 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). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( his 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: /Qct 9, PHIL BATCHELOR, Clerk, By v � ems— , Deputy Clerk DARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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: ��� .�P.t ��, l9 9(_0 BY: PHIL BATCHELOR by�J � — Deputy Clerk CC: County Coinsel County Administrator Ak)• Aiovcx q6 / Co ole --- S f'- (037 RECEIVED i g CLERK 80ARD OF SUPERVISE CONTRA COSTA CO. ® - ,� , 1�✓e�os�o® �s "09 5e Iii vl2epss veo evel, r Q � �.%�� �� a X69 '00V � " Claim 'to: BOARD OF SQPERVLSORS OF CONTRA CC?SI`A OOUN7Y INSTRUCTIONS TO CLADLW 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, 19870 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 Roam 1069 County Administration Building, 551 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. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * f * * * * RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED } �Pde Inst the County of Contra Costa ) [�' or } `►- � T ,District) CLERK BOARD OF SUPERVISORS *Fi lin 77� I name ) CONTRA COSTA cry. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ /„ ?®d. Qpm• 0 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) dw ALI& as e l C 4-4 19 9 4_ —: , A _.1 �,... 2. Where did the damage or injury occur? (Include city and county) fiblAVLVEZ CAQAJZ:.%� JALL. 3. How did the damage or injury occur? (Give full details; use extra paper if required)" kobep NC � ��� oQ5.5n a l-4-4,4 m&/ �-"M 4i;44:vq r4e,A 4ud +-1 7-h B 4L f ltd. Coo _hea4AI _)�J lle�&M�.'SW7* a&f 0 4. 'What particular act or omission on the part of county or district officers, ser vants or employees caused the injury or damage? -1-6 the (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? C.,AAMI 544f Cea Kb -** 61, 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Am sdffe-A 6.4. ,d k)JqCx 7. How was the amount claimed above computed? (I elude the estimated amount of any prospective injury or damage.) �� ,� � vhf ctugesc, rSaMROCI 104 ® 00/ S HITT •-14e 4d o/I ll *A1 T LA-, As 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 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 �; d jQd •. ���,, Claimants Si ture Address 4 Telephone No. 16' Telephone No. ffe-k 70 ; !r i i �F f • * f * of a i * f # 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. y'tan rTti4 tz! ,i `a-x4 ivt" fk st Tyy'& "F'�#,i4 n -.c 16 s zr $' rt z3- - . 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'� "� °+. "S F' .ra°x rLy ,j .y.se�'P'%. �' r s yt iy tsy pa ,4k z 5�'a ac.,'i<'.E rs a, � St'e ., 3> �z=3 a, 'i' $""xi s'1�. e, ( :fi'a. i ri fxr� < 7' sem.t�`, Y � - mss: f t J LY. 'h'�`v+ 1. -� { .� 'u`.,.> ut+/ a, , �, -,. ,: £ A #�t rp s '•^ 4.r 1 'C rsr'" t "t s,6 r,s k^i ]fes r "kms -s a , �r�- ,.'` f� a v r r s '4 �' _. ,...,. j -su rF ,w^ �i .&' 'n'``��. :n "r..sr„-11 d ,s " T CLAIM + BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Cl; im Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 Gi Amount: $10,000.00+ Section 913 and 915.4. Please note all Xn%*"qMM CLAIMANT: Trudie Rogers SEP 1 3 1996 ATTORNEY: MARTINEZ CAUFL Date received ADDRESS: P.O. Box 4001 BY DELIVERY TO CLERK ON September 12, 1996 Antioch, CA 94509 ber 5tem BY MAIL POSTMARKED: September 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 13, 1996 IVIL �epuHtylOR, C1er���y�, II. FROM: County Counsel TO: Clerk of the Board of Supervisors 1107 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: t l��'9�o BY: 11W Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (1) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (►/f 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: ) 99�" PHIL BATCHELOR, Clerk, By(J , Deputy Clerk YARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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: &UVe5 1105 1 BY: PHIL BATCHELOR by�J`� — Deputy Clerk CC: County Coinsel County Administrator lttiss $rudie Vogers PO Box 4001 • Antioch CA 94509 RECEIVED SEP 1 2 1996 L,4 September 03, 1996 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CLAIM AGAINST THE COUNTY OF CONTRA COSTA Per Govt. Code§§900-905; 906; 910-910.2;911.2; 915-915.2 JEANNE MAGLIO, Chief Clerk, Board of Supervisors of Contra Costa County 651 Pine Street Room No. 106 Martinez CA 94553 510-646-2371/75 510-335-1913 (fax) Dear Chief Clerk Maglio: I miss trudie rogers aka claimant make this Claim prior to filing a Complaint for Damages in a Court of law. I am a resident of the Concord Homeless Shelter at 2047#C Arnold Industrial Way Concord CA. 1 have no phone. The total amount of my claim is within the jurisdiction of the Superior Court. The address to which all notices are to be sent is P O Box 4001 Antioch CA 94509. The dates of my loss are Tuesday July 23, 1996 through the present Tuesday September 03, 1996 and on-going. The location of the loss I have suffered is within the County of Contra Costa,and includes the cities of Brentwood,Antioch,Pittsburg,and Concord while I was homeless and waiting to get into the Shelter AND at the Shelter itself after I became a resident. The public employees/business entities who have caused my injuries and damages and losses include the Now Go, Write it before them in a table, J)OLY ,r�, y,,•yGC:: and note it in a Book, that it may be for the time to come PIBLE For ever and ever. Isaiah 34:8 CLAIM September 03,1996 Page two of three Board of Supervisors; Shelter,Inc. ; Concord Homeless Shelter; Mr. Kenneth Jackson,Director of the Concord Homeless Shelter; Mr.Scott Philbrook,Assistant Dirctor of the Concord Homeless Shelter; Miss Yvonne Collins, an employee at the Concord Homeless Shelter; Letha Hackett,a member of"the council"at the Concord Homeless Shelter; and other persons/entities unknown to me. Attached are the covers of proposed court pleadings,not yet filed,the entirety of which may be filed,pending the Board's acceptance or denial of my claim. I have suffered grievously since my first attempt to get into the Concord Homeless Shelter AND have suffered even more and worse since becoming a resident of the place. The program and its staff are woefully disoriented,disconnected,incompetent,untrained,and arrogant,seeming to believe that punishment,not reward, is the way to help needy,destitute people,some of whom are suffering genuine illnesses. I am constantly threatened with either being"written up"or the police being called. Three NOA's aka write- ups aka Notices of Action and you're out. I've been written-up twice already in two weeks-and I haven't even done anything yeti The NOA's and threats of police are used punitively and in retaliation by some staff members for residents' complaints to management,which doesn't do anything anyway. I have been denied food,even though there was lots of food locked in refrigerators and stored for people who come in late at night. Although there are homeless women desperate to get into the shelter, and on waiting lists,beds in the women's dorm go empty. The bunk beside mine has been empty the whole time I've been there and was only just occupied on the 28th of August. Some of the ladies were using it to keep stuff on. It is blatant discrimination that the shelter has 40 beds reserved for men and only 20(actually 22,but again, two to four bunks stay empty)reserved for women. I first made attempt to get into the shelter on Tuesday July 23, 1996. After following each and every instruction to the letter,not missing a step,phoning each and every day,I finally got into the shelter on Monday August 12, 1996. Each Monday I lost my Friday's seniority and had to start brand new on the waiting list. The privilege to come in at a later hour than the regular 7:00 pm curfew(called a" late night") is given totally arbitrarilly and by favoritism. I've asked for a late-night more than once in advance to work and been denied Two men left the shelter at 8:45 pm and returned at midnight on the 31 st of August; they attended a party. On the 1 st of September,a woman phoned in at 5:30 pm stating she had to work; she was given until 11:00 pm. That same night,a woman on"the council"did not show up at 7:00 pm curfew and roll-call. No one had heard from her or knew where she was. When she came in at 9:45 pm,my check of the Women's Dorm List indicated " L N IOpm " had been written by her name by the same woman who had written me up after I complained. I personally witnessed the cruel and malicious treatment of a resident,so eager to please,active in the 12 Step programs,a military veteran of the Desert Storm conflict,being threatened with an NOA,the police-the man CLAIM September 3, 1996 page three of three has simply gone last week,just quit. I saw him this morning at 6:45 at the North Concord BART station. I told him we were worried about him and missed him. We hugged. He said he couldn't take it any more - the NOA's, threats of police, the totally unnecessary cruelty. I realize his fate is my fate. I'm trying just as hard as he tried. These people's specialty is not helping the homeless find housing but to see how much delight they can get in being mean to poor people who have already literally lost everything. Their success rate at placing people in housing is abysmal and it is obvious to me why that is. I am not an animal, not a criminal, but this is how we are treated. I declare under penalty of perjury under the laws of the state o California that the regoin is true and correct. Dated : September 03, 1996 trudie rogers 1 miss trudie rogers PO Box 4001 2 Antioch CA 94509 3 4 5 IN THE SUPERIOR COURT OF CALIFORNIA 6 COUNTY OF CONTRA COSTA 7 8 9 Case No. 10 COMPLAINT FOR DAMAGES 11 Harassment,Order to Show Cause, 12 trudie rogers, Intentional Infliction of Emotional Plaintiff. Distress,Negligent Infliction of 13 Emotional Distress,Gender V. Discrimination,Slander,Breach of 14 Implied Warranty of Habitability, 15 Contra Costa County; Co Co Co Battery,Exemplary Damages Bd of Supervisors; Shelter,Inc.; 16 Concord Homeless Shelter; (CCC§§ 43; 46 ; 51 ; 52 ; 1708 ; Kenneth Jackson; Scott 1941 ; 1942.5; 1013a; 1954; 17 Phdbrook; Yvonne Collins; Letha 1%2.7; 3294; CCP§§425.10; IS Hackett; and Does I thru XX, 425.115; 474; 527; -527.6; Ev §§665; 668; Govt§§ 12955; 19 Defendants. 12980; Pen§§242;243; USC 42 20 §§ 1982-1983; 3601 ; 3604; 3613) 21 22 1. The defendants in this action,whose names and capacities,are known to plaintiff 23 on information and belief,are as follows: 24 a The defendant CONTRA COSTA COUNTY is a public government entity 25 operated by a BOARD OF SUPERVISORS and is not a natural person. 26 b. The defendant SHELTER,INC. is the sub-contractor of defendant Contra 27 Costa County and operates the CONCORD HOMELESS SHELTER located at 2047#C Arnold 28 Industrial Way Concord CA. I miss trudie rogers P O Box 4001 2 Antioch CA 94509 3 4 5 6 7 IN THE SUPERIOR COURT OF CALIFORNIA 8 COUNTY OF CONTRA COSTA 9 10 11 12 trudie rogers, Plaintiff. 13 Case No. 14 V. PLAINTIFF'S DECLARATION 15 Contra Costa County;Co Co Co IN SUPPORT OF Bd of Supervisors; Shelter,Inc.; COMPLAINT FOR DAMAGES 16 Concord Homeless Shelter; Kenneth Jackson; Scott 17 Philbrook; Yvonne Collins; Letha (CCP§ 425.10 (a) ; 2015.5 ) Hackett; and Does I thru XX, 18 19 Defendants. 20 21 22 I, miss trudie rogers,do hereby declare: 23 1. I am the plaintiff in the above-entitled action and that I do make this Declaration 24 in Support of the Complaint for Damages. 25 2. That I am a resident of the county of Contra Costa state of California and have 26 been continuously since 1986. 27 3. That on or about Monday August 12, 1996 I entered the Concord Homeless 28 Shelter located at 2047 #C in Concord California as a resident. _.` .,!�� �*.?raY� ."4+.�q^ais--r.Y>� .v�.,. `7.r� ?" �.'� t� C a.Pxt'R.v' 3ci..a'c,°"'."�•�'"9- X: as m -�' 4 S.sz� n.�b 1•.k` �'tu>+� '£.*.�y nx4. 0.� 7�ttz�" .r�uk..r•zrccyv �' ;:�'raa t.. - . ..a�'.f` $' S s ���a � �. s .e-,��"Pex�•�L+�- m' x '}; -T��' .: .�'"i��.'^tt��s�".'"t y» r+E'�^�',' 'L'�" y.. a .3T 4 .M"r�a s,' SEP OKIlar, 1 r}.a-baa^ nrr A a nax ;y I;Bx zx '"+ t sx t'^�a- ,F5 "{•ae xtt W', �a �'x.:.--t'`�' a^rz x "#�.'3''u ', aF �r3 0000 "k T"+ x-1'k tC 'OAEtL tt"W Y�"i1 F. He .sd'.& �Xh t 000620, 1 ;,`""�+Y°'i�k'F 1AF' 4k�w-� snt� Y.,-�—{�Ixy�yY..,rs m "Y.. *��. - A A+A'y3 .. .SIL 9, 4 . wt,. ya �; .''E `�'# i x 'wr "-�� "• e 9... 54,.,. #Rn �G ap" 'tea,: .N�""yyt- ma :# .A`7:�Y �������� - arx° T_� •��r�'�*��'� � �� _ -.k3'�•.��pr �� r r �,�� i max. � .., ��a�,.s� , �9 �,tx<a..,ra.,- .e Yi�arr. "t F� �< s R i ice. tt u•'a m^C t �. Q' F! a( � ' fir 4�"w>' 01 ° say x `a ,f �i a sc+ z�as s a AN z yn ON Px zr.�r��"cc^x: rte� � ,ez �.S�i"�°rx.�'�� Bs"P '� "�- 'nom `as�l• "hi Mm 31 NOv. �'a'aw^.#'"'t+r +•f�. �r ..�- s ��i6�,+AT �`L'.'7�, i "' S '�'y"-a'-r ,�' .a.t C"u'._ se-cC��G�: '�•d � ...rm a����,.. r5 r] '� � � '�3y-' �� i a '",��v„r.��' '� '`Lei A "•� r,��.y d .fix k, � ss�.., � •t ''iA.'S �` f"�'.,t +��"• .a. ��r" :.' � +'"� $ cb s MW LL L : +'- U<; �y"4 a... ✓�,`"a r��4si �- +s' "����<'teS�' n.��c. �i` ''F°� `�".,r "� y& F •¢ F-�=° :- Tix At � ^sw �"m { i��let @` � d �µ's ✓�sY �� � .F.. n � °'*�.Y '� ,�'�, � �: +`� n �_�., a �✓ � � ,� a �.y, ,r ,y IN& 4M g WE ry �. .. a..� � �` '. 'Yrs',. �y .. .yt�.,• Y � w �,a � � a. .�.e�kE+t�2� -`mak�,_� ��iYW ,,. F�,�W.w, `��.�. r�� � �-,�d�� -a.�L�"1`x•�'�, �` � �� �" �''�''"� a � v.� A, •. •• ' h.='a S43aL M _ -•SA .� S '-�cx a` w`,!A7 :/. `�. y ,: `�•�' �; '� 1 '"�,a�. �, ^�' � .. � ,�, � �s. G. 4P R � ����,..j a�;� x'•i A"fi'3.:'�"t � � 1Ys,' �6°'.: � Y .c � f n � `" ,.__ �°. r. 3 h°:%T S. ytx• w -t+'ia. .!�.� 7,k -.x r�.Pn ,++�,,.. _ ' Original First Amended Second Amended CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: Unknown Section 913 and 915.4. Please note all "W IAZIIM113) CLAIMANT: Joseph Barron and Rhonda Barron SEP 16 1996 ATTORNEY: Douglas E. Jaffe, SBN 88758 COUNTY COUNSEL Law Offices of Douglas E. Jaffe Date received MARTINEZ CALIF. ADDRESS:. 1129 D St. , Ste. 250 BY DELIVERY TO CLERK ON August 20, 1996 Sacramento, CA 95814 BY MAIL POSTMARKED: Via County Counsel & mail I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. g H DATED: September 16, 1996 ��iL Deputy OR, Clerk 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: 7 ' �(o - � BY:�/Lt/S,G6t 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. BOARDD 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: �� �99Lo PHIL BATCHELOR, Clerk, ?iLQii..ci�-��4�-- , Deputy Clerk NARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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: � j 9 9 BY: PHIL BATCHELOR by�� JE). aal..r 'Deputy Clerk CC: County Coirsel County Administrator ri ' 1 DOUGLAS E. JAFFE, SBN 88758 Law Offices of DOUGLAS E. JAFFE ter. 2 1129 D Street, Suite 250 :€.r. Sacramento, CA 95814 3 Telephone: (916) 443-1575 e�� Facsimile: (916) 442-7485 AW 2 0 �� 4 5 Attorney for Claimants , SUPERVISOR SMITE# 6 7 JOSEPH BARRON AND RHONDA ) No. 8 BARRON, ) NOTICE OF INTENTION -TO 9 Claimants, ) COMMENCE ACTION 10 V. ) Re: JOSEPH BARRON 11 MERRITHEW MEMORIAL HOSPITAL, ) DOB: 10/15/33 a California business ) SSN: 546-46-3270 12 entity, SHARON HEINER, M.D. ) and DOES I-L, INCLUSIVE ) 13 ) Defendants. ) 14 ) 15 The .address to which notices should be sent is 1129 D street, 16 Sacramento, California 95814. Notices should be sent to Douglas E. 17 Jaffe of the Law Offices of Douglas E. Jaffe at that address. 18 Plaintiff brings this claim for damages sustained by plaintiff 19 Joseph Barron as a result of the improper care and treatment by Dr. 20 Sharon ' Heiner and defendant public entity, and for loss of 21 consortium for Rhonda Barron. 22 Although plaintiff had treated with defendant entity and Dr. 23 Heiner for many years, they failed to perform prostate examinations 24 and it was only recently discovered that the plaintiff has severe 25 prostate problems which have resulted in surgery. Said prostate 26 problems were first discovered on March 11th, and plaintiff 27 continues to treat with Dr. Heiner until the present time. 28 Plaintiff contends the principals, employees of Merrithew 1 1 Hospital including Dr. Sharon Heiner, failed to adequately 2 diagnose, treat, and care for plaintiff's prostate problems and 3 other health problems for a time up until the present and that 4 their actions fell below the applicable standard of medical and 5 surgical care in the following respects: 6 1. By failing to timely perform adequate tests, including 7 prostate tests, failing to timely diagnose and treat his prostate 8 and possible cancer problems, failing to timely and adequately 9 treat his other health problems, and improperly and inaccurately 10 treating and managing plaintiff's prostate and kidney problems. 11 2 . Defendants negligently treated, cared for, diagnosed, 12 failed to obtain informed consent, prescribe medication or 13 treatment, operated on, advised, observed, managed, controlled, 14 examined, or failed to make disclosure of relevant information, 15 and/or perform surgery upon, and otherwise acted negligently toward 16 plaintiff in their care and treatment of him which proximately 17 caused physical and emotional injuries, pain, wage loss, need for 18 medical care,, and economic damages, and caused a loss of consortium 19 for which damages are claimed by plaintiff Rhonda Barron. 20 21 Dated: August 19, 1996 22 Respectfully Submitted, on behalf of the claimants, 23 24 LAW OFFICES OF DOUGLAS , JAFFE 25 26 By: UG E. J FE 27 28 2 1 DOUGLAS E. JAFFE, BAR #88758 Attorney at Law 2 1129 D Street, Suite 250 3 Sacramento, California 95814 (916) 443-1575 4 JOSEPH BARRON AND RHONDA BARRON V. MERRITHEW MEMORIAL HOSPITAL 5 6 Case Number: 7 PROOF OF SERVICE 8 1 am employed in the County of Sacramento, California. I am over the age of eighteen years and not a party to the within action. My business address is 1129 D 9 Street, Suite 250, Sacramento, California 95814. 10 On this date I served the foregoing NOTICE OF INTENTION TO COMMENCE 11 ACTION by placing true copies thereof, each enclosed in a sealed envelope with postage thereon fully prepaid, in the United States mail at Sacramento, California, addressed in 12 the manner set forth below: 13 Clerk Of The Board 14 Contra Costa County Board of Supervisors 651 Pine Street, Room 101 15 Martinez, CA 94553 16 17 1 declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct, and that this document was executed on August 19, 1996, 18 California. 19 20 TANY LOVER 21 22 c:\wp51\barron\Proof 23 24 25 26 27 28 1 � 1 DOUGLAS E. JAFFE, SBN 88758 Law Offices of DOUGLAS E. JAFFE 2 1129 D Street, Suite 250 Sacramento, CA 95814 3 Telephone: (916) 443-1575 Facsimile: (916) 442-7485 4 Attorney for Claimants 5 6 7 8 9 JOSEPH BARRON AND RHONDA ) No. BARRON, j 10 ) FIRST AMENDED Claimants, ) NOTICE OF INTENTION TO 11 ) COMMENCE ACTION V. ) 12 ) COUNTY OF CONTRA COSTA, ) Re: JOSEPH BARRON 13 MERRITHEW MEMORIAL HOSPITAL, ) DOB: 10/15/33 a California business ) SSN: 546-46-3270 14 entity, SHARON HEINER, M.D. ) and DOES I-L, INCLUSIVE ) 15 ) Defendants. ) 16 17 The address to which notices should be sent is 1129 D street, 18 Sacramento, California 95814. Notices should be sent to Douglas E. 19 Jaffe of the Law Offices of Douglas E. Jaffe at that address. 20 Plaintiff brings this claim for damages sustained by plaintiff 21 Joseph Barron as a result of the improper care and treatment by Dr. 22 Sharon Heiner, and Merrithew Hospital and for loss of consortium 23 for Rhonda Barron. Merrithew Hospital is owned and operated by, 24 and Dr. Heiner and the hospital staff are employees of, defendant 25 Contra Costa County. 26 Although plaintiff had treated with defendant entity and Dr. 27 Heiner for many years, they failed to perform prostate examinations 28 and it was only recently discovered that the plaintiff has severe 1 ' 1 prostate problems which have resulted in surgery. These actions 2 took place from the time the claimant first treated with defendants 3 in the mid 1980 's until the present time. Said prostate problems 4 were first discovered on March 11, 1996, and plaintiff continues to 5 treat with Dr. Heiner until the present time. 6 Plaintiff contends that defendant, Contra Costa County, 7 through its employees at Merrithew Hospital including Dr. Sharon 8 Heiner, failed to adequately diagnose, treat, and care for 9 plaintiff's prostate problems and other health problems for a time 10 up until the present and that their actions fell below the 11 applicable standard of medical and surgical care in the following 12 respects: 13 1. By failing to timely perform adequate tests, including 14 prostate tests, failing to timely diagnose and treat his prostate 15 and possible cancer problems, failing to timely and adequately 16 treat his other health problems, and improperly and inaccurately 17 treating and managing plaintiff's prostate and kidney problems. 18 2 . Defendants negligently treated, cared for, diagnosed, 19 failed to obtain informed . consent, prescribe medication or 20 treatment, operated on, advised, observed, managed, controlled, 21 examined, or failed to make disclosure of relevant information, 22 and/or perform surgery upon, and otherwise acted negligently toward 23 plaintiff in their care and treatment of him which proximately 24 caused physical and emotional injuries, pain, wage loss, need for 25 medical care, and economic damages, and caused a loss of consortium 26 for which damages are claimed by plaintiff Rhonda Barron. 27 \\\ 28 \\\ 2 1 Dated: September 3, 1996 2 Respectfully Submitted, on behalf of the claimants, 3 4 LAW OFFICES OF DOUGLAS E. JAFFE 5 6 By: i IM U E. FE 7 8 9 c:\up51\barron\claim 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3 1 DOUGLAS E. JAFFE, BAR #88758 Attorney at Law 2 1129 D Street, Suite 250 3 Sacramento, California 95814 (916) 443-1575 4 JOSEPH BARRON AND RHONDA BARRON V. MERRITHEW MEMORIAL HOSPITAL 5 6 Case Number: 7 PROOF OF SERVICE 8 1 am employed in the County of Sacramento, California. I am over the age of eighteen years and not a parry to the within action. My business address is 1129 D 9 Street, Suite 250, Sacramento, California 95814. 10 On this date I served the foregoing FIRST AMENDED NOTICE OF INTENTION 11 TO COMMENCE ACTION by placing true copies thereof, each enclosed in a sealed envelope with postage thereon fully prepaid, in the United States mail at Sacramento, 12 California, addressed in the manner set forth below: 13 Clerk Of The Board (via certified and first-class mail) 14 Contra Costa County Board of Supervisors 651 Pine Street, Room 101 15 Martinez, CA 94553 16 17 1 declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct, and that this document was executed on September 3, 18 1996, at Sacramento, California. 19 20 TAN A GLOVER 21 22 c:\wp51\barron\Proof 23 24 25 26 27 28 1 1 DOUGLAS E. JAFFE, SBN 88758 Law Offices of DOUGLAS E. JAFFE 2 1129 D Street, Suite 250 Sacramento, CA 95814 3 Telephone: (916) 443-1575 Facsimile: (916) 442-7485 4 Attorney for Claimants 5 6 7 8 9 JOSEPH BARRON AND RHONDA ) No. BARRON, ) 10 ) SECOND AMENDED Claimants, ) NOTICE OF INTENTION TO 11 ) COMMENCE ACTION V. ) 12 ) COUNTY OF. . CONTRA COSTA, ) Re: - .JOSEPH BARRON 13 MERRITHEW MEMORIAL HOSPITAL, ) DOB: 10/15/33 a California business .) SSN: 546-46-3270 14; '' entity, } SHARON HEINER, M.D. , ) JAMES .STANTON, ...-M.D. , and ) 15 DOES I-L, INCLUSIVE ) 16 Defendants. 17 The address to which notices should be sent is 1129 D street, 18 Sacramento, California 95814. Notices should be sent to Douglas E. 19 Jaffe of the Law Offices of Douglas E. Jaffe at that address. 20 Plaintiff brings this claim for damages sustained by plaintiff 21 Joseph Barron as a result of the improper care and treatment by Dr. 22 Sharon Heiner, Dr. James Stanton, and Merrithew Hospital and for 23 loss of consortium for Rhonda Barron. Merrithew Hospital is owned 24 and operated by, and Dr. Heiner; Dr. Stanton and the hospital staff 25 or employees and/or agents of, defendant Contra Costa County. 2,6 Although plaintiff had treated with defendant entity and Dr. 27 Heiner for many years, they failed to perform prostate examinations 28 and it was only recently discovered that the plaintiff has severe 1 . 1 prostate problems which have resulted in surgery. Said prostate 2 problems were first discovered in late March of 1996. Surgery was 3 performed by Dr. Stanton in April 1996. During the surgery, part 4 of the urethra was severed, causing severe disability including 5 urinary problems and impotence. Dr. Heiner also treated claimant 6 for his blood pressure and cardiovascular problems and in so doing 7 failed to adequately treat claimant's cholesterol level, did not 8 prescribe and order appropriate tests for his problems, and treated 9 him incorrectly for his cardiovascular disease. These actions took 10 place from the time the claimant first treated with defendants in 11 the mid 1980's until the present time. 12 Plaintiff contends that defendant, Contra Costa County, 13 through its employees at Merrithew Hospital including Dr. Sharon 14 Heiner, and Dr. James Stanton failed to adequately diagnose, treat, 15 and care for plaintiff's prostate problems and other health 16 problems for a time up until the present and that their actions 17 fell below the applicable standard of medical and surgical care in 18 the following respects: 19 1. By failing to timely perform adequate tests, including 20 prostate tests, failing to timely diagnose and treat his prostate 21 and possible cancer problems, failing to properly perform his 22 prostate surgery, failing to timely and adequately treat his other 23 health problems, including his cardiovascular problems, and 24 improperly and inaccurately treating and managing plaintiff's 25 prostate, kidney and cardiovascular problems. 26 2. Defendants negligently treated, cared for, diagnosed, 27 failed to obtain informed consent, prescribe medication or 28 treatment, operated on, advised, observed, managed, controlled, 2 0 . i 1 examined, or failed to make disclosure of relevant information, 2 and/or perform surgery upon, and otherwise acted negligently toward 3 plaintiff in their care and treatment of him which proximately 4 caused physical and emotional injuries, pain, wage loss, need for 5 medical care, and economic damages, and caused a loss of consortium 6 for which damages are claimed by plaintiff Rhonda Barron. 7 Dated: September 11, 1996 8 Respectfully Submitted, 9 on behalf of the claimants, 10 LAW OFFICES OF DOUGLAS E. JAFFE 11 12 By: 13 66udfA& E. AFFE 14 7 15 16 c:\up51\barron\claim 17 18 19 20 21 22 23 24 25 26 27 28 3 e 1 DOUGLAS E. JAFFE, BAR #88758 Attorney at Law 2 1129 D Street, Suite 250 3 Sacramento, California 95814 (916) 443-1575 4 JOSEPH BARRON AND RHONDA BARRON V. MERRITHEW MEMORIAL HOSPITAL 5 6 Case Number: 7 PROOF OF SERVICE 8 1 am employed in the County of Sacramento, California. I am over the age of eighteen years and not a party to the within action. My business address is 1129 D 9 Street, Suite 250, Sacramento, California 95814. 10 On this date I served the foregoing SECOND AMENDED NOTICE OF INTENTION 11 TO COMMENCE ACTION by placing true copies thereof, each enclosed in a sealed envelope with 'postage thereon fully prepaid, in the United States mail at Sacramento, 12 California, addressed in the manner set forth below: 13 Clerk Of The Board (via certified and first-class mail) 14 Contra Costa County Board of Supervisors 651 Pine Street, Room 101 15 Martinez, CA 94553 16 17 1 declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct, and that this document was executed on September 11, 18 1996, at Sacramento, California. 19 20 21 TANYA GLOVER 22 23 24 c:\wp51\barron\Proof 25 26 27 28 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 G "nd Amount: Unknown Section 913 and 915.4. Please note all ngs". CLAIMANT: James Fredrick Zwetz SEP 2 3 1996 NSE ATTORNEY: Ronald D. Foreman MART NNTYEZOALIFL Foreman & Brasso Date received ADDRESS: 807 Montgomery St. BY DELIVERY TO CLERK ON September 20, 1996 San Francisco, CA 94105 BY MAIL POSTMARKED: September 19, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCtIELOR, Cler DATED: September 23, 1996 If. Deputy i - 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). 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:AWW 8, 9w PHIL BATCHELOR, Clerk, B,�/Z-��- "�-�` � , Deputy Clerk YARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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. c Dated: a&& Q6- , � BY: PHIL BATCHELOR by�c��,.z �' Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST GOVERNMENT ENTITY FOR DAMAGES TO PERSON OR PROPERTY CLAIM FOR DAMAGES TO: RECEIVED Diablo Water District/East Bay Regional SEP 2 Q SM P.O. Box 127 3990 Main Street Oakley, CA 94561 CLERK BOARD OF SUPERVISORS (510 ) 625-2112 CONTRA COSTA CO. parcel no. 037-191-006-8 East Bay Regional Park District 450 Walnut Meadows Drive Oakley, CA 94561 parcel no. 037-191-023-3 Oakley-Bethel Waste Water District P.O. Box 1103 Oakley, CA 94561 Contra Costa Water District Michael Salazar 1331 Concord Avenue Concord, CA 94520 (510) 688-8000 County of Contra Costa (for itself and the unincorporated City of Oakley) Board of Supervisors 651 Pine Street, Rm 106 Martinez, CA 94553 (510) 646-2371 Claimant: James Fredrick Zwetz dob: 12/8/56 8145 Lone Tree Way Brentwood, CA 94513 Address To Send Communications Regarding This Claim: Ronald D. Foreman Foreman & Brasso 807 Montgomery Street San Francisco, CA 94105 (414 ) 433-3475 When did Damage or Injury Occur: Date of Accident: March 27, 1996 (Wednesday) Time: 1 :20 p.m. CLAIM FOR DAMAGES September 19, 1996 Page 2 Where did Damage or Injury Occur: Location: Service Road for the Contra Costa Pump Station #1, East of Oakley and North of Highway 4 at the Contra Costa Canal and between Railroad Signals #11451 and #11452, approximately 130 feet north of S/R 4, near Rose Avenue in the City of Oakley in Contra Costa County, California. At the scene of the collision, a one lane, northbound/southbound roadwav intersects the railroad tracks . The tracks run in an east/west direction and consist of two sets of parallel tracks . The intersection is controlled by a stop sign on either side of the tracks . Dirt service roads run parallel with the tracks . How Did Damage or Injury Occur? On March 27 , 1996, Zwetz, in the course and scope of his employment with Pacific Bell, was on an inspection to locate a downed telephone line on the north side of the north track by the Sanitary Weigh Station and Water District Corporation office, just east of Oakley. Zwetz was driving a 1988 white Ford F-350, license number 3M50010 CA. It was a one ton 4-wheel drive truck with a flat bed dumpster. The owner of the truck was Zwetz ' s employer, Pacific Bell, 3707 Kingsway, Sacramento, CA 95851 . Zwetz made a left hand turn off of the dirt service road up a small hill to turn his truck to the right to drive over and across the railroad crossing. As he made his right hand, he approached the railroad crossing at this service road crossing. The paved, but deteriorated road, dips down towards the track, continues across the track, and travels up a small ravine to the other side as it approaches Highway 4 . (Highway 4 is one lane of traffic in either direction. ) The railroad crossing is unprotected. There are no signal lights, wig-wags or other barricades to block one from crossing the tracks . To the left of the dip of the road is a construction shed sitting on top of the canal . This service road runs parallel with the canal. The construction shed, inside a cyclone fence, blocks one ' s view of the oncoming train traffic from the left. There is a blind spot for drivers as the train approaches . As Zwetz approached the intersection, he drove his truck forward, southbound, and the next obstacle blocking his view was the railroad traffic light for oncoming trains, #11541 . This light is about 20 to 40 yards east of the service road. As Zwetz approached the railroad tracks creeping along at 0 to 5 m.p.h. , he caught site of his coworker Ted Davis, standing on the other side of the tracks . Davis was a maintenance splicer who had called in the repair order that caused Zwetz respond to the service call . [A Pacific Bell CLAIM FOR DAMAGES September 19, 1996 Page 3 customer had complained of down lines . ] Zwetz recalls seeing Davis standing somewhere on the south side of the tracks between the tracks and Highway 4 . He recalls a silver flash on his left prior to being struck by a speeding train. Zwetz was struck by a blue, GM 2006 Amtrack train, license. number 713, travelling westbound on the Santa Fe Railroad Track. The Amtrack train consisted of an engine and four passenger cars, approaching the intersection at approximately 79 miles per hour. The front end of Zwetz ' s truck caught the calguard of the right side of the train, which tore the truck apart. The flat bed of the truck flew over the top of the train landing on the south side of the tracks . Zwetz was thrown from the truck and landed approximately 60 feet west of the service road. What particular Act or Omission Caused The Injury: These defendants, who owned and controlled the subject property where the accident occurred, failed to adequately protect the crossing, i.e. , no lights, bells, automatic gates or other such warning devices at the crossing. Also, there was an inadequate line of sight, non-standard signing and an irregular grade and surface on the approach and crossing. Defendants are liable for both the dangerous condition of public property and negligent creation of dangerous condition. The grade crossing was dangerously designed. There were inadequate warning devices at the subject crossing, given the railroad' s operations, the road design and use. Defendants had notice of these deficiencies as there were two prior accidents at the same location. Defendants failed to protect against the hazard after such notice of the dangerous condition. Defendants also had a mandatory duty, pursuant to the PUC regulations, to adequately protect said crossing. Please list the names and address of Witnesses, Doctors and Hospitals: Doctors and Hospitals: Cal Star: Helicopter John Muir Hospital 1601 Ygnacio Valley Road Walnut Creek, CA 94598 (510) 939-3000 Physical Therapy CLAIM FOR DAMAGES September 19, 1996 Page 4 Witnesses: Barbara Nue B-1851 Bldg. A 5th Street Oakland, CA 94607 (510) 433-5613 Gary Burke B-1851 Bldg. A 5th Street Oakland, CA 94607 (510) 433-5613 Mark William Jones (Driver of Amtrack Train) B-1851 Bldg. A 5th Street Oakland, CA 94607 (510) 433-5613 Ted Davis (Co-employee of Zwetz) H-3141 Mountaire Drive Antioch, CA 94509 (510) 757-4426 (510) 432-1017 What Damage or Injuries resulted: Zwetz was evacuated from the accident scene by helicopter and taken directly to John Muir. The doctors at John Muir diagnosed him as having seven fractured ribs, a punctured left lung, chest problems, and he was operated on for splenectomy and other problems . He was hospitalized for 3-� weeks at John Muir Hospital . Dr. John Knight was one of a number of doctors who worked on Zwetz including an internist, a general surgeon, an orthopedic surgeon, and a blood specialist. - Zwetz ' s ongoing and future medical problems relate to soft tissue in the scapula area, lung problems, problems with his back, shoulder swelling as well as emotional and psychological injuries . CLAIM FOR DAMAGES September 19, 1996 Page 5 What Is the Amount of Your Claim: Economic Damages : medical in excess of $156,270 . 70; wage loss in excess of $50, 000 and continuing; loss of future wage loss unknown at this time. Non-Economic Damages : $1,500, 000 Dated: September 19, 1996 F & SO By: onald eman A torneys for Plaintiff JAMES ZWETZ yY aL cn U aNN _ Q , p 0 0 M M Y 7 tll g Nc W N � V � g Z w � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY_,_CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 note all CLAIMANT:Antonio Albolaez Lopez SFP 2 3 1996 ATIC[Nff: Law Offices of Peter J. McNulty MARTIY0 CAIFL Date received ADDRESS: 827 Moraga Dr. BY DELIVERY TO CLERK ON September 19, 1996 Bel Air, CA 90049 September 17, 1996 BY MAIL POSTMARKED: P I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �aIL gATC ELOR, Clerk DATED: September 23, 1996 . Depu y II. FROM: County Counsel TO: Clerk of the Board of Supervisors V"') O) 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: (/{A�/ 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 ( 1.4'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:� �w9 �� 99co PHIL BATCHELOR, Clerk, Be., A ��a0CZ-- , Deputy Clerk NARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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. c Dated: �c /6 , �99co BY: PHIL BATCHELOR b�� Deputy Clerk CC: County Counsel County Administrator In Re the Claim of ) ANTONIO ALBOLAEZ LOPEZ, ) GOVERNMENT CLAIM Claimants, Against ) CONTRA COSTA COUNTY, RECEIVED PITTSBURG HEALTH CENTER ) a Public Entity, ) 9 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CLAIM AGAINST CONTRA COSTA COUNTY; PITTSBURG HEALTH CENTER TO: CONTRA COSTA COUNTY; PITTSBURG HEALTH CENTER 1 . Name of Claimant: Antonio Albolaez Lopez . 2 . Address and Telephone Number of Claimants: 68 Treatro Ave. , #6, Pittsburgh, CA 94565; (510) 439-0518 . 3 . Notice Re Claim Should be Sent To: Law Offices of Peter J. McNulty, 827 Moraga Drive, Bel Air, CA 90049; (310) 471-2707 . 4 . Date of Birth: July 13, 1942 . 5 . Date of Incident: July 29, 1993 through March 25, 1996; not discovered until April 17, 1996. 1 6. Names of Public Entity Employees Involved: N. Corser, M. D. and other yet unidentified employees of Contra Costa County, Pittsburg Health Center. 7 . Location of Incident: Pittsburg Health Center, 550 School Street, Pittsburg, CA 94565 . 8 . Claim of Negligence: Failure to diagnose and treat Antonio Albolaez Lopez' prostate cancer. 9. Claim of Damages: In addition to general damages of $250, 000, Antonio Albolaez Lopez has sustained damages in the form of medical expenses and loss of earnings . It is anticipated that he will incur future medical expenses and will continue to have a loss of earnings and/or earning capacity. 10 . Witnesses: Antonio Albolaez Lopez; N. Corser, M. D. ; as well as other yet unidentified employees of Contra Costa County, Pittsburg Health Center whose names and identities are unknown. 11 . Damages Claimed: 1 . General Damages: $250, 000 (per M. I .C.R.A. ) 2 . Past Medicals : $20, 000 (estimate) 3 . Future Medicals : Unknown at present. 4 . Loss of Earnings : $10, 000 (estimate) 5 . Future Loss of Earnings : Unknown at present. 2 12 . Action on Claim: If you contend that this claim is in any way defective, insufficient or untimely, you are directed to give the undersigned attorney for claimants written notice of same within ten (10) days of your receipt. Failure to provide such written notice will be deemed waiver of any objections to the timing, form and/or sufficiency of this claim. Respectfully submitted, DATED: September 1996 LAW OFFICES OF PETER J. McNULTY By (/�'7torne McN sfor Claimants 3 I PROOF OF SERVICE 2 STATE OF CALIFORNIA ) ss. 3 COUNTY OF LOS ANGELES ) 4 I am employed in the County of Los Angeles, State of California. I am over the age of 18 and not a party to the within action. My business address is 827 Moraga Drive, Bel Air, California 5 90049. 6 On September___G 1996,I served the foregoing document described as: GOVERNMENT CLAIM in this action by placing a true copy thereof enclosed in a sealed envelope addressed as 7 follows: 8 Clerk of the Board of Supervisors 651 Pine Street 9 Martinez, CA 94533 10 X BY U.S.MAIL.(Certified Mail/Return Receipt Requested)I caused such envelope to be 11 deposited in the mail,with postage thereon fully prepaid,at Bel Air, California. [I am"readily familiar"with this firm's practice of collection and processing correspondence for mailing. It is deposited with the 12 U.S.Postal Service on that same day in the ordinary course of business. I am aware that on motion of the party served,service is presumed invalid if the postal cancellation date or postage meter date is more than one(1)day 13 after the date of deposit for mailing in the affidavit.] 14 — BY PERSONAL SERVICE I personally delivered such envelope to the offices of the addressee. 15 — BY FEDERAL EXPRESS MAIL, I personally delivered such envelope on**to a Federal 16 Express drop box or office in Bel Air, California,marked for delivery on**, 1996. 17 — BY TELECOPIER I telecopied such document to the addressee at the telecopier number listed for each addressee. 18 I declare that I am employed in the office of a member of the bar of this Court at whose 19 direction the service was made. 20 I declare under penalty of perjury under the laws of the Statepf California that the above is true and correct and that this declaration was executed on September� , 1996 at Bel Air,California. 21 22 (kLAAA0A OIE 23 24 25 26 27 28 f rn� f ' n o � 0 A N 0 s W O r3 Q C� N w CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY,_CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 Goverment Code P&%Ww',z) Amount: $100,000.00+ Section 913 and 915.4. Please note CLAIMANT: Kimberly Ann Habiger and Kenneth Habiger app 19 1996 ATTORNEY: Walter H. Walker, III COUNTY COUNSEL Law Offices. of Walker & Durham Date received MARTINEZ CAUR ADDRESS: 50 .Francisco St. , Ste. 160 BY DELIVERY TO CLERK ON September 18, 1996 San Francisco, CA 94133 BY MAIL POSTMARKED: September 16, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Se tember 19 1996 QQ 8aIL BgATCVELOR, Cie -- OATED: p . Depu y 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: // . ( ( /G BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1)V 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: Pull e, j99� PHIL BATCHELOR, Clerk, By Deputy Clerk iiARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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: (0� �� �99� BY: PHIL BATCHELOR b ��r-�-�a - _Deputy Clerk CC: County Coirsel County Administrator 1 WALTER H. WALKER, III (STATE BAR #63117) 2 LAW OFFICES OF WALKER & DURHAM 50 Francisco Street, Suite 160 RECEIVED 3 San Francisco, CA 94133 Telephone : (415) 986-3339 SEP 1 8 1996 4 Attorneys for Plaintiffs [ 1 5 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 1. 6 7 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 IN AND FOR THE COUNTY OF CONTRA COSTA 9 10 Claim of Kimberly Ann Habiger ) Case No. 11 and Kenneth Habiger, ) CLAIM FOR PERSONAL 12 Plaintiffs, ) INJURIES (Government Code 13 ) Section 910) 14 V. ) ) 15 ) 16 ) 17 County of Contra Costa ) 18 Defendants . ) 19 20 To the Board of Supervisors of the County of Contra Costa : 21 YOU ARE HEREBY NOTIFIED THAT Kimberly Ann Habiger, whose 22 address is 5109 Marita Drive, Antioch, CA 94509, and her husband, 23 Kenneth Habiger of the same address, claim damage from the County 24 of Contra Costa in an amount in excess of $100, 000 . 25 This claim is based on personal injuries maintained by 26 claimant on or about July 2 , 1996, on Concord Avenue 27 approximately 1 . 6 miles east of its intersection with Balfour 28 1 Law Offices of Walker&Durham Fifty Francisco St.,Suite 160 San Francisco,California 94133 (415)986-3339 1 Road, in an unincorporated area of Contra Costa County near 2 Antioch. The following circumstances caused the accident . 3 Concord Avenue was temporarily closed for construction. No 4 adequate signs informed motorists of the closure, so that 5 vehicles entering from Balfour Road were not adequately warned of 6 the closure, which had commenced July 28, 1992 , and continued 7 driving on Concord Avenue until they were suddenly confronted 8 with barricades and the need to turn around in the road. Jeffrey 9 Steward driving a 1996 Chevrolet pickup truck at 6 : 10 a.m. , came 10 to the barricade, was surprised, turned around, and drove head-on 11 into a vehicle operated by Kimberly Habiger, who also did not 12 know the road was closed and who was leading a procession of 13 other vehicles whose operators did not know the road was closed. 14 Kimberly Habiger' s injuries includes breaks to both her 15 ankles, as well as head and facial wounds, and were caused by the 16 negligence of employees of the County of Contra Costa whose names 17 are currently unknown to the claimant . Said employees were 18 negligent in failing to post signs adequately warning of the road 19 closure . 20 Kimberly Habiger has suffered physical and emotional 21 injuries, loss of earnings, impairment of earning capacity, 22 medical expenses in excess of $64, 902 .46, nursing and attendant 23 expenses; and Kenneth Habiger has suffered loss of consortium. 24 Jurisdiction over this claim rests in the Superior Court . 25 26 27 2 28 Law Offices of Walker&Durham Fifty Francisco St.,Suite 160 San Francisco,California 94133 (415)986-3339 1 All notices or other communications with regard to the claim 2 should be sent to Walter H. Walker, III, at the Law Offices of 3 Walker & Durham, 50 Francisco Street, Suite 160, San Francisco, 4 CA 94133 . 5 DATED: September 13, 1996 LAW OFFICES OF WALKER & DURHAM 6 8 WALTER WALKER, III 9 �.. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 3 Law offices of Walker&Durham Fifty Francisco St.,Suite 160 San Francisco,California 94133 (415)986.3339 . 1 PROOF OF SERVICE BY MAIL 2 Habiger v. County of Contra Costa 3 I am over the ears 18 age of and not a g y party to the within 4 action. My business address is 50 Francisco Street, Suite 160, San Francisco, CA 94133 . 5 I am readily familiar with the Firm' s practice for 6 collection and processing of correspondence for mailing with the United States Postal Service ( "Postal Service" ) . Pursuant to 7 that practice, correspondence which is placed for collection and mailing with the Postal Service during regular business hours on 8 a given date would be deposited with the Postal Service on that same date in the ordinary course of business . 9 On September 16, 1996 I served the attached CLAIM FOR 10 PERSONAL INJURIES by mail in this cause by placing a copy thereof. in envelopes bearing the following names and addresses of the 11 persons to be served: 12 Board of Supervisors County of Contra Costa 13 651 Pine Street Martinez, CA 94553 14 On the above date, during regular business hours, I sealed 15 the above-described envelopes and placed them for collection and mailing with the Postal Service in accordance with the Firm' s 16 ordinary business practice described above . 17 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct . 18 Executed September 16 , 1996, at San Francisco, California. 19 20 SERENA L. OBINSON 21 22 23 24 25 26 27 28 Law Offices of Walker&Durham Fifty Francisco St.,Suite 160 San Francisco,California 94133 (415)986-3339 �c w o N 0 C R K O n d n a M a W W PL) tLn00 r N � � °n N. rti r-r u} ru m O -j t-3 !D O u, n � nr- 02 (D � � (D rt n rt Ul Ln LA) nO mm rt v i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIAOctober 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 pursua � Amount: $1000.00 Section 913 and 915.4. Please not arn1ngV CLAIMANT: Elizabeth B. Hoch SEP 17 1996 ATTORNEY: COUNTY COUNSEL MARTINEZ CALIF. Date received ADDRESS: 216 Castle Glen Rd. BY DELIVERY TO CLERK ON September 12, 1996 Walnut Creek, CA 94595 Via Count Counsel BY MAIL POSTMARKED: Y I. FROM: Clerk of the board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH B H DATED: September 17, 1996 itiil Deputy OR, C1e�� e� II. FROM: County Counsel TO: Clerk of the Board of Supervisors (A) 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: Me- BY: ' A 0. YZ== 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. Dated: �J, �99�v PHIL BATCHELOR, Clerk, By �is- � . Deputy Clerk YARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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. C Dated: © +��" /� /99(-o BY: PHIL BATCHELOR by�J „ Za off— Deputy Clerk CC: County Coirsel County Administrator ' • •VICTOR J. WESTMAN CONTRA COSTA COUNTY COUNSEL TO fl P.O. BOX 69, CO. ADMIN. BLDG., MARTINEZ, CA 94553 DATE ` 1`( `� SUBJECT v D� Office of District Attorney Contra DistrictAttomeyQY Court House,Fourth Floor �O.sj P.O.Box 670 ll - ) ez California 94553-0150 (510)C46-4500 Cn u n{ y 1 2 1996 COUNTY COUNSEL MARTINEZ CALIF. Sr'9 COUPi'� September 10, 1996 Elizabeth Hoch 216 Castle Glen Road Walnut Creek, CA 94595 RE: Your recent complaint Complaint No. 96-09-499 Dear Ms. Hoch: Your complaint regarding the above referenced appears to be within the jurisdiction of the agency listed below. We are forwarding a copy of this letter together with the complaint for their attention. Your complaint will be re-evaluated by this office in light of any further investigation done by said agency. Very truly yours, GARY T. YANCEY District Attorney Curtis R. Hoffman Deputy District Attorney CRH.:ch Enc CC: County Counsel 651 Pine Street 9th Floor Martinez, CA 94553 t CH WILLIAME:HO ELIZABETH B. HOCH 216 CASTLE"'GW4 BOA13 WALNUT CREI=JC, CA:.94595 O77 8 . { QontraC sta.. County c/Qbistri ct Attorney �onsum�r Complaints Walnut Creek, aept.5.1996 t7 r Re `Personal Injury ,tJn duly 21«, -996 at 11-.30 am Elizabeth F. Hoch of 216 Castle. Glen Road, 'Walnut' Creek, ale, 70, tripped and fell over an elevated rLanholecover ( photo. enclosed} infront of 224 Castle .Glen Road, WC. ahe suffered a broken fin3er and minor bruises. At John Muir EmerEency Dr. N. Livermore repaired the damaGe and applied braces. i After my call to County Maintenance the road has been repaired, Now Medicare stopped payments and advised us to file a legal claim or lawsuit. The total medical charges ( emergency plus follow up Dr. visits} will amount to about $1000. ( onethousant } Please respond before we have to take other steps. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 Gover Y*113)s Amount: $70,000.00+ Section 913 and 915.4. Please note ail Ipxs CLAIMANT: Rodeo Sanitary District SEP 17 1996 ATTORNEY: COUNTY COUNSEL David J. Levy, Esq. MARTINEZ CALIF. Schwartz, Levy & Lavin Date received ADDRESS: 2121 North California Blvd. , BY DELIVERY TO CLERK ON September 16, 1996 Ste. 1010 September 13 1996 Walnut Creek, CA 94596 BY MAIL POSTMARKED: P I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 17, 1996 BaII �epuylOR. Cle � � , 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). ( 1/� Other: 1 Dated: y BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County nistrator (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: o�ei /`�9� PHIL BATCHELOR, Clerk. BY�11��/�-� - , Deputy Clerk NARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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: bma, /,571 19%c BY: PHIL BATCHELOR by(vF, a.tj . �jL� —Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM \ TO: David J. Levy, Esq. Schwartz, Levy, & Lavin 2121 North California Blvd., Ste 1010 Walnut Creek, CA 94596 RE: CLAIM OF: Rodeo Sanitary District Please Take Notice as Follows: The claim you presented against the County of Contra Costa 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: [ ] L The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [xx] 3. The claim fails to state the date, place or other 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 is behalf. [xx] 7. Other: Because of claimant's failure to state the date of the alleged tortious conduct, the County is unable to determine the timeliness of this claim. The County of Contra Costa therefore reserves the right to deny the claim as untimely when an amended claim is filed. VICTOR J. WESTMAN, County Counsel By: Gregory ;(u/nity . arvey Deputy C Counsel v Page 1 CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;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 addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: September ""')1996 at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 SCHWARTZ 9 LEVY & LAVIN ATTORNEYS AT LAW A PROFESSIONAL ASSOCIATION 2121 NORTH CALIFORNIA BOULEVARD,SUITE 1010 WALNUT CREEK, CALIFORNIA 94596 15101 934-6082 FACSIMILE 15101 934-1507 MARCHMONT J.SCHWARTZ OF COUNSEL BEVERLY J.LAVIN September 13, 1996 DAVID J. LEVY KENNETH H.LAVIN .�..��...� RECEIVED CERTIFIED MAIL Y RETURN RECEIPT REQUESTED SEP 116 19A6 Clerk, Board of Supervisors CLERK BOARD OF SUPERVISORS 651 Pine Street CONTRA COSTA CO. Martinez, CA 94553 Re: Claim of Rodeo Sanitary District Our File No. 603-005 Dear Sir: Enclosed for filing and presentation to the full Board of Supervisors please find the claim of Rodeo Sanitary District. Yours very truly, Schwartz, Levy & Lavin A Professional Association David J. Le DJL/car Enclosure cc: Mr. Valentin Alexeeff, Director Contra Costa County Growth Management and Economic Development Agency Thomas B. Bruen, Esq. Bruen& Gordon 603-005/Supervisor/Itr/DJL/car RODEO SANITARY DISTRICT P. O. Box 97 Rodeo, CA 94572 RECENED CLAIM AGAINST PUBLIC ENTITY 16 US To: The Honorable Chairman and Members, SUPERVISORS Board of Supervisors gyp, County of Contra Costa State of California Rodeo Sanitary District hereby makes claim against the County of Contra Costa for a sum in excess of Seventy Thousand Dollars ($70,000.00) and makes the following statements in support of the claim: 1. Claimant's post office address is: Rodeo Sanitary District P. O. Box 97 Rodeo, CA 94572 2. Notices concerning the claim should be sent to: David J. Levy, Esq. Schwartz, Levy & Lavin 2121 North California Boulevard, Suite 1010 Walnut Creek, CA 94596 3. The date and place of the transaction giving rise to this claim are as follows: Effective on August 5, 1996,the Board of Supervisors granted exclusive garbage franchise rights to Pleasant Hill Bayshore Disposal, Inc., for the area in Contra Costa County that is entirely within the Rodeo Sanitary District. 4. The circumstances giving rise to this claim are as follows: Rodeo Sanitary District(herein referred to as Rodeo) is an autonomous special district in Contra Costa County, California, created pursuant to the Sanitary District Act of 1923 with the 504-008/Claim/DJL/car full statutory authority to collect waste and garbage within the District and to enter into contracts for the collection and disposition of garbage. For over forty (40) years, Rodeo has administered, set fates and supervised the collection and dispostion of garbage within the District by entering into an exclusive garbage franchise with a qualified contractor. Pleasant Hill Bayshore Disposal, Inc., has an exclusive garbage collection franchise within Rodeo Sanitary District through and including October 31, 2001 whereby Rodeo is paid a franchise fee of four percent(4%) of garbage rates that are collected within the District. The funds collected as franchise fees are for the purpose of defraying costs, attorney fees and liability resulting from Acme Landfill's litigation to close the garbage landfill. Without the concurrence or approval of Rodeo, the County of Contra Costa acting through its Board of Supervisors knowingly and willfully tortiously induced Pleasant Hill Bayshore Disposal, Inc.,to breach its exclusive contract with Rodeo and to enter into an exclusive agreement with Contra Costa County for a garbage collection franchise within the same area of Rodeo Sanitary District. 5. Claimant's claim is in an amount that would place it within the jurisdiction of the Superior Court. 6. The name of the public employee who is most knowledgeable about this claim is Val Alexeef. Dated: September 13, 1996 Rodeo Sanitary District By David J. L as Attorne or Rodeo Sanit ict 504-008/Claim/DJL/car N V+ N Q A t top- op A >Y� Cyn lie 71, 'P lD O i F a N N �k W tea' f t� J � J r � p +.` !,` N RkR�R• k s 1 ' r _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 note al V 1%) CLAIMANT: Ronald W. Fray SEP 19 1996 ATTORNEY: COUNTYCOUNSEL Date received Se tember 18MA1996ZCALIF. ADDRESS: 1723 Bishop Dr. BY DELIVERY TO CLERK ON P , Concord, CA 94521 BY NAIL POSTMARKED: September 17, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHHit DepuH _ORCl DATED: September 19, 1996 ty II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( L4 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: 9 , /� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admin strator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ✓l 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: ®ZW.1,(A 8, )'7 411PHIL BATCHELOR, Clerk, 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. * For Additional Warning See Reverse Side Of This Notice. 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: ° `R� ' �9c` BY: PHIL BATCHELOR by'\-fl_e4�,— ` Deputy Clerk CC: County Counsel County Administrator RECEIVED i IN THE MATTER OF: RONALD W. FRAY SEP 18 Fffit,D SEPTEMBER 17, 1996 CLERK BOARD OF SUPERVISORS FIRST AND FOURTEENTH AMENDMENT COMPLAINTFW =1ON.. . AND DAMAGES FOR CIVIL RIGHTS VIOLATIONS, SEX DISCRIMINATION AND PENDENT STATE CLAIMS Filed with the Board of Supervisors of Contra Costa County a political subdivision of the State of California (September 17,1996) (Government Code, § 910 et seq.) TO: Supervisor JEFF SMITH, Chairperson, and to the other Supervisors of the County of Contra Costa, State of California: The claim of RONALD W. FRAY("Claimant") respectfully shows: (a) Name and post office address of Claimant: RONALD W. FRAY, 1723 Bishop Drive, Concord , California 94521. (b) Name and post office address to which Claimant Desires notices to be sent: RONALD W. FRAY, 1723 Bishop Drive, Concord, California 94521, until otherwise amended. (c) Date place and other circumstances of the occurrence(s) or transaction. which Gave rise to the claim asserted: Claimant RONALD FRAY ("claimant") alleges as follows: 1. This action arises under the United States Constitution particularly the provisions of the Fourteenth Amendment and Federal Law, Including the Title VII of the Civil Rights Act of 1964, as amended, (42 U.S.C., § 2000e, et sea. (The title VII of the Civil Rights Act) and the Federal Rights Act of 1871 (42 U.S.C..§ 1938) (the "1871 Act") and the Americans with Disabilities Act ("ADA"). The issues of this case are under Federal jurisdiction as defined under 29 U.S.C, § 633(c) and 28 U.S.C, § 1343 (a)(3). In addition, there are pendent State claims for sex, race, color, national origin., ancestry, and marital status discrimination under the California Fair Employment and Housing Act (the "FEHA" ) (California Government Code, § 12900, et seq. - references hereafter to the"Government Code" are to the "California Government Code" wrongful discharge in violation of public policy and violation of privacy. 2. Claimant is of Northern European white ancestry and thus qualifying under the classification of discrimination in the reverse. Claimant is over forty years old and thus qualifies under the Age Discrimination Act in Employment of 1967. Claimant is male and has been harassed, coerced and discriminated against by his employer. 3. Defendant Contra Costa County ("County") was at all times relevant hereto a legal subdivision of the State of California, and was an"employer" within the meaning of Section ii of Title VII (42 U.S.C. § 2000e)FEHA, Government Code, § 12926(c). 1 IN THE MATTER OF: RONALD W. FRAY FH_ED SEPTEMBER 17, 1996 4. From about February 1991, when County hired him as an Eligibility Worker I, and then discriminated against him in the initial training. Claimant filed a complaint for the discrimination and it was apparently settled by offering the position of Economic Opportunities Specialist I the title he presently occupies. For the duration of his employment Claimant worked for County as a Full Time, Permanent, Merit, Employee. Although the job title and pay schedule should have been considerably higher to match the responsibilities that were placed on him during his tenure with the County, he expanded the focus of the Community Services Department concentrating on expanding divisions and projects to assist low income individuals in Contra Costa County. Claimant brought in approximately 3.7 million dollars in a three year period. Claimant served as County and Department representative on multiple boards, School Boards, and other jurisdictions in the County and as a representative with proxy vote, when the Director could not attend, to the California and Nevada Community Action Agency, a coalition of Community Action Agencies for two states. Additionally , Claimant was in charge of the preparation, conforming, and verifying of approximately two hundred and twenty - five contracts amounting to approximately 16 million dollars, which he did successfully. During the term of his employment he received at least one award for outstanding service from the County and three from other jurisdictions. In short, Claimant was in every way, a thoroughly satisfactory employee. 5. Claimant, until recently an Economic Opportunities Specialist I , responsible for preparation of all of the contracts and a major portion of the grants for the Community Services Department ("DEPARTMENT") Administration, was disciplined and constructively discharged by JOAN SPARKS, the Department Director, ("SPARKS"), and MICHAEL WEEKS, the Department Personnel Officer ("WEEKS"). This all occurred without due process, without cause, and with threatening manner toward claimant. This all occurred without due process and without due cause in violation of the County's Personnel Management Regulations, and among other things, violated Claimant's Civil rights. FIRST CLAIM (Retaliation) 6. Claimant realleges and incorporates herein by this reference, each and every allegation of paragraphs 1 through 5 hereof. 7. Claimant was denied promotion after being subpoenaed to testify and testifying at a Federal and State hearing for Title VII and Claimant believes that it is indicated that some of the harassment comes from that obligation. 8 On September 18, 1995 Complainant was constructively terminated due to retaliation for being subpoenaed and testifying at a State of California Workers' Compensation Case (WCK 16923, WCK 8940; Yvonne King-Scott (a black woman) v. Contra Costa County). The day he testified he return to his office and had his first and only formal review in about four years after he started with the Department. Claimant was again subpoenaed and testified in a Federal court for the same claimant on a Title VII , On or about October 11,1995( Case number 4:92CV04533), matter and the harassment increased until the ultimate termination. 2 r` IN THE MATTER OF: RONALD W. FRAY FILED SEPTEMBER 17, 1996 SECOND CLAIM (Sex and Race Discrimination Under Title VII) 9. Claimant realleges and incorporates herein by this reference, each and every allegation of paragraphs 1 through 8 hereof. 10. Claimants had researched, written, and presented contracts on a regular basis, for the Community Services Department for almost four years. There has been no complaint of record of performance in Claimants personnel file or any other file that Claimant is aware of. On or about February 1995, Al Prince, the Administrative Services Officer, returned from over one month of stress leave (this individual was the one that normally assisted in the contract information and some preparation). The day that Al Prince returned, Joan Sparks took me in her office and I was removed form contract preparation and I was told to report to Darnell Turner as my immediate supervisor instead of her. There was no reason and it was without due process. I ask what I was supposed to do instead? She said: " The County Administrators Office told me to fire you" because they wanted to fund part of two positions for women friends of the County Counsels assistant with the funds that were designated for my wages. The two females were being contracted to do my job at, it is my knowledge and belief, $60.00 per hour each, with no restrictions on their overtime. (The cost of contract preparation costs swelled, sometimes as much as $14,000 per month). The job remained vacant with those outside contractors occupying it for approximately 8 months. Finally, after the take over of one, of the agencies that unsuccessfully operated one of the Head Start programs on or about October of 1995, an Asian female was hired to perform the contract operation. THIRD CLAIM (Discrimination due to Disability Under ADA) 11. Claimant, alleges and incorporates herein by this reference, each and every allegation of paragraphs 1 through 10 hereof. 12. Defendant created such a hostile work environment that Claimant became ill from the stress of the job and developed physical maladies. He then sought and received medical and psychological care. The Dr. and Psychologist told Claimant to stay away from the office because that environment was the cause. Claimant was released to return to work August 29, 1995. Weeks contacted the Claimant before August 24th and informed him that he could not return to work until he arranged an appointment with Dr. Gordon Wolf, a contract psychologist the Department uses regularly. Claimant told him he would comply and scheduled an appointment and filed a Worker's Compensation claim (WCK 0025025) the proximate cause of the illness was the ongoing harassment from the County. There were two appointments with Dr. Wolf: 1) Dr. Wolf alone; and 2)about two weeks later with Dr. Wolf, Turner, and Weeks. I was finally allowed to return to work on September 18, 1995. At that meeting/appointment I was told that I would be placed in the Housing and Energy Division of the Department. Mike Weeks also told me that if I went to the appeal meeting that night for my merit 3 IN THE MATTER OF: RONALD W. FRAY FILED SEPTEMBER 17, 1996 complaint I would be terminated. (Claimant was aware of the condition of the Division because I had written all of their contracts. The division had been operating at a deficit for years. I ask why was being placed in a position that would fail shortly). When finally he was allowed to returned to work the computer that I used was gone and all of his personal belongings were "lost". he was physically moved to the Housing and Energy Division of the Department to assist a clerk. Claimant alleges that at the point of return to work on September 18, 1995 he was constructively terminated based on substantially reduced benefits through office space, status, freedom, availability of a vehicle and other services. Claimant alleges that he was laid off as a result and is to be finally terminated September 3,1996. Claimant has spent approximately ten months in the Housing and Energy Division assisting a clerk as required. The office is located in a warehouse with no hot water, the bathroom is located outside the office area with no heating, and there is no windows in that office. During that period the blacks in the department were treated differently than the Claimant. They were given special privilege ,i.e., like paid mileage for daily home commute, given trucks to drive home on weekends and evenings from work, given special and pertinent training to their job, and etc. I did not receive those benefits. The Temporary status individuals, who were both black, were retained until the contract was exhausted yet on September 3, 1996, Claimant, a permanent employee who was equally or more qualified than the temporary performing the same task is being laid off. The alleged excuse is to be " lack of available contract funds combined with continued Division losses have necessitated the phasing out of the Housing and Energy Division . . . ". These losses were based on salary and rent as explained by Scott Tandy, Assistant County Administrator . A predicted end. FOURTH CLAIM (Disparate Impact) 13. Claimant realleges and incorporates herein by this reference, each and every allegation of paragraphs 1 through 12 hereof. 14. Complainant alleges that the Department of Community Services dose not have the correct racial, and sexual mix required by Federal standards and that specific elements of the employer's promotion criteria had a significant disparate impact on him. (d) General description of the indebtedness, obligation, injury, damage or loss incurred so far as it may be know at the time of presentation of claim: WHEREFORE, Claimant prays for judgment as hereinafter set forth; 1. for judgment against the County defendants, and each of them: a. For lost earnings and benefits equivalent to the contractors that were used in his place, at least in the sum equivalent; b. For his general and other damages in accordance with proof, c. For exemplary damages according to proof, and 4 IN THE,MATTER OF: RONALD W. FRAY FILED SEPTEMBER 17, 1996 e. For such other and further relief as to the Courts seem proper in the premises. (e) The name or names of public employee or employees causing the injurychange or loss, if known: JOAN SPARKS, MICHAEL WEEKS, and DARNELL TURNER directly caused Claimant's losses, but also PHIL BATCHELOR, County Administrator, and his Deputy SCOTT TANDY, Chief Assistant County Administrator, were involved and let it happen. They also must share in the blame. (f) The amount claimed: The amount claimed will be well in excess of$10,000, and jurisdiction over the claim will rest in the Superior Court, and/or United States District Court, as applicable. DATED: September 17,1996 nald W. Fray, ClaiVant, in ppersona 5 • , awl G � IV 'O N u% C:3 -,l 51 • ,.D s cp O p p OD � Q k CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 8, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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 r � 3) Amount: Unknown Section 913 and 915.x. Please note alai ngs'; CLAIMANT: Nina T. White SEP 13 1996 ATTORNEY: COUNTY COUNSEL DMARTINEZCAUF. ate received ADDRESS: 223 California St. BY DELIVERY TO CLERK ON September 12, 1996 Rodeo, CA 94572 BY WAIL POSTMARKED: Via Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p DATED: September 13, 1996 BAIL BATCepuVE OR, Cleri:�/`s_ 2 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: Gated: 7! l �7 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. BOARDD 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: �� �� �99Cv PHIL BATCHELOR, Clerk, Deputy Clerk 41ARNING (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. * For Additional Warning See Reverse Side Of This Notice. 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: tyarP�e� j5 /99co BY: PHIL BATCHELOR byV � `��Lj ool�— Deputy Clerk T— CC: County Coirsel County Administrator Clair to: BOARD OF SUPERVISORS OF COMM CO.S`TA C(:KJt+I'3CY INSTRUMONS T10 CLADiANT 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 angst 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 amnths 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 5911.2.) B. Claims must be filed with the Clear of the Board of Supervisors at its office in Boom 106, County Administration Building, 631 Pine Street, Martinez, CA 94553. C. If claim isaggainst 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 Ser. 72 at the end of this fo r. BE: Claim By ) Reserved for Clerk's filing stamp 77 �ZL/ 7z RECEIVED ,Against the County of Contra Costa LSEP ,9961 District) CLERK BOARD OF SU RVISORS (Fill in name) ) CONTRA COSTA CO. The wldersigned claimant hereby makes claim agairpt the County of Contra Costa or the above-named District in the sum of $ 4&---a,!�7_-44AaZ-4 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 injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) �G,e 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 5. «mat; are the nz.-es of county or district officers, servants or employees causing the da:,::ae or in jury' 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. T. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of witnesses, doctors and hospitals. 11V `� ' 4eooes//-)Z--- 14:5�1 7,-4 7- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMXW 3 ��•:,�� ��. �w n Gov. Code Sec. 910:2 provides: • r - "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) or by spm person on his f." Name and Address of Attorney (Clainnnis Signature �Q Ad s. Telephone No. Telephone No �0 ,, -cam- / e e !F +� a�I " ' f'�E"Ir I T f'if'iF �E iE 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 s=h and Fine. dtl/22/'ib (ihYJ:dlS> VRUUkC IDL HU5PIIHL Fuge 1 of 1 1+RUUKb1LE HUSPi IAL LmEkUENCY vLP I. 2Wbw Vale Rd. San Pablo LA 94806 Discharge Instructions SPHRiN: ANKLE You have an ankle sprain which is a tearing of the ligaments that hold the .joint together. (here are no broken bones. Sprains take from three to six weeks to heal. HUME LAKE: 1) Keep your LLU elevated to reduce pain and swelling. 'phis is very important during the first 48 hours. 2) Apply an ice pack to the injured area for eb minutes every two hours the first day. Lontinue this three to four times a day until the swellinq goes down. a) fou may take aspirin, Tylenol or ibup•roten (Advil) for pain, unless another pain medicine was prescribed. 4) Keep the splint/cast dry. When bathing, protect the splint/cast with a large plastic bag, rubber-banded at the top end. It you have a WNLKINu SPLINE (the kind you can wear with your shoe).: -- Resume weight-bearinq gradually. It you have a PLAbl*Lk or FIBERGLASS SPLINT: -- Use crutches and do not put weight on the splint or it will break. It you have a WALKING LAST: ` -- Lo not walk on the cast until it has fully dried: VLH51 Ek LAb'l : wait 4ts hours. F 1tfER LASS LAST; wait e. hours. rULLUW UM with your doctor or this facility it you are not starting to improve within the next IHNEE days. It a cast or splint was applied, it should be chec►ted in 24 HUUkS to be sure it has not become too tight from swelling. Look for the warninq siqns below. LNuIE: It X-rays were taken, they will be reviewed by a radiologist. You will be notified of any other findings that may affect your care.J kLIU1<N PRUMPILY or contact your doctor if any of the following occur: -- or splint be -- !~gain or swelling increases, or redness appears -- loes become cold, blue, numb or tingly VRUUK8iVL HUSPI]kL Page 1 of e Discharge Instructions (cont.) MEDI,GATIUNi ViLUDIN (Hydrocodone) You have been prescribed a PAIN MLDICA*IIUN called VICUDiN (generic HYDRUGUoUML). It is also available under the trade names; LUk1AB and ANLXbIH. Vicodin is a narcotic and'may cage drowsiness. Be sure to take it only as directed. T DIRECTIONS FOR USE: Vicodin may be irritating to the stomach. To minimize this problem, you may take this medication with food. Pain medication should be taken only it needed at the times prescribed. If you are not having pain, do not take the medicine. WHAT TO WWCH FOk: Contact your doctor or this facility if any of the following occur: PUSSIbLL SIDE EFFECTS include: dizziness, drowsiness, nausea, vomiting, and constipation. These effects may be minimized by taking a smaller dose (for example, breaking a pill in half or taking it less often). ALLEk6lG REACTION: consists of rash, itching, swelling, trouble breathing or swallowing. IMPOR'TANT DO not drive or operate dangerous equipment while taking' this drug. Prolonged use of this drug can be habit-forming. DRUB MIERACtIUN Alcohol, barbiturates, Cimetidine (fagamet) will increase the drowsiness caused by this drug. "Jo k PLEASE NOTE: The examination and treatment that you have received in the Emergency Department has been given on an emergency basis only,and is not intended to be a substitute for complete medical care. It is important that you be checked again as instructed. If an x-ray or EKG has been performed, it has been read on a preliminary.basis only, and will be reviewed by a radiologist or internist within 24 hours.You will be notified if additional findings are noted. YOUR DIAGNOSIS IS:G 13(7jr T I"X, yN LST' lq-W TRAUMA Z i R )q' C PEDES' GYN-GU Laceration/Puncture Head Injury Viral URI Pneumonia/Bronchitis Fever Control Otitis Media Miscarriage,Spont. PID Sprain/Strain Concussion` Gastroenteritis CDPD/Asthma Viral URI Otitis/Externa Miscarriage,Threaten Ovarian Cyst Burn/Abrasion Neck/Back Pain Ulcer/Gastritis Tension Headache Gastroenteritis Pneumonia/Bronchitis Irregular Vag.Bleed Curettage Contusion Corneal Abrasion" Esophagitis' Hypertension,New Pharyngitis,Viral" Asthma" Vaginitis` Menstrual Pain' Fracture Abscess` Seizure,Recurrent` Biliary Colic Pharyngitis,Strop's Poisoning,Pedes' Cystitis,Fem. Kidney Stone' Cast and Splint Care Cellulitis Abdominal Unknown No Complications Chicken Pox Febrile Seizure" Pyelonephritis* GC/Chlamydia" Suture Removal- Animal Bite Alcohol W/D Synd. Migraine Headache Conjunctivitis` Allergic Reaction Scabies, No Complications Chest Wall Pain Diabetes Chest Paln-Non Cardiac Croup' Sinusitls Dehydration Contact Dermatitis Atopic Dermatitis PRINTED INSTRUCTIONS PROVIDED AS INDICATED ABOVE other: PARENTS/GUARDIAN INFORMED OF CAR SEAT LAW. ADDITIONAL INSTRUCTIONS: wt)� 4C-r-'Wg.'g' FDS. ♦3�'Sls �L-fit?'C-i�5 �D C,•-ir--f �Y(,�1�//lf0 ,fix'_ '�- �'�5, ��� ,�-t,•�l�r�ca'�11r �i9'G''y fitST' GL//VlG s^ tiG? TCi i�7t�1Y ?y / DG '(r1+' G1f t 1�c' TG1le14r 1�9�2_ FFUR treatth of your child fo!!aw u with our dost�r to our X11 Is full Im -7YMERGENCYA D ARTMENT PHYSICIAN HAS BEEN: �u 7 � E.Nipomnick 1.Ahwah J.Rampulia R.Turner C.Freye R.Mandiberg L.H.Hodgson E.Sterling Other. If you notice any worsening of your symptoms,return to hospital immediately,or if you notice no improvement of your symptoms within 24 hours call your referred MD promptly or return to the hospital. 1 have recelued and understand the Instructions outlined above. X x iY1 �ukt is�n U1 : 5o Patient or Representative Staff Date D/C Time HOSPITAL WORK/SCHOOL NOTIFICATION FORM was seen in the Emergency Department on He/She should be able to return to work/school on with the following restrictions: X M.D. BROOKSIDE HOSPITAL CONDITIONS OF SERVICE SAN PABLO,CALIFORNIA (((� 1. CONSENT TO MEDICAL AND SURGICAL PROCEDURES ' The undersigned consents to the procedures .which may be performed during this hospitalization or on an outpatient basis, including emergency treatment of services, and s which may include but are not limited to laboratory procedures,x-ray examination,medical or surgical treatment or procedures, anesthesia, or hospital services rendeied the patient under the general and special instructions of the patient's physician or surgegn. 2. NURSING CARE 't� This hospitakjrovides only general duty nursing-care unless,upon order4o patient's physician,the patient is provided more intensive nursing care. li j the patient's fndition is such as to need the service of a special duty nurse, itis agreed that such must,be arranged by the jiatlent or his/her lega representatives The hospital shall in no way be responsible for failure to pro ide the same and is hereby released from any and all liability arising from the fact that said patient is not provided with such additional care. ` 3. LEGAL,RELATIONSHIP BETWEEN HOSPITAL AND PHYSICIAN;" All physicians and surgeons furnishing ser\4ces to the patient, including,the radiologist, pathologist, anesthesiologist and the like, are independent contractors with the patient and are not employees or agents of the hospital.!The patient is under the care and supervision of his/her attending physician and it is the responsibility of the hospital and its nursing staff to carry out.tlie.,irAtructions of such physician. It is the responsibility of the patient's physician or al or surgical treatment, special diagnostic or therapeutic procedures, or hospital surgeon to obtain the patient's informed consent,when required,to medic services rendered the patient under the general and special instructions of the,jiysician. 4. RELEASE OF INFORMATION Upon inquiry, the hospital may make available to the public certain basic information about the patient, including name, address, age, sex, general description of the reason for treatment (whether an injury, burn, poisoning,.or other condition), general nature of the injury, burn, poisoning, or other condition,and general condition. If the patient or the patient's legal represent4tive does not want such information to be released, he/she must make a written request for such information to be withheld. The patient or the patient's legatirepresentative may obtain a separate form,for this purpose upon request. The hospital will obtain the patient's consent and his/her written authorization to release information,other than basic information,concerning the patient, except in those circumstances when the hospital is permitted or required by law to release information. The undersigned agrees that,to the extent necessary to determine liability:foli payment and to obtainreimbursement,the hospital may disclose portions of the patient's record,inctuding his/her medical records,to any person of:borpor6oh which is gr may be liable,for all or any por ion'bf ttie hospitaCs"charges, including but not limited.to insurance companies,health care service plans;"orb. o?kers'compensation carriers. Special permission is,needed to release this information.where tW patient is being treated for alcohol gr drug abuse `y� A J 3. ..'FINANCIAL AGREEMENT ! . I ...; .-The undersigned aree�b„ tIi}at;_ji ip-ova6, ndered to the-Patient,'he/she hereby iniiivitlually obligates tiimaetf/herself'to pay the account of a hospital in aceprdance,with the regular rates and terms of the hospital. Should the account be referred to an attorney or'collection agency for collection;the undersigned shoji.pay.actual attorney's fees ands collection expenses.,All delinquent accounts $(call bear interest at th"gal-rate: 6. ASSIGNMENT OF INSURANCE BENEFITS ~ The undersigned authorizes,whether he/she signs as agent or as patient,"direct payments to the hospital of any insurance benefits otherwise payable to or on behalf of the undersigned for this hospitalization or for these outpatient services, including emergency services if rendered, at a rate not to exceed the hospital's regular charges. it is agreed that payment to the hospital,pursuant to_ihis authorization,by an insurance company shall discharge said insurance company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he/she is financially responsible for charges not covered by this assignment. The undersigned assigns to providers 6t,c_at'e or hospital based physicians any insurance or health plan benefits as described above. 7. HEALTH DARE SERVICE PLAN OBLIGATION (This hospital maintains a list of the health care service plans with which it is contracted. A list of such plans is available upon request from the financial office. The hospital has no conlact;eiioress or implied,with any plan that does not appear on the list. The undersigned agrees that he/she is individually obligated to pay the full cost of all services rendered to him/her by the hospital if he/she belongs to a plan which:does not appear on the mentioned list. 8. NOTIFICATION OF BILLING Services provided(either inpatient"or outpatient)at this hospital may generate more than one bill. One bill will cover your hospital charges- Other bills may come from:Anesthesiologist, Pulmonologist,Cardiologist;Pathologist,Radiologist.or any other physician,or reference laboratory service. If you are being "Admitted to-Observation% please"know your physician has ordered an outpatient service. Although you will be in a "regular,hospital bed",you will be considered an outpatient(by Medicare regulations). YQV'may be responsible for pay.' The undersigned certifies that he/she has read the foregoing, reeeive Copy 1! and,is the tient, the patient's le/�epiesq;' `' is' my authorized b}(tffftatient as the patient's general agent to execute the a ov nac tits-terms. Date ;x, arent J Guardian!C• nservator 2, Ratient 1 P _ s Time �f other than patient,indicate relationship: Financial Responsibility Agreement by Person Other than the Patient,or the Witness(es) Patient's Legal Representative:I agree to accept financial responsibility for services rendered to the patient and to accept the terms of the Financial 1 Agreement. Assignment of Insurance Benefits,:and Health Care Service Plan REASON FOR NOT SIGNING(Document datettime/signatLVe/reason not obtained) ,06iia�ation Provision above. ' t Financially Responsible Party A COPY OF THIS DOCUMENT IS TO BE DELIVERED TO THE PATIENT AND ANftTHER PERSON WHO SIGNS THIS DOCUMENT. 60.106(9/95)SEQ 829 White- Medical Records Yellow .04tient ' Pink .Patient Accounts