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HomeMy WebLinkAbout06- Ingram - Notice of Claim - 11-20-06 LAW OFFlCES OF WALTER H. MADDEN and KARL KNUCHEL, P.C. A Professional Corporation Attorneys at Law 116 West CaUeoder P.O. Box 9!3 Llvtnpton, MT g(M7 Telephone: 4061222-O13! Facsimile: 4061222-8!17 e-mail: knuchel@wispwest.net NOTICE OF CLAIM November 6, 2006 THE HONORABLE JANET KELLY DIRECTOR, DEPARTMENT OF ADMINISTRATION MONTANA STATE GOVERNMENT P.O. BOX 200101 HELENA, MONTANA 59620-0101 and BRIT FONTENOT, CLERK OF COMMISSION CITY OF BOZEMAN CITY HALL 411 EAST MAIN STREET BOZEMAN, MONTANA 59715 Re: Kayle Ingram Dear Ms. Kelly and Mr. Fontenot: With your permission, please note that we represent the Estate of Kayle Ingram who sustained severe injuries, including partial severance of the right arm, experienced severe pain and ~uffering over several hours and ultimately died following a traffic accident at occurred on North 19th in Bozeman, Montana, on October 18, 2005. Pursuant to MCA fi2-9- 301, please accept this correspondence as the Notice of Claim for the following: \i....r... 11/17/2006 Page 2 Claimants: Estate of Kale Ingram. by his personal representative, Cole Ingram; Cole Ingram individually; Jackie Ingram; Capri Ingram; Michelle Ingram; Date of Loss: 10--18-2005; Accident Location: North 19m Street, just north of its intersection with Dead Man's Gulch/Cattail Drive in Bozeman, Montana; Attorneys: Walter Madden and Karl Knuchel at P.O. Box 953, Livingston, Montana 59047; Enclosures: 1. Crash Investigator's Report (this investigation was handled predominately by the City of Bozeman Police Department); 2) Attorney/Client Fee Agreements: 3) State of Montana standards applicable to height of medians; Claim Facts: Kayle Ingram, a then high school junior, was a right front seat passenger in a vehicle operated by David Cherry on the afternoon of October 18, 2005, in Bozeman, Montana. Mr. Cherry was driving a 1984 Toyota. At the time in question there were two northbound lanes on North 19m. The City of Bozeman contracted with Thomas, Dean & Hoskins of Great Falls for the engineering work on the North 19th project including overseeing the operation and creating engineering design and specifications. The City also contracted with JTL of Belgrade, Montana to do the construction work. On the afternoon in question, JTL suddenly funneled traffic from the right (or east) northbound lane to the left (or west) northbound lane in such a manner as to prevent a reasonable opportunity for motorists to merge over from the right northbound to the left northbound lane. After David Cherry maneuvered his 1984 Toyota from the right northbound lane to the left northbound lane, his vehicle came into contact with the median on North 19m just north of its intersection with Dead Man's Gulch / Cattail. The median was unmarked and was at that time at least 8 1/2 inches high contrary to the Montana State Department of Transportation's own standards for medians. Medians are to have a height of no higher than 15Om.m (6 inches) with a face no steeper than 1 horizontal to 3 vertical. The unmarked median which the Cherry vehicle encountered was at least 8 1/2 inches high. The design speed called for a maximum of 70 kIn per hour (approximately 43 mph). The posted speed limit on North 19m at the'time was ~5 mph with a 35 mph speed in work zones. When David Cherry's 1984 Toyota came into the contact with the 8 V2 inch high median, the impact tore asunder the undercarriage of the Toyota causing the driver to lose control and resulting in the vehicle going over the median making contact with the roadway on 2t.;.. 11/17/2006 Page 3 the driver's side of the vehicle and sliding on its left side northbound now in the southbound lane of oncoming traffic. The Toyota made contact with a truck which sheered the roof from the Toyota. There were no warning signs of the unmarked median or of its 8 V2 inch height contrary to state and national standards. The Montana Department of Transportation and herein the City of Bozeman have a duty to exercise ordinary and reasonable care in maintaining and improving the roadways. They breached this duty by creating an unsafe highway condition by virtue of the negligent design, engineering, construction, maintenance and inspection of the project. This resulted inclusively in the presence of an unmarked 8 Y2 inch high median which was way beyond the national and state standard for heights of such medians, to wit, being no more than 6 inches. The low clearance of the 1984 Toyota simply could not accommodate contact with a median that high. The State and the City left the median at that 8 1h inch height level for many months after the accident in question. Ultimately, the roadway surface of the area in question recently underwent asphalt paving thereby raising the surface of the roadway some 2 Vz inches in an effort to bring the median within the state and national standards of no more than 6 inches in height. Separate and apart from the incktent in question of October 18, 2005, other motorists voiced grave concern about the height and concomitant dangers of the median as well. As a result of the above described negligence, Kayle Ingram sustained serious and severe injuries including the partial severance of his right arm along with massive internal injuries from which he suffered and ultimately died several hours later. In addition to Kayle's horrific pain aml suffering, his loss of future earnings reduced. to present value approximates 1.4 million dollars alone. Based on the above, the claimants make the following demand: consistent with the provisions of MCA ~2-9-108(3), and the March 17, 2003, contract between the City of Bozeman and Thomas, Dean & Hoskins, Inc. and the contract of May 19, 2005, between the City of Bozeman and JTL Group, which incorporate liability insurance, the total demand on behalf of all claimants to resolve all claims is $7 million. If there is any other governmental entity(s) that may be liable to the claimants either in full or in part, please provide us with the name, address, and agent for each such entity. Also, please provide a copy of this Notice to such potentially responsible party. This Notice is submitted in compliance with the provisions of ' Montana's Tort Claims Act, MCA ~2-9-101 et seq. including MeA ~2-9-301. -0:.:0,.. ....~-,,-~-- 11/17/2006 Page 4 Lastly, as an accommodation to you, you are invited to an initial exploratory " meeting concerning the matter to be held at the Wingate Inn Board Room on Thursday, December 14, 2006, beginning at 10:00 a.m. Please confirm that date and time at your earliest opportunity. Thanking you for your courtesy and attention. I remain, ;2d~~ Walter H. Madden, Esq. Enclosures xc: Cole Ingram, Personal Representative of the Estate of Kayle Ingram ~'\. [-,: Repoltinf Officer. Bozeman Police Department ON FI 0 ENTIAL Fatal Crash Report THIS INFORMATION IS FOR LAW Sgt.MarkJohnson ENFORCEMENT PURPOSES ONct ANY UNAUTHORIZED USE IS 0501211411002 STRICTLY PROHIBITED. Crash Report # : Date of Report: November 29,.2005 SynQpsis: This was a two vehicle, sideswipe, opposite direction collision involving a Toyota passenger car and a d1evrolet pickup auck The Toyota was traveling north on North 19th Avenue and had two occupants. Th.e Chevrolet was traveling south on North 19th Avenue and had one occupant. The Toyota failed to negotiate a lane change, strock the median, rolled onto the'driver's side and slid into the lane of the Olevrolet, striking the driver's side of the Chevrolet. CJriI;n:1tion of Call: The call came into the Gallatin County/City of Bozeman 911 Center at 1734 hours on October 18, 2005. I was dispatched to this accident at 1735 hours. Environment21 Conditions: The weather conditions at about the time of the accident were in the mid 60's degree Fahrenheit with clear skies. Wmds rnnged from 6 miles per hour out of the north to 7 miles per hour of the southeast. Date/Time/Location: October 18, 2005 at 1734 hours on the 2800 to 2900 blocks of North 19dt Avenue in Bozeman, Gallatin County, Mr. Initial Observations qpon Aniv.d: I arrived on scene at about 1742 hours and obsexved a number of vehicles parked along both sides of the straight roadway and people st::mrling on the southbound lanes of North 19th Avenue. This section of NOM 19th Avenue was currentlywithin a construction zone, .with po~d speed limit signs of 35 miIes per hoW'. A Bozeman FireDe~m truck and an Amencan Medical Response (AMR) ambulance were alSo sceJJe. I observed a maroon, Toyota passenger car on the inside, southbound lane of N. 19th, on its driver's side~..facing north. As I approached the Toyota, a witness informed me there was an~ther victim to the south of me. I turned around and obsexved a dainaged silver Orevrolet pickup parked on the outside, southbound lane of N. 19dt facing south. Sitting to the west of this pickup was an adult male who appeared to have blood on th~ back of his shirt and left arm. The license plate on the To}Ota was Montana license 6-A91621 and the license plate on the Chevrolet Wo1S MOntana license 6T-E4107. On ~ene Medical PelSonnel: Bozeman Fire Depa.rtment Muk Criner Jeb Fisher Kurtis Bushnell Jason Kolman Orris Dubay Graver Johnson Travis Batton Cody MnmTTlPY Central Valley Fm Department Jason Wheeler Tun Anderson Kevin Striclder American Medical Response (AMR) Aaron ShUltZ Holly Helstrom Vehicles/Occqpants: Vehicle # c Year/Make/Modeh VIN: License: Registered Owners: Driver: Name: Address: OOB/OIN: Issuing State: Endorserrents: Restrictions: Restraint: AleohoVDrugs: Injwy: E jeered: Entrapment: Extrication: Passenger. Name: Address: DaB: Location: Restraint: AlcohoVDrugs: Injury: Ejected: Entrapment: Extrication: 1984 To~ta Celica Jf2RA64CSE6229220 6-A91621 Geoffrey David <l1eny & James Edwa.rd Oleny 259 Evening Star Lme Bozeman, Mf 59718 Geoffrey David <lteny 259 Eve' Star~ Bozeman,MT59718 Montana None Provisional None Yes-alcohol and marijuana Fatal injuries NlA N/A N/A \ .A, Kayle L Ingr.un '. 1000 North 1rt> Avenue, II 120 Bozeman, Mf 59715 -Front right seat None Yes-alcohol and marijuana Fatal injuries N/A NlA N/A Insurance: Property and Casualty Insurance Company of Hartford Policyll 55 PHJ514375-264401 2 Vehicle # 2: Year/Make/Model: VIN: License: Registered Owner. Driver. Name: ~s: DOB/OIN: Issuing State: Endorsements: Restrictions: Restraint: AlcohoVDrugs: Injury. Ejected: Entrapment: Extrication: Instmloce: Allstate Policy# 048710577 2005 Otevrolet pickup lCXJHDC23215F855218 6T~E4107 Jared A Schroeder 147 High K Street Be~e.~59714 Bozeman, Mf 59715 Montana None None Lap and shoulder belt None Non-incapacitating evijent injwy NlA NlA NlA Crash SceDC Investiption: On-scene forensic mapping and speed estimates were conducted by the Montana Highway Patrol (MHP). to include Troopers Jay Nelson, Kenneth Klapan. Pat MeT "1~lin) and J2Son Hoppert. Photographs of the scene \\'ere taken by Deputy QUef Bill Dcwe and Detective Trent Schumacher of the Bozeman Police Depa.mnent. Biood ~ws of Ingram and Abbott were conducted by Bozeman Deaconess Hospital Phlebotomist JallleS Knight at the request of Bozeman Police Department Officer K.a~e Anderson. GaIIatin County Deputy Coroner Roger Layton was responsible for coUerring blood draws of Clleny: Witnesses: John A Laing 1045 5th Avenue East (406)755-6025 Stephen G. Sparks 705 Stonegate Drive (406)522-0884 Janrs G. Sparlts 705 Stonegare Drive (406)522-0884 K2lispell, Mf 59901 Bozeman. Mf 59715 Bozeman, MT 59715 3 Allison Levy CONFIDENTIAL 1011 River Drive, # 301 Livingston, Mf 59047 THIS INFORMATION IS FOR LAW (406)570-0940 ENFORCEMENT PURPOSES ONL'f. Trechell Y. Schroeder ANY UNAUTHORIZED USE IS 1203 Guiser Lane Belgrade, Mf 59714 STRICTLY PROHIBITED. (406)924-6052 Derek C TlSdel 65 East Kimberly Coun Bozeman, Mr 59718 (406)585-2763 Margaret J. Lewis 7340 Fowler Lane Bozeman, MT 59718 (406)587-3066 Drew R McDowell 1230 Candlelight Drive Bozeman, MT 59718 (406)388-2046 Richard R Ridenour 229 Painted Hills Road Bozeman, ill 59715 (406)586-0425 Brett L. Layman 9100 Trooper Trail Bozeman, Mf 59715 (406)585-8569 Herbert C Homan \ 153 Pathfinder Trail Bozeman, MT 59718 (406)388-0634 /\ Judith K. Franzak 153 Pathfinder Trnil Bozeman, MI' 59718 (406)388-0634 Marianne E. Baumberger 1013 East Silverbow Avenue Belgr.ule, MT 59714 (406)3887263 Andrew W. Beland 29 Annette Patk Drive Bozeman, Mf 59715 (406)585.-0001 4 Robin L. Stoddard 99 Frank Road, # 7 (406)539-3999 Lacie J. Sikes 1814 West Beall, # A (406)209-4817 Be~,~59714 CONFIDENTIAL THIS INFORMATION IS FOR LAW, eNFORCEMENT PURPOSES ONL'f. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. Bozeman, Mf 59715 Robert E. Poublon 1707 Rainbow Road (406)522-8453 Bozeman, Mf 59715 Evidence: Measurements, digital photogr.lphs, toxicology results, taped interviews. Contribut:in& Factors: Driver # 1 was exceeding the posted speed limit of 35 miles per hour and per some witness accounts, was driving in a careless manner. Driver # 1 had bo~ alcohol and marijuana in his system. The street was under coIlStl'UCtion and only one northbound lane was open to traffic. Namltivc: This crash was a twO-vehicle, sideswipe, opposite direction collision. Vehicle II 1 was traveling north on North 19th Avenue. Vehicle II 2 was traveling south on North 19th Avenue. Vehicle II 1 was traveling in the east lane of a posted, 35 mile per hour constIUCtion zone and approaching a section of the roadwa.ywhich redUected all northbound traffic, via orange traffic barrels, into the west side, northbound lane. As Vehicle II 1 attempted to change lanes from right to left, driver /I 1 lost control of his vehicle and stnlCk the 1J11dd1e concrete median with the vehicle's front undercarriage. This caused vehicle /I 1 to roll onto the driver's side of the vehicle. Vehicle # 1 then slid northbound on its side into the southbound lane and struCk vehicle II 2 in the west side, northbound lane. Vehicle II 1 then sheared off of vehicle II :2 and skidded to a rest, facing north, on the inside, southbound lane of North 19th Avenue. This narrative is based on in'frviews conducted with the above--listed witnesses. (Refer taped interview tnlDScripts). Upon fwther inspection of vehicle II 1, MHP Trooper McI~l1ghlin noted ~ rear tires were studded but the front tires were not. Mclaughlin said vehicles with only two studded tires tend to skid more on dry surlaces, such as pavement. Mclaughlin said most authorized tire installation businesses will not place only two studded tires on a vehicle. MHP Troopers Nelson, Klapan, Mclaughlin, and Hoppert conducted measurements of the accident scene as well as their own skid test of the roadway. Per their findings, the minimum speed of vehicle II 1 MS approximately 73.34 miles per hour prior to impact with t.he concrete median. (.Refer MHP repents) Conclusion: In conclusion, this accident oc~d due to driver # 1 failing to negotiate a lane change while traveling at a high rate of speed and while having a detectable amount of alcohol and marijuana in his system. Vehicle # 1 then stIUCk a concrete median, thus resuhing in the vehicle to roll onto its side. Vehicle II 1 then slid into the southbound lane of traffic, striking vehicle # 2. 5 End of Repo.tt, Sgc~~ Bouman Police Department / CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. \ A 6 .""-'l'-' -_"' CONFIDENTIAL THIS INFORMATION IS FOR tAW ENFORCEMENT PURPOSES ONLY. MONT ANAHIGHW AY P ~~THORIZED USE IS CRASH RECONSTRUCTION RJfi1ljitJf-Y PROHIBITED. On October 18, 2005, at 1835 hours, I was notified by the Montana Highway Patrol Communications Center and Captain Keith Edgell of a two-vehicle fatality crash on North 19th in Bozeman, MT. I was in off-duty status at the time of the notification and was advised that I needed to respond to reconstruct the crash. I called Trooper Ken Klapan of the Montana Highway Patrol and had him obtain the Total Station Forensic Mapping Device from the Butte Patrol Office and meet me while enroute to the crash scene. Trooper Klapan and I arrived at the crash scene at 2020 hours and were met by Trooper Pat McLaugWin, Trooper Jason Hoppert, and Captain Keith Edgell, all of the Montana Highway Patrol. Sergeant Mark Johnson of the Bozeman Police Department also met us on scene. Trooper McLaughlin walked Trooper Klapan and I through the crash and advised us that the Bozeman Police Department would handle all aspects of the fatal crash investigation except for the Forensic Mapping and speed estimates. Trooper Klapan and myself made the following initial observations of the crash scene. The scene was located within the 2900 block of North 19th in Bozeman, MT. This location is within the city limits of Bozeman and located in Gallatin County. The crash was within a construction zone that included a reduced speed zone and traffic barrels that directed northbound traffic from two lanes down to one lane. The traffic was directed into one lane by the use of orange traffic barrels. The roadway itself was comprised of two lanes for northbound tnlffic and two lanes for sovtllbouDd traffic with a eel\ter turh lane for both northbound and southbound traffic. The center turn lane w~ separated by a raised cement median. The traffic lanes and turn lanes were comprised oInew bituminous asphalt and showed no apparent defects. Dashed white liJles separated the two northboWld lanes and the two southbound lanes. The center turn lane near the crash scene had a painted double yellow line that separated the two southbound lanes from the turn lane. Initial observations of vehicle number one was that ofa maroon Toyota Celica with two occupants that had been traveling northbound on North 19th. The vehicle was resting on its driver's side and the top of the vehicle along with the occupant area was fully exposed. Vehicle number two was that of a silver Chevrolet pickup truck with one occupant that had been traveling southbound on North 19th. The vehicle was parked in the right lane of the southbound traffic. There was a yaw mark in the right and left lanes of the northbound traffic adjacent to the driveway of Bozeman Ford at 2900 North 19th. There were two tire marks that extended from the center median divider to the point of impact. There were two short tire marks that extended south from the point of impact. There was a distinct debris field that consisted of vehicle parts, human tissue, and gouges that extended from the point of impact north in a cone shaped pattern to the final position of vehicle number one. CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLV: ANY UNAU~O~I · Trooper Klapan and I set up the Total Station Forensic Mappin'fm~ USE IS of the southbound lanes in between vehicle number one and two. Trooper oppe . Trooper McLaughlin assisted in positioning the prism as Trooper KJapan and I triggered the instrument from the position of the Total Station. All evidence points were diagramed including: Final positions of the vehicle number one and two, all tire marks, debris field and gouges, traffic lanes. turn lane. median divider. traffic islands, roadway edge and driveways at the scene of the crash. Upon completion of the Total Station Forensic Mapping Trooper Klapan, Trooper McLaughlin, Trooper Hoppert, and I measured the yaw mark in the northbound lanes. We measured the first one third of the right front tire mark of vehicle number one. We measured the chord of the yaw mark that measured 46.0 ft. from inside of the yaw mark to inside of the yaw mark. We then measured the middle ordinate from the chord to the inside of the yaw mark. The middle ordinate measured 0.5625 ft. Trooper Klapan then disabled his antilock brake system in his patrol car and performed three skid tests in the left lane of the northbound traffic near the yaw marks. The skid tests measured as follows: #1 112.0 ft. at 49 mph, #2 106.0 ft. at 50 mph, and #3 113.0 ft. at 51 mph. These skid tests gave an average drag factor of 0.76. With the chord, middle ordinate, and drag factor a minimum speed of73.34 mph was calculated. In conclusion, through the training and experience of Trooper Klapan and I it is are findings that vehicle number one was northbound in the 2900 block of North 19th. Vehicle number one entered a construction zone that included a reduced speed zone and redirected traffic from two lanes into one lane. The lanes were redirected into the left lane. This redirection of traffic was made with the use of orange traffic barrels. Vehicle nUIllbsr one entered this area at a high rate .fspeed ahd as ttae vehicle neared the driveway for Bozeman Ford located at 2900 North 19t\ the driver lost con\I'ol of the vehicle. The vehicle yawed counterclockwise and struck a raised center m~dian divider with the vehicle's oil pan and undercarriage. When the vehicle struck)he median divider the vehicle was facing northeast. Due to the angle of the collision, the 'area of the vehicle that struck the median divider, and the speed of the collision vehicle number one rotated on to its left-side tires. The vehicle then traveled at an approximate 45~degree angle across the turn lane into the left lane of the southbound tmffic on its left tires. This is consistent with the two tire marks on the roadway leading to the point of impact. Vehicle number two was traveling southbound in the 2900 block of North 19th. Vehicle number two was traveling in the left lane. Vehicle number one sideswiped vehicle number two. TItis collision had enough energy to rem(}ve the top of vehicle number one and cause fatal injuries to both occupants of vehicle number one. Post collision, vehicle number one continued northbound in the southbound left lane of North 19th sliding on the vehicle's driver's side. Vehicle number one came to rest on its driver's side in the left lane of the southbound traffic. Vehicle number two did have two short tire marks near the point of impact consistent with evasive action. Vehicle number two continued southbound moving into the right lane and stopping the vehicle across the road from the Bozeman Ford driveway. rooper Ja~ M. Nelson (MHP266 / ID # 1493) Montana Highway Patrol Crash Reconstructionist CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL'(. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. \ /, CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY; ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. DASHED CEN MEDIAN DMDER SED TRAFF1C ISlAND \ /. * ~ CRASH I Of51018OO13 DAlE OF CRASH 1CH8-Q!5 lOCAnON NORlH 10lH BOZENAN, MT IN\GnGA TED BY SERGEANT MARK JOHNSON BOZEMAN POlICE OEPARlMENT TOTAl.. STAnON lEAt.f WHP 1ROOPER NELSON. TROOPER KLAPAN, lftOOPER MCLAUGHLIN, TROOPER HOPPERT DRA~NQ BY MHP TROOPER KLAPAN, TROOPER NELSON ......... BEGIN SPEED CALCULATION ......... Comment: Input values: .............. min radius = 472.601429 feet max radius = feet step radius "" feet minimum coef of friction = .76 maximum coef of friction = step in coef of friction >= e, superelevation = 0 degree o degree = tan(O) slope '"" 0.000000 slope The input values after conversions: .................................. min radius = 472.601429 feet max radius = 472.601429 feet step in radius = 0.000000 feet minimum coef of friction = 0.760000 maximum coef of friction - 0.760000 step in coef of friction = 0.000000 m. roadway grade = 0.000000 slope S, speed = 3.87 · sqrt(R · (f + e)) where e is the road superelevation in slope (rise/run) coef of friction "'" 0.760000, distance = 472.601429 -= 3.87. sqrt(472.601429.. (0.760000 + 0.000000)) = 73.344116 mile/hr Recap ........ min radius = 472.601429 feet max radius :::: 472.601429 feet step in radius "" 0.000000 feet minimum coef of friction = 0.760000 maximum coef of friction = 0.760000 step in coef of friction = 0.000000 In, roadway grade = 0.000000 slope S,speed = 3.87 · sqrt(R · (f + e)) CONFIDENTIAL THIS INFORtJlATION IS FOR LAW ENFORCEMENT PURPOSES ONL'f. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. \ .,z where e is the road superelevation in slope (rise/run) coef of friction \ radius -~-> u 472.601429 feet I 0.760000 --> 'U 73.344116 mile/hr -............... END SPEED CALCULATION ............. CONFIDENTIAL THIS INFORMATION IS FOR lAW ENFORCEMENT PURPOSES ONL'Y. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. \ /, CRASH 'VESTIGATOR'S REPORT 00 ~~~ TFffl!S1~T<!5>>J I~~ ~~Vf. NJV'(~~'OJai€I@ ffiflID:HkY ~1.ffP. n 12 oottalllN TYN......,.. ""- t__ 'lIIiIN_ J<I t=--_ ...""'T.... 20 J_OopooIOO ,z:::::- -. "'"""""- .~ ~..... :="" 'C"~ Refer attaChed diagram. 01 ill 00 '~~~;~~;~~:~V:~'~'~.\.:;~.;"~.l.~~ ~ :/ ABBOTT DANIEL BERYl ---...- 13525 BRIDGER CANYON RD BOZEMAN MT If 00 ......,.- (U8710m lIl>Codo MT 59714 --- ..--- JT2~$4C5E6229220 1 GCHK2321 SF855218 6TE4107 -- TOTOTA CHEVROLET --- .... -~ -- -8=0- ....... ~- ... ~? :. """"""'-.."''''''- -,.Oooooogod ..-- o-w_ --- 01?oI NONE NONE _000010 --.. ~ - ...~ .-..0 ~~ _,__"- No_ ~D~.. '-''''''''~ :;"'o..~ . I:.... BeST RATE ~o.:=. :::- MR.rs R COMMERCIAl EHICLE AND FAT" ACCIDENT JPPLEMENT ~ 'FAT'w:ACCIDENT,:ONL:'Y': ' ''. ' ; ( ;; ::,L r: .;~:,.""J,';. NoUftoatlon TlrM !MS Arrival TIIM EMS (mlUtefy tImll) ??oo _not notlllecl ;17:34 I 17:42l NarM of~. Involved SAC TMt OJqn Method of A1c:oho1 o.tarmlnltlOl\(~} '.'1' ..;."i'" '," ,.'".;""""" ISMS t1nw at hotlfJltal of uo.t S.vw.ly Injured I 17:~9 EjactIon Path ABBOTT, DANIEL BERYL ~~ER~~~~9f'=:~ ~~y'I~_ INGRAM, KAYLE L ._-~-~-~~~.-._~ ----~- y y y 1 EvIdentIIl Tilt (8tatI1, Blood, Urlne 1 Not ejected I not appllolble 1 EIIIo18lUI TeIt (BrMth. Blood. UrIM 1 Not..1IlUd I not appIIeablll --....-..------.---....--~~- ~--- - 1 ~l Tilt (8rHIh, tllood. l..lrtne 1 Not ejected I not ttppIcabl. ._ _~__..............-~~, _~ ~'.r'_.._~___. ~-_. Rqadway Surface Type 2 Blacktop (blb.Jmlnous) I V.h1 Veh2 E8t 6pMd: n Number ofTrafllo Lanea: .Ci CONFfDENTIAL' THIS !NFORMATION IS FOR LAW EM~OACEMP!.NT PURPOSES ONLY. ANY UNALJit--IORIZEO USE IS IfftlfJfl.V PROHIBITED. \ ~A, Calla For Service Report CaIlID: O~10180090 Printed: October 19,2005 1. Ao-ncy 2. PelllOll Received 3. O-.m.... Received S. 11me ArrIved 7. Cu.'" BPD Complaint 10/1812005 17:34 17:39 4. 11.... Dlapatched e. 11.... Complete 0510-180013 17:35 01:49 8. Nature Of Incident Mva Reported Injuries 9. Location Of Incident N 19TH AVB/BURKE ST,BOZEMAN MT ALLTEL 866-S20-0429 10. VIctim or Caller 1121 MANDEVTI..J...E LN: NW SECf 4063219216 11.Clualflcatlon 12. How Received 13. Disposition 14.otfIcer 16. Dat. Submitted TRAFFIC ACCIDENT 'ANI/ALf lICAD REPORT TAKEN Johnson, Mark 10/18/2005 Notes: CAILBK-(406)209-408iv~1l1.0S9224 +4S.71167S 1709...2 VEH INVOLVED. MRN CAR.. LOI searoh completed at 10/18/05 17:34:48 .. Recommended unit AMR. for ~ AMR(O) (2.64 mi) .. Reoommendod unit BOZFD for requirement BOZF'D\O) (3.36 mi) Duplicate EventLocation:a N 191H A VFJBURKE ST BOZE, Cross Street 1 m N 19TIl A VB -ONE VEHICLE ROIL OVER. PEOPLE LAYING IN THE STREET BURKE ST, Cross Street 2 - BURKE ST, Typo - MY A - MY A, Subtype - INJ - REPORTED INJURIES, Alann Lovel- 0 End of Duplicate Event data 141 IN RT ADV SIREN NOT WORKnil"G 636 ADV 2 PATIENTS ON SCENE ADV 1 OOA 1 EXIREML Y CRITICAL BOZ ENG 1 REQ CORONER.. LAYTON PAGED. 636 ADV 115 BODY MA'ITER IN THE ROADWAY NEED TO KEEP PEOPLE AWAY FROM 115 RESP PARKING AT SUBWAY.. Cross Referencod to Event # c2ooS00090 at: 10/18/0S 17:40:37.. >>>> by: NICOLE SMITH on t.crminal: firecms2141 REQ ANOTHER. AMBULANCE 2ND AMB PAGE SENT 650 PAGED REQ BELGRADE FIRE AMB TO RESPOND TO TRANSPORT. III. Cr088 Reforenccd to Event # L200500S95 at: 10/1S/0S 17:45:59 .. >>>> by: NICOLE SMITII on terminal: firccms2 132 132 REQ MHP FOR FATAL ACCIDENT RECONSTUCTION 297 WILL RESPOND AND IS CALLING OUT A PARlNER TO ASSIST.'" LOI search completed at 10/18/05 18:19:06.. LOI search completed at 1O/18/0S IS:21:48 .. Case numberbOSl01S0013 has been assigned.. >>>> by: BROOKE M. LANNON on terminal: citylaw.. PER search completed at 10/18/05 18:45:58 III. PER search completed at 10/18/05 18:46:30 .. PER search completed at 10/18/05 18:46:51 .. PER soarch completed at 10/18/05 18:48:15 .. LOI search completed at 10/18/05 19:31:37 NEXT ROTATIONAL WRECKER. CHEVY TK FRONT END DAMAGE TO A&D AUTO BODY. MR T'S REQ BEST RATE FOR TIlE OTHER VEHICLE - ON IT'S SIDE WilL NEED A FLAT BED 141 ADV ROAD IS OPEN IN AlL DIRECTIONS 141- Vehiclc 1 (passenger car) wastra.vcling northbound on North 19th, when tho driver drove over the median. rolled onto thc driver's sidc and sideswiped vchicle 2 (pickup truck), which was traveling southbound. One juvenile in passonger car was dcccascd upon police arrival Other juwnile puscngerwas transported to Bil1.ing8 hospital via helicopter and was deceased upon anival. Adult male in pickup truck was transported to BDH and subsoquently released. Montana Highway PatrolassiBted with investigation. Investigation to continue. CONfIOENT\A\.. N \S FOR LAW T\-\\5 \NFORMAT'~UR?OSES ONLY. ENFORC.EMENO:TR'lEO USE \S UNAUTH t ANY PROH\etTEO, STR\CTLY R_ Cfm w~ , If) - J 1-0 ~ f fJ~ ' ,t)~ c~.;JJr-r-. cc;-? '\ ""1""" 0" ...... ; I", ,. I . I I I ~. 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"".'}H-..", ',I, \11,~~~:....' 1~.~l"'I~"~'Il~l""P..~V"~llfl!I~/I,, , jl l,., ,I' I ~ ,,_ . ,. jll '" 1 It. '\ :." ~." ...~~' '."~' ....\. ''I, I ' ., ~ ..,~. : h."L.....i, !.:y~.II.:j1rr ''''~...:~II:,:I;"I.;.A'\~f :\1' CONf\DENT\AL N IS FOR LAW 1\-\\5 \NFORMAT\~URPOSE.S ONLY. ENFO~~~~~~6R\ZEO USE \5 ~~\CTLY PROH\B\TED. \ ( AI.<<IC'JNllIIIC - OCA N Bozeman Police Department INCIDENT IINVESTlGA TI,- .4 0510180013 c OR! REP~~~-\. ~~\. 0..:" / Time Reported ( ** C - _ -:f+ 0 ~~ . WE Oct 19. 2005 02:50 E Crime IncldCllt ,~ JRl ~w JUt \~~ ~'~m List Known Secure N #1 OiliER TU Oct 18. 2005 17:34 T Crime IDcident .\fc 'l~~' . ~lS.E \5 DAn At fouod 0 #2 1F~' i Deom TUOct 18,2005 17:34 A ~~~. T #3 Crime Incident t;.'J :l' DAn A A o CoIn LocatiDn oflncidCDl N 19th Ave / Burke St, Bozemon. fjJ ;\1\ '" 1 PJa:uise Type Hillhwav/RoadIAllev ~ How Attacked or Committed (0 Fon;ibIc EPtry 0 Yes 0 No rt:I NI A Wmpou I Took #I VICtims 2 I Type Iodividual Injury None I Raridcocy Status Residant Vic1:irnlBusilloss NlIDUl (Lut. Finlt, Middle) Victim of Crime II ~: Sell: V VI 1 Cherry. Geoffrey David JUVENILE I RdUiomhip to Oft'codcn M C T Home Addn:n Homo Phone I 259 Evening Star Ln, Gallatin county. Ml' (406) 585-7876 M Employm Namo'Addfea Bus PboDc ~~4 I~h I~ I~ I~ I ~1621 MT I vrNmlU64C5E62292220 ::> cc 0fI..5: V- Y' . V2 Y3) 0" other R- p-.. {if othcI' l- Ived r Code NaIll" (LaIt, Ft.nlt, Middle) Type: V]o~ of Aac I DOB Ingram. Kayle L JUVEimE Crime i# fI VI2 I W M Ii R Home Addfta Home S LOOO N 17th Ave Apt. 120, Bozeman. MI' 59715 (406) 587-5602 Bmployar" NlIDIO' Ado:huI BUlIi_ Phone I "l Code N.me (Ust, FiIst, Middle) Victim of I Aie I DOB Race Sell V 101 Abbott. Daniel Beryl Crime #I 1!!IIJll ) W M L Homc Addten me PC V 13525 Bridger Canyon Rd. Gallatin_county. MT S liUijilOyer DC !) Gallatin J"alley Homes Statui L - Lost S - Stolco R - R.ocovertd D .. DamI&cd z.. SeIzed B - Burned C.. Counterfeit I FOIled F - FOUDd U" Unknowu CHI_ le VlCk .or column if fur.... . ~ UCR StatuS - Date Value OJ QTY Property Description MaktIModel Sma! Numb<<' ~ l ) ;) ~ 't r '{ NumberofVehick4 Stolen 0 Number V~ Rcoovend 0 0 Officer (141) JOHNSON. MARK Ollie<< Slpature ISupcmsor~"OHNSON. MARK Complainant Signature ~ SWUlI: Cue Disposition: Further InVQ/JfaJion October 19.1005 'rinted at: 11/2912005 23:00 Page: 1 Incident I Investigation Report I OCA: 0510180013 , .&-'iit.i<..t';',4f1"~';: "Ai.W;\J~";; ':~'! .~~I<I~'11'~:'6r',~~~~~~~'~~:',~ "I,~~.~.1'~LI louman Pollee Department L"Lost StalWl Qu4ntity TyPe Masuro Swpectcd 0Iu& Type o R U o S S U S Scacs, M P E C THat Jacket Wu Suapect AImed? Offmd~.) Suspectc:d OfUlIlng OOend... 1 Oft'_der 2 Off_d<< 3 ~Offcada Age: Race: Sex: Ap: Race; Sell: Aj~ Race: See ResidMt Status o Drup (if Nt A RtlIidtnt o Akohol OOeader .- O<<tIIlder 5 Off_der , Non-Relidcat o Comput<< Ap: :0/ R.oc: Sex: At,c: Race: Sell: Ap:. Race: Set: Uabowa DOS. t Ale Build Hair Style en acoCIllt, \'0 fWr Color Hair l..cmIth . ) VYR SWlpoot Halo I Bw Motivated: r Name (lut, Flnt, Middle) T Laing, John Arthur '0{ E Home Addrosll ~ /045 5th Ave East. Kallspell. MT 5990 1 Assisting Officers : (115) ANDERSON, KA YCEE l (636) PETERSON, DON l (MHP)MTIDGHWAYPATROL i (160) PANKRATZ, ADAM BENJAMIN I o y~ It! No Socks Shoa Mode ofTravd 0.0.8. - Homo Phone ~ Race S& 57 W M EllIpIoycr Ekroth Musk Phone ; V I was driving Vehicle I, and V2 was a passeoger in V chicle 1. V ohiclo I was northbound on 19th Avenue when it erossed over the concreto median and sideswiped Vowelo 2. 10 was driving Vohicle 2 southbound on 19th Avenue. VI was deceased upon officer arrival. V2 was transported to a hospital in Billings via holicopter and died onroute. 10 was transported to Bozeman Deaconess Hospital and subsequently roleased. Montana Highway Patrol officers responded and conducted accident investigation. Related to:Abbott, Daniel Beryl- INVOLVED OTHER 2005 CHEVROLET PICKUP - SlL \fER tinted at 11/2912005 23:00 Page: 2 Incident I Investigation Report Owner I BCHROBDBR, JARED ALLKN VIM I 1~3215F855218 Licanae: MT/6TK4107 PURPOSES ONL'f. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. ~v \ Printed at: 11/29/2005 23:00 Page: 3 Incident I Investigation Report Bozeman Police Department CONFI~0013 I THE INFORMATION BELOW IS CONFIDENTIAL - FOR usN~IAtT+B~EiSbNNEL ONLY y \ Printed at: 11/29/2005 23:00 Page: 4 Incident I Investigation Report Name (Lan, Flnt, Middle) bee S.. Name Sparh, Stephen Gray 56 W M Address 705 Stonegate Dr, Gallatin_county, MT H: (406) 522.JJ884 Employer Wingate Inn B: (406) 5824995 Name Sparks, James G ~ 15 W M Addren 705 Stonegate Dr. Gallatin_county, MT 59715 H: (406) 587.3665 EmpJ.yer B: Name Levy, A.llison - 19 W F Adllren 1011 River Dr Apt. 301. Livingston, MT 59047 Ht Employer B: Name Schroeder, Trechell Yevette - 35 W F y' AdcInn 1203 Cruiser Ln, Belgrade, MT H: EmpIeyer \ Bt Name Tisdd, Derek Carvelle 30 W M Add.... 65 E Kimberly Ct, Gallatin_ ccunty, MT 59718 HI (406) 585-1763 Employer BI Name lAwis. Margaret Jones .... 67 W F Addret. 7340 Fowler Ln, Gallatin_county, MT 59718 Ht ,,106) 587.3066 ElIIpIoyer B: Name Mcdowell, Drew Randall - 17 W M A...... 12JlJ CtmtJlfl/ig/tt Dr. GdlItJitIIJOWlty, NT 5'7118 H: (416) ~IH6 Employer B: Name Ridenour, Richard Ross 17 W M Addren 229 Painted Hills Rd, Gallatin_county. MT 59715 HI (406) 586-fHIJ Employer B: Name Layman, BreU Leasure - 17 W M Addren 9100 Trooper Trl, Gallatin_county, MT59715 H: (406) 585-8569 EnIpIoyer B: Name Hollran. Herbert C - 60 W M Addr_ 153 Patlifinder Tr/, GalJatiTU:OJUfty,MI' 59718 H: (406) 3u..0634 Employer Bozeman Senior High &hool BI NlUJMI Frarttak, Judith K - 41 W F Adllres. 153 Pathfinder Trl, Gallatin_county, MT 59718 H: (406) 388-06J4 Employer 81 Name Baumberger. Marianne Evelyn - 46 W F Addnl. /013 E Silverlx1wAve. Belgrade. MT Ht (406) 388-716J EPIpIoyer B: Printed at: 11/29/2005 23:00 Page: 5 Incident I Investigation Report Name Na_ (Last, Flnt, Middle) Beland, Andrew Westerlund ENf~~ ~~ - ,'- . ~.~ ~'lE\ . 29 Annette Park Dr, Gallatin county, MI' 59715 ",~"f ~.~ , ...:"'.'r'I\~' - . - S't\i\C1"\.:" . I ~. Ale Raee Sex Name Stoddard, Robbin Lynn .A.ddr... 99 Frank Rd Apt. 7, Belgrade, MT 59714 EnIpIoyer Mt Lines Name Sikes, lAcie Jo AlId.-- 1814 W Beall St Apt. A, Bozeman, MT 59715 EJIpIeyer Montana Lines N.... Poublon, Robert Eugene Addreu 1707 RainbowRd, Gallail:, county, MT59715 17 W M H: (406) SIJS..(}()(}} B: _ 46 WF H: BI Addren Empleyer EPIpIoyer _ 23 WF H: B: _43WM H: (406) S11-84J3 BI \ Printed at: 11/29/2005 23:00 Page: 6 200S-l0wn 112:38 F ror'lt hp cor ldt.r + MONTANA-HIGHWAY PATROL FAT AUTY CRASH REPORT Date: # Vehlclt*: 200&1018 Time: 1730 COt.Inty: GALLATIN 2 # KilI9d: 2 ,J # InJuRK1: 1 L P C10HSt CIty or TO'NI1: 80ZEMAN Highway: NO 19TH & BURKE AlCOhol a Factor: NO Road ConditIcJM: DRY MPM: Speed. Factor: UNK Commerc al Vehicle: Haz. Mal Involved: NO MotorCycle: NO Bicycle: NO Out-of-SUtte Vehicle Involved: NO Pedestrian: NO Occurred Outing OayUght Ho\n: YES NO ,,~, 1 MakelModel: 1884 TOYOTA CST Driver: CHERRY, GEOFFREY OAVlD OOB: _ Addt..: 259 EVENING STAR LANE BOZEMAN MT 69716 AGE: 17 MorF M condition: FATAL Seat Belt U"': NO Hospital: OO.A Paaerlgc 11': INGRAM,KAYLE'v' OOB: AGE: 16 MorF M -....- Addren: 1000 NO~ 17TH AVENUE #170, BOZEMAN MT 68716 COMmon. FATAl Seat Belt Usod: NO Hospital: at Vincente Bmlngs passengnr. DOS: AGE:. MOI'F Address: Condition Seat Bait Used: Hospital: Vehicle # 2 MakalModel: I1rfver. ASSarT, DARREU. 2005 CHevROLET TRUCK 008:. - AGe. 44 MorF !L- Address: 13S25 BRIDGER CANYON ROAD, BOZEMAN MT 89715 COndiUon Minor Injuries Snt Bolt UMd: NO PaaungfJr. 008: Ac:ldfess: Hospital: BoHman Deaconess AGE: MorF Puaeng'u: Address: Condldon: DOB: Hospltal: AGE: MorF COndfUon: SNt Belt Uaad: Seat Belt u..d: Hospital: Commen:s: DO NOT RELEASE Next of K n Notified: YES Dlstrtct Office Notified: YES NARRATIVE FOR pRESS ReLl!ASE: . VEHICLE 1 WAS NORTHBOUND ON 19TH AND CROSSED OVER CONCRETE MEDIAN WHERE IT : . SIOESW!PEO VEHICLE 2 SOUTHBOUND ON 1QTH. BOTH OCCUPANTS 01= VEHICLE 1 WERE FATALlY INJURer.. ORNER OF VEHICLE 2 sustAiNED MINOR INJURIES. Inveatige1ing Offtcer: BOZEMAN pouce DEPARTr4ENT CFS# 101806w22B Received: 20081010 TIma: CSO: JERRY FOX 0167 HQ 1087 INVOLVED: REPORT OF INVFSTIGATlONC~~~~N~W'W ~,&.t\~J~fQ~~fc.c:.(,)bllY. December 7, 2005 lH~'I'.!';:;;r~~~~~l' E~_~~g~ Fatality Motor vehicle Crash ~~~Tu{'rR~~~ . DRIVER 1984 TOYOTA CAR ~ Deceased IIiiiiiiiiId Cherry 259 Evening Star LaDe, Bozeman, MT 585-7876 DATE: SUBJECf: PASSENGER 1984 TOYOTA CAR ~ Deceased ~ ~120, Bozeman, MT 587~S601 DRIVER 1005 CHEVROLET TRUCK Daniel Abbott Brldeer Canyon Road, Bozem.aa, MY 539-6931 REFERENCE: ponce Case # 051018-0013 REPORTING: Lieutenant Rich McLane DETAILS OF INVESTIGA'90N: On October 18, 2005, at about 9:00-p.m. I was informed that numerous patrol officers, MHP troopers, Gallatin County Deputies and various first responder.J had responded to a fatality accident on N. 19dt, located in the city limits of Bozeman, MT. The Fire departmont bad already contacted the coroner prior to law enforcement arrival. On October 19, 2005, at about 07:00 a.m. I met with Sergeant Mark Iohnson, Deputy Chief Mark Lachapelle and Deputy Chief Bill Dove. I was updated on the status of the investigation and it was determined that I w<JUld assist by holping conduct related. follow-up interviews and help facilitate gathering any related reports documenting this accidC2lt investigation. I learned the below listed Bozeman Police Officers and Gallatin County Sheriff Deputies responded and assisted with this accident or it's investigation: Sergeant M. Iohnson Bozeman Police Department Officer K. Anderson Bozeman Police Department Officer A. Pankratz Bozeman Police Department Sergeant C. Schumacher Bozeman Police Department Officer T. Schumacher Bozeman Police Department Detective C. Gappmayer Bozeman Police Department Deputy ChiefB. Dove Bozeman Police Department Deputy Chief M. Lachapelle Bozeman Police Department Deputy ChiefM. Kent Bozeman Police Department Lieutenant R. Mclane Bozeman Police Department Deputy T. Quillen Gallatin County Sheriff's Office Page 10f5 , ......~ --. i' \ - , \. ;' -./ t .. C'~ Deputy D. Peterson Gallatin County Shcriff.~CON FIDE NTIAL Chaplain W. Hiebert Gallatin County Sh . cn9FORMATION IS FOR LAW l'FfcEMENT PURPOSES ONL'f. On October 19, 2005, I collected all existing digital recordings &it" Jr.J~Y~4mi~a .!&1ected all existing digital photographs done at the accident location. I ~~HYe ~ draw from Ingram and Abbott had been submitted into Bozeman Police Evidence. I received and secured a video tape showing the traffic conditions and signage as Officer Anderson approached the accident on October 18,2005. On October 19, 2005, I spoke with Derek Carvelle Tisdel. Tisdel indicated on October 18,2005 at about 5:30 p.rn., he had just left Cost-Cutters near Radio Shack, located on the west side of N. 19th Avenue, when he heard a vehicle crash. Tisdel looked to the road and saw a car (1984 Toyota) sliding northbound on the road on its side and going at a fast rate of speed. Tisdel went back inside and called 9-1-1 and reported the accident. Tisdel approached the car and saw two bodies inside, neither of which appeared to be alive. Tisdel said one of the persons appeared to start to breath with some typo of body reaction occurring. Tisdel said people present kept saying the airway needed to be opened, but everyone appeared to be in shock and the male (Ingram) had severe injuries to his face. Tisdel said he tried to help with traffic Wltil officers mrived. Tisdel said he didn't see the truck involved in the accident at all, until he looked aroWld after awhile. (Refer taped interview) On October 19, 2005, I contacted local news stations and gave them an updated report of the accident. On October 19, 2005, I spoke to Robbin Stoddard. Stoddard works for ''Montana Lines" and helps with signage and controlling tmffic for the construction occurring on N. 19m. Stoddard indicated her primary work area during the day was near the intersoetion ofN. 19th and Valley Center road, controlling traffic onto Valley Center road and southbound traffic onto N. 191h. Stoddard had completed her dutiosand was getting in her vehicle parked in the west lot on N. 1911I near Burke Street. Stoddard had a second employee with her, Lacie Sikes. Stoddard said she was getting into her vehicle when she heard a crash. Stoddard looked up and saw a).~ (1984 Toyota) coming to rest in the southbound lane ofN. 19th, facing toward the North and on its side. Stoddard did not see the truck get hit, but saw it sitting on the west side of the road. faCiing tQ tJle 8Quth. StQlidard IJW .lw driva:- JitPq ~rt"i~ of t.bo v4Aig}t; with blQOd. on his ann. Stoddard indicated none of the cones, signs or markings had changed on the road for several days and the medians had been in place for most of the summer. (Refer taped interview) On October 19, 2005, I spoke to Herb Hotban. Hothan was driving northbound on N. 19th and was stopped near Burke Street. Hothan indicated the right (eastern.) lane had eroded with cones running at a 45 degree angle into the existing northboWld (western) lane. Hothan said he saw a red car (1984 Toyota) going fast in the western lane. The car cut directly in front of him, striking the median. Hothan was unsure if the car rolled over or hit the truck (2005 Chevrolet), but saw it slide to a stop, facing north in the southboWld lane. Hothan indicated prior to him stopping, he was going 30-35 miles per hour. Hothan described the red car as passing "at a flash" and was going a lot faster than he was. (Refer taped interview) On October 19, 2005, I spoke to Judith Franzak. Franzak was a passenger in Hothan's vehicle. Franzak said the red car (1984 Toyota) came out of nowhere, flying past her at an angle and cut in front of Hothan's vehicle. Franzak said there was nowhere for the vehicle to go but into traffic and the car hit the median going into oncoming traffic and hit a truck (2005 Chevrolet) and flipped onto its side. Franzak said none of the other traffic was moving fast. Franzak said at the timo the rod car passed in front of Hothan's vehicle, Hothan's vehicle was only a few feet from the point where the eastern lane ended and was basically ''the front-of the line". (Refer taped interview) On October 19, 2005, I spoke with Treche11 Schroeder. Schroeder said on October 18, 2005, at about Page 2'of 5" . .... .r- -- I 'CONFJDENTJAl 5:30 p.m. she was getting into her vehicle parkod near Subway. 31m T .~al3 tiUUtAW She heard a loud acceleration and looked to the south and saw the ~L'I. fast and then driving on only its two driver side wheels, prior to hi H ~blSliit ISo middle median, landed onto its side and slid into a southbound :r~~JBSE6&eder said tho truck plowed through tho car, peeling off the top of the car. (Refer taped interview) On October 19, 2005, I spoke with School ResoW"CC Officer Trent Schumacher. Schumacher indicated there were rumors circulating in the schools that Cherry and Ingram may have been drinking earlier that day and may have been racing in vehicles. I conferred with Officer Anderson and determined it was necessary to re-interview the mends that wore last with Cherry and Ingram. On October 19, 2005, I was able to reach either the youths or their parents that wore last with Cherry and Ingram. This included Andrew Beland, Richard Ridenour, Brett Layman and Drew McDowell. All four youths came to the L&J Center. Officer Anderson interviewed Layman and McDowell and I interview Beland and Ridenour. On October 19, 2005, I interviewed Richard "Ross" Ridenour. Ridenour indicated all six above named males were initially at KMMS at a radio show meeting. After tho meeting, they all went together to Wendy's. After being at Wendy's, they went to their vehicles parked in the N. 15th parking lot. Cherry and Ingram were in one vehicle, McDowell was in a 2114 vehicle, and Layman, Beland and Ridenour were in the 3id vehicle. Cherry, McDowell and Ridenour were the respective drivers. Ridenour said they were going to 10 to eheny's house to hang out. Ridenour said he was initially in front of Cherry going North on N. 19 and was in the western lane. Cherry accelerated to pass and merge in front of McDowell, when Ridenour said he saw a tnJ.ck (200S Chevrolet) get hit. Ridenour didn't initially know it was Cherry's vehicle, until he started passing by the accident location. Ridenour pulled into the Border~ s parking lot and the three of them got out to observe what had happened. Ridenour indicated he thought he was driving 35-40 miles per hour and that Cherry was &,oing about 45 miles per hour when Cherry passed. Ridenour denied anyone had been drinking in any of the three vehicles or that anyone had been racing. (Refer taped interview) >. On OQtobcr 19. 2005, . ~_ Andrew:Qttl'lD4 ~ pvc, a ailni1ar aecoUDt as given by Ridenour. (Refer taped interview) On conclusion of interviews with Beland and Ridenour I conferred with Anderson. AndCfSOn related similar responses had been given by both Layman and McDowell. All four youths were given a ride home by their parents. On October 20, 2005, I verified with Evidence Tecbnician Tom Weigbtman that Abbott and Ingram's blood would be sent the next day to the Montana Crime Lab for a toxicology screen. On October 20, 2005, I met with Trooper McLaughlin. I verified which MHP Troopers had responded to assist in the accident and ensured the extent of investigation we were doing was consistent with that necessary to investigate a fatality accident. M4-augblin BlX'ced that our investigation was consistent with those done by MHP troopers and indicated tho below officers from the MHP were pI:csent to investigate the accident: Trooper Pat McLaughlin 297 Trooper Jason Hoppert 205 Trooper Jay Nelson 266 Trooper Ken Klapan 327 On October 20, 2005, I interviewed Lacie Sikes. Sikes gave a similar account as given by Stoddard. (Refer taped interview) Page 3 of5 .,.. .(_.~, I,,.,,,, '<-CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL'f. On October 20, 2005, I spoke with Assistant Coroner Roger Layton. ~~ been sent in for toxicology analysis and gave mea copy of pictures ~~'PROHIBITED. On October 20, 2005, I went to Best Rate Towing. I retrieved a copy of the registration and proof of liability insurance card from the business. I. verified the following tires were on tho vehicle: Front: Cooper Lifesaver P185/70R14 Classic STE Rear: Pacemaker Radial ST12 P185/70R14 878 I knew the left tires bad not been photographed and took a photo of these. On October 20,2005, I received copies of the Ccntra1. Valley Fire and AMR ambulance reports. I later received a copy of the Bozeman Fire Department report. The following were first responders for medical attention at this crash: Jeb Fischer Bozeman Fire Department Mark Criner Bozeman Fire Department (5 other Bozeman Fire Departmcot pc:sonnel) Aaron Shurtz AMR Holly Helstrom AMR Jason Whocler Central Valley Fire Tim Anderson Central Valley Fire Kevin Strickler Central Valley Fire On October 20, 2005, I received copies of all medical recoros for Daniel Abbott from Bozeman Deaconess Hospital. On October 20, 2005, I spoke briofly with Daniel Abbott and obtained his insuranco information. ). On October 24,2005, I intcrviewedjLobcrt Poublon. Poublon indicated he.was traveling southbound on N. 19th, about three cars behind the 2005 Chevrolet truck. Poublon said the southbound traffic was just starting to accelerate faster than 25 miles pel' hour. Poublon said he saw the northbound car (1984 Toyota) launch off the median onto its side, hit the 2005 tru.ck and slide mnthbound on N. 19th. Poublon said he tried to call 9-1-1, but the phone lines were jannned. On October 27,2005, I received a CD copy of all 9,..1-1 phone calls of this accident and all radio traffic during the time period of the accident. On November 1, 2005, I forwarded. an email to all Bozeman Police and Gallatin County employees present to complete a supplemental report of their involvement in this investigation. On November 2, 2005, I received the coroner report on Geoffrey David Cherry. On November 3, 2005, I forwarded a CD copy of all photographs to Trooper Jay Nelson, Montana Highway Patrol. On November 15, 2005, I spoke with Deputy Chief Dove and Deputy ChiofK.ent. Both indicated they were at tho accident scene, but did not conduct any investigation or speak: with any witnesses. Deputy Chief Dove said he took some additional photographs of the accident; which he bad already given to me. Deputy Chief Kent said he assisted with some traffic control. Page40fS 0.' 1"'"'" \'" , '.. On about November 18, 2005, I spoke with Cole Ingram. the father of Kayle. I explained to him the investigation and that we were still waiting on reports from the MHP and crime lab. On November 30, 2ooS, I received a copy of the MHP report. I spoke with Trooper Nelson and asked him to add a narrative explanation on the report, which he agreed to and is forthcoming. On December 1, 2005, I received facsimile copies of toxicology reports from the Montana Department of Forensic Science in Missoula, MT. I gave copies of these to Coroner McNabb. On December 1, 2005, I received the coroner report on Kayle Ingram from Deputy Coroner Roger Layton. On December S. 200S, I forwarded toxicology reports to Sergeant Mark: Johnson and asked he complete the fatality report. On December 6, 2005, I "met with Jn1i8nnaand Jim Cherry, the guMdi.ans for G. David Cherry. I explained the results of our investigation and the toxicology findings on David. I also explained the reasons for delays on completing the investigation and that it would be done shortly. This concludes my involvement in this investigation through December 7, 2005. ~ Lieutenant Rich McLane CC~\F~:)::~!T'Al THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. ).. ."/ Page 5 of5 r.: N\\~\.. REPORT OF IHVESTIGATIOH r.OlWl~fi~'ir~tA\J'; ~~\~~;~J:~Nl1. DATE: October 30, 2005 ~~~~'USE. \5 ~'(C~rlI:;9 .:,~ol-'n8rrEr SUBJECT: Fatal Motor Vehicle Acddent SlRICi\.. . REFER: Case #0510180013 VICTIM 1: Geoffrey David Cherry OOB: OLN: VICTIM 2: Kayle L. Ingram OOB: SSN: Unknown REPORTING OFFICER: Officer' Kaycee Anderson, 115 OET AILS OF COMPLAINT: On October 18, 2005 at approximately 1734 hours, my Communications Center dispatched me to an injury accident at 19th Ave and Burke St. While enroute, Communications informed us the Injuries sounded severe. Deputy Don Peterson arrived on scene before l:dld and said over the radio one of the persons Involved was DOA (dead on arrival), and the other was in critical condition. As I arrived on scene at approximately 1139 hours, rSeputy Peterson told me where to park and to try to avoid driving over the human debris between my patrol vehicle and the wrecked vehicle. OET AilS OF INVESTIGATION: I approached the vehicle and observed a body covered in a blanket (later identified as Geoffrey David Cherry), and I observed a male (later identified as Kayle l. Ingram) near the body. Ingram had a severed right arm and several people were providing medical attention to Ingram. I asked a witness if only one vehicle had been involved, and the witness said he had only observed the one vehicle as it was rolling over. The witness fdentified himself as Derek Tfsdel. There were several vehicles backed up in' the scene of the accident and I tried to get those vehicles to move along. I began to identify wftnesses of the accfdent. One of those witnesses was Steve Sparks. Sparks told me he observed the accident and was one of the first people on scene. Sparks told me the passenger car had hit a truck that was now stopped south of the location of the car. Sgt. Johnson had contacted the driver of the truck (identified as Daniel Abbott), and we requested medical attention fo~ Abbott from the medical ~rsonnel on scene. While I was With " \ -~ CONFIDENTIAL THIS IN~ORMAT/ON IS FOR LAW Sgt. Johnson, he informed me an arm was left on the fron~~~~g~ERrrOSES ONLY relayed that information to a fireman on scene. STAiLY Pl1 ,12 TO USE IS I photographed the scene, and at 1821 hours, I went to ~zeman~rto~~ss Hospital. Whfle I was at BDH, I requested a legal blood draw from Ingram to determine the presence of drugs or alcohol. Before Ingram was airlifted to Billings, a phlebotomist, James Knight, under the direction of Dr. Blend was able to get a blood sample from Ingram. The blood sample was taken at 1925 hours, and Knight immediately gave the sample to me. The blood sample was retained in my vehicle and by me until 2230 hours, at which time I placed the blood sample in Evidence. I contacted Abbott, and asked him about the accident. Abbott said he remembered seeing a vehicle come flying at him out of the corner of his eye. Abbott said the top of the car hit the side of his truck, and his truck then continued down the road. Abbott said he got out of the truck and sat on the curb, where Sgt. Johnson found him. Abbott said he was not wearing his seatbelt and had not consumed any alcohol before the collision. I did not have any indication that Abbott was under the influence of alcohol, but because of the seventy of the accident, I read the Implied Consent Advisory to Abbott. Abbott agreed to give blood and he agreed to complete a Medfcal Release Form. (For'complete interview, refer to Abbott's Interview). Knight took a blpod sample from Abbott at 2025 hours, and Knight immediately gave the blood sample to me. The sample remained in my vehicle and in my custody untfl2230 hours when I placed the blood sample in Evidence. Evidence Technician Tom Weightman later gave me copies of the Blood Analysis Request for both Ingram's and Abbott's blood samples, which were sent to the MT State Crime Lab for analysis. On October 19, 2005, I assisted Lt. Rich Mclane in interviewing witnesses of the accident. I contacted Peggy Lewis. We had received info~matfon from Lewis' son-in-law, Joe Johnson, thatlewfs told him she had seen some Idds playing uchicken" on N 19th Ave right before the accident. I asked Lewis what she had seen, and she said she had driven up N 19th Ave shortly before the accident, but had not seen anyone racing or playing uchicken." Lewis said she had no idea where Johnson had received information like that, but she said she did not tell him any such thing. I later contacted Johnson, and Johnson said Lewfs had told him that while she was Southbound on N 19th Ave, she met a couple of cars headed Northbound that caused her concern. This would have been a few minutes before the accident occurred. That same night, I assisted Lt. Mclane in interviewfng the juvenile witnesses who were traveling behind Cherry and Ingram at the time of the accident. Student Resource Officer Trent Schumacher had informed us that there were some rumors in the Bozeman High School about the juveniles all racing down N 19th Ave at the time of the accident. I interviewed Drew McDowell. McDowell said a group of them were headed to Cherry's house. McDowell said, he was driving his own car, and did not have any passengers. McDowell said Cherry and Ingram were in Cherry's car, and Brett Layman, Andrew Beland, and Richard (Ross) Ridenour were in Ridenour's truck. McDowell said that he was headed Northbound on 19th Ave, and was in the right lane ri "'.,,~ '" -, ',QONFIDENTIAL f~l~ INf=5MMAT/ON IS FOR LAW ENffiFtSEMENf~Q~ES ONL'f. when he stopped at the traffic signal at 19th Ave and B~fIW ~'fl4t\ ''M!EY IS was a couple cars back in the left lane. McDowell said hi1*jl\M~mftmto the left lane, and that was when Cherry had evfdently pulled Into the right lane and McDowell said Cherry just kind of "ripped by" in the right lane and was trying to get ahead of the group of vehicles in the left lane. McDowell said he didn't know how fast Cherry was going, other than to say "too fast," and that McDowell thought speeding was a factor. McDowell said Cherry merged too late, and McDowell thought Cherry had panicked and overcorrected, and then hit the median. McDowell said, to his knowledge, neither Cherry, Ridenour or McDowell were racing or playing any games. McDowell said they never race, and in addition, Ridenour was about 4 or 5 cars back from McDowell at the time of the accident. (For full interview, refer to McDowell's Interview). I also interviewed Brett Layman that night. Layman said he was In Ridenour's truck, and they were headed out to Cherry's house. Layman said they were back in traffic a ways and he did not actually see the accident or how it happened. Layman said he just recognized Cherry's car as they drove by the accident. Layman also said there was no racing or other type of games being played by the drivers. Layman said, "we've never raced before, and we weren't racing." Layman said he would tell us if they had been racing S9 Cherry's and Ingram's parents would know. (For full interview, refer to Layman's Interview). That same night, I interviewed Marianne Baumberger. Baumberger said she was also Northbound at the time of the accident. Baumberger said she had started in the right lane at 19th Ave and Baxter. Baumberger said she merged into the left lane, and another white car alsQ merged Into the left lane in front of her. Right after that, Baumberger said a reddish, maroon car (Cherry's car) came "just flying by" on the ./' ' right side. Baumberger said sfie was thinking that Cherry's car was just going to force its way in and was trying to get ahead of the vehicles In the left lane. Baumberger said she saw Cherry's car miss the orange pylons and miss a car in the left lane before veering to the left. Baumberger said Cherry's car then hit the cement median, hit a silver pickup, and continued north and landed on Its side. Baumberger said she pulled over to the side of the roadway, and tried to help direct traffic for a while. Baumberger said she also spoke with the people In the white car that Cherry's car had cut In front of. Baumberger said a police officer (Deputy Chief Lachapelle) came over and spoke with them. Baumberger estimated that she was going about 35 mph, and she said it didn't take very long for Cherry's car to go around her. Baumberger said she was unsure of the speed of Cherry's vehicle, but estimated the speed at about 45 - 50 mph. (For full interview, refer to Baumberger's Interview). This concludes my involvement In this investigation. END OF REPORT 1(~ c' --T'<.. f j -./" StlPPLBMBNTARY CONfioeNTIAl .iFtls INFt)~MATION IS FOR LAW RBPOR"ENF@~~EM;NT PURPOSES ONl'l AN~ YH^YfMO~iZEO USE IS stRlctL\" pf\C~H'1'TED. CASBz BPD * 0510180013 DATE O~ REPORTs November 2, 2005 REPORTING O~~ICBRs D. Peterson 636 DBTAILS O~ RBPORT ~ On October 18, 2005 at about 17:35 hours I was southbound on 19th street, croBsing the I-90 overpass when I was flagged down by a northbound vehicle. The female advised me of a vehicle on its side in front of Subway and she thought that one person was dead. I noticed the vehicle in the roadway and advised dispatch that I would be out investigating. I approached the vehicle, which was on its driver'S side and noticed two male passengers partially within it. Due to the inj urias of one male I detennined him to be expired and covered him with a blanket that was wi thin the car. The other male was unconscious but still had a pulse and was breathing but seemed to be somewhat obstructed. One male approached and advised that he was an EMT and asked if he could help. I advised him that he could and he retrieved a bag and attempted to clear the airway and give the victim medical attention. A passerby pointed out to me that there was a second vehicle that was involved just south of my location. As Officer 115 was arriving from the s9uth I instructed her to stop near the second vehicle that was involved and block the scene so that vehicles would Rot disturb it. ./ Fire and Medical units began to arrive and I attempted to direct them to the scene and around traffic. As medical units began to work on the patient, a passerby approached me and pointed to a group of juveniles and stated that they were following the involved passenger car. I approached the males and questioned if the new anything of the incident. They stated that they did and went to school with the two males within the passenger car. As I began to get information from them, more Bozeman Officers arrived and began to speak with them as well. At about the same time I was requested to clear the scene as 800n as possible to respond to county calls that were backing up. I advised Officer Schumacher that I had to clear and that I had not gotten any names or addresses from the juveniles. I then cleared the scene and did not return. End Report. ~D. peter.on.636 ~~~,~ - ,- .~ -\ ....-,;/ , " DATE: GONFiDE,'iTIAL REPORT OF INVESTIGATIT~ INf=t1FiMA TION IS FOR LAW 11-14-0S $N~~@eMeNr PURPOSES ONL'f. ANf UN~\.Jtl=-KmIZEO USE IS Snll€tL y P?l'Ot1'~TEO, SUBJECT: Fatal Vehicle Accident REFERENCE: PROS1018-OO13 REPORTING: Detective Trent Schumacher DETAILS OF INVESTIGATION: On October 18, 200s at approximately 5:30pm I was working at the Law and Justice Center preparing to leave for my residence. At 5:34pm Dispatch advised there was a vehicle accident on 19t1a street. Radio traffic by omcers arriving at the scene indicated the possibility of injuries or fatalities.. Sgt. Colt Schumacher and I went to the location to assist with the Investigation. Sgt. Schumacher and I arrived at the 2800 block ofN. 19th at 5:42pm. I spoke with Sgt. Mark Johnson and advised him I would start taking df&ital photos of the scene. I photographed the involved vehicles as weD as the debris areas and impact points. The vehicles Involved were a silver Chevy picknp and Maroon Toyota Celies. I observed the passenger of the pickup receiving medical treatment oear IUs vehicle. Schumacher advised me that the driver and passenger of the Toyota were believed to be high school students by witnesses he had spoken with. The driver of the Toyota had suft'end severe head trauma and was dead at the scene. :ne passenger was tnuuported by ambulance to Bozeman Deaconess HospitaL I checked the wanet of the driver and Identified him as Geoffrey David Cherry by his drlver'l ~ Calls to the hospital and ltitbais iIlfonnadon confirmed the passenger from the Toyota to be Kayle Ingram. After photographing the scene I contacted HIgh School Principal Godfrey Saunders and advised him that two High School students were involved in the accident. I informed. Saunders of their identities to reduce any confusion since several students were at the ,cene and word of the accident was passing quickly by cen phone. I spoke with Sgt. Johnson aDd Deputy Chief Lachapelle about what needed to be done nert. They..bel me to go to Bozeman Deaconeu Hospital with medical release forms and usut OMcer Kaycee Anderson. Andenon had gone to the hospital when Ingram had been transported from the location. On October 18, 2005 at 8:03pm I arrived at Bozeman Deaconess Hospital I provided medical release fol'JlUl to Aadenon. I spoke with. Jaclde Inp'am (Kale Ingrul's mother) and eIplained the circum8tances of the accident. She thanked me for the information and left for Billings where Kale was being Down to by air ambulance. I left the hospitalat"9:39 pm. This ended my involvement in the inveltigation~ T~ent SchumaChe:/. / . _{ ~~ 1 , 0--' ,~J CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. PHOTO LOG ANY UNAUTHORIZED USE IS BOZEMAN POllCE DEPARTMI!ImICTLY PROHIBITED. \ i , .......~." Pollce Report:0510184)013: Date: 11-14-05 Subject: Fatal Vehicle Accident Location: 2800 North 19th Time of Photos: 1743-1920 Camera: Olympus C-740 ~enae:l:2.8-3.7 Film: Digital Format" Flash: X Fstop: Auto Frame # 1. 149C 2 149D 3 149E 4 149F 5 149G 6 149H Daylight:X Nipt: X Other: Shutter Speed:Auto Number of Photos: 51 Descriotion Bv: . Driver of struck silver pickup - Daniel B. Abbott 149 Facing N/B-struck Silver Chevy tnlck in SIB 149 Outside lane. ). Facing NIB-Debris trail to Toyota Celica Location 149 ./ r Facing NIB-location of 1984 Toyota Celica from 149 pickup location Facing NIB-Toyota Celica from estimAted 149 impact point Facing NIB-Location and Position of Toyota Celica 149 7 1491 Treatment/transport prep of Kayle Ingram 149 8 149J Facing FJBwLocationIPosition of Toyota Celica 149 9 149K Facing S/BwLocationIPosi1ion of Toyota Celica, 149 10 149N Facing FJB-Damage to undercarriage of Toyota 149 Celica .----- , , , '"_,,ICONFIDENTIAL !" ll.:r..,~..,.... THIS INFORMATION IS FOR lAW ENFORCEMENT PURPOSES ONLY. 11 149M Facing EIB- Treatment/transport OfKa~}h~UTIM!RIZED USE IS SiRI TLY PROHIBITED. 12 149Q Facing NIB-Impact point on median by Toyota 149 Celiea. 13 149P Skid mark of Toyota Celica from median to 149 impact point 14 149U Front let\: passenger compartment area of Chevy 149 pickup 15 149T . Dash board of pickup - severed hand from Ingram 149 16 149X Pacing SIB - Driver's side of Chevy pickup 149 17 149W Pacing W IB-Close up - damaged side of Chevy 149 truck 18 149AA Pacing SIB-medical treatment of Chevy 1ruck 149 driver Daniel Abbott. 19 149Z Facing NIB..cloBe-Up of passenger side of Chevy 149 truck 20 149AC Pacing W/B..close-up of underside of Toyota Celica 149 ).- 21 149AE Pacing SfB..close-up of oil pan of Toyota Ce~ca 149 ./ 22 149AD Same as above. 149 23 149AH Close-up of severed hand on Chevy trock dashboard149 24 149AG Dashboard and steering column of Chevy truck 149 25 149AL Pacing FiB-passenger compartment of Toyota 149 Celica 26 149AK Pacing N/B..close-up of Toyota Celica top under 149 Chevy truck UP tire 27 149AO Facing FiB-passenger and rear compartment of 149 Toyota Colica 28 149AN Same as above - no flash 149 29 149AR Foot/Leg position of driver of Toyota. 149 ~. "~~ON PI OShlTjAL ,-- THIS INFOAMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. Celiea (Cherry). ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED, 30 149AQ Facing NIB-position of driver of Toyota Celiea 149 31 149AV Facing E/B-rear passenger compartment of Chevy truck 149 32 149AU Facing NIB-drivers area of Toyota Celica 149 33 149A Facing N/B-position/location of Chevy truck 149 34 149AX Dashboard close-up of Chevy truck 149 35 149AY Close-up ofairbag and floorboard of Chevy truck 149 36 149B Facing NIB-front of Chevy truck 149 37 149AW Passenger compartment area of Chevy Truck 149 38 149AT Foot po,sition of Cherry in Toyota Coliea 149 39 149AS ,Position of Cherry in Toyota Celiea - note photo 149 is rotated counterclockwise. Bottom of photo is to the left. 40 149AP Facing FiB-position of Cherry prior to removal from 149 veJUcle 41 149AM Facing N7B-passenger and engine compmtment ef 1~9 Toyota Celica 42 149AJ Close-up of Toyota Celica top under front end of 149 Chevy truck. 43 149AI Facing W IB-wing window area and windshield 149 of Chevy truck. Rotated 90 clockwise 44 149AF Facing SIB-from approximate Celiea location to location 149 of Chevy truck. Rotated 90 clockwise. 45 149AB Facing N/B--close-up of Toyota Celica rear-end 149 46 149Y Facing SIB-right rear and side of Chevy truck. 149 4T 149V Facing West-profile of Chevy truck. 149 48 1498 Close-up of driver's airbag in Chevy tmck. 149 49 50 51 149R 1490 149L f~-'j f\.....__ ~ r \ \-...,......... Chevy truck passenger compartment thru driver's window. 149 Facing NIB-passenger area of Toyota Celica 149 Treatment/transport of Ingram 149 CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL~ ANY UNAUTHORIZED USE IS SmlCTLY PROHIBITED. ).. ../ 1:. Date: Subject: Refer: Driver 1: DOB: Passenger: DOB: Driver 2: DOB: SQ))plemental Report 11/2/05 Fatal Crash., North 19"'/Burke 0510180013 _frey David . illiiliyle L Abbott, Daniel Beryl Reporting Officer: Colton Schumacher DETAILS OF COMPLAINT: crash. Officer.> responded to the lltea of North 19'" and Burke for a .teport of a traffic DETAILS OF INVESTIGATION: On 10/18/2005 at approximately 1735 hours, Detective Trent Schwnacher and I were leaving the Law and Justice Center after completing our shift when we overheard a report of a possible fatality crash on North 191h neu the inreuection of Burke. Detective Schumacher and I immediately realized that the combination of the location and the fact that it was the peak of the rush hour traffic would tmke it imperative that we respond to assist the officers on the scene. Deputy Chief Lachapelle, Deputy Chief Dove responded ahead of Detective Schumacher and myself in separate vehicles. Upon our arrival of the scene, I began an initial walk through of the scene to determine what resources we had available. As I walked north on 19d1 through the scene, Deputy Chief Lachapelle shouted to me and gestured to a group of juveniles that were standing near the parking lot in front of Radio Shack adjacent to the crash scene. Deputy Chief Lachapelle told me that the juvenile were witnesses and that we needed to contact them. I approached the group of boys and I noticed that Deputy Peterson of the Gallatin County Sheriffs Department was already talking to them. The first male that I contacted was identified as Richard Ridenour. Ridenour told me that he was driving his trock: north on 19d1 behind the T oyata. Ridenour advised me that he did not see the actual crash. The ~ ~~.l\. second male that I contacted was identified as Brett Layman, DOB 11/13/1987. Layman told me that he was riding in the back seat of the trUck driven by Richard Ridenour. Layman told me that they were coming from the high school Layman told me that he did not see the actual collision but he did see the pickup that was involved and saw the Toyota was tipped over. Layman told me that he was friends with the driver of the Toyota and he identified the driver as David Cherry. I then interviewed Drew McDowell who was driving his own vehicle north on 19lh behind the Toyota that was involved. in the crash. McDowell told me that he was traveling north on 19lh coming from the high school parking lot and had merged into the left lane with traffic when the Toyota involved in the crash passed by him on the right going "too fast". McDowell told me that he observed the Toyota merge to the left, strike the curb, flip McDowell told me that the driver of the Toyota was a friend of his named David Cherry. -McDowell told me that the passenger of the Toyota was a male named Kayle (he did not know a last name). The conversation with McDowell and part of the conversation with Layman was digiWly recorded with my pocket recorder. I advised McDowell and Ridenour to go to their vehicles and stay warm and that I would returo to talk to them some more later. I then contacted Chaplain Heibert of the Gallatin County Sheriffs Department and directed him to where McDowell, Layman and Ridenour were located so that he could talk to them. At approximat~ly 1911 hours, Officer Pankratz and I cleared the scene and were available for calls. This .concludes my involvement in the inves' cion. ~~ Serg... Colton Sch1Qll8Qker CONf\Oe..\lTIAL "nUl tN~OAMA ilON IS FOR LAW ENt!OJ'\C!M!NT PURPOSES ONL" ANV UNAUTHOR\ZED USE IS sf~\etl\f fl~OH'8lTEO. ____AJ""'""&<l ;~ N."i9"~A';;':;.='lS~"'n ~~@,(-f~(. Herbert C. Hothan (Driver) . 153 Pathfinder Trail Bozeman MT ooB:_ Phone~34bm (406) 522-6237 wk WITNESSES: Hothan Vehicle: Mf - ACI473 I~ith (Judy) Franzak (Passenger with Hothan) . 153 Pathfinder Trail Bozeman MT 59718 DOB:_ Phone: ~0634inn M~e Evelyn Baumberger (Driver) 1013 Silverbow Avenue Belgrado-MT 59714 DOB:_ Phone:~1263 inn (406) 522-2549 wk Baumberger Vehicle: Mf -6A75807 REPORTING OFFICER: Mark Lachapelle, Deputy Chief -..,."-':f"'1I"'I, .A. ....... CI_ DATE: CCQNEt~ij'N"A~L BOZEMAN POLICE DEPARTME~19"l'Q8(3~fJi1~"f~fS ~R~\i\f'.~ SUPPLEMENTAL REPORT ENl!t.jAOe~t4u~~8S~~J~. AN~NDN~U~~~~EOs~~S IS Friday, November 11, 2005 ST$~l:."t~~f1~~tfED INCIDENT: North 19t1a Ave I Barke Street FataUty Accident REFERENCE: 0510180013 DRIVER(S): GEOFFREY DAVID CHERRY DOB:_ DANIEL BERYL ABBOTI' D08: REPORTING OFFICER: Officer Adam Pankratz , . DETAILS OF INVESTIGATlON: On October 18,2005 I was assigned patrol duties in a marlced patrol car in the City of Bozeman. At approximately 1734 hours patrol was informed of an injury accident at North 19th Ave and Burke Street. Initially, Sgt. Johnson, Officer Anderson and I responded to the scene. Upon arriving at the scene I observed a passenger car to be on its side and blocking the southbound lane of North 19th Avejust south of Burke Street. I obsetVed Sgt. Johnson and Officer Anderson to be on'icenc dealing with those in.....olved in the crash. lobserved members of the Bozeman Fire Department to be attending to the injured people involved in the crash. I realized the southbound lane ofNortb. 19th Ave needed to be shutdown and traffic diverted to protect persoIUlel on scene and the evidence relating to the crash. I placed my patrol vehicle at the intersection of North 19th Ave and Burke Street at an angle to block all southbound traffic. All emergency lights were activated.. I then began to divert southbound traffic on North 19th Ave, west onto Burke Street. I continued to do so until approximately 2030 hours when I was replaced by Deputy Chief Kent. I then cleared from the scene with Sgt Schumacher and began answering calls for service unrelated to the crash. END OF RE ~ Page 1 of 1 - Supplemental Report BPD Officer Pankratz 8r'-". .. :t:--'" STATE OF MONTANA DIVISION O!!~~~~C SCIE-NCECCJ.:aN'Fl1J6NmAL ....-.~~ Street nll:llSN~OOMM<<\I)NSlS=<B1ID13tlWN MiuouIa. --- ......... (406) 728-4970 Ett~~WsfNWlffiWRB6SESl9NlY. UllHSlBIiIEDJOOeslS Y 'f?AOOJESHED. CORONER'S REPORT FORM SUBMITTING AGENCY: Gallatin Co Coroaer COUNTY CORONER'S omCE County: Gallatin CoronerlDeputy: Layton DECEDENT (Full Given Name): Geoffrey David Cberry Addr~ag Star Laae 8ozetaaIl, Mt. 59718 D.O.B.: ~ Gender. Male Race: WhIte OccupatIon: Stadellt . OATE & TIME LAST SEEN ALIVE 0; OR IF KNOWN DATE & TIME OF DEATH [81: 10-.18-05 1715 bra. DATE & TIME FOUND IF TIME OF DEATH UNKNOWN: PlACE OF DEATH: 2900 North 19- Street Bcn;MU... Mt. 59715 IF DEATH IN HOSPITAl, DATE & TIME ADMITTED: Dr.'a NaTle: AUTOPSY? NO IF YES. BY DR. TOXiCOlOGY SPECIMENS TAKEN? YES IF YES. CHECK WHICH: 181 Blood D VItreous [8J Urine ANGERPRINTS TAKEN? NO PHOTOGRAPHS TAKEN? YES IF YES: [81 Scene 0 Autopsy DEATH CERTlACATE (D.C.) CERTIFIED BY: [8J CoronerIOeputy Ropr IL Laytoa. OR 0 Dr. CAUSE OF DEATH (As appears on D.C.): D Pending OR ~pIe bIwrt force InjOOes OR ~~~..n"--"{ ~ f OF DEATH (As appears on D.C.): ACCIDENT DETAILS SURROUNDING DEATH (Desatle beloW. It applicable, pleaIo Include pat medical hiItofy,l.e. heart disease. hypertenlllon. dlabetu. alcohol abl.lM; 88lzurn. etc..nd oumIf1tlMdk:atlona.): D REPORT ATTACHED Received . ~ 6'om Oallatin County Sheritrs Dispatch to nlIpOIId to ~ above wtKn . JUUII& n1aIo - dcIoeated. lbo ftlIIIlt ofanMVA. Amved OIl _ @ appt'Ox. 1820 hm. Multiple Bomman PO, Bcwman Firo. OaI\atiIl.Comty Sheriff's Deputiea _ MHP Oftlocq ~ on..:ene. Deputy Chief Mark Lachapelle. 132, advilcd dallbo crab involvod. two vWDoloI. 1\e vcbioIo occupied by the decedeDt was traveling IlOrthbotmd when it au.... IIIe modi... bland at . blah lip-'. _Itnd:... CDlOmia& wIdcIe. Thln_ two oocupana of the northbound vehicle md OOCI oa:upmt orllle toUlhbomd YdaIoIa.. TbCI..-cer In the ~I vcbilllllWII tmuported to 8oJ:emaD [)eaooneQ with severe lqjuries. Jbo opentor ofebe IOOCbbouod vdiieio '0\'11 abet b.64tpOdIlld to 8<nmnaa De.loDCII with appateDt minor- injuries. lobI<<vCld . )'OUIII male lyiDa flee down in the raJIIhq ofthc vdaicIe. Hill lop W~ still in lbe clrtWl["I ~ \lDdcmlIIdl the IlCrJClrinI wheIl. 1bml WlIll obvioul RVere trauma to bls oppel" bocIJ: 'Ibml wat ex.poIlld bctuIa of the 11Ift ann_ band. ~ _ . manivo defect to the upper left ~ quadraat ofbis skull Tho body __ wanu to the tooda with 110 evicleoce of riaor- or dqJeodeot lividity pl'ClClDl He _ dmo5Cd in . toil ahirt. jeans, aocb md lIboeI. Wich the uslItmce of Bor.cman PIre the body -.va remowd tbr" er.aport by Coroncfll van to PUDCAI and Crcmatioo 0aUcry at lho nqueat oCtile family. Upon arrival at the tuner.l boDUlldditional pbotograpbll were bbu aDd fluids ~ col~ for IIilllliaion to tile CriGas Lab i.a. MilIIoula fOl'toxiooloey analysis. The flunlly _ oonW:md by friends of the decedent Additiooal details of the aecldcnt Ir'C included In the Bozmnan PO RIpOff. A copy Is included in tho file. l'ORII DF82 (CompuIw Format 05101) . CORONER DI81'RIW11ON: c- I saw Medk:III eu...IrW I County AUonMy Signature: "--L,~..u"~"'!I~' .(~- \' STATE OF MONTANA < ; DIVISrON O!!2~~~~f SCIE~NCECONFIDENTIAL MIuouIa,MonbI="9~8trMt (4CNI)728-4I70 THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. AUTHORIZED USE IS PROHIBITED. ,-r-:-.., CORONER'S REPORT FORM SUBMITTING AGENCY: Gallatin Co Coroner COUNTY CORONER'S OFFICE County: Gallatin CoronerlDeputy: Layton DECEDENT (Full Given Name): Kayle Iqram Address: D.O.B.: Gender: Mal. Raclt: WhIte Occupation: StudeDt . DATE & TIME LAST SEEN ALIVE 0; OR IF KNOWN DATE & TIME OF DEATH [gI: 10--18-05 1039 hra. DATE & TIME FOUND IF TIME OF DEATH UNKNOWN: PLACE OF DEATH: We Fllcht heUcopter @ approximately BI& TImber Mt. IF DEATH IN HOSPITAL, DATE & TIME ADMITTED: Dr.'a Name: AUTOPSY? NO IF YES, BY DR. TOXICOLOGY SPECIMENS TAKEN7 NO IF YES, CHECK WHICH: 0 Blood 0 VItreous 0 Urtne FINGERPRINTS TAKEN? NO PHOTOGRAPHS TAKEN? NO IF YES: 0 Scene 0 Autopsy DEATH CERTIFICATE (D.C.) CERTIFIED BY: [gI CoronerlDeputy Roaer H. Laytoll OR 0 Dr. I CAUSE OF DEATH (As appears on D.C.): 0 Pending OR Multiple blunt force Injuries OR ~~~.../" .-{ DMadl1 OF DEATH (As appeenl on D.C.): ACCIDENT DETAILS SURROUNDING DEATH (Descrlbe boIow. If applicable. plaase Include past medlcaI history; I.e. heart disease. hypertenllion. diabetes, alc0hoi abuse: .lzure., etc. and current lTl8ClIcllIdona.): 0 REPORT ATTACHED Received a mJ.ueIt from Gallatln County Sheriff'. DlipItch to oontaet Deputy Steve c-. CoroJMi". otBoe. Yello'oVlttnMl County. He advised tIW the pasengec from the MV A earlier in the eveom., hid died In fliabt to BilIiD.p.. tMUll ofhijurilll auataioed in the aooidmt. The decedtot had been cmatcd at the lICCIDe. tnD8pOrkd to Bozeman DeaooDCIII and aubIeqacntly lJ1b-FUaht trusport to BillliD8I. See dcWilI in C8ICl O~ 1018. CbCIlTy. Oeofti'ey David. Following diecuasion with Deputy Conlon and staff at S~\rincmtl Hoapi:tal, the body wu reIcucd to Frlmzal Cavil Funeral HOlM In Uvin&Jton, Mt. I"OItM OF8a (Compuw Pormat 0Ml1) . CORONER DI8TRJaUT1ON: Coranw I ,.... MedIcal bwnIner I County Attorney ./ Signature: '~~~ ..-..... .,. .. ;::~~~~ .. .-.-.... P~Uent BU9lnusl'l Servl~ (800) 711~2703 ~"' II IfCaIoW P\1'~'rPNI. ~.~'l!llBPOR' M'I IlIl:MJ ~.'IIlIC~1 11'. 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'"'NAI1MGMr, ,~.!.-.__.. -..,....--' ..._--~_.- . :,,) (I' /',1 ':It.', ~~;' ,r. f~ \. ~ \~. \ , ~ ',' !.~ ,\ i;'~" 15;, ;~~:. ~r', "I' ,1./ " ':\;J~I~ '.':'\:. . ;\ WI nl! r~11 ~,~~ l".NI^/1'r Pldl''''/,! Pll'1I( I-1OlIPITfIl OOP'Y OTRNIl. 1~ "" '.........-...-.. ,. ...~.... ~~_",.u __ .-...,-_ "_ii~ ....f_...t...Iwo.~. '\I..'........,.Ii!fI,,~. 'l Incident Repo 2005~01686 -000 Alarm Date and Time Arrival Time Controlled Date and Time Last Unit Cleared Date and Time Response Time Priority Response Fire Department Station Incident Type Initial Dispatch Code Aid Given or Received Alarms Action Taken 1 Casualties EMS Provided Apparatus. Suppression Personnel - Suppression Personnel Fire Service Injwies Property Use Location Type Address City, State Zip Latitude Longitude BozomanIC~IDENTIAL THIS INFORMATION IS FOR lAW ENFORCEMENT PURPOSES ONLY. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED, Batie 17:33:45 Tuesday, Octobor 18,2005 17:42:09 23:10:59 Tuesday, Octobor 18,2005 0:08:24 Yes 1 312 - Vehicle accident with injwies MVA N - None 1 32 ~ Provide basic life support (BLS) Yes Yes 2 7 1 963 - Street or road in commercial area Intersection On N 19m AVE at BURKE ST BOZEMAN, Mf 59715 49.490048 506.184816 EMS Patient Last Name First Name Street Address ).. Person Involved - Cherry, Geoffrey Yes ./ Cherry Geoffi'ey 259 Evening Star EMS Patient Last Name First Name Street Address "P.O. Box City, State Zip Person Iawlved - IllIram, Kayle Yes Ingram Kayle 310 Livingston Location Type Service Type AreaTypo Mass Casualty Incident ID of First Unit on Scene Number ofPationts This Incident Response Mode to Scene EMS Scene Street or Highway Unknown Urban Multiple Patient Incident BOZE2 2 Emergency Page: 1 Printed: 1012012005 12:37:44 'I Incident Repo{ 2005-0001886 .000 First Name Last Name Street Address Gender Pate of Birth Age Race Ethnicity Provider Impression / Assessment Cause of Illness/Iqjury Injury Intent Severity of Injury Transporting Unit Chief Complaint Code Code ofVchicle Patient Involved In Code of Vehicle Patient Involved With Location of Patient RE: Vehicle Restraint Used Path ofEjcction Condition of Steering Wheel Condition of Windshield Driver Name Driver Address Bozeman I Department '. CONfiDENTIAL THIS INFORMATION IS FOR LA~ ENFORCEMENT PURPOSES ON~ . R\ZED USE IS STRICTLY PROHI!3\TE . EMS Patient - Cherry, Geotrrey Geoffrey Cherry 259 Evening Star 1 - Male November 21, 1987 17 1 - White o - Non Hispanic or Latino 28 - Obvious death 29 - Motor vehicle accident Unknown Full Arrest R99 Motor Vehicle Car Truck/Bus DriVel; Unknown Other Compressed Other Cheny, Geoffrey 259 Evening Star Assessment - Obviou:l Death Assessment - Bleeding EMS Patient - Cherry, Geofli'ey Assessment Traum.~ Brain Severe Symptom 1 Symptom 2 EMS Patient - Cherry, Geoffrey Symptoms UnrcsponsivrlUnconscious Traumatic Injury Triage Criteria 1 EMS Patient - Cherry, Geofli'ey Triage Criteria Death same MV Injured Body Site 1 Injury Type 1 17:45:00 - Assessment Only Provider Success Charge EMS Patient - CIIerry, (Jeoff'ffy 1..,."- Head/Scalp. Medial FX/Open, Incapaciting; 3rd Degree or Higher fur Burns EMS Patient - Cherry, Geoft'rey Flow Chart Attempts "" 1; Quantity -; Size -; Checked pulse of MV A victim 126 - FISCHER, JEB S Yes $0.00 Narrative Name Narrative Type EMS Patient - Cherry, Geoft'rey Narrative Cherry MV A EMS Page: 2 Printed: 10/2012005 12:37:44 ... Incident Repo( 2005-0001686 -000 Bozeman I 'neeeNFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY.: ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED, Narrative Date Author Author Rank Author Assignment Namtive Text EMS Patient ~ Cherry, Geoffrey Narradve 06:33:31 Wednesday, October 19,2005 120 - CRINER, MARK A AC 1 Report of an MY A with injmics. One victim was pronOlmced OOA. Firefighters assisted ambulance personnel with the other victim in loading and transport to the hospital. >- ./ Page: 3 Printed: 10/2012005 12:37:44 , ~,--:--' T- Incident Repot 2005-0001686 ..000 First Name Last Name Street Address P.O. Box City, State Zip Gender Race Ethnicity Provider Impression I Assessment Cause of mneullnjury Il\iury Intent Severity ofInjury Transporting Unit Chief Complaint Code Time to Extract Code ofVchicle Patient Involved In Code ofVchicle Patient Involved With Location of Patient RE: Vehicle Restraint Used Patient Was Ejected From Vehicle Path ofEjcction Condition of Steering Whccl Condition of Windshield Driver Name Driver Address Assessment - Bleeding Bozeman I EMS Padent . lnanm, Kayle Kayle Ingram 310 Livingston I - Male I - White o - Non Hispanic or Latino 38 - Trawna 29 - Motor vehicle accident Unknown Urgent AMRl Motor Vehicle 10 Car Truck/Bus Front Unknown Yes Other Compressed Other Cherry, Geoffrey " 259 Evening Star EMSP;'dent - (Biram, Kayle Aaessmeat Severe -'~ent ' CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. ANY UNAUTHORIZED USE I , EO, Symptom 1 EMS Padent - Ingram, Kayle Symptoms Traumatic Injury Triage Criteria 1 Injured Body Site 1 Injury Type 1 Injured Body Site 2 Injury Type 2 17:43:00 - Assessment Only Provider Charge EMS Patient - Ingram, Kayle Trial" Criteria MV Speed 40+ MPH EMS 'a.ot - {ncn.... ~yIt Injllri. Head/Scalp, Medial Penetrating, Jocapacitins; 3rd.Degree or Higher tOr aurns Fore Ann, Right Amputation, Non-Incapacitating; 2nd Degree for Burns EMS Patleat - (BIram, Kayle F1ow. Cbart Attempts '"" 1; Quantity ""; Size -; Provided assistance to ambulance crew 126 - FISCHER, JEB S $0.00 Narrative Name EMS Padent .. (agnm, Kayle Narrative Ingram MV A Page: 4 Printed: 10120/2005 12:37:44 '\. Incident Repo( 2005..0001686 -000 .,.... Bozeman 1 ~Department Narrative Type Narrative Date Author Author Rank Author Assignment Narrative Text EMS Padent - Ingram, Kayle Narrative EMS 06:55:00 Wednesday, October 19,2005 120 - CRINER. MARK A AC 1 Report of an MV A with injuries. One victim was pronounced DCA. Firefighters assisted ambulance personnel with patient care, loading and transport to the hospital. CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL'f. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. >" ./ Page: 5 Printed: 10/20/2005 12:37:44 ~ Incident Repo, 2005..0001686 ..000 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatus Clear Date and Time Apparatus priority response Number of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 Personnel 4 Bozeman 1 Department Apparatus - BOZE2 BOZE2 0:04:17 17:37:51 17:37:52 17:42:09 23:10:59 Yes 4 1 11 - Engine 115 - BUSHNELL, KURTIS E Position: CAPT 126 - FISCHER. JEB S Position: FF 0529 - KOLMAN, JASON Position: FF 2942 - DUBAY, CHRIS Position: FF Tuesday, October 18,2005 Tuesday, October 18,2005 Tuesday, October 18,2005 Tuesday, October 18,2005 Apparatus ID Response Time Apparatus Dispatch Date and Time En route to scene date and time Apparatus Arrival Date and Time Apparatua Clear Date and Time Apparatus priority response Nwnber of People Apparatus Use Apparatus Type Personnel 1 Personnel 2 Personnel 3 Apparatus - DOZEI BOZE 1 0:36:30 17:37:52 18:19:05 '> 11:42:35 18:39~J.. Yes 3 1 11 - Engine 117 - JOHNSON, GRAVER Position: AC 136 - BARTON, TRAVIS W Position: FF 5537 - MUMMEY, CODY PCliSition: FF Tuesday, October 18,2005 Tuesday,Octo~18,2oo5 Tuesday, October 18, 2005 Tu<<$day, 0ct0tJer 18,2i05 Reported By Officer In Charge Reviewer Authority 115 - BUSHNELL, KURTIS E 06:56:34 Wednesday, October 19,2005 115 - BUSHNELL. KURTIS E 06:56:38 Wednesday, October 19,2005 103 - WINN, CHUCK C 12:22:23 Thursday, October 20, 2005 Narratives Narrative Name Narrative Typo Cherry MV A Incident Page: 6 Printed: 10/2012005 12:37:44 . . Narrative Date Author Author Rank Author Assignment Narrative Text Narrative Name Narrative Type Narrative Date Author Author Rank Author Assignment Narrative Text ,;fr-_" Incident Repo~ 2005-0001688 -000 Bozeman If ):>cpartmcnt CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. S IS Narratives 06:44:06 Wednesday, October 19,2005 120 - CRINER, MARK A AC 1 Report of an MV A with injwics. One victim was pronOWlced OOA. Firefighters assisted ambulance personnel with patient care, loading and transport to the hospital. New Narrative Incident 12:35:09 Thursday, Ootobcr 20,2005 103 - WINN, CHUCK C CHIEF 7 At 1733 hours on Tuesday October 18, 2005 we were dispatched to a vehicle accident with itijuries. Two units were assisned to this incident. Seven personnel responded. We arrived on scene at 1742 hours and cleared at 2310 hours. The incident occurred at On N 19TH AVE at BURKE ST, BOZEMAN. The local station is 1. The general description of this property is street or road in commercial area. The primary task(s) performed at the scene by responding personnel was to provide basic life support (BLS). No mutual/automatic aid was given or received. A special resource was called to staff Bozeman Engine 3. Engine 2 and Engine 3 remained on scene to provide lighting and scene control during MHP's accident reconstruction and investigation iwo patients were involved with this incident. One fire service casualty was associated with ~!J..incident. Alarm nwnber 0001686 has been assigned to this incident. End ofRcport Page: 7 Printed: 10/20/2005 12:37:44 !trY! rz 1. 'CRt:i ro () <Sh tAr+:e- I1oI/.er J-f dsfro yV7 Tra YlS{XJ rt-.f!(/ ra- ~ (e 4 ra rY7 , , , , '- CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONLY. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED - _. T3r;/h1ZMG!e VPD: TaSir>1 wh~~/.!r 0rY1 I/-rvllAS 071 ~fllll SfriC ~e1 TrJ< ftSp<>rl2d )y. YI rrbboff. 3o~Y1 F6 l1s96sed boA oY1 S(lULR ).. ./ ... @ ~ .~t..J<:' >1 i A~'TE 5.8~-33.36 I--~oo- ?'1~--1J;J.O ,Alkv-- &; ;;;""4/4 I . CONf\DENTlAL tM~~6~~~~~~R~: ~~ ;~V UN~LJTHOA\ZED USE'S Sit\\CTl'f' ?ROH\BIiEO. .' 1 " I. , ,i \ j ;/ MONTANA AUTOMOBILE INSURANCE IDENTIFICATION CARD (STATEI " COMPANY N"~.R"R COMPANY PROP & CASUALTY INS CO OF HTFD. POLICY NUMBER EffECTIVE DATE EXPIRATION DATE 55 PHJ514375-264401 04-28-05 04-28-06 YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER 1984 TOYOT CELICA GT JT2RA64C5E6229220 INSURED rCHERRy,GEOFFREY CHERRY 259 EVENING STAR LN LBOZEMAN & JA MT 59715 SEE IMPORTANT NOTICE ON REVERSE SIDE . ( 5~~i3~ ~fX)$ ~t( ~ o/fJ~ / tJS' '1 ? f)IIRE TO RESIST DRUGs" AND VIOLENCE. v-e~,~. Jt- M, 1 . {' I'P' },tJ''^'tA,J~ CONFIDE.\JTiAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL'{. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. PLATE 6 p,9 162 1 Ot\ TE OS 162005 F617 !:.~S,8 1"'10"ITAt'.I~\ VEHICLE REGI:3TRATION AND PAYMENT RECEIPT TAXES PAID THROUGH 04302006 VALID THROUGH 05312006 T'.....F' \IF' tVlAI/E 1-.100L ST{L COLon VII\I PC '19F::4 TUfT (";:)1' 2Cl Ml:..F<: .J1'2Rl~64C5E6229220 1'TL 0/-\86 18 1 S:LDT 03192005 TI'-.'TRC G(::t,1J /tvlGVW 000000 PL T 1 G A9 16:: 1 Tyr' PC B(~l< NOOO SJ:.)E:C TAB 06X04597 1 F'UEL TYPE 1 EOUIP NO UNLADEN WG1' 0:';000 TON 000 CI-iERFN ~ GETJFFRE....t . DI~VID CHEF-<:RV . .jAr'IIE:::. . EDWARD 259 EVENING :3T ";~R LANE J;:,02EMAN MT !-:;.97''15 \. ~'FEE INFORMATION: .-------'-----------------'-~--------------'-- 32 TTLS~TT 5.00 94 TTLTEC' 5.00 2,1-\ Lr\/I"\TT 2.00 12 VETFEE 0.50 13 TRNFEE 0.25 61 REGRAT 6.00 14 COOPT ;2 . \3(') 70 NE\lvI'3:::: 5.00 84 L TI-1\1PI< 4.00 87 HVYREG 2~~ .00 ....COUNTV INFOF:\Y1A TION : ,__.__.h.__~_.__________r_-------_:--..,.----------- T(.l,)(W:..L 500.00 (:0 06 SCH 7R--03 0$8 PROF';T, 00 FEE hl \lEHVAL 8799..00 -IY1ILL 00000 pee Tr;;:EAS DEP 10 CALC\I.o,L t~SSo DATE 05162005 ASSD [-;,\' UI'.!L,t~WF:-I.JL TO uf:'t:~:F<_,'J1 TE Vl:::,H Vv lOUT VALID ""i[] -t LTf"E:.IL.ITV INSURANCE .l ~ c:ER...rIFI'~/~j.TE ()F: r::t:L.F-r ~~.Ir\.l::;:1.Jr~~l~tr~I~.l: t!I CJf\' P()~3T[::[) .II'..jCIEJv'jr"~ ( BONO 1 PIS REQUIRED BY 61 ~-6-'30 1, UNLESS EXEMPT e,\( 61-6-'303. /(~ YJ .POL /, _J.....r 1- '.. - '.::.'_.cONFIDENTIAL FORENSIC SCIENCE DIVI~INFORMATION IS FOR LAW DEPARTMENT OF JUSTICE ENFORCEMENT PURPOSES ONLY. STATE OF MONTANA ANY UNAUTHORIZED USE IS 2679 PALMER STRlPTt;LfRO. HIBITED. MISSOULA, MT 59808 "' i'(---1) 8'; '\\0'-' (406) 728-4970 ,"'- I)::'=- ' '1/ .,_m__... ~~...'''::''i: ,".' \,;t~ ".'1'lt,i. I /J..,.. ',.' ..~ I... .,....... :J '~:. 7-~...:.t~~~~w- ~. ;~ ~;",:,A'.::' ,gi, '." ~ '\i ". ::"n~. :-..s:~t.it ;,., ,..~~~~~ ROGER LAYTON GALLATIN COUNTY CORONER 615 SOUTH 16TH AVE BOZEMAN, MT 59716 Lab Case #: FSO..Q5..o04697 Agency Case #: 051018 SUBJECT: CHERRY, GEOFFREY DAVID SUBJECT: INGRAM, KAYLE L. SUBJECT: ABBOTT, DANIEL B. cc: EVIDENCE: The laboratory received the following evidence tor analysis: One kit reported to contain biological spec/mens DRUG CONFIRMATION RESULTS: SUBJECT: CHERRY. GEOFFREY DAVID CAFFEINE DETECTED IN BLOOD AND URINE THC..cOOH, 5.3 NGIML ./ QUANTITATED IN THE BLOOD AT THIS CONCENTRATION (THC-COOH IS AN INACTIVE METABOLITE OF THe) QUANTITATED IN THE URINE AT THIS CONCENTRATION (THC-COOH IS AN INACTIVE METABOLITE Of THC) " slfll/lf Forensic Toxicologist THC-COOH, 47 NG/ML ).. ~4d-h;4 J~. u n,Jr. Fo nslc Toxlcoloalstl Supervisor - Date of Report: 11/23/2005 PLEASE NOTE: All bioloiica1 specimens or other items that were submitted In this CllSCl will be retained at this Laboratory for a period of two years at which time they will be dcstroyeq unless or until werccclve a letter from your office stating what other action you may require. CERTIFICATION: The undersigned, as Custodian of Rocords for the Department of Justice, Division of Forensic Sciences, hereby certifies that this document, when signed and dated, is a true and correct copy of the original of said documC(l1t on file In the offices of the Division, of FQlP!tSic Sciences....., ~ / Dated thIS ~ day of ---.n~ . ~ Ic Sciences - PrlntS(fOn: 11/23/2005 PaQe 1 of 1 I I .".,.m.it:, .,~~.. ".' ':~1.... '0'1 . " "' ,r."\ , .. ~. ~! ,''', ~.!~~2".;"':~:'""'":"~ ~~, ;,,~...:-;.:......:;, ' - , ~~ ~..:: " .-.0."'.' of . . ,.\"~ :y. 7C' \ &. .:,.......!>l' ,.. ....:1"., I ~~,t,. . .~~;Y.oI <.;i CONFIOENTIAL FORENSIC SCIENCE DIVISI~IS INF.ORMATION IS FOR LAW DEPARTMENT OF JUSTICE ENFORCEMENT PURPOSES ONLY. STATE OF MONTANA ANV..llN.A(e)Q81?EO USE IS . 2679 PALMER STHf~ ~ HreI)flto7 MISSOULA,MT 59808 .~j7 ~I /1-- , (406) 728-4970 ;. ROGER LAYTON GALLATIN COUNlY CORONER 615 SOUTH 16TH AVE BOZEMAN, MT 59716 Lab Case #: FSO..oS..o04697 Agency Case #: 051018 SUBJECT: CHERRY, GEOFFREY DAVID SUBJECT: INGRAM, KAYLE L. SUBJECT: ABBOTT, DANIEL B. cc: EVIDENCE: The laboratory received the following evidence for analysis: TOX KIT ,t.,'; '. ALCOHOL RESULTS: Subject CHERRY, GEOFFREY DAVID:' Date of Report 10/27/2005 >. BLOOD - NONE DETECTED - "T:.o1" BLOOD - 0.01 GM/100 ML - "T -02" URINE - 0.02 GM/75.3 ML ./ PLEASE NOTE: All biologiCal speclmCIU or other Items that were submitted In this C8SC will be rctai of two years at which time they will be dcstroyect unless or until we rcocive a letter from your office require. CERTIFICATION: The undcr3lgncd, as Custodian of Records for tho Department of JUltloc, Division of Forensic Sciences.. hereby ~ clJac rJW ~ Wll~ ::I1~1gu. 6hd ulbo, IS a uud' ana comet copy CU Ml!I OheiiiACOflaid dOCUrrieDtoil'tIfe fn the oftlccs oftlic g=::fFO~:~~ ~. a~ .. J l.~ Custodian ofRecol,'ds, Division Forensic Sciences \~ Printed On: 1'1/23/2005 .,. . " , Page 10f 1 DEC. C.~. 200, (THO) 11: 58 FORB:1fBIC BCIB:NC!!: DIV 1-' -, 406S~~1067 PAGE. 2 FORENSIC SCIENCE DIVISIOrtON~-;:U:H.;.\jTiAL DEPARTMENT OF JUSTICE THIS INFOFlMAT10N 1$ FOR LAW STATE OF MONTANA ENFOAC!MENT PURPOSES ONL'f. 2679PALMER ANY UNAUiHORIZED USE IS MISSOULA, MT 59808 STRICtLV ~~R()HlaITEO. (406) 72fJ..4970 JI CORONEH LT. WILLIAM JONES YELLO~ TONE COUNTY CORONER PO BOX 35020 BILLINGS, MT 89107 Lab Cue f;: FSD..o&..Q046Q7 Agency Calle #; 051018 SUBJl!CT: CHERRY, GEOFFREY DAVID SUBJECT: INGRAM, KAYlE L. SUBJECT: ABeOTT, DANIEL B. cc: EVIDENCE: The laboratory received the following evk:lance for analysis: One kit reported to contain biological specjmena DRUG CO" FIRMATION RSSUI. r8: SUBJECT: INGRAM, KAYLE 1.,. NICOllNE DETECTED IN BLOOD OETECTED IN BLOOD AND URINE CAFFEINE: FENTANY_ ./ DETECTED IN URINE QUANTITATED IN THE BLOOD AT THIS CONCENTRAnON (TliC-COOH IS AN INACTlVE METABOUTE OF lHC) QUANTITATED IN 11iE URINE AT THIS CONCENTRATION (THC-COOH IS AN INACTIVE METABOLITE OF THe) DETECTED IN URINE THC-cOO -I, 9.4 NGIML ::.. THc..cOOI-l, 71 NG/ML ALPHA..H'V DROXYMlOAZOlAM J a_~~~ e! eoloB~ SUpervialOT ( sm~?~ ~~ ---~ ForensIc TOX:~ I I\: f<'oJ'CDlllc ToxfaolOlillt Date of RelJOrt: 11/2312005 PLEASE NUTE: All bfologlcalllpeClmcns or other items lhal were $Uhm1tt8d In thll cue will bo r<<aiu<<J at tbb Laboratory for IS pOIiod of two years It which timo trnty will bedntroycq una or unlil wotOOetve alett<< ft'om your oftloo Jtatll\gwhar. other action youmly requbu. Prlnted On: 11/2312005 Page 1 of2 DEC. (4. 2003 (THO) 11: 58 FORENSIC 8CIENC~ DIV 4065491067 " - - ltInuadon of Report for Lab # FS0-06-004' -. . PAGB:. S CERTIFt(:A.TION: The undcralplcd. u CUltDdlan of ReoordIlbr tho Dcpwtmcut of JUIdca, O'vllton of PORlDllio ScIences. hereby certJfica tht t \his document, wbcn signed and dIred, ls a It\tC and 00I1'0Clt copy at thc: orfsJaal of.tald document 01'1 roo in the otftocs of the Division of fJOI'tlJ1Ifc ScleftCCIS. Dated thls_ ~ oC_ Printed On 11/2312005, " CUslodiln oCRoDordI. Dlvllioo ofForcnalc 8clencet CONFiDEi\JTIAL THIS INrzORMA TIQN IS FOR LAW ENFOACf!M!Ni PURPOSES ONL'i. ANY IJNAufHORIZED USE IS STRICTLY PROHIBITED. ), ....... Page 2 of 2 DEC. O~. 2005 (THU) 11:56 'OREN8IC SCIENCE DIV 40654.91067 PAGE. 4 ; j , , FORENSIC SCIENCE DIVISlCiNcoNFIDENllAl DEPARTMENT OF JUSTICE ~Ff18 INf!ORMA TIQN IS FOR LAW STATE OF MONTANA ~NP:OACIM!NT PURPOSES ONL'f. 1679 PALMER ANV UNAUlHORIZED USE IS ' MISSOULA, MT 59808 sf~lejL'~' PROHfSrrED (406) 728-4910 ' r-. KAYCEE J~OERSON BOZEMAN POLICE DEPARTMENT 61 ri S 16TH AVE BOZEMAN, MT 59715 Lab elM .; F8D.o!l-004897 Agenoy Case #: 051018 SUBJECT: CHERRY, GEOFFREY DAVID SUaJECT: INGRAM, KAYLE L SUBJECT: ABBO"., DANIEL B. cc: eviDeNce: The laboratory received tho tollowfng evidence for ana1y81s DUI KIT -INGRAM ALCOHOL ReSUL TI: Subject: lto. GRAM, KAYlE L. Date <tf Report 1OJ2~ ./ BLOOD - 0.04 GM/100 ML VlTREOUB - NONE SUBMITTED URINE - (1.03 GMI75.3 ML URINE SAMPLE SUBMITTED BY YELLOWSTONE CO CORON ). PLEASE NOD.. All b1nlOSlcalllp8CUncna or other items thal W1lf'O aublnllled In thIt cae will be of two YCUlllt which timo they wal be desaroyc4 unk:a or until wo rMVO alo<<ar troa'l your oft! tcquirc. CERTJFICJ.nON: Tho undcnJ8oed, u CustodJan of Record. fur 1110 ~t of Jl1Idcc, JJlvtslOll 0 0. Sclencea, ha"cby cortI1JM that thla dOCW1lCllt" when lIicno.1 and dated, II A b'UO end comet copy of Ch~ OtlafnaJ of IIAId doc:umcnt on illo in (h~ QtliceA of the Division ocf onwlo SclonceJ. Dared thl.!l__day of __ -cu.odllD of Rooorck. Dlvl,Jnn of forcn;[c ScIClllOCl Printed On 11/2312006 Page 1 of 1 ~ l" '4..,..~ ;1..." .... .'..... ..,~,.......''''''.J: :~!: ., ".~ 1,ft " . .., "J ,; .;.":,,,,:...i-IIlII'~'i ~~ ,,.,...~?',,,", .' "':~ '-.: ~:~, ~.:':";~J.'" ;..~-~~ FORENSIC SCIENCE DIVISIONCONFIOEi\JTiAl DEPARTMENT OF .ruSTICE THIS INFORMATION IS FOR LAW STATE OF MONTANA ENFORCEMENT PURPOSES ONL'f. 2679 PALMER ANY UNAUTHORIZED USE IS :MISSOULA, MT 59808 STRICiLY NiOHI8ITEO, (406) 728-4970 i:, C. ANDERSON BOZEMAN POLICE DEPARTMENT 615 S 16TH AVE BOZEMAN, MT 59715 Lab Case #: FSO.QS..()Q4697 Agency Case #:051018 SUBJECT: CHERRY, GEOFFREY DAVID SUBJECT: INGRAM, KAYLE L. SUBJECT: ABBOTT. DANIEL B. cc: EVIDENCE: The laboratory received the following evidence for analysis: DUI KIT - ABBOTT DRUG CONFIRMA nON RESULTS: SUBJECT: ABBOTT, DANIEL B. LIDOCAINE Ao,.,. I" 'Hilla> & '( l}.OH- DETECTED IN BLOOD (tit l-1-€t..4 UJ~ . HutchisOn. Jr. Ic Toxicologist! Supervisor ../ Date of Report: 11/23/2005 PLEASE NOTE: All biological specimens or other items that were submitted in this case will be retained at this Laboratory for a period of two yCllI5 at which time they will be destroyeq unless or until we receive a letter from your office stating what other action you may require. CERTIFICATION: The undersigned, lIS Custodian of Records for the Department of Justice, Division of Forensic Sciences, hereby certifies that this document, when signed and dated, is a true and comet copy of the original of said document on file in the offices of the Division of Forensic Sciences. ~ -'10. ~ - / . -:l~__- l Dated this ex \dayof , \...l"'TV . ~ ." ~ _"- ~ ~ Custodian of Reoords; Division ~iC Sciences Page 1 of 1 Printed On: 11/23/2005 . .{ -~ ~.,~4:1.~. t:~:"."'':'i ,r. ""," ","" '~ t.,::..> "( "" ." ~ ~, ~ ......':..;<.~,~~~. '''it,:-''~';il'' '" ,:J ~;.\.... .~.:w~' ,. ...It," J~~ ...4_~~~ .,~> , FORENSIC SCIENCE DIVISI(j~ONF1DENT'AL. DEPARTMENT OF JUSTICE ON IS FOR LAW STATE OF MONTANA THIS INFO:~:;lpURPOSES ONL'l 2679 PALMER ENFORC;UTHORIZEO USE IS MISSOULA, MT 59808 ANY CU~y PROHIBITED. (406) 728-4970 sTA1 .' KAYCEE ANDERSON BOZEMAN POLICE DEPARTMENT 615 S 16TH AVE BOZEMAN, MT 59715 Lab Case #: FSO..oS..o04697 Agency Case #: 051018 SUBJECT: CHERRY, GEOFFREY DAVID SUBJECT: INGRAM, KAYLE L. SUBJECT: ABBOll, DANIEL B. cc: EVIDENCE: The laboratory received the following evidence for analysis: OUI KIT - ABBOTT ALCOHOL RESULTS: Subject ABBOTT, DANIEL B. .. NONE DETECTED Date of Report: 10/27/2005 >. CERTIFICA nON: The undersigned, as Custodian of Records for the Department of Justice.. retlslc Sciences, hereby certifies that this document, when signed and dated, Is a tnle lUld correct copy of the orl&lnal of said document on filo in the offices of the Division ofF2f..OI1sic Sciences.'-"1 A ...._J Doted this ~ Cf day of v v!2:!.... ,~ L Custodian ofRccords, Divis! 0 orenslc Sciences Printed On: 11/23/2005 Page 1 of 1 CONfH)ENl'HAL THIS INFORMATION IS fOR LAW ENf:OACEMENT PURPOSES ONLY. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED. !IUim ~t ' < t ' Ii 'Z n m >. ./ CONFIDEJ\lT~Al THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL'f. ANY UNAUTHORIZED USE IS STRICTLY PROHIBITED, ~ J l 0 l l I !l '1 f !l t < i r r' I . ! I .f · I '. - l/ ic ~.D I p'i f f m ! ~."~.f~"~ fZ ~ ~ ~ ~ (l) sa, i' . .~I ~ ,;. m: " EVIDENCE I PROPERTY IN-PUT 2. PR NUMBER/OTHER NUMBER OS) 60 I 5. BADGE ~ \ t.;.) 1. DATE IN 9. Q.EfENSE l-q ta. J =-..1. } t'~ 0J~vJ I /G.y/p Tt'()r,,~ ~ol ~,ooLf)r~t..J , [ SAFE KEEPING WHiTE COPY - TO E'/IDENCE YELLOW COPY - TO EVIDENCE PfNK COPY - TO CASE ALE GOLD COPY - ATfACH TO CITATION OR REQUEST FOR PRQSECUnON "- 'J 3. AGENCY o VAULT STORAGE OTHER 15. OUT-PUT ~ DATE OUT SECT10N # OF ITEMS RELEASED SHELF o TO BE RE11JRNED o NOT TO BE RETURNED o DESTROYED o CONVERTED ..-:. 17. DlSPOSmON . 0 GUILTY ~ 0 DISMISSED/AQU!TfED -.~ 0 APPEALED TO DISTRICT COURT 18. RELEASE DEFENDANT o V1CTIM o STATE o DESTROY o OTI-lER JUDGES SIGNATURE DATE . CONFIDENTIAL THIS INFORMATION IS FOR LAW ENFORCEMENT PURPOSES ONL'f. ~t\Y UNAUTHORIZED USE IS E10,OD TEST REQUEST E'O~-RICT'LY PROHIBITED. - Pursuant to the provisions of MeA Section 61-8-405, I, ~I ,JlcJU-;'9- (Officer' name -- please print) request that a blood sample be withdrawn by IHt-GBo1YJI'1/ST (Physician, R.N., etc, please print) ror the purpose of determining the alcohol co~centration therein from the follqwinq individual: - '~lf Namf' 1()Ob III Ad.ctre~5 Gn(~~(iY"lI Aft sq'7rS ~~ (2t~ 17K Ate f7~o J K. 4t~/~~^~ ot!icerl~ s gna ure r) r,n...t"A\^Aid-. A if) Agen'ey Ie II '?' /~ Date of R'eque5t CHECKLIST FOR MEDICAL STAFF /verifY that gray top "Vacutainer" tube supplied with our ---- Kit does contain crystals (powder) in the tuba and integriby of the vaccum has been maintained. Important use a gray top tube or one that contains a perservative. / .~ ~ A non-alcoholic or non-phenolic swab was used to prepare the site for blood draw. Povidina-Iodine swab supplied in kit or an appropiate substitute, betadine solution, may be used. (Requesting officer should witness the blood collection so that he/She may attest to the authenticity of the sample.) . ~ The tube is labeled with the, subject's name, date, and time of the blood collection. ~ ~ The tube is seij.led with .nclpseGi paper seal and given to the requesting officer. AzP-' iT (Signature, Medical staff) Refer to Administrative Rules of Montana of blood samples for alcohol analysis. 'Hl.G SOTU Yt-\l .s 1 (Title) 23.4.220 -- "Collection THIS FORM TO BE RETAINED BY REQUESTING O~FICER -- PHOTOCOPY ~S NEEDED FOR MEDICAL STAFF. ." . . 2S~~ l22~ 5000 09~t hOOL IIIII~IIIII" III 2S~~ t22h 5000 09~t hODL SCIENCE DIVIS~1 I'MENT OF JUSTICE EN E OF MONTANA ~ 9 PALMER ST. ~~ OULA, MT 59808 STR1" 406) 728-4970 .~tJft:O~~rlAl. ~ ~ ~fl@fl t.8 FOR tAW " MT_ ~ld~POSES ONlY: -.. REQUEST FOR ALCOHOL AND DRUG ANALYSIS Submitting Officer. -t<. Andt~~ ~E PRINT) ==: 't1?""'S i~u-t. ~ l,.c..4'\^ tJ~ M I Zip (NpOrt will be rttumed ~ to tNe addrwu) Phone No.: ~ $b.J~ dO}) I RELA: ED (check d that apply) o OUI 0 DRIVER $ACCIOENT J'.8-. PASSENGER J8lFATAl 0 Other BREAlH ANALYSIS PERFORMED? Agency Case No.: (is/oJ ~()() f3 \Yl7/S SubJectName~jrlll'^- I .~C-- l.Mt RlIt O.O.B. . Sex IlA Race \tJ Date CoUected: 0 llme Collected: ~ Sample Drawn By: .. L, M. (PhytikWI. NurM, MIld. Tech) Court Date: E LA: D (dleetI: alIlhat apply) o SUSPECT o VICTIM o Other o HOMICIDE o UNATTENDED DEATH o Other PBT? Y N INTOXlLY"ZER Y _ N /" RESULTS: O.---PflJ/210L >. . Please list all drugs, medications, prescriptions, etc. ,/ SpIdty doJge{a). It knoWn.) EVIDENCE RECEIVED FROM CHAIN OF CUSTODY EVIDENCE DELIVERED TO DATE COMMENTS PlEASE LABEL, DATE., SIGN AND SEAL AU. SPECIMENS LABORATORY USE ONLY Speelmen Submitted: 0 BLOOD OVITREOUS 0 OTHER Seal: label: Seal: Intaat 0 Broken 0 ANALYSIS RESULTS ETHANOL: gml100 mI Blood Other Other Volatiles Detected: Date Analyzed: Analyst: unTC. at C ^ cc <<11 (QUIT anTU ,..nDtI:a ne TU(~ en.::",. Lh6~ L22h 5000 09tt hOQ~ I111II II I' Lh6~ L22h 5000 D9tt hOOL . Submitting Officer ~~ ~.fO G'/.S- -5 Jb~ ~ City ~'2..~ ST~Zip~ (t"IpOrl win he ~ to Ihb adtinzs) Agency Phone No. (LJOIo s-8;J- ;;).~ Address Subject Name La.d, FinJ M. D.O.B___ S~x /Ill Racey Date Collected ...J 0 /,3 los- TIme Collected ;)0 ~ , , Samplo DtawnBy -.ewe..b~ sf" (Phy.Jtck1n, Nur.rfl, Md 7lteh) Agency Court Date Q DUI ;3...ACCIDENT ~FATAL 'IAFfIC .IUTED (chock all that apply) )1i.. DRIVER o PASSENGER o OTIffiR .....TIIFfle BELATED . (check all that apply) Q HOMICIDE 0 SUSPECT o UNATIENDED DBAlH 0 VICTIM Q OlHER 0 OTHER BREAn.fANALYSIS PERFORMED? PBT? Y N ~ >.INtOXlLY'ZER Y N ~ RESULTS: O. Please list all drugs.. lIledications, proscriptions, *' (SpecifY dNglI ifknown) gm/21OL CIIII Of CaSTODY EVIDENCE RECEIVED FROM EVIDENCE DELIVERED TO - DATE 0: COMMENTS Ponn FS03 (Rev. 3AJS) PLEISE UBEl, DITE. SIGI... SEll AU SPECIMENS NOTE: PLEASE SUBMIT BOTH COPIES OF TIllS FORM MONTANA DEPARTMENT OF JUST Non..cMV IMPLIED CONSENT ADVIS...... \ Y , '(Operation of non-commerdal motor vehicles. only) .:-. J, \ \ A You are under arrest for. (check aooroorlateoffenslif) eQ~!R~ iF. o Driving (or being In actual physlcal control of) a motor vehlde while unde~ifl ' o Being under twenty-one (21) yean> of age and driving (or being In actual alcohol concentration of ,02 or more. t4j.tf.t ~ ' - OR - .~'l<Ic'l. ?B9 \ .' B. I have probable cause to believe that you were drMng or In actual physical conuqli1r1N6~e, 'snd: cnecf appropriate circumstance) o Were under the Influence of alcohol (and/or drugs) In violation ot 61-8-401 and the vehicle you were driving was Involved in a motor vehicle accident resulting in property damage. ~ Were Involved In a motor vehlde accldent rosultlng In serious bodily Injury or death. Under Montana law, a person In your situation Is deemed to have given his or her ImpUed consent to testing for alcohol and possIbly testing for drugs. . As the requesting officer, I have the right to select the type of test or tests you will be asked to take. I am going to ask you to take a breath (or blood) test (lat8r J may ask you to take a'blood test.) (1) You must decide to take or refuse this test without talking to an attorney. Your right to an attorney under Miranda does not apply. (2) W DRlVEA HOLDS A BASE DRIVER'S UCENSE (ONLY NON..cOMMERCIAL MOTOR VEHICLE DRIVING"'PRIVILEGES): It you refuse this test, your driver's ficense will be seized and suspended forslx (6) months; It you have refused similar testing within the ps'st t1ve years and you refuse again today, your driver's liCense will be seized and your prtvRege to drive will be suspended tor one year. IF DRIVER HOLDS A COMMERCIAL DRIVER'S UCENSE: In addition to any actions taken against your non-commerclal driving prlvfieges. as the holder of a com,mercial driver's license: (3) (4) (5) (6) (7) (8) , If you refuse this test, your commercial driver's license \!fill be seized and suspended for one (1) year. ~ r ~ 4 ~_ ~ 1 If you have refused similar testing In the pas,t of,tiav& a prior major offense on your driving record and you refuse testing today, your commercial driver's license will be seli~ 8J1d sus~nded for life. . .... ,~ 'l. . . If you have a driver's license issued ~ another Jurisdiction and you refuse to tal;te this test, your non-resldent driving privileges In Montana wiU be suspended for a minimum of six months to a maximum ot lite, depending on the class of license that you are holding (noo.commercial or commercial driver's liceru:-e) and your current drlvlnlfrecOrd. plus your Ucense will be seized and returned to the licensing aqency at your home jurisdiction eTong with a repan of your testing refusal. You will not be eligible for a probationary driver's license during the suspension. It you refuse testing, you may contest the action taken against your "cense by tiling a petltlon In a Montana District Court. The action wi! not be overturned unless you prove that your arrest or the Investigatory stop was unlawful or that you did not refuse testing. You may as the court to restore your driving privileges \Jl)~1 the court rules on your petition. Your test results or testing refusal may bEl' used as evidence agaln,st you In a criminal trial. Additionally. if you refuse testing today. the Jury (or judge In a non-jury trial) may Inter trom your refusal that you were under the Innuance ot alcohol and/or drugs. The Inference Is reputable. After the requested testing Is completed or refused. you may have 8 dodoror nurse administer an Independent test for alcohol or drugs your expense. If you refuse testing now, taking an Independent test will not change the action taken on your drlver'sllcense. A-brenth t~1,6quire$ ) Ol::l tQ. blew a-pfe(ilQr i:iml"lo of air into thJs In.:str\Jm9Rt. It win analyze your breath sample tor alcohol concentration. WIll you take a tJreettt test? /' tfcsrrv\ Yas . V . No This advisory was read on Name -'-oq."i "'_\ Date of Birth to: '1 1 (S~f \ J '-/ Ir-r AI , ' A-J.:.t~ t-/- J~ /t,rf,./J )/,/':i/\r__ Advising Officer's Signature Commercial Driver's Ucense: 0 Yes Commercial Motor Vehicle: 0 Yes Witness SIQnature - Optional TO BE REf AINED BY OFFICER FOR FUTURE REFERENCE No No Driver's Ucense Number 3S-0300 10103 : QtJS:P""'ENTlAL CN;~~'xl~" ~W ~~tk~neuRf.P$fjA~ t;n~~mf&d$S!l ~L'l BOZEMAN DEACONESS HOSPIT~2irUTROR'\nBl1lQJSE IS 915 HIGHLAND BOULEVARD etIl\h.v.V" .. BOZEMAN, MONTANA 59715 STRICTLY ~Rt~HIBlTE[, PHONE - 585-5000 . .Abb.:J:+ DATE OF BIRTH: MED REC #: DATES OF SERVICE: ~ 8 /0.<:- ~ RELEASE TOWHOM: ()'" l:.1.J' '',,If_ p~:r.,. r~F" The undersigned hereby authorizes and consents to the disclosure by the above named hospital to the above named company or persons, or their representatives or the bearer of this instrument, of medical records and consen~s to the inspection and copying of sarne by said company, persons or bearer and to the furnishing to them of photostatic or other copes of same. In furtherance of this authorization, I do hereby waive all provisions of law and privilege-related to the disclosure hereby authorized. ~ DATE: --1Q(m/bS I ........ ~~j)~ PA lENT'S SlGNAT- E OR NEAREST RELATIVE RELATIONSHIP RELEASED BY: ~ COMMENTS: 1 BOZEMAN DEACONESS HOSPITAL Admission/Registration Record 915 Highland Blvd. ~i""" ;\';' '. (406) 585.5000 H 1.'1i ,,' Admit Date/Time: 1 Discharge Date/Time: Service/Location: E " Account No: V00009093576 ROOOI/Bed : Patient Type: REF PATIENT ABBOTT. DAN 1627 W MAIN NO 106 BOZEMAN. MT 59715 (406)539-6931 Emp 1 oyer: SSN:'" [X)B: Marital Status: M Sex: H Age: 44 Phone: GUARANTOR ABBOTT. DAN 1627 W MAIN NO 106 BOZEMAN. HT 59715 Home: (406)539-6931 Work: PERSON TO NOTIFY NEXT OF KIN ABBOTT. AL YSSA 1627 W MAIN NO 106 BOZ~N.MT 59715 Home: (406)539-6931 Work: Relationship: SP Horne: Work: Relationship: INSURANCE POlICY l)PATIENT WILL SUBMIT 010010001 Reason for Visit: LEGAL SA Accident Oeser: Admit Physician: Attend Physician: NONSTAFF MD ER Physician: Last Visit Date: 10/18/95 Registrar: SUBSCRIBER ABBOTT. DAN QUICH ICD-9 CGOES ../ PROCEDURt CODES CPT-4 CODES EDITING CHECK LIST Edi ted by: Clear for disch? Yes / No Consent Signed. If not signed. why? Fin/Agreement signed by patient Indicate if you saw patient: Yes / NO Medicare appeals letter 5lgned Card/s scanned! Check payors: Med MA BC Infonmat1on verifie~ Other notes: wny! questlonna1re comptetea. we Other camm. ----- 11I..DlII..BIIIII.11 Printed on: 10/18/0S at 2046 by QUreH , , ,. , ,^" CONFiDENT~f4.L THIS INFORMATION IS FOR LAW BLOODTESTREQ~STFO~~O~~;~~~:~:6~~~~N~ STRICTLY PROHIBITED, Pursuant to the provisions ofMCA Section 61-8405, I. (ornccr1;;mc -1~:::;~ req~est that a blood sample be withdrawn by pt1t-e~f)rf)#1 (.s~ for the purpose of (phYSician. R.N.. etc. - P 91. print) . d<:termining the alcohol concentration therein from the following individual: _Oa~;~ 13tp H~bb+4- ubJcct name leu. p nt) t.~ ce 8 'I;naturc \ 3~ GdJer rOt\Y^~ ~ J;o7qv.a", All r6'17JS- J ' ~7~ fo Aaency )oIJ~/o& ' atCI of cst CHECKLIST FOR MEDICAL STAFF J Verify that gray top "Vacutainer" tube supplied with DUl kit does contain crystals (powder) in the tube and integrity of the vacuum bas been maintained. Important: use a gray top tube'>or one that contains a preservative. /' ../ A non-alcoholic or non-phenolic swab was used to prepare the site for blood draw. Povidine-Iodine swab supplied in kit or an appropriate substitute, betadine solution, may be used. (Requesting officer should witness the blood collection so that he/she may attest to the authenticity of the sample.) ~ The tube is labeled with the subject's name, date and time of the blood collection. ~ The tube is sealed with enclosed paper seal and given to the requesting officer. !'";;..f6L-'-- (H-Le&r0Il115 T (Title) Refer to Administrative Rules of Montana 23.4.220 - "Collection of blood samples for alcohol analysis." THIS FORM TO BE RETAINED BY REQUESTING OFFICER. PHOTOCOPY AS NEEDED FOR MEDICAL STAFF. ]:crmlshareJblood telt request "-~ Bozeman Deaconess"~.J~FIDENTIAl Consent for Treatm8'~IS INFORMATION IS FOR LAW ~t\l1= PURPOSES ONL'Y. 1. Medical Consent: I hereby consent to the provisions of health care Serv1CUS. ~rf.:1' such as X-rays, exams, administration of drugs, lab tests, and other hospital (Bot4)I~ IYPhysiclan. I understand that the patient care Is under the control of an Independent$'fii".'l'alibYa I liable for any act of omission provided the hospital has followed the Instructions of said physlclan(s). Services provided by all physicians are Independent of SOH. r-- ( 2. Release of Infonnatlon: I will refer to the BOHS Notice of Privacy Practlces regarding the release of my health Information. 3. Assignments of Seneflts: I hereby authorize payment directly to the hospital for the hospital benefits herein specified and otherwise payable to me. I also authorize payments directly to the physlclan(s) providing services to me from the benefits otherwise payable to me. 4. Insurance Disclosure: I understand that it Is my responsibility to notify my Insurance company directly within the time limits of my polley, if I am admitted to SOH or for pre-authorization of special procedures and/or tests. 5. Financial Agreement I hereby assume full responsibility for charges I incur for services from SOH and agree to pay said charges In full. I have given my Insurance InfonnatJon, If any, to BOH. It Is my understanding that I will be responsible for any balance not paid by this Insurance. If I. or my guarantor, choose to bill my Insurance, my account will be considered as self-pay. If I am unable to pay In full, I will contact the Credit Dept. at 585-1015 to discuss options, with a minimum-monthly payment of $100. It Is further understood that the entire balance. pursuant to this agreement, will be due and payable one year from the date of admission/service. (Guarantor Initials) 6. Personal Valuables: I understand that SOH shall not be liable for persona/Items. If admitted, I have been advised to send all valuable personal property home. 7. Nursing Care: SOH provides general duty nursing care. If a patient needs continuous or special duty nursing care, the patient, legal representative. or the physician must arrange such care. SOH shall /n no way be responsible for failure to provide the same and 18 hereby released from any and all liability. 8. Grievance Procedure: All patients have the right to submit a complaInt regarding care and services rendered without fear of retribution. As a patient, I may communicate my concerns regarding care, services rendered or billing to the BOH Quality Improvement Oept>at 585-5045 or send It In writing to 915 Highland Blvd., Bozeman, MT 69715-6999. 9.lntormstion Practices: I acknowledg&r8c81pt of the abHS Notice of Privacy Practices. 10. Patient's Rights & Responsibilities: I understand my patient rights as desctibed In the Patlenfs Rights and Responsibilities brochure. (Pattent/Responslble Party Initials) 11. Facility Directory: If I am admitted, SOH maintains a facUlty directory that lists my name, room number, and If I wish, my religious affiliation. This Infonnatlon (excluding religious affiliation) will be disclosed to anyone who requests It by asking for me by name. I DO NOT want this information listed In the facility dIrectory. I DO NOT want religious affiliation shared with the clergy. I certify that I have read the above Infonnatlon and as the patient, or one who Is duly authorized to act in a representative capacity for the patient, that the Information has been fully explained, that I unaerstand Its content, that It may not be modified and that I may withdraw my consent for services at any time. PatlenUGuarantor Signature: Relationship to Patient: Reason Patient Unable to Slgn:~ ~f\ I acknowledge receipt of an Importa~' Message from Trlcare Date: Witness: Date: 1 acknowledge receipt of an Important Message from MedIcare Signature: Signature: Date: Date: Acct#: V00009093394 Name: ABBOTT,DAN MR#: M01148341 SvclLoc: ER 10/18/05 NEURO ~ lOG: AlERT lETHARGIC UNRESP PUPILS: EQUAl NON-EQUAl REACTIVE NON-REACTlVE HEADACHE.: YES NO ONSET GCS: EYES MOTOR VERBAl TOTAl CARDIAC NA-- CHEST PAIN: YES NO SEVERITY (HOL RADIATION: YES NO ONSET: DATE TIME MONITOR RHYTHM RElPUWORY NA_ BREAlli SOUNDS: ClEAR . PRESENT ABSENT DIMINISHED WHEEZE CRACKlES COUGH: YES NO CP WIINSP: YES NO SPUTUM Oz: NONE NC FM PKFlOW: PRE _ POST_ OIl8U N~ PAIN: ABO PELV FLANK SHARP CRAMPING ACHING BURNING CONSTANT INTERMITTENT RADIATING ASSOC. SYMPTOMS: NAUSEA VOMITlNG DIARRHEA BlEEDING DYSURIA ~URIA URGENCY FREQUENCY LASTMEAL MUSCUlOSKElETAL AA- EXTREMITY: TENDERNESS SWElliNG ECCHYMOSIS DEFORMITY SENSATION: NORMAL NUMljNESS TINGLING ROM: NORMAl lIMITED PULSE: YES NO ImOOMENTARY ""-- LACERATION: LENGTH LOCATION M1RASION: YES NO LOCATION RASH: YES NO :..OCATlON 3URN: PARTIAl RJLl _OCATlON EENT NL- nsUAl ACUITY OS 00 OU rHROAT: PAIN SWELUNG REDNESS DYSPHAGIA ) ) J TIME ARRMD: HOW ARRIVED: AMBUlANCE WAlK W!C BROUGHT BY: SELF RELATIVE ffilEND 0 NURSING HISTORY: CHIEf COMPLAINT: NURSE SIGNAtuRE: PRIMARY PHY11CAN: 0 YES DNa EA PHYSICIAN TO SEE 0 TETANUS: o CURRENT o UNKNOWN o OUT-OF-DATE WEIGHT LMP Al.LERGIES: .). MEDICATIONS: TIME T P R BP P BP TIME FSBS IV THERAPY TIME CATH SITE flUID RATE TOTAL INIllAl , ,.-UIl T/O_ OEKGl/o_ CHEM T/. _ 0 TROP 1/._ o AMYl f/, _ OCI(MB 1/._ QPTT/o OA8GTfo_ o PIT '10 _ 0 RAPID SlR T/._ OHCGf/o_ OUATfo_ o 0 o 0 o 0 PHYSICIAN ORDERS - RADIOLOGY X-RAY o o o o TIME TO CT o o TIME TO us o llMETO T/. T/. fl. 'I. FROM~ 'f. II. . FROM_ IlUCMED o FROM_ PHYSICIANS ORDERS - MEDICATION PHYSICIANS ORDfR8 - PROCEOURU o roLEY oOSU o VNJ EXAM ONG o QRlllO VS o OLD CHART O. o OClfAN WOUNDS o DRESS WOUNDS o KNEE IMM o AIR 8l1RRUP o SUNG o WRIST SPl o o PHYSICIANS ORDERS - PREPACIS PHYSICIANS ORDERS. PRESCRIPTIONS MEDICATIONS (ADOmONAl SPACE ON BAa) OISPOSmoH NO PAAT HOME NAA POlICe DEe R8. lIB.. R8. NA ADMIT: ROOM NO PAAT PHVS: RB.. llEl RB.. NA NO PART R8. RB. RB.. NA DISCHARGE INSTRUCTIONS: 1<<) IWIT WRITfEN VERBAL \HIT: RB. llEl R8. NA :mc:~m q;. DIAGNOSIS: PHYSICIAN SIGNATURE "'........ BOZEMAN DEACONESS HOSPITAL Account No: V00009093394 Room/Bed: Pa~1ent Type: ER PATIENT ABBOTT. DAN 1627 W MAIN NO 106 BOZEMAN.MT 59715 Employer: GUARANTOR ABBOTT. DAN 1627 W MAIN NO 106 BOlEMAN.MT 59715 Home: . Work: INSURANCE l)PATIENT WILL SUBMIT . SSN: OOB: Marital Status: U Sex: M Age: 44 Phone: PERSON TO NOTIFY NEXT OF KIN Home: Work: Relationship: Home: Work: Relationship: POLICY 010010001 SUBSCRIBER ABBOn. DAN Reason for Visit: MVC Accident Oeser: 10/18/05 Admit Physician: Attend Physician: ER Physician: MAJXNER MO.R JAMES last Visit Date: .>. Registrar: CARJ 1CD-9 CODES .'/ PROCEDURE CODES CPT -4 CODES EDITING CHECK LIST Edited by: Consent Signed. If not signed. Why? Fin/Agreement signed by. patient Indicate if you saw patient: VfiS I ria Medi ca re, appea 1 s 1 etter signed Card/ s scanned.t Check payors: Hed MA Be Information verifiedt Other notes: 1118111111I11111.11111 Clear for disch? Yes I No WhY't questlonnalre completed. we Other comm. Printed on: 10/18/05 at 1829 by CARJ CY PHYSICIAN RECORD MY A (S NInIRI~ IWMwed RrM....-d 0 PHYSICAL EXAM ~ Appearance 7c-c~/1n ED) ...:..~CIStreSS ~ ~I seveR dls 'ilert - anxIo~ I ~ .r.. ~ ~:'~JtI ~01t1J-€ .::::::tlO evidence of Satde.s tip I Raccoon Eya tn&Jma DATE:_ TIM . HISTORIAN: padent spouse _HX I _EXAM lJt1ITED BY: HPI occurred: QlA It- =OfDaI~~U In"",": - <: S l ')~ - had face moUth C ~ neck chest abdomen back upper mid- Iaw<er ~ to (RIIJ thIfh tier sev.ritv of pain: mild l c '5 J..o elt. of imD8ct: reStfalntl:~ "p" .. primary "S" <= secondary none shoulder doesn't realI ~ or seat (oM low mod~ PAST HX Cnepdv) ~mnm_ KD I see nurses note ~ -EOH mkllne _He cJb&nm _~ polnt-tMdemesI _muscle spam I decreased ROM --Plin on movement of neck ~l ~ nmI exwnaf / lnIpecdon _no dentallnjwy RESP I CV8 ~non-tMder sounds nmI _heart sounds nml ~EH ~ - orpnomepIy " Nt- NEJJ.RO I PSYCH ~t.d x3 ~n)POd & aBect nml ~s nml ~ _sensation & motor nml \ I _unequal pupils A- _/111II L-_rrvn EOM entnpment I palsy -subconJuncdvll hemorrha&e- _hemocympanum _1M obscured by WlUC dotted nasal blood dentallnfurY I maIocdusiof' _Jell cUavam (on reverse) decreased breath sounds wheezlnll raJa _spIInq I paradoxkal movementS _confusion I dIsorienbdon _EOM palsy I anIsocorb. _&cb1 asymmetry _unsteady I awdc pit _sensory I motOl" deficit + It ll.n.IC.. ')\0/1'''-'-' T...... ...,.... ~1-* ~ ~ ....n ~.-M _Irrr ~... ~ 1lno - T____ ,."... (NNH,I ,""'" , CONFtDEi~T~Al ~~ THIS INFORMATION IS FOR ~LY. ORCEMENT PURPOSES' . ~~~ IINAUTHORIZEO U .. _ ~ _ , 5'tRICTLY ~'ROHI8ITE ~ _ I diaphoresis ~ _wann,dry BA':K ~no CIA ~ tenderness ~ES ~tMdemess ~ Stable ~ I unable to bear W81aftt. 3fB' non-tender -f'U~.tIcIt ..... .- ..... ~ \ ~ j/Yrs\ ~I ROM _~~ ~ ~l c\.u. L ().JJ I I _" R III~ IIXIty I Join .tfi.JIIon 1Lu\_ I a.. ~ . "'\ <... _see dJacnm _vembnlpol~ _ OIA t:endemus _muscM spasm I limited ROM ~r7 L R PROGRESS: TIme undw1pd Improved r&4Xamlned -s- O'V\ to.. c.. 6(o~ ~LJ, /lr~.~~J!:Jts~ contualon IMad wrist R/L cae. hand R/L chat hlp R/L abdomen chi. R/L bad< knee R/L w/o LOC ~ Ie& I\/L arm anIcIe k/L elbow foot R/L foNlnrl (. - horM D~ D~ D. unchanIId 9inproved stabI- CXR _rib fractunl _nmll NAD _Inflltrata I ,teIectuIs _no infiltrates nml heart size - nml mediastinum OTHER OSee separate ~~ ~ V -" MDIDO o D\ctlI.tedAddendum . ) 0 Template Complete MVA.17 j J , ~~~~~D~ac ER C~~fro\g~~~j. ~93394 M01l4~~OZEMAN DEACONESS HO ~:un~ II F . :-ry;t;J1 tt \ )1 .c NF.2- MD, R JA DO~ EMERGENCY OEPARTME It-\ "1 .J.ii rrr. '.' 10/00 irlilii......... NURSING FLOW SHEE' ~N'~ I ~I \ t ~ ' \~E \5 ~ NEURO' ~ TIMEARRIVE~: ,0 ~T~~! I"' -\ V'pl- \P"PHYSlC1ANORDERS'lAIl =k. UAl~&:~- I-oow NlRMiQ~ WN.I4--WIC( ~_.~ -..-.- .-- . REACTIVE NON-REACTIVE OROOOHT BY' fiVE ffilENO OTHER PHONE NUMBER: 0 cec f/~ - 0 EKG '/~- iEAOACHE' YES NO I QCHEM 1.- OTROP 1.- )NSET . NURSING HISTORY: hiliA- R ~ J.-! A - Lt JAM ~iA. tfi J At nt1 . 0 AMYL rfo - 0 CKMB f/._ ICS: /Y! AI;ih~ / /Yf-l"Jl' tJf1~ /1 *r" i j) P ~ I') I X1.!..P..tl ~~/:, ~::I~.~ EYES J A () !J A ( f- I # I '" I'oll;. - '-' f ,un 0_ MOTOR 191LA' /lA iLIA 'J-C.I"7Y 'ff-JA f -lJ7- -1 dA1IP 1!1 QHCG 10- QUA 1.- ~~ 0 0 TOTAl I111l1tJA) If ~ ~ CARDIAC ~ MURSIMG AS.SE88MEIIT: :tfEST PAIN: YES NO EVEAfTY (1-10) .ADIATION: YES NO NSET: 'OATE TIME IONITOR RHYTHM REATH SO=~ NA_ RESENT ~MINlSHEO WHEEZE CRACKlES DUGH: YES NO P WIlNSP: YES NO F'UTUM ,: NONE NC fM (~:PRE _ POST_ ~rO ) QIIOU IIA_ . 0 PElV flAHK P CRAMPING ACHING ALl..fRGIES: BURNING CONSTNlT INTERMIITENT RADIATING :SOC. SYMPTOMS: NAUSEA VOMITING DIARRHEA BLEEDING DYSURIA HEMATURIA URGENCY ffiEOUENCY TIME T P R ST MEAl rrK?o ~'11 fn1 10 M~AL, NA........:.... TREMl1Y' TENDER - SWELUNG ECCHYMOSIS DEfORMITY NSATION: NORMAl NUMBNESS TINGlING 1M: NORMAL UMfTED LSE:YES NO ENTAfty GERATlO~GTH liImUNiQ. RASION: 1tS' NO CATION SH: YES NO ::ATION RN: PARTIAl FULL ::ATION HA_ EENT UAl ACUiTY OS 00 OU NA 7- lOAT: PAIN SWElliNG ~EONESS DYSPHAGIA PHYSICIAN ORDERS - RADIOl..OOY ;i~.1t't1~~ - " 0 ~ -' Tfo ~ \. ....._~ IYMAI/J run \:xl II """-f"'AA/"-I~'" ~., """\...)11'1 ~ ~ AM... A ~ . . /"\~. nMErO FROM ' ,r 1C CT IV ad>:,o l"f~:( ~ f/o n . .0 TlMHO.o FROM us 'NUCMED C 0 T1METO . \ 1_____ I,~ \ 1'1\ Kt\fl.AJ.\- (j./( I A ~./1A^ . J _ ( I 1(.1f J t/11 /Yl tIJ/lP / J D IIJ1tV\1 ~I 7 CH~COMPlAIHT:'7(f rnJIl/ (j)n-~/~ PCtR ~ -A MUIUIE SIGNATURE: .'~ PRIMARY PHYSICAN: 0 YES-V ~O ER PHYSICIAN roSEE TETANUS: o CURRENT o UNKNOWN o OUH1F-OATE WEIGHT LMP ).. MEDICATIONS: n ~X - ;L./ TIME CATH UP i~ ~ 'J:!.~ P ~ OP ~ TIME .~ FSB$, IV THERAPY '-ro> FLUID TOTAl 0-- ll.. SITE RATE FROM PHYSICIANS ORDERS - MEDICATION o ~ 0.\ f\^.L 1M... 1 PHYSICIANS ORDERS. PROCEDURES o FOlfY 0 ClEAN WOUNDS IJ DSU 0 DRESS wotR<<lS o VPl!. EXAM 0 KNEE IMM o NG 0 AIR 6TIRRUP o DRTHO VS 0 SUNG o OLD CHART 0 WRIST SPl o 0 o 0 PHYSICIANS ORDERS - PREPACKS - U VW ~ -- t!!-Gf- INITI~ viOl .:f?on A<<: a~ A if r,-.. PHY8lCIAH1i ORDER \V t.-tCoaA'Y\ S7~1JJ (f}) (/n1i?: (~t. ~1J6/l~~~ t '-'U '(L U ___ DISPOSlnuN I VWMt:' /1NA. POLICE DEe NA. '--"" ADMIT: ROOM NA PHYS: MEDICATIONS (ADDmOIW. SPACE ON 1IACl) TIME MEDICATION AUT ROIITF ~In: NIT m:~ I'l'}] ~5-T__ Ohll,'fl J 1 Ifl~:'/ l:r ror_ u.o. ~VN:;" l.IS O<M Ue...277 RI..., I / l.Jicf I'IUIT 1Md1ty.__m_' IlK RB. lIB. _"" 18l1O IJSI\ <:pre C<Jdo: lIlI7l1 ..3J HI) . PART I , " I I Ra I\B. . AEl NA. ~~.INSmUCTlONS: I I I IRa:' :r NA. ~ VERBAl INtT: DIAGNOSIS: r)\ r:tf. l~ eCAJI I J N llli , .-' 0 C- _ rt1" J . .aill 1..I1J C I {l r <: rJII\ (LJ 1 ya.+... AJ,.-, j Itli' c..rr-.. "'rl.."r~ n -\::7 'v . . '1/1 {./\ -/1.,1 /1~.,. ..., G..Ld; ;J. PHYSICIAN SIGNATURE r J.AJ I A Jfi, ./ r V v V r -V Bozeman Deaconess Hospital Trauma Rowsheet G-SpIne Immobilized: ~ Removed by TIme: ~Of ArrtvaI: _ Ambulance _ Helicopter _ Private Auto _ Ambulatory _ Other Safety Equlpment: _ Helmet _ Soatbelts}J 0 _ Ch8d Seat _ Protective Clothing _ None TIme of 1r1ury: A/ 1'7 T1me of EO AnfvaI: I f 170 TT AotivalIon: Yea No ER EMS 5 N AN Na e aed Armed Radlology; Portable: C.Splne Chest Pelvis IV '1 12 13 Departmental: Chest Pelvis C-Splne T -spine LS-Sploe NGlOGT Foley Chest Tube DPlAJS FIuicl Wanner Blood Adm Product , of UnIt8 TIme to: _ TIme From: _ CT: Head Abdomen Chest Pelvis Total IV Intake Total Output TIme to:_TIme From:_ Temp Weight LMP Tetanus::~M- Outdated _ GIven: SIte: lot; :=~'f~~~/~ ).. Glasgow Coma Scale ~ Spontal'l8OU5 4 To Voice 3 To Pain 2 None 1 NF-31 3/03 _ Deceased Transfer Facility NoUfled Arrtve Depart Phy8Iclan _ Helicopter _ FIxed Wing _Ground IV Tne!1!PY: TIme Ruld Amt lnlt Y.IxtHlI; Oriented 5 Confused 4 Inappropriate 3 lneomprehenslble 2 ~e 1 6 5 4 3 2 1 RevIsed Trauma, Score: RR:+SBP+QCS RR: SBP: GCS: 1()"29 - 4 >89mmHg "" 4 12-15 '" 4 >29 - 3 >76mmHg - 3 9.12.. 3 5-9 - 2 >5OmmHg - 2 e..s '" 2 1-$ '" 1 >1mmHg '" 1 4-5 _ 1 No pulse - 0 <4 - 0 .-" Mt:Ilac Obeys Command Purpoaetul/Paln WIlhdnlwsIPaln FfexIon Extension None ::tupll Slle: .....e.. 123.5. 1 . Pupil Reaction: S'.. sluggfsh B _ brlsk N EO non-reactlve NWlI89 Notoo 71 1.-1) q7 : ~ :S' I 1 I , MedIcation Bozeman Deac ER ABBOT'!' , DAN V00009093394 MOl14~ MAJXNER MD,R JA DO~ tfBl1io.DDill Diii.....1D Name: ABBOTT, DAN Phys: MAJXNER MD, R JAMES tJOZEMAN DEACONESS HOSPIT '~t..;.:J ',",' '1:' u Age: 44 Sex: M 115 HIGHLAND BL VD ' 'N l~ e:: 093394 Loe: ER 106-585-1035 THIS INF -~ ' " : ENFORC ~'Ei5ru" ,tl.J:J1C ...,MOl148341 ANY UN I '-rEo'\-! Xt-E[ STRICTC I . REG ER IR AI1JEl<?Wl, SPEAKIN:; 'IO FAST, PIEASE FIIL IN BLANK CERVICAL SPINE SERIES RFAS:N FtR EXAM: M:JICR VEIUOE ACf'llltNI', INJURY '10 'mE NEO<., NEX:K PAIN, EVAlIlA1E FCR FAACIURE. Carpariscn - none. FINDIN3S : AP and lateral radicgraphs of the cervical spine were cbtained as well as lateral an:l <:pen m:uth odontoid view radicgraphs of the cervical spine. These radi~a{i:ls dem::nstrate m:derate1y severe l3fXJlrlylosiB an:l degenerative disc disease seen at the (5-6 leveL 'lbere is no evidence of acute fracture or subluxaticn. :>. a::NCU1SIrn : 1. M:x:lerately severe degenerat!'Ve chan3e at the CS-6 level wt no evidence of acute fracture. If patient has clinical synptars of radiculcpathy or myelcpathy than MRI of the cervical spine nay l:e helpful in further evaluatiCll. lEFT FOREARM SERIES: RJW:OIl R:R EXAM: MJICR VEHIOE ACOI>>n'. INJURY 'IO 'mE FtRE:ARM. EVAI.llA1E llQR FRAC1tJRE. O:trpariscn - none. FlNDlN3S : AP and lateral radicgraphs of the left foreann are dJtai.ned denonstrate what appears to be radiopaque debris seen overlyi.n;J the tredi.al aspect of the left wrist. 'Itere is no evidence of acute fracture or dislocaticn alCX1lJ the forearm. PAGE 1. Draft Report Printed From PCl ( CONTINUED) BOZEMAN DEACONESS HOSPITAL 915 HIGHLAND BLVD 80ZEMAN, MT 59715 406-585-1035 Name: ABBOTT t DAN Phys: MAJXNER MD, R JAMES DOB: Age: 44 Sex: M Acct: V00009093394 Loc: ER. . Exam Date: 10/18/2005 Status: REG ER Radiology No: Unit No: M01148341 'T& ~11~&jj.i{ -."~i~~es%@ti~Y. . )~_nt. OJ~~gS aHllEICN, ~ J:\' iCTL'l~R:c;,..'i~EO L PrdJable debris overlyi.nJ the rredi.al aspect of ~ Wrist rot no evidence of acute fractUre. . IEFr HlMEro\L SERIES: RE1\.9:N FOR EXAM: K1IOR VFHIa..E ~. INJURY 'ID '!HE ARM. EVAIJJATE Frn. FRACIURE. CCrrpariaan - none. FINDlN3S : AP anci lateral radiographs of the left burrerus ~ cbtained dem:nstrate no evidence of acute fracture or dislocation. a:N:LlJSICN: .). 1. Onrem3J:kable left hurreral series. ....... cr SCAN OF TIlE BRAIN WI'IlOJI' o:::t'lIRASI': ~ KR EXAM: rvroR. VEHIOE ACCII'ENl'. HFAD INJURY. AI1ImED lEVEL OF CXNSCIaBIESS. EVAIllA'IE F(R INIRACRANIAL INJURY . O:rr{:arlsan - nc:ne. ~: Patient was eK2IIrIined m a .Philips Brilliance 1.6 slice nultidetector cr scanner. M..tltiple 4.5 mn. thick helical cr i.rrages were obtained t.hra1gh the brain witJ:xnt the use of IV cx::ntrast. FINOI:N3S : 'Ihese irrages dem::nstrate 00 evidence of acute cortical infarct or acute intracranial hem::1.rrbage. '!be ventricles appear within xx:mnal limits for size. PAGE 2 Draft Report Printed From PCl ( CONTINUED) BOZEMAN DEACONESS HOSPITAL 915 HIGHLAND BLVD BOZEMAN, MT 59715 406-585-1035 Name: ABBOTT, DAN Phys: MAJXNER MD, R JAMES DOB: Age: 44 Sex: M Acct: V00009093394 Loc: ER Exam Date: 10/18/2005 Status: REG'ER Radiology No: Unit No: MOl148341 I I \ .1.,_ erijf@>rR~M~.*1l0~PISSE:G,q)~ ,ijW~f'i{1a~liItmRPOseslt>NL ' cncr..usICN: ~,(r.blNAUTH(l).I~Z8fr USE IS 1. Ulren'arkable non ccntrast cr scan of the brain. STRICTLV FRCH-<181TED 1U.J;D/ at d:. 10/18/2005 20:34 t: 10/19/2005 09:38 -----------------~------------ RepJrt.ed By: AI.DERMAN, DANIEL M.D. ). ,- cc: R JAMES MAJXNER, M.D.; Technologist: ANDERSON, KIM Transcribed Date/Time: 10/20/2005 (1516) Transcriptionist: TANS Printed Date/Time: 10/20/2005 (1516) PAGE 3 Draft Report Printed From PCI BOzeman Deac ER r r'"'.' I--' .., . --IAL ~=O~~9~ ~~1~~~"" Bozeman Deaconess HOS~MSt:~~~rJ;,;;~;~;~<~'~s4/F.()p I f.g~ IWiRlll1 AFTERCARE INSTRUCT~AC2~~f;,ri::t t l'j~!f~~1.Aw.. ..ai..1 (406) 585.1000 EI>RN.'lrUJllA\l~~ "jj'>i;iQSES.{)P!lV. NOTE: THE EXAMINATION AND TREATMENT YOU HAVE RECEIVED IN THE EMERGENCY DE~e~€tklij Af&MERGENCY BASIS ONLY AND IS NOT INTENDED TO BE A SUBSTI ruTE FOR OR AN EFFORT TO PRCMOE ~l1::lE MEDICI';L ClRij:'IT:IS IMPORTANT THAT YOU LET 'rtlUR DOClDR CHECK 'iOU AGAIN AND THAT YOU REPORT 10 HIM ANY NEW OR REMAINuiiG PR6BLEMS AT THAT TiMe, BECAUSE IT IS IMPOSSIBLE --JO R~nr.NI7F ANn TRI=.u:ALLFI FUI=NTC:: nFIN.llIRV nR III NF<::<:: IN 4 C::IN~I F FUEjDns::W"'V n!;D4RnAliNl IJ.ISQ:, l~ 'YOU hlAD-X-RA\C$TAKIiit>'. THERE MAY HAVE BEEN ONLY A PRELIMINARY READING OF YOUR X-RAYS, IN WHICH CASE. FiNAl REVIEW BY THE "'IADlOLOGIST WILL BE MADE WITHIN 2-4 HOURS. MEANWHILE. FOllOW THE DIRECTIONS BELOW AS INDICATED FOR YOu. H 0 INJURY INSTRUCTIONS REPcl=rr 10 YOUR DOCTOR IMMEDIATELY IF ANYTHING LISTED OCC~S (EVEN W~IN SEVERAL MONTHS). AWAK N PATIENT TIMES THE FIRST NIGHT TO CHECK ,f ~:~I ENT VOMITING, STIFF NECK,. FEVER OR HEADACHE. I ~ UNE AL EYE PUPILS (ONE LA~GE. ONE SMALL). O:::::~Y ANGES IN VISION. ~CON SION OR UNUSUAL DROWSINESS. .L"boN LSIONS OR UNCONSCIOUSNESS. ZoWFI ULTY IN SPEECH OR INABILITY 10 SPEAK. ~U BlING. WEAKNESS OR OTHER PROBLEMS WITH NORMAL USE ARMS OR LEGS; OR AREAS ON SKIN NUMBNESS. ~D NAGE OF BLOOD OR FLUID FROM EARS OR NOSE. LAN TYPE OF UNUSUAL BEHAVIOR. A AlCOHOL. SLEEPING PILLS. TRANQUILIZERS. SEDATIVES. OR aTles FOR 2-4 HOURS. ING STRONGER THAN ASPIRIN OR TYLENOL UNLESS RESCRIBED BY DOCTOR AWARE OF THIS TRAUMA. BACK AND NECK INJURY rNSTRUCTION~ ~ USE HEATICOLD ON INJURED AREA. Co\. )C't... a...t.r S I fA-uJ ~REST AS MUCH AS POSS.lBLE UNTIL YOU ARE IMPROVED. 11..{ U:r ....,('"AVOID POSITIONS AND MOVEMENTS THAT MAKE THE PAIN jVORSE. ". LRELAX, EMQTIONAUY. IF YOU ARE TENSE, THE PROBLEM MAY ,- ...- SEE A PHYSICIAN OR RETURN IF YOU DEVELOP: ~ TINGLING, NUMBNESS, WEAKNESS. OR LOSS OF USE qF ARMS 9R LEGS. LLoss OF CONTROL OF BOWEL OR BLADDER. NARCOTIC MEDICATIONS t.l\..Co~ $/ <;~ TAKE THIS MEDICINE ONLY AS DIRECTED BY YOUR MEDICAL DOCroR. 00 no( lake more of II and do not lake II more ohen or for a longer period of lime lhan ordered. NF.l 6/l o SPRAIN, FRACTURES, SEVERE BRUISES _ ELEVATE THE INJURED PART TO LESSEN SWELLING. _ USE ICE PACKS TO HELP PREVENT SWELLING THE FIRST 48 HOURS. _ IF YOU HAVE AN ElASTIC BANDAGE ON, REWRAP IT IF IT IS TOO TIGHT OR TOO LOOSE. _ IF YOU HAVE A CAST. KEEP IT PERFECTLY DRY AT ALL TIMES. ALLOW CAST TO HARDEN 48 HOURS BEFORE PUTTING PRESSURE OR WEIGHT ON ANY PART OF IT. _ WIGGLE TOES OR FINGERS TO HELP PREVENT SWELLING IN THE CAST. DO THIS OFTEN IF IT IS NOT PAINFUL 10 DO SO. _ IF THE PART SWELLS ANYWAY OR GETS COLO. BLUE. NUMB, OR IF PAIN INCREASES MARKEDLY, HAVE IT CHECKED PROMPTLY. _ REMOVE ACElSPLlNT/SUNG. I. ; WHEN COMFORTABLE WITHOUT rr. IN DAYS. : ~ ONLY WHEN FOLLOW-UP DOCTOR INSTRUCTS YOU. _ SlOP USING CRUTCHES: C: WHEN ABLE 10 WALK WITHOUT PAIN IN DAYS. L: WHEN FOLLOW-UP DOCTOR INSTRUCTS YOU. ~OUND CARE (CUTS, BURNS, ABRASIONS) ~'5EEP THE DRESSINGS CLEAN AND DRY. ./'f:LE"'~TE THE WOUND TO HELP RELIEVE SORENESS AND SPEED HEALING. ~ DESPITE THE GREATEST CARE. ANY WOUND CAN BECOME INFECTED. IF YOUR WOUND BECOMES RED. SWOLLEN. SHOWS PUS OR Reo $TRflAKS, OR FE!:LS MORE SORE INSTEAD OF v!:ESS AS DAYS GO BY. REPORT TO YOUR DOCTOR IMMEDIATELY. ~F RESSINGS NEED 10 BE CHANGED, YOU SHOULD: CHANGE'THEM 0 CALL YOU?V' ........ HAVE SUTURES REMOVED IN -- ~ YS. This medicine wi" add 10 I e effects of alc0hoi and or r CNS depreasants. CHECK WITH YOUR DOCTOR BEFORE TAKING ANY SUCH DEPRESSANTS WHILE YOU ARE USING THIS MEDICATION. CHECK THE LABELS OF ALL NONPRESCRIPTION AND Thi. ~clolt mJY.~ IIOmopeoptlll to become cll'l'JWsy, dizzy or PRESCRIPTION MEDICINES YOU NOW TAKE. If any conlaln lightheaded, or 10 feel 8 false sense of 'MIIJ.being. MAKE SURE YOU acetaminophen or III narcotic, be especially CIlIf9ful. since laking them KNOW HOW YOU REACT 10 THIS MEDICATION BEFORE YOU DANE. white.. 13k1ng IhllI medicine may lead 10 overdose. USE JAAC;tflNES ,OR DO QTHER JOBS THAT REQUIRE YOU 10 BE '1"- 0 ffWk ~ {C L.J.{ lrwr . ALERT AND CLEARHEADED. KEEP THIS AND ALL OTHER MEDICINES OUT OF THE REACH OF CHILDREN AND NEVER SHARE YOUR MEDICINES WITH OTHERS. ~~~~~;;~:S:~ri~iiS~~'l5 ~~I ~11'I\(~a.bO/t..).,IA'llri~~ COWVIl'l5/d7 E THAT ALL PHYSICIAN CARE HAS BEEN PROVIDED BY I EPENDENT MEDiCAl PRACTITIONERS. I ACKOWlEDGE RECEIPT o THE RUCTIONS INDICATED ABOVE. I UNDERSTAND THAT I HAV AD EMERGENCY TREATMENT ONLY. AN THAT I MAY BE RELEASED E AC MY IPS ARE KNCMlN OR T "D. "'ij'firE fUR FOLLCMI.UP RE INSTRUCTED ABOVE. BOZEMAN DEACONESS HOSPITAL Admission/Registration' . lt~"'.tp1AL Tt'Jt~st~NFB~' ~~ 915 Highland Blvd. EE!Nt::(:H~t;e' 't: - y (406) 585-5000 A ,,~,' 1- _ ,_ ,H Il'Y Admit Date/Time: 10/~64 PRH~ 48341 Discharge Date/Time: Service/Location: ER F/e: CO Account No: V00009094780 Room/Bed: Patient Type: ER PATIENT ABBOTT. DAN 1627 W MAIN NO 106 BOZEMAN.MT 59715 (406)539-6931 Employer: SSN:_ DOS: ...... Marital tatus: M Sex: M Age: 44 Phone: GUARANTOR ABBOTT. DAN 1627 W MAIN NO 106 BOZEMAN.MT 59715 Home: (406)539-6931 Work: PERSON TO NOTIFY NEXT OF KIN ABBOTT.ALYSSA 1627 W MAIN NO 106 BOZEMAN.MT 59715 Home: (406)539-6931 Work: Relationship: SP Home: Work: Relationship: INSURANCE POLICY l)PATIENT WILL SUBMIT. 010010001 Reason for Visit: RE CHECK ARM Accident Oeser: Admit PhYSician: Attend Physician: ER Physician: ELSON MD.DOUGLAS R Last Visit Date: 10/18/OS Registrar: SUBSCRIBER ABBOTT. DAN 10/18/05 BURK ICD-9 CODES ./ PROCEDURE CODES CPT -4 CODES EDITING CHECK LIST Edited by: Clear for disch? Yes / No Consent Signed. If not signed. why? Fin/Agreement signed by patient Indicate if you saw patient: Yes I No Medicare appeals letter signed Card/s scanned'! Check payors: Med MA Be Information verifiear--- Other notes: Why ! -, qaest, onn'a 1 re camp 'I e~ea. we Other comm. 11.1111111111111.011 Printed on: 10/19/05 at 1004 by BURK Bozeman D8aconesS_h~O~!FIDEi\JT~i~L Consent for Treat.'~~~~MATION IS FOR IJ\W ENFORCEMENT PURPOSES ONLY. 1. Medical Consent: I hereby consent to the provisions of health care sf,lOfJ~/rJt:Il~Jall6lDdlttllBnJ81ts, such as X-rays. exams, administration of drugs, lab tests, and other hospital @~I:1~~rAAl't~y my physician. I understand that the patient care Is under the control of an Independenl physician aria 'Bt:5l4'lsn6t liable for any act of omission provided the hospital has followed the Instructions of said physlclan(s). Secvlces provided by all physicians are independent of BOH. ( 2. Release of Infannatlon: I will refer to the BOHS Notice of Privacy Practices regarding the release of my health information. 3. Assignments of Benefits: I hereby authorize payment directly to the hospital for the hospital benefits herein specified and otherwise payable to me. I also authorize payments directly to the physlcian(s) providing services to me from the benefits othelWise payable to me. 4. Insurance Disclosure: I understand that It is my responsibility to notify my Insurance company directly within the time limits of my policy, If ~ am admitted to BoH or for pre-authortzatlon of special procedures anellor tests. 6. Financial Agreement: I hereby assume full responsibility for charges I Incur for services from SOH and agree to pay said charges In full. I have given my Insurance Information, If any, to SOH. It Is my understanding that I will be responsible for any balance not paid by this Insurance. If I, or my guarantor, choose to bill my Insurance, my account will be considered as self~pay. If I am unable to pay In full, I will contact the Credit Dept. at 585-1015 to discuss options, with a minimum monthly payment of $100. It Is further understood ~ entire balance, pursuant to this agreement, will be due and payable one year from the date of admission/service. ~ (Guarantor Initials) 6. Personal Valuables: I understand that BOH shall not be liable for personal Items. If admitted, I hava been advised to sand all valuable personal property home. 7. NursIng Care: SOH provides general duty nursing care. If a patient ne&cls continuous or special duty nursing care, the patient. legal representative, or the physician must arrange such care. SOH shall In no way be responsible for faUure to prOVide the same and Is hereby released from any and all liability. 8. Grievance Procedure: All patients have the right to submit a complaint regarding care and services rendered without fear of retribution. As a patlen~, I may communicate my concerns regarding care, services rendered or billing to the BOH Quality Improvement Oepl: at 585-5046 or send It In wrttlng to 915 Highland Blvd., Bozeman, MT 59715-6999. 9. Infonnatlon Practices: I acknowled~recelpt of the BOHS Notice of PrivacY Practices. 10. Patient's Rights & Resp~lItl~S: I understand my patient lights as descr1bed In the Patient's Rights and Reaponslbilltl86 brochure. ~ 8< (Patlent/Respenslble Party fnlttals) 11. Facility Directory: If I am admitted, BOH maintains a faclllty directory that lists my name, room number, and If I wish, my religious affiliation. this Information (excludIng religious affiliation) will be disclosed to anyone who requests It by asking for me by name. I DO NOT want this Information listed in the facility directory. I DO NOT want religious affiliation shared with the clergy. I certify that I have read the above infonnatlon and as the patient, or one who Is duly author1zed to act In a representative capacity for the patient, that the InfO(Tnatlon has b,en fully explained, that I under(ttand its content, that it may not be modllled and that I may n con.ant ~ sarvIcas at any tlma. Patlant/Guarantor Signature: P 'Ij ~ Date: V Relationship to Patient: Witness: Data: 1'Jf~5 Reason Patient Unable to Sign: I acknowledge receipt of an Important Message from Trlcare I acknowledge receipt of an Important Message from Medicare Signature: Date: Signature: Date: Acct#: V00009094780 Name: ABBOTI,OAN MR#: M01148341 SvclLoc: ER 10/19/05 Bozeman Deac tER _ " :...1 . C. J ~-', (:Cd:.NffJ:OcNTiaL _. - ~:gO~BO MOlUB34l 44/M; 80zeMAN DEACONESS HOSPMt:tNf',QffiiM. l\.1'~ NF ELSON MD,OOUGLA DO EMERGENC n ~j:~1 .T. W~ .J.RJli....11 Y DEr'AR1ME"rIN'lT~HO~E[DJ 10/( ,.......... ~,~ fjURSlNG FLOW SHeE'JA _'l'IJI-': ?OO$;j~OOED TlME ARRIVED: {/lfq)- D~ /I)---n HOW MRlVED: AMBULMCE WALK W/C GURNEY CNlRlED.... BROUGHT BY: S8.f CE:I 'T1UI: FRIfHD OTHER PHONE NUMBER: 11 i" _ NURSING HISTORY: J{ I A~ AI) A I V N V'-1..--ffl / I /1 L./ U ~o .~ . GIC UHAESP PU. NON-EOUAl REACTM NON-RfACTM :ACHE: ~ GCS: - EYES MOTOR VERBAl It -- TOTAl I Q. CARDIAC CHEST PAIN; YES NO SEVERRY (HO) RADlAllOtt YES NO 0NSEr. DATE TIME MJNrroR RHYTHM RElPUWOftY ___ BREATH SOUNDS: ClEAR PRESENT ABSENT DIMINISHED WHEEZE CRACKlES COUGH: YES NO CP W/INSP: YES NO SPUTUM Oa: NONE NC fM PKR.OW: PRE _ POST_ --- Ol,m ~ PAIN: ABD PELV FlANK SHARP CRAMPING ACHING BURNING CONSTANT INTERMrmNT RADIATING ASSOC. Sl'MPTOMS: twJSEA VOMITING DIARRHEA BlEEDING DYSURIA HEMATIJRIA URGENCY fREOUENev lAST MEAl : IlUlCULDlmETAL ~ E'xTREMTY: TENDERNESS SWElUNG ECCHYIIOSIS DEFORMITY SENsAmN: NORMAl NUMBNESS TINGliNG fl_ NOfUMl UMfTB) PUlSE: YES NO UflEGUIIEHTARY lACERATION: LENGTH L~TION ABRASION: YES NO lOCATION RASH: YES NO LOCATION BURN: PARTIAl FULL lOCATION HA_ EfNT VISUAl ACUITY OS 00 au NA . ~ nfROAT: PAIN SWEWNG REDNESs DY5PHAGIA PHY'IICIAN ORDERS - UIl .u~~-I) ;:V4ff~t;7/ !YJ?/11/YJ?c/ ,VI: _ ~ '''''1 OC8C'I._ OEKG'I,_ OCHEM'I._ 011lOpr/o_ o AIM.. '10 _ 0 ClCM8 Tlo _ o PT'I, 0 AlIIP/. _ OPTTTfI_ ORAPJOSlR'I, OHCQ'I,_ OUAT/._ o 0 o 0 o 0 PIfYBICWI ORDERS .IWJIOLOS X-RAY o o o o TIME TO CT o o TIME TO us o TIME TO 'I. T/. '1. 'fa 1J'oU /1 ~(&m/ I AiYf~d~/It&tb/a/" FROM_____ '/0 'I. CHIEf COMPlAINT: fROM_ NUCMEO o / /UAJ .?C NURSE SIGNATURE: ~ J /, / VI J.L~ PRIMARY PHYSICM: 0 YES' J!'/1 . (I . o NO ....h~..ft /" FROM_ PHYSICWIS ORDERS - MEDICATI(j AI.l.EROIES: "1" n;rn ~'.- . ... -~. ER PHYSICIAN TO SEE mANUS: o CURRENT o UNKNOWN o OOT-QH)ATE WEIGHT lMP PHYSICIANS ORDElla - PROCEDURI o FOlEY 0 ClEM WOUHO:: o OSU 0 OREll5 WOUNDl 1:1 V1.b EXAM 0 kNI;E IUM o NO 0 AIR STIRRUP o ORllfO lIS 0 SlMG o OLD CHART 0 WRIST SPl o 0 o 0 o >. -.- TIME T P R BP, I~ %!f~t IRJ ~ ~ ~ ~ ~ PHYIICWCS ORDERS - PREPACKS I1I/3tI1 ~ ? 0-- P 8P TIME TIME FSBS IV THERAPY R.UlD INmAl CArn SITE RATE TOTAl PHY8ICIAIIS OROERS - PftESCRIPTIOIf. TIW: MEDICATIONS (ADDI11OIIAL SPACE 011 WK) AUT ROim SITE WIT ~ DISPOsmON PART ' " -1iOMi'-.. POlICE DEe R8. Hi( ADUlT: ROOM PART _ 1'tUV<\. RB. ..... ro".. lW\T RB. PART lIB. lla. 10 lIB. Ill) AS. NO RB. 1(1 llEL fM DISC~~m~s:_ }veRlIAlJ INR: fM . c' '. .-/"<' JI1 -..;:::::>> lIB. A8. DIAGNOSIS: I'-<,,~ RB. (.P:tS:.-, ~/ (~ ~jJ -/ STICI(EA l. O. PHYSICIAN SIGNATURE WUUNU 1iMt: ._h_ , ,. CllAIaN8: STERILE WATER f) ".."_ GLENS III I'MT HYDROGEN PEROXIDE BET ADINE fIB. RI!l. NA HIBIGLENS CASTILE NO fMT As.. Aa leA DfIE88IN8: CONFORM ACE WRAP BETADINE NO PART AOAPTIG KERLEX SILVADENE Ra fIB. NA POLYSPORIN NUGAUZE STERI STRIP NO PAIIT GAUZE 4 X 4'8 (10PK) BACTOBAN BANOAlDE fIB. AS. NA NO PART ruBE GAUZE RB. Ra leA DATE TIME NURSES NOTES: >- ..-' NURSES SIGNATURE: o SEE CODE SlEET CJ SEE TRAUMA SHEET 0 lEE ADDmONAL MURSlNI Mom f\f)--~ PHYIICIAN 8IBNATURE: ~~ ~......: ~ J ( ~ , ~ ,f ,~'i -~~\'- CONTINGENT FEE EMPLOYMENT AGREEMENT WALTERH. MADDEN KARL KNUCHEL Attorneys at Law 116 West Callender P.O. Box 953 Livingston, MT 59047 Gentlemen: You are hereby employed to represent me, Cole Ingram, individually and as Personal Representative of the Estate of Kayle Ingram with respect to all claims for damages both incurred by Kyle Ingram and myself arising out of the following: Automobile accident of October 18,2005, on North 19th A venue in Bozeman, Montana in which Kayle Ingram was a passenger in a vehicle being operated by David Cherry. For your services you shall receive the following: Twenty-five percent (25%) of the gross amount recovered by settlement. If the case is tried. the fee would be forty percent (40%) of the amount recovered from the trial. You shall be promptly reimbursed for all court costs advanced by you and any other expenses necessarily incurred in the prosecution of the claim whether said prosecution is successful or not. You are hereby authorized to take such action on behalf of the undersigned as in your jlldgment may be necessary or desirable for the proper handling of the above claim. . Each of us shall keep the other fully informed at all stages of the proceedings relative to the prosecution of the above claim and no settlement shall be made unless acceptable to all parties hereto. ! DATED thi~ day October, 2005. ividually and as Personal e Estate of Kayle Ingram /, . Madden and Karl Knuchel. ~ ~(2) c~oss SECTIONELEMEt;r8 December 2000 .. In urban/suburban areas. Seqtion 11.2.4 provides Inrormation on design details for 8 TVVL TL. 11.3.2.2 __Ised MedI.. A median Is defined as 8 ra~ median if it contains 8: raised portion within Ita limits. Raised medians may be used bn urban end IUburban htghway8 and streets to control ecceas and left turns. The use of raised medians Is not recommended adjacent to high-- speed lanes N > 70 kmJh}. ~ .,~ ~ Advantaoes VVhen compared to flush medl8Jf1s, raised medians offer several advant8ges: 1. MJd..bIock left tLwns are controlled. 2. Left-tum chamellzation 08n be more effectively deJlneated. 3. A dlsthct Ioc8Uon Is available for trsrrJc signs. BignIlIII8 and pedestr1an refuge. 4. Limited physical separation Is available. 5. UnoonttoIled erose-tnmlc movemera ere prevented. 6. RedUC8 the potential for ~ead-on oolli8tor'ts. Dl8advant8aes The disadvtlnt8Q88 of raised medians wtwn compared to flush medians ere~ ~ 1. Access for emergency W1h1clM (e.g., fire, 8I'11buln:8) may be men dIIicufl 2. Prohibiting mJd--bJock left hnl8 may overload ...t Inter8ectIons and may Increase the numb<< aflHu'ns. They also may Impact other A Nta In the corridor. 3. They may need greater roedw8y widths to serve the earns function (e.g., Ieft-tum lanes at intersections) bec:8use fA the rafMd Island and otfa4tt between c.rb and travel lane. ~ 4. --'? 5. 6. Curbs may result In adver8e vehicular behavior upon Impact. They ere more exp<<lllve to construct and more dltllcult to maintain. Prohibiting mid-block Ieft-tums causes drivers to take alternative 8CC88S routes to and from adjacent propart~s. " - December 2000 c~oss SECTION ElEMEtfTS 11.3@ ~ Desion If a raised median will be used, consider the following In the design c:I the median: ~ 1. ~. Mountable concrete curbs are used for railed medians. ~ 3. Surf8cina. The raised portiOn of the median wID be psried, typically with concrete. 7> 4. ~ Wlere raised medlml 8re used, the roedway mLllt be Ught8d and the medians must be delineated. Existiog Evaluate all existing raised mledlans within the project Ilmila for their current appropriateness. The existing configIntion of the I'llIsed median should be evaluated with Its consistency to the existing' geometric needs. This includes sight distance for the :'~ ,,' - "" 48. 49. so. 51. 52. 53. 54. ~8) GLOSSARYIINDEX December 2000 44. .LmL.I.IIm!a. Level t9l1l'81n is generally COI'lIIdered to be flat, and has minimal impact on vehicular performance. HJghWay elglht distances are either long or could be made long without major c:onetnJctlon expense. .Ls. length of spiral. Low-Soeed j,frb8n StreIU. 1heIe are all streeta within urbanized and smell urban areas with a d$S1gh speed 0170 kmlh or lese. Maximum S~. The overall ~1IW8t1on control used on fa specific facQity. Ita selection depends on aeversl fllctora Including overall climatic conditions, terrain cond~, type of facility end type d .... (rural or l.Wban). ~. Channelization which Mp8I'8teS opposing traffic flows, 818m. the driver to tho cross rosd ahe8d and tegu1ate8 traffic through the 1nt8l"MCtion. MftdIIn. The portion of 8 divided highway eeparating tho two traveled Wttf8 for traffic In opposite d~.. The median width incbtes both Inside $houIders. Median Ooenfng. OpenIngs in the median (raised or depre8sed) on divided facilities which allow vehldle8 to aoss the facility or to make a u-turn. Median SIooe. The slope In the ansa section view of a d&pre888d median beyond the surfacing inelaper &xpressed as a retlo of the cIw1ge In horizontal to the ch8nge in vertical. Morne~ ~. A aite where en upgrudG ia preceded by 8 d6Nngrade, thereby allcrNlng 8 tnJck to increase Its speed on tho upgrade. lhie Incr8a8e In speed allows the detlgner to use . higher speed ftIClIt.IctIDn in the' critJcIIllength of grade fbn. ~ Curb. A longitudinal element, typ~ concrete, pIaoed at the roadway edge for dellneetion, to control drainage. to 'control 8CCeS8, etc. Mountable oorbs have 8 height of 160 mm or leas wflh 8 face no eteepet tha11 horizontal to 3 vertical. . 45. 46. 47. .YOtJI1ainous T erraIQ. longitudinal and tr8nIVerI8 changes fn elevatiOn ana abrupt. Benching and aide, hili 8XCfWatIon are frequently required to provide the desirable histawaY allgrment. Motnainous lenah eggravatea the performance of trucks relstlve to passenger cara, resulting In 8Ort1e trucks operating at alIWI speeds.