`COUNTY OF QUEENS
`
`-X
`
`ISABELE LEON, an infant by her Mother and Natural
`Guardian. JUDITH LEON
`
`Infant Compromise
`Order
`
`Plaintiff(s),
`
`-against-
`
`LENOX HILL HOSPITAL
`
`Defendant(s).
`
`-X
`
`Index No.:
`700114/2011
`
`^&^ <?
`
`Upon reading and filing of the annexed Affidavit of Judith Leon. Mother and Natural
`
`the annexed
`2014.
`day of^*-*-
`Guardian of the Infant Plaintiff, duly sworn this ^
`affirmation of Robert Vilensky, Esq., affirmed the ± day ofMr-^
`,2014. the report of Daniel
`
`Adler. a pediatric neurologist, dated June 17. 2013, all of the pleadings and pr&ceedings
`
`heretofotje had herein, and the appearance ofthe infant having been waived and due deliberation
`
`having been had thereon, and the trial of this action having resulted in a defendant's verdict and
`
`it appearing to my satisfaction that the best interest of the infant plaintiff will be served.
`
`Now on Motion of Robert Vilensky. Esq., attorney for the Plaintiff, it is
`
`ORDERED, that the infant plaintiff, Lsabelle Leon, is hereby ordered and deemed to be a
`
`"qualified plaintiff within the meaning of Public Health Law 2999-h(4). having sustained a
`
`"birth related neurological injury" within the meaning of Public Health Law 2999-h(4); and it is
`
`further
`
`ORDERED, that the infant plaintiff. lsabelle Leon, is hereby ordered and deemed to be a
`
`"qualified plaintiff within the meaning of Public Health Law 2999-h(4). having sustained a
`
`
`
`"birth related neurological injury" within the meaning of Public Health Law 2999-h(4); and it is
`
`further
`
`ORDERED, that Judith Leon, as mother and natural guardian of the Infant Plaintiff,
`
`Isabel Leon, be and he is hereby authorized to enter into a compromise of the cause of action of
`
`said Infant Plaintiff, Isabel Leon, for up-front cash and future periodic payments and enrollment
`
`in the Medical Indemnity Fund in the total amount of $250,000.00, being paid on behalf of
`
`Lenox Hill Hospital, with $125,000.00 (or 50%) attributable to future medical expenses payable
`
`by and through the Medical Indemnity Fund (the "fund damages") and $125,000.00 (or 50%)
`
`attributable to all claims other than future medical expenses (the "non-fund damages"); and it is
`
`further
`
`ORDERED, that defendant, Lenox Hill Hospital is to make immediate payments in the
`
`total sum of $162,500.00 as follows:
`
`A.
`
`The sum of$37,500.00 to be paid to Ronemus & Vilensky, LLP, attorneys for the
`
`plaintiffs, as and for their pro ratashare of attorney's fees on the "fund damages";
`
`B.
`
`The sum of $30,130.09 to be paid to Ronemus & Vilensky, LLP, attorneys for the
`
`plaintiffs, as andfor their pro ratashare of attorney's fees on the "non-fund damages";
`
`C.
`
`The sum of$49,132.72 to be paid to Ronemus & Vilensky, LLP, attorneys for the
`
`plaintiffs, as and for the reimbursement for the cost and disbursements regarding the prosecution
`
`of this action;
`
`D.
`
`The sum of $45,737.19 to the aforesaid parentand natural guardianof the said infant,
`
`jointly with an officer ofthe Hudson Valley Bank, located at60 East 42nd Street, New York, NY
`
`10017, said funds to be deposited in said Bank and held therein for the sole useand benefit of
`
`said infant, subject to the further order of this Court;
`
`
`
`ORDERED, that the aforesaiddepository Bank which, pursuant to this Order, receives
`
`funds jointlywiththe parentand natural guardian of the infant, shall place said funds in the
`
`highest interest bearing time accounts or certificates of deposit, and said certificates and
`
`accounts shall be renewed upon maturity, provided, however, the maturity date of such
`
`certificates and accounts or any renewal thereof, shall not extend beyond the date of the infant's
`
`eighteenth (18th) birthday; and itis further
`
`ORDERED, that the attorney for the plaintiffs shall serve a copy of this Order upon said
`
`Bank and shall arrange for the deposit of said funds as expeditiously as is reasonably possible;
`
`and it is further
`
`ORDERED, that within thirty (30) days of the deposit of said funds in the above-
`
`designated bank(s) the above guardian shall submit to the Office of the Clerk for the Court, a
`
`copyof each certificateof deposit(s) issued by said bank(s); and there shall be no right of
`
`withdrawal from any of the aforesaid account(s) and certificates of deposit until the infant
`
`plaintiffs eighteenth (18th) birthday,exceptupon further order of this Court, which said Order
`
`shall be certified by the Clerk of this Court; and it is further
`
`ORDERED, that in the event that the amount on deposit at any Bank exceeds the then
`
`prevailing Federal Deposit Insurance Corporation limits, the officer-trustee of said Bank and the
`
`infant's guardian herein are directedto notify the Courtso that a further designation of an
`
`additional depository maybe made in orderto keep theamount within federally insured limits;
`
`and it is further
`
`ORDERED, that (each) said Bank shall pay over all monies held in the aforesaid
`
`certificates and accounts to the infant plaintiff herein upon demand and without further Court
`
`orderwhenthe infant reaches the age of eighteen (18) years upon presentation of properproof
`
`
`
`and compliance with the Bank rules of withdrawal; and it is further
`
`ORDERED, that each year (or quarterly as the case may be) during the minority of the
`
`infant plaintiff, upon presentation to the Banks of a duly executed income tax return or other
`
`document showing the amount of income tax or estimated income tax due on behalf of the infant,
`
`said Bank shall providethe infant's guardian herein with checks made payableto the Internal
`
`Revenue Service and/or State and/or Municipal Taxing Authority to which said income tax is
`
`owed by said infant. However, said checks shall be only for the amounts as may be due and
`
`payable for that portion of the infant's personal income tax liability attributable to income earned
`
`on the accounts maintainedpursuant to this Order [including interest and penalties thereon] as
`
`shownon any official bill therefor issued by the taxing authority. Said checks shall identifythe
`
`infant and said infant's social security number in orderto insure that said amounts are being
`
`made for the benefit of the infant; and it is further
`
`ORDERED, that the Banks are hereby authorized without further order of this Court to
`
`pay out of the infant's bank accounts, reasonable fees for the preparation of any income tax
`
`return or estimatedincome tax return or accounting that may be required to be filed by or on the
`
`infant's behalf. Said fees shall not exceed ($750.00) without the further order of the Court; and
`
`it is further
`
`ORDERED, that the cause of action for lossof services and/or medical expenses of the
`
`guardian be and the same hereby is dismissed without costs and with prejudice; and it is further
`
`ORDERED, that conditioned upon compliance with the terms of this order, the aforesaid
`
`parent and natural guardian of the infant plaintiff, be and hereby is authorized and empowered to
`
`execute and deliver a general release and all other instruments necessary to effectuate the
`
`settlement herein; and it is further
`
`
`
`ORDERED, that upon the payment of the amounts set forth herein and execution of the
`
`settlement agreement and the assignment agreement, defendant(s) and their insureds) shall have
`
`no further liability herein; and it is further
`
`ORDERED, that the filing of a bond be dispensed with in accordance with the applicable
`
`provisions of the Civil Practice Law and Rules.
`
`Date
`
`HON. PHYLLIS ORLIKOFF FLUG, J.S.C.
`
`
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF QUEENS
`
`ISABEL LEON, an infant by her Mother and Natural
`Guardian, JUDITH LEON
`
`Plaintiff(s),
`
`-against-
`
`LENOX HILL HOSPITAL
`
`-X
`
`AFFIDAVIT
`
`Index No.:
`700114/2011
`
`Defendant(s).
`
`-X
`
`STATE OF NEW YORK )
`
`ss.:
`COUNTY OF NEW YORK)
`
`Judith Leon, being first duly sworn, deposes and says:
`
`1.
`
`I am the mother of the infant plaintiff herein, Isabel Leon, who was bom on May 18,
`
`2001. She is presently 13 years old and resides with me in Elliot City, Maryland.
`
`2. My daughter was bom via Ceasarian section. The labor and delivery was complicated
`
`by fetal distress.
`
`I was informed that my daughter's APGAR scores were low and she
`
`was eventually diagnosed with developmental delays as she failed to achieve various
`
`milestones. It is my understanding that her delays are related to a lack of oxygen
`
`during the course of her complicated delivery. She is currently in school but requires
`
`supportive services.
`
`3.
`
`I contacted the firm of Ronemus & Vilensky, LLP regarding a possible medical
`
`malpractice lawsuit regarding the medical care I received during the course of my labor
`
`and delivery.
`
`It was our belief that the defendants should have performed a caesarian
`
`section sooner.
`
`
`
`4. Upon meeting with Robert Vilensky, Esq. I signed a retainer which provides that
`
`Ronemus & Vilensky, LLP receive a sliding scale fee as set by the State of New York.,
`
`subject to Court approval. I support his application for attorney fees and disbursements
`
`in the amount of $ 116,762.81. I know of the tremendous amount of work his firm did
`
`even though there was never any guarantee that they would be paid. They represented
`
`me at depositions, conducted depositions of the defendants, obtained experts to testify
`
`in this matter and conducted the trial of this matter. Unfortunately the jury rendered a
`
`verdict in favor of the defendant; however, a "hi-low" settlement was placed on the
`
`record during the course of the trial. Mr. Vilensky informed that the defendants have
`
`offered a total of $250,000.00 to settle this lawsuit (even though we lost) and have
`
`agreed to accept this settlement, subject to the Court's approval.
`
`5. Mr. Vilensky has explained to me that under the new Law Section 2999 of the Public
`
`Health Law, Isabel would be deemed a "qualified plaintiff." Therefore certain rules
`
`apply. Specifically, I understand that although this lawsuit is being settled for
`
`$250,000.00 the defendants are paying $125,000.00 or 50% of the settlement (plus
`
`$37,500.00 for defendant's share of the legal fee). I understand that Isabel will only
`
`receive the benefit of this portion of the settlement and that the remaining 50% of the
`
`settlement is attributable to the recently created neurologically impaired infant fund.
`
`Additionally, I understand that the legal fee will be computed on the entire amount of
`
`the settlement. I consent to Ronemus & Vilensky, LLP being awarded their full legal
`
`fee pursuant to the retainer agreement.
`
`6. Once legal fees and disbursements are paid a balance of $45,737.19 remains for the
`
`benefit of my daughter.
`
`
`
`7. Mr. Vilensky has explained to me that $45,737.19 will be placed into a bank account
`
`with me and an officer of the bank. I understand that the money will stay in the
`
`account until my daughter reaches the age of 18, at which time the money can be
`
`withdrawn.
`
`8. That I am not aware of any liens for Medicare, Medicaid or public assistance of any
`
`kind.
`
`9. The proposed compromise Order provides that upon compliance with the terms and
`
`conditions of the compromise Order, I as mother and natural guardian of the infant
`
`plaintiff, be authorized and directed to execute and deliver a General Release to the
`
`defendants, and serve the same, through Ronemus & Vilensky, together with a copy of
`
`the compromise Order as well as Stipulations of Discontinuance upon the attorneys for
`
`the defendants, and to execute such supplemental documents as may be necessary or
`
`expedient, consistent with the terms and intent of the settlement and compromise
`
`Order. The proposed compromise Order further provides that I be authorized to
`
`execute and deliver a General Release to the defendants, and to discontinue with
`
`prejudice, as to said defendants, and to any parties, real or corporate even though they
`
`are not named, or to any parties that may be held, in law and equity, to be derivatively
`
`or contractually liable for, the injuries and damages sustained, and that the filing of a
`
`bond be dispensed with.
`
`10. In light of the foregoing, your petitioner and the firm of Ronemus & Vilensky believe
`
`that the settlement is fair and reasonable and is in the best interests of the infant, my
`
`daughter.
`
`
`
`11. Your affiant is not connected, either directly or indirectly, with the defendant, its agents
`
`or representatives, and is not interested in this litigation or the subject matter of this
`
`application, either directly or indirectly at the instance of the defendant, its agents or
`
`representatives, and has not received, now nor will I receive, any compensation from
`
`any of said parties, either directly or indirectly, but only such compensation as is fixed
`
`by the Court herein.
`
`12. That no previous application for the relief requested herein has been made to this or
`
`any other Court.
`
`WHEREFORE, it is respectfully requested that my petition to settle the cause of action of
`
`the infant plaintiff against the defendants, herein, in the total sum of $250,000.00. to pay
`
`Ronemus & Vilensky attorney's fees and disbursements and that the filing of a bond be
`
`dispensed with, be granted, and that an Order to that effect be entered herein.
`
`Sworn to before me
`This U
`day of A
`
`. 2 H
`
`ROBERT VILENSKY
`NOTARY PUBLIC-STATE OF NEW YORK
`No. 02VI4749214
`Qualified In Nassau County
`My Commission Expires June 30, 2016
`
`
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF QUEENS
`
`X
`
`ISABELLE LEON, aninfant byher Mother and Natural
`Guardian, JUDITH LEON
`
`ATTORNEY
`AFFIRMATION
`
`Plaintiff(s),
`
`-against-
`
`Index No.:
`700114/2011
`
`LENOX HILL HOSPITAL
`
`Defendant(s).
`
`X
`
`Robert Vilensky, an attorney duly admitted to practice in the Courts ofthe State ofNew
`
`York, affirms that the following are true under penalties ofperjury.
`
`I was retained by the plaintiff inorabout
`
`to represent the interests ofher
`
`daughter, the infant plaintifflsabelle Leon as well as herselfin apotential medical malpractice
`
`case. This case was recently tried to ajury verdict before this Court. Unfortunately, the jury
`
`rendered a verdict in favor ofthe defendant, however, shortly before the verdict was rendered a
`
`"hi-low" settlement was reached by the parties. This settlement was placed on the record and a
`
`transcript is annexed hereto. Briefly, the settlement agreement provided that in the event ofthe
`
`defendants verdict this matter would be settled in the amount of$250,000.00 with the plaintiff
`being deemed aqualified plaintifffor the recently created neurologically impaired infant's fund.
`The theory ofthe case was that during the pre-natal period as well as during the course of
`
`the labor and delivery there were certain signs and symptoms that aCaesarian delivery should
`
`have been performed in this instance. Our experts had informed us that the indications on the
`
`fetal monitor should have alerted the delivering obstetricians to order a Cesarean section and take
`
`the baby earlier in time. The infant plaintiff is now 12 years old and was found to be
`
`
`
`developmentally delayed in language and motor skills. The infant plaintiff receives in-home
`
`tutoring as well as physical and occupational therapy. Attached hereto as Exhibit A is a report
`
`from Dr. Daniel Adler, a pediatric neurologist that examined the infant plaintiff.
`
`This case and the settlement are more complicated than simply resolving it at
`
`$250,000.00. Recently, the NYS Legislature passed a new law under section 2999 of the Public
`
`Health Law. This section was passed as part of Medicaid and Medical Malpractice Reform in
`
`New York State. In its simplest form this section requires that this Court determine that the
`
`infant plaintiff is a "qualified plaintiff' under the statute. Once the Court determines that the
`
`infant plaintiff is a "qualified plaintiff' under the new statute the Court has to make a
`
`determination (and/or agree to the determination of the parties) as to what percentage of the
`
`settlementis allocated towards future medical care and expenses and what percentage of the
`
`settlement is allocated to pain and suffering, loss of earnings and loss of enjoyment of life. The
`
`reason for this is that the new statute provides for payment of the "future" medical expenses by
`
`the establishment of the "Medical Indemnity Fund." This created "Fund" pays for the "qualified
`
`plaintiffs" future medical expenses through the State of New York. Copies of the pertinent
`
`sections of Public Health Law 2999 are attached.
`
`While the parties to this lawsuit may disagree regarding any alleged departures from
`
`good and accepted medical practice there is no doubt that the infant plaintiff suffers from various
`
`neurological injuries sustained at the time of birth. These are exactly the types of injuries this
`
`statute was designed to address. Section PHL 2999-h (4), defines a "qualified plaintiff' to mean:
`
`"every plaintiff or claimant who has been found by a jury or Court to have sustained a
`
`birth-related neurological injury as a result of medical malpractice, or has sustained a
`
`birth-related neurological injury as the result of alleged medical malpractice, and has
`
`
`
`settled his or her lawsuit or claim therefore."
`
`Your affiant submits that the infant plaintiff herein clearly meets these criteria.
`
`As this Court is aware, once there is a determination that the infant-plaintiff is a
`
`"qualified plaintiff' the Court must make an allocation of the settlement between fund and non-
`
`fund damages. Fund damages include all future medical expenses and non-fund damages
`
`include, past and future pain and suffering, future loss of earnings and past medical expenses.
`
`The parties have agreed, subject to this Court's approval that this settlement be allocated 50% to
`
`non-fund damages and 50% to fund damages. Given the reality of the infant-plaintiffs condition
`
`it is clear that his condition is permanent and a large component of her damages are the pain and
`
`suffering and loss of enjoyment of life she has and will continue to endure as well as the future
`
`expected loss of earnings. The infant-plaintiff will need future medical care but mostly in the
`
`form of physical therapy. As such, it is respectfully, requested the proposed allocation be
`
`approved by this Court. The infant will enroll in the MIF and be provided with the benefits of
`
`the new law, which will be further explained herein.
`
`Our client signed a standard medical malpractice retainer which provides for a sliding
`
`scale fee, after deduction of expenses. Said retainer agreement was duly filed with the office of
`
`Court administration. Our office handled everything on this case from the start. We investigated
`
`the case, obtained the medical records, attended conferences, did many depositions and
`
`conducted the trial of this matter. Once the case was on the trial calendar I appeared at multiple
`
`pre-trial conferences. We prepared in earnest for trial meeting with multiple experts in the weeks
`
`leading up to and during the course of the trial. As this Court is aware shortly before the verdict
`
`a "hi-Iow agreement" was placed on the record. A copy ofthe transcript referencing this
`
`agreement is annexed hereto. Unfortunately, the jury rendered a defense verdict but the plaintiff
`
`
`
`will still receive a settlement on account ofthe "hi-low agreement." Even though the jury
`
`rendered a defense verdict the case is still settled in the amount of $250,000.00. While
`
`plaintiffs attorney did not win the trial our firm certainly earned our legal fee. Ouroffice spent
`
`$49,432.72 in disbursements. A list of our disbursements is attached. All of the expenses were
`
`necessary to properly represent this infantand given our effort in prosecuting this case, we
`
`hereby ask that the Court return to us all disbursements incurred in this matter. If not for us
`
`expanding these efforts with all the amounts of disbursements that we did this child would not
`
`have endedup with the proposed settlement. Accordingly, we request this Court to returnour
`
`disbursements back to us.
`
`As stated previously herein under the New Public Health Law Section PHL 2999, the
`
`amount of future medical expenses is NOT paid by the defendants. Rather the new law (again in
`
`its simplest terms) provides for a "Medical Indemnity Fund"to pay for the future medical
`
`benefits of the infant plaintiff. The "Fund" has certain requirements which the plaintiffs will
`
`have to show in order to obtain payments for her future medical expense. Howeverthose
`
`requirements are NOT part of this Compromise Order. Oncethe infant plaintiff is determined to
`
`be a "qualified plaintiff' under the new law, the "Funds" future medical benefits provisions
`
`apply.
`
`Section PHL 2999 states the future medical expenses of the infant plaintiffare notpaid
`
`by the defendants, however, the attorneys' fees applicable to amount allocated to the "Medical
`
`Indemnity Fund"are paid by the defendants. Section J (14) of PHL 2999 provides:
`
`"The determination ofthe qualified plaintiffs attorney's fees shall be
`
`based upon the entire sum awarded by the jury or the Court or the full sum of the
`
`settlement, as the case may be. The qualified plaintiffs attorney's fee shall be paid in a
`
`
`
`lump sumby the defendants and their insurer pursuant to section four hundred seventy-
`
`four-a of thejudiciary law; provided however that the portion of the attorneys feethat is
`
`allocated to the non-fund elements of damages shall be deducted from the non-fund
`
`portion of the award in a proportional manner.
`
`Accordingly we have calculated the fee as follows:
`
`Settlement
`
`Attorney's fees
`
`$250,000.00
`
`30% of $250,000.00
`
`$ 75,000.00
`
`Total attorney's fees without regard to disbursements
`
`$ 75,000.00
`
`The defendants pays plus 50% of the
`
`attorney's fees which equal
`
`$ 37,500.00
`
`Your affirmant now must calculate theallocation of up-front monies between theplaintiff
`
`and my firm's fees and disbursements. I have done that as follows:
`
`Total settlement
`
`Disbursements
`
`Amount remaining after disbursements
`
`Attorney's fees after disbursements
`
`$250,000.00
`
`$ 49,132.72
`
`$200,867.28
`
`30% of $200,867.28
`
`$ 60,260.18
`
`Total attorneys fees equal
`
`The plaintiffs pays 50% of the attorneys fees
`
`$ 60,260.18
`
`$ 30,130.09
`
`As stated previously an allocation of 50%-50% non-fund to fund has been negotiated.
`
`This means thatthe defendant Lenox Hill Hospital will pay$125,000.00 (50% of $250,000.00)
`
`
`
`plus $37,500.00 for a total of $162,500.00. Attorney's fees and disbursements equal 116,762.81.
`
`Subtracting this amount from the $162,500.00 leaves a balance of $45,737.19. That amount shall
`
`be paid in up front monies to Judith Leon on behalf of the infant Isabel Leon jointly with an
`
`officer of a savings bank, said funds to remain in said account until the infant reaches the age of
`
`eighteen (18), unless otherwise specified by a further order of this Court or a Court of competent
`
`jurisdiction. Said funds to be available to the infant plaintiff upon proper application.
`
`Your affirmant submits that based on all of the above, my firm clearly acted in the best
`
`interest of the plaintiffs herein. Your affirmant submits that we have more than earned our fee
`
`and that requests that this Court sign the Compromise Order as prepared by my firm and
`
`submitted herein.
`
`Dated: New York, New York
`April 24,2014
`
`
`
`SUPREME COURT OF THE STATE OF NEW YORK
`COUNTY OF QUEENS
`
`x
`
`ISABEL LEON, an infant by her Mother and Natural
`Guardian, JUDITH LEON
`
`PHYSICIAN
`AFFIRMATION
`
`Plaintiff(s),
`
`-against-
`
`Index No.:
`700114/2011
`
`LENOX HILL HOSPITAL
`
`Defendant(s).
`
`-X
`
`STATE OF NEW YORK, COUNTY OF NEW YORK
`
`DANIEL ADLER, MD., hereby affirms the truth of the following statements under the
`penalties of perjury:
`
`1.
`
`I am a physician duly licensed to practice medicine in the State of New York and
`
`maintain an office for practice at 145 West 571" Street, New York, NY 10019.
`
`2.
`
`I am board certified in the field of pediatric neurology.
`
`3.
`
`I most recently examined Isabel Leon on June 17,2013. A copy of the report of my
`
`examination is annexed hereto.
`
`4.
`
`I found her vital signs to be normal. Her Blood Pressure was 115/70 with a pulse of 60
`
`and her respiration measured 18 breathes per minute.
`
`5.
`
`I examined her central nervous system and found it to be normal with the exception of
`
`low muscle tone and some difficulty with gross and fine motor skills. She walks with a
`
`normal gait but she experiences some difficulty with jumping, walking on slippery
`
`surfaces and has difficulty stopping when riding a bicycle or ice skating. Additionally,
`
`her sentences are grammatically correct but her writing is reported to be slow and
`
`deliberate.
`
`
`
`6.
`
`I also conducted a medical history of the infant plaintiff.
`
`7.
`
`Isabel Leon has neurological and neurodevelopmental disabilities occasioned by a
`
`deprivation of oxygen during birth. I diagnosed her with hypoxic ischemic
`
`encephalopathy; motor and language delay; fine and gross motor incoordination;
`
`Dysarthria and Cognitive impairment. She is currently in a normal classroom setting but
`
`reads slowly and requires someone to take notes for her.
`
`8. Her condition is permanent and she will require continued use of Zoloft for her anxiety as
`
`well as educational support for her disabilities.
`
`rANIEL ADLER, M.D.
`
`
`
`Daniel Adler,MD
`Specializing in Pediatric Neurology
`
`145West 57* Street The Tenth Floor « New York, NY 10019
`Tel: 201.89-t.15Sl » Fax: 2125048100 « drdanadler@cs.com
`
`June 17,2013
`
`Robert Vilensky, Esq.
`Ronemus & Vilensky
`112 Madison Avenue
`New York, NY 10016
`
`Dear Mr. Vilensky:
`
`RE: LEON. ISABELLE
`
`I saw lsabelle Leon in pediatricneurological consultation on June 17,2013. Hermother
`brought her to the office, lsabelle is 12 yearsand 1month of age. Prior to seeing lsa
`belle, I had an opportunity to review medical records that document that Isabelle's birth
`was difficult. These records indicate that Isabelle'smother suffered cardiac arrest, which
`required resuscitation and afterward, lsabelle was delivered byemergency cesarean sec
`tion because of fetal bradycardia. Her Apgar scores were depressed and lsabelle then
`wenton to develop seizures.
`
`School records and medical records document that lsabelle went on to have developmen
`tal delay, incoordination, with low muscle tone and apraxia. Neuropsychological testing
`documents a significant difference between verbal and non-verbal learning. Occupa
`tional therapists have documented processing delays, as well as an attentiondeficit, lsa
`bellehas required school-based services.
`
`Isabelle's mother told me that lsabelle did not walk until she was almost 19 months of
`age. She told methat Isabelle's first words did not appear until she was approximately 3.
`These first words were only pieces ofwords orwere difficult to understand, lsabelle only
`began speaking in sentences aftertheageof 4. Atthat time, only Isabelle's mother could
`understand whatshe said. Isabelle'sspeech wasnotfully comprehensible until she was 6
`or 7 years ofage.
`
`lsabelle isa girl who writes slowly and deliberately. lsabelle is a girlwho has gaitdiffi
`culties. Because of that, she has fallen and broken her elbow. She has fallen and broken
`her ankle. Despite this, with intensive help on a one-to-one basis, lsabelle can ride a bi
`cycle and lsabelle can ice skate. Her parentsreportthat when she uses ice skates or a bi
`cycle, stopping can be a problem, lsabelle can have difficulties walking when the side
`walk is uneven, lsabelle can have difficulties walking when the ground is covered in ice
`
`
`
`PATIENT:
`DATE:
`PAGE:
`
`LEON. ISABELLE
`June 17,2013
`Two
`
`or in snow. lsabelle does not always know her right from her left. When she rides a bi
`cyclewith her father, he will tell her they are turningright and she will then turn left.
`
`lsabelle continues to require support inschool. Shereads slowly. She hassomeone tak
`ing notes for her.
`
`lsabelle hastremendous anxiety in social situations. Because ofthis, she is prescribed
`Zoloft, which she takes in the generic form.
`
`The general physical examination reveals a blood pressure of 115/70. The pulse is 60
`and respirations 18. The head circumference was 52 cm. The head, ears, eyes, nose and
`throat are negative. There isno heart murmur. The chest is clear. The abdomen is soft.
`
`The neurological examination revealed a girl who isalert and cooperative. There was
`lingual dysarthria. There was an excessive nasal tone heard in Isabelle's speech as well.
`Her sentences are grammatically correct lsabelle uses normal syntax. Muscle tone is
`decreased inall four extremities. Fine finger movements and rapid alternating move
`ments are awkwardly performed. While Isabelle's simple gait is normal, she has difficul
`ties hopping, lsabelle has difficulty standing on one foot. She cannot tandem walk for
`wards and backwards. She can jump in place but only elevates a few inches offthe
`ground.
`
`CLINICAL IMPRESSION: I. Hypoxic ischemic encephalopathy
`2. Motor and languagedelay
`3. Fine and gross motor incoordination
`4. Dysarthria
`5. Cognitive impairment
`
`FORMULATION: lsabelle Leon isa girl with neurological and neurodevelopmental
`disabilities. These neurological and neurodevelopmental disabilities were caused by hy
`poxic ischemic brain injury that occurred after her mother suffered cardiac arrest and lsa
`belle was deprived ofhypoxia. The area ofthe brain injured in an acute catastrophic
`event ofthat type is the deep gray structure and produces the exact type ofneurological
`and neurodevelopmental disability that lsabelle currently suffers from.
`
`lsabelle Leon will always have motor disabilities. lsabelle has fine and gross motor inco
`ordination. She has dysarthria. These motor problems and articulation disturbances are
`permanent and will continue. There will not be significant improvement in the future.
`
`
`
`PATIENT:
`DATE:
`PAGE:
`
`LEON. ISABELLE
`June 17,2013
`Three
`
`lsabelle Leon will always be cognitively impaired and she will require educational sup
`port. Acquired brain injuries result in deficits which are not obvious at first but evolve at
`alater time. These deficits appear because later brain organization is impaired by dam
`age that may or may not have been detected by the tests performed to date. The deficits
`typically occur in the areas ofhigher cognitive function and executive skills. Executive
`skills include higher order thinking requiring organization and planning, complex prob
`lem solving, and abstract thinking.
`
`lsabelle Leon's motor disabilities will limit her opportunities in the competitive job mar
`ket, lsabelle Leon's cognitive impairments will limit her employment opportunities in the
`competitive job market as well, lsabelle Leon will have anormal life expectancy.
`These opinions are provided with areasonable degree ofmedical probability.
`
`Sincerely yours,
`
`Daniel Adler, M.D.
`
`
`
`06/05/14
`
`RONEMUS & VILENSKY
`Transactions by Account
`All Transactions
`
`Type
`
`Date
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`Num
`
`Source Name
`
`Original Amount
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`Paid Amount
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`DUE FROM CLIENTS
`Check
`6/9/2011
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`7/8/2011
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`5/10/2012
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`1/8/2014
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`2/4/2014
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`2/20/2014
`2/20/2014
`Check
`Check
`3/4/2014
`
`54850
`52244
`56002
`56085
`56314
`56493
`56524
`52072
`56188
`56187
`56985
`57304
`57239
`57958
`57733
`57741
`58140
`58048
`58048
`58602
`58603
`58604
`58605
`58606
`58607
`58608
`58609
`58610
`58611
`58612
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`58614
`58589
`585S0
`58591
`58615
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`58618
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`58592
`58635
`56727
`56727
`58640
`58642
`58641
`58792
`58819
`58856
`58880
`58746
`58911
`59421
`58226
`59047
`58247
`58411
`59066
`59068
`59075
`59092
`58385
`58498
`59740
`59593
`
`E-law, LLC.
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