HomeMy WebLinkAboutClaim 786 - N.M. Torsney CITY OF PALM DESERT
CITY CLERK DEPARTMENT
STAFF REPORT
REQUEST: CLAIM AGAINST THE CITY (#786) BY NANCY M. TORSNEY IN AN
UNSPECIFIED AMOUNT
SUBMITTED BY: Rachelle Klassen, City Clerk
DATE: March 23, 2017
CONTENTS: • Staff Report
• Recommendations of Claims Adjusters and Staff
• Claim No. 786
Recommendation
By Minute Motion, reject the Claim and direct the City Clerk to so notify the
Claimant.
Strategic Plan Objective
This request represents routine conduct of municipal affairs; there is no specific Strategic Plan
Goal associated.
Background
Based on a review of the subject Claim and the recommendation of the Claims Adjuster,
Risk Manager, City Attorney, and staff, it is recommended that the Claim be rejected.
Discussion of this item should be held in Closed Session pursuant to Government Code Section
54956.9(d)(2), potential litigation.
Fiscal Analysis
City of Palm Desert participates in the self-insurance pool of the California Joint Powers Insurance
Authority (CJPIA). Action to reject the subject Claim does not have a fiscal impact on the City at
this time.
Submitted by: Approved:
AP
Rai'elle D. Klassen, M , City Clerk Lauri Aylaian, City Manager
rdk
Attachments (as noted)
RECEIVED CITY OF PALM DESERT
CITY CLERK'S OFFICE
PALNDESERT CA ASSIGNED CLAIM NO..--1C?'c
CLAIM AGAINST THE CITY OF PALM DESERT
(For Damage(s) to Person(s) or Personal ProPerrdDEC 27 PM I: 54
Received by: -cx..c- k., ,tic)
via: U.S. Mail Interoffice Mail Over-the-Counter
A CLAIM MUST BE FILED WITH THE CITY CLERK OF THE CITY OF PALM DESERT WITHIN SIX
MONTHS AFTER WHICH THE INCIDENT OR EVENT OCCURRED. BE SURE YOUR CLAIM IS
AGAINST THE CITY OF PALM DESERT, NOT ANOTHER PUBLIC ENTITY. WHERE SPACE IS
INSUFFICIENT, PLEASE USE ADDITIONAL PAPER AND IDENTIFY INFORMATION BY
PARAGRAPH NUMBER. COMPLETED CLAIMS MUST BE MAILED OR DELIVERED TO THE CITY
CLERK, CITY OF PALM DESERT, 73-510 FRED WARING DRIVE, PALM DESERT, CA 92260.
TO THE HONORABLE MAYO& AND CITY COUNCIL, City of Palm Desert, California:
The undersigned respectfully submit(s) the following claim and information relative to damage(s) to
person(s) and/or personal property:1. CLAIMANT INFORMATION: c Se t /l 1 7*G l/
NAME
ADDRESS
PHONE NO. ( ) DATE OF BIRTH:
SOCIAL SECURITY NO. - - DRIVER'S LICENSE NO.
2. Name, telephone number and post office address to which claimant desires notices to be
sent, if other than above:
3. Occurrence or event from which the claim arises:
a. DATE: b. TIME: c. PLACE (exact and specific
location)
d. How and under what circumstances did damage or injury occur? Specify the particular
occurrence, event, act or ommission you claim caused the injury or damage. (Use
additional paper if necessary.)
e. What particular action by the City, or its employees, caused the alleged damage or
injury?
Page 1 of 2
4. Give a general description of the indebtedness, obligation, injury, damage, or loss incurred
so far as it may be known at the time of presentation of the claim. If there were no
injuries, state "no injuries":
•
5. Give the name(s) of the City employee(s) causing the damage or injury:
6. Name and address of any other person(s) injured:
7. Name and address of the owner of any damaged property:
8. Damages claimed:
a. Amount claimed as of this date: $
b. Estimated amount of future costs: $
c. Total amount claimed: $
d. Basis for computation of amounts claimed (include copies of all bills, invoices,
estimates, etc.):
9. Names and addresses of all witnesses, hospitals, doctors, etc.:
10. Any additional information, including police reports, which might be helpful in considering
this claim:
WARNING:IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM! (PENAL CODE 72;
INSURANCE CODE 556.1).
I have read the matters and statements made in the above claim, and I know the same to be true of
my own knowledge, except as to those matters stated upon information or belief as to such matters
I believe the same to be true. I certify under penalty of perjury that the foregoing is TRUE AND
CORRECT. ,* �
Signed this Z;"Z day of �re", 7? ,20 P( , at F�fvi fJ 6 sG_2Y f CI
SIGNATURE OF CLAIMAINT a�w
13
SIGNAT E OF CLAIMAN1L>‘:4
Office of the City Clerk, Palm Desert, California DOC. NO. 77( DATE FILED 1/),-
Page 2 of 2
111/11111111111111111•111111111111111111111111111111111wH rr •
--4448101101110111111111111411111111101011011111011110
CARL WARREN&COMPANY
Cid n1S Marage!ren:and Sctctmls
January 27, 2017
TO: City of Palm Desert
ATTENTION: Rachelle Klassen
RE: Claim • Torsney vs. Palm Desert
Claimant • Nancy Torsney
Member • City of Palm Desert
Date Rec'd by Mbr : 12/27/16
Date of Event : 11/6/16
CW File Number • 1954113 TVQ
Please allow this correspondence to acknowledge receipt of the captioned claim. Please take the
following action:
• CLAIM REJECTION: Send a standard rejection letter to the claimant.
Please include a Proof of Mailing with your rejection notice to the claimant. An exemplar copy
of a Proof of Mailing is attached. Please provide us with a copy of the Notice of Rejection and
copy of the Proof of Mailing. If you have any questions feel free to contact the assigned adjuster
or the undersigned claims specialist.
Very Truly Yours,
CARL WARREN & CO.
TiA4 .of 6uJ M. Va ro-w
Timothy M. Varon
Claims Specialist
An Employee-Owned Company
P. !.i. i3c:4 24 i . i;,sli% CA 9271
Tel: 657-622 4200 . =ax: 855-6U,? 2:;5.5 ! .vv::v.:_niw .: r::r•.;:c:;
A Hceris;. No: 260/296
ifirammarsiimisissaw
£w •
CARL WARREN&COMPANY
Claims Management and Solut.ons
January 4, 2017
Nancy M. Torsney
CIO Patrick J. Torsney, J.D.
27961 Alaflora Dr.
Rancho Palos Verdes, CA 90275
RE: Claim Torsney vs. Palm Desert
Claimant Nancy M. Torsney
Member : City of Palm Desert
Date Rec'd by Mbr : 12/27/16
Date of Event : 1 1/6/16
CW File Number : 1954113 TVQ
Please be advised the above-referenced claim was referred to our office for investigation. We
are the liability Claims administrators for the City of Palm Desert.
This matter is being handled under the file number provided above and is being investigated by
our Claims Adjuster Timothy Varon.
Upon completion of the investigation, we will contact you concerning our determination of
liability.
Very Truly Yours,
CARL WARREN & CO.
T i 44-1-k y M. V aro-w
Timothy M. Varon
Claims Examiner
657-622-4287
cc: Member Agency: City of Palm Desert, attn:Rachelle Klassen
An Employee-Owned Company
P. O. Box 2411 I Tustin, CA 92781
Tel: 657-622-4200 I Fax: 855-683-3055 I www.carlwarren.com
CA License No: 2607296
CLAIM AGAINST THE CITY OF PALM DESERT
Attachment#1
1. CLAIMANT INFORMATION:
NAME: Nancy M.Torsney
ADDRESS:
PHONE NO: DATE OF BIRTH:
Social security NO.: DRIVER'S LIC NO:
2. Name,telephone number and post office address to which claimant desires notices to be sent, if
other than above:
Patrick J.Torsney,J.D.,27961 Alaflora Drive, Rancho Palos Verdes,CA 90275, 310-486-7373 &
Claimant.
3. Occurrence or event from which the claim arose.
a. DATE: 11/06/2016 b. TIME: 10:00 A.M. c. PLACE: The sidewalk on the north side of
Heatherwood between Emerson & Hollister adjacent to the 2nd tree east of Emerson
along the side the property line of 37930 Emerson.
d. How and under what circumstances did damage or injury occur? Specify the particular
occurrence,event, act or omission you claim caused the injury or damage. While walking
on the unrepaired sidewalk the claimant fell braking the right humerus and requiring
surgery to replace the claimant's right shoulder. The sidewalk had been dangerously
raised and unrepaired. In addition loose gravel and/or sand made the sidewalk dangerous
to walk on.
e. What particular action by the City, or its employees caused the alleged damage or
injury? The City, and its employees failed to maintain the sidewalk in a safe condition.
4. Give a general description of the injury incurred so far as may be known at the time of the
presentation of this claim.The claimant broke the humerus bone in her right arm requiring surgery to
replace the shoulder, there were various contusions on the hands and arms as well as significant pain
and suffering.
5. Give the names of any City employees causing the damage. UNKNOWN
6.Name and address of other persons injured. NONE
7. Name and address of the owner of any damaged property: NONE
8. Damages claimed:
a. Amount claimed as of this date: $to be determined
b. Estimated future costs: $to be determined
c. Total amount claimed: $to be determined
e. Basis for computation of amounts claimed: $to be determined
9. Names&addresses of all witnesses, hospitals,doctors etc.: JFK Emergency Room,47111, Monroe
Street, Indio,CA 92201,Andrew S. Kassinove, MD&various nurses; Patrick R, Duke, P.A., Kaiser
Riverside Orthopedics; Lawrence P. Hsu, MD, Kaiser Riverside,Orthopedic Surgeon;various nurses
Kaiser Riverside orthopedic surgery;various physical therapists Kaiser Palm Desert.
10. Any additional information which might be helpful. Claimant has only very limited use of her right
arm, and claimant is right handed.
Torsney, Nancy(MR# Page 1 of 3
After Visit Summary Nancy Torsney
11/8/2016 MRN:
Visit and Patient Information
Visit Information
_&, Time Provider Department
11/8/2016 3:00 PM PATRICK ROBERT DUKE PA, P.A. Orpririv Orp
Patient Demographics
;t O Bstl- Sex Race Ethnicity.
Preferred Language
-f=rred Saoke
tua ;e P;efe red Written Language
Kaiser Permanente supports federal law that requires the collection of your race and ethnicity to improve the quality of
your health care. Please inform a staff member of your selections, of any changes to current entries or if you prefer not
to have this information appear in your health record.
Visit Summary
Vitals - Last Recorded
�? PUise Temp(Src) Ht lnit BMI
121/37 mmHg 65 99 °F (37.2 °C) (Oral)
Vitals History Recorded
Social History
_a ry H;story
Smoking Tobacco Use Never Smoker
Smokeless Tobacco Use Never Used
Tobacco Comment
BMI Data
Mass Body Surface Area
Health Problems Reviewed
RIGHT PROXIMAL HUMERUS OTHER TYPE FX, DISPL INIT
Patient Instructions
None
Allergies
Reviewed On 11/8/2016 By. Duke, Patrick
Allergies as of 11/8/2016 Robert(P.A.), P.A.
Noted Reaction Type Reactions
Rash not hives
Medications
Patient reported, restarted, and new medications relevant to this visit. This may not reflect all medications the
patient is taking.
Kaiser Permanente, SCPMG: Torsney, Nancy Page 1 of 3
,orsney, Nancy(MR# Page 2 of 3
Patient reported, restarted, and new medications relevant to this visit. This may not reflect all medications the
patient is taking. (continued)
Dosage
Atorvastatin (LIPITOR) 20 mg Oral Tab Take 1 tablet by mouth daily to lower cholesterol and keep arteries
(Taking) open
Common Medication Direction Abbreviations
PO = Orally, QD = Once/day, BID=Twice/day, TID = 3x/day, QID=4x/day, PRN = as needed
QHS = Every night at bedtime, AC = Before meals, PC =After meals, c=With, s= Without
Orders
New Orders
Or.`1e h!s V s'
BUN [84520 CPT(R)]
CBC W AUTOMATED DIFFERENTIAL [85025 CPT(R)]
CREATININE [82565 CPT(R)]
ELECTROLYTE PANEL(NA, K, CL, CO2) [80051 CPT(R)]
GLUCOSE [82947 CPT(R)]
1NR [85610 CPT(R)]
OBTAIN SIGNED CONSENT FORM [249496 Custom]
TYPE(ABO-RH)AND ANTIBODY SCREEN PANEL[210914 Custom]
XR RIGHT HUMERUS 2 OR MORE VIEWS[73060 CPT(R)]
XR RIGHT SHOULDER 2 OR MORE VIEWS [73030 CPT(R)]
Future LabsProcedures No Sooner Than No Later Than
ELECTROCARDIOGRAM, 11/8/2016 1/10/2017
ROUTINE,W AT LEAST 12 LEADS,
INTERP AND RPT[93000 CPT(R)]
Active Problem History
HISTORY OF TOTAL HYSTERECTOMY, NO PAP SMEAR REQUIRED
HISTORY OF CANCER OF THE CERVIX
HYPERLIPIDEMIA(HIGH BLOOD FATS)
NEGATIVE COLONOSCOPY DONE OUTSIDE KP IN 2001
IRRITABLE BOWEL SYNDROME
PREDIABETES
COLONOSCOPY DONE OUTSIDE KP IN 2011
ADVERSE DRUG REACTION
MULTICYSTIC DYSPLASTIC KIDNEY
OSTEOPENIA (LOWER BONE DENSITY)
NECK PAIN
NOT CURRENTLY A SMOKER
CERVICAL SPONDYLOSIS
OBESITY, BODY MASS INDEX(BMI) 31-31.9
Visit Lab Results
There are no results available from this visit.
Future Appointments
Provider Department Center
11/17/2016 9:45 AM Vora, Milan Pramod (P.A.) ORTHOPEDICS RIVU
General Information
Protect yourself from the flu. Get vaccinated.
Kaiser Permanente. SCPMG: Torsney, Nancy (000001783104) Page 2 of 3
,orsney, Nancy(MR# Page 3 of 3
The flu is a serious, contagious illness caused by influenza viruses. Anyone can get the flu. It can cause mild to severe
illness. The best way to prevent the flu is by getting a flu vaccine each year. The CDC recommends that everyone 6
months and older get a flu shot every year.
Flu vaccine clinics open in September. No appointment is necessary.
Flu shots are available at no charge to members at Kaiser Permanente medical facilities.
For information about hours, times, and locations, please visit kp.org/flu or call
1-866-70-NOFLU (1-866-706-6358).
Adults should participate in at least 30 minutes, and children at least 60 minutes, of moderate exercise (such as brisk
walking) for five or more days each week, unless instructed otherwise by your provider. For more information on the
health benefits of walking please refer to http://www.everybodywalk.org. THRIVE!
Register at www.kp.org to email your physician, renew prescriptions, request appointments, learn more about your
personal health, or obtain tips for healthy living!
Save money and time! Get your refills for home delivery at www.kp.org/refill
•
Kaiser Permanente, SCPMG: Torsney, Nancy(000001783104) Page 3 of 3
Page 2 Q12__._
KAISER PERMANENTEX Name: Torsney, Nancy
Kaiser Foundation Hospitals MRN: _
Southern California Permanente Medical Group DOB:
Hospital: RIVERSIDE MEDICAL CENTER U
3. I hereby authorize and direct the above-named hospital, medical group, surgeon and/or his/her
associates and assistants, to provide such additional services for me as he/she or they may deem
medically advisable, including, but not limited to, the selection and administration of anesthesia and
the performance of pathology and radiology services.
4. I hereby authorize the hospital and medical group to dispose of any severed tissue or member in
accordance with accustomed hospital practice.
Date: 11/8/2016 Time: 4:06:25 PM Signed:
PATIENT,PARENT,OR LEGAL GUARDIAN
Relationship: !Self
Witness:_
Sight Translated by: (if applicable)
✓ In person
✓ Over the phone/video
✓ Other method: I
Enter Interpreter's Name and Identification Number:
12-2163(2-11)HIPAA COMPLIANT
SPANISH-12-9666.CHINESE-NS6281
file:///C:/ProgramData/Epic/8I/TempData/40A4A37E34I 740AC8409A9204363D9FC/E-PRODI... 11/8/2016
XR Elbow 2 Views Right TORSNEY, NANCY M -
* Final Report *
* Final Report *
Reason For Exam
FALL. PLEASE INCLUDE DISTAL HUMERUS;Trauma
REPORT
EXAM: XR RT ELBOW
CLINICAL INDICATIONS: FALL. PLEASE INCLUDE DISTAL HUMERUS
FINDINGS: 2 views right elbow
11/6/2016
AP and lateral views
no prior study for comparison.
findings
no acute fracture is seen.
Right elbow joint is in good alignment.
There is spur arises from coronoid process of proximal right ulna.
No significant joint effusion is seen.
IMPRESSION: No obvious acute fracture is seen.
Dictated and Electronically Signed: Aninchana Sangkharat ON Nov-06-2016 at 12:57:41 PM
Signature Line
*****Final Report*****
Dictated: 11/06/2016 12:57 pm Dictated by: SANGKHARAT DO, ANINCHANA
Electronic Signature: 11/06/16 12:57 pm Signed by: SANGKHARAT DO, ANINCHANA
Transcribed: 11/06/2016 2:05 pm
IMAGE
This document has an image
Completed Action List:
* Order by HANCOCK NP, KIMBERLY M on November 06, 2016 11:29 PST
* VERIFY by SANGKHARAT DO, ANINCHANA on November 06, 2016 12:57 PST
* Perform by Perez , Nelson on November 06, 2016 13:02 PST
Result type: XR Elbow 2 Views Right
Result date: November 06, 2016 13:02 PST
Printed by: HANCOCK NP, KIMBERLY M Page 1 of 2
Printed on: 11/06/2016 15:16 PST (Continued)
XR Elbow 2 Views Right TORSNEY, NANCY M -
* Final Report *
Result status: Auth(Verified)
Result title: XR Elbow 2 Views Right
Performed by: SANGKHARAT DO, ANINCHANA on November 06, 2016 12:57 PST
Verified by: SANGKHARAT DO, ANINCHANA on November 06, 2016 12:57 PST
Encounter info: 100585936, IND, 3- Emergency, 11/06/2016-
Printed by: HANCOCK NP, KIMBERLY M Page 2 of 2
Printed on: 11/06/2016 15:16 PST (End of Report)
•
XR Shoulder Complete Right TORSNEY, NANCY M -
* Final Report *
* Final Report *
Reason For Exam
PLEASE INCLUDE PROX HUMERUS;Shoulder Pain
REPORT
EXAM: XR RT SHOULDER
CLINICAL INDICATIONS: PLEASE INCLUDE PROX HUMERUS
FINDINGS: 3 views right shoulder
11/6/2016
2 AP and Y scapular views
no priors for comparison
Findings:
There is an acute comminuted displaced fracture at superiolateral aspect head
of right humerus with fracture likely extends into medial aspect head of
right humerus at the right glenonumeral joint
There is acute nondisplaced fracture at the neck of proximal right humerus.
There is moderate size area of airspace opacity in right lung base and
right infrahilar region.
The right acromioclavicular joint and right glenohumeral joint are in
alignment.
No pneumothorax is seen.
demineralization of bones noted.
Numerous small opacities overlying right shoulder and right lung seen in AP
views.
IMPRESSION: Acute comminuted displaced fracture at superiolateral aspect head
of right humerus with fracture likely extends into medial aspect head of
right humerus at the right glenonumeral joint
Acute non-displaced fracture at neck proximal right humerus
Area opacity in right lung base and medial right base likely represent
atelectasis or infiltrates
Numerous small oval opacities overlying right shoulder and right lung
likely represent objects overlying patient. Please correlate clinically
Dictated and Electronically Signed: Aninchana Sangkharat ON Nov-06-2016 at 12:53:21 PM
Signature Line
*****Final Report*****
Dictated: 11/06/2016 12:53 pm Dictated by: SANGKHARAT DO, ANINCHANA
Electronic Signature: 11/06/16 12:53 pm Signed by: SANGKHARAT DO, ANINCHANA
Transcribed: 11/06/2016 2:05 pm
IMAGE
This document has an image
Printed by: HANCOCK NP, KIMBERLY M Page 1 of 2
Printed on: 11/06/2016 15:16 PST (Continued)
XR Shoulder Complete Right TORSNEY, NANCY M -
* Final Report *
Completed Action List:
* Order by HANCOCK NP, KIMBERLY M on November 06, 2016 11:29 PST
* VERIFY by SANGKHARAT DO, ANINCHANA on November 06, 2016 12:53 PST
* Perform by Perez , Nelson on November 06, 2016 13:08 PST
Result type: XR Shoulder Complete Right
Result date: November 06, 2016 13:08 PST
Result status: Auth (Verified)
Result title: XR Shoulder Complete Min 2 Views Right
Performed by: SANGKHARAT DO, ANINCHANA on November 06, 2016 12:53 PST
Verified by: SANGKHARAT DO, ANINCHANA on November 06, 2016 12:53 PST
Encounter info: 100585936, IND, 3- Emergency, 11/06/2016-
Printed by: HANCOCK NP, KIMBERLY M Page 2 of 2
Printed on: 11/06/2016 15:16 PST (End of Report)
•
CT Head or Brain w/o Contrast TORSNEY, NANCY M -
* Final Report *
* Final Report *
Reason For Exam
Trauma
REPORT
EXAM: CT Head w/o Contrast
CLINICAL INDICATIONS: Trauma
FINDINGS: Procedure: Unenhanced CT scan of the head dated November 6 2016 .
Axial images obtained followed by coronal and sagittal reconstructions.
Comparison: None
Findings: No air-fluid levels noted visualized portion of the paranasal
sinuses. Opacification inferior mastoid air cells left side. The remainder
of the left-sided mastoid air cells and right-sided mastoid air cells are
air-filled. External ear canals air-filled. No evidence of a depressed
skull fracture. Athero-sclerotic changes noted within the intracranial
vasculature. Mild ventriculomegaly is present, commensurate with dilatation
to the stable sulci, sylvian fissures and basilar cisterns. No evidence of
an intra-or extra-axial mass lesion, mass effect or bleed. No hyperdense
vessel sign identified. Gray-white differentiation is maintained.
IMPRESSION: No evidence of depressed skull fracture nor intracranial bleed.
Some opacification of inferior mastoid air cells, left side.
All CT scans at this facility use dose modulation, iterative reconstruction,
and/or weight based dosing when appropriate to reduce radiation dose to as
low as reasonably achievable
Dictated and Electronically Signed: Gary Dier, M.D. ON Nov-06-2016 at 2:51:12 PM
Signature Line
***** Preliminary Report *****
This report has not yet been verified for accuracy.
Dictated: 11/06/16 2 :51 pm Dictated by: DIER MD, GARY L
Transcribed:ll/06/16 2 :52 pm
IMAGE
This document has an image
Completed Action List:
Printed by: HANCOCK NP, KIMBERLY M Page 1 of 2
Printed on: 11/06/2016 15:15 PST (Continued)
CT Head or Brain w/o Contrast TORSNEY, NANCY M -
* Final Report *
* Perform by Perez , Nelson on November 06, 2016 14:32 PST
Result type: CT Head or Brain w/o Contrast
Result date: November 06, 2016 14:32 PST
Result status: Auth (Verified)
Result title: CT Head or Brain W/O Contrast
Performed by: DIER MD, GARY L on November 06, 2016 14:51 PST
Encounter info: 100585936, IND, 3- Emergency, 11/06/2016 -
Printed by: HANCOCK NP, KIMBERLY M Page 2 of 2
Printed on: 11/06/2016 15:15 PST (End of Report)
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