air : arity Foy a ts denice Bown: Sot oh M00S¥S‘-x/o9n ne ees woe ‘Ls /000b 08 Oktune Brock Fain Pasion feos DHewher LSegae ober ne Yow Reience yells oe Psychiatric Assessment Sheet PY SIN OS aus oe Endose (beim wich ace appropriate - Comacnewhcereleune | Kontgy ON For REFERRAL: (WHY NOW?) 1 Mad of Aisin se fly fiend profesional Qambulsne Cones pce Yoher_Cae BT Pecipiae Cid aenge Dil eaton porter ie bhaineann propery mage Gian vlc Gon of weapon CCouaenay Sources No ne Reo ims ee a ims eg ee eee Histony oF Present In.nEss: ‘Curnenr Terarment: / Reouces Q mere bihyam OGD sae papiaie other Doage Maliaton Dense ‘Alegifdrg reactions NEP,Since November 1979 I've been and currently am an Adjunet Faculty Member of the US. Army Command and General Staff College, Fort Leavenworth, Kansas. ‘A truncated chronology of my security clearances i a follows: 16daly 1969: ‘Security Investigation for appointment to sensitive United States Department of Justice position completed favorably bby USDJ and the Federal Bureau of Investigation. 12 Febru 1973 National Agency Check completed favorably. 15 November 1976: Final TOP SECRET Clearance awarded by HQ, FORSCOM, Fort MePherson, GA, following a Special Background Investigation by’ the Defense Investigative Agency, Civilian and military commendations, honors and awards include 20 Apeil 1971 Commendation, Director, BI, Washington, DC 10 December 1971 Special Achievement Award, Attorney General, US Depuustice, Washington, DC 18 Apri 1972 Commendation, Director, FI, Washington, DC 29 September 1974: Appreciation Plague, US Department of Justice Sune 1980: Centitiete of Appreciation, 41624 US Army Reserve School, Shreveport, Louisiana December 1981: Commendation, US Army Third ROTC Region, Senior Program, Northeast Louisiana University July 2001; Certificate of Appreviation, US Command/General Staff College, Ft. Leavenworth, KS 2003: Military Order ofthe World Wars, Commander, Tyler | received these military medals: 1972: Armed Forces Reserve Medal 1982: Meritorious Service Medal 1984; Army Achievement Medal: Holy Family 54 Pals {Maun un Joe ETM EAE Vine tutor Brock Faun Paition Heer Lange [Dowie Residence Psychiatric Assessment Sheet Enc the ton wich ae appropite ~ Oommen where relent “MENTAL STATUS EXAMINATION: Govenat Opstaysrions: lox shred aoe , whaling hosp Pris, Udlet-buid i, Onionded <2 6 x “ MgooiAnicr, Anyi gi ct to ann Peccwpahard Poe ssi orbauilste -Glond elstrvaten. + dkscrph SuicpatsTe tolanox,, Bone Dacive Dpasive Man: Oyes Ono Paeous arrmurrs: Gfrone Gone O more chan one Leriatity oF Prewous arrewets: high Gow Qnla Huiains of grandeur - Po dalasicng ani fe Ronee ix Gee os a Nowe on Sosy Canto dane Dyin Bae Phin arms german — oe eye ince" an | tremor pegs | Scoop cermin toms fet 23 4 5 feat | Prcporssome pate dug | Peers sme ae hog x cre hope of dee Beas leat [Sorsrenresadsnte [React [Eraispmetsee (Qs 2 > « fe | Semen | es ey ts | ten iaaaleas ser vor [gamit [Satara ai (Gs aa ease ian 1@ Repo ia ian Reps mony ewan wer | Exposes ano an ign a fgerwenomed [fmkimimar [fmmowicrndeae'™ [ty 7? <@) ka Q, HirofanmerEpqeapic | Unsaler tiene fe | een ie an loon Eeickmacnardditaat | Stason ante Ds Seas pas eee ot. pace iogomamites |Bxckmerams, (Bisiaaouans! Mech iid lining eh | TF dre, bw ig Pacstinter = [Sateen: DHly Family. Pals froviderce Noun Sin: Joegh MEARE CARES. Vincents UAusue Q Brock Fain Povion CiHenher CO Lange a Youle Residence chiatric Assessment Sheet eee GUT 2b ob yee nbn eens ihe pine Comin we loan Tama Danone. gets N Aik @ychons ROS eT uname poraned Figgas ate. Bi es Ben full wT, ot Hy Saf [ante ae = ane ume ABV. 35 id Sasbnee Incl Aree ee i elie ToL FORMULATION: —SUIGDE RIS @Tow Qmodence Dhigh Cousens Hose: Drblem Iveretion/ Prete [Esper cng Dae of Discharge. 2:Mild SModene Ses [allnatry Beherour | Coneepal Disrganzation — [Disorientation Ss Disrosmow: = Dae_ Mor 5 Physician: © = RC NI gd PagetKEMPO, BRADLEY J Birth Dato: 23Apr1988 Or. Richford, Carola Allorios: No Known Allergy comments Diaghosis: PSYCHOSIS NOT OTHERWISE SPECIFIED Current Orders————______ Risperidone Tab 1 ma “Ping (tab) po hs PRN Orders Benztropine Mesylate Tab 1 ma "21mg (12 tab) po aBh pm max: mgr 2Ahrs) ‘Benztropine Mesylat Inj 1mgimt. "2 mp (1-2 mL} iy gBh pn ax: Bg 24h) Methotimeprazine Tab 25 mg 2580 mg (12 tab) pons pn Meciostions as of 23:05 09M2005 End of Report scusoeepogrotes izzy ba ‘DAP oraton Systems te (00548771-8 00007 ‘Admit: 1858 O7Feb2005 Stat-Stop Status ‘22Feb2005-20F0b2015 Cost: $4.27 idote o7Fen2006.05Feb2015 Cost § 0.02 iso, 7 Fe02006-05Feb2015 Cost $4.01 dose 24Feb2005-19Feb2015 Cost $0.13 dose Page 1 ofPHYSICIAN'S ORDERS AUTOMATIC STOP ORDERS TION STATIN Hike | ap resaauans a cry | InIecTABLE NARCOTICS AND ‘contmoLeD oFUCE says ‘ona. naRcoMes ano CONTROLLED DRUGS _ 10 DAYS é RUECTASLE ANTIICTICS AND HyANTAGONESTS. "3 DAYS On aumBionics robave | Kempo __ NeeoUzeD MEDICATIONS Days ILLOTHER MEDICATIONS zeoavs | NO DRUG WILL BE DISPENSED OR cE ADMINIS) F HOSP DRUG CO D WITHOUT A COMPLETED RAINDICATION FORM eg om OPO Tran cares me MORO ‘DRUG DOSE - ROUTE -FREBUENCY - DURATION -1V RATE yess Feb 7 205 zap [EMERGENCY DEPARTMENT PSYCHIATRIC ORDERS 4 Status: Cfinvoluntary [1 Voluntary GY/Certiied x__GSection 28 {Close observation Ps | 1 Restraints prn Bf Seclusion pn | = @’aat Vials Routine 2. Admission laboratory work: ‘coc, tyes, Ef BUN, Creatinine So a w AST, LOM, GT, Brin oe Ue Syh e poss 5/otn Sueppord TSH 3. Medications: COMPLE ef Loxapine 245 mgronm ——q_L_hpm (max 180mQ/26 hr) ¢ Benztropine [-AmgPONMAV —q_{2_h pn (max 6mgi24 hr) 1D Naloperidol mg POMWV qh pn max 30mg/28 hn ‘Lorazepam 1-2 ing Ponty q_L_h pra (max 20mg/26 hn) Call MD if max. doses reached in <24 hes and more doses are required 4 0 salutation and chemetp on all agitated or restrained patients, and all // patient in seclusion room, Posh (es), Nicotine gum pen. 7 ce ‘ALL NEW ORDERS MUST BE FLAGGED 0 Tih koa ee@ohnidews “| Mount Saint Joseph Hospital St Paul's Hospital EMERGENCY NURSING ‘TRIAGE / FAST TRACK TREATMENT RECORD TRIAGE Danesie Vows: No Yen Not Aad: Wh peers yen, rsd to Socal Won: No-_Yos ediatone co Tee Drug and Dena i | 7 | a | | Does Seon by Pysian and Ducared1 lary Hosp 8 ota ot eerste 1 Youle Resience 2N 2120, ESTIMATED DATE OF DISCHARGE & BARRIERS TO DISCHARGE: [Ped slog Fearzjoy AHL ore es | ade ao - a AHN decreas | peg 257 |pesas ) [aimed up|) Heme: T° 5 |Pacrane: [SAF HO GAP [AF GO | afr vO Orin onte or viscnance: §— OCP" © Seale sos Snr Ta Wits ies tia Oe Siceale 7 ks Bib a Ojo be vbe ies sated foe Fe 2U0s bier eno Led ‘Gd. peletafegt wrctH.jfos| Coitrue € gootd roves : MAR Mes ees hows tof Aue Gorey ~ CON Honegty me ood ne Fesen ted th Aen, FOOG A Lb S/O Mf eden bf; he. nada Cee ee | lige fee pica ge (ootte Le Feet op tthe mtrided ote febted et JAG ae ee aw edt park (Ga? a [recs fot nO) @ O* pases darve Aoee!“Neo Known Aleray Medication Administration : Record ‘SPH 2N 2120 From 0800 04 Mar 2005 P055777.8/00007 Carole Richford 7, To 0759 05 Mar 2005, = pclae: 08 09 10 11 12 19 14 15 16 17 18 19 20 21 22 23 00 O1 G2 08 O4 05 08 O7 ‘Medications orcer #99 Risperidone Tab 1 mg (Risperdal or equiv) Groered 22 Feb 2005 mg (stab) poms a PRN Medications conser #3 Benztropine Mesylate Tab 1 mq (Cagentin or oquiv) Srsetod 07 Fob 2005 2g (3-2 tab) 96 aBh pm (mae (Werdstoct) emgi24hs) Orser #4 Beratronine Meayatf mgmt (Copeninor eu) Sreted 07 Fab 2005 Trg drm i ab (max (Waréstock) omgrztnes) v Onder #97, Mothotimeprazine Tab 25 mg _(Nozinan or equiv) Ordered 21 Feb 2008 25:50.mg 12 tab) pons pn (Wardstock) v 08 09 4 11 12 19 14-15 16 17 48 19 20 21 22 23 00 OF G2 03 OF 05 06 OF Printed: 0024 04 Mar 2005 Page of 2Allergios: KEMPO, BRADLEY JOHN 'No Known Alloray Medication Administration Record ‘SPH 2N 2120 (00545777-8100007 From 0300 03 Mar 2005 (05#5777.8/00007 To 0759 04 Mar 2005 j i * 8 08 10 11 12 19 14 18 16 17 18 19 20 21 22 23 00 Ot OZ OS OF 05 06 OF Medications Onder #39, Risperidone Tab 1mg (Risperdal or equiv) (Om PRN Medications Onder #3 Bonatropine Mesylate Tab 1 mg (Cogentin or equiv) Grdered 07 Feb 2008 4:2'mg {1-2 tao} po aah pn (ma (Wardstock) emgr2ds) Order Benztropine Mesylate nj tmgimL (Cogentin oF equiv) Ordered a7 Feb 2005 1-2 mg (12 mL) imfv adh pm imax: (Wardstock) mgizens) Oraer #37, Mothowrimeprazine Tab 25 mg__(Nozinan or equiv) Ordered 21 Feb 2008 25-80 mg (1-2 tab) pos pn (Wardstock) 05 09 10 11 12 19 14 15 16 17 18 19 20 21 22 23 © 01 G2 03 04 05 05 OF af tay OH) Printed: 0025 03 Mar 2005 Page 1 of2Arges: KEMPO, BRADLEY JOHN No Known Alergy ‘Medication Administration Record ‘SPH 2N 2120 (00545771-8/00007 From 0800 01 Mar 2005 0545778100007 T2 To 0759 02Mar2005, OG 09 10 11 12 13 14 15 16 17 18 1 20 21 22 23 00 01 G2 OS OF 05 OS OF Modications: onder #39 Risperidone Tab 1 mg (Risperdal or equiv) Ordered 22 Feb 2005 4 mg (2 tab) pons a0 el PRN Medications Order #3 ‘Benztropine Mesylate Tab 1 mg (Cogentin or equiv) Grdered) 07 Feb 2005 ‘-2mg (1-2 tab) po qoh pn (ae (Wardstock) emarene) Order 4 ‘Benstropine Mosylate nj tmgimL _(Cogentin or equiv) Grdered) 07 Fet 2005 5-2 mg (+2 mu} ml qh pm ta (Wardstock) emgrzens) Onder #7 ‘Nicotine Gum amg (Nicorette or equiv) (Ordered 07 Feb 2005 2 mg (1 gum) po pm (ite twice Men plac in Buccal aa) (Max: 10 Plecos24hrs) 08 08 10 M_sB-AT-TH 15 16 17 18 19 20 21 22 29 00 01 02 09 OF O5 06 OF Z Printed: 0024 0% Mar2005 Page ofneyo : REMPU, BRADLEY SURI ‘No Known Alleray ‘Medication Administration Record ‘SPH 2N 2120 (0058571-8/00007 From 0800 01 Mar 2005 QOS4S77 BCA To 0759 02Mar2005, 08 09 10 1 12 19 14 15 16 1 18 19 20 21 22 25 00 Ot O2 08 04 05 08 OF PRN Medications Onder #37 Methotrimeprazine Tab 25mg (Nozinan or equiv) Grdered 21 Feb 2005 25-80'mg 12120} po he pn (Wardstock) 08 09 10 11 AZ" 14 15 16 17 18 19 20 21 22 29 00 OI 02 02 OF 05 06 OF 2 FP Printed: 0024 01 Mar 2005 Page2 of 2Allergies: KEMPO, BRADLEY JOHN ‘No Known leroy Medication Administration Record ‘SPH cmox csTR-s (005457 1-8/00007 | From 0800 09 Feb 2005 by ciyistine Taylor To. 0759 10 Feb 2005, De 08 10 11 12 19 14 15 16 17 18 19 20 21 22 23 OD OF O2 09 04 05 06 OF PrN Heiations ers eaten Pamasecy Srderad_ 07 Feb 2009-2 mg (2 ta) po aah pn (ma (wardsteck) Soles ee oo are Pree ere ee ee Grooved o7 Feb 2005 Trng (2 ml) tiv gGh pen (max (Wardtock) pa uf Sana Taeaia Tah am nore ES orrenzaos Sait OB oth tae wardsck guts) < 9s cnn ae eel, aan mene SEES orrov cans SPURS My aftpneoe (ordstc) SomStie tn cave coeur ae? Vicon Gur dra (emote oreo) Sideted 07 Feb 2005 2m (I gum) po pn (to twice Hen place in Buccal area) (Max: 10, v pices/24hrs) 08 09 10 11 12 19 14 15 16 17 18 19 20 21 22 28 00 OF O2 03 OF OS 0G OF Printed: 0025 09 Feb 2005 Pago? of 251 > ty Review Panel Mental Health Act British Sion 25.8 19965 24 COLUMBIA — : Gale Rebroay, 25. doo To Brao Kemeo Wort QX Facity ST, Paols tosritel- ‘As you know, a Review Panel met recently to consider your application for review as permitted under Section 25 of the Mental Health Act. It is the decision of the Review Panel that you BE DETAINED. You will be aware that your ward treatment has authority under the same Mental Health Act to work with you towards discharge and that your physician has authority to discharge you when it is considered appropriate to do so. ‘This appears to be a good time for you to sit down with the staff on the ward to discuss plans for your continuing treatment. The Review Panel urges you to do Pale a Mr. B, Cruiksank Trent aggre Mu ig an coat Nitany steam ana Taath Gare bona “elophone (609) sau Tam0/ 722577107 Minaby Response Bulng, Holy rv, 800 Leughood Hay Dorwoed Pacha (oon sacra for Seniors Port Coquitlam, 86 VIC 4J2 2a Form 8 REVIEW PANEL Bamistt Mental Health Act DETERMINATION, COLUMBIA Geos 2585.86. 1996,0289 ly aaah a Firion _CrpM so chart review pana crit hatha hare view panethasreviewedthecaseat == _ “Brak ViertQq Tat arene ple (ease pan) whowssacnited’s 3K, Books tosis on OT, Kb Ips, : ‘ane eeepiaiau Sey ae rm oa * ma yhose sats as anjevlutary Was ls renewed etetve BE, (de aa eam) a_i ‘Ye, the members, or a majoiy ofthe members, of he review pa have determined thatthe patient named above ests continue to be detained in or through a desionsted fell because section 2 (3X) and} of he im Mtcontnues fo deseribe the condition athe patient T] sould be discharged LTRs aime enti Fo_gdbir_ Spe “Secfmtamenih odiswler , ptenely cesrwnceh chia Anemia Hed, gen tne Ais oe ot fie bal fx Et i cei lel a fare Ph eras Cece, fed 6, me ss Gs mn haf ew} oe, Lean nis Opa qt be ll cca fl maple ayehitt cane fos apace staan on a i enor The panel, or a majority of the We i —, _—— Sane Apo ie, Brats of Patan hmeForm 8 REVIEW Payee Bamisy Mental Health Act DETERMINATION COLUMBIA (Secon BSB... 215 ity Runge tor seniors Aeontoueay “Seana eva palin ‘Borah of Brent Appin page _JSRITISH ao MEDICAL REPORT. re one eit | B-AUTHORITY TO RELEASE roa Sra sy Eto ep = exiat 4D | ‘C- MEDIGAL As IMENT - To be completed by a Mediest Practitioner fPtsaee Pri) 1 irate pemmcmer amen teinmnreci rap Z| ACESS A asa on ent een | ‘eer wit be snaed tho Erpoynen and Asistance AspoaThbsnal ¥ 2 appeal inte, | 1 cranmara nana: SCH 2OPUCENVA a | ——— | © seven pwanmeene oar eee ee aa ee cree sane pba T1300 Closes (Jeane CJniaree Pheianes toate (iene zn stsnaonmene, CERO LS | 2 Mescatconsortyeepate nee C]vee [OAKS Fi Rest gene etc ewe te mci) fr xa eon tan emg) | seme Pichi acionatesaceneres | KSC oe - Vancourer ae Voz We . fae | sae toned porn res | Ch ZD SESS. Paeroms ayy& BRITISH FORM 4 MEDICAL CERTIFICATE. COLUMBIA MENTAL HEALTH ACT (VOLUNTARY ADMISSION) Sees mans 1 Buda (ange MD cot tat exons Bet begen Ltrachetefle om ONONTS OF) In summary form, the reasons for my opinion are: information may be obtained trough ilencews,ebeewatens an coteral sources) 1. Inmy opinion, his person: nasa cisco the min that requires ‘enna and wen sot noes ‘the person's abilily to react appropriately ch, {Dhar enenentartssicaate t ‘eos acon tne Men ; mat oat Ach; and 2. lamy opinion, tis person (@) requtes vostment nor trough @ (enignated faci, and (©) roqiros care, supervision and ‘conto nor through a designated {acl to prevent afer substartil ‘mental or physical deleevation or {forthe protecton of he person or or 7 a the protection of ters; and (©) cannot eutaby be sdmited as 2 - voluntary pation | Cconsible under section 28 ofthe Ac A OF O07, QOY £2. oc. 6F2 2344 rence porn wh amet he ail spot ae pect acd adel re camo tin a eba BrivisH FORM 4 MEDICAL CERTIFICATE COLLIMBIA MENTAL HEALTH ACT (VOLUNTARY ADMISSION) reeset a oa rl ‘tty Reopens Soiene n—_ Towartay Fy , crtty nat exaind Mecca Bred lg The Meters o DA ep Zee In suremary for, the reasons for my opinion are: infomation may be obtained {trough itaniews,cbeerations and cole! sources) 1. tnmy opinion, his person: has asitorcer ofthe min that requires treatment and wticnserousiy impairs the peson's ably to react aporoseataly tonisner envionment oro associate wah thers (sechon 1 ofthe Mental Heat Ac) and 2. Inmy opinion this person (2) requires treatment in x trough a ‘signa acy, and (©) requres care, supervision and onto ino trough a designated facity to prevent nner substantial ‘mental er physical detarraton or forthe protection of the person or for the protection of oes; and cannot suitably be aamited as @ voluntary patent | © ns ponon Chas _ Cn rt Loam bial nem tics o, uZeeos SFR BAoes lost Becearl SE ees 6&2 -a Ue Sos carrot ar Now rs meet cnet when yar ‘Tepononwa nes cyto sosin oa tron 0 pose sno aia enna ann ete arin pin marie pene aoieit Sionee005 MON 16:10 FAX 604 524 7216 REVIEW PANELS Bon E Review Panel FA Bamst, Mental He lth Act COMBA ecaskas twctg — E SD) Patient's Right io Counsel Date February 14,2005 : = . nurse inch ca | Plesse Sign and fax back! e lurse in Charge SR ae Posie’ | Patient: Bradley Kempo = (604) 524-7216. Binh Date: zanna Faciiy & Ward: St. N ‘Tentative Review Panel Date: 25-Feb 2005 @ 10:00 ‘This will acknowledge receipt of the Application for Feview (Form 7) from this patient. The Review Panel Office wil contact the panol appointes named by the patient. Please tell the patient that they have the right to be r presented by counsel or an agent. Patients who want counse! may make their own arra igements or they may get free representation from the Community Legal Assisstan:0 Society's Mental Health Law Program (M.IHLLP.). The Review Panel Office will iniorm M.H.L.P. ifthe patient is interested in free represeniation and the patient may also call M.H.LP. directly at (604) 525-2615, Please explain the above to the patient and hav> him/her complete and return this | form to the Review Panel Office AE SOON AS POSSIBLE. ‘Thank You (wil make my own arrangements for counse or an agent. | want the M. H. L. P, to contact me to discuss free representation at Review Panel | do not wany-counsel AG reer ae evan en fas eS Uhltet | copes ee Sn ash a Tolshene (3247200) 2237107 Eley | Donat Bulan Hy De 20% Ls Freie! eon scree