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MINUTES - 06251991 - 1.14
' CLAIM JUN J 190j BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY COUNSEG MARTINET CALIF. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JUNE 25, 1991 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: $2,612.12 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: FAUGHT, Delicia (05 9116 041) ATTORNEY: State Farm Insurance Companies 6400 State Farm Drive Date received ADDRESS: Rohnert Park, CA 94926-0001 BY DELIVERY TO CLERK ON May 31, 1991 (Via Risk Mgmt.) ATTN: Bill Rossi BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. June 4, 1991 ppHIL BATCHELOR, Clerk DATED: BT: Deputy II. FROM: County Counsel TO: Clerk of the Board of S ors � ) 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 / 19 1 BY: � Leputy 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: JUN 2 5 1991 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code se ion 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; 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: JUN 2 7 .9, BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator STATE FARM State . Farm Insurance Companies . & C// / I�A INSURANCE Zo May 20, 1991 RECEIVED Northern California Office 6400 State Farm Drive 3 ' Rohnert Park,California 94926-0001 Contra Costa County CLEMMOF Department of Public Works CONTRA 255 Glacier Drive Martinez, CA 94553 IMPORTANT PLEASE WRITE OUR CLAIM NLMBER* ON YOUR REPLY OR PAYMENT. THANK YOU. Re: Our Claim Number: *05 9116 041 Our Insured: Faught, Delicia Date of Loss: December 28, 1990 State Farm Mutual Automobile Insurance Company on behalf of Subrogee Delicia Faught hereby makes claim for $2,612.12 and makes the follow- ing statements in support of the claim. 1 . Notices concerning this claim should be sent to State Farm Insurance Companies , 6400 State Farm Drive, Rohnert Park, California 94926, referencing the above claim number. 2. The date and place of the accident giving rise to this claim are; on December 28, 1990 on La Paloma and Appian Way in E1 Sobrante, California. 3. You company left pot-holes in road at night without putting up barriers or cones. Our insured hit this hole causing damage. 4. There were no injuries reported. 5. Our total claim is as follows: Company's Net Payment $1,972. 12 Insured's Deductible Interest $ 640.00 Total Property Damage $2,612.12 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 • STATE FARAA State Farm Insurance Companies INSURANCE Page 2 Northern California Office 6400 State Farm Drive Rohnert Park,California 94926-0001 NOTICE: This form is to provide notice of our claim for damages in accordance with the six (6) month statute. If this form is not acceptable for compliance with the statute, please rush the necessary forms to my attention for proper filing. STATE FARM INSURANCE COMPANIES Dated• By: Bill Rossi Claim Specialist - ROAC (707) 584-6471 BR/DF:by 20-006 AC-51 Encl: Supports cc: 2615 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710.0001 !r , a ' r a dK��l1 : (4c 1490 Fangmtte Ave. CONCORD, CA 94520 .. Phone 676.3888 REOUEBTED By , DATE - r NAMe SERVICE TIME EXTRA PERSON MILEAGE 1 FINISH FINISH FINISH START START START t TOTAL TOTAL TOTAL -,�w'�C t�v;>•aCC+ �: y f .. a x `3' `f•"'4 '.r;�%�r"•+v�-.� "y l t`'. 'i( i- .. - � Y 4 4 �5`�-�-`� .- ��'� � � - � ..';�•'x7��'.:i..e, a d't vP--, t -�.. J d Y '��,'C7T h.' z.,z; 1 'w•-evtak�vA+s4i�5r+. .ir_. ar- -*�� (r''� - I. ... •! } niG*'N r TIRE n �r= h 1 fg 't'�inh�•s. , FLAT j s r DOILY ❑ u rs xas w _ a43 r f START.❑ r«. LOCK OUT tr b .r Y �,:. � ti ,..�y t �� .•�r. AF e c — { t x' OAB.❑ y a FLAT WET ❑ r t4, BATTERY.❑ HOiSTTOMf FLOODED ❑ WRECK ❑ ... BRAKES ❑ TOWED TO REMARKS GE CHG. I tp fi '� ' �t TOWING C�HG. � .•r _. �-1 f'{�-x �+rais" i J" rfr-• ,ia i ..Y.q 'qtr -.x �C' .f*'�'�J .�._ 'x y- .•.� ... ` '• AIC ��t -•d L a < � -r r _ _� x LABORCHG. Y t 1 - L 17 7 STORAGE Cli(L 77 r _ `TOTAL N S �.: _ service road ll ` 97 r� PRODUCT 613.3( Inc.Grow.Wu.01U1. •. i GROG O 3133 N .. 0D g I D nmm� :. p m A ,C ......_: .___ .... gas - ... .. ..... ..._.....-._-.- , ���mmo i t 1. � a`. ♦ f {.'..�� - i" *f `'"'L TCC 7 .. G m C 7 Y 7 m .+ r'r-. -:."f '- y h• S /int m 1F IWiQ n o o n -�o m { .� z } � '•.r +,� •r �.. af'y�a,Liy .t3,."�• �y,R.'�t m � � ' m m�Pmmp e: p i >'00 a��•�� ..+,. _�z L =s ;� 7': cF i�vf �'.$3 �'� H � Y '1,r� � r y�fi'z�•' At g p T �m c sti n t =a3Rvo r ` Rik Aw las I zb- m N = + o - -� m m g C � _ o m CA $0 p t o SD m r. r w 3 rr 0 xmrn •fl D m F ' r to r o N z. O m m z sCA r C i O c c D m m 3 Q o o v 114 n a O m C � w • m m , c f •fl :k u:rc,•ux�u•Lcx3c-:•:•:..::..Iran::C.C.G.Si AN UAMU•MtN I-A-UAM FED I.D.#77-0132046 �JSTRIDOR ORIGINAL est-A-Cay- RA#11 - 15123 1800 MONUMENT BLVD.,STE N • "A Family Business" CONCORD, CA 94520 41682-9444 RELATE ;�t Qr �. CAR NO. 1 CAR NO.2 p� NLIC. P M O CAR N CAR N C n/ ( i CURRENT CI Llc.Nr+ XV ry� LIc.N E H o t\l RESIDENC122 ST 9 P ONE Make Me I CO.12N C NTACT 14OUT a I OUT Det J/ Time / • Y l CITY PHONEoo I Date _ IN Date Time �" i REFERRED BY Mlle �r E OP EndinMileage ndlnp COJCONTACT Mileage Mileage N Beginning Beginning INS. DOL I TOTAL TOTAL a MAXS bEPOSIT ❑CC VOTHER miles m ( CONFIRMED CAR AT 1 TYPE R.II , 9soa Hours O •PFA DAY BFREE MILES DAILY PER MILE AFT l PER WEEK FREE MILES WEEKLY • PER MILE AFTER TAR- PER MONTH FREE MILFS/MONTHLY y� PER MILE AFTER Days O J� AODITIONAL HOURS w�S �' I Dll O` tY V l�.=G ! A,9 l��T�9' FV F1� 90� STO'AGREEDT '. : . 1 'L aidRefueling Service LOW• ADO DRIVER a (SEE 11) PAI DR.LIC. AGE R.LIC.EXP. r Yom/ r I rCY Adjustments Dl�M AGE TOTAL CHARGE / r No.t pare Glass OK `�C-,4 Car No.2 N Spare'5 Glass•OK GAS LEVEL 1 Less Deposit one Jack O Glass•Damage V None "-H,►ag lass-Damage (] _ E 1/8 218 318 518 8/8 718 F Lass Amt.Billed GAS LEVEL 2 - , 0 � DUE Iron Renter VTr�TE 118 218 318 418 5/8 8 718 F REFUND Ck Cash C 1. All drivers must be r •--•^•�•Mrrx anv extension of re Pon 2. Renter Is rasponslt 225.00 processing I LIMITED LOSS DAMAGE WAIVER(LOW)IS NOT INSURANCE 3. Standard Renl A Ca 1, if renter has direct( LIMITED LDWACCEPTS LIMITED LDWDECLINES billed they shall fail 5. MI money owed wt I AGREE TO PAY STANDARD RENT•A-CAR 8.-Customer Is respol vehicle,regardless f_ • PER DAY.AND WILL 1 AGREE TO BE RESPONS'BLE FOR ANY T Vehicles are presu� NOT BE RESPONSIBLE FOR ANY LOSSIDAMAGE TO THIS VEHICLE UP TO THE more than 5 days LOSSIDAMAGE TO THE CAR. PROVIDED FULL VALUE CAUSED BY ANY REASON AND 8. It Is the renters re I USE IT IN ACCORDANCE WITH THE PAY FOR THE DAMAGES UPON DEMAND. gffice,during our RENTAL AGREEMENT. SEE PARAGRAPH 86 9. Renter is not alto SEE PARAGRAPH e8 ON THE REVERSE SIDE. without Fauthorfral ON THE REVERSE SIDE. v 10. Vehicle will not b�X 0�1 A I1. II customer elects flip PAI•ACCEPTS PAI-DECLINES • ' 1 A(i EE TO PAY STANDARD RENTACAR TH o IS REI I UNDERSTAND THAT THERE IS VERSE.CUSTOMI 1 O 0 CIDENTAL MEDICAL T DEATH COVERAGE UCHER IN CUSTC nE FOR CHARGES.CUJIGMER REPRESLNTti r•L. PER DAY IN ORDER TO FOR ME OR ANY PASSENGERS IN THIS UNDER$�}L{�1.1L�..ccti WITH THES CONDITIONS RECEIVE PERSONAL At- VEHICLE. CIDENT INSURANCE v COVERAGE ^ SIO • - 1512 3 VEHICLE RAa 11 RENTED RETURNED CHECKED C I G B BY TO s IN BY AND REV 890 T LEMANS Rt:Rtl(-F'E/1-E AE_ROOPE 2HE PRGE 2 AI?1 # 05 9116 041 Al LOG HQ 0305695 DATE 01/10/91 O fiIAL CALCULATIONS & ENTRIES 1, GROSS PARTS 555 . 75 ED OTHER FARTS 10 . 00 DNcn S, FAINT MATERIAL 26 . 00 C.Ov un iRTS TOTAL 591 . 75 >m o TAX ON PARTS & MATERIAL td 7 . 000% 41 . 42 Tm D Dz z L ABOR RATE REPLACE HRS REPAIR NRS KN c 1-SHE METAL 45 . 00 16 , 4 5 . 6 990 . 00 r-m = 2 -MECH/ELEC 45 . 00 . 9 1 . 0 85 . 50 �� 0 3-FRAME 45 . 00 mm 4-REFINISH 45 . 00 1 . 3 . 56 . 50 m'20 5-PAINT MATERIAL 20 . 00 moZ IBOR TOTAL 1 , 134. 00 Zn o TAX ON LABOR >9 M SUBLET REPAIRSmo TOWING & STORAGE \OSS TOTAL 1 , 767 . 17 LESS: DEDUCTIBLE 500 . 00- '--I' TOTAL 1 , 267 . 17 f �i DF'#AUDATEX Al U ES LOG 9305685 DATE 01/10/91 17 :00 : 52 042 4N: NNi00/00;00/00 CUM= 00/00/00/00 -- NSU - a - -- -- -- NOTICE - REPAIRS .TO .THIS VEHICLE MAY REQUIRE' SPECIFIC }' �� � :.LDING EQUIPMENT -AS RECOMMENDrO BY THE MANUFACTURER" >-0Z nm ---- ---- --- --------- -- --- azz s c r �o 0 Es LD Mm N m > mo z O cn m -1 Zai Db m W71 J 1' i t 1 1 mm m D :1);pc m� Z> -r0 1 • ST�-,TE FRPM MUTUAL It;SURANCE COMPANY HILLTOP' SFfiO"ICE CENTER' 2920 HILLTOP MHLL ROAD S ' RICHMOND , CA 94906 mr- (415 (415) 262-4900 .4rcp Al LOG NO 9376968 DATE 01/14/91 c (n Dr zr. HIM# 05 5116 041 POLICY# mm O SURED TAUGHT, DELICIA CLAIMANT nm z SS DATE 12;28/90 TYPE OF LOSS COL /F >N o m -•, m D D 0.tt r— m 1 SP DATE 01/0`9/91 LOCATION MARTIN BUICK mm D TIMATOR JIM CARLE COMPANY 0mo ONE 262 4931 Z.1P mp z Nm -4 ZD O Du m ZO D_., NAME FAUGHT, DELICIR m> .. ADDRESS 1737 STARDUSTER J CITY STATE NEVADA CITY , CR ZIP 94959 PHONE 798 9700 C# ZJGM280 VIN KL2TN2163JB33260B - i G/COLOR MILEAGE 101136 NDITION ACCT'NG CTL# DARLENE DN> _ N CAM N NEW PART EC-QUAL REPL PART EU-LIKE KIND & QUALITY EP-QUAL RPL --PRT -RPT--P-CHECK >mo REPAIR/ALIGN/SUBLET L-REFINISH N-ADDITIONAL LABOR. OPERATION TmD -PART/PARTIAL REPLACE ET-LABOR/PARTIAL REPLACE ' IT-LABOR/PARTIAL REPAIR Dz z -APPEARANCE ALLOWANCE RP-RELATED . PRIOR DAMAGE " UP-UNRELATED PRIOR DAMAGE ' Mm c m = 10TE lLEFT AXLE BOOT TORN OPEN MAINTENCE ALSO RIGHT FRONT TIRE , WORN LONE COLLISION mm �' M-0 x '88 PONT LEMANS AEROCPE/LE AEROCPE 2HB W1702A OPTNS A/ mm Z> 0- GDE MC DESCRIPTION MFG PART NO . PRICE AJ% HOURS R Dm m :zO D 590 SIDE MEMBER,FRONT RT 90244793. GM PART 159`. 00 10 .5.; 1 ,!n>Pa 590 SIDE MEMBER,FRONT RT REFINISH - " .5 4 588 PAN,FLOOR - REPAIR/ALIGN 4. 0*1 974 SUSPENSION ALIGN,FRT ADDTL LABOR 1.. 0 2 654 ARM,LWR CONTROL R/F 90235046 GM PART 141 . 00 .4 2 677 01 BOOT,SHAFT INNER RT 26002230 GM PART 21 . 75 . 5 2 18 R+I SEAT AND RUGS REPAIR/ALIGN 2 . 0*1 x. UNDERCOAT REFINISH 10 .00* 1 . 0*1 Q,> -�i RIGHT FROM MAG WHEEL NEW PART 125 .00* .5*1 >Ny RIGHT VOLOCITY JOINT NEW PART 280 . 00* 1 . 5*1LMCA RIGHT INNER SKIRT REPAIR/ALIGN 2 . 0*1 -Demo mm -1 mm D` 11 ITEMS M? z. D n� a MC MESSAGE �o 0 3c � 01 CALL DEALER FOR EXACT PART # REQUIRED •� mm >• m22 o mp 2 m m -4 ZD O cO D mD po r AIN #� .0F 9116 041 Al LOG PO 937'n968 DATE 01/14/91 NAL CALCULATIONS & ENTRIES GROSS PARTS 776 . 75 OTHER PARTS 10 . 00 D x PAINT MATERIAL 10 . 00 DN RTS TOTAL 746 . 75cn'o lo TAX ON PARTS & MATER%IAL 0 7 . 000% 52 . 27 -Dim Z LABOR RATE REPLACE HRS REPAIR NRS ,nm D � DZ Z 1-SHEET METAL 45 . 00 13 . 5 8 . 0 967 . 50 >ccnc 2-MECHi ELEC 45 . 00 9 1 . 4 95 . 50 r-m i 3-FRAME 45 . 00 1. 0 4-REFINISH 45 . 00 . 5 22 . 50 Amy 5-PAINT MATERIAL 20 , 00 �� � iBOR TOTAL 1 ,075 . 50 mo z TAX ON LABOR ZD o SUBLET REPAIRS >'U m TOWING & STORAGE <o > BOSS TOTAL 1 ,874 .52 m3; ?o LESSz DEDUCTIBLE 500 . 00- :7 TOTAL 1 .374. 52 Y. F` )P#AUDATEX Al U CO LOG 9376968 DATE 01/14/91 19 , 20.53 042 �g KNSNN/00/00/00/00 CUMS00/00/00/00 NSU a ' NOTICE - REPAIRS TO THIS VEHICLE MAY REQUIRE SPECIFIC - - _ Dc N ELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER" Vis: =: chv (a � z ----------------------- ----- ------ rn O z Z ND �M p 7o m N rn mO Z m� ZD0 >'a ir, c0 D _ mD f s r DC 4 � a u z �m C j nm i >Z Z �c Z 0 C M m 2 M v - • ! 7�0� C m0 : CPM • Z> C • c 0 ✓. m< D ._.... ....... .. _ ..._............. _._._._....1...��_ ..: ,_._.,...:_._ .. ......- .:....- `+. t....__..v. ..s.-,n.... .. ..... ..✓3'ti.l• ..F+..0_ri J✓"SS Y.....'.'L.FL 'T.-:Fb:..4w-,,... .5.. _.. ...., ..- ... Li 0000NED CLAIM JUN 5 1991 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY COUNSEL MARTINEZ, CALIF. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JUNE 25, 1991 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GALLAGHER, Danny ATTORNEY: Roni Rothol.z, Esq. Attorney at Law Date received a 28 1991 (via Counsel.) ADDRESS: 1533 N. Main Street BY DELIVERY TO CLERK ONMay Walnut Creek, CA 94596 May 20, 1991 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. GATED: May 28, 1991 JAIL BATCHELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of S6p—eryrsors ( ) This claim complies substantially with Sections 910 and 910.2. V,) 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: (, tj /9BY: I ,Deputy County Counsel IT7, 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: JUN 2 5 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec - ) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUN27 oIJ91 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Roni Rotholz , Esq . Attorney at Law 1533 N . Main Street Walnut Creek , California 94596 Re: Claim of GALLAGHER , Danny Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for -the reasons checked below: X 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which . the person presenting the claim desires notices to be sent . X 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. X4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage, or loss, if known. X5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10 , 000 ) . If the claim totals less than ten thousand dollars ( $10, 000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss ' so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: J Deputy y Counsel CERTIFICATE OF SERVICE BY MXA C .C.P. SS 1012 , 1013a, 2015 . 5 ; Evid. C. §§ 641 , 664 ) My business address is the County Counsel 's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it, in an envelope(s) addressed as shown above (which is/are place( s ) having delivery service by U.S. Mail) , which envelope( s ) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California . I certifyunder penalty of perjury that the foregoing is true and correct. Dated: (��-c (o / 9/ , at Martine Calif or cc: erk of the Board of Supervisors iginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4 , 910 . 8 ) RE�Fa'vRD errithew MAY ;;� 1991 rOON—TRA ECEemorial IVED UN OO Q 0VLi-�1L5 �T���AND CLINICS 281991 DOFSUPERVISORS COSTA CO. TO: Office of County Counsel DATE: May 23, 1991 Contra Costa County FROM: Mark Finucane `y�� � RE: NOTICE OF INTENT TO Health Services Director C—I�j COMMENCE ACTION Danny Gallagher Record #499370-5 Enclosed is Notice of Intent to Commence Action regarding the above patient. This was received by Merrithew Memorial Hospital on May 22, 1991. SP Enclosure cc: Ron Harvey, Risk Management SE ot Contra Costa County sr'9 COUNTY � A-301A (3/87) 1 RONI ROTHOLZ 1533 N. Main Street 2 Walnut Creek, CA 94596 .3 Telephone: (415) 932-0193 ,4 Attorney for Plaintiff, DANNY GALLAGHER 5 6 NOTICE OF INTENTION TO COMMENCE ACTION 7 AGAINST HEALTH CARE PROVIDER 8 (CCP §364) 9 10 TO: Merrithew Memorial Hospital Legal Department 11 2500 Alhambra Avenue Martinez, CA 94553 12 13 YOU ARE HEREBY NOTIFIED that, pursuant to the provisions of California 14 Code of Civil Procedure §364, DANNY GALLAGHER intends to, and will, commence 15 -a legal action against you ninety days or more after the date of service of this notice. 16 The legal basis for such action will be that you and the other defendants 17 to be named in such action were negligent, specifically by failure to properly diagnose 18 and treat injuries sustained by claimant. 19 All of the foregoing is based on facts as presently known and there may 20 be other and additional losses and expenses to be ascertained. 21 If you contend that this claim is subject to arbitration, please serve upon 22 this claimant, by counsel, a copy of the contract upon which you rely. Failure to do 23 so within ten days of service thereon shall constitute a waiver of claimant's right to 24 arbitrate said claim. 25 Dated this 20th day of May, 1991. 26 27 R—ONI\,qOTHOLZ 28 Attorney for Plaintiff/Claimant r a co LO V 11 0 a N w � A `G crk waN. RECEIVED CLAIM JUN 5 1991 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY COUNSEL MARTINEZ, CALIF. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JUNE 25, 1991 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: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HOWELL, Kevin and HOWELL, Melanie Danille ATTORNEY: William E. Gagen, Jr. Gagen, McCoy, McMahon & Armstrong Date received May 31, 1991 ADDRESS: P'.10. Box' 21&:,< BY DELIVERY TO CLERK ON Danville, CA 94526-0218 Cert. P351-581-294 BY MAIL POSTMARKED: May 30, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. June 4 1991 ee IL BATCHELOR Clerk DATED: ea: Deputy ' II. FROM: County Counsel TO: Clerk of the Board of Sup ors � ) 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: /5 9 j BY: - Deputy County Counsel - I 77 II1. 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 ( V) 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: JUN z 1591 PHIL BATCHELOR, Clerk, y , Deputy Clerk WARNING (Gov. code se ' n 913) Subject to certain exceptions, you have only six (6) months from the date this notice was pervonally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; 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: _11IN-2 7 X99 BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator 1 WILLIAM E. GAGEN, JR. MICHAEL P. CANDELA 2 GAGEN, McCOY, McMAHON & ARMSTRONG RECEIVE A Professional Corporation 3 279 Front Street, P.O. Box 218 MAY 3 11991 Danville, California 94526-0218 4 Telephone: (415) 837-0585 CLERK BOARD OF U VISORS 5 Attorneys for Claimants CONTRA STA 0, KEVIN HOWELL individually and 6 on behalf of his minor daughter MELANIE DANILLE HOWELL 7 8 BEFORE THE BOARD OF SUPERVISORS, COUNTY OF CONTRA COSTA 9 10 11 KEVIN HOWELL and MELANIE DANILLE NO. HOWELL, 12 CLAIM AGAINST CONTRA COSTA Claimants, COUNTY 13 VS. 14 CONTRA COSTA COUNTY, 15 Respondent. 16 17 18 TO: THE CLERK OF THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS 19 AND TO THE CLERK OF THE CONTRA COSTA COUNTY HEALTH DEPARTMENT: 20 KEVIN HOWELL, individually and on behalf of his minor 21 daughter MELANIE DANILLE HOWELL hereby submits their claim 22 against the CONTRA COSTA COUNTY BOARD OF SUPERVISORS and CONTRA 23 COSTA COUNTY HEALTH DEPARTMENT and makes the follow statements in 24 support of their claim: 25 a. Claimant's post office address is 15 Cleopatra Drive, 26 Pleasant Hill, California 94523-3447. Law Offices GAGEN, McCOY, McMAHON & ARMSTRONG A Professional Corporation is\client\22336\HeaClaim.pld 279 Front Street —1— Danville, 1_Danville, CA 94526 I b. Notices concerning the claim should be sent to 2 claimants' attorney, William E. Gagen, Jr. , at Gagen, McCoy, 3 McMahon & Armstrong, A Professional Corporation, 279 Front 4 Street, P. O. Box 218, Danville, California. 5 C. The incident giving rise to this claim occurred on or 6 about January 3, 1991, at 15 Cleopatra Drive, Pleasant Hill, 7 California 94523, and the circumstances giving rise to this claim 8 are as follows: On or about January 3, 1991, PATRICIA HAZEL 9 TOMSIK drove her motor vehicle into claimant's Pleasant Hill home 10 and bedroom by reason of her medical condition and/or disorder 11 characterized by a lapse in consciousness and control. Once 12 inside claimant's home said vehicle ran over TERRY HOWELL, wife 13 of claimant KEVIN HOWELL and mother of claimant MELANIE DANILLE 14 HOWELL, causing her death. A police report was prepared and is 15 attached hereto and is incorporated herein by reference. 16 Prior to January 3, 1991, CONTRA COSTA COUNTY had actual or 17 constructive notice that PATRICIA HAZEL TOMSIK suffered from a 18 medical condition and/or disorder characterized by a lapse in 19 consciousness and control and was unable to safely operate a 20 motor vehicle upon a highway; however, CONTRA COSTA COUNTY failed 21 to take reasonable steps to prevent PATRICIA HAZEL TOMSIK or 22 cause others to prevent her from operating a motor vehicle. 23 d. A general description of the injuries, damages, or 24 losses incurred so far as they are known at this time are: the 25 loss of the decedent's love, companionship, comfort, affection, 26 society, solace, moral and financial support; loss of enjoyment Law Offices GAGEN, McCOY, McMAIION & ARMSTRONG A Professional Corporation is\client\22336\HeaClaim.pld 279 Front Street _2_ Danville, CA 94526 1 of sexual relations, ability to have children; physical and moral 2 assistance and support, personal services, advice and training in 3 the operation and maintenance of the home and in the rearing of 4 decedent's minor daughter; pain, discomfort, fears, anxiety, 5 mental and emotional distress suffered by the claimants and/or 6 the decedent; medical and hospital services and supplies; damages 7 to claimant's real and personal property; anticipated future 8 contributions, earning ability and anticipated future earnings as 9 well as anticipated future employment benefits; funeral and 10 burial expenses. 11 e. The names of the public employees causing the claimants' 12 injuries, damages or losses are not known at the present time, 13 however, investigation is continuing. 14 f. The amount of claim at this time is way in excess of 15 $25,000 and jurisdiction over the claim rests in the Superior 16 Court. 17 Dated: dT' �� ��( GAGEN, McCOY, McMAHON & ARMSTRONG A Professional Corporation 18 19 20 ILLIAM E. GEN, JR. Attorneys for Claimant . 21 22 23 24 25 26 Law Offices GAGEN, McCOY, McMAHON& ARMSTRONG A Professional Corporation is\client\22336\HeaClaim.pld 279 Front Street —3— Danville, CA 94526 _ \ \ ,~ I& w Q e\ \ ~ :� . .9-4-Y � 350 U./ � � (Y) o Q �. �k cr 6-2 : | � "z ■0 \ | m \ aUi ge « Q ` �§ ou { 1 � t / U LO 7 t / \ � q | 44 0 2 § \ 2 1 : � � ¢ ■ a w w � 2 U2U $ (U P4 . m = N . . ... _. \ $/ n EL 0k/ 2 7 LLJ § 02 $ 7 j . \ Qx ) w \ $\ \ 0 Ir 114 C3 q o, f / : !� I = q . ; ■ � pLESANT HILL (POLICE DEPARTMENT ARREST REPORT 330 Civic Dr, P H , CA, 94523, (415) 671 4600 a Date Time PH Clap- - BCS I s Arr.N �� �Q r - 3 �, ► r� _ � cF JDENTIFICATION,:INFORMATION NAME (Las (First) (M) SUF RACE/SEX DOB/AGE A r cls I ;r` -a�- ADDR: APT. ITY ST ZIP M D A 'rL'L HM TELE: a r WK TELE: PARENTS DAY TELE: DDL# SSN HG\�L. Lt HAIR,.POOl J STY FBI DOJ EYES 2 L BRD HAND OTH# OCC MARKS COMMENTS HAT COAT SHIRT PANTS/DRESS SHOES JEWELRY ADDR 2 ST ZIP AKA'S/NICKNAMES CITY VEHICLE---,., ST, (�IC LIC —rb5 OL 1 COL 2 YEAR MAKE MODEL BODY FEATURES DISPO BOOKING 4 FELONY MISD INF 5150 CIVIL WRNT CA 5170 NARRATIVE ON WARRANTS/CHARGES: WRNT# COURT BAIL . a 5 \j S' g b PC s 10 1,-10 � RECORD CHECK: PHPD LINX S.OJ PIS DOJ. NCIC OTHER PHOTO TAKEN: FP PP TELEPHONE CALLS MADE: /U0' VISIBLE INJURIES: COMPLAINT OF PAIN: DISPOSITION,.'}t' ' RR YSB 849PC CITED, DETOX. BOOKED: JAIL J.HALL CO.HOSPITAL JUV.RELEASED TO: DATE TIME BY CITIZEN'S ARREST: I HEREBY ARREST THE ABOVE NAMED INDIVIDUAL FOR AND REQUEST THAT THE POLICE TAK HIM/HER INTO CUSTODY.I WILL APPEAR AS DIRECTED TO SIGN A COMPLAINT. NAME(PRINT): SIGNED: ADDRESS CITY STATE ZIP ARRES FICER: BOOKING OFFICER: Copy to: D)te y, Q/ Of c. t / IT c PH Dispo Prgc��e!5/ PG of Time3 1, / Sup b FIT•7� / S BCS Dispo Reviewed •,� A t STATE OF CALIFORNIA T AFFIC COLLISION REPORT PAGE ) of 15 SPECIAL CONDITION* NUMBER HRA RUN CITY /� JUDICI DISTRICT LOCAL REPORTNUMBER A/A/AC INJURED FELONY ZC4J� JT /LL rU/48COL NUMBER MTA RUN COUNTY REPORT)NG CT - *EAT /�/� C/ 17 Eo o �ovr.ea cdsra ovE' 7 COLLISION OCCURRED ON MO. DAY YEAR TIME(2100) N Ac S OFFICER L D. Z (?LCOPArRA Dk 1 3 9i /03/ o7oR as7 o --------------------------------------------- F MILEPOST INFORMATION ------------- S oSAT WEEKc S TOWAWAY WAY P�C�R CU R.)����-/ U FEET/MILES OF J I ❑AT INTERSECTION WITH _ STATE HWY REL OR: .3D ET OF DYES 9NO ❑NONE PARTY DRIVER'S LICENSE NUMBER STATErFl SAFETY VEIL YEAR MAKE IMOD L/COLOR LICENSE NUMBER STA" 1 S065-S15.3 ICA E 83 Fok 1.81gD1Z 1)eSa, Dy JGPZ l,2,9- DRIVER NAME(FIRST,MIDDLE,LAST) / ' ' • • • ' ' , , • • • ' • • ' • • ' PATRICIAAroZEL S/ V` PEDES- TREET ADDRESS OWNER*$NAME SAME AB DRIVER TRo 089 -S E� A� IT^lV PARKED CIT/YY I SST/ATTEE�/ZIP OWNER'S ADDRESS �}BAYE AS DRIVER VE❑E / U6i ,5 /1V7— l 1LI- LST ! S,23 /f Xil' BICY• SEX HAIR EYES IS WEIGHT BIRTHDATE RACE DISPOSITION OF VE19CLE ON ORDERS OF. [" (OFFICER ❑DRIVER ❑OTHER `oT F' ae� Hzt 5y ao�po ' as ;30 OTHER HOME PHON 1E y/��_i/1 X75 / BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE❑ ❑ ( //5/ 395— /v3& / - CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER TYPE RIER POLICY NUMBER - ❑UNK. []NONE ❑MINOR Ai/~s SNS, 8814019 ?..s- =- ❑MOD. ❑MAJOR &OTAL OIR.OF ON STREET OR HIGHWAY SPEED PCF ICC 0 ` sNE�P �� .vR a3 coc .73/-53 P-13 ,. CHP❑ PARTY DRIVER'S LICENSE NUMBER STATE CLA68 SAFETY YEN.YEAR Y /YODEL/COLOR ENSE HUMBER STAT 2 EG1AP. `7 s G�C IRA t L' 1 Al /�Qrl/) Gq Da . r1RR- DRIVER NAME(FIRST,MIDDLE,LAST) PEDES STREETADDRESS OWNER'S NAME �pSAMEASDRIVER d- - VSs-ay�9 / D i 6Ty% J- ua A,eD✓ �s� - r a8 I PARKED CITY/STATE/ZIP OWNER'S ADDRESS SAM AS DRIVER ME 'z96/ s,�/E,�i'jI,9A) 9 PCEASR r 1Z BICY• SEX HAIR HYES HpGNT Wp0liT SIRTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER []DRIVER []OTHERY0. DAY YEAR ❑ � i OTHER HOME PHONE BUSINESS PHONE PRIOR MECHAMCAL DEFECTS: NONE APPARENT❑ REFER TO NARRATIVE❑ ❑ ( ( CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE LINK. ❑NONE ❑MINOR ' MOD. ❑MAJOR ❑TOTAL DIR OPON STREET OR HIGHWAY SPEED PCF ICC[I13 t B` s E,e q,� �k as ❑CHP cnP PARTY DRIVER'S LICENSE HUMBER STATE CLASS IL SAFETY VEYEAR MAKE/MOO L/COLOR LICENSE NUMBER STATE 3 EQUIP. -- o ea/flu 64A) 3979.11J- DRIVER Cf} NAME(FIRST,MIDDLE,LAST) ' TRIAN STREET ADDRESS _ OWHERy.NAYE S EAS DPoVER-.3.L7 El PARKED CITY STATE/ZIP OWNER'S ADDRESS VEHICLE AS DRIVER VEHICLE BICY• SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OR ❑OFFICER [:]DRIVER []OTHER CLIST MO. ) DAY 1 YEAR OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT❑ REFER TO NARRATIVE❑ ❑ ( ) ( , VEMCLE TYPE CNP USE ONLY DESCRIBEVEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER POLICY NUMBER UNK, ❑NONE [:]MINOR ) M00. ❑MAJOR ❑TOTAL DIROF SPEED PCF ICC❑i 1 ` jON.TRELrORI9OMWAY SNE2 AP -DRas CH o PREPARERS NAMEp DISPATCH NOTIFIED REVIEWER'S NAME JOATE REVIEWED ' O (YES 0 NO E3N/A L. s CHP 555 PAGE i (R1v T 88) OPI 042 ��(j� yA /ri //O r D TG - j,o f 1 07 A♦ p:866/ I STAT_''OFCAA.L'1*6A fiRAFFIC COLLISION CODINGPACE 2 4 7 - � ` MAT OF LLISIODAY YEAR /' nME(IO3/ NCICN /V OFFICER LQ��,� 09 OWNER'S NAME/ADDRESS DO�rJJ PDAMAGEROPERTY sDE1SvCR1IPrn;1 OlF DwAMAeGy€�.L0411 SE�a�rC7-. -6C5, S / )k XHOYnESfl[:]NC NC CA SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE OCCUPANTS L-AIR BAG DEPLOYED M/C BICYCI F.HEL MET 0-NOT EJECTED A-NONE IN VEHICLE M:AIR BAG NOT DEPLOYED B-UNKNOWN N-OTHER DRIVER 1-.FULLY EJECTED C-LAP BELT USED P•NOT REQUIRED V- E 2-PARTIALLY EJECTED 1-DRIVER D-LAP BELT NOT USED W-YYES 3-UNKNOWN Z 3 E-SHOULDER HARNESS USED 2-S 6-PASSENGERS PASSENGER Q 5 6 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT X-NO 8-REAR OCC.TRK.OR VAN G.LAP/SHOULDER HARNESS USED Q-IN VEHICLE USED Y-YES 9-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED 7 0-OTHER J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 2 3 TYPE OF VEHICLE 2 3 MOVEMENT PRECEDING UST NUMBER (N) OF PARTY AT FAULT COLLISION AYSECTION ►S3ED CIT D ACONTROLS FUNCTIONING APASSENGERCAR/STATION WAGON ASTOPPED [JrEs No B CONTROLS NOT FUNCTIONING 113PASSENGER CAR W/TRAILER B PROCEEDING STRAIGHT x B OTHER IMPROPER DRIVING C CONTROLS OBSCURED "' C MOTORCYCLE/SCOOTER C RAN OFF ROAD"''"` - --- D NO CONTROLS PRESENT/FACTOR• D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF COLLISION E PICKUP/PANEL TRUCK W/TRAILER IE MAKING LEFT TURN D UNKNOWN• HEAD-ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN M E FELL ASLEE B SIDESWIPE G TRUCK/TRUCK TRACTOR W/TRLR. G BACKING C REAR END HSCHOOLBUS SLOWING/STOPPING WEATHER( MARK I TO 21TEMS) D BROADSIDE I OTHER BUS J PASSING OTHER VEHICLE ACLEAR - E HIT OBJECT —HOUSE I Ij EMERGENCY VEHICLE •J CHANGING LANES B CLOUDY F OVERTURNED IK HIGHWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC r. D SNOWING OTHER•: IMOTHER VEHICLE MOTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH IN PEDESTRIAN N XING INTO OPPOSING LANE P OTHER•: ANON-COLLISION MOPED PARKED G WIND B PEDESTRIAN P MERGING LIGHTING C OTHER MOTOR VEHICLE 0 TRAVELING WRONG WAY A DAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER,: B DUSK-DAWN E PARKED MOTOR VEHICLE Z 3 (MARK 1 TO 2ITEMS) CDARK-STREET LIGHTS FTRAIN AvcsEcnoNvaunoN: QED D DARK•NO STREET LIGHTS BICYCLE C�� as 35D "YES E DARK.STREET LIGHTS NOT ANIMAL: BvcsECnoNvaunoN: CITED FUNCTIONING• H []YES 13,40 SOBRIETY-DRUG A DRROADWAY SURFACE I FIXED OBJECT:, `+vcsEcnONvauTi pip y 2 3 PHYSICAL (x(S5 ❑YES (MARK 1 TO 21TEMS) B WET OTHER OBJECT: ❑NO C SNOWY-ICY D HAD NOT BEEN DRINKING J D SLIPPERY(MUDDY,OILY,ETC.) E VISION OBSCUREMENT: B HBD-UNDER INFLUENCE F INATTENTION•: HBD-NOT UNDER INFLUENCE ROADWAY CONDITION(S) G STOP&GO TRAFFIC HBD-IMPAIRMENT UNKNOWN (MARK 1 TO 2 ITEMS) PEDESTRIAN'S INVOLVED E UNDER DRUG INFLUENCE' A NO PEDESTRIAN INVOLVED H ENTERING 1 LEAVING RAMP A HOLES,DEEP RUT• I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL CROSSING IN CROSSWALK UNFAMILIAR WITH ROAD IMPAIRMENT NOT KNOWN B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION NOT APPLICABLE C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK-NOT K DEFECTIVE VER EQUIP.: aYEp DYES I SLEEPY/FATIGUED D CONSTRUCTION-REPAIR ZONE AT INTERSECTION ❑NO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK I L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL FLOODED IE INROAD-INCLUDES SHOULDER M OTHER G OTHER IFNOT IN ROAD NONE APPARENT NO UNUSUAL CONDITIONS APPROACHING/LEAVING SCHOOL BUS I 1 10 RUNAWAY VEHICLE SKETCH MISCELLANEOUS piDICAT[NORTH PAry Of >!I ►� at c�E A7kA pe CHP S55 PAGE 2 1 Rev 148 1 OP1042 ri STATE Of CALIFOIpiU `. TRAFFIC COLLISION REPORT ,3 GF FADE SPECIALCONDRIONS -... NUMBERHITA RUN CITY .. JUDH7ALOISTRICT LOCAL IPEPORTNUMBER FATAL INJURED FELONY �CC,DEA)r i [IPL6ASA,0 r 1il- Nr, DIgBLD 9 f- S' NUMBER MTA RUN COUNTY REPORTING DISTRICT BEAT KILLED MIS0. \' ❑ G�oreq cosrA / o of OLL/SION OCCURRED ON MO. DAY YEAR TME(24!0) NGC/ OFFICER L D. X870 -�6olpA ,�AX ��--------------------------------------- ` �/ io�3/ azo 9 87 MILEPOST INFORMATION DAY OF WEEK TOW AWAY PHOTOGRAPHSBY: / 7 U FEET MILES OF - S M T W�F S OYER [:]No OF�n' CbNAJELLy ;7/ O ❑AT INTERSECTION WITH STATE HW Y RFL J j�p DGR: 301 //FEET/lift" E OF Dk Ee�'JAI� ❑YES NO 11 NONE PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEK YEAR MAKEIMODEL/COLOR LICENSE NUMBER ST EQUIP. DRIVER NAME(FIRST,MIDDLE,LAST) o TE,�k L 6/90b)61-L PEDES• STREET ADDRESS OWNER'S NAME E]SAME AS DRIVER 0 /s Cl-Ea PA reA PR PARKEVEHICLE D CITY/STATE/ZIP - - OWNER'S ADDRESS _ ❑SAME AS DRNER /nom/G C�} Q _.. _. .. BICY• SEX HAIR EYE 9 HEIOMTT WEIGITT BIRTHDATE RAC[ OIBPOSITON OF VEHICLE ON ORDERS OFFICER []DRIVER []OTHER C r 8R� 6 e� y 'ia i�0 W OTHER HOME PHONE BUSINESS PHONE NOR MECHANICAL DEFECT'S: NONE APP RENT[] REFER TO NARRATIVE❑ CHPU8EONLY ..___.._...SHADE IN DAMAGED AREA -` -- - DESCRIBE VEMCLE DAMAGE '" VEF/CL[TYPE INSURANCE CARRIER - POLICY NUMBER ❑UdK. []NONE ❑MINOR . ❑MOD. ❑MAJOR ❑TOTAL DIF.OF jONSTRFETORHlGH*AV SPEED PCF ICC TRAVEL - LIMIT P` I�HP❑ PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEK YEAR MAKE/MODEU COLOR LICENSE NUMBER STAT DRIVER NAME(FIRST,PADDLE.LAST) - - • • • • • ' • • • • ' • ' ' ' ' • • ' ' PEDE& STREETADDRESS OWNER'S NAME ❑SAME AS DRIVER TRIAN PARKED CITY/STATE/ZIP OWNER'SADDRESS ❑SAME AS DRIVER VEHICLE BICY• SEX HAIR EYES HEIGHT WE/OHT BIRTIIDATB RACE DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER ❑DRIVER ❑OTHER CLIST MO. ) DAY YEAR OTHER HOME PHONE BUSINESS PHONE 1 PRIOR MECHANICAL DEFECTS: NONE APPARENT❑ REFER TO NARRATIVE❑ ❑ ( ) / CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA INSURANCE CARRIER - - POLICY NUMBER VENICLETYPE ❑UNK. ❑NONE ❑MINOR . ❑MOD; ❑&MOR ❑TOTAL DIF.OF ION STREET OR HIGHWAY SPEED PCF ICC❑ TRAVEL LIMIT PUC CMP❑ PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEK YEAR MAKE/MODEL/COLOR LICENSE NUMBER STATE 3 EQUIP. DRIVER NAME(FIRST,MIDDLE.LAST) • • • • • • • • • • • ' • • • • • • • ❑ PEDES STREETADDRESS - - OWNER'S NAME []SAME AS DRIVER TRIAN PARKED CRY/STATE/ZIP OWNER'S ADDRESS ❑SAME AS DRIVER VEHICLE BICY• SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPOSITION OF VEHICLE ON ORDERS OF: ❑OFFICER ❑DRIVER ❑OTHER CLIST MO. DAY YEAR ❑ i i OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[] REFER TO NARRATIVE❑ ❑ ( ) ( ) CMP USE VENICLETVP[ONLY DESCRIBE VEMCLE DAYAOE SHADE U4 DA&AGED AREA INSURANCE CARRIER POLICY NUMBER ❑UIK. C]NONE 1:1 MINOR i DODO. ❑MAJOR ❑TOTAL DI0.OP JONSTREETORMI.HMPAY SPEED JPCF ICC❑ TRAVEL LIMITPUCo cHPE3 I ( PREPARERS NAME DISPATCH NOTIFIED REVIEWER'SNAME - DATE REVIEWED o F� ,�os��B E;e� I YES ❑NO O N/A CHP 555 PAGE T (Rev 1.88) OR 042 — 88 48667 r STATE OF CALIFORNIA TRAFFIC COLLISION CODING VALE DATE OF COLUSION M Q TIME($400) ? NGC NUMBER OFRCER 1.0 NUMBER MO/r DAY 3 YEAR // C��J/ 0 709 8 7 OWNER'S NAME/ADDRESS NOTIFIED PROPERTY Pokra IGD LIL4y G(I 1)-7-7, ?Off /+ . 0,4 Wv - 016 YES aNO DAMAGE DESCRIPTION OF DAMAGE MA 0) SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE H MET OCCUPANTS L-AIR BAG DEPLOYED M/C BICYC F- 0•NOT EJECTED A-NONE IN VEHICLE M-AIR BAG NOT DEPLOYED B-UNKNOWN' N-OTHER DRIVER t•FULLY EJECTED C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED" D-LAP BELT NOT USED 1-DRIVER W-YES 3-UNKNOWN - 1 2 3 2 TO 6'PASSENGERS E•SHOULDER HARNESS USED PASSENGER 4 5 6 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT G-LAP/SHOULDER HARNESS USED 0-IN VEHICLE USED X-NO e-REAR OCC.TRK.OR VAN D-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y•YES 7 O-OTHER J-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U•NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES 2 3 TYPE OF VEHICLE 1 2 3 MOVEMENT PRECEDING LIST NUMBER (p) OF PARTY AT FAULT COLLISION # AVC SECTION VIOLATED: Cla YES ACONTROLS FUNCTIONING APASSENGER CAR/STATION WAGON ASTOPPED NO B CONTROLS NOT FUNCTIONING' $PASSENGER CAR W/TRAILER B PROCEEDING STRAIGHT $OTHER.IMPROP._.IV, •: CONTROLS OBSCURED IC MOTORCYCLE/SCOOTER .. C RAN OFF ROAD -. - - D NO CONTROLS PRESENT/FACTOR• D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION IE PICKUP/PANEL TRUCK W/TRAILER E MAKING LEFT TURN D UNKNOWN• HEAD-ON I IF TRUCK OR TRUCK TRACTOR F MAKING U TURN M E FELL ASLEE B SIDESWIPE I IG TRUCK/TRUCK TRACTOR W/TRLR. G BACKING C REAR END H SCHOOL BUS IH SLOWING/STOPPING WEATHER( MARK 1 TO 2 ITEMS) D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE ACLEAR E HIT OBJECT J EMERGENCY VEHICLE J CHANGING LANES B CLOUDY F OVERTURNED K HIGHWAY CONST.EQUIPMENT J(PARKING MANEUVER C RAINING G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC D SNOWING H OTHER•: MOTHER VEHICLE MOTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH I I IN PEDESTRIAN N XING INTO OPPOSING LANE F OTHER i—ANON-COLLISION MOPED PARKED G WIND B PEDESTRIAN P MERGING LIGHTING C OTHER MOTOR VEHICLE Q TRAVELING WRONG WAY A DAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER B DUSK-DAWN E PARKED MOTOR VEHICLE 1 2 3 (MARK 1 TO 2 ITEMS) CDARK-STREETLIGHTS FTRAIN AVC SECTION VIOLATION,: CITED DDARK-NO STREET LIGHTS BICYCLE []YES E DARK-STREET LIGHTS NOT ANIMAL: B vc sEcnoN vaunoN: CITED -.- FUNCTIONING• H ROADWAY SURFACE ONO SOBRIETY-DRUG •-; FIXED OBJECT: vC SECTION VIOLATION: PHYSICAL A DRY i C CITED 1 2 3 OYES (MARK t TO 21TEMS) B WET OTHER OBJECT: ONO C SNOWY•ICY D HAD NOT BEEN DRINKING J D SLIPPERY(MUDDY,OILY,ETC.) E VISION OBSCUREMENT: B HBD-UNDER INFLUENCE HBD-NOT UNDER INFLUENCE F INATTENTION•: ROADWAY CONDITIONS) HBD-IMPAIRMENT UNKNOWN' (MARK t TO 2 ITEMS) PEDESTRIAN S INVOLVED G STOP GO TRAFFIC E UNDER DRUG INFLUENCE A NO PEDESTRIAN INVOLVED H ENTERING/LEAVING RAMP A HOLES,DEEP RUT' I PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL B CROSSING IN CROSSWALK IJ UNFAMILIAR WITH ROAD IMPAIRMENT NOT KNOWN B LOOSE MATERIAL ON ROADWAY• AT INTERSECTION NOT APPLICABLE C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK-NOT K DEFECTIVE VER EGUIP.: q�p prEs ISLEEPY/FATIGUED D CONSTRUCTION-REPAIR ZONE AT INTERSECTION ❑NO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK I IL UNINVOLVED VEHICLE F JAHAZARDOUS MATERIAL F FLOODED• IN ROAD-INCLUDES SHOULDER OTHER G OTHER': NOT IN ROAD NONE APPARENT H NO UNUSUAL CONDITIONS APPROACHING/LEAVING SCHOOL BUS I I JORUNAWAYVEHICLE SKETCH MISCELLANEOUS O INDICATE NORTH I CHP 555 PAGE 2( Rev 1-88)OPI 042 t. " • PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL-,- CALIFORNIA � FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 1 CASE REPORT Section - l: VC23153 2: PC1915 3: PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10 : 31 Reporting officer: ROSENBERG, KRISTIN (287 ) SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. --------==-------------------- NAME(S) -_- _- __--______- __- ------ ----- ***** VICTIM # 1- Name: Name: HOWELL, TERI LEIGH Suffix: Race: W Sex: F DOB: 08-16-61. Address:.... 15 CLEOPATRA DR, PLEASANT HILL, CA 94523 Phone 1: (.415 ) - Phone 2: (415 ) - AKA: . DDL #: Height: 410 Weight: 110 Hair Color: BRO Eyes: B. Arrest #: Charges: _ NTA #: Comments:DECEASED/246 ***** INVOLVED # 1 . Name: PORTER, FRIEDA ELIZABETH Suffix: Race: W Sex: F DOB: 12-07-07 Address: 2099 SHERMAN DR,_ PLEASANT HILL, CA 94523 Phone 1: (415) 689-5016 -. Phone 2: (415) AKA: DDL #: Height: Weight: Hair Color - Eyes: Arrest #: Charges: NTA #: Comments: 246/PROPERTY DAMAGE ***** INVOLVED # 2 Name: SMITH, MARY LOUISE Suffix: Race: W Sex: F DOB: 07-02-65 Address: 2057 SHERMAN DR, PLEASANT HILL, CA 94523 Phone 1: (415 )798-7286 Phone 2: (415)689-6642 AKA: DDL #: Height: Weight: ' . Hair Color: .; Eyes: Arrest #: Charges: NTA #: Comments: 246/PROPERTY DAMAGE PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-c BCS Class: Disposition: Page: 2 NAME(S) ***** INVOLVED # 3 Name: TOMSIK, PATRICIA HAZEL Suffix: Race: W Sex: F DOB: 10-27-30 Address: 2089 SHERMAN DR, PLEASANT HILL, CA 94523 Phone 1: (415 ) 825-1336 Phone 2: (415 ) - AKA: DDL #: 50855153 Height: 504 Weight: 200 Hair Color: BRO Eyes: h Arrest #: Charges: NTA #: Comments: 246 **** OWNER # 1 Name: HUBBARD, TIMOTHY SHANNON Suffix: Race: . W Sex: M DOB: 02-03-44 Address: 2061 SHERMAN DR, PH, CA 94523 Phone 1: (415 ) 685-2489 Phone 2: (415) 444-4664 AKA DDL #: J0700648 . Height: 600 Weight: . 230 Hair Color: GRY Eyes: H: Arrest #: Charges: NTA #: Comments:LIC/052MRR/246 ***** OWNER # 2 Name: HUBBARD, TIMOTHY SHANNON. Suffix: Race: W Sex: . M DOB: 02-03-44 Address: . 2061 SHERMAN DR, PH, CA 94523 Phone 1: (415 ) 685-2489 Phone 2: (415)44.4-4664 AKA: DDL #: J0700648 Height: 600 Weight: 230 Hair Color: GRY ' Eyes: HT Arrest #: Charges: NTA #: Comments:LIC/39794J/246 VEHICLES ***** VEHICLE # 1 ST:CA LiC:052MRR Colorl:GRN Color2:WHI Year:. Make:GMC .. .'Madel:RALL Body:VN-VAN/CARRYALL Hazard: Features: Reg. Owner:HUBBARD, TIMOTHY S Driver: * NONE Comments: 246 PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-C BCS Class: Disposition: Page: 3 ___________ VEHICLES ***************************************************************************** ***** VEHICLE # 2 ST:CA Lic: 1GPZ128 Colorl:MAR Color2: Year: 83 Make:FORD Model:BIRD Body: -NONE Hazard: Features: Reg. Owner:TOMSIK, PATRICIA HAZEL Driver: TOMSIK, PATRICIA HAZEL ` Comments: 246 ***** VEHICLE # 3 ST:CA Lic: 39794J Colorl :GRN Color2: Year: 58 Make:FORD Model:F100 Body:PU-PICKUP TRUCK Hazard: Features: Reg. Owner: Driver: * NONE Comments: 246 NARRATIVE INVESTIGATION: I WAS SENT TO 15 CLEOPATRA DRIVE TO ASSIST OTHER PHPD OFFICERS WITH THIS COLLISION. I RESPONDED FROM THE AREA OF 320 CIVIC DRIVE AND ARRIVED ON THE SCENE AT ABOUT 1045 . ALL MEASUREMENTS FOUND IN THIS INVESTIGATION ARE APPROXIMATE. MEASUREMENTS WERE MADE WITH A ROLATAPE. SCENE: IN THIS AREA, SHERMAN DRIVE IS A NORTH/SOUTH ROADWAY WITH .HOUSES SITUATED. ON THE EAST SIDE. ON THE WEST SIDE ARE VACANT LOTS WHERE HOUSES WERE AT ONE TIME. CLEOPATRA DRIVE IS AN EAST/WEST ROADWAY THAT INTERSECTS SHERMAN DRIVE AT APPROXIMATELY 90 DEGREES. HOUSES ARE SITUATED ON BOTH THE NORTH AND SOUTH SIDES OF CLEOPATRA DRIVE IS A T-INTERSECTION WITH CLEOPATRA DRIVE ON THE EAST SIDE OF SHERMAN DRIVE WHICH EXTENDS NORTH OF CLEOPATRA DRIVE. AT THE TIME OF THE COLLISION, NO ROADWAY SIGNS WERE' VISIBLE, HOWEVER, THIS IS A RESIDENTIAL AREA. . PARTIES: V-1 (FORD) WAS LOCATED ON ITS WHEELS AT ITS POINT OF REST AS SHOWN ON THE FACTUAL DIAGRAM. V-1 SUSTAINED TOTAL DAMAGE TO THE FRONT AND BOTH SIDES. THE DAMAGE TO THE RIGHT SIDE STARTED AT THE FRONT AND EXTENDED TO THE TRUNK LID. THE DAMAGE TO THE LEFT SIDE STARTED AT THE FRONT AND EXTENDED TO THE TRUNK LID. THE RIGHT REAR TIRE WAS FLATTENED PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 4 NARRATIVE WITH THE SPOKED HUBCAP INTACT. BOTH THE LEFT FRONT AND REAR TIRES WERE INTACT WITH SPOKED HUBCAPS. THE RIGHT FRONT TIRE WAS FLATTENED AND THE RIM WAS BENT. THE HUBCAP WAS MISSING. D-1 WAS FOUND AND TENDED BY OTHER PHPD OFFICERS. REFER TO, OTHER SUPPLEMENTAL REPORTS. V-2 (GMC) WAS LOCATED ON ITS WHEELS AT ITS POINT OF REST AS SHOWN ON THE FACTUAL DIAGRAM. V-2 HAD BEEN PARKED AND DID NOT APPEAR TO HAVE MOVED SIGNIFICANTLY FROM ITS POINT OF IMPACT. V-2 SUSTAINED MODERATE DAMAGE TO THE LEFT REAR QUARTER PANEL. THE LEFT REAR TIRE WAS FLATTENED AND THE RIM WAS BENT. GLASS DEBRIS WAS IN THE ROADWAY ON THE LEFT SIDE AND REAR OF V-2. A PORTION OF A SPOKED HUBCAP WAS LOCATED ABOUT 411 FROM THE LEFT REAR TIRE. A SILVERTONE BEAUTY RING WAS FOUND ABOUT 1811 FROM THE REAR OF V-2 , ABOUT 611 AWAY FROM V-2. V-3 (FORD PICKUP) WAS LOCATED ON ITS WHEELS AT ITS POINT OF REST AS SHOWN ON THE FACTUAL DIAGRAM. V-3 HAD BEEN PARKED IN FRONT OF V-2 AT THE TIME OF THE COLLISION. V-3 WAS MOVED APPROXIMATELY 51 FROM WHERE IT WAS ORIGINALLY PARKED TO ITS POINT OF REST. AN INDENTATION IN THE EARTH SHOWED WHERE V-3 ORIGINALLY WAS PARKED. V-3 SUSTAINED MODERATE DAMAGE TO THE LEFT FRONT QUARTER PANEL AND FRONT BUMPER. BURGUNDY PAINT TRANSFERS WERE FOUND ON THE LEFT FRONT QUARTER PANEL. THE LEFT SIDE OF THE FRONT BUMPER WAS PULLED TO THE FRONT OF THE VEHICLE ABOUT 20" . THE RIGHT SIDE OF THE FRONT BUMPER WAS STILL ATTACHED TO THE VEHICLE. GLASS DEBRIS WAS IN THE ROADWAY ON THE LEFT SIDE AND FRONT AND REAR OF V-3. ALL WINDOWS ON V-2 AND V-3 WERE INTACT. ABOUT 1811 NORTH OF V-3 A BURGUNDY AND BLACK RUBBER PIECE WAS FOUND ON THE ROADWAY. A SILVERTONE WINDOW MOLDING WAS FOUND INCHES FROM THE RUBBER PIECE. 0-1 (HOUSE AT 15 CLEOPATRA DRIVE) IS A SINGLE LEVEL RESIDENCE SITUATED ON THE NORTHEAST CORNER OF CLEOPATRA DRIVE AND SHERMAN DRIVE. THE RESIDENCE FACES TO THE SOUTH. THE HOUSE IS LOCATED 381411 NORTH OF THE NORTH CURBLINE OF SHERMAN DRIVE. 0-1 SUSTAINED TOTAL DAMAGE TO THE SOUTHWEST CORNER. ' A RAINGUTTER WAS LOCATED ON THE WEST LAWN ABOUT 201 WEST OF THE WEST WALL AND 381 NORTH OF THE NORTH CURBLINE OF CLEOPATRA DRIVE. HOUSE AND VEHICLE DEBRIS WAS FOUND IN AND AROUND THE POINT OF IMPACT #4. A MAILBOX AND WOODEN PLANTER IN FRONT OF 2057 SHERMAN DRIVE WERE FOUND IN SEVERAL PIECES TO THE NORTH OF 2057 SHERMAN DRIVE. REFER TO THE FACTUAL DIAGRAM. A MAILBOX AND WOODEN POST WERE ALSO STRUCK SEVERAL HOUSES SOUTH AT 2099 PLEASANT HILL POLICE DEPARTMENT. PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 5 NARRATIVE SHERMAN DRIVE. THE OWNER, FRIEDA PORTER, PHONED PHPD AFTER. SHE HAD STACKED THE BROKEN PIECES ON THE DRIVEWAY. PORTER TOLD ME THE PIECES WERE ON HER FRONT LAWN TO THE NORTH OF HER HOUSE. BURGUNDY PAINT TRANSFERS WERE FOUND ON THE WOODEN POST. STATEMENTS: ALL STATEMENTS WERE OBTAINED BY OTHER PHPD OFFICERS. REFER TO SUPPLEMENTAL REPORTS. PHYSICAL EVIDENCE: ALL RETAINABLE EVIDENCE WAS COLLECTED BY DETECTIVE CONNELLY #271. REFER -TO SUPPLEMENTAL REPORT. POINTS OF IMPACT: P.O.I. #1 - V-1 VS MAILBOX 2099 .SHERMAN DRIVE) WAS DETERMINED BY A SQUARE HOLE IN THE GROUND SURROUNDED BY RED BRICKS. P.O. I. #1 WAS LOCATED 891711 NORTH OF THE NORTH PROLONGATION OF. BELINDA DRIVE AND APPROXIMATELY 1211 EAST OF THE EAST CURBLINE OF SHERMAN DRIVE. P.O.I. #2 - (V-1 VS V-2) WAS ESTIMATED BY THE LOCATION OF V-2. P.O.I. #2 WAS LOCATED 2221911 SOUTH OF THE SOUTH PROLONGATION OF CLEOPATRA DRIVE. THE RIGHT SIDE TIRES WERE PARKED ON TOP OF THE SLOPING CURB. P.O.I. #3 (V-1 VS V-3) WAS ESTIMATED BY THE TIRE INDENTATION IN THE LAWN OF 2061 SHERMAN DRIVE. THE RIGHT REAR TIRE OF V-3 WAS LOCATED 1941511 SOUTH OF THE SOUTH PROLONGATION OF CLEOPATRA DRIVE. THE INSIDE OF THE RIGHT REAR TIRE AND RIGHT FRONT TIRE WERE RESTING ON THE .EDGE OF THE SLOPING CURBLINE, IN THE LAWN AREA OF 2061 SHERMAN DRIVE. P.O.I. #4 (V-1 VS MAILBOX AND PLANTER AT 2057 SHERMAN DRIVE) WAS ESTIMATED BY A SPLINTERED PIECE, OF SQUARE WOOD IN THE GROUND. THE WOODEN PLANTER WAS TO THE SOUTH OF THE MAILBOX BY INCHES. THE MAILBOX (P.O. I. #4) WAS LOCATED 1591911 SOUTH OF THE SOUTH PROLONGATION OF CLEOPATRA DRIVE. IT WAS ABOUT 1211 EAST OF THE EAST CURBLINE OF SHERMAN DRIVE. P.O.I. #5 (V-1 VS HOUSE AT 15 CLEOPATRA DRIVE) WAS ESTIMATED BY VEHICLE LOCATION AND DAMAGE TO THE RESIDENCE. P.O.I. #5 WAS LOCATED 381411 NORTH OF THE NORTH CURBLINE OF CLEOPATRA DRIVE AND 301711 EAST OF THE EAST CURBLINE OF SHERMAN DRIVE. OPINIONS: D-1 , PATRICIA TOMSIK, WAS NORTHBOUND ON SHERMAN DRIVE IN V-1 (FORD) . V-1 STRUCK THE CURB NORTH OF BELINDA DRIVE AND STRUCK A PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA 9 FULL REPORT PD Class: ACCF Disposition: A Case Number: C91=000051-c� BCS Class: Disposition: Page: 6 NARRATIVE _______________=_________=____=__ MAILBOX. D-1 CORRECTED, THEN STRUCK PARKED V-1 AND V-2. AND A SECOND MAILBOX AND PLANTER. V-1 CONTINUED ACROSS THE LAWNS OF 2057 SHERMAN DRIVE AND 16 CLEOPATRA DRIVE. V-1 CONTINUED ACROSS CLEOPATRA DRIVE ACROSS THE LAWN OF 15 CLEOPATRA DRIVE AND INTO THE SOUTHWEST CORNER OF THE RESIDENCE, STRIKING THE VICTIM, HOWELL, WHO WAS SLEEPING IN THE BEDROOM. RECOMMENDATIONS: REFER TO REPORT BY OFFICER LAUDERDALE #196 . FACTUAL DIAGRAM LEGEND: 1. RAIN GUTTER FROM 15 CLEOPATRA DRIVE 2. WOODEN MAILBOX COVER FROM 2057 SHERMAN DRIVE 3. MAILBOX FROM 2057 SHERMAN DRDIVE 4. WOODEN MAILBOX COVER FROM 2057 SHERMAN DRIVE 5. WOODEN MAILBOX COVER FROM 2057 SHERMAN DRIVE 6. WOODEN MAILBOX POST FROM 2057 SHERMAN DRDIVE 7. WOODEN FRAGMENTS FROM PLANTER AND MAILBOX POST FROM 2057 SHERMAN DRIVE 8. WOODEN MAILBOX POST FROM 2057 SHERMAN DRIVE 9. WOODEN MAILBOX 45 DEGREE ANGLE SUPPORT FROM 2057 SHERMAN DRIVE 10. INDENTATIONS OF THE TIRE TRACKS IN LAWN 11. WOODEN FRAGMENTS - PLANTER AND MAILBOX FROM 2057 SHERMAN DRIVE 12. SPOKED HUBCAP - BROKEN 13. PIECE OF BURGUNDY RUBBER TRIM FROM V-1 14. SILVERTONE MOLDING FROM V-1 15. GMC HUBCAP FROM V-3 16. SPOKED BROKEN HUBCAP. FROM V-1 WITH BLACK T-BIRD CENTER 17. BEAUTY RING FROM V-1 18.. GOUGE MARKS ON CEMENT AREA• WITH MANHOLE COVER 19. MAILBOX TO 2099 SHERMAN DRDIVE. GOUGE MARKS ARE 36 '2" NORTH OF BELINDA DRIVE ON THE EAST SIDE OF SHERMAN DRIVE. P.O. I. #1 IS 8917" NORTH OF THE NORTH CURB OF BELINDA DRIVE AND 12" EAST OF THE EAST CURBLINE OF SHERMAN DRIVE. P.O.I. #2 IS 22219" SOUTH OF THE SOUTH PROLONGATION OF CLEOPATRA DRIVE AND ABOUT 6 ' WEST OF THE EAST CURBLINE OF SHERMAN DRIVE. P.O. I. #3 IS 194 '5" SOUTH OF THE SOUTH PROLONGATION OF CLEOPATRA DRIVE • PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA i' FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-0 BCS Class: Disposition: Page: 7 NARRATIVE AND ABOUT 6 ' WEST OF THE EAST CURBLINE OF SHERMAN DRIVE. P.O.I. #4 IS 15919" SOUTH OF THE SOUTH PROLONGATION OF CLEOPATRA DRIVE. AND ABOUT 12" EAST OF THE EAST CURBLINE OF SHERMAN DRIVE. P.O.I. #5 IS LOCATED 3814" NORTH OF THE NORTH PROLONGATION OF CLEOPATRA DRIVE AN 3017" EAST OF THE EAST CURBLINE OF SHERMAN DRIVE. 1-8-91/246/136 RPT# DATE TIME OFC OFC NAME I/T R/T 01 01-05-91 1348 287 ROSENBERG, KRISTIN 180 30 Reviewed by Date: F/U assigned to: Due Date: STATE OF CALIFORNIA INJURED / WITNESSES / PASSENGERS PAGE /D DA"OF COLUSION__ / TIME(2400) NCIC NUMBE$7Q EOFFICER L``Jg� NUMBER ✓{ 1 UXTENT OF INJURY(( "X" ONE) INJURED WAS ( "X" ONE)WITNESS PASSENGER AGE SEX PARTY SEAT SAFETY ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINY NUMBER P.S. EQUIP. EJECTED INJURY. INJURY INJURY OF PAIN DRIVER PASS. PED. BICYCLIST OTHER ❑tt ❑ a9 r ❑ ❑ ❑ ❑ EIE] fQ -joJ ArejEr DRESS,616ty O A)a ��// /_� IS ZZ,60p j7-RA -DA PH, �s1L3 TELEPHONE ONJUED ONS')Tp StPORTED Y: //l/ j„ (9 19 TAKEN TO: /V`l/V A./1A .�M4U�A-SCE /�T 01A61-0V S'P1,7N. DESCRIBE INJURIES UA4 //t)7W 145S ❑ VICTIM OF VIOLENT CRIME NOTIFIED N HT/GI��RE55� yC 700SI/` )0-;2-30 , ?OV / .JI1V4m,41i lb!V �Y���' TELEPHONE���/ al PORTED BY: _ J TAKEN TO: ��LL DESCRIBE INJURIES M in1l OF A!A) ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME I D.O.B.I ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME I D.O.B.I ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME 10.0.8./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED NAME I D.O.Y.I ADDRESS TELEPHONE ONJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED PREPAR R'S CE I.D.NUM BF,R_ MO.' DAY IYEAR I REVIEWERS NAMEMO. DAY YEAi CHP 555-Page 3(Rev.7-87) OPI 042 - 3 87 43637 'FACTUAL DIAGRAM ;:... DATE OR COLLISION -- - - TIME (100 .CIC NU / R^� OI WIC�.ERR{�(I.0*7 NUMBER .. •`9 MO. ! DAV VR. V / . r ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED ISCALE. SNE�2�1AN DR d 38' r, APPKD?(I A INDICATE NORTH �5 acop-A kA v 38'q" C J-EoPATRA Dg. k C[EOPAU D a o O - a o ao� C�E. _ : .. .. ..." ]'1.0. -. ... erre I DRAWN BV �' NUMBlR MO, DAY YR, REVIEW ER•S NAME • " MO. F/DAV YR. .1. , .. . CHP 555—Page 4 (Rev 11-85)OPI 042 ,. IrAI,.1 UAL UlAlihfAIVI PACE 1 �- ;' • DATE OF COLLISION TIME (300) NCIC NUMBER OFFICER I.O. INUMBER '.•lp MO. DAY VR. .. ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE PD•I• 1�( , y )qPPRo 1 Ali INDICATE NORTH aot�► S yE,Q.lgR�J DR - 14• - PD,1. U 3 va OQ . _ .: Rai• _ _ - . - _ _ 1 . . VCR. n1 `.-... -. ...rm.•.,'n�,-.o-,e++e ,.I:�.a.;•;+.. ♦v..r...+.va.a,......n:.aK•..y.r.a.,.,.'I �c..n.c..�.,,..:,:�.W.-•a...n.daus.:...:<a,c>a._.w..Y...:._,.-J• 1..... ♦_ .n._._... ............. ,.....i.. DRAWN BY, �� I.D.N UM B" R MO. DAY YR, IREV 19WER'3 NAME Mo DAY ' Yq zosw BERG - CHP 555—Page 4 (Rev 11.85)OPI 042 rA(, I UAL UTAl HAIVi PAGE IJ DATE OF COLLIg1ONTIME (2400) MO. DAY rw. NCIC U.9"" MbER OFFICER I.O, NVNBEq ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE e �QPR01► ATE NDICATE NOR7N 1 8EWa AA DR 1 sNE1elna� DR . :.. . -..... •... ... .v;�,.r. .nrtw�«r..i,.vi�� Yne: .. �..:•w w w .� !.yL a DRAWN ■Y - I O.NUMblR MO, CA' YR, 0lV1EW9R S NAM! M Y r'R CHP 555—Page 4 (Rev II.85)OPI 042 PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-1 BCS Class: Disposition: Page: 1 CASE REPORT Section - 1 : VC23153 2: PC1915 3: PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: SMITHEY, MICHAEL (154 ) SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS. MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. ------------------------------- NARRATIVE -------------------------------- SUPPLEMENTAL REPORT: INVESTIGATION: THURSDAY 1-3-91 AT 1031 HOURS I RESPONDED ALONG WITH OFFICER WILDES, TO A REPORT OF A VEHICLE INTO A HOUSE AT SHERMAN DRIVE AND CLEOPATRA DRIVE. UPON OUR ARRIVAL ON SCENE I SAW THE REAR END OF A RED FORD THUNDERBIRD STICKING OUT OF THE SOUTHWEST CORNER OF THE RESIDENCE AT 15 CLEOPATRA DRIVE. THE REMAINDER OF THE VEHICLE WAS INSIDE THE RESIDENCE. AT THIS TIME I REQUESTED THAT CONSOLIDATED FIRE AND PARAMEDICS RESPOND. PG&E WAS ALSO REQUESTED DUE TO THE VEHICLE HAVING SEVERED THE GAS METER. NUMEROUS CITIZENS WERE AROUND THE HOUSE AND I SAW ONE WF EXITING THE HOME CARRYING A BABY. I WAS TOLD BY SEVERAL SUBJECTS THAT A WOMAN WAS TRAPPED INSIDE THE BEDROOM THAT THE VEHICLE HAD ENTERED. I WENT THRU THE HOUSE AND ENTERED THE BEDROOM. AT THIS POINT AN ELDERLY WF .WAS SEEN INSIDE THE VEHICLE. THE WF, LATER IDENTIFIED AS PATRICIA TOMSIK, WAS ASSISTED OUT OF THE VEHICLE AND -THEN OUTSIDE. THE CITIZENS WHO HAD GATHERED THEN SAID THAT THE RESIDENT OF 15 CLEOPATRA DRIVE WAS IN THE BEDROOM AT THE TIME OF THE ACCIDENT. MYSELF AND OTHER OFFICERS STARTED CLEARING THE DEBRIS IN THE TWO BEDROOMS ON THE WEST SIDE OF THE RESIDENCE IN AN ATTEMPT TO LOCATE THE VICTIM. CONSOLIDATED FIRE ARRIVED ON THE SCENE AND I ADVISED THEM OF THE SITUATION INVOLVING THE VICTIM. CONSOLIDATED FIRE, USING ENGINE 5 AND CHAINS, WERE ABLE TO PULL THE VEHICLE PARTIALLY OUT OF THE BEDROOM. PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-C BCS Class: Disposition: Page: 2 NARRATIVE CONSOLIDATED FIRE WAS ABLE TO LOCATE THE VICTIM AND BEGAN THEIR EXTRACATION PROCEDURES. THEY WERE THEN JOINED BY PARAMEDICS FROM REGIONAL AMBULANCE. ONCE THE VICTIM WAS REMOVED FROM THE HOUSE SHE WAS TRANSPORTED TO MT. DIABLO HOSPITAL. VICTIM WAS PRONOUNCED DEAD AT 1139 HOURS. I THEN RESPONDED TO KAISER HOSPITAL IN MARTINEZ AND CONTACTED OFFICER LAUDERDALE. D-1 TOMSIK HAD BEEN TRANSPORTED TO THIS HOSPITAL FOR TREATMENT. I MET WITH D-1 TOMSIK AND HER HUSBAND RICHARD TOMSIK. I EXPLAINED TO THEM THAT WE WANTED THE MEDICATIONS THAT PATRICIA HAD AT THEIR HOME. I OBTAINED A CONSENT TO SEARCH FROM MR. AND MRS. TOMSIK. MR. TOMSIK THEN MET MYSELF AND DET. CONNELLY AT HIS RESIDENCE. DET. CONNELLY SEIZED SEVERAL MEDICATIONS FROM THE RESIDENCE. I THEN RECONTACTED MRS. TOMSIK AT KAISER HOSPITAL. I ASKED HER IF SHE WOULD BE WILLING TO SIGN AN AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS_ ALLOWING US TO GET HER RECORDS FROM KAISER HOSPITAL.. MRS. TOMSIK SAID THAT SHE DIDN'T HAVE HER. GLASSES WITH HER AND COULD NOT CLEARLY SEE THE FORM. I READ- THE FORM TO HER VERBATIM, TWICE. TOMSIK THEN SAID SHE WOULD SIGN THE FORM. THE FORM WAS LATER GIVEN TO DET. CONNELLY. I GAVE MR. TOMSIK A COPY OF THE RELEASE FROM CUSTODY (849PC) FORM. I TOLD MRS. TOMSIK THAT THE RELEASE HAD BEEN GIVEN TO HER HUSBAND AND ,SHE WAS NO LONGER IN CUSTODY. FOR ADDITIONAL INFORMATION REFER TO REPORTS BY OTHER INVOLVED OFFICERS. 1-9-91/246/15$ RPT# DATE TIME QFC OFC NAME I/T R/T -02 01-04-91 0000 154 SMITHEY, MICHAEL 300 60 Reviewed by: Date: F/U assigned to: Due Date: Oda— Huambo ne�wr Hui City of Pleasant Hill 1111011111!1111111i X agam James R. Nunes Chief of Police • POLICE DEPARTMENT • _ �;.Q-N-Uz 1'�0 JaI VI KCii PLACE: ,.[B !_e!_� ��✓ /nMSI , llavin,g been i.!it..�r!r, �tl of ll:V (Print name) ,,onsti�:utional Rights rnot. to have a search mad,' of diose Y rem i :;es wi.thour. a search warra r- , ar.d of my ric tt: r.o. refuse— co!i;;ent .for a search, hereby au,+,:ilorize thc-,e to conduct tz complete search these i.rtc:tiv i.zig all structures and rooms adjoining or. used In cca!;nectiorj wi :.h said premises , whish are :Located in Ca: i 'ornia rpt or vehicle which is described as , WId 7 authorize these officers to take ::ront said preinises any 01ings , letters , papers, materials or ottier property o:liich they may desire for their official use. T give this permission to the above named officers vol:aW1--ar.i.ly and without threats , coercion or premises of ,any kizid. t signature ) WITT3 --- 330 Civic Drive 0 Pleasant Hill, California 94523 9 (415)671.4600 PLEASANT HILL POLICE DEPARTMENT Pleasant Hill, California Case No. + s CERTIFICATE OF RELEASE As required by the provisions of Penal Code section 851.6 (as amended bynStats. 1975, ch. 1117), I hereby certify that the taking into custody of "Tb W%S 1 Y` on (subject's name) (date) by the Pleasant Hill Police Department was a detention only, not an arrest. was released on 1- 3- q 1 (subject's name) (date) by the Pleasant Hill Police Department pursuant to the provisions of: 1. Paragraph (1) of subdivision (b) of Penal Code section 849 I1. Paragraph (3) of subdivision (b) of Penal Code section 849 Ill. Penal Code section 849.5. Penal Code section 849 provides in part: (a) When an arrest is made without a warrant by a peace officer or private person, the person arrested, if not otherwise released, shall, without unnecessary delay, be taken before the nearest or most accessible magistrate in the county in . which the offense is triable, and a complaint stating the charge against the arrested person shall be laid before such magistrate. (b) Any peace officer may release from custody, instead of taking such person before a magistrate, any person arrested without a warrant whenever: (1) He is satisfied that there are insufficient grounds fora a criminal complaint against the person arrested. (2) The person arrested was arrested for intoxication only, and no further proceedings are desirable. (3) The person was arrested only for being under the influence of a narcotic, drug, or restricted dangerous drug and such person is delivered to a facility or hospital for treatment and no further proceedings are desirable. (c) Any record of arrest of a person released pursuant to paragraphs (1) :and (3) of subdivision (b) shall include a record of release. Thereafter, such arrest shall not be deemed an arrest, but a detention only. Penal Code section 849.5 provides: In any case in which a person is arrested and released and no accusatory pleading is filed charging him with an offense, any record of`arrest of:1the person shall include a record of release. Thereafter. the arrest shall not be deemed an arrest but a detention only, Signed—P i Title ;R Releasing Officer PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051- BCS Class: Disposition: Page: 1 CASE REPORT Section - 1: VC23153 2: PC1915 3: PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: SPENCER, SHAWN {281 ) SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. NARRATIVE SUPPLEMENTAL REPORT: INVESTIGATION: ON 1-3-91 AT ABOUT 1030 HOURS I WAS SENT TO 15 CLEOPATRA DRIVE REGARDING A REPORT OF A VEHICLE INTO A HOUSE. DISPATCH ADVISED THAT THE VEHICLE WAS LEAKING GAS INSIDE OF THE RESIDENCE. UPON ARRIVING AT THE SCENE I SAW THAT A CAR HAD DRIVEN ALMOST COMPLETLY THROUGH THE SOUTH WALL OF THE RESIDENCE. THE GAS METER TO THE RESIDENCE WAS BROKEN AND I COULD SMELL A STRONG ODOR OF NATURAL GAS IN THE AIR. I WENT INSIDE THE RESIDENCE WHERE I FOUND THE DRIVER AND SOLE OCCUPANT SITTING IN THE DRIVERS SEAT OF THE CAR. THE DRIVER, LATER IDENTIFIED AS PATRICIA TOMSIK, APPEARED TO BE VERY CONFUSED AND SHE ACTED IS IF SHE DID NOT KNOW WHERE SHE WAS. TOMSIK KEPT ASKING ME FOR HER PURSE. DUE TO THE GAS LEAK I TOLD TOMSIK TO GET OUT OF THE CAR AS THERE WAS A LARGE AMOUNT OF GAS FUMES INSIDE OF THE ROOM. WITH THE HELP OF A CITIZEN, I ' WAS. ABLE TO REMOVE TOMSIK FROM HER VEHICLE. TOMSIK WALKED OUT OF THE HOUSE ON HER OWN WITHOUT ANY ASSISTANCE. AFTER I GOT TOMSIK_ OUT OF HER CAR I WAS TOLD THAT THE RESIDENT TERRI HOWELL HAD BEEN SLEEPING IN THE ROOM PRIOR TO THE ACCIDENT. THE VEHICLE HAD TRAVELED COMPLETELY THROUGH THE MASTER BEDROOM AND PARTIALLY INTO THE NEXT BEDROOM. I COULD SEE THAT THE VEHICLE WAS ON TOP OF A MATTRESS, HOWEVER DUE TO THE LARGE AMOUNT OF DEBRIS AT THE SCENE I WAS AT FIRST UNABLE TO LOCATE THE VICTIM. I CLIMBED ONTO THE HOOD OF THE VEHICLE AND STARTED MOVING SEVERAL PIECES OF WOOD, ETC. AT THIS POINT I COULD HEAR HOWELL MOANING AND GASPING FOR AIR. I LOOKED DOWN ALONG THE FRONT RIGHT FENDER OF THE CAR AND SAW HOWELL'S LEGS. THE REST OF HER BODY WS STILL COVERED WITH DEBRIS FROM THE ACCIDENT. PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA y.,. FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 2 ------------ _-__-_- -__-_-_-_-_- NARRATIVE --------------------------------- CONTRA COSTA FIRE HAD ARRIVED AT THE SCENE AND HOWELL WAS LATER FREED. IN ORDER TO .FREE HOWELL IT WAS NECESSARY TO USE THE FIRE ENGINE TO PULL TOMSIK'S VEHICLE OUT OF THE HOUSE. REFER TO ORIGINAL REPORT FOR FURTHER INFORMATION. 1-9-91/246/158 RPT# DATE TIME OFC OFC NAME I/T R/T 03 01-04-91 0930 281 SPENCER, SHAWN Reviewed by Date: 1 71-1 F/U assigned to: Due Date: PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-o BCS Class: Disposition: Page: 1 CASE REPORT Section -- 1: VC23153 2: PC1915 3 : _PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: WILDES , DONALD (317 ) SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. NARRATIVE SUPPLEMENTAL REPORT: INVESTIGATION: ON 1-3-91 APPROXIMATELY 1031 HOURS CPL. M. SMITHEY, #15.4 AND I WERE DISPATCHED TO A POSSIBLE INJURY ACCIDENT, VEHICLE INTO A HOUSE AT CLEOPATRA DRIVE AND SHERMAN DRIVE. WE ARRIVED APPROXIMATELY 1035 HOURS. THERE WAS A RED THUNDERBIRD THAT HAD CRASHED INTO THE LEFT FRONT CORNER OF THE HOUSE AT 15 CLEOPATRA. AS I WAS RUNNING UP TO THE FRONT OF THE HOUSE A WHITE FEMALE RAN UP TO ME AND SAID THERE WAS A PERSON TRAPPED IN THE HOUSE. CPL. SMITHEY AND I ENTERED THE HOUSE TO CHECK ON VICTIMS.. CPL. SMITHEY AND I REMOVED THE DRIVER FROM THE CAR AND I TOOK HER OUTSIDE. THE DRIVER HAD BLOOD ON HER NOSE AND MOUTH AND SAID SHE WAS ALRIGHT. SHE TOLD ME SHE WAS DRIVING HOME FROM THE STORE WHEN HER CAR STARED "ACTING FUNNY, SWERVING BACK AND FORTH, " THEN SHE SAID "EVERYTHING JUST WENT BLANK. " THE WHITE FEMALE THAT RAN UP TO ME UPON MY ARRIVAL, AGAIN RAN UP TO ME AND TOLD ME THAT THE PERSON I HAD WAS NOT THE PERSON SHE WS REFERRING TO WHEN SHE SAID SOMEONE WAS TRAPPED. SHE SAID THE PERSON SHE WAS REFERRING TO WAS IN THE BED IN THE FRONT BEDROOM AND WAS TRAPPED UNDER THE CAR. I RAN BACK INTO THE HOUSE AND TOLD CPL. SMITHEY OF THE INFORMATION AND BEGAN PULLING DEBRIS AWAY. WHEN CONSOLIDATED FIRE ARRIVED I WENT OUTSIDE AND WENT TO THE DRIVER. I TOLD TRAFFIC OFFICER LAUDERDALE WHO THE DRIVER WAS AND BEGAN TO LOOK FOR POSSIBLE WITNESSES. JUST AS I STARTED TO LOOK FOR WITNESSES , THE FIRE DEPARTMENT AND AMBULANCE CREW CAME OUT OF THE HOUSE WITH THE VICTIM ON A STRETCHER, PLEASANT HILL POLICE. DEPARTMENT PLEASANT HILL CALIFORNIA' _.FULL _REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-c BCS Class: Disposition: Page: 2 NARRATIVE APPROXIMATELY 1052 HOURS. CPL. SMITHEY AND I FOLLOWED THE AMBULANCE TO MT. DIABLO HOSPITAL AND ARRIVED APPROXIMATELY 1102 HOURS. I STAYED WITH THE VICTIM IN THE EMERGENCY ROOM. DR. CHARLES HANSEN PRONOUNCED THE VICTIM DEAD AT 1139 HOURS. THE CONTRA COSTA COUNTY CORONER OFFICE WAS CALLED BY THE HOSPITAL STAFF. 1-9-91/246/158 RPT# DATE TIME OFC OFC NAME I/T R/T . -04 01-03-91 1031 317 WILDES, DONALD 270 .40 Reviewed by. -,:: Date: F/U assigned to: Due Date: PLEASANT .HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051 BCS Class: Disposition: Page: 1 CASE REPORT Section -* l : VC23153 2: PC1915 3: PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: HASKELL, KIRK (249 } SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. ------------------------------- NARRATIVE SUPPLEMENTAL REPORT: INVESTIGATION: ON THURSDAY, 1-3-91 APPROXIMATELY 1330 HOURS, SGT. EZELL ASKED IF I WOULD ATTEND AN AUTOPSY AT THE COUNTY CORONERS OFFICE. ON ARRIVAL I WITNESSES AN AUTOPSY ON TERRI HOWELL. IN ADDITION I TOOK A_ TOTAL OF 25 PHOTOGRAPHS OF HOWELL. LATER THESE PHOTOGRAPHS WERE DEVELOPED AND BOOKED INTO PHPD EVIDENCE. 1-9-91/246/169 EVIDENCE ID:C91000051-05-001 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc: 25PHOTOGRAPHS 25 PHOTOGRAPHS TAKEN BY CORONERS OFFICE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-05-91 05 EVIDENCE EVIDEN 249 246 RPT# DATE TIME OFC OFC NAME I/T R/T 05 01-05-91 1800 249 HASKELL, KIRK 180 5 Reviewed by: Date: F/U assigned to: Due Date: PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT . PD Class: ACCF Disposition: A Case Number: C91-000051-� BCS Class: Disposition: Page: 1 CASE REPORT --_ Section - 1: VC23153 2: PC1915 3: PC849B 4: Level Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: CONNELLY, DAN (271 ? SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. NARRATIVE SUPPLEMENTAL REPORT: INVESTIGATION: ON THURSDAY, 1-3-91 AT ABOUT 1031 HOURS, THE PLEASANT HILL POLICE DEPARTMENT RECEIVED A CALL OF A TRAFFIC COLLISION INVOLVING A VEHICLE THAT HAD COLLIDED WITH A HOME AT 15 CLEOPATRA DRIVE. IT WAS DETERMINED THAT THE RESIDENT OF THE HOUSE WAS IN BED AT THE TIME AND SUFFERED MAJOR INJURIES AS A RESULT OF THE COLLISION. THE RESIDENT LATER DIED AS A RESULT OF THESE INJURIES. THE RESIDENT OF THE HOME WAS DETERMINED TO BE TERRI HOWELL AND THE DRIVER OF THE VEHICLE WAS PATRICIA TOMSIK. AT ABOUT 1057 HOURS I WAS REQUESTED TO RESPOND .TO THE SCENE ALONG WITH DET. SGT. HORGAN, TO ASSIST IN THE INVESTIGATION. WE ARRIVED AT THE SCENE AT ABOUT 1105 HOURS WHERE WE CONFERRED WITH THE SCENE COMMANDER, SGT. EZELL. SGT. EZELL REQUESTED THAT I PHOTOGRAPH HIM AND COLLECT EVIDENCE. I FIRST PHOTOGRAPHED THE PATH WHERE THE VEHICLE TRAVELED NORTHBOUND ON SHERMAN DRIVE, PRIOR TO COLLIDING WITH THE HOUSE AT 15 CLEOPATRA DRIVE I THEN PHOTOGRAPHED THE' INTERIOR• AND EXTERIOR OF THE HOUSE. , ALONG WITH OFFICER ROSENBERG, I COLLECTED THE FOLLOWING EVIDENCE: A PIECE OF THE MAILBOX POST AND PAINT TRANSFERS FROM THE MAILBOX AT 2099 SHERMAN DRIVE. A WHEEL CAP FROM THE FORD THUNDERBIRD THAT WAS FOUND UNDER THE REAR BUMPER OF THE GREEN AND WHITE VAN IN FRONT OF 2061 SHERMAN DRIVE. I ALSO COLLECTED SEVERAL PIECES OF CLEAR BROKEN GLASS FROM THE AREA AROUND THE VAN. I ALSO COLLECTED PAINT TRANSFERS FROM THE VAN AS WELL AS A PIECE OF BURGUNDY FIBERGLASS THAT WAS FOUND IN THE STREET ADJACENT TO THE VAN. FROM THE FRONT OF V-3 (PICKUP) I COLLECTED A PIECE OF RUBBER SIDE PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA • FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 2 NARRATIVE MOLDING AND A PIECE OF THE HUB CAP FROM THE THUNDERBIRD. FROM THE FRONT YARD OF 15 CLEOPATRA DRIVE NEAR THE POINT OF IMPACT, I COLLECTED THE FRONT HEADLAMP HOUSING OF THE THUNDERBIRD. ON THE WEST SIDE YARD OF THE HOME I COLLECTED THE HEAD LIGHT RIM FROM THE THUNDERBIRD. FOR FURTHER INFORMATION REFER TO THE ATTACHED PLEASANT HILL POLICE DEPARTMENT SCENE EVIDENCE INVENTORY AND THE COLLISION REPORT BY OFFICER ROSENBERG. WHEN I FINISHED COLLECTING THE EVIDENCE, SGT. EZELL ADVISED ME THAT CPL. SMITHEY HAD OBTAINED A CONSENT TO SEARCH FOR THE RESIDENCE OF MR. AND TOMSIK. SGT. EZELL REQUESTED THAT I CONDUCT THE SEARCH OF THE TOMSIKS HOME WITH CPL. SMITHEY. WHEN CPL. SMITHEY ARRIVED AT THE TOMSIKS, 2089 SHERMAN DRIVE, WITH MR. TOMSIK WE CONDUCTED THE SEARCH. IN THE TOMSIKS BEDROOM -I LOCATED EIGHT (8) BOTTLES OF MISCELLANEOUS MEDICINE, BOTH PRESCRIPTION AND NON-PRESCRIPTION, ON THE NIGHT STAND NEXT TO THE BED. IN THE TOP DRAWER OF THE NIGHT STAND, I LOCATED THREE MORE BOTTLES OF MEDICINE. IN THE HEADBOARD CABINET I LOCATED A BOX OF DEXATRIM. ALL THESE WERE COLLECTED AS EVIDENCE AND LATER BOOKED INTO PHPD EVIDENCE ALONG WITH ALL THE OTHER ITEMS OF EVIDENCE MENTIONED IN THIS REPORT. ALSO, THE FILM THAT WAS ,USED TO PHOTOGRAPH THE SCENE WAS DEVELOPED AND I BOOKED INTO PHPD EVIDENCE. CPL. SMITHEY ALSO RECEIVED A CONSENT TO RELEASE MEDICAL RECORDS FORM FROM PATRICIA TOMSIK. ON 1-4-91 1 DELIVERED THE CONSENT TO RELEASE MEDICAL TO THE KAISER HOSPITAL IN MARTINEZ. LATER THIS SAME AFTERNOON I WENT BACK TO THE HOSPITAL AND RECEIVED THE RECORDS FOR PATRICIA TOMSIK FOR THE PAST TWO YEARS, THESE ITEMS WERE ALSO BOOKED INTO PHPD EVIDENCE. ATTACH A COPY OF THIS REPORT TO ALL COPIES OF THE ORIGINAL REPORT BY OFFICER ROSENBERG. 1-9-91/246/158 v PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-C BCS Class: Disposition: Page: 3 EVIDENCE ID:C91000051-06-001 Owner:HILL , DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:PAINTCHIPS PAINT CHIPS FROM MAILBOX AT 2099 SHERMAN DR AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- - ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 ID:C91000051-06-002 Owner:HILL, DANIEL LEE .Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:WOODCHIP WOOD CHIP FROM. MAILBOX AT 2099 SHERMAN DR AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --=------ -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-003 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:WHEELCAPFORD .. . WHEEL CAP FROM FORD T-BIRD IFO 2061 SHERMAN DR AC# Date Rept# Activity -AG Storage Disp OF1 OF2 Comments 01 01-04-91 0.6 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-004 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color Quan: Serial number: . Value: $ Desc:BROKENGLASS BROKEN GLASS IFO 2061 SHERMAN DR AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 4 EVIDENCE ID:C910000,51-06-005 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:PAINTCHIPS PAINT CHIP TRANSFERS FROM V--2 AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ------ --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-006 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:FIBERGLASSCHIP FIBERGLASS CHIP NEAR V-2 AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-007 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: . Serial number: Value: $ Desc:PIECEHUBCAP PIECE OF HUBCAP FROM IFO V-3 AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --= ---- ----- --------- -- ------- ---- --- --- ---------------- 01 O1-04-91 06 EVIDENCE EVIDEN 271 246 ID:C91000051-06-008 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:SIDEMOLDING FORD SIDE MOLDING FOUND IFO V-3 AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- ---------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 ., PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA "> FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-c BCS Class: Disposition: Page: 5 EVIDENCE ID:C9100005.1-06-009 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:HEADLAMPHOUSING FORD HEADLIGHT HOUSING FOUND AT P.O. I. AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-.04-91 06 -EVIDENCE EVIDEN 271 246 ID:C91000051-06-010 Owner:HILL, DANIEL LEE Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:HEADLAMPRIM FORD HEADLIGHT RIM FOUND ON WEST SIDE YARD OF 15 CLEOPATRA DR AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 . 06 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-011 Owner:TOMSIK, PATRICIA HAZEL .. Category: . Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:NYQUILMEDICINE NYQUIL MEDICINE 10 FL OZ BOTTLE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 • " PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA "' FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 6 EVIDENCE ID:C:'1000051-06-012 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:TYLENOL500MG TYLENOL 500 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments 01 01-04-91 06 EVIDENCE EVIDEN 271 246 ZD:C91000051-06-013 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:ASPIRIN325MC ASPIRIN 325 MC AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 ID:C91000051-06--014 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan Serial number: Value: $ . Desc:CENTRUMVITAMINS CENTRUM VITAMINS AC# Date Rept# Activity .AG Storage Disp OF1 OF2 Comments 01 01-04-91 06 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-015 Owner:TOMSIK, PATRICIA HAZEL Category Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:DIPYRIDAMOLE DIPYRIDAMOLE 75 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments O1- 01-04-91 06 EVIDENCE EVIDEN 271 . 246 „ PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD . Class: ACCF Disposition: A Case Number: C91-000051- BCS Class: Disposition: Page: 7 EVIDENCE ID:C91000051_ -06-016 Owner:TOMSIK, PATRICIA HAZEL Category: . Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:TRIAMTERENE/HCTZ TRIAMTERENE/HCTZ 75/50 MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ----- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 ID:C91000051-06-017 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:VASOTEC5MG VASOTEC 5 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments - - --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-018 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan:. Serial number: Value: $ Desc:TAGAMET400MG TAGAMET 400 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments 01 - -01-04-91 06 EVIDENCE EVIDEN 271 w - 246 ---------- ID:C91000051-06-019 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:TAGAMET800MG TAGAMET 800 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments 02 01-04-91 06 EVIDENCE EVIDEN 271 --- --246 H - T - v PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-0 BCS Class: Disposition: Page: 8 EVIDENCE ID:C91000051-06-020 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:VERAPAMIL240MG VERAPAMIL 240 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 ID:C91000051-06-021 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:CHLORIAZEPDXIDE10MG CHLORIAZEPDXIDE 10 MG MEDICNE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 . 246 ID:C91000051-06-022 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:ASPIRIN325MG ASPIRIN 325 MG MEDICINE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments 01 01-04-91 06EVIDENCE EVIDEN 271 2.46 ID:C91000051-06-023 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:DEXATRIMDEXATRIM EXTRA STRENGTH AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments ---- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 246 r J r r • p PLEASANT HILL POLICE DEPARTMENT w PLEASANT HILL CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-C BCS Class: Disposition: Page: 9 EVIDENCE ID:C91000051-06-024 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc: 3ROLLSFILM 3 ROLLS OF FILM TO BE DEVELOPED AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- --- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE EVIDEN 271 2.46 ID:C.91000051-06-025 Owner:TOMSIK, PATRICIA HAZEL Category: . Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:KAISERDOCUMENT PAST MEDICAL RECORDS OF TOMSIK - KAISER DOCUMENTS AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 06 EVIDENCE 'EVIDEN 271 246 . RPT# DATE TIME OFC OFC NAME I/T R/T 06 01-04-91 0000 271 CONNELLY, DAN Reviewed by Date: F/U assigned to: Due Date; V 1 OF 2 PLEASANT HILL POLICE DEPARTMENT SCENE EVIDENCE INVENTORY CASE# 91-51 DATE: January 3, 1991 TIME: 10:31 HRS LOCATION: 15 Cleopatra Dr. PROPERTY COLLECTED ITEM # DESCRIPTION OF PROPERTY AND LOCATION FOUND OWNER BY INT 1 PAINT CHIPS FROM MAILBOX AT 2099 SHERMAN DR RESIDENT CONNELLY V 2 PIECE OF MAILBOX POST, FROM IFO 2099 SHERMAN DR - -. -- 3 FORD T-BIRB WHEEL CAP, IFO 2061 SHERMAN DR 4 . CLEAR GLASS, IFO 2061 SHERMAN DR , BEHIND V-2 " " �✓ 5 — - PAINT CHIPS -FROM PARKED -VAN,--IFO .-2061".SHERMAN 6 BURGUNDY FIBERGLASS NEAR V-2, IFO 2061 SHERMAN DR - '=-- --- - " - 7 HUBCAP PIECE FROM IFO V-3,- IFO 2061 SHERMAN DR "`----- - --" --=- 8 RUBBER SIDE MOLDING, FROM IFO V-3, IFO 2061 SHERMAN 9 HEADLAMP HOUSING FROM IFO 15 CLEOPATRA DR, (P.O.I.) 10 -- - - HEADLIGHT RIM, SIDE -YARD OF 15 CL-EOPATRA--DR.--------------- =--_"--=_-=- " ----- FROM SUSPECTS HOME 11 NYQUIL, 10 FL. OZ. TOP OF NIGHT STAND TOMSIK CONNELLY 12 TYLENOL, 500 MG 13 ASPRIN, 325 MG 14 CENTRUM VITAMINS " " " " " '► �' 15 DIPYRIDAMOLE 75 MG " " " " " '► ti' 16 TRIAMTERENE/HCTZ 75/50 " " " 1 17 VASOTEC, 5MG " " tv 18 TAGAMET, 400 MG 19 " 800 MG TOP DRAWER OF NIGHT STAND 20 VERAPAMIL 240 MG it " if 21 CHLORIAZEPDXIDE 10MG " " " " " R. TOMSIK " ` • 2OF2 PLEASANT HILL POLICE DEPARTMENT SCENE EVIDENCE INVENTORY CASE# 91-51 DATE: JANUARY 3, 1991 TIME: 10:31 HRS LOCATION: 15 CLEOPATRA DR PROPERTY COLLECTED ITEM # DESCRIPTION OF PROPERTY AND LOCATION FOUND OWNER BY INT 22 ASPRIN FOR ARTHRITIS, 325 MG TOP DRAWER OF NIGHTSTD TOMSIK CONNELLY 23 DEXATRIM EXTRA STRENGTH HEADBOARD CABINET I PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-t BCS Class: Disposition: Page: 1 CASE REPORT Section - 1: VC23153 2: PC1915 3: PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: LAUDERDALE, ROBERT (196 ) SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. NAME(S) _____------------------ ------- ***** WITNESS #...1 Name: BEEBE, ROSANNE Suffix: Race: W Sex: . F DOB: 02-07-4$ Address: 2.491 SAN RAMON BL #13.45 , SAN RAMON, CA Phone 1: (415 ) 372-2441 Phone 2:. (415 )833-1960 AKA: DDL #: Height: Weight: Hair Color: Eyes: . Arrest #; Charges: ' NTA #: Comments: 246 ***** WITNESS # 2 Name: WILLIAMS, KELLY Suffix: Race: W Sex: F DOB: Address: 2921 NORTH MAIN ST, WALNUT CREEK, CA Phone 1:: (415)932-9036 Phone 2: (415 ), - AKA: DDL #: . .Height: Weight: Hair Color: . Eyes: Arrest #: Charges: . NTA #: Comments: 246 **** ARRESTED # 1 Name: TOMSIK, PATRICIA HAZEL Suffix: Race: W Sex: F DOB: 10-27-30 Address: 2089 SHERMAN DR, PLEASANT HILL, CA 94523 Phone 1: (415 ) 825-1336 Phone 2: (415 ) - AKA: DDL #: 50855153. , Height: 504 Weight: 200 : Hair Color: BRO Eyes: HAr Arrest #: A34690 Charges: VC23153 PC191. 5 PC849B NTA #: Comments:246 PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91--000051-E BCS Class: Disposition: Page: 2 NARRATIVE SUPPLEMENTAL REPORT: INVESTIGATION: ON THURSDAY 1-3-91 AT APPROXIMATELY 1031. HOURS I WAS DISPATCHED TO THE INTERSECTION OF CLEOPATRA DRIVE AND SHERMAN DRIVE ON A REPORT OF A VEHICLE INTO A HOUSE. I WAS RESPONDING FROM THE POLICE DEPARTMENT. CPL. SMITHEY, OFFICER WILDES AND OFFICER SPENCER WERE THE FIRST POLICE UNITS TO ARRIVE ON THE SCENE. WHILE ENROUTE CPL. SMITHEY ADVISED DISPATCH TO HAVE CONSOLIDATED FIRE AND-AN AMBULANCE TO RESPOND BECAUSE THERE WAS A WOMAN UNDER THE VEHICLE. ON ARRIVAL AT THE SCENE THE VICTIM RESIDENCE WAS ON THE NORTHEAST CORNER OF THE INTERSECTION OF CLEOPATRA DRIVE AND SHERMAN DRIVE. A RED FORD THUNDERBIRD HAD DRIVEN THROUGH THE SOUTH WALL OF THE WEST BEDROOM UP TO AND INCLUDING THE REAR WHEELS. AS I EXITED MY VEHICLE I WAS ADVISED BY OFFICER WILDES THAT THE DRIVER HAD ALREADY BEEN REMOVED FROM THE VEHICLE AND WAS SITTING IN A PATROL UNIT NEAR BY. OFFICER WILDES ALSO SAID THE DRIVERS PURSE WAS ON THE COUCH IN THE LIVING ROOM OF THE VICTIM'S RESIDENCE. I ASSISTED WITH THE REMOVAL OF DEBRIS FROM A BACK BEDROOM IN ORDER TO FREE THE VICTIM FROM BENEATH THE VEHICLE ALONG WITH SMITHEY. AND WILDES. CONSOLIDATED FIRE TOWED VEHICLE 1 PARTIALLY OUT OF THE BEDROOM AND THE VICTIM WAS REMOVED AND TRANSPORTED .TO MT. DIABLO HOSPITAL FOR TREATMENT. REFER TO CPL. SMITHEY'S AND OFFICER WILDE'S REPORT. I PICKED UP D-11S PURSE AND CONTACTED HER ON THE FRONT LAWN OF THE VICTIMS RESIDENCE. I HANDED HER PURSE TO HER AND ASKED TO SEE HER: DRIVERS LICENSE WHICH SHE PRODUCED FROM A SMALL POCKET BOOK INSIDE HER PURSE. THE LICENSE IDENTIFIED HER AS PATRICIA TOMSIK OF 2089 SHERMAN DRIVE. D-1 ' HAD A SMALL AMOUNT OF BLOOD AROUND THE MOUTH AND SWELLING TO THE UPPER RIGHT HALF OF HER LIP. I ASKED D-1 TO TELL ME WHAT HAD HAPPENED. SHE SAID SHE DIDN'T KNOW AND COULDN'T REMEMBER ANYTHING. THE LAST THING SHE REMEMBERED WAS DRIVING PAST HER HOUSE WHICH IS LOCATED MID BLOCK ON SHERMAN DRIVE SOUTH OF THE VICTIM RESIDENCE BETWEEN BELINDA DRIVE AND CLEOPATRA DRIVE. D-1 'S SPEECH WAS CLEAR AND I COULD NOT DETECT AN ODOR OF AN ALCOHOLIC BEVERAGE. I ASKED IF SHE HAD BEEN DRINKING AND SHE ANSWERED "NO". I ASKED HER' IF SHE WAS UNDER THE CARE OF A DOCTOR OR TAKING PRESCRIBED PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA. FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-0' BCS Class: Disposition: Page: 3 NARRATIVE MEDICATION. SHE SAID DR. BERRY OF KAISER, MARTINEZ WAS CURRENTLY TREATING HER FOR A CONDITION WHICH SHE DESCRIBED AS BLOOD SOMETIMES GOES TO HER HEAD AND SHE IS TEMPORARILY UNABLE TO TALK. SHE SAID SHE TAKES SIX OR SEVEN DIFFERENT MEDICINES HOWEVER SHE COULD NOT TELL ME THE NAMES OF THE MEDICATION OR WHAT EACH ONE DOES SPECIFICALLY. I ASKED D-1 IF SHE HAD TAKEN ANY MEDICATION TODAY AND SHE SAID SHE HAD TAKEN A PILL WHICH SPEEDS UP HER BLOOD. D-1 WAS CONTACTED BY REGIONAL AMBULANCE "PERSON KELLY WILLIAMS WHO ASKED D-1 IF SHE WOULD LIKE TO GO TO THE HOSPITAL AND ASKED, "WHAT ABOUT MY BAG, IT'S STILL IN THE CAR?" D-1 AT FIRST DECLINED MEDICAL ASSISTANCE BUT WAS PERSUADED TO GO FOR TREATMENT DUE TO THE SERIOUSNESS OF THE COLLISION AND BECAUSE SHE IS TAKING MEDICATION. D-1 WAS `TRANSPORTED TO KAISER MARTINEZ BY REGIONAL AMBULANCE. I FOLLOWED REGIONAL AMBULANCE TO THE HOSPITAL WITH THE INTENTION OF PLACING D-1 UNDER ARREST FOR 23153A VC, DRIVING UNDER THE INFLUENCE OF ALCOHOL OR DRUGS AND CAUSING AN INJURY. THIS IS BASED ON THE FACT THAT SHE HAD DIFFICULTY IN SPEAKING, SEEMED DISORIENTED, TROUBLE ANSWERING QUESTIONS AND OBLIVIOUS TO HER SURROUNDINGS. SHE ALSO SAID SHE WAS TAKING MEDICATION AND SEEMED TO BE UNDER THE INFLUENCE. WHILE ENROUTE TO KAISER, MARTINEZ I REQUESTED PLEASANT HILL DISPATCH TO CONTACT A BLOOD TECHNICIAN AND HAVE THEM RESPOND TO MARTINEZ IN ORDER TO DRAW BLOOD TO DETERMINE WHAT DRUGS D-1 MAY HAVE TAKEN. ON ARRIVAL D-1 WAS TAKEN TO THE EMERGENCY ROOM #1 FOR A PRELIMINARY EXAM. I STOOD AT THE DOORWAY OF THE ROOM AND ADVISED THE NURSE THAT BLOOD WOULD BE DRAWN FROM TOMSIK BY A BLOOD TECH AND TOMSIK SHOULD NOT BE GIVEN ANY MEDICATION. THE NURSE DID EXTRACT BLOOD FROM TOMSIKS LEFT ARM FOR THE HOSPITAL. WHILE STANDING AT .THE DOORWAY I HEARD A CONVERSATION BETWEEN TOMSIK AND THE ATTENDING NURSE. TOMSIK STATED SHE KNEW SHE WAS NOT SUPPOSE TO BE DRIVING A VEHICLE WHILE TAKING HER CURRENT MEDICATION. AMBULANCE ATTENDANT WILLIAMS ALSO RELATED TO ME THAT TOMSIK TOLD WILLIAMS SHE WAS NOT SUPPOSE TO BE DRIVING WHILE TAKING HER CURRENT MEDICATION. TOMSIK MADE THE STATEMENT DURING THE RIDE TO THE HOSPITAL IN THE AMBULANCE. AT APPROXIMATELY 11.40 HOURS I CONTACTED PLEASANT HILL DISPATCH WHO SAID THE BLOOD TECH WAS ENROUTE. DISPATCH ALSO ADVISED THAT VICTIM HOWELL ' PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-0 BCS Class: Disposition: Page: 4 NARRATIVE HAD DIED. BLOOD TECH ROSANNE BEEBE, RN, ARRIVED AT THE EMERGENCY ROOM AT APPROXIMATELY 1150 HOURS. BEEBE AND I ENTERED THE ROOM AND I ADVISED TOMSIK THAT SHE WAS UNDER ARREST FOR DRIVING UNDER THE INFLUENCE OF DRUGS AND OR ALCOHOL. TOMSIK SAID SHE HADN'T HAD A DRINK IN TWO YEARS. I TOLD TOMSIK WHO BEEBE WAS AND DUE TO THE SERIOUSNESS OF THE COLLISION SHE WAS REQUIRED TO GIVE A SAMPLE OF BLOOD. TOMSIK WAS COOPERATIVE AND , THE BLOOD WAS EXTRACTED FROM HER LEFT ARM. I TOLD TOMSIK I WOULD LIKE TO ASK HER SOME QUESTIONS ABOUT THE ACCIDENT . BUT WOULD HAVE TO ADVISE HER OF HER RIGHTS. SHE WAS ADVISED OF HER MIRANDA RIGHTS WHICH SHE ACKNOWLEDGED AND WAIVED A 1206 HOURS. TOMSIK SAID SHE LEFT HER HOUSE TO GO TO PAYLESS TO DO SOME SHOPPING AT APPROXIMATELY 0950 HOURS. SHE SAID SHE WAS AT THE STORE FOR APPROXIMATELY 20 OR 30 MINUTES AND THEN WENT STRAIGHT HOME. SHE SAID SHE REMEMBERS TURNING DOWN HER STREET AND. GETTING CLEAR TO HER HOUSE BUT DOESN'T REMEMBER ANYTHING AFTER THAT. I ASKED IF SHE HAD TAKEN ANY MEDICATION TODAY. SHE SAID, "I TOOK ONE TO SPEED UP MY BLOOD. " I ASKED IF HER IF HER DOCTOR ADVISED HER NOT TO DRIVE WHILE TAKING MEDICATION. . SHE SAID DR. BERRY HAD TOLD HER NOT TO DRIVE AND HER HUSBAND RICHARD TOMSIK HAD BEEN PRESENT AT THE TIME. SHE SAID HER HUSBAND HAD BEEN DOING ALL THE DRIVING FOR HER FOR APPROXIMATELY THE PAST TWO WEEKS. SHE SAID SHE WENT TO DR. BERRY BECAUSE SHE HAD WHAT SHE DESCRIBED AS THREE MINI MAUL SEIZURES WITHIN THE PAST TWO WEEKS. SHE SAID SHE DOESN'T FAINT BUT HAS A HARD TIME TALKING BUT THIS WAS THE FIRST TIME SHE COULDN'T REMEMBER WHAT HAPPENED. SHE SAID SHE KNEW SHE WASN'T SUPPOSE TO DRIVE BUT THOUGHT IT WOULD BE OK TO GO THE STORE. TOMSIK SAID SHE NORMALLY TAKES HER MEDICATION AT NIGHT. BEFORE BED BUT TAKES HER NEW MEDICATION ONCE IN THE MORNING AND ONCE BEFORE BED. TOMSIK SAID SHE GOT UP THIS MORNING, (1-3-91) AT 0.645 HOURS AND HAD A BISCUIT WITH BACON AND EGG WITH HER HUSBAND AT APPROXIMATELY 0730 HOURS. } PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL , CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-0' BCS Class: Disposition: Page: 5 ______________________________ NARRATIVE SHE ALSO ALSO TOOK HER MEDICATION WHICH SHE DESCRIBED AS A D. I.P. PILL. I ASKED HER IF SHE COULD FEEL ANY EFFECTS OF THE PILL AND SHE SAID NO. I ALSO TALKED WITH HUSBAND RICHARD TOMSIK OUTSIDE THE EXAM ROOM. HE SAID HIS WIFE IS NOT A DRINKER AND DOESN'T BELIEVE SHE'D HAD A DRINK IN TEN MONTHS. HE ALSO SAID THAT ON 12-27-90 OR 12-28-90 HE RECEIVED A CALL FROM HIS WIFE'S SISTER WHO WAS CONCERNED ABOUT PATRICIA TOMSIK'S BEHAVIOR WHILE VISITING HER MOTHER IN SAN LEANDRO. TOMSIK DESCRIBED THE BEHAVIOR AS NOT BEING HERSELF. HE SAID HE DROVE TO SAN LEANDRO AND TOOK HIS WIFE TO , KAISER HOSPITAL MARTINEZ. AFTER THE EXAM HER DOCTOR PUT HER ON A NEW MEDICATION. (DIPYRIDAMOLE 75 MG 12-17-90) DURING MY INTERVIEW WITH PATRICIA TOMSIK SHE SAID SHE WOULD TAKE ME HOME TO SHOW ME HER MEDICATION. CPL. SMITHEY AND OFFICER WILDES ARRIVED AT THE EMERGENCY ROOM WITH A CONSENT SEARCH FORM FOR HER MEDICATION AND A RELEASE FROM CUSTODY FORM. DUE TO EXTENSIVE EXAMS AND TESTS ACCOUNTING FOR SEVERAL HOURS AT THE HOSPITAL TOMSIK WAS RELEASED FROM CUSTODY (849PC) . I. TOOK THE BLOOD SAMPLES FROM BLOOD TECH BEEBE AND DELIVERED THEM DIRECTLY TO THE COUNTY LAB AT 729 CASTRO STREET, MARTINEZ , FOR ANALYSIS. SAMPLES WERE RELEASED TO MARY HERSHEY. . 1-10-91/246/158 EVIDENCE ID:C91000051-07-001 OWner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:BLOODSAMPLE BLOOD SAMPLE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-04-91 07 EVIDENCE CRIM 196 246 RPT# DATE TIME OFC OFC NAME I/T R/T 07 01-04-91 1346 196 LAUDERDALE, ROBERT 300 120 Reviewed by: Date: F/U assigned to: Due Date: t �• DECLARATION under penalty of perjury says (print Name) i am employed b Y in the capacity checked below: ❑ physician ML] registered nurse ❑ licensed vocational nurse ❑ licensed clinical laboratory technologist - ❑ clinical laboratory bioanalyst f On thate I took blo d from a person identified to me as IOM S I k the defendant.. cleaned the area to be punctured with the non-alcoholic disinfectant included in the Contra Costa County Criminalistics Laboratory.blood withdrawal kit. Using the sterilized needle and holder from the kit, I inserted the needle into the defendant's vein and withdrew enough blood to fill the two vacuum vials - discarded the needle, holder and disinfectant and shook the vials thor ( oughly to prevent the blood from clotting. The'vials of blood were labelled with the full name of the defendant,,the date and time of withdrawal and I laced m .: p y initials on the label. ., l ;.-ave..the vials to the officer who accompanied the defendant, and observed the officer seal the top of each vial with a label seal and place his initials on the seal and.°on the label of each vial. The samples) was/were taken in a medically.approved manner. I.declare under penalty of perjury that the foregoing is true and correct /Zyo at :. ,. } California. Signature of Declarant): To be completed by person * � collecting blood (WHITE COPY) DISTRICT ATTORNEY'S COPY—PLEASE RETURN TO THE BLOOD WITHDRAWAL KIT: (YELLOW COPY) POLICE AGENCY'S COPY—PLEASE DETACH AND MAINTAIN FOR YOUR RECORDS (PINK COPY) COPY FOR PERSON MAKING BLOOD WITHDRAWAL—PLEASE DETACH AND MAINTAIN FOR YOUR RECORDS'. . _,. (GOLDENROD COPY) LABORATORY'S COPY—PLEASE RETURN TO THE BLOOD WITHDRAWAL KIT' PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-0 BCS Class: Disposition: Page: 1 CASE REPORT ----- Section - 1 : VC23153 2: PC1915 3: PC849B 4: Level: Location: 15 CLEOPATRA DR, PLEASANT HILL Beat: 11 Complaint received on 01-03-91 at 10: 31 Reporting officer: LAUDERDALE, ROBERT (196 ) SYNOPSIS REPORT OF VEHICLE INTO RESIDENCE, GAS MAIN LEAKING. DETERMINED RESIDENT DECEASED - HOWELL, TERRY 29 YRS. TOMSIK VS RESIDENCE. NARRATIVE --------------------------------- SUPPLEMENTAL REPORT: INVESTIGATION: ON TUESDAY 1-8-91 AT APPROXIMATELY 0920 HOURS I DID AN INSPECTION OF TOMSIK'S VEHICLE WHICH WAS IMPOUNDED AND BEING STORED AT THE PLEASANT HILL CORP YARD. CORP YARD MECHANIC DAN BOAZ ASSISTED WITH THE VEHICLE INSPECTION. VEHICLE WAS BEING STORED OUTSIDE WITH A TARP COVER THE ROOF AND HOOD. THE VEHICLE ELECTRICAL SYSTEM WAS OUT OF ORDER POSSIBLY DUE TO A DEAD BATTERY. THE IGNITION LOCK WAS OPERATING AND THE STEERING WHEEL WOULD MOVE THE FRONT WHEELS IN EITHER DIRECTION FROM LOCK TO LOCK. I PUMPED THE BRAKE PEDAL FOUR TIMES AND THE PEDAL WAS FIRM AND NOT FADING. I CHECKED THE MASTER BRAKE CYLINDER AND BOTH COMPARTMENTS HAD FLUID. MECHANIC BOAZ PULLED THE FRONT WHEELS OFF THE VEHICLE FOR A BRAKE INSPECTION. FRONT BRAKES WERE DISC TYPE. THE DISC BRAKE PAD WAS REMOVED AND BOAZ STATED THE PAD ,WAS ALMOST COMPLETELY WORN ON THE RIGHT FRONT PADS. THE LEFT FRONT PADS HAD APPROXIMATELY 40-50% LINING MATERIAL ON THE PADS. THE REAR BRAKES WERE DRUM TYPE. THE LEFT REAR DRUMS .HAD APPROXIMATELY 50-60% LINING AVAILABLE AND THE RIGHT REAR HAD APPROXIMATELY 50% LINING AVAILABLE. BOAZ ESTIMATES THAT THE BRAKING EFFICIENCY OF THE VEHICLE WOULD STILL BE APPROXIMATELY 85%. BOTH FRONT TIRES OF THE VEHICLE HAD A TREAD DEPTH OF 7/3211 , WHILE THE LEFT REAR HAD A DEPTH 3/3211 , THE RIGHT REAR HAD 4/321- . p PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL, CALIFORNIA •. FULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-( BCS Class: Disposition: Page: 2 NARRATIVE _____________-__________________= BOTH THE RIGHT FRONT AND RIGHT REAR TIRES WERE DEFLATED AS A RESULT OF THE COLLISION. BOTH FRONT WHEEL DISC PADS REMOVED FROM V-1 AND PLACED INTO EVIDENCE AT PHPD. I ALSO HAD BOAZ REMOVE THE FRONT GRILLE OF V-1 WHICH WAS STAINED WITH BLOOD. THIS ALSO WAS PLACED INTO EVIDENCE. THE FRONT AND RIGHT FRONT OF V-1 HAD SUFFERED MAJOR DAMAGE UP TO AND INCLUDING THE PASSENGER DOOR. THE FRONT WINDSHIELD WAS SHATTERED BUT INTACT. BOTH RIGHT SIDE TIRES WERE DEFLATED AS A RESULT OF THE CRASH AND THE RIGHT FRONT RIM WAS BENT APPROXIMATELY 1" - 211 FROM ROUND. AT THE TIME OF THE INSPECTION THE GEAR LEVER WAS IN PARK AND THE SPEEDMETER WAS AT REST. THE INSPECTION WAS COMPLETED AT APPROXIMATELY 1000 HOURS. LT. SIMPSON NOTIFIED FARMERS INSURANCE (POLICE #58876925) ADJUSTER TIM GORDON THAT THE VEHICLE COULD BE RELEASED. CONCORD TOW WORLD TOWED THE VEHICLE TO SUN VALLEY FORD ANNEX, 1660 CHALLENGE DRIVE, CONCORD, AT APPROXIMATELY 1320 HOURS. 1-10-91/246/154 EVIDENCE ID:C91000051-08-001 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: Value: $ Desc:BRAKEPADS FORD ,T-BIRD BRAKE PADS - DISC TYPE AC# Date . Rept# Activity AG Storage Disp OF1 OF2 Comments 01 01-09-91 08 EVIDENCE EVIDEN 196 2.46 PLEASANT HILL POLICE DEPARTMENT PLEASANT HILL , CALIFORNIA PULL REPORT PD Class: ACCF Disposition: A Case Number: C91-000051-(. BCS Class: Disposition: Page: 3 EVIDENCE ID:C91000051-08-002 Owner:TOMSIK, PATRICIA HAZEL Category: Article: Brand: Model: Color: Quan: Serial number: value: $ Desc:TBIRDGRILLE FORD T-BIRD FRONT GRILLE AC# Date Rept# Activity AG Storage Disp OF1 OF2 Comments --- ---- ----- --------- -- ------- ---- --- --- ---------------- 01 01-09-91. 08 EVIDENCE EVIDEN 196 2.46 RPT# DATE TIME OFC OFC_ NAME I/T R/T 08 01-09-91 1052 196 LAUDERDALE, ROBERT 40 30 Reviewed by: Date: F/U assigned to: Due Date: % II SEK PATIENT NAME M.R.NUMBER AGE IMPRINT AREA Cov, GROUP ACCOUNT SUB GAD, Toms I I C 1 4 HOME ADDRESS ONES 0 C 'y 94 15 2()@ 9 41 .41 A ,j"r ..I bsioll MLL 4 15 8':25 3 3 6 CA qxT" 21 ISOURCE OF ..&I U RACE RELIGION L_1• 328 0 06510 1--y.ENT Is"O"A 11 NEWBORN MOTHER'S M.A.NUMBER ON OEPOSITNAME � tios SVBSCRiaER 3 NAME SUBSCRIBER'S EMPLOYER H T ZZ '31 OTHER INSURANCE"ST.F. /* ADMISSION O!i, AXIMIrTINOPHYSICIAN • E DATE ADMITTED N TYPE AD4. I " Y6 ATTENDING PHY31C.A.j ✓ LIVELY M D 45 i 19 1,:f-e, qY6 9 M...T I.00-NO. .1. PROF-SIR.. 4 0 k) E-1 E R 10 A D E DATE OISCSAAGEO• USUALPHYfACIAN 4- FACILITY, EMERGENCY CONTACT$ MC, DAY YR. I:- ,rATIENT CARE IL-I&a, !�Q i L B R R Y JR "'110"sk"i"C!+A,RD T 0 M i T 1 K -t I _� *0.�.-1 i :)-_`" ADMITTING CLERK S DOE"'.By OLA.'VER 415-609-0 1 15; w MAS"ON AXIMITTIN I G DIAGNOSIS 1 ERH t T 'A EXT. SURGERY REPAIR R45r=�_ HERNIA ON A6 •.19 . G i9 PRINCIPAL DIAGNOSIS CODE SECONDARY DIAGNOSIS OR COMPLICATIONS PRINCIPAL PROCEDURE OuI,,v,j CONSULTANTS RESULTS AUTOPSY CORONER CASE DISCHARGED DISCHARGED AGAINST MEDICAL ADVICE EXPIRED F-1 Y ES D NO FIYES FNO KAISER. PERMANENTS - MARTINEZ HISTORY AND EXAMINATION RECORD PATIENT MR# DATE TOMSIK, PATRICIA H. 0651077 10/26/90 PHYSICIAN SERVICE Judson Lively, M.D. Surgery chief Complaint: .Ventral hernia. History of Present Illness: This patient is a 6o-year-old woman who has had multiple prior attempts at a repair of a ventral incisional hernia which include two attempts performed -at Walnut Creek using suture and one attempt using -mesh which was performed here at. Martinez Kaiser. These all originally resulted from an . upper midline incision through which a gastric stapling procedure was performed. Her most recent repair was performed in February.. ..of 1.989 here at. Martinez Kaiser at which time she was admitted and underwent repair. of ventral incisional hernia. using Marlex _ mesh , .__ .At __that time,__the . old._.vertical__midline incision was reopened and hernia sac was identified and dissected off.. of the fascia. A. 10 X 5 cm, strip of Marlex mesh was inserted, sutured with a running #1 Prolene around the fascia. AJackson-Pratt drain was brought out through the skin through a separate stab incision. By postoperative day #5, her drain was removed and she had a bowel movement. At that point, she was discharged to.home. On May 25th, 1990 she was seen in the Emergency Room and then on 5/29/90, she was seen in the Urgent Care Clinic, Both times she was complaining of abdominal pain. She was placed on Zantac 150 mg. b.i.d., and she was referred to, the Surgery Clinic for evaluation of her recurrent ventral hernia. When she*was seen in Surgery Clinic, she was noted to have a ventral hernia measuring approximately 4 cm. in diameter located to the right side of the umbilicus and a vague large bulge in the midright abdomen upon straining. The only discrete defect that could be palpated was -the one to the right side of the umbilicus and the large bulge did not appear to have any actual fascial defects. An upper GI series was obtained in order to fully evaluate her epigastric pain which returned, showing deformity of the proximal stomach secondary to the prior gastric stapling but was otherwise Aft normal. She was then referred to GI and she underwent an upper endoscopy at which time they noted erosions and retained food in the stapled portion of the stomach. This was felt to be gastritis and she was begun on Cimetidine 800 mg. p.o. q.h.s. which has relieved most of her epigastric discomfort. She still, however, has pain and tenderness around the site of the apparent ventral hernia. She is now scheduled for repair of this hernia. I have discussed with her the probable need for again, using mesh. She also understands the potential risk of.other complications during the course of the operation including recurrence of hernia, infections, as well as things along the lines of pneumonia, strokes, heart attacks and even potentially death. Allergies: None. Medications: 1) Tagamet, 800 mg. p.o. q.h.s. , 2) Vasotec 5 mg. p.o. q.d. , 3) Maxide one q.d. , 4) Calan SR 240 mg. one q.d. , 5) aspirin one q.d. �+ KAISER..PE-RMANENTE - MARTINEZ HISTORY AND EXAMINATION RECORD PATIENT MRN DATE TOMSIK, PATRICIA H. 0651077 10/26/90 PHYSICIAN SERVICE __.. Judson Lively, M.D. Surgery Page 2=Continued Medical Illnesses: 1) Hypertension. 2) History of TIAfs. 3) Morbid obesity, status post gastric stapling procedure. social History: She smokes four to five cigarettes daily. She works as a computer operator and anticipates she will retire in approximately one year. Review of Systems: Negative for any recent illnesses. She denies any recent cough, upper 'respiratory tract • infection, urinary. tract infections, nor other flulike symptoms. Family History: Noncontributory except there is no history . of any unusual reactions to anesthetics nor of bleeding tendencies. Physical Examination: Height 5r411, weight ' 218 lbs. , blood pressure of 120/70, pulse '80, respirations 18, temperature 98.4. In general, she is an obese woman appearing in no acute distress, HEENT: Shows pupils equal round reactive to light. Mouth. and throat remarkable for dentures,- but no pharyngeal erythema. NECK: Supple without adenopathy. LUNGS: Clear with equal breath sounds bilaterally. BREASTS: Normal without masses. " CARDIAC: Regular sinus rhythm without murmurs, gallops, rubs. ,:: ABDOMEN: Soft, nontender except in the region of -the hernia located to the right of umbilicus which measured approximately -4 cm. .in diameter. It was reducible but was tender upon palpation. She also had a larger area lateral to this which bulged upon straining but without any discrete fascial defects. The upper midline incision was well healed and there was no obvious hernia defect_ in it. No inguinal hernias appreciated. EXTERNAL GENITALIA: Normal. RECTAL: Normal tone, guaiac negative. EXTREMITIES: Unremarkable other than some small varicosities. NEUROLOGIC: Intact. Assessment: This patient is an elderly woman with multiple ventral hernias who now presents with more recent development of a ventral hernia to the right side of her umbilicus. She will be admitted to hospital or to surgery on 10/26/90. JUDSO LIVELY, M.D. JLt-mjp, d&t: 10/24/90 CC: Chart KAISER PERMANENTS - MARTINEZ DISCHARGE SUMMARY PATIENT MR# Tomsik, Patricia A. 0651077 PHYSICIAN ADMITTED DISCHARGED Judson Lively, M.D. 10/26/90 10/29/90 Discharge Diagnoses: 1. Recurrent ventral hernia. 2 . 'Hypertension. Principle Procedure: Repair of recurrent ventral hernia with Marlex mesh. History of Present Illness; This patient is a 60-year-old woman who has had multiple prior abdominal operations all performed through the same upper abdominal incision. . The last three operations have been attempts to repair ventral hernias. The most recent operation included the insertion of Marlex mesh, however, she now presents with a definite recurrence lateral to the Marlex mesh and she is now scheduled for surgery in. an effort to solve her recurrent hernia problem. Hospital Courser This patient was admitted to the hospital on 10/26/90 and was taken to the Operating Room that day, where under general anesthesia, a transverse incision was made in the upper abdomen centered over the area of the transverse incision was made in the upper abdomen centered over the area of the hernia defect and the hernia -was exposed. . It was found to be a large hernia defect located lateral to the preexisting site of Marlex mesh. The hernia was reduced and the sac itself was excised. A second sheet of Marlex mesh was then inserted and sutured in place to the lateral edge of the preexisting Marlex mesh sheet as well as to the healthy, firm fascia all the way around the perimeter of I the defect. A single ]A mm. Jackson-Pratt drain was inserted and the patient •was then allowed to awaken and was taken from the operating Room. She tolerated the procedure well. Postoperatively she only complained of incisional pain. Her diet was steadily advanced, and by postoperative day 13, the Jackson-Pratt drainage was down to 4 cc. /8 hr. period. It was then removed. The dressing had been changed, incision looked good without evidence of seroma formation, nor erythema. There was no drainage. The abdomen was soft and nontender except right over the incision. She was eating a regular diet by this time, passing flatus without difficulty. She had been afebrile, following surgery and she had no complaints other than for mild incisional pain. Consequently, it was felt that she could be discharged to home on 10/29/90. The pathology from the operation returned as a hernia sac and adipose tissue. CBC on the morning following • surgery was 37.9, . hematocrit, 12.3 hemoglobin and a 7.8 white blood cell count. Discharge+ instructions: Include: 1. Follow-up appointment with Dr.Lively in Surgery Clinic in one week. Continued on Page 2 KAISER PERMANENTE - MARTINEZ DISCHARGE SUMMARY PATIENT MR# Tomsik, Patricia A. 0651077 PHYSICIAN ADMITTED DISCHARGED Judson Lively, M.D. 10/26/90 10/29/90 Page 2-Continued 2. Vicodin if needed for pain. 3. She is to avoid heavy lifting over 10 to 15 lbs. for the first three weeks post operation and over 15 to 20 lbs. second three weeks post operation. She is allowed to shower as she desires. Diet is unrestricted. JUDSON LIVELY, JL/mjp ✓ d: 11/13/90 t: 11/20/90 ` cc; Chart • .v i\Hl�ClSf Cr) M.R. PER MA NC-'NTE v 1 MEDICAL CENTER I G P PATIENT PROG SS RECORD DISP: PATIENT'S NA�IkSTFIRST, MIDOLEI NURSE: TIME: T 0 M 3 1 K PATRICIA Ft ADDRESS --. STRE ALLERGIES rclTrl MEDS i '? BIRTHOA jPrECODE GROUPTEMP. r� ULSE P,ESP v \c�.,�c-fir.-- c.�C• • N i 4 a 7009559 THE PERMANENTE MEDICAL GROUP,INC. _.... .__.......,..._... KAISER FOUNDATION HOSPITALS ( EMERGENCY ROOM RECORD ROU Oq.¢EDNO. NO DRUG T MP.R J R.ATIJfIIE n BLOODP ESSURE .+ a r � � .0 SENSITIVITY j ]. . .M. YES-DRUG: PULSE _n J RESPIRATtOt� - SEEN P.M. THE UNDERSIGNED CONSENTS TO THE EXAMINATION OF THE PATIENT AND TO THE PERFORMANCE BY MEDICAL GROUP PHYSICIANS.THEIR ASSISTANTS,AND HOSPITAL ASSISTANTS,AND HOSPITAL PERSONNEL, OF SUCH DIAGNOSTIC AND MEDICAL PROCEDURES AS ARE CONSIDERED NECESSARY OR DESIRABLE IN THE CARE OF THE PATIENT,INCLUDING INJECTIONS, ADMINISTRATION OF ANESTHETICS,AND REMOVAL OF TISSUE.NO ASSURANCES HAVE BEEN GIVEN AS TO ANY RESULT OR CURE. SIGNATURE(OR O.THHE.R_WITNESS) / DATE RECEPT, a WITNESS L/ { t a" u zGSiS CHIEF COMPLAINT s R � - i ��l.'L�~ __.._S...k.�-,.-�� ...i _ �.✓i'.1Z'i^� _��h1�VY�1�YI_..,.._._ .�//� y^_ ���..1�i {•' � I - SCR v 0'f , ;SUBTOTAL' ; ____.__`�Yt�/_�._./��,t,C�_..--F�i�__—j�ozl..f�i"�,.�.'.•-_cz���.�i'r_�._._.�,,..tr.��4�--�—,�.---{ �...._ ._..___,.�.�G�%i�t3�^�'t/t:�.'•,_�. _._ _w.._..�._.__......�_._..V_.__ ___..._(_t� I � � TOTALS +� R IT ?N, SERIALI(S) / tADISP SITZ NREGULAR M.D.9kTIME jr OADMITTED DECEASED CONSULTANTT� 2OUT O(H)NOT ADMITTEd AMBULANCE /) ,,� „��.. CODES (MSTRUCTIONS� NT u P.WITH(Or.•CWUc-Date) REFERRED TO{Conic b Data) TRAM £ RED ' I,THE UNDERSIGNED ACKNOWLEDGE RECEIPT OF A COPY OF THESE INSTRUCTIONS TOGETHER WITH ANY OF THE SPECIAL INSTRUCTIONS NOTED, /) •® M.R. x PSE PATIENT PROGRESS RECORD `" -- x PATIENT'S NAME(LAST,FIRST,MIDDLE) loMSIK PATRICIA 11 0 0 C 10 30 ® ADDRESS(NO.,STREET) 3 o b J l 0 CITY F S 1 328 0 0651077 BIRTHDATE PHONE CODE GROUP 1 ENT M.D. JAO . t . . Sw.Cr fig-•�n.� . 1�' cti..�.. -- :.. oll S� Z i vi �✓ W f.;ciilC%,L:�F�C�h7S1c`i i __... .._. .....__._..... ...... .......-_-,_._.-......_.. tdC1V 2 1 198$ 3 _.. BERRY, MD. Tv��+ "VLA._..._... _.. ...._. . . ..... __..... ... _..._..._...__. iZ-- . .. .._.... .... _... ._. .. . U ............ _....____. .,. APPOINTMENT................ _._. , 61988 _ }....DEC 1 _._..__.... .:. _. .. - - 1 S,.SINGER. M.D."RTINEZ SURGERY -: - -- - -- - I/�K`�7Ce.Q -��/�,tti cam. --- _: _.: --•------ -- sal- _ - #- _. _..._.._ ...... c � . - .. _ _.._. - ..................................._..._..._ ..... l r •9 M.R. x KAISCR PERMANENTS �tt PA__ T'TIENTP_ROGRESS RECORD d:. PATIENS N_AME�L, T, FIRST,MLDD l ADDRESS (NO.,STR ET) CITY BIRTHDATE PHONE CODE GROUP SURGERY CUb:)C MARTINEZ AP? t ' .rc ! JAN 311988 Sr SINGER, M.D. SURGEMY GUM; MARTINEZ APPOWNIENT. . " FEB 13198y p S. SINGER, MA SugGERY CLINIC f IARTINEZ APPOINTMENT FEB 14 'Ndj -1 J / SURGERY CLINIC MARTINEZZ AAP OINTMENT 1��- MAR o 7c2nd P14 S. SINGER, M�.n P'f'0i ' GIlez o� A/Ij f .r • :. .. - f f _.... .. T' V i THE PERMANENTS MEDICAL GROUP,INC. 0 -1 KAISER FOUNDATION HOSPITALS 0 C1 . 7 1.4! ............ ------ EMERGENCY ROOM RECORD .............. .......... D %00 BEAN TEMPERATURE 4 NO DRUG IBLOOD PRESSURE -JI R'H �A r j QOM SENSI-71VITY cle"LJ TIME M-k—M YES.-DRUG: PULSE FIESPIRAT17N .1-.,.,A' SEEN P.M. THE UNDERSIGNED CONSENTS TO THE EXAMINATION OF THE PATIENT AND TO THE PERFORMANCE BY MEDICAL GROUP PHYSICIANS,THEIR ASSISTANTS,AND HOSPITAL ASSISTANTS,At HOSPITAL PERSONNEL,OF SUCH DIAGNOSTIC AND MEDICAL PROCEDURES AS ARE CONSIDERED NECESSARY OR DESIRABLE IN THE CARE OF THE PATIENT,INCLUDING INJECTION ADMINISTRATION OF ANESTHETICS,AND REMOVAL OF TISSUE.NO ASSURANCES HAVE BEEN GIVEN AS TO ANY RESULT OR CURE. SIGNATURE(OR OTHER WITNESS) DATE RECEPT. WITNESS L CHIEF COMPLAINT r7 PROBABLE E BY DIAGNOSiS 1_7 L A -6, A Al A-1 7 0,4 PE7 Mho ANL!' [NJ Im! 0 d26� N;J' C= Zi' AY EA 76SEN ^=aS:;-', :PATIENT 20110iTION ON OiSCHAAGE) Gj a SCA SUBTOTAL 93• 9 ............. A TALS TO SERIAL o(S) . SMMINITIATED *TIME 1]LA M. REGULAR DISPOSITION )A CONSULTANT -0 3-o DISPO ULANCE CODES OUT P 0 ADMITTED DECEASED M I+NANEW IT TED QAMB 0 1 12 (INSTRUCTIONS TO PATIEN T03z_:a�z/ APP.WITH(Dr.-Cimic-Date) REFERRED TO(Cb*8 Date) TRANSFERRED TO—(og Service.Floor,QxAty) 1,THE UNDERSIGNED ACKNOWLEDGE RECEIPT OF A COPY OF THESE INSTRUCTIONS TOGETHER WITH ANY OF THE SPECIAL INSTRUCTIONS NOTED. __[EMERGENCY RM.PHYSICIAN PATIENT OR OTHER RESPONSIBLE PERSON �3 28 R9 goo \11II�, Iv�15erL TRIAGE TONS I „ PAIR PERwc- RECORD 0 p Cif; M Cri C j , z KAISER PERMANENTE MARTINEZ u J � �� 28 P �' . ' oo obs*J01 DATE : TIME,. F Sl 328 0 06510 : TRIAGE NURSE- TEMP : C' B/ '0( , P: Gi R: INDUSTRIAL YES NO MEDICATIONS - ] Nov ALLERGIES : URGENT O JURGENT OIEMERGENTO CHIEF C/O TO ER TO_ UCC O TO PEDS O lftO', E .0 OTHER: PHYSICIAN ' S D.T. PROGRESS NOTES L.M.P. CHART .. •:. . . ORDEP.ED.: B/P . ADVICE: .• ; • � �-RAY:......--.._ .. ....._ LAB : `r .i 1v%KAJSCR M.R.► PENAANEMM PATIENT PROGRESS RECORD PATIENT'S NAME(LAST.FIRST,MIDDLE) ADDRESS(NO.,STREET) „ 0 O NN S I K PATRICIA 11 0 C 10 30 ro clry 3: i �: BIRTHDATE PHONE CODE C3ROUP F SI 3,28 0 0651077 DATE TIME ME ICAI P.P.•O:NTMEiW - i �+:elf+:i; ���•?+ .%y.:. •..• � ;�. + ... .w.u..., +• '^w':.t++��.�:.i:.-r{i•.iv?iG•✓"�flt:rl y:ii�<!itiN,?r�..lrC�:;•��,It i t G U C" o �s .1 ® M.R. • KAISGR Pcpw'NENTC PATIENT PROGRESS RECORD - PATIENT'S NAME(LAST, FIRST,MIDDLE) T Q 1{S 1 K F �, f R I C I • h: ' p p p 0'��"' 1 0 3 p ADDRESS(NO.,STREET) O b S 1 O 0651077 CITY BIRTHDATE PHONE CODE GROUP 4 MEDICAL APPOINTMENT MARTINEZ JUL 2 51989 J. BERRY, M. _r f A s . Wim• Sc S - 6 , J. :::• :y: v -e-(a �c .� o q .y, OV�/I/ WA)SU2 j- t PCRMANC.NTC REQUEST FOR CONSULTATION & REPLY Tc "DOCTOR) C 10 3 DEPT.OR CLINIC LOCATION 0651077 PROM (DOC R) PHONE (HOME) PHONE(WORK) DEPT.OR CLINIC LOCATION r- ADORE F1 CITY STATE . REASON FOR CONSULTATION: Brief Abstract of Clinical Problem(s) DATE /�,r,L IME %0'" tt /�: ���1 J L.iJ CJ�Cj �GL� (/ Ce/f 1-C� C%'� ► REFERRED FOR OPINION FOR TREATMENT REPLY REQUESTED BY TELEPHONE REQUESTED BY MAIL SPACE FOR REPLY BY CONSULTANT: NEUROLOGY APPOINTMENT K • KA 13 Cancellation' JUN 301989 MD/NP: Fill in Nurse: fill in P�AICHAEL BUTLER, M.D. _ b-Wo-action needed O MD/NP :0 Send Letter ❑ Patient Need to see pt. If new appt. WA dcys made date MD/NP initiaT Date Letter sent by Date MARTINEZ NEUROLOGY -CONSUTLATION JULY 28, 1989 This 58 year old right-handed secretary is referred by Dr. Berry because of spells of loss of speech. She reports that over the last two years she has had three separate spells , all occurring at work, :during which time she is unable to produce speech. She may be able to mumble slightly but cannot be understood. On one occasion during one of the spells , she lost continence of her urine but has never had an alteration of consciousness , nor any pain, nor any other dysfunction at all. During the spells , she can type normally on her computer and what she types makes sense. She can understand the spoken speech of those around her. She has no motor, visual or other deficits except for the difficulty speaking. She has not tried to swallow during the spells , but does not seemingly drool or have other cranial nerve dysfunction. The last spell occurred in January of this ❑PATIENT INSTRUCTED TO COMPLETE TREATMENT HERE 0PATIENT TO RETURN TO YOU FOR TREATMENT OTHER INSTRUCTIONS: Continued. . . M.D. , 19 Referring doctor should complete in triplicate;hold one copy for information:send original and one Copy with Carbon Paper to Consultant. Consultant should c plete form, file original with patient's chart and return other copy to the referring doctor. v MARTINEZ NEUROLOGY CONSULTATION RE : TOMSIK, PATRI:CIA I JULY 28, 1989 MR# 0651077 Continued. . . year. After that time she saw Dr. Berry and has had adjustments in her antihypertensive medications and begun aspirin, one daily. There have been no other- spells since that time and she has felt well. PAST HISTORY: Significant only for hypertension for which she takes Canal, Maxzide and one other medication. Her only other medication is aspirin, one tablet daily. SOCIAL HISTORY: She is a married secretary. She smokes less than pack of cigarettes a day and says she is planning to quit smoking this evening. She has at least a 25-pack-year history of smoking. She takes no alcohol or caffeine. FAMILY HISTORY: One brother has epilepsy. One sister has had strokes. The father died in an accident and the mother is living and well at age 77. PHYSICAL EXAMINATION : An obese , middle-aged woman with no bruit in the head or neck, normal cardiac examination and normal optic fundi. Mental state is normal. There is no language disturbance. CRANIAL NERVES : Extraocular movements and visual fields are full. There is no nystagmus.. Pupils are 4 mm. and equally reactive. to light and accommodation.' Facial movement and sensation are normal and symmetrical. Speech, swallowing, palatal elevation and tongue movement are normal. In particular there is no evidence of dysarthria of any kind. MOTOR EXAMINATION: Muscular power, bulk , ..tone , gait, station , and coordination are normal. . Muscle stretch` reflexes are Grade -II and symmetrical except for Grade I ankle jerks. Plantar responses are . flexor. SENSORY EXAMINATION: - Shows no deficit -:6 any modality. The Romberg test is negative. IMPRESSION: Probable posterior circulation transient -:ischemi.c--;attacks � in a patient with several risk factors for atherosclerotic cerebrovascu_ disease . Certainly, the loss of urin-ary continence is unusual during a transient ischemic attack and for this reason, I would recommend evaluation with an electroencephalogram for the possibility of complex partial seizures. In any event, whether transient ischemic attack or 'complex partial seizure , she maintains that she has not lost consciousness at any time, nor lost any motor control. RECOMMENDATION: Continue aspirin, one tablet daily and have electroencephalogram. She will return in two months. t July 28, 1989 KI-CHAEL BU LER, M.D. , NEUROLOGY, MARTINEZ MB :bb Ne_uroloay. Martinez �mj� KA)SCR PCRMANCAITC . 15I By y.. iA PATIENT PROGRESS RECORD n TC,i`'J'1D PATIENT'S NAME(LAST, FIRST,MIDDLE) 1r PATRICIA ADDRESS(NO.,STREET) f T OHS I X f Q T R I C I A Ii ' 1 0 0 C 10, 30 CITY : 3 V b S 1 0 1 1 131 RTHDATE PHONE CODE GROUP '! C 7 1 328 0 0651077 -.y ate•.,........ .... .,...-.. .. 22 t �V„ ti.L�La t NEUROLOGY APPOINTMENT SEP15 1989 MICHAEL BUTLf R, M.D. IF J 1 e VIA �� ,• t; - i ..� *rt1ENT PRr' '3R .SS RECGF"D .. _ . MART NEL ! SEP. 1989 J. BERRY, M.D. .' j _. ............_. .. . ......... ........ .._ 3 ' AL �, _ _..._.....___. - - _-�._ _ �Jw,,�,-._... __.___►gyp _��1 ._.c. (� �-- �-� 'c�t�o,1�.r ...C�,�.� lw�...:�-� _.... ._._ - - � ...__.... ...........-_._._---:.._:......._........._.....:.. ................................... .--------------------------------------.---------- ...................._...........................•---•_,._..._......_...._..__ .._._..._ ...... ........._____......__...... .____.............................................................._........_....._..._.._._...........................................__.._..._.._._..._,..._.__.___............. _-.__....._.._......._....____..._....._....__._....... -.. ._. ..__._._.....-_....--__.__...__.-___.-_._._._.._..__.._.._......._....._..___...__._.........__..................___»_. __.___.. -------- .......... .__._. y � TOY.519 PAiPICIA 5 � NCEPHALOG APHIC a C j 30 ;JLTATION REQUEST/REPORT 0 b S j 01 j 4TATIVE DIAGNOSIS: 1 ✓S , d' St 3d p G�rSICl� PREVIOUS EEG: fz NONE []AT OAKLAND ELSEWHERE (SPECIFY) IMPRINT AREA ABSTRACT OF HISTORY (CHIEF COMPLAINT, FULL DESCRIPTION OF SEIZURES, HEAD TRAUMA, OPERATIONS,FAMILY HISTORY E� POSITIVE NEUROLOGICAL .FII,NDDIINGS((INCLUDE MENTAL STATUS) AND PERTINENT LAB DATA: CURRENT MEDICATION(S) & DOSAGE: MAY PATIENT BE SEDATED, rf NECESSARY? YES NO p c MD. DATE 2 0 4 rtEPORT OF ELECTROENCEPHALOGRAM. k 8-23-89 Age:58 EEG N0. The tracing is obtained using standard international electrode placement with both bipolar and referential montages. The record commences in wakefulness and proceeds through stage II of sleep. During the waking record, well-formed background activity of 10 Hz is noted over the posterior head regions with an average amplitude of 40 to 60 microvolts. Nearly continuous low amplitude polymorphic delta slowing is present over the left frontal and fronto-temporal areas. Occasional ].eft anterior temporal sharp theta transients occur with markedly paroxysmel appearance, and increase with hyperventilation. Photic stimulation produces physiologic driving response. ANAL ARM IMPRESSION: Abnormal EEG awake and asleep with continuous left fronto-temporal focal slowing and focal paroxysmal activity. The findings suggest under- lying focal structural pathology in this area and a convulsive tendency:` ��^•�-?y MD. DATE 1 AISCR 1 j �E.RM/�NElVTE � � .. • F GENCY DEPARTMENT NURSES NOTES /// ATIONS ORDERED SITE ROUTE TIME BY INTAKE AND OUTPUT TIME IN OUT CODE IMPRINT AREA EMERGENCY RECORD# TIME E.R.DOCTOR CONSULT#t CONSULT#2 CONSULT#3 ADMITTING CALLED REPORT GIVEN TO BED# DISCHARGED I&O CODE NG.N.G.TUBE TRANSFERRED TO D -DIARRHEA U -URINE F -FOLEY •E -EMESIS ALLERGIES: OTHER: LV:ORDERS I.V.# AMT.CCs TYPE RATE/HR MEDICATIONS ADDED SITE - SIZE TIME BY I.V.INTAKE DATE/TIME V.S./OTHER OBSERVATIONS BY MEDICAL STAFF s a- X,/ f r � ci n97P 4-1111 )5214-f.c 3`� 72? �: �� AI:CILLA�tY I VAYIIENT THE PERMANENTS MEDICAL GROUP,INC. aL I KAISER FOUNDATION HOSPITALS J. I DATE LABEL 4 FATIcIi S Q.�M1l�Il"ST.FIRST Jd.l.) l 7 3� 2 y� �- ----------_°' EMERGENCY ROOM RECORD _ OR BED NO. NO DRUG 'TEMPERAT RE C BLOODPRESSURE BIRTH DATE-_-----___-_ -----'------------'------- [� SENSITIVITY Ccs �`f-��(,`I 1 — T :I 0 YES-DRUG: MEDICAL RECORD NUMBER ..AM. PULSE RESPIRATION tj SEEN THE UNDERSIGNED CONSENTS TO THE EXAMINATION OF THE PATIENT AND TO THE PERFORMANCE BY MEDICAL GROUP PHYSICIANS,THEW ASSISTANTS,AND HOSPITAL ASSISTANTS,AND HOSPITAL PERSONNEL,OF SUCH DIAGNOSTIC AND MEDICAL PROCEDURES AS ARE CONSIDERED NECESSARY OR DESIRABLE IN THE CARE OF THE PATIENT,24CWDING MACTK)NS, ADMINISTRATION OF ANESTHETICS,AND REMOVAL OF TISSUE.NO ASSURANCES HAVE BEEN GIVEN AS TO ANY RESULT OR CURE. SIG.NATURE(OROTHERWITNESS) (DATE RECEPT. \` W"wESS - � t V C.f _ �'r % �c'�L7 ��y 5�C`� I /�> /r_7� < `r.LL •V-,/ . CHIEFCOMPLAINT 4 I PROBABLE E BY�jDIA�jk.tSs" �.!�"�.j: moi? �r� r ✓rys.,� .-�1-w1 C.c�=C/ 2� f /C EIL RY ---- - - ----- _ - --. S . ci. , �/I'`�'""y_.__ �'-•."'•*i �`I'�--t__ J�-�-C /J-�r�—Y yY � _—/Y �_G. _'_tit�, < `J -. . G `7 /tJ"/.Lc.��-t" [i..r�• 3 iL iC G'__ • - kA?.t. I.</�✓ r�"� ,i < n ). /\C/:v ups U CJ--+sir �—� O `� S ..c.•� .SEE'J �N t — n ffjj} IN ?IMM ,� i I rC, A C��� ,_. rK�1L�, S 6 c7' S E�._T�_c f E _T_ °.17fA c' JL E 'NC NOTAL t 93 94 TOTALS ✓ Y 8CR(S11MIIIATEO !J V 2 *TIME J,�M. J�01) OSITION REGULARM.D.7 CONSULTANT T� ®� 12� 13-1 J MITTEDDECEASED OUT pM.C] )NOTADMITTED AMBULANCE ��--�`-�r' CODES (INSTRUCTIONS TO PATIENT) J Z J J yam' ./— APP,WITH`(x•Chic-Date) REFERRED TO(Clinic 8 Date) TRANSFERRED TO—(e0 Service.Fbor,Cants 1,THE UNDERSIGNED ACKNOWLEDGE RECEIPT OF A COPY OF THESE INSTRUCTIONS TOGETHER ANY OF THE SPECIAL INSTRUCTIONS NOTED. I rur:mr;:wry Au PHYSICIAN - M.R. w oCJ2 ° / � CJVTC T"r; / MAN 4 ` .. �`1'IENT PROGRESS RECORD No ATIENT'S NAME(LAST, FIRST,MIDDLE) '� TOMSt �( PA'CNICi � }1 ADDRESS(NO.,STREET) U C I Q 30 CITY BIRTHDATE PHONE CODE GROUP J1 "YC is C'�51 �. f+^MICAL APPOWTMEW ' MART NEZ Cate:. _ D1�) c At_t_EhGIES FLAY 2 y 1990 .. U Temp: t7 Yes, to what J. BERRY, M.D. •�'> JRegular titD - S v �, CSS-e�. (�, (�•�"— .�: .. i�tel!`� �"`-�v` ,►'1�'�`��/1/� t�/V V� �� � ::::� _ c It d. c� c-- l SZ L ��Y SURGERY CLINIC . Jut, 07 1990 J. LIVELY, M-D' - ._....... ......_. __. _.. - _.__. ._. .... ...._ ... . .... . ......_... { re��-- -._v� �.��yv\,,.� r�bw;<..._�-•'{__7v1-.�....._.. .._ . z , ... . . , 5 .� _ - - - F _.--....................................... .. .... SURGERY, CLIN IC -` - - - - ---- �^ �- --- -�- -- __ _ JUN � 1990 J. LIVELY, M•®• .cn rc Q.. ❑ Send Ie., P� -----------_...._.. .........__......�;.�nrd. ¢1.__._.. },.. .._....._..._. .»...._.�. ..C�.._o .s r . __----- .......... ..._.._._...._..._ __..._..- _ _ - _ . . —--- --..__... -------------_...--------—--•........................_..._.. -- _ .................. _....__..._.._........ _........ _._........... _ Am -•C +.w ♦'/..eN.M f.M/iq crta.�.•f.4 7 Mr�.fYM/1i0 R- a D+ I4..srmnx .h r --�f.3's7 v ✓� n s v9;��s'' `Kh&yw 1� 1`,3" t �r anU � - :e s..^ � - +"�tUy • w e mB M.R. a► PCRMANCML- PATIENT PROGRESS RECORD ^ PATIENT'S NAME (LAST, FIRST, MIDDLE) ADDRESS(NO.,STREET) ct- « CITY BIRTHDATE PHONECODE GROUP6QL� IISS/J 1 t l ) SURGERY CL NIC t J. LIVELY, M u C'17 r1 Y' 0 i r•- r _ . L i M.R. w �mO 1• �'ll� ICAISCtt PERMANCN fL- • +` ' �. TONSIX PATRICIA H PATIENT PROGRESS RECORD 1y,;_',+ 0 0 0 C t 0 ;• PATIENT'S NAME (LAST, FIRST,MIDDLE) O 1 O ADDRESS(NO.,STREET) F S I 321 C c ) CITY 81RTHDATE PHONE CODE GROUP - ii JUN 911 C-Lc . 1 ;= Medical Appointment [ Martinez { JUL 131990 ..t_ 'Thomas QUIT. M-D. 62n.►: ,n 1 6!�� v+t)L 1Iy Gi'�S7w� f Uri- /n N,-r S -Tu- S PAITIcNT Pi10GE'SS cC0c,D AV ...._._. ... A � ..� .. PAI S _ .- _ l S L i',� . � •. .--_.. r i......---._...........__..._.....:......................_..:...._.......,......................._...._._........__.•........... ............ ------- -_.._.. ....... _ ..__.-._-.._...__...-#....................._..._..._......................................................................._._.......-...........................................__..... -_-. :.._..._..._..__._. ....._...__..::.:._..._.................................._..:........... ..__..........._................. . KASER PERMMJENTE TOMS IK F A T R I C I A H PATIENT PROGRESS RECORD 0 0 0 C t o 30 PATIENTS NAME (LAST,FIRST,MIDDLE) G � S1Q�� .. ( SI 329 0 0651077 ADDRESS (NO.,STREET) CRY g, THDATE PHONE CODE GROUP IMPRINT AREA Endoscopy procedure: { Physician: Date: 11-7/ Pre-Procedure Data Base_ Vital Signs: T 3 P d'o R B/P i . i NPO status: .�i y Dentures Transportation: Allergies iZz M44edications it I V - t. :Signature:. Procedure Data Base ;. Medications: Meperidine I.V. J�C� Glucagon I.V. Diazepam LV. Other I Naloxone I.V. i, Pulse Oximeter: Pre During Post i Not used Used Pulse: SaO2%: 77 02. Not used V_Used Rate ml/min Nasal cannula Nasal catheter' I Skin Condition: PATIENT PROGRESS RECORD _ -0 , DATE f4 Md �• int . Post ProcecT. i Time: B/P P �� �OP, _,e:z'C tel./ GGCG.�� �'+{���.,.-x"s�.'}" ?r h,"a ,s•A*.w '�''aF� t a x , . .' -. _.. � K x . _ x '._X43 L2; 'r ��ST t y, .c �'fi'Y9F" 1�•+� �a s�Y{. `jY sNot), Fir ru S 7� G.b o a(I,M OA) a (JF 70/yj IOLIq LIJM firJ b 2q9 /L/OT 6'1-) A-S w� 6 1_2�oGnj /9LC,OvV)AIG 266 SOA S S'wG6 U cap 67 j� CCr9S`•r1.�T�S U� S���,r�Lfi� �r�sr::�i'^ UJ vi s COs M.R. KAISER a - PERMANENTIZ PATIENT PROGRESS RECORD PATIENT'S NAME(LAST, FIRST,MIDDLE) 1-� kID ADDRESS (NO.,STREET) / CITY BIRTHDATE PHONE CODE GROUP SURGERY CLINIC SEP :,1 1980 J. LIVELY, M.D. SAA 2kh�� i i� I, e� M.R. w I<NSCR m. PGRMANCWE , PATIENT PROGRESS RECORD PATIENT'S NAME(LAST, FIRST,MIDDLE) ADDRESS (NO.,STREET) t CITY BIRTHDATEP440NE CODE GROUP i - SUR ERS'CLINIC ENT IN.Ar% s c rORZ, M.D. LI AM -- u'u I tosu y cl ¢- r „ i9 O a i i • 4 C PCRMANCJVEC PATIENT PROGRESS RECORD T HS I K P ATR I C I A N t PATIENT'S NAME(LAST, FIRST,MIDDLE) 0 0 C 10 30 ADDRESS NO. STREET '7'J O O , I O ( ) SI 328 . 0 0651077 CITY BIRTHDATE PHONE CODE GROUP .ti Ci_INi � ' t; � 0 19.. --� J. L-IVELY, .` �ane:_ �,�•..,'�- � Vc. 1'V •. j- 2 � { SURGERY QTS -, J. LIVELY '-3 90537 90537 (REV. 1.861 ^� MEDICAL A:i C:NTVIENT MART;NEZ ' . DEC 27-1990 ..... ........... _.__..._...._ ... . _. .__. . . J. BERRY, M.D. i W a Q __ ... .._:.... ... .... ry - - -- _ - .._._. ..__ __--._............ _.._ ._..._ ... __ _ _.._-____..._.__......_.__...._..__..__-...__...._...... .....................-_-•_---_----._._._._._._._---_..............__._..____.__.._.._..._.... ............_._........ ,LA- _.._.._. . .___.... .__.. ._____. ................. --- ..... .__O.A, ._.. __----------------------------- _------- ------------------ •--.._. -- - - -- - -- . _..___- .r . --...-- .. ._._ -t- �_................__ .............. ....._ _... ._.._. ......: ;......................... _... _.......__ --.-----•---_.......__... _ . ._......................_............._.._......_.......__...:............_.__...... ......._......__......._.._..._. - -..._..---. -.-.. ...-_--..-------------.------...---.. ._._..-----•---•------ _....--- -_-_ __---- - _ - _ ...._...... ................................... ..._...._......... .. - o" KAISER PATIENT PROGRESS RECORD PATIENT'S NAME(LAST,FIRST,MIDDLE) 0 i{s ( j( PAIRICIA N 0 0 0 C 10 30 ADDRESS(NO.,STREET) CITY f s1 328 0 06510,77 BIRTHDATE PHONE CODE GROUP M�F+Ytrv�t` A BERRY,M.D. y r - L- u n\,,.s" 4-u kg- IT c A. t% INSTITUTE NUMBER i INSTITUTE OF FORENSIC SCIENCES 103470 P.O.Box 20250 • Oakland,California 94620-025 Phone(415)451-1060 2945 Webster Street • Oakland,California 94609 TOXICOLOGY LABORATORY PHILIP Chief REYNOLDS f Toxicologist JAMES E.MEEKER, Ph.D.. Associate Toxicologist PAUL W. HERRMANN,M.D. Director NAME: SUBMITTED BY: TOMSIK, PATRI_CIA HAZEL PLEASANT HILL PD 91-51 LAUDERDALE SAMPLES RECEIVED: BLOOD BY: DATE: TIME: SEALED: FROM: JS 1-14-91 11:00 YES LOCKED BAG REQUESTS: SEDATIVE SCREEN BLOOD: NO COMMON BARBITURATES, MEPROBAMATE, GLUTETHIMIDE, PHENYTOIN, - ACETAMINOPHEN, SALICYLATES, DIAZEPAM, NORDIAZEPAM, METHAQUALONE OR CHLORDIAZEPDXIDE ARE . RECOVERED. DATE /J � oL. errithew � emorial JUN 10 1991 0 �Lf���(X115 COUNTY COUNSEL A N D C L I N I C S MARTINEZ, =1F TO: Office of County Counsel DATE: June 5, 1991 Contra Costa County FROM: Mark Finucane 177� RE: CLAIM Kevin Howell , etc. vs TR Contra Costa County PATIENT: Patricia Hazel Tomsik Record # The attached claim for the above named patient was received by Merrithew Memorial Hospital on June 5, 1991. SP Attachment cc: Risk Management Department RM-2 n: Contra Costa County A-301A (3/87) f, 1 WILLIAM E. GAGEN, JR. MICHAEL P. CANDELA 2 GAGEN, McCOY, McMAHON & ARMSTRONG A Professional Corporation 3 279 Front Street, P.O. Box 218 ,' Danville, California 94526-0218 4 Telephone: (415) 837-0585 5 Attorneys for Claimants Ct,= „ KEVIN HOWELL individually and MERRi H' �'U-,i C, 6 on behalf of his minor daughter �t4r►�CL��/CS f IIAL MELANIE DANILLE HOWELL 7 8 BEFORE THE BOARD OF SUPERVISORS, COUNTY OF CONTRA COSTA 9 10 11 KEVIN HOWELL and MELANIE DANILLE NO. HOWELL, 12 CLAIM AGAINST CONTRA COSTA Claimants, COUNTY 13 V5. 14 CONTRA COSTA COUNTY, , 15 Respondent. 16 17 18 TO: THE CLERK OF THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS 19 AND TO THE CLERK OF THE CONTRA COSTA COUNTY HEALTH DEPARTMENT: 20 KEVIN HOWELL, individually and on behalf of his minor 21 daughter 14ELANIE DANILLE HOWELL hereby submits their claim 22 against the CONTRA COSTA COUNTY BOARD OF SUPERVISORS and CONTRA 23 COSTA COUNTY HEALTH DEPARTMENT and makes the follow statements in 24 support of their claim: 25 a. Claimant's post office address is .15 Cleopatra Drive, 26 Pleasant Hill, California 94523-3447. Law offices RECEIVED GMGMA1ON 11 JUN - 3 1991 ARMSTRONG A Professional pr�I T Corporation is\client\22336\F1eaClaitn.pld vim"� +•...� 279 Front Street Danville, CA 94526 I b. Notices concerning the claim should be sent to 2 claimants' attorney, William E. Gagen, Jr. , at Gagen, McCoy, 3 McMahon & Armstrong, A Professional Corporation, 279 Front 4 Street, P. O. Box 218, Danville, California. 5 C. The incident giving rise to this claim occurred on or 6 about January 3 , 1991, at 15 Cleopatra Drive, Pleasant Hill, 7 California 94523, and the circumstances giving rise to this claim 8 are as follows: On or about January 3, 1991, PATRICIA HAZEL 9 11 TOMSIK drove her motor vehicle into cla imant I s Pleasant Fall home 10 and bedroom by reason of her medical condition and/or disorder 11 characterized by a lapse in consciousness and control. Once 12 inside claimant's home said vehicle ran over TERRY HOWELL, wife 13 of claimant KEVIN HOWELL and mother of claimant MELANIE DANILLE 14 HOWELL, causing her death. A police report was prepared and is 15 attached hereto and is incorporated herein by reference. 16 Prior to January 3, 1991, CONTRA COSTA COUNTY had actual or 17 constructive notice that PATRICIA HAZEL TOMSIK suffered from a 18 medical condition and/or disorder characterized by a .lapse in 19 consciousness and control and was unable to safely operate a 20 motor vehicle upon a highway; however, CONTRA COSTA COUNTY failed 21 to take reasonable steps to prevent PATRICIA HAZEL TOMSIK or 22 cause others to prevent her from operating a motor vehicle. 23 d. A general description of the injuries, damages, or 24 losses incurred so far as they are known at this time are: the 25 loss of the decedent's love, companionship, comfort, affection, 26 society, solace, moral and financial support; loss of enjoyment Law Offices GAGEN, McCOY, McMAIION & ARMSTRONG A professional Corporation is\client\22336\HeaClaim.pid 279 Front Street —2— Danville, CA 94526 1 of sexual relations, ability to have children; physical and moral 2 assistance and support, personal services, advice and training in 3 the operation and maintenance of the home and in the rearing of 4 decedent's minor daughter; pain, discomfort, fears, anxiety, 5 mental and emotional distress suffered by the claimants and/or 6 the decedent; medical and hospital services and supplies; damages 7 to claimant's real and personal property; anticipated future 8 contributions, earning ability and anticipated future earnings as 9 well as anticipated future employment bene-fits; funeral and 10 burial expenses. 11 e. The names of the public employees causing the claimants' 12 injuries, damages or losses are not known at the present time, 13 however, investigation is continuing. 14 f. The amount of claim at this time is way in excess of 15 $25, 000 and jurisdiction over the claim rests in the Superior 16 Court. 17 Dated: 5; GAGEN, McCOY, McMAHON & ARMSTRONG A Professional Corporation 18 19 20 ILLIAM E. GEN, JR. Attorneys for Claimant . 21 22 23 24 25 26 Law Offices GAGEN, McCOY, McMAIION& ARMSTRONG A Professional Corporation is\client\22336\HeaClaim.pld 279 Front Street _3_ Danville, CA 94526 c� a v t N � J � d +- d ct1 N eL � O�4 N RECEIVED ,r JUN 51991 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY COUNSEL MARTINEZ, CALIF. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JUNE 25, 1991 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: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: ROSS, Beverly ATTORNEY: Stanley T. Grydyk, Esq. Grydyk & Pierce Date received ADDRESS: 4006 Macdonald Ave. BY DELIVERY TO CLERK ON May 29, 1991 Richond, CA 94805 Cert. P 671 679 8 BY MAIL POSTMARKED: May 28, 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: June 4, 1991 IYIL BAATTCHELOR, Clerk ty 11. FROM: County Counsel TO: Clerk of the Board of Su ors `(" ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: S 9I BY: I 0, J - Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present ( V1 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. JUN 2 5 1991 Dated: PHIL BATCHELOR, Clerk, ByDeputy Clerk WARNING (Gov. code sec 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JUN 2 7 MI BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RECEIVE® MAY 2 91991 CLERK 80ARD PERViSORS CONTRA os A cry. �lOD6 May 28 , 1991 Clerk , Board of Supervisors Chief Executive Officer 651 Pine Street Merrithew Memorial Hospital Martinez , CA 94553 2500 Alhambra .Avenue Martinez , CA 94553-3191 RE: BEVERLY ROSS, MEDICAL RECORD NO. 005230099-12-0004, CLAIM UNDER GOVERNMENT CODE §910 Gentlemen: The following claim is hereby presented : 1 . Name and address of claimant: Beverly Ross , 1467 Madeline Road , San Pablo, CA 94806 . 2 . Address to which claimant desires notices to be sent: Stanley T. Grydyk , Esq. , 4006 Macdonald Avenue , Richmond, CA 94805 . 3 . Date, place and circumstances of occurrence: Claimant was admitted to Merrithew Memorial Hospital in Martinez , California, on January 4, 1991 , for treatment for her asthma condition. She had been treated for the same condition on a number of previous occasions at the same hospital . Claimant is informed and believes that Merrithew Memorial Hospital at all times herein mentioned was owned and operated by Contra Costa County, California. Claimant ' s treating physician was Neil Jorgensen, M.D. . Claimant was referred to the x-ray department for x-rays at a time when she was in a weakened condition and could not stand for the x-ray without a possibility of falling. She informed the x-ray technician of her condition. Ongprevious occasions her x-ray had been taken at the same hospital by alternate means , to wit, in bed or in her wheelchair . Claimant fell while her x-ray was being taken in a standing position, bringing down with her an intravenous apparatus and her wheelchair which was standing empty adjacent to her , both of which struck her . 4 . Description of injury, damage or loss incurred: As a proximate cause of said fall , claimant fractured her right ankle , which required additional hospital convalescence at. Merrithew Clerk , Board of Supervisors Merrithew Memorial Hospital May 28 , 1991 Page Two Memorial Hospital for four days , application of a cast on January 11 , 1991 , and removal of the cast on February 1 , 1991 , at the Richmond Clinic , which is also owned and operated by Contra Costa County. Claimant suffered pain and suffering, inconvenience be- cause she had to arrange for the care of her minor child, loss of consortium and restricted physical activity for four months . Claimant still has to restrict her activities and is unable to engage in her usual physical activities which involve bowling, dancing and playing with her child because her ankle swells and hurts . 5 . Names of employees causing such injury, damage or loss are not known. 6 . The amount of the claim insofar as known at this time exceeds $10 ,000 .00 . The jurisdiction over this claim would rest in the municipal court. This claim is being presented by Stanley T. Grydyk on behalf of Beverly Ross this 28th day of May, 1991 . - STANLE T. GRMerly Attorney for Ross STG: jv CERTIFIED MAIL - RETURN RECEIPT REQUESTED k y r YP SRA A N Cn O N N � 'd ,j t� �N G n� to CD V`o r to 6' � 4d C'3 dart 0 W � � VICTOR J. WESTMAN CONTRA COSTA COUNTY COUNSEL TO P.O. BOX 69, CO. ADMIN. BLDG., ` MARTINEZ, CA 94553 DATE SUBJECT e QS � 1 errithew emorial RECEIVE® 0WOCT&I JUN 31991 A N D CLINICS COUNTY COUNSEL MARTINEZ. CALIF. TO: Office of County Counsel DATE: DATE: May 31, 1991 Contra Costa County FROM: Mark Finucane �wA" RE: CLAIM Health Services Di-rector BEVERLY ROSS Record #523009-9 The attached claim for the above named patient was received by Merrithew Memorial Hospital on May 30, 1991. SP Attachment cc: Risk Management Department ROSS Contra Costa County A-301A (3/87) t +itl Au'-'i .._ . .iµi fl006 /i�wca�o a�a i S v�r�rcuPi CLIN105 �(O� yziav9/l�OS May 28 , 1991 Clerk , Board of Supervisors Chief Executive Officer 651 Pine Street Merrithew Memorial Hospital Martinez , CA 94553 2500 Alhambra Avenue Martinez , CA 94553-3191 RE: BEVERLY ROSS, MEDICAL RECORD NO. 005230099-12-0004, CLAIM UNDER GOVERNMENT CODE §910 Gentlemen : The following claim is hereby presented : 1 . Name and address of claimant: Beverly Ross , 1467 Madeline Road , San Pablo, CA 94806 . 2 . Address to which claimant desires notices to be sent: Stanley T. Grydyk , Esq. , 4006 Macdonald Avenue , Richmond , CA 94805 . 3 . Date, place and circumstances of occurrence: Claimant was admitted to Merrithew Memorial Hospital in Martinez , California , on January 4 , 1991 , for treatment for her asthma condition. She . had been treated for the same condition on a number of previous occasions at the same hospital . Claimant is informed and believes that Merrithew Memorial Hospital at all times herein mentioned was owned and operated by Contra Costa County, California. Claimant ' s treating physician was Neil Jorgensen , M.D. . Claimant was referred to the x-ray department for x-rays at a time when she was in a weakened condition and could not stand for the x-ray without a possibility of falling. She informed the x-ray technician of her condition. On previous occasions her x-ray had been taken at the same hospital by alternate means , to wit , in bed or in her wheelchair . Claimant fell while her x-ray was being taken in a standing position , bringing down with her an intravenous apparatus and her wheelchair which was standing empty adjacent to her , both of which struck her . 4 . Description of injury, damage or loss incurred: As a proximate cause of said fall , claimant fractured her right ankle , which required additional hospital convalescence at Merrithew Clerk , Board of Supervisors Merrithew Memorial Hospital May 28 , 1991 Page Two Memorial Hospital for four days , application of a cast on January 11 , 1991 , and removal of the cast on February 1 , 1991 , at the : Richmond Clinic , which is also owned and operated by Contra Costa County. Claimant suffered pain and suffering, inconvenience be- cause she had to arrange for the care of her minor child , loss of consortium and restricted physical activity for four months . Claimant still has to restrict her activities and is unable to engage in her usual physical activities which involve bowling, dancing and playing with her child because her ankle swells and hurts . 5 . Names of employees causing such injury, damage or loss are not known. 6 . The amount of the claim insofar as known at this time exceeds $10 , 000 .00 . The jurisdiction over this claim would rest in the municipal court. This claim is being presented by Stanley T. Grydyk on behalf of Beverly Ross this 28th day of May, 1991 . 4STANLEX T. GRY K Attorney for Beverly Ross STG: jv CERTIFIED MAIL - RETURN RECEIPT REQUESTED E o R� N as J � O Ca s � r .9 a � r sa a 0 a 0 J� IA � _ : f i_ RECEIVED JUN 31991. 0 FfiUPE SORS �� � .•'. �j• � 't'1T� �l00 A CO. May 28 , 19 91 Ron t 4arvey Clerk , Board of Supervisors Chief Executive Officer 651 Pine Street Merrithew Memorial Hospital Martinez , CA 94553 2500 Alhambra Avenue COn$i8 COS�B COun�� . Martinez , CA 94553--319 (DECEIVED RE: BEVERLY ROSS, MEDICAL RECORD JUN 3 1991 NO. 005230099-12-0004, CLAIM UNDER GOVERNMENT CODE 5910 Kish Management Gentlemen : The following claim is hereby presented : 1 . Name and address of claimant: Beverly Ross , 1467 Madeline Road , San Pablo, CA 94806 . 2 . Address to which claimant desires notices to be sent: Stanley T. Grydyk , Esq. , 4006 Macdonald Avenue , Richmond , CA 94805 . 3 . Date, place and circumstances of occurrence: Claimant was admitted to Merrithew Memorial Hospital in Martinez , California , on January 4 , 1991 , for treatment for her asthma condition. She had been treated for the same condition on a number of previous occasions at the same hospital . Claimant is informed and believes that Merrithew Memorial Hospital at all times herein mentioned was owned and operated by Contra Costa County, California. Claimant' s treating physician was Neil Jorgensen, M.D. . Claimant was referred to the x-ray department for x-rays at a time when she was in a weakened condition and could not stand for the x-ray without a possibility of falling. She informed the x-ray technician of her condition. On previous occasions her x-ray had been taken at the same hospital by alternate means , to wit , in bed or in her wheelchair . Claimant fell while her x-ray was being taken in a standing position , bringing down with her an intravenous apparatus and her wheelchair which was standing empty adjacent to here, both of which struck her . 4 . Description of injury, damage or loss incurred: As a proximate cause of said fall , claimant fractured her right ankle, which required additional hospital convalescence at Merrithew l Q ;;;; O 1 7 R'. T : y ` T ..............i Y 11 t :.'.':::.'.'.'::.'.':::.'.'.'::.':':.'.'.'.'.'.':.".'::::.'.:.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.:'.:'.'.:'.:'.'.'.'.'.':.':.'. ...... :.'.' . ........... . T Y .::::... yy ........ LF' ® ........... ..........................................:.....:.5.:........ ................................ w t-n (D D' Pi O H r. rt o f'i (D ;,- art N W E (D � n C7CrC > Pi (D rt tvgr• O C %D 9 H (D .r� C r• - u, (Dwo w C rn w O n .0 b Pi tp - rt mop t¢ • `.,' om Hop.. Ws dpOlfis RECEIVE® errlthew 14 ,og, 4emorial ��UNTM RT1NEz GUF O�P�4C� AND CLINICS TO.. Office of County Counsel DATE: June 13, 1991 Contra Costa County FROM: Mark Finucane *44k RE. NOTICE OF INTENT TO Health Services Director s��T� COMMENCE ACTION Name Beverly Ross Record # 523009-9 Claim # Enclosed is Notice of Intent to Commence Action regarding the above patient. This was received by Merrithew Memorial Hospital on June 13, 1991. SP Enclosure cc: Risk Management Department ROSS n: ., Contra Costa County A-301A (3/87) NOTICE TO: Merrithew Memorial Hospital 2500 Alhambra Avenue Martinez , CA 94553 This notice of action is based on Section 364 of the Code of Civil Procedure and on the injury to BEVERLY ROSS which occurred on or about January 7 , 1991 , which resulted from your negligence and the negligence of your employees and agents . The negligence claimed will be based upon the fact that you, your employees and agents failed to comply with all of the professional standards in the treatment and care of BEVERLY ROSS as follows : 1 . BEVERLY ROSS was admitted to Merrithew Memorial Hospital in Martinez , California, on January 4 , 1991 , for treat- ment for her asthma condition. She had been treated for the same condition on a number of previous occasions at the same hospital . BEVERLY ROSS is informed and believes that Merrithew Memorial Hospital at all times herein mentioned was owned and operated by Contra Costa County, California. - BEVERLY ROSS ' treating physi- cian was Neil Jorgensen, M.D. . BEVERLY ROSS was referred to the x-ray department for x-rays at a time when she was in a weakened condition and could not stand for the x-ray without a possibility of falling. She informed the x-ray technician of her condition. On previous occasions her x-ray had been taken at the same hospital by alternate means , to wit , in bed or in her wheelchair. BEVERLY ROSS fell while her x-ray was being taken in a standing position, bringing down with her an intravenous apparatus and her wheel- chair which was standing empty adjacent to her , both of which struck her . 2 . As a proximate cause of your aforesaid negligence and the negligence of your agents and employees , BEVERLY ROSS suffered a fractured right ankle , which required additional hospital convalescence at Merrithew Memorial Hospital for four days , application of a cast on January 11 , 1991 , and removal of the cast on February 1 , 1991 , at the Richmond Clinic , which is also owned and operated by Contra Costa County. BEVERLY ROSS suffered pain and suffering, inconvenience because she had to arrange for the care of her minor child , loss of consortium and restricted physical activity for four months . BEVERLY ROSS still has to restrict her activities and is unable to engage in her usual physical activities which involve bowling, dancing and play- ing with her child because her ankle swells and hurts . You should notify your malpractice insurance carrier and your attorney immediately. I am amenable to discuss this action with you with the possibility of a settlement which would preclude the necessity of filing a legal action against you, if you do so prior to the expiration of 90 days from the date of this notice. Dated : June , 1991 . BEVERLY ROS c/o Stanle T. Grydyk Attorney at Law 4006 Macdonald Avenue Richmond , CA 94805 -2- � S ��pjlA"�Q .� � ✓ TFl l 'f 1 t S m •„ q � rA c7% 4-3 ,.n 3� N N "rA,,, o � � o 'T N p1� J ' 4 d t W W � N N HN � wa U � O e CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA U Claim Against the County, or District governed by) BOARD ACT1( RT1N �i4LIPa the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JUNE 25, :1991 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: $684.28 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: TITLOW, Ernest 103 Heather Drive ATTORNEY: San Pablo, CA 94806 Date received. ADDRESS: BY DELIVERY TO CLERK ON May 28. 1991 (via transmittal) BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg DATED: June 4, 1991 BILL DepuLyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of S isors � ) 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: c /5 / 91 BY: I J 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 ORD R: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JUN 2 5 W1 PHIL BATCHELOR, Clerk, By . Deputy Clerk WARNING (Gov. code sec 3) Subject to certain exceptions, you have only six (6) months from the date this nitice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; 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: JUN 2 7 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CNM COSTA COUNTY INSTRUCTIONS M CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and 'which accrue on orafter January 1, 1988, must be presented not later than six months after the accrual of the cause of action. -Claims relating to any other cause of action must be presented not later than,one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors 'at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a -district governed by.the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity;--separate clalms*must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal- Code See. 72 at the end of this To-rM. RE: Claim By Reserved for Clerk's filing stamp Mr. Ernest Titlow RECEIVED rE 103 Heather Drive, San Pablo, CA. LC 19L Against the-County of Contra Costa A I 1W 2 8 1991 or Contra Costa County Dis I tric:t) OF SORS _Mil in I CoNTRA,CO CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: I Glass alone is $684.28 to replace. ---------------------------- ..__..__..______.._...._..__....__---___-__..__ 1. When, did the damage or injury occur? (Give exact date and hour), The damage o I ccur Thursday April 25th 1991 around 3:40pm. --——--------—--——--------------—-----------------------—--------------- 2. Where did the damage or injury occur? (Include city and county) The damage occurred/injury at 103 Heather Drive, 'San Pablo in Contra Costa County. ------------------------------------ ---------—-------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required),, -Bullets shout at 103 Herther Dr. from 124 Herther Dr. and 103 ,'Property. became a comman post for the police department. —-——-——----—-------------—----------------—------------I-—----—-------- .4. What particular act or omission on the part ;of county or district offioers, servants -or employees caused the injury or damage? 103 Herther Dr. was use as police comman post and became a tar'get. The house,cainpertruck,("and other perperties were hit by bullets. ' (over) 5. • What are the naaes'of county or district olTicers, servants or employees causing j the. damage or injury? R f I Contra Costa Sheriff Department, and other police agencies. - 5. What damage or injuries do you claim resulted? (Give Hall extent-of injuriesor damages claimed. Attach two estimates for auto damage. Glass in house and camper truck glass was shout out. . -------------------------------------------1------------------- --,..---..---..--------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) The glass was computed by Crown Glass Co. Mr. Don Thevenot did 'the estimate. --rr.1s—a®®sages—es--- $. Names and addresses of witnesses, doctors and hospitals. Fred Ortega 1454 Rachel Road, San Pablo. Terrie Phllips 144 Hearther Dr. San Pablo. -------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE, ITEM AMOUNT Undetermened # # dF # * # # # # # # # E! # # # # # # # # # # # # # # # # # # # #! W # # # # # # # Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) orb some person on his behalf." Name and Address of Attorney ,; Claimant's Signature Mr. Ernest Titlow i Address 103 Heather Drive, San Pablo, CA 94806 Telephone No. Telephone No. 415 223-5920 a � NOTICE Section 72 of the Pena]. Code provides: "Ever person who with intent to defraud y p , presents for allowac nee or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false,'or fraudulent ' claim, bill, account, voucher, or writing, is punishable either by! imprisonment in the county jail for a period of not more than one year, by a fine ,of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. i Auto Gid Installed t Window Glass °• Foreign-Domestic CRO/CALIF. "` Mirrors C' ved Windshields t f t Plate Glass Channels-Regulators 3y2 2 3 Shower Doors Felt Channels GLASS f"�°` �r Medicine Cabinets Rubber Weatherstrip Tel• 646-4155 Table Tops • Desk Tops 1231 23rd STREET 3262.SAN PABLO 94804 Date 21 cMe3' 191 Sold To Contra Costa Couhty Deliver To Mr. Ernest Risk Management Divienn' 103 Heather Drive Address 651 Pine Street (6th floor) Address San Pa4b, CA.94806 Martinez,. CA 94553 CityAWnt-ic (Mg City, Tel:. .22j__5920- Quantity DESCRIPTION Price Amount t ., eomrr ,e ' HCl,( .7 24 14� ` O ©Sinus 33 t x ` S t . o'41, t � ��t `-'"'—t,"�r �`� „-t'�—..3f'.v2✓ `�. �5J 1, is TERMS: A ..BILLS—DUE END'OF MONTH OF PURCHASE. DELINQUENT AFTER 10TH OFFOLLOWING MONTH. 7%INTEREST CHARGED -AFTER 66 DAYS. ©s 0 �v 0 740 a m ACL N V S tS1 � Z O S `i Ya v ID ZU1'in a � N cU N ✓ cn O a° s�-