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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
MATTHEW SHETTERLY, a minor, by
and through his natural guardian,
MARGARET MAIZE,
Plaintiff
AMICABLE ACTION
NO. 00 - ;),l..ol..
Ccu..t '-r~
v.
JOHN D. KURTZ, alkJa JACK D. KURTZ
Defendant
JURY TRIAL DEMANDED
A.. ORDER
AND NOW, "', 1-- day of ~ ,2000, ""'" 00"';"""'"
of the within Petition, a hearing is scheduled on th~ ';1 '/ ~ of ~
2000, at /I,. p p. at the Cumberland County Coutthouse in Courtroom Number3 .
BY THE COURT:
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AKS
J.
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
MATTHEW SHETTERLY, a minor, by
and through his natural guardian,
MARGARET MAIZE,
Plaintiff
AMICABLE ACTION
I/A':()
NO. d.;nnJ - o{(;,Ocp ~
v.
JOHN D. KURTZ, a/kJa JACK D. KURTZ
Defendant
JURY TRIAL DEMANDED
AND NOW, thU ~y of
ORDER
consideration of the foregoing Petition for Ap rov I of Minor Plaintiff's Compromise Settlement
2000, upon presentation and due
and Distribution of Proceeds, it is hereby Ordered and Decreed in accordance with the provision of
Pa.R.C.P. 2206 that the Petition is GRANTED.
Payment of fees and expenses as listed in the Petition is approved and payment ofTweleve
Thousand Eight Hundred Seventy-Five and 00/100 Dollars ($12,875.00) to Minor Plaintiff Matthew
Shetterly is directed to be made and deposited in a Bank. a depository which is insured by the
Federal Government, and no withdrawal will be made from such account until the Minor Plaintiff
attains majority, except as authorized by Order of Coutt.
BY THE COURT:
211812.I\RASIMLB
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYL VANIA
MATTHEW SHETTERLY, a minor, by
and through his natural guardian,
MARGARET MAIZE,
Plaintiff
AMICABLE ACTION
NO. t.'-tJ- .2t;ot. ~ /~
v.
JOHND. KURTZ, a/kJa JACK D. KURTZ
Defendant
JURY TRIAL DEMANDED
PETITION FOR APPROVAL OF MINOR PLAINTIFF'S
COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS
The Petition of Matthew Shetterly, by his parent and natural guardian, Margaret Maize,
respectfully represents:
I. Matthew Shetterly, the minor Plaintiff, is the son of Margaret Maize, Petitioner,
herein. Matthew is 16 years old having been born on March 26, 1984.
2. On February 27, 1999, Matthew Shetterly sustained a jejunal perforation, right
posterior liver hematoma, seromuscular laceration of the pylorus "corkscrew" appendix, closed heat
injury, and multiple abrasions from a motor vehicle accident.
3. Minor Plaintiff was a passenger in a vehicle being driven by his mother, Margaret
Maize.
4. A copy of the Police Accident Report is attached hereto as Exhibit A.
211812.I\RASIMLB
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5. Minor Plaintiff was flown to the Hershey Medical Center where he underwent
treatment for his injuries.
6. Minor Plaintiff received treatment for his injuries from Robett E. Cilley, M.D. of the
Hershey Medical Center.
7. Minor Plaintiff last saw Dr. Cilley on May 26, 1999, when he was discharged. A
copy of Dr. Cilley's July 6, 1999 report is attached hereto as Exhibit B.
8. Defendant Kurtz was covered by an insurance policy with Erie Insurance Company.
9. At the time of the motor vehicle accident, minor Plaintiff was a resident of his
mother's household.
10. Motor vehicle insurance for minor Plaintiff's household was provided by the
Progressive Insurance Company.
11. The Progressive policy carries the limited tort option.
12. The Defendant driver and his insurer have agreed to pay and to compromise all
claims arising from the injuries to Matthew Shetterly for the sum of Eighteen Thousand Dollars
($18,000.00), subject to the approval of Your Honorable Coutt.
13. Petitioner wishes to accept the settlement and believes the settlement offer is fair and
reasonable and in the best interest ofthe minor Plaintiff.
14. Should the Court deem it necessary to schedule a hearing to approve the settlement,
and if a hearing is scheduled, Minor Plaintiff, his mother, and Petitioner's counsel will be present at
me hearing.
211812.IIRASIMLB
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15. Your Petitioner has retained the law firm of Angino & Rovner, P.c. to prosecute this
action and has entered into a contingency fee agreement with said attorney whereby said attorney is
to receive, for professional services, 30% of any amount recovered after filing suit, plus
reimbursement of expenses. However, Plaintiffs' counsel has agreed to reduce his fee to
approximately 25% or Four Thousand Four Hundred Ninety and 92/100 Dollars ($4,490.92).
16. To date, Plaintiffs' counsel has incurred expenses totaling Six Hundred Thitty-Four
and 08/100 Dollars ($634.08) in pursuit of Matthew Shetterly's claim.
17. Petitioner understands the remainder of the settlement, Twelve Thousand Eight
Hundred Seventy-Five and 00/100 Dollars ($12,875.00), is to be held in trust for Matthew Shetterly
in an account which is insured by the Federal Government and that no withdrawal be made
therefrom until Matthew attains majority or authorized by Coutt Order.
WHEREFORE, Petitioner respectfully requests Your Honorable Court to approve the
minor's compromise settlement and authorize the payment of attorney's fees from the fund due the
minor and direct payment due to the minor to be deposited in a bank in trust for Matthew Shetterly.
Date: April 26, 2000
211812.I\RAS\MLB
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r;OMMONWEALTIl OF PENNSYLVANIA
POLICE ACCI(JENT REPORT ( .
~RgFER TO OVERLAY SHEETS
f~~&:~...' ~/."
1. INCIDENT
NUMBER
2.AGENCY
NAME
3.STATIONI 21/212
PRECINCT
5. INVESTIGATOR
Pl'L. JEFF roITEIGER
6.APPROVED BY
2410
7. ~~~~SllGATlON 02/27/1999
SAWRDAY
12.NUMBER 2
OF UNITS
15.PRIV.PROP. 0 'Xl
ACCIDENT Y N . ~
17.VEHICLE DAMAGE 0
O-NONE UNIT 1 3
1-L1GHT
2-MODERATE ~
3-SEVERE UNIT 2 ~
a:JM8ERL1:\ND
21.MUNICIPALITY SILVER SPlUN3 'IWP
21
CODE 212
PRINCIPAL ROADWAY INFORMATION
22.ROUTE NO.OR SR01l4
STREET NAME
23.SPEED 45
LIMIT
IF NOT AT INTERSECTION:
30.CROSS STREET OR
SEGMENT MARKER
31.DIRECTION N
FROM SITE
33.DISTANCE WAS
4 CONSTRUCTI ON
ZONE
4 TYPE
HIGHWAY 2
INTERSECTING ROAD:
SR0081 (INI'ERSTATE 81)
8 TYPE
HIGHWAY 1
5 ACCESS 1
CONTROL
9 ACCESS
CONTROL
2
S E W 32.DISTANCE
FROM SITE
MEASURED 0 ESTIMATED D
5 TRAFFIC PRINCIPAL
CONTROL
DEVICE
FT.
MI.
INTERSECTING
yDNgg
yOONOyOONO
18.HAZARDOUS .0. . .'x1 19.PENNDOT
MATERIALS Y N ~ PROPERTY
"[ffjt.." ~'. '.~~~"Ailiff'll~11;~w~W%li.J~tff.;;:'~~fi!,*f~ ~~{f~~*tit~~<<f~W*Wl~~;ilil.~IWj.~~~~;;;'.~:~"~.~~.
,......~.:::~.;>N....W~_:m.<::<<::;.~~........JL.~)M;tl~.ffl~s.~..w...'w,..._%m-(?,>>.~:::::,A.*~Jr.R.;x:::::@$..:<<. &f_~~~.~.....v...:t~nt...MJilit....,............v...,>>-~1:Y:;.....*~.<<J.{$~Wlf.k.vx..:K:::. .&~rn w...-:-....
36.LEGALLY Y N 37.REG. 38.STATE
PARKED? DO PLATE BIG-FEU\. FA
39.PA TITLE OR
OUT-OF-STATE VIN 44979250002 KU
40.0WNER ..,JACK D. I<DIn'Z
41.0WNER 127 16'IH CO'T>t')"""'"
ADDRESS ,;'"=~
42.~lnp~6~~E NEW CUMBERlAND, FA 17070
43. YEAR 1992 44.MAKE CHEIlROLEI'
45.MODEL-(NOT 46. INS""
BODY TYPE) Y Il>l NO UNKO
4 BOOY 0 49 VEHICLE 1
TYPE OWNERSHIP
o INITIAL IMPACT 0 2 TRAVEL
POIHT. 3 SPEED
3 VEHICLE 5 DRIVER
GRADIENT 1 CONDITION
NUMllER 13079675
58.~~~ER JOHN D. KURTZ
59.DRIVER 127 16'IH """''''''''''
ADDRESS ou,,=~
6D.CITY,STATE NEW """''''=T''~'''' FA
& ZIPCODE ~UO'~~,
61.~X 62.gmHoF 06/18/1947
CLASS C
17070
63. PHONE., S. 5"'
717- ,71\- '" ....
68.CARRIER
ADDRESS
69.CITY,STATE
& ZIPCOOE
7D.USDOT #
7 VEH.
COHFIG.
75.NO. OF
AXLES
ICC #
PUC #
74.GV\lR
CARGO
BODY TYPE
76 HAZARDOUS
MATERIALS
.RELEASE OF HAZ MAT
YO.N IXl UNKO
36.LEGALLY Y N 37.REG. 38.STATE
PARKED? DO PLATE BCF-3230 FA
~GT~~F~~mEoeIN 42050251602 Ml\
4D.OWNER DENNIS E; & ~ A. MAIZE
41.~~~~~ss RD #1 OOX #768
42.~I~Ip~6~~E I1\NDISBURG, FA 17040
43. YEAR 1989 44.MAKE CHEVROLEI'
45.MODEL" (NOT 46.INS~ 0 0
BODY TYPE) Y "" N . UNK
4 BODY 4 VE~ICLE 1
TYPE OWNERSHIP
o INITIAL IMPACT 2 TRAVEL
POINT 1 SPEED
3 VEHICLE 5 DRIVER
GRADIENT 1 CONDITION
. HUMBER 17012543
58'~mER MARGl\REl' A. MAIZE
59'~~~ms RD #1 OOX #768
6D.~liIp~6~~E I1\NDISBURG, FA 17040
61.SEX 62.DATE OF 12/25/1955
M BIRTH
CLASS C
99
1
FA
'YON
67.CARRIER IDiIE
68.CARRIER
. ADDRESS
69.CITY ,STATE
& ZIPCODE
70.USDOT #
VEH.
CONFIG.
75.NO. OF
AXLES
~
o
o
45
1
FA
63.PHONE
717-789-4809
ICC #
PUC #
74.GVIlR
.RELEASE OF HAZ MAT
Y N IXlUHK 0
CENTER FOR HIGHWAY SAFETY
T!> CARGO
80DY TYPE
6 ~AZARDOUS
MATERIALS
PAGE: \ ,,~ 3
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78.RESPONDING EMS AGENCY SILVER SPRIN3 -
H1\MI?DEN 'Ia'lNSHIP EMS rrnCIDENT #: 'm99-049
=-'-- . '
79.MEDICAl FACILITY 'ror.,YCLINIc:a:::. :mI., UNIVERSITY- HOSPITAL CCIDENT D~TE: Q2/27/1999
A B C 0 E F G NAME ADDRESS H I J K l M
1 1 M 51 3 1 0 U1 (KORrZ) 3 9 7 B 6 1
2 1 F 43 3 1 0 U2 (MlIIZE) 4 9 7 B 8 1
2 3 M 11 3 1 0 .AARCN Ml\IZE SAME: AS 02 3 9 7 B 8 1
2 4 M 10 2 1 0 ANDREW Ml\IZE SAME: AS 02 3 9 7 B 8 1
2 6 M 14 2 1 0 MATIHE.w Skl!;l.l:&<UY SAME: AS 02 3 9 8 C 6 2
@.lllUMINATlON 0 @WEATHER ~ 86. DIAGRAM:
: 0
@).ROAD SURFACE 0 .
84~PENNSYlVANIA SCHOOL DISTRICT ,.,. :S.~.l. A-:r:rl'\,:~~.:. .c~~~,.~.\!'..,J. J>.'.~.~.lt~..
(IF APPLICABLE)
IDlE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BS.DESCRIPTIDH OF DAMAGED PROPERTY
IDlE
OWNER .....................,........ ... >................ -.. .... ............ . . . . . . . . . . . . . . . . . . . . . . . . . . .
ADDRESS
..
PHONE. ..................................................-.................. . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .
87.NARRATIVE-IDENTIFY PRECIPITATING EVENTS, CAUSATION FACTORS, SEQUENCES OF EVENTS, WITNESS STATEMENTS, AND PROVIDE ADDITIONAL
DETAILS, lIKE INSURANCE INFORMATION AND lOCATION OF TOWED VEHICLES, IF KNOWN.
SR0114 IS A FIVE (5) LANE ROAI::mAY, WHIO! TRAVErS IDRIH AND SCXJrn, AL'IHCl\J3H IT IS
DESIGNATED FASl' ANDWE'Sl'. SR0114 HAS 'IWJ (2) LANES roR WE'Sl' rolND TRAVEL, 'IWJ (2) LANE'S
roRE1IST'PGUND TRAVEL AND OOE (1) LEPr 'IURNlANE WITHIN TIm lNI'ERSECI'IOO'.
SR0081 (lNI'ERSTATE 81) IS AN INI'ERS'I1\TE ROAI:mAY WHIO! HAS ENl'RANCE AND EXITS RAMPS THAT
CXlNNECl' WI'IH SR0114 00' TIm IDRIH AND SCJ(]IH SIDES OF TIm INI'ERS'I1\TE.
SR0081 HAS AN EXIT RAMP FRCM SR0081 mID SR0114 00' '!HE SR0114 EAST rolND SIDE OF TIm
ROl\IMAY AND AJ..ro AN ENl'RANCE RAMP 'IO SR0081 rn TIm SR0114 WE'Sl' rolND SIDE OF 'lliE ROAI:mAY
AND 'IRIS IS a::NI'ROLLED BY A TRAFFIC <::niII'ROI. SIGNM..
'!HIS ACCIDENT OCCORRED AS U1 WAS SITI'IN3 IN TIm LEPr 'IURN lANE OF SR0114 EAST rolND,
INI'ENDlN; 'IO MAKE A LEPr 'IURN rnro SR0081 IDRIH rolND. WHILE 02 WAS TRAVE:L:JJ>n 00' SR01l4
WE'Sl' BOUND, APPR0ACHIN3 TIm lNI'ERSECI'IOO' wrrn SR0081. 02 WAS TRAVE:L:JJ>n IN 'lliE RIGHI' LANE
OF SR0114, APPR0ACHIN3 TIm lNI'ERSECI'IOO', WHEN U1 PULLED FRCM '!HE LEPr 'IURN LANE AND IN'IO
TIm PMH OF 02. U1 AND 02 COLLIDED 00' SR0114 WE'Sl' rolND IN '!HE RIGHI' lANE AND AFl'ER
IMPACl' , U1 SPUN 180 DEX3REFS CIDCKWISE AND Cl\ME 'IO FINAL RESl'.
,
l~F~lrtANfalN COMPANY IrMU~CE COIIPANY
ERIE INSURANCE EKCHANE lOTION PRCX3RESSIVE INS en.
UNIT POll CY NO UNIT POll CY NO
1 . ooi 1701399 H 2 60181657-0 I
N'~ <lXlDE PHOHE
88. 107 SHAWNEE DR-~ PA 17363 717-993-5643
WITNESSES NAME ADDRESS PHONE
wpry. VIULAIlUNS 'N".e".." yu. .ce, 'UN , (UNL T It Te Nle I
,Z.H% ,
UNIT 1 VEHICLE 'IURNIN3 LEPr VC3322 ~o
UNIT 2 IDlE N:NE 00
~ '& ~~~T ~ CXJ NO TEST~ USE = TEST NO TEST ,4. INVESTlIiA"~]
1~~ . ::>~~.' USE CXJ COIIPlETE?
UNIT 1 0 0 O. % o REFUSE UNIT 2 0 0 O. % 0 REFUSE YES m NO 0
DUNK 0 UNK
PAGE:;;l. ot" 3
CENTER FOR HIGHWAY SAFETY
''''
~REFER TO OVERLAY SHEETS
INCIDENT
NUMBER TA99-049
, 'UN:U'C.
I"'K BCD E F G
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COMMONWEAL11I OF PENNSYLVANIA
PAR CONTI!(UA110N SHEET .
REPORTABLE CXJ NON-REPORTABLE D
I ACCIDENT
DATE 02/27/1999
NAME '" ....r 'U" "uuc,
COUNTY
CODE 21
PENNDOT USE ONLY
jMUNICIPAL
CODE 212
HIJKLM
ADDRESS
~!::.!!!!~" ~!.! .
WHEN 'IHlS OFFICER ARRIVED rn '!HE SCENE, Ul DRIVER WAS Sl'ILL SEMED IN 'IHE DRIVERS SEAT AND
WAS 'Ilm CNLY PERSCN '!HAT WAS IN 'IRE VEHI:CLE. U2 DRIVER WAS WALKIN3 ARa.lND 'IRE ACCIDENI'
SCENE, AIQiG WI'lH 'IW:) (2) OIHER PEOPLE '!HAT WERE AIEIJ IN U2 VEHI:CLE AND A FOURlH PERSCN
WAS SEMI: CXNSCIOUS, SEMED IN 'IRE REAR SEAT OF U2.
Ul DRIVER REU\TED 'IHAT HE WAS IN 'IRE LEFT '!URN LANE OF SR0114 AND WANI'ED 'IO MAKE A LEFT
'!URN rnro INI'ERSmTE 81 AND '!HAT HE HAD A GREE:N LIGHI'. HE 8'mRI'ED 'IO MAKE 'Ilm LEFT '!URN
AND M1IDE rr ACROSS 'Ilm ~ AND SAW A VEHI:CLE CXMlN3 '!HAT APPEARED 'IO BE OOIN3 'IOO J!2\ST
AND WAS S'l'RtJq{ rn 'Ilm rn R1\MP 'IO INI'ERSTATE 81~ JUST PAST 'IRE a::NCREI'E TRIAN3LE.
Ul'bRIv:SR'SUSTAINED J:N:JURl:FS IN 'IRE ACCIDENr AND WAS TAANSroRI'ED 'IO roLYCLINIC HOSPITAL BY
~.
Ul VEHICLE SUSTIIINED SEVERE DI\MAGE AND WAS 'IOOED FRCM'IRE SCENE BY MILLER AND S1lMS ']U;oI]N3
SERVICE .
U2 DRIVER RErATED THAT SHE WAS IN 'IRE RIGHI' LANE OF SR0114 AND OBSERVED '!HAT SHE HAD A
GREEN. I4GH):\~,~ CJ,;-lI,iY'.q;)IN3 45 MPH. AS ~W\S APPR0ACHIN3 'IRE TRAE'FIC SIGNAL, I. SAW
'IHAT 'lHE:RE WAs' A TImCK SlOPPED IN '!HE LEFT '!URN LANE OF SR0114 FAST AND 'lHEN HE TURNED
RIGHT IN FRCINI' OF ME AND WE HIT.
U2 DRIVER SUSTAINED INJURIES IN 'IRE ACCIDENI' AND WAS TAANSroKl:W 'IO UNIVERSITY HOSPITAL BY
AMBUIANCE. U2'S'IHREE (3) PASSEN3ERS AIEIJ SUS'lroNED INJURIES IN '!HE ACCIDENI' AND 'IW:) (2)
OF 'IHEM WERE TRANSroRTED 'IO UNIVERSITY HOSPITI\L BY AMBUI1INCE, WHILE 'IRE 'IHIRD PASSEN3E:R
WAS Fl.OilN 'IO UNIVERSITY HOSPITAL BY LIFE LIrn AERCMEDICAL SERVICE.
U2 VEHICLE SUSTIIINED SEVERE DI\MAGE AND WAS 'IOOEDFRCM THE SCENE BY MILLER AND
SAMS '.I'a'lIm SERVICE.
WI'INFSS #1 (OCODE) RErATED '!HAT HE WAS S'IOPPED BEHIND 'IRE DRIVER OF '!HE PICKUP 'IRUCK rn
SR01l4 FAST BOUND IN THE LEFT '!URN LANE, WAI':I'IN3 'IO MAKE A LEFT '!URN CNro lNI'ERSTh.TE 81.
THE TRAFFIC SIGNAL TURNED GREEN AND THE PICKUP TRUCK 'lURNED LEFT AND OOJDE REJ:ATED 'IHAT HE
SAW THE OIHER VEHICLE '!HAT WAS TRAVELlN3 IN 'IRE RIGHI' LANE OF SR01l4 AND rom VEHICLES
CRASHED, THE PICKUP 'IRUCK 'lHEN SPUN AROUND AFrER IMPACI'.
i.I:OY. .,
UNIT 1
11
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'UN" I "
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UNIT 1
1 PROBABLE
USE
11921 TYPE
I ~- TEST
I@ RESULTS NO TEST ~~ff
D fmffi......
D REFUSE UNIT 2
DUNK
~ ~ROABLE
USE
I~!YPE
TEST
~ RESULTS
D
D
D
00
00
4. INVESTIGATION
NO TEST COMPLETE?
REFUSE ~ 0
UNK YES ~NO
UNIT 2
PAGE:~
CENTER FOR HIGHWAY SAFETY
TA I: Q'\-OL\:9
DATE:~q'i
.. TINE: .;l:lLHI IIRS.
SILVER SPRING T<MNSIIIP
POLICE DEPARTMEN!'
-,
COLLISION DIAGRAM
SILVER SPRING T<MNSHIP-212
CUMBERlAND COUNl'Y-21
INl'ERSOCTION: Se.Ol\Lt ~~Roogl
Nor TO SC1\LE/ILLUSI'RI\TION ONLY
OFFICER :'Y0<1'rE1c.1l1(.
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~ PennState Jelsmger
. Health Systern
Section of Pediatric Surgery
Department of Surgery
Telephone 717531-8342
Fax 7175314185
Peter W. Dillon, M.D.
Section Head
Robert E. Cilley, M.D.
Coteen P. Greecher, M.S, R.D.,
C.N.S.D.
NeonatallPediatric Nutritionist
Janet H. Shields, M.S.N.,
C.R.N.P., C.S.
Clinical Nurse Specialist
Susan Rzucidlo, M.S.N., R.N.
Pediatric Trauma Nurse Coordinator
Administrative Staff:
Marcia A. Krick
Section Coordinator
Lee A. Naylor
Staff Assistant
Specializing in the Surgical Care
of Infants, Children. and Adolescents
Including:
Biliary Atresia
Neonatal Surgery
ECMO
Pediatric Trauma and Injury
Prevention
Minimally Invasive Surgery
Pediatric Surgical Oncology
Pediatric Thoracic Surgery
Anorectal Malformations
Inflammatory Bowel Disease
Pediatric Weight Management
Vascular & Lymphatic
Malformations
Hirschsprung's Disease
Children's Hospital
The Milton S. Hershey Medical Center
P.O. Box 850, M.C. H113
Hershey, Pennsylvania 17033~0850
July 6, 1999
Riohard A. Sadlock
Angino Rovner
4503 North Front Street
Harrisburg, PA 17110
Dear Mr. Sadlook:
Thank you for your note of June 24, 1999, regarding Matthew Shetterly, DOB
3/26/84, SS #160-70-1616, HMC #976383.
This 14 year old male was involved in a motor vehiole orash on 2/27/99. He was
cared for at The Milton S. Hershey Medical Center on the pediatric surgery service
under my supervision. The story accompanying the patient indicated that he was the
back seat lap-belted passenger in a motor vehicle crash. He presented as a trauma
alert to The Milton S. Hershey Medical Center. His injuries included a closed head
injury, multiple external bruises and abrasions and internal visceral injuries
irwluding ajejuna] perforation, retroperitoneal hematoma, small liver contusion and
incomplete pyloric crush injury. On initial examination, he had some abdominal
tenderness and a small amount of interperitoneal fluid. His CT scan did not show
olear cut evidence of viscera] perforation and his bladder was .intact. He was
adrnitted for serial examinations, which during his first day in the hospital,
demonstrated him to have peritoneal irritation consistent with intestinal perforation.
His white blood cell count was elevated and he had a low grade fever. For this
reason, exploratory surgery was recommended to his family with the likelihood of an
intestinal perforation being found. This plan of care represents our standard
treatment for such injuries. Once the diagnosis of intestinal perforation was olear by
the progression of his physical examination, the surgical procedure was undertaken
on 2/28/99. A ]aporoscopic evaluation was performed. At that time, a jejunal
perforation was identified and a laporoscopically assisted repair was performed. He
had an unusual configuration of the appendix 'and, therefore, an appendectomy was
also performed. His liver had a small hematoma which was not significant and
should cause no bleeding. There was also evidence of a crush injury to the pyloric
region of the stomach which was not full thickness and demonstrated not be
perforating and was, therefore, left to heal on its own. He was cared for post
operatively on the pediatric surgery service. I rendered daily care during his
hospitalization. Daily care was also rendered by other members of the pediatric
surgery service. Post operatively he was maintained on intravenous nutrition. He
had a prolonged stomach dysfunction (gastric ileus). This was most likely due to his
pyloric injury. A contrast study was performed to prove that he was not obstructed.
He was weaned gradually from the TPN as his diet was advanced slowly. His gastric
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emptying was improved by the addition of Reglan (a prokinetic, gastric emptying medication).
At the time of discharge, he was tolerating a diet, ambulating without difficulty, and his pain was
under good control with medication. His discharge medications included Reglan, and Tylenol #3.
Matthew was seen in follow up on April 7, 1999. At that time, we reviewed his injuries including
his liver contusion/laceration, jejunal perforation, central mesentary hematomy and pyloric
contusion/crush injury. We discussed his prolonged intestinal dysfunction and his return to good
feeding at the time of discharge. Since discharge, he was ambulatory and doing well at that time
without difficulty eating. We indicated that he had no nausea or vomiting and minimal
abdominal pain. He does have some minor intestinal symptoms which he describes as indigestion
giving his a little bit of discomfort in the epigastric area. He continued to take his Reglan.
We indicated that he should stay on his Reglan if it helps him and use an over-the-counter H2
blocker (Pepsid) to see how that makes him feel. We indicated that he should restrict his physical
activities to walking alone and light activity without placing him at risk for further abdominal
injury and should stay out of Phys Ed at school. We planned on seeing him in 6-8 weeks for
follow up testing and evaluation.
We saw him again on May 26,1999.. He returned with a CTscan which demonstrated no residual
liver injury. This is our standard practice to document healing of injuries. At that time, he
indicated that he was having minimal abdominal pain, he was on an unrestricted diet and had
returned to his normal activities. At that time, we released him from our care and indicated that
we would be happy to see him at any time in the future.
We have n() ,future tr~atmentplans for Matthew. I believe his prognosis is good. Concerns we
would raise include the possibility of musculoskeletal discomfort related to his injury. He had no
documentation of back or neck injury during our care, but such problems may be present in
patients for extended periods of time after significant injuries sustained in motor vehicle crashes.
His concussion and head injury was minor and we have no evidence that he has residual
problems. Again, such problems may occasionally be present after a motor vehicle crash. His
intestinal injuries seem to be well healed. He continued to have some mild epigastric pain for
which we have not established a diagnosis. An additional diagnostic work up may be needed if
this is persistent. This could include laboratory test, upper GI, gastrointestinal radiographic tests
and CT scans and endoscopy studies. At this time we have no plans for further diagnostic studies
or treatments for Matthew. In addition, the pyloric contusion/crush injury of which we spoke is
likely responsible for his slow stomach emptying and difficulty eating that he had after surgery.
Weare uncertain whether this will cause him symptoms in the future. Certainly if it does,
diagnostic work ups may be in order. It is impossible to determine the costs of these work up or
treatment. It is impossible to determine the degree of symptoms that this problem may cause in
the future.
Please call me if there are any questions regarding this report.
Sincerely,
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VERIFICATION
1, MARGARET MAIZE, as parent and natural guardian of MATTHEW SHETTERLY,
Plaintiff, have read the foregoing PETITION FOR APPROVAL OF MINOR PLAINTIFF'S
COMPROMISE SETTLEMENT AND DISTRIBUTION OF PROCEEDS and do hereby
swear or affirm that the facts set fotth in the foregoing are true and correct to the best of my
knowledge, information and belief. I understand that this Verification is made subject to the
penalties of 18 Pa.C.SA Section 4904, relating to unsworn falsification to authorities.
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CERTIFICATE OF SERVICE
1, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.C., do hereby
certifY that I am this day serving a true and correct copy of PETITION FOR APPROVAL OF
MINOR PLAINTIFF'S COMPROMISE SETTLEMENT AND DISTRIBUTION OF
PROCEEDS on the following via postage prepaid, first class United States mail, requested
addressed as follows:
Ms. Debra A. Klinger, AIC
Claims Adjuster
Erie Insurance Company
P.O. Box 2013
Mechanicsburg, PA 17055
Claim Number: 010170414911
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Mar yL. B mes r
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Date: April 26, 2000
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
MATTHEW SHETTERLY, a minor, by
and through his natural guardian,
MARGARET MAIZE,
Plaintiff
AMICABLE ACTION
NO. 00-2606 Civil Term
v.
JOHN D. KURTZ, a/k/a JACK D. KURTZ
Defendant
JURY TRIAL DEMANDED
PRAECIPE
TO THE PROTHONOTARY:
Please mark the above-captioned action as settled, satisfied, and discontinued.
ANGIN
P.C.
ichard A. , sqUIre
. . 0.47281
4503 N. Front Street
Harrisburg, PA 17110
(717) 238-6791
Counsel for Plaintiff
Date: August 1, 2000
cc: Ms. Debra A. Klinger, AIC
Claims Adjuster
Erie Insurance Company
P.O. Box 2013
Mechanicsburg, P A 17055
Claim Number: 010170414911
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IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
MATTHEW SHETTERLY, a minor, by
and through his natural guardian,
MARGARET MAIZE,
Plaintiff
AMICABLE ACTION
NO. 00-2606 Civil Term
v.
JOHN D. KURTZ, alk/a JACK D. KURTZ
Defendant
JURY TRIAL DEMANDED
PROOF OF DEPOSIT
In accordance with Pennsylvania Rule of Civil Procedure 2039, attached is a photocopy of
the Certificate of Deposit issued on July 28, 2000 from The Firt National Bank of Liverpool to
Margaret A. Maize, as Custodian for Matthew E. Shetterly, a Minor, as proof of deposit of the
settlement proceeds.
No withdrawal can be made from any such account until the Minor attains majority, except
as authorized by a prior Order of Court.
ANGINO & ROVNER, P.C.
Rich rd A. Sadloc Ulre
1.0. No. 47281
4503 Notth Front Street
Harrisburg, PA 17110
(717) 238-6791
Counsel for Plaintiff
Date: August 1, 2000
217566.lIRAS\MLB
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THE FIRST NATIONAL BANK
OF LIVERPOOL
P.O. Box A, 1 04 N. Front St.
Uverpool, PA 17045
JEANETTE K. TOWSEY
ASSISTANT CASHIER
PH: 717-444-3714
FAX: 717-444.2157
.
~~@~A..:mP~j~W-9QQ:.:;;~II:'lOOl~'t;iNO~B4'fflZ.CON'UlQJC:orJ:.l".UNDS;;;.u:N:t~Ile~RMClIES .
AGE OF MAJORITY
TIME CERTIFICATE OF DEPOSIT 3/26/2002 DATE JULY 28, 2000 4558
NOT NEGOTIABLE - NOT SUBJECT TO CHECK
O"POSIT TWELVE THOUSAND EIGHT IlUlIDRED SEVENTY FIVE AND NO/loo
O"POSITDR(S) MARGARET A. MAIZE AS CUSTODT AN FOR MA'I'TRF.W F. SllRTTF.RT.V
ADDRESS RR 1 BOX 768. T.ANllTSBURG PA 17040
This 2 YEAR Time Certificate of Deposit matures on JULY 28. 2002 .
o PRESENTTHIS CERTIFICATE PROMPTLY AT MATURITY FOR PAYMENT. THIS CERTIFICATE IS NOT AUTOMATICALLY RENEWABLE.
I'\'V THIS CERTIFIC. ATE MATURES ON THE MATURITY DATE STATED ABOVE. IT WILL AUTOMATICALLY RENEW FOR SUCCESSive TERMS, EACH EQUAL 10 THE ORIGINAL TERM.
~ UNTIL ONE OFJHE FOLLOWING THINGS HAPPENS: 1) THIS CERTIFICATE IS PERSONALLY PRESENTED FOR'PAYMENT ON A MATURITY DATE OR WITHIN TEN DAYS AFTER THE MATURITY
DATE; 2) WE RECEIVE WRIITEN NOTI(:E FROM YOU BEFORE A'MATURITY DATE OFYOUR INTENTION TO CASH INTHIS CERTIFICATE.
POST MATURITY INTEREST: Unless we tell you otherwise in a separate document, interest will not accrue on this deposit after final maturity.
INTERESTTO FIRST MATURITY DATE WILL ACCRUE AT THE RATE OF 5 .50 % WITH AN
ANNUAL PERCENTAGE YIELD OF 5 . 64 %, USING A 365 DAY/YEAR.
INTEREST WILL BE: :g ADDED TO PRINCIPAL. 0 MAILEDTOTHEOWNERS.
o PAIDTO ACCOUNT NUMBER
o ..
NOtify this institution immediately of any change in lhe above address. Addlltonallerms are on page two.
@ 1963,1995 aankers Systems, Inc., St. Cloud, MN (1.600-397-2341) Form MPCD 612195
""OOLLARS, $
SOC. SEC. NO.
12.875.00
1"0-70_1"1"
THE FIRST NATIONAL BANK OF LIVERPOOL
LIVERPOOL, PA 17045
.
._ tJ:~~._~ ~~~~~GNATURE
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t_.I.IIt11~r.'...I.lttll ',I~nil\l!::tIiIU:ll~U::l.l'ltl~lIto1.1:::l.. 11..,.,Il:1:I:f"totU'J::;g:/.,u::!.u''Ii:",:W'.,',lltt:IOJ::J:IIH.::ltlll:t.1:lol::l;_!,
ANGINO & ROVNER, P.C.
ESCROW ACCOUNT
4503 NORTH FRONT STREET
HARRISBURG. PENNSYLVANIA 17110-1708
FIRST-UNION
12008
NUMBER
22008
3-501310
PAY:
B~Y "*.*12,815 DOLLARS AND 00 CENTS *'**
DATE
7/07/2000
AMOUNT
$*****12,815.00
VOID AFTER 90 DAYS
TO THE
ORDER
OF
H1\RGARET MAIZE, AS PAREtrr ANI>
NATURAL GUARDIAN OF MA'l"rBEW
SHE'l"1'ERLY
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DISCLOSURE OF ACCOUNT TERMS
FEES AND INTEREST RATES
FIRST NATIONAL BANK
104 NORTH FRONT ST.
LIVERPOOL, PA 17045
717 - 444.3714
TERM 2 YEAR CERTIFICATE OF DEPOSIT
Rate Information
The interest rate for your account
with an Annual Percentage Yield of
You will be paid this rate until the maturity date. Your certificate will mature on
~_~o
5.64
Jill.Y 28. 2002
0/...
%
Interest for your account will be compounded MONTHLY
Interest will be credited to your account on the anniversary day of each MONTH
period. The APY assumes that interest remains on deposit until maturity. A withdrawal will reduce earnings.
Interest begins to accrue on the business day you deposit any non-cash items (for example, checks).
Minimum balance Requirements
You must deposit $ 5.000.00 to open this account.
Dailv balance comDutation method
We use the daily balance method to calculate the interest on your account. This method applies a daily periodiC
rate to the principal in the account each day.
Transaction limitations: I
After the account is opened, you may not make deposits into or withdrawals from the account until the maturity
date.
Exception - An IRA or other tax qualified plan can make deposits in amounts not less than $100.00, within the limits
of your plan.
Earlv withdrawal Denalties (a penalty may be imposed for withdrawals before maturity)
. If your account has an original maturity of one year or less:
.....~e fee we may impose will equal three month's interest on the amount withdrawn subject to penalty.
(' . II YOor account has an original maturity of more than one year:
'-------the fee we may impose will equal six month's interest on the amount withdrawn subject to penalty.
There are certain circumstances, such as the death or incompetence of an owner, where we may waive or reduce
this penalty. See your plan disclosure if this account is part of an IRA or other tax qualified plan.
Automaticallv renewable time account
This account will automatically renew at maturity. You may prevent renewal if you withdraw the funds in the
account at maturity (or within a ten day grace period.) If you prevent renewal, interest will not accrue after final
maturity.
Each renewal term will be the same as the original term, beginning on the maturity date. The interest rate will
be the same we offer on new time deposits on the maturity date which have the same term, minimum balance (if
any) and other features as the original time deposit.
,........
. PER COURT OllDER DATED 5/25/2000, MATTHEW MAY NOT HAVE CONTROL OF FUNDS UNTIL HE REACHES
AGE OF MAJORITY ON 3/26/2002.
I have received a copy of this disclosure on the date indicated below.
1'~8-0() ~(jfca~~ _
(Date) Account older ~
Account holder
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CERTIFICATE OF SERVICE
I, Marcy L. Brymesser, an employee of the law firm of Angino & Rovner, P.c., do hereby
certifY that I am this day serving a true and correct copy of PROOF OF DEPOSIT on the
following via postage prepaid, first class United States mail, requested addressed as follows:
Ms. Debra A Klinger, ArC
Claims Adjuster
Erie Insurance Company
P.O. Box 2013
Mechanicsburg, PA 17055
Claim Number: 010170414911
ilOJl (lJ/;/@&wOMP/v
Mar y L. Brymesser
Date: August 1, 2000
217566.I\RASIMLB
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