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Item 19 - Denial of Claim - - AGENDA REPORT SUMMARy - TO: Honorable Mayor and Members of the City Council FROM: James L. Bowersox, City Man~ ,-" INITIATED BY: John 0, Fitch, Assistant City Manager~)t ~ Peggy A. Stewart, Director of Administ ativ service~ Douglas A. Milton, General Services Manage '_ . DATE: September 5, 1995 SUBJECf: Denial of Claim -- Lupe Van Roy ABSTRACf Ms. Lupe Van Roy presented the City of Poway with a claim for damages relating to an ankle injury she received while climbing on rocks near Boulder Bay at Lake Poway, The amount of the claim is $32,000. It is recommended that this claim be denied, - ENVIRONMENTAL REVIEW This agenda item is not subject to CEQA review, FISCAL IMPACf Unknown ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCE None RECOMMENDATION It is recommended that the City Council deny this claim. ACfION - 1 of 6 SEP 5 1995 ITEM 19 .- AGENDA REPOR'l CITY OF POW A Y This report is included on the Consent Calendar. There will be no separate discussion of the report prior to approval by the City Council unless members of the Council. staff or public request it to be removed from the Consent Calendar and discussed separately. If you wish to have this report pulled fOf discussion. please fill out a slip indicating the report number and give it to th, City Clerk prior to the beginning of the City Council meeting. TO: Honorable Mayor and Members~e City Council FROM: James l. Bowersox, City Man , INITIATED BV: John D. Fitch, Assistant City Manage~~ Peggy A. Stewart, Director of Administ ativ~s Douglas A, Milton, General Services Manager DATE: September 5, 1995 SUBJECT: Denial of Claim -- lupe Van Roy BACKGROUND A claim was received from Ms. lupe Van Roy of Oceanside, California, on July 21, 1995, The amount of the claim is $32,000. It is recommended that this claim be denied. FINDINGS Ms, Van Roy was standing on rocks at the Boulder Bay area of lake Poway when she slipped and injured her ankle. ENVIRONMENTAL REVIEW This agenda item is not subject to CEQA review. FISCAL IMPACT Unknown ADDITIONAL PUBLIC NOTIFICATION AND CORRESPONDENCE None RECOMMENDATION It is recommended that the City Council deny this claim. JlB:JDF:PAS:DAM:eg Attachment: Claim for Damages -- lupe Van Roy ACTION: SEP 5 1995 ITEM 19 J 2 of 6 D � d City of Poway _ 2 I D CLAIM AGAINST THE CITY OF POWAY Received by �• G��-�'�o �'/ via U:8 Mail _�_ Inter-ONice Mail �ver tfie Counter � 9S- 9` -oo/ A,claim must be filed with the Ciy'Clerk or Risk Managero} the City of Poway.within':6 months which the incident or event aCCUned:'Be sure your'daim is against the G of Poway, not anoiher pubY'�c eMity. Where: space,is insufficient, please use sdditional paper and identrfy information by�paragraph numbec Completed claims�:must be mailed o� delivered to The City of Poway; 13325 Civic Genter D'nve, Poway, CA?92064 (P.O: 8ox 789). Attn: Rfsk Manager. fO THE HONORABLE MAYOR AND CITY COUNCIL„THE CCfY OF POWAY,:CALIFORNIA lhe.undersigned respectfuity submits'the'toflowing claim and Infortnatwn relative to damage to personsantl/or personal ProPertY: 1. Narne oi�claimant � � � � ' a. Address oi claimant —h. Phone No. c. Date oYBirth d.'Social Securiry No: e: Driver's Lic: No. 2. Name, tele hone and °� p post oHice address to which ciaiinant desires notices to be sentif'other than above: r ., ..��,�r� �r �o��e _ __ _ W � 3: Occurrence o� event trom wfiich the claim,arisesi a. Date .- � � � — 7..5 - b. Time �- ,J &�' c. Place (exact a d s ec'rfic location) a . : ' '' — . • ! 7f . "' t.citcfe.r.�</�'a ,STe�vh �ccn >'.SE• e. in a� ir y. : d. How and uhder whatcircumstanoes d�d`damage or injury ocxur? pecify he� ular occurre e, eve f; act of omissio� you claimoaused the'injury ordamage:(use additional paper it necessary). � , r , S�,v�>h� o�, � s,�,�tr.� .r.x;�L.s/�9;��- �w� �,� r..��,�,.�,,: �,.�f� r«,�l ,.,,�/ �r-�„�se,, ( 3 y_ �" -�^/L�/ 5/�?Lj:�if l L/•ash /'�fiJ���li ��./ !.G?1fPr ,�:/� ,��i,�.G; %'l:,•[ir;� — ��. G r•� / F a y ��J� ? ,. , . : : `, ' t � � �� � -� �' Ti� �� '. I e?o!ta G C.��2? i'!t uC.,d» rr}r 4h/(fC , hat particular actio y e, iry or its emplbyees, c used the Ileged damage or injury? , - �.� ��r . � �- �,, �.�� ,, ,^--,,, � , �� � � � 2�—! !S� �1.�6'r w: G'it�a ���'imr� � i� f Ocs f /�%l�diiiG'e� ('G«fo�ri.rc /Jvnot;,,_� 6� q/a� � Dn4C„ �N� �,rlci� ' Exc�.�/� ��I't �v �_ _ �— ,- ---�Pf �:so/E+.<o- . '. . � _,. . _�/ . ' .' . . . " � � '�� r ^�e �'"�°/L. � � 6G�! fC' � ' D : ' ; � e, _ . . � � ., Pr Tliit f `�ii+� `�i 1 .SP ory.� �`'!y''.SD/t;, y/y1��' �R''S ✓/"OF Ph Q P�.!` /H � � �!�'rFi 3 of 6 _ .� � %t,. ' _ J,,. , � F,.Y/: . :, ,..._- -_ . . ..< . _ �.,t.. , e 4. Give a description of ihe injury, pra mage or loss so far as is'known at th f the Gaim. If there were no injuries, state "No Iniuries." 11.7 I ��G�O//� /'��� 1 ,Ywc T�%�i./J /Ji�/�i� /h i �o ��' ��IP Hi� �` Q�iiid' lin >i ="�:</�-�T�PA f�/r:c�� �Tr i7;u�5B�ai�f�✓���.°aSS/c.f'-.�P�sFr a�.r�tt,/�/s� 7XQ l.�.i�e �u�S� 1/ . -C " lX7cr , ,.� , o a�- B/7�ir.,riF!` / GvitS 4 O.w�ir �+i� G/r�— � /1PS iil /j,� � �''�6/bi��' 5. Give name(s) of the City employee(s) causing the damage or injury: �i/� 6. Name and address oi any other person injured: � 7: Name and address of the ownerof any damagedproperty: ---_.__- 8. Damages claimed: a. Amount claimed as of this date $ 3:? l•T�J •d� ? b. Estimated amount oi future costs: $ c. Total amount claimed: $� 7�n• 4� ��./c�i�� d. Basis for computation oi.amounts claimed (include.copies of all bills, invoices;,esiimates, etc.) —= •--• �llp�P L^lr.� r 9. Names and addresses of all witnesses,.hospitals;,doctprs, etc. ��,v.t�� �- ��P��/�f ni� /'l�l� �. �--, (' a. ' _ i—�'7�E� 7 . .. / b. �. . - y �- . . G'� <c�v c. �' d. 10. Any additional information that might,be helPful in considering the claim: -,��' lfiu n � 2. a� � f Qu.� �i _ l -L i'r/Ev , �. . .,. . � : . .ti...r>-ls�;.� e'� Tke b'aw �; iaw ..�io., � os i6/ iryeqr • 7�fc �� WARNING: IT IS A CRIMINAL.OF TO FILE A:FALSE Cl'AIM!'(P,enaf Gode�72, insurance Code'§ 556.1) y � `� J have read the matters,and,statements made,in the above;claim and I.know the�same to be true of'my own knowledge excepf as.to tFiose-matters stated upon information;or beliei as to such matters I believe the same to be,true. I certify under penalty'of pe�jury that the foregoing°is TRUE!and CO5AECT. $igned tfiis ��dayot� �Y , 19 � , at /a �3o,G7�1 ClaimanYs.Signaturec---- /J� ���t �,, ) Office of the Ciry Clerk Powa��, Califomia DOri innFn�T ��n FILED �EP 5 1995 �E� 19 4 of 6' — -� r "�" KAZSER HE^! DONOT . TH PLAN , STAPLE . .. � _- ^ 7'.. PO BOX 4, � IM�THIS __ . . . ,,. ' �, . • . � €. AAEA, LOS ANGELES, CA 90041-0916 � [ . PiC� ( HEALTH,INSURANCE•,CLAIM F.ORM P, , - SDiLARE MED+GAID C11AMP�,S pW�ypVA . GROUP.. � .FELA �� - - ' OTNER�t�_�W$�RED'SiA.:NUMBER ' � �FOBPqp(RAUy1�TEM't' � -.M'ORan/l. 'lWdealO"q� lSNN�w'sSSN/'. eIVAFY�q" MEKTMPLAN BLKIVNG ..�__ . . . � � - ' ' �' . )/ � IE�&R �. f55N1 .POJ � ,� 2 ATiENT 5 NAME Nsi Narrr.�Fn� Nam� 4M041r�q -�"" . . TX WT - ��.INSUREO'S'NAYE Ilau Wrn�. FrN Wme.�Ym4 WWI1 VAN�OY LUPE VJ M� 'oo, rv sex s e�neNrs�ooness'iNO sv«�i F V9NROY LUF'E - -�� O,VATIENiAEUT10M$MIP�TOINSURED 1 W$upEOSADDRE55'jNO yr��� �."'�c�:'0 �,.°O �.,� �. � $TATE I:IVATIENT�STATVS �� _ ., _ - Si�TE � �:ra yWy� Mrr�a� pr�.r� . � ZIPCODE .. . TEIEinOHEl��nua,Mi+Gawl ' C.a —___.._.�_ IW.C= ... � t\t�RCYifiYK:INOI.�MI�(,py(�' • H_ �NSURE � � . E^�rwr' , fi/4.ti V.xi inw ... � f � U. sma.+� (-. S�,n,,, F .. D'S HAME 1�� Nam�. f�l Nu�y. W�y Y y�l) � 10 �.5 oATIFNTB CONpTqN I�UTE O. � � 1:� N5UqE05 POLICY 6NOUV pq FEU WN�g6R �� � _ 1 .OTNERINSUNEp'SPOIiCVORGRWPHUUBER � � ' �..E � � � U MLSUNED �% � � ��ES �fq. u' r '. � � e OTHER�WSUFEDb�ATEOF.BiRTH �M ' e �uTOnCCiDEMT ►IApF��iSUM,. e�EYROv MY. . pp YY. K � � � M f 'r"'� YES rJMt� � ; EMVLOYER 5 NA4E OR $��qp� NAME ., LJ LJ ' „ � . �"OTFEX�CCIOENT+ i waWU.:FP.Mnu,(�011�pppq�y�yE F �YES �NO � 4 i�.INSURANCEPI.ANN�NEORPqp�iWINAME �10Y.q(SERVEDFpqLOCAL�NSE 0 �S�in �� � O' .. READ 7eCK M. fORY BEFORE CGMLETMO�{ MO�IVW �iM tO110t ""' ... I�t 5� I�F � / p� �wum U Yk mnWM� Mm Y��0: 2 FATIEM�SOf1�UTi10NIjEDPEPSON351GN�TUFE�I�ump�t�ino�vM�w.a�����vypy��Nq�yy� �� ��U bp0utf � IWWm.I � i W��yW 6 �W1'�IOI�OpvMMWI1HMr44NIMi'IOinMMUC� �� W MM� I O m �OCi�Gw 1 � 1 ��qtltlYflOMW'IbMYffYAWM,W��MIp E�IOY' � .-. 1 1✓tl wC i6�lf Wp1Y11M11 Mvql� OM'YOYC W�O�`, .,IGNATURE` ON F4LE .°.I:GNATURE ON FILE S�GNED ,D�tF � . . . - - SIGNED. �:DATFOFCURPENT Y.LHESSIFrtslarmqpnlOR�. 15 K�iY�IRNirW�Wpy�yE�pyl�yqARLLLME55. . CUAYYIp� MM V]� :WJVRY.I�CCtl�npON GIY[�iUiSf..D�iE W_ .� Yv —S �A S'S ..VREGNANCYIIMGI . .. '._-� '�S ... Fqpy��� �. � W TO� � � I EOiREF�RFINGVHY5IGMNOROTMERSpJp�E�� '�i]� i0 NuMBEROiqEiEMWGPw+S�CiAN 1! Hp$p�7KWTpNpnTESREUTEDTOCIIRRENTSERV�CES' PUMERADO HOSPI?AL Ek F �"w �°D rv ww , oo rr i. RESEMED FOP LOCq USE To 70�WTSIpEU�g? �fCw1R6E5 �� 'QYES �NO' - � DIAGNOSISORNATUNEOiILLNE550RIWUNY INEI�TEd � y! y[DCAIDpESUBWSS�ON - , e�. 44_ FX ANhLE EIMALLEG' r """'"'"'"�"+" �7 L_ . _ :] iRiOR'�U1MO�WT10NMUMlER... � � � � � � . B �.0 . ' U: E .. F . Fr Pl�p Tyq' Y .. �' - .N ' I J N . �.. IM VV NM� DD YV �� a (EaW'^UiwWNCiiri1m�iantnl UiAONOGIS ' "OR� Fam FESERYEDGOA .. CGTm�P 5� - KIER CUOE 1CIMAGES �pq1T5 P�� E �' C �' L(1L'uUSE t 5 24 95 5 24 95 1 2 278T4'80 ] 4-1300 7 g ASSZST T,SURGE � � ; 'Jud , •V `nn=Watao� . RN R. .'F A.; � � ' J ' � , ;, , ; � I r , FEDEN�LTiVt1.0 NUMBER; S$N;IEIN I25:�pATIENT'SAC�ppNTNO. �Y7.ACLEYTI$$IGNMENT ' . „� . ' ❑ F �: � mi. µ � Y0,"TOTAL GMAR(iE ZY. A4qJNT PAID .17 9�LANLE�DUE .. 53..86�12 r¢s �o � 41300 f 000 f 4°1"300 SKaNA�VREOFVMYS�CUWONSUGGCIER' '7�:H�MEANDAD�XESSOFPA�LLITYWM�qESERVICESWERE��}7;�PNYSICUH'S,-SUGPLIEH'SBILLIN(�qAyE;,�pDRE55ZIPCOOE� ��UDMG DEGFEES OR LREDENTIALS' ' ��^'��"••u�•^�•�^�M�••. PU'FP����SYS`�B�Y�� EbW�'�tb A VENNWATSON MD �� m "` � ' 615 PDMERADO RD 1263,0 MONTE VIBTA RD 105 CA 92064 E 1 1 5 ; POWAY GA 92064 MED O�TE � _ PINi'. WGZQOI'ZQ. ...GRP�� IAVOqAVFl1 Rv y/� f!Y Mf�i � µEau��sEqv�ce n�eei.. pLEASE PR/NT OR TYPE FOqM 11 �FA.150p�.. 113�9p1 � 5 Of 6 FORYOWLP,IS00 FORMRRB�1500 'C . ILIM-1YSiM�Mw SEP 5 1995 RERA 19 ��fnAly�II1Hf�Y��IPIMiM.W11 PREOPERATIVE DIAGNOSiS: Simalleolar fracCUre, open, left ankle. POSTOPERATIVE DiAGNOSIS: Bimalleolar fracture, open. PROCEDURE PERFORMED.: Open reduction internal fixation of inedial malleolue and fibula. SyRGEON: Edward A, Venn-WaCSOa, M.D. ASSISTANT: Judy Venn-Wataon, R.N., R.N.F.A. ANESTHESIA: Spinal FROeEDURE: The patient waa taken to the operating room and leg was pre placed under spinal aneetheeia. The patient'e pped and draped, tourniqueE' was applied to 350 mm Hg. A lateral inciafon was made to the f;ibula, carried down through ekin and eubcutaneoua tiasue�. There was a large amount of clot,and blood. The fibul`a was expoaed after the periosteum was cut. The:fracture aite was.expoaed and cleaned. with irrigating solution with anG'abiotice. T6e patiant wae on:anCibiocics duririg the procedure. The fracture was then ieduced with a lion,jaw. A croas-ecrew was then,pleced using interfragmentary;eompresaion. The 7-hole plate was then applied to the fibula, and a reduction,done. The distal most screws were difficult to feel the depth on repeated triea. A;2a and a 22 acrew were placed. On x-ray, Chese were too Iong and were changed to an 18 and a 16. The fibula was then exposed. There was an open wound. Thie was. debrided. The fibula was expoaed. Thie wae cleaned with,a Surgilav of;ail debrie. The curet wae uaed, the fracture aite wae open. The talus was cleaned. The talus articul'ar aurfice looked good. A K-wire wae then,placed at the back of the tibia, seabilizing rhe fragment. A 55 mm malleolaz ecrew was the:n placed using a 3.2 drill and ecrewdriver and depth gauge, X•:raye were taken which ahowed a good reduct'aon. The two acrewa in ,the lateral side were changed after the x-ray'. The ankle moved'freely, The tourniquet was released, fiemostasis obtained_ The aubcu wae-clo.aed.using 2-A Dexon, the akin was closed using,siaplea on the lateral eide and nylon on the medial aide. A short-leg cast was ,appli`ed. Marcaine was placed in the wound. The patient left the opersting room in good condition. There eeemsd Lo be no complicatione. �- . ,. .__ .- __ _.�d Edward A: Venn-W�teon, M.D. F�+v/j,ea D: OS'/24/95 7:26 P 'T: 05'/24/9'S 8:44 P cc: Edwar.d A. Venn-Watson, M.D. Judy Venn-Wateon, R.:N'.F,A ,P� -1- :vr�w � . . . - VANROY, LUPE �r ro: DATE OF ;OP,ERATION: O5/24/95 O.perative Report Room SUR 04160i SEND TO� Edward A. Voan-Wat�on, 14.D. °O��'`DOXOSxrti, I COPY ' 6 of 6 SEP 5 1995 ITEAA 19