HomeMy WebLinkAbout03-2571COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Narciso A. Rodriguez-Cayro and
Mamie Lynn Roddguez-Cayro, individually and
parents and natural guardians of
Kyli Nicole Rodriguez-Cayro, a minor
Devon Noelle R0driguez-Cayro, a minor
Zack Alexander Rodriguez-Cayro, a minor
American Hospitality Concepts, Inc. d/b/a
The Ground Round
NO. O~ -o~'Q~/
PETITION FOR LEAVE TO SETTLE OR
COMPROMISE MINORS' ACTIONS
TO THE HONORABLE, the Judges of Said Court:
The Petit!0ns~, ofKyli Nicole Rodriguez-Cayro, Devon Noelle Roddguez-Cayro and Zack
Alexander Roddguez-Cayro' minors, by their parents and natural guardians, Narciso A.
Rodriguez-Cayro and Marine Lynn Rodfiguez-Cayro respectfully request:
Plaintiffs' are Narciso A. Rodriguez-Cayro and Mamie Lynn Rodriguez-Cayro.
The minor Devon Noelle Roddguez-Cayro was bom on December 28, 1998 and
his social security number is 182-78-2804.
3. The minor Devon Noelle Rodriguez-Cayro resides with his parents Narciso A.
Roddguez-CayrO and Mamie Lynn Rodriguez-Cayro at the following address:
· 40 Mayberry Lane, Mechanicsburg, PA 17050
4. A~guardian was not appointed for the minor, Devon Noelle Rodriguez-Cayro.
5. The minor's parents are Narciso A. Roddguez-Cayro and Marnie Lyrm
Rodriguez-Cayr0, who reside at the following address:
;
· 40 Mayberry Lane, Mechanicsburg, PA 17050
6. The defendant is American Hospitality, Inc. On March 9, 2002, the minor
sustained juries while dining at the defendant's Ground Round restaurant in Johnstown, PA.
7. No Complaint was filed.
8. Devon Noelle Rodriguez-Cayro, a minor did not seek medical attention following
the incident of March 9, 2002. It is alleged that Devon Noelle Rodriguez-Cayro, a minor
suffered emotional distress as a result of the aforesaid incident.
9. Attached hereto is a statement, under oath, of the minor's mother and father certifying
that the physical and/or mental condition of minor, Devon Noelle Rodriguez-Cayro, confirming
that the minor plaintiff has made a full recovery. (See Exhibit "A")
10. The following settlement has been proposed:
· " $2,500 for minor Devon Noelle Rodriguez-Cayro.
11. Pah-ties are of the opinion that the proposed settlement is reasonable due to the
lack of treatment: hnd a full recovery made by the minor Devon Noelle Roddguez-Cayro.
12. Tile minor Kyli Nicole Rodriguez-Cayro was bom on February 18, 1994 and her
social security nt~nber is 186-76-1971.
13. The minor Kyli Nicole Rodriguez-Cayro resides with her parents Narciso A.
Rodriguez-Cayrd~ and Mamie Lynn Rodriguez-Cayro at the following address:
· 40 Mayberry Lane, Mechanicsburg, PA 17050
14. A guardian was not appointed for the minor, Kyli Nicole Rodriguez-Cayro.
15. Ttie minor's parents are Narciso A. Rodriguez-Cayro and Mamie Lynn
Rodriguez-Cayro,: who reside at the following address:
· 40 Mayberry Lane, Mechanicsburg, PA 17050
16. The defendant is American Hospitality, Inc. On March 9, 2002, the minor
sustained juries while dining at the defendant's Ground Round restaurant in Johnstown, PA.
17. No Complaint was filed.
18. Kyli Nicole Rodriguez-Cayro, a minor did not seek medical attention following
the incident of March 9, 2002. It is alleged that Kyli Nicole Rodriguez-Cayro, a minor suffered
emotional distress as a result of the aforesaid incident.
19. Attached hereto is a statement, under oath, of the minor's mother and father
certifying that the physical and/or mental condition of minor, Kyli Nicole Rodriguez-Cayro,
confirming that the minor plaintiff has made a full recovery. (See Exhibit "^")
20. The following settlement has been proposed:
· $4,000 for minor Kyli Nicole Rodriguez-Cayro.
21. Parties are of the opinion that the proposed settlement is reasonable due to the
lack of treatment and a full recovery made by the minor Kyli Nicole Rodriguez-Cayro.
22. The minor Zack Alexander Rodriguez-Cayro was born on January 18, 2001 and
his social security number is 184-80-1756.
23. Tl~e minor Zack Alexander Rodriguez-Cayro resides with his parents Narciso A.
Rodriguez-Cayr0'and Mamie Lynn Rodriguez-Cayro at the following address:
· 40 Mayberry Lane, Mechanicsburg, PA 17050
24. A guardian was not appointed for the minor, Zack Alexander Rodriguez-Cayro.
25. The minor's parents are Narciso A. Rodriguez-Cayro and Mamie Lynn
Rodriguez-Cayr0, who reside at the following address:
· 40 Mayberry Lane, Mechanicsburg, PA 17050
26. The defendant is American Hospitality, Inc. On March 9, 2002, the minor
sustained juries while dining at the defendant's Ground Round restaurant in Johnstown, PA.
27. No Complaint was filed.
28. Attached is a copy of the Department of Emergency Medicine at UPMC Lee
Regional in Johnstown, PA indicating the extent of treatment ("Exhibit B") as a result of the
aforesaid incident.
29. Attached hereto is a statement, under oath, of the minor's mother and father
certifying that the physical and/or mental condition of minor, Zack Alexander Rodriguez-Cayro,
confirming that the minor plaintiff has made a full recovery. (See Exhibit "A")
30. The following settlement has been proposed:
·~'' $8,500 for minor Zack Alexander Rodriguez-Cayro.
31. P~ies are of the opinion that the proposed settlement is reasonable due to the
lack of treatment and a full recovery made by the minor Zack Alexander Rodriguez-Cayro.
WHEREFORE, Plaintiffs request that they be permitted to enter into a settlement
recited above and that the Court enter an Order of Distribution as follows:
FOR MI~OR Kyli Nicole Rodriguez-Ca~o
To Kyli, ./~:minor in restricted accounts not to be withdrawn
before a majority upon leave of the Court in the amount of $4,000
FOR MINOR Devon Noelle Rodriguez-Ca~o
To Devon, a minor in restricted accounts not to be withdrawn
before a majority upon leave of the Court in the amount of $2,500
FOR M~OR Zack Alexander Rodriguez-Ca~o
To Zack, a minor in restricted accounts not to be withdrawn
before a majority upon leave of the Court in ~ount of $8,500
B T . CERIN
~ 1V~A~'~CH~J~E¥, ESQ~IRE -,
Attorney for AHC d/ba/The Ground Round
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Narciso A. Rodriguez-Cayro and
Mamie Lynn Rodriguez-Cayro, individually and
parents and natural guardians of
Kyli Nicole Rodriguez-Cayro, a minor
Devon Noelle Rodriguez-Cayro, a minor
Zack Alexander Rodriguez-Cayro, a minor
vii.
American Hospitality Concepts, Inc. d/b/a
The Ground Round
NO.
AFFIDAVIT OF PARENTS/PLAINTIFFS
FOR APPROVAL OF MINORS' COMPROMISE
COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF CUMBERLAND :
We, Narciso A. and Mamie Lynn Rodriguez-Cayro, parents and natural guardians of Kyli
Nicole Rodriguez-Cayro, Devon Noelle Rodriguez-Cayro and Zack Alexander Rodriguez-Cayro,
being duly swom~according to law depose and say:
1. The parents/plaintiffs desire that the causes of action arising from the accident
should be settled for the amount set forth in the Petition and request that distribution be ordered
as proposed in the scheduled distribution set forth in the proposed order and further confirm that
the minor plainti~s have all made a full recovery to
ie bes~e and information.
iARCI~g"O A.'~O-'~~A'~RO
MA~NIE ~'YNN ROD~I~2~/Ct~YRO
EXHIBIT "A"
UPMC I-~'m SYs"i,_.~
UPMC Lee Regional -...
EMERGENCY DEPARTMENT
DISCHARGE INSTRUCTIONS
RODR I F.,UE ZCARY. RO, ZAC K
M 01/18/02 50D
NO,FAMILY DR
ER 03/09/02
865 EVERGREEN CIRCLE
T E L F 0 ~ D Addre~s&gmlp~ 9 6
PLEASE READ THIS SHEET VERY CAREFULLY: We have marked your Instructions in the't~'(~x~'S with an "X".~`~'~
INSTRUCTIONS MARKED WITH AN "X", APPLY TO YOU. If you call us back for any reason, have this paper in front of you
when you call.
Your diagnosis is:
/
Continue taking all medications that you normally take, unless told otherwise.
The doctor(s) that took care of you in the Emergency Department want you to take
NAME OF MEDICINE
the following medicines.
DOSE
HOW OFTEN
Bring a'"lis-~'~'~ll medicines that you are taking to your doctor or the' Emergency Department.
[~You have been given the following discharge instruction sheets: [] Wound care/Tetanus [] Cast care [] Crutch Walking
.~prain/Soft tissue injury ~'lead injury [] Fever Sheet [] Sore Throat [] Other '-
[] Your x-ray reading is preliminary. The radiologist will review your films. You will be called if there is a change in your reading
which requires a change in treatment. You may be reached at:
[] You may arrange to take your x-rays to another physician. Please call the x-ray Department (533-0121) one day in advance
to make arrangements. Allow a 1/2 hour to pick up your xrays.
[] We have arranged to send your x-rays to the referral M.D.
[] If you have a culture done, you will be notified if a change in treatment is required. You may be reached at:.
[] REFERRAL:
You have been referred to. 'Your appointment is:
Please contact this doctor/clinic to arrange/confirm the follow-up care. Phone number is:
[] RELEASE OF INFORMATION: I hereby authorize UPMC Lee Regional to release a copy of this Emergency Department
record to the physician/clinic that I am referred to for follow-up treatment.
[] Work. e~scompensation.cases. You are.to f. ollow-up in Occup~{3'onal-Iflealth.{814)533~O18J:at: .... . -,.. -:(~..':~', '~"
".', -.L~,:..~.,.<;,,,,-:~' ........... ,' ..,.~.. --. · " '
[] Other instructions for you~ ":'*\ (..~ '-'X..~-~,'.'/~"~.,..._r_.~-'T ~m f ~
For routine folloW-up_~care you should see your family Medical Doctor. If you feel worse and cannot make appropriate
follow-up arrangemedts,~r&tarn.io {he Emergency Department (814) 533-0109
I have read and understood the.,pbO~ dis,~.cl~.rge instructions that apply to me. I understand that ! have received,._,/
emergency care only and t~at~t is my r~(spon~ibility t~ arrange follow~up-c~re.
N~R-14-2002 THU 09:22 ~M H' TH INFO DEPT F~× NO, B, $33 0080 P,~02
PATIENT: RODRIGUEZ-CARYO, ZACH
MR#: 337284
PCP/REFERRING PHYSICIAN:
DEPARTMENT OF EMERGENCY MEDICINE
UPMC LEE REGIONAL
JOHNSTOWN, PA
DATE: 3-9-2002
TIME: 1320
CHIEF COMPLAINT
Possible burn.
HISTORY OF PRESENT ILLNESS This is a 50-day-old, white, male
patient who was being carried by his dad in The arm and according
to the dad, a waiter at Ground Round accidentally dropped a bowl of
hot onion soup. Mechanism of injury is really unknown but father
stated that the bowl kind of hit the patient's head over the right
posterior parietal area and may have splashed some hot soup over
the head and eye. This happened this afternoon around 1:23.
Patient was brought here for further evaluation and treatment.
PAST MEDICAL HISTORY Unremarkable.
Immunizations are already started.
Patient was born full term.
SOCIAL HISTORY
Unremarkable.
FAMILY HISTORY
Unremarkab!e.
ALLERGIES None.
CURRENT MEDICATIONS
None.
REVIEW OF SYSTEMS Possible pain over the scalp area.
to obtain fully review of systems.
Unable
PHYSICAL EXAMINATION
VITAL SIGNS
REENT
Shows a well-nourished, well-developed
baby, very vibrant, not toxic looking.
Pulse 120, respirations 32, temperature
97.4°.
Normocephalic although they claim that
there is a prominence or swelling over the
right side of the head. I tried to compare
for both sides of the head. Both left and
right posterior parietal areas are really
prominent. Actually, it is not swollen. I
do not see any redness at all at the
DICTATED BY: FEBENIDO PASCUA, M.D.
DD: 3-9-2002 TR: MTS
DT: 3-9-2002 JOB~ 0460
DEPARTMENT OF EMERGENCY MEDICINE
RECEIVED
MAY 2.8 2002
NRR-14-2002 THU 09:23 RN "-tLTN INFO DEPT FRX NO, , 533 0080 P, 03
PATIENT: RODRIGUEZ-CARYO, ZACH
MR#: 337284
PCP/REFERRING PRYSICIAN:
UPMC L~E REGIONAL
JOHNSTOWN, PA
DATE: 3-9-2002
TIME: 1320
NECK
REST OF EXAM
present time. I do not see any blister
noted at the present time although they
point to me an area of blister. I think
thi~ is just more a prominent capillary at
.the present timP.' Nega~tive-hemotympanum.
Pupils are reactive to light. Father said
that there might be some onion soup
splashed over =he left eye, a little bit of.
tears in that area. I went ahead and did
an examination. I do not see any trauma at
the present, time. I went ahead and did
fluorescein staining. At the present time,
there is no uptake. Upper airway is
patent.
Supple.
Unremarkable.
TREATMENT PLAN Parents advised to observe. Ice'
compresses. Tylenol for pain. Observe for any blister.
by their pediatrician in Philadelphia.
Follow up
DIAGNOSIS
1. 'Possible closed head injury, possible
first degree thermal burn.
DICTATED BY: FEBENiDO PASCUA, M.D.
DD: 3-9-2002 TR: MTS
DT: 3-9-2002 JOB# 0460
DEPARTMENT OF F/4ERGENCY MEDICINE
RECEIVED
2 ~.-
· --' ".~-.'-C_z. :' . '~
JUN 0 3
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Narciso A. Rodriguez-Cayro and
Mamie Lynn Rodriguez-Cayro, individually and
parents and natural guardians of
Kyli Nicole Rodriguez-Cayro, a minor
Devon Noelle Rodriguez-Cayro, a minor
Zack Alexander Rodriguez-Cayro, a minor
American Hospitality Concepts, Inc. d/b/a
The Ground Round
4o. 03 -
ORDER APPROVING SETTLEMENT
AND
ORDER FOR DISTRIBUTION
AND NOW, this ~. ~' day of O. ~.~-- ,2003, upon consideration of
the Petition for l~ave to Settle or Compromise Minors' Actions. l~Id ,>ii --ja .... vl~
, .29...~, it is hereby ORDERED and DECREED that Plaintiffs are authorized to enter
into settlement with the defendant, American Hospitality Concepts, Inc, ("AHC"), in the
amounts of:
· Four Thousand ($4,000) Dollars for minor Kyli Nicole Rodriguez-Cayro;
· Two Thousand Five Hundred ($2,500) Dollars for minor Devon Noelle Rodriguez-
Cayro; and
:i
· Eight Thousand Five Hundred ($8,500) Dollars for minor Zack Alexander Rodriguez-
Cayro.
Defendant shall forward all settlement drafts or checks to Narciso A. Rodriguez-Cayro,
parent and natural guardian, proper distribution.
IT IS FURTHER ORDER and DECREED that the settlement proceeds be distributed
as follows:
1.
NAME
Kyli Nicole Rodriguez-Cayro
Devon Noelle Rodriguez-Cayro
Zaek Alexander Rodriguez-Cayro
To Minor Plaintiffs:
DATE OF BIRTH
February 18, 1994
December 28, 1998
January 18, 2001
SOCIAL SECURITY NUMBER
186-76-1971
182-78-2804
184-80-1756
· To Kyli Nicole Rodriguez-Cayro, a minor, in restricted accounts, not to be
withdrawn before majority or upon prior leave of the Court in the amount of Four Thousand
($4,000) Dollars.
· To Devon Noelle Rodriguez-Cayro, a minor, in restricted accounts, not to be
withdrawn before majority or upon prior leave of the Court in the amount of Two Thousand Five
Hundred ($2,500) Dollars.
· ~ To Zack Alexander Rodriguez-Cayro, a minor, in restricted accounts, not to
be withdrawn before majority or upon prior leave of the Court in the amount
of Eight Thousand Five Hundred ($8,500) Dollars.
Narciso A. Rodriguez-Cayro, parent and natural guardian, is hereby authorized to execute
all documentation necessary to purchase saving certificates from federally insured banks or
federal institutions having an office in Cumberland County in the amounts of:
A: In the sum of Four Thousand ($4,000) Dollars for minor Kyli Nicole
Rodriguez-Cayro~ not to exceed the insured amount with the funds payable to the minor upon
majority the certificate shall be titled and restricted as follows:
2
i. Kyli Nicole Rodriguez-Cayro, a minor, shall not redeemed except for renewal
in its entirety, not to be withdrawn, assigned, negotiated or otherwise alienated before the minor
obtains majority, except upon prior order of the Court.
B. In the sum of Two Thousand Five Hundred ($2,500) Dollars for minor
Devon Noelle Rodrignez-Cayro, not to exceed the insured amount with the fimds payable to the
minor upon majority the certificate shall be titled and restricted as follows:
i. Devon Noelle Rodrignez-Cayro, a minor, shall not redeemed except for renewal
in its entirety, not to be withdrawn, assigned, negotiated or otherwise alienated before the minor
obtains majonty, except upon pnor order of the Court.
C'.! In the sum of Eight Thousand Five Hundred ($8,500) Dollars for minor
Zack Alexander Rodrignez-Cayro, not to exceed the insured amount with the funds payable to
the minor upon majority the certificate shall be titled and restricted as follows:
i.'Zack Alexander Rodrignez-Cayro, a minor, shall not redeemed except for
renewal in its entirety, not to be withdrawn, assigned, negotiated or otherwise alienated before
the minor obtain~ majority, except upon prior order of the Court.
Narciso ~. Rodrignez-Cayro, parent and natural guardian, shall file with the Court
Administrator within sixty (60) days from date of this Order, proof of the establishment of the
accounts as requked herein by affidavit from Narciso A. Rodrignez-Cayro, parent and natural
guardian, certifying compliance with this Order. Narciso A. Rodrignez-Cayro, parent and natural
guardian, shall attach to the affidavit a copy of the Certificate of Deposits and/or bank accounts
containing the required restrictions by the Court.
BY THE COURT: /