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HomeMy WebLinkAbout99-06311NANCY J. MARTIN as parent IN THE COURT OF COMMON PLEAS OF and natural guardian of CUMBERLAND COUNTY, PENNSYLVANIA BRIAN W. MARTIN, a minor NO. 99.6311 CIVIL TERM V. CIVIL ACTION -LAW VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 6168 NOTICE OF ARBITRATION HEARING YOU ARE HEREBY NOTIFIED that the arbitrators named below and appointed by the Court in the above captioned matter will meet for the purpose of their appointment on April 9, 2001 at 9:30 a.m. in the 2' floor hearing room of the Old Court House Carlisle, Pennsylvania, at which time you may appear and be heard, together with your witnesses and counsel, if you so desire. March 8, 2001 TO: Michael A. Scherer, Esq. Attorney for Plaintiffs Thomas E. Brenner, Esq. Attorney for Defendant Gregory Knight, Esq. Arbitrator Susan Confair, Esq. Arbitrator Frances H. DO Duca, Chairman Bulletin Board Prothonotary's Office 320 MARKET' ST'NFE'I'• STRAWnFNRY SOI!ARF. P.O. BOX 1268 • HARRISBURG, PENNSYLVANIA 17108•1268 717.234.4161 • 117.23-0.6808 (FAX) GOLDBERG, rILV KATZMAN & SIHI'MAN, P.C. UW ATTORNEYS AT LAW April 3, 2001 OF CnuvsEt. F. LIM SHIPMAN JOU11IA D. LOCK Frances Del Duca, Esquire ART,wR L. G 1 10 West High Street -200-2000) (19551 IIARRY B. GOLDRERO Carlisle, PA 17013 (1961.199X) Susan Confair, Esquire 2331 Market Street R1/NALD J . E SIO Camp Hill, PA 17011 . E5I'O SPOX1T MAUI. J NEIL HENDERSHOT Gregory Knight, Esquire J. JAY CoorKR J 19 Brookwood Road rIlOX1A E. BNENNER Carlisle, PA 17013 mrv A . S,rAiLF, J APRD. L. STRANII•KOrAY Re: Martin v. Vets Canteen Association GUY II BROGKY No. 99-631 1 JEFFERSON J. SIIII'NAN JERRY' I. RI13SO Dear Arbitrators: MICTIAEI. J. cROCENY.I TDOAIAY J. w1:RER I enclose a Memorandum on behalf of Defendant Vets Canteen Association S I E"N' E. GIt URR April 9'" at submitted in advance of the arbitration hearing scheduled for Monday ARNnI.D 11. KOGAN , Ro%CF. L. MORRIS 9:30 a,m. EVAN J. KLINE, III JOAN DEWREn¢n Ve truly yours, JUAN R. NINUSKY k !\ DAVID %I. ZS I ECKLI. .Lv Thomas E. Brenner TEB:nd Enc. cc: Michael Scherer, Esquire 61245.1 CAN LIS1.1. 0111( l.: 717.245.115'11 • YORK 01'1101. 717. 843. 7Y 11 NANCY J. MARTIN, as parent and IN THE COURT OF COMMON PLEAS natural guardian of BRIAN W. MARTIN, : CUMBERLAND COUNTY, PENNSYLVANIA a minor, Plaintiffs No.: 99-6311 Civil Term V, CIVIL ACTION - LAW VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 6168, ARBITRATION' MEMORANDUM°OF'DEFENDANT This matter involves a claim for injuries arising from am incident that occurred on November 10, 1997. Brian Martin, a minor, was in attendance at a football banquet held by the Shippensburg Vets who had sponsored the football team. Following a sit-down dinner, coffee was being served by a volunteer helper when another worker who was cleaning tables bumped her and coffee spilled from cups on a tray and struck Brian Martin on his head and along the left side of his body. The mere happening of an accident does not establish negligence. Hardy v. Cloverleaf Mills, 426 Pa. 206, 232 A 2d 755 (1967); I'egelev v. Costello, 416 Pa. 448, 208 A.2d 243 (1965). It is anticipated that the testimony will show that two women bumped each other as one was serving coffee at the Martin table and the other was cleaning dishes from a nearby table. These facts do not support a finding of negligence. Issues of medical expenses have been resolved and the claim being presented is for pain and suffering A follow-tip evaluation of Brian Martin was conducted by Dr. John Stratis, a plastic surgeon. His report has been provided to Plaintiffs' counsel and is submitted for consideration by this panel pursuant to Pa. R.C.P. 1305(b) (copy attached). Respectfully submitted, Date: 'C 3 v f _ 61261.1 GOLDBERG KATZMAN & SHIPMAN, P.C. omas renner, Esquire ID#: 32085 PO Box 1268 Harrisburg, PA 17108-1268 (717) 2344161 Attorney for Defendant Wma Exhibit A John P. Stratis, M.D. 018 Bolvedera Stroot Carlisle, PA 17013 (717)249-0100 Fax(717)249.8889 040 N. Front Street Womnloysburq. PA 17043 (717) 249,0100 Fax (717) 2490089 CONSULT ON BRIAN W. MARTIN SEPTEMBER 15, 1999 William R Graham, III, M.D. 650 N. Twelfth Street Lemoyne, PA 17043 (717)763.9766 Fax(717)763.7710 This is an 11 year old white male who comes in for consultation to check his facial scarring after burns to the face. Apparently this child had a tray of hot coffee in cups spill onto his face when he was nine years old in 1997. He was treated at Chambersburg Hospital with local wound care. Local wound care Included Silvadene. It was noted that he did have some blistering. Multiple photographs were brought in with the patient for toy review. His burns were described by the physicians taking care of him as first and second degree. Ile was also apparently taking some pain medication which included Vieodan. The child was not very forthcoming with any of the history. Examination revealed all areas were well healed, well epithelialized. No dermal scarring. His mother did describe hie fear and the pain associated with the burn, however the child did not participate in this discussion. On specific reply to questions addressed in a letter from the patients attorney - What level of pain was associated with the burns suffered by Brien? - Pain is a subjective complaint and the degree of pain also is subjective. Generally speaking, second degree burns are painful and the pain lasts variable period of time depending on tire methods used for treatment. I would expect the patients pain to be minimal after about ten dayu. There is no need for any future treatment. There is no scarring present frotrt the burns. There should Le no significant .precautions for the future as a result of sustaining the burns. I cannot comment on any repressed emotional feeling as a result of having .the burns and would recommend a child psychologist or psychiatrist evaluate the patient in that regard. JPS/klf 30h P tits, M. D. PlastWCosmoOc Surgery • Breast Procedures • Micro Surgery • Laser Capab8i6os • Hand Surgery Birth Doleds • Endoscopk Plas9c Surgery • Blomedic Skin Care Program State Licensed Surgical Facility On-S4o L ? s rucl? c: -. ta?ery ufCcllital Prnnspll'alill, RC. I hereby certify that I served a copy of the foregoing document upon the person(s) indicated below by depositing a copy of the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania and addressed as follows: Michael A. Scherer, Esquire O'BRIEN, BARIC & SCHERER 17 West South Street Carlisle, PA 17013 Attorney for Plaintiffs 'gOLDBEI G, KATZMAN & SHIPMAN, P.C. W_ BY: . Thomas E. Brenner, Esquire Attorney for Defendant Date: x/3/01 (T • E,MEa;1G NCY CARE UNIT RECORD I 11/10/97 .? _ . _ . MARTIN BRIA CVEA ? , N W ,ATgNTNWMII , O CHAMBEMURG LOT 188 SME 711773.2 HOSPITAL ADAMS M D L, LYNN 1 f SHIPPENSBURG, PA A n ys ltetr 01SwandS NrahA AMB 17257 nW 20:03 07/29188 BY SAME W o 2 NANCY MARTIN MTHR RT SIDE COFFE BURN ? 1717)530-1413 75 ` Ip? 387010 196.70.5654 ' c FATIOM SAS 111097 w , u 05 11 SHIPPENSBURG UNIVERS 1000 BLUE CROSS 381 7MART16. SHAWN OBDI59589372 940000000 HARRISBURG, PA ECU DOCTOR TATED STAT, D MEDIC CALL 0 ADDENDUM A PA TIME SEEN 0 DICTATED 0 ORDERS 0 ATTEND NOTE a VITAL SIGNS: T P ZQ R BP ALLERGIES NO : NE 1 a 1. c? 2. s A IN 7 OLD RECORDS: ? ECU ? INPATIENT • iEKO AB r om CARDIAC VIA Kt PORT CXF1 EKG: TO X;RAY L URINE i M R PAILAT XR )NTERP. TRAUMA PACK - R M PREGNANCY HIP T XR ' - PSYCH PACK SMP H AMYIA HAND AA FROM X-RAY TR MA• RY PMP FA IA El NE ATTN. PORT PELVIS l: PELVIC PA IVP WRIT PELVIS K PROFILE AM lA PED T HEA FOREA RM PORT SPINE X-RAYS LAO DRAWN A I IN LEVEL - P T ABD MEN ELBOW %N A FIR GWET READ A. Y IN V T F T SHOU LDER PIN r I A TIN V R M R. X R. ANK AVI LE T PIN LAB REPORT ETOH STREP SCR;EN TIB/FIB HIS SE RIES LS SPINE TIME I Id c D O HUTCHES P - le Gu O rQAFA M41AL M101 T 1 V V W O IMMMOBILIZER I -- NEW PHYSICIAN LIST A ORTHOSTATIC TIME M VITAL SIGNS YI • SITTING p STANDING a A MONITOR. 02? 8 VU LSE OA - % a MED PREPACKS AMOXIL 250mg • 1 po lid KEFLEX 250mg • 1 po old TYLENOL 03 _po 4 4 M with food pen pain AMOXIL 125rng/Scc _tip Too lid ROSITUSSIN AC _Cc TO,-top Do 4 4 M TYLENOL 83 ELIXIR _cc T0,_ltp 4 4 he pen pain AMOXIL 250mg15cc _tsp po lid BLEPH 10 _gtts ODIOS old PERCOCET • 4TO • 1 Do It 4 he with food pen pain ERYTHRO 250mg late. 470 • 1 pa old with food GENTICIOIN DROPS _Olt$ ODIOS old DARVOCET • I po 4 4 M with food pen pain BACTRIM DS • 2TO • 1 po bid FLEXERIL 1 po lid pen spasm CHILDRENS MOTRIN _ tap D 4 0 ho r RIDIUM 200.3 • 1po lid pen burning DIAGNOSTIC 0 DISCHARGE IMPRESSION 22 0 23 OBS ROOM NO. 0 ADMIT ROOM NO. 0 TRANSFER CONDITION N SCHARGE REFERRED TO. TREATMENT 3 RN II TIALS .)EMERGENT t ATI 0 CATEGORY 0NON EMERGENT 1 ICI NS SIGN 1 (REFERRAL PHYSICIAN SIGNATURE) DISCHARGE TIME ECU PATIENT ASSESSMENT Name T Date d ' 97 Time °?? ? 0 CafggoryMode ol'Arrival. O Ambulatory a Wheelchair OStretcher O Carded VS: T -P-IO R ly BP IEFCOMPLAI?j /BRIEF HISTORY/ PATIENT AQS E$SMENT., M ATIONS: DOSE FREQUENCY LAST DOSE ZL `yaT f ri I Art 1 r _ U PMH: Dale of last DTpTi1FRa(Td) Weight Height Ci Instructions given prior to Td ? Peds: shots up to date? ?Yes ? No Do you have any religious or cultural preferences that will affect your care? Evidence of suspected physical/psychosocial abuse Identified? ? No Pregnant/Lactating (circle) If no, Immunization material provided ,#No ?Yes ?Yes ? If yes, note findings and refer to social services. Date Time Evidence of growth/developmentat/nutritional problems:. ? No ? Yes Referral to Date_ Time Do you have any other concerns that you want to tell me about? j lco" Inltlal SAFETY PROGRESSNOTES ID armband Consent for Tx signed Side rails x with patient/significant otherconsent Clothing/belongings separated from patient Immobilization Appliance Spinal immobilization removed per MD order Ice to Crutches fitted/instructions given with return demonstration Time T P R BP 02 T PAIN 0•t0I MEDICATION UPONARRIVAL C•COLtAR 13SPINEBOARDI CICERVICAL IMMOBILIZATION VI VISUALACUITY R L DISCHARGE Rx given on DC J Mode of exit Accompanied by Mental Status on DC 1)Alert ?Other Initials Family notified Q Police notified Report to ECF CHAMBELSBURG HOSPITAL A..Qll r/.t.. N V !'Anbrd.r1 PA /A Initials INTERVENTIONS ?See Nurse's notes Wound site cleaned Wound site dressed 1) 11:? ? II/10/S7 1<317010 1 TI Id' I I" S?11 17 :' r ?I? 530-141 CHI MBERSEIURG 1406PMAL M,rallrp i/S..wrNeelA 111 North Seventh Street C19MEenbwE, PA I?2OI m7! 262.3000 EMERGENCY CARE UNIT PATIENT INSTRUCTION SHEET (717) 267-7146 The treatment you have received has been rendered on an emergency basis only. It Is Important that you follow discharge Instructions and receive follow-up care. Follow the Instructions below that are checked and any additional Instructions given. WOUND CARE (4 dressing clean and dry for next I 1 day(s). ? Following this lime period, remove dressing, wash wound with soap and warm water, dry ' thoroughlyy and cover with appropriate bandage. Repeat daily until the wound has healed. ? Return here for wound check in-clay(s). Dale: ? Have sutures removed in day(s). Date- 0 lime(s) a day; wash burns thoroughly with soap and water; then reapply Silvadene cream and redress. Keep dressing clean and dry. ? Your wound has been closed with sleri-strips. They must be kept clean and dry. Leave star!- strips In place until they lall off spontaneously in about live to seven days. ? Warm water soaks or compresses for 15 minutes lour times daily. ? Return Immediately to the Emergency Department or your family doctor if signs of infection develop -Increasing redness, shelling, pus, foul odor, red streaks, lever. ORTHOPEDIC& BACK INJURIES ? Apply ice Intermittently to the affected area for the next 48 hours and keep it elevated to reduce swelling. ? Rest affected area _ day(s) or until pain-Iree. ? Use vetches; do not bear weight until able to stared without pain; then slowly return to usual activities. ? You may remove elastic bandage and/or splint ever .. . day(s). If affected area is still pain ul, reapply and continue use until pain-free. ? tied rest for the next day(s). ? Wear elastic bandage and/or splint for day(s). ? 11 1 e extremity below any bandage becomes increasingly painful, numb, blue, or swollen, remove or loosen it immediately and contact the Emergency Department. ? Use air cast according to the instruction sheet. ? Get prescription filled; take or apply medicine as occurs or other sudden, unexpected symploms)and contact Emergency DepaNnenl Immediately. ? Take 2 3 AdwftlitiMbuprofen every 4 6 hours as needed forpain or fever greater than 101'. Take with loon ? Take two Tylenol every lour ho`uT for pain or lever See additional medication Information: (over) ? Antibiotics ? Muscle relaxants ? Anti-inflammalories ? Decongestants/ gyarcdlics/sedatives Antihistamines fluid intake. 1 small amounts of clear fluids overnight. f resume a normal diet. Carbohyd(ales oast, plain rice, applesauce may be )airy products may make your symptoms ? Use vaporiser or cool mist humidifier. ? For lain or temperature over 101' use aspirin-Iree medicalion (TXlenol.Tempra, Acetaminophen, CHIIDRENS ACETA611NOPHEN DOSAGE RECOMMENDATIONS AGE 4.11 1243 2-3 45 64 9.10 11 12.14 GROUP Mcs MCS YAS IRS IRS YRS YK YRS y't' Ixsl 12.11 1643 24-35 36.0 46.59 50-71 11-25 r%1 oar ACED ".4 60 120 160 310 IN 400 160 6e 1 ml nq nq ^q 1q av rq eq 119 OAOPS (60rgd6m) t 1:4 2 ei Ad1 atxlA (Itp O x N 1 14 2 24 a CKNASIE TAKEN - 14 2 3 4 5 6 Iso ex`. ii)i?45" 2 24 3 4 ow ?•1 GROUP MO MO Y Y Y YAS YAS we tits) 1111 IS-231 14-35 *47 48.59 66n n'% - 000XMep If 1 14 11 24 3 1 1 Repeat dose every 4 hours as needed. Do not bundle child in blankets. ? for pain or temperature over 101' use Child(eny Motrinbyfollowing schedule. lw hery 6UisrtW. FOLLOW-UP CARE INSTRUCTIONS ? Return to the Emergency Department In day(s). Date: Time: ? Call Dr. lelephone lot follow-up appointment in -day(s). ? Driving restrictions: ? DO NOT drive for the next _ hours/days (circle one). ? DO NOT drive until evaluated by Donor ? Worker's Compensation: Return to the Emergency Department or contact your company`s designated physician it you develop new symptoms, II your symptoms have not Improved in day(s), or if arty aspect of your condition should suddenly worsen. ? Return to the Emergency Department or call your family doctor immediately it you develop new symptoms, If your symptoms have not Improved in _ days, or It an y aspect or your condition should suddenly worsen. ADDITIONAL INSTRUCTIONS ? Your x-rays have received a preliminary interpretation by the Emergency physician and will be reviewed by the radiolooist within 24 ? Eye Instructions: Return to the Emergency Department or Call your eye doctor Immediately it increasing pain, redness, discharge, or blurred vision develops. ? While In the Emergency Department, your blood pressure was found to be elevated. This may be due to the stress of an Emergency Department visit. We recommend your blood pressure be rechecked by your lmily physician within one week. ? A culture specimen has been obtained to lest lot bacleria. Please call the Emergency Department in 3 days lot the results. ? Stop smoking. See additional Instructions- • Head injury (over) ? Animal bile ? Tetanus immunisation series (over) i herob ac` knowledge receipt and understanding of the above instrucWns, including the additional Instruction sheets Dale II 4 l Time AMiPM. !11c!saRtspona. !Prty'sSGrawra FOAM NO P01111 (REV 10,911 PrSl wis S greure h: S! S $1y Vbra THE CHAMBERSBURG HOSPITAL 112 N. Seventh St. Chambersburg, PA 17201 r EMERGENCY CARE UNIT (717) 267-7146 MARTIN, BRIAN W Patient #: 7117732 Treatment Date: 11/10/97 L. J. Boyler, M.D. . Page I Medical Record #: 387010 Patient Type: 2 D.O.B: 07/29/88 CHIEF COMPLAINT: Coffee bums. HISTORY OF PRESENT ILLNESS: This 9-year-old had a tray of coffee cups spilled on his face a short while ago. No other injuries. PHYSICAL EXAM: On examination at 2012 hours, temperature 96.87, pulse 74, respirations 20. The patient has erythema over the left side of his face including his ear and down onto his neck. A small area of blistering on his neck, top of his head and his forehead. DIAGNOSIS: Partial thickness burns. The coffee had been poured from the pot into cups just a few seconds prior to the spill. Expect the wound will do very well because of the likely lower temperature of coffee in the cups. Will recheck tomorrow, however, to reevaluate the extent of the blistering. Six Vicodin given, one scat. The patient also had his burns dressed with Silvadene. LJB/et D: 11/10/97 T: 11/11/97 cc: Dr. Adams L. J. Boyler, M.D. 5 cT T ??Iluf iuYyluaNtl MARTIN BRI 11/11/97 I CVEA I/J • • ? 1 , AN W ,ahat , ? . ? . CHAMBERSBURG LOT 188 SME awaA 711838.3 °r HWrrAL ADAMS MD L, LYNN I I S SHIPPENSBURG, PA IiaN n/ An aQ Y1Y,r11 lltalih WALKED 17257 nYI 10:36 N il, 07129/8 9Y M SAME E S W 01 NANCY MARTIN BECK BURNS MTHR 13 76 Yto NCI ar Nd Ttocc~l coNltt t 387010 196.70.5654 aIS o5 1 t 1097 t N SHIPPENSBURG UNIVERS 1000 BLUE CROSS 381 MARTIN, SHAWN OBDI59589372 940000000 HARRISBURG, PA 1 ECU DOCTOR O DICTATED STAT O MEDIC CALL D ADDENDUM TIME SEEN D DICTATED A D ORDERS D ATTEND NOTE a/ VITAL SIGNS: TC P R BP ALLERGIES: ONE t if is 1. el 2. L A I T OLD RECORDS: ?ECU MINPATIENT K CARDIAC P C UTA KN E URINE 6 FEMUR RT XR PA AT XR EKG: EKG: TO X-RAY 1 • TRAUMA K SERUM PREGNANCY HIP AT XR . PSYCH PACK BMP CHLAMY IA HAND AAS FROM -X-RAY a TFIAMA-XRY CPMP FACIAL BONES ATTN . PORT PELVIS I K _ PELVIC PACK IV IV P WRI T PELVIS FED FILE A YlA T H A F R ARM PORT PIN X-RAYS LAB DRAWN 1 I PT T ABDOMEN ELBO W PIN AT FIRST DWET READ A PHY IN EV PTT FOOT N OER C• PIN r DILAN IN V LE L RUM R. TOX. R. ANKLE V A I l T PIN LAD REPORT TOH STREP SCREEN TIOXIII AIDS RIES LS SPINE T IME o c 1 ACE 1ST CRUTCHES 11,'^??ff 1? l l ue r I, METAL SPLINT a N bPLINT 1 L nl gG e I A ORT140STA71C TIME N VITAL SIGNS Y N A I SITTING p STANDING TOFU. "A -- a MED PREPACKS AMOXIL 250m0 • I Po tad KEFLEX 250m0 • 1 po oid TYLENOL 03 _po of 4 hr with food pm pain AMOXIL 125mp15cc _tip po tid ROBITUSSIN AC _cc TG,_ttp po IT 4 hr TYLENOL 13 ELIXIR _cc TG,_ttp of 4 hr pm pain AMOXIL 250m0/5cc _tsp po Vol BLEPH 10 _91tt DOJOS old PERCOCET • 4TG • T po q 4 hr with food pin pain ERYTHRO 25Onq tab. 4TG • Too qid with food GENTICIDIN DROPS _Ctts ODIOS old DARVOCET • 1 po q 4 hr with food pin pain 13ACTFIIM DS • 2TG • 1 po hid FLEXERIL 1 po tid pin spasm CHILORENS MO IN 11p po q B hour PYRIDIUM 200 • 3TG • lpo tid pin Ouminp DIAGNOSTIC 2 ?• C- 0 ?f D ROE D IMPRESSION _ . OD O 2 23 3 005 ROOM NO. • O ADMIT ROOM NO. O TRANSFER CONDITION OtkOISCHARG REf EIIRf010: TREATMEN IIN IIN111A15 ?EAICRGENT r r ATI 'T CATEGORY EINON EME [GENT IPI#YSKIANS SIG IATU I IHEWMAL PHYSICIAN SIGNATUREI DISCHARGE TIME EMERGENCY CARE UNIT RECORD c"Hb PA Fucatololln I I1 ; "t ! 7: . il) i1J-lrl: -'i CHIEF COMPLAINT/ BRIEF HISTORY/ PATIEN/TASSESSMENT: / ,p f14M r ECU PATIENT ASSESSMENT Name ?J i att g, Triane Date -Z/ -yy-y 7) Timed C at6gory Mode of Arrival. ? Ambulatory O wheelchair O Stretcher O Carried VS: T-??P R BP MEDICATIONS: DOSE FREQUENCY LAST DOSE Mental Status: CI-Alert ?Olher RN Signature PMH: Date of last bpTgeria(Td) Weight Height Circumference Pregnant/Lactating (circle) Instrucfions given prior to Td ? Peds: shots up to dale? ?Yes ? No If no, Immunization material provided ? Do you have any religious or cultural preferences that will affect your care? Emb ?Yes Evidence of suspected physicaVpsychosociat abuse Identified? E MO ?Yes If yes, note findings and refer to social services. Date Time Evidence of growth/developmentallnutritional problems:. JC1Mo ? Yes Referral to Date_ Time_ Do you have any other concerns that you want to tell me about? A/ rJ Initi Is SAFETY Clothing/belongings nnni+n?ee ?rnt?e ID armband Consent for Tx signed Side rails x with patient/significant other consent separated from patient Initials INTERVENTIONS ?Sae Nurse's notes Wound site cleaned Wound site dressed immobilization Appliance Spinal Immobilization removed per MD order Ice to Crutches fittedlinstructions given with return demonstration .Time.` T P R BP 02 SAT PAIN (0.10) MEDICATION UPON ARRIVAL 13C-COLLAR SPINE BOARD CICERVICAL IMMOBILIZATION VRISUALLCUITY uwt.rv+nvc Rx given on DC Mode of exit Accompanied by Mental Status on DC MAlert ?Olher Innmib Family notified Police notified Report to ECF White • Chart Copy yelloty - Physician Billing CHAMBERSDURG HOSPITAL A.,yTlun ^rll.Ji" r.,.w.....s rA P00091E (0:7197) 37)10 L 1 IE dL-9 b I •?_ •:, PS 1745' -;Y 717 530-1113 - ( L CHAME MSBURG HOSPITAL Aa,rallw. oytwti NnrA 112 North Sevemh Street CYMmbenbury PA 17101 (717) 267-3000 EMERGENCY CARE UNIT PATIENT INSTRUCTION SHEET (717) 267-7146 The treatment you have received has been rendered on an emergency basis only. It is important that you follow discharge Instructions and receive follow-up care. Follow the instructions below that are checked and any additional Instructions given. ? Keep dressing clean and dry for next ? Following this time period, remove check in _I day(s). ? lime(s) a day; wash burns thoroughly with soai and water; then reapply Silvadene cream and redress. Keep dressing clean and dry ? Your wound has been closed with steri-strips. They must be kept clean and dry. Leave sleri- strips In place until they fail off spontaneously in about live to seven days. ? Warm water soaks or compresses for 15 minutes four limes daily. Return immediately to the Emergency Department or your family doctor fl signs of infection develop Increasing redness, swelling, pus, foul odor, red streaks, fever. ORTHOPEDIC & BACK INJURIES ? Apply ice intermittently to the affected area for the next 48 hours and keep It elevated to reduce swelling. ? Rest affected area _ day(s) or until pain-free. ? Use vetches; do not bear weight until able to stand without pain; then slowly return to usual activities. ? You may remove elastic bandage and/or splint every dav(s).Itaffected area isstill paInlul, reapplyandd continue use until pain-free. ? Bed rest for U1c next day(s). ? Wear elastic bandage and/or splint for day(s). ? 11 the extremity below any bandage becomes increasingly painful, numb, blue, or swollen, remove or loosen it immediately and contact the Emergency Department. ? Use air cast according to the Instruction sheet. MEDICATION INSTRUCTIONS ? Get prescription filled; take or apply medicine as directed on label. Discontinue medication it allergic reaction occurs ((ash, trouble breathing or of er sudden, unexpected symptoms) and contact Emergency Department immediately. ? Take 2 3 Advll/NupriMbuprofen every 4 6 hours as needed for pain cr fever greater than 101'. Take with loud. ? Take twd Tylenol every lour hours for pain or fever medication information: over) ? Musc a relaxants oratories ? Decongestants/ edatives Antihistamines ? Take only small amounts of clear fluids overnight. ? Gradually resume a normal diet. Carbohydrates such as toast, plain rice, applesauce may be helpful. Dairy products may make your symptoms wo(se. Q,WSe vaporizer or cool mist humidifier. 4=o or IempetabuaoveP I * use aspirin-free n (Tylenol, Tem ra, Acetaminophen, etc) by following schedule. CI9LDRENS ACETAMINOPHEN DOSAGE RECOMMENDATIONS Art 4.11 1223 2-3 45 its 9.10 II 12-14 GPXP Nos MOS YRS YRS YRS YRS YAS YRS (' RV 1e43 2145 3641 4e39 601 11-95 m ACn?'scKN 00 1201 160 240 320 am 480 W Imm N rtq R4 R9 rq A'g IN M (60?M) 1 14 T - It" p60ma Srtq 4 K 1 14 7 N 2 ChEWW lik"s - 14 2 7 4 S 6 IeOR pU 2 24 3 4 n ue4 Repeat dose every 4 hours as needed. Do not bundle child in blankets. ? For pain or temperature over 101' use Childiens Molrin by loilowino schedule. Tatz eaY 6 ran n *ed ALA GPO UP 11 4 12-23 MOS 12.3 Y Y YRS YA:7lIm) 17?I1 164] 24.75 7A-11 4639 Ga7i R?9S - GCt45thNP x 1 14 2 74 7 4 4 FOLLOW-UP CARE INSTRUCTIONS ? Return to the Emergency Department in day(s). Date Time: ? Call Dr. telephone for follow-up appomtmenl 4n-day(s), ? Driving resiricilons: ? 00 NOT drive for the next-hours/days (circle one). ? DO NOT drive until evaluated by Doctor ? Worker's Compensation: Return to the Emergency Department or contact your companys designated physician if you develop new symptoms, II your symptoms have not improved in day(s), or if any aspect of your condition should Relom to the Emergency Department or call your lamily doctor immediately II you develop new symptoms, it your symptoms have not improved in _ days, or if any aspect of your condition should suddenly worsen. ADDITIONAL INSTRUCTIONS ? Your x-rays have received a preliminary interpretation by the Emergency physician and will be reviewed by the radiologist within 24 hours. Please tail the Emergency Department In 24 hours for final Interpretation. ? he Iristruclions: Return to the Emergency Department or call your eye doctor immediately if increasing pain, redness, discharge, or blurred vision develops. ? While In the EmergencyDepartment, your blood pressure was found to be elevaled. This may be due to the stress of an Emergency Department visit. We recommend your brood pressure be rechecked by your family physician within one week. ? A culture specimen has been obtained to lest for bacteria. Please call the Emergency Department in 3 days for the results. ? Stop smoking. See additional instructions: ? Head injury (over) ? Animal bite ? Tetanus immunization series (over) 1 rebby W/. edge receipt and understanding of the above instructions, Including the additional instruction sheets / !4 Date ?1` ' / y l Cp Time J 1 ISM M /..., r paLL,° 0 ? P' 't S'g"a!°rt ?I ? JP. is I Pn3sicanis1gna!ure ? h: setSjy?4!ur .? ; l/!?.-% FOAM NO Pott44 (ACV IGilI THE CHAMBERSBURU HOSPITAL t Page 1 112 N. Seventh St. Chambersburg, PA 17201 EMERGENCY CARE UNIT (717) 267-7146 MARTIN, BRIAN W Patient M 7118383 Treatment Date: 11/11/97 V. C. Stevens, M.D. . Medical Record 11: 387010 Patient Type: 2 D.O.B: 07/29/88 CHIEF COMPLAINT: Recheck bums. HISTORY OF PRESENT ILLNESS: This is a 9-year-old who had hot coffee spilled on his face last night. He was evaluated and treated here last evening. He returns for scheduled recheck. PHYSICAL EXAM: Alert, pleasant child. He tells me he slept well last night. He has areas of erythema over the left forehead with small blistered area on the forehead. Erythema extends around the neck and he has a small area of blistering in the left postauricular area. There is no - evidence of infection. EMERGENCY DEPARTMENT TREATMENT: The area is being thoroughly cleansed with sterile normal saline. He will be redressed with Silvadene. 1 have asked mother to bring him back in the morning for redressing and recheck of the burns but they appear satisfactory at this time. DIAGNOSIS: VCS/sml D: 11/11/97 T: 11/!2/97 cc: V/?7 V. C. Stevens, M.D. EMERGENCY CARE UNIT RECORD GNA4Nassu'4rA I om,041fi ,TN 11/12/97 " ' Y Ix 40'" 3 CVEA MARTIN, BRIAN W FAOINT NUYftI , CHAMBERSBLTRG MA1 LOT 188 SME 711953-0 ` ADAMS MD L LYNN I HOSP , Art Ofiatr r/SwlTfl HmItA SHIPPENSBURG, PA WALKED MI IWO TO DXT04 17257 hot 11:00 M Y WMCI I t4 ,? M Y 07129188 9Y M RECHECK BURNS IIS W 021 NANCY MARTIN SAME uto NCO no MTHR "JhK9 cc - No ". (717)530.1413 75 387010 198.70.5854 TOP 05 1111 97 I)C,UFA,IO#iVIWFL 0 PLAN Cc W 4 W SHIPPENSBURG UNIVERS 1000 BLUE CROSS 381 MARTIN, SHAWN OBDI59589372 940000000 HARRISBURG, PA 0 r' ECU DOCTOR O DICTATED STAT O MEDIC CALL O ADDENDUM TIME SEEN O DICTATED O ORDERS O ATTEND NOTE VITAL SIGNS: T C `1 P R BP ALLERGIES: ONE IF w 2• As ITT OLD RECORDS: ? ECU ? INPATIENT AB r m IA KNEE PORT XR EKG: TO X-RAY CARDIAC PACK B URINE 8 F M R PA AT XR INTERP. , l TRAUMA K SERUM PREGNANCY C NIP LAT XR A PSYCH PA BMP HLAMYDIA HAND AA FROM X-RAY s TRAM •XRY PMP FACIAL N ATTN. PORT PELVIS IVP WR T P VI i PELVIC A IS EL S K 4 4 r PROFILE PED 1 XIN LEVEL TH PHY IN EV I ANTIN LEVEL AMYLASE P PTT RUM R. TOX. SCR. T HEAD T ABDOMEN FOOT ANKLE FOREA SHOU CLAVI RM W LDER CLE PORT PIN PINE AT FIRST C•SPINE T SPINE X-RAYS OWET READ LAB DRAWN LAB REPORT ETON STREP SCREEN TIB/FIB RIB SE RIES LS SPINE TIME c VIS GIVEN PRIOR TO TO At;E AIRCAhi UTURE REMOVAL D1 . 9 ? '1 r ' 1 , jjllr T •11'r? ' I C ? v ?' iS I ?,,. 1, i,; ,?• ?. ?; poll 'Sy'!,r• Ii:? r' V y ORTHOSTATIC TIME VITAL SIGNS N I:: t• •- ; ut; . .;1;iir :cr Lam Lflul- o LVIN a SITTING p TAN IN6 s a a IV N' KVO. MONITOR,-02 I PULSE Oa % MED PREPACKS AMOxa 250mg • t pp dd KEFLEX 250mp • 1 po old TYLENOL 13 _P0 q 4 hi with food pin pain AMOXIL 125mgl5cc _tsi, po fid ROBITUSSIN AC _cc TG,_ttp po q 4 hr TYLENOL 83 ELIXIR _cc TO, tap q 4 ht pin pain PERCOCET - 4TG • 1 so q 4 M with food pin pain DARVOCET • 1 po1114 hr with food pin pain Isis PO Of a hour CHILDRENS MOTRIN AMOXIL 250m g15cc _Isp po lid ERYTHRO 250mg lab. 4TG - tpo qid with food BACTRIM DS • 2TG - 1 Po bid PYRIDIUM 200. 3TO • 1po fid prn burning BLEPH 10 -pits ODIOS qid GENTICIDIN DROPS -pits 00105 pid FLEXERIL 1 go lid pin spasm - DIAGNOSTIC IMPRESSION _ O DISCHARGE O 23 OBS ROOM NO. O ADMIT ROOM NO. O TRANSFER wa I CONDITION 0 r)RISCHARGE A I% O OJ, REFERRED TO. TREATMENT CATEGORY it IRUTIALSI L O ENT NON.EMERGEN , J IP S? 5 ATU (REFERRAL PHYSICIAN SIGNATURE) DISCHARGE TIME t 11 I, i I .,r ,L ECU PATIENT ASSESSMENT Name :7 r I e ;.-j omi /' /1,j Tna Ile Dale I 1 ? Time ?5 Cat?gory Mode of Arrival. 464.,mbulalory O Wheelchair 0Stretcher O Carried S.' Pa 17 t ;17 53') I{I: CHIEF COIVPLAKr/BPJEF HISTORY/ PATIENT ASSESSMENT: rM? G lt"l G "fh,f c IN- PMH: VS: T ?-1 P R BP MEDICATIONS: DOSE FREQUENCY LAST DOSE rl ,ei l - /Al D " Date of last blpTRe'da(Td)_A rb Weight Height Cl Instructions given prior to Td ? Peds: shots up to date? pYes ? No Do you have any religious or cultural preferences that will affect your care? Evidence of suspected physical/psychosocial abuse identified? ANo Pregnant/Lactating (circle) If no, immunization material provided ? dd lo ?Yes ?Yes If yes, note findings and refer to social services. Dale Time Evidence of growth/developmental/nutritional problems: , 07 (,o ?Y,1s Referral to Date_ Time_ Do you have any other concerns that you want to tell me about? -z4- - - InitiSAFETY (\K V ID armband Consent for Tx signed Side rails x with patienUsignificant other consent Clothing/belongings separated from patient 00^1%ocaa wnTec Initials INTERVENTIONS ?See Nurse's notes Wound site cleaned Wound site dressed Immobilization Appliance Spinal Immobilization removed per MD order Ice to Crutches fitted/instructions given with return demonstration ' Time ,? ..T.., . P ?V R BP 02 A PAIN (O.tO) MEDICATION UPONARRIVAL C•COLLAR SPINE00ARD I A IMMOBILIZATION DEVICE VISUALACUITY R L DISCHARUE Rx given on DC Mode of exit nn.. Accompanied by n`"It Menta1Status on DC lert ?Other IAn.dn . /IC/v7 !`5 7?I Initials Family notified Police notified Report to ECF . Phvcirian Flithnn = 1 CHA?L? BERSBURG 110SPITAL P00084E (0 7197) I1'-, 97 S-:7?iOf tL 7 I 51 F'1 171 ,Y 717 533-141: MEDICATI ? Get piesc directed alterQc r or otr contact E ? Take2 3 as neede Take wilt ? Take two greater it ? Conllnu See addition ? Antibiolii ? Anti-intk ? Narcotic GENERAL ? Increase ? Take onl, ? Gradual) such as helpful. worse. ? usevapl ? For pain The treatment you have received has been rendered on an ome Instructions and receive follow-up care. Follow the instructions below WOUND CARE ? Keep dressing clean and dry for next day(s). ? Following this time period, remove dressing,' wash wound with soap and warm water, dry thoroughly and cover with appropriale bandage. Repeal dally until the wound teas healed. ? Return here for wound check in day(s). Date: ? Have sutures removed in day(s). Date: ? time(s) a day; wash burns thoroughly with soap and water; then reapply Silvadene cream and redress. Keep dressing clean and dry. ? Your wound has been closed with steii-strips. They must be kept clean and dry. Leave sted- strips In place until they fall off spontaneously In about five to seven days. ? Warm water soaks or compresses for 15 minutes four times daily. ? Return immediately to4he Emergency Department or your family doctor if signs of infection develop -increasing redness, swelling, pus, foul odor, red streaks, lever. ORTHOPEDIC & BACK INJURIES ? Apply ice intermittently to the allected area for the next 48 hours and keep it elevated to reduce swelling. ? Rest affected area _-day(s)of until pain•Iree. ? Use crutches; do not bear weight until able to stand without pain; then slowly return to usual activi0es. ? You may remove elastic bandage and/or splint everryy day(s). II affected area is still painful, reapply and continue use until pain-tree. ? Bed rest for the next day(s). ? Wear elastic bandage and/or splint for dal S). ? It life extremity below any bandage becomes increasingly painful, numb, blue, or swollen, remove or loosen it Immediately and contact the Emergency Department. ? Use air cast according to the instruction sheet. I hereby wORY NO pa.1Al (REV 10?d (.-H CI AMDEMtlRG 112 North Srventh Su"t liOSMAL Ctumbmbura, PA 17201 A. gels r./S..wHgM (717) 267-M EMERGENCY CARE UNIT PATIENT INSTRUCTION SHEET (717) 267-7146 cy basis only. It is important that you follow discharge are checked and any additional instructions given. tined; tare or appl memcme as Disconlfnuewicallon If FOLLOW-UP CARE INSTRUCTIONS occurs (rash, trouble breathing ? Return to the Emergency Depadment in unexpected symptoms) and day(s). Date. Time: .cy Depadmenl immediately` ? Call Dr. or lever greater than 101-. ery four hours for pain or fever current medicine medication information; (over) ? Muscletelaxants oratories ? Decongestants/ iedalives Antihistamines or coot mist clear fluids overnight. diet. Carbohydrates auce may De pies r make your symptoms use run nor" Arril W NOR44EN f nUr.E RECOMMENMATIONS 356E 411 12•n 2a 45 6e 410 11 12-14 MRouR MOS Mos YRS YRS VS YRS YRS YRS wt It 12-11 1623 2435 3641 4459 %?1 2195 V4 D?E 01 e0 120 1e0 240 ro 400 450 610 aEN x N eq R9 r9 419 R9 n rry rr9 N DROPS (50a 011d) 1 Ix 2 (s E60S?M( x x 1 Ix 2 2x '7 ; I WOVA 4E lwxs - Ix 2 2 4 S 6 - m exn 11 pnl - - 2 235 7 1 4150 W11 Repeat dose Very 4 hours as necoca. Do not bundle child in blankets. ? For pain or lemperatule over 101' use ChildreM Ramon by fnllnwinn schedule. We eM 6h it a Iwkrd Opp;P... i 1011 mosl Vz 41 Y s YRS whgtl(-0s) 13,17 1623 2435 3611 4459 x421 1195 - Don0eN6p X 1 Ix 2 2x 3 4 4 ? Driving restrictions: ? DO NOT drive for the next _ hours/days (circle one). ? 00 NOT drive until evaluated by Doctor ? Worker's Compensation: Return to the Emergency Department or contact your comparrys designated physician if you develop new symptoms, If your symptoms have not Improved in day(s), or if any aspect of your condition should ?ssuddenlyworsen, t?Return to the Emergency Department or all your family doctor immediately if you develop new symptoms, it your symptoms have not Improved in days, or it any aspect of your ADDITIONAL INSTRUCTIONS ? Your x-rays have received a preliminary interpretation by the Emergency physician and will be reviewed by the radiologist within 24 hours. Please call the Emergency Department In ? Eye Instructions: Return to the Emergency Dertadmenl or call your eye doctor Immediately if vision develops ? While in the Emugency Department your blood pressure was found to be elmted. This may ba I due to the stress of an Enter ency Department visit. We recommend your blood pressure be rechecked by your family physician within one week. ? A culture specimen has been obtained to lest for bacteria. Please call the Emergency Department in 3 days for the results. ? Stop smoking. See additional instructions' ? Head injury (over) ? Animal bite ? Tetanus immunization series (over) r _ a V-i?µ' or y"J°V" 4 above instmD?cNit ons, in luding the addn onallinsMion sheets Date !?' I Time alure ?? ?- course S St9ral^Je THE CHAMBERSBURG HOSPITAL ( Page 1 112 N. Seventh St. Chambersburg, PA 17201 EMERGENCY CARE UNIT (717) 267-7146 MARTIN, BRIAN W Patient #: 7119530 Treatment Date: 11/12/97 S. R. Ginder, M.D. Medical Record #: 387010 Patient Type: 2 D.O.B: 07/29/88 CHIEF COMPLAINT: Burn recheck. HISTORY OF PRESENT ILLNESS: This is a 9-year-old male who sustained a coffee bum two days ago. He has been using the Silvadene and bandage. There has been no increased redness. He only complains of a burn around the left ear at this time. He has had no fevers. PHYSICAL EXAM: Temperature 96.9. He has healing first and second degree burns to the left forehead extending back to and around the left ear. It is healing well. There is no evidence of infection. ASSESSMENT: Recheck of facial burn. PLAN: 1. Apply Silvadene cream and a bandage twice a day. 2. Return in 2-3 days for recheck. Return sooner if there is any change or worsening. SRG/dad D: 11/12/97 T: 11/13/97 cc: Dr. Anderson V t I . S. R .Gin 'M. T. E. Anderson D. ¦ r T ¦ EMERGENCY CARE UNIT cNAYUIWV10.PA 10ppto m wn /A111N1 MIN4•p0N11 11/15/97 Manu M, Mna wM ..Y Yno porn ' iW CVEA, I L MARTIN, BRIAN W rAI1INTNVNUN ' CHAMBERSBURG SME 188 712271-6 OSPITAL ADAMS MD L LYNN I H NK , SHIPPENSBURG , PA WALKED N'two To WIN AA a fflUart nSwluni/ Health 17257 Tim[ 10:53 DATJ Of kATH All 07/29/88 9Y M ~ w RECHECK BU N. Y u N SAME AA RN TO HEAD als V 8'2' NANCY/SHAWN PRINT (7171530.1413 75 uro vu fir meo'lly. Dec~ 387010 196.70.5654 R A c R 05 11 1097 A Y w w N 4,V w N 4 Y l , Y SHOO UNIVERSITY 1000 BLUE CROSS 361 MARTIN, SHAWN GOD159589372 940000000 SHBO,PA 17257 ECU DOCTOR / ICTATED STAT D MEDIC CAL( G ADDENDUM TIME SEEN DICTATED G ORDERS G ATTEND NOTE r K' VITAL SIGNS: T P R BP ALLERGIES: ONE 'L t. NOT^ • I Cm 1 11 or Il;o Inf • f r; s!rl,+h, ,, 2. n B^L? ,. f ,.1 v. H-0 T ^n OLD RECORDS: Q ECU Q INPATIENT K AEG room U/A KNE PORT XR EKG: TO X-RAY CARDIAC PACK BC URINE 6 S FEM R PA/LAT XR INTERP. L TRAUMA P SERUM PREGNANCY GC HIP LAT XR PSYCH PACK BMP HLAMYDIA HAND AA FROM X•RAY T AMA•XRY CPMP FACIAL BONES ATTN. PORT PELVIS K P VI Vie WRIST PE V r K EL C PED PROFILE AMYLASE CT HEAD FOREARM L IS PORT C SPINE X-RAYS LAB DRAWN A I XIN LEVEL PT CT ABDOMEN ELBOW -SPIN AT FIRST GWET READ A TH OPHYI INE LEV PTT FOOT SHOU LDER C• PINE LAS REPORT Y DI ANTIN LEVEL SERUM R. TOX. SCR. ANKLE CLAVI CLE T SPINE ETON STREP SCREEN TIB*111 RIB SE RIES LS SPINE TIME L L/ To 0. c AI, a n-• .111 ?C ? •C,'7 S 1 GIVEN 1 b? AMID 7MJTCHES 2 ' SUTU r ?• 1 -MRI 4 1 N U1 0 Y V a i e A ORTHOSTATIC TIME VITAL SIGNS K 11 D VIN SITTING o STANDING ' R, 02 _ PULSE F. • % 1 a MED PREPACKS ANOXIC 250mp • 1 po tid KEFLE% 250mg • 1 Do qid po q 4 he with food Tiro pain TYLENOL 13 AMOXIL 125mg15cc _Irp po Ud ROBITUSSIN AC _cc TO.-lip po q 4 he _ TYLENOL 13 ELIXIR cc T0._tfp q 4 he pen pun AMOXIL 250mp15cd _t+0 Tio lid BLEPH 10 _gtta ODIOS qid _ PERCOCET • 4T0 • 1 Tile q 4 he with food pro pain ERYTHRO 250mg file. 4TG • lpo qid with food GENTICIDIN DROPS _gtta ODIOS qid DARVOCET • 1 Do q 4 he with food pen pain BACTRIM DS • 2TO • 1 Do bid FLEXERIL 1 Do lid Den $Daam CHILDRENS MOTRIN _ tap Do of 6 hour PYRIDIUM 200 • 3TG • too lid pen burning ISCHARGE DIAGNOSTIC IMPRESSION . nI ?1 23 OBS ROOM NO. Cl ADMIT ROOM NO. D T ANSFER• ? I L (r. CONDITION ON DISCHARGE COATIS, 0 R EFERRED TO. TREATMENT CATEGORY RN IINITULSI /' EMERGENT NON EMERGEN ' I (PHYSICIANS SIGNATURE( (REFERRAL PHYSICIAN SIGNATUREI DISC ARGE TIME CHART C0Pr it/IW/ 7 :/ r -:i ECU PATIENT ASSESSMENT a Name ' IV Date -1-L?11?1 Time Pat gory Mode of Arrival. I?pAmbulatory O Wheelchair O Stretcher O Carried VS: T-?P R BP CHIEF COMPLAINT/ BRIEF HISTORY/ PATIENTASSESSMENT: MEDICATIONS: DOSE FREQUENCY LAST DOSE 2e 0ho (It rn_ `hi lh A_, --/6 al.ca MentalStatus;-G<e'rt ?Other PMH: RN ? Signature Date of last b PITIOna(Td) Weight 'Height C Instructions given prior to Td ? Peds: shots up to date? es ? No Do you have any religious or cultural preferences that will a ect your care? Evidence of suspected physicaVpsychosocial abuse Identified? ?No if yes, note findings and refer to social services. Date Time Evidence of growlh/developmentaltnutritional problems:. No 0 Yes Referral to Date_ Time_ Do you have any other concerns that you want to tell me about? /t 16 Initials SAFETY &",dns mband antfor Tx signed Side rails x with patient/significant other consent Clothing/belongings separated from patient PROGRESS NOTES Initials INTERVENTIONS ?See Nurse's notes Wound site cleaned Wound site dressed immobilization Appliance Spinal Immobilization removed per MD order Ice to Crutches fitted/instructions given with return demonstration Tuna T P R BP 02 SAT PAIN (0.10 MEDICATION UPONARRIVAL C• COLLAR SPINE BOARD A I 11 TI VISUALACUITY R -L DISCHARGE Rx given on DC Mode of exit Accompanied by Mental Status on DC ?Alert 00ther Initials Family notified Police notified Report to ECF Whirs . rhart rnnv Ynunw. • Phvsirian Bdlina PregnanVLactating (circle) If n p, Immunization material provided 0 Po ?Yes ?Yes (07/97) 1L 1 t Sr'i' '1 !:li' • T :li 537-!tl? allergic reaction occurs or other sudden, unexp contact Emergency Dep ? Take 2 3 Adwl/NuprinA as needed lot pain or le The treatment you have received has been rendered on an emergency basis only. It is important that you follow discharge Instructions and receive follow-up care. Follow the instructions below that are checked and any additional instructions given. WOUND CARE ? Keep dressing clean and dry for next day(s). O Following this lime period, remove dressing, wash wound with soap and warm water, dry ' thoroughly, and cover with appropriate bandage. Repeal dally until the wound has healed. ? Return here for wound check in day(s). Dale: ? Have sutures removed in day(s). Dale: O time(s) a day; wash burns thoroughly with soap and water; then reapply Silvadene cream 2nd redress. Keep dressing clean and dry. O Your wound has been closed with steri-strips. They must be kept clean and dry. Leave steri- strips in place until they fall on spontaneously in about live to seven days. O Warm water soaks or compresses for 15 minutes X fo Imes daily. eturn immediately to the Emergency Department ' or your family doclor•il signs of Infection develop - Increasing redness, swelling, pus, foul odor, red streaks, lever. ORTHOPEDIC 6 BACK INJURIES ? Apply Ice intermittently to the affected area for the next 48 hours and keep it elevated to reduce swelling. ? Rest affected area _ day(s) Or until pain-free. O Use crutches; do not bear weight until able to stand without pain; then slowly return to usual activities. ? You may remove elastic bandage and/or splint every day(s). If affected area Is still paln ul, reapply and continue use until pain-free. ? Bed rest for the next day(s). O Wear elastic bandage and/or splint for day(s). ? It the extremity below any bandage becomes Increasingly painful, numb, blue, or swollen, remove or loosen it immedialely and contact the Emergency Department. ? Use a (cast according to the Instruction sheet. A? 'I EMERGENCY CARE UNIT PATIENT INSTRUCTION SHEET (717) 267-7146 ine as if ? Take two Tylenol every four hours for pain or fever greater than 101'. O Continue current medicine See additional medication Information: (over) ? Antibiotics ? Musclerelaxants ? Anfi-inflammatories ? Decongestants/ ? Narcotics/sedatives Antihistamines FOLLOW-UP CARE INSTRUCTIONS ? Return to the Emergency Department in day(s). Dale: Time: ? Call Dr. telephone / for follow-up appointment in _ day(s). ? Driving restrictions: ? DO NOT drive lot the next _ hours/days (circle one). ? 00 NOT drive until evaluated by Doctor O Worker's Compensation: Return to the Emernenev 112 North Secmlh Stmt Ch"btMura, PA 1201 (717, 267.X100 O Increase fluid Intake. ? Take only small amounts of clear fluids overnight. ? Gradually resume a normal diet. Carbohydrates such as toast, plain rice, applesauce may be -W helpful. Dairy products may make your symptoms ? Use vaporizer or cool mist humidifier. ? For pain or temperature over 101' use aspirin-free medication (Tylenol, Tempra, Acetaminophen, CHILDREN'S ACETAMINOPHEN DOSAGE RECOMMENDATIONS AGE 411 1253 2J 43 6 9 610 I I 12.14 GPaP MOs Alps YRS YRS YRS YRS YRS VAS "s0 12.11 16-23 2435 3647 4659 6611 1195 We ow uETTAAWhaafNER 60 120 160 240 326 400 4a0 64 (gym N " ^q Rq nq nq rN -rq Vats (50 rrgga net 1 14 2 - - - 6u till ELIXIR (LED ?q Sint W x N 1 14 2 29 3 T E LE S L - 14 2 3 4 S 6 - !o rxA .A 1 V 3 4 M6 wl Repeat dose every 4 hours as needed. Do not bundle child in blankets. ? For pain or temperature over 101' use Children's Motrin by lullowlna schedule. We ri62xusareeeld M IRS M wey4(Nsl 1}12 1653 2 *47 4&S V fa 95 - 1 1 C it you dev have not the Emergency Department or call your clor immediately if you develop new s, if your symptoms have not Improved _ days, or it any aspect of your ADDITIONAL INSTRUCTIONS ? Your x-rays have received a preliminary interpretation by the Emergency physician and will be reviewed by the radiologist within 24 hours. Please call the Emergency Department in 24 hours for final Interpretation. ? Eye Instructions: Return to the Emergency Department or call your eye doctor immediately it increasing pain, redness, discharge, or blurred vision develops. ? While in the Emergency De Ml paenL your blood pressure was found to be elevated. This may be due to the stress of an Emergency Department visit. We recommend your blood preswre be rechecked by your lamily physician within one week. ? A culture specimen has been obtained to test lot bacteria. Please call the Emergency Department in 3 days for the results. ? Stop smoking. See additional instructions: ? Head Injury (over) O Animal bile ? Tetanus Immunization series (over) I hereby ack?edge receipt and understanding of I e above instructions, Including the additional Instruction sheets. Dales, Time; AM1W. 11 N Pitt iarResponsibleParry's Signature y FORM NO P03MI I?+EJ m%I Physicians Signature Ndrses Signa'uR THE CHAMBERSBURG HOSPITAL ` Page 1 112 N. Seventh St. Chambersburg, PA 17201 EMERGENCY CARE UNIT (717) 267-7146 MARTIN, BRIAN W Patient #: 7122716 Treatment Date: 11/15/97 G. E. Willwerth, M.D.. Medical Record #: 387010 Patient Type: 2 D.O.B: 07/29/88 CHIEF COMPLAINT: Check of bums. HISTORY OF PRESENT ILLNESS: This 9-year-old patient returns for recheck of his bums. The areas are dry today. No sign of infection. The patient will discontinue Silvadene. Will apply Bacitracin to the affected areas morning and night. No further dressing required. Return as needed. IMPRESSION: Healing burns to the face and neck. The patient is without complaints. Slight scale and peel noted to the area. All bum areas are healing nicely without signs of infection. GEW/psp D: 11/15/97 T: 11/16/97 cc: G. E. Wiliwerth, M.D.\K? a t ?k t X t. Jl?1Cll? of Central Pelnfsykania, AC. John P. Straits, M.D. William P. Graham, III, M.D 816 Belvedere Street 840 N. Front Street 650 N. Twelfth Street Carlisle, PA 17013 Wormleysburg, PA 17043 Lemoyne, PA 17043 (717)249.0100 (717)249.0100 (717)763.9766 Fax(717)249.8889 Fax(717)249.8889 Fax(717)763.7710 CONSULT ON BRIAN W. MARTIN SEPTEMBER 15, 1999 This is an 11 year old white male who comets in for consultation to check his facial scarring after burns to the face. Apparently thin child had a tray of hot coffee in cups spill onto hie face when he was nine years old in 1997. He was treated at Chambersburg Hospital with local wound care. Local wound care included Silvadene-. It was noted that he did have some blistering. Multiple photographs were brought in with the patient for my review. His burns were described by the physicians taking care of him as tirat and second degree. Ile was also apparently taking come pain medication which included Vicodan. The child was not very forthcoming with any of the history. Examination revealed all areas were well healed, well epithelialized. No dermal scarring. His mother did describe his fear and the pain associated with the burn, however the child did not participate in this discussion. On specific reply to questions addressed in a letter from tlee patients attorney - What level of pain was associated with the burns suffered by Brian? - Pain is a subjective complaint and the degree of pain also is subjective. Generally speaking, second degree burns are painful and the pain lasts variable period of time depending on the methods used for treatment. I would expect the patients pain to be minimal after about ten days. There is no need for any future treatment. There is no scarring preaent frum the burled. There whould be no significant precautions for the future as (s result of uuutaining the burns. I cannot comment on any repreased emotional feeling as a result of having the burns and would recommend a child psychologist or psychiatrist evaluate the patient in that regard. Jo ?,)P _i?atiiuii M. D. JPS/klf PlastidCosmetk Surgery • Breast Procedures • Micro Surgery • Laser Capabilities - liand Surgery Birth Detects • Endoscopic Plastic Surgery • Biomedic Skin Care Program State Licensed Surgical Facility On-Site THE BEISTLE COMPANY e //ilanu?a?sitet0 Jsiree, 7900 November 26, 1997 Nancy J. Martin 188 Shbg Mobile Estates Shippensburg Pa 17257 Dear Nancyr The following wage information is being provided per your renuest. Your year-to-date average hourly rate is $12.83. This is based on your earnings year-to-date divided by the number of hours you have worked. Your weekly wages varies from week to week depending on the number of 'nieces produced. Also you are eligible to receive discretionary profitability bonuses on a monthly and yearly basis. Company policy prohibits projection of any bonus income. You were absent from work on 11/11/97 and 11/12/97 for a total of 12-1/4 hours. This absence was concerning your son's injury. Hope this information will suit your needs. if you need further assistance, please feel free to call me at (717)532-2131. Cordially, THE BUSTLE C04PA?IY a, i4,6 Arliss Kunkleman Payroll Clerk ARK/ark ? I Beistle Plaza* P.O. Box 10, Shippensburg, PA 17257-0010 ? (717) 532.2131 • FAX (717) 532-7789 z: f=, u W _ w 5 co m s C . • . r r NANCY J. MARTIN, as parent IN THE COURT OF COMMON PLEAS OF and natural guardian of CUMBERLAND COUNTY, PENNSYLVANIA BRIAN W. MARTIN, a minor Plaintiffs NO. 99- 6311 CIVIL TERM V. CIVIL ACTION - LAW VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by an attorney and filing In writing with the court, your defenses or objections to the claims set forth against you. You are warned that if you fall to do so, the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 17013 (717) 249-3166 NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor Plaintiffs V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO.99-6311 CIVILTERM CIVIL ACTION - LAW COMPLAINT AND NOW, comes the Plaintiff, Nancy J. Marlin, as parent and natural guardian of Brian W. Martin, a minor, by and through their attorney, Michael A. Scherer, Esquire, and respectfully represents as follows: 1. The Plaintiff, Brian W. Martin, Is a minor, who resides at Lot #188, Shippensburg Mobile Estates, Shippensburg, Cumberland County, Pennsylvania. 2. The Plaintiff, Nancy J. Martin, is an adult individual and the natural mother of Brian W. Martin, who resides at Lot #188, Shippensburg Mobile Estates, Shippensburg, Cumberland County, Pennsylvania. 3. The Defendant, Vets Canteen Association, Durff-Kuhn Post No. 6168, is a Pennsylvania Association, with a principal place of business located at 130 West King Street, Shippensburg, Cumberland County, Pennsylvania 17257. 4. The facts and occurrences hereinafter related occurred on or about November 10, 1997, at or about 7:30 p.m. at the VFW Building, 130 West King Street, Shippensburg, Pennsylvania. 5. At the aforesaid time and place, Brian W. Martin, together with his parents, Shawn Martin and Nancy Martin, attended a football banquet. 6. At the conclusion of dinner, two waitresses, who were employed by the Defendant, collided near the Martin table, causing one of the waitresses to spill her tray containing steaming cups of hot coffee on Brain Martins head and down the left side of his body. 7. After receiving first aid at the scene, Brian Martin was rushed to the emergency room at the Chambersburg Hospital to treat the burns he received from the hot coffee. 8. The aforesaid accident was a direct and proximate result of the negligence of the waitresses, In that they: a. failed to use proper care in serving the hot coffee; b. failed to warn Brian Martin that they were approaching with hot coffee; C. failed to maintain a safe distance between one another to avoid a collision and the spillage of the hot coffee; and, d, failed to keep proper control of the tray of hot coffee which was being served. 9. As a result of the aforesaid accident, Brian W. Martin suffered serious injuries, which include the following: a, first and second degree burns to the scalp, forehead, face, neck, left ear and left shoulder; b. severe shock to the nerves and nervous system. 10. As a result of his injuries, Brian W. Martin was forced to receive medical treatment for the burns. 11. As a result of his injuries, which required him to take pain medication, apply burn cream to the wounds, and wrap the wounds in sterile bandages, Brian W. Martin missed five days of school. 12. As a result of the first and second degree burns, Brian has undergone pain and suffering, loss of life's pleasures, inconvenience, embarrassment and anxiety. 13. At all times material hereto, the aforesaid waitresses were employees of the Defendant. 14. The aforesaid waitresses were engaged in furthering the interests, activities, affairs and business of Defendant at the time of the accident. 15. Defendant is liable for the damages to Brian W. Martin as set forth above by virtue of the principal of respondeat superior. WHEREFORE, Brian W. Martin demands judgment against Defendant for damages, costs and delay damages in an amount in excess of the limits requiring compulsory arbitration. Respectfully submitted, O'BRIEN, BARIC & SCHERER ----1?%f"?v6 ?1• ?17? Michael A. Scherer, Esquire I. D. # 61974 17 West South Street Carlisle, Pennsylvania 17013 (717)249-&873 mas.dir/genlit/martin.com VERIFICATION 1 verify that the statements made in the foregoing Complaint are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C. S. § 4904, relating to unsworn falsification to authorities. v Pa?cy J. Martin DATED: & acv NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor Plaintiffs V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO.99-6311 CIVILTERM CIVIL ACTION - LAW CERTIFICATE OF SERVICE hereby certify that on April 19, 2000, I, Amanda L. Fisher, secretary to Michael A. Scherer, Esquire, did serve a copy of the Complaint, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Manager, Vets Canteen Association, Durff-Kuhn Post No. 6168 130 West King Street Shippensburg, Pennsylvania 17257 al-n? . 17 ikL1i? Amanda L. Fisher, Secretary NANCY J. MARTIN, an parent and natural guardian of BRIAN W. MARTIN, a minor v. VETS CANTEEN ASSOCIATION DURFF-RUHN POST NO. 6168 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 6311 CIVIL 19 99 RULE 1312-1. The Petition for Appointment of Arbitrators shall be substantially in the following form: PETITION FOR %PPOTNTIENT OF ARBITRATORS TO THE HONORABLE, THE JUDGES OF SAID COURT: Thomas E. Brenner counsel for the X /defendant in the above action (or actions), respectfully represents that: 1. The above-captioned action (or actions) is (are) at issue. 2. The claim of the plaintiff in the action is $1ass than $2n nnn The counterclaim of the defendant in the action is n/a The following attorneys are interested in the case(s) as counsel or are other- wise disqualified to sit as arbitrators: Thomaa E. Brenner, Esquire and Michael Scherer, Esquire WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitrators to whom the case shall be submitted. 7omWo tf?ubmittad, ?.?Brenner, squirn ORDER OF COURT I.D. No. 32085 AND NOW,._ QCy,"aaf_ 27 in consideration of the foregoing petition, A?eJd Xb.. X64e-e? Esq., Esq., and it ,Esq., are appointed arbitrators in the above-captione action (or actions) as prayed for. By AM410 P. J. i Y z.; r n ill FF3 7,7 (,it tt ,,c r a, wi l:r?,I.1id1Y k` F 45, W F lir k r: CERTIFICATE OF SERVICE I hereby certify that I served a copy of the foregoing document upon the person(s) indicated below by depositing a copy of the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania and addressed as follows: Michael A. Scherer, Esquire O'BRIEN, BARIC & SCHERER 17 West South Street Carlisle, PA 17013 Attorney for Plaintiffs Date: .2 /)- L+FV & SHIPMAN, P.C. GOLD ER 9 4w? ? Thomas E. Brenner, Esquire Attorney for Defendant r it i" u +- . ? C^ .t ?. ?? ? Q 4 ? ; y ?^ = < ? 7:? ? ? C'? ? .? 4a1 i O ,. h NANCY J. MARTIN, as parent and : IN THE COURT OF COMMON PLEAS natural guardian of BRIAN W. MARTIN, : CUMBERLAND COUNTY, PENNSYLVANIA a minor, Plaintiffs : No.: 99-6311 Civil Term V. CIVIL ACTION - LAW VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 61680 Please enter the appearance of THOMAS E. BRENNER, ESQUIRE and Goldberg, Katzman, & Shipman, P.C. on behalf of Defendant, Vets Canteen Association Durff-Kuhn Post No. 6168. Respectfully submitted, GOL, BERG ZMAN & SHIPMAN, P.C. BY: c?r?x Thomas E. Brenner, Esquire ID9:32085 PO Box 1268 Harrisburg, PA 17108-1268 (717) 234-4161 Attorney for Defendant Date: May 9, 2000 :44325.1 CERTIFICATE OF SERVICE I hereby certify that I served a copy of the foregoing document upon the person(s) indicated below by depositing a copy of the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania and addressed as follows: Michael A. Scherer, Esquire O'BRIEN, BARIC & SCHERER 17 West South Street Carlisle, PA 17013 Attorney for Plaintiffs O BE 1 - MAN & SHIPMAN, P.C. B AN-' Thom renner, Esquire Attorney for Defendant Date: May 9, 2000 -1 ? J16. r-1 ? 1' , ` SHERIFF'S RETURN - REGULAR CASE NO: 1999-06311 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MARTIN NANCY J ET AL VS. VETS CANTEEN ASSOCIATION ET AL HAROLD WEARY , Sheriff CUMBERLAND County, Pennsylvania, who being duly to law, says, the within WRIT OF SUMMONS or Deputy Sheriff of sworn according was served upon VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO 6168 the defendant, at 10:47 HOURS, on the 22nd day of October 1999 at VETERANS OF FOREIGN WARS 130 WEST KING STREET SHIPPENSBURG PA 17257 CUMBERLAND County, Pennsylvania, by handing to WENDY OTT (CLUB STUART) a true and attested copy of the WRIT OF SUMMONS and at the same time directing Her attention to the contents thereof. Sheriff's Costs: So answers: Docketing 18.00 Service, 13.02 Affidavit .00 ?c Surcharge 8.00 R. MUM -rulnef SneTI -- $39.02 00 RI2 1J99ARIC &&? SSCCHERER by ' • D5 Sworn and subscribed to before me this 99" day of "ca,u? 19 A.D. 1 II NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor Plaintiffs V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant NO. 99- 63// CIVIL TERM IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY: Kindly issue a Writ of Summons on behalf of the above-captioned Plaintiffs and against the above-captioned Defendant. Respectfully submitted, O'BRIEN, BARIC & SCHERER Date: /D. 15% qq Please serve the Defendant as follows: Veterans of Foreign Wars 130 West King Street Shippensburg, Pennsylvania 17257 Michael A. Scherer, Esquire I. D. # 61974 17 West South Street Carlisle, PA 17013 (717) 249-6873 0 N r r?- CL ti? i• 7 1? , e t. e ti 1?. r ?: Y U -ltit a ? G <J V v tia ^ <g h r Y ? a OC ? ra u O . . le 1. I ` Commonwealth of Pennsylvania County of Cumberland Nancy J. Martin, as parent and natural guardin+ of Brian W. Martin, a minor vs Vets Canteen Association Court of Conunon Pleas Durff-Kuhn Post No. 6168 99-6311 CIVIL TER4 Veterans of Fbreign Wars - ____ ________________________________ 19 130 West King Street Civil Action-Law Shippensburg, Pa. 17257 I° --------------------------------------------- To Lets. Cant- eeaAssoc:.iation.__Dtxc£fr]Cuhn. Post No. 6168 You are hereby notified that NaDpy_J,.MartJLn-as__Pw cut_ and-natural-g uaaiiaanf-Brian.W._Martin..-a_tninor--_-_-__ the Plaintiff ha B commenced an action in ----- CiviL.Law.---------------------------------------- against you which you are required to defend or a default judgment may be entered against you. (SEAL) Date ---October 15__ --°------- 19 99_ ..----Curtis Rs-_LoI3g-------------------------- Prothonotary BY 712!Q!_t!----------------- Deputy 1 z g ,coo Ln W l?pJ 0 'T. N qy W •.U7 p• Cpl •n O -1 ?0 j O .Z '?1 ? 10 Y g al 41 0m a+ h 1 ?? aw S ++o• .A O 1 N O 1O • m .? 3 ?-?1 .r•1 F C NANCY J. MARTIN, as parent and : IN THE COURT OF COMMON PLEAS natural guardian of BRIAN W. MARTIN, : CUMBERLAND COUNTY, PENNSYLVANIA a minor, Plaintiffs : No.: 99-6311 Civil Tenn V. : CIVIL ACTION - LAW VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 6168, Defendant TO: Nancy J. Martin, as parent and natural guardian of Brian W. Martin, a minor, Plaintiffs c% Michael A. Scherer, Esquire O'BRIEN, BARIC & SCHERER 17 West South Street Carlisle, PA 17013 You are hereby notified to plead to the enclosed Answer with New Matter within twenty (20) days from service hereof or a default judgment may be entered against you. Respectfully submitted, TZMAN & SHIPMAN, P.C. Z6 LDDBEXv BY. f\ (f 1 Thoma's E-. Brenner, Esquire ID#: 32085 PO Box 1268 Harrisburg, PA 17108-1268 (717) 234-4161 Date: June 30, 2000 NANCY J. MARTIN, as parent and : IN THE COURT OF COMMON PLEAS natural guardian of BRIAN W. MARTIN, : CUMBERLAND COUNTY, PENNSYLVANIA a minor, Plaintiffs : No.: 99-6311 Civil Term V. CIVIL ACTION - LAW VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 6168, Defendant AND NOW COMES the Defendant, Vets Canteen Association Durff-Kuhn Post No. 6168, by its attorneys, Goldberg, Katzman, & Shipman, P.C. and states: 1. Admitted. 2. Admitted. 3. Admitted. 4. Admitted. 5. Admitted. 6. Denied. The waitresses were volunteers serving the function. The remainder of this paragraph is denied pursuant to Pa.R.C.P. 1029(e). 7. Denied. The waitresses were volunteers serving the function. The remainder of this paragraph is denied pursuant to Pa.R.C.P. 1029(e). 8. It is denied that the waitresses were negligent. In further response, the remainder of this paragraph is denied pursuant to Pa.R.C.P. 1029(e). 9. It is denied that the waitresses were negligent. In further response, the remainder of this paragraph is denied pursuant to Pa.R.C.P. 1029(e). 10. It is denied that the waitresses were negligent. In further response, the remainder of this paragraph is denied pursuant to Pa.R,C.P. 1029(e). 11. It is denied that the waitresses were negligent. In further response, the remainder 12. It is denied that the waitresses were negligent. In further response, the remainder of this paragraph is denied pursuant to Pa.R.C.P. 1029(e). 13. Denied. 14. Admitted. 15. Denied. This paragraph states a legal conclusion to which no response is necessary. WHEREFORE, Defendant, Vets Canteen Association Durff-Kuhn Post No. 6168, requests that the Plaintiffs' Complaint be dismissed with prejudice. 16. Plaintiff's injuries, if any, arose from his comparative negligence under the circumstances. WHEREFORE, Defendant, Vets Canteen Association Durff-Kuhn Post No. 6168, requests that the Plaintiffs' Complaint be dismissed with prejudice. Respectfully submitted, GO BERG; MAN & SHIPMAN, P.C. BY:a Thomas E. Brenner, Esquire IDN: 32085 PO Box 1268 Harrisburg, PA 17108-1268 (717) 234-4161 Attorney for Defendant Date: June 30, 2000 4707 L 1 VERIFICATION I hereby acknowledge that I have read the foregoing document and that the facts stated herein are true and correct to the best of my knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unswom falsifications to authorities. DATE: 47071.1 17071.1 VET TEEN ASSOCIATION By:. s'i I hereby certify that I served a copy of the foregoing document upon the person(s) indicated below by depositing a copy of the same in the United States mail, postage prepaid, at Harrisburg, Pennsylvania and addressed as follows: Michael A. Scherer, Esquire O'BRIEN, BARIC & SCHERER 17 West South Street Carlisle, PA 17013 Attorney for Plaintiffs LDBERG, MAN & SHIPMAN, P.C. BY` Thorne renner, Esquire Attorney for Defendant Date: June 30, 2000 S P. t, s :.. !rY ; et{t Ll rp F k 4 ? f xt ., 1 ? te a + ti t?k L ? v ` ' U 1?4 + L ? p? z H NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor Plaintiffs V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99- 6311 CIVIL TERM CIVIL ACTION - LAW REPLY TO DEFENDANT'S ANSWER WITH NEW MATTER 16. Denied. This allegation is a conclusion of law, to which no response is necessary. To the extent this response is not a conclusion of law, Plaintiff denies that Brian W. Martin was negligent in any manner in connection with the accident in this case. Respectfully submitted, O'BRIEN, BARIC & SCHERER Mid ael A. Scherer, Esquire I. D. # 61974 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 mas.dir/gentit/martin.rep VERIFICATION I verify that the statements made in the foregoing Reply To Defendants Answer With New Matter are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unsworn falsification to authorities. N cy J. Martin DATED: 7-ae'66 CERTIFICATE OF SERVICE I hereby certify that on August I, 2000, I, Jennifer S. Lindsay, secretary to Michael A. Scherer, Esquire, did serve a copy of the Reply To Defendant's Answer With New Matter, by first class U.S. mail, postage prepaid, to the party listed below, as follows: Thomas E. Brenner, Esquire Goldberg, Katzman & Shipman, P.C. P.O. Box 1268 Harrisburg, Pennsylvania 17108-1268 A fflfi??N el -A?jajA Je i r say Y{ 4 J r,S Nancy J. Martin X41 A/1"- 5/ f /I";r/tr/ ;-In The Court of Common Pleas of /! n. J .L A j ?Z rl c C. v /7 w ,7.n'," u F ) Cumberland County, Pennsvlvania fi/.ii7N cam. d),1+rTll?! A rf1120 /"? ) Brian W. Martin ) No. i9 / Vets Cantr:en Association l? j 9 P 11 n. 7-e *,v ?E <l tao ?. Il Tic N 1 Qv .4 Fr • K dN N 1"?si NG G <L 2 Durff-Kuhn Post No 6168 OATH tie do solemnly swear (or affirm) the Constitution of the United States wealth and that we will discharge the J that we will support, obey and defend and the Constitution of this Common- duties of our office with fidelity. a rma`h AWARD We, the undersigned arbitrators, having been duly appointed and sworn (or affirmed), make the following award: (Note: If damages for delay are awarded, they shall be separately stated.) 114424 ^f n/ Fi9?0/ D/ - %///1 Jeifils°s't .fi . e S/ J' ?'/r9 4 T , ?? /? ? ?l.,Pf?ti i ?I.L i R- Ar'oR/9 t ?:. / A.,2 Oi r..-, i9 f ?sTi A ?? lr ?Yl ?/.?% ?N A'R A/ 4 0 A:</N?/ T /Y</?iti Ir? LDS i riyi?/f? /N i 6 ifiyfil•d,.-T 0/1 ' .pf$157.17 $5,00000 r / ??E i6va 5070"7) (e - 61,eA, <f/ i171)'fiR y /J/0/d/t Fo er 0`9.1L/ AND SGl`Irlsx-IA4 Lvc F(AT!' /fG/Piw9?', T/fE ,Glfr'.FN Ar- -r ViCZ5 Cyi1'rvT??n- Se OG?i=/= le&M x- 94 4- G_•/G ?? Arbitrator, dissents. (Insert name i-' applicable.) Date of Hearing: /?, tt e Ve- t t Date of Award: Chai n NOTICE OF LMR° OF AWARD Now, the q-14 day of ?<i ,o at)G, C1...;1., the above award was entered upon the docket and notice thereof given by mail to the parties or chair attorneys. Arbitrators' compensation =o be paid upon appeal: s ozgo 6,) 0 1,5 Protho Cary By: ! -J- Deputy a L h vi, ?o 1 r t NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor, PLAINTIFFS V. VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 6168, DEFENDANTS : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA :99-6311 CIVIL TERM AND NOW, this day of June, 2001, IT IS ORDERED: (1) Approval of the settlement of this minor's claim for $5,000 for Brian W. Martin, born July 29, 1988, IS GRANTED. (2) From the settlement of $5,000, petitioner's counsel is awarded a fee of $1,666.65 and costs of $387.94. (3) The net proceeds of $2,945.41 shall be placed in an interest bearing account at the Orrstown Bank, Shippensburg, Pennsylvania in the name of Brian W. Martin, born July 29, 1988. (4) The account shall contain the following notation: "NO WITHDRAWAL CAN BE MADE PRIOR TO BRIAN W. MARTIN OBTAINING HIS MAJORITY EXCEPT BY AN ORDER OF COURT OF COMPETENT JURISDICTION:' (5) Counsel for plaintiffs shall file with the Prothonotary and forward a copy to the chambers of this judge proof of compliance with this order. By Edgar B. t 1': it Michael A. Scherer, Esquire For Plaintiffs \ / L ]s•ol Thomas E. Brenner, Esquire For Defendants :sea ? `•j 1 ? J 4 fL P r!J C7 C'a LAW Ulril r• (JOLmmit ),:KATZMAN & SIIIPMAN, P.G. nuur MANNKr NINrrr NINAMIIVNIIY ApItANK 1•. 1). IN)N INN. UANNGOVNO, 1'KNN.YLVANIA 111IM-1911H DUN JUN 0 6 2001 61V/ NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor, Plaintiffs V. VETS CANTEEN ASSOCIATION DURFF-KU14N POST NO. 6168, Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 99-6311 CIVIL TERM PETITION FOR APPROVAL OF SETTLEMENT OF MINOR'S CLAIM AND NOW, come the Plaintiffs, Nancy J. Martin, as parent and natural guardian of Brian W. Martin, a minor, who state; 1. Brian W. Martin, a minor, bom July 29, 1988, resides with his parents at 10360 Possum Hollow Road, Shippensburg, Pennsylvania. 2. On November 10, 1997, while attending a youth football banquet at the VFW in Shippensburg, Cumberland County, Pennsylvania, Brian W. Martin sustained first and second degree burns when coffee was spilled and splashed upon his head, car and shoulder. 3. The parties were unable to resolve the claim and the matter was scheduled and heard by an arbitration panel of this Court resulting in an Award to the minor of $5,000.00 on April 9, 2001, a copy of which is attached hereto as "Exhibit A." 4. Attorney Michael A. Scherer of the firm of O'Brien, Baric k Scherer has served as counsel for Brain W. Martin and pursuant to the fee arrangement signed by his parents he is entitled to the recovery fee of $1,666.65 from the arbitrator's award. In addition, the firm has advanced $387.94 in costs and request reimbursement of those costs from the arbitration award. 5. The remainder of the Award totals $2,945.41. Pursuant to the provisions of Pa.R.C.P. 2039, those funds shall be deposited in an account insured by an agency of the federal government and be marked as funds for a minor that arc not to be removed, without prior consent of a court of competent jurisdiction, with the balance of the money to be paid to Brian W. Martin upon his reaching the age of 18. WHEREFORE, the parties by their counsel would request that this Court approve the attached Order to distribute the funds awarded in this arbitration. Respectfully submitted, O'BR1EN, BARK & SCHERER BY: l g- JfJ- ichael A. Scherer, Esquire I.D. 61974 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Attorney for Plaintiffs GOLDBERG, KATZMAN & SHIPMAN, P.C. "i ,kv- 'ic e BY: omas E. Brenner, Esquire I.D. 32085 P.O. Box 1268 Harrisburg, Pennsylvania 17108-1268 (717) 234.4161 Attorney for Defendants mas.dir/gentiNmart ln/approval.pet wnnr Exhibit A q,C ,/ •f iyifi'F' i/ib /1 %r;•;, j In The Court of Common Pleas of AaC GcljA',..??i" OF ) Cumberland County, Pennsylvania /i.6'i,lN w. ,11?9?T,N /7 dI?GOIT ) ) :10 11F Ire! T'i Q. C F<- :? url n. foss` NO c /t OATH We do solemnly swear (or affirm) that we will supoorc, obey and defend the Constitution of the United States and the Constitution of this Common- wealth and chat we will discharge the ducies of our office with fidelity. AWARD We, the undersigned arbitrators, having been duly appointed and sworn (or affirmed), make the following award: (Note: If damages for delay are awarded, they shall be separately stated.) Z A4= /Yti/ 1,40 , kl r/ VO/Z Ol T//d- ,Icifigllilt- r. Ad d c y/ j- j,d n Y? 11-5 ?if rf riT /l.c i A, I rl'IV 4 Qt I AA Or.y .ti e9 A Aorti.f w ?.• if?il ri iiy wpAIR .f r A,C 0 n,ANa/ i /Yll?itfir? Cdi i ? ?iA.t ?? ins i //,?e ifit?.s.?.r T 0/1 ANo SGI?/' l15-71V /fN0 ?S07ri? ? iA? Cy.f9/?.l/N!?/11?iY0ic Fo: 191Al W r_' F r N 0 /1 ??i i? s?' Th'?-` .Of?'•c?Cl /!r` 7- d?73 C'i9n/T???•- S e ?G? M N JYO e, ^ ?/G Arbitrator, dissents. (Insert name i_° Z?licable.) Date of Hearing: X1,1LL _4 .: CP i Date of Award: . .Chairmjan I_A? k4- 14 NOTICE OF ENTRY OF AWARD Now, the qjk day of ATn t award was entered upon the docket and parties or chair attorneys. Arbitrators' compensation to be paid upon appeal: ,o?' , ac/L?L, L.H., the above notice thereof given by mail to the NANCY J. MARTIN, as parent IN THE COURT OF COMMON PLEAS OF and natural guardian of CUMBERLAND COUNTY, PENNSYLVANIA BRIAN W. MARTIN, a minor Plaintiffs NO. 99- 6311 CIVIL TERM V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant TO THE PROTHONOTARY: CIVIL ACTION - LAW PRAECIPE Kindly accept this Praecipe to satisfy the requirements of the Honorable Edgar B. Bayley's June 25, 2001 Order of Court in this matter. Respectfully submitted, O'BRIEN, BARIC & SCHERER ,2&Z4sz^ Michael A. Scherer, Esquire I.D. # 61974 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 mas.dirlgenlitlmartinlprascipe.sat No.-m- 5 919 Z3 TIME CERTIFICATE OF DEPOSIT QI-m51?/N l3fWK lam W. MARTINI 196-770-5S//,, w.N.M.aA000UNI.coNEwtE"""0° P.O.BO%00 OEPOSITOFI191 10360 POSSUM BOLLOW RD c1E:TfIS?nT SHIPPENSBURO. PA 17257 SBIPPR118aURC Pe 717-532-0114 °,owl.NO a.Awaw. G.I ADDREss"M WrXMOAWAL CAN aE N6DR MOR TO aRIA(?I eoTURNn G 18 TEARS OF RICE JULY 29, 2006 pn COW ORDER FROM CpMBEltLw$7• y 313 1tEMSEArm 1 ?'?I?' Of. 'l.: 1 CI .I" I? I coONTY '*$2,945.41* . 1l HAS DEPOSITED IN THIS BANK { {MVBLE TO SAID DEPOSITOnIS1r SUBJECT TO THE CONDITIONS MMTED OH TICE REVERSE SIDE OF CERTIFICATE. F MATU 4,44W ?iM1 ??MCEH7IFICATE r DATES ??ERANtIW E WTERE ., ?IAAIL CHECK ?MON111LV 0 SEMI., NNUALLY GROWTH 3.49ZRA ?=TERLV 0M WLLr NOS 7-26-01 12 MONi118 7-26-02 1 um I/«„ I .II aAWC ° cnEaT ACCT. NO rENALTAt,orrEltAlmltEmsrNMTtIrtABOVENwo[nnurcarrcclu,lr.uluNirluTKN rAAetn p KAAAK uauwlt„tTt[KTIICAIEBT[Y70NEALKI I Moot NOT KEN NOTf[O?IAUSSUSUECT TO MCXn M ?CKAO.AAAAS FIESTA Or A f'AXWE 101K1/Ont Ai AInOwI1CAUVA[ 1M1tUCEMVrATt11TEY40NMRI ALL INTEREST On ONO[Nm 011 T/I. NtE IIEVENU: SEANCE HAS NOTIFIED ME lm I AM NO LOIIOEn I SUBJECT rot1ACAU/ rTHHOLD"o SDEPOSITORS AUT{grt2ED ' I7 iSTf 1,? G TAP E SIONA ®'r?4SD1?@mRTQG•e O'BRIEN BARIC&SCHERER A7<TORNEYSATLAW 17 WEST SOUTH STREET 2382 Oop NUMBER CARLISLE, PENNSYLVANIA 17017 60110311 PAY' 1 ,/ TW?.o /11 "jlAn? nir/(, /t V/KIr{y' {i/. I•??/C DATE AMOUNT 7.26. o I 2.9 95-. yi TO THE n ?? ? ORDER IJ?i? /? 'e?l)I^ eusTACC Ug- °F fHONZIO SKNLA II'00238211E 40313150364108 00347611E •Ir lMrrlr l//Ir r.l rr ,. r,lr rlr /. n.rll. ,r rr.llr rrr r?lr rrr rr rr rrr. r. r.rr Irl llrl .. Ir ..rr rrrrr/I+\r /r Ir NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor Plaintiffs V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant TO THE PROTHONOTARY: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99- 6311 CIVIL TERM CIVIL ACTION - LAW PRAECIPE Kindly accept this Praecipe to satisfy the requirements of the Honorable Edgar B. Bayley's June 25, 2001 Order of Court in this matter. Respectfully submitted, O'BRIEN, BARIC & SCHERER Michael A. Scherer, Esquire I.D. # 61974 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 mas.dirlgenlit/martinlpraecipe.sat No.-m- 5919 8 TIME CERTIFICATE OF DEPOSIT Q? I IV Dim K 0-Mar 54 ?.n. or.ceoun.ea.w. c. n..m. W. MARTIN PA.BOXBO •. DEPOSITOR(S) 10360 FOSM HOLLOW RD m>fiM- SMPPENSeuagwt 17257?'. o,on,..,n,.,unve,. 4:,P..?.e,r 717•s92•Bt 11 •. >381t1DSE11R6o PA 0, -Norowmftw ADORESSAlNO W1lIII)R6HAL CAN DE MADE PRIOR TO DRL1R' Kom"cotwamml eo.ieOaTIIRDIIIC 18 TEARS OF WE JULY 29. 2006 OOO1kP ORDER PROM ^e0103EE1I111D 313 MIMYIIrm r 1 HE IS[(k-2'9 4 5 it 1. W Y$[* 2 945.41• HAS DEPOSITED N THIS BANK PAYBLE TO SAID DEPOSITOR'S THE #4u .? DATE .?SR AM11AI O MONTHLY 0 SEMI•ANNUAILr MAL CIE" CQD>y19 7-26-01 12 MONIHS 7-26-02 3.49xRA O W AwRrERLr D ANNUALLY SZOMPOUNDM SSTA" Dun nwr r m 3C ADD.ON 0 CREDT ACCT. No. - DEPOSITOR'S SIDNATURE O'BRIEN BARIC&SCHERER 2382 ATTORNEYSATLAW NUMBER Oe" 17 WEST SOUTH STREET CARLISLE. PENNSYLVANIA 17017 60I10313 PAY,,/ TWo ?11.?rMK /7 NI E• It vnrar-trf {+/?+ FiV< y DATE AMOUNT 7.24.oI 4v 2,9yS.Ll TO THE L ORDER / I1A, filr RUSTACC U OF ?? - 11'00238211' 40313150364108 003476u' t1r.001 Hn?J•{.hn•.rrr^d.. rrv'II", r4n^. I.r•r?Iprannn pn r•ru M.nnnos r rl Lr 1111-1 •iw n..+nrl.u..r"'..'.{A r 11. - ---------- U S*KUVAnMVClXMCATIrmY]mr , !' NANCY J. MARTIN, as parent and : IN THE COURT OF COMMON PLEAS OF natural guardian of BRIAN W. : CUMBERLAND COUNTY, PENNSYLVANIA MARTIN, a minor, PLAINTIFFS V. VETS CANTEEN ASSOCIATION DURFF-KUHN POST NO. 6168, DEFENDANTS ; 99 6311 CIVIL TERM AND NOW, this day of June, 2001, IT IS ORDERED: (1) Approval of the settlement of this minor's claim for $5,000 for Brian W. Martin, born July 29, 1988, IS GRANTED. (2) From the settlement of $5,000, petitioner's counsel is awarded a fee of $1,666.65 and costs of $387.94. (3) The net proceeds of $2,945.41 shall be placed in an interest bearing account at the Orrstown Bank, Shippensburg, Pennsylvania in the name of Brian W. Martin, born July 29, 1988. (4) The account shall contain the following notation: "NO WITHDRAWAL CAN BE MADE PRIOR TO BRIAN W. MARTIN OBTAINING HIS MAJORITY EXCEPT BY AN ORDER OF COURT OF COMPETENT JURISDICTION:' (5) Counsel for plaintiffs shall file with the Prothonotary and forward a copy to the chambers of this judge proof of compliance with this order. By TRUE COPY FROM RECORD in Teetlrnony whereof, I here unto set my hand / and the seal of said g at wide, Pa. ._ ?"/??i Th a-?- 77c?Lk„ Edgar B. Protfronota NANCY J. MARTIN, as parent and natural guardian of BRIAN W. MARTIN, a minor Plaintiffs V. VETS CANTEEN ASSOCIATION : DURFF-KUHN POST NO. 6168, Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 99- 6311 CIVIL TERM CIVIL ACTION - LAW PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY: Kindly mark the above-captioned action as having been settled and discontinued. Respectfully submitted, O'BRIEN, BARIC & SCHERER Michael A. Scherer, Esquire I.D. # 61974 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Date: 4.1. o mas.dir/genlit/martin/praecipe.dis r, x. ?; ? n i? ?I? y> 4 CJv :J .Si' f A ?i?? t ? j ? 7, } ? ?? w t ,:. ?? ?? [4_ ?. ?'1?? 1' T! _ '. 1, 1'<'E??: ?C:+Y: 't3L ' a j(t°? S i{??a{ ? 3 i £vt? y ???MV ' ? ??? ' r N r, ¢4 ? 1 ??? ?? r .? Y .? . '.. of PrY!a?