202?225?3396

01:52:04 pm. 02?17-2016 212
THE ATTENDING PHYSICIAN
Concus- or'nra Urn-lea Sum
"-100. Ill. CAPITOL
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pearls-on DP Il?l?l AND PATHOLOBY
February 16, 2016
Judge Cinderella Guevara
300 N. Highland Avenue
Marfa, TX 79843
RE: Associate Justice Antonin Scalia DOB: 3/ 1/1936
Dear Judge Guevara:

This letter is in follow-up to our telephone conversation of Saturday evening February 13" at
19:56 EST. Just prior to that time, I was notified by the US Supreme Court Chief of Police that Associate
Justice Antonin Scalia was found dead at a ranch in Texas and that you were conducting an inquiry as to
the circumstances of his death in your of?cial capacity as the presiding Judge. You asked me to
characterize his health and I related a summary of his medical conditions for which he was receiving care
through my of?ce. My of?ce has supported the Justice's care for the past 29 years.

You asked when he most recently visited with me, and I stated this was January 2016 for
discussion of his right shoulder weakness. He related an injury to his right shoulder after playing tennis
in November 2015 and completed independent evaluation by OrthopediclSports Medicine and Primary
Care physicians. Justice Scalia stated he underwent a range of therapies including topical creams, steroid
injections and physical therapy home exercises and modalities for a diagnosis of frozen shoulder.

Following his stated lack of improvement at his visit with me on January 2016, i ordered an
scan of the right shoulder and consultation with an Orthopedic surgeon. The MRI was conducted on
February 91h 2016, revealing very severe arthritis and multiple tendon disruptions throughout his right
shoulder at the sites of previously repaired rotator cuff mars. Orthopedic surgery consultation
immediately followed the and determined that the risks and bene?ts of a repeat rotator cuff repair,
his age, and his medical conditions did not favor an operative intervention at this time. Alternatively,
Justice Scalia elected to pursue an intensive physical therapy rehabilitation program for massive rotator
cuff tears. He received care in my of?ce for this program on February I 2016.

Justice Antonin Scalia, age 79, had many chronic medical conditions. These included severe
degenerative joint disease of the cervical spine and lumbar spine that progressed despite multiple
laminectornies and operative interventions, hypercholesterolemia, obesity, tobacco use, diabetes mellitus,
hypertension, asthmatic bronchitis and mild chronic obstructive pulmonary disease, obstructive sleep
apnea, gastroesophageal re?ux disease, and coronary artery disease. In conjunction with a network of
medical specialists he engaged over the years, these conditions were coordinated through my of?ce.

In the absence of information supporting any other cause, it is reasonable to conclude that his age
and signi?cant medical conditions led to his death.

Ve truly yours,
652/ 

Brian P. Monahan, MD, MACP