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HomeMy WebLinkAbout07-7219 IN RE: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA BROOKE CHEYENNE LOVELL NO. PETITION FOR COURT APPROVAL PETITION FOR COURT APPROVAL TO SETTLE A CLAIM OF A MINOR 1. Petitioner, Christopher W. Lovell, is an adult individual who currently resides at 284 Tanger Road, Boiling Springs, Cumberland County, Pennsylvania, 17007. 2. Petitioner, Kimberly "Paige" Lovell, is an adult individual who currently resides at 284 Tanger Road, Boiling Springs, Cumberland County, Pennsylvania, 17007. 3. Petitioners are the parents and natural guardians of the minor child, Brooke Cheyenne Lovell (DOB: June 10, 2004). 4. The claim arises out of an incident that occurred on June 10, 2004, when Brooke Lovell was born at the U.S. Naval Hospital, Okinawa, Japan. On that day, as the time of birth was approaching, Brooke's heart rate dropped indicating she was in distress and needed to be delivered expeditiously. The Navy's family practice doctor applied a vacuum device to try to speed up delivery of the baby. One and a half hours later, after at least seven attempts to deliver the baby by vacuum, Brooke Lovell was finally born. 5. Petitioners claim that the repeated attempts to deliver Brooke using the vacuum were negligent and done using excessive force, causing Brooke to suffer bleeding in her brain. This traumatic brain damage resulted in the following injuries over the first 12 days of Brooke's life: Seizures; Hypoxic Ischemic Encephalopathy; Perinatal Asphyxia Hypotension; Anuria; Sepsis, suspected (ruled-out); Hypomagnesemia; Hypocalcemia; Anemia, Acute Blood Loss (secondary to subgaleal hem.); Disseminated Intravascular Coagulopathy; Thrombocytopenia; Acute Tubular Necrosis; Hypokalemia; Abnormal Transaminase Levels; Subgaleal Hemorrhage (severe) A true and correct copy of the discharge summary from the birth admission is attached hereto and incorporated herein by reference as "Exhibit A." 6. On July 27, 2004, when Brooke was six-weeks old, the doctor noted she had no further seizures, an EEG was read as normal and Brooke was developing appropriately. At the two-month well baby check done on August 16, 2004, Brooke's development was normal. On September 15, 2004, Brooke was seen for a comprehensive developmental evaluation. The developmental pediatrician noted that Brooke's birth was remarkable for having a very difficult delivery and while Brooke did not show any developmental delays it was "very early" to make definitive statements about developmental outcome. A true and correct copy of the reports regarding these visits are attached hereto and incorporated herein by reference as "Exhibit B." 7. On October 26, 2004, Brooke was seen at the Pediatric Neurology Clinic at Tripler Army Medical Center in Hawaii. She was 4 '/2 months old and the doctor noted Brooke continued to make developmental progress and was receiving early intervention services with physical therapy. The doctor's impression after an exam was that Brooke's development seemed to be progressing quite well. On December 24, 2004, Brooke was examined again and was noted to be a well child with normal growth and development. A true and correct copy of the reports regarding these visits is attached hereto and incorporated herein by reference as "Exhibit C." 8. Exams done at 7 months of age (January 18, 2005), 9 months of age (March 10, 2005) and 12 months of age (May 25, 2005), showed Brooke was developing normally. A comprehensive evaluation done when Brooke was just over one year old (June/July 2005) showed Brooke was continuing to develop normally despite her traumatic birth history. Brooke's 2 year well child exam done on July 28, 2006, again showed she was developing normally. Brooke's 3 year well child exam, done on April 24, 2007, showed she was a normal child. A true and correct copy of the reports regarding these visits are attached hereto and incorporated herein by reference as "Exhibit D." 9. In addition to Brooke's injury, Kimberly Paige Lovell, Brooke's mother, suffered significant depression and Post Traumatic Stress Disorder after Brooke's birth. A true and correct copy of the medical records regarding Kimberly Paige Lovell's treatment are attached hereto and incorporated herein by reference as "Exhibit E." 10. Brooke has had normal growth and development and all recent exams find no evidence of a permanent injury. Specifically, on December 13, 2006, Brooke had a comprehensive developmental evaluation done at the National Naval Medical Center in Bethesda, Maryland. The Navy doctor concluded that Brooke was developing normally but admitted Brooke did have a lifelong risk of behavioral, learning and developmental issues given her history. A true and correct copy of the report regarding this visit is attached hereto and incorporated herein by reference as "Exhibit F." 11. On January 16, 2007, Brooke had a comprehensive evaluation performed by Dr. Peter H. Berman, MD, an attending neurologist at Children's Hospital of Philadelphia (CHOP). He reviewed recent MRI and EEG studies and said both were w normal. He also reported that Brooke's physical exam and development were "perfectly normal." Dr. Berman would not say that Brooke was likely to have any future problems. A true and correct copy of the report regarding this visit is attached hereto and incorporated herein by reference as "Exhibit G." 12. On December 9, 2004, Plaintiffs, individually, and on behalf of the Minor, filed administrative claims for medical negligence against the United States Navy under the Military Claims Act ("MCA'), 10 U.S.C. § 2733. Under the MCA, recovery is limited and there is no right to file a lawsuit if the claimant is not satisfied with the United State's adjudication of the claims. A true and correct copy of the claim documents are attached hereto and incorporated herein by reference as "Exhibit H." 13. The United States' has vigorously disputed liability and damages, claiming the vacuum delivery was necessary to save Brooke's life and that damages were caused by the umbilical cord being wrapped tightly twice around Brooke's neck and not by the vacuum delivery. In addition, the United States claimed that there is no proof of any permanent, functional injury and any risk of future injury is small. 14. In order to pursue claims against the United States, Petitioners retained the services of Ryan & Brown, PA. Attorneys' fees for the medical malpractice claim are limited by federal statute to 20% or the total cost (present day value) of the settlement. Costs advanced in pursuit of the medical malpractice claim as well as fees and costs for court approval of the settlement are also recoverable. A true and correct copy of the fee agreement is attached hereto and incorporated herein by reference as "Exhibit I." t-1 15. Ryan & Brown retained the services of Nealon Gover & Perry to obtain court approval of the claim. The fees of Nealon Gover & Perry will be billed on an hourly basis and paid from the parent's share of the settlement proceeds. 16. In order to prosecute the claims, Ryan and Brown, PA incurred expenses and costs totaling $2,219.86. A true and correct copy of the expenses is attached hereto and incorporated herein by reference as "Exhibit J." 17. After almost three years of negotiations, the plaintiffs and the United States reached a compromise settlement with a total present day value of $175,000. The settlement is as follows: Benefit Cost to the Certain United Payout States UP FRONT CASH for payment of attorneys $87,500 $87,500 fees and costs, remainder to parents as compensation for their individual claims Gross Payment $87,500.00 Attorney Fees (20% of $175,000) -$35,000.00 Costs advanced for med mal claim (as of 10/23/07) -$2,219.86 Local counsel fees and costs for court approval (approximate) -$1,750.00 NET CASH TO PARENTS $48,530.14 COLLEGE FUND FOR BROOKE $54,715 $131,600 Guaranteed payments of $32,900 annually to Brooke, who will be 18 at the time of the first payment, for a period of 4 years (4 payments) LUMP SUM PAYMENTS TO BROOKE $32,785 $100,000 $45,000 at age 22 $55,000 at age 25 TOTAL $175,000 $319,100 A true and correct copy of the settlement agreement and proposed structure is attached hereto and incorporated herein by reference as "Exhibit K." 18. Petitioners concur in the proposed settlement and request that it be approved. Petitioners also request that the Court approve the payment of attorney's fees and reimbursement of expenses. Petitioner believes that the fees and expenses were reasonable and necessary to obtain the settlement. WHEREFORE, Petitioners, Christopher W. Lovell and Kimberly "Paige" Lovell, urge This Honorable Court to approve the settlement of the claim of the minor, Brooke Cheyenne Lovell, approve the payment of attorney's fees and reimbursement of expenses and authorize them to execute all documents necessary to effectuate settlement. Respectfully submitted, NEALC Date: t tS by: 1 James G. Nealon, III, Esquire I.D. M 46457 2411 North Front Street Harrisburg, PA 17110 717/232-9900 VERIFICATION We, Christopher W. Lovell and Kimberly "Paige" Lovell, verify that the statements made in the foregoing Petition are true and correct. We understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. Dated: i 11510--7 v imberly "Paige" Lovell Discharge Report: NICU, U. S .N.H., Okinawa inistrative . Patient: Infant Female Lovell, Brooke Admit Date: 6/10/2004 Sponsor Status: O 4 Dependent Spouse Marine Corps Age at Admit (days) 0 Home Phone: 622-8136 Duty Station: D/CDate: 6/22/2004 Duty Phone: Days of Admission: 12 Age at D/C 12 Prenatal Age: 32 Maternal Prenatal Labs Parity: G2 Fl PO AO L1 Race: Caucasian Blood Type: O+ Antibody: Neg Language: English PPD: ORD CXRLast6Mos: INH: Maternal Religion: Protestant Herpes: Neg ActiveHerpes: NA Occupation: Home maker Syphylis: Neg TripleScreen: Pos Pref Learn: Demo/Practice GBS: Neg HTLV 1: NA Father of Baby: Chris Lovell HepB: Neg Chlamydia: Neg Married: ? HIV: Neg GCCulture: Neg Rubella Susc: IMM Chickenpox: Susceptib le LMP: 8/30/2003 SickleDex: NA EGA by OB: 40 5/7 weeks Smoking: None Meds/Drugs: PNV, Zyrtec US for Dates: 12/8/2003 Dates'Consistent [J Past Medical History: No Known Disease US for Anat: 2/6/2004 USComment: Difference of 6 days with LMP. Change EDC to reflect 1 st trimester us Amriio Results: Past OB History: Prenatal History: Transfer Status Maternal Transfer: No Transfer Date: Referring MD: Infant Transfer: No Transfer Time: Referring Hospital: Comment: Labor Course History Of Presentation: 32 y/o G2P1 IUP at 41+1 weeks EGA, present for induction of labor. Positive FM, neg VB, neg LOF. Pos CTX's. Membranes: AROM at 15:15 on 6/10/200 Fluid: Hrs Rupt: 5 Induction: Oxytocin Augmentation: Pitocin Complications: Variable Decelerations Comment: 32 y/o G213 I IUP at 41+1 weeks EGA here for term induction. Delivery/Nursery Course Discharge Report for Infant Female Lovell, Brooke Computer Generifeff- 21 Sponsor SSN: 02/155-52-9729 6/102004 End P)g*941% / HosD1D: 0149049 04 Marine. rnrnc T)PnPn/iPnt RnnnCP ^- ^ Dischai-ge Summary: USNH, Okinawa Birth Date: 6/10/2004 Neo/PedsAttend: L BirthTime: 20:58 Birth Weight: 3120 Ballard/Dubowitz: EGA: 40 weeks Size for EGA: AGA Multiplicity: Singleton Delivery Type: Vaginal Delivery Anesthesia: Epidural Delivery Comment: Resusc Comment: Nursery Course ResuscitationProvider: Huang, Thomas K. PostPartum: Apgar 1: 1 Apgar 5: 3 Apgar 10: 5 BVM Ventilation Temp: 97.9 Cord blood for Type/Rh/Coombs HR: 144 Cord gases sent RR: 37 ETT for resuscitation Nuchal cord x2 cut and clamped Sys/Ds/meanBP: 076/39 Mean=53 on perineum Birth OFC: 35 Length: 54 P.E.Comment: Arrived at I 1 min of life. Initial resus Appearance: Term Infant. Facies: Nml. Cry: underway by FP and Anesthesia. Reportedly nonexistent. Breathing: Quiet, rare intermittent agonal needed vacuum extraction for variable decels. breath. Cyanosis: acrocyanosis. Skin: Pink, CR Tight nuchal cord. Needed PPV for I min, prolong 4sec. Vernix: Nml. Subcut Tissue: Adequate. then intubated by anesthesia with 2.5 ETT. On Pallor: None. Icterus: None. Head: Mod arrival by me, unsure whether ETT in place, so Molding.+caput. Fontanelles: Soft, flat. Sutures: extubated and bagged with quick response with Overriding. Eyes: RR x 2. Ears: Nml. Nose: Nml. spont resps, but with rare intermittent agonal Mouth: NmI.ETT secured at 9.5cm. Throat: Nml. breathing. Taken over to NICU on mask Neck: Nml. Chest: Symmetric. Lungs: CTA.coarse CPAP with no problems. rhonchi. Heart: RRR. Murmurs: None. Abdomen: Nml. No HSM. Cord: 3 vessel. Genitals: Nml. Anus: Patent. Meconium: Present. Spine: Straight, no dysraphism. Extremities: Nml, symmetric. Tone: marked decreased initially, now improved slightly. Paralyses: None. Reflexes: decreased. Moro: absent. Joints: Nml, no hip dislocation. On arrival in NICU, unable to get nasal prongs in all the way, also still having rare intermittent agonal breathing, so intubated with 3.5 ETT. Confirmed with auscultation and CXR. Initial ABG 6.97/14/378/- 28/3. Establish UVC/UAC. F/U ABG from UA C placement-7.12/13/547/-25/4. Weaned vent. Started NS bolus and NaHC03 infusion. Will follow ga ses. Hospital Course Summary: Overview: Term female born via SVD after difficult delivery c/b tight nuchal cord, multiple vacuum attempts and evidence of fetal HR abnormalities. Intubated at birth-established spont resp in DR by 11 min of life with vigorous BMV PPV. Intubated in NICU and umbilical lines placed. Initial art pH = 6.98 with BD = -28. Infant received several NS boluses and NaHC03 over the first few hours of life; rapidly weaned off vent but noted to have hyperalert phase and irritability. Had partial/ generalized tonic-clonic seizures at --20 HOL. Hct dropped from initial 50% to 20% by 20 HOL-- clinical exam c/w subgaleal hemorrhage. Coagulopathy present; received FFP, platelets, and PRBCs, with improvement in PT/PTT by DOL 4. CT on DOL 5 c/w HIE with bilateral small parietal/frontal hemorrhages but no mass effect or blood present in ventricles. Infant has clearly experienced significant hypoxic-ischemic injury. Difficult to elucidate etiology from bleed versus ischemia due to tight nuchal cord with subsequent coagulopathy producing bleed. Currently with normal PE with appropriate wakefulness, tone, and return of reflexes. Reemergence of bowel function, started trophic enteral feedings DOL 7 advancing to full volume feedings DOL9. Currently taking all via nipple X2days. Summary By Systems: CNS: Hypoxic-ischemic encephalopathy with exam and course most consistent with Sarnat stage 2. Multifoca) seizures, predominantly RUE none since DOL 2. Loaded with 20mg/kg phenobarbital at onset of seizures and received additional 1 Omg/kg, then 5mg/kg. EEG obtained on Monday but voltage limited due to scalp edema/blood. Head CT on DOL 5 showed mod scalp edema, bil frontal lobe parenchymal hemorrhages, and epidermal hemorrhages. Phenobarb level DOL 7 was 51, held dose x 2 days. Level on DOL 9 was 37. Today-22. Parents have been informed of concerns and potential long-term effects. OAl j / Discharge Reporf for Infant Female Lovell, Brooke Computer Generated - SF 502 Sponsor SSN: 02/155-52-9729 6/10/2004 End P 2tofa?e^(? Nncnin- 111 ARndQ 0 d AA-ino r-- Tlrnrml?n? C..ro.er )) ll Discharge Summary: USNH, Okinawa passed AU. ABR as out pt. Infant to be followed by EDIS upon d/c. Cardio: Had initial normal BP, followed by few hours of hypotension requiring DA. Infant with normal range BP since DOL 2 without significant tachycardia despite low Hct. UAC DOL 1-7. UVC DOL1-9. Resp: Intubated due to respiratory distress and unable to place nCPAP prongs to ensure adequate oxygenation. Initial ABG = 6.97/14/378/-28/3 on SIMV 20/4 R30 IT 0.4, 100% with patient over-breathing the ventilator. Weaned off ventilator quickly. Has not had apnea. On NC DOL 1-5 to ensure adequate oxygenation in face of seizure activity and nadir of 18% for HCT. Increased Fi02 to 55% over DOL3 suspected due to atelectasis. Weaned back down to 2l % flow on DOL 4 esp with prone positioning. Transitioned to RA on DOL5 without problems. GI: Electrolytes initially notable for hypocalcemia and hypomagnesemia, c/w asphyxic insult. Started HAUIL DOL 4-9. PT/PTT normalized DOL 4. LFTs peaked DOL 3-4 but coming down slowly. Currently on full vol enteral fdgs and have d/ced her TPN/IL. Changed to q 3-4h nippling schedule with improved nippling. Able to nipple all fdgs X2days. Still at least 400 g above BW. Nutritional Screen: Not currently at risk. Metab\Lab: Severe initial metabolic acidosis now resolved. S/p NaHC03 X 3. Had persistent hypokalemia despite multiple KCL runs and increasing the K in TPN- K now nl on DOL 8. Renal: UOP delayed and noted to be cola-colored with large amount of dark blood/sediment present, c/w ATN. Urine output good and urine is now clear yellow. Heme: Hct = 50 at birth. By 12 HOL had dropped to 31; subsequently noted to correlate with increased size/fluctuance of scalp fluid, c/w subgaleal hemorrhage. By 33 hours of life, hct down to 18. Transfused 15cc/kg prbc with rise to 37, latest hct 28%. Bleed may have occurred in-utero during difficult labor, or may have resulted from coagulopathy due to ischemic injury. Clinical picture c/w D1C with elevated PT/PTT and thrombocytopenia at 22hour of life--recvd FFP (l Occ/kg x 4), plt (2 transfusions). No evidence of further active bleeding. Post transfusion Hct from tx on DOL 5 was 40%. Plts stable at 70/80K on DOL 5-6. H/H was 16/47.5% with improved pits to 147K. InfectDis: Completed amp/cefotax x 48 hours. Blood cx neg at 48hr. Low likelihood of infectious etiology. Social: Parents updated at bedside. Appear to understand and appropriately concerned. Continue with bedside updates at each visit. Parents holding and feeding every day. Informed consent on chart, witnessed. Parents grateful for care. Very realistic , but hopeful. Will follow up with EDIS as out pt. Other: NBS done 6/12 prior to transfusion . Brooke eligible for EDIS enrollment; have spoken to parents as to need for early intervention and close followup of her development. Ophtho #1: NA Last Ophtho: NA HUS #1: NA Last HUS: NA NB Screen: 6/12/2004 NBS: 6/12/2004 Immunizations: NA Audiology: 6/22/2004 passed AU-still needs ABR EFMP: NA D/C Weight: 3506 Change from BirthWeight 386 grams D/C OFC 35 Change from Birth OFC: 0 cm Blood Type: 0- Last Hct: 47.5 D/C Physical Exam: Term infant in OC. Opens eyes spont. AFOF. Sutures opposed. Good muscle tone. CTA Follow-Up: bilaterally. RRR without murmur. 2+ pulses. CR <2 sec. Good bowel sounds. Skin clear. No clicks. Good symm Moro, suck and grasp. Discharge Report for Infant Female Lovell, Brooke Computer Generated - SFA 2 Sponsor SSN: 02/155-52-9729 6/10/2004 Page 3 of 5 HosplD: 0148049 04 Marine Coros Deoendent Soouse _a / I I \ _ /, 1.. Discharge Summary: USNH, Okinawa Passport Transfer: No NeedsSBC Disposition: DC Home t_.I CarSeatCheckDone D/C Location: I,_.1 D/CMonitor F/U MD: Bilyeu, Suzanne C. D/C02 F/UComment: F/U Dr Bilyeu for wt check 24 June 0730. Cont Phenobarb (20mg/5ml)- Take 3ml po gDay. F/U Dr Tacker for continuity June 29 1300. Sooner for any acute changes (seizures, poor feeding, lethargy, T> 100.4, etc.) Detail Report: 6/22/21104 6/22/2004 9:39 9:39 BC b4flbO G" ` ? .Glu a " R . ., 6fi 20 phenobarb 22.1 6/11/2004 Qa"a. Phenobarbital t 20mg1kg load, 10/kg miniload, 5/kg/d main[ 6/16/2004 Breast Milk 6/10/2004 6/1012004 Naloxone 6/10/2004 6/1012004 Normal Saline 6.10/2004 6/11/2004 Normal Saline 6/10/2004 6111/2004 Sodium Bicarbonate 6/1112004 6/11/2004 Lorazepam Single dose 6/11/2004 6111/2004 Normal Saline 6/11/2004 6/11/2004 Sodium Bicarbonate 6/11/2004 6111/2004 Dopamine 1211212004 6/12/2004 Calcium Gluconate 100mg/kg x 1 12004 6112/2004 Magnesium Sulphate 25mg/kg x 1 J/2004 6/13/2004 mpicillin 6/11/2004 6113/2004 efotaxime 6/13/2004 611312004 Potassium Chloride 6/12/2004 6/18/2004 Hyperalimentation 6/13/2004 6/18/2004 0% IntraLipids 6/12/2004 Newborn Screening Tucker, Mark H. 6/17/2004 Nipple Feeds Tan, Rosemarie C. 6/18/2004 Open Crib Tan, Rosemarie C. 6/10/2004 6111/2004 Intubation Huang, Thomas K. 6/10/2004 6/11/2004 Conventional Ventilation Huang, Thomas K. 6/11/2004 6111/2004 Nasal CPAP Huang, Thomas K. 6/12/2004 6112/2004 Fresh Frozen Plasma Transfusion PT 24, PTT 43 Hawk, Bobbi J. 6/12/2004 611212004 Fresh Frozen Plasma Transfusion PT 31, PTT 52 Hawk, Bobbi J. 6/12/2004 6112/2004 Transfusion; Platelets pit 87K, active bleeding Hawk, Bobbi J. 6/12/2004 6/12/2004 Transfusion; Packed Red Blood Cells hct 19% Hawk, Bobbi J. 6/12/2004 6/12/2004 Fresh Frozen Plasma Transfusion PT 18, PTT 54 Hall, Brian 6/11/2004 6/14/2004 Nasal Canula Oxygen Hawk, Bobbi J. 6/14/2004 6/1412004 Transfusion; Packed Red Blood Cells Tan, Rosemarie C. 6114/2004 6/14/2004 CT of Head bilateral frontal/parietal hemorrhages Tan, Rosemarie C. 6/14/2004 6/1412004 Electroencephalogram Tan, Rosemarie C. 6/10/2004 6/16/2004 Umbilical Artery Catheter Huang, Thomas K. 6/16/2004 611712004 Orogastric Feedings Tan, Rosemarie C. "012004 6/1812004 Radiant Warmer Huang, Thomas K. '2004 6/19/2004 Umbilical Venous Catheter Huang, Thomas K. ,/2004 6/19/2004 Orogastric Tube Tan, Rosemarie C. 6/19/2004 6121/2004 Nastigastric Tube Tan, Rosemarie C. Discharge Report for Infant Female Lovell, Brooke Sponsor SSN: 02/155-52-9729 6/10/2004 HosplD: 0148049 04 Marine Corps Dependent Spouse Computer Generated - SF 502 i ' Pa? 4 of 5 Enel (l t , Pao l Printed 11-Jun-04 Discharge Summary: USNH, Okinawa -tD? f$topDalp r. R yh ' F.ot;' dtiieCoder x.E ProFedUre omrrigniu ,fir j/2004 6122/2004 Cardiorespiratory Monitor Huang, Thomas K. 6/10/2004 6/22/2004 Pulse Oximetry Huang, Thomas K. 6/2212004 MOW 01 6/22/2004 S,"10, tee Audiology Exam w -sa -e: sa -e an W -W. ,•. 'liOxNamaML? passed AU-still needs ABR c,_, Huang, Thomas K. 09l? ` 6/11/2004 Seizures on phenobarbital 779.0 6/11/2004 Hypoxic Ischemic Encephalopathy Sarnat stage 1 progressed to stage 2 768.5 6/10/2004 6/11/2004 Perinatal Asphyxia, Mild / Mod 768.6 6/10/20.04 6/11/2004 Acidosis, Metabolic severe 7751 6/11/2004 6/11/2004 Hypotension, Without Shock 458.9 6/11/2004 6111/2004 nuria 788.5 6/10/2004 6112/2004 Sepsis, Suspected V29.0 6/11/2004 6/12/2004 Hypomagnesemia 775.4 6/11/2004 6/13/2004 Hypocalcemia 775.4 6/12/2004 6/1312004 Anemia, Acute Blood Loss secondary to subgaleal hem 772.8 6/11/2004 6/14/2004 Disseminated Intravascular Coagulopathy s/p 3 FFP Ix 776.2 6/12/2004 6/14/2004 hrombocytopenia s/p pit tx x 2 776.1 6/12/2004 6117/2004 cute Tubular Necrosis max Cr 2.5; cola-colored urine 584.5 6113/2004 6/17/2004 Hypokalemia 276.8 6/11/2004 6/18/2004 Abnormal Transaminase Levels 790.5 6/12/2004 6121/2004 Subgaleal Hemorrhage severe For questions regarding the care of this patient, please contact the Neonatal lntensiv Care Unit at autovon #643-7241. Huang, T. - as K. Staff Neonatologist Discharge Report for Infant Female Lovell, Brooke Co puter?enerated - SF 502 Sponsor SSN: 02/155-52-9729 6/10/2004 page Z'0 age 5 of 5 HosDID: 0148049 04 Marine r'nmc neoenrlPM gz--cP txOAj - Personal Data - Privacy Act of 1974 (PL 93-579) HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE/SF600E SYMPTOMS, DIAGNOSIS, TREATMENT TREATING ORGANIZATION Date: 27 Jul 2004@0745 Clinic: PEDIATRIC CLINIC Provider: TUCKER,MARK H Division: US NAVAL HOSPITAL OKINAWA Objective: S BP(Sit/Stand). / Pulse Resp Temp: BP(Supine) / Height: Weight: v Pain (0-10): Allergies: NKKD_A . (13ii JUL04 KBH) AGE?J rS MEDS• NE Tobacco use in the home: Y /? ING NEEDS ASSESSED Fluoride:/ N TED ON DX, TX & RX Imm up-to-date by hx: N LIZES UNDERSTANDING AND/OR DEPLOYME RELATED STRATES Y N ? M ? ?ERSTANDING Clinic Note AA11- er ? 4-- l ` d?-s s?..•1 ? / ? ?f'? . ?? ?/ N Div w.?.-(mac ?,VS.cc I 11a?- ?iws-r? yzs? C a?s? ?"?? C '(? ? ? -.?°'rE- JJJ ??J j)Y7? 1169 ( , - A 1;1ivaI ,, ?t7Si= c7?4 g i w/1GAG s,?? IV--e eA* 47 /' -"-/ _2 7" Cow . ?a 'J'_ "a -F Ael S rN-4ii ------------------ --------------Z?.vi---(stli ---------------------------- Name: aw-LOVELLBR C FMPISSN: 02/155529729 Sex: F PCat: M41 Spon: LOVELL,CHRISTOPHE W Clinic: PEDIATRIC CLINIC Rank: CAPTAIN Outpt Rec Rm: USNH OUTPATIENT RECORDS Unit: III MHG CAMP HANSEN H£: 6228136 DOB: 10 Jun 2004 MTF : NH OKINAWA W£: Ins: N Ins Co: Policy £: MC Status: NOT ENROLLED Reg Comm: PCM: POC: CHRONOLOGICAL RECORD OF MEDICAL CARE/STANDARD FORM 600E (Rev.'S- 4) .1W 7040.00-634-406 HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL :ARE (2 weeks to 12 months) '?E` qUG .4 ? ik?rS Well Child Check: ? 2wk 2 mo ? 4 mo ? 6 mo ? 9 mo ? 12 mo Age: Female ? Male Nutrition formunization History: UTD ?Yes ?No Temp: OF 0 21 Breastfeeding: q Hrs for min. DTaP ? 1 ? 2 Head Circ: dm % the ? Formals amt o2_ n _= Type: HBV ? 1 ? 2 ?.3 cm % the Hei ht: ? Solids _j3j1iby frond D Table Food HIB ? 1 2 ? 3 ? 4 Lj Wei ht: ` k s %the uonde: ? Iron: Comvax ? I ? 2 ? 3 ? 4 Birth Weight: k s % tile Sleeping: zij/ IPV ? 2 ? 3 Pain Stoolin : A-All PCV7 ? l ? 2 ? 3 ? 4 Patient following owth curve? N Voidin : MM ? 1 Allcrgiea/ReaBtigry PMNx/PSHx: G P ? Zero mm ? Positive: Current medicsti0w ?-+ FanalyHx Varicella ? Yes ? NO kajA es No Prevention/Sereenin Irsterval History/Parental Concerns: oking in household? ?< < J ?•d? Car seat being used? ' I A, Domestic violence at home? i Sib or a 'th el ead level Lives in ome built before 180 NML ABN Physical Exam NML ABN Physical Exam Lives near lead proces " ant/industry oa. ? General El Heart-Pulses Lives wit ult with job/hobby using lead ? ? Head-Font sc.?6 ? ?" Abd-Um1i Live in/visits site known as major lead risk N 'El Eyes ? ? Genitalia Enrolled in W.I.C.? ,?. ? Ears ? ? Msk-Hips w Birth Weight or Preemie ? Nose ? Skin w / No Iron formula y ? Throat-teeth ? Neurologic ed only breast milk beyond 6 months ? IN. ? Extremities 46- a or 12 months ? Chest-Lungs ? Developmental Screening (reverse side) tvafL dBN Pend Assessment/Comments: Newborn Metabolic Screen # 1 Newborn Metabolic Screen # 2 t? -f p 2, Eo f Newborn Hearing Screen qtj rovG/cr signalu -1 &,lot __ it Antici ato l nce Immunization Screenin Medication .? a. enting afetp- u yen aP. [] Hep B El PPD ? H1B ? MMR Comvax ? VA CV 7 ? CBC ? Lead ? Hearing ? Fluoride ? Iron ? Li ? Follow-u : ? monsomwen" ? Metabolic Screen ? \'J PAT IENT'S IDENTIFICATION - RECORDS MAINTAINED AT: USNH OKINAWA, JAPAN Clinic: ? Bush ? Evans ? Foster ? Kinser ? Lester (Use this space for Mechanical Imprint) PATIE TTNAME (Last, Fast, Middle inkho LGV2 U VZOOKI- C SEX Y RELATIONSHIP TO SPONSOR QAv ter *ER STATUS AP RANWGRADE CAP-WAS SPONSOR'S NAME Lo v)= L t^ / C la R (S7Tj pO E w UNIT rn' M r? l; p p D USMGICE SL Z 1I$S-S2 I ? 1 DIV-5E/,V OF BIRTH 200 t CHRONOLOGICAL RECORD OF MEDICAL CARE nut V^,- Any 1 t1 I WAI Reference: Bright futures Guidelines for Health Supervision of Infants, Children and Adolescents 1996 and CDC Immunization Guidelines x = month Developmental Milestone is normally seen ? 2 week ? 2 month ? 4 month ? 6 month ? 9 month ? 12 month ? Know signs of ? Take time for ? Have siblings • Give opportunities ? Model talking, ? Establish routines illness oneself "help" with baby for exploration ? sing songs • Limit setting, ? Encourage ? Know signs of ? . Maintain ? Separation anxiety ? Play pat-a-cake consistency partner to care illness community ? Talk/sing/read to and peekaboo • Limit number of r for infant . ? Learn about involvement baby ? Have siblings child care givers ? Them-iometer playgroups ? Babysitters ? Use distraction as "help" with baby • Give individual a use ? Day care ? Sleeps through the discipline attention, positive ? Crying/colic night reinforcement ? Spitting up ? No solids or ? o • Introduce solid ? Start cup for water ? Start finger foods • Provide healthy water ths of n food at 4-6 months or juice ? Avoid choke foods choices • Don't use ? No honey; cows ? Avoid choke foods (peanuts, popcorn, ? Honey; eggs, nuts C? y A microwave to • ow's yv, milk, fish, nu ts, (peanuts, popcorn, carrot sticks) are OK heat bottles milk; fish, nuts, egg, citrus until carrot sticks) ? Supervise eating ? Give whole milk d egg, citrus until one year old one year.. old v ? Never leave • Hot water < 120 ? Childproof home ? Check for hazards ? Do not use baby • Ensure water safety ?C infant degrees ? Choking ® baby's level walkers ? Lower crib unattended ? Fall/Bath safety ? Falls/bums ? Do not use baby ? Bums mattress ? Ensure crib is ? Keep small/sharp ? Don't use walkers walkers ? Keep hot liquids ? Supervise. closely n safe objects out of ? Ingestions/ Ipecac/ away from baby near streets, dogs, ?' ? Back to sleep reach Poison control # etc. + Smoke ? Don't leave ? Avoid too much ? Use sunscreen detectors unattended sun ? ? No bottle to crib ? No bottle to crib ? Fluoride. ? Fluoride ? Wean bottle ? No bottle propping • Teething • Brush teeth ? Brush teeth ? Fluoride A signs/myths ? Discuss bottle ? Tooth care caries ? Lifts up chin. ? Li ad wh ? On forearms in ? Rolls both ways ? Pulls to stand (8-9) ? Cruise (10) prone p o prone (3) (5) ? Crawls hand/knees ? Walk alone (12) t h ? t cone ? Rolls over prone to ? Sits leaning (9) position (2) supine (4) forward (6) h d w ? . Equal s o t ? Grasps object (3) ? Transfers objects ? 3-finger grasp (9) ? Mature pincer ,v movement, fist iefi ? Brings hands to (5+) grasp (11+) 4L closed ? nds o 50% ? midline (4-5) ? Radial rake grasp ? Voluntary release d (2) 6 12 ? Responds to ? um n") ? Orients to voice ? Ah-goo (5) ? Mama/dada (non- ? Understands no ? noise ? e-cooin (3+) ? ' Babbling (6) specific) (8) (10) ? •1 ? Laughs aloud (4) ? Peek-a-boo, pat-a- ? Mama/dada + 1-2 > d cake (9) words (12) A ? Regards face Social smile (2) ? Spontaneous smile _ ? Explores ? Shy with strangers ? Imitates actions p (4) environment with ? Comes when called eyes, hands, mouth tk ? Metabolic ? Check Metabolic ? Check Hearing ? ? Anemia ? TB r screening screening results screening results ? Lead If not done at 9 months: i ? Hearing ? Check 'ng ? Anemia. r? screening s res is ? Lead ? Hep B Comvax # 1 ? Comvax # 2 ? DTaP # 3 ? ? Comvax # 3 ? (at Birth) DTaP # 1 11 DTaP # 2 ? IPV # 3 ? MMR # 1 N II PV # 1 ? IPV # 2 ? PCV7 # 3 ? Varicella 34 PCV7 1 ? PCV7 # 2 ? PCV7 # 4 _ ti ? PPD nWTF,,...„4n11N 171AY EVALUATION REPORT FOR OFFICIAL USE ONLY Page l of 6 ,,KEDUCATIONAL AND DEVELOPMENTAL INTERVENTION SERVICES mss, "'? U.S. Naval Hospital Okinawa, Japan r Developmental Pediatrics Consultation o NS Patient: Lovell, Brooke Patient ID: 02/155-52-9729 Date of Evaluation: 15 SEP 2004 Date of Birth: 10 JUN 2004 Chronologic Age: 3 months Introduction: Brooke is a 3 month old female sent for consultation by the Early Intervention Team from EDIS. Requesting clinician's concerns were for evaluation of this infant with a history of difficult birth and subsequent seizures. Brooke is accompanied to the clinic today by her mother and father, whose concerns include obtaining a "second opinion" with regard to her current medical care. Specifically they are interested in seeing a-pediatric-neuroiogist. - Theyare-concerned about the difficulty of aduiiiiisteruig-Phenobarbital to Biooke and want to know if there aren't other alternatives or if she even needs to take the medication. Parents also have concerns about how the delivery was handled and are interested in finding out'%vhen she became distressed". The following records were reviewed for this appointment: Copy of NICU discharge summary, Copy of mother's hospital discharge summary, EDIS intake form. Perinatal History: Brooke was the third pregnancy and second live birth to a 32 year old Caucasian female. Previous pregnancies were remarkable for a miscarriage at 10 weeks. The pregnancy with Brooke was remarkable for preterm labor at 20 weeks gestation, successfully treated with oral tocolytics. Mother had a positive triple screen. Parents report that an ultrasound was performed and was normal. Fetal movements were normal. There was no teratogen exposure. Maternal blood pressure and glucose tolerance tests were normal. There were no maternal infections or rashes. There was no history of bleeding or spotting. Labor and delivery was remarkable for a very difficult delivery. Brooke was delivered at 41 weeks gestation by induced vaginal delivery. During the delivery fetal distress was noted and vacuum extraction attempted. It is unclear to me from the records how many vacuum attempts were made. Per parents' report, "at least 6 to 10 pop-offs" occurred. There was a double nuchal cord that was cut at the perineum. Birth weight was 3120 gm. Birth OFC 35 cm. APGAR scores were 1/3/5 at one, five and ten minutes, respectively. First ABG was 6.97 with a base deficit of 28. Brooke remained in the hospital for 12 days. Hospital stay was remarkable as follows: Cardiopulmonary: Brooke was on the ventilator for a short time. She was quickly weaned to oxygen only, then room air. No report of cardiac anomalies. RECORDS MAINTAINED AT: USNH PATIENT'S NAME- SEX: PATIENT'S SSN/IDENTIFICATION NO.: LOVELL. BROOKE C Male SPONSOR RELATIONSHIP: STATUS: RANK/GRADE: FATHER USHC DEP AD 04 SPONSOR'S NAME: ORGANIZATION: LOVELL, CHRISTOPHER III MHG DEPART./SERVICE: SPONSOR'S SSN/IDENTIFICATION NO.: DATE OF BIRTH: Marines 02/155-52-9729 10 Jun 20074 AUTOMATED VERSION OF STANDARD FORM 600(5-64) EVALUATION REPORT FOR OFFICIAL USE ONLY Page 2 of 6 Heme / Bili: During the first 24 hours Brooke's hematocrit began to fall from 50% down to a nadir of 18 by 33 hours. She was noted to have a significant subgaleal hemorrhage. She had a coagulopathy consistent with DIC. She received transfusions of PRBC's, FFP, and platelets. Infectious Disease: No positive cultures. GI / FEN: Clinical picture consistent with ATN which resolved. No feeding problems. Initial coagulopathy accompanied by elevated liver enzymes. Neurological: At 20 hours of life Brooke experienced a "partial/generalized tonic-clonic seizure". These seizures predominantly involved the right upper extremity. Brooke was begun on Phenobarbital with resolution of the seizures by day of life 2. An initial EEG was difficult to read secondary to the subgaleal hemorrhage and swelling. Reading by the pediatric neurologist at TAMC stated "markedly abnormal secondary to diffuse low voltage and poorly developed background". A CT scan on day of life 5 showed "bilateral right greater than left frontal lobe parenchymal hemorrhage". The neonatologist note states that Brooke had hypoxic ischemic encephalopathy "with exam and course most consistent with Sarnat stage 2." Infancy: Parents describe Brooke as a good baby. Brooke is breasted without difficulty. There are no problems with sleep routine. Brooke awakens every two to three hours. Developmental History: Overall, parents are good historians. They were advised of possible developmental sequelae during the NICU stay and have been watching carefully. They currently feel Brooke is doing well with regard to development Past Medical History: Hospitalizations: NICU history as above. Chronic Illnesses: Seizures. Brooke has not had another seizure since day of life 2. She is taking Phenobarbital, currently at 7.5 cc qhs (30 mg, which is approximately 4.6 mg/kg/d based on parental report of weight). Brookes last Phenobarbital level was on 8/4/04 at 1500 and was 15.4. Accidents / Injuries: None. Surgeries: Norte. Medications: Phenobarbital. Parents are finding it very difficult to give her the Phenobarbital, as she does not like the taste and spits it out. Mother has resorted to giving her half of the medication at bedtime and half at around midnight. Drug Allergies: NKDA. Immunizations: Up to date. Review of systems included HEENT (hearing, vision, dental, headaches, etc), Cardiopulmonary (asthma, heart defect, etc), GI (swallowing / feeding problems, appetite, constipation/diarrhea/encopresis, diet, etc), GU (pyelonephritis history, enuresis, etc), Endocrine (growth, thyroid, etc), Orthopedics (scoliosis, hip RECORDS MAINTAINED AT: USHH PATIENT'S NAME: SEX: PATIENT'S SSN/IDENTIFICATION NO.: LOVELL, BROOKE C Male SPONSOR RELATIONSHIP: STATUS: RANK/GRADE: FATHER USMC DEP AD 04 SPONSOR'S NAME: ORGANIZATION: LOVELL, CHRISTOPHER III MG DEPART./SERVICE: SPONSOR'S SSN/IDENTIFICATION NO.: DATE OF BIRTH: Marines 02/155-52-9729 10 Jun 2004 AUTOMATED VERSION OF STANDARD FORM 600(5-84) EVALUATION REPORT FOR OFFICIAL USE ONLY Page 3 of 6 dysplasia, etc), Neurology (seizures, tone, etc), sleep issues, equipment needs, and services. Review of systems was unremarkable except for the NICU history and seizure history as outlined above. Parents use to have concerns about Brooke's vision, stating that her eye would sometimes turn in. However they feel this has resolved. Brooke has not seen an ophthalmologist. Hearing screen was normal in the NICU and an ABR was reportedly normal. Parents report concerns about Brooke's legs "shaking". They state this is different from the seizures they saw in the NICU in that the current "shaking" isn't rhythmic, but more like a tremor or jitteriness. They state it occurs in one or both legs at a time and does not involve the upper extremities. Shaking lasts about 10-15 seconds. It can occur waking or sleeping and there is no associated change in behavior or consciousness that they can ascertain. Shaking does not stop with positioning or holding the limb. Previous Evaluations: Brooke has not had developmental evaluations in the past. She had the previously mentioned EEG and CT scan in the NICU. She had a repeat EEG in July. There is a preliminary reading by the adult neurologist at USNH, but no final reading by the pediatric neurologist from TAMC. The EEG appeared "normal for age" by the adult neurologist's reading. Brooke had a normal newborn screen with the exception of hemoglobin (which was consistent with the transfusions she received). Educational Intervention History: Brooke is currently in process of evaluation for Early Intervention Services through EDIS. Behavior History: No current concerns except the difficulty with medication previously mentioned. Family istory / Social: Review of family history revealed a history of olivopontocerebellar degeneration on mother's side of the family. Mother's grandmother and several of mother's aunts/uncles have the disease however her father does not. (As this group of diseases is autosomal dominant, it should not be a risk for Brooke as Brooke's . grandfather did not have the disease). There is no other history of developmental delay, special education / learning disability, mental retardation, ADHD, cerebral palsy, seizures, or consanguinity. The family moved to Okinawa 6/03. Father is active duty USMC. He is in logistics and is frequently deployed. Orders are due in 2006. They live in base housing. Support in the area includes church, friends. Brooke is not enrolled in EFMP. Physical Examination: Wt: Not obtained, as scale not working OFC: 39 cm (12%) General: Well developed female, no acute distress. RECORDS MAINTAINED AT: USHR PATIENT'S NAME: SEX: PATIENT'S SSN/IDENTIFICATION NO.: LOVELL, BROOKE C Male SPONSOR RELATIONSHIP: STATUS: RANK/GRADE: FATHER USMC DEP AD 04 SPONSOR'S NAMES ORGANIZATION: LOVELL, CHRISTOPHER III MHG DEPART./SERVICE: SPONSOR'S SSN/IDENTIFICATION No.: DATE OF BIRTH: Marines 02/155-529729 10 Jun 2004 AUTOMATED VERSION OF STANDARD FORM 600(5-84) FOR OFFICIAL USE ONLY EVALUATION REPORT Page 4 of 6 Dysmorphic Features: None Skin: There are no unusual markings, features, or abnormal pigmentation. Hair is of normal -quality and distribution. Nails and palmar creases are normal. HEENT: Normocephalic. The face has some very mild asymmetry with a question of greater movement on the right side than the left. Fundi not well- visualized. PERRL. Ears are normal size and shape. Tympanic membranes not examined. Neck is supple with no masses. Thyroid is not enlarged. Chest: - Symmetric without deformities. Lungs: Clear to auscultation. Cardiac: Normal S 1 S2 without murmurs. Abdomen: Soft, nontender. No masses. Liver and spleen are not palpable. Genitalia: Deferred. Back: Straight. Extremities: No deformities. Free range of motion. Neurologic Examination: CN: Vision and hearing not formally tested. CN II-XII grossly intact. Motor: Muscle mass and distribution appears normal throughout. Strength is normal. Muscle tone is high-normal for bilateral hip adductors, otherwise normal throughout, with no asymmetries. Pull-to-sit shows good head control with head held in neutral but not leading the body. Ventral suspension shows good trunk control. Cerebellar. No evidence of ataxia. Tremors of the arms and legs are noted with excitement Reflexes: DTR's are +3 for patellar and +2 for biceps bilaterally. Plantar reflex is RECORDS MAINTAINED AT: USNH PATIENT'S NAME: SEX: PATIENT'S SSN/IDENTIFICATION No : LOVELL. BROOKE C Male . SPONSOR RELATIONSHIP: STATUS: RANK/GRADE- FATHER USMC DEP AD 04 SPONSOR'S NAME: ORGANIZATION: LOVELL, CHRISTOPHER III MHG DEPART./SERVICE: SPONSOR'S SSN/IDENTIFICATION NO.: DATE OF BIRTH: Marines 02/155-52-9729 10 Jun 2004 AUTOMATED VERSION OF STANDARD FORM 600(5-84) EVALUATION REPORT FOR OFFICIAL USE ONLY Page 5 of 6 Equivocal bilaterally. There is 5-7 beat clonus bilaterally. ATNR is present and obligate bilaterally. Developmental Examination: Tests administered today included the CATCLAMS. Brooke was cooperative with testing. Results are felt to be an accurate reflection of skills. Gross motor: Brooke can push up on her forearms in prone position. She cannot yet roll, though does go to her side. Developmental age is 3 months. Developmental Quotient is 100. Fine motor: Brooke can hold a rattle and is generally unlisted. She cannot reach and does not demonstrate an active grasp. Developmental age is 3 months. Developmental Quotient is 100. Language: Brooke passed all skills at the 3 month level, with scatter through the 4 month level. nevelopmental age is 3.5 months. Developmental Quotient is 117. Problem Solving: Brooke passed all skills at the 3 month level, with scatter through the 4 month level. Developmental age is 3.3 months. Developmental Quotient is 110. Assessment: Brooke is a 3 month old female with a significant Perinatal history consistent with moderate (stage 2) hypoxic ischemic encephalopathy. Currently Brooke does not show any developmental delays, however it is very early to make definitive statements about developmental. outcome. According to the literature, between 20-25% of children with moderate HIE will have developmental disabilities. The percentage of children that have learning problems or other mild developmental problems such as ADHD is less well researched. Brooke does show some mildly abnormal neuromotor findings on physical examination today, including clonus, tremors and brisk patellar reflexes. These may be indications of an immature nervous system or may be indications of persistent sequelae from the HIE - only time will tell. Although Brooke has not had any seizures since the NICU stay, I feel it is too early to begin the process of weaning her off of medication. I wholeheartedly support an evaluation by pediatric neurology and would include an EEG and MRI as part of that evaluation to help assess current treatment plans and possibly help predict future prognosis. Diagnosis: 1. History of moderate hypoxic-ischemic encephalopathy (768.6) 2. Abnormal neuromotor examination (781.0, 796.1) 3. History of seizures (779.0) Educational Implications: 1. As outlined above, Brooke is at risk for developmental disability given her history of hypoxic ischemic encephalopathy. RECORDS MAINTAINED AT: USNH PATIENT'S NAME: SEX: PATIENT'S SSN/IDENTIFICATION NO.: LOVELL. BROOKE C Male SPONSOR RELATIONSHIP: STATUS: RANK/GRADS: FATHER USMC DEP AD 04 SPONSOR'S NAME: ORGANIZATION: LOVELL, CHRISTOPHER III MHG DEPART./SERVICE: SPONSOR'S SSN/IDENTIFICATION NO.: DATE OF BIRTH: Marines 02/ISS-52-9729 10 Jun 2004 AUTOMATED VERSION OF STANDARD FORM 600(5-84) EVALUATION REPORT FOR OFFICIAL USE ONLY Page 5 of 6 Equivocal bilaterally. There is 5-7 beat clonus bilaterally. ATNR is present and obligate bilaterally. Developmental Examination: Tests administered today included the CATCLAMS. Brooke was cooperative with testing. Results are felt to be an accurate reflection of skills. Gross motor: Brooke can push up on her forearms in prone position. She cannot yet roll, though does go to her side. Developmental age is 3 months. Developmental Quotient is 100. Fine motor: Brooke can hold a rattle and is generally unfisted. She cannot reach and does not demonstrate an active grasp. Developmental age is 3 months. Developmental Quotient is 100. Language: Brooke passed all skills at the 3 month level, with scatter through the 4 month level. Developmental age is 3.5 months. Developmental Quotient is 117. Problem Solving: Brooke passed all skills at the 3 month level, with scatter through the 4 month level. Developmental age is 3.3 months. Developmental Quotient is 110. Assessment: Brooke is a 3 month old female with a significant Perinatal history consistent with moderate (stage 2) hypoxic ischemic encephalopathy. Currently Brooke does not show any developmental delays, however it is very early to make definitive statements about developmental outcome. According to the literature, between 20-25% of children with moderate HIE will have developmental disabilities. The percentage of children that have learning problems or other mild developmental problems such as ADHD is less well researched. Brooke does show some mildly abnormal neuromotor findings on physical examination today, including clonus, tremors and brisk patellar reflexes. These may be indications of an immature nervous system or may be indications of persistent sequelae from the HIE - only time will tell. Although Brooke has not had any seizures since the NICU stay, I feel it is too early to begin the process of weaning her off of medication. I wholeheartedly support an evaluation by pediatric neurology and would include an EEG and MRI as part of that evaluation to help assess current treatment plans and possibly help predict future prognosis. DiWosis: 1. History of moderate hypoxic-ischemic encephalopathy (768.6) 2. Abnormal neuromotor examination (781.0, 796.1) 3. History of seizures (779.0) Educational Implications: 1. As outlined above, Brooke is at risk for developmental disability given her history of hypoxic ischemic encephalopathy. RECORDS MAINTAINED AT: USNH PATIENT'S NAME: SEX: PATIENT'S SSN/IDENTIFICATION NO.: LOVELL, BROOKE C Male SPONSOR RELATIONSHIP: STATUS: RANK/GRADE: FATHER USMC DEP AD 04 SPONSOR'S NAME: ORGANIZATION: LOVELL, CHRISTOPHER III MHO DEPART./SERVICE: SPONSOR'S SSN/IDENTIFICATION NO.: DATE OF BIRTH: Marines 02/155-52-9729 10 Jun 2004 AUTOMATED VERSION OF STANDARD FORM 600(S-64) Q) w w? co Ci 0 2 0 S M O ? JI U 15X4 I b- ? TRIPLER AMC, HI 13 Dec 2004@1336 Page 1 Personal Data - Privacy Act 1974 (PL 93-579) Consult Notes ------------------------------------------------------------------------------- 29 Oct 200401403 OUTPT NEUROLOGIST PED NEUROLOGY-ROUTINE CONSULT Personal Data - Privacy Act of 1974 (PL 93-579) Automated Version of SF513 ----------------------------------------------------------------------------- CONSULT FOR LOVELL,BROOKE C - Order date: 01 Oct 200402031 Requested Date: To: PEDIATRIC NEUROLOGY CLINIC, TRIPLER From: WEST PAC CLINIC ------------------------------------------------ ------------------------------ Reason for Request: AIR EVAC from Camp Lester, Japan/Dr. Tucker/DSN 643-7555 TAMC/Dr. R. Pedersen Dx: Grade 2 IVH, Neonatal seizures, Tremors Hx: 4 moth old female s/I? asphycia ® birth. Neonatal seizures in NICU. On phenobarbitol prophylactically. Now with elevated "tremors". Meds: Phenobarbitol(mother dipenses out patient) NMA:1 mother Request appt date/time Provisional DX: Grade II IVH, Neonatal Seizures, Tremors Requesting HCP: KINSEY,JILLIAN J Priority: ROUTINE ---------.--------------------------------------------------------------------- CONSULTATION REPORT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - i -------------------------------------------- Appointment Date: 26 Oct 2004010:30 Appt Comment: PLF/NEW CONSULT Entry Date: 28 Oct 2004@070452 Consultant: PEDERSEN,ROBERT C Problem List: ------------- Consult: ------- Name: --------------------------- LOVELL,BROOKE C --------------------------- FMPISSN: 02/155529729 ------ Sex: ------------ F PCat: M41 Spon: LOVELL,CHRISTOPHER W Clinic: PEDIATRIC NEUROLOGY CLINIC Rank: CORPORAL Outpt Rec Rm: Unit: UNKNOWN H#: 6228136 DOB: 10 Jun 2004 MTF • TRIPLER AMC, HI W#:.6234851 Ins: N HIPAA ? Ins Co: Policy #: CM: MC Status: NOT ENROLLED Reg comm: PCM: POC: CONSULTATION SHEET Medical Record/STANDARD FORM 513E (Rev. 8-92) TRIPLER AMC, HI 13 Dec 2004®1336 Page 2 Personal Data - Privacy Act 1974 (PL 93-579) Consult Notes History of Present Illness: Brooke is a 4-1/2-month-old girl who was air evac'd from Okinawa to the Child Neurology service at Tripler Army Medical Center for follow-up of her neonatal seizures and evaluation of her development. According to the parents, Brooke was the product of a 41-1/7 week gestation. The pregnancy was complicated by preterm labor at 20 weeks which required oral tocolytics. At the time of labor there reportedly were problems with fetal decelerations, which required delivery with vacuum assistance. It sounds'as_ if the vacuum was applied to the head about 10 times before she was successfully delivered, at which point a double nuchal cord requiring surgical reduction was noted. After birth, the father believes that she had a heart rate, but she required resuscitation. Apgars were 1..(1 minute), 3 (5 minutes) and 5 at 10 minutes. The first ABG revealed a pH of 6.97 and a base deficit of -28. Brooke was taken to the neonatal intensive care unit for care. Her NICU course was complicated by oliguria and presumed ATN. She required about 20 hours of ventilator support, but was quickly weaned to room air. There were no cardiac abnormalities. The father is unaware of any GI difficulties, although it sounds as though she had elevated LFTs and was not fed for about 5 days. In the nursery, she received transfusions of PRBCs, platelets and FFP for DIC. At 20 hours of life, Brooke was noted to have focal clonic seizures starting in the right arm. The clonic activity then involved the right leg and eventually the left leg. The parents state that•these clonic movements did not stop with restraint of the limb. She was loaded with phenobarbital with resolution of the seizures within about 48 hours. CT scan on day of life #5 revealed several left frontal lobe parenchymal hemorrhages, as well as a right frontal hemorrhage. Brooke's neonatal seizures were felt to be secondary to the hemorrhages, as well as HIE. She has remained on phenobarbital, but has been seizure-free since approximately day of life #2 or #3. According to the family, there are no apparent sequelae other than a concern about her neurologic status. Developmental: the family states that she has normal hearing, and she passed her audiology screen including an ABR. She appears to have normal vision. She has a social smile. She tracks objects 180 degrees. She is very sociable and engaging. She will reach for objects and bring them to her ------------------------------------------------------------------------------- Name: LOVELL,BROOKE C FMP/SSN: 02/155529729 Sex: F PCat: M41 spon: LOVELL,CHRISTOPHER W Clinic: PEDIATRIC NEUROLOGY CLINIC Rank: CORPORAL Outpt Rec Rm: Unit: UNKNOWN H#:.6228136 DOB: 10 Jun 2004 MTF : TRIPLER AMC, HI W#: 6234851 Ins: N. HIPAA ? Ins Co: Policy #': • CM: MC Status: NOT ENROLLED Reg comm: PCM: POC: CONSULTATION SHEET Medical Record/STANDARD FORM 513E (Rev. 8-92) TRIPLSR AMC, HI 13,Dec 200401336 Page-3 Personal Data - Privacy Act 1974 (PL 93-579) Consult Notes ------------------------------------------------------------------------------- mouth, although they have not yet seen her transfer objects. She is able to roll from her back to her front. The mother does riot believe she has rolled from front to back yet. She is able to bear weight on her legs. Her head -control is good. Overall, she continues to make developmental progress. She has been enrolled in the EDIS program, and is receiving early intervention services with physical therapy. The parents mention that the physical therapist has noted some asymmetry of the hands and upper extremities. Current Medications: Phenobarbital 4.5 ml b.i.d. The phenobarbital does cause some drowsiness. Immunizations: Up-to-date. Past Medical History: Otherwise notable for a recent hospitalization for RSV bronchiolitis. Family History: Unremarkable. Physical Examination: VITAL SIGNS: Pulse 133. Res iprations 28. Length 61 cm. Weight 6.84 kg. Head circumference 39 cm, which is about the 2nd percentile. Pulse oximetry 99% on room air. GENERAL: She is an alert, sociable, attentive and happy little baby girl who is in no apppparent distress. HEENT: Her anterior fontanelle is closed. There is some mild ridging of her sagittal suture. There are no obvious dysmorphic features. LUNGS: Clear. CARDIOVASCULAR: Without murmur.- ABDOMEN: Benign, without organomegaly. NEUROLOGIC: Cranial nerves II through XII. Pupils are equal and reactive to light. Extraocular muscles are full She has normal vestibuloocular reflexes. .She has a red reflex bilaterally. Her visual fields appear to be normal. She tracks objects 180 degrees. Her hearing is normal to a ringing bell and a finger rub. Her face is symmetric. She appears -to have. normal tongue and mouth movements. Sensation is intact'to light touch. Motor reveals normal-truncal tone. She has good vertical and horizontal suspension. There is no head lag when pulled by traction and she has a good arm pull. She was able to bear weight on her extended-legs without difficulty. When in the prone position, she is up on her flexed forearms with her chest up about 45 degrees. She has good head control. I noted asymmetry of her :upper extremities, as she often had her right hand softly closed, whereas the left hand was typically opened. She did spontaneously reach for objects with either hand and brought them to her mouth. There is no obvious ----------------------------------------•------- Name: LOVELL,BROOKE C FMP/SSN: 02/155529729 Sex: F PCat: M41 Spon: LOVELL,CHRISTOPHER W Clinic. PEDIATRIC NEUROLOGY CLINIC Rank: CORPORAL Outpt Rec Rm: Unit: UNKNOWN H#: 6228136 DOB: 10 Jun 2004 MTF • TRIPLBR AMC, HI W#: 6234851 Ins: N HIPAA 7 Ins Co: Policy #: CM: MC Status: NOT ENROLLED Reg comm: PCM : POC : CONSULTATION SHEET Medical Record/STANDARD FORM 513E (Rev. 8-92) TRIPLER AMC, HI 13•Dec 200401336 Page 4 Personal Data - Privacy Act 1974 (PL 93-579) Consult Notes ------------------------------------------------------------------------------- ataxia. Reflexes are 2+ and symmetric. There is no ankle clonus elicited. She has a good plantar grasp. She has a symmetric ATNR. Impression: Brooke is a 4-1/2-month-old who had a complicated perinatal course, with presumed hypoxic-ischemic encephalopathy and intraparenchymal, hemorrhages in the frontal lobes, left ggreater than right. Her development seems to be progressing quite well. I do perceive an asymmetry in her upper extremities with some soft fisting of the right hand suggesting a possible early, mild, right hemiparesis. Also of some concern is her mi.crocephaly and her closed fontanelle, but otherwise her neurologic is normal in detail, and her development seems to be progressing as expected. Recommendations: 1. A baseline brain MRI scan is recommended before her first birthday to assist with prognosis, counselling of parents. We were unable to arrange a timely MRI, so will pre-arrange an MRI on her follow-up visit in 6 months. 2. As she has gone 4 months without recurrence of her seizures, I discussed with the family the goal to wean off phenobarbital, as many children will not seize outside the newborn period once the acute insult. is over. There is a risk for her to have seizures in the future, however, given the intraparenchymal hemorrhages in the frontal lobe. .3. She should continue to receive early intervention services through EDIS, and I would particularly pay attention to her right hand and right arm over this next year. The parents' questions were answered. 4. Certainly she should be followed by pediatrics and developmental .pediatrics to identify any other problems as she gets older. 5. Follow-up with me in 6 months, sooner prn. dk DD:10/26/2004 18:45:10(ET) DT:10/28/2004 07:04:52(ET) ' Job#: 6939327 ------- Name: --------------------------- LOVELL,BROOKE C ---------------- ----------- FMPISSN: 02/155529729 ------ Sex: ------------ F PCat: M41 Spon: LOVELL,CHRISTOPHER W Clinic: PEDIATRIC NEUROLOGY CLINIC Rank: CORPORAL Outpt Rec Rm: Unit: UNKNOWN H#: 6228136 DOB: 10 Jun 2004 MTF • TRIPLER AMC, HI W#: 6234851 Ins: N HIPAA 7 Ins Co: Policy #: CM: MC Status: NOT ENROLLED Reg comm: PCM : . • POC : CONSULTATION SHEET Medical Record/STANDARD FORM 513E (Rev. •8-92) TRIPLER AMC, HI 13 Dec 200401336 Page 5 Personal Data - Privacy Act 1974 (PL 93-579) Consult Notes - ------------------------------------------------------------------ Entered by: 28 Oct 20040070452 Verified by: Robert C. Pedersen, MD 29 Oct 200401403 Name: --- LOVELL,BROOKE•C --------------------------- FMP/SSN: 02/3,55529729 ----------------- Sex: F PCat: M41 Spon: LOVELL,CHRISTOPHER W Clinic: PEDIATRIC NEUROLOGY CLINIC Rank: CORPORAL Outpt Rec Rm: Unit: ' UNKNOWN H#: 6228136 DOB: 10 Jun 2004 MTF • TRIPLER AMC, HI W#: 6234851 Ins: N HIPAA 3 Ins Co: Policy #: . CM: MC Status: NOT ENROLLED Reg comm: PCM: POC: CONSULTATION SHEET Medical Record/STANDARD FORM 51319 (Rev. 8-92) MqW 7140- -344176 HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE (2 weeks to 12 months) at me: DFeeL IC4 Well Child Check: ? 2wk ? 2 mo ? 4 mo 6 mo ? 9 mo ? 12 mo Age: Female ? Male Nutrition `^ G Immunization History: UTD ?Yes ?No Temp: OF °C _ C l? S Breastfeeding: q Hrs for ml x /d T TaP ? 1 ? 2 ? 3 Head Circ: cm % file ? Formula: amt: oz, q hrs, Type: HBV ? 1 ? 2 ? 3 Height: s em % the Solids: ? Baby fibpj. ? Food ZNt? ' HIB ? I ?2 ?3 ?4 i ht: k °!o file ?? / [I Flacon e: on: gir omvax ? 4 [12 3 ?1 ? Birth Weight: k %tile Ste in a .r3 IPV ? 1 ? 2 ? 3 Pain 0-10 : B/P: Stoolin : lxtvp PCV7 ? 1 ? 2 ? 3 ? 4 Patient following growth curve? ?Y ?N Voidin : MMR ? I Allergies/ Reaction: ?- Curremmedications: ----- PMHXIPSH?y' Z - Lac - _ NUy.a..?t,W' [CO? y Ah !(?' F [plnilyHz: Y?Wtt7?'r` f ??.Z1?{r>'3 rl ?71i}' II2•i12?J PPD ? zero mm ? Posi 'v : Varicella ? Yes ? No uft/-% Yes No Prevention/Screening Interval HistotylParental Concerns: _ -0 n Smoking in household? x Car seat being used? ?1 Domestic violence at home? Pylyne- Sib or playmate with elevated lead level PrIa V4 1 Y. x Lives in home built before 1980 to a NML' ABN Physical Exam NML ABN Physical Exam Lives near lead processing plant/industry d v ? General ? Heart-Pulses Lives with adult with job/hobby using lead v ? Head-Font E] Abd-Umb Live in/visits site known as major lead risk N ? Eyes ? Genitalia Enrolled in W.I.C.? E!f ? Ears Msk-Hips Low Birth Weight or Preemie d ? Nose ? Skin Low'/ No Iron formula ? Throat-teeth ? Neurologic Fed only breast milk beyond 6 months ? ? Neck ? Extremities Cow milk before 12 months >v El Chest-Lungs ? Developmental Screening (reverse side) NML ABN Pend AssessmenilComments: Newbom Metabolic Screen # 1 M.t omtsA Newbom Metabolic Screen # 2 x Newbom Hearing Screen /i 1 ` P7 ?( /?Jy G C _6LYG Provider Signals" Sta ( Ut - r CPO Antici ato id nce Immunization Screening Medication I: 4 Pa ting Safety Diet ? Dental ? Handout given ,?DTaP ? Hep B ? PPD ? HIB ? MMR ? Comvax 0 IPV ? VAR O PCV 7 ? CBC ? Lead ? Hearing - Fluoride ? Iron ? ? Follow-u : ? Metabolic Screen ? PATIENTS IDENTIFICATION RECORDS mmmrAINED AT: USNH OKINAWA, JAPAN Clinic: ? Both ? Evans ? Foster ? Kinser ? Lester (Use this space for Mechanical Imprint) .. PATIENT NAME (Lan, Fest• Middle initial) SEX ` DEC 2 9 2004 RELATIONSHIP TO SPONSOR STATUS t RANKIGRADE SPONSORS NAME R CE U?NI.T?. % DEPARTJSEE SSN 0S*-tC oa- -Sa- is 1-b5 DATE OF BIRTH I to ?ct??" •.nnv?.vw•a?a.na. nr.?vnY Vr --u^L e.AKL nTZT 'v__v„ ,<ni T m r ,7/ni Reference: Bright futures Guidelines for Health Supervision of Infants, Children and Adolescents 1996 and CDC Itntnunitation (irtideltnes x = month Developmental Milestone is normal seen ? 2 week ? 2 month ? 4 month 6 month ? 9 month ? 12 month • Know signs of • Take time for ? Have siblings ? Give opportunities ? Model talking, ? Establish routines illness oneself . . . "help" with baby for exploration 1 ? sing songs • Limit setting, • Encourage ? Know signs of • . Maintain ? Separation anxiety ? Play pat-a-cake consistency partner to care illness community ? Talk/sing/read to and peekaboo • Limit number of y for infant . ? Learn about involvement baby IEA • Have siblings child care givers ? Thermometer playgroups • Babysitters • Use distraction as "help" with baby ? Give individual d use ? Day care ? Sleeps through the discipline attention, positive a ? Crying/colic night reinforcement ? Spitting up ? No solids or • Delay solid foods • Introduce solid - water ------- . _... ._.untiL4ingnths of_ food at 4-6 months_ ? Don't use age ? No honey, cows microwave to ? No honey, cow's milk, fish, nuts, heat bottles milk, fish, nuts, egg, citrus until egg, citrus until one year old one year old • Never leave • Hot water < 120 ? Childproof home infant degrees ? Choking unattended ? Fall/Bath safety ? Fallstbums ? Ensure crib is • Keep small/sharp ? Don't use walkers safe objects out of ? Back to sleep reach ? Smoke ? Don't leave detectors unattended ? ? No bottle to crib ? No bottle to crib • No bottle propping • Teething signs/myths ? Lifts up chin ? Lifts head when ? On forearms in prone prone (1) prone (3) ? Chest up in prone ? Rolls over prone to position (2) supine (4) d o ? Equal ? Grasps object ? Grasps object (3) a movement, fist briefly (1) ? Brings hands to GL closed ? Hands open 50% midline (4-5) Responds to ? Turns to sound(]) ? Orients to voice noise ? Pre-cooing (2) (3+) ? Laughs aloud (4) Regards face I? Social smile (2) I? Spontaneous smile (4) ? Start cup for water ? Start finger foods ? Provide healthy orce? ? Avoid choke foods choices • Avoid choke foods (peanuts, popcom, ? Honey, eggs, nuts (peanuts, popcorn, carrot sticks) are OK carrot sticks) ? Supervise eating ? Give whole milk Check for hazards ? Do not use baby • Ensure water safety Q baby's level walkers ? Lower crib Do not use baby ? Bums mattress walkers • Keep hot liquids ? Supervise closely Ingestions/ Ipecac/ away from baby near streets, dogs, Poison control # etc. Avoid too much ? Use sunscreen sun Fluoride ? Fluoride • Wean bottle Brush teeth ? Brush teeth • Fluoride ? Discuss bottle ? Tooth care caries Rolls both ways ? Pulls to stand (8-9) ? Cruise (10) (5) ? Crawls hand/knees ? Walk alone (12) Sits leaning, (9) forward (6) Transfers objects ? 3-finger grasp (9) ? Mature pincer (5+) grasp (I I+) K Radial rake grasp ? Voluntary release Ah-goo (5) ? Mama/dada (non- ? Understands no Babbling (6) specific) (8) (10) ? Peek-a-boo, pat-a- ? Mama/dada +1-2 cake (9) words (12) Explores ? Shy with strangers ? Imitates actions environment with ? Comes when called eyes, hands, mouth ? Metabolic ? Check Metabolic ? Check Hearing ? ? Anemia ? TB screening screening results screening results ? Lead If not done at 9 months: ? Hearing ? Check Hearing ? Anemia r? screening screening results ? Lead ? Hep B ? Comvax # 1 ? Comvax # 2 DTaP # 3 Z ? ? Comvax # 3 c ? (at Birth) ? DTaP # 1 ? DTaP # 2 PV # 3 I ? MMR #I ? IPV # 1 ? IPV # 2 tJ PCV7 #3 ? Varicella ? PCV7 # 1 ? PCV7 # 2 1 ? PCV7 # 4 ? PPD ?y . n" r,.,-... Any 1 i1 117 /Al January 18, 2005 (11:19AM) WP60401 PATIENT'S NAME: LOVELLE, DOCTOR'S NAME: MIG TELE (H): 937-9440 INSURANCE: TRICARE CURRENT MEDICATION: NONE AGE: 7 MOS HT: 26" WT: BROOKE (CORD) NURSE'S NAME: SES/SP 17-12/8.1 KG HEAD CIRC: 41 CMS PROBLEM: HEALTH SUPERVISION 1 S : 7 MO, new patient, who has returned with her mother to mother' s home town after a near disastrous beginning in Okinawa at birth. Dad currently is in Thailand, aboard a carrier, doing tsunami relief. Mrs. Lovelle is trying to access mental health services as she herself is likely depressed by her own judgement. This YL had a very difficult birth. It was vaginal. Mother's 3rd pregnancy, 21d child. Apgars were low at 1, 3 and 5. She was recognized initially as having severe hypoxia. She spent 11 days in the intensive care unit. She has seizures the first 48 hours of life and required phenobarbital until approximately 4 1-? - 5 MO. She had EEG's at 2 days and 2 weeks of age. She had a CAT scan at 2 days of age that may have been normal. However mother was told after one of the tests that it showed that she had scarring of the brain. Mother has accessed medical care at Tripler in Hawaii. I believe she has seen a Pediatric neurologist there and because of the terrible birth history, mother has feared the worst. To make matters even more intense, Brook doesn't have much of a fontanelle and she has a small head circumference though mother admitted to me that her husband has an exceptionally small head circumference and has to have a special size for his covering. Mother listed 5 different concerns. 1. Concerns from the birth history. 2. Soft spot has closed early. 3. Whether she needs referral for developmental pediatrician, and I shared with her that we really didn't have such. However, we had a DEI clinic. 4. Referral for an MRI and/or CAT scan. And I suggested that, that was something we can and should do if there are developmental concerns. 5. Mother's other concern was head circumference being small. 0: Exam shows a beautiful spontaneous social baby. She was being breast fed when I walked in. She didn't object to stopping. She permitted a full, easy exam. I spent the first several minutes simply watching how she managed play items that I gave her: tongue blade, ear speculum. She transfers readily. LOVELLE, BROOKE #60401 DOS: 01/18/05 -continued- 2 She has a fine and symmetrical pinchers grip, both upper extremities. She sits well and has been sitting for over a month with excellent truncal control. Again, good social presence with herself in the mirror and me. When place prone, she has good use of both lower extremities. She appears to be using them quite normally. Mother is concerned that she tends to roll only 1 way when she is moving about and I suggested that, that we should explain as just a habit. The way she learned to roll and push into a sitting position. HEENT is totally benign. Neck supple, no adenopathy. Chest clear. Heart no murmurs. Abdomen no masses. Genitalia and extremities are normal. I forgot to do deep tendon reflexes but there was nothing to lead me to worry about that. A: Birth history not withstanding, this is a beautiful baby and I think we can explain the fontanelle as normal, the small head circumference as familial and mother is going to get Dad's head circumference. P: 1. I suggested that we needed to get out from under the clouds that she has been living under. That we ought to carefully and meticulously plot her developmental milestones but lets not make her sick or delayed unless we see clear evidence of such. I think just the opposite appears to be true. 2. Well checkup at 9 MO. Mother is going to send for the immunization record. She may be behind a Prevnar. 3. I encouraged mother to access mental health services and Dr. Buckley may herself be willing to put her on an antidepressant. TGM/lh DT: 1/20/05, 12:31PM LOVELLE, BROOKE DATE: 01/27/05 NURSE'S NOTE: Mother is breastfeeding. Her physician may describe an antidepressant for postpartum depression. Wanted Dr. Mignerey's input. Per Dr. Mignerey she can take anything her doctor wants to put her on. Mrs. Lovelle has been informed. Cindy/cr PATIENT'S NAME: LO DOCTOR'S NAME: MIG TELE (H): 937-9440 INSURANCE: TRICARE AGE: 9 MOS HT: 28 March 10, 2005 (6:13PM) WP60401 VELLE, BROOKE (CORD) NURSE'S NAME: CT/SP WT: 18-11/8.5 KG HEAD CIRC: 42 CMS 3 PROBLEM: HEALTH SUPERVISION S: 9 MO who is doing wonderfully. She's pulling herself up and cruising along furniture. Brooke has her first word at 9 MO, being uh-oh when something drops. Mother is now on an antidepressant herself. Dad is now home, and the family is going to be restationed to the East Coast. Actually, family is moving out of Pensacola, leaving at 0500 tomorrow already. Mother did not bring the immunization dates in, so I jotted down what Brooke should have at this point. 0: Exam shows a WDWN infant who is following normal growth curves. ENT exam is normal. TMs perfect. Normal teeth without evidence for decay. Neck supple, no adenopathy. Chest clear. Heart no murmurs. Abdomen, skin and genitalia WNL. P: 1. Next health supervision at age 12 months. 2. IPV not given as she may have gotten the 3rd at 6 MO. Mother going to check all dates. 3. Hemoglobin of 16 was documented x2, so I sent child for CBC at Sacred Heart Hospital. TGM/lh DT: 3/15/05, 1:38PM LOVELLE, BROOKE DATE: 03/11/05 NURSE'S NOTE: CBC done 03/10/05: WBC 10.8, HGB 14.8, HCT 43.4, platelets 440, 000, neutrophils 41, lymphs 23, monos 30, eos 4, basos 1, bands 1, 9 atypical lymphs. Parents informed of results by Dr. Mignerey on 03/10/05. MAM/cr NAME &00 KP In DATE OF BIRT$ 1O RECORD NUMBER -4, GE DATE 1-2 wk 2 mo 4 mo 6 mo 9 mo 12 mo sI zs?,, 1 ? mo 18 mo 24- mo 30 mo 3 yr 4 yr Developmental Assessment fixes / turns head side to side / responds to voice I grasps; startle follows 180 / lifts head / tuuns to voice / smiles responsively reaches / grasps / hands midhne / bears weight / squeal / laugh / no head lag /rolls one way works for toy out of reach / sits (with support) / transfers / babbles pat-a-cake /peek-a-boo / crawls / cruises / non- ecific mama-dada / bans cubes / ets t sit i c ma d wa s s al /ate uses spoon / throws ball / 3 words ! imitates / climbs stairs / points to body parts stranger anxiety / stacks / locks ball / helps undress / combines words . separates / helps dress /jumps in place / plurals / 50 words / imitates dresses w/supervision / identifies colors / imitates bridge / imagination dresses w/o supervision / copies O / balances on one foot/ gives first & last name / edals trike copies square / propositions / catches ball / opposites / hops on one foot / draws man (3 5 yr dresses self / writes name / skips / rides bike / defines words 6 yr rides 2-wheeler / knows left-right / school / roller skates / draws erson . social skills 7 yr tells time / chores / school performance ) reads / 1 U y1" l 12 yx i 1 .1 q ; r ? i 16 yr .8 yr I i erformance / chores / social skills reads / sexual development / school performance / chores / family responsibility / social skills reads / sexuality / school performance / chores / family responsibility / social ..kills resn?•ns.our; soc;'ai sl?lls reads / sexuality / school performance / family responsibility / social skills / anticipate driving adult transition (college/job) /school performance / family responsibility Anticipatory Guidance smoke detector / water temp / fevers / stuffy nose / cord care / siblings / sleep on side or back car seat / no solids / rolling sleep-patterns / belly time / immunization reactions car seat / rear facing / falls / no walkers / ? solids / separation stage / teething car seat/ cup/ solids/ fluoride / outlet/ cords /stair safety /'sun / slow weight gain exploration safety / car seat / table foods /shoes / tooth care / separation / independence cagLa ?? fidjs, inets / =V/ %n? Fgan Y we milk tantrums / discipline / picky diet / off bottle / spoons / dreams / waking / car seat / water / climbing car seat / water / doors / delay toileting / negativism / tantrums / choices / time-out car seat / water / fire / outside safety / toileting / imagination / bed transition nightmares / genital exploration / toilet consistency ! positive reinforcement car seat /water / pedestrian / bike helmet / dentist / fears / sharine / rules car restraint / water./ ped / firearms / bike safety / social! preschool / limit TV car restraint / water / bike { ped / firearms / stranger / school readiness /phobia / chores seat belt /bike / ped / water / helmet / stranger/ school / social / chores seat belt/ bike / ped / water /firearms / substance / seat belt / bike / ped / water / firearm / substance / c ' seat belt / bike I ped-/ water / firearms / substance / school i" social / sexual develo ment seat belt /pass engei / pedestrian / water /.bike / smoking / alcohol / drutrs-sexuality / violence / contidcntialir -moods % coping ! school social transi ons ; school. social coping ; STD abstinence / contraception car / driving safety / ped / bike / water / substance use / sexuality / BSE/TSE / coping / violence / jobs / eers / dating / school / autici ate career car / water I ped / substance use -risk taking / adult transitions / sexuality / STD / BSPME - violence / mood / coping -school CHRONOLOGICAL RECORD OF WELL-BABY CARE For use of this form, see AR 40-66; the proponent agency is the Office of The Surqeon General DOB WEIGHT HEIGHT KU SIGNIFICANT NEONATAL HX 7 DATE OF VISIT i/5- r D.3 AGE *amonths 15 to 18 months WEIGHT HEIGHT !?Q HEAD CIRCUMFERENCE SUBJECTIVE (HISTORY) ?? ? ? Milk /Juice -_ • a.. Milk !Juice 1. FEEDING Diet: fiz, (o ?Q, Diet Stools/Day j= Voids f- Stools/Day Voids 2. FORMULA/BREAST Feeds self with fingers _ Uses cup + Walks/runs _ Climbs_ Uses spoon_ SOLIDS Says Da-Da/Ma-Ma and 1 to 3 words, =t=- Says 5 to 15 words Phrases Stands alone/support ' Points to body parts VITAMINS/FLOURIDE Walks alone/support 16. M.-? r Builds a 1 to 3 block tower Pincer grasp Waves bye-bye Takes two commands together 3. ELIMINATION Bends and recovers + Allergies Sleep pattern Current meds 4. GROWTH AND DEVELOPMENT Allergies Parental concerns Current meds 14, 5. PARENTAL CONCERNS Parental concerns d OBJECTIVE PHYSICAL EXAM NUTRITION HEAD/FONTANEL EENT NECK/CLAVICLES LUNGS HEART ABDOMEN GENITALIA/HERNIA HIPSISPINE EXTREMITIES SKIN NEUROLOGICAL ASSESSMENT PLANS AND COUNSELING Dental care discussed. Dental care and toilet training discussed. Discussion and handouts given on nutrition, Discussion and handouts given on nutrition, SAFETY safety, and growth and development. safety, and growth and development. GROWTH AND DEVELOPMENT Tylenol drops / elixir Tylenol drops / elixir IMMUNIZATION Parents verbalized understanding of instruc- Parents verbalized understanding of Instruc- NEXT VISIT tions. Return to clinic at age I-?^^??? ? tions. Return to clinic at age EXAMINED BY EXAMINED BY CA--P lk-K PATIENT'S IDENTIFICATION (Name, last. first, mi dle, grade, : R RI<S date, hospital or medical facility j Lin a J. I ?c?rit M.D. Pediatrician 6?/97s? 9 DA FORM 5568-R, OCT 86 MEDDAC (Ft Meade) OP 228, 1 Mar 92 a ? CCS ? U ? • Q p U1 O N LVJ Cd •- +- 4,,') rid cs co :-d o rq O - ? V Cd ?i ;? Cd r > c O w ?-q ? bA N H 4.4 CO N r---? O r? 'D Z N -- t 7. u ? V ? '-i- -?? LIZ ? 0 V V O O J ? ? Iz, ? .p O • v1 v a 6 w O w O + m o ? y 0 _ O o ID ) C N rs m 4i O W ro Q 4i 0 • N W w W W O y- O w m ?. `r- W co V1 O k ? m O CD cm Q w 9) CL Fes- Z Q ] Q O Z Q (0 C i _ r c ? ? N ? n L J m m l n ? ? ? w , . o ? (?? . v y (fl ?+ 6 d G. CL m m c ? Q > H rn C d eA v 7 Ol L. .. ? ? v r o 44 4 -71 i ? I fJ // 1 s O ,? o ?v o • lU co cu _ U- =0 .? U O V O U LO C5 0 _' ?- Z m n, W V/ O ? y v O 7 , O N ? ? m N r+ ? I \?J , Y t` V > c0 h a ++ C m 1 fD "? W m a C m -- m m H ma 2 m (D r rn 75 a m a ,; c /?, N m ) c c -? . ?- _ \r \r 0 ? . C r ? } CIO - C } ? 1--r cc-l- o D u O 17 , r C s v E . O 1 cu N W 4 ? ? 's? l ? J wI lz? L . L1_V 45 ?? j, cfl • o 75 a ca si J w O O ? N d .2 j cc :3 5 y Q C m "? O O •Cl LU W o O U t t0 0 7 V) N CL d 0) 0) co 0) C? Q 7t Q c 75 V N Q ? O ' 1 -+- L' C p " v t i CZ) 1 s. L t -tea V J U ? > Q ? Y h ?` ^.- ?V ? Q1 ;f t O c ? c mil/ ` r 5 o .. M 1 m r d} ' C1 H (1 7 ------------- ---- - • in %n cd a , , ? - ? ' ? _ , ? ' ,, -gyp v V V) •- O c ' N v O , L ? co 4- d iL 0 U) r C L U ? c n ?. . O G ? .D 4 I 0 , L . y = c U U) l0 '- L N 1 ' C O C • ?. E d Y w M ?ts~ - o 0 •- O IY7 C _ C Y ?'a CD N L ca ? C N 3 cn , (L)?a) ? ? J ?o =0?N C C Q U) 0 C D.0 C L 0 IX - CN O ? U 10:. 06 C(a L_ M L 4) ` E rn c c N L ca •- 9 1 3 c a cu 't -` . - J w !G , - (>0 CYO 2 N o s?c: ? ?* N s c -- c 3 i C, s: 0 M" V L _O (0 t? y N a E (D :E cc = U d 1 _ w ima yt E~ _ E O y y N c ~ f0 > o N 'o N N C ` N N t = . O C Rf .E _? J C I L, S L C j, ? •`? . ,_}.. ? `.1 ! i I 1 I i I ? ! I j I I j I U L ? I E O cD w' ?o - f° m ac L _ n N _ w 5 cc o a f ? l zz:k I! 3 ca omc?c Z -'vm-? d c N E ccy) E ? E(D t c c cB E w U 0 N 0 h 0 T " - HEALTH RECORD CHRONOLOGICAL RECORD OF MF -'SAL CARE Patient: LOVELL, BROOKE CHEYENNE Date: 26 Jul 20061000 EDT Appt Type: WELL Facility: NNMC Bethesda, MD Clinic: Pediatric Clinic Dunham Provider: CLARK, LINDA J Patient Status: Outpatient Reason for Appointment: WELL CHILD Appointment Comments: SSF AutoCites Refreshed by CLARK, LINDA J 0-28 Jul 20061023 EDT Problems Allergies • OTITIS MEDIA ACUTE No Allergies Found. • ALLERGIC RHINITIS Active Medications Active Medications Status Sig Refills Left Last Filled CETIRIZINE HCL, 1MG/ML, SYRUP Active GIVE 112 TEASPOON PO 1 of 3 26 Jul 2006 BID #240 RF3 Screening Written by DONMOYER, STEPHEN M Ca. 28 Jul 20061005 EDT Reason For Appointment: WELL CHILD Allergen Information verified by DONMOYER, STEPHEN M @ 28 Jul 2006 1005 EDT Vitals Vitals Written by DONMOYER, STEPHEN M 01) 28 Jul 2006 1005 EDT HR: 100 Apical, Regular, RR: 20, T: 97.5 °F Axillary, HT: 33.5 In, WT: 23.6 Ibs, Head: 18 in, BMI: 14.78, BSA: 0.493 square meters, Tobacco Use: No, Alcohol Use: No, Pain Scale: 0 Pain Free Questionnaire AutoCltes Refreshed by CLARK. LINDA J 0, 28 Jul 2006 1023 EDT Questionnaires No Questionnaires Found. SO Note Written by CLARK, LINDA J (ED 28 Jul 2006 1032 EDT Reason for Visit Visit for. 2-3 year visit. .History of present illness The Patient is a 2 year 1 month old female. Source of patient information was mother AT THIS APPT MOTHER DENIES ANY PROBLEMS EXCEPT CHILD STILL LIKES TO WAKE AT NIGHT AND FOR MOTHER TO BREASTFEED. MOTHER WOULD LIKE TO STOP ° Puts on clothing ° Washes and dries hands ° Separates from parent easily ° Plays interactively with other children ° Stacks five or more blocks ° Turns single pages Uses two-three word. sentences ° Jumps in place ° Runs well ° Walks up and Diagnosis History: - - Z-YRTEE- Previous therapy History of discussed storage of medications and nutritional need milk quantity Review of systems Otolaryngeal symptoms: No earache, no nasal discharge, and no nasal passage blockage. Pulmonary symptoms: No wheezing. Gastrointestinal symptoms: No vomiting and no diarrhea. Physical findings Standard Measurements: ° Weight was normal. ° Height was normal. General appearance: Name: LOVELL, BROOKE CHEYENNE Sex: F FMPISSN: 02/155529729 Tel H: 717-241-4495 Sponsor/SSN: LOVELL, CHRISTOPHER W/155529729 Rank: DOB: 10 Jun 2004 Tel W: 717-2414495 Unit: PCat: M41 USMC PAM MBR AD CS: Outpt Rec. Rm: DUNHAM OUTPT RECORDS C MC Status: SWS: PCM: _ CLARK,LINDA J Insurance: No Tel, PCM: 717 245 4574 CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5) THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS Prescribed by GSA and ICMR TO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED. FIRMR (41 CPR) 201-45.505 Page I of 4 HEALTH RECORD 28 Jul 2006 1002 CHRONOLOGICAL RECORD OF MY _,_ _TAL CARE Facility: NNMC Bethesda, MD Clinic: Pediatric Clinic Dunham Pro. .der: CLARK, LINDA J • Alert. • Well developed. ' Active. Eyes: General/bilateral: Extraocular Movements: • Normal. • No strabismus was observed. Retina: • Red retinal reflex was elicited. Ears: Right ear: Tympanic Membrane: • No decreased mobility of tympanic membrane. Left ear: Tympanic Membrane: • No decreased mobility of tympanic membrane. Pharynx: Oropharynx: • Had no white patches. Mucosal Findings: • Pharynx had no mucosal abnormalities. Lungs: ' Clear to auscultation. Cardiovascular system: Murmurs: • No murmurs were heard. Abdomen: Palpation: • Abdomen was soft. Hepatic Findings: • Liver was not enlarged. Splenic Findings: • Spleen was not enlarged. Neurological: Motor: • Muscle tone was normal. Growth and development: • No delayed milestones. C ounselinp/Education • No loss of tympanic membrane light reflex. • No loss of tympanic membrane light reflex. • Discussed use of car seats • Discussed storage of cleaning agents and chemicals • Discussed 'chiid-proofing' the house • Discussed premature discipline • Discussed preventing falls • Discussed bum precautions • Discussed concerns about tooth brushing A/P Written by CLARK. LINDA J (a) 28 Jul 2006 1054 EDT 1. Preventive Medicine Established Patient Checkup Child 14: DAPT/HIBNARIVAX/HEPATITIS A DISCUSSED WITH MOTHER MUST TRY TO SUBSTITUE A BLANKET OR STUFFED TOY INSTEAD OF USING MOTHER TO COMFORT HER AT NIGHT BY BREASTFEEDING. DISCUSSED WAYS TO REDUCE NIGHT AWAKENING Disposition Written by CLARK. LINDA J ® 28 Jul 20061028 EDT neNNhere are - Coinments, INFLUENZA VACCINE , .... fs-?A1Cerrtatives?aterlflaF?e-E#ect??iirt?h-PareRf _. ._..,_. . 30 minutes face-to-face/floor time.. Note Written by DONMOYER STEPHEN M 0 28 Jul 20061009 EDT Name: LOVELL, BROOKE CHEYENNE Sex: F Sponsor/SSN: LOVELL, CHRISTOPHER W/155529729 FMP/SSN: 02/155529729 Tel H: 717-241-4495 Rank: DOB: 10 Jun 2004 Tel W: 717-241-4495 Unit: PCat: M41 USMC FAM MBR AD CS: Outpt Rec. Rm: DUNHAM OUTPT RECORDS C MC Status: SWS: PCM: CLARK,LINDA J Insurance: No Tel. PCM: 717 245 4574 CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5) THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS Prescribed by GSA and ICMR TO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED. FIRMR (41 CFR) 20145.505 Pft 2et4. HEALTH RECORD CHRONOLOGICAL RECORD OF 7DICAL CARE Patient: LOVELL, BROOKE CHEYENNE Date: 24 Apr 20071000 EDT Appt Type: WELL Facility: NNMC Bethesda, MD Clinic: Pediatric Clinic Dunham Provider: MCKIERNAN, SHARON P Patient Status: Outpatient Reason for Appointment: WELL CHILD EXAM/REQ REFERRAL FOR SPEECH Appointment Comments: SES AutoCltes Refreshed by MCKIERNAN, SHARON P A) 24 Apr 2007 1127 EDT Problems Allergies • STRABISMUS • ALLERGIC RHINITIS No Allergies Found. • BIRTH TRAUMA ' Active Medications Active Medications Status Sig Refills Left Last Filled CETIRIZINE HCL, 1 MG/ML, SYRUP Active GIVE 1/2 TEASPOON PO 3 of 3 07 Peb 2007 BID #240 RF3 Screeninla Written by KNEPPER, TAMMY K (dl 24 Apr 2007 1022 EDT Reason For Appointment: WELL CHILD EXAM/REQ REFERRAL FOR SPEECH Allergen information verified by KNEPPER, TAMMY K @ 24 Apr 2007 1022 EDT Vitals Vitals Written by KNEPPER, TAMMY K (ED 24 Apr 2007 1022 EDT BP: 80/42 Pediatric Cuff, Left Arm, HR: 104 Radial Artery, Regular, RR: 20, T: 97.5 °F Axillary, HT: 36 in Without Shoes, Actual, WT: 27.25 ibs Upright Scale, Without Shoes, Actual, Head: 18.25 in, BMI: 14.78, BSA: 0.552 square meters, Pain Scale: 0 Pain Free Comments: 3 Y/O WELL CHILD/DAYCARE EXAM. Questionnaire AutoCites Refreshed by MCKIERNAN. SHARON P 0 24 Aar 2007 1127 EDT Questionnaires No Questionnaires Found. SO Note Written by KNEPPER, TAMMY K (a) 24 Apr 2007 1027 EDT History of present illness The Patient is a 2 year 10 month old female. ° Knows name, age, and sex ° Can ride a tricycle • Does not button clothes ° Dresses with supervision ° Dresses without supervision ° Symbolic play ° Can copy a circle ° Can copy a cross • Cannot draw a person ° Comprehends cold, hungry, tired ° Uses prepositions ° Uses pronouns ° Recognizes three of four colors ' Balances on one foot for five seconds Does not balance on one foot for ten seconds ° Alternates feet walking up stairs SO Note Written by MCKIERNAN, SHARON P Aa 24 Apr 2007 1055 EDT Chief complaint The Chief Complaint is: 2 thru 3 Year Old Well Child Visit History of present illness The Patient is a 2 year 10 month old female. Source of patient information was mother. LEARNING ASSESSEMENT DONE [ ] YES [ X ] NO DATE:24 APRIL 07 • Past medical history reviewed Traumatic Birth with asphyxia and sz, had been receiving EIS services in Okinawa but not since moving here. Determined no longer needed Name: LOVELL, BROOKE CHEYENNE Sex: F Sponsor/SSN: LOVELL, CHRISTOPHER W/155529729 FMP/SSN: 02/155529729 Tel H: 717-241-4495 Rank: DOB: 10 Jun 2004 Tel W: 717-2414495 Unit: PCat: M41 USMC FAM MBR AD CS: Outpt Rec. Rm: DUNHAM OUTPT RECORDS C MC Status: SWS: PCM: CLARK,LINDA I Insurance: No Tel. PCM: 717 245 4574 CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5) THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS Prescribed by GSA and ICMR TO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED. FIRMR (41 CFR) 20145.505 19 P.- Y rd; HEALTH RECORD 24 Apr 2007 1004 Facility: CHRONOLOGICAL RECORD OF 11 ""DICAL CARE ethesda, MD Clinic: Pediatric Clinic Dunham ' ivider: MCKIERNAN, SHARON P ° Visit is not deployment-related. Past medical/surgical history Reported History: Recent events: No active illness. Reported medications: Medication history zyrtec pm allergies Not taking OTC medications, no dietary supplements, and no vitamin supplements. Pediatric history: Thumb sucking. Bladder trained and bowel trained. Previous therapy No history of herbal medicines Review of systems Systemic symptoms: No fever. Otolaryngeal symptoms: No nasal discharge. Pulmonary symptoms: No cough. Physical findings Vital signs: ° Current vital signs reviewed. General appearance: ° Alert. ° Well nourished. ° Well hydrated. ° Healthy appearing. Head: ° Showed no asymmetry. Eyes: General/bilateral: Pupils: ° Reactive to light. Retina: ° Red retinal reflex was elicited in both eyes. Ears: Right ear: Tympanic Membrane: ° Not erythematous. ° No decreased mobility of tympanic membrane. ° No loss of tympanic membrane light reflex. ° No loss of tympanic membrane landmarks. Left ear: Tympanic Membrane: ° Not erythematous. ° No decreased mobility of tympanic membrane. ° No loss of tympanic membrane light reflex. ° No loss of tympanic membrane landmarks. Oral cavity: Buccal Mucosa: ° Examination showed no abnormalities. Neck: ° Demonstrated no decrease in suppleness. ° No cervical mass was seen. Lymph Nodes: ° Cervical lymph nodes were not enlarged. Chest: ° Visual inspection revealed no abnormalities. Lungs: ° Clear to auscultation. Cardiovascular system: Heart Rate And Rhythm: ° Heart rate was normal. Murmurs: ° No murmurs were heard. Arterial Pulses: ° Femoral pulses were normal. Abdomen: Auscultation: ° Bowel sounds were normal. Palpation: ° Abdomen was soft. ° No mass was palpated in the abdomen. Hepatic Findings: ° Liver was not enlarged. Splenic Findings: ° Spleen was not,enlarged. Hernia: ° No umbilical hernia was discovered. ° No inguinal hernia was discovered. Genitalia: External: ° Genitalia showed no abnormalities. ° No labial adhesions were observed. Rectum: Anus: ° Normal. Skin: ° Color and pigmentation were normal. Musculoskeletal system: Thoracolumbar Spine: General/bilateral: ° No scoliosis was noted. Neurological: Motor: ° Muscle tone was normal. Reflexes: ° Normal. Nalne: LOVELL, BROOKE CHEYENNE Sex: F Sponsor/SSN: LOVELL, CHRISTOPHER W/155529729 FMP/SSN: 02/155529729 Tel H: 717-241-4495 Rank: DOB: 10 Jun 2004 Tel W: 717-241-4495 Unit: PCat: M41 USMC FAM MBR AD CS: Outpt Rec. Rm: DUNHAM OUTPT RECORDS C MC Status: SWS: PCM: CLARK,LINDA J Insurance: No Tel. PCM: 717 245 4574 CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5) THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS Prescribed by GSA and ICMR TO THIS INFORM ATION IS A VIOLATION OF FEDERAL LAW. fIOLATORS WILL BE PROSECUTED. FIRMR (4I CPR) 201-45.505 _HEALTH RECORD 1 CHRONOLOGICAL RECORD OF;' 'DICAL CARE 24 Apr 2007 1004 Facility: NNM. tthesda, MD Clinic: Pediatric Clinic Dunham ovider: MCIQERNAN, SHARON P Therapy • Review immunization schedule. Counseling/Education • Discussed use of car seats • Discussed 'child-proofing' the house • Discussed concerns about tooth brushing • Parent education about dental visits A/P Last updated by OCKER. KATHY D (a) 24 Apr 20071105 EDT 1. Preventive Medicine Established Patient Checkup Child 1-4: speaks with lisp. CHilDFIND eval recommended though may not meet therapy criteria. also to schedule opt apt..consuit already placed by other physician. 2. Need For Vaccination Hepatitis A: Vaccine administered by Kathy Ocker Ipn Procedure(s): -Immunization Administration One Vaccine -Hep A Vac Ped/Adol Dosage (Intramusc Use) 2 Dose Schedule Disposition Written by MCKIERNAN, SHARON P (a) 24 Apr 2007 1054 EDT Released w/o Limitations Follow up: as needed with PCM. Discussed: Diagnosis, Medication(s)/Treatment(s), Alternatives, Potential Side Effects with Parent who indicated understanding. 20 minutes face-to-face/floor time.. Note Written by KNEPPER, TAMMY K aa. 24 Apr 2007 1031 EDT Name: LOVELL, BROOKE CHEYENNE Sex: F SponsorISSN: LOVELL, CHRISTOPHER W/I55529729 FMP/SSN: 02/155529729 Tel H: 717-2414495 Rank: DOB: 10 Jun 2004 Tel W: 717-241-4495 Unit: PCat: M41 USMC FAM MBR AD CS: Outpt Rec. Rm: DUNHAM OUTPT RECORDS C MC Status: SWS: PCM: CLARK,LINDA J Insurance: No Tel. PCM: 717 245 4574 CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5) THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESS Prescribed by GSA and ICMR TO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED. FIRMR (41 CPR) 20145.505 4 Dnnn's nrA Name: Kimberly P. Lovell Clinical Record Provider: Ann D. Walker, LCSW Date: 6109/2005 Personal Data ID: 30/155-52-9729 Birth Date: 12/7/1971 Treatment Status: Active Address: 284 Tanger Rd. Age: 33 Previously Treated?: No Gender: Female Pri. Care Physician: Dr. Young City: Boiling Springs Race: Caucasian Employer: State: PA Marital Status: Married Referral Source: PCM Zip: 17007 Military Rank: Psychiatrist: Home Phone: 717-2414495 Treatment Start Date: 6/9/2005 Setting: Outpatient Work Phone: Treatment End Date: Department: Behavioral Health SSN: 591-70-6311 Last Review: Diagnosis - Axis 1 296.22 Major Depressive Disorder, Single Episode 309.81 Posttraumatic Stress Disorder Axis II V71.09 No Diagnosis Axis III None Axis IV Support Group Deficit: Socially Isolated Stress Severity Rating: 3 Moderate Axis V Current: 51-60 Prior: Presenting Problems Primary Depression Secondary Posttraumatic Stress Disorder (PTSD) Progress Notes Session 1 Date: 6/9/2005 Time: 11:00 AM to 12:00 PM (60 min) Progress Rating: N/A Modality: Diagnostic Interview CPT Code: 90801 Narrative Progress Note: Kim was seen for an acute appt. today. Her husband had telephoned and stated that he was very concerned about her due to depressive symptoms. He had also telephoned his wife's PCM, and she made a referral for Kim to be seen at Behavioral Health before she meets with Kim on 6/14/05. Kim reported numerous symptoms of depression. However, she also described many symptoms which are congruent with PTSD. She discussed the fact that she had witnessed her daughter going through a severe birth trauma, one year ago. She noted that her daughter was bom lifeless and had to be revived, and then lost all vital signs several times throughout the first day of life. She indicated that her daughter seems to be fine now, "but Mom is not OK." I told Kim of my impression of her diagnosis. I told her that I would speak to Dr. Young about her symptoms before her appt. on 6/14. We discussed some coping techniques. Kim was given suggestions such as developing an exercise program. Kim agreed to return for counseling on a regular basis. Treatment will focus on depression and PTSD. Please refer to the Prro'vider's BHA when completed, after one or two additional sessions. Provider Signature: 6, 0 y ter Ann D. Walker, LCSW Date AUTHORIZED FOR LOCAL REPRODUCTION MEDICAL RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry) 6/8/05 1400 Spoke to MAJ Lovell reference his call to Dr. Young's office about his wife. MAJ Lovell indicated that they have recently arrived in the area from Okinawa. He indicated that his wife has suffered significant symptoms since the birth of the first child 3.5 years ago. At the time she spoke about thoughts of self harm. The couple had a child 1 year ago and MAJ Lovell describes it as being a "traumatic birth" resulting in a life threatening situation. Since the birth of that child MAJ Lovell's wife has experienced numerous "episodes" of "crying and yelling" and "not being herself." MAJ Lovell indicates that his wife has said that she hears voices and that the voices have told her to put a hose to the van and close the doors. When asked if she has expressed thoughts of harming the children he indicates that she has stated that she has wanted to "strangle" the older child but he believes it is just a figure of speech. MAJ Lovell indicates that his wife has received care in Okinawa however they were PCS to his area as a result of his wife's symptoms. MAJ Lovell' s wife has seen both a psychologist and a psychiatrist but not apparently on a consistent basis. She was deemed as being Level II suicidality. She has been prescribed Zoloft but neither MAJ Lovell nor his wife know if she has been taking the medication consistently. Currently there is an added stressor of a family birthday part for the youngest child this week. MAJ Lovell indicated that he has an appt with Dr. Young for his wife on 6/14/05 but would like her to been seen sooner due to his concerns about her health.. I encouraged MAJ Lovell to take his wife to Carlisle ER or Holly Spirit ER in order to have her evaluated for medication and then monitor her medicationsl also informed MAJ Lovell about accessing care in the network and that he does not need a referral from Dunham to access care. MAJ Lovell indicated that he is familiar with accessing the network because he has done it in search of a pediatrician MAJ Lovell was encouraged to take his wife to the ER and to access care in the network since no appt before the 14th would be available at Dunham. INES ROE LPC CCMHC COUNSELING PSYCHOLOGIST HOSPITAL OR MEDICAL FACILITY STATUS DEPART./SERVICE RECORDS MAINTAINED AT SPONSOR'S NAME SSN/ID NO. RELATIONSHIP TO SPONSOR PATIENT'S IDENTIFICATION: (For typed or written entries, give: Name - last, first, middle; ID No or SSN; Sex; Date of Birth; Rank/Grade.) REGISTER NO. WARD NO. CHRONOLOGICAL RECORD OF MEDICAL CARE Medical Record STANDARD FORM 600 (REV. 6-97) Prescribed by GSA/ICMR FIRMR (41 CFR) 201-9.202-1 USAPA V2.00 TELEPHONE MEDICAL ADVICElCONSULTATION RECORD For use of form, see AR40-66; the proponent agency Is the OTSG. NAME (Last, First, MI) Lovell, Kim TELEPHONE NO. ORGANIZATION OF PATIENT/SPONSOR FMP SSN OF PATIENT/SPON- SOR 155-52-9729 LOCATION OF PATIENTS MEDICAL RECORD ? CENTRAL FILES AREA ? OTHER (Specify) HOSPITAL AND CLINIC IDENTIFICATION SERVICE AFFILIATION ? ARMY ? NAVY ® MARINE CORPS ? AIR FORCE ? OTHER (Specify) BENEFICIARY CATEGORY ? AD ®DEPN AD ? RET ? DEPN RET ? DEPN RET/DECD ? OTHER (Specify) PATIENT STATUS DATE AND TIME OF CALL 10/13/05 ? INPATIENT ® OUTPATIENT ? EMERGENCY NON-EMERGENCY SUMMARY (Include complaint, diagnosis, instructions to patient) T/C to Kim to inquire about her interest in continuing with treatment. She stated that she was doing much better, but would like to come in one more time, to discuss the need for additional treatment. She scheduled for 10/18/05. ? CHECK IF CONTINUED ON REVERSE SIGNATURE OF PHYSICIAN/CARE PROVIDER ` n DA FORM 5008, OCT 81 USAPA V1.01 ANN D. WALKER LCSW PMe 1 of 2 DUNHAM US ARMY HEALTH CLINIC SOCIAL WORKER NSN 7540-00-634-4176 600-108 HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE DATE SYMPTOMS, DIAGNOSIS, TREATMENT, TREATING ORGANIZATION (Sign each entry) BEHAVIORAL HEALTH TERMINATION SUMMARY AND DISCHARGE PLAN 05 Dec 05 1. Thera for this patient was terminated on this date: 05 Dec 05 2. The atient was a medical referral. 3. Type of treatment modality utilized: Individual 4. Total number of sessions: 4 From: 09 Jun 05 To: 01 Au 05 5a. Medications: Zoloft 5b. Hospitalizations: None 6. The patient's current clinical status has: substantial) improved 7. The decision to terminate was discussed with understood b the patient. 8a. Initial diagnosis: 8a. Termination diagnosis: AXIS I: MDD, in partial remission, PTSD, in partial AXIS I: Maior Depressive Disorder, PTSD remission AXIS II: No Diagnosis AXIS 11: No Diagnosis AXIS III: None AXIS III: None GAF: 51-60 GAF: 70 OQ-45: 100 OQ-45: 37 9. Patient was stable psychiatrically and medically. No homicidal or suicidal ideations were identified. Yes 10. Treatment recommendations, special instructions, limitations: Continue on reverse if necessary) Kim made significant improvement in her treatment. However, she was not able to fully complete it due to her busy schedule. She was encouraged to return for treatment if her symptoms escalate. ANN D. WALKER LCSW DUNHAM US ARMY HEALTH CLINIC SOCIAL WORKER 11 a. Provider's printed name or stamp 11 b rovlder's signature: HOSPITAL OR MEDICAL FACILITY STATUS DEPARTMENT/SERVICE RECORDS MAINTAINED AT SPONSOR'S NAME SSN/ID NUMBER RELATIONSHIP TO SPONSOR PATIENT'S IDENTIFICATION: (For typed or written entries, give: Name - last, first, middle; ID No or SSN; Sex; Date of Birth; Rank/Grade) REGISTER NUMBER WARD NO. CHRONOLOGICAL RECORD OF MEDICAL CARE Last, First, MI: Lovell, Kimberly SSN: 30/155.52-9729 Medical Record STANDARD FORM 600 (Rev. 6-97) Prescribed by GSA/ICMR FIRMR (41 CFR) 201.9.202.1 MEDDAC (Fort Meade) OP 388, 1 Apr 02 Pravlous editlons are obsolete. IiF, V,'I'hI RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE Patient: LOVELL, BROOKE CHEYENNE Date: 13 Dec 2006 0900 EST Appt Type: SPEC Facility: NNMC Bethesda, MD Clinic: Ped Development Bethesda Provider: BAECHLER, VERONICA R Patient Status: Outpatient Reason for Appointment: Delayed Developmental Milestones Appointment Comments: fcb AutoCites Refreshed by BAECHLERyVERONICA R ?a 13 Dec 2006 1111 EST Problems Allergies • Delayed Developmental Milestones No Allergies Found. • Vaccines Prophylactic: Need Against Inf!uenta • ALLERGIC RHINiT'S • BIRTH TRAUMA • walk is wobbly or unsteady (ataxia) (Sx] • Need For Vaccination Chickenpox (Active) • Need For Vaccination Haemophilus Influenzae Type E • Need For Vaccination Hepatitis A • Vaccines Prophyiactic Need Against DTP • Preventive Medicine Established Patient Checkup Child ' -1 SO Note Written by BAECHLER VERONICA R 13 Dec 2Q06 1119 E5T History-of present illness The Patient is a ." year 6 month old female. ' Encounter 3ackground Information: see below for complete Dev Peds eval report AJP Written by BAECL_c?. VERONICA R an 13 Dec 2006 112 EST 1. visit: screening early childhood developmental handicaps Proceduro(, ; -Psychiatric Evaluation Comprehensive Examination -Dr. Services Special Review /Reporting Of Patient Status 2. CONVULSIONS IN NEWBORN Disposition Written _:)y_ BAECHLER, VERONICA R @ 13 Dec 2006 1122 EST Released w/o Limitations Follow up: 2 voth PCM or sooner if there are problems. Discussed: Diagnosis, Medication(s)ITreatment(s), Alternatives, Potential Side Effects with Parent who indicated understanding. 90 minutes `ace-to-face!floor time. >50% of appointment time spent counseling and/or coordinating care. Note Written oy WARi !S F,AC W_ (a. 13 Dec 2006 0929 EST Consult Order Referring Provider: CLARK, LINDA J Date of Request: 08 Nov 2006 Priority: Routine Provisional Diagnosis: Delayed Developmental Milestones Reason for Request: Nance: LONTIA., BROOKE CHEYENNE Sex: F S[xxtst)r SSN: I.OW-11., CHRISTOPHER !Vd5552972y FMP'SS`v: 02/155529729 Fel 11: 117-241-4495 Rank: 1)013: 10.1un 218)4 1el W: 717-241-449.5 Unit: P( at M41 I IS%4( FANI N113R :%P CS: Outpt Rm Rm: DUNIIAM OUl P'I' RFC'ORDS C %IC Status: SWS: PC M: CLARK,LINDA I insurancc. Nn 1'c!. PC'M: 717 245 4574 C11RU\OLOGI(':11. RECORD OF MEDICAL CARE STANDARD FORM Afro (RED'. 5) CHIN IN1 ORN4A !It )h IS PRO l i-C-1'h.'D BY THE PRIVACY AC" I OF 1974 (PL-93.579). EINAU'DIORI%ED ACCESS Prescribed by GSA and ICNIR '10111 !S INI Y RNI.\ 1'1('\ IS :\ VIOLA1ION OF I+DFRAL LAW. VIOI,AI'ORS WILL. BE PROSE;CUI'EL). F'IRMR(41 rFR) 2ol4.>_115 Page I of I1I:AI.111 RECORD L', Dec 2004 0929 CI4RON(1 OCTCAi. RECORD OF MEDICAL-. CARE t'ucility: NNNIC Bethesda, MD Clinic: Ped Development Bethesda 2 YEARS OLD CHILD S P DIFFICULT DELIVERY LATER DEVELOPED SEIZURES IN NICU.CHILD HAS DONE WELL BUT NEEDS A RE-EVALUATION. PLEASE EVALUATE AND TREAT Note Written by BAECHLEfZ VERONI A R a7 13 Dec 2006 1112 EST Developmental Pediatrics Service Initial Developmental Pediatrics Evaluation (at NNMC) Developmental Pediatrics Service DEPARTMENT OF PEDIATRICS WALTER zf FEF;D ARMY MEDICAL. CENTER Washington, D.C. C'OMM 202-782-0057 WR Motor Clinic Initial Developmental Pediatrics Evaluation (at NNNIC) Date of Evaluation: 13 DEC 2006 PRESENTING INFOICNIATION: 30 month old girl with history of Hypoxic Ischemic L ncephalopathy, referred by Dr. (.larke, civilian pediatrician in Pcmisylvania, accompanied by both parents and almost 5vo brother. Additional inlorniation reviewool included her medical record. Primary care provider: Dr. Clarke. Patient was co-evaluated with Ms. Nona CQ irone. Peds PT, and Mr. Mark Farinas, Peds OT. PRESENTING CONCERNS: Parents have chronic concerns following awareness of heightened risk of developmental and )Carning issues in Brooke. Current concerns surround her sleeping issues and her positional flexion of the 6011 arm '. "hen she nuns. DF.VFI.0l1NiUNI':A1. IIISfORY: Reassuring development. Walked at 13nt of-age, spoke first words at IWo currently speaks ii: "otnplete,tenleliees with about 50% intelligibility. Asks "wli" questions. Tells her name, identifies a number of body parts, names several body parts, follows two step commands, initiates dressing herself. manipulates sttial] objects such as zippers and stacks small things on top of each other. Rotat-,s her wrists to twist things opened. Sl:e jump,, runs, alternates steps when climbing up stairs. -kicks a ball. i-toilet training at this time. uses feedin t utensii-? with left handed preference. No regression. BI:11:?VlC)R NIS I CjRY: No particular behavior concern other than night time frequent awakening. FD1 K'ATIONA1. 1-IIS'I'ORY: Received early intervention services for the first 6 months of life. but none thereafter. Pending enrollment its preschool. Can count. Does not yet identify colors or shapes, but likes puzzles and drawing. ?iI;DICAI.1lIS'l ORl Born at terns by normal spontaneous vaginal delivery, BW 7 pounds. PNC c,b concern over possible Down Syndrome, although parents declined amniocentesis. Parent denied any ETON. tobacco, illicit drug use during the pregnancy. The delivery and prenatal courses were complicated with perinatal severe metabolic acidosis and bon(a) lobe CNS hemorrhage with subgaleal bleeding post vacuum extraction. Systemic coagulopathy also ensued. Required ETT with conventional ventilation for one day. Developed neonatal seizures which was treated with I'lienoharhital for 4 months. Discharged home at DOL 12 without any breathing or eating difficulties. Underwent Peds Neurokwv and Developmental Pediatrics (Dr. John King) evaluations at 4m of agc. There were concerns over motor- asymmetries at that time, but no specific deficit was identified. Since then. overall health has been good except for allergies which are treated with Zyrtec periodically. No recurrence of sei ures. No other chronic medications, hospitalizations, or illnesses. Reassuring Audiology testing results, vision, overall ;rowth, and eating patterns. Has chronic history of frequent night time awakening with crying episodes ahoul hours afier falling asleep. Currently still awakens at least twice a night" Name: LOVFI.L, BROOKE CHEYENNE Sex: F SrxmsorSSN: i,OVf:LL, C'IIRIS"I'UPllI R W155529,29 I NIL' 55`: 02/155529729 lei 11: 717-241-4495 clank: DOW 10 Jun 2tH)4 Tcl w: 717-2414495 shit: I'Cat. M41 0Sb1(' FAN1 N113R AD (.'S! Outpt Rec. Kim DI;NIIAM OUI'i''t RFCORDS C \I(' Status: SWS: PC M: CLARK,LINDA J Insurance: No Tel. PC:M: 71 7 245 4574 Provider: BAECIILF,R, VERONICA R CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 400 IREV.:) 11 [IS iNF(WMATION IS PRO i"EC'FED BY THE PRIVACY AC'I OF 1974 (PL-93-579). UNAtrMORIZED ACCESS Prescribed by GSA and IC:MR 1'0 11 [IS 1\)'OR.\1A I IUN IS A VIOl.AI'ION OF i LDBRAL I.AW. VIOLATORS WILL BE PROSECUTED. FIR MR 141 CFR)201.45.5n5 Page 2 of 3 111.AI:l'II REC'ORi) ' CHRONOLOGICAL RECORD OF MEDICAL. CARE 13 We ?011609'9 t I'ucilit} NYMC l3eth"da, NID Clinic: Ped Development Bethesda Provider BACCIILLN, VERONICA R FAN4I1-Y SOC'IAI. IIISTORY: Resides with both parents and almost 5yo brother (there is parent concern with older brother not c(n>perative with preschool activities and hyperactivity; behaviors are monitored closely and managed through parenting at this time). Family history significant for depression in mother. but no outer known family history of learning problems, genetic disorders, psychiatric disorders, or neurologic disorders. Psychosocial stressors: Brooke was born in Okinawa. The tamily relocated to Pennsylvania when she was 6m ot'age. The family remains stationed in Pennsylvania. Pi iYSICAI. FXAMi v`ATION: Brooke impressed as a socially responsive youngster who displayed average activity ]evc], attention span, and great cooperation in the clinic setting. OFC4C cm (10'-nile. chromic as per growth Chart). I IFFNT: Et: ME bilateral PERRLA, no nystagnius: no gaze paisv; 0/p: no drooling; NECK: FROM: L: CfA, hilatcral; CCOR RRR w o mutYnur: ABD: no HSM or masses; BACK: midline w/o scoliosis; F_.XT: FROM %N -o d: ixntities: ntildl Increased joint hyperextensibility; Skin: no neurocutaneous lesions: NEURO: CN ll-Xll grossly intact: no facial n,r-.e palsy (symnnetric ;mile); no spasticity; borderline low muscle tone (trunkiextremities): Gait and stance: norma!-l:zuccl/sytnmetric: minimal right arm flexion posturing during run. although appropriate swing; I)TR'; ;'_ beat clcmus, svnnnetric. NeurodevelopmenLit! Observations: see Peds OT report for specific skills demonstrated. -vci)., compliant Youngster. IMPRESSION 1 _ Reassuring development 2. Neonatal history of Hypoxic Ischemic Encephalopathy entails chronic and lifelong risk of behavioral. learning, and developmental issues, although none evident in Brooke thus far. 3. '?Night terrors With chronic history' of sleep disturbance (frequent night time awakening). 4. See separate ?10S OT and 71'evaluations and recommendations. RLCOMh'1FNDA -1 ION: i . C'ontinuc \vith -vigilant developmental monitoring and stimulation provided by parents at home and school. Trial of Mclato nin at '/% tablet of 3nig tablet at 30 minutes before bedtime to regulate sleep eveles in Brooke. Developnncma1 Pediatrics follow up as desired by parents. w. Serial niw?itorin of her health, behaviors and development through her primary care nianager. :. il'siuniticant ccincerns arise in her brother, recommend Developmental Pediatrics evaluation followint! Veronica R. Bacehler, MD LTC, MC, USA Developmental Pediatrician Veronica.Baecttler(c,NA.AMEDD.AR\4Y-. M I I_ Signed By BAE.C111A.R, VERONICA R (Physician, Landstuhl RNW) ru' 13 Dec 2006 1122 Name: LOVEL.L, BROOKE: CHEYENNE Sex: FNi1'. SSN: 021155529729 DOB ill.Jun 2W4 Pt'at: \141 USMU FAM MHE AD MC Status: Insuranc; No Tel I I : 717-241-4495 TO W: 717..241-4495 C'S: SWS Six>nsor/SSN: I.OVI I.L,C'Itit15'rUPltl•;It Wi5i529729 Rank: Unit: Outpt Roc. Rm: DUNIIAM Of i l P 1' RECORDS PCM: (LARK.I.INDA 1 •I Cf. P(_'M: 717 245 4574 CIIRONOI.OGICAi. RECORD OF MEDICAL. CARL: I I I IS INFO )IttilAllON IS 111(Ol'1:C" 11'13 13Y I IIE PRIVACY ACT OF 1974 (M-93-579). UNAUTHORIZED ACCESS in 11 IN INt ORMA IIO'? IS A VIOLA LION OF FEDFRAI. i.AW. ViO1.A"FORS Will. BE PROSECU"FL•D. ti 1'ANDARV FORM 0110 IRl'V. S'. Prescribed by GSA and IC',%tR FIRN1R (41 CPR) 201-15.505 i'nue 3 of 3 ii EA LTII RECOR1) CHRONOLOGICAL RECORD OF iN1EDICAL CARE. Patient: LOVELL, BROOKE CHEYENNE Date: 13 Dec 2006 0901 EST Appt Type: SPEC Facility: NNMC Bethesda, MD Clinic: Pod Oce Ther Be Provider: FARINAS, MARK V. Patient Status: Outpatient Reason for Appointment: Dev Motor Clinic Appointment Comments: fcb AutoCites Refreshed by = ARINAS. MARK V. t7 13 Dec 2006 1400 EST Problems • CONVULSIONS IN NEWBORN • visit: screening early chiidhood developmental handicaps • Delayed Developmental Milestones • Vaccines Prophylac:ic Need Against Influenza • ALLERGIC RHINITS • BIRTH TRAUMA • walk is wobbly or unsteady (ataxia) [Sx] • Need For Vaccination Chickenpox (Active) • Need For Vaccination Haemophilus influenzae Type B • Need For Vaccination Hepatitis A • Vaccines Prophylactic, Need Against DTP • Prevent we Medicine 'Established Patient Checkup Child 1--; Active Medications Allergies No Allergies Found. Active Medications Status Sig Refills Left Last Filled CETIRIZINE HCL, 1"Cirf?4L. SYRUP Active GIVE 1/2 TEASPOON PO 3 of 3 13 Nov 2006 BID #240 RF3 Screening Written c_,._f iR'NAS MARK V. (cr7 13 Dec 200U4.04 EST Reason For Appointment: Dev Motor Clinic Reason(s) For Visit (Chief Complaint): Delayed Developmental Milestones (Follow-Up): walk is wobbly or unsteady (ataxia) [Sx) (Folfow-Up) : CONVULSIONS IN NEWBORN (Follow-Up) ; SO Note Nlritten by FARIN.AS MARK V. Cod) 13 Dec 2006.1432_EST Chief complaint The Chief Complaint is: potential developmental delay. Unsteady gait. (R)UE fixing when running Reason for Visit Visit for: Assessed as part of multi-disc neuro-motor clinic w/ developmental pediatrician Dr. Veronica Baechler. peds PT Ms. Nona Cedrone, MR 7", and pods OT Mr. Mark Farinas. MS. OTR/L History of present illness The Patient is a 2 year 6 month old female. Source of patient information was mother and father • Patient accompanied by mother • The father . Both parents consented to team evaluation " Puts on clothing w:' moderate (A) ' Washes and dries hands ' Separates from parent easily ° Has a vocabulary of 20 words or more " Uses two-three word sentences ' Balances on one foot for one second ° Runs well ' Walks up and down stairs Past medicallsurgical history Reported History: HIE, neonatal seizure in the first day of life for which she was treated w/ phenobarbitol for 4 months. Otherwise, mostly North': 1AVELL, 13ROOKF (JIFNENNE Sex: P Sponsor/SSN: LOVELL. CHRISTOPHER W1155529729 FMI'SSN: 02/155529729 fel I1: 717-2.414495 Rank: 0013 10.1un 2004 Tel W: 717-2414495 Unit: 1't':u: \141 USMC" FAM M11R.M) CS: Outpt Rex. Rm: O[:NIIAM OUI'P'I RFCOROS C %1( 'Status. SWS: PC"N: C'LARK.LINI)AJ y Tel. PC'M: 717 245 4574 In.ur.UA :. . u _ _.-- - ` CHRONOLOGICAL RECORD OF MEDICAL. CARE. STANDARD FORM 600 (RF:y. ?i CI [IS INFORNIA-1ION IS PROI'I:C'Tlil) BY "t'fll: PRIVACY A(" I' OF )974 (111.•93-579). UNAUI'llORIZED ACCESS Prescribed by CSA and IC\IR 10 11 PS 1NFORNI AII(% IS A VIOLA I ION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED. FIRDIR NI C'FRI 20 1-45.5415 Pauv I of 2 HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE 13 Dec 2006 0937 Facility: NNMC Bethesda, N1D Clinic: Ped Occ 7'her Be Provider: FARINAS, MARK N. healthy Pediatric history: The personal birth history was abnormal Pt born at full term. Required vaccum extraction 212 to nuchal cord complications. Pt required NICU stay for 12 days where she required vent for one day Previous therapy Received PT and OT for First 6 months of life when the family resided in Okinawa, Japan Personal history Family: Family social history Pt lives w., her parents and older brother in Pennsylvania. Pt and her family resided in Okinawa, Japan anti; she was* , rn;o Functional status Activities of daily living. No difficulty feeding (1) w/ spoon and fork use. Drinks from an open cup. Consumes good variety of `gods Putting on Lippe., garments requires moderate assistance and putting on lower garments requires moderate assistance. Going to the bathroom with no difficulty Pt is emergent w/ potty training, brushing teeth with no difficulty, and washing hands/face with no difficulty. No difficulty communicating. Physical findings Vital signs: • Pain level was ;expressed by behavior In no acute, distress General appearance: " Awake. ° Alert. ° VIell developed. " Healthy appearing. ` Active. ° In no acute distress . Pt was environmentally aware and socially interactive. Demonstrated sustained interest in and was compliant with a variety of gross and fine-motor activities. Her ternperrnent was easy going and she easily transitloned between OT/PT tasks. Pt was persistent w/ difficult tasks and eager to problem-solve Musculoskeletal system: General/bilateral: - A range of motion evaluation was performed of extremity(s) WNL Neurological: Motor: ° Musci(: tone was normal in BUEs " No hand ?reference was observed Pt's report that she is mostly left-handed. However, she mostly stacked blacks wi -fight hanrl. 5: G both her left and right hand while drawing Growth and development: Fine motor ski!'* ?r.,ere not delayed Stacked up to 9 blocks w/ careful aflignment. Stringed 112" beads following guided practice. mitated 4 block train. Emergent ability to imitate 3 block bridge. Able to imitate vertical horizontal lines and circle wi ec+ : points meeting. Grasp skills included: 1) Mature grasp to stabilize crayon. 2) Consistent use of pincer grasp. 3 Cor:sisienl use of tripod grasp. A/P Written by FARiNAS. MARK V. (cD 1.3 Dec 2006 1518 EST 1. Occupational Therapy: 2 y/o female w/ hx of HIE who presents w/ visual-motor and self care skills that are commensurate with her age based on clin:cai observations and parent report. Occupational therapy services are not indicated at this time. 2. Delayed Developmental Milestones Procedure(s): -Developmental Testing Limited With Interpretation and Report x 4 -Occupational Therapy Evaluation x 6 Disposition Written. ov PARINAS. MARK V. tat 13 Dec 2006 1518 EST Released wlo Limitations Follow up: as needed . Discussed: Medicaticn(s)/Trea(men t(s) with Parent who indicated understanding. 90 minutes face-to-face/floor time.. Signed By FARiNAS, MARK V. (MS. OTR)L Pediatric Occupational Therapist, National Naval Medical Center. Bethesda. MD) a 13 Dec 2006 1518 Name: LONTIA.., 13ROOKE CHEYENNE Sex: F SpunsurrSSN: (WELL. ('iIRIS 10Pi U-N W `155529729 f• M P tiS N : 02/155529729 TeI 11: 717.241.4495 Rank: 1)013 10 Jun 2(N)4 Tel W': 717-2414495 Unit: I'('at: N141 USM(' FANI N113R AD C'S: Outpt Rcc. Rtn: DIJNJ]AM OLD T1'T RECORDS C iNIC Scttus: SWS: PCM: CLARK,LINDA J hizurancc No Tel. 11C'M: 717 245 4574 CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 601) (REA. 5? H [IS INF(*UMATION IS PRO"1Fl' 11:1) 1)Y THY PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCIiSS Prescribed by GSA and WNW IO'I'I [IS INFORMATION IS A VIOI.ATION OF FFDFRAL LAW. VIOLATORS WILL BE PR0SFCU FD. FIRNiR (4l CFR) 2014.5.50; Prix 2 of 2 Division of Neurology Ph. 215-590-1719 Linda Clark, M.D. Dunham Army Health Clinic Carlisle Barracks Carlisle, PA 17013 Dear Dr. Clark: January 16, 2007 RE: LOVELL,, BROOKE MRN: 02632297 DOB: 06/10/04 DOV: 01/09/07 Fax 215-590-1771 Major and Mrs. Lovell brought their daughter, Brooke, to the office for neurologic consultation on January 9, 2007 because of "possible seizures." Brooke is now 2-7/12-years-old. BIRTH AND DEVELOPMENTAL HISTORY: Further history disclosed that Brooke was born to a gravida 3, para 1, Ab 1 (first trimester), then 33-year-old mother after a pregnancy that was not complicated until the onset of preterm labor during the sixth or seventh month of gestation. Mrs. Lovell was given medication and the labor pains stopped. Subsequently the pregnancy was again normal until labor was induced during the 41 st week of gestation. Labor lasted approximately 12 hours. Delivery was difficult. Vacuum extraction had to be attempted several times, but was always unsuccessful. There was a nuchal cord times two. There were also frequent decelerations. The birth weight was 6 lb 11 oz. During the first 24 hours of life, Brooke had seizures and was placed on phenobarbital. The seizures subsided. She remained seizure-free and phenobarbital was finally discontinued when she was six- months-old. She has had no definite convulsions since. The early psychomotor development progressed normally. Specifically, Brooke walked independentlyby 12 months and talked in phrases and sentences by two years, but is not yet toilet-trained. Brooke had been enrolled in an Early Intervention Program because of the perinatai difficulties. However, she was discharged when she was one-year-old because she was doing very well. At the present time, the parents do not have any developmental concerns and Brooke has had no further definite seizures. However, there are sleep issues. She has a hard time going to sleep and will wake up two times a night crying and agitated. It takes her ten minutes to calm down. She then goes back to sleep. REVIEW OF SYSTEMS: A full system review is otherwise not remarkable. PAST MEDICAL HISTORY: The past medical history disclosed that Brooke had RSV infection in early infancy. She recovered nicely. She has had no other significant illnesses. She has had no surgical procedures or head injuries. There is no history of allergies. FAMILY HISTORY: The family history disclosed that the father is a Major in the Marine Corps. The mother, now 35-years-old, is taking college courses. A five-year-old brother is perfectly well. There is no family history of epilepsy. PHYSICAL EXAM: The general physical examination was within normal limits. The head circumference measured 46.9 em. (slightly less than two standard deviations below the mean for the age); the weight, 11.2 kg; and the height, 88 cm. There were no cranial asymmetries or bruits. There were no skin lesions or dysmorphic features. There was no organomegaly. Neurologic examination disclosed an alert, appropriately interactive youngster who was quite interested in her environment. She reached for and grasped objects with either hand and played with them actively. Mental state was grossly normal. Examination of the cranial nerves, including the fundi, was also normal. Motor examination disclosed normal muscle, tone and power. There were no tremors or other abnormal movements. Deep tendon reflexes were equal and active bilaterally. No pathologic reflexes could be elicited. Her gait was normal. There were no detectable sensory abnormalities. I reviewed a head MRI performed locally on December 18, 2006. The study was normal. 1WRESSION: The neurologic examination of this youngster is normal for her age. There is no history of definite seizures. She does have a sleep abnormality which is described above. The findings and implications were discussed with the family. I assured them that Brooke's psychomotor development was perfectly normal. I doubt that the sleep abnormality is due to seizures. I did give them a sleep calendar and instructed them on its use. They should fill out the calendar over the next two weeks and then fax the completed calendar to me. I made no definite arrangements for neurologic reevaluation at the present time, but will discuss the report of the sleep calendar by phone with them. Depending on the nature of her sleep abnormality, we may well set up a sleep study. Should you desire any additional information, do not hesitate to contact me. Sincerely yours, t04- eter H. Berman, M.D. Attending Neurologist PHB: rcf/TransRx Lovell-Brooke-O 1-09-07-BERMAN cc: Major and Mrs. Christopher Lovell 284 Tanger Road Boiling Springs, PA 17007 ADDENDUM: An electroencephalogram was performed in the waking state with hyperventilation and photic stimulation. No abnormalities were noted. CLAIM FOR DAMAGE INSTRUCTIONS: Please read carefully the instructions on the reverse side and ?p1y Information requested on both sides of this form. Use additional FORM APPROVED OMB NO. 1105-0008 INJURY, OR DEATH ahe a) if necessary, See reverse side for additional instructions. EXPIRES 3-31-91 Submit to Appropriate Federal Agency: 1 2. Name, Address of claimant and claimant's personal representative, if any. . Office of the Judge Advocate General flee Instructions on reverse.) (Number, street city, State and zip Code) 1322 Patterson Avenue, Suite 3000 Kimberly Paige Lovell, as Natural Parent and Guardian of Washington Navy Yard Brooke C. Lovell, a minor Washington, D.C. 20374-5066 PSC 559, Box 5061 FPO AP 96377-5000 TYPE OF EMPLOYMENT 3 4. DATE OF BIRTH 5. MARITAL STATUS 6. DATE AND DAY OF ACCIDENT 7. TIME W. OR P.M.) . N/A June 10, 2004 Single June 10, 2004 NIA 8. Basis of Claim (State in detail the known facts and ckrumstancw attend47g the damage, Injury, or death, klentifyIng persons and property involved, the place of occurrence and the cause thereod (Use additional pages ff necessary.) SEE ATTACHED 9 PROPERTY DAMAGE NAME AND ADDRESS OF OWNER, IF OTHER THAN CLAIMANT (Number, street, city, State and zoo Code) NIA BRIEFLY DESCRIBE THE PROPERTY, NATURE AND EXTENT OF DAMAGE AND THE LOCATION WHERE PROPERTY MAY BE INSPECTED. (See instructions on reverse side.) N/A 10 PERSONAL INJURYMIRONGFUL DEATH STATE NATURE AND EXTENT OF EACH INJURY OR CAUSE OF DEATH, WHICH FORMS THE BASIS OF THE CLAIM. IF OTHER THAN CLAIMANT, STATE NAME OF INJURED PERSON OR DECEDENT. SEE ATTACHED 11. WITNESSES NAME ADDRESS (Member, street. city, State, and . Code) Medical and Nursing Personnel at: Okinawa Naval Hospital Okinawa, Japan 12. (See instructions on reverse) AMOUNT OF CLAIM fin dollars) 12a. PROPERTY DAMAGE 12b. PERSONAL INJURY 12c. WRONGFUL DEATH 12d. TOTAL (Failure to specify may cause forfeiture of your rights). 815,000,000.00 - ---- 815 000,000.00 1 CERTIFY THAT THE AMOUNT OF CLAIM COVERS ONLY DAMAGES A gjLLstA-nqFACTIONANnFINAISFMFUENTOF i T ND INJURIES CAUSED BY THE ACCIDENT ABOVE AND AGREE TO ACCEPT TIOS14AWA *I m SA AM 3 . SIGNATURE CLAIMA (See Iris s on roverse side.) 13b. PHONE NUMBER OF SIGNATORY 14. DATE OF CLAIM Kimberly p vel. as Natural Parent and Guardian of Brooke C. Lovell, a minor CIVIL PENALTY FOR PRESENTING CRIMINAL PENALTY FOR PRESENTING FRAUDULENT FRAUDULENT CLAIM CLAIM OR MAKING FALSE STATEMENTS The claimant shall forfeit and pay to the United States the sum of 62,000, Fine of not more than $10,000 or imprisonment for not more than 5 plus double the amount of damages sustained by the United States. years or both. (See 18 U.S C. 287, 1001.1 pt us 141 u_S_C. 3729.) _ 95-108 Previous editions not usable. NSN7540-00-634-4046 51-AIVUAHU POW *0 VIM f-001 PRESCRIBED BY DEPT. OF JUSTICE 28 CFR 14.2 Ryan & Brown P.A. 366 Jackson Street, Suite 300 St. Paul, MN 65101-1925 Telephone: 651-695-8787 By: C Anne E. Brown CLAIM FOR DAMAGE, INJURY, OR DEATH - Page 2 Kimberly Paige Lovell, as Natural Parent and Guardian of Brooke C. Lovell, a minor 8. Medical and/or nursing personnel at Okinawa Naval Hospital, Japan, were negligent in the labor, delivery and neonatal period surrounding the birth of Brooke Lovell by, including, but not limited to: Failing to appropriately and timely respond to signs of fetal distress, inappropriate use of Pitocin, and negligent use of a vacuum extractor causing severe trauma and hypoxia to Brooke Lovell. Military healthcare personnel may have been in other ways negligent as well. 10. The negligence of the military healthcare personnel, described above, caused a significant brain injury to Brooke Lovell resulting in both economic and non-economic damages to Brooke Lovell. CLAIM FOR DAMAGE INSTRUCTIONS: Please read carefully the instructions on the reverse side and FORM APPROVED , supply information requested on both sides of this form. Use additional OMB NO. 1105-MB INJURY, OR. DEATH sheet(s) if necessary. See reverse side for additional instructions. EXPIRES 3-31-91 1. Submit to Appropriate Federal Agency: 2. Name, Address of claimant and claimant's personal representative, if any. Office of the Judge Advocate General ISee instructions on reversed (Number, street, city, State and Zip Code) 1322 Patterson Avenue, Suite 3000 Christopher W. Lovell Washington Navy Yard PSC 559, Box 5061 Washington, D.C. 203745066 FPO AP 96377-5000 3. TYPE OF EMPLOYMENT T 4. DATE OF BIRTH 5. MARITAL STATUS 6. DATE AND DAY OF ACCIDENT 7. TIME (A.M. OR P.M.1 Military Febru 5, 1969 Married June 10, 2004 N/A 8. Basis of Claim (State in detaff the known facts and dreumstances attending the damage, Injury, or death, Wentlfying persons and property Involved, the place of occurrence and the cause thereof( [Use addidonal pages If necessary.! SEE ATTACHED 9. PROPERTY DAMAGE NAME AND ADDRESS OF OWNER, IF OTHER THAN CLAIMANT (Number, street city, State and Zip Code) N/A BRIEFLY DESCRIBE THE PROPERTY, NATURE AND EXTENT OF DAMAGE AND THE LOCATION WHERE PROPERTY MAY BE INSPECTED. (See Instructions on reverse s/de.) N/A 10. PERSONAL INJURY/WRONGFUL DEATH STATE NATURE AND EXTENT OF EACH INJURY OR CAUSE OF DEATH, WHICH FORMS THE BASIS OF THE CLAIM. IF OTHER THAN CLAIMANT, STATE NAME OF INJURED PERSON OR DECEDENT. SEE ATTACHED 11. WITNESSES NAME ADDRESS (Number, street, efty, State, and ' Codel Medical and Nursing Personnel at: Okinawa Naval Hospital Okinawa, Japan 12. /See Instructions on reverse/ AMOUNT OF CLAIM (In db9arsl 12a. PROPERTY DAMAGE 12b. PERSONAL INJURY 12c. WRONGFUL DEATH 12d. TOTAL (Failure to specify may cause forfe/ture of your rights/. 82,500,000.00 -- 82,500,000.00 1 CERTIFY THAT THE AMOUNT OF CLAIM COVERS ONLY DAMAGES AND INJURIES CAUSED BY THE ACCIDENT ABOVE AND AGREE TO ACCEPT 13a. TMFC NT ( ructions on reverse s(de.) 13b. PHONE NUMBER OF SIGNATORY 14. DATE OF CLAIM ) a dj /0 W. veM V PENALTY FOR PRESENTING CRIMINAL PENALTY FOR PRESENTING FRAUDULENT FRAUDULENT CLAIM CLAIM OR MAKING FALSE STATEMENTS The claimant " forfeit and pay to the United States the sum of $2,000, Fine of not more than $10,000 or imprisonment for not more than 5 plus double the amount of damages sustained by the United States. years or both. ISee IS (14C. 287, 1001.) (See 31 U.S.C. 3729.1 95-108 Previous editions not usable. NSN7540-00-534-4046 STANDARD FORM 93 (Rev. 7.85) PRESCRIBED BY DEPT. OFJUS)7CE 28 CFR 14.2 Ryan & Brown P.A. 366 Jackson Street, Suite 300 St. Paul, MN 55101-1925 Telephone: 651-695-8787 By: ?.. Anne E. Brown CLAIM FOR DAMAGE, INJURY, OR DEATH - Page 2 Christopher W. Lovell 8. Medical and/or nursing personnel at Okinawa Naval Hospital, Japan, were negligent in the labor, delivery and neonatal period surrounding the birth of Brooke Lovell by, including, but not limited to: Failing to appropriately and timely respond to signs of fetal distress, inappropriate use of Pitocin, and negligent use of a vacuum extractor causing severe trauma and hypoxia to Brooke Lovell. Military healthcare personnel may have been in other ways negligent as well. 10. The negligence of the military healthcare personnel, described above, caused a significant brain injury to Brooke Lovell resulting in both economic and non-economic damages to Christopher Lovell, Brooke's father. CLAIM FOR DAMAGE, INSTRUCTIONS: Please read carefully the instructions on the reverse side and supply Information requested on both sides of this form. Use additional FORM APPROVED OMB NO. 1105-0008 INJURY, OR DEATH shestis) If necessary. See reverse side for additional instructions. EXPIRES 3-31-91 1. Submit to Appropriate Federal Agency: 2. Name, Address of claimant and claimant's personal representative, If any. Office of the Judge Advocate General (See butrucgons on reverse.) (Number, street city, State and Zip Code) 1322 Patterson Avenue, Suite 3000 Kimberly Paige Lovell Washington Navy Yard PSC 559, Box 5061 Washington, D.C. 20374-5066 FPO AP 96377-5000 3. TYPE OF EMPLOYMENT 4. DATE OF BIRTH 5. MARITAL STATUS 6. DATE AND DAY OF ACCIDENT 7. TIME (A.M. OR P.M.) N/A Dec. 7, 1971 Married June 10, 2004 N/A B. Basis of Claim (State In detar7 the known facts and circumstances attending the damage, injury, or death, Identifying persons and property Involved, the place of occurrence and the cause thereof) (Use additional pages If necessary.) SEE ATTACHED g PROPERTY DAMAGE NAME AND ADDRESS OF OWNER, IF OTHER THAN CLAIMANT (Number, street city, State and Zip Code) NIA BRIEFLY DESCRIBE THE PROPERTY, NATURE AND EXTENT OF DAMAGE AND THE LOCATION WHERE PROPERTY MAY BE INSPECTED. (See instructions on reverse side.) N/A 10, PERSONAL INJURY/WRONGFUL DEATH STATE NATURE AND EXTENT OF EACH INJURY OR CAUSE OF DEATH, WHICH FORMS THE BASIS OF THE CLAIM. IF OTHER THAN CLAIMANT, STATE NAME OF INJURED PERSON OR DECEDENT. SEE ATTACHED 11. WITNESSES NAME ADDRESS lNumber, street city, State, and Zip Code) Medical and Nursing Personnel at: Okinawa Naval Hospital Okinawa, Japan 12. (See dastnrctlans on reverse) AMOUNT OF CLAIM fin dollars) 12a. PROPERTY DAMAGE 12b. PERSONAL INJURY 12c. WRONGFUL DEATH 12d. TOTAL (Failure to specify may cause forfeiture of your rights). $2,500,000.00 ---- -------- $2,500,000.00 1 CERTIFY THAT THE AMOUNT OF CLAIM COVERS ONLY DAMAGES AND INJURIES CAUSED BY THE ACCIDENT ABOVE AND AGREE TO ACCEPT 13a. SIGNATURE F CI.AI NT (See dnstrvcdons on reverse side.) 13b. PHONE NUMBER OF SIGNATORY 14. DATE OF CLAIM VIA K berl Paige vell CIVIL PENALTY FOR PRESENTING CRIMINAL PENALTY FOR PRESENTING FRAUDULENT FRAUDULENT CLAIM CLAIM OR MAKING FALSE STATEMENTS The claimant shall forfeit and pay to the United States the sum of $2,000, Fine of not more than 410,000 or Imprisonment for not more than 5 plus double the amount of damages sustained by the United States. years or both. (See f8 U.S.C. 287, 1001.) See 31 U.S.C. 3729.1 95-f08 Previous editions not usable. N5N7b4U-00-6344046 S ArvuAnu runrn va Inev. /roe/ PRESCRIBED BY DEPT. OF JUS77CE 28 CFR 14.2 Ryan & Brown P.A. 366 Jackson Street, Suite 300 St. Paul, MN 55101-1925 Telephone: 651-695-8787 By: Anne E. Brown CLAIM FOR DAMAGE, INJURY, OR DEATH. - Page 2 Kimberly Paige Lovell 8. Medical and/or nursing personnel at Okinawa Naval Hospital, Japan, were negligent in the labor, delivery and neonatal period surrounding the birth of Brooke Lovell by, including, but not limited to: Failing to appropriately and timely respond to signs of fetal distress, inappropriate use of Pitocin, and negligent use of a vacuum extractor causing severe trauma and hypoxia to Brooke Lovell. Military healthcare personnel may have been in other ways negligent as well. 10. The negligence of the military healthcare personnel, described above, caused a significant brain injury to Brooke Lovell resulting in both economic and non-economic damages to Kimberly Paige Lovell, Brooke's mother. F,X kybi? I t RYAN & BROWN P.A. Attorneys at Law 366 Jackson Street Suite 4000 Saint Paul, Minnesota 55101-2995 Telephone: (651) 695-8787 Dated: This document sets out the fee agreement that has been reached between Ryan & Brown P.A. (the "Firm"), and Christopher W. Lovell and Kimberly Paige Lovell (the "Client"), in the matter of Christopher W. Lovell and Kimberly Paige Lovell, individually and as Parents and Natural Guardians of Brooke Lovell, a minor v. United States ofAmerica. In return for the services rendered, or to be rendered by the Firm, the Client agrees as follows: CONTINGENT FRF. C:ASF,. The Client agrees to pay to the Firm as attorneys' fees twenty percent (20%) of the total cost of the settlement amount in this matter, together with costs and disbursements deducted from the Client's share of the settlement proceeds. This percentage is based on the total cost of the settlement and is payable in full on settlement from the settlement proceeds. The attorney fee percentages conform with the guidelines set forth in the Military Claims Act, 10 United States Code, § 2733. If there is no recovery by settlement, then there are no fees incurred by the Client. < 1--) The Client understands that recovery it, Individually, and as Natural of Brooke Lovell, a minor Kimberly Pfge Lovell, Individually, and as Natural Parent and Guardian of Brooke Lovell, a minor RYAN & BROWN P.A. By: Anne E. Brown w w? ? U o a 0 0 $ co III W I I?j W Q ' RYAN & BROWN P.A. 366 Jackson Street, Suite 300 St. Paul, MN 55101 DATE 10/23/2007 Invoice INVOICE # 5509 BILL TO ris op er Paige Lovell 284 Tanger Road Boiling Springs, PA 17007 SERVICES/COSTS ITEM AMOUNT Contingent fee for legal services (20% of $175,000) Atty Fee 35,000.00 Expert Witness Expert Witness 900.00 Medical Records Medical Records 144.90 Fed Ex Fed Ex 102.86 Copies Copies 441.45 Tabs Tabs 59.50 Binding Binding 35.00 Client Postage Client Postage 36.15 Westlaw Research Research 500.00 Total $37,219.86 r--? X k I ?) + P", STIPULATION FOR COMPROMISE SETTLEMENT AND RELEASE OF MILITARY CLAIMS ACT (MCA), 10 USC 2733 AIR FORCE CLAIM NOS: YOKOTA 05-0521053/054 It is hereby stipulated by and between the undersigned claimants (meaning any person, other than the United States of America and the structured settlement broker, signing this agreement), and the United States of America, by and through their respective attorneys, as follows: 1. The parties do hereby agree to settle and compromise each and every claim of any kind, whether known or unknown, arising directly or indirectly from the acts or omissions that gave rise to the administrative claims, alleging negligence in the neonatal, labor, and delivery care of Brooke Lovell because they failed to respond appropriately to signs of fetal distress, they used the drug Pitocin inappropriately, they failed to perform an emergency caesarean-section operation timely, and they used a vacuum extractor improperly, causing Brooke Lovell severe trauma and hypoxia that injured her brain significantly, under the terms and conditions set forth in this Settlement Agreement. 2. This Stipulation For Compromise Settlement And Release is not, is in no way intended to be, and should not be construed as, an admission of liability or fault on the part of the United States, its agents, servants, or employees, and it is specifically denied that they are liable to the claimants. This settlement is entered into by all parties for the purpose of compromising disputed claims under the Military Claims Act. 3. The United States agrees to pay the cash sums set forth below in paragraph 3.a. and to purchase the annuity contract(s) described below in paragraph 3.b. at a total cost to the United States of One Hundred Seventy Five Thousand Dollars and No Cents ($175,000.00). a. As soon as it is practicable after the execution of this Stipulation For Compromise Settlement And Release, the United States will wire transfer to EPS Settlements Group Settlement (July 2003 Edition) Page 1 of 7 Trust Account (at UMB Banks, 1670 Broadway, Denver, Colorado 80202, ABA#, 101000695, Account No. 6971176575) the sum of $175,000.00 (hereinafter "settlement amount"), out of which the following disbursements will be made by EPS Settlements Group from said trust account: i. On behalf of Claimants, EPS Settlements Group will distribute from the settlement amount to the claimants' attorney, Ms. Anne Brown, the sum of Eighty Seven Thousand Five Hundred Dollars and No Cents ($87,500.00), and claimants' attorney agrees to distribute this cash sum amongst them as claimants and claimants' attorney have agreed. It is understood among the parties that under the Military Claims Act, as implemented by the Secretary of the Air Force instruction published in the Code of Federal Regulations, attorney's fees for services rendered in connection with this matter shall not exceed 20 per centum of the amount of the compromise settlement. ii. To a life insurance company or companies rated at least A+ by A.M. Best rating service, the sum of $87,500.00 to purchase the annuity contracts described below in part b. b. The United States will purchase the following annuity contracts: The United States will purchase annuity contracts to make the following payments payable to Brooke Lovell at a cost not to exceed $87,500.00. It is understood and agreed by the parties that the purchase price of the annuities set forth below for Brooke Lovell may vary according to the price charged for said annuities on the date of purchase. The parties agree that the total cost to the United States of all payments required under this Stipulation For Compromise Settlement And Release shall not exceed $175,000.00. In the event the annuity purchase price for the benefit of Brooke Lovell has changed by the time of funding, the annuity payments set forth below, will be adjusted either upward or downward, so that the total purchase price of the annuity contracts for the (July 2003 Edition) Page 2 of 7 C] benefit of Brooke Lovell shall be neither more than nor less than $87,500.00. In the event of the death of Brooke Lovell during a period of certain payments, all remaining certain payments shall be made payable to the Estate of Brooke Lovell. i. An annual annuity in the amount of Thirty Two Thousand Nine Hundred Dollars and No Cents ($32,900.00) payable beginning fourteen (14) years and seven months from the date of annuity purchase, for four (4) years certain only. ii. A certain lump sum annuity payment of Forty-Five Thousand Dollars and No Cents ($45,000.00) payable nineteen (19) years from the date of annuity purchase. iii. A certain lump sum annuity payment of Fifty-Five Thousand Dollars and No Cents ($55,000.00) payable twenty-two (22) years from the date of annuity purchase. The annuity contracts will be owned solely and exclusively by the United States and will be purchased as soon as practicable following the execution of this Stipulation For Compromise Settlement And Release. The parties stipulate and agree that the United States' only obligation with respect to said annuity contracts and any annuity payments therefrom is to purchase the annuity contracts, and they further agree that the United States does not guarantee or insure any of the annuity payments. The parties further stipulate and agree that the United States is released from any and all obligations with respect to the annuity contract(s) and annuity payments upon the purchase of the annuity contract(s). The parties stipulate and agree that the annuity company that issued the annuity contracts or its assignee(s) shall at all times have the sole obligation for making all annuity payments. The obligation of the annuity company to make each annuity payment shall be discharged upon the mailing of a valid check in the amount of such payment to the address designated by the party to (July 2003 Edition) Page 3 of 7 whom the payment is required to be made under this Stipulation For Compromise Settlement And Release. Checks lost or delayed through no fault of the annuity company shall be promptly replaced by the annuity company, but the annuity company is not liable for interest during the interim. The parties stipulate and agree that the annuity payments cannot be assigned, accelerated, deferred, increased, or decreased by the parties, that no part of any annuity payments called for herein or any assets of the United States or the annuity company are subject to execution or any legal process for any obligation in any manner, and that the claimants shall not have the power or right to sell, assign, mortgage, encumber, or anticipate said annuity payments, or any part thereof, by assignment or otherwise. Claimants and their guardians, heirs, executors, administrators or assigns and claimants' attorney do hereby agree to maintain with the annuity company and the United States a current mailing address, and to notify the annuity company and the United States of the death of any beneficiary of said annuity contracts within ten (10) days of death. 4. Claimants and their guardians, heirs, executors, administrators, and assigns agree to and do accept this settlement in full settlement and satisfaction and release of any and all claims, demands, rights, and causes of action of any kind, whether known or unknown, including without limitation any claims for fees, costs, expenses, survival or wrongful death, arising from any and all known or unknown, foreseen or unforeseen bodily injuries, personal injuries, death, or damage to property, which they may have or hereafter acquire against the United States of America, its agents, servants, or employees on account of the subject matter of this administrative claim, or that relate or pertain to or arise from, directly or indirectly, the subject matter of the administrative claims. Claimants and their guardians, heirs, executors, administrators, and assigns further agree to (July 2003 Edition) Page 4 of 7 reimburse, indemnify, and hold harmless the United States of America, its agents, servants, and employees from and against any and all claims, demands, rights, and causes of action of any kind, whether known or unknown, including without limitation claims for subrogation, indemnity, contribution, or lien of any kind, or for fees, costs, expenses, survival or wrongful death that relate or pertain to or arise from, directly or indirectly, any act or omission that relates to the subject matter of this administrative claim. 5. This compromise settlement is specifically subject to each of the following conditions: a. An agreement by the parties on the terms, conditions, and requirements of this Stipulation For Compromise Settlement And Release, and the annuity contracts. The parties stipulate and agree that the Stipulation For Compromise Settlement And Release and the compromise settlement are null and void in the event the parties cannot agree on the terms, conditions and requirements of this Stipulation For Compromise Settlement And Release and the annuity contract(s). The terms, conditions and requirements of this Stipulation For Compromise Settlement And Release are not severable and the failure to agree, fulfill or comply with any term, condition, or requirement renders the entire Stipulation For Compromise Settlement And Release and the compromise settlement null and void. The authorization by the Secretary of the Air Force or Secretary of the Air Force's designee to negotiate and consummate a settlement for the amount agreed upon by the parties does not make the settlement binding upon the United States unless and until the other terms, conditions and requirements of this Stipulation For Compromise Settlement And Release have been completely agreed upon in writing. (July 2003 Edition) Page 5 of 7 V 0 b. Each beneficiary of the annuity contracts set forth above in paragraph 3.b. must be alive at the time of the purchase of said annuity contracts or the entire Stipulation For Compromise Settlement And Release and the compromise settlement are null and void. c. The claimants must obtain State Court approval of the settlement on behalf of Brooke Lovell at their expense. Claimants agree to obtain such approval in a timely manner: time being of the essence. Claimants further agree that the United States may void this settlement at its option in the event such approval is not obtained in a timely manner. In the event claimants fail to obtain such State Court approval, the entire Stipulation For Compromise Settlement And Release and the compromise settlement are null and void. 6. The parties agree that this Stipulation for Compromise Settlement and Release, including all the terms and conditions of this compromise settlement and any additional agreements relating thereto, may be made public in their entirety, and the claimants expressly consent to such release and disclosure pursuant to 5 U.S.C. § 552a(b). 7. It is contemplated that this Stipulation may be executed in several counterparts, with a separate signature page for each party. All such counterparts and signature pages, together, shall be deemed to be one document. Executed this day of , 2007• JOSEPH E. FOURNIER Attorney for United States of America Executed this day of, 2007. (July 2003 Edition) Page 6 of 7 • KIMBERLY PAIGE LOVELL, Individually and as Guardian of BROOKE LOVELL, a minor Executed this day of , 2007. CHRISTOPHER W. LOVELL, Individually and as Guardian of BROOKE LOVELL, a minor Executed this day of $2007. ANNE BROWN, Esquire Attorney for Claimants Executed this day of , 2007. EPS SETTLEMENTS GROUP STRUCTURED SETTLEMENT BROKER Tax ID Number: 95-4134668 (July 2003 Edition) Page 7 of 7 0 4 Structured Settlement Illustration September 24, 2007 Brooke Lovell - D.O.B.: 06/10/2004 Benefits Cost Certain Payout Upfront Cash $87,500 $87,500 $87,500 Periodic Payments (To assist with post-high school education expenses) $32,900 a year for 4 years certain only. Payments begin 14 years and 7 months after annuity purchase. $54,715 $131,600 Lump Sum Payments at about ages 22 and 25 $45,000 lump sum certain payable in 19 years; $16,048 $45,000 $55,000 lump sum certain payable.in 22 years. $16,737 $55,000 Totals $175,000 $319,100 This is an illustration, not a contract. Annuity costs are subject to change and must be repriced after 7 days. The Periodic Payments may vary - either up or down - depending upon annuity cost at time of settlement funding. (1) Under IRC 104(a)(2), payments received by payee on account of personal, physical injury are not included in income for federal income tax purposes. (2) "Certain Payout" will be paid regardless of whether or not the payee is living. (3) Company quoted is rated A+ or better by A.M. Best rating service. (4) Assumed annuity purchase date is December 1, 2007. Prepared by EPS Settlements Group, Rockville, MD. Tel. 800-448-8360; Fax: 800-738-2086 is ii 4,, ?ilc r i(;.co n; mlong@epssettlements.com Q ? d 1+? 1? ? ? ...2 .. r '? ? .,?? l 3 ?? v ? -. ? f ,..7 .r._. 7,`,s _ 1 ., .?. '-..: "'? h DEC 0 5 2001!yV IN RE: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY,PENNSYLVANIA BROOKE CHEYENNE LOVELL : :NO. PETITION FOR COURT APPROVAL ORDER Ltm b0< AND NOW THIS day o er, 2007, upon consideration of the Petition for Court approval to Settle a Claim of a Minor, it is hereby ordered and decreed that a hearing is scheduled for A?n" ? , 20GS, at -36 A.M.Y I. in Courtroom of the Cumberland County Co use. J. v? r0 1?y ?,t'd € .6 WV L- 3301. J, 0Z w ?'? ? Lit L?Z1 'JH . -JO ? f J.. 01 ILA IN RE: IN THE COURT OF COMMON PLEAS BROOKE CHEYENNE LOVELL CUMBERLAND COUNTY, PENNSYLVANIA NO. 07-7219 CIVIL TERM PETITION FOR COURT APPROVAL ORDER OF COURT AND NOW, this 8th day of January, 2008, upon consideration of the Petition for Court approva:9_ to Settle a Claim of a Minor, it is hereby ordered and decreed that the settlement is approved, in accordance with Paragraph 17 of the petition. Petitioners, Christopher W. Lovell and Kimberly "Paige" Lovell, are authorized to execute any and all documents to effectuate the settlement. By Edward E. Guido, J. James I. Nealon, Esquire -eye5 q?vew I- q-0&- © L srs ?re