TIMOTHY J. MARTEN, M.D.
Plastic and Reconstructive Surgery
450 Sutter St Suite 826 San Francisco, CA 94108 (415) 677 - 9937

May 19, 1997

To Whom It May Concern,

I write to summarize the findings and recommendations made as part of the evaluation I performed on Ms. Hess on May 19,1997.

Ms. Hess sustained multiple injuries when brutally attacked on May 16, 1997 in Los Angeles. Currently her concerns are as follows:

1) tender swellings on her upper arms, shoulders, back, flanks, chest and lower extremities
2) bilateral wrist pain and intermittent numbness and paresthesias in the left upper extremity
3) swelling, tenderness and eccymosis over her groin and genitalia
4) nasal tenderness and a visible nasal tip deformity
5) bilateral temporo-mandibular joint tenderness

Her history is remarkable for repeated forceful blows to the face, breast, body and groin adminisered by multiple assailants while handcuffed in a secluded area. Blows included punches with closed fists and kicks with hard soled shoes delivered while she struggled face down on a hard surface. No immediate medical evaluation or attention was provided. Ms. Hess denies experiencing, diplopia, hematuria or epistaxis. She is uncertain whether she experienced any loss of conciousness but it appears she has some amnesia to at least some parts of the assault.

Examination in this office was remarkable for a 4X5 cm area of tender eccymosis over the lateral left arm; 5X6 cm areas of tender eccymosis over the left deltoid; scattered, faint tender eccymosis areas over the torso and lower ectremities; eccymoses and scattered peticeae over both wrists; a 2X3 mm blood filled vesicle in the palm of the left hand; scattered superficial excoriations on the dorsum of the left hand, right and left forearms and lower extremities; superficial abrasions on both knees; tender eccymosis over the base of the genitalia, bilateral TMJ tenderness without evidence of fracture, dislocation or mal-occlusion; tenderness over both wrists; decreased sensationiin the left upper extremity in a median nerve distribution. there was no diploplia, enopthalmous, ocular entrapment, infra-orbital anethsia or evidence of facial fracture.

All findings are consistent with the patiet's accounts of events.

The patient's nasal deformity may resolve on its own but may require reconstructive reshaping if it does not and remains a concern to the patient. This is usually undertaken 12 to 18 months after injury. It should be noted that the patient has had prior nasal plastic surgery. This results in a nose that is more esasily injured and more diifficult to reconstruct.

Ms. Hess has been advised to seek consultation with an oral surgeon regarding the possibilty of temporomandibular joint (TMJ) injury. TMJ problems, once established, are difficult to treat and can sometimes result in lifelong pain syndromes.

Ms. Hess has been advised to seek consultation with a hand surgeon regarding the possibility of traumatic nerve injury at the wrists. Post-traumatic nerve compression syndromes, once established, are difficult to treat, often require surgery and can sometimes result in lifelong numbness, weakness, chronic pain and other disabilities.

Ms. Hess has been advised to seek counseling with an apropriate therapist. Post-traumatic stress syndromes, once established, can sometimes result in lifelong agoraphobia, panic attacks, stranger axiety and other significant psychological disablities.

Ms. Hess has been advised to discuss the possibility of head injury with her internist and seek consultation with an appropriate specialist, if needed. Frequently symptoms are subtle following serious head injury and their onset is often not immediate.

Ms. Hess has been advised to seek consultation with urologist should she develop genito-urinary problems.

Currently there is no specific treatment needed for Ms. Hess' other injuries which should only require symptomatic treatment and are expected to resolve with time.

I hope this information has been helpful. Please let me know if I can be of further assistance.

Sincerely: Timothy J. Marten, M.D.

Certified by the American Board of Plastic Surgery Member, American Society of Plastic & Reconstructive Surgeons