Declaration In Support of Motion To Pfizers Opposition To Plaintiffs Motion In Limine No 12 And Attached Exhibits

Motion

Cal. Super. - 2nd Dist.December 24, 2014

Electronically FILED by Superior Court of California, County of Los Angeles on 01/18/2019 11:30 AM Sherri R. Carter, Executive Officer/Clerk of Court, by M. Panganiban,Deputy Clerk ~N O Y B A W 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Heidi Hubbard (admitted pro hac vice) hhubbard@wc.com Andrew Rudge (admitted pro hac vice) arudge @wc.com Jessica Rydstrom (CA Bar No. 256600) jrydstrom @wc.com Jack Pararas (CA Bar No. 310755) jpararas @wc.com WILLIAMS & CONNOLLY LLP 725 Twelfth Street, N.W. Washington, D.C., 20005 Tel: 202.434.5000 Fax: 202.434.5029 Matthew A. Holian (CA Bar No. 211728) matthew.holian @dlapiper.com DLA PIPER LLP (US) 33 Arch Street, 26th Floor Boston, MA 02110 Tel: 617.406.6000 Fax: 617.406.6100 Attorneys for Defendant Pfizer Inc. SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF LOS ANGELES - CENTRAL DISTRICT MICHAEL SHABSIS, an individual, Plaintiff, Vv. THE REGENTS OF THE UNIVERSITY OF CALIFORNIA; RESNICK NEUROPSYCHIATRIC HOSPITAL AT UCLA; an organization, form unknown; PHILIP COGEN, M.D., an individual; COUNTY OF LOS ANGELES, a local public entity; LOS ANGELES COUNTY SHERIFF’S DEPARTMENT, a local public entity; PFIZER, INC., a Delaware Corporation; and DOES 1 through 200, inclusive, Defendants. CASE NO. BC567668 DECLARATION OF JACK PARARAS IN SUPPORT OF PFIZER INC.’S OPPOSITION TO PLAINTIFF’S MOTION IN LIMINE NO. 12 Date: February 6, 2019 Time: 8:30 a.m. Dept.: 32 Judge: Hon. Daniel S. Murphy Trial Date: February 19, 2019 Complaint Filed: December 24, 2014 DECLARATION OF JACK PARARAS IN SUPPORT OF PFIZER INC.’S OPPOSITION TO PLAINTIFF'S MOTION IN LIMINE NO. 12 ~N O Y B A W 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 I, Jack Pararas, declare: 1. I am an attorney at law, duly admitted to practice before all the courts of the State of California, and I am an associate in the law firm of Williams & Connolly LLP, attorneys of record for defendant Pfizer, Inc. (“Pfizer”) in this matter. I am familiar with the aspects of this case, including all of the matters which are set forth in this Declaration. If called upon to testify at the hearing of this motion, I could and would competently testify to these facts based on my own personal knowledge. 2. Attached as Exhibit 1 is a true and correct copy of Cedars-Sinai Medical Records from December 8-9, 2015 (DX 23). 3. Attached as Exhibit 2 is a true and correct copy of Cedars-Sinai Medical Records from December 8-10, 2009 (DX 13). 4. Attached as Exhibit 3 is a true and correct copy of Cedars-Sinai Medical Records from December 13, 2009 through January 25, 2010 (DX 14). 5. Attached as Exhibit 4 is a true and correct copy of Application for Conservatorship and Appointment of Conservator (DX 15). 6. Attached as Exhibit 5 is a true and correct copy of an excerpt of the April 13, 2018 Deposition Transcript of Dimitry Shabsis. 7. Attached as Exhibit 6 is a true and correct copy of an excerpt of the April 5, 2018 Deposition Transcript of Irene Spitkovsky. Dated: January 18, 2019 WILLIAMS & CONNOLLY LLP By A anan a do se, JACK F. PARARAS Attorneys for Defendant PFIZER INC. 3. DECLARATION OF JACK PARARAS IN SUPPORT OF PFIZER INC.’S OPPOSITION TO PLAINTIFF'S MOTION IN LIMINE NO. 12 EXHIBIT 1 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS: - MEDICAL CENTER. Adm: 12/8/2015, D/C: 12/9/2015 Psych Consult - Initial by Bolton, Michael A, MD at 12/8/2015 11:32 PM Author: Bolton, Michael A, MD Service: Psychiatry Author Type: Physician Filed: 12/8/2015 11:39 PM Note Time: 12/8/2015 11:32 PM Status: Signed Editor: Bolton, Michael A, MD (Physician) Emergency Psychiatry Consult Note Psychiatry attending: Bolton Date of Service: 12/8/2015 Reason for Consult: Suicidal and Homicidal Physician Requesting Psychiatry Consult: Foster-Goldman ID: Patient is a 30 year old male. Patient was admitted on 12/8/2015 Patient assents to interview. Sources of information: Patient, medical record, staff interview Subjective / History Chief complaint: Suicidal and Homicidal | 30 yo m with h/o bipolar and self enucleation of both t reatening mother with suicide and wanting to hurt family members. Pthas h/o nucleating both of his own eyes and has h/o impulsivity. Pt on exam refuses to answer questions but per ERMD pt was suicidal and homicidal at home and was brought here by mother... Pt has extreme anger but denies all ~~ other psychiatric symptoms, likely due to defiance. Pt reports not taking his mediciations but refuses to answer questions about details about when. [The patient denies target sx of depression, mania, psychosis, PTSD, OCD, anxiety and panic. Pt reports si and hi but has plan to "cut! for both, no specific target. Allergies: Shellfish Past Psychiatric History: The patient has h/o bipolar, multiple hospitalizations, multiple suicide attempts by cutting, denies current treaters and is vague about current meds Substance Abuse History: H/o meth abuse Family Psychiatric History: Pt denied family history of mood, anxiety, and psychotic disorders. There is no known history of suicide. Social History: Lives in apartment by himself History This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1071 Cedars-Sinai Medical Center” Page 3002 SHABSISM-17PPR-04437 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS: -» MEDICAL CENTER. Adm: 12/8/2015, D/C: 12/9/2015 ¢ ~ Psych Consult - Ini ial (continued) es Psych Consult - Initial by Bolton, Michael A, MD at 12/8/2015 11:32 PM (continued) Social History » Marital Status: Single Spouse Name: N/A Number of Children; N/A » Years of Education: N/A Occupational History » Not on file. Social History Main Topics » Smoking status: Current Every Day Smoker -- 1.00 packs/day = Smokeless tobacco: Current User +» Alcohol Use: Yes Comment: occasionally » Drug Use: Not on file - Sexual Activity: Partners: Ti Female Narrative GE Social History Narra None on file = Medical History: Past Medical Hist 0 Diagnosis ~~ : » Bipolar disorder (HCG) + Bipolar affective (HCC) Date Patient Active Problem List Diagnosis + Bipolar 1 disorder (HCC) » Drug overdose + Suicide attempt (HCC) + Lethargy . Bipolar affective disorder, current episode manic (HCO) Medications: Denies re e\ital Signs (last filed): BP 141/60 mmHg | Pulse 80 | Temp(Src) 98.1 °F (36.7 °C) | Resp 20 | SpO2 100% This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1072 Cedars-Sinai Medical Center Page 3003 SHABSISM-17PPR-04438 = SHABSIS,MIKHAL S) MRN: 020634384 et DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 12/8/2015, D/C: 12/9/2015 4 4 ~~ Psych Consult - Ini ial (continued) h Consult - Initial Bolton, Michael A, MD at 12/8/2015 11:32 PM (continued valuation rance ing in Im abnormaliti uate, abl difficulties t wi mad" ught process inear and ons t content and hi ies Value 102* NINE = 0.9 TININE = 0.9 TININE = 1.2 EA 17 NITROGEN SODIUM 139 POTASSIUM 37 ORIDE 101 N 26 DE M, 8.6 2.0 This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1073 Cedars-Sinai Medical Center Page 3004 SHABSISM-17PPR-04439 -- CEDARS-SINAI MEDICAL CENTER. 4 4 ~~ Psych Consult - Ini ial (continued) Psych Consult - Initial by Bolton, Michael A, MD at 12/8/2015 11:32 PM (continued ALT ALT ALT AST AST AST ALKALINE PHOSPHATAS E BILIRUBIN, TOTAL TOTAL PROTEIN ALBUMIN Component ETHANOL = SCREEN, URINE COCAINE METAB SCREEN, URINE INE SCREEN URINE PHENCYCLIDI NE SCREEN, URINE Urineanalysis: Cedars-Sinai Medical Center” @D Thyroid Function ~~ NEG BENZODIAZEP POS* NEG Value BILIRUBIN, UA NEG This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1074 02/12/2014 NONE DETECTED 04/21/2012 11/22/2011 02/12/2014 04/21/2012 11/22/2011 02/12/2014 02/12/2014 02/12/2014 02/12/2014 Date 03/03/2010 07/08/2010 07/08/2010 Date 11/21/2015 11/21/2015 11/21/2015 11/21/2015 11/21/2015 Date 07/08/2011 SHABSISM-17PPR-04440 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M Adm: 12/8/2015, D/C: 12/9/2015 Page 3005 CEDARS: Smal oe Ox CENTER. SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M Adm: 12/8/2015, D/C: 12/9/2015 ¢ Psych Consult - Initial (continued) BLOOD, UA NEG CLARITY, UA CLOUDY COLOR, UA YELLOW GLUCOSE, UA NEG KETONES, UA TRACE® LEUKOCYTE NEG ESTERASE, UA PH, UA 8.0" PROTEIN, UA" 1+* SPECIFIC 1.018 GRAVITY, UA SPECIFIC 1.006 GRAVITY, UA <1 Impression: 0 cut. Patient Active Problem List Diagnosis + Bipolar 1 disorder (HCC) + Drug overdose + Suicide attempt (HCC) + Lethargy TI / Medical Decision Making: Cedars-Sinai Medical Center” 07/08/2011 07/08/2011 07/08/2011 07/08/2011 07/08/2011 07/08/2011 07/08/2011 07/08/2011 07/08/2011 07/09/2010 07/09/2010 30 yo m with h/o tibia = self enucleation of both eyes presents after threatening mother with suicide and wanting to hurt family members. Pt has h/o enucleating both of his own eyes and has h/o impulsivity. Pt on exam refuses to answer questions but per ERMD pt was suicidal and homicidal at home and was brought here by mother. Pt has extreme anger but denies all other psychiatric symptoms, likely due to defiance. Pt reports not taking his. mediciations but refuses to answer questions about details about when. The patient denies target sx of depression, mania, psychosis, PTSD, OCD, anxiety and panic. Pt reports si and hi but has plan to "cut” for both, no specific target. The patient's history and presentation are consistent with si.and hi with plan - Bipolar affective disorder, current episode manic (HCC) This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1075 SHABSISM-17PPR-04441 Psych Consult - Initial by Bolton, Michael A, MD at 12/8/2015 11:32 PM (continued) Page 3006 CEDARS: - MEDICAL CENTER. SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M Adm: 12/8/2015, D/C: 12/9/2015 Psych Consult - Initial (continued) Past Medical History Diagnosis Date + Bipolar disorder (HCC) + Bipolar affective (HCC) Recommendations: Medical management per ERMD and/or primary team Psychologically, supportive therapy provided at bedside. Socially, pt may benefit from social worker Risk assessment: suicide. The ptis at t high. risk for homicide. decision to sign circumstances) a please reconsult, since last eval, or if no eval done yet. MA or other assessments, depending on of eventual discharge from this or other facility. religiosity, family and friends. Legal: Holdable for dts/dto Elopement risk: Low, pt does not want to leave hospital Disposition: waiting PET for dts/dto Communication: DW Dr. Foster-Goldman Biologically, if agitated give haldol 5mgiM/ativan 2mglM/benadryl 50mg IM thorough risk assessment was performed. The patient is at high risk for If there are safety. concerns during the course of the hospitalization or patient ave: gainst medical advice it is suggested that the primary eam be contacted to do an assessment (of patients capacity to make the solve psychiatry if needed. Capacity can change, so = necessary if pt's behavior or circumstances change Pt instructed to call 911 or go to nearest ER with any urgent concerns at time Protective factors include: Treatment seeking behavior, future orientation, The patient denies hi, has no known history of violence toward others. Psych Consult - Initial by Bolton, Michael A, MD at 12/8/2015 11:32 PM (continued) This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1076 Cedars-Sinai Medical Center” SHABSISM-17PPR-04442 Page 3007 SD) SHABSIS,MIKHAL y MRN: 020634384 Bh Salina DOB: 5/20/1985, Sex: M CEDARS'SIN Al MEDICAL CENTER. Adm: 12/8/2015, D/C: 12/9/2015 Psych Consult - Initial (continued) h Consult - Initial Bolton, Michael A, MD at 12/8/2015 11:32 PM (continued 8-6pm please contact 31 evenings, nights, weekends an to contact ency department liaison (psychiatry). igned: Michael A Bolton 12/8/2015 11:32 PM Time of note does not necessarily reflect time t was seen. Serial ams and reassessments were perfo ED course. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1077 Cedars-Sinai Medical Center Page 3008 SHABSISM-17PPR-04443 rinted on 7/25/2016 12:11 PM Page 12 of 13 HABSIS,MIKHAL Scan on 7/13/2016 8:08 PM by User: SAYAS, LAURO N. [ Second | National This form MUST be signed & 700 E. Bona Ave. AEE RIRIAE AA returned whether or not you Pomona, CA 91767 have records. Thanks! |. Registered Los Angeles County # 2015183669 W.O. # 335475-024 DECLARATION OF CUSTODIAN OF RECORDS REGARDING: Michael Shabsis D.0.B: 5/20/1985 S.S.N: UNKNOWN AKA: Mikhail Shabsis LOCATION: Cedars-Sinal Medical Center’; (310) 423-3277 I, the undersigned, being the duly authorized Custodian of Records and having authority to certify the record declare the following (please check the appropriate boxes): CERTIFICATION OF RECORDS PROVIDED The records were prepared by the personnel of the business in the ordinary course of business at or near the Pursuant to Evidence Code Section 1560(e), the original records described in the Subpoena Duces Tecum/Deposition Subpoena/Authorization were delivered to the attorney's representative for copying at the witness" place of business. CERTIFICATION OF NO RECORDS -] Medical Records PLEASE SPECIFY REASON: [I RECORDS/FILMS ARE LOST | RECORDS/FILMS ARE DESTROYED [| OTHER (please explain) A thorough search of our files, carried out under my direction and control revealed no documents, records, or other items listed in the Subpoena Duces Tecum/Deposition Subpoena/Authorization presented to me. It is understood that such records may exist under another spelling, name, or classification, but with the information provided to our office and to the best of my knowledge, no such records exist. | DECLARE UNDER PENALTY OF RERJURY eT THE LAWS OF THIS STATE THAT Tre poReENe 15yTRUE AND CORRECT. ~ 20-4 , at Nn Myra WSore /) Mga pom Print Name Signature Executed on DO NOT WRITE BELOW THIS LINE. FOR SECOND IMAGE USE ONLY | am the attorney's representative and | state that [Imade true copies of the records, (cnn copies of the records, [] received a Certificate of No Records provided to me by the custodian of records of the above location. | DECLARE UNDER PENALTY OF PERJURY AND UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. [CJ Location did not properly complete and/or sign the declaration of records. Notes: ' Executed on B® q-) - | , at Tore Ar C Cc , CA. w& Date ty By: custodroN Signature Cedars-Sinai Medical Center” Page A1 SHABSISM-17PPR-04484 EXHIBIT 2 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - H&P Psych Report - H&P signed by Gross, Lawrence S at 12/14/2009 4:48 PM Author: Garg, Sunita Rajesh, MD, Service: (none) Author Type: Resident MD Filed: 12/14/2009 4:53 PM Note Time: 12/9/2009 12:39 PM Status: Addendum Editor: Garg, Sunita Rajesh, MD, MD (Resident) Related Notes: Original Note by Garg, Sunita Rajesh, MD, MD (Resident) filed at 12/10/2009 10:46 AM FINAL VERIFIED REPORT PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: SUNITA RAJESH GARG, M.D. THALIANS - HISTORY AND PHYSICAL EXAMINATION 12/08/2009 IDENTIFICATION: This is a 24-year-old single Caucasian male. CHIEF COMPLAINT: Racing thoughts. HISTORY OF PRESENT ILLNESS: This is a 24-year-old single Caucasian male with a self-reported history of bipolar disorder who was brought in by his mother at the referral of his outpatient psychiatrist. The patient was interviewed thoroughly and was admitted voluntarily on the inpatient unit. Upon interviewing the patient, he reports that he went to see his psychiatrist, Dr. Korchamared yesterday to tell him that he has been doing well and does not need the medications and that his psychiatrist referred him to Cedars-Sinai. He reports that he does not think that he is in a manic phase but does have racing thoughts and reports being preoccupied with God. He says that his behavior is fine and, "I won't hurt myself or anyone." He reports having thoughts of harming self prior to using cocaine but none currently. He reports that he has been sleeping fine and denies any psychotic symptoms. He does report using cocaine and methamphetamine on Sundays to slow him down. Per the emergency room report, collateral information was obtained from the outpatient psychiatrist, Dr. Korchamared who saw this patient yesterday where the patient presented in "an acute manic state" with racing thoughts, hyperreligiosity, delusions of grandiosity and intrusiveness. Per report, the mother also noticed change in the patient's behavior for the past 3 days and has worsened progressively since then. Per mother, the patient has been agitated, intrusive, talking to people on the street or talking to people driving by in cars in front of his home. He is hyperreligious and at baseline does not have any type of religious conversation. The patient has been taking Cymbalta 30-60 mg at bedtime and Abilify 15 mg p.o. daily. There appear to be no identifiable stressors at this time. PAST PSYCHIATRIC HISTORY: The patient has multiple psychiatric hospitalizations and most recently was admitted in October 2009 at Thalians. He has about 3 suicide attempts at ages 17, 20 and last year by cutting his wrists in by overdosing on medications. He has been following Dr. Alexander Korchamared for the past 2 years and has tried multiple medications in the past including, but not limited to, This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 102 Cedars-Sinai Medical Center” Page 2033 SHABSISM-15PPR-03468 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - H&P (continued) Psych Report - H&P signed by Gross, Lawrence S at 12/14/2009 4:48 PM (continued) Depakote, lithium, Risperdal, Seroquel, Klonopin, Haldol, clomipramine, Ativan as well as Clozaril, Zyprexa, Lexapro and Lamictal. The patient has a long history of noncompliance and did not give sufficient trial to these medications. He is also reported to have "low blood counts possibly on Depakote? from prior dictations. FAMILY PSYCHIATRIC HISTORY: None. MEDICAL HISTORY: None. ALLERGIES: No known drug allergies. The patient reports that he uses marijuana on a daily basis. He also reports using methamphetamine. Most recent use was on Sunday, about 3 days ago. Prior to using methamphetamine, he used cocaine. PERSONAL AND SOCIAL HISTORY: The patient is single and lives with his roommate in an apartment. He is unemployed and receives social security and also financial support from the family. He reports working several jobs in the The patient reports working several jobs in the past but not being able to hold any job for long enough. He reports taking a few college courses at Santa Monica City College. The patient reports being arrested in the past for walking naked in the middle of the street. MENTAL STATUS EXAM: The patient appears age appropriate, well developed, well nourished. He has tattoos of Greek philosophers on both arms. His speech appears with normal rate, rhythm and latency. He makes good eye contact and psychomotor is within normal. His mood is "good." Affect is elevated. Thought process is mostly linear. Thought content is positive for some underlying paranoia, hyperreligiosity with ideations negative for suicidal ideations, homicidal ideations, auditory hallucinations. Insight is impaired as well judgment is impaired. Impulse control is fair. IMPRESSION: A 24-year-old single Caucasian male with a history of bipolar disorder who was brought in by his mother at the referral of his outpatient psychiatrist, due to concerns of decompensating and being in manic phase. The patient presents with elevated expansive mood, elevated affect, racing thoughts, grandiosity, hyperreligiosily and inappropriate behavior in the context of substance use. He has multiple biopsychosocial factors contributing to the presentation. Biologically, he has a long history of noncompliance, marijuana use, methamphetamine and cocaine. Psychosocial factors include unemployment, limited finances. ASSESSMENT: AXIS I: 1. Bipolar disorder type 1, current episode manic. 2. Polysubstance use with abuse versus dependence. 3.. Rule out substance-induced mood disorder. AXIS II: This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 103 Cedars-Sinai Medical Center” Page 2034 SHABSISM-15PPR-03469 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - H&P (continued) Psych Report - H&P signed by Gross, Lawrence S at 12/14/2009 4:48 PM (continued) Deferred. AXIS Ill: None. AXIS IV: 1. Unemployment. 2. Limited finances. AXIS V: GAF of 25-30. PLAN: 1. Risk assessment. The patient appears to be at low risk for danger to self, danger to others. 2. Level of care. Inpatient level of care on voluntary basis. 3. Collateral. Urine toxicology as well collaterals from mother and the patient's psychiatrist will be obtained. The patient's psychiatrist, Dr. Korchamared be reached at 818-788-7580. 4. Treatment. We will continue the patient on Abilify 20 mg p.o. daily and Klonopin 1 mg p.o. b.i.d. with the plan to taper down the Klonopin and discontinue by the time of discharge. The patient will benefit from individual and group therapy during his hospital course. Case manager will be involved in the disposition plan. 5. Communication. This case was discussed in detail with my attending Supervisor, Lawrence Gross, MD who agrees with this assessment and plan. SUNITA RAJESH GARG, M.D. LAWRENCE GROSS, M.D SRG/MEDQ/398693872 D: 12/09/2009 T: 12/09/2009 JOB#: 488885 PRELIMINARY UNVERIFIED REPORT Change History and Electronic Signatures: Edited and saved as draft by GARG, SUNITA (10438) at 12/10/2009 10:35 Edited and signed by GARG, SUNITA (10438) at 12/10/2009 10:37 Signed by GROSS, LAWRENCE (2181) at 12/14/2009 16:48 Psych Report - D/C Summary Psych Report - D/C Summary signed by Gross, Lawrence S at 12/17/2009 5:53 PM Author: Revoredo, Katherine Service: (none) Author Type: Resident Michelle, MD Filed: 12/17/2009 5:56 PM Note Time: 12/14/2009 1:59 PM Status: Signed Editor: Revoredo, Katherine Michelle, MD (Resident) FINAL VERIFIED REPORT This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 104 Cedars-Sinai Medical Center” Page 2035 SHABSISM-15PPR-03470 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: KATHERINE MICHELLE REVOREDO, M.D. THALIANS - DISCHARGE SUMMARY DATE OF ADMISSION: 12/08/2009 DATE OF DISCHARGE: 12/10/2009 ATTENDING: LAWRENCE S GROSS ASSESSMENT UPON ADMISSION: AXIS I: 1. Bipolar disorder, manic episode without psychotic features. 2. Rule out substance-induced mood disorder. 3. Rule out schizoaffective disorder. AXIS II: Deferred. AXIS III: Denies. AXIS IV: Moderate with unemployment, limited financial resources, limited social support. AXIS V: Global assessment of functioning scale 25. ASSESSMENT UPON DISCHARGE: AXIS I: 1. Bipolar disorder, manic episode without psychotic features. 2. Substance-induced mood disorder. 3. Rule out methamphetamine dependence. AXIS II: Deferred. AXIS Ili: Denies. AXIS IV: Moderate with unemployment, limited financial resources, limited social support. AXIS V: Global assessment of functioning scale 50-55. HISTORY OF PRESENT ILLNESS: The patient is a 24-year-old single Caucasian male with a self-reported history of bipolar disorder type 1 who presented to the emergency room brought in by his mother at the referral of his outpatient psychiatrist. In the emergency room the patient displayed target symptoms of mania including an elevated expansive mood, grandiosity, racing thought, hyperreligiosity and inappropriate behavior. The patient reportedly compliant with medications. Did endorse recent marijuana use, methamphetamine use and This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 105 Cedars-Sinai Medical Center” Page 2036 SHABSISM-15PPR-03471 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) cocaine use. The patient displayed poor insight, reporting he did not have a psychiatric diagnosis. Per collateral information obtained from mother, mother noticed a change in the patient's behavior 3 days prior to presentation with progression of symptoms. She reported he has displayed agitation, intrusiveness. talking to people on the street or to people driving in their cars in front of his home. Reports the patient is hyperreligious and at baseline does not have any type of religious conversation. Upon psychiatric interview the patient continued to display target symptoms of mania including pressured speech, elevated expansive mood, racing thoughts, grandiosity, hyperreligiosity. The patient continuously requesting medication for ADHD stating that he would rather receive prescribed amphetamines then having to obtain it on the streets. The patient was compliant with medications. Appeared to have some response to Abilify 20 mg p.o. daily. The patient is unwilling to start mood stabilizer medication at the time. Perseverated on being able to contact or to talk to the patient on 3-West who he had briefly met during this hospitalization stay. HOSPITAL COURSE: The patient was admitted to Thalians 3-West for further psychiatric evaluation and treatment. The patient was started on Abilify 15 mg p.o. daily. The patient was noted to be increasingly affectionate with another patient on the same unit. The patient verbally stated that he would have an intimate relationship with the patient and due to the patient's functional status the patient was transferred to the 3-East unit as it was thought that he would benefit more from the group therapy provided on the East unit. Primary team spoke with the patient about being started on mood stabilizing medication. However the patient refused, stated he only needed to be prescribed amphetamines for his self-reported diagnosis of ADHD. Stated multiple times that he was "tired of obtaining meth off of the street" and wanted his current doctor to prescribe the medication. The patient wrote two extensive notes to primary psychiatric team stating that he would try not to obtain "meth off of the street or snort the medication" if it was prescribed to him. He stated his only psychiatric illness was ADHD, however would be willing to continue taking his Abilify medication. The patient was seen interacting with peers and staff appropriately. He appeared to be in a hypomanic state, however did not display significantly severe symptoms in order to be placed on a 5150 hold for grave disability. The patient decided to sign out against medical advice on December 10, 2009, stating he no longer needed to be on the inpatient unit and wanted to follow up with his outpatient psychiatrist. The patient had a home to return to as he rents an apartment which he shares with a roommate. Due to the patient having an appropriate plan and not meeting criteria for a 5150 hold, the patient was allowed to sign out against medical advice. The patient reported he was tired of confinement. He was upset about being over-medicated and not getting amphetamines prescribed to him. He displayed a calm behavior with limited insight, recognizing symptoms but not recognizing a need for treatment. The patient had a plan to return home to his apartment to live with his roommate and obtain follow-up care with outpatient psychiatrist Dr. Korshmared. The patient was assisted to This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 106 Cedars-Sinai Medical Center” Page 2037 SHABSISM-15PPR-03472 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) call Dr. Korshmared and leave a message regarding leaving against medical advice and to call the patient the following day to make an appointment as soon as possible. MENTAL STATUS EXAMINATION UPON ADMISSION: APPEARANCE: Revealed a 24- year-old Caucasian male, well-developed, well-nourished in no acute distress, tattoos on forearms. The patient seen pacing in front of his gurney, making adequate eye contact. MOTOR: Some psychomotor agitation noted. No tics or tremors. SPEECH: Was pressured, normal in rhythm, tone and volume, increased spontaneity, decreased latency of speech. ATTITUDE AND BEHAVIOR: The patient was calm and moderately cooperative with interview. MOOD: Euphoric. AFFECT: Elevated. THOUGHT PROCESS: Tangential with derailment and loose associations. Negative for suicidal ideations, plan or intent. Negative for homicidal ideations, plan or intent. Positive for grandiose delusions. The patient perseverated on religious themes. PERCEPTIONS: Were lacking in auditory or visual hallucinations. INSIGHT: Impaired. JUDGMENT: Impaired. IMPULSE CONTROL: Mildly impaired. MENTAL STATUS EXAMINATION UPON DISCHARGE: APPEARANCE: A 24-year-old Caucasian male, well-developed, well-nourished in no acute distress, tattoos on forearms. ATTITUDE AND BEHAVIOR: The patient is calm and cooperative. MOTOR: No psychomotor agitation or retardation. No tics or tremors. SPEECH: Normal in rate, rhythm, volume and tone. Normal spontaneity and latency of speech. MOOD: Euthymic. AFFECT: Constricted. THOUGHT PROCESS: Mostly concrete however, linear with episodes of tangential thought process. THOUGHT CONTENT: Negative for suicidal ideations, plan or intent. Negative for homicidal ideations, plan or intent. Possible mild grandiose delusions. Patient still perseverating on religious themes. PERCEPTIONS: Lacking in auditory or visual hallucinations. INSIGHT: Impaired. JUDGMENT: Fair. IMPULSE CONTROL: Fair. PLAN: 1. Risk assessment. A thorough risk assessment was performed. The patient presents as low risk for danger to self, low risk for danger to others. The patient not endorsing suicidal ideations, plan or intent and not endorsing homicidal ideations, plan or intent. Risk factors for danger to self included chronic psychiatric illness, recent cocaine use, methamphetamine use and marijuana use. Protective factors for danger to self include the patient appears to be in a hypomanic state, no suicidal ideation, plan or intent, complying with psychiatric treatment and This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 107 Cedars-Sinai Medical Center” Page 2038 SHABSISM-15PPR-03473 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/10/2009 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) medications. Cognitively intact. The patient has a home. Appears to have good social support in mother and friend. Risk factors for danger to others include chronic psychiatric illness, methamphetamine use and cocaine use. Protective factors for danger to others include no homicidal ideation, plan or intent. 2. Legal assessment. The patient does not meet criteria for a hold at this time. The patient will be continued on a voluntary status. The patient signed out against medical advice as the patient would benefit from continued inpatient treatment. 3. Diagnostic workup. None at this time. 4. Treatment according to biopsychosocial model. Biologically the patient is to continue Abilify 20 mg p.o. daily. He is to make an appointment to see his outpatient psychiatrist on the day after signing out against medical advice. Psychologically the patient is to continue individual therapy with outpatient psychiatrist. Socially the case manager involved in case to assist with disposition planning. However, the patient signed out against medical advice. 5. Communication. The case was discussed with the psychiatry attending, Dr. Lawrence Gross who agrees with the assessment and plan for this patient. KATHERINE MICHELLE REVOREDO, M.D. KMR/MEDQ/399306509 D: 12/14/2009 T: 12/14/2009 JOB#: 510922 Change History and Electronic Signatures: Signed by REVOREDO, KATHERINE (11451) at 12/16/2009 00:45 Signed by GROSS, LAWRENCE (2181) at 12/17/2009 17:53 This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 108 Cedars-Sinai Medical Center* SHABSISM-15PPR-03474 Page 2039 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/8/2009 Psych Report - ED Psych Eval Psych Report - ED Psych Eval signed by Callander, David W at 12/24/2009 3:02 PM Author: Revoredo, Katherine Service: (none) Author Type: Resident Michelle, MD Filed: 12/24/2009 3:21 PM Note Time: 12/8/2009 2:17 PM Status: Signed Editor: Revoredo, Katherine Michelle, MD (Resident) FINAL VERIFIED REPORT PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: KATHERINE MICHELLE REVOREDO, M.D. EMERGENCY DEPARTMENT- PSYCHIATRIC EVALUATION 12/08/2009 IDENTIFY INFORMATION: The patient is a 24-year-old single Caucasian male. CHIEF COMPLAINT: Manic episode. HISTORY OF PRESENT ILLNESS: The patient has a past psychiatric history significant for bipolar disorder type 1 presents to the emergency room brought in by his mother at the referral of his outpatient psychiatrist for a psychiatric evaluation. Upon psychiatric interview the patient endorses racing thoughts, noted to have pressured speech, hyperreligious, some psychomotor agitation, grandiosity. The patient reports he has been compliant with his medications which consist of Cymbalta and Abilify. He endorses using methamphetamines and cocaine 2 weeks ago and marijuana yesterday evening denies any alcohol consumption. Denies suicidal ideations, plan or intent. Denies homicidal ideations, plan or intent. Denies target symptoms of depression. Denies target symptoms of psychosis. The patient frequently interrupts the interview stating, "I'm bored." The patient also frequently perseverates on religious themes, is notably intrusive in the emergency room, interrupting conversations between the patient's and ER staff, frequently stating, "Look how | perfect | am. | look so wonderful." Per collateral information by outpatient psychiatrist, Dr. Korchamared who was reached at (818) 788-7580, patient has been seen in his outpatient psychiatric clinic for the last 2 years. The patient presented day today in an "acute manic state" with a racing thoughts, derailment, hyperreligiosity, delusions of grandiosity, intrusiveness. Outpatient psychiatrist reports that his current state should be taking seriously as he has had a history of risk of presenting well during psychiatric evaluations in the emergency room and quickly thereafter decompensating and getting into legal trouble and/or endangering himself. The outpatient psychiatrist reports the patient is currently on Abilify 15 mg daily and the patient has been taking Cymbalta either 30-60 mg daily, states that he is inconsistent with his compliance of the Cymbalta medication. Dr. Korchamared also notes that the patient in the past has been on Depakote, lithium Zyprexa, Risperdal, Clozaril, and Lexapro as well as many other medications. However, has failed This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 84 Cedars-Sinai Medical Center” Page 2015 SHABSISM-15PPR-03450 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/8/2009 Psych Report - ED Psych Eval (continued) Psych Report - ED Psych Eval signed by Callander, David W at 12/24/2009 3:02 PM (continued) medications due to noncompliance. Outpatient psychiatrist was asked if the patient has experienced any adverse effects with lithium and Depakote medication. He reports not to his knowledge; however, per previous dictations, it has been noted that the patient may have developed low blood counts while on Depakote. Outpatient psychiatrist reports that in his opinion, the patient should be started on Lamictal medication as the patient did not give Lamictal a fair trial in the past. Per collateral information obtained from mother who was reached at (818) 445-5008, the patient is compliant with medications, started noticing changes in the patient's attitude and behavior approximately 3 days ago and has progressively worsened since then. States that the patient is often agitated, intrusive, talking to people on the streets or talking to people driving by in their cars in front of his home. He is hyperreligious, states that the patient at baseline does not have any type of religious conversation. The patient noted to have increased energy; however, the patient has reported to mother he was sleeping 8 hours a night. Mother does not live with the patient; however, he feels concerned about the patient's current mental state as in the past he has been arrested for walking naked in the middle of the street, an event which was preceded by a mental state similar to his current presentation. PERTINENT PAST HISTORY: The patient has a diagnosis of bipolar disorder type 1. He has a history of approximately 10 psychiatric hospitalizations in the past, the first at the age of 18. Last hospitalization was October 2009 in Thalians. Per previous dictation, the patient has been on Depakote, lithium, Risperdal, Seroquel, Klonopin, Haldol, clomipramine and Ativan as well as Clozaril, Zyprexa, Lexapro, and Lamictal. Per previous dictation, the patient has a history of developing "low blood counts possibly on Depakote." He has a history of three suicide attempts in the past by cutting his wrists and by overdosing on Tylenol and vodka. Outpatient psychiatrist is Dr. Alexander Korchamared who can be reached at (818) 788-7580. He reports using methamphetamines and cocaine 2 weeks ago and marijuana on a daily basis. Last time yesterday evening. Denies any current medical issues. ALLERGIES: Denies allergies to medications. EDUCATIONAL HISTORY: The patient has an educational history of taking a few college course at Santa Monica City College. He has worked several jobs in the past including Calvin Klein sales, working as bartender. The patient has an extensive track record of quitting jobs, currently receives Social Security income approximately $930.00 a month from SSI . Currently lives in an apartment with a friend. MEDICATIONS: 1. Cymbalta 30-60 mg p.o. at bedtime. 2. Abilify 15 mg p.o. daily. ALLERGIES: No known drug allergies. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 85 Cedars-Sinai Medical Center” Page 2016 SHABSISM-15PPR-03451 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/8/2009 Psych Report - ED Psych Eval (continued) Psych Report - ED Psych Eval signed by Callander, David W at 12/24/2009 3:02 PM (continued) MENTAL STATUS EXAMINATION: APPEARANCE: Reveals a 24-year-old Caucasian male, well-developed, well-nourished in no acute distress, tattoos on forearms. The patient seen pacing in front of his gurney, makes adequate eye contact. MOTOR: Psychomotor agitation noted. No tics or tremors. SPEECH: Speech is pressured, normal in rhythm, tone and volume, increased spontaneity, decreased latency of speech. MOOD: Euphoric. AFFECT: Affect is elevated. THOUGHT PROCESS: Thought process is extremely tangential with derailment and loose associations. Thought content is negative for suicidal ideation, plan or intent. Negative for homicidal ideations, plan or intent. Positive grandiose delusions. The patient perseverates on religious themes. Perceptions are lacking in auditory and visual hallucinations. Insight is impaired. Judgment impaired. Impulse control is mildly impaired. IMPRESSION: A 24-year-old Caucasian male with a history of bipolar disorder type 1 presents to the emergency room brought in by his mother at the referral of his outpatient psychiatrist due to concerns of a manic episode. The patient displaying racing thoughts, grandiosity, psychomotor agitation, guarding, perseverating on religious themes. Biopsychosocial factors contributing to the patient's presentation include possible genetic loading. The patient taking an antidepressant, possible noncompliance with medications, marijuana use, methamphetamine use 2 weeks ago, cocaine use 2 weeks ago. Psychosocial factors contributing to the patient's presentation include unemployment, limited financial resources, limited social support. AXIS |: 1. Bipolar disorder, manic episode without psychotic features. 2. Rule out substance-induced mood disorder. 3. Rule out schizoaffective disorder. AXIS II: Deferred. AXIS Ill: Denies. AXIS IV: Moderate with unemployment, limited financial resources, limited social support. AXIS V: Global assessment of functioning 25. PLAN: 1. Risk assessment: A thorough risk assessment was performed. The patient presents at a low risk for danger to self, low risk for danger to others. The patient not endorsing suicidal ideations, plan or intent. Denies homicidal ideations, plan or intent. Risk factors for danger to self include chronic psychiatric illness, currently in acute manic episode, possible non compliance with medication, cocaine use, methamphetamine use. Protective factors for danger to self include no suicidal ideation, plan, or intent. The patient is complying with psychiatric treatment, cognitively This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 86 Cedars-Sinai Medical Center” Page 2017 SHABSISM-15PPR-03452 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/8/2009 Psych Report - ED Psych Eval (continued) Psych Report - ED Psych Eval signed by Callander, David W at 12/24/2009 3:02 PM (continued) intact. The patient has a home, appears to have good social support in mother. Risk factors for danger to others includes the patient having an acute manic episode, chronic psychiatric illness, methamphetamine use, and cocaine use. Protective factors for danger to others includes no homicidal ideation, plan, or intent. 2. Legal assessment: The patient will be continued on a voluntary status. 3. Elopement risk is moderate. The patient willing to comply with psychiatric resources and treatment. The patient is wearing a hospital gown with a sitter at the bedside. 4. Treatment is according to the biopsychosocial model. Biologically will increase Abilify to 20 mg p.o. daily. Will start the patient on Klonopin 1 mg p.o. b.i.d. and Ativan 1 mg p.o. q.6h. p.r.n. agitation, anxiety. Psychologically, provided bedside supportive therapy. Socially, no case manager involved in case at this time. 5. Disposition. The patient will be admitted to Thalians for further psychiatric evaluation and treatment. 6. Communication: The case was discussed with the ED attending, Dr. Hoh, and the psychiatry attending, Dr. Callander, who are all in agreement with assessment and plan for this patient. PSYCHIATRY ATTENDING | discussed case w/resident, read/agree w/assessment plan. KATHERINE MICHELLE REVOREDO, M.D. DAVID W CALLANDER, MD KMR/MEDQ/398555321 D: 12/08/2009 T: 12/08/2009 JOB#: 993646 Change History and Electronic Signatures: Signed by REVOREDO, KATHERINE (11451) at 12/10/2009 13:39 Edited and signed by CALLANDER, DAVID (11132) at 12/24/2009 15:02 This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 87 Cedars-Sinai Medical Center* SHABSISM-15PPR-03453 Page 2018 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER Adm: 12/8/2009, D/C: 12/8/2009 ED Notes ED Provider Notes signed by Hoh, Daniel Kayun, MD at 12/9/2009 12:08 PM Version 1 of 1 Author: Hoh, Daniel Kayun, MD Service: (none) Author Type: Physician Filed: 12/8/2009 9:11 PM Note Time: 12/8/2009 8:40 PM Status: Signed Editor: Hoh, Daniel Kayun, MD (Physician) PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: DANIEL KAYUN HOH, M.D. EMERGENCY TREATMENT RECORD 12/08/2009 CHIEF COMPLAINT: Manic behavior. HISTORY OF PRESENT ILLNESS: The patient is a 24-year-old male with a history of bipolar disorder who is presenting to the ER from his psychiatrist's office with racing thoughts as well as manic episodes that have been persistent for the past several weeks, however, have worsened as of late. The patient has a letter from his psychiatrist, a Dr. Korchmarev, which states that the patient has a long history of being hospitalized and treated for his bipolar, that he is willing to undergo a voluntary psychiatric admission at this time and he should be evaluated. The patient is in agreement with the information contained in the letter. The patient denies any medical complaints. No fevers, chills, nausea, or vomiting. The patient says that he has not had any recent drug use. The patient says that he has been taking his medication. The patient denies any suicidal ideation. PAST MEDICAL HISTORY: Bipolar disorder. PMD: Psychiatrist, Dr. Korchmarev. MEDICATIONS: 1. Abilify. 2. Cymbalta. ALLERGIES: None. SOCIAL HISTORY: The patient is a smoker, drinks alcohol on a social basis. He has a history of cocaine and meth use, however none recently. EMERGENCY DEPARTMENT REVIEW OF SYSTEMS: GENERAL: No fevers, chills, nausea or vomiting. No generalized weakness. HEAD: No headache. CARDIOVASCULAR: No chest pain or shortness of breath. RESPIRATORY: No cough. GASTROINTESTINAL: No abdominal pain. No melena. No diarrhea. GENITOURINARY: No dysuria. SKIN: No rash. NEUROLOGIC: No deficits. PSYCHIATRIC: Racing thoughts and manic behavior. No suicidal ideations. There are no hallucinations. The patient does not appear anxious at this time. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 80 Cedars-Sinai Medical Center” Page 2011 SHABSISM-15PPR-03446 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/8/2009, D/C: 12/8/2009 ED Notes (continued) ED Provider Notes signed by Hoh, Daniel Kayun, MD at 12/9/2009 12:08 PM (continued) Version 1 of 1 PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 97.7, heart rate 116, respirations 20, blood pressure 126/103, saturating 100% on room air. GENERAL: Alert and oriented x3, coherent, conversant, in no acute distress. HEENT: Head atraumatic. Extraocular movements are intact. NECK: No meningismus. BACK: No CVA tenderness. RESPIRATORY: Clear to auscultation bilaterally. CARDIOVASCULAR: Regular rhythm with a mild tachycardia. ABDOMEN: Soft, nontender, nondistended. MUSCULOSKELETAL: No cyanosis, clubbing or edema. NEUROLOGIC: Cranial nerves II-XII grossly intact. Spontaneously moving all 4 extremities. SKIN: Unremarkable. PSYCHIATRIC: Normal mood and affect. The patient is cooperative here in the ER. He is talkative and coherent. EMERGENCY DEPARTMENT COURSE AND TREATMENT/DISCUSSION: Psychiatry Team came down to evaluate the patient. They will admit him on a voluntary basis for his bipolar disorder, manic episode. The patient was given 1 mg of Ativan p.o. here. He otherwise appeared well. There was a substance abuse panel that was requested for him as well. The patient did not give any urine sample while in the ER. DIAGNOSIS: Bipolar disorder with a manic episode. DISPOSITION: Admission. CONDITION UPON DISCHARGE FROM EMERGENCY DEPARTMENT: Good. DANIEL KAYUN HOH, M.D.:10701 DH/MEDQ/398596314 D: 12/08/2009 20:40:02 T: 12/08/2009 21:03:31 JOB#: 486684 ED Notes by Roditti, Michael, RN at 12/8/2009 2:00 PM Version 1 of 1 Author: Roditti, Michael, RN Service: (none) Author Type: Registered Nurse Filed: 12/8/2009 2:03 PM Note Time: 12/8/2009 2:00 PM Status: Signed Editor: Roditti, Michael, RN (Registered Nurse) Alert and orientated x 4, Ambulates via steady gait, Bed in low position, call light in reach, Moves all extremities, Respirations - no acute distress, Resting comfortably, skin warm and dry. Speech unhurried. Side rails up x 2. Pt. C/o racing thoughts, seen by Psych this am and inst. To report to ER for eval. Denies any SI/HI. Pt. Anxious and pacing hallway. Pt. Cooperative. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 81 Cedars-Sinai Medical Center” Page 2012 SHABSISM-15PPR-03447 = SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER Adm: 12/8/2009, D/C: 12/8/2009 ED Notes (continued) ED Notes by Roditti, Michael, RN at 12/8/2009 2:00 PM (continued) Version 1 of 1 ED Notes by Maine, Heather, RN at 12/8/2009 12:40 PM Version 1 of 1 Author: Maine, Heather, RN Service: (none) Author Type: Registered Nurse Filed: 12/8/2009 12:42 PM Noie Time: 12/8/2009 12:40 PM Status: Signed Editor: Maine, Heather, RN (Registered Nurse) Pt c/o manic episode, pt states having racing thoughts, pt denies SI/HI. Pt's mother with pt. Pt seen at dr. korchmarev's office today. Pt anxious, pacing in waiting room. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 82 Cedars-Sinai Medical Center” Page 2013 SHABSISM-15PPR-03448 EXHIBIT 3 Los Angeles County Department of Mental Health ~ MH 302 NCR 08/20/04 APPLICATION FOR 72-HOUR DETENTION DETAINMENT ADVISEMENT FOR EVALUATION AND TREATMENT My nama is i 3 Pati . | am a (Peace Officer, etc.) with (Name of Agency). You are : car ton Code to aon not under criminal arrest, but | am taking you for examination 3 by mental health professionals at (Name of Facility). W & I Code, Section 5157, requires that each person when first detained for You will be told your rights by the mental health staff. psychiatric evaluation be given certain specific information orally, and a record be kept of the advisement by the evaluating facility. NOTE: If taken into custody at his or her residence, the person shall also be lold the following information in substantially the xX Advisement Complete (J Advisement Incomplete following form: com, Advisement You may bring a few personal items with you which | will have Good Cause For | plete to approve. You can make a phone call and/or leave a note to tell your friends and/or family where you have been taken. Advisement Completed By Position Date gun \ 2 et MD riz) 6 9) Application is hereby made to csm Cc for the admission of __ Miche | Shab gS residingat ___ {2152 roorgar let 201 Srv Cifq CA Ueb¥ , California, for 72-hour treatment and evaluation pursuant to Section 5150, (aduM) et seq. or Section 5585 et seq. (minor), of the Welfare and Institutions Code. If a minor, to the best of my knowledge, the legally responsible party appears to be/is: (Circle one) Parent; Legal Guardian; BT Court as a WIC 601/302; Conservator. If known, provide names, addresses and telephone numbers: The above person's condition was called to my attention under the following circumstances: Ev ve . om the evaluation and treatment is sought is in fact a danger to others, a danger to himself/herself and/or gravely disabled). PL phemead bopll WT geedfathes fe nor es revi) {a God . Deve Ws ar reckless c Mo and afenid to oo home geshrasy be sper fete Ha devin WES FY i Lay an | ¢- following information has becn established: (Please give sufficiently detailed information to support the belief that the person for ed upon the above information it appears that there is probable cause to believe that said person is, as a result of mentat disorder: B.A danger to himself / hersalf 58 A danger to others A Gravely disabled adult 0 Gravely disabled minor Peace RO CRCMSon a Sg SR Evaluation FacRiyPemon Designated by County 4 -- / rs [o 5 AND 9(7 b Tme: 2607 Name of Law Enforcement Agency or Evaluation Facility/Person: Phone: \ For patients in medical CSM C Uo Y2% B42. | | ERs, detention began: Address of Law Enforcement Agency or Evaluation Facility/Person: Date: FA3o Alden OC doi Anias, CA A004 Time: O Weapon was confiscated and detained person notified of procedure for return of weapon pursuant to W & | Code Section 8102. (officer/unit & phone #) NOTIFICATIONS TO BE PROVIDED TO LAW ENFORCEMENT AGENCY NOTIFICATION OF PERSON'S RELEASE FROM AN EVALUATION AND TREATMENT FACILITY IS REQUESTED BY THE REFERRING PEACE OFFICER BECAUSE: Person has been referred under circumstances in which ciminal charges might be filed pursuant to W & | Code Section 5152.1 and 5152.2. Natify {offices/unit & phone #) [J weapon was confiscated pursuant to W & | Code Section 8102. Notify (officerfunit & phone #) SEE REVERSE SIDE FOR LEGAL AUTHORITY Original: Accompany Client Copy. Clinical Record SHABSTIS, MICHAEL 020634384 Cedars-Sinai Medical Center Page 353 SHABSISM-11PPR-01751 State of California - Health and Human Services Agency Department of Mental Heaith NOTICE OF CERTIFICATION Confidential Patient Information HIPAA Privacy Rule MH 1760 (Rev. 08/04) See Welfare & Institutions Code 45 CER § 164.508 Section 5328 and Penat Code 11142 T-~ authorized agency providing evaluation services in the County of Los Healoz, has evaluated the condition of: Name HA \ Chae \ Salo SS Address Marital Status Stee le Date of Birth 5/g0/ 8s” Sex Hale We, the undersigned, allege that the above-named person is, as a result of a mental disorder or impairment by chronic alcoholism (Mark all that apply): a danger to others [OJ A danger to himself or herself X Gravely disabled as defined in paragraph (1) of subdivision (h) or subdivision (1) of Section 5008 of the Welfare and Institutions Code *Strike out ail inapplicable classifications. e specific facts which form the basis for our opinion that the above-named person meets one or more of the classifications indicated above are as follows: Poly pre [SV S Ss alien | vaca andra | pressured i py ) Unereacecl ew ; Aenwtor, Ag.tation, ~ Pach ob Jompynoes gpl MhSiveruss | aprtabion | impulsivignass { pushy ofrare st ola races) y 3 otra ‘bahénds unit | endorsi Aelus 3 pushe ll Nas Pakrend on Nit NY WOOT above-named Person has been informed of this evaluation, and has been advised of the need for, but has not been able or willing to accept treatment on a voluntary basis, or 10 accept referral to, the following services: CSM Wnpedrient prvplhcdric SeeV\Cces We, therefore, certify the above-named person to receive intensive treatment related to the mental disorder or impairment by chronic alcoholism beginning this 1c day of _Deczm bor. .20_09F _, in the intensive treatment facility & named Cedars Xen Hedical Cevdea . 12} 16)oq ! Dhte Signature LL _ £ / form ~o Jte< Signature Lr 1 hereby state that I delivered a copy of this notice this day to the above-named person and that | informed him or her that unless judicial review is requested, a certification review hearing will be held within four days of the date on which the person is certified for a period intensive treatment and that an attorney or advocate will visit him or her to provide assistance in preparing for the hearing or to ®- questions regarding his or her commitment or to provide other assistance. The court has been notified of this certification on this 04 % Sigatature Dchoon & Copics: Person Certified-Personally delivered Person's Attorney/Advocat SHABSIS,MICHAXL 020634384 Page 362 Cedars-Sinai Medical Center SHABSISM-11PPR-01760 NOTICE OF CERTIFICATION FOR ADDITIONAL 30 DAYS INTENSIVE TREATMENT The author ized agency providing 30-day intensive treatment in the Ousty of Los Angeles has evaluated the condition of: ® neme__Miclge | Shabs LS | Marital sows Sales patorirt sao fags sex Halo \ : We, the undersigned, allege that the above-named person is, as a result of 8 mental disorder or impairment by chronic alcoholism, BRAVELY DISABLED es defined in paragraph ( 1) of subdivision (h) of Sectinn 5008 of the Welfsre and Institutions Code or under section 5585.25 of the Welfare & Institutions Code. TH wens facts which form the basis for our opinion that the above-named person meets the classification indicated above are as follows: fahertt emihives to have poe nsighd~ | antated] , labile, ot rechvectablo cequiriney inframuscilar. medicahon Pah exit ree & his mother Avery a Lami ly meeting in Bowe with open Gstaad ord Hen punched wall. Halds relgrenda poe AA 1 © The above-nemed person has been informed of this evaluation, and has been advised ut hes not been able or willing to accept treatment on 8 voluntary basis, or to accept referral to the following services: Cedars Sinai Medical Center Tnpahent Psychiatric. Facd by : 4 -5 ®... certify the above-named person to receive intensive treatment related to the mental disorder or impairment by Ha . chronic slcoholism for no more than 30 days beginning this 20 gay o_Delemborre 200 in the intensive treatment facility herein net (SMC Togateat Crvchuadnc ATH Date Signature. Signature. 1 { Qo 4360 I hereby state that | delivered 2 copy of this notice this day to the above-named person and that | informed him or her that unless judicial review is requested, a certification review hearing will be held within four(4) days of lhe date on which the per son 1s certified for 8 period of intensive treatment and that an attorney or edvocate will visit him or her to provide assistance in preparing for the hear My or to answer questions regarding his or her commitment or to provide other assistance The cour! has been notified of this cestifigatipn on thse * CONFIDENTIAL PATIENT INFORMATION Copies: Person CertiNed-Personsily delivered California Wai Code Section 5328 Person's Attorney/Advocale SHABSIS, MICHAEL 020634384 Cedars-Sinai Medical Center* Page 825 SHABSISM-12PPR-02225 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 12/13/2009 Psych Report - ED Psych Eval Psych Report - ED Psych Eval signed by Link, Patrick E at 1/7/2010 12:06 PM Author: Lee, Samuel B., MD Service: (none) Author Type: Resident Filed: 1/7/2010 12:11 PM Note Time: 12/13/2008 4:20 PM Status: Signed Editor: Lee, Samuel B., MD (Resident) FINAL VERIFIED REPORT PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: SAMUEL B. LEE, M.D. EMERGENCY DEPARTMENT- PSYCHIATRIC EVALUATION 12/13/2009 REFERRING PHYSICIAN: Dr. Kirk Patrick Burgamy. IDENTIFICATION: This 24-year-old Russian male brought in by his mom with chief complaint of manic state. HISTORY OF PRESENT ILLNESS: The patient has a history of bipolar disorder type 1. He presents with hyper-religious ideation believing he is a Jewish Messiah, grandiosity, also tangential as well as flight of ideas. The patient, however, does report he has been sleeping 9 hours per night. The patient was recently admitted to Thalians last week and just recently discharged approximately 3 days ago. The mother reports that the patient had been minimizing his symptoms while on the ward because he was afraid someone in the ward was going to kill him and ever since he has come out, he has been very reckless. He has been threatening to Kill his grandfather because his grandfather said he did not believe in God. He has been driving his car very recklessly. The patient reports he was just trying to learn how to drift. The patient reports that yesterday he was very paranoid because he felt like the devil was going to kill him. He believes the Mexican mafia wants to kill him and that he is a Jewish Messiah. He realized that today when he went to the Synagogue. Apparently he got kicked out of the Synagogue for causing disruption and cussing at Synagogue. Yesterday, he was afraid to go home because he felt someone was going to kill him. Target symptoms of mania as mentioned above. Currently, he is denying key depressive symptoms. He says he feels good. He is denying auditory and visual hallucinations, as well as denying suicidal and homicidal ideation. Collateral information maybe obtained from his mother, Irene. Her phone numbers 818-445-5080. Also, his psychiatrist was attempted to be reached, Dr. Korchamared. His phone number is 818-788-7580. However, he could not be reached at this time. PERTINENT PAST HISTORY: The patient has a diagnosis of bipolar disorder type. He has a history of approximately 10 psychiatric hospitalizations in the past, the first one being a age 18. He was last hospitalized last week here Thalians. Per previous dictation, the patient has been on Depakote, lithium, Risperdal, Seroquel, Klonopin, Haldol, clomipramine, Ativan, as well as Clozaril, Zyprexa, Lexapro and Lamictal. Per previous dictation, the patient has a history of developing low blood counts, possibly on Depakote. He has a history of This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 137 Cedars-Sinai Medical Center” Page 2068 SHABSISM-15PPR-03503 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 12/13/2009 Psych Report - ED Psych Eval (continued) Psych Report - ED Psych Eval signed by Link, Patrick E at 1/7/2010 12:06 PM (continued) 3 suicide attempts in the past by cutting his wrists and overdosing on Tylenol and vodka. As mentioned above, his outpatient psychiatrist is Dr. Alexander Korchamared, phone number a 818-788-7580. Reportedly approximately 2 weeks ago, he used methamphetamines as well as cocaine. He reports that he uses methamphetamines because it helps slow him down. He reports it has opposite affect on him instead of speeding him up, it helps him calm down. The patient denies any current medical issues at this time. CURRENT MEDICATIONS: 1. Abilify 15 mg p.o. daily. 2. The patient was also on Cymbalta most recently as a week ago, however, his psychiatrist stopped it, probably due to his manic state at that time. ALLERGIES: The patient denies any allergies. PERSONAL AND SOCIAL HISTORY: The patient is educated with a few college courses at Santa Monica City College. He has worked several jobs in the past including Calvin Klein sales, working as a bartender, however, he has a track record of quitting jobs and currently he is receiving SSI approximately $930 a month, currently living in apartment with his friend, Jackie, in West Hollywood. MENTAL STATUS EXAM: Reveals a bald, 24-year-old, Russian male with tattoos all over his body as well as his knuckles. The patient is malodorous at this time. The patient speaks in pressured speech, increased rate and rhythm. His mood is good. His affect is congruent. His thought process is tangential with flight of ideas. Thought content with delusions of being the Jewish Messiah, as well as other religious delusions, currently denying suicidal or homicidal ideation. Perceptions: Denying any auditory or visual hallucinations. The patient is alert and oriented x3. The patient's insight is poor. His judgment is poor. His impulse control is poor. IMPRESSION: This is a 24-year-old Russian male with a history of bipolar disorder type 1 presenting with acute manic state of hyper was religious tangential and flight of ideas and grandiosity. The patient has delusions of being the Jewish Messiah, has recently been driving his car recklessly as well as harassing people in the street, as well as threatening to kill his grandpa because he did not believe in God. The patient currently denying key depressive symptoms or psychotic auditory or visual hallucinations at this time, also denying SI, HI. Biological factors contributing may include inadequate psychotropic medication and possible genetic loading. Psychosocial factors includes decreased financials, unemployment. ASSESSMENT: AXIS I: Bipolar disorder, current manic state with psychotic features. Rule out schizoaffective disorder, rule out substance-induced psychosis. AXIS II: Defer. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 138 Cedars-Sinai Medical Center” Page 2069 SHABSISM-15PPR-03504 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 12/13/2009 Psych Report - ED Psych Eval (continued) Psych Report - ED Psych Eval signed by Link, Patrick E at 1/7/2010 12:06 PM (continued) AXIS Ill: Denies AXIS IV: Unemployed, limited financial resources, limited social support. AXIS V: GAF of 25. PLAN: 1. Risk assessment: A thorough risk assessment was performed. At the current time, the patient is at low risk for danger to self. Currently, the patient is denying any suicidal ideation, intent or plans. The protective factors include rapport with mental health care as well as support from his mother. Risk factors may include history of previous attempt as well as a mental illness. At the current time, the patient is at low risk for danger to others, although the patient has been noted to have threatened to kill his grandfather for not believing in God. He currently is denying any homicidal ideation, intent or plans. He reports that he was joking when he threatened to kill his grandfather 2. Legal status: Currently is voluntary elopement risk. 3. Low: The patient is in hospital gown, willing to come into the hospital. 4. Treatment. Done according to the biopsychosocial model. Biologically, the patient received Ativan 1 mg p.o. here in the ER. The patient will be started on Abilify 15 mg p.o. daily, Cymbalta will be held as he is currently in a manic state. Primary team may decide what other psychotropic medications the patient may benefit from. Psychosocially, the patient may benefit from individual as well as group therapy, and case manager may be consulted for assistance with disposition as well as follow-up. 5. Disposition: The patient will be admitted voluntarily to Thalians 3-West. 6. Communication: This case was discussed with psychiatry attending physician, Dr. Patrick Link, who agrees with above assessment and plan. SAMUEL B. LEE, M.D. PATRICK E. LINK, M.D. SBL/MEDQ/399179299 D: 12/13/2009 T: 12/13/2009 JOB#: 508064 Change History and Electronic Signatures: Signed by LEE, SAMUEL (11936) at 1/6/2010 11:03 Signed by LINK, PATRICK (11121) at 1/7/2010 12:06 This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 139 Cedars-Sinai Medical Center” Page 2070 SHABSISM-15PPR-03505 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Consults (continued) Consults signed by Lebovics, Irving S at 1/12/2010 1:36 PM (continued) inpatient status, dental work cannot be completed. The patient advised to seek dental health either by the patient's private dentist or the patient can become a patient of Cedars-Sinai dental clinic upon being discharged. Prescription for amoxicillin regimen given for odontogenic abscess of tooth #3. For further questions, please contact dental department at extension 36361. MINH-KY YOUNG, D.D.S. IRVING S. LEBOVICS, D.D.S. MY/MEDQ/402593241 D: 01/11/2010 T: 01/11/2010 JOB#: 77611 cc: LAWRENCE S. GROSS, M.D. Irving S. Lebovics, D.D.S. Change History and Electronic Signatures: Edited and signed by YOUNG, MINH-KY (11975) at 1/12/2010 10:20 Signed by LEBOVICS, IRVING (3944) at 1/12/2010 13:36 Psych Report - H&P Psych Report - H&P signed by Gross, Lawrence S$ at 12/17/2009 5:53 PM Author: Revoredo, Katherine Service: (none) Author Type: Resident Michelle, MD Filed: 12/17/2009 5:57 PM Note Time: 12/14/2009 9:05 AM Status: Signed Editor: Revoredo, Katherine Michelle, MD (Resident) FINAL VERIFIED REPORT PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: KATHERINE MICHELLE REVOREDO, M.D. THALIANS - HISTORY AND PHYSICAL EXAMINATION 12/14/2009 IDENTIFYING INFORMATION: The patient is a 24-year-old Russian male brought into emergency room by his mom. CHIEF COMPLAINT: Manic symptoms. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 157 Cedars-Sinai Medical Center* SHABSISM-15PPR-03523 Page 2088 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Psych Report - H&P (continued) Psych Report - H&P signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) HISTORY OF PRESENT ILLNESS: The patient has a history of bipolar disorder type 1, presents to the emergency room in a hyper religious state believing that he is a Jewish Messiah. The patient exhibits grandiosity, is tangential with his speech, displays flight of ideas. The patient however is reporting that he sleeps 9 hours per night. The patient was recently admitted to Thalians; however, signed out against medical advice approximately 3 days prior to presentation. Per mother's report in the emergency room, stated that the patient was minimizing his symptoms while on the unit because he was afraid someone on the ward was going to kill him. Mother also reports that since his discharge he has become very reckless, and "threatening to kill his grandfather because his grandfather said he did not believe it God." Mother also reports he has been impulsive with his driving, states he has been driving recklessly. Upon questioning the patient, the patient reports he is "learning how to drift." The patient endorses persecutory delusions stating he felt the devil was going to kill him. He believes the Mexican mafia wants to Kill him and believes that he is the Jewish Messiah. Upon psychiatric interview on inpatient unit, the patient continues to display symptoms of mania including: PAST PSYCHIATRIC HISTORY: Patient diagnosed with bipolar disorder type 1. He has a history of approximately 10 psychiatric hospitalizations, first hospitalization at the age of 18. The patient recently signed out against medical advice 3 days prior to presentation. The patient previously has been treated with Depakote, lithium, Risperdal, Seroquel, Klonopin, Haldol, clomipramine, Ativan, Zyprexa, Lexapro and Lamictal. The patient has history of three suicide attempts, via cutting his wrists and overdosing on Tylenol and vodka. The patient has an outpatient psychiatrist by the name of Dr. Alexander Korchamared who can be reached at 818-788-7580. The patient is noncompliant with medications. MEDICATIONS: 1. Abilify 50 mg p.o. daily. ALLERGIES: No known drug allergies. FAMILY HISTORY: Unknown at this time. PAST MEDICAL HISTORY: Denies. SOCIAL HISTORY: The patient attended a few college courses at Santa Monica City College. He has worked several jobs in the past including Calvin Klein sales, working as a bartender; however, has an extensive track record of quitting his job. Currently receives SSI, approximately $93 a month. The patient lives in an apartment with a friend in West Hollywood. MENTAL STATUS EXAM: APPEARANCE: The patient is a 24-year-old Russian male with tattoos over upper extremities bilaterally. The patient is well-developed, well-nourished, in no acute distress. Makes This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 158 Cedars-Sinai Medical Center” Page 2089 SHABSISM-15PPR-03524 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Psych Report - H&P (continued) Psych Report - H&P signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) intermittent eye contact. MOTOR: No psychomotor agitation or retardation. No tics or tremors. SPEECH: The patient is talkative, slightly increased in rate, normal in rhythm and tone and volume, normal spontaneity and latency of speech. MOOD: "Fine." Affect is labile. THOUGHT PROCESS: Linear with episodes of tangential speech. PERCEPTION: Lacking in auditory or visual hallucinations. THOUGHT CONTENT: Negative for suicidal ideations, plan or intent. Negative for homicidal ideations, plan or intent. Positive for persecutory delusions. INSIGHT: Poor. JUDGMENT: Poor. IMPULSE CONTROL: Poor. IMPRESSION: The patient is a 24-year-old Russian male with a history of bipolar disorder type 1 who presents to the emergency room with target symptoms of mania including impulsivity, persecutory delusions, pressured speech, grandiosity. The patient has limited insight and poor judgment. Biopsychosocial factors contributing to the patient's presentation include biologically noncompliance with medication, possible genetic loading, recent use of cocaine, methamphetamines and marijuana. Psychosocial factors contributing to the patient's presentation include limited financial resources, unemployment. ASSESSMENT: AXIS I: 1. Bipolar disorder type 1 currently manic state with psychotic features. 2. Rule out schizoaffective disorder. 3. Rule out substance-induced psychosis. AXIS II: Deferred. AXIS III: Denied. AXIS IV: Mild to moderate with limited financial resources, unemployment, limited social support. However, good social support in mother. AXIS V: Global assessment of functioning 25. PLAN: 1. Risk assessment. A thorough risk assessment was performed. The patient presents as low risk for danger to self, low risk for danger to others. The patient currently denies suicidal ideations, plan or intent. Denies homicidal ideations, plan or intent. Risk factors for danger to self include: Patient experiencing target symptoms of mania including impulsivity and poor judgment, patient with a history of suicide attempts, and recent cocaine use, marijuana use and methamphetamine use. Protective factors for danger to self include no suicidal ideations, plan or intent. The patient not displaying any self-injurious behavior, willing to comply with treatment. Risk factors for danger to others include experiencing target symptoms of mania, illicit substance use including cocaine, marijuana and methamphetamine use. Protective This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 159 Cedars-Sinai Medical Center” Page 2090 SHABSISM-15PPR-03525 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Psych Report - H&P (continued) Psych Report - H&P signed by Gross, Lawrence S at 12/17/2009 5:53 PM (continued) factors for danger to others includes no homicidal ideations, plan or intent. 2. Disposition/ legal status. The patient will be admitted. Will continue inpatient level of care. He will be continued on a 5150 hold for grave disability. 3. Diagnostic workup. Routine labs. 4. Treatment is according to biopsychosocial model. Biologically, the patient will be restarted on his Abilify 50 mg p.o. daily. Psychologically provided bedside supportive therapy. Socially, case manager will be assigned to case to assist with disposition planning. 5. Communication: The case was discussed with the patient and the psychiatry attending, Dr. Gross who were all in agreement with the assessment and plan for this patient. KATHERINE MICHELLE REVOREDO, M.D. LAWRENCE S. GROSS, M.D. KMR/MEDQ/399239673 D: 12/14/2009 T: 12/14/2009 JOB#: 1075 Change History and Electronic Signatures: Signed by REVOREDO, KATHERINE (11451) at 12/17/2009 05:41 Signed by GROSS, LAWRENCE (2181) at 12/17/2009 17:53 Psych Report - D/C Summary Psych Report - D/C Summary signed by Gross, Lawrence S at 3/4/2010 4:42 PM Author: Miglani, Megha, MD Service: (none) Author Type: Resident Filed: 3/4/2010 5:05 PM Note Time: 2/16/2010 8:47 AM Status: Signed Editor: Miglani, Megha, MD (Resident) FINAL VERIFIED REPORT PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: MEGHA MIGLANI, M.D. THALIANS - DISCHARGE SUMMARY DATE OF ADMISSION: 12/13/2009 DATE OF DISCHARGE: 01/25/2010 ADMISSION DIAGNOSIS: AXIS |: Bipolar disorder type 1, currently manic with psychotic features, rule out schizoaffective disorder rule out substance-induced psychosis. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 160 Cedars-Sinai Medical Center” Page 2091 SHABSISM-15PPR-03526 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 3/4/2010 4:42 PM (continued) AXIS II: Deferred. AXIS Ill: Denies. AXIS IV: Mild to moderate, limited financial resources unemployment, limited social support. However good social support and mother. AXIS V: Global assessment of functioning 25. DISCHARGE DIAGNOSIS: AXIS |: Bipolar disorder not otherwise specified. Methamphetamine abuse. AXIS II: Deferred. AXIS III: Denies. AXIS IV: Moderate. Unemployment, conserved, limited support. AXIS V: Global assessment of functioning of 45. HISTORY OF PRESENT ILLNESS: This is a 24-year-old Russian male with a history of Bipolar disorder who was brought into the emergency room by his mother for concerns of manic symptoms. The patient exhibited target symptoms of mania of grandiose, hyperreligious delusions, tangential speech and flight of ideas. He had recently been admitted to Thalians and signed out AMA three days prior to presentation. According to mother, during his earlier admission, the patient had minimized symptoms and believed that someone on the unit was trying to kill him. He had not been compliant with medications since leaving. Please refer to Thalians History and Physical dated 12/13/09 by Dr. Revoredo for more information regarding history of present iliness, past psychiatric history and mental status exam on admission. HOSPITAL COURSE: The patient was admitted to 3-West voluntarily and was restarted on his medications of Abilify 15 mg daily. Upon admission, the patient was agitated and received Haldol, Ativan and Benadryl orally. At that time, he was also placed on a on a 5150 hold for grave disability, danger-to-self and danger-to-others. Given the patient?s psychosis and impulsivity his Abilify was immediately titrated up to 30 mg. He was transferred to 3-East but after showing multiple episodes of agitation he was transferred back to 3-West soon thereafter. The patient was receiving daily IM cocktails and thus, Seroquel was added as a p.r.n and increased from 100 mg q.4.h. to 200 mg q.6.h. He required 1:1 sitters at times and was very difficult to redirect. He was grandiose, hypersexual and labile, often yelling that the staff was the KKK. He would repeatedly ask the treatment team for Adderall to ?calm down.? The patient was also started on Trileptal for mood stabilization and it was titrated up to 600 mg b.i.d. He had been on Depakote in the past and developed thrombocytopenia, and given his impulsivity lithium was not a safe possibility. The patient continued to receive almost daily intramuscular or oral cocktails and thus, Klonopin 1 mg p.o. b.i.d. was ordered on 12/21/10 as well as Klonopin 0.5 mg q.6.h. p.r.n. He also continued his requests for stimulants. As the Abilify and Seroquel did not appear to have much effect it was discontinued on 12/22/10 and replaced with Risperdal at 2 mg g.a.m. and 4 mg q.h.s.; this was subsequently discontinued and replaced with Haldol 5 mg b.i.d. the following day. He was also provided with Haldol 5 mg q.6.h. p.r.n and Benadryl 50 mg b.i.d. was also added for risk of EPS. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 161 Cedars-Sinai Medical Center” Page 2092 SHABSISM-15PPR-03527 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 3/4/2010 4:42 PM (continued) Haldol continued to be titrated up as the patient continued to receive additional p.r.n. doses and intramuscular or oral cocktails. Given his history of medication noncompliance, the patient received a Haldol decanoate of 100 mg on 12/28/10. He continued to display multiple episodes of agitation, culminating on 12/31/10 where the patient slapped his mother during a family meeting and then banged his head against the wall so hard that it cracked. Thorazine was added as an additional p.r.n. medication on 1/3/10 as he had at that point been receiving thorazine intramuscularly as well and the patient had been escalating since learning conservatorship would be filed. The Trileptal did not appear to be achieving full effect and it was discontinued on 12/31 and replaced with Tegretol. This was titrated up to 400 mg b.i.d. and levels were checked to monitor compliance and metabolism. His last level was on 1/21 and was therapeutic at 8.8. Discussions regarding conservatorship had been underway since admission and given the patient?s behavior on the unit and history of multiple hospitalizations and noncompliance, the decision was made to file for conservatorship on 1/4/10. The patient?s court date was not set until 1/25/10 and after learning this fact on 1/10/10, the patient became agitated about having to stay for an additional 2 weeks. He began to throw trashcans in the community room and yelling and received an intramuscular cocktail. His Klonopin was then increased to 1 mg t.i.d. as he had been receiving multiple Klonopin p.r.n. doses. The patient continued to display agitated behavior for a couple of more days, requiring IM medications; and thus, his haldol was increased to 10 mg b.i.d. After a while, the patient settled down and was found to be requesting p.r.n. medications for being suicidal. He reported that he was suicidal and depressed and resumed his requests for Adderall or an antidepressant. After discussion with the team, the patient reported that he wanted medications to ?zone out? and ?sleep? for the remainder of his stay. Therefore, we started to titrate down on his Haldol and Klonopin and discontinued to thorazine p.r.n. On 1/21 we decreased the Benadryl to 25 mg b.i.d., Haldol to 10 mg g.h.s and Klonopin to 1 mg g.h.s. We later decreased the Haldol to 2 mg q.6.h. p.r.n. anxiety and agitation. The patient also complained of oral pain and stated that he had been told previously that he had an abscess 1 year prior. The dental consult saw him and started him on amoxicillin 500 mg t.i.d. x 10 days and recommended a root canal or tooth extraction after leaving the hospital. He was provided with Motrin for his oral pain. Before the trial, conversations were held with the mother and father expressing their concern with the patient being medicated with Haldol. It was discussed that it was chosen given the patient?s level of agitation and his history of non-compliance. Parents agreed with continuing him on Haldol in the hospital and possibly transitioning him back to Abilify with his outpatient psychiatrist. The patient did not want an additional Haldol decanoate while in the hospital and the father also decided against a decanoate once he won conservatorship. On 1/25/10 the patient was taken to court and conservatorship was granted to his This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 162 Cedars-Sinai Medical Center” Page 2093 SHABSISM-15PPR-03528 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 1/25/2010 Psych Report - D/C Summary (continued) Psych Report - D/C Summary signed by Gross, Lawrence S at 3/4/2010 4:42 PM (continued) father. The patient was sent home to his father in improved condition with plans to resume living in his apartment and follow up with his outpatient psychiatrist. MENTAL STATUS EXAM ON DISCHARGE: This is a 24-year-old Russian male who appears his stated age. He is well-developed and well groomed in casual attire. Speech is spontaneous with normal rhythm, rate and volume. There are no psychomotor abnomalities. Mood is ?tired.? Affect is appropriate and full. Thought process is linear. Thought content is negative for suicidal or homicidal ideation. No overt delusions. No perceptual abnormalities. Insight and judgment are limited. Discharge medications: 1. Tegretol 400 mg p.o. b.i.d. 2. Benadryl 25 mg b.i.d. 3. Haldol 10 mg q.h.s. PLAN: 1. Risk assessment - a thorough risk assessment has been performed. At the current time the patient is found to be at low risk for suicide. He denies suicidal ideation intent or plan. Risk factors include - mental illness, history of substance abuse and impulsivity. Protective factors include therapeutic alliance, connections to family access to care, intact reality testing was a the patient was at low risk for homicidality, he denies homicidal ideation intent or plan. 2. Disposition - discharged to father and now current conservator. 3. Diagnostic workup is complete at the current time, collateral information was obtained from the patient's father, Dmitri 310 409 5969 as well as mother, Irene (818) 445-5080. His psychiatrist Dr. Alex Korchmarev can be reached at (818) 788-7580. 4. Treatment will be in the biopsychosocial model. Biologically the patient was discharged on the medications listed above. Psychologically the patient will follow up with outpatient psychiatrist, Dr. Korchmarev. Socially case management assisted with his disposition. 5. Communication - this case was discussed with psychiatry attending, Dr. Lawrence Gross. MEGHA MIGLANI, M.D. LAWRENCE S. GROSS, M.D. MM/MEDQ/407294523 D: 02/16/2010 T: 02/16/2010 JOB#: 691543 Change History and Electronic Signatures: Edited and signed by MIGLANI, MEGHA (11938) at 2/21/2010 16:31 Signed by GROSS, LAWRENCE (2181) at 3/4/2010 16:42 This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 163 Cedars-Sinai Medical Center” Page 2094 SHABSISM-15PPR-03529 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER Adm: 12/13/2009, D/C: 12/13/2009 ED Notes ED Provider Notes signed by Burgamy, Kirk Patrick, MD at 1/5/2010 10:59 PM Version 1 of 1 Author: Burgamy, Kirk Patrick, MD Service: (none) Author Type: Physician Filed: 12/13/2009 7:35 PM Note Time: 12/13/2009 4:11 PM Status: Signed Editor: Burgamy, Kirk Patrick, MD (Physician) PATIENT: SHABSIS, MICHAEL MED REC: 020634384 CEDARS-SINAI MEDICAL CENTER DICTATOR: KIRK PATRICK BURGAMY, M.D. EMERGENCY TREATMENT RECORD 12/13/2009 METHOD OF ARRIVAL: Walk-in. CHIEF COMPLAINT: Paranoia. HISTORY OF PRESENT ILLNESS: The patient is a 24-year-old male with past medical history significant for bipolar disorder and substance abuse who presents with his mother complaining of decreasing paranoia and agitation at home over the past 2 days. The patient was recently discharged from Thalians approximately 1 week ago, had been compliant with his Abilify, however, developed worsening mania. The patient admits to using speed he states 2 weeks ago but no other recent drug use. The patient states he has thoughts that people want to kill him. The patient denies any suicidal or homicidal ideation. The patient denied any toxic ingestions, fevers, chills, headache, nausea, vomiting and abdominal pain, chest pain, shortness of breath. PAST MEDICAL HISTORY: Bipolar disorder. MEDICATIONS: 1. Abilify. 2. Cymbalta. ALLERGIES: No known drug allergies. SOCIAL HISTORY: History of speed. Denies tobacco or alcohol use. FAMILY HISTORY: Noncontributory. EMERGENCY DEPARTMENT REVIEW OF SYSTEMS: GENERAL: Negative. EYES: Negative. ENT: Negative. HEAD: Negative. CARDIOVASCULAR: Negative. RESPIRATORY: Negative. GASTROINTESTINAL: Negative. GENITOURINARY: Negative. MUSCULOSKELETAL: Negative. SKIN: Negative. NEUROLOGIC: Negative. PSYCHIATRIC: See HPI. ENDOCRINE: Negative. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 132 Cedars-Sinai Medical Center” Page 2063 SHABSISM-15PPR-03498 ay SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 12/13/2009, D/C: 12/13/2009 ED Notes (continued) ED Provider Notes signed by Burgamy, Kirk Patrick, MD at 1/5/2010 10:59 PM (continued) Version 1 of 1 ALLERGIC/IMMUNOLOGIC: Negative. HEMATOLOGIC/LYMPHATIC: Negative. All systems have been reviewed and are negative except for those described in HPI. PRIMARY MEDICAL DOCTOR: Dr. Korchmareb. PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 97.7, blood pressure 131/84, respirations 22, pulse 80. Pulse ox 100% on room air. GENERAL: The patient is alert, oriented x3, appears agitated at times but is re-directable. HEENT: Normocephalic, atraumatic. PERRL. EOMI. Sclerae white. No nystagmus. Moist oral mucosa. NECK: No thyromegaly. LUNGS: Clear to auscultation bilaterally, no wheezing, rhonchi or rales. CARDIOVASCULAR: Regular rate and rhythm, no murmurs, rubs or gallops. ABDOMEN: Positive bowel sounds, soft, nontender, nondistended. No rebound, guarding or rigidity. MUSCULOSKELETAL: No clubbing, cyanosis or edema. NEUROLOGICAL: Cranial nerves II-XIl intact. Motor 5/5 throughout. No focal weakness. SKIN: No track marks, multiple tattoos. No rashes, ecchymosis or erythema. PSYCHIATRIC: Elevated mood, hyperverbal. Positive paranoia, delusions and auditory hallucinations. Denies suicidal or homicidal ideation. LABORATORY DATA: None. EMERGENCY DEPARTMENT COURSE, TREATMENT AND DISCUSSION: The patient was seen and evaluated plus placed on medical treatment and was given Ativan 1 mg orally for his intermittent agitated behavior. The psychiatric resident was consulted who agrees with emergency department assessment of bipolar disorder with manic episode with psychotic features. There is no evidence of toxic ingestion, endocrine or neurological or other medical disease at this time, given that he has a normal exam and normal vital signs. The patient is medically cleared. DIAGNOSTIC IMPRESSIONS: 1. Manic episode. 2. Bipolar disorder. 3. Psychosis. DISPOSITION: Transfer to Thalians voluntarily. DISCHARGE CONDITION: Stable. KIRK PATRICK BURGAMY, M.D.:10496 This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 133 Cedars-Sinai Medical Center” Page 2064 SHABSISM-15PPR-03499 @d CEDARS-SINAI MEDICAL CENTER. SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M Adm: 12/13/2009, D/C: 12/13/2009 ED Notes (continued) ED Provider Notes signed by Burgamy, Kirk Patrick, MD at 1/5/2010 10:59 PM (continued) Version 1 of 1 KB/MEDQ/399178809 D: 12/13/2009 16:11:51 T: 12/13/2009 19:29:43 JOB#: 508061 ED Notes by Poffenroth, Dallas, RN at 12/13/2009 4:09 PM Version 1 of 1 Author: Poffenroth, Dallas, RN Service: (none) Filed: 12/13/2009 4:09 PM Note Time: 12/13/2009 4:09 PM Editor: Poffenroth, Dallas, RN (Registered Nurse) Pt now resting on guerney, watching TV. ED Notes by Poffenroth, Dallas, RN at 12/13/2009 3:55 PM Author: Poffenroth, Dallas, RN Service: (none) Filed: 12/13/2009 3.56 PM Note Time: 12/13/2009 3:55 PM Editor: Poffenroth, Dallas, RN (Registered Nurse) Author Type: Registered Nurse Status: Signed Version 1 of 1 Author Type: Registered Nurse Status: Signed Pt continues to pace in room; standing up to eat food provided per his request. Attempts to come out of room to talk with staff, remains hyper verbal. ED Notes by Englemann, Lauren, RN at 12/13/2009 3:54 PM Version 1 of 1 Author: Englemann, Lauren, RN Service: (none) Filed: 12/13/2009 3:54 PM Note Time: 12/13/2009 3:54 PM Editor: Englemann, Lauren, RN (Registered Nurse) Sybil, cp at bedside as sitter. ED Notes by Englemann, Lauren, RN at 12/13/2009 3:30 PM Author: Englemann, Lauren, RN Service: (none) Filed: 12/13/2009 3:31 PM Note Time: 12/13/2009 3:30 PM Editor: Englemann, Lauren, RN (Registered Nurse) Psych resident at bedside speaking with pt ED Notes by Poffenroth, Dallas, RN at 12/13/2009 2:57 PM Author Type: Registered Nurse Status: Signed Version 1 of 1 Author Type: Registered Nurse Status: Signed Version 1 of 1 Author: Poffenroth, Dallas, RN Service: (none) Filed: 12/13/2009 3:24 PM Note Time: 12/13/2009 2:57 PM Editor: Poffenroth, Dallas, RN (Registered Nurse) Author Type: Registered Nurse Status: Signed Patient minimally cooperative with care; given Lorazepam as ordered. Per Dr. Bergamy, pt on detainment at this time. Pt moved to room 15; will have clothing and belongings secured. Clinical This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 134 Cedars-Sinai Medical Center* SHABSISM-15PPR-03500 Page 2065 z SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER Adm: 12/13/2009, D/C: 12/13/2009 ED Notes (continued) ED Notes by Poffenroth, Dallas, RN at 12/13/2009 2:57 PM (continued) Version 1 of 1 partners with pt and mother at this time. Pt will be observed by clinical partner. Awaiting psych evaluation. ED Notes by Gonzalez, Sylvia, RN at 12/13/2009 3:20 PM Version 1 of 1 Author: Gonzalez, Sylvia, RN Service: (none) Author Type: Registered Nurse Filed: 12/13/2009 3:20 PM Note Time: 12/13/2009 3:20 PM Status: Signed Editor: Gonzalez, Sylvia, RN (Registered Nurse) Bed:15 Expected date: 12/13/09 Expected time: 3:01 PM Means of arrival: Comments: ED Notes by Poffenroth, Dallas, RN at 12/13/2009 2:53 PM Version 1 of 1 Author: Poffenroth, Dallas, RN Service: (none) Author Type: Registered Nurse Filed: 12/13/2009 2:57 PM Note Time: 12/13/2009 2:53 PM Status: Signed Editor: Poffenroth, Dallas, RN (Registered Nurse) Pt received fully ambulatory; color good, skin warm and dry. Mother is with pt at this time. Mother states pt has become increasingly paranoid since discharge from psych unit 4 days ago. Pt states he is taking his medications as prescribed. Mother states he has H/O bipolar; was hospitalized after methamphetamine use. Pt denies any thoughts or hurting himself or others; mother feels he made a threatening remark at home; she feels he may hurt someone. Pt is intermittently loud and hyper verbal at this time. ED Notes by Reese, Shannon, RN at 12/13/2009 2:41 PM Version 1 of 1 Author: Reese, Shannon, RN Service: (none) Author Type: Registered Nurse Filed: 12/13/2009 2:42 PM Note Time: 12/13/2009 2:41 PM Status: Signed Editor: Reese, Shannon, RN (Registered Nurse) Pt mom called 911 for behavior pt has known psych disorder. Pt denies psych hx or need for hosp. Pt is with mom. ED Notes by Reese, Shannon, RN at 12/13/2009 2:41 PM Version 1 of 1 Author: Reese, Shannon, RN Service: (none) Author Type: Registered Nurse Filed: 12/13/2009 2:41 PM Note Time: 12/13/2009 2:41 PM Status: Signed Editor: Reese, Shannon, RN (Registered Nurse) Pt mom states pt took meth and has been acting out. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 135 Cedars-Sinai Medical Center” Page 2066 SHABSISM-15PPR-03501 CASE MANAGEMENT ASSESSMENT FORM DATA DATE/TIME: 01/22/2010 3:39 pm FOCUS DATE: 12/14/2009 PATIENT NAME: SHABSIS MICHAEL MRN: 020634384 CURRENT HOME LIVING SITUATION: Pra SITUATION: ADULT OR MINOR CHILDREN: KEY CONTACTS: EXISTING HOME CARE: EXISTING DME: FUNCTIONAL STATUS PRIOR TO ADMISSION: MENTAL STATUS: HISTORY OF: HISTORY DETAILS: TRANSPORTATION (ANTICIPATED) AT DISCHARGE: CURRENT COMMUNITY RESOURCES: HEALTH PLAN / FUNDING: ANTICIPATED TRANSITION AND / OR DISCHARGE PLAN: PATIENT'S UNDERSTAND OF TRANSITION AND / OR DISCHARGE PLAN: ANTICIPATED DISCHARGE DATE: CSMC REFERRAL: CSMC REFERRAL DETAILS: RISK FACTORS: RISK FACTORS DETAILS: CASE MANAGER/SOCIAL WORKER: SIGNATURE: COMMENTS: HOME W/FAMILY LIVES WITH ROOMMATE JACK 818.571.3534 MO. IRENE 818.445.5008 PT'S ADDRESS: 1221 SPAULDING AVE. # 108 L.A. 90046 NONE NONE INDEPENDENT co PERSECUTORY DELUSIONS, BELIEVES THE DEVIL'S OUT TO KILL HIM NON-COMPLIANCE MULTIPLE HOSPITALIZATIONS ETOH / DRUGS VIOLENT BEHAVIOR PSYCHIATRIC ISSUES KICKED JULIA MEW HERE THIS INPT. EPISODE SELF OR FAMILY/FRIEND TAXI GRANDMA GIVE MEDS DAILY @ PT'S. RESIDENCE PER RMMATE JACK UBH / BLUE SHIELD PPO OUTPATIENT PROGRAM PT. WANTS TO "GET OUTTA HERE" 12-21-09 NONE POSSIBLY PHP HERE IF THEY WILL ACCEPT NON-COMPLIANCE SELF NEGLECT HX OF ETOH, METH AND MJ Lau,Colleen A CHART REVIEWED, MET WITH PT. IN CONFERENCE ROOM WITH REST OF TREATMENT TEAM. PT. UNCOOPERATIVE WITH THIS WRITER RE: D/C PLANNING @ THIS TIME, LAST INPT, EPISODE A TENTATIVE D/C, FOLLOW UP PLAN WAS IN THE WORKS. IF PHP HERE WOULD NOT ACCEPT PT., THEN THE IN NETWORK DUAL DX PHP'S WERE BROTMAN 310.836.7000 OR LESS OF AN OPTION ACTION FAMILY COUNSELING 800.367.8336. THE INS. CASE MGR. DOUBTS THE LATTER COULD HANDLE THIS SEVERE A PT. THUS PHP HERE @ CSMC OR BROTMAN WOULD BE MORE IDEAL. WILL ASSIST WITH FURTHER D/C NEEDS 12-15-09 CHART REVIEWED, DISCUSSED WITH YULIA, R.N. AND JANE VAN LOON, MFT. PT. HYPERRELIGIOUS, HYPERSEXUAL, GRANDIOSE, WITH MAGICAL THINKING, INTRUSIVE, NEEDS ALMOST CONSTANT REDIRECTION, AND 1:1. VERY DIFF FOR STAFF TO REDIRECT, AS PT. THINKS FEMALES ARE THE DEVIL AND THEY ARE EASY TO KILL. ? CHEEKING MEDS, CLAIMS STAFF ARE THE KKK, HAD IM COCKTAIL LAST NIGHT, NOW SEROQUEL PRN ORDERED, INTRUSIVE, THREATENING, WAS TRANSFERRED TO 3E AND MAY TRANSFER BACK wn TO 3W AS SOON AS SELECT PEERS THERE LEAVE..MO. REQUESTING CONSERVATORSHIP, AS WELL AS INSURANCE WOULD LIKE FOR IT TO BE CONSIDERED ALSO, DR. REVOREDO 12-17-09 CHART REVIEWED, IN THE LAST SEVERAL DAYS, PT, RECEIVED SEVERAL IM LM-2757 SHABSIS, MICHAEL 020634384 Cedars-Sinai Medical Center” Cou IN MEN 24313, SHABSISM-12PPR-02253 Page 852 CASE MANAGEMENT ASSESSMENT FORM DATA DATE/TIME: 01/22/2010 3:39 pm PATIENT NAME: SHABSIS, MICHAEL FOCUS DATE: 12/14/2009 MRN: 020634384 COCKTAILS, AS WELL AS PO COCKTAILS FOR IMPULSIVE, AGITATED BEHAVIOR, SPITTING ] AND VERBALLY ABUSIVE. PT. DECLARED HE WILL NOT TAKE MEDS WHEN HE LEAVES. PROVOCATIVE, INTRUSIVE, GRANDIOSE AND PERSECUTORY DELUSIONS. PT. REQUIRES MUCH REDIRECTION. TRILEPTAL STARTED. PT. PLACED ON 14 DAY HOLD. POSSIBILITY OF CONSERVATORSHIP LOOMING AHEAD, DEADLINE 01-04-10. MOTHER REQUESTED SS1 AND CONSERVATORSHIP INFO. ATTEMPTED TO CALL HER, PHONE # ANSWERED WITH "THIS SUBSCRIBER NOT ACCEPTING CALLS @ THIS TIME". WILL ASSIST WITH FURTHER D/C NEEDS PRM svissimmaissssesisiramionsetis imssnass is smvissinssosvrorssu Gila ses sioses 12-28-09 PT. "CONTINUES INTERMITTENTLY AGITATED, HIT HEAD AGAINST WALL OVER WEEKEND, IRRITABLE, ANXIOUS, WITH RACING THOUGHTS, HAD PO / IM COCKTAILS. HALDOL INC., HALDOL DEC ORDERED, FAM. MTG MO/DR. GROSS TODAY, POSSIBLY LEANING TOWARDS CONSERVATORSHIP.... 0s crsevesnssrronsnsanssasas CAL............ 12-31-09 PT. THIS WEEK PT. IN FAM. MTG. PT. SLAPPED MO. ACROSS FACE HARD, BANGED HEAD AGAINST WALL SO HARD, WALL WAS CRACKED AFTERWARDS. LATER IN WK., PT. GOT FRUSTRATED AGAIN ABOUT BEING HERE, BANGED HEAD ON FLOOR REPEATEDLY, HAD IM COCKTAIL, CONTD. SCREAMING. POOR INSIGHT. INSURANCE MD DR. BAILEY WANTED DR. GROSS TO "CLEARLY START ANOTHER ANTIPSYCHOTIC GIVEN PT'S. BEHAVIOR", LIKE STARTING PROLIXIN, RISPERDAL OR INVEGA IN HOPES THAT THESE COULD BE GIVEN TO PT. IN LONG ACTING FORM. PER DR. GROSS, JUST GAVE HALDOL DEC 100 MG IM, WILL NEED TO WAIT FOR RESPONSE. ALSO INS. DR. BAILEY WANTED PT. TO 8E CONSIDERED FOR ALTERNATIVE MOOD STABILIZER EITHER DEPAKOTE OR LI+ AND POSSIBLY HAVE IT REPLACE TRILEPTAL. HOWEVER PER DR. GROSS DUE TO LOW PLATELET COUNT AND PAST ISSUE WITH THROMBOCYTOPENIA, PT. NOT SUITABLE CANDIDATE FOR DEPAKOTE. ALSO A LI+ TRIAL WOULD NOT BE SAFE, GIVEN PT'S. LACK OF INSIGHT AND NONCOMPLIANCE, AS IT WOULD POSE SAFETY RISKS TO PT...THIS eo WRITER ALSO MET WITH MO., EXPLAINED CONSERVATORSHIP PROCESS, GIVEN : LITERATURE, ENC HER TO ATTEND FAM./SIGNIF. OTHERS SUPPORT GROUP ON WKEND AS SHE SAID SHE DOES NOT KNOW WHAT TO SAY TO PT. WHEN HE BEGS HER TO BE RELEASED, EVEN THOUGH HE HIT HER THIS WEEK. CONSERVATORSHIP APPLICATION PENDING........... CAL. 01-04-10 CHART REVIEWED, MET WITH PT., WHO VERBALIZED RESISTANCE TO CONSERVATORSHIP APPLICATION WHICH WAS SENT TO COURT "FILED" TODAY. OVER NEW YEARS WEEKEND, PT. THREW CHAIRS IN DAYROOM, THREATENED STAFF, KICKED WALL, PATIO WINDOW, CALLED STAFF KKK, BARGED DOOR, REFUSED REDIRECTION, GOT HALDOL a IM COCKTAILS X 2, THORAZINE 100 MG IM X 1, ANOTHER HALDOL POL AND THEN THORAZINE PO Q 6 HRS. PRN. TRILEPTAL D.C.ED, TEGRETOL STARTED AND TEGRETOL LEVEL ORDERED FOR TOMORROW. TODAY PT. BANGED ON NRSG STATION DOORS WITH ALL HIS STRENGTH, GOT ANOTHER IM COCKTAIL. PT. INTRUSIVE, INAPP SEX., SUSPICIOUS, HOSTILE, ARGUMENTATIVE, INT PREOCCUPIED, WITH RACING THOUGHTS. .......ocvnnnnns CAL... 01-06-10 PRESSURED SPEECH, ANGRY, HOSTILE, INTERNALLY PREOCCUPIED. PT. PROVOCATIVE/TEASED PEERS, RECEIVED HALDOL 5 MG PO PRN IN LAST 24 HRS. PT. ANNOUNCED PLANS TO MOVE TO IRELAND AND HAS NO PLAN ON HOW TO GET THERE, WHAT HE WILL DO FOR $ OR WHERE HE WILL LIVE. REQUIRES PROMPTS WITH ADL'S..CAL. \ 4 ZN MS) i vy 4 LM-2757 ‘ / a BMY = SHABSTS, MICHAEL 020634384 Cedars-Sinai Medical Center* Page 853 SHABSISM-12PPR-02254 CASE MANAGEMENT ASSESSMENT FORM DATA DATE/TIME: 01/22/2010 3:39 pm PATIENT NAME: SHABSIS, MICHAEL FOCUS DATE: 12/14/2009 MRN: 020634384 ww» 01-11-10 CHART REVIEWED, MET WITH PT., IN CONFERENCE ROOM WITH REST OF TREATMENT TEAM, OVER WEEKEND, PT. BECAME AGITATED RE: HAVING TQ STAY INPT. UNTIL CONSERVATORSHIP HEARING, NOW SCHEDULED FOR 01-25-10. PT. DEROGATORY, HYPERVERBAL WITH RAPID, PRESSURED, HALTING SPEECH, RACING THOGUHTS, ANXIOUS, ANGRY, LABILE, INTRUSIVE, PROVOCATIVE, ARGUMENTATIVE, HYPERSEXUAL. THREW DAYROOM GARBAGE CANS, BANGED PAYPHONE, SLAMMED DOOR, YELLED, ATTEMPTED AWOL, WAS NOT REDIRECTABLE. RECEIVED 2 IM COCKTAILS, SEVERAL KLONOPIN PRN'S, KLONOPIN INCREASED. THIS AM WALKED QUT OF CONFERENCE ROOM DURING ROUNDS. WILL CONTINUE TO FOLLOW CASE AND ASSIST WITH D/C PLANNING, AT THIS POINT, MAY REQUIRE LOCKED PLACEMENT .ccooicssseuscanssarinssissncasnsarannsanasasnniasens CAL 01-18-10 PER STAFF PT. HAD HIT PHOTO DISPLAY GLASS CASE IN HALLWAY WITH FIST LAST WEEK. CONTINUES TC BE ANGRY, THOUGH SLIGHTLY LESS SO TODAY, CHART REVIEWED, MET WITH PT. IN CONFERENCE ROOM WITH REST OF TREATMENT TEAM. PT. PREQCCUPIED, ENTITLED, WANTS TO BE TRANSFERRED TO 3 EAST. PER NRSG. STAFF = VIOLETTA CHAIT, R.N., PT. NEEDS ALMOST CONSTANT REDIRECTION, REQUIRES PROMPTS WITH ADL'S, SEDUCTIVE, PROVOCATIVE WITH FEMALE SELECT FEMALE PEERS. GUARDED, INAPPROPRIATE, INTRUSIVE, WITH RAPID SPEECH. HAS CONSERVATORSHIP HEARING SCHEDULED FOR 01-25-10........ccoonnd CAL... 01-19-10 CHART REVIEWED, MET WITH PT., IN CONFERENCE ROOM WITH REST OF TREATMENT TEAM. PT. EXCLAIMED, "I'M MANIC, I 'M GRANDIOSE, I'M DOCILE, 1 DON'T GET UNSTABLE." HAD THORAZINE LAST NIGHT FOR ANXIETY AS REQUESTED. ELOS Q = 7 DAYS, TREATMENT PLAN, 1S ANOTHER DOSE OF HALDOL DECANOATE TODAY , CONTINUE CURRENT MEDS, TALK WITH FA. RE: PLACEMENT OPTIONS. CURRENTLY PT. HAS HIS APT. WITH ROOMMATE, QUESTION IS WILL PARENTS CONTINUE TO PAY FOR THIS OR INSIST HE BE PLACED IN A B+C OR OTHER SETTING? DISCUSSED THIS WITH PT'S. FA DIMITRI 310.409.5969 ALONG WITH CONSERVATORSHIP HEARING 01-25-10. HE AGREED TO DISCUSS THIS FURTHER WITH DR. MIGLANI. PT. WILL BE ACCOMPANIED TO CONSERVATORSHIP HEARING WITH AN OFF DUTY POLICE OFFICER ESCORT PER DAVID w KARCHER, NURSE MGR..CAL - 01-22-10 CHART REVIEWED, MET WITH PT. IN CONFERENCE ROCM WITH REST OF TREATMENT TEAM. PT. ASKED ABOUT GETTING STIMULANTS PRESCRIBED TO HELP FOCUS. PT. DISCLOSED HE TOOK HALDOL PRN YESTERDAY TO "ZONE OUT." FATHER DIMITRI 310.409.5969 CALLED AND SAID IF PT. WINS CONSERVATORSHIP HEARING MON 01-25-10 HE WILL GO BACK TO HIS SHARED APT...FATHER DID NOT INDICATE HE WOULD HAVE PT. GO TC A B4+C PLACEMENT @ THIS TIME. PT. STATED, "MY LIFE IS EMPTY. ] WANT TO GO TO SLEEP. THE ENERGY HERE 1S VERY DRAINING." AWAIT OUTCOME OF CONSERVATORSHIP COURT HEARING 01-25-10... PT. EXPECTED TO GO WITH OFF DUTY POLICE OFFICER PER DAVID KARCHER......ccoocvenieieinnnnc CALL, we LM-2757 SHABSTIS, MICHAEL (020634384 Cedars-Sinai Medical Center* Page 854 SHABSISM-12PPR-02255 EXHIBIT 4 Wai B&B LOS ANGELES COUNTY - DEPARTMENT OF MENTAL HEALTH ~ OF :E OF THE PUBLIC GUARDIAN TE APPLICATION FOR MENTAL HEALTH CONSERVATORSHIF INVESTIGATION : CL (PLEASE TYPE OR PRINT| PAGE 1 of 5 - crs ee ----- | --- ae \ G OFFICE ONLY Send Original and one copy to: PG Case #: - Office of the Public Guardian 320 Wes! Temple St., 8% Floor Pps i (213)974-0515 (General Info) Assign To: sR - |" 074.508 (New cases) - . __“ 226:2927 (County Cou nsel) Serre fy -- (213) 65.1 ~47%((Primary PG) g "62-1405 (Back-up Fax #) Comments: {|v 22''-8865 (Public Defender Fax 2) A ---------- ei mt I. REFERRING AGENCY OR FACILITY (Must be designated by County Mental Health ) NamelEDARS ~ SInA( Me (cdl CENTER Date sree: 8730 ALDEN DR. ‘Ward/unit 3_ WEST ® Lh. ef see. (A Zip: Qo0048” rescnsal as. dF Contact Pe rson COLLEEN Lav, 2. v, m.S AL mn ce a------------- ee 11. PATIENT NAME: MICHAEL SHABSIS AKA: t idd Last ; $ ca SNA meds cal center THRALIA NS 3 WEST Current Address; § 730 RlLdew be, (Where the patient is now) Facility Name (if any) Number Street } any: LA state: CA zo: 400 YF Tels (3/0 HR3 39) Home Address: 19a SPAULDING AVE. 4 10% fw Faciltly Name (if any) Nume r Street City: L.A state CR Zp 10046 1a 8I§ ) S#. 3555 Age: 24 Birthdate” a0. £5 Birthplace Sex: M _ Race/Ethnicity : 608. Religlon: SSN: Marital Status, S Co. Mental Health MIS# Education Level A <_. Veterans? Yes NO v VA. # Last or Usual Occupation: SALES] ARN K LEIN__STORG Medi-Cal #: Medicare #: Driver Licens e# State: Expires Height: 2 FT. Weight: b0¥ Hair Color; ERoW nN Eyes Colors GREG 1 [- (If any) - | B me ee Ree Sm I LAC 7 PE Dame mm Eidmmtlal Datiant TRfArmMarinn - Goa Walfare A Tnetitiions Code 53 28 wEso lined QAN/IONA RAT=I -uoly wdggilg 60-10-) Tmimy SHARBSTS,MTCHAEL 020634384 Cedars-Sinai Medical Center” Page 366 SHABSISM-11PPR-01764 LOS ANGELES COUNTY - DEPARTMENT OF MENTAL HEALTH - C:FFICE OF THE PUBLIC GUARDIAN APPLICATION FOR MENTAL HEALTH CONSERVATORSHIP INVESTIGATION @ rien nave MOL, SHABSYS (PLEASE TYPE OR PRINT) PARTNERS ISA, SPOUSE, RELATIVES, FRIENDS, TT = OTHERS Page 20f5 ITI. RELATION NAME HY | TEL ¥ 5 0 0% 1452 moor JR PARK ST. &0 1. MOTHER If cory, 91604 BIS. : 2 FATHER DIMTRYSHAB SIS = (yest tour weed, CA | LRAND ER Bony seovoky [123] ES gue. E03 333.961.5770; Zo FBG anion 4. Gi) mo hin SHALSIS cover cuyy, cA , | tv. INCOME (List all known or possible sources of income) : : - SOURCE © PAYE ) MONTHLY AMT social Security/sst ____ Veterans Comp/Retirement Z Ea Other Specify SHI Fl. | 100 _ Other Specify, = I ------------ V. ASSETS [ J Real Property [ 0 Furniture [ VY Car/Motor Vehicle [ 1 Mobile Home [ Bank Account(s) [ ] Life Insurance [ ] Stocks/Bonds/Notes [ w® (Specify): Describe all known assets: ITEM LOCATION OR ID# VALUE (If known) 1. 2 3; 4, -e i ®.. ar any) FD. MOTHEASTRTED “I THAK HE Meds TIMS. SeveRRL TIES. a bio, Ur prom The NET oN hit Etch P NAKED, COVED | HAC 7) DC Dhfmeral renfrantial Patient Tnfarmation - See Welfare & Institutions Code 5328 11h=d OANZINA' A CR7.] -Wosd UdRF: 10 AN=jN=130 SHABSIS,MICHAEL 020634384 Cedars-Sinai Medical Center* Page 367 SHABSISM-11PPR-01765 LOS ANGELES COUNTY - DEPARTMENT OF MENTAL HEALTH - OFFI 2E OF THE PUBLIC GUARDIAN x DECLARATION IN SUPPORT OF LPS CONSER''ATORSHIP ) gf = OR PRINT : ) Page 3 of 5 VEPATIENT MICGAREL SHABSIS Facility /Agency Lears - Saal _mép cpt CENTER + 72 Hr, Hoid date 8[(309 14 Day cert. Efi. Date 3e| 09 _* 30 Day Cert. £7. Dare 13/30/07 *Note: No T-Cons. will be granted on 30 dav certs, Application must b+ received by PG with 3 minimum of 25 davs remaining on the 30 day certification, 1S PATIENT CURRENTLY IN AN INTENSIVE TREATMENT FACILITY? Yes X] No[ ] Penal Code No. . Exp. Date If no = I hereby certify that further examination on, an in-patient basis is not necessary for a determination that this padent Is gravely disabled). recommending conservatorship for the above-referenced person. 1 believe he or she is hot able to provide &- or her personal needs for food, clothing, or shelter as = result of & mental disorder and is: DX Unwilling or [ ] Unable to accept voluntary treatm: at. Diagnosis: By gc {a Dh seca A 22 4. DSM IV Classification number __27¢ . 44 SuRdfic facts or Incidents that demonstrate the patient is gravely disable! and is unwilling or unable to accept voluntary treatment: (Attach additional documentation If necessary). Valiant Asolo tocegt Syovoteens oN was neluchac, oon beckian, , J 3 So J 1p lsd as wve\\ as © ACANG On + @ J] No er The patlent’s privilege of possessing a license to oper 2 a -- vehicle should be revoked. Reasons: Tt & iy Yes (¥ Nog os € possession of a firéarn or other deadly weipon by the patient present a danger . to his or her safety or to other perso Rs? oy Reasons: Tocearena and _assac\tive, ‘owards oars & 3 VII. I declare under penalty or perjury that the forizgoing is true and correct and I recommend a temporary Conservatorship. or on Date: California =< ure of Sa Evaluator Sfgriature of Physician In che.“ge of Facility or his/her designate Kathering, Reverecks Lows rence LEn. mo. PRINT OR TYPE NAME & TITLE PRINT OR TYPE NAME & TITLE NOTE: Treating physician may be required to testify In Court. TTI -Ty Famfidmntial Dotiant Tnfarmatian - See Welfare & Tne:lhitions Code 5328 120-4 800/£00°d 862-1 -Bo1y wdgg:ig §0-L0-330 SHABSIS,MICHAEL 020634384 Cedars-Sinai Medical Center” Page 368 SHABSISM-11PPR-01766 LPS CONSERVATEE INITIAL TREATMENT PLAN di . Page 4 of 5 LE -- Faclity: Ce DARS -. SIAL NED CRC _CENFER : THA AN = weT NameJH QBS (S MICHAEL poe:5.%0.85 HiSN: (Last) (First) Partlclpants: __ Consumer, ___ Family Member, specify ._ Other, specify. Principle Diagnosis (DSM IV) refated to Grave Disability: Bigalac Asordec at po. A car 25-30 Rerer to In order physicloglc dysfunction contributing the psych sacla¥occupatio agpressivaness/homicidal Ideation dissociative familly discord specific impulse/gensaral impulsivity suicidal thoughts/salf-destruetiveness self-malntenance of of disorders of disorder of of Souls related to reduction of grave disability acommended discharge setting: x Home, ___ Assisted Living, __ Open Rasige | R esldentlal 124%! Jo 9 L No ay a ion \ anned Review Date: Clinician Signature & Licensure: (ined anA/eOn‘d RR7=] -00J4 WAGE: |e GO-L0-390 SHABSIS,MICHAZL 020634384 Cedars-Sinai Medical Center* Page 370 SHABSISM-11PPR-01768 $45 (LPS Referral) : Be LOS ANGELES COUNTY - DEPARTMENT OF MENTAL HEALTH OFFICE OF THE PUBLIC GUARDIAN Lo . . Page 5 of 5 arent nave MCHREL 5 Hab SIS (PLEASE TYPE OF PRINT) YEMARIKS; (Use this page for additional remarks or information identify si: ztion additional documentation may be attached). XM ana old Cov casian ale w AA, on Ags : a {ack ET Wn Nao \usshe Mga. Roe ace, Moen on, geonauntecl {ea we AA Fuopaphemy ole snd i Gey; dation a ie \ Parent bas { gp ve, wih tne Tewnshh _Hessialn |, Mcecden Grand= Olde Wooecuse. We dees net Noi lode, WA Eel” pose WAS ofa Patek beavis acy rede on ONY cequirt abrouraselar- madkiahion fr viclavtr outlaucst . Pabank alse ® mothe on Lwe.. Avewey A Cid Meghna whan ve \Lvecume dicikailanid) Pah wnt nas Ai speed perseorty ais ons - wk has heard pect ent nan he wants to kW uf and bomb ould ivey = bok patont AGRE. Hl cepted do moter price de Wa ney acim ted to Har We ied net Hust =) members and BH bespited people wed out Jo ot he Pr WneL UU posneluats ie Yeam re conmands consecvodters hig ror colin, | prhints lrgstarcling hiskey of mothple. hospitalizations ~ acd hstomy ob rencump livres to DS Referral) «0 Jd WdRF: IN AN=In=320 10a chnzann- J RY. SHABSIS, MICHAEL 020634384 Page 369 Cedars-Sinai Medical Center* SHABSISM-11PPR-01767 q CONSERVATOR\ATTORNEY : | © DIMITRY SHABSIS PRO/PER FED 1411 N. CURSON AVE APT 1 LOS A + Ad ry LOS ANGELES CA 90046 IE inl OR COURT o (310) 409-5969 JAN 5 25 SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELESM ,.. -..- Lisa MENTAL. HEALTH DEPARTMENT Vdd TT TT TT me BreRIesEn egy Case Number In the Matter of { ZE034292 The Conservatorship of MICHAEL SHABSIS LETTERS OF CONSERVATORSHIP (Mentally Disordered) STATE OF CALIFORNIA, County of Los angeles: DIMITRY SHABSIS is/are hereby Appointed Conservator of the PERSON ONLY of the aboved named Conservatee with the powers as set forth in the "Order Appointing Conservator" These letters shall be in effect for a period of one year from (Date) C€1/25/10. WITNESS, John A. Cl Clerk of the above entitled court, with the By crder of the Court of 1 iperior Court of Lalifornia, Col YO T.os Angeleg. By FR RU r 2 3 John sllarke, Executive Officer/Clerk FIRMET TON ~*~ VEU I solemnly AFFIRM that I will perform according to law l\the duties of Conservator of the PERSON for the above named ® Conservatee =F 0, at Los Angeles, California. DIMITRY SHABSIS CERTIVFICATTION I hereby certify that the foregoing is a correct copy of the original and that said letters have not been revoked, on file in my : pend are still in [full force and effect. Dated: of California, JAN 25 2010 oe , Deputy ive QOfficer/Clerk SHABSIS,MICHAEL 020634384 Cedars-Sinai Medical Center” SHABSISM-14PPR-03010 Page 1576 L SHABSIS, MICHAEL Cedars-Sinai Medical Center” CONSERVATOR'S (Please Print) NAME: Pina tr Ih 55) =U Sy = Aqesys | ADDRESS: /Y/] A. Curso, Ave irae cry. Los Angeles _ state. Ca J ZIP CODE: 9 CCY(» TELEPHONE: HOME (3/0) 409-5 569 Clerc) DAY -_- SUPE SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGE! £5 Conservatorship of Michael Shabses Conservatee } ) ) ) ) ) The Honorable MELISSA N. WIDDIFIELD Day of - "2 ___ __ inDepartment 95-B. The Court finds as follows: The petition for (ws)appointment of a conservator for the above-named Conservates came gp ave been given. Evidence in support of th regularly for hearing on this day. All notices required by law H 1 Case Number MREE) (OD 34.29 5 ORDER (igs) APPOINTING CONSERVATOR Pursuant to Lanterman-Petris-Short Act (W.1.C, 5350 gt seq , Judge {i ORIGINAL py gy) AN 25 2010 A LOS ANGE gg RIOR COURT ~- 1 presiding this [1] petition has been produced and presented. The Court finds that the conservatee is gravely disableq ang lacks capacity to consent to psychotic medication, The Court grants only those powers and imposes thode disabilities that it has checked beiow, Ad to each checked power or disability, the Court finds that the evidence Presented establishes that the J or power or disability is necessary to the care, custody, maintenance and protection of the conservates, Ng additional power shall be granted nor disability imposed except upon a duly-noticed hearing in which the necessity and propriety of the power or disability is established. NOW, THEREFORE, IT IS ORDERED: 1. That pD 11 A Lad Sh “bss be (m)appointed conservator for the PERSON ONLY. 2. That be (re)appainted conservator of the PERSON anp ESTATE. nd in the amount of § Letters of conservatorship to issue upon posting of a hg Bond increased/decreased by 3 3. That be (re)appo ESTATE. (The acts of the conservator since the termin retroactive to the date of termination), Letters of conservatorship to issue upon posting of a bo Bond Increased/decreased by § This Order (W®)Appointed Conservatorship shail terminate on - -1/ Page 1 of 3 Revised: 02/14/08 020634384 nted conservator of the PERSON anDp ation are ratified ang the appointment is 1d in the amount of § Remaing Remains Date SHABSISM-14PPR-03011 Page 1577 In determining the placement of residence of the conservatee, the conservato strictive setting which is appropriate for the conser, conservator shall permit the conservatee to reside in a hom sO desires: [f the conservatee jg not to be placed in hig or h priority shall be to placement in a suitable facility in Californ the home of a relative. least re er own home or the home to transport, or cause another Conservator is authorized he County within the mea psychiatric facitit treatment plan to be es | cause an individualized en days cf the day of this order. The conservator shal . Section 5352.6 within t Welfare and Institutions Code designated under Welfare and Institutions Code the conservator shall promptly refer the matter to the Court. VEN THE FOLLOW CONSERVATOR SHALL BE GI EE IN RESPECT TO THE CONSERVAT 4. To place the conservatee in 3 private residence facility, board and care,-nursing or other into or, out of the premises. 5. To place the conservatee in a portion of a private acute care County hospital operated by the Regents of the Univers ity of California Government, whereat the conservatee hag free access inta or put of the hospital. 6. To place the conservatee in a medical or psychiatric nursing facility or other State licensed facility, whereat the conservatee does not have free abcess into or gut of the premis nate - == ty hospital facili further order of the Court, this power shall termi portion of a State of, Coun d States Govern 7. To place the conservatee in that operated by the Regents of the University of California or by the Unite acute care psychiatric hospital, whereat the conservatee does not have fre hospital. Pending further order of the Court, this power shall ‘einate 7arhe se hoy; o pl e disa . X 8. To require the conservatee toh the recurrence of his/her being gravely dis. , S 8a. To require the conservatee to accept psychotropic m ave treatment related abled. edications. Page 2 of 3 | Revised: 02/14/08 SHABSIS,MICHAEL 020634384 Cedars-Sinai Medical Center” SHABSISM-14PPR-03012 tee's care and needs. Where possible 1 e or other residential settin a as close as possible to h to transport, the conservatee to 3 ning of Welfare and Institutions Code, Section for intensive tablished as described in » Section 5352.6 fails or refuses fo establish such 4 pla ING POWERS psychiatric hospital, State or or by the United States ty or a hospital € access into or out of such ice hy acility-for The devetopmantaly, specifically to remedying or preventing the 8 g if the conservateg of a relative, first is or her home! or r shall choose hall e if the agency mn » Psychiatric or non-psychiatric residentig| care State licensed faciiity|whereat the Conservatee has free access or County eS. Pending ment or of a private -{ leh Page 1578 Cedars-Sinai Medical Center” THE FOLLOWING DISABILITIES AND NO OTHERS ® ARE TO BE IMPOSED ON THE CONSERVATEE X 9. The privilege of possessing a license to operate a motor vehicle. a The privilege of Possessing, controlling or maintaining custody of a firearm or any other deadly weapon. 10. The right to refuse or consent to treatment related specifically to the conservatee’s being gravely disabled. 11. The right to enter into an property. i 12. The right to refuse or consent to medical treatme anservatee’s being gra ourt finds that specific dvidence.s ® justify({ies)/the ithposiffons of thi: @®... 2; Page 3 of 3 MELISSA N. WIDDIFiELD Revised: 02/14/08 SHABSIS, MICHAEL 020634384 Y contract in which the consideration for performance is money or JUDGE|(R% OF THE - SUPERIOR COURT OF CALIFORNIA COUNTY OF LOS ANGELES SHABSISM-14PPR-03013 Page 1579 EXHIBIT 5 Dimitry Shabsis Shabsis vs. The Regents of the University of California Page 1 Page 3 1 SUPERIOR COURT OF THE STATE OF CALIFORNIA 1 APPEARANCES: 3 COUNTY OF LOS ANGELES - CENTRAL DISTRICT 2 For the Plaintiff, MICHAEL SHABSIS: 5 3 LAW OFFICES OF MICHAEL LIBMAN BY: MICHAEL J. LIBMAN, ESQ. 4 ~~ MICHAEL SHABSIS, AN INDIVIDUAL, ) 4 18321 VENTURA BOULEVARD, SUITE 200 ) TARZANA, CALIFORNIA 91356 5 PLAINTIFF, ) 5 (818) 995-7300 ) MJIL@LIBMANLAW. COM 6 6 VS. ) CASE NO. BC676668 For the Defendants, PFIZER: ) 7 7 THE REGENTS OF THE UNIVERSITY OF ) DLA PIPER - SAN DIEGO CALIFORNIA; RESNICK ) 8 BY: BROOKE KILLIAN KIM, ESQ. 401 B STREET, SUITE 1700 8 NEUROPSYCHIATRIC HOSPITAL AT UCLA; ) 5 SF THES, BeCTORRT SoG -iE AN ORGANIZATION, FORM UNKNOWN; ) (619) 699-2637 9 PHILIP COGEN, M.D., AN INDIVIDUAL; ) 10 BROOKE . KIM@DLAPIPER . COM COUNTY OF LOS ANGELES, A LOCAL ) 1: For the Defendant, PHILIP COGEN, M.D.: 10 PUBLIC ENTITY; LOS ANGELES COUNTY ) 12 LAW BRANDMEYER LLP , BY: MARYAM AZIZI, ESQ. SHERIFF'S DEPARTMENT, A LOCAL ) 13 2 NORTH LAKE AVENUE, SUITE 820 11 PUBLIC ENTITY; PFIZER, INC., A ) PASADENA, CALIFORNIA 91101 DELAWARE CORPORATION; AND DOES 1 ) 14 (626) 463-1307 12 THROUGH 200, INCLUSIVE, ) MAZIZI@LAWBRANDMEYER . COM DEFENDANTS. ) For the DEFENDANT, THE REGENTS OF THE UNIVERSITY OF 13 ) 16 CALIFORNIA: 14 17 FRASER WATSON CROUTCH 15 BY: EVAN A. GUZE, ESQ. 16 VIDEOTAPED DEPOSITION OF DIMITRY SHABSIS 18 100 WEST BROADWAY, SULTE, 650 GLENDALE, CALIFORNIA 91210-1201 17 TAKEN ON 19 (818) 543-1380 18 FRIDAY, April 13, 2018 EGUZE@WCLLLP . COM 19 20 20 For the DEFENDANTS, COUNTY OF LOS ANGELES AND LOS ANGELES 51 2 COUNTY SHERIFF'S DEPARTMENT: 22 IVIE, MC NEILL & WYATT 22 BY: CHANDLER A. PARKER, ESQ. 23 Reported By: 23 444 SOUTH FLOWER STREET, 18TH FLOOR 24 Sandra Mitchell LOS ANGELES, CALIFORNIA 90071 24 (213) 489-0028 C.8.R. 12553 CPARKER@IMWLAW . COM 25 Job No. 10041743 25 Page 2 Page 4 1 SUPERIOR COURT OF THE STATE OF CALIFORNIA 1 APPEARANCES (CONTINUED) 2 COUNTY OF LOS ANGELES - CENTRAL DISTRICT 2 3 Also Present: 4 MICHAEL SHABSIS, AN INDIVIDUAL, ) ) 3 5 PLAINTIFF, ) CHANCE LIEKKIO, VIDEOGRAPHER ) 4 6 vs. ) CASE NO. BC676668 . ) 7 THE REGENTS OF THE UNIVERSITY OF ) 6 CALIFORNIA; RESNICK ) 7 8 NEUROPSYCHIATRIC HOSPITAL AT UCLA; ) g AN ORGANIZATION, FORM UNKNOWN; ) 9 9 PHILIP COGEN, M.D., AN INDIVIDUAL; ) COUNTY OF LOS ANGELES, A LOCAL ) 10 10 PUBLIC ENTITY; LOS ANGELES COUNTY ) 11 SHERIFF'S DEPARTMENT, A LOCAL ) a 11 PUBLIC ENTITY; PFIZER, INC., A ) 13 DELAWARE CORPORATION; AND DOES 1 ) 12 THROUGH 200, INCLUSIVE, ) 14 DEFENDANTS . ) 15 13 ) 16 14 Tt 17 16 18 17 19 18 VIDEOTAPED DEPOSITION OF DIMITRY SHABSIS, taken on 5 19 behalf of the Defendants, at 2000 Avenue of the Stars, 20 Suite 400, Los Angeles, California, commencing at 21 21 1:08 p.m., Friday, April 13, 2018, before Sandra 22 22 Mitchell, C.S.R. 12553, pursuant to Notice. 23 23 24 24 5% 25 Page 1..4 www.aptusCR.com Shabsis vs. The Regents of Dimitry Shabsis the University of California Page 61 Page 63 1 Q You were designated as the conservator; 1 MS. KIM: I'm sorry, guys. | think | only 2 correct? 2 copied one for you guys. 3 A That, I'm not sure. It was either me or my 3 BY MS. KIM: 4 first wife. | don't remember who it was, maybe it was 4 Q Okay. Mr. Shabsis, I'm going to help orient 5 both us. 5 you to the record. Do you see at the bottom of the page 6 Q Do you recall what factored into the decision 6 marked 3526 at the first page? Do you see that it lists 7 to establish a conservatorship? 7 on this record the date of admission December 13, 2009? 8 MR. LIBMAN: Objection. Calls for expert 8 MR. LIBMAN: Objection. The document speaks 9 opinions. Legal conclusions. 9 foritself. Instructs not to answer. He's not here to 10 THE WITNESS: Well, we were concerned with his | 10 read again documents. If you have a question -- 11 behavior and we were not certain if he could manage his | 11 MS. KIM: Is there a privacy or privilege 12 day-to-day operations, like finances, et cetera, or 12 objection too? I'm just trying to orientate him and 13 decisions to go to a hospital. 13 refresh his recollection? 14 BY MS. KIM: 14 MR. LIBMAN: What's the foundation for 15 Q Who was involved in the decision to file a 15 refreshing? He did not make this -- is there any 16 decision to file a petition for conservatorship? 16 foundation? 17 A Who was involved, what do you mean? 17 MS. AZIZI: The question was, "Do you see." 18 Q Did you and your ex-wife discuss it? 18 MR. LIBMAN: Do you see -- Okay. Do you see 19 A Yes. 19 anything? | mean the sense that thy think in this case 20 Q Did you involve Mr. Shabsis in those 20 is the least useful to people. Can you see? 21 discussions? 21 THE WITNESS: The date? 22 A | think so. He was aware. 22 BY MS.KIM: 23 Q Was there any -- strike that. 23 Q Can you see the date on this? 24 Do you recall when you first discussed 24 A Yes, |can. 25 obtaining a conservatorship over Mr. Shabsis? 25 Q Okay. Let's take a look at the third page of Page 62 Page 64 1 A I'm notsure. Could be after the first 1 the exhibit, and | don't need you to read it out loud. 2 incident or first hospitalization. Could be, but not 2 Butdo you see the third paragraph on the third page 3 sure. 3 beginning with "discussions"? Can you take a read that 4 Q Were you and your wife married? Were you and | 4 yourself and let me know when you're done? 5 Ms. Spitkovsky married at the time you establisheda | 5 A Which one would that be? 6 conservatorship? 6 Q Third paragraph beginning with "discussions 7 A Yes. 7 regarding." 8 Q Did you establish a conservatorship morethan | 8 A I'm notsure which page we are on. 9 once over Mr. Shabsis? 9 Q [I'msorry. Righthere. This paragraph. 10 A | believe only once. 10 A Okay. 11 Q What do you recall about the incident that led 11 Q Does that refresh your recollection that you 12 up to the decision to establish a conservatorship? 12 discussed having taking -- or establishing a 13 MR. LIBMAN: Objection. Assumes facts notin 13 conservatorship over Mr. Shabsis in 2009? 14 evidence. Argumentative. 14 MR. LIBMAN: Objection. Improper attempt to 15 THE WITNESS: I think it was just the first 15 refresh recollection. Lacks foundation. This is nota 16 experience for us, and maybe Dr. Lavretsky suggested 16 document believe that you established he has authored. 17 that would be -- this would be a good thing. And that 17 This is a complete hearsay within hearsay. You're 18 since it's been a while ago, | don't have much to add. 18 having him to comment on something for the first time 19 BY MS. KIM: Mr. Shabsis, I'm going to see if | can 19 and you're asking him to basically authenticate it 20 refresh your recollection. I'm going to mark as 20 improperly. 21 Exhibit1, a medical record Bates labeled 15PPR 21 What was the question again? 22 03526 through 29. 22 (Whereupon, the record was read back 23 (Exhibit 1 was marked for 23 by the Court Reporter as follows: 24 identification by the Court Reporter 24 "Q Does that refresh your 25 and is attached hereto.) 25 recollection that you discussed Page 61..64 www.aptusCR.com Shabsis vs. The Regents of Dimitry Shabsis the University of California Page 73 Page 75 1 by the Court Reporter as follows: 1 BY MS. KIM: 2 "A Yes." 2 Q To beclear, Mr. Shabsis, I'm not blaming you 3 BY MS. KIM: 3 for-- 4 Q Why did you feel -- first of all, when you said 4 MR. LIBMAN: Sure she is. She's trying to 5 itwas important for Mr. Shabsis to take his medication, 5 building a case. 6 did you believe -- do you mean his medication relating 6 BY MS. KIM: 7 to his mental illness? 7 Q The question was, did you feel it was important 8 MR. LIBMAN: Objection. Misstates his 8 to establish a conservatorship? 9 testimony. Argumentative. 9 A Yes, that's why we got it the first time. 10 THE WITNESS: Itwas suggested by doctors. 10 BY MS. KIM: 11 That's why. 11 Q Why did you feel that way? 12 BY MS. KIM: 12 A Because we were faced with an unexpected events 13 Q Ithink the question I'm asking is, did you 13 in our life related to our son's change in behavior, and 14 feel it was important for Mr. Shabsis to take his 14 we felt that if we can have a control to take him to the 15 medications for his bipolar disorder? 15 hospital, when he doesn't feel it's needed, | mean 16 A Yes. 16 something like that. 17 Q Okay. Why is that? 17 Q Before 2013 did Mr. Shabsis, to your knowledge, 18 MR. LIBMAN: Calls for expert opinions. 18 believe he had a mental illness? 19 THE WITNESS: Itwas suggested by doctors as a 19 MR. LIBMAN: Objection. Calls for speculation. 20 treatment he has to take this, so any strange behavior 20 THE WITNESS: I'm not sure how to answer that. 21 doesn'toccur. 21 | mean -- 22 BY MS. KIM: 22 MR. LIBMAN: I'm not sure how to answer that is 23 Q Was there ever a period where you were aware 23 an answer. 24 that Mr. Shabsis had stopped taking the medications that | 24 BY MS. KIM: 25 he used for his bipolar disorder? 25 Q Is there anything else you needed to add to Page 74 Page 76 1 MR. LIBMAN: Objection. Overbroad. Vague and 1 make your answer complete? 2 ambiguous. 2 MR. LIBMAN: | thought the answer was complete? 3 THE WITNESS: Since we didn't live together, | 3 THE WITNESS: No. 4 cannot -- | cannot answer that, but | believe my ex-wife 4 BY MS. KIM: 5 might have mentioned something like that. 5 Q Okay. Did Mr. Shabsis ever say to you that he 6 BY MS.KIM: 6 thought he did not have a mental illness before 2013? 7 Q Whatdid your ex-wife mention? 7 MR. LIBMAN: Objection. Vague and ambiguous. 8 A Thatsometimes he doesn't want to take his 8 Calls for speculation. 9 medication. 9 THE WITNESS: | believe he mentioned that. 10 Q Did Ms. Spitkovsky say anything about how 10 BY MS. KIM: 11 Mr. Shabsis behaved when he wasn't taking his bipolar | 11 Q Whatdo you recall about what he said to you 12 medication? 12 about feeling like he didn't have a mental illness? 13 A | can'tanswer that because | think at times it 13 A He would basically say that he feels fine and 14 didn't take any effect, depending on which phase he 14 he doesn't need any of this, he doesn't help him. 15 would be in. And attimes he would get back to the 15 That's it. 16 behavior that brings him back to the hospital. 16 Q When you say, "he doesn't need any of this," 17 Q Okay. By which phase he was in, do you mean |17 what do you mean? 18 the manic versus the depressive cases? 18 A He doesn't need medication, I'm sorry. 19 A Yes. 19 Q Did he say why he felt he didn't need 20 Q Okay. Did you feel it was important o 20 medication? 21 establish a conservatorship over Mr. Shabsis? 21 A He would just explain, like, he feels great. 22 MR. LIBMAN: Objection. Vague and ambiguous. 22 Q Did Mr. Shabsis ever say -- explain to you one 23 Now you're blaming him? The conservatorship wasn't 23 way or the other whether the medication helped his 24 there for, you know, what are you guys coming up with 24 bipolar disorder? 25 here. It's his fault now, sorry. 25 A | don'tthink we had that kind of conversation. Page 73..76 www.aptusCR.com Shabsis vs. The Regents of Dimitry Shabsis the University of California Page 77 Page 79 1 Q Okay. Did Mr. Shabsis agree to the 1 recall. I know they had some arguments, but I'm not 2 conservatorship? 2 sure if I'm informed about like getting physical either 3 MR. LIBMAN: Objection. Calls for speculation. 3 ofthem. 4 THE WITNESS: | believe he was against it. 4 Q Which uncle does this refer to, is it your 5 BY MS. KIM: 5 brother or Ms. Spitkovsky brother? 6 Q Did you have a discussion with him about that? | 6 MR. LIBMAN: Objection. Argumentative. 7 A Well, we informed him that we will be seeking 7 Assumes facts notin evidence. It hasn'tbeen 8 conservatorship. 8 established there was a brother or uncle. You're 9 Q Why do you believe he was against the 9 testifying right now putting words in his mouth, you 10 conservatorship? 10 know. 11 MR. LIBMAN: Calls for speculation. 11 THE WITNESS: I'm sorry. You kind of lost me 12 THE WITNESS: | would think that because it 12 here. 13 restricts his freedom, obviously. 13 BY MS. KIM: 14 BY MS. KIM: 14 Q You said that Mr. Shabsis had some arguments 15 Q Did Mr. Shabsis tell you why he was against the | 15 with an uncle. 16 conservatorship? 16 MR. LIBMAN: No, that's not he said. 17 A What just mentioned, so basically he was 1.7 THE WITNESS: Uncle, he doesn't have an uncle. 18 implying that. Because | can't remember specific words, |18 BY MS. KIM: 19 let's say, but he didn't want his freedoms to be 19 Q Okay. You said he was having arguments with 20 restricted. He didn't want anybody to make decision 20 somebody. Who were you referring to? 21 when he has to see the doctor, let's say. 21 MR. LIBMAN: Objection. You said he had 22 Q Okay. How long did the conservatorship last? | 22 arguments with somebody. You're trying to put in his 23 A I'm notsure, somewhere around one year, 23 mind. So why don't you ask a question. 24 possibly. |think it has an expiration date. | think 24 Do you know what she's talking about? The 25 thathas to be revisited one year. I'm not sure, maybe 25 answer is no. Page 78 Page 80 1 six months. | have a feeling it was somewhere in that 1 THE WITNESS: I'm notsure. 2 range, maybe nine months. 2 MS. KIM: Can you read back the question where 3 Q Was there a reason why itlapsed? 3 [first asked about the uncle. 4 MR. LIBMAN: Objection. Calls for a legal 4 (Whereupon, the record was read back 5 conclusion. And speculations. 5 by the Court reporter as follows: 6 BY MS. KIM: 6 "Q Okay. Do you have any 7 Q Letme askita different way. 7 knowledge about Mr. Shabsis being 8 Did you intend for it to end after the first 8 arrested for hitting his uncle? 9 year or did you want it to continue on after the first 9 MS. KIM: And the answer? 10 year? 10 (Whereupon, the record was read back 11 A We were notsure at the time because his 11 by the Court reporter as follows: 12 condition was improving at the moment. And the whole 12 "A No, being arrested for 13 process was complicated. So we didn't extend because he 13 hitting -- | can'trecall. | know 14 shows some signs of positive condition. 14 they had some arguments, but I'm not 15 Q Okay. Atany pointin time since the first 15 sure if I'm informed about like 16 conservatorship lapsed, have you considered establishing | 16 getting physical either of them." 17 a further conservatorship over Mr. Shabsis? 17 BY MS. KIM: 18 A We thought aboutit, butit never came. It 18 Q When you said they had some arguments, who did 19 never materialized. 19 you refer to for "they"? 20 Q When did you think about it? 20 A | mean his grandfather. 21 A Basically every time he would end up in the 21 Q Okay. You're not aware of any incident where 22 hospital, we were thinking about it. 22 Michael hit an uncle; correct? 23 Q Okay. Do you have any knowledge about 23 A No. 24 Mr. Shabsis being arrested for hitting his uncle? 24 Q And Michael doesn't have an uncle? 25 A No, being arrested for hitting -- | can't 25 MR. LIBMAN: Objection. Argumentative. Page 77..80 www.aptusCR.com Shabsis vs. The Regents of Dimitry Shabsis the University of California Page 153 Page 155 1 to your knowledge he has, but he had to be hospitalized 1 STATE OF CALIFORNIA ) 2 anyway? ) ss. 3 MR. LIBMAN: Objection. 2 COUNTY OF 10S ANGELES ) 4 THE WITNESS: It's not that | can verify. . 5 MR. LIBMAN: Okay You answered 4 I, Sandra Mitchell, Certified Shorthand Reporter, 6 BY MS AZI7I: ’ ‘ ‘ 5 License No. 12553, for the State of California, do hereby ’ ' 6 tify: 7 Q lunderstand you cannot verify it. Has anyone er 8 ever say, for example, a health care provider told you 9 that Michael was not taking his medications when Michael 10 had told you he was? That, prior to being examined, the witness named in the foregoing deposition, to wit, DIMITRY SHABSIS, was by me duly sworn to testify the truth, the whole truth 10 and nothing but the truth; 11 MR. LIBMAN: Objection. Vague and ambiguous. 11 That said deposition was taken down by me 12 And overbroad as to health care provider. Calls fora 12 in shorthand at the time and place therein named and 13 legal conclusion. And expert opinions. 13 thereafter reduced to computer-aided transcription 14 THE WITNESS: | can't remember such 14 under my direction. 15 conversations it was with health care provider. 15 That the foregoing transcript, as typed, is a 16 THE VIDEOGRAPHER: Since J anuary 2014 has 12 ree meee OF THE FERC HEOSEEUTAR 17 Michael ever told you he has stopped taking his 1 T further certify that I am not interested 18 medications 18 in the event of the action. ’ . . . 19 Witness my hand this 19th day of April, 2018. 19 MR. LIBMAN: Objection. Vague and ambiguous. 2 20 Overbroad. ” 21 THE WITNESS: No. 53 22 BY MS. AZIZ: Lal, [FEL 23 Q To your knowledge has Michael ever stopped 23 SANDRA MITCHELL, C.S.R. No. 12553 24 taking his medications since J anuary of 2014? 24 25 A No. 25 Page 154 Page 156 1 Q Since) anuary 2014, has Michael ever told you | DECLARATION UNDER PENALTY OF PERJURY 2 that he stopped taking his medications before 2 Cage Name: Shabigis ve. The Regents .of 3 December 2013? the University of California 4 MR. LIBMAN: Overbroad 3 Date of Deposition: 04/13/2018 5 THE WITNESS: No. 4 Job No.: 10041743 6 MS. AZIZI: No further questions. 2 7 THE VIDEOGRAPHER: Is that it for today? Do ¢ hy DUNEIRS SHABHLS, hemehy eswtily 8 you have any anything else? 7 under penalty of perjury under the laws of the State of 5 8 that the foregoing is true and correct. 9 MR. LIBMAN: Those are all the questions. 10 THE VIDEOGRAPHER: This ares the ’ Frecated this day of i. 10 , 2018, at 11 deposition for today. We're going off the record at . : 12 5:15 p.m. 12 13 MS. KIM: By Code. It's your witness. 15 14 MR. LIBMAN: If you want to offer a stip, it's 1 DIMITRY SHABSIS 15 up to you, offerit. iE 16 MS. KIM: Lets do it by Code. 16 NOTARIZATION (If Required) 17 THE REPORTER: By Code? 17 State of 18 MS. KIM: Yes. 18 County of 19 THE REPORTER: Copies anyone? 19 Subscribed and sworn to (or affirmed) before me on 20 MR. PARKER: Yes. 20 this day of ; 20, 21 MR. LIBMAN: Copy. 21 by ; proved to me on the 22 MS. AZIZ: Copy. 22 basis of satisfactory evidence to be the person 23 MR. GUZE: Copy. 23 who appeared before me. 24 (The proceedings were concluded 24 Signature: (seal) 25 at5:15 p.m.) 25 Page 153..156 www.aptusCR.com Dimitry Shabsis Shabsis vs. The Regents of the University of California Page 157 1 DEPOSITION ERRATA SHEET 2 Case Name: Shabsis vs. The Regents of the University of California 3 Name of Witness: Dimitry Shabsis Date of Deposition: 04/13/2018 4 Job No.: 10041743 Reason Codes: 1. To clarify the record. 5 2. To conform to the facts. 3. To correct transcription errors. 6 Page _ Line Reason 7 From to 8 Page ~~ Line Reason 9 From to 10 Page ~~ Line Reason 11 From to 12 Page _ Line Reason 13 From to 14 Page ~~ Line Reason 15 From to 16 Page _ Line Reason 17 From to 18 Page ~~ Line Reason 19 From to 20 Page ~~ Line Reason 21 From to 22 Page ~~ Line Reason 23 From to 24 Page ~~ Line Reason 25 From to Page 158 1 DEPOSITION ERRATA SHEET 2 Page ~~ Line Reason 3 From to 4 Page ~~ Line Reason 5 From to 6 Page _ Line Reason 7 From to 8 Page ~~ Line Reason 9 From to 10 Page ~~ Line Reason 11 From to 12 Page _ Line Reason 13 From to 14 Page _ Line Reason 15 From to 16 Page ~~ Line Reason 17 From to 18 Page ~~ Line Reason 19 From to 20 Page ~~ Line Reason 21 From to 22 Subject to the above changes, I certify that the transcript is true and correct 23 No changes have been made. I certify that the transcript is true and correct. 24 25 DIMITRY SHABSIS www.aptusCR.com Page 157..158 EXHIBIT 6 Volume ll Shabsis vs. The Regents of Irene Spitkovsky the University of California Page 201 Page 203 1 SUPERIOR COURT OF THE STATE OF CALIFORNIA 1 APPEARANCES: 2 COUNTY OF LOS ANGELES - CENTRAL DISTRICT 2 For the Plaintiff, MICHAEL SHABSIS: 5 3 LAW OFFICES OF MICHAEL LIBMAN BY: MICHAEL J. LIBMAN, ESQ. 4 MICHAEL SHABSIS, AN INDIVIDUAL, ) 4 18321 VENTURA BOULEVARD, SUITE 200 ) TARZANA, CALIFORNIA 91356 Ee SE ATR ) 5 (818) 995-7300 ¢ \ MJIL@LIBMANLAW. COM 6 6 vs. ) CASE NO. BC567668 For the Defendants, PFIZER: ) i WILLIAMS & CONNOLLY, LLP 7 THE REGENTS OF THE UNIVERSITY OF ) VOLUME II g BY: JACK DARARAS, ESO. CALIFORNIA; RESNICK ) BY: JESSICA BODGER RYDSTROM, ESQ. 8 NEUROPSYCHIATRIC HOSPITAL AT UCLA; ) 9 725 12TH STREET. NW AN ORGANIZATION, FORM UNKNOWN; ) WASHINGTON, D.C. 20005 10 (202) 434-5000 9 PHILIP COGEN, M.D., AN INDIVIDUAL; ) JRYDSTROMGWC . COM COUNTY OF LOS ANGELES, A LOCAL ) 11 10 PUBLIC ENTITY; LOS ANGELES COUNTY ) For the Defendant, PHILIP COGEN, M.D.: 12 ' SHERIFF'S DEPARTMENT, A LOCAL ) EE -- 11 PUBLIC ENTITY; PFIZER, INC., A ) 13 BY: GREGORY B. GEER, ESQ. DELAWARE CORPORATION; AND DOES 1 ) 2 NORTH LAKE AVENUE, SUITE 820 12 THROUGH 200, INCLUSIVE, ) 14 PASADENA, CALIFORNIA 91101 (626) 463-1307 DEFENDANTS. ) 15 GGEER@LAWBRANDMEYER . COM 13 ) 16 For the DEFENDANT, THE REGENTS OF THE UNIVERSITY OF 14 CALIFORNIA: 17 15 VIDEOTAPED DEPOSITION OF IRENE SPITKOVSKY FRASER WATSON CROUTCH 16 TAKEN ON 18 BY: EVAN A. GUZE, ESQ. 17 THURSDAY, APRIL 5, 2018 100 WEST BROADWAY, SUITE 650 1 19 GLENDALE, CALIFORNIA 91210-1201 (818) 543-1380 12 20 EGUZE@WCLLLP . COM 20 21 For the DEFENDANTS, COUNTY OF LOS ANGELES AND LOS ANGELES 21 COUNTY SHERIFF'S DEPARTMENT: 2s 22 IVIE, MC NEILL & WYATT 23 Reported By: 23 BY: CHANDLER A. PARKER, ESQ. Sandra Mitchell 444 SOUTH FLOWER STREET, 18TH FLOOR 9% .C.5.R. 12553 24 LOS ANGELES, CALIFORNIA 90071 (213) 489-0028 25 Job No. 10041739 25 CPARKER@IMWLAW . COM Page 202 Page 204 1 SUPERIOR COURT OF THE STATE OF CALIFORNIA 1 APPEARANCES (CONTINUED) 2 COUNTY OF LOS ANGELES - CENTRAL DISTRICT 2 3 Also Present: 4 MICHAEL SHABSIS, AN INDIVIDUAL, ) ) 3 5 PLAINTIFF, ) MICHELLE BARTFAY, VIDEOGRAPHER ) 4 6 vs. ) CASE NO. BC567668 . ) 7 THE REGENTS OF THE UNIVERSITY OF ) VOLUME II 6 CALIFORNIA; RESNICK ) 7 8 NEUROPSYCHIATRIC HOSPITAL AT UCLA; ) g AN ORGANIZATION, FORM UNKNOWN; ) 9 9 PHILIP COGEN, M.D., AN INDIVIDUAL; ) COUNTY OF LOS ANGELES, A LOCAL ) 10 10 PUBLIC ENTITY; LOS ANGELES COUNTY ) 11 SHERIFF'S DEPARTMENT, A LOCAL ) a 11 PUBLIC ENTITY; PFIZER, INC., A ) 13 DELAWARE CORPORATION; AND DOES 1 ) 12 THROUGH 200, INCLUSIVE, ) 14 DEFENDANTS . ) 15 13 ) 16 14 Tt 17 16 18 17 19 18 VIDEOTAPED DEPOSITION OF IRENE SPITKOVSKY, taken 5 19 on behalf of the Defendants, at 550 South Hope Street, 20 19th Floor, Los Angeles, California, commencing at 21 21 12:14 p.m., Thursday, April 5, 2018, before Sandra 22 22 Mitchell, C.S.R. 12553, pursuant to Notice. 23 23 24 24 Se 25 Page 201..204 www.aptusCR.com Volume ll Shabsis vs. The Regents of Irene Spitkovsky the University of California Page 265 Page 267 1 Q Didyou -- did you think when he was put under 1 someone else that he wanted to hurt himself? 2 conservatorship, that it was going last longer than one | 2 MR. LIBMAN: Calls for speculation. 3 year? 3 Go ahead. 4 A Yes, | didn't know atthe time. It was only 4 THE WITNESS: It's like -- what do you mean if 5 lastone year. 5 he ever told somebody? That he wanted to kill himself? 6 Q And how did you come find out that the 6 BY MS.RYDSTROM: 7 conservatorship had ended? 7 Q Uh-huh. 8 A Like after about two years later he didn't take 8 A Idon'tknow. 9 his medication and | took him to the hospital, and | 9 Q Soyoudon'tremember any times that Michael 10 told to the staff that I'm conservator, and they asked 10 told someone that he wanted to kill himself regardless 11 me for paper. And when they show the paper, they 11 of whether you thought he really did want to? 12 explained to me how it's work, before | didn't know. 12 A Maybe he did tell somebody in the hospital, 13 Q Okay. What were you trying to do when you had | 13 maybe. 14 taken him to the hospital and you thought you were his | 14 Q Do you remember whether any of Mr. Shabsis' 15 conservator? 15 hospitalizations before he became blind, whether any of 16 A Because he doesn't take his medication. 16 those were because he had told somebody he was going to 17 Q Were you trying to get someone at the hospital | 17 kill himself? 18 to make him take his medication? 18 MR. LIBMAN: Objection. Calls for speculation. 19 A Yes. 19 Assumes facts notin evidence. 20 Q And you thought that, as his conservator, you 20 THE WITNESS: Maybe. 21 would be able to tell the hospital that he had to take 21 BY MS.RYDSTROM: 22 his medication? 22 Q Butyou don't remember anything about those? 23 A Yes. 23 A No. 24 Q Butthey told you they couldn't do that if you 24 Q Mrs. Spitkovsky, were there any times that 25 weren't his conservator? 25 Michael was involved with the police that you remember Page 266 Page 268 1 MR. LIBMAN: Objection. Argumentative. 1 telling the police you did not want to press charges 2 Assumes facts notin evidence. 2 against him? 3 THE WITNESS: | don't remember how it was. 3 MR. LIBMAN: Objection. Vague and ambiguous as 4 BY MS.RYDSTROM: 4 to "involve with police." 5 Q Did you ever try and renew the conservatorship 5 THE WITNESS: | don't remember. 6 after you found out that it had lapsed? 6 BY MS.RYDSTROM: 7 A No. 7 Q Do you remember any times that Mr. Shabsis was 8 Q Why not? 8 brought o the hospital by the police? 9 A Because it's very difficult procedure. You 9 A Yes. 10 should stay in the hospital for one month. So it's very 10 Q During any of those times was he brought to the 11 difficult. 11 hospital by the police because he had been threatening 12 Q Were there any times after the conservatorship 12 towards his grandparents? 13 had lapsed that you remember Mr. Shabsis going to the | 13 MR. LIBMAN: Objection. Argumentative. 14 hospital for a long period of time? 14 Assumes facts notin evidence. Calls for speculation. 15 A No. 15 THE WITNESS: No. 16 Q Mrs. Spitkovsky, is the overdose with the 16 BY MS.RYDSTROM: 17 Tylenol that we talked about earlier, is that the only 17 Q Can lask you, Mrs. Spitkovsky, was Mr. Shabsis 18 time you think Mr. Shabsis tried to hurt himself? 18 ever accused of hitting his grandmother? 19 MR. LIBMAN: Objection. Calls for speculation 19 MR. LIBMAN: Objection. Calls for speculation. 20 Assumes facts notin evidence. Argumentative. 20 Assumes facts notin evidence. Calls for a legal 21 THE WITNESS: Yes. To my knowledge. 21 conclusion. 22 BY MS.RYDSTROM: 22 THE WITNESS: | know he pushed her. Itwas, 23 Q Letme ask a slightly different question. 23 again, arguments with his grandfather. 24 And that is, is the overdose with Tylenol the 24 BY MS.RYDSTROM: 25 only time that you're aware of that Mr. Shabsis told 25 Q Okay. Tell me what you remember about that. Page 265..268 www.aptusCR.com Volume ll Shabsis vs. The Regents of Irene Spitkovsky the University of California Page 329 Page 331 1 THE VIDEOGRAPHER: Going off the record at 1 hospitalizations. | know we discussed this before. | 2 3:39 p.m. 2 wanted to clarify a few things. 3 (A recess was taken.) 3 Specifically regarding the incident where you 4 THE VIDEOGRAPHER: We're back on the record at | 4 then applied for conservatorship, do you recall what 5 3:41pm. 5 incident that was? 6 MS. RYDSTROM: Mrs. Spitkovsky, | don't have 6 MR. LIBMAN: Objection. Vague and ambiguous. 7 any further questions for you now. Thank you for your 7 THE WITNESS: | don't remember. 8 time. 8 BY MS.RYDSTROM: 9 THE WITNESS: Thank you. 9 Q When did you apply for conservatorship for your 10 10 husband? 11 EXAMINATION 11 A You mean the year? 12 BY MR. GEER: 12 Q Yes. 13 Q Good afternoon, Mrs. Spitkovsky. My name is 13 A | don't remember the year. Probably 2006 or 14 Gregory Geer. | represent Dr. Cogen. | have a few 14 '7, don't remember. 15 questions to ask you. 15 Q So itwould be logical to say then there was an 16 Let's start with, when did Michael -- I'm 16 incident around that time that led to you applying for 17 sorry, Mr. Shabsis end up moving out? As lunderstand | 17 conservatorship? 18 you were living together in a home, and he moved out. | 18 MR. LIBMAN: Objection. Argumentative. 19 When was that? 19 Assumes facts notin evidence. Calls for speculation. 20 A Itwas about 2007. 20 THE WITNESS: What do you mean accident? What 21 Q Where did you move to? 21 kind of accident? 22 A You mean address? 22 BY MS.RYDSTROM: 23 Q Sure. Or any other description. 23 Q Could you explain to me as to why you applied 24 A 1221 North Spaulding, Apartment 108, West 24 for conservatorship over Mr. Shabsis? 25 Hollywood 90046. 25 A It was hospital recommendation. Page 330 Page 332 1 Q Is that the same address as your parents live 1 Q And the hospital recommended for what reason, 2 at? 2 do you recall? 3 A Yes. Different apartment number. 3 MR. LIBMAN: Objection. Calls for speculation 4 Q Where do they live? 4 Assumes facts notin evidence. 5 A 103. 5 THE WITNESS: That we can control his medicine. 6 Q Did Mr. Shabsis pay for this apartment on his 6 BY MS.RYDSTROM: 7 own or was it provided by his grandparents? 7 Q So as far as you recall, the reason that you -- 8 A Sometimes. 8 the hospital told you to get a conservatorship is so you 9 MR. LIBMAN: Objection. Vague and ambiguous. 9 could regulate his medicine; correct? 10 THE WITNESS: Sometimes his own, sometimes | | 10 A Yes. 11 helped him. 11 Q And] believe as you mentioned before, that 12 BY MS.RYDSTROM: 12 conservatorship lasted for a year, and you did not know 13 Q You mentioned that you helped him? 13 that it expired? 14 A Yes. 14 A Yes. 15 Q And he paid the money to who in this case--do [15 Q Could you tell me where you currently work? 16 you know -- the rent for the apartment? 16 MR. LIBMAN: Objection. Invasion of privacy. 17 MR. LIBMAN: Objection. May call for 17 Instruct not to answer. 18 speculation. Assumes facts notin evidence. 18 MS.RYDSTROM: Mr. Libman, this is the precise 19 THE WITNESS: Whatdo you mean to whom? The |19 issue and the question that we raised before J udge 20 landlord. 20 McCoy. Your objections and instructions were overruled. 21 BY MS.RYDSTROM: 21 MR. LIBMAN: Can you show me the specific 22 Q Okay. So he was paying it to the landlord. 22 question? 23 Did he own a vehicle of his own at that time? 23 MS. RYDSTROM: | will show the portion of the 24 A Yes. 24 order setout. 25 Q I wanted to go through a few of his 25 MR. LIBMAN: You know what, actually I'll Page 329..332 www.aptusCR.com Volume ll Irene Spitkovsky Shabsis vs. The Regents of the University of California Page 385 Page 387 al STATE OF CALIFORNIA ) 1 DEPOSITION ERRATA SHEET ) ss. 2 Case Name: Shabsis vs. The Regents of 2 COUNTY OF LOS ANGELES ) the University of California 3 3 Name of Witness: Irene Spitkovsky 4 I, Sandra Mitchell, Certified Shorthand Reporter, Date of Deposition: 04/05/2018 5 License No. 12553, for the State of California, do hereby 4 Job No.: 10041739 6 certify: Reason Codes: 1. To clarify the record. 7 That, prior to being examined, the witness 5 2. To conform to the facts. 8 named in the foregoing deposition, to wit, IRENE SPITKOVSKY, St TO ICOrrEC BrangeripEIon CreoTsy 9 was by me duly sworn to testify the truth, the whole truth 6 Page Line Reason i 7 F E 10 and nothing but the truth; rom © 8 Page Line Reason 11 That said deposition was taken down by me 9 - 9 From to 12 in shorthand at the time and place therein named and 10 Page Line Reason 13 thereafter reduced to computer-aided transcription = 11 From to 14 under my direction. 12 Page Line Reason 15 That the foregoing transcript, as typed, is a 13 From to 16 true record of the said proceedings. Td = fi 5 age ine eason 17 I further certify that I am not interested fie . & rom o 18 in the event of the action. iE Page Fdme Heo 19 Witness my hand this 7th day of April, 2018. 17 From to 20 18 Page Line Reason 2x (7 19 From to 22 Aa / REL 20 Page Line Reason a2 ~~ [2 , - v 21 From to 23 22 Page Line Reason SANDRA MITCHELL, C.S.R. No. 12553 23 From to 24 24 Page Line Reason 25 25 From to Page 386 Page 388 1 DECLARATION UNDER PENALTY OF PERJURY 1 DEPOSITION ERRATA SHEET 2 Case Name: Shabsis vs. The Regents of 2 Page Line Reason the University of California 3 From to 3 Date of Deposition: 04/05/2018 4 Page Line Reason 4 Job No.: 10041739 5 From te E 6 Page Line Reason 7 From to 6 I, IRENE SPITKOVSKY, hereby certify 8 Page Line Reason 7 under penalty of perjury under the laws of the State of 9 From to 8 that the foregoing is true and correct. 10 Page Line Reason 9 Executed this day of 11 From to 10 + 2018, at 12 Page Line Reason 11 13 From to 12 14 Page Line Reason 13 15 From to 14 IRENE SPITKOVSKY 16 Page Line Reason is 1:7 From to 16 NOTARIZATION (If Required) 18 Page _ Line Reason 17 State of 12 From te 20 Page Line Reason 18 County of _- . . 21 From to 19 Subscribed and sworn to (or affirmed) before me on 22 Subject to the above changes, I certify that the 20 this day of 20 ! -' transcript is true and correct 21 b roved to me on the y- E 23 No changes have been made. I certify that the 22 basis of satisfactory evidence to be the person transcript is true and correct 23 who appeared before me. 24 24 Signature: (Seal) 25 25 IRENE SPITKOVSKY Page 385..388 www.aptusCR.com EXHIBIT 7 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 Progress Note - Psych (continued) Psych Consult - Initial Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM Author: Juarez, Grace, MD Service: Psychiatry Author Type: Physician Filed: 11/21/2015 11:30 PM Note Time: 11/21/2015 11:10 PM Status: Addendum Editor: Juarez, Grace, MD (Physician) Related Notes: Original Note by Juarez, Grace, MD (Physician) filed at 11/21/2015 11:25 PM INITIAL PSYCHIATRY CONSULT NOTE DATE OF SERVICE: 11/21/2015 REFERRING PHYSICIAN: Shah, Amar J, MD REASON FOR CONSULT: eval for mood symptoms TIME SPENT ON EVALUATION: 30 minutes including>50% counseling & coordination of care. SOURCE OF INFORMATION: | interviewed the patient, reviewed the chart including cocurrent notes, consults, labs, imaging, as well as past medical records from Cedars. | discussed the case with the attending physician , RN SUBJECTIVE: IDENTIFYING DATA/ CHIEF COMPLAINT: MIKHAL SHABSIS is a 30 year old male presented on 11/21/2015 for There are no admission diagnoses documented for this encounter. HISTORY OF PRESENT ILLNESS: This 30 year old male with PMH bipolar disorder, self-enucleation of b/l eyes, nonadherent with VPA x 3 days. Per chart, pt's parent called 911 for as pt is exhibiting manic symptoms. This writer attempted to interview pt but he only sang louder, "Glory, glory Hallelujah!" the more | tried to speak with him. He also did not engage with ED staff. Pt was previously evaluated by Psychiatry through the years with same presentation that led to inpatient psychiatric hospitalization. ROUTINE NURSING INTAKE DEPRESSION SCREEN RESULTS: REVIEW OF SYSTEMS: Reviewed ROS by Dr Shah PAST PSYCHIATRIC HISTORY: Per psych note from 2011: He has diagnosis bipolar disorder and methamphetamine Dependence. Hospitalized at Thalians This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1019 Cedars-Sinai Medical Center” Page 2950 SHABSISM-17PPR-04385 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SIN Al MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 Psych Consult - Initial (continued) Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM (continued) in July 2010 for a depressive episode. Patient's father is his conservator at that time. He has had multiple suicide attempts including slashing his wrists. SUBSTANCE ABUSE HISTORY: methamphetamine dependence. FAMILY PSYCHIATRIC HISTORY: Patient denies family history of drug or alcohol abuse, depression, bipolar disorder, anxiety, schizophrenia or suicide attempts SOCIAL HISTORY: Per psych note from 2011: The patient lives by himself in an apartment owned by his Grandparents. His parents provide him with financial support. He has never worked. MEDICAL HISTORY: Past Medical History Diagnosis Date » Bipolar disorder (HCC) + Bipolar affective (HCC) Patient Active Problem List Diagnosis + Bipolar 1 disorder (HCC) * Drug overdose + Suicide attempt (HCC) + Lethargy No past surgical history on file. ALLERGIES Shellfish MEDICATIONS PRIOR TO ADMISSION Prior to Admission medications Medication Sig Start Date End Date Takin Authorizing Provider g? ABILIFY DISCMELT PO, Provider, Historical ARIPIPRAZOLE, ABILIFY PO, Provider, Historical ARIPIPRAZOLE, asenapine (SAPHRIS) 10 Provider, Historical mg SUBL bupropion (WELLBUTRIN Take 150 mg by Provider, Historical XL) 150 mg tablet mouth daily. CYMBALTA PO, Provider, Historical DULOXETINE HCL, OLANZapine (ZYPREXA) 5 Take 5 mg by Provider, Historical mg oral tablet mouth daily. propranolol (INDERAL) 20 Take 20 mg by Provider, Historical mg oral tablet mouth 3 times daily. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1020 Cedars-Sinai Medical Center* Page 2951 SHABSISM-17PPR-04386 MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 Psych Consult - Initial (continued) Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM (continued) 7 SHABSIS,MIKHAL © CURRENT MEDICATIONS: Current Facility-Administered Medications Medication Dose Route Frequency + ciprofloxacin HCI 1drop Both Eyes Q2H (CILOXAN) 0.3 % ophthalmic solution + OLANZapine zydis 10 mg Oral Once (ZyPREXA ZYDIS) disintegrating tablet 10 mg Current Outpatient Prescriptions Medication + ABILIFY DISCMELT PO, ARIPIPRAZOLE, ABILIFY PO, ARIPIPRAZOLE, + asenapine (SAPHRIS) 10 mg SUBL » bupropion (WELLBUTRIN XL) 150 mg tablet + CYMBALTA PO, DULOXETINE HCL, » OLANZapine (ZYPREXA) 5 mg oral tablet « propranolol (INDERAL) 20 mg oral tablet OBJECTIVE: VITAL SIGNS (last filed): BP 138/102 mmHg | Pulse 97 | Temp(Src) 97.5 °F (36.4 °C) (Oral) | Resp 16 | Ht 1.778 m (5' 10") | SpO2 98% VITAL SIGNS RANGE LAST 24 HOURS: BP Min: 138/102 Max: 138/102 Temp Avg: 97.5 °F (36.4 °C) Min: 97.5 °F (36.4 °C) Max: 97.5 °F (36.4 °C) Pulse Avg: 97 Min: 97 Max: 97 Resp Avg: 16 Min: 16 Max: 16 SpO2 Avg: 98 % Min: 98 % Max: 98 % Height Avg: 177.8 cm (5' 10") Min: 177.8 cm (5' 10") Max: 177.8 cm (5' 10") MENTAL STATUS EXAMINATION: ‘GENERAL APPEARANCE: dressed in hospital gown, good grooming and hygiene, lying in bed, s/p self- enucleation of b/l eyes COGNITION: awake BEHAVIOR: uncooperative, loud, does not engage with staff *ATTENTION: poor ‘MEMORY: unable to assess LANGUAGE: intact FUND OF KNOWLEDGE: unable to assess SPEECH: loud MOOD: irritable, manic AFFECT: expansive, congruent This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1021 Cedars-Sinai Medical Center” Page 2952 SHABSISM-17PPR-04387 @D CED4RS-SINAI MEDICAL CENTER. Psych Consult - Initial (continued) SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M Adm: 11/21/2015, D/C: 11/22/2015 Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM (continued) «THOUGHT PROCESSES: unable to assess *ASSOCIATIONS: impaired «THOUGHT CONTENT: unable to assess *INSIGHT & JUDGMENT: poor MUSCLE STRENGTH AND TONE: intact, no tremor IMPULSE CONTROL: poor DIAGNOSTIC DATA REVIEW: CBC: Lab Results Component HEMOGLOBIN HEMOGLOBIN HEMOGLOBIN HEMATOCRIT WBC PLATELET COUNT Chemistry: Lab Results Component GLUCOSE CREATININE UREA NITROGEN SODIUM POTASSIUM CHLORIDE CARBON DIOXIDE CALCIUM, SERUM MAGNESIUM Liver Function Tests: Lab Results Component ALT AST ALKALINE PHOSPHATASE BILIRUBIN, TOTAL TOTAL PROTEIN ALBUMIN This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1022 Cedars-Sinai Medical Center* Value 16.5 14.3 15.5 45.9 8.4 129* Value 93 0.9 141 4.1 104 26 9.1 20 Value 29 14 130° 0.8 6.7 3.8 Date 11/21/2015 02/12/2014 04/23/2012 11/21/2015 11/21/2015 11/21/2015 Date 02/12/2014 02/12/2014 02/12/2014 02/12/2014 02/12/2014 02/12/2014 02/12/2014 02/12/2014 12/14/2009 Date 02/12/2014 02/12/2014 02/12/2014 02/12/2014 02/12/2014 02/12/2014 SHABSISM-17PPR-04388 Page 2953 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 Psych Consult - Initial (continued) Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM (continued) Urinalysis: Lab Results Component Value Date CLARITY, UA CLOUDY 07/08/2011 SPECIFIC 1.018 07/08/2011 GRAVITY, UA PH, UA 8.0" 07/08/2011 PROTEIN, UA 1+ 07/08/2011 GLUCOSE, UA NEG 07/08/2011 KETONES, UA TRACE* 07/08/2011 BILIRUBIN, UA NEG 07/08/2011 UROBILINOGEN NEG 07/08/2011 BLOOD, UA NEG 07/08/2011 WBC, UA <1 07/09/2010 LEUKOCYTE NEG 07/08/2011 ESTERASE, UA NITRITE, UA NEG 07/08/2011 Thyroid Function Lab Results Component Value Date TSH 0.86 03/03/2010 T4, TOTAL Fc 07/08/2010 ADJUSTED T4 7.6 07/08/2010 Vitamins: No results found for: VITB12, FOLATE, VITD2, VITD3, VITD, VITDDH Alcohol Screen Lab Results Component Value Date ETHANOL NONE DETECTED 02/12/2014 LEVEL Urine Drug Abuse Screen Lab Results Component Value Date OPIATE NEG 04/21/2012 SCREEN, URINE COCAINE NEG 04/21/2012 METAB SCREEN, URINE AMPHETAMINE NEG 04/21/2012 SCREEN, URINE BARBITURATE NEG 04/21/2012 SCREEN, URINE PHENCYCLIDIN NEG 04/21/2012 E SCREEN, URINE This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1023 Cedars-Sinai Medical Center* SHABSISM-17PPR-04389 Page 2954 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 Psych Consult - Initial (continued) Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM (continued) METHADONE NEG 04/21/2012 SCREEN, URINE BENZODIAZEPI NEG 04/21/2012 NE SCREEN URINE PROPOXYPHEN NEG 04/21/2012 E SCREEN URINE CANNABINOID NEG 04/21/2012 SCREEN, URINE Drug Levels: Lab Results Component Value Date VALPROIC ACID <2.0 04/21/2012 LEVEL LITHIUM LEVEL 0.40* 07/14/2010 CARBAMAZEPIN 9.2 03/13/2010 E LEVEL Coagulation: Lab Results Component Value Date PATIENT 13.6 11/18/2011 PROTIME PTT 29 11/18/2011 INR 1: 11/18/2011 Syphilis: Lab Results Component Value Date RPR NONREACTIVE 07/08/2010 HIV: No results found for: HIVAGAB, HIV1X2, HIVIX2INDEX, HIVIRNAVL, HIVPCRCOP, CD4PCT, CD4ABS, CD8PCT, CD8ABS Lipid Screen: No results found for: CHOL, HDL, LDLCALC, LDLDIRECT, TRIG, CHOLHDL Imaging: EKG: IMPRESSION MIKHAL SHABSIS is a 30 year old male with bipolar disorder and methamphetamine dependence presented on 11/21/2015. Psychiatry consulted on 11/21/2015 for risk assessment and eval of mood symptoms. Pt with symptoms c/w bipolar disorder, manic, severe with psychotic symptoms secondary to nonadherence with This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1024 Cedars-Sinai Medical Center” Page 2955 SHABSISM-17PPR-04390 TE SHABSIS,MIKHAL @D MRN: 020634384 - DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 Psych Consult - Initial (continued) Psych Consult - Initial by Juarez, Grace, MD at 11/21/2015 11:10 PM (continued) medication. Pt not engaging with staff and required Olanzapine for agitation. He is at high risk for unintentional harm to self or others due to mania and impulsivity. TREATMENT PLAN/ RECOMMENDATIONS Problem #1: Bipolar affective disorder, current episode manic, severe with psychotic symptoms -med clearace per ED -Medications: Zyprexa Zydis 10 mg po BID, in case of severe agitation where nonpharmacologic intervention has failed, compramising pt and other's safety, may give Olanzapine 10 mg IM daily prn severe agitation. RISK ASSESSMENT: A thorough risk assessment was performed. P Patient appears to be at HIGH risk for unintentional danger to self but LOW risk for danger to others. HIGH AWOL risk. -Risk Factors: nonadherence with meds, mania, poor coping skills, h/o meth use -Protective Factors: supportive family, no known family psychiatric history -Safety Plan: no current actions required; will continue to monitor DISPOSITION & DISCHARGE PLANNING: Patient is HOLDABLE for danger to self danger to others. Transfer center has been notifed to arrange for a PET evaluation to place the patient on a 5150 involuntary psychiatric hold and transfer to inpatient psychiatric hospital.. If the patient attempts to leave AMA or to AWOL call security x35511 and consider code Dr Strong. COORDINATION OF CARE: The current impression and recommendations were discussed with attending physician. The Psychiatry Consultation Liaison Team will continue to follow this patient PRN to provide supportive psychotherapy and psychotropic medication recommendations. For further questions please page 2333. General line for Psychiatry Consults is 310-423-3465. Thank you for this consult. SIGNED: Grace Juarez 11/21/2015 11:10 PM T ime of note does not necessarily reflect the time of day patient was seen. This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1025 Cedars-Sinai Medical Center” Page 2956 SHABSISM-17PPR-04391 SHABSIS,MIKHAL MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER Adm: 11/21/2015, D/C: 11/22/2015 ED Notes (continued) ED Provider Notes by Shah, Amar J, MD at 11/21/2015 11:59 PM (continued) Version 1 of 1 ED Notes by Eliav, Jenna, RN at 11/22/2015 12:02 AM Version 1 of 1 Author: Eliav, Jenna, RN Service: (none) Author Type: Registered Nurse Filed: 11/22/2015 12:03 AM Note Time: 11/22/2015 12:02 AM Status: Signed Editor: Eliav, Jenna, RN (Registered Nurse) Pt is now holdable. Transfer center aware per psych MD. ED Notes by Eliav, Jenna, RN at 11/21/2015 11:31 PM Version 2 of 2 Author: Eliav, Jenna, RN Service: (none) Author Type: Registered Nurse Filed: 11/21/2015 11:35 PM Note Time: 11/21/2015 11:31 PM Status: Addendum Editor: Eliav, Jenna, RN (Registered Nurse) Related Noles: Original Note by Eliav, Jenna, RN (Registered Nurse) filed at 11/21/2015 11:33 PM Medicated pt per MD order. Pt placed on CM with ST noted. HR in low 100's, O2 sat 96% on RA. Pt is resting in NAD. Resp even and unlabored. Calm at this time. Comfort measures provided. Fall precautions observed. 1:1 observation at all times by Mirella, MHW and Security Rodriguez. Will continue to monitor. ED Notes by Eliav, Jenna, RN at 11/21/2015 11:31 PM Version 1 of 2 Author: Eliav, Jenna, RN Service: (none) Author Type: Registered Nurse Filed: 11/21/2015 11:33 PM Note Time: 11/21/2015 11:31 PM Status: Signed Editor: Eliav, Jenna, RN (Registered Nurse) Related Notes: Addendum by Eliav, Jenna, RN (Registered Nurse) filed at 11/21/2015 11:35 PM Medicated pt per MD order. Pt placed on CM with ST noted. HR in low 100's, O2 sat 96% on RA. Pt is resting in NAD. Resp even and unlabored. Calm at this time. Comfort measures provided. Fall precautions observed. Will continue to monitor. ED Notes by Eliav, Jenna, RN at 11/21/2015 11:14 PM Version 1 of 1 Author: Eliav, Jenna, RN Service: (none) Author Type: Registered Nurse Filed: 11/21/2015 11:15 PM Note Time: 11/21/2015 11:14 PM Status: Signed Editor: Eliav, Jenna, RN (Registered Nurse) Pt pulled out his IV. Pressure and dressing applied. Pt is now singing "Halleluya, Jesus Christ is Lord!" Dr. Shah notified. Pt is very hard to redirect. ED Notes by Eliav, Jenna, RN at 11/21/2015 10:53 PM Version 1 of 1 Author: Eliav, Jenna, RN Service: (none) Author Type: Registered Nurse Filed: 11/21/2015 10:58 PM Note Time: 11/21/2015 10:53 PM Status: Signed Editor: Eliav, Jenna, RN (Registered Nurse) Pt continued to refuse to speak with this RN and staff. Explained to pt in English and Russian that | need to This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1011 Cedars-Sinai Medical Center” Page 2942 SHABSISM-17PPR-04377 SHABSIS,MIKHAL @D MRN: 020634384 DOB: 5/20/1985, Sex: M CEDARS-SINAI MEDICAL CENTER. Adm: 11/21/2015, D/C: 11/22/2015 ED Notes (continued) ED Notes by Eliav, Jenna, RN at 11/21/2015 10:53 PM (continued) Version 1 of 1 start IV and collect urine via intermittent catheter for specimen. Pt did not answer. PIV started w/o difficulty. Pt was calm and compliant. Labs drawn. During intermittent catheterization, pt became combative and attempted to hit and bite me and Ashley, RN who was assisting me. Security was called to assist with pt. Urine was collected. After the procedure, pt became calm again and is currently resting quietly in NAD. Resp even and unlabored. Mirella, MHW and Security Rodriguez at bedside for 1:1 observation. Will continue to monitor. ED Notes by Eliav, Jenna, RN at 11/21/2015 9:23 PM Version 1 of 1 Author: Eliav, Jenna, RN Service: (none) Author Type: Registered Nurse Filed: 11/21/2015 9:38 PM Note Time: 11/21/2015 9:23 PM Status: Signed Editor: Eliav, Jenna, RN (Registered Nurse) Rec'd pt in gurney with eyes closed. Pt is calm but not cooperative. Refuses to talk. Does not answer any questions. Pt is just blinking his eyes w/o opening them. Pt bib ambulance after his mom called 911 d/t pt threatening to kill himself. Per paramedic report mo stated on scene that pt has not take his Depakote for 4 days. Mom told medics, last time he stopped his meds he "gouged his eyes out" and is now legally blind. This RN unable to find out if pt has a plan to hurt himself at this time. Spoke with Jim, LCSW who stated he is very familiar with pt and pt has a long h/o psychosis and psychiatric problems. Jim advised me not to insist on pt answering questions and participating in assessment at this time. Pt changed into gown and belongings inventoried by Mirella. MHW and Todd, CP. Belongings placed in cage. Lighter and small metal folding spoon given to security. Mirella, MHW and Officer Andrino providing 1:1 observation. Warm blankets provided. Falls safety measures observed. Awaiting EDMD eval. Will continue to monitor. ED Notes by Tomlinson, Todd B at 11/21/2015 9:12 PM Version 1 of 1 Author: Tomlinson, Todd B Service: (none) Author Type: Clinical Partner Filed: 11/21/2015 9:15 PM Note Time: 11/21/2015 9:12 PM Status: Signed Editor: Tomlinson, Todd B (Clinical Partner) Assisted MHW with changing PT into gown and personal items inventoried. ED Notes by Langhans, Carrie, RN at 11/21/2015 8:52 PM Version 1 of 1 Author: Langhans, Carrie, RN Service: (none) Author Type: Registered Nurse Filed: 11/21/2015 8:54 PM Note Time: 11/21/2015 8:52 PM Status: Signed Editor: Langhans, Carrie, RN (Registered Nurse) Pt brought in by ambulance from home with complaint of wanting to hurt himself. Pt has not been on depakote for 4 days. Pt has a hx of stabbing own eyes out. Mother called 911. Pt states that he has been speaking to"GOD". This report was printed by the Health Information Dept, please call (310) 423-3313 with any questions. Page 1012 Cedars-Sinai Medical Center” Page 2943 SHABSISM-17PPR-04378 rinted on 7/25/2016 12:11 PM Page 12 of 13 HABSIS,MIKHAL Scan on 7/13/2016 8:08 PM by User: SAYAS, LAURO N. [ Second | National This form MUST be signed & 700 E. Bona Ave. AEE RIRIAE AA returned whether or not you Pomona, CA 91767 have records. Thanks! |. Registered Los Angeles County # 2015183669 W.O. # 335475-024 DECLARATION OF CUSTODIAN OF RECORDS REGARDING: Michael Shabsis D.0.B: 5/20/1985 S.S.N: UNKNOWN AKA: Mikhail Shabsis LOCATION: Cedars-Sinal Medical Center’; (310) 423-3277 I, the undersigned, being the duly authorized Custodian of Records and having authority to certify the record declare the following (please check the appropriate boxes): CERTIFICATION OF RECORDS PROVIDED The records were prepared by the personnel of the business in the ordinary course of business at or near the Pursuant to Evidence Code Section 1560(e), the original records described in the Subpoena Duces Tecum/Deposition Subpoena/Authorization were delivered to the attorney's representative for copying at the witness" place of business. CERTIFICATION OF NO RECORDS -] Medical Records PLEASE SPECIFY REASON: [I RECORDS/FILMS ARE LOST | RECORDS/FILMS ARE DESTROYED [| OTHER (please explain) A thorough search of our files, carried out under my direction and control revealed no documents, records, or other items listed in the Subpoena Duces Tecum/Deposition Subpoena/Authorization presented to me. It is understood that such records may exist under another spelling, name, or classification, but with the information provided to our office and to the best of my knowledge, no such records exist. | DECLARE UNDER PENALTY OF RERJURY eT THE LAWS OF THIS STATE THAT Tre poReENe 15yTRUE AND CORRECT. ~ 20-4 , at Nn Myra WSore /) Mga pom Print Name Signature Executed on DO NOT WRITE BELOW THIS LINE. FOR SECOND IMAGE USE ONLY | am the attorney's representative and | state that [Imade true copies of the records, (cnn copies of the records, [] received a Certificate of No Records provided to me by the custodian of records of the above location. | DECLARE UNDER PENALTY OF PERJURY AND UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. [CJ Location did not properly complete and/or sign the declaration of records. Notes: ' Executed on B® q-) - | , at Tore Ar C Cc , CA. w& Date ty By: custodroN Signature Cedars-Sinai Medical Center” Page A1 SHABSISM-17PPR-04484