Claim Clark, TImothy & Tanner
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This wri"en report constitutes your claim against the City of Dubuque, Iowa. You should complete this form in full and attach any additional
information that supports your claim.
The claim must be filed WITh the City Clerk at City Hall, 50 West 13'" St., Dubuque, IA 52001. It will then be referred to the appropriate
department fur investigation and to the Legal Department. Once that investigation is completed, a report and recommendation will be
submi"ed to the City Council. You will be provided with a copy of that report and recommendation.
The final decision on all claims is made by the City Council. No employee of the Cüy of Dubuque has the authority to make any
representation to you as to whether your claim will or will not be paid.
1. Name of Claimant. _TImothy G. Clark on behalf of Tanner G. Clark
2. Address; _31050 463" Ave Vermimon, SD 57069
3. Telephone Numbe" _605-<324-4690 home 605-677<;142 work
4. Date of Incident. _3/20/04
5. Time of Incident _approx;mately ';30 pm
6. Location of Incident (Be specific); _Door leading to 5'" Street on the Northeast comer of the building (see a"ached map).
7. Describe the accident or occurrence that caused injury or damage. (Give full details upon which you base your claim. If a City employee
was involved, give the employee's name.)
My 6 year old son, Tanner, was a"empting to enter the facility through a door at the Northeast side of the building on 5'" Street. While trying
to open the southern most door in the bank of doors, the door slammed shut. I was nearby and heard Tanner screaming. I looked over and
saw that he was caught in the door. I ren to the door and arrived at about the same time as a city police officer who had been di,ecting
Uaffic near the loading zone. Tanner was screaming hysterically and I immediately saw the end of his finger was bleeding profusely and
tipped sideways. I picked him up and ran to get my wife. We asked the officer where the closest hospitel was given directions to Finley
hospital. While we were driv;ng to the hospital Tanne' screamed non-stop. Upon amval to the ER Tanner was immediately examined by a
physician and pain medication was administered. However, the medication was ineffeclive and did not stop the pain. A second dose of
pain Il)edication was given but it still did not help;. Thefinge, needed to be immediately evaluated so the physicians decided to have him
physically restrained and proceed. Tanner had to be held down and he screamed throughout the painful examination. Afte, he was
examined.the.physicians fuund that the 5'" dig" on his left hand had been crushed breaking the tip of the bone and amputating the end of
the fing.... The fingertip was only held on by a small flap of skin on the palm side of the finger. An orthopedic su'geon was called to
reattach the fing...; However during the procedure Tanner was still in severe pain and had to be forcibly restrained by 4 individuals in order
for the surgeon to rea"ach the finger. Tanner's finger was placed into a brace fur 4 weeks to allow the bone and tissue to heal. Twoweeks
late'when the sutu,eswere to come out. Tanner again was hysterical in anticipation of the pain of suture removal. He, as well as his
mothe,and I, were Uaumatized by this procedure. He had intended to show in the dog show that evening and was unable to because of his
injury. Furthermore, he is just now regaining full use of the finger and was fureed to stop several activ;ties (soccer, piano, etc.) during the
recovery period. He has scamng and the side of the finger is permanently deformed.
8. What were weather conditions like? _cool and breezy
9. Give name and address of any WITnesses; _Timothy G. Clark
10. Did polica investigate? (If so, give names of officers.)
_No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
_Tanner G. Clark 31050463" Ave, Vermimon, SD 57069
_severed the 5'" digit at the level of the base of the fingernail
12. Was any damage done to property? (If 50, describe property and the extent of damages. Attach estimates of damagas or describe
basis for ascertaining extent of damage.)
_No
13.. What othe'damages do you ciaim, if any? _Medical Bills and Pain and suffering.
~M~<Íi~IBiIIs$1674.55 pain and suffering $5Ò25.45
14. Have you been compensated fur any part or all of your claim by any ins"ca"ce company? (If so, give name and address of insurance
company and amount paid.)
_So far our personal insurance has covered $574.03
15. What amount do you claim from the City of Dubuque? $6700. We intend to reimburse our medical insurance once we have been
compensated.
16. Why do you claim the CITY of Dubuque is responsible?
Due to a improperly adjusted doo, closer on your facility, my 6 yea' old son lost the end of his finger. The doo, closer, which should have
allowed the door to close slowly, was improperly adjusted, allowing the heevy door to slam shut. My son had to endure the trauma of the
amputation as well as the surgical reattachment of the digit During the reattachment procedure he was fully awake and had to be forcibly
restrained by his mother, myself, a physician and a nurse so that the surgeon could suture the severed portion. He, as well as his mother
and I, were traumatized by this procedure. He had intended to show in the dog show that evening and was unable to because of his injury.
Furthermore, he is just now regaining full use of the finger and was forced to stop several activities (soccer, piano, etc.) during the recovery
period. He has scamng and the side of the finger is permanently deformed.
17. Have you made any claim against anyone else for damages as a result ofthis incident? (If yes, give name and address.)
_NO
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated this_'0th_day of_June
,2004_.
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(Signature)
_TimothyG.Clark
(Print Name)
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