Exhibit A — USA v. Rivera et al. (Dkt. 126-1, D.N.J. No. 1:23-mj-02053)

Record facts

Full text

Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 1 of 12 PageID: 713
EXHIBIT A
[cut off at the page edge]r-00267-KMW Document 126-1 Filed 05/26/26 Page 2 of 12 P[cut off at the page edge]
Gary S. Nitsche, P.A.*
Joel H. Fredricks-
Rachel D. Al[illegible]en^
James Gaspero, Jr.-
Caroline A. Kami[illegible]ski -
Robert S. Hunt, Jr. -
* Also admitted in PA & N[illegible]
- Also admitted in PA
^ Also admitted in MD
NITSCHE & FREDRICKS, LLC
ATTORNEYS AT LAW
305 North Union Street, Second Floor
P.O. Box 2324
Wilmington, DE 19805
Phone (302) 655-4040
Fax (302) 654-4892
www.nitschefredricks.com
Bear Office:
[illegible] Becks Woods Drive
Suite [illegible]
Bear, DE [illegible]
(302) [illegible]
Smyrna Office:
33 De[illegible]k Drive, Suite [illegible]
Smyrna, DE [illegible]
(302) [illegible]
E-mail: [illegible]@[illegible].com
May 12, 2026
Adrienne T. Po[illegible]zo
335 Latrobe Drive
Newark, DE 19702
RE: Your Work Related Accident of Tuesday, December 30, 2025
Dear Adrienne:
Please be advised that defense counsel has scheduled a medical examination for you on June 18, 2026 at 11:30 am with Eric T. Schwartz, M.D.. The office is located at 230 Beiser Boulevard Suite 100, Dover, DE 19904. The telephone number is (302) 730-0840 should you need directions. It is important that you keep this appointment. Failure to keep the appointment can result in cancellation fees to you, delays or even in dismissal of your case. If you do not attend this examination, you will be charged a significant "no-show" fee. Also, please be on time for the appointment since the doctor may not see you if you are late.
Also, please bring with you a photo ID. Failure to provide a photo ID may result in the cancellation of the appointment and a fee may be imposed.
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 3 of 12 PageID: 715
First State Medical Associates LLC
2055 Limestone road, suite 111
Wilmington , DE 19808
Tel. 302-9998169; Fax. 302-9998190
firststatemedical@yahoo.com
05/18/2026
To Whom It May Concern
RE: Adrienne Ponzo, DOB-01/09/1975
I am writing this letter in support of above-mentioned patient of mine. Ms. Ponzo has a history of severe asthma with recurrent exacerbations warranting multiple emergency room visits and intensive room admissions, sometimes with intubation and being placed on a respirator.
She is currently on maintenance treatment including Proventil HFA 2 puffs every 6hrs, Albuterol nebulization 2.5 mg q 6hrs as needed and Advair Diskus 500 mcg-50mcg inhalation 1 puff bid. She needs to follow up regularly for monitoring and treatment to avoid worsening of condition and hospitalization.
If you have any questions, do not hesitate to call.
Yours Truly
[signature]
Franklin Ampadu, M.D.
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 4 of 12 PageID: 716
First State Orthopaedics
4745 Ogletown-Stanton Road
Suites 225
Newark, DE 19713-1338
New Castle Locations Kent County Locations
Phone: (302) 731-2888 Phone: (302) 735-8700
Fax: (302) 355-4434 Fax: (302) 735-8703
Patient: Adrienne Ponzo MR #: 000000671864 DOB: 01/09/1975 Age: 51 year old
Date of Visit: 02/03/2026
Date of Injury: 12/30/2025
Height:
Weight: BMI: 52.13 .
Adrienne Ponzo was seen in our office today, Tuesday, February 3, 2026. The following is a summary of
today's visit.
Chief Complaint/Reason for visit:
This 51 year old female presents for low back pain.
Current Symptoms
low back pain
Onset: 12/30/2025. The patient is currently describing posterior LBP, left leg pain and left buttock. Back pain is greater than
leg pain. BP is % and LP is %. There was radiation of pain to the left post thigh and left lat thigh. The patient rates their
symptoms as a 8 on a scale of 0 to 10. The problem has worsened . The frequency is constant. Location of
numbness/tingling is in the left post thigh. She describes the pain as severe, aching and shooting. Location of weakness is
in the left hip. Aggravating factors include bending, changing positions, lifting, sitting, driving, walking, standing and all
activities. Denies relieving factors. Symptoms failed to improve with time. Associated symptoms include balance
disturbances, spasms, gait disturbances and weakness.
HPI
Adrienne Ponzo is a 51-year-old female who presents for evaluation of low back pain following a work-related
injury on 12/30/2025. She works as a battery decorator operator at Theragun's and slipped on a battery handle,
falling onto concrete and landing on her back. Since the injury, she has experienced constant low back pain
rated as 10/10 at its worst, which is aggravated by sitting, standing, bending, lifting, and twisting. She reports
difficulty performing activities of daily living, including lifting her two-year-old son, tying her shoes, and sleeping
in bed due to pain. She has been sleeping in a media room chair for comfort. She also notes intermittent
shooting pain into both legs, left greater than right, which occurs with prolonged standing, such as washing
dishes. She describes the back pain as radiating and worsening with lumbar movement.
She visited occupational health initially, where she was advised to use ice, but her pain has progressively
worsened. She has not undergone physical therapy or chiropractic care. Her primary care physician prescribed
medications but recommended seeing a pain management specialist, which she has not yet done. She visited
the emergency room on 1/21 due to excruciating pain and was evaluated for urinary urgency and incomplete
bladder emptying, which she attributes to the injury. She denies incontinence but reports residual bladder
symptoms.
She has difficulty standing from a seated position and maintaining a neutral spine position. She experiences
worsening pain with lumbar flexion and extension and is approximately five degrees shy of neutral spine
position. She has weakness in her right hip flexors, right knee extension, and right dorsiflexors, rated as 4/5.
PE
Ponzo, Adrienne 01/09/1975 1/3
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 5 of 12 PageID: 717
- Difficulty standing from a seated position.
- Difficulty standing in a neutral spine position.
- Worsening pain with lumbar flexion past neutral.
- Approximately five degrees shy of neutral spine position.
- Weakness in right hip flexors 4/5, right knee extension 4/5, right dorsiflexors 4/5.
- Positive right straight leg raise.
Assessment/Plan
Lumbar spondylosis(M47.816)
Lumbar paraspinal muscle spasm(M62.830)
Plan
Recovery and GO/compression unit was ordered for the patient today. Recovery and GO provides intermittent
cold/compression to direct edema, pain, and swelling from the lumbar spine and towards the heart, promoting
venous return, enhancing circulation, and controlling pain without the risks of addiction or harmful side effects.
I am prescribing the Smart-Stim (TEJSD) device, FDA-cleared for the treatment of joint pain and muscular
discomfort. Based on my medical examination and clinical expertise, I deem it medically necessary to provide
temporary pain relief for the patient's lumbar spine pain, which may involve both joint and muscular pain,
including the paraspinal muscles. The Smart-Stim device delivers electrical stimulation to reduce pain, alleviate
symptoms associated with arthritis, and help relieve muscular tension and spasms in the lumbar paraspinal
regions. The recommended treatment time is 15 minutes, with use every 2 to 4 hours as needed.
The patient will proceed with a formal course of physical therapy at Rise PT. She will be provided with a list of
recommended supplements, including turmeric, magnesium glycinate, and vitamin B12. She will also be
provided with a list of topical medications, including diclofenac gel and Lidoderm patches, which will be sent to
her pharmacy.
I will see her back in six weeks for reevaluation. We may proceed with interventional spine care treatment
during her next office visit if warranted. Conservative treatment with physical therapy and medications was
discussed in full detail. She was advised to remain at work at this time.
PT Order Information
Physician Goals include pain relief, increased function, activities of daily living., ROM, stretching, heat, stim,
massage, postural exercises, proper lifting techniques, core strengthening Physical Therapist to evaluate and
treat. for a duration of 6 weeks.
Medications Ordered this Encounter:
Brand | Dose | Sig Desc
DICLOFENAC SODIUM | 3 % | apply by topical route 2 times every day to effected areas
LIDOPRO PATCH | 4 %-0.1 %-0.5 % | Apply 1 patch by topical route 2 times per day (May wear up to 12 hours)
[signature]
Provider
Mikhail PA-C, Alexandre 02/03/2026 10:16 AM
CC Providers:
Ponzo, Adrienne 01/09/1975 2/3
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 6 of 12 PageID: 718
First State Orthopaedics
4745 Ogletown-Stanton Road
Suites 225
Newark, DE 19713-1338
New Castle Locations Kent County Locations
Phone: (302) 731-2888 Phone: (302) 735-8700
Fax: (302) 355-4434 Fax: (302) 735-8703
Patient: Adrienne Ponzo MR #: 000000671864 DOB: 01/09/1975 Age: 51 year old
Date of Visit: 03/26/2026
Date of Injury: 12/30/2025
Height: 5ft 6in
Weight: 323lb 146kg BMI: 52.13 .
Adrienne Ponzo was seen in our office today, Thursday, March 26, 2026. The following is a summary of today’s
visit.
This 51 year old female.
HPI
Adrienne Ponzo is a 51-year-old female who presents for a follow-up visit. She reports persistent lower back
pain radiating down her legs, with the back pain being significantly worse than the leg pain. She also notes neck
pain. The pain has impacted her daily activities, including difficulty standing in the shower, inability to lift her
22-month-old child, and challenges with driving due to numbness in her legs. She attempted physical therapy
but was unable to continue due to missed appointments related to family circumstances, including her son's
RSV pneumonia. She has not experienced improvement with time, rest, medications, or physical therapy. She is
seeking more aggressive treatment options.
Assistant Comments
Lumbar fu
PE
- Difficulty standing from a seated position.
- Difficulty maintaining a neutral spine position.
- Worsening pain with lumbar extension past neutral and forward flexion at 10 degrees.
- Weakness in right hip flexors, right knee extensions, and right dorsiflexion (4/5 strength).
- Positive right straight leg raise.
Assessment/Plan
Muscle spasm of back(M62.830)
Plan
The patient and I discussed proceeding with a bilateral L4-L5 facet joint nerve block. This procedure will be used
for both diagnostic utility and therapeutic value. The patient was instructed to keep a pain diary before and after
the procedure to document pain levels hourly. If the diagnostic block demonstrates significant pain relief, the
next step will be a radiofrequency ablation to provide longer-term relief for approximately 12 to 18 months.
The patient was educated on the procedure, including the use of lidocaine for diagnostic purposes and the
option for sedation during the injection. She opted for sedation and was advised not to eat for six hours prior to
the procedure and to arrange for a driver.
Ponzo, Adrienne 01/09/1975 1/2
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 7 of 12 PageID: 719
Given her lack of improvement with physical therapy, medications, and rest, this approach is considered the next step before surgical intervention. The patient was also provided with reading materials regarding the procedure.
She will remain out of work at this time, with work status updated from office visit to office visit. The patient is in agreement with the plan and will call back with any questions or concerns.
[signature]
Provider
Mikhail PA-C, Alexandre 03/26/2026 1:36 PM
CC Providers:
Ponzo, Adrienne 01/09/1975 2/2
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 8 of 12 PageID: 720
First State Orthopaedics
4745 Ogletown-Stanton Road
Suites 225
Newark, DE 19713-1338
New Castle Locations Kent County Locations
Phone: (302) 731-2888 Phone: (302) 735-8700
Fax: (302) 355-4434 Fax: (302) 735-8703
Patient: Adrienne Ponzo MR #: 000000671864 DOB: 01/09/1975 Age: 51 year old
Date of Visit: 05/14/2026
Date of Injury: 12/30/2025
Height: 5ft 6in
Weight: 323lb 146kg BMI: 52.13 .
Adrienne Ponzo was seen in our office today, Thursday, May 14, 2026. The following is a summary of today’s
visit.
This 51 year old female.
HPI
Adrienne Ponzo is a 51-year-old female who presents for reevaluation of her lumbar spine. She is status post
bilateral L4-L5 facet joint nerve block completed by Dr. Ginsberg on 04/20/2026, which provided no relief. She
followed up with Dr. Ginsberg on 04/28/2026, who recommended a steroid injection at L4-L5 on the right side,
which was completed on 05/11/2026. Adrienne reports persistent back pain radiating to her right lower extremity
and worsening pain in her left lower extremity. She describes her back pain as feeling like her back is being
crushed into her hips, making it difficult to stand, cook, or perform household tasks. She also reports tingling in
her toes, pain in her legs, and difficulty sleeping. She has experienced a fall due to her leg giving out. Adrienne
has a history of degenerative discs compressing the nerve root at L5 and a right foraminal disc protrusion at
L4-L5 with significant facet hypertrophy. She has tried methocarbamol 750 mg for muscle spasms, which
provides relief during active spasms, and liquid Tylenol. She has previously tried gabapentin and pregabalin but
discontinued them due to side effects. She uses a lidocaine patch at night. Adrienne has a history of gastric
bypass surgery, workers’ compensation involvement, and allergies to CODEINE and ASPIRIN. She has lost
approximately 20 pounds over the past two months with the use of Ozempic.
Assistant Comments
Lumbar fu
PE
- Patient ambulates with a forward side-to-balance and touch-a-gait pattern.
- Limited forward flexion at 20 degrees.
- Weakness: Left knee extensors 4/5, left dorsiflexion 4/5, left EHL 4/5.
- Difficulty maintaining a neutral spine position.
Assessment/Plan
Spondylosis without myelopathy or radiculopathy, lumbar region(M47.816)
Muscle spasm of back(M62.830)
Plan
I recommend proceeding with a left-sided L4-L5 epidural steroid injection to address nerve compression and
associated symptoms. Adrienne will remain out of work at this time. She is advised to follow up with Dr. Z to
discuss continued nonoperative and operative treatment measures, including the possibility of lumbar spine
surgery. Based on her imaging findings and clinical presentation, she may be a candidate for the Intercept
Ponzo, Adrienne 01/09/1975 1/2
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 9 of 12 PageID: 721
procedure at L4-L5, which involves burning the nerves inside the bones. Adrienne is encouraged to continue her dieting and weight loss exercise program, which will be beneficial in determining her surgical candidacy and optimizing postoperative outcomes. All questions and concerns were addressed during the visit, and Adrienne is in agreement with the plan.
[signature]
Provider
Mikhail PA-C, Alexandre 05/14/2026 12:00 PM
CC Providers:
Alexandre Mikhail PA-C
4745 Ogletown Stanton Rd
Newark, DE 19713-
Joe Fredrick (Attorney)
Ponzo, Adrienne 01/09/1975 2/2
Scanned with CamScanner
Case 1:24-cr-00267-KMW Document 126-1 Filed 05/26/26 Page 10 of 12 PageID: 722
MR #: 000000671864
DELAWARE WORKERS' COMPENSATION
PHYSICIAN'S REPORT OF WORKER'S COMPENSATION INJURY
A COPY OF THIS REPORT MUST BE SENT TO THE INJURED WORKER, EMPLOYER AND THE INSURER
REPORT TYPE __Initial _X_Progress __Closing
WORKER'S NAME AdriennePonzo
Employer Name
Employer Phone/Fax /
Insurer Name
Insurer Claim No.
Insurer Phone/Fax
DOB 01/09/1975
Date of Injury
Body Part(s):
EXAM DATE 05/14/2026
Physician's Phone/Fax (302) 731-2888/(302) 355-4434
INITIAL VISIT ONLY
Injured worker's description of accident/injury:
WORK RELATED MEDICAL DIAGNOSIS (ES) Spondylosis without myelopathy or radiculopathy, lumbar region(M47.816), Muscle spasm of back(M62.830)
TREATMENT PLAN:
Diagnostic Tests
Procedures
Therapy
Medications
Hrs. per day patient can work: __8+ __8 __6 __4 __2 __0
D.O.T Classification of Work
__Sedentary Exerting up to 10 lbs. of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
__Light Exerting up to 20 lbs. of force occasionally and/or up to 10 lbs. of force frequently and/or negligible amount of force constantly to move objects. Physical Demand requirements are in excess of those for Sedentary Work.
__Medium Exerting 20 to 50 lbs. of force occasionally and/or 10 to 25 lbs. of force frequently and/or greater than negligible up to 10 lbs. of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.
__Heavy Exerting 50 to 100 lbs. of force occasionally and/or 25 to 50 lbs. of force frequently and/or 10 to 20 lbs of force constantly to move objects. Physical Demand requirements are in excess of those for Medium Work.
__Very Heavy Exerting in excess of 100 lbs. of force occasionally and/or in excess of 50 lbs. of force frequently and/or in excess of 20 lbs. of force constantly to move objects. Physical Demand requirements are in excess of those for Heavy Work.
Definitions:
Occasionally: activity or condition exists up to 1/3 of the time
Frequently: activity or condition exists from 1/3 to 2/3 of the time
Constantly: activity or condition exists from 2/3 or more of the time
Work Postures/Positional tolerances: Comment as appropriate in the space provided regarding the patient's abilities/limitations for the following Postures/Positions.
(e.g. Sitting: No more than 30 minutes continuously)
Sitting: Squatting:
Standing: Crawling:
Walking: Climbing:
Driving: Repeated arm motions:
Bending: Repetitive user of wrist/hands:
Turn/Twist: Reaching up above shoulder:
Kneeling: Foot controls:
Comments: Alexandre Mikhail is managing pt's work status. Alexandre Mikhail is managing this patient's work status NO WORK 05/14/2026 to 08/13/2026 Until Next Office Visit
Above safe work capacities are: __temporary __permanent __anticipate full duty release
Return to work modified duty start date:
RELEASE TO FULL DUTY WITH NO RESTRICTIONS __YES (Start Date____) __NO
[signature]
Physician Signature: Date: 05/14/2026 Next Appointment: 08/13/2026
Physician Name: Alexandre Mikhail PA-C Certified Provider: _X_YES __NO "Refernces the Healthcare Practice Guidelines adopted pursuant to the 19 Del.C. §2322(A)"
Scanned with CamScanner
PROVIDER FORM
[cut off at the page edge]r-00267-KMW Document 126-1 Filed 05/26/26 Page 11 of 12[cut off at the page edge]
[Photograph: a clinician in gloves examining a patient's wrapped forearm in an exam room; no other text.]
[cut off at the page edge] Document 126-1 Filed 05/26/26 P[cut off at the page edge]
[Phone screenshot of an email; the ECF stamp is printed over the phone status bar.]
11:54
[ENCRYPTED] DR. GINSBERG APPOINTMENT
Belynda Lasocha 11:32 AM
to me
Hello Ms. Ponzo,
I have attached the appointment reminder to this email. Please call or email with any other questions. Have a great weekend.
Respectfully,
Belynda Lasocha
Surgical Coordinator for Dr. Ginsberg
302-735-8700 ext.4126
Fax 302-224-1881
SKM_451i260515 11280.pdf
PDF
Reply
Forward


File and source

File

gov.uscourts.njd.546707.126.1.pdf

Size

5,572,800 bytes

SHA-256

41179731bbbf572729cb7af0c922cf8b55939a738c457d737277ee9fb6f25914

Our copy

gov.uscourts.njd.546707.126.1.pdf

Original

PACER (login required)