Resolution No. 4704
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RESOLUTION NO. 4704
A RESOLUTION OF THE CITY COUNCIL OF THE
CITY OF VERNON DETERMINING THE DISABILITY
RETIREMENT OF KEITH SLIFKA
A LOCAL, SAFETY MEMBER EMPLOYED BY THE CITY
OF VERNON [~S21024 & 21025 of the Government
Code]
WHEREAS, the City of Vernon (hereinafter referred to
as IIAgency") is a contracting Agency of the Public Employees
Retirement System; and,
WHEREAS, the Public Employees Retirement Law requires
that a contracting agency determine whether.,a>n employee of such
Agency in employment in which he is classified as a Local Safety
Member is disabled for the purposes of the Public Employees
Retirement Law and whether such disability is lIindustria111 within
the meaning of such law; and,
WHEREAS, by this Resolution the Agency is hereby filing
an application for the disability retirement of Keith
Slifka
employed by the Agency in the position of Hoseman
in the Vernon Fire
Department; and,
WHEREAS, the City Council of the City of Vernon has
reviewed the medical and other evidence relevant to such alleged
disability; and,
\'JHEREAS, such II industrial II disability was not caused
by third party liability.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF
THE CITY OF VERNON AS FOLLOWS:
SECTION 1: That the City of Vernon hereby finds and
determines that Keith Slifka
is incapacitated within
the meaning of the Public Employees Retirement Law for performance
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of -.his duties in the position of a Hoseman in the Vernon Fire
Department for the City of Vernon.
SECTION 2: That the City of Vernon hereby finds and
determines that such disability is a result of injury or disease
arising out of and in the course of employment and neither
Keith Slifka
nor the Agency has applied to the Workers'
Compensation Appeals Board for a determination pursuant to S21026
of the Government Code whether such disability is industrial.
SECTION 3: That the City Council of the City of Vernon
determines that such disability became permanent and stationary on
January 14, 1980 and said disability is determined to be of a
permanent nature, and said Keith Slifka
is removed
from the City payroll on March 4, 1980
SECTION 4: That the City Clerk of the City of Vernon
shall certify to the passage of this Resolution and thereupon
and thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 4th day of March, 1980.
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--- LEONIS C. MALBU G, Mayor '
ATTEST:
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BRUCE V. MALKENHORST, City Clerk
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STATE OF CALIFORNIA )
) 55.
COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, City Clerk of the City of
Verno~, do hereby certify that the foregoing Resolution, being
Resolution No. 4704 , was duly adopted by the City Council
of the City of Vernon, and was approved by the Mayor of said
City at a regular meeting of the City Council held on Tuesday,
March 4
, 1980.
D;, ~p",
BRU V. HALKENHORST, City Clerk
(SEAL)
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REPORT OF THE CITY ATTORNEY TO THE FINANCE COMMITTEE
OF THE CITY OF VERNON
CONCERNING THE INDUSTRIAL DISABILITY OF MR.
KEITH SLIFKA IN RELATION TO HIS QUALIFICATION FOR
DISABILITY RETIREMENT
FEBRUARY 19, 1980
Mr. Keith Slifka is employed by the City of Vernon as a
Hoseman. Mr. Slifka has filed four (4) Applications for Adjudication
of Claims with the Division of Industrial Accidents, Workers'-
Compensation Appeals Board on 3/8/79, 3/16/79 and 7/6179 alleging
that he sustained injuries arising out of and in the course of his
employment on 3/74, 1/3/78, 3/74-3/79 and 6/30/79 re: "back". Mr.
Slifka, at present, is not reporting for duty.
Mr. Slifka has visited several doctors at the request of
CDS of California, the City's consultant for workers' compensation
matters and at the request of his attorney.
He has not received a final award in response to his claims
for workers' compensation benefits and he is presently permanent and
stationary in regard to all of his injuries.
He has not filed for Public Employees Disability Retirement
and the City is presently in receipt of the following medical reports
and files.
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1. Reports of Mitsuo Yanagihara, D.C., 10133 Atlantic Avenue,
South Gate, CA 90280~ dated 4/24/78 and 6/26/78. Said reports concern
examinations performed at the request of CDS of California, the City's
workers' compensation consultant.
2. Report of G. E. Bonecutter, M.D., 4132 Kate11a Avenue,
Los A1amitos, CA 90720. Said report concerns an e1ectromyographic
exarninationperformed at the request of Dr. Owens on 5/12/78.
3. Report of Wayne W. Owens, M.D., 12820 Studebaker Road,
Norwalk, CA 90650, dated 5/26/78. Said report concerns an examination
performed at the request of CDS of California, the City's workers'
compensation consultant On 5/1/78.
4. Reports of Jack H. Goldfarb, Ph.D., 1100 Glendon 'Avenue,
Ste. 1616, Los Angeles, CA 90024 dated 5/4/79 and 7/5/79. Said
reports concern examinations performed on 4/5/79 and 6/20/79 at
the request of CDS of California, the City's workers' compensation
consultant and referred by Dr. Bursk.
5. Reports of Melvin Stoltz, M.D., 2300 South Hope St., Ste.
100, Los Angeles, CA 90007/2400 S. Flower St., Los Angeles, CA 90007
dated 7/6/79 (Doctor's First Report) and 7/30/79. Said reports
concern an examination performed on 6/30/79 at the request of CDS
of California, the City's workers' compensation consultant.
5. Report of Richard M. Siebold, M.D., 6135 Wilshire Blvd.,
Ste. 201, Los Angeles, CA 90048 dated 10/17/79. Said report concerns
an examination performed on 9/24179 at the request of CDS of California,
the City's workers' compensation consultant.
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6. Reports of Allen S. Bursk, M.D., 3875 Wilshire Blvd.,
Ste. 209, Los Angeles, CA 90010 dated 10/31/78, 1/22179, 3/1179,
3/6/79, 5/3/79, 5/25/79, 6/22/79, 7/2179, 7/19/79, 8/20/79, 8/28/79,
10/18/79 and 1114180. Said reports concern examinations performed
on various dates wherein x-rays, mye10grams, etc. were performed at
the request of CDS of California, the City's workers' compensation
consultant.
Mr. Slifka was hired by the City of Vernon on 12/16/60, he
was born on 1115137, and he is approximately 43 years of age.
Mr. Slifka went off work on 6/30/79 and has not returned
to work.
Since that time he has been examined by Drs. Bursk, Siebold,
Stoltz, Goldfarb, Owens, Bonecutter and Yanagihara and his attorney
has filed four (4) Applications for Adjudication of Claims with the
Workers' Compensation Appeals Board and has filed a Declaration of
Readiness to Proceed.
It appears from the report of Dr. Bursk dated 1/14/80 that
lithe patient is permanent and stationary II and "the patient's permanent
disability will consist of the following: 1) scar on his back; 2)
decreased range of motion, lumbar spine, of approximately 20%; 3)
subjective complaints of pain which I would rate as minimal at rest,
slight after light to moderate activities, and intermittent moderate
after full activities. There is no neurological deficit demonstrable
at this time nor is there any atrophy". Dr. Bursk further indicates
that IIthis patient will never be able to return to his usual work as
a fireman. He will have to be retrained to perform some type of work
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that doesn't require heavy lifting, pushing, pulling, or working in
a bent-over cramped position". In addition, Dr. Bursk indicates in
his report of 8/28/79 that lIeven though the patient had a prior
injury, I would have to consider this a new injury as of the date,
6/30/79, as it was this incident that precipitated the patient1s
need for hospitalization, myelography, and surgeryll.
It appears from the report of Dr. Siebold dated 1Q/17/79
that he would apportion "approximately 15% of the patient's continued
subjective complaints and objective findings to the injury of 5 years
ago II , 1150% of the patient's subjective complaints and objective
findings to the injury of 1/3/78" and "35% of his subjective complaints
and objective findings" to the final injury of 6/30/79. Dr. Siebold
also indicates that he "cannot agree with Dr. Bursk's comment that
he considered the injury of 6/30/79 a new injury since it necessitated
a hospitalization, myelography and surgery. That is difficult to
comprehend when the patient already was hospitalized and had myelography
which one must assume was done in preparation for possible surgery".
There is obviously some difference between the opinions of
Dr. Siebold and Dr. Bursk in many areas involving Mr. Slifka's
allegations and claims; however, they do agree in one essential area
and that is that the condition has an involvement due to his industrial
occupation.
Since Mr. Slifka has not filed an Application for Disability
Retirement, if the Committee wishes to retire Mr. Slifka, the City must
file said Application and may do so concurrent with its adoption of a
Resolution of Disability Retirement.
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The Government Code requires that the disabling condition
be industrially related and that his condition be permanent and
stationary.
I think it is important to note that both Drs. Siebold and
Bursk appear to agree on the essential matter that the injuries are
industrially related and that Dr. Bursk feels that Mr. Slifka has
reached a permanent and stationary position with job restrictions
which preclude him from performing activities and other assignments
for the Vernon Fire Department as the assignments are currently
described.
This report is hereby submitted for your consideration.
DAVID B. BREARLEY
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CITY COUNCIL
583.8811
587.5171
58.3.4821
583.8811
583.8811
1583.8811
OFFICERS
LEONIS C, MALBURG. MAYOR
HILARIO GONZALES
KEITH K, KAESER
WILLIAM M, McCORMICK
THOMAS A, YBARRA
BRUCE V, MALKENHORST.
CITY ADMINISTRATOR / CITY CLERK
DAVID B, BREARLEY, CITY ATTORNEY
TELEPHONES
CITY CLERK . .
POLICE DEPT. . . .
FIRE DEPT, . _ . . . .
BUILDING DEf'T,
PUBLIC WORKS DEPT.
HEALTH OEPT, . . . . .
ARTHUR E. NELSON. JR"
DIRECTOR OF PUBLIC WORKS/BUILDING/HEALTH OFFICER
GEORGE F. BASS. FIRE CHIEF
SPENCERE, HOGAN, POLICE CHIEF
IN REPLY REFER TO:
45-044
CITY HALL
4305 SANTA FE AVENUE, VERNON. CALIFORNIA 90058
(bQ)f>Y
March 6, 1980
Workers' Compensation Appeals Board
819 Broadway
Santa Monica, CA 90401
Re: Keith Slifka v. City of Vernon
WCAB Case No(s). 79 MON 270661 79 MON 27354/55; 79 MON 29976
Gentlemen:
In accordance with the Rules of Practice and Procedure, we re-
spectfully submit the following, copies of which are being mailed
concurrently herewith to the parties listed below on this date:
Stipulation
Compromise and Release Agreement
(xx) Medical Report(s) and other documents as follows:
1. Jack H. Goldfarb, ph.D., dated 10/15/79;
Please conform a copy of this letter with the date the above-
mentioned documents were filed and return the same in the envelope
provided.
DBB : j 1
Enc10sure(s)
Daniel L. Fe1sen, Esq., Law Offices of Richard J. Silber, 1100
Glendon Avenue, Ste. 1800, Los Angeles, CA 90024
Robert Graham, Esq., State Compensation Insurance Fund, 600 S.
Lafayette Park Place, Los Angeles, CA 90057
90S of Calif. (no medicals enclosed) ,
JBruce V. Ma1kenhorst (no medica1s encl.) .
Very truly yours,
CITY OF VERNON
BY'\) f-;\'\') \). '\'L:i~../tv
DAVID B. BREARLEY
City Attorney
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