Petition for Writ of Certiorari — Michael Lee Mac Cleary, Petitioner v. United States

Supreme Court briefSep 26, 2023

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APPENDIX

TABLE OF CONTENTS

APPENDIX A, Appendix A, Unpublished Memorandum

Disposition of the U.S. Court of Appeals

for the Ninth Circuit, April 25, 2023………………………………………………………1a

APPENDIX B, Order of the U.S. Court of

Appeals for the Ninth Circuit, denying

petition for rehearing en banc,

June 28, 2023................................................................................................................7a

APPENDIX C, Transcript of Sentencing

Hearing, November 1, 2021, U.S. District

Court for the Southern District of

California.......................................................................................................................8a

APPENDIX D, Compiled Medical Record……………………………………………….39a

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APPENDIX A

FILED

NOT FOR PUBLICATION

APR 25 2023

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

UNITED STATES OF AMERICA,

No.

Plaintiff-Appellee,

MOLLY C. DWYER, CLERK

U.S. COURT OF APPEALS

21-50240

D.C. No.

3:20-cr-02361-LAB-1

MICHAEL LEE MAC CLEARY,

MEMORANDUM*

Defendant-Appellant.

Appeal from the United States District Court

for the Southern District of California

Larry A. Burns, District Judge, Presiding

Submitted April 21, 2023**

Pasadena, California

Before: WARDLAW and KOH, Circuit Judges, and MCMAHON,*** District

Judge.

Michael Lee Mac Cleary pleaded guilty to knowing importation of

methamphetamine, in violation of 21 U.S.C. §§ 952 and 960. He was sentenced,

This disposition is not appropriate for publication and is not precedent

except as provided by Ninth Circuit Rule 36-3.

The panel unanimously concludes this case is suitable for decision

without oral argument. See Fed. R. App. P. 34(a)(2).

The Honorable Colleen McMahon, United States District Judge for

the Southern District of New York, sitting by designation.

***

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principally, to a term of 84 months incarceration and a five-year term of supervised

release that included—among other conditions—a digital search condition.

Alleging procedural and substantive errors in connection with his sentence, Mac

Cleary appealed. We have jurisdiction under 28 U.S.C. § 1291, and we affirm. 1

1. The district court did not procedurally err in its consideration of Mac

Cleary’s medical condition. Mac Cleary’s claim for procedural unreasonableness is

reviewed for abuse of discretion. 2 Although Mac Cleary received inadequate

medical care for his colostomy bag in the past, the district court’s conclusion that

he was getting adequate medical treatment in the Bureau of Prisons at the time of

sentencing was “plausible, rational, and based on the record; therefore, it [was] not

clearly erroneous.” See United States v. Graf, 610 F.3d 1148, 1158 (9th Cir. 2010)

(citing United States v. Hinkson, 585 F.3d 1247, 1261 (9th Cir. 2009) (en banc)).

In particular, the note in Mac Cleary’s medical records concerning his colostomy

bag change—which mentions “ineffective health care maintenance”— refers to his

The parties are familiar with the facts of this case, so we include them only as

necessary to resolve the appeal.

The government argues that the procedural errors Mac Cleary alleges are subject

to plain error review because they were not raised below. See United States v.

Burgum, 633 F.3d 810, 812 (9th Cir. 2011). However, it appears that Mac Cleary’s

lawyer did not have a full opportunity to assert her objections, so plain error review

is inappropriate. Fed. R. Crim. P. 51(b); United States v. Martinez, 850 F.3d 1097,

1100 n.1 (9th Cir. 2017).

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previous issues with inadequate medical care but does not mention continued

inadequacy.

2. The district court properly considered Mac Cleary’s childhood abuse

when evaluating the 18 U.S.C. § 3553(a) sentencing factors. The presentence

report indicates that Mac Cleary had suffered sexual abuse, which the court

expressly recognized in considering Mac Cleary’s history and characteristics.

Given the nature and seriousness of the offense, Mac Cleary’s extensive criminal

record, and that his conviction was for the same offense as his previous conviction

(only two years prior), the district court did not abuse its discretion by not giving

“a lot of weight” to Mac Cleary’s abuse as a child. See United States v. Stoterau,

524 F.3d 988, 1001–1002 (9th Cir. 2008) (explaining that abuse a defendant

suffered as a child, along with other considerations, did not render 151-month

sentence unreasonable).

3. The district court did not impose a substantively unreasonable sentence.

Mac Cleary’s sentence is not “shockingly high,” and there is nothing illogical or

“otherwise unsupportable” about the district court’s 84-month sentence. See United

States v. Ressam, 679 F.3d 1069, 1088 (9th Cir. 2012) (en banc) (quoting United

States v. Rigas, 583 F.3d 108, 123 (2d Cir. 2009)); see also Gallo v. United

States, 552 U.S. 38, 52 (2007) (“[T]hat the appellate court might reasonably have

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concluded that a different sentence was appropriate is insufficient to justify

reversal of the district court.”).

Mac Cleary received a sentence at the low-end of the Sentencing Guidelines.

The district court expressly considered the range of sentencing factors, including

the nature and seriousness of the offense, as well as Mac Cleary’s history and

characteristics, and concluded that a within-Guidelines sentence was appropriate.

See United States v. Amezcua-Vasquez, 567 F.3d 1050, 1055 (9th Cir. 2009) (“[A]

Guidelines sentence will usually be reasonable.”) (internal quotation marks and

citations omitted). The offense was Mac Cleary’s sixth felony conviction and the

court found that it was part of a “pattern of continuing criminal activity” that was

“getting more serious.” Mac Cleary attempted to import distributable quantities of

methamphetamine twice in a span of two years, and he had not been deterred by a

lesser sentence.

4. The computer search condition in Mac Cleary’s written judgment is not

unlawful. Supervised release conditions are reviewed “deferentially, for abuse of

discretion.” United States v. Weber, 451 F.3d 552, 557 (9th Cir. 2006). Whether a

written judgment conflicts with an oral pronouncement of sentence is reviewed de

novo. United States v. Napier, 463 F.3d 1040, 1042 (9th Cir. 2006). Where a

district court’s oral pronouncement of sentence is “ambiguous,” the written

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judgment controls to the extent that it clarifies that ambiguity. United States v.

Munoz-Dela Rosa, 495 F.2d 253, 256 (9th Cir. 1974).

The district court stated at the hearing that Mac Cleary would be “subject to

search of his person, his property, his residence, and his vehicle by the probation

officer.” The court’s written judgement merely clarifies what “property” was

subject to search, including not only “residence” and “vehicle” (both of which

were mentioned at sentencing), but also “house” and “papers,” as well as

“computers” and “electronic or digital storage devices.” At most, the court’s oral

pronouncement is ambiguous about whether the word “property,” includes

computers and digital storage devices. See United States v. Allen, 157 F.3d 661,

668 (9th Cir. 1998) (“[An oral sentence] is ambiguous when it is capable of two or

more different constructions, both of which are reasonable.”). But “where there is

an ambiguity in the oral pronouncement of a sentence, [the] unambiguous written

judgment controls.” Fenner v. U.S. Parole Com’n, 251 F.3d 782, 787 (9th Cir.

2001); see also Green v. United States, 447 F.2d 987, 987 (9th Cir. 1971) (“That

the sentence in writing should be referred to in order to resolve ambiguities in the

oral pronouncement is well settled.”).

Mac Cleary alternatively argues that the district court erred in imposing the

computer search condition because the court did not articulate a nexus between the

search condition and the sentencing goals set forth at 18 U.S.C. § 3583(d). “The

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law only requires some nexus between the computer search condition and

furthering ‘the goal of deterrence, protection of the public, or rehabilitation of the

offender.’” United States v. Bare, 806 F.3d 1011, 1019 (9th Cir. 2015) (quoting

United States v. T.M., 330 F.3d 1235, 1240 (9th Cir. 2003)).

The search condition here applies only if “reasonable suspicion exists that

the offender has violated a condition of his supervision and that the areas to be

searched contain evidence of this violation,” and the supervised release conditions

are themselves designed to deter the defendant from further criminal conduct, to

protect the public, and to encourage defendant’s successful rehabilitation. See

United States v. King, 608 F.3d 1122, 1131 (9th Cir. 2010) (affirming a

reasonable-suspicion-based search condition as “reasonably related to protecting

the public and preventing recidivism”). Accordingly, the required nexus between

the search condition and the goals of probation is satisfied.

AFFIRMED.

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APPENDIX B

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

FILED

JUN 28 2023

MOLLY C. DWYER, CLERK

U.S. COURT OF APPEALS

UNITED STATES OF AMERICA,

No.

Plaintiff-Appellee,

21-50240

D.C. No.

3:20-cr-02361-LAB-1

Southern District of California,

San Diego

MICHAEL LEE MAC CLEARY,

ORDER

Defendant-Appellant.

Before: WARDLAW and KOH, Circuit Judges, and MCMAHON,* District Judge.

The panel has unanimously voted to deny the petition for panel rehearing.

The petition for panel rehearing is DENIED.

The Honorable Colleen McMahon, United States District Judge for

the Southern District of New York, sitting by designation.

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.174 Page 1 of 31

APPENDIX C

UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF CALIFORNIA

UNITED STATES OF AMERICA,

Plaintiff,

MICHAEL LEE MAC CLEARY,

Defendant.

_________________________________

)

No. 20-CR-2361-LAB

November 1, 2021

12:09 p.m.

San Diego, California

TRANSCRIPT OF SENTENCING

BEFORE THE HONORABLE LARRY ALAN BURNS

UNITED STATES DISTRICT JUDGE

APPEARANCES:

For the Plaintiff:

UNITED STATES ATTORNEYS OFFICE

By: LYNDZIE MARIE CARTER, ESQ.

880 Front Street

San Diego, California 92101

For the Defendant:

FEDERAL DEFENDERS OF SAN DIEGO, INC.

By: ZAINAB KHAN, ESQ.

225 Broadway

San Diego, California 92101

Court Reporter:

CYNTHIA R. OTT, RDR, CRR

District Court Clerk's Office

333 West Broadway, Suite 420

San Diego, California, 92101

cynthia_ott@casd.uscourts.gov

Reported by Stenotype, Transcribed by Computer

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.175 Page 2 of 31

SAN DIEGO, CALIFORNIA, NOVEMBER 1, 2021, 12:09 P.M.

* * * *

THE CLERK:

Calling number 13 on the calendar,

20-CR-2361, United States of America versus Michael Lee

Mac Cleary.

If counsel could state their appearance, please.

MS. KHAN:

Good afternoon, Your Honor.

Zainab Khan

from Federal Defenders, appearing for Mr. Mac Cleary.

apologize for making the Court wait.

Battaglia arguing motions in limine.

THE COURT:

Okay.

MS. CARTER:

Good afternoon, Your Honor.

Lyndzie

Carter on behalf of the United States.

THE COURT:

Mr. Mac Cleary is present.

I was in with Judge

All right.

Ms. Carter, good afternoon.

Good morning,

Mr. Mac Cleary.

THE DEFENDANT:

THE COURT:

Good morning, sir.

This matter is on for sentencing.

Mr. Mac Cleary has pled guilty to importing methamphetamine.

One of the things that I've reviewed to prepare for sentencing

is a presentence report.

Ms. Khan, did you go over the presentence report with

your client.

MS. KHAN:

I did, Your Honor.

THE COURT:

Here's what else I have looked at and

considered.

First, a sentencing memorandum, filed on behalf of

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the defendant.

Mr. Mac Cleary, which I've looked at, and some medical records.

I have reviewed all of those.

Attached to that is a letter from

The defense sentencing recommendation is contained in

their sentencing memo.

summary chart, which includes their recommendation.

looked at that as well.

The government filed a sentencing

I have

The defendant's filed objections to the presentence

report.

And those objections have been responded to by a

probation officer in an addendum.

reviewed.

submitted beyond -- beyond what I reviewed?

So those are the things I've

Have I failed to mention anything that either side

MS. KHAN:

No, Your Honor.

MS. CARTER:

No, Your Honor.

THE COURT:

Okay.

First are factual objections to paragraphs 7 and 9.

Let me start with the objections.

Paragraph 7 says that following his arrest, the defendant

admitted his involvement in the drug smuggling venture.

started by telling agents he'd been released from county jail

in May for a previous smuggling conviction.

He noted he was placed in a hotel upon his release due

to the pandemic, included that he was able to extend his stay

at the hotel with financial assistance from a family member.

And the objection is that looking at the videotape of his

post-arrest statement, he didn't state that he was placed in a

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hotel upon his release from custody, but instead said he was

homeless until he was able to stay at the hotel.

None of that will affect the Court's sentencing

discretion on this, whatever the reasons were for him being at

the hotel, so I'll resolve that that way.

Paragraph 57 contains another factual objection.

And

in 57, it's reported that when the defendant was arrested for a

previous smuggling offense at the border, that a week before he

was arrested for that offense, which was, by the way, August

2nd, 2019, he was involved in a physical altercation with

someone in Tijuana, a man.

He stated he had no knowledge that the male was

somehow connected to the local cartel.

After he -- after the

altercation, he was telephonically contacted by the man, told

if he wanted to avoid his group from taking revenge, he'd have

to unlawfully transport drugs.

The defendant agreed, a taxi cab picked him up, took

him to an apartment complex where he was given eight packages

which were taped to his legs and groin.

then sent him to the border.

Mexican pesos for cab fare and trolley fare.

received a smuggling payment.

defendant made an unsolicited statement that he committed the

crime for the sole purpose of financial gain.

The taxi cab driver

And he admitted he was given 650

He denied he

During fingerprinting, the

The objection is that he didn't make an unsolicited

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statement that he committed the crime for financial gain.

says he was under duress, so he maintains that.

to the offense in state court?

MS. KHAN:

Yes, Your Honor.

THE COURT:

All right.

He pled guilty

The Court will rely on the

guilty plea, rather than any of the attending circumstances of

what the defendant said.

that he was criminally liable for the crime of importing drugs

into the United States on that occasion.

The guilty plea, of course, admits

He was given a 16-month sentence that he served, so

that's the way I'll resolve that.

generally, Ms. Khan, on behalf of Mr. Mac Cleary.

MS. KHAN:

I'm happy to hear from you

Yes, of course, Your Honor.

Your Honor, I

don't think Your Honor addressed some other factual objections

made in my first objection.

that, you know, he didn't say he intended to transport the

drugs to Apple Valley.

statement, and I just wanted to make that clear as well.

I just wanted to bring them forth,

I reviewed them myself, the post-arrest

THE COURT:

I'm sorry I jumped over that.

And the defendant explained he intended to smuggle the

methamphetamine and transport the drugs to Apple Valley.

What did he say with regard to that?

MS. KHAN:

Oh, okay.

Well, let me back up, then.

Let's see.

That's paragraph 9.

Your Honor, he said that he had heard that

someone could sell drugs for more money if sold in northern

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California.

know where the drugs would be sold.

And that near the end, he reiterated he didn't

THE COURT:

Okay.

There's no objection to paragraph

8, though, right?

In paragraph 8, he says that, once he received the drugs, his

friend, Mirabelle, helped him package them, so that he could

transport them.

Then took a taxi cab to cross the border.

You didn't list an objection to paragraph 8.

He placed the packages on his body himself.

MS. KHAN:

No, I don't object to that.

THE COURT:

Okay.

Well, I'll consider all that in

context of 8 and 9 together, and 7, for that matter.

accept your exception that he didn't definitively say he was

going to Apple Valley to distribute the drugs.

But I'll

MS. KHAN:

Thank you, Your Honor.

THE COURT:

So, Ms. Khan, I'm happy to hear from you,

MS. KHAN:

Thank you, Your Honor.

then.

Your Honor,

admittedly, I recognize that some of the circumstances of this

case would give the Court pause.

and, you know, the circumstances of his arrest.

recognize that.

sentence, Your Honor, is that I do believe that Mr. Mac Cleary

has certainly looked at what his actions were in the past two

years.

Of course, his recent prior

I certainly

The reason I'm asking for a three-year

He wrote what I thought was a wonderful letter to the

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Court, admitting that -- you know, accepting responsibility for

what he did previously, and then what he did in this case.

You know, he -- you know, hadn't -- I think he had a

difficult situation occur, and a case resulted state side.

then he, you know, left custody in the middle -- right when the

pandemic and everything shut down in March of 2020.

And

And he wasn't getting his Social Security disability

insurance.

He was in a lot of pain, he needed health care

certainly.

I've included a lot of medical records or a summary

of the medical records that Mr. Mac Cleary was dealing with.

Mr. Mac Cleary has been dealing with pain all his

life.

You know, he was in a crane accident about a decade ago,

and a crane hit him in his back.

spine.

It certainly messed up his

It provided -- it produced a lot of injuries.

And after that, he sustained a car accident in which,

again, he suffered through a lot of injuries for that as well.

And then he suffered a gunshot wound to his back as well.

mean, there's been repeated hemorrhaging of his back certainly.

Since then he has had to manage his pain through

opioids.

And it's been extremely, extremely difficult for him

just to live a life of constant pain.

He's also, you know, dealt with a lot growing up.

think Mr. Mac Cleary, you know, when he was younger, he was

unfortunately molested at a very young age by a neighbor.

And he -- you know, he acted out in ways when he was

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younger that had his parents put him into psychiatric treatment

and other things like that.

derailed him from finishing school.

deal with those emotions.

he had this terrible work accident.

And it took a -- you know, it

He wasn't able to properly

And then he began working, and then

And he, unfortunately, also due to his pain, became

addicted to methamphetamine.

in Mr. Mac Cleary's life that has led him to this point.

will also note, Your Honor, when Mr. Mac Cleary was arrested in

this case, I recognize he understood the COVID pandemic was

occurring, conditions of confinement were harsh, but, you know,

he took this action during a pandemic.

So there's been a lot happening

I recognize that.

However, he did have a colostomy bag when he entered

custody, and it was not properly cared for.

recognize, and I know the Court said this in other cases, where

our clients, you know, go into custody during the pandemic,

having committed a crime during the pandemic, they are aware

that conditions will be harsh.

So I certainly can

Certainly, I think that there may be some truth to

that certainly, but I do think that here, there was a complete

lack of medical care.

just nose dived since he entered custody.

of COVID.

e-mail the marshals multiple times to talk to the facilities to

get him new changes to colostomy bags.

Mr. Mac Cleary has -- his health has

And not for purposes

His colostomy bag was not getting changed.

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I had to

And he would wake up in

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his mess repeatedly.

how his colostomy bag site became infected, and it led to other

symptoms as well.

And, you know, the medical records detail

It ended up becoming that, you know, I really pushed

for a surgery to occur for his colostomy bag to be removed.

And when that eventually happened months and months later of

Mr. Mac Cleary suffering, they did remove it.

realized that due to the lack of care that had occurred, it

produced other -- other symptoms as well and other illnesses.

He -- you know, I can tell you that I met

But then they

Mr. Mac Cleary when he was first arrested.

now, he looks completely different.

know, he's been in the hospital for months.

this sentencing for several months because he's been in the

hospital.

And what he looks

He has certainly -- you

We've continued

It's my understanding that he has another operation

scheduled for April.

really wanted to be sentenced.

for him.

that he could go to a medical facility.

little bit easier than being at the hospital, because they put

his legs in handcuffs, his hands in handcuffs the entire time.

So I thought -- and Mr. Mac Cleary just

It's been a very anxious time

And he also wanted to, you know, be designated, so

And it would be a

He's actually gotten two blood clots in his legs

because of that, and he will have to be operated on for that as

well.

So it's just been a very difficult time for him,

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medically speaking.

this crime, and that there has to be punishment.

asking for three years, which is certainly more than what he

did last time.

asking for that is so that he can, you know, get the care that

he needs while in BOP custody, but then also, you know, the

after care is not a burden upon the BOP, but instead he uses

his Social Security and disability benefits to get the care

that he needs, once he's released.

And, Your Honor, I recognize he committed

And we're

And you know I think the reason that we're

I also included that, you know, he became infected

with COVID-19 during this time as well.

that's been happening with Mr. Mac Cleary, in terms of his

health.

So he's been in custody for about 15 months and 20

days now.

You know, there was a very low amount of drugs

involved in this case, about 394 grams of methamphetamine was

found on his person.

So there's been a lot

He completed Safety Valve successfully.

Due to his

health issues and just the things that he's faced in his life,

including the sexual abuse at the age of 11, including the loss

of his only child.

three from a SIDS-like incident.

devastating to him.

the mother of his deceased child.

His daughter passed away at the age of

And this was extremely

And it really ended his partnership with

And I think it's just been one thing after another.

And he certainly hasn't helped himself by engaging in this type

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of conduct, but he has certainly -- and when he speaks, it will

be clear that he certainly does not want to live the rest of

his life in jail.

I think even the crane injury, even the car accident,

and everything else that he's been through, the pain

management, his current hospitalization has been much worse

than what he's ever experienced before.

And it's left upon him that his life is short and he

doesn't want to spend it in jail.

has been deterred.

stay, Your Honor.

So he certainly, I think,

And that's why we're asking for a 36-month

If you have any other questions, we're happy to answer

them.

THE COURT:

All right.

Thank you, Ms. Khan.

Mr. Mac Cleary, what do you have to say on your own behalf this

morning?

THE DEFENDANT:

I want to get across the part that I

don't want to stay in jail.

the same room.

and handcuffs on him.

There's a man that's next to me in

He's 68 years old, and they're putting chains

I want no part of that.

I -- obviously, I haven't taken advantage of anything

that anybody has done for me in the past.

mean?

you do with vinegar, and I've had vinegar my whole life.

But I get it.

And you know what I

You know, you get more with honey than

I have -- I'm encouraged -- I'd like to tell you that

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I want to go to school to learn how to cut hair, while I'm on

probation, when I come out.

successful, you know, that's -- I'm done.

You know, I mean, and be

I mean, you will never see me again.

You hear that all the time, and they come back to you.

a 99 percent recidivism rate.

because I was in the Feds before.

the people go back.

within the first year.

the COVID, you know, I thought I could get away with it.

be honest.

And I get it.

There's

But I beat probation last time,

And, you know, 99 percent of

I was one of four that didn't go back

12 years later, I messed up because of

I'll

You know what I mean?

And I don't know that -- what I thought success was,

but I for sure didn't anticipate staying in jail.

And then

going to the hospital, and being in the hospital.

I've been in

there six months, handcuffed to a bed 23 and a half hours a

day.

can barely walk.

And that's real harsh.

The food is better, but I mean, I

I'm on this -- one of them walker things.

This is the

first time I've walked with a cane in six months.

want to come in here in a wheelchair.

wheelchair out there, because I'm proud.

that, hey, I'm going to do this, because, for no other reason,

that people don't believe that I'll do it.

like that.

I didn't

You know, I left the

I just wanted to show

I'm hard-headed

You know, I live in Mexico, because I can't afford to

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live in San Diego.

what I mean?

across the border versus $2,000.

Security.

That's the God's honest truth.

You know

It's $250 for a one-bedroom apartment right

And I get $950 Social

So there's no money there.

And I didn't do the best -- I mean, I made mistakes.

I rushed it.

more money, I think, on my Social Security, but I didn't.

didn't do a lot of things.

And, you know, I get it.

-- I've been warned by Homeland Security that if they catch me

again, they're going to whisper in your ear that I don't

deserve to come out.

THE COURT:

I did all kinds of stuff when I could have gotten

And I aim to make corrections.

Two strikes, and you know, you're on

And I would agree with that.

Well, let me assure you, they don't

contact me or whisper in my ear or anything.

THE DEFENDANT:

THE COURT:

may have said that.

I'm telling you what they told me.

It sounds like an idle threat that they

THE DEFENDANT:

THE COURT:

THE DEFENDANT:

It worked.

Okay.

Anything else?

Other than thank you, Ms. Khan, for

everything that you've done and said on my behalf.

for that.

going forward, sir.

THE COURT:

behalf of the United States?

I thank you

And anything you could do, you know what I mean,

All right.

20a

Thank you, Mr. Mac Cleary.

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.187 Page 14 of 31

MS. CARTER:

Thank you, Your Honor.

The government

isn't recommending minor role in this case.

recommending the minus four Fast Track.

criminal history, as the Court is aware, spanning from 1984 to

2019, but he did accept responsibility for his offense

immediately in the post-arrest.

agreement within two months.

However, we are

He has a significant

And I believe signed his plea

We're also recommending the minus two variance for the

waiver of indictment.

relates to that.

further variance down to 60 months.

I understand the Court's position as it

And then ultimately, we are requesting a

As Ms. Khan had indicated, this is a small amount, 394

grams actual.

addiction problem, and has significant medical issues.

The

government appreciated his letter that he had written.

was -- it came across as very genuine, but given the criminal

history that he has, the fact that he committed this offense a

month after being released from the state after a smuggling

conviction, the government is submitting that a 60-month

sentence would be appropriate in his case.

I recognize that the defendant does have an

THE COURT:

I think it was a little bit longer, wasn't

it?

the probation report.

so it was a short time, but more than a month.

He was released in March of 2020, March 23rd, according to

MS. CARTER:

And he committed this offense in August,

Thank you, Your Honor.

21a

That is correct.

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.188 Page 15 of 31

So on that, Your Honor, we would submit on our recommendation.

We would defer to the Court for any further variances, given

the medical outline that the defense counsel has submitted to

the Court.

THE COURT:

All right.

Thank you.

The Court finds as

follows:

involved the importation of methamphetamine, two levels are

added.

minor role, nor has the defense.

brief, and there's no argument that's been made.

The base offense level here is a 32.

Because this

As the prosecutor points out, they have not recommended

I've read the sentencing

I don't know that I'm required to address that sua

sponte, but given the fact that the defendant had committed a

very similar offense in 2019, the year before, I would not be

inclined to find minor role in consideration of the 3B factors

and his criminal record overall.

moot.

But, again, I think it's

Neither side has recommended minor role here.

The government has recommended Safety Valve.

The

defendant, under the current guidelines, is not eligible for

Safety Valve, so the Court will follow that recommendation, but

do so by giving the defendant a variance, rather than

correctly -- rather than calculating as part of the guidelines,

which would be an incorrect calculation at this point.

remain at 34.

So we

Three points come off for acceptance, four points

comes off for Fast Track.

22a

I grant that adjustment and that

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.189 Page 16 of 31

departure.

just -- just the guidelines.

find that the defendant's offense level, then, is actually 27,

not 25.

So from 34, seven points come off.

And this is

Seven points come off.

He's in criminal history category IV.

And I

And these

guidelines, I find, are a hundred to 125 months, rather than 84

to 105, as listed in the government's sentencing summary chart.

Turning to the 3553 factors, and keeping in mind the

guidelines, the Court first adjusts downward -- varies downward

two levels to account for the Fast Track.

I do so because there's now a conflict between the

criteria for -- I'm sorry, Fast Track -- Safety Valve.

now a conflict between the current guidelines and the First

Step Act regarding what qualifies for Safety Valve.

defendant would qualify under the latter, but does not qualify

under the present iteration of the guidelines, but it seems to

me it's a matter of time before that gets corrected.

There's

The

The Sentencing Commission does not have a quorum at

this point, so it can't take that action, but everyone

anticipates that it will.

variance is warranted, because the defendant gave a full

account of his involvement.

case would not be disqualifying.

105 on the guidelines.

In all events, I find that a

And the record under the Lopez

So that gets us down to 84 to

I find that this offense is serious, not because of

23a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.190 Page 17 of 31

the amount of drugs involved.

this is -- it kind of pales in comparison to cases that, even

this day, I've had.

methamphetamine.

As the prosecutor points out,

The last one was 86 kilos of

Another one was 54 kilos.

This fellow, you know, compared to them is a piker.

But what does set him apart is he's got a long record.

told that, well, it's -- you know, a lot of this is due to his

addiction, but -- and the addiction was due to his health

problems, but the record sort of belies that, in my judgment.

He began committing crimes at 18 years old, and he's

now 55.

These were misdemeanor charges.

He was arrested in 1984 at age 18.

I'm

Again, in '88.

In 2002, before the onset of these medical problems,

he was convicted of possessing methamphetamine as a felony

charge, and was given a probationary sentence for that.

that, as far as I can tell from his history and what's

self-reported, as well as in the medical records and police

report -- I'm sorry, probation report, all of that preceded --

the possession of methamphetamine preceded any addiction to

drugs caused by an injury.

And

2003, again, preceding the onset of the medical

problems, he's convicted of delivering methamphetamine.

years custody suspended, two years, probation.

Willful injury and causing bodily injury.

felony.

On and on.

He pled guilty to a

The probation report notes that there were three

24a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.191 Page 18 of 31

victims involved.

2004, an assault.

Again, in 2004, this is the federal

conviction the defendant alluded to, possession of a firearm by

a convicted felon.

make it through supervised release without being violated.

He did 46 months.

As he points out, he did

2010, minor offense, driver's license or something.

2012, he pled guilty to possessing K2 and marijuana, under an

ounce.

And also some kind of traffic offense.

But by 2019, you know, he's back to serious bad

behavior.

actus reus is concerned, very similar circumstances to this

crime.

He's in almost -- well, at least, as far as the

He's in the pedestrian lanes at San Ysidro.

He comes

by, and he gets caught with 520 grams of methamphetamine

strapped to his thigh.

And to his groin.

And then he tells this pretty fantastic story about

coming to the aid of someone.

oh, they're going to come after him.

really explained.

says about how he was struggling to get by.

hotel for 250.

had a cell phone or something, but to tell you the truth,

Ms. Khan, the whole thing seemed contrived to me.

And then getting a call that,

And none of that is

And particularly curious in light of what he

He 's living in a

I don't know how they reached him.

Maybe he

In all events, without regard to the facts, he pled

guilty and he was given 16 months.

25a

I note, and according to

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.192 Page 19 of 31

the probation report, he only served six months of that.

And I don't know if it was because he was released

early, the release date was right at the beginning of the

pandemic, March 23rd, 2020.

halftime credit, but even with that, he was sentenced 9/16/19,

and he's out in March, which is about six months.

even less than the halftime credits.

would be eight months.

I understand the state court gives

So that's

Halftime on 16 months

He did less than that.

And in all events, you've pointed to that as the

sentence, and it does not provide a benchmark for me,

particularly because the halftime credits, and I don't know the

circumstances, but the state court sentences are typically

very, very low.

I don't know whether they take into account his

criminal history or not.

practiced in state court, criminal history used to be part of

the equation in the sentence, but who knows what goes on now.

Maybe they do.

They used to.

When I

In all events, I don't consider it a benchmark for the

sentence imposed here, which is imposed with consideration of

the advisory guidelines and 3553 factors.

In terms of his history and characteristics, I'd note

that he does have substantial medical issues.

corroborated by the medical reports in this case.

points out, up to this point, he's been on a walker.

and he obviously needs additional medical attention.

26a

Those are

And as he

You know,

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.193 Page 20 of 31

I paid attention as you described his particular

problem with the colostomy and the bag, and the bag not being

treated correctly.

And I do have that in mind as well.

I think that's been resolved at this point.

But, at the same time, his criminal history is -- is

mixed.

some adversities in life.

And he's 55 years old.

-- and I don't mean to discount that, but you know, there's

been a lot of water under the bridge since that happened as a

child.

I don't give a lot of weight to that factor.

upsetting and tragic that he lost a child.

mind.

I'm sorry, his personal history is mixed.

You mentioned he lost a daughter.

I don't know when he was molested, but

And he's now 55, and been in jail many, many times.

not a fake in any respect.

condition.

accidents and dope addiction.

And it's -- it's

I have that in

And then I have his physical condition in mind.

He's had

It's

He's not faking any kind of medical

He's truly suffered from injuries in the past and

You know, I note that his purpose here was to cross

methamphetamine in order to sell it.

in his personal statement to me.

he writes, planned to walk across the border, so I could take

it into the U.S. and make some good money.

He even reiterates that

I got 330 grams of crystal,

So he was going to distribute this.

matter of crossing.

It wasn't just a

It wasn't a personal use amount.

27a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.194 Page 21 of 31

intended to make money off of it.

what he says about his financial condition, that provides some

explanation.

a variance down to 30 months is -- or 36 months is warranted,

given his criminal record and the fact that, you know, he did

this not a month later, but about three months or four months

after he got out, he did the same thing again.

And I suppose in light of

But with all respect, Ms. Khan, I don't find that

And, you know, the larger picture is, it's just a

pattern of continuing criminal conduct.

serious.

he's here, notwithstanding the small amount, because, you know,

they tried by sending him to state court.

lenient sentence.

we're not going to do that again.

actual reasoning is, but you know, that would make sense to me.

So I decline to vary down to 36 months.

And it's getting more

Now he's back in federal court again.

He got six months.

And I assume

And he got a fairly

And they said, you know,

I don't know what their

The government's asked me to vary down to 60 months.

And they point out that, well, he waived his right -- he waived

his right to appeal, Speedy Trial Act provisions.

noted, Ms. Khan, I've not accepted that justification for a

variance before.

a fellow who was in custody, in custody during the pandemic.

He was released in March, right at the beginning of the

pandemic, but we knew about it.

it.

As you've

Let's put this in its proper context.

28a

Here's

And he must have known about

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.195 Page 22 of 31

And, again, I don't know this for sure, but it's

possible that his early release from custody -- appears to be

early was on account of the pandemic.

began, here, I was the chief judge.

in custody.

We made a concerted effort to cull the jail

population.

We got it down to 1900.

the same thing.

At the time the pandemic

We had over 3,000 people

Maybe the state court did

It was a dangerous place to be.

But who knew that best?

The defendant.

The defendant

knew that best.

And it was not a place where you wanted to be in close contact

during the pandemic.

subjects himself to being arrested again, with the natural and

probable consequence that he would go back to jail, and be back

in that same condition.

He was in custody with all of these folks.

And yet months later, he goes out and

So for the government to say, well, number one, you

know, give him a variance because of COVID.

time, place, and manner to do this.

15th to do this.

that point, particularly the defendant.

defendant.

He picked the

He picked the date of July

Everyone was well aware of the pandemic at

Particularly the

And yet he did this then.

Second -- no, no, I've heard from you fully, Ms. Khan,

I'm not going to revisit this.

Second, the idea that he waived his right to a speedy

trial.

You know, look, he waived that by pleading guilty.

everyone knows that it's black letter law, Tollett versus

29a

And

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.196 Page 23 of 31

Henderson decided by the Supreme Court in 1973 makes clear that

all nonjurisdictional claims, including, in particular, speedy

trial claims, are waived when one pleads guilty.

So if he tried to raise that, it would, you know,

immediately run up against that legal obstacle.

second, what were we supposed to do?

Ninth Circuit has not said we were supposed to be trying cases

in the middle of the pandemic.

April.

because he picked the, you know, onset of the pandemic to

commit this offense, and then gave up certain rights, I reject

both of those as basis for a variance.

Second --

Well, we know that the

They decided the Olson case in

So the idea that he's entitled to some kind of credit

You've asked me to consider his medical condition and

his hardships that I've already referred to as a basis for

further variance.

the first variance for Safety Valve are 84 to 105 months.

There's nothing, nothing that says that there's a presumption

that I have to give the low end of the guidelines.

guideline range is to be considered.

consider and weigh the equities that are argued in favor of the

defendant, and those that cut against him.

And here, I've done that.

Now, the guidelines here, even giving him

The

And the Court's to

You know, if it weren't for

the equities, I'd certainly be at 105 months on this case.

Even though it's a smaller amount, the defendant's criminal

record, and the fact that he'd just done this, and just been

30a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.197 Page 24 of 31

punished before would push me to find that this was an

aggravated case.

I am taking into consideration all of the equities

that you wrote about, the things that he's mentioned, the

things that he said today, including, in particular, his

medical condition, which, by the way, he's getting adequate

treatment for, I find now in the Bureau of Prisons.

that into consideration in setting his sentence within the

guidelines.

sentence at the low end of the range, 84 months.

The Court imposes 84 months.

But I take

And I find that from 105, they justify setting the

That's to be followed by

five years supervised release.

Mexico during the period of supervised release.

reapply or ask for a reconsideration of the amount you get

through Social Security if you can't survive here on that.

The defendant is not to go into

There may be other forms of aid, but being in Mexico

is not a good thing for you.

last year by trying to smuggle drugs in.

You'll have to

You've proved that twice in the

He's subject to search of his person, his property,

his residence, and his vehicle by the probation officer.

must participate in a program of drug and alcohol abuse

treatment, including drug testing.

regimen as three random tests per month for the first year.

He's not to have any drugs in his system, including marijuana,

no illicit drugs.

The Court sets the testing

And he's not to miss any tests without a

31a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.198 Page 25 of 31

good excuse.

If after the first year, he's tested clean, and he's

shown up for all the tests, the probation officer will have

discretion to reduce or eliminate the drug testing regimen.

He must provide complete disclosure of his personal

and financial records.

to seek and maintain employment.

Security disability, right?

The Court is not going to require him

THE DEFENDANT:

THE COURT:

I assume you're on Social

That's correct.

Yeah, so he's not able to work, so I don't

order that.

He may reside in a residential reentry center for up

to 120 days, once he's released from custody.

nonpunitive condition.

your feet back on the ground, find a place to go live, and not

be out on the street while you adjust and assimilate back to

society.

This is a

It's a way to give you a place to get

I impose no fine.

I don't impose a hundred dollar

penalty assessment, if the government will remit it.

doesn't look like he's in any condition to work in prison

industries.

MS. CARTER:

So remitted, Your Honor.

THE COURT:

So no penalty assessment based on the

government's motion.

supervised release, Mr. Mac Cleary, and 84 months in custody.

So that's the sentence.

32a

Thank you.

Five years

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.199 Page 26 of 31

You have a right to appeal.

provision, but it cut off at below the low end of the

guidelines at 71 months.

sentence 13 months higher than the appeal.

You signed a waiver of appeal

And I have obviously imposed a

So if you disagree with the sentence that I have

imposed, if you think I made the wrong decision, or I've messed

up procedurally, whatever your reasons are, you can appeal.

You need to speak to Ms. Khan, and she'll file the papers for

you.

But here's what you need to know about the right to

appeal.

You have 14 days to make your decision and get the

paper filed, if that's what you choose to do.

understand?

THE DEFENDANT:

THE COURT:

I do.

If you had one more thing you wanted to

say, you can tell me.

MS. KHAN:

THE DEFENDANT:

MS. KHAN:

THE DEFENDANT:

Do you

Please do not discuss any appeals.

No, no, no.

This has nothing --

Well, I would rather you not say anything.

Where my probation is.

My probation

is, I want to go back home to Omaha.

THE COURT:

Okay.

You can make that request at the

time.

You know, if you've done fine in jail, there haven't

been problems, I have no problem granting a transfer of

supervision to Nebraska.

33a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.200 Page 27 of 31

THE DEFENDANT:

Thank you very much.

That's where I

have cousins at, and you know, people that will take care of

me, and I can afford to live.

THE COURT:

Okay, good.

That sounds like a good plan.

And I'll embrace it if the recommendation is made.

MS. KHAN:

Your Honor, if I could make two requests.

I would ask that he be designated to as close to Omaha as

possible.

THE COURT:

Okay.

The Court will make that request,

that he do his time as close to Omaha, Nebraska as possible.

What's the other one?

MS. KHAN:

I would also request that the Court

recommend RDAP.

THE COURT:

Yeah, I'll recommend RDAP for him, too.

He's got a longstanding drug problem.

MS. KHAN:

And the final thing, Your Honor, is that I

just wanted to make an objection to the sentence, because there

will be an appeal of substantive and procedural defects.

THE COURT:

What are the procedural defects?

Substance is -- you don't even have to raise that.

automatically preserved if the sentence is just too long.

What are the procedural problems?

It's

What didn't I do

that I should have done?

MS. KHAN:

Your Honor --

THE COURT:

Because we can cure them now.

34a

I mean, if

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.201 Page 28 of 31

there's really a problem where I just glossed over something or

didn't follow what the Ninth Circuit says I need to do.

think the guidelines were correctly calculated.

went through all my reasons.

What procedural problem was there?

MS. KHAN:

And I think I

I embraced all your arguments.

Your Honor -- I would say, Your Honor, that

the criminal history was a little mischaracterized, while the

Court was going through it.

THE COURT:

How so?

I read right from the

probation report.

MS. KHAN:

I think, Your Honor, there was that one

point, where you said that there was a trafficking conviction,

where instead it was a possession of methamphetamine

conviction.

history does not score.

Court didn't properly, you know, look at how many years had

gone between the different various --

There was also, you know, a lot of his criminal

THE COURT:

It's several years ago.

I think the

No, you're wrong about that, Ms. Khan.

went through year by year, and gave the year of each offense to

which I was alluding.

concerned, he pled guilty, this is page 8, paragraph 40, to

delivery of methamphetamine, according to the probation report.

Delivery of methamphetamine, possession of controlled substance

with intent to deliver while in possession of a firearm.

looks like they dropped the firearm charge.

As far as the trafficking conviction's

35a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.202 Page 29 of 31

That's certainly a trafficking charge.

Delivery is

trafficking.

importing.

told me in his own letter that his purpose was to traffic in

drugs.

And then, of course, there's a second offense of

And then in this case, as I mentioned, you know, he

He was going to sell them in the United States.

So I don't want to belabor this.

Do you have any

other objections?

MS. KHAN:

Yes, Your Honor.

I think the Court should

have taken -- knowing that Mr. Mac Cleary has been hospitalized

at the very beginning of sentencing, I think there should have

been some questioning of whether he was in -- he was able to

proceed to sentencing.

THE COURT:

Able to?

MS. KHAN:

Proceed on sentencing.

THE COURT:

Today?

MS. KHAN:

Yes.

THE COURT:

You're saying today?

MS. KHAN:

Yes.

THE COURT:

Look, Ms. Khan, that's so disingenuous,

because I was willing to continue the case.

no, don't continue the case anymore.

from the hospital.

MS. KHAN:

Yes.

THE COURT:

And to say that I should have said, oh,

And you told me,

He's ready to be brought

That's the background here.

well, he really doesn't want to come, even though he told me he

36a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.203 Page 30 of 31

wants to come.

And you told me explicitly in e-mails.

then to raise the idea that I should have questioned that?

That's disingenuous on your part, Ms. Khan.

MS. KHAN:

No, Your Honor, I mean --

THE COURT:

That's enough.

That's all.

And

We're in

recess.

(The proceedings concluded at 12:49 p.m., November 1, 2021.)

37a

Case 3:20-cr-02361-LAB Document 56 Filed 08/15/22 PageID.204 Page 31 of 31

COURT REPORTER'S CERTIFICATE

I, CYNTHIA R. OTT, Official Court Reporter, United States

District Court, Southern District of California, do hereby

certify that pursuant to 28 U.S.C. §753 the foregoing is a

true, complete and correct transcript of the stenographically

reported proceedings had in connection with the above-entitled

matter and that the transcript page format is in conformance

with the regulations of the Judicial Conference of the United

States.

DATED at San Diego, California, December 3, 2021.

_/s/ CYNTHIA R. OTT

CYNTHIA R. OTT, RDR, CRR

38a

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 54 of 128

APPENDIX D

DATE

11/28/2007

12/5/2007

12/27/2007

1/24/2008

6/5/2010

EVENT

Discharged from hospital in good condition. Pain controlled with

meds, advised to wear Aspen collar for three months at all times.

Meds: Ranitidine 20mg; Colace 100mg; Percocet 5mg; Bacitracin –

topical

Spouse- Brenda MacCleary

Scalp stables removed. He is unable to control pain (taking Tylenol,

Percocet, Ibuprofen) will try adjusting his meds to obtain better pain

control (prescribed OxyContin 30mg every 12 hours -12 tabs;

Percocet 5mg-10 tabs; Ibuprofen -30 tabs 800mg).

Impressions: neuralgia 2) scapula fracture 3) HTN (hypertension) 4)

scalp laceration staple removed

Admitted to ED in Omaha (lives in Council Bluffs, IA) for cervical

spine MRI – mild broad based disc protrusion at C6-C7 fracture

RECORD

BATES

MACCLEARY_0024516

MACCLEARY_002520-24

MACCLEARY_002532-34

MRI shoulder – mild to mod hypertrophic panus involving AC joint w

mild impingement upon supraspinatus muscle

X-ray of spine shows cervical fracture

Admitted to the Creighton Medical Center ED in Omaha, NE 4

(discharged same day). 44 year old, car accident 3 days

ago. Driver hit by another car– injured neck, back, right

wrist, r foot, and left wrist; headache, neck pain, numbness

and weakness. Broke dentures and glasses during accident.

Past history – chronic pain. Lives with spouse,

unemployed. Current meds: ibuprofen 800mg, Lyrica

75mg; Percocet 10mg 4xday; Methadone 10mg 3xday

Diagnosis: contusion and musculoskeletal strain.

Impressions: Radiculopathy LLe (lower left extremity), t

strain

39a

ER-54

MACCLEARY_002539

MACCLEARY_002541-47

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 55 of 128

DATE

5/25/2012

3/6/2014

4/3/2014

5/1/2014

EVENT

Admitted to the Creighton Medical Center ED, Omaha NE, for

narcotic withdrawal. Experiencing Nausea/ vomiting (15x in 24

hours). Ill-appearing and anxious. Moderate distress; History of

abdominal surgery. Methadone pills fell in the sink – sick when

doesn’t have pills, vomited 3x during assessment; diarrhea on

stretcher. Given Dilaudid i/m and Phenergan. Prescription for

Percocet 10mg (10tabs) and Phenergan (helps nausea)

Current meds: ibuprofen 800mg, Lyrica 75mg; Percocet 10mg 4xday;

Methadone 10mg 3xday

Seen at pain management clinic for f/u and med refills. Complains of

right arm cramping. Med history: arthritis, hep c, HTN.

Assessments: other symptoms referable to back; displacement of

lumbar intervertebral disc without myelopathy

Current meds: Oxycodone 10mg 1 4/day; Percocet 10mg (1tab every

4hours, 180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen

800mg 2/day. Lyrica 100mg. Cyclobenzaprine 10mg. Given refills

for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; displacement of lumbar intervertebral disc without

myelopathy.

Current meds: Oxycodone 10mg 4xday; Percocet 10mg (1tab every

4hours, 180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen

800mg 2/day. Lyrica 100mg. Cyclobenzaprine 10mg. Given refills

for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

intervertebral disc without myelopathy; pain in soft tissues of limb.

40a

ER-55

RECORD

BATES

MACCLEARY_002548-56

MACCLEARY_002681-82

MACCLEARY_002679-80

MACCLEARY_002677-78

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 56 of 128

DATE

5/29/2014

EVENT

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Lyrica 100mg. Given refills for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

intervertebral disc without myelopathy.

RECORD

BATES

MACCLEARY_002675-76

Seen at pain management for f/u and med refills. Ran out of meds

earlier, not tolerating the decrease so well; neck pain with rue

radiculopathy Med history: arthritis, hep c, HTN. Assessments: other

symptoms referable to back; pain in joint, shoulder region;

displacement of lumbar intervertebral disc without myelopathy.

MACCLEARY_002677-74

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Lyrica 100mg. Given refills for Percocet and methadone

6/26/2014

8/19/2014

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Lyrica 100mg. Given refills for Percocet and methadone.

Seen at for pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

intervertebral disc without myelopathy; pain in soft tissues of limb.

MACCLEARY_002671-72

9/17/2014

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Lyrica 100mg. Given refills for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

intervertebral disc without myelopathy; pain in soft tissues of limb

MACCLEARY_002669-70

41a

ER-56

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 57 of 128

DATE

EVENT

RECORD

BATES

11/10/2014

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Lyrica 100mg. Given refills for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

intervertebral disc without myelopathy; pain in soft tissues of limb

MACCLEARY_002667-68

12/9/2014

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Refills for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

intervertebral disc without myelopathy; pain in soft tissues of limb.

MACCLEARY_002665-66

MACCLEARY_002663-64

MACCLEARY_002659-60

3/17/2015

5/12/2015

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Lyrica 100mg. Given refills for all meds.

Seen at pain management for f/u and med refills. Waiting for

primary care to do blood work. Med history: arthritis, hep c, HTN.

Assessments: other symptoms referable to back; pain in joint,

shoulder region; displacement of lumbar intervertebral disc without

myelopathy; pain in soft tissues of limb

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Given refills for Percocet and methadone

Seen at pain management for f/u and med refills. Med history:

arthritis, hep c, HTN. Assessments: other symptoms referable to

back; pain in joint, shoulder region; displacement of lumbar

42a

ER-57

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 58 of 128

DATE

8/5/2015

9/8/2015

EVENT

intervertebral disc without myelopathy (protrusion or herniated

disc); pain in soft tissues of limb

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Given refills for Percocet and methadone

Seen at pain management clinic for follow up. Low back pain,

radiating down both legs, meds are doing well.

Current meds: Percocet 10mg (1tab every 4hours, 180tabs);

Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg 2/day.

Given refills for Percocet and methadone

Seen at pain management for med refill. Patient ran out of

methadone for 4 days now, he was out of town so unable to make

appt – he’s going through what he thinks are withdrawals.

RECORD

BATES

MACCLEARY_002657-58

MACCLEARY_002655-56

Med history: arthritis, hep c, HTN

Assessments: other symptoms referable to back; pain in joint,

shoulder region; displacement of lumbar intervertebral disc without

myelopathy; pain in soft tissues of limb

2/3/2016

Refill: Percocet 10mg (1tab every 4hours, 180tabs); Methadone 10mg

(1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but

meds take edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis (inflammation bottom layers of

skin) affecting regions of neck and back; lumbosacral (5

joints, lumbar vertebrae and sacrum region); other

intervertebral disc displacement (herniated disc),

43a

ER-58

MACCLEARY_002652-54

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 59 of 128

DATE

3/30/2016

4/27/2016

5/25/2016

6/20/2016

EVENT

lumbosacral region. Refill: Percocet 10mg (1tab every

4hours, 180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

30 tabs

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

44a

ER-59

RECORD

BATES

MACCLEARY_002649-51

MACCLEARY_002646-48

MACCLEARY_002643-45

MACCLEARY_002640-42

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 60 of 128

DATE

7/20/2016

8/17/2016

9/14/2016

EVENT

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs) Ibuprofen 800mg,

60 tabs

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

45a

ER-60

RECORD

BATES

MACCLEARY_002637-39

MACCLEARY_002634-36

MACCLEARY_002631-33

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 61 of 128

DATE

10/12/2016

11/15/2016

12/14/2016

1/17/2017

EVENT

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain rated 9/10 –

intensified by cold weather.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

46a

ER-61

RECORD

BATES

MACCLEARY_002628-30

MACCLEARY_002625-27

MACCLEARY_002623-24

MACCLEARY_002620-22

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 62 of 128

DATE

2/15/2017

3/21/2017

4/25/2017

EVENT

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs) Ibuprofen 800mg,

60tabs

47a

ER-62

RECORD

BATES

MACCLEARY_002617-19

MACCLEARY_002614-16

MACCLEARY_002611-13

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 63 of 128

DATE

5/23/2017

6/24/2017

8/2/2017

9/6/2017

10/4/2017

EVENT

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Pain clinic does a Tox Screen - Results positive for THC, Methadone

and Percocet

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

48a

ER-63

RECORD

BATES

MACCLEARY_002608-10

MACCLEARY_002697-99

MACCLEARY_002605-07

MACCLEARY_002602-04

MACCLEARY_002599-01

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 64 of 128

DATE

11/8/2017

12/19/2017

1/17/2018

EVENT

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs)

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity. Assessments: panniculitis affecting

regions of neck and back; lumbosacral region; other intervertebral

disc displacement, lumbosacral region. Refill: Percocet 10mg (1tab

every 4hours, 180tabs); Methadone 10mg (1-2/8hours, 150tabs);

Ibuprofen 800mg

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity. Stopped marijuana 1/2/2018.

RECORD

BATES

MACCLEARY_002596-98

MACCLEARY_002593-95

MACCLEARY_002590-92

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (2 tabs every 8hours, 150tabs); Ibuprofen

800mg

Tox Screen for pain management clinic. Positive for THC,

Hydrocodone, Hydromorphone, Dihydrocodeine, Norhydrone,

Oxycodone, Methadone, EDDP, Acetaminophen

49a

ER-64

MACCLEARY_002693-96

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 65 of 128

DATE

3/6/2018

3/20/2018

4/24/2018

5/22/2018

EVENT

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity. Stretched out medications due to being

late.

Med history: arthritis, viral hep c, HTN

Surgical history: Gunshot wound to back

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

90tabs); Methadone 10mg (1-2/8hours, 90tabs); Ibuprofen 800mg

Tox Screen for pain management clinic. Positive for THC,

Methadone, EDDP, Naproxen, Diphenhydramine

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Tox Screen for pain management: Pos for THC, Oxycodon,

Oxymorphone, Noroxycodone Methadone, EDDP, Acetaminophen

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

50a

ER-65

RECORD

BATES

MACCLEARY_002587-89

MACCLEARY_002690-92

MACCLEARY_002583-85

MACCLEARY_002687-89

MACCLEARY_002580-82

MACCLEARY_002577-79

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 66 of 128

DATE

5/22/2018

6/19/2018

7/7/2018

EVENT

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Tox Screen for pain management clinic: Pos for THC, Oxycodon,

Oxymorphone, Noroxycodone Methadone, EDDP, Acetaminophen

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Admitted to hospital for sigmoid perforation (page 1896)

[colon perforation is a puncture, cut, or tear in the wall of

the colon (large intestine). Can cause air and intestinal

material to leak into the abdomen.]

CT Abdomen & pelvis:

1. Perforated viscus & associated findings as described. The

site of perforation may lie in the sigmorectal junction.

2. Other findings - Significant hepatic fatty infiltration.

Secondary enteritis with probable inflammatory changes

noted. Adrenal gland

enlargement.

Findings: Perforated viscus with free air and complex

moderate ascites.

Descending colon and sigmoid colon has moderate wall

thickening.

51a

ER-66

RECORD

BATES

MACCLEARY_002683-86

MACCLEARY_002574-76

SCRIPPS_Page 764-765

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 67 of 128

DATE

7/8/2018

EVENT

Large amount of stool with some liquid materials in the

colon. The

sigmorectal junction may be site of perforation with

unusual sinus track right laterally. Mid small bowel mild to

moderate wall thickening and inflammatory changes are

present

The lower lungs have atelectasis without large

consolidations.

Significant hepatic fatty infiltration. Pancreatic fatty

atrophy.

Moderate diffuse left adrenal gland enlargement and mild

right adrenal gland enlargement. Mild prostatic

enlargement with minor dystrophic calcifications. Small

hiatal hernia. Mild atherosclerosis.

Received patient from OR (page 137]). Intubated to vent,

sedated. Sedated on fentanyl and ketamine drip (page 48)

RECORD

BATES

SCRIPPS_Page 22

SCRIPPS_Page 2225

Stoma pinkish w minimal bloody secretion in colostomy

bag (page 33)

Post ex lap and colostomy. Mid abdomen incision stapled

half up and lower half of incision open with gauze packing

(page 36)

Preoperative diagnosis: perforated intestine (page 119)

7/8/2018

Post op diagnosis: perforated recto sigmoid colon.

Procedures: Partial colectomy with end colostomy

(removing part of colon but not rectum)

Mobilization of the splenic flexure for partial colectomy

Case Manager notes. History: Hep C, chronic shoulder pain/goes to

methadone clinic, gunshot wound/exploratory abdominal surgery in

52a

ER-67

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 68 of 128

DATE

7/9/2018

7/12/2018

7/13/2018

7/14/2018

7/15/2018

EVENT

2010. Admitted with sigmoid perforation after a week of constipation

and either enema or colonoscopy In Mexico.

OR (operating room) for partial colectomy and end colostomy, now

sedated and on ventilator. No family has been here with patient. Will

await change in patient's level of consciousness for full assessment.

Hospitalized at Scripps Mercy – here for wound vac placement in

abdomen. No drain for now, JP and colostomy intact.

Assist with locating family.

Restless and delirious – given Haldol. CT scan of head w/out

contrast – No CT evidence of acute intracranial abnormality.

History: Sigmoid colon perforation. Encephalopathic

Abdomen Ultrasound - No definite abdominal pathology identified

on sonogram. No biliary obstruction identified.

Needs restraints bc keeps pulling feeding tube out and pulling gown

off

Came to hospital with severe abdominal pain over last 6 days;

constipated, water enema in TJ (lives in Mexico). Continued pain.

Abdominal surgery for GSW in abdomen, Nebraska 2010 (this is

actually a MVA, not a GSW – don’t seem to have the GSW records)

History:

1. HEP C (accdg to patient)

2. Chronic pain, shoulder injury, motorcycle accident –

methadone from pain clinic

3. Denied Diabetes mellitus

Assessment:

1. perforated viscus sigmoid/rectal junction area

2. Hx of constipation, r/u iatrogenic perforation

3. Anion gab metabolic acidosis, secondary to perforated viscus

4. Sepsis secondary to perforated viscus and acute abdomen

53a

ER-68

RECORD

BATES

SCRIPPS_Page 12; Page 31

SCRIPPS_Page 59 & Page

2391

SCRIPPS_Page 2411

SCRIPPS_Page 309

SCRIPPS_Page 403

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 69 of 128

DATE

EVENT

RECORD

BATES

7/16/2018

Pain controlled with methadone 40mg and oxy before wound vac

change

SCRIPPS_Page 15

SCRIPPS_Page 1846

SCRIPPS_Page 538-539

HEP C, GSW hx, chronic pain (page 150)

Discharge planning - patient lives alone and does not have support;

never been to a SNF before (skilled nursing facility). (page 174)

7/17/2018

Was living in a trailer in Mexico, but recently sold it and has no place

to go (page 219)

Re Eval due to surgical debridement of wound.

Dx: Sigmoid perforation

7/18/2018

Debridement - removal, thoroughly cleaning the wound

and removing all hyperkeratotic (thickened skin or

callus), infected, and nonviable (necrotic or dead) tissue,

foreign debris, and residual material from dressings

Social worker notes: Pt endorses symptoms associated with anxiety,

depression or PTSD. Pt believes he suffers from PTSD following work

accident - beam fell killing seven of his coworkers and severely

injuring him.

Denied family history of mental illness as well as any current or

previous SI/ HI. Provided outpatient mental health resources

including Family Health Centers and Access and Crisis Line for

outpatient follow up.

Pt lives alone in SSH located in Tijuana, Mexico.

54a

ER-69

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 70 of 128

DATE

7/19/2018

EVENT

SW provided extensive emotional support and supportive counseling

as pt discussed "near death" experience of sigmoid perforation

caused by negligent medical care in Mexico.

Surgery performed 1) partial colectomy with end colostomy

2) Mobilization of the splenic flexure for partial colectomy

RECORD

BATES

SCRIPPS_Page 527

SCRIPPS_Page 1775 &

Page 2486]

Pre Op diagnosis: perforated intestine

Post op diagnosis: perforated rectosigmoid colon

Perforation of rectum or sigmoid -not uncommon and can

occur in any age group. Rectosigmoid colon is

characterized by inadequate blood supply and high

pressure due to less caliber which is the rationale behind

perforation of the distal part of the colon

7/21/2018

CT scan of abdomen/pelvis showed left capsular hematoma

and possible PE at the right lower lobe. CT angiogram and

venous doppler. Another surgical intervention pending

doctor’s recommendation.

Findings:

1. Bilateral pyelonephritis (infection of kidney) with no

hydronephrosis or urinary tract calculi.

2. Moderate consolidation left lower lobe possibly from

pneumonia and aspiration. Moderate left pleural effusion.

3. Fat stranding throughout the small bowel mesentery,

greater omentum from recent bowel perforation with

postsurgical change. Persistent peritonitis possible.

55a

ER-70

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 71 of 128

DATE

EVENT

4. Large left perisplenic fluid collection with rim

enhancement. Probably subcapsular given the mass effect

on the spleen. No active bleed. Most likely from a subacute

subcapsular hematoma. Superinfection is possible.

RECORD

BATES

5. Status post recent Hartmann procedure with surgical

drain. No abnormal fluid collections identified adjacent to

the surgical drain. Thickening of rectum, distal colon

probably from mild colitis, proctitis.

6. Small bowel ileus.

7. Metallic shrapnel in the spine.

8. Possible pulmonary embolism at the right lower lobe.

Consider CT

angiogram of the chest for evaluation.

7/21/2018

9. Findings of possible pulmonary embolism (blood clot),

perisplenic hematoma, pyelonephritis

CT Angio Chest Impressions:

1. Acute moderate bilateral pulmonary emboli. No

pulmonary artery

hypertension or right heart strain.

2. Moderate to severe consolidation left lower lobe with air

bronchograms from pneumonia or aspiration. Adjacent

moderate pleural effusion. Patchy mild pneumonia right

upper lobe.

3. Moderate thickening of the distal esophagus could be

from esophagitis.

56a

ER-71

SCRIPPS_Page 2506 2508

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 72 of 128

DATE

EVENT

RECORD

BATES

SCRIPPS_Page 13

SCRIPPS_Page 1577

SCRIPPS_Page 290

SCRIPPS_Page 425

MACCLEARY_002571-73

MACCLEARY_002566-70

4. Metallic foreign body (shrapnel) embedded in the

posterior elements at T11-T12. MRI is contraindicated. Old

fracture deformity right scapula.

7/22/2018

7/25/2018

7/26/2018

7/29/2018

9/26/2018

10/23/2018

Surgical wound mid abdomen connected to wound vac. Colostomy at

left abdomen JP Drain at right abdomen. S/P prior to admit at left

buttock

VU Venous Duplex Lower Ext: Negative for deep vein thrombosis in

both lower extremities [page 2524]

Pt on flagyl PO, wound vac still present to abdominal wound. RLQ JP

drain in place, dressing changed.

Closure of abdominal wound on Friday. Going to Skilled nursing

facility - Windsor Gardens San Diego. Friend Andres plans to cross

border and pick him up after rehab done

Ready to transfer to Windsor Gardens

Chest x-rays: Improving but persistent patchy left basilar

consolidation

with small left pleural effusion.[page 2585]

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity.

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Seen at pain management for med refill. Sore all over, achy muscles;

can’t get up

57a

ER-72

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 73 of 128

DATE

11/20/2018

12/19/2018

1/22/2019

EVENT

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Seen at pain management for med refill. Pain present, but meds take

edge of & allow daily activity

Assessments: panniculitis affecting regions of neck and back;

lumbosacral region; other intervertebral disc displacement,

lumbosacral region. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

Seen at pain management clinic for med refills. Pain still present –

meds take edge off. Refill: Percocet 10mg (1tab every 4hours,

180tabs); Methadone 10mg (1-2/8hours, 150tabs); Ibuprofen 800mg

RECORD

BATES

MACCLEARY_002565-67

MACCLEARY_002559-64

MACCLEARY_002559-61

EMR_Page 588

last date of these records

3/11/2019

Prehospital admission. Chief complaint: medication refill,

generalized body pain. In July 2017 – major trauma victim –

multiple bone fractures and colostomy bag placed. Crossing border

bc he resides in TJ to seek attention and get pain meds refilled.

Requesting non emergent transportation assistance to hospital –they

pick him up

58a

ER-73

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 74 of 128

DATE

3/12/2019

EVENT

Admitted at Scripps Chula Vista ED via ambulance for

abdominal pain (discharged same day). Started over a week

ago, chronic, nauseated, sharp off and on pain in LLQ.

RECORD

BATES

EMR_Page 557-589

EMR_Page 553-554

53 yo male w extensive abdominal history of colonic

perforation and colostomy. Chronic abdominal pain

slightly worse of the last couple of days. Increased output in

the colostomy & complaining of double vision (intermittent

but concerning) since an auto versus pedestrian accident in

March. Came across the border today for pain management

as he has run out of his pain medicines. (Pg 567)

Past medical: Rectosigmoid colonic perforation status post

colectomy

Bilateral pulmonary emboli status post IVC filter;

Anemia of chronic disease;

Chronic pain from abdomen;

shoulder pain from motor vehicle accident – on methadone

from clinic in Apple Valley.

3/12/2019

Morphine injection 2mg.

CT Head without contrast at Scripps. History: head trauma,

headache, double vision.

Findings: no acute infarct; no intracranial hemorrhage.

Other findings: ventricles are mildly enlarged -probably from normal

variation.

Sulci are within normal limits.

Brain parenchyma is unremarkable.

vascular structures - normal limits for age.

Midline structures - normal limits.

Paranasal sinuses show mild mucosal thickening of the ethmoid air

cells.

Bony structures - normal limits for age.

59a

ER-74

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 75 of 128

DATE

EVENT

Soft tissues show high density in the external auditory canals

consistent with cerumen.

RECORD

BATES

9/28/2019

At Scripps Health Liberty Station – needs flu vaccine

EMR_Page 549-552

8/24/2020

Referral from ICE to Alvarado Radiology – fell during “Mexican

basketball play” about a week ago. Pain in right elbow – requesting

x-ray

MACCLEARY_001842

9/1/2020

9/11/2020

At Scripps Health Express Solana Beach – needs flu vaccine

Medical wound follow up – scheduled colostomy bag change

9/10/20. Stoma normal appearing – no medical concerns

EMR_Page 544-548

MACCLEARY_002313

MACCLEARY_002450

MACCLEARY_002325-32

Change colostomy bag every 2 weeks

Meds:

amlodipine 10mg

Atorvastatin calcium 20 mg

Colace 100mg

Ibuprofen 600mg

Lisinopril 10mg

9/13/2020

10/15/2020

Colostomy bag changed. Stoma appears normal with no sign of

infection. Return in 2 days

Initial Intake Screening – arrived with negative TB

Weight: 239 Height: 6’1

Alcohol withdrawal in June 2020

Pain from accident injuries, 11/26/2007

Chronic generalized pain

60a

ER-75

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 76 of 128

DATE

10/15/2020

10/16/2020

EVENT

Meds:

amlodipine 10mg

Atorvastatin calcium 20 mg

Colace 100mg

Ibuprofen 600mg

Lisinopril 10mg

RECORD

Reports history of ADD/ADHD

NEGATIVE COVID-19 test

Urgent mental health appt for 10/16- reports inability to sleep due to 3

PTSD r/t accident in 2007

Health appraisal: Complaints - pain right shoulder, back, neck, arms. 3

Impaired vision; Muscle, joint pain

Drug & alcohol: Alcohol – 1 pint/day for 2mos; tobacco daily for 35

years, last used 3/23/20; marijuana 40 daily, last used 7/11/20

Mother & Father – deceased; Brother – unknown

Medical/surgeries: HTN, HCV since 2007 – never treated, no IV

drug use.

7/2018 colostomy r/t GSW- got sick in hospital (Dr Sue at Sharp CV);

2007 – hit by crane, c6-c7 sheared off end bone, torn brachial plexus,

shattered scapula, broken left foot, 4 toes and right foot, BL hands

broken

54 yo, healthy appearing, with colostomy in place to LLQ, tattoos

generalized; LROM (limited range of motion) to left arm

Problem list: colostomy care, colostomy present; S/P partial

colectomy; Hypertension benign

Housing: lower bunk, job limited, and program

61a

ER-76

BATES

MACCLEARY_001887

MACCLEARY_002312

MACCLEARY_002329-32

MACCLEARY_002453-55

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 77 of 128

DATE

EVENT

RECORD

BATES

10/16/2020

Cardiac chronic care: Conditions - Hypertensive since 2007;

Dyslipidemia since 2007; S/P colostomy

MACCLEARY_002319-22

MACCLEARY_002342

MACCLEARY_002310

MACCLEARY_002308-09

MACCLEARY_002397

Intolerant diet; Hospitalizations: GSW

Obese w colostomy mid abdomen – weight: 237.4lbs. BP: 114/63

Recommended diet for health; daily exercise

Medications:

Amlodipine 10mg

atorvastatin calcium 20mg

Lisinopril 10mg

Ibuprofen 600mg

Tylenol extra strength

10/16/2020

10/17/2020

10/18/2020

Ran out of meds for 3wks for HTN – got meds 2 days ago

All over body pain from old crane injury. Pain 8 out of 10

Colostomy bag changed

Colostomy bag changed at request. Wants to speak directly to

medical director re renewing chronos

Meds:

amlodipine 10mg

Atorvastatin calcium 20 mg

Colace 100mg

Ibuprofen 600mg

Lisinopril 10mg

Tylenol extra strength 500mg

NEGATIVE COVID-19 test

62a

ER-77

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 78 of 128

DATE

10/19/2020

RECORD

BATES

MACCLEARY_002346-47

MACCLEARY_002306-07

MACCLEARY_002305

Abdomen – non distended, hyperactive bowel sounds

10/23/2020 COVID-19 test Positive results

MACCLEARY_001887

10/26/2020

MACCLEARY_002304

MACCLEARY_002303

MACCLEARY_002301-02

MACCLEARY_002299

10/19/2020

10/22/2020

EVENT

Mental Health – no current or past mental health symptoms. Drug

abuse/dependence – alcohol & cigarettes

Requesting cotton blanket – wool allergy. Colostomy and wants ABD

binder to support his ABD (unsure what this is)

Colostomy bag changed at patients request; requesting renewal of

chronos

Stoma bag change is due tomorrow

Assessment: ineffective healthcare management

10/27/2020

Requesting blanket chrono – hasn’t had one since coming back from

Arizona – approved

10/29/2020 Asked about dressing changes (s/p partial colectomy);

should be getting dressing changes every two days – but

hasn’t received dressing supplies for three days (10/25/20).

Doesn’t get all the supplies he needs. Housing unit in

quarantine - supplies brought to housing

11/1/2020

Scheduled for dressing changes M, W, F

Issues sleeping, feeling run down. Colostomy not changed

since Thursday and needs to be changed every 2 days –

bruise on right ring finger

Meds:

amlodipine 10mg

Atorvastatin calcium 20 mg

Colace 100mg

Ibuprofen 600mg

Lisinopril 10mg

63a

ER-78

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 79 of 128

DATE

EVENT

RECORD

Tylenol extra strength 500mg

Right 4th finger – proximal interphalangeal joint slightly red purplish 3

– assured may have tiny vascular rapture and might get bruises that’ll

resolve

F/u for COVID recovery – c/o headache, loss of smell,

cough, loss of taste, body aches, malaise – not recovered

BATES

c/o headache, loss of smell, cough – thick white sputum;

loss of taste; body aches and malaise. Patient appears

unkempt

F/u for COVID positive – intermittent loss of smell, taste,

fatigue – return to housing unit tomorrow; observed doing

tricep dips

MACCLEARY_002295

MACCLEARY_002293

11/5/2020

F/u for COVID positive – reports feeling fine. Recovered

MACCLEARY_002291-92

11/9/2020

(had) Positive COVID test– seen for medical clearance; housed in

quarantine; loss of taste, regained smell – patient stable /recovered

from COVID-19

MACCLEARY_002288

11/12/2020

Complaints of RLS (restless leg syndrome) with inability to sleep –

feels like running in sleep; the cold aggravates

MACCLEARY_002287

11/13/2020

Complains about diet– wants to cont. on the allergy/intolerant diet

MACCLEARY_002285

11/15/2020

MACCLEARY_002284

11/16/2020

11/19/2020

Unable to sleep at night – RLS, kicks and moves; requesting

colostomy supplies

Colostomy bag supplies

Missing all teeth except #21-29 (extract 29-26)

MACCLEARY_002283

MACCLEARY_002361-62

11/20/2020

Given Colostomy supplies

MACCLEARY_002281

11/2/2020

11/3/2020

11/4/2020

64a

ER-79

MACCLEARY_002297-98

MACCLEARY_002295-96

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 80 of 128

DATE

11/23/2020

EVENT

Complains about RLS and his diet intolerance bc of GERD. He didn’t

receive correct diet this am. Colostomy changed during visit.

1) RLS

2) GERD

3) Colostomy care

Start Mirapex .125mg

RECORD

BATES

MACCLEARY_002279-80

MACCLEARY_002356-57

MACCLEARY_002338-41

MACCLEARY_002414

MACCLEARY_002276-77

MACCLEARY_002300

MACCLEARY_002272

Meds: amlodipine 10mg

Atorvastatin calcium 20 mg

Colace 100mg

Flucelvax 05ml injection

Ibuprofen 600mg

Lisinopril 10mg

Magox 400mg

Tylenol extra strength 500mg

11/24/2020

11/28/2020

11/29/2020

11/30/2020

12/1/2020

12/5/2020

Dental - Teeth extracted - #26-29

Other skin conditions: Both legs are swollen and red –

onset 10 days ago

BP: 136/74. Weight: 248.8. Discolorations in skin – pink,

warm to touch.

Plan – elevate legs, sick call if swelling and pain doesn’t

decrease. F/U on 11/30/20. F/U with Thompson on 11/30

Chest x-ray – hazy opacity in lef lower lobe, could be atelectasis,

scarring, promint paracardiac fat pad or pneumonia

Seen for c/o tooth pain; swelling/redness improved from water pill;

colostomy site irritation from old adhesive. Meds: Furosemide 20mg

Notified about COVID test result

Signed up for water pills

65a

ER-80

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 81 of 128

DATE

RECORD

BATES

12/07/2020 Reports pain at colostomy site – started on weds after

changing bag pain 8/10; sharp radiating from outer

colostomy to stoma. Site is “angry red” stoma growing in

size. Taking Ibuprofen 500m, but not helping

12/10/2020

Requesting meds for RLS. He’s cold and requests an extra blanket

MACCLEARY_002258

MACCLEARY_002270

12/16/2021

MACCLEARY_002267

MACCLEARY_002265

MACCLEARY_002262

MACCLEARY_002259

MACCLEARY_002256

12/17/2020

12/18/2020

12/25/2020

EVENT

Meds for RLS not working. RLS started 1 ½ years ago after he quit

taking methadone

Needs something diff for RLS, asks for lotion for dry legs/flakey skin.

Given A&D ointment

Requesting eye glasses; agitated that others have received glasses, he

still hasn’t and he’s requested three times. Informed he did not meet

criteria to receive eye glasses.

Provided with colostomy bag supplies

Seen for stoma bag and flange change. Supplies provided to patient.

Stoma paste not in stock; stoma site in poor condition, surface of skin

eroded back 10 cm around opening and oozing fluid; unwilling to

change stoma care techniques. Noted that he ripped the wafer (part

of the appliance that goes against the skin and has a hole that fits

around your stoma) with fingers to make to opening, then used

medipore and paper tape to adhere stoma wafer to abdomen; patient

expressed dissatisfaction with stoma supplies.

12/28/2020 Pain at colostomy site for past 10 days – lower abdomen;

increased severity in past three days. Sharp, radiating pain

through left abdomen increased in size. Requesting

additional ostomy bag supplies – asks for supplies that will

decrease irritation at ostomy site; changes dressing

3x/week. Experiencing similar abdomen pain resulted in

66a

ER-81

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 82 of 128

DATE

12/29/2021

1/2/2021

1/4/2021

EVENT

hospitalization – polypectomy scheduled then deferred due

to Covid

X-ray of abdomen – nonspecific bowel gas pattern; mild constipation

RECORD

BATES

MACCLEARY_002255;

MACCLEARY_002412

MACCLEARY_002252

MACCLEARY_002250-51

MACCLEARY_002247

MACCLEARY_002245

Requesting help with colostomy change, “my bag is leaking” 3

and can’t do it by himself, medical says they can pass

supplies through the food port. Patient refused stating he

MACCLEARY_002246

Skin irritation and leaking from colostomy bag after using

the new bag supply. Requesting thicker ostomy bag which

didn’t’ break or as difficult to keep intact. Supplied with

extra bags

Seen for RLS. C/O sharp pain around colostomy

site/radiating pain in middle of colostomy; lower abdomen

swollen/distended; been swollen for 1 ½ months; abdomen

is bloated and swollen around colostomy.

Colostomy only supposed to be temporary until Jan 2019but arrested and incarcerated. Saw a GI surgeon in Jan

2020 – Sharp to Tri City Vista hospital. Colonoscopy in Jan

2020 – multiple polyps detected – then sent back to George

Bailey- not seen a GI specialist since

1/5/2021

1/8/2021

1/7/2021

Changed own bag. Mirapex changed from 1 to 2 tabs at

night

Reports current colostomy bags are falling off and he’s

running out of supplies; he has no backing for the bags

which is why they keep falling. Asks for a blanket bc he’s

cold.

Macerated skin noticed around the stoma – resistant to teaching &

would enlarge the circumference of properly cut stoma.

67a

ER-82

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 83 of 128

DATE

1/11/2021

EVENT

needs help. Pod is currently on lockdown – security says

unsafe and not an option to bring patient out

Requesting furosemide – helpful for lower leg edema. Discontinued

bc he’d refused meds several times. Noticed leg swelling so re

ordered

RECORD

BATES

MACCLEARY_002243

1/13/2021

COVID-19 – negative test

MACCLEARY_002404

1/21/2021

Refusing medical – he wants to get colostomy bag changed later

MACCLEARY_002417

1/25/2021

COVID-19 – negative test

MACCLEARY_002402

1/26/2021

Follow up on restless leg syndrome. Medication increased but now

getting RLS during the day

MACCLEARY_002238

1/27/2021

Evaluated at Chula Vista Emergency Room - parastomal

hernia detected

MACCLEARY_001158

1/28/2021

Admitted to ED. 55 yo seen at Alvarado Hospital for pain

and swelling at colostomy site. Emergency colonic surgery

in 2018 & colostomy bag placed – does not recollect the

nature of surgery or why it was done. Believes he was living

in Mexico and brought emergency to San Diego – states

surgery at Sharp Hospital, but no records found.

MACCLEARY_0011581161

Patient underwent colonoscopy in Jan 2020 – multiple

polyps found. Scheduled for takedown of colostomy but

canceled due to Covid.

Evaluated on 1/27/21 – parastomal hernia. Medical history:

restless leg; hypertension; hyperlipidemia. Surgery:

emergency colostomy 2018.

Social history: smoking history

68a

ER-83

(copy in record set 3

MACCLEARY_002374-77)

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 84 of 128

DATE

EVENT

RECORD

BATES

MACCLEARY_002237

Meds: amlodipine 10mg; Atorvastatin 20 mg daily; Colace

100 mg daily; Ibuprofen prn; Lisinopril 10 mg daily;

Mirapex 0.125 mg daily; Tylenol prn

Also seen at Tri City – trying to get those records

1/28/2021

Plan: requires surgery bc large parastomal hernia;

probable colostomy takedown at same time

Patient returned from offsite, no injuries, no signs of pain

1/29/2021

Restless leg syndrome – meds help at night, getting RLS during day.

Changed meds – Mirapex am / pm; pramipexole dihydrochloride am

/ pm

MACCLEARY_002236

2/1/2021

Reddened left extremity with few scabs – leg cramp kept awake.

MACCLEARY_002231

2/1/2021

Requesting plastic chair to help with chronic back pain;

lower leg swelling – doctor won’t assign personal chair

MACCLEARY_002223

2/2/2021

COVID-19 – negative test

f/u lower leg swelling 3-4 mos; mild erythema, redness with pitting

edema in both lower legs; skin scratches w dry blood and mile

erythema around left lower leg; takes amlodipine for BP control can

cause edema – will prescribe topical abx to prevent skin infection

MACCLEARY_001887

MACCLEARY_002229

2/2/2021

COVID-19 – negative test

MACCLEARY_002401

2/9/2021

COVID-19 – negative test

MACCLEARY_002400

2/11/2021

Asks for Covid vaccine

MACCLEARY_002227

69a

ER-84

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 85 of 128

DATE

2/16/2021

EVENT

Refused to come down and change bag or sign refusal form

RECORD

2/16/2021

Colostomy bag change – small polyp present on right side of stoma;

site is red and intact; bag changed by patient

COVID-19 – negative test

MACCLEARY_002242

MACCLEARY_002249

MACCLEARY_002399

2/16/2021

BATES

2/17/2021

Colostomy bag leaks – leaks all over clothes, underwear,

uniform – needs supplies

MACCLEARY_002224

2/18/2021

Needs to drain out ear – ear lavage 10 years ago worked great

MACCLEARY_002223

2/19/2021

MACCLEARY_002221

2/23/2021

Colostomy bag leaking and soiling his clothes, distressing

bc of contents on clothing; ear lavage – profuse wax

drainage from both ears, decreased hearing

COVID-19 – negative test

MACCLEARY_002426

3/3/2021

COVID-19 – negative test

MACCLEARY_002391

3/9/2021

COVID-19 – negative test

MACCLEARY_002398

3/13/2021

Seen for puss draining from leg for 8 days, “need my bags

Monday, wed, Friday.”

MACCLEARY_0022152216

3/14/2021

Seen for superficial skin tear left shin – seen for wound care dressing changed

MACCLEARY_0022132214

3/15/2021

COVID-19 – negative test

MACCLEARY_002389

3/17/2021

Offsite referral to general surgery for colonic reanstomosis

per consult

MACCLEARY_001845

70a

ER-85

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 86 of 128

DATE

3/17/2021

EVENT

Presents with history of gunshot wound to abdomen status

post laparotomy with partial colectomy and descending

colostomy. Patient underwent colonoscopy and evaluation

of rectal stump. Patient is now requesting reversal of his

colostomy.

RECORD

BATES

MACCLEARY_0011621165

[also located in record set

3, MACCLEARY_00237173]

Past surgery: laparotomy w Hartman’s procedure

Family history: father - lung cancer, mother – cancer

Morbid obesity

Diabetes mellitus

hyperlipidemia

Substance abuse in remission; incarcerated

Dental - only four or five teeth left on lower

Past neck injury

Stasis dermatitis from ankles down

3/19/2021

3/24/2021

4/3/2021

4/8/2021

Presents offsite for surgery consult 2 days ago for ostomy

closure and hernia repair. Ostomy placed after 2018 GSW

– doesn’t know any details just woke up with ostomy bag.

Incarceration delayed treatment of temporary colostomy.

Not confirmed by records yet, patient good historian

Seen at housing unit for restless leg syndrome- not better

with Mirapex; unable to sleep at night bc of RLS, wakes 6+

times a night. C/O leg edema and open sores spontaneously

appear on left leg. Increased dosage of Mirapex

Seen for colostomy bag change.

Seen for colostomy bag change & rash on both knees (poss from

laundry) putting hydrocortisone cream but not helping

Cardiac chronic care –

71a

ER-86

MACCLEARY_002208

MACCLEARY_0022102211

MACCLEARY_002206

MACCLEARY_002203

MACCLEARY_002314-18

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 87 of 128

DATE

EVENT

Hypertensive since 2007

Dyslipidemic since 2007

RECORD

BATES

MACCLEARY_002387-88

MACCLEARY_002510-11

Chronic diseases: colostomy status, trauma, chronic pain

Intolerant diet

Hospitalizations: GSW, trauma

Obese w colostomy mid abdomen – weight: 277

Cholesterol 143 (1/5/21)

Abnormal EKG found on 11/18/2021

Covid-19 vaccination when available.

Medications:

Amlodipine 10mg

atorvastatin calcium 20mg

Loratadine 10mg

Lisinopril 10mg

Pramipaxole .125

Pramipexole dihydrochloride .125mg

Ibuprofen 600mg

Tylenol extra strength

Change in meds: Norvasc 10mg & Lisinopril 10mg

4/16/2021

4/13/2021

Ran out of meds for 3wks for HTN – got meds 2 days ago

Labs – high triglycerides; hemoglobin 6.0 (increased risk for

diabetes

Imaging left leg – no evidence of hemodynamically sign etenosis;

ankle brachial indices could not be performed due to vessel

incompressibility

72a

ER-87

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 88 of 128

DATE

5/10/2021

EVENT

No evidence of deep vein thrombosis

Seen for colostomy bag supplies; ear pain, nasal congestion; ointment

for dry leg

Seen for colostomy bag supplies

Dental - missing all but 5 teeth. Gingiva – inflames; masticating

efficiency: poor. Prosthesis needed for upper and lower denture –

extraction of decayed teen #22-26

Refused medical treatment this am

5/13/2021

Chest x-ray – normal

MACCLEARY_002405

5/13/2021

Patient snapshot sent to Core Civic:

x Abdominal pain

x Allergy

x Back pain

x Colostomy care

colostomy present on admission

x Covid-19 w multiple comorbidities

x Dependent edema

x Dry skin

x Dyslipidemia

x Immunization

x Covid test

x Generalized joint pain

x GERD

x Health maintenance

x Hearing loss due to cerumen impaction

x Restless leg syndrome

x Hypertension

x Impacted cerumen

x Leg edema

MACCLEARY_001903

4/28/2021

4/30/2021

5/5/2021

73a

ER-88

RECORD

BATES

MACCLEARY_002187

MACCLEARY_002184

MACCLEARY_002350-53

MACCLEARY_001913

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 89 of 128

DATE

5/13/2021

5/17/2021

5/19/2021

5/20/2021

EVENT

x Leg pain

x Mouth pain

x Obesity

x s/p partial colectomy

x skin tear of lower leg without complication

Treated for restless legs (RLS) with pramipexole (meds seem to be

working) Current Meds at Otay Mesa Detention Center:

x A&D ointment;

x amlodipine;

x atorvastatin (check sp?) calcium

x Golytely solution

x Hydrochlorothiazide

x Lisinopril

x Electrolyte solution

x Pramipexole dihydrochloride

x Tylenol extra strength

Asks for ear lavage because he can’t hear well. Receives lavage before

returning to pod

COVID-19 – negative test

Labs – consistent with diabetes

Sick call for bilateral ear ringing – ear pressure & pops when yawns;

previous problem resolved with ear wax cleaning – ear lavage

scheduled

Admitted to hospital for surgery - colostomy reversal with

repair of parastomal hernia, appendectomy, & extensive

lysis of adhesions. Under general anesthesia

Appendix removed to prevent future complications

74a

ER-89

RECORD

BATES

MACCLEARY_0021792180

MACCLEARY_002178

MACCLEARY_001887

MACCLEARY_002380

MACCLEARY_002185-86

MACCLEARY_001166-70

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 90 of 128

DATE

EVENT

Findings: extensive adhesions, rectal stricture, large

parastomal hernia containing small bowel.

RECORD

BATES

MACCLEARY_001166-77

MACCLEARY_001183

Monitored for safety (falls); pain, psychosocial needs

during hospital stay. Remains at hospital until 6/1/21.

History of GSW to abdomen status post laparotomy w

partial colectomy and descending colostomy. Presented to

ED earlier this year secondary to pain and change in stool

habits. Undergone colonoscopy and evaluation of rectal

stump. Now requesting reversal of colostomy

Assessment: parastomal hernia, obesity

5/21/2021

Weight: 282lbs. Scheduled meds:

x •atorvastatin 20 mg

x •hydroCHLOROthiazide 12.5 mg

x •lisinopril 20 mg Oral Daily

x •pantoprazole 40 mg Oral QAM AC

x •pramipexole 0.125 mg Oral TID

Infusing meds:

x Dextrose

x Lactated ringers

5/21/2021

PRN meds:

x acetaminophen, 650 mg, Q6H PRN

x docusate sodium, 100 mg, Daily PRN

x HYDROmorphone, 1 mg, Q3H PRN

x • ondansetron, 4 mg, Q4H PRN

Hospital Plan:

1. Parastomal hernia

75a

ER-90

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 91 of 128

DATE

5/22/2021

5/23/2021

EVENT

-Status post surgical repair

-Reversal colostomy

-Continue pain management

-Monitor by surgery

2. Hypertension

-Monitor trend and justification accordingly

3. Acute renal failure

-Secondary to acute tubular necrosis

-Continue with IV fluid

-Monitor BMP urine output

-Renal consult if indicated

Additional problem added to his medical plan:

Tachycardia

-Unclear etiology

-Continue with pain management

-Monitor on telemetry

Post surgery: worsening acute renal failure Post 1

colostomy reversal #2

prostatectomy #3 previous laparotomy for gunshot wound.

Elevated white count hyperkalemia and nausea vomiting

and pain. Appears to have diabetes with elevated glucose

levels; hypertension with probable hypertensive

cardiovascular disease to some component;

gastroesophageal reflux disease; restless leg syndrome

Patient w expected ileus (obstruction of intestine) but non-compliant

as he continues to remove it. Transferred to telemetry for better

monitoring of vital signs

Indication for hospitalization - Acute renal failure most

likely secondary to ATN with associated infection.

76a

ER-91

RECORD

BATES

MACCLEARY_001184;

MACCLEARY_001191

MACCLEARY_001199

MACCLEARY_001208

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 92 of 128

DATE

EVENT

Urine for eosinophils is Positive; consistent with infection

or component of interstitial nephritis with associated

infection; urine sodium is elevated at 36 consistent with

acute tubular necrosis.

RECORD

BATES

MACCLEARY_001218

MACCLEARY_001224

MACCLEARY_001238

MACCLEARY_001256 &

001270

Renal ultrasound only shows mild left Hydronephrosis

(kidney enlargement); no significant obstructive uropathy.

Status post colostomy reversal, prostatectomy (partial or

complete prostate removal), appendectomy, and

laparotomy (incision to examine abdominal organs).

Elevated white count; hyperkalemia. Diabetes with

probable end organ disease; hypertension with probable

hypertensive cardiovascular disease.

Gastroesophageal reflux disease; nausea vomiting and pain

syndrome; restless leg syndromes.

5/24/21

5/25/21

5/26/2021

May take 6 to 8 weeks to fully recover renal function;

increased risk for further renal exacerbations.

Renal function slowly improving

Cognition - Overall Cognitive Status Impaired

Orientation: Disoriented to time & situation

Awareness of Errors: Assistance required to identify errors

made

Deficits: Decreased awareness of deficits

Problem Solving: Assistance required to implement

solutions

Patient noted with acute chronic renal failure. Nephrology - Showing

renal improvement

Renal function is improving; disoriented to fact he’s a prisoner

77a

ER-92

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 93 of 128

DATE

5/27/2021

5/28/21

5/29/21

EVENT

Renal function continues to improve. No respiratory distress at this

time. Acute hypoxic respiratory failure

Pulmonary consult: Continue breathing treatment;

Doppler ultrasound to look for DVT;

Unable do CT Angio (heart/blood vessels) due to kidney failure consider VQ scan

No acute distress. Clinically improving. No fever chills. Pain is well

controlled.

Complaining of increased abdominal pain. Surgical consult

notified. KUB done 2 days ago showed possible ileus. Mild

gas, no bowel movement. No surgical intervention at this

time.

RECORD

BATES

MACCLEARY_001282 &

001288

MACCLEARY_001336

MACCLEARY_001337

5/30/21

Patient still complain abdominal pain. No bowel movement; passing

gas. Surgical consult recommended LTAC evaluation. Continue all

current medical management.

MACCLEARY_001356

5/31/2021

Patient clinically improving. Abdominal pain has improved, but still

there.

Watery diarrhea. Surgical consult request for LTAC evaluation.

MACCLEARY_001370

6/1/2021

Discharged from hospital to US Marshals.

MACCLEARY_001392-93

Discharge diagnosis:

1. Parastomal hernia (when intestines press outward near

a stoma) 2. Hypertension 3. Acute renal failure 4. Acute

hypoxic respiratory failure (not enough oxygen in blood) 5.

Deep vein thrombosis (blood clots in veins)

Medications:

Amlodipine 10 MG tablet

Apixaban 5 MG

78a

ER-93

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 94 of 128

DATE

EVENT

Calcium carbonate 500 MG chewable tablet

Clonidine 0.1 MG tablet

DSS 100 MG Caps

Gabapentin 100 MG capsule

Ipratropium-albuterol 0.5-2.5 mg/ml nebulizer

Oxycodone ER 10 MG 12 hr tablet

Oxycodone-acetaminophen 10-325 MG per tablet

Pantoprazole 40 MG tablet

Polyethylene glycol

Hospital course: reversal of his colostomy & parastomal

hernia repair. Acute renal failure secondary to acute

tubular necrosis. - Renal function worsened despite

receiving aggressive IV fluids. Renal ultrasound revealed

mild left hydronephrosis with trace right perinephric fluid.

Renal function gradually improved.

Tachycardia - improved

Hyperlipidemia, obese, history of high blood pressure.

Abdominal pain & some abdominal distention noted; NGT

was placed for slow, intermittent suction.

Per Surgery the patient had an ileus (bowel obstruction)

from narcotics used. Abdominal pain gradually improved

but was still present.

Surgery requested for LTAC evaluation for the patient.

Pulmonary Critical Care consulted - on board for patient’s

acute hypoxic respiratory failure.

79a

ER-94

RECORD

BATES

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 95 of 128

DATE

EVENT

Cont on oxygen supplement and breathing treatments.

Attempts to titrate down on his oxygen resulted to

saturation being in the 80's.

RECORD

BATES

MACCLEARY_003030

CT Angiogram could not be done at time of evaluation due

to kidney failure. He was not in any distress and was

started on Eliquis.

LTAC evaluation done & accepted by Select Specialty

Hospital.

Discharged once clinically stable, not in distress, and

cleared by consult services.

6/16/7/2021

Discharge disposition: LONG TERM ACUTE CARE

Admitted to Select Specialty Hospital. History of present

illness: GSW to Abdomen, status post laparotomy with

partial colectomy and descending colostomy. Alvarado ED

earlier this year secondary to pain at the site as well as

change in stool habits. Found to have a parastomal hernia.

Patient has undergone colonoscopy and evaluation of rectal

stump. Been following as outpatient.

On 5/20/2021, pt was admitted to the hospital for reversal

of his colostomy - taken to OR and tolerated procedure

well. However, post op, his renal function deteriorated.

With aggressive IV - renal function improved. Still

complaining of abdominal pain…. surgery team

recommends transfer to LTAC; case manager notified and

transferred to Select Hospital

Surgical history: abdominal surgery & hernia repair

80a

ER-95

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 96 of 128

DATE

6/1/2021

EVENT

Medications at Select Hospital:

x Norvasc 10mg

x Eliquis 5mg

x Lipitor 20mg

x Neurontin 100mg

x Hydrodiuril 12.5

x Zestril 20mg

x OxyContin 10mg

x Protonix 40mg

x Zosyn 3.375mg

x Mirapex .125mg

x Tylenol 650mg

x Tums

x Catapres .1mg

x Colasce 100mg

x Duo-neb 3ml solution

x Zofran 4mg inj

x Percocet 5mg

Problem list:

1. Parastomal hernia

2. Hypertension

3. Acute renal failure

4. Acute hypoxic respiratory failure

5. Deep vein thrombosis [MACCLEARY_003033]

RECORD

BATES

MACCLEARY_003027;

003032-33

6/2/2021

6/3/2021

Pain managed with Percocet prn and routine OxyContin

JP drain was dislodged; developed loose stools improved after

Imodium

Developed low grade fever

MACCLEARY_002785

MACCLEARY_002743

6/5/2021

81a

ER-96

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 97 of 128

DATE

EVENT

RECORD

BATES

6/6/2021

Fever - temp of 100.5; suspect stool may be draining from his lower

abdominal wound with odor present.

MACCLEARY_002743

MACCLEARY_002710

MACCLEARY_002709

MACCLEARY_002711

6/7/2021

Later temp was 101.2. Cultures and CXR were done; started on

Zosyn. A CT a/p ordered.

Transferred to Select Hospital from Alvarado Hospital to

continue care of drainage tube post-surgery. At Alvarado

for reversal of his colostomy; complicated by worsening

renal function. Aggressive IV fluids improved renal

functioning. Lots of discharge at drainage tube.

Decision made to transfer him to LTAC facility for

continued management so transferred to Select.

6/7/2021

Patient had just undergone surgical reversal of his

colostomy. He did accidentally pull out his JP drain and

Surgery was consulted and per Surgery there was no need

to replace JP drain

Discharged from Select Specialty Hospital. Diagnosis:

1. Parastomal hernia

2. Hypertension

3. Acute renal failure

4. Acute hypoxic respiratory failure

5. Deep vein thrombosis

6. Sepsis/ abdominal infection

Temperature spiked over the weekend. Possible bowel leakage. May

need transfer to Alvarado so surgery can assess leakage. Pt is

clinically stable. Blood pressure is stable. Awake and alert. No

increase in abdominal pain.

82a

ER-97

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 98 of 128

DATE

6/7/2021

6/76/17/2021

EVENT

Fever, bacteremia, wound infection - blood culture is

positive for GNRs. Chills with constant abdominal pain but

no n/v. He continues to have loose stools. Reports

substernal chest pain. EKG done.

Transferred to Alvarado Emergency Dept

Admitted to Alvarado Emergency Dept for evaluation of

postoperative abdominal pain. Reports worsening

abdominal pain since surgery, worsened over past four

days, noted foul smelling drainage from drain in surgical

site. Feels feverish, diarrhea since surgery, but semiformed stool today; passing gas.

RECORD

BATES

MACCLEARY_002743

MACCLEARY_001394;

1398

MACCLEARY_001540

Brought in by ambulance by SD Court/Law Enforcement.

Discharged on 6/17/21 (MACCLEARY_001157)

6/7/2021

Infectious symptoms not stabilized. Patient at risk of rapid

decompensation. Admitted for careful hydration, antibiotic

therapy, and infectious source control

(MACCLEARY_001398)

Infectious disease is consulted:

x Stricture obstructed distal left ureter with air within the left

renal collecting system and left ureter status post

percutaneous nephrostomy and study showing left ureteral to

small bowel–ureteroenteric fistula. Purulent urine from the

upper tract left renal pelvis. Cultures in progress.

x Positive rectal VRE screen R/Ot urinary retention bladder

outlet obstruction this is now resolved with an indwelling

Foley. Creatinine Improved

x Intra-abdominal fluid collections after elective takedown of a

colostomy with reanastomosis and repair of parastomal hernia

with mesh.

83a

ER-98

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 99 of 128

DATE

6/8/2021

EVENT

x Incidental appendectomy

x Obesity

x Hepatitis C untreated

x Enlarged fatty liver

x No clinical evidence of portal hypertension or splenomegaly

x Hypertension

x Dyslipidemia

x Diabetes

x Tobacco marijuana use

x Maximum creatinine 1.8 now stable at 1.2

Recovering at select long-term acute care facility – increasing

abdominal pain over the weekend with a CT scan suggesting

anastomotic leak with abdominal abscess - patient transferred back

for reassessment and intervention. He has no known drug allergies

Complex comorbid medical history/past medical history:

2006 - Diagnosed with hepatitis C - never treated.

2007 - Work-related accident related to a crane with energy

injury.

2018 - sustained gunshot wounds for which he was admitted

Sharp Chula Vista & had a colostomy and Hartmann

procedure. Patient very vague about details of those events

that he states he does not remember much about. In addition

in reviewing

GI note from Dr. A Reddy back in February there was no

record of any major surgery done in the sharp healthcare

system.

Lived in Mexico prior to his incarceration

2019 - federal custody

84a

ER-99

RECORD

BATES

MACCLEARY_001416

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 100 of 128

DATE

6/8/21

6/9 /21

6/9/2021

6/10/21

EVENT

x Denies injection drug use

x Nonalcoholic Liquor

x half a pack of cigarettes per day

x Recently diagnosed hypertension hyperlipidemia

x Elevated glycosylated hemoglobin

x Parastomal hernia

Procedure performed: anterior intra abdominal drain placement,

ultrasound and fluoroscopic guidance

RECORD

BATES

MACCLEARY_0017251728

Admitted with a complicated medical and urological

history. Underwent reversal of colostomy with repair of

parastomal hernia approximately 3 weeks ago - persistent

drainage of intra-abdominal fluid into a JP drain which was

traumatically removed in previous facility.

MACCLEARY_001455

CT scan revealed multiple abscesses which were drained

percutaneously by IR; air/gas within the left renal

collecting system and ureter raising the concern for

ureteral enteric fistula or emphysematous pyonephritis.

C/O abdominal pain and left flank pain; denies nausea or

vomiting. Urine is grossly clear.

Recommended surgery for cystoscopy, bilateral retrograde

pyelograms, left ureteral stent placement. The risks, benefits, and

alternatives explained & agreed upon. He understands that they are

unable to place a stent in a retrograde fashion, may require

percutaneous nephrostomy tube drainage thereafter. Continue

antibiotics as per infectious disease recommendations

Surgery performed - Cystoscopy bilateral retrograde

pyelogram, left ureteral stent placement

Preoperative Diagnosis: Left hydronephrosis, air in the left

renal collecting system and left ureter, ureteral enteric

85a

ER-100

MACCLEARY_001459

MACCLEARY_001478

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 101 of 128

DATE

6/11/2021

6/14/2021

6/15/21

6/17 6/24/2021

EVENT

RECORD

fistula, possible emphysematous pyelonephritis, status post

colostomy takedown and repair of parastomal hernia

Postoperative Diagnosis: Same plus urethral stenosis, left

distal ureteral occlusion

Nephrostomy tube placed for urethral stenosis and left distal ureteral

occlusion and ureteral intestinal fistula seen on cystoscopy

Seemingly stable; reports abdominal pain - diffuse in nature; nausea

or vomiting. Left nephrostomy tube &Foley catheter

May need to be transferred to a tertiary care center.

Problem list:

1) wound infection at surgical site

2) intra-abdominal abscess

3) urinary retention

4) hypertension

5) obesity

6) hyponatremia

7) acute renal failure w atn

8) hypalbuminemia

9) anemia, chronic

10)

parastomal hernia repair and appendectomy

11) deep vein thrombosis

12)

restless leg syndrome

13)

hyperlipidemia

14)

fatty liver

Stable and transferred to Select Specialty Hospital for continued

physical therapy & occupational therapy. Resting comfortably

without SOB; no fever

Medications:

x Norvasc 10mg

86a

ER-101

BATES

MACCLEARY_003138

MACCLEARY_001555

MACCLEARY_001568-69

MACCLEARY _003134-35

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 102 of 128

DATE

EVENT

x Eliquis 5mg

x Lipitor 20mg

x Neurontin 100mg

x Hydrodiuril 12.5

x Zestril 20mg

x Percocet 5 mg

x Protonix 40mg

x Zosyn 4.5 g

x Mirapex .125mg

x Tylenol 650mg

x Tums

x Catapres .1mg

x Colasce 100mg

x Dulcolax 10mg

x Duo-neb 3ml solution

x Ambien 5mg

RECORD

BATES

6/17/2021

Estimated stay at Select Specialty is 25 days. Patient is appropriate

for Long Term Acute Care Hospital

Scripps Lab microbiology

MACCLEARY_003142

EMR_491-497

EMR_Page 491-496

MACCLEARY_003205

EMR_479

MACCLEARY_003183

6/176/18/2021

6/18/2021

6/20/2021

6/21/2021

Lab work at Scripps Mercy Hospital

Blood in nephrostomy tube; urgency to urinate

Labwork at scripps

Difficulty with urinating. Foley in place. Spoke with team at

Alvarado, recommend patient go to UCDS for surgery to

correct complete stenosis of left ureter that is unable to be

stent.

Uretal-colic fistula needs repair

87a

ER-102

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 103 of 128

DATE

6/21/2021

6/22/2021

6/216/23/2021

6/23/2021

6/24/2021

EVENT

Note: Flomax .8mg added to medications

[MACCLEARY_003190]

Patient missed visit and declining all options for therapy this date

secondary to abdominal discomfort, minimal motivation for OOB,

fatigue. Concerned with abdominal pain and blood in output from

nephrostomy drain.

Blood on TP last night, some upper abdomen pain. Here for ongoing

medical stabilization and wound care [3222]

Pt is very high functioning, demonstrating impairments in

endurance. Had inconsistent participation with therapy so far. Often

limited by abdominal discomfort, pain, low energy.

Barriers to discharge: medical complications and pain

Lab work from Scripps

Barriers to Discharge: Caregiver limitations, Capacity for

self-care, Mobility challenge, Potential need for 24 hour

care, Potential need for skills/non-skilled services

Clinical Barriers: Clinical needs exceed caregiver capacity,

Wound (nephrostomy tube, JP drain)

Admission Diagnoses at Select Specialty (same discharge

diagnoses)

1. Wound infection

2. Intra-abdominal abscess in the left abdominal wall

3. Hx of urinary retention with left hydronephrosis. S/p

nephrostomy tube placed.

4. Hypertension

5. Obesity

6. History of Acute Kidney Injury with ATN. Resolved with

creatinine 1.1

88a

ER-103

RECORD

BATES

MACCLEARY_003319

MACCLEARY_003192

MACCLEARY_003279-80

EMR_ 461-490

MACCLEARY_003295

MACCLEARY_003143 -45

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 104 of 128

DATE

EVENT

7. Hypoalbuminemia with severe protein calorie

malnutrition

8. Deep Venous Thrombosis

9. Restless leg syndrome

10. Hyperlipidemia

11. Uretal-Colic Fistula

Hospital course: 55 y.o. male w complex past medical

history. Restless Leg Syndrome, Hypertension, history of

trauma secondary to a gunshot wound to the abdomen

requiring multiple surgeries.

Hospital course complicated by pain and swelling at the

colostomy site. Gunshot wound in the abdomen and

Exploratory laparotomy done along with partial colectomy

and descending colostomy.

Hospitalized multiple times over the year for complications

including swelling around the colostomy site, presence of a

large parastomal hernia. Followed and managed by Surgery

and GI consults. Seen by Surgery in mid-March and

colostomy reversal & repair of the parastomal hernia done.

Admitted to Alvarado for procedure. Later complicated by

worsening renal failure and persistent abdominal pain.

Transferred to Select Hospital on June 1. Antibiotic

continued and the patient followed by Infectious Disease,

who, at the time, recommended Surgery evaluation of

possible anastomotic leakage.

Patient discharged to Alvarado for Surgical evaluation.

Reversal of his ostomy done by Surgery 2 weeks prior.

89a

ER-104

RECORD

BATES

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 105 of 128

DATE

EVENT

Returned to Select hospital on June 17 to have continued

rehabilitative management per PT/OT.

Admitted to Select and PT/OT Services continued

rehabilitative therapies. Zosyn continued as Abdominal CT

done previously showed evidence of abdominal abscess.

Repeat Ct showed abdominal abscess on the left abdominal

wall.

Nephrostomy tube was placed on the patient on June 11,

2021 due to urethral stenosis and left distal ureteral

occlusion and ureteral intestinal fistula as seen on

cystoscopy. Wound care also provided by the wound nurse.

Discussed with team at Alvarado - recommended patient be

transferred to UCSD for corrective surgery of complete

stenosis of the left ureter that was unable to be stented.

Also has uretal-colic fistula in need of surgical repair the

patient tolerated his treatment and therapies, followed

closely by consult team and improved clinically. No distress

and no complaints of chest pain, palpitations, or

diaphoresis. Remained afebrile and in good spirits.

Nephrostomy tube was in place and draining. Some

hematuria but cleared eventually. Foley was also replaced.

Urinalysis done. Nursing staff reported ST elevation on

monitor. Serial Troponin negative and the patient did not

have complaints of chest pain. Cardiology consulted and

followed the patient - discharged to UCSD for Urology

evaluation once patient clinically stable and cleared by

consult team. Dressings were intact, nephrostomy and

Foley were in place.

90a

ER-105

RECORD

BATES

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 106 of 128

DATE

6/24/2021

EVENT

RECORD

Infectious Disease recommended continuing the patients

Zosyn for 15 days starting on June 15, at the time of

abdominal wall fluid aspiration. On the day of discharge the

patient was with stable vital signs and not in distress

Pt to be discharged from PT services. Per EMR pt discharged 6/24/21 6

at 2045 to acute facility. Pt with minimal participation with PT

secondary to abdominal pain, low energy, low motivation. Pt had

walked 100ft using FWW during evaluation session only. Further

attempts to walk for endurance pt declined. Provided with a written

HEP. Pt to be re-evaluated as appropriate if returning to the facility.

Recommend follow up with male PT per pt preference.

Admitted to ED in Hillcrest Emergency for surgical

problem re evaluation. Bleeding from nephrostomy tube

and recurrent pelvic abscesses.

In custody – sentencing soon. Came in for hematuria; he

states he doesn’t know why brought to ED. Unsure when

urine became bloody Doesn’t need admission or acute

surgical intervention at this point.

Tertiary recommended given complexity of GU problems.

Outpatient follow up for reconstruction workup

Nephrostomy tube bleed; complication of foley catheter;

left flank pain. Final diagnoses:

x hemorrhage of incontinent external stoma of urinary

tract;

x Cutaneous abscess of abdominal wall

x Hydroenphrosis w ureteral stricture; other specified

disorders of kidney and ureter; acute embolism &

thrombosis of right popliteal vein; dorsalgia; contact

w & suspected covid exposure

91a

ER-106

BATES

MACCLEARY _003318

MACCLEARY _004755

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 107 of 128

DATE

EVENT

x Precipitous drop in hematocrit

x Hyperlipidemia

x Essential hypertension

x Obesity

x Long term use of anticoagulants

x Long term drug therapy

x Acquired absence other specified digestive tract

x Personal history of other healed physical injury and

trauma

x Personal history of other venous thrombosis and

embolism

x Other diseases digestive system

x Other diseases respiratory system

x Other diseases of urinary system

RECORD

BATES

6/24/2021

6/25/2021

Covid test – negative

Seen by surgery and cleared for discharge. Abscesses very small, he is

afebrile, hemodynamically stable

CT abdomen and pelvis w contrast – abdominal pain,

Nephrostomy tube bleeding. Placed for diversion due to

ureteroenteric fistula.

MACCLEARY_004781

MACCLEARY_004771-72

MACCLEARY_004797-98

MACCLEARY_003694-95

6/25/2021

Impressions: splemeomegaly; splenic varies; portal

hypertension

On 6/24/21, patient transferred to UCSD for urology consult due to

bloody output from foley. Urology consulted. CT abdomen and pelvis

showed no acute changes. Pt is to be seen with urology outpatient

follow up. Readmitted at Select Specialty.

Diagnosis: 1) gastrointestinal symptom 2) hypertension 3) obesity

Meds:

92a

ER-107

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 108 of 128

DATE

EVENT

TYLENOL 650 mg

NORVASC 20 mg

ELIQUIS 5 mg,

LIPITOR 20 mg,

TUMS

CATAPRES .1

COLACE 100 mg

NEURONTIN 100 mg,

HYDRODIURIL 12.5 mg,

DUO-NEB 0.5-2.5 mg/3 mL nebulizer solution

ZESTRIL 20 mg,

PERCOCET 5-325 MG

PROTONIX EC/DR 40 mg,

ZOSYN 3.375 g

MIRAPEX .125 mg

Appropriate for long term acute care. Length of stay estimated 25

days [MACCLEARY_003698]

Labwork at scripps

6/266/28/2021

6/28No distress / no pain

7/3/2021

7/4/2021

Some leakage from Foley bag

7/5-7/7/2021 Lab work at Scripps

7/5/2021

No new issues

7/6/2021

Patient accidentally moved nephrostomy tube out a little while going

to the bathroom yesterday. No flank pain. Tube is draining out blood.

Renal US was ordered. Pt will have follow up appt with urology

7/7/2021

Nephrostomy tube less bloody. No bright red blood. No flank pain.

Renal U/S results pending.

7/8-7/13

No changes, no pain

93a

ER-108

RECORD

BATES

EMR_441-460

MACCLEARY_003711

EMR- Page 429-440

MACCLEARY_003711

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 109 of 128

DATE

7/9/2021

7/11/2021

7/12/2021

7/14/2021

7/15/2021

7/16/2021

EVENT

Kidney function is probably deteriorating due to

dehydration. Continue hydration. Resting /good spirits.

Foley catheter ; nephrostomy tube

Nursing note: c/o severe pain, located mainly in the back;

generalized body ache - throbbing and uncomfortable. Can’t sleep –

requested Tylenol PRN. Will continue to monitor pain level

Renal imaging: Right kidney is 10.6 cm. Left kidney is 9.8 cm.

Moderate amount of hydronephrosis in the left kidney. 4 cm cyst in

the right mid kidney. No right hydronephrosis. IMPRESSION: Right

renal cyst.

Currently stable and transferred to Select Hospital for continued

physical therapy as well as occupational therapy. Resting comfortably

in bed without any SOB. Kidney function is probably deteriorating

due to dehydration.

RECORD

BATES

MACCLEARY_003730-32

MACCLEARY_003873

MACCLEARY_003721

MACCLEARY_003699

Pt had some leakage from nephrostomy tube. No foul smelling, no

puss [MACCLEARY_003711]

Serangous fluid drained from nephrostomy tube. Trying to make appt 6

with urology. If worsens will get IR involved here at select or UCSD

ER.

MACCLEARY_003708

Ambien 5mg & Flomax added to medications

Patient’s nephrostomy drain is dislodged and leaking, he is unable to

see urology until 8/18 - they may send him to ED. Will continue to

follow up. Clinical updates faxed to US Marshal.

Admitted to Scripps Mercy ED for leakage of nephrostomy

catheter. Nephrostomy complications; kidney infection;

covid-19 vaccination administered

Hospital problems:

Nephrostomy complication (primary)

Bladder infection

94a

ER-109

MACCLEARY_003706

EMR_Page 191-198

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 110 of 128

DATE

7/16/2021

7/17/2021

7/18/2021

7/19/2021

EVENT

High blood pressure disorder

History of blood clot to lungs

High cholesterol or triglycerides

Collection of pus in the abdomen

Status post insertion of inferior vena caval filter

RECORD

BATES

EMR_Page 215

Felling well however, still having drainage coming from nephrostomy 8

tube. Procedure deferred until Monday – non urgent

Reports feeling well with mild left-sided discomfort at the

nephrostomy tube site. He reports continuous leakage without bloody

output or purulence. Urinalysis consistent with infectious etiology

therefore Rocephin started.

At Scripps for IR Nephrostomy Tube Change. Tube located in left

kidney. Successful replacement. Given non emergent nature

procedure deferred to 7/19/21. Procedure this am without any

complications. Subsequently tolerating a diet without any pain and

would like to transfer back to LTAC. Maintained on his home

medications.

EMR_Page 408

CT Abdomen Impressions:

1. Left ureteral stent in place. No hydronephrosis.

2. Rectosigmoid anastomosis with small amount of soft

tissue fascial thickening along the superior margin. No

loculated fluid.

3. Hepatic steatosis.

Administered J&J COVID-19 vaccine

Current scheduled meds:

acetaminophen (TYLENOL) 325 mg

lisinopriL (PRINIVIL) 20 mg

amLODIPine (NORVASC) 10 mg

pantoprazole (PROTONIX) 40 mg

gabapentin (NEURONTIN) 100 mg

95a

ER-110

EMR_Page 245

EMR_Page 215-219

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 111 of 128

DATE

EVENT

ipratropium-albuterol (DUONEB) .5-2.5mg

pramipexole (MIRAPEX) 0.125 mg

atorvastatin (LIPITOR) 20 mg (page 219)

RECORD

BATES

Clinical impressions:

1) Nephrostomy complication

2) Pyelonephritis

3) COVID-19 vaccine administered

Discharge Diagnosis:

7/19/2021

Nephrostomy complication (CMS/HCC)

History of pulmonary embolus (PE)

Intra-abdominal abscess (CMS/HCC)

Hyperlipidemia

S/P insertion of IVC (inferior vena caval) filter

Essential hypertension

Acute cystitis without hematuria [pg 215]

Discharged from Scripps and transferred to rehab. Discharge

Summary: 55 yo M with a somewhat complicated past medical

history, made more complicated by the fact that he has been to

multiple facilities, and does not recall details from each - currently he

is as at Select Specialty. Also

under custody, and has two guards at his bedside.

Summary of medical care: From past records and LTAC paperwork –

history of GSW to the abdomen, followed by multiple surgeries as

well. He also has a hx of restless leg syndrome, is s/p a parastomal

hernia repair with appendectomy (more recently perhaps?), DVT

HLD, and obesity, and was admitted to Select on 6/7 after a

prolonged

hospital stay. He also had a reversal of an ostomy prior to this. He

thinks he was at Alvarado for this admission.

96a

ER-111

EMR_Page_227-235

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 112 of 128

DATE

EVENT

RECORD

Surgical history includes a rectosigmoid colonic perforation, status

post partial colectomy, end colostomy placement, and wound vac

placement on the midline abdominal wound on 07/08 with

secondary closure of the abdominal wound on 07/27 and bilateral

pulmonary emboli, status post IVC filter placement, not on

anticoagulation secondary to splenic hematoma.

Appears to have been on Zosyn for an E. Coli abdominal abscess;

most recent imaging was 6/14 and reportedly showed a left abd wall

abscess. He had a Foley for urinary retention (no longer) and had

nephrostomy tubes placed on 6/11 for hydronephrosis. This is

reportedly 2/2 urethral stenosis and left distal ureteral occlusion and

ureteral intestinal fistula. He had associated AKI. On 6/24 he was

reportedly transferred to UCSD for a urology consult due to

hematuria, and was supposed to be set up for OP follow up. Doctor

could not find record of this admission in "care everywhere"

Past Medical History

•AKI (acute kidney injury)

•Brachial plexus injury

•Chronic pain

•DVT (deep venous thrombosis)

•E. coli infection

•Hyperlipidemia

•Hypertension

•Intra-abdominal abscess

•Obesity

•Restless leg syndrome

•Scapula fracture

•Urinary retention

•Wound infection

97a

ER-112

BATES

Case: 21-50240, 06/06/2022, ID: 12464860, DktEntry: 10, Page 113 of 128

DATE

8/30/2021

EVENT

Admitted to ED via ambulance, transported from jail with clogged

nephrostomy tube; reports tube is draining, constant pain in left leg.

Diagnosis: malfunction Nephrostomy tube - Tube is replaced and

started on Keflex (antibiotic) Given 4mg morphine. Discharged to

detention facility.

98a

ER-113

RECORD

BATES

MACCLEARY_002145-20

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.