HomeMy WebLinkAbout01-5803RICHARD LEBOWITZ and
DARLENE LEBOWITZ,
as parents and natural guardians of
JOSEPH LEBOWITZ, a minor,
377 Ronald Drive
Fairfield, CT 06830
Plaintiffs
ASHCOMBE VEGETABLE FARM,
906 Grantham Rd.
Mechanicsburg, PA 17055
Defendant
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, pENNSYLVANIA
: CIVIL ACTION LAW
pRAECIPE FOR WRIT OF SUMMONS.
TO THE PROTHONOTARY:
Please issue a Writ of Summons to Defendant, Ashcombe Vegetable Farm in the above-
captioned matter.
BY:
^St. THplVp/S t&,Jq)pFER, LLP
74../34 -
I~ic~ele l.lThorp, Es~tu~e ' 9
305 N. Front S et/egt4PO Box 99
Harrisburg, PA 17108
IDNo. 71117
(717) 237-7153
WRIT OF SUMMONS
To: Ashcombe Vegetable Farm, Defendant
You are notified that the above-named Plaintiff has commenced~an acUop,~mnst you.
Pr~honotary ' ' (~
- Deputy
RICHARD LEBOWITZ and
DARLENE LEBOWITZ,
as parents and natural guardians of
JOSEPH LEBOWITZ, a minor,
377 Ronald Drive
Fairfield, CT 06830
Plaintiffs
ASHCOMBE VEGETABLE FARM,
906 Grantham Rd.
Mechanicsburg, PA 17055
Defendant
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
: NO.: 01-5803 Civil Term
: CIVIL ACTION LAW
PETITION TO APPROVE MINOR'S COMPROMISE SETTLEMENT
AND NOW, comes Plaintiffs Richard Lebowitz and Darlene Lebowitz as parents and
natural guardians of Joseph Lebowitz ("Plaintiffs") and file this Petition to Approve Minor's
Compromise Settlement and aver the following in support thereofi
1. Plaintiffs Richard and Darlene Lebowitz are the parents and natural guardians of
minor Joseph Lebowitz ("Minor").
Plaintiffs and the Minor reside at 377 Ronald Drive, Fairfield, CT 06432.
Minor was bom on June 11, 1990, and was seven (7) years old on the date of the
3.
accident described hereinafter.
4. Defendant Ashcombe
Vegetable Farm ("Defendant") is a Pennsylvania
Corporation with a principal place of business at 906 Grantham Road, Mechanicsburg, Pa 17055.
5. This Petition is filed as a result of an accident which occurred on or about October
4, 1997, at Defendant's place of business on Grantham Road in Mechanicsburg, Cumberland
County, Pennsylvania.
6. At the time of the accident, Defendant had a children's play area on its business
premises, with one of the items in the play area being signs painted with various animals.
Generally, children placed their heads in the cut outs of the various animals and their pictures are
taken.
8.
sign fell over.
9.
10.
Minor was participating in aforesaid activity in the children's play area, when the
As a result of the accident, the Minor sustained cuts to his chin and neck.
Minor was treated after the incident at Holy Spirit Hospital, where he obtained the
stitches. A copy of the Minor's Holy Spirit records are attached hereto, incorporated herein by
reference, and marked as Exhibit "A."
I 1. Since the accident, the Minor has had additional treatment, including removal of
the stitches and evaluation of the residual scar on the Minor's neck. A copy of the Minor's
medical records from Fairfield County Healthcare Associates, P.C. d/b/a Pediatric Healthcare
Associates and records from Rick Rosen, M.D. are attached hereto, incorporated herein by
reference, and marked as Exhibits "B" and "C" respectively.
12. At the time of the accident, Defendant was insured by a commercial liability
policy issued by Commercial Union Insurance Company, now known as OneBeacon Insurance.
Said policy was Commercial Union policy no. APR508858.
13. On behalf of Defendant, OneBeacon has offered to compromise this claim for the
sum of fifteen thousand dollars ($15,000.00).
14.
15.
se~lement.
Plaintiffs believe that this offer is fair and in the best interest of Minor.
Therefore, Plaintiffs request that this Honorable Court approve the proposed
16. Plaintiffs understand that the settlement funds will be placed in a restricted,
federally insured account, with no withdrawals from the account until Minor reaches the age of
majority, unless authorized by Court Order.
17. Additionally, Defendant requests that Plaintiffs be authorized and directed to
execute a full and final general release in the form that is attached hereto, incorporated herein by
reference and marked as Exhibit "D."
18. Defendant also requests Plaintiffs be authorized and directed to file a
discontinuance of record with the Prothonotary of the Court of Common Pleas of Cumberland
County.
Wherefore, Plaintiffs Richard Lebowitz and Darlene Lebowitz, as parents and natural
guardians of Joseph Lebowitz, pray this Honorable Court enter an order compromising this
action; approving the proposed settlement; authorizing and directing Plaintiffs to execute a full
and final release; and authorizing and directing Plaintiffs to file a discontinuance of record.
By:
'chard Lebowit~ ~. ~
Darlene Lebowitz ~
M[ch~l~ J.'T~rp, s~q~e ~
EXHIBIT A
=-NAME,.%= ~ LEBOWITZ ,JOSEPH M ' ' ~,-
....... ~5 .......... ,---= =-.,': ............ ~ z'=~.' :.~=.. ~,.~ ~ .... ~:i~.~~ Y~]Y-V~T1190
ADDRE~ 377 R]NAL~ ~RIV~ /~AIRFIE~D /CT/0~432 PH ~ 203-334'i~0~
: BIR~HD~TE: 0~/11/.~?~ . AGE: 7 SEX: M MS: S RACE:
.NAME:
A[DRE~o.
CHILD
EMERt~=NCY CONTACT INFORMATION
KRAuSE ,SCHERi REL TO PT: V '~ WORK PH ~: 7!7-00G-0000
3700 BARNSTAPLE /MECHANiCSBURG /PA/17055 PH ~: 717-7~o-o._,.~/
NAME:. REL TO PT: WORK PH ~:
.A£DRESS. / / / PH ~:
CASE INFORMATION
180018 .ED GROU~ ~' REG SOURCE: EO PATIENT TYPE: E
.AMB B~T. IN BY:
,COMMENT:
~J~J¢,i':/TIME: 10/04/97 16:55
,.-DESCR. I.P, ZIO?~: RT FELL WHILE GETTING' PICTURE
HOSP 8ERV: :ECO FINANGi. At~ CZ;LS: B
VISIT CLINIC CODE: EOJ_i ~OIJT
I CD -';? riX:
BRT iN BY: PAREd. TS/FRIEND'._=;
ACCIDENT INFORMATION
A_.C iND: 0 JOB RELATED: N LOCATION:
TAKEN· !N FACE ~IGN
.,NAME:.. ... R D LEBpW~]'Z
ADDRESS: 377 RONALD DRIVE
,EMPLOYER: AIFS tNO
102 GREENWICH AVE
GUARANTOR iNFORMATION
PT REL TO GUAR: 0 SS #:
/FAIRFIELD /CT/06432 PH ~:
CONTACT NAME:
/GREENWICH /CT/06830 PH¢:
12G-48-126'~
INSURANCE INFORMATION
PLAN iNSURANCE CO '
SUBSCRIBER
~EBOWITZ ,RICHARD
MEDICA_RE SECONDARY QUEaTION~.
~,CO~MENTS: FMD:
!:i PATIENT, NAME:
COB POLICY ~ GROUP #
REL F'C VFY CARD PRECERT/AUTH ~ PRECERT PHONE
I XGC01234812 6~ 068~52000
0 Y Y =
Mechanicsburg, PA Claims
INITIALS:
PT~:
OUT OF AREA ~ .
.L.E..B,.3.~WiTZ ,_.._J~S_E_PH,..~ //~/,/ .
1111773& MRS: --,7; 4,:,4
[] Pull [] Attach '¢
MEDIOARE~'SIGNATURE ON FILE: ~,~
CONSEN'? TO MEDI AL _ .~ TMENT
I hereb~ .sent and authorize Holy Sprit Hospital, its agents, and employees, to the rendering of medical care, which may include routine die n
procedures and such medical treatment as my attendino or consultin- -~---:--' ...... '~ ..... ' . . ' g ostic
~sc~h~m°rwei~lovr~vns~c o~et~r ~effdh~olo~s.u~s..t~;~,p.rocednr~. w. iii,be p.e. ff. ormed upon me unless or until I have had an opportunhy to
- . - .............. ~..~,,-~lonai ~o my sa~tact~on, il' 1 am a competent adult, I have the right to consent or refuse
~lOc~.~.ta.~t.o ~y,, .p~_s~_. p..r~_.ed.~ re or ~era~utic ~..neot.,l will not.~ involv~t in any r~.arch or exporimenUd procedu~ without my fun knowledg
mJary or even death and acknowledge that no ~arantee has been made to me as to the results of any examination or treatment in this Hospital.
I understand many of the physicians on the stuff of Holy Spirit Hospital are not employees or agents of the HospiTal, but rather are indet~ndant contractors
who have been ~ranted the privilege of using these facilities for the care and treatment of their patients. Further, I ~alize this Hospital is a teaching
Hospital and at the Hospital are health care personnel in training who, unless expressly requested otherwise, may participate or mav be resent during
my care as pan of their education. Still or r~tion picturias av~- closed-circuit~elevision monitoring of patient care may also be n~ed fPor educational
purposes, unless I expressly request other.~j~e. '/ ] ~ /~// -% ~.~·
Relationship
RELEASE OF ~
MEDICAL INFORK/ATION
I authorize Holy Spire Hospital to release to rextuestmg health insurance carries(s), their representatives and auditors, and any referring health care providers, .
such diagnostic and therapeutic information (including any information relating to treatment for alcohol and substance abuse and/or treatment of nsvchiatric
disorders, and/or confidential HIV related information), as may be necessary for them to determine benefit entitlement; to process payment ciaiths for
health care servines provided during this hosphalization/treatn~ent episode, and for continuing care/treatment. A photostatic or carbon copy of this
anthotization shall be considere~i as effective and valid as the original. The undersigned also authorizes Medicare, when applicable, to release to another
insurance carrier, upon their request, medical information needed to mnke payment upon that claim..
Ip.u~n..d:~er_s~ta..n..d..~and c~ns~n.~tha.~ the. m?nufa.cm~re~' o.f a~,.y impl.anotble al?vice i~..serted by my physician during the course of my surgory/procedure may be
........ m, my memmcauon mw~/~__, mc??ng sT~/~ecu~u~ber, as ma~at~ by Federal. Law.
· Relatiomhip
Date II~l[-/ S~gnature/~_,/.~ /~ ~/~7M~//~~/ To Pedant
i: UR*NeE ASS ONME /' ' - -' ' 0"
I authorize payment directly to Holy Spirit Hc2~ilal and/for physicians of all bean,s payable under my insurance policies. I understand I am responsible
to the Hospital for all charges not covered/~# this as/igntaent~nd/or photo~I~f-th-is assiznm~t: -
/ STATEM TE~pT~O PERMI'~ PAYqd. I/NT OF MED~RE BENEFITS
RoxrmE~S, PHYSICt~NS AN~-V~t(rmNt
! request ,pay~n~ of Au~o,r ,~, ed..Medicare ben?fits to. me or o[~ my behalf for any servie~(s~raished me by or in Holy Spirit Hospital inc uding physic an
~C~nte~i~sm~ornZreelaanat~t~ricOets ,medical aha other information about mo, to released to Medicare and its agencies any information needed to deteraline
DATE: SIGNATURE:
HOSPITAL BENEFITS/PART A/EFF. DATE:
MEDICAL BENEFITS/PART B/EFF. DATE:
MEDICAL ASSISTANCE RECIPIENT
My signature certifies that I received a service or items from Holy Spirit Hospital and Dr. on the date listed below.
I understand that payment for this service or item will be from Federal and State funds, and ~t any false claims, statements, or documents, or concealment
of material may be prosecuted under applicable Federal and State Laws.
I have read and agree with the above statements:
DATE:__ RECIPIENT/AGENT SIGNATURE:_
RELEASE AGAINST MEDICAL ADVICE
This is to certify that I, ., a patient at Holy Spirit Hospital, am leaving the hospital
against the advice of Dr. and the administration. I have been informed of the risk involved and hereby
release the physician and the hospita/from all responsibility and legal liability.
SIGNATURE: WITNESS :.
RELATION TO PATIENT: TIME: DATE:
FORM WITNESSED BY
Date lOlL{ {O{fl Signature
HOLY SPIRIT HOSPITAL, CAMP HILL, PA
CONSENT FOR TREATMENT/RELEASE OF INFORMATION
INSURANCE ASSIGNMENT
HOLY EP!RiT HOSPITAL
DEPARTMENT -- ~HYSI~!~N REPORT
years. AT PUMPKIN PATCH oatient comolains of bruise forehea~
REVIEW OF ~YSTEMS: Ail other systems are negatice.
PMH: Noncontributory.
PHYSICAL EXAM: Visal Signs: Reviewed Nurse's no,es.
PATIENT STATUS: Aie~t and cooperative.
I: Dee~ 3 cm laceration o~ the u~per neck below left aandibie, clean.
~a~ien; coaplains of having a laceration an ~ne left uBper cervical below
mandible. Laceration was caused by ~lunt trauza ap~roxiaateiy i ~our ~rior
arrival. 'There i~ no foreign boby sensation. Patient conies any
n~urova~cuiar ceficits. Patient hoe had a tetanus booster within ~e last
There
is no fareiBn body in the wound. No neurovascuiar deficit related to this
injury. There are no signs of a tendon injury.
1: The affecte, d area was pre~ped with Betadine. !% Xyiocaine with
e~id~FiSe, i. ocai black. AFTER TAC APPLiCATiON The laceration was explored .to
its base. There was no foreign body in ~he wound. Wound re~aired: The skin
D~ACNOSIs:Was closed with several 5-0 nylon sutures. ~ ~u~ ~%~ ~
V
3 ca Laceration of Neck, 874.8
DISPOS!TiON: Pa~ien~ was discharged home.
R,qNESH HR.. , .
Sat Oct 04~ .997. ~5,35 Pt~
E.D. Clinician: er,~.~.n~..~m ARORA. M.D. EMERGENCY DEPARTMEh~T' REPORT
Da~e: Sa: Oc~ 04, 1997
Pa~e I of 1
Initial t & X-Ray Orders:
Labs / bi,,,e Specimens
] Acel~minophen [ ] ESR
] Alcohol [ ] Glucose
] AmyJue/Llpase [ ) HCGS
] AP'IF [ ] Liver
] Blood Cuftums Profile
]C8C [ ] Lyres
] CKMB [ ] PTP
] CPRO [ J F/anal
] CRP1 Profile
] Digoxin [ ] Ouinidine
] Dilantin [ ] Salicylate
Radiolo~l¥
] AbdfObstr. Series
] Ankle R L
] Clavicle R L
] Cerv. Spine Lateral
] Cerv. Spine Routine
] Chest Rt~. / Porl / TPA
· ] Elbow R L
] Facial
] Femur R L
J Finger R .. L
] Foot R L
] Forearm R L
] Hand R L
] Hip R L
] Humerus R L
) K~ee FI L
] Other:
l Serum Acetone
] l~lyroid Profile
] Tox Screen
] TPA Labs
]Type&Dross # of unibl
] Type & Screen
] U/^
] UrineC& S
] Workman's Comp Drug Screen
] Other
] KUS
] L/S Spine
] Nasal
] Orbit Fl L
] Pelvis i
] Pyalogmm IV?
] Shoulder R L
] Skull
] Stamum
] T~b / Fib R L
)Toe R L
] Wrist R L
Time/C RT~lrli,
Special Procedures:
Ultrasound:
] Abdomen
] Duplex Doppler
] Gallbladder
] P~mvlc
Cultures
] Beta Stred AG / Culblre
] Cervical
] Cblamydia
]GCCulture
Blliln~,l Classification:
CT Scan of.
]VQ Scan
Other:
3qme/CRT/Ipt.
Sputum C & S
)SloolC &S
]StoblO & P
Stool C. Dffficile
]Wound C & S
[ ] Level I [ ] Follow up
[ ]L~valil [ ]Casel
] Level IV
] Leval v
Accident
Medical
Medical Non-Emergency
Holy Spirit Hospital
Camp Hill, PA
Emergency Care Unit
Physician Order Sheet
206-ECU REV. ~,~
TimeS.n:
Cardiac. Resplratoq/
[ ] Monitor [ ] ASa's paged at,
[ ] EKG paged at [ ] Peak Flows Before/After Rasp. Tx.
[ ]02 L/Min. [ ]ReediratoryTx.
[ ]O2Saturation
Medications / IV's / Additional Orders
R.N
Initials: Signature: / FI.N
Initials: Signature: ~.N.
Initials: , Signature: R.H.
Signature: MD/DO
Date:
Mechanicsburg, PA Claims
1
,~0"', "~ *" 37q4~4
J-/ll/~ ~., CF 25432
Time Datefl3me/Int.
IV: NSS/D5W/LPJ DS/.45NS/D5.9NS
infuse at cc/hour.
[ ] Obtain old records.
Date:/~ / ~ /
Age:
Log-in Time: /-'~' ~
Triage Time: /"--/'/0 ,.,,,
Time to Exam Room: / ' /
Mode of Arrival: ~¢..]~bu~atory [ ] BLS [ ] AL, S [ ] M~.~!,-~! Command /
Info,etlon obtain~ ~m: ~Patient __Family~.O. ~Reco~s ~EMT~aram~ic ~ ~
~m~ E~luedom Trlag~ to radiology for:
Defo~i~ Yes / No Skin Tamp Wa~ / C~I Dis~l Pulses Present / Absent Destination: [~CU [ ] EDP
Inte~ention: T,,,, Pare~esfe Present / Ab~nt Time:
~ r Signature:
Allergies/Reactions:'' --o ]~tex - Yes I N 4'
~st Tetanus__ LMP:. Weight: ~al~estimate (if pe~inent)
Visual Acui~: O.D. O.S. O.U. ~Correcfive lenses
Subjective:
Last Dose Medication Last Dose
Has patient had exposure to measles, chickenpox orTB in past mor~
NURSING DIAGNOSIS
~rdiac Output, alteration in
mfort, alteration in
Fluid volume, alteratloq in
Impaired gas exchange
Potential/Actual infection
Knowledge Deficit t/r_~ / /
Assessment completed at / / ~2
Data obtained by:
... Are there advance directives? Is copy available?
EXPECTED OUTCOMPR
jkfi'provement in cardiac output demonstraled by improved v.s. and diagnostic tests,
L ./r Decrease or relief of discomfort
-- Improvement in fluid vol. demonstrated by decrease in symptoms of fluid vol. imbalance
Improved gas exchange demonstrated by improved oxygenation and vital signs
-- Decrease in symptoms indicating infection or potential for infection
~ Improved knowledge demonstrated by verbalization / return demonstration
Admission Called:
Repor~ Called:.~ _ Admitted to
Disposition: [~d~ome [ ]_AMA{ ]O,R~
Discharged:/~ ! zC.-~f-~ -~ ~'~ischarge Instructions
Holy Spirit Hospital
Camp Hill, PA
ECU Nursing Assessment
201 -ECU 5/97 6th Rev. JD, MD, BR
[ ] Admission [ ] Observation
at.__
[ ] Old Records Sent
Hfs, Transferred to at
[ ] Satisfactor~ [ ] Ir~,~_ci [ ] C.~cal L] D~ceased to morgue at
Discharge R.N. ~_/~~.~AJ
byl
(71~) 763,23,,16 (717) 763-2461 ~
SPECIFIC .TRUCTIONS: Follow~ies~ [n~tmction-s if they differ from thc pat/ant informat on sheet.
-. · , .
[] Return for summ removal in ' days.., &'--" "r~'~:.to. ECU/'FI-IC on for a recheck.
[] Change dressing [] Se¢'~tt~'-pli~si~an'or specialist if not better in days.
times a day until J ' - ."7~- ~
-' 'Re'rt~rn~') ECU fi.unable to do so.
and apply
[] Tetanus/diphtheria booster given.
[] Elevate injured partabove heart for days,
[] Ace [] Sling [] Splint [] Crutches for days
[] Apply: [] Ice r'l H~t [] Alternate ice and heat for
minutes times a day until symptom free.
[] Wear cervical collar for days.
MEDICATION INSTRUCTIONS
l~l?ake ~t :-.~, Tylenol or Advii every hours.
[] Take the following ( O.TC. ) medicines
4. Your regular medicines except
[] Do not drive or operate any mactfinery while taking
~.ee family / compafiy physician / FHC on_~, for
[]-Recheck -"~t Suture removal -7 C,~-t.-~c,y'
[] Pick up your x-rays from the Radiology Dept. on the 2/ad floor
before going to doctor's office. (Call 763-2696 before arrival.)
[] Your blood pressure was Please get it rechecked
by your family docton
[] Test reports ! E.D. record given to patient.
[] CBC [] CPRO [] Renal Pm. [] Glue.
[] EKG [] X-Ray Copy [] Records Copy Chart
ADDITIONAL INSTRUCTION
[] Off work / school: From___to__
[] Remm to work on [] Light
[] Limitation:
[] No gym or sport for days.
[] See Workmen's Compensation sheet,
U Other
[] Regular duty.
Signatures: M.D./D.O.
P~ ~O~ON: Patient infomation shee~ conuin impomt infommion to review ~d keep.
[3 Corneal abra~ion/foralgn body
[3 Croup/broncldtis
[3 Crutch walking
[3 Diarrhea and Vomiting / Ped. Vomiting
[3 Drag/Alcohol abusWaddiction
[3 Febrile con~'ulsion
[3 Fever / Ped. Fever
[3 Flu
I'l Fracture
ri Headache
[3 H~ad injury D PID/VD
13 Hypertension [3 Raah
[] Immunizations/tetanus [3 Seizure
[3 Kidney stones n Sore throat
[3 Laceration
Abdominal pain
· ~lcobul abuse
Allergic reaction
As~ma
Back pain
l~it*s-Human/Animal/Ia~¢t
Bum
Ghest pain
qoajunctivitis
qOPD
F1 Neck strain
[3 Nosebleed
[30titi~ media
[3 Pediatric head injury
I3 Sprains and strains
FI Threatened miscarriage
[3 Toothache
[3 UPI and colds
[3 . . . .. [3 UTI and pyeloneBluftis
lllyoue~,o,,doctorwfllb~mfc~rt~di,th~.i,l¢.geindi,snosi,.lhem,¥aekno.[¢dg,__ip£o
H~LY SPIRIT HOSPITAL EMERGENCY CARE UNIT
50~ NORTH 21ST STREET CAMP HILL, PA 17011-2288 (717) 763-2316 //
( ) yanitha Abraham, M.D. 038840L ( ) Robert Hynick,
( )Thomas Aldous, M.D. 017075E
( ) Richard Luley, M.D. 029960~E
( ) ~aivatere Alfano, M.D. 0'2550ZE . ( ) Phillip Maguire,
( ) Ramesh Arora. M.D. 016727E ( ~
( ) 91eh Daughtry. D.O. 0S006776E
( ) ,Ion Dubin, D.O. OS 006991L (
D^~
SIGNATURE
1N RDER FO~ A BRAND NAME PR~O~DUCT TO BE DI~pF2~SED, THE
LABEL Il SUBSTITUTION PERMISSIBLE
( ) David Spurder, M.D. 023502-E
( ) Alan Teplis, M.D. 030018,E
( ) Elaine Thallner, M,D, 057303-L
( ) David Zimmerman, M;D. 005636-E
TI34ES
EXHIBIT B
'0.
FAIRFIELD COUNTY FF_PI.THC.qRE RDSOC,, P.C,
dba PEDi[tTRiC FF~qLTHC~RE .q~SOC.
15 CORPO~TE DRIVE
TRUMBULL, CT, 06611
TEL (283) 45R-832~
Page 1
RICHARD D LEBOWITZ
377 RONA~ DRIVE
FhlRFiELD CT 06430
wC.~OUbl~ NUM~ER:71'~i
FROM: i0/'84i~7 TO: 06i16/96
I8/86/~7 9%,si4 OFFICE ViSiT - ~vi ~ .~u~¢n ur:.9 i_Aur_R.,uI-EN PUNCi. AN~ SIT- uOMP~I~T~ 90,~0
DOCTOR:ROBERT HOBBLE, M.D, 62,~8
1~/89/~7 ~%~13 ~FICE VISIT - ~VEL 2 3~E~ V~.2 SUTURE RE~VAL
DOCTOR:~O~RT J HOBBLE, ~i.L
........ ~ ..... 455 TCNsi~Li i iB~ ACUIE
i2~7t97 99213 OFFICE vi~l; - ~=v=~ ~
D~TOR:ROBERT HOBB1E~ ~,~, ~:,~ ~ c ,r. F
12/i7/g7 ~588 THROAT uUL~UR.
DOCTOR:RObERT HOBSiE, N,~. , ~,~
02/i2i~6 99213 OFFICE ViSiT -- LEVEL 3 ~J~:~.~ 4~/ :
u.~ Ua,U~H~ WOODS, ~,[ .......... - 15.
· ,-o~qa 'fcc~' 462
~ ao~ ~ 86588 THR[~t L:ULiURE
DuuIOR.C~ WOODS, M,D, 78,~
85/85/Q6 ~2i3~e OFFICE ViSiT - LEU~ 3 - EVENiN6 J[~EPH B7%Qg VIRAL SY~/RO~iE, UNSPECIFIED
~CTOR:CHARLES A ~ODS~ M, D.
,. ~ .--~.~:" JOS~'H V88,2 EX~M-ROUilNE iNFANT/CHILD HEALTH CHECK
86!8~/~8 Bi~8 U~IN~LY~S KUu,.N~
DOCTOr:JUDiTH r, H~HSTADi~ N,D ........ _. , .- ,s, .= r,. ,~ ...... .
~OCTOR:JUDiTH ~t nOCHS~AOi, r. :, "'
DOCTOR:JUDiTH K HO~STADT, M.D, _ ................................................
............................................................................... TOi~ ~RGE~
FED iD:06i45297i
CT, LIC~ !50~8
: LIST OF ACTIVITIES
t .'IENT: JOSEPH LEBOWITZ Acct: 4660
377 RONALD DRIVE
FAIRFIELD ,CT 06430-0000
BILL TO: JOSEPH LEBOWITZ
377 RONALD DRIVE
FAIRFIELD, CT 06430-0000
ACCT BAL: 0.00 PAT BAL: ', 0.00
Type: 8
Practice Info:
RICK ROSEN, MD
2600 POST ROAD
SOUTHPORT, CT 06490-1258
Fed Id 061207653
Current 30 Days 60 Days 90 Days 120 Days+
0.00 0.00 0.00 0.00 0.00
· DATE, , DX DESCRIPTION CPT CHARGE PAYMNT
~A~a~a~A~A~A~A~A~A&~A~A~A~A~A~~
01/07/98 //~--~ Payment, Insurance PI 0.00 70.00
12/08/97/ 709.2 ~ INITIAL OFFICE VISIT - DE 99203 85.00 15.00
Mech~nicsburg, PA CIaims
RICK D. ROSE~I, M.D., F.^.C.S.
2600 POST ROAD
SOUTHPORT, CT 06490-125~
~echanic?burg, PA Claims
E] Pull [] Attach
FULL AND FINAL RELEASE
For and in consideration of payment to RICHARD LEBOWITZ and
DARLENE LEBOWITZ as parents and natural guardians of JOSEPH
LEBOWITZ of the sum of Fifteen Thousand 00/100 Dollars ($15,000.00), We,
RICHARD LEBOWITZ AND DARLENE LEBOWITZ (hereinafter sometimes
referred to as "Releasors'), do hereby release and forever discharge ASHCOMBE
VEGETABLE FARM~ COMMERCIAL UNION INSURANCE~ COU INSURANCE
AND ONEBEACON INSURANCE, {hereinafter sometimes referred to collectively
as "Releasees") their insurers, employees, agents, and any and all other persons
and firms, of and from any and all actions, causes of action, claims, demands,
damages, costs, loss of services, expenses, compensation, consequential damage,
or any other thing whatsoever including claims not only for personal injuries and
damages on account of or in any way growing out of, any and all known and
unknown personal injuries, debts, and property damage resulting or to result
from an incident involving the Minor Joseph Lebowitz that occurred on or about
October 4, 1997, at 906 Grantham Road, Mechanicsburg, Pennsylvania,
Cumberland County, Pennsylvania.
We hereby acknowledge and assume all risk, chance, or hazard that the
said injuries or damages may be or become permanent, progressive, greater, or
more extensive than is now known, anticipated, or expected. No promise or
inducement which is not herein expressed has been made to us in executing this
Release. We do not rely upon any statement or representation made by any
person, fi,m, or corporation, hereby released or any agent, physician, doctor, or
other person representing them or any of them concerning the nature, extent, or
duration of said damages or losses, or the legal liability therefor.
This Release contains the entire agreement between the parties hereto and
the te~ms of this Release are contractual and not a mere recital.
We certify that we are over eighteen (18) years of age and we further state
that we have carefully read the foregoing Release and we know the contents
thereof and we have signed the same as our free act and intending to be legally
bound thereby.
IN WITNESS WHEREOF, we have hereunto set our hands and seal this
day of ., 2001.
WITNESSETH:
RICHARD LEBOWITZ
DARLENE LEBOWITZ
RICHARD L. MILLER, F_2~UIRE
-2-
VERIFICATION
I, Darlene Lebowitz, Parent and Natural Guardian of Joseph Lebowitz, hereby state
that the statements made in the foregoing Petition to Approve Compromise Settlement are true and
correct to the best of my knowledge, information and belief. The undersigned understands that the
statements therein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unsworn
falsification to authorities.
Date:
D~a-lene Lebowitz, as parent and .[
natural guardian of Joseph Lebowitz
VERIFICATION
I, Richard Lebowitz, Parent and Natural Guardian of Joseph Lebowitz, hereby state
that the statements made in the foregoing Petition to Approve Compromise Settlement are true and
correct to the best of my knowledge, information and belief. The undersigned understands that the
statements therein are made subject to the penalties of 18 Pa.C.S. §4904 relating to unswom
falsification to authorities.
Date:
natural guardian of Joseph Lebowitz d~
CERTIFICATE OF SERVICE
I do hereby certify that on this day I served a true and correct copy of the foregoing by
first class mail, postage prepaid, addressed to the following:
Richard Miller
Ballin & Associates
151 Providence Hwy
Norwood, MA 02062-2630
Ashcombe Vegetable Farm
906 Grantham Rd.
Mechanicsburg, PA 17055
Thomas, Thomas & Hafer, LLP
M'icfief6 J. orp, ui e r
305 N. Front Street
P.O. Box 999
Harrisburg, PA 17108-0999
BBS:
$~!),u!eld Jo-I
eJ!nbs3 'dJoq/'? eleqo!lhl
· r '~el'~e8 '8 Je§p'4
'ZO0~ 'BZ ~enuer 'Xepuo~ "~u'd
0~:: Lle 'e!UeAl~SUUecl 'els!PeO 'esnoqpnoo/qunoo puelJeqLuno '~ JaqLunN LuooJpnoo
u! pelonpuoo eq Ileqs luewelRes s,~ou!w e jo leao~dde JO~ uo!l!led u!qlF~ eql uo 6upeeq
e leql a:~l~(]~lO $1J.I '~00~ '/uenue? jo ~ep
~::~j j s!ql 'MON aNY
I~lBBm 91AIO £0BCj-~0:
INVaNB:IBO
IAIB¥:I :Ig8¥J.3E)BA :IBIAIOOHS¥
'A
¥1NVAgASNN:Id '~NnO0 aN~qaaemno:
~0 SV39d NO~O0 -10 ±anoo 3HI NI :
S-I_-II/NIV-Id
'JOU!LU B 'Z/IMOB~9 Hcl:lSO?
~o ue!pJen§ leJnleu pue slueJed se
'ZNIMOB39 3N39BYa
pue Z~IMOB39 OBYHOIB
, ~"~: ,' ..~' 60UNTY
PENNSYLYAN!^
RICHARD LEBOWITZ and
DARLENE LEBOWITZ,
as parents and natural guardian of
JOSEPH LEBOWITZ, a minor,
PLAINTIFFS
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
:
ASHCOMBE VEGETABLE FARM,
DEFENDANT
: 01-5803 CIVIL TERM
AND NOW, this
ORDERED:
day of January, 2002, following a hearing, IT IS
(1) Approval of the settlement of this minor's claim for $15,000 for Joseph
Lebowitz, born June 11, 1990, IS GRANTED.
(2) From the settlement of $15,000, counsel fees are awarded in the amount of
$3,750,
(3) The net proceeds of $11,250 shall be placed in an interest bearing fully
insured investment at the Melrose Credit Union in Queens, New York, in the name of
Joseph Lebowitz, born June 11, 1990.~
(4) The account shall contain the following notation: "NO WITHDRAWAL CAN
BE MADE PRIOR TO JOSEPH LEBOWlTZ, BORN JUNE 11, 1990, OBTAINING HIS
MAJORITY EXCEPT BY AN ORDER OF A COURT OF COMPETENT
JURISDICTION."
(5) Richard Lebowitz and Darlene Lebowitz, as parents and natural guardians of
Joseph Lebowitz, are authorized to sign any release necessary to effectuate this
The parents' name shall not be on this account.
settlement, and to then settle and satisfy the docket. Counsel for plaintiff, Michele J.
Thorp, Esquire, shall file with the Prothonotary, and forward a copy to the chambers of
this judge, proof of compliance with this order.
~Vl~hele j. Thorp, Esquire
For Plaintiffs
:saa
Edgar B. Bayley, J. (~
VINYA"IASNN~c]
RICHARD LEBOWITZ and
DARLENE LEBOWITZ,
as parents and natural guardian of
JOSEPH LEBOWITZ, a minor,
PLAINTIFFS
ASHCOMBE VEGETABLE FARM,
DEFENDANT
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY, PENNSYLVANIA
: 01-5803 CIVIL TERM
AND NOW, this ~'.~ day of April, 2002, the order of January 29, 2002, is
vacated and replaced with this order.
(1) Approval of the settlement of this minor's claim for $15,000 for Joseph
Lebowitz, born June 11, 1990, IS GRANTED.
(2) From the settlement of $15,000, counsel fees are awarded in the amount of
$3,750.
(3) The net proceeds of $11,250 shall be placed in an interest bearing fully
insured investment at the Peoples Bank, in Connecticut, in the name of Joseph
Lebowitz, born June 11, 1990, with the parents and natural guardians, Richard
Lebowitz and Darlene Lebowitz, as co-guardians on the account.
(4) The account shall contain the following notation: "NO WITHDRAWAL CAN
BE MADE PRIOR TO JOSEPH LEBOWlTZ, BORN JUNE 11, 1990, OBTAINING HIS
MAJORITY EXCEPT BY AN ORDER OF A COURT OF COMPETENT
JURISDICTION."
(5) Richard Lebowitz and Darlene Lebowitz, as parents and natural guardians of
Joseph Lebowitz, are authorized to sign any release necessary to effectuate this
settlement, and to then settle and satisfy the docket. Counsel for plaintiff, Michele J.
Thorp, Esquire, shall file with the Prothonotary, and forward a copy to the chambers of
this judge, proof of compliance with this order.
Michele J. Thorp, Esquire
For Plaintiffs
:saa
By the~ourt, . ~
Edgar B. ~ayley J.
JOSEPH P. HAFER
JAMES K. THOMAS, II
ROBERTSON B. TAYLOR
JEFFREY B. RETTIG
PETER J. CURRY
R. BURKE McLEMORE, JR.
EDWARD H. JORDAN. JR.
C. KENT PRICE
RANDALL G GALE
DAVID L. SCHWALM
PETER J. SPEAKER
DOUGLAS B. MARCELLO
PAUL 3. DELLASEGA
SARAH W, AROSELL
EUGENE N. McHUGH
OF COUNSEL
JAMES K. THOMAS
THOMAS, THOMAS & HAFER, LLP
ATTORNEYS AT LAW
305 NORTH FRONT STREET
SIXTH FLOOR
P.O. BOX 999
HARRISBURG, PA 17108
(717) 237-7100
FAX (717) 237-7105
WRITER'S DIRECT DIAL NUMBER
(717) 237-7153
mjt@tXhlaw.com
STEPHEN E. GEDULDIG
KAREN S. COATES
TODD B. NARVOL
JAMES J. DODD-O
DANIEL L. GRILL
JOHN J. McNALLY, 11I
KEVIN C. McNAMARA
BROOKS R. FOLAND
JONATHAN C. DEISHER
JOHN FLOUNLACKER
JOHN T. HUSKIN. JR.
MICHELE J. THORP
STEPHANIE L. HERSPERGER
HUGH R O'NEILL, IH
W. DARREN POWELL
LAURA J. HERZOG
DRUMMOND B. TAYLOR
DEREK D. BAHL
KIMBERLY A. BOHLE
MARK J. POWELL
April 18, 2002
Honorable Edgar B. Bayley
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Lebowitz v. Ashcombe Vegetable Farm
Our File No4 220.11293
Dear Judge Bayley:
As you may recall, you presided over a Minor's Compromise hearing in the above
referenced matter on January 28, 2002. I am enclosing a copy of the Order you issued approving
the settlement in that case.
The Lebowitzs have advised me that they have been unable to find a financial institution
which will comply with the Order. For instance, Melrose Credit Union, which was the
institution named in the Court's Order, will not open an account for anyone under 13 years of
age and the Court Order states that the account must be in Joseph's name only. The Lebowitzs
did find that Peoples Bank in Connecticut will open a restricted account, but only if the Court
Order is changed to name them. The Bank further insists that the names of Mr. and Mrs.
Lebowitz appear on the account as co-guardians.
In light of the above problems, I would ask that the Court issue a new Order wherein the
actual bank is not named and the account is not solely in Joseph's name, but rather in Joseph's
name with Mr. and Mrs. Lebowitz as co-guardians. Accordingly, I am enclosing a proposed
amended order to that effect.
LEHIGH VALLEY OFFICE: 3400 BATH PIKE, SUITE 201, BETHLEHEM, PA 18017 (610) 868-1675 FAX (610) 868-1702
Should you have any questions, please feel free to have your office contact me.
MJT/akc:14502'l.4
Enclosures
cc: Richard Miller, Esquire
Very truly yours,
RICHARD LEBOWITZ and
DARLENE LEBOWITZ,
as parents and natural guardians of
JOSEPH LEBOWITZ, a minor,
377 Ronald Drive
Fairfield, CT 06830
Plaintiffs
ASHCOMBE VEGETABLE FARM,
906 Grantham Rd.
Mechanicsburg, PA 17055
Defendant
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNSYLVANIA
:
NO.: 01-5803 Civil Terni
:
.
: CIVIL ACTION LAW
.
.
:
TO THEPROTHONOTARY:
Please mark the above-captioned case as settled, discontinued and ended.
by
Respectfully submitted,
Thomas, Thomas & Hafer, LLP
Mmhel~J Tl{orp, s~Id~re
I.D. No.: 71117
305 N. Front Street
P.O. Box 999
Harrisburg, PA 17108-0999
RICHARD LEBOWITZ and
DARLENE LEBOWITZ,
as parents and natural guardians of
JOSEPH LEBOWITZ, a minor,
377 Ronald Drive
Fairfield, CT 06830
Plaintiffs
ASHCOMBE VEGETABLE FARM,
906 Grantham Rd.
Mechanicsburg, PA 17055
Defendant
: IN THE COURT OF COMMON PLEAS
· CUMBERLAND COUNTY, PENNSYLVANIA
:
:
:
: NO.: 01-5803 Civil Term
:
: CIVIL ACTION LAW
.
:
PRAECIPE
TO THEPROTHONOTARY:
Please file the attached proof of deposit with regard to the above-referenced matter.
Respectfully submitted,
by
Thomas, Thomas & Hafer, LLP
I.D. No.: 71117
305 N. Front Street
P.O. Box 999
Harrisburg, PA 17108-0999
May 25, 2002
]Ur..lm'd D. Lebow'lu~
D~I.~
377 l~p,,~a
F~-~..eld, CT
This I _e~er_ is to e~uf~n d~ on ~/16/02. yo~ opened up & mrd,g,~ o~dq2o~ st t~ople's
Bank in dm ai~ reh, ene, ed dBc i~ d~g mnounz of Sl 1,2.~O.0O. Per opler ~lh~ Coug or'
me et 203-358-7057, /
Caml~ P,. Croteeu
Bl~ck Rock
CERTIFICATE OF SERVICE
I do hereby certify that on this day I served a tree and correct copy of the foregoing by
first class mail, postage prepaid, addressed to the following:
Richard Miller
Ballin & Associates
151 Providence Hwy
Norwood, MA 02062-2630
Date:
Thomas, Thomas & Haler, LLP
P.O. Box 999
Harrisburg, PA 17108-0999