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HomeMy WebLinkAbout04-05-07 (2) ,. ....... .... In re: Stephanie Bailes : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA : ORPHAN'S COURT DIVISION : CIVIL ACTION - APPOINTMENT OF AN : EMERGENCY GUARDIAN : NO. 07-316 PETITION OF KIM WOLF AND JENNIFER WILLIAMS SUPPORTING APPOINTMENT OF AN EMERGENCY GUARDIAN OF THE PERSON OF STEPHANIE BAILES. AN INCAPACITATED INDIVIDUAL. PURSUANT TO 20 Pa.C.S. CH. 5513 TO THE HONORABLE JUDGE OLER: The Petitioners, Kim Wolf, residing at 314 Bonnybrook Road, Carlisle, Pennsylvania, 17015, and Jennifer Williams, residing at 321 Majestic Circle, Dallastown, Pennsylvania, 17313, 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 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 emergency guardian of her person and Jennifer Williams as secondary emergency guardian of her person. C-2 4. A hearing for the adjudication of incompetency and appointment of a g~dian _ ==0 of the person of Stephanie Bailes has been scheduled before this Honnr~le -- '~-:"'r.J ~.:,~ Court on May 4, 2007 at 11 a.m. ...... --rl 5. Stephanie Bailes, the alleged incapacitated person, will turn eighteen :6ti:":~pril .. . . . ... 13, 2007. Therefore, there will be a lapse of sixteen days where Stephanie Bailes will have no guardian and will suffer irreparable harm as a result, as described below: a. Emergency 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. b. 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. c. In a letter dated March 21, 2007, Stephanie Bailes' pediatrician, Dr. Holly 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 0" 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. d. During 2006 alone, Stephanie Bailes had approximately fifty (50) appointments with doctors and lab visits, one (I) 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. 6. Under newly enacted Act 2006-169, signed November 29,2006, in absence of a designated health care representative, there is an order of persons who may act as representatives. Since Stephanie Bailes is not married and has no children, her health care representative would be her parent and it is possible for more than one member of a class to assume authority. (20 ~5461(d)(1)). .. .r Stephanie Bailes' biological parents are divorced and have had differences of opinions in the past and the statute explicitly states that if they do not agree on a health care decision, then no decision can be made until the dispute is resolved. Given Stephanie Bailes' extreme condition, this potential outcome would result in irreparable harm. (20 ~5461(g)(2)). WHEREFORE, Petitioners respectfully request that this Court assign to Petitioner Kim Wolfprimary emergency guardianship of the person and if Ms. Wolf becomes unwilling, unable, or unavailable, assign to Petitioner Jennifer Williams secondary emergency guardianship of the person of Stephanie Bailes. Date:~ ~,,~ ~(/Yl Virgini Spiess Certified Legal Intern ~/lf<>>~ Meg . esmeyer Supervising Attorney The Disability Law Clinic 45 North Pitt Street Carlisle, PAl 70 13 (717) 243-3696 VERIFICATION We verify that the statements made in the foregoing PETITION SUPPORTING APPOINTMENT OF AN EMERGENCY GUARDIAN OF THE PERSON 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. ~ 4904, relating to unsworn falsifications to authorities. Date:~/41 CJ{"Y."'I-=f Virginia less Certified Legal Intern Date: tJJ1/07 I , t1!/J:.(!~~~ Supervising Attorney , ..... CARLISLE PEDIATRIC ASSOCIATES A PROFESSIONAL CORPORATION STEPHEN J: KREBS, M.D. J. LYNN HOFFMAN, M.D. DEBORAH RAUBENSTlNE. 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 March 21,2007 r.e. Stephanie Bailes, SSN 185-70-6116 ToWhom 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 Vehic1e 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 fractures 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 'i .. damage and atrophy of her cerebral cortex. Her prognosis for significant improvement i 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. Hoffinan, MD .. - CONFIDENTIAL For Professional Use 0nJv ," 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 EvaI: 5/13/05 Age: 16 Service Location:. Outpatient DOH: 4/13/89 Procedure Code: 96115 - 3. writs 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 neurocogoitive functioning as well as appropriate trealment recommendations. BACKGROUND INFORMATION: Stephanie Bailes is a 16-year~ld girl who was involved in a motor vehicle accident on March 27, 200 I when she was II 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-fibular fracture, right femur fracture, right wrist fracture. She underwent emergency craniotomy with evacuation of subdural hematoma' as well as VP shunt placement. There were variOU$ revisions of the shunt over time secondary to hydrocephalus. In addition, a tracheostomy and NG tube were also placed. Stephanie's medical recovery was complicated by aspiration pneumonia as well as onset ofseizure disorder in September 2004. Stephanie's mother, Kim Wolf: indicates that her daughter spent three months in the acute care hospital and was eventually returned home in June of2001. Stephanie's mother indicates that her daughter exhibited ey~ opening following her injury, although she did not begin to follow any coriunands until May 2002. Stephanie currently receives significant nursing and home care and is also attended to by rehabilitation aides in the home. , I Division .of PS'prhoJogiro! ~rr\'ir" ....~':\ Christo her Royer, PsyD Amy Ku 'rb, PsyD Lisa Ear n, PsyD 4950 Wi son Lane' Mechani sbuz:g. PA 17055 ' ,Bloom Bl g., S~~JQ6 4310 Lo dondery:'-''C!. Harrisbu g. PA 1'-'. Phone 71 691-4847 Fax 717 6 1-4959 www.pnsdrs.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 mnghter struggled significantly with her grades. She was diagnosed and placed on Adderall, with a subsequent improvement in her grades: Medical history is otherwise non-ccmtributory. CUrrent medications include Sinemet, Reglan, Baclofen, MiraIax, Prilosec, Senokot, Lamic:tal. Stephanie continues to be NPO and receives tube feedings. Stephanie resides with her mQther Kim, step13ther Brad, younger brother John, age 8. Her &ther is Don Bailes. She has an older sister Jennifer, age 21. StCphanie receives a variety of rehabilitation as well as educational services. Home-based school based services inc~ OTIPT once per week, Speech Therapy two times per ~ Music Therapy two times per week, Special EducationllnstructionallDterveotion two days per week. In addition, she also receives non-school funded therapies as wen 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. lnte.rpersonaI 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 queStiOJ:lS. She has demoDstrated significant improvement in breath sow:-dS and recently began to mouth words in Jamwy of this year. There is also an emergence of autmDatic sequencing and verbalizations. There isl however, oral and verbal apraxia. Available school records indicate that Speech Therapy treatment is also addressing oromotor mov.ements. In addition, augmented communication with the use Ofa Dynavox. is-being utilized. Accuracy_ofher arm movements as wen as learning of new icons is apparently underway. Socia1language, addressed the yes/no responding and expressiOn ofbasic wants and needs, is also reflected as a goal. School Occupational and Physical Therapy is addressing walking with the "Up and Go" ~ as well as range ofmation and sitting. In addition to gait training, standi"g, 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 Occupationallberapy is addressing Stephanie's participation in activities of daily living, both upper and lower extremity as ~ll 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 Instructional and Special Educational goals recently have a4dressed map skills inc~ding the location of continents, oceans, and states. Reacling Comprehension as well as sorting of shapes are also indicated as recent instructional tasks and activities. Instructional interventions are also addressing the.usc of the Dynavox. Of note, therapy notes do indicate that distractibility as well as mtigue at times impedes Stephanie's full participation in her therapies. FINDINGS: Stephanie was accompanied to the evaluation by her mother as well as one ofher aides. She was evaluated seated in her wheelchair: She presented initially as awake, alert, and attentive, I. j Page 3 Stephanie Bailes May 13, 2005 although throughout the evalu@on, there were significant indications of distractibility. In addition, throughout the evaIuatlon, there were periodic episodes of dimini!ilhed 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, Stepbame demonstrated a left gaze preference. A right hemianopsia is suspected. She deinonstrated both distant and near point tmcking in the left visual field only. She demonstrated the capacity for both object locali~on as well as object identification. In the left visuaI field, Stephanie did demonstrate significant deficits in visual atteDtional capability. SpecifiealIy, her ability to identify letters in an org;mi'7ed may was at app.toximately the 40010 level., She was able to identify two of five letters to command, again presented in an organized &shion. 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 protrusiODS. ~ addition, with verbal prompting from the examiner or her mother or through the facilitation with mng;ng, in addition to proD1ptiug; she did demonstrate some incousisteni verbalizations. At timeS, she was able to mouth and sing single words such'as bye or hi. This behavior was inconsistent and infrequent, however. Stephanie, on today's evaluation, did not demonStrate verbal yeslno responding to basic factual questions. For instance, she did not respond to various questioos 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 ayeslno 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 DO. 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 horizoiItal forritat. 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 70010 accuracy. On today'S examination, she was not able to follow ~o-step motor commands. DIAGNOSTIC IMPRESSION: Stephanie Bailes is a l6-year-old, young lady who was involved in a motor vehicle accident in 2001. She is presenting with severe cognitive dysfunction status posttraumatic 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 limitatiODS. Presumable s~ere left ---- -- -- --- 1-- 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 Jauguage and auditoIy comprehension. In addition, Stephanie is demODStlating ubiquitous defects in ~on as well as higher order cognition. RECOMMENnATIONS: I. Recommend consideration for stimulant medication given concenis regarding variable arousal and inatt"'"tion. Mrs. Wolf indicates that she will follow-up with this suggestion with Stephanie's neurologist, Dr. Faircloth. 2. Given Step~e's complex rehabilitation needs, including the presence of spasticity and tone. physiatry consultation is suggested. 3. Ongoing Physical Therapy and Occupational Therapy is obviously wammtcd. Ong~~essof~~~~and~are~~~of Physical Therapy as well as address of activities of daily Iiving'in Occupational Therapy. In addition; given Stephanie's visual deficits, coDSideration for a neurophtbamologic COn!ilnltation is suggested for address ofhemianopsia. 4. Ongoing muIti-sensory therapy modalities are warrauted, 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 ~ week. Ongoing address of oromotor and oromuscle strength is indicated. In addition, address of Stephanie's swaIIowing bas been ongoing. A swallowing study is also ' suggested. 6. Regarding cognitive issues, establishment of a reliable communic::ation system with Stephanie appears to be paramouut It is unclear if reliable yeslno responding ~ been established. Achievement of this through use of either the ~vox or utilization of two cards for choices is suggested. Furthermore, 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 and language issiles. . 8. Ongoing educational instruction in Special Education intervention is warranted. Integration of S~ Therapy communication techniques, either the utilization . oftbe Dynavox on a consistent basis or utilUation of reliable yes/or system is pat'amouut. Teaching to Stephanie's comprehension level is also necessary and can best be C$tablished once a reliable communication system is established and consistently utilized. For instance, if Stephanie only responds with 50% accuracy with a yeslno fonnat 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 instructioDa1level. 9. Neuropsychological re-ev3luation in approximately two or.three months is suggested for ongoing assessment of Stephanie's neurocognitive status. Ongoing &miIyeducation and support will also be provided. '~(Q Lisa A. Eaton, Psy.D. CJinica1 Neuropsychologist licensed Psychologist LAElasap