Lake County Sheriff?s Of?ce
Case Management Supplemental Report

 

 

 
 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Of Original Offense: Case Number:
Offense:
Beard 2W. [$10090 #55
I 
Amended Offense: Related Case Numbers:
MTMZAL 
Added Suspects: Recovered Property
Value:
CBA, The perpetrator in this case was arrested by Deputy Sheriff: 
On 
1. A Charging Af?davit was flied with the State Attorney on 
2. An Arrest Warrant was obtained on 
l. The of?ce of the State Attorney was contacted in reference to this case and prosecution was
ECS: declined on per SAO: am
2. Suspect identi?ed; however victim refuses to assist agency with investigation (No Intent)
3. Suspect deceased
The victim in this case was provided appropriate instructions to present incident to State Attorney?s
ECM.
Of?ce.
UNF  No criminal violation exists
TOT: This case was turned over to for ?irther investigation.
A follow-up investigation was made on this case?no sustiects were identi?ed, case will remain
INAC: inactivated till there are new leads or suspects.
Reprint
Remarks:
Detective'  0.:  e? 
. . 5.15.13 20!} DATE. 12/ 08 
1 
Supervisor:  CD DATE: 1 9  

 

 

 

 

 

Supplemental Narratives
Supplemental Narratives Incident 130090458

 

 

SUPPLEMENTAL NARRATIVE:
3
Name: WATKINS 209

I)ate: 09:12:44 12/23/13
Report Written By: Detective J.C. Watkins

Offense/Class: Death Investigation
Evidence: See CSI Report
Crime Scene: Processed By CSI

Attachments: DCF Intake report, AdvoServ Medical Records, Advoserv
Incident/Injury Reports, Behavior Data Sheet, Sleep Charts

Canvass Area: Interviews Staff

Narrative:

   
 

On July 11, 2013 Detective Watkins respond
(Carlton Palms Educational Facility}
investigation.

Florida in reference to a death

Detective Watkins had a telephone conversation with Sergeant K. Stone and
learned on Jul . as not breathing and was transported to
for treatment. Sgt. Stone advised 
died and was tranSported to the fifth District Medical Examiner?s
Office to have an autopsy performed- Sgt. Stone advised on July 11, 2013
Investigator Danielle Lampkin and Amanda Marchese with the Department of
Children and Family Services contacted deputies and asked them to assist her
with the death investigation. Intake report 2013-189452~01} Sgt. Stone
advised Deputy Robbins was in the process of obtaining sworn written statements.

  
 
 

   

A Lake County Sheriff's Office records check revealed on July 6, 2013 at
approximately hours, Lake County Sheriff's deputies and Lake and Sumter EMS
responded to a medical call at Carlton Palms Educational Facility
Florida. (See CAD notes 1

 

Detective Watkins requested Crime Scene Investigation respond to the Carlton
Palms Educational Facility to document the scene.

Detective Watkins received and reviewed the Department of Children and Family
Intake Report. {See Intake Report #2013~189452}

On July 11, 2013 at approximately 1701 hours, David Dugo advised he was on



 

 

 

 

Supplemental Narratives Incident 130090458 Page 2 of 12

 

death and advised he would make copies of

 

vacation at the time of
is file.

 

Detective Watkins obtained a copy of floor plan for iiving facility.

 

On July 11, 2011 Detective Karl Johnson had a telephone conversation with Chief
Medical Examiner Wendy Lavezzi with the Fifth District Medical Examiner's Office
and she advised had bruise from head to toe which were not
consistent with restraints. Doctor Lavezzi further advised the autopsy results

were pending further studies.

 

On July ll, 2013 at approximately 1749 hours, Robert M.D. with Carlton
Palms Educational Facility {Advoserv} provided a sworn audio taped statement,
stating on June 26, 2013 he examined when a . checked into the
facility. Doctor advised would try to injure during
the examination had to be physically restrained by staff. Doctor advised
he changed I medication. {See medical records} Doctor adviSed
on July 5, 2013 he received a request to examine had
been vomiting Eor five (5) days. Doctor advised he put on a
liquid diet and gave some anti-nausea medicine. Doctor adv1sed on
Saturda July 6, 2013 he received a call from the onrstaff indicating that
(deceased) was in distress. Dr. stated he responded to the
facility and was met with EMS and the Fire Rescue pa amedics. Dr. stated
CPR was being administered. Dr. stated that . was then trans-orted to
saw. with him followinc. Dr. also confirmed that'
pronounced deceased at -- - Dr. also verified that
(See audio taped statement and

  
   

 

 
 

 

 

 

   
  

 
   
 
 
 

  

  

 

 

written 3 atement

On July 11, 2013 at approximately 1830 hours. Detective Karl Johnson, Detective
Deana Cameron, Detect? Watkins and Scene Investigator Amanda Wolford
responded to m' e+ Florida photograph
and document i?room and the restraints equipment. Detective Watkins
observed video cameras in the bedroom and the main living area of the . .
Residence. Detective Watkins learned the cameras in the bedroom were used fo
monitoring the patients and were not recorded. Detective Watkins learned the
cameras in the main living and hallways were recorded. Detective Watkins
requested a copy of the surveillance video. {See CSI report and

photographs}

   

      

     

 
 

 

'ents at the facility that were

 
  
 

Detective Karl Johnson inte
houses ith the deceased; .rm 
Mr. Dugo was cooperative in faCilitating the interviews and allowed us

to interview the patients privately.

  
 

 

CPI Marchese and Detective Johnson interviewed each patient individually in
their bedrooms. None of the aforementioned patients indicated they had suffered
any abuse or neglect during their stay at the facility. The patients indicated
they knew had died. The three patients had
very limited information conCerning' . had only been there a short
time. All three patients indicated they had gone to sleep that evening in their
assigned bedrooms and were awakened in the morning by the ambulance. The patient
learned had passed away.

 
 
         

   

On July 11, 2013 at approximately 1900 hours,

omen-1

 

 

 

 

Suppfementa! Narratives Incident 130090458 Page 3 of 12

 

  

 
 
  

advis d; lived in the bedroom next to
would eat cookies and throw them up.
vomited ever time Iate and staff would lie 
i would scream and hurt~v I
advised to the window and
did not have a roommate. . heard aming during the
ht nd the ambulance. advised the next morning ilearned in 
had died. (See audio taped interview)

 

  
    
     
 
  

  
 

said on Friday.
on a mat unrestrained.

 

   

 

 
 
   

 

 
 

2013 at approximately 1910 hours, 
ikes arlton Palms and is about to

e" was none verbal and would rock back

rotective clothing because

aw the decedent the morning of

bedroom and saw "Loy"

      
  
 
    
 
 
  
  

leave the facility.
and forth on 

 

 

death.

doing CPR on (See audio taped interview}

 
 
 
 
   

On July 13, 2013 at approximately 1910 hours,
advised loves 'ving at Carlton Palms.
would not eat and would vomit every time "ate anything.
would scream and hurt . Eadvised on Thursday night
was going crazy and kicking at staff. -could not
remember if was screaming during the night. advised the
next morning learned I 7had died. (See audio taped interview)

    
 

  

    

The three patient interviews were recorded and placed into evidence. (See
audio taped interviews)

On July 11, 2013 at approximately 1914 hours, Thomas Shea provided a sworn
video?taped statement describing the procedure for care of the students while in
the facility. Thomas Shea advised the camera in the main living area were
recorded and the camera in the bedrooms were monitored and not recorded. (See
video-tape)

On July 11, 2013 at approximately 1914 hours, Thomas Shea {State Program
Director Licensed Behavioral Analyst) with Carlton Palms Educational Facility
(Advoservl provided a sworn audio taped statement, stating -
{deceased} had been a patient at "residential living facility ini
Florida. Mr. Shea advised on June 26, 2013 - transferred to
lton Palms Educational Center and examined by Doctor Thomas Shea

was diagnosed with
in Mr. Shea advised came into the facility wit
equipment to keep' from injuringa Thomas Shea advised 
wore a helmet, arm splints, waist harness and chest protector Thomas Shea
advised was assigned one CLS to take care during the
intake period. Mr. Shea further stated CLS completed sleep logs, restraint logs
and injury incident reports. Mr. Shea advised he would provide copies of the
logs to investigators. Mr. Shea advised belongings had been mailed to

. family.

      
 
 

 

 
 
 
 
 

    
    
 

crotective

 

   

 
 

 
   
 

Shea advised on July 5, 2013 the evening shift had been placed
in four point restraints in the bed to keep from injuring
and was moved the chair because . was vomiting. Mr. Shea confirmed they have a
bed net at the facility. Mr. Shea advisad staff members have not use the bed net
for some time and he did not even know where the bed net was located. Mr. Shea

contacted Shem Orvis and asked him to bring the bed net and,

     
 

 

\Spi 01:40:14

 

 

 

Supplemental Narratives Incident 130090458 Page 4 of 12

protective equipment to the office. r. Shea advised the goal of the facility is
to reduce the patient?s medication and restriants in order to re-introduce them
into another facility or back into the home.

  

Mr. Shea advised on July 6, 2013 he learned ?(victim) was not
breathing and the staff immediately called 911 and CPR was administered by

staff. Mr. Shea stated EMS transported to Florida 
later died. Mr. Shea also stated ctor Robert was

also notified and responded to the 'dence, Mr. Shea went on to state that he
immediately notified the parents.

  

     
 

 

  
 

 

Thomas Shea provided a list of employees who re assi ned to care for .
., Thomas Shea provided Copies of Imgr_?. ?medical records,
Behavior Data Sheets, Sleep Charts, Intake Schedule, Incident/Injury
Intervention Report and a Diagram of for the . . acility. Mr. Shea
advised he and Keith Jacobs conducted all the staff interviews in reference to
death. Thomas Shea advised he would make a copy of the video
surveillance and provide it to Detective Watkins. {See audio-taped statement

and written statement)

        

     

 
 

 

Detective Watkins collected protective equipment from Shem
Orvis (CLS supervisor) and turned the items over to 081 Wolford. CSI Wolford

photographed the equipment.

 
 

CSI Wolford photographed the wooden restraint chair that was used to restrain
(See photographs)

On July 12th, 2013 Detective Johnson obtained the EMS run sheets and photographs
from the Fifth District Medical Examiner?s Office. Detective Johnson turned the
material over to Detective Watkins. (See EMS run sheet and M.E. Photographs)

On July 12, 1013 DCF Investigator Amanda Marchese requested a copy of Florida
2 medical records involving death.

      

 

On July 15, 2013 Detective Watkins reviewed photographs of 
by the Fifth District Medical Examiner?s Office at autopsy. Detective Watkins
observed *had bruises on face, chest, arms and leg. Detective
Watkins observed bite marks on arms and shoulders. Detective
Watkins had a telephone conversation With Wendy Lavezzi M.D. and she advised the
bruise were superficial and did not cause . m. was death. Wendy Lavezzi
M.D advised the autopsy result were pending further studies.

    

  
 

On July 15, 2013 Detective Watkins reviewed the Behavioral Data Sheets;

 

 

On July 5, 2013 at a roximately 2200 hours, L. i was injuring

pulling elmet off, biting arms and hitting i
report indicated a four poi restraint was used to secure
bed. The report indicated would slip the restriants and would pul
hair. The report indicatedg was placed in EROM {Emergency Range of Motion}
wrist only for 55 minutes.

       

The
to the

  
    
 

 
  

On July 5, 2013 at approximately 2250 hours, . was placed into the
Emergency Mechanical Restraint Chair (ERCH) wrist only for approximately 49
minutes

 
 

On July 15, 2013 Detective Watkins reviewed the Incident reports 

 

 

 

Supplemental Narratives Incident 130090458 Page 5 of 12

 

 
   

On June 26, 2013 at approximately 2100 hours Staff attempted to give her

medication and m' became agitated. had bruises 0 arm and legs
where ?was being held by the staff. Staff notified the supervisor and

completed a report.

 

   

 

 

On June 30, 2013 at approximately 0115 hours woke up and started banging
head. Staff placed in a waist belt and protective equipment. Staff

notified clinician and supervisor.

   

 

On June 30, 2013 at approximately 0730 hours Staff noticed blood on'
forehead and first aid was applied and supervisor notified.

H'swas sitting on mat and hitting head on the

 

On July 2, 2013 at 0820 hours, i
floor. Supervisor was notified.

 

On July 2, 2013 at approximately 0850 hours, hitting head on floor and
staff attempted to re?direct and became aggressive towards staff.

   

 

On July 3, 2013 at approximately 1545 hOurs, was sitting in chair and
throwing up. Staff cleaned up and notified supervisor.

 

refused a main and substitute

 

On July 3
meal.

2013 at approximately 1605 hours, .. .
vomited fluid and supervisor was notified.

 

 

 

inas walking out of the safe
a

On July 3, 2013 at approximately 1606 hours, -
zone and was hitting head on hard surfaces. Staff placed
protective waist belt and notified supervisor.

    

    

?t approximately 1647 hours, i started banging head and
was placed in protective waist belt. Staff notified supervisor

  
 

On July 3, 2013
crying out. 
and clinician.

On July 5, 2013 at approximately 1650 hours, i was drank Gatorade and
vomited. Staff cleaned -up and notified supervisor.

 

 

 

On July 5, 2013 at approximately 1727 walking out of the safe
zone and was hitting ead on hard surfaces. Staff placedi 
protective waist belt and notified supervisor.

   

   

On July 5, 2013 at approximately 192 hours, was banginc?
and biting warms. Staff placed in a protective waist belt (EROM) and

notified supervisor.

    

 

On July 5, 2013 at approximately 2200 hours
biting pper arms. Staff placed- in a protective waist belt (EROM) and

notified supervisor.

   

  
 
 

was sitting in the restraint chair and seemed
,.to bed. Supervisor was

On July 6, 2013 1205 hours 
calm. Staff took out of the chair and put?
present all night with. {See reports)

   

 

On July 15, 2103 Detective Watkins reviewed ?n sleep charts and
determined On July 5, 2013 at approximately 0900 hours to July 6, 2013 at 0730
hours, did not sleep. {See Sleep Charts)

 

0151084

 

 

 

 

Supplemental Narratives Incident 130090458

Page 6 of i2

 

On July 15, 2103 Detective Watkins reviewed the intake schedule and diagram of
[See Intake Schedule and diagram)

with room assignments.

 

 
 
 

Detective Watkins reviewed
was: and would injure?
extremities. Detecti ins lea
increase when

  

  
 

2013 Keith Jacobs conducted an internal
investigation and took notes. Detective Watkins reviewed the notes and learned

Detective Watkins learned on July 6.

at approximately 0200 hours, _gave Ibuprofen and gave
some Gatorade. Mrs. Loy said appeared to be dehydrated and at
approximately 0708 hours, and she called nurse_Marcella and Diana. Mrs. Loy
advised Diana said she told the staff to give .vi?IaGatorade, popsicles and
Jell-O and the medication to stop the vomiting. rs. Loy advised was
injuring and they had to use the restraint chair. Mrs. Loy advised
lips were turning blue and was making a gurgling sound while eating the
popsicle. Mrs. Loy advised said at approximately 0720 hours, looked
unresponsive and 911 was called. (See notes}

   
   

      

   

 

Detective Watkins learned on July 6. 2013 Keith Jacobs conducted an internal
investigation and took notes. Detective Watkins reviewed the notes and learned
Kathleen Evans would drink half a cup of cle liquids at a time and vomit it
back up. Kathleen Evans advised she gave Zofran and ?appeared to
be fine afterwards. (See notes}

   

 

Florida records indicated (deceased) arrived at
0813 hours and was pronounced dead at 0815 hours. Records indicated at 0819
hours, a 'had a temperature of 103.5 degrees and had bruising and
bite marks on multiple areas of body.

 

 

 

[See Medical Records}

 

On July 15. 2013 Detective Watkins had a conversation with Deputy Chief Medical
Examiner Wendy Lavezzi and she advised she believed the injuries were post
mortem and superficial. Doctor Lavezzi advised she was still waiting on further
studies to complete her findings.

On July 15, 2013 Detective Watkins reviewed Lake County EMF
which stated on July 6. 2013 at approximately 0724 hours,
{deceased} was having breathing problems and was transported to F1
I Florida for treatment. The report indicated 
face, arms and legs. {See Lake County EMS report)

          

medical records.

orida

 
  
  

contu51ons on

On July 15, 2013 at approximately 1500 hours. Detective Watkins had a
conversation with Tom Shea and Bob Bacon and learned the requested video had
been accidentally deleted when trying to copy it for the investigation. Tom Shea
advised he had previously copied one hour of the video to a flash drive
during an administrative investigation. Tom Shea allowed Detective Watkins to
view the video and Detective Watkins did not observed anything unusual during
the hours of video leading up to . death. Bob Bacon advised he
was going to take the DVR and have a company forensically recover the video.

  

On July 15, 2013 at approximately 1511 hours, Loy Sydnah Reid (CLS Weekend Night
Shift Supervisor} with Carlton Palms Educational Facility (Advoserv) provided a
sworn audio taped statement stating Monday she was assigned to the 1 to 1
intake team with ?and explained duties of the intake team. Loy

 
 

?-.Spi I ImanServeriapp\forcc\up11\i wsu pl . x1

01HOH4

 

 

 

 

Supplements! Narratives Incident 130090458 Page 7 of 12

 

 
 
 
  

   

osed with; 
*wore a protective helme protective
from injuring Loy
?breakfast and
svomited and she
vwent for
gate lunch

 
  

Reid advised

 

  

 

arm splints, gloves and a harness to prevent
Reid said on the morning of Thursday July 4, 2013 she gave
dressed protective clothing. Loy Reid advised
did not allow to go to the pool for the day. Loy Reid advrsed'
a walk and sat in her office while she worked. Loy Reid advised
and vomited after lunch. Loy Reid advised on July 5, 2013 at approxrmately 2345
hours she came into work and saw-: in the restraint chair in the
hallway. Loy Reid advised the evening shift told her had been injuring
ng. Loy Reid advised she decided to ta 
chair and put a ?to bed. Loy Reid advised she decided to stay with .
for the night. Loy Reid advised she and Tofoyia Hill stayed with
i ?stayed up all night. Loy Reid said called
the nurse and told her .wn was dehydrated. Loy Reid advised the nurse advised
her to give-- Gatorade and popsicles. Lo 'Reid advised she and Tafoyia
stayed with ..m'all night and 'istayed up all night. Loy
Reid advised she and Tafoyia gave her medication. Loy Reid said Tafoyia
noticed . lips were purple and she told Tafoyia to call 911. Loy Reid
advised she performed CPR on? until EMS Arrived. Loy Reid denied using a
bed net or harming {See audio taped interview}

    
 
   

 

    
 
  

 
 
 
 
 

 
 
     

   

    

  

  
  

 

On July 15, 2013 at approximately 1600 hours, Tafoyia Amaris Hill (3rd shift
with Carlton Palms Educational Facility (Advoserv) provided a sworn audio
taped statement, stating- .was diagnosed wit? 
.lr. is.. ,g Taioyia Hill advised ?Wt - wore a protective
helmet, and a walking harness to prevent rom injurin- m: 
Hill advised on July 5, 2013 at approximate 2345 hours she came into work and
saw 3? in the re aint chair in the hallway. Tafoyia Hill advised
the evening shift told her i'had been injuring rand vomiting
Tafoyia Hill advised Mrs. Loy decided to assist her and sta with - .jl_-ph?
for the night. Tafoyia Hill advised Loy Reid decided to take *-aut of the
chair and put her to bed. Tafoyia said Mrs. Loy, Mr. Floyd. Samantha and Shamika
moved to her bed. Tafoyia Hill advised at approximately 0000 hours, they
moved back to the restraint chair for roximately five minutes.
Tafoyia advised she and Mrs. Loy escorted f' back to the bed. Tafoyia said

?rolled around on the floor, kicked and bite Mrs. Loy during the night:

foyia advised they put her helmet and splints on to keep from hurting

Tafoyia adviSed? did not vomit, but would spit during the night
Tafoyia said they had to hold leg down during the night. Taioyia called
the on?call nurse and told them had been up all night. Tafoyia Hill said
Loy told the nurse was dehydrated and the nurse advised them to give
Gatorade and popsicles. Tat 'll advised she and Mrs. Loy stayed with
 night and stayed up all night. Tafoyia Hill
advised Mrs. Loy and Mr. Floyd gave her medication. Tafoyia said she
noticed lips were purple and Mrs. Loy told her to call 911. Tafoyia
advised Mrs. Loy, Samantha and Shamika performed CPR on auntil EMS Arrived.
Tafoyia denied using a bed net or harming INN-II (See audio taped
interview)

        

      

 

 
             
   

 
 

  
    

  

 
  
 
    
 

   
  
 
 

 

  
  

On July 15, 2013 at approximately 1914 hours, (CLS Shift Supervisor} with
Carlton Palms Educational Facility (Advoserv) provided a sworn audio taped
statement, statin

On July 15. 2013 Detective Watkins had a telephone conversation with Deputy
Chief Medical Examiner Wendy Levezzi and she indicated the bruises were

0 If I 0r" 4

 

 

 

 

Supplemental Narratives incident 130090458 Page 8 of 12

 

superficial and the autopsy was pending further studies. Detective Watkins
provided a copy of the photographs of the restraint device to Doctor Lavezzi for
review.

On July 16, 2013 Detective Watkins confirmed Bob Bacon had taken the video to
Data Analyzer in an attempt to recover the deleted video. Detective Watkins had
a telephone conversation with Data Analyzers and confirmed they were trying to
recover the video.

Detective Watkins obtained a subpoena for the Carlton Palms video surveillance.
{See subpoena)

  
 

  
    
 
 
   
  

Detective Watkins had a telephone conversation with .i and
advised =had received a telephone call from Doctor stating 
had aspirated on vomit during the night and heart stopped.
- said.: learned Doctor had given 1 {deceased}
Zofran for the nausea. advised Doctor had taken
off of the medication prescribed by the other facility. 
confirmed . .had and would 
biting and or banging er head. advised i would wear
protective clothing to help prevent the injuries. described the
types of equipment used to protect i such as helmet, arm guard and chest
protector. advised.~ had eumails sent to - from Carlton Palms
Educational Facility and agreed to send them to Detective Watkins. - 
further agreed to complete a statement and send it to Detective Watkins.

 
 
    
 
   

   
  

    

 
   

  

On July 16, 2013 at 1333 hours, Detective Watkins had an audio taped
conversation with Samantha Benjamin {3rd shift stating et'
diagnosed with ?land - . Samantha Benjamin
advised era. i ..wore a protective helmet, gloves, arm splints and a
walking harness to prevent from injuring'i Samantha noticed bite
marks on arm amantha Benjamin advised on July 5, 2013 between 2345 and
000 hours. she saw in the restraint chair in the hallway.

ntha Benjamin adVised evening shift told her had been injuring 
and vomiting. Samantha Benjamin advised Mrs. Loy decrded to assist her and
stay with "for the night. Samantha Benjamin advised Loy Reid
decided to take.. out of the chair and put to bed. Samantha Benjamin
said Mrs. Loy, Mr. Floyd, Samantha and Shamika moved 1 a bed. Samantha
Benjamin advised she and Mrs. Loy and Tafoyia secured ankles and wrist
to the bed using four point restraints for a couple minu es. Samantha Benjamin
said ooked like she had gone to sleep and Mrs. Loy took off the
restraints. Samantha said at approximately 0430 hours, {deceased}
got out of th bed would walk around th roup home. Samantha said she saw Mrs.
Loy giving -liquids and i was vomiting and/or spitting the
liquid back up. Samantha Benjamin advised they put. helmet and splints on to
keep from hurtin .- Samantha Benjamin advised Tafoyia and Mrs. Loy
stayed wit all night and- stayed up all night.
Samantha advised in the morning, Mrs. Loy and Mr. Floyd gave her
medication. Samantha Benjamin said Tafoyia and Mrs. boy had to ysically hold

down during the night. Samantha Benjamin called the on-call nurse and
asked Shamika to get some Gatorade and popsicles from the kitchen. Samantha
Benjamin said Mrs. Loy was helping drink the some Gatorade and she noticed
gasping for breath and stop breathing. Samantha advised Mrs. Loy told
her to call 911 and Mrs. Loy performed CPR on until EMS arrived. Samantha
Benjamin denied seeing anyone harm (See audio taped interview}

  

was

   
  

   
  

 

  

     

 
  
  
 

  
   
  

 

  
     

   
 

 

 
 

 
 
 

 
   
 

 

 

 

  
 
 
 

012?10114

 

 

 

 

Supplemental Narratives incident 130090458 Page 9 of 12

On July 16, 2013 at 1552 hours, Detective Watkins had an audio taped
conversation with Floyd Cornelius (3rd acting shift supervisor) and he advised
covering the shift, because Ms. Loy (Shift Supervisor) was helping with
in, Floyd Cornelius advised they temporarily used a four point
restraint to secure i to the bed and?= ahead against the
wall. Floyd advised Ms Loy decided to tak _1 out of the four point
restraints and move id_-to the chair. Floyd Cornelius advised he assisted moving
from the restraint chair to- bed. Floyd said he continued with his
regular duties and at approximately 0645 hours, Mrs. Loy gave her
medication and later he heard Tafoya and Shamika yelling to call 911. Floyd
Cornelius denied using a bed net or harming {See audio tape
statement)

he was

  

 

  
 
    

 

 

 

   

      

 

On July 16, 2013 at approximately 1627 hours, Detective Watkins had an audio
taped interview with Nicole Douglas {2nd shift CLS Special Ed Teacher) and she
advised she was assigned to the intake team for Nicole Douglas
advised wore a protective helmet, chest protector, arm splints
and lifting be . Nicole Douglas stated Helmet was too big for head.
Nicole Douglas advised she had to change helmet twice. Nicole Douglas stated
on July 5, 2103 at 1545 hours, refused to walk and they had to assis
into the house. Nicole Douglas advised 3 was placed on a met an
was banging head. Nicole Douglas said she clippe-g the chair and
would block form biting Nicole said she heard from day shift
that had been vomiting during the morning. Nicole Douglas said she gave
refused to eat. Nicole said at approximately 1600 hours,
she gave some Gatorade and vomited up the liquid. Nicole said she ot
permission to strap 1 arms to the chair, because __was inuring 
Nicole advised after 2100 hours, a projectile vomited five (5) more
times and it was clear. Nicole advised there should be approximately five (5)
data sheet for every action taken. Nicole advised head in
bed and they clipped *?to the bed. Nicole described how was clipped to
the bed. Nicole Douglas advised the clinician advised them to take out of
the bed and put into the chair. Nicole advised Kristine, Kathleen,
Yolanda, LaQuanda and Shem helped put . into the chair. Nicole advised they
told Kathleen about the vomiting and the self?injury behavior. Nicole Douglas
advised she told the oncoming shift about behavior and vomiting. Nicole
denied using a bed net or harming {See audio tape statement)

 
  
 

  
   

    

 

    

 
   

 

a cookie and

              
   

  
   

 

   

 
 

On July 16, 2013, Detective Watkins reviewed Carlton Palms had approrimately
Forty Four (44) reported investigation between 2004 and 2013. Detective
Watkins observed three of the complaints were verified, ten (10} had some
indicators and Thirty (30) complaint were unfounded.

On July 19, 2013 at approximately 1444 hours, Detective Watkins had an audio
taped interview with Kathleen Evans {2nd shift CLS alternate supervisor) and she
advised on July 4, 2013 (deceased) wore a protective helmet,
chest protector, arm splints and lifting belt. Kathleen advised she had heard

., was sick and had been vomiting. Kathleen advised she saw vomit one
time on Thursday July 4, 2013. Kathleen advised th had given
Gatorade and . would spit it up. Kathleen advised . would eat cereal and
was on a liquid diet. Kathleen advised she had a conversation with Bonnie
Clugston (Nursing Supervisor} and she advised she would check on 
Kathleen advised a nurse never came to see during the shift.

     
  

 
 

   

   

Kathleen Evans stated on July 5, 2103 at 1500 hours, Kathleen Evans advised she
ewas sick and was put on an all liquid diet. Kathleen said the day

 

0 I Ii 0214

 

 

 

 

Supplemental Narratives Incident 130090458 Page 10 of 12

 

 
  
 

and vomiting throughout

 

shift told her trad been injuring
the shift. Kathleen advised she did not know if "saw the nurse or doctor
prior to her coming to work. Kathleen Evans said* - refused to eat and would
spit out the liquids. Kathleen Evans advised on July 5, 2013 at approximately
2000 hours, was given and anti?nausea medication. Kathleen said she got
permission to strap arms to the chair, because was inuring 
Kathleen Evans advised between 1500 hours and 2000 hours, vomited
three (3) more times and it was lear liquid. Kathleen Evans advised she
called Bonnie the second time vomited and Bonnie told her to give the
nausea medication. Kathleen would vomit up the medication. Kathleen
advised ,kept banging head in bed and they clipped io the bed.
Kathleen 'vans described how . was clippe to the bed. Kathleen Evans
advised at approximately 2100 hours, l-:began projectile vomiting
onto the wall. Kathleen Evans advised Shem Orvis (CLS supervisor) instructed
them to take- 'out of the bed and put Einto the chair if :was
vomiting. Kathleen Evans advised Kristine, Kathleen, Yolanda, LaQuanda and Shem
helped put into the chair. Kathleen advised she called Bonnie and Kathleen
to tell them abOut self-injury behavior and medical condition. Kathleen
Evans advised she told the oncoming shift about behavior and vomiting.
Kathleen Evans denied using a bed net or harming_ {See audio tape
statement)

 
 

      
 

 

   
 
 

 

  
  
 

   
 

 

   
     

 

    
 

On July 19, 2013 at approximately 1531 hours, Detective Watkins had an audio
taped conversation with Bonnie Clugston {Director of Nursing) with Carlton Palms
Educational Facility and she stated she oversees the facilities in four 
states as well as Carlton Palms for eighteen (18) years. Bonnie Clugston advised
on Tuesday, July 1, 2013, she learned i (deceased) had been
vomiting and she was not worried because ive (5) other students had been sick.
Bonnie Clugston said she put on a liquid diet and arranged for .to be
seen. Bonnie said on July 2 or 3rd 2013, Amy Chapman LPN or Paul Nolan RN
examined and *?did not have a temperature. Bonnie Clugston
advised was only vomiting after eating lunch. Bonnie Clugston said on
Wednesday, July 3, 2013, she had a conversation with the staff and the staff.
believed the vomiting might be a behavioral problem. Bonnie advised on July 3.
2013, she had a telephone conversation with Diana Ries RN informing
??had been vomiting and had been ced on a clear liquid diet. Bonnie
Clugston said on Thursday, July 4 2013 m_ had vomited again and she advised
staff to call Diana Ries if continued to vomit. Bonnie Clugston advised
on July 5, 2013 Doctor examined land prescribed 4 mg Zofran,
three times a day for nausea. Doctor advised to up the amount to 8mg

continued to vomit after a 24 hour oeriod of time. Bonnie
Clugston said she instructed Diana Ries to check on condition on
Saturday July 6, 2013 at approximately 1400 hour. Bonnie advised on July 6, 2013
at approximately 0710 hours, Diana Reis . "-had taken the Zofran and was
fine. Bonnie said at 0723 hours, she was told was gasping for air and had
been transported to a .ili.inn.i.. . Bonnie advised the nurses should
have taken 'temperature when the checked medical condition. (See
audio taped statement)

     
     

   

   
 

 

 

   

 

   
 

 

 

 

   
  
     

   

On July 20, 2013 at approximately 1705 hours, Detective Watkins had an audio
taped interview with LaQuanda Alston (2nd shift CLS) and she stated on 07/02/13
and 07/03/13 awas projectile vomiting a yellow clear liquid with an awful
smell. LaQuanda said she did not speak to the nurse and did not believe her
supervisor spoke to the nurse. LaQuanda advised she never saw a nurse check on

LaQuanda said on 07/01/13 and 07/02/13 .ate a handful of Fruit loops
and refused the chicken broth. LaQuanda stated the nurse put

 

   
 

\Spi 0 I fl 0H 4

 

 

 

 

SuppJ'ementa:t Narratives Incident 130090458 Page 11 of 12

 

diet a a visit to the doctor by the day shift. LaQuanda advised tried to
take - helmet off and would bite at 'arm through the splin s. LaQuanda said
they put a jacket on backwards and ripped it up to keep from biting
LaQuanda state Yolanda, Christine and Nicole attempted to clip-
3 to the bed. LaQuanda Alston stated: ,.projectile vomited
25 30 times her shift and Cathleen notified the clinician and the nurse.
LaQuanda said I would dry heaving and Cathleen called the nurse. LaQuanda
advised. was injuring' and staff. LaQuanda Alston advised they
attempted would not work becaus moved too much.
LaQuanda Alston advised on 0?/05/l3 at approximately 2305 hours, they moved
to the restraint chair using a locking belt, wrist restraints, ankle
restraints and bicep restraints. LaQuanda advised
head and they put a pillow behind head. LaQuanda de
seeing anyone harm {See audio tape statement)

 

     
 
 

     

    
     

  
  
   

  

nied harming

 

 

On July 20, 2013 at approximately 1359 hours, Detective Watkins had an audio
taped interview with Shem Orvis (2nd shift CLS supervisor) and he advised

wore a protective helmet, chest protector, arm splints and lifting
harness belt. Shem Orvis stated on July 5 2103 a 2330 hours, he received a
telephone call from Cathleen stating 'had been vomiting and biting 
Shem Orvis advised he learned they had use four point restraints to secure is
to the bed, but kept slipping the restraints. Shem Orvis advised Cathleen to
.., into the chair if was vomiting. Shem Orvis said he and assisted
Nicole, Yolanda, Ca lean and Tonya strap into the chair. Shem stated
Cathleen told him . i had been vomiting for days. Shem believed
Cathleen had a telephone conversation with Bonnie (Nursing Supervisor} about
i vomiting. Shem Orvis denied using a bed net or harming 
{See audio tape statement)

 
     

  
  

 

 
   
 

     
 

    

Between July 19 and 27th, 2013 Detective Watkins received several e-mails,
photograph of protective an. i notes.
w. .. .-provided notes regarding Nconversation with the staff at
Carlton Palms Educational Center. e.dvised Doctor had taken
- a previously prescribed medications. said on June
28, 2013 received an e~mail from Paul Nolan RN. advised on
July 6, 2013 a 0933 hours, Doctor notified them . had been sick and
vomiting. ,said Doctor stated he examined _and did not
appear to be dehydrated and put on a 1i 'd diet. Do tor said he did
not admit ,to the hospital because of :'behavior. Doctor advised

ontinued to vomit throughout the night and they rushed
ospital where later died. .M. said ""spoke to the Medical
Examiner's Office and learned the autoasy was pending further studies and
toxicology. advisad Fhad a conversation with Dr. and Tom
Shea in reference to the death. (See notes, photograph and e?mails)

     
  

 
         
  
  

 

    

      

 

   
 

  

      

 

   

Detective Watkins learned Data Analyzer were unable to recover the video
surveillance and collected the Clinton DVR from Bob Bacon. (See report,

property receipt)

On September 16, 2013 Detective Watkins received a Fifth District Medical

Examiner?s Cause and Manner of Death Report which indicated the cause of death
was dehydration, gastrointestinal infection and the manner of death was Natural.

Investigation revealed no criminal activity and case submitted to the State

".Spil 

 

 

Supplementa! Narratives Incident 130090458 Page 12 of 12

 

attorney 3 off ice

 

 

0 HIGH 4

 

 

Lake County Sheriff's Of?ce
Case Management Supplemental Report 

 

 

 

 

 

 

 

 

 

Date of Offense: Original Offense: Case Number:
07/1 1/13 Death Investigation 130090458
Victim: Amended Offense: Related Case Numbers:
Suspect: Added Suspects: Recovered PrOPerty
Value:
CB The perpetrator in this case was arrested by Deputy Sheriff:
0n 
FSA: l. A Charging Af?davit was ?led with the State Attorney on 

2. An Arrest Warrant was obtained on _f 

 

1. The of?ce of the State Attorney was contacted in reference to this case and prosecution was

declined on per 

2. Suspect identi?ed; however victim refuses to assist agency with investigation (N Intent)

 

3. Suspect deceased

 

 

The victim in this case was provided appropriate instructions to present incident to State Attorney?s
Of?ce.
UNF N0 criminal violation exists

 

This case was turned over to State Attorney?s Of?ce for review and further
investigation.
TOT:

A follow?up investigation was made on this casenno suspects were identi?ed, case
will remain inactivated till there are new leads or suspects.

 

 

 

 

 

Reprint
Remarks:

 

 

2 -
Detective: 

Supervisor: DATE: /,723 


 

 

 

Revised 08/133119

 

 

 

3 

LAKE COUNTY OFFICE 2

Case Report for Incident 130090458

Nature: Address:

Location: 1

 

Offense Codes: 0000

Received By: HINDS-GRACEY Agency: LCSO
Responding Of?cers: ROBBINS 1203, STONE 874, MCKANE 840, ABBOTT 1890, RUSH 2016
Responsible Of?cer: WATKINS 209 Disposition: ACT 071111113

When Reported: 15:54:04 07/1103 Occurred Between: 15:53:32 and 15:53:37 07/1 1f13

Assigned To: WATKINS 209 Detail: MIR Date Assigned: 071 12/ 13
Status: TOT Status Date: 12/233113 Due Date: 

 

Complainant: 92035

Last: MARCHESE First: AMANDA Mid:
DOB: Dr Lic: Address: 13008DUNCAN DR
Race: Sex: Phone: (352)742~6330 City: 

Offense Codes

Reported: 9068 ASSIST OTHER AGENCY Observed:
Additional Offense: 0000 

CRIMINAL

Circumstances

CIB Criminal Investigations Report

Responding Of?cers: Unit 

ROBBINS 1203 1203
STONE 874 874

MCKANE 840 840

ABBOTT 1890 1890
RUSH 2016 2016

Responsible Of?cer: WATKINS 209 Agency: LCSO
Received By: Last Radio Log: 20:35:55 0711 1/13 
. Clearance: REPORT
When Reported: 15:54:04 0701113 Disposition: ACT Date: 07111/13

Judicial Status: Occurred between: 15:53:37 02/111?13

[2126113

 

 

 

Case Report for incident 130090458

Page 2 of19

 

Misc Entry: PENDING TOX

35:53:37 {)Wllx?l3

 

 

 
 
   

Modus Operandi: Description Method 
lnvolvements
Date Type Description
09/19/13 Name HILL, TAFOYIA AMARIS witness/CLS
09(19/1 3 Name CLUGSTON, BONNIE nursing director
3 Name LOY SYDNAH witness
07mm Name Patient Carlton Palm
07922213 Name Patient Carlton Pain}
013/22! 13 Name Patient Carlton Palm
07/] NB Name SHEA, THOMAS Other One
07111/13 Name MARCHESE, AMANDA DCF Complainant
07H 1H3 Name MARCHESE, AMANDA DCF Complainant

07/ 112? 13 Name ROBERT Other TWO
07/1 1/13 Name Other Three
07111;?13 Name . Other Four Juvenile
07/17l13 Evidence Evidence Incident
1 7f 13 Evidence Evidence Incident
07! 171? i 3 Evidence Evidence Incident
07/17! 13 Evidence Evidence Incident
07/17/13 Evidence Evidence Incident
Evidence Evidence Incident

12t26i?l 3

 

 

Case Report for Incident 130090458 Page 3 of 19

 

Narrative
Offense/Class: Police Information

Reporting Officer: D/s Robbins {91203)

Evidence: Turned over to C18

Crime Scene: Turned over to CID

Attachments: Two Sworn Affidavits, DCF Intake Report #2013u1894S2?Ol
Canvass Area: N/a

Narrative:

On 07/11/2013, at approximately 1553 hours, we received call from the
Complainant, Amanda Marchese, that she was responding to the above location in
reference to a DCF investigation.

Upon arrival, contact was made with DCF Investigator Marchese who handed me an
intake report #2013-189452-01. In this report it alleges that over the weekend
of 07/06/2013 a child passed away during the night after. . had been placed in
a 6-point restraint. A bed net was used to restrict the child?s movements even
further. Staff approved the restraints and communicated only through text
messages. The Supervisor did not actually speak with the approving clinic to get
details. Using that much restraints may have made the child's underlining issues
even worse. The child had medical issuas for several days prior to death.
"had been throwing up colored liquids for days. There were data sheets and
documentation missing the morning of the child?s passing.

 

 

 

At this point, upon reading the allegations, Stone (P874) was then notified
and made aware of the situation. I also attempted to pull up information to
find out if law enforcement had responded on Friday, 07/05/2013, or Saturday,
07/06/2013, in reference to this incident. I was unable to find any information
of where we had responded out. Stone notified CIB and was advised they were
able to determine that EMS was notified and responded out to this location on
Saturday, 07/06/2013.

Other One, Thomas She sworn affidavit stating he was notified of
Juvenile Other Four,a? being in distress on Saturday, 07/06/2013.
According to Mr. Shea, 911 was immediately called and EMS responded. Mr. Shea
stated that at the time was not breathing and CPR was administered by EMS.
Mr. Shea also stated that his on?call doctor for the facility, Other Two,
Robert was also notified and responded. Mr. Shea stated that _was
then transported to - was later pron nced
deceased. Mr. Shea Iotified the juvenile?s
parents. Mr. Shea also stated that had arrived at this facility
approximately less than one week ago. Mr. Shea stated that is an
child with to the, ll . Mr. Shea also stated that
was sick when he arrived and was seen by Dr. Mr. Shea provided a
sworn affidavit.

   
    

 

  

  
 
  

     

 
  

I then briefly spoke with Dr. who also provided a sworn affidavit. Dr.

stated that on Saturday, 07/06/2013, early morning hours, he received a

call from the on-staff indicating that was in distress. Dr. stated

he responded to the facility and was met With EMS and the Fire Rescue

paramedics. Dr. stated CPR was being administered. Dr. stated that
- was then transported to with him following. Dr. 

 

   

 2i26f13

 

Case Report for Incident 130090458 Page 4 of 19

   

 
 

also confirmed that

was pronounced deceased at
also verified tha - 

was~ ?"nd

 

Clay Watkins (I209) from CIB than arrived on scene and took over the
investigation.

Nothing further at this time.

12/26ll3

 

 

 

Case Report for Incident 130090458

Page 5 of 79

 

Supplement

INVESTIGATIVE SUPPLEMENT
DETECTIVE KARL JOHNSON 1412
CASE NUMBER: 130090458

OFFENSE:
Death investigation

EVIDENCE:

07/11/13 audio interviews:

  

CRIME SCENE:
None

ATTACHMENTS:
None

CANVASS AREA:


NARRATIVE:

On July 11th, 2013 at 4:30pm I responded to the Carlton Palms Educational
Facility in to assist Detective Watkins (209) in a death
investigation. At Detective Watkins' request I interviewed thre patients at the
facility that were housed with the deceased; fvif?

and Mr. Dugo was cooperative in facilitating the interviews
and allowed us to interview the patients privately.

 

 

 
 

   

DCF CPI Marchese and I interviewed each patient individually in their bedrooms
with no other persons present. with each patient we made small talk and built
rapport. Each patient interviewed displayed clear signs of being
Due to their the interviews were kept short. The patients
had trouble with communication and comprehension during the interviews but they
were cooperative and appeared open to questioning. No patients indicated that
they had suffered any abusa or neglect during their stay at the facility.

  
 
 

   

 

had died. The

Each patient indicated they knew the decedent and were aware
had

three patients had very limited information concerning the decedent as
only been there a Short time. All three patients indicated they had gone to
sleep that evening in their assigned bedrooms. They were awakened in the morning
by the ambulance and they were later told the decedent had passed away. Only one
patient, indicated that they saw the decedent the morning of. 
death. _m stated; walked out bedroom and saw "Lori" deing
CPR on - three patient interviews were recorded and I placed them into
evidence reference property receipt 229451.

 

     
 

After interviewing the three patients DCF CPI Marchese left to return to the
main facility office and I spoke with C31 Wolford (2016). She had completed
documenting the scene and collecting evidence from within the decedent's bedroom
as Detective Watkins had requested. CSI Wolford and I returned to the main
facility office and met with Detective Watkins.

On July 12th, 2013 I obtained the run sheets from EMS and a CD containing

 
 

l2i26ff3

 

 

Case Report for incident 130090458 Page 6 of 19

photographs from the Fifth District Medical Examiner's Office. I provided this
material to Detective Watkins.

On July 11th, 2013 and July 16th, 2013 I was present for several interviews with
Detective Watkins; please refer to Detective Watkins report.

Nothing further.

l2f26? 3

 

 

Case Report for Incident 130090458 Page 7 of 19

 

Supplement

Report Written By: Detective J.C. Watkins
Offense/Class: Death Investigation
Evidence: See CSI Report

Crime Scene: Processed By CSI

Attachments: DCF Intake report, AdvoServ Medical Records, Advoserv
Incident/Injury Reports, Behavior Data Sheet, Sleep Charts

Canvass Area: Interviews Staff

Narrative:

  
  

On July 11, 2013 Detective Watkins res
(Carlton Palms Educational Facility)?
investigation.

Florida in reference to a death

Detective Watkins had a telephone conversation with Sergeant K. Stone and
learned on July 6, 2013 vwas not breathing and was transported to
Florida Center for treatment. Sgt. Stone advised 
_m died and was transported to the fifth District Medical Examiner?s
Office to have an autopsy performed. Sgt. Stone advised on July 11, 2013
Investigator Danielle Lampkin and.Amanda Marchese with the Department of
Children and Family Services contacted deputies and asked them to assist her
with the death investigation. (DCF Intake report 2013-189452?01) Sgt. Stone
advised Deputy Robbins was in the process of obtaining sworn written statements.

 
    

 

  

A Lake County Sheriff?s Office records check revealed on July 6, 2013 at
approximately hours, Lake County Sheriff's deputies and Lake and Sumter EMS
responded to a medical call at Carlton Palms Educational Facility
Florida. (See CAD notes 

 

Detective Watkins requested Crime Scene Investigation respond to the Carlton
Palms Educational Facility to document the scene.

Detective Watkins received and reviewed the Department of Children and Family
Intake Report. (See Intake Report #2013~189452}

On July 11, 2013 at approximatel
vacation at the time of 
file.

 

1701 hours, David Dugo advised he was on
death and advised he would make copies of

   
 

 

Detective Watkins obtained a copy of floor plan fo living facility.

On July 11, 2011 Detective Karl Johnson had a telephone conversation with Chief
Medical Examiner Wend Lavezzi with the Fifth District Medical Examiner's Office
and she advised "had bruise from head to toe which were not
consistent with restraints. Doctor Lavezzi further advised the autopsy results
were pending further studies.

 

On July 11, 2013 at approximately 1749 hours, Robert M.D. with Carlton
Palms Educational Facility (Advoserv) provided a sworn audio taped statement,
stating on June 26, 2013 he examined . when i checked into the
facility. Doctor advised' 'would try to injure herself during

    
 

12/26/ 1 3

 

 

Case Report for Incident 130090458

Page 80f19

 

the examination had to be physically restrained by staff. Doctor advised
he changed . medication. {See medical records} Doctor advised
on July 5, 2013 he received a request to examine? -
been vomiting for five 5) days. Doctor adv1sed he put.
liquid diet and gave some anti~nausea medicine. Doctor advised on
Saturday, July 6, 2013 he received a call from the on?staff indicating that
i . (deceased) was in distress. Dr. stated he responded to the
facility and was met with EMS and the Fire Rescue paramedics. Dr. stated
CPR was being administered. Dr. stated that was then transported to
-with him followin Dr. also confirmed that .
pronounced deceased at L. Dr. also verified thati 
(See audio taped statement and

   
   
 

   

 

        
 

written statement}

2013 at approximately 1830 hours, Detective Karl Johnson, Detective
Detective Watkins and Crime Scene Investigator Amanda Wolford
responded tol .i Florida photograph
and document - room and the restraints equipment. Detective Watkins
observed video cameras in the bedroom and the main living area of the
askesidence. Detective Watkins learned the cameras in the bedroom were used for
monitoring the patients and were not recorded. Detective Watkins learned the
cameras in the main living and hallways were recorded. Detective Watkins
requested a copy of the surveillance video. (See CSI report and
photographs}

On July 11,
Deana Cameron,

    

    

 

Detective Karl Johnson interviewed three patients at the facility that were
hoes with the deceased; 3
Mr. Dugo was cooperative in facilitating the interviews and allowed us

to interview the patients privately.

 
    

 
 

CPI Marchese and Detective Johnson interviewed each patient individually in
their bedrooms. None of the aforementioned patients indicated they had suffered
ct during their stay at the facility. The patients indicated
*and were aware had died. The three patients had
very limited information concerning had only been there a short
time. All three patients indicated they had gone to sleep that evening in their
assigned bedrooms and were awakened in the morning by the ambulance. The patient

     
    

   

  

  
 

aid on Friday-

on a mat unrestrained.

. . advised
did not have a roommate.

ni ht and the ambulance. a

had died. (See audio taped interview)

. ate and staff would lie
ould scream and hurt 

    
 
 

earne

 
   

 

On July 11,

2013 at approximately 1910 hours,

   
   
     
 
 
   

leave the facility. was non? verbal and would rock back

and forth
would hurt

 

a W. indicated a
.stated walked out of
{See audio taped interview)

saw the decedent the morning of
bedroom and saw "Loy"

 
     

doing CPR oir

 

12f26f13

 

 

 

Case Report for Incident 1 30090458

Page 9 01?19

 

      
  
  

On July 13.

2013 at approximately 1910 hours,* .
advised loves 11v1ng Carlton Palms.
.culd not eat and would vomit every time

would scream and hurt 
crazy and kicking at staff. .
was screaming during the night.
learned= had died.

           
      

   

saidil
advised

   
 
 
   
 
 

?adv hursday night

ised on 
ad 

sed

    
 

 

remember if

advised the
next morning

{See audio taped interview)

 

The three (3) patient interviews were recorded and placed into evidence.
audio taped interviews)

(See

On July 11, 2013 at approximately 1914 hours, Thomas Shea provided a sworn
videowtaped statement describing the procedure for care of the students while in
the facility. Thomas Shea advised the camera in the main living area were

recorded and the camera in the bedrooms were monitored and not recorded. (See
video~tape}

On July 11, 2013 at approximately 1914 hours, Thomas Shea {State Program
Director Licensed Behavioral Analyst) with Carlton Palms Educational Facility
(Advoserv) provided a sworn audio taped statement, stating
(deceased) had been a patient at residential living faCility in
a Florida. Mr. Shea advised on June 26, 2013 transferred to
Carlton Palms Educational Center and examined by Doctor Thomas Shea
advised?i, was diagnosed with
Mr. Shea advised 
equipment to keep 
wore a helmet arm splints, waist harness and chest protector. Thomas Shea
advised was assigned one (1) CLS to take care during the
intake period. Mr. Shea further stated CLS completed sleep logs, restraint logs
and injury incident reports. Mr. Shea advised he would provide copies of the

10 to investigators. Mr. Shea advised belongings had been mailed to
amily.

   

     

 
 

  
   
  

 

came into the facility with protective
Thomas Shea advised

    

 

    

    

  

Mr. Shea advised on July 5, 2013 the evening shift had been placed"; 
-M. -in four point restraints in the bed to keep': from injuring

and was moved the chair because T?was vomiting. Mr: Shea confirmed they have a
bed net at the facility. Mr. Shea advised staff members have not use the bed net
for some time and he did not even know where the bed net was located Mr Shea
contacted Shem Orvis and asked him to bring the bed net and 
protective equipment to the office. Mr. Shea advised the goal of the facility is
to reduce the patient's medication and restriants in order to re?introduce them
into another facility or back into the home.

    

 

 

 

  
   

    

Mr. Shea advised on July 6, 2013 he learned 
breathing and the staff immediately called 911 and CPR 
staff. Mr. Shea stated EMS transported a .
where "'later died. Mr. Shea also stated Doctor Robert was
also notified and reaponded the residence. Mr. Shea went on to state that he
immediately notified the 1 parents.

. (victim) was not
as administered by

   
      
 
     
 

 

Thomas Shea provided a list of employees who were assigned to care for 5
-Thomas Shea provided copies of
Behavior Data Sheets, Sleep Charts, Intake Schedule Incident/injury
Intervention Report and a Diagram of for the acility. Mr. Shea
advised he and Keith Jacobs conducted all the staff interviews in reference to
the is death. Thomas Shea advised he would make a copy of the video
surveillance and provide it to Detective Watkins. {See audio-taped statement

     

medical records,

 

 

 

 

12126ff3

 

Case Report for Incident 130090458 Page 10 of 19

 

and written statement)

Detective Watkins collected protective equipment from Shem
Orvis (CLS supervisor) and turned the items over to CS: Wolford. CSI Wolford
photographed the equipment.

 

CSI Wolford photographed the wooden restraint chair that was used to restrain
(See photographs)

  

On July 12th, 2013 Detective Johnson obtained the EMS run sheets and photographs
from the Fifth District Medical Examiner?s Office. Detective Johnson turned the
material over to Detective Watkins. (See EMS run sheet and M.E. Photographs}

 

l2,

   

   

1013 Investigator Amanda Marchese regue ted a copy of
t-medical records involving death.

 

 

  

   

On July 15, 2013 Detective Watkins reviewed photographs of taken
by the Fif Medical Examiner?s Office at autopsy. Detective Watkins
observed r?ihad bruises on: face, chest, arms and leg. Detective

   

Watkins observed bite marks on: -s arms and shoulders. Detective
Watkins had a telephone conversation with Wendy Lavezzi and she advised the
bruise were superficial and did not cause - death. Wendy Lavezzi
M.D advised the autopsy result were pending further studies.

On July 15, 2013 Detective Watkins reviewed the Behavioral Data Sheets;

 

On July 5, 2013 at approximately 2200 hours, Ian 5 was injuring
pulling helmet off. biting arms and hitting-
report indicated a four-point restraint was used to secure 5% 
bed- The report indicated would slip the restriants and would pull?
hair. The report indicated was placed in EROM (Emergency Range of Motion)
wrist only for 55 minutes.

     
 

   

 
  

 

On July 5, 2013 at approximately 2250 hours, w- u- was placed into the
Emergency Mechanical Restraint Chair (EROH) wrist only for approximately 49
minutes

On July 15, 2013 Detective Watkins reviewed the Incident reports;

  

on June 26. 2013 at approximately 2100 hours Statf attempted to give" 
medicati and-t became agitated ihad bruises on arm and legs
where ff was being held by the staff. Staff notified the supervisor and
completed a report.

     

 

On June 30, 2013 at appr ?mately 0115 hours woke up and started banging
head. Staff placed in_a waist belt and protective equipment. Staff
notified clinician and supervisor.

 

 

  

 

On June 30, 2013 at approximately 0730 hours Staff noticed blood 0
forehead and first aid was applied and supervisor notified.

On July 2, 2013 at 0820 hours, was sitting on mat and hitting head on the

floor. Supervisor was notified.

 

 

0850 hours, _f hitting head on floor and

On July 2. 2013 at approximatel 
and "became aggressive towards staff.

staff attempted to re?direct;

     

 

On July 3, 2013 at approximately 1545 hours, was sitting in chair and
throwing up. Staff cleaned up and notified supervisor.

 

I2f26f13

 

 

 

 

Case Report for Incident 130090458 Page 11 of 19

 

 

On July 3, 2013 at approximately 1605 hours, refused a main and substitute
meal.? vomited fluid and supervisor was notified.

 

 

On July 3, 2013 at approximately 1606 hours, ?i'was walking Out of the safe
zone and was hitting- head on hard surfaces. Staff placed 
protective waist belt and notified supervisor.

   

    

On July 3, 2013 at approximately 1647 hours, ?mt'started banging
crying out. was placed in protective waist belt. Staff notified supervisor

and clinician.

 

  
 
 
 
 

as drank Gatorade

 

On July 5, 2013 at approximately 1650 hours
vomited. Staff cleane-

 

On July 5, 2013 at approximately 1727 hours,
zone and was hitting

 

On July 5, 2013 at approximately 1925 hours, - head on floor
and biting rms. Staff placed: 'in a protective waist belt (EROM) and

notified supervisor.

    

   

On July 5, 2013 at approximately 2200 hours, was banging head and
biting upper arms. Staff placed a in a protective waist belt and

notified supervisor.

   

 

was sitting in the_restraint chair and seemed
to bed- Supervisor was

On July 6, 2013 1205 hours 
calm. Staff took out of the chair and put
present all night with (See reports}

    
 

 
 

On July 15, 2103 Detective Watkins reviewed charts and
determined 0 July 5, 2013 at approximately 0900 hours to July 6, 2013 at 0730
hours, aid not sleep. (See Sleep Charts)

 

On July 15, 2103 Detective Watkins reviewed the intake schedule and diagram of
with room assignments. {See Intake Schedule and diagram)

   

 
    
 
 

Detective Watkins reviewed information learned 
was and would injure- -by banging-

extremities. Detective Watkins learned this sel
increase whe was sick. See

 

 

Detective Watkins learned on July 6, 2013 Keith Jacobs conducted an internal
investigation and took notes. Detective Watkins reviewed the notes and learned
at approximately 0200 hours, Mrs. Loy gave 2 Ibuprofen and gave
-some Gatorade. Mrs. Loy said "lappeared to be dehydrated and at
approximately 0708 hours, and she called nurse Marcella and Diana. Mrs. Loy
advised Diana said she told the staff to give . Gatorade, popsicles and
Jell-O and medication to stop the vomiting. Mrs. Loy advised was
injuring and they had to use the restraint chair. Mrs. Loy advised
lips were turning blue and was making a gurgling sound while eating the
popsicle. Mrs. Loy advised said at approximately 0720 hours, 
unresponsive and 911 was called. (See notes)

   
 

 

 
     

 

Detective Watkins learned on July 6, 2013 Keith Jacobs conducted an internal
investigation and took notes. Detective Watkins reviewed the notes and learned

12/26f13

 

 

Case Repon? for Incident 130090458 Page 12 of 19

 

Kathleen Evans would drink half a cup of clear liquids at a time and vomit it

the Zofran and appeared to

   

back up. Kathleen Evans advised she gave
be fine afterwards. (See notes)

  

. .. records indicated (deceased) arrived at
0813 hours and was pronounced dead at 0815 hours. Records indicated at 0819
hours, 1 had a temperature of 103.5 degrees and had bruising and
bite marks on multiple areas of__ body. (See Medical Records)

 

   

On July 15, 2013 Detective Watkins had a conversation with Deputy Chief Medical
Examiner Wendy Lavezzi and she advised she believed the injuries were post
mortem and superficial. Doctor Lavezzi advised she was still waiting on further
studies to complete her findings.

On July 15, 2013 Detective Watkins reviewed Lake County EMS medical records,
which stated on July 6, 2013 at approximately 0724 hours, 
{deceased} was having breathing problems and was tranSported to
i Florida for treatment. The report indicated 
face, arms and legs. (See Lake County EMS report)

 

had

   
 

  

contusions on

On July 15, 2013 at approximately 1500 hours, Detective Watkins had a
conversation with Tom Shea and Bob Bacon and learned the requested video had
been accidentally deleted when trying to copy it for the investigation. Tom Shea
advised he had previously copied one hour of the video to a flash drive
during an administrative investigation. Tom Shea allowed Detective Watkins to
view the video and Detective Watkins did not observed anything unusual during
the hours of video leading up to a . death. Bob Bacon advised he
was going to take the DVR and have a company forensically recover the video.

 
 

On July 15, 2013 at approximately 1511 hours, Loy Sydnah Reid (CLS Weekend Night
Shift Supervisor) with Carlton Palms Educational Facility {Advoserv} provided a
sworn audio taped stating Monday she was assigned to the to 
intake team with 7' and explained duties of the intake team. Loy
Reid dvised was d' ed with a? ?and having: 
.iw? Loy Reid advised i wore a protective helmet
arm splints, gloves and a harness to prevent u? ?from injuring
Reid said on the morning of Thursday July 4, 2013 she gave 
dressed 'protective clothing. Loy Reid advised 
did not allow her to go to the pool for the day. Loy Reid advised
a walk and sat in her office while she worked. Loy Reid advised_w ate lunch
and vomited after lunch. Loy Reid advised on July 5, 2013 at appr mately 2345
hours she came into work and saw 'in the restraint chair in the
hallway. Loy Reid advised the evening shift told her had been injuring

and vomiting. Loy Reid advised she decided to take out of the
chair and put to bed. Loy Reid advised she decided to stay with-w
for the night. Loy Reid advised she and Tofoyia Hill stayed with 
all night and stayed up all night. Loy Reid said called
the nurse and told her'__mn was dehydrated. Loy Reid advised the nurse advised
her to give Gatorade and popsicles. Reid advised she and Tafoyia

   
   

    
  

 
  
  

   

  

   
  

   
 

   

     

protective
.Loy

breakfast and
vomited and i;
went for

          
 

   
  

   

  
 
         

    
 

stayed with all night and ?um? stayed up all night. Loy
Reid advised and Tafoyia gave Paige her medication. Loy Reid said Tafoyia
noticed lips were purple and she told Tafoyia to call 911. Loy Reid
advised she performed CPR i until EMS Arrived. Loy Reid denied using a

 
 

bed net or harming {See audio taped interview}

On July 15, 2013 at approximately 1600 hours, Tafoyia Amaris Hill (3rd shift
CLS) with Carlton Palms Educational Facility {Advoserv} provided a sworn audio

[2f26f13

 

 

 

 

Case Report for Incident 130090458 Page 13 of 19

 
 
 
 

taped statement, stating was diagnosed with
helmet, and a walking harness to prevent 1 from injurin- 
Hill advised 0 July 5, 2013 at approximately 2345 hours she came into work and
saw in the restraint chair in the hallway. Tafoyia Hill advised
the evening shift told her -had been injuring and vomiting.
Tafoyia Hill advised Mrs. Loy decided to assist her and stay with.
for the night. Tafoyia Hill advised Loy Reid decided to take out of the
chair and pu I to bed. Tafoyia said Mrs. Loy, Mr. Floyd, Samantha and Shamika
moved Fto bed. Tafoyia Hill advised at approximately 0000 hours, they
moved - ?back to the restraint chair for oximately five (5) minutes.
Tafoyia advised she and Mrs. Loy escorted back to the bed. Tafoyia said

. rolled around on the floor, kicked an bite Mrs. Loy during the night.
Tafoyia advised they put - ghelmet and splints on to keep .from hurting
Tafoyia advised did not vomit, but would spit during the night
Tafoyia said they had to hold leg down during the night. Tafoyia called
the on-call nurse and told them- had been up all night. Tafoyia Hill said
Mrs. Loy told the nurse?? . was d?hydrated and the nurse advised them to give
ade and popsicles. foyi 1 advised she and Mrs. Loy stayed with
 all night and stayed up all night. Tafoyia Hill
Loy and Mr. Floyd gave medication. Tafoyia said she

lips were purple and Mrs. Loy told her to call 9l1. Tafoyia
ntil EMS Arrived.

(See audio taped

 
   
 
 

  

 

 

     

 

 
 
   
 
  

 
  

 
   
   
   
  
  
   

        
  

 

 

advised Mrs;
noticed_n 
advised Mrs. Loy. Samantha and Shamika performe'
Tafoyia denied using a bed net or harming:
interview)

 
 
 
 
 

On July 15, 2013 at approximately 1914 hours, Shift Supervisor) with
Carlton Palms Educational Facility {Advoserv) provided a sworn audio taped
statement, statin

On July 15, 2013 Detective Watkins had a telephone conversation with Deputy
Chief Medical Examiner Wendy Levezzi and she indicated the bruises were
superficial and the autopsy was pending further studies. Detective Watkins
provided a copy of the photographs of the restraint device to Doctor Lavezzi for

review.

On July 16, 2013 Detective Watkins confirmed Bob Bacon had taken the video to
Data Analyzer in an attempt to recover the deleted video. Detective Watkins had
a telephone conversation with Data Analyzers and confirmed they were trying to

recover the video.

Detective Watkins obtained a subpoena for the Carlton Palms video surveillance.
{See subpoena)

  

Detective Watkins had a telephone conversation with ,m 
advised - had received a telephone call from Doctor stating
had aspirated on vomit during the night and heart stOpped.
said learned Doctor had givena deceased)
20 ran for the nausea. advised Doctor had taken
off of the medication prescribed by the other facility.

 
  
  
  

       
    
  
  

  

 
 
  
 
 

by hitting,

biting and or banging - would wear
protective clothing to help prevent the injuries. described the
types of equipment used to protect ?such as helmet, arm guard and chest
protector. aim? ?NI-?advised . id e?mails sent to
Educational Facrlity and agreed to send them to Detective Watkins.
further agreed to complete a statement and send it to Detective Watkins.

con irmed

    



 

 

 

Case Report for Incident 130090458 Page 14 of 19

 

On July 16, 2013 at 1333 hours, Detective Watkins had an audio taped
conversation with Samantha Benjamin {3rd shift CBS) 
diagnosed with 

 
 

.was
. Sam Benjamin
advised . wore a protective helmet, arm splints and a
walking harness to prevent from injuring Samantha noticed bite
marks on Samantha Benjamin advised on July 5, 2013 betWeen 2345 and
000 hours, she saw in the restraint chair in the hallway.
Samantha Benjamin advised the evening shift told her had been injuring.
and vomiting. Samantha Benjamin advised Mrs. Loy decided to assist her and
stay with for the night. Samantha Benjamin advised Loy Reid
decided to take out of the chair and put to bed. Samantha Benjamin
said Mrs. Loy, Mr. Floyd, Samantha and Shamika moved to her bed. Samantha
Benjamin advised she and Mrs. Loy and Tafoyia secured ankles and wrist
to the bed using four point restraints for a couple minutes. Samantha Benjamin
said My looked like she had gone to sleep and Mrs. Loy took off the
restraints. Samantha said at approximately 0430 hours,
got out of the bed would walk around the group home. Samantha said she saw Mrs.
Loy givinr liquids and was vomiting and/0r Spitting the
liquid back up. Samantha Benjamin advised they put =helmet and splints on to
keep from hurting Samantha Benjamin advised Tafoyia and Mrs. Loy
stayed with ,nr .w all night and 1 stayed up all night.
Samantha advised in the morning, Mrs. Loy and Mr. Floyd gave her
medication. Samantha Benjamin said Tafoyia and Mrs. Loy had to physically hold
?e down during the night. Samantha Benjamin called the on-call nurse and
asked Shamika to get some Gatorade and popsicles from the kitchen. Samantha
Benjamin said Mrs. Loy was helping drink the some Gatorade and she noticed
rs gasping for breath and step breathing. Samantha advised Mrs. Loy told
her to call 911 and Mrs. Loy performed CPR on =until EMS arrived. Samantha
Benjamin denied seeing anyone harm - (See audio taped interview)

   
 
  

 
 

 

 
    
   

  

  
 
  

 

  

 
 

   
   
 

 

 

     

 

  

     
 

On July 16, 2013 at 1552 hours, Detective Watkins had an audio taped
conversation with Floyd Cornelius (3rd acting shift supervisor) and he advised
he was covering the shift, because Ms. Loy (Shift Supervisor) was helping with
Floyd Cornelius advised they temporarily used a four point
restraint to secure a ?-to the bed and - head against the
wall. Floyd advised Ms. Loy decided to take out of the four point
restraints and move a to the cha' Floyd Cornelius advised he assisted moving
rom the restraint chair to - bed. Floyd said he continued with his
regular duties and at approximately 0645 hours, Mrs. Loy gave - her
medication and later he heard Tafoya and Shamika yelling to call 911. Floyd
Cornelius denied using a bed net or harming L(See audio tape
statement)

 
 

     

       
     

 

On July 16, 2013 at approximately 1627 hours, Detective Watkins had an audio
taped interview with Nicole Douglas {2nd shift CLS Special Ed Teacher) and she
advised she was assigned to the intake team for-r Nicole Douglas
advised m. wore a protective hel et, chest protector, arm spl'nts
and lifting belt. Nicole Douglas stated'y Helmet was too big for-' I. ead-
Nicole Douglas advised she had to change i helmet twice. Nicole Douglas stated
on July 5, 2103 at 1545 hours, 5_refused to walk and they had to assist.
into the house. Nicole Douglas aoVised 

was banging head. Nicole Douglas said she cli ped
would block 4 form biting i Nicole said she heard from day shift

ha ?been vomiting during the morning. Nicole Douglas said she gave

a cookie and refused to eat. Nicole said at approximately 1600 hours,
she gave:" some Gatorade and_v vomited up the liquid. Nicole said she got

      
 

 

    
     

_to the chair and

 

 
 
  

   
   

 

i2/26fl3

 

  

 

Case Report for Incident 130090458

Page 15 01?19

 

  
 
 
 
 
  

    

's arms to the chair, because was inuring 
Nicole advised after 210 hours, projectile vomited five (5) more
times and it was Clear. Nicole advised there should be approximately five 
data sheet for every action taken. Nicole advised-
bed and they clipped g?m

permission to strap

 

   

Kathleen,
into the chair. Nicole advised they

told Kathleen about the vomiting and the self?injury behavior. Nicole Douglas

the bed and put, into the chair. Nicole advised Kristine,

Yolanda, LaQuanda and Shem helped puti

 

_behavior and vomiting. Nicole

advised she told the oncoming shift about
(See audio tape statement}

denied using a bed net or harming

On July 16, 2013, Detective Watkins reviewed Carlton Palms had approximately
Forty Four (44} reported DCF's investigation between 2004 and 2013. Detective
Watkins observed three (3) of the complaints were verified, ten (10) had some
indicators and Thirty (30) complaint were unfounded.

On July 19, 2013 at approximately 1444 hours, Detective Watkins had an audio
taped interview with Kathleen Evans {2nd shift CLS alternate supervisor) and she
advised on July 4, 2013 {deceased} wore a protective helmet,
chest protector, arm splints and lifting belt. Kathleen advised she had heard
was sick and had been vomiting. Kathleen advised she saw ?'vomit one

time on Thursday July 4, 2013. Kathleen advised they had given 
would eat cereal and

 

 
  

    
 

    
 

Gatorade and would spit it up- Kathleen advised. 
was on a liqui diet. Kathleen advised she had a conversation with Bonnie
Clugston (Nursing Supervisor} and she advised she would check on a "i
Kathleen advised a nurse never came to see during the shift.

Evans stated on July 5, 2103 at 1500 hours, Kathleen Evans advised she

Kathleen
learned was sick and was put on an all liquid diet. Kathleen said the day

shift told her Thad been injuring and vomiting throughout
the shift. Kathleen advised she did not know if saw the nurse or doctor
prior to coming to work. Kathleen Evans said,. refused to eat and would
spit out the liquids. Kathleen Evans advised on July 5, 2013 at approximately
2000 hours, a. was given and anti?nausea medication. Kathleen said she got
permission to strap arms to the chair, because 
Kathleen Evans advised between 1500 hours and 2000 hours,
three more times and it was a clear liquid.
called Bonnie the second time 'vomited and Bonnie told her to give-
nausea medication. Kathleen said :_would vomit up the medication. Kathleen
advised head in bed and they clipped the bed.
Kathleen Evans described how ;as Clipped to the bed. Kathleen Evans
advised at approximately 2100 hours,. began projectile vomiting
onto the wall. Kathleen Evans advised Shem Orvis supervisor) instructed
them to take gout of the bed and put into the chair if was
vomiting. Kathleen Evans advised Kristine, Kathleen, Yolanda, LaQuanda and Shem
helped put 3 into the chair. Kathleen advised she called Bonnie and Kathleen
to tell them a?out self-injury behavior and medical condition. Kathleen
Evans advised she told the oncoming shift about behavior and vomiting.
Kathleen Evans denied using a bed net or harming {See audio tape
statement)

  
  

  
  
     

  

 

 

    

 
  
 

   

 

     
   

 
  

On July 19, 2013 at approximately 1531 hours, Detective Watkins had an audio
taped conversation with Bonnie Clugston (Director of Nursing} with Carlton Palms
Educational Facility and she stated she oversees the facilities in four 
states as well as Carlton Palms for eighteen (18) years. Bonnie Clugston advised
July 1, 2013, she learned - {deceased} had been

 

on Tuesday,

    

I2QGH3

 

 

 

Case Repori for Incident 130090458 Page 16 of 19

 

vomiting and she was not worried because five (5) other students had been sick.

 
 

 

Bonnie Clugston said she put on a liquid diet and arranged fort
seen. Bonnie said on July 2 or 3rd 2013, Amy Chapman LPN or Paul Nolan RN
examined .and did not have a temperature. Bonnie Clugston
advised was only vomiting after eating lunch. Bonnie Clugston said on
Wednesday. July 3, 2013. she had a conversation with the staff and the staff,
believed the vomiting might be a behavioral problem. Bonnie advised on July 3.
2013 she had a telephone conversation with Diana Ries RN informing
ad been vomiting and had been placed on a clear liquid diet Bonnie
said on Thursday, Jul 4 2013 'had vomited again and she advised
staff to call Diana Ries if continued to vomit. Bonnie Clugston advised
on July 5, 2013 Doctor examined and preacribed 4 mg Zofran,
three times a day for nausea. Doctor advised to up the amount to 8mg

- 1 continued to vomit after a 24 hour peri ime. Bonnie
Clugston said she instructed Diana Ries to check on {film} condition on
Saturday July 6, 2013 at approximately 1400 hour. Bonnie adv1sed on July 6, 2013
at approximately 0710 hours, Diana Reis - had taken the Zofran and was
fine. Bonnie said at 0?23 hours, she was tol- was gasping for air and had
been transported to . Bonnie advised the nurses should
have taken temperature when the checked medical condition. (See
audio taped statement} 

   
 

 

  
  

 

   

?lugst

    

 

    

   
    
    

   

On July 20, 2013 at approximately 1705 hours, Detective Watkins had an audio
taped interview with LaQuanda Alston {2nd shift CLS) and she stated_on 07/02/13
and 07/03/13 was projectile vomiting a yellow clear liquid with an awful
smell. LaQuanda said she did not Speak to the nurse and did not believe her
supervisor spoke to the nurse. LaQuanda advised she never saw a nurse check on

LaQuanda said on 07/01/13 and 07/02/13 ate a handful of Fruit loops
an' efused the chicken broth. LaQuanda stated the nurse put 
diet and a visit to the doctor by the day Shift. LaQuanda adv1sed
take helmet off and would bite at arm through the splint
they put a jacket on backwards and ripped it up to keep p? from biting
4 LaQuanda stated Yolanda, Christine and Nicole attempted to clip
to the bed. LaQuanda Alston stated _mi projectile vomited
25~30 times her hift and Cathleen notified inician and the nurse.

would dry heaving and Cathleen called the nurse. LaQuanda
and staff. LaQuanda Al

 

   
     
 
          

 

    

 

  
 

LaQuanda said

   

  

to the restraint chair using a locking belt, wrist restraintsr ankle
res raints and bicep restraints. LaQuanda advised
head and they put a pillow behinda"_ head. LaQuanda denied harmin-
seeing anyone harm {See audio tape statement}

 
   
 

 

On July 20. 2013 at approximately 1359 hours, Detective Watkins had an audi
taped interview with Shem Orvis (2nd shift CLS supervisor) and he advised i
wore a protective helmet, chest protector, arm splints and lifting
harness belt. Shem Orvis stated on July 5, 2103 a 2330 hours. he received a
telephone call from Cathleen statin- 'had been vomiting and biting?
Shem Orvis advised he learned they had use four point restraints to secure 
to the bed, but kept slipping the restraints. Shem Orvis advised Cathleen to
into the chair if vomiting. Shem Orvis said he and assisted
Nicole, Yolanda. Cathleen and Tonya strap?: into the chair. Shem stated
Cathleen told him H- had been vomiting for days. Shem believed

Ca hleen had a telephone conversation with Bonnie (Nursing Supervisor) about

vomiting. Shem Orvis denied using a bed net or harming
(See audio tape statement)

  
 

   
 

 

    
   

    



 

 

Case Report for incident 130090458 Page 17 of 19

 

Between July 19 and 27th, 2013 Detective Watkins received several e?mails,
photograph of protective and - notes.
provided notes regarding 'conversation with the staff at
Car ton Palms Ed cational Center. advised Doctor had taken
-off of previously prescribed medications. said on June
received an eemail from Paul Nolan RN. advised on

   
  
 

    
 
    
   

   
 
 

    
    
 

28, 2013
July 6, 20? at 0933 hours, Doctor notified them had been sick and
vomiting. said Doctor stated he examined and did not

 

- on a liquid diet. Doctor said he did
not admit to the hospital because of behavior. Doctor advised

ontinued to vomit throughout the night and they rushed to the
-said {spoke to the Medical

 

appear to be dehydrated and put a

   

       

Detective Watkins learned Data Analyzer were unable to recover the video
surveillance and collected the Clinton DVR from Bob Bacon. (See report,
property receipt}

On September 16, 2013 Detective Watkins received a Fifth District Medical
Examiner's Cause and Manner of Death Report which indicated the cause of death
was dehydration, gastrointestinal infection and the manner of death was Natural.

Investigation revealed no criminal activity and case submitted to the State
attorney?s office



 

Case Report for Incident 130090458 Page 18 of 19

 

Name lnvolvements:

Other One 84258

Last: SHEA First: THOMAS Mid: 
DOB: 05f22/49 Dr Lie: 8000835491820 Address: 28308 CHURCHILL SMITH LN
Race: Sex: Phone: (352)735-0588 City: MOUNT DORA, FL 3275?

 

First: Mid:
Dr Lie: Address
Phone: - City:

 

Mid:
Address:
City

   

 

       

 

First:  Mid:
Dr Lie: Address:
Phone: - City:
First: .  Mid:
Dr Lie:  Address:
Race: II Phone: a City:
Other Two 145288
Last: First: ROBERT Mid:
DOB: 03l22/55 Dr Lie: Address: 28308 CHURCHILL SMITH 
CARLTON PALMS
Race: Sex: Phone: City: MOUNT DORA, FL 32757
witness 146385
Last: REID First: LOY Mid: SYDNAH
DOB: 10/05l63 Dr Lie: R30053763 8650 Address: 2484 TECLA ST, #205
Race: Sex: Phone: (407)310-9476 City: ORLANDO, FL 32835
witness/CLS 13533 
Last: HILL First: TAFOYIA Mid: AMARIS
DOB: 05/12/83 Dr Lie: H400801836720 Address: 5653 TERRELL RD
Race: 8 Sex: Phone: (352)321-0427 City: TANGERINE, FL 32777

I 3

 

 

 

Case Report for Incident 130090458

 

Page 19 of19

 

nursing director63127

Last: CLUGSTON
DOB: 
Race: 

 

Race:

 

92035

Last: MARCHESE
DOB: 
Race: Sex: 

Complainant 

First:
Dr Lie:
Phone:

First:
Dr Lic:

Phone:

First:
Dr Lie:
Phone:

BONNIE

(352)408-1080

 



AMANDA

(352)742-6330

Mid:
Address: 28308 CHURCHILL SMITH LN
City: MOUNT DORA, FL 3275?

 

Mid:
Address:
City: TAVARES, FL 32??8

1300 DUNCAN DR

12/2611 3

 

 

 

 
 

 
    

 
     

 .

Citrus, Hernando, Lake, Marion Sumter Counties
809 Pine Street
Leesburg, Florida 34748
Phone: (352) 326-5961
Fax: (352) 365-6438

AUTOPSY REPORT

  
 

CASE NUMBER:

 

 

DATE OF DEATH: July 6, 2013

COUNTY: Lake

 

:00 PM

DATE AND TIME OF AUTOPSY: July 6, 2013 

 

AUTOPSY FINDINGS:

Gastroesophageal in?ammation
Pulmonary congestion and edema

Cerebral edema

Numerous cutaneous abrasions and bruises



 

CAUSE OF DEATH: Behydration due to gastrointestina} infectien

MANNER OF DEATH: Natural

qu?/MM- Mar/aw? 

Wendy A. zzi, MD.
Deputy Chic Medical Examiner
Date: September 16, 2013

 

      

NAME:  . 

EXTERNAL EXAMINATION:

The body is received in a zippered white body bag, wrapped in a white sheet with blood staining
around the head. The body is received clothed in a short-sleeved pink shirt and a dry diSposable

diaper. No other clothing accompanies the body.

 

The bOdY is that thi :2 .- appearing consistent with the stated age  The
body weighs 69 pounds, which is at less than the 3rd. percentile for age. The body measures 60
inches in length, which is at the 10th percentile for age. The body mass index is 13.5, which is at

less than the 3rd percentile for age.

 

The body is warm to touch. Rigor mortis is partially present in all joints. Postmortem lividity is
patchy maroon and blanching in the posterior dependent portions of the body, sparing the mid

back and buttocks.

The hair is brown, straight, and approximately V2 to 1 inch in length. There are scattered small
foci of patchy hair loss with scarring of the scalp. The eyes are partly open. The globes are
collapsed. The corneas are clear. The irides are brown. The sclerae are white, with tache noire
drying artifact. There are no conjunctival hemorrhages. The skeleton of the nose is intact. Both
ears display nodular, ?cauli?ower? deformities. The lips and frenula diSplay no abnormalities.
The teeth are natural and in good repair, but ground down. Foamy pink ?uid exudes from the

nose and mouth.

 

The breasts are small and without masses. The abdomen is ?at. The external genitalia are
normal female, with curly brown pubic hair, and display no evidence of injury. The anus
displays no abnormalities.

There are no deformities of the upper or lower extremities. The ?ngernails are short, clean, and
The knees are calloused. The toenails are 311011: and clean.

 

EVIDENCE OF ENJURY:

Two 3/3 inch round red abrasions, a 2V2 1% inch aggregate of thin horizontal red abrasions and
multiple red abrasions are present across the forehead. There is a 2 
1 inch aggregate of punctate red abrasions and red bruises, with patchy hair loss on the mid back
of the head. A few punctate red abrasions are present on the left side of the head. There is a 2 
1% inch vertical linear red abrasion anterior to the right ear. Diffuse punctate to 3 inch red
abrasions are present over the ears, cheeks, philtrum and chin, many of which are con?uent.
There are diffuse punctate to inch red abrasions behind both ears and on the anterior and

posterior neck.

is.)

 

 

 

 

      

mats; CASNM 

 

Several punctate red abrasions are present across the upper chest and shoulders. There are a few
punctate red abrasions on the lower chest. A 2 1 inch oval red abrasion is present on the lateral
left abdomen and a 1/2 inch horizontal red abrasion with two punctate red abrasions are present on

the left lower abdomen.

A 1 inch oval red abrasion is present on the midline upper back. There are a few 1/8 to 1
inch red abrasions on the left upper back. A 5 31/2 inch patchy red abrasion is present on the
posterior left shoulder and a 4 2% inch patchy red abrasion is present on the posterior right
shoulder. There is a 1% inch diagonal red abrasion on the right lower back. A 31/2 2 inch
aggregate of red abrasions is present on the lateral right lower back, extending onto the right side
of the abdomen. Two 2 2 inch irregular red abrasions are present on the lateral left back.
There are several haphazardly-oriented linear red abrasions on the midline and left lower back.
A 13/; inch red bruise is present on the lateral le? upper buttock. There is a 1 inch round red
bruise on the lateral left mid buttock. A 2 1 inch oval brown bruise is present over the sacrum.
There is a 2 inch red abrasion on the upper right buttock and a 2 1 inch brown bruise on
the lateral right mid buttock. A 1% 3/4 inch brown bruise is present on the lateral right lower
buttock. Subcutaneous dissection of several of the bruises on the back and buttocks reveals
minimal hemorrhage in the underlying soft tissue. There is no hemorrhage beneath the abrasions.

A 6 3 inch aggregate of red abrasions with surrounding red/purple bruise is present on the
anterolateral right arm. There is a 3A V2 inch oval red bruise on the medial right arm. A inch
round brown bruise, a 1 inch oval red bruise, and a 1/2 inch round red bruise are present on the
posterior right arm. There is a 3 V2 is: 3 inch aggregate of punctate red abrasions surrounded by red
bruise on the right elbow. A few punctate red abrasions surrounding a 5 3 inch aggregate of
red bruises are present on the anterior and lateral right arm and in the right antecubital fossa.
There is a 31/2 2 inch patchy red bruise in the medial right antecubital fossa. There is a inch
round yellow bruise on the anterior right forearm. A 4 3 inch aggregate of red abrasions and
red bruises is present on the posterior right forearm. There is a 3 1% inch aggregate of red
abrasions on the lateral right wrist and thumb. A few punctate red abrasions are present on the
posterior right hand. There are two V2 inch oval red bruises on the posterior right index ?nger.

A 51/2 3 inch aggregate of red abrasions surrounded by red/purple bruises is present on the
anterior left arm. There is a 2% 1 inch oval red abrasion surrounded by an 8 3 inch aggregate
of red bruises on the left elbow. A inch round yellow bruise is present on the lateral left
forearm. There are numerous 3/2 inch round red bruises on the posteromedial left forearm. A 5 
1% inch aggregate of red abrasions and purple bruises is present on the posterior left 

hand.

 
 

There are numerous punctate to inch red abrasions on the anterior thighs. A 1/1 inch round
yellow bruise and a 3/2 inch round blue bruise are present on the anterior left thigh. There are
several small patchy yellow and red bruises on the lateral and posterior left thigh. A 11/2 inch
round brown bruise is present on the lateral right thigh. There are diffuse and focally con?uent

3

 

 

 

 

   

NAME:

patchy red bruises on the anterior and posterior legs and on the dorsal feet. A 1 inch vertical
linear abrasion is present on the posterior right ankle.

X-RAY EVIDENCE:

AP views of the head, neck, chest, abdomen, pelvis, and extremities are examined. No recent or
remote fractures are identi?ed.

EVIDENCE OF RECENT MEDICAL INTERVENTION:

An orapharyngeal airway is present in the mouth. There are multiple electrocardiogram leads on
both sides of the chest, abdomen, and thighs. A bandage covers injuries on the anterior left arm.
There is a hospital band around the left wrist. An intraosseous needle is present in the anterior

left leg.
INTERNAL EXAMINATION:

BODY CAVITIES: The body is entered by a Y?shaped incision. All organs are present in their
usual anatomic positions, present their usual anatomic relationships, and show no evidence of

trauma. No excess ?uid is present in any body cavity. There are no pleural or peritoneal
adhesions.

NECK ORGAN S: The anterior muscles of the neck reveal no evidence of hemorrhage. The
cartilages of the larynx and epiglottis display no abnormalities. The hyoid bone is intact.
Examination of the tongue reveals no evidence of injury. The thyroid gland is red/brown and
?rm, without nodularity. The cervical spine is intact. There is a 20 gram tan/purple lobulated

thymus gland in the anterior mediastium.

RESPIRATORY SYSTEM: The right lung weighs 460 grams. The left lung weighs 400

grams. The lungs are blue/red and ?rm, with no anthracotic pigmentation. The trachea and
bronchi display no abnormalities and contain no aspirated material. No thromboernboli are

present in the pulmonary arteries. On cut section, the pulmonary shows diffuse
congestion and edema. No nodular or cavitary lesions are identi?ed.

CARDIOVASCULAR SYSTEM: The pericardial sac is intact and contains no excess ?uid.
The heart weighs 130 grams. The coronary arteries pursue a normal anatomic course and display
no abnormalities. The mitral valve shows mild myxoid change. There are no abnormalities of
the aortic, pulmonic, or tricuspid valves. Sections of the myocardiurn reveal no focal areas of
pathologic change. The left ventricle is 1.0 cm in thickness. The interventricnlar septum is 1.0
cm in thickness. The right ventricle is 0.2 in in thickness. The aorta and venae cavae are intact

and without abnormalities.

 

 

 

 

 

 

     

NAME:   

 

HEPATOBILIARY SYSTEM: The liver weighs 840 grams. The liver is brown, with smooth
surfaces and sharp margins. On cut section, the hepatic parenehyma is brown and unremarkable.
The gallbladder contains a few cc of thin green bile and has velvety green mucosa.

SYSTEM: The spleen weighs 80 grams. The capsule is red/brown and
smooth. On cut section, the splenic is dark red and firm, with indistinct white pulp.

No is identi?ed.

GASTROINTESTINAL SYSTEM: The esophagus displays no abnormalities. The stomach
contains 200 cc of thin bilious dark green/brown ?uid. The gastric and duodenal mucosa has
normal rugal folds. The small and large intestines diSplay no abnormalities along their serosal or
mucosal surfaces and have no palpable masses. The appendix is present.

GENITOURINARY SYSTEM: Each kidney weighs 70 grams. The kidneys are redfbrown,
with smooth surfaces. The renal capsules strip with case. On cut section, the renal 
is red/brown and muemarkable. The renal pelves, ureters, and urinary bladder display no
abnormalities. The bladder contains less than 5 cc of cloudy yellow urine.

The vaginal mucosa is atraumatic. The uterine cervix displays no abnormalities. The
endometrium is ?at and hemorrhagic. There are no abnormalities of the myometrium.

The ovaries are enlarged and cystic. The fallopian tubes are intact.

ENDOCRINE SYSTEM: The pancreas has ?rm, lobulated, tan The adrenals
have thin, yellow/tan cortical ribbons and dark tan medullae. The pituitary gland is not enlarged.

MUSCULOSKELETAL SYSTEM: The muscles are normally developed. No recent or
remote fractures are identi?ed.

CENTRAL NERVOUS SYSTEM: Re?ecting the scalp reveals no subscalpular hemorrhages.
The skull is intact. On entering the cranial cavity, there is no epidural or subdural hematoma.
The leptomeninges are translucent. The brain weighs 1300 grams. The hemispheres are
symmetric and display cerebral edema, manifested by ?attening of the cortical convolutions,
narrowing of sulci, and widening of gyri. Sections of the brain reveal no focal areas of
pathologic change. The arteries at the base of the brain display no abnonnalities. Stripping the
dura reveals no fractures. Fluid blood is present in the dural sinuses.

 

 

NAME:

   

MICROSCOPIC SECTIONS SUBMITTED:

heart

right lung

left lung, thymus gland

liver, spleen, thyroid gland

right kidney, right adrenal gland, pancreas

left kidney, left adrenal gland, urinary bladder
pituitary gland, appendix, gastroesophageal junction
cerebellum

cerebrum



 

 

 

 

 

 

 

NAME: CASE NUMBER: i

 

MICROSCOPIC EXAMINATION:

BRAIN: unremarkable cerebrum, cerebellum, and meninges
PITUITARY GLAND: unremarkable

THYROID GLAND: unremarkable

THYMUS GLAND: involutional changes, with depletion of cortical and septal
?brosis 

LUNGS: patchy autolysis, with areas of marked bacterial without neutrophilic
response; preserved alveoli Show congestion, with focal septal capillary expansion by neutrophils
and rare foci of intra~alveolar neutrophils associated with amorphous material and bacteria,

consistent with aspiration; patchy edema

HEART: mild myxoid change of the mitral valve; unremarkable myocardium
LIVER: scattered groups of hepatocytes with glycogenated nuclei

SPLEEN: red pulp congestion; white pulp with focal germinal center formation

GASTROESOPHAGEAL JUNCTION: marked acute in?ammation with mucosal necrosis
and neutrophilic in?ltration of submucosal soft tissue

APPENDIX: ?brous obliteration of the lumen

PANCREAS: unremarkable

KIDNEYS: congestion; 3 mm benign cortical nodule composed of renal tubules, congested
vessels and focus of smooth muscle, with chronic in?ammatory in?ltrate

URINARY BLADDER: unremarkable

ADRENAL GLANDS: unremarkable

 

 

 

 

  

  

Wuesthoff Reference Laboramry
6800 C0011

Melbourne, Florida 32940
Julie Bell, M.D., Laboratory Director

  

 
3.0000076000-

 

 

  
  
    

 
 

 

Patient: .
Client Patient ID: Account#: 
Physician WENDY Client: DIST 5 MEDICAL EXAMINER

 

 

 

  

 

Specimen Collected :07/06/2013

    

Reg Date: 07/08/13

Lab Order No: 310801039

 

 

 

 

 

 

 

 

 

 

 

Test Name Result Units Cutoff/Reporting Limits
VOLATILE PANEL VOLP
SPECIMEN TYPE
ILIAC BLOOD
ETHANOL NONE DETECTED g/dL 0.020
ACETONE NONE DETECTED mg/dL 
METHANOL NONE DETECTED mg/dL 15.0
ISOPROPANOL NONE: DETECTED mg/dL 15.0
Analysis by Gas Chromatography (GC) Headspace Injection
BLOOD DRUG SCREEN BDSME
SPECIMEN TYPE
ILIAC BLOOD

IBUPROFEN, CAFFEINE

FLUOXETINE, RISPERIDONE, LORATADINE, ARIPIPRAZOLE, CAFFEINE
BLOOD IMMUNOASSAY SCREEN
AMPHETAMINES NEGATIVE mg/L 0.100
BARBITURATES NEGATIVE mg/L 0.100
BENZODIAZEPINES NEGATIVE mg/L 0 050
BUPRENORPHINE NEGATIVE mg/L 0.001
CANNABINOIDS NEGATIVE mg/L 0.050
COCAINE METABOLITE NEGATIVE mg/L 0.100
FENTANYL NEGATIVE mg/L 0.001
METHADONE NEGATIVE mg/L 0.050
OPIATES NEGATIVE mg/L 0.050
SALICYLATES NEGATIVE mgr/L 50.0
TRICYCLICS POSITIVE mg/L 0.100

Page1of4 Printed: 08/20/13 10:11

 

 

 

      

   
 
    
 
 

   
1x  ..
 
L-e'eoemom

Patient:
Client Patient ID
Physician:

 

  

LAVEZZI,

Wuestheff Reference Laboratory

WE

 

6800 CouIt
Melboume, Florida 32940
Julie Bell, M.D., Laboratory Director

 

  

Aocount#:
Client; DIST 5 MEDICAL EXAMINER

 

 

VX266

 

 

 

 

Specimen Collected :07/06/2013 Lab Order No: 310801039 Reg Date: 07/38/13
Test Name Result Units Cutoff/Reporting Limits

SPECIMEN TYPE
ILIAC BLOOD
170 ng/mL 20

Steady-state plasma levels in adults following a daily regimen have been

reported asTesting

FLUOXETINE AND METABOLITE

SPECIMEN TYPE
ILIAC BLOOD
FLUOXETINE

Daily therapy with 40 mg Fluoxetine/day126 ng/mL

ng/mL
ng/mL
ng/mL
ng/mL



840

ng/mL

20

Steady?state concentration at 4 to 8 hours after dosing ranges

from 91 302 ng/mL serum.

NORFLUOXETINE

Daily therapy with 40 mg Fluoxetine/day:

1200

og/mL

20

Steady-state concentration at 4 to 8 hours after dosing ranges from
72 258 ng/mL serum.

performed by HMS Labs, 3701 Welsh Rd, Willow Grove, PA 19090-2910

Testing performed by NMS Labs, 3701 Welsh Rd, Willow Grove, PA 19090-2910
- LONMS

LORATADINE AND METABOLITE

SPECIMEN TYPE
ILIAC BLOOD
LORATADINE

DESCARBOETHOXYLORATADINE
Peak plasma levels of Loratadine and Desoarboethoxyloratadine (DCL)
following a single oral dose of 10, 20, or 40 mg Loratadine:

(10 mg) 3.7, 10.8, 26.1 ng and 4.0, 9.9, and 16.0 ng 

8.3
4.1

ng/mL

ng/mL

1.
l.


0

Peaks occur at 1.0 to 1.5 hours post dose for LOR, and at 1.5 to 3.7 hours post

 



Form: MINI Single RLIT

 

 

AUG  2 2013

 

 

Printed:

08/20/13 10:11

 

 

Wuestheff Reference Laboratory

 

i



  6800 Court
?m - 


 

  

 

 
 
 
  
 

 

 

 

 

 

Patient:
Client Petieh Aocount#:
Physician: LAVEZZI, WENDY Client; DIST 5 MEDICAL EXAMINER
.M ?0
Specimen Collected :07/06/2013 Lab Order No: 310001039 Reg Date: 07/08/13
Test Name Result Units Cutoff/Reporting Limits

 

dose for DCL.

Mean levels following a 40 mg once daily regimen:
Loratadine: Peak of 27 ng/mL at 1.4 hours

Loratadine: Trough of approximately 1.0 ng/mL

DCL: Peak of 29 ng/mL at 3.0 hours

DCL: Trough of approximately 6 nngL.

 

Testing performed by NMS Labs, 3701 Welsh Rd, Willow Grove, PA 19090-2910

RISPERIDONE AND.METABOLITE - RINMS
SPECIMEN TYPE
ILIAC BLOOD
RISPERIDONE 3.4 ng/mL 1.0

 

9-HYDROXYRISPERIDONE 1.5 ng/mL 1.0

Risperidone and 9-Hydroxyrisperidone are approximately equieffeotive, therefore,
the sum of their concentrations is pertinent.

4.9 nQ/mL
Mean steady~state plasma levels for the total active moiety following daily
regimens:

2 mg/day - 14 ngme (Risperidone Metabolite)
6 mg/day 45 ng/mL (Risperidone Metabolite)
10 mg/day 73 ng/mL (Risperidone Metabolite)
16 mg/day 110 ng/mL (Risperidone Metabolite)

Testing performed by EMS Labs, 3701 Welsh Rd, Willow Grove, PA 19090?2910

 

   
 

Specimen Collected :07/06/2013 Lab Order No: 310801040 Reg Date: 07/08/13
Test Name Result Units Cutoff/Reporting Limits

ELECTROLYTE PANEL ELEPV
SPECIMEN TYPE

 


UREA NITROGEN 39.3 - mg/dL
CREATININE 0.29 mg/dL

 

AUG 2 2 2013

 

 

  



30:
me:MMsmaeRLu? Printed 08/20/1 1 11

{25

 

 

 

 

 

Wuestheff Reference Laboratory


Melbourne, Florida 32940
Julie Bell, M.D., Laboratory Director

  
  

 


  

 

 
 

 

   
 

  

Patient:  
Client Pati nt ccount#: VX26697

physician: LAVEZZI, WENY Client: DIST 5 MEDICAL EXAMINER

 

 

 

 

 

07/08/13

 

 

Specimen Collected :07/06/2013 Lab Order No: 310801040 Reg Date:
Test Name Result' Units Cutoff/Reporting Limits
SODIUM 15? mEq/L
POTASSIUM 7 .8 mElq/L
CHLORIDE 139 mEq/L
GLUCOSE 21 . 3 mg/dL

Glucose results from patients with gamnopathies, in particular
Waldenstrom's Macroglobulinemia may result in an abnormal
reaction profile. Although the incidence of this occurrence
is rare, glucose results from these patients should be
interpreted with caution.

 

MG 2 2 2033

Specimens were intact upon receipt. Chain of custody, specimen security and integrity has
been mantained. Testing has been performed as requested
K.

Reviewed by:  _Date: 

FINAL REPORT - THIS COMPLETES REPORTING ON THIS CASE

 

   

 

TOX I COLOGYWRE PORT

Form: NEW Single RLIT

Printed: 08/20/13 10:11

  

Page 4 of 4

8 Egg/g

 
 
 

 

 

Wuesthoff Wuesthoff Reference Laboratory

5800 Spygiaes Court
Melbourne, Florida 32940
Julie Bell. M.D., Laboratory Director
Client Patient iD:
MRN: 

 

   
 

 

Patient:
DOB:
Client: DISTSMEDIC EXAMINER
Physician: 

 

 

Site:

 

m" MICROBIOLOGY

Order No: 310801041 Reg Date: OWOSHS

Specimen Collected: OWUSHE 13:49

Source: Blood
Culture, Bloggl FINAL 07/15/13 12:59

BLOOD CULTURE
Gram Stain:

Gram positive cocci in pairs
Gram negative rods

Escherichia coli
Enterococcus species

rm. 2 2913

 

 

 

REGULAR Printed:07/15r13 13:01

Form: MICSE

 

 

 

 

 

Wuesthoff Wuesthoff Reference Laboratory

 6800 Court
Melbourne, Florida 32940
Julie Bell. Mil, Laboratory Director

 

 

 
 
 

 

Patient: Client Patient E):
DOB: MRN: VX00018057 A 

Ciient: DISTSMEDIC 
Physician: 

Site:

MICROBIOLOGY

Order No: 310801053 Reg Date: 07l'08i13

Specimen Coilected: 07f06f13 13:52

Source: Post Mortem Lung Swab
Gram Stain! Aerobic FJNAL 07/1313 15:04
Many Gram negative rods
No white blood cells seen
FINAL 07/12/13 15:04

Culture, Other - CXME 01258

Heavy growth mixed gram negative and gram positive
organisms.

The growth of mixed gram negative and gram positive
organisms may reflect postmortem contamination of this
culture by organisms of the large bowet. The clinical
significance of these cultures is therefore difficult

to evaluate.

wt. 2 9 2013

 

  

 

REGULAR Printed: own/13 15:14

am; Micse  

 

 Wuesthoff Reference Laboratory
6800 Spygiass Court
Melbourne, Florida 32940
Julie Bell, M.D.. Laboratory Director
Client Patient ID:  
MRN: VX00018057 Acct No.

 

   
     

Patient  . a
DOB: I VX25597
Client: 5 EXAMINER

Physician: LAVEZZI, WENDY

Site:
Reg Date: 07:08:13

MICROBIOLOGY

Specimen Collected: 07016113 13:51 Order No: 310801049

 

 

Source: Post Mortem Ear right
Gram Stain Aerobic 071?12i1 3 15:04
Many Gram variable rods
Few Yeast
No white blood cells seen
FINAL 15:04

Culture. Other - CXME 01258

Moderate growth mixed gram negative and gram positive
organisms.

The growth of mixed gram negative and gram positive
organisms may reflect postmortem contamination of this
culture by organisms of the large bowel. The clinical
significance of these cultures is therefore difficult

to evaluate.

Staphylococcus aureus - MRSA

Predominant organism
Candida albicans
Yeast, not C. albicans

Heavy growth

Heavy growth
Moderate growth

Mi 2 9 2013

 

 

 

RE 
GU AR Printed: 07mm 15:13

Form: MICSE

 

 

 

 Wuesthoff Reference Laboratory

5800 i rt
HEALTH 5 EM  355 01.1
Melbourne. Florida 32940

Julie Belt, M.D., Laboratory Director
Client Patient it):

 

  
 

 

 
 
 
 

 

 

 

 

 

 

E?atient:
DOB: Age. MRN: VX00018057 Acct No: VX26697
Client: DIST 5 MEDICAL EXA 
Physician: 
MICROBIOLOGY Site:
Specimen Collected: 07r06r13 13:51 Order No: 310801047 Reg Date: 07:98? 3
Source: Post Mortem Ear - left ear
Gram Stain Aerobic 87H 21/13 15:04
Many Gram positive cocci
Few Yeast
No white blood cells seen
Culture, Other - CXME 01258 FINAL 0711213 15:04
Moderate growth Candida albicans
Light growth Yeast, not C. albicans
Moderate growth Staphylococcus aureus MRSA
- log, 2 9 2913

 

 

 

 

 

REGULAR I  Printed: om2r13 15:12

pm we I 349i

 

 

 

 

 

Witegfhoff Wuesthoff Reference Laboratory

6800 Court
SYSTEM Melbourne, Florida 32940

Juiie Bell, Mil, Laboratory Director 
Client Patient iD:
MRN: VX00018057 Acct No. VX2697

 

    
   

 

  

oa: Age: ..  .. 
Client: DIST 5 MEDICAL EXAMINER
Physician: LAVEZZE, WENDY

 

Site:

 

MICROBIOLOGY

Order No: 310801043 Reg Date:0?i08i13

Specimen Collected: OWOBMB 13:50

 

Source: Post Mortem Cerebral Spinal Fluid Swab
Gram Stain Aerobic FINAL o7r12n3 t5103
Many Gram negative rods
Few white blood cells
FINAL 15:03

Culture Other - CXME 01258

Heavy growth mixed gram negative and gram positiva
organisms.

The growth of mixed gram negative and gram positive
organisms may reflect postmortem contamination of this
culture by organisms of the large bowel. The clinical
significance of these cultures is therefore difficult

to evaluate.

.3131. 2 9 2013

 

 

REGULAR

Form: 

I  Printed: 0?2112i13 15:11

 

 

 

@WUESthoff Wuestheff Reference Laboramry 

HEALTH 6800 Court
SYSTEM Melbourne. Florida 32940

Julie Bell, M.D., Laboratory Director
Client Patient iD:

 

 

  

 

 

 

Patient 

DOB: MRN: VX00018057 Acct No. 

Client: DIST 

Physician: LAVEZZI: WENDY 
LABORATORY

Specimen Collected: O7!06i2013 Order No#: 310801042 Status: Reg Date: 0?;08l13

Test Name Low Normal High ABN Reference Site Code

 



 

?eference
Source lung
Viral Culture. General SEE BELOW

No Virus isolated.

Performed at: BN, LabCorp Burlington

1447 York Court, Burlington, NC, 272163361
William MD, Phone: 8007624344
Previous value was Comment, at 12:18 on 

Jill 2 9 2013

 

 

Lab Key for Results: 2 New Results Low High ABN - Abnormal Critical

 

Form: MM Single 

 

 

 

 

  
 
  

Medlcal Exammer, S?h Judlcial 
Citrus. Hernando. Lake. Marion and Sumter Counties

309 Pine Street

Laesburg, FL 34743

Phi} {3 52} 326-5961 an? {352) 365-6433

    

 

 

Decedent?s Name:

Cause of Death: 

 

hfd?vx? 

 

 

 

 

District 5 Medical Examiner

Citrus, Hernando, Lake, Marion and Sumter Counties
809 Pine Street

FL 354748

Phil (352) 326-5961 Fart! {352) 3656438

 

Medical Examiner Phetogreph Reteese Form

from the fellowiog law enforcement

Persuaet to 496.135 1: 1) 3r (3) (C) RS. this is a written request
requirements

agency for Medical Examiner autopsy photographs. This request ?rt?lis tut: statute
regarding the procedure and necessity to obtain autOpsy photographs. Specifically, the law

enforcement agency requires these photographs for:

?Furtherance of its of?cial duties"
a "Is for a criminal proceeding"

The agency will keep the photographs con?dential and exempt from disclosure, except where

required in the performance of their duties.


 

 

LAW ENFORCEMENT AGENCY
a - 
OFFICER REQUESTING PHOTOGRAPHS Wk
{1?1 1 
L.) i 

 

MEDICAL-EXAMINER CASE NUMBER 

- 
i




NAME OF FER-SON SENDING 

. .
?5 

:1

rat
to
F3

SIGNATURE. OF PERSON RECEIVING 




 

 

 Lake County Sheriff?s Of?ce

Gary S. Borders
SHERIFF

360 W. 
TA VARES, FLORIDA 32778

 

 

   

 TO: Joy Whitehead 

 

State Attorney?s Of?ce 352?742-4269
. FROM: Detective Clay Watkins PHONE:
Lake County Sheriffs Of?ce 352?343?9529
Major Crimes Unit FAX:
352?343-9569
DATE: July 16, 2013
 of pages: 2
 (including this cover)
-I REF: Request for Investigative Subpoena 
. ?i
MESSAGE: "9'9 oil??


 

 

 

Note: This facsimile transmission is intended only for the use of the individual or entity in which it is addressed,
and may contain information that is privileged, confidential. or exempt from disclosure under applicable law. if
the reader of this message is not the intended recipient. you are hereby notified that any dissemination.
distribution or copying of this communication is strictly prohibited. If you have received this cemmunication in
error, please notify us immediately at 35243439529.

 

 

 

 

 

Case 130090458

From: Clay Watkins

Rank: Detective

Agency: Lake County Sheri?as O??ice

Type of Wolation: Death Investigation


Request is hereby made of the Of?ce of the State of Attorney, Fifth Judicial Circuit, for
the issuance of an investigative subpoena to:

Person: Tom Shea

Address: 28308 Churchhill-Smith Lane
Mount Dora, FL 32757

Fax: 352-735?4095

Phone: 352-735-0588

Items (if any) to be produced: Any and all video surveillance from Carlton-
Palms Education Center between the dates of July 1, 2013 and July 6, 2013.

Time/Place to appear: INSTANTER Please call Detective Clay Watkins
at 352-343?9529 or Fax the information to me at 352-343-9569. Items may

be mailed to the Lake County Sheriffs Of?ce, 360 West Ruby Street, Tavares, Florida,

32778, Attention Detective Daniel Morales.

Reason witness/material required:
I certify that the above requested subpoena is necessary for the furtherance of a
criminal investigation. No dissemination of the information via this assistance will be

made outside the Criminal Justice System; the requesting agency will carefully adhere
to the provision of Title 5, US. Code, Section 552 (A) dealing with improper
dissemination of criminal information.

I further certify that if any costs are incurred in obtaining compliance with
this subpoena, the requesting agency will be responsible for payment of such

cost.

Daniel Morales
Detective Assistant State Attorney

 

 

Date: 07g16i13 Date:

 

 

 

 

 

interview conducted with Loy Reid re:

 

Conducted by Keith Jacobs

   

..  ali night? Around 1 called Marcelia then Diana to say that appeared
dehydrated. Diana said giv  Gatorade, popsicle, jello- indicated  houid have gotten the new
med to stop the vomiting last night. At 911 was cailed. I came back to the room (from taiking
with Diana) and asked to get Gatorade i had a popsicie~ I could see  was drinking it-looked
unresponsive-l said someone go cai1911 for me-i put on the bed and started to do i could hear
a gurgiing sound- when I gave 
 was awake the entire night? at I gave  
might be in pain. indication of distress through the night other than the 
side of outh  went blue in the hands and lips  was warm but didn tfeel like
temperature?told staff call 911 immediateiy-get me some Gatorade then started CPR

 

 

   
    
     

 

  

 

 

as in the restraint chair? staffindicated that it had been a rough nightvOnce

Evening Shift ieft i took oom- i took:
was in the helmet) and to try to bite? 

  
  

  
  

ups ofjuice and water, and iater V2 cup of chocolatiik. 
aybe four or ?ve cups with
 was given it. i called Diana

continued giving 
about 1A cup of liqurd each time lgav
maybe half of each cup. -. 'd not vomit but was drooling liquid whe
around 

 

 

      

 

 

 

interview conducted with Kathieen Evans re: 

 

Conducted by Keith jacobs 

  
 

 was exhibiting a
iiquds in a haif cup at

 

 

great deal of 518? attempting to bite and head bangs

would drink some clear
a time

    
 
  

was abie to in some make certain the 1 kept it down which 

 got.  - was ?ne when we

   
   

left-

 

 

EH3 Fax:352385?883 Jul 12 20138011'lpm 

Lake EMS

Billing Of?ce
2761 West Old Highway 441
Mount Dora, Florida 32757

 

Fax Cover Sheet

 

 

 

 

 

To: ILcso loam: {7/12/13
Aim: Defecl'lve Kori Johnson Fax: I 352-343?9569
From: !Angie Lee )szone: {352-385-2537

 

 

Tz?tie: #Billan/Coding/Quoll'ry Review Far: 3352-335-9063
Re: Medical Record 

Number-of pages including cover sheet: I 11

 



 

Message:
Here is The informoiion you requested. Have a green? day]

 

 

 

NUTS: Health information is personal and sensitive information related to a person?s health
care. It is being faxed to you after appropriate authorization from the patient or under
circumstances that don?t require patient authorization. You, the redpient, are obligated to
maintain It in a safe, secure and con?dential manner. Re?discioouro without additional
patient au?mriza?on or as permitted by law is prohibited. Unau?'Iorized re-disdooure or
failure to maintain con?dentiality could subject you to penalties deou'ibod in federal and
state law.

If you are not the intended recipient, or an employee or agent of the intended recipient with
responsibility for delivering this communication to the intended you are haeby
notified that any reproduction, distribution or disclosure of this communication is strictly
prohibited. The recipient of this information agrees to the terms weed herein. If you have
received this communication in error, please notify us immediatoiy by holaphone to amnge
for the return of the original document to us. Thank-you.

 

 

  

Fax 3523859053

    

EH BILLING Ju!

 
     
 
  
   
 
   
   
    
  

   
  

Run Number: I

 

Lake EMS

   

361W OLD HIGHWAY 1141 12 ?1
MOUNT DORA. FL. 3275?-3509 Dam Of aamca 06 3

 

 
  
 

    
    
  
   
        

 
  
 
 
 
 
 
  
 

 
  
 
  
 

   
  

VGWGIOI M151 Madin D7521 {5-06-13 Trampcn: 07:58 67-66?13
Crew Rice. Gaty Diaqu 07m- GEMS-13 mam: 03:13 010843
Cm: Acevedo. Chad Rum: Change: En mum 07:24 Avaifnhu: 0923 GY-OB-ES
Mann?s Ofcall: Stamina aniama sauna: am? 07-36-13
096d 85"- Rine? Gan; Cailraimn by: 911 R: mum 07:33 own-13
13m Rag, wan: Lake Ocunfy FD
?Emma 39: La!? cam? FD Pt. Faund: On Fleet 8mm

.ma mm: as Tam Landed Mileage

 
 
  
  

  
 

Rap. Daisy: [31mm

        
  

  
 

mg: Outcome: Transport In Hospital
Loca?cn Type: mm Blames am. Hanan: tiniest Facing:
?mac:

   
  
 
 
 
 
  

Ina-alumni Inatitu?un (Ming harm. ACL 
Prinrhy change;
Pt. Wager-tad: supine - Mam My. Full spineme

GondIUm at Dub: Unchangod

Furriers tn cam: Hm
Mm
Hm:

mm?: mam

 

   

Pan mm mm

   

Pickup County: Lake

 

Heme Adda 

 

     
  
  
    
 

Work Remus-1: No

   

Mariam
Comm: FMEIJICAID Policy 3: Group 9:
Guaman
Name: Address:

"mm! q-u 

53?: CGO-OG-OGDC Phanm
0513 Of El?n:

 
  
 

   

Other Gepmaal'm

 

 

Pace 1 m? 113

 

 

 

Jul 12 2013 00:18pm 

 

EMS BILLING

     
 
 

 

Lake EMS

2761 OLD HIGHWAY 441
MOUNT DORA. FL 327574500
[352} 335.5003 Ext.

 
 
  
   
   
   
  

Data of Service}: 

Patient Name:

 

Wipil?dlf - Wu - Ciam?n - AHva -
Olhar- Nut Uaivnd 
Nm: MNEI

 
    
 

 
  

Cm Amen: Tyne: 
Odain.va11y am "Umm 
Fauna In W. Wimaed By - Mam.
Appraximtt- Down 111m - 1a b: 29
minutu. Emmi-Em Prim :9 -
Respiratory CPR PTA By 
Medrzal' Hum. Ame Mining Hum?
ACLF. ?080 on ED Air-ltd No

Nuts. .
I
NC Chat! Pun  No Abdominal Pain . Nu Nauasa'
le?nc Ho Diarrhea No Ccnecpwm No Emma
I I MannaSad: Pain
- No Na Haunt Gimmes: :1!th Turn; He 0on {Flu 
No comm: Pmuc?vu No man: Nay-prch No Clam-Imus Leas at Cmadoummaa

Nu (Slider Win No Mm

 

 



I Airway Par?alfy Obstructed - Emesia Bra-8&1an Abaem'

Circuiatfon Pumas Carotid - Absent LOC mac 9? UnmaamsI-m
Central Nee-van System No Near: Activity Bioccb'Fiuid Loss Nana New

Head Contamch Face Calms)
52! Weed with No Len Ear Mm Ho Abnurmalf?es
Right Assam with Na Ahmnmu?as Lair AW 'wftn No AD?amaPE??as
Nose Ammo with No AMrmIitiera Neck with No Abmrmall?ea
Trauma Mlc?Iine Chest Auesud wf?a Na 
Abdomen Comments} Pelvis Massed With NC: Abnonnau?ee
Gem'me Nat Assessed Upper Right Arm 

upper Left Arm Comma} Lime: Right Arm Cantata-1(a)

Ir mar Lam Am Can Right Hand Assam am No Abnormanm

I La? Hand Mam with N0 Abnarma??es Upper Right Lag 
Upper Left Leg Wham Lower Leg WI)

 

awe-A (A

 

EMS BILLING 0011/01? 


     
        
  

Lake EMS Run Number.  

 

2751W OLD HIGHWAY 441 ammo?
MOUNT DORA, FL 32757-3590 Date or Sumac.

(3523 335-9003 Ext. patient Name:

 

Lower Let! Leg Gamma} Right Fact Assessed wi?-I Na Abnomafi?n
Lift Foot mm mm No Abmmwitim sack Lower 

Bad: - Upper Amsad am No 
AN NOTATION 

  
   

 

Capy?gi'rt CI 3564 Nucieu: Medical An. Inc. rid?: name?d. 
I 

  
  

Primary an: ARREST
Secondary Imprama: RESPARREST

- -
Gnu! 1 ago up un?i we: of tundra: arm:

   

 
  
    

nap-sum: :mmd

 

 

 

 

 

 

 

EMS 

 
 
     

 
  
  
 

  

Lake EMS

HIGHWAY 441 
mum norm. i=1. saw-sacs
{352} 355-9006 Ext

- Run Numb-er:

 
 

Date of Service:

     
  

 
  
 

Elma EB Em M31225: mm mm 99% ?29; ?5.92.
0:0 0. Absent. <None> 'Abaant 0 Absen?: ?Nona? ?ia?ah ?1 V1 a 3
Skin Tempziavgrm Skin CoicrwNormai Skin Moisura=Nomi Glucose-32

Pupii 35.23: Learns, Rigth Pupil Reacts: Left-rue Reac?on? Righimwo Rasc?on Pupil Diia?gn: Le?HDilatad. Right-amazed
Lave! of Consciousness: Pain Sealer-0; Arm Movement: Le?nNona, Rigmubione: Lag Mavemem: Left-"Nana. Righmione

ECGwAaystula 
qa??spiauu By: Lake County FR 

  

0?:49 WC 0. Absent <Nan?> Abaeni 0 Absam? =None> #:Nonav- 51 V1 M1 3
Temp=103.5 Skin Tarrtanann Skin CoiowNomw Skin MoisureaNarma!
Pupif sins: Lam's, Rights Pup}: Reacts: La?n?a Reactian. Raaction Pupii Elation: Ls?=D?iated. Rig:thth
Lmi of Consciougness: Unrespansive; Pain Ari-n Mairemant: La?uNone. Leg McNamara?: Left?Wane. Rightr?iene
I 

6mm Rice; Gary

08:05 OH.) 0. Absent, Wane) Ahaam 0 Absent ?None: <N?na> Mi 3
Temp=103.5 Skin TempaWann 3km GalorHNon-nai Skin Moisture-Wanna! 
Pupi! sham Lab-5. Pupli Raects: Left-Nu Reaction. Right=No Reaction Pupil Lemmiated, RigthiIai'ad
1 Laval of Consciouanasa: Unreaponsiw; Pain Sealant}: Arm Movement: LaRhNona, Right?iane: Leg Movement: Le?nNena, Righwiane

ECG=Aaystcie .
Campfxiad 35:: Rice. Gary I 

no imuma scores sm?amd

 

   
   

 

 

 

 

 

 

'm are; 13mm: Elam 
Open Airway Lake scanty 
Typezi-iaad TWChin Lift A?emptam?i await-16pm
erm 
Airway?rai Lake Countv FR
Typemi GPA indication=Cardiac Arrest Reauitua?aucwsafui
11m H. ?wm?m Mm
nygen Laka C011an FR
Daulce=BVM indicationr-Reapiraiary Ame: LPM
Remit-Na Change 
Ema 93mm mwm' WM
Cardiac Monitor Lake: Ceith FR I
intarp?Aays?toia Edovaone indica?onwiniuai Madlcai Care
Laad?addi?a 1? Combo Pads

 

 

 

 

 

 

 

 

 

I

 

 

 

13 00:19 

  

 

Fax:3523859053 .20

   

       
  
 
 
  

 
 

Run Number: I 

    
 

Lake EMS

2751?s? OLD HIGHWAY 441
WOUNT DORA, FL 3275??8500
(352} 885?9 006 Ext.

 

mm of Service: swarms

 
 
 

Patient Name:

 

 

    
  

 

 

  
      
  
  
  
 

 

 

 

 

11m Era lawman; Sham -
CPR Lam Ceuntv FR continued thmughout pt cars
IndtcationaAdu? Arrest Method?wa Hands Raeuihpulsa with CPR
Gamma R980 ER
h. m. ?m??mwm?m?u?
11m: ETA lawman: 5301mm 
07:41 ALS Asaassmant Rice. Gary
32m em EMT WM Wm imam
07:43 Lake Count? FR
Rat?x?et Sito=L5? AC. Sclu?onzNot Applicable
Tubingawo: Appifcabfa Ska-18 RqumUnsuccemJl
Type?N 
11m EIA Mm KW 
9?:44 10 Laks Ccunw FR
swam meimambia Adult?ed?d?t Saline
Tubing=Macro Drip How Rats=wo ResulmSuccessfui
MW 
07:45 1:10,000 . - Rica. Garv -
005399-19 mg Romantic indica?onv-?Asystole
Resuita?ymra 
. BIA mm 
07:45 Fluid 301% Rice. {Saw
Volume?sco mi Remit-Wu change:
IE mm 
07:4? King Airway Acevedo? Shed
Indication=Cardiac Arrest Tube Straw: Rasuithuai Breath Sounds
Outcame?ucceasml .
E?hmm?m mi 1? 
07:50 1:10.000 Rice. Gem
m9 Routarrc indicationmAEystola



Resuftw?syswia
11m BIA lama WW Sam

 

0?:50 Mavad ta Stretcher Rice, Gary LBS
Movement by?amad wf Device Outcame?em red w! Straps
mm 
0?:52 Moved ta Unit Rita Gary
(Bummer-Stretcher Seemed in
Ambumnce
w. . ?ham 

 

 

 

 

 

 

 
  

Lake EMS

OLD 441
MOUNT DORA. FL 3273253500
(352,} 385-3008 Ext.

       
 

 

    

37:53 Sac-?an Rice. 631'?
TypeuYaunksr Sita=0rai . indica?cnaFiuidfn Airway
ReamMrway Cleaned 
EEHW WW WMWW
07:53 Imbation Ramsessment Rica. Ban;

Reassassment-No Swath Seunda

BilatemHy -
Ems BIA humus mam Sis-manna

07:54 Airway-Oral  Gary
Type=4 GPA Indica?cnmCardlacAn-ost . ResuftNSuccasafui
0?:55 Sodium Bicarbonata Rice. Gal-v

908896150 mEq Houtn=t0 Indica?onwardfac Arrest

Resuth Change .

11m: Era 
07:8? Bleed mucosa Test - Rice. Garv 

Biacd Sugar (Wan-32 
. . .. .  . 
rim: BIA lam 531mm 

8?:58 Rice. Gary

Dosaga=1.0 mg Rnutenfo Indlca?onmeymie

Reauir??Aaystoie -

07:58 Daxtrose Rice. Gaw

Dosag?mi?? GM Routazfi) - fndm?mntupoglycamta

RaauitcNo Change

.- 
11mg Ena- Im?mm mm 

08:02 EPI 1:16,000 Rica. Gary
Damgam .0 mg IndicationEAaystoEo
RewftzAay-mie 

Ema min?pm gamma}:
03:05 8105:! Gimme Test Rica. Garv no change after administration ed 050
Bioed 8ugar 

Inna Em 1mm 
08:09 Radio Report Rica ?3an
Noti?edmwa??sd Hospirainlorida Hospital Waterman Comm. Type=RedJo

.- . 



  



 

 

 

EH8 BILLING Eax:35?23853083 Jui 12 2313 [3020 P008 D11

        
   
 

 

 

an. mumm-

Lake EMS

    

Run Number:

     
  
 
 

2731 OLD HIGHWAY 441 .
DOM. FL 32757-3550 Data ?Service- 0mm?

(352} 335-9006 Ext. Patient Name:

 

 

 

minimum mamm- 

 

 

08:10 EPJ 1:10.000 Rice. Gan;
Dosage=1.0 mg Route-JO Endica?on-Aaystcie
Remit/Emmott;

11$? mam 

08:30 Transfer of Patient Care Rica. Gary
Care TOT-=83meer Him

  

[:pon arrive! enmunterad LGFR 7E marking a cardiac was: with CPR In swam Phwician on scene stated that pt has aniy been in their since
June 25: 2013. During that pt has been sick and vomiting ccntin musly. Pt was Zo?'an 2n comm! the names. Staff stated thatt {hay went to
I am pt the medication mund W15 and pi took it with out complaint. Staff went back in amund one ta ?nd Waming for man When ata?went ta
8131'! stated that down time was appmx. 15 min, but upon initial assessment. 331?s condition and presentation showed a dam ?rm that was much ionger.
EMS crew was advisad that contusion are aelf'fn?icted due in Intense SIB. Upon ar?vai at FHW ED. RN of me pf: (why stand the pi: must be In
might arm restraint and heme?: at all ?rms. thaa not In those restraints upon arrival

  
    
   
   
 

 

     
 

no ms?m entered

 

 

 

 

 

 



 

   

EH8 

 

Laka EMS

2731 cm HIGHWAY 441
MOUNT com. FL 32757-3ch mm service: oms?zou
{352) 335-6006 Ext

  
   

 

 

Inna 

OWUBIEMS 08:35 (Laks) Nurse - Patisn?: Signcd

 

i hereby accept from crew members Rice. Gary, Acevedo,
Chad for cumcacc of m?nuing treatineni as raculrnd by patinnt. such i affirm that the
patient was transported via unbuianca to our facility on ibis dais by Lama EMS. in cases
arth the patient is unable ic sign due in Physicaifmntai Incapacity and as documentcd by
Rice, GaryI Acavcdc, Obcd, my signature chali also seam to acacia Lakc EMS to submit a
hill transport acrvicac in the patients insurance carrier as provided for in 

 

Notice cf Privacy Practices 
Emergency Excepticn Signatum (if applicabic):

E. Matti. hereby receipt of the LEMS Notice of Privacy Practices cn bchaif cf
inc patient in be dniivercd to the patient on behaif cf LEMS at such time they are :1ch to
receive it. 
@108;in 3 08:40 Trecnnem and Crew Mamba-rm Rica Gary Unavailabie


 

 

 

Page 8 of 10

 

 

Jul 12 201300?21tn P1110 [111

  

Fax:3529859683

  

EH8 BILLING

     
  
  

    

Lake EMS

2791 OLD HIGHWAY 441 
MOUNT WM FL Date of Service: orroerzcta

(352) ?wees Patient Name:

Run Number: 

    
   

  

 

ThIs In acknewladgement twat I. mint tmatrnent'and transport by Crew

membertc) Rice. Gary, Acewedc, -
PAYMENT INFORMATION

MEDICAL CONSENT AND GUARANTEE 0F PAYMENT
I .  erehy consent to medical care and treatment by Rice. Gary. Acevedo.
Obad ct Lat-re Emergency Medical ServtcaetLEMS) which may Include and

therapeutic preceduree. I agree'tc accept full respenatbtirty forchargee Incurred and agree
to pay in tuII upon receipt of inveicu It LEMS has agreed to but my Insurance
er party it has agreed tc do 39 as a'ceurteey end that LEMS has the right
to demand payment In futI hem me at any date prter tn full pewter-rt from any Insurance
carrier or third party payer antes; cthentriae prohibited by law or unless LEMS and my
Insurance company or third party payer have agreed I will net be ecticn In
neceme I 1 ng8 to pay all cost: of ceIIewcn includtng reasonable attorney?s fees. court
costs and ccllactten agency fees associath With the de?ection greenest

RELEASE OF MEDICAL AND INSURANCE 
PERTAINING re ALL 

I.  LEMS to release Infomticn er canton of all medlcat records.
inducing these that they centaIn related to HIWAIDS, Sexuain Transmitted
Menml Health (axctudlng de?ne}. Alcohol er Substance Abuse.
Genetic testing and Pregnanclee invetving minom. which are In my patient ?le te
any ether treating heath-ream for-mm purpcsee and to any third party payer or
their representatives for the pumme- of obtaining payment for the senators rendered by
LENS. If It let necessary to expadtta treatment of my payment fer
eenrlcee, I authorize LEMS to send such mettle vie facetmita met, or telephone. -I
any or other person who has nuanced or examtned meet any heepttat
In which I was treated or examlned. te disclose any knwiedge or to release medIcaI
Infennction. patient records. or other acqutred tn. LAKE EMERGENCY
MEDICALSERVICES. 2T81 W. Otd Hwy. 441-, Mount Dora FL 3275?. This Inl'crmatton will
he obtained and need fer treatment. payment. or Matti-lean operations oniy. I authorize,
request and acalgn payment directty to LSEMS by all Insurance centers with whom I have
coverage or from whom bene?ts are or may beecth payable to the Inducing settlements or
judgments ?ewan from the Incidents for which] may be receiving Imatment I understand
that the aforementioned rateacea are and can only be revoked
wrench written request to LEMS.

T0 MEDICARE PATIENTS
I certify that the Informettcn gtven by me In fer payment under Tttle cfthe

octet Security Act In correct I reduce: that payment at Medicare bene?ts he
made on my behetf fer any servicee'htrnished the by LEMS. I any hctdar
ct medlcat information about me to release to the Centers for Medicare a Medicaid Sewicca
and Ita agents any needed to detaching-these bene?ts or the bens?ts payable
for related services. 1 agree to execute such terms and comma as may be nacea?ary tn
apply tor and obtain payment. Under Section tmtalm cf the Medicare law, Medtcere 
pay cnty fer services that It detenninec tn be and necessary?. I understand I
am responsible for certain hearth insurance coinsurance mounts, net
medicaliy necessary aewicee and neh-ccvered canines.

 

 

 

 

 

PERTAINING TO MEDICAID PATIENTS

I certify that i am a reclptent cf the Medicaid program. We XIX. and request that payment of
bene?ts: he" matte an my behatr. I authorize LEMS to matte auntiebte to the
Florida Department of Children and Famlty Services any requested infermatlcn concerning
median: insurance and ?nenan recent: related to my treatment. I hereby certify all health
Insurance shalt be assigned to LEMS fer services prodded I understand that I am
reepcnsibta for certain health Insurance dedude Oct-insurance amounts. not medicain
necessary serum and non-covered eenricec

PERTAINING To AUTHORIZED SIGNERS ON BEHALF OF THE PATIENT

By signing on behalf etthe patient. that In so, I am actth In the capacity
at an Signer? as de?ned under Federet Law. As such. it in not an acceptance of
?nanch responsibility for the services rendered

 

COMPLIANCE WTTH F58 119.071 REGARDING OUR COLLECTION AND USAGE OF
YOUR SOCIAL SECURITY NUMBER

Page 9 of 10

 

 

 

 

 

 

 
 
 

EMS BILLING

  
 

Lake EMS

2?81 OLD HIGHWAY 451
MOUNT DORA, FL 399-8500
(362} 385-3008 Ext

 
 
 
    
 

 

a that I have been fntunnad In waiting by Rice. Gary. Acevedo. Chad
my Social Security number is mammary for billing purposes and to
bare provfdans and?or hearth Insurers ta identify my mcords.

I hereby acknoudedg
that the coilec?cn of

 

enable other heatth

PEACHCES

NOTICE OF 
t. erehy admisdge mm of the Lake EMS Notice at Privacy Practices

 
 

EMERGENCY EXCEPTIONS (if tippiicabit?:

 

Pertaining to Signer ether than patient:

9 on behaifaf the patient. hereby acknoMedge that the patients

an that thaw are unabte to sign the form that-name: i ?lm-tar
that Lake EMS crew man-bars. Rica. Gary, mm, Obad, have made a gocd
faith effort to provide a copy of the Lake EMS Notice of?PriVacy Practices to the patient by
prevailing ms with a copy of the natica t1: datiwrto the patient.

1, Gary Rica, by 
wrrant condition Ia su

 

 

 

 

 

 

Pertaining tn Crew Signature an behalf of Patient:

signing on uha?' of :11; patient, hereby that
uch that they are unable in Sign the than themselves. and?
and sun on behalf of the pa?ant.

3. Rice. Gary. Acevedo, Obed, by
that patients current conditton Is 5

no othar autho?zad algn'er in av 

 
  

 

   

 

amazon 0?:90
SAME Hm

2mm-

1619 Rica. Gary . 1612 Acevedo, Chad

i

 

 

 

 



FugeWo?o

 

Here are the notes you requested from the conversations we had with Dr and Tom Shea, Director

of Carlton 

A couple days atte got to Carlton Palms, we received a phone call from someone saying that they
were taking off some of edications. assumed at that time, they knew to wean  
medications, since most of those you cannot stop "cold turkey? without severe side effects.
remember who i spoke withone ofthe emails we will be sending (June 28) the
nurse Paul Nolan refers to a conversation we had, so think it must have been him.

 
       

I can?t

At 0922 on July 6, 2013, Dr called my cell phone and left message that he would try and alternate
number. At 0933, he called home phone and talked to me He said that he was ?sorry to
expired this morning.? He wen to say, 
id not appear to be dehydrated at that time. Due to
I a clear liquid diet. He said during
collapsed and they

 

        
  

inform you, but your

 

and he examined and  
behavior he decided to not take the hospital and monitor
the night, tarted vomiting again and they rushed  to the hospital where
were not able to revive 2' He mentioned that other kids at Carlton Palms have had a virus and he

mentioned something about meningitis.

           

 

On July I alked to the medical examiner and he said the autopsy was virtually negative, that
had a small amount of brain swelling (not trauma), lungs were clear, heart was normal, and nothing was
wrong with- bdomen. entioned the concern we had about some ofthe medications bein
stopped by Carlton Palms shortly after rrived at the facility. was standing next to  
as repeating things back to me. Medical examiner said we had to wait on toxicology reports.

 

  

and

    

 

      

Dr and Tom Shea called again and talked to ith me standing by. eated wha
said back to me.  sked him what happened an wanted more details regardin  
hours. Dr said tha  vomited on Friday, he examined did not appear to be
dehydrated, and since was so agitated he felt-

   
 

  
   
 
   
 

    

.. to be put through any more torture by having to
needles in the ER. They would keep  

the ambulance. Dr stated the ambulance took 9
vas pronounced at 0815. He said they worked 0

  

 year olds don?t die from Cardiac arrest, they usually go into respiratory failure first than
cardiac arrest. old him that and he didn?t really say anything.

 

lips

 

July 8, Medical Examiner called and said the blood cultures are negative so far. Mentioned that
face appeared sun burned and with a road rash appearance. ?Just wanted you to

 

were really red and
know, not to be alarmed when you see

 

 

 

 

   

Went to funeral home to make arrangements after that, and the first thing the funeral director says is
?Don?t be alarmed, but we have to use a lot ofmake-up on because it looks lik  

     

burn/road 

 

July 10, we had a conference call with Dr and Tom Shea. Thye told us the same story as the one
on the 7th (wher  collapsed at Carlton Palms not at the hospital). Only this time 
since Friday, but tey gave i Zofran (antinausea medication) Saturday morning anyway. Dr 
then said this time  had poblems breathing first, collapsed, had no pulse, they started CPR and
called ambulance etc. We asked about the rash/rug burns on

He said those could be from the mask used when they were performing CPR.

 

 

 

 
 

July 11, Dr called again to find out how we were doing and to ask where he could send flowers.
honor in the area where other people
when he was talking to

 
 

have died from Carlton Palms. I once again was right next to my 
him, and i told him to ask ifthey have a defibrillator. He asked Dr that and he said they do. Asked
 was in when it was placed on My I I couldn?t ask that

that even though they have a defibrillator, ?he did not use it since
the ambulance got there quick". Previously, he told us the ambulance took 9 minutes to get there. He
pinephrine.

 

 

During one of the conversations, don?t remember which date it was, we asked Dr. if he stopped
the medications suddenly or weaned ff ofthem. He told us he took  ffof all of them except
nbilify and Risperidone because those are the 2 that can?t be stopped abruptly. For he
mentioned that they had changed from V2 pill 2x/day, to 1 pill lx/day. The rationale behind eliminating
some of the other medications, such as Buspar, Melatonin, and Fluoxetine (Prozac) was really two-fold
per Dr. After consulting with their resident they deemed those medications to be
outdated, and not really adding therapeutic value. Dr. also reiterated what we had heard earlier
from the Nurse, Paul Nolan, that it was extremely difficult to give edications, so eliminating
some was definitely going to help the situation.

   

 

 

 

 

Watkins, Clay

    

From:

Sent: Friday, July 19, 2013 1:34 PM
To: Watkins. Clay

Subject: FW: Happy Friday

Couple emails from OP. Thanks,

 

From: Paul Nolan 
Sent: Wednesda Jul 03 201? 3'54 PM

  
 

Subject: RE: Happy Friday

  

   

Hello to all.  was having a nice day in class today. I sent away to s? of?ce for 
teacher did say that aw the hernia pop out on Monday Nothing there when I checked on 
Today. I will let you know if I do not hear back. ?'orn  but they seemed very nice. They said it may

take a while that the Dr. must approve any release of information. Have a great day, Paul.

 

   
 

    
 

Sent: Monday, 01 2013 1219 .
To: Paul Nolan; 

CC: Bridget Shore
Subject: RE: Happy Friday

     

  

    

Paul, the diagnosis originally came fro Nidia then took to a specialist
who con?rmed the hernia. I?m pretty sure all the paperwork was faxed to Carlton Palms a few months back,
including consent to Speak to the physicians. I left a W111 with Nidia a few minutes back to either pass the

in formation along to me to send/fax to you, or to contact you directly.

requires

 

I?m not aware of any recent CAT scans performed, and de?nitely nothing for the groin region.
complete sedation for any MRI or CAT scans.

Thanks,

 

 

 

 

 

From: Paul Nolan [mailto :NolanPt?rDadvose-rv. com]
Sent: Mond, July 01, 2013 11:47 AM
TO: 

  

 ridget Shore
Subject: RE: Happy Friday

Did she have a cat scan at any time? Sometimes a swollen node can pop out also that appears to be a
hernia. Thanks for forward to Nidia. I will watch for her email. Have a great day, Paul.

  
   

Sent: Fri ay,ne ,013 7:38 PM
To: Paul Nolan
 ridget Shore

Subject: Re: Happy Friday

Thanks for the update Paul, I forwarded this mail to Nidia since she should have the Doctor
notes/diagnosis. Per my who is a RN, hernias can "pop inXpop ou but it's de?nitely there as 
?rst hand. Let's see what-Nidia has.

   

 

On Jun 28, 2013 5:02 PM, "Paul Nolan" <NolanP@advoserv.c01n> wrote:

Hello to you both. This is Nurse Paul. We spoke on the phone the other day. I just wanted to let you know that
seems to be doing very well here has had a good couple ofdays.
winning our hearts wit  .. pirited ways. We did not see any evidence ofa hernia on examination. Do you
have any dictated notes from the Dr. that you could send over? 0 hurry but whenever you have a chance. We
were expecting to see something prominent if the Dr. thought  I eeded surgery. Fax ?g;383?8631 comes
right to my desk. The examined ?le on Thursday and Dr. was able to do a good exam on
. I rrived. I do not check email over the weekend but if you have any uestions I should be
able to get back in touch with you Monday. Thank you for trusting us to look after your 
it is an honor and a pleasure for me to help you and in any way I can. I hope
well. Have a great day, Paul Nolan, RN.

   

   

 

 

   
    

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.
2

 

 

 

DISCLAIMER:

The contents of this email message and any attachments are con?dential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

 

 

Watkins, Clay

 
   

From:  

Sent: Saturday, July 27, 2013 11:12 AM

To: Watkins, Clay -
Subject: Summary of Correspondence w! Carlton Palms Re:
Attachments: Carlton Palms Conversationsoocx

 

Clay, I apologize for the delay sending this it was stuck in my Outlook outbox. Please see attached for the
Summary. Please keep in mind this is our best ellhit at reconstructing the highlights of the conversations we
had with Dr. and Tom Shea, but certainly not verbatim. We still don?t understand why they didn?t use
the de?brillator and waited all that time for the paramedics to arrive. That should be pan?: of standard protocol 1
would think and isthe training that I have received as a RN.

Also, for the Toxicology results, l?m sure it would show an overdose of medication, but how would it reveal
and underdose, which is what we think went horribly wrong in case. Do they have to do certain tests,
outside the normal battery, to reveal that? would like to speak 0 the Medical Examiner about that if you feel
it?s appropriate before the results come in. Finally, when the results do come in, I?m assuming we would be
noti?ed ?rst, not Dr. or anyone representing Carlton Palms. Please clarify.

We are really looking forward to getting to the bottom of this and getting some closure.

Thank you,

 

 

  

Medication:

CLOMIPRAMINE 25mg: 1 cap. BID
BUSPAR 15mg: tab. TID

FLUOXETINE 20mg/Sml: 10ml. by mouth daily

RISPERDAL lml: at bedtime (Before 4/10/13, Risperdal was lmg/lml: 3111}. AM
- 2m]. PM. and it gradually decreased weekly)

ABILIFY 7.5m] BID (Abilify was added on 4/10/13 starting at 2.5111} PM and it
gradually increased weekly)

MELATONIN 5mg. 2 tabs PM

LORATIDINE 10mg: 1 tab. PM

 

 

 

 

Watkins, Clay

  

From: 

Sent: rlday, July 19, 2013 1:48
To: Watkins, Clay

Subject: FW: Medication
Attachments: Medicationdoc

   

Attached is the med list that  was on when

 

 

From: Nidia Ariza 
Sent: Friday,lu1y19,2013 1:10 PM

To:  .  

Subject: Medlcahon

 

Hepe everything is well, attach medication information.

Thank you,

Nidia Ariza

 

 

 

Watkins, Clay

   

From: 

Sent: Friday, July 19, 2013 1:46 
To: Watkins, Clay

Subject: FW: Happy Friday

From: Paul Nolan 
Sent: Monday, Jul 01 2013 1232 PM

  
  

Co: is 
Subject: RE: Happy Friday

 

Hello to all I hope all is well. You do not happen to remember what sedation worked well do you? Was it a
combination of oral and IV sedation? Sorry for all of the questions but if we know what works and what does
not, it will help in the future. Have a great day, Paul.

   



  

From.    
Sent: Mon Jul 01 2023 12.1
To: Paul Nolan;  -
Cc: Bridget Sho
Subject: RE: Happy Friday

 

   
    

Paul, the diagnosis originally came fro   Nidia then took her to a specialist
who con?rmed the hernia. I?m pretty sur . to Carlton Palms a few months back,
including consent to speak to the physicians. I left a v/rn with Nidia a few minutes back to either pass the

information along to me to send/fax to you, or to contact you directly.

 

I?m not aware of any recent CAT scans performed, and definitely nothing for the groin region.
complete sedation for any MRI or CAT scans.

Thanks,

Terry

 

 

From: Paul Nolan 
Sent? Mond Jul 01, 2013 11:47 AM

   

 Bridget Shore
Subject: RE: Happy Friday

 

 
 

From m.

Sent: Fay, June 28, 20l3 
To: Paul Nolan

     

ef?Happy Friday

Thanks for the update Paul  forwarded this mail to Nidia since she should have the Doctor
notes/diagnosis. Per my   who is a RN, hernias can "pep in/pop out?, but it's de?nitely there as

?rst hand. Let's see what Niia has.

 

 

On Jun 28, 2013 5:02 PM, "Paul Nolan" wrote:

Hello to you both. This is Nurse Paul. We soke on the phone the other day. lust wanted to let you know that
coins to be doing very well here. as had a good couple of days. .. 3 taking pills whole and
Winning our hearts with  ways. We did not-see any evidence ofa hernia on examination. Do you
have any dictated notes from the Dr. that you could send over? \lo hurry but whenever you. have a chance. We
were expecting to see something prominent if the Dr. thought needed surgery. Fax sagging; comes
right to my desk. The examined - ?le on Thursday and Dr. was able to do a good exam on
Wednesday a?e arrived. I do not check email over the weekend but if you have any uestions I should be
able to get back in touch with you Monday. Thank yo for trusting us to look after you
it is an honor and a pleasure for me to help you and   any way I can. I hop
well. Have a great day, Paul Nolan, RN.

 



  

 

    
    

DISCLAIMER:
contents of this email message and any attachments are confidential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

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information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmissmn is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

BISCLAEVIER:

The contents of this email message and any attachments are con?dential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

 

 

 

 

 

 

Watkins, Clay

 
      

From:

Sent: Friday, uly 19, 2013 l: .
To: Watkins, Clay

Subject: FW: Happy Friday

From: Paul Nolan 
Sent: Frida June 28 2013 5:02 PM
Bridget Shore

  

Subject: Happy Friday

Hello to you both. This is Nurse Paul. We spoke on the phone the other day. I just wanted to let you know that
 seems to be doing very well here. *3 has had a good couple of days - 3 taking pills whole and
winning our hearts with  pirited ways. We did not see any evidence of a hernia on examination. Do you
have any dictated notes horn the Dr. that you could send over? No hurry but whenever you have a chance. We
were expecting to see something prominent if the Dr. though  needed surgery. Fax 352-383-8631 comes
right to my desk. The examined ?le on Thursday and Dr. was able to do a good exam on
Wednesday after arrived. I do not check email over the weekend but if you have any uestions I should be
able to get back in touch with you Monday. Thank you for trusting us to look after your -.
it is an honor and a pleasure for me to help you and -
well. Have a great day, Paul Nolan, RN.

       

 

 
 
  

DISCLAIMER:
The contents of this email message and any attachments are confidential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

 

Watkins, Clay

 
 
      

From:

Sent: r2 ay, 
TO: Watkins, Clay
Subject: FW: Happy Friday

From: Paul Nolan [mailto :Nolan13@advoserv. com]
t' July 02, 2013 9:03 AM

    
 

RE: Haday

Thanks guys got them both.

  
   
 

From: 
Sent: Monday, July 01

 

2013 7:39 PM



 

 

Cc: Bridget Shore
Subject: RE: Happy Friday

as we got a bounce back on our end. Sending agai? just in

 

Paul, I?m not sure ifyou got this from


- 

 

For CT Sean?s needs high dose ofAtivan. For MRI Versed. Ativan doesn?t knoc

  

93+
0:
"1

pa
:3


   

 

From: Paul Nolan [mailtozNoIanP@advosew.com]
Sent: M0 01 .2013 12:32 PM
110:
Cc: Bridget Shore

Subject: RE: Happy Friday

  
 
 

 

 

 

 

 

Hello to all I hope all is well. You do not happen to remember what sedation worked well do you? Was it a
combination of oral and IV sedation? Sorry for all ofthe questions but ifwe know what works and what does

not, it will help in the future. Have a great day, Paul.

  
  

From: 
Sent: Monday, July or 2013 
To: Paul Nolan;
Cc: Bridget Shore

Subject: RE: Happy Friday

      

Paul, the diagnosis originally came ?om  .  a specialist
who con?rmed the hernia. I?m pretty sure a paperwor was axed to Carlton Palms a few months back,
including consent to speak to the physicians. I left a Wm with Nidia a few minutes back to either pass the

information along to me to sendifax to you, or to contact you directly.

 

I?m not aware of any recent CAT scans performed, and de?nitely nothing for the groin region. 
complete sedation for any MRI or CAT scans.

Thanks,

 

From: Paul Nolan 
Sent' 

    

'have a cat scan at any time? Sometimes a swollen node can pop out also that appears to be a
henna. Thanks for forward to Nidia. I will watch for her email. Have a great day, Paul.

 

 
 

Sent Friday. June 
To: Paul Nolan

 

 

 

 

  

Ce: 3 ridget Shore

Subject: Re: Happy Friday

forwarded this mail to Nidia since she should have the Doctor
who is a RN, hernias can "pop infpop out?, but it's de?nitely there as 2:
ia has.

Thanks for the update Paul
notes/diagnosis. Per my 
?rst hand. Let's see wha

 

   

 

 

On Jun 28, 2013 5:02 PM, "Paul Nolan" <NolanP@advoserv.eom> wrote:

Hello to you both. This is Nurse Paul. We soke on the phone the other day I 'ust wanted to let you know that
eems to be doing Very well here as had a good couple ofdays. is taking pills whole and
pirited ways. We did not see any evidence of a hernia on examination. you
have any dictated notes from the Dr. that you could send over? No huny but Whenever you have a chance. We
were expecting to see something prominent if the Dr. thought needed surgery. Fax 352?383?8631 comes
right to my desk. The examined  ?le on Thursda and Dr. was able to do a good exam on
arrived. I do not check email over the weekend but if you have any uestions I should be
able to get back in touch with you Monday. Thank trusting us to look after you 1 can tell you
it is an honor and a pleasure for me to help you and . in any way can. I hope
well. Have a great day, Paul Nolan, RN.

   

 

 

 

 
   

     

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissomination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

DISCLAIMER:

The contents of this email message and any attachments are confidential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. if you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

 

DISCLAIMER:

The contents of this email message and any attachments are con?dential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

 

 

 

 

 

Watkins, lay

 
   

From:

Sent: Friday, July 19, 2013 1:38 PM
To: Watkins, Clay

Subject: FW: Happy Friday

Emails from OR

From: Paul Nolan 
Sent: Friday June 28, 2013 5:02 PM
   Bridget Shore

   
  

Hello to you both. This is Nurse Paul. We spoke on the phone the other day. I just wanted to let you know that
 seems to he doing very well here. I  as had a good couple ofdays. .
winning our hearts with  pirited ways. We did not see any evidence of a hernia on examination. Do you
have any dictated notes in the Dr. that you could send over? No hurry but whenever you have a chance. We
were expecting to see something prominent if the Dr. though  needed surgery. Fax 352683?8631 comes
right to my desk. The examined  ile on Thursday and Dr. was able to do a good exam on
Wednesday a?er I rrived. I do not check email over the weekend but if you have any questions I should be
able to get back iueh with you Monday. Thank you for trusting us to look after yur' I can tell you
it is an honor and a pleasure for me to help you and  I is doing
well. Have a great day, Paul Nolan, RN.

 

   
    

 

 

 

   

        
 

DISCLAIMER:

The contents of this email message and any attachments are con?dential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transoxission is strictly
prohibited. If you are not the intended recipient, please unmediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

 

Watkins, Clay

 
   

From: 
Sent: Friday, July 19, 2013 1
To: Watkins, Clay
Subject: FW: Happy Friday

Emails from OP.

From: Paul Nolan 
Sent: Monda Jul 01 2013 1232 PM
To: 
Cc: ridget Shore
Subject: RE: Happy Friday

 
 
  

   

Hello to all I hope all is well. You do not happen to remember what sedation worked well do you? Was it a
combination oforal and IV sedation? Sorry for all of the questions but if we know what works and what does

not, it will help in the ?xture. Have a great day, Paul.

    

Ce: Bridget Shore
Subject: RE: Happy Friday

 

Paul, the diagnosis originally came fro    Nidia then took her to a specialist
who coa?med the hernia. I?m pretty sure all the paperwork was faxed to Carlton Palms a ?aw months back,
including consent to speak to the physicians. 1 left a Will with Nidia a few minutes back to either pass the

information along to me to send/fax to you, or to contact you directly.

 

i?m not aware of any recent CAT scans performed, and de?nitely nothing for the groin region. 
complete sedation for any MRI or CAT scans.

Thanks,

 

From: Paul Nolan 
Sent: I da July 01, 2013 11:47 AM

   

Cc: Bridget Shore
Subject: RE: Happy Friday

Did  have a cat scan at any time? Sometimes a swollen node can pop out also that appears to be a
hernia. Thanks for forward to Nidia. I will watch for her email. Have a great day, Paul.

 

 
 
 
 
 

From:  
Sent: Friday, June 28, 2013 7:38 PM
To: Paul Nolan
Ce-

 

Hp 

Thanks for the update Paul, I forwarded this mail to Nidia since she should have the Doctor
notes/diagnosis. Per  who is a RN, hernias can "pop ou but it's de?nitely there a
first hand. Let's see What Nidia has.

   

 

On Jun 28, 2013 5:02 PM, "Paul Nolan? wrote:

Hello to you both. This is Nurse Paul. We Spoke on the phone the other day. I just wanted to let you know that
seems to be doing very well here.  I ?has had a good couple of days. is taking pills whole and
wing our hearts with pirited ways. We did not see any evidence of a hernia on examination. Do you
have any dictated notes from the Dr. that you could send over? No hurry but Whenever you have a chance. We
were especting to see something prominent if the Dr. thought she needed surgery. Fax  comes
right to my desk. The examined the on Thursday and Dr. was able to do a good exam on

 
 

 

 

  

Wednesday after  rrived. I do not check email over the weekend but if you have any questions I should be
able to get back in uch with you Monday. Thank you for trusting us to look after your  can'tell you
it is an honor and a pleasure for me to help you and. in any way i can. i hop p?)is domg

 

well. Have a great day, Paul Nolan, RN.

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmissxon lS strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete tins

message and its attachments, if any.

 

 

 

DISCLAIMER:
The contents of this email message and any attachments are confidential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmisston IS strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete tins

message and its attachments, if any.

DISCLAIMER:

The contents of this email message and any attachments are confidential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

 

 

  .. 

Watkins, Clay

  
 

 

From:

Sent: 

To: Watkins, Clay
Subject: FW: Happy Friday

Emails from C.P.

From: Paul Nolan 
Sent: Monday July 01, 2013 11:47 AM

 
      
    

  ridget Shore
. RE: Happy r1 ay

 

 

  

 have a cat scan at any time? Sometimes a swollen node can pop out also that appears to be a
hernia. Thanks for forward to Nidia. I will watch for her email. Have a great day, Paul.

  
 
 

From:
Sent: Friday, une 28, 2013 7:38 PM
To: Paul Nolan

 

- Bridget Shore
Subject. Re: Happy Fr1day

 

Thanks for the update Paul I forwarded this mail to Nidia since she should have the Doctor
notes/diagnosisRN, hernias can "pop out", but it's de?nitely there as
?rst hand. Let's see what Ndia has.

    

 

On Jun 28, 2013 5:02 PM, "Paul Nolan? <NolanP@advoser1/ygm> wrote:

Hello to you both. This is Nurse Paul. poke on the phone the other day. I just wanted to let you know that
 eems to be doing very well here. ..  has had a good couple of days 3 taking pills whole and
spirited ways. We did not see any evidence of a hernia on examination. Do you

have any dictated notes from the Dr. that you could send over? No hurry but whenever you have a chance. We

   
           

were expecting to see something prominent ?f the Dr. though eeded surgery. Fax 34337383863; comes
right to my desk. The examined ?le on Thursday and Dr. was able to do a good exam on

ions I should be
 I can tell you
p?)is doing

Wednesday a?e   arrived. I do not check email over the weekend but if you have any
able to get back in ouch with you Monday. Thank you for trusting us to look after your
it is an honor and a pleasure for me to help you an 

well. Have a great day, Paul Nolan, RN.

  
  
 

 

 

 

 

 

DISCLAIMER:

The contents of this email message and any attachments are con?dential and are intended solely for addressee. The
information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

 

 

 

Watkins, Clay

    

From:

Sent: Friday, July 19, 2013 1.38 PM
To: Watkins, Clay

Subject: FW: Happy Friday

Emails from C.P.

From: Paul Nolan 
Sent' July 02, 2013 9:03 AM

 

 
 

Thanks guys got them both.

  

From: . 

Sent: Monday, July 01, 2013 39 PM
TO: Paul Nola?' .    

Cc: Bridget Shore

Subject: RE: Happy Friday

 

Paul, I?m not sure if you got this from as we got a bounce back on our end. Sending again just in

 

 

 

For CT Sean?s she needs high dose of Ativan. For MRI Versed. Ativan doesn?t knock
till for MRI. Thanks

   

From: Paul Nolan 
Sent: Monday, July 01, 2013 12:32 PM
To. 

Cc: Bndgot Shore

Subject: RE: Happy Friday

 

 

 

 

 

Hello to all I hope all is well. You do not happen to remember what sedation worked well do you? Was it a
combination of oral and IV sedation? Sorry for all of the questions but if we know what works and what does
not, it will help in the future. Have a great day, Paul.

    

From: .. . 
Sent: Monday, July 01 70
To: Paul Nolan;  

Cc: Bridget Shore
Subject: RE: Happy Friday

 

Paul, the diagnosis originally came from  . Nidia then too  to a specialist
who confirmed the hernia. I?m pretty sure all the paperwor was axe to Carlton Palms a ew months back,
including consent to speak to the physicians. I le? a v/m with Nidia a few minutes back to either pass the

information along to me to send/fax to you, or to contact you directly.

requires

 

I?m not aware of any recent CAT scans performed, and de?nitely nothing for the groin region.
complete sedation for any MRI or CAT scans.

Thanks,

 

From: Paul Nolan [mailtozNolanP?advosew.com]
Sent: y01,2013 11:47 AM

To:
Cc:
Subject: RE: Happy 

  
  

 
 

 

Did have a cat scan at any time? Sometimes a swollen node can pop out also that appears to he a
hernia. Thanks for forward to Nidia. I will watch for her email. Have a great day, Paul.

 

From:
Sent: Friday, June 28, 2013 7:38 PM
To: Paul Nolan

 

 

 

 

 
 

.. Bridget Shore
Subject: Re: Happy Friday

Thanks for the update Paul, I forwarded this mail to Nidia since she should have the Doctor
notes/diagnosis. For my who is a RN, hernias can "pop ill/pop out?, but it's de?nitely there as -
first hand. Let?s see what Ni ia has.

   

 

On Jun 28, 2013 5:02 PM, "Paul Nolan? <NolanP@advoserv.com> wrote:

Hello to you both. This is Nurse Paul. We Spoke on the phone the other day. I just wanted to let you know that

  

right to my desk. The examined ?le on Thursday and Dr. was able to do a good exam on
arrived. I do not check email over the weekend but if you have any a estions I should be
able to get back I ouch with you Monday. Thank you for trusting us to look alter your can tell you
it is an honor and a pleasure for me to help you and in any way I can. I hope  ?)is doing
well. Have a great day, Paul Nolan, RN.

 

 
 

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this

message and its attachments, if any.

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If you are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any. -

DISCLAIMER:
The contents of this email message and any attachments are con?dential and are intended solely for addressee. The

information may also be legally privileged. This transmission is sent in trust, for the sole purpose of delivery to the intended
recipient. If you have received this transmission in error, any use, reproduction or dissemination of this transmission is strictly
prohibited. If yen are not the intended recipient, please immediately notify the sender by reply email or phone and delete this
message and its attachments, if any.

 

 

 

Watkins, Clay

 
 
  
 
 

 

From: 
Sent: Friday, Juty 19, 2013

To: Watkins, Ctay

Subject: Paige
Attachments: -with-headgear.jpeg

 rm and chest gear. Looks

 

mm: Tara Sheehan 
Sent' Friday July 19, 2013 9:51 AM

To 

Subject: RE: Paige

 

 

Attached is a photo 0  wearing the black protective headgear.

 

The headgear is from the Everlast company and it is designed for the sport of boxing. It is labeled Everfresh
Headgear Levei II for Sparring, model 4022. We selected this model because of the ventilation if provides.

Please do not hesitate to contact me if you need any additional information.

Warmly,

Tara

Tara Sheehan, M.S., BCBA

 

Research Scientist

Severe Behavior Disorders Program

Mailman Segai Center for Human Devebpment
Division of Applied Interdisciplinary Studies

Nova Southeastern University

 

From:
Sent: Thursday, July 18, 2013 1:49 PM
To: Tara Sheehan

Subject: 

 

 

Hi Tara the Detective from Lake Co. is requesting a picture 0 
insist   elmet was white. Carlton Palms told them   ever had a black one. I would i
had a black one. I don?t know what that has to do w'th anything, but the one the 

   

  

     

 

 

 

 

 

 

 

  
 

  naiyae rs

Robert Bacon DVR Report
Clinton Electronics DVR CE- R165
RB71613

Data Analyzers received this DVR (Digitai Video Recorder) for the purpose of
recovering CCTV (Closed Circuit Television) footage from the DVR after it had been formatted.
The DVR unit contains 2 hard drives inside:

Western Digital 1TB model WD WCC1U0522394
WesLern Digital 2TB model SEN \i?v?MC30087952-4

After making an exact copy of each drive we noticed that the larger, 2TB hard drive did
not have any data on it, even at a raw level {it consists of all The 1TB hard drive
is almost completely full of data despite the DVR only presenting a small amount of footage
that had been recorded since the format. The system also only seems to use the 1TB drive, at
least in its current state. A quick format would not have zeroed out the 2nd 2TB WDZOEURS hard
drive so either the 2nd hard drive was never in use or it was fully formatted. A full format on a
2TB drive would take a few hours at minimum so it is highly unlikely that it was on accident if in
fact it was fully formatted and not just disabled.

it is important to understand that a large variety of DVR systems exist; Many
manufacturers in Asia make them and often use their own proprietary file system. In the case
ofclients DVR, it consists of4 partitions. 2 Linux Ext3 data partitions, 1 Linux swap partition,
and a final raw partition. The last partition is the largest and ofan unknown file system. it is raw
data that only the DVR can read/write and interpret. This is where the footage is stored.

Various techniques were utilized to carve and piece the raw data back together but a
sufficient enough pattern couid not be found. The small amount of footage that is on the DVR
now was exported to USB via the built in DVR software. We compared the exported video files
to the data on the hard drive. Many similarities could be found but not enough to recreate the

deleted data.

 

 

 

From what we have learned is that there are index files which link to the various sectors
of raw data on the hard drive. These index files store metadata including time, data offsets,
and which footage belongs to which camera. When formatted these index files have been
removed, but not the actual video data. We tried to scan for the deleted index files as well as
recreate them but neither methods were successful.

I spoke with the lead tech support Bill at Clinton electronics who informed me that there
was no tools or help he could provide. After additional time spent on analysis of the data
structure without success, made another call to Bill and this time he informed me that he
could email their manufacturer in South Korea to ask ifthere is anything that can be done. Bill
also mentioned that he had been contacted before about a similar case with a formatted DVR.
He recommended them to a leading national data recovery lab that also could not perform a
successful recovery on his client?s DVR system.

Their manufacture?s response was that they could not provide any tools but if we
wanted to send the drive in they would attempt to recover the data. The provided was
R130726018T2 and the drive would have to be sent to Clinton Electronics headquarters in


Unfortunately there is nothing we can recover from this DVR here at Data Analyzers. We
tried for many weeks to manually carve out the footage. Due to the proprietary file system it
will be very difficult for anyone other than the manufacture to recover deleted footage from.
We would recommend sending a copy of the hard drive to Clinton Electronics manufacturing
engineeringteam for the greatest chance of recovery.

Prepared by: David Edwards Date:   


David Edwards
Recovery Engineer

 

 

 

lnsert thumb drive
Go to windows icon
Select computer

Back up folder and double click

You will see 2 segments double click on DVR picture
Hit sign on MY PC

Select drive

Hit segment 1 or 2

 

Segment one has all 8 cameras
Select camera 3 (hallway)

Segment 2 is ONLY camera 3 (hallway)

 

 

 

A person who knowineg or wiilfuliy makes public or discloses to any unauthorized person any confidential
information contained in the central abuse hotiine is subject to the penaity provisions of s. 3929;

REPQRT

 

 

       
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   

   
   

    

intake Name Intake Number County Secondary County
Unknown: Unknown 2013-189452-01 Lake Lake
Date and Time intake Received am Ty investigative Sub~Type Provider Name
07H ii2013 2:09 PM  institutional CARLTON PALMS
a EDUCATIONAL
Background Checks Required Reason Call Record Number 3 Hits Reviewed
Yes No Other El Yes 8 WA
Worker Safety Concerns Prior lnvoivement Law Enforcement Notified
Send Florida Administrative Message to Law Enforcement Yes NIA
Response Time Name Worker Name - Supervisor
immediate Eaton, Diane I BARRETT, KIMBERLY 
1. Family Information
Name Family Telephone Number Home
Unknown, Unknown
Unit Designator Cit State I
FL

 

 

 

 

 
 

 

 

~Primary Language: Interpreter Needed: Yes No

ewe

     

 

A. Prtictpants

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

   
 

 

 

 

 

 

 

 

 

 

 

 

Name it) Number Roie Gender 
Unknown, Unknown MN mme
I Ethnicity Race 
. Unable to Determine Yes No
Hearing Impaired: Yes No 24 Access Yes No
I Device Needed: 
I Name ID Number Role Gender DOB
I Unknown, Unknown AP Unknown -
Est. Age Ethnicity Race mm Disability 
I 40 Unable to Determine - Yes N0
Imiiearing impaired: Yes No 24 Access Yes ?No
I Device Needed: "My
AP Alleged Perpetrator PC ParentiCaregiver JS Alieged Juvenile Sexual Offender
CH Chiid In Home IN intake Name ii.) a identified Child
HM Household Member 30 Significant Other RN Referral Name I SC Referral Name
NM Non-Household Member Victim
8. Address and Phone information
Name  Type I Add Teiephone Number
Unknown, Unknown Primary
Residence
Unknown, Unknown Primary 1
mm?m Residence
 Relationships
Subject I Relationship I Subject 

 

 

Lunknown, Unknown  I Staff I Unknown 

 

 

 

A person who knowingly or willfully makes public or discloses to any unauthorized person any confidential
information contained in the central abuse hotline is subject to the penalty provisions of 5. 32.39;

 

 

o. Alleged Maltreatment  a

 

 

 

 

 

Alleged Victim Maltreatment Code
Unknown, Unknown Bizarre Punishment 
Unknown, Unknown Death

 

 

 

 

E. Location of incident

 

 

 

 

 

 

 

 

 

 

 

 

Address Street Apt. City State Zip Code
Telephone Number Home Telephone Number - Work Telephone Number Cell
il. Narratives

 

A. Allegation Narrative 
Over the weekend of 7/6/l3, th i passed away during the night after I ad been placed into 6-p01nt 
restraint. A bed not was used to restrict the movement even further. was in toomuch restraint
for longer than necessary. The staff approving the restraint only communicated Vla text messaging. .The Shift
supervisor not actually speak with the approving clinicia to get details. Using that much restraint may hay
made the  I underlying medical issues even worse. The   ad medical issues for several days prior to

had been throwing up colored liquids for days. Tere were data sheets and documentation
assing.

 

   

 

 

   

      
 

missing the morning of the

 

 

a. Provider Detail:

 

B. Narrative for Worker Safety Concerns

 

Agency Response
A. Recommendation

 

 

 

 

System Screening Recommendation I Counselor Screening Recommendation Counselor Screening Reason
Pending
Counselor Name Counselor Screening Date/Time

 

 

 

Reason for Override:

 

System Response Priority Counselor Response Priority Dateleme Decision Made
Recommendation Recommendation

 

 

 

 

Reason for Override:

 

B. Decision
Decision Date/Time Decision Made Reason
Screen in om 1/2013 2:47 PM Screen in - Accepted for



 

 

 

 

 

 

 

A person who knowingly or willfully makes public or discloses to any unauthorized person any coofidential
information contained in the central abuse hotline is subject to the penalty provisions of 5. 

Explain:

 

 

IV. Cl Unit Documentation
First Call Attempted DatefTime
Will/2013 2:48 PM

 

Completed Call Datez?Time
0711149013 2:52 PM

 

 

 

?Call Log
Called Out By Called To
Eaton, Diane Benn, Elois 

 

 

 

 

 

     
    
 

1 
DdIQ/zkx
. 
1..



 

 

1 
a? 1x as; .f??uiwcas? Evil} Cami??

 

 

 

 

 

 

 

 

 

 

1.,
.3: ax. D?V?tn' 

. A ?6
Phone. Pals: {mw'u  Shea) g2,
Re. 
MW

 

urgent For Review Page Con-amen? 912858 REPIY REESE R381;de

 



?Summer-am:

CO NFIDENTIAL NFORMKATION

The inmma?gn Gama} - I is pri?xgegad and con?dentiai parish-a.- Jt ta
Pursuant to chapter 33mm}: AIS records and reaon?s Dime sheik! protection team of the

or" ?ea are can?damtial 215:?. ?exempt from the pay-isms afgsx 1 19m and 453.057. and Shag 
be. discidsed? Ema P1: Upan ma?a: to the sig'i?e attorney, law enforcement, the depamen-# z: 
neCessa Q'Profassionafs, in furthers. race of the tree?m eat 9: add b50113} avaiuative n?ds GT if?? by
01:68er the court, or to. heaffh Dian Payom, iimf?ted to $313.1: im?oma?m used for insurance
reimbursemeni pun-20593,

mad 5:1  facsimile meme?

w}

This facsimile is fniended form-e use of the fndividuai or may named above' we {Easier Of this
meas?ge 35 not the intended recipient, You are named ma?: ?ursuarri to 39,295[3) a Person w; 
kn om 91y and Mimi?? m8 keg pub?c D, any as m?Edsntia? information contained in the again!
abuse hot?ne or in the records of any chad abuse, abam donm em or negf?c?f Case} ext": Pi as pray-mad
in this Chapter is gum}, of a misdameangr of the second degree, punishabhe as provided in s. 
ors. if you have mceived. this communication In error, pEeasefmmedi-zf?i?y? "Giff? by
teiephane. Thank you.

      

Wei?: kirk
3 Lmeisumrm child protection ?eam
 .?hni?jm??a ?a?imi Sagaw?gm

MEBICAL REPORT

   



3433?: Amanda Marchesse, Lake- Ct?} Child Protectim {$213633ngth 

LAW ENFORCEWT: WA

 



Puma an: :0 c?apzer record? and reporm ofzhe chifdprotecm?on ream of?m Depmmem? of are
con?de-trial and exempr?om the provisions 01?s: I IRWH) and 45021937, and s?aJZ not be diydos?ea: except, 74pm
reggae-31. to the ?are afrorney, law enforcement. {?re department, and necessary professr?onab, oft/w
treatment 9r adaG-?rz?onm? evalua?ve mew ofzize child, by order ofthe count or to hem}? p363: paw-5, Zimired to that
infarmarz'on usedfor insurance rer'm (ii-urgemam purposes.

Pursuant :0 39.2056) 6: person w?o and wfz??r?y mam? pu?fic or disclosay any corg?z?a?ergz?a! 
camaz'nesf in ska central slime hozmze or in the magnify afany chifa? a?me. or negfecz? case, ram: as
prm?z?ded in this chapzer  guifzy ofa: misdemeanor oftfre secorm? degree, pm?yha?rfe as provided :34 .5: $575.85? or 3.
$715. 383?

 

 



 

 

 

Lake Sumner Chiidren"s Advocacy Center Chiid Protection Team
300 3. Cam: Street a Lecsburg, FL 34743 a Phone: (352) 323~3303 Fax: {352) 323-1394
Funded by the State of Florida Department of Health

 

 

 

 

 

EVALUATION

Mama:

Date af?imh
Data :31? Bmlna?m: 09/22/283

Loca?bn m" Bvaiuatiom: 13% 

C2333 Coordiamtor: {Jenna Riefaey

Child Protective investigator: Amanda Marchese
Law Enforceme?t: WA

  

HSTORY

Pmsent Medical Eatery: This is a wager: {31" a medicai ream-d revisw completed 3333:: documents
femarded fay CPI from various Venues where the client wag mndared care aad an 311mva report dated
GQGEB and received if: the CAC an 3092212313. The records are those of a

 

     
 
 
  
 
  
 
 

   

 dented to discharge
There is

       
   

Severe SaEf-Injurious Bahamas [51:83.

 
 

   
 

 . a
decamentat?en .  'as hamin ..  . Map-11m ?i'zeir e?brts to protect: wigh gear and at times mszrainm.

was de?cribed 115207: admissmn to the Carith Paws-as having  that cause
'56 f?in?icted physical ham} and injuries :0 those around was repo?ed is be in

Jags. Her parents? admissim?i goal? were to have am American Sign
aggressive behaviarsa 33:? to 223m batter sei?mcduia??g behaviors.

- - as deteriorating behaviora?y.

W11 hair and had deveioped signi?cant pathoiogy of cit ear from 

ru ing and pu?ing at I. as had many complications of severe and ear infections ad has had
attempts at reconstructive ear surgery. The pain. xperienced when infected contributed to
behaviorai denim.

While in the previous facility, as I
necessary for be clothed in protective garb induding padded clam 1315;
upon others for total care.
En late: June 213 became i1! a?d reportedly had bean vomiting episadicaiiy far a week, The 
report states . stemmed over the week and had not been avaiuated by the an cal} physician until I
had been in 1% use to {our da 3.
On the morning of? demisa; I  was observed being in 6-point ramainta and with protective netting
over the bed . The reporter state I a nursing supervisor communicated with the medical provider via. text
messagino to upda?e the medical status and gain pemission to restrain. The assigned physician: did
see the,  ?2'15/13 an umented it wouid be traumatic to transport bar to the {0ch hosp?ai as 
wouid have to be chemically restrained as was too difficult to manage.

ont?nm-zd t0 vamit and deteriorate a?er being examined by the physician.

0n 0 "11/13 at 7:00 AM the was administered medications [Zofran] with Popsicle. At 7:20 AM 
 as observed to be in distress and Emergency Medical services were ca?ed.
paramedics to be in Cardiac (mast. Ratsuscitative effom were instituted, but the 
be opened, so intubation was met able to be initiated. as transported to the 
I '1 Nurses mid paramedics the - ad been vomiting ?several! days? and had been

stated 11, an antiemetic that" moming. Mood sugar upon arrival was '30. The
nursing staff related may found {he .. to be for breatl1e?_, but no one had been there to witness
the time of Game: of the Th time ofthe unwimes ed cardiac arms: couer not be established . Upon
arrival at the hospita rectal temperature was E035 was unmaponsive and had no 13100:?! pressure or

{43 ha? eXpTESsive Ian
Lamggage 

  
 
 

   

     
     

 

scams: What was described as ?wers?ni? behavioral? it became
. 
as Completely rehant

     

     

 

 

     

  

:1

 
    
 
 
 

 
 
 

.. mouth col?d not

 
     
 

  



    

     

 

heart beat
mot?od?

A striking observation to tho attending sraff was the extent of Enjoy-mo, bruises, Iaoora?ons, abrasioos, of
Ody. The  had a hisiory of soif?mj'urious behaviors. The woondo were extensive.

A: 88:15 AM was pronounced dead to cardiac; arrest and acute raspim?imy faiioro 

a 101* was noted to ho

 

was desor?bed as having rigor mortis of rho oppor exo?omit?os and

 

 

   

   

Autopsy ?ndings:
The  .orpso was described as bo?og th 1, weight: 69 pounds; length? 60 iochos; Body Mass- Index
?E?th measurements pano 11 the peroon? Is for ago and sex. The soaip had patchy hair
dissibution and the skoiotai survey was nogat?vo. We remainder of the anatomy was osseo?a?y
unremarkable. Toxicology screens showed tho pmsonco oftricyo?os in i006 and jao Hood was
positive for a?p?pmzolo, ?uoxotino? no?iuoxotioe, iom?dino, and fespimdone.

loo-d chomistries were with in norms? ?iorlits excopting a 30w serum biood sugar. Eiood whores wow:
positive for E. and spocies suggestive of contamination oi. the time of the draw. - hing
ouitazros were of mixed ?ora again soggostivo of contomioation perhaps by aspiration of gastric content.
ears wore found to be infooiod with Siaphl?yloccos anions, Mothaci?lin resistant strain as as jwitfo
Londida albicans and non?C a?bioans 3 
Spins! ?uid was gross?y contaminated with mixed  negative and gram positive organisms suggestive:
of contamination at the time of coilootion. more wow no positive vim} carom-s idonti?od.
Prescribod medications attimo ofdomfso were:
Resp-arm}
Ciomipmmine
ELL-soar
CEa??o and Masons}: nasai spray
Melatonin
Azior?orazoio

 
   

 

 
   

  
   

  

Develogmenta}: Severe docmnonted congenital developmentav? cognitive delays



I. Autopsy ?ndings of9K16/13 Namral Death:
Gasooesophageal in?ammation
Pulmonary congestion and edema
Cerebral edema
Numerous cutaneous abrasions and bruises
Biiaterai ear infections with fungal and bacteria} pathogens
Cause ofDeath: dehydration due to gastrointestinal infection

  

Hearing impairment due to ohmnio ear infections

. Allergic Rhinitis

. SciZUre disorder

. Histovy of Self-inflicted behaviors 

. Wrongful dearh due to modioai nqgloot is orobabio. There is no evidence that the medical and
nursing ff acted in accordance with the: standards of practice of the state of Fion?da in rendering
this fa cam.

umszy-tlu

 

RECOMMENDATIONS

 

 

1. Amanda. Marsheso, Child Pmioolcfw Ilivos?liga?sor with the Dopar?fomt of Children and Familial;
was infomed of the initial impressions.

. The records subml??ecl for review do not include Elie notes from tho week loading up to the client?s
death.
Dun?ng the time oz illness nursing staff" should have clocomontod {heir visual assessment of 
at 13 minute iotowals. Those assessments shoolo' have included o' . onto! seams,
vital ss?gos, and ?uid intake and output. Since had been so ill for so moo}; days? ?uid balance
should have been of paramount concern. The cause: of death was and the assessment
of  urioary output and the: qooifty o.  urine shoold have been enamored. Also, skin elasticity
god mx?gor should have been annotated as anozoor chook of  ?ydmion status. The character of

 feces shoulo? have boon described to include frequency, oolor, anal esthnatod volume. An

estimation of the amount? of vomims should have been documented. These are ?sndamootol
standards of nursing praci?ico?. Tho available records do not reflect whether these assessments
were indeed aocompl ?shed. Any altemtlon in the mootal status would have been a warning
of impending floid depletion and f?r?e mantles: potential for catastrophe. The facilityoeocls to
provide dooagmeo ?loo of these assessments am the ?ndings as dooumenied. Further, if there was
a dotorim?oo of ?uid stability or change in alertness or menial status, an oboe-War should be
able to road rho report dooumeotfog the epprop?ate oursng interventions had boon lostimtod. In
the absence of such documentation, the assumpo?oo is the work had not been done. would be a
very problematic situation for the facility to defend.

3. The dooisioo io restrain a. person mus: ?oe made with exoemel'y careful deliberotloo and in
Mall the lows of {he state of Florida. When the staff elects io do so, it must be with a
written doctor?s males: for a prosoobed time period ,aod with the availability of continuous nursing
oboorvation. Tnore are no records fonvardod that Show these guidelines wore {0.510W9d. A
physician must see the re aimed pa?en? within 24 hours of ordering lie remains. ?like doctor?s
notes and orders wow mot forwarded for i'ovfow.

4. Vomiting over the course of a ?ve day time period is on 1. Despite the inconvenience to the

staff and alleged concern of trauma to the patient, this  should have been taken to the hospital
at an earlier point to be evaluated. At a minimuma blood ohemistries, and perhaps
culturing should have been done. In the absence of. documentation regarding the physical

examination by the physician, One does not have a differential diagnosis or findings to explain the

cause of the prolonged emosls and ultimate cause of 9' 

The a temperature upon arrival at the emergency room was 103.5. This is quite high

especially as a post mortam temperature reading. This should be explored. Ono cause of the

compel-am elevation could be asoimtion pneumonia. The autopsy documents pulmonary
congestion Which might reflect asoiration.

had chronic infection 0 ears with resistant Staphlococcal organisms. This should
have been treated and given the fact Bad such otoloryngological disease, . hould
have been followed by an Otolaryngologist.

. The had a very low serum blood glucose noted in the FHW ED note. This is not explaineble.

The blood glucose was low during autopsy too. The implications of this are not evident, but an

endocrinologist may offer light as to the possible cause. Again, the 5 medical records do not

document prior laboratoa'y results that provide: evidence whether this was a pattern when 
alive.

Ix}

   

   

 

 

 

    

  

  

 

 

 
  

     
 

if:

    

 



 

 

 

  

"Kg? quila loy oc
Dam: September 25, 2013

 

 

 

 

 

    

 

 

 

 

 

 

Pg LPKE 
a-Evm?mm Calm?

Lake 5mm 
38%} S. Cam? gay-352$
Lawburgg FL %?43

FEQNE: 352~323m8393

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAX: 
7?9: Amiga-?g Marchase Frcm: Rickey
Fax: (352} 2534419 D333: September 27, 2913
P1 am: Pgs: {Imiuding cave! Shae?)

 

 

 

. ?re Smary CC:

  

 

 

 

 

 



 

 

 

Urgent For Review Heme Comment Name Regan; Pieasa Recycle

 

*Camments:
CONHDENTML JNFOFEMATION
Andria EstreHa-Roa, LMFT

OPT Team Conrdinator

The infc?naifcn co?tained in this facsimile message is prMie-gad and confidentiai pursuant to

puts mam: to chapter All records and reports of the child protection team ofthe Department
of Heaith are con?dential and exempt from the provisions as. and 456.39, and shail mat
be dischsed, axcept, upon request, to the state attorney, iaw enforcement, the department, and
necessary professionais, in furtherance of the treatment or addi?nnai evaiuatiVe needs 92' the chiid, by
order of the court, or to hesith pian payers, limited in that infoma?on used for insurance

reimbursemerit purpcmes.

This facsim?e is intended for the use of the individual or en?ty named above. ff the ma?a: of ms
message ?5 not the intended recipient, you are harehy Wed that pursuanzto a person who
knowingly and wififuiiy makes puh?c or diacioses any Con?den?ai information contained in the Gemini
abuse he:th or in the records of any child ahase, abandonment, 0r negiect case, except as pmvidad
in this chapter is gu?iy cfa misdemeanor of the second degree, punis habie as provided in 5. ??5.082
er 3. 7751083. If you have received this cemmunfcation In error, piease immediater natify us by
telephone. Thank yea.

 

 

 

 

 
   

child Kano-tootim; Ragga
?ssdiso! 

Lsitowgornisr Chiid ?foam

Final case Summon; Room:

 

 

noose Room: 3: amassed: 1383?s Child's County: Eda
mass oi 07/232013 Refs-wad by: DCFl?Oiner Amanda mars-nose

 

Rsfoned Cniid Nam: DQB:

    

Linked Abuse ?ssion Nomi-ism 

 

 



so? Reform:
Gilli Amanda Marchess requssisd CPT services to address siiegsiions of ins death of

     

"ins aiiegsiions in the report sisied: "Over the weekend dine/13, ins asses" sway duriro the night one? had been oiaced
into Eulooin?i A bed not was used to restrict the - movement even further. The I: was in too much restraint for
longer than necessary. The staff approving the rssii?aini Iy oommonicaisd via text messaging. ins sni? supervisor did not
sotoaiiy speak wiin ins oiinl?oian to got details. Using tnsi moon resiraini may have made the   u?d?iiying 
issues oven worse. The  had msdiosi issues for sevslsi days odor to  ?lad been throwmg up colored liquids for
days. There were data sheets and documentation missing the morning of the passmg."

 

 

    
  

Assessmenm Provided Date Completed Data Report Sent
Medical Consu iiation 09.129201 3 09/25/2013

Fina; Assessment of Risk:

Basso on information provided to tho Child Protsoiion Team, the risk Factors have been identi?ed;
DCF prior reports include the following:
*No indicators i Not substantiated for Physical injury and inadequate Supervision Environmental Hazards (2307}; Physical
injury (2006}
2070 CPT mood; indicated the medical assossmeni did not suppori the allegation of abuse and recommended the continuation of

for I . .
2006 CPT report indicated the physical abuse examination 0 did not support the allegaiion of abuse andior neglect and
re mmonded support oounseiin for the arents and respite care o:  

was diagnosed with  .. .   and was .-
i a higher risk for abuse.

  

   
 

        

above average mental health needs

   
    

Conclusions and Recommendations:

MFRESSIONS
Autopsy ?ndings of 9/16/13 Natural Death:
Gasimesophageal in?ammation
Pulmonary congestion and edema
Cerebral edema
Numerous cutaneous abrasiOns and bruises

Page i of 3

 

 

 

 

?eet i?see groomer}; erort

 

 

 

 

 

 

obi-es Retro?t: sororities: Wises a cross courier: jets 
Bets  Referrai: 0W22128?i3 Referred by: pCF/{ithor ?mm soonest: Amends marchese 

Referred ?nite? Name: {:33 

     

Lin tree Abuse Report 

 

 

Biisterei ear infections with fungal and becteriei pathogens
Cause of Death: dehydratim one to gastrointestinai infection

. Heaan impairment one to chronic ear infections

. Aiiergic Rhinitis 

. Seizure disorder

. History of Soft-in?ated behaviors [318}

. Wronng death due to meotcet neoiect is creosote. There is no evidence that the medical and nursing staff acted in
accordance with the stands do of preciice of the state of i-?iorids in rendering this child sets sore.

.E-X 

m! 0'1



t. Amends Marchese, Chiici Protective investigator with the Separation: of Citiioren and was informed of the initiei
impressions.

2. the records submitted for review so not inciooe the notes From the week tossing up to the oiient?s death. Ewing the time of
nursing emit snooio have documented their Vise of  st 15 minute intent-sis. These assessments shooid
have documentation of  menmi statusyi?tsi signs. and ?uid intake and output. Since . had been so for so msny
o'eys. ?uid beierice shouio have been of paramount concern. The cause of death was dehydration and the assessment or 
urinary ootpot end the qoaiit'y of urine shoots have been annotated. Aiso, skin siestioity and tor-got shouio? have been annotated
so another check hydration status. The character or

- eces shooto? have been described to inciude frequency, coicr. and estimated soiome. so

estimation of the amount of vomitus sh0oio' have been dooumented. These are fundamental

standards of nursing practices. The evaiiabie records do not re?ect whether these assessments were indeed Any
  mental status wouid have been a Warning of impending ?uid depietion and its attendant potentiai for
catastrophe. The faoii.? on of these assessments and the ?ndings as documented. Further. if there

?iuid stability or change in siertnoss or mental status, an observer shouio? be state to read the report
documenting the appropriate nursing interventions had been instituted. in the absence of such documentation, the assumption is
the work had not been done. This wouio be a very prooiematio situation for the administration to defend.

3. The decision to restrain a person must be made with extremes; cerefui deliberation and in accordance with the tows of the state
of iorida. When the staff eiects to do so, it must be with 3 Written doctor?s order, for a proscribed time period .and with the
of continuous nursing observation. There are no records forwarded that Show these were foiiowed- A
physician must see the restrained patient within 24 hours of ordering the restraints. The doctors notes and orders were not

forweroed for review.

4. Vomiting over the com
trauma to the patient, 
blood chemisiries, and perhaps cuituring shoutd have been done. in the absence of documentation regarding the
examination by the "physician, one does not have a differential diagnosis or ?ndings to expisio the cause of the
emesis and uitimete cause 0 .. demise.

S. The   temperature upon arrivai at the emergency room was 103.5. This is quite high especiain as a postmortem
temperature reading. This shooid be expioreci. One cause of the temperature eievation couid be aspira?oon pneumonia. The
autopsy documents poimonery congestion which might re?ect aspiration.

s. Th so chronic infection of ears with resistant Stapniocoocei organisms. This shouid have been treated and given
had such extensive otoiaryngoiogicai disease. - shooid have been iotioweo by on Otoieryngoiogist

had a very iow serum brood giuoose noted in the FHW ED note. This is not expiainsbie.
The giocom was tow during autopsy too. The implications of this are not evident, but an endocrinologist may offer
ight as to the possibie cause. Again, the  medics! rscords do not document prior laboratory resuits that provide evidence

whether this was a pattern when

  

 

      

 

 
   

  
   

of a five day time period is omens}. Despite the inconvenience to the staff and aiieged concern of
houid have been taken to the hospitei at an senior point to be evsiuateo. A: a minimum. urinetysis,

hysical

protonged

  

  
 

  

 

      

    

  
 

 

Page 2 of 3

 

 

 

M: 1:38: Regm? 
$333 92" Ra?fewai: O?r.2232013


Rea?ai?m? misc: Mama:

L??ke? A?mme Ragnar}: Mumbara 

Refe?ed by: 

 

?rm: {235$ gamma: Ewart:

CW?Q?r??ee:

$38155.

maws Ct)

Ama?da marchese

?35.33:

 

 

 

 

(Ease Cecrdmamr: 209% 959m?!

 

33% R?pg? Seat: ?093235201 3

81::

Pregare? 5y:

gamma; 

Re?ewad By:

Pursuan: ?33 Chg: pier 332338;; AH mixer-d3 and re
the pmvisians of 53. 133.9?1{
mam, and the ?ega?me?t sf (that!

con?dentiai anal exemgt $me
mquasi the state a?cmay,
gsfef?

heaiih plan payos's, :im?ted 25 we? ink:

iaw 9532?s:

ssionafrs, in ?z?hemnce of tree

Bate:

GQIZWZUH

{Ems Appmved:

33mm 92* 

we
aim-em or 
ma?e? asst: f0? insara?

Page 3

a chiic?.? pra?fec??ea ?Exam: ?he i3

and 3328?; am: shat? mi in ??ackzsaa?, exam}: upon

ran and 
mama med 3% the an;
as reimbumame?i 331:?

01?3

epar?me? a? Hea?ah am

am?iies, and necessary
a? by Marie? a? the mark 5? in
3:03:95.

 

 

 

Friday Dav Shift
One On One: Nicole Rivera Douglas

Other Staff: Christina Scruggs, Venesha Aiken

Fridayr Evening Shift
One on One: Nicoie Rivera Douglas

Other Staff: Tonya Lee, Laquanda Aiston

Friday Night Shift
One on One: Loy Reed

Other Staff: Tafoyia Hill, Samantha Benjamin

 

 

 

 

KAE- Karolin Edwards (813)391?3832
KDH-Keyatta HEN (407)668-2850

KP- Kristi Pettway (772)985-0840
CAM- Chenell Mathew (352)551-1752
Veronica Hodges (352)450~5247
LA-Laquanda Aiston (407)924-3564
NS- Natasha Scott (352)246-7563

Venesha Aiken (407) 7041-4751
Reid (407)310-9476

DS Devi Saywack (407)438?8834

jD? Jaime Drake (407)218-9517
VRB-Vanessa Bellamy 

Nicoie Riviera?Douglas (407)704-3536

 

Supplemental Narratives
Supplemental Narratives Incident 13009045 8

 

 

NAIUKATBVE:
2
Name JOHNSONE4D

l)ate: 16:00:04 07/22/13
INVESTIGATIVE SUPPLEMENT
DETECTIVE KARL JOHNSON 1412
case NUMBER: 130090458

OFFENSE:
Death investigation

EVIDENCE:
PR 229451; 07/11/13 audio interviews:

 

CRIME SCENE:
None

 

ATTACHMENTS:
None

CANVASS AREA:


NARRATIVE:

On July llth__2013 at 4:30pm I responded to the Carlton Palms Educational
Facility in .to assist Detective Watkins (209} in a death
invastigation. At Detective Watkins? request I interviewed three patients at the
facil' at were housed with the deceased; 
ands' -mp. Mr. Dugo was cooperative in faCilitating the interViews
and allowed us to interview the patients privately.

  
 

 

DCF CPI Marchese and I interviewed each patient individually in their bedrooms
with no other persons present. with each patient we made small talk and built
rapport Each patient interviewed displayed clear signs of being-
to thei ,the interviews were kept short. The patients

   

   

had trouble with communication and comprehension during the interviews but they
were coOperative and appeared open to questioning. No patients indicated that
they had suffered any abuse or neglect during their stay at the facility.

 

\Spil I 07130:?! 3

 

 

 

Supplemental Narratives Incident 130090458 Page 2 of 2

 

 

only been there a short time. All three patients indicated they had gone to
sleep that evening in their assigned bedrooms. They were awakened in the morning
by the ambulance and they were later told the decedent had paSSed away. Only one
indicated that they saw the decedent the morning of
stated 'walked out of oedroom and saw "Lori" dorng
The three patient interviews were recorded and I placed them into

evidence reference property receipt 229451.

 

patient,

  
 

   

After interviewing the three patients DCF CPI Marchese left to return to the
main facility office and I spoke with C31 Wolford (2016}. She had completed
documenting the scene and collecting evidence from within the decedent's bedroom
as Detective Watkins had requested. CSI Wolford and I returned to the main
facility office and met with Detective Watkins.

On July 12th, 2013 I obtained the run sheets from EMS and a CD containing
photographs from the Fifth District Medical Examiner's Office. I provided this
material to Detective Watkins.

On July 11th, 2013 and July 16th, 2013 I was present for several interviews with
Detective Watkins; please refer to Detective Watkins report.

Nothing further.

 

1 0730/13

 

 

 

Report Face Sheet

 

 

 

 

 

 

 

 

 

 

ORIGINAL FORWARD TO: CIB SIB [j INTEL 
SUPPLEMENT . COPY T0:
ORIGINAL UPDATED  DEPUTY II) It 1412
(needs to be reprinted)
CASE 130090458 REPORT WRITER:
N0 ATTACHMENTS [it] WORKFLOW SENT TO: INDIV
C13 CLRK
Af?davits
Baker Form ACT (Active)
Booking Sheets CBA (Cleared by Attest)
Consent IO Search CBJ (Cieaxed by Arrest Juvenile}
Domestic Violence Worksheet ECM {Misdemeanor Instructions 3A0)
Intake Checklist ECS {Prosecution Declined by SAD)
Intake Witness List SA {Filed with 3A0)
Intent to Prosecute INA (Inactive)
Property Receipt NI (No Intent)
Stolen Vehicle Identi?cation Form NPC (No Probable Cause)
Vehicle Sheet TOT {Turned over to other Agency)
Victim?s Rights Pamphlet UNF {No Criminai Violation Exists)

Other: (Added/Changed)

 

 

 

 

 

Approved I ID.  

 

 

 

 

 

  mm comm   ens osmce

Case Report for Incident 130090458

    

Nature: AOA

Location: [:11

 

 

Offense Codes: 0000

Received By: HINDS-GRACBY Agency: LCSO
Responding Of?cers: ROBBINS 1203, STONE 874, MCKANE 840, ABBOTT 1890, WOLF 0RD 2016
Responsible Of?cer: ABBOTT 1890 Disposition: ACT 0711 1/13

When Reported: 15:54:04 071111113 Occurred Between: 15:53:37 071111.13 and 15:53:53? 07/11113

 

Assigned To: Detail: Date Assigned: 
Status: Status Date: Due Date: 

 

Complainant: 92035

Last: MARCHESE First: AMANDA Mid: CHRISTINE
DOB: Dr Lie: Address: 1300 DUNCAN DR
Race: Sex: Phone: (352)742-6330 City: TAVARES, FL 32778
Offense Codes
Reported: 9068 ASSIST OTHER AGENCY Observed:
Additional Offense: 0000 INFORMATIONIN ON
CRIMINAL
Circumstances
ReSponding Of?cers: Unit 
ROBBINS 1203 1203
STONE 874 874
MCKANE 840 840
1890 1890
WOLFORD 2016 2016
Responsible Officer: ABBOTT 1890 Agency: LCSO
Received By: Last Radio Log: 20:35:55 07/11/13 
Clearance: REPORT
When Reported: 15:54:04 07/11/13 Disposition: ACT bate: 07/11113
Judicial Status: Occurred between: 15:53:37 07/11/13
Misc Entry: and: 15:53:37 07111113

07112113

 

 

 

Case Report for Incident 130090458 Page 2 of 5

 

 

    

Modus Operandi: Description Method 
Involvements

Date Type Description

07/11/13 Name SHEA, THOMAS Other One

U13 Name MARCHESE, AMANDA CHRISTINE DCF Complainant

07!] 1/13 Name MARCHESE, AMANDA CHRISTINE DCF Complainant

07H {/13 Name ROBERT Other Two

0721 1f13 Name Other Three

07/1 1 3 Name Other our Juvenile
07/11f13 Cad Cali 15:54:04 ()Wl N13 AOA Initiating Call

 

 



 

 

 

Case Report for Incident 130090458 Page 3 of 5

 

Narrative
Offense/Class: Police Information

Reporting Officer: D/s Robbins (91203}
Evidence: Turned over to CIB
Crime Scene: Turned over to C18

Attachments: Two Sworn Affidavits, DCF Intake Report -

 

Canvass Area: N/a

Narrative:

On 07/11/2013, at approximately 1553 hours, we received call from the
Complainant, Amanda Marchese, that she was responding to the above location in
reference to a investigation.

Upon arrival, contact was made with Investigator Marchese who handed me an
intake report? In this report it alleges that over the weekend
Of 07/06/2013 a passed away during the night after had been placed in
a 6-point restraint. A bed net was used to restrict then movements even
further. Staff approved the restraints and communicated only through text
messages. The Supervisor did not actually speak with the approving clinic to get
details. Using that ch restraints may have made the 'underlin ng issues
even The had medical issues for several days prior to.
'had been throwing up colored liquids for days. There were data sheets and
documentation missing the morning of the passing.

  
      

     

 

 

At this point, upon reading the allegations, Stone {9874) was then notified
and made aware of the situation. I also attempted to pull up information to
find out if law enforcement had responded on Friday, 07/05/2013, or Saturday,
07/06/2013, in reference to this incident. I was unable to find any information
of where we had responded out. Stone notified C13 and was advised they were
able to determine that EMS was notified and responded out to this location on
Saturday, 07/06/2013.

Other One, Thomas Shea, orovided a sworn affidavit stating he was notified of
Other Four, - being in distress on Saturday, 07/06/2013.
According to Mr. Shea, 911 was immediately called and EMS responded. Mr. Shea
stated that at the time :was not breathing and CPR was administered by EMS.
Mr. Shea also stated that his on~call doctor for the facility, Other Two,
Robert was also notified_and reSponded. Mr. Shea stated that f' was
then transported to -where was later pronounced
deceased. Mr. Shea went on to state that he immediately notified the-
Mr. Shea also stated that Paige had arrived at this facility
approximately less than one week a 0 Mr. Shea stated that is an
with _Im_ Mr. Shea also stated that
was sick when he arrive was seen by Dr. Mr. Shea provided a

sworn affidavit.

  
 

 

   

 
 
    

   
 
 

     

   
 

I then briefly spoke with Dr. who also provided a sworn affidavit. Dr-
stated that on Saturday, 07/06/2013, early morning hours, he received a
call from the on-staff indicating that was in distress. Dr. stated
he reaponded to the facility and was met with EMS and the Fire Rescue
paramedics- Dr. stated CPR wa administered. Dr. stated that
was then transported to with him following. Dr. 

  
  
   

 

 

 

Case Report for incident 130090458 Page 4 0f 5

  
  

DI.

   

 

also confirmed that

pronounced deceased at'
also verified that -

was and suffered from;

 

Clay Watkins {1209) from CIB then arrived on scene and took over the
investigation.

Nothing further at this time.

071I2I13

 

 

 

 

Case Report for Incident 130090458

Page 5 of 5

  

 

Name Involvements:

 

   
   

 

 

Other One: 84258
Last: SHEA First: THOMAS
DOB: 0322/49 Dr Lie: 8000835491820
Race: Sex: Phone: (352)735?0588
145290
First:
Dr Lie:
Phone: 

Other Three
Last

DO 

Race

Complainant 92035

Last: MARCHESE First: AMANDA
DOB: DrLic:
Race: Sex: Phone: (352)742-6330
Other Two 145288
Last: First: ROBERT
DOB: 03f22/55 Dr Lie:
Race: Sex: Phone: 

 

Mid: 
Address:
City:

Mid-
Address:

Cit

Mid:
Address:

City:

Mid:
Address:
City:

CHRISTINE
1300 DUNCAN DR
TAVARES, FL 32778

Mid:
Address:
CARLTON PALMS

City: MOUNT DORA, FL 327?57

28308 CHURCHILL SMITH LN
MOUNT DORA, FL 32757

28308 CHURCHILL SMITH 

   
    
   
  
     

07ll2fl3

 

 

 

 

 

 

Report Face Sheet

 

 

ORIGINAL FORWARD TO: (3113:] 
SUPPLEMENT l:l COPY TO:
ORIGINAL UPDATED EMPLOYEE ID 1203

 

(Needs to be reprinted)

 

 

 

CASE REPORT WRITER:
NO ATTACHMENTS WORK FLOW SENT TO: INDIV .
CIB CLRK
CIB SUP

RP SUP 
SRD SUP
ATTACHMENTS CLEARANCE CODES
Af?davits
Baker Acthransport Form ACT (Active)

CBA (Cleared by Arrest)

CBJ (Cleared by Arrest-Juvenile)

ECM (Misdemeanor Instructions SAD)

EC (Prosecution Declined by SAO)

FSA (Filed with 

INA (Inactive)

N1 (N0 intent)

NPC (No Probable Cause)

TOT (Turned over to other Agency)

UNF (Unfoondcd-wNo Criminal Violation Exists)

Booking Sheets

Consent to Search

Domestic Violence Worksheet
Intake Checklist

Intake Witness List

Intent to Prosecute

Property Receipt

Stolen Vehicle LD. Form
Vehicle Impound Sheet
Victim's Rights Pamphlet





Other: (Added/Changed)
DCF INTAKE REPORT
EMERGENCY INFORMATION

 
  

 

 

Approved by:  

 

 

 

  



 

Thomas P. Shea, BCBA
State Program Director
emaii: sheat@advoserv.com

 

 

 

 

Flarida Department of
- Children and Families

Amanda 
Child Protective Investigator
Family Safety

1300 Duncan Drive
Ta VHFES, Fl, 32?78

Call: 352378-7331
us

Fax: 352-253-4419

 

 

 

 

 

 

 

         
 

     

 

      
  

A person who knowingly or willfuin makes public or discloses to any unauthorized person anyr confidential
information contained in the central abuse hotline is subject to the penalty provisions of s. 

ego  

 

 

   
 

 

Intake Name

  

 

Gaunty Secondary County
Unknown, Unknown Lake Lake
Date and Time Intake Received investigative Sub?Type Provider Name
07/11/2013 2:09 PM institutional CARLTON PALMS

 

 
  



 

Background Checks Required
Yes No

 

Reason
Other

Cali Record Number

 

3 Hits Reviewed

Yes NIA

 

 

 

Worker Saety Concerns
Yes No

 

Prior Involvement

Yes

Send Florida Administrative Message to Law Enforcement El Yes

 

El No Yes



Law Enforcement Notified

ENC:

    

 

 

Response Time
immediate

 

Name Worker
Eaton, Diane 

 

Name Supervisor
BARRETT. KIMBERLY 

  

 

I. Family information
Name Family
?Unknown, Unknown

Telephone Number? Home

   

 

 

Unit Designator

 

   

State
Ft.

 

  

 

 

 

 


Directions to House

Carlton Palms address: 28308 CHURCHILL SMITH LN,
A. Participants

 

Interpreter Needed: Yes No

MOUNT DORA, FL, 32757-9301 (DOR Lake)

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

?ame iD Number Role
Unknown, Unknown 
Est As I Ethnicity Race
Unable to Determine
?earing impaired: Yes No 24 Access Yes No
Device Needed:
game it] Number Role Gender
Unknown, Unknown AP Unknown
Est. Age Ethnicity Race Disabilitii
40 Unable to Determine Yes No

 

 

Hearing impaired: Yes No

 

24 Access El Yes No

 

 

Device Needed:

 

 

 

 

AP 2 Alleged Perpetrator
CH Child in Home
HM Household Member

PC Parent/Caregiver
intake Name
80 Significant Other

IC 3 identified Child

J8 Alleged Juveniie Sexual Offender

RN Referral Name i SC Referral Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NM Non?Household Member Victim
B. Address and Phone information
Name Type Address Telephone Number
Unknown, Unknown Primary .
Residence ?5
Unknown, Unknown Primary 
- Residence
Relationships
Subject Relationship I 
LUnknown, Unknown I Facility Staff Unknown: 

 

 

 

 

 

 

   

person who knowingly or willfully makes public or discloses to any unauthorized person any confidential
information contained in the central abuse hotline is subject to the penalty prowsrons of s. 

 

D. Alleged Maltreatment

 

 

 

Alleged Victim Maltreatment Code
Unknown, Unknown Bizarre Punishment
Unknown, Unknown Death

 

 

 

 

E. Location of incident

 

 

 

 

 

 

 

 

 

 

 

 

Address Street Apt. City State Zip Code
Telephone Number Home Telephone Number - Work Telephone Number Cell
ll. Narratives

 

A. Allegation Narrative .
Over the weekend of 7/6/13, the passed a ay during the night after  had 11 placed into 6-p01nt .
restraint. A bed not was used to restrict the   g. movement even ?thher'. The '5 as in too much restraint
for longer than necessary. The staff approving the restraint only communicated Via text messaging. The shift
supervisor did not actually speak with the approving clinician to get details. Using that much restraint may hav

 '5 had medical issues for several days prior to
up colored liquids for days. here were data sheets and documentation
passmg.

 

 

   
  

   

  

 

 

sing the oming of the 

 

 

3. Provider Detail:

 

B. Narrative for Worker Safety Concerns

 

Ill. Agency Response

 

 

A. Recommendation

 

 

 

 

System Screening Recommendation Counselor Screening Recommendation Counselor Screening Reason
Pending
Counselor Name Counselor Screening Date/Time

 

Reason for Override:

 

System Response Priority Counselor Response Priority DateITirne Decision Made
Recommendation Recommendation

 

 

 

 

Reason for Override:

 

 

 

B. Decision
Decision Dateffime Decision Made Reason
Screen "1 07/11/2013 2:47 PM Screen in - Accepted for
Services/investigation

 

 

 

 

 

 

 

A person who knowingiy or willfuliy mkes public or discloses to any unauth ized person any confidentiai
information contained in the centrai abuse hotiine is subject to the penalty provisions of s. 

 

Expiain:

 

 

 

IV. Cl Unit Documentation
First Cat! Attempted DatefTime
07H 1/2013 2:48 PM

 

Compieted Caii Datefiime
07/11/2013 2:52 PM

 

 

 

Call Log
Called Out By Calied To
Baton, Diane Benn, Elois 

 

 

 

 

 

 

5,
AFFIDAVIT W, _l   
(I  f? 1 zoom:

 

Agency Number Agency Name

no I 3 5_l_0 I I 0 8.0.

ori/gglm?enepyd/ /13 case Rama? fig?93: 
Relation to Offender:

 

 

Contact Information 
Address:

Mailing Address: L, b7     

Some Phone: 3 'g/va 3;

Persona: information - - -
Race: Sex: Height: Weight:
Build: Complexion: Color: Hair Color:

ScarslMarksNattoos:

Clothing/Description:

SSN:

License: State: EXP: CLASS:

- City: StateICountry: Citizen:

 

Comments:

Employer Information 



 
  
   

Employer:

I Address:
Work Phone:
NARRATIVE

o?ztomuv) SAW  - on {Over My a; vissz UM Mom/3 ,6.qu WW
owe? (Loom maxim TL wg?m gym, ,wx or;ng
11w T1qu MK {Lecyt?i?if per Lat-s? 4 le-?Zfi? Mom mama
711M mm o1 (if-9.092 Team" to: cram we gee Pro/m, 
$0956 WU ?rm/lit \Jgokath Lump. (Eu  Jun-?n} xii-T AIL-W,
on? _-??tH9?gr ?7 ega? awai?rmw men r0536?! 
. - anew wit-MQJ
.. cv- Melon/234? 2: ow? dun/n 
Wm? 31:7: Mr}me [wt nlrrENJTTo PnoSEoor
fwd? 12?me Mdu: to?" soar-4:, isglam' 91w 1  YES  noEi MIA
oil? I 0P   
?Vim (Lem   MA  Signature ma ing statement

 to Max (Maid? @335:  m.
gt 5 pom/L 6, 5/619

Enforcement Officer or Notary

Related Flopon Numbeds)

Report ConWa, (37/ 
a 3 5d.)   
near 9 owing (If App cable} ID. Number Routed To Referred To Assign?! To 5! Date
9
2
3 Case Status Clearance Type A-Adult Dale Cleared Arrest NUmbBr Numb? ?my? 
t, Anust 3. Unloundcd .J-duvenlio I :1
2. Exceptional i I I I
Exception Type 2. Arrest on Prtmary 3. Death of D?end? 5, Prosecution Declinad 0313 Number 999 9
1. Extradition Offense Secondary O?ense 4. on Relused to 6. Juvenile! No Custody 
Docllnecl Without Prosecution Cooperate o, I


 

 

 

 

Lcs?q 

 

 

w? Agency URI Number

 

Agency

FLO 315LOIOIG

VICTEMIWITNESSISUSPECT

Name

Arrlomrn

AAKE COUNTY 8.0.

  

1, Offense Juvenile 1.0riglnai
2. Arrest 2. Supplomont ..

    

       

'??anc -

   

 

 



?133ml 2

 

Case Reference




I/damr/lc/W

 

Ho 
A 
Relation to Offender

Contact Information --
Address:
Mailing Address:


(Home Phone:


Personal Information 

14/

Race: Sex:
Build:
Soarsf??arks?at?toos:
Clothingmesciptio
SSN:
License;
Birthpiace - City:
Comments:

 

Empioyer:
Address:
Work Phone:

GARL-

   

 

 

NARRATWE



  



 
   

.5 HA2 #4

.gl?u 1?

?03: 

 
 
  

 

fCr?tphonEE) 

Height: ?3

Complexion:

Empioyer information 

State: 1/32.. 
StateICountry:
Tb/ A ms

  

NARRATIVE

Jr'le

- Weight:
Color: 33L ?4 Hair Color:

23.0, gyro??

 

Mr

      



CLASS:
Citizen:

  

  
 

 

49f?? TMLV f;

Tree-onus

44}. :rmv 
43 TARTRD


 

Qho?

71in

A Rm'ws?n
xiv .112:

 
5 TM 

mop {4/5 x571 rm 

A f?

S'c?m'a.

 
 

   
  

?nssr?v
In/fE/a t/ bifw 
a E.

 

 

 

 

 

 

 

 

 

 

 
 is A .024} a 5 N75 
0 av .859 9g 
f? (5 7 M, ?my? [7'53 FNTENT TQ 

we avail)

 

mom

 

WA M454: .0 ac 

FR 6- WE

YES 

 

if. 

 

7?63 .9 

 

How  

    

  

of rson making statement
gm? We 9

 

Var/2.5m; om?wr
{pr/Mr ?7 pm

 

S?l/JD/frj/ Tar, 7

page

Swoyl/ subs 6
this 9f Mmmim 20


 

?of? wig/4mg? 5,2944?) ?rm-W395

Law Enforcement Officer or Notry

I

 

 

 

 

ADMINISTRATWE

 

Report Contains . .,
falsif/ w: It

romeo/urn

(3?0

Related Report Nomber{s}

 

 

as) Reporlln? A)
0 or bro Ill

nomad To

Number

Timer-red To 7

Unit

By 

Assig neo To

 

 

Case Status Clearance Type
1. Arrest

2. Exceptlonal

 

 

3. Unfounded

 

A-Eu?w
vonilo

Pane Cleared

1 i

 

Arrest Nnmber Number Arrested

 

ExcepllonType
1. Extradl?tion
Oaclfosd

2. Arresl on Prlma
Gnome Secondary Offense
WithouI Prosecution

 

3. Death or O?ender
4. WWHeI?useoto
Cooperate

Prosecution Dociinad
G. JuvenHerrio Custody 

OBTS Number

 

 

Fags Pa
m1

 

Load-1

 

 

Friday Day Shift
One to One: Nicoie Rivera Douglas

Other Staff: Christina Scruggs, Venesha Aiken

Friday Evening Shift
One to One: Nicole Rivera Dougias

Other staff: Tonya Lee, Laquanda Aiston

Friday to Saturday night shift
One to One: Loy Reid

Other Staff: Tafoyia Samantha Benjamin

{m 

 

 

 

 

 

NRME 

 

DOB:
DOA: 6/26/13

ALLERGIES: NKDA 

 
 

COVERAGE

    
  
 

MEDICAL



MEDICAL HI STORY

FAMILY HISTORY:

MEDICATIONS: ABILIFY 15m PO at 1600
RISPERDAL PO DAILY,
FLOUKETINE 20MG PO AM
CLARITIN 10% PO DAILY
NASONEX 1 SPRAY EACH NOSTRIL HS

PRESEDATION: Used papose in the past

DIET: REGULAR
TD:

UPDATED: 6/28/13
71-Msz was

)4 
QUSRNQ
Mbm?i?onm

 

 -  Dai?krikne; 

 x: .h?rabsif??k?n?wied?i  . .  .  
 all: await-?at} have .  I 

 -    .     
 maimed .. -    .

-- 1 Tim 'e?'latggyeglisted; ?39;de a gym? 

I I- aft'l'j



 

JiStdi'e? 'Pr?r?elr-isi;   E.
it. Evi?ance 

  



-

 

   

 

 

        
 
  
    

 

 

 

          

 
 

 

. 1 a
.I 

Qih.eri?epi? Case Np: 

   

 

 

 

  [Gi?ei      

 

  

 

   Adam's?s,  

 

 

 

    

 

  

 

 

 

 

 . 

 

 

 



 

 

 

 

 

 

 



 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 - -- 
.5115 . 

 

 

 

 

 

 

 

 

 

 

 

 

 

 -

    
 

 

  



   

 

?rm-rum{Ea

  
  
  

 

 

  

 

   

 

- ..

 

Received By 

"rm We..me  weer- ?450 {emcee- - 

State Statute.-

      

 

   

  
 7 I  . Thlir?jareslziorida? -

   
    
   
  
   
     
     
 

. . of  .
)Stoien Ptopem' )Triarevidenee weeds 'i 
Property )Lab'?Evide?oe -, r' . .  
Damime [moved-ed "Ewes i?-E-eO-Caeii?r?be
"Orher'DepthCese No.- - - Other 
Address where property impounded 

 ?Qm?g  fogs/we; I  - I ii Ewe-E. 51* 
Ownerof Properiy? Address - - PhoneNo._ I 
. Lt;)Vio?rim )Defenda'ni - Address Phone 

 

 

i .iUi?eMeeney(Give me ieceii'o'n was iooated) -

 

 

 

Compiainani?r' Address

 Pbone?Nri  

 

 

 

 

Prowssin?' I.-

were" --  

Currency I I .Bir? 
-Total . No. .

Item

No Quantity Description (itemize currency by denorrlineiion)

 

 

 

 




?ud?n' I 

   

 

 

 

 

 

 

 

 

 

 

 

 



 

 

 

 

 

 

 

 

I hereby acknowledge 
property impounded by me in' the oi?oi'a'i periormesoe?oii
duty as a. Deputy SheriffILew Enforcemon-  -  

I hereby acknowledge that ihe above list represents I
all preperty taken from my possession and that have
received a copy of the receipt. -

    

      
  

 
 

Print Name - I Led-nvestigetormn? 

 

 

 

. impounding Of?cer
ems. seiosmoe seo?oos -
. . Regs?"  .

 

 

 

Sign Name I

 

'Dateffime Rooeived

     

WU  
. I . . -. 'oFsIo's 70F 
T0: Lake County-Sheriff's Of?ce -  

Property and Evidence Section

Date -
The above listed evidence may be disposed of or returried'to rightim owner as appropriate; is swordsnoe with Fiorids'-  

 

Signed . 'Print Narnia-"1 I I Date   

 

 

White Copy Technical Services 

Yenow Pink Copy? Receipt Mamie Copy. I 

- osemeesos?rss?oo seveesesies

    

 

 

same oeesc? 

i Tave'res, Fierida-
PROPERTY RECEIPT

Page of  

)SioieriProperty (I )TiaiE?ide?Ce )Homicide - )?Safekeeoing I -  
 )Found Property -- (Kauai-demo )chey;.22?oe?ll

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  
 
     

    
 

       
 

 

 

 

 

 

 

 

 

 

Datem?me Impounded ?gjg?.?g I L.C.S.O. Case Number fm??  I 
cher Dept- case No 3' 'OiherDept. NamefAddres's'_ .- - Other DeptPho'n'eNo.
19/9? .. .  - 
Addressw ro of im oundod Give eXaoHooation where property waS'iooeted) Type of?ese I
gig? I  ferv??ef?e??
-- 3-     - ne'NOg.? I . 
5?53Wag/Q? 
Address - Phone No; 
Qcaniity' . Description.(itemizecurrency bodenomioatioh) - I  I. P35352219
 .w?ga?   Wa?ggrw I I I  I
Eerma 'i/f?ueo  we I
So 132;!" Zir'?c?? EM: 2 5.7 
we magi; my km; new  .  
I-hereby acknov?edge. that the above list represents Ii hereby acknowledge that the aboveilist repreoentea?i. I I
 - ail property taken" from my possession .andthat l- have property impounded mom in the official'lperforman'ce of 
.31; received a copy of the receipt. I .. I - duty as a Depd?ySheri?/Law Enforcement     
- - -- - *??/wseer
 Name Leadlnvestigato'n?Unit' I  (.Intand sign) I 
  
5 ion Name . Impounding Officer - . . 
MeevuoE-Nce . . -  
Receive-d BY - Reason - "m Deterrime_eeceiv_ed-_ - - 1

 

 W'Le??m .gz,woe ?fe/30 
 . I. . OFFICE OF 
TO: Lake. County Sheriff?s-Office I 

Property and Evidence Section . - - - .  
The above listed evidence maybe disposed of or returned to rightful owner as appropriaie; in accordance wi-thiorida- 
State Statute. - . . . 

Signed

Date 

Print Naroe I Date 
. White Copy *Technical Service's Yellow Copy Centrai Records I Pink Copy ?Receipt Manila Copy State Attorney

- 7 (SHAW oe oeemoyoe ne'vEesE 
. - -.

   

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