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IN THE CIRCUIT COURT FOR THE CITY OF ST. L 1 f l 1

STATE OF MISSOURI
~~
TWENTY SECOND JUDICIAL CIRCUIT
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DA VID BERGSTROM and K A Y E )

BERGSTROM, his wife,
)
)
Plaintiffs,
)
v.

84 LUMBER,
KCG, INC., et aI.,
Defendants.

)
)
)
)
)
)
)

0 !} 2014

22ND JUDICIAL CIR

8yC/RCUIT CL K'S

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DEPUTY
No. 1322-CC09325
Division No. 18

EN1"EREO
I\UG 5 10\~

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PROPOSED ORDER FOR LOGISTICS RELATED TO THE BLOOD

EXAMINATION OF PLAINTIFF DAVID BERGSTROM FOR THE PURPOSE
OF LIMITED GENETIC TESTING
Defendant Georgia-Pacific LLC's ("Georgia-Pacific") Motion for an Order
Compelling a Blood Examination of Plaintiff David Bergstrom for the Purpose of
Limited Genetic Testing was granted in part with various provisions on August 1,2014.
That Motion was joined by Defendant Welco Manufacturing Company ("Welco"). This
Order details the logistics of the blood draw and testing.
NOW THEREFORE, the Court further ORDERS as follows:

1.

Subject to any written objections from physicians treating Plaintiff David , /

Bergstrom, Plaintiff is directed to provide a two- to five-milliliter whole
blood sample for the sole purpose of enabling Prevention Genetics, a
CLiA-certified laboratory located at 3800 S. Business Park Ave.,
Marshfield, Wisconsin 54449, to conduct genetic testing solely for a BAPl
gene mutation.

2.

The Court appoints one of Mr. Bergstrom's physicians, Dr. Hengbing /

Page 1 of 4

Wang at Humphrey Cancer Center, 3435 West Broadway Street, Suite

61, ((\~ oJWf\o:f,,,e,.

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1135, Robbinsdale, MN 55422, to order a BAPl gene mutation test from

Prevention Genetics using the Test Requisition Form attached hereto as

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Exhibit A.
3.

The Court further appoints Accurate Testing, 2626 E. 82 nd St., Suite lOS,
Bloomington, MN 55425, to collect a whole blood sample from Mr.
Bergstrom pursuant to Prevention Genetics' specifications.

4.

Accurate Testing shall collect the blood sample on Tuesday, August 5,

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2014, at the home of Plaintiff David Bergstrom. AEEI:IFate Testif'lg shall

provide via facsjmile to Plaintiffs' cOllnsel on MOQday, Al:Igttsl 4,

~014,

the

name of the individual who will be appearjng to collect tbe blood and tM
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contact jnformation for Accurate Testing so that Mr. Bergstrom or his

attorneys can contact Accurate Testing to arrange the time on Tuesday to
conduct the blood sample collection.

5.

Accurate Testing shall collect a two- to five-milliliter sample of whole

blood from Mr. Bergstrom in a purple-top tube containing EDTA.

6.

Once the blood sample is collected, Accurate Testing shall ship it to

Diagnostic Lab, Prevention Genetics, 3800 S. Business Park Ave.,
Marshfield, Wisconsin 54449, for overnight delivery, in a manner
consistent with the following shipping and handling instructions:
a.

7.

BLOOD: Do not freeze. During hot weather, include a frozen ice pack
in the shipping container. Place a paper towel or other thin material
between the ice pack and the blood tube.

Upon receiving Mr. Bergstrom's whole blood sample, Prevention Genetics

Page 2 of4

is authorized to test the sample for a BAPl gene mutation, only, and to
provide the parties listed herein, through their attorneys, and their
designated experts with a written report of the test results on or before
~~ ~ ~~
August )..{, 2014. No additional reports shall be delivered to any entity,
the ordering physician, the test collection facility, any experts, or the
parties, either directly or through their attorneys. All reports prepared
by Prevention Genetics and/or referred to in any other expert reports
shall be returned to Plaintiffs' counsel upon the conclusion of this matter.
8.

The scope of Prevention Genetics' testing of Mr. Bergstrom's whole blood

sample shall be limited to a test for a BAPl gene mutation, and no
additional tests shall be conducted on that sample without further order
of this Court.

9.

The Court understands that in order for Prevention Genetics to keep its
certifications and accreditations (Clinical Laboratory Improvement
Amendments (CLIA) and American College of Pathologists), it must
maintain records from blood tests for two (2) years, at which time all
records related to the blood tests shall be destroyed. This paragraph
amends the Court's Order of August 1, 2014.

10.

Georgia-Pacific and Welco shall be responsible to pay the costs of

collecting, shipping and testing Mr. Bergstrom's blood sample as
described in this Order.

11.

Notwithstanding any requirements related to certification and/or

accreditation of Prevention Genetics, or any other record keeping
Page 30f4

requirements pursuant to state and/or federal regulations and/or

statutes for Prevention Genetics or any other entity involved in the blood
sample collection and/or genetic testing performed pursuant to this
order, each an every entity or person shall:
a. Not maintain any interest, commercial, research, or otherwise, of any
kind, in any test results, genetic materials, and/or any information
resulting from the processes outlined above;
b. Release to Plaintiff any and all explicit or implied licenses, exclusive,
non-exclusive, or any others, for the use for any purpose of any of the
genetic testing materials or results;
/'" c.

Release and return all raw test materials and blood samples, if any
remaining, to a treating physician of David Bergstrom, to be provided

"if (\JCl+

later; and

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d. Maintain the complete confidentiality of the results of the genetic

testing except as previously ordered pursuant to this Court.

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So ordered.

,
r-----,.

Robert H. Dierker

Dated:

_......=~-l--J4-+1_)>__

Circuit Judge

Page 4 of 4

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GENETICS

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DISEASE PREVENTION THROUGH GENETIC TESTING

Test Requisition Form

(revised 7/28/2014)

This form must accompany all specimens.

Billing instructions are on pages 3-4.
Specimen and shipping instructions are on pages 5-6.

Person completing form

Test information is available from our web site

(ww".... preventiongenetics.com).
All testing must be ordered by a qualified health care
provider.

Contact Information (phone or email)

Date of Request

Patient Information
Patient's Last (Family) Name

First Name

Patient ID Code

Date
Collected:

Specimen Source:
Whole blood

D Extracted DNA

MI

Month

Source:

GeoAncestrylEthnicity (please provide as

much detail as possible)

Month

Year

Day

Day

Year

Gender:

D Male DFemale

D Cultured Cells

Source:

Date of Birth:

D Tissue

D Direct Amnio

Source:

Reason for test

Has patient been tested

at Prevention Genetics
previously?

D Diagnosis
D PresymptomaticlAt risk
D Carrier Testing

DYes DNo

D Other:

DDirectCVS

Ongoing pregnancy?

DYes

DNo

Prenatal Healthcare Provider Statement

required for ongoing pregnancies. Mee
studies offered at no additional charge

Other relevant clinical information (Labs, biopsies, other genetic testing performed, etc). Please attach pedigree if possible.

Test Selection
Please /1st below the tests that 818 to be performed. The Test Numbers and Names, and tum around tine C8Il be obtained from our web site
preventiongenetics.com. Please include any special test instructions In the comments section. The tests will be performed In the order listed unless
othetwise specified. Unless specJficeI/y requested we will run Senger panels sequentially as listed in our test descrtptlons. We offer a STAT option 01/ our
tests with ~10 calender dey tumeround for Senger sequencing tests. We C8f1not gtI8I8fItee STAT TAT for Test Code 600 and will only charge STAT
surcharge fftestfng Is completed within 10 days. Next-Gen panels are not currently available to be orrIered STAT.
Test Order

Test Code

Test Name

Test Code

Test Name

Test Code

Test Name

Test Code

Test Name

Test Code

Test Name

Special Instructions

1
Test Order

(All tests ordered, including genes

within panels, to be tested simultaneously.)

2
Test Order

STAT Testing Requested. *

(for STAT add 25% to price)
*See paragraph above for limitations.

3
Test Order

4
Test Order

Concurrent Testing Requested

Comments:

5
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clinicaldnatesting@preventiongenctics.com

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www.preventiongenetics.com

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PREVENTION

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DISEASE PREVENTION THROUGH GENETIC TESTING

Provider/Laboratory Contact Information

In an effort to 'go green,' we will not routinely mail reports unless 'Mail Report' option is selected.
If you desire a faxed report, please provide fax number. If you do not need a faxed report, do not
provide fax information.
If you have additional specific reporting requests, please indicate them below.

Provider Information
Institution

Address (please include city, state, country & postal code)

Requesting Physician (please print legibly)

Requesting Genetic Counselor (please print legibly)

Phone Number

Phone Number

Email

Email

Test Reporting Instructions

Test Reporting Instructions

Fax Number:
Mail Report:

Fax Number:

Mail Report:

Other Requests:

Other Requests:

Senclout Laboratory (Complete only If report needed)

Other

Laboratory & Contact Person

Contact Name

Address

Address

Phone Number

Phone Number

Email

Email

Test Reporting Instructions

Mail Report:

Test Reporting Instructions

Fax Number:

Fax Number:

Mail Report:

Other Requests:

Other Requests:

.
clinicaldnatesting@preventiongenetics.com

www.preventiongenetics.com

21