### NO. 03-15-00596-CV
IN THE COURT OF APPEALS THIRD DISTRICT OF TEXAS, AUSTIN
GRACY WOODS I NURSING HOME Appellant,
v. MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OFMARY RIVERA Appellee.
ON INTERLOCUTORY APPEAL FROM THE 250TH

### JUDICIAL DISTRICT, TRAVIS COUNTY, TEXAS
APPELLANT’S BRIEF
EMILY J. DAVENPORT STATE BAR NO. 24012501 REED, CLAYMON, MEEKER & HARGETT, PLLC 5608 PARKCREST DRIVE, SUITE 200 AUSTIN, TEXAS 78731 (512) 660-5960 TELEPHONE (512) 660-5979 FACSIMILE ATTORNEYS FOR APPELLANT 

### ORAL ARGUMENT REQUESTED ACCEPTED 03-15-00596-CV 7771576 THIRD COURT OF APPEALS

AUSTIN, TEXAS 11/10/2015 3:54:12 PM JEFFREY D. KYLE

CLERK

### i 

### IDENTITY OF PARTIES AND COUNSEL Pursuant to TEX

### . R. APP

### . 38.1(a), Appellant certifies that the following is a complete list of all parties to this litigation and the names and addresses of all counsel. Party Appellate Counsel Trial Counsel Gracy Woods I Nursing Home, Appellant Emily J. Davenport Janice Byington Reed, Claymon, Meeker & Hargett, PLLC 5608 Parkcrest Drive Suite 200 Austin, Texas 78731 edavenport@rcmhlaw.com jbyington@rcmhlaw.com Emily J. Davenport Janice Byington Reed, Claymon, Meeker & Hargett, PLLC 5608 Parkcrest Drive Suite 200 Austin, Texas 78731 edavenport@rcmhlaw.com jbyington@rcmhlaw.com Martha Mahan, as the Representative of the Estate of Mary Rivera, Appellee Jack Modesett, III ModesettWilliams, PLLC 515 Congress Avenue Suite 1650 Austin, Texas 78701 jack@modesettlaw.com

### ii 

### TABLE OF CONTENTS Page IDENTITY OF PARTIES AND COUNSEL .............................................. i TABLE OF CONTENTS ............................................................................ ii INDEX OF AUTHORITIES ...................................................................... iv ABBREVIATIONS AND RECORD REFERENCES ............................. viii APPENDIX ................................................................................................ ix STATEMENT OF THE CASE .................................................................. x STATEMENT REGARDING ORAL ARGUMENT .................................. 1 STATEMENT OF JURISDICTION .......................................................... 1 ISSUE PRESENTED ................................................................................ 1 Does Dr. Lipson’s report represent a good faith effort to comply with TEX

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### §74.351? STATEMENT OF FACTS ......................................................................... 2 SUMMARY OF THE ARGUMENT .......................................................... 4 ARGUMENT AND AUTHORITIES ......................................................... 6 I. Standard of Review ................................................................. 6 II. The Expert Report Requirement ............................................ 7 III. The Four Corners Rule .......................................................... 10 IV. Dr. Lipson is Not Qualified to Offer the Opinions Asserted in His Report ........................................................... 11

### iii 

### A. Dr. Lipson is Not Qualified to Offer Causation Opinions, Particularly That a Sexual Assault Occurred ............................................................................. 11 B. Dr. Lipson is Not Qualified to Offer Opinions Concerning Gracy Woods’ Standard of Care or Alleged Breach ................................................................... 13 1. The expert must be qualif ied on standard of care and breach ..................................................................... 13 2. Dr. Lipson did not establish his qualification ............. 17 V. Dr. Lipson’s Report is Conclusory, Based on Assumption and, Therefore, Deficient ....................................................... 20 A. Dr. Lipson’s Report is Deficient as to the Element of Breach ................................................................................ 20 B. Dr. Lipson’s Report is Deficient as to the Element of Causation ........................................................................... 23 CONCLUSION ......................................................................................... 27 PRAYER .................................................................................................... 28 CERTIFICATE OF COMPLIANCE ........................................................ 30 CERTIFICATE OF SERVICE.................................................................. 31

### iv 

### INDEX OF AUTHORITIES Page CASES Am. Transitional Care Ctrs. v. Palacios, 46 S.W.3d 873 (Tex. 2001) ............................. 5, 6, 7, 9, 10, 15, 20, 21, 22, 23, 24,28 Austin Heart, P.A. v. Webb , 228 S.W.3d 276 (Tex.App. –Austin 2007, nopet.) .......................................... 9, 10, 20 Bowie Memorial Hosp. v. Wright , 79 S.W.3d 48 (Tex. 2002) ......................................................................... 6, 9, 10, 23 Broders v. Heise , 924 S.W.2d 148 (Tex. 1996) .................. 4, 10, 11, 12, 13 Certified EMS, Inc. v. Potts, 392 S.W.3d 625 (Tex.2013) ................... 6, 26 Christus Health Southeast Texas v. Broussard , 267 S.W.3d 531 (Tex.App. –Beaumont 2008, no pet.) .............................................. 16 Cooper v. Arizpe , 2008 WL 940490 (Tex.App. –San Antonio 2008, pet. denied) ................................ 6, 26 Cortez v. Tomas , 2012 WL 407382 (Tex.App. –Fort Worth 2012, no pet.) ............................................. 13 Costello v. Christus Sant a Rosa Health Care Corp. , 141 S.W.3d 245 (Tex.App. –San Antonio 2004, no pet.) ........................................... 25 Earle v. Ratliff , 998 S.W.2d 882 (Tex. 1999) ............................................. 9 Foster v. Zavala, 214 S.W.3d 106 (Tex.App.—Eastland 2006, pet. denied) ......................................... 19 Fung v. Fischer, 365 S.W.3d 507 (Tex.App.-Austin 2012, no pet.) .................................................. 6, 26

### v 

### Hutchinson v. Montemayor , 144 S.W.3d 614 (Tex.App. –San Antonio 2004, no pet.) ........................................... 26 In re Samonte , 163 S.W.3d 229 (Tex.App. –El Paso 2005, orig. proceeding) ........................ 11, 15, 28 In re Windisch , 138 S.W.3d 507 (Tex.App. –Amarillo 2004, orig. proceeding) .................................. 28 Jelinek v. Casas , 328 S.W.3d 526 (Tex. 2010) ............................................... 5, 6, 7, 9, 20, 23, 24, 27, 28 Jones v.King , 255 S.W.3d 156 (Tex.App. –San Antonio 2008, pet. denied))................................... 10 Kerlin v. Arias , 274 S.W.3d 666, 668 (Tex. 2008) ................................... 22 Kettle v. Baylor Med. Ctr. , 232 S.W.3d 832 (Tex.App. –Dallas 2007, pet. denied) .......................................... 7, 10 Lenger v. Physician’s Gen. Hosp. , 455 S.W.2d 703 (Tex. 1970) ............. 23 Lewis v. Funderburk , 253 S.W.3d 204 (Tex. 2008) ................................... 8 Ly v. Austin , 2007 WL 2010757 (Tex.App. –Austin 2007, no pet.) ................................ 4, 6, 10, 15, 18 Methodist Hosp. Levelland v. Kimbrell , 2009 WL 3101315 (Tex.App. –Amarillo 2009, no pet.) ................................................. 15 Murphy v. Mendoza , 234 S.W.3d 23 (Tex.App. –El Paso 2007, no pet.) ................................................... 26 Nacogdoches County Hosp. Dist. v. Felment , 2013 WL 6207838 (Tex.App. –Tyler 2013, no pet.)........................................... 16, 18, 19 Nexion Health v. Treybig , 2014 WL 7499373 (Tex.App. –Dallas 2014, no pet.) ................................. 5, 7, 16, 19, 28

### vi 

### Pediatrix Med. Servs. Inc. v. De La O , 368 S.W.3d 34 (Tex.App.–El Paso 2012, no pet.) .................................................... 13 Reed v. Granbury Hosp. Corp.,117 S.W.3d 404 (Tex. App. – Ft. Worth 2003, no pet.) ................................... 5, 16, 19 Samlowski v. Wooten , 332 S.W.3d 404 (Tex. 2011) ................................ 20 Scoresby v. Santillan , 346 S.W.3d 546 (Tex. 2011) ............................. 9, 10 Senior Care Centers, LLC v. Shelton , 459 S.W.3d 753 (Tex.App. –Dallas 2015, no pet.)..................... 5, 6, 21, 22, 23, 24, 27 Shelton v. Sargent , 144 S.W.3d 113 (Tex. App. – Ft. Worth 2004, pet. denied) ................................ 17, 19 Tenet Hosps. Ltd v. Love , 347 S.W.3d 743 (Tex.App. –El Paso 2011, no pet.) ............. 5, 7, 16, 18, 19, 23, 24, 28 Tomasi v. Liao , 63 S.W.3d 62 (Tex.App. –San Antonio 2001, no pet.) ..................................... 15, 18 Walker v. Packer , 827 S.W.2d 833 (Tex. 1992) ......................................... 6 STATUTES TEX

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### § 51.014(a)(9) ............................................ 1 TEX

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### § 74.351 ........................................... passim TEX

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### § 74.351(a) ............................................ 3, 7 TEX

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### § 74.351(b) ............................................ 1, 7 TEX

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### § 74.351(c) ................................................. 7 TEX

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### § 74.351(l) ........................................... 8, 28

### vii 

### TEX

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### § 74.351(r)(5) ...................................... 4, 14 TEX

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### § 74.351(r)(6) .... 5, 9, 10, 20, 23, 24, 27, 28 TEX

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### § 74.402 ..... 4, 10, 13, 14,15, 16, 18, 19, 28 TEX

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### § 74.403 ............................. 4, 10, 11, 13, 28 TEX

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### . 702 ...................................................................... 4, 12, 13, 28

### viii 

### ABBREVIATIONS AND RECORD REFERENCES Abbreviations: Appellee, Martha Mahan, as the Representative of the Estate of Mary Rivera, will be referred to as “Mahan.” Mary Rivera will be referred to as “Ms. Rivera.” Appellant, Gracy Woods I Nursing Home, 1

### will be referred to as “Gracy Woods.” The Texas Medical Liability Act will be referred to as “TMLA.” TEX

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### §74.001-§74.507. Record References: References to the Clerk’s Recordare in the form of “CR _____.” References to the Clerk’s Supplemental Record are in the form of “Supp. CR ___.” References to the Reporter’s Record are in the form of “RR ___.” References to Appendix items attachedto the Brief are in the form of “App. ___.”

1Gracy Woods was sued as “Gracy Woods I Nursing Home.” Appellant is actually known as PM Management – Austin NC, LLC d/b/a Gracy Woods Nursing Home (also referred to herein as “Gracy Woods”). (CR 8).

### ix 

### APPENDIX Order Denying Defendant’s Motion to Dismiss ....................... Appendix 1 Defendant’s Motion to Dismiss ................................................. Appendix 2 Plaintiff’s Response to Defendant’s Motion to Dismiss ........... Appendix 3 Defendant’s Objections to Plaintiff’s Expert Report and Curriculum Vitae ............................................................... Appendix 4 Report of Loren Lipson, M.D. .................................................... Appendix 5 Curriculum Vitae of Loren Lipson, M.D................................... Appendix 6

### x 

### STATEMENT OF THE CASE Nature of the Case This is a health care liability claim. (CR 3, 4). Gracy Woods is a nursing home where Ms. Rivera resided. Id . Mahan has sued on behalf of Ms. Rivera’s estate. Id . Mahan claims that Ms. Rivera was sexually assaulted at Gracy Woods. (CR 4).
Trial Court 200th

### District Court, Travis County, Texas, Honorable Gisela D. Triana, Presiding. Filed in 250th

### District Court, Travis County, Texas.
Course of the Proceedings and Disposition December 11, 2014: December 12, 2014: January 30, 2015:
February 20, 2015: Mahan filed suit. (CR 3). Gracy Woods filed its Original Answer. (CR 8). Mahan served the report and curriculum vitae of Loren Lipson, M.D. (CR 11). Gracy Woods filed its objections to Dr. Lipson’s report and curriculum vitae. (CR 101).

### xi 

### April 11, 2015:
August 12, 2015: August 24, 2015: August 25, 2015: September 1, 2015: September 17, 2015: The 120-day expert report deadline expired. (CR 8). TEX

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### §74.351(a). Gracy Woods filed its Motion to Dismiss. 2

### (CR 301). Mahan filed her response. (CR 376). The trial court heard oral argument. (CR 374, RR 1). The trial court denied Gracy Woods’ Motion to Dismiss. (CR 446). Gracy Woods filed its Notice of Accelerated Appeal. (CR 447).

2Proceedings against Gracy Woods were abated for 60 days on March 4, 2015 pursuant to TEX. CIV. PRAC. & REM. CODE § 74.052 due to Mahan’s failure to identify physicians and health care providers in her presuit notice and authorization. (CR 196, 269). TEX. CIV. PRAC. & REM. CODE § 74.052.

### 1 

### STATEMENT REGARDING ORAL ARGUMENT Gracy Woods requests oral argument pursuant to TEX

### . R. APP

### . P 39.1 and respectfully submits that oral argument would aid the Court in determining the legal and factual issues presented in this appeal. STATEMENT OF JURISDICTION Gracy Woods seeks interlocutory relief from an order denying a motion to dismiss pursued under Section 74.351(b) of the Texas Civil Practice and Remedies Code. (CR 446). TEX

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### §74.351(b). This Court has jurisdiction pursuant to Section 51.014(a)(9) of the Texas Civil Practice and Remedies Code. TEX

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### §51.014(a)(9). ISSUE PRESENTED Does Dr. Lipson’s report represent a good faith effort to comply with TEX

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### §74.351?

### 2 

### STATEMENT OF FACTS Gracy Woods is a nursing home. (CR 3-4). Ms. Rivera, now deceased, was a resident of Gracy Woods. Id . Mahan, Ms. Rivera’s daughter, has sued Gracy Woods on behalf of Ms. Rivera’s estate. 3 

### Id
. Mahan filed suit on December 11,2014, alleging that Ms. Rivera was sexually assaulted at Gracy Woods on November 10, 2012. 4

### (CR 3-4). Mahan claims that she discovered the alleged assault, based on what Mahan describes as “signs of a struggle in her mother’s room” and “bloody tissue in the bathroom trash can.” Id . at 4. In her petition, Mahan claims that a Sexual Assault Nurse Examination (referred to herein as the “SANE nurse report”) “indicated sexual assault on Ms. Rivera.”5 

### Id
.

3

### Mahan was appointed guardian of Ms. Rivera in June 2013. Ms. Rivera objected to Mahan’s appointment. According to the Order Appointing Permanent Guardian, Mahan was prohibited from removing Ms. Rivera from Gracy Woods without further order from that court. (CR 69). 4 

### The petition asserts that a sexual assault occurred on November 10, 2012. (Supp. CR 4). Dr. Lipson’s report implies that an assault allegedly occurred on the night of November 8, 2013. (CR 17). The SANE report, reviewed by Dr. Lipson and filed with his report, contends that the date and time of the alleged assault were unknown and occurred “perhaps early 11/8/13.” (CR 92). 5

### According to the SANE nurse report, Ms. Rivera recalled no sexual contact. (CR 96).

### 3 

### Mahan alleges that Gracy Woods failed to protect Ms. Rivera from sexual assault. 6

### (CR 5). (Supp. CR 4). Gracy Woods denies Mahan’s allegations. (CR 8). Gracy Woods filed its Original Answer on December 12, 2014. Id
. Mahan served the report and curriculum vitae of Loren Lipson, M.D., on January 30, 2015, in an attempt to comply with the 120-day expert report deadline. (CR 11). TEX

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### §74.351. Gracy Woods timely filed objections tothe report and curriculum vitae on February 20, 2015. (CR 101). TEX

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### §74.351(a). The 120-day deadline for Mahan to serve a compliant expert report expired on April 11, 2015. (CR 8). TEX

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### §74.351(a). Gracy Woods filed its Motion toDismiss on August 12, 2015. (CR 301). Mahan filed her response on August 24, 2015. (CR 376). The Honorable Gisela Triana heard oralargument on August 25, 2015. (CR 374, RR 1).

6 

### On behalf of Ms. Rivera’s estate, Mahan seeks punitive damages and damages for pain, suffering, mental anguish, disability, reasonable and necessary medical expenses, lost earning capacity, loss of household services, and past and future medical care. (CR 5). (Supp. CR 5).

### 4 

### Judge Triana denied Gracy Woods’Motion to Dismiss on September 1, 2015. (CR 446). Gracy Woods filed its Notice of Accelerated Appeal on September 17, 2015. (CR 447). SUMMARY OF THE ARGUMENT Dr. Lipson’s report is deficient and does not satisfy the expert report requirement set forth in TEX

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### § 74.351. Qualification on Sexual Assault Dr. Lipson is not qualified to of fer the opinion that Ms. Rivera was sexually assaulted. Dr. Lipson lacks the requisite knowledge, skill, experience, training or education regarding the diagnosis or treatment of sexual assault to opine that an assault occurred. TEX

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### § 74.351(r)(5)(C), § 74.403; TEX

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### . 702; Broders v. Heise , 924 S.W.2d 148, 153 (Tex. 1996); Ly v. Austin , 2007 WL 2010757, at *2 (Tex.App. –Austin 2007, no pet.). Qualification on Nursing Home Standards of Care Dr. Lipson has not shown that heis qualified by training or experience to offer the standard of care opinions at issue. TEX

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### § 74.351(r)(5)(C), §74.402; Ly , 2007 WL 2010757, at *5 (generalized, conclusorystatements do not establish an expert’s

### 5 

### qualification); Nexion Health at Garland, Inc. v. Treybig , 2014 WL 7499373, at *4 (Tex.App. –Dallas 2014, no pet.); Reed v. Granbury Hosp. Corp.,117 S.W.3d 404, 411-414 (Tex. App. – Ft. Worth 2003, no pet.). Opinions on Breach Dr. Lipson’s report is deficient as to the element of breach. (CR 15- 21). Dr. Lipson’s report offers no explanation based in fact as to when the alleged assault occurred, where the alleged assault occurred, who committed the alleged assault, or how Gracy Woods departed from its applicable standards of care to prevent the alleged assault. (CR 15-21). Am. Transitional Care Ctrs. v. Palacios , 46 S.W.3d 873, 880 (Tex. 2001)(breach cannot be inferred exclusively from an alleged injury); Senior Care Centers, LLC v. Shelton , 459 S.W.3d 753, 758 and 760 (Tex.App. –Dallas 2015, no pet.)(plaintiff’s affidavit does not supply a basis any greater than the expert’s own conclusions). Opinions on Causation Dr. Lipson’s report is deficient asto the element of causation. Dr. Lipson offers no explanation to link his conclusions to the facts. TEX

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### § 74.351(r)(6); Jelinek v. Casas , 328 S.W.3d 526, 539- 40 (Tex. 2010); Tenet Hosps. Ltd v. Love , 347 S.W.3d 743, 755 (Tex.App.

### 6 

### –El Paso 2011, no pet.) (“... causation cannot be inferred; it must be clearly stated.”). Dr. Lipson’s opinions are based on assumption. Fung v. Fischer, 365 S.W.3d 507, 533-34 (Tex.App.-Austin 2012, no pet.), overruled on other grounds byCertified EMS, Inc. v. Potts, 392 S.W.3d 625 (Tex.2013); Cooper v. Arizpe , 2008 WL 940490, at *3-4 (Tex.App. – San Antonio 2008, pet. denied). He fails to explain how – if at all – he eliminated causes other thansexual contact. (CR 15-21). Jelinek , 328 S.W.3d at 536; Senior Care Centers, LLC , 459 S.W.3d at 759. ARGUMENT AND AUTHORITIES I. Standard of Review. A challenge to a trial court’s decision concerning the sufficiency of an expert report is reviewed for abuse of discretion. Am. Transitional Care Ctrs. v. Palacios , 46 S.W.3d 873, 875, 877-78 (Tex. 2001). An abuse of discretion occurs when a trial court acts in an arbitrary or unreasonable manner or without reference to any guiding rules or principles. Bowie Memorial Hosp. v. Wright , 79 S.W.3d 48, 52 (Tex. 2002). A clear failure by the trial court to analyze or apply the law correctly constitutes anabuse of discretion. Walker v. Packer , 827 S.W.2d 833, 840 (Tex. 1992); Ly , 2007 WL 2010757, at *3.

### 7 

### A court has no discretion to findthat a conclusory report is sufficient. Palacios , 46 S.W.3d at 880; Jelinek v. Casas , 328 S.W.3d 526, 540 (Tex. 2010); Kettle v. Baylor Med. Ctr. , 232 S.W.3d 832, 837 (Tex.App. –Dallas 2007, pet. denied). It is an abuse of discretion to overrule a defendant’s objection whenqualification is not demonstrated in the report. Nexion Health v. Treybig , 2014 WL 7499373, at * (Tex.App. –Dallas 2014, no pet.); Tenet Hosps. Ltd. , 347 S.W.3d at 752. II. The Expert Report Requirement. Section 74.351 of the Texas Civil Practice and Remedies Code requires a health care liability claimant to serve on each defendant one or more expert reports, with corresponding curricula vitae, no later than 120 days of the date the original answer was filed. TEX

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### §74.351(a). Section 74.351 provides: (a) In a health care liability claim,a claimant shall, not later than the 120th

### day after the date each defendant’s original answer is filed, serve on that party or the party’s attorney one or more expert reports, with a curriculum vitae of each expert listed in the report for each physician or health care provider against whom a liability claim is asserted. ... (b) If, as to a defendant physician or health care provider, an expert report has not been served within the period specified by Subsection (a), the court, on the motion of

### 8 

### the affected physician or health care provider, shall, subject to Subsection (c), enter an order that: (1) awards to the affected physician or health care provider reasonable attorney’sfees and costs of court incurred by the physician or health care provider; and (2) dismisses the claim with respect to the physician or health care provider, with prejudice to the refiling of the claim. (c) If an expert report has not been served within the period specified by Subsection (a) because elements of the report are found deficient,the court may grant one 30- day extension to the claimant in order to cure the deficiency. ... TEX

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### §74.351(a)-(c). Dismissal is mandatory if no report is served within the 120-day deadline. Id . at § 74.351(b). A deficient report, even if timely served, does not satisfy the statute. Lewis v. Funderburk , 253 S.W.3d 204, 207-08 (Tex. 2008). A report is deficient whenit “does not represent an objective good faith effort to comply with the definition of an expert report.” TEX

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### §74.351(l ). The statute defines “expert report” as: a written report by an expert that provides a fair summary of the expert’s opinions as of the date of the report regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to

### 9 

### meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed. Id . at §74.351(r)(6). To qualify as a “good faith effort” and satisfy the statute, the report must provide enough information to fulfill two purposes. First, the report must inform the defendant of the specific conduct the plaintiff has called into question. Second, and equally important, the report must provide a basis for the trial court to conclude that the claims have merit. Scoresby v. Santillan , 346 S.W.3d 546, 556 (Tex. 2011), citing Am. Transitional Care Ctrs of Tex., Inc. v. Palacios , 46 S.W.3d 873, 879 (Tex. 2001). The report or reports must include the expert’s opinion on all three elements – standard of care, breach and causation. Scoresby , 346 S.W.3d at 556; Palacios , 46 S.W.3d at 878-79. A report cannot merely state the expert’s conclusions about the elements, but rather, the expert must explain the basis of his statements to link his conclusions to the facts. Jelinek v. Casas , 328 S.W.3d at 539; Bowie v. Wright , 79 S.W.3d 48, 52 (Tex. 2002)(quoting Earle v. Ratliff , 998 S.W.2d 882, 890 (Tex. 1999); Palacios , 46 S.W.3d at 879; Austin Heart, P.A. v. Webb , 228 S.W.3d 276, 279 (Tex.App. –Austin 2007, no pet.). It is not enough that the report “provide insight” about the

### 10 

### plaintiff’s claims. Jones v. King , 255 S.W.3d 156, 159 (Tex.App. –San Antonio 2008, pet. denied). Also, the author of the report must be qualified. TEX

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### § 74.351(r)(6), § 74.402 (defining qualifications of an expert witness as to departures from the standard of care), and § 74.403 (defining the qualifications of an expert on causation); Broders , 924 S.W.2d at 153; Ly v. Austin , 2007 WL 2010757, at *2 (Tex.App. –Austin 2007, no pet.)(“an ‘expert report’ first must be a ‘written report by an expert .’”)(emphasis in original). III. The Four Corners Rule. When evaluating the report, the court must not fill gaps or draw inferences with respect to opinions or qualification. 7 

### Scoresby , 346 S.W.3d at 556; Wright , 79 S.W.3d at 53; Palacios , 46 S.W.3d at 878 (“... the only information relevant to the inquiry is within the four corners of the report.”); Austin Heart, P.A. , 228 S.W.3d at 279 (the four corners rule “precludes a court from filling gaps ina report by drawing inferences or guessing as to what the expert likely meant or intended to say.”); Ly v.

7 

### Reports should not be construed in favor of the claimant. Kettle v. Baylor Med. Ctr. , 232 S.W.3d 832, 837 (Tex.App. –Dallas 2007,pet. denied (emphasis supplied); Palacios , 46 S.W.3d at 877 (directing courts not to indulge in reasonable inferences in favor of the nonmovant).

### 11 

### Austin , 2007 WL 2010757, at *2; In re Samonte , 163 S.W.3d 229, 234 (Tex.App. –El Paso 2005, orig. proceeding). IV. Dr. Lipson is Not Qualified to Offer the Opinions Asserted in His Report. A. Dr. Lipson is Not Qualified to Offer Causation Opinions, Particularly That a Sexual Assault Occurred. Ms. Rivera did not claim that she was sexually assaulted. (CR 15- 22). According to the records Dr. Lipson reviewed, Ms. Rivera did not recall having any sexual contact. (CR 16, 96). Dr. Lipson is not qualified to conclude that Ms. Rivera’s alleged injuries and behavior were the result of sexual assault. TEX

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### § 74.403(a); Broders , 924 S.W.2d at 152-53. The TMLA provides that “... a person may qualify as an expert on the issue of the causal relationshipbetween the alleged departure from accepted standards of care and the in jury, harm or damages claimed only if the person is a physician and is otherwise qualified to render opinions on that causal relationship underthe Texas Rules of Evidence.” TEX

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### § 74.403(a). The Texas Rules of Evidence state that “[i]f scientific, technical, or other specialized knowledge will assistthe trier of fact to understand the

### 12 

### evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education may testify thereto in the form of an opinion or otherwise.” TEX

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### . 702. Every licensed doctor is not automatically qualified to testify as an expert on every medical question. Broders , 924 S.W.2d at 152. “What is required is that the offering party establish that the expert has ‘knowledge, skill, experience, training, or education’ regarding the specific issue before the court which would qualify the expert to give an opinion on that particular subject .” Id . (emphasis supplied). Dr. Lipson does not claim to haveany expertise in the diagnosis of sexual assault. (CR 15-67). Dr. Lipson’sreport does not show that he has ever examined a patient for sexual assault, diagnosed a patient with sexual assault, or treated a patient for sexual assault. Id . Dr. Lipson’s report does not reveal that he has any experience treating any injury or conditions of the female genitalia or even performing pelvic examinations. Id
. Dr. Lipson’s opinions do not rise above mere speculation. He simply lacks the special knowledge, skill, experience, training, or education to testify that Ms. Rivera’s alleged injuries were caused by sexual assault.

### 13 

### (CR 15-67). TEX

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### §74.403; TEX

### . R. EVID

### . 702; Broders , 924 S.W.2d at 152-54 (f inding that an emergency medicine physician was not qualified to offer opinions that earlier diagnosis and treatment of a head injury would have prevented the patient’s death due to lack of experience treating head injuries); Cortez v. Tomas , 2012 WL 407382, at *3, 6 (Tex.App. –Fort Worth 2012, no pet.)(finding that a Board-certified OB/GYN was not qualified to offer causation opinions concerning the outcome of an ovarian surgery due to lack of experience performing the surgery); Pediatrix Med. Servs. Inc. v. De La O , 368 S.W.3d 34, 39-40 (Tex.App.–El Paso 2012, no pet.) (finding that a Boardcertified neonatologist and pediatrician was not qualified to render opinions as to the cause of a baby’s blindness). B. Dr. Lipson is Not Qualified to Offer Opinions Concerning Gracy Woods’ Standard of Care or Alleged Breach. 1. The expert must be qualified on standard of care and breach. To offer opinions on the issue of whether a health care provider departed from the accepted standards of health care, the expert must satisfy the requirements of TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.402: (b) In a suit involving a health care liability claim against a health care provider, a person may qualify as an expert witness on the issue of whether the health care provider

### 14 

### departed from accepted standards of care only if the person: (1) is practicing health care in a field of practice that involves the same type of care and treatment as that delivered by the defendant health care provider, if the defendant health care provider is an individual, at the time the testimony is given or was practicing that type of health care at the time the claim arose; (2) has knowledge of accepted standards of care for health care providers for the diagnosis, care, or treatment of the illness, in jury, or condition involved in the claim; and (3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards of health care. (c) In determining whether a witness is qualified on the basis of training or experience, the court shall consider whether, at the time the claim arose or at the time the testimony is given, the witness: (1) is certified by a licensing agency of one or more states of the United States or a national professional certifying agency, or has other substantial training or experience, in the area of health care relevant to the claim; and (2) is actively practicing healthcare in rendering health care services relevant to the claim. TEX

### . CIV

### . PRAC

### . & REM

### . CODE

### §74.402(b) and (c), §74.351(r)(5)(B).

### 15 

### “Practicing health care” includes: (1) training health care providers in the same field as the defendant health care provider at an accredited educational institution; or (2) serving as a consulting health care provider and being licensed, certified, or registered in the same field as the defendant health care provider. Id . at §74.402(a). Generalized, conclusory statementsdo not establish an expert’s qualification; the report must provide specific details regarding the expert’s training and experience. Ly , 2007 WL 2010757, at *5 (emphasis supplied); Tomasi v. Liao , 63 S.W.3d 62, 66 (Tex.App. –San Antonio 2001, no pet.); Methodist Hosp. Levelland v. Kimbrell , 2009 WL 3101315, at *2 (Tex.App. –Amarillo 2009, no pet.)(“... we must know not only what the nurse was obligated to do but alsohow the expert knew that.”); In re Samonte , 163 S.W.3d at 234; see Palacios , 46 S.W.3d at 879 (“the only information relevant to the inquiry is within the four corners of the document.”). Experience as a physician – evenexperience as a physician who treats geriatric patients in nursing homes – does not automatically establish expertise on nursing home standards of care. TEX

### . CIV

### . PRAC

### . &

### 16 

### REM

### . CODE 

### § 74.402(b); Nexion Health at Garland, Inc. v. Treybig , 2014 WL 7499373, at *4 (Tex.App. –Dallas 2014, no pet.)(a physician’s statement that he has provided primary care to patients in nursing homes did not establish the physician’s familiarity with nursing home standards of care); Nacogdoches County Hosp. Dist. v. Felment , 2013 WL 6207838, at *3-4 (Tex.App.–Tyler 2013, no pet.)(a physician who served on hospital ethics and bylaws committees was not qualified to offer opinions concerning hospital protocols); Tenet Hosps. Ltd. v. Love , 347 S.W.3d 743, 750-51 (Tex.App. –El Paso2011, no pet.) (“merely working for a hospital does not automatically qualify an expert with experience in running a hospital, nor does serving on a committee without further explanation as to whether those committees involved determining hospital policies and procedures...”); Christus Health Southeast Texas v. Broussard , 267 S.W.3d 531, 536 (Tex.App. –Beaumont 2008, no pet.)(“[t]he fact that [Dr.] Peters is on staff at a hospital and serves on the hospital’s credentials committee does not establish that he possesses specialized knowledge of the protocols,policies, or procedures a hospital of ordinary prudence would have in place ... .”); Reed v. Granbury Hosp. Corp., 117 S.W.3d 404, 411-414 (Tex. App. – Ft. Worth 2003, no pet.)(a

### 17 

### board certified emergency medicine physician and neurologist with thirty years of experience treating stroke patients was not qualified to offer opinions on standards of care for hospital policy relating to administration of stroke therapy); Shelton v. Sargent , 144 S.W.3d 113, 123 (Tex. App. – Ft. Worth 2004, pet. denied) (a physician’s experience on tumor boards and staffs of various hospitals did not qualify the physician to offer opinions on hospitalstandards of care relating to the diagnosis of cancer). 2. Dr. Lipson did not establish his qualification. Dr. Lipson describes his experience as follows: I am familiar with the problem of sexual assault in the nursing home setting. I am familiar with the standard of care for preventing such assaults. I continue to treat patients in the long term care setting and have done so for more than thirty years. I am familiar with the standard of care for the treatment of patients like MaryRivera and familiar with the required training of employees providing care to residents like Mary Rivera. (CR 16). Dr. Lipson does not explain the foundation for his familiarity with sexual assault in nursing homes, or how he knows the standard of care to prevent sexual assault in nursing homes. (CR 16). Further, Dr. Lipson does not explain how or why he knows the standard of care for training

### 18 

### employees in nursing homes. (CR 16). Dr. Lipson cannot utilize generalized, conclusory statementsto establish his qualification. Ly , 2007 WL 2010757, at *5; Tomasi , 63 S.W.3d at 66; see also TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.402. He must provide specific details of his training and experience and relate that to the specific issue in this case. Ly , 2007 WL 2010757, at *5; Tenet Hosps. Ltd. , 347 S.W.3d at 750-51; Tomasi , 63 S.W.3d at 66; Nacogdoches County Hosp. Dist. , 2013 WL 6207838, at *3-4. Dr. Lipson asserts that the standard of care requires nursing staff to be in each resident’s room, the adjacent room, or moving through the hall next to the room at all times. (CR 20). Dr. Lipson also asserts that nursing staff should have be walking the halls at intervals not to exceed ten minutes and documenting “regularchecks” in residents’ charts. Id
. Dr. Lipson provides no basis or explanation as to how or why he allegedly knows these measures were required by the standard of care for nursing home staffing and documentation. (CR 15-67). Dr. Lipson’s report does not establish that he has ever participated in determining nursing home staffing levels or supervising nursing home staff, or that he has any expertise to opine that the standard of care requires nursing

### 19 

### staff to walk the halls at intervals not to exceed ten minutes. Id . Dr. Lipson’s report does not show any basis, nor does he offer any explanation, as to how he would know the documentary requirements for nursing home staff, generally, or inrelation to performing “regular checks” on residents. Id
. Dr. Lipson’s report does not establish that he has the requisite expertise to offer opinions on the alleged nursing home standards of care at issue or as set forth in his report, and consequently, his report is deficient. (CR 15-67). TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.402; Treybig , 2014 WL 7499373, at *4-6; Nacogdoches County Hosp. Dist. , 2013 WL 6207838, at *3-4; Tenet Hosps. Ltd. , 347 S.W.3d at 750-51; Christus Health Southeast Texas , 267 S.W.3d at 536; see also Reed,117 S.W.3d at 411-414; Shelton v. Sargent , 144 S.W.3d at 123; Foster v. Zavala, 214 S.W.3d 106, 116 (Tex.App.—Eastland 2006, pet. denied)(concluding that an expert report by a person not qualified to testify regarding the standard of care does not represent a good faith effort to comply with the statute.).

### 20 

### V. Dr. Lipson’s Report is Conclusory, Based on Assumption and, Therefore, Deficient. To satisfy the “good faith effort” requirement, the report must include all the required elements and explain their connection to the defendant’s conduct in a non-conclusory fashion. Samlowski v. Wooten , 332 S.W.3d 404, 410 (Tex. 2011); Jelinek , 328 S.W.3d at 539; Palacios , 46 S.W.3d at 879. The trial court’s analysisis limited to the four corners of the report, and the court may not consider extrinsic evidence or supply omissions by inference. Bowie Mem’l Hosp. v. Wright , 79 S.W.3d 48, 53 (Tex. 2002); Palacios , 46 S.W.3d at 878. A. Dr. Lipson’s Report is Deficient as to the Element of Breach. Dr. Lipson’s report is deficient asto the element of breach because he offers only conclusory opinions without the requisite factual basis and explanation. (CR 15-21). TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.351(r)(6). Consequently, the report does not provide the court with a reasonable basis to conclude the claims have merit. (CR 15-21). Palacios , 46 S.W.3d at 878-9; Austin Heart, P.A. v. Webb , 228 S.W.3d 276, 279 (Tex.App. – Austin 2007, no pet.)(the trial court isprecluded from drawing inferences or filling gaps).

### 21 

### Dr. Lipson alleges that “[t]he facility breached the standard of care by not providing twenty-four hour skilled nursing care. The nursing staff was not present in the halls or her room to prevent the sexual assault of Ms. Rivera.” (CR 20). Dr. Lipson offersno factual basis for these opinions, and therefore, they are deficient. (CR 15-21). Palacios , 46 S.W.3d at 879. The opinions are further conclusorybecause they require the court to infer that a breach occurred based solely on the alleged injury. (CR 20). A finding of negligence may not be inferred solely on evidence of an alleged injury. Palacios , 46 S.W.3d at 880 (breach cannot be inferred from the existence of an injury alone because the doctrine of res ipsa loquitur generally does not apply in health care liability claims);Senior Care Centers, LLC v. Shelton , 459 S.W.3d 753, 758 (Tex.App. –Dallas 2015, no pet.); see also TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.303(e)(2)(jury instruction for health care liability claims) and § 74.201 (provision limiting application of res ipsa loquitur). Dr. Lipson also asserts that “[t]hefacility breached the standard of care by not preventing access to her room by unsupervised males.” (CR 20). Dr. Lipson does not explain – with any basis in fact – when the assault allegedly occurred, where the assault allegedly occurred, or who

### 22 

### allegedly assaulted Ms. Rivera. (CR 15-21). His allegations that the facility allowed access to Ms. Rivera’s room by unsupervised males is merely conclusory and, therefore, deficient. Id .; Palacios , 46 S.W.3d at 879. Dr. Lipson alleges that “[t]he records do not indicate any checks on Ms. Rivera the night she was assaulted.” (CR 20). Dr. Lipson does not provide any factual basis as to which night he claims the alleged assault occurred. (CR 15-21). The court mustinfer that date based on Dr. Lipson’s reliance on Mahan’s affidavit regarding broken Christmas ornaments. 8

### (CR 17). Dr. Lipson also asserts that “[t]hefacility breached the standard of care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room.” (CR 20). Dr. Lipson does not identify the location of Ms. Rivera’s room or its proximity to the nursing station, nor does he describewhere Ms. Rivera allegedly should have been moved in relation tothe nursing station. (CR 15-21).

8 

### Mahan’s allegations and affidavit do not supply Dr. Lipson with the necessary rational basis for his opinion to any greater degree than if they were his own belief about the facts. Senior Care Centers, LLC , 459 S.W.3d at 760, citing Kerlin v. Arias , 274 S.W.3d 666, 668 (Tex. 2008).

### 23 

### Dr. Lipson’s opinions concerning Gracy Woods’ alleged breach are deficient because they do not include the requisite explanation and connection to the facts. TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.351(r)(6); Jelinek , 328 S.W.3d at 539-40; Palacios , 46 S.W.3d at 879-80. Dr. Lipson’s bare conclusions do not provide the court with a reasonable basis to conclude that the claim has merit. Palacios , 46 S.W.3d at 879-80. B. Dr. Lipson’s Report is Deficient as to the Element of Causation. Causation cannot be inferred; it must be clearly stated. Senior Care Centers, LLC v. Shelton , 459 S.W.3d 753, 760 (Tex.App. –Dallas 2015, no pet.); Tenet Hosps. Ltd. v. Love , 347 S.W.3d 743, 755 (Tex.App. –El Paso 2011, no pet.). The causal connection in health care liability claimsmust be made “beyond the point of conjecture” and “must show more than a possibility.” Lenger v. Physician’s Gen. Hosp. , 455 S.W.2d 703, 706 (Tex. 1970); see Wright , 79 S.W.3d at 53; algreen Co. v. Hieger , 243 S.W.3d 183, 186-87 (Tex.App. –Houston [14th

### Dist.] 2007, pet. denied)( report stating that the patient had symptoms “consistent with” known side effects of medication was insufficient to demonstrate causal link).

### 24 

### An expert report cannot simply opine that the breach caused the injury. Jelinek v. Casas , 328 S.W.3d 526, 539 (Tex. 2010). Otherwise, the report does not give the trial court any reasonable basis for concluding that the claims have merit. Id .; Palacios , 46 S.W.3d at 879; Jelinek , 328 S.W.3d at 539-40 (reiterating that the expert must explain, to a reasonable degree, how and why the breach caused the injury based on the facts presented); Senior Care Centers, LLC , 459 S.W.3d at 760 (holding that the statement “neglect of [the patient] ... caused her to aspirate food into her airway, causing acute respiratory failure and is the proximate cause of her death,” was insufficient to satisf y the element of causation); Tenet Hosps. Ltd. v. Love , 347 S.W.3d 743, 755 (Tex.App. –El Paso 2011, no pet.). Dr. Lipson does not explain, to any reasonable degree, how an alleged breach by Gracy Woods caused the injuries, damages or harm asserted in this litigation. (CR 15-21). TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.351(r)(6). He simply states “[s]hewas sexually assaulted.” (CR 20). Dr. Lipson does not explain how an alleged failure to conduct hallway surveillance every ten minutescaused the alleged assault. (CR 15-21). Dr. Lipson does not explain how or why the alleged assault would

### 25 

### have been prevented but for such surveillance. Id .; see e.g., Costello v. Christus Santa Rosa Health Care Corp. , 141 S.W.3d 245, 249 (Tex.App. –San Antonio 2004, no pet.)(the reportwas deficient because it failed to explain how the alleged breach was a substantial factor in bringing about the injury, without which the injury would not have occurred). Similarly, Dr. Lipson does not explain how the location of Ms. Rivera’s room in proximity to the nursing station caused the alleged sexual assault. (CR 15-21). Dr. Lipson does not explain how an unidentified, unsupervised male allegedly accessed Ms. Rivera’s room, nor does he explain how moving Ms. Rivera to a different room would have prevented that alleged access. Id . Accordingly, the report does not provide the court with a reasonable basis to conclude the claim has merit. Dr. Lipson’s report is equally conclusory as to the question of whether sexual contact occurred. (CR 15-21). Dr. Lipson does not explain how he concluded that the alleged injuries were sexual in origin. Id . Dr. Lipson does not explain how he determined that Ms. Rivera’s alleged presentation as “tearful and afraid” was the result of sexual assault rather than her depression and dementia, which was documented in his report. (CR 17, 20). Dr. Lipson does not explain how he concluded that

### 26 

### the physical findings were caused bysexual contact rather than medical examination or routine perineal care. 9

### (CR 15-21). (RR 11). Connecting the opinion to the facts is key. Reports based on assumption, speculation, conjecture or contradictory statements do not provide the trial court with a basis to conclude the claim has merit. Fung v. Fischer, 365 S.W.3d 507, 533-34 (Tex.App.-Austin 2012, no pet.)(opinion was deficient because itturned on assumption unsupported by the report), overruled on other grounds by Certified EMS, Inc. v. Potts, 392 S.W.3d 625 (Tex.2013); Cooper v. Arizpe , 2008 WL 940490,at *3-4 (Tex.App. –San Antonio 2008, pet. denied)(report was deficient because it relied on the assumption of what was contained in the emergency department chart); Murphy v. Mendoza , 234 S.W.3d 23, 28 (Tex.App. –El Paso 2007, no pet.)(report was deficient because it was based on an assumption that recuts of pathology slides were identical to the originals)(emphasis in original); Hutchinson v. Montemayor , 144 S.W.3d 614, 617-18 (Tex.App. –San Antonio 2004, no pet.)(report was deficient because it did not show more than possibility and speculation that the

9 

### Ms. Rivera had an extensive list of physicians and health care providers, but Dr. Lipson limited his analysis of medical records to Gracy Woods and St. David’s Hospital. (CR 16, 282-92). See also CR 105 (Gracy Woods’ objection to Dr. Lipson’s limited review of Ms. Rivera’s medical records).

### 27 

### patient would have had a better outcome had an arteriogram been performed). When the facts support equal inferences from which different conclusions could be drawn, the expert must explain how he eliminated the possibilities not chosen to reach his conclusion. Senior Care Centers, LLC , 459 S.W.3d at 753, citing Jelinek , 328 S.W.3d at 536. A conclusion should be rejected if it is not accompanied by an explanation demonstrating why the other, rationalpossibilities are inferior to the chosen conclusion. Jelinek , 328 S.W.3d at 536; Senior Care Centers, LLC , 459 S.W.3d at 759-60. Dr. Lipson assumes that Ms. Rivera experienced sexual contact, without excluding other, innocuous causes. Consequently, his report is deficient. Jelinek , 328 S.W.3d at 536; Senior Care Centers, LLC , 459 S.W.3d at 759-60. CONCLUSION Dr. Lipson’s report does not represent a good faith effort to comply with TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.351(r)(6). Dr. Lipson is not qualified to render the opinions contained in his report, as to the standard of care, alleged breach, or the purported causal

### 28 

### relationship. (CR 15-67). TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.402, §74.403; TEX

### . R. EVID

### . 702. As such, the trial court abused its by overruling Gracy Woods’ objections to Dr. Lipson’s lack of qualification. Nexion Health v. Treybig , 2014 WL 7499373, at * (Tex.App.–Dallas 2014, no pet.); Tenet Hosps. Ltd. , 347 S.W.3d at 752; In re Samonte , 163 S.W.3d 229, 237-38 (Tex.App. –El Paso 2005,orig. proceeding); In re Windisch , 138 S.W.3d 507, 514 (Tex.App. –Amarillo 2004, orig. proceeding). Additionally, the trial court abused its discretion in finding Dr. Lipson’s report satisfies TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.351(r)(6) because the report is conclusory and, therefore, deficient as to the elements of breach and causation. (CR 15-21). TEX

### . CIV

### . PRAC

### . & REM

### . CODE 

### § 74.351 (l ), (r)(6); Palacios , 46 S.W.3d at 880; Jelinek v. Casas , 328 S.W.3d at 540. PRAYER Gracy Woods prays that the Court reverse the trial court’s Order Denying Defendant’s Motion to Dismiss and that the Court render dismissal of all claims against Gracy Woods with prejudice to their refiling. Gracy Woods seeks such other relief that the Court deems appropriate.

### 29 

### Respectfully submitted, By: /s/ Emily J. Davenport EMILY J. DAVENPORT State Bar No. 24012501 JANICE M. BYINGTON State Bar No. 24006938 REED, CLAYMON, MEEKER & HARGETT, PLLC 5608 Parkcrest Drive, Suite 200 Austin, Texas 78731 (512) 660-5960 Telephone (512) 660-5979 Facsimile ATTORNEYS FOR APPELLANT

### 30 

### CERTIFICATE OF COMPLIANCE I hereby certify that the foregoing brief has been compiled using a computer program in Word with 14-point font conventional typeface for the body of this brief. Excluding the portions of the brief exempted pursuant to rule 9.4 of the Texas Rules of Appellate Procedure, this petition for writ of mandamus contains 6,113 words. /s/ Emily J. Davenport Emily J. Davenport

### 31 

### CERTIFICATE OF SERVICE Pursuant to rule 9.5 of the Texas Rules of Appellate Procedure, I hereby certify that a true and correct copy of the foregoing instrument has been served electronically through the electronic filing manager or sent by e-mail, if possible, and alsoby certified mail, return receipt requested on the Appellee this 10th

### day of November, 2015: Jack Modesett, III ModesettWilliams, PLLC 515 Congress Ave., Suite 1650 Austin, Texas 78701 jack@jmodesettlaw.com /s/ Emily J. Davenport Emily J. Davenport

### 446 DC BK15246 PG179



### CAUSE NO. D-1-GN-14-005169 Filed in The District Court of Travis County, Texas 

## SEP - 12015
MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA, 

### § § § § § § TRAVIS COUNTY, TEXA


### v. PM MANAGEMENT- AUSTIN NC, LLC 

### § d/b/a GRACY WOODS I NURSING HOME 

### § 250TH JUDICIAL DISTRICT

ORDER DENYING DEFENDANT'S MOTION TO DISMISS

# On~**c~ ~~fi.eard**  Defendant's Motion to Dismiss in this matter. Having heard the evidence and arguments ofcounsel in this matter the Court hereby denies in all things Defendant's motion.

# 5~/J 

# --k L 

# rL**~ ~~**  .2G1> 0

# ~ k1wA.. £)

# ~ J6DGEPRESIDING



### 1111111111111111111111111111111111111111111111111111111 004195097 

# ®!J

### 301 8/12/2015 4:05:13 PM

CAUSE NO. D-1-GN-14-005169
MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA 

## v. GRACY WOODS I NURSING HOME 

### § § § § § § § IN THE DISTRICT COURT

TRAVIS COUNTY, TEXAS 250TH JUDICIAL DISTRICT
DEFENDANT'S MOTION TO DISMISS 

### TO THE HONORABLE COURT: Velva L. Price District Clerk Travis County D-1-GN-14-005169

Tamara Franklin



### NOW COMES Defendant Gracy Woods I Nursing Home, actually known as PM Management- Austin NC, LLC d/b/a Gracy Woods Nursing Center ("Defendant"), and files its Motion to Dismiss pursuant to TEX. Crv. PRAC. & 

### REM. 

### CODE §74.351(b) and would respectfully show: I. 

### This is a motion to dismiss a health care liability claim pursuant to TEX. Crv. PRAC. & 

### REM. 

### CODE. §74.351(b). Plaintiff filed suit on December 11, 2014, alleging that Ms. Rivera was sexually assaulted while a resident at Gracy Woods. Defendant filed its answer the next day, December 12, 2014, denying Plaintiff's allegations. Plaintiff served the report and curriculum vitae ofLoren Lipson, M.D., on January 30, 2015 in an effort to comply with the 120-day expert report rule. 1 

### Gracy Woods timely filed its objections? In summary, Defendant objected that Dr. Lipson is not qualified to offer the opinions stated in his report, that Dr. Lipson's opinions are conclusory and speculative, and that Dr. Lipson relies on and incorporates causation opinions

1 True and correct copies of Dr. Lipson's report and curriculum vitae are attached hereto as Exhibits A and B, respectively, and incorporated herein for all purposes. 2 Defendant previously filed its Objections to Plaintiffs Expert Report and Curriculum Vitae. Defendant incorporates its Objections to Plaintiffs Expert Report and Curriculum Vitae herein by reference pursuant to Rule 58 ofthe Texas Rules of Civil Procedure. 1

### 302 from witnesses who are barred from offering opinions pursuant to TEX. Crv. PRAC. & 

### REM. CODE §74.402 and §74.403. More than 120 days have expired since Defendant filed its original answer
on December 12, 2014, and Defendant seeks dismissal pursuant to TEX. Crv. PRAC. & 

### REM. CODE §74.351(b). II. 

### Section 74.351 ofthe Texas Civil Practice and Remedies Code provides: (a) In a health care liability claim, a claimant shall, not later than the 120th day after the date each defendant's original answer is filed, serve on that party or the party's attorney one or more expert reports, with a curriculum vitae of each expert listed in the report for each physician or health care provider against whom a liability claim is asserted. The date for serving the report may be extended by written agreement of the affected parties. Each defendant physician or health care provider whose conduct is implicated in a report must file and serve any objection to the sufficiency of the report not later than the later of the 21st day after the date the report is served or the 21st day after the date the defendant's answer is filed, failing which all objections are waived. (b) If, as to a defendant physician or health care provider, an expert report has not been served within the period specified by Subsection (a), the court, on the motion of the affected physician or health care provider, shall, subject to Subsection (c), enter an order that: (1) awards to the affected physician or health care provider reasonable attorney's fees and costs of court incurred by the physician or health care provider; and (2) dismisses the claim with respect to the physician or health care provider, with prejudice to the refiling ofthe claim. (c) If an expert report has not been served within the period specified by Subsection (a) because elements of the report are found deficient, the court may grant one 30-day extension to the claimant in order to cure the deficiency
.... TEX. Crv. PRAC. & 

### REM. CODE §74.351(a)-(c). III. 

### A report "has not been served" under the statute when it has been physically and timely served but is found deficient by the trial court. 

### Lewis v. Funderburk, 253 S.W.3d 204, 207-08 2

### 303 (Tex. 2008). A report is deficient when it "does not represent an objective good faith effort to comply with the [statute's] definition of an expert report." Tex. Civ. Prac. & Rem. Code §74.351 (!). The statute defines "expert report" as "a written report by an expert that provides a fair summary of the expert's opinions as of the date of the report regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed." 

### !d. §74.351(r)(6). 

### IV. To qualify as a "good faith effort," the report must provide enough information to fulfill two purposes. First, the report must inform the defendant ofthe specific conduct the plaintiffhas called into question. Second, and equally important, the report must provide a basis for the trial court to conclude that the claims have merit. 

### Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011), 

### citing Am. Transitional Care Ctrs ofTex., Inc. v. Palacios, 46 S.W.3d 873, 879 (Tex. 2001). No particular words or formality are required, but bare conclusions will not suffice. 

### Palacios, 46 S.W.3d at 879. The report must address all elements, and omissions may not be supplied by inference. 

### !d.; Bowie Mem 'l Hasp. v. Wright, 79 S.W.3d 48, 53 (Tex. ("[t]he report must include the required information within its four comers."). The trial court is precluded from filling gaps by drawing inferences or guessing as to what the expert likely meant or intended to say. 

### Austin Heart P.A. v. Webb, 228 S.W.3d 276, 279 (Tex.App. -Austin 2007, no pet.). 

## v. OBJECTIONS TO QUALIFICATIONS An expert report is not adequate unless the author is qualified. 

### Ly v. Austin, 2007 WL 2010757, at *2 (Tex.App. -Austin 2007, no pet.) ("an 'expert report' must first be a 'written report by an 

### expert."') (emphasis in original); 

### In re Windisch, 138 S.W.3d 507, 511 (Tex.App.- 3

### 304 Amarillo 2004, orig. proceeding). The author must be qualified to offer opinions regarding the
care which is the specific subject of the claim against the defendant. Broders v. Heise, 

### 924 S.W.2d 148, 153 (Tex. 1996); Cortez v. Tomas, 

### 2012 WL 407382, at *3. Analysis ofthe expert's qualification is limited to the four comers of the report and the expert's CV. Cortez, 

### 2012 WL 407382, at *3; Ly v. Austin, 

### 2007 WL 2010757, at *2 (reiterating that the "report itself must establish the expert's qualifications on the basis of training and experience"); Foster v. Zavala, 

### 214 S.W.3d 106 (Tex.App. -Eastland 2006, pet. denied); In re Samonte, 

### 163 S.W.3d 229, 234 (Tex.App. -El Paso 2005, orig. proceeding); In re Windisch, 

### 138 S.W.3d at 511; Palacios, 

### 46 S.W.3d at 879. VI. 

### For someone offering opinion testimony regarding the standard of care and alleged breach, the statute defines an "expert" as follows: (a) For the purposes ofthis section, "practicing health care" includes: (1) training health care providers in the same field as the defendant health care provider at an accredited educational institution; or (2) serving as a consulting health care provider and being licensed, certified, or registered in the same field as the defendant health care provider. (b) In a suit involving a health care liability claim against a health care provider, a person may quality as an expert witness on the issue of whether the health care provider departed from accepted standards of care only ifthe person: (1) is practicing health care in a field ofpractice that involves the same type of care and treatment as that delivered by the defendant health care provider, if the defendant health care provider is an individual, at the time the testimony is given or was practicing that type ofhealth care at the time the claim arose; (2) has knowledge of accepted standards of care for health care providers for the diagnosis, care, or treatment of the illness, injury, or condition involved in the claim; and

4

### 305 (3) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards ofhealth care. (c) In determining whether a witness is qualified on the basis of training or experience, the court shall consider whether, at the time the claim arose or at the time the testimony is given, the witness: (1) is certified by a licensing agency of one or more states ofthe United States or a national professional certifying agency, or has other substantial training or experience, in the area ofhealth care relevant to the claim; and (2) is actively practicing health care in rendering health care services relevant to the claim. TEX. Crv. PRAC. & 

### REM. CODE §74.351(r)(5)(B), §74.402. VII. 

### For someone offering opinion testimony as to the alleged causal relationship, the statute defines "expert" as a physician who is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence. 

### !d. at §74.351(r)(5)(C), §74.403 ("
... a person may qualify as an expert witness on the issue of the causal relationship between the alleged departure from accepted standards of care and the injury, harm, or damages claimed only if the person is a physician and is otherwise qualified to render opinions on that causal relationship under the Texas Rules of Evidence."); TEX. R. Evm. 702 ("If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training or education may testify thereto in the form of an opinion or otherwise."). The expert must have knowledge, skill, experience, training, or education regarding the 

### specific issue before the court that would qualify the expert to give an opinion on that particular subject. 

### Broders v. Heise, 924 S.W.2d 148, 153 (Tex. 1996).

5

### 306 VIII. A. LOREN LIPSON, MD, IS NOT QUALIFIED TO OFFER CAUSATION OPINIONS. Dr. Lipson does not claim to have any special training or experience in the diagnosis or treatment of gynecological illnesses or injuries, nor does he claim to have any special knowledge, skill, experience, training or education in the diagnosis or treatment of sexual assault. Exhibits A and B. Nothing in Dr. Lipson's report or curriculum vitae indicates that he has ever diagnosed a sexual assault or rendered any treatment to a patient following an alleged sexual assault. 

### !d. Nothing in Dr. Lipson's curriculum vitae or his report indicates that he lectures on sexual assault or gynecological illnesses or injuries relevant to this claim or that Dr. Lipson has any other special knowledge in the diagnosis or treatment of sexual assault. 

### !d. Dr. Lipson has failed to establish that he has any special knowledge, skill, experience, training or education on the specific issues in this case: whether Ms. Rivera sustained injuries and whether those injuries, if any, were caused by a sexual assault. Exhibits A and B; TEX. Crv. PRAC. & 

### REM. CODE §74.403; TEX. R. Evm. 702; 

### Broders, 924 S.W.2d at 152-54. Although Dr. Lipson is a physician, his opinions on causation do not rise above mere speculation. 

### !d. at 153. Dr. Lipson is not qualified to offer the opinions asserted in his report concerning Ms. Rivera's alleged sexual assault, and consequently, his report is deficient. TEX. Crv. PRAC. & 

### REM. CODE §74.351, §74.403; TEX. R. Evm. 702; 

### Broders, 924 S.W.2d at 152-54 (finding that an emergency medicine physician was not qualified to offer opinions regarding causation in a head injury case); 

### Pediatrix Med. Servs. Inc. v. De La 0, 368 S.W.3d 34, 39-40 (Tex.App.-El Paso 2012, no pet.) (finding that a Board-certified neonatologist and pediatrician was not qualified to render an expert opinion as to the cause of a baby's blindness); 

### Cortez, 2012 WL 407382, at *3, 6 (finding that a Board-certified OB/GYN was not qualified to offer causation opinions
6

### 307 concemmg an ovanan surgery because the physician lacked surgical expenence removmg ovaries and relating to injury to the patient's bowel). 

### B. JENNY BLACK, RN, IS NOT QUALIFIED TO OFFER CAUSATION OPINIONS. Plaintiff served a statement by Jenny Black, RN, but failed to serve any corresponding curriculum vitae. According to her statement, Ms. Black is a nurse but not a physician. Therefore, she is not qualified to make medical diagnoses or offer causation opinions in this litigation? TEX. Crv. PRAC. & 

### REM. CODE §74.351(r)(5)(C), §74.403 (limiting causation opinions only to physicians who are otherwise qualified pursuant to the Texas Rules ofEvidence); TEX. R. Evm. 702; 

### Costello v. Christus Santa Rosa Health Care, 141 S.W.3d 245, 248-49 (Tex.App.

- San Antonio 2004, no pet.)(discussing nurses' lack of qualification to render medical opinions in expert reports). C. 

### LOREN LIPSON, MD, IS NOT QUALIFIED TO OFFER LIABILITY OPINIONS. Dr. Lipson has failed to establish that he has the requisite knowledge, training or experience in the operation, management or supervision of nursing homes to offer the opinions asserted in his report. TEX. Crv. PRAC. & 

### REM. CODE §74.402. Dr. Lipson claims that he continues to treat patients in the long term care setting, but neither his report nor his CV identifies a medical practice or a long term care facility where such treatment occurs. Exhibits A and B. Dr. Lipson does not explain how that alleged experience or experience in geriatric medicine qualify him to offer opinions relating to nursing home standards of care. 

### !d. Dr. Lipson does not appear to have any current Board Certification in geriatric medicine. Exhibit A at 1.

3 Dr. Lipson's reliance on Ms. Black's opinion does not qualify it for the purposes ofTEX. Crv. PRAC. & REM. CODE §74.403 and TEX. R. Evm. 702, because Dr. Lipson is not qualified by his own special knowledge, skill, experience, training or education in the diagnosis and treatment of sexual assault. See, e.g., Kelly v. Rendon, 255 S.W.3d 665 (Tex.App. -Houston [14 1 h Dist.] 2008, no pet.) (finding that "[w]hile a nurse's report, standing alone, is inadequate to meet the requirements ofthe statute as to medical causation, nothing in the health care liability statute prohibits an otherwise qualifiedphysician from relying on a nurse's report in the formation of the physician's own opinion.") (emphasis added). 7

### 308 Dr. Lipson's report and CV do not describe events in the last decade where he has had responsibility for the operation or management of a nursing home, nor does he appear to have had the responsibility as the medical director of any nursing home. 

### !d. Dr. Lipson offers conclusory statements regarding his alleged familiarity with the standard of care by stating "I am familiar with the standard of care for the treatment ofpatients like Mary Rivera and familiar with the required training of employees providing care to residents like Mary Rivera," but he provides
no facts in support ofthose assertions. Exhibit A at 2. Dr. Lipson's conclusory statements do not establish qualification on the specific issues in this case. "An expert cannot rely on generalized, conclusory statements to establish [his] qualifications; [he] must provide specific details of [his] training and experience." Ly 

### v. Austin, 2007 WL 2010757, at *5 (Tex.App. -Austin 2007, no pet.) (affirming the trial court's decision that a Board Certified Physical Medicine and Rehabilitation physician who treated stroke patients was not qualified to offer expert opinions concerning standards of care for the emergency care of acute stroke patients). Dr. Lipson has failed to establish that he has experience in the specific issue before this court- nursing home standards of care to prevent sexual assault. TEX. Crv. PRAC. & 

### REM. CODE §74.402. Even if it is recent, Dr. Lipson's experience in geriatric medicine does not quality him to offer opinions relating to nursing facility standards of care. 

### Reed v. Granbury Hasp. Corp., 117 S.W.3d 404, 411-414 (Tex. App.

- Ft. Worth 2003, no pet.)(a board certified emergency medicine physician and neurologist with thirty years of experience treating stroke patients not qualified to offer opinions on standards of care for hospital policy relating to administration of stroke therapy); 

### Shelton v. Sargent, 144 S.W.3d 113, 123 (Tex. App.

- Ft. Worth 2004, pet. denied). Dr. Lipson has failed to demonstrate that he has the relevant, recent experience required to offer opinions relating to Gracy Woods' standards ofcare and alleged breach, meaning that his 8

### 309 report is deficient. TEX. 

### Crv. PRAC. & 

### REM. CODE §74.402; 

### Ly v. Austin, 2007 WL 2010757 (Tex.App. -Austin 2007, no pet.) (concerning Chapter 74's predecessor, TEX. 

### REv. Crv. STAT., art. 4590i). 

### IX. OBJECTIONS TO THE REPORT A report is deficient, and dismissal is mandatory, if the report does not represent an objective good faith effort to comply with the definition of an expert report as set out in TEX. 

### Crv. PRAC. & 

### REM. CODE §74.351 (r)(6). TEX. 

### Crv. PRAC. & 

### REM. CODE §74.351 (b), 

### (1) and (r)(6). To constitute a good faith effort to comply with the statute, the report must provide enough information to fulfill two purposes: (1) inform each defendant ofthe specific conduct the plaintiff has called into question; and (2) provide a basis for the trial court to conclude that the claims have merit. 

### Palacios, 46 S.W.3d at 878. A report cannot merely state the expert's conclusions about the elements, but rather, the expert must explain the basis ofhis statements to link his conclusions to the facts. 

### Jelinek v. Casas, 328 S.W.3d 526, 539 (Tex. 2010); 

### Bowie v. Wright, 79 S.W.3d 48, 52 (Tex. 2002)(quoting 

### Earle v. Ratliff, 998 S.W.2d 882, 890 (Tex. 1999); 

### Palacios, 46 S.W.3d at 879. "A report that merely states the expert's conclusions about the standard of care, breach and causation does not fulfill the two purposes of the good-faith effort." 

### Jelinek, 328 S.W.3d at 539. When assessing the sufficiency of an expert report, the trial court's review is limited exclusively to the four comers ofthe report, and the court may draw no inferences as to what the expert meant or intended to say. 

### Gray v. CHCA Bayshore, L.P., 189 S.W.3d 855, 859 (Tex.App. -Houston [1st Dist.] 2006, no pet.)(

### citing Palacios, 46 S.W.3d at 879 (Tex. 2001)); 

### Wright, 79 S.W.3d at 53; 

### Austin Heart, P.A. v. Webb, 228 S.W.3d 276, 279 (Austin 2007, no pet.); 

### see also Garcia v. Marichalar, 198 S.W.3d 250, 254 (Tex.App. -San Antonio 2006, no pet.)(holding that
9

### 310 the trial court could not consider counsel's argument or any evidence brought forward at the hearing). A report cannot merely state the expert's conclusions about the elements, but rather, the expert must explain the basis of his statements to link his conclusions to the facts. 

### Jelinek, 328 S.W.3d at 539 (Tex. 2010); 

### Bowie, 79 S.W.3d at 52 (Tex. 2002); 

### Palacios, 46 S.W.3d at 870. "A report that merely states the expert's conclusions about the standard of care, breach and causation does not fulfill the two purposes ofthe good faith effort," which is to put the defendant
on notice of the specific claims against it and to give the trial court a reasonable basis to conclude the claim has merit. 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. For example, it is conclusory to say that a health care provider's breach in "reasonable medical probability, resulted in a prolonged hospital course and increased pain and suffering." 

### Jelinek, 328 S.W.3d at 539. An expert cannot simply opine that a breach caused the injury. 

### !d. Stated so briefly, the report fails to satisfy the second prong ofthe good faith effort in that it does not give the trial court a reasonable basis to conclude the case has merit. 

### !d.; Palacios, 46 S.W.3d at 879. Instead, the expert must go further and explain "to a reasonable degree, how and why the breach caused the injury based on the facts presented." 

### Jelinek, 328 S.W.3d at 539-40. 

### A. DR. LIPSON'S REPORT IS DEFICIENT AS TO BREACH. Dr. Lipson's report is deficient because he offers only broad, conclusory opmwns, without the requisite factual basis and explanation. TEX. Crv. PRAC. & 

### REM. CODE §74.351(r)(6). For example, Dr. Lipson asserts that "[t]he facility breached the standard of care by not providing twenty-four hour skilled nursing care." Exhibit A, at 6. Dr. Lipson offers no explanation or factual basis for his opinion. This assertion does not inform Defendant of the specific conduct Plaintiff has called into question with respect to twenty-four hour skilled nursing care, nor does it give the court a reasonable basis to conclude that the claim has merit. 10

### 311 This is merely a bare, conclusory statement, and it does not reflect a good faith effort to comply with TEX. Crv. PRAC. & 

### REM. CODE §74.351. TEX. Crv. PRAC. & 

### REM. CODE §74.351; 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. Similarly, Dr. Lipson concludes that "[t]he nursing staff was not present in the halls or her room to prevent the sexual assault of Ms. Rivera." Exhibit A, at 6. Dr. Lipson does not identify when or how the alleged sexual assault occurred or who the alleged perpetrator was. He does not explain the basis for his conclusion that staff were not present in the halls or Ms. Rivera's room. Dr. Lipson does not offer an explanation from which Gracy Woods could determine how Dr. Lipson believes the events allegedly occurred, so as to put Gracy Woods on notice of the claim, nor does Dr. Lipson offer a reasonable basis for a court to conclude this claim has merit. TEX. Crv. PRAC. & 

### REM. CODE §74.351. TEX. Crv. PRAC. & 

### REM. CODE §74.351; 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. Dr. Lipson's report claims that "[t]he facility breached the standard of care by not preventing access to her room by unsupervised males." Exhibit A at 6. Dr. Lipson does not identify any factual basis for his assertion that Ms. Rivera's room was accessed by any unsupervised males. He does not identity the time at which the alleged access occurred, nor does he make any effort to identify the person who he claims accessed Ms. Rivera's room. This is merely a bare assertion, with no factual basis. It 

### does not provide enough information to inform Defendant of the specific conduct Plaintiff has called into question, nor does it give the trial court a reasonable basis to conclude this claim has merit. TEX. Crv. PRAC. & 

### REM. CODE §74.351. TEX. Crv. PRAC. & 

### REM. CODE §74.351; 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. Similarly, Dr. Lipson asserts that "[t]he facility breached the standard of care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could 11

### 312 enter her room." Exhibit A at 6. Dr. Lipson offers no explanation or factual basis for his opinion. He does not describe the location of Ms. Rivera's room as it relates to the nursing station. As discussed above, he offers no information concerning the alleged access to Ms. Rivera's room by any unsupervised male. This conclusory statement does not provide the trial court a reasonable basis to conclude this claim has merit. TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. B. DR. LIPSON'S REPORT IS DEFICIENT AS TO CAUSATION. Dr. Lipson does not offer an explanation or factual basis concerning a causal relationship between an alleged breach by Gracy Woods and an alleged sexual assault ofMs. Rivera. Exhibit A. Dr. Lipson's report does not provide the trial a reasonable basis to conclude that this claim has merit. TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. Dr. Lipson does not explain the basis for his conclusion that a sexual assault occurred. Exhibit A. His opinion on this is based on assumption and speculation, and therefore, it is deficient. Dr. Lipson states that he has considered "other causes of this injury," but he does not indicate that the "other causes" are by any means exhaustive. Exhibit A at 7. Dr. Lipson considers no alternative to sexual assault, except that the alleged injury might have been selfinflicted. 

### !d. When facts support equal references from which different conclusions could be drawn, it is incumbent on the expert to explain to a reasonable degree of medical probability how the expert eliminated the possibilities not chosen and derived his conclusion. 

### Jelinek, 328 S.W.3d at 536; 

### Senior Care Centers, LLC v. Shelton, 459 S.W.3d 753, 759-60 (Tex.App. -Dallas 2015, no pet.). Here, Dr. Lipson failed to consider and eliminate other causes - particularly those 12

### 313 incidental to the patient's care or underlying conditions. Exhibit A. An expert's conclusion not accompanied by a rational explanation demonstrating why the other possibilities are inferior to the expert's chosen conclusion is a conclusory opinion based solely on the ipse dixit of a credentialed witness, and the Texas Supreme Court has instructed that such opinions be rejected. 

### Jelinek, 328 S.W.3d at 536; 

### Shelton, 459 S.W.3d at 759-60. Dr. Lipson's opinions are merely speculative and, therefore, deficient. Dr. Lipson's causation opinions do not provide the court with a reasonable basis to conclude this claim has merit. Consequently, this report does not constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d at 878 (Tex. 2001). 

### X. OBJECTIONS TO THE ATTACHMENTS TO THE REPORT Defendant reiterates its objections to Dr. Lipson's report to the extent it incorporates statements, medical records and other attachments and would require the Court to draw inferences and fill gaps in violation of the four comers rule. Exhibit A. 

### Am. Transitional Care v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001). 

### XI. Defendant objects to Ms. Black's statement or other documentation attached to and referenced in Dr. Lipson's report to the extent Plaintiff asserts those items, individually, constitute expert reports, which they do not. 4 Defendant reasserts its objections that Ms. Black lacks the qualification to offer expert opinions regarding causation because she is not a licensed physician. TEX. Crv. PRAC. & REM. CODE §74.403; TEX. R. Evm. 702. Defendant objects that no

4 Exhibit 3 to Dr. Lipson's report, documents bearing the names of Austin/Travis County and St. David's Medical Center, are attached hereto as Exhibit F and incorporated herein for all purposes. Defendant attaches these documents for the purpose of objecting to them pursuant to TEX. Crv. PRAC. & REM. CODE §74.351. Defendant objects to the admissibility ofthese documents pursuant to TEX. R. Evm. 802. 13

### 314 curriculum vitae was provided with respect to Ms. Black. TEX. Crv. PRAC. & 

### REM. 

### CODE §74.351, §74.402 and §74.403. Defendant objects that Ms. Black is not qualified to offer standard of care or breach opinions relating to Defendant. TEX. Crv. PRAC. & 

### REM. 

### CODE §74.402. Defendant further objects to Ms. Black's statement and all other documents authored by Ms. Black that are attached to Dr. Lipson's report because they are conclusory and do not provide the required explanation or factual bases to represent a good faith effort to comply with Section 74.351. TEX. Crv. PRAC. & 

### REM. 

### CODE §74.351; 

### Bowie Mem'l Hasp. v. Wright, 79 S.W.3d 48, 52-53 (Tex. 2002); 

### Palacios, 46 S.W.3d 873, 878 (Tex. 2001). XII. 

### Defendant reiterates its objections to the Affidavit of Martha Mahan to the extent Plaintiff asserts that Ms. Mahan's affidavit constitutes an expert report, which it does not. Plaintiffprovided no curriculum vitae. Plaintiff lacks the knowledge, skill, training, education or experience to offer opinions regarding Defendant's standard of care, alleged breach or the alleged causal relationship. TEX. Crv. PRAC. & 

### REM. 

### CODE §74.351, §74.402 and §74.403. Defendant further objects to the Affidavit ofMartha Mahan because it is conclusory, speculative, and does not constitute a good faith effort to comply with TEX. Crv. PRAC. & 

### REM. 

### CODE §74.351. Additionally, Ms. Mahan's affidavit does not supply Dr. Lipson with the necessary rational basis for his medical opinion to any greater degree than the beliefs stated in Ms. Mahan's affidavit were his own beliefs. An affiant's beliefs about what the facts are does not make those beliefs facts nor constitute personal knowledge of the believed facts. 

### Shelton, 459 S.W.3d at 760. XIII. 

### Defendant reiterates its objections to the records attached as Exhibit 3 to Dr. Lipson's report because they do not constitute an expert report. TEX. Crv. PRAC. & 

### REM. 

### CODE §74.351. 14

### 315 Defendant objects that no curricula vitae of the records' authors were produced. Defendant objects that the authors of the records attached as Exhibit 3 to Dr. Lipson's report are not qualified to offer opinions regarding Defendant's standard of care, alleged breach or the alleged causal relationship. TEX. Crv. PRAC. & 

### REM. CODE §74.351, §74.402 and §74.403. Defendant further objects to the records attached to Dr. Lipson's report as Exhibit 3 because the opinions contained therein, if any, are conclusory and do not constitute a good faith effort to comply with TEX. Crv. PRAC. & 

### REM. CODE §74.351. XIV. CONCLUSION 

### Defendant object to Dr. Lipson's report because he has not demonstrated that he is qualified to offer opinions concerning Defendant's standard of care or alleged breach. TEX. Crv. PRAC. & 

### REM. CODE §74.402. Defendant further objects to Dr. Lipson's report because Dr. Lipson lacks the requisite experience to offer opinions concerning the diagnosis of sexual assault
or opinions concerning the alleged causal relationship. TEX. Crv. PRAC. & 

### REM. CODE §74.403; TEX. R. Evm. 702. Defendant further objects to Dr. Lipson's report because Dr. Lipson offers no explanation or factual basis to support his breach opinions, meaning that they are merely conclusory and, therefore, deficient. TEX. Crv. PRAC. & 

### REM. CODE §74.351(!), (r)(6); 

### Jelinek, 328 S.W.3d at 539; 

### Palacios, 46 S.W.3d 873. Finally, Defendant objects to Dr. Lipson's report because it offers no factual basis or explanation of the causal relationship between Defendant's alleged breach and the injuries, damages or harm asserted in this litigation, and because Dr. Lipson fails to exclude other reasonable causes for Ms. Rivera's presentation. TEX. Crv. PRAC. & 

### REM. CODE §74.351(!), (r)(6); 

### Jelinek, 328 S.W.3d at 536, 539; 

### Palacios, 46 S.W.3d 873; 

### Shelton, 459 S.W.3d at 759-60.

15

### 316 WHEREFORE, Defendant Gracy Woods I Nursing Home, actually known as PM Management

- Austin NC, LLC d/b/a Gracy Woods Nursing Center, respectfully requests that its objections to Plaintiff's expert report be sustained, that all claims against it be dismissed with prejudice to their refiling, that it be awarded its reasonable attorneys' fees and costs of court, and that it be granted such further reliefto which it may show itself justly entitled. 

### REED, CLAYMON, MEEKER & 

### HARGETT, PLLC 5608 Parkcrest Dr., Suite 200 Austin, Texas 78731 (512) 660-5960 (512) 660-5979 (facsimile) edavenport@rcmhlaw.com jbyington@rcmhlaw.com By: /s/ Emily J. Davenport Emily J. Davenport State Bar No. 24012501 Janice M. Byington State Bar No. 24006938 

### ATTORNEYS FOR DEFENDANT GRACY WOODS I NURSING HOME A/KIA PM MANAGEMENT - AUSTIN NC, LLC DIB/A GRACY WOODS NURSING CENTER

16

### 317 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy ofthe foregoing document has been served in accordance with TRCP 21a on the 12th day ofAugust, 2015 to the following: Jack Modesett 

### III Walter V. Williams ModesettWilliams, PLLC 2202 Lake Austin Blvd. Austin, TX 78703 j ack@jmodesettlaw.com
/s/ Emily J. Davenport Emily J. Davenport

17

### 376 CAUSE NO. D-1-GN-14-005169 8/24/2015 3:25:36 PM Velva L. Price District Clerk Travis County D-1-GN-14-005169 Jonathan Sanders 

### MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA, § § § § § § IN THE DISTRICT COURT OF



### v. TRAVIS COUNTY, TEXAS PM MANAGEMENT- AUSTIN NC, LLC § d/b/a GRACY WOODS I NURSING HOME § 250TH JUDICIAL DISTRICT PLAINTIFF'S RESPONSE TO DEFENDANT'S MOTION TO DISMISS COMES NOW PlaintiffMartha Mahan, as the Representative ofthe Estate ofMary Rivera, and files this her response to Defendant's Motion to Dismiss and would respectfully show the Court the following: I. INTRODUCTION 

### On November 8, 2013, 78 year-old demented Mary Rivera was sexually assaulted in her room, while a resident at Defendant's nursing home facility. The rape occurred after regularly scheduled events at the nursing home during which alcohol was served. Mrs. Rivera's daughter, Martha Mahan, had previously complained to the facility that younger male residents had behaved inappropriately towards Mrs. Rivera. Defendant took no action. Early in the morning of November 9, 2013, Ms. Mahan went to visit her mother in the nursing home. Ms. Rivera was distressed. Ms. Mahan noted broken glass on the floor of her
room. When she took her mother to the bathroom, Ms. Rivera attempted to urinate standing up, which was unusual. Ms. Mahan also found a wad ofbloody rags in Mrs. Rivera's trash can. Ms. Mahan showed this evidence to nursing home employees, who destroyed it. Ultimately, Mrs. Rivera was taken to St. David's Medical Center where a Sexual Assault Nurse Examiner (SANE) performed a post-rape examination. This SANE nurse found bruising to posterior fourchette and

### 377 periurethral areas of Mrs. Rivera's vulva as well as bruising on her posterior vaginal wall. According to the SANE nurse, this definitively indicated penetration ofthe female sexual organ. In general, Defendant's motion complains that Plaintiffs expert is not qualified to opine that a nursing home should take reasonable steps to protect its residents from sexual assault and failed in that responsibility to Ms. Rivera. This, ofcourse, is just common sense. II. 

### WHY DEFENDANT'S MOTION SHOULD BE DENIED :::} Defendant's criticism ofDr. Lipson's qualifications is misplaced. Dr. Loren Lipson is one of the most qualified experts in the nation in geriatric medicine and elder abuse. His experience is broad and deep. His 44 page CV makes the point. In addition to his education and teaching, he consults with numerous governmental agencies concerning the standard ofcare for nursing homes, including elder abuse. :::} Contrary to Defendant's straw man assertion, there is no need for an expert on "gynecological illnesses." Ms. Rivera was raped while a resident in Defendant's facility. Rape is not an illness. It 

### is a physical, sexual assault. Dr. Lipson's report on the standard of care for a nursing home to not let their residents be sexually assaulted, in light of the facts contained in the Mrs. Rivera's medical records, witness statements, Defendant's records and the unassailable statistical data concerning sexual assault in nursing homes, is on point and remains unrefuted. :::} Defendant's other criticism of Dr. Lipson's report is equally misplaced. It 

### is axiomatic that experts may rely on a patient's medical records for purposes of a Chapter 74 report. Experts can even rely on the pleadings to support a Chapter 74 report. Defendant's objections are really evidentiary and wholly inappropriate in connection with a Chapter 74 report. :::} Defendant's criticism about the detail in the report- that it is "conclusory," is betrayed by a simple reading ofthe report itself. 

### III. DR. LOREN LIPSON- NATIONALLY PROMINENT PHYSICIAN, PROFESSOR, LECTURER, CONSULTANT IN GERIATRIC MEDICINE, ELDER ABUSE AND RELATED TOPICS 

### 1. Plaintiffretained the services ofDr. Loren Lipson to evaluate and opine on the facts ofthis case. Dr. Lipson's 7 page report and 44 page CV is attached as Exhibit 1. 

### Plaintiff's Response to Defendant's Motion to Dismiss Page2

### 378 A. Dr. Lipson- Educational Background in Geriatric Medicine 2. Dr. Lipson is a graduate of UCLA and The John Hopkins University School of Medicine (See CV). Dr. Lipson did his internship and residency at The John Hopkins Hospital. Dr. Lipson has fellowships from Harvard (Geriatric Medicine), Beth Israel Hospital (Gerontology), Brigham-Women's Hospital (Gerontology), Hebrew Rehabilitation Center (Geriatric Medicine) and John Hopkins (Clinical Fellow) among others (See CV). B. Dr. Lipson

- Certification in Geriatric Medicine 3. He is boarded in Internal Medicine and Quality Assurance and Utilization Review and holds a Certificate of Expertise in Geriatric Medicine from the American Board of Internal Medicine (See CV). Quality assurance is the study and implementation ofimprovements to care provided, in Dr. Lipson's case, for the elder population in both the nursing home and hospital setting (See CV). C. Dr. Lipson- Twenty Seven Academic Appointments in Geriatric Medicine 4. Dr. Lipson has received twenty-seven academic appointments to include John Hopkins, Harvard Medical School (Scholar Geriatric Medicine), Massachusetts General Hospital, USC (Associate Professor-Geriatric Medicine), USC (Chief-Division of Geriatric Medicine), Brigham-Women's Hospital (Geriatric Medicine), Beth Israel (Geriatric Medicine), USC (Gerontology Research Institute) and University of Alaska (Geriatrics). His teaching responsibilities include USC-Fellowship Program-Geriatric Medicine, USC-Development and Improvement of Geriatric Medical Curriculum, USC-Steering Committee-Pacific Geriatric Education Center, and USC-Ethel Percy Andrus Gerontology-Director and lecturer. His
Plaintiff's Response to Defendant's Motion to Dismiss Page3

### 379 teaching responsibilities at the University of Alaska also include Director-Care of Elderly, CoDirector in Geriatric Education and Faculty Consultant to Geriatric residents. D. Dr. Lipson

- Geriatric Administrative Positions, Including Directorships 5. Dr. Lipson has further served innumerous administrative positions to include Chief ofDivision Geriatric Medicine, Senior StaffPhysician-Geriatric Programs, Director ofthe USC Ambulatory Health Center Japanese Retirement Homes, Director-Geriatric Medicine VA Clinic, Director of USC Teaching Nursing Home Program, Director of Senior Cancer Center, Director of Senior Care Program-USC, Co-Director-Adult Protective Team-Geriatric Medicine Program-LAC/USC, Medical Director-Alaska Geriatric Education Center and Medical Director National Resource Center for Studies in Native American, Alaskans and Hawaiian Elders, University ofAlaska. E. Dr. Lipson

- Geriatric Consultancies: Boards, Program Development 6. His public service includes Consultant-Geriatric Medicine-State of Alaska, Board ofDirectors, California Association ofMedical Directors, and Task Force on Elder Abuse, City ofLos Angeles. 7. Dr. Lipson's consultancies include Geriatric Medicine-Silverado Senior Living Centers, Geriatric Medicine-Glendale Adventist Medical Center, Geriatric Program Development-Bay Shores Medical Group, Geriatric Program Development-San Dimas Community Hospital, Geriatric Program Development and Long Term Care-The Motion Picture & 

### Television Home, Long Term & 

### Geriatric Medicine- State of California, Elder Abuse & 

### Geriatric Medicine

- State of California, Office ofthe Attorney General, Long Term Care, Elder Abuse and Geriatric Medicine-State of California-Office of the Attorney General

- Medicaid Fraud, Geriatric Medicine and Elder Abuse-State ofNew Mexico, Geriatric Medicine and Elder Plaintiff's Response to Defendant's Motion to Dismiss Page4

### 380 Abuse-United States ofAmerica-Department ofJustice, and Long Term Care, Geriatric Medicine and Elder Abuse-United States ofAmerica-Department ofHealth and Human Services-Office of the Inspector General (See CV).



### F. Dr. Lipson's Lectures on Elder Abuse: Washington U; Harvard; Stanford; Yale; Brown; Baylor, etc. 8. Dr. Lipson has lectured all over the country on issues involving geriatrics, long term care, and elder abuse (See CV). The lectures include Washington University, Harvard, Yale, the University ofNew Brunswick, the University of Florida, Stanford, University of Pittsburgh, University of Hawaii, University of California San Francisco, Brown, University of Nevada, University of Guam, Kansas University, Baylor, Chicago Medical College, University of Oklahoma, University ofColorado, University of Kentucky, University ofUtah, Southern Illinois Medical School, Allegheny Medical School, University ofArizona as well as many others (CV). 9. Dr. Lipson has published numerous peer reviewed articles, book chapters and monograms dealing with the care ofthe elderly (See CV). 10. In short, Dr. Lipson is a nationally prominent physician, professor, lecturer and consultant in geriatric medicine, abuse of the elderly and related topics. Indeed, he may be the most qualified expert in the country and the one the United States Department ofJustice and the United States Department ofHealth and Human Services retain when they are in need ofthis type ofexpertise. 

### IV. DR. LIPSON'S REPORT EXCEEDS CHAPTER 74's REQUIREMENTS A. Dr. Lipson's Review ofPertinent Medical and Other Record 11. Dr. Lipson's report sets out in detail the information he reviewed in order to render his opinions. They include: 

### Plaintiff's Response to Defendant's Motion to Dismiss PageS

### 381 a. The statement ofthe daughter Martha Mahan; b. The Gracy Woods nursing home records;
c. The SANE nurse report; d. The SANE nurse statement;
e. The St. David's Hospital records; f. The guardianship records regarding Mrs. Rivera; and g. The Texas Department ofAging and Disability Services Report. B. Dr. Lipson Sets Out Facts Leading to Ms. Rivera's Rape 12. Dr. Lipson analyzes the facts leading up to the rape of Mrs. Rivera. Dr. Lipson notes that several months before Mrs. Rivera's incident another complaint of sexual assault was made inthe same facility. He opines this should place the facility on heightened alert for this type ofproblem. 13. Dr. Lipson reviews the citations issued by the State against the nursing home including the failure to implement written policies and the failure to report the prior incident to the proper law enforcement authorities. 14. Dr. Lipson then reviews the guardianship records ofMrs. Rivera, which place her under the guardianship ofher daughter, Martha Mahan. Judge Herman, based on medical exams, found Mrs. Rivera was a "totally incapacitated person without capacity to care for herself." Dr. Lipson opines this finding is consistent with the records from the nursing home. C. Dr. Lipson Carefully Reviews Nursing Home Chart and Ms. Mahan's Statement 15. Dr. Lipson then conducts a careful review ofthe nursing home chart to establish the fact that Ms. Rivera had very poor short and long term memory problems and often did not Plaintiff's Response to Defendant's Motion to Dismiss Page6

### 382 remember people or where her room was. Dr. Lipson goes on to opine that due to her significant mental limitations, Mrs. Rivera required careful monitoring by the staff. 16. Dr. Lipson then reviews the statement ofMartha Mahan, Mrs. Rivera's daughter and guardian. Ms. Mahan's statement discussed parties on Friday afternoons where alcohol is served to the residents. Ms. Mahan reports that certain male residents acted inappropriately towards Mrs. Rivera and that this fact was reported to the management. 17. Dr. Lipson then reviews the facts surrounding the discovery ofthe broken glass, bloody rags and distressed Mrs. Rivera. He then notes that an external head to toe exam was done
on Mrs. Rivera which found no exterior wounds. No vaginal exam was done. 18. Dr. Lipson then discusses the calling ofthe police and the examination done at St. David's Hospital by SANE nurse Jenny Black. Dr. Lipson notes the injuries to both the posterior and anterior portions of the vagina. He further reviewed the statement of the SANE nurse indicating definitive "penetration ofthe female sexual organ". 

### D. Dr. Lipson Reviews Literature on Sexual Assaults in Texas 19. Dr. Lipson then cites literature for the disturbing fact that in the four years leading up to Mrs. Rivera's assault nearly 400 sexual assaults were reported in Texas nursing homes. Dr. Lipson further relates the fact that those who suffer from dementia are at particularly high risk for this type of abuse as they are very poor historians. 20. Dr. Lipson then goes on to discuss how these assaults can be prevented. He notes that these facilities all provide 24 hour skilled nursing care as required by law. This means the facility must have skilled nurses as well as certified nursing aides on stafftwenty-four hours a day three hundred and sixty-five days a year.


### Plaintiff's Response to Defendant's Motion to Dismiss Page 7

### 383 21. Dr. Lipson goes on to review the literature and reports that most ofthese assaults
occur at night and if a facility has a history of reported assaults they are at a greater risk for additional incidents. He then reviews the history of reported assault, non-compliance and management awareness of these issues. Dr. Lipson reviews the general knowledge within the industry ofthese assaults and the press coverage regularly offered this issue. E. Dr. Lipson

- Ms. Rivera's Injury Foreseeable and Defendant Owed Duty to Ms. Rivera 

### 22. He then opines that with the significant number of assaults in Texas nursing homes, the recent history of reported assault in Defendant's facility and the complaints of the daughter Martha Mahan that it is foreseeable assaults would occur if precautions are not taken. He then opines a nursing home owes a duty of protection to patients suffering from mental incapacity. He then writes that such patients require enhanced supervision and additional staff time to protect them from others. This is particularly true, he states, in a facility with a history of reported assault and a history offamily complaints ofinappropriate behavior towards Ms. Rivera. F. Dr. Lipson Sets Out Standard of Care 

### 23. After pages of detail concerning the facts, the records and the foreseeability, Dr. Lipson then sets out the standard of care.
a. The standard of care requires the nursing home provide twenty-four hour a day skilled nursing care. The practical result ofthis requirement is that the staffmust be moving through the halls and the rooms ofthe residents all night long. There should never be a time when a staff member is not in the next room or moving through the halls next to a resident's room. b. The standard of care requires that following the report of an assault at a nursing facility that the facility control unsupervised access to the rooms ofresidents at risk. The standard of care requires the facility take note of the families' concerns of inappropriate behavior and eliminate access to the patient by unsupervised males. Residents at risk include women with significant dementia such as Ms. Rivera. In light of the family's expressed concern of inappropriate advances to Ms. Rivera, Plaintiff's Response to Defendant's Motion to Dismiss Page8

### 384 the standard requires heightened scrutiny to include regular walks through the entire hall at intervals not to exceed ten minutes to prevent access to her room by males. The standard of care requires the nursing staff document the fact that it is performing the regular checks in the patients' charts. In addition, the standard of care requires Ms. Rivera be moved to a room in close proximity to the nursing station following complaints ofinappropriate contact with Ms. Rivera. G. Dr. Lipson Identifies Breaches of Standard of Care 

### 24. Dr. Lipson then set out the breaches ofthe standard ofcare.
a. The facility breached the standard ofcare by not providing twenty-four hour skilled nursing care. The nursing staffwas not present in the halls or her room to prevent the sexual assault ofMs. Rivera. b. The facility breached the standard ofcare by not preventing access to her room by unsupervised males. The records do not indicate any checks on Ms. Rivera the night she was assaulted. The facility breached the standard ofcare by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room. H. Dr. Lipson Identifies the Harm to Ms. Mahan 

### 25. Dr. Lipson then sets out the harm caused. The harm caused Ms. Rivera is significant. She was sexually assaulted. The injuries to her vagina are well documented in the SANE nurse report and above. The daughter reports she was tearful and afraid. This is a
common response in sexual assault victims. The daughter reports this behavior offear continued
even after Ms. Rivera was removed from the facility. The fact she suffered from dementia does not lessen the harmful mental effects of sexual assault. Even an animal can remember when it has been abused. In many ways Ms. Rivera was like a small child

- confused and afraid as a result of this sexual assault. The history of problems together with the decision to ignore the families' complaints and eliminate unsupervised males from Ms. Rivera's room indicates a conscious disregard for the well-being ofMs. Rivera by the facility's management. I. Dr. Lipson Eliminates Other Causes ofInjury 

### Plaintiff's Response to Defendant's Motion to Dismiss Page9

### 385 26. Dr. Lipson then considers other potential causes of this injury. He considers whether the injuries may be self-inflicted, but discards this idea after a chart review found no indications of sexual self-stimulation or self-abuse. He further considered whether the family might have caused these injuries but again discards this idea after a chart review indicates the family was nothing but supportive. Dr. Lipson further notes Mrs. Rivera was inthe nursing home at all relevant times and there was no indication she was assaulted on the way to the hospital to check to see if she had been sexually assaulted. 27. In short, Dr. Lipson explains the background facts, his review ofthe medical and factual history, explains the problem with sexual assaults in nursing homes, explains the standard of care, the breaches ofthe standard of care as well as the harm caused. His report explains the Defendant's conduct called into question and provides detailed information for this Court to determine the claims have merit. 

# v. ARGUMENT AND AUTHORITIES A. The Legal Standard for Qualifications and Reports Defendant complains that Dr. Lipson is not qualified under TEX. CIV. PRAc. & 

### REM. CODE §74.402 (be a healthcare provider or consultant in "same field" as a defendant, knowledge ofthe standard ofcare and qualified on basis oftraining or experience) and §74.403 (i.e., be a physician and be otherwise qualified). Dr. Lipson's qualifications are unassailable. Defendant also complains that Dr. Lipson's report does not provide it adequate notice ("good faith effort") under TEX. CIV. PRAc. & 

### REM. CODE §74.351(1). Scoresby v. Santillan, 

### 346 S.W.3d 546, 556 (Tex. 2011)(To qualify as a good faith effort, it must inform the defendant ofthe

Plaintiff's Response to Defendant's Motion to Dismiss Page 10

### 386 conduct called into question and provide a basis for the trial court to conclude the claims have merit.). The Supreme Court's position on expert reports is well described. "The expert report must represent only a good faith effort to provide a fair summary ofthe expert's opinions. A report need not marshall all the plaintiffs proof, but it must include the expert's opinion on each ofthe elements identified in the statute. Am. Transitional Care Ctrs. OfTex., Inc. v. Palacios, 

### 46 S.W.3d 873, 878. Dr. Lipson's detailed report exceeds this standard. A. Dr. Lipson Well-Qualified to Opine on Preventable Sexual Assault in Nursing Home Defendant complains Dr. Lipson is not qualified to issue opinions about whether Ms. Mahan suffered from a "gynecological illness." Rape is not a gynecological illness. It 

### is an assault. The assault has been copiously documented by the SANE nurse and a doctor and reviewed by Dr. Lipson. The argument that Dr. Lipson cannot rely on other medical professionals' records for his opinions strains credulity. That's like saying a surgeon couldn't rely on a radiologist's reading of an MRI to provide the opinion that a patient had a brain tumor. The Court's inquiry should focus on whether the expert has the "knowledge, skill, experience, training or education regarding the specific issue before the Court which would qualify the expert to opine on a particular subject." Tenet Hosp. Ltd. v. Love, 

### 347 S.W.3d 743, 749-50 (Tex. App.

- El Paso 2011, no pet.) The relevant issues addressed by Dr. Lipson are: what do the records say about Ms. Mahan's assault; what is the standard ofcare with respect to the assault; did Defendant breach the standard ofcare concerning the assault; and, was Ms. Mahan injured as a result ofthat breach. In 

### short, should this nursing home have prevented Ms. Rivera's sexual assault? Dr. Lipson is wellqualified to render those opinions.
Plaintiff's Response to Defendant'sMotion to Dismiss Page 11

### 387 

### 1. Defendant's Straw Man Argument- Whether Sexual Assault Occurred After setting up the straw man- that the required opinions should include whether a sexual assault occurred at all

- Defendant takes a swing at the medical records that establish the sexual assault. Defendant misses. Defendant argues Dr. Lipson may not rely upon the SANE nurse report or the medical records in this matter. Defendant cites TEX. 

### CIV. PRAC. & 

### REM. CoDE§ 74.402 & 

### § 74.403 and Texas Rules ofEvidence 702 for this proposition. Defendant's reliance is misplaced. §74.402(b)(3) and (c)(2) set out in relevant part: (b)(3) (an expert may qualify if he) is qualified on the basis of training or experience to offer an expert opinion regarding those accepted standards ofhealth care ( c)(2) is actively practicing health care in rendering health care services relevant to the claim. § 74.403 deals with the qualification of a retained expert witness to render opmwns. It 

### sets out in part: A person may qualify as an expert witness on the issue of causal relationship between the alleged departure from the accepted standard of care and the injury, harm or damages claimed only if the person is a physician
... This section does apply to Dr. Lipson. It 

### does not apply to the medical records or statements. Only Dr. Lipson addresses the issues of "causal relationships" and "departure from the accepted standard ofcare". Expert witnesses must be able to rely upon the medical records to render opinion. Expert witnesses may rely on witness statements. If one follows Defendant's argument to its logical conclusion, experts could not rely on the nursing home chart (made mostly by nurses), the medical records (made by nurses and treating doctors whose resumes are not available). This is not the law in Texas. Defendant knows this because it cites a case for this very proposition in a footnote ofits motion. See 

### Motion at 7 fn 

### 3. 

### Plaintiff's Response to Defendant's Motion to Dismiss Page 12

### 388 Indeed, the Texas Supreme Court has expressly stated that expert reports would likely be inadequate ifthey did not look at the medical records. Loaisiga v. Cerda, 

### 379 S.W.3d 248, 261 (Tex. 2012). This is a case which involved the sexual assault of patients. The Supreme Court also held in the same case that experts could rely upon the pleadings on file in the case to render expert opinions. Id. 

### A reading ofthe statute and the relevant case lawmake it clear that§ 74.402 and§ 74.403 do not apply to the underlying information reviewed by experts, such as the medical records or SANE nurse examination. The Defendant's objection to the review ofthe statement of Martha Mahan is unfounded for the same reason. 

### B. Dr. Lipson- Well-Qualified to Opine on Nursing Home Elder Abuse Defendant has closely scrutinized the Plaintiff's report, but appears to have overlooked the pages and pages of Dr. Lipson's CV setting out his experience teaching future nursing horne directors at multiple Tier 1 universities and governmental entities. In Dr. Lipson's CV, there are at least 9 references to lectures, courses and papers relating to "Elder Abuse." There are over 30 references to geriatrics, including fellowships at Harvard. There are multiple references to his directorships over programs and facilities involving care for the elderly. His experience includes consulting at nursing homes and governmental entities on the operation ofnursing homes. He is board certified in Quality Assurance. He has spent a many years learning, lecturing, writing and testifying on nursing horne abuse issues. 

# v. CONCLUSION Over the course ofits 16 page motion, Defendant strains mightily to copy and paste pages of black letter law on Chapter 74 claims. This larding of citations attempts to serve as a substitution for actual analysis ofDr. Lipson's report. Defendant ignores the details ofthe report, Plaintiff's Response to Defendant's Motion to Dismiss Page 13

### 389 cherry-picking quotes to create a false sense that the report is conclusory and has otherwise failed to make any meaningful criticism. The report from this nationally recognized physician is detailed on the facts, causation and harm. Defendant knows exactly what the claims are against it: A helpless old woman got raped in her room after alcohol was served on its premises, and after being put on notice ofinappropriate conduct towards Mr. Rivera. It should have never happened. Plaintiff has met and exceeded the standard for expert qualifications and reports. Defendant's motion should be denied in all things.

By: Respectfully Submitted, MODESETTWILLIAMS, PLLC 515 Congress Avenue, Suite 1650 Austin, Texas 78701 512.472.6097- Telephone 512.481.0130- Telecopier jack@jmodesettlaw.com

1 J ck Modesett, III / t'exas Bar No. 14244337 VWalter V. Williams

Texas Bar No. 21584800



### Plaintiff's Response to Defendant's Motion to Dismiss Page 14

### 390 CERTIFICATE OF SERVICE I hereby do certify that in compliance with the provisions of Rule 21a, a true and correct copy ofthe above and foregoing has been served via ProDocs electronic service on this day ofJuly, 2015 as follows: Emily J. Davenport Kemp Smith, LLP 816 Congress Avenue, Suite 1260 Austin, Texas 78701-2443 Emily.davenport@kempsmith.com



### Plaintiff's Response to Defendant's Motion to Dismiss PagelS

### 101 2/20/2015 12:36:17 PM

CAUSE NO. D-1-GN-14-005169 Velva L. Price District Clerk Travis County D-1-GN-14-005169
MARTHA MAHAN, AS THE REPRESENTATIVE OF THE ESTATE OF MARY RIVERA 

## v. GRACY WOODS I NURSING HOME 

### § § § § § § § IN THE DISTRICT COURT

TRAVIS COUNTY, TEXAS 250TH JUDICIAL DISTRICT
DEFENDANT'S OBJECTIONS TO PLAINTIFF'S EXPERT REPORT AND CURRICULUM VITAE


### TO THE HONORABLE COURT: NOW COMES Defendant Gracy Woods I Nursing Home, actually known as PM Management- Austin NC, LLC d/b/a Gracy Woods Nursing Center, and files its Objections to Plaintiff's Expert Report and Curriculum Vitae pursuant to TEX. Crv. PRAC. & 

### REM. CODE §74.351(a) and would respectfully show: I. 

### This is a health care liability claim. On January 30, 2015, Plaintiff served the report and curriculum vitae of Loren G. Lipson, M.D., in an attempt to comply with Section 74.351 of the Texas Civil Practice and Remedies Code. True and correct copies of Dr. Lipson's report and curriculum vitae are attached here to as Exhibits A and B, respectively, and incorporated herein for all purposes. II. OBJECTIONS TO QUALIFICATIONS 

### Defendant objects to Dr. Lipson's report and curriculum vitae because Dr. Lipson has failed to establish that he has any expertise to offer opinions that an alleged sexual assault occurred. TEX. Crv. PRAC. & 

### REM. CODE §74.403; TEX. R. EVID. 702; 

### Broders v. Heise, 924
1

### 102 S.W.2d 148, 152-54 (Tex. 1996). Neither Dr. Lipson's report nor his curriculum vitae indicates that he has any education, training, skill or experience in the diagnosis or treatment of sexual assault; the diagnosis or treatment of gynecological injury, conditions or disease; or gynecological care or treatment of patients like Mary Rivera. Exhibits A and B. 

### Broders, 924 S.W.2d at 152-54; 

### Thomas v. Alford, 230 S.W.3d 853, 857 (Tex. App.-Houston [14th Dist.] 2007, no pet.); 

### Pediatrix Med. Servs. Inc. v. De La 0, 368 S.W.3d 34, 39-40 (Tex.App.-El Paso 2012, no pet.); 

### Cortez v. Tomas, 2012 WL 407382, at *3, 6 (Tex.App. -Fort Worth 2012, no pet.). Dr. Lipson lacks the requisite expertise regarding the 

### specific issue before the court that would qualify him to offer the opinions asserted in his report. TEX. Crv. PRAC. & 

### REM. CODE §74.403; TEX. R. Evm. 702; 

### Broders, 924 S.W.2d at 152-54. 

### III. Defendant objects to Dr. Lipson's report to the extent it relies on the conclusions of nonphysicians. 1 Dr. Lipson relies on the observations and conclusions of Plaintiff and a registered nurse, neither ofwhom is qualified to offer diagnoses or medical causation opinions. 2 Exhibit A. TEX. Crv. PRAC. & 

### REM. CODE §74.403(a) (limiting causation opinions to physicians otherwise qualified according to TEX. R. Evm. 702); TEX. R. Evm. 702. Exhibits D, E. Dr. Lipson relies on the statement of Jenny Black, R.N. Ms. Black is a registered nurse, not a licensed physician. Exhibit E. Registered nurses are expressly prohibited from rendering medical diagnoses, and they lack the medical expertise required to offer causation opinions. TEX. 

### Occ. CODE §301.002(2)(excluding "acts of medical diagnosis" from the definition of "professional

1 Defendant also respectfully objects to Exhibit 1 to Dr. Lipson's report to the extent Plaintiff or Dr. Lipson attempts to rely upon the opinion ofa non-physician for a medical causation opinion in a health care liability claim. TEX. CN. PRAC. & REM. CODE §74.403(a); TEX. R. Evm. 702. A true and correct copy of the Order Appointing Permanent Guardian is attached hereto as Exhibit C and incorporated herein for all purposes. 2 A true and correct copy ofthe Affidavit of Martha Mahan is attached hereto as Exhibit D and incorporated herein for all purposes. A true and correct copy of the Statement of Jenny Black is attached hereto as Exhibit E and incorporated herein for all purposes. 2

### 103 nursing"); TEX. Crv. PRAC. & REM. CODE §74.403(a); TEX. R. Evm. 702; 

### Costello v. Christus Santa Rosa Health Care, 141 S.W.3d 245, 248-49 (Tex.App. -San Antonio 2004, no pet)(regarding nurses' lack ofqualification to render medical opinions in expert reports); 

### Jones v. King, 255 S.W.3d 156, (Tex.App. -San Antonio 2008, pet. denied)(regarding application of the four comers rule when an expert report attempts to rely on the opinions of a physician whose qualifications were not established in the report). 

### IV. Defendant further objects to Dr. Lipson's report because Dr. Lipson has failed to establish that he has the requisite knowledge, training or experience in the operation, management or supervision of nursing homes to offer the opinions on standard of care and breach asserted in his report. TEX. Crv. PRAC. & REM. CODE §74.402; 

### Reed v. Granbury Hasp. Corp., 117 S.W.3d 404, 411-414 (Tex. App.

- Ft. Worth 2003, no pet.)(a board certified emergency medicine physician and neurologist with thirty years of experience treating stroke patients not qualified to offer opinions on standards of care for hospital policy relating to administration of stroke therapy); 

### Shelton v. Sargent, 144 S.W.3d 113, 123 (Tex. App.

- Ft. Worth 2004, pet. denied). Dr. Lipson's conclusory statements about his alleged familiarity with the standard of care do not establish that he has the knowledge, training or experience on the specific issues in this case. 

## v. OBJECTIONS TO THE REPORT Defendant objects to Dr. Lipson's conclusion that "[t]he facility breached the standard of
care by not providing twenty-four hour skilled nursing care." Exhibit A, at 6. Dr. Lipson offers
no explanation or factual basis for his opinion. This conclusory statement does not put Defendant

3

### 104 on notice of the conduct complained of, nor does it constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. VI. Defendant objects to Dr. Lipson's conclusion that "[t]he nursing staff was not present in the halls or her room to prevent the sexual assault of Ms. Rivera." Exhibit A, at 6. Dr. Lipson offers no explanation or factual basis for his opinion. This is a mere conclusion, and it does not constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. 

### VII. Defendant objects to Dr. Lipson's conclusion that "[t]he facility breached the standard of
care by not preventing access to her room by unsupervised males." Dr. Lipson offers no explanation or factual basis for his opinion. This conclusory statement does not put Defendant on notice of the conduct complained of, nor does it constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. VIII. Defendant objects to Dr. Lipson's conclusion that "[t]he facility breached the standard of
care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room." Dr. Lipson offers no explanation or factual basis for his opinion. This conclusory statement does not put Defendant on notice of the conduct complained of, nor does it constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. 

### IX. Defendant objects to Dr. Lipson's conclusion that Ms. Rivera was sexually assaulted. Dr. Lipson offers no explanation or factual basis to support his conclusion that a sexual assault occurred. Dr. Lipson offers no explanation or factual basis in support of his conclusion that the

4

### 105 alleged injury was due to sexual contact. Dr. Lipson offers no explanation or factual basis to support his conclusion that the alleged assailant was male. Dr. Lipson's opinions are merely speculative and, therefore, deficient. 3 Accordingly, Defendant objects to Dr. Lipson's report because his statements regarding the alleged sexual assault are merely conclusory, do not put Defendant on notice of the claim against it, do not give the trial court a reasonable basis to conclude that this claim has merit, and do not constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; 

### American Transitional Care Ctrs. v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001). 

### X. OBJECTIONS TO THE ATTACHMENTS TO THE REPORT Defendant objects to the report, generally, to the extent it incorporates statements, medical records and other attachments and would require the Court to draw inferences and fill gaps in violation of the four comers rule. Exhibit A, C, D, E and F. 

### Am. Transitional Care v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001). 

### XI. Defendant objects to Ms. Black's statement or other documentation attached to and referenced in Dr. Lipson's report to the extent Plaintiff asserts those items, individually, constitute expert reports, which they do not. 4 Defendant reasserts its objections that Ms. Black lacks the qualification to offer expert opinions regarding causation because she is not a licensed physician. TEX. Crv. PRAC. & REM. CODE §74.403; TEX. R. EVID. 702. Defendant objects that no curriculum vitae was provided with respect to Ms. Black. TEX. Crv. PRAC. & REM. CODE

3 In fact, it appears that Dr. Lipson failed to review all ofMs. Rivera's medical records. 4 Exhibit 3 to Dr. Lipson's report, documents bearing the names of Austin/Travis County and St. David's Medical Center, are attached hereto as Exhibit F and incorporated herein for all purposes. Defendant attaches these documents for the purpose of objecting to them pursuant to TEX. Crv. PRAC. & REM. CODE §74.351. Defendant objects to the admissibility ofthese documents pursuant to TEX. R. Evm. 802. 5

### 106 §74.351, §74.402 and §74.403. Defendant objects that Ms. Black is not qualified to offer standard of care or breach opinions relating to Defendant. TEX. Crv. PRAC. & REM. CODE §74.402. Defendant further objects to Ms. Black's statement and all other documents authored by Ms. Black that are attached to Dr. Lipson's report because they are conclusory and do not provide the required explanation or factual bases to represent a good faith effort to comply with Section 74.351. TEX. Crv. PRAC. & REM. CODE §74.351; 

### Bowie Mem'l Hasp. v. Wright, 79 S.W.3d 48, 52-53 (Tex. 2002); 

### Palacios, 46 S.W.3d 873, 878 (Tex. 2001). XII. Defendant objects to the Affidavit of Martha Mahan to the extent Plaintiff asserts that Ms. Mahan's affidavit constitutes an expert report, which it does not. Plaintiff provided no curriculum vitae. Plaintiff lacks the knowledge, skill, training, education or experience to offer opinions regarding Defendant's standard of care, alleged breach or the alleged causal relationship. TEX. Crv. PRAC. & REM. CODE §74.351, §74.402 and §74.403. Defendant further objects to the Affidavit of Martha Mahan because it is conclusory, speculative, and does not constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351. XIII. Defendant objects to the records attached to Dr. Lipson's report as Exhibit 3 because they do not constitute an expert report. TEX. Crv. PRAC. & REM. CODE §74.351. Defendant objects that
no curricula vitae of the records' authors were produced. Defendant objects that the authors of the records attached as Exhibit 3 to Dr. Lipson's report are not qualified to offer opinions regarding Defendant's standard of care, alleged breach or the alleged causal relationship. TEX. Crv. PRAC. & REM. CODE §74.351, §74.402 and §74.403. Defendant further objects to the records attached to Dr. Lipson's report as Exhibit 3 because the opinions contained therein, if any, are

6

### 107 conclusory and do not constitute a good faith effort to comply with TEX. Crv. PRAC. & 

### REM. CODE §74.351. WHEREFORE, Defendant Gracy Woods I Nursing Home, actually known as PM Management

- Austin NC, LLC d/b/a Gracy Woods Nursing Center, respectfully requests that its Objections be sustained and that it be granted such further relief to which it may show itself justly entitled. Respectfully submitted, 

### KEMP SMITH LLP 816 Congress Avenue, Suite 1260 Austin, Texas 78701-2443 512-320-5466 512-320-5431 (facsimile) emily.davenport@kempsmith.com By: /s/ Emily J. Davenport Emily J. Davenport State Bar No. 24012501 

### ATTORNEYSFORDEFENDANT GRACY WOODS I NURSING HOME A/KIA PM MANAGEMENT - AUSTIN NC, LLC D/B/A GRACY WOODS NURSING CENTER

7

### 108 CERTIFICATE OF SERVICE I hereby certify that a true and correct copy ofthe foregoing document has been served in accordance with TRCP 21a on the 20th day ofFebruary, 2015 to the following: Jack Modesett 

### III Walter V. Williams ModesettWilliams, PLLC 2202 Lake Austin Blvd. Austin, TX 78703 j ack@jmodesettlaw.com
/s/ Emily J. Davenport Emily J. Davenport

8

### 15 DECLARATION OF LOREN G. LIPSON, M.D. I, Loren G. Lipson, M.D., declare as follows: I am a licensed physician in the State of California. I am Board-Certified in Internal Medicine, as well as in Quality Assurance and Utilization Review. I have been board certified in Geriatric Medicine. My curriculum vitae, attached hereto as Exhibit 1 accurately reflects my education, training and experience as a Medical Doctor, Professor Emeritus of Medicine at the Keck School of Medicine at the University of Southern California, Los Angeles, California, Affiliate Professor in the Biomedical WW AMI Program, College of Arts and Sciences, and Affiliate Professor at the College of Health and Social Welfare both at the University of Alaska Anchorage. I am the former chief of the section of Geriatric Medicine and Associate Professor of Medicine, Gerontology, Clinical Pharmacy, Medical Dentistry and Public Health, and Occupational Science and Occupational Therapy, all at the University of Southern California where I have been on the faculty for over 29 years. In addition, I am a consultant to the Department of Justice United States and the States of California and New Mexico, and the Office ofthe Inspector General, U.S. Department of Health and Human Services in areas of geriatric care and elder abuse. I have served as a Consultant to the Departments of Administration, Health and Social Services and Law, State of Alaska, in the
areas of geriatric medicine and long term care. I also have been the Physician Advisor to USC University Hospital in areas ofutilization management and quality assurance. I have extensive personal experience in primary medical care as well as subspecialty consultation and long-term care. I personally have provided care for patients in addition to my academic teaching, research and administrative responsibilities. My background is more fully DECLARATION OF LOREN G. LIPSON, M.D. PAGE 1

### 16 described in my curriculum vitae attached hereto as Exhibit A. I am familiar with the problem of sexual assault in the nursing home setting. I am familiar with the standard ofcare for preventing such assaults. I continue to treat patients in the long term care setting and have done so for more than thirty years. I am familiar with the standard ofcare for the treatment ofpatients like Mary Rivera and familiar with the required training ofemployees providing care to residents like Mary Rivera. I have reviewed the following records. They formulate a basis for my opinions in this matter. 1. The statement ofthe daughter, Martha Mahan; 2. The Gracy Woods I records; 3. The SANE Nurse Report; 4. The SANE Nurse Statement 5. The St. David's Hospital Records 6. The guardianship records regarding Ms. Rivera; and 7. Texas Department ofAging and Disability Services' Reports. The nursing home had a complaint of a sexual assault of a resident several months before the assault of Ms. Rivera. This report should place the facility on a heightened alert for this problem. The facility was cited by DADS for: 1. Failing to implement written policies that protect against this activity; and 2. Failing to report the incident to law enforcement. On June 20, 2013, Ms. Mary Rivera was placed under the guardianship of her daughter, Martha Mahan, by Judge Guy Herman. Judge Herman determined that Mary Rivera was a "totally incapacitated person without capacity to care for herself." (Ex. 1) DECLARATION OF LOREN G. LIPSON, M.D. PAGE2

### 17 The findings of Judge Herman are consistent with the records from Gracy Woods I, (the nursing home) where Ms. Rivera was a long term resident. When Ms. Rivera admitted to the nursing home she carried a diagnosis of dementia. A review of the nursing home chart indicates that Ms. Rivera's short- and long-term memory declined over the time of her residency. The chart indicated she frequently did not know the location ofher room, the season ofthe year or recognize staffmembers. This is confirmed in the appointment ofher guardian when Judge Herman finds Ms. Rivera as "totally incapacitated" due to mental as well as physical limitations. The nursing home chart describes an individual who, while able to ambulate, clearly required careful monitoring due to significant mental limitations. The nursing home chart further indicates Ms. Rivera suffered from depression secondary to the diagnosis of dementia as well as due to her admission to the nursing home, an admission she likely did not fully understand. The daughter ofMs. Rivera describes in her statement alcohol parties that the nursing home had on Friday afternoons. (Ex. 2) She states that another male resident would inappropriately touch or speak to Ms. Rivera. (Ex. 2) The daughter reported this concern to the management of the nursing home. The nurses caring for Ms. Rivera were aware ofthis behavior. (Ex. 2) Early on November 9, 2013, a Saturday morning, the daughter visited her mother at the nursing home. She found her more confused than usual and crying. The daughter also found broken Christmas ornaments on the floor. She took her mom to the bathroom, and she appeared to be in pain. Ms. Rivera urinated standing up, which was unusual. After she put her mom back to bed, the daughter used the restroom herself. When she was discarding a paper towel she noted there was a pile ofbloody rags in the trash.

DECLARATION OF LOREN G. LIPSON, M.D. PAGE3

### 18 Concerned that her mother had fallen, she took the rags to the charge nurse, Wendy, who did a head-to-toe skin examination. The nursing home records confirm that no open wounds were found. The daughter ultimately took her mother to the hospital where they found bruising to her back. No vaginal exam was done at that time. The daughter reports Ms. Rivera continued to act like she was afraid. She noted bleeding from her mother's vagina. The daughter began to suspect sexual assault. The police were notified. Ms. Rivera was taken to St. David's Hospital. An examination was done by a Sexual Assault Nurse Examiner (SANE Nurse). The SANE nurse told Ms. Rivera that her mother had suffered vaginal trauma. The SANE nurse exam specifically found trauma to the posterior fourchette/fossa navicularis as well as trauma to the periurethral area of the vagina. (Ex. 3) In other words, she found bruising to both the front ofthe vagina as well as the posterior ofthe vaginal wall. (Ex. 3) The statement of the SANE nurse indicates the findings "definitively indicate penetration of the female sexual organ." (Ex. 4) As referenced above, Ms. Rivera was incompetent. In other words, she was sexually assaulted as she is unable to give consent to sexual contact.Sexual assault in the nursing home environment is a very serious problem. In the four years leading up to this assault, nearly four hundred sexual assaults were reported in Texas nursing homes. At high risk are seniors such as Ms. Rivera who suffer from dementia. They are poor historians due to their illness and many suffer from impaired communication skills. As such they
are extremely vulnerable. The good news is that, if the nursing home takes a few simple steps, the assaults can be prevented. Facilities such as this nursing home are 24 hour skilled nursing facilities. This means DECLARATION OF LOREN G. LIPSON, M.D. PAGE4

### 19 they are required by law to have skilled nursing staffas well as certified nurses' aides on duty and providing care to the residents twenty-four hours a day, seven days a week, three hundred and sixty five days a year. The nursing home in question has one hundred and eighteen beds in the entire facility. These types ofassaults, according to most reports in the literature, occur at night. The literature indicates that facilities with a history ofabuse and noncompliance are more likely to have future incidents of abuse. This nursing facility has a history ofreported abuse and sexual abuse and was cited by the state for several indications ofneglect leading up to the assault ofMs. Rivera. The nursing home management and owners are aware ofthis history ofabuse and
are obligated to take steps to prevent future abuse. Everyone in the nursing home business is
aware ofthe problem of sexual assault. It 

### is well discussed in the literature and the press. Given the history ofproblems in the facility and the complaints ofthe daughter, it is foreseeable assaults like this would occur without the proper precautions. This nursing home owes a duty ofprotection to patients suffering from mental incapacity due to decreased cognitive abilities. This duty includes monitoring the physical and mental conditions of the patients and meeting the fundamental care needs of the residents. Nursing homes are required to assess each resident's needs and capabilities. Some residents, like Ms. Rivera, require enhanced supervision and additional staff to protect them from others. The nursing home must take reasonable precautions to protect Ms. Rivera from the foreseeable consequences ofher impairment including sexual assault. This is particularly true when there is
a previously reported assault and the patient's family has voiced concerns of inappropriate behavior towards their mother.

DECLARATION OF LOREN G. LIPSON, M.D. PAGES

### 20 STANDARDS OF CARE 1. The standard of care requires the nursing home provide twenty-four hour a day skilled nursing care. The practical result ofthis requirement is that the staffmust be moving through the halls and the rooms ofthe residents all night long. There should never be a time when a staff member is not in the next room or moving through the halls next to a resident's room. 2. The standard of care requires that following the report of an assault at a nursing facility that the facility control unsupervised access to the rooms ofresidents atrisk. The standard of care requires the facility take note of the families' concerns of inappropriate behavior and eliminate access to the patient by unsupervised males. Residents at risk include women with significant dementia such as Ms. Rivera. In light ofthe families expressed concern ofinappropriate advances to Ms. Rivera, the standard requires heightened scrutiny to include regular walks through the entire hall at intervals not to exceed ten minutes to prevent access to her room by males. The standard of care requires the nursing staff document the fact that it is performing the regular checks in the patients' charts. In addition, the standard of care requires Ms. Rivera be moved to a room in close proximity to the nursing station following complaints ofinappropriate contact with Ms. Rivera. BREACH OF STANDARD OF CARE 1. The facility breached the standard ofcare by not providing twenty-four hour skilled nursing care. The nursing staffwas not present in the halls or her room to prevent the sexual assault ofMs. Rivera. 2. The facility breached the standard of care by not preventing access to her room by unsupervised males. The records do not indicate any checks on Ms. Rivera the night she was assaulted. The facility breached the standard ofcare by not moving Ms. Rivera to a room close to the nursing station where no unsupervised males could enter her room. 

### HARM The harm caused Ms. Rivera is significant. She was sexually assaulted. The injuries to her vagina are well documented in the SANE nurse report and above. The daughter reports she
was tearful and afraid. This is a common response in sexual assault victims. The daughter reports this behavior offear continued even after Ms. Rivera was removed from the facility. The fact she suffered from dementia does not lessen the harmful mental effects ofsexual assault. Even
DECLARATION OF LOREN G. LIPSON, M.D. PAGE6

### 21 an animal can remember when it has been abused. In many ways Ms. Rivera was like a small child

- confused and afraid as a result of this sexual assault. The history of problems together with the decision to ignore the families' complaints and eliminate unsupervised males from Ms. Rivera's room indicates a conscious disregard for the well-being of Ms. Rivera by the facility's management. I have considered other causes ofthis injury. I considered ifthe vaginal injuries were selfinflicted. There is no evidence in Ms. Rivera's chart to indicate she engaged in either sexual selfstimulation or self-abuse. I considered the injury may have been inflicted by someone outside the facility or even a family member. There is no evidence to support this approach. There is no record the family was anything other than supportive. The timeline in the chart indicates she was the facility at all relevant times save during transfer to the hospital. There is no evidence anyone sexually assaulted her when she was being transferred to the hospital to have her examined for InJuries.

DECLARATION OF LOREN G. LIPSON, M.D. PAGE7

### 22 

### I declare under the penalty ofperjury under the laws of

### the State of California that 

### the foregoing is 

### true and cotteot. Executed this

# R~oy**of~** , 2015.

# ~

DECLARATION OF LOREN G. UPSON, M.D. PAGES I 

# I I

### 24 "ld. 

### CURRICULUM VITAE JLoren G.**Lipson~** M.D. August 1, 2009 A. :lle.I·sonallnfol'lllation L 

### 2.

3. 

### 4. 5. 6. Nrurie; Titles! 

### Loren G. Lipson, M.D. Professor Emeritns ofMedicine at the Keele School of Medicine of the 

### University of 

### Southe.m California, Los 

### Angeles, Califonrla; and AffiJiate**Professor~** 

### Biomedical WW 

### A'M1 Program, 

### College of Atts and 

### Sciences, and Affiliate Professor, 

### College of Health and Social Welfare at the 

### University ofAlaska Anchorage. 

### Mailing Address: P.O.BoxJ 

### South Pasadena, California 91031 Business 

### Telephone: 626-403-0169 

### Fax:**626-403~0165** Pager! 800-209-2380 (Nume1io 

### Only) B. Education. 1. High 

### School- Birmingham Bigh School, Van 

### Nuys, California. Graduated, June 1961. 2. University- U.C.L.A.: B.S. in 

### Chemistry with a 

### minor inMath 

### and English. (Summa Cmn. Laude) 1 

### June 1965. 3. Medical 

### School

- The Johns Hopkins University 

### Schqol of Medicin(;}, Baltimore. Maryland: 

### M.D., June 1969 4. Internship- The Johns Hopldns Hospifu1 1 

### Osler Medical**Service~** 1969-1970. 5. 

### Residency H 

### The Joh11s Hopkins Hospital) 

### Osler Medical**Service~** 1970-1971**~~** '

### 25 T I ' 6. Fellowships:
a. TI1e Johns Hopkins University School of**Medicine~** Baltimore, Maryland: Clinical Fellow in Medi<line, 1969- 1971

· b. The Natio11al Institutes ofHealth, Bethesda; Marylaud: Research Associate

- Protein Chemistty, Physical Biochemistry, Molecular Biology

- Labo1·atory of .Chemical**Biology~** National Institute of Arthritis, 

### Metabolic and Digestive Diseases (NlAMDD), 1971-1973.
c. Massachusetts General Hospital, Boston, Massachusetts: Clinical and Research Fellow in Medicine (Endocrinology and Metabolism),**1973~** 1976 d. Harvard Medical School, Boston, Massaolmsettsi Clinbal and Research Fellow in Medicine (Endocrinology and Metabolisin),l973·1975. · 

### e, Harvard Medical School, 

### Boston, Massachusetts: 

### John A. Hartford Senio:r Scholar in Gerfatdc**Medicine~** Division of Aging,l9&4·.1985

- f. Beth Israel**Hospital~** Boston, Massachusetts! Clinieal Fellow in Medicine**(Gerontology)~ 1984~1985**  g. Brigham

-**Women~s** Hospital, Boston,**Massachusetts~** Clinical Fellow in Medicine (Getontology), 1984-1985 

### h. Hebrew Rehabilitation Center for the Aged, Boston, Massachusetts: Clinical Fellow in Geriatric Medicine, 1984**~1985.** i Institute ofAdvanced Studies on Gerontotogy, Ethel Percy Ail.dtus 

### Gerontology Center,**USC~** 

### Los Angeles, 

### California: Fellow 

### in Insl'itute, 

### Area- Drugs inthe Elderly, 1985-19S7 j. Geriatric Research fnstitute. Ethel Percy Andrus Gerontology Center>**USC~** Los Angeles, California: 

### Senior Research 

### Associate. 1985-1989. 7. Honors and Award

... & • 

# ..

### 26 I i !·



# .. , . 1965

1968-1969
.
1975 -1977

1975-1978
1977 -·1978 1984-1985

1989

1989
1999


### 2000 

### 2002 Phi Beta Kappa; Recipient 

### ofMerck Award in Chemistry; Outstanding Underg1•aduate in Chemistry Award of Phi 

### Lambda Upsilon; Medal 

### for Soholarshlp of the 

### American Institute 

### of Chemists; The 

### Ramsey Prize in Physical Chemistry; Sigma XIAll at U.C.L.A. Heruy Strong Denison Scholarship for Research. in Medicine, The Johns Hopkins University School ofMedicine. National Research Service Award in Diabetes (NIAMDD), National Institutes of Health. Daland ·FelLowship in Clinical Medicine, American Philosophical Society. Clinical Investigator Award in Diabetes, NIAMDD, National Institutes ofHealth. John A. Hartfo1·d Seniot Scholat· Award in Geriatric Medicine, Division of Aging, Harvard.Medical School. 

### The Genesis A wru:d, For Innovative Health Care Delive1y, Los Angeles Bush1ess 

### Journal. Professional Leadership Progxam Award, Volunteer Center ofLos Angeles. One ofTop 20 Physicians 

### in the 

### G1'eater Los Angeles Atea (and 

### only Gerlatl'ician named), Los Aflgeles Business Joumal. One ofTop**Primary~Care** Physicians inthe**U.S.~** 

### Tow.n an.d Country 

### Magazine. 

### One ofTop Ten 

### Physicians inLos Angeles, 

### Ametica.-On-Line. 8. Licensure: California.

;**~** 

### . . 

## .

### 27 ... 4**~** 

### 9. Boards: American Board oflnternal Medicine, 1974. Am.edcan Boatd of Quality Assurance ru.td Utilization Revlew Physicians, 1995 Certificate ofExpertise in Geriatric Medicine, American Board of Internal Medicine, 1996
C. Professional Baclcground l. Academic Appointments
a. The Jolms Hopkins University School of**Medicine~** Baltimore, Maryland; Clinical Fellow inMedicine, 1969"1971. b. Massachusetts General Hospital7 Boston, Massachusetts; Clinical and Research Fellow in Medicine (Endocrinology !ll1d Metabolism), 1973"1976.
c. Harvard Medical School, Boston, Massachusetts; Clinical and Research Fellow in Medioitte (Eltdoctinology and Metabolism), 1973H1975, d. Harvard Medical School, Boston. Massachusetts; fustructor in Medioine (Diabetes), 1975"1978.
e. Massachusetts General Hospital 1 Boston 1 Massachusetts; Clinical Assistant in Medicine (Diabetes Unit), 1976-1978. University of Southern California School of Medicine; Los Angeles, Califonrla; Assistant Professor of Medicine (Diabetes**Division)~** 197**8~**1981. g, University of Southern California School of**Medicine~** Los Angelesj California; Assistant Professor of**M~.dicine.** with tenure (Division of Diabetes and Clinical Nutrition); 1981

- January 1984. h. Los Angeles County/University of Southem Califomia Medical Center, Los Angeles.**Califomia~** Staff Physician 

### 1:n Medicine (Diabetes Service), 1978**~January** 1984 i. University of Southern California School of Medicine, Los Angeles, California; Associate Professor ofMedicine (Division of Geriatric Medicine), January 1984- September 2006.

4

... J •

### 28**~**

# . . j. Univel'Sity of Southern California Schbol of Medicine, Los Angeles, California; Chief, Division of Geriatric Medicine in the 

### Department of**Medicine.~** January 19&4- 2005. k. University of Southern 

### Califotnhb Los Angeles, California; Associate Professor of Gerontology, Leonard Davis School of Gerontology, Ethel Percy Andrus Gerontology Center, January 1984- September 2006. 1. University of Southern Califomia1 Los Angeles, · California; Associate P1'ofessor of Clinical Pharmacy, U.S.C. School of Pharmacy, October 1989**~** September 2006.
m. Los Angeles County/University of Southe.rn California Medical**Center~** Los Angeles, California; Staff Physician in Medicine, (Geriattic Medicine),**1984~2004.** u. Sabbatical Leave, Harvard Medical School, Boston, Massachusetts; Division of**Aging~** John A. Hartford Senior**ScholarinGeriatdcMedicine~** 1984-1985.
o. Brigham & Women's Hospital, Boston> Massachusetts; Clinical Fellow in Medicine (Geriatric Medicine), 1984 ·1985. p. 

### Beth Israel Hospital, Boston, Massachusetts; Clinical Fellow 

### in Medicine (Geriatric Medicine), 1984-1985 q. University of Southern California, Los**Angeles~** California; Senior Research**Associate~** Getontology Research Institute, Ethel Percy Andrus Gerontology Center, 1985- 1989.
r. University ofSouthern**Callfomi~** Los Angeles) California; Fellow Institute of Advance Study, Ethel Percy And1us Gerontology Center, 1985 -1987.
s. University of Southern California University Hospital, Los**Angeles~** California; ChiefofGeriatric Medicine,**1991~** 2005 t.



### u. University of Southern California**~** School of Dentisb:y Associate Professor ofMedical Dentistry and Public Health, l994

- September 2006. Uni-versity ofSottthem California- School ofindependentHealth _Pl'ofessionals

- Associate Professor of Occupational Science and Occupational 'Therapy, 1998-**S~ptember** 2006.

5 i

# I ' I I f t 

# j**~~~~·--·--~-~** 

### --- -1.
! l**~A** • 

# I I

·-·+



# I

### 29 '"{j. v. University ofAlaska,**Anchorage~** Adju11ct Associate Professor of Human Biology, 2001- September 2006,


### w. Unive.r:sity of Alaska Southeast, Sitka**~·** Adjunct Associate 

### Professor ofHuman Studies, 

### 2001**~** 

### 2006. 

### x, University of Alaska, Attchomge, Affiliate Professor, College of Health and 

### Social Welfare, 2006- Present. y, University of Alaska Anchorage, Afftliate Professo:t•, Biomedical W\VAMI Program, College ofArts and Sciences, 2006- Present.
z. 

### University of**Alaska~ Anchorage~**  Faculty Consultant in Geriatdcs, Alaska 

### Family Medical Residency, September 2006- Present.
aa. 

### Univel'sity of Southern California, Keck School of Medicine, Professor Emeritus ofMedicine, September 2006 -Present. 2A. Teaching Responsibilities (University ofSouthern California) · a. Attenditl.g Staff :Physician LAC/USC Medical Centel' o1t the General Medical Service- teaching and supervising patient care1 both inpatient and outpatientto house staffand students 1985

- 2004. b. Attending Staff Physician at USC University 

### Hospital in Geriatric Medicine for Medical House Staffand 

### students. 1991-2005.
c. Xn charge of the Fellowship Program

- Geriatric Medicine. 1985

- 2004. d. Development and improvement ofGeriatric Medical 

### Curriculum ill the Medical School-**Univ~t·sity** ofSouthem California. 1985-2004


### e. Development of 

### Oel'iatdc Medical Core Curriculum for the Medical House Staff- LAC/USC Medical Center, 1985-2004 f. Member of Steering**Committee~** Key Faculty and Study Site Cootdi11ator

- Pacific Geriatric Education Center at the 

### University of Southern California(DHHS), 1984-1993. g. 

### Attending Physician Year III Medicine Rotation, 1992. h. Dit:eotor and lecturer 

### in various courses at the Eth6l Pel'cy Andrus Gerontology Center including Gerontology 599 - Geriatric Health 

### Issues.
6

..**--~--~·-~---·--.** -- -· ·--- ------·**----'--------:-~--:-----;--:-~-'-;-------,**

·q. 

### . ,,

., l.

### 30 i. Director- Geriatrics Update- ABoard Review Course. j. Director

- History ofMedicine in the Healtll Sciences Program, 1994 -200L 2B. · Teaching Responsibilities (University ofAlaska)



### 3. a. Director- Care ofthe Elderly Conference, University ofAlaska, Southeast- Sitka> 1994- Present b. Instructor

- Promoting Best Practices in Aging, University of Alaska, Anchorage, 2006- Present
c.**Co~Director** - University of Washington Medical School 596- Human Biology

- Course for Alaskan Students.- Multi" Disciplinary and Ethnicity in Gerontology 

### and Geriatdcs, (Univetsity ofAlaska, Anchol'age- Spring and Fall, 2009 and then yeat'ly). d.**Co~Director** in Geriatric Education to Alaskan Medical Stgdentll in the University ofWashington 

### Medical School WW AMI 

### Progt·am, Ulliversity ofAlaska, Anchorage, 2006- Present
e. Faculty consultant in Geriatrics to Residents ofthe 

### Alaska 

### :Family Medicine Residency Program. 2006- Present. Administrative Responsibilities
a. Chiefofthe Division of Geriatric Medicine. Department ofMedicine, University of Southern Califom1a School of MG:e:Iicine, In charge of staff arid feliow recruitment and training; divisional budge;'lt; gtatlt procurement; progrw:u development and supervision of research and clinical activity. 1984- 

### 2005. b. Study Site Coordinator 

### and Key Faculty .of the Pacific Geriatrlc Educatio.tl Center, University of Southern California School of Medicine, 1984-1993.
c. Senior StaffPhysician in charge 

### ofGeriatric Programs at Los Angeles County/University of Southern California Medical Center, 1985

- 

### 2004. d. Chief of Geriatric Medicine at the USC University**Hospital~** 1991

- 

### 2004.


### -·-1

...**~** - 

## ..**~** . 11 ' -l.l. : '**~----~---·-~-** 

# ! ' 

# I i

### 31 a • e. Faculty liaison between Geriatric Medicine and University flffiliated hospitals and long term care :fucillties. Director ofGeriatric Medicine Priv1l.te Practice Plan. 1984**~** 2004 f. Director of the USC Ambulatory Health Center sites at the Japanese Retil'emen.t Homes and Angelus Plaza, 1985- 1993. g. Dit·ectot ofthe Division of Geriatric Medicine's Program at the V.A. Outpatie1lt Clinic in downtown Los Angeles, 1986- 2001. h. Director ofthe USC Teaching Nursing Home Program at Hollenbeck :Home and. Atherton BaptistHome, 1999-2005. i; Dh·ector ofthe Senior Cancer Center at Norris Comprehensive Cancer Centel' and Hospital, 1999

- 200 1. j. Dh-ector ofthe Senior Cal.'e Program- USC Care and USC Physicians. 199& -2002,•. k.**Co~Director-** Adult :Protective Team

- Oerlatd.c Medicine Program

- LAC/USC Medical Center, 2000

- 2004. 1. Director

- Cate of the Elderly Conference) University of Alaska**Southeast~** 

### Sitka, 1994- Present.
m.**Co~**Director

- Geriatrio Education for Alaskan Medica[ Stndents in the WW AMI Program 1 University ofAlaska1 Anchorage. 2006- Present,
n. Medical Directo1·- Alaska Geriatdo Education Center, University of Alaska, Anchorage. 2005 -Present.
o. Medical Director- National Resource Centel' for Studies in Native**American~** Alaskan, and Hawaiian Elders, University of Alaska, Anchorage, 2006**~Present** 4. Service A. University Service

"6 • a. Medical Executive Cotll.lllittee, Department ofMedicine, USC 1985- 2003. b. Utilization Management Committee) USC University Hospital, 1991- 1999, 2003- Present, Chairman ofthis Co:mmittee, 1994**~** 1999.

"'4 • ·u.

### 32 c. Phru:maoy and Therapeutics Committee, LAC/USC Medical Center1 200[- 2004. d. Pharmacy and 

### Therapeutics Conunittee1 USC University Hospital, 1991

- 2005, Chairman, 1996- 

### 2000.
e. Patient Care Evaluation Committee, USC University Hospiial, 1994- 1999. f. Lecturer in School of Pharmacy, University of Southern Californhi., 1985**~2004.** g. Continuing Medical**Post~Graduate** Edt.tcation Lectures at outlying**hospitals~** 1919-2004. h. Core Ctu'l'icl.llum. Conunittee for the New Medical School Oluiculum, USC School ofMedicine, 1998**~** 2002 L County Operations Committee, Department of Medicine, LAC/USC Medical Center, 1997- 2000 j. Development Cotnmittee, Departm.ent of Medicine, LAC/USC Medical Center, 1997- 2000. k. Senior Health Care Program, USC Care, (chair/member), USC 199&- 2002. L Executive Co:nunittee, USC Norris Comprehensive Cancer Center and Hospital- Senior Cancer Care Center, 1998

- 200L
m.**Co~**Director

- 

### Adult Protective Team**~** Geriatric Medicine Program

### LACJ{]SC Medical**Center~** 2000- 

### 2004. B. Public Service
a. Consultant in Geriatric Medicine and Long Term Care; State of Alaska. Depru.'tm.ents ofAdministration Law, Health and Social Services, 1991 -·2004 b. Consultant in Gerontology and Geriatric Medicine, UniveJ:sity of Alaska, both at the Anchorage and Sitka**campuses~** 1994- present.
c. Board ofDirectors, California Association ofMedical Directors, 1992-**~~** 1999.

### 33 .., 6 ' d, Citizen's Oversight Committee-- California Stem Cell Research & Cures Act, 2007- Present.
e. Board ofDirectors, USC Friends ofMusic} 1989-1997. f. TaskFotce on Elder Abuse, City ofLos Angeles, 2001 -2004-. g. CalifomiaRare Fruit Growers, 1988 - Present. h. Pennsylvania Horticulture Society, 1992-2007. i. Affenpinscher Club ofAmedca, 2002**~Present.** j. Kennel Club ofPasadena, 2004-2007. 5, Military Service 1971**~-1973** Active duty as Surgeon

- U.S.F.B.S. serving as Research Associate (Protein Chemisuy) in the Laboratory ofChemical Biology with Dr. Robert 

### Goldberger and Dr. Christian**Anfmse~** NIAMDD, NIH: Inactive Resorvc U.S.P.lLS. 1969-1971, 1973- 1979. 6. Other Activities
a. Editor for ENDOCRlNOLOGY 

### for Diabetes and 

### Intermediary**Metabolism~** 1985- 1986. b. Member of the Committee of Interdisciplinary Geriatdc Education, Association for Ge1·ontology In Highet Education, 2002 -2006.
c. Reviewer for: · AMERJCAN JOURNAL OF l?HYStOLOGY ANNALS OF INTERNAL MEDICINE ARCHIVES OF INTERNAL 

### MEDICINE BIOCHEMICAL 

### MEDICINE DIABETES ENDOCRINILOGY EXPERIMENTAL GERONTOLOGY JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM JOURNAL OF GERONTOLOGY HORMONE AND METABOLISM RESEARCH JOURNAL OF THE AMERICAN GERIATRICS SOCffiTY DRUGS AND AGING NEW ENGLAND JOURNAL OF MEDICINE

clO · ·-· ·.-- ---·------·· ··**~**

# I I 

# I

I 

## I 

# I

l

# I I 

# I

j ; i l

# I

I**~ ~**  --**-.---~---~** -**--t~~** I 

## I ! l 

# I
l

### 34 D. S()ciety Membe.i•ships 1. Local Cross Town Endocrine Club Professional StaffAssociation ofLAC/USC Medical Center Center Fellow of the UCLMJSC Long Tenn Care Gerontology Center FarEastern Study Centel' USC/UCLA California**~ssocia.tion** ofMedical Directors 2. Regional



### 3. We.'ltern Society for Clinical Investigation Western Section ofthe Amedcan Federation for Clinical Research
Nai"ional Sigma Xi, Phi Beta Kappa, Phi Lam.bda Upsilo11 The Johns Hopldns Medical an.d Surgical Society The Johns Hopkins flistoty ofMedic1ne Club The Associates ofthe Countway Library The American Association for the History ofMedicine American Federation fot Clinical Research Amerioan.Diabetes Assocration The Endocrine Society American Physiological Society The Gerontological Society ofA1tl.edca The American Geriatric Society The American Federation for Aging Research Atnerican Gerontological Association American Association ofMedical Directors ,;:::.,.,,. E, Consulta.llltships and Directorships

... 

## , . 1. Consultant in Geriatric Medicine and Supewisot ofthe Oerlatl.'ic Progre.m at the Veterans Administration Outpatient Clinic in downtown Los Angeles, 1986-2001. 2. Executive Director ofthe USC Ambulatoty Health Center at Angelus 

### Plaza, 1989- 1993.
. 3. Board of Diteotors, California Association of Medical Directors, 1992

- 

### 1999. 4. Board ofDirector, USC friends ofMusic, 1989-1997
.

### 35 ... 6 • 5. Consultant 

### in Geriatric Medicine and Long Term Care- State of Alaska 1991-2004; a, Department ofAdministration b, Department 

### ofHealth and Social Services c, Department ofLaw d. Mental Health Board 6. Appointments in Gedatdos- University ofAlaska: 

### a. Sitka I. Adjunct Associate Professor of Human Studies,**2003~** 2006. IL Course Director

- Care of the Bldel'ly Conference> 1994 Present b. Anchorage · I. Affiliate**Ptofessm~** College of Arts and Sciences, Biomedical WW AMI FrogramJ 2006**~Present** II. Consultant1**Co~Founder** and Medical Director

- Alaska Gei'iatdc Institute thtough the Alaska Geriatric Education Center, 2003 -Present. IIL Consultant**~** rnstitute ofCircumpolar Health IV. Consultant and Medical Director -National Resource Center for Ar.nedcan Indians, Alaska Natives and Native Hawaiian Eldets. 2005 -Present. V. ·Faculty Consultant in Geriatrics, Alaska Family Reside11cy Program, 2005 ·· Present VL Affiliate P.F.ofess.or. College ofHealth a11d Social Welfare. 7. Consultant, BritishColumbiaHealthFoundation, 1994-1999. 8. Consultant in Gel'latdc Medicine and Long 

### Tenn Care, Silverado Senior Living Centers, San Juan Capistrano, CA 2()01 -2002. 9. Consultant in Geriatric Medicine and Supervisor ofthe Geriatric Medicine Medical House StaffTraining Program, Ketn Medical**Center~** Bakersfield, CA 1986-2003. 10. Consultant ill Geriatric Medicine and Supervisor ofthe Geriatl.'ic Family Medicine House Staff Training Program,**Glendal~** Adventist Medical Center, Glendale, CA 1998-2001

·---. ··-····· --12-···--------·-·

------ --

;**~** 

# .

### 36 

## ./ 11. Consultmt in Geriatric Program Development

- 

### Bay Shores Medical Gronp, Torrance, CA., 1986-1989. 12. Consultant in Geriatric Progratt1 Development- San Dimas Coxnmunlty, Hospital, 1986-1989. 13. Consultant in Gel'iatrlc Program Development and 

### Long Tenn Care**~** Keiro Services

- The Jap$.nese

- American Retirement**Homes~** Los Angeles, CA., 1986**~** 1993, 

### 14. Consultant in 

### Geriatric J?.r:ogram Development 

### and Long Term Care-1'he Motion Pioture and Television Home, Woodland Hills, CA 1986- 1990. 15. Consultant in Long Term Care and Geriatric Medicine, State ofCalifornia, Depru.1thent ofSocial.Services, 2000- Pt·esent. 16. Consultant in Elder Abuse, Geriatric Medicine and Long Tenn Care, State of California, Department of Justice, Office of the Attorney General, Bureau ofMedical Fraud and Elder Abuse, 2000**~Present.** 17. Consultant in Long Term Care, Elder Abuse and Geriatric Medicine

- State ofCalifomia, Department of**Justice~** Office ofthe Attorney General, Bureau ofMedical Fraud and Elder Abuse- Operation Gual'dians (nttrsing homes**~** unaru10unced inspections) 2000- Present. 18. Consultant in Long Term Care, Geriatric Medicine and Elder Abuse**~** State of New Mexico, Department of Justice, Office of the Attorney General, Medicaid Fraud and Elder Abuse Unit, 2003**~** Present. 19. Consultant in Long Term Care, Geriatric Medicine and Elder Abuse, United States ofAmerica, Depru:t.tue.nt of Justice, Civil Rights Division,
· ..**·t.~-~""'-··-** 

### 2006- Present. · .. '·""""'-
....··-··

. 20. Consultant 

### in Long Term Care, Geriatric Medicine and Elder Abuse, United States of America, Department of Health and Human Sclrvices, 0 ffioe ofthe Inspectur General, 2006 -Present. 21. Board ofDirectors. Musica Angelica, 2006- Present. 

### JF. Research Activities



# .. , ' 1. Research Interests
a. Use ofmedications inthe senior populations with specific emphasis on prescribing habits ofphysicians
.



### ... . JJ
..

" J • '11.

### 37 

# ... b. Health care systems and delivery modes for the demented eldedy in Alaska. c. D1'Ug interactions it1 the elderly, looking at drug-drug interactions. changed actions; polypharmacy} misuse' and abuse. d. Studies In the elderly diabetic patient. e, Studies in the elderly hypertensive patient. f. Studies insexual dysfunction in the eldedy. g. 

### Studies inelde1' abuse. h. Maintenance ofjndependence ofliving in frail and demented seniors. 2. Research inProgress: Investigations 

### in man a. Studies in prescribing 

### habits {If physicians in retirementhousing. b. Studies ofadverse drug effects in the aging population with special emphasis on the most commonly prescribe medication and 

### psychotropio agents. c. Studies on care offrail and demented**senio~·s** in Alaska. d. Studies onthe prevention and early detection ofelder abuse. e. Studies on decreased longevity in**th~** Pueblo lndians. G. Long Tel'm Ca:re Experience 1. Director ofthe two USC Teaching-Nursing Home 

### Progl·ams, 1999

- 2005
a. Hollenbeck Home- Los Angeles b. Atherton Baptist 

### Home

- Alhlllilbra 2. Member and Member Board of Director, California Association of Medical DirectOl'S, 1992**~** 1999. 3.**Consultant~** State of**Alask~** 

### Department ofAdministration, Division of Longevity Services (Aging Progtruns. and State ofAlaska Long :r'l;lmtCare Facilities- the Pioneers' Homes). 1991-2004. ·· 4. Affiliate Professor, College ofHealth atld Social Welfare and College of Arts and**Sciences~** University of Alaska, Anchorage, · Areas of involvement

- 

### Alaska Geriatric Education Center, Geriatric 

### Assessment, Prewmed and Medical**Education~** Long 

### nmn Care, 2006 to Present.
. 5. Consultant'- 

### Universtty ofAlaska"' Sitka. Areas ofinvolvement- Care of Elderly Conference- Director, 1994 "Present**~.** 

### Consultant in Long Term 

### Care. Elder Abuse and Oerlatdc 

### Medicine

- State of

### Alaska. Department ofLaw; 2000

- 2003



### JA

..

• , 8

- 'H •

### 38 

# .

'

. 7. Consultant in Long Tenn Care and Geriatric Medicine

- State of California, Department of

### Social Services. 8. Consultant in Long Tettn Care, Geriatric Medicine and Elder Abuse

- State ofCalifomia, Department ofJustice) Office ofthe Attomey General, Bureau ofMedical Fraud and Elder**Abuse~** 2000-2003. 9. Consultant in 

### Long Tenn Care

- 

### State of 

### California1 

### Department 

### of Justice) Office of the Attomey General, Bureau of Medical Fraud 1:1nd Elder Abuse

- Operation Guardians (nursing 

### home- unannouniY'.Al inspections), 2000 -·Present. l0. 

### Consultant in Long Term Care, Geriatric 

### Medicine and Elder 

### Abuse

- State of New Mexico, Department of**Justice~** Office of the Attorney General, Medicaid Fmud and Elder Abuse Unit} 2003 -Present. 11. Consultant in Long Term Care, Geriatric Medtcine and Elder Abuse, United States of**America~** Department of 

### Justice, Civil 

### Rights Division, 2006- Present. 12. P:dmary cat•e provider for Geriatric Medicine for Long Term Cal'e Patients -Hollenbeck Home, Los Angeles; California, 1998

- 2004. 13. LACfUSC M(ldioal Center Clinic -Adult Protective Team

- Geriatric Medicine-Clinic**Co~director,** 2000-2004. 14. Member ofthe Arn.ericatl Association ofMedical Directors. 15. USC

- Angeles Plaza

- Senior Clinic**~** Founding 

### Director and oare provider (1989- 1992). (The largest low-income seniorl1ousing pl'Oject in the Western United States). 

### 16. Consultant in Geriatric Medicine and Long Term Care- Silvemdo Senior Living Centers 1 San Juan Capistrano, 2001 -2002. 17. Consultant in Geriatric Program Development and Long Term Care

- K.eiro Services

- The Japanese 

### AlUerican Retirement Homes, Los Angeles, 1986-1994. · 18. Consultan.t in Geriau:ic Program Development and Long Term Ca.l.'e- The Motion Picture and Television Home, Woodland**Hills~· CA~**  1986 -1990 m. Sigllificant lnvited Lectures (Since JU!ly 1984

- selected flt'Oilll over 3,500 lectures given) 

### t Harbor General Hospital- U.C.L.A. Medical Center. 7/84
.



### . li -

->!' ·, ' '\" 

# . ->!'

### 39 

# ... . Medical Grand Rounds

- uew concepts in the treatment 

### of Type II Diabetes. 2. Harbor General Hospital- U.C.L.A. Medical-center, 7/84. Endocrine Orand Rounds -The hewer oral agents. 

### 3. Mm:tinLuthel' King**Gene~al** 

### Hospital, Los Angeles, 

### CA, 7/84 Medical Grand**Rounds~** The approach to the pathmt withNIDDM. 4. Nisei Awat:eness Day; Little Tokyo, Los Angeles, CA, 7/84 Health issues for the elderly. Keynote speech. 5. The Cleveland Clinic, 9/84. Symposium on Diabetes Mellitus-

- The**T~·eatment** of the Patient with NIDDM. 6. American Academy of;Family Practice, Kllnsas City, MO, 10/84 ·National Meeting, Invited Speaker: a. Nutrition in the elderly b. New concepts in the thet•apy ofthe Type II 

### diabetic patient. 7. Associates of the Countwa.y Library, Harvard Medical School, 11184. Biannual History of Medicine lecture

- "The Black Death Comes to**AJ.:nedca.~~** 8. 

### Washington University 

### of St. 

### Louis and St. Louis V.A. Hospital, 11/84. Symposium on Diabetes Mellitus

- The treatment ofhYPertension in the patient with Diabetes Mellitus. 9. The Jackson 

### Laboratory, Bar Harbor,**Maine~** 12/84. 

### Visitjng Scientist- Insulin seo1·etion in aging. 

### 10. .Gordon Research Conference,.01mat.d, 

### CA, 2/85. The biol<Jgy Of aghg**~** Invited Speaker- Cyclic AMP and insulin 

### secretion in aging. 11. Tnorodike Rounds, Beth Israel 

### Hospital, Boston, MA 3/85. The approach to the treatment of diabetes mellitus in the elderly individual. 12. Division on Aging, Harvard Medioal School, 3/85. Grand Rounds

- Hyperosmolar 

### coma.,_... a complication ofdiabetes mellitus 

### inthe Elderly. 13. The 

### University**ofNewBrunswick~ SaintJo~**  

### N.B•• 3/85. Visiting professor of

### Biology. Lecture topics:
a. The role ofcalmodulin 

### in insulin secretion.
_J6
..

.. 4 •

### 40 

# ... b. The exciting new approaches to the treatment of diabetes mellitus. 14. Beth lsi:ael Hospltal1 Boston) MA> 3/85 Endocrine G1·and Rounds -Sex and the diabetic. 15. The Johns Hopkins University Scholl ofMedicine, Baltimore, MD) 3185. Visiting Professor of the History of 

### Medicine. Lectw:e topic- «Black Death Conte to America.,, 16. Btigham-Women1s Hospital, Boston, MA, 3/85 Endocrine Grand Rounds**~·Insulin** secretion in aging. 17. Yale University School ofMedioine, New**Have~** CT, 4/85 Endocrine Research ConfetefiCe -Insulin seGretion in aging•

.... t... Hypertension Grand Rounds- Special problems ofhypetteusioll fn**~** the diabetic patient. · 18. University ofFlorida}**Gainesville~** FL 4/85 Gedatric Medicine Grand Rounds -The older diabetic patient.

. . 19. University ofCalifornia at Los**Ang~l~s** School ofMedicine, 4/85. Fanl.ily Medicine Grand Rounds- Treatment ofdiabetes mellitus in tbe elderly. 20. Stanfoi:d University of**Medicine~** V.A. Hospital. Menlo Pari; CA, 5/85, Clinical Conference

- Sexual dysfunction in the elderly. 22. University of Pittsburgh School of Medicine, Pittsburgh, PA, 6/85. Symposium on Diabetes Mellitus -The older diabetic patient.**23~:** ,·.:.!W.Jliv.etsity ofHawaii School ofMedicine, Honolulu, HI. 8/85 Medical Orand Rounds- Diabetes in the elderly.

. 24.

25. 26.

27. Department ofPublic Health and Sooial Welfare1 Guat_n, 8/SS Special Leotru:e- Wellness and pathology in the elderly. American Academy ofFamily Practice, Anaheim, CA. 10/fiS. National Meeting -:tn.vited Speaker- Oiabetes in the elderly. University of 

### C111ifornia at San Francisco

- Valley Medical Center, Fresno, CA, 11/85. Endo01ine**symposium~** Sexual 

### Dysfunction .in fue elderly, Mayor's Conference on Aging, Los Angeles, 

### CA. 3/86. treatment of chronic diseases in the elderly.

'"lj. I .. l

### 41 

### .. •.



# .

# . . 28.
29.
30.
31.
32. ,:33·.
34. V.A. Hospital, Mmtinez, CA and U.C. Davis School afMedidne, 4/86. Medical Grand RoUll,ds -Treatment ofhypertension in diabetic patients. Pasadena Council on Alcoholism, Pasadena, CA, 4/86. Symposium on the Older Alcoholic Patient. Pathology and normalcy in aging. Brown University Medical School, Providence, RI 4/86. Medical 

### Grauel · Rounds- 

### Hypertension inthe elderly. Medical Board Drug Review, Sacramento 1 CA, 5/86. 

### Invited Speaker

- 

### The new oral 

### agents. · Conference

- Scientific Basis ofSexual Dysfunction

- Sponso:red by NIH and the National Kidney Foundation, Baltimore, MD, 6/86, F.D.A. Symposium ofBioequivalence of Solid Preparations, Washington, D.C., 10!86. Itwited Speaker- Oral sulfonyhu:ea agents. University ofNevada, Reno, NV, 2/87. Visiting Professot of Medicine, Lecture topic**~Sex** after 60. 35. University of Guam, .Guam., USA, 4/87. Symposium on Care of the Elderly

- Symposium Leader. 36. National Council on Hypertehsion1 

### Biannual Meeting, Las Vegas, 

### NV. 4/87. Invited Speaker

- Antihypertensive medications and sexual dysfunction. 37. 

### American Hospital Pha.nnacists Association, Washington, D.C. 

### 5/87.**I~vited** Speaker- Aging inAmerica- Wellness vs. Disease. 3S. University of California, Davis- School of Medicine, 6/87. Course on Medicine, Invited Speaker- 

### f:I;vpertension in the elderly. 39. University of Nevada, Las Vegas, 

### Nevada, 10/87. Visiting 

### Professor of Medicine, Lecture 

### Topics; Gel'iatric Medicine 

### Todayl' Geriatric 

### Cmu:se Planning. 40. California Pharmacy Association, San Francisco, CA, 11/87. Invited Speakeu- Endocrinology ofaging. 41. Evanston**Hospital~** Northwestern 

### University School of Medicine,**~v:mston>** IL, 11/87. Visiting Professor ofMedicine, Topic**~** Sex after 60.

······--18--··

., 4 • "'i4 • 

## 'I'

.

### 42 

# .

# .. 42. Conference on Pathogenesis and Treatment of Pressure Sores. Kansas City, MO, I/88. Invited Speaker. 43. Conference on**~?What Phannaceuti~als**  are Needed for the Elderly?" Phoenix) AZ, 2/88. Invited Speaker. 44: Confert;lnce on "Post Retirement IJealth Care Funding" sponsored by I.R.L, New York, NY, 3/88. Invited Speaker-The gedatricirnperative. 45. Board Review Com:se: Geriatrics Update, 1988, U.S.C. School of Medicine, Pasadena, CA, 3/88. Two and one-half day symposium on geriatrics. Director, Moderator and Presenter for the course. 46. Symposium on Geriatric. Medicine

- Motion Picture and Television Retirement Home And Hospital, Woodland Hills, CA, 4/88. Moderator and Presenter. 47. American Geriatdc Society National Meeting, Symposium and Physician

- Patient Communication, Aneheim, CA, 5/l.l8. Co-moderator and presenter. 48. Symposium on Geriatric Medicine, San Dimas Community**Hospital~** Sa11 Dimas, CA, 9/88, Moderator attd 

### Presenter. 49. American Society for Enteral and Pa:rental Nutrition Confere:t.lCes: Ethics and Nutrltion, New York, NY, 10/88 50. Symposium on Nutrition in the Elderly, California Medical Center, Los Angeles, CAj 12/88. Moderator and**Pre~enter~** Topic- Nutrition in the Elderly. 51. Calif@n.tia Academy ofFamily 

### Medicine, Annual Meeting, San**Fraucigco~ ~** 

### ..**~.!1~;<t{·'** ,_, CA 2/89. fuvited Keynote Speaker, Topic- Dementia. 52. Kansas University Medical Center, Family Medicine Grand Rounds, Kansas City, KS, 5/89,; Visiting Profess<lr, Topic- Drngs in the elderly. 53. California Association for Homes for the Aged, Anmtal Mcefulg. Symposium on Drugs 

### In the Elderly, San Diego, CA. 5/89. In-vited Speaker,**Topic~** Medical Aspocts ofDrugs in the Bldedy. 54. Symposium on. Geriatric**Ca1'e~** Motion Picture and Television Home, ·woodland Hills, CA., 6(89. Modera.tot and Presenter, Topic- Tests and exams pedodically needed fqr Seniorhealth

.... -····19 ,..... .

'\j'**~!.** '\ & • 

## .., .

### 43 , I·•**'~** 55. Symposium of Diseases Affecting Extended Care Management of 1he Eldel'ly, California Federation on· Aging, Newport Beach, CA, 6/89. Moderatol'. 56. Symposium of Diabetes in the Elderly, USC School of**Medicine~** Los**Angeles~** CA} 8/89. Moderator. 57. V.A. Medical Center, Phoenix, AZ, 9/89. Medical Grand Rounds, dmgs in the Elderly. 58. Gel'iatric Medicine Symposium, Hawaii Medical Association, 9/&9, Invited Speaker. Topic- 

### Hypertension in th.e Elderly. 59.

I 60,

61. 

### 62. 63. 

### 64
.. 65 •.. 

### 66.

67. 68.
69. 

### University 

### Medical Center 

### of Kansas**City~** 

### Kansas City, MO, 9/89. Medical Grand Rouuds- Sex after 60. National Confexence of Consulting Actuaries, Hot Springs, VA, 9/89. Invited Speaker. California 

### Phartuacists Association, Los Angeles; CA, 10/89. 

### Endocrinology in the Eldel'ly. Program Director. Family Medicine Program, Santa Rosa, CA, 11/89. Visiting Professot of Geriatric Medicine. Symposium on Geriatric Medicine. Tacoma General Hospital, Tacon1a, W**A~** 1/90. Course 

### Directo1· and Speaker. Symposium. on Gedatric Medicine, Antelope Valley Medical Center, Lancaster, CA, 2190. Course Director and Speaker. 

### Unive.t:sity of Nevada School of**MediGin~,,~Re:no,** 

### NV, 3/90. Visiting Professor ofGeriatric Medicine. USC Gedat:dc Review Course, USC School of Medicine, Los Angeles, CA, 3/90. Two and**one~half** day intensive course in gerlatdc medicine. Course Director and Speaker. Eisenhower Hospital, Rancho Mirage, CA, 3/90. Medical Gl:and RoundsDrugs inthe Elderly. American Geriatric Society Arumal Meeting, Atlanta, GA, 5190. Symposium on Syndrome X; The correlation ofdiabetes andhypertension. American Diabetes Association Symposium, Santa Ba1-·bara, CA, 6/90. Diabetes in**Th~;:** Mexicat'l. American 

### Population. Invited Speaker.
20

### 44**~**

# .. ' 

### . ·70. Lorna .Linda University School of

### Medicine~ Loma Linda, CA, 7/90. Grand Rotmds, Drugs in the 

### Elderly. 71. American Heart Association/ 

### American Diabetes Association Symposium, Santa Barbara, CA, 9/90. Treatment of the hypertellSive diabetic patjent. Keynote 

### Speaker. 72. Baylol' College of Medicine, Houston, TX, 10/90. Symposimn on the Complicated Diabetic. Invited 

### Speaker. 73. City of Hope, Duarte1 CA, 1/9 L Medical Grand Rounds, Diabetes i11 the Elderly. 74. Providence Hospital, Anchorage, AK, 2/91. Medical Grand Rounds} Sex after60.



# . .. 75. Symposium 

### on Geriatdc 

### Medicine, Antelope Valley 

### Medical Cente1', Lanoaste1; CA, 3/91. Course 

### Director and 

### Speaker. 76. U.C.S.F.

- Valley Medical Center, Fresno, CA, 3/91. Medical Grand Rounds, Sex after 60. 77. U.C.D•...:.. 

### Sacramento, ¢A, 4/91. 

### Medical Grand 

### Rounds, Sex after 60. 78. Chicago Medical College,**Chicago~** IL, .5/91, Medical Grand Rounds, Drugs in 

### the Elderly. 79. Symposium of**G~;~riatric** Medicine, Antelope 

### Valley M('ldical Center, Lancaster,**CA~** 2192. Course Director and Speaker. 80. Depa.tr.Wlrw.t .of Administration, State of Alaska, 4/92. Invited Speaket', -·"'"<l'l.>l'-"F<t·f• · ..**~.** Assisted living in long tenn care. 

### 81. International Institute for 

### Reseal'oh Symposium.: Utilities and FAS 106, Washington, D.C., 7/92. Keynote Speaker, Drugs in tho retired population. 

### 82. Alaska 

### Gexiatric Institute,**Anchorage~** 

### AK, 2/93**~** 

### Keynote Speake:r. 83. University of Oklahoma, Tulsa, OK, 3/93. Family Medicine Grand Rounds, Drugs inthe elderly. 84. Symposium on Geriatric Medicine, Antelope Valley Medical Center, Lancaster, 

### CA1 3/93. Course 

### Director and Speaker.



### "

# .. .., . "1! • t 

### ! 

# ,. I 

# I

t

### 45

.l_ •. 85. Depru:tment of Administration, State of Alaska, 4/93. Invited Speaker, MedicatiollS in the nursing home population.

·86. Dallas Business Group on Health, 5/93. Invited Speaker, Medications in the Elderly. 87. Symposium on Rl;ltirement**Health~are** Benefits, Chicago, JL, 

### 9193. lnvited**Speaker~** Medications fn the elderly. 88. University of Hawaii, Division of Geriatric Medicine1 Honolulu, 

## ·m, 10/9/93. Visiting Professor ofGerlatria Medicine, Diabetes i11 tlie elderly, Use ofdrugs inth.e elderly. 89. Providence Hospital, Anchorage, Alaska. Medical Grand Rounds, 2/94. :Dementia. 90. Nevada Academy of Family Medicine, A)IDUal Meeting. Lake Tahoe> Nevada, 2194. Keynote**Speake!'~** Sex after 60. 91. University ofCclorado Mfiliated Hospital. Medical Grand RQunds, 3194. Dnlgs 

### inthe Elderly. 92. University of Kentucky Affiliated Hospital. Gerlatdc Medical Orand RolUlds, Lexington, Kentucky, 4/94. Dementia. 93. Alaska Psychiatric Institute

- API 2000 Meeting, Anchorage, Alaska, 6/94. Plans for the Future- C<Jnsultant and Facilitator. 94. USC School of Medicinet Los Angeies 1 California

- Medical Gnmd Rounds, 9/94. Drugs in the elderly. 95. Alaska State Mental Health Board

-**Q~JJly**...Meeting,**bilingham,~.** Alaska; 9194. Invited Speaker, The Alaska Geriatric Institute. 96. Alzheimer's Society of 

### Northem Califot.nif4 Sacramento, CA, 10/94. Speakett Research In dementia. 97. Alaska Geriatric Institute, 

### Anchorage, Alaska, 2/95. Organizer and Keynote Speaker. The largest health care symposium in the history ofthe state ofAlaska. 98. V.A. Medical Center Westwood and UCLA- Medical Grand**Rounds~** 

### 2/95. 99. Symposium on 'Geriatric Medicine) Antelope Valley Medical Center} IJancasterJ CA, 3/95. Course Director and Speaker
.

·---·--·---- -:·-:--::--:·--:--- -·-**-~---·----** - . -----;---·.· ---



### .,

# .. "'4 •**~** j •

### 46 100. Nevada. Academy of Family**Medicine~** Annual Meeting, Lake Taltoe, Nevada, 3/95. 

### Key11ote**Speaker~Den:tentia** 101. Idaho Academy ofFamily Medicine, Annual Meeting, Sun Valley, Idaho, 5195. Keynote Speaker- Dementia: Sex after 60. 

### 102, Martin Luther ICing, Jr. Medical Center, Los Angeles, CA, 

### 6/95, Medical 

### Orand Rounds- 

### Dementia. 103. Martin Luther King, Jr. Medical**~nter,** Los Angeles, CA, 8/95. Medical Grand Rounds- Sex after 60. 104, University of Alaska, 

### Southeast

- Sitka Geriatric 

### Symposium, Sitka, Alaska, 9/95. Organizer, Keynote Speaker. 105. V.A. Outpatient Clinic, Las Vegas, NV, 10/95, Medical Gmnd Rounds, Dementia. 106. V.A. Outpatient**Clinic~** Los Angeles, CA, 11/95, Grand Rounds

- Dementia. · 1 107. V.A
.. Outpatient Clinic Los Angeles, CA, 12/95. Grand Rounds- Sleep disorder in the elderly. 108. State ofAlaska, Division ofSenior**Services~** 2/96. Leotutes and site visits to six State ofAlaska nursing homes. 109. Symposium on Geriatric Medicine, Antelope Valley Medical Center, Lancaster, CA) 3/96. Course Director and Speaker
. .110. Family**~e._Tfaining** Program, Spokane} Washington, 3/96. Lecture**~Dementia.** 111. Family Medicine Training Program, Central Montana, 4/96. Lecture**~** Drugs in the Elderly. 112. University of Utah Affiliated Programs, Salt Lake City, 4/96. LectlU'e

- Depression inthe Eldedy. 113. State of Alaska, Department of Administration, Divlsi<m of SEmior Services, Course Coordinator for visits of 16 Alaskan State officials to USC School ofMedicine, Andrus Gerontology Center and affiliated local Southern California Geriatric Programs. Duration**~** one month, earty 

### May to em:ly June, 1996, Los Angeles, CA. •,**M~i.<t<ilf**

- ·- ·-**~-** -- . - --**--------;--~-** ·--- -----·**.---_::~-.-** --. -----

... 4 • ·q,

### 47 ..**I~ ~**  '1 " 114. State of Alaska) Division of Senior Services, Department of Administration. Site visit to Administrative offices for review of Geriatric Programs.**Junea~** Alaska, 6/96. Outside ConsuLtant and Lecturer. 115. University of Alaska; Southeast Sitka. Care of the Elderly**Symposiu:n~** Sitka, Alaska> 9/96. Course Director and Lecturer. 116. Boise Health Consortium

- Medical Grand Rounds,**Boise~** Idaho, 11/96. Sex. after 60. 117. Symposium on Long Term Cm:e for Providers, Milwaukee; Wisconsin, 2/97. KeynDte Speaker- Drugs in the elderly. 118. Symposium on Geriatric Medicine, Antelope Valley Medical Ce:nter1 Lancaster, CA, 3/97. 

### Course Director 

### and Speaket'. 119. Osteopathic Medical College, Des Moines, Iowa,· 4/97.· Symposium on diabetes Mellitus> Keynote Speclcer- Diabetes in the Elderly. 120. University of Southern Illinois Medical School, ChampaigiJ, Urbana, Illinois, 4/97, Medi:cal House Staff Lectures. Topics

- Diabetes in the**Eldedy~** Drugs in the Elderly. 121. Aliegheny Medi(la-1 School, Philadelphia, P.A, 5/97. Keynote**Speaker~** Sytnposium on Diabetes and Lipids in the Elderly. 122. State Senior Care Program, Oldahoma City, Oklahoma, 7/97, Keynote Speaker- State ofOklahoma 

### Senior Care Ptogtam. 123. Eastem Carolina Univel'Sity Medical School, Greensboro, North Carolina, 8/97. Medical Grand Rounds. 124. University of Alaska, Southeast Sitka. Cw;e of the Eldedy 

### Symposium, Sitka, Alaska) 9/97, Course Director andLecturer. 125.
126. 

### 127.
128. Unive"J:sity of Colorado, Denver, CO, 10/97. University of Colorado Affiliated. Programs, Several States, Medical 

### Grimd Rounds. Arizona Chapter of the American Gerontologic Society, 

### Phoenix, AZ, 11/97. Sex After 60. Symposium of Geriatric Medicine, Antelope Valley Medical Centet·, Lancaster, CA, 3/93. Course Din:ctor and Speaker. Medical University of South Carolina, Charleston, South Caroliua, 4!98. Family Medicine Grand**Rounds~** Sex After 60.


### ----24--

-**---------~--------~------;** --------;--:--- --:.--:-"----- ___..........,

### _________ ------**~'** ' 

### l 

# l 

# I 

# l ! 

# I i ll!i 

### l !li 

# I

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## I I

- 1·---

## L---~-

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### j 

### r I 

# I

### 48 ,. . 129, University of Colorado,**Denver~ CO~**  4/98, University of Colorado Affiliated Progrants 1 Several Sites, Medical Grand Rounds. 1:30. Eisenhower Medical Center, Rancho Mirage, CA, 4/98. Medical Grand RoUtlds, Drugs in the Elderly. 131. University ofAlaska 

### mid U.S.C., Sitka, Alaska, 9/98. Care ofthe Elderly Symposium, Course Director and Speaker. 132. University of South Carolina School of Medicine, Charleston, South Carolina, 10/98. Family Medicine Grand Rounds. Sex After 60. 133. V.A. Outpatient Clinic, Los Angeles, CA1 10/98. Memorial Lecture Set[es, Medi.cations inthe Elderly. 134. V.A. Outpatient Clinic, Los Angeles, CA, 10/98, Memorial Lecture Series Alzheimer's disease. 135. Visiting Professor of Geriatric Medicine, Alaska Gedatric Institute, Anchorage, AlMka, April, 1/99. Multiple Lectnres•. 136. Visiting Professor of Geriatric Medicine, University of New Mexico School of Medicine. Albuquerque, New Mexico, 6/99,**Alzheim~r's** disease. 137. UniveJ;Sity of Alaska, Sitka, Alaska,**9/17/99~9119/99.** Care ofthe Elderly**Conferenc~;J,** Course Director and Lecturer. 138. Visiting Professor ofGeriatric Medicine, University ofArizona Affiliated Hospitals ofTucson and Phoenix, AZ, 10/20/99-10/23/99. 139. 

### Symposium ofthe Gerontological Society ofAmerica, 

### San Francisco, CA1 11/21/99. Interdisciplinary Approaches to Teaching Geriatrtcs, Invited Speaker. 140. State ofAlaska, Anchorage, Alaska, 2/20/00-2/23/00. Task Force for the Assessment of Assisted Living in the Pioneers' Homes, Leader and Spokesperson. 141. Visiting Professor of Geriatric Medicine, University of Colorado School ofMedicine Affiliated Hospitals, Denver, Colorado, 3/7/00-3/8/00. 142. Visiting Professor of Geriatric Medicine, Affiliated Internal Medicine 

### Programs, El Paso, 

### Texa-,,**4/26/00~4/47/00.**

'\j. H o 

## . . -

i 

# J

### 49 .n::;**~\.t· ·~**  t•....,. 143.
144.
145.
146.
147.
148. 149.
150.
151.
152.
153.
154.
155. Newport Beaoh 1 California) 5/5/00, Alumal Meeting of the California Association ofMedical**Directors~** Invited Speaker. Antelope Valley 

### Hospital, Lancaster, California. Medical Gnmd Rounds, 11!17 /99, Treatment ofArtlu·itic Pain in the Elderly. Kern County Medical Center, Bakersfield, California. Medical Grand Rotu1ds, 117100. Hazards ofDrugTherapies in the Elderly. Hoag Hospital, Newport Beach, California. Medical Grand Rounds, 3/10/00. Sex After 60. Visiting Professor of Geriatric 

### Medicine, Affiliated Internal Medicine**Programs~** E1 Paso, Texas. 4/26/00A/27/00 Arrowhead Medical Center, San**Bem~rdino** County Hospital, Colt()n, Ca.Iiforniaj 5/17/00. Medications in the Eiderty.

11Annual Meeting of the California Association of Medical Directors/j Invited Speaker, Newpo1t Beach, California. 5/5!00. Riverside General Hospital, Merino Valley, California) 6/16/06. Medical Gral'l.d Rounds, Medications in the Eldedy. The Elderly Diabetic, Care of the Elderly Conference, University of 

### Alaska. Sitka) Alaska; 9/21/00. Treatme11t ofArtbxitic Pain. Care ofthe 

### Elderly Conference, University of Alaska, Sitb, Alaska, 9/21!00. Depression in the Elderly. Care ofthe Elderly Conference, University of Alaska, Sitka, Alaska, 9/21/00.
. . '·· Treatment of Hypertension in the Elderly. Cro:e of the Elderly Conference, University of Alaska, Sitka, Alaska. 9/21/00, Medications ln the Elderly. Continuous Quality Improvement (CQI) in 'the**State~Assisted** Living Facilities, Depa.rtment of Administration,**Stat~** of Alaska,**Anchotag~,** Alaska, 11/13/00. 156. Fails in the Elde:dy. Continuous Quality Improvement (CQl) in the**State~** Assisted Living Faoilities, Department ofAdministration, State ofAlaska, Anchorage! Alaska, 11/13/00. 157. Dementia. 

### Memorial Lecture Series, Outpatient Department,**Vet~rans** Administration, Los Angeles, California, 112/0 1.

"4. "'d. .,1'

### 50 ' 

# I i !

' 

# .. 158. Geropsychiatric Assessment ofthe 

### Elderly. Bureau ofMedi-Cal Fraud and Elder Abuse) Department of Justice, State of 

### Ca.tifomta, Ontario**California~** 2/22/01. 159. Treating Chronic Pain in the Elderly. Memorial Lecture Sedes, Outpatient Depruimet1t, Veterans Administration Los Angeles, California. 1/2/01. · 

### 160. Medications in 

### the Elderly. 

### Continuous Quality Irt>.provemem (CQI) and the**Risk~Plus** 

### Program ill the**State~Assisted** 

### Living**Facilities~** 

### Department ofAdministration> State ofAlaska, Sitka, Alaska, SflfO 1. 161. Falls in the Elderly. Continuous Quality Improvement (CQI) and the :Risk-Plus Pwgram in the**State~Assisted** Living Facilities, Depa:t1ment of Administration) State ofAlaska,**Sitk~** 

### Alaska, 5/1101. 162. Sexuality. Nol'th American Forum on Women's Health, Los Angeles, Calif01nia, 6/19/01. 

### 163.**Alzheitner~s** 

### Disease. North American Forum on 

### Women's Health, 

### Los Angeles,**California~** 6/19/0l 

### 164. Ge:ropsy(:hological 

### Evaluation of Seniors. Symposiu111 

### on Elder Abuse.

165.
166.
167.
168. 169.
170. 

### Department of

### Justice-Bureau ofMedical 

### Fraud and Elder**Abuse~** Rancho Mirage, California, 9/7/01 Depression in the Elderly. Hoag Hospi1al. Newport Beach, Callfomia, 9/7/01. Sleep Disorders iu th" Eldel'ly. Care ofthe Elderly Conference. 

### Univetsity of**Alaska~** Sitka, Sitka, Alaska, 

### 9/23/01. "' 

### Medications in the 

### Elderly. Memorial Hospital, S;mta Rosq., califo:mia, 10/19/0L 

### Dementia. Medical Orrutd RoundsJ Riverside 

### General Hospital, Marino Valley, California, 11115/01. · Dementia in the Elderly. Medical Grand Rounds, Arrowhead Medical Center, San Bernardino Gene.t:aJ Hospital, Colton, California, 11129/0l. 

### Patient and Family Satisfaction 

### in Long Term. Care. Alaska**Pion~tlrs~** Home, Anchorage, Alaska. A site 'ilisit and**symposi~ 12/11101~**  

### 12/15/01.
.



### .,, ' "J
. 

# I I 

# I

### 51 I- ·• 

### .···. 

## ..

' 

# .. 171.
172.
173.
174.
175.
176.
177.
178.
179. 180. 

### Normal Aging vs. Disease. Symposium on Geriatric Medicine. Annenberg Center, Rancho Mirage,**Califmnl~** 2/202. 

### Medications in the Elderly, Memorial 

### Lecture Series, Outpatient Department) Veterans Administration, Los Angeles, California, 2/26/02. Life Style Redesign in Elder Care. 2nd Annual North American Forum on Women's Health, Anaheim, California, 3/1/02. Dementia in the 

### Elderly. Memorial Lecture Series, Outpatient Department, Vetet·ans Administration, Los Angeles) California, 3/12/02. Diabetes in the Elderly. Endocrine Grand Rounds. Harbor General Hospital, Torrance, California, 4/l/0/2. Medications in the Elderly. 

### MultiHlecture**series~** 

### Commission on Aging, State ofAlaska, Anchorage and Fairbanks,'**4112/02~4/26/02**. Treatment (!f Pain in the. Elderly. Care of the Eldei'ly Confel'ence; University of**Alaska~** Sitka. Sitka, Alaska, 9/19/02. Treatment of Cardiovascular Risk Factors in the Elderly. Care of the Eldel'ly Conference, University ofAlaska, Sitka, Alaska9/19/02. Special Issues in Long Term Care. Assessment and Evaluation of the Artchorage Pioneers' Home, Anchorage, Alaska, 12/10-12114/02. Identification and Treatment ofCardiovascular Risk Factors in ihe Elderly - A symposium Montgomery Cardiology· Programs.**Montgomery~** Alabama, 3/21/03. '··· 181. Medications in the Elderly.**Multi~lecture** series, 

### Conunissio:n.on Aging, State ofAlaska, Anchorage and Fairbanks1**4/23~4/26/03.** 182. Assessment of Mental Competency and Discussion of an Elder Abuse Case. 

### Symposium on Elder 

### Abuse, Department of Justice**·~** Bureau of**Medi~Cal** 

### Fraud and Elder**Abuse~** 

### Squaw**Valley~** 

### California, 5/21kS/30/03. 183. Medications 

### in the 

### Elderly. Multi-lecture series, Commission 

### on Aging, 

### State of Alaska, Juneau. and Ketchikan, 6J27-6129i03. i84. Dementia in the Elderly: Medications in the Elderly. Care ofthe Eldedy Conference, University ofAlaska,**Sitk~** Sitka,**Alask~** 9/18-9/19103. 185. Dementia. GeriatJ:ic Symposium :.... St.**Mary~s** Hospital and**Scan~** Lang 

### Beach. California, 10/4/03. ; ! '



# .. -- -- --......L

• .., 6 • 

# l 

# l I i

### 52 t • .t .. ,,.... 

# I 186. Senior Assessment for the Care Provider. Public Health Fonun- State of Alaska. Anchorage, 

### Alaska, 12/1/03. 187. Senior Assessment Workshop. Alaska Geriatric Education Center, University ofAlaska, Ancho1·age, Alaska, 1/23/04. 188. Sleep Disorders in the Elderly. Coping with Chronic Disease. Care ofthe Elderly Conference, University ofAlaska1 Anchorage; Alaska, 9/17/04. 189. Elder Abuse. Coping with Chronic Disease. Cardiovasculru: Risk Factors in the Elderly. Senior Lives**Conference~** 

### University ofAlaska> Anchorage, Alaska 

### 6/10/05. 190. Assessment of the Chart in Skilled Not'sing Facilities. Symposium on Eld.er Abuse, Department**o~** Justice, Bureau of Medical 

### Fraud and Elder
.. . Abuse, Long**Beach~** California, 6/6-6/9/05. 191. Coping with Chronic Disease. The Chart in the Skilled Nursing Home. Care·ofthe Elderly Conference, University ofAlaska, Sitka, 9/16/0S. 192. Sex After 60. The Chart in the Skilled Nursing Home. Promoting :Best Practices in Aging Conference, University ofAlaska 1 Anchorage- 6/8/06 -6/10/06. 193. Medic-al Realities and Diminished Tribal Longevity, New Aspects ofLong Tenn Care. Cate ofthe Elderly**Confetenc~,** University ofAlaska , Sitka, 9/14/06-9/16/06.
. 194. Standw:d of Care, Symposium on Elder Abuse, Depal.iment of Justice, State of Califomia, Buteau of**M~di~CAL** Fraud and Elder**Abuse~** San.

.. Mateo, California**May~M0FJ,..:..** 195. futegrated Therapies for Aging. The 

### Thet'apies, Care of the Elderly Conference, University ofAlaska, Southeast; Sitka**9/~5'/0S-** 9/27/08. 196. Human Biology 596 Course University of Washington Medical School

- WW AMI Program- Multi-Disciplinary and Bthnicity in Gerontology and Geriatrics. 

### Lectu.r:es to Alaskan 

### Medical Students, 

### University of**Alaska~** Anchorage, Aprll2009. 197. Mental Health and Dementia. Inter-disciplinary l?taciioo in Geriatrics Sex 

### After 60. 

### Prompting Best Ptactices in Aging Conference, University of Alaskf4 Anchorag·e, 6/3/09-6/5109. ][, PUBLICAT][ONS

'TJl • "\j. ,,

### 53 Papers- 

### Pee1· Review L McCleverty, J.A, an.d**Wilklrtso~** Q, 

### (Submitters), Lipson, L.G., Maddox, M.D. and Kaesz, H.D. (Checkers): Dichlorotetracarbonyldirhodbm. Inorganic Synthesis Vol. VHf, oltzclaw, H.F., Jr. (Ed) McGraw-Hill, New York, 1966, pp.211-214. 2. McCleverty, J.A. and Wilkinson. G. (Submitters), Lipson1 L.G.,**Maddox~** M.D. and Kaesz 1 H.D. (Checkers): Chlorocarbonylbis (uiphenylphospine) rhodh.un and cblorocarbonylbis (tdpheuylarslne) rhodium. Inorganic Synthesis Vol.**VIII~** Holtzclaw, B.G. Jr. (Ed), McGraw-Hill> New York, NY 1966,**pp214~2l7.** 3.**Lip~pn,** L.G., Capuzzi, C.M. and Margolis, S.M: Effect on method ofcell isol'll.tion on the metabolic activity of. isolated rat liver cells. J. CellSC. · · · 10:167A179, 1972. 4. Lipson, L.G.: Plague il.t San Francisco in 1900, Atm. Int. Med.**77~303~** 310, 1972. 5. Kohler, T.R., Lipson, L.G.,**Flores~** J.> Witkum, P.A., Fischer,**J.B.~** and Sharp, G.W.O.! Sequence ofevents in the activation of adenylate cyclase by cholera toxin. Bull Schweitz, Akad. Med. Wiss. 32·223w23Z, 1976. 6. Beiteins, l.Z.,**Lipson~** L.G. and McCarthur, J.W.:Luteiniz\ng hormone, follicle stimulating hormone and their subunits released in cultnre by hmnanpituitary tumors. J. Clin. Endo. Metab. 45:1271-1280, 1977. 7. Fischer,**J.J;3.~** Kohler, T.R., 

### Lipson, L.G.:I**Flores,~** J., Witkam. P.A., and Shru:p_, G.W.G.; Studies on the time course and**rat~** limiting steps in the activation of adenylate cyclase by cholera toxin. Biocltem. J. '173: 59-64. 1978. 

### 8. Lipson, 

### L.G., Beitins, I.Z., Komblith,**l?.D.~** McArtluu·. 

### J.W.•**Frie~en,** H.G., Kliman, B. and Kjelbexg, R.N.; Tissue cultw:e studies on human pitultal'y ·tumors: Radioimtnunoa.ssay of ante11or pituitary hotntones in culture medium. Acta. Endocrln. 88:239-249, 1978. 9. Lipson, L.G. and**Shmp~** G.W.G.; 1nsulin sec1'etion in pregnancy: Studies on adenylate Cyclase, phosphodiestarase, protein kinase and phosphoprotein phosphotase in Isolated islets of Langerhans of the rat. Endocrinology**103:1272~1280j** 1978. 10. Lipson, L.G., Beitins, I.Z., Kornblith, P.D., McArthur, J.W., Friesen, 

### H.G.j**Klimat~,** B. 

### and Kjelberg,**R.N.~** 

### Tissue culture studies on hu.tnan

. ·-30--·
.... - ..**-------~---::** ---"::---.--- --:-;·--;------

'

# ..

### 54 piMtru.y tumors:**Loug~term** .r:elease of anterior pituitary hormones. Acta. Endocrin.**90~421~433,** 1979. lL**Lipson~ L.G.~**  Siegal, E., Wohlheim, C.B. and Shatp, G.W.G.: Insulin release in fasting: Studies on 

### adenylate cyclase,**phosphodiesU~rase, pr<~tein**  kinase and 

### phosphoprotein phosphatase in isolated islets ofLangerhans of the rat Endocrinology 105:702-717, 1979. 12. Lipson, L.G., Bush, M.J., 

### Tietjen, O.E. and Yooll, A.; Role ofthe adenylate cyclase sy.stem in altered insulin release from. islets of 1angerhans ofaging rats. Acta. Endocrin. 96:222·226, 

### 1981. 13. Lipson, L.G.,**Bobt·ycki~** V.A., Bush, M.J., Tietjen, G.B. and Yoon, A.: 

### Insulin release 

### in aging: Studies on adenylate cyclase, phosphodiestarase and protein kiuase iu islolated islet'l on Lange1'hans ofthe rat. Endoodnology 108: 602-624> 1981:•. t, ·'· 14. Lipson, L.G., Moore1 D., Pope, A.M.J Todd, G.J., and Avila. S.:**S~xual** dysfull.Ction in Hypertensive diabetic patients. J. Cardiovascular Med. 6: Supp.l, 30-37,1981. 15. Cotton, 

### D.B., Strassner1 

### H. G., Lipson, 

### L.G., and Goldstein, D.A.: 

### the effects ofterbutaline on acid-base, electrolytes and glucose homeostasis during the managementofpretenn labor. Am. J. Obstet. And Gy:n. 141: 617-624, 1982. 16. Oldhrun, S.B., Upson, L.G. and Tieijen, G.B.: Evidence 

### for the presence of

### calmodulin in 

### humanparathyroidtissue
..Mineral and Electrolyte Metabolism 7: 273-280, 1982. 17. Lipson, L.G., Oldham, S.B.: The presence ofcalmodulin- stimulatflb1e phospho.diestatase inpancl'eatic islets ofLangerhans ofpregnant and 11011nal female rates. Life Sciences 32! 775-780, 1983. 18. Mircheff,**A.C.~** Conteas, C.N., Lu, C.C,, Santiago, N.A., Gray, G.M. ood Lipson, L.G.: Basal»lateral a.nd intracellular membrane populations ofthe rate exorbitallacd.mal gland. 

### Am. J. Pltysiol. 24-5: G 133*142, 19&3. 19. Premdas, F.H., Molina, J.M. and tipso.11; L.G.: Insulint·elease in aging: 

### Role ofglyce:raldehydes.Acta. Endoorin. 103:539-543, 1983. 20. Lipson, L.G. and**Lipso~** M.: Treatment ofthe obese maturity onset diabetic patient, Arch. Int. Med. 144: 135-138, 1984
.

' 

# . ' ... d •

### 55 21. Oldham, S.B., Molloy, C. and Lipson, L.G.:**Calc~um** inhibition of adenylate cyclase in the parathyroid gland. Endoorlnology 114: 207-214, 1984. 22. Lipson,.L.G.: Sexual dysfunction in the diabetic patient with hypertension. Am. J, Cardiol. 53:**46A~50~** 1934. 23. Lipson, L.G.: Special problems inthe treatment ofhypertension in the patient with diabetes mellitus. Arch. IntMed. 144: 1829ul831, 1984. 24. Olclliam, S.B., Rude, R.K., Molloy, C. and Lipson,**L.G.~** The 

### effect of ·magnesium on calcium inhibition ofparathyroid adenylate cyclase. Endocrinology. 115: 1883-1890, 1984.**25~** ... 

### Molina, J.M., Prem.das, F.H.• Klenck, 

### R.R. Eddlestone, G., Oldham, S.B: ' ·and Lipson, L.G.: The dynamic insulin-secretory response 

# orisolated .· · · pancreatic islets ofthe diabetic mouse: Evidenoe for a gene dosage effect on insulin secretion. Diabetes 33: 1120-1123. 26. Bddlestone,**G.T.~** Oldham, S.B., Lipson,**L.G.~** Premdasl F,B. and Beigehnan, P.M.: Electrical activity, cAMP 

### concentration and insulin release in mouse islets ofLangerhans, Am. J. Physiol. 248: C 145-153 1 1985.
. 27. Molina, J.M., Premdas, F.H. and Lipson, L.G.: Insulin release in aging! Dynamic response ofisolated islets ofLangerhans ofthe rat to**D~** glyceraldehyde. Endocrinology 116:**821~826,** 1985. 28. Oldham, S.B. and 

### Lipson, L.G.: The high affinity**c~lcium** inhibition of parathyroid adenylate cyclase is notcalmodulin-dependent. Catcif, Tissue Int. 38: 275-281, 1986
. • ····"t-"i- • •**~..** • • ...,. '
... 29. Bailey, C.J., Day, D., Bray, G.A., Lipson, L.G. and Flatt, P.R.: Role of adrenal glands in the development ofthe abnormal glucose and insulin homeostasis in genetically obese (ob/ob) mice. Hormone and Metabolism Research.**18~** 357-360, 19&6. 30. Prochazka, M.• Premdas, 

### F.H.y Leiter, E.H. and Lipson, L.G.: Estrone 

### treatment dissociates 

### primary ve1·sus secondary 

### consequences of**"diab~tes"** (DB) gene expression inmice. Diabetes, 35: 725w728, 1986. 31. Lipson, L.G.: Diabetes .in the elderly:**Diagnosis~** pathogenesis, and therapy. Am. J. Med. 80: Supp. SA: 10-21l 1986
.

y**~** • ... 

## , '

### 56 . ' 32. Fadda, G.Z., Alanal, M., Premdas, F.H., Lipso11l L.G. 

### andMassry, S.G.; Insulinrelease from pancreatic islets! Effects o{CRF and excess PTH. Kidney 

### 1nt. 33: 1066wl072,1988. 

### 33. Leiter, E. H., 

### Premdas, F.H., Hanison, 

### D.H. and Llpson, 

### L.G.: Aging 

### at:d glucose homeostasis inC57BL/6Jmale mice. FASEB Joumal. 2: 2807·**2811~** 1988. 34. Fadda, G.Z., Alttnal, M., Lipson, L.G., Soliman, A. andMassry, S.G.: Correction ofglucose**into~erance** and the impaired insulin release of chronic nmal 

### failure by verapamil. 

### Kidney lnt 

### 36: 173-770, 1989. 35. Fadda, G,Z., Akmal, M., Lipson, L.d. and Massry, S.G.: Direct effect of parathyroid homtone secl'etio.n from 

### pancreatic islets. Am. J. Physiol., 258 (Endocrinol. Metab. 21):**E975~B984,** 19.90.

• I I**~** 36': 

### Mulligan, R.J Lipson, L.G. and Heaton, S. G.: Detecting diabetes in

# an.... · eldel'ly dental patientpopulation. Special care in Dentistry: Feature Article: September-October, 142-147, 1990. 37. Xin·Gin, Z.,**Fad.d~** G.Z,, Lipson, L.G. and Massry. S.G.: Phosphate depletion impairs insulin secretion by**panc~·eatic** islets. Kid. Int. 39: 120- 128, 1991. 38. Fadda, G.Z., Hajjar,**S.M.~** Perna, A.F., Chau, X.J., Lipson, L.O. and
. Massry, S.G.: Onthe mechanisms ofimpaired insulin secretion in chronic renal failure. Jour. Clin. Invest. 87:**225~261 ~**  

### 1991. 39. Clark, F. Carlson, M., Zhnlce, R.,**Frank~** 0,, Patterson, 

### K., Lru·son, B.,**Rankin~**Martinez, A.) Hobson, L., Crandall, J •• 

### Mandel, D. and Lipson, L.G.: A qualitative study of the life domains and adaptive stmtegies ofthe lowincome,.wellelderly. 

### Am. 

### J. Occup. 

### Therapy, 1994 40. Clark F. Carlson, M., Zimke, R., Frank, G., Patterson, 

### K.., Ennevor, B., Rankin-Millilnez, A, Hobson, L., Crandall, J., Mandel, D.and Lipson,**L.G.~** Life domains and adaptive strategies ofa gl'oup**oflow~income,** well older adults. Am. Jt. ofOccupational Therapy, 99-108, 1995. 41. Rho, Jay P. and Lipson, L.G.: Focus on acetylcholinestreraseiuhi.bitor for the treatment ofAlzheimer's disease. Fonnulazy, Vol. 32,**677~684,** 1997. 42. Clark, F., Azen, S.P., Zemke,**R.~** Jackson, J., Carlson1M., Mandel, D., Hay, J., Josephson, K., Cherry, B., Hessle,**C.~** Palmer, J. and Lipson, L.G.: Occupational Therapy for IndependenMjving Older Adults. JAMA, 278: 1321-1326, 1997.

33··



# .

.. •I 4 •

.. & • ! i ! ( {



# -I



# I

i ! l

### 57 43. Clm'k 1 F.,**Azen~** S.P., Cttrlson,**M.~** Mandel, D., LaBree, 1., Hay, J.. Zemke, R., Jackson, J. and Lipson, L.G.: Ernbedding**health~promoting** changes into the daily lives of**independent~**living older adults: Long-tenn followwup ofocc11pational therapy inte1vention. Journal ofGerontology: Psychological Sciences, 56B, PP- 60"63, 2001. · Requested Chapters, Papers, and Monograms 1.**Sharp~** G.W.O., Fisher, J.G., Lipson, L.G., Kohler, T.R., Flores, J. and Witkum, P.A.! 

### Time course studies onthe mechanisms ofaction cholem. toxin. Hormonal Receptors in Digestive Tract Physiology. 

### In Bonftls,**S.~** Fromageot, P., Rosselin. G.**(~ds.). Eldevier~North**  Holland Biomedical Press, Amdsterdam, pp.447-454, 1976. 2. Sharp, G.W.O., Wiedenkeller1D.E.,**Lipson~** L,G., Oldhnm, S.B., 

### I{J;ausz,

"'' 1"'' • ': Y., Janjis) D., PianwSrn.ith, M.C.M. and Wollheim, C.B.: Multiple roled of calmodulin, the endocrine**p~ucrea.s** and the control of1nsu1in secretion. 

### P1·oceedings of the 11th Congress ofthe 

### Intentattonat Dlabetes Federation. Int. Congress Series #600: Excerpta Medica, Princeton, N.J., Mngola, En.N. (Ed.) pp 329-336, 1983. 3. Lipson, L.G.: Hypertension and**diab~tes** rrielUtus. Diabetes forecast 38:53, 1985. 4. Lipson, L.G.: Diabetes mellitus in the elderly: Special problems, special approaches. Co. Medical, New York, 

### N.Y.j pp. 1-20) l98S. 5. Lipson, L.G.: Diabetes after**sb;.ty~five.** Diabetes Forecast. VoL 39, No. 7, 54-58, 1986. 

### 6.**Lipso~** L.G.: Diabetes in the elderly! A 

### multifaceted problem. A.nl. J. Med, 80: supp. 5A:1-2, 1986. 7. Lipson, L.G. an.d**Bray~** G.A." Energy intake and utilization in aging man: Chen (ed.), Nutritional Aspects ofAging, Voi. 1, CRCpress
.. In.o., BocaRaton,J:<"'L. Pp.184-185, 1986. 8. · Lipson, t.G.: Diabetes and aging.lu Beigelman1 P.M.an.d Kuman, D., (Eds), Diabetes Mellitus for the house <Jfficer. Williams and Wilkins., Baltimore, MD., pp.**184~185,** 1986. 9. Lipson, L.G. and Kumar, D.: O.:al hypoglycemic agents. In Beigehnan, P.M. and Kumar, D. (Eds.) Diabetes Mellitus for the House Officer. Williams and Wilkins, BaltimoJ:e, MC. Pp.**112~118.** 1986
.



## .

# . . "1 A •**"~** 

# . ... 6 •

### 58 

## . . 10. Lipson> L.G.: Dental problems ill. the diabetic patients. In Beigelmru.t, P.M. and Kumar, D. (Eds.) Diabetes Mellitus for the House Officer. Williams and**Wilkins~** Baltimore> MD., pp.**181~183,** 1986. 11. Lipson, L.G.,: Hypertension inthe diabetic patient. In Beigelman, P.M. and Kumar, D., (Eds.) Diabetes Mellitus for the House Officer. Williams and Wilkins, 

### Baltimore, MD., pp 160
.. 163, 1986. 12. Lipson, L.G.: Hypertension inthe diabetic patient. In Beigehnan, P.M. and Kumar, D., (Eds.), Diabetes Mellitus for the House Officer. Williams and Wilkins, Balthnore, MD., pp.**173~175,** 1986. 13. Dinwiddie, R. and**Lipso~** L.G.: 

### Improved control of

### serum glucose in obese,**new~onset** u1sulinopenic non-insulin dependent diabetes mellitus: Partial respiration ofNorman dynamic insulin secretion. Roerlg Division, pp. l-6, 1986, ·:,... ' · •••• ,..**~** •} ·" ., ••.**~** t,r

### 14. Lipson1 

### L.G. and Katow:Patrner 1 

### S.: Diabetes 

### in Asians. Diabetes 

### Forecast, Vol. 41, No.9, 4Sw51, 1938. 15. Lipson, L.O., Kato-Palmer, S., Boggs, W.L., Moore,D., and ope1 A.:

. Diabetes in the :Slack population. Diabetes Forecast Vol. 41, No.9, pp.

34w38, 1988, 16. Williams; B.R., Nichol, M.B., Lowe, B.F., McCombs, J.S. 1 Yoon, P.S. and Lipson) L.G.: phru:ruacist intervention residential care faciliti6s. In 

### Rowet J.W, and Alu·onheim, 

### ,T.C. (Eds.) 

### Annual Review 

### ofGeronto:ogy at1d Geriatrics; Foc·us on Medications and the Elderly. Springer Publishing Co. New York, N.Y., pp. 150wl62, Vol. 12, 1992. 17. The Use ofMedications: A Tmining and Reference Manual Developed for Staffin.Residential 

### Care Facilities for the Elderly, 1195. Lipson.
. ,_,.., L.G.- Project Co-Director. 18. Weiner, 

### J. and Lipson, L.G.: Human diseases as models ofaccelerated aging. In**Rose~** C., Glowacld, J. and Bilezikian> J. (Eds.) The Aging Skeleton1 Academic Press, Chapter**~:.pp. 51~58,**  1999. 19. Raghaven1**D.~** Weiner, J. and Lipson, L.G.: Cancer in the elderly: principles oftreatment in Soulbami, R.L. et al (Bds.), Oxford Textbook**Oncology~** znd Edition, Oxford University Press, Oxford 1 London) 

### i 999. Films atld Videos



# .

# .. .. & • "d
.

### 59 1. Discharge Plmming for the Elderly Hospitalized Patient: 

## r. \Vhat to do wllen you go Home. Hospital Sateiiite Network, 1986. 15 min. L.G. Lipson- Moderator and Context Exper. 2. Discharged Planning for the Elderly Hospitalized Patient: H. The patient with acute medical problems after discharge. Hospital SatelliteNetwork 1986, 15 

### min. L.G. 

### Lipson- Moderator and content expert. 3. Discharge Planning for the Elderly Hospitalized Patient: UI. The chronically disabled patient. Hospital Satellite Netwotk) 1986, 15 min. L.O. Lipson- Moderator and content expert. 4. Discharge PlEU11ling for the Elderly Hospitalized Patient: IV. Community programs for the elderly. Hospital SatelliteNetwork, 19861 15 min. L.G. Lipson- Moderator**m~d** content expert. 5. Normal Aging Versus Disease:"l'hysicianJoumai Update. Lifetime Network, 1987, 15 min. L.G. Lipson- Content expert. 6. Drugs and the Elderly. Physician's Journal Update. Lifetime Network, 1987, 15 min. L.G. Lipson- Contentexpert.**7~26.** Caring for and Aging Soo(ety. 20 videos on various aspects ofGeriatrics gnd Gerontology. Each 30 minutes inlength. Producer- Neil Steinbe):g Produotions 1 Executive Producers- Hospital Satellite Network and Age**Wave~** Sponsor- Marion Laborato:des. 1987"1988. L.G. LipsonTechnical advisor and content**exp~rt. ~SP#.**  HSN# 001 8649X ()02 0462X 003 57.33X Q04 8648X 005 77l6X 006 5734X 012 8650X 013 5735X 014 5736X .OIS 5737X 016 8652X 017 7717X 018 612SX \l19 6726X CARING FOR AN AGING SOClETY SHOW TITLES AND NUMBER

.. ,.......**~~**..

# - ..... 

### !lTLE NEW IMAGES OF AGIN"G (F) DYCHTWALD flOW 

### TO TALK TO YOlJR.'DOCTOR (F) LIPSON GERIATRIC ASESSMENT (F) BUtLER DRUGS AND THB ELDElll,Y (F) :LAMY ACUTE CARE GERIATRIC NURSING (F) FOLMER HEART DISEASE AND THE ELDERLY (F) SWAN PRINCEPLES OF AGING (F) HAZZARD PRESENTATION OF DISEASE (F) ABRASS GEROl;JSYCHfATRIC FOUNDATIONS (W) OLSEN PltYS!CtA:N'S ROLE IN DRUG THBMPY (F) VESTAL ETHICAL ISSUES lN ELDERCARB (F) CASSEL GEROJ?SYC:HIATRlC NURSlliG (W) WYKLE TBE HUB CONCEPT (W) DYCHTWALD ELDBRCARE FlNANClNG (W) DYCH!WALD

.. 4 •

### 60 020 021 022 023 ()24 02S 27.


### 28.

3().

31.

32. 6727){ ELPERCARE: MODELS OF SUCCESS (F) DYCHTWALD 5738X DJABBTES IN THE ELDERLY {W) Lrl?SON 8651X GERIATRIC DISCHARGE PLANNING (F) WERTHEIMER 0473X PROMOTING WELLNESS {W) F ARQUJ!Al!. 0475X**SELF~MEDXCATWN** IN THE ELDERLY (W) StMONSOl\' 0414X FAMILY ROLES lN BEALTHCARE FOR BRATI'ER THE ELDERLY Medical Checkup; Health Aware11ess '88. Aging in the Black Conunuqtty. A 30 min. Video. Producer, Mark Alyn Communications) Sponsor- 

### Marion LabOratories) 1988. 

### L.G. Lipson- Moderator 

### and content expert. Medical Checkup: Health Awareness ,88 Aging inthe Hispanic Community. A 30 min. Video, Producer, Mark

### Alyn Communications, Sponsor- Marion Lab<>ratories, 1988. L.G. Lipson- Moderator and content expert. Medical Checkup: Health Awareness '88. Aging in the Asian Commuuity. A 30 min. Video. Producer, MarkAlyn**Communications~** Sponsor- Madon'Laboratories, 1988. L.O. Lipson- Mode1·ator and content expert. Medical Checkup: Health Awareness '88. Diabetes Mellitus in the Black Community. A 30 min. Video. Producer> Mark Alyn Commonlcations, Sponsor- Madan Labotatories, 1988. L.G. Lipson- Modemtor and content**exp~rt.** Medical Checkup: Health Awl'll:eness '8 8. Diabetes Mellitus in the Asian Community. A 30 min. Video. Producer7 Mark Alyn**Communications~** Sponsor- Marion LaboratotieS 1 1988. L.G.**Lipson~** Mode1·ator and content expert. · Medical Checkup: Health Awareness '88. Diabetes Mellitus in the Hispanic Community. A 30 min. Video. Producer, Mark Alyn Communications 1 Sponsor- Marion Laboratories, 1988. L.G. Lipson- Moderatot and content expe1t.**33~38.** Diet and**Exexciw-~Lifustyles** for Aglng. Hospital Satellite Network. Six**lO~minute** ''"' Segments, 1989. L.G. Lipson- conteil.t expett. 

### 39. How to Talk

### to the 

### Older Patient. 

### Baylor Hospital 

### and Age Wave, 

### 1989. L.G. LipsonMedical Moderator and content expert. 40-41. The Aging Skin. Age Wave, 1991. 

### L.G.Lipson- Medical Editor. 42. Diabetes and the 

### Eldel'ly. Living with Diabetes: Diabetes on the Air, 1991. 43. 

### Sex and Sexuality in Seniors- A Documentary, 1999 L.G. Lipson- 

### Guest E:xpert. I, Abstracts

'\**~** .

### 61 *1. Upson}**L.G.~** Margolis, S.M. and Capuzzi, D.M.: Comparison ofacetate and amino acid incorporation in. rat liver cells isolated by three techniques. Fed. Ptoc. 28:336 (absl 607). 1969. 

### 2. Lipson, 

### L.G., Ackerman, I.P. and Klima:n, B.: simultaneous 

### acromegaly and partlally suppressible 

### adrenocot'tioal function in a patient with a pituitary tumor. 

### Clin. Res. 24: 274A, 1976. 3. Lipson. L.G.) Beitins, I.Z., Kornblith, P.O., McArthur, J, W., Friesen> H.G.• 

### K.liman. B. and**Kjelberg~** R.N. Hormone secretory patterns ofhuman pituitary tumors in tissue culture. Clin. Res. 328A, 1976. 4. Lipson, L.G.> Fon:istall, C.A. and Shatp, G.W.G. Phosphorylation and dephosphorylation in the control ofthe insuliu release: Isletphosphoprotein phosphatase. Diabetes 25: Supp. 1,374 (abst. 213). 1976. *5. Lipson, L.G., Vachon, C., 

### F6histall, C.A" and**Sharp~** G.W.G.: Stimulation ofspecific protein phosphorylation in intactrats islets ofLangerhans by both 3-isob\ltyl-1- methlxanthine and D-glucose. Clin. Res. 26:530A) 1978. 6. Lipson, L.G. and Sharp, G.W.G.: Insulin release in pregnancy; Relatior.ship to ptotein and phosphorylation. Endocrinology 102: (abst. 711), 1978. 7. Lipson, L.G. Wollhei:m, C.B. and Sharp, O.W.G.: Insulin release in fas1ing. Diabetes 27: Supp. 2, 489 (abst. 236), 1918. S. Lipsonl L.G.J Bobrycki, V.A., Bush, M.J••**Gross~** E. and lnouyte1 D.: Role ofadenylate cyclase system inaltered insulin release from islets ofaged rats, Clin.Res.**28:51A~** 1980,**~'9.** Cotton, D.B., Strassner, H.G., 

### Lipson. L.G. and Goldstein, D.A.: Effect 

### ofterbutaHne on serum concentrations ofglucose, insulin, J_Jo'tassium, ionized and total calcium lactate, and colloid osmotic pressure. Gyecol. Invest. 1980... .·t-:· .•.. *10. 11. 

### 12.
*13. Lipson, L.G., Bush,**M.:r.~ Tie~** en, .G.E. and Yoon, A.; Insulin release 

### itt aging: the role of adenylate cyclase system. Endoorinology 106:**(abs~.** 34)) 1980. Mircheff, a. C., Lipson, L.G.• Bush, MJ., Yoon, A. and Barish, J.J.: Analytical fraction of B·cells. Diabetes 29: Supp. 2, 109A (abst. 425), 1980 Moore, D., Pope, A.M. 1 Todd, G.J.:I Rosenquist, R.J. 1 and Lipson, L.G.: Treatment of hypertensive diabetic patients with pl'azosin. 

### Diabetes 29: Supp. 2, 67A(abst. 267) 1980. Oldham, S.B., Lopson, L.G. andTiegen. G.B.: Ev-idence for the presence ofcalmodulin in human parathyroid tissue. VIII International Conference in CalciumRegulating Honnones, 1980.



### -····· -- ·-ss

' ' "'!
. ... 4 •

### 62 I *14. Lipso'n, L.G.• Bush, M.J. and Bobrycki, V.A.: The role ofthe adenylatecyclase system in the decreased**glucose~stirnulated** insulin. release from isolated islets ofLangerhans of
. aging rats. Gordon Research Conference- The Biology ofAging. 1980. 15. Lipson, L.G. Oldham, S.B. and Bush, M.J.; Calmodulin-- stimulatable phosphodiestarase in isolated islets ofLangerhans oftherat. Clin. Res. 29:56A, 1981. 16.**Lips~n.** L.G., Moore. 0. 1 Pope A.M., Todd, F.J. and Avila, S.: lncidenceofhypertension in male diabetic populations. Clin. Res. 29:413A. 19tH. 17. Lipson, L.G. and Oldham, S.B ,!**Colmodulin~stimulatable** phosphodiestarase inpancreatic islets ofthe pregnant rat. Clin. Res. 29-413A, 1981. *18. Conteas, C.N., Lipson. L.G. and Mircheff; A,C.: Basal lateral membranes fl•om rat parotid acinar cells. Gastroenterology 80: 1128A, 1981.

• •• .....t 

### .. 19
. Lipson, L.G. and Oldham, S.B.: The presence ofa calmod"ulin!:stimulatable phospl10diestarase in pancreatic islets from pregnant and notmal female rats. Endocrinology 108:343, (abst. 1942), 1981.

'

# .. 20. Lipson, L.G. Bush, M.J. and Najdziuk, J.: lnsulitll'elease in aging: Role of glyceraldehydes. Diabetes 30: Supp. 1 (abst. 296), 198.1. · *21, Lipson, L.G,: Insulin release in aging. Gordon Rese!U'ch Conference- The Biology of Aging. 1982. · 22. Lipson. L.G., Moore1 D., Pope, 

### A.M. and Todd, Ci.J,: Sexual dysfunction in hypertensive diabetic 

### patients: The role ofprazosin in its prevention. Diabetes 31: Sup. 2 (abst. 365)t 1982. ) *23. Oldham, S.D. andLipson, L.G.: Biphasio inhibition ofparathyroid adenylate cyclase activity by calcium1,**~~llf.,** Tissue int. 34:843, 1982. *24. Lipsou, L.G., Premdas, F.H., Molina, J.M.:Studies on dynamic insuli.nr.elease in aging. The physiologist 25: 288 (abst. 47.8), 1982. · *25. Molina, J.M., Premdas, F, H. andLipson, L.G.! Dynamics ofinsulinsecretion inagirtg Clin.Res.**31~58A,** 1983. *26. Sharp, G.W.G., Wolheim, C.B., Siegel, E., Lipson,.L.G. and Kraus, Y.: The role of calmodulin in insulin secretion. International Diabetes Fed. Meeting in Kenya1 November 1982. *27. Eddlestone, G.T., Oldham, S.B., Lipson, 

### t•.G. and Beigehnan, l?**.M.~** Fotskolin**inc~:eases** cyclic AMP and potel\tiates electrical activity in the mouse pancreatic B·ce1L Fed. Proc. 42: 897, (abst. 3544), 1983.

'tl. ..j. -\ d •

### 63 *28, Eddlestone, 

## o:r.,**Oldha~** S.B., Lipson, L.G. and Beigelman, P.M.: Forskolin potentiati<m ofthe B-cell response to glucose. Diabetes 32; Supp. l(abst 552), 1983. *29. Oldham, S.B. and Lipson, L.G.: The effects ofionic calcium on magnesium activation of parathyroid adenylate cyclase. Calcif. Tissue Int.**35:686~** 1983. *30 Premdas, F.H., Molina, J.M. and Lipson, L.G.: Restol'ation ofnormal dynamic insulin 

### in secretion in aging rats. The Physiologist 26:ASO, (abst. 32.1), 1983. *31. Oldham, S.B. and Lipson, L.G.! Calcium 

### inhibition ofparathyroid 

### a.denylate cyclase: Is calmodulin medicated? VIII International Conference on Calcium Regulation l!ol.'ll1.ones, Kobe, Japan, October, 1983. 32. Johnson, M.D. and Lipson, L.G.: Prevalence ofHypertenslon and sex\tal 

### dysfunction in diabetic women. Clin. Res. 32:48A, 1984. *33. Molina, J.M.,**Pt~inaJs,** F.H.,**Lipson~** L.G., 

### Klenckj 

### R., Eddleston.e; G. and Oldham, S.B.: · Comparison ofdynamic insulin release to P-glucose and**D~glyceraldehyde** in isolated pancreatic islets .from the db/db mouse. Clin. Res. 32:51A, 1984. *34. Oldhatn, S.B. and Lipson, L.G.: Ionic control ofparathytoid 

### adenylate cyclase activity. UCLA symposium 1984 onMembrane Receptors and Cellular Recognition. 35. Lipson, L.G., Liebig, P.S. and**Sloane~** R.B.: Training of

### facuLty mentors and advocates**i~** geriatrics. Annual Meeting of Gerontological Society ofAmerica. November, 1984, San Antonio, Texas. *36. Lipson, L.G., Premdas, F.H., Molinas, J.M. and Lewis, D.: Cyclic Al\1P and insulin secretion. Gordon 

### Reseaxch**Conference~** The Biology ofAging, 19&5. *37. Flldda G., Akmal,**M.~** Premdas, F.H.• Lipson, L.G. and 

### Mass1y. S. G.: Direct evidence o:l

......,.••:·•!<.. an inhlbitoty effectifparathyroid hormone (PTfD on 

### insuHn.xe,ea:::e inchronic 

### renal failure (CRF). Kidney International. 

### 31:348; 1987, American SooietyofNeplu·ology, Washington, D.C.i 1986. *38. Fadda G.,**Akma~** M.• P,;emdas, F.H.• Lipson, L.G. 

## an4 Massry. S. G.! Correction of glucose intolerance (OINT) mtd the impaired insulin release o chronic renal faibn•e (CRF by verapamil. American Society ofNephrology, San Antonio. Texas 1988. 39. Palmer. S.I(.i Madison, R.E. and Lipson.**L.G.~** Self-reported prevalel'!lce and associated factors intype II diabetes 

### in Japanese Am.edcans in Los Angeles. Diabetes: 37:1 SOA (abst. 587), 1988. *40. Garcia, D.L., Palmer, S.K., Boggs, W.L. and Lipson, L.G.: Challenges inwpatient compliance ofelderly Mex:.ican Am.ericatt Diabetics. Diabetes: 37;68A (abst. 269) 1 American Diabetes Association, New

### Orleans, L.A., 1988
.



# .. , . 

# ..

# ..

### 64 

# .**~** . 41. Schwa111, W.J,, Lefevre
.. T.M. and Lipson, L. G.: Falls in the**elderly~** Tl:e use ofIU.ultiple balance tests. Nov. 1988 meeting ofGerontological Society ofAmerica. *42. Oldham, S.B., Eddlestone, G.T., 

### Premdas, F.H. and Lipson; L.G.: the influence 

### ofage on glucose and forakolin- stimulated :insulinrelease from islets ofthe**diabeti~** mouse. No. 198 8meeting ofGerontological Society ofAmedca. *43. ·Lipson, L.G.: Cal'ing for an aging society- twenty 30 minute -videos on gerontology and geriatrics. Nov.**1988~** meeting ofGerontological Socjety ofAmerica. *44. Palmer, S.K.,**Madison~** R.E. and Lipson, L.G.: Diabetes in older**Japanese~Amerioans.** November 198 Smeeting ofGerontological Society ofAmerica. *45. Boggs, W.L., Garcia,**D.L.~** Palmer, 

### S.K., and Lipson, L.G.; Patient compliance inan ethnic population: Diabetes 

### care inelderly Mexican"Americans, Nov. 1988, meeting of Gerontological Society ofAmerica. *46. Fadda, G.Z.,**Akm.al~** M., Lipson, L.G. and Massry,**S.G.~** Correction ofGlucose lntolerance (GINT) and the impaired ·insulin release ofchronic renal failure (CRF) by Verapoamil.Kidneylnt. 35:427,1989,1989**Meetingofthe21~ Natio:na1Kidney**  Foundation scientific Symposium. *47 Fadda., G.Z., Akmal, M., Lipson, L.G. and 

### Massry. S.G.: Evidence for a direct effect of parathyroid hormone (PTH) on pancreatic islets. Kidney Int. 37:466, 1990, 1990 meeting 

### ofthe 22nd 

### National Kidney Foundation Scientific 

### Symposium, *48 Fadda, G.Z., Akmal, M., Lipson, L.G. and 

### Massry, S.G.: Mechanism ofimpaired insulin secretion in chtonic renal failure. Kidney Int. 37!505, 1990. 1990 meeung ofthe 22nd National Kidney Foundation Scientific Symposium.' *49. Comunale, R., Fadda, G.Z., Premad, F.H., Tha.naldtcharu, P, Lipson, L.G, andMassryt 

### S.G.: Reduced 

### K-inducedJt'!S.Ulh.t secretion in chronic renal 

### failme (CRF) contribute

### to impaired extrarenal disposal ofK: Role ofexcess PTH. Am. Soc. Nephrol. 1:624, 1990. *50 Williams, B., Lowe, B., Nichol, M., McCombs,**J.~** Yoon, P. and Lipson, L.G.: Improving drUg therapies 

### in residential care facilities. 1994 Annual Meeting ofthe American Geriatric Society, Los Angeles, CA. *51. Lipson, L.G.,**McCombs~** J., Jelliffe, R., Williams, B., and Wilson, P.: Medications I the elderly: problems, policies and new solution, a symposium. 1995 Annual Meeting ofthe Ge.t:ontological Society ofAmerica, Los**Angeles~** CA. *52. Lipson, L.G. and Kohn, J.: Govetlltnental responsiveness to changes in demographics of aging disease: Aunique state approach to geriatric ADRD care and treatment. 1996 Annual Meeting ofSouthern Medioal Association, Baltimore, Maryland•

.. 4 • '\A • 1 A •

### 65 53. Symposium Annual Meeting of

### Gerontological Society ofAmerica, San F:rancisco 1 California, 1998. *Presented I. Gl'Mits and Research Funding**(1975~2001)** L National Research Sentice Awards in**Diabetes~** 1975-1977. NIAMDD. NIH. 1F32 AM 05219 MET. 2. Clinicalfnvestigator Award in Diabetes. 1977**~** 1978. 

### NIAMDD, NlH. 1KOB 

### AM 0320 MET. Two additional**ye~us** ofsuppoxt,yrere given up in ol'der to change institutions. 3. Daland Fellowship in Clinical Medicine (Diabetes Research) ofth.e American Philosophical Society, 1975-1978. 4. NIH research Grant- "Pregnancy: Its role in altered insulin release." NICHlD, NIIi 1/79 through 12/81, $134,000. 1R01 HD 12517. L.G. Lipson, P.I. 5. 

### AmericanDiabetes Association Grant- "Mechanism ofInsulin**Release.~)** 3/79 through. 8/80. L.G. Lipson, PJ. 6. American Cancer Society Pilot Project Grant- "Tissue Cultul'e Studies on Human. Pituitary 'fumors.'t 10178-9/79.1.0. Lipson, PJ. 7. Los Angeles County Medical Association Auxiliary Grant**-~~Research** in Clinical Diabetes."**7/78~1/82.** L.G. Lipson, P.I. 8. NIH 

### Research Grant- "Calcium modulated proteins in the parii;thyroid." lWAMDD, 

### NIH lROl am 27816. 12/80 through 6/85,***205~000** L.G. Lipson, Co-P.X•

.**~,.,.,**..**~iL,** NIH Ttai:u.ing Grant- "Training in Endocrine Hypertension and EnclGc:ciru)logy**Metabolism.''NIAMDD~** NIH. T 32 AM 07119. 7/8(J THROUGH6i85 $414,500. L.G.**Lipso~** Iusttuctor. 10. NIH Training Grant- "Training inthe Endool'inology and Neurobiology ofAging." NIA, NIH, 

### 9/82 through**8/87~** $803,882. L.G. 

### Lipson,**Co~director.** AG 00093. 11. NIH Research G:rant- "Microencapsulation: A novel transplantation technique." NfAj NIH.**3/83~2/85.** L.G. Lipson, 

# P.r. 12. Amel'ican Diabetes Association Grant- "The 1'ole ofcyclic AMP in insulin secretion in the diabetiomouse.j' 8/83 through 1/85. L.G. 

### Lipsoni Co-P.I.

----------------· ·42- ·-···-·· ---·- -----**----~-** ---- --------- ------- - ----**~'** 

## . 'i A •

### 66 • ••••••••..• ol 13, E>HHS Center Gmnt -·**~·oerlatlic** Education Center Gl'ant.'' DFlliS 1031 AH 69000. $9521000. 10/83 through 9/88. L,G, Lipson, Faculty Coordinator and Membetofthe Steering Committee. 14. NIH Center**Grant~** "Southern California Consortium for the Study ofAlzheimer's Disease." NIA, NIH. 1/85 through 12/89. $750,000/year. L.G. Lipson, Clinical Investigator. 15. John A. Hartford Senior Scholar Award in Geriatric Medicine- at Harvard Medical School. 9/84 tlu·ough 8/85. L.G. Lipson,**Award~e.** 16. Research Grant from Roerig, Pfizer Pharmaceuticals,**~'Diabetes** inElderly Mexican Amerlcans
... l/86 through 7/87. $80,000 L.G. Lipson, M.D
.

### .,P.L 17. Research Grantfi.·omRoss**Laboratories~** '!Diet and Dementia." 1/88 through 12/89.$37,500. L.G. Lipson, M.D., P.I. 18. Research Gxant from HoechstPhaw.aoeuticats- "Neuropathy in the Elderly!' 1/83 through 12/89, $27, 500. L.G. Lipson, M.D., P.l. 19. Research Grant fi:om Boehr1n.ge1' Ingelhehn 

### Phannaaccutioals- <'Control of

### Mild Hypertension in the Elderly lnnc:r- City Population." 6/88 through 12/8&. $45, 000. L.G. Lipson, M.D.,P.l. 20. Research Grant from Marion Laboratories- "A New Tl'eatment foJ: Pressure Sores.'' 6/88 through 3/89.$15,000 L.G. Lipson, M.D., P.I. · 21. Research Gtantfrom Roerig**Pharmaceuticals·~** ''Diabetes in the Elderly." 7/1/89-12/31/90.**$15~000,** L.G. Lipson, M.D., P.I. 22. Reseru:ch Grant from the John A. HaTtford Foundatiou- '"Prescribing Habits ofPhysicians in Retirement Housing." 2/89 through 1/93. $487,000. L.G. Lipson} M.D., P.l.

.........**t.~** ... 23. DHHS center Grant- "Geriatric Education Center. u 10/89 through 9/92. $450,000 L.G. Lipson, M.D. Clinical Site Coordinator, Key Faculty Member, and Member ofthe Steering Committee. 24. Gel'iatdc Medicine Fellowship Grant from the Japanese Retirement and Skilled

### Nursing Facilities (Keiro Services), 7/88 tiu·ough 7/90, $170,000. L.G. Lipson, M.D., P.I. 2-5. Geriatric Medicine Fellowship Grant from the Motion Picture and Television Retirement Home and Hospital 7/87 through 6/90. $50,000/year. L.G. Lipson, M:D., P.I. 26. Nffi Research Grant- NIDDK- "Subtle 

### Disturbc:l.nces ofCobalamin Status." 2R01- DK32640-07. 2/1191 through 1/31/95. $235)827. L,G, Lipson) M.D.,**Co~Investigator.**



### ,

# ..**~** l • 

## .., .

### 67 

# .

. . 27. Development Grant- USC Irvine Foundation. Diversity Project. Couxse Development. !(Diversity in Aging: Roles in Bthnicity, Gender, Biology and**Environment.~>** 1992· onward, $5;000, L.G. Lipson, M.D., Course Director and P.r. 28. NIH Research Grant- "Multicenter Ti'ail ofPrednisone in Alzheimer's Disease." 1995, $80,000. L.O. Lipson, M.D., Co-P.I. 29. State of Alaska- Educational Grant ('Training ofAdministrators in Long Tenn. Care Institutions and Health Care Providers and Planners in Special Topics 'ofGerontology and Gedatrics." 3/l/96- 5120196, $16,000. L.G. Lipson, M.D., Director. 30. Glendale Adventist Medical Center- "Family Practice Residency Training in Geriatric Medicine!' 7/l/96- 6/30/00, $6,000/year. L.G. Lipson, M.D., DireQtol'. 31. Research Grant from G.D. Searle and Co. '**·~controll¢d** Onset Verapamil Investigation of Cardiovascular Endpoints." 5/97 through 5/02. $75.000. L.G. Lipson,**M.D.~** P.I.**~** ,, ' ... 32. State ofAlaska, "Training in Gemphatmacy, Fall P!.'evention, and Quality Assurance in the frail and 

### demented elderly.''**4/98~ 111102~** **$200~000.** L.G. Lipson, M.D .• P.I. 33. Research Grant from Pfizel' Phrumaceuti<lals,-**~~studies** in Fine Motor Coordination in Alzheimer's Disease.'' 6/98-10/99,$97,000. L.G. Lipson, M.D., PJ. 34. Research Grant from the Keck Foundation "Studies on the Use ofMedications in the Eldedy.>'9/30/02, $4,000. L.G. Lipson, M.D.,**P.I.~** 12/31/02. 35, State ofAlaska, "Training in Geropharmacy: Quality Assurance in the FtaJ and Demented Elderly; CQI ofPjoneers' Homes,"l/1/02-12/31/02. $100,000. L.G. Lipson, M.D., P.I. 36. State ofAlaska, "Training

# in Quality**Assuranc~;~** ofthe Frail and Demented Elderly: CQI of Pioneers' 

### Homes/' 1/1/03-12/21/03. $100,000 L.G. Lipson, M.D., P.(.

t .....

,.,.J;."

..**~IJ...r.l!"'-~,o-.** •

. 37. State ofAlaska- University ofAlaska. Alaska Getiatric Education**Center~** Consultant 7/1/03**~** 12/31/04. $18>000. 38. State ofAlaska- University ofAlaska,. Alaska Geriatric Education Center- Consultant

. 10/1/07- 6/30!08.**$10~000.** 39. State of Alaska- University ofAlaska, Alaska Geriatric Education Center- Consultant 7/1/08-6/30/09. $1

## o.ooo.

... 4 • 

### "''.