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HomeMy WebLinkAbout04-02-07 Inre: Stephanie Bailes : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : CIVIL ACTION - ADJUDICATION OF ~~-- ! : INCOMPETENCY AND APPO~NT OF& ( , ...-J : GUARDIAN OF THE PERSON '='~ .....-..../ ~LD : NO.~\ (:)1 D~ I N -..-.,~ ::..~ . ..." \,1:'1 ., en PETITION OF KIM WOLF AND JENNIFER WILLIAMS SUPPORTING -.~---, ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A G~IAN~ OF THE PERSON OF STEPHANIE BAILES. AN INCAPACITATE>>~ :-:: ~'i ;:) "'~.,i INDIVIDUAL. PURSUANT TO 20 PaoCoSo CHo 55 (:0 TO THE HONORABLE JUDGES OF SAID COURT: The Petitioners, Kim Wolf, residing at 314 Bonnybrook Road, Carlisle, Pennsylvania, 17015, and Jennifer Williams, residing at 321 Majestic Circle, Dallastown, j~' Pennsylvania, 1731 f, depose and say: 1. Kim Wolf and Jennifer Williams are the named Petitioners in the above titled civil cause of action and Stephanie Bailes is the allegedly incapacitated person. 2. Kim Wolf is the mother of Stephanie Bailes and the settlor of Stephanie Bailes' trust. Jennifer Williams is the older sister of Stephanie Bailes. 3. This petition is to inform the Court as to the incapacity of Stephanie Bailes and to appoint Kim Wolf as primary legal guardian of her person and Jennifer Williams as secondary legal guardian of her person. 4. Stephanie Bailes will be eighteen (18) years old on April 13, 2007, has never been married, and resides at home with her mother, Kim Wolf, at 314 Bonnybrook Road, Carlisle, Pennsylvania, 17015. 5. The name and address of Stephanie Bailes' primary physician is: Dr. Holly Hoffman Carlisle Pediatrics 804 Belvedere Street Carlisle, P A 17013 6. The name and address of the trustee of Stephanie Bailes' trust is: Ameriserv Trust and Financial Services c/o Nancy Marley, Assistant Trust Officer 216 Franklin Street P.O. Box 520 Johnstown, PA 15907 7. The name and address of Stephanie Bailes' transportation provider is: Cumberland County Transportation 37 East High Street Carlisle, P A 17013 8. Stephanie Bailes receives home helpers, via waivers, from two organizations. The names and addresses of the organizations are: UCP Central PA 925 Linda Lane Camphill, P A 17011 CPARC 71 Ashland Avenue Carlisle, P A 17013 9. The name and address of Stephanie Bailes' provider of home nursing care is: Links to Care 43 Brookwood Avenue Carlisle, P A 17013 10. The name and address of Stephanie Bailes' special education provider is: South Middleton School District 4 Forge Road Boiling Springs, P A 17007 11. The name and address of Stephanie Bailes' medical supplies provider is: Choice Critical Care 10 South Sixth Street McSherrystown, P A 17344 12. Stephanie Bailes' next of kin is her father, Donnie Bailes, who resides in Middletown, Pennsylvania and is divorced from Kim Wolf. Pursuant to a custody order entered on December 11, 2001, Kim Wolf has primary physical custody of Stephanie Bailes. Donnie Bailes is in agreement with this petition to determine Stephanie Bailes incapacitated and to appoint Kim Wolf as Stephanie Bailes' primary guardian of the person, and to appoint Jennifer Williams as secondary guardian of Stephanie Bailes' person. The consent to appointment of a guardian, signed by Donnie Bailes, is attached to this petition. 13. Guardianship of the person is being sought because Stephanie Bailes suffers from severe cognitive dysfunction as a result of a traumatic brain injury. She also suffers from physical paralysis which has left her bedridden and unable to communicate. Her worsening condition impairs her capacity to make decisions. This petition is instituted to aid and benefit Stephanie Bailes. The nature of Kim Wolfs relationship with Stephanie Bailes is that of a mother, caretaker, and settlor of Stephanie Bailes' trust. Kim Wolf has been the primary caretaker for Stephanie Bailes since her disability onset of March 2001 and has had primary physical custody of her since December 2001. Kim Wolf has also served as the settlor of Stephanie Bailes' trust since its creation in January 2002. Jennifer Williams', the Petitioner for secondary guardianship, relationship with Stephanie Bailes is that of an older sibling. Jennifer Williams assists her mother, Kim Wolf, in caring for Stephanie Bailes. 14. Stephanie Bailes is incapacitated as defined in Chapter 55 of the Probates Estates and Fiduciaries Code. She is an adult whose ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that she is totally unable to meet essential requirements of her physical health and safety. 15. A neuropsychological evaluation performed on May 13,2005, by Lisa Eaton, a clinical neuropsychologist and licensed psychologist of Physicians of Rehabilitation, Industrial & Spine Medicine, showed that Stephanie Bailes presented with "severe cognitive dysfunction status posttraumatic brain injury." The diagnostic impression included visual impairments, significant oromotor and language limitations, impaired receptive and expressive language skills, and ubiquitous defects in attention. The 2005 psychological evaluation is attached to this petition. 16. An earlier psychological evaluation performed on November 16, 2001, by Eugene Stecher, M.A. psychologist of Guidance Associates of Pennsylvania, listed Stephanie Bailes' condition as "profoundly mentally retarded" with an IQ estimate below twenty (20). Diagnostic impressions noted a "catastrophic decrease in functioning" and recommended that she is "deserving of all county services available to a profoundly multiply handicapped child." The 2001 psychological evaluation is attached to this petition. 17. Stephanie Bailes' pediatrician, Doctor Holly Hoffman, of Carlisle Pediatric Associates, is in agreement with this petition. In a letter dated March 21, 2007, Dr. Hoffman listed Stephanie Bailes' diagnoses as "severe encephalopathy due to motor vehicle accident, vocal and swallowing dysfunction, chronic gastritis and constipation, blind left eye, shunt placement, right hemiplegia, severe osteoporosis of undetermined etiology with multiple pathologic fractures, and hypercalciuria and serum phosphate disorder." Dr. Hoffman concluded that Stephanie Bailes "easily meets criteria for incapacity" and that Stephanie Bailes "is completely reliant on caretakers." Dr.. Hoffman noted that the "prognosis for significant improvement is extremely guarded to none." Stephanie Bailes is "unable to speak and can communicate only be gestures and with sign boards, with prompting." Finally, Stephanie Bailes' "[c]entral nervous system imaging shows marked damage and atrophy of her cerebral cortex." The letter from Dr. Hoffman is attached to this petition. 18. During 2006 alone, Stephanie Bailes had approximately fifty (50) appointments with doctors and lab visits, one (1) trip to the emergency room, and. one (1) hospitalization. Stephanie Bailes has a shunt to relieve intracranial pressure. Common complications of the shunt include blockage, infection, and malfunction. It is necessary that the shunt be fixed as soon as any complication arises before further brain trauma results from any delays. In 2002 and 2004, Stephanie Bailes' shunt malfunctioned, requiring immediate attention. 19. The Petitioners have made efforts to allow Stephanie Bailes to retain as much autonomy as possible. However, she continues to be dependant upon others to assist her in her personal care. Because of Stephanie Bailes' mental and physical condition, she is unable to make responsible decisions concerning her person, health, welfare, and safety. Stephanie Bailes is unable to communicate her needs, tend to her personal hygiene, medicate herself, and provide for her personal safety. 20. No other guardian of the person of Stephanie Bailes has been appointed by any court. 21. All less restrictive alternatives to the appointment of a guardian of the person have been considered. The Petitioners believe that such alternatives will be ineffective. 22. The type of guardian of the person that the Petitioners ask be appointed is plenary . 23. Both Petitioners are qualified to be Stephanie Bailes' guardian because they are interested in her welfare and have no interest adverse to hers. The consent of the proposed guardians of the person is attached to the petition. WHEREFORE, Petitioners respectfully request that this Court adjudicate Stephanie Bailes an incapacitated person and assign to Petitioner Kim Wolf primary powers of guardianship of the person and if Ms. Wolf becomes unwilling, unable, or unavailable, assign to Petitioner Jennifer Williams secondary powers of guardian of the person of Stephanie Bailes. Date: ~ I e21.:J.0rCS":f jWjj~ ~i>1 Virginia Spiess Certified Legal Intern ~~. ~ Meg . esmeyer I1UUj Supervising Attorney The Disability Law Clinic 45 North Pitt Street Carlisle, P A 17013 (717) 243-3696 VERIFICATION We verify that the statements made in the foregoing PETITION SUPPORTING ADJUDICATION OF INCAPACITY AND APPOINTMENT OF A GUARDIAN OF THE PERSON AND ESTATE are true and correct, to the best of our knowledge, information and belief. We understand making a false statement would subject us to the penalties of 18 Pa.C.S. S 4904, relating to unsworn falsifications to authorities. Date: .~. 36. 6 7 K~~ Kim Wolf Petitioner Date: 3!80{D +- ~;t W~~ l/Jennifer illiams Petitioner NOTARIZED On this, the ~day of J7//wA, 2007, before me,~;?4';;z-....o-z.., a Notary Public of the Commonwealth of Pennsylvania, the undersigned officer, personally appeared Kim Wolf, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Verification, and acknowledge that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have set my hand and notarial seal. cY5~4 /Jl (l~ 3- =<0-.07 Date . On this, the ~;-..; day ofp?~~, 2007, before me,~~~~Notary Public of the Commonwealth of Pennsylvania, the undersigned officer, personally appeared Jennifer Williams, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Verification, and acknowledge that she executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have set my hand and notarial seal. ~ Notary Public My Commission Expires: UllOA M. CARVER NOTARY PUBLIC MCAyRCLO'SMLME,BSORO.. CUMBERLAND C1Jl!NTV SION EXPIRES DEC. 22. :0 . ~. 36' d-t7/J7 Date Inre: Stephanie Bailes : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA : ORPHAN'S COURT DIVISION : CIVIL ACTION - ADJUDICATION OF : INCOMPETENCY AND APPOINTMENT OF A : GUARDIAN OF THE PERSON : NO. ~\ t1 ~\U CONSENT OF INDIVIDUAL TO APPOINTMENT AS GUARDIAN I, Kim Wolf, hereby consent to my appointment as primary legal guardian of the person of Stephanie Bailes, an alleged incapacitated person, and certify that: 1. I am 18 years of age or older. 2. I reside at 314 Bonnybrook Road, Carlisle, Pennsylvania, 17015. 3. My occupation is personal caregiver for the alleged incapacitated person at issue. 4. I speak, read, and write the English language. 5. I am a citizen of the United States. 6. I do not have any interest adverse to the alleged incapacitated person. 7. I am not a fiduciary, or an officer or employee of a corporate fiduciary, of an estate in which the alleged incapacitated person has an interest, or a surety, or an officer or employee of a corporate surety, of such a fiduciary. 8. I am the biological mother of the alleged incapacitated person. Date: 3. 30~07 -i~ W~_ Kim Wolf Petitioner In re: Stephanie Bailes : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA : ORPHAN'S COURT DIVISION : CIVIL ACTION - ADJUDICATION OF : INCOMPETENCY AND APPOINTMENT OF A : GUARDIAN OF THE PERSON ; NO. ~ \ lJ '\ \0\\0 CONSENT OF INDMDUAL TO APPOINTMENT AS GUARDIAN I, Jennifer Williams, hereby consent to my appointment as secondary legal guardian of the person of Stephanie Bailes, an alleged incapacitated person, and certify that: 1. I am 18 years of age or older. ~~ 2. I reside at 321 Majestic Circle, Dallastown, Pennsylvania, 1731~. 3. My occupation is medical secretary. 4. I speak, read, and write the English language. 5. I am a citizen of the United States. 6. I do not have any interest adverse to the alleged incapacitated person. 7. I am not a fiduciary, or an officer or employee of a corporate fiduciary, of an estate in which the alleged incapacitated person has an interest, or a surety, or an officer or employee of a corporate surety, of such a fiduciary. 8. I am the biological sister of the alleged incapacitated person. Date: 3 / 3 6 ! 0 1- ~*(~~ J . fer lliams Petitioner i'--~,~! PEN N STATE ~ The Dickinson . School of Law Disability Law Clinic A service to the community by students from The Dickinson School of Law of The Pennsylvania State University The Dale F. Shughart Community Law Center 45 North Pitt Street Carlisle, PA 17013 Office: 717-243-3696 Fax: 717-243-3639 In re: Stephanie Bailes IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION CIVIL ACTION - ADmDICATION OF INCOMPETENCY AND APPOINTMENT OF A GUARDIAN OF THE PERSON : NO. ~ \ t)l ~\\.J ;.-., CONSENT OF INDIVIDUAL TO APPOINTMENT OF A GUARI>f'AN ;;:- uJ I, Donnie Bailes, hereby consent that Kim Wolf be named the primary guardian of the person of Stephanie Bailes, an alleged incapacitated person, and that Jennifer Williams be named the secondary guardian of the person and certify that: 1. I am a competent person of 18 years of age or older. 2. My interest in the above-named proceeding is as the biological father of Stephanie Bailes, the alleged incapacitated person. 3. I reside at 100 Shirley Drive, Middletown, Pennsylvania, 17057. 4. I speak, read, and write the English language. 5. I am a citizen of the United States. 6. I am aware of my right to seek legal representation and have decided to proceed without legal representation. 7. I understand that the Disability Law Clinic represents Petitioners Kim Wolf and The Dickinson School of Law of The Pennsylvania State University An Equal Opportunity University PENN STATE ~ The Dickinson . School of Law Disability Law Clinic A service to the community by students from The Dickinson School of Law of The Pennsylvania State University The Dale F. Shughart Community Law Center 45 North Pitt Street Carlisle, PA 17013 Office: 717-243-3696 Fax: 717-243-3639 Jennifer Williams in this action. 8. I fully understand the effects of granting primary guardianship of the person to Kim Wolfand secondary guardianship of the person to Jennifer Williams. Date: 3 - 30 -C)7 t1_ojjd Donnie Bailes On this, the 30fl. day of Vrnev.dt..... 2007, before me~~'l l'Y1 ~~'-Ia Notary Public of the Commonwealth of Pennsylvania, the undersigned officer, personally appeared Donnie Bailes, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Verification, and acknowledge that he executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have set my hand and notarial seal. oj~/77!J~ S' - 30- ~ oc7] Date Notary Public My Commission Expires: The Dickinson School of Law of The Pennsylvania State University An Equal Opportunity University ~ \ ~\ O'6\\.D CONFIDENTIAL For Professional Use Only The confidentiality of the information contained in this document is protected by the State Statute. Disclosure of this information without the proper written consent of the patient, the patient's authorized legal representative, or the patient's legal guardian is prohibited. NEUROPSYCHOLOGICAL CONSULTATION Patient Name: Stephanie Bailes Date of Eva!: 5/13/05 Age: 16 DOB: 4/13/89 Service Location: Outpatient Procedure Code: 96115 - 3. units Education: Student Employment: Student Referred by: Dawn Irwin-Groleau REASON FOR REFERRAL: The patient is referred for a Neuropsychological consultation for assessment of her current neurocognitive functioning as well as appropriate treatment recommendations. BACKGROUND INFORMATION: Stephanie Bailes is a 16-year-old girl who was involved in a motor vehicle accident on March 27,2001 when she was 11 years old. She was the passenger in her sister's vehicle. She required extrication from the vehicle. She sustained a severe head injury secondary to impact on the left side of her head. Injuries sustained included skull fracture, right tIbial-fibuIaf fracture, right femur fracture, right wrist fracture. She underwent emergency craniotomy with evacuation of subdural hematoma as well as VP shunt placement. There were vari~ revisions of the shunt over time secondary to hydrocephalus. In addition, a tracheostomy and NGtube were also placed. Stephanie's medical recovery was complicated by aspiration pneumonia as well as onset of seizure disorder in September 2004. Stephanie's mother, Kim W oll: indicates that her daughter spent three months in the acute care hospital and was eventually returned home in June of200l. Stephanie's mother indicates that her daughter exhibited eye opening following her injury, although she did not begin to follow any commands uirtil May 2002. Stephanie currently receives significant nursing and home care and is also attended to by rehabilitation aides in the home. ~ pRiSM Physicians oj Rehabilitation, Industrial & Spine Medicine, P. Division of P.s.y(bC'Log;ral ~\rn'i({:; Christopher Roycr, PsyD Amy Kucirka, Psy D Lis~[on, PsyD 1:':) . _I \.0 4950 Wilson Lane Mechanicsburg, PA17055 Bloom Bldg., Su,i,re.l06 4310 LondondenjRd. Harrisburg, PA l,~" Phone 717 691-4847 Fax 717691-4959 www.prismdrs.com '- Page 2 Stephanie Bailes May 13, 2005 Premorbid medical and academic history is significant for attention deficit disorder, inattentive type. Mrs. Wolf indicates that in the third and fourth grades, her daughter struggled significantly with her grades. She was diagnosed andplaced on Addera1l, with a subsequent improvement in her grades. Medical history is otherwise non-contributory. Current medications include Sinemet, Reglan, &clofen, MiraIax, Prilosec, Senokot, Lamictal. Stephanie continues to be NPO and receives tube feedings. Stephanie resides with her mother Kim, stepfuther Brad, younger brother John, age 8. Her father is Don Bailes. She has an older sister Jennifer, age 21. Stephanie receives a variety of rehabilitation as well as educational services. Home-based school based services incl1!-de OT IPT once per week, Speech Therapy two times per ~k, Music Therapy two times per week, Special Educationllnstructional Intervention two days per week. In addition, she also receives non-school funded therapies as well including Speech Therapy two times per week, OT two times per week, PT two times per week as well as aquatics therapy one day per week and myofascial release one time per week. Speech Therapy is addressing oral muscle strength and coordination. Communication skills are also being addressed. ~onal communication with speech therapist Dawn Groleau was undertaken; She indicates that Stephanie is able to use a communication system involving vertical presentation of cards indicating yes/no. She was 90% accurate with self- related/relevant questions. She has demoDstrated significant improvement in breath soundS . . and recently began to mouth words in January of this year. There is also an emergence of automatic sequencing and verbalizations. There is~ however, oral and verbal apraxia. A vaiJable school records indicate that Speech Therapy treatment is also addressing oromotor mo~ements. In addition, au8mented communication with the use of a Dynavox is. being utilized. Accuracy of her arm movements as well as learning of new icons is apparently underway. Social language, addressed the yes/no responding and expression of basic wants and needs, is also reflected as a goal. School Occupational and Physical Therapy is addressing walking with the "Up and Go" walker as well as range of motion and sitting. In addition to gait training, standing, sitting, and balance issues, spasticity and tone in the right . lower extremity are being addressed as well as transfers and ranging of the lower extremities. Home based Occupational Therapy is addressing Stephanie's participation in activities of daily living, both upper and lower extremity as well as functional mobility issues. Aquatics Therapy is addressing mobility skills and walking in the pool environment. Fine and gross motor movements and sequencing are being addressed in Music Therapy. School Instmctional and Special Educational goals recently have a4dressed map skills including the location of continents, oceans, and states. Reading Comprehension as well as sorting of shapes are also indicated as recent instructional tasks and activities. Instructional interventions are also addressing the use of the Dynavox. Of note, therapy notes do indicate that distractibility as well as fatigue at times impedes Stephanie's full participation in her therapies. FINDINGS: Stephanie was accompanied to the evaluation by her mother as well as one of her aides. She was evaluated seated in her wheelchair: She presented initially as awake, alert, and attentive, Page 3 Stephanie Bailes May 13, 2005 although throughout the evaln~rion, there were significant indications of distractibility. In addition, throughout the evaluation, there were periodic episodes of diminished arousal and lethargy, prompting verbal stimulation to which she was responsive. Stephanie also displayed a left gaze preference as well as some reflexive oromotor behavior in the form of tongue protrusion. During assessment, there were also episodes of stimulus bound behavior. She was evaluated individually as well as with the assistance of her mother. Regarding visual capabilities, as previously discussed, StePhanie demonstrated a left gaze preference. A right hemianopsia is suspected. She demonstrated both distant and near point tracking in the left visual field only. She demonstrated the capacity for both object InNI11~rion as well as object identification. In the left visual field, Stephanie did demonstrate significant deficits in visual attentional capability. Specifically, her ability to identify letters in an organized army was at approximately the 40% level. She was able to identify two of five letters to command, again presented in an organized fashion. Regarding motor function, Stephanie presented with a right hemiparesis. She demonstrated the capacity for object manipulation and reaching. However, on today's evaluation, no :functional object use was evident. Specifically, Stephanie was unable to 'demonstrate how to utilize such objects as a pencil, or cup when presented. ' Regarding oromotor and language skills, Stephanie did demonstrate some reflexive oromotor behavior in the form of tongue protrusions. In addition, with verbal prompting from the examiner or her mother or through the facilitation with singing, in addition to prompting, she did demonstrate some inconsistent verbalizations. At times, she was able to mouth and sing single words such' as bye or hi. 1bis behavior was inconsistent and infrequent, however. Stephanie, on today's evaluation, did not demonStrate verbal yes/no responding to basic f3ctual questions. For instance, she did not respond to various questions such as her name, if she was a boy or a girl, and the like. In addition, was unable to establish with Stephanie a non-verbal communication system. She was not able to nod her head in a yes/no fashion to communicate her thoughts or intentions. With the assistance of Stephanie's mother, a non- verbal'communication system was attempted in which Stephanie would touch one ofher mother's hands within her left hemispace to indicate yes or no. Stephanie was unable, during today's evaluation, to utilize the system. In addition, Mrs. Wolf also utilized cards with the words yes or no placed in front of Stephanie in a similar horizoirtal fonnat. Again, Stephanie was not responsive to this technique. The difficulty in establishing a reliable communication system limited scope oftoday's evaluation. Additional assessment of receptive language . skills was assessed through command following. Stephanie was able to inconsistently follow one-step commands with 70% accuracy. On today's examination, she was not able to follow tw,o-step motor commands. DIAGNOSTIC IMPRESSION: Stephanie Bailes is a 16-year-old, young lady who was involved in a motor vehicle accident in 200 1. She is presenting with severe cognitive dysfunction status posttramnatic brain injury. In addition to right hemiparesis and motor deficits, she is demonstrating visual impairments involving left gaze preference and likely right hemianopsia. Stephanie is also presenting with significant oromotor and language limitations. Presumable s~ere left Page 4 Stephanie Bailes May 13,2005 I hemispheric dysfunction bas resulted in impaired receptive and expressive language skills. As a result, her expressive capabilities are severely limited and there are severe deficits in receptive language and auditory comprehension. In addition, Stephanie is demonstrating ubiquitous defects in ~on as well as higher order cognition. RECOMMENDATIONS: 1.. Recommend consideration for stimulant medication given concerns regarding variable arousal and inattention. Mrs. Wolf indicates that she will follow-up with this suggestion with Stephanie's neurologist, Dr. Faircloth. 2. Given Stephanie's complex rehabilitation needs, including the presence of spasticity and tone, physiatry consultation is suggested. 3. Ongoing Physical Therapy and Occupational Therapy is obviously warranted. Ong~~~~~~~~on,~~~areobvi~~m Physical Therapy as well as address of activities m daily living in Occupational Therapy. In addition; given Stephanie's visual deficits, consideration for a neurophtbamologic consultation is suggested for address of hemianopsia. 4. Ongoing multi-sensorytherapy modalities are wananted, e.g., music and aquatics interventions. 5. Given Stephanie's pronounced oromotor and language impairments, strongly recommend increase in Speech Therapy to at least five days per week. Ongoing address of oromotor and oromuscle strength is indicated. In addition, addr~ of Stephanie's swallowing has been ongoing. A swallowing study is also suggested. 6. Regarding cognitive issues, establishment m a reliable communication system with Stephanie appears to be paramount h is unclear if reliable yes/no responding has been established. Achievement of this through use of either the Dynavox or utilization of two cards for choices is suggested. Furthennore, given StePhanie's comprehension as well as inattention and other cognitive deficits, simplification. of the Dynavox with limited icon usage is suggested. 7. Coordination of home and school based Speech Therapy interventions is suggested due to Stephanie's pronounced communication ~ language issUes. I 8. Ongoing educational instruction in Special Education intervention is wammted. Integration of Speech Therapy communication techniques, either the utilization . of the Dynavox on a Consistent basis or utilization of reliable yes/or system is paramount. Teaching to Stephanie's comprehension level is also necessary and can best be established once a reliable communication system is established and consistently utilized. For instance, if Stephanie only responds with 50% accuracy with a yes/no format to comprehension questions, this reflects only chance perfonnance and does not necessarily indicate comprehension. This -- Page 5 Stephanie Bailes May 13, 2005 information must be integrated into educational interventions with appropriate catering 'of instructional level. 9. Neuropsychological re-eValuation in approximately two OT.three months is suggested for ongoing assessment of Stephanie's neurocognitive status. Ongoing fiunily education and support will also be provided. '~(Q Lisa A. Eaton, Psy.D. Clinical Neuropsychologist Licensed Psychologist LAFJasap 07/20/2004 15:29 .\ '. . MAIN OFFICE 412 Eriorcl Road Camp Hill, PA. 17011 Stanley E. Schneid~r, Ed.O. Director Client: Birth Date: Age: Education: Refening Agency: Intake Coordinator: Evaluation Date: 7172406415 GUMB PERRV MHMR PROG PAGE 01/02 -- - "11 (fi?~1~~Atr~~ES . " PENNSYLVANIA 1, ." , Camp Hill: (717) 732.2917 HerstJey: (717) 533.4312 Carlisle: (717) 245.2289 Chambersburg: (717) 263-9392 FAX:: (71n 732-5375 .., .-' ,,- PSYCHOIJOGICAL EV ALVA TION Stephanie Bailes 04/13/89 12)'1'8 7mQs 3days Home schooling (1th) CP MHiMR Christina K. Penn 11/16/01 ..r:- \.D Referral Information. Stephanie has been referred fOr a psychological evaluation to ,help determine intelligence and daily adaptation levels toward qua.H:ticati,on for county services. I met ~lth Stephanie and her mothet in their home to conduct the evaluation. Assessment Tools. Review of records, Observation, Parent Intmn.e~'. Review of Records. Materials available for review included the 2000-2001 Report Card, CP lvf.I-J/l\..1R Intake, Hers.hey Medical Center records, and the school district Comprehensive Evaluation Report and IEP. Stephanie's .report ca.n! for the 2000~2001 school year at Yenow Breeches l\.fiddle School indicates an average 3rd quarter subject grade of91. A typical comment was, "Work completed to high standard~." Subsequently, Stephanie was in an automobile accident on 03/27/01 and !luff~cd a "severe closed head trauma." A letter from Dr. Ramer (10/12/01) indicates continued "vet). slow recQ'i.'efy" with little change in n.eurologic sfatLt,. Stc:pha.nie is in a deep coma. Trcattncnt goals include relearning "isual s!<j,U~ relearning expressive language, relearning auditory/receptive skills; re.lea.ming beginning percepruallmotor skil1s, passive listening to infonnaoon from. immediate, r~nt, and remote mcmory~ passive receptior. of sensory stimulatio~ and demonstration of a differential response to people. Pulmonary status was stabilized by 6/1101 ~Iith healed traeh site, but swallowing remains problematic. Observ:r.tion. I made an afternoon "ic;it (l :30PM) to the home. One large: room, formerly used for child caret is devoted to meeting Stephanie's needs. Stephanie, herrnother, and a ne1ghbor who had corne to help were present. Stephanie appeared to be laying on her side comfOrtably in her bed She was dressed casually .and made a neat and clean appearance. lltere wcr~ ocoasion.aI vocaJizatior.s, 'and she may have been aware of my presence by the sound of anew voice. but I cannot be sure. She evidenced no purposeful verbal or perceptual/motor skills. Mother would stimulate S1ephanif;l with touch and the vibration ofhe:r mattress. During my -vi$it Stephanie did " ComprehensivE Psychological Services . Drug and Alcohol Treatment 07/20/2004 15:29 _ 7172406415 CUMB PERRY MHMR PRG3 PAGE B2/fi2 .r- .-."" ........{ not appe.lI'to become emotionally distressed, but some 'Vocalizations were louder than others, There was l;:.t1e evidence of specific reactions to particular adult behaviors or statements, Pa.rent Interview. Living at home are mother., Kim Wolf, Stephanie's stepfather Brad, her brother JOM (5), and her sister Jennifer (17). Father, Don Bailes, vism briefly, the last rime about one month ago. The neighborhood is well organized to help Stephanie. Someone helps out v.i.th direct care almost daily, and a number offund raisers have been held. Prior to the accident Stephanie was a good studen~ and her conc~ntration benefited, beginning in 5th grade, with a mild (5mg) daily administration of Adderall, Subsequent to the ac;;ident, Stephanie has received various inerapies from tv.lO st:rvice tracks. The school provides one hour per week in-home of speech, OGcupational therapy, and physical the'rap)', the a teacher is pre~ent for: two hours. Health insurance pro"ides two hours per week of occupational thera.py and physical therapy, and one hour per week of speech. Mother's additional goal is to provide music therapy. Prior to her accident Stephanie: was very active. Interes~ included field h.ockey, playing the trumpet and piano, socc;er~ bicycling, rcadil1& camping, andjumpil.lg on the trampoline. She h~d b~gun to baby-sit and was a member of the school choir and band. She was 3, member of the church choir and had ju,t begun to participate in a church youth group. She had a good friend Abby, and three girls still \isit her regularly. She might have had six girls over for a birthday and slumber parry. Prcl::lem~ occasionally tak~ the fonn ofloud vQcalizations when agitated by being on her side too long or from wetting her diaper. Heat regulation has to monitored very closely since that brain .fUnction has been impaired, and there is seldom opportunity to be outdoors. Stephanie does run fevm~ and a delica.te temperature balance in the environment is required. Diagnostic and Clinical Impressions. Stephanie has e:lCpcrienced a catastrophic decrease in functioning. Level of person/environment interaction falls in the profoundly mentally retarded range ~ith IQ estimate below 20 following severe closed head trauma.' Stephanie is certain1)' deserving of aU COUJ'lty services available to a profoundly multiply handicapped cr.i1d. _E~~~ ~H. Stech~, M.A. Psychologist G.Ap!CPMHI!v1REval/StepbanieBailes II/16iOl 2 CARLISLE PEDIATRIC ASSOCIATES A PROFESSIONAL CORPORATION STEPHEN J~ KREBS, M.D. J. LYNN HOFFMAN, M.D. DEBORAH RAUBENSTINE, M.D. HOLLY C. HOFFMAN, M.D. ELlSEO ROSARIO, JR., M.D. ELENA MAN, M.D. DIANNA RUDY, PA-C 804 BELVEDERE STREET. CARLISLE, PA 17013 243-1943 0-) (..) ~~,o ., "r;:- 1.."0 March 21, 2007 " r.e. Stephanie Bailes, SSN 185-70-6116 To Whom It May Concern: Stephanie Bailes is our almost-18 year old patient who suffered a severe head injury with cerebral atrophy in March 2001. She carries the following diagnoses: 1) Severe Encephalopathy due to Motor Vehicle Accident in March 2001 2) Vocal and Swallowing Dysfunction (at risk for obstructive apnea, 100% dependent on G-tube feeds and meds) 3) Chronic Gastritis and Constipation 4) SIP VP Shunt placement 5) Blind Left Eye 6) Right hemiplegia 7) Severe Osteoporosis of undetermined etiology with multiple pathologic fractllIes 8) Hypercalciuria and Serum Phosphate disorder Stephanie easily meets criteria for incapacity. Stephanie is completely reliant on caretakers for position changes; she cannot walk, cannot sit up alone, and cannot even turn herself over in bed. She cannot feed herself or take anything by mouth; she is tube fed through a gastrostomy. She is unable to speak and can communicate only by gestures and with sign boards, with prompting. She cannot do any of her activities of daily living without 100% assistance. She requires 24 hour a day monitoring by nurses to protect her airway; she currently receives 16 hours a day of skilled nursing care and the rest is done by her mother. She requires an extensive and complicated medical regimen. She has periods of alertness and reacts to caretakers with smiles and noises, but this is the extent of her cognitive ability at this time. Central nervous system imaging shows marked damage and atrophy of her cerebral cortex. Her prognosis for significant improvement is extremely guarded to none. Accordingly, she is unable to manage any part of her estate and will be completely dependent on a guardian for such decisions. I have practiced pediatrics for over 21 years and have regularly cared for children with anoxic and traumatic brain injury. I feel quite comfortable in making this determination accurately. Sincerely, ~?-- Holly C. Hoffman, MD