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HomeMy WebLinkAbout00-02606 - 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: ~~ j -;( -QO AKS J. 211812.I\RASIMLB ..-, 1ililIillt~"IIIi8liilili_iiIiillwIii_llI~ :.1 ."~_,1Il ~) '--'- >--- ~ '-7 :54' ;;'~;1i~ ~..:.: 5~ " 'j.' ,'J~; ;':;0- :-.,,1 ,-:-J CJ ::5 'lL Illlilili. ~ '.~o." ','~c'", >-, .",,> "j,_ ,_~ ., ","~~_ ~, -~ " I ~ < -' ~._'''~.'. ~'-~ =--"" - ~~'~'" 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 J. ii 5-0( f-rJ7i {J-er-NV-Ptl- s.cw; c.e.., li .~'~." 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 " li ^"-.<,o,c 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 , --'."". 'w__o _, ~-",~.' ~. ,,~'" , .-,,,";.<1 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 ($12,875.00), is to be held in trust for Matthew Shetterly in an account which is insured by the Federal Government and that no withdrawal be made therefrom until Matthew attains majority or authorized by Coutt Order. WHEREFORE, Petitioner respectfully requests Your Honorable Court to approve the minor's compromise settlement and authorize the payment of attorney's fees from the fund due the minor and direct payment due to the minor to be deposited in a bank in trust for Matthew Shetterly. Date: April 26, 2000 211812.I\RAS\MLB " ~ 4'~~ ~ ~"-- .wiII1_~ ~~ r;OMMONWEALTIl OF PENNSYLVANIA POLICE ACCI(JENT REPORT ( . ~RgFER TO OVERLAY SHEETS f~~&:~...' ~/." 1. INCIDENT NUMBER 2.AGENCY NAME 3.STATIONI 21/212 PRECINCT 5. INVESTIGATOR Pl'L. JEFF roITEIGER 6.APPROVED BY 2410 7. ~~~~SllGATlON 02/27/1999 SAWRDAY 12.NUMBER 2 OF UNITS 15.PRIV.PROP. 0 'Xl ACCIDENT Y N . ~ 17.VEHICLE DAMAGE 0 O-NONE UNIT 1 3 1-L1GHT 2-MODERATE ~ 3-SEVERE UNIT 2 ~ a:JM8ERL1:\ND 21.MUNICIPALITY SILVER SPlUN3 'IWP 21 CODE 212 PRINCIPAL ROADWAY INFORMATION 22.ROUTE NO.OR SR01l4 STREET NAME 23.SPEED 45 LIMIT IF NOT AT INTERSECTION: 30.CROSS STREET OR SEGMENT MARKER 31.DIRECTION N FROM SITE 33.DISTANCE WAS 4 CONSTRUCTI ON ZONE 4 TYPE HIGHWAY 2 INTERSECTING ROAD: SR0081 (INI'ERSTATE 81) 8 TYPE HIGHWAY 1 5 ACCESS 1 CONTROL 9 ACCESS CONTROL 2 S E W 32.DISTANCE FROM SITE MEASURED 0 ESTIMATED D 5 TRAFFIC PRINCIPAL CONTROL DEVICE FT. MI. INTERSECTING yDNgg yOONOyOONO 18.HAZARDOUS .0. . .'x1 19.PENNDOT MATERIALS Y N ~ PROPERTY "[ffjt.." ~'. '.~~~"Ailiff'll~11;~w~W%li.J~tff.;;:'~~fi!,*f~ ~~{f~~*tit~~<<f~W*Wl~~;ilil.~IWj.~~~~;;;'.~:~"~.~~. ,......~.:::~.;>N....W~_:m.<::<<::;.~~........JL.~)M;tl~.ffl~s.~..w...'w,..._%m-(?,>>.~:::::,A.*~Jr.R.;x:::::@$..:<<. &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 ~ "''''J"., .....""... . > ~. , , ,;,j,."-l~ - '"'"" , "". 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 @ ~- 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 . .U. 'UN" I " '" HI" '1.&1 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(. ^'-,-""", I 'N ., ", "" '- .- .......,...~-,-_. .- - - - - - 'lolTI;ll.lnl'T"!(816). -=--- ~'t'lI-n8IQ ~~');!,,", ~ 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 .,,-,"< --' -- ',',~" <I . 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, , ,~, ,,,' ' ~ . -',"' co ~ ~ ~,..._" "C"-' ',_,__ j~ , 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. lli 'm~ ~~ize ~ Dmd i/1A/ 203793.1\RASIMLB II ~,.~-"~' ," --,~,~',~- '-- ~.~~- _ =-~--=-'''' "'''",..- "'+-" ! 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 ~{I~~X~ DAhA Mar yL. B mes r .-' Date: April 26, 2000 211812.1\RAS\MLB ti 1/,;,-,;;,: L-"., '-''''''iIiIililililiiiilli_ii__llii...iill_.''~'='~~--' .-' '~' "',. .q~-,~','---'''' ,~ L., , . ,~ ~' ~ '-', ""." .. '~-- , "jJ ~ ./:: ~ " 0 s-=: " J c: ~.. ~ h h -r;:---* C5 -r: 8 0 n',' rS () ~ L': ,', ['-) _.u.',', .0 D u' '-:L -- , .c: ~ , r-;:C ~ I :.:~-. , , ~ ;::: ~ Q, if F r",} " , 7~ :;::i -j Co.) :''::1 --. .......l -< J L -<. ~ "'~_ w" ~_'_~"'.' _~,N",~""~r_,~'~--"'" "-<<"'-""'''i 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 Lilia"'" ,_~"i""'-'i'''__' ,~"""",~,-;.,-~ (') C) S'~ C.:.: C) ~ }"::lio co rr: rTI [~ C;-') Z ...,;.... ',,:., (f) "::. r'0 -< r- ,- ::~ ,-,-' w - ,- ;'----,' > '-,- 1"-,) c: ~;;- ~ :.-'1 -< ~[::-. ~. ^ " .~, ,--.'~".'~~ "F"'''-_''' .,_~, ,-.">~," '.-' ",~'h,,,, ,1 oo.~" __.'-d_ L-, ,-:; ~,~,~, 1 ~", " " -":'''i 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 -- . , - ,J" 0# 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 . "..-.______----,--.- o___'_____'___~__.__~ r 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 l _. ~'fiiljI;tI;I:a:t:t'l ::l.I:1:1'1i:11'I:Utl::RIl:n;1I.!tltol'I,' '::l~'i'IlIl"I...I"I:::l-"1l1"~W":&ll~lttr.'IIIl'.'l'~.::l:I-",.,:t;iII'llI:!tIIllO.'~Il!"'~D"'U("IIll:::llltolll'II:t','_t 11'00000 ~ 200811' 1:03 woOS031: 2000b ~1. 21.SQ8?II' ~""..~~_. _._,--.....~.,.~.,---:-.'"~-'--" ..,,--,~ ,....~.~,-..,,-,-,.'. . ~~ ~~" >>~,I' ~-".. - .1 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 '-'.-'" -,"" '~".-' ,"'=--y~" ,.UV'.',,"",''''', ,",',' n~~ ,~' """~'<=."'-m""',"',o,,,,,~',,,,,,,-,,__,,,,,"-,;,'"~_',,~,;:"',< '~--'~-''',c,li;.;<;;:-t 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 ,_,'"',,'C ,,"- -- "'---'ilIIliiIiiiiiiIiIi_Iil~w-~, ~N~ i ~ ~'LliIllltIi ',''''.,,-,' ,~, .~' , " (") C: ;;-7~ ~r- C :-:.-::: ::,.,,.'--< :!.-..,.c ? :'! f',.) .~ .-" C~l C;.; ]":1!>0 () --"1 "'-.I ';~I=G ;~,::i I r,,--, "'\,_.i ~'O " ) , - ~~: '~ =<