ACCEPTED 03-15-00596-CV 8332526 THIRD COURT OF APPEALS AUSTIN, TEXAS 12/21/2015 4:56:48 PM JEFFREY D. KYLE CLERK NO. 03-15-00596-CV FILED IN IN THE THIRD COURT OF APPEALS 3rd COURT OF APPEALS AUSTIN, TEXAS AUSTIN, TEXAS 12/21/2015 4:56:48 PM JEFFREY D. KYLE Clerk GRACY WOODS I NURSING HOME APPELLANT v. MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA APPELLEE

ON INTERLOCUTORY APPEAL FROM THE 250TH JUDICIAL DISTRICT,' TRAVIS COUNTY, TEXAS

APPELLEE'S BRIEF

Jack Modesett, III Texas Bar No. 14244337 Walter V. Williatns Texas Bar No. 21584800 MODESETTWILLIAMS, PLLC Congress Avenue, Suite 1650 Austin, Texas 78701 512-472-6097- Telephone 512-481-0130- Telecopier j ack@modesettlaw .cotn ATTORNEYS FOR APPELLEE

ORAL ARGUMENT REQUESTED IDENTITIES OF PARTIES AND COUNSEL Pursuant to Tex. R. App. P. 38.1(a), Appellee cetiifies that the following is a complete list of all parties to this litigation and the names and addresses of all counsel.

Party Appellate Counsel Trial Counsel Grace Woods I E1nily J. Davenpoti Emily J. Davenport Nursing Home, Janice Byington Janice Byington Appellant Reed, Claymon, Meeker & Reed, Claymon, Meeker & Hargett, PLLC Hargett, PLLC 5608 Parkcrest Dr. Suite 5608 Parkcrest Dr. Suite 200 200 Austin, Texas 78731 Austin, Texas 78731 [email protected] [email protected] [email protected] [email protected] Martha Mahan, as Jack Modesett, III Jack Modesett, III the Representative Walter V. Williams Walter V. Williams of the Estate of ModesettWilliams, PLLC ModesettWilliams, PLLC Mary Rivera, 515 Congress Ave., 515 Congress Ave., Appellee Suite 1650 Suite 1650 Austin, Texas 78701 Austin, Texas 78701 [email protected] j [email protected] [email protected] [email protected]

TABLE OF CONTENTS

IDENTITY OF PARTIES AND COUNSEL .................................................... i TABLE OF CONTENTS ................................................................................ ii TABLE OF AUTHORITIES ......................................................... .iv ABBREVIATIONS OF RECORD REFERENCES ......................................... vi APPENDIX ..................................................................................................... vii STATEMENT OF THE CASE ....................................................................... viii COURSE OF PROCEEDINGS AND DISPOSITION ................................... viii STATEMENTREGARDINGORALARGUMENT........................................ 1 STATEMENT OF JURISDICTION ................................................................. 1 ISSUES PRESENTED ...................................................................................... 1 STATEMENT OF FACTS ................................................................................ 2 SUMMARY OF ARGUMENT ......................................................................... 4 ARGUMENT AND AUTHORITIES ................................................................ 5 I. STANDARD OF REVIEW ................................................................. 5 II. DR. LIPSON IS QUALIFIED ............................................................. 5 A. Summary ofDr. Lipson's Qualifications ............................... 6 B. Dr. Lipson is Qualified to Offer Causation Opinion ............. 9 C. Dr. Lipson is Qualified to Offer Opinions on Standard of Care and Breach ................................................ 18 III. THE REPORT IS A GOOD FAITH EFFORT TO COMPLY WITH CHAPTER 74 ................................................. 21 A. Summary of Dr. Lipson's Report ........................................ 21 B. The Report is Sufficient as to Breach and Causation ......... 28 CONCLUSION AND PRAYER ..................................................................... 32 CERTIFICATE OF SERVICE ....................................................................... 33 CERTIFICATE OF COMPLIANCE .............................................................. 34

NO. 03-15-00596-CV

IN THE THIRD COURT OF APPEALS AUSTIN, TEXAS

GRACY WOODS I NURSING HOME APPELLANT v. MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA APPELLEE

ON INTERLOCUTORY APPEAL FROM THE 250TH JUDICIAL DISTRICT, TRAVIS COUNTY, TEXAS

APPELLEE'S BRIEF

Jack Modesett, III Texas Bar No. 14244337 Walter V. Williatns Texas Bar No. 21584800 MODESETTWILLIAMS, PLLC Congress Avenue, Suite 1650 Austin, Texas 78701 512-4 72-6097- Telephone 512-481-0130- Telecopier [email protected] ATTORNEYS FOR APPELLEE

ORAL ARGUMENT REQUESTED whether S.B. had been raped. Timberlawn's arguments are best summarized in the conclusion and prayer set forth in its brief: [Levine] did not and/ or could not express an opinion, based on his education, training or experience, that [S.B.] was sexually assaulted or raped. [S.B.' s] expert did not nor could not articulate facts to support any opinion that [Timberlawn' s] alleged breaches in the standard of care proximately caused [S.B. 's] alleged sexual assault or rape. [S.B. 's] expert has not shown himself to be qualified to render an opinion that [S.B.] was sexually assaulted or raped or that the alleged breaches in the standard of care proximately caused [S.B. 's] sexual assault or rape.

Thus, the premise of Timberlawn's arguments is that unless S.B. can present the report of a qualified expert opining that S.B. was actually raped, her expert report( s) cannot identify the alleged causal relationship between Timberlawn' s actions or omissions and S.B.' s alleged injuries, as required by section 74.351(r)(6). We reject this premise.

In some healthcare liability claims, the ((injury, harm, or damages claimed" flow from the existence of a medical condition that itself resulted from the breach of the applicable standard of care. In such cases, identifying the causal relationship between the alleged breach of the standard of care and the resulting harm involves not only an explanation as to how the standard of care was breached, but also how the breach gave rise to the new, deleterious medical condition. Similarly, other healthcare liability claims may allege that a breach of the applicable standard of care exacerbated a pre-existing medical condition, or hindered or prevented the effective treatment of such a condition. Identifying the ((breach/injury" causal relationship in these cases may well require an expert to opine as to the existence, extent, and prognosis of the pre-existing medical condition, as well as how the alleged breach of the standard of care aggravated such a condition, impeded or prohibited its treatment, and otherwise affected the patient's prognosis.

However, S.B. 's claim is different. S.B. alleges that, as a result of Timberlawn's failure to meet the applicable standards of care ABBREVIATIONS AND RECORD REFERENCES Abbreviations: Appellee will be referred to as "Appellee", "Mahan" or "Ms. Rivera." Appellant, Gracy Woods I Nursing Home will be referred to as "Appellant" or "Gracy Woods." Record References: References to the Clerk's Record are in the form of "CR " References to the Clerk's Supplemental Record are in the form of"Supp. CR_." References to the Reporter's Record are in the form of"RR_." References to the Appendix items attached to the Brief are in the form of "App._."

Vl APPENDIX Report of Loren Lipson, M.D. with exhibits 1 .......................................... Appendix 1

Appellant's Appendix 5, "Report of Loren Lipson, M.D." does not contain all of Dr. Lipson's referenced exhibits.

Vll STATEMENT OF THE CASE Appellee is satisfied with Appellant's statement of the case. Tex. R. App. P. 38.2(a)(l )(B).

COURSE OF THE PROCEEDINGS AND DISPOSITION Appellee is satisfied with Appellant's Course of Proceedings. Tex. R. App. P. 38.2(a)(l)(B).

Vlll NO. 03-15-00596-CV

IN THE THIRD COURT OF APPEALS AUSTIN, TEXAS

GRACY WOODS I NURSING HOME APPELLANT v. MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA APPELLEE

ON INTERLOCUTORY APPEAL FROM THE 250TH JUDICIAL DISTRICT, TRAVIS COUNTY, TEXAS

APPELLEE'S BRIEF

Jack Modesett, III Texas Bar No. 14244337 Walter V. Williatns Texas Bar No. 21584800 MODESETTWILLIAMS, PLLC Congress Avenue, Suite 1650 Austin, Texas 78701 512-4 72-6097- Telephone 512-481-0130- Telecopier [email protected] ATTORNEYS FOR APPELLEE

ORAL ARGUMENT REQUESTED STATEMENT REGARDING ORAL ARGUMENT Appellee requests oral argument pursuant to TEX. R. APr. P. 39.1 and respectfully submits that oral argument would aid the Court in determining the legal and factual issues presented in this appeal.

STATEMENT OF JURISDICTION Appellee is satisfied with Appellant's Statement of Jurisdiction. Tex. R. App. P. 38.2(a)(1)(B).

ISSUES PRESENTED Appellee is satisfied with Appellant's statement of the Issues Presented.

Tex. R. App. P. 38.2(a)(1)(B).

STATEMENT OF FACTS On November 8, 2013, 78 year-old demented Mary Rivera was sexually assaulted in her room, while a resident at Appellant's nursing home facility. (CR 17.) The rape occurred after regularly scheduled events at the nursing home during which alcohol was served. (CR 17.) Mrs. Rivera's daughter, Martha Mahan, had previously complained to the facility that younger male residents had behaved inappropriately towards Mrs. Rivera. Appellant took no action. (CR 17.)

Early in the morning of November 9, 2013, Mahan went to visit her mother in the nursing home. Mrs. Rivera was distressed. Mahan noted broken glass on the floor of her room. When she took her mother to the bathroom, Mrs. Rivera attempted to urinate standing up, which was unusual. Mahan also found a wad of bloody rags in Mrs. Rivera's trashcan. (CR 17-18.) Mahan showed this evidence to nursing home employees, who destroyed it. (CR 17-18.) Ultimately, Mrs. Rivera was taken to St. David's Medical Center where a Sexual Assault Nurse Examiner (SANE) performed a post-rape examination. (CR 18, 92, 100.) This SANE nurse found bruising to posterior fourchette and periurethral areas of Mrs. Rivera's vulva as well as bruising on her posterior vaginal wall. (CR 18, 94, 100.)

According to the SANE nurse, this definitively indicated penetration of the female sexual organ. (CR 18, 94, 100.)

j. Unive~·sity of Southe111 California S¢l:Cool of Medicine~ Los Angeles? California; Chie~ Dlvlsion of Gerlatdo Medicine· jn the DepartJ;ne11t ofMedlcinej January 19&4- 2005.

k. University of Southern Califotnhh Los Angeles~ Califot:nia~ Associate Professot of' Gerontology, L~onard Davis School of Gerontology~ Ethel Percy An.drus Gerontology Center~ Januaty 1984 ,_ Septetnber 2006.

1. University of Southern CalifomiaJ Los Angeles,· California; Assooiate Professor cf Clinical Pharmacy, U.S.C7 Sohool of Pharmacy~ October 1989 .... September 2006~ m. Los Angeles County/University of Southe:n1 California Medical Center~ Los Angeles, California; Staff Physloia11 in Medioinej (Oeriatdo Medicine), 1984..2004.

u, Sabbatioal Leave> Harvard Medical School~ Boston, Massachusetts~ Dlvisio11 of Agingt John A. Hartfol'd Seniol' Scholar in Gerlatdc Medicine-~ 19 84- 1985.

o. B:dghant & Women~s Hospital, Boston,. Massaohusetts; Clinioal Fellow in Medioine (Oer!atrio Medicine)~ 1984 ..1985.

p 4 :Beth Israel I-iospital~ Boston~ Massachusetts; Clinical Fel~ow in Medicine (Ge:dai1'lc Ivfedioine), 1984 .... 1935 q. University of Southern California, Los Angeles~ California; Senior Research Associate; Getontology Research Institute; Ethel Percy Andrus Gerontology Cente1~ 1985 .-.. 1989.

r. University of Southern. California., Los Angeles~ California; Fellow Institute of Advance Study, Ethel Percy Andtus Gerontology Center, 19B5 . . . 1987.

$. University of Southern California University Hospital, Los A11geles~ California; Chief of Geriatric Medicine~ 1991.. 2005 University of Southern California . . . School of DentistJ:y - Associate Professor of Medical Dentistry and Public HealthJ 1994 i -September 2006.

I u. Unlversity of Sottthem California~ School of Independent Health _Professionals - Associate Professor o:f Oocupa.!ional Science and Oooupational Therapy~ 1998~ S~ptember 2006.

I l I I I I I J ·-·--· ----·----,---,--··-·~-------·- --- -····-·····-·----··-·-----:-- ··--· ··--·{:·· i .. D ' '\,! • j 'i J .• ~~-.

. . J

APPENDIX 1 SUMMARY OF THE ARGUMENT A smattering of citations to black letter law belie what Appellant's Brief really appears to be: a cut-and-paste boilerplate appeal of an adverse ruling on a Section 74.351 motion to dismiss. Appellant challenges the qualifications of an expert eminently qualified on nursing home healthcare, and argues that a detailed and comprehensive export report somehow fails to meet the "good faith" standard.

Appellant largely ignores both the level of detail of Dr. Lipson's report, as well as his unassailable CV. Dr. Lipson is the expert that the U.S. Department of Justice, U.S. Department of Health and Human Services, the Office of the Inspector General, and the states of Alaska, California, and New Mexico have turned to regarding geriatric medicine, elder abuse, and long term care of the elderly. He is quite possibly the most qualified expert in the country on these issues. His report details his background, the facts and documents that form the basis of his opinion, the applicable standard of care, specifically what Appellant should have done but failed to do, breach, causation, and the resulting injury. His report certainly meets the "good faith" standard, as the trial court correctly determined. The trial court's determination was not an abuse of discretion-- it was in no way "an arbitrary or unreasonable [act] without reference to any guiding rules or principles" -- and it should be affirmed.

ARGUMENT AND AUTHORITIES I. STANDARD OF REVIEW A trial court's order granting or denying a motion to dismiss filed under Section 74.351 of the Texas Civil Practices and Remedies Code is reviewed under an abuse of discretion standard. Hendrick Med. Ctr. v. Texas Podiatric Med. Ass'n, 392 S.W.3d 294, 296-97 (Tex. App.-Eastland 2012, no pet.); Bowie Memorial Hasp. v. Wright, 79 S.W.3d 48, 52 (Tex. 2002); Am. Transitional Care Ctrs. v. Palacios, 46 S.W.3d 873, 875, 877-78 (Tex. 2001 ). An abuse of discretion occurs if the court acts in an arbitrary or unreasonable manner without reference to any guiding rules or principles. Wright, 79 S.W.3d at 52. A court of appeals may not substitute its own judgment for the trial court's judgment. !d.

II. DR. LIPSON IS QUALIFIED Appellant complains that Dr. Lipson is not qualified under TEx. CN. PRAC. & REM. CODE § 74.402 (be a healthcare provider or consultant in "same field" as a defendant, knowledge of the standard of care and qualified on basis of training or experience) and § 74.403 (i.e., be a physician and be otherwise qualified).

Dr. Lipson is a nationally prominent physician, professor, lecturer and consultant in geriatric medicine, abuse of the elderly and related topics. Dr. Lipson's qualifications are extensive; he may be the most qualified expert in the country and is the one the U.S. Department of Justice and the U.S. Department of

Health and Human Services retain when they need expertise in this area. He is qualified under both TEX. CIV. PRAC. & REM. CODE §74.402 and §74.403.

A. SUMMARY OF DR. LIPSON'S QUALIFICATIONS 1. Educational Background in Geriatric Medicine Dr. Lipson is a graduate of UCLA and The John Hopkins University School of Medicine. (See Dr. Lipson's CV, CR 24-67 1). Dr. Lipson did his internship and residency at The John Hopkins Hospital. Dr. Lipson has fellowships from Harvard (Geriatric Medicine), Beth Israel Hospital (Gerontology), Brigham-Women's Hospital (Gerontology), Hebrew Rehabilitation Center (Geriatric Medicine) and John Hopkins (Clinical Fellow) among others. Id. 2. Certification in Geriatric Medicine He is boarded in Internal Medicine and Quality Assurance and Utilization Review and holds a Certificate of Expertise in Geriatric Medicine from the American Board of Internal Medicine. Quality assurance is the study and implementation of improvements to care provided, in Dr. Lipson's case, for the elder population in both the nursing home and hospital setting. I d.

3. Twenty-Seven Academic Appointments in Geriatric Medicine Dr. Lipson has received twenty-seven academic appointments to include John Hopkins, Harvard Medical School (Scholar Geriatric Medicine),

Appendix 1 to Appellee's Brief.

Massachusetts General Hospital, USC (Associate Professor-Geriatric Medicine), USC (Chief-Division of Geriatric Medicine), Brigham-Women's Hospital (Geriatric Medicine), Beth Israel (Geriatric Medicine), USC (Gerontology Research Institute) and University of Alaska (Geriatrics). His teaching responsibilities include USC-Fellowship Program-Geriatric Medicine, USC- Development and Improvement of Geriatric Medical Curriculum, USC-Steering Committee-Pacific Geriatric Education Center, and USC-Ethel Percy Andrus Gerontology-Director and lecturer. His teaching responsibilities at the University of Alaska also include Director-Care of Elderly, Co-Director in Geriatric Education and Faculty Consultant to Geriatric residents. !d.

4. Geriatric Administrative Positions, Including Directorships Dr. Lipson has further served in numerous administrative positions to include Chief of Division Geriatric Medicine, Senior Staff Physician-Geriatric Programs, Director of the USC Ambulatory Health Center Japanese Retirement Homes, Director-Geriatric Medicine VA Clinic, Director of USC Teaching Nursing Home Program, Director of Senior Cancer Center, Director of Senior Care Program-USC, Co-Director-Adult Protective Team-Geriatric Medicine Program- LAC/USC, Medical Director-Alaska Geriatric Education Center and Medical Director National Resource Center for Studies in Native American, Alaskans and Hawaiian Elders, University of Alaska. !d.

5. Geriatric Consultancies: Boards, Program Development His public service includes Consultant-Geriatric Medicine-State of Alaska, Board of Directors, California Association of Medical Directors, and Task Force on Elder Abuse, City of Los Angeles. I d.

Dr. Lipson's consultancies include Geriatric Medicine-Silverado Senior Living Centers, Geriatric Medicine-Glendale Adventist Medical Center, Geriatric Program Development-Bay Shores Medical Group, Geriatric Program Development-San Dimas Community Hospital, Geriatric Program Development and Long Term Care-The Motion Picture & Television Home, Long Term & Geriatric Medicine- State of Califo1nia, Elder Abuse & Geriatric Medicine - State of California, Office of the Attorney General, Long Term Care, Elder Abuse and Geriatric Medicine-State of California-Office of the Attorney General - Medicaid Fraud, Geriatric Medicine and Elder Abuse-State of New Mexico, Geriatric Medicine and Elder Abuse-United States of America- Department of Justice, and Long Term Care, Geriatric Medicine and Elder Abuse-United States of America-Department of Health and Human Services- Office of the Inspector General. I d.

6. Lectures on Elder Abuse: Washington U; Harvard; Stanford; Yale; Brown; Baylor, etc. Dr. Lipson has lectured all over the country on issues involving geriatrics, long term care, and elder abuse. The lectures include Washington University, Harvard, Yale, the University of New Brunswick, the University of Florida, Stanford, University of Pittsburgh, University of Hawaii, University of California San Francisco, Brown, University of Nevada, University of Guam, ICansas University, Baylor, Chicago Medical College, University of Oklahoma, University of Colorado, University of l(entucky, University of Utah, Southern Illinois Medical School, Allegheny Medical School, University of Arizona as well as many others. ld.

Dr. Lipson has published numerous peer-reviewed articles, book chapters and monograms dealing with the care of the elderly. ld.

B. DR. LIPSON IS QUALIFIED TO OFFER CAUSATION OPINION 1. Dr. Lipson Does Not Need to "Diagnose" the Sexual Assault Mrs. Rivera's daughter found her crying and confused, in pain, with a pile of bloodied tissues in the trashcan and broken Christmas decorations on the floor of her room. (CR 73-74.) Ms. Mahan noticed her mother appeared to be in pain and urinated while standing up, which was very unusual, and ultimately took her to St. David's Hospital. (CR 74.) Mrs. Rivera was examined by a Sexual Assault Nurse Examiner (SANE nurse), who found specific evidence of vaginal trauma; she had bruising to both the front of the vagina as well as the posterior of the vaginal wall. (CR 98, 100.) The SANE nurse concluded that her exam "definitively indicate[s]

penetration of the female sexual organ." (CR 100.) She recommended that Mrs. Rivera have an HIV and other STD tests conducted. (CR 78.)

Appellant strangely treats sexual assault as a disease to be diagnosed and treated. Appellant argues that Dr. Lipson is not qualified to issue opinions about whether Mrs. Rivera was sexually assaulted because his report does not show "that he has ever examined a patient for sexual assault, diagnosed a patient with sexual assault, or treated a patient for sexual assault." (Appellant's Br. at 12.)

In a health care liability case resulting from a patient's sexual assault by another patient while under the defendant's care, there is no requirement that the expert opine that the victim was sexually assaulted. UHS of Timber/awn, Inc. v. S.B. ex rei. A.B., 281 S.W.3d 207, 211-13 (Tex. App.-Dallas 2009, pet. denied). In UHS of Timber/awn, Inc., the Dallas Court of Appeals rejected the identical argument Appellant makes - nearly verbatim - here.

Timberlawn asserts Levine's revised report and curriculum vitae do not establish he is qualified to render an opinion as to causation, and the revised report is inadequate and conclusory as to that issue. These arguments all flow from Timberlawn's position disputing whether S.B. was, in fact, raped.

Timberlawn contends that, absent a statement in Levine's revised report (presumably based on all reasonable medical probability) that S.B. was in fact raped, Levine's revised report fails to identify the {(causal relationship between [Timberlawn' s actions] and the injury, harm, or damages claimed." See TEX. CIV. PRAC. & REM.CODE ANN.§ 74.351(r)(6). Timberlawn argues Levine did not opine, nor did he show he was qualified to opine, as to

1/1. Normal Aging vs. Disease. Symposhtm on Geriatric Medicine. Annenberg Centerl Rancho Mirage. Californi~ 2/202.

172. Medications in the Eldedy, Memorial Lecture Series, Outpatient Department, Veterans Administration~ Los Angeles, California, 2/26/0'2.

173. Life Style Redesign in Elder Ca:ro. zua Annual North- Ame.dcan Forum on Women's Health! Anah~im~ California} 3/1/02.

174. Dementia in the Elderly. Memorial Looture Series, Outpatient Department~ Vetet·ana Adminfstra.tto:n, Los Angeles:. California; ::l/12/02.

175. Diabetes in the Elderly. Endocrine Orand Rounds, Harbor General Hospital, Torranoe, California, 4/l/0/2.

176. Medications in the Elderly. Mtllll..lecture series~ Co1111'riissloh on Aging~ I" ,, ~f ' • ., .. State of Alaska, Anchorage and Fairbanks,' 4112/02.. 4/26/02.

177. Treatment (!f l)aiti in. the. Elderly. Care o£ the Eldei'ly Cortfereno~\ Univel'sity of Alaska~ Sitka Sitka, Alnska~ 9/19/02.

178. Treatment of Cardiovascular Risk Factors in the Elderly. Care of the Eldetly Conference~ University of Alaska> SitkaJ. Alaska 9/19/02.

179. Special Issues in Long Tenn Cat·~, Assessment and Evaluation of the Artcho:rage Plorteers' Home; Anchorage~ Alaska, 12!10~12/14/02.

180. Identification and Treatment of Cardiovascular Risk Factors in 'lhe Elderly - A symposium Montgomery Cardiology · Programs. Montgotnety~ Alabama> 3/2l/03~ I ••• un. Me4ications in the Eldel'ly, Multi..lecture serlesj Connnission,on Aging> State of Alask~ Anchotage and Fairbanksi 4/23 ..4/26/03.

182. Assess1nent of Mental Competency and Discussion of an Elder Abuse Case. Symposium on Eldet Abuse) Departtnent of Justice .... Bureau of Medi~Cal Praud and Bldet Abus~~ Squaw Valley; California, 5/27~-5/30/03.

183. Medications in the Elderly. Multi-lecture series, Commission on. Aging, State of Alt'\ska;,Juneau and K6tchU~JUl, 6127-6129i03. i84. De1nentla in the Elderly: Medications in the Elderly. Csx~ of the Elderly Conference~ University ofAlask~ Sitk~ Sitka~ Alask~ 9/18w9/19/03.

18S. Demerttiay Gerlatdc Symposium:.... St. Mmy~s Hospital and Soan, tong Beach, CaUfonlia; 10/4/03. i I i ~:

! - ......·-----:- ·~--;-~*'--.~., .•- ------ ~..t..... ~~·-···-·----18-. ·-""--·-·· -··-···-.. ·-.......... · · "· ,- - ·- - . --.----·------·--·-----.._. ___,____,_~--~. - -1--- . ! "'". ..,. A • l APPENDIX 1 I relevant to its treatment of her, she was raped. Rape is not a medical condition. It is an assault. Moreover, rape may-or may not-be accompanied by medically ascertainable evidence of physical trauma, or even physical evidence that it occurred.

Medical evidence of an alleged sexual assault is not required even in criminal prosecutions; the rule in Texas is that ((penetration may be proven by circumstantial evidence." See Villalon v. State, 791 S.W.2d 130, 133 (Tex.Crim.App. 1990) ....

We decline to hold that in order to identify the causal relationship between Timberlawn 's actions and S.B. 's claimed injury, see TEX. CIV. PRAC. & REM.CODE ANN.§ 74.351(r)(6), she was required to proffer an expert report opining that she was in fact raped. Thus we reject Timberlawn's arguments that the trial court erred in not dismissing S.B.'s claim because: (1) Levine's report did not show him to be qualified to render an opinion on whether S.B. was in fact raped; and (2) because Levine's report did not render an opinion on that issue.

UHS of Timber/awn, Inc. v. S.B. ex rei. A.B., 281 S.W.3d 207,211-13 (Tex. App.- Dallas 2009, pet. denied) (emphasis added).

Sexual assault is not a disease, and this is a case about negligence in nursing home health care, not gynecology; Mrs. Rivera was injured as a result of Appellant's multiple failures in protecting her from sexual assault. The Court's inquiry should focus on whether the expert has the "knowledge, skill, experience, training or education regarding the specific issue before the Court which would qualify the expert to opine on a particular subject." Tenet Hasp. Ltd. v. Love) 347 S.W.3d 743, 749-50 (Tex. App.- El Paso 2011, no pet.) The specific issue before the court is the nursing home's breach of its duty to protect its patient from sexual assault, despite being put on notice of a prior sexual assault and inappropriate behavior towards Mrs. Rivera by males at the facility. See Diversicare Gen. PartnerJ Inc. v. Rubio, 185 S.W.3d 842, 850 (Tex. 2005) (involving sexual assault by another resident; nursing home is obligated to protect "the patient population from harming themselves and each other").

2. Dr. Lipson Properly Relies on the Medical Records and Exa1nination by Sexual Assault Nurse Examiner Appellant argues that Dr. Lipson is not qualified to offer causation opinions under TEX. Crv. PRAc. & REM. CODE § 74.403(a). Under Section 74.403(a), "a person may qualify as an expert witness on the issue of causal relationship between the alleged departure from accepted standards of care and the injury, harm, or damages claimed only if the person is a physician and is otherwise qualified to render opinions on that causal relationship under the Texas Rules of Evidence." Dr. Lipson is a physician. CR 15.2 He is also qualified to render opinions on that causal relationship under the Texas Rules ofEvidence. 3 Appellant suggests that Dr. Lipson may not rely upon the SANE nurse report or the medical records in detennining that Mrs. Rivera was sexually assaulted. But Dr. Lipson properly relies on medical records available to him. The assault has been copiously documented by the SANE nurse and a doctor and reviewed by Dr.

Appendix 1 to Appellee's Brief.

See generally Tex. R. Evid. 702 (a qualified witness may testify in the form of an opinion if it will help the trier of fact to understand the evidence or to determine a fact in issue) and 703 (an expeti may base an opinion on facts or data that the expert has been made aware of, reviewed, or personally observed).

Lipson. (See CR 78-100.) The SANE nurse found bruising to both the front of the vagina as well as the posterior of the vaginal wall. (CR 98, 100.) The nurse stated that the findings "definitively indicate penetration of the female sexual organ." (CR 100.) In arguing that Dr. Lipson is unqualified, Appellant does not even mention the SANE nurse report or her declaration.

Appellant's argument that Dr. Lipson cannot rely on the SANE examination or other medical records ignores TEX. R. EVID. 703 and strains credulity. It is like saying a surgeon could not rely on a radiologist's reading of an MRI to provide the opinion that a patient had a brain tumor. Experts can undoubtedly rely on medical records (and even hearsay) in formulating an expert report. See TEX. R. EVID. 703 (expert may base opinion on facts or data that the expert has been made aware of, reviewed, or personally observed, including facts or data that would not normally be admissible so long as experts in that field would reasonably rely on those kinds of facts or data). As the court noted in Palacios, [A] plaintiff need not present evidence in the report as if it were actually litigating the merits. The report can be informal in that the information in the report does not have to meet the same requirements as the evidence offered in a summary-judgment proceeding or at trial.

See, e.g., Tex. R. Civ. P. 166(f) (setting out the requirements for the form and content of affidavits offered as summary-judgment proof); Tex.R. Evid. 802 (stating that most hearsay is inadmissible). 46 S.W.3d at 879.

Expert witnesses must be able to rely upon the medical records to render op1n1on. Expert witnesses may rely on witness statements. If one follows Appellant's argument to its logical conclusion, experts could not rely on the nursing home chart (made mostly by nurses), the medical records (made by nurses and treating doctors whose resumes are not available). This is not the law in Texas.

A reading of the statute and the relevant case law make it clear that the limitations of § 74.402 and § 74.403 do not apply to the underlying information reviewed by experts, such as the medical records or SANE nurse examination.

Indeed, the Texas Supreme Cou1i has expressly stated that expert reports would likely be inadequate if they did not look at the medical records. See Loaisiga v. Cerda, 379 S.W.3d 248, 261 (Tex. 2012) (involving the sexual assault of patients).

The Supreme Court also held in the same case that experts could rely upon the pleadings on file in the case to render expert opinions. Id. Even a case relied on by Appellant's notes that "section 74.351 does not prohibit experts, as opposed to courts, from making inferences based on medical history." Cortez v. Tomas, 02- 11-00231-CV, 2012 WL 407382, at *2 (Tex. App.-Fort Worth Feb. 9, 2012, no pet.) Dr. Lipson may properly rely on the SANE nurse examination and other medical records in reaching his conclusions.

3. The Cases Appellant Relies On Are Distinguishable

Broders v. Heise, 924 S.W.2d 148 (Tex. 1996); Cortez v. Tomas) supra)· and Pediatrix Med. Servs. Inc. v. De La OJ 368 S.W.3d 34 (Tex.App.-El Paso 2012, no pet.), on which Appellant relies, are distinguishable. In those cases, simply put, the expert at issue did not have experience in the area of health care at issue. For example, in Broders, a hospital and physicians were sued after allegedly failing to diagnose head trauma, resulting in death. In affirming the trial court's evidentiary ruling, the Texas Supreme Court noted that there was no evidence that Plaintiffs expert, while a physician, had experience or knowledge about the effectiveness of treatlnents for head trauma. Id. at 153.

In contrast to Broders and the other cases Appellant cites, Dr. Lipson is highly qualified in the precise area of health care at issue. Based on his knowledge and experience, he is qualified to testify that Appellant should have been able to prevent Mrs. Rivera's sexual assault. He has taught future nursing home directors at multiple Tier 1 universities and governmental entities. In his CV there are at least 9 references to lectures, courses and papers relating to "Elder Abuse." There are over 30 references .to geriatrics, including fellowships at Harvard. There are multiple references to his directorships over programs and facilities involving care for the elderly. His experience includes consulting at nursing homes and gove1nmental entities on the operation of nursing homes. He is familiar with treatment of patients like Mrs. Rivera and familiar with the training of employees

providing care to residents like Mrs. Rivera. He is board certified in Quality Assurance. Dr. Lipson has spent many years learning, lecturing, writing, and testifying on nursing home abuse issues. (See Dr. Lipson's Dec. and CV, CR 15- 67.)

4. The Degree of Appellant's Negligence Does Not Protect It From Liability Appellant argues that Dr. Lipson's inability to identify the attacker or the precise time Mrs. Rivera was attacked means that he is unqualified. (See Appellant's Br., 21-22.) Appellant's position is that Mrs. Rivera's suit cannot go forward because the attacker was not apprehended. The reason the attacker was able to sexually assault Mrs. Rivera in the first place, and the reason he was not apprehended, was because Appellant did not timely check on Mrs. Rivera in her room, adequately patrol the halls, or have Mrs. Rivera moved to a more observable location. Appellant treats its own negligence as a defense; it essentially argues that it cannot be held liable because its failure to monitor and protect Mrs. Rivera was so egregious that that attacker cannot be identified and the precise time of the assault cannot be determined. Sticking one's head in the sand cannot be a defense.

Further, if anyone had superior access to this information, it was Appellant, whose agents destroyed the bloody rags, evidence of a crime, when given the opportunity.

To meet the requirements of Section 74.351, Dr. Lipson does not have to be omnipotent. He does not have to succeed where the Austin Police Departtnent failed by identifying the attacker and sleuthing out other details of the assault.

Those details are irrelevant to the cause of action being asserted. No jury is going to be asked to identify the rapist was or determine precisely when the rape occun ed. The relevant issues addressed by Dr. Lipson are: what do the records say

about Mrs. Rivera's assault; what is the standard of care with respect to the assault; did Appellant breach the standard of care concerning the assault; and, was Mrs. Rivera injured as a result of that breach. In short, should this nursing home have prevented Mrs. Rivera's sexual assault? Dr. Lipson is well qualified to render those opinions.

C. DR. LIPSON IS QUALIFIED TO OFFER OPINIONS ON STANDARD OF CARE AND BREACH In what appears to be a copy-and-paste job of other appeals Appellant has likely filed in similar cases, Appellant argues that Dr. Lipson is not qualified to opine on the standard of care for nursing homes, or breach of such standard of care.

Appellant appears to have overlooked the pages and pages of Dr. Lipson's CV setting out his experience, described in this brief supra. Dr. Lipson is well qualified to opine on nursing home elder abuse. He is, in fact, perhaps the most qualified person in the country to opine on this subject. The trial court acted within its discretion in concluding that Dr. Lipson is qualified to render his opinions on the standard of care and breach at issue in this case.

... ;.: ,;=t - ··::tt ~- 0·

PART A .. PATIENT INFORMATION ".PLEASE COMPLETE P.ART A AND PART B (£,, Today's Date: /d___tJvJ3_ Have you received .c~ Facility Before? 0 Yes D No I came to the Emergency Department today because~ ~ I

T FOR FEMALE PATIENTS ONLY: Are you pregnant? DYes I Last menstrual period: _ _/_~/_ _ Have you had a baby within the past six weeks? DYes~~- E~F~o~rm~co~m~p~le~te~d~b~y:~O~S~e~lf~·==~~~~~~============~~R~e~la~tio~n=sh~ip~:~~~~~~~~~~~~~~~~~~== N PART B .. CURRENT SYMPTOMS ~------------------------------------------------------------------------- 1 Please check any of the following symptoms you surre-ntly have: D Persistent cough greater than 3 weeks ErS__,_Throat D Fever greater than 100.4oF C}t:rody aches D Night Sweats D Cough (not related to allergies or COPD) D Cough with blood production D Rash D Fatigue D Nasal congestion (not related to allergies or sinus infections) History of TB or Positive TB Skin Test 0 Close contact with person who has lnfluenza-Jil<e illness D Close contact with person who has TB D Unexplained weight loss PART C .. TRIAGE INFORMATION (For Facility Use Only) 'S: lA- '.\J.~_t-...._f ·- 1st Call for Triage at: 2nd Call for Triage at: 3rd Call for Triage at: / 4th Call for Triage at: AM PM .. AM PM AM PM AM PM Triage Nurse Notes: G .. '(~ c-0~ • ...(J • ~·\f~~ ~l!fr' t'rt··~- !(<I Y( ,; ! dd. t."'-' fy r:rrPLr Y1 ( f(,/. De~-~ ~~'V\.rL-r.Ja·~·""··· ~ ~~ tfr~f.- F " ' .iff ·~ A PART D .. RAPID (INITIAL) TRIAGE (For Facility Use Only) '-:/. 1-1. I:J f I[ rc.:":-< It C' C'.<·'Vl Time: First Point of Contact Screening Positive: D Y D N Patient requested to mask? D Y D N c AIRWAY: D Patent D Impaired BREATHING· Respiratory Distress: 0 None D Mild, 0 r9-d~e ~ Se::fe I CIRCULATION: D Warm/Dry/Normal Color D Pale D Diaphoretic ~; Sc:f ) /_a I

L Pulse Rate: D WNL D Rapid Capillary Refill: D < 2 seconds D > 2 seconds DEFORMITY/DISABILITY .. Loss of Consciousness: DYes DNo 0 No Neuro Deficits 0 Neuro Changes I Extremity: Neurovascular Integrity Intact: DYes ON/A DNa T CHIEF COMPLAINT: y I TRIAGE ACUITY: 1 Resuscitation 2 Emergent 3 Urgent 4 Semi Urgent 5 Non Urgent DISPOSITION: D Immediate Bed D Stable- To Walling Area after Instructions ~ Comments: ~· {~ -~ctl 5 r I · ttqsrp Triage Nurse Signature: ·~yfa\ ,-' --=s<-es·- ':):i, llf\ 11:Y- ,fiJI' \.,, Ae!) ~f'~ '"'*=

11111111111111111111111111111111111 (;:) MARY DELAROSA · RlV~~1\oo071683103 M/Rii: L001D2Z 5 ~ 3 Acct • ER I

15~~~ Loc:L. EH ' 11112/13 \1\\11~\m Ullll\111111111\1\lllllllll\11\11\II\\\ \\1\1 1\1\\ Ill\ 1\11 '"EDPRS* Sign~ln Sheet ·for Ernergency Services T3107BC (Rev. 7/i2) ~OJ__ APPENDIX 1 Parfb& of PATIENT INFORMATION FOR OFFICE USE ONLY f}fL+d._r:t mt+~u PATIENT'S NAMErn MRNo.: ACCTNo.: ADDRESS 1: DOS: LOCATION ADDReSS 2: I COMMENTS/COMPLETION DATE: ClTY, STATE, i Cf /)(f) (' '7l;t 7&6/~ FACILITY FROM WHICH PHI WILL BE RELEASED (Check all that ap_pj'l) DATES OF SERVICE BIRTH DATE: {) St. David's Hospital r/-tl--t_~ SOCIAL SECURitY' NO.: I ' St. David's Rehabilitation Center (Optional) St. David's Georgetown Hospital CONTACT NUMBERS: Other FACILITY/PERSON TO WHOM PHI WILL BE RElEASED/DISCLOSED: PURPOSE OF DISCLOSURE: (Note:** IJPdicates Foe for Copies}_ Avc;_-fiV\ \Pn l) ( e NAME: Follow Up Care Insurance** ADDRESS 1: Attorney** Personal Usek* I ADDRESS2: It

'-f Other** Please Explain L-(___.~ CITY, STATE, ZIP: METHOD OF RELEASE/DISCLOSURE:

0 Fax (t::me~ cy Only) Fa}!)umb~~~ CONTACT NUMBERS: Mall ther ' ( /JL) rL . ( INFORMATION TO BE USED/DISCLOSED: (Check aJI that apply) 1 t ·- Is this request for psychotherapy notes? 0 Yes, then this is the only Item you may request on this authorization. You must submit another authorization for other Items below;·- No, then you may check as many Items below as you need, D Pertinent Package 0 EKG, EEG, EMG 0 Pathology Slides 0 Psychiatric Evaluatlons{Tests D Front Sheet 0 Laboratory Report 0 Physician Orders 0 Infections Disease (Including HIV Test Results) Discharge summary 0 EA Information 0 Progress Notes 0 Consultations D History/Physical 0 Imaging Reports (X·rays, CTs, MRis) 0 Nursing Information ~omplete Copy Operative ReporVProcedure Cathl.ab Imaging Films Pathology Report Medication Records Therapy Notes ~~~~lzatlon Record '~P1Slcc· .\ J understand that: 1. I may refuse to sign this authorization and that It Is strictly voluntary.

2. My treatment, payment, enrollment or eligibility for benefits may not be conditioned on signing this authorization.

3. Medldallnformation Is considered Protected Health Information (PHI) under both Federal and State Privacy Laws.

4. Unless otherwise specified, this authorization shall expire 180 days from the date of my signature, OR from the date of discharge, whichever Is later. (Othervvlse spectfled date ) 5. I acknowledge, and hereby consent to such, that the released information may contain alcohol, drug abuse, psychiatric, HIV testing, HIV results or AIDS information.

6. A facility may not condition the provision of treatment to an individual on signing an authorization except for: 1. · Research-related treatment; and 2. Health care that Is solely for the purpose of creating Information for disclosure to a third party.

7. I may revoke an authorization In writing except to the extent that: i, The facility has taken action prior to receiving the revocation; or 2. If an authorization was obtained as a condition of obtaining Insurance coverage.

Further details may be found In the Notice of Privacy Practices. -- 8. If the requester or receiver Is not a health plan or health care provider, the released Information may no longer be protected by federal privacy regulations and may be redlsclosed.

9. I understand that I may see and obtain a copy of the Information described on this form, for a reasonable copy fee, If I ask for it. There Is a fee for copy setvlces rendered.

1o. I will receive a copy of this form after I sign it.

SIGNATURES J have read the above and authorize tl)p disclosure of the protected health information as~staled. s~c;::J!Vhori2J~ cU-UL---- Date: !f/;J(~ Witness (If applicable}: , • v Wttness (If Applicable): - Cl\ J(Ll{d '1Clf\\ ,) I Print Name of Patient or Authorized Party: Relationship to Patient:

StDavid's I MEDICAL CENTER Authorization for Release of Protected Health Information RIVERA.I1ARY DELAROSA ER Acct;ff: L00071683103M/R#: L001022503 loc:L.ER IF Dr: CEA 11/12/13 IUIIlllllllllllllllllll <ROI* 1/lll/111111 IIIII IIIII 1111111111/lllf 11111/l/lf /Ill/Ill// IIIII 1111/ffl APPENDIX 1 '52626 (02/20/i 2) Page8'Pf 1 III. THE REPORT IS A GOOD FAITH EFFORT TO COMPLY WITH CHAPTER 74 Appellant also complains that Dr. Lipson's report does not provide it adequate notice ("good faith effort") under TEX. Crv. PRAC. & REM. CODE §74.351(1). To qualify as a good faith effort, it must inform the defendant of the conduct called into question and provide a basis for the trial court to conclude the claims have merit. Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011). The Supreme Court's position on expert reports is well described.

The expe1i report must represent only a good faith effort to provide a fair summary of the expert's opinions. A repo1i need not marshal all the plaintiffs proof, but it must include the expert's opinion on each of the elements identified in the statute.

Am. Transitional Care Centers of Texas, Inc. v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001 ). A "fair summary" is "something less than a full statement of the applicable standard of care and how it was breached," it merely "sets out what care was expected, but not given." Id. at 880. Dr. Lipson's detailed report exceeds this standard.

A. SUMMARY DR. LIPSON'S REPORT 1. Dr. Lipson's Review of Pertinent Medical and Other Records Dr. Lipson's repo1i sets out in detail the information he reviewed in order to render his opinions. They include: a. The statement of the daughter Martha Mahan;

RIVERA. MARY 11/12/2013 11:15 MR# L001022503 Visit# L00071683103 Clinical Report" Nurses 3 of3

15:1 0. Reassessment after procedure. The patient reports no complaints and the patient is calm and resting quietly. Patient reports current pain level as 0/10. Overall patient status Is improved~ the patient states feels better. ED physician notified about patlent1s status. --15:10 Jenny Black, R.N.

15:26. (APD VS here with patient and family. APS referenence number 64190731. APD VS is working with guardian to move patient to a different ·nursing home. If that is not possible, APD VS will contact current nursing home to assure patient's safety there.). -~15:26 Jenny Black, R.N ..

Assault I Forensic Flowsheet 15:09. The patient has family for support. Personal safety plan, reporting plans, STD and contraceptive prophylaxis, need for medical follow-up, counseling, coping/fear reduction and interventions/services discussed with patient. The patient has been given education and resource materials. --15:09 Jenny Black, R.N ..

DISPOSITION I DISCHARGE 15:28. BP: 165/70 sitting. HR: 90. RR: 18. Temp: deferred. Condition at departure: improved and stable. Patient reports pain level on departure as 0/10. The goals identified in the patient's plan of care were met. The following issues were addressed: psycho-social issues, pain control, comfort issues, nutritional issues, educational issues and follow up care. Fall risk assessment completed. No fall risk identified. No learning barriers present. Discharge Instructions provided and reviewed with the patient.

Reviewed referral to family practice, a women's shelter, Planned Parenthood, the public health departmen1 and crisis hotllne for followup and testing. Summary of care provided to famHy. Patient and family verbalized understanding. Written Instructions provided in English. Guardian verbalized understanding.

The patient was discharged by the physician. The patient was discharged to the nursing home and accompanied by guardian. The patient left the Emergency Department ambulatory and via private vehicle.

Driving (guardian.). --15:28 Jenny Black, R.N.

15:28.

Departure time; 15:28. --15:28 Jenny Black, R.N.. .

The patient's home medications have been reviewed and validated with patient by the nurse. -.-15:28 Jenny Black, R.N ..

This report is not final

APPENDIX 1 3. Dr. Lipson Carefully Reviews Nursing Home Chart and Ms. Mahan's Statement Dr. Lipson then conducts a careful review of the nursing home chart to establish the fact that Mrs. Rivera had very poor short and long term memory problems and often did not remember people or where her room was. Dr. Lipson goes on to opine that due to her significant mental limitations, Mrs. Rivera required careful monitoring by the staff. (CR 17.)

Dr. Lipson then reviews the statement of Martha Mahan, Mrs. Rivera's daughter and guardian. Ms. Mahan's statement discussed parties on Friday afternoons where alcohol is served to the residents. Ms. Mahan reports that certain male residents acted inappropriately towards Mrs. Rivera and that this fact was reported to the management. (CR 17.)

Dr. Lipson then reviews the facts surrounding the discovery of the broken glass, bloody rags and distressed Mrs. Rivera. He then notes that an external head to toe exam was done on Mrs. Rivera which found no exterior wounds. No vaginal exam was done. (CR 17-18.)

Dr. Lipson then discusses the calling of the police and the examination done at St. David's Hospital by SANE nurse Jenny Black. Dr. Lipson notes the injuries to both the posterior and anterior portions of the vagina. He further reviewed the statement of the SANE nurse indicating definitive "penetration of the female sexual organ". (CR 18.)

4. Dr. Lipson Reviews Literature on Sexual Assaults in Texas Dr. Lipson then cites literature for the disturbing fact that in the four years leading up to Mrs. Rivera's assault nearly 400 sexual assaults we!e reported in Texas nursing homes. Dr. Lipson further relates the fact that those who suffer from dementia are at particularly high risk for this type of abuse as they are very poor historians. (CR 18.)

Dr. Lipson then goes on to discuss how these assaults can be prevented. He notes that these facilities all provide 24-hour skilled nursing care as required by law. This means the facility must have skilled nurses as well as certified nursing aides on staff twenty-four hours a day three hundred and sixty-five days a year. (CR 18-19.)

Dr. Lipson goes on to review the literature and reports that most of these assaults occur at night and if a facility has a history of reported assaults they are at a greater risk for additional incidents. He then reviews the history of reported assault, non-compliance and management awareness of these issues. Dr. Lipson reviews the generallmowledge within the industry of these assaults and the press coverage regularly offered this issue. (CR 19.)

5. Dr. Lipson- Rivera's Injury Foreseeable and Defendant Owed Duty to Rivera He then opines that with the significant number of assaults in Texas nursing homes, the recent history of reported assault in Defendant's facility, and the complaints of the daughter Martha Mahan, that it is foreseeable assaults would occur if precautions are not taken. He then opines a nursing home owes a duty of protection to patients suffering from mental incapacity. He then writes that such patients require enhanced supervision and additional staff time to protect them from others. This is patiicularly true, he states, in a facility with a history of reported assault and a history of family complaints of inappropriate behavior towards Mrs. Rivera. (CR 19.)

6. Dr. Lipson Sets Out Standard of Care After pages of detail concerning the facts, the records and the foreseeability, Dr. Lipson then sets out the standard of care: The standard of care requires the nursing home provide twenty- four hour a day skilled nursing care. The practical result of this requirement is that the staff must be moving through the halls and the rooms of the residents all night long. There should never be a time when a staff member is not in the next room or moving through the halls next to a resident's room.

The standard of care requires that following the report of an assault at a nursing facility that the facility control unsupervised access to the rooms of residents at risk. The standard of care requires the facility take note of the families' concerns of inappropriate behavior and eliminate access to the patient ·by unsupervised males. Residents at risk include women with significant dementia such as Ms. Rivera. In light of the family's expressed concern of inappropriate advances to Ms. Rivera, the standard requires heightened scrutiny to include regular walks through the entire hall at intervals not to exceed ten minutes to prevent access to her room by males. The standard of care requires the nursing staff document the fact that it is performing the regular checks in the patients' charts.

In addition, the standard of care requires Ms. Rivera be moved to a room in close proximity to the nursing station following complaints of inappropriate contact with Mrs. Rivera. (CR20.)

7. Dr. Lipson Identifies Breaches of Standard of Care Dr. Lipson then set out the breaches of the standard of care.

The facility breached the standard of care by not providing twenty-four hour skilled nursing care. The nursing staff was not present in the halls or her room to prevent the sexual assault ofMs. Rivera.

The facility breached the standard of care by not preventing access to her room by unsupervised males. The records do not indicate any checks on Ms. Rivera the night she was assaulted.

The facility breached the standard of care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room. (CR20.)

8. Dr. Lipson Identifies the Harm to Mrs. Rivera Dr. Lipson then sets out the harm caused. The harm caused Mrs. Rivera is significant. She was sexually assaulted. The injuries to her vagina are well documented in the SANE nurse report and above. The daughter reports she was tearful and afraid. This is a common response in sexual assault victims. The daughter reports this behavior of fear continued even after Mrs. Rivera was removed from the facility. The fact she suffered from dementia does not lessen the harmful mental effects of sexual assault. Even an animal can remember when it

has been abused. In many ways Mrs. Rivera was like a small child - confused and afraid as a result of this sexual assault. The history of problems together with the decision to ignore the families' complaints and eliminate unsupervised males from Mrs. Rivera's room indicates a conscious disregard for the well-being of Mrs. Rivera by the facility's management. (CR 20-21.)

9. Dr. Lipson Eliminates Other Causes of Injury Dr. Lipson then considers other potential causes of this injury. He considers whether the injuries may be self-inflicted, but discards this idea after a chart review found no indications of sexual self-stimulation or self-abuse. He further considered whether the family might have caused these injuries but again discards this idea after a chart review indicates the family was nothing but supportive. Dr. Lipson further notes Mrs. Rivera was in the nursing home at all relevant times and there was no indication she was assaulted on the way to the hospital to check to see if she had been sexually assaulted. (CR 21.)

In short, Dr. Lipson explains the background facts, his review of the medical and factual history, explains the problem with sexual assaults in nursing hotnes, explains the standard of care, the breaches of the standard of care as well as the harm caused. His report explains the Defendant's conduct called into question and provides detailed information for the trial court to determine the claims have merit.

B. THE REPORT IS SUFFICIENT AS TO BREACH AND CAUSATION Appellant argues Dr. Lipson's report is deficient as to breach and causation.

Appellant attempts to put requirements on Dr. Lipson's report that exceed those required under the Civil Practices and Remedies Code, and ignores what is actually stated in his report. Appellant's assertions that the report is insufficient in this way or that way fall apart under examination.

Dr. Lipson expressly details the breach of the standard of care 1n his declaration. See CR 20, quoted supra. Dr. Lipson states in his report: The standard of care requires the nursing home provide twenty- four hour a day skilled nursing care. The practical result of this requirement is that the staff must be moving through the halls and the rooms of the residents all night long. There should never be a time when a staff member is not in the next room or moving through the halls next to a resident's room.

The standard of care requires that following the report of an assault at a nursing facility that the facility control unsupervised access to the rooms of residents at risk. The standard of care requires the facility take note of the families' concerns of inappropriate behavior and eliminate access to the patient by unsupervised males. Residents at risk include women with significant dementia such as Ms. Rivera. In light of the family's expressed concern of inappropriate advances to Ms. Rivera, the standard requires heightened scrutiny to include regular walks through the entire hall at intervals not to exceed ten minutes to prevent access to her room by males. The standard of care requires the nursing staff document the fact that it is performing the regular checks in the patients' charts.

In addition, the standard of care requires Ms. Rivera be moved to a room in close proximity to the nursing station following complaints of inappropriate contact with Ms. Rivera.

The facility breached the standard of care by not providing twenty-four hour skilled nursing care. The nursing staff was not present in the halls or her room to prevent the sexual assault ofMs. Rivera.

The facility breached the standard of care by not preventing access to her room by unsupervised males. The records do not indicate any checks on Ms. Rivera the night she was assaulted.

The facility breached the standard of care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room. (CR 20.) Dr. Lipson thoroughly and in specific terms describes what tasks the standard of care requires and how Appellant failed to perform those tasks. Similar statements were found to be sufficient in another case involving an assault on a patient (this one committed by the staff): Moreover, we conclude that [the expert] identified the care that was expected but not rendered under the applicable standard of care. She states that Spohn-Shoreline "[f]ailed to provide adequate supervision to the CNA [DeJesus] and the RN [Njoh]," "[f]ailed to protect Ms. Sanchez from sexual harassment and sexual abuse," and "[f]ailed to provide safety to Ms. Sanchez in her immediate post operative [sic] when the CNA lifted Ms. Sanchez up and began dancing with her." She explains the specific tasks and responsibilities required of Spohn- Shoreline and notes that it failed to perform as such.

Christus Spohn Health Sys. Corp. v. Sanchez, 299 S.W.3d 868, 877 (Tex. App.- Corpus Christi 2009, pet. denied). Dr. Lipson's description of specific failures of Appellant is tnore than sufficient to meet the good faith standard of Section 74.3 51.

Appellant argues that Dr. Lipson's report is conclusory as to whether sexual assault occurred. First, Appellant misstates the law when insisting that Appellee offer an expert optnton that Rivera was sexually assaulted. See UHS of Timber/awn, Inc., 281 S.W.3d at 211-13 (discussed supra; "Rape is not a medical condition. It is an assault. ... We decline to hold that [plaintiff] was required to proffer an export report opinion that she was in fact raped.") Second, Appellant ignores the well-documented medical records including the SANE nurse examination, Ms. Mahan's statement, and Mrs. Rivera's medical history (which prevents her from being able to consent to sexual activity). All of these facts are those upon which Dr. Lipson may rely in forming his opinion. TEX. R. EVID. 703.

Dr. Lipson opined that by not having skilled nursing staff present in the halls or in Mrs. Rivera's room, no staff was present to prevent the sexual assault. (CR 20.) Appellant failed to prevent access to her room by unsupervised males, failed to check on Mrs. Rivera the night she was assaulted, and failed to move her close to the nursing station where no unsupervised males could enter her room. Id. As a result, "The harm caused [to] Rivera [was] significant. She was sexually assaulted." Id. These statements, and others in Dr. Lipson's report, are sufficient as to breach and causation. See, e.g., UHS ofTimberlawn, Inc. v. S.B. ex rei. A.B., 281 S.W.3d 207, 213 (Tex. App.-Dallas 2009, pet. denied) (in a case involving sexual assault by another patient, expert report met Section 74.351 requirements where expert opined that standard of care required facility to house victim where

she could not be accessed by unsupervised males and had facility housed her in a safe and appropriate manner, she would not have been victimized).

Finally, Appellant claims that Dr. Lipson failed to exclude ''other, innocuous causes" for the vaginal bruising, bleeding, crying and confusion Mrs. Rivera displayed. Contrary to Appellant's assertion, Dr. Lipson did consider other causes for the injury and found no evidence to support them. 4 This case is thus distinguishable from Jelinek v. Casas, 328 S.W.3d 526 (Tex. 2010) and similar cases cited by Appellants. In Jelinek, there was no causal nexus between the defendant hospital's lapse in the treatment of antibiotics and the patient's suffering, where the expert admitted there was no direct evidence that the patient had an infection treatable by the omitted antibiotics, but the patient did have two other infections that could account for all of her symptoms and for which the omitted antibiotics would have been ineffective. Id. at 534-535. Here, in contrast, there are no realistic alternative causes for Mrs. Rivera's sexual assault. Further, Dr. Lipson specifically considered other causes and found the evidence did not support any cause other than Appellant's negligence. (CR 21.)

He states: "I have considered other causes of this injury. I considered if the vaginal injuries were self-inflicted. There is no evidence in Ms. Rivera's chart to indicate she engaged in either sexual self-stimulation or self-abuse. I considered the injury may have been inflicted by someone outside the facility or even a family member. There is no evidence to support this approach. There is no record the family was anything other than suppotiive. The timeline in the chart indicates she was [in] the facility at all relevant times save during transfer to the hospital.

There is no evidence anyone sexually assaulted her when she was being transferred to the hospital to have her examined for injuries." (CR 21.)

CONCLUSION As the trial court correctly determined, Appellant's boilerplate arguments fall apart upon examination of the actual qualifications and report of Dr. Lipson.

The trial court's order denying Appellant's motion to dismiss should be affirmed because Dr. Lipson is qualified and his expert report adequately sets forth the standard of care, identifies how Appellant breached the standard, and explains how the breach caused the injury Mrs. Rivera suffered. The report constitutes a good faith effort to comply with Section 74.3 51 because it puts Appellant on notice of the specific conduct complained of and provides the trial cou1i with a basis on which to conclude Appellee's claim has merit. See TEX. CIV. PRAC. & REM. CODE ANN. § 74.351(1); Palacios, 46 S.W.3d at 879. The trial court did not abuse its discretion in denying Appellant's Motion to Dismiss.

PRAYER For the foregoing reasons, Appellee respectfully requests that the Cou1i affirm the trial court's denial of Appellant's Motion to Dismiss. In the alternative, if the Cou1i finds the expert report to be deficient, Appellee prays that the Court remand the case for consideration of a thirty-day extension to cure the deficiency.

See Scoresby v. Santillan, 346 S.W.3d 546, 557 (Tex. 2011) ("a thirty-day extension to cure deficiencies in an expert repo1i may be granted if the report is served by the statutory deadline, if it contains the opinion of an individual with

expertise that the claim has merit, and if the defendant's conduct is implicated."); Leland v. Branda!, 257 S.W.3d 204, 207-208 (Tex. 2008) (court of appeals has discretion to sua sponte remand the case for consideration of a thirty-day extension to cure a report's deficiency).

Respectfully Submitted:

Isl Jack Modesett, III JACI( MODESETT, III State Bar No. 1424433 7 WALTER V. WILLIAMS State Bar No. 21584800 MODESETTWILLIAMS, PLLC Congress Ave., Suite 1650 Austin, Texas 78701 Telephone: (512) 472-6097 Facsimile: (512) 481-0130 ATTORNEYS FOR APPELLEE CERTIFICATE OF SERVICE I hereby certify that on the 21st day of December 20 15, the foregoing Brief of Appellee was electronically filed with the Clerk of Court using the Texas Online E-file system, and a true and correct copy was served via the Court's e-filing service, electronic mail and U. S. Regular Mail on the following counsel: Emily J. Davenport Janice Byington Reed, Clayman, Meeker & Hargett, PLLC 5608 Parkcrest Drive, Suite 200 Austin, Texas 78731 [email protected] [email protected] Isl Jack Modesett, III Jack Modesett, III

CERTIFICATE OF COMPLIANCE I hereby certify that this brief complies with Tex. R. App. P. 9.4(i)(2)(B) in that it contains 7333 words, exclusive of the items identified in Tex. R. App. P. 9.4(i)(l ).

Is/ Jack Modesett, III Jack Modesett, III

1/30/2015 3:11:20 PM Velva L. Price District Clerk Travis County CAUSE NO. D-1-GN-14-005169 D-1-GN-14-005169

MARTHA MAHAN, AS THE REPRE- § IN THE DISTRICT COURT OF SENTATIVE OF THE ESTATE OF § MARY RIVERA, § § v. § TRAVIS COUNTY, TEXAS § PM MANAGEMENT- AUSTIN NC, LLC § d/b/a GRACY WOODS I NURSING HOME § 250TH JUDICIAL DISTRICT PLAINTIFF'S CHAPTER 74 PRODUCTION OF EXPERT REPORT TO THE HONORABLE JUDGE OF SAID COURT: COMES NOW Martha Mahan, as the Representative of the Estate of Mary Rivera, Plaintiff in the above-entitled and numbered cause, and files this, Plaintiffs Production of Expert Reports pursuant to Civil Practice & Remedies Code, Title 4, Liability in Tort, Section 74.351, and in support thereof, would respectfully show unto the Court as follows: I.

In cmnpliance with Civil Practice & Remedies Code, Title 4, Liability in Tort, Section 74.3 51, Plaintiffs hereby file the attached report of Loren Lipson, M.D. (attached hereto as Exhibit A).

APPENDIX 1 II.

Plaintiffs hereby also provide opposing counsel with copies of Loren Lipson, M.D.'s curriculum vitae (attached as Ex. 1 to Report), in co1npliance with Civil Practice & Re1nedies Code, Title 4, Liability in Tort, Section 74.351.

Respectfully Submitted, MODESETTWILLIAMS, PLLC 2202 Lake Austin Boulevard Austin, Texas 78703 512.472.6097 - Telephone 512.481.0130- Telecopier . . ~---~~-,.:== ·-~--~--··~~"··-- ~--- ,( \ -7 ' . ~. =~~·~ . --- "~-~- ~~

rl~- f~~· -- ~~ ) (\

By.. ).tt?wiJM ,, ! .

t_ /-~~k - vt; " . ~-~ J atk/Modesett, III Tpx.{ls Bar No. 14244337 #Iter V. Williruns Texas Bar No. 21584800

Plaintiff's Chapter 74 Production of Expert Report Page 2

APPENDIX 1 CERTIFICATE OF SERVICE I hereby do certify that in compliance with the provisions of Rule 21a, a true and correct copy of the above and foregoing has been served via Pro Docs electronic service on this 3oth day of January, 2015 as follows: Emily J. Davenport K.emp Smith, LLP Congress Avenue, Suite 1260 Austin, Texas 78701-2443 Emily.davenport@kempsmith. con1

Plaintiff's Chapter 74 Production of Expert Report Page 3

APPENDIX 1 EXHIBIT A

APPENDIX 1 DECLARATION OF LOREN G. LIPSON, M.D.

I, Loren G. Lipson, M.D., declare as follows: I am a licensed physician in the State of California. I am Board-Certified in Internal Medicine, as well as in Quality Assurance and Utilization Review. I have been board certified in Geriatric Medicine.

My cuniculun1 vitae, attached hereto as Exhibit 1 accurately reflects my education, training and experience as a Medical Doctor, Professor Emeritus of Medicine at the ICeclc School of Medicine at the University of Southern California, Los Angeles, California, Affiliate Professor in the Biomedical WWAMI Program, College of Arts and Sciences, and Affiliate Professor at the College of Health and Social Welfare both at the University of Alaska Anchorage. I an1 the fonner chief of the section of Geriatric Medicine and Associate Professor of Medicine, Gerontology, Clinical Phan11acy, Medical Dentistry and Public Health, and Occupational Science and Occupational Therapy, all at the University of Southern California where I have been on the faculty for over 29 years.

In addition, I am a consultant to the Departtnent of Justice United States and the States of California and New J\tfexico, and the Office of the Inspector General, U.S. Departlnent of Health and Human Services in areas of geriatric care and elder abuse. I have served as a Consultant to the Departments of Administration, Health and Social Services and Law, State of Alaska, in the areas of geriatric medicine and long term care. I also have been the Physician Advisor to USC University Hospital in areas of utilization1nanagement and quality assurance.

I have extensive personal experience in primary medical care as well as subspecialty consultation and long-term care. I personally have provided care for patients in addition to my acadetnic teaching, research and administrative responsibilities. My background is more fully DECLARATION OF LOREN G. LIPSON, M.D. PAGE 1

APPENDIX 1 described in my curriculum vitae attached hereto as Exhibit A.

I an1 fatniliar with the proble1n of sexual assault in the nursing home setting. I am familiar with the standard of care for preventing such assaults.

I continue to treat patients in the long tenn care setting and have done so for more than thirty years. I am fatniliar with the standard of care for the treatlnent of patients like Mary Rivera and familiar with the required training of employees providing care to residents like Mary Rivera.

I have reviewed the following records. They forn1ulate a basis for my opinions in this 1natter.

1. The statement ofthe daughter, Martha Mahan; 2. The Gracy Woods I records; 3. The SANE Nurse Report; 4. The SANE Nurse Statement 5. The St. David's Hospital Records 6. The guardianship records regarding Ms. Rivera; and 7. Texas Department of Aging and Disability Services' Reports.

The nursing home had a complaint of a sexual assault of a resident several months before the assault of Ms. Rivera. This report should place the facility on a heightened alert for this problem. The facility was cited by DADS for: 1. Failing to impletnent written policies that protect against this activity; and 2. Failing to rep011: the incident to law enforcement.

On June 20, 2013, Ms. Mary Rivera was placed under the guardianship of her daughter, Martha Mahan, by Judge Guy Herman. Judge Herman detennined that Mary Rivera was a "totally incapacitated person without capacity to care for herself.'' (Ex. 1) DECLARATION OF LOREN G. LIPSON, M.D. PAGE2

APPENDIX 1 The findings of Judge Herman are consistent with the records from Gracy Woods I, (the nursing home) where Ms. Rivera was a long tenn resident.

When Ms. Rivera adtnitted to the nursing home she carried a diagnosis of dementia. A review of the nursing home chart indicates that Ms. Rivera's short- and long-te1n1 n1emory declined over the tin1e of her residency. The chart indicated she frequently did not know the location of her roon1, the season of the year or recognize staffn1embers. This is confirmed in the appointment of her guardian when Judge Hern1an finds Ms. Rivera as "totally incapacitated" due to mental as well as physical limitations.

The nm·sing home chart describes an individual who, while able to ambulate, clearly required careful monitoring due to significant mentallin1itations. The nursing home chart further indicates Ms. Rivera suffered frotn depression secondary to the diagnosis of dementia as well as due to her adtnission to the nursing home, an admission she likely did not fully understand.

The daughter of Ms. Rivera describes in her statetnent alcohol parties that the nursing home had on Friday aften1oons. (Ex. 2) She states that another male resident would inappropriately touch or speak to Ms. Rivera. (Ex. 2) The daughter reported this concern to the management of the nursing home. The nurses caring for Ms. Rivera were aware of this behavior. (Ex. 2) Early on November 9, 2013, a Saturday 111orning, the daughter visited her mother at the nursing home. She found her more confused than usual and crying. The daughter also folmd broken Christmas ornaments on the floor. She took her n101n to the bathroom, and she appeared to be in pain. Ms. Rivera urinated standing up, which was unusual. After she put her mom back to bed, the daughter used the restroom herself. When she was discarding a paper towel she noted there was a pile of bloody rags in the trash.

DECLARATION OF LOREN G. LIPSON, M.D. PAGE3

APPENDIX 1 Concerned that her n1other had fallen, she took the rags to the charge nurse, Wendy, who did ahead-to-toe skin examination. The nursing hmne records confinn that no open wounds were found. The daughter ultimately took her mother to the hospital where they found bruising to her back. No vaginal exan1 was done at that thne.

The daughter reports Ms. Rivera continued to act like she was afraid. She noted bleeding fro1n her mother's vagina. The daughter began to suspect sexual assault. The police were notified.

Ms. Rivera was taken to St. David's Hospital. An examination was done by a Sexual Assault Nurse Examiner (SANE Nurse). The SANE nurse told Ms. Rivera that her n1other had suffered vaginal trauma. The SANE nurse exam specifically found tramna to the posterior fourchette/fossa navicularis as well as trauma to the periurethral area of the vagina. (Ex. 3) In other words, she found bruising to both the front of the vagina as well as the posterior of the vaginal wall. (Ex. 3) The statetnent of the SANE nurse indicates the findings "definitively indicate penetration of the fetnale sexual organ." (Ex. 4) As referenced above, Ms. Rivera was incotnpetent. In other words, she was sexually assaulted as she is unable to give consent to sexual contact.

Sexual assault in the nursing home environn1ent is a very serious problem. In the four years leading up to this assault, nearly four htmdred sexual assaults were reported in Texas nursing homes. At high risk are seniors such as Ms. Rivera who suffer from dementia. They are poor historians due to their illness and many suffer fi·on1 iinpaired cotnmunication sldlls. As such they are extre1nely vulnerable.

The good nevvs is that, if the ntu·sing home takes a few simple steps, the assaults can be prevented. Facilities such as this nursing home are 24 hout skilled nursing facilities. This means DECLARATION OF LOREN G. LIPSON, M.D. PAGE4

APPENDIX 1 they are required by law to have sldlled nursing staff as well as certified nurses' aides on duty and providing care to the residents twenty-four hours a day, seven days a week, three hundred and sixty five days a year. The nursing hon1e in question has one hundred and eighteen beds in the entire facility. These types of assaults, according to most reports in the literature, occur at night.

The literature indicates that facilities with a history of abuse arid noncompliance are more likely to have future incidents of abuse. This nursing facility has a history of reported abuse and sexual abuse and was cited by the state for several indications of neglect leading up to the assault of Ms. Rivera. The ntu·sing home management and owners are aware of this history of abuse and are obligated to take steps to prevent future abuse. Everyone in the nursing home business is aware of the problen1 of sexual assault. It is well discussed in the literature and the press. Given the history of problems in the facility and the complaints of the daughter, it is foreseeable assaults like this would occur without the proper precautions.

This nursing home owes a duty of protection to patients suffering frotn mental incapacity due to decreased cognitive abilities. This duty includes monitoring the physical and mental conditions of the patients and meeting the fundamental care needs of the residents. Nursing homes are required to assess each resident's needs and capabilities. Sotne residents, like Ms. Rivera, require enhanced supervision and additional staff to protect them from others. The nursing home must take reasonable precautions to protect Ms. Rivera from the foreseeable consequences of her impairment including sexual assault. This is particularly true when there is a previously reported assault and the patient's family has voiced concerns ·of inappropriate behavior towards their tnother.

DECLARATION OF LOREN G. LIPSON, M.D. PAGES

APPENDIX 1 STANDARDS OF CARE 1. The standard of care requires the nursing hmne provide twenty-four hour a day skilled nursing care. The practical result of this requirement is that the staff must be n1oving through the halls and the rooms of the residents all night long. There should never be a time when a staff member is not in the next room or moving through the halls next to a resident's room.

2. The standard of care requires that following the repoti of an assault at a nursing facility that the facility control unsupervised access to the rooms of residents at tisk.

The standard of care requires the facility take note of the families' concerns of inappropriate behavior and eliminate access to the patient by unsupervised n1ales.

Residents at risk include vv-omen with significant dementia such as Ms. Rivera. In light of the families expressed concern of inappropriate advances to Ms. Rivera, the standard requires heightened scrutiny to include regular walks through the entire hall at intervals not to exceed tentninutes to prevent access to her room by males.

The standard of care requires the nursing staff document the fact that it is perfotming the regular checks in the patients' charts. In addition, the standard of care requires Ms. Rivera be moved to a room in close proximity to the ntu·sing station following complaints of inappropriate contact with Ms. Rivera.

BREACII OF STANDARD OF CARE 1. The facility breached the standard of care by not providing twenty-four hour sldlled nursing care. The nursing staff was not present in the halls or her room to prevent the sexual assault of Ms. Rivera.

2. The facility breached the standard of care by not preventing access to her room by unsupervised n1ales. The records do not indicate any checks on Ms. Rivera the night she was assaulted. The facility breached the standard of care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room.

HARM The harm caused Ms. Rivera is significant. She \Vas sexually assaulted. The injuries to her vagina are well documented in the SANE nurse report and above. The daughter reports she was tearful and afraid. · This is a cotntnon response in sexual assault victims. The daughter reports this behavior of fear continued even after Ms. Rivera was removed fron1 the facility. The fact she suffered from dementia does not lessen the harmfuln1ental effects of sexual assault. Even

DECLARATION OF LOREN G. LIPSON, M.D. PAGE6

APPENDIX 1 an anitnal can remen1ber when it has been abused. In tnany ways Ms. Rivera was like a small child -confused and afraid as a result of this sexual assault. The history of problems together with the decision to ignore the fatnilies' cotnplaints and eliminate unsupervised males from Ms. Rivera's rootn indicates a conscious disregard for the well-being of Ms. Rivera by the facility's tnanagement.

I have considered other causes of this injury. I considered if the vaginal injuries were self- inflicted. There is no evidence in Ms. Rivera's chart to indicate she engaged in either sexual self- stimulation or self-abuse. I considered the injury may have been inflicted by son1eone outside the facility or even a fatnily n1ember. There is no evidence to support this approach. There is no record the family was anything other than supportive. The titneline in the chart indicates she was the facility at all relevant tin1es save during transfer to the hospital. There is no evidence anyone sexually assaulted her when she was being transferred to the hospital to have her exatnined for injuries.

DECLARATION OF LOREN G. LIPSON, M.D. PAGE7

APPENDIX 1 I declare tmder the penalty of pe1jury under the laws of the State of California that the foregoing is true and correct Executed this P,~ay of~ , 2015.

Cf~,

DB:CtARA.TlON OF LO:REN G. LlPSONJ I\1.D. PAGE8

APPENDIX 1 EXHIBIT A

APPENDIX 1 CDAAIC'OL'VM VITAE

August 1, 2009 A. P~l'HOlUlllnfol'matio:n.

L Nmtie; Loren G. Lipson) M.D.

2. 11tles! Professol' Emeritns ofMedichte at the Keck School of Medicine of the University of Southern Califonrlap Los Angeles> Califonrla; and AffiJiat6 Professor~ Biomedical WWAMI Ptogram> College of A:tts and Sciences~ and Affiliate Professor~ College of Health and Social Welfar1;1 at the University of Alaska Anchorage.

3. MaiH11g Address! P.O, BoxJ South Pasadena, California 91 031 4. Business Telephone: 626-403w0169 5. Fax: 626-403.-0165 6. Paget! 800 ..20~-2380 (Numetio Only) B. Educafio.tt 1. High Sobool- :Sirminghmn Bigh School~ Van Nuys) Califor.hla.

Graduated, June 1961.

2~ University- U.C.L.A.~ B.S. in Chemistrywithami:no1•inMath and En~lish. (Sununa Cmn. Laude)1 June 1965, 3. Medical School - The J'olms llopldns University Schqol of Medicine> Baltimore~ 'Maryland: M.D., June 1969 4, Internship ..... The Johns Hopkins I-Iospital1 Osler Medical Service~ 1969-1970.

5. Residency .. The Joh1.1s Hopldns Hospital~ Osle1· Medical Servlce~ 1970-1971 I I I

-··.-----···-······-··-·------ --- ···----"· .,. --··--·--:--------.-:::-7-:-.------;-:--,-~,-.,·-----~-~----·-;·--·--· ...... ---·-··-·· ·---.. ---·~--·--....- ..,....................... -·------·--'·--··~----------··------- ............

I ! ......... \ . - ii j l iI 'i d • . . "'"' '1l • I APPENDIX 1 I I 6, Fellowships: a. Tite Johns Hopkins University School of Medicine, Balthnote:l Marylnnd: Clinical Fellow in Medicine~ 1969~ 1971 · b. The Natiol1al ftlstitutes of Health., Beth~sd~ Marylaud!

Research Associate - l?rote:in Chemistty; Physical Biochemistry~ Moleculat Biology ..... Labot·atory of ~Chemical Biology. Nationat Institute of Atthtitis~ Metaoolio and Digesti~e Diseases (NIAMDD), 1971-1973, o. Massaclmsetts Genetal Hospital~ Bostoni Massachusetts: Clinical and Research Fellow 1n Medicine (Endocrlnology and Metabolism)~ 1973.-1976 d, Harvard Medical School, Boston, h1assaoltusettsf Clinitml .and Research Fellow in Medicine (Endoorinology and Metabolfsin)>l973 .. 197S. · e~ Ha:rvru:d Medical School, Boston, Mass~ohusetts: Jolm A.

H'ru:tfht•d Seufol' Scholar in G0ri~rtdc Medicine_, D:lvision of Aging,1984 ...1985 - f. Beth Israel .Hospital~ Boston, Massachtlsetts! Clinieal Fellow in Medicine (Gerontology)~ 1984...1985 g. Brigham - Women~s Hospital, Boston> Massachusetts~ Clinical Fellow in Medlcine (Get:ontology)1 19&4.. 1985 .

h. Hebrew Rehabilitation Center for the Aged> Boston, Mass'achusetts! Cih1ical Fellow in Gerlatrio Medicine~ 1984 ..1985.

i Institute of Advanced Studies on Gerontology; Ethel Pemy Andrus Gerontology Cente1; ·usc~ Los Angeles, Califot.nla!

Fellow in In.stitute, Area-Drugs .in the Elderly; 1985-19&7 j. Geriatric Research Institute~ Ethel Percy Andrus Gerontology Center> USC1 Los Angeles; California: Senior ~esearch Associate; 1985..1989.

7. Honors and. Award

I -~:-_-----;-.---~·~·#·~-~---~ .. ~~----.~-----··;--,-.. ---- .---:-.-=.-·.:.:·:;=·:;-;~·-:::.-:.::::.·.:;·.:.--:;·=..:.:.·.:-..=.:.:.:-•• :· :~:: :_-.;··- ·--2;---~ .. ·-· ........--· ..... ·:-~------------------~-----~··--,..---,..,- .. c-·~~-.~-~ I ----··••----·-i--- ...

I va , "\ & • .' II

APPENDIX 1 25__ 1 1965 Phi Beta Kappa; Recipient of' Merck Award in Chemistry; Outstanding U~tdergt•aduate in Chemtstty Award of Phi Llllllbda Upsilo11; Medal for Soholarship o-£ the Am~dQan Institute of Chemists; The Ramsey :Ptize irt Physical Chemistry; Sigma XI- All atU.C.L.A.

1968-1969 Hemy Strong Denison Scholarship for Research in Medicine1 The Johns Hopkins Universlty Sohool of' Medicine~ 1975 -1977 National Reseru:oh Sel'Vioe Award in Diabetes (NIAMDD)} Natioru:tllnstituteu of Health.

1975-1978 Daland ·Fellowship in Clinical Medicine, American Phllosophloal Society.

1977 _: '1978 CHnioal Investiga.to1' Awro.'d iu Diabetes, NIAMDD> National Institutes ofBealth.

1984.-.1985 John. A. Hartfoi'd Senlot Soholat• Award in Gel'latdo Medicine, Division of Aging, Hanrard'Medical School.

1989 The Genesis Awru:d, Fo:t.' Innovative Health Care DeHve1y, Los Artgeles Bushless Journal.

1989 Ptofessional. Leadership Program Award, Volunteer Cento:r of Los Artgelos.

1999 One of Top 20 :Physicians in the Ch-eater Los Angeles Ate a (and only Gerlafliclan natned)ll Los Atlgeles Business Jm:unal.

2000 One of Top 1?rlmmy--Caxe Physioiaus in th~ U.S.~Tow.n an.d Country Magazine.

2002 One of Top Ten Physicians in Los Angetes1 Amet1car-On-Line.

8. Licensure: California..

·-:::-----· ---~···~---------------··---···---···-···----·-·- ·-·-- -- --. · · · - -·.,.-.:;·.:··-~.-.·--;-;.~-, "0.: .-,.- ...- .., -~,----:·"' ... - . - - - -,·-----·-·--·-............. - .................... ~-- •..• --·-~------;-~,...,...,.

' .

APPENDIX 1 9. Boards! A1nedo(tn Board of I:ntel'nal Medicine> 1974.

Atnedcan Boatd of Quality Assurance rutd Utilization Review Physicians, 1995 Certificate of Expertise itt Geriatric Medicinel American Board of Intel'nal Medicine, 1996

C. Pl·ofesstonal Background 1. Academic Appointments a~ Tlw Jolms Hopkins University School of Medicine~ Baltlmore7 Maryland; Clinical Fellow in Medioine~ 1969"197L b. Massachusetts General Hospital7 Boston7 Massachusetts; Cltntoa1 and Reaeatoh Fellow in Medicine (Endocrinology and Metabolism)> 1973 ..1976.

c. Hawatd Medioal School~ J3oston, Massachusetts; Clinioa1 and Research Fellow in Medicitl.e (Endocrinology and MetaboliStn), 1973.. 1975.

d. Hlu.\Tatd Medical School) Bosto~ Massachusetts; fustructQr ln M¢dioine (Diabetes)~ 1975~1978-.

e. Mammch\lseii:s General Hospital> Boston1 Massachusetts-; Clitllcal Assistant in Medicine (Diabetes Unit):~ 1976~1978..

University of Southern California School of Medicine; Los Angeles~ Califonda; Assistant Pxofessor of Medicine (Diabet(7s Division); 1978-1981. gt University of Southern Cruiforoia School of Medicine~ Los Angelesj Califo:mla; Assistant Professor of Medicine~ with tenure (Division of Diabetes and Clinical Nutrition)~ 1981 - Jtmtiaty 1984.

h. Los Angeles County/Unive:rsity of So'U-thetn Califomia Medical Centex) Los Angeloo., California~ Staff Physician in Medicine (Diabetes Service), 1978 -.January 1984 i. University of Southern California School of lVIediclne;p :Los Angeles~ Califotuia; Associate Professor of Medicine (Division of Geriatric Medicine), January 1984-Septelnber 2006.

··"'"'·~~~:·-::::~.::o c·c~=::c:."'"""'-~O:.-.:-:::;,..,.~·-;_:·:,·:-c. ;.-,-,-··.;·,-:;o·~c-···· ---~·-;--~·-·:~ ·---···c-···-···..··-········ ........,.....!. . -.,........ _--·-- _·- -----~····--· -.· ·------ ·~ . ·."· .. --~------------ . -.-·. ,. . -.---. l ·-:· --' ~---

~~ t1 • ., ' . "\ J • ~ I

APPENDIX 1 j. Unive~·sity of Southe111 California S¢l:Cool of Medicine~ Los Angeles? California; Chie~ Dlvlsion of Gerlatdo Medicine· jn the DepartJ;ne11t ofMedlcinej January 19&4- 2005.

k. University of Southern Califotnhh Los Angeles~ Califot:nia~ Associate Professot of' Gerontology, L~onard Davis School of Gerontology~ Ethel Percy An.drus Gerontology Center~ Januaty 1984 ,_ Septetnber 2006.

1. University of Southern CalifomiaJ Los Angeles,· California; Assooiate Professor cf Clinical Pharmacy, U.S.C7 Sohool of Pharmacy~ October 1989 .... September 2006~ m. Los Angeles County/University of Southe:n1 California Medical Center~ Los Angeles, California; Staff Physloia11 in Medioinej (Oeriatdo Medicine), 1984..2004.

u, Sabbatioal Leave> Harvard Medical School~ Boston, Massachusetts~ Dlvisio11 of Agingt John A. Hartfol'd Seniol' Scholar in Gerlatdc Medicine-~ 19 84- 1985.

o. B:dghant & Women~s Hospital, Boston,. Massaohusetts; Clinioal Fellow in Medioine (Oer!atrio Medicine)~ 1984 ..1985.

p 4 :Beth Israel I-iospital~ Boston~ Massachusetts; Clinical Fel~ow in Medicine (Ge:dai1'lc Ivfedioine), 1984 .... 1935 q. University of Southern California, Los Angeles~ California; Senior Research Associate; Getontology Research Institute; Ethel Percy Andrus Gerontology Cente1~ 1985 .-.. 1989.

r. University of Southern. California., Los Angeles~ California; Fellow Institute of Advance Study, Ethel Percy Andtus Gerontology Center, 19B5 . . . 1987.

$. University of Southern California University Hospital, Los A11geles~ California; Chief of Geriatric Medicine~ 1991.. 2005 University of Southern California . . . School of DentistJ:y - Associate Professor of Medical Dentistry and Public HealthJ 1994 i -September 2006.

I u. Unlversity of Sottthem California~ School of Independent Health _Professionals - Associate Professor o:f Oocupa.!ional Science and Oooupational Therapy~ 1998~ S~ptember 2006.

I l I I I I I J ·-·--· ----·----,---,--··-·~-------·- --- -····-·····-·----··-·-----:-- ··--· ··--·{:·· i .. D ' '\,! • j 'i J .• ~~-.

. . J

APPENDIX 1 v. University of Alnska, Anchorage_. Adju11ct Aasooiat~ Professor of Human Biology) 2001- September 2006.

w. · UniversitJ of Alaska Southeast, Sitka .... Adj\.1not Associate Professor of Human Studies, 200~ .. 2006.

x, University of Alaska, At~ohorage) Affiliate Professor, College of Health and Social Welfare, 2006 -:Present.

y. Unive1'sity of Ala~ka. Anchorage~ Afftllate Professm.; Biomedioal WWAMr Program, College of Axts and Sciences~ 2006- Present.

Univexsity of Alaska; A.ltchol'age~ Faculty Consultant in Geriat.dcs, • i Alaska Family Medictil Residency! September 2006- Present.

aa, Un1vetsity of Southern California, Keel< School of Medicine~ :Professor Emeli'tt1s ofMediohte~ September 2006 - Present.

2A. Teaching Responsibilities (University ofSouthern Califotnia) · a. Attenditl.g· Staff :Physician LAC/USC Medical Cent~t· ott the Geue~al Medical Service- teaching and supervising patient oru:e~ both inpatient and ouipatient to house staff and students 1985 - 2004.

b. Attending Staff Physician. at USC UniversitY Hospital in Geriatric Medicine for lv1edic~L Ho1.1se Staff and students. 1991- i005. a. Xn charge of the Fellowship Program - Geriatric Medicine. 1985 - 2004. .

I d. Development at1d improvement of Gerlatdc Medical Cun·loulum in the Medical School- UniV'et'sity of Southern CaU£omia. 1985 -2004 e. Developn1ent of Oedatrlc Medical Core Cm:d:oulum for House Staff~ LAC/USC Medical Center, 1985 ~ 2004 fu~ Medical • I,

f. Member of Stee1·1ng Committee~ Key Faculty and Study Site Cootditu~tor ~ Pacific Geriatric Education Center at the University of Southe1n Califottda(DHHS), 1984-1993. . . g. Atton.ding Physician Year HI Medicine Rotation) 1992.

1L Dit.'eotot and lecturer in various cou.rses at the Eth£;)1 Percy Andrus Gerontology Center including Gerontology 599 - Geriatric Health Issues~

'1 j I .. 1' . , a•

APPENDIX 1 i. Director- C.reriatrics Update- A Board Review Course. j. Director__. ~istoty of Medicine in the Healtlt Sciences Program~ 1994 ~200L 2l3. ·Teaching ResponsibiHttes (University of Alaska) a. Director.-.. Care oftlte Elderly Cortferenc~, University of AlaskaJ So\lthefiSt- Sitka> 1994-Ptesent b. lustruoto:r .- Promoting Best .Practi<3es in Aging, University of Alaska, Anchorage> 2006- Present c, Co··Director- University of Washington Med(oal Soltool 596 ~ Human Biology - Course for Alaskan Students . - Muitl..

Disciplinary and Ethnicity in Gerontology and Geriatrics, (University of Alaska~ Anchotage .. Sprirtg and Fail$ 2009 and then yeady).

d. Co~Dil'ector in Geriatric Education to Alaskan Medio~U St1Jdents iu. the University of Washington Medical School WW AMI Progt·arn> University of Alaska, Anchorage~ 2006 - Prese11t e. Fa-oulty consulmnt in Oerlatdcs to Residents of the Alaska :Fan:rl.ly Medicine Residency Program, 2006 . . ., Ptesent.

3. Administrative Responsibilities a. Chief of the Division of Geriatric Med~oine~ Departme11t of Medicine, Unive:tsity of Southern Califbrma. School of M~clicine. In charge of ataff arid fellow recruitment and trahrlng; divisional budg~t; gtatlt procu;rement; program. development and S\lpervision of researoh a11d olllrlcal activity. 1984 . . . 2005~ b.. Study Site Coordinato:r and. Key Faculty .of .the Pacific Gedatrlc Education Center, Dtrl.versity of Southern California Sohool of Mt;Jdicine1 1984--1993. · c. Senlo:t Staff Physician in charge of Ger1atr1o P.rogtmns at Los Ang~les County/O"niverslty of Southern Califo1nia Medical Center~ 1985 - 20044 d. Chief o:f Geri~ttic Medicine at the USC University Hospital> 1991 - 2004;

- -- --~----· ._ __ ·--· - .. ··----·-- ,.._,~ __ ...__, __ ,

APPENDIX 1 e. Faculty liaison betwee11 Geriatric Medicine and Univel'sity affiliated hospitals and long term care fuollltles. Director of Oedatrio Medicine Private Praotice Platt. 1984 ..... 2004 f, Dlrectox of the USC Ambulato1y Health Center sites at the Japanese Retire:ment Homes and Angelus Plaza., 1985- 1993.

g. Dft•ectot of the Division of Gedatdo Medicine>s Program at the V.A.

OutpatielJ.t Clinic in downtown Los Angeles, 1986- 2001.

h. Director of the DSC Teaching Nm·sing Hon1e Program at Hollenbeck :Home ~nd. Atherton Ba})tlst Home, 1999 -2005.

i: Director of the Senior· Cancer Center at Nords Comprehensive Cancer Ce:nte1· and J.iospitalt 1999 - 200 1.

j. Ditector of the Senior Cru:e Program.~ USC Care and. USC )?hysicians.

199& - 2002,. .

k Co.-Director- Adult :Protective Terun - Gerlatdo Medioine Program- LAC/USC Medical Center, 2000 ..... 2004.

L Director - Cate of the Eldedy Conference~ University of Alaska Southeast~ Sitka, 1994 - Present.

m. Co~Pxrecto1.· ,__. Gerlatrlo Eduo~t.ion for Alaskan Medical Stndents in the WWAMr Program;. University of Alaska1 Anchorage. 2006 ~ :r~·esen.t, n. Medical Directol.' .-Alaska Gel'intdo Eduoatton Center~ Univet·sity of Alaska1 Anchorage. 2005 - Pxesent, o. Medical Dh·eotot . . . . National Resource Centet for Studies in l'lative Amerloan~ Alaskan, and Hawaiia11 Elders, Uni'\lersity of Alask~ Attchorage, 2006 .. Ptesent 4. Senrice A. University Service a. Medical Executive Cotunrlttee, Deparhnent ofMedloine~ USC 1985- 2003.

b. Utilizatioll Management Comtnlttee; USC Universit-y Hospital, 1991-- 1999~ 2003 ..... Present, .Chairman o:tthis Co;nunlttee, 1994---1999.

"til. 11 4 '

APPENDIX 1 31! o. Phru:maoy and Therapeutics Committee, LAC/USC Medical Center$ 2001-2004.

d. Pharmacy attd Therapeutics C(ntJ.mittee~ USC University Hospital, 1991 - 2005:~ Chairman, 1996- 2000.

e~ Pati~ut Ca1.·e Evaluation Committee~ USC University Hospiial, 1994 - 1999, f. Le6ture;r in School of Pharmacy:. University of Southern California> 1985 ..2004.

g~ Continuing Medical Post. .Graduate Education Lectures at outlying hospitals~ 1979- 20Ct4. h. Core Cwt1cultlrn Conunittee forth~ New Medical Sol1ool Cu1·riculu:ml USC School o:fMedioine~ 1998 ..... 2002 · L County Operations Committee~ Department of Medicint)> lAC/USC Medical Center, 1997 . . . 2000 j. Development CotnrrtitteeJ< Depamnent of Medicine, LAC/USC Medical Center, 1997-2000, k. Senior Health Care Progrru.n, USC Cate2 (chair/member);~ USC 199~ .....

2002.

L Executive Committee~ USC Norris Comprehensive Cancer Center and Hospital._ Senior Cancer Catt;} Center, 1998 ... 200l.

m. Co..Director - Adult l?tot~ctive To<UU ..... Ge1iatrio Medicine Program ~ LAC/OSC Medical Center~ 2000 .... 2004t l3. Public Service a. Consultant in Geriatric Medicine and Long Term Ca:re1 State of Alaska~ Depru.:tments of Aihninistta.tlon Law, H&;}alth and Sooial Se:rvice~, 1991 ..·2004 b. Consultant in Gerontology and Geriatric Medi.oine, UniveJ:sit.y of .Alaska, both at the Anchorage and Sitka campuses~ 1994-present.

c. Board of Directors~ California AssociatloJJ. of Medical Directol'Si' 1992- . 1999. ~... .. .

·---..--··-····--·-----:-:· ·-· .. ---·:- ----·-----:-----'--9----.-- --······· ··---:-~:--~";';' .. ::=;;'·::-.;-;~::-::-·:·:.- :· -~·-;··-~--------.-·- ·-·· ..••... ,....•..... ···4··-~···4 4 .. 4--•· ... ·4---··--~-

.. ., 4 .. ,, 4 • '\if • •\ A •

APPENDIX 1 d, Citizen's Oversight Committee ·~ CalifDtnia Stem Cell Resea.tch & Cures Act, 2007- Pl·esent.

e. Board ofDirectors, USC FriendsofMusic, 1989-1997.

f. Task Fotce on Elder Abuse) City of Los Angeles~ 2001 . . . 2004-.

g. California Ra1'e Fruit Growel's~ 198 8 - J?t'esent h. Pennsylvallia Horticulture Socjety~ 1992- 200'7.

· i. Affenpins¢her Club of Amedoal 2002 ,_Present.

j. Kenn.el Club ofPasadena, 2004- 2007.

5, Milital'y Service 1971 . . ~ 1973 Aottve duty as Sutgeon- U.S.F.:H.S. serving as Research Associate (PJ:otein Chemisb:y) in the LaboxatOI'Y of Chemical Biology with Dr. Robet~t Goldbetget and Dr~ Christian Anfmse~ NIAMDD, NIH: I.naotiveResorveU.S,P.H.S.1969-1971, 1973-1979, 6. Other Activities a. Editor for ENDOCRINOLOGY for Diabetes and I11ter.ntediary Membolism61985 -1986.

b. Member of the CotrUUittee of Interdisciplinary GeJriatl'ic Education~ Association for Gei'ontology In Highe!' Education) 2002 - 2006·. c. Reviewer fo1•: · AMERICAN JOURNAL OF l?B:YSrOLOGY ANNALS OF INTERNAL MEDICINE ARCHIVES OF INTERNA:L MEDICINE BIOCHEMICAL MEDICINE DIABETES BNDOCRINILOGY EXPERDMENTALGERDNTOLOGY JOURNAL OF CLINICAL ENDOCRINOLOGY AND. METABOLISM JOURNAL OF GERONTOLOGY HORMONE AND METABOLISM RESEARCH JOl.JRNAL OF TI):E AMERICAN GERIATRICS socmrY DRUGS AND AGING NEW ENGLAND JOURNAL OF MEDICINE

,., 6 I ' r

APPENDIX 1 '.

1. Local Ct•oss ~"fown Endocrine Club PL·ofessional Staff Association of LAC/USC Medical Center Center Fellow of the UCLMJSC Long Term Care Gerontology Center Far Eastern Study Center USC/UCLA California ~ssociation of Medical Directors 2. Regional We,~tern s·ociety for Clinical Investigation We.sterlJ. Section of the Arnel'ican Federation tor Clinical R()searoh

3. National Sigu.ta Xi~ Phi Beta Kappa) Phi Lambda Upsilo11 The Johns :S:opldns Medical an.d Surgical Society The Joh11s Hopkins flisto.ty ofMediclne Club The Associates of the Countway Librm'j tlle American Association for the History of Medicine A:tnerloau Federation for Clinical Research Amerloan'niabetes Assootation The Endocrine Society American Phy~lo1C1gical Society The Gerontological S{)ciety of Afiledca.

The Amerloan Geriatric Society The American Federation fm: Aging Research American Gerontological Associatio11 American Association of Medical Ditectors .: ~.. . .

E. Cnnsult~.ntshlps ~nd :O:h·ectol'ships 1, Consnltant in Geriatric Medicine and Supeu'ViSoi' of the Oerlatdc 1?rognun at the Veterans Administration Outpatient Clinic in downtown Los Angeles~ 1986-2001.

2. Executive Director of the USC Alnbulatoty Health Center at Angelus Plaza, 1989~ 1993. .

3. Board of Dil'ectors~ California Assoeiation af Medical birt;Jotors~ 1992 ~ 1999, .

4. Board ofDirector, USC friends ofMusic.I989-1997.

-·--••~••·r~·~--~~- - •·•· ••• - · - -• ~·-••--•••• ~---- • •· -. ••• - ,_,,, •• ~·- ---•- •--··•----•••r• __ ,._ __ ._,.,,.,_,_ -••• •• •

t •

APPENDIX 1 5. Consultant in Gerlatdc 1vfedioin~ and Long Tettn Care- State of Alaska 1991-2004; a, Department of Administratio11 b, Departmentb£Realth and Social Services c, Department of Law d. Mental Healfu Board 6. Appointments in Gedatrlos ..-.University of Alaska: a. Sitka I. Adjunct Associate Professor of Human Studies) 2003 ..

2006.

IL Course Direotox - Care of the Bldel'lY Conference) 1994 Present b, Anchol'age · l. Affiliate Ptofess01~ College of Arts and Soienoes~ Biomedical WWAMl Program~ 2006 .. Present II. Cotlsultant~ Co-.Founder artd Medical Director ..... Alaska Oedatdc Institute tlu:ough the Alaska Oerlatric Education Center~ 2003 ~ Present.

IIL Consultant ·· fnstitute of Circumpolar .Health IV. Consultant and Medical Director -National Resourae Ce.nteJ.' fol' Arnedoan Indiausll Alaska Natives and Native Hawaiian EldetsJI 2005 .... Presertt.

V. ·Faculty Consultant in Geriatrics? Alaska Family Reside11cy Ptogrmn~ 2005 •· Pl'esent Vt Affiliate P.:t::ofessm:~~ College of Health rutd Social Welfare.

7. Consultant> British Columbia Health Foundation., 1994 ..... 19,99.

8. Consultant in Gel'latdc Medicine w.d Long Term Care, Silverado Seniot· L:f:vlng Centers) San Juan Capistt·anoJ CA 2001 ..... 2002.

·9.. Consultant in Geriatric Medicine and Supervisor of the- Gedatdo Medicine Medical House StaffThaining Pxogram, !Ce:tn Medical Center~ Bakersfield~ CA 1936 .-... 2003.

10. Consultant ill Geriatric Medicine and Supetv1so.t of the Gedab:ic Family · Medicine House Staff Training Program, Glendalo Adventist lVIedtcal Center, Glendale~ CA 1998-2001

········--------·------------ ... -·-: -- ·-.--·:----:·:····----------~-·--.- · : . ····· .- -----·-·. ------. ·---···----1:2---·--.--------- -- ...

... 6 • 1 ~ I ·,

APPENDIX 1 11. Cons-ult$lt i.n Geriatric Progran1 Deveiopme11t . _. . Bay Shores Medio~l Gronp., Torrance~ CA.) 1986-1989.

12. Consultant in Geriat.tlc P1'c;>gram Development .... San Phnas Co):'U1rtun.lty, Hospital, 1986-1989.

13. Consultant in. Gedatrlc Program Development and Long Tenn Care - Keiro Services ~ The Jap.!inese ..... American Retirement Homes~ Los Angeles, CA.> 1986 .... 1993.

14. Consultant in Gedatric Ptogram Development and Loug Term Cal'e--the Motion Pfoture an<l Television Home~ Woodland Hilla, CA 1986- 1?90.

15. Consultant in Long Term Ca.re and Geriatric Medicine> State ofCaliforn1a) Depru.1to.ent of Social.S~rvices> 2000- Ptesent .I lI 16.. Consultant in Elder Abuse~ Gedatric Medicine ~nd Long Te11n Care~ State of California7 Department of Justice~ Office. of the Attorney Gertetalj Bureau ofMedioal Fraud and Elder Abuse., 2000 _.Present.

17, Consultant in Long Tetm Care~ Eld0r Abuse and Geriatric Medtoi~e - State ofCalifomia, Department of Justice~ Office of the Attot.ney Ge1~enu~ Bureau of Medical Fraud and Eld{)r Abuse - Operation Gua1'dians (lltttsing homes .. un.am10unced inspections) 2000 - Ptesent.

18. Consultant in Long Term Care.~ Geriatdo Medicine and Elder Abuse ..., State of New M~xico 1 Departm.ent of Justice, Offioo of the Attorney General, Medicaid Fraud and Elde:r Abuse Unit~ 2003 . . . Present.

19. Consulta11t in Long Term Cftte, Geciatrio Medicin6 and Elder Abuse> United States of Arnerlcal Department of Justice, Civil Rights Dl11Islon, • •• ·.t. .,......,:."' 1-.. - 2006 ._.Present. · .. ~.IL.".t:=~...·--·· . 20. Consultant mLong Term Cat·~, Gedatric Medioine and Elder AbUSt;\ United States of America} Department of Health and Ruman St:!J:1lloes~ Office <>f the Inspectur General, 2006 ..... Preseht 21. Boatd ofDil'eotors~ Musica Angelica:1 2006- Present.

JF 4 JRcse~:rcb. Activities 1. R~search Tnte1·ests a. Use o'frnedications in the .senior populations with specific emphasis on prescribing habits of physicians.

·-·--·----·-·---·----·- ·--·-·-·-·--·---·-····-···.···-·-·---:--···;-·-··-- _________ _13_·-·-··-····-··-··---------·--- ·- ~~- -·-··----~·-- ~-; ·--~--'""-:-··-:·!;..:·.::o.:-•... ~···.::::.::=-;;;---.-;-·~;--·--- ·--·---····-···~-- •.. -· .

..... I

APPENDIX 1 b, Health cat·e systems and delivery modes fat' the demented eldedy in Alaska. c. D1'Ug interactions in. the eldel'lyt looking at dtug-dtug interacttomt~ changed actions~ polypharmacy} n1isuse' and abuse. d. Studies in the elderly diabetic patient. e. Studies in the elderly hypertenst-ve patient. f. Studies in sexual dysfunction in the eldedyr g. Studies iti -elde1 abuse.

h~ Ma.h.).tenance of independen?e of living in frail attd demented ~etlio:rs.

2. Research it1 Progress: In'lestigations bt man a. Studies in prescribing habits .ofphysicilitns in retirement housing. b. Studies of adverse drug effects in the aging population with special [ emphasis on the most commonty prescribe medication and psychotropic agents~ c. Studies on. care- offi:ail and demented senfo~·s in Alaska. d, Studies on the prevention and early detection of elder abuse. e. Stud.tes on d~reased longevity in the Pueblo lndians~ G~ Long Tel·.m Cu:re Expedeuce.

1. Dltector of the two. USC Teaching"Nursing Hom~ Prog~·ams) 1999 ~ 2005 a. Hollen~beck Home- LOS Angeles b. Atherton Baptist Home- Alhambra 2. Member and M~mber Boru:d of Plreotor~ California Association o£ Medical DirectOJ.'S, 1992 .... 1999.

3. Consultant,_, State of Alask~ Department of AdministratlonJ Division of Longevity Se1·vioes (Aging Prow,wna and State of Alaska Long t~nn.Cnre Facilities- the Pionoo:ta' Hontes). 1991-2004.

4.. · Affiliate Professot, College of Ifealth at:td Social Welfare and College of Arts and Sciences~ Uruvet.sity of Alaska;- Anchorage. · Areas of involvement - Alaska Oerlatric Educatl011 Center, Gerlatrio. Assessment.~ Pre~med aud Medioal Education,. Long Tel'm Care, 2006 to Present. .

5. Consultant'- UniV'erslty of Alaska, Sitka. ArtYa.3 of involvement- Care of Elderly Cotuerettce-- Dit·ect()r=- 1994 . . Present !5. Consultant in Long Tetro Care) Elder Abuse and Gerlatdc Medidne - State of Alask~~ Peparlment ofLaw> 2000 - 2003

·~.--- . -~ ---- -··-- ~-.- ---. - -- ---

.. ~ ., b - "\a •

APPENDIX 1 7. Consultat1.t in Lo11g Tenn Cru·c rutd Ged£~ttio Medicine ~ State of Californi~ DepartmentofSocxal Services.

Consultant in Long Tetm Care~ Geriatric Medicine and Elder Abuse - • j State ofCalifomi~ Depru.1:ment of Justice~ Office of the Attmney General, Bureau of Medical Fraud and Elder Abuse; 2000 ..... 2003.

9. Consultant in Long Te:nn Cro:e . . . State of California> Department of Justice> Office of the Attomey GeneraL~ Bureau. of Medical Fraud 1:1nd Eldet Abuse - Operation Guardians (nuraiug home~ unannounwA inspections)? 2000 -·Present 10. Consultau.t in Long Term Caxej Gerlatrio M~dicine and Elder Abuse - State of New Mexico, Departroent of Jusdc{}~ Office of the Attorn~y General~ Medicaid Fraud and Eldet Abuse Unit> 2003 - Present.

11. C<msultant in Long Term Care~ Geriatdo Medtcine and Elder Abuse~ United States of America, Depro:tmf;)nt of JusticeJ Civil Rights Division, 2006- Present. · 12. Pd:mw:y cai'e provider fot Geriatric Medicine for Long Term Ca~·~ Patients -Hollenbeck H01ueJ Los Angeles) CaHfomia, 1998 . . . 2004.

13. LAC!OSC Medical Cent¢.r CHnlo . . . Adult Protective T~~m- Oerintrlo Medicine-Clinic Co . . dire~tor, 2000-2004.

14. Member of the Ar.nerica11 Association of Medical Directors.

15, USC __. Angeles Plaza - Senior Clinic ~ !founding Director and oare provider (1989 ~ 1992). (The largest low-income seniorl10using p1·oject in th~ Westen1 Unit~d States).

16. Co.nsuUant in Gel'iau:lc Medicine and Long Term Care- Silvemdo Senior Living Cent~rs) San Juan Capistrano> 2001 -2002. .

1'1, Consultant in Geriatric Program Development mtd Long Term cm~e - K.eiro Services ~ The Japanese Atu~rioan Retirement Homes, Los Angeles~ 1986-1994. · 18. Consultafit ih Gcdau:ic P.rogram. Developtnent and Long Term Cm·e- The Motion Plcture and Television Home; Woodland Hills~· CA1 1986 -1990 :m. Significant ln'Vi:ted :Luc¢ures (Since J utly 1984 ..... selected fll•onn ()ver 3,500 leetutres given) · · t Harbor General Hospital- U.C,L.A, Medical Center~ 7/a4.

··----. -~- --· ------ - ··-- ~-~-- -oo- ~--~-· ----- 0 --·-· _ _ _ _ _ _ _ _ _ _ . . _____ o --.~~ •• - ... --0 ~- o --00---~.-.;·-~-·~···--•' ·- -•- ''~'"'"' -···-·--• - o -··.- 0-- • 0 -0 0 - .. o ~-·-- 0 -- * • 0 0 -----M 0 .... - -

"o 0 0'". !

APPENDIX 1 lI Ivfedicnl Grand Rounds - new concepts in the tl'eatment of Type II Diabetes, 2. Harbor General Hospital- U.C.L.A. Medicatcenter~ 7/84, Endocrl11e Grand Rounds -The ;t>.ewer oral agents.

3. MattinLnthe~· King Getteml Hospita~ Los Angeles, CA) .7/84 Medioal Grand Rounds .... The approach. to the patient with NIDDJ\4.

4. Nisei Awat:en~as Day1 Little Tokyo:. :Los A.tlge.les, CA, 7/84 Health issues for the elderly. Key11ote speech.

5, The Cleveland Clini¢, 9/84. Sym.posiUtn on Diabetes Mellitus- · The 'f~'eatment ofthe Patient with NIDDM.

6. American Academy ofVamily Practice> Kansas City> MO, 10/84 ·National Meeting, Jnvl£ed Speake:~:: a. Nutdtton in the elderly b~ New concepts in the thetapy of the Type II diabetic patient.

7. Associates of the Countway Library:t BatVatd Medical School~ 11184.

Biannual History of Medicine lecture ~ "The Black Death Cornes to A:l.nedoa:H 3. Washington University of St. Louis and St. Louis V.A. Hospital, 11/84.

Symposium on Diabetes Mellitus - The u:ootment of hYPertension in the patient with Oiabctes Mellitus, 9. The Jackson Laborato1'y, Bar Harbot·, Maine~ 12/84.

Visithlg Scientist..- Insulin secretion in aging.

10. ,Gordon Research C<;mferenoo,.O:gmat,(}, CA~ 2/85. The biol()gy of' agbg; .- Invited Speake.r . . . Cyclic AMP and insulin secretion ~n aging. .

11. Thorndike Rounds,. Beth Israel Hospital, Boston~ MA 3/85.

The appl'oach to the treatment of diabetes mellitus in the elde:dy individual.

12. Division on Aging, HarvardMedioa1Schoo1, 3/SS.

Gtw.d Rounds - Hyperosmolru.· co11:1a"""' a complication of diabetes mell~tus in the Elderly.

13~ The University ofNewBrunswiok~ SaintJohr4 N.B. 1 3/85.

Visiting professor of Biology; Lecture topics: a. The role of calmodulin in insulin secretion .

..... . ·u.

APPENDIX 1 b~ Th~ exciting new approaches to the treatment of diabetes ·mellitus.

14. Beth lsraeL :Hospital:- Boston~ MA> 3/85 Endocrine Gl·and Rounds -Sex and the diabetic.

15. The Johns I-Iop1dns University Scholl of Medicin~, Baltimoret MD~ 3185.

Visiting Professor of the History of Medioine. Lectw:e topic - '<Black Death Co111e to America.~' 16. Bt1gham~Wonten~s Hospital, Boston} MA> 3/85 Endoorine G.ra.nd Rounds ...-·Insulin secre.tim1 in aging.

17. Yale Uni-versity School ofMedioine~ New Have14 CT, 4/85 Endocrine Reseruch Confel'en.ce -Insulin seQretion in aging~ ··• t... Hypertension Grand Rounds- Special problems ofhypei'tetlsioll in · the diabetio patient. · 18. University ofifl01'ida~ Gainesville~ FL 4/85 Gel'iatdc Medicine Grand Rounds . -The older diabetic . patient.

19i University of California at Lo::: Ang~les School of Medicine, 4/85, FaroHy Medicine Grand 'Rounds ~ Treatment of diabetes 1nellitus in the elderly.

20. Stanfol;'d University of Medicine .- V.A. Ho.apital, Menlo Patl; CAt 5/85~ Clinical Conference- Sexual dysfunction in the elderly.

22. University of Pittsburgh School o£ Medicine_, Pittsbut·gh) PA, 6/85.

Symposium on Diabetes Mellitus - ~rhe older diabetiG patient.

23.. : ...t~!W..niv.ersity ofHawaH School o£Medio1ne) Honolulu, :HI~ 8/85 Medical Grand Rounds- Diabetes in the elderly.

· 24. Depattme.nt of' Public Health and Social Welfare1 Guatp., 8/85 Special L~otute- Wellness and pathology in the eldedy, 25. American Aoade,my ofFamily Practice) Anaheim, CA. 10/85..

National Meetlttg -ln.vited Speaker- Oiabetes ill. the elderly.

26. University of Ct1lifornia at San Pranoisoo ~Valley Medical Center, Ftesno, CA:. 1liS$. Endootine symposium ..... Sexual Dysfunction 1u. the elderly, 21. Mayol'->s Conference on Aging, Los .Augeles> CA.:, 3/86. treatment of chronic diseases in the elderly.

'( p • ~ 4 • -\ l I

APPENDIX 1 28. V.A. Hospital~ Miutinez1 CA. and t.J.C. Davis Sohool afMedic1ne7 4/86.

Medical Grand Rouu.ds ._ Treatmep,t of hypertension in diabetic patients.

29. Pasadena Council on Alcoholism, PasadenC4 CA> 4/86. Symposium on tlie Older Alcoholic Patient. Pathology and normalcy in aging.

30. Brown University Medical School) Providence, R1 4/86. Medical Gra.nct · Rounds- Hypertension in the eldf;}rly.

31. Medical Board Dl'ug Review, Sacramento1 CA, 5/86. Invited Sp~aker- The new otal agents. · 32~ Confere1lce - Scll;lntific Basis of Se~ual Dysfunction- Sponso:red by NlH a11d the National Kidney Foundation, Baltitnote> MD) 6/86, " •. ··SS·. F.D.A. SyJnposlum of Bioequivalenoe of SoHd Pt¢paratlons~ Washington> D.C., 10!86. htvited Speaker- Oral sulfonyhu:ea agents.

34.. Univetsity of Nevada, Reno, NV~ 2/87. Visiti11g Professor of Medicine, Lecture topic . . . Sex after 60.

35. University of Guam~ .Guatu~ USA> 4/87. Sym.poslum on Cru:e of the EI~etly - Symposium Leader.

36. National Council on Hypertehston, Biannual Meeting; Las Vegas~ NV, 4/87. Invited Speaker ~ Antihypertensive medications and se~~H1l dysfunction.

37. Ame:doan Hospital Phrumaciats Assoolatlon, Washington~ D.C. 5/87, !~vited Speaker ..... Aging in .Alnerioa ~ Wellness vs. Disease. ! t,.,._;__.

I f 38. University of California;. Davis- School o.f Medioine~ 6/87. Cours~ (In ~ Medicine~ Invited Speaker- f~ypertension i11 the elderly. i 39. University of Nevada, Las Vegas> Nevad~ 10/87. Visiting Professo1: ()f Medicine~ L~cture Topics: Ge1'iat.ric Medicine Today~ Geriatric Course Planning.

40. California Phrumacy Association~ San Francisco~ CA> 11/87. Invited Speake!!- Bndocrinology·of aging. i ' 41. Evanston Hospital> No1'thwestern Ui1iversity School of Medicine} 1 ~vanstou> lL~ 11/&7. V1sitingProfessm.·ofMedicine~ TQpic . . . Sr;;x after60.

I I

.. n ' '"'A • i /J •

APPENDIX 1 42. Confe1'enct o:n Pathogenesis and Treatment of 'Pressure "Sores. Kansas City, MO, I/88. Invited Speaker.

43. Conference on HWhat Phannaceuti~als are Needed for the Elderly?, Phoenlx~ AZ>2/&8. Invited Speaker.

44: Confet~nce on l'Post Retirement I;Iealth Care Funding'~ sp'onsored by l.R,t, New Yotl; NY~ 3/88. I11vited Speat{er-The gedatdo I.mperative. · 45. Board Review Course: Geriatrics Updatej 1988, U.S.C~ School of Medicine, Pasadena, CA> 3(88 .. Two and one~half day s-ymposium on gel'iatrios. Dk~ctor, Modet·ator and Presenter for the course, 46. Symposhun on Geriatric Medicine - Motion Picture and Television Retirement Home And Hospital~ Woodland Hills, CA~ 4/88. Moderator. and Presenter, · 47. America11 Getiatdo Society National Meetingt Symposium and Phys~oian - :Patient Conununicatlou, Anaheim~ CA> 5/88. Co. .moderator and presenter.

48. Symposium on G$datdo Medicine, San Dima~ Co1111t).unity Hospital~ San.

Pimas., CA, 9/88, Moderatot· attd Presentet.

49, .Amedcan Society for Entem1 Md Pal'ental Nutritlon Conferences= Ethios and Nutrltion~ New York~ NY, 10/88 SO. Symposium on Nutrition in the Elderly, California lv.tedical Centet1~ Los Angeles) CAJ 12/8&. Mod~rator and Pl'e.~enter~ Topic- Nutrition in the Eldel'ly.

51. Cali:f~~rJ:iia Academy ofFatuily Medicine~ AnuWll Meetlug, San Ftaucigoo> .. \.t-r.~<.l;lt{·s~---.

CA 2/89. fuvited Keynote Speakel'7 Topic- Dementia.

52. Kansas University Medical Center, Fa.rully Medicint;1 Grand Rounda; Kansa$ City; KS; S/89~ Visiting FrofesS()f, Topic-- Drngs in the eldet•ly.

53. California Association f'ol' Homes for the Aged:~ Ann1.1al Meeting.

Symposium on Drugs In the ElderlY:~ San Diego~ CA) 5/89, Invited SpefJ.ker, Topio ..... Mooioal Asp~ots ofDtugs in the Eldet'Ly.

54. Symposium on. Gel1atdc Ca1·e,. Motion Picture and Television I{Qme; ·\Voodland Hills, CA.; 6189. Modemtot and Pt:esenter1 Topic- Tests and exams pedodically needed fqr Seniot health

i ············--·· ·······--·----·-·-.·---:---··--·········-····- ·-............ -. --- ···-····- ....._.- --;. --··-··-----19 ,--·-- ·-· - ·····-·- ---- .----··..·-·- -:-::~-~·. : : :.-. . o-.- -···· --· - - • -·----· • ·- ·-·-~~--:# ~#·-----· ---.. . "7.- ·~

'i 4 I '\ J • ~I,

APPENDIX 1 55. Syrn.poshu:n of Diseases Affecting Ex.t~nd¢d C-are Managentent of 1he Elde1'ly~California Federation on· Aging, Newport Beach, CA, 6/89y Moderato1·.

56. Symposium of Diabetes in the Elderly, USC School of Medicine~ Los Angeles~ CA> 8/S9. Moderator.

57. V.A. Medical Centet; Phoenix, AZ) 9/89. Medical Grend Rounds~ d111gs in the Elderly.

58r Gel'iatl.ic Medicine Symposium, Hawaii Medioa.l Association_, 9/&9~ lnvi.ted Speaket'7 Topic- Hypertension in the Elderly.

59~ Univ~rslty Medical Center of Kansas City~ Kansas City~ MO, 9/B9~ Medical OJ:and Routtds- Sex after 60. • 1~-l ...

I 60, National Confe-.veuoc of Consulting Actuaries, Hot Springs~ VA> 9/89. fuvited Speaker.

61. California Pharmac.ista A~sooiatlCH\, Los Angeles1 CA~ 10/89.

Enc'toorlnology in ihe Elde1'1y. Progran1 Dll'cotor..

62. Family Medicine Program, Santa Rosa, CA~ 11/89~ Visiting Professor of Geda.trlc Medicine.

63. Symposium on Geriatric Moclioine. Tacoma Ge!leral Hospital> Tacoma, WAj 1/90, Course Director and Speaker.

64.. Symposium on Gedatric Medicine~ Antelope Valley Medical Center, Lancastet1 CA, 2190. Cour~e Diteotor and Speaker.

65 •.. Unive.t:sity of Nevada School of Medi~1ne>.. ~-R~no,. NV, 3/90. Visiting Ptofessot {)f Gel'iatrlc Medicine.

66. USC Gedat;dc Review CQurse; USC School of Medicine~ Los Angeles~ CA~ 3/90. Two and one ..half day :intensive course in geriatric medicine.

Co1.u:s~ Director and Spe~er.

67. Eisenhowet· Hospital~ Rancho Mttag~~ CA, 3/90. Medical Grand Rounds- Dl'ugs in the Elderly.

68~ Atnedcau Geriatric Society Arulual Meeting, AtlantaJ GA, 5190.

Symposium on Syndrome X: The con:elation of diabetes and hypertension.

69. American Diabetes Assooiaiiolt Symposit'tltl> Santa B~bartt;, CA; 6/90.

Diabetes in The Mexicati. American Population. Invited Speaker.

-- --- ·--.. . . ~-- -~--..- ---- -~ .... -·---:·----~· ----· --- . . -:- --~ --.. . ~:. -- -: . ----- ·--.. . -·· -~ - . 20 • - - - - - - - - - ----- -'; .7' ::;: :-~-.;:;::·:-. - .::·-••. • :· .-:;---.--·---.---·-· . ..___. ____ ···- - ---------- .. -~ ----·-.---.-·--

.... ... d •

APPENDIX 1 I I 1 ·70. Loma .Linda Univer$ity School of Medicine~ Lorna Linda~ CA, 7/90. . ! Grand Rollilds, Drugs in the Eld~rly.

71. A.me;ricl;lll Heart Association/ American Diabetes Association Symposium, Santa Bal'bata, CA, 9/90. Treatm.en:t of the hypertel1Sive diabetic pat.ient.

Keynote Speaker.

?2. Baylol' College of lVledioine, HotlSton l'Xl 10/90. Symposium on the Complicated Diabetic. Invited Speaker.

73. City of Hope, Duarte~ CA1 1/9 L M~dical Gra11d Rounds, Diabetes ht the Elderly.

74. Providence Hospital, Anohol'age, AK) 2/91. Medical Grand Rounds-~' Sex after60. .•, 75. Sym.posium on Geriatdo Medicine, Antelope Valley Medical Cente1'11 Lanoaste1~ CA~ 3/91. Course Director and Speaker.

76. U.C.S.F. - Valley MedicaL Center1 FresnD~ CA, 3/91. Medical Gtand Rounds, Sex after 60.

77. U.C.D. ~ Sacram~ll:t<>., ¢A) 4/91. Medical Grand Rounds) Sex after 60.

78, Chicago Mec11cal College~ Cl'ticago~ IL~ .5/91. Medical Gtatul Rounds, Drugs in the Eldedy.

79. Symposium of Gt}riatric Medicine~ Antelope Vall~y M('3dical Center, Lancastet; CA~ 2/92. Couts<.1 Directo1' and Speaker.

80. Dep~oot ~-of Administration~ State of Alaska> 4192. In:vited Speaket, ~ .. '-llr..'l!I.>HN~·f~ ·~.-.· Assisted living in long tenn c~te.

8L Intetnational Institute for Reseru:oh Symposium.: Utilities and FAS 106, Washington~ D.-C.~ 7/92. Keynote Speaker, J?rugs in the~ retited population.

82, Alaska Oe.datric Institute$ Anoho1'age~ AK, 2/9'3~ Keynote. Spe~ke;r. 33. University of Oldahoma, Tulsa, OI~ 3/93., Farnily Medici11e Grand Rounds, Dt•ugs in the elderly.

84. Symposium on Gerlau:lc Medicine, Antelope Valley Medical' Center, Lancaster> CA1 3/93, Cours~ Ph:eotor and Speaker.

.. . ~ I r '1 a • 1 A •

APPENDIX 1 :

85, Depru:tme:nt of Administra.tion, State of Alaska~ 4/93. Invited Speaker~ Medfcatkms in the nursing home population. ·86. Dallas Business Group on Health, 5/93. In-vited Speaker, Medications in the Elderly.

87. Symposium on Rc;Jtirem~nt He~Ithoare Benefits, Chicago, lL) 9/93. lnvited Speaicer) Medications in the elderly.

88. University of Hawaii~ Divigio~1. of Geriatric Medicine~ Honolu.lu.) ·lU, 10/9/93. Visiting Professol' of Gerlatric Medicine Diabetes h1 tn~ eldetly, Use of drugs in the eldetly.

89~ Providence l-Iospital~ Anchomge~ Alaska. Medical Oxand Rounds~ 2194. ))ementia.

90. Ne-vada AoadeJny of Fatn..Lly Medicine~ A).1l1Ual !vfeeting. Like Tahoe> Nevada> 2194·.. Keynote Speak~i'- Sex. niter 60r 91. University ofCnlorado Mfiliated Hospital. Medioa.l Grand Rounds~ 3194.

Dl1lgs in the Elderly.

92,. University of Keu.tuclcy Affiliated Hospital. Geriatdc Medl.oal Orand Rounds~ Lexhlgfon, l{entuoky, 4/94. Dementia.

93. Alaska Psyclrlatrlc Institute- API 2000 Me~ting> Anchorage;. Alaska, 6/94. Plans for the Future_.. C()nsultant and Facilitator.

94. USC School of Medici·ne7 los Angeles> California - Medical Gnmd Rounds, 9/94. Drugs in the elderly.

95. Alaska State Mental Health Boatd - Q"tUru~dy:..,Meetlng, :OiHnghun~"· Alask~ 9/94~Invited Speaker~ The Alaska Geriatric Institute.

96. Alzheimer's Society of Northe~n Califomi~ Sacramento~ CA) 10/94-.

Speaketf Researoh in dementia.

91. Alaska Gedatrlc Institut~~ Anchomg<;J~ Alask~ 2/95. Organizer an.d . Keynote Spealcer, The largest health ¢ate symposium in ihe history of the state of Alaska.

98. V.A, Medical Center W<;~stwood and UCLA-- Medical Grand Rounds) 2/95.

99. Symposium on ·Geriatri<} Medicinell A.ntelop~ V.alley MediQal Centet~ I.Jancast~r~ CA, 3/95~ Course Direotot' and Speaker.

'\A • ~II'

APPENDIX 1 100. Nevada Academy of Family Medicine} Ann.ual Meeting, Lake Taltoe~ Nevada, 3/95. Keyltote Speaker-.Dementia 10L Idaho Academy of Family Medicine, Annual Meeting~ Sun Valley~ Idaho, 5!95. Keynote Speaker-- Dementia! Sex aftet 60.

102. Martin L'Uthet King, Jr. Medical C~ntel\ Los Angeles~ CA, 6/95, Medical Orand Rounds- Dementia.

103, Martin Luther Ring, J'r.. Medical C~nter, Los Angeles> CAJJ 8/95. Mecioal C3nU1d Rounds~ Sex after 60.

l 04. University of Alaska~ Southeast - Sitka Geriatric SymiJosium, Sitka1 Aluskaj 9/95. Orgauizer, Keynot~ Speaker.

105. V.A. Outpatient Clinic~ tas Vegas~ NV~ 10/95, Medioa1 Gmnd Rounds, Dementia.

106. V.A. Outpatient CHnic~ Los Angeles, CA~ 11/95. Gx~n.d Routlds - Dementia. ' 107. V.A..Outpatient Clinic Los Angeles> CA} 12/95. Grand Rounds- Sleep disorder in the elderly.

108. State of Alaska.) Di'Vision of Senior Serviof.'ls, 2{96. Leotutes and site visits to six State of Alaska nw:aing homes.

109. Symposium. on Geriatric Medicine~ Antelope Valley Medioal Center, Lancaster, CA~ 3/96. Course. Director and Speak~t. .11 0. Family ~e..T1'aitling Program, Spokane, Was4tngton, 3/96. Lecture ..... De:rnenti:a.

111. Family Medicine Tratu.ing Ptograrn, Central Montana7 4/96. Lecture .....

Drugs in the Elderly.

112. University of Utah Affiliated Programs, Salt Lake City, 4/96. Lectm:e - Depression in the Eldedy.

113, State of Alask~ Department of Administration~ DlvlslQn ()f S6nior Services, Course Cootdinato:c for visits of l6 Alaskan State officials to USC School of Medicine, Andtu$ Oetontology Center and affiliated local Southern California Geriamo Programs. Duration. ._ one month, early May to eaxly J~me, 1996:> Los .Angeles~ CA.

APPENDIX 1 46!

114. State of Alaska; Division of Senior Services; Department of Administ.t:ation. Site visit to Ad111inistrative offices for review of Geriatric Programs. Jtmeau,. Alaska, 6/96. Outside Consultant and Lecturet 115. University of Alaska; Southeast Sitka. Care of the Elderly Sym.pOSA\l.!il~ Sitka, Alaska~ 9196. Cours~ Direotor and Leotut·e:c.

116. Boige Health Consortium- Medical Grand Rou11ds1 Boise~ Idaho, 11/96.

Sex. after 60.

117. Symposium on Long 1'~nn Cm.•e for Prov1dc.ts~ Milwaulcee~ Wisconsin) 2197, Keynnte Speaker~ Drugs in the elderly,.

118. Symposium. on Gel'iatdc Medicine:~ Antelope Valley Medical Center~ Lancaster, CA:. 3/97. Course Director and Speaket'.

Osteopathic Medical College, Des Moines1 Iowa~· 4/97: Symposium on • ,, ... "' u 119. diabetes Mellitus> Keynote St'ooker ~ Diabetes in the Elderly.

120. Utiiversity of Southern Illinois Medical School, ChampaigiJ, Urbana) IiHnois, 4/97, Medi:oal House Stuff Lectures. Topics - Diabete$ in -the Bldedy~ Drugs in the Elderly.

121. Allegheny Medioal School, :Philadelphia, PA, 5/97. Keyn<)te Speak(}7: ....

Sy.trtposiunl. on Diabetes ruul Lipids in the Elderly.

122. State Seni-or Care Progratrl> Oldaho:ma City~ Oklahoma, 7/97, Keynote Speaker- Stat~ of Okl~homa Senlor Care Ftogram.

123.. Eastent Cal'olina Unive1'8ity Medical SchoolJ Greensboro, North Carolima> S/97. Medioal Grand Rounds.

124. University of Alaska, Southeast Sitka. Cm·e of the Eldel'ly Symposium, Sitka> Alaska~ 9/97~ Coutse Director and Lecturer.

125. Univel'sity of Colo1'ado11 Denver> CO~ 10/97. University of Colorado AffiHated. Programs~ Several States~ Medicat G1.m1d llounds. i 126. Arizona Chapter of the Amedcan Gerontologio Society) Pho~uix, A'l, 11197.. Sex Aftet 60. t . . l i 127. Symposium of Gerlattlc Medicine, Antelope Valley Medical Cenfut', Lancaster~ CA, 3/98. Course Director and Speaker.

128. Medical University of South Carolina, Charleston, Soutl1 Carolina_, 4!9&.

Family Medicine Grand Rounds:> Sex After 60. I I I I I I I 1 . ·--·-· +·--··-1~----··-- ·-·· I l lI '16. .... 6 • t ! , I APPENDIX 1 129. University of ColDrado2" Denvet~ CO~ 4/98 1 University of Colorado Affiliated Programsi Several Sites, Medical Grand Rounds.

130~ Eisenhowst M~dical Center; Rancho Mirage~ CA, 4/98. Medioal Chand Rounds/~ Dntgs itt the Elderly, l3L University of Alaslca 1:'\nd U.S.C.:> Sitka, Alaska; 9/98. Cro:e of the Elderly Symposium, Course Dh'eotor and Speal~:t:n'.

132. University of South Carolirta School of Medicine~ Charleston~ South Carol:ina11 10/98, Family Medicine G:ta.nd Rounds~ Sex A.ftel' 60.

133. V.A. Outpatient Clinic, Los Angeles; CA, 10/98, Memorial Leoture Set[es~ Medi.cations in the Elderly, 134. V.A. Outpatient Clirtio, tos Angeles_, CA~ 10/98, Me1notial Lecture Series . ~ - Alzheimer's disease.

135~ Visiting Professor of Geriatdo Medicine; Alaska. Gedatric Institute, Anchorage: Alaska> Aprilj 1199. Multiple Lectures~· 136. Visiting Profess('~\' of Gelia.trio Medicine, University of New Mexico School of Medicine;. Albuquerque, New Mexico, 6/99) Alzheim~t's disease.

137. Univetsity of Alaska~ Sitka, Alaska) 9/17/99..9/19/99. Care of the Elderly Conferenc1;J~ Course Director and Leoturel'.

138. Visiting Ptof~ssor of Ger1au1c Medioine~ University of .Arizona Affiliated Hospitals of Tucson and Phoenbc, A2} 10/20/99-10/23/99.

139. Symposium of the G!7rontological Society of .Alnerfc~ San Francisoo, CA., 11/.21/99. Inte1·disoiplinary Approaches to Teaching Gerlatrlcs, Invited Speaker.

140. State of AI~sk~ Anchorage, Alaslm~ '2/20/00-2/23/00. Task Force for the Assessment of Assisted Living in the Pioneersi Homes, Leader and Spokesperson.

141. Visiting Professor of Geriatric Medicine; University of Colorado School ofMedicine Afftliated Hospitals~ Denvo~~ Colorado, 3/7/00~3/8/00.

142. Visiting Ptofessor of -Geriatric Medicine, Affiliated lntel'nal Medicine Programs, Bl Paso, Texa~, 4/26/00--4/'2.7/00.

I . . I ~---~--- ~_;-o-··-·· -·-: --:-----· ·----· -·-.--- ···;--;-;·· ... :····-··--,.--~- .... ·-- :.-;;-:::."·~·-·:;:·:=::.· ·.. :c;,.,.,~;-:-;··,·:·-···-.- ---------.1'~-----·-- . -- --·------" --- ---·· -- ------- --· i -1-------· '! .. u • .. 'Ll '

APPENDIX 1 143. Newp01t Beach> California> 5/5/00. Al111ual Meeting of the California Associ~tion ofMedioal Directors~ In~ited Speaker.

144. Antelope Valley Hospital,. tancaste;c, California, Medical Grand Roun,.1s, 11!17/99~ Treatment of Artlll'itic Fain in the Eldedy.

145. Kern Cotmty Medical CenterJ Bakersfield, California. Medfoal Grand Ro\U1c1s~ 1/7/00. Hazards ofDrugThecapies in the Elderly.

I 1 146. Hoag Hospit~ Newport Beach.t Californ.ia, Medical Gr~nd Roun.ds)l 3/10/00. Sex After 60~ 1474 Visiting Professor of Oeriatric Medioin(i}; Affiliated Internal Mediolne Programs~ Bl Paso., Texas. 4/26/00.. 4/27/00

; 148. Arrowhead Medical Ccnte:t.·~ San Bern~tdino County Hospital, Colt<>n, California~ 5/17/00. Medications in the ElderLy.

149. Annual Meeting of the Callfor.rrla Association of Medical Directors),j Invited Speaker~ Newport Beach, Califoxnia, 5/5!00.

150.. Riverside General HospitaL, Merino Valley~ California~ 6/16/06. Medical Grm1d Rounds~ Medications in the Eldedy.

151. The Elderly Diabetic. Care of the Elderly Conference, University. of Al~ska:- Sitka~ Alaska~ 9/21100.

152. Treatmel1t of Arthxitic Pain. Care of the Elderly Conference;, University of Alaska, Sitk~, Alaska, 912.1100~ 153. Depression in th~ Elderly. Care of the Elderly Conference~ University of :_n:..; ,,11~ ·~ t.w~ Al~sl<:~ Sitl\~ .Alaska:, 9/21/00. ·. .. t., 154+ Treatment of Hype;rtension in the Elderly. Cw:e of the Elderly Confere11ce1 University ofAlask~ Sitka, Alaska., 9/21/00, 155. Medioations in the Elderly. Continuous Quality lw.ptovement (CQI) in ihe Smte..Assisted Living Faoilitles:- Depw:tment of Administration) Stat~ of Alaska, Ancho:tagej Alru1k~ 11/13/00.

156. Falls in the Eldedy~ Continuous Quality Improvement (CQl) in the State..

Assisted Living Faoilitles, Depru.tment o£ Adrrt:b:rlstratioll,· State of Alaska, Anchorage" Alaska, 11/13/00.

l57. Dementia. Memorial Lecture Series) Outpatient Department~ Vet~rsns Admittistratlon~ Los Angeles:t California, 112101.

-·- --~-· --·-~---:·--:------- :·-:-·- - ·--- ·:--:--------------------:-··--- -------· ----·-.. ·-··---------·----·-------16:

~t I

APPENDIX 1 158. &ropsychiatdc Assessment of the Eld-e:rly. .Bu1'eau of Medi-Cal Fraud and Elder Abuse, Department of Justice~ State of Cali£ontta~ Ontario California> 2/22/01.

159. Treating Chronic Pain in the Elderly. Memol'lal Lecture Sed~s, Outpatient Depatime11t, Veterans Administration Los Angeles1 Californi~ 1/2/0L · 160, Medications in the Elderly. Continuot\s Quality In>.protrement (CQI) and the Risk..Plus Ptogrrun irt the State. .Asslsted Living Facilities~ Department of Administt'a.tion) State of Alaska, Sitka, Alaslta, SflfOl.

161. Falls in the Elderly. Con:tmuous Quality Improvement (CQI) and the IUsk-Plus PL'Ogran1 in the StateMAssisted Li'ving Faoilitieg; Depru.iment of Administration, State of Alaska, Sitk~ Alaskat 511101'. ' ·.

162, Sexuality. N01'th Amerioan Fotun1 on Women's Health, Los Angeles, Cnllfotnia, 6119/01. ' I i 163. Alzheimet~s Disease, North American Fo1·urn on Women.~s Health1 Los Angele~> Califot·nia~ 6/19/0 1· 164. Ge:ropsycht>logical Evaluatron of Seniors. Syroposiuh1 on Eldet AbtlSt).

Depattment of Justice-Bureau. of' Medical Fraud and Elder Abuse,. R~mcho Mirage1 California~ 9/7/01 165. Depression in the Elderly. Hoag Hospi1al. Newpott Beach> Califomla> 9/7101.

I 166. Sleep Disorders in th~ Eldel'ly. Care of the Elderly Coufeten.oe. Uuivetsity I' of Alaska ..... SitkaJ Sitka.., Alaska, 9/2'3/01. t .... ! 167.. Medications in the El<lerly. Metno:rlal Hospital, S;m.ta Ros~ Ctllifonrla~ 10/19/01.

168.. Dementia. Medical O.trul-d Rounds,. Riverside General Hospital, Marino Valleyt California, 11115/01. · 169. Dementia in the Elderly. Medical Grand Rounds, Arrowhead Medical Centet> San Bernardino Gene.t:aJ Hospital, Colto~1)1 Californl~ 1l/29/01.

170F Patient and Family Satisfaction in Long Ter1n Cat~. Alasku. Pio.n~~ra~ Home, Anchorage~ Alaska. A :site visit and symposi~ 12111101...

1~/15/0L .

····-····-·-···· .... ···- . --·.---.·-::;-"-;':"';:-.!~--.-:::·-··--:~.: •.-.":.::-: ·-;- :·.·;-~ ..

.. ~ . ., ~ ' . ... J •

APPENDIX 1 sol 1/1. Normal Aging vs. Disease. Symposhtm on Geriatric Medicine. Annenberg Centerl Rancho Mirage. Californi~ 2/202.

172. Medications in the Eldedy, Memorial Lecture Series, Outpatient Department, Veterans Administration~ Los Angeles, California, 2/26/0'2.

173. Life Style Redesign in Elder Ca:ro. zua Annual North- Ame.dcan Forum on Women's Health! Anah~im~ California} 3/1/02.

174. Dementia in the Elderly. Memorial Looture Series, Outpatient Department~ Vetet·ana Adminfstra.tto:n, Los Angeles:. California; ::l/12/02.

175. Diabetes in the Elderly. Endocrine Orand Rounds, Harbor General Hospital, Torranoe, California, 4/l/0/2.

176. Medications in the Elderly. Mtllll..lecture series~ Co1111'riissloh on Aging~ I" ,, ~f ' • ., .. State of Alaska, Anchorage and Fairbanks,' 4112/02.. 4/26/02.

177. Treatment (!f l)aiti in. the. Elderly. Care o£ the Eldei'ly Cortfereno~\ Univel'sity of Alaska~ Sitka Sitka, Alnska~ 9/19/02.

178. Treatment of Cardiovascular Risk Factors in the Elderly. Care of the Eldetly Conference~ University of Alaska> SitkaJ. Alaska 9/19/02.

179. Special Issues in Long Tenn Cat·~, Assessment and Evaluation of the Artcho:rage Plorteers' Home; Anchorage~ Alaska, 12!10~12/14/02.

180. Identification and Treatment of Cardiovascular Risk Factors in 'lhe Elderly - A symposium Montgomery Cardiology · Programs. Montgotnety~ Alabama> 3/2l/03~ I ••• un. Me4ications in the Eldel'ly, Multi..lecture serlesj Connnission,on Aging> State of Alask~ Anchotage and Fairbanksi 4/23 ..4/26/03.

182. Assess1nent of Mental Competency and Discussion of an Elder Abuse Case. Symposium on Eldet Abuse) Departtnent of Justice .... Bureau of Medi~Cal Praud and Bldet Abus~~ Squaw Valley; California, 5/27~-5/30/03.

183. Medications in the Elderly. Multi-lecture series, Commission on. Aging, State of Alt'\ska;,Juneau and K6tchU~JUl, 6127-6129i03. i84. De1nentla in the Elderly: Medications in the Elderly. Csx~ of the Elderly Conference~ University ofAlask~ Sitk~ Sitka~ Alask~ 9/18w9/19/03.

18S. Demerttiay Gerlatdc Symposium:.... St. Mmy~s Hospital and Soan, tong Beach, CaUfonlia; 10/4/03. i I i ~:

! - ......·-----:- ·~--;-~*'--.~., .•- ------ ~..t..... ~~·-···-·----18-. ·-""--·-·· -··-···-.. ·-.......... · · "· ,- - ·- - . --.----·------·--·-----.._. ___,____,_~--~. - -1--- . ! "'". ..,. A • l APPENDIX 1 I 1&6. Senior Assessment for the Care Provider. Public Health Foront-- State of Alaska. Anchorage~ Alaska~ 12/1(03.

187. Seniot Assessment Workshop, Alaska G~tiatrlc Education Center, Unlversity· ofAlaskar Anohom.ge.,. Alaska) 1/23/04. 'i 188. Sleep Disorders in. the Eldedy. Coping wlth Chronic Disease. Care ofthe Elderly Conference~ Unive1'sity of Alaska~ Anchorage, Alaska.t 9/11/04.

189. Eldet Abuse. Coping wlth Chronic Oisease. Cardiovasoulru: lUsk Factors in the Elderly. Senio:r Lives Conference~ Untve1·.sity of Alm~ka-> Anohoragej Alaska 6/10/05.

190. Assessment of the Chart ln Sldl1ed Nul'Sing Facilities. Symposium on l • .:t.... ,.,. ..

Eld.er Abuse; DeparttnJ}nt o~ Justice~ Bureau of l\1edical Fraud attd Eldet ... i . ! Abuse~ Long Beach~ CaUfo1nia~ 6/6~6/9/05. · ·' 191. Coping with Chronic Disease. The Chru:t in. the Skilled Nursing Home.

Care· of the Elderly Conference~ University of Alaska~ Sitka~ 9/16/0S.

192. Sex After 60. The Chati: ifi the Skilled Nursing Home. Ptolnoting :Best Practices in Aging Gonfetence~ Unive~'Sity of Alaska> Anchorage- 6/S/06 -6/10/06.

l93. Medic.al Realities and Dimin{sh~d Tribal Longevity. New Aspects of Long Tenn Care. Cate of th(1 Elderly Confetenc~, University of Alaska , Sitka~ 9114106- 9/16/06. .

194. Standw:d of Care> Symposium on Elder Abuse~ ))epattment of .Justice~ . State Qf Califomin, Buteau of Medi...CAL Fxaud a11d Elder AbuBe~ San ·. Mateo1 Callfotni.a IY.Iay~oo.ou-~..:..

195. Integrated Therapies fot· Aging. The Thet·apies~ Care of the Elderly Conference~ University \>f AlMka~ Southeas~ Sitka 9/~S/08 ..... 9/27/08.

196. Human Biology 596 Course University of Washirtgton Medical School - WWAlYJl Program- Mnlti~Disciplinaty and E1hnicity in Gerontology and Geriatrics. L~ctur:es to Alaskan Medical Students~ Unive1's1ty of Alaska~ Anchorage, Apdl2009. · · 197. Mental Health and Dementia. . Inter-disciplinm'Y Ptao1ioo in Geriatrics Se)r After 60. Pt:omptlng Best Practices in Aging Confet-Gnce., Univexs~ty of Alaskf4 Anchorage, 6/3/09-6/5109.

)[. PllJBLJ(CAT)[ONS

- ---~--;-.- •• ·--~-:-·---~ -·- -- ------ -~.· - - - - - - · · - - - - - - •• · - - - : - · · · ,:, ·~: :!--.: - ·'--29 -.--::.·:-. ··-- ;-- ---,-·- ____ : . - ~----- ... -------- ~ . --·- ---·-- .. ---------- ----· ----

'Yl1 •

APPENDIX 1 Papers- Peet• Re'View L McCleverty> J.A. and Willdnsol\ Gl (Submi«~rs)~ Lipson> L. O., Maddox, M.D. and Kaesz, H.D. (Checkers): Dichlorotetracarbonyldbhodbm.

Inorganio Synthesis Vol. VIIr. oltzclaw, H.F., Jr. (Ed) MoOrawwBill, New York, 1966 pp.211-214.

2. McCleV'erty1 J.A. and Wilkinson) G. (Submitters), Lipson~ L.G., Maddox~ M.D. and Kaesz~ H.D. (Checkers): Chlorocarbonylbl$ (tdpl1enylphosph1e) rl1odium and chloroom·bonylbis (triphenylarsh1e) thQdium. Inorganic Synthesis VoL VIII; Holtzclaw) H.G. Jr. (Ed), McGraw~Hill~ New Yotlc) NY 1966, pp214..217~ lipa~m} L.G. 1 Capuzzi1 c.M. and Margolis> S.M! Effect on method of cell isol~tion on the metabolic activity of. isolated rat liver cells. J. CellSC. · ·· 10~167 ..179, 1972.

Lipson~ L.G.: Plague itt San. :F):anoisoo in 1900, Atm, Int. Med~ 77~303 ..

310, 1972.

Kohler, T.R., Lipson> L.G., Flores,) J.> Witkum, P.A.~ Fischer~ J.B,~ and Sharp, G.W.O.! Sequence of events in the activation. of adenylate cyclase by cholera toxin. Bull Schwe;itz, Akad. Med. Wiss. 32--223..23:2~ 1976.

6. Beiteins~ r.z.) Lipson~ L.G. and McCarthur~ J.W.~Lu.teinizing hormone, follicle stimulating honuone and their subunits released in cultnre by human pituitary tumors. J. Clin. Endo. M~tab. 45!1271-1280~ 1977.

7. Fisoher, J.J.3~> Kohle1 1- T.R.., Lipson.t L.G.:~ Flores.t J.; Wttkam., P.A.; and

I I Shru:p.t G.W~G.~ Studies on the time oours~ and tat~ limiting steps irt the i activation of adenylate cyclase by cholera toxin. Biocltetu. J. '173 ~ 59-64..

J '197ft J f l 8. Lipso~ L. G., Beitins, LZ., Kornblith, F.D.lo MoArthm·!! J.W., Frie~en., fl llG.~ Klirnan~ B. and Kjelbe1·g, R.N.: Tissue cu1tme studies on lm.t.nan ! pituitruy ·tumors: Radioitumunoassa.y of ant~nior pituitary hormones in culture medium. Acta. Endo(~.cln. 88:239--249~ 1978.

9. Lipson, L.G~ and Shw.p~· G.W.G+; 1nsulin sec1·etion in vregnan.cy! Studies on adenylate Cyolase, phosphodiestarase, protein kinase and phosphoprotein phosphotase in Xsolated islets of Langerhans of the xat.

Endocrinology 103!l272.-1280j 1978.

10~ Lipson, L.G.~ Beitins) l.Z.~ Kornblith, P.D., McArthur,· J~W., Friesen~ HLG.; Klim~ B. and Kjelberg, R.N.~ Tissue culture studies on hu.tnan

.... , A ' .. 14 •

APPENDIX 1 pitnitru:y tumoxa~ Loug"term .t:elease of antetior pituitary l1ormones. Acta.

Endocrln. 90~421~433, 1979~ 1L Lipson~ L,G.~ Siegal~ E., Wohlheim~ C.B. and Shatp, G.W.G.: Insulin release in fast[ng! Studies on ade.nylate cyolaset phosphodies~rase7 p);.otein kinase and phosphoprotein phosphatase in isolated islets ofLa.ngerha.ng of the rat. E:ndoc1·inology 105:702..717~ 1979.

12. Lipson> L.G.) Bush~ M.J., Tieljen3 G.E. and Yoon, A.; Role of the aden.ylate cyclase sy.ste111 in altered insulin ~eiease from. islets of Langerhans of aging rats. Acta. Endoodn.. 96:222H226, 19tH.

13. Lipson~ L.O.: Bobl'ycld~ V.A.$ Bush, M.J.> Ttetjert, G.E. and Yoon~ A.: Insulin release in aging: Studies on adenylate oyclase, phosphodiestatase at1d protein kirt.ase in islolated islets on Lange1'hans of the rat.

Endoodnology 108: 602-624> 1~81: 1;~ •• -: · ' •

14. Lipson> L.G.> Moore,~ D., Pope" A.M.J ToddJ G.J., an.dAvil~ S.; S~xual dysfunction in Hypertensive diabetic pf.ltients. J. Cardiovascular Med. 6: Supp. 1) 30-37~ 1981.

15. Cottou? D.B.~ Straa.anet1 B.G~, Lipson} L~G., and Goldstein~ D.A,: 'Ih~ effeets of terbutaline on add-base) eleob:olytes and glucose homeostasts dur1n.gthe managementof'preterm labor. Am. J. Obstet. And Gy.n, 14l~ 617.. 624~ 1982.

16. Oldhru~ S.B .1 LipsQ~ L. <l and Tielj en~ G.E.~ Evid~noe for the. prese.n.ce of calmodulin in human _parathyroid tissue..M.ineral and Electrolyte Metabolism. 7! 273..-280; 1982.

17. Lipson, L.G., Oldham~ S.B.! The pr~sence of calmodulin- stim1llat~ble phospho.diestatase in pancl'eatic islets ofLange1·hans ofpregnant and 11onnal female rates. Life Soie11ces 32! 775...780!J 1983.

18, Mil:cheff, A.C..) Conteas, C.N.> Lu~ C.C~, Santiago, N.A. 1 Gray~ G.M, and .

Lipson, L.G.: Basal.-Jate.eal and intJ:acellular membrane vopulations of th(l tate exorbitallacd:tnttl gland. Am+ J. Physiol. 2.45: G 133 ..142, 19S3.

19. Premdaa, F.H., Molin~ I.M. and tipso.t4 L.G.: fusulini'elease in aging: Role <If g;lyceraldebydes~ Acta. Endoorin. 103: 539-543, 1983.

20. LipsoH> L.G. and Lipso~ M.: Treatment of the obes~ maturity onset diabetic pmient$ A:roh. Int. Med. 144! 135-138, 1934.

'n ,

APPENDIX 1 21. OJdha.m, S.B.}Molloy, C. and Lipson~ L.G.: Calo~um inhibition of adenylatecyclase in the parathyroid gland. Endooi'lnology 114~ 207~214, 1984.

22. Lipson>.L.G,: Sexual dysftmction in the diabetic patient with hypert<;}nsion.

Am.. J, Cardloi. 53: 46A..50[\ 1984.

23. Lipson> X.,. G.: Speci.ai problems in the treatment of hypertension in tht> patient with diabetes mellitus. Arch, Int Med. 144! 1829.. 1831> 1984.

24. Oldllam~ S.B,; Rude, R.K.; Molloy~ C. and Lipson:r L.G.~ The effect of )nagnesiun.t on calcium inhibition of parathyroid ade:nylate cyclase.

Endocrinology.115: 1883u1890, 1984.

25~. ... Molina, J.M.J P.rem.das, F.H.~ Klenck, R.E.~ Eddlestonej G.~ Oldhmn~_S.~.:- ' · and Lipson; 1.G.: The dynamic insulin. secretmy respon~e or isolateci · · · pancreatic islets of the diabetic .mouse~ Evidenoe fot a gene dosage effect. on il'lsulin secretion. Diabetes 33: 1120.. 1123.

26. Bddlestone, G.T.~ Oldham> S.B.~ Lipson) L.G.~ Premdnsj F.H~ and Beigebna~ P.M.! Electrloal aotivtty~ cAMP concentration and insulin release in mouse islets ofLangerh~s, Am. J. Physiol. 248: C 145-153~ 1985.

27. Molina, J.M., Prerndas~ F.E. and Lipson1 L.G.: Insulin release in aging!

Dynnntio response of isolated islets ofLangerhans of the rat ton . . glyce~aldehyde. Endoctinclogy 116: 821 ..826> 1985.

28. Oldham> S.B. and Lipson) L.G.: The high affinity cJtlcium inhibition \If parathyroid adenylate oyolase is not calmodulin-dependent. Calcif1 Tissue Int. 38~ 275-281~ 1986.

29. Bailey., C.J.; Day, D.; Bray~ G.A.; Lipson) L.G. and Flatt> P~R.: Role of adrenal glands in the development of the abnonnal glucose and insulin homeostasis ingenetioa,lly obese (ob/ob) mice. Hormone and Metabolism Research, 18~ 357-360; 19&6, 30. Prochazka_, M._, Pxemdaa, F.H.t Leiter1 EJI. and Lipson1 L.G.: Estrone treatment di$sociat~s. primru.y vel·sus secondary consequences of ''diabetes'' (DB) gene ~xp:ressionh1nrloe. Diabetes, 35~ 7?/5.. 728~ 1986.

31. :Gipson, L.G.: Diabetes in the elderly: Diagnosis.'# pathogenesis~ and therapyA Am. J. Med. 80! Supp. SA: 10~21~ 1986.

--·~------------- ------~----·---

y ~ •

APPENDIX 1 32.. Fadda> G.Z., Ak.tnal, M.~ Premdas, F.H., Lipso11~ L.G. andMassry) S.G.; Insulin release from pancreatic isLets! Effects of.CRF at1d excess l?TH.

Kidney 1nt. 33% 1066.. 10721 1988.

3j, L~lter, E. H.) Prerodas> F.H.~ Hmrlson, D.H. and Lipson, L.G.~ Aging ar:d glucose homeostasis in C57BL/6J male mice. FASEB Journal. 2: 2807. .

2811,.1988.

34. Fadd~ G.Z.~ Aktnal~ M., Lipson~ L.G.~ SolimM, A. andMassry1 S.G.~ Correction of glucose into~erance and the impaired insulin release ()f chronic renal failure by verapamll. Kidney lnt. :36: 773~7?0, 1989.

35.. Fadda, G,Z., Akma.4 M.~ Lipson, L.G. and Massry, S.G.: Directeffeot of p~athyroid homtcne seo1•etion from pancreatic islets. Am. J. Physiol.~ 258 (EndoorlnDl. Metab. 21)~ E975.-.B984, 19.90. · .... ,.

36': Mulligan, R., Lipson~ L.G. and Heaton;! S. G.: Detecting diabetes iu ari"'' · eldel'ly dental patient population. Special cate in Dentistry: Feature Article: SeptemberwOctobex, 142.. 147, 1990.

37. Xin ..Gin) z.~ Fad.d~ G.Z,, Lipson, L.G. and Massry1 S.G.! Phosphate depletion impaits insulin seotetion by pa11CJ.'eatic islets. Kid. Int. 39~ 120..

128~ l99L 38. Fadda.1 G.Z.) H$Jjat·, S~M.~ Pe.tna A. F.~ Chaut X.J., !Jipson, L.G. ar1d Massry, S.G.: On the mechtmisms of impaired insulin secretion in chtonic l'enal.:failure. Jout~ Clin. Invest. 87: 225. .261~ 1991. · 39. Clark~ F. Carlson~ M., Zim.Ice, R.~ Frank~ 0,~ Patterson, K.~ Lat·son, B.)

Rankin--Martinez> A.) Hobson, L., Crandall> J,~ Mcu1del, D. and Lipson, L.G.: A qualitative study (lfthe life dCJ.tnilins w:td adaptive stmt~gies of the lowincome).wellelderly~ Am. J. Occup. Therapy~ 1994 . 40. Clark F~ Carlson, M., Zhnke, R., Franlc1 G. 1 Patterson~ lC; Et1I1evor, B.~ Rankin-Martinez> A., Hobson~ L., Crandal~ J.~ Mandel) P.and Lipson, L.G,; Life domains and adaptive strategies of a gl'oup oflow..inconle, well older adults, Am. J1'. ofOocupati.onal Therapy~ 99.. 108~ 1995.

41. Rho 1 Jay P. and Lipson, L.G.! Focus on acetylcholinestnmmeinhibitot~ for the treatment ofAlzheitrt(lt's disease. Fot.tnulacy)) Vol. 32~ 677. .684_, 1997.

42. Clark, F., Azet)) S.P., Zemke, ll.~ Jacl<sonJ J,) Carlson) M., Mandel, D., Hay, J. Josephson, K., Chon:y:~ B.> :Hessle; C~~ Palmer) J. and Li.pson> L.G,: Occupational Therapy for Independent...J..Av.i.ng Older Adults. J'AMA) 273: 1321..1326;J 1997.

--·-·. --· --- _,......, __ *~--.. ··-- -:-:--:-: .. :-·:.--··---- ~- ..- - -··-··-·····~··· .. -·--·- ... --·· ·-·----·····-

. \. .., a • 1! • 4111 I

APPENDIX 1 43. Clad<~ F., Azen> S.P., C\ltlson> M.,. :M~andel~ D.~ LaBl·ee, L.~ Hay~ J.~ z~'nnke1 R.~ Jackson) J. and Livson!l L.G.: EPibeddhlg health..promoting chang~s into the daily lives of independent... living older adults~ Long.. tenn foUow..up of oco11pational therapy intel'Vention. Journal of Gerontology: Psychological Sciencest 56B, pp. 60"6~, 20<)1. · Reqt1ested Chapters, Papers> and Monograms 1. Sharp~ G.W.G.) Fisltet·, J.Cf., Lipsot~ L.G.~ Kohl~w, T. R., Flores, J. and Witkum, P.A.! Titne course studies on the mechanisms of action cholet'l:\ toxin. .Hormonal Receptors in Digestive Tract Physiology. In Bonftls, S,~ Fromageot~ P., Rosselin~ G. (-eds.)lt·Bldevier..North Holland Biomedical Press~ Amdste.rdm~ pp.447-454~ 1976. . 2. Sharp, G.W.O.) Wledenkellert DjE. 1 Lipson~ L,G., Oldham, S.B.~ l{J;a.ue!z, "'' 1M\,,: Y., .Tanjis> D.> Pian-.Strdth, M.C.l\1!. and Wollheim, C.B.! ·Multiple :r:oledof calmodulin> the endocrine p~ncreas and the conttol of insulin secretion.

Pa·oceedinga ofthe 11th Congress of the lnteruatlonat Dlabetes Fede1'ation.

Int. Congress Serlea #600! E::tcerpta Medica.) Princeton, N.J.~ Mngofa} En.N. (Ed.)pp 329..336, 1983.

3. Lipson, L.G.! Hyperte11sion and diab~t~s niellttus. Diabetes forecast 38:53) 1985.

4. Lipson, L.(b Diabetes 1neiHtus in the elderly: Special problems, special a.ppt{)aches. Co. Medical, New York, N.Y.~ pp. 1-20) L985.

5.. Lipson,. L.G.: Diabetes after si-x.ty. .five. Dfabet~ Foxecast. Vol. 39~ No. 7, 54.. 58, 1986.

6. Lipso~ L.G.t Diabetes in the elderly! A multifaceted problem. Am. J.

Med, 80! supp. 5A:1~2, 1986.

7. Lipson~ L.G. mtd Bray, G.A."j Energy intak:e and utilization in aging man: Chen (ed,), Nutdtional Aspects of Aging~ Vol. 1~;~ CRCpl'~SS.t tfio.~ Boca Raton_, lt"'L. Pp. 184..18S, 1986.

8~ · Lipson, t.G.: Diabetes and aging. fu Beigelrnan1 P .M~ and Kuman> D.J (Eds)? Diabetes Mellitus fo,: the house ()fficer. Williams and Willdn~ l3altimore, MD. 1 pp. 184.. 185, 1986.

9.. Lipson, L.G. and Kumar, D.~ Otal hypoglycemio agents. In Beigelman1 P.M, and Kumm.·, D. (Eda.) Diabetes Mellitus for the House Officer1 WHliams and Wilkins, Baltimore~ MC. Pp. 112.. tl8) 1986.

•II • '1 A•

APPENDIX 1 10. Lipson> L.G.~ Dental problems i11 the diabetic patie~1.ts. In Beigelmrut~ P.M. tmd Kumar~ D. (Eds,) Diab~tes Mellitus for the House Offic~r. Williams and Wilkins~ Baltimore~ MD., pp. 181 .. 183, 1986. '!

11. Lipson, L.G.,: Hypertension ln the diabetio patient. In Beigelman, P.M~ and Kumarp D.) (Eds.) Diabetes Mellitus for the Hol..lse Officer. Williams and Wilkins, Baltimol.'e~ MD,~ pp 16().. 163, 1986.

12, Lipson~ L.G.: Ryp~rtensio1tin the diabetic patient. In Beigehnan~ P.M. and Kumru.·~ D., (Eds.), Diabetes Mellitus fox the House Offl(ler.

Williams and Wflldns~ Baltintore~ MD., :pp. 173.. 175p 1986 .

13. Dinwiddie, R. tmdL~pso~ L.G~: Improved control ofsenlm glucose in obese~ 11ew~onset h1sulinopenio non-immHn dependent diabetes mellitus: Partial respiration o£Nonnm1 dy11amic insulin secretion. Roedg Division, pp. J..6, 1986, .:..... ' · .,.., ·-- ",,_ ,"\ •a,., ... tt/"'

14. Lipson~ L.O. and Kato . .:Pahner> S.: Diabetes in Asians. Diabetes Forecast, V<>t 41, No.9, 48 ..51, 19B8.

15. Lipson~ L.OI) Kato~Palmer~ S., Boggs, W.L.) Moore,D., and. ope-1 A.: . Diabetes in the :Slack population. Dlabetes Forecast Vol. 41, No.9; pp.

34--38> 1988.

16. Williams~ B.R., Nichol, M.B.~ Lowe:~ B.F., McCombs~ J.S.~ Yoon, P.S. and Lipson) L.G.: phatmacist intetverttion residenti~l care f<\cnities.ln Rowet 1-W. and Alu·onheim1 J. C. (Eds.) Annual Re'\l'iew Qf Geronto~ogy a11d Geriatrics; Foous on Medioatlons and the Elderly. Spdnger PublishingCo.NewVod~N.Y.~pp.150.-162, Vo1.12, 1992, 17. The Use of Medications: A Ttaiuing and Referenoe Manual Developed fot Staff in.Residentlal Care Facilities for the Elderly~ 1195. Lipsort; • •~~-<" L.O.- Project Co-Director.

1&. Weiner, J. and Lipson,. L.G.: Htunrut diseases as n1odels of accelerated agblg. In Rose~ C., Glowacld, J. and :Silezikian> J. (Bds.) The Aging Skeleton> Academic Press, Chapter ~;.pp. 51..-58, 1999.

19. Raghaven~ D.~ Weiner1- J. and Lipson~ L.G.: Cancer in tlte elderly~ principles oftr~atrn~nt mSoulbartli~ R.L. et al (Bds.)~ Oxford Textbook Oncology; 1.nd Edition> Oxford University Press~ Oxford1 London~ 1999.

Films and Videos

-~~-~ ~-·~-~·~-· --·-·---· ·----- -=----=.::: __ ==-··:-_-,c·-;;·. ~ -------.-· --·· ·-·- ·---- .... ···:35-·--- ---·-----.--·------ --· ·-- ·-· -. ······----·-- . -·····---·---·-----··---·

. ' • p • ··.& •

APPENDIX 1 :

1. Discharge Planning for the Elderly H<Jspitalized PaUent; X. What to do when you go Home. Hosp.itai SateiiiteNetwork, 191}6. 15 min. L.G.

Lipson - Moderator and Context Exper.

2. Discharged Planning for the Rldetly Hospitaliz~d :Patient: If. The patient with acnte medical pmblems aftel' dischm-ge. Hospital Satellite Network, 6, 15 min, r.. G. Lipson -Moderator and content expe~t.

3. Discha-rge l?lruming for the Elderly Hospitalized Patient: lli. The chronically disabled patient Hospital Satellit~ Nctwol'k> 1986~ 15 min.

L.O. Lipson~ Moderator and oontent expert.

4. Discha:cge Plru.ll1irLg for the Elderly Hospitalized Patient IV. Community programs fotthe eldel.'ly. Hospital Satellite-Network, 1986~ 15 min. L.G.

Lipson..,. Moderato1• trt~d content expert. .. .

5. Normal Aging Versus Disease:·:Physician1ourna! Update. Lifetime Netwotkj 1987 ~ 15 min. L. G. Lipson- Conten.t expert.

6. Dl'ugs and the Elde.rly. Physlcian1s Journal Updato. Lifethne N~twork) 1987~ 15 min. L.G~ Lipson- Collteni:expert, 7. .26. Caring fot a.11d Agirtg Soolety. 20 videos on various aspects of Geriatrics gnd Gerontology. Each 30 minutes in length. Producer- Neil Steinbetg Productions1 Executive Producers- HospitatSat~llite Netwot'lc and Age Wave~ 8ponsor-¥ariort Laborato:d¢s. 1987. .1988. L~G. Lipson.- Technical advisor and content exp~rt.

CAlUNG FOR AN AGING SOCIETY SHOW TITLES AND NUMBER "tiSP#_ HSN# !lTLE 001 8649X NEW!MAGESOFAGING(F) DYCHTWALD ()02 0462X ff.OW tO TALK TO YOOR:DOCTOR (F) LIPSON 003 5733X GERIATRIC ASESSMENT (F) B'Ul'LER 004 8648X DRUGS AND THE ELDEl.U.,Y (F) :LAMY <J05 7716X ACUTE CARE OBIUA'l'RIC NORSING (F) Ft'ILMER 006 5134X HEART DISEASEAN.O 'l'Iffi ELDERLY (F) SWAN 012 86SOX PRlNCEPLES OF AGlNO (F) HAZZARD 013 5735X FRESENTATION OF DISEASE (F) ABRASS 014 57:36X GEROPSYCHfATRIC FOUNDATIONS (W) OLSEN {)IS S737X PfCYSICtAl',PS ROLE IN DRUG TaBRAPY (F) VESTAL 016 8652X ETHICAL I$SUES XN ELDERCARB (E') CASSEL 017 ?717X GEROJ?SYC:HIATRIC NURSING (W) WYKLE 018 672SX TBB HUB CONCEPT (W) DYCHTWALP \l19 6126X ELDBRCARE FlNANClNO (W) DYCHTWALD

. \ ....

APPENDIX 1 020 6727X ELPERCARE: MOlJELS OF SUCCESS (F) DYCHTWALD 021 5738X DJ:ABETES 1N THE ELDERLY (W) LIPSON 022 8651X OERIATRJC DISCHARGE PLANNING (F) WERTfiEIMER 023 0473X PROMOTING WELLNESS (W) FARQ~ {)24 0475X SELF~MBDXCA'l'XON IN THE ELDERLY (W) StMONSOl' 02S 04'74X FAMJI,Y ROLES lN BEALtRCARE FOR BRATl"'ER TtmELDERLY Medical Cheolrop! Health Aware11ess '88. Aging in the Black ConunuJ11ty. A30 min.

Vidt>o. Producer> MarkAlyn Conunm1ications) Sponsor- Mal'ion LaboratOJ:ies) 1988.

L.G. Lipson- Moderator and content expert.

28. Medical Checkup: Health .Awa:eenesa 1 88 Aging in the Hispanic Community. A 30 min.

Video, Ptoduoer, Mru:kAlY.n Co.oornunioations~ Sponsor- Marlon LabQ(atodes. 1988.

L.G. Lipson- Moderato:r attd content expert.

Medical Cheokup: Hea.IthAwru·eness 188. Aging in the Asian Community. A30 min.

Video. Produoer11 Mad<:Alyn Communications> Sponsor- Mation'Labor.atodes, 1988.

L.G. Lipson ..... Model~atol' and content expert, 3Ct. MedicaL Checkup: Health Awareness ~ 88. Diabetes Mellitus in fue Black Community. A min. Video. Pl'oduce.r)' Mark Alyn Comm\1~1lcations, Sponsot- Mation. Labotatodes 1 19$8. L.G.. .Lipson- Mode1•ator and content expert.

31. Medical Checkup; ftertlth Aw~u:eness '88. bia.betes MellitU$ in the Asian Community. A min. Video. Ptoducer, Mark Alyn Conununicatio:ns~ Sponsor.-Marion Labofatoties~ 1988. t.G. Lipson.-- Mode1•ator and content expert. · 32. Medical Checkup~ Health Awareness ~ss. Diabetes Mellitus in the Hispanic Comriiuutty.

A 30 min. ·video. Producer~ Mark Alyn Cmonmnications~ Sponsor- Marlon Laboratories, 1938. L.G. tipson ~ Moderato.t and content ex.pett.

I 33--38. Diet and Exexci~~-~rArestyles for Aghtg. Hospital Sat~llite Network. Six lO~miutttE> Segments, 1989. L.G. Lipson- contei\t expe.r:t. ,.,p

39~ flow to Tall<; to the Older Patient. Baylor Hospital and Age Wave, 1989. L.G. t.ipson- Medical Moderator and content expert.

40-41. The Agifig Skin. Age Wa'Ve, 1991. t.G.Lipson-- Medical Bdito1: 42. Diabetes and the Elderly. Li-ving with Diabetes! Diabetes on the Air~ 1991.

43. Se:>r and Sexuality it1 Seniors-· A Pocumentary~ 1999 L.G. Lipson ..... Guest E.:s.pert.

I •

Abstracts

~ ll • I I '\,S..

APPENDIX 1 *1. Lipson} L.G.~ Mal'golis, S.M. and Cap-uzz4 D~M·.~ Compru.ison of acetate and mnino acid incorporation in rat li-ver cells isolated by thtee techniques. Fed.l?toc. 28:336 (abst. 607):.

1969.

2. Lipson} L,G,> Ackerman,) l.P, and K.liman, B.: simultaneous acl'omegaly and partlally suppressible ~dtenocol'tioal fun<~Hon in a patient with a pituitary tumor. Clin. Res. 24: 274A)1976. .

3. Lipson. L.G.) Beitins, I.Z.s Ko1·nblith, P.P~) McArthur, J. W., Ftlesen> H.G,j Klima.nt B. and Kjelberg, R.N. Horn:tone secretory patterns ofhmnan pituitary tumors in tissne culture. Clin. Res. 328A~ 1976, 4. Lipson~ L,G.> Fol'dsta11, C.A, and Sharp, G.W.G. Phosphorylation and dephosphotylation in the oontrol of the insulin release: Islet phosphoprotein phosphatase, Diabetes 25: Supp. 1~~74 (abst. 213)~ 1976.

*5. Lipson) t.G.~ Vachon~ ·c., Fdiristall, C.A,.:I and Sharp~ G.W.G.: Stimula1ion of specific protein phosphotylation in intact rat~ islets of Langerhans by both 3wfsob\lty1..1- methlxanthine and :0-glucose. Olin. Re$, 26:530A~ 1978.

6~ Lipson, L.G. and Sharp~ G. W.O.: Insulin release in pregnancy~ Relatior.ship to protein and phosphorylation. Endocrinology 102: (abst. 711)~ 1978.

7. Lipson, L.G. WolJheim, C.l3. and Sharp, Q.W.G.i lnsulin release in fasling. Diabetes 27: Supp. 2, 489 (abst. 236), 1978.

8. Lipson~ L.G,J Bobtycki1 V.A.~ Bush~ MJ., Gt·oss~ E. and Inouyte) D.: Role ofadenylate · cyclase system in altered insulin rel~ase from islets of aged tats~ Clin.R$S, zg~s tA} 1980, *9. Cotto~ D.B.~ Strassner~ H.G,~ Lipson~ L.G. and Goldstein, D.A.! Effect ofterbutaline on se.J:l'Jl)1 concentrations of glucose~ insulin) votassiurn, ionized and total calcium lactate> and colloid osmotic pressure. Gyecol, Invest. 1980.,, .·t-:· .•..

*10. Lipson, L.G\~ Bush1 M.J.~ Ti~'ijen; .G.E. and Yoo:n) A.~ Insulin release ittagh~g! the t•ole of adenylate cyclase system. Endocrinology 106! (abs~. 34).} 1980.

11. Mirche~ a. C.~ Lipson~ L.G.;I Bush~ M.J?~ Yoon~ A. andBaxlsh~ J.J.: Analytical fraction of B.. c~lls. Diabetes 2.9: Supp. 2, 109A (abst. 425), 1980 12. Moore, D.) Pope~ A.M.~ Todd~ G.J.:t Rosenquist~ R.J.1 and Lipson> L.G. : Treatment of hypertensive dia.b~tia patients with pmzosln, Diabetes 29; Supp~ 2t 67A (abst. 267) 1980. ~ *13~ Oidhamj S.B., Lopson} L.G. and Ti~qen) G. E.; Evidence fo:r the presence of calmodulin 1 in human parathyroid tl.ssue~ VIII International Conference in Calcium Regulating f Honnones, 1980. I I .. ··--· ·-·-·~-·----·--·-·-- --- ·-----· ··-·- -· ·-·. . ........... _...._______,. . . . . . - .................... "'-'" . . -................................._3 8· ..... ·- ·- . . . . .:-···----............ --..·-·-----·-· . . . . . . . . . . . . . . . . _, _____. . ._....................................

'II • I '

APPENDIX 1 . ~

*14. Lipsd'n, L.G.,. Bush} M.J. and Bobrycld, V.A.: The role of the aden.ylate cyalase system In the deoreased gluoose.-stirnulated insulin release fl'om isolated islets of' Langerhans of . aging rats. Gordon Research Conference . . . The Biology of Aging. 1980.

15. Lipson~ L.G. Oldham) S.B. and Bush, M.J,; Calmodulin·- stimula.tabl.e phosphodiestatase in isolated islets ofLangerhans oftherat. Clin. Res. 29:S6A, l981.

16. Lips~n. L.G., Moo:re, D.~ Pope. A.M., Todd, F.J. andAvlla> S.: lncldenceofhypertension in male diabetic populations. Clln. Res. 29:413A.l981.

17. Lipson1 L. G. and 0 Idham,. S.B ,! Colmodulfn...gf:irnulatable phosphodiestaxase ht pancreatic islets of the, pregnant rat. CHn. ~es. 29w413A_, 1981.

fk18. Conteas, C.N.~ Lipson~ L.G, and Mircheff, A, C. .: Basal lateral membranes fi•om rat pm:otid acinar cells. Gastroenterology 80: 1128A> 198L .'. 19.

LipsoJJ, L.G. and Oldham, S.B..: The presen<Je of a calmod~lin!:atimulai:able ' . · , .. 1 .t

phospllOdiestat·ase in pancreatic islets frolil p1·egnant and normal femalf; rats.

Endoorlnoldgy 108:343s (abst. 1942)~ 1981.

20. Lipson, L.G. Bush1 M.Jj and Najdziuk~ J.: lnsulitl.l'elease in aging: Role of gl~ceraldehydes. Diabetes 30r .Supp. 1 (abst. 296), 198.1. · *21. · Lipso11, L.G.: Insulin release in aging. Gordon Reseaxoh Conference--The Biology of Aging. 1982+ · 22. Lipson. L.G., Moore~)),, Pope, A.M. and Todd, G.J,: Sexual dysfunotion in hypertensive diabetic patierits~ The role ofprazosin in its prevention. Diab6tes 31: Sup. '2 (abst. 365)~ 1982. ) *23. Oldham, S~D. and Lipson, L.G.: Biphasic inhibition ofpru:athyroid adenylate cyola.se ~ctivity by calciWtl:~<;!~Hf.> Tissue int. 34!843, 1982.

*24. Lipson, L.G., P.remdast F.H., l\1oli:na~ J.M.:Studies on dynamic insulin release in aging.

The physiologist 25: 288 (abst. 47.8)> 1982. · *25. Molina, J.M., Pr.emdasJ F\ H. and Lipson) L.G,! Dyrtamics of insulin secretion in. aging Clin.Res. 31:58A1 1983.

*26.- Shatpj G~W.G.~ Wolheim, C.B,j Siegel, E.; Lipson~.L~G. and Kraus, Y.: The tole of calmodulin in insulin soo:r:etion. International Diabetes Fed~ Meeting in Kenyaj November 1982.

)It27. Eddlestone, G.T., Oldham~ S.B.> Lipson, l.t.G.. and Beigehnan~ P.M.; ~otskolin inc~;eases cyclic AMP and potentiates electrical acti-vity in the n1ouse pancreatic B.. oe11~ Fed. P1·oc.

42: 89711 (abst. 3544)~ 1983.

-~·--:---:-···-----·---;-c-:~~-:-- --···-----~----·--·· -··------- ······-····:·---:-·--·- ··-·· --·_-·····-··---..-... ···---·--·-·--- ----39-- ·------- -···-··-·····--· ... - ··-··· ·- ··-· - . -:·--------···- · · · ·---·---- - - - • - ·-~---;---;··~--- ~· .. :-~:.-==·.:.::·~·-:·::--:::-.._:...--:-7o.~-:-:···.·-.· -~- •.• ~---

' ' "'\ d •

APPENDIX 1 *28, Bddlestont7t G~'l\~ Oldha~ S.:B.) Lipson, t.G. and Beigelman, PJvf.~ Forskolin ·potentiatiol1 of the B~cell resports~ to glucose. Diabetes 32; Supp. l(abst 552), 1983.

*29. Oldham, S.B. and Lipson: L.G.: The effects of ionic ca1oium on magnesium activation of parathyroid adenylate cyclase. Calcif. Tissue IntA 35:686~ 1983.

*30 Premdas~ F.H., Molina} J.M. and Lipson, L.G.: RestOL'a.tion ofnormal dynamic insulin in secretion in aging l'ats. The Phy~jologist26:A50~ (abst. 32.1)) l9S3.

*31. Oldham, S.B. and Lipson~ L.G.! Calcium inhibition ofparathyroid adeuylate cyolase: Is calmoduli-n medicated? VIlllnternatiortal Conference on Calcium Regulation l!o~mones, Kob~~ Japan, October, 1983.

32. Johnson~ 1vf.D. and Lipsont L.G.: Prevaleltce ofHypertenslon and sex\lal d.ysfunction in diabetic women. Clin. Res. 32:48A1 1984, *33. Molina, J.M.~ Pt~fna~s, F,H,, Lipson~ L.G., Klenckj R,; Eddleston.e; G. and Oldham~ S.B.: · Comparison. of dynamic insulin release to P~glucose md D"glycera.ldehyde in isolated pancre~tic 1slets .from the db/db mouse. Clin. Res, 32:51~ 1984~ *34. Oldhatn~ S.B. and Lipson, L.G.: IoniQ oontrol ofpal'athy,..oid adenyla'te cyclase af)tivity.

UCLA aymposium 1984 on.Mernbr~me Receptors and CeUular Recognition.

35. tipson> L.G.; Liebig, P.S, and Sloane~ R.B.! Training o-f faculty mentors and advocates in geriatrics. Annual Meeting of Gerontological Society-oflun.edca. November~ 1984> San Antonio~ Texas.

*36. Lipson) L.G..1 Premdas, F.H.~ Molinas~ 1.M, and Lewis~ D.: Cyclic AMP end insulin secretion. Gordon Research Conference--. The Biology of Agi~g, 19~5.

*3 7. F~dda G.~ Akmal.lvf.~ Pxemdas~ F.H.~ Lipson~ L.G. and Massl'Y~ S. G.: Direct evidence o1 ..... ~v~·:·t!:l·· an inhibitoty effect .if patathYJ.·oid hormone (PTil} on insulin,;;e'e~~e in chronic renal failure (CRF). KidneyJnternation.a1. 31~348~ 1987, Ar.o.e:ricanSooietyofNeplttology, Washington, D.C.j 1986.

*38, Fadda G., Akma~ M., P,;erndas, F.H.~ Lipson, L.G. an41Vfassry, S. G.~ Cot.t:eotionof glucose intoletan.oe (GINT) ~d the impaired insulin release<> olu:onic renal failm'e. (CRF by verapamit Arnerioan SocietyofNeplu:ology, San. Antonio~ Texas 1988.

39. Palmer, S.K.~ Madlso.n, R.E~ and Lipson, L.G.~ Self-reported pre-val~ntce and. associated factors in type II diabetes in Japanese Amedcans in Los Angeles. Diabetes: 37: 150A (abst 537)~ 1988.

*40. Garcia, D~L., Palmer} S.K., Boggs~ W.L. aud Lipson~ L.G.: Challenges in..patient oom.plianoe. of elderly Mex.lcan Amel'ioatt Diabetics. Diabetes: 37~68A (abst.. 269), Amerlcan Diabetes Association, New Odeans; t.A.~ 1988, ~--............_._ _,_ ...__....._ ~ ....... __ _ ------ -----~.-------:----·c-·---·-·-------- ---·--40----·- - -.... . - ~ . --~ . ~· ~ ---~-- --·· -- •-• ................... _. -~ ~ - o .... - - - - - - - -- - -~··--H~ ....

'1J. •\ A • '\ ..

APPENDIX 1 41. Schwamj W.J., Lefevre.} T.M. andLipsol\ L.G.! Falls in fh.e eldedy! Tleu~e ofmultipte balance tests. N?v· 1988 1neeting of Gerontological Society of Alnerica. · *42. Oldham, S.B., Eddlestone, G.T.> Premdas, FJI. and Lipson; L,G.: the influence of age on glucos~ and forskolin- stirrmlated insulih release from islets of the diabeti(} mOllSe. No. 8 meeting of Gerontological Society of Ametion~ *43. ·Lipson) L.G.: Caring for an aging society- twenty 30 minute 'Videos on gerontology and getiatrics. Nov, 1988~ meeting ofGerontologioal Society of America. •!144. Palmel', S.K.~ Madisonj R.E. and Lipson, L.G.~ Diabetes in older Japanese. .Am~:d.oans.

November 198 Smeeting of Gerontological Society of Amedc~ *45. Boggs, W~L., Garcia, D.L,~ Palmer~ S,J(. ~ and Lipson, L.G.; Patient compliance in an ethnic population~ Diabetes oar~ in elderly Mexican"Amedoans> Nov. 19&8J meeting of Get:ontolo gi<tal Society .of Ametica. *46. Fadda, G.Z., Akmal~ M~, Lipsoni L.G. and Mass.cy) S.G.~ C<>rreotion ofGlucosl:l rntole.rance (OINT) and the impah'ed ·insulin release of chronic renal failure (CRF) by Vel'apoamil.Kidneylnt. 35:427~ 1989,1989 Meetingoft11e21~ Nationa1Kidney 1

Foundation scientific Symposium.

*47 Faddf4 G.Z.~ A1ctnal1 M.~ Lipson:, L.G. and Massry~ S.G.: Evidence for a dh:ect eff~ct of parathyroid honnone (PTH) on pancreatic isl~ts. Kidney Int. 37:466} 1990, 1990 meeting o:fthe 22nd National Kidney Foundation Scientific Symposium~ *48 Fadd~ G.Z., Akmal 1 M, 1 Lipson> L.G. and Massry 1 S.O.: Meohanism of impaired insulin .secretion in chtonlc renal failure. Kidney Int. 37!50~~ 1990. 1990 meeting ofthe 22nd National Kidney Foundation Scientific Symposium.

*49, Com.unale, R., Fadda, G.Z.~ Ptem.ad, F.H.~ Thanaldtoharu~ P, Lipso~ L.(h andMe.ssl'Yt S.G.! ~educed K...fnduce.G!Jmulin secretion. in ·chronic renal failme (C:RF) oontribute to hnpah:ed extrarenal disposal ofK: Role of excess PTff. Am. Soc. Nep:hrol. 1~624~ 1990.

*50 Williams~ B.:l Lowe) B., Nichol1 M., McCombs~ J,~ Yoon~ P. rutd Lipson, L.G.: hnptovlng drUg tberapi"s inresldetl.tial care faoilitiea. 1994 Annrutl Meeting of the Alnerloon Geriatric Society, Los Augeles, CA.

lf 51.

Lipson, L.G.:~ McCombs,. J.~ Jelliffe~ R., Williams~ B., and Wilson~ P. : Medications I the elderly: pi'oblems, polici~s and new solutio~ asymposlun1. 1995 Annual Meeting of the Ge.t:on.tologloal Society of Amerlca, Los Angeles#- CA.

*52. Lipson, L.Gv and Kohn> J.: Govetil.tne.ntal responsivenesg to ohangos in dentographios of aging disease: A unique state apptO$.Oh to geriatLic ADRD ctU'e and tteatment. 1996 Annual Meeting of Southern Medioal Association, Baltimore~ Maryland.

i -·--·- ·- .. __ --. -· .......... _.. ... --· ---· --·-· ..,_ ·-·. ---··- -#-- --- ·-- -~--- ---~ -~---. -- -·--~·-··-----·····- -···- ·· . ..........41· ··-.··:•·, ;·· ·:·""~.-;:-~·."-,·.~o=.--:=,;;,.;:•:;·;;··"'---···""•·-··· .. - ! · ......... - •• ,. .. --··•- ..... _ ... , -·-~-,r CCC

"A , 1.!. •

APPENDIX 1 53. Syrnpositn:n Anm.lal Meeting of Gerontological Society of America~ San Francisco, California~ 1998.

*Presented I. G~·a>J.ts and Research Funding (1975.. 2001) I

1. National Rese~rch Service Awards irtDiabetesb 1975..1977.

NIAlYIDD) NlH. 1F32 AM 05219 MET.

2. Clinical fnvestigatorAwardinDiabetes.19T7--197$. NIAMDD, NrH.l KOB ArV£0320 MET. Two ad<lit~onal ye~rs ofsuppoxtcyre:re given up ittm•der to change instituti.ol1S. . .

3~ Daland Fellowship in Clinical Medicine (Diabetes Research) of the Am~dcan l?hilosophicat Society~ 1975~1978.

4. NIH :reseal'oh G~·ant ~ '~P:r~gnancy: Its rola in nlte:red .inaulin'release. •~ NICIHD • NIIi 1/79 through 12/8l.~ $134~000~ 1R01 HD 12517. L.G. Lipson) PJ.

5. American Diabetes Association Grant~ t'Mechanimn oflnsulin Release.H 3179 through 8/80.

L.G. Lipsonj l'.I.

6. Antet.ioan Cancer Society PHot Project Grant- ''Tissue Cultw:e Studies on Huma11. Pituitary ·'fm:nors.'t 10/18-9179. L.O ~ Lipson, PJ.

7. Los Angeles County Medical Association Auxilia1'Y G1'ant -· uReseatch irt Clinical Diabetes.'~ 7/78 ..1/82. L.G. Lipson, l?.t 8. NIH Research Grant- ~~caloitU):). modulated proteins in the par~thyroid.', NfAMDD; Nlfl 1R01 am 27816. 12/80 through 6/85, *205~000 L.G. Lipson,J Co-P .X.

I

. ~~ ..~2.... NJI-I Ttahrlng Grant- '(Tl'mning i1:1 Endocrine Hypei't:ension and Elwo.crln¢logy __. . f I • Metabolism},NIAlviDD;~ NIH. T 32 AM 07119. 7/80 THROUGH6i85 $414,500. L.G.

Lipson~ Iusttuctor.

10. NIH Ttainlng O.rtlllt- '~Tnuning in the Endoodnology and Neurobiology of Aging." NI~ NIH, 9/82 through 8/87~ $803~382. L.G~ Lipson~ Co"director. AG 00093.

1t NIH Research G:rant- {~f\1icroencapsulation: A 11ovel transplantation technique.~' NfAj NIH.

3/83.-.2/85. L.G. I.ipson,. P.r. 12. Amedc.ml Piabetes Associatio;n G.rant . . . "The role of cyclic AMP in insulin secretion in the diabetic :m.ouse.H 8/83 tbrQugh 1/85. L.G.. Lipson~ Cc~F.l~

y" '

APPENDIX 1 13, I!:>HHS Center Grant-· '~Gerlatl'io Education Center Ch:ant. ~' DHHS 1031 AH 69000. $952>000. 10/83 through ~/88. L. G. Lipson, Faculty Coordinator and Member of the Steering Co:rn:mittee.

14. NIH Center Grant .... t<Southem California Consortium for the Study of Alzheimerts Disease." NlA, NIH. 1/85 through 12/89. $750l000/year. L.G. Lipson) Clinical Investigator.

15. John A. r.Iartford Seniot Scholar Award in Geriatric Medicine ..... at Harvard Medical Schoot 9/&4 through 8/85. L.G. Lipson~ Awardee.

16. Resea1'ch Grant from Roerig, P.fizer Pharmaoeutioals, {'Diabetes in Elderly Mexican · Amerlca~s.;~ 1/86 tlu:ough 7/87. $80,000 L.G. Lipson, M.D.,.P.I, · 17. Reseru:clt GrantfrotnRoss Laboratories~ riDiet and Dementia.H 1/88 through 12189. $37t 500.

L.G. Lipson, M.D., P.l. " ..... , •• .a..·' · 18. Research G~·ant from HoechstPhmmaoeuticals . . . '~Neuropathy in the Elderly. 3' 1/88 thl'ough 12/89, $27~ 500. L.G. Lipson~ lVLD., P.l.

19v Resea1'oh Grant fJ:o.mBoehr.irtger Ingelheim Pharmaaceu.tioals- <ccont1·o1 ofMild Hypertension in. the Elderly Innc:r . . . City Population." 6/88 through 1218&. $45, 000. . L.G.. Lipson, M.D.)P.l, 20.. Research Grant from Marlon Laboratories . . . <'A New T1·eatoo.ent fot Pressute Sores." 6/88 through 3/89. $15,000 L.G. Lipson, M.D., P.I. .

21. Research Gtantfrorn R(lerig Pharmaceuticals~. . HDiabetes in the Elderly,,~7/1/89 -12/31/90. $15.tOOO, t.G. Lipson~ M.D~, PJ.

22. Resem:ch Grantfrorn the John A. Hroifotd FQundatio11. .... '~l?rescribing Habits ofPhysicians in .

Retirement Housing." 2/89 through 1/93. $487,000. L.G. Lipson; M.D., P.l. .....\.•t,t~a.., 23. DiffiS center Grant ..... ("Gerlattlc Education Center.H 10/89 through 9/92.. $450,000 t.G.

Lipsou, M.D. Clinical Site Coordinator, Key Paculty Member, and :tvfember of the Steering ConunltteB.

24. Gel'lntdc Medioin.e Fellowship Grant from the 1apanese Retirement and Skilled N\lfsing Facilities (Keiro Services), 7/38 through 7/90. $170~000. L.G. Lipson:- M.D., 1?.1.

2.5. Geriatric Medicine Fellowship Grant front t~e Motion Picture and Television Retire.men.t Home and Hos,pitat 7/87 through 6/90. $50,000/year. L.G. Lipson1 M:D., P.I.

2.6. Nll! Research Grant-NIDDIC ..... "Subtle Disturbances of Cobalamin Status.' 2R01- 1

DK32640~07~ 2!1!91 through 1131/95~ $235)827, L.G. Lipson~ M.D.:: Co ..Investigator.

~ .. - · ----- 4. • . -··--- --~~ ---- . -.. --;---- - -

... "' a ,

APPENDIX 1 66· 27. Development Gtm:lt- USC lrvine Foundation. Diversity Project. Course Development.

HDiversity ill Aging~ Roles in Ethnicity~ Get).der~ Biology and Bnvh'onntent, It 1992" onward> $5~000. L.G~ Lipson, M.D.> Course Director and P,L 28. NlH Research Gt~nt- <~Multicenter Tl'ail ofPl'ednisone h,_ Alzheimer's Disease. n 1995~ $80,000. L.G. Lipson, M.D., Co--P.I.

29~ State ofAlaska- Educational Grant (~Training of Administrators in Long Tenn. Care lnstitutions and Health Care Providers and Planners in Special Topics 'of Gerontology and Gedatdcs~n 31V96- 5/20/96, $16,000. L.G~ Lipson~ M.D., Director.

30. Glendale Adventist Medical Center- '~Family Praotioe Residency Training in Geriatric Medicine.~' 7/1/96- 6/30/001 $6,000/year. L.G. Lipson, M.D., DlreQtol!.

31. Research Grant from GJ). Searle and Co. ' '~Conttoll~d Onset Verapamll Investigation of Cardiovascular Ettdpoin.ts/' 5/97 through 5/02. $75.000. L.G. LipSOI\ M.D.~ P.t ., ......

32. State of Alaska> "Training in Ge1•ophatntaoy, Fall Prevention> and Quality Assurance in the fraU and demented eldedy.H 4/98.. 1/1/02} $200}000. L.G. Lipson) M.D._, P.I.

33. Research Grant from Pfizer Phmmaceu.ticals, ~ HStudtes in Fine Motor Coordination in Alzheimer)s Disease.~~ 6/98.. 10/99, $97)000. L.G. Lipaon~ M.D.) PJ.

34.. Research Grantft·om the Keck Foundatio:n '1Studies on the Use ofM~dicattous in the Eldedy.~) 9/30/02~ $4,000. L.G. Lipson) M.P., P.J... 12/31/02.

35, State of Alaska~ '"<Tr.aining in Gerophannacy: Quality Assurance in the Fr~d and Dement~d Elderly; CQI ofPJoneers; Homes/'1/1/02.. 12/31/02~ $100~000. L.G. LipsonJ M.D., P.I.

in 36. State of Alaska> "Training ~uality Assutancf;'l of the Frail and Demented Bldedy: CQI of Pioneers; ltomes/) 1/1/03~12/21/03. $100,000 L.GA Lipson> M.D.j P.r. r ••t\\'lJ'.e',.tt:J..H'J'J.c.."' 4 \'11i~&Jhrtl'1'~".t \.a.

. 37. ~tate of ALaska_. Uuiversity of Alaska. Alaska Geriatric Education. Centet~- Conaultant 7/1103 ~ 12/3l/04. $18~000, 38, State of Ataska ..... University of Ala.Bk~ Alaska Geriatric Education Center ..... Consultant . _10/1/07 ..... 6/30!08. $10~000.

39. State ofAlaska.- University of Alaska, Alaska Oe11atrio Education Center- Consultant 7/1/08 ,_ 6/30/09, $10~000.

. I

-···· ··-·-;:----. ···----·-·----··,........_-.--·····-· .. .. ::- - ----~~ :---:--~~-··-- .... ···-·······- --·--··- ~ ·: .... -;-""";-;::·:--::--·-·--·~----· .. -----~-----·- ·--·~---·-··--··- ·····------· ~·-. - -----~~-;;· ··-·-- --

~a ' ... 4 •

APPENDIX 1 APPENDIX 1 NO. C-1 ..1)B .. 12~00162S INTHEGUARDIANSHIPOF § INTHEPROBATECOURTN~l ·~ § ~ ~\ MARYRIVERA, § OF ;.. ~.;. ~> ~ (:) ..,'\ § 1!/1:.· ._g~ 0 ~<!.

ANINCAPACITATEDPERSON § TRAVIS coUNTY, TEAi~?;.J ~ ~~" '6~rn e ORDER APPOINTING PERMANENT GUARDIAN ~ 1~~ "2" J-"' ·:s. ·;.,;;rr t'f\ C1 OFTHEPBRSONWITHFULLAUTHORITY ~~~~k~~; ~ ~l ,,.,~~ ~ ~ . '·]-<. p t.J\ \JI On this day, the Court heard the Application for Appointment ofPermanent GuardianftJ/the Person and Estate with Full Authority of Mary Rivera, filed in this proceeding by Martha Mahan. Martha Mahan appeated in person and through her attorney of record~ Vivian Ross-Bennett. The Court finds that Mary Rivera, the ward, appeared through her attorney ad litem, Kathleen Ford Bay.

ln accordance with § 684 of the Texas Probate Code, the Court finds: a, by clear and convincing evidence that; 1. Ma:ty Rivera is a totally incapacitated person without capacity to care for herself, to operate a motor vehicle, and to vote in a public election; 2. it is in. the best interests of Mary Rivera to have a permanent guardian oft4e person with full authority; and 3. the rights of Mary Rivera will be pi'otected by the appointment of a guardian. •' ~ •• • ' I II

by a preponderance of the evidence that: . · ·· 1. this Court has venue and jurisdiction of this proceeding and of all necessary parties~ and that citation and notice have been given in the manner and for tlie length of time required by law; · ..

2. Martha Mahan is eligible to act as guardian~ is eittitled't6 be appointed as such and }s not disqualified by law; .

3. Mary Rivera is a totally jnqa'pacitated per~on as iiJ.dicated by her mental and physical limitations and as evidenced by: recurrhig acts Within the p~eceding six months and continuing to this date; and . .. . . . ·. · 4: M~rtha Mahan has acted in goocl faith in the filing a1:1-d'prosecution of~he application .. . fot· guardianship. . . · · . :··. · . . ..

IT IS THEREFORE ORDERED, ADJUDGED, AND. DECREED ~ythis CourtthatMarthaMahan is appointed permanent ~arqian ofthe person with full authority of Mary Rivera, tho ward, and shall exercise all the powers; rights. and dutic~) both general and. sp,ecHic, that are given 'to a guardian of the person in Chapt~r XIII of the Tex~s ProbatQ) Code, subject to further orders of this Court. Tl).¥ powers granted to the guardian by this or~er speciflcally'i'm.clude, hut are iwt limited· to:.· . . · ·· , . • \0 • . .• (1) the right to establish the :w~rd' s legal d0n1icile, except that the ward shall.not be removed from "her current residence at Gracy Vv r9ods I Nursing Center until fut):he~ ~~der pf this Court~ .. (2) the power to arrange for the wf.il.".0 1"S food and housing needs;' ' 1 • (3) the power. to apply for, to atrange, ,;\'ltd f:o c~nsent to any and all medical and dental care, including but not limited to medical tests, exar, :J.natiqns, and the administration of medication, as required and needed by. the w~rd;

/ .:. . • ' • • .. " , • • • , , , I ,

(4) the power tQ apply for, to ro:range a~t~l· t.o cpnsent to any and all psycholog1eal tests and evaluatmns · · which may be need~d by the ward .. · it.herthan the inpatient psy~hiatri~ commitment of the ward; • .. • ~ t t- • • • • • • •

~!fJ. Jl~oQI/111111.11111'.111111/flf 1111111111 /111/JII ·.,:,' . .,· ... ·-~""""·~~-.~~~-1YA·~~----

. . . . . .__ . . . .....4~~Lt:J~ ... ~~~~~-------"""" ' .. •

APPENDIX 1 ,~ . •·. ' ·. .. ·. \ ~·· '·. . ..·. r '

. (5) th~ power to apply to and receive funds.fro~ state or federal gov~rinnep.t sources for the ward'~ . benefit; · · (6) the power to apply for and secure governmental services for the ward; (7) the power to apply for and to secure '!ll identification card for tije warp; (8) the power to execute all documents necessary to facilitate employment; arid (~) t;tte power to consent to the disolositte of the ward's conf14ential records.

IT IS F~THER ORDE~D that the guatdhw of the, person shaJl.not prevent the ward's.fam~ly members froni visiting the ward subject to futther order ofthis Court, and that the guardian of the person shalf execute the necessary documents to grant family members access to thew~~' s m~di9al records.

IT IS FURTHER ORDERED that Maiy Rivera will no longer hav~ the right tm 1) vote in a public election; ..

2) own, possess, or purchase a ·firearm; and . .. :: .

3) hold or obtain a license to operaie a motor vehicle under Chapter 521 of the Texas TransportatiOll Code- IT IS FURTHER ORDERED that the Clerk of the Court shall prepare and transmit an abstract of judgment for this proceeding to the Travis County Voter Registrar and to the Texas Department of Public Safety. · IT IS FURTHER ORDERED that the clerk of.the Court shall report to 1h~.T.Pi~r~~ Dep\l~tinent ofPublio Safety pursuant to Texas Government Code§§ 411.052.'},)·'~~ 411.0521. ... · · · · · · ·· " . . .. .

IT IS ;FtrRTHER ORDERED that Martha Mahar.t post a'' corporate surety bond in the amooot of ~ ~~ ~!i~ft I ffB00 \3tQQ? t ~~n the time required by law. ·.. · ·· · · • • · · . . . '. · .. ~t~ ~-;· .~j ~ ~ . IT IS FuRTHER ORDERED that this Order does ~ot con~ti~te imthority for Martha Mahan, the ·~ i l: j iguar~ian of.the :pet~on, to act as ~araian ;un~U sh~ bas qualified ·acc?rdit~g to la:V 'by filing ~n oath ~~~h. th~ ~ ?? ~ ~ ~ ~Travts. County C~erk's office, posting the ~eq01red corpomte surety bond, a~d havmg the bond approved h¥ the G.f ~ &g ~ ~JlJdge: Upon her qualification as guardian~ the Tta:vis County Clerk will issu~ Letters of Guardianship~ with a ~. ~ ~ ~ ~certified copy ofthis Order attached~ that WILL BE EVIDENCE TO ALL' CONCERNED ofMartha Mahan's g ~~ ~ :JlauthoritY to act as guardian o~ the person of the w.ard, and that th~ letters qf guardianship will expire one year ...~ g fl ~·[and four months after .the guardian~ s date of qualification unless renewed according to law. f:'b -•ro ~ .

~ ~&.J IT IS FURTHER oimERED that within. i2lnon~ ftom. the date of her qualification, and annually ~ ~ thereafter:~ Martha Mahan. will ~ubmit to the Court an annual report of the person. .

ey adl~te~teP'rese1111~.e.eW._9.f.!he ~f • • ..,~......... , .. - ............ toof....,~

. . ~IS FURTHER ORDERED that the te~ pfthis gu~dianship ·shali be ~iii the ward is restored to full capa~ity, di~s~ or until the Court determines this matter. shall be' terminated.

SIGNBP tqe 2.0 dayof.fune 2013.

Recommended · ·c·.;0~, j.~~~~:;;;;=7it7ft. IDINGJUDGE ThisZO.dayo&l~~.e. , 20f3. · ... . .?Q.f\& - 2 ;Dan P~~~S9ciate Judge ... ....,_,_. -----~-~=-------....,;-,_.,_, 1,\ ... .. ', APPENDIX 1 LETTERS OF GUARDIANSHIP C=l-PB-12~001625

GUARDIANSHIP OF PROBATE COURT.NUMBER ONE MARY RivERA, TRAVIS COUNTY,· TEXAS' An Incapacitated Person THE STATE OF TEXAS CbUNTY bF T~VIS

I the undersigned Clerk of the Probate Co~rt Number One of Travis County, Texas, do hereby certi~y that· on June 20, 2013, MARTHA MAHAN was duly appointed by said Court, Guardian of the Person with Full Authority of MARY RIVERA, an incapacitated ~erson and granted certain specific powers as set forth in the attached copy of the order of· appointment.

I further certify that said MARTHA ~· qual.~fi'ed as such Guardian on Ju~y 18 r 2013, ··as the law .requi~es r and the authority under the letters expires on November 18, 2014.

GIVEN' UNDER MY HAND AND THE SEAL OF SAID COURT at office in Austin, Texas, this quly 19, 2013

Dana DeBeauvoir County Clerk, Travis ·County, Tex.as P. 0. Box 1493~~!AiJ'n,., Te~Jl.S .78714-9325 . . 'I /) ,. .

B.Y Deputy .:. /, I . ~~~· ..

Oo R ~z

23P - 000005030 C-1-PB-12-001625

·~· ...

APPENDIX 1 APPENDIX 1 AFFIDAVIT OF MARTHA MAHAN

COUNTY OF WILLIAMSON § § STATE OF TEXAS §

BEFORE ME, the unde1·signed Notary Public, on this day personally appeared Martha Mahan, who being by me duly sworn on his oath and said the following: 1. "My name is Martha Mahan. I am over the age of eighteen years, of solUld mind, have never been convicted of a crime of moral turpitude, and competent to testify. I have personal lmowledge of the facts stated herein and they are true and correct. I am authorized to make this affidavit.

2. I am the daughter of Mary Rivera. At all relevant times, I was the legal guardian of my mother.

3. On a nuniber of occasions during the Friday afternoon happy hours at the nursing home, another resident made inappropriate statements and inappropriately touched my mother. I complained to the management about these concerns. The nurses caring for my mother were aware of this problem.

4. I often visited my mother in the hours between 11:00 p.m. and 6:00 a.m .. I did so many times in the months before I removed her from the facility. I would sit with her sometimes for several hours. The staff never came into her room or checked on my mother dudng these visits.

Indeed, I rarely saw staff in the hallways during these visits.

5. Around 6:00a.m., early on Saturday morning on the gth ofNovember, I arrived at my mother's room. My mother was in obvious distress. She was crying and more confused than usual.

APPENDIX 1 6. I noticed that thete were broken Christtnas ornaments on the floor and I wondeted if she had fallen. I took her to the bathroom, as I usually did, and she seemed to be in pain. When she urinated she did so standing up which was very unusual. I put her back in her bed and then went to use the bathroom myself. When I went to throw some paper towels in the trash~ I noticed a whole stack of wet and bloody rags.

7. Concerned my mother was hurt, I took the rags to Wendy, the charge nurse. Wendy did a skin assessment of my mom while I watched and did not find any cuts or open wounds.

8. I decided to take my mom to the hospital. We went to Seton Hospital- Williamson ColUlty and they found mom had some bruising to her back. They did not do any type of vaginal exam.

9. I began to worry my tnother was the victim of a sexual assault. The police were contacted and I ulthnately took her to St. David's Hospital. During the whole time my mother was acting strange -like someone had hurt her. She would flinch like someone who was afraid or who had been hit.

10. At St. David's, a nurse did a vaginal exam on my mother. She told me my mom had vaginal injuries. I took my mom out of the nursing home and back to my house. My mom continued to act like she was afraid of something. This continued until she died.

FURTHER AFFIANT SAYETHNOT."

APPENDIX 1 SIGNED this the ~ay of December~ 2014.

&adltu ,#&£c;~ Martha Mahan

SUBSCRIBED AND SWORN TO this th/1/hday of December, 2014.

"/)JW y Public, In and For the State of Texas

APPENDIX 1 APPENDIX 1 RIVERA,MARY DELAROSA ER AccW: L00071683103 M!R#: L001022503 Loc:L, ER /F Dr: CAPITOL EMERGENCY AS 11/12/13 I1111\l\\Ill Ill\\ ll\11 IIIII IIIII1\l\ll\\l\ \\Ill \1\11 IIlii \1\ll Ill\ \Ill

APPENDIX 1 AUSTIN/TRAVIS COUNTY Law Enforcement: 1-}V?-n'v'' r'"D I i lt: SEXUAL ASSAULT NURSE ExAMINERS Your Case Number: \1, ·· ~:,( ~:J 1:{) Discharge Instructions MEDICATIONS (Prev~ntatlve medications you received are checked below.) _ _ Plan B: 1 pill, 1.5 milligrams, given to. prevent pregnancy _Zlthromax: 4 pills, 1gram, given to prevent chlamydJa, a sexually transmitted Infection _Rocephln: 1 shot, 250 milligrams, given to prevent gonorrhea, a sexually transmitted infection _Fiagyl: 4 pills, 2 grams, given to prevent trichomonas, a sexually transmitted infection If you received Flagyl to take at home, take all 4 pills by mouth after eating o n - - - - - - - - Do not consume alcohol for 24 hours before and 48 hours after taking the piUs.

Abstain from unprote~ted sexual. contact until medications are completed.

Addlflonallnformgtlon: - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

FOLLOW-UP (Your recommendaflons are checked below.)

JMMEDIATE ___._ Prescription antibiotics If you chose to receive a prescription for antibiotics, fill these prescriptions soonps possible and take the medications according to their Instructions. . -V- SafePiace (267-SAFE) offers free and confidential servrces to women, men and children who ha expepenced sexual assault and/or domestic violence. _iL_ VIctims Services at the Austin Police Department {512-97 4-5037) and Travis County Sheriff's Offi~ (512-854-9709) can provide assistance regarding personal safety, your rights as a victim of crime, informaH about the Investigation, counseling, referrals to helpful resources, assistance with Crime Vfctln Compensation applications~ and emotional support throughout the criminal justice process.

WITHJN ONE WEEK ---tf_ HIV and syphilis baseline tests can be done by a physician, clinrc, Planned Parenthood, the cit· sexually transmitted infection clinic ( 15 Waller Street, 972-5430), and People's Clinic {2909 N. IH ..35, 478-493 Addftfonat locations can be found by calling the Texas Health and Human Servlces Department (211).

ONtfO TWO WEEKS _V_ Sexually transmitted Infection tests If you did not take preventative medications, you can be test' for chlamydia, gonorrhea and trlchomonas at the same locations listed above.

THREE WEEKS _ _ Pregnancy test If pregnancy Is possible, testing is recommended to be sure the preventative medici you took worked or to test for pregnancy If you chose not to toke preventative medicine.

SIX WEEKS ~ Repeat HIV and syphilis tests THREE MONTHS ~ \ LRepeat HIV and syphilis tests -~-- sSexually transmitted Infection tests Tests for chlamydia, gonorrhea and trlchomonas are recommended to be sure the preventative medication you took worked. RIVERA, MARY DELAROSA ER NTHS Acct#: L000716831031VR#: L001022503 Loc:L.ER /F 1111111111~ llllllllfllll[[[lllllllllllllllliii~I~MIIIIIIIIIIII; 0 e peat H V nd sYP hIlls te sis OTHER: l. If there is an indictment made related to your case you have the legal right to request the results of an assa11c HIV test.

2. If you have questions about which collected evidence items were tested and testing results, please contact law enforcement.

Signature~A_ClcltQ ~k~ ,Q i~ Examiner's signature: Cl-/t!l{))!J_'(L.JJ ~,/\--- ' APPENDIX 1 (A-cl1,t~ 78 Discharge Summary St. David's Medical Center E 32nd St Austin, TX 78705 512"544-4240 11/12/2013 11:15 Patient: RIVERA, MARY DELAROSA MRN: L001022503 Acct#: L00071683103 Sex: F 008: Age: .

Thank you for visiting the St. David's Medical Center~Emergency Department.

You have been evaluated today by Goertz, Frederick, M.D. for the following condition(s): Sexual assault (CONSIDERATION OF ASSAULT).

INSTRUCTIONS (FOLLOW SANE NURSE'S RECOMMENDATION).

Warnings: GENERAL WARNINGS: Return or contact your physician Immediately If your condition worsens or changes unexpectedly, if not Improving as expected, or if other problems arise.

Understanding of the discharge Instructions verbalized by patient.

You have been given the following additional information: SEXUAL ASSAULT Exam [Adult]

Medical Records Copy TIME _ __ APPENDIX 1 Discharge Summary with ExitWriter St. David's Medical Center E 32nd St, Austin, TX 78705 512-544-4240 11/12/2013 11:15 Patient: RIVERA, MARY DELAROSA MRN: L001022503 Acct#: L00071683103 Sex: F Thank you for visiting the St. David's Medical Center-Emergency Department.

You have been evaluated today by Goertz, Frederick, M.D. for the following condition(s): Sexual assault (CONSIDERATION OF ASSAULT).

INSTRUCTIONS (FOLLOW SANE NURSE'S RECOMMENDATION).

Warnings: GENERAL WARNINGS: Return or contact your physician immediately If your condition worsens or changes unexpectedly., if not improving as expected, or if other problems arise.

Understanding of the discharge instructions verbalized by patient.

ADDITIONAL INFORMATION SEXUAL ASSAULT Exam [Adult] You have had an exam today because of a sexual assault. The purpose of this exam is to: ~- Find out if you have any injuries that need treatment -- Offer treatment to prevent gonorrhea and chlamydia Infections (common sexually transmitted diseases) ~- Offer treatment to prevent HIV infection ~- Offer treatment to prevent pregnancy ~~Arrange for follow-up counseling -- Collect specimens (which will be turned over to the law enforcement agency) --Answer any questions that you might have After a sexual assault, it is normal to have many strong and unexpected feelings. Shock, embarrassment, fea! depression, blame, guilt, shame and anger are all very common and normal feelings. There may also be: -- General sense of anxiety and fear -- Recurring thoughts or nightmares about the event -- Trouble sleeping or changes in appetite -- Feeling depressed, sad or low in energy -- Irritable or easily upset -- Feeling the need to avoid activities, places or people that remind you of the event These are normal reactions and usually go away within a few days or a few weeks.

RIVERA. MARY 11/12/2013 11:15 MR# L001022503 Visit# L00071683103 Discharge summarv with ExltWriter 1 of 5 APPENDIX 1 RIVERA MARY 11/12/2013 11:15 MR# L001022503 VIsit# L00071683103 Dlsoharge Summary with ExitWriter 2 of 5

HOME CARE: 1) For the next few days, you may prefer to stay with family or a friend. This will help give you emotional support and a sense of physical safety.

2) Sexual assault is a crime of violence. Remember that lt was NOT YOUR FAULT.

3) A sexual assault can affect your self. . esteem. It can also affect relationships with partners, family members and friends. Talking with a counselor who understands these issues may be helpful to you. Sometimes, months or years after the assault, feelings may come to the surface again. Counseling or a support group can be helpful at these times too.

4) Many states require your doctor to tell a law enforcement agency when they treat a victim of a violent crime This does not mean that you have to prosecute or go to trial. However, If you decide to prosecute, the evidence taken today will be useful In support of your case.

5) You may be able to receive compensation for medical costs or losses that relate to the sexual assault. Talk to your counselor or the local law enforcement agency for details.' FOLLOW UP with your doctor for continued medical care. If emotional or mental symptoms last more than 3 weeks, you may have a more serious traumatic stress reaction. Follow up with the counselor or agency we referred you to for emotional support. There are treatments that can help.

GET PROMPT MEDICAL ATTENTION if any of the following occur: -- Redness, swelling or increasing pain In any injured area -- Vaginal discharge or unexpected bleeding -- Lower abdominal (pelvic) pain -- Fever over 100.0° F (37.8° C) without an obvious cause -~ Pain or burning with urination

Please make an appointment for further treatment as instructed. Be sure to tell your referral doctor or clinic that we have sent you, and take your medicines and instructions to the office. If you had x-rays, an EKG, or lab tests today, they have been reviewed by your doctor. We will contact you at once if other Important findings are noted after further review by our staff. If you do not continue to improve or If your condition . worsens, we request you to please call your doctor or the emergency department right away so you can be examined. CULTURE REPORTS-- If you had cultures drawn: You will be notified of your culture only if further treatment Is recommended by the ED Physician. You may obtain a copy of your culture results from our medical records department Monday- Friday 8:30am ~ 5:00pm. The phone number is 512-544-4280. X-Rays -- If you have received any radiology testing today, please note that the x-ray has been read by your ED physician. A final reading by a Radiologist will be completed and you will be notified by the Emergency Department staff of any additional findings. If you need a copy of your x-ray for your follow-up appointment, please call 512-544-4280 to have films ready for pickup. ··

THINGS WE THINK YOU SHOULD KNOW ABOUT YOUR HEALTH:

APPENDIX 1 RIVERA. MARY 11/12/2013 11:15 MR# L001 022503 Vlsl!# L000716831 03 Discharge summary with ExitWriter 3 of 5

SMOKING CESSATION: Smoking is related to many diseases including Pneumonia, Bronchitis, Emphysema, Various Cancers, Heart Attack, and Stroke. If you are a smoker, we encourage you to quit. There are many methods to help you quit.

Please discuss these options with your primary care physician, your clinic, or go online to the American Lung Association at www.lungusa.org and double clic~ the Quit Smoking icon In the tabs at the top of the page.

IMMUNIZATIONS: Vaccines are available for vaccine preventable diseases including Hepatitis A and B, Diphtheria, Tetanus, Pertusis, Haemophllus lnfluenzae, Polio, Measles, Mumps, Rubella, Varicella (chicken Pox), Pneumococcal and Influenza. It Is important to keep children up to date on their immunization schedule to help prevent the spread of these diseases. If you have children, please discuss their immunization schedule with the child's primary care physician or clinic. If you are In Williamson County call 512-930-4386; or in Travis County call 512-972-5400 for more information.

ABUSE: No one deserves physical or emotional abuse. If you are the victim of abuse; either physical, sexual, or psychological, help is available. Please discuss any concerns you have with your ED physician, your primary care physician, or your clinic. Safe Place is an organization with the sole purpose of assisting those affected by domestic abuse and violence. Please call their hotline at 512-267-7233 (267-SAFE) or online to www.austin-safeplace.org.

SEAT BELTS: Seat belts save lives. Each percentage-point increase in safety belt use represents 2.8 million more people buckling up, 250 more lives saved, and 6,400 serious injuries prevented annually. We encourage everyone to use your safety belt correctly and restrain children appropriately. Please go to www.rntsa.dot.gov for more information.

FOLLOW UP: If you are unable to make a follow~up appointment with the referral physician or do not have a family physician, you may be able to receive follow-up care at one of the following clinics. Many of the clinics listed accept Medicare, Medicaid, MAP card, or base the fees for services on your ability to pay.

NORTH AUSTIN

North Austin Health Center Northwest Rural

APPENDIX 1 RIVERA. MARY 11/12/2013 11 ;15 MR# L001022503 Visit# L00071683103 Discharge Summary with ExltWriter 4 of 5

7112 Ed Bluestein Blvd. 18649 Hwy. 1431 Suite #155 Jonestown, TX 972-4622 All services, all ages

St. Johns Community Center North Rural Community Health Center 15803 Windermere 7500 Blessing Avenue Pflugerville Suite 30 251-4168 972-5185

Need a Doctor?

St. David's Physician Referral Line 478-3627 For patients with Medicaid/Medicare and Private Insurance

SOUTH/CENTRALAUSTIN

El Buen Samaritano South Austin Clinic 1919 S. 1st St. 2529 S. 1st St. Well Women's Health available 972-4722 Immunizations- Tues- 5-7pm (Children) All Services

South Rural Center Clinic Austin General Medical 3518 FM 973 South 1701 East 7th St. Del Valle, TX 473-2222 247-4407 APPENDIX 1 RIVERA. MARY 11/12/2013 11:15 MR# L001022503 VIsit# L00071683103 Discharge summary with ExltWrlter 5 ot 5

Seton McCarthy East Clinic 2811 East 2nd St. 389-1498 All ages (fees based upon ability to pay)

CENTRAL I EAST AUSTIN

Blackstock Health Center Rosewood Zaragosa 1313 W. Red River Suite 101 2808 Webberville Road 324-8600 972w4792 Well child care, medical, minor surgical All ages, Medicaid, or MAP card GYN, Prenatal Care, Adolescent

East Austin Community Health Center STD Clinic Coma! St. 15 Waller St. 972-4322 972-5430 All services, all ages

East Rural Community Health Center West Carrie Manor Manor, TX - 272w5561 Immunizations, family practice, maternity, AIDS testing (MAP card only)

APPENDIX 1 OrderSheet ORDER SHEET Weight: 100.2 kg (stated) Allergies: No Kno\Vll Drug Allergy GENERAL ORDERS: ... (Medical forensic exam per protoc9ol, APD case# XX-XXXXXXX. Detective Stewat·t.) (13:53 11/12/2013 JBlackR.N. verbal order read back to FGoertz M.D.) (13:58 JBlack R.N.) lVIEDICATION ORDERS: IV FLUIDS: ORDER SHEET NOTES:

This document has not been locked and should not be saved in the medical record.

Patient: RIVERA, MARY DELAROSA OrderSheet MRN: Q56545 St. David's Medical Center VisltiD: L00071683103 919 E 32nd St. Austin, TX 78705 512-544-4240 78y, F. Registration Date/Time: 11/12/2013 14:20 APPENDIX 1 ... ;.: ,;=t - ··::tt ~- 0·

PART A .. PATIENT INFORMATION ".PLEASE COMPLETE P.ART A AND PART B (£,, Today's Date: /d___tJvJ3_ Have you received .c~ Facility Before? 0 Yes D No I came to the Emergency Department today because~ ~ I

T FOR FEMALE PATIENTS ONLY: Are you pregnant? DYes I Last menstrual period: _ _/_~/_ _ Have you had a baby within the past six weeks? DYes~~- E~F~o~rm~co~m~p~le~te~d~b~y:~O~S~e~lf~·==~~~~~~============~~R~e~la~tio~n=sh~ip~:~~~~~~~~~~~~~~~~~~== N PART B .. CURRENT SYMPTOMS ~------------------------------------------------------------------------- 1 Please check any of the following symptoms you surre-ntly have: D Persistent cough greater than 3 weeks ErS__,_Throat D Fever greater than 100.4oF C}t:rody aches D Night Sweats D Cough (not related to allergies or COPD) D Cough with blood production D Rash D Fatigue D Nasal congestion (not related to allergies or sinus infections) History of TB or Positive TB Skin Test 0 Close contact with person who has lnfluenza-Jil<e illness D Close contact with person who has TB D Unexplained weight loss PART C .. TRIAGE INFORMATION (For Facility Use Only) 'S: lA- '.\J.~_t-...._f ·- 1st Call for Triage at: 2nd Call for Triage at: 3rd Call for Triage at: / 4th Call for Triage at: AM PM .. AM PM AM PM AM PM Triage Nurse Notes: G .. '(~ c-0~ • ...(J • ~·\f~~ ~l!fr' t'rt··~- !(<I Y( ,; ! dd. t."'-' fy r:rrPLr Y1 ( f(,/. De~-~ ~~'V\.rL-r.Ja·~·""··· ~ ~~ tfr~f.- F " ' .iff ·~ A PART D .. RAPID (INITIAL) TRIAGE (For Facility Use Only) '-:/. 1-1. I:J f I[ rc.:":-< It C' C'.<·'Vl Time: First Point of Contact Screening Positive: D Y D N Patient requested to mask? D Y D N c AIRWAY: D Patent D Impaired BREATHING· Respiratory Distress: 0 None D Mild, 0 r9-d~e ~ Se::fe I CIRCULATION: D Warm/Dry/Normal Color D Pale D Diaphoretic ~; Sc:f ) /_a I

L Pulse Rate: D WNL D Rapid Capillary Refill: D < 2 seconds D > 2 seconds DEFORMITY/DISABILITY .. Loss of Consciousness: DYes DNo 0 No Neuro Deficits 0 Neuro Changes I Extremity: Neurovascular Integrity Intact: DYes ON/A DNa T CHIEF COMPLAINT: y I TRIAGE ACUITY: 1 Resuscitation 2 Emergent 3 Urgent 4 Semi Urgent 5 Non Urgent DISPOSITION: D Immediate Bed D Stable- To Walling Area after Instructions ~ Comments: ~· {~ -~ctl 5 r I · ttqsrp Triage Nurse Signature: ·~yfa\ ,-' --=s<-es·- ':):i, llf\ 11:Y- ,fiJI' \.,, Ae!) ~f'~ '"'*=

11111111111111111111111111111111111 (;:) MARY DELAROSA · RlV~~1\oo071683103 M/Rii: L001D2Z 5 ~ 3 Acct • ER I

15~~~ Loc:L. EH ' 11112/13 \1\\11~\m Ullll\111111111\1\lllllllll\11\11\II\\\ \\1\1 1\1\\ Ill\ 1\11 '"EDPRS* Sign~ln Sheet ·for Ernergency Services T3107BC (Rev. 7/i2) ~OJ__ APPENDIX 1 Parfb& of PATIENT INFORMATION FOR OFFICE USE ONLY f}fL+d._r:t mt+~u PATIENT'S NAMErn MRNo.: ACCTNo.: ADDRESS 1: DOS: LOCATION ADDReSS 2: I COMMENTS/COMPLETION DATE: ClTY, STATE, i Cf /)(f) (' '7l;t 7&6/~ FACILITY FROM WHICH PHI WILL BE RELEASED (Check all that ap_pj'l) DATES OF SERVICE BIRTH DATE: {) St. David's Hospital r/-tl--t_~ SOCIAL SECURitY' NO.: I ' St. David's Rehabilitation Center (Optional) St. David's Georgetown Hospital CONTACT NUMBERS: Other FACILITY/PERSON TO WHOM PHI WILL BE RElEASED/DISCLOSED: PURPOSE OF DISCLOSURE: (Note:** IJPdicates Foe for Copies}_ Avc;_-fiV\ \Pn l) ( e NAME: Follow Up Care Insurance** ADDRESS 1: Attorney** Personal Usek* I ADDRESS2: It

'-f Other** Please Explain L-(___.~ CITY, STATE, ZIP: METHOD OF RELEASE/DISCLOSURE:

0 Fax (t::me~ cy Only) Fa}!)umb~~~ CONTACT NUMBERS: Mall ther ' ( /JL) rL . ( INFORMATION TO BE USED/DISCLOSED: (Check aJI that apply) 1 t ·- Is this request for psychotherapy notes? 0 Yes, then this is the only Item you may request on this authorization. You must submit another authorization for other Items below;·- No, then you may check as many Items below as you need, D Pertinent Package 0 EKG, EEG, EMG 0 Pathology Slides 0 Psychiatric Evaluatlons{Tests D Front Sheet 0 Laboratory Report 0 Physician Orders 0 Infections Disease (Including HIV Test Results) Discharge summary 0 EA Information 0 Progress Notes 0 Consultations D History/Physical 0 Imaging Reports (X·rays, CTs, MRis) 0 Nursing Information ~omplete Copy Operative ReporVProcedure Cathl.ab Imaging Films Pathology Report Medication Records Therapy Notes ~~~~lzatlon Record '~P1Slcc· .\ J understand that: 1. I may refuse to sign this authorization and that It Is strictly voluntary.

2. My treatment, payment, enrollment or eligibility for benefits may not be conditioned on signing this authorization.

3. Medldallnformation Is considered Protected Health Information (PHI) under both Federal and State Privacy Laws.

4. Unless otherwise specified, this authorization shall expire 180 days from the date of my signature, OR from the date of discharge, whichever Is later. (Othervvlse spectfled date ) 5. I acknowledge, and hereby consent to such, that the released information may contain alcohol, drug abuse, psychiatric, HIV testing, HIV results or AIDS information.

6. A facility may not condition the provision of treatment to an individual on signing an authorization except for: 1. · Research-related treatment; and 2. Health care that Is solely for the purpose of creating Information for disclosure to a third party.

7. I may revoke an authorization In writing except to the extent that: i, The facility has taken action prior to receiving the revocation; or 2. If an authorization was obtained as a condition of obtaining Insurance coverage.

Further details may be found In the Notice of Privacy Practices. -- 8. If the requester or receiver Is not a health plan or health care provider, the released Information may no longer be protected by federal privacy regulations and may be redlsclosed.

9. I understand that I may see and obtain a copy of the Information described on this form, for a reasonable copy fee, If I ask for it. There Is a fee for copy setvlces rendered.

1o. I will receive a copy of this form after I sign it.

SIGNATURES J have read the above and authorize tl)p disclosure of the protected health information as~staled. s~c;::J!Vhori2J~ cU-UL---- Date: !f/;J(~ Witness (If applicable}: , • v Wttness (If Applicable): - Cl\ J(Ll{d '1Clf\\ ,) I Print Name of Patient or Authorized Party: Relationship to Patient:

StDavid's I MEDICAL CENTER Authorization for Release of Protected Health Information RIVERA.I1ARY DELAROSA ER Acct;ff: L00071683103M/R#: L001022503 loc:L.ER IF Dr: CEA 11/12/13 IUIIlllllllllllllllllll <ROI* 1/lll/111111 IIIII IIIII 1111111111/lllf 11111/l/lf /Ill/Ill// IIIII 1111/ffl APPENDIX 1 '52626 (02/20/i 2) Page8'Pf 1 Clinical Report· Nurses St. David•s Medical Center Emergency Department E 32nd St, Austin, TX 78705 512-544-4240 11/12/2013 11: 15 Patient: RIVERA, MARY DELAROSA URN: Q56545 MRN: L001022503 Acct#: L00071683103 Sex: F DOB: Age: *This is a preliminary document and is subject to change

TRIAGE Triage time 11 :43. Acuity: LEVEL 2.

Chief Complaint: STATED POSSIBLE PHYSICAL and SEXUAL ASSAULT (Pt. took her Mom to the ER or Friday and Scott and White yesterday for gyn exam. This did not happen. Pt. 's daughter filed a pollee report. She said the case was approved and hour ago by Officer Flores. They do not have case number or badge number.).

BP: 141 I 72. HR: 50. RR: 20. Temp: 98.2 oral. 02 saturation: room air -95 percent. Alert. Glasgow Coma Scalew eyes open spontaneously (4); best verbal responsew disoriented (4); best motor responsew obeys commands (6). No acute distress. --11:57 Ritschard, Heather, R.N ..

Weight: 100.2 kg stated. Height: 57 inches Per Patient. BMI: 47.9. --11:56 11/12/2013Heather Ritschard, R.N ..

Medications Daughter does not have med list. She will attempt to get them. •.. 1155 ( 11 /12/13) Heather Ritschard, R.N ..

Allergies No Known Drug Allergy. --1155 (11/12/13) Heather Ritsohard, R.N ..

History This occurred just prior to arrival (Friday). Police department notified (APD called in triage, Pt.•s daughter reports she made the report on Sunday and it was not approved for lack of evidence. Det. Flores approved case this am. Daughter can not find case/ badge number.). Pain level now: 0/10.

PAST MEDICAL HX: Hypertension. Diabetes mellitus. Immunizations: up-to-date. (Dementia, KD failure stage 3. UTI. CHF).

SURGERY HX: Back surgery. Cataract surgery on the right eye. Hernia repair has been performed three times.

SOCIAL HX: Nonsmoker. No alcohol use. A potential harm assessment was performed. The patient answered 1'no" to the question "Are you here because you tried to hurt yourself?", "Have you ever tried to hurt yourself before today?", "Have you recently had thoughts about killing yourself?" and "Have you recently had thoughts about harming or killing others?". Functional assessment: no impairments noted.

The nutritional risk assessment revealed no deficiencies. No report of abuse. No infectious disease exposure.

Patient: RIVERA, MARY DELAROS.t URN: Q56545 Acct#: L000716831 0: Sex: F DOB: 11/12/201: of.

APPENDIX 1 RIVERA. MARY 11/12/2013 11:15 MR# L001022503 Visit# L00071683103 Clinical Report- Nurses 2 of 3

Historian: patient. Primary physician (Dr. Choen. Dr. Router for nephrology.) .. ~-11 :57 Rltschard, Heather R.N.

(Case# 1331407 43 Detective Stewart Badge# 6301 APD). --12:00 Doug Cargill, R.N ..

Interventions band on patient. To room. .... 11 :57 Ritschard, Heather, R.N ..

PHYSICAL ASSESSMENT 12:04. Alert. Appears in no acute distress. Affect appears normal. Glasgow Coma Scale: 14- eyes open spontaneously (4); best verbal response- disoriented (4); best motor response- obeys commands (6).

Revised trauma score: 12. Pupils equal, round and reactive to light. Respirations not labored. Normal heart rate and rhythm. Pulses within normal limits. Capillary refill less than 2 seconds. Extremities exhibl1 normal ROM. Neuro-vascular status Intact to the extremity. Skin is warm and dry. --12:04 Caroline Doyle, R.N ..

NURSING PROGRESS NOTES 12:04. Two patient identifiers checked. The initial plan of care for this patient includes an assessment with efforts to address the patient's anxiety, fear, grief and anger; comfort measures; Impairment of the genitourinary system; therapeutic needs of the patient as indicated by complaint specific guidelines; referrals, additional testing and hospital admission; educational needs of the patient and family regarding the patient,s medications and disease process and available services and resources. This plan of care wa~ discussed with the patient and family. Call light placed in reach. Side rails up x 2. Bed placed in lowest position. Brakes of bed on. --12:04 Caroline Doyle, R.N.

12:04. (Approval received. Jenny, FEC R.N. called . Safe place called.). ..-12:06 Ritschard, Heather, R.N.

12:50. (SANe arrived. Patient medically cleared for medical forensic exam by Dr. Goertz. Introduced self to patient, guardian and family. Plan of care for medical forensic exam discussed, questions elicited and answered. Guardian verbalized understanding of plan and consents. Consents signed. Guradlan declines prophylactic medications for patient, prefers to d.o testing and treat if necessary later. Guardian states patient is current on tetanus and hepatitis b vaccines.). --13:38 Jenny Black, R.N.

13:00. Patient ID band checked for patient name and birthdate: patient confirmed. Blood samples drawn from the right antecubital space with Vacutainer and 23g butterfly by nurse per protocol ; labeled in presence of the patient and held: purple and gray top. --13:38 Jenny Black, R.N.

13:46, (Safe Place advocate arrived.). --13:46 Jenny Black, R.N.

13:53. The patient reports no complaints and the patient is calm and resting quietly. Patient reports current pain level as 0/10. --13:53 Jenny Black, R.N.

14:39. BP: 147167 lying. HR: 53. RR: 18. Temp. Patient 10 band checked for patient name and birthdate: patient confirmed. Urine collected with return of yellow-colored clear urine. Specimen labeled in the presence of the patient. (Patient ambulated to bathroom and room 17 with walker.). w-14:39 Jenny Black, R.N. .

I 15:09. Pelvic exam performed by SANE. Preparation: sexual assault evidence kit (applicable consents obtained). Procedure: sexual assault exam per protocol. Specimens collected and sent to lab: sexual assault evidence kit sealed/signed and placed in lockbox per protocol. Status post-procedure: the patient was stable and no complications were noted. Total time of assist I procedure:>90 minutes. ·-15:09 Jenn· Black, R.N.

APPENDIX 1 RIVERA. MARY 11/12/2013 11:15 MR# L001022503 Visit# L00071683103 Clinical Report" Nurses 3 of3

15:1 0. Reassessment after procedure. The patient reports no complaints and the patient is calm and resting quietly. Patient reports current pain level as 0/10. Overall patient status Is improved~ the patient states feels better. ED physician notified about patlent1s status. --15:10 Jenny Black, R.N.

15:26. (APD VS here with patient and family. APS referenence number 64190731. APD VS is working with guardian to move patient to a different ·nursing home. If that is not possible, APD VS will contact current nursing home to assure patient's safety there.). -~15:26 Jenny Black, R.N ..

Assault I Forensic Flowsheet 15:09. The patient has family for support. Personal safety plan, reporting plans, STD and contraceptive prophylaxis, need for medical follow-up, counseling, coping/fear reduction and interventions/services discussed with patient. The patient has been given education and resource materials. --15:09 Jenny Black, R.N ..

DISPOSITION I DISCHARGE 15:28. BP: 165/70 sitting. HR: 90. RR: 18. Temp: deferred. Condition at departure: improved and stable. Patient reports pain level on departure as 0/10. The goals identified in the patient's plan of care were met. The following issues were addressed: psycho-social issues, pain control, comfort issues, nutritional issues, educational issues and follow up care. Fall risk assessment completed. No fall risk identified. No learning barriers present. Discharge Instructions provided and reviewed with the patient.

Reviewed referral to family practice, a women's shelter, Planned Parenthood, the public health departmen1 and crisis hotllne for followup and testing. Summary of care provided to famHy. Patient and family verbalized understanding. Written Instructions provided in English. Guardian verbalized understanding.

The patient was discharged by the physician. The patient was discharged to the nursing home and accompanied by guardian. The patient left the Emergency Department ambulatory and via private vehicle.

Driving (guardian.). --15:28 Jenny Black, R.N.

15:28.

Departure time; 15:28. --15:28 Jenny Black, R.N.. .

The patient's home medications have been reviewed and validated with patient by the nurse. -.-15:28 Jenny Black, R.N ..

This report is not final

APPENDIX 1 AUSTIN/TRAVIS COUNTY SEXUAL ASSAULT NURSE: EXAMINERS CONSENT FOR MEDICAL FORENSIC EXAMINATION, TREATMENT.,__AND COLLECTION OF EVIDENCE 1. I hereby authorize J (\'?( tterlL_ ·(2_;j C£Q MJf\--CJr·~~¥ual assault nurse examiner who is credentialed at St. David's Medical Center to perform a medical forensic examination, treatment and the collection of evidence. (.!Wj))(lnitial) 2. I understand that a forensic medical examination for evidence of sexual assault can, with my .consent, be conducted by a health care professional to discover and preserve evidence of the assault. I understand that the examination may include the collection of reference specimens at the11 If JJJ time of the examination or at a later date. {llLt!!!.!1 (initial) 3. I understand that the collection of evidence may include photographing~///// injuries, and that t~ese photographs may include the genital area. ~(initial) 4. I understand that I may refuse to consent or withdraw my consent at any time for any portion of the examination. I understand that if r refuse consen~ . to any exam procedure, it may result in loss of evidence. (initial) 5. I understand that I will not be billed for the evidence collection portion of this examination. I understand that I will be responsible for the payment of any medical treatment and medications to the extent I am not eligible for discounted medical care based on my financial classification and ability to~ pay. (initial) 6. I understand that the collection of evidence may include the collection o, ;/;t blood and urine specimens for toxicology (drug screening). y~\initial) 7. I understand data without patient identity may be collected from this report for health and forensic purposes and provided to health authorities and other qualified persons with a valid educational or scientific interest for.. 1 , 1 JA demographic and/or epidemiological studies. ~ (rnittal) 8. If conducted, the report of the examinatron and any evidence obtained, ~ !1/J A will be released to law enforcement authorities. · 1 ~rnitial) I certify this form has been fully explained to me, that I have read It or have had it read to me, and that I understand Its contents. I hereby consent to a forensic medical examination for evidence of sexual assault. I similarly consent to the examination of mfnor child{ren) for whom I am the legal guardian.** I understand that under § 261.101 of the Texas Family Code, St. David's Medical Center, its employees, and/or representatives are required to report suspected or identified child abuse or neglect to the proper authorities. /

o Patient o Parent ~uardian o Surrogate m~m~~ signature ~~~~IL3~-- Dfftf/ F . *"'If the parent or guardian Is not available, the child may be·examlned for sexual abuse under the T~xa.s Family Code § 32.005.

RIVERA,HARY DELAROSA ER Acct#-: L00071683103 14/R#: L001022503 Loc:L.ER 78 /F li li l il~ lllllllllllllllllllllllllllllllllil~1111~111111111111111 APPENDIX 1 Austin/Travis ColUlty Sexual Assault Nurse Examiners Sexual Assault Forensic Examination Report Patient name: Rivera, Mary Case: 13..3140743 Date of exrun: 11/12/2013 MR #: 1022503 DOB: Name of examiner.................. Jenny Black, RN, SANE A, CA~SANE Name offacility..................... St. David's Medical Center Law enforcetnent agency ....... Austin Police Department CPS~ APS notified.................. Yes (~ ~ \101 ~ \ Beginning time of exam 13:30 Ending time of exam 15: 15 Patient information Gender ................. Female . ........... ,. . H'lSpantc EthniClty .

Accompanied by · Agency or relationship ........ Safe Place Advocate, Family Present during exam per patient's request. ...... daughter/~ \)(i\;vd ~e.t-vx.

Advocate present during exam ......... ,.. No Patient action after assault and before exam Douched....... No j . . . . . . . . . . . . . . . . . . 111 • • •

Wiped vulva................. ~~···· ... No Wiped anal area.................... No Washed................................. Yes Bathed................. ,.................. No Showered.. Yes I •• I . . . . . . . . . . . . . . . . . . . . . . . .

Urinated................................ Yes Defecated..................... Yes I. I ......

Vonll.ted............. ,................. , No Had food .................. ,.. ,......... Yes Had drinlc........................... Yes I ..

Brushed teeth ........................ No Used mouthwash ...................No Changed clothes .................... Yes Smoked........................... ,..... No Medications taken................. unknown (not received from hospital) Other..................................... Yes; cleaned dentures Information on assault Date and time of assault. ...... unknown, perhaps early 11/8/13 Number of assailants ........... unknown Gender of assailants ............. Unknown. ?jj~ ..P-JJ SAiJ6-A- Signature of examiner Page# 1 of4 APPENDIX 1 Patient name: Rivera, Mary Austin/Tmvis County Sexual Assault Nurse Examiners Case: XX-XXXXXXX Sexual Assault Forensic Examination Report Date of exam: 11/12/2013 MR #: 1022503 DOB:

At time of assault Condotn..................... ,........... Unknown Lubrica11t............................... Unknown Contraceptive foam/ spertnicide .. ~ ...................... Unknown Assailant injured.................... unknown Assailant scratched................ unknown Penetration. Anal penetration.......

I •••••• I ••••••••••••••••••• Unknown I ••••• I •••••

Vaginal penetration............... Unknown ....................... 1 ........... 1 ..........

Oral penetration.................... Unlmown . . . . . . 1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ejaculation, ............................ Unknown Weapon.................. Unkno'Wll I •••••••••••••••

Physical force ........................ Unknown Restraint .. ,...... Unknown I •••• I , , • • • • • • • • • I • • • • •

Tllreat................................... ,.. Unlmown Coercion................................ Unlmown Feru--..................... ,............... 4 .......... Uil.lal.o'Wll.

At time of exam Most recent sexual contact 0 ...... , More than a week ago Significant medical history Last normal menstrual period began..... ,. <yuL lA.. o ·k 7 Vaginal tampons last used ... ~ ................. ..

Last normal bowel movement. ................ 11/12/2013 Recent constipation..................................No Recent diarrhea................. ,...................... No General appearance Alert Cooperative Maintains eye contact Speech clear Bodily surface injuries See attached diagram Genital examination (Please see attached diagram for details) Tanner stage Breasts ...... 5 G~tal~..... 5/ . rs ,. T c tJ Jf74 (/jf CM..-/_; _1.,._)\J ,)r\1'- ,) Signature of examiner Page# 2 of 4 APPENDIX 1 Patient name: Rivera, Mary Austin/Travis County Sexual Assault Nurse Examiners Case: XX-XXXXXXX Sexual Assault Forensic Examination Report Date of exam: 11/12/2013 MR #: 1022503 DOB: Labia majora........................................ No trauma Labia minora........................................ No trauma Hymen............... ,., ............ ,........... ,.... ,., ,No traUlll.a Posterior fourchette/fossa navicularis .. Trauma Cetvix....... ,.......... ,..... ,.. ,,. ........... ., .............. No tra-wn.a Perinel.UTI............................................... No trauma Atlus . . _...................................... ,............... No tra-wn.a Othe1· area(s) of trauma........................ periurethral tramna Colposcope used.................................. 3.75, 7.5, 15x, with images Toluidine dye used............................... No Impressions from exam History of memory lapse Head to toe exam with trauma Detailed anogenital exam with trauma Medical forensic examination completed Evidence items collected Oral swabs (4) ....... ,................................ No Oral smear ................. ,_ ..............................No Circumoral swabs (2) .............................No Neclc swabs (2) ...................................... No Breast swabs (4) .. ,..................................No Vaginal swabs (2) .................................. Yes, Blind Vaginal smear........................................ Yes Cervical swabs (2) ................................. Yes, Blind Cervical smear ...... ,............................. ,.. Yes Pubic hair combings and comb.............. No Pulled pubic hair standards .................... No Anal swabs (2) ....................................... Yes, Blind .An..al smear., ..................................... ,..... Yes External genital swabs (2) ..................... Yes, Blind External penile smear............................ No External penile swabs (0) ...................... No Buccal swabs (2) .................................... Yes Purple blood tube ................................... No Tampon........... ,..... ,............ ~······· . ····,···········No Sanitary pad........................................... No Fingernail swabs (4) .............................. No Right & left palm swabs (4) .................. No Head hail' combings & comb ................. No Pulled head hair standards ..................... No ~-~ti{k. (1J] <s;t06-A- Signature of examiner · Page# 3 of4 APPENDIX 1 Patient name: Rivera~ Mnry Austin/Travis County Sexual Assault Nurse Examiners Case: 13..3140743 Sexual Assault Forensic Examination Report Date of exam: 11/12/2013 MR #: 1022503 DOB: Changing paper...................................... No FTA card...... ,.. ,.... -....... ,.. ,................ t ....... Yes Oth.er. ,. 'II • • • a.' •• ' •••••••••• t • • • t •• t • • • • ' • • ' • • • • • • I I .... " • • N0 Items sent that are not in kit Paper bags (how many)., none Urine sample ................... Yes Blood sample .................. Yes Clothing.......................... None Oilier,,, ..... ~. None ......... , .............

Examiner notes Guardian states that patient's last menstrual period was arolUld 2004.

Signature of examiner Page#4 of4 APPENDIX 1 HISTORY OF SEXUAL ASSAULT Page 1 ofl Patient states that she recalls no sexual contact.

RIVERA.MARY DELAR Acct#: L00071 683103OSA ER ~ loc:L.ER LDD1022503~ Dr: CAPITOL IF (7 )j l l~l /1!1/ /l/1 1 1111/lflllfIIIIIDH!IDfii~D/1111111111111Ill/ I

Signature of patient: APPENDIX 1 STEP 2 BODY DIAGRAMS

J

( \

APPENDIX 1 Yellow-Low Enforcement Representative Pinlc-Lab Copy No.TXAI'Dl~ ARY DElAROSA RIVER_A·L~007l 683103 M/R#": ER y L00102250j.lr?.~t \ 'l STEP 2 BODY DIAGRAMS Acct#.

Loc:L.ER DOB . 11/12/13 /F ))

mill~~ ll\1\ ll\11 ll\11IIIII IIIII IIIIIIIIII IIIII IIIII ll\11 Ill\Ill

~ .. ···') ) -.::7' ·~ APPENDIX 1 Yellow-Law Enfo1·cement Rcpl'esentative Pink-Lnh Copy Nu, TXAPIHog:g EXHIBIT 4

APPENDIX 1 STATEMENT

My name is Jenny Black. I am a certified sexual assault nurse examiner. I performed the medical forensic examination of Mary Rivera on November 12, 2013 at St. David's Medical Center. My examination found bruising on the posterior fourchette and periurethral areas of Ms. Rivera's vulva and bruising on her posterior vaginal walL These findings definitively indicate penetration of the female sexual organ.

Jenny Black, BSN, RN, SANE-A, CA..SANE

APPENDIX 1