The Thirty-Fifth Annual Iowa Middle School Mock Trial Tournament 2018

THE THIRTY-FIFTH ANNUAL IOWA MIDDLE SCHOOL MOCK TRIAL TOURNAMENT 2018

LARRY & RITA LUDGATE, as Parents and Next Friends of APRIL LUDGATE

Vs.

GRYZZL CORP d/b/a CAMP MORNING STAR

A program of The Iowa State Bar Association Center for Law & Civic Education

In cooperation with the Young Lawyer’s Division Of The Iowa State Bar Association With generous financial support from The Iowa State Bar Foundation IOWA MIDDLE SCHOOL MOCK TRIAL TOURNAMENT 2018

LARRY & RITA LUDGATE, as Parents and Next Friends of APRIL LUDGATE

Vs.

GRYZZL CORP. d/b/a CAMP MORNING STAR

Original Case Materials Developed by

Many thanks to the Davis Brown Law Firm, Des Moines, Iowa for Research Assistance in preparation of these materials.

STIPULATIONS

1. The jurisdiction and venue for this mock trial case have been previously established and are proper.

2. The applicable law is contained in the jury instructions that are set forth in this case file.

3. All exhibits included in the problem are authentic and accurate in all respects, and no objections to authenticity of the exhibits will be entertained. Unless stated otherwise, the admissibility of the exhibits on other grounds may be challenged.

4. All signatures on letters, witness statements and other documents are authentic. Those statements not including a signature are presumed to have been signed and authenticated.

5. The dates of witness statements are not relevant and therefore not included. No challenges based on the dates of the witness statements will be entertained. All statements were taken after the alleged incident but before trial.

6. This trial is bifurcated and the only issue to be determined is liability. The amount of damages to be awarded, if any, will not be at issue in this trial.

7. Whenever a rule of evidence requires that reasonable notice be given, it has been given.

8. All pretrial motions have been considered by the Court and do not affect the trial of this case.

WITNESSES

The following witnesses are available and must be called by the parties:

For the Plaintiff - For the Defendant – Andy/i Dwyer Leslie Knopf Ron/da Swanson Bennie Wyatt Dr. Chris Traeger Avery Perkins, C.N.P.

All witnesses may be female or male. The victim, April Ludgate, is female. This does not affect the gender of the witnesses involved nor does it have an impact on the relationships between the decedent and the witnesses.

NOTE: If space allows within individual mock trial courtrooms, the Plaintiff may designate an alternate member of the team to portray a parent of the victim and sit at counsel table. The participant portraying the parent will have no official role in the mock trial proceedings and will not be evaluated for scoring purposes. Under NO circumstance may a team designate a member to portray the victim, April Ludgate, in the Mock Trial Courtroom.

EXHIBITS AVAILABLE TO BOTH PARTIES The parties have stipulated to the authenticity of the trial exhibits listed below. The court will, therefore, not entertain objections to the authenticity of these trial exhibits. The parties have reserved any objections to the admissibility of any of these exhibits until the trial of the above- captioned matter. The trial exhibits may be introduced by either the Plaintiff or the Defendant, subject to the Rules of Evidence and stipulations of the parties contained in the materials. The exhibits are pre-marked and are to be referred to by number, as follows:

Exhibit No. Exhibit Description

1 Map of Camp Morning Star 2 Excerpt from Parent Handbook 2017 3 Iowa Department of Public Health Pamphlet 4 Lyme Disease Fact Sheets 5 Camp Morning Star Daily Schedule 2017 6 Curriculum Vitae of Dr. Chris Traeger 7 Maps of Reported Cases of Lyme Disease 8 Camp Morning Star Nurse’s Log for April Ludgate 2017 9 Email Exchanges between Camp Morning Star and Ludgate Family 10. Information and Photos of Ticks 11. Examples of Tick-Borne Rashes 12. Tick Prevention Poster from Camp Morning Star Dining Hall

Case Note: This problem is designed as a jury trial. However, your arguments will be presented to a panel of judges. You should evaluate and review all appropriate jury instructions provided in preparing your case. UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF IOWA ______

LARRY & RITA LUDGATE ) As Parents and Next Friends of ) APRIL LUDGATE ) CIVIL ACTION NO. ) Plaintiffs, ) 20180828 ) v. ) ) GRYZZL CORP. ) d/b/a CAMP MORNING STAR ) ) Defendant. ) ______

COMPLAINT

INTRODUCTION

Plaintiffs Larry and Rita Ludgate bring this action on behalf of their minor daughter,

April Ludgate, to recover for the catastrophic personal injuries she sustained as a result of the

negligence of the Defendant, GRYZZL Corporation, while April attended Camp Morning Star, a camp run and owned by GRYZZL Corporation, during the summer of 2017. Plaintiffs seek to recover for their daughter’s injuries and for the substantial damages that she has sustained, and will continue to sustain, as a result of her injuries.

JURISDICTION

1. Plaintiff April Ludgate is a citizen of Nebraska.

2. Defendant GRYZZL Corp. is a domestic, regular, non-stock corporation incorporated

in the State of Iowa and with a principal place of business in the State of Iowa.

3. This Court has jurisdiction because the parties are citizens of different states and the amount in controversy exceeds $75,000.

4. Venue is proper in this District in that a substantial part of the events or omissions

giving rise to the Plaintiff’s claims occurred in the District; the injury at issue was inflicted in the

District; and the Defendant is incorporated in, and has its principal place of business in, this

District.

FIRST CLAIM FOR RELIEF: NEGLIGENCE

5. From June 18 to July 29, 2017, then 14-year-old April Ludgate attended Camp

Morning Star in Jones County, Iowa, a camp owned and run by the Defendant GRYZZL

Corporation.

6. While April attended the camp, she was in the sole care and custody of the Defendant and the Defendant’s employees, agents, servants and representatives.

7. While April attended the camp, the Defendant stood in loco parentis to April.

8. While April attended the camp, the Defendant had the duty and responsibility to do everything in its power to keep her safe and protected from disease.

9. Among other materials prepared by the Defendant and given by the Defendant to

April and her parents prior to April’s attendance at the camp was a Parent Information Handbook which acknowledged “the probability of a tick attaching itself to a camper and possibly causing

Lyme’s disease or other tick-borne illnesses,” and promised a “multi-step protocol” of precautions to protect campers against that risk.

10. The “multi-step protocol” included the following: (a) “daily, each camper is observed in a state of undress (as discreetly as possible) by her/his cabin counselor for the purposes of noticing any rashes, infected bug bites, sores or other unusual skin conditions”; and

(b) “campers involved in activities outside of the core and mowed areas of the Camp… are informed at the meal preceding that activity to wear appropriate clothing (long pants and

sneakers) and apply bug lotion to exposed skin just prior to participation. The activity instructor

reinforces this procedure at the time of the activity.”

11. The Defendant failed to comply with its own Tick-Borne Disease precautions

contained in the Parent Information Handbook.

12. The Defendant’s cabin counselors failed to observe, or failed to carefully and

adequately observe, April for purposes of noticing any rashes, infected bug bites, sores or

unusual skin conditions.

13. The Defendant’s cabin counselors failed to notice any unusual skin conditions on

April, despite the presence of one or more such conditions.

14. During the period prior to, on, and possibly following July 5, an engorged tick

nymph (a vector for Lyme disease and other tick-borne diseases) was attached to April’s lower

left leg, in plain sight to any cabin counselor, nurse, or other camp staff member observing April

for the purpose of noticing the presence of a tick or other unusual skin condition.

15. During the period of June 18 to July 29, 2017, one or more other ticks infected with

Lyme disease or other tick-borne diseases were attached to April’s body and infected her with

such disease.

16. The Defendant failed to inform April, prior to activities outside of the core and mowed areas of camp, to wear appropriate tick-bite protective clothing.

17. Appropriate tick bite protective clothing includes: light-colored long pants, light colored socks, light colored long-sleeved shirt, closed toed shoes, and tucking pants into socks.

18. The Defendant failed to consistently inform April, prior to activities outside of the core and mowed areas of the camp, to apply bug lotion to exposed skin prior to or during participation.

19. The Defendant failed to inform April or her parents, prior to or during the camp session, that, to protect against ticks infested with Lyme and other tick-borne diseases, the camper must use insect repellant containing DEET.

20. The Defendant also failed to warn or educate April about the risk of contracting a tick borne disease while at camp and about the precautions necessary to prevent infection.

21. As a result of Defendant’s failure to comply with its duty to protect April from diseased-infected ticks, she was bitten by one or more ticks infected with Lyme disease or other tick-borne diseases and she contracted a tick-borne disease.

22. The Defendant’s breaches of its duty of care to April, individually and taken together, were substantial factors causing April to become infected with a tick-borne disease while at the camp and to suffer the injuries enumerated in this Complaint.

23. On at least 30 separate occasions between June 18 and July 29 April sought care and treatment from the camp infirmary and from the camp infirmary staff, nurse Avery Perkins and nurse Donna Meagle.

24. At all relevant times the nurses were agents, servants, employees and representatives of Defendant GRYZZL Corporation.

25. At the time of her visits to the infirmary and her consultations with camp nurses,

April presented with obvious signs and symptoms of Lyme disease and other tick-borne disease.

26. These signs and symptoms included headache, fever, chills, sweats, muscle and joint pain, extreme fatigue, dizziness and generalized achiness.

27. The camp nurses failed to adequately document at least 4 of April’s visits and consultations.

28. Notwithstanding April’s complaints and objective evidence of infection with Lyme

and other tick-borne disease, the nurses failed to examine April for attached ticks or to otherwise conduct a minimally adequate physical examination.

29. The nurses also failed to examine April for tick bites or skin rashes.

30. The nurses also failed to advise April to examine herself for attached ticks, tick bites or skin rashes.

31. The nurses also failed to appreciate that April’s symptoms were consistent with Lyme or other tick-borne disease.

32. The nurses also failed to advise April or her parents that April’s symptoms were consistent with Lyme disease and other tick-borne disease.

33. The nurses also failed to appreciate that April required immediate medical care, treatment and advice by a competent and qualified medical practitioner.

34. The nurses also failed to develop a plan of action and follow-up care.

35. The nurses also failed to follow the nursing process.

36. The nurses also failed to refer April, or to ensure that she was referred, to a competent and qualified medical practitioner for immediate care, treatment and advice.

37. Also during the period of June 18 to July 29, April reported her symptoms to her camp counselors, all of whom were agents, servants, employees and representatives of GRYZZL

Corporation.

38. Notwithstanding April’s repeated complaints, and obvious evidence of her illness, the cabin counselors failed to provide, or to ensure the provision of, competent and qualified medical attention, care and treatment.

39. The cabin counselors also failed to notify April’s parents of April’s complaints and condition.

40. As a result of the Defendant’s negligent acts and omissions, individually and taken together, April suffered, continues to suffer, and will in the future suffer the following injuries and conditions, all of which are severe and debilitating:

a. Lyme disease;

b. Chronic Lyme disease and/or late Lyme disease and/or post-Lyme disease

syndrome;

c. Co-infection with other tick-transmitted disease;

d. Encephalopathy and sequelae;

e. Cognitive impairment, including memory loss and attention deficits,

confusion, and executive functioning disabilities;

f. Radicular pain;

g. Paresthesia;

h. Dysesthesia;

i. Headaches;

j. Widespread musculoskeletal pain and inflammation;

k. Arthritis;

l. Insomnia;

m. Hypersomnia;

n. Depression;

o. Anxiety;

p. Muscle spasms, twitching and weakness;

q. Air hunger/difficulty breathing;

r. Heart palpitations;

s. Dizziness/fainting;

t. Blurred vision;

u. Disorientation;

v. Tinnitus;

w. Light and sound sensitivity;

x. Dental pain;

y. Skin hypersensitivity;

z. Weight gain and loss;

aa. Decreased appetite;

bb. Nausea/vomiting;

cc. Sweats and chills;

dd. Extreme fatigue;

ee. Mental and emotional suffering and anguish.

41. As a further result of the Defendant’s negligent acts and omissions, individually and taken together, April will in the future suffer loss of her earning capacity.

42. As a further result of the Defendant’s negligent acts and omissions, individually and taken together, April will in the future incur hospital, rehabilitation, and other medical expenses all to her financial loss.

43. As a further result of the Defendant’s negligent acts and omissions, individually and taken together, April has suffered and will continue to suffer a loss of her ability to carry on and enjoy all of life’s activities.

44. As a further result of the Defendant’s negligent acts and omissions, individually and

11 taken together, April missed a vast majority of her 10th grade of school; she is currently unable to attend the 11th grade; for those days of school she was able to attend, she suffered numerous tardies, early dismissals, and nurse visits; and her grades, class standing, and ability to be accepted to college suitable to her abilities, intelligence and talents have been irreparably compromised.

WHEREFORE, the Plaintiffs pray for the following relief:

1. Compensatory damages in the amount of $41,750,000.00 plus costs;

2. Such other relief as the Court deems just and proper.

______

Attorney for Plaintiff

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF IOWA ______

LARRY & RITA LUDGATE ) As Parents and Next Friends of ) APRIL LUDGATE ) CIVIL ACTION NO. ) Plaintiffs, ) 20180828 ) v. ) ) GRYZZL CORP. ) d/b/a CAMP MORNING STAR ) ) Defendant. ) ______

DEMAND FOR JURY TRIAL

Pursuant to Fed R. Civil P. Rule 38, the Plaintiffs in the above-captioned matter hereby demand a trial by jury on all issues.

______

Attorney for Plaintiff

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF IOWA ______

LARRY & RITA LUDGATE ) As Parents and Next Friends of ) APRIL LUDGATE ) CIVIL ACTION NO. ) Plaintiffs, ) 20180828 ) v. ) ) GRYZZL CORP. ) d/b/a CAMP MORNING STAR ) ) Defendant. ) ______

DEFENDANT’S ANSWER AND SPECIAL DEFENSES

The Defendant, GRYZZL Corporation hereby submits its answer and affirmative defenses to the Complaint of the Plaintiffs.

ANSWER

Introduction

The Defendant neither admits nor denies the contents of this paragraph, as it appears not to be a fact pleading requiring a response.

Jurisdiction

1. The Defendant has no knowledge and/or information sufficient to form a belief as to the truth of these allegation and therefore denies the same and leaves the Plaintiffs to their proof thereof.

2. Admitted.

3. The Defendant has no knowledge and/or information sufficient to form a belief as to

the truth of these allegation and therefore denies the same and leaves the Plaintiffs to their proof

thereof.

4. The portion of this paragraph that reads “the Defendant is incorporated in, and has its

principal place of business in this District” is admitted. As to the remainder of the paragraph, the

Defendant has no knowledge and/or information sufficient to form a belief as to the truth of these

allegations and therefore denies the same and leaves the Plaintiffs to their proof thereof.

First Claim for Relief: Negligence

5. Admitted.

6. Denied as phrased.

7. Denied as phrased.

8. Denied as phrased.

9. The portion of the paragraph that reads “Among other materials prepared by the

Defendant and given by the Defendant to April and her parents prior to April’s attendance at camp was a Parent Information Handbook” is admitted. As to the remainder of the paragraph, the

Parent Information Handbook is a document that speaks for itself, and to the extent the document

differs from the allegations of this paragraph, they are denied.

10. The Parent Information Handbook is a document that speaks for itself, and to the

extent the document differs from the allegations of this paragraph, they are denied.

11. Denied.

12. Denied.

13. Denied.

14. As to the portion of the paragraph that reads “During the period prior to, on, and

possibly following July 5, 2017, an engorged tick nymph (a vector for Lyme disease and other

15 tick-borne diseases) was attached to April’s lower left leg,” the Defendant has no knowledge and/or information sufficient to form a belief as to the truth of these allegations and therefore denies that same and leaves the Plaintiffs to their proof thereof. The remainder of the paragraph is denied.

15. As to the paragraph that reads “During the period of June 18 to July 29, 2017, one or more other ticks infected with Lyme disease of other tick-borne diseases were attached to April’s body,” the Defendant has no knowledge and/or information sufficient to form a belief as to the truth of these allegations and therefore denies same and leaves the Plaintiffs to their proof thereof. The remainder of the paragraph is denied.

16. Denied.

17. Denied as phrased.

18. Denied

19. Denied.

20. Denied.

21. As to the portion of the paragraph that reads “she was bitten by one or more ticks

infected with Lyme disease or other tick-borne diseases and she contracted a tick-borne

disease,” the Defendant has no knowledge and/or information sufficient to form a belief

as to the truth of these allegations and therefore denies that same and leaves the Plaintiffs

to their proof thereof. The remainder of the paragraph is denied.

22. Denied.

23. Denied.

24. Admitted.

25. Denied.

26. Denied.

27. Denied.

28. Denied.

29. Denied.

30. Denied.

31. Denied.

32. Denied.

33. Denied.

34. Denied.

35. Denied.

36. Denied.

37. Denied.

38. Denied.

39. Denied.

40. Denied.

41, Denied.

42. Denied.

43. Denied.

44. Denied.

AFFIRMATIVE DEFENSES

1. Plaintiff has failed to state a claim upon which relief may be granted.

2. Plaintiff has failed to mitigate her/his damages.

3. Defendant asserts that any injuries or damages sustained by Plaintiff were due to and solely occasioned by the negligence of the Plaintiff and Defendant pleads the sole negligence and sole recklessness of the Plaintiff as a complete bar to this action.

4. Defendant asserts that any injuries and damages sustained by Plaintiff were caused by the negligence or willfulness of the Plaintiff combining, concurring and contributing with the negligence or willfulness, if any, on the part of Defendant. Because the Plaintiff’s negligence or willfulness is greater than the alleged negligence or willfulness of the Defendant,

Plaintiff is barred from recovery against the Defendant.

5. Defendant asserts any injuries and damages sustained by Plaintiff were caused by the negligence or willfulness of the Plaintiff’s Decedent combining, concurring and contributing with the negligence or willfulness, if any, on the part of the Defendant. Therefore, the Court should reduce any recovery awarded to the Plaintiff for the alleged injury and damaged based upon the percentage of negligence or willfulness attributed to the Plaintiff.

______

ATTORNEY FOR DEFENDANT

LEGAL DEFINITIONS

“NEGLIGENT” OR “NEGLIGENCE” The term “negligent” or “negligence” means the failure to use that degree of care that an ordinarily careful person would use under the same or similar circumstances. The degree of care used by an ordinarily careful person depends upon the circumstances that are known or should be known and varies in proportion to the harm that person reasonably should foresee. In deciding whether a person was negligent you must determine what that person knew or should have known and the harm that should reasonably have been foreseen.

“ORDINARY CARE”

The phrase “ordinary care” means that degree of care that an ordinarily careful person would use under the same or similar circumstances. The degree of care used by an ordinarily careful person depends upon the circumstances that are known or should be known and varies in proportion to the harm that person reasonably should foresee. In deciding whether a person exercised ordinary care you must consider what that person knew or should have known and the harm that should reasonably have been foreseen.

JURY INSTRUCTIONS

GENERAL

100.1 Statement Of The Case. Members of the Jury: In this case Plaintiff claims injuries caused by the negligence of the Defendant.

The Defendant denies fault and claims the Plaintiff was negligent.

Do not consider this summary as proof of any claim. Decide the facts from the evidence and apply the law which I will now give you.

100.2 Duties Of Judge And Jury, Instructions As Whole. My duty is to tell you what the law is. Your duty is to accept and apply this law.

You must consider all of the instructions together because no one instruction includes all of the applicable law.

The order in which I give these instructions is not important.

Your duty is to decide all fact questions.

Do not be influenced by any personal likes or dislikes, sympathy, bias, prejudices or emotions.

100.3 Burden Of Proof, Preponderance Of Evidence. Whenever a party must prove something they must do so by the preponderance of the evidence.

Preponderance of the evidence is evidence that is more convincing than opposing evidence. Preponderance of the evidence does not depend upon the number of witnesses testifying on one side or the other.

100.4 Evidence. You shall base your verdict only upon the evidence and these instructions.

Evidence is: 1. Testimony in person or by deposition. 2. Exhibits received by the court. 3. Stipulations which are agreements between the attorneys. 4. Any other matter admitted (e.g. answers to interrogatories, matters which judicial notice was taken, etc.).

Evidence may be direct or circumstantial. The weight to be given any evidence is for you to decide.

Sometimes, during a trial, references are made to pre-trial statements and reports, witnesses’ depositions, or other miscellaneous items. Only those things formally offered and received by the court are available to you during your deliberations. Documents or items read from or referred to which were not offered and received into evidence, are not available to you.

The following are not evidence: 1. Statements, arguments, questions and comments by the lawyers. 2. Objections and rulings on objections. 3. Any testimony I told you to disregard. 4. Anything you saw or heard about this case outside this courtroom.

100.8 Stipulated Testimony. Counsel have stipulated to certain evidence before trial. Consider stipulated testimony as if it had been given in court.

100.9 Credibility Of Witnesses. You will decide the facts from the evidence. Consider the evidence using your observations, common sense and experience. You must try to reconcile any conflicts in the evidence; but, if you cannot, you will accept the evidence you find more believable.

In determining the facts, you may have to decide what testimony you believe. You may believe all, part or none of any witnesses’ testimony.

There are many factors which you may consider in deciding what testimony to believe, for example: 1. Whether the testimony is reasonable and consistent with other evidence you believe; 2. The witnesses’ appearance, conduct, age, intelligence, memory and knowledge of the facts; and, 3. The witnesses’ interest in the trial, their motive, candor, bias and prejudice.

100.12 Opinion Evidence, Expert Witness. You have heard testimony from persons described as experts. Persons who have become experts in a field because of their education and experience may give their opinion on matters in that field and the reasons for their opinion.

Consider expert testimony just like any other testimony. You may accept it or reject it. You may give it as much weight as you think it deserves, considering the witness’ education and experience, the reasons given for the opinion, and all the other evidence in the case.

100.19 Clear Convincing And Satisfactory Evidence. Evidence is clear, convincing and satisfactory if there is no serious or substantial uncertainty about the conclusion to be drawn from it.

100.20 Corporate Party. The fact that a Plaintiff or Defendant is a corporation should not affect your decision. All person are equal before the law, and corporations, whether large or small, are entitled to the same fair and conscientious consideration by you as any other person.

COMPARATIVE FAULT

400.1 Fault Defined. In these instructions I will be using the term "fault." Fault means one or more acts or omissions towards a person which constitutes negligence, recklessness, subjects a person to strict tort liability, unreasonable assumption of risk not constituting an enforceable express consent, misuse of a product for which the defendant otherwise would be liable, unreasonable failure to avoid an injury.

400.2 Comparative Fault. Damages may be the fault of more than one person. In comparing fault, you should consider all of the surrounding circumstances as shown by the evidence, together with the conduct of the Plaintiff and Defendant and the extent of the causal relation between their conduct and the damages claimed. You should then determine what percentage, if any, each person's fault contributed to the damages.

400.3 Comparative Fault - Effects Of Verdict. After you have compared the conduct of all parties, if you find the Plaintiff was at fault and the Plaintiff's fault was more than 50% of the total fault, the Plaintiff cannot recover damages.

However, if you find the Plaintiff's fault was 50% or less of the total fault, then I will reduce the total damages by the percentage of Plaintiff's fault.

400.5 Comparative Fault - Plaintiff - Essentials For Recovery. The Plaintiff claims the Defendant was at fault in one or more of the following particular(s):

a. Failure to comply with stated Tick-Borne Disease precautions;

b. Failure to carefully and adequately observe campers for the purposes of noticing rashes, infected bug bites, sores or unusual skin conditions;

c. Failed to inform campers prior to activities outside of the core and mowed areas of camp to wear appropriate tick-bite protective clothing;

d. Failed to consistently inform campers prior to activities outside of the core and mowed areas of camp to apply bug lotion to exposed skin prior to and during participation;

e. Failed to inform campers or their parents prior to or during the camp session to protect against ticks infested with Lyme disease and other tick-borne illnesses the campers must use insect repellant containing DEET.

f. Failed to warn or educate campers about risks of contracting a tick-borne disease while at camp and about the precautions necessary to prevent infection;

g. Failed to provide adequate medical care to campers;

h. Failed to educate campers on effective methods to self-detect for ticks and other insects;

i. Failed to appreciate that April Ludgate required immediate medical care, treatment and advice from a competent and qualified medical professional;

j. Failed to advise April or her parents that symptoms were consistent with Lyme disease and other tick-borne disease;

k. Failed to follow accepted nursing practices;

l. Failed to communicate with April’s parents regarding her grave medical condition.

These grounds of fault have been explained to you in other instructions.

The Plaintiff must prove all of the following propositions:

1. The Defendant was at fault. In order to prove fault, the Plaintiff must prove Defendant was negligent as explained in instruction No. 700.1. 2. The Defendant's fault was a proximate cause of the Plaintiff's damage. 3. The amount of damage.

If the Plaintiff has failed to prove any of these propositions, the Plaintiff is not entitled to damages. If the Plaintiff has proved all of these propositions, you will consider the defense of comparative fault as explained in Instruction No. 400.6

400.6 Comparative Fault - Defendant - Essentials For Defense. The Defendant claims the Plaintiff was at fault in one or more of the following particular(s):

a. In failing to exercise reasonable care for her own safety;

b. By failing to allow supervisors and medical staff to properly inspect for insects, bites, rashes, infections or other unusual skin conditions;

c. By failing to notify caregivers of her medical situation;

d. By failing to abide by posted and generally accepted camp practices regarding safety and security.

These grounds of fault have been explained to you in other instructions.

The Defendant must prove both of the following propositions:

1. The Plaintiff was at fault. In order to prove fault, the Defendant must prove the Plaintiff was negligent or unreasonably failed to avoid injury as explained in these instructions. 2. The Plaintiff's fault was a proximate cause of the Plaintiff's damage.

If the Defendant has failed to prove either of these propositions, the Defendant has not proved its defense. If the Defendant has proved both of these propositions, then you will assign a percentage of fault against the plaintiff and include the Plaintiff's fault in the total percentage of fault found by you in answering the special verdicts.

400.7 Comparative Fault - Mitigation. Defendant claims Plaintiff was at fault for failing to mitigate her damages by not exercising ordinary care.

Plaintiff has a duty to exercise ordinary care to reduce, minimize or limit her damages. However, Plaintiff has no duty to do something that is unreasonable under the circumstances.

To prove Defendant's claim of failure to mitigate, they must prove all of the following:

1. There was something Plaintiff could do to mitigate her damages;

2. Requiring Plaintiff to do so was reasonable under the circumstances;

3. Plaintiff acted unreasonable in failing to undertake the mitigating activity; and

4. Plaintiff's failure to undertake the mitigating activity proximately caused an identifiable portion of her damages.

If the Defendant has proved all of these numbered propositions, then Defendant has proved this defense, and you shall assign a percentage of fault to the Plaintiff for the time period after the failure to mitigate. This amount will be used in answering the special interrogatory in the verdict. If the Defendant has failed to prove one or more of these numbered propositions, then Defendant has not proved Plaintiff failed to mitigate her damages.

400.8 Unreasonable Failure To Avoid An Injury Defined. A party is required to exercise reasonable care for their own safety. This means that if, in the exercise of ordinary care under the circumstances, a party could have taken some particular action to avoid an injury, then they are under a duty to take such action.

400.9 Assumption Of Risk - Defined. The Defendant claims that Plaintiff assumed the risk by consenting to participate in all camp activities.

To prove this defense, the Defendant must prove all of the following propositions:

1. The Plaintiff knew the risk was present. 2. The Plaintiff understood the nature of the risk to herself. 3. Nevertheless, the Plaintiff freely and voluntarily took the risk. 4. The Plaintiff's assumption of the risk was a proximate cause of Plaintiff's damage.

If the Defendant has failed to prove any of these propositions, the Defendant has not proved this defense. If the Defendant has proved all of these propositions, then you will assign a percentage of fault against the Plaintiff and include it in the total percentage of fault, if any, found by you in your answers to the special verdicts.

NEGLIGENCE – PROXIMATE CAUSE

700.1 Essentials For Recovery. The Plaintiff must prove all of the following propositions:

1. The Defendant was negligent in one or more of the grounds of fault specified in instruction No. 400.5. 2. The negligence was a proximate cause of damage to the Plaintiff. 3. The amount of damage.

700.2 Ordinary Care - Common Law Negligence - Defined. "Negligence" means failure to use ordinary care. Ordinary care is the care which a reasonably careful person would use under similar circumstances. "Negligence" is doing something a reasonably careful person would not do under similar circumstances, or failing to do something a reasonably careful person would do under similar circumstances.

700.3 Proximate Cause Defined. The conduct of a party is a proximate cause of damage when it is a substantial factor in producing damage and when the damage would not have happened except for the conduct.

"Substantial" means the party's conduct has such an effect in producing damage as to lead a reasonable person to regard it as a cause.

700.8 Accident Does Not Constitute Or Raise Presumption Of Negligence. The mere fact an accident occurred or a party was injured does not mean a party was negligent

WITNESS STATEMENTS

PLAINTIFF WITNESSES

Statement of Andi/y Dwyer

1 I keep thinking that one day soon I’ll wake up and this nightmare will be over.

2 I’ll look at my phone and see an Instagram post from April and realize that this whole

3 thing has been a really bad dream. Unfortunately, it’s really real.

4 My name is Andi/y Dwyer. I’m 16 years old and am a Junior at Pawnee City

5 High School in Pawnee City, Nebraska. I was April’s best friend and continue to

6 support her during her struggles. I know that I talk about her in the past tense – not

7 because she’s dead, but because the April that I know is gone.

8 The April that I know, grew up with, and was inseparable from, was full of life,

9 sneaky smart with a dry, sarcastic sense of humor. She was always a fairly private

10 person. She hated to be the center of attention, but she always wanted to be in the orbit

11 around the fun. Once she knew someone and was comfortable with a situation, she

12 warmed up fast and really let her true personality shine through.

13 But since the Summer of 2017, that’s all changed. She got progressively worse

14 throughout the Summer and Fall, so that by this Spring, April was barely functional.

15 The doctors knew immediately what had happened but they said that since she didn’t

16 get treated right away, there was little that could be done except watch, wait, and pray.

17 Since January 2018, April has either been in the hospital or at home confined to

18 bed, undergoing tons of tests, lots of experimental medical procedures, and drug

19 regimens. Nothing seems to have worked, but we all (all of April’s family and friends)

20 keep hope alive that the real April will emerge and everything will go back to normal

21 again.

22 April’s parents have told me what the doctors said. I can’t remember it all

23 though. It seems that she has suffered neurological and brain damage due to getting

24 bitten by ticks at Camp Morning Star when we were there during June and July 2017.

25 They tell me that the condition is fairly rare, but that in most situations, it was

26 preventable. There is a slim chance that April will recover – whether in full or just

27 partly. Right now, she doesn’t seem to be aware of her surroundings. Needless to say,

28 she has missed more than a year of school. For someone so bright and full of life, this is

29 just tragic.

30 April was diagnosed with a form of Lyme Disease that she got by exposure to

31 ticks at camp. I guess, looking back, I should have seen the signs. Now that I know

32 more about her disease, her condition and her symptoms are classic. I’m really pissed

33 off that the nurse or the counselors didn’t pay attention or see the symptoms for what

34 they really were. Instead they just made jokes about April always going to the nurse or

35 skipping activities. They got to referring to this as “Aprilitis.” They really need to pay

36 for dissing April’s health and well-being.

37 I guess I’m not a very good storyteller. I should probably start at the beginning –

38 or at least the beginning of where this whole thing began.

39 April’s parents and my parents had attended camp in Iowa pretty much every

40 summer growing up as teenagers. They lived in Des Moines, but their parents wanted

41 them to get out and get some fresh air and exercise in the country. Even though we live

42 in Nebraska now, our parents wanted the same experience for us. So they signed us up

43 for the 6 week program at Camp Morning Star in eastern Iowa. I think they were

44 hoping to pass along some of their magical teen experiences to their kids. We live in

45 Pawnee City, Nebraska – not exactly a thriving metropolis, but apparently Jones

46 County, Iowa could offer some wilderness experience different from just hanging

47 around our neighborhood all summer.

48 The camp is located just outside of Monticello, Iowa – about a 6 or 7 hour drive

49 from Pawnee City. The camp is organized into 4 cabins or houses with about 120

50 campers in total. In goofy Hogwarts fashion, the first day when we arrived, we were

51 sorted into houses – and these houses (cabins really) would be our home group for the

52 whole time. Any events or activities that we did gained points for our house – or got

53 points deducted. It seems that April and I were really good at losing points for our

54 house, Lynx. They kept this scoreboard thing outside the dining hall so that you always

55 knew where things stood in the competition.

56 April and I were sorted into the same cabin – we had requested to stay together –

57 but another friend from Pawnee City, Beatty Wiese, was put in a different house, Bear. I

58 suppose they wanted to make sure that you met new friends rather than just hang out

59 with your homies. Anyway, everyone was divided up, the camp director, Leslie Knopf,

60 gave some instructions and directions about camp rules and the chain of command.

61 Within each house, there were 4 counselors – roughly one for every 6 campers – and

62 each house also had a head counselor or head of house. At Lynx, that was Bennie

63 Wyatt. While we were obviously supposed to follow the house counselors instructions,

64 we were also told to mind all of the other counselors as well – that they had our best

65 interests in mind and would keep us safe and out of trouble. They also all had the

66 power to give and take away house points for various successes or rule violations.

67 So we had our first house meeting that first evening. The head counselor, Bennie,

68 made introductions, we did this game where we try to remember everyone’s name and

69 kind of bond as a team, and then there was a long discussion about rules. In a nutshell,

70 this boiled down to: obey all counselors, stay out of the woods, and that there was a

71 “Buddy plus one” system in place anytime we were outside the cabin. That meant that

72 if you wanted to go anywhere, you had to have at least 2 people with you. The

73 counselors explained that alone each of us might make a bad decision, that with a friend

74 along, we might make an even worse decision, but with 3 people involved, the hope

75 was that we’d at least think about the bad decision before acting on it. I guess they

76 never considered April, Wyatt, and me.

77 There were also some specific rules about ticks. We were told that they were

78 expecting a particularly bad tick season and that while the camp had done some stuff to

79 lessen the risk, we had to take some precautions on our own. We were told to stay on all

80 paths and to not go into the woods alone. Even if we needed to retrieve a ball or

81 something, to ask a counselor to do it for us. We were also told that there would be

82 some activities happening over the next 6 weeks taking place in the woods, but that we

83 would be told in advance and be required to wear closed-toed shoes and long pants.

84 Long sleeved shirts were advised but were optional. And then there was the really

85 creepy part – at the end of each day, right before shower time, there was to be a tick

86 inspection where we all had to strip down to our underwear while the counselors

87 checked for ticks. Now this didn’t bother me so much since I play sports and am kind of

88 used to a locker room, but it really freaked some of the other kids out, especially April. I

89 mean talk about invasion of privacy! As I said, April is a real private person and the

90 thought of having to strip down in front of everyone else was really doing a number on

91 her. And that’s when she began to routinely request to see the nurse. Pretty much every

92 day at about shower time, she would head off to the nurse’s office. I didn’t ask, but I

93 figured that she was getting a tick check privately from the nurse.

94 Our cabin counselors were really hard core with rules during the first week of

95 camp. Everything was done strictly by the books. I say books, plural, because it seemed

96 like the counselors had tons of notebooks around that they were supposed to refer to for

97 pretty much everything. I guess they wanted to set a good example or something, but

98 things finally slacked off after that first week. The tick inspections, for example, seemed

99 to become optional. The counselors told us all to soap and rinse carefully and to let

100 them know if we discovered a tick or a weird looking bite or anything as we showered.

101 This made everyone a lot more comfortable, but April continued to go to the nurse just

102 about every day.

103 After curfew (everyone had to be in their own cabins) and especially after lights

104 out, the counselors would all get together to relax and joke around. This gave April and

105 me a great chance to sneak out and meet up with Beatty from Bear cabin. I mean we

106 didn’t sneak out every night, but maybe once a week or a couple of times in a two-week

107 period, we’d get away to just hang out and goof off with Beatty and a couple of the

108 other kids. Some evenings there were already group activities planned – camp fires,

109 music nights, etc – but at least a couple of times, we were able to meet up with Beatty

110 and whoever else got out to join us.

111 Now don’t get me wrong, sneaking out - especially after that first week – was

112 not exactly difficult. I mean we didn’t need to use an invisibility cloak or a marauder’s

113 map or anything, we just needed a little misdirection, a little subterfuge, and a little

114 climbing to get out of the window and be on our way. We did stay out of the deeper

115 woods during our nocturnal excursions, except when we heard someone coming. I

116 mean we’re from town, the last thing we wanted to run into was a bear or a coyote or

117 something at night. Heck, one of our counselors actually showed us an easier way to get

118 out and gave us some tips on how to avoid getting caught.

119 As I said, things got a lot better after that first week. While they mostly insisted

120 on that Buddy +1 system, we were given a little more leeway. We would frequently

121 retrieve balls or frisbees from the tall grass or take shortcuts through the woods on our

122 way to other activities. While we still had the tick-check, it was usually pretty quick and

123 we were on the honor system to look on our own.

124 A couple of the other campers did find a tick after one of our deep woods

125 adventures during the second week of camp – I think it was either the shelter-building

126 or the geo-cache thing. One of the kids found a tick on his jeans. Another girl was

127 freaking out because tick had attached itself to her arm. The counselor took care of it

128 pretty quickly with a pair of tweezers, but for the next couple of days, we were stuck

129 with closer inspections, and April was again off to the nurse. We even cut back on our

130 evening jaunts for a couple of days. That incident had us all a little spooked.

131 April’s nurse visits kind of got to be a joke within our cabin. At first, she kind of

132 smirked and played along with it – I think everyone knew what was really going on –

133 but after about 2 or 3 weeks or so, you know, she really did start to look a little worse

134 for wear. She did look a little nauseous. She complained – even in private to me – about

135 headaches. She did seem to be running a fever on and off and she told me that all of her

136 joints seemed to hurt – I mean beyond the normal aches and pains of a very active camp

137 experience.

138 But she would always come back from the nurse without incident. Occasionally

139 she would have been given Tylenol or ibuprofen or something, but I kind of got the

140 impression that the nurse knew that this was a game and quit listening to or looking at

141 April when she arrived for her daily visits.

142 Certainly as we got closer to the end of camp, April really looked beat up. She

143 was really lethargic, always seemed to have a headache and she had developed this

144 rash that she said the nurse had diagnosed as poison ivy. She even stopped sneaking

145 out with me at night. All she wanted to do was curl up in her bunk and rest. I was really

146 concerned about her and even talked to our counselor and the head counselor about

147 April’s condition. Bennie agreed that April didn’t look good, but that it was probably

148 just a result of a long 6 week camp, that she would be home soon, and would probably

149 perk right back up. I think unspoken in all of that was a general impression among the

150 counselors that April was faking it and just milking it til the end.

151 Let me say this about the counselors and the staff at the camp. They all seemed

152 very nice. They were friendly and welcoming and for the first week or so, they really

153 went out of their way to put the campers first. But as the camp went on, some of the

154 counselors seemed to be off in their own little world. It was almost as though they were

155 at camp for fun themselves and not responsible for anyone else.

156 A lot of times when they were supposed to be supervising activities, they instead

157 were huddled together laughing and joking among themselves. A couple of times

158 during some of the sports activities a ball or a frisbee got away and went into the

159 woods. Remember, we were told that in such a situation, we were to ask a counselor for

160 help. But when asked, they kind of snorted and told us to go get them ourselves. Now

161 April was always looking for an excuse to not participate in activities, so she usually

162 volunteered to traipse into the woods and get the lost ball, frisbee, or equipment.

163 So there was this drink at every meal – some red, fruity thing called Bug Juice.

164 Now I’ve been to other camps and weekend trips before and they all have a similar

165 swill. I thought that this was just the generic name that campers worldwide called that

166 drink. It always tastes horrible, but this camp’s version was simply awful. And I have

167 since come to find out that it was supposed to have some medicinal properties? Cripes,

168 the camp was trying to poison us or brainwash us or something! It wasn’t mandatory

169 that we drink it, but there weren’t a lot of other beverage options available.

170 The camp director, Leslie Knopf, made it a point to been seen at all of the larger

171 camp gatherings and at meal times. S/he seemed to feed off of everyone giving glowing

172 comments. But if anyone had anything negative to say, s/he could deflect very quickly.

173 It was always someone else’s fault of due to circumstances beyond control. The best you

174 would ever get was, “I’ll see what I can do.” I mean really, “I’ll see what I can do”?! You

175 run the stupid place, I’m pretty sure that you can do whatever you want – or whatever

176 needs to be done. I know that I informed her about my concerns for April at least twice

177 and got the standard, “I’ll check into it” thing both times.

178 I really don’t know anything about the nurse. I met him/her along with the rest

179 of the camp staff on the first day, but since I don’t take any daily meds, I really didn’t

180 have a reason to interact with him/her at all. April never really complained about Nurse

181 Perkins or anything, so I assumed that s/he was doing a decent job.

182 At the end of camp, April’s folks came to pick her, me and Beattie up to drive us

183 back home to Pawnee City. April wasn’t feeling so hot that day and looked pretty beat

184 up. One look from her parents and they were on the phone right away setting up a visit

185 to the University of Iowa hospital in Iowa City. So we took a detour home. My mom

186 finally came to pick up Beatty and me, since Aril was going to stay at the hospital for a

187 while to see some sort of specialist.

Statement of Ron/da Swanson

1 My name is Ron/da Swanson. I’m 20 years old and currently a Junior at

2 Hotchkiss College in Shipley, Illinois. During the Summer of 2017, between my

3 Freshman and Sophomore years, I worked as a Summer Camp Counselor at Camp

4 Morning Star in Iowa. One of my buddies at Hotchkiss, Abhay Nadipuram, had been a

5 counselor there and said it was a pretty sweet deal to goof off for a Summer. I took his

6 advice and applied. I had an interview with Leslie Knopf, the Camp Director and with

7 Bennie Wyatt, one of the head counselors and landed the job. I think my experience

8 with summer camps must have helped. While I never attended Camp Morning Star, I

9 did have loads of camp experience as a kid. I was looking forward to a laid back

10 Summer of fresh air, a little exercise, goofing around with kids, and making some

11 money. Boy, Camp Morning Star was a mess!

12 As I said, I’m a veteran of Summer camps having attended 3 different ones as a

13 pre-teen and a teenager. There are lots of different management styles – everything

14 from prison camp commandant to hippie commune - but I’ve never seen such as

15 dysfunctional camp as this one. Sure, there were a lot of policies and procedures – all

16 spelled out in intricate detail in notebook after notebook, but where the rubber hit the

17 road, there was little or no enforcement and frankly little or no attention given.

18 As counselors, we were supposed to arrive about 10 days before the start of camp for

19 the kids. I think I arrived at Camp Morning Star on Friday, June 9 for staff training and

20 to get everything set up for the start of camp. Did I say training? I’m not sure you could

21 call it training. Yes, the senior staff reviewed the various policies, procedures and

22 protocols – mostly ad nauseum. I mean Leslie has binders and binders of materials.

23 There is no possible way to digest it all. But then the presentation style was basically, let

24 us talk at you for 5 straight days so that you can absorb all of the goodness. I’m sorry

25 but I sure don’t learn stuff that way.

26 I was hoping that there might be some discussion about strategies to deal with

27 specific problems and running through hypotheticals of situations likely to come up at

28 camp. But, instead, it was more a week of sitting around the fire singing kumbayah and

29 making goo goo eyes at the other counselors. Really the whole thing had more of a

30 “counselor-only.com” vibe: You don’t have to be lonely at counselors only dot com.

31 I figured that my fellow counselors might cool their jets just a bit once the

32 campers arrived, but it actually got worse. Now it was much more noticeable that they

33 weren’t doing their jobs. And those of us who are actually responsible had to pick up

34 the slack. It gets a little frustrating to be an adult when most of those around you don’t

35 feel like “adulting.”

36 The camp director, Leslie Knopf, is a real nice person. A little too Type A for my

37 preference, but s/he did give off an air of being in control. But s/he definitely had a

38 weakness for notebooks.

39 I really think the camp as a whole suffered from binder blindness. Whenever

40 there was a situation, the solution was always another binder full of policies, plans and

41 procedures. Sometimes I think Leslie is just a walking policy in search of a problem. It

42 got to a point where you didn’t or couldn’t possibly read all of that stuff, let alone

43 digest it and make sense of what you as a counselor were supposed to do.

44 So there was a situation involving raccoons getting into the trash at the back of

45 the dining hall. Now the smart solution would be either to lock the lids or weigh down

46 the cans. But, no, Leslie came up with a solution requiring multiple steps, checks and

47 rechecks – all presented in, wait for it, a binder. Yes, the problem was resolved, but it

48 just seemed like overkill.

49 Then there was another situation involving mulch. I honestly can’t remember if it

50 had to do with the type or the amount. All I remember is that it required an hour-long

51 meeting of all of the counseling staff and a notebook full of instructions. I’m not sure

52 why we counselors were involved at all. This seemed like a discussion with the grounds

53 crew. There was no need for everyone else to be looped in – other than perhaps to

54 demonstrate how well Leslie was on top of things.

55 You get to a point where the amount of information and policies you have to

56 know is so great that you just stop reading them and just do what you think is right.

57 Just Wing It became a common slogan among the Camp Morning Star counselors.

58 I think all of the counselors agree that Camp Morning Star had way too many

59 rules. I mean a camp should have a little structure, but really the 2 primary rules should

60 be Have Fun and Be Safe. Leslie just seemed to suck the life out of the party with all of

61 the policies and procedures and all those friggin binders. It’s Summer; it’s supposed to

62 be fun and care free. Especially for the older campers, the teen-agers, they deserve a lot

63 more freedom.

64 Listen, I went to a Summer camp when I was in middle school and part of high

65 school as well. Not Camp Morning Star mind you. But I’m very familiar with what goes

66 on after curfew and I’ve picked up some tricks along the way. It’s an age-old tradition

67 for the older campers to sneak out so that they can relax and chill with the other older

68 campers. I think that’s an important part of the camp experience and an important part

69 of growing up. So, yeah, I turned a blind eye to some rather blatant attempts to sneak

70 away, and in fact gave some of the campers a few words of advice on how better to

71 avoid detection. It was simply harmless fun. I warned them to stay out of the deep

72 woods because, well, it was the deep woods and in a strange place – you never know

73 what kind of creatures come out at night.

74 Sure I gave the kids nicknames, so what? They actually liked them. It showed at

75 least that I knew who they were. I mean Leslie calls everyone “buddy,” “sweetie,” or

76 “pal” – mostly because I think s/he doesn’t have a clue about which camper is which.

77 The campers really caught on to the nicknames. They started to refer to each

78 other by the names I had come up with. Fishbait (a kid named Tom Levis), for example,

79 was really proud of that name, even though it referred to something that I didn’t think

80 he was really proud of – falling out of a canoe. But everyone in our house certainly

81 knew who he was after that.

82 I gave April Ludgate the nickname Rainy because of her mood; and, you know,

83 April showers and all that. She usually just moped around the cabin and was reluctant

84 to join in activities. Mostly she just wanted to be left alone and to hang out with her

85 friends from home, Andi/y Dwyer and Beatty Wiese. Most of the other campers started

86 calling her Rainy as well. She didn’t seem to mind it at all. In fact, I think the extra

87 attention sometimes put a smile on her face.

88 I think it had to be pretty clear to anyone paying even a little attention that April

89 was ill. I took a special interest in her situation. It really sucks to be sick during camp.

90 It’s even worse when no one seems to care about your situation. That’s the type of

91 formula that could lead to some really serious consequences. I was thinking suicide

92 prevention. But it turns out that there was something else wrong with her. The poor girl

93 has really been dealt a bad hand.

94 April was pretty much always complaining of something – headache, stomach

95 ache, joint stiffness, being tired, feverish. Who could tell if it was real or imagined, or

96 just a way of getting out of doing something she didn’t want to do – like going through

97 the tick inspection or showering for example. We also had a weekly cabin cleaning, but

98 April always seemed to come down with something at the most opportune time to

99 skate out of the chores.

100 April pretty much went over the see the nurse on a daily basis complaining of

101 one thing or another. It got to be a running joke in our cabin.

102 Conveniently, most of her requests to go see the nurse where at shower time, etc.

103 and designed to get her out of work or anything she didn’t want to do. But there was at

104 least one situation where she asked to go see the nurse in the morning and two other

105 situations where I brought her to see the nurse because she looked so bad. I kept

106 encouraging her to go to the nurse in hopes that eventually they could figure out was

107 making her ill.

108 I talked to our house head counselor, Bennie Wyatt, about her on numerous

109 occasions. I asked Nurse Perkins about April’s condition, but all I ever got was a lecture

110 on patient privacy. I even went to Leslie to talk about April. Predictably, all I got back

111 were binders and more binders.

112 Look I believe in limited government, but at a minimum, the things that those in

113 authority should provide to their charges is protection and safety. There’s a level of

114 personal responsibility involved, but at a minimum, the camp officials, especially the

115 nurse, should recognize and treat a sick camper. Everyone at Camp Morning Star,

116 certainly everyone in Lynx House, knew April was not doing well. Why they were not

117 able to figure out what was wrong and treat it is beyond me.

118 At Camp Morning Star there was a specific procedure in place for prevention

119 and detection of ticks. Apparently, the experts at the University of Iowa and the Iowa

120 Department of Public Health predicted a worse than normal year, so we were to be on

121 high alert.

122 The procedure involved letting campers know before we were heading out into

123 the woods so that they could dress properly. This meant closed-toe shoes and long

124 pants. We were to encourage campers to wear long-sleeved shirts as well, but, let’s face

125 it, it’s really hot in Iowa in June and July. We also had them apply bug spray before

126 going into the woods.

127 There was at least one situation where we were not able to give advanced

128 warning to campers – the House Games. Each week, the different cabins would face off

129 against each other in various sports-like contests. I mean, we even played a version of

130 Quidditch. We never knew in advance what these games would involve. Sometimes, it

131 was just kickball or dodgeball, but on a least 2 occasions, Capture the Flag and a

132 Treasure Hunt scenario, we traipsed out into the woods without any preparation.

133 The policy was also for counselors to retrieve any equipment that might go into

134 the woods for the campers. We counselors were also to conduct inspections on campers

135 every day to see if there were any ticks.

136 I didn’t mind the first few rules at all. Those were just common sense – although

137 I think some campers intentionally kicked and threw sports equipment into the woods

138 just so that we counselors had to go get them. That got a little old real fast.

139 The inspection thing though felt pretty creepy. I mean I can understand doing a

140 quick exam of a 4 or 5 year old, but with older kids, jeez, give them a little privacy! And

141 give them a little credit to do an inspection on themselves. Our compromise was to do

142 the inspections during the first week or so, but after that to rely on the campers to do a

143 self-inspection. We would be available to help if requested, and certainly if they actually

144 found a tick, we would help remove the sucker.

145 It was really easy for inspection and detection to slip through the cracks. As a

146 counselor dealing with the kids, you’re always doing something, always on your toes.

147 When it came to the daily inspections, if a kid didn’t want to be inspected and told you

148 that there wasn’t a problem, you trust him/her and move on.

149 The “thorough” check usually consisted of asking campers to do a self-exam in

150 the shower and to take a quick look at their arms and legs. A couple of big problems

151 with this is that a) some of the campers didn’t take showers every day (even though

152 they really needed it!) and b) even if they did shower, they didn’t really seem to use

153 much soap. In some instances, I think it would be impossible to do any self-inspection

154 at all given the fact that the “shower” lasted somewhere around 20 seconds.

155 So it turns out that there was also an additive that they decided to put into the

156 juice at all meals. The bug juice stuff tasted disgusting. We were not informed of its

157 “medicinal” properties at all. I only found out about it in passing from our head

158 counselor. There was no way I was going to drink that Kool Aid. So, I stuck with water.

159 I really didn’t reapply to be a counselor in 2018. I mean I put an application in

160 just as a matter of form, but unless I didn’t have anything else lined up, I probably

161 wasn’t going to take the job again. There are better ways to spend the Summer. In fact,

162 this past Summer, I spent playing sax with smooth jazz legend Duke Silver and his

163 band at gigs throughout the Upper Midwest. I had a lot more fun, made some good

164 cash, and made a lot of great connections in the music world. We even played a couple

165 of gigs at the Des Moines Farmers Market. It was a magical experience. So much better

166 than chasing after snot-nosed kids in the heat at a Summer camp.

Statement of Chris Traeger, M.D., Ph.D.

1 My name is Chris Traeger. I am a medical doctor, the Everett Thompson

2 Professor of Medicine at the University of Iowa’s School of Public Health and also serve

3 as the Assistant Director of the Iowa Center for Emerging Infectious Diseases at the U of

4 Iowa. The Center focuses on research and training in cross-cutting emerging infectious

5 diseases, particularly those that are zoonotic. Our Center has a national reputation of

6 excellence in the study of vector borne disease and environmental, occupational, and

7 wildlife exposures to infectious diseases.

8 Vector-borne diseases are bacterial and viral diseases transmitted by mosquitos,

9 ticks and other insects. Some of these diseases have been present in the United States for

10 many years, while others have recently emerged. Most people are familiar with

11 mosquito-borne diseases such as malaria, West Nile virus, and Zika. In recent years,

12 much of my research has focused on the emerging threat of tick-borne disease.

13 Most ticks go through four life stages: egg, six-legged larva, eight-legged nymph,

14 and adult. After hatching from the eggs, ticks must eat blood at every stage to survive.

15 Ticks that require this many hosts can take up to 3 years to complete their full life cycle,

16 and most will die because they don’t find a host for their next feeding. As ticks feed,

17 they have the potential to pass along parasites and bacteria that can sicken the host.

18 While many of these are harmless to humans, there are some serious illnesses cause by

19 exposure to ticks. The most common of these are Babeosis, Ehrlichiosis, Lyme disease,

20 Powassan, and Rocky Mountain spotted fever. Exposure to each of these may result in a

21 series of symptoms such as fever, headache, chills, muscle aches, tiredness, confusion,

22 dizziness, nausea, vomiting, conjunctivitis, and rash. Often these conditions can be

23 confused with more typical flu-like symptoms. However, left untreated, these tick-

24 borne diseases may cause serious issues such as severe joint swelling, facial palsy,

25 irregular heartbeat, inflammation of the brain, long-term neurological disorders,

26 hearing loss, mental disability, paralysis, and even death.

27 While still rare in Iowa, the rate of tick-borne disease has been increasing

28 exponentially. For example, the incidence of Lyme disease, the most common tick-borne

29 illness north of the Equator, has jumped in Iowa from 232 cases in 2016 to 254 reports in

30 2017. And, this is more than 3 times the number of reported cases in 2010. Obviously,

31 the prevalence of ticks and illnesses cause by tick exposure is growing. This is most

32 likely due to changing climate factors, specifically warmer winters that fail to kill of

33 ticks, and through tick migration patterns from the Northeast United States to the

34 Midwest. The biggest risk obviously is in the warmer weather months – roughly April

35 through September or October, with a spike in late-June through late-August, when

36 more people are outside and potentially exposed to nature.

37 There are more than a dozen species of ticks active in Iowa, but the three most

38 commonly encountered variants are the black-legged or deer tick, the American dog

39 tick, and the lone star tick. The deer tick is the species that generally puts humans at risk

40 of Lyme disease. These ticks are so small that people may not know that they have been

41 bitten until the ticks have been attached for 36 hours. The American dog tick is the

42 variety most commonly found in Iowa. These ticks carry the bacteria that can cause

43 Rocky Mountain Spotted Fever. While this disease is rare in Iowa, its prevalence is also

44 on the upswing. Lone star ticks are identifiable by their characteristic star pattern on

45 their hard shells. These ticks can transmit bacteria that may cause ehrlichiosis in

46 humans. Needless to say, tick are nasty little buggers that can cause some very

47 unpleasant issues in humans.

48 In most cases, if a tick is found early enough, it will not have enough time to

49 transmit diseases. And, in general, most people who encounter ticks never show any

50 symptoms of tick-borne illness. Their own immune systems are able to battle back the

51 offending bacterium and viruses. However, exposure to ticks can lead to severe

52 consequences, as I’ve referenced above.

53 Most often, signs and symptoms of Lyme disease and other tick-borne disease

54 become evident between 3 and 30 days after being bitten by an infected tick. In the case

55 of Lyme disease, most but not all victims will show a bull’s-eye shaped skin rash. In the

56 case of Rocky Mountain Spotted Fever, the victim may show signs of a rash, usually

57 about 3 days after exposure, but again, not all victims will evidence skin irritation. With

58 all but the most rare forms of tick-borne illnesses, with early identification, removal and

59 treatment by the proper course of antibiotics, patients have a very high chance of

60 recovery. However, symptoms left undiagnosed and untreated may result in more

61 severe consequences.

62 In the situation of Lyme disease, a particularly virulent variant of which we are

63 dealing with in the case of April Ludgate, there is usually a sudden onset of fever and

64 headache within 3 to 12 days after exposure to an infected tick. This is typically

65 accompanied by nausea, vomiting, abdominal pain, myalgia and rash. In approximately

66 10% of the cases, though, rash may be absent entirely or atypical in appearance.

67 Unfortunately, people in whom a rash presents atypically are at an increased risk of

68 being misdiagnosed.

69 Untreated, Lyme disease may lead to more severe manifestations including

70 encephalitis, seizure, acute respiratory and renal failure, profound neurological deficits,

71 and even death. Fatal cases of Lyme disease are very rare and usually occur within the

72 first 8 days of exposure among people with already compromised immune systems.

73 People exposed to ticks suspected of carrying Lyme disease should start a

74 treatment of Doxycycline. This treatment is most effective if started within the first five

75 days of symptoms. Fever generally subsides with 24 to 48 hours, but severely ill

76 patients may require longer before the fever resolves. The important thing here is that

77 treatment should never be delayed pending lab results nor be withheld on the basis of

78 an initially negative test result. I can not stress enough, if Lyme disease is suspected,

79 Doxycycline should always be administered. The failure to diagnose and treat April

80 Ludgate quickly and effectively has put her in her current situation.

81 There are some pretty easy preventative measures that people can take to lessen

82 exposure to ticks. In terms of prevention, wearing long pants tucked into socks with a

83 long-sleeved shirt can frustrate a tick’s ability to find exposed skin. In general, people

84 should avoid exposure to wooded or brushy areas and walk in the center of established

85 trails. Wearing insect repellant containing 20% or more of DEET and treating clothes

86 and gear with products containing permethrin can substantially reduce the risk of a tick

87 latching on.

88 More importantly, there are some quick techniques that can be used to check for

89 ticks once away from infested areas. After you come indoors, check clothing carefully

90 for ticks. Clothes should be washed in hot water and tumbled dry on high heat for at

91 least 10 minutes to kill ticks effectively. Even if you took all proper clothing and

92 treatment precautions, potentially exposed people should shower. Showering may help

93 to wash off unattached ticks and it is also a good opportunity to do a tick check. You

94 should check carefully for any ticks that may have latched on. Remember, ticks are

95 quite small, so a thorough examination is needed. Ticks particularly like hiding in areas

96 harder to detect – under arms, under the hairline, behind ears, bellybuttons, waists,

97 between the legs, behind the knee, and even between toes.

98 If an attached tick is found, use care in removing the insect. Common folk

99 remedies, such as using matches or alcohol, can be dangerous and can even increase the

100 chances of contracting a tick-transmitted disease. Instead, you should carefully remove

101 the tick by using tweezers to grasp the tick as close to the skin as possible. Pull upward

102 with steady, even pressure. After removing the tick, clean the wound and disinfect the

103 site of the bite. If the removed tick is swollen and a gun-metal grey color, then it may

104 have been attached for the minimum length of time needed for disease transmission.

105 Under normal circumstances the tick can be submersed in alcohol, flushed down the

106 toilet, or wrapped in plastic or tape and disposed of in the trash.

107 Part of my job in working in the area of Public Health is to make sure that

108 information is out there, that treatment and prevention options are readily available,

109 and that those spending a lot of time in the outdoors during the late Spring and

110 Summer months know the risks involved. To that end, I team up with a colleague at the

111 Iowa Department of Public Health, Jerry Schnurr, to do a series of information sessions

112 and seminars with doctors, nurses and other health care professionals involved in

113 public health. Since children are at a particular risk to vector-borne illnesses, primarily

114 because they tend to be outside more often in the target months, we make sure to

115 organize programs and is some cases actually visit with directors and health staff of

116 youth-oriented outdoor activity locations – Summer camps, outdoor equipment

117 businesses, camping supply businesses, excursion outfitters, canoe and river raft

118 companies, etc. Ticks, mosquitoes and other vector threats were a prime topic of our

119 presentation in Winter and early Spring of 2016. Due to the spiked increase of disease

120 exposure in Northeast Iowa, we wanted to emphasize the need for prevention,

121 detection, and treatment. Unfortunately, there is not yet a vaccine effective for tick-

122 borne diseases.

123 In that capacity, I came to meet Leslie Knopf and Avery Perkins, the Director and

124 the head Nurse from Camp Morning Star in Jones County, Iowa. Avery Perkins had

125 attended one of our public health-focused sessions in late Winter. Shortly after, I

126 received a call from Leslie Knopf, who invited me to tour the camp facility and to

127 review a protocol that they had developed to address the tick situation.

128 I must say that I was impressed. They clearly had done their homework. Leslie

129 presented me with a binder full of information and materials and outlined their multi-

130 step protocol for dealing with potential tick issues. I subsequently reviewed the

131 protocol and found it to be a very thorough and complete plan of action. I actually

132 commented to Leslie that I would like to use Camp Morning Star’s protocol as a model

133 to show other camps. She looked very pleased and agreed.

134 Since I was already there, I took a quick tour of the main camp facilities. I noticed

135 all of the appropriate pamphlets and flyers, but in typical fashion, the Tick-Borne

136 Disease flyer was buried under other notices on the crowded bulletin board. One would

137 be hard pressed to find any information at all on the board in the dining hall unless you

138 knew what you were looking for. The information was also available in the infirmary

139 and nurse’s office. The facilities appeared well enough equipped and adequate for a

140 Summer camp. I inquired about the availability of basic meds (and asked specifically

141 about Doxycycline) and Nurse Perkins indicated that they were available on site, but

142 that they probably would not be needed. S/he indicated that while s/he gets a few ticks

143 to remove every Summer, it has never amounted to anything more than a frightening

144 experience for the campers and perhaps a mild skin irritation. S/he indicated that s/he

145 was much more concerned about poison ivy. Nurse Perkins struck me as a typical old-

146 school school nurse – dispensing more hugs and pats on the back than medication – but,

147 again, in most situations, that is perfect for a Summer camp.

148 As I mentioned, I did review the protocol designed for Camp Morning Star. If

149 followed, they had a comprehensive plan to prevent as much as possible Tick-Borne

150 Diseases. If followed. That’s the key aspect. Unfortunately, most prevention strategies

151 require strict adherence and vigilance. There are no simple solutions. Any kind of

152 slacking on following any aspect of even the best protocol could lead to serious

153 situations. And, in this instance, tragically, that lack of attention to detail did lead to

154 April Ludgate’s current issues.

155 When April’s parents picked her up at Camp Morning Star on July 29, 2017, they

156 were understandably concerned about her health and well-being. Rather than driving

157 their daughter home, they instead took her to the University of Iowa Hospital Urgent

158 Care department. My colleagues at the Hospital ran a series of tests, including

159 submitting blood samples for analysis. Since April had come directly from a Summer

160 camp and presented with classic symptomology, they correctly considered Lyme

161 disease, Rocky Mountain Spotted Fever or some variant of a tick-borne disease. Based

162 on that diagnosis, I was contacted to provide expert consultation.

163 Simply put, April is a very sick girl. The records from Camp Morning Star

164 indicate that she visited the infirmary more than 30 times within the 6-week period.

165 While it is impossible to determine specifically when she was exposed to infected ticks,

166 based on the Nurse logbook, she most likely contracted the disease on or around July 5

167 through July 18. This would satisfactorily account for her feverish and flu-like

168 conditions on July 18 and also corresponds to prolonged exposure in a heavily wooded

169 area during one of the camp’s excursions. During my investigation of the potential

170 source of April’s illness, I spoke with her head house counselor, Bennie Wyatt. I asked

171 specifically about any cabin activities between July 5 and July 18 that would have put

172 April specifically in wooded areas. Bennie mentioned that during this almost 2-week

173 span, there were multiple excursions into the woods for various activities and games.

174 Bennie mentioned specifically a Capture the Flag activity on July 5 that was then

175 followed by a cabin camp out on July 7 and July 8.

176 I immediately treated April with a course of Doxycycline and other antibiotics.

177 She showed only minimal signs of improvement. The initial blood tests came back

178 negative for Lyme disease, but that is sometimes the case. I ordered additional tests

179 throughout the month of August in an effort to pinpoint the exact nature of the disease.

180 While an additional blood test again came back negative, we did finally get a positive

181 result indicating a rare variant of Lyme disease in early September. It is not uncommon

182 to receive a false negative test result in these cases. However, with all of the

183 characteristic signs and symptoms, I was confident that she had contracted a TBI and I

184 treatred it as such.

185 Unfortunately, April has not been able to attend school. She has a few good days

186 when she appears to be relatively pain-free and lucid, but clearly she is suffering severe

187 symptoms from her tick exposure. She continues to show signs of cerebral swelling and

188 neural deficits. It is unknown at this point whether she will experience any permanent

189 brain damage. At the moment, she requires continual skilled care. Unless there is some

190 sort of miracle discovery, April will have a very long road to recovery, if she is able to

191 recover at all.

192 The truly sad part of her situation is that it was preventable. With proper

193 precaution, proper identification, and proper treatment, April would never have had to

194 experience this level of pain or disability. She would be able to lead a healthy, active life

195 befitting a 16 year-old girl.

196 April went to the nurse with clear symptoms of a tick-borne illness. The nurse

197 refused to administer the appropriate course of medication. The nurse further did not

198 see April’s condition as serious enough to consult with additional medical staff – either

199 at a local hospital or with world-wide experts at the nearby University of Iowa hospital.

200 I’ve seen the Nurse logbook and am frankly shocked that these combination of

201 symptoms did not immediately trigger concern. Based on our conversations in the

202 Spring, I would have expected the camp personnel to be on high alert for tick-borne

203 illness. And even if there was some doubt about the nature of April’s condition, there is

204 no reason not to call in experts and/or administer medication.

205 After meeting with the patient and with others who were at Camp Morning Star

206 with her, after reviewing the Nurse’s Logbook, and after conducting a thorough review

207 of the entire situation, I conclude that April’s situation was both preventable and

208 treatable. The fact that the camp established protocols that they then chose to ignore or

209 at the very least chose to enforce haphazardly, makes them responsible for the

210 condition April is in today. Protocols without enforcement merely amount to wasted

211 paper.

WITNESS STATEMENTS

DEFENSE WITNESSES

Statement of Leslie Knopf

1 My name is Leslie Knopf. I am the CEO of Gryzzl Corp and the Director of Camp

2 Morning Star in Jones County, Iowa. Gryzzl Corp specializes in outdoor experiences:

3 for kids, for families, for companies. We build relationships between people and

4 between people and nature. At the heart of it, we offer an outdoor experience in rural

5 Iowa that features friendship, fun, and character-building exercises. Outdoors implies

6 exposure to the elements and all other aspects that nature has to offer – flora, fauna,

7 natural conditions, geography, etc.

8 Our flagship program is our annual Summer Camp for pre-teens and teenagers,

9 but we also operate outdoor-based programs and experiences throughout the Spring

10 and Fall. This November, for example, we will be hosting an outdoor extreme obstacle

11 course event, Storm Chase, at our location. It will be the first national Storm Chase

12 event in Eastern Iowa. We’re really excited to have this partnership.

13 The Summer program at Camp Morning Star is a 6 week long outdoor

14 experience targeted toward young people throughout the Midwest. We get a number of

15 campers from urban areas whose parents are looking for an opportunity for their

16 children to connect with nature in a meaningful way. Other campers are legacies,

17 meaning that their parents or siblings have attended the camp in the past. The camp

18 itself has been around for decades - at least since the 1950’s, primarily as a church camp.

19 The owners of the camp were looking to retire, and so in 2007, I left my job as director

20 of the Northeast Iowa Regional Parks and Recreation Commission to form Gryzzl and

21 to purchase the camp and expand the offerings.

22 Camp Morning Star offers a series of outdoor experiences for kids over the

23 Summer. These are structured daily activities designed to build healthy bodies, healthy

24 minds and healthy living. There is a basic schedule for each day involving instruction

25 and activity. We do incorporate elements of freedom and choice into the schedule as

26 well. Campers may choose to engage in a selection of fun activities. All are well

27 monitored and fully staffed.

28 Our camp is divided into 4 main cabins or houses, each named after an

29 indigenous Iowa species (Lynx, Wolf, Bear, Eagle). At our opening feast on the first day,

30 campers are sorted into houses. This is all great fun! As camp director, I welcome

31 campers and remind everyone of rules and regulations. I also make clear that unless

32 accompanied by a counselor or staff instructor, the deeper woods are off limits. I also

33 emphasize our “Buddy Plus One” system. This is a rule that basically keeps campers

34 from wandering off alone or getting in trouble with a friend. The idea is that if you have

35 to have at least 2 other people accompany you, you might rethink your choice. As I like

36 to say, “If not a group of three, then why me?”

37 We also run a camp tournament where each cabin receives points for success,

38 and points take away for violations. Any counselor can award or deduct points, but any

39 serious deductions must be made or brought to the attention of head house counselors

40 and or senior camp staff (instructors, directors, nurse, etc.). This is a fun and exciting

41 way to build camp spirit.

42 We have a core group of employees throughout the year, but also employ

43 seasonal staff for the Summer Camp program and temporary employees for specific

44 special events. All are fully vetted and trained on camp protocol, policies and practices.

45 I pride myself on being hyper-prepared. Look, I don’t see how being thorough is

46 an issue. Too often our society looks for quick, easy solutions where none exist. If you

47 always go with your gut instinct, you often end up having to address the same situation

48 again later. I have a system. I call it the 4 R’s: Research, Reflect, Write, Resolve.

49 Complicated situations demand comprehensive solutions. I don’t think anyone can ever

50 accuse me of being careless, and the last time I looked, being too careful is no crime.

51 We start planning for Summer camp pretty much as soon as the previous year’s

52 is over. I do a debrief with all of the staff to discuss what worked and what didn’t and

53 any improvements that might be needed, all while it is still fresh in mind. The senior

54 staff (including head counselors) meet in December to begin the actual planning and to

55 make hiring decisions. I also meet with Nurse Perkins at that time to talk about any

56 health or medical issues that may be on the radar for the next Summer. At our meeting

57 in December 2016, s/he indicated that s/he had seen some increased activity both at the

58 Iowa Department of Public Health and at the University of Iowa’s Center for Emerging

59 Infectious Diseases concerning Tick Borne Disease (TBD) in eastern Iowa. I asked Avery

60 to set up a meeting with both organizations to see what new protocols might need to be

61 developed in preparation.

62 We met with Dr. Chris Traeger of the University of Iowa and Dr. Jerry Schnurr of

63 the Iowa Department of Public Health in March, 2017. We discussed the TBD vector in

64 eastern Iowa and the emerging threats of different strains related to Lyme Disease. They

65 indicated that they were planning to hold a series of public health presentation in the

66 early Spring about the threats and tips for prevention and treatment. I made sure that

67 Avery Perkins was signed up for one of those meetings.

68 Not content to let well enough alone, I started doing some independent research

69 – I must have called or emailed Dr. Traeger at least a dozen times – in preparation for

70 developing a Camp Protocol for the Prevention, Detection, and Treatment of Tick-Borne

71 Disease. Now, we’ve always had an insect protocol – mosquitoes can be a real problem

72 – but once I learned about the severity of the tick situation, we enhanced our policies.

73 You know how some people tell you not to sweat the details? Well, I’m sorry, I’m

74 a detail sweater. And I realize that I sweat heavily. I believe that complex problems

75 deserve complex thought and a well-reasoned workable solution. My solutions won’t fit

76 on a bumper sticker, but my solutions are solutions.

77 Camp Morning Star developed a 12-Step Protocol for TBD Prevention. Once

78 completed, I submitted copies to both Dr. Traeger at the University of Iowa and Dr.

79 Schnurr at the Iowa Department of Public Health. Both complimented me on the plan,

80 noted it’s comprehensive nature and asked if they might use it as a model for other

81 camps and outdoor outfitters. Of course, I was happy to share my work.

82 Basically the 12-Step Protocol involves 12 basic steps:

83 The first two steps deal with Preparation. We wanted to create as safe of an

84 environment as possible. In consultation with the Grounds Manager, Jerry Gergich, we

85 planned to clear tall grass and brush farther back from main paths and from the open

86 grounds where most of the camper activities take place. Second, Jerry suggested that we

87 apply a multi-use pesticide to areas in close proximity to general camper areas

88 approximately 3 weeks prior to camp. We wanted to ensure that any immediate

89 dangerous effects of the pesticide to humans would be well past by the time camp staff

90 arrived for training. In my experience in the Parks and Rec department, I know that this

91 application should take care of most issues for most of the Summer.

92 The next six steps of the protocol deal with prevention. In the pre-camp notice to

93 campers, we would encourage parents to use a laundry additive (permethrin) on any

94 clothes the kids were likely to wear at camp. This repellant stays effective even after

95 numerous washings, so a single treatment would suffice for the entirety of the camp.

96 Next, before engaging in any deeper woods activities, counselors and camp staff would

97 give notice to campers so that they could prepare accordingly. This includes the

98 wearing of appropriate clothing (long-sleeved shirts, long pants, closed-toed shoes) and

99 the application of a bug spray containing DEET. The camp would provide this bug

100 spray to campers if necessary.

101 At any time during camp activities where sports equipment or other items fell

102 into the taller grass or wooded areas, campers were to notify counselors and staff who

103 would retrieve these articles. We do not want campers exposed to potentially tick-laden

104 areas unnecessarily.

105 As camp director, I had received a notice advertising a new product claiming to

106 prevent tick exposure on humans by slightly altering body chemistry. Dr. Thom’s Bug

107 Juice was developed in Colorado by Dr. Thom Haverford as a drink additive. While I

108 was not completely sold on the product’s effectiveness, I could see no harm in adding

109 the extra protective measure to the protocol. I instructed our dining hall staff to add the

110 powder to the fruit juice served at every meal.

111 The next two steps deal with tick detection. After each day of activity, we

112 instructed camp counselors to do an inspection of campers for any ticks. This could

113 reasonably be done before each cabin’s shower time. Campers would be requested to

114 strip down to their underwear, in private of course, so that counselors could do a visual

115 examination. Counselors would also teach and encourage campers to do a more

116 thorough self-examination for ticks in the shower stall itself. While we required daily

117 cursory checks, after any activities that took our campers into the deeper wooded areas,

118 the inspections were to be much more thorough.

119 Finally, steps 11 and 12 have to do with treatment. If a tick was discovered,

120 counselors and other staff would be fully trained in the proper method of tick removal.

121 I am aware that there are a lot of home remedies for tick removal involving matches or

122 alcohol. From my research, these appear to be ineffective. Instead, staff were trained to

123 use tweezers to gently remove the offending bug and to then treat the area with

124 disinfectant and antibiotic cream. The final aspect of the camp protocol was the

125 presence of a fully trained medical staff, lead by Nurse Avery Perkins. Nurse Perkins is

126 available throughout the 6 week camp for consultation and treatment. At any time that

127 Nurse Perkins might be unavailable we have a second nurse, Donna Meagle, on duty.

128 I was very proud of this protocol development. I made sure that each staff

129 member received a binder outlining the 12 steps and including additional information

130 (photos, facts, statistics, maps, projected spread vectors, warning signs, etc.) about ticks

131 specific to our region of the state and country.

132 In accordance with our new Camp Morning Star TBD Protocol, we gave proper

133 notice to parents, laying out the threat (as remote as it might be) and our plan for

134 handling situations as they arose. We included a fact sheet and pamphlet with the other

135 camp materials sent in advance. We further requested that parents send campers with

136 appropriate bug spray (containing DEET) and to pack long pants, long-sleeved shirts,

137 and closed-toes shoes. We also advised as a further precaution for them to pretreat

138 laundry with permethrin.

139 During our pre-camp program for counselors approximately 10 days prior to the

140 start of the campers arrival, we reviewed the new protocol, heard from Nurse Perkins

141 about the dangers of ticks and other insects, and fully trained the staff on tick

142 protection, detection and treatment.

143 By the time camp began on Sunday, June 18, 2017, I was confident that we put

144 adequate protocols into place and had done everything possible to protect our campers.

145 I checked periodically with the head house counselors to make sure that all policies and

146 practices were being followed and interacted with campers frequently to ensure that

147 they felt safe and were having an enjoyable time. The care and concern that we have for

148 campers here at Camp Morning Star is paramount.

149 I remember being informed about April Ludgate by Nurse Avery Perkins

150 sometime during either the second or third week of camp. I can’t recall the specific date,

151 but I do know that it was a Wednesday. The dining hall staff knows of my love of

152 waffles, so they make sure to serve waffles every Wednesday morning at breakfast. I

153 know that it was a Waffle Wednesday that Nurse Perkins and I had our first

154 conversation about poor April.

155 Now Nurse Perkins and I meet regularly – usually every morning briefly over

156 coffee – to review any pressing medical issues. April Ludgate became a regular topic of

157 conversation. Nurse Perkins had told me previously that a few of the campers were

158 making it a habit to visit her/his office on an almost daily basis. This is typical for

159 younger campers who may be feeling homesick. This phase usually passes fairly

160 quickly. However, in April’s situation, it persisted throughout the duration of camp.

161 Nurse Perkins suggested, and I agreed to send an email to April’s parents outlining the

162 situation with her frequent nurse visits. The replies that I received did not seem overly

163 worrisome. They indicated that April was fairly shy and sometimes it took time for her

164 to gain a level of comfort to come out of her shell.

165 I continued to receive updates on April from the nursing staff. At one point,

166 Nurse Perkins suspected that April may have come down with a touch of the flu and

167 had kept her in the Nurse station overnight for rest and observation. We did not want a

168 flu outbreak to spread around the camp, so we were extra cautious. I made a suggestion

169 to try antibiotics with April. Nurse Perkins, however, indicated that it was most likely a

170 viral thing that antibiotics could not treat. I agreed with her/his medical decisions. After

171 all, s/he’s the expert.

172 As the end of camp drew closer, Nurse Perkins and I discussed whether to send

173 April home early. It was our opinion, however, that rather than put her parents to the

174 extra trouble, we would just keep a close eye on her. She actually seemed to improve

175 somewhat. I emailed her parents, however, indicating that they might want to set up an

176 appointment with their personal care physician to have April more thoroughly

177 examined after camp.

178 From my understanding, the expert doctors still have not definitively

179 determined the nature or cause of April Ludgate’s illness. I know that she has suffered

180 and has missed a lot of school. As an organization, though, we had every possible

181 protection in place. It’s just a quirk of nature that has caused this terrible situation.

182 We put as many preventative measures and procedures into place as possible,

183 but we’re not going to give up deep woods activities – that’s part of what defines us as a

184 camp. If all activities were on lawns or asphalt, then there would be no reason to ever

185 leave town. We offer nature in a natural setting unapologetically.

186 I’m proud of my team and the work that we do together to create a great

187 environment for kids at Camp Morning Star. Our passion, our commitment to core

188 values, and our attention to details set us apart from other camps. Planning for fun and

189 games is no fun and games, but the end result is that campers get a better fun-and-

190 games experience. In order to accomplish our mission, we look for special types of

191 people to bring on board. Our team members must have a great commitment to kids

192 and a dedication to rules and policies that have been carefully crafted to achieve our

193 mission. Once we have identified a quality team member, we tend to keep them. We

194 have a retention rate of approximately 80 to 90%. With a Summer Camp staff of 40

195 people or so, we typically only replace 6 to 8 people from year to year. Most of these are

196 counselors who decide to move on to do other things after college graduation.

197 Every once in a while though, we do have some issues with counselors or staff

198 who just don’t work out. We did receive an application from Ron/da Swanson to be a

199 Counselor for the Summer of 2018. I chose not to rehire based on recommendations

200 from head counselor, Bennie Wyatt, who oversaw Ron/da’s work in 2017, and others.

201 Based on these discussions, it became clear that Ron/da just didn’t have what it takes to

202 be a Camp Morning Star counselor.

203 I did not believe that we had left on bad terms – more of a mutual parting of

204 ways. But now that I know that Ron/da is prepared to testify for the Plaintiff in this

205 lawsuit, I wonder how much of that is driven by animosity over our employment

206 decision.

207 Let me just say that all of us at Camp Morning Star care deeply for April

208 Ludgate, as we do for all of our campers. Over the 6-week program, we become a real

209 family, sharing our hopes, dreams, and aspirations; celebrating together life’s joys and

210 sharing each other’s moments of sadness and set-backs. April’s situation has deeply

211 impacted the psyche of the Camp Morning Star community. We keep April in our

212 thoughts and prayers and know that she will recover from the cruelty that nature has

213 thrown at her. Together, as a family, I know that we will overcome.

Statement of Bennie Wyatt

1 My name is Bennie Wyatt. I’m currently a graduate student in the school of

2 Environmental Sciences at Dakota Tech in Dinkla, North Dakota. Once my Master’s

3 program has been completed, I hope to pursue a career with the National Park Service

4 or with a trekking outfit or a private camp company like Gryzzl.

5 During the Summer of 2017 (and again during this past Summer), I served as a

6 Head Counselor at Camp Morning Star in Jones County, Iowa. I’ve actually been at

7 Camp Morning Star longer than Leslie Knopf. Leslie took over as Camp Director in

8 2007, but I’ve attended or worked at the Camp since I was in 6th grade, so since 2006. I

9 attended camp until I graduated from high school in 2013 and then worked as a

10 Counselor for 4 years, before serving as a Head Counselor or the past 2 years. I’m proud

11 to work at Camp Morning Star with such a dedicated staff under the capable leadership

12 of Leslie Knopf. Leslie is the most prepared, most organized, and most thorough leader

13 with whom I’ve worked. Leslie really listens to problems and comes up with solutions

14 that work. I always feel like my contributions are valued.

15 As I mentioned, I was a camper at Camp Morning Star myself, so I’ve seen things

16 from multiple angles – young camper, teen-age camper, counselor and head counselor.

17 I’m very familiar with not only official policies and protocols, but also how things

18 actually work at camp. I must say that when Leslie became Director, s/he really gave

19 Camp Morning Star new life. S/he was just what the camp needed to revitalize and

20 become relevant to the experiences of a younger generation. Leslie kept many of the

21 older program aspects that worked, but also added some new, more challenging

22 features to the Camp. But, most importantly, s/he instituted a new set of rules and

23 regulations that, perhaps on their face are kind of harsh, but which give much needed

24 structure to the camp experience.

25 As a camper, I sometimes thought that all of the various rules were a little much,

26 but having now worked as a counselor and head counselor, I see that the policies and

27 procedures are all designed with camper safety and well-being at the forefront. I know

28 that people joke that Leslie seems to have a binder for everything – and while it is true

29 that s/he is hyper-organized, I actually think that type of leadership is necessary to the

30 success of the camp and the company.

31 As a staff, we meet and train with Leslie and the administrative staff frequently.

32 Heads of House get together with Leslie in the Winter to plan out details for the next

33 year’s camp and to assist with hiring decisions. We then meet again in early May for

34 more in-depth training on policy and procedures. The camp nurse, Avery Perkins, also

35 gives us a first aid refresher course and presents information on any medical points of

36 emphasis for the coming year. In May, 2017, for example, s/he did a lengthy program on

37 Insect Vectors and Mosquito and Tick-Borne Diseases. It was fascinating stuff, if

38 perhaps a bit long and over our heads with medical jargon. But we all got the gist of

39 what Nurse Perkins was saying. We were to be on high alert for ticks that Summer. The

40 full staff then assembles about a week to 10 days before the campers arrive to get

41 everything organized, to discuss any last-minute developments, and to really bond as a

42 team. It’s important for campers to see that the staff is a family and that we’re all on the

43 same page when it comes to setting an atmosphere for the Summer.

44 Leading up to the 2017 camp, there were a number of points of emphasis (I have

45 the binders to prove it!), but I want to focus on two major areas: the Buddy +1 System,

46 and the newly formulated Tick Protection Program.

47 The Buddy +1 System has been in place for a number of years. It remains one of

48 the most effective ways to make sure that campers do not get into trouble. We require

49 that any camper movement outside of the cabins and dining hall area but done with

50 partners. If a counselor or other staff person is not available to accompany a camper, she

51 or he must find at least 2 other campers to go with them. The idea behind this system it

52 that a young camper could make a bad choice on their own, and maybe even a worse

53 choice with a friend alongside them, but in a group of three, the hope is that wiser

54 heads will prevail and potential trouble might be averted. The system has worked really

55 well. I know that when I was a camper, and new campers today, find it harsh, but once

56 you get used to always needing 2 friends to go with you, it becomes commonplace.

57 The Tick Protection Program was new in 2017. It was a plan formulated by

58 Director Knopf, Nurse Perkins, and the head of grounds, Jerry Gergich, to keep campers

59 safe from those blood-sucking pests. As I mentioned, Nurse Perkins gave a presentation

60 to the camp staff about ticks and the threats they pose. S/he also taught us the correct

61 way to remove attached ticks. That was a little gross, but necessary information to have.

62 Leslie, obviously, had come up with a multi-stage protocol that included both

63 protection from and detection of ticks. Leslie called the main points for counselors the

64 Inform, Protect and Detect procedures. The Information part was to let campers know

65 before we were going to do an activity that bring them in contact with ticks. The Protect

66 part had to do with the right kind of clothing and using bug spray. The Detect part

67 involved teaching campers how to spot a tick attached to their body and also to assist

68 with the inspections process (and removal if necessary). We were also told that only

69 counselors were to retrieve any errant sports equipment – balls, frisbees, etc. – that

70 might end up in the tall grass or the woods. That way only counselors, who had been

71 better trained, would be exposed to tick danger.

72 Needless to say, we were prepared when camp rolled around in mid-June 2017.

73 After the campers arrived and went through the sorting process, we held house

74 meetings with our campers. Lynx House had 24 campers, 4 counselors and myself as

75 head counselor. In Lynx, our counselors included Maggie White, Bill Boyd, Torey

76 Cuellar and Ron/da Swanson. Together we met with our group to talk about rules,

77 regulations, procedures, and also did some icebreaker activities and intros to get

78 everyone comfortable with the group. Some of the campers were repeats, so I knew

79 them from past years, but most were brand new to Camp Morning Star. We described

80 the Buddy +1 system and the Tick protocol to them during these meetings. The

81 individual counselors got the campers settled into their rooms and bunks and did a few

82 more getting-to-know-you activities. By the end of the first day, the Lynx team was

83 pretty psyched about our group. We were raring to go win a Camp championship.

84 Now the first week of camp, we are always real strict on rules and procedures. It

85 is important to set a tone and to make things safe for campers. But we also want them to

86 be excited for their camp experience and have fun. So after the first week, we might

87 relax some of the rules a bit. The tick inspection protocol was one of the procedures that

88 was relaxed – but only just a bit. During the first week, we went pretty hard core. Before

89 shower time, which in Lynx House was before dinner each evening, we had the

90 counselors do the mandatory tick inspection on each camper. Obviously for privacy and

91 modesty’s sake, the female counselors did the tick check on the female campers and the

92 male counselors were responsible for the males. Basically, each camper had to strip

93 down to their underwear so that a counselor could do a visual inspection for ticks. The

94 campers were also told how to look for ticks themselves while bathing. After the first

95 week, the counselors did a cursory check of exposed skin and the campers were on their

96 honor to do a more thorough check of themselves in the shower. However, we always

97 did the full inspection protocol after any event or activity that involved campers in the

98 deeper wooded areas of the camp.

99 Those deep woods activities happened about once or twice a week. We did some

100 shelter building activities, a capture the flag type event, geo-caching, and treasure hunts

101 among other things. We also occasionally had House Games that brought us into the

102 deeper woods. At mealtimes before we ventured out, we always reminded campers to

103 wear closed-toed shoes, long pants and recommended long-sleeved shirts. We also

104 provided bug spray with DEET to all campers participating in those activities. When we

105 returned to the cabin afterwards, we did the full tick inspection protocol.

106 In our cabin, we did actually have two campers who found ticks on themselves.

107 In both cases, I removed the ticks with tweezers and put disinfectant on the bite sites. I

108 did not hear of anyone else who found any ticks, but there might have been some in

109 other cabins for all I know. Shower time is always a chaotic part of the day. Trying to

110 get two dozen campers in and out of showers while doing the inspections and

111 respecting privacy and getting them moving before dinner is quite the undertaking. We

112 did the best we could on a daily basis. When I noticed that the inspection process was

113 getting a little lax, I held a Lynx team meeting and impressed upon the counselors to

114 take the time needed to complete the task – dinner could wait.

115 As counselors, we regularly led or monitored camper activities – both formal and

116 informal. Part of the tick protocol involved counselors retrieving errant items from the

117 woods. Some of the campers thought that it was quite fun to intentionally kick or throw

118 stuff into the tall grass or the woods for counselors to fetch. But usually after some

119 deductions from house points, this “fun” stopped.

120 During the six weeks of the camp, counselors were always on duty. There were

121 always things that needed to be done. Camp Morning Star had plenty of staff, it’s just

122 that to do the job well, you have to be ON all of the time. Even after curfew, when all of

123 the campers were expected to be in their own cabins, and after lights out and bed check,

124 at least one counselor in every cabin was still on duty to monitor the situation. You

125 never know when a camper might need help or there might be emergencies to deal

126 with. Especially early on in the camp, there were always campers who were homesick

127 and who needed a little extra emotional support. The nighttime duty also included at

128 least one tour of the outside of the cabin and grounds just to ensure that the campers

129 were not doing any nocturnal wandering.

130 Remember, I was a camper at Morning Star myself. I know that there are ways to

131 slip by counselors. And I also know that as a counselor we sometimes turn a blind eye

132 to an occasional nighttime walkabout. But we have to make sure that everyone is safe

133 and secure, so we did enforce the rules when we caught campers abusing our

134 discretion.

135 April Ludgate and her sidekick, Andy/i Dwyer, were constantly pushing the

136 boundaries in our cabin. I swear those two lost more points for Lynx House than the

137 rest of the campers in the cabin combined. Andy/i always seemed to have some secret

138 plan working that involved sneaking away from the group without that crucial third

139 person. I caught them both outside after curfew on at least 3 different occasions and

140 once we had to conduct an all-out search of the area to find them when they were

141 unaccounted for during bed check. We found them outside a different cabin – Bear

142 House – along with their friend Beatty Wiese, who I think is from their hometown.

143 April and Andy/i were also two of the biggest violators of the equipment

144 retrieval policy. I think And/i would intentionally throw frisbees into the woods. April

145 would “volunteer” to retrieve it and then, if not noticed, would slip away with Andy/i

146 following, “to go look for April.” We counselors were really kept on our toes with those

147 two.

148 April had another scheme brewing as well. Just about every day, she seemed to

149 come up with an excuse to go see the nurse. Sometimes she went to the nurse more than

150 once a day. Unsurprisingly, most of the nurse-going happened either right before cabin

151 clean up chores or shower time. It became quite the game with April to see what excuse

152 she would come up with to avoid cabin responsibilities. I’m afraid that some of her

153 fellow campers, and even a few of the counselors, were not always kind to her – and

154 even start referring to her medical conditions as “Aprilitis.”

155 Now, to be fair, April initially struck me as a naturally shy person. So I can see

156 how the tick checks might cause her more concern and angst than normal. I saw that

157 she was embarrassed, so I offered her more privacy during the tick inspection, even

158 offering to use my room as a more secluded location, but she routinely refused to be

159 checked. She said that she would do her own inspection in the shower. But shower time

160 got to be her favorite time to ask to see the nurse. At no time, however, did April either

161 indicate to me or report to anyone else exposure to ticks.

162 When April requested to go see the nurse, it would always be with some version

163 or combination of symptoms, such as headache, nausea, fatigue, aching joints, fever,

164 stomach ache, or just “I don’t feel so good.” Admittedly, April didn’t always look too

165 good when she asked to see the nurse. A couple of times, I thought that she might

166 actually be coming down with something, but the nurse sent her back to the cabin, and

167 she seemed normal – at least normal for April. Toward the end of camp – the last 2

168 weeks or so – she did look a little beat up. There were a lot of campers by then who

169 were feeling, looking, and acting a little rough by then. It’s just part of the long Summer

170 camp experience.

171 I feel badly for April and her family. As her head counselor, I know that the staff

172 at Lynx House did everything we could to keep her and all of the campers safe and

173 happy. It’s awful that she has contracted this disease. I hope she’ll recover soon. But

174 nothing we did caused her situation. I know that sounds harsh, but it’s the truth.

175 I’ve come to find out that Ron/da Swanson plans to testify against the camp in

176 this lawsuit. That sounds to me like sour grapes. Based on his/her performance as a

177 counselor in 2017, I did not recommend that Leslie rehire Ron/da as a counselor this

178 year. While I was really proud of my Lynx House crew, there definitely was a weak

179 link; someone who just didn’t seem to be a team player – and that was Ron/da.

180 Ron/da was always lax in rule enforcement. I had to speak with her/him on a

181 number of occasions to follow policy and rules when dealing with campers. There were

182 a number of times when Ron/da was supposed to be monitoring camp activities that

183 s/he just seemed to be spaced out; off in her/his own little world. The campers are not

184 allowed electronic devices during the Summer, but counselors and staff may have them

185 to use during any off hours and for use in emergencies. The cell coverage is spotty at

186 best and the WiFi is almost non-existent. But Ron/da always seemed to have her/his face

187 in a screen. There was one time, for example, when Ron/da was supposed to be

188 overseeing a house v house kickball game. The ball was kicked into the high grass over

189 to one side of the clearing we used as the field. Per rules, only counselors were

190 supposed to retrieve any equipment that went that far into or close to the woods.

191 Ron/da was oblivious. The kids were shouting at her/him to get the ball. S/he just kind

192 of put up a finger to indicate “just a sec” but never actually got the ball. One of the

193 campers finally went to fetch the ball. I was across the way and saw most of what

194 transpired. Normally, I would have taken points away from that camper’s house, but

195 given the circumstances, I gave them a pass. I spoke with Ron/da that evening about the

196 incident, but s/he seemed to not know what I was talking about. That was just the tip of

197 the iceberg.

198 Ron/da was also not the kindest person as a counselor. S/he had a habit of giving

199 campers creative nicknames. Most of them were harmless and referred to some inside

200 joke. For example, a smaller redheaded boy was named “Lucky” because he kind of

201 looked like a leprechaun. And a girl’s whose last name was Bierman became “Leinie”

202 after the beer.

203 But others were a little snarky and even somewhat mean. After one of our campers fell

204 out of a canoe in the first week of camp, Ron/da called her “Fishbait.” I’m pretty sure

205 that Ron/da is the one to come up with Aprilitis. I know that s/he called her Rainy a lot

206 – I think because April showers bring May flowers. S/he said that it really matched

207 April’s mood. While some of the nicknames kind of formed a bond with campers, the

208 somewhat mean ones had a “us vs them” feel to them. It felt like those campers were

209 getting picked on and that it was being promoted by their counselor.

210 I’m just not sure that Ron/da really fit the Camp Morning Star mold. That’s why

211 when Leslie said that s/he had received an application from Ron/da for 2018, I voted

212 against her/him.

Statement of Avery Perkins, C.N.P.

1 My name is Avery Perkins. I’m 68 years old and am a Certified Nurse

2 Practitioner. I received my B.S.N. from Southern Iowa University in 1972 and continued

3 my education at the same school with an M.S.N. in 1975. I have been fully licensed as a

4 Registered Nurse in Iowa since 1975. I completed the credentialing and educational

5 requirements as a C.N.P. in 1982. I have worked in a variety of settings during my

6 career as a ward nurse in various hospitals and with medical practices throughout

7 eastern Iowa. A dozen years ago, my spouse passed away from cancer. Since that time,

8 while I have maintained my nursing credentials, I have slowed down a bit – working as

9 a School Nurse for the Concord County school district in far northeast Iowa and over

10 the Summers, working as a Camp Nurse for Leslie Knopf at Morning Star Camp.

11 I’ve known Leslie for years. S/he has always been a leader in the community and

12 is an excellent role model for civic involvement. When s/he took over Morning Star

13 Camp about 10 years ago and asked if I would consider helping out in the Summers, I

14 jumped at the chance to be part of something so impactful. Leslie has my highest

15 respect and admiration. It’s a real shame that s/he is being accused of neglecting a

16 camper. It’s always been my observation that s/he treats every camper as if they were

17 her/his own child. I would hate to think that this one incident could ruin Leslie’s career,

18 reputation, and future in working with kids.

19 As the head nurse at Camp Morning Star, I have a number of responsibilities.

20 Even before camp begins, I am in contact with Leslie to set up proper medical protocols

21 for each year. While many of the policies and procedures stay the same from year to

22 year, there are circumstances that make us rethink and revise some practices. In 2016,

23 for example, we enhanced our policies regarding both tick and mosquito-borne

24 diseases. Together, and in consultation with both the Iowa Department f Pubic Health

25 and the Center for Emerging Infectious Diseases at the University of Iowa, we set up a

26 comprehensive program of prevention, protection and treatment. Since this legal issue

27 involves a TBI (tick-borne illness), I’ll elaborate on these particular protocols.

28 Leading up to the summer programs at Camp Morning Star, I attend the annual

29 briefing from the Iowa Department of Health and the University of Iowa. Dr. Traeger

30 provides an update on trends and the most up-to-date statistics regarding insect-borne

31 illness and projected disease vectors for the coming warm-weather months. In 2016 and

32 again in 2017, Dr. Traeger made a point of emphasis on TBI and Lyme disease. I

33 discussed with her/him ideas for a plan to combat the threat. Once we came up with the

34 protocols, I ran it by him/her and s/he seemed impressed by the breadth of our plan.

35 Working with Leslie Knopf, the camp director, and with Jerry Gergich, the

36 grounds superintendent, we put together a plan for prevention, for protection, for

37 detection, and for treatment. In terms of prevention, we devised a plan to spray high

38 traffic areas with a pesticide approximately one month before the beginning of the

39 Summer Camp. While we wanted the spray to be effective, we did not want any

40 residual to make campers sick. We also asked Jerry to have his/her crew keep the main

41 paths closely mowed and widened and to keep the areas immediately adjacent to the

42 paths cut back close. That way if campers stuck to the main paths throughout the camp,

43 their risk of exposure to ticks would be minimized.

44 Obviously, Morning Star is a nature camp, so we can’t protect campers

45 completely from natural elements. In fact, we want them to experience nature

46 authentically. At least once or twice a week, campers would engage in deep woods

47 activities. Clearly this increased the risk of tick exposure. So we put into place a

48 protection plan: requiring campers to wear closed-toed shoes, long pants, and, where

49 possible, long sleeved shirts. Prior to each of the deep woods activities, the campers

50 would be informed to use spray or lotion containing DEET. In the information sent

51 home to parents prior to camp, we also encouraged them to treat and wash camp

52 clothing with products containing permethrin. Once treated, clothing with the chemical

53 insect repellant should provide an extra layer of protection for the duration of the camp.

54 We did not make this a requirement, nor did I recommend to Leslie that the camp

55 laundry wash clothes in the product, due to possible allergic reactions from campers.

56 Once treated the clothing should maintain its repellant qualities for at least a few

57 subsequent washings.

58 Jerry had also come across a product that claimed to prevent ticks through a

59 drink additive. While I was skeptical of the science behind the product, I couldn’t see

60 any harm in giving it a try – it certainly didn’t increase risk and, if used in conjunction

61 with everything else, it might actually help. We decided to use Dr. Thom’s Bug Juice

62 additive to the camp fruit punch at all meals.

63 Fully aware that campers would be exposed and at greater risk during the deep

64 woods activities, we devised a plan for inspection and detection. As a general rule, we

65 encouraged camp counselors to inspect campers for ticks on a daily basis. We advised

66 that this could be done either through counselor inspections or by teaching campers

67 how to look for ticks themselves. After deep woods activities though, we really wanted

68 the counselors to take extra care in tick detection.

69 If any ticks were detected attached to a camper, and every year we have at least a

70 couple of incidents, we instructed counselors on proper removal technique. Basically,

71 this is to take a pair of tweezers and carefully grasp the tick by its mouthparts which are

72 closer to the skin. Careful not to squeeze the body, pull the tick directly away from the

73 skin. Removing the body is the main goal, so you don’t need to worry if the mouthparts

74 break off. Then, of course, clean the wound and disinfect the site of the bite. It’s a pretty

75 simple and easy process, but some people get really queasy when dealing with insects.

76 If the counselor or the camper preferred, however, they knew that they could call

77 me to come and remove the insect or to send the camper to my office for tick removal.

78 In 2017, for example, I believe that I removed 3 ticks from campers and counselors and

79 that the counselors reported that they removed 4 additional ticks. That’s a significant

80 number for one Summer, but not unusual given the amount of outdoor activities.

81 Finally, in all public areas of the camp- the cabins, the dining hall, the main

82 office, and my office, there were flyers, fact sheets and posters describing what to look

83 out for. All in all, the campers would have the knowledge and assistance needed to

84 protect themselves as much as possible.

85 The counselors arrive at camp about 10 days to 2 weeks before the start of camp.

86 They have classes and training is all aspects of camp, including medical protocols. I met

87 with all of the camp counselors as a group and did include a section on tick-borne

88 illnesses in my presentation.

89 Once campers arrive, the real work begins. On the first day of camp, I meet with

90 all campers who have medical needs: prescription and over-the-counter medications,

91 pre-existing conditions, any special needs or concerns. I create a file for each camper,

92 documenting each interaction. I am also available in the dining hall during all regular

93 meal times, both to dispense with medications and to be seen by campers in case they

94 need any nursing attention. As you can imagine, a summer camp nurse has to be

95 equipped to deal with a variety of situations: bumps, bruises, sprains, poison ivy,

96 sunburn, stomach aches, etc. and also serve as an informal counselor for any homesick

97 kids.

98 When I’m not at the dining hall, I can always be found in the infirmary (that’s

99 also where I live during camp) for any campers needing individual consultation and

100 attention. I get a fairly steady stream of campers each day – some days more than

101 others, usually the days featuring rock climbing (bumps, scrapes, and bruises) and river

102 tubing (sun burn).

103 Of course I remember April Ludgate very well from the Summer of 2017. I think

104 I saw her just about every day – and on some days more than once. I joked with her

105 about getting a frequent visitor punch card. You know, with the 10th visit, you get a

106 latte. Anyway, as with all of the campers, I kept a record of her visits to the medical

107 cabin. This log, however, does not list informal interactions with April in the dining hall

108 or on the camp grounds. Every time I saw her, I made sure to check up on her health

109 and well-being. I take each camper’s total health very seriously.

110 Typically April would complain of a consistent set of symptoms – stomach aches,

111 nausea, dizziness, running a temp, joint soreness, headaches, etc. Each time, I listened

112 and, when necessary, gave her Tylenol, ibuprofen, Pepto Bismol, cold compresses,

113 whatever I thought would help the best. She occasionally ran a slight temperature –

114 never high enough to cause too much concern. It was a particularly hot Summer, so a

115 lot of the temp increase may have been over exertion in the heat.

116 Part of being a good nurse is listening to your patients. I have to trust that the

117 story they’re telling me is real. But it does make you wonder when every day it seems

118 like a different malady or complaint. I’m old enough to remember the old TV show

119 MASH. The was a character on the show, Corporal Klinger, who always tried to get out

120 of situations by recycling old complaints – mother dying, sister pregnant, sister dying,

121 mother pregnant. I’m not saying that April was a hypochondriac, but all of her

122 complaints put together were a bit much to find plausible.

123 She did come to see me twice on July 10 complaining of a combination of

124 symptoms which did raise some suspicion. On that date, she described headache,

125 nausea, and joint soreness. I asked her if she had been exposed to ticks. She said that she

126 had not. I asked her if her counselor had found any ticks during the daily check, she

127 said no. I asked her if he would allow me to do a more complete examination, again she

128 refused.

129 A few days later, she showed me a rash that had developed on her foot and

130 lower leg. It appeared to be consistent with poison ivy, so I treated it accordingly. I’m

131 familiar with the signature bulls-eye rash characteristic of Lyme disease and TBI. April’s

132 did not look like that at all. Her rash appeared to be garden variety poison ivy. I see lots

133 of cases each Summer, I know what it looks like and I treated it accordingly.

134 Nevertheless, I again offered to do a complete examination, but April refused. She told

135 me that her counselor had already checked her out and that she also did a bug check in

136 the shower. She was wearing shorts and a t-shirt, so I did a quick visual inspection of

137 her exposed skin. I found no signs of ticks.

138 Approximately a week later, April came to me complaining of flu-like

139 symptoms. I took the precaution of keeping her at the infirmary over night for rest and

140 observation. With rest and fluids, she seemed much better the next morning.

141 I did not administer any antibiotics to April. In my judgement, her condition did

142 not warrant it. I am very hesitant to use antibiotics prophylactically. In my opinion, kids

143 are given too many antibiotics and they can build up an immunity so that the

144 medication is less effective. Antibiotic overuse has led to newer, resistant strains of

145 disease.

146 As the weeks went on at camp, April looked more and more worn down by the

147 experience. Where at the beginning of camp she may have looked just fine as she

148 complained of various maladies, by the end of camp, it was readily apparent that she

149 was not feeling well. I gave her Tylenol, a cold compress, and a place to lie down. This

150 seemed to make her feel better. I honestly thought that the cumulative effect of being

151 away from home at camp had worn her down. I did not suspect anything more serious.

152 Based on the symptoms presented, the history with this patient, and the patient’s

153 refusal to a more thorough examination, I believe that I did all that I could.

154 Look, nature is nature. And nature is inherently risky. We can take precautions,

155 but there is only so much care you can take. I’m not sure what else we could have done.

156 In terms of prevention, we did everything reasonably possible. In terms of education,

157 we tried our best. In terms of detection, I fell that we went above and beyond what

158 could be expected. The symptoms of Lyme disease, and all tick borne diseases for that

159 matter, mimic other, less extreme maladies. The illness is rare in eastern Iowa, but

160 despite our best efforts, we were not able to protect all campers against the vagaries of

161 nature. I’m truly sorry that April has suffered. She has been in my thoughts and prayers

162 ever since Dr. Traeger informed me of her situation.

EXHIBITS

Exhibit 1

Exhibit 2 (Excerpt from Camp Morning Star Parent Handbook 2017)

Preventing Tick-Borne Illnesses at Camp Morning Star The Iowa Department of Public Health has advised that Ticks are presenting an ever-greater risk. Ticks produce a serious health risk to campers and others who spend time outdoors in warm-weather months. Ticks can carry disease, the most concerning of which is Lyme Disease. Deer Ticks, which are very small, carry Lyme disease. They can be difficult to detect, so it’s important to talk about them with your child before they come to Camp.

Ways to Prevent Lyme Disease • Insect Repellant including DEET is an important way to repel deer ticks. Campers should apply this at least twice a day while at camp. In addition, families should consider pre-treating clothing and gear with permethrin. • Campers should wear long pants, socks and closed-toed shoes during any activities in wooded areas. • Campers are not allowed to sleep in the same clothes that they wore that day • Campers should do a DAILY tick check in a well-lit location. Showers are a good place to do a visual check of your body. Counselors and health staff are available to assist. • If campers should locate a tick on their body, they should not remove it themselves, but instead ask for help from counselors, nurses or health staff.

While camps and families do their best to prevent tick bites, it is also important to know the symptoms of Lyme disease and take your child to a doctor right away if you suspect your child may have had a tick bite. Symptoms of Lyme disease include: Muscle Aches, Headaches, Fatigue, Fever, Rash (sometimes ring-shaped).

Tick Prevention, Protection, Detection & Treatment at Camp Morning Star To combat threats posed by ticks, Camp Morning Star is instituting a multi-step protocol to protect, prevent, detect and treat campers. This Protocol is intended to reduce the probability of a tick attaching itself to a camper and the possibility of Lyme disease.

• Daily, each camper is observed in a state of undress (as discreetly as possible) by his/her camp counselor for the purposes of noticing any rashes, infected bug bites, sores or other unusual skin conditions. • Campers involved in activities outside of the core and mowed areas of camp, such as nature walks and deep woods games and activities, are informed at the meal preceding that activity to wear appropriate clothing (long pants and sneakers) and to apply bug lotion to exposed skin just prior to participation. The activity instructor reinforces this procedure at the time of the activity. • Campers involved in overnight tenting activities (outdoor living program) should take the same precautions as in Step 2, as well as request a visual inspection from a counselor or nurse, and undertake an extensive self-check while showering. • In all activities where any sports equipment goes into brush or an unmowed grass areas, Camp staff will retrieve the equipment, not the campers themselves.

Camp Morning Star has prepared a more extensive Protocol which we will be happy to share upon request. At ALL times, Camp Morning Star is staffed by Skilled Health Care Professionals

Exhibit 3 Iowa Department of Public Health Pamphlet

Exhibit 4 Lyme Disease Fact Sheet – A1

Exhibit 4 Lyme Disease Fact Sheet – A2

Exhibit 4 Lyme Disease Fact Sheet – B1

Exhibit 4 Lyme Disease Fact Sheet – B2

Exhibit 5 CAMP MORNING STAR DAILY SCHEDULE - 2017

7:15 A.M. WAKE UP!

7:45 A.M. BREAKFAST PREP

8:00 A.M. BREAKFAST

8:45 A.M. FREE TIME

9:30 A.M. ALL CAMP MEETING

10:00 A.M. MORNING PROGRAMS

12:15 P.M. LUNCH

1:00 P.M. REST TIME

2:00 P.M. WATER ACTIVITES/CRAFTS

4:30 P.M. ELECTIVE ACTIVITIES

6:00 P.M. DINNER

EVENING GAMES & EVENING PROGRAMS (including HOUSE GAMES COMPETITION – For Points & For Glory!)

10:00 P.M. CABIN CURFEW

11:00 P.M. LIGHTS OUT

Individual Cabins will determine appropriate SHOWER times Morning Programs are different each week, incl. sports, games, arts & crafts & tons of other wacky stuff

Weekly Deep Woods activities include: Flora Collection, Shelter Building, Orienteering, Geo-Caching, Night Hiking, and the Annual Camp Out

Weekends include campers’ choice of activities & special events

2017 Saturday Night Concert Series! Featuring:

MOUSE RAT JOHNNY KARATE SCARECROW ON A BOAT

L’IL SEBASTIAN DUKE SILVER

ANNUAL CAMP TALENT SHOW!

Exhibit 6 Chris Traeger, M.D., Ph.D. Curriculum Vitae

EDUCATION Southern Iowa University, Iowa Doctor of Philosophy, Preventative Medicine, 2004 Specialty: Public Health and Tick-Borne Human Pathogens

Southern Iowa University, Iowa Doctor of Medicine, 1995 Specialties: Infectious Diseases, Microbiology

Tabard University, Iowa Bachelor of Science, 1988

CURRENT EMPLOYMENT Iowa Center for Emerging Infectious Diseases Assistant Director

University of Iowa College of Public Health Everett Thompson Professor of Medicine

University of Iowa Medical Center Consulting Physician, Infectious Diseases

REPRESENTATIVE PUBLICATIONS & PRESENTATIONS Over 40 scholarly peer-reviewed journal articles, including most recently Journal of Emerging Infectious Diseases, 2016 “Emerging Tick-Borne Human Pathogens: Midwestern United States”

More than 80 Presentations and Panel Discussions, including most recently Great Plains Emerging Infectious Diseases Conference, Spring, 2018 “Virologic and Bacterial Surveillance Activities in Human Populations: Emerging Threats to Midwestern United States.”

Exhibit 7 Reported Cases of Lyme Disease United States - 2016

United States - 2014

Exhibit 8

Exhibit 9

From: Leslie Knopf To: [email protected] CC: Perkins, Avery Date: Tues, July 25, 2017

Subject: Re: April at Camp Morning Star

I know that you’ll be picking April up from Camp on Saturday. She’s been a real joy to have at Camp Morning Star this Summer!

Since April has had so many visits to the infirmary, you might consider making an appointment with your primary care physician once she’s back home just to check her out.

From: Larry & Rita Ludgate To: [email protected] CC: [email protected] Date: Wed, July 19, 2017

Subject: Re:April at Camp Morning Star

We’re so glad that she’s receiving such good care! We’re sorry for any problems that April has caused. Quite frankly, we didn’t expect to hear from her (or anyone else from Camp) all Summer. Usually she likes to go her own way and isn’t much trouble.

Again, let us know if she (or you) need anything from us!

From: Avery Perkins To: [email protected] CC: Director Knopf Date: Wed, July 19, 2017

Subject: Re: April at Camp Morning Star

Hi! This is Avery Perkins, the nurse at Camp Morning Star. Just wanted to let you know that April had a small bout with the flu yesterday and today. I kept her here at the Infirmary overnight and made sure that she got plenty of fluids and rest. She seems much better today – her temp is back down close to normal and she says she’s not as nauseous and dizzy.

From: Leslie Knopf To: [email protected] CC: Perkins, Avery Date: Wed, July 5, 2017

Subject: Re: April at Camp Morning Star

No need for a doctor. Nurse Perkins has everything under control. I’ll keep you posted if anything changes. As I said, I don’t actually think that April is ill, but it seems to give her comfort to go visit the nurse every day.

From: Larry & Rita Ludgate To: [email protected] CC: [email protected] Date: Sat, July 1, 2017

Subject: Re:April at Camp Morning Star

No medical issues with April. We’re a little concerned about frequent nurse visits. Is she coming down with anything? Should we make arrangements to have her go to a doctor?

From: Leslie Knopf To: [email protected] CC: Perkins, Avery Date: Sat, July 1, 2017

Subject: Re: April at Camp Morning Star

Andy/i is in her House group and I know that she’s been hanging out with both of her friends from home.

She is visiting the Nurse’s office pretty regularly. We don’t think it’s anything serious, more of a ploy to get out of camp stuff that she doesn’t want to do!

Are there any medical issues that we should be aware of?

From: Larry & Rita Ludgate To: [email protected] CC: [email protected] Date: Wed, June 28, 2017

Subject: Re:April at Camp Morning Star

Thanks for the update. April will warm up once she gets to know folks there. She can be a bit introverted, but is really a lot of fun once she feels comfortable. I know that her friends Andy/i and Beatty can help bring her out of her shell.

Let us know if she’s causing any problems!

From: Leslie Knopf To: [email protected] CC: Perkins, Avery Date: Wed, June 28, 2017

Subject: April at Camp Morning Star

Greetings from Camp Morning Star! After one week of camp, things are going great here! The campers are having such a good time making friends and making memories!

April seems to be having a bit of a rough time adjusting to camp. She doesn’t seem to want to take part in many group activities and doesn’t really say much when staff tries to engage her. We’ll keep an eye on her and try to get her to join in on the fun.

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Tick Prevention Poster Camp Morning Star Dining Hall 2017