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HomeMy WebLinkAbout01-1766 FX '0' ,.j '6 W~ -. ,- j--i.< DUANE LEBO v. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. t> I - 17(, (, G;::J f..u-... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING : LICENSE RECALL APPEAL LICENSE RECALL APPEAL AND NOW, comes Petitioner, Duane Lebo, by and through his attorneys, Mancke, Wagner, Hershey & Tully, and makes the following averments in support of this License Recall: 1. Petitioner, Duane Lebo, is an adult individual and a Pennsylvania licensed driver with a residence address of 661 West Old York Road, Carlisle, Cumberland County, Pennsylvania 17013. 2. Respondent, Pennsylvania Department of Transportation, Bureau of Driver Licensing, has a mailing address at Riverfront Office Center, Third Floor, 1101 South Front Street, Harrisburg, Dauphin County, Pennsylvania 17104-2516. 3. Petitioner received a notice of license suspension by way of letter dated February 24, 2001 from the Department of Transportation indicating that his Pennsylvania driving privileges are to be recalled on March 31, 2001. See Exhibit "A" attached hereto and incorporated herein by reference. 4. The specific issue complained of by the Department of Transportation was that Petitioner has a seizure disorder that could affect his ability to drive. 5. The Department's recall action is illegal, improper, and invalid for some or all of the fol!owing reasons: h ,'_' ,-, '_J; a. Petitioner does not have a seizure condition which prevents him from safely operating a motor vehicle; b. Petitioner's accident which triggered the Department's notice, in the opinion of his treating neurologist, was a fainting episode as a result of severe chest pain, not a seizure; c. Petitioner's treating neurologist has more information to adequately evaluate Petitioner than the information received by the Department of Transportation from the emergency room physician at Carlisle Hospital; and d. According to Petitioner's neurologist, he is safe to operate a motor vehicle notwithstanding any pre-existing medical condition. e. The Department's action is in violation of Petitioner's rights under the Americans with Disabilities Act, the Federal Rehabilitation Act of 1973, and the Pennsylvania Human Relations Act because Petitioner is an individual affected with a disability and the Department of Transportation, as an entity receiving government funding, is therefore subject to the provisions of the above three mentioned Acts; --11.';'1- "I-. "',,I--.,."\iiitbi, WHEREFORE, Petitioner respectfully requests that this Court issue a stay on the Department of Transportation's proposed action recalling his license effective March 31, 2001 and schedule a hearing to determine the validity of the suspension proposed by the Department in Exhibit "A". Respectfully submitted, Date: 03/23/01 :;]j;;;;&TU~Y David E. Hershey, Esquire 1.0.#43092 2233 North Front Street Harrisburg, PA 17110 (717) 234-7051 3 -"< , .l . I ;t,- FROM: MAHCKE WRGNER HERSHEY FFlX= 2347888 M~r-23-81 Fri l1z50 Pj:lSE = 132 VERIFICA liON I verify thatltle statements made in the foregoing document are true and correct to the best of my knowledge, information, and belief, I understand that false statements herein are made s~lbject 0 the penalties of 18 Pa.C.S, ~904 relating to unsworn falsffication to authorities. DatBo~/~f! jl~//~ DUANE LE130 ,C ' '...;1-_" E'"i- CERTIFICATE OF SERVICE I, Tammy L. Kelly, an employee of the law firm of MANCKE WAGNER HERSHEY & TUllY, hereby certify that I am this day serving a copy of the foregoing document to the attorneys or parties of record in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, on the 23"' day of March, 2001, at the address listed below: George Kabusk, Esquire Office of Chief Counsel PA Department of Transportation Riverfront Office Center, Third Floor 1101 South Front Street Harrisburg, PA 17104-2516 BY:~ l:o OOA , Tammy L. Kelly '----== 1'" MANCKE WAGNER HERSHEY & TUllY ,.~ .,- -". ,..., J,j" reca]szr COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: February 24, 2001 DUANE LEBO 661 W OLD YORK RD CARLISLE PA 17013 Dear Mr. DUANE LEBO: We have received medical information indicating that you have a Seizure Disorder condition which prevents you from safely operating a motor vehicle. As ()f 03/31/2001, you may no longer drive. Your driving privilege is hereby recalled indefinitely as mandated by Section 1519(c) of the Vehicle Code. This decision has been made by comparing your medical condition with the standards recommended by our Medical Advisory Board and adopted by this Department. This action will remain in effect until we receive-medical information that your condition has improved and you are able to safely operate a motor vehicle. Since you have a seizure disorder, you must remain seizure free for a six month period, with or without medication, before you will be eligible for reinstatement of your driving privilege. Our records indicate that your seizure occurred on 2/8/01. In order to comply with this action, you must return all current Pennsylvania driver's licenses, learner's permits, temporary driver's licenses (camera cards) in your possession, on or before the effective date listed above. If you cannot comply with the requirements stated above, a sworn affidavit stating that you are aware of the sanction against your driving privilege must be submitted. When the Department receives your license or affidavit, we will send you a receipt. YOU MAY NOT RETAIN YOUR DRIVER'S LICENSE FOR IDENTIFICATION PURPOSES. However, you may apply for and obtain a photo identification card at any Driver License Center. You must present two (2) forms of proper identification (e.g., birth certificate, valid U.S. passport, marriage certificate, etc.) in order to obtain your photo identification card. You have the right to appeal to the Court of Common Pleas (Civil Division) within thirty (30) days of the mail date of this notice. If you file an appeal in the County Court, the Court will give you a time-stamped certified copy of the appeal. In order for your appeal to be valid, you must send this time-stamped certified copy of the appeal by certified mail to: o_,~ "I '0 J. Pennsylvania Department of Transportation Office of Chief Counsel Third Floor, Riverfront Office Center Harrisburg. P A 17104 You still must send in your license before the effective date of recall unless you appear in person before ajudge and receive an order permitting you to continue driving. If you have any questions or need further information, please contact the Medical Unit, P.O. Box 68682, Harrisburg, P A 17106-8682 or call (717) 787-9662 between the hours of 8:00 a.m. and 4:30 p.m. Sincerely, ~~\~ Rebecca L. Bickley, Director Bureau of Driver Licensing Driver License #: 15713702 !:i '.'" DUANE LEBO IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA v. NO. 01 -/7C-6 etod't~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING LICENSE RECALL APPEAL ORDER OF COURT AND NOW, thiSO<'T~ day of<J1l~ , 2001, the court being advised that this matter is a medical recall and that Petitioner is entitled to an independent determination by the Court as to whether or not he is entitled to a sup~eas pendi~~ the outcome ~f a hearing, a hearing on the supersedeas only is scheduled for 'r! {J!/ Jj...5Q., 2001 at/d,30o'clock ..9...m. in Courtroom #!t. ()' A hearing on the merits of this appeal is scheduled for the tfl.. day of ~.1 /J1 0 ,2001, at 7' (]"V o'clock 3.,.m. in Courtroom Number L, Cumberland County ourthouse, One Courthouse Square, Carlisle, Cumberland County, Pennsylvania, all proceedings to stay meanwhile. Notice of the hearing on the merits shall be given by Petitioner's counsel to the Department of Transportation at least sixty (60) days prior to the date of said hearing. BY THE COURT: ,/ 'Il~ J. Prothonotary's Office Office of Chief Counsel, Penn DOT 1101 S. FrontSt., Harrisburg, PA 17104-2516 David E. Hershey, Esquire 2233 N. Front St., Harrisburg, PA 17110 L~ _~~,O\ O~ \)" ~l\;.) Distribution: " ,-~~ . ~ >, - ." - 'I , ~'"' '-' "'~ -, y'-" ""-4."', '""C,;,.,,,",,,, -J '. " ' . , o THREE SPRINGS FAMILY PRACTICE \9 y,1J ti . T H. ROBERT DAVIS, MD MICHAEL O. DANIELS, MD DAVID A. DELL, MD KELLI L. SCURFIELD, PA-C March 16,2001 David E. Hershey Mancke, Wagner, Hershey & Tully 2233 N. Front Street Harrisburg PA 17110 Re: Duane L Lebo DOB 11/22/52 Dear Mr. Hershey: This letter is in response to your correspondence concerning Duane Lebo. In review, Mr. Lebo experienced the onset of chest pains in early February. On February 8th, he apparently had a rather severe episode of discomfort in his chest while operating his motor vehicle at the Sheetz convenience store in Mt. Holly Springs. Subsequent events, ascertained from Emergency Room documentation and Duane's recollection, include EMS notification with transport to the hospital ER in Carlisle. A grand mal seizure was witnessed by ambulance personnel, and the ER physician describes Duane as post-ictal (somnolence after a seizure). Dilantin and phenobarbital levels were recorded as subtherapeutic. Due to the chest pain and concern for myocardial ischemia, Duane was admitted to the hospital's chest pain clinic to undergo further evaluation. He underwent serial enzyme testing, electrocardiograms and a subsequent exercise echocardiogram. Based upon these studies, the chest pains were not felt to be of cardiac origin. Persistent symptoms led him to our office on 2/13/01 for follow-up. An upper gastrointestinal x ray and abdominal ultrasound were ordered to evaluate further his symptoms of abdominal (epigastric) and chest pain. These studies were unrevealing as to a cause for his pain. Subsequently, he developed a rather sharp pain localizing to the costosternal jl,mction. He was felt to have costochondritis. However, anti-inflammatory medication did not seem to help; anti-acid therapy was reinstituted and a consult was requested with Dr. Berk, a gastroenterologist, to further evaluate his pain. Mr. Lebo is currently under the care of Dr. Richard Brown for his seizure disorder. As to specific recommendations concerning his dosage of medication " PE'fIifj"''S .OM" I . . . .. 303 NORTH BALTIMORE AVENUE MT. HOLLY SPRINGS, PA 17065 717-486-8550 ". d, "'" .lJt "~- . ,~ ~,~ - .. :,c. 1j - . ... o o Page Two March 16,2001 Re: Duane Lebo for seizures, driving precautions, or seizure control, I would defer to Dr. Brown's expertise as a neurologist. Further work-up of Duane's chest pain is ongoing at this time. Sincerely, ~aJmM() David A. Dell, M.D. DAD/pg NEUROLOGY RICHARD B. BROWN, M.D., F.A.C.P. 2645 NORTH THIRD STREET, SUITE 450 HARRISBURG, PENNSYLVANIA 17110-2001 March 26, 2001 Judges of Cumberland County Attn: David E. Hershey, Esquire 2233 North Front Street Harrisburg, PA 17110 RE: Duane L. Leb9 To Whom It May Concern: I am the treating neurologist who has cared for Mr. Lebo's convulsive disorder since February 28, 1980. Mr. Lebo has been a very compliant patient and has had no seizure activity for at least several years. There was an event on February 8, 2001, in which he had severe pain in his chest causing him to faint. His situation was reviewed by a Carlisle neurologist, 1. Craig Jurgensen, M.D. while he was a patient in the emergency department of the Carlisle Hospital. When I saw the patient subsequently on February 27,2001, I reviewed the situation completely and took note of the fact that Mr. Lebo did not have any of the usual symptoms associated with his seizure activity. Dr. Jurgensen and I independently concluded that Mr. Lebo had had an episode of syncope associated with severe pain, however, he was reported to the Pennsylvania Department of Transportation in error as having had a seizure. After taking Mr. Lebo's complete history, performing a complete neurological examination, after having performed appropriate therapeutic drug monitoring, and having spoken with Dr. Jurgensen, I conclude, with a reasonable degree of medical certainty that he did not have a seizure on February 8, 2001, and that he is safe to operate a motor vehicle and is not prohibited from doing so as a result of any medical condition. Sincerely, Richard B. Brown, M.D. RBB/tlp ~ PETITIONER'S J,' ~HIBIT IJ.JO.O\ ucr .iJ ~ I _r r-!, DL-326 (9/95) CERTIFICATION . , DATE MARCH 29,2001 I hereby certify that Rebecca L Bickley, Director of the Bureau of Driver Licensin9 of the Pennsylvania Department of Transportation, is the legal custodian of the Driver License records of the Pennsylvania Department of Transportation. As the Director of the aforesaid Bureau, she has legal custody of the original or microfilm records which are reproduced in the attached certification. IN TESTIMONY WHEREOF, I HAVE HEREUNTO SET MY HAND AND SEAL OF THIS DEPARTMENT THE DAY AND YEAR AFORESAID. ~;(~ BRADLEY L. MALLORY, SECRETARY OF TRANSPORTATION I HEREBY CERTIFY THAT THE FOREGOING AND ANNEXED IS A FULL, TRUE AND CORRECT CERTIFIED PHOTOSTATIC COpy OF: 1) OFFICIAL NOTICE OF RECALL DATED & MAILED 02124/01, EFFECTIVE 03/31/01; 2) INTIAL REPORTING FORM, DATE Of;'EXAMINATION 02/08/01; 3) LETTER DATED 10/13/00, TO THE OPERATOR APPROVING CONTINUANCE TO DRIVE; 4) CONVULSIVE DISORDER REPORTING FORM DATED 09/28/00; 5) INITIAL REPORTING FORM, DATE OF EXAM 08/19/00; 6) LETTER DATED 09/18/00 TO THE OPERATOR REQUIRING PHYSICAL EXAM AND/OR DRIVER'S TEST AND CONVULSIVE DISORDER REPORTING FORM TO BE COMPLETED BY A PHYSICIAN, AND 7) DRIVING RECORD, WHICH APPEARS IN THE FILE OF THE OPERATOR DUANE LUTHER LEBO, OPERATOR'S NO. 15713702, DATE OF BIRTH 11/27/52, IN THE BUREAU OF DRIVER LICENSING, HARRISBURG, PENNSYLVANIA. CERTIFIED TO as prescribed by Sections 6103 and 6109 of the Judicial Code, Act of July 9,1976, P.L. 586, as amended, 42 Pa.C.S. ~~6103 and 6,109. IN TESTIMONY WHEREOF, I HAVE HEREUNTO SET MY HAND AN~AftTHE DAYJrD YEA~AF.O ESAID. \5.~~~~. SEAL REBECCA L. BICKLEY, DIRECTOR BUREAU OF DRIVER LICENSING COMMONWEALTIrS EXIllBIT I ~~.," " , ~,"",,, "i "'.',. --', -"->l.-."",' ,'~-I~ _. ._' _.-,-~, --, '~""""'N,,,J- ,,,I I" ""!': recalszr COMMONWEALTH OF PENNSYL VANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing ~mIDate:February24,2001 DUANE LEBO 661 W OLD YORK RD CARLISLE PA 17013 Dear Mr. DUANE LEBO: We have received medical information indicating that you have a Seizure Disorder condition which prevents you from safely operating a motor vehicle. As of 03/31/2001, you may no longer drive. Your driving privilege is hereby recalled indefinitely as mandated by Section 1519(c) of the Vehicle Code. This decision has been made by comparing your medical condition with the standards recommended by our Medical Advisory Board and adopted by this Department. This action will remain in effect until we receive medical information that your condition has improved and you are able to safely operate a motor vehicle. Since you have a seizure disorder, you must remain seizure free for a six month period, with or without medication, before you will be eligible for reinstatement of your driving privilege. Our records indicate that your seizure occurred on 2/8/01. In order to comply with this action, you must return all current Pennsylvania driver's licenses, learner's permits, temporary driver's licenses (camera cards) in your possession, on or before the effective date listed above. If you cannot comply with the requirements stated above, a sworn affidavit stating that you are aware of the sanction against your driving privilege must be submitted. When the Department receives your license or affidavit, we will send you a receipt. YOU MAY NOT RETAIN YOUR DRIVER'S LICENSE FOR IDENTIFICATION PURPOSES. However, you may apply for and obtain a photo identification card at any Driver License Center. You must present two (2) forms of proper identification (e.g., birth certificate, valid U.S, passport, marriage certificate, etc.) in order to obtain your photo identification card. You have the right to appeal to the Court of Common Pleas (Civil Division) within thirty (30) days of the mail date of this notice, If you file an appeal in the County Court, the Court will give you a time- stamped certified copy of the appeaL In order for your appeal to be valid, you must send this time- stamped certified copy of the appeal by certified mail to: k\ -.," c -". L .~" '__, " ,_ "'-'..-.-~,. <I,. ~ '._ '-,,'-~,. '''.-,-,~,_,,' ""J,~-;.-_ ,__ Pennsylvania Department of Transportation Office of Chief Counsel Third Floor, Riverfront Office Center Harrisburg, PA 17104 You still must send in your license before the effective date of recall unless you appear in person before a judge and receive an order permitting you to continue driving. If you have any questions or need further information, please contact the Medical Unit, P.O. Box 68682, Harrisburg, P A 17106-8682 or call (717)787-9662 between the hours of 8:00 a.m. and 4:30 p.m. Sincerely, ~~,~ Rebecca L. Bickley, Director Bureau of Driver Licensing Driver License #: 15713702 . d_ _, .'< ,n,,", ,..', ~ d,' _ "t',' 'Ol.l:3 (4.9:1) ~.oOJ:--'-' {, :- ~ J ......'1i' DEPARTMENT OF TRANSPORTATION BUR"..U OF DRIVER LICENSING INITIAL REPORTING FORM {Print or Typ. Roque$ted Information} FOR BUREAU USE ONLY Date R.eceived OrNer # . . Referenca DEAR PROVIDER: Although the Department seeks your judgement about your patient's medical fitness tosa/ely operate < motor vehicle, the decision about your patient's driver's license is a responsibility of the Department" Bureau of Driver Licensing which must also take into account other consideration~ Please complete Sections A, B, C, and D. :# IS-I J S 1 D ~ PATIENT INFORMATION OATE OF BIRTH LAST NAME Llbo AOOAESS (p /.; / W, Oid VOIU<.... FIRST NAME f)uaV/(. 6u-l'-rG flA- ;J <( 01 MIOOlE NAME L. no /3 'fEAR DATE OF EXAMINA TlON: . DIAGNOSIS OF DISORDER OR DISABILITY: Piease Check (v) appropriate items o Loss or Impairment of a Foot, Leg, Finger, Thumbs, or Hand. - Condition: o Unstable Diabetes o Cerebral Vascular Disease o Cardiovascular Disease ~)..oss ot Consciousness ~ Cause: J2I Neurological Disorder o Mental Deficiency or Marked Mental Retardation o Mental or Emotional Disorder o Alcohol Abuse fEB ~ 2 2001 o Drug or Controlled Substance Abuse DR"'ER 8!\FETY DIViSION o Vision Deficiency BUR~ OF DRIVER LlCENSlNG o Other Medical Condition which would interfere with the patient's ability to drive. - Explain: '$urzun. ti.l~ !~ ~\, ~,;: ;j;' ~'l?:':, V;'~~ ~~",;r' ~"',"'f, ,~,.". ,J ri i:;}t.\') i;~:;;~ .~~ t:~~/~~-g o Comments: Do these conditions affect the patient's ability, from a medical standpoint only, to safely operate a motor vehicle? 0 YES 0 NO Seizure Disorder: ,\YES 0 NO Date sf Last Seizure: :::2 ~ OJ . Does the patient meet any of the Department's waiver requirements? Q YES 0 NO If yes. please explain ALL INFORMATION IS CONFIDENTIAL AS PROVtDED IN THE PA VEHICLE CODe. SeCTION 1518(3) PROVIDER'S N~E J\ /1 it /7 /1/7 1/r/YJi71a ff../Jrt n/;ftcA , 1)-0 x _ I~ ~ PLGASE j:J~INT SIGNATURE OF PROVIOE:A CLASSIFICATION OR SPECIAl.llY f: 7Jfutu:~~ ~5- 00111). L PAOVrCER'S ACD REjS &,t,j,sL/ t~{; 4 /70/3 ( 7 n) ;)-L/5.- 55W STATE PHYSICIAN LICENSE NUMBER Rerum (his form to: \td-. ~, '~'-'.ili - _ ';" >_' ' I .' , -, .,.~,', . ,':I"~-, -" "--", C"'._ ~__~ ';Ai 4;- ',_ ;:'''''['' ,J" mmlO COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: October 13, 2000 DUANE LEBO 661 W OLD YORK RD CARLISLE PA 17013 Dear Mr. DUANE LEBO: I am pleased to inform you that you have met the Department's medical standards. You may continue to drive. Please drive safely. If you have any questions, please contact the Medical Unit at (717) 787-9664, between the hours of 8:00 a.m. and 4:30 p.m. Sincerely, ~~,~ Rebecca L. Bickley, Director Bureau of Driver Licensing Driver License #: 15713702 ~, "",,-, "'" k, ., U"'" "1.'k>,.1 - '_, ,'J'" ;~"', ]~~-', to-. . - h ",,~~~,_, '" DL-1?1 (7-97) CONVULSIVE DISORDER REPORTING FORM PA Department of Transportalion BUreau of Driver Licensing P.O. Box 68682 Harrisburg, PA 17106-8682 (717) 787-9662 PATIENT INFORMATION DRIVER'S LICENSE NUMBER 15713702 HEIGHT SEX EYE COLOR LAST NAME(S) LEBO SOCIAL SECURITY NUMBER JR. ETC. FIRST NAME DUANE OATE OF BIRTH PHONE NUMBER /Y1 ;./~ DAY YEAR 2..:~ ~"}.- (7/7 )l-'f'7...g~3 STREET ADDRESS 661 W OLD YORK RD CITY CARLISLE STATE liP CODE PA 17013 CHECK (v') ONE: YES NO 1. Has the patient been diagnosed as having a seizure disord r'? . . . . . . . . . . . . . . . . . . . . . . If yes, date of last episode c>>1 Or Plf,...J I. 2..000 Has the patient had an EEG? If yes, date of EEG , . . . . . . , . . . . . I d' r f' tt? &n&-e./w~{l;'~ ~~ (/?..JbL n Ica IVEI 0 seizure pa ern. . .. . .. . . . . .. . .., .. . . . l' ..-.'.~ ..-. ()~"'V' W1t~'1 . Is the p~ien~being treatOO with medicfjtion? II ves.typ~ apiJj dosage " , _ , ;P;I~ 530""" 'P~<t'fI/ IS-O)>4' Does the medication affect the patient's ability to safely operate a motbr vehicle? . . . . . . . . . Does the patient have seizure episodes attributable to a prescribed change in or removal from medication? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 cr'"o 2. ~o 3.. 4. 5. ~o ~O o ~ a--" If yes, date of last episode? Has the original medication been reintroduced? 0 0 6. Does the patient have seizure episodes aiways preceded by a specific prolonged aura? I/;V' 0 If yes, what is the duration of the l},ura? ~ 11U.11 ' How is it manifested? --.A ~i~ ~~ J....e ~ How long has the patient experien~d this aura? 0 VU ! 0 lot. S 7. Does the patient experience only an aura? . . . . . . . . . . . . . . . . . , . . . , . .. . . . . . . . . . . . . . .. 0 ~ How long has the patient experienced this aura? 8. Does the patient have a pattern of seizure episodes occurring only during sleep or immediately upon awakening? ................................................. 0 U)/ If yes, .how long has the patient experienced this pattern? 9. Does the patient h~ve seizure episodes attributable to a17~~'j"trans~~f,~n-eSlJ".toxiC Ingestion, metabolic Imbalance, or nonrecurnng trauma? .. .....\i't::1VED. . . . . . . . .. Q ~ If yes, please explain Btp DRIIIE,,! . i! 9 2DOO BUR 0 ~ ~.4r:Eiv tJ . /'- nl?'l"-' IV'S" . , ~J'(J II"!..... II fV 10. Has the patient been diagnosed as having episodes of loss of consci61'iS'_er awareness which would interfere with the safe operation of a motor vehicle? . . . . . . . . . . . . . . . . . . . . .. 0 ~ . SEIZURE D/SOIi'DER - More than one seizure or a single seIzure of electrically dIagnosed epilepsy. PHYSICIAN INFORMATION (Please print or type) A(D, SP!=C\AL TY l Na.uv-o 0 crr~l b I<:j C[ fT>'S;: 1A./' 1F~ ~ l """ ~. . ^_ ,,,"~ ",.' f ~ ,~.,.c ',,",,-- "^,,,,,-"^,,"'. ~'"I , < "I'" OL.13 (4-93; ~ '~i ~..# DEPARTMENT OF TRANSPORTATION BURto..U OF ORIVER LICENSING INITIAL REPORTING FORM (Prim or Type Requested Information) FOR BUREAU USE ONLY Date Received . Driver' . Reference DEAR PROVIDER: Although the Department seeks your judgement about your patient's medical fitness to safely operate a motor vehicle, the decision about your patient's driver's license is a responsibility of the Department's Bureau of Driver Licensing which must also take into account other consideration~ Please complete Sections A,B,C,andD. ~ IS-I 131D~ SECTION A: PATIENT INFORMATION LEBo AOORESS {, FIRST NAME DAUNe.. "'100l!: NAME L DATE OF BIRTH uotI'TH . OA.V YEAR 1/ 2?- 1167. LAST NAME '(J CA-l2l1..fLE f3 - Jq- :J.Oo() i DATE OF EXAMINATION: . : . DIAGNOSIS OF DISORDER OR DISABILITY: Piease Check (*') appropriate items a Loss or Impairment of a Foot, Leg, Finger, Thumbs, or Hand.' Condition: .' . ... a Unstable Diabetes . a Cerebral Vascular Disease RECB\rEti'%! a Cardiovascular Disease a Loss of Consciousness - Cause: a Neurological Disorder M1G Y"O 2!W).{;' a Mental Deficiency or Marked Mental Retardation a Mental or Emotional Disorder DEh;~i~ Sl~F:;:TV ~~p.1l~:fiJl-.:~ a Alcohol Abuse SUA. OF DBiv"r::f,-, L:('E~~;:jl~;""\ ".., ..... ~. 1011 '0"..1 ~, a Drug or Controlled Substance Abuse o Vision Deficiency .. _.~. '-'.'~, . ... ~. -, JiQ Other Medical Condition which would interfere with the patient's ability to drive. - Explain: IIBOUE. WAS OtZiVlACr A pCkufJ ~ck. HA{) /9- .51!iZLl~ IIIJ1J Ct2AS#EJ).. , .QO Comments: SElzufll2 Type. /ten Iii" /VAS oBsE(l.UW ~ 6yS1lfj\/'et-.S to Pr flJltS PosTIctAl. l.JpD~ 1l'IV ExftllfJJJAT'ploJ. I Do thes:snditions atlect the patient's ability, from a medical standpoint only, to safely operate a motor vehicle? YES a NO Seizure Disorder: )Ii YES 0 NO Date sf Last Seizure: B -Iq -z.~ Does the patient meet any of the' Department's waiver requirements? 0 YES ~ NO If yes, please explain SECTION D: ALL INFORMATION IS CONFIDENTIAL AS PROVIDED IN THE PA ClASSIJ:ICAflON OR SP~CIALITY ?AOVI(!ER'S AODRESS PROVIDER'S NAME TROy t... t.AJISEt2 PLEASE PAINT E"/YlT 51 ATE PHYS1C1AN LICENSE NUMBER ~MT - 01..{ II OFfICe PHONE (7/7) 77"-47'-17 Return rhis form to: BUREAU OF DRIVER LICENSING, DRIVER QUALIFICATIONS SECTION. P.O. BOX 68682 . HARR~"II"~ 0" ...inlU\All? #$" mm17 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: September 18, 2000 DUANE LEBO 661 W OLD YORK RD CARLISLE PA 17013 Dear Mr. DUANE LEBO: Information submitted to the Department indicates that you may have a Seizure Disorder condition that could affect/limit your ability to drive. In order to determine if you meet the Department's medical standards for driving, it is necessary that you undergo a physical examination and/or a driver's test. The enclosed formes) must be completed by your physician and returned to the Bureau of Driver Licensing. I have enclosed a self-addressed envelope for your convenience. If you fail to comply with this request within 30 days from the date of this letter, your driving privilege will be suspended. If you have any questions, please contact the Medical Unit at (717) 787-9664 between the hours of 8:00 a,m. and 4:30 p.m. Sincerely, ~~,~ Rebecca L. Bickley, Director Bureau of Driver Licensing Driver License #: Enclosures: 15713702 DL-121 : Convulsive Disorder Reporting Form #(p ." ~ L -~ " . ~~~'" , I. OJ PAGE 1 PENNSYLVANIA DEPARTMENT OF TRANSPORTATION BUREAU OF DRIVER LICENSING CERTIFIED DRIVING HISTORY MAR 27 2001 DRIVER: DUANE LUTHER LEBO 661 W OLD YORK RD CARLISLE, PA 17013 DRIVER LICENSE NO DATE OF BIRTH SEX RECORD TYPE 15713702 : NOV 22 1952 MALE REG LICENSE DRIVER LICENSE (DL) COMMERCIAL DRIVER LICENSE (CDL) ------------------------------- --------------------------------- LICENSE CLASS LICENSE ISSUE DATE: LICENSE EXPIRES : C NOV 30 200,0 NOV 2 3 20"i~ NONE:: CDL LICENSE CLASS lf~~LICENSE ISSUED : ,'CI)I:ii!iA~:J:~ENSE EXPIRES: , '" SEMENTS : TIONS , PERMITS: SlE.!f:sTATUS NONE NONE MED RESTRICTIONS LEARNER PERMITS LICENSE STATUS PEND RECALL , Y LICENSE (PL) ASS IG, ISS: iSSUED DtRES : ~US : A!((lIMITED LICENSE (OLL) "~~-------------------- , Sl~A' CLASS : OL "qfNpE ISSUED : "AAiAi!A~~l:t ~,~~SE EXPIRES: '<5Ll':!!!l3lt:ENSE STATUS : ,,'iii/ii, <!-,!,;'ii " Ii"Hilili'Z'uu, *** CONTINUED *** ff:1 ~-~- ",.J - lL ~:l:;:,j_. PAGE 2 CE~TIFIED DRIVING HISTORY - MAR 27 2001 - LICENSE NUMBER 15713702 CONTINUED ------------------------------------------------------------------------------- REPORT OF VIOLATIONS AND DEPARTMENTAL ACTIONS ------------------------------------------------------------------------------- NO VIOLATIONS OR DEPARTMENTAL ACTIONS DURING THIS REPORTING PERIOD ------------------------4~L7 ACTION: ACTION: ---------------------- --------------------- *** END OF RECORD *** ;;);';~?::',(." i . .' .-'J - ",.;-~. nL! PAGE 3 CE~TIFIED DRIVING HISTORY - MAR 27 2001 - LICENSE NUMBER 15713702 CONTINUED IN COMPLIANCE WITH YOUR REQUEST, I HEREBY CERTIFY THAT I HAVE CAUSED A SEARCH TO BE MADE OF THE FILES OF THE DEPART- MENT OF TRANSPORTATION, AND HAVE SET FORTH ABOVE AN ACCURATE SUMMARY OF ALL RECORDS IN THE NAME OF THE PERSON INDICATED. SINCERELY, SEAL ~ ~'.~i'iii~b :~;;'~::;~':,~::,'q,,"~> '" e",::,:' -"<--,~,',.,',-,-c<",-+ -'"-,, ':;";;<": ;:+'--'="'~_'_:t,_:'+-0;" '''' .iV'" '+ LICENSING COMMONWEALTHi!flft\ PENN SYLVAN I HEREBY CIii BUREAU OF D~ OF TRANSPOR LICENSINGii~ THE DIREC'l'" ;1;"""11' OF THE OR OF THE ABO 27 2001 . CTOR OF THE b DEPARTMENT DRIVER TAJI,liION. AS ~~ CUSTODY '11l:1E SUBJECT IN OF ~, HA~E, H~~EUN00b~ijll~Y! HAND .;;..~ilil;\~JL~i;;~i, , tD. W'":':'i;!+:::::::::::::~WW'W::~',o",;~_/'"9r''''' ' __,-,,-' +:'''I:.h AND SEAL SINCERELY, ~ SECRETARY OF TRANSPORTATION SEAL , '. , ,_ b _ C'_, _~ 'c>'<_' _ < - ~ :...:.1 ' i '"_'~'! COMMONWEALTH OF PENNSYLVANIA: DEPARTMENT OF TRANSPORTATION: BUREAU OF DRIVER LICENCING Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. DUANE L. LEBO, Defendant 01-1766 CIVIL TERM ORDER OF COURT AND NOW, this 30th day of March, 2001, the request for supersedeas is granted, pending full hearing of this matter. 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